Plan for your best health
2019 Aetna Pharmacy Drug Guide Aetna Value Plus Plan: Federal Employees
aetna.com 05.02.424.1 A (1/19)
How to use this guide
Your guide includes a list of commonly used drugs covered on your pharmacy plan. The amount you pay depends on the drug your doctor prescribes. It’s either a flat fee or a percentage of the prescription’s price after you meet your deductible, if applicable. Preferred generic drugs cost less. Preferred brand drugs will have a higher cost.
Your plan includes
• Brand and generic drugs that are hand-picked for their quality and effectiveness
• Aetna Specialty Pharmacy® fills specialty drug prescriptions (ones that are injected, infused or taken by mouth) — and provides services that include personal support, helpful resources and training, and free secure home delivery
• Aetna Rx Home Delivery® pharmacy that delivers maintenance drugs to your home or wherever you choose (for drugs that are taken regularly to treat conditions like arthritis, diabetes or asthma)
What you can expect to pay
With your pharmacy plan, the amount you pay depends on the drug your doctor prescribes. It’s either a flat fee or a percentage of the drug’s/medicine’s price.
Each drug is grouped as a generic, a brand or a specialty drug. The preferred drugs within these groups will generally save you money compared to a non-preferred drug. Generic drugs are less expensive than brands.
Specialty prescription drugs typically include higher-cost drugs that require special handling, special storage or monitoring. These types of drugs may include, but are not limited to, drugs that are injected, infused, inhaled or taken by mouth.
You’re covered for all types of medicine — some more expensive, and some less.
• Preferred generic: the lowest cost
• Preferred brand: a slightly higher cost
• Non-preferred brand and generic: a higher cost
• Preferred Specialty: lower cost for specialty drugs
• Non-preferred specialty: higher cost for non-preferred specialty drugs
Your pharmacy plan may not have all the coverage levels listed above so check your plan documents to see how much you will pay.
For your exact coverage and cost, and to learn more about your plan
Visit the website that’s on your member ID card. Then log in to your account, where you can:
• Find out the coverage and estimate of cost for specific drugs
• View your deductibles and plan limits
• Order medications
• Check your pharmacy order status
• Get a member ID card
• View your claims, Explanation of Benefits and more
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Pharmacy Management administers, but does not offer, insure or otherwise underwrite the prescription drug benefits portion of your health plan and has no financial responsibility therefor. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment.
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Have more questions about your pharmacy benefits?
We’re here to help. There are several ways you can learn more about your benefits:
• Check your Plan Design and Benefits Summary in your enrollment kit.
• Call the toll-free number on your member ID card.
• Review our pharmacy frequently asked questions (FAQs) and answers. Just visit the website that’s on your member ID card to search for the “Pharmacy FAQ.”
Aetna Specialty Pharmacy
Aetna Specialty Pharmacy® medicine and support services is our in-house specialty pharmacy that can fill your prescriptions for specialty drugs. These are the types of drugs that may be injected, infused or taken by mouth. They often need special storage and handling. And they need to be delivered quickly. A nurse or pharmacist may monitor you during your treatment, if needed. With Aetna Specialty Pharmacy, you can get this medicine sent right to your mailbox.
How to get started with Aetna Specialty Pharmacy
Ordering your prescription through Aetna Specialty Pharmacy is easy. And we typically offer a 30-day medicine supply.
• To transfer your prescription, just call us toll-free at 1-866-353-1892.
• For a new prescription, your doctor can send it to us in one of four ways:
1. Electronically: Through e-prescribe
2. Fax: 1-866-FAX-ASRX (1-866-329-2779)
3. Mail: Aetna Specialty Pharmacy 503 Sunport Lane Orlando, FL 32809
4. Phone: 1-866-782-ASRX (1-866-782-2779), option 2
If you mail in your own prescription, please send it with a completed Patient Profile Form. To find this form, just visit the website that’s on your member ID card, to search for the “Patient Profile Form.”
Aetna Rx Home Delivery
You can have maintenance drugs sent right to your home or anywhere else you choose with Aetna Rx Home Delivery® pharmacy. These are drugs that are taken regularly for chronic conditions like arthritis, diabetes or asthma. Depending on your plan, you can get up to a 90-day supply of medicine for less cost. It’s fast and convenient, and standard shipping is always free.
Get started right away
You can submit your order using one of these options:
1. Online — Visit your secure member website and sign in to your account. There you can add or remove your prescriptions.
2. Phone — Call us toll-free, 24/7 at 1-888-792-3862. If you need the help of a telephone device for the deaf, call 1-877-833-2779.
3. Mail — Get a new prescription from your doctor. Then mail it to us with a completed order form. You can find the form on your secure member website. The mailing address is on the form.
Your doctor can submit your order using one of these options:
1. Online — They can submit your prescriptions using the e-prescribe services on our provider website.
2. Fax — They can fax your prescription to 1-877-270-3317. Make sure they include your member ID number, date of birth and mailing address on the fax cover sheet. Only a doctor may fax a prescription.
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Frequently asked questions
How can I save on prescriptions?
Here are some tips to pay less out of pocket for your prescription drugs:
• Ask your doctor to consider prescribing drugs that are on the Pharmacy Drug Guide (formulary).
• Ask your doctor to consider prescribing generic drugs instead of brand-name drugs.
• Check to see if your plan includes our home delivery pharmacy service. Depending upon your plan, our home delivery service may save you money. For more information, visit the website on your member ID card and log in to your account.
• Remind your doctor to check your plan to make sure you get maximum coverage.
What are generic drugs?
Generic drugs are proven to be just as safe and effective as brand-name drugs. They contain the same active ingredients in the same amounts as the brand-name drugs and work the same way. So they have the same risks and benefits as brand-name drugs. However, they typically cost less.
When appropriate, your doctor may decide to prescribe a generic drug or allow the pharmacist to substitute a generic drug.
What is precertification?
Precertification is one way that we can help you and your doctor find safe, appropriate drugs and keep costs down. Precertification means that you or your doctor need to get approval from the plan before certain drugs will be covered. Generally, precertification applies to drugs that:
• Are often taken in the wrong way
• Should only be used for certain conditions
• Often cost more than other drugs that are proven to be just as effective
Keep in mind that your doctor must contact us to request approval of coverage for these drugs.
What is step therapy?
Some drugs require step therapy. This means that you must try one or more prerequisite drug(s) before a step therapy drug is covered.
The prerequisite drugs are equally effective, have U.S. Food and Drug Administration (FDA) approval and may cost less. They treat the same condition as the step therapy drug.
If you don’t try the appropriate alternative drug first, you may need to pay full cost for the brand-name version.
What are quantity limits?
Quantity limits help your doctor and pharmacist make sure that you use your drug correctly and safely. We use medical guidelines and FDA-approved recommendations from drug makers to set these coverage limits. The quantity limit program includes:
• Dose efficiency edits — Limits prescription coverage to one dose per day for drugs that have approval for once-daily dosing
• Maximum daily dose — If a prescription is lower than the minimum or higher than the maximum allowed dose, a message is sent to the pharmacy
• Quantity limits over time — Limits prescription coverage to a specific number of units over a specific amount of time
What if I need a drug that requires an exception to the precertification, step therapy or quantity limits requirements? Or what if I need a drug that’s not covered under my plan?
In certain cases, you or your prescriber can request a medical exception to the precertification, step therapy or quantity limits requirements. And also for a drug that’s not covered in your plan. If you ask for your request to be expedited, a coverage determination will be made within 24 hours of receiving it.
We’ll then contact you or your prescriber with our decision. All medically necessary outpatient prescription drugs will be covered. If a medical exception is approved, you only need to pay the copay after the deductible. This amount is based on your pharmacy plan design.
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How can your provider request a medical exception?
• Submit their request through our secure provider website on NaviNet®.
• Call the Aetna Pharmacy Precertification Unit at 1-855-240-0535.
• Fax the completed request form to 1-877-269-9916.
• Mail the completed request form to: Aetna Pharmacy Management 1300 East Campbell Road Richardson, TX 75081
How is the formulary (drug list) developed?
Our Pharmacy and Therapeutics Committee meets regularly to review new drugs and new information about current drugs. We review them for their safety, effectiveness and current use in therapy.
This committee includes licensed pharmacists and doctors. They are currently in practice or are Aetna employees.
Once we complete our clinical review, we also consider overall value before adding or removing a drug from the formulary. We may recommend moving a drug to a different coverage level. Or that it be placed on our Formulary Exclusions List and no longer be covered.
Can the formulary change during the year?
The formulary can change throughout the year. Some reasons why they can change include:
• New drugs are approved.
• Existing drugs are removed from the market.
• Prescription drugs may become available over the counter (without a prescription). Over-the-counter drugs are not generally covered in a formulary.
• Brand-name drugs lose patent protection and generic versions become available. When this happens, the brand-name drug is likely to be covered at a higher cost. And the generic versions cost less. See the “What are generic drugs?” section above for more information.
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Commercial 1557 Nondiscrimination Notice
Aetna complies with applicable Federal civil rights laws and does not discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability.
Aetna provides free aids/services to people with disabilities and to people who need language assistance.
If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.
If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting:
Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: PO Box 24030 Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), [email protected].
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at:
U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health Care plans and their affiliates (Aetna).
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Remember to visit the website on your member ID card. Then sign in to your account for the most up-to-date information.
Please note that if your prescription drug benefits plan changes, the information here may no longer apply. A copayment is a flat fee. Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise. Some drugs on the Preferred Drug List are subject to manufacturer rebates. Coinsurance is calculated before any rebates are subtracted. That means it may be possible for your cost of a preferred drug to be higher than your cost of a non-preferred drug. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Pharmacy Drug (formulary) Guide. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is subject to change. The drugs on the Pharmacy Drug (formulary) Guide, Formulary Exclusions, Precertification, and Quantity Limit Lists are subject to change. The quantity limits and drug coverage review programs are not available in all service areas. The drugs on the Pharmacy Drug (formulary) Guide, Formulary Exclusions, Precertification, Quantity Limit and Step Therapy Lists are subject to change. The quantity limits and step therapy drug coverage review programs are not available in all service areas. For example, step therapy programs do not apply to fully insured members in Indiana. Step therapy does not apply to fully-insured members in New Jersey. However, these programs are available to self-funded plans. In accordance with state law, commercial fully insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added or removed from the Pharmacy Drug (formulary) Guide, Precertification, Quantity Limits or Step-Therapy Lists during the plan year will continue to have those medications covered at the same benefit level until their plan’s renewal date. In Texas, precertification approval is known as “pre-service utilization review.” It is not “verification” as defined by Texas law. In accordance with state law, fully insured Commercial California health maintenance organization (HMO) members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-Therapy Lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee’s medical condition. In accordance with state law, fully insured Commercial Connecticut preferred provider organization (PPO) members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-Therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions. This material is for information only. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is subject to change.
aetna.com ©2018 Aetna Inc. 05.02.424.1 A (1/19)
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Empoyees
Table of Contents
*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*....................................................17*AGENTS FOR NARCOTIC WITHDRAWAL***.................................................................................18*AMEBICIDES*........................................................................................................................................18*AMINO ACIDS***..................................................................................................................................18*AMINOGLYCOSIDES*..........................................................................................................................18*ANALGESICS - ANTI-INFLAMMATORY*........................................................................................ 19*ANALGESICS - NONNARCOTIC*.......................................................................................................22*ANALGESICS - OPIOID*.......................................................................................................................22*ANDROGENS-ANABOLIC*................................................................................................................. 26*ANORECTAL AGENTS*....................................................................................................................... 27*ANTHELMINTICS*............................................................................................................................... 28*ANTIANGINAL AGENTS*................................................................................................................... 28*ANTIANXIETY AGENTS*....................................................................................................................29*ANTIARRHYTHMICS*.........................................................................................................................29*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*.............................................................. 30*ANTICOAGULANTS*........................................................................................................................... 32*ANTICONVULSANTS*......................................................................................................................... 33*ANTIDEMENTIA AGENT COMBINATIONS***............................................................................... 36*ANTIDEPRESSANTS*........................................................................................................................... 36*ANTIDIABETICS*..................................................................................................................................38*ANTIDIARRHEALS*.............................................................................................................................42*ANTIDOTES AND SPECIFIC ANTAGONISTS*.................................................................................42*ANTIDOTES*..........................................................................................................................................43*ANTIEMETICS*..................................................................................................................................... 43*ANTIFUNGALS*....................................................................................................................................44*ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES***...........................................45*ANTIHISTAMINES*.............................................................................................................................. 45*ANTIHYPERLIPIDEMICS*.................................................................................................................. 46*ANTIHYPERTENSIVES*.......................................................................................................................48*ANTI-INFECTIVE AGENTS - MISC.*..................................................................................................51*ANTIMALARIALS*............................................................................................................................... 52*ANTIMYASTHENIC AGENTS*........................................................................................................... 52*ANTIMYASTHENIC/CHOLINERGIC AGENTS*.............................................................................. 53*ANTIMYCOBACTERIAL AGENTS*................................................................................................... 53*ANTINEOPLASTIC - BCL-2 INHIBITORS***.....................................................................................53*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*................................................................. 53*ANTIPARKINSON AGENTS*.............................................................................................................. 57*ANTIPSYCHOTICS/ANTIMANIC AGENTS*..................................................................................... 59*ANTIRETROVIRALS ADJUVANTS***...............................................................................................60*ANTIVIRALS*........................................................................................................................................ 60*ASSORTED CLASSES*.......................................................................................................................... 64*ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES***............................................................65*BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB***............................. 66*BETA BLOCKERS*................................................................................................................................ 66*BILE ACID SYNTHESIS DISORDER AGENTS***............................................................................ 67*BIOLOGICALS MISC*........................................................................................................................... 67*CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG***................................67
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*CALCIUM CHANNEL BLOCKERS*................................................................................................... 67*CARDIOTONICS*.................................................................................................................................. 69*CARDIOVASCULAR AGENTS - MISC.*.............................................................................................69*CEPHALOSPORINS*............................................................................................................................. 70*CIC AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS***.................................................72*CONTRACEPTIVES*............................................................................................................................. 72*CORTICOSTEROIDS*........................................................................................................................... 77*COUGH/COLD/ALLERGY*..................................................................................................................78*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***.............................................................. 79*CYSTIC FIBROSIS AGENT - COMBINATIONS***............................................................................79*DERMATOLOGICALS*........................................................................................................................ 79*DIAGNOSTIC PRODUCTS*................................................................................................................. 90*DIGESTIVE AIDS*................................................................................................................................. 94*DIRECT-ACTING P2Y12 INHIBITORS***..........................................................................................94*DIURETICS*........................................................................................................................................... 94*ENDOCRINE AND METABOLIC AGENTS - MISC.*........................................................................95*ESTROGENS*......................................................................................................................................... 99*ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB***............................ 100*FARNESOID X RECEPTOR (FXR) AGONISTS***.......................................................................... 100*FLUOROQUINOLONES*.................................................................................................................... 100*GASTROINTESTINAL AGENTS - MISC.*........................................................................................ 100*GENITOURINARY AGENTS - MISCELLANEOUS*....................................................................... 102*GOUT AGENTS*.................................................................................................................................. 103*HEMATOLOGICAL AGENTS - MISC.*.............................................................................................103*HEMATOPOIETIC AGENTS*.............................................................................................................105*HEMOSTATICS*...................................................................................................................................109*HEPATITIS C AGENT - COMBINATIONS***.................................................................................. 109*HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS**.................................................109*HYPNOTICS*........................................................................................................................................109*HYPOPHOSPHATASIA (HPP) AGENTS***...................................................................................... 110*IBS AGENT - MU-OPIOID RECEPTOR AGONISTS***................................................................... 110*INSULIN-INCRETIN MIMETIC COMBINATIONS***................................................................... 110*INTEGRIN RECEPTOR ANTAGONISTS***.................................................................................... 110*INTERLEUKIN ANTAGONISTS***.................................................................................................. 110*INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)***.................................................................... 111*INTERLEUKIN-5 ANTAGONISTS (IGG4 KAPPA)***.................................................................... 111*ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS***.......................................................111*ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS***.......................................................111*LAXATIVES*........................................................................................................................................ 111*LEPTIN ANALOGUES***................................................................................................................... 112*LHRH/GNRH AGONIST ANALOG COMBINATIONS***.............................................................. 112*LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG***............................112*LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS***.................................................. 112*MACROLIDES*.................................................................................................................................... 112*MEDICAL DEVICES*.......................................................................................................................... 112*MIGRAINE PRODUCTS*....................................................................................................................115*MINERALS & ELECTROLYTES*.......................................................................................................117*MIXED ALLERGENIC EXTRACTS***............................................................................................. 117*MONOBACTAMS***........................................................................................................................... 118*MOUTH/THROAT/DENTAL AGENTS*............................................................................................118
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*MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS***............................................................ 118*MULTIPLE VITAMINS W/ MINERALS & FLUORIDE-IRON-FOLIC ACID***.......................... 118*MULTIVITAMINS*..............................................................................................................................119*MUSCULOSKELETAL THERAPY AGENTS*.................................................................................. 120*NASAL AGENTS - SYSTEMIC AND TOPICAL*.............................................................................. 121*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***.............................122*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS***.......................................122*NEUROMUSCULAR AGENTS*.........................................................................................................122*OPHTHALMIC AGENTS*................................................................................................................... 122*OPHTHALMIC RHO KINASE INHIBITORS***...............................................................................127*OREXIN RECEPTOR ANTAGONISTS***.........................................................................................127*OTIC AGENTS*.................................................................................................................................... 127*OXABOROLE-RELATED ANTIFUNGALS - TOPICAL***............................................................. 128*OXYTOCICS*........................................................................................................................................128*PASSIVE IMMUNIZING AGENTS - COMBINATIONS***............................................................. 128*PASSIVE IMMUNIZING AGENTS*...................................................................................................128*PCSK9 INHIBITORS***....................................................................................................................... 129*PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC***............................................129*PENICILLINS*......................................................................................................................................129*PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS***................................................... 130*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL***.....................................................130*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***.........................................................................130*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS**......................................................130*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***.....................................................131*POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS***................................131*POTASSIUM REMOVING AGENTS***.............................................................................................131*PROGESTINS*...................................................................................................................................... 131*PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS***.......................................... 131*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*..........................................132*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***....................................................134*PULMONARY FIBROSIS AGENTS***..............................................................................................134*PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST***........................134*RESPIRATORY AGENTS - MISC.*.................................................................................................... 135*SEROTONIN MODULATORS***.......................................................................................................135*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***......................................................135*SINUS NODE INHIBITORS**.............................................................................................................135*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***..................... 135*SPLEEN TYROSINE KINASE (SYK) INHIBITORS***.................................................................... 136*SULFONAMIDES*............................................................................................................................... 136*TETRACYCLINES*..............................................................................................................................136*THYROID AGENTS*........................................................................................................................... 137*TRYPTOPHAN HYDROXYLASE INHIBITORS***......................................................................... 137*ULCER DRUGS*.................................................................................................................................. 138*URINARY ANTI-INFECTIVES*.........................................................................................................140*URINARY ANTISPASMODICS*........................................................................................................ 140*VAGINAL PRODUCTS*...................................................................................................................... 141*VASOPRESSORS*.................................................................................................................................142*VITAMINS*........................................................................................................................................... 142
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2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Empoyees
lowercase italics = Generic drugsUPPERCASE = Brand name drugs
Drug StatusCE = Copay Exception: Available to some members at no cost with a prescription from your provider when obtained at an in-network pharmacy. Certain limitations may apply.NC = Not CoveredNP = Non-Preferred Brand and GenericNPS = Non-Preferred SpecialtyPB = Preferred BrandPG = Preferred GenericPSP = Preferred Specialty
Drug Details# = Brand-name drug expected to become available generically in the near future. After the generic drug becomes available, the brand-name drug may be covered at a higher non-preferred copay and/or added to the Formulary Exclusion List. The brand-name drug may also be subject to precertification and/or step-therapy.AL = Age LimitLGC = Lowest Generic CopayMPG = PG tier applies to members residing in Massachusetts.MST = Step Therapy does not apply to members residing in Massachusetts.N1 = Refer to member plan documents for erectile dysfuncition use/coveragePA = Prior Authorization QL = Quantity LimitSelect OTC = Select OTC Program if your pharmacy plan includes this program you may have coverage for products noted with a doctors prescription. Please see your plan benefit information for specific coverage details.SP = You may pay higher out of pocket costs and may be required to get these products at an Aetna Specialty Pharmacy network provider, like Aetna Specialty Pharmacy. Specialty products are
limited to a 30 day supply.ST = Step Therapy
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201916
Drug Name Drug Status Drug Details
*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*
ADDERALL NP ST; QL
ADDERALL XR NP ST; QL
ADZENYS ER NP PA; ST; QL
ADZENYS XR-ODT NP PA; ST; QL
amphetamine-dextroamphet er PG QL
amphetamine-dextroamphetamine PG QL
APTENSIO XR NP PA; ST; #; QL
armodafinil PG PA; QL
atomoxetine hcl PG QL
clonidine hcl er PG PA; QL
CONCERTA NP ST; QL
COTEMPLA XR-ODT NP PA; ST; QL
DAYTRANA NP PA; ST; #; QL
DESOXYN NP PA; ST; QL
DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR
NP ST; QL
dexmethylphenidate hcl PG QL
dexmethylphenidate hcl er PG QL
dextroamphetamine sulfate er PG QL
dextroamphetamine sulfate oral solution PG PA; QL
dextroamphetamine sulfate oral tablet PG QL
DIDREX NP
DYANAVEL XR NP PA; ST; QL
EVEKEO NP PA; ST; QL
FOCALIN NP ST; QL
FOCALIN XR NP ST; QL
guanfacine hcl er NP PA; QL
INTUNIV NP PA; ST; QL
KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR
NP PA; ST; QL
METADATE ER ORAL TABLET EXTENDED RELEASE 20 MG
PG QL
methamphetamine hcl PG PA; QL
METHYLIN ORAL SOLUTION NP ST; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201917
Drug Name Drug Status Drug Details
methylphenidate hcl er PG QL
methylphenidate hcl er (cd) PG QL
methylphenidate hcl er (la) PG QL
methylphenidate hcl oral solution 10 mg/5ml PG QL
methylphenidate hcl oral solution 5 mg/5ml NP QL
methylphenidate hcl oral tablet PG QL
methylphenidate hcl oral tablet chewable NP QL
modafinil PG PA; QL
MYDAYIS NP PA; ST; QL
NUVIGIL NP PA; QL
PROCENTRA NP PA; ST; QL
PROVIGIL NP PA; QL
QUILLICHEW ER NP PA; ST; QL
QUILLIVANT XR NP PA; ST; #; QL
RELEXXII PG QL
RITALIN NP ST; QL
RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 20 MG, 30 MG, 40 MG
NP ST; QL
STRATTERA NP ST; QL
VYVANSE PB QL
ZENZEDI ORAL TABLET 10 MG, 5 MG PG QL
ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG
NC
*AGENTS FOR NARCOTIC WITHDRAWAL***
LUCEMYRA NP QL
*AMEBICIDES*
SOLOSEC NC
*AMINO ACIDS***
ENDARI NP PA; ST; QL
*AMINOGLYCOSIDES*
BETHKIS NPS SP; QL
gentamicin sulfate injection NC
neomycin sulfate oral PG
paromomycin sulfate oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201918
Drug Name Drug Status Drug Details
streptomycin sulfate intramuscular NC
TOBI NPS SP; QL
TOBI PODHALER PSP SP; QL
tobramycin inhalation PSP SP; QL
tobramycin sulfate injection solution 10 mg/ml, 2 gm/50ml
NC
tobramycin sulfate injection solution reconstituted
NC
*ANALGESICS - ANTI-INFLAMMATORY*
ACTEMRA INTRAVENOUS NPS PA; ST; SP
ACTEMRA SUBCUTANEOUS NPS PA; ST; SP; QL
ANAPROX DS NP
ARAVA NP QL
ARCALYST NPS PA; SP
ARTHROTEC ORAL TABLET DELAYED RELEASE
NP
CELEBREX NP ST; QL
celecoxib oral NP QL
DAYPRO NP
diclofenac potassium PG
diclofenac sodium er PG
diclofenac sodium oral tablet delayed release 25 mg, 50 mg
PG
diclofenac sodium oral tablet delayed release 75 mg
PG LGC
diclofenac-misoprostol oral tablet delayed release
PG
DUEXIS NC
EC-NAPROSYN NP
ENBREL MINI PSP PA; ST; SP; QL
ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
PSP PA; ST; SP; QL
ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR
PSP PA; ST; SP; QL
etodolac er PG
etodolac oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201919
Drug Name Drug Status Drug Details
FELDENE NP
fenoprofen calcium oral capsule 200 mg NC
fenoprofen calcium oral capsule 400 mg PG
fenoprofen calcium oral tablet PG
FENORTHO ORAL CAPSULE 200 MG NC
flurbiprofen oral PG
HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML
NPS PA; ST; SP; QL
HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT
NPS PA; ST; SP; QL
HUMIRA PEN-CD/UC/HS STARTER NPS PA; ST; SP; QL
HUMIRA PEN-PS/UV STARTER NPS PA; ST; SP; QL
HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT
NPS PA; ST; SP; QL
IBUPROFEN COMFORT PAC NC
ibuprofen oral tablet 400 mg, 600 mg, 800 mg PG LGC
IC 400 NC
IC 800 NC
ILARIS SUBCUTANEOUS SOLUTION NPS PA; SP
INDOCIN ORAL NC
INDOCIN RECTAL NC
indomethacin er PG
indomethacin oral PG QL
ketoprofen er PG
ketorolac tromethamine oral PG QL
KEVZARA NPS PA; ST; SP; QL
KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP; QL
leflunomide oral PG QL
LODINE NP
meclofenamate sodium oral PG
mefenamic acid oral NP QL
meloxicam oral tablet PG LGC
MOBIC ORAL TABLET NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201920
Drug Name Drug Status Drug Details
nabumetone oral PG
NALFON ORAL CAPSULE 400 MG NP
NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG, 500 MG, 750 MG
NC
NAPROSYN ORAL TABLET 250 MG, 500 MG
NP
NAPROXEN COMFORT PAC NC
naproxen dr PG
naproxen oral suspension PG
naproxen oral tablet PG LGC
naproxen sodium er NC
naproxen sodium oral tablet 275 mg, 550 mg PG
OLUMIANT NPS PA; ST; SP; QL
ORENCIA CLICKJECT NPS PA; ST; SP; QL
ORENCIA INTRAVENOUS NPS PA; ST; SP
ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP; QL
OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.4ML, 15 MG/0.4ML, 17.5 MG/0.4ML, 20 MG/0.4ML, 22.5 MG/0.4ML, 25 MG/0.4ML
NPS ST; SP
OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 12.5 MG/0.4ML
NPS ST
oxaprozin PG
piroxicam oral PG
PONSTEL NP QL
RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML, 12.5 MG/0.25ML, 15 MG/0.3ML, 17.5 MG/0.35ML, 20 MG/0.4ML, 22.5 MG/0.45ML, 25 MG/0.5ML, 30 MG/0.6ML, 7.5 MG/0.15ML
NPS ST; SP
RIDAURA NP
SIMPONI ARIA PSP PA; ST; SP; QL
SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR
PSP PA; ST; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201921
Drug Name Drug Status Drug Details
SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
PSP PA; ST; SP; QL
SPRIX NC #
sulindac oral PG
TIVORBEX NC
tolmetin sodium PG
VIMOVO NC
VIVLODEX NC #
XELJANZ PSP PA; ST; SP; QL
XELJANZ XR PSP PA; ST; SP; QL
ZIPSOR NC
ZORVOLEX NC
*ANALGESICS - NONNARCOTIC*
ALLZITAL NC
BUPAP ORAL TABLET 50-300 MG NC
butalbital-acetaminophen oral capsule NC
butalbital-acetaminophen oral tablet 50-300 mg NC
butalbital-acetaminophen oral tablet 50-325 mg PG
butalbital-apap-caffeine oral capsule PG
butalbital-apap-caffeine oral tablet 50-325-40 mg
PG
butalbital-asa-caffeine PG
choline-mag trisalicylate PG
diflunisal oral PG
eq aspirin low dose oral tablet chewable CE
eq aspirin low dose oral tablet delayed release CE
ESGIC ORAL CAPSULE PG
FIORICET ORAL CAPSULE NP
FIORINAL NP
PRIALT NPS SP
salsalate oral PG
VANATOL LQ NC
ZEBUTAL ORAL CAPSULE 50-325-40 MG PG
*ANALGESICS - OPIOID*
ABSTRAL NP PA; ST; #; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201922
Drug Name Drug Status Drug Details
acetaminophen-codeine PG PA; QL
acetaminophen-codeine #2 PG PA; QL
acetaminophen-codeine #3 PG PA; QL
acetaminophen-codeine #4 PG PA; QL
ACTIQ NP PA; ST; QL
apap-caff-dihydrocodeine oral capsule NP PA; QL
apap-caff-dihydrocodeine oral tablet 325-30-16 mg
NC
ARYMO ER NP PA; ST; MPG; QL
ASCOMP-CODEINE PG PA; QL
BELBUCA NP PA; QL
BUNAVAIL NP ST; MST; QL
buprenorphine PG PA; QL
buprenorphine hcl sublingual PG QL
buprenorphine hcl-naloxone hcl sublingual tablet sublingual
PG QL
butalbital-apap-caff-cod PG PA; QL
butalbital-asa-caff-codeine PG PA; QL
butorphanol tartrate nasal NP PA; QL
BUTRANS NP PA; QL
codeine sulfate oral tablet PG PA; QL
CONZIP NC
DILAUDID ORAL NP PA; QL
DOLOPHINE NP PA; QL
DURAGESIC-100 NP PA; ST; QL
DURAGESIC-12 NP PA; ST; QL
DURAGESIC-25 NP PA; ST; QL
DURAGESIC-50 NP PA; ST; QL
DURAGESIC-75 NP PA; ST; QL
EMBEDA PB PA; MPG; QL
ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG
PG PA; QL
EXALGO ORAL TABLET ER 24 HOUR ABUSE-DETERRENT
NP PA; ST; QL
fentanyl PG PA; QL
fentanyl citrate buccal NP PA; ST; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201923
Drug Name Drug Status Drug Details
FENTORA BUCCAL TABLET 100 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG
NP PA; ST; #; QL
FIORICET/CODEINE ORAL CAPSULE 50-300-40-30 MG
NP PA; QL
FIORINAL/CODEINE #3 NP PA; QL
hydrocodone-acetaminophen oral solution 2.5-108 mg/5ml, 5-217 mg/10ml, 7.5-325 mg/15ml
NP PA; QL
hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg
PG PA; QL
hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg
PG PA; QL
hydromorphone hcl er NP PA; QL
hydromorphone hcl oral PG PA; QL
hydromorphone hcl rectal PG PA; QL
HYSINGLA ER PB PA; #; QL
IBUDONE ORAL TABLET 10-200 MG NP PA; QL
ibudone oral tablet 5-200 mg PG PA; QL
KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG
NP PA; ST; QL
LAZANDA NC
levorphanol tartrate oral NP PA; QL
LORCET PG PA; QL
LORCET HD PG PA; QL
LORCET PLUS ORAL TABLET 7.5-325 MG PG PA; QL
LORTAB ORAL ELIXIR 10-300 MG/15ML NP PA; QL
meperidine hcl oral PG PA; QL
METHADONE HCL INTENSOL NP PA; QL
methadone hcl oral concentrate NP PA; QL
methadone hcl oral solution PG PA; QL
methadone hcl oral tablet PG PA; QL
methadone hcl oral tablet soluble PG PA; QL
METHADOSE ORAL CONCENTRATE 10 MG/ML
NP PA; QL
METHADOSE ORAL TABLET SOLUBLE PG PA; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201924
Drug Name Drug Status Drug Details
METHADOSE SUGAR-FREE NP PA; QL
MORPHABOND ER NP PA; ST; MPG; QL
morphine sulfate (concentrate) oral solution 100 mg/5ml
PG PA; QL
morphine sulfate er beads PG PA; QL
morphine sulfate er oral capsule extended release 24 hour
PG PA; QL
morphine sulfate er oral tablet extended release PG PA; QL
morphine sulfate oral PG PA; QL
morphine sulfate rectal PG PA; QL
MS CONTIN ORAL TABLET EXTENDED RELEASE
NP PA; ST; QL
nalbuphine hcl injection NC
nalocet NC
NORCO NP PA; QL
NUCYNTA NP PA; ST; QL
NUCYNTA ER NP PA; ST; QL
OPANA ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT
NP PA; ST; QL
OPANA ORAL NP PA; QL
OXAYDO PB PA; MPG; QL
oxycodone hcl er oral tablet er 12 hour abuse-deterrent
PG PA; QL
oxycodone hcl oral capsule PG PA; QL
oxycodone hcl oral concentrate 100 mg/5ml PG PA; QL
oxycodone hcl oral solution PG PA; QL
oxycodone hcl oral tablet PG PA; QL
oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg
PG PA; QL
oxycodone-aspirin oral tablet 4.8355-325 mg PG PA; QL
oxycodone-ibuprofen PG PA; QL
OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT
PB PA; QL
oxymorphone hcl PG PA; QL
oxymorphone hcl er PG PA; QL
pentazocine-naloxone hcl NP PA; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201925
Drug Name Drug Status Drug Details
PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG
NP PA; QL
PRIMLEV NC
ROXICODONE ORAL TABLET NP PA; QL
SUBOXONE SUBLINGUAL FILM NP #; QL
SUBSYS NC
tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg
PG PA; QL
tramadol hcl er oral capsule extended release 24 hour
NC
tramadol hcl er oral tablet extended release 24 hour
PG PA; QL
tramadol hcl oral PG PA; QL
tramadol-acetaminophen PG PA; QL
TREZIX ORAL CAPSULE 320.5-30-16 MG NP PA; QL
TYLENOL WITH CODEINE #3 NP PA; QL
TYLENOL WITH CODEINE #4 NP PA; QL
ULTRACET NP PA; QL
ULTRAM NP PA; QL
VERDROCET PG PA; QL
vicodin es oral tablet 7.5-300 mg PG PA; QL
vicodin hp oral tablet 10-300 mg PG PA; QL
vicodin oral tablet 5-300 mg PG PA; QL
XODOL ORAL TABLET 5-300 MG, 7.5-300 MG
NP PA; QL
XTAMPZA ER NP PA; ST; QL
ZOHYDRO ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT
NP PA; ST; #; QL
ZUBSOLV NP ST; MST; #; QL
*ANDROGENS-ANABOLIC*
ANADROL-50 NP
ANDRODERM TRANSDERMAL PATCH 24 HOUR
NC
ANDROGEL PUMP TRANSDERMAL GEL 20.25 MG/ACT (1.62%)
PB PA; #; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201926
Drug Name Drug Status Drug Details
ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)
PB PA; #; QL
ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)
NC
danazol oral PG
DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION
NP
FORTESTA NC
methitest NP
methyltestosterone oral PG
NATESTO NC
OXANDRIN ORAL TABLET 10 MG NP
STRIANT NC #
TESTIM NC
testosterone cypionate intramuscular solution200 mg/ml
PG
testosterone enanthate intramuscular solution PG
testosterone transdermal gel 10 mg/act (2%), 12.5 mg/act (1%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)
PG PA; QL
testosterone transdermal solution NP PA; ST; QL
VOGELXO PUMP NC
VOGELXO TRANSDERMAL GEL 50 MG/5GM (1%)
NC
*ANORECTAL AGENTS*
ANA-LEX NC
ANALPRAM-HC RECTAL CREAM NP
ANALPRAM-HC RECTAL LOTION 2.5-1 %
NP
anucort-hc NC
ANUSOL-HC RECTAL CREAM NP
ANUSOL-HC RECTAL SUPPOSITORY NC
CORTIFOAM NC
hydrocortisone ace-pramoxine rectal cream 2.5-1 %
NC
hydrocortisone acetate rectal NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201927
Drug Name Drug Status Drug Details
hydrocortisone rectal cream 2.5 % PG
lidocaine-hydrocortisone ace rectal NC
PROCTOCORT NC
PROCTOFOAM HC NC
PROCTO-PAK PG
PROCTOZONE-HC RECTAL PG
RECTIV NP QL
UCERIS RECTAL NP PA; #; QL
*ANTHELMINTICS*
ALBENZA NP QL
benznidazole NP PA; QL
BILTRICIDE NP
EMVERM NP QL
ivermectin oral PG
praziquantel oral PG
STROMECTOL NP
*ANTIANGINAL AGENTS*
DILATRATE-SR NP
GONITRO NP
ISORDIL TITRADOSE NP
isosorbide dinitrate er PG
isosorbide dinitrate oral PG
isosorbide mononitrate PG
isosorbide mononitrate er PG
MINITRAN PG
NITRO-BID NP
NITRO-DUR NP
nitroglycerin sublingual PG
nitroglycerin transdermal patch 24 hour PG
nitroglycerin translingual solution PG
NITROLINGUAL NP
NITROMIST NP
NITROSTAT NP ST
RANEXA PB #; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201928
Drug Name Drug Status Drug Details
*ANTIANXIETY AGENTS*
alprazolam er PG QL; AL
ALPRAZOLAM INTENSOL NP
alprazolam oral PG AL
alprazolam xr PG QL; AL
ATIVAN ORAL NC
buspirone hcl oral tablet 10 mg, 5 mg PG LGC
buspirone hcl oral tablet 15 mg, 30 mg, 7.5 mg PG
chlordiazepoxide hcl PG AL
clorazepate dipotassium PG AL
DIAZEPAM INTENSOL PG
diazepam oral concentrate PG
diazepam oral solution 5 mg/5ml PG
diazepam oral tablet PG
hydroxyzine hcl oral syrup PG
hydroxyzine hcl oral tablet PG
hydroxyzine pamoate oral PG
lorazepam oral PG
meprobamate PG
oxazepam PG AL
TRANXENE-T ORAL TABLET 7.5 MG NP AL
VALIUM NP
VISTARIL NP
XANAX NC AL
XANAX XR NC AL
*ANTIARRHYTHMICS*
amiodarone hcl oral PG
disopyramide phosphate oral PG
dofetilide PG
flecainide acetate PG
mexiletine hcl oral PG
MULTAQ NP QL
NORPACE NP
NORPACE CR NP
propafenone hcl PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201929
Drug Name Drug Status Drug Details
propafenone hcl er PG SP; QL
quinidine gluconate er PG
quinidine sulfate oral PG
RYTHMOL SR NP QL
TIKOSYN NP
*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*
ACCOLATE NP QL
ADVAIR DISKUS NP #; QL
ADVAIR HFA NP QL
AIRDUO RESPICLICK 113/14 NP PA; ST; QL
AIRDUO RESPICLICK 232/14 NP PA; ST; QL
AIRDUO RESPICLICK 55/14 NP PA; ST; QL
albuterol sulfate er PG
albuterol sulfate inhalation PG
albuterol sulfate oral PG
ALVESCO NP PA; ST; QL
ANORO ELLIPTA PB QL
ARCAPTA NEOHALER NP PA; ST; QL
ARMONAIR RESPICLICK 113 NP PA; ST; QL
ARMONAIR RESPICLICK 232 NP PA; ST; QL
ARMONAIR RESPICLICK 55 NP PA; ST; QL
ARNUITY ELLIPTA NP QL
ASMANEX 120 METERED DOSES PB #; QL
ASMANEX 14 METERED DOSES PB #; QL
ASMANEX 30 METERED DOSES PB #; QL
ASMANEX 60 METERED DOSES PB #; QL
ASMANEX 7 METERED DOSES PB #; QL
ASMANEX HFA PB QL
ATROVENT HFA NP QL
BEVESPI AEROSPHERE NP PA; ST; QL
BREO ELLIPTA PB QL
BROVANA NP PA; ST; QL
budesonide inhalation PG PA; QL; AL
COMBIVENT RESPIMAT PB QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201930
Drug Name Drug Status Drug Details
cromolyn sodium inhalation PG
DALIRESP NP PA; ST; QL
DULERA PB QL
ELIXOPHYLLIN NP
FLOVENT DISKUS NP #; QL
FLOVENT HFA NP #; QL
fluticasone-salmeterol PG QL
INCRUSE ELLIPTA PB QL
ipratropium bromide inhalation PG
ipratropium-albuterol PG
levalbuterol hcl inhalation nebulization solution0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml
PG
LONHALA MAGNAIR REFILL KIT NP PA; ST; QL
LONHALA MAGNAIR STARTER KIT NP PA; ST; QL
metaproterenol sulfate oral PG
montelukast sodium oral PG QL
PERFOROMIST NP PA; ST; QL
PROAIR HFA PB #
PROAIR RESPICLICK PB
PROVENTIL HFA NP ST; #
PULMICORT NP PA; QL; AL
PULMICORT FLEXHALER NP PA; ST; #; QL
QVAR REDIHALER PB QL
SEEBRI NEOHALER NP PA; ST; QL
SEREVENT DISKUS PB QL
SINGULAIR NP QL
SPIRIVA HANDIHALER PB QL
SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT, 2.5 MCG/ACT
PB QL
STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT
PB QL
STRIVERDI RESPIMAT NP PA; ST; QL
SYMBICORT PB QL
terbutaline sulfate oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201931
Drug Name Drug Status Drug Details
THEO-24 PB
THEOCHRON ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG
PG
theophylline PG
theophylline er PG
TRELEGY ELLIPTA PB QL
TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED
NP PA; ST; QL
UTIBRON NEOHALER NP PA; ST; QL
VENTOLIN HFA PB
XOLAIR PSP PA; ST; SP
XOPENEX NP
XOPENEX CONCENTRATE NP
XOPENEX HFA NP ST; QL
zafirlukast PG QL
zileuton er NP QL
ZYFLO NP QL
ZYFLO CR NP QL
*ANTICOAGULANTS*
ARIXTRA NP QL
BEVYXXA NP PA; ST; QL
COUMADIN ORAL NP
ELIQUIS PB QL
ELIQUIS STARTER PACK PB QL
enoxaparin sodium PG QL
fondaparinux sodium NP QL
FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML, 95000 UNIT/3.8ML
NP QL
heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml
PG
heparin sodium (porcine) pf PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201932
Drug Name Drug Status Drug Details
IPRIVASK NP QL
JANTOVEN PG
LOVENOX NP QL
PRADAXA NP QL
SAVAYSA NP ST; QL
warfarin sodium oral PG LGC
XARELTO PB QL
XARELTO STARTER PACK PB QL
*ANTICONVULSANTS*
APTIOM NP QL
BANZEL ORAL TABLET NP QL
BRIVIACT ORAL NP PA; QL
carbamazepine er PG
carbamazepine oral PG
CARBATROL PB
CELONTIN PB
clonazepam oral PG
DEPAKENE ORAL CAPSULE NP
DEPAKENE ORAL SOLUTION NP
DEPAKOTE NP
DEPAKOTE ER NP
DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE
NP
DIASTAT ACUDIAL PB QL
DIASTAT PEDIATRIC PB QL
diazepam rectal PG QL
DILANTIN PB
DILANTIN INFATABS PB
divalproex sodium er oral tablet extended release 24 hour
PG
divalproex sodium oral capsule delayed release sprinkle
PG
divalproex sodium oral tablet delayed release PG
EPITOL PG
ethosuximide oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201933
Drug Name Drug Status Drug Details
felbamate PG
FELBATOL NP
FYCOMPA ORAL SUSPENSION NP
FYCOMPA ORAL TABLET NP QL
gabapentin oral capsule PG QL
gabapentin oral solution 250 mg/5ml PG
gabapentin oral tablet PG QL
GABITRIL NP QL
KEPPRA ORAL NP
KEPPRA XR NP QL
KLONOPIN NP
LAMICTAL ODT ORAL KIT NP
LAMICTAL ODT ORAL TABLET DISPERSIBLE
NP QL
LAMICTAL ORAL TABLET NP
LAMICTAL ORAL TABLET CHEWABLE 25 MG, 5 MG
NP
LAMICTAL STARTER NP
LAMICTAL XR ORAL KIT NP
LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR
NP QL
lamotrigine er PG QL
lamotrigine oral tablet PG
lamotrigine oral tablet chewable PG
lamotrigine oral tablet dispersible NP QL
lamotrigine starter kit-blue PG
lamotrigine starter kit-green PG
lamotrigine starter kit-orange PG
levetiracetam er PG QL
levetiracetam oral PG
LYRICA PB #
MYSOLINE NP
NEURONTIN ORAL CAPSULE NP QL
NEURONTIN ORAL SOLUTION NP
NEURONTIN ORAL TABLET NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201934
Drug Name Drug Status Drug Details
ONFI ORAL SUSPENSION NP #
ONFI ORAL TABLET 10 MG, 20 MG NP #; QL
oxcarbazepine PG
OXTELLAR XR NP ST; QL
PEGANONE NP
PHENYTEK PB
PHENYTOIN INFATABS PG
phenytoin oral suspension 125 mg/5ml PG
phenytoin oral tablet chewable PG
phenytoin sodium extended PG
primidone oral PG
QUDEXY XR NP ST; QL
SABRIL ORAL PACKET NPS PA; SP; QL
SABRIL ORAL TABLET NPS PA; #; SP; QL
SPRITAM NP ST; QL
TEGRETOL ORAL SUSPENSION PB
TEGRETOL ORAL TABLET PB
TEGRETOL-XR PB
tiagabine hcl PG QL
TOPAMAX NP
TOPAMAX SPRINKLE NP QL
topiramate oral capsule sprinkle PG QL
topiramate oral tablet PG
TRILEPTAL NP
TROKENDI XR NP ST; #; QL
valproate sodium oral solution PG
valproic acid oral capsule PG
valproic acid oral solution PG
vigabatrin PSP PA; SP; QL
VIGADRONE PSP PA; SP; QL
VIMPAT ORAL NP #; QL
ZARONTIN NP
ZONEGRAN NP
zonisamide oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201935
Drug Name Drug Status Drug Details
*ANTIDEMENTIA AGENT COMBINATIONS***
NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK
PB PA; AL
NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 14-10 MG, 21-10 MG, 28-10 MG, 7-10 MG
PB PA; AL
*ANTIDEPRESSANTS*
amitriptyline hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg, 75 mg
PG LGC
amitriptyline hcl oral tablet 150 mg PG
amoxapine PG
ANAFRANIL NP
APLENZIN NC
bupropion hcl er (sr) PG QL
bupropion hcl er (xl) PG QL
bupropion hcl oral PG QL
CELEXA ORAL TABLET NP QL
citalopram hydrobromide oral solution PG
citalopram hydrobromide oral tablet PG LGC; QL
clomipramine hcl oral PG
CYMBALTA NP QL
desipramine hcl oral PG
desvenlafaxine er NP PA; ST; QL
desvenlafaxine succinate er NP PA; ST; QL
doxepin hcl oral PG
duloxetine hcl oral PG QL
EFFEXOR XR NP QL
EMSAM NP #; QL
escitalopram oxalate oral solution PG
escitalopram oxalate oral tablet PG QL
FETZIMA NP PA; ST; QL
FETZIMA TITRATION NP PA; ST; QL
fluoxetine hcl oral capsule PG LGC; QL
fluoxetine hcl oral capsule delayed release PG QL
fluoxetine hcl oral solution PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201936
Drug Name Drug Status Drug Details
fluoxetine hcl oral tablet PG QL
fluvoxamine maleate PG QL
fluvoxamine maleate er PG QL
FORFIVO XL NC #
imipramine hcl oral PG
imipramine pamoate NP
KHEDEZLA NP PA; ST; QL
LEXAPRO ORAL TABLET NP QL
maprotiline hcl PG QL
MARPLAN NP
mirtazapine oral PG QL
NARDIL NP
nefazodone hcl NP
NORPRAMIN ORAL TABLET 10 MG, 25 MG
NP
nortriptyline hcl oral capsule 10 mg, 25 mg PG LGC
nortriptyline hcl oral capsule 50 mg, 75 mg PG
nortriptyline hcl oral solution PG
PAMELOR ORAL CAPSULE NP
PARNATE NP
paroxetine hcl er PG QL
paroxetine hcl oral tablet PG LGC; QL
PAXIL NP QL
PAXIL CR NP QL
PEXEVA NC
phenelzine sulfate oral PG
PRISTIQ NP PA; ST; QL
protriptyline hcl PG
PROZAC ORAL CAPSULE NP QL
REMERON ORAL TABLET 15 MG, 30 MG NP QL
REMERON SOLTAB NP QL
sertraline hcl oral concentrate PG
sertraline hcl oral tablet PG LGC; QL
SURMONTIL NP
TOFRANIL NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201937
Drug Name Drug Status Drug Details
tranylcypromine sulfate PG
trazodone hcl oral tablet 100 mg, 150 mg, 50 mg PG LGC
trazodone hcl oral tablet 300 mg PG
trimipramine maleate oral NP
TRINTELLIX NP PA; ST; QL
venlafaxine hcl PG QL
venlafaxine hcl er oral capsule extended release 24 hour
PG QL
venlafaxine hcl er oral tablet extended release 24 hour
NP QL
VIIBRYD ORAL TABLET NP ST; QL
VIIBRYD STARTER PACK NP
WELLBUTRIN SR NP QL
WELLBUTRIN XL NC
ZOLOFT ORAL CONCENTRATE NP
ZOLOFT ORAL TABLET NP QL
*ANTIDIABETICS*
acarbose PG
ACTOPLUS MET NP QL
ACTOPLUS MET XR NP QL
ACTOS NP QL
ADLYXIN NC
ADLYXIN STARTER PACK NC
ADMELOG NC
ADMELOG SOLOSTAR NC
AFREZZA INHALATION POWDER 12 UNIT, 4 & 8 & 12 UNIT, 4 (90) & 8 (90) UNIT, 4 UNIT, 8 UNIT
NP PA
alogliptin benzoate PG QL
alogliptin-metformin hcl PG QL
alogliptin-pioglitazone PG QL
AMARYL NP
APIDRA NC
APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR
NC
AVANDIA ORAL TABLET 2 MG, 4 MG NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201938
Drug Name Drug Status Drug Details
BASAGLAR KWIKPEN PB
BYDUREON BCISE NC
BYDUREON SUBCUTANEOUS PEN-INJECTOR
NC
BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER
NC
BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR
NC #
BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR
NC #
chlorpropamide PG
CYCLOSET NP QL
DUETACT NP QL
FARXIGA PB QL
FIASP NC
FIASP FLEXTOUCH NC
FORTAMET NC
glimepiride PG LGC
glipizide er oral tablet extended release 24 hour10 mg, 5 mg
PG LGC
glipizide er oral tablet extended release 24 hour2.5 mg
PG
glipizide oral PG LGC
glipizide xl PG
glipizide-metformin hcl PG
GLUCAGEN HYPOKIT PB QL
GLUCAGON EMERGENCY PB QL
GLUCOPHAGE NP
GLUCOPHAGE XR NP
GLUCOTROL NP
GLUCOTROL XL NP
GLUCOVANCE ORAL TABLET 5-500 MG NP
GLUMETZA NC
glyburide micronized oral tablet 1.5 mg PG
glyburide micronized oral tablet 3 mg, 6 mg PG LGC
glyburide oral tablet 1.25 mg PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201939
Drug Name Drug Status Drug Details
glyburide oral tablet 2.5 mg, 5 mg PG LGC
glyburide-metformin PG
GLYNASE NP
GLYSET NP
HUMALOG PB
HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML
PB
HUMALOG MIX 50/50 PB
HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR
PB
HUMALOG MIX 75/25 PB
HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR
PB
HUMULIN 70/30 PB
HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR
PB
HUMULIN N PB
HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR
PB
HUMULIN R PB
HUMULIN R U-500 (CONCENTRATED) PB
HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR
PB
INVOKANA PB QL
JANUMET PB QL
JANUMET XR PB QL
JANUVIA PB QL
JARDIANCE PB QL
JENTADUETO PB QL
JENTADUETO XR PB QL
KAZANO NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201940
Drug Name Drug Status Drug Details
KOMBIGLYZE XR NC
KORLYM NPS PA; SP; QL
LANTUS NC
LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR
NC
LEVEMIR PB
LEVEMIR FLEXTOUCH PB
metformin hcl er (mod) NC
metformin hcl er (osm) oral tablet extended release 24 hour 1000 mg, 500 mg
NC
metformin hcl er oral tablet extended release 24 hour 500 mg
PG LGC
metformin hcl er oral tablet extended release 24 hour 750 mg
PG
metformin hcl oral solution NP
metformin hcl oral tablet PG LGC
miglitol PG
nateglinide NP
NESINA NC
NOVOLIN 70/30 NC
NOVOLIN 70/30 RELION NC
NOVOLIN N NC
NOVOLIN N RELION NC
NOVOLIN R NC
NOVOLIN R RELION NC
NOVOLOG NC
NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR
NC
NOVOLOG MIX 70/30 NC
NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR
NC
NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE
NC
ONGLYZA NC
OSENI NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201941
Drug Name Drug Status Drug Details
OZEMPIC NC
pioglitazone hcl PG QL
pioglitazone hcl-glimepiride PG QL
pioglitazone hcl-metformin hcl PG QL
PRANDIN ORAL TABLET 1 MG, 2 MG NP
PRECOSE NP
PROGLYCEM NP
repaglinide NP
repaglinide-metformin hcl NP QL
RIOMET NC
STARLIX NP
STEGLATRO NC
SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR
NP PA; #; QL
SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR
NP PA; #
tolazamide PG
tolbutamide NP
TOUJEO MAX SOLOSTAR NC
TOUJEO SOLOSTAR NC
TRADJENTA PB QL
TRESIBA FLEXTOUCH PB
TRULICITY PB PA; ST; QL
VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR
PB PA; ST; QL
*ANTIDIARRHEALS*
diphenatol PG
diphenoxylate-atropine PG
LOMOTIL ORAL TABLET NP
MOTOFEN NP
MYTESI NP PA; ST; QL
*ANTIDOTES AND SPECIFIC ANTAGONISTS*
deferoxamine mesylate PSP SP
DESFERAL INJECTION SOLUTION RECONSTITUTED 500 MG
NPS SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201942
Drug Name Drug Status Drug Details
RADIOGARDASE NP
VISTOGARD PSP SP; QL
*ANTIDOTES*
CHEMET NP
deferoxamine mesylate PSP SP
DESFERAL INJECTION SOLUTION RECONSTITUTED 500 MG
NPS SP
EVZIO INJECTION SOLUTION AUTO-INJECTOR 2 MG/0.4ML
NC
EXJADE NPS PA; #; SP
FERRIPROX ORAL SOLUTION NPS PA
FERRIPROX ORAL TABLET NPS PA; #; SP
JADENU NPS PA; #; SP
JADENU SPRINKLE NPS PA; #; SP
naltrexone hcl oral PG
NARCAN PB #; QL
RADIOGARDASE NP
VISTOGARD PSP SP; QL
VIVITROL NP
*ANTIEMETICS*
AKYNZEO ORAL NP PA; ST; QL
ALOXI INTRAVENOUS SOLUTION 0.25 MG/5ML
NC
ANZEMET ORAL NP QL
aprepitant PG QL
BONJESTA NP PA; ST; QL
CESAMET NP QL
DICLEGIS NP PA; #; QL
dronabinol NP PA; QL
EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG
NP QL
EMEND ORAL SUSPENSION RECONSTITUTED
PB #
granisetron hcl oral NP
MARINOL NP PA; QL
ondansetron PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201943
Drug Name Drug Status Drug Details
ondansetron hcl oral PG
SANCUSO NP QL
scopolamine PG
SYNDROS NP PA; #; QL
TIGAN INTRAMUSCULAR NC
TIGAN ORAL NP
TRANSDERM-SCOP (1.5 MG) NP
trimethobenzamide hcl oral PG
VARUBI ORAL NP QL
ZOFRAN ODT NP
ZOFRAN ORAL NP
ZUPLENZ NC
*ANTIFUNGALS*
ANCOBON NP
CRESEMBA ORAL NP
DIFLUCAN NP
fluconazole oral suspension reconstituted PG AL
fluconazole oral tablet PG
flucytosine oral NP
griseofulvin microsize oral PG
griseofulvin ultramicrosize PG
itraconazole oral PG QL
ketoconazole oral PG QL
LAMISIL ORAL TABLET NP
NOXAFIL ORAL SUSPENSION NP
NOXAFIL ORAL TABLET DELAYED RELEASE
NP #; QL
nystatin oral tablet PG
SPORANOX ORAL CAPSULE NP QL
SPORANOX ORAL SOLUTION NP
SPORANOX PULSEPAK NP QL
terbinafine hcl oral PG
VFEND NP
voriconazole oral tablet PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201944
Drug Name Drug Status Drug Details
*ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES***
HEMLIBRA NPS PA; SP
*ANTIHISTAMINES*
ALAVERT ORAL TABLET DISPERSIBLE PG Select OTC
ALLEGRA ALLERGY PG Select OTC; QL
ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION
PG Select OTC
ALLEGRA ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE
PG Select OTC
allergy relief oral tablet dispersible PG Select OTC
carbinoxamine maleate oral tablet 4 mg PG
carbinoxamine maleate oral tablet 6 mg NC
cetirizine hcl oral tablet PG Select OTC
cetirizine hcl oral tablet chewable PG Select OTC
childrens loratadine PG Select OTC
CLARINEX ORAL SYRUP NP
CLARINEX ORAL TABLET NP QL
CLARITIN PG Select OTC
CLARITIN REDITABS PG Select OTC
cyproheptadine hcl oral PG
desloratadine oral tablet NP QL
desloratadine oral tablet dispersible 2.5 mg NP QL
desloratadine oral tablet dispersible 5 mg NP
fexofenadine hcl childrens PG Select OTC
fexofenadine hcl oral tablet 180 mg, 60 mg PG Select OTC
KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE
NP ST
levocetirizine dihydrochloride oral NC
loratadine childrens oral solution PG Select OTC
loratadine childrens oral syrup PG Select OTC
loratadine oral capsule PG Select OTC
loratadine oral solution PG Select OTC
loratadine oral tablet PG Select OTC
loratadine oral tablet chewable PG Select OTC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201945
Drug Name Drug Status Drug Details
PHENADOZ RECTAL SUPPOSITORY 12.5 MG
PG
promethazine hcl oral PG
promethazine hcl rectal PG
PROMETHEGAN RECTAL SUPPOSITORY 25 MG, 50 MG
PG
RYVENT NC
TRIAMINIC ALLERCHEWS PG Select OTC
XYZAL ALLERGY 24HR PG Select OTC
XYZAL ALLERGY 24HR CHILDRENS PG Select OTC
ZYRTEC ALLERGY ORAL CAPSULE PG Select OTC
ZYRTEC ALLERGY ORAL TABLET PG Select OTC
*ANTIHYPERLIPIDEMICS*
ALTOPREV NP ST; #; QL
ANTARA ORAL CAPSULE 30 MG, 90 MG NP #; QL
atorvastatin calcium oral tablet 10 mg CE QL
atorvastatin calcium oral tablet 20 mg, 40 mg, 80 mg
PG QL
cholestyramine light PG
cholestyramine oral PG
colesevelam hcl PG
COLESTID NP
COLESTID FLAVORED NP
colestipol hcl PG
CRESTOR NP ST; QL
ezetimibe PG QL
ezetimibe-simvastatin PG QL
fenofibrate micronized oral capsule 130 mg, 43 mg
NP QL
fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg
PG QL
fenofibrate oral capsule 150 mg, 50 mg NP QL
fenofibrate oral tablet 120 mg, 40 mg NC
fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg
PG QL
fenofibric acid PG QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201946
Drug Name Drug Status Drug Details
FENOGLIDE NC
FIBRICOR NP QL
flolipid NC
fluvastatin sodium PG QL
fluvastatin sodium er NP QL
gemfibrozil oral PG LGC
JUXTAPID NPS PA; ST; SP; QL
KYNAMRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP; QL
LESCOL ORAL CAPSULE 20 MG NP QL
LESCOL XL NP ST; QL
LIPITOR NP ST; QL
LIPOFEN NP QL
LIVALO NP ST; QL
LOPID NP
lovastatin PG LGC; QL
LOVAZA NP QL
MEVACOR ORAL TABLET 40 MG NP QL
niacin er (antihyperlipidemic) PG
NIACOR NP
NIASPAN NP
omega-3-acid ethyl esters PG QL
PRAVACHOL ORAL TABLET 20 MG, 40 MG, 80 MG
NP ST; QL
pravastatin sodium PG QL
PREVALITE PG
QUESTRAN NP
QUESTRAN LIGHT ORAL POWDER NP
rosuvastatin calcium PG QL
simvastatin oral tablet 10 mg, 5 mg CE LGC; QL
simvastatin oral tablet 20 mg, 40 mg, 80 mg PG LGC; QL
TRICOR NP QL
TRIGLIDE ORAL TABLET 160 MG NP QL
TRILIPIX NP QL
VASCEPA PB QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201947
Drug Name Drug Status Drug Details
VYTORIN NP ST; QL
WELCHOL NP #
ZETIA NP ST; QL
ZOCOR NP ST; QL
ZYPITAMAG NC
*ANTIHYPERTENSIVES*
ACCUPRIL NP
ACCURETIC NP
ALTACE ORAL CAPSULE NP
amlodipine besy-benazepril hcl PG
amlodipine besylate-valsartan PG QL
amlodipine-olmesartan NP QL
amlodipine-valsartan-hctz PG QL
ATACAND NP ST; QL
ATACAND HCT NP ST; QL
atenolol-chlorthalidone PG
AVALIDE ORAL TABLET 150-12.5 MG, 300-12.5 MG
NP ST; QL
AVAPRO NP ST; QL
AZOR NP ST; QL
benazepril hcl oral PG LGC
benazepril-hydrochlorothiazide PG
BENICAR NP ST; QL
BENICAR HCT NP ST; QL
bisoprolol-hydrochlorothiazide PG LGC
candesartan cilexetil PG QL
candesartan cilexetil-hctz PG QL
captopril oral PG
captopril-hydrochlorothiazide PG
CARDURA NP
CATAPRES NP
CATAPRES-TTS-1 NP
CATAPRES-TTS-2 NP
CATAPRES-TTS-3 NP
clonidine hcl oral PG LGC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201948
Drug Name Drug Status Drug Details
clonidine hcl transdermal NP
CORZIDE NP
COZAAR ORAL TABLET 100 MG NP ST
COZAAR ORAL TABLET 25 MG, 50 MG NP ST; QL
DEMSER NPS ST; SP
DIBENZYLINE NPS ST; QL
DIOVAN NP ST; QL
DIOVAN HCT NP ST; QL
doxazosin mesylate oral PG
DUTOPROL NC
EDARBI NP ST; QL
EDARBYCLOR NP ST; QL
enalapril maleate oral PG LGC
enalapril-hydrochlorothiazide PG LGC
EPANED ORAL SOLUTION NP PA; #; QL
eplerenone NP
eprosartan mesylate NP QL
EXFORGE NP ST; QL
EXFORGE HCT NP ST; QL
fosinopril sodium PG
fosinopril sodium-hctz PG
guanfacine hcl oral PG
hydralazine hcl oral tablet 10 mg, 100 mg, 50 mg PG
hydralazine hcl oral tablet 25 mg PG LGC
HYZAAR NP ST
INSPRA NP
irbesartan PG QL
irbesartan-hydrochlorothiazide PG QL
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg PG LGC
lisinopril oral tablet 30 mg, 40 mg PG
lisinopril-hydrochlorothiazide PG LGC
LOPRESSOR HCT ORAL TABLET 50-25 MG
NP
losartan potassium oral tablet 100 mg PG LGC
losartan potassium oral tablet 25 mg, 50 mg PG LGC; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201949
Drug Name Drug Status Drug Details
losartan potassium-hctz PG LGC
LOTENSIN ORAL TABLET 20 MG, 40 MG NP
LOTREL ORAL CAPSULE 10-20 MG, 10-40 MG, 5-10 MG, 5-20 MG
NP
MAVIK ORAL TABLET 4 MG NP
methyldopa oral PG
methyldopa-hydrochlorothiazide PG
metoprolol-hctz er NC
metoprolol-hydrochlorothiazide PG
MICARDIS NP ST; QL
MICARDIS HCT NP ST; QL
MINIPRESS NP
minoxidil oral PG
moexipril hcl PG
moexipril-hydrochlorothiazide PG
nadolol-bendroflumethiazide NP
olmesartan medoxomil oral PG QL
olmesartan medoxomil-hctz PG QL
olmesartan-amlodipine-hctz NP QL
perindopril erbumine NP
phenoxybenzamine hcl oral PSP QL
prazosin hcl oral PG
PRESTALIA NP #
PRINIVIL NP
propranolol-hctz PG
QBRELIS NP PA
quinapril hcl PG
quinapril-hydrochlorothiazide PG
ramipril PG
TARKA ORAL TABLET EXTENDED RELEASE 2-180 MG, 2-240 MG, 4-240 MG
NP
TEKTURNA NP ST; #; QL
TEKTURNA HCT NP ST; QL
telmisartan PG QL
telmisartan-amlodipine NP ST; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201950
Drug Name Drug Status Drug Details
telmisartan-hctz PG QL
TENORETIC 100 NP
TENORETIC 50 NP
terazosin hcl oral PG LGC
trandolapril PG
trandolapril-verapamil hcl er PG
TRIBENZOR NP ST; QL
TWYNSTA NP ST; QL
valsartan PG QL
valsartan-hydrochlorothiazide PG QL
VASERETIC NP
VASOTEC NC
VECAMYL NPS PA; ST; SP; QL
ZESTORETIC NP
ZESTRIL NP
ZIAC NP
*ANTI-INFECTIVE AGENTS - MISC.*
ALINIA NP #; QL
atovaquone oral PG
BACTRIM NP
BACTRIM DS NP
CLEOCIN ORAL NP
CLEOCIN PHOSPHATE INJECTION NC
CLEOCIN PHOSPHATE INTRAVENOUS SOLUTION 600 MG/4ML, 900 MG/6ML
NC
clindamycin hcl oral PG
clindamycin phosphate injection solution 9 gm/60ml, 9000 mg/60ml
NC
clindamycin phosphate intravenous solution 900 mg/6ml
NC
COLY-MYCIN M NPS SP
dapsone oral PG
FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML
NP
FLAGYL NP
IMPAVIDO NP PA; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201951
Drug Name Drug Status Drug Details
linezolid oral PG QL
MEPRON NP
metronidazole oral PG
NEBUPENT PB
SIVEXTRO ORAL NP QL
sulfamethoxazole-trimethoprim oral suspension200-40 mg/5ml
PG LGC
sulfamethoxazole-trimethoprim oral tablet PG LGC
TINDAMAX ORAL TABLET 500 MG NP
tinidazole oral NP
trimethoprim oral PG
trimpex NP
VANCOCIN HCL NP
vancomycin hcl oral NP
XIFAXAN ORAL TABLET 200 MG NP QL
XIFAXAN ORAL TABLET 550 MG PB PA; QL
ZYVOX ORAL SUSPENSION RECONSTITUTED
PB QL
ZYVOX ORAL TABLET NP QL
*ANTIMALARIALS*
atovaquone-proguanil hcl NP
chloroquine phosphate oral PG
COARTEM NP
DARAPRIM PB
hydroxychloroquine sulfate oral PG
MALARONE NP
mefloquine hcl NP
PLAQUENIL NP
primaquine phosphate oral PG
QUALAQUIN NP
quinine sulfate oral NP
*ANTIMYASTHENIC AGENTS*
guanidine hcl oral PG
MESTINON NP
pyridostigmine bromide er PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201952
Drug Name Drug Status Drug Details
pyridostigmine bromide oral PG
*ANTIMYASTHENIC/CHOLINERGIC AGENTS*
guanidine hcl oral PG
MESTINON NP
pyridostigmine bromide er PG
pyridostigmine bromide oral PG
*ANTIMYCOBACTERIAL AGENTS*
CAPASTAT SULFATE NC
cycloserine oral NP
ethambutol hcl oral PG
isoniazid oral PG
MYAMBUTOL ORAL TABLET 400 MG NP
MYCOBUTIN NP
PASER NP
PRIFTIN NP
pyrazinamide oral PG
rifabutin PG
RIFADIN ORAL NP
RIFAMATE NP
rifampin oral PG
RIFATER NP
SIRTURO NPS PA; SP; QL
TRECATOR NP
*ANTINEOPLASTIC - BCL-2 INHIBITORS***
VENCLEXTA NPS PA; SP; QL
VENCLEXTA STARTING PACK NPS PA; SP; QL
*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*
ACTIMMUNE NPS PA; SP
AFINITOR NPS PA; SP; QL
AFINITOR DISPERZ NPS PA; SP; QL
ALECENSA NPS PA; SP; QL
ALFERON N NPS SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201953
Drug Name Drug Status Drug Details
ALKERAN INTRAVENOUS NC
ALKERAN ORAL NP ST
ALUNBRIG NPS PA; SP; QL
anastrozole oral PG
ARIMIDEX NP
AROMASIN NP
ARRANON NC #
ARZERRA NC
bexarotene PSP PA; SP
bicalutamide PG QL
BOSULIF NPS PA; ST; SP; QL
BRAFTOVI NPS PA; SP; QL
BUSULFEX NC
CABOMETYX PSP PA; SP; QL
CALQUENCE NPS PA; SP; QL
CAMPTOSAR NC
capecitabine PG PA; SP
CAPRELSA NPS PA; SP; QL
CASODEX NP QL
COMETRIQ (100 MG DAILY DOSE) NPS PA; SP; QL
COMETRIQ (140 MG DAILY DOSE) NPS PA; SP; QL
COMETRIQ (60 MG DAILY DOSE) NPS PA; SP; QL
COTELLIC NPS PA; SP; QL
cyclophosphamide injection NC
cyclophosphamide oral capsule PG
ELIGARD NPS PA; SP
EMCYT PB
ERIVEDGE NPS PA; SP; QL
ERLEADA NPS PA; SP; QL
ETHYOL NC
etoposide intravenous solution 100 mg/5ml, 500 mg/25ml
NC
etoposide oral PG
exemestane PG
FARESTON PB
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201954
Drug Name Drug Status Drug Details
FARYDAK NPS PA; SP; QL
FASLODEX INTRAMUSCULAR SOLUTION 250 MG/5ML
NPS PA; #; SP
FEMARA NP
FIRMAGON NPS PA; SP
flutamide PG
GILOTRIF NPS PA; SP; QL
GLEEVEC NC SP
GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG
NP PA
HEXALEN PB
HYCAMTIN ORAL NPS PA; SP
HYDREA NP
hydroxyurea oral PG
ICLUSIG NPS PA; SP; QL
imatinib mesylate PG PA; SP; QL
IMBRUVICA ORAL CAPSULE 70 MG NPS PA; SP; QL
IMBRUVICA ORAL TABLET NPS PA; SP; QL
INLYTA NPS PA; SP; QL
INTRON A NPS PA; SP
IRESSA NPS PA; QL
irinotecan hcl NC
JAKAFI ORAL TABLET 10 MG NPS PA; SP
JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG
NPS PA; SP; QL
JEVTANA NC
KISQALI FEMARA 200 DOSE NPS PA; SP; QL
KISQALI FEMARA 400 DOSE NPS PA; SP; QL
KISQALI FEMARA 600 DOSE NPS PA; SP; QL
LENVIMA 10 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 12 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 14 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 18 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 20 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 24 MG DAILY DOSE NPS PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201955
Drug Name Drug Status Drug Details
LENVIMA 4 MG DAILY DOSE NPS PA; SP; QL
LENVIMA 8 MG DAILY DOSE NPS PA; SP; QL
letrozole oral PG
leucovorin calcium oral PG
LEUKERAN PB
leuprolide acetate injection PG PA; SP
LONSURF NPS PA; QL
LUPRON DEPOT (1-MONTH) NPS PA; #; SP
LUPRON DEPOT (3-MONTH) NPS PA; #; SP
LUPRON DEPOT (4-MONTH) NPS PA; #; SP
LUPRON DEPOT (6-MONTH) NPS PA; #; SP
LYSODREN PB
MATULANE PB
megestrol acetate oral tablet PG
MEKINIST NPS PA; SP; QL
MEKTOVI NPS PA; SP; QL
melphalan PG
melphalan hcl NC
mercaptopurine oral PG
methotrexate oral PG
methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml
PG
MYLERAN PB
NERLYNX NPS PA; SP; QL
NEXAVAR NPS PA; SP; QL
NILANDRON PB
nilutamide PG
NINLARO NPS PA; QL
ODOMZO NPS PA; QL
POMALYST NPS PA; SP; QL
PURIXAN NPS PA; ST; SP; QL
RYDAPT NPS PA; SP; QL
SOLTAMOX NP #
SPRYCEL NPS PA; ST; SP; QL
STIVARGA NPS PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201956
Drug Name Drug Status Drug Details
SUTENT PSP PA; SP; QL
SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG
NPS PA; SP
SYNRIBO NC
TABLOID PB
TAFINLAR NPS PA; SP; QL
TAGRISSO NPS PA; SP; QL
tamoxifen citrate oral CE
TARCEVA PSP PA; #; SP; QL
TARGRETIN ORAL NPS PA; SP
TASIGNA NPS PA; ST; SP; QL
TEMODAR ORAL NC
temozolomide PG PA; SP
toposar intravenous solution 100 mg/5ml NC
TORISEL NC #
TRELSTAR MIXJECT NPS PA; #; SP
tretinoin oral PG SP
TYKERB NPS PA; SP
VELCADE INJECTION NC #
VORAXAZE NC
VOTRIENT NPS PA; SP; QL
XALKORI NPS PA; SP; QL
XATMEP NP PA
XELODA NC
XTANDI NPS PA; ST; SP; QL
YERVOY NC
YONSA NPS PA; ST; SP; QL
ZANOSAR NC
ZELBORAF NPS PA; SP; QL
ZOLINZA NPS PA; SP; QL
ZYKADIA NPS PA; SP
ZYTIGA PSP PA; #; SP; QL
*ANTIPARKINSON AGENTS*
amantadine hcl oral PG
AZILECT NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201957
Drug Name Drug Status Drug Details
benztropine mesylate oral PG LGC
bromocriptine mesylate oral PG
carbidopa oral PG
carbidopa-levodopa PG
carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg
PG
carbidopa-levodopa-entacapone NP
COMTAN NP
DUOPA ENTERAL NPS PA; ST
ELDEPRYL NP
entacapone PG
GOCOVRI NC
LODOSYN NP
MIRAPEX NP
MIRAPEX ER NP QL
NEUPRO NP #; QL
OSMOLEX ER NC
PARLODEL ORAL CAPSULE NP
pramipexole dihydrochloride PG
pramipexole dihydrochloride er NP QL
rasagiline mesylate oral PG QL
REQUIP NP
REQUIP XL NP QL
ropinirole hcl PG
ropinirole hcl er NP QL
RYTARY NP #
selegiline hcl oral PG
SINEMET NP
SINEMET CR NP
STALEVO 100 NP
STALEVO 125 NP
STALEVO 150 NP
STALEVO 200 NP
STALEVO 50 NP
STALEVO 75 NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201958
Drug Name Drug Status Drug Details
TASMAR ORAL TABLET 100 MG NP
tolcapone NP
trihexyphenidyl hcl oral elixir PG
trihexyphenidyl hcl oral tablet 2 mg PG LGC
trihexyphenidyl hcl oral tablet 5 mg PG
XADAGO NP PA; ST; QL
ZELAPAR NC
*ANTIPSYCHOTICS/ANTIMANIC AGENTS*
ABILIFY ORAL TABLET NP ST; QL
aripiprazole PG QL
chlorpromazine hcl oral PG
clozapine PG QL
CLOZARIL NP PA; ST; QL
COMPRO PG
EQUETRO NP
FANAPT NP ST; QL
FANAPT TITRATION PACK NP ST
FAZACLO NP PA; ST; QL
fluphenazine hcl oral PG
GEODON ORAL NP PA; ST; QL
haloperidol lactate oral PG
haloperidol oral PG
INVEGA NP PA; ST; QL
LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 80 MG
NP ST; #; QL
LATUDA ORAL TABLET 60 MG NP ST; #
lithium PG
lithium carbonate er PG
lithium carbonate oral PG
LITHOBID NP
loxapine succinate oral PG
NUPLAZID NPS PA; SP; QL
olanzapine oral PG QL
paliperidone er NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201959
Drug Name Drug Status Drug Details
perphenazine oral PG
prochlorperazine PG
prochlorperazine maleate oral PG
quetiapine fumarate PG QL
quetiapine fumarate er NP QL
REXULTI NP PA; ST; QL
RISPERDAL ORAL SOLUTION NP PA; ST
RISPERDAL ORAL TABLET NP PA; ST; QL
RISPERIDONE M-TAB ORAL TABLET DISPERSIBLE 0.5 MG, 1 MG, 2 MG
PG QL
risperidone oral solution PG
risperidone oral tablet PG QL
risperidone oral tablet dispersible 0.25 mg PG
risperidone oral tablet dispersible 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
PG QL
SAPHRIS NP PA; ST; #; QL
SEROQUEL NP PA; ST; QL
SEROQUEL XR NP ST; QL
thioridazine hcl oral PG
thiothixene oral PG
trifluoperazine hcl oral PG
VERSACLOZ NP PA; ST
VRAYLAR ORAL CAPSULE NP PA; ST; QL
VRAYLAR ORAL CAPSULE THERAPY PACK
NP PA; ST
ziprasidone hcl PG QL
ZYPREXA ORAL NP PA; ST; QL
ZYPREXA ZYDIS NP PA; ST; QL
*ANTIRETROVIRALS ADJUVANTS***
TYBOST NP QL
*ANTIVIRALS*
abacavir sulfate PG
abacavir sulfate-lamivudine PG
abacavir-lamivudine-zidovudine PG
acyclovir oral capsule PG LGC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201960
Drug Name Drug Status Drug Details
acyclovir oral suspension PG
acyclovir oral tablet 400 mg PG LGC
acyclovir oral tablet 800 mg PG
adefovir dipivoxil PG SP; QL
APTIVUS PB
atazanavir sulfate PG QL
ATRIPLA PB QL
BARACLUDE ORAL SOLUTION NPS SP
BARACLUDE ORAL TABLET NPS SP; QL
BIKTARVY NP PA
cidofovir intravenous PG SP
CIMDUO NP QL
COMBIVIR NP
COMPLERA PB QL
CRIXIVAN ORAL CAPSULE 200 MG, 400 MG
NP
CYTOVENE NPS SP
DAKLINZA NPS PA; ST; SP; QL
DESCOVY NP QL
didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg
PG
EDURANT NP QL
efavirenz PG
EMTRIVA ORAL CAPSULE PB QL
EMTRIVA ORAL SOLUTION PB
entecavir PG SP; QL
EPIVIR NP
EPIVIR HBV ORAL SOLUTION NP #
EPIVIR HBV ORAL TABLET NP
EPZICOM NP
EVOTAZ NP
famciclovir oral PG QL
FLUMADINE NP
fosamprenavir calcium PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201961
Drug Name Drug Status Drug Details
FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED
NPS PA; #; SP
ganciclovir sodium intravenous solution reconstituted
PG SP
GENVOYA NP PA; QL
HEPSERA NPS SP; QL
INTELENCE NP QL
INVIRASE NP
ISENTRESS HD PB QL
ISENTRESS ORAL PACKET PB
ISENTRESS ORAL TABLET PB QL
ISENTRESS ORAL TABLET CHEWABLE PB QL
JULUCA NP ST; QL
KALETRA ORAL SOLUTION NP
KALETRA ORAL TABLET PB #
lamivudine PG
lamivudine-zidovudine PG
LEXIVA ORAL SUSPENSION PB #
LEXIVA ORAL TABLET NP #
lopinavir-ritonavir PG
MODERIBA 1200 DOSE PACK NPS SP
MODERIBA 800 DOSE PACK NPS SP
moderiba oral tablet 200 mg PG SP
nevirapine er PG QL
nevirapine oral tablet PG
NORVIR ORAL CAPSULE PB #
NORVIR ORAL PACKET PB
NORVIR ORAL SOLUTION PB #
NORVIR ORAL TABLET NP
ODEFSEY NP QL
oseltamivir phosphate oral PG QL
PEGASYS PROCLICK NPS PA; SP
PEGASYS SUBCUTANEOUS SOLUTION NPS PA; SP
PREVYMIS ORAL NPS PA; SP; QL
PREZCOBIX PB
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201962
Drug Name Drug Status Drug Details
PREZISTA ORAL SUSPENSION PB QL
PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG
PB QL
REBETOL NPS SP
RELENZA DISKHALER NP QL
RESCRIPTOR NP #
RETROVIR INTRAVENOUS NC
RETROVIR ORAL CAPSULE NP
RETROVIR ORAL SYRUP NP
REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG
NP QL
REYATAZ ORAL PACKET PB #
ribasphere PG SP
ribasphere ribapak oral tablet 400 mg, 600 mg PG SP
ribavirin oral capsule PG SP
ribavirin oral tablet 200 mg PG SP
rimantadine hcl PG
ritonavir PG
SELZENTRY ORAL SOLUTION NP QL
SELZENTRY ORAL TABLET 150 MG, 25 MG, 75 MG
NP QL
SELZENTRY ORAL TABLET 300 MG NP
SITAVIG NC
SOVALDI PSP PA; SP; QL
stavudine oral capsule PG
STRIBILD NP PA; QL
SUSTIVA NP
SYMFI NP
SYMFI LO NP
SYMTUZA NP PA
TAMIFLU ORAL CAPSULE NP QL
TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MG/ML
NP QL
tenofovir disoproxil fumarate PG QL
TIVICAY PB QL
TRIUMEQ PB QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201963
Drug Name Drug Status Drug Details
TRIZIVIR NP
TRUVADA PB
valacyclovir hcl oral PG
VALCYTE NPS PA; SP; QL
valganciclovir hcl PG PA; SP; QL
VALTREX NP ST
VEMLIDY NPS PA; ST; SP; QL
VIDEX PB
VIDEX EC NP
VIRACEPT ORAL TABLET NP
VIRAMUNE NP
VIRAMUNE XR NP QL
VIREAD ORAL POWDER PB #
VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG
PB #; QL
VIREAD ORAL TABLET 300 MG NP QL
ZERIT NP
ZIAGEN NP
zidovudine PG
ZOVIRAX ORAL NP
*ASSORTED CLASSES*
ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG
NPS #; SP; QL
ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG
NPS #; SP
ATGAM NPS SP
azathioprine oral PG
BENLYSTA INTRAVENOUS NPS PA; ST; SP
BENLYSTA SUBCUTANEOUS NPS PA; ST; SP; QL
CELLCEPT NPS SP
CUPRIMINE ORAL CAPSULE 250 MG NPS PA; ST; #
cyclosporine intravenous PG SP
cyclosporine modified PG
cyclosporine oral capsule PG
DEPEN TITRATABS PSP PA
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201964
Drug Name Drug Status Drug Details
ENVARSUS XR NPS
gengraf oral capsule 100 mg, 25 mg PG
gengraf oral solution PG
HYLAFEM NC
IMURAN NP
KIONEX ORAL SUSPENSION PG
LOKELMA NP PA
morcin NC
mycophenolate mofetil PG SP
mycophenolate sodium PG SP
MYFORTIC NPS SP
NEORAL NPS SP
NULOJIX NPS SP
PROGRAF NPS SP
RAPAMUNE NPS SP
REVLIMID NPS PA; SP; QL
SANDIMMUNE NPS SP
SIMULECT NPS SP
sirolimus oral PG SP
sodium polystyrene sulfonate oral PG
SPS PG
SYPRINE NPS PA; SP
tacrolimus oral PG SP
THALOMID NPS PA; #; SP
THYMOGLOBULIN NPS SP
TRAUMEEL EXTERNAL OINTMENT NC
trientine hcl PSP PA; SP
VELTASSA NP PA; QL
XIAFLEX PSP SP
ZORTRESS NPS #; SP
*ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES***
DUPIXENT NPS PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201965
Drug Name Drug Status Drug Details
*BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB***
BYVALSON NP PA; ST; QL
*BETA BLOCKERS*
acebutolol hcl oral PG
atenolol oral PG LGC
BETAPACE AF NP
BETAPACE ORAL TABLET 120 MG, 160 MG, 80 MG
NP
betaxolol hcl oral NP
bisoprolol fumarate PG
BYSTOLIC NP PA; ST; QL
carvedilol PG LGC
carvedilol phosphate er NP QL
COREG NP
COREG CR NP QL
CORGARD NP
HEMANGEOL NP PA
INDERAL LA NC
INDERAL XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 80 MG
NP QL
INNOPRAN XL NP QL
KAPSPARGO SPRINKLE NP
labetalol hcl oral PG
metoprolol succinate er PG QL
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
PG LGC
metoprolol tartrate oral tablet 37.5 mg, 75 mg PG
nadolol oral tablet 20 mg, 40 mg, 80 mg PG
pindolol PG
propranolol hcl er PG
propranolol hcl oral solution PG
propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 80 mg
PG LGC
propranolol hcl oral tablet 60 mg PG
sotalol hcl (af) oral tablet 120 mg PG LGC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201966
Drug Name Drug Status Drug Details
sotalol hcl (af) oral tablet 160 mg, 80 mg PG
sotalol hcl oral tablet 120 mg, 80 mg PG LGC
sotalol hcl oral tablet 160 mg, 240 mg PG
SOTYLIZE NP
TENORMIN NP
timolol maleate oral PG
TOPROL XL NP ST; QL
*BILE ACID SYNTHESIS DISORDER AGENTS***
CHOLBAM NPS PA
*BIOLOGICALS MISC*
ADAGEN NPS SP
GRASTEK PB PA; ST; QL
mixed vespid venom protein injection solution reconstituted
NC
RAGWITEK NP PA; ST; QL
VENOMIL MIXED VESPID VENOM NC
*CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG***
AIMOVIG NP PA; ST; QL
AIMOVIG 140 DOSE NP PA; ST; QL
*CALCIUM CHANNEL BLOCKERS*
ADALAT CC NP QL
AFEDITAB CR PG QL
amlodipine besylate oral PG LGC
CALAN ORAL TABLET 120 MG, 80 MG NP
CALAN SR NP
CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 360 MG
NC
CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG
NP QL
CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 420 MG
NP
CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG
NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201967
Drug Name Drug Status Drug Details
CARTIA XT PG QL
diltiazem cd PG QL
diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
PG QL
diltiazem hcl er coated beads oral capsule extended release 24 hour
PG QL
diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg, 240 mg, 300 mg, 360 mg
NP QL
diltiazem hcl er coated beads oral tablet extended release 24 hour 420 mg
NP
diltiazem hcl er oral capsule extended release 12 hour
PG
diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg
PG
diltiazem hcl er oral capsule extended release 24 hour 240 mg
PG QL
diltiazem hcl oral PG LGC
dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg
PG
dilt-xr oral capsule extended release 24 hour 240 mg
PG QL
felodipine er PG QL
isradipine PG
MATZIM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 180 MG, 240 MG, 300 MG, 360 MG
NP QL
MATZIM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 420 MG
NP
nicardipine hcl oral PG
NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG
PG QL
nifedipine er PG QL
nifedipine er osmotic release PG QL
nifedipine oral PG
nimodipine oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201968
Drug Name Drug Status Drug Details
nisoldipine er oral tablet extended release 24 hour 17 mg, 20 mg, 30 mg, 34 mg, 40 mg, 8.5 mg
PG QL
nisoldipine er oral tablet extended release 24 hour 25.5 mg
PG
NORVASC NP
NYMALIZE ORAL SOLUTION 60 MG/20ML
NP QL
PROCARDIA NP
PROCARDIA XL NP QL
SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR 17 MG, 34 MG, 8.5 MG
NP QL
TAZTIA XT PG QL
TIAZAC NP QL
verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg
PG QL
verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg
PG
verapamil hcl er oral tablet extended release 120 mg
PG LGC
verapamil hcl er oral tablet extended release 180 mg, 240 mg
PG
verapamil hcl oral PG LGC
VERELAN NP
VERELAN PM NP QL
*CARDIOTONICS*
DIGITEK PG
DIGOX PG
digoxin oral PG
LANOXIN ORAL NP
*CARDIOVASCULAR AGENTS - MISC.*
ADCIRCA NPS PA; ST; #; SP; QL
ADEMPAS NPS PA; ST; SP; QL
amlodipine-atorvastatin NC
BIDIL NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201969
Drug Name Drug Status Drug Details
CADUET ORAL TABLET 10-10 MG, 10-20 MG, 10-40 MG, 10-80 MG, 5-10 MG, 5-20 MG, 5-40 MG, 5-80 MG
NC
CIALIS ORAL TABLET 2.5 MG, 5 MG PB PA; N1; #; QL
epoprostenol sodium PG PA; SP
FLOLAN NPS PA; SP
LETAIRIS PSP PA; #; SP
OPSUMIT PSP PA; SP; QL
ORENITRAM NPS PA; SP
REMODULIN NPS PA; #; SP
REVATIO INTRAVENOUS NPS PA; ST; SP
REVATIO ORAL SUSPENSION RECONSTITUTED
NPS PA; ST; #; SP
REVATIO ORAL TABLET NPS PA; ST; SP; QL
sildenafil citrate oral tablet 20 mg PG PA; SP; QL
tadalafil (pah) PSP PA; SP; QL
TRACLEER ORAL TABLET PSP PA; #; SP
TRACLEER ORAL TABLET SOLUBLE PSP PA; SP
TYVASO NPS PA; ST; SP; QL
TYVASO REFILL NPS PA; ST; SP; QL
TYVASO STARTER NPS PA; ST; SP; QL
VELETRI NPS PA; #; SP
VENTAVIS NPS PA; SP
*CEPHALOSPORINS*
cefaclor PG
cefaclor er PG
cefadroxil PG
cefazolin sodium injection NC
cefazolin sodium intravenous solution reconstituted
NC
cefdinir PG
cefditoren pivoxil NP
cefepime hcl NC
cefepime-dextrose NC
cefixime NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201970
Drug Name Drug Status Drug Details
cefotaxime sodium injection solution reconstituted 1 gm, 500 mg
NC
cefotetan disodium NC
cefoxitin sodium NC
cefoxitin sodium-dextrose NC
cefpodoxime proxetil PG
cefprozil PG
ceftazidime injection solution reconstituted 1 gm, 2 gm, 6 gm
NC
ceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 250 mg, 500 mg
NC
ceftriaxone sodium intravenous NC
cefuroxime axetil oral tablet PG
cefuroxime sodium injection solution reconstituted 7.5 gm, 750 mg
NC
cefuroxime sodium intravenous solution reconstituted 1.5 gm
NC
cephalexin oral capsule 250 mg, 500 mg PG LGC
cephalexin oral capsule 750 mg PG
cephalexin oral suspension reconstituted PG
cephalexin oral tablet PG
DAXBIA NC
KEFLEX NP
MAXIPIME INJECTION SOLUTION RECONSTITUTED 1 GM, 2 GM
NC
MAXIPIME INTRAVENOUS NC
ROCEPHIN INJECTION SOLUTION RECONSTITUTED 1 GM
NC
SPECTRACEF ORAL TABLET 400 MG NP
SUPRAX ORAL CAPSULE NP #
SUPRAX ORAL SUSPENSION RECONSTITUTED
NP
SUPRAX ORAL TABLET CHEWABLE NP #
tazicef injection NC
tazicef intravenous solution reconstituted NC
TEFLARO NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201971
Drug Name Drug Status Drug Details
*CIC AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS***
TRULANCE PB QL
*CONTRACEPTIVES*
ALTAVERA CE
alyacen 1/35 CE
alyacen 7/7/7 CE
AMETHIA CE
AMETHIA LO CE
APRI CE
ARANELLE PG
AUBRA EQ CE
AVIANE CE
AZURETTE PG
BALCOLTRA NP
BALZIVA PG
BEYAZ NP
briellyn CE
CAMRESE CE
CAMRESE LO CE
CAZIANT CE
CHATEAL CE
CHATEAL EQ CE
CRYSELLE-28 PG
CYCLAFEM 1/35 PG
DASETTA 1/35 PG
DASETTA 7/7/7 PG
DAYSEE CE
DELYLA CE
DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML
NP
desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg
CE
drospirenone-ethinyl estradiol oral tablet 3-0.02 mg
PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201972
Drug Name Drug Status Drug Details
drospirenone-ethinyl estradiol oral tablet 3-0.03 mg
CE
ELINEST CE
ELLA CE #
EMOQUETTE CE
ENPRESSE-28 PG
ENSKYCE ORAL TABLET 0.15-30 MG-MCG
CE
ERRIN PG
ESTARYLLA PG
ESTROSTEP FE NP
FALMINA CE
FAYOSIM CE
GENERESS FE NP #
GIANVI PG
GILDESS FE 1.5/30 PG
GILDESS FE 1/20 PG
HEATHER CE
INTROVALE CE
ISIBLOOM CE
JENCYCLA PG
JOLESSA CE
JOLIVETTE PG
JUNEL 1.5/30 PG
JUNEL 1/20 PG
JUNEL FE 1.5/30 PG
JUNEL FE 1/20 PG
KARIVA PG
KELNOR 1/35 CE
KURVELO PG
KYLEENA CE
LARIN 1.5/30 CE
LARIN 1/20 CE
LARIN FE 1.5/30 CE
LARIN FE 1/20 CE
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201973
Drug Name Drug Status Drug Details
LEENA CE
LESSINA CE
LEVONEST CE
levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 mg
CE
levonorgestrel oral tablet 1.5 mg CE
levonorgestrel-ethinyl estrad CE
LEVORA 0.15/30 (28) PG
LO LOESTRIN FE NP
LOESTRIN 1.5/30 (21) NP
LOESTRIN 1/20 (21) NP
LORYNA PG
LOSEASONIQUE NP
LOW-OGESTREL PG
LUTERA CE
LYZA PG
marlissa CE
medroxyprogesterone acetate intramuscular suspension
CE
MIBELAS 24 FE CE
MICROGESTIN 1.5/30 PG
MICROGESTIN 1/20 PG
MICROGESTIN FE 1.5/30 PG
MICROGESTIN FE 1/20 PG
MINASTRIN 24 FE NP
MIRCETTE NP
MIRENA (52 MG) CE #
MONO-LINYAH PG
MONONESSA PG
NATAZIA NP
NECON 0.5/35 (28) PG
NECON 1/35 (28) CE
NEXPLANON CE
NEXT CHOICE ONE DOSE CE
NIKKI PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201974
Drug Name Drug Status Drug Details
NORA-BE PG
norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg
CE
norethin ace-eth estrad-fe oral tablet chewable CE
norethindrone oral CE
norethin-eth estradiol-fe oral tablet chewable0.8-25 mg-mcg
CE
norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg
CE
norgestim-eth estrad triphasic oral tablet0.18/0.215/0.25 mg-35 mcg
CE
NORTREL 0.5/35 (28) PG
NORTREL 1/35 (21) PG
NORTREL 1/35 (28) PG
NORTREL 7/7/7 PG
NUVARING CE #
OCELLA PG
OGESTREL PG
OPTION 2 CE
ORSYTHIA CE
ORTHO MICRONOR NP
ORTHO TRI-CYCLEN (28) NP
ORTHO TRI-CYCLEN LO NP
ORTHO-CYCLEN (28) NP
ORTHO-NOVUM 1/35 (28) NP
ORTHO-NOVUM 7/7/7 (28) NP
PARAGARD INTRAUTERINE COPPER NP
PHILITH PG
PIMTREA CE
PIRMELLA 1/35 CE
PLAN B ONE-STEP PG
PORTIA-28 PG
PREVIFEM PG
QUARTETTE NP
QUASENSE CE
RAJANI CE
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201975
Drug Name Drug Status Drug Details
RECLIPSEN PG
RIVELSA CE
SAFYRAL NP
SEASONIQUE NP
SKYLA CE
SPRINTEC 28 PG
SRONYX CE
SYEDA PG
TAKE ACTION CE
TAYTULLA NP #
TILIA FE CE
TRI FEMYNOR CE
TRI-ESTARYLLA PG
TRI-LEGEST FE PG
TRI-LINYAH PG
TRI-MILI CE
TRINESSA (28) PG
TRI-NORINYL (28) NP
TRI-PREVIFEM PG
TRI-SPRINTEC PG
TRIVORA (28) PG
TULANA CE
TYDEMY CE
VELIVET PG
VESTURA PG
VYFEMLA CE
WERA CE
WYMZYA FE CE
XULANE CE
YASMIN 28 NP
YAZ NP
ZARAH PG
ZENCHENT PG
ZOVIA 1/35E (28) PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201976
Drug Name Drug Status Drug Details
*CORTICOSTEROIDS*
budesonide er oral tablet extended release 24 hour
PG QL
budesonide oral PG
CORTEF NP
cortisone acetate oral PG
DEXAMETHASONE INTENSOL NP
dexamethasone oral PG
EMFLAZA NC
ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES
NP
fludrocortisone acetate oral PG
hydrocortisone oral PG
MEDROL NP
methylprednisolone oral PG
MILLIPRED NP
ORAPRED ODT NP
prednisolone oral solution PG
prednisolone sodium phosphate oral solution 10 mg/5ml, 20 mg/5ml
NP
prednisolone sodium phosphate oral solution 25 mg/5ml, 6.7 (5 base) mg/5ml
PG
prednisolone sodium phosphate oral tablet dispersible
NP
PREDNISONE INTENSOL NP
prednisone oral solution PG
prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg
PG LGC
prednisone oral tablet 50 mg PG
prednisone oral tablet therapy pack PG
RAYOS NC
TAPERDEX 12-DAY NC
TAPERDEX 6-DAY NC
UCERIS ORAL NP ST; #; QL
VERIPRED 20 NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201977
Drug Name Drug Status Drug Details
*COUGH/COLD/ALLERGY*
acetylcysteine inhalation PG
ALAVERT ALLERGY/SINUS PG Select OTC
ALLEGRA-D ALLERGY & CONGESTION PG Select OTC
benzonatate PG
cetirizine-pseudoephedrine er PG Select OTC
CLARINEX-D 12 HOUR NP QL
CLARITIN-D 12 HOUR PG Select OTC
CLARITIN-D 24 HOUR PG Select OTC
fexofenadine-pseudoephed er oral tablet extended release 24 hour
PG Select OTC
guaifenesin ac NC
guaifenesin-codeine oral syrup NC
hydrocod polst-cpm polst er oral suspension extended release
NP QL
hydrocodone-homatropine PG
loratadine-d 12hr PG Select OTC
loratadine-d 24hr PG Select OTC
NEBUSAL INHALATION NEBULIZATION SOLUTION 3 %
PG
promethazine vc PG
promethazine vc/codeine PG
promethazine-dm PG
pseudoeph-chlorphen-hydrocod NP
SEMPREX-D NP
sodium chloride inhalation nebulization solution10 %, 3 %
PG
SSKI PB
TESSALON PERLES NP
TUSNEL C NC
TUSSICAPS NP QL
TUSSIONEX PENNKINETIC ER ORAL SUSPENSION EXTENDED RELEASE
NP QL
ZYRTEC-D ALLERGY & CONGESTION PG Select OTC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201978
Drug Name Drug Status Drug Details
*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***
IBRANCE NPS PA; SP; QL
KISQALI 200 DOSE NPS PA; SP; QL
KISQALI 400 DOSE NPS PA; SP; QL
KISQALI 600 DOSE NPS PA; SP; QL
VERZENIO NPS PA; SP; QL
*CYSTIC FIBROSIS AGENT - COMBINATIONS***
ORKAMBI ORAL PACKET NPS PA; SP; QL
ORKAMBI ORAL TABLET NPS PA; QL
SYMDEKO NPS PA; SP; QL
*DERMATOLOGICALS*
ABREVA PG Select OTC
ABSORICA NC
ACANYA NC #
acitretin PG QL
acyclovir external NP
ACZONE EXTERNAL GEL 5 % NP ST; QL
ACZONE EXTERNAL GEL 7.5 % NP ST; #; QL
adapalene external cream NP PA; AL
adapalene external gel 0.1 % NC
adapalene external gel 0.3 % NP PA; AL
adapalene external lotion NP PA; AL
adapalene-benzoyl peroxide PG PA; AL
AKTIPAK NP
ALA-QUIN NC
alclometasone dipropionate PG
ALCORTIN A NC
ALDARA NP QL
ALTABAX NP
amcinonide NP ST
AMELUZ NP #
AMNESTEEM NP PA; QL
APEXICON E NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201979
Drug Name Drug Status Drug Details
ASTERO NC
ATRALIN NC
AVAR CLEANSER NC
AVAR LS CLEANSER NC
avar-e emollient NC
avar-e green NC
AVAR-E LS NC
avita PG PA; AL
AZELEX NP
BACTROBAN EXTERNAL CREAM NP QL
bensal hp NC
BENZACLIN NC
BENZACLIN WITH PUMP NC
BENZAMYCIN NP
benzoyl peroxide-erythromycin PG
betamethasone dipropionate aug external cream PG
betamethasone dipropionate aug external gel PG QL
betamethasone dipropionate aug external lotion PG QL
betamethasone dipropionate aug external ointment
PG QL
betamethasone valerate external cream NP ST
betamethasone valerate external foam NP
betamethasone valerate external lotion NP ST
betamethasone valerate external ointment NP ST
bp 10-1 NC
calcipotriene external cream NP ST
calcipotriene external ointment NP ST
calcipotriene external solution NP
calcipotriene-betameth diprop NC
calcitrene NP ST
calcitriol external NP
CAPEX NC
CARAC NC
CEM-UREA NC
CENTANY NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201980
Drug Name Drug Status Drug Details
CICLODAN EXTERNAL SOLUTION PG
CICLODAN SOLUTION NC
ciclopirox external gel NP
ciclopirox external shampoo NP
ciclopirox external solution PG
ciclopirox olamine external cream PG
ciclopirox treatment NC
claravis oral capsule 10 mg NP PA; QL
CLEOCIN-T EXTERNAL GEL NP ST
CLEOCIN-T EXTERNAL LOTION NP ST
CLEOCIN-T EXTERNAL SOLUTION NP ST
CLEOCIN-T EXTERNAL SWAB NP
CLINDACIN ETZ EXTERNAL KIT NC
CLINDACIN PAC NC
CLINDAGEL NP ST
clindamycin phos-benzoyl perox NC
clindamycin phosphate external foam NP
clindamycin phosphate external gel NP ST
clindamycin phosphate external lotion NP ST
clindamycin phosphate external solution NP ST
clindamycin phosphate external swab NP
clindamycin-tretinoin NP PA; AL
clobetasol prop emollient base NP ST; QL
clobetasol propionate e NP ST; QL
clobetasol propionate emulsion NP QL
clobetasol propionate external cream NP ST; QL
clobetasol propionate external foam NP QL
clobetasol propionate external gel NP ST; QL
clobetasol propionate external liquid NP QL
clobetasol propionate external lotion NP ST; QL
clobetasol propionate external ointment NP ST; QL
clobetasol propionate external shampoo NP QL
clobetasol propionate external solution NP ST; QL
CLOBEX EXTERNAL LOTION NP ST; QL
CLOBEX EXTERNAL SHAMPOO NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201981
Drug Name Drug Status Drug Details
CLOBEX SPRAY NP QL
clocortolone pivalate NP
clodan external shampoo NP QL
CLODERM NP
CLODERM PUMP NP
clotrimazole-betamethasone external cream PG
coal tar external solution PG
CONDYLOX EXTERNAL GEL NP
CORDRAN EXTERNAL CREAM NP QL
CORDRAN EXTERNAL LOTION NP QL
CORDRAN EXTERNAL OINTMENT NP QL
CORDRAN EXTERNAL TAPE NP #; QL
CORTISPORIN EXTERNAL OINTMENT PB
COSENTYX NPS PA; ST; SP
COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML
NPS PA; ST; SP
CROTAN PG
CUTIVATE EXTERNAL LOTION NP
dapsone external PG QL
DENAVIR NP
DERMA-SMOOTHE/FS BODY PB
DERMA-SMOOTHE/FS SCALP PB
DESONATE NP #
desonide external NP ST
DESOWEN EXTERNAL CREAM NP ST
DESOWEN EXTERNAL LOTION NP ST
desoximetasone external cream NP ST
desoximetasone external gel NP ST
desoximetasone external liquid NC
desoximetasone external ointment NP ST
diclofenac sodium transdermal gel 1 % PG QL
diclofenac sodium transdermal gel 3 % NC
diclofenac sodium transdermal solution NC
DICLOFEX DC NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201982
Drug Name Drug Status Drug Details
DIFFERIN EXTERNAL CREAM NP PA; AL
DIFFERIN EXTERNAL GEL 0.1 % PG PA; Select OTC; AL
DIFFERIN EXTERNAL GEL 0.3 % NP PA; ST; AL
DIFFERIN EXTERNAL LOTION NP PA; ST; AL
diflorasone diacetate external NP ST; QL
DIPROLENE NP QL
DIPROLENE AF NP
DOVONEX EXTERNAL CREAM NP ST
doxepin hcl external NP QL
doxycycline NC
DUAC NC
econazole nitrate external NP QL
ECOZA NC
EFUDEX EXTERNAL CREAM NC
ELIDEL NC #
ELIMITE NP
ELOCON EXTERNAL CREAM NP ST
ELOCON EXTERNAL OINTMENT NP ST
ENSTILAR NP QL
EPIDUO PB PA; AL
EPIDUO FORTE PB PA; #; AL
ERTACZO NC
ery PG
erythromycin external pad PG
erythromycin external solution PG
EURAX NP
EVOCLIN NP
EXELDERM NC
EXTINA NC
FABIOR NP PA; ST; AL
FINACEA EXTERNAL FOAM NP
FINACEA EXTERNAL GEL NP #
FLECTOR NC #
fluocinolone acetonide body PG
fluocinolone acetonide external cream NP ST
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201983
Drug Name Drug Status Drug Details
fluocinolone acetonide external ointment NP ST
fluocinolone acetonide scalp PG
fluocinonide external cream NP ST; QL
fluocinonide external gel NP ST; QL
fluocinonide external ointment NP ST; QL
fluocinonide external solution PG QL
FLUOROPLEX NC
fluorouracil external cream 0.5 % NC
fluorouracil external cream 5 % PG
fluorouracil external solution PG
flurandrenolide NP QL
fluticasone propionate external cream NP ST
fluticasone propionate external lotion NP
fluticasone propionate external ointment PG
gentamicin sulfate external PG
GORDONS UREA EXTERNAL OINTMENT 22 %
NC
halobetasol propionate NP ST; QL
HALOG NP
hydrocortisone ace-pramoxine external cream2.5-1 %
NC
hydrocortisone acetate NC
hydrocortisone butyr lipo base PG
hydrocortisone butyrate external cream PG
hydrocortisone butyrate external lotion NP
hydrocortisone butyrate external ointment PG
hydrocortisone butyrate external solution PG
hydrocortisone external cream 2.5 % PG
hydrocortisone external lotion 2.5 % PG
hydrocortisone external ointment 2.5 % PG
hydrocortisone valerate PG
ILUMYA NPS PA; ST; SP; QL
imiquimod external PG QL
IMPOYZ NC
JUBLIA NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201984
Drug Name Drug Status Drug Details
KENALOG EXTERNAL NP
ketoconazole external foam NC
KLARON NP
KLOFENSAID II NC
LDO PLUS NC
LEVULAN KERASTICK NP QL
lidocaine external ointment NP PA; QL
lidocaine external patch 5 % NP PA; ST; QL
lidocaine hcl external solution PG PA; QL
lidocaine pak NP PA; QL
lidocaine-prilocaine external cream PG PA; QL
lidocaine-tetracaine PG PA; QL
LIDODERM NP PA; ST; QL
lindane external shampoo PB
LOCOID EXTERNAL CREAM NP
LOCOID EXTERNAL LOTION NC
LOCOID LIPOCREAM NP
LOPROX EXTERNAL KIT 0.77 % NC
LOPROX EXTERNAL SHAMPOO NP
LOTRISONE EXTERNAL CREAM NP
luliconazole NC
LUXIQ NP
LUZU NC
malathion external PG
methoxsalen rapid PG
METROCREAM NP
METROGEL EXTERNAL GEL NP
METROLOTION NP
metronidazole external cream PG
metronidazole external gel 0.75 % PG
metronidazole external gel 1 % NP
metronidazole external lotion PG
MICORT-HC NC
MIRVASO NC
mometasone furoate external cream NP ST
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201985
Drug Name Drug Status Drug Details
mometasone furoate external ointment NP ST
mometasone furoate external solution PG
mupirocin calcium PG QL
mupirocin external PG QL
myorisan oral capsule 10 mg, 20 mg, 40 mg NP PA; QL
MYORISAN ORAL CAPSULE 30 MG NP PA; QL
naftifine hcl external cream 1 % NP
naftifine hcl external cream 2 % NC
NAFTIN EXTERNAL CREAM 2 % NC
NAFTIN EXTERNAL GEL 1 % NC
NAFTIN EXTERNAL GEL 2 % NC #
napro external NC
NATROBA NP
NEO-SYNALAR EXTERNAL CREAM NP
NEUAC EXTERNAL GEL NC
NOLIX EXTERNAL LOTION NP QL
NORITATE NP
nystatin external cream PG
nystatin external ointment PG
nystatin-triamcinolone PG
OLUX NP QL
OLUX-E NP QL
ONEXTON NC #
ORACEA NC
OVIDE NP
oxiconazole nitrate NC
OXISTAT NC
OXSORALEN ULTRA NP
PANDEL NP
PANRETIN PB
PENLAC NP PA; ST
PENNSAID TRANSDERMAL SOLUTION 2 %
NC
permethrin external cream PG
PICATO PB QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201986
Drug Name Drug Status Drug Details
PLEXION NC
PLEXION CLEANSER EXTERNAL LIQUID
NC
PLEXION CLEANSING CLOTH EXTERNAL PAD
NC
PLIAGLIS NP PA; QL
podofilox external PG
PRAMOSONE EXTERNAL CREAM 1-1 % NP
PRAMOSONE EXTERNAL LOTION NP
prednicarbate NP
PROTOPIC NC
PRUDOXIN NP QL
psorcon NP ST; QL
REGRANEX NP PA; QL
RETIN-A NP PA; ST; AL
RETIN-A MICRO NP PA; ST; AL
RETIN-A MICRO PUMP NP PA; ST; AL
RHOFADE NP QL
ROSADAN EXTERNAL CREAM PG
ROSADAN EXTERNAL GEL NP
ROSADAN EXTERNAL KIT NC
ROSANIL CLEANSER NC
rynoderm NC
SANTYL NP QL
selenium sulfide external lotion PG
selenium sulfide external shampoo 2.25 % NC
SELRX NC
SELSUN BLUE MEDICATED NC
SERNIVO NC
SILIQ NPS PA; ST; SP; QL
SILVADENE NP
silver sulfadiazine external PG
SOOLANTRA NP ST
SORIATANE ORAL CAPSULE 10 MG, 25 MG
NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201987
Drug Name Drug Status Drug Details
SORILUX NC
spinosad PG
sss 10-5 NC
STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5ML
PSP PA; SP; QL
STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
PSP PA; ST; SP; QL
sulfacetamide sodium-sulfur external cream NC
sulfacetamide sodium-sulfur external emulsion NC
sulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 %
NC
sulfacetamide sodium-sulfur external lotion NC
sulfacetamide sodium-sulfur external pad 10-4 % NC
sulfacetamide sodium-sulfur external suspension NC
sulfacetamide sod-sulfur wash external kit NC
sulfacleanse 8/4 NC
SULFAMYLON NP
SUMADAN NC
SUMADAN XLT NC
SUMAXIN NC
SUMAXIN CP NC
SUMAXIN TS NC
SYNALAR (CREAM) NC
SYNALAR (OINTMENT) NC
SYNALAR EXTERNAL CREAM NP ST
SYNALAR EXTERNAL OINTMENT NP ST
SYNALAR EXTERNAL SOLUTION NP
SYNALAR TS NC
SYNERA NP PA; QL
TACLONEX EXTERNAL OINTMENT NC
TACLONEX EXTERNAL SUSPENSION NP #; QL
tacrolimus external NP PA; ST
TALTZ NPS PA; ST; SP
TARGRETIN EXTERNAL PSP SP
tazarotene external PG PA; AL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201988
Drug Name Drug Status Drug Details
TAZORAC NP PA; ST; AL
TEMOVATE EXTERNAL CREAM NP ST; QL
TEMOVATE EXTERNAL OINTMENT NP ST; QL
TOLAK NC #
TOPICORT EXTERNAL CREAM NP ST
TOPICORT EXTERNAL GEL NP ST
TOPICORT EXTERNAL OINTMENT NP ST
TOPICORT SPRAY NC
TREMFYA PSP PA; ST; SP; QL
tretinoin external cream PG PA; AL
tretinoin external gel 0.01 %, 0.025 % PG PA; AL
tretinoin external gel 0.05 % NP PA
tretinoin microsphere PG PA; AL
tretinoin microsphere pump PG PA; AL
triamcinolone acetonide external aerosol solution
PG
triamcinolone acetonide external cream PG LGC
triamcinolone acetonide external ointment PG LGC
TRIDERM EXTERNAL CREAM PG
TRIDESILON NP ST
ULESFIA NP #; QL
ULTRAVATE EXTERNAL CREAM NP ST; QL
ULTRAVATE EXTERNAL LOTION NP QL
ULTRAVATE EXTERNAL OINTMENT NP ST; QL
ULTRAVATE X (CREAM) NC
ULTRAVATE X (OINTMENT) NC
UTOPIC NC
VALCHLOR NPS PA; SP; QL
VANOS NC
VANOXIDE-HC NP
VECTICAL NP
VELTIN NP PA; ST; AL
VENIPUNCTURE CPI NC
VERDESO NC
VEREGEN NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201989
Drug Name Drug Status Drug Details
VOLTAREN TRANSDERMAL PB QL
XELITRAL NC
XERESE NP
XOLEGEL NC
zenatane oral capsule 10 mg, 20 mg, 40 mg NP PA; QL
ZENATANE ORAL CAPSULE 30 MG NP PA; QL
ZIANA NP PA; ST; AL
ZONALON NP QL
ZOVIRAX EXTERNAL CREAM NP
ZOVIRAX EXTERNAL OINTMENT NC
ZYCLARA NC #
ZYCLARA PUMP EXTERNAL CREAM 2.5 %
NC
ZYCLARA PUMP EXTERNAL CREAM 3.75 %
NC #
*DIAGNOSTIC PRODUCTS*
ACCU-CHEK AVIVA PLUS IN VITRO NC
ACCU-CHEK COMPACT PLUS NC
ACCU-CHEK SMARTVIEW NC
ACCUTREND GLUCOSE NC
ADVANCE INTUITION TEST NC
ADVANCE MICRO-DRAW TEST NC
ADVOCATE REDI-CODE IN VITRO NC
ADVOCATE REDI-CODE+ TEST NC
ADVOCATE TEST NC
AGAMATRIX AMP TEST NC
AGAMATRIX JAZZ TEST NC
AGAMATRIX KEYNOTE TEST NC
AGAMATRIX PRESTO TEST NC
ASSURE 3 TEST NC
ASSURE 4 TEST NC
ASSURE II NC
ASSURE II CHECK NC
ASSURE PLATINUM NC
ASSURE PRISM MULTI TEST NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201990
Drug Name Drug Status Drug Details
ASSURE PRO TEST NC
BAYER BREEZE 2 TEST NC
BAYER CONTOUR TEST NC
BIOSCANNER GLUCOSE TEST NC
blood glucose test NC
CARESENS N GLUCOSE TEST NC
CLEVER CHEK AUTO-CODE TEST NC
CLEVER CHEK AUTO-CODE VOICE IN VITRO
NC
CLEVER CHEK TEST NC
CLEVER CHOICE AUTO-CODE TEST NC
CLEVER CHOICE MICRO TEST NC
COOL BLOOD GLUCOSE TEST STRIPS NC
CVS ADVANCED GLUCOSE TEST NC
diatrue plus test NC
DUO-CARE TEST NC
easy plus blood glucose test NC
EASY STEP TEST NC
easy talk blood glucose test NC
EASY TOUCH TEST NC
easy trak blood glucose test NC
EASYGLUCO IN VITRO NC
EASYGLUCO PLUS IN VITRO NC
EASYMAX 15 TEST NC
EASYMAX TEST NC
easyplus blood glucose test NC
EASYPRO BLOOD GLUCOSE TEST NC
EASYPRO PLUS IN VITRO NC
element compact test NC
ELEMENT TEST NC
EMBRACE BLOOD GLUCOSE TEST NC
EMBRACE EVO BLOOD GLUCOSE TEST NC
EMBRACE PRO GLUCOSE TEST NC
EVENCARE BLOOD GLUCOSE TEST NC
EVENCARE G2 TEST NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201991
Drug Name Drug Status Drug Details
EVENCARE G3 TEST NC
EVENCARE MINI GLUCOSE TEST NC
EVOLUTION AUTOCODE IN VITRO NC
EZ SMART BLOOD GLUCOSE TEST NC
EZ SMART PLUS GLUCOSE TEST NC
FIFTY50 GLUCOSE TEST 2.0 NC
FORA D15G BLOOD GLUCOSE TEST NC
FORA D20 BLOOD GLUCOSE TEST NC
FORA D40/G31 BLOOD GLUCOSE NC
FORA G20 BLOOD GLUCOSE TEST NC
FORA G30/PREM V10 GLUCOSE TEST NC
FORA GD20 TEST NC
FORA GD50 BLOOD GLUCOSE TEST NC
FORA TN'G/TN'G VOICE NC
FORA V10 BLOOD GLUCOSE TEST NC
FORA V12 BLOOD GLUCOSE TEST NC
FORA V20 BLOOD GLUCOSE TEST NC
FORA V30A BLOOD GLUCOSE TEST NC
FORACARE GD40 TEST NC
FORACARE PREMIUM V10 TEST NC
FORACARE TEST N GO TEST NC
FORTISCARE TEST NC
FREESTYLE INSULINX TEST PB QL
FREESTYLE LITE TEST PB QL
FREESTYLE PRECISION NEO TEST PB QL
FREESTYLE TEST PB QL
ge100 blood glucose test NC
GENSTRIP 50 NC
ght test NC
GLUCO PERFECT 3 TEST NC
GLUCOCARD 01 SENSOR PLUS NC
GLUCOCARD EXPRESSION TEST NC
GLUCOCARD SHINE TEST NC
GLUCOCARD VITAL TEST NC
GLUCOCARD X-SENSOR NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201992
Drug Name Drug Status Drug Details
GLUCOCOM TEST NC
GLUCONAVII BLOOD GLUCOSE TEST NC
IN TOUCH BLOOD GLUCOSE TEST NC
INFINITY BLOOD GLUCOSE TEST NC
kroger blood glucose test NC
kroger test NC
LIBERTY NEXT GENERATION TEST NC
liberty test NC
meijer blood glucose test NC
MEIJER TRUETEST TEST NC
MEIJER TRUETRACK TEST NC
MICRODOT TEST NC
MYGLUCOHEALTH TEST NC
NEUTEK 2TEK TEST NC
NOVA MAX GLUCOSE TEST NC
ON CALL EXPRESS BLOOD GLUCOSE NC
ON CALL PLUS BLOOD GLUCOSE NC
ON CALL VIVID BLOOD GLUCOSE NC
ONETOUCH ULTRA BLUE PB QL
ONETOUCH VERIO IN VITRO STRIP PB QL
POCKETCHEM EZ TEST NC
PRECISION PCX PB QL
PRECISION PCX PLUS TEST PB QL
PRECISION POINT OF CARE TEST PB QL
PRECISION QID TEST PB QL
PRECISION SOF-TACT TEST PB QL
PRECISION XTRA BLOOD GLUCOSE PB QL
PRODIGY NO CODING BLOOD GLUC NC
PTS PANELS GLUCOSE TEST NC
RA TRUETEST TEST NC
SMART SENSE VALUE TEST NC
SMARTEST BLOOD GLUCOSE TEST NC
SOLUS V2 TEST NC
SUPREME TEST NC
SURE EDGE TEST NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201993
Drug Name Drug Status Drug Details
SURECHEK BLOOD GLUCOSE TEST NC
SURE-TEST EASYPLUS MINI TEST NC
TELCARE BLOOD GLUCOSE TEST NC
THYROGEN PSP SP
TRUE METRIX BLOOD GLUCOSE TEST NC
TRUETEST TEST NC
TRUETRACK TEST NC
ULTIMA TEST NC
ULTRATRAK PRO TEST NC
ULTRATRAK ULTIMATE TEST NC
UNISTRIP1 GENERIC NC
VICTORY AGM-4000 TEST NC
VOCAL POINT BLOOD GLUCOSE TEST NC
*DIGESTIVE AIDS*
CREON PB
PANCREAZE NP ST
PERTZYE NP ST
SUCRAID NPS SP
VIOKACE NP ST
ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-14000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT
PB
*DIRECT-ACTING P2Y12 INHIBITORS***
BRILINTA PB QL
*DIURETICS*
acetazolamide er NC
acetazolamide oral PG
ALDACTAZIDE NP
ALDACTONE NP
amiloride hcl oral PG
amiloride-hydrochlorothiazide PG LGC
bumetanide oral PG
CAROSPIR NC
chlorothiazide oral PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201994
Drug Name Drug Status Drug Details
chlorthalidone oral tablet 25 mg, 50 mg PG
DEMADEX ORAL TABLET 10 MG, 20 MG NP
DIURIL NP
DYAZIDE NP
DYRENIUM NP
EDECRIN NP
ethacrynic acid oral NP
furosemide oral tablet PG LGC
hydrochlorothiazide oral capsule PG LGC
hydrochlorothiazide oral tablet 12.5 mg PG
hydrochlorothiazide oral tablet 25 mg, 50 mg PG LGC
indapamide oral PG
KEVEYIS NPS PA; QL
LASIX NP
MAXZIDE NP
MAXZIDE-25 NP
methazolamide oral PG
methyclothiazide oral NP
metolazone PG
MICROZIDE NP
spironolactone oral tablet 100 mg, 50 mg PG
spironolactone oral tablet 25 mg PG LGC
spironolactone-hctz PG
torsemide oral PG
triamterene-hctz oral capsule 37.5-25 mg PG LGC
triamterene-hctz oral tablet PG LGC
*ENDOCRINE AND METABOLIC AGENTS - MISC.*
ACTONEL ORAL TABLET 150 MG, 30 MG, 35 MG, 5 MG
NP ST; QL
ALDURAZYME NPS PA; SP
alendronate sodium oral solution PG
alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg
PG QL
alendronate sodium oral tablet 70 mg PG LGC; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201995
Drug Name Drug Status Drug Details
AMMONUL NPS SP
ATELVIA NP ST; QL
BINOSTO NC
BONIVA INTRAVENOUS NPS SP
BONIVA ORAL TABLET 150 MG NP ST; QL
BUPHENYL ORAL POWDER 3 GM/TSP NPS PA; SP
BUPHENYL ORAL TABLET NPS PA; SP; QL
cabergoline PG
calcitonin (salmon) PG QL
calcitriol oral capsule PG
CARBAGLU NPS PA; #; SP
CARNITOR ORAL SOLUTION NP
CARNITOR SF NP
CYSTADANE NPS PA; SP
DDAVP INJECTION SOLUTION 4 MCG/ML
NC
DDAVP NASAL NP
DDAVP ORAL NP
DDAVP RHINAL TUBE NP
desmopressin ace spray refrig PG
desmopressin acetate injection NC
desmopressin acetate oral PG
desmopressin acetate spray PG
doxercalciferol intravenous NC
doxercalciferol oral PG QL
ELAPRASE PSP PA; SP
etidronate disodium NP
EVISTA NP
FABRAZYME NPS PA; SP
FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML
NPS PA; ST; #; SP
FOSAMAX ORAL TABLET 70 MG NP QL
FOSAMAX PLUS D NP ST; #; QL
GALAFOLD NPS SP; QL
GENOTROPIN NPS PA; ST; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201996
Drug Name Drug Status Drug Details
GENOTROPIN MINIQUICK NPS PA; ST; SP
HECTOROL INTRAVENOUS NC
HP ACTHAR NPS PA; SP
HUMATROPE NPS PA; ST; SP
ibandronate sodium intravenous solution 3 mg/3ml
PG SP
ibandronate sodium oral NP ST; QL
INCRELEX PSP PA; SP
JYNARQUE PSP PA; SP
KUVAN NPS PA; SP
levocarnitine oral solution PG
LUMIZYME NPS PA; SP
LUPRON DEPOT-PED (1-MONTH) NPS PA; #; SP
LUPRON DEPOT-PED (3-MONTH) NPS PA; #; SP
MIACALCIN NASAL NP ST; QL
NAGLAZYME NPS PA; SP
NATPARA NPS PA; QL
NITYR NPS PA; SP
NOCTIVA PB QL; AL
NORDITROPIN FLEXPRO NPS PA; ST; SP
NUTROPIN AQ NUSPIN 10 NPS PA; ST; SP
NUTROPIN AQ NUSPIN 20 NPS PA; ST; SP
NUTROPIN AQ NUSPIN 5 NPS PA; ST; SP
octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml
PG PA; SP
OMNITROPE PSP PA; SP
ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG
NPS PA; SP
ORFADIN ORAL CAPSULE 20 MG NPS PA
ORFADIN ORAL SUSPENSION NPS PA; SP
ORILISSA NPS PA; SP; QL
OSPHENA NP QL
PALYNZIQ NPS PA; ST; SP; QL
pamidronate disodium PG SP
paricalcitol intravenous NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201997
Drug Name Drug Status Drug Details
paricalcitol oral PG QL
PROLIA NPS PA; ST; SP
raloxifene hcl PG
RAVICTI NPS PA; ST; SP; QL
RAYALDEE NP PA; ST; QL
RECLAST NPS SP
risedronate sodium oral tablet 150 mg NP ST; QL
risedronate sodium oral tablet 30 mg, 35 mg, 5 mg
NP QL
risedronate sodium oral tablet delayed release NP QL
ROCALTROL NP
SAIZEN NPS PA; ST; SP
SAMSCA PSP PA; #; SP; QL
SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML
NPS PA; SP
SANDOSTATIN LAR DEPOT NPS PA; #; SP
SENSIPAR NP PA; #; QL
SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG, 5 MG, 6 MG
NPS PA; SP
SIGNIFOR NPS PA; SP; QL
sod benz-sod phenylacet PG
sodium phenylbutyrate oral powder 3 gm/tsp PSP PA; SP
sodium phenylbutyrate oral tablet PSP PA; SP; QL
SOMATULINE DEPOT NPS PA; #; SP
SOMAVERT NPS PA; #; SP
STIMATE NP PA
SYNAREL NPS PA; SP
TRIPTODUR NPS PA; SP
TYMLOS PSP PA; ST; SP; QL
XGEVA NPS PA; ST; SP
ZEMPLAR INTRAVENOUS NC
ZEMPLAR ORAL CAPSULE 1 MCG, 2 MCG
NP ST; QL
zoledronic acid intravenous concentrate PG SP
zoledronic acid intravenous solution PG SP
ZOMACTON NPS PA; ST; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201998
Drug Name Drug Status Drug Details
ZOMETA NPS SP
ZORBTIVE NPS PA; SP
*ESTROGENS*
ACTIVELLA NP QL
ALORA NP QL
AMABELZ PG QL
ANGELIQ NP
CLIMARA NP QL
CLIMARA PRO NP #; QL
COMBIPATCH NP QL
DIVIGEL NP
ELESTRIN NP QL
ESTRACE ORAL NP
estradiol oral PG LGC
estradiol transdermal PG QL
estradiol valerate intramuscular oil 20 mg/ml PG
estradiol-norethindrone acet PG QL
ESTROGEL NP QL
EVAMIST NP QL
FEMHRT LOW DOSE NP
FYAVOLV PG
jevantique lo PG
JINTELI PG
MENEST ORAL TABLET 0.3 MG, 0.625 MG
PB
MENEST ORAL TABLET 1.25 MG NP
MENOSTAR NP #; QL
MIMVEY PG QL
MIMVEY LO PG QL
MINIVELLE NP #; QL
norethindrone-eth estradiol PG
PREFEST NP QL
PREMARIN ORAL PB
PREMPHASE PB
PREMPRO PB
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/201999
Drug Name Drug Status Drug Details
VIVELLE-DOT NP QL
*ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB***
DUAVEE PB QL
*FARNESOID X RECEPTOR (FXR) AGONISTS***
OCALIVA ORAL TABLET 5 MG NPS PA; ST; SP; QL
*FLUOROQUINOLONES*
AVELOX ORAL NP
BAXDELA ORAL NP PA; QL
CIPRO ORAL SUSPENSION RECONSTITUTED
NP
CIPRO ORAL TABLET 250 MG, 500 MG NP
CIPRO XR NP
ciprofloxacin hcl oral tablet 100 mg, 750 mg PG
ciprofloxacin hcl oral tablet 250 mg, 500 mg PG LGC
ciprofloxacin oral suspension reconstituted 500 mg/5ml (10%)
PG
ciprofloxacin-ciproflox hcl er PG
LEVAQUIN ORAL TABLET NP
levofloxacin oral PG
moxifloxacin hcl oral PG
ofloxacin oral tablet 300 mg PG QL
ofloxacin oral tablet 400 mg PG
*GASTROINTESTINAL AGENTS - MISC.*
ACTIGALL NP
alosetron hcl PG PA; ST
AMITIZA NP ST; QL
APRISO NP ST; #; QL
ASACOL HD NP ST; QL
AZULFIDINE NP ST; QL
AZULFIDINE EN-TABS NP ST; QL
balsalazide disodium PG QL
CANASA PB #; QL
CHENODAL NP PA
CIMZIA PREFILLED NPS PA; ST; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019100
Drug Name Drug Status Drug Details
CIMZIA STARTER KIT NPS PA; ST; SP; QL
CIMZIA SUBCUTANEOUS KIT 2 X 200 MG
NPS PA; ST; SP; QL
COLAZAL NP ST; QL
DELZICOL PB #; QL
DIPENTUM NP ST; QL
enulose PG LGC
FOSRENOL ORAL PACKET NP
FOSRENOL ORAL TABLET CHEWABLE 1000 MG, 500 MG, 750 MG
NP
GATTEX NPS PA; SP; QL
INFLECTRA PSP PA; ST; SP
lactulose encephalopathy PG LGC
lanthanum carbonate NP
LIALDA PB QL
LINZESS PB QL
LOTRONEX NP PA; ST
mesalamine oral PG QL
mesalamine rectal PG
metoclopramide hcl oral solution 5 mg/5ml PG LGC
metoclopramide hcl oral tablet 10 mg PG LGC
metoclopramide hcl oral tablet 5 mg PG
metoclopramide hcl oral tablet dispersible PG
MOVANTIK PB QL
PENTASA PB QL
PHOSLO NP
REGLAN ORAL NP
RELISTOR ORAL NP PA; #; QL
RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML, 8 MG/0.4ML
NP PA; QL
REMICADE PSP PA; ST; SP
RENAGEL ORAL TABLET 800 MG NP #
RENFLEXIS PSP PA; ST; SP
RENVELA PB
sevelamer carbonate PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019101
Drug Name Drug Status Drug Details
SFROWASA NP
sulfasalazine oral PG QL
SULFAZINE PG QL
SYMPROIC NP PA; ST; QL
URSO 250 NP
URSO FORTE NP
ursodiol oral capsule PG
ursodiol oral tablet NP
VELPHORO NP #
*GENITOURINARY AGENTS - MISCELLANEOUS*
acetic acid irrigation PG
alfuzosin hcl er PG QL
AVODART NP ST; QL
CARDURA XL NP QL
CYSTAGON NP PA
cytra-2 NC
CYTRA-3 PG
cytra-k PG
dutasteride oral PG QL
dutasteride-tamsulosin hcl PG
ELMIRON PB QL
finasteride oral tablet 5 mg PG PA
FLOMAX NP
JALYN NP
potassium citrate er PG
PROCYSBI NPS PA; ST; SP; QL
PROSCAR NP PA; ST
PYRIDIUM ORAL TABLET 100 MG NP
RAPAFLO PB #
SHOHLS MODIFIED NC
sod citrate-citric acid NC
tamsulosin hcl PG LGC
THIOLA NPS PA; ST
tricitrates PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019102
Drug Name Drug Status Drug Details
UROCIT-K 10 NP
UROCIT-K 15 NP
UROCIT-K 5 NP
UROXATRAL NP QL
*GOUT AGENTS*
allopurinol oral PG LGC
colchicine oral PG QL
colchicine-probenecid PG
COLCRYS NC
DUZALLO NP PA; ST; QL
KRYSTEXXA NPS PA; ST; SP
MITIGARE NP QL
probenecid oral PG
ULORIC NP ST; QL
ZURAMPIC NP PA; ST; QL
ZYLOPRIM NP
*HEMATOLOGICAL AGENTS - MISC.*
ADVATE PSP PA; SP
adynovate intravenous solution reconstituted1000 unit, 2000 unit, 250 unit, 500 unit
NPS PA
adynovate intravenous solution reconstituted1500 unit, 3000 unit, 750 unit
NPS PA; SP
AFSTYLA NPS PA; SP
AGGRENOX NP
AGRYLIN NP
ALPHANATE/VWF COMPLEX/HUMAN NPS PA; SP
ALPHANINE SD NPS PA; SP
ALPROLIX NPS PA; SP
anagrelide hcl PG
aspirin-dipyridamole er PG
BEBULIN NPS PA; SP
BENEFIX INTRAVENOUS KIT PSP PA; SP
BERINERT NPS PA; ST; SP
BRILINTA PB QL
cilostazol PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019103
Drug Name Drug Status Drug Details
CINRYZE NPS PA; ST; SP; QL
clopidogrel bisulfate oral PG QL
COAGADEX NPS PA
CORIFACT NPS PA; SP
dipyridamole oral PG
DURLAZA NP
EFFIENT NP PA; QL
ELOCTATE NPS PA; SP
FEIBA PSP PA; SP
FIBRYGA PSP PA; SP
FIRAZYR NPS PA; ST; #; SP; QL
HAEGARDA PSP PA; ST; SP; QL
HELIXATE FS NPS PA; SP
HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1700 UNIT, 250 UNIT, 500 UNIT
NPS PA; SP
HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 500-1200 UNIT
NPS PA; SP
IDELVION NPS PA; SP
IXINITY NPS PA; SP
KALBITOR NPS PA; ST; SP
KCENTRA NPS PA
KOATE NPS PA; SP
KOATE-DVI NPS PA; SP
KOGENATE FS NPS PA; SP
KOGENATE FS BIO-SET INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 3000 UNIT
NPS PA; SP
KOVALTRY NPS PA; SP
MONOCLATE-P INTRAVENOUS KIT 1000 UNIT, 1500 UNIT
PSP PA; SP
MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT
PSP PA; SP
NOVOEIGHT NPS PA; SP
NOVOSEVEN RT PSP PA; SP
NUWIQ NPS PA; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019104
Drug Name Drug Status Drug Details
pentoxifylline er PG
PLAVIX NP QL
prasugrel hcl NP PA; QL
PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT
NPS PA; SP
PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT
NPS PA
PROFILNINE SD NPS PA; SP
REBINYN NPS PA; SP
RECOMBINATE NPS PA; SP
RIASTAP PSP PA; SP
RIXUBIS NPS PA; SP
RUCONEST NPS PA; SP
TRETTEN NPS PA; SP
VONVENDI NPS PA
WILATE INTRAVENOUS KIT NPS PA; SP
XYNTHA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 500 UNIT
NPS PA; SP
XYNTHA SOLOFUSE NPS PA; SP
YOSPRALA NC
*HEMATOPOIETIC AGENTS*
ABANEU-SL NC
active fe NC
AIRAVITE NC
ANIMI-3 NC
ANIMI-3/VITAMIN D NC
ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML
PSP PA; SP
ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 500 MCG/ML, 60 MCG/0.3ML
PSP PA; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019105
Drug Name Drug Status Drug Details
av-vite fb NC
b-6 folic acid NC
BIFERARX NC
bp vit 3 NC
CENFOL NC
CENTRATEX NC
CERDELGA PSP PA; SP; QL
CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT
PSP PA; SP
CIFEREX NC
CORVITA 150 NC
CORVITE 150 ORAL TABLET 150-1.25 MG NC
cyanocobalamin injection PG
DIVISTA NC
DOPTELET ORAL TABLET 20 MG NPS PA; SP; QL
durachol NC
ELELYSO NPS PA; SP
EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML
NPS PA; ST; SP
fabb NC
fa-vitamin b-6-vitamin b-12 NC
FERIVA 21/7 NC
ferocon NC
ferotrinsic NC
ferraplus 90 NC
FERRLECIT NPS SP
FERROCITE PLUS ORAL TABLET NC
FERRO-PLEX HEMATINIC NC
FERROTRIN NC
folbee NC
FOLGARD RX NC
folic acid oral capsule 20 mg PG
folic acid oral tablet 1 mg CE LGC
folic acid oral tablet 400 mcg PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019106
Drug Name Drug Status Drug Details
FOLIVANE-F NC
FOLIVANE-PLUS NC
folplex 2.2 NC
foltrin NC
FULPHILA PSP PA; SP
FUSION PLUS NC
gnp folic acid PG
GRANIX NPS PA; ST; SP
hematinic plus vit/minerals NC
hematinic/folic acid NC
HEMATOGEN FA NC
HEMATOGEN FORTE NC
hemetab NC
HEMOCYTE PLUS NC
HEMOCYTE-F ORAL TABLET NC
hemocyte-plus oral tablet 106-1 mg NC
hm folic acid PG
INTEGRA F NC
INTEGRA PLUS NC
IROSPAN 24/6 NC
IS 24/6 NC
kp folic acid oral tablet 800 mcg CE
K-TAN PLUS NC
LEUKINE INTRAVENOUS NPS PA; SP
MAXFE ORAL TABLET NC
miglustat PSP PA; SP; QL
MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.3ML, 200 MCG/0.3ML, 50 MCG/0.3ML, 75 MCG/0.3ML
NPS PA
MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 30 MCG/0.3ML
NPS PA; SP
MOZOBIL NC
MULPLETA NPS PA; SP; QL
MULTIGEN NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019107
Drug Name Drug Status Drug Details
MULTIGEN FOLIC NC
MULTIGEN PLUS NC
na ferric gluc cplx in sucrose PSP
NASCOBAL NC
NEPHRON FA NC
NEULASTA ONPRO NPS PA; ST; SP
NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP
NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML
NPS PA; ST; SP
NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE
NPS PA; ST
neurin-sl NC
NPLATE NPS PA; SP
NUFOL NC
ortho d NC
PROCRIT NPS PA; ST; SP
PROFERRIN-FORTE NC
PROMACTA NPS PA; SP; QL
PROTECTIRON NC
purefe plus NC
purevit dualfe plus NC
px folic acid PG
ra folic acid oral tablet 400 mcg PG
RETACRIT PSP PA; SP
revesta NC
se-tan plus NC
SIKLOS NP PA
sm folic acid PG
TANDEM F NC
TANDEM PLUS NC
taron forte NC
tl gard rx NC
tl icon NC
TRICON NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019108
Drug Name Drug Status Drug Details
trigels-f forte NC
VENOFER NPS SP
VIRT-GARD NC
VPRIV PSP PA; SP
ZARXIO PSP PA
zavara NC
ZAVESCA NPS PA; #; SP; QL
*HEMOSTATICS*
AMICAR ORAL SOLUTION NP
AMICAR ORAL TABLET PB
LYSTEDA NP QL
tranexamic acid oral NP QL
*HEPATITIS C AGENT - COMBINATIONS***
EPCLUSA PSP PA; SP; QL
HARVONI PSP PA; SP
MAVYRET PSP PA; ST; SP; QL
TECHNIVIE NPS PA; ST; QL
VIEKIRA PAK NPS PA; ST; SP
VIEKIRA XR NPS PA; ST; QL
VOSEVI PSP PA; SP; QL
ZEPATIER NPS PA; SP; QL
*HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS**
XURIDEN PSP PA; SP; QL
*HYPNOTICS*
AMBIEN NP ST; QL; AL
AMBIEN CR NP ST; QL; AL
BUTISOL SODIUM ORAL TABLET 30 MG NP
DORAL NP
EDLUAR NC AL
estazolam PG AL
eszopiclone PG QL; AL
flurazepam hcl oral capsule 15 mg PG
flurazepam hcl oral capsule 30 mg PG AL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019109
Drug Name Drug Status Drug Details
HALCION NP AL
HETLIOZ NPS PA; SP
INTERMEZZO NC AL
LUNESTA NP ST; QL; AL
phenobarbital oral PG
quazepam NP
RESTORIL ORAL CAPSULE 15 MG, 30 MG
NP AL
RESTORIL ORAL CAPSULE 22.5 MG, 7.5 MG
NP QL; AL
ROZEREM NP ST; #; QL; AL
SILENOR NC #; SP
SONATA NP ST; QL
temazepam oral capsule 15 mg, 30 mg PG AL
temazepam oral capsule 22.5 mg, 7.5 mg NP QL; AL
triazolam PG AL
zolpidem tartrate er NP QL; AL
zolpidem tartrate oral PG QL; AL
zolpidem tartrate sublingual NC
ZOLPIMIST NC #
*HYPOPHOSPHATASIA (HPP) AGENTS***
STRENSIQ NPS PA; SP
*IBS AGENT - MU-OPIOID RECEPTOR AGONISTS***
VIBERZI PB PA; QL
*INSULIN-INCRETIN MIMETIC COMBINATIONS***
SOLIQUA PB ST; QL
XULTOPHY PB ST; QL
*INTEGRIN RECEPTOR ANTAGONISTS***
ENTYVIO PSP PA; ST; SP
*INTERLEUKIN ANTAGONISTS***
STELARA INTRAVENOUS PSP PA; ST; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019110
Drug Name Drug Status Drug Details
*INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)***
NUCALA NPS PA; SP; QL
*INTERLEUKIN-5 ANTAGONISTS (IGG4 KAPPA)***
CINQAIR NPS PA; SP
*ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS***
TIBSOVO NPS PA; SP; QL
*ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS***
IDHIFA NPS PA; SP; QL
*LAXATIVES*
CLENPIQ CE
COLYTE WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED 240 GM
NP QL
gavilax oral packet CE
GAVILYTE-H CE
GOLYTELY NP
KRISTALOSE NP QL
lactulose oral solution 10 gm/15ml PG LGC
lactulose oral solution 20 gm/30ml PG
MIRALAX CE
MOVIPREP CE #
NULYTELY WITH FLAVOR PACKS NP
OSMOPREP CE #
peg 3350 CE
peg 3350/electrolytes CE
peg 3350-kcl-na bicarb-nacl CE
peg-3350/electrolytes CE
PEG-PREP CE
PLENVU CE
polyethylene glycol 3350 oral CE
PREPOPIK CE #
SUPREP BOWEL PREP KIT CE
TRILYTE CE
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019111
Drug Name Drug Status Drug Details
*LEPTIN ANALOGUES***
MYALEPT PSP PA; SP; QL
*LHRH/GNRH AGONIST ANALOG COMBINATIONS***
LUPANETA PACK NPS PA; SP
*LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG***
XIIDRA PB
*LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS***
KANUMA PSP PA; SP
*MACROLIDES*
azithromycin oral packet PG
azithromycin oral suspension reconstituted PG
azithromycin oral tablet 250 mg, 500 mg, 600 mg
PG
BIAXIN ORAL TABLET 500 MG NP
clarithromycin er PG
clarithromycin oral PG
DIFICID NP QL
E.E.S. 400 ORAL TABLET NP
E.E.S. GRANULES NP
ERYPED 200 NP
ERYPED 400 NP
ERY-TAB NP
ERYTHROCIN STEARATE ORAL TABLET 250 MG
NP
erythromycin base oral tablet PG
erythromycin ethylsuccinate oral tablet PG
erythromycin stearate oral tablet 250 mg PG
ZITHROMAX ORAL NP
ZITHROMAX TRI-PAK NP
ZITHROMAX Z-PAK NP
*MEDICAL DEVICES*
ACCU-CHEK FASTCLIX LANCETS NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019112
Drug Name Drug Status Drug Details
ACCU-CHEK MULTICLIX LANCETS NP
ACCU-CHEK SOFT TOUCH LANCETS NP
ACCU-CHEK SOFTCLIX LANCETS NP
ACTIVE 1ST BLOOD LANCETS 30G NP
ASSURE LANCETS NP
BAYER MICROLET LANCETS NP
BD AUTOSHIELD 29G X 5MM , 29G X 8MM
PB
BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27.5G X 5/8" 2 ML, 27G X 1/2" 1 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.5 ML, 31G X 5/16" 0.3 ML, U-100 1 ML
PB
BD INSULIN SYRINGE HALF-UNIT PB
BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML
PB
BD INSULIN SYRINGE U-500 PB
BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML
PB
BD LANCET ULTRAFINE 30G NP
BD LANCET ULTRAFINE 33G NP
BD MICROTAINER LANCETS NP
BD PEN PB
BD PEN MINI PB
BD PEN NEEDLE MINI U/F PB
BD PEN NEEDLE NANO U/F PB
BD PEN NEEDLE SHORT U/F PB
BD PEN NEEDLE ULTRAFINE PB
BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 ML, 30G X 5/16" 0.5 ML
PB
BD SAFETY-LOK INSULIN SYRINGE PB
bullseye mini safety lancets NP
BULLSEYE SAFETY LANCETS NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019113
Drug Name Drug Status Drug Details
COAGUCHEK LANCETS NP
comfort assured lancets 28g NP
comfort assured lancets 33g NP
EASY TOUCH LANCETS 21G NP
EASY TOUCH LANCETS 23G NP
EASY TOUCH LANCETS 26G NP
EASY TOUCH LANCETS 26G/TWIST NP
EASY TOUCH LANCETS 28G NP
EASY TOUCH LANCETS 28G/TWIST NP
EASY TOUCH LANCETS 30G NP
EASY TOUCH LANCETS 30G/TWIST NP
EASY TOUCH LANCETS 32G NP
EASY TOUCH LANCETS 32G/TWIST NP
EASY TOUCH LANCETS 33G/TWIST NP
EASY TOUCH LANCING DEVICE NP
EASY TOUCH SAFETY LANCETS 21G NP
EASY TOUCH SAFETY LANCETS 23G NP
EASY TOUCH SAFETY LANCETS 26G NP
EASY TOUCH SAFETY LANCETS 28G NP
EASY TWIST & CAP LANCETS NP
FC2 FEMALE CONDOM CE
FEMCAP CE
FINGERSTIX LANCETS NP
FREESTYLE LANCETS NP
FREESTYLE UNISTICK II LANCETS NP
insulin syringe PG
insulin syringe/needle PG
insulin syringe-needle u-100 31g x 1/4" 0.3 ml, 31g x 1/4" 0.5 ml, 31g x 1/4" 1 ml
PG
lancets PG
lancets super thin 28g NP
LANCETS ULTRA THIN NP
lancets ultra thin 30g NP
LIFESCAN UNISTIK 2 NP
LIFESCAN UNISTIK II LANCETS NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019114
Drug Name Drug Status Drug Details
lite touch lancets NP
LITETOUCH LANCETS NP
MICROLET LANCETS NP
MICROTAINER SAFETY FLOW LANCET NP
ONETOUCH CLUB LANCETS FINE PT NP
ONETOUCH COMBO PACK NP
ONETOUCH DELICA LANCETS 33G NP
ONETOUCH DELICA LANCETS FINE NP
ONETOUCH DELICA LANCING DEV NP
ONETOUCH FINEPOINT LANCETS NP
ONETOUCH ULTRASOFT LANCETS NP
pen needles PG
pen needles 1/2" PG
pen needles 3/16" PG
pen needles 5/16" PG
SAFETY LET LANCETS NP
SAFETY-GLIDE SYRINGE PB
sapscare twist top lancets NP
SIMPLE DIAGNOSTICS LANCING DEV NP
super thin lancets NP
TRUEPLUS LANCETS 26G NP
TRUEPLUS LANCETS 30G NP
TRUEPLUS SAFETY LANCETS 28G NP
VANISHPOINT INSULIN SYRINGE 30G X 3/16" 0.5 ML, 30G X 3/16" 1 ML
NP
WIDE-SEAL DIAPHRAGM 60 CE
WIDE-SEAL DIAPHRAGM 65 CE
WIDE-SEAL DIAPHRAGM 70 CE
WIDE-SEAL DIAPHRAGM 75 CE
WIDE-SEAL DIAPHRAGM 80 CE
WIDE-SEAL DIAPHRAGM 85 CE
WIDE-SEAL DIAPHRAGM 90 CE
WIDE-SEAL DIAPHRAGM 95 CE
*MIGRAINE PRODUCTS*
almotriptan malate NP QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019115
Drug Name Drug Status Drug Details
AMERGE NP QL
CAFERGOT PB
CAMBIA NC
D.H.E. 45 NP
dihydroergotamine mesylate injection NP
dihydroergotamine mesylate nasal NP ST; QL
eletriptan hydrobromide NP QL
ERGOMAR NP
FROVA NP ST; QL
frovatriptan succinate NP QL
IMITREX NP QL
IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE
NP QL
IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR
NP QL
MAXALT ORAL TABLET 10 MG NP QL
MAXALT-MLT NP QL
MIGRANAL NC
naratriptan hcl PG QL
ONZETRA XSAIL NP ST; QL
RELPAX NP ST; QL
rizatriptan benzoate PG QL
sumatriptan nasal PG QL
sumatriptan succinate oral PG QL
sumatriptan succinate refill subcutaneous solution cartridge
PG QL
sumatriptan succinate subcutaneous solution 6 mg/0.5ml
PG QL
sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml
PG QL
sumatriptan-naproxen sodium NC
TREXIMET ORAL TABLET 10-60 MG NC #
TREXIMET ORAL TABLET 85-500 MG NC
ZEMBRACE SYMTOUCH NP ST; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019116
Drug Name Drug Status Drug Details
zolmitriptan oral PG QL
ZOMIG NASAL NP ST; QL
ZOMIG ORAL NP QL
ZOMIG ZMT NP QL
*MINERALS & ELECTROLYTES*
FLUORABON CE
FLURA-DROPS ORAL SOLUTION 0.55 (0.25 F) MG/DROP
CE
GALZIN NP
iodine strong oral PG
KLOR-CON 10 PG
KLOR-CON ORAL PACKET 20 MEQ NP QL
K-PHOS-NEUTRAL NP
K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ
NP
potassium chloride crys er oral tablet extended release 10 meq
PG LGC
potassium chloride er oral capsule extended release 10 meq
PG LGC
potassium chloride er oral capsule extended release 8 meq
PG
potassium chloride er oral tablet extended release 10 meq, 20 meq
PG
potassium chloride er oral tablet extended release 8 meq
PG LGC
potassium chloride oral packet NP QL
potassium chloride oral solution 20 meq/15ml (10%)
PG
potassium chloride oral solution 40 meq/15ml (20%)
NP
sodium fluoride oral solution CE
sodium fluoride oral tablet PG
sodium fluoride oral tablet chewable PG
*MIXED ALLERGENIC EXTRACTS***
ODACTRA NP PA; ST; QL
ORALAIR NP PA; ST; QL
ORALAIR ADULT SAMPLE KIT NP PA; ST; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019117
Drug Name Drug Status Drug Details
ORALAIR ADULT STARTER PACK NP PA; ST; QL
ORALAIR CHILDRENS SAMPLE KIT NP PA; ST; QL
ORALAIR CHILDRENS STARTER PACK NP PA; ST; QL
*MONOBACTAMS***
AZACTAM NC
aztreonam NC
CAYSTON NPS SP; QL
*MOUTH/THROAT/DENTAL AGENTS*
cevimeline hcl PG QL
chlorhexidine gluconate mouth/throat PG
clotrimazole mouth/throat PG
DENTA 5000 PLUS CE
EVOXAC PG QL
GELCLAIR NC
lidocaine viscous PG
NAFRINSE DAILY ACIDULATED CE
NAFRINSE DAILY/NEUTRAL CE
NAFRINSE WEEKLY CE
NEUTRASAL NC
nystatin mouth/throat PG
ORAVIG NP QL
paroex PG
periogard PG
PREVIDENT 5000 PLUS CE
SALAGEN NP
sf 5000 plus CE
triamcinolone acetonide mouth/throat PG
*MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS***
VIMIZIM PSP PA; SP
*MULTIPLE VITAMINS W/ MINERALS & FLUORIDE-IRON-FOLIC ACID***
QUFLORA FE NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019118
Drug Name Drug Status Drug Details
*MULTIVITAMINS*
CITRANATAL 90 DHA ORAL 90-1 & 300 MG
NP
CITRANATAL B-CALM NP
CITRANATAL DHA NP
CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG
NP
CITRANATAL MEDLEY NP
CITRANATAL RX NP
CORVITA PG
hemenatal ob NP
multivitamin/fluoride oral tablet chewable 0.5 mg, 1 mg
NP
MYNATAL ADVANCE PG
MYNATAL ORAL TABLET PG
mynatal plus PG
mynatal-z PG
NEEVO DHA ORAL CAPSULE 27-1.13 MG NP
NEPHPLEX RX NP
NESTABS NP
NICOMIDE ORAL TABLET 750-27-2-0.5 MG
NP
OB COMPLETE GOLD NP
O-CAL PRENATAL NP
OCUVEL ORAL CAPSULE 0.5 MG NP
pnv-omega NP
POLY-VI-FLOR FS ORAL STRIP 1 MG CE
POLY-VI-FLOR ORAL TABLET CHEWABLE
PB
PREFERAOB ONE NP
PRENATABS RX NP
prenatal plus iron NP
PRENATE MINI ORAL CAPSULE 18-0.6-0.4-350 MG
NP QL
QUFLORA FE PEDIATRIC NP
QUFLORA PEDIATRIC NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019119
Drug Name Drug Status Drug Details
SYNAGEX NC
SYNATEK NC
TARON-C DHA NP
TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 MG
NP
TRINATE PG
TRIVEEN-DUO DHA NP
TRI-VI-FLOR ORAL SUSPENSION 0.25 MG/ML
PB
TRI-VI-FLOR ORAL SUSPENSION 0.5 MG/ML
NP
VINATE DHA RF NP
virt-pn dha NP
VITAFOL FE+ NP
VITAFOL GUMMIES NP
VITAPEARL NP
VITATRUE NP
VIVA DHA NP
vol-tab rx NP
ZATEAN-PN DHA NP
ZATEAN-PN PLUS NP
*MUSCULOSKELETAL THERAPY AGENTS*
AMRIX NC #
baclofen oral tablet 10 mg PG LGC
baclofen oral tablet 20 mg, 5 mg PG
carisoprodol oral tablet 250 mg NC
carisoprodol oral tablet 350 mg PG
carisoprodol-aspirin NP
carisoprodol-aspirin-codeine NP
chlorzoxazone oral tablet 250 mg NC
chlorzoxazone oral tablet 500 mg PG
cyclobenzaprine hcl oral tablet 10 mg, 5 mg PG LGC
cyclobenzaprine hcl oral tablet 7.5 mg PG
DANTRIUM ORAL CAPSULE 25 MG, 50 MG
NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019120
Drug Name Drug Status Drug Details
dantrolene sodium oral PG
DUROLANE INTRA-ARTICULAR NPS PA; ST; SP
EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE
PSP PA; SP
GEL-ONE INTRA-ARTICULAR PREFILLED SYRINGE
NPS PA; ST; SP
GELSYN-3 NPS PA; ST
HYALGAN NPS PA; ST; SP
HYMOVIS NPS PA; ST; SP
LORZONE NC
metaxalone NP
methocarbamol oral PG
MONOVISC PSP PA; SP
orphenadrine citrate er PG
ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE
PSP PA; SP
ROBAXIN ORAL NP
SKELAXIN NP
SOMA NC
SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP
SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE
NPS PA; ST; SP
TIZANIDINE COMFORT PAC NC
tizanidine hcl oral capsule NC
tizanidine hcl oral tablet PG
ZANAFLEX NC
*NASAL AGENTS - SYSTEMIC AND TOPICAL*
ADRENALIN NASAL PB
ASTEPRO NASAL SOLUTION 0.15 % NP
azelastine hcl nasal solution 0.1 % PG
azelastine hcl nasal solution 0.15 % NP
BACTROBAN NASAL PB SP
BECONASE AQ NP ST
budesonide nasal NP Select OTC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019121
Drug Name Drug Status Drug Details
DYMISTA NC
FLONASE NC
FLONASE ALLERGY RELIEF PG Select OTC
flunisolide nasal solution 25 mcg/act (0.025%) PG
fluticasone propionate nasal PG Select OTC
ipratropium bromide nasal PG QL
mometasone furoate nasal PG
NASACORT ALLERGY 24HR PG Select OTC; QL
NASACORT ALLERGY 24HR CHILDREN PG Select OTC; QL
nasal allergy 24 hour PG Select OTC; QL
NASONEX NP ST
olopatadine hcl nasal NP
OMNARIS NP ST; #
PATANASE NP
QNASL NP ST
QNASL CHILDRENS NP ST
RHINOCORT ALLERGY PG Select OTC
triamcinolone acetonide nasal aerosol PG Select OTC; QL
XHANCE NC
ZETONNA NP ST
*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***
ENTRESTO PB PA; QL
*NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS***
NORTHERA NPS PA; ST; SP; QL
*NEUROMUSCULAR AGENTS*
BOTOX PSP PA; ST; SP
DYSPORT NPS PA; SP
RILUTEK NP PA
riluzole PG PA
XEOMIN NPS PA; SP
*OPHTHALMIC AGENTS*
ACULAR NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019122
Drug Name Drug Status Drug Details
ACULAR LS NP
ACUVAIL NP
AKTEN NC
ALAWAY PG Select OTC
ALAWAY CHILDRENS ALLERGY PG Select OTC
allergy eye drops PG Select OTC
ALOCRIL NP
ALOMIDE NP
ALPHAGAN P NP
ALREX PB
apraclonidine hcl PG
atropine sulfate ophthalmic PG
AZASITE NP #
azelastine hcl ophthalmic PG
AZOPT PB
bacitracin ophthalmic PG
bacitracin-polymyxin b ophthalmic ointment500-10000 unit/gm
PG
BEPREVE NP #
BESIVANCE NP
BETAGAN NP
betaxolol hcl ophthalmic PG
BETIMOL NP
BETOPTIC-S NP
bimatoprost ophthalmic NP PA; ST
BLEPH-10 NP
BLEPHAMIDE NP
BLEPHAMIDE S.O.P. NP
brimonidine tartrate ophthalmic solution 0.15 % NP
brimonidine tartrate ophthalmic solution 0.2 % PG
bromfenac sodium (once-daily) NP
BROMSITE NP
carteolol hcl PG
CILOXAN NP
CLARITIN EYE PG Select OTC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019123
Drug Name Drug Status Drug Details
COMBIGAN PB
COSOPT NP
COSOPT PF NC #
cromolyn sodium ophthalmic PG
CYCLOGYL NP
CYCLOMYDRIL NP
cyclopentolate hcl ophthalmic PG
CYSTARAN NPS PA; #; SP; QL
dexamethasone sodium phosphate ophthalmic PG
diclofenac sodium ophthalmic PG
dorzolamide hcl ophthalmic PG
dorzolamide hcl-timolol mal PG
dorzolamide hcl-timolol mal pf PG
DUREZOL PB #
ELESTAT NP
EMADINE NP
epinastine hcl PG
erythromycin ophthalmic PG
eye itch relief PG Select OTC
EYLEA INTRAVITREAL NPS PA; SP
FLAREX NP
flucaine NC
fluorometholone ophthalmic PG
flurbiprofen sodium PG
FML PB
FML FORTE NP
FML LIQUIFILM NP
gatifloxacin ophthalmic NP
GENTAK OPHTHALMIC OINTMENT NP
gentamicin sulfate ophthalmic solution PG
ILEVRO NP
IOPIDINE NP
ISOPTO CARPINE NP
ISTALOL NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019124
Drug Name Drug Status Drug Details
JETREA INTRAVITREAL SOLUTION 0.375 MG/0.3ML
NPS PA; SP
ketorolac tromethamine ophthalmic NP
ketotifen fumarate ophthalmic PG Select OTC
LACRISERT NP
LASTACAFT NP
latanoprost ophthalmic PG
levobunolol hcl ophthalmic solution 0.5 % PG
levofloxacin ophthalmic PG
LOTEMAX OPHTHALMIC GEL PB #
LOTEMAX OPHTHALMIC OINTMENT PB
LOTEMAX OPHTHALMIC SUSPENSION PB
LUCENTIS INTRAVITREAL SOLUTION PREFILLED SYRINGE
NPS PA; SP
LUMIGAN OPHTHALMIC SOLUTION 0.01 %
NP PA; ST
MACUGEN NPS PA; SP
MAXIDEX NP
MAXITROL NP
metipranolol PG
MOXEZA NP #
moxifloxacin hcl ophthalmic PG
MYDRIACYL NP
NATACYN NP
neomycin-polymyxin-dexameth ophthalmic ointment
PG
neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1
PG
NEOSPORIN NP
NEVANAC NP
OCUFLOX NP
ofloxacin ophthalmic PG
olopatadine hcl ophthalmic PG
OMNIPRED NP
PATADAY NP
PATANOL NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019125
Drug Name Drug Status Drug Details
PAZEO NP
PHOSPHOLINE IODIDE PB
pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 %
PG
polymyxin b-trimethoprim PG
POLYTRIM NP
PRED FORTE NP
PRED MILD NP
PRED-G NP
PRED-G S.O.P. NP
prednisolone acetate ophthalmic PG
prednisolone sodium phosphate ophthalmic PG
PROLENSA NP
proparacaine-fluorescein NC
RESTASIS PB #
RESTASIS MULTIDOSE PB #
SIMBRINZA NP
sulfacetamide sodium ophthalmic PG
sulfacetamide-prednisolone ophthalmic solution PG
sulfacetamide-prednisolone ophthalmic suspension
PB
TETRAVISC PG
timolol maleate ophthalmic gel forming solution PG
timolol maleate ophthalmic solution 0.25 %, 0.5 %
PG
timolol maleate ophthalmic solution 0.5 % (daily)
NP
TIMOPTIC NP
TIMOPTIC OCUDOSE NP
TIMOPTIC-XE OPHTHALMIC GEL FORMING SOLUTION 0.5 %
NP
TOBRADEX NP
TOBRADEX ST NP
TOBREX NP
TRAVATAN Z PB #
trifluridine ophthalmic PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019126
Drug Name Drug Status Drug Details
tropicamide ophthalmic NP
TRUSOPT NP
VIGAMOX NP
VIROPTIC NP
VISUDYNE NPS PA; #; SP
VYZULTA NP PA; ST
XALATAN NP PA; ST
ZADITOR PG Select OTC
ZIOPTAN NP PA; ST
ZIRGAN NP #
ZYLET NP
ZYMAXID NP
*OPHTHALMIC RHO KINASE INHIBITORS***
RHOPRESSA NP ST
*OREXIN RECEPTOR ANTAGONISTS***
BELSOMRA NP ST; QL; AL
*OTIC AGENTS*
ACETASOL HC PG
acetic acid otic PG
CETRAXAL NP
CIPRO HC NP #
CIPRODEX PB #
ciprofloxacin hcl otic NP
COLY-MYCIN S NP
CORTANE-B AQUEOUS NC
CORTANE-B OTIC NC
cortic-nd NC
cyotic NC
DERMOTIC NP
exotic-hc NC
FLOXIN OTIC NP
fluocinolone acetonide otic NP
hydrocortisone-acetic acid PG
neomycin-polymyxin-hc otic solution 1 % PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019127
Drug Name Drug Status Drug Details
neomycin-polymyxin-hc otic suspension PG
ofloxacin otic PG
OTICIN HC NR NC
OTIPRIO NP
otomax-hc NC
OTOVEL NP
*OXABOROLE-RELATED ANTIFUNGALS - TOPICAL***
KERYDIN NP PA; ST
*OXYTOCICS*
CERVIDIL NP
METHERGINE ORAL PG QL
PREPIDIL NP
*PASSIVE IMMUNIZING AGENTS - COMBINATIONS***
HYQVIA NPS PA; ST; SP
*PASSIVE IMMUNIZING AGENTS*
BIVIGAM NPS PA; ST; SP
CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED 12 GM, 6 GM
NPS PA; ST; SP
CUVITRU NPS PA; ST
CYTOGAM PSP SP
FLEBOGAMMA DIF INTRAVENOUS SOLUTION 0.5 GM/10ML, 10 GM/200ML, 2.5 GM/50ML, 20 GM/400ML, 5 GM/100ML, 5 GM/50ML
PSP PA; SP
FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 GM/100ML, 20 GM/200ML
PSP PA
GAMASTAN S/D INTRAMUSCULAR INJECTABLE
NPS SP
GAMMAGARD NPS PA; ST; SP
GAMMAGARD S/D LESS IGA NPS PA; ST; SP
GAMMAKED NPS PA; ST; SP
GAMMAPLEX INTRAVENOUS SOLUTION 10 GM/200ML, 20 GM/400ML, 5 GM/100ML
PSP PA; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
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Drug Name Drug Status Drug Details
GAMUNEX-C PSP PA; SP
HEPAGAM B PSP
HIZENTRA SUBCUTANEOUS SOLUTION 1 GM/5ML, 10 GM/50ML, 2 GM/10ML, 4 GM/20ML
PSP PA; SP
HYPERHEP B S/D NPS SP
HYPERRAB NPS SP
HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE
NPS SP
HYPERTET S/D PSP SP
MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE
NPS SP
NABI-HB NPS SP
OCTAGAM PSP PA; SP
PRIVIGEN NPS PA; ST; SP
RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE
NPS SP
RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE
PSP SP
SYNAGIS PSP PA; SP
WINRHO SDF NPS SP
*PCSK9 INHIBITORS***
PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR
PSP PA; ST; QL
REPATHA PSP PA; ST; QL
REPATHA PUSHTRONEX SYSTEM PSP PA; ST; QL
REPATHA SURECLICK PSP PA; ST; QL
*PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC***
TEXAVITE LQ CE
*PENICILLINS*
amoxicillin oral capsule PG LGC
amoxicillin oral suspension reconstituted PG LGC
amoxicillin oral tablet PG
amoxicillin oral tablet chewable 125 mg, 250 mg PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
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Drug Name Drug Status Drug Details
amoxicillin-pot clavulanate er PG
amoxicillin-pot clavulanate oral PG
ampicillin oral capsule 500 mg PG
AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML
PB
AUGMENTIN ORAL SUSPENSION RECONSTITUTED 250-62.5 MG/5ML
NP
AUGMENTIN ORAL TABLET 500-125 MG, 875-125 MG
NP
AUGMENTIN XR NP
dicloxacillin sodium PG
MOXATAG NP
penicillin v potassium oral solution reconstituted125 mg/5ml
PG LGC
penicillin v potassium oral solution reconstituted250 mg/5ml
PG
penicillin v potassium oral tablet 250 mg PG LGC
penicillin v potassium oral tablet 500 mg PG
piperacillin sod-tazobactam so intravenous solution reconstituted 2.25 (2-0.25) gm, 3.375 (3-0.375) gm, 4.5 (4-0.5) gm, 40.5 (36-4.5) gm
NC
ZOSYN INTRAVENOUS SOLUTION RECONSTITUTED
NC
*PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS***
ZYDELIG NPS PA; SP; QL
*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL***
EUCRISA NC
*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***
OTEZLA ORAL TABLET PSP PA; ST; SP; QL
OTEZLA ORAL TABLET THERAPY PACK
PSP PA; ST; SP; QL
*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS**
LYNPARZA NPS PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019130
Drug Name Drug Status Drug Details
RUBRACA ORAL TABLET 200 MG, 300 MG
NPS PA; QL
RUBRACA ORAL TABLET 250 MG NPS PA; SP; QL
ZEJULA NPS PA; SP; QL
*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***
LYNPARZA NPS PA; SP; QL
RUBRACA ORAL TABLET 200 MG, 300 MG
NPS PA; QL
RUBRACA ORAL TABLET 250 MG NPS PA; SP; QL
ZEJULA NPS PA; SP; QL
*POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS***
GRALISE NP ST; QL
GRALISE STARTER NP ST; QL
LYRICA CR PB QL
*POTASSIUM REMOVING AGENTS***
KIONEX ORAL SUSPENSION PG
LOKELMA NP PA
sodium polystyrene sulfonate oral PG
SPS PG
VELTASSA NP PA; QL
*PROGESTINS*
AYGESTIN NP
hydroxyprogesterone caproate intramuscular oil PSP PA; SP
MAKENA INTRAMUSCULAR NC #
MAKENA SUBCUTANEOUS NPS PA; SP; QL
medroxyprogesterone acetate oral PG LGC
MEGACE ES NP
megestrol acetate oral suspension 625 mg/5ml NP
PROMETRIUM NP QL
PROVERA NP
*PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS***
ZONTIVITY NP PA; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019131
Drug Name Drug Status Drug Details
*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*
acamprosate calcium NP QL
AMPYRA NPS PA; #; SP; QL
ANTABUSE NP
ARICEPT ORAL TABLET 10 MG, 23 MG, 5 MG
NP PA; AL
AUBAGIO PSP PA; SP; QL
AUSTEDO NPS PA; ST; SP; QL
AVONEX PSP PA; SP; QL
AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT
PSP PA; SP; QL
AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT
PSP PA; SP; QL
BETASERON SUBCUTANEOUS KIT PSP PA; SP; QL
BRISDELLE NP PA; ST; QL
bupropion hcl er (smoking det) CE QL
CHANTIX CE QL
CHANTIX CONTINUING MONTH PAK CE QL
CHANTIX STARTING MONTH PAK CE
chlordiazepoxide-amitriptyline NP
COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML
NC SP
COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML
NC
disulfiram oral PG
donepezil hcl oral tablet 10 mg, 5 mg PG PA; AL
donepezil hcl oral tablet 23 mg NP PA; AL
donepezil hcl oral tablet dispersible PG PA; AL
ergoloid mesylates oral NP
EXELON TRANSDERMAL NP PA
EXTAVIA SUBCUTANEOUS KIT NPS PA; ST; SP; QL
fluoxetine hcl (pmdd) PG
galantamine hydrobromide NP PA; AL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019132
Drug Name Drug Status Drug Details
galantamine hydrobromide er NP PA; AL
GILENYA ORAL CAPSULE 0.25 MG PSP PA; SP; QL
GILENYA ORAL CAPSULE 0.5 MG PSP PA; #; SP; QL
GRALISE NP ST; QL
GRALISE STARTER NP ST; QL
HORIZANT ORAL TABLET EXTENDED RELEASE
NP PA; ST; QL
INGREZZA NPS PA; SP; QL
LEMTRADA PSP PA; SP; QL
LYRICA CR PB QL
memantine hcl er PG PA; AL
memantine hcl oral tablet PG PA; AL
NAMENDA ORAL TABLET NP PA
NAMENDA TITRATION PAK NP PA
NAMENDA XR PB PA; AL
NAMENDA XR TITRATION PACK PB PA; #; AL
nicotine CE QL
nicotine polacrilex mouth/throat CE QL
NICOTROL CE QL
NICOTROL NS CE QL
NUEDEXTA PB PA; QL
olanzapine-fluoxetine hcl oral capsule 12-25 mg, 12-50 mg, 6-25 mg, 6-50 mg
NP QL
olanzapine-fluoxetine hcl oral capsule 3-25 mg NP
ORAP NP
paroxetine mesylate NP PA; QL
perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-25 mg
PG
pimozide NP
PLEGRIDY PSP PA; SP; QL
PLEGRIDY STARTER PACK PSP PA; SP; QL
RAZADYNE ER NP AL
RAZADYNE ORAL TABLET NP PA; AL
REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR
PSP PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019133
Drug Name Drug Status Drug Details
REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR
PSP PA; SP; QL
REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
PSP PA; SP; QL
REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE
PSP PA; SP; QL
rivastigmine NP PA
rivastigmine tartrate NP PA
SARAFEM ORAL TABLET 10 MG, 20 MG PG
SAVELLA NP ST; QL
SAVELLA TITRATION PACK NP ST; QL
SYMBYAX ORAL CAPSULE 12-25 MG, 12-50 MG, 6-25 MG, 6-50 MG
NP QL
SYMBYAX ORAL CAPSULE 3-25 MG NP
TECFIDERA PSP PA; SP; QL
tetrabenazine PSP PA; QL
TYSABRI NPS PA; ST; SP
XENAZINE NPS PA; ST; SP; QL
XYREM NPS PA; SP
ZYBAN NP QL
*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***
OFEV NPS PA; SP; QL
*PULMONARY FIBROSIS AGENTS***
ESBRIET NPS PA; SP; QL
*PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST***
UPTRAVI ORAL TABLET 1000 MCG, 1200 MCG, 1400 MCG, 1600 MCG, 400 MCG, 600 MCG, 800 MCG
NPS PA; SP; QL
UPTRAVI ORAL TABLET 200 MCG NPS PA; SP
UPTRAVI ORAL TABLET THERAPY PACK
NPS PA; SP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019134
Drug Name Drug Status Drug Details
*RESPIRATORY AGENTS - MISC.*
ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG, 500 MG
NPS PA; SP
GLASSIA NPS PA; SP
KALYDECO NPS PA; SP; QL
PROLASTIN-C INTRAVENOUS SOLUTION
NPS PA; SP
PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG
NPS PA; SP
PULMOZYME PSP PA; SP; QL
ZEMAIRA NPS PA; SP
*SEROTONIN MODULATORS***
nefazodone hcl NP
trazodone hcl oral tablet 100 mg, 150 mg, 50 mg PG LGC
trazodone hcl oral tablet 300 mg PG
TRINTELLIX NP PA; ST; QL
VIIBRYD ORAL TABLET NP ST; QL
VIIBRYD STARTER PACK NP
*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***
GLYXAMBI PB QL
QTERN NC
STEGLUJAN NC
*SINUS NODE INHIBITORS**
CORLANOR NP PA; ST; QL
*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***
INVOKAMET PB QL
INVOKAMET XR PB QL
SEGLUROMET NC
SYNJARDY PB QL
SYNJARDY XR PB QL
XIGDUO XR PB QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019135
Drug Name Drug Status Drug Details
*SPLEEN TYROSINE KINASE (SYK) INHIBITORS***
TAVALISSE NPS PA; SP; QL
*SULFONAMIDES*
sulfadiazine oral NP
*TETRACYCLINES*
ACTICLATE NC
avidoxy NC
AVIDOXY DK NC
COREMINO NC
demeclocycline hcl oral NP
DORYX MPC NC
DORYX ORAL TABLET DELAYED RELEASE 200 MG, 50 MG
NC
doxycycline hyclate oral capsule PG
doxycycline hyclate oral tablet 100 mg, 50 mg PG
doxycycline hyclate oral tablet 150 mg, 75 mg NC
doxycycline hyclate oral tablet 20 mg NP
doxycycline hyclate oral tablet delayed release NC
doxycycline monohydrate oral capsule 100 mg, 50 mg
PG
doxycycline monohydrate oral capsule 150 mg, 75 mg
NC
doxycycline monohydrate oral suspension reconstituted
PG
doxycycline monohydrate oral tablet NC
MINOCIN ORAL CAPSULE 100 MG, 50 MG
NP
minocycline hcl er NC
minocycline hcl oral capsule PG
minocycline hcl oral tablet NC
MORGIDOX COMBINATION NC
MORGIDOX ORAL CAPSULE 100 MG PG
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG, 55 MG, 80 MG
NC #
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019136
Drug Name Drug Status Drug Details
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 115 MG, 65 MG
NC
TARGADOX NC
tetracycline hcl oral PG
VIBRAMYCIN NP
XIMINO NC
*THYROID AGENTS*
ARMOUR THYROID ORAL TABLET 120 MG
PG
ARMOUR THYROID ORAL TABLET 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG
NP
CYTOMEL NP
levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg
PG LGC
levothyroxine sodium oral tablet 300 mcg PG
LEVOXYL PG
liothyronine sodium oral PG
methimazole oral PG
NATURE-THROID NP
np thyroid oral tablet 30 mg, 60 mg, 90 mg PG
propylthiouracil oral PG
SYNTHROID NP
TAPAZOLE NP
TIROSINT NP
UNITHROID PG
UNITHROID DIRECT PG
WESTHROID ORAL TABLET 130 MG, 195 MG, 32.5 MG, 65 MG, 97.5 MG
NP
WP THYROID ORAL TABLET 113.75 MG, 130 MG, 32.5 MG, 65 MG
NP
*TRYPTOPHAN HYDROXYLASE INHIBITORS***
XERMELO NPS PA; SP; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019137
Drug Name Drug Status Drug Details
*ULCER DRUGS*
acid reducer maximum strength oral tablet 150 mg
NC
acid reducer oral tablet 150 mg NC
ACIPHEX NP PA; ST; QL
ACIPHEX SPRINKLE NP PA; ST; #; QL
amoxicill-clarithro-lansopraz PG
BENTYL ORAL CAPSULE NP
CARAFATE NP
cimetidine hcl oral PG
cimetidine oral tablet 200 mg NC
cimetidine oral tablet 300 mg, 400 mg, 800 mg PG
CUVPOSA NP #
CYTOTEC NP
DEXILANT NC
dicyclomine hcl oral capsule PG LGC
dicyclomine hcl oral tablet PG LGC
esomeprazole magnesium oral capsule delayed release 20 mg
PG Select OTC; QL
esomeprazole magnesium oral capsule delayed release 40 mg
PG QL
esomeprazole strontium oral capsule delayed release 49.3 mg
NC
famotidine oral tablet 10 mg PG
famotidine oral tablet 40 mg PG LGC
FIRST-LANSOPRAZOLE NC
FIRST-OMEPRAZOLE NC
glycopyrrolate oral tablet 1 mg, 2 mg NP
heartburn relief 150 max st NC
hyoscyamine sulfate NC
lansoprazole oral capsule delayed release 15 mg PG Select OTC; QL
lansoprazole oral capsule delayed release 30 mg PG QL
lansoprazole oral tablet dispersible NP PA; QL
LIBRAX NC
misoprostol oral PG
NEXIUM 24HR PG Select OTC; QL
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019138
Drug Name Drug Status Drug Details
NEXIUM ORAL CAPSULE DELAYED RELEASE 20 MG
NC
NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG
NP ST; QL
NEXIUM ORAL PACKET NP ST; #; QL
nizatidine PG
OMECLAMOX-PAK NP
omeprazole magnesium PG Select OTC
omeprazole oral capsule delayed release 10 mg, 40 mg
PG
omeprazole oral tablet delayed release PG Select OTC
OMEPRAZOLE+SYRSPEND SF ALKA NC
omeprazole-sodium bicarbonate oral capsule 20-1100 mg
PG Select OTC; QL
omeprazole-sodium bicarbonate oral capsule 40-1100 mg
NC
omeprazole-sodium bicarbonate oral packet NC
pantoprazole sodium oral PG
PEPCID ORAL SUSPENSION RECONSTITUTED
NP
PEPCID ORAL TABLET 40 MG NP
PREVACID 24HR PG Select OTC; QL
PREVACID ORAL CAPSULE DELAYED RELEASE 15 MG
NC
PREVACID ORAL CAPSULE DELAYED RELEASE 30 MG
NP ST; QL
PREVACID SOLUTAB NP PA; ST; QL; AL
PREVPAC NP
PRILOSEC ORAL PACKET NC #
PRILOSEC OTC PG Select OTC
propantheline bromide NC
propantheline bromide oral PG
PROTONIX ORAL NP ST
PYLERA NP #
rabeprazole sodium PG QL
ranitidine hcl oral capsule PG
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019139
Drug Name Drug Status Drug Details
ranitidine hcl oral tablet 300 mg PG LGC
ROBINUL ORAL NP
ROBINUL-FORTE NP
sucralfate oral PG
SYMAX DUOTAB NC
ZANTAC ORAL TABLET 300 MG NP
ZEGERID NC
ZEGERID OTC PG Select OTC; QL
*URINARY ANTI-INFECTIVES*
FURADANTIN NP
HIPREX NP
hyophen NC
MACROBID NP
MACRODANTIN NP
methenamine hippurate PG
methenamine mandelate oral PG
MONUROL NP
nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg
PG
nitrofurantoin monohyd macro PG
nitrofurantoin oral suspension PG
phosphasal NC
urelle NC
uretron d/s NC
uribel NC
URIMAR-T NC
urin ds NC
uro-mp NC
ustell NC
utira-c NC
utrona-c NC
*URINARY ANTISPASMODICS*
bethanechol chloride oral PG
darifenacin hydrobromide er NP QL
DETROL NP ST
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019140
Drug Name Drug Status Drug Details
DETROL LA NP ST; QL
DITROPAN XL NP ST; QL
ENABLEX NP ST; QL
flavoxate hcl PG
GELNIQUE TRANSDERMAL GEL 10 % NP ST
MYRBETRIQ PB ST; QL
oxybutynin chloride er PG QL
oxybutynin chloride oral syrup PG
oxybutynin chloride oral tablet PG LGC; QL
OXYTROL NC #
OXYTROL FOR WOMEN PG #; Select OTC; QL
tolterodine tartrate PG
tolterodine tartrate er NP QL
TOVIAZ NP ST; QL
trospium chloride PG QL
trospium chloride er PG QL
URECHOLINE NP
VESICARE NP ST; #; QL
*VAGINAL PRODUCTS*
AVC VAGINAL NP
CLEOCIN VAGINAL NP
clindamycin phosphate vaginal PG
CLINDESSE NP
CRINONE VAGINAL GEL 4 % NP
ENDOMETRIN NP #
ESTRACE VAGINAL NP
estradiol vaginal cream PG
estradiol vaginal tablet NP
ESTRING NP
FEMRING NP #; QL
GYNAZOLE-1 NP
IMVEXXY MAINTENANCE PACK NP ST
IMVEXXY STARTER PACK NP ST
INTRAROSA NP QL
METROGEL-VAGINAL NP
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019141
Drug Name Drug Status Drug Details
metronidazole vaginal PG
miconazole 3 vaginal suppository NP
NUVESSA NP
PREMARIN VAGINAL PB
TERAZOL 7 NP
terconazole PG
TODAY SPONGE CE
VAGIFEM VAGINAL TABLET 10 MCG NP
VANDAZOLE PG
VCF VAGINAL CONTRACEPTIVE VAGINAL FILM
CE
VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM
CE
YUVAFEM NP
*VASOPRESSORS*
ADYPHREN NP QL
ADYPHREN AMP II NP QL
ADYPHREN II NP QL
AUVI-Q INJECTION SOLUTION AUTO-INJECTOR
NC
epinephrine injection solution auto-injector PG QL
EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR
NP #; QL
EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR
NP #; QL
EPISNAP NP QL
midodrine hcl PG SP
*VITAMINS*
CALCIDOL NC
CALCIFEROL NC
cvs d3 oral capsule 2000 unit, 5000 unit NC
d 10000 NC
d 2000 NC
d 5000 NC
d-2000 maximum strength NC
d2000 ultra strength NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019142
Drug Name Drug Status Drug Details
D3 DOTS NC
d3 maximum strength NC
d3 super strength NC
d-3-5 NC
D3-50 NC
d-5000 NC
DDROPS ORAL LIQUID 2000 UNT/0.03ML, 2000 UT/0.028ML
NC
DECARA ORAL CAPSULE 25000 UNIT, 50000 UNIT
NC
DIALYVITE VITAMIN D 5000 NC
DIALYVITE VITAMIN D3 MAX NC
DRISDOL ORAL CAPSULE NP
eql vitamin d3 oral capsule 2000 unit, 5000 unit NC
ergocal NP
ergocalciferol oral capsule PG
ergocalciferol oral solution NC
gnp vitamin d maximum strength NC
gnp vitamin d super strength NC
hm vitamin d3 NC
MAXIMUM D3 NC
MEPHYTON PB QL
nat-rul vitamin d oral tablet 2000 unit, 5000 unit NC
natural vitamin d-3 NC
OPTIMAL D3 M NC
OPTIMAL-D NC
OPURITY VITAMIN D NC
pa vitamin d-3 oral capsule NC
phytonadione oral PG QL
ra vitamin d-3 oral capsule NC
REPLESTA NC
REPLESTA CHILDRENS NC
REPLESTA NX NC
sm vitamin d3 oral capsule 2000 unit, 4000 unit NC
super daily d3 oral liquid 2000 ut/0.028ml NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019143
Drug Name Drug Status Drug Details
THERA-D 2000 NC
THERA-D 4000 NC
THERA-D RAPID REPLETION NC
vitamin d (ergocalciferol) oral capsule 50000 unit
PG
vitamin d oral capsule 2000 unit NC
vitamin d oral tablet 2000 unit NC
vitamin d2 oral tablet 2000 unit NC
vitamin d3 maximum strength NC
vitamin d3 oral capsule 10000 unit, 2000 unit, 5000 unit, 50000 unit
NC
vitamin d3 oral liquid 5000 unit/ml NC
vitamin d3 oral tablet 10000 unit, 2000 unit, 3000 unit, 5000 unit, 50000 unit
NC
vitamin d3 oral tablet chewable 2000 unit, 5000 unit
NC
vitamin d3 super strength oral tablet NC
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019144
2019 Aetna Pharmacy Drug Guide - Aetna Value Plus Plan: Federal Employees
The formulary is updated the first week of each month
01/01/2019145
Index
abacavir sulfate ........................ 60abacavir sulfate-lamivudine ...... 60abacavir-lamivudine-zidovudine 60ABANEU-SL........................ 105ABILIFY................................ 59ABREVA................................ 79ABSORICA............................ 79ABSTRAL.............................. 22acamprosate calcium .............. 132ACANYA............................... 79acarbose ...................................38ACCOLATE........................... 30ACCU-CHEK AVIVA PLUS.90ACCU-CHEK COMPACT PLUS...................................... 90ACCU-CHEK FASTCLIX LANCETS............................ 112ACCU-CHEK MULTICLIX LANCETS............................ 113ACCU-CHEK SMARTVIEW........................ 90ACCU-CHEK SOFT TOUCH LANCETS............. 113ACCU-CHEK SOFTCLIX LANCETS............................ 113ACCUPRIL............................ 48ACCURETIC......................... 48ACCUTREND GLUCOSE....90acebutolol hcl ........................... 66acetaminophen-codeine .............23acetaminophen-codeine #2 ........23acetaminophen-codeine #3 ........23acetaminophen-codeine #4 ........23ACETASOL HC................... 127acetazolamide .......................... 94acetazolamide er ...................... 94acetic acid .......................102, 127acetylcysteine ...........................78acid reducer ............................138acid reducer maximum strength...............................................138ACIPHEX.............................138ACIPHEX SPRINKLE........ 138acitretin ................................... 79ACTEMRA............................ 19ACTICLATE........................ 136ACTIGALL.......................... 100ACTIMMUNE....................... 53ACTIQ.................................... 23
ACTIVE 1ST BLOOD LANCETS 30G.....................113active fe ..................................105ACTIVELLA.......................... 99ACTONEL............................. 95ACTOPLUS MET.................. 38ACTOPLUS MET XR............38ACTOS................................... 38ACULAR..............................122ACULAR LS........................ 123ACUVAIL............................ 123acyclovir ....................... 60, 61, 79ACZONE................................79ADAGEN............................... 67ADALAT CC......................... 67adapalene .................................79adapalene-benzoyl peroxide ......79ADCIRCA..............................69ADDERALL.......................... 17ADDERALL XR....................17adefovir dipivoxil ......................61ADEMPAS............................. 69ADLYXIN..............................38ADLYXIN STARTER PACK..................................... 38ADMELOG............................38ADMELOG SOLOSTAR.......38ADRENALIN...................... 121ADVAIR DISKUS................. 30ADVAIR HFA....................... 30ADVANCE INTUITION TEST.......................................90ADVANCE MICRO-DRAW TEST.......................................90ADVATE.............................. 103ADVOCATE REDI-CODE... 90ADVOCATE REDI-CODE+ TEST.......................................90ADVOCATE TEST................ 90adynovate ...............................103ADYPHREN........................ 142ADYPHREN AMP II...........142ADYPHREN II.................... 142ADZENYS ER....................... 17ADZENYS XR-ODT............. 17AFEDITAB CR......................67AFINITOR.............................53AFINITOR DISPERZ........... 53AFREZZA..............................38
AFSTYLA............................ 103AGAMATRIX AMP TEST... 90AGAMATRIX JAZZ TEST...90AGAMATRIX KEYNOTE TEST.......................................90AGAMATRIX PRESTO TEST.......................................90AGGRENOX....................... 103AGRYLIN............................103AIMOVIG.............................. 67AIMOVIG 140 DOSE.............67AIRAVITE........................... 105AIRDUO RESPICLICK 113/14...................................... 30AIRDUO RESPICLICK 232/14...................................... 30AIRDUO RESPICLICK 55/14........................................30AKTEN.................................123AKTIPAK.............................. 79AKYNZEO.............................43ALA-QUIN............................ 79ALAVERT..............................45ALAVERT ALLERGY/SINUS.................78ALAWAY.............................123ALAWAY CHILDRENS ALLERGY........................... 123ALBENZA..............................28albuterol sulfate ....................... 30albuterol sulfate er ................... 30alclometasone dipropionate .......79ALCORTIN A........................79ALDACTAZIDE....................94ALDACTONE........................94ALDARA............................... 79ALDURAZYME....................95ALECENSA........................... 53alendronate sodium ...................95ALFERON N......................... 53alfuzosin hcl er ....................... 102ALINIA.................................. 51ALKERAN.............................54ALLEGRA ALLERGY......... 45ALLEGRA ALLERGY CHILDRENS......................... 45ALLEGRA-D ALLERGY & CONGESTION...................... 78allergy eye drops .................... 123
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allergy relief .............................45allopurinol ..............................103ALLZITAL.............................22almotriptan malate ................. 115ALOCRIL.............................123alogliptin benzoate ................... 38alogliptin-metformin hcl ........... 38alogliptin-pioglitazone .............. 38ALOMIDE............................123ALORA.................................. 99alosetron hcl ...........................100ALOXI....................................43ALPHAGAN P.....................123ALPHANATE/VWF COMPLEX/HUMAN...........103ALPHANINE SD................. 103alprazolam ............................... 29alprazolam er ........................... 29ALPRAZOLAM INTENSOL 29alprazolam xr ...........................29ALPROLIX.......................... 103ALREX.................................123ALTABAX............................. 79ALTACE................................ 48ALTAVERA...........................72ALTOPREV........................... 46ALUNBRIG........................... 54ALVESCO.............................. 30alyacen 1/35 ............................. 72alyacen 7/7/7 ............................ 72AMABELZ............................. 99amantadine hcl ......................... 57AMARYL...............................38AMBIEN.............................. 109AMBIEN CR........................ 109amcinonide ...............................79AMELUZ............................... 79AMERGE............................. 116AMETHIA............................. 72AMETHIA LO....................... 72AMICAR.............................. 109amiloride hcl ............................ 94amiloride-hydrochlorothiazide .. 94amiodarone hcl .........................29AMITIZA............................. 100amitriptyline hcl ....................... 36amlodipine besy-benazepril hcl ..48amlodipine besylate .................. 67amlodipine besylate-valsartan ...48amlodipine-atorvastatin ............ 69
amlodipine-olmesartan ............. 48amlodipine-valsartan-hctz .........48AMMONUL...........................96AMNESTEEM....................... 79amoxapine ............................... 36amoxicill-clarithro-lansopraz ..138amoxicillin ............................. 129amoxicillin-pot clavulanate ..... 130amoxicillin-pot clavulanate er . 130amphetamine-dextroamphet er . 17amphetamine-dextroamphetamine ..................17ampicillin ............................... 130AMPYRA............................. 132AMRIX.................................120ANADROL-50....................... 26ANAFRANIL........................ 36anagrelide hcl ......................... 103ANA-LEX.............................. 27ANALPRAM-HC...................27ANAPROX DS.......................19anastrozole ...............................54ANCOBON............................ 44ANDRODERM......................26ANDROGEL..........................27ANDROGEL PUMP..............26ANGELIQ.............................. 99ANIMI-3...............................105ANIMI-3/VITAMIN D........ 105ANORO ELLIPTA.................30ANTABUSE......................... 132ANTARA............................... 46anucort-hc ................................27ANUSOL-HC......................... 27ANZEMET.............................43apap-caff-dihydrocodeine ......... 23APEXICON E........................ 79APIDRA................................. 38APIDRA SOLOSTAR............38APLENZIN............................ 36apraclonidine hcl .................... 123aprepitant ................................ 43APRI.......................................72APRISO................................ 100APTENSIO XR...................... 17APTIOM.................................33APTIVUS................................61ARALAST NP......................135ARANELLE...........................72
ARANESP (ALBUMIN FREE)...................................105ARAVA.................................. 19ARCALYST........................... 19ARCAPTA NEOHALER.......30ARICEPT............................. 132ARIMIDEX............................54aripiprazole ..............................59ARIXTRA.............................. 32armodafinil .............................. 17ARMONAIR RESPICLICK 113...........................................30ARMONAIR RESPICLICK 232...........................................30ARMONAIR RESPICLICK 55.............................................30ARMOUR THYROID.........137ARNUITY ELLIPTA............ 30AROMASIN...........................54ARRANON............................54ARTHROTEC........................19ARYMO ER........................... 23ARZERRA............................. 54ASACOL HD........................100ASCOMP-CODEINE.............23ASMANEX 120 METERED DOSES....................................30ASMANEX 14 METERED DOSES....................................30ASMANEX 30 METERED DOSES....................................30ASMANEX 60 METERED DOSES....................................30ASMANEX 7 METERED DOSES....................................30ASMANEX HFA................... 30aspirin-dipyridamole er ...........103ASSURE 3 TEST....................90ASSURE 4 TEST....................90ASSURE II............................. 90ASSURE II CHECK.............. 90ASSURE LANCETS............ 113ASSURE PLATINUM...........90ASSURE PRISM MULTI TEST.......................................90ASSURE PRO TEST..............91ASTAGRAF XL.....................64ASTEPRO.............................121ASTERO.................................80ATACAND............................ 48
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ATACAND HCT................... 48atazanavir sulfate ..................... 61ATELVIA............................... 96atenolol .................................... 66atenolol-chlorthalidone ............. 48ATGAM................................. 64ATIVAN................................. 29atomoxetine hcl ........................17atorvastatin calcium ................. 46atovaquone ...............................51atovaquone-proguanil hcl ..........52ATRALIN.............................. 80ATRIPLA............................... 61atropine sulfate .......................123ATROVENT HFA................. 30AUBAGIO............................132AUBRA EQ............................ 72AUGMENTIN..................... 130AUGMENTIN XR...............130AUSTEDO............................132AUVI-Q................................ 142AVALIDE.............................. 48AVANDIA..............................38AVAPRO................................ 48AVAR CLEANSER............... 80AVAR LS CLEANSER..........80avar-e emollient ........................80avar-e green ............................. 80AVAR-E LS............................80AVC VAGINAL................... 141AVELOX.............................. 100AVIANE................................. 72avidoxy .................................. 136AVIDOXY DK.....................136avita .........................................80AVODART...........................102AVONEX..............................132AVONEX PEN..................... 132AVONEX PREFILLED.......132av-vite fb ................................ 106AYGESTIN.......................... 131AZACTAM...........................118AZASITE..............................123azathioprine ............................. 64azelastine hcl .................. 121, 123AZELEX.................................80AZILECT............................... 57azithromycin .......................... 112AZOPT..................................123AZOR..................................... 48
aztreonam .............................. 118AZULFIDINE......................100AZULFIDINE EN-TABS.... 100AZURETTE........................... 72b-6 folic acid ...........................106bacitracin ............................... 123bacitracin-polymyxin b ........... 123baclofen ..................................120BACTRIM..............................51BACTRIM DS........................51BACTROBAN........................80BACTROBAN NASAL........121BALCOLTRA........................ 72balsalazide disodium ...............100BALZIVA............................... 72BANZEL................................ 33BARACLUDE........................61BASAGLAR KWIKPEN....... 39BAXDELA........................... 100BAYER BREEZE 2 TEST......91BAYER CONTOUR TEST....91BAYER MICROLET LANCETS............................ 113BD AUTOSHIELD.............. 113BD INSULIN SYRINGE.....113BD INSULIN SYRINGE HALF-UNIT........................ 113BD INSULIN SYRINGE MICROFINE........................113BD INSULIN SYRINGE U-500.........................................113BD INSULIN SYRINGE ULTRAFINE....................... 113BD LANCET ULTRAFINE 30G........................................113BD LANCET ULTRAFINE 33G........................................113BD MICROTAINER LANCETS............................ 113BD PEN................................ 113BD PEN MINI......................113BD PEN NEEDLE MINI U/F........................................113BD PEN NEEDLE NANO U/F........................................113BD PEN NEEDLE SHORT U/F........................................113BD PEN NEEDLE ULTRAFINE....................... 113
BD SAFETYGLIDE INSULIN SYRINGE........... 113BD SAFETY-LOK INSULIN SYRINGE........... 113BEBULIN............................. 103BECONASE AQ................... 121BELBUCA..............................23BELSOMRA.........................127benazepril hcl ........................... 48benazepril-hydrochlorothiazide . 48BENEFIX............................. 103BENICAR.............................. 48BENICAR HCT..................... 48BENLYSTA............................64bensal hp .................................. 80BENTYL...............................138BENZACLIN......................... 80BENZACLIN WITH PUMP..80BENZAMYCIN..................... 80benznidazole .............................28benzonatate ..............................78benzoyl peroxide-erythromycin .80benztropine mesylate ................ 58BEPREVE.............................123BERINERT.......................... 103BESIVANCE........................ 123BETAGAN........................... 123betamethasone dipropionate aug ...........................................80betamethasone valerate ............ 80BETAPACE............................66BETAPACE AF......................66BETASERON.......................132betaxolol hcl ..................... 66, 123bethanechol chloride ............... 140BETHKIS............................... 18BETIMOL.............................123BETOPTIC-S........................ 123BEVESPI AEROSPHERE..... 30BEVYXXA............................. 32bexarotene ............................... 54BEYAZ................................... 72BIAXIN................................ 112bicalutamide .............................54BIDIL..................................... 69BIFERARX.......................... 106BIKTARVY............................61BILTRICIDE..........................28bimatoprost ............................ 123BINOSTO............................... 96
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BIOSCANNER GLUCOSE TEST.......................................91bisoprolol fumarate .................. 66bisoprolol-hydrochlorothiazide ..48BIVIGAM.............................128BLEPH-10.............................123BLEPHAMIDE.................... 123BLEPHAMIDE S.O.P.......... 123blood glucose test ..................... 91BONIVA................................. 96BONJESTA............................ 43BOSULIF............................... 54BOTOX.................................122bp 10-1 .....................................80bp vit 3 ................................... 106BRAFTOVI............................ 54BREO ELLIPTA.................... 30briellyn .....................................72BRILINTA......................94, 103brimonidine tartrate ................123BRISDELLE.........................132BRIVIACT............................. 33bromfenac sodium (once-daily)...............................................123bromocriptine mesylate ............ 58BROMSITE.......................... 123BROVANA.............................30budesonide .................. 30, 77, 121budesonide er ............................77bullseye mini safety lancets ..... 113BULLSEYE SAFETY LANCETS............................ 113bumetanide ...............................94BUNAVAIL........................... 23BUPAP................................... 22BUPHENYL...........................96buprenorphine .......................... 23buprenorphine hcl ..................... 23buprenorphine hcl-naloxone hcl .23bupropion hcl ........................... 36bupropion hcl er (smoking det)...............................................132bupropion hcl er (sr) ................ 36bupropion hcl er (xl) ................36buspirone hcl ............................ 29BUSULFEX........................... 54butalbital-acetaminophen ......... 22butalbital-apap-caff-cod ........... 23butalbital-apap-caffeine ............22butalbital-asa-caff-codeine ....... 23
butalbital-asa-caffeine .............. 22BUTISOL SODIUM.............109butorphanol tartrate ................. 23BUTRANS............................. 23BYDUREON..........................39BYDUREON BCISE..............39BYETTA 10 MCG PEN......... 39BYETTA 5 MCG PEN........... 39BYSTOLIC............................. 66BYVALSON........................... 66cabergoline ...............................96CABOMETYX....................... 54CADUET................................70CAFERGOT.........................116CALAN.................................. 67CALAN SR.............................67CALCIDOL.......................... 142CALCIFEROL..................... 142calcipotriene .............................80calcipotriene-betameth diprop ...80calcitonin (salmon) .................. 96calcitrene ................................. 80calcitriol ............................. 80, 96CALQUENCE........................54CAMBIA.............................. 116CAMPTOSAR........................54CAMRESE............................. 72CAMRESE LO....................... 72CANASA.............................. 100candesartan cilexetil .................48candesartan cilexetil-hctz ......... 48CAPASTAT SULFATE......... 53capecitabine ............................. 54CAPEX................................... 80CAPRELSA............................54captopril ...................................48captopril-hydrochlorothiazide ... 48CARAC.................................. 80CARAFATE......................... 138CARBAGLU.......................... 96carbamazepine ......................... 33carbamazepine er ..................... 33CARBATROL........................ 33carbidopa ................................. 58carbidopa-levodopa .................. 58carbidopa-levodopa er .............. 58carbidopa-levodopa-entacapone 58carbinoxamine maleate .............45CARDIZEM...........................67CARDIZEM CD.................... 67
CARDIZEM LA.....................67CARDURA............................ 48CARDURA XL.................... 102CARESENS N GLUCOSE TEST.......................................91CARIMUNE NF.................. 128carisoprodol ........................... 120carisoprodol-aspirin ................120carisoprodol-aspirin-codeine ... 120CARNITOR........................... 96CARNITOR SF......................96CAROSPIR............................ 94carteolol hcl ............................123CARTIA XT...........................68carvedilol ................................. 66carvedilol phosphate er ............. 66CASODEX............................. 54CATAPRES............................48CATAPRES-TTS-1.................48CATAPRES-TTS-2.................48CATAPRES-TTS-3.................48CAYSTON............................118CAZIANT.............................. 72cefaclor .................................... 70cefaclor er ................................ 70cefadroxil .................................70cefazolin sodium .......................70cefdinir .....................................70cefditoren pivoxil ......................70cefepime hcl ............................. 70cefepime-dextrose .....................70cefixime ................................... 70cefotaxime sodium ....................71cefotetan disodium ....................71cefoxitin sodium ....................... 71cefoxitin sodium-dextrose .........71cefpodoxime proxetil ................ 71cefprozil ................................... 71ceftazidime ...............................71ceftriaxone sodium ................... 71cefuroxime axetil ..................... 71cefuroxime sodium ................... 71CELEBREX............................19celecoxib .................................. 19CELEXA................................ 36CELLCEPT............................ 64CELONTIN............................33CEM-UREA........................... 80CENFOL.............................. 106CENTANY.............................80
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CENTRATEX...................... 106cephalexin ................................ 71CERDELGA.........................106CEREZYME.........................106CERVIDIL........................... 128CESAMET..............................43cetirizine hcl .............................45cetirizine-pseudoephedrine er .... 78CETRAXAL......................... 127cevimeline hcl ......................... 118CHANTIX............................ 132CHANTIX CONTINUING MONTH PAK...................... 132CHANTIX STARTING MONTH PAK...................... 132CHATEAL............................. 72CHATEAL EQ....................... 72CHEMET............................... 43CHENODAL........................ 100childrens loratadine .................. 45chlordiazepoxide hcl ................. 29chlordiazepoxide-amitriptyline132chlorhexidine gluconate .......... 118chloroquine phosphate .............. 52chlorothiazide ...........................94chlorpromazine hcl ................... 59chlorpropamide ........................ 39chlorthalidone .......................... 95chlorzoxazone ........................ 120CHOLBAM............................ 67cholestyramine ......................... 46cholestyramine light ................. 46choline-mag trisalicylate ...........22CIALIS................................... 70CICLODAN........................... 81CICLODAN SOLUTION...... 81ciclopirox ................................. 81ciclopirox olamine .................... 81ciclopirox treatment ................. 81cidofovir ...................................61CIFEREX............................. 106cilostazol ................................ 103CILOXAN............................ 123CIMDUO................................61cimetidine ...............................138cimetidine hcl ......................... 138CIMZIA................................101CIMZIA PREFILLED......... 100CIMZIA STARTER KIT..... 101CINQAIR............................. 111
CINRYZE.............................104CIPRO.................................. 100CIPRO HC............................127CIPRO XR............................100CIPRODEX.......................... 127ciprofloxacin .......................... 100ciprofloxacin hcl ............. 100, 127ciprofloxacin-ciproflox hcl er ..100citalopram hydrobromide ..........36CITRANATAL 90 DHA...... 119CITRANATAL B-CALM.... 119CITRANATAL DHA...........119CITRANATAL HARMONY...............................................119CITRANATAL MEDLEY...119CITRANATAL RX..............119claravis .................................... 81CLARINEX............................45CLARINEX-D 12 HOUR...... 78clarithromycin ........................ 112clarithromycin er .................... 112CLARITIN............................. 45CLARITIN EYE...................123CLARITIN REDITABS.........45CLARITIN-D 12 HOUR........78CLARITIN-D 24 HOUR........78CLENPIQ............................. 111CLEOCIN....................... 51, 141CLEOCIN PHOSPHATE.......51CLEOCIN-T........................... 81CLEVER CHEK AUTO-CODE TEST...........................91CLEVER CHEK AUTO-CODE VOICE........................ 91CLEVER CHEK TEST.......... 91CLEVER CHOICE AUTO-CODE TEST...........................91CLEVER CHOICE MICRO TEST.......................................91CLIMARA............................. 99CLIMARA PRO.....................99CLINDACIN ETZ................. 81CLINDACIN PAC................. 81CLINDAGEL.........................81clindamycin hcl .........................51clindamycin phos-benzoyl perox ....................................... 81clindamycin phosphate .51, 81, 141clindamycin-tretinoin ................81CLINDESSE.........................141
clobetasol prop emollient base ...81clobetasol propionate ................81clobetasol propionate e ............. 81clobetasol propionate emulsion . 81CLOBEX................................ 81CLOBEX SPRAY...................82clocortolone pivalate .................82clodan ...................................... 82CLODERM............................ 82CLODERM PUMP................ 82clomipramine hcl ...................... 36clonazepam .............................. 33clonidine hcl ........................48, 49clonidine hcl er ......................... 17clopidogrel bisulfate ................104clorazepate dipotassium ............29clotrimazole ........................... 118clotrimazole-betamethasone ..... 82clozapine .................................. 59CLOZARIL............................ 59COAGADEX........................104COAGUCHEK LANCETS..114coal tar .................................... 82COARTEM............................ 52codeine sulfate ..........................23COLAZAL............................101colchicine ............................... 103colchicine-probenecid ..............103COLCRYS............................ 103colesevelam hcl .........................46COLESTID.............................46COLESTID FLAVORED...... 46colestipol hcl ............................ 46COLY-MYCIN M.................. 51COLY-MYCIN S..................127COLYTE WITH FLAVOR PACKS..................................111COMBIGAN........................ 124COMBIPATCH...................... 99COMBIVENT RESPIMAT....30COMBIVIR............................ 61COMETRIQ (100 MG DAILY DOSE)....................... 54COMETRIQ (140 MG DAILY DOSE)....................... 54COMETRIQ (60 MG DAILY DOSE).....................................54comfort assured lancets 28g .... 114comfort assured lancets 33g .... 114COMPLERA.......................... 61
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COMPRO............................... 59COMTAN...............................58CONCERTA.......................... 17CONDYLOX..........................82CONZIP..................................23COOL BLOOD GLUCOSE TEST STRIPS.........................91COPAXONE.........................132CORDRAN............................ 82COREG.................................. 66COREG CR............................ 66COREMINO.........................136CORGARD............................ 66CORIFACT.......................... 104CORLANOR........................ 135CORTANE-B........................127CORTANE-B AQUEOUS... 127CORTEF................................ 77cortic-nd .................................127CORTIFOAM........................ 27cortisone acetate ...................... 77CORTISPORIN......................82CORVITA.............................119CORVITA 150...................... 106CORVITE 150.......................106CORZIDE.............................. 49COSENTYX........................... 82COSENTYX SENSOREADY PEN............. 82COSOPT............................... 124COSOPT PF..........................124COTELLIC.............................54COTEMPLA XR-ODT.......... 17COUMADIN..........................32COZAAR................................49CREON.................................. 94CRESEMBA...........................44CRESTOR.............................. 46CRINONE............................ 141CRIXIVAN............................ 61cromolyn sodium ...............31, 124CROTAN................................82CRYSELLE-28....................... 72CUPRIMINE......................... 64CUTIVATE............................ 82CUVITRU............................ 128CUVPOSA............................ 138CVS ADVANCED GLUCOSE TEST................... 91cvs d3 ..................................... 142
cyanocobalamin ......................106CYCLAFEM 1/35...................72cyclobenzaprine hcl .................120CYCLOGYL.........................124CYCLOMYDRIL.................124cyclopentolate hcl ................... 124cyclophosphamide .................... 54cycloserine ............................... 53CYCLOSET............................39cyclosporine ............................. 64cyclosporine modified ............... 64CYMBALTA.......................... 36cyotic ..................................... 127cyproheptadine hcl ....................45CYSTADANE........................ 96CYSTAGON.........................102CYSTARAN.........................124CYTOGAM.......................... 128CYTOMEL........................... 137CYTOTEC............................ 138CYTOVENE...........................61cytra-2 ................................... 102CYTRA-3..............................102cytra-k ................................... 102d 10000 .................................. 142d 2000 .................................... 142d 5000 .................................... 142D.H.E. 45.............................. 116d-2000 maximum strength ...... 142d2000 ultra strength ................142D3 DOTS.............................. 143d3 maximum strength ............. 143d3 super strength .................... 143d-3-5 ...................................... 143D3-50.....................................143d-5000 ....................................143DAKLINZA........................... 61DALIRESP.............................31danazol .................................... 27DANTRIUM........................ 120dantrolene sodium ...................121dapsone .............................. 51, 82DARAPRIM.......................... 52darifenacin hydrobromide er ... 140DASETTA 1/35.......................72DASETTA 7/7/7......................72DAXBIA.................................71DAYPRO................................19DAYSEE.................................72DAYTRANA......................... 17
DDAVP.................................. 96DDAVP RHINAL TUBE...... 96DDROPS.............................. 143DECARA..............................143deferoxamine mesylate ....... 42, 43DELYLA................................ 72DELZICOL...........................101DEMADEX............................95demeclocycline hcl .................. 136DEMSER................................49DENAVIR..............................82DENTA 5000 PLUS..............118DEPAKENE...........................33DEPAKOTE...........................33DEPAKOTE ER.....................33DEPAKOTE SPRINKLES.... 33DEPEN TITRATABS............ 64DEPO-PROVERA..................72DEPO-TESTOSTERONE...... 27DERMA-SMOOTHE/FS BODY..................................... 82DERMA-SMOOTHE/FS SCALP.................................... 82DERMOTIC......................... 127DESCOVY..............................61DESFERAL...................... 42, 43desipramine hcl .........................36desloratadine ............................45desmopressin ace spray refrig ... 96desmopressin acetate ................ 96desmopressin acetate spray .......96desogestrel-ethinyl estradiol ......72DESONATE........................... 82desonide ................................... 82DESOWEN.............................82desoximetasone ........................ 82DESOXYN............................. 17desvenlafaxine er ......................36desvenlafaxine succinate er .......36DETROL.............................. 140DETROL LA........................ 141dexamethasone .........................77DEXAMETHASONE INTENSOL............................ 77dexamethasone sodium phosphate ............................... 124DEXEDRINE.........................17DEXILANT..........................138dexmethylphenidate hcl ............ 17dexmethylphenidate hcl er ........ 17
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dextroamphetamine sulfate .......17dextroamphetamine sulfate er ...17DIALYVITE VITAMIN D 5000....................................... 143DIALYVITE VITAMIN D3 MAX..................................... 143DIASTAT ACUDIAL............33DIASTAT PEDIATRIC.........33diatrue plus test ........................ 91diazepam ............................ 29, 33DIAZEPAM INTENSOL.......29DIBENZYLINE..................... 49DICLEGIS..............................43diclofenac potassium .................19diclofenac sodium ........ 19, 82, 124diclofenac sodium er ................. 19diclofenac-misoprostol ..............19DICLOFEX DC..................... 82dicloxacillin sodium ................ 130dicyclomine hcl .......................138didanosine ................................ 61DIDREX.................................17DIFFERIN............................. 83DIFICID...............................112diflorasone diacetate .................83DIFLUCAN........................... 44diflunisal .................................. 22DIGITEK............................... 69DIGOX................................... 69digoxin .....................................69dihydroergotamine mesylate ... 116DILANTIN............................ 33DILANTIN INFATABS........ 33DILATRATE-SR................... 28DILAUDID............................23diltiazem cd ..............................68diltiazem hcl .............................68diltiazem hcl er .........................68diltiazem hcl er beads ............... 68diltiazem hcl er coated beads .... 68dilt-xr ...................................... 68DIOVAN................................ 49DIOVAN HCT....................... 49DIPENTUM......................... 101diphenatol ................................ 42diphenoxylate-atropine .............42DIPROLENE......................... 83DIPROLENE AF................... 83dipyridamole .......................... 104disopyramide phosphate ............29
disulfiram ...............................132DITROPAN XL................... 141DIURIL.................................. 95divalproex sodium .................... 33divalproex sodium er ................ 33DIVIGEL................................99DIVISTA.............................. 106dofetilide .................................. 29DOLOPHINE.........................23donepezil hcl ...........................132DOPTELET.......................... 106DORAL................................ 109DORYX................................ 136DORYX MPC...................... 136dorzolamide hcl ...................... 124dorzolamide hcl-timolol mal ....124dorzolamide hcl-timolol mal pf 124DOVONEX............................ 83doxazosin mesylate ...................49doxepin hcl ......................... 36, 83doxercalciferol ......................... 96doxycycline .............................. 83doxycycline hyclate ................ 136doxycycline monohydrate ....... 136DRISDOL.............................143dronabinol ................................43drospirenone-ethinyl estradiol...........................................72, 73DUAC.....................................83DUAVEE..............................100DUETACT............................. 39DUEXIS................................. 19DULERA................................31duloxetine hcl ........................... 36DUO-CARE TEST.................91DUOPA.................................. 58DUPIXENT............................65durachol ................................. 106DURAGESIC-100.................. 23DURAGESIC-12....................23DURAGESIC-25....................23DURAGESIC-50....................23DURAGESIC-75....................23DUREZOL........................... 124DURLAZA...........................104DUROLANE........................121dutasteride ............................. 102dutasteride-tamsulosin hcl .......102DUTOPROL.......................... 49DUZALLO........................... 103
DYANAVEL XR................... 17DYAZIDE.............................. 95DYMISTA............................ 122DYRENIUM..........................95DYSPORT............................ 122E.E.S. 400.............................. 112E.E.S. GRANULES..............112easy plus blood glucose test .......91EASY STEP TEST..................91easy talk blood glucose test .......91EASY TOUCH LANCETS 21G........................................114EASY TOUCH LANCETS 23G........................................114EASY TOUCH LANCETS 26G........................................114EASY TOUCH LANCETS 26G/TWIST...........................114EASY TOUCH LANCETS 28G........................................114EASY TOUCH LANCETS 28G/TWIST...........................114EASY TOUCH LANCETS 30G........................................114EASY TOUCH LANCETS 30G/TWIST...........................114EASY TOUCH LANCETS 32G........................................114EASY TOUCH LANCETS 32G/TWIST...........................114EASY TOUCH LANCETS 33G/TWIST...........................114EASY TOUCH LANCING DEVICE................................114EASY TOUCH SAFETY LANCETS 21G.....................114EASY TOUCH SAFETY LANCETS 23G.....................114EASY TOUCH SAFETY LANCETS 26G.....................114EASY TOUCH SAFETY LANCETS 28G.....................114EASY TOUCH TEST.............91easy trak blood glucose test ...... 91EASY TWIST & CAP LANCETS............................ 114EASYGLUCO........................ 91EASYGLUCO PLUS............. 91EASYMAX 15 TEST..............91EASYMAX TEST.................. 91
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easyplus blood glucose test ........91EASYPRO BLOOD GLUCOSE TEST................... 91EASYPRO PLUS................... 91EC-NAPROSYN.................... 19econazole nitrate ...................... 83ECOZA................................... 83EDARBI................................. 49EDARBYCLOR.....................49EDECRIN.............................. 95EDLUAR..............................109EDURANT............................ 61efavirenz .................................. 61EFFEXOR XR....................... 36EFFIENT..............................104EFUDEX................................83ELAPRASE............................ 96ELDEPRYL........................... 58ELELYSO.............................106element compact test ................ 91ELEMENT TEST...................91ELESTAT............................. 124ELESTRIN............................. 99eletriptan hydrobromide ..........116ELIDEL..................................83ELIGARD.............................. 54ELIMITE................................83ELINEST................................73ELIQUIS.................................32ELIQUIS STARTER PACK.. 32ELIXOPHYLLIN...................31ELLA...................................... 73ELMIRON............................102ELOCON................................83ELOCTATE..........................104EMADINE........................... 124EMBEDA............................... 23EMBRACE BLOOD GLUCOSE TEST................... 91EMBRACE EVO BLOOD GLUCOSE TEST................... 91EMBRACE PRO GLUCOSE TEST.......................................91EMCYT.................................. 54EMEND..................................43EMFLAZA............................. 77EMOQUETTE........................73EMSAM..................................36EMTRIVA..............................61EMVERM.............................. 28
ENABLEX............................141enalapril maleate ......................49enalapril-hydrochlorothiazide ... 49ENBREL................................ 19ENBREL MINI...................... 19ENBREL SURECLICK......... 19ENDARI.................................18ENDOCET............................. 23ENDOMETRIN................... 141enoxaparin sodium ................... 32ENPRESSE-28........................73ENSKYCE..............................73ENSTILAR.............................83entacapone ............................... 58entecavir .................................. 61ENTOCORT EC.....................77ENTRESTO..........................122ENTYVIO.............................110enulose ................................... 101ENVARSUS XR.....................65EPANED................................ 49EPCLUSA.............................109EPIDUO................................. 83EPIDUO FORTE................... 83epinastine hcl ..........................124epinephrine .............................142EPIPEN 2-PAK.................... 142EPIPEN JR 2-PAK............... 142EPISNAP.............................. 142EPITOL.................................. 33EPIVIR................................... 61EPIVIR HBV.......................... 61eplerenone ................................ 49EPOGEN.............................. 106epoprostenol sodium ................. 70eprosartan mesylate ..................49EPZICOM.............................. 61eq aspirin low dose ....................22eql vitamin d3 ......................... 143EQUETRO............................. 59ergocal ................................... 143ergocalciferol ......................... 143ergoloid mesylates .................. 132ERGOMAR..........................116ERIVEDGE............................54ERLEADA............................. 54ERRIN....................................73ERTACZO..............................83ery ........................................... 83ERYPED 200........................ 112
ERYPED 400........................ 112ERY-TAB............................. 112ERYTHROCIN STEARATE...............................................112erythromycin .................... 83, 124erythromycin base .................. 112erythromycin ethylsuccinate ....112erythromycin stearate .............112ESBRIET.............................. 134escitalopram oxalate ................ 36ESGIC.....................................22esomeprazole magnesium ........138esomeprazole strontium .......... 138ESTARYLLA......................... 73estazolam ............................... 109ESTRACE....................... 99, 141estradiol ............................99, 141estradiol valerate ......................99estradiol-norethindrone acet ..... 99ESTRING............................. 141ESTROGEL............................99ESTROSTEP FE.....................73eszopiclone ............................. 109ethacrynic acid ......................... 95ethambutol hcl ..........................53ethosuximide ............................ 33ETHYOL................................ 54etidronate disodium .................. 96etodolac ................................... 19etodolac er ............................... 19etoposide .................................. 54EUCRISA............................. 130EUFLEXXA......................... 121EURAX.................................. 83EVAMIST...............................99EVEKEO................................ 17EVENCARE BLOOD GLUCOSE TEST................... 91EVENCARE G2 TEST...........91EVENCARE G3 TEST...........92EVENCARE MINI GLUCOSE TEST................... 92EVISTA.................................. 96EVOCLIN...............................83EVOLUTION AUTOCODE..92EVOTAZ................................ 61EVOXAC.............................. 118EVZIO.................................... 43EXALGO................................23EXELDERM.......................... 83
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EXELON.............................. 132exemestane ...............................54EXFORGE............................. 49EXFORGE HCT.................... 49EXJADE................................. 43exotic-hc ................................ 127EXTAVIA.............................132EXTINA................................. 83eye itch relief ..........................124EYLEA................................. 124EZ SMART BLOOD GLUCOSE TEST................... 92EZ SMART PLUS GLUCOSE TEST................... 92ezetimibe ..................................46ezetimibe-simvastatin ............... 46fabb ........................................106FABIOR................................. 83FABRAZYME....................... 96FALMINA............................. 73famciclovir ............................... 61famotidine .............................. 138FANAPT................................ 59FANAPT TITRATION PACK..................................... 59FARESTON........................... 54FARXIGA..............................39FARYDAK............................ 55FASLODEX........................... 55fa-vitamin b-6-vitamin b-12 .....106FAYOSIM.............................. 73FAZACLO..............................59FC2 FEMALE CONDOM... 114FEIBA...................................104felbamate ................................. 34FELBATOL............................34FELDENE..............................20felodipine er ............................. 68FEMARA............................... 55FEMCAP.............................. 114FEMHRT LOW DOSE.......... 99FEMRING........................... 141fenofibrate ............................... 46fenofibrate micronized ..............46fenofibric acid .......................... 46FENOGLIDE......................... 47fenoprofen calcium ................... 20FENORTHO.......................... 20fentanyl ....................................23fentanyl citrate .........................23
FENTORA............................. 24FERIVA 21/7........................ 106ferocon ................................... 106ferotrinsic ...............................106ferraplus 90 ............................ 106FERRIPROX......................... 43FERRLECIT........................ 106FERROCITE PLUS............. 106FERRO-PLEX HEMATINIC....................... 106FERROTRIN....................... 106FETZIMA.............................. 36FETZIMA TITRATION........36fexofenadine hcl ....................... 45fexofenadine hcl childrens .........45fexofenadine-pseudoephed er .... 78FIASP..................................... 39FIASP FLEXTOUCH............ 39FIBRICOR............................. 47FIBRYGA............................ 104FIFTY50 GLUCOSE TEST 2.0............................................92FINACEA.............................. 83finasteride .............................. 102FINGERSTIX LANCETS... 114FIORICET..............................22FIORICET/CODEINE...........24FIORINAL.............................22FIORINAL/CODEINE #3.....24FIRAZYR.............................104FIRMAGON.......................... 55FIRST-LANSOPRAZOLE...138FIRST-OMEPRAZOLE.......138FIRVANQ.............................. 51FLAGYL................................ 51FLAREX.............................. 124flavoxate hcl ...........................141FLEBOGAMMA DIF..........128flecainide acetate ......................29FLECTOR.............................. 83FLOLAN................................ 70flolipid ..................................... 47FLOMAX............................. 102FLONASE............................ 122FLONASE ALLERGY RELIEF................................ 122FLOVENT DISKUS.............. 31FLOVENT HFA.....................31FLOXIN OTIC..................... 127flucaine .................................. 124
fluconazole ...............................44flucytosine ................................44fludrocortisone acetate ............. 77FLUMADINE........................61flunisolide ...............................122fluocinolone acetonide . 83, 84, 127fluocinolone acetonide body ...... 83fluocinolone acetonide scalp ......84fluocinonide ..............................84FLUORABON......................117fluorometholone ..................... 124FLUOROPLEX......................84fluorouracil .............................. 84fluoxetine hcl ...................... 36, 37fluoxetine hcl (pmdd) .............132fluphenazine hcl ........................59FLURA-DROPS.................. 117flurandrenolide ......................... 84flurazepam hcl ........................109flurbiprofen .............................. 20flurbiprofen sodium .................124flutamide ..................................55fluticasone propionate ....... 84, 122fluticasone-salmeterol ...............31fluvastatin sodium .................... 47fluvastatin sodium er ................ 47fluvoxamine maleate .................37fluvoxamine maleate er .............37FML......................................124FML FORTE........................124FML LIQUIFILM................124FOCALIN.............................. 17FOCALIN XR........................17folbee ..................................... 106FOLGARD RX.................... 106folic acid ................................ 106FOLIVANE-F...................... 107FOLIVANE-PLUS............... 107folplex 2.2 .............................. 107foltrin .....................................107fondaparinux sodium ................ 32FORA D15G BLOOD GLUCOSE TEST................... 92FORA D20 BLOOD GLUCOSE TEST................... 92FORA D40/G31 BLOOD GLUCOSE..............................92FORA G20 BLOOD GLUCOSE TEST................... 92
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FORA G30/PREM V10 GLUCOSE TEST................... 92FORA GD20 TEST................ 92FORA GD50 BLOOD GLUCOSE TEST................... 92FORA TN'G/TN'G VOICE....92FORA V10 BLOOD GLUCOSE TEST................... 92FORA V12 BLOOD GLUCOSE TEST................... 92FORA V20 BLOOD GLUCOSE TEST................... 92FORA V30A BLOOD GLUCOSE TEST................... 92FORACARE GD40 TEST..... 92FORACARE PREMIUM V10 TEST................................92FORACARE TEST N GO TEST.......................................92FORFIVO XL........................ 37FORTAMET.......................... 39FORTEO................................ 96FORTESTA............................27FORTISCARE TEST............. 92FOSAMAX.............................96FOSAMAX PLUS D.............. 96fosamprenavir calcium ..............61fosinopril sodium ...................... 49fosinopril sodium-hctz ...............49FOSRENOL......................... 101FRAGMIN.............................32FREESTYLE INSULINX TEST.......................................92FREESTYLE LANCETS..... 114FREESTYLE LITE TEST......92FREESTYLE PRECISION NEO TEST..............................92FREESTYLE TEST............... 92FREESTYLE UNISTICK II LANCETS............................ 114FROVA.................................116frovatriptan succinate ............. 116FULPHILA.......................... 107FURADANTIN................... 140furosemide ................................95FUSION PLUS.....................107FUZEON................................62FYAVOLV............................. 99FYCOMPA.............................34gabapentin ............................... 34
GABITRIL............................. 34GALAFOLD.......................... 96galantamine hydrobromide ..... 132galantamine hydrobromide er ..133GALZIN............................... 117GAMASTAN S/D.................128GAMMAGARD...................128GAMMAGARD S/D LESS IGA....................................... 128GAMMAKED......................128GAMMAPLEX.................... 128GAMUNEX-C......................129ganciclovir sodium ....................62gatifloxacin ............................ 124GATTEX.............................. 101gavilax ................................... 111GAVILYTE-H......................111ge100 blood glucose test ........... 92GELCLAIR.......................... 118GELNIQUE..........................141GEL-ONE.............................121GELSYN-3........................... 121gemfibrozil ............................... 47GENERESS FE...................... 73gengraf .....................................65GENOTROPIN...................... 96GENOTROPIN MINIQUICK..........................97GENSTRIP 50........................ 92GENTAK............................. 124gentamicin sulfate ....... 18, 84, 124GENVOYA............................ 62GEODON............................... 59ght test .....................................92GIANVI..................................73GILDESS FE 1.5/30................73GILDESS FE 1/20.................. 73GILENYA............................ 133GILOTRIF............................. 55GLASSIA..............................135GLEEVEC.............................. 55GLEOSTINE.......................... 55glimepiride ............................... 39glipizide ................................... 39glipizide er ............................... 39glipizide xl ............................... 39glipizide-metformin hcl ............. 39GLUCAGEN HYPOKIT.......39GLUCAGON EMERGENCY.......................39
GLUCO PERFECT 3 TEST...92GLUCOCARD 01 SENSOR PLUS...................................... 92GLUCOCARD EXPRESSION TEST..............92GLUCOCARD SHINE TEST.......................................92GLUCOCARD VITAL TEST.......................................92GLUCOCARD X-SENSOR...92GLUCOCOM TEST...............93GLUCONAVII BLOOD GLUCOSE TEST................... 93GLUCOPHAGE.....................39GLUCOPHAGE XR.............. 39GLUCOTROL........................39GLUCOTROL XL................. 39GLUCOVANCE.....................39GLUMETZA..........................39glyburide ............................ 39, 40glyburide micronized ................ 39glyburide-metformin .................40glycopyrrolate ........................ 138GLYNASE............................. 40GLYSET.................................40GLYXAMBI.........................135gnp folic acid .......................... 107gnp vitamin d maximum strength ..................................143gnp vitamin d super strength ... 143GOCOVRI..............................58GOLYTELY......................... 111GONITRO..............................28GORDONS UREA................ 84GRALISE......................131, 133GRALISE STARTER...131, 133granisetron hcl ......................... 43GRANIX.............................. 107GRASTEK............................. 67griseofulvin microsize ............... 44griseofulvin ultramicrosize ........44guaifenesin ac ...........................78guaifenesin-codeine .................. 78guanfacine hcl .......................... 49guanfacine hcl er ...................... 17guanidine hcl .......................52, 53GYNAZOLE-1..................... 141HAEGARDA....................... 104HALCION............................ 110halobetasol propionate ..............84
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HALOG.................................. 84haloperidol ............................... 59haloperidol lactate ....................59HARVONI............................109heartburn relief 150 max st ..... 138HEATHER............................. 73HECTOROL...........................97HELIXATE FS..................... 104HEMANGEOL...................... 66hematinic plus vit/minerals ......107hematinic/folic acid .................107HEMATOGEN FA.............. 107HEMATOGEN FORTE.......107hemenatal ob .......................... 119hemetab ..................................107HEMLIBRA........................... 45HEMOCYTE PLUS............. 107HEMOCYTE-F.................... 107hemocyte-plus .........................107HEMOFIL M....................... 104HEPAGAM B.......................129heparin sodium (porcine) ......... 32heparin sodium (porcine) pf ..... 32HEPSERA.............................. 62HETLIOZ............................. 110HEXALEN............................. 55HIPREX................................140HIZENTRA..........................129hm folic acid ...........................107hm vitamin d3 .........................143HORIZANT......................... 133HP ACTHAR......................... 97HUMALOG........................... 40HUMALOG KWIKPEN....... 40HUMALOG MIX 50/50......... 40HUMALOG MIX 50/50 KWIKPEN............................. 40HUMALOG MIX 75/25......... 40HUMALOG MIX 75/25 KWIKPEN............................. 40HUMATE-P......................... 104HUMATROPE.......................97HUMIRA............................... 20HUMIRA PEDIATRIC CROHNS START.................. 20HUMIRA PEN.......................20HUMIRA PEN-CD/UC/HS STARTER.............................. 20HUMIRA PEN-PS/UV STARTER.............................. 20
HUMULIN 70/30................... 40HUMULIN 70/30 KWIKPEN............................. 40HUMULIN N.........................40HUMULIN N KWIKPEN.....40HUMULIN R.........................40HUMULIN R U-500 (CONCENTRATED)............. 40HUMULIN R U-500 KWIKPEN............................. 40HYALGAN.......................... 121HYCAMTIN.......................... 55hydralazine hcl ......................... 49HYDREA............................... 55hydrochlorothiazide ..................95hydrocod polst-cpm polst er ...... 78hydrocodone-acetaminophen .....24hydrocodone-homatropine ........ 78hydrocodone-ibuprofen ............. 24hydrocortisone .............. 28, 77, 84hydrocortisone ace-pramoxine...........................................27, 84hydrocortisone acetate ........ 27, 84hydrocortisone butyr lipo base .. 84hydrocortisone butyrate ............84hydrocortisone valerate ............ 84hydrocortisone-acetic acid ...... 127hydromorphone hcl ...................24hydromorphone hcl er ............... 24hydroxychloroquine sulfate .......52hydroxyprogesterone caproate 131hydroxyurea .............................55hydroxyzine hcl ........................ 29hydroxyzine pamoate ............... 29HYLAFEM............................ 65HYMOVIS............................121hyophen ..................................140hyoscyamine sulfate ................138HYPERHEP B S/D...............129HYPERRAB.........................129HYPERRHO S/D................. 129HYPERTET S/D...................129HYQVIA...............................128HYSINGLA ER..................... 24HYZAAR............................... 49ibandronate sodium .................. 97IBRANCE.............................. 79IBUDONE..............................24ibudone .................................... 24ibuprofen ..................................20
IBUPROFEN COMFORT PAC........................................ 20IC 400......................................20IC 800......................................20ICLUSIG................................ 55IDELVION........................... 104IDHIFA................................ 111ILARIS................................... 20ILEVRO................................124ILUMYA................................ 84imatinib mesylate ..................... 55IMBRUVICA......................... 55imipramine hcl ..........................37imipramine pamoate ................. 37imiquimod ................................ 84IMITREX............................. 116IMITREX STATDOSE REFILL................................ 116IMITREX STATDOSE SYSTEM...............................116IMPAVIDO............................ 51IMPOYZ.................................84IMURAN............................... 65IMVEXXY MAINTENANCE PACK.....141IMVEXXY STARTER PACK....................................141IN TOUCH BLOOD GLUCOSE TEST................... 93INCRELEX............................ 97INCRUSE ELLIPTA............. 31indapamide ...............................95INDERAL LA........................66INDERAL XL........................66INDOCIN...............................20indomethacin ............................20indomethacin er ........................20INFINITY BLOOD GLUCOSE TEST................... 93INFLECTRA........................101INGREZZA..........................133INLYTA................................. 55INNOPRAN XL.....................66INSPRA..................................49insulin syringe ........................ 114insulin syringe/needle ..............114insulin syringe-needle u-100 .... 114INTEGRA F.........................107INTEGRA PLUS..................107INTELENCE..........................62
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INTERMEZZO.................... 110INTRAROSA....................... 141INTRON A.............................55INTROVALE......................... 73INTUNIV............................... 17INVEGA.................................59INVIRASE............................. 62INVOKAMET...................... 135INVOKAMET XR............... 135INVOKANA.......................... 40iodine strong ...........................117IOPIDINE............................ 124ipratropium bromide ......... 31, 122ipratropium-albuterol ............... 31IPRIVASK..............................33irbesartan .................................49irbesartan-hydrochlorothiazide . 49IRESSA...................................55irinotecan hcl ............................55IROSPAN 24/6......................107IS 24/6................................... 107ISENTRESS........................... 62ISENTRESS HD.................... 62ISIBLOOM............................. 73isoniazid ...................................53ISOPTO CARPINE.............. 124ISORDIL TITRADOSE.........28isosorbide dinitrate ................... 28isosorbide dinitrate er ............... 28isosorbide mononitrate ............. 28isosorbide mononitrate er ..........28isradipine ................................. 68ISTALOL..............................124itraconazole ............................. 44ivermectin ................................ 28IXINITY...............................104JADENU................................ 43JADENU SPRINKLE............43JAKAFI.................................. 55JALYN..................................102JANTOVEN........................... 33JANUMET............................. 40JANUMET XR...................... 40JANUVIA...............................40JARDIANCE......................... 40JENCYCLA............................73JENTADUETO...................... 40JENTADUETO XR............... 40JETREA................................125jevantique lo ............................. 99
JEVTANA.............................. 55JINTELI................................. 99JOLESSA................................73JOLIVETTE........................... 73JUBLIA.................................. 84JULUCA.................................62JUNEL 1.5/30......................... 73JUNEL 1/20............................ 73JUNEL FE 1.5/30................... 73JUNEL FE 1/20...................... 73JUXTAPID.............................47JYNARQUE...........................97KADIAN................................ 24KALBITOR.......................... 104KALETRA............................. 62KALYDECO........................ 135KANUMA............................112KAPSPARGO SPRINKLE....66KAPVAY................................17KARBINAL ER..................... 45KARIVA.................................73KAZANO............................... 40KCENTRA........................... 104KEFLEX................................ 71KELNOR 1/35........................ 73KENALOG............................ 85KEPPRA.................................34KEPPRA XR.......................... 34KERYDIN............................128ketoconazole .......................44, 85ketoprofen er ............................20ketorolac tromethamine .... 20, 125ketotifen fumarate .................. 125KEVEYIS............................... 95KEVZARA............................. 20KHEDEZLA.......................... 37KINERET.............................. 20KIONEX......................... 65, 131KISQALI 200 DOSE.............. 79KISQALI 400 DOSE.............. 79KISQALI 600 DOSE.............. 79KISQALI FEMARA 200 DOSE......................................55KISQALI FEMARA 400 DOSE......................................55KISQALI FEMARA 600 DOSE......................................55KLARON............................... 85KLOFENSAID II...................85KLONOPIN........................... 34
KLOR-CON......................... 117KLOR-CON 10.....................117KOATE.................................104KOATE-DVI........................ 104KOGENATE FS...................104KOGENATE FS BIO-SET...104KOMBIGLYZE XR...............41KORLYM...............................41KOVALTRY........................ 104kp folic acid ............................107K-PHOS-NEUTRAL............117KRISTALOSE......................111kroger blood glucose test .......... 93kroger test ................................93KRYSTEXXA...................... 103K-TAB.................................. 117K-TAN PLUS....................... 107KURVELO.............................73KUVAN..................................97KYLEENA............................. 73KYNAMRO........................... 47labetalol hcl ..............................66LACRISERT........................ 125lactulose ................................. 111lactulose encephalopathy ........ 101LAMICTAL........................... 34LAMICTAL ODT.................. 34LAMICTAL STARTER.........34LAMICTAL XR.....................34LAMISIL................................44lamivudine ................................62lamivudine-zidovudine .............. 62lamotrigine ...............................34lamotrigine er ...........................34lamotrigine starter kit-blue ....... 34lamotrigine starter kit-green ..... 34lamotrigine starter kit-orange ...34lancets ....................................114lancets super thin 28g ............. 114LANCETS ULTRA THIN... 114lancets ultra thin 30g .............. 114LANOXIN..............................69lansoprazole ........................... 138lanthanum carbonate .............. 101LANTUS................................ 41LANTUS SOLOSTAR........... 41LARIN 1.5/30......................... 73LARIN 1/20............................ 73LARIN FE 1.5/30................... 73LARIN FE 1/20...................... 73
157
LASIX.....................................95LASTACAFT....................... 125latanoprost ............................. 125LATUDA................................59LAZANDA.............................24LDO PLUS............................. 85LEENA................................... 74leflunomide ...............................20LEMTRADA........................133LENVIMA 10 MG DAILY DOSE......................................55LENVIMA 12 MG DAILY DOSE......................................55LENVIMA 14 MG DAILY DOSE......................................55LENVIMA 18 MG DAILY DOSE......................................55LENVIMA 20 MG DAILY DOSE......................................55LENVIMA 24 MG DAILY DOSE......................................55LENVIMA 4 MG DAILY DOSE......................................56LENVIMA 8 MG DAILY DOSE......................................56LESCOL................................. 47LESCOL XL........................... 47LESSINA................................74LETAIRIS.............................. 70letrozole ................................... 56leucovorin calcium ....................56LEUKERAN.......................... 56LEUKINE............................ 107leuprolide acetate ..................... 56levalbuterol hcl ......................... 31LEVAQUIN..........................100LEVEMIR.............................. 41LEVEMIR FLEXTOUCH..... 41levetiracetam ............................34levetiracetam er ........................34levobunolol hcl ........................125levocarnitine .............................97levocetirizine dihydrochloride ... 45levofloxacin .................... 100, 125LEVONEST............................74levonorgest-eth estrad 91-day ... 74levonorgestrel ...........................74levonorgestrel-ethinyl estrad ..... 74LEVORA 0.15/30 (28).............74levorphanol tartrate ..................24
levothyroxine sodium ..............137LEVOXYL............................137LEVULAN KERASTICK......85LEXAPRO..............................37LEXIVA..................................62LIALDA............................... 101LIBERTY NEXT GENERATION TEST........... 93liberty test ................................93LIBRAX............................... 138lidocaine ...................................85lidocaine hcl ............................. 85lidocaine pak ............................ 85lidocaine viscous ..................... 118lidocaine-hydrocortisone ace .....28lidocaine-prilocaine .................. 85lidocaine-tetracaine .................. 85LIDODERM.......................... 85LIFESCAN UNISTIK 2.......114LIFESCAN UNISTIK II LANCETS............................ 114lindane ..................................... 85linezolid ................................... 52LINZESS.............................. 101liothyronine sodium ................ 137LIPITOR.................................47LIPOFEN............................... 47lisinopril ...................................49lisinopril-hydrochlorothiazide ... 49lite touch lancets .....................115LITETOUCH LANCETS.....115lithium ..................................... 59lithium carbonate ..................... 59lithium carbonate er ................. 59LITHOBID............................. 59LIVALO..................................47LO LOESTRIN FE.................74LOCOID................................. 85LOCOID LIPOCREAM.........85LODINE................................. 20LODOSYN............................. 58LOESTRIN 1.5/30 (21)........... 74LOESTRIN 1/20 (21).............. 74LOKELMA..................... 65, 131LOMOTIL.............................. 42LONHALA MAGNAIR REFILL KIT.......................... 31LONHALA MAGNAIR STARTER KIT...................... 31LONSURF............................. 56
LOPID.................................... 47lopinavir-ritonavir .................... 62LOPRESSOR HCT.................49LOPROX................................ 85loratadine .................................45loratadine childrens .................. 45loratadine-d 12hr ......................78loratadine-d 24hr ......................78lorazepam ................................ 29LORCET................................ 24LORCET HD......................... 24LORCET PLUS......................24LORTAB................................ 24LORYNA............................... 74LORZONE........................... 121losartan potassium ....................49losartan potassium-hctz ............ 50LOSEASONIQUE..................74LOTEMAX...........................125LOTENSIN............................ 50LOTREL.................................50LOTRISONE..........................85LOTRONEX.........................101lovastatin ................................. 47LOVAZA................................ 47LOVENOX............................. 33LOW-OGESTREL................. 74loxapine succinate .................... 59LUCEMYRA......................... 18LUCENTIS...........................125luliconazole .............................. 85LUMIGAN...........................125LUMIZYME.......................... 97LUNESTA............................ 110LUPANETA PACK............. 112LUPRON DEPOT (1-MONTH)................................ 56LUPRON DEPOT (3-MONTH)................................ 56LUPRON DEPOT (4-MONTH)................................ 56LUPRON DEPOT (6-MONTH)................................ 56LUPRON DEPOT-PED (1-MONTH)................................ 97LUPRON DEPOT-PED (3-MONTH)................................ 97LUTERA................................ 74LUXIQ....................................85LUZU..................................... 85
158
LYNPARZA................. 130, 131LYRICA................................. 34LYRICA CR................. 131, 133LYSODREN...........................56LYSTEDA............................ 109LYZA......................................74MACROBID.........................140MACRODANTIN................140MACUGEN..........................125MAKENA............................ 131MALARONE......................... 52malathion .................................85maprotiline hcl ......................... 37MARINOL............................. 43marlissa ................................... 74MARPLAN............................ 37MATULANE......................... 56MATZIM LA......................... 68MAVIK...................................50MAVYRET...........................109MAXALT............................. 116MAXALT-MLT................... 116MAXFE................................ 107MAXIDEX........................... 125MAXIMUM D3................... 143MAXIPIME............................71MAXITROL......................... 125MAXZIDE............................. 95MAXZIDE-25.........................95meclofenamate sodium ............. 20MEDROL...............................77medroxyprogesterone acetate......................................... 74, 131mefenamic acid .........................20mefloquine hcl .......................... 52MEGACE ES........................131megestrol acetate .............. 56, 131meijer blood glucose test ...........93MEIJER TRUETEST TEST.. 93MEIJER TRUETRACK TEST.......................................93MEKINIST.............................56MEKTOVI..............................56meloxicam ................................20melphalan .................................56melphalan hcl ........................... 56memantine hcl ........................ 133memantine hcl er .................... 133MENEST................................ 99MENOSTAR.......................... 99
meperidine hcl .......................... 24MEPHYTON........................143meprobamate ........................... 29MEPRON............................... 52mercaptopurine ........................ 56mesalamine ............................ 101MESTINON......................52, 53METADATE ER....................17metaproterenol sulfate ..............31metaxalone .............................121metformin hcl ........................... 41metformin hcl er ....................... 41metformin hcl er (mod) ............41metformin hcl er (osm) ............ 41methadone hcl .......................... 24METHADONE HCL INTENSOL............................ 24METHADOSE....................... 24METHADOSE SUGAR-FREE...................................... 25methamphetamine hcl ...............17methazolamide ......................... 95methenamine hippurate ...........140methenamine mandelate ..........140METHERGINE................... 128methimazole ........................... 137methitest .................................. 27methocarbamol .......................121methotrexate ............................56methotrexate sodium (pf) ........ 56methoxsalen rapid .................... 85methyclothiazide ...................... 95methyldopa .............................. 50methyldopa-hydrochlorothiazide ..................50METHYLIN...........................17methylphenidate hcl ..................18methylphenidate hcl er ..............18methylphenidate hcl er (cd) ......18methylphenidate hcl er (la) ...... 18methylprednisolone ...................77methyltestosterone ................... 27metipranolol ........................... 125metoclopramide hcl .................101metolazone ...............................95metoprolol succinate er .............66metoprolol tartrate ................... 66metoprolol-hctz er .................... 50metoprolol-hydrochlorothiazide 50METROCREAM................... 85
METROGEL.......................... 85METROGEL-VAGINAL.....141METROLOTION...................85metronidazole ..............52, 85, 142MEVACOR............................ 47mexiletine hcl ........................... 29MIACALCIN......................... 97MIBELAS 24 FE.................... 74MICARDIS............................ 50MICARDIS HCT................... 50miconazole 3 ...........................142MICORT-HC......................... 85MICRHOGAM ULTRA-FILTERED PLUS................ 129MICRODOT TEST................ 93MICROGESTIN 1.5/30.......... 74MICROGESTIN 1/20.............74MICROGESTIN FE 1.5/30.... 74MICROGESTIN FE 1/20....... 74MICROLET LANCETS.......115MICROTAINER SAFETY FLOW LANCET.................. 115MICROZIDE......................... 95midodrine hcl ..........................142miglitol .................................... 41miglustat ................................ 107MIGRANAL........................ 116MILLIPRED.......................... 77MIMVEY................................99MIMVEY LO......................... 99MINASTRIN 24 FE............... 74MINIPRESS........................... 50MINITRAN........................... 28MINIVELLE.......................... 99MINOCIN............................ 136minocycline hcl .......................136minocycline hcl er ................... 136minoxidil ..................................50MIRALAX........................... 111MIRAPEX..............................58MIRAPEX ER........................58MIRCERA............................107MIRCETTE............................74MIRENA (52 MG)................. 74mirtazapine .............................. 37MIRVASO..............................85misoprostol .............................138MITIGARE.......................... 103mixed vespid venom protein ...... 67MOBIC................................... 20
159
modafinil ..................................18moderiba .................................. 62MODERIBA 1200 DOSE PACK..................................... 62MODERIBA 800 DOSE PACK..................................... 62moexipril hcl ............................ 50moexipril-hydrochlorothiazide .. 50mometasone furoate .... 85, 86, 122MONOCLATE-P..................104MONO-LINYAH................... 74MONONESSA....................... 74MONONINE........................ 104MONOVISC......................... 121montelukast sodium ..................31MONUROL..........................140morcin ......................................65MORGIDOX........................136MORPHABOND ER............. 25morphine sulfate .......................25morphine sulfate (concentrate) .25morphine sulfate er ...................25morphine sulfate er beads ......... 25MOTOFEN............................ 42MOVANTIK........................ 101MOVIPREP.......................... 111MOXATAG..........................130MOXEZA............................. 125moxifloxacin hcl ............. 100, 125MOZOBIL............................ 107MS CONTIN.......................... 25MULPLETA.........................107MULTAQ...............................29MULTIGEN.........................107MULTIGEN FOLIC............ 108MULTIGEN PLUS.............. 108multivitamin/fluoride .............. 119mupirocin ................................. 86mupirocin calcium .................... 86MYALEPT........................... 112MYAMBUTOL...................... 53MYCOBUTIN........................53mycophenolate mofetil ..............65mycophenolate sodium ..............65MYDAYIS..............................18MYDRIACYL......................125MYFORTIC........................... 65MYGLUCOHEALTH TEST. 93MYLERAN............................ 56MYNATAL.......................... 119
MYNATAL ADVANCE......119mynatal plus ...........................119mynatal-z ............................... 119myorisan .................................. 86MYORISAN...........................86MYRBETRIQ.......................141MYSOLINE........................... 34MYTESI................................. 42na ferric gluc cplx in sucrose ... 108NABI-HB..............................129nabumetone ..............................21nadolol ..................................... 66nadolol-bendroflumethiazide .....50NAFRINSE DAILY ACIDULATED.................... 118NAFRINSE DAILY/NEUTRAL..............118NAFRINSE WEEKLY........ 118naftifine hcl .............................. 86NAFTIN................................. 86NAGLAZYME.......................97nalbuphine hcl .......................... 25NALFON................................21nalocet ..................................... 25naltrexone hcl ...........................43NAMENDA......................... 133NAMENDA TITRATION PAK...................................... 133NAMENDA XR...................133NAMENDA XR TITRATION PACK.............133NAMZARIC.......................... 36NAPRELAN.......................... 21napro ....................................... 86NAPROSYN.......................... 21naproxen ..................................21NAPROXEN COMFORT PAC........................................ 21naproxen dr ..............................21naproxen sodium ...................... 21naproxen sodium er .................. 21naratriptan hcl ........................116NARCAN............................... 43NARDIL.................................37NASACORT ALLERGY 24HR.....................................122NASACORT ALLERGY 24HR CHILDREN...............122nasal allergy 24 hour .............. 122NASCOBAL......................... 108
NASONEX........................... 122NATACYN...........................125NATAZIA.............................. 74nateglinide ................................41NATESTO.............................. 27NATPARA............................. 97NATROBA.............................86nat-rul vitamin d .....................143natural vitamin d-3 ................. 143NATURE-THROID.............137NEBUPENT........................... 52NEBUSAL..............................78NECON 0.5/35 (28).................74NECON 1/35 (28)....................74NEEVO DHA....................... 119nefazodone hcl .................. 37, 135neomycin sulfate .......................18neomycin-polymyxin-dexameth...............................................125neomycin-polymyxin-hc .. 127, 128NEORAL................................65NEOSPORIN........................125NEO-SYNALAR....................86NEPHPLEX RX................... 119NEPHRON FA.....................108NERLYNX.............................56NESINA................................. 41NESTABS............................. 119NEUAC.................................. 86NEULASTA......................... 108NEULASTA ONPRO.......... 108NEUPOGEN........................ 108NEUPRO................................58neurin-sl ................................. 108NEURONTIN........................ 34NEUTEK 2TEK TEST...........93NEUTRASAL...................... 118NEVANAC...........................125nevirapine .................................62nevirapine er .............................62NEXAVAR.............................56NEXIUM..............................139NEXIUM 24HR................... 138NEXPLANON....................... 74NEXT CHOICE ONE DOSE.74niacin er (antihyperlipidemic) .. 47NIACOR.................................47NIASPAN...............................47nicardipine hcl .......................... 68NICOMIDE..........................119
160
nicotine .................................. 133nicotine polacrilex .................. 133NICOTROL..........................133NICOTROL NS....................133NIFEDICAL XL.................... 68nifedipine ................................. 68nifedipine er ............................. 68nifedipine er osmotic release ..... 68NIKKI.................................... 74NILANDRON........................56nilutamide ................................ 56nimodipine ................................68NINLARO..............................56nisoldipine er ............................ 69NITRO-BID........................... 28NITRO-DUR......................... 28nitrofurantoin .........................140nitrofurantoin macrocrystal .... 140nitrofurantoin monohyd macro140nitroglycerin .............................28NITROLINGUAL................. 28NITROMIST.......................... 28NITROSTAT..........................28NITYR....................................97nizatidine ................................139NOCTIVA.............................. 97NOLIX....................................86NORA-BE.............................. 75NORCO.................................. 25NORDITROPIN FLEXPRO. 97norethin ace-eth estrad-fe ......... 75norethindrone ........................... 75norethindrone-eth estradiol ....... 99norethin-eth estradiol-fe ........... 75norgestimate-eth estradiol ........ 75norgestim-eth estrad triphasic ...75NORITATE............................86NORPACE............................. 29NORPACE CR.......................29NORPRAMIN....................... 37NORTHERA........................ 122NORTREL 0.5/35 (28)............75NORTREL 1/35 (21)...............75NORTREL 1/35 (28)...............75NORTREL 7/7/7.....................75nortriptyline hcl ........................37NORVASC............................. 69NORVIR.................................62NOVA MAX GLUCOSE TEST.......................................93
NOVOEIGHT.......................104NOVOLIN 70/30.....................41NOVOLIN 70/30 RELION.....41NOVOLIN N.......................... 41NOVOLIN N RELION.......... 41NOVOLIN R.......................... 41NOVOLIN R RELION.......... 41NOVOLOG............................ 41NOVOLOG FLEXPEN..........41NOVOLOG MIX 70/30.......... 41NOVOLOG MIX 70/30 FLEXPEN.............................. 41NOVOLOG PENFILL........... 41NOVOSEVEN RT................ 104NOXAFIL.............................. 44np thyroid ...............................137NPLATE...............................108NUCALA............................. 111NUCYNTA............................ 25NUCYNTA ER...................... 25NUEDEXTA........................ 133NUFOL.................................108NULOJIX............................... 65NULYTELY WITH FLAVOR PACKS.................111NUPLAZID............................59NUTROPIN AQ NUSPIN 10 97NUTROPIN AQ NUSPIN 20 97NUTROPIN AQ NUSPIN 5.. 97NUVARING.......................... 75NUVESSA............................ 142NUVIGIL............................... 18NUWIQ................................ 104NYMALIZE........................... 69nystatin .......................44, 86, 118nystatin-triamcinolone ..............86OB COMPLETE GOLD.......119O-CAL PRENATAL............ 119OCALIVA.............................100OCELLA................................ 75OCTAGAM.......................... 129octreotide acetate ..................... 97OCUFLOX........................... 125OCUVEL.............................. 119ODACTRA...........................117ODEFSEY.............................. 62ODOMZO...............................56OFEV.................................... 134ofloxacin ................. 100, 125, 128OGESTREL............................75
olanzapine ................................59olanzapine-fluoxetine hcl ........ 133olmesartan medoxomil ............. 50olmesartan medoxomil-hctz ...... 50olmesartan-amlodipine-hctz ......50olopatadine hcl ................122, 125OLUMIANT.......................... 21OLUX..................................... 86OLUX-E................................. 86OMECLAMOX-PAK...........139omega-3-acid ethyl esters ..........47omeprazole .............................139omeprazole magnesium ...........139OMEPRAZOLE+SYRSPEND SF ALKA..........................139omeprazole-sodium bicarbonate ............................ 139OMNARIS............................122OMNIPRED.........................125OMNITROPE........................ 97ON CALL EXPRESS BLOOD GLUCOSE............... 93ON CALL PLUS BLOOD GLUCOSE..............................93ON CALL VIVID BLOOD GLUCOSE..............................93ondansetron ..............................43ondansetron hcl ........................ 44ONETOUCH CLUB LANCETS FINE PT............ 115ONETOUCH COMBO PACK....................................115ONETOUCH DELICA LANCETS 33G.....................115ONETOUCH DELICA LANCETS FINE.................. 115ONETOUCH DELICA LANCING DEV...................115ONETOUCH FINEPOINT LANCETS............................ 115ONETOUCH ULTRA BLUE......................................93ONETOUCH ULTRASOFT LANCETS............................ 115ONETOUCH VERIO.............93ONEXTON.............................86ONFI...................................... 35ONGLYZA.............................41ONZETRA XSAIL...............116OPANA.................................. 25
161
OPANA ER............................ 25OPSUMIT...............................70OPTIMAL D3 M.................. 143OPTIMAL-D........................ 143OPTION 2...............................75OPURITY VITAMIN D...... 143ORACEA................................86ORALAIR............................ 117ORALAIR ADULT SAMPLE KIT.......................117ORALAIR ADULT STARTER PACK.................118ORALAIR CHILDRENS SAMPLE KIT.......................118ORALAIR CHILDRENS STARTER PACK.................118ORAP....................................133ORAPRED ODT....................77ORAVIG...............................118ORENCIA.............................. 21ORENCIA CLICKJECT........21ORENITRAM........................70ORFADIN..............................97ORILISSA.............................. 97ORKAMBI............................. 79orphenadrine citrate er ............121ORSYTHIA............................75ortho d ................................... 108ORTHO MICRONOR........... 75ORTHO TRI-CYCLEN (28).. 75ORTHO TRI-CYCLEN LO... 75ORTHO-CYCLEN (28)..........75ORTHO-NOVUM 1/35 (28)... 75ORTHO-NOVUM 7/7/7 (28).. 75ORTHOVISC........................121oseltamivir phosphate ............... 62OSENI.................................... 41OSMOLEX ER.......................58OSMOPREP......................... 111OSPHENA..............................97OTEZLA...............................130OTICIN HC NR................... 128OTIPRIO.............................. 128otomax-hc .............................. 128OTOVEL...............................128OTREXUP............................. 21OVIDE....................................86OXANDRIN.......................... 27oxaprozin .................................21OXAYDO............................... 25
oxazepam .................................29oxcarbazepine .......................... 35oxiconazole nitrate ................... 86OXISTAT............................... 86OXSORALEN ULTRA......... 86OXTELLAR XR.................... 35oxybutynin chloride ................ 141oxybutynin chloride er ............ 141oxycodone hcl .......................... 25oxycodone hcl er .......................25oxycodone-acetaminophen ........25oxycodone-aspirin .................... 25oxycodone-ibuprofen ................ 25OXYCONTIN........................ 25oxymorphone hcl ...................... 25oxymorphone hcl er .................. 25OXYTROL........................... 141OXYTROL FOR WOMEN..141OZEMPIC.............................. 42pa vitamin d-3 .........................143paliperidone er ..........................59PALYNZIQ............................ 97PAMELOR.............................37pamidronate disodium .............. 97PANCREAZE........................ 94PANDEL................................ 86PANRETIN............................86pantoprazole sodium ...............139PARAGARD INTRAUTERINE COPPER..75paricalcitol ......................... 97, 98PARLODEL........................... 58PARNATE............................. 37paroex ....................................118paromomycin sulfate ................ 18paroxetine hcl ...........................37paroxetine hcl er .......................37paroxetine mesylate ................133PASER....................................53PATADAY........................... 125PATANASE..........................122PATANOL............................125PAXIL.................................... 37PAXIL CR.............................. 37PAZEO..................................126peg 3350 .................................111peg 3350/electrolytes .............. 111peg 3350-kcl-na bicarb-nacl .... 111peg-3350/electrolytes .............. 111PEGANONE.......................... 35
PEGASYS...............................62PEGASYS PROCLICK..........62PEG-PREP............................111pen needles ............................. 115pen needles 1/2" ...................... 115pen needles 3/16" .................... 115pen needles 5/16" .................... 115penicillin v potassium ..............130PENLAC.................................86PENNSAID............................ 86PENTASA............................ 101pentazocine-naloxone hcl ..........25pentoxifylline er ..................... 105PEPCID................................ 139PERCOCET............................26PERFOROMIST.................... 31perindopril erbumine .................50periogard ................................118permethrin ................................86perphenazine ............................ 60perphenazine-amitriptyline ..... 133PERTZYE.............................. 94PEXEVA.................................37PHENADOZ.......................... 46phenelzine sulfate ..................... 37phenobarbital ......................... 110phenoxybenzamine hcl ..............50PHENYTEK...........................35phenytoin ................................. 35PHENYTOIN INFATABS.... 35phenytoin sodium extended ....... 35PHILITH................................ 75PHOSLO...............................101phosphasal ..............................140PHOSPHOLINE IODIDE....126phytonadione ..........................143PICATO..................................86pilocarpine hcl ........................ 126pimozide .................................133PIMTREA.............................. 75pindolol .................................... 66pioglitazone hcl ........................ 42pioglitazone hcl-glimepiride ...... 42pioglitazone hcl-metformin hcl ..42piperacillin sod-tazobactam so 130PIRMELLA 1/35.................... 75piroxicam .................................21PLAN B ONE-STEP...............75PLAQUENIL......................... 52PLAVIX................................105
162
PLEGRIDY.......................... 133PLEGRIDY STARTER PACK....................................133PLENVU.............................. 111PLEXION...............................87PLEXION CLEANSER......... 87PLEXION CLEANSING CLOTH...................................87PLIAGLIS.............................. 87pnv-omega ..............................119POCKETCHEM EZ TEST.....93podofilox ..................................87polyethylene glycol 3350 .........111polymyxin b-trimethoprim ...... 126POLYTRIM..........................126POLY-VI-FLOR...................119POLY-VI-FLOR FS............. 119POMALYST...........................56PONSTEL...............................21PORTIA-28.............................75potassium chloride .................. 117potassium chloride crys er .......117potassium chloride er .............. 117potassium citrate er ................ 102PRADAXA.............................33PRALUENT......................... 129pramipexole dihydrochloride .....58pramipexole dihydrochloride er .58PRAMOSONE....................... 87PRANDIN..............................42prasugrel hcl ...........................105PRAVACHOL........................47pravastatin sodium ................... 47praziquantel ............................. 28prazosin hcl .............................. 50PRECISION PCX...................93PRECISION PCX PLUS TEST.......................................93PRECISION POINT OF CARE TEST........................... 93PRECISION QID TEST.........93PRECISION SOF-TACT TEST.......................................93PRECISION XTRA BLOOD GLUCOSE..............................93PRECOSE...............................42PRED FORTE......................126PRED MILD........................ 126PRED-G................................126PRED-G S.O.P..................... 126
prednicarbate ........................... 87prednisolone ............................. 77prednisolone acetate ............... 126prednisolone sodium phosphate......................................... 77, 126prednisone ................................77PREDNISONE INTENSOL.. 77PREFERAOB ONE..............119PREFEST............................... 99PREMARIN................... 99, 142PREMPHASE........................ 99PREMPRO............................. 99PRENATABS RX.................119prenatal plus iron ....................119PRENATE MINI..................119PREPIDIL............................ 128PREPOPIK........................... 111PRESTALIA...........................50PREVACID.......................... 139PREVACID 24HR................139PREVACID SOLUTAB....... 139PREVALITE.......................... 47PREVIDENT 5000 PLUS.....118PREVIFEM............................ 75PREVPAC............................ 139PREVYMIS............................ 62PREZCOBIX.......................... 62PREZISTA............................. 63PRIALT.................................. 22PRIFTIN................................ 53PRILOSEC........................... 139PRILOSEC OTC...................139primaquine phosphate ...............52primidone ................................. 35PRIMLEV.............................. 26PRINIVIL...............................50PRISTIQ................................. 37PRIVIGEN........................... 129PROAIR HFA........................31PROAIR RESPICLICK......... 31probenecid ..............................103PROCARDIA.........................69PROCARDIA XL.................. 69PROCENTRA........................ 18prochlorperazine .......................60prochlorperazine maleate ..........60PROCRIT............................. 108PROCTOCORT......................28PROCTOFOAM HC..............28PROCTO-PAK....................... 28
PROCTOZONE-HC...............28PROCYSBI........................... 102PRODIGY NO CODING BLOOD GLUC...................... 93PROFERRIN-FORTE......... 108PROFILNINE...................... 105PROFILNINE SD................ 105PROGLYCEM....................... 42PROGRAF............................. 65PROLASTIN-C.................... 135PROLENSA..........................126PROLIA..................................98PROMACTA........................ 108promethazine hcl ...................... 46promethazine vc ....................... 78promethazine vc/codeine ........... 78promethazine-dm ......................78PROMETHEGAN................. 46PROMETRIUM...................131propafenone hcl ........................ 29propafenone hcl er .................... 30propantheline bromide ............ 139proparacaine-fluorescein .........126propranolol hcl ......................... 66propranolol hcl er ..................... 66propranolol-hctz .......................50propylthiouracil ......................137PROSCAR............................ 102PROTECTIRON.................. 108PROTONIX..........................139PROTOPIC.............................87protriptyline hcl ........................37PROVENTIL HFA.................31PROVERA............................131PROVIGIL............................. 18PROZAC................................ 37PRUDOXIN...........................87pseudoeph-chlorphen-hydrocod . 78psorcon .................................... 87PTS PANELS GLUCOSE TEST.......................................93PULMICORT.........................31PULMICORT FLEXHALER........................ 31PULMOZYME.....................135purefe plus ..............................108purevit dualfe plus .................. 108PURIXAN.............................. 56px folic acid ............................108PYLERA...............................139
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pyrazinamide ............................53PYRIDIUM..........................102pyridostigmine bromide ............ 53pyridostigmine bromide er ...52, 53QBRELIS................................50QNASL................................. 122QNASL CHILDRENS......... 122QTERN.................................135QUALAQUIN........................52QUARTETTE........................ 75QUASENSE........................... 75quazepam ............................... 110QUDEXY XR.........................35QUESTRAN...........................47QUESTRAN LIGHT............. 47quetiapine fumarate ..................60quetiapine fumarate er ..............60QUFLORA FE..................... 118QUFLORA FE PEDIATRIC...............................................119QUFLORA PEDIATRIC.....119QUILLICHEW ER.................18QUILLIVANT XR................. 18quinapril hcl ............................. 50quinapril-hydrochlorothiazide ... 50quinidine gluconate er ...............30quinidine sulfate ....................... 30quinine sulfate .......................... 52QVAR REDIHALER.............31ra folic acid ............................ 108RA TRUETEST TEST........... 93ra vitamin d-3 ......................... 143rabeprazole sodium .................139RADIOGARDASE................ 43RAGWITEK.......................... 67RAJANI..................................75raloxifene hcl ........................... 98ramipril ....................................50RANEXA............................... 28ranitidine hcl ...................139, 140RAPAFLO............................102RAPAMUNE......................... 65rasagiline mesylate ................... 58RASUVO................................ 21RAVICTI................................98RAYALDEE.......................... 98RAYOS...................................77RAZADYNE........................ 133RAZADYNE ER..................133REBETOL.............................. 63
REBIF...................................134REBIF REBIDOSE.............. 133REBIF REBIDOSE TITRATION PACK.............134REBIF TITRATION PACK 134REBINYN............................ 105RECLAST.............................. 98RECLIPSEN...........................76RECOMBINATE................. 105RECTIV..................................28REGLAN..............................101REGRANEX..........................87RELENZA DISKHALER......63RELEXXII............................. 18RELISTOR........................... 101RELPAX...............................116REMERON............................ 37REMERON SOLTAB............ 37REMICADE......................... 101REMODULIN....................... 70RENAGEL........................... 101RENFLEXIS........................ 101RENVELA............................101repaglinide ............................... 42repaglinide-metformin hcl .........42REPATHA............................129REPATHA PUSHTRONEX SYSTEM...............................129REPATHA SURECLICK.... 129REPLESTA...........................143REPLESTA CHILDRENS...143REPLESTA NX....................143REQUIP................................. 58REQUIP XL........................... 58RESCRIPTOR........................63RESTASIS............................ 126RESTASIS MULTIDOSE....126RESTORIL........................... 110RETACRIT.......................... 108RETIN-A................................87RETIN-A MICRO..................87RETIN-A MICRO PUMP......87RETROVIR............................63REVATIO...............................70revesta ....................................108REVLIMID............................ 65REXULTI...............................60REYATAZ............................. 63RHINOCORT ALLERGY.. 122RHOFADE.............................87
RHOGAM ULTRA-FILTERED PLUS................ 129RHOPHYLAC......................129RHOPRESSA....................... 127RIASTAP..............................105ribasphere ................................ 63ribasphere ribapak ....................63ribavirin ................................... 63RIDAURA............................. 21rifabutin ................................... 53RIFADIN............................... 53RIFAMATE........................... 53rifampin ................................... 53RIFATER...............................53RILUTEK.............................122riluzole ................................... 122rimantadine hcl ........................ 63RIOMET.................................42risedronate sodium ................... 98RISPERDAL.......................... 60risperidone ............................... 60RISPERIDONE M-TAB........ 60RITALIN................................18RITALIN LA......................... 18ritonavir ................................... 63rivastigmine ............................134rivastigmine tartrate ............... 134RIVELSA............................... 76RIXUBIS.............................. 105rizatriptan benzoate ................116ROBAXIN............................ 121ROBINUL............................ 140ROBINUL-FORTE.............. 140ROCALTROL........................ 98ROCEPHIN............................71ropinirole hcl ............................ 58ropinirole hcl er ........................ 58ROSADAN.............................87ROSANIL CLEANSER......... 87rosuvastatin calcium ................. 47ROXICODONE..................... 26ROZEREM...........................110RUBRACA...........................131RUCONEST......................... 105RYDAPT................................ 56rynoderm ..................................87RYTARY................................58RYTHMOL SR...................... 30RYVENT................................46SABRIL.................................. 35
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SAFETY LET LANCETS.... 115SAFETY-GLIDE SYRINGE...............................................115SAFYRAL..............................76SAIZEN.................................. 98SALAGEN............................118salsalate ................................... 22SAMSCA................................ 98SANCUSO..............................44SANDIMMUNE.................... 65SANDOSTATIN.................... 98SANDOSTATIN LAR DEPOT................................... 98SANTYL.................................87SAPHRIS................................60sapscare twist top lancets ........115SARAFEM........................... 134SAVAYSA.............................. 33SAVELLA.............................134SAVELLA TITRATION PACK....................................134scopolamine ............................. 44SEASONIQUE....................... 76SEEBRI NEOHALER............31SEGLUROMET................... 135selegiline hcl .............................58selenium sulfide ........................ 87SELRX....................................87SELSUN BLUE MEDICATED........................ 87SELZENTRY......................... 63SEMPREX-D......................... 78SENSIPAR............................. 98SEREVENT DISKUS............ 31SERNIVO...............................87SEROQUEL........................... 60SEROQUEL XR.....................60SEROSTIM............................ 98sertraline hcl ............................ 37se-tan plus .............................. 108sevelamer carbonate ............... 101sf 5000 plus ............................ 118SFROWASA.........................102SHOHLS MODIFIED..........102SIGNIFOR............................. 98SIKLOS.................................108sildenafil citrate ........................70SILENOR............................. 110SILIQ...................................... 87SILVADENE..........................87
silver sulfadiazine ..................... 87SIMBRINZA........................ 126SIMPLE DIAGNOSTICS LANCING DEV...................115SIMPONI.......................... 21, 22SIMPONI ARIA.....................21SIMULECT............................ 65simvastatin ...............................47SINEMET...............................58SINEMET CR........................ 58SINGULAIR.......................... 31sirolimus .................................. 65SIRTURO...............................53SITAVIG................................ 63SIVEXTRO.............................52SKELAXIN.......................... 121SKYLA................................... 76sm folic acid ........................... 108sm vitamin d3 ......................... 143SMART SENSE VALUE TEST.......................................93SMARTEST BLOOD GLUCOSE TEST................... 93sod benz-sod phenylacet ............98sod citrate-citric acid .............. 102sodium chloride ........................ 78sodium fluoride .......................117sodium phenylbutyrate ..............98sodium polystyrene sulfonate......................................... 65, 131SOLIQUA.............................110SOLODYN....................136, 137SOLOSEC...............................18SOLTAMOX.......................... 56SOLUS V2 TEST.................... 93SOMA................................... 121SOMATULINE DEPOT........ 98SOMAVERT.......................... 98SONATA.............................. 110SOOLANTRA........................ 87SORIATANE......................... 87SORILUX...............................88sotalol hcl .................................67sotalol hcl (af) ................... 66, 67SOTYLIZE............................. 67SOVALDI...............................63SPECTRACEF....................... 71spinosad ................................... 88SPIRIVA HANDIHALER.....31SPIRIVA RESPIMAT............31
spironolactone .......................... 95spironolactone-hctz .................. 95SPORANOX...........................44SPORANOX PULSEPAK..... 44SPRINTEC 28........................ 76SPRITAM...............................35SPRIX.....................................22SPRYCEL...............................56SPS.................................. 65, 131SRONYX................................76SSKI........................................78sss 10-5 .................................... 88STALEVO 100........................ 58STALEVO 125........................ 58STALEVO 150........................ 58STALEVO 200........................ 58STALEVO 50..........................58STALEVO 75..........................58STARLIX............................... 42stavudine .................................. 63STEGLATRO.........................42STEGLUJAN....................... 135STELARA.......................88, 110STIMATE...............................98STIOLTO RESPIMAT...........31STIVARGA............................ 56STRATTERA......................... 18STRENSIQ........................... 110streptomycin sulfate ................. 19STRIANT............................... 27STRIBILD.............................. 63STRIVERDI RESPIMAT...... 31STROMECTOL..................... 28SUBOXONE...........................26SUBSYS..................................26SUCRAID.............................. 94sucralfate ............................... 140SULAR................................... 69sulfacetamide sodium ..............126sulfacetamide sodium-sulfur ......88sulfacetamide sod-sulfur wash ...88sulfacetamide-prednisolone ..... 126sulfacleanse 8/4 ........................ 88sulfadiazine ............................ 136sulfamethoxazole-trimethoprim 52SULFAMYLON.....................88sulfasalazine ...........................102SULFAZINE........................ 102sulindac ....................................22SUMADAN............................88
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SUMADAN XLT................... 88sumatriptan ............................ 116sumatriptan succinate ............. 116sumatriptan succinate refill .....116sumatriptan-naproxen sodium .116SUMAXIN............................. 88SUMAXIN CP........................88SUMAXIN TS........................88super daily d3 ......................... 143super thin lancets ....................115SUPRAX................................ 71SUPREME TEST................... 93SUPREP BOWEL PREP KIT...............................................111SURE EDGE TEST................93SURECHEK BLOOD GLUCOSE TEST................... 94SURE-TEST EASYPLUS MINI TEST............................ 94SURMONTIL........................ 37SUSTIVA................................63SUTENT.................................57SYEDA................................... 76SYLATRON...........................57SYMAX DUOTAB...............140SYMBICORT......................... 31SYMBYAX...........................134SYMDEKO............................ 79SYMFI....................................63SYMFI LO..............................63SYMLINPEN 120...................42SYMLINPEN 60.................... 42SYMPROIC..........................102SYMTUZA.............................63SYNAGEX........................... 120SYNAGIS............................. 129SYNALAR............................. 88SYNALAR (CREAM)........... 88SYNALAR (OINTMENT).....88SYNALAR TS........................88SYNAREL..............................98SYNATEK............................120SYNDROS..............................44SYNERA................................ 88SYNJARDY......................... 135SYNJARDY XR...................135SYNRIBO...............................57SYNTHROID.......................137SYNVISC..............................121SYNVISC ONE.................... 121
SYPRINE............................... 65TABLOID...............................57TACLONEX...........................88tacrolimus ...........................65, 88tadalafil (pah) ......................... 70TAFINLAR............................57TAGRISSO.............................57TAKE ACTION..................... 76TALTZ....................................88TAMIFLU..............................63tamoxifen citrate ......................57tamsulosin hcl .........................102TANDEM F......................... 108TANDEM PLUS.................. 108TAPAZOLE..........................137TAPERDEX 12-DAY............ 77TAPERDEX 6-DAY.............. 77TARCEVA............................. 57TARGADOX........................137TARGRETIN................... 57, 88TARKA.................................. 50taron forte ..............................108TARON-C DHA...................120TASIGNA...............................57TASMAR................................59TAVALISSE......................... 136TAYTULLA...........................76tazarotene ................................ 88tazicef ...................................... 71TAZORAC............................. 89TAZTIA XT........................... 69TECFIDERA........................134TECHNIVIE.........................109TEFLARO..............................71TEGRETOL........................... 35TEGRETOL-XR.................... 35TEKTURNA.......................... 50TEKTURNA HCT................. 50TELCARE BLOOD GLUCOSE TEST................... 94telmisartan ...............................50telmisartan-amlodipine ............. 50telmisartan-hctz ....................... 51temazepam ............................. 110TEMODAR............................ 57TEMOVATE.......................... 89temozolomide ........................... 57tenofovir disoproxil fumarate ....63TENORETIC 100................... 51TENORETIC 50..................... 51
TENORMIN.......................... 67TERAZOL 7......................... 142terazosin hcl ............................. 51terbinafine hcl .......................... 44terbutaline sulfate .....................31terconazole .............................142TESSALON PERLES.............78TESTIM..................................27testosterone ..............................27testosterone cypionate .............. 27testosterone enanthate .............. 27tetrabenazine ..........................134tetracycline hcl ....................... 137TETRAVISC.........................126TEXAVITE LQ.....................129THALOMID.......................... 65THEO-24................................ 32THEOCHRON....................... 32theophylline ..............................32theophylline er ..........................32THERA-D 2000.................... 144THERA-D 4000.................... 144THERA-D RAPID REPLETION........................ 144THIOLA............................... 102thioridazine hcl .........................60thiothixene ............................... 60THYMOGLOBULIN.............65THYROGEN..........................94tiagabine hcl .............................35TIAZAC..................................69TIBSOVO..............................111TIGAN................................... 44TIKOSYN...............................30TILIA FE................................76timolol maleate ................. 67, 126TIMOPTIC........................... 126TIMOPTIC OCUDOSE....... 126TIMOPTIC-XE.....................126TINDAMAX.......................... 52tinidazole ................................. 52TIROSINT............................137TIVICAY................................63TIVORBEX............................ 22TIZANIDINE COMFORT PAC.......................................121tizanidine hcl .......................... 121tl gard rx ................................108tl icon .....................................108TOBI....................................... 19
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TOBI PODHALER................ 19TOBRADEX.........................126TOBRADEX ST................... 126tobramycin ...............................19tobramycin sulfate ....................19TOBREX.............................. 126TODAY SPONGE................142TOFRANIL............................37TOLAK...................................89tolazamide ................................42tolbutamide .............................. 42tolcapone ..................................59tolmetin sodium ........................22tolterodine tartrate ................. 141tolterodine tartrate er ............. 141TOPAMAX............................ 35TOPAMAX SPRINKLE........ 35TOPICORT............................ 89TOPICORT SPRAY...............89topiramate ............................... 35toposar .....................................57TOPROL XL.......................... 67TORISEL................................57torsemide ................................. 95TOUJEO MAX SOLOSTAR. 42TOUJEO SOLOSTAR............42TOVIAZ................................141TRACLEER........................... 70TRADJENTA.........................42tramadol hcl ............................. 26tramadol hcl er ......................... 26tramadol hcl er (biphasic) ........ 26tramadol-acetaminophen .......... 26trandolapril .............................. 51trandolapril-verapamil hcl er .... 51tranexamic acid ......................109TRANSDERM-SCOP (1.5 MG)........................................ 44TRANXENE-T.......................29tranylcypromine sulfate ............ 38TRAUMEEL.......................... 65TRAVATAN Z..................... 126trazodone hcl .................... 38, 135TRECATOR...........................53TRELEGY ELLIPTA............ 32TRELSTAR MIXJECT..........57TREMFYA.............................89TRESIBA FLEXTOUCH...... 42tretinoin ..............................57, 89tretinoin microsphere ................89
tretinoin microsphere pump ...... 89TRETTEN............................ 105TREXIMET..........................116TREZIX..................................26TRI FEMYNOR.................... 76triamcinolone acetonide..................................89, 118, 122TRIAMINIC ALLERCHEWS..................... 46triamterene-hctz ....................... 95triazolam ................................110TRIBENZOR......................... 51TRICARE PRENATAL DHA ONE............................ 120tricitrates ............................... 102TRICON............................... 108TRICOR................................. 47TRIDERM............................. 89TRIDESILON........................ 89trientine hcl .............................. 65TRI-ESTARYLLA................. 76trifluoperazine hcl .................... 60trifluridine ..............................126trigels-f forte .......................... 109TRIGLIDE............................. 47trihexyphenidyl hcl ................... 59TRI-LEGEST FE................... 76TRILEPTAL...........................35TRI-LINYAH.........................76TRILIPIX............................... 47TRILYTE............................. 111trimethobenzamide hcl ..............44trimethoprim ............................ 52TRI-MILI............................... 76trimipramine maleate ............... 38trimpex .................................... 52TRINATE.............................120TRINESSA (28)...................... 76TRI-NORINYL (28)...............76TRINTELLIX.................38, 135TRI-PREVIFEM.................... 76TRIPTODUR......................... 98TRI-SPRINTEC..................... 76TRIUMEQ............................. 63TRIVEEN-DUO DHA......... 120TRI-VI-FLOR...................... 120TRIVORA (28)....................... 76TRIZIVIR...............................64TROKENDI XR.................... 35tropicamide ............................ 127
trospium chloride ....................141trospium chloride er ................141TRUE METRIX BLOOD GLUCOSE TEST................... 94TRUEPLUS LANCETS 26G115TRUEPLUS LANCETS 30G115TRUEPLUS SAFETY LANCETS 28G.....................115TRUETEST TEST..................94TRUETRACK TEST............. 94TRULANCE.......................... 72TRULICITY...........................42TRUSOPT............................ 127TRUVADA............................ 64TUDORZA PRESSAIR......... 32TULANA................................76TUSNEL C............................. 78TUSSICAPS........................... 78TUSSIONEX PENNKINETIC ER...............78TWYNSTA.............................51TYBOST................................. 60TYDEMY...............................76TYKERB................................ 57TYLENOL WITH CODEINE #3......................... 26TYLENOL WITH CODEINE #4......................... 26TYMLOS................................98TYSABRI............................. 134TYVASO.................................70TYVASO REFILL................. 70TYVASO STARTER..............70UCERIS............................ 28, 77ULESFIA............................... 89ULORIC............................... 103ULTIMA TEST...................... 94ULTRACET........................... 26ULTRAM...............................26ULTRATRAK PRO TEST.... 94ULTRATRAK ULTIMATE TEST.......................................94ULTRAVATE........................ 89ULTRAVATE X (CREAM)...89ULTRAVATE X (OINTMENT)........................ 89UNISTRIP1 GENERIC......... 94UNITHROID....................... 137UNITHROID DIRECT....... 137UPTRAVI.............................134
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URECHOLINE.................... 141urelle ......................................140uretron d/s ..............................140uribel ......................................140URIMAR-T.......................... 140urin ds .................................... 140UROCIT-K 10...................... 103UROCIT-K 15...................... 103UROCIT-K 5........................ 103uro-mp ................................... 140UROXATRAL..................... 103URSO 250............................. 102URSO FORTE......................102ursodiol .................................. 102ustell ...................................... 140UTIBRON NEOHALER....... 32utira-c .................................... 140UTOPIC..................................89utrona-c ................................. 140VAGIFEM............................142valacyclovir hcl .........................64VALCHLOR.......................... 89VALCYTE..............................64valganciclovir hcl ......................64VALIUM................................ 29valproate sodium ...................... 35valproic acid .............................35valsartan .................................. 51valsartan-hydrochlorothiazide ...51VALTREX..............................64VANATOL LQ.......................22VANCOCIN HCL.................. 52vancomycin hcl .........................52VANDAZOLE......................142VANISHPOINT INSULIN SYRINGE.............................115VANOS...................................89VANOXIDE-HC.................... 89VARUBI................................. 44VASCEPA.............................. 47VASERETIC.......................... 51VASOTEC.............................. 51VCF VAGINAL CONTRACEPTIVE............. 142VECAMYL.............................51VECTICAL.............................89VELCADE..............................57VELETRI............................... 70VELIVET................................76VELPHORO......................... 102
VELTASSA..................... 65, 131VELTIN..................................89VEMLIDY..............................64VENCLEXTA........................ 53VENCLEXTA STARTING PACK..................................... 53VENIPUNCTURE CPI..........89venlafaxine hcl ......................... 38venlafaxine hcl er ..................... 38VENOFER............................109VENOMIL MIXED VESPID VENOM..................................67VENTAVIS.............................70VENTOLIN HFA...................32verapamil hcl ............................69verapamil hcl er ........................69VERDESO..............................89VERDROCET........................ 26VEREGEN............................. 89VERELAN............................. 69VERELAN PM.......................69VERIPRED 20........................77VERSACLOZ......................... 60VERZENIO............................ 79VESICARE........................... 141VESTURA..............................76VFEND...................................44VIBERZI...............................110VIBRAMYCIN.....................137vicodin ..................................... 26vicodin es ................................. 26vicodin hp .................................26VICTORY AGM-4000 TEST. 94VICTOZA...............................42VIDEX....................................64VIDEX EC..............................64VIEKIRA PAK.....................109VIEKIRA XR....................... 109vigabatrin .................................35VIGADRONE........................ 35VIGAMOX........................... 127VIIBRYD........................ 38, 135VIIBRYD STARTER PACK......................................... 38, 135VIMIZIM..............................118VIMOVO................................ 22VIMPAT................................. 35VINATE DHA RF............... 120VIOKACE.............................. 94VIRACEPT.............................64
VIRAMUNE.......................... 64VIRAMUNE XR....................64VIREAD................................. 64VIROPTIC............................127VIRT-GARD........................ 109virt-pn dha ..............................120VISTARIL.............................. 29VISTOGARD......................... 43VISUDYNE..........................127VITAFOL FE+.....................120VITAFOL GUMMIES......... 120vitamin d ................................ 144vitamin d (ergocalciferol) .......144vitamin d2 .............................. 144vitamin d3 .............................. 144vitamin d3 maximum strength .144vitamin d3 super strength ........ 144VITAPEARL........................ 120VITATRUE.......................... 120VIVA DHA........................... 120VIVELLE-DOT.................... 100VIVITROL............................. 43VIVLODEX............................22VOCAL POINT BLOOD GLUCOSE TEST................... 94VOGELXO............................. 27VOGELXO PUMP................. 27vol-tab rx ............................... 120VOLTAREN...........................90VONVENDI......................... 105VORAXAZE.......................... 57voriconazole ............................. 44VOSEVI................................ 109VOTRIENT............................ 57VPRIV...................................109VRAYLAR.............................60VYFEMLA.............................76VYTORIN.............................. 48VYVANSE..............................18VYZULTA............................127warfarin sodium ....................... 33WELCHOL.............................48WELLBUTRIN SR................ 38WELLBUTRIN XL................38WERA.................................... 76WESTHROID.......................137WIDE-SEAL DIAPHRAGM 60...........................................115WIDE-SEAL DIAPHRAGM 65...........................................115
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WIDE-SEAL DIAPHRAGM 70...........................................115WIDE-SEAL DIAPHRAGM 75...........................................115WIDE-SEAL DIAPHRAGM 80...........................................115WIDE-SEAL DIAPHRAGM 85...........................................115WIDE-SEAL DIAPHRAGM 90...........................................115WIDE-SEAL DIAPHRAGM 95...........................................115WILATE............................... 105WINRHO SDF..................... 129WP THYROID..................... 137WYMZYA FE........................ 76XADAGO...............................59XALATAN........................... 127XALKORI..............................57XANAX..................................29XANAX XR........................... 29XARELTO............................. 33XARELTO STARTER PACK..................................... 33XATMEP................................57XELITRAL............................ 90XELJANZ.............................. 22XELJANZ XR........................22XELODA................................57XENAZINE..........................134XEOMIN.............................. 122XERESE................................. 90XERMELO...........................137XGEVA.................................. 98XHANCE............................. 122XIAFLEX...............................65XIFAXAN..............................52XIGDUO XR........................135XIIDRA................................ 112XIMINO............................... 137XODOL.................................. 26XOLAIR................................. 32XOLEGEL..............................90XOPENEX............................. 32XOPENEX CONCENTRATE.................. 32XOPENEX HFA.................... 32XTAMPZA ER.......................26XTANDI.................................57XULANE................................76
XULTOPHY.........................110XURIDEN............................109XYNTHA............................. 105XYNTHA SOLOFUSE........ 105XYREM................................134XYZAL ALLERGY 24HR.... 46XYZAL ALLERGY 24HR CHILDRENS......................... 46YASMIN 28............................76YAZ........................................ 76YERVOY................................57YONSA...................................57YOSPRALA......................... 105YUVAFEM.......................... 142ZADITOR............................ 127zafirlukast ................................32ZANAFLEX......................... 121ZANOSAR............................. 57ZANTAC.............................. 140ZARAH.................................. 76ZARONTIN........................... 35ZARXIO............................... 109ZATEAN-PN DHA..............120ZATEAN-PN PLUS............. 120zavara .................................... 109ZAVESCA............................ 109ZEBUTAL.............................. 22ZEGERID.............................140ZEGERID OTC....................140ZEJULA............................... 131ZELAPAR.............................. 59ZELBORAF........................... 57ZEMAIRA............................135ZEMBRACE SYMTOUCH. 116ZEMPLAR............................. 98zenatane ...................................90ZENATANE...........................90ZENCHENT...........................76ZENPEP................................. 94ZENZEDI...............................18ZEPATIER........................... 109ZERIT.....................................64ZESTORETIC........................ 51ZESTRIL................................ 51ZETIA.....................................48ZETONNA........................... 122ZIAC.......................................51ZIAGEN................................. 64ZIANA....................................90zidovudine ................................ 64
zileuton er ................................ 32ZIOPTAN............................. 127ziprasidone hcl ..........................60ZIPSOR.................................. 22ZIRGAN...............................127ZITHROMAX...................... 112ZITHROMAX TRI-PAK..... 112ZITHROMAX Z-PAK......... 112ZOCOR...................................48ZOFRAN................................44ZOFRAN ODT...................... 44ZOHYDRO ER...................... 26zoledronic acid ......................... 98ZOLINZA...............................57zolmitriptan ............................117ZOLOFT.................................38zolpidem tartrate .................... 110zolpidem tartrate er ................ 110ZOLPIMIST......................... 110ZOMACTON......................... 98ZOMETA............................... 99ZOMIG................................. 117ZOMIG ZMT....................... 117ZONALON.............................90ZONEGRAN..........................35zonisamide ............................... 35ZONTIVITY.........................131ZORBTIVE.............................99ZORTRESS............................ 65ZORVOLEX...........................22ZOSYN................................. 130ZOVIA 1/35E (28)................... 76ZOVIRAX.........................64, 90ZUBSOLV.............................. 26ZUPLENZ.............................. 44ZURAMPIC......................... 103ZYBAN.................................134ZYCLARA............................. 90ZYCLARA PUMP................. 90ZYDELIG.............................130ZYFLO................................... 32ZYFLO CR.............................32ZYKADIA..............................57ZYLET..................................127ZYLOPRIM..........................103ZYMAXID........................... 127ZYPITAMAG........................ 48ZYPREXA..............................60ZYPREXA ZYDIS................. 60ZYRTEC ALLERGY.............46
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ZYRTEC-D ALLERGY & CONGESTION...................... 78ZYTIGA................................. 57ZYVOX...................................52
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