drug requirements/ drug name drug requirements/ …...2014/10/01 · ponstel) caps 1 meloxicam susp...

2014 Empire Plan Medicare Rx eff 10/01/2014

PA - Prior Authorization QL - Quantity Limits ST - Step Therapy B/D - Covered under Medicare B or D LA - Limited Access

1

Drug Name Drug Tier

Requirements/Limits

ANALGESICS GOUT ALLOPURINOL SODIUM 3

allopurinol tab (generic of ZYLOPRIM)

1

colchicine w/ probenecid 1

COLCRYS 2

probenecid 1

ULORIC 2

ZYLOPRIM 3

MISCELLANEOUS ARTHROTEC 3

diclofenac w/ misoprostol (generic of ARTHROTEC 50)

1

diclofenac w/ misoprostol (generic of ARTHROTEC 75)

1

DUEXIS 3

VIMOVO 2

NSAIDS ANAPROX 2

ANAPROX DS 2

CATAFLAM 3

CELEBREX 2

DAYPRO 2

diclofenac potassium (generic of CATAFLAM)

1

diclofenac sodium (generic of VOLTAREN-XR) TB24

1

diclofenac sodium TBEC 1

diflunisal 1

EC-NAPROSYN 3

etodolac 1

etodolac er 1

FELDENE 3

fenoprofen calcium 1

flurbiprofen TABS 1

ibuprofen SUSP 1

ibuprofen TABS 400mg, 600mg, 800mg

1

ketoprofen CAPS; CP24 1

mefenamic acid (generic of PONSTEL) CAPS

1

MELOXICAM SUSP 7.5 MG/5ML

1

Drug Name Drug Tier

Requirements/Limits

meloxicam tabs (generic of MOBIC)

1

MOBIC 2

nabumetone TABS 1

NALFON 3

NAPRELAN 3

NAPROSYN 2

naproxen (generic of NAPROSYN) SUSP; TABS

1

naproxen (generic of EC-NAPROSYN) TBEC

1

naproxen sodium (generic of ANAPROX) TABS 275mg

1

naproxen sodium (generic of ANAPROX DS) TABS 550mg

1

oxaprozin (generic of DAYPRO)

1

piroxicam (generic of FELDENE) CAPS

1

PONSTEL 3

sulindac TABS 1

tolmetin sodium 1

VOLTAREN-XR 3

ZIPSOR 3

ZORVOLEX 3

OPIOID ANALGESICS acetaminophen w/ codeine SOLN

QL (5000mL / 30 days)

1 QL

acetaminophen w/ codeine TABS

QL (400 tabs / 30 days)

1 QL

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS


1 QL

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS


1 QL

butorphanol nasal spray 1

butorphanol tartrate SOLN 1



2

Drug Name Drug Tier

Requirements/Limits

BUTRANS 5mcg/hr, 10mcg/hr, 15mcg/hr, 20mcg/hr

2

capital and codeine QL (5000mL / 30 days)

3 QL

CONZIP 3

hycet QL (5400mL / 30 days)

3 QL

hydrocodone-acetaminophen 2.5-325mg


1 QL

hydrocodone-acetaminophen 5-300mg (generic of XODOL)


1 QL

hydrocodone-acetaminophen 5-325mg (generic of NORCO)


1 QL

hydrocodone-acetaminophen 7.5-300mg (generic of XODOL)


1 QL

hydrocodone-acetaminophen 7.5-325 mg/15ml (generic of HYCET)

QL (5400mL / 30 days)

1 QL

hydrocodone-acetaminophen 7.5-325mg (generic of NORCO)


1 QL

hydrocodone-acetaminophen 10-300mg (generic of XODOL)


1 QL

hydrocodone-acetaminophen tab 10-325mg (generic of NORCO)


1 QL

hydrocodone-ibuprofen 2.5-200mg (generic of REPREXAIN)

1

hydrocodone-ibuprofen 7.5-200mg (generic of VICOPROFEN)

1

ibudone tab 5-200mg (generic of REPREXAIN)

1

lorcet (generic of NORCO) QL (360 tabs / 30 days)

1 QL

Drug Name Drug Tier

Requirements/Limits

lorcet plus tab 7.5-325 (generic of NORCO)


1 QL

lortab (generic of NORCO) QL (360 tabs / 30 days)

1 QL

lortab elx 10-300mg QL (6000 mL / 30 days)

3 QL

norco 5/325 QL (360 tabs / 30 days)

3 QL

norco 7.5/325 QL (360 tabs / 30 days)

3 QL

norco 10/325 QL (360 tabs / 30 days)

3 QL

reprexain 2.5/200 3

reprexain 5/200 3

reprexain 10/200 1

SYNALGOS-DC 3

tramadol hcl er (generic of ULTRAM ER) TB24 100mg, 200mg

1

TRAMADOL HCL ER TB24 300mg

1

TRAMADOL HCL ER (BIPHASIC) 100MG

1

TRAMADOL HCL ER (BIPHASIC) 200MG

1

tramadol hcl er (biphasic) 300mg

1

tramadol hcl tab 50 mg (generic of ULTRAM)

1

tramadol-acetaminophen (generic of ULTRACET)


1 QL

tylenol with codeine #3 QL (400 tabs / 30 days)

3 QL

tylenol with codeine #4 QL (400 tabs / 30 days)

3 QL

ULTRACET QL (240 tabs / 30 days)

3 QL

ULTRAM 2

ULTRAM ER 3

vicodin (generic of XODOL) QL (400 tabs / 30 days)

1 QL

vicodin es (generic of XODOL)


1 QL



3

Drug Name Drug Tier

Requirements/Limits

vicodin hp (generic of XODOL)


1 QL

VICOPROFEN 3

xodol 5/300 3

xodol 7.5/300 QL (400 tabs / 30 days)

3 QL

xodol 10/300 QL (400 tabs / 30 days)

3 QL

zamicet QL (5400mL / 30 days)

3 QL

OPIOID ANALGESICS, CII ABSTRAL

QL (120 ea / 30 days) 3 QL PA

ACTIQ QL (120 lpop / 30 days)

3 QL PA

AVINZA 2

CODEINE SULFATE TABS 1

DILAUDID INJ 3 B/D

DILAUDID TAB 3

DILAUDID-5 ORAL LIQD 3

DILAUDID-HP INJ SOLN 3 B/D

DILAUDID-HP INJ SOLR 2 B/D

DOLOPHINE 3

DURAGESIC QL (10 ea / 30 days)

3 QL PA

DURAMORPH 1 B/D

endocet 5/325 (generic of PERCOCET)


1 QL

endocet 7.5/325 (generic of PERCOCET)


1 QL

endocet 10/325 (generic of PERCOCET)


1 QL

ENDODAN 1

EXALGO 8mg, 12mg 2

EXALGO 16mg, 32mg 3

fentanyl citrate (generic of ACTIQ) LPOP

QL (120 lpop / 30 days)

1 QL PA

fentanyl patch (generic of DURAGESIC)

QL (10 ea / 30 days)

1 QL PA

FENTORA QL (120 tabs / 30 days)

2 QL PA

Drug Name Drug Tier

Requirements/Limits

hydromorphone hcl (generic of DILAUDID) LIQD

1

hydromorphone hcl (generic of DILAUDID-HP) SOLN 500mg/50ml

1 B/D

hydromorphone hcl (generic of EXALGO) T24A 8mg, 12mg, 16mg

1

HYDROMORPHONE HCL T24A 32mg

1

hydromorphone hcl (generic of DILAUDID) TABS

1

INFUMORPH 200 2 B/D

INFUMORPH 500 2 B/D

KADIAN 2

LAZANDA QL (30 / 30 days)

2 QL PA

levorphanol tartrate TABS 1

methadone hcl (generic of METHADOSE) CONC

1

methadone hcl SOLN 1

methadone hcl (generic of DOLOPHINE HCL) TABS 5mg

1

methadone hcl (generic of DOLOPHINE) TABS 10mg

1

METHADONE INJ 10MG/ML 3

METHADOSE CONC 3

MORPHINE SUL 20MG/ML ORAL SOL

1

morphine sulfate (generic of KADIAN) CP24

1

MORPHINE SULFATE SOLN 2mg/ml

1 B/D

MORPHINE SULFATE SOLN 10mg/5ml, 20mg/5ml

1

MORPHINE SULFATE TABS

1

morphine sulfate beads cap sr (generic of AVINZA)

1

morphine sulfate ext-rel tab (generic of MS CONTIN)

1

MORPHINE SULFATE INJ 1mg/ml, 4mg/ml, 8mg/ml, 10mg/ml, 15mg/ml

1 B/D

morphine sulfate inj .5mg/ml, 1mg/ml

1 B/D

MS CONTIN 3



4

Drug Name Drug Tier

Requirements/Limits

NUCYNTA 2

NUCYNTA ER 2

OPANA TABS 3

OPANA ER (CRUSH RESISTANT

2

OXECTA 3

OXYCODONE HCL CAPS 1

OXYCODONE HCL CONC 1

OXYCODONE HCL SOLN 1

oxycodone hcl (generic of ROXICODONE) TABS 5mg, 15mg, 30mg

1

oxycodone hcl TABS 10mg, 20mg

1

oxycodone w/ acetaminophen 2.5-325mg (generic of PERCOCET)


1 QL

oxycodone w/ acetaminophen 5-325mg (generic of PERCOCET)


1 QL

oxycodone w/ acetaminophen 7.5-325mg (generic of PERCOCET)


1 QL

oxycodone w/ acetaminophen 10-325mg (generic of PERCOCET)


1 QL

oxycodone-aspirin (generic of PERCODAN)

1

oxycodone-ibuprofen 1

OXYCONTIN 2

oxymorphone hcl (generic of OPANA) TABS

1

percocet 2.5/325 QL (360 tabs / 30 days)

3 QL

percocet 5/325 QL (360 tabs / 30 days)

3 QL

percocet 7.5/325 QL (360 tabs / 30 days)

3 QL

percocet 10/325 QL (360 tabs / 30 days)

3 QL

PERCODAN 3

roxicet QL (1800mL / 30 days)

2 QL

Drug Name Drug Tier

Requirements/Limits

roxicet tab 5-325mg (generic of PERCOCET)


1 QL

ROXICODONE 15mg, 30mg 3

SUBSYS QL (120 ea / 30 days)

3 QL PA

XARTEMIS XR QL (120 ea / 30 days)

3 QL

ANESTHETICS LOCAL ANESTHETICS lidocaine hcl (local anesth.) (generic of XYLOCAINE-MPF) 4%

1

lidocaine hcl (local anesth.) (generic of XYLOCAINE) .5%

1 B/D

lidocaine inj 0.5% (generic of XYLOCAINE-MPF)

1 B/D

lidocaine inj 1% (generic of XYLOCAINE) 1%

1 B/D

lidocaine inj 1% (generic of XYLOCAINE-MPF) 1%

1 B/D

lidocaine inj 1.5% (generic of XYLOCAINE-MPF)

1 B/D

lidocaine inj 2% (generic of XYLOCAINE) 2%

1 B/D

lidocaine inj 2% (generic of XYLOCAINE-MPF) 2%

1 B/D

XYLOCAINE .5%, 2% 3 B/D

XYLOCAINE INJ 1% 3 B/D

XYLOCAINE-MPF 3 B/D

ANTI-INFECTIVES ANTI-BACTERIALS - MISCELLANEOUS amikacin sulfate SOLN 1

BETHKIS 3 B/D

gentamicin in saline 0.9mg/ml 3

gentamicin in saline 1.4mg/ml 3

gentamicin in saline 60mg 1



gentamicin sulfate SOLN 1

neomycin sulfate TABS 1

paromomycin sulfate CAPS 1

streptomycin sulfate SOLR 1

sulfadiazine TABS 3

TOBI NEB 3 B/D

TOBI PODHALER 2 PA



5

Drug Name Drug Tier

Requirements/Limits

tobramycin (generic of TOBI) NEBU

1 B/D

tobramycin sulfate SOLN; SOLR

1

tobramycin sulfate in saline 3

ANTI-INFECTIVES - MISCELLANEOUS ALBENZA 2

ALINIA 2

atovaquone (generic of MEPRON) SUSP

3

AZACTAM 3

AZACTAM/DEX INJ 1GM 2

AZACTAM/DEX INJ 2GM 2

aztreonam (generic of AZACTAM)

1

BACTRIM 2

BACTRIM DS 2

BILTRICIDE 2

CLEOCIN CAPS 2

cleocin SOLR 2

CLEOCIN CAP 75MG 2

CLEOCIN IN D5W 3

CLEOCIN INJ 3

CLEOCIN PHOSPHATE 3

clindamycin hcl (generic of CLEOCIN) CAPS

1

clindamycin palmitate hydrochloride (generic of CLEOCIN PEDIATRIC GRANULE)

1

clindamycin phosphate SOLN 150mg/ml

1

clindamycin phosphate (generic of CLEOCIN PHOSPHATE) SOLN 150mg/ml, 300mg/2ml, 600mg/4ml, 900mg/6ml, 9000mg/60ml

1

clindamycin phosphate in d5w (generic of CLEOCIN IN D5W)

1

colistimethate sodium (generic of COLY-MYCIN M) SOLR

1

COLY-MYCIN M 3

CUBICIN 2 B/D

dapsone TABS 1

Drug Name Drug Tier

Requirements/Limits

DARAPRIM 2

DORIBAX 2

erythromycin-sulfisoxazole for susp 200-600 mg/5ml

1

FLAGYL 3

FLAGYL ER 3

FURADANTIN 3

HIPREX 3

imipenem-cilastatin (generic of PRIMAXIN IV)

1

INVANZ 2

MACROBID 2

MACRODANTIN 2

MEPRON 2

meropenem (generic of MERREM)

1

MERREM 3

methenamine hippurate (generic of HIPREX)

1

METRO IV 3

metronidazole (generic of FLAGYL) CAPS; TABS

1

metronidazole inj 1

NEBUPENT 2 B/D

nitrofurantoin (generic of FURADANTIN) SUSP

1

nitrofurantoin macrocrystal (generic of MACRODANTIN)

1

nitrofurantoin monohyd macro (generic of MACROBID)

1

PENTAM 300 2

polymyxin b sulfate SOLR 1

PRIMAXIN 3

PRIMSOL SOL 50MG/5ML 3

SIVEXTRO SOLR 2

SIVEXTRO TABS 3

STROMECTOL 2

sulfamethoxazole-trimethoprim SUSP

1

sulfamethoxazole-trimethoprim (generic of BACTRIM) TABS

1

sulfamethoxazole-trimethoprim (generic of BACTRIM DS) TABS

1



6

Drug Name Drug Tier

Requirements/Limits

sulfamethoxazole-trimethoprim inj

1

SYNERCID 2

trimethoprim TABS 1

TYGACIL 2

VANCOCIN HCL 3

vancomycin hcl (generic of VANCOCIN HCL) CAPS

1

vancomycin hcl SOLR 10gm, 500mg, 1000mg, 5000mg

1 B/D

vancomycin hcl SOLR 750mg

2 B/D

VIBATIV 250mg 3

VIBATIV 750mg 2

XIFAXAN TAB 200MG 3

ZYVOX 2

ANTIFUNGALS ABELCET 2 B/D

AMBISOME 2 B/D

AMPHOTEC 3 B/D

amphotericin b SOLR 1 B/D

ANCOBON 3

CANCIDAS 2

DIFLUCAN 3

ERAXIS 2

fluconazole (generic of DIFLUCAN) SUSR; TABS

1

fluconazole in dextrose 1

fluconazole in nacl 100mg 3



flucytosine (generic of ANCOBON) CAPS

1

GRIS-PEG 2

griseofulvin microsize SUSP 1

griseofulvin microsize (generic of GRIFULVIN V) TABS

1

griseofulvin ultramicrosize (generic of GRIS-PEG)

1

itraconazole (generic of SPORANOX) CAPS

1 PA

ketoconazole TABS 1

LAMISIL 3 PA

MYCAMINE 2

NOXAFIL SOLN; SUSP 2

Drug Name Drug Tier

Requirements/Limits

NOXAFIL TBEC 3

nystatin TABS 1

ONMEL 3 PA

SPORANOX 3 PA

SPORANOX PULSEPAK 3 PA

SPORANOX SOL 10MG/ML 3 PA

terbinafine hcl (generic of LAMISIL) TABS

1 PA

VFEND 3

VFEND IV 3

VFEND SUS 40MG/ML 3

voriconazole (generic of VFEND) SUSR; TABS

1

voriconazole inj 200mg (generic of VFEND IV)

1

ANTIMALARIALS ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG

1

atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)

1

chloroquine phosphate TABS 250mg

1

chloroquine phosphate (generic of ARALEN) TABS 500mg

1

COARTEM 2

MALARONE 2

mefloquine hcl 1

PRIMAQUINE PHOSPHATE 2

QUALAQUIN 3

quinine sulfate (generic of QUALAQUIN) CAPS

1

ANTIRETROVIRAL AGENTS abacavir sulfate (generic of ZIAGEN)

1

APTIVUS 2

CRIXIVAN 2

didanosine (generic of VIDEX EC)

1

EDURANT 2

EMTRIVA 2

EPIVIR SOL 10MG/ML 2

EPIVIR TABS 2

FUZEON 2

INTELENCE 2



7

Drug Name Drug Tier

Requirements/Limits

INVIRASE 2

ISENTRESS 2

lamivudine (generic of EPIVIR) 150mg, 300mg

1

LEXIVA 2

NEVIRAPINE SUSP 1

nevirapine (generic of VIRAMUNE) TABS

1

nevirapine (generic of VIRAMUNE XR) TB24

1

NORVIR 2

PREZISTA 2

RESCRIPTOR 2

RETROVIR CAPS 2

RETROVIR IV INFUSION 2

RETROVIR SYRP 2

REYATAZ 2

SELZENTRY 2

stavudine (generic of ZERIT) 1

SUSTIVA 2

TIVICAY 2

VIDEX EC 2

VIDEX PEDIATRIC 2

VIRACEPT 2

VIRAMUNE 2

VIRAMUNE XR 2

VIREAD 2

ZERIT 2

ZIAGEN 2

zidovudine (generic of RETROVIR) CAPS; SYRP

1

zidovudine TABS 1

ANTIRETROVIRAL COMBINATION AGENTS abacavir sulfate-lamivudine-zidovudine (generic of TRIZIVIR)

1

ATRIPLA 2

COMBIVIR 3

COMPLERA 2

EPZICOM 2

KALETRA SOL 2

KALETRA TAB 100-25MG 2

KALETRA TAB 200-50MG 2

Drug Name Drug Tier

Requirements/Limits

lamivudine-zidovudine (generic of COMBIVIR)

1

STRIBILD 2

TRIZIVIR 2

TRUVADA 2

ANTITUBERCULAR AGENTS CAPASTAT SULFATE 2

cycloserine CAPS 1

ethambutol hcl (generic of MYAMBUTOL) TABS

1

isoniazid SOLN; SYRP 1

isoniazid tabs 1

MYAMBUTOL 2

MYCOBUTIN 2

paser d/r 3

PRIFTIN 2

pyrazinamide 1

rifabutin (generic of MYCOBUTIN)

1

rifadin CAPS 150mg 2

RIFADIN CAPS 300mg 2

RIFADIN SOLR 3

rifamate 3

rifampin (generic of RIFADIN) CAPS; SOLR

1

RIFATER 2

seromycin 3

SIRTURO 3 LA

TRECATOR 2

ANTIVIRALS acyclovir (generic of ZOVIRAX) CAPS; SUSP; TABS

1

acyclovir sodium 1 B/D

adefovir dipivoxil (generic of HEPSERA)

1

BARACLUDE 2

cidofovir (generic of VISTIDE) 1

COPEGUS 3 PA

CYTOVENE 3 B/D

EPIVIR HBV SOLN 2

EPIVIR HBV TABS 3

famciclovir (generic of FAMVIR) TABS

1

FAMVIR 3



8

Drug Name Drug Tier

Requirements/Limits

FLUMADINE 3

foscarnet sodium 1

ganciclovir inj 500mg (generic of CYTOVENE)

1 B/D

HEPSERA 3

INCIVEK 2 PA

lamivudine (generic of EPIVIR HBV) 100mg

1

moderiba pak 2 PA

moderiba tab 200mg (generic of COPEGUS)

1 PA

OLYSIO 2 PA

REBETOL CAPS 3 PA

REBETOL SOLN 2 PA

RELENZA DISKHALER 2

ribapak mis 600/day 2 PA

ribasphere (generic of REBETOL) CAPS

1 PA

ribasphere (generic of COPEGUS) TABS 200mg

1 PA

ribasphere TABS 400mg, 600mg

1 PA

ribasphere ribapak 800 2 PA



ribavirin 200mg (generic of REBETOL) CAPS

1 PA

ribavirin 200mg (generic of COPEGUS) TABS

1 PA

rimantadine hydrochloride (generic of FLUMADINE)

1

SOVALDI 2 PA

TAMIFLU 2

TYZEKA 2

valacyclovir hcl (generic of VALTREX) TABS

1

VALCYTE 2

VALTREX 3

VICTRELIS 2 PA

VISTIDE 3

ZOVIRAX SUSP 3

ZOVIRAX TABS 400mg 3

CEPHALOSPORINS CEDAX 3

cefaclor 1

cefaclor monohydrate 3

Drug Name Drug Tier

Requirements/Limits

cefadroxil 1

cefazolin inj 1

cefazolin sodium 1gm, 20gm 1

cefazolin/dextrose 3

cefdinir 1

CEFEPIME 1GM SOLN 3

CEFEPIME 2GM SOLN 3

cefepime inj 1gm (generic of MAXIPIME)

1

cefepime inj 2gm (generic of MAXIPIME)

1

cefotaxime sodium (generic of CLAFORAN)

1

cefotetan disodium 3

cefoxitin sodium 1

CEFOXITIN SODIUM IN DEXTROSE

3

cefpodoxime proxetil 1

cefprozil 1

ceftazidime (generic of FORTAZ) 1gm, 2gm, 6gm

1

CEFTAZIDIME/DEXTROSE 2

ceftibuten 1

CEFTIN 3

ceftriaxone sodium SOLR 1gm, 2gm, 10gm, 250mg

1

ceftriaxone sodium (generic of ROCEPHIN) SOLR 1gm, 500mg

1

cefuroxime axetil SUSR 1

cefuroxime axetil (generic of CEFTIN) TABS

1

cefuroxime sodium (generic of ZINACEF) 1.5gm, 7.5gm, 750mg

1

cefuroxime sodium 7.5mg soln

3

cephalexin (generic of KEFLEX) CAPS

1

cephalexin SUSR; TABS 1

claforan 1gm, 2gm 3

CLAFORAN 1gm, 2gm, 10gm, 500mg

3

FORTAZ SOLN 2

FORTAZ SOLR 3

KEFLEX 3



9

Drug Name Drug Tier

Requirements/Limits

MAXIPIME 1gm, 2gm 2

MAXIPIME 1gm, 2gm 3

rocephin 3

SUPRAX CAPS 2

suprax CHEW 2

suprax SUSR 100mg/5ml, 200mg/5ml

2

SUPRAX SUSR 500mg/5ml 2

suprax TABS 2

tazicef vial (generic of FORTAZ)

1

TEFLARO 2

ZINACEF SOLR 3

ERYTHROMYCINS/MACROLIDES AZITHROMYCIN PACK 1

azithromycin (generic of ZITHROMAX) SOLR 500mg

1

azithromycin (generic of ZITHROMAX) SUSR

1

azithromycin (generic of ZITHROMAX) TABS

1

BIAXIN 3

BIAXIN XL 3

BIAXIN XL PAC 3

clarithromycin SUSR 125mg/5ml

1

clarithromycin (generic of BIAXIN) SUSR 250mg/5ml

1

clarithromycin (generic of BIAXIN) TABS

1

clarithromycin (generic of BIAXIN XL) TB24

1

DIFICID 2

e.e.s. 1

E.E.S. GRANULES 3

ery-tab 3

ERYPED 200 3

ERYPED 400 2

erythrocin lactobionate 500mg

2

erythrocin stearate 1

erythromycin base 1

erythromycin ethylsuccinate 1

PCE 3

ZITHROMAX 3

Drug Name Drug Tier

Requirements/Limits

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3

ZMAX 3

FLUOROQUINOLONES AVELOX 2

AVELOX ABC PACK 2

CIPRO SUSR 2

CIPRO TABS 3

CIPRO I.V.-IN D5W 3

ciprofloxacin SOLN 200mg/20ml

1

ciprofloxacin (generic of CIPRO) SUSR

1

ciprofloxacin er (generic of CIPRO XR)

1

ciprofloxacin hcl TABS 100mg, 750mg

1

ciprofloxacin hcl (generic of CIPRO) TABS 250mg, 500mg

1

ciprofloxacin in d5w (generic of CIPRO I.V.-IN D5W)

1

ciprofloxacn inj 1

FACTIVE 3

LEVAQUIN 3

LEVAQUIN INJ 3

levofloxacin SOLN 25mg/ml 1

levofloxacin (generic of LEVAQUIN) SOLN 25mg/ml

1

levofloxacin (generic of LEVAQUIN) TABS

1

levofloxacin in d5w (generic of LEVAQUIN)

1

moxifloxacin hcl (generic of AVELOX)

1

NOROXIN 3

PENICILLINS amoxicillin 1

amoxicillin & pot clavulanate CHEW

1

amoxicillin & pot clavulanate (generic of AUGMENTIN) CHEW

1

amoxicillin & pot clavulanate SUSR

1



10

Drug Name Drug Tier

Requirements/Limits

amoxicillin & pot clavulanate (generic of AUGMENTIN) SUSR

1

amoxicillin & pot clavulanate (generic of AUGMENTIN ES-600) SUSR

1

amoxicillin & pot clavulanate TABS

1

amoxicillin & pot clavulanate (generic of AUGMENTIN) TABS

1

amoxicillin & pot clavulanate (generic of AUGMENTIN XR) TB12

1

ampicillin 1

ampicillin & sulbactam sodium 1

ampicillin & sulbactam sodium (generic of UNASYN)

1

ampicillin & sulbactam sodium (generic of UNASYN BULK PACK)

1

ampicillin inj 1

ampicillin sodium 1gm, 2gm, 250mg, 500mg

1

AUGMENTIN 3

AUGMENTIN ES-600 3

AUGMENTIN XR 3

BACTOCILL IN DEXTROSE 3

BICILLIN C-R 2

BICILLIN L-A 2

dicloxacillin sodium 1

MOXATAG 3

nafcillin sodium 1

NALLPEN ISO-OSMOTIC IN DE

3

NALLPEN/DEXTROSE 3

oxacillin sodium 1

PENICILLIN G POT IN DEXTROSE

2

PENICILLIN G POTASSIUM SOLN

2

penicillin g potassium SOLR 1

penicillin g procaine 3

penicillin g sodium 1

penicillin v potassium 1

pfizerpen 1

Drug Name Drug Tier

Requirements/Limits

piperacillin sodium-tazobactam sodium (generic of ZOSYN)

1

TIMENTIN 2

TIMENTIN INJ 3.1GM 2

UNASYN 3

UNASYN BULK PACK 3

ZOSYN SOLN 2

ZOSYN SOLR 3

TETRACYCLINES adoxa CAPS 3

demeclocycline hcl 1

DORYX 3

doxycycline (monohydrate) CAPS 50mg

1

doxycycline (monohydrate) (generic of MONODOX) CAPS 75mg, 100mg

1

doxycycline (monohydrate) (generic of ADOXA) CAPS 150mg

1

doxycycline (monohydrate) (generic of VIBRAMYCIN) SUSR

1

doxycycline (monohydrate) (generic of ADOXA) TABS 50mg, 75mg, 100mg

1

doxycycline (monohydrate) (generic of ADOXA PAK 1/150) TABS 150mg

1

doxycycline hyclate CAPS 50mg

1

doxycycline hyclate (generic of VIBRAMYCIN) CAPS 100mg

1

doxycycline hyclate SOLR 1

doxycycline hyclate TABS 1

doxycycline hyclate TBEC 75mg, 100mg

1

doxycycline hyclate (generic of DORYX) TBEC 150mg

1

dynacin 3

MINOCIN CAPS 50mg, 100mg

3

MINOCIN KIT 100mg 3

minocycline hcl (generic of MINOCIN) CAPS

1



11

Drug Name Drug Tier

Requirements/Limits

minocycline hcl TABS; TB24 1

SOLODYN 3

TETRACYCLINE HCL CAPS

1

VIBRAMYCIN CAPS; SUSR 3

VIBRAMYCIN SYRP 2

ANTINEOPLASTIC AGENTS ALKYLATING AGENTS ALKERAN SOLR 3 B/D

BICNU 2 B/D

BUSULFEX 2 B/D

CEENU 2

CYCLOPHOSPHAMIDE CAPS

3 B/D

cyclophosphamide SOLR 2 B/D

cyclophosphamide TABS 1 B/D

dacarbazine 200mg 1 B/D

EMCYT 2

HEXALEN 2

IFEX 3 B/D

IFEX INJ 3GM 2 B/D

ifosfamide SOLN 1gm/20ml, 3gm/60ml

3 B/D

ifosfamide (generic of IFOSFAMIDE) SOLN 1gm/20ml, 3gm/60ml

1 B/D

ifosfamide (generic of IFEX) SOLR

1 B/D

IFOSFAMIDE FOR INJ 3 GM 2 B/D

LEUKERAN 2

LOMUSTINE 1

melphalan hcl (generic of ALKERAN)

1 B/D

MUSTARGEN 2 B/D

TREANDA 2 B/D

ZANOSAR 2 B/D

ANTHRACYCLINES adriamycin 20mg 2 B/D

daunorubicin hcl 1 B/D

daunorubicin hcl for inj 20 mg 1 B/D

DOXIL 3 B/D

doxorubicin hcl SOLN 1 B/D

doxorubicin hcl SOLR 50mg 1 B/D

doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml (generic of DOXIL)

1 B/D

ELLENCE 3 B/D

Drug Name Drug Tier

Requirements/Limits

EPIRUBICIN INJ 50MG 2 B/D

epirubicin inj 50mg/25ml (generic of ELLENCE)

1 B/D

epirubicin inj 200mg (generic of ELLENCE)

1 B/D

IDAMYCIN PFS 3 B/D

idarubicin hcl (generic of IDAMYCIN PFS)

1 B/D

ANTIBIOTICS bleomycin sulfate 1 B/D

COSMEGEN 3 B/D

mitomycin SOLR 1 B/D

ANTIMETABOLITES adrucil 1 B/D

ALIMTA 2 B/D

ARRANON 2 B/D

azacitidine (generic of VIDAZA)

1 B/D

cladribine 1 B/D

CLOLAR 2 B/D

cytarabine inj 1 B/D

DACOGEN 3 B/D

decitabine (generic of DACOGEN)

1 B/D

fludarabine phosphate SOLN

1 B/D

fludarabine phosphate (generic of FLUDARA) SOLR

1 B/D

fluorouracil SOLN 1 B/D

GEMCITABINE 2 B/D

gemcitabine hcl (generic of GEMZAR) 1gm, 200mg

1 B/D

gemcitabine hcl 2gm 1 B/D

GEMZAR 3 B/D

mercaptopurine (generic of PURINETHOL) TABS

1

methotrexate sodium inj 1 B/D

NIPENT 3 B/D

PURINETHOL 2

TABLOID 2

VIDAZA 3 B/D

ANTIMITOTIC, TAXOIDS ABRAXANE 2 B/D

DOCETAXEL CONC 20mg/0.5ml

2 B/D



12

Drug Name Drug Tier

Requirements/Limits

DOCETAXEL CONC 20mg/ml, 80mg/4ml

2 B/D

docetaxel CONC 140mg/7ml 2 B/D

DOCETAXEL SOLN 80mg/8ml

2 B/D

paclitaxel 1 B/D

TAXOTERE 2 B/D

ANTIMITOTIC, VINCA ALKALOIDS vinblastine sulfate SOLN 2 B/D

vincasar 1 B/D

vincristine sulfate 1 B/D

vinorelbine tartrate (generic of NAVELBINE)

1 B/D

BIOLOGIC RESPONSE MODIFIERS AVASTIN 2 B/D

ERBITUX 2 B/D

ERIVEDGE 2 LA

HERCEPTIN 2 B/D

ISTODAX 2 B/D

KADCYLA 2 B/D

PROLEUKIN 2 B/D

RITUXAN 2

TORISEL 2 B/D

VECTIBIX 2 B/D

VELCADE 2 B/D

ZOLINZA 2

HORMONAL ANTINEOPLASTIC AGENTS anastrozole (generic of ARIMIDEX) TABS

1

ARIMIDEX 2

AROMASIN 2

ARZERRA 2 B/D

bicalutamide (generic of CASODEX)

1

CASODEX 2

DEPO-PROVERA INJ 400/ML 2 B/D

ELIGARD 2 B/D

exemestane (generic of AROMASIN)

1

FARESTON 2

FASLODEX 2 B/D

FEMARA 2

FIRMAGON 2 B/D

flutamide 1

letrozole (generic of FEMARA) TABS

1

Drug Name Drug Tier

Requirements/Limits

leuprolide acetate KIT 1

LUPR DEP-PED INJ 11.25MG (3-MONTH)

2

LUPR DEP-PED INJ 30MG (3-MONTH)

2

LUPRON DEPOT 3.75mg, 11.25mg

2

LUPRON DEPOT 7.5mg 2 PA

LUPRON DEPOT INJ 22.5MG (3-MONTH)

2

LUPRON DEPOT INJ 30MG (3-MONTH)

2

LUPRON DEPOT-PED 11.25mg, 15mg

2

LYSODREN 2

MEGACE ES 2

MEGACE ORAL 2

megestrol acetate (generic of MEGACE ORAL) SUSP

1

megestrol acetate TABS 1

NILANDRON 2

SOLTAMOX 2

tamoxifen citrate TABS 1

TRELSTAR DEPOT MIXJECT

2 PA

TRELSTAR LA MIXJECT 2 PA

TRELSTAR MIXJECT 2 PA

XTANDI 2 LA

ZYTIGA 2

KINASE INHIBITORS AFINITOR 2

AFINITOR DISPERZ 2

BOSULIF 2

CAPRELSA 2 LA

COMETRIQ 2

GILOTRIF 2

GLEEVEC 2

ICLUSIG 2 LA

IMBRUVICA 2

INLYTA 2 LA

IRESSA 3

JAKAFI 2 LA

MEKINIST 2

NEXAVAR 2 LA

SPRYCEL 2

STIVARGA 2 LA



13

Drug Name Drug Tier

Requirements/Limits

SUTENT 2

TAFINLAR 2

TARCEVA 2

TASIGNA 2

TYKERB 2 LA

VOTRIENT 2

XALKORI 2 LA

ZELBORAF 2 LA

ZYKADIA 2 LA

MISCELLANEOUS DROXIA 2

HALAVEN 2 B/D

HYDREA 2

hydroxyurea (generic of HYDREA) CAPS

1

IXEMPRA KIT 2 B/D

MATULANE 2

mitoxantrone hcl 1 B/D

POMALYST CAP 2 LA

SYLATRON 2

TARGRETIN CAPS 2

tretinoin CAPS 1

TRISENOX 2 B/D

UVADEX 2 B/D

PLATINUM-BASED AGENTS carboplatin SOLN 1 B/D

cisplatin 1 B/D

ELOXATIN 2 B/D

oxaliplatin 1 B/D

PROTECTIVE AGENTS amifostine crystalline (generic of ETHYOL)

1 B/D

dexrazoxane (generic of ZINECARD) 250mg

1 B/D

ELITEK 2 B/D

KEPIVANCE 2 B/D

leucovor ca inj 1 B/D

leucovorin calcium SOLR 50mg, 200mg

1 B/D

leucovorin calcium SOLR 500mg

2 B/D

leucovorin calcium TABS 1

leucovorin calcium inj 10 mg/ml

1 B/D

mesna (generic of MESNEX) 1 B/D

MESNEX SOLN 3 B/D

Drug Name Drug Tier

Requirements/Limits

MESNEX TABS 2

ZINECARD 3 B/D

TOPOISOMERASE INHIBITORS CAMPTOSAR 40mg/2ml, 100mg/5ml

3 B/D

CAMPTOSAR 300mg/15ml 2 B/D

ETOPOPHOS 2 B/D

etoposide SOLN 500mg/25ml

1 B/D

HYCAMTIN SOLR 3 B/D

irinotecan hcl (generic of CAMPTOSAR) 40mg/2ml, 100mg/5ml

1 B/D

irinotecan hcl 500mg/25ml 1 B/D

toposar 1gm/50ml 1 B/D

topotecan hcl (generic of HYCAMTIN) SOLR

1 B/D

CARDIOVASCULAR ACE INHIBITOR COMBINATIONS ACCURETIC 3

amlodipine besylate-benazepril hcl (generic of LOTREL)

1

benazepril & hydrochlorothiazide

1

benazepril & hydrochlorothiazide (generic of LOTENSIN HCT)

1

captopril & hydrochlorothiazide

1

enalapril maleate & hydrochlorothiazide

1

enalapril maleate & hydrochlorothiazide (generic of VASERETIC)

1

fosinopril sodium & hydrochlorothiazide

1

lisinopril & hydrochlorothiazide (generic of ZESTORETIC)

1

LOTENSIN HCT 3

LOTREL 2

moexipril-hydrochlorothiazide 1

moexipril-hydrochlorothiazide (generic of UNIRETIC)

1

quinapril-hydrochlorothiazide (generic of ACCURETIC)

1



14

Drug Name Drug Tier

Requirements/Limits

TARKA 2

UNIRETIC 3

VASERETIC 3

ZESTORETIC 3

ACE INHIBITORS ACCUPRIL 3

ALTACE 3

benazepril hcl TABS 5mg 1

benazepril hcl (generic of LOTENSIN) TABS 10mg, 20mg, 40mg

1

captopril TABS 1

enalapril maleate (generic of VASOTEC) TABS

1

fosinopril sodium 1

lisinopril (generic of ZESTRIL) TABS 2.5mg, 30mg, 40mg

1

lisinopril (generic of PRINIVIL) TABS 5mg, 10mg, 20mg

1

LOTENSIN 20mg, 40mg 3

MAVIK 3

moexipril hcl (generic of UNIVASC)

1

perindopril erbumine 2mg 1

perindopril erbumine (generic of ACEON) 4mg, 8mg

1

PRINIVIL 3

quinapril hcl (generic of ACCUPRIL)

1

ramipril (generic of ALTACE) 1

trandolapril (generic of MAVIK)

1

UNIVASC 3

VASOTEC 3

ZESTRIL 3

ALDOSTERONE RECEPTOR ANTAGONISTS ALDACTONE 2

eplerenone (generic of INSPRA)

1

INSPRA 2

spironolactone (generic of ALDACTONE) TABS

1

ALPHA BLOCKERS CARDURA 3

Drug Name Drug Tier

Requirements/Limits

doxazosin mesylate (generic of CARDURA)

1

MINIPRESS 3

prazosin hcl (generic of MINIPRESS)

1

terazosin hcl 1

ANGIOTENSIN II RECEPTOR ANTAGONIST COMBINATIONS ATACAND HCT 3

AVALIDE 3

AZOR 2

BENICAR HCT 2

candesartan cilexetil-hydrochlorothiazide (generic of ATACAND HCT)

1

DIOVAN HCT 3

EDARBYCLOR 3

EXFORGE 2

EXFORGE HCT 2

HYZAAR 3

irbesartan-hydrochlorothiazide (generic of AVALIDE)

1

losartan potassium & hydrochlorothiazide (generic of HYZAAR)

1

MICARDIS HCT 2

telmisartan-amlodipine (generic of TWYNSTA)

1

TELMISARTAN-HYDROCHLOROTHIAZIDE

1

TEVETEN HCT 3

TRIBENZOR 2

TWYNSTA 3

valsartan-hydrochlorothiazide (generic of DIOVAN HCT)

1

ANGIOTENSIN II RECEPTOR ANTAGONISTS ATACAND 3

AVAPRO 3

BENICAR 2

candesartan cilexetil (generic of ATACAND)

1

COZAAR 3

DIOVAN 2

EDARBI 3



15

Drug Name Drug Tier

Requirements/Limits

eprosartan mesylate (generic of TEVETEN)

1

irbesartan (generic of AVAPRO)

1

losartan potassium (generic of COZAAR)

1

MICARDIS 3

TELMISARTAN 1

TEVETEN 3

valsartan (generic of DIOVAN)

1

ANTIARRHYTHMICS amiodarone hcl SOLN 1

amiodarone hcl TABS 100mg, 400mg

1

amiodarone hcl (generic of CORDARONE) TABS 200mg

1

amiodarone inj 50mg/ml 1

BETAPACE 2

BETAPACE AF 2

disopyramide phosphate (generic of NORPACE)

1

flecainide acetate 1

mexiletine hcl 1

MULTAQ 2

NORPACE 2

NORPACE CR 2

pacerone 100mg, 400mg 1

pacerone (generic of CORDARONE) 200mg

1

propafenone hcl (generic of RYTHMOL SR) CP12

1

propafenone hcl (generic of RYTHMOL) TABS 150mg, 225mg

1

propafenone hcl TABS 300mg

1

quinidine gluconate er 1

quinidine sulfate TABS; TBCR

1

RYTHMOL 2

RYTHMOL SR 2

sorine (generic of BETAPACE) 80mg, 120mg, 160mg

1

Drug Name Drug Tier

Requirements/Limits

sorine 240mg 1

sotalol hcl (generic of BETAPACE) 80mg, 120mg, 160mg

1

sotalol hcl 240mg 1

sotalol hcl (afib/afl) (generic of BETAPACE AF)

1

TAMBOCOR 2

TIKOSYN 2 PA

ANTILIPEMICS, HMG-CoA REDUCTASE INHIBITORS ALTOPREV 3

atorvastatin calcium (generic of LIPITOR)

1

CRESTOR 2

fluvastatin sodium (generic of LESCOL)

1

LESCOL 3

LESCOL XL 3

LIPITOR 3

LIVALO 3

lovastatin 10mg 1

lovastatin (generic of MEVACOR) 20mg, 40mg

1

MEVACOR 20mg 3

PRAVACHOL 3

pravastatin sodium 10mg 1

pravastatin sodium (generic of PRAVACHOL) 20mg, 40mg, 80mg

1

simvastatin (generic of ZOCOR) TABS

1

ZOCOR 3

ANTILIPEMICS, MISCELLANEOUS ADVICOR 3

ANTARA 2

cholestyramine (generic of QUESTRAN)

1

cholestyramine light 1

choline fenofibrate (generic of TRILIPIX)

1

COLESTID 3

colestipol hcl (generic of COLESTID)

1

FENOFIBRATE CAPS 1



16

Drug Name Drug Tier

Requirements/Limits

fenofibrate (generic of TRICOR) TABS 48mg, 145mg

1

fenofibrate (generic of LOFIBRA) TABS 54mg, 160mg

1

FENOFIBRATE CAP 1

FENOFIBRATE MICRONIZED 43mg, 130mg

1

fenofibrate micronized (generic of LOFIBRA) 67mg, 134mg, 200mg

1

FENOFIBRIC ACID 1

FENOGLIDE 3

FIBRICOR 3

gemfibrozil (generic of LOPID) TABS

1

LIPOFEN 2

LIPTRUZET 3

lofibra 3

LOPID 3

LOVAZA 2

niacin er (generic of NIASPAN) TBCR

1

niacor 1

NIASPAN 3

omega-3-acid ethyl esters 1

prevalite (generic of QUESTRAN LIGHT)

1

questran 3

questran light 3

SIMCOR 2

TRICOR 3

TRIGLIDE 3

TRILIPIX 3

VASCEPA 3

VYTORIN 2

WELCHOL 2

ZETIA 2

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone (generic of TENORETIC 50)

1

atenolol & chlorthalidone (generic of TENORETIC 100)

1

Drug Name Drug Tier

Requirements/Limits

bisoprolol & hydrochlorothiazide (generic of ZIAC)

1

CORZIDE 3

DUTOPROL 3

LOPRESSOR HCT 2

metoprolol & hctz tab 50-25mg (generic of LOPRESSOR HCT)

1

metoprolol & hctz tab 100-25mg (generic of LOPRESSOR HCT)

1

metoprolol & hctz tab 100-50mg

1

nadolol & bendroflumethiazide (generic of CORZIDE)

1

propranolol & hydrochlorothiazide

1

TENORETIC 2

ZIAC 2

BETA-BLOCKERS acebutolol hcl (generic of SECTRAL) CAPS

1

atenolol (generic of TENORMIN) TABS

1

betaxolol hcl (generic of KERLONE)

1

bisoprolol fumarate (generic of ZEBETA)

1

BYSTOLIC 2

carvedilol (generic of COREG)

1

COREG 3

COREG CR 2

CORGARD 3

INDERAL LA 3

labetalol hcl SOLN 1

labetalol hcl (generic of TRANDATE) TABS 100mg, 200mg

1

labetalol hcl TABS 300mg 1

LOPRESSOR 3

metoprolol succinate (generic of TOPROL XL)

1

metoprolol tartrate (generic of LOPRESSOR) SOLN

1



17

Drug Name Drug Tier

Requirements/Limits

metoprolol tartrate TABS 25mg

1

metoprolol tartrate (generic of LOPRESSOR) TABS 50mg, 100mg

1

nadolol (generic of CORGARD) TABS

1

pindolol 1

propranolol hcl er (generic of INDERAL LA)

1

propranolol inj 1mg/ml 1

propranolol sol 1

propranolol tab 1

SECTRAL 3

TENORMIN 3

timolol maleate TABS 1

TOPROL XL 3

TRANDATE 3

ZEBETA 3

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS AMLODIPINE BESYLATE/ATORV

1

CADUET 3

CALCIUM CHANNEL BLOCKERS ADALAT CC 3

afeditab cr (generic of ADALAT CC)

1

amlodipine besylate (generic of NORVASC) TABS

1

CALAN 3

CALAN SR 3

CARDIZEM 3

CARDIZEM CD 3

CARDIZEM LA 3

cartia xt (generic of CARDIZEM CD)

1

dilacor 3

dilt-cd 120mg 1

dilt-cd (generic of CARDIZEM CD) 180mg, 240mg, 300mg

1

dilt-cd cap 120mg (generic of CARDIZEM CD)

1

dilt-xr 1

diltiazem cap 120mg/24hr 1

diltiazem cap er/12hr 1

Drug Name Drug Tier

Requirements/Limits

diltiazem hcl SOLN 1

diltiazem hcl SOLR 3

diltiazem hcl (generic of CARDIZEM) TABS 30mg, 60mg, 120mg

1

diltiazem hcl TABS 90mg 1

diltiazem hcl coated beads (generic of CARDIZEM CD)

1

DILTIAZEM HCL ER 1

diltiazem hcl extended release beads (generic of TIAZAC)

1

diltzac (generic of TIAZAC) 1

felodipine 1

isradipine 1

matzim la (generic of CARDIZEM LA)

1

nicardipine hcl CAPS 1

nifedical (generic of PROCARDIA XL)

1

nifedipine (generic of ADALAT CC) TB24

1

nifedipine er (generic of PROCARDIA XL)

1

nimodipine CAPS 1

nisoldipine (generic of SULAR) 8.5mg, 17mg, 34mg

1

nisoldipine 20mg, 25.5mg, 30mg, 40mg

1

NORVASC 3

NYMALIZE 3

PROCARDIA XL 3

SULAR 3

taztia xt (generic of TIAZAC) 1

TIAZAC 3

verapamil hcl (generic of VERELAN PM) CP24 100mg, 200mg, 300mg

1

verapamil hcl (generic of VERELAN) CP24 120mg, 180mg, 240mg

1

VERAPAMIL HCL CP24 360mg

1

verapamil hcl SOLN 1

verapamil hcl TABS 40mg 1

verapamil hcl (generic of CALAN) TABS 80mg, 120mg

1



18

Drug Name Drug Tier

Requirements/Limits

verapamil hcl (generic of CALAN SR) TBCR

1

VERELAN 3

VERELAN PM 3

DIGITALIS GLYCOSIDES digoxin (generic of LANOXIN) 1

digoxin inj (generic of LANOXIN)

1

DIGOXIN SOL 50MCG/ML 1

LANOXIN INJ 0.25MG/ML 3

LANOXIN PEDIATRIC 2

LANOXIN TAB 2

DIRECT RENIN INHIBITORS/COMBINATIONS AMTURNIDE 2

TEKAMLO 2

TEKTURNA 2

TEKTURNA HCT 2

DIURETICS acetazolamide (generic of DIAMOX) CP12

1

acetazolamide TABS 1

acetazolamide sodium 1

ALDACTAZIDE 2

ALDACTAZIDE 3

amiloride & hydrochlorothiazide

1

amiloride hcl 1

bumetanide 1

chlorothiazide 1

chlorthalidone 25mg, 50mg 1

DEMADEX 3

DIAMOX 2

DIURIL SUS 250/5ML 3

DYAZIDE 3

DYRENIUM 3

EDECRIN 3

furosemide SOLN 1

furosemide (generic of LASIX) TABS

1

furosemide inj 1

furosemide oral soln 8 mg/ml 2

hydrochlorothiazide (generic of MICROZIDE) CAPS

1

hydrochlorothiazide TABS 1

Drug Name Drug Tier

Requirements/Limits

indapamide 1

LASIX 3

MAXZIDE 3

MAXZIDE-25 3

methazolamide (generic of NEPTAZANE) TABS

1

methyclothiazide 1

metolazone (generic of ZAROXOLYN) 2.5mg, 5mg

1

metolazone 10mg 1

MICROZIDE 3

SODIUM DIURIL 3

spironolactone & hydrochlorothiazide (generic of ALDACTAZIDE)

1

torsemide inj 2

torsemide tabs (generic of DEMADEX)

1

triamterene & hydrochlorothiazide

1

triamterene & hydrochlorothiazide cap 37.5-25 mg (generic of DYAZIDE)

1

triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)

1

triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)

1

ZAROXOLYN 3

MISCELLANEOUS BIDIL 2

CATAPRES 2

CATAPRES-TTS 2

clonidine hcl (generic of CATAPRES-TTS-1) PTWK .1mg/24hr

1


1


1

clonidine hcl (generic of CATAPRES) TABS

1



19

Drug Name Drug Tier

Requirements/Limits

clorpres 0.1/15 1

clorpres 0.2/15 1

clorpres 0.3/15 1

DEMSER 2

DIBENZYLINE 2

guanfacine hcl (generic of TENEX)

1 PA

hydralazine hcl 1

midodrine hcl 1

minoxidil TABS 1

RANEXA 2

TENEX 2 PA

NITRATES DILATRATE SR 3

imdur 2

ISORDIL TITRADOSE 2

isosorbide dinitrate (generic of ISORDIL TITRADOSE) TABS 5mg

1

isosorbide dinitrate TABS 10mg, 20mg, 30mg

1

isosorbide dinitrate TBCR 1

isosorbide dinitrate sl tab 2.5 mg

1

isosorbide mononitrate TABS

1

isosorbide mononitrate (generic of IMDUR) TB24

1

minitran (generic of NITRO-DUR)

1

nitro-bid 3

NITRO-DUR 2

NITROGLYCERIN .4mg/spray

1

NITROGLYCERIN LINGUAL 1

nitroglycerin patches 1

NITROLINGUAL SPR PUMPSPRA

2

NITROMIST 2

NITROSTAT 2

PULMONARY ARTERIAL HYPERTENSION ADCIRCA 3 PA

ADEMPAS 3 PA

FLOLAN INJ 3 PA

LETAIRIS 2 LA PA

Drug Name Drug Tier

Requirements/Limits

OPSUMIT 3 PA

ORENITRAM 3 PA

REMODULIN 2 B/D LA

REVATIO SOLN 2 PA

REVATIO TABS 3 PA

sildenafil citrate (pulmonary hypertension) (generic of REVATIO)

1 PA

TRACLEER 2 LA PA

VENTAVIS 2 B/D

CENTRAL NERVOUS SYSTEM ANTIANXIETY alprazolam CONC

QL (300 ml / 30 days) 2 QL

alprazolam (generic of XANAX) TABS 1mg


1 QL

alprazolam (generic of XANAX) TABS 2mg


1 QL

alprazolam (generic of XANAX) TABS .5mg


1 QL

alprazolam (generic of XANAX) TABS .25mg


1 QL

ATIVAN SOLN 3

ATIVAN TABS QL (150 tabs / 30 days)

2 QL

buspirone hcl TABS 1

fluvoxamine maleate 1

fluvoxamine maleate er (generic of LUVOX CR)

1

fluvoxamine tabs 1

lorazepam CONC QL (150 mls / 30 days)

1 QL

lorazepam (generic of ATIVAN) SOLN

1

lorazepam (generic of ATIVAN) TABS


1 QL

LUVOX CR 3

XANAX 1mg QL (120 tabs / 30 days)

2 QL

XANAX 2mg QL (150 tabs / 30 days)

2 QL

XANAX .5mg QL (240 tabs / 30 days)

2 QL



20

Drug Name Drug Tier

Requirements/Limits

XANAX .25mg QL (480 tabs / 30 days)

2 QL

ANTICONVULSANTS APTIOM 3

BANZEL 3

carbamazepine CHEW 1

carbamazepine (generic of CARBATROL) CP12

1

carbamazepine (generic of TEGRETOL) SUSP; TABS

1

carbamazepine (generic of TEGRETOL-XR) TB12

1

CARBATROL 2

CELONTIN 3

clonazepam (generic of KLONOPIN) TABS 1mg


1 QL

clonazepam (generic of KLONOPIN) TABS 2mg


1 QL

clonazepam (generic of KLONOPIN) TABS .5mg


1 QL

clonazepam TBDP 1mg QL (600 tabs / 30 days)

1 QL

clonazepam TBDP 2mg QL (300 tabs / 30 days)

1 QL

clonazepam TBDP .5mg QL (1200 tabs / 30 days)

1 QL


1 QL


1 QL

clorazepate dipotassium (generic of TRANXENE T) 3.75mg, 7.5mg


1 QL

clorazepate dipotassium (generic of TRANXENE T) 15mg


1 QL

DEPACON 3

DEPAKENE 2

DEPAKOTE 2

Drug Name Drug Tier

Requirements/Limits

DEPAKOTE ER 2

DEPAKOTE SPRINKLES 2

DIASTAT ACUDIAL 3

DIASTAT PEDIATRIC 3

diazepam CONC QL (240 ml / 30 days)

1 QL

diazepam SOLN QL (1200mL / 30 days)

1 QL

diazepam (generic of VALIUM) TABS


1 QL

DIAZEPAM GEL 1

diazepam inj 1

dilantin CAPS; CHEW 2

DILANTIN SUSP 2

divalproex sodium (generic of DEPAKOTE SPRINKLES) CPSP

1

divalproex sodium (generic of DEPAKOTE ER) TB24

1

divalproex sodium (generic of DEPAKOTE) TBEC

1

epitol (generic of TEGRETOL) 1

ethosuximide (generic of ZARONTIN) CAPS; SOLN

1

felbamate (generic of FELBATOL)

1

FELBATOL 3

FYCOMPA 3

gabapentin (generic of NEURONTIN) CAPS; SOLN; TABS

1

GABITRIL 2

KEPPRA SOLN 100mg/ml 2

KEPPRA SOLN 500mg/5ml 3

KEPPRA TABS 250mg, 500mg

2

KEPPRA TABS 750mg, 1000mg

3

KEPPRA XR 500mg 2

KEPPRA XR 750mg 3

KLONOPIN 1mg QL (600 tabs / 30 days)

2 QL

KLONOPIN 2mg QL (300 tabs / 30 days)

2 QL



21

Drug Name Drug Tier

Requirements/Limits

KLONOPIN .5mg QL (1200 tabs / 30 days)

2 QL

LAMICTAL TABS 2

LAMICTAL CHEWABLE DISPERS 5mg

2

LAMICTAL CHEWABLE DISPERS 25mg

3

LAMICTAL ODT 2

LAMICTAL STARTER 2

LAMICTAL XR 2

lamotrigine (generic of LAMICTAL CHEWABLE DISPERS) CHEW

1

lamotrigine (generic of LAMICTAL) TABS

1

lamotrigine (generic of LAMICTAL XR) TB24

1

levetiracetam (generic of KEPPRA) SOLN; TABS

1

levetiracetam (generic of KEPPRA XR) TB24

1

LYRICA 2

MYSOLINE 2

NEURONTIN 2

ONFI 3

oxcarbazepine (generic of TRILEPTAL)

1

OXTELLAR XR 3

PEGANONE 3

phenobarbital ELIX; TABS 1

PHENOBARBITAL SODIUM 65mg/ml

1

phenobarbital sodium 130mg/ml

1

phenytek 3

phenytoin (generic of DILANTIN INFATABS) CHEW

1

phenytoin (generic of DILANTIN) SUSP

1

phenytoin inj 50mg/ml 1

phenytoin sodium extended (generic of DILANTIN) 100mg

1

Drug Name Drug Tier

Requirements/Limits

phenytoin sodium extended (generic of PHENYTEK) 200mg, 300mg

1

POTIGA 3

primidone (generic of MYSOLINE) TABS

1

QUDEXY XR 3

SABRIL 2 LA PA

STAVZOR 3

TEGRETOL 2

TEGRETOL-XR 2

tiagabine hcl (generic of GABITRIL)

1

TOPAMAX 25mg, 50mg, 100mg

2

TOPAMAX 200mg 3

TOPAMAX SPRINKLE 15mg

2

TOPAMAX SPRINKLE 25mg

3

topiramate (generic of TOPAMAX SPRINKLE) CPSP

1

topiramate (generic of TOPAMAX) TABS

1

TOPIRAMATE ER 1

TRANXENE T 3.75mg, 7.5mg


3 QL

TRANXENE T 15mg QL (180 tabs / 30 days)

3 QL

TRILEPTAL 2

TRILEPTAL SUSP 2

TROKENDI XR 3

VALIUM QL (120 tabs / 30 days)

2 QL

valproate sodium (generic of DEPACON) SOLN

1

valproate sodium (generic of DEPAKENE) SYRP

1

valproic acid (generic of DEPAKENE) CAPS

1

VIMPAT 2

ZARONTIN CAPS 2

zarontin SOLN 2

ZONEGRAN 2



22

Drug Name Drug Tier

Requirements/Limits

zonisamide (generic of ZONEGRAN) 25mg, 100mg

1

zonisamide 50mg 1

ANTIDEMENTIA ARICEPT 3

ARICEPT ODT 3

donepezil odt 5mg 1

donepezil odt 10mg (generic of ARICEPT ODT)

1

donepezil tab hcl 23mg (generic of ARICEPT)

1

donepezil tabs 5mg (generic of ARICEPT)

1

donepezil tabs 10mg (generic of ARICEPT)

1

EXELON 3

EXELON PATCHES 2

galantamine hydrobromide (generic of RAZADYNE ER) CP24

1

galantamine hydrobromide (generic of RAZADYNE) SOLN; TABS

1

NAMENDA 2

NAMENDA TITRATION PAK 2

NAMENDA XR 2

NAMENDA XR TITRATION PACK

2

RAZADYNE 3

RAZADYNE ER 3

rivastigmine tartrate (generic of EXELON)

1

ANTIDEPRESSANTS amitriptyline hcl TABS 1

amoxapine 1

ANAFRANIL 3

APLENZIN 3

BRINTELLIX 3

budeprion (generic of WELLBUTRIN SR)

1

bupropion hcl (generic of WELLBUTRIN) TABS

1

bupropion hcl (generic of WELLBUTRIN SR) TB12

1

bupropion hcl (generic of WELLBUTRIN XL) TB24

1

Drug Name Drug Tier

Requirements/Limits

CELEXA 3

citalopram hydrobromide SOLN

1

citalopram hydrobromide (generic of CELEXA) TABS

1

clomipramine hcl (generic of ANAFRANIL) CAPS

1

CYMBALTA 3

desipramine hcl (generic of NORPRAMIN) TABS

1

doxepin hcl CAPS; CONC 1

duloxetine hcl (generic of CYMBALTA) CPEP

1

EFFEXOR XR 3

EMSAM 3

escitalopram oxalate (generic of LEXAPRO)

1

FETZIMA 3

FETZIMA TITRATION PACK 3

fluoxetine hcl (generic of PROZAC) CAPS

1

fluoxetine hcl (generic of PROZAC WEEKLY) CPDR

1

fluoxetine hcl SOLN 1

fluoxetine hcl TABS 10mg, 20mg

1

FLUOXETINE HCL TABS 60mg

2

FORFIVO XL 3

imipramine hcl (generic of TOFRANIL) TABS

1

imipramine pamoate (generic of TOFRANIL-PM)

1

LEXAPRO 3

maprotiline hcl 1

MARPLAN 2

mirtazapine TABS 7.5mg 1

mirtazapine (generic of REMERON) TABS 15mg, 30mg, 45mg

1

mirtazapine (generic of REMERON SOLTAB) TBDP

1

NARDIL 2

nefazodone hcl 1

NORPRAMIN 2

nortriptyline hcl (generic of PAMELOR) CAPS

1



23

Drug Name Drug Tier

Requirements/Limits

nortriptyline hcl SOLN 1

OLEPTRO 3

PAMELOR 3

PARNATE 2

paroxetine er tab (generic of PAXIL CR)

1

paroxetine hcl (generic of PAXIL)

1

PAXIL 3

PAXIL CR 3

PEXEVA 3

phenelzine sulfate (generic of NARDIL) TABS

1

PRISTIQ 2

protriptyline hcl (generic of VIVACTIL)

1

PROZAC 3

PROZAC WEEKLY 3

REMERON 3

REMERON SOLTAB 3

sertraline hcl (generic of ZOLOFT) CONC; TABS

1

SURMONTIL 3

tofranil 2

TOFRANIL-PM 3

tranylcypromine sulfate (generic of PARNATE)

1

trazodone hcl TABS 1

trimipramine maleate 1

venlafaxine cap er (generic of EFFEXOR XR)

1

VENLAFAXINE HCL ER TAB (VERT)

3

venlafaxine tab 1

VENLAFAXINE TAB 225MG ER

1

venlafaxine tab er (generic of VENLAFAXINE HCL ER)

1

VIIBRYD 2

vivactil 3

WELLBUTRIN 3

WELLBUTRIN SR 3

WELLBUTRIN XL 3

ZOLOFT 3

ANTIPARKINSONIAN AGENTS

Drug Name Drug Tier

Requirements/Limits

amantadine hcl CAPS; SYRP; TABS

1

APOKYN 2 LA PA

AZILECT 2

benztropine mesylate (generic of COGENTIN) SOLN

1

benztropine mesylate TABS 1

bromocriptine mesylate (generic of PARLODEL) CAPS

1

bromocriptine mesylate TABS

1

carbidopa (generic of LODOSYN) TABS

1

carbidopa-levodopa (generic of SINEMET) TABS

1

carbidopa-levodopa (generic of SINEMET CR) TBCR

1

carbidopa-levodopa TBDP 1

CARBIDOPA/LEVODOPA/ENTACA

1


1


1


1


1


1

COGENTIN 3

COMTAN 3

ELDEPRYL 3

ENTACAPONE 1

LODOSYN 3

MIRAPEX 3

MIRAPEX ER 2

NEUPRO 2

parcopa 10/100 3

parcopa 25/100 3

parcopa 25/250 3

PARLODEL 2

pramipexole dihydrochloride .75mg

1



24

Drug Name Drug Tier

Requirements/Limits

pramipexole dihydrochloride (generic of MIRAPEX) .125mg, .25mg, .5mg, 1mg, 1.5mg

1

REQUIP 3

REQUIP XL 3

ropinirole hydrochloride (generic of REQUIP) TABS

1

ropinirole hydrochloride (generic of REQUIP XL) TB24

1

selegiline hcl (generic of ELDEPRYL) CAPS

1

selegiline hcl TABS 1

SINEMET 3

SINEMET CR 3

STALEVO 3

trihexyphenidyl hcl 1 PA

ZELAPAR 2

ANTIPSYCHOTICS ABILIFY 2

ABILIFY DISCMELT 10mg 2

ABILIFY DISCMELT 15mg 3

ABILIFY INJ 2

ABILIFY MAINTENA 2

chlorpromaz inj 25mg/ml 3

chlorpromazine hcl TABS 1

CLOZAPINE ODT 1

clozapine tab (generic of CLOZARIL) 25mg, 100mg

1

clozapine tab 50mg, 200mg 1

CLOZARIL 3

FANAPT 3

FANAPT TITRATION PACK 3

FAZACLO 3

fluphenazine decanoate SOLN

1

fluphenazine hcl 1

GEODON 3

GEODON INJ 2

HALDOL 3

HALDOL DECANOATE 50 3

HALDOL DECANOATE 100 3

haloperidol TABS 1

Drug Name Drug Tier

Requirements/Limits

haloperidol decanoate (generic of HALDOL DECANOATE 50) SOLN 50mg/ml

1

haloperidol decanoate (generic of HALDOL DECANOATE 100) SOLN 100mg/ml

1

haloperidol lactate CONC 1

haloperidol lactate (generic of HALDOL) SOLN

1

INVEGA 3

INVEGA SUSTENNA 2

LATUDA 2

loxapine succinate 1

loxitane 3

NAVANE 3

olanzapine (generic of ZYPREXA)

1

olanzapine odt (generic of ZYPREXA ZYDIS)

1

ORAP 2

perphenazine TABS 1

quetiapine fumarate (generic of SEROQUEL)

1

RISPERDAL 3

RISPERDAL CONSTA 2

RISPERDAL M-TAB 3

risperidone (generic of RISPERDAL)

1

risperidone odt (generic of RISPERDAL M-TAB) .5mg, 1mg, 2mg, 3mg, 4mg

1

risperidone odt .25mg 1

SAPHRIS 3

SEROQUEL 3

SEROQUEL XR 2

thioridazine hcl TABS 1 PA

thiothixene 1

trifluoperazine hcl 1

VERSACLOZ 3

ziprasidone hcl (generic of GEODON)

1

ZYPREXA 3

ZYPREXA ZYDIS 3



25

Drug Name Drug Tier

Requirements/Limits

ATTENTION DEFICIT HYPERACTIVITY DISORDER adderall 3

adderall tab 5mg 3

adderall tab 7.5mg 3

adderall tab 10mg 3

adderall tab 12.5mg 3

adderall tab 15mg 3

adderall tab 30mg 3

ADDERALL XR CAP 5MG 2






amphetamine-dextroamphetamine cap sr 24hr 5 mg (generic of ADDERALL XR)

1


1


1


1


1


1

amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)

1

amphetamine-dextroamphetamine tab 7.5 mg (generic of ADDERALL)

1


1

amphetamine-dextroamphetamine tab 12.5 mg (generic of ADDERALL)

1

Drug Name Drug Tier

Requirements/Limits


1


1


1

CONCERTA 2

DAYTRANA 2

INTUNIV 2

METADATE CD 3

metadate tab 20mg er (generic of RITALIN SR)

1

METHYLIN 2

METHYLIN CHEW TAB 2

methylphenidate hcl (generic of RITALIN LA) CP24

1

methylphenidate hcl (generic of METADATE CD) CPCR

1

methylphenidate hcl (generic of METHYLIN) SOLN

1

methylphenidate hcl (generic of RITALIN) TABS

1

METHYLPHENIDATE HCL ER 18mg, 36mg, 54mg

1

methylphenidate hcl er (generic of CONCERTA) 27mg

1

methylphenidate tab 10mg er 1

methylphenidate tab 20mg er (generic of RITALIN SR)

1

QUILLIVANT XR 2

RITALIN 2

RITALIN LA 2

RITALIN SR 3

STRATTERA 2

VYVANSE 2

HYPNOTICS AMBIEN

QL (30 tabs / 30 days) 3 QL

AMBIEN CR QL (30 ea / 30 days)

3 QL

EDLUAR QL (30 ea / 30 days)

3 QL



26

Drug Name Drug Tier

Requirements/Limits

eszopiclone (generic of LUNESTA)

QL (30 tabs / 30 days) 90 day limit if >64 yr

1 QL

INTERMEZZO QL (30 ea / 30 days)

3 QL

LUNESTA QL (30 tabs / 30 days)

3 QL

RESTORIL 7.5mg QL (30 caps / 30 days)

3 QL

RESTORIL 15mg QL (60 caps / 30 days)

3 QL

ROZEREM QL (30 tabs / 30 days)

3 QL

SILENOR 3mg QL (60 tabs / 30 days)

2 QL

SILENOR 6mg QL (30 tabs / 30 days)

2 QL

SONATA QL (30 caps / 30 days)

3 QL

temazepam (generic of RESTORIL) 7.5mg

QL (30 caps / 30 days)

1 QL

temazepam (generic of RESTORIL) 15mg

QL (60 caps / 30 days)

1 QL

zaleplon (generic of SONATA) QL (30 caps / 30 days)

1 QL

zolpidem tartrate (generic of AMBIEN) TABS


1 QL

zolpidem tartrate (generic of AMBIEN CR) TBCR


1 QL

ZOLPIMIST QL (1 bottle / 30 days)

3 QL

MIGRAINE ALSUMA

QL (4 mL / 30 days) 3 QL

AMERGE QL (9 tabs / 30 days)

3 QL

AXERT QL (12 tabs / 30 days)

3 QL

cafergot tab 1-100mg 2

D.H.E. 45 3

Drug Name Drug Tier

Requirements/Limits

dihydroergotamine mesylate (generic of D.H.E. 45) 1mg/ml

1

DIHYDROERGOTAMINE MESYLATE 4mg/ml

QL (8 mL / 30 days)

1 QL

ergomar 2

FROVA TAB 2.5MG QL (18 tabs / 30 days)

3 QL

IMITREX SOLN 5mg/act, 20mg/act

QL (12 inhalers / 30 days)

3 QL

IMITREX SOLN 6mg/0.5ml QL (8 vials / 30 days)

3 QL

IMITREX TABS QL (9 tabs / 30 days)

3 QL

IMITREX STATDOSE REFILL 4mg/0.5ml

QL (8 cartridges / 30 days)

3 QL

IMITREX STATDOSE REFILL 6mg/0.5ml

QL (8 syringes / 30 days)

3 QL

IMITREX STATDOSE SYSTEM

QL (4mL/30 days)

3 QL

MAXALT QL (12 tabs / 30 days)

3 QL

MAXALT-MLT QL (12 ea / 30 days)

3 QL

migergot 1

MIGRANAL QL (8 bottles / 30 days)

3 QL

naratriptan hcl (generic of AMERGE)


1 QL

RELPAX QL (12 tabs / 30 days)

2 QL

rizatriptan benzoate (generic of MAXALT) TABS


1 QL

rizatriptan benzoate (generic of MAXALT-MLT) TBDP


1 QL



27

Drug Name Drug Tier

Requirements/Limits

SUMATRIPTAN SUCCINATE SOLN 5mg/act, 20mg/act

QL (12 inhalers / 30 days)

1 QL

sumatriptan succinate (generic of IMITREX) TABS


1 QL

SUMATRIPTAN SUCCINATE INJ SOAJ 4mg/0.5ml

QL (4 mL / 30 days)

1 QL

sumatriptan succinate inj (generic of IMITREX STATDOSE SYSTEM) SOAJ 6mg/0.5ml

QL (8 syringes/vials / 30 days)

1 QL

SUMATRIPTAN SUCCINATE INJ SOCT 4mg/0.5ml

QL (4 mL / 30 days)

1 QL

SUMATRIPTAN SUCCINATE INJ SOCT 6mg/0.5ml

QL (4mL/30 days)

1 QL

sumatriptan succinate inj (generic of IMITREX) SOLN

QL (8 syringes/vials / 30 days)

1 QL

sumatriptan succinate inj SOSY

QL (4mL/30 days)

1 QL

SUMAVEL DOSEPRO QL (6 mL / 30 days)

2 QL

TREXIMET 2

zolmitriptan (generic of ZOMIG) TABS

QL (12 tabs per 30 days)

1 QL

zolmitriptan odt (generic of ZOMIG ZMT)

QL (12 tabs per 30 days)

1 QL

ZOMIG QL (12 tabs / 30 days)

3 QL

ZOMIG NASAL SPRAY 2.5mg

QL (2 boxes / 30 days)

2 QL

ZOMIG NASAL SPRAY 5mg QL (2 bottles / 30 days)

2 QL

ZOMIG ZMT QL (12 ea / 30 days)

3 QL

Drug Name Drug Tier

Requirements/Limits

MISCELLANEOUS BRISDELLE 3

EQUETRO 3

GRALISE 2

GRALISE STARTER 2

HORIZANT 3

lithium carbonate CAPS 1

lithium carbonate TABS 1

lithium carbonate (generic of LITHOBID) TBCR 300mg

1

lithium carbonate TBCR 450mg

1

LITHIUM CITRATE 2

LITHOBID 2

MESTINON SYRUP 2

MESTINON TAB 2

MESTINON TIMESPAN 2

NUEDEXTA 2

pyridostigmine bromide (generic of MESTINON) TABS

1

RILUTEK 3

riluzole (generic of RILUTEK) 1

SAVELLA 2

SAVELLA TITRATION PACK 2

XENAZINE 2 LA PA

MULTIPLE SCLEROSIS AGENTS AMPYRA 2 LA PA

AUBAGIO 3 PA

AVONEX 2 PA

AVONEX PEN 2 PA

BETASERON 3 PA

COPAXONE 2 PA

COPAXONE INJ 40MG/ML 2 PA

EXTAVIA 2 PA

GILENYA 2 PA

REBIF 3 PA

REBIF TITRATION PACK 3 PA

TECFIDERA 2 PA

TECFIDERA STARTER PACK

2 PA

TYSABRI 3 LA PA

MUSCULOSKELETAL THERAPY AGENTS AMRIX 3 PA

baclofen TABS 1



28

Drug Name Drug Tier

Requirements/Limits

carisoprodol (generic of SOMA) TABS 350mg

1 PA

chlorzoxazone (generic of PARAFON FORTE DSC)

1 PA

cyclobenzaprine hcl TABS 5mg, 10mg

1 PA

cyclobenzaprine hcl (generic of FEXMID) TABS 7.5mg

1 PA

DANTRIUM 2

dantrolene sodium (generic of DANTRIUM) CAPS 25mg, 50mg

1

dantrolene sodium CAPS 100mg

1

fexmid 3 PA

methocarbamol (generic of ROBAXIN) TABS 500mg

1 PA

methocarbamol (generic of ROBAXIN-750) TABS 750mg

1 PA

PARAFON FORTE DSC 2 PA

SOMA 350mg 3 PA

tizanidine (generic of ZANAFLEX) CAPS

1

tizanidine TABS 2mg 1

tizanidine (generic of ZANAFLEX) TABS 4mg

1

ZANAFLEX CAPS 3

ZANAFLEX TABS 2

NARCOLEPSY/CATAPLEXY modafinil (generic of PROVIGIL)

1 PA

NUVIGIL 2 PA

PROVIGIL 3 PA

XYREM QL (540 ml / 30 days)

3 QL LA PA

PSYCHOTHERAPEUTIC-MISC acamprosate calcium (generic of CAMPRAL)

1

antabuse 2

buprenorphine hcl SUBL 1

buprenorphine hcl-naloxone hcl sl

1

buproban (generic of ZYBAN) 1

CAMPRAL 3

CHANTIX 2

CHANTIX STARTER PACK 2

Drug Name Drug Tier

Requirements/Limits

disulfiram (generic of ANTABUSE) TABS

1

naloxone hcl SOLN 1

naltrexone hcl (generic of REVIA) TABS

1

NICOTROL INHALER 2

NICOTROL NS 2

revia 2

SARAFEM 3

SUBOXONE MIS 2-0.5MG 3

SUBOXONE MIS 4-1MG 3



VIVITROL 2 PA

ZUBSOLV 2

ZYBAN 2

ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM 2

ANDROGEL 1% 3

ANDROGEL 1.62% 3

androxy 3

AXIRON 2

DELATESTRYL 3

depo-testosterone 100mg/ml 2

depo-testosterone 200mg/ml 3

FORTESTA 2

oxandrolone (generic of OXANDRIN) TABS

1

STRIANT 3

TESTIM 3

testosterone cypionate OIL 100mg/ml

1

testosterone cypionate (generic of DEPO-TESTOSTERONE) OIL 200mg/ml

1

testosterone enanthate OIL 1

VOGELXO 3

VOGELXO PUMP 3

ANTIDIABETICS, INJECTABLE ALCOHOL PREPS PADS 2

APIDRA 2

APIDRA SOLOSTAR 2

BYDUREON 2



29

Drug Name Drug Tier

Requirements/Limits

BYETTA 3

GAUZE PADS 2X2 2

HUMALOG 3

HUMALOG KWIKPEN 3

HUMALOG MIX 50/50 3

HUMALOG MIX 50/50 KWIKPEN

3

HUMALOG MIX 75/25 3

HUMALOG MIX 75/25 KWIKPEN

3

HUMULIN 70/30 3

HUMULIN 70/30 PEN 3

HUMULIN N 3

HUMULIN N U-100 PEN 3

HUMULIN R 3

HUMULIN R U-500 (CONCENTRATE)

2 B/D

INSULIN PEN NEEDLES 2

INSULIN SAFETY NEEDLES 2

INSULIN SYRINGES 2

LANTUS 2

LANTUS SOLOSTAR 2

LEVEMIR 2

LEVEMIR FLEXPEN 2

LEVEMIR FLEXTOUCH 2

NOVOLIN 70/30 2

NOVOLIN 70/30 RELION 3

NOVOLIN N 2

NOVOLIN N RELION 3

NOVOLIN R 2

NOVOLIN R RELION 3

NOVOLOG 2

NOVOLOG FLEXPEN 2

NOVOLOG MIX 70/30 2

NOVOLOG MIX 70/30 PREFILL

2

NOVOLOG PENFILL 2

SYMLINPEN 60 2

SYMLINPEN 120 2

TANZEUM 3

VICTOZA 2

ANTIDIABETICS, ORAL acarbose (generic of PRECOSE)

1

Drug Name Drug Tier

Requirements/Limits

ACTOPLUS MET TAB 15-500MG

3

ACTOPLUS MET TAB 15-850MG

3

ACTOPLUS MET XR 15-1000MG

3

ACTOPLUS MET XR 30-1000MG

3

ACTOS 3

AMARYL 3

DIABETA 3 PA

DUETACT 3

FARXIGA 3

FORTAMET 3

glimepiride (generic of AMARYL)

1

glipizide (generic of GLUCOTROL) TABS

1

glipizide er (generic of GLUCOTROL XL)

1

glipizide-metformin 2.5-250mg 1

glipizide-metformin 2.5-500mg 1

glipizide-metformin 5-500mg 1

GLUCOPHAGE 3

GLUCOPHAGE XR 3

GLUCOTROL 3

GLUCOTROL XL 3

GLUCOVANCE 1.25-250MG 3 PA

GLUCOVANCE 2.5-500MG 3 PA

GLUCOVANCE 5-500MG 3 PA

GLUMETZA 3

glyburide 1 PA

glyburide micronized (generic of GLYNASE)

1 PA

glyburide-metformin 1.25-250mg (generic of GLUCOVANCE)

1 PA

glyburide-metformin 2.5-500mg (generic of GLUCOVANCE)

1 PA

glyburide-metformin 5-500mg (generic of GLUCOVANCE)

1 PA

GLYNASE 3 PA

GLYSET 3

INVOKANA 2

JANUMET 2



30

Drug Name Drug Tier

Requirements/Limits

JANUMET XR TAB 50-500MG

2

JANUMET XR TAB 50-1000 2

JANUMET XR TAB 100-1000 2

JANUVIA 2

JENTADUETO 2

KAZANO 3

KOMBIGLYZE XR 2.5-1000MG

3

KOMBIGLYZE XR 5-500MG 3

KOMBIGLYZE XR 5-1000MG 3

metformin er (generic of GLUCOPHAGE XR)

1

metformin hcl (generic of GLUCOPHAGE) TABS

1

metformin hcl (generic of FORTAMET) TB24

1

nateglinide (generic of STARLIX)

1

NESINA 3

ONGLYZA 3

OSENI TAB 12.5-15MG 3



OSENI TAB 25-15MG 3

OSENI TAB 25-30MG 3

OSENI TAB 25-45MG 3

pioglitazone hcl (generic of ACTOS)

1

pioglitazone hcl-glimepiride (generic of DUETACT)

1

pioglitazone hcl-metformin hcl (generic of ACTOPLUS MET)

1

PRANDIMET 2

PRANDIN 3

PRECOSE 2

repaglinide (generic of PRANDIN)

1

RIOMET 3

STARLIX 3

TRADJENTA 2

BISPHOSPHONATES ACTONEL 2

alendronate sodium SOLN 1

alendronate sodium TABS 5mg, 10mg, 35mg, 40mg

1

Drug Name Drug Tier

Requirements/Limits

alendronate sodium (generic of FOSAMAX) TABS 70mg

1

ATELVIA 2

BINOSTO 3

BONIVA 3 B/D

FOSAMAX 3

FOSAMAX PLUS D 3

ibandronate sodium (generic of BONIVA)

1 B/D

pamidronate disodium SOLN 6mg/ml

2 B/D

pamidronate disodium SOLN 30mg/10ml, 90mg/10ml

1 B/D

risedronate sodium (generic of ACTONEL)

1

zoledronic inj 4mg/5ml (generic of ZOMETA)

1 B/D

ZOMETA CONC 3 B/D

ZOMETA SOLN 2 B/D

CALCIUM RECEPTOR ANTAGONISTS SENSIPAR 2 PA

CHELATING AGENTS CHEMET 2

EXJADE 2 LA PA

FERRIPROX 3 PA

KAYEXALATE 3

kionex (generic of KAYEXALATE) POWD

1

kionex SUSP 1

sodium polystyrene sulfonate 1

sps sus 15gm/60ml 1

SYPRINE 3

CONTRACEPTIVES altavera 1

amethia 91 day (generic of SEASONIQUE)

1

amethyst 28 day 1

apri 28 day (generic of DESOGEN)

1

aranelle 28 (generic of TRI-NORINYL 28)

1

aviane 28 1

balziva 28 day (generic of OVCON-35)

1

BEYAZ 2

BREVICON-28 3



31

Drug Name Drug Tier

Requirements/Limits

briellyn 28 day (generic of OVCON-35)

1

camila 28 day (generic of NOR-QD)

1

CAMRESE LO TAB 1

cryselle 28 1

cyclafem 1/35 28 day (generic of NORINYL 1+35)

1

cyclafem 7/7/7 28 day (generic of ORTHO-NOVUM 7/7/7)

1

CYCLESSA 3

DEPO-PROVERA CONTRACEPTIV

2

DEPO-SUBQ PROVERA 104 2

DESOGEN 3

drospirenone-ethinyl estradiol (generic of YASMIN 28)

1

ELLA 2

emoquette (generic of DESOGEN)

1

enpresse 28 day 1

errin 28 day (generic of ORTHO MICRONOR)

1

ESTROSTEP FE 3

FEMCON FE 3

GENERESS FE 3

GIANVI 1

gildagia (generic of OVCON-35)

1

heather tab 0.35mg (generic of NOR-QD)

1

introvale 91 day 1

JOLIVETTE 1

junel 1.5/30 21 day (generic of LOESTRIN 1.5/30-21)

1

junel 1/20 21 day (generic of LOESTRIN 1/20-21)

1

junel fe 1.5/30 28 day (generic of LOESTRIN FE 1.5/30)

1

junel fe 1/20 28 day (generic of LOESTRIN FE 1/20)

1

kariva 28 day (generic of MIRCETTE)

1

kelnor 1/35 28 day 1

larin 1/20 (generic of LOESTRIN 1/20-21)

1

Drug Name Drug Tier

Requirements/Limits

larin fe 1.5/30 (generic of LOESTRIN FE 1.5/30)

1

larin fe 1/20 (generic of LOESTRIN FE 1/20)

1

LEENA 1

lessina 28 day 1

levonest 28 day 1

levonorgestrel (emergency oc) (generic of PLAN B ONE-STEP) 1.5mg

1

levonorgestrel (emergency oc) (generic of PLAN B) .75mg

1

levonorgestrel-ethinyl estradiol (91-day)

1

levora 0.15/30 28 day 1

LO LOESTRIN FE 2

LO MINASTRIN FE 3

loestrin 1.5/30-21 3

loestrin 1/20-21 3

LOESTRIN 24 FE 2

loestrin fe 1.5/30 3

loestrin fe 1/20 3

lomedia 24 fe 1

loryna 28 day (generic of YAZ)

1

LOSEASONIQUE 3

low-ogestrel 28 day 1

lutera 28 day 1

lyza (generic of ORTHO MICRONOR)

1

marlissa 28 day 1

medroxyprogesterone acetate (contraceptive) (generic of DEPO-PROVERA CONTRACEPTIV)

1

microgestin 1.5/30 21 day (generic of LOESTRIN 1.5/30-21)

1

microgestin 1/20 21 day (generic of LOESTRIN 1/20-21)

1

microgestin fe 1.5/30 28 day (generic of LOESTRIN FE 1.5/30)

1



32

Drug Name Drug Tier

Requirements/Limits

microgestin fe 1/20 28 day (generic of LOESTRIN FE 1/20)

1

MINASTRIN 24 FE 2

MODICON 3

MONONESSA 1

my way (generic of PLAN B ONE-STEP)

1

myzilra 1

necon 0.5/35 28 day (generic of BREVICON-28)

1

necon 1/35 28 day (generic of NORINYL 1+35)

1

NECON 1/50-28 1

NECON 7/7/7 1

necon 10/11 28 day 3

next choice tab 1.5mg (generic of PLAN B ONE-STEP)

1

NOR-QD 2

NORA-BE 1

norethindrone (contraceptive) (generic of NOR-QD)

1

norgestimate-ethinyl estradiol (triphasic) (generic of ORTHO TRI-CYCLEN)

1

NORINYL 1+35 3

NORINYL 1+50 3

nortrel 0.5/35 28 day (generic of BREVICON-28)

1

nortrel 1/35 21 day (generic of NORINYL 1+35)

1

nortrel 1/35 28 day (generic of NORINYL 1+35)

1

nortrel 7/7/7 28 day (generic of ORTHO-NOVUM 7/7/7)

1

NUVARING 2

OCELLA 1

ogestrel 28 day 1

orsythia 28 day 1

ORTHO EVRA 2

ORTHO MICRONOR 2

ORTHO TRI-CYCLEN LO 2

ORTHO-CEPT 3

ORTHO-CYCLEN 3

ORTHO-NOVUM 1/35 3

Drug Name Drug Tier

Requirements/Limits

ORTHO-NOVUM 7/7/7 3

ovcon 35 28 day 3

philith (generic of OVCON-35) 1

pimtrea pack (generic of MIRCETTE)

1

pirmella 1/35 28 day (generic of NORINYL 1+35)

1

portia 28 day 1

previfem 28 day (generic of ORTHO-CYCLEN)

1

QUARTETTE 3

quasense 91 day 1

reclipsen 28 day (generic of DESOGEN)

1

SEASONIQUE 3

SOLIA 1

sprintec 28 day (generic of ORTHO-CYCLEN)

1

sronyx 28 day 1

syeda (generic of YASMIN 28)

1

tri-legest 28 day (generic of ESTROSTEP FE)

1

TRI-NORINYL 28 3

tri-previfem 28 day (generic of ORTHO TRI-CYCLEN)

1

tri-sprintec 28 day (generic of ORTHO TRI-CYCLEN)

1

TRINESSA 1

trivora 28 day 1

velivet 28 day (generic of CYCLESSA)

1

vestura (generic of YAZ) 1

viorele (generic of MIRCETTE)

1

vyfemla (generic of OVCON-35)

1

xulane (generic of ORTHO EVRA)

1

YASMIN 28 3

YAZ 3

zarah (generic of YASMIN 28) 1

zenchent 28 day (generic of OVCON-35)

1

zenchent fe 28 day (generic of FEMCON FE)

1

zovia 1/35e 28 day 1



33

Drug Name Drug Tier

Requirements/Limits

zovia 1/50e 28 day 1

ENDOMETRIOSIS danazol CAPS 1

LUPANETA PACK 3 PA

SYNAREL 2

ENZYME REPLACEMENTS ADAGEN 2 LA PA

ALDURAZYME 2 LA PA

BUPHENYL 3

BUPHENYL TAB 500MG 2

CARBAGLU 2 LA PA

CARNITOR SOLN 1gm/10ml

2 B/D

CARNITOR SOLN 200mg/ml

3 B/D

CARNITOR TABS 2 B/D

CEREZYME 200unit 3 PA

CEREZYME 400unit 2 PA

CYSTADANE 2

CYSTAGON 2 PA

ELAPRASE 2 PA

ELELYSO 2 PA

FABRAZYME 2 PA

KUVAN PACK 3 PA

KUVAN TBSO 2 PA

levocarnitine (metabolic modifiers) (generic of CARNITOR)

1 B/D

LUMIZYME 2 PA

MYOZYME 2 PA

NAGLAZYME 2 LA PA

ORFADIN 3 LA PA

PROCYSBI 3 LA

sodium phenylbutyrate (generic of BUPHENYL)

1

VIMIZIM 3 PA

VPRIV 2 PA

ZAVESCA 2 LA PA

ESTROGEN/PROGESTINS estradiol & norethindrone acetate (generic of ACTIVELLA)

1

jinteli 1 PA

mimvey lo 28 day (generic of ACTIVELLA)

1

ESTROGENS ALORA 2 PA

Drug Name Drug Tier

Requirements/Limits

CLIMARA 3 PA

COMBIPATCH 2 PA

DELESTROGEN 3

depo-estradiol 2

estrace CREA 2

estrace TABS 3 PA

estradiol (generic of CLIMARA) PTWK

1 PA

estradiol (generic of ESTRACE) TABS

1 PA

ESTRADIOL VALERATE OIL 10mg/ml

1

estradiol valerate (generic of DELESTROGEN) OIL 20mg/ml, 40mg/ml

1

ESTRING 3

estropipate 1 PA

FEMRING 3

menest 3 PA

MENOSTAR 3 PA

MINIVELLE 2 PA

PREMARIN 2 PA

PREMARIN CREAM 2

PREMARIN INJ 2

PREMPHASE 2 PA

PREMPRO 2 PA

VAGIFEM 2

VIVELLE-DOT 2 PA

GLUCOCORTICOIDS a-hydrocort inj 100mg 1

CORTEF 2

cortisone acetate TABS 1

DEPO-MEDROL 20mg/ml 2

DEPO-MEDROL 40mg/ml, 80mg/ml

3

dexamethasone CONC 2

dexamethasone ELIX; SOLN; TABS

1

dexamethasone sodium phosphate

1

dexpak taperpak 13 day 2

FLO-PRED 3

fludrocortisone acetate TABS

1

hydrocortisone (generic of CORTEF) TABS

1



34

Drug Name Drug Tier

Requirements/Limits

MEDROL 2

MEDROL DOSEPAK 2

methylprednisolone (generic of MEDROL DOSEPAK) TABS 4mg

1

methylprednisolone (generic of MEDROL) TABS 4mg, 8mg, 16mg, 32mg

1

methylprednisolone acetate (generic of DEPO-MEDROL)

1

methylprednisolone sod succ (generic of SOLU-MEDROL)

1

millipred 3

orapred 2

ORAPRED ODT 2

pediapred 2

prednisolone (generic of PRELONE)

1

prednisolone sodium phosphate (generic of PEDIAPRED) 5mg/5ml

1

prednisolone sodium phosphate 15mg/5ml, 25mg/5ml

1

prednisone CONC 3

prednisone SOLN; TABS 1

RAYOS 2

SOLU-CORTEF 100MG 2

SOLU-CORTEF 250MG 2

SOLU-CORTEF 500MG 2

SOLU-CORTEF 1000MG 2

SOLU-MEDROL 2gm 2

SOLU-MEDROL 40mg, 125mg, 500mg, 1000mg

3

veripred 3

GLUCOSE ELEVATING AGENTS GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY KIT

2

PROGLYCEM 2

HUMAN GROWTH HORMONES GENOTROPIN 3 PA

GENOTROPIN MINIQUICK 3 PA

HUMATROPE 2 PA

HUMATROPE COMBO PACK 2 PA

NORDITROPIN FLEXPRO 2 PA

Drug Name Drug Tier

Requirements/Limits

NORDITROPIN NORDIFLEX PEN

2 PA

NUTROPIN 3 PA

NUTROPIN AQ NUSPIN 5 3 PA

NUTROPIN AQ PEN 3 PA

OMNITROPE 5.8MG 3 PA

OMNITROPE 5MG 3 PA

OMNITROPE 10MG 3 PA

SAIZEN 3 PA

SAIZEN CLICK.EASY 3 PA

SEROSTIM 2 PA

TEV-TROPIN 3 PA

ZORBTIVE 2 PA

MISCELLANEOUS ACTHAR HP 2 PA

cabergoline 1

calcitonin (salmon) nasal spray (generic of MIACALCIN)

1

CHORIONIC GONADOTROPIN SOLR

1 PA

EGRIFTA 1mg 3 PA

EGRIFTA 2mg 2 PA

FORTICAL SPR 200/ACT 3

INCRELEX 2 LA PA

KORLYM 3 PA

methylergonovine maleate (generic of METHERGINE) TABS

1

MIACALCIN INJ 200U/ML 2 B/D

MIACALCIN SPR 200/ACT 3

NOVAREL INJ 10000UNT 1 PA

octreotide acetate (generic of SANDOSTATIN)

1 PA

PREGNYL W/DILUENT BENZYL

1 PA

PROLIA 3 PA

SAMSCA 2 PA

SANDOSTATIN 3 PA

SANDOSTATIN LAR DEPOT 2 PA

SIGNIFOR 2 PA

SOMATULINE DEPOT 2 PA

SOMAVERT 10mg, 15mg, 20mg

2 LA PA

XGEVA 2

PARATHYROID HORMONES FORTEO 2 PA



35

Drug Name Drug Tier

Requirements/Limits

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) (generic of PHOSLO) CAPS

1

calcium acetate (phosphate binder) (generic of ELIPHOS) TABS

1

eliphos 3

FOSRENOL 2

PHOSLO 3

PHOSLYRA 2

RENAGEL 3

RENVELA 2

VELPHORO 3

PROGESTINS aygestin 3

CRINONE 2

ENDOMETRIN 2

MAKENA 2 PA

medroxyprogesterone acetate (generic of PROVERA)

1

norethindrone acetate (generic of AYGESTIN) TABS

1

progesterone micronized (generic of PROMETRIUM) CAPS

1

PROMETRIUM 3

PROVERA 3

SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA 2

raloxifene hcl (generic of EVISTA)

1

THYROID AGENTS CYTOMEL 2

levothyroxine sodium (generic of SYNTHROID) TABS

1

LEVOXYL 1

liothyronine sodium (generic of TRIOSTAT) SOLN

1

liothyronine sodium (generic of CYTOMEL) TABS

1

methimazole (generic of TAPAZOLE) TABS

1

propylthiouracil TABS 1

Drug Name Drug Tier

Requirements/Limits

SYNTHROID 2

tapazole 2

TIROSINT 3

TRIOSTAT 3

UNITHROID 1

VASOPRESSINS DDAVP SOLN 4mcg/ml 3

DDAVP SOLN .01% 2

DDAVP TABS 2

DESMOPRESSIN ACETATE SOLN

1

desmopressin acetate (generic of DDAVP) TABS

1

desmopressin acetate inj (generic of DDAVP)

1

desmopressin acetate spray (generic of DDAVP)

1

desmopressin acetate spray refrigerated

1

STIMATE 2 PA

GASTROINTESTINAL ANTIEMETICS ALOXI 2

ANTIVERT 3

CESAMET 3 B/D

compro supp 1

dronabinol (generic of MARINOL)

1 B/D

EMEND CAPS 40mg 3

EMEND CAPS 80mg, 125mg

3 B/D

EMEND PAK 80 & 125 3 B/D

granisetron hcl SOLN 1

granisetron hcl TABS 1 B/D

granisol 2 B/D

MARINOL 3 B/D

meclizine hcl TABS 1

metoclopramide hcl SOLN 1

metoclopramide hcl (generic of REGLAN) TABS

1

metoclopramide hcl inj 5 mg/ml

1

METOZOLV ODT 3

ondansetron hcl (generic of ZOFRAN) TABS 4mg, 8mg

1 B/D

ondansetron hcl TABS 24mg 1 B/D



36

Drug Name Drug Tier

Requirements/Limits

ondansetron hcl inj 1

ondansetron hcl oral soln (generic of ZOFRAN)

1 B/D

ondansetron odt (generic of ZOFRAN ODT)

1 B/D

phenadoz 1 PA

phenergan 3 PA

prochlorperazine inj 5 mg/ml 1

prochlorperazine maleate (generic of COMPAZINE) TABS

1

prochlorperazine supp 1

promethazine hcl (generic of PHENERGAN) SOLN

1 PA

promethazine hcl SUPP; SYRP; TABS

1 PA

promethegan 1 PA

REGLAN 3

SANCUSO 2

TRANSDERM-SCOP 2 PA

ZOFRAN SOLN 4mg/5ml 3 B/D

ZOFRAN SOLN 40mg/20ml 3

ZOFRAN TABS 3 B/D

ZOFRAN ODT 3 B/D

ANTISPASMODICS ATROPINE SULFATE SOLN .05mg/ml, .1mg/ml

1

BENTYL 2

CANTIL 3

CUVPOSA 2

dicyclomine hcl (generic of BENTYL) CAPS; TABS

1

dicyclomine hcl SOLN 1

glycate 3

glycopyrrolate (generic of ROBINUL) SOLN

1

glycopyrrolate (generic of ROBINUL) TABS 1mg

1

glycopyrrolate (generic of ROBINUL FORTE) TABS 2mg

1

methscopolamine bromide (generic of PAMINE) TABS 2.5mg

1

methscopolamine bromide (generic of PAMINE FORTE) TABS 5mg

1

Drug Name Drug Tier

Requirements/Limits

PAMINE 3

PAMINE FORTE 3

ROBINUL 3

ROBINUL FORTE 3

H2-RECEPTOR ANTAGONISTS AXID SOLN 3

cimetidine TABS 1

cimetidine sol 300/5ml 1

famotidine SOLN 20mg/2ml 1

famotidine (generic of PEPCID) SUSR

1

famotidine (generic of PEPCID) TABS 20mg, 40mg

1

famotidine inj 1

nizatidine CAPS 150mg 1

nizatidine (generic of AXID) CAPS 300mg

1

nizatidine (generic of AXID) SOLN

1

PEPCID 3

ranitidine hcl CAPS 1

ranitidine hcl (generic of ZANTAC) SOLN

1

ranitidine hcl SYRP 1

ranitidine hcl (generic of ZANTAC) TABS 150mg, 300mg

1

ZANTAC 3

INFLAMMATORY BOWEL DISEASE APRISO 2

ASACOL HD 3

AZULFIDINE 2

AZULFIDINE EN-TABS 2

balsalazide disodium (generic of COLAZAL)

1

budesonide (generic of ENTOCORT EC) CP24

1

CANASA 2

COLAZAL 3

colocort (generic of CORTENEMA)

1

CORTENEMA 2

DELZICOL 3

DIPENTUM 2

ENTOCORT EC 3



37

Drug Name Drug Tier

Requirements/Limits

ENTYVIO 3

GIAZO 3

HYDROCORTISONE (INTRARECTAL)

1

LIALDA 2

mesalamine enema 1

mesalamine enema kit (generic of ROWASA)

1

PENTASA 2

ROWASA 2

SFROWASA 2

sulfasalazine dr (generic of AZULFIDINE EN-TABS)

1

sulfasalazine ir (generic of AZULFIDINE)

1

UCERIS 3

LAXATIVES COLYTE-FLAVOR PACKS 3

constulose 1

enulose 1

gaviltye-g (generic of GOLYTELY)

1

gavilyte-c (generic of COLYTE-FLAVOR PACKS)

1

gavilyte-n (generic of NULYTELY/FLAVOR PACKS)

1

generlac 1

GOLYTELY 3

HALFLYTELY BOWEL PREP/FLA

3

kristalose 2

lactulose 1

lactulose (encephalopathy) 1

MOVIPREP 2

NULYTELY/FLAVOR PACKS 3

OSMOPREP 3

PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE

1

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of GOLYTELY)

1

peg 3350-potassium chloride-sod bicarbonate-sod chloride (generic of NULYTELY/FLAVOR PACKS)

1

Drug Name Drug Tier

Requirements/Limits

polyethylene glycol 3350 PACK; POWD

1

PREPOPIK 3

RELISTOR 2

SUCLEAR 2

SUPREP BOWEL PREP 2

trilyte (generic of NULYTELY/FLAVOR PACKS)

1

VISICOL 3

MISCELLANEOUS ACTIGALL 2

AMITIZA 2

amoxicillin-clarithromycin w/ lansoprazole (generic of PREVPAC)

1

CARAFATE 2

cromolyn sodium (mastocytosis) (generic of GASTROCROM)

1

CYTOTEC 2

diphenoxylate w/ atropine LIQD

1 PA

diphenoxylate w/ atropine (generic of LOMOTIL) TABS

1 PA

GASTROCROM 3

GATTEX 3 LA PA

LINZESS CAP 145MCG 2

LINZESS CAP 290MCG 2

LOMOTIL 2 PA

loperamide hcl CAPS 1

LOTRONEX 2

misoprostol (generic of CYTOTEC) TABS

1

OMECLAMOX-PAK 3

PREVPAC 3

PYLERA 2

SUCRAID 2

sucralfate (generic of CARAFATE) TABS

1

URSO 250 2

URSO FORTE 2

ursodiol (generic of ACTIGALL) CAPS

1

ursodiol (generic of URSO 250) TABS 250mg

1



38

Drug Name Drug Tier

Requirements/Limits

ursodiol (generic of URSO FORTE) TABS 500mg

1

XIFAXAN TAB 550MG 2

PANCREATIC ENZYMES CREON 2

PANCREAZE 3

PERTZYE 3

ULTRESA 2

VIOKACE 10440 UNIT 2

VIOKACE 20880 UNIT 2

ZENPEP 2

PROTON PUMP INHIBITORS ACIPHEX 3

ACIPHEX SPR CAP 5MG 3

ACIPHEX SPR CAP 10MG 3

DEXILANT 2

esomeprazole sodium inj 20mg

1

esomeprazole sodium inj (generic of NEXIUM I.V.) 40mg

1

lansoprazole (generic of PREVACID) CPDR

1

NEXIUM 2

NEXIUM GRANULES 2.5MG DR

2

NEXIUM GRANULES 5MG DR

2


2


2


2

NEXIUM I.V. 2

omeprazole (generic of PRILOSEC) CPDR

1

pantoprazole sodium (generic of PROTONIX)

1

PREVACID 3

PREVACID SOLUTAB 3

PRILOSEC CPDR 3

PROTONIX 3

PROTONIX INJ 3

rabeprazole sodium (generic of ACIPHEX)

1

Drug Name Drug Tier

Requirements/Limits

ZEGERID PACK 3

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin hcl (generic of UROXATRAL)

1

AVODART 2

CARDURA XL 3

finasteride (generic of PROSCAR) TABS 5mg

1

FLOMAX 3

JALYN 3

PROSCAR 3

RAPAFLO 2

tamsulosin hcl (generic of FLOMAX)

1

UROXATRAL 3

MISCELLANEOUS bethanechol chloride (generic of URECHOLINE) TABS

1

ELMIRON 2

POTASSIUM CITRATE (ALKALINIZER) 15meq

1

POTASSIUM CITRATE (ALKALINIZER) 540mg

1

POTASSIUM CITRATE (ALKALINIZER) 1080mg

1

urecholine 2

UROCIT-K 2

URINARY ANTISPASMODICS DETROL 3

DETROL LA 3

DITROPAN XL 3

ENABLEX 3

GELNIQUE 2

MYRBETRIQ 3

oxybutynin chloride SYRP; TABS

1

oxybutynin chloride (generic of DITROPAN XL) TB24

1

OXYTROL 3

SANCTURA 3

SANCTURA XR 3

tolterodine tartrate (generic of DETROL)

1

TOLTERODINE TARTRATE ER

1



39

Drug Name Drug Tier

Requirements/Limits

TOVIAZ 3

trospium chloride 1

VESICARE 2

VAGINAL ANTI-INFECTIVES CLEOCIN CREA 2

CLEOCIN VAG SUPP 100MG 2

clindamycin cre 2% vag (generic of CLEOCIN)

1

METROGEL-VAGINAL 2

metronidazole vaginal (generic of METROGEL-VAGINAL)

1

miconazole nitrate vaginal 1

TERAZOL 3 2

TERAZOL 7 2

terconazole vaginal (generic of TERAZOL 7) CREA .4%

1

terconazole vaginal (generic of TERAZOL 3) CREA .8%

1

terconazole vaginal SUPP 1

VANDAZOLE 1

zazole (generic of TERAZOL 7) .4%

1

ZAZOLE .8% 1

HEMATOLOGIC ANTICOAGULANTS ARIXTRA 2.5mg/0.5ml 2

ARIXTRA 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml

3

COUMADIN 3

COUMADIN INJ 2

ELIQUIS 2

enoxaparin sodium (generic of LOVENOX)

1

fondaparinux sodium (generic of ARIXTRA)

1

FRAGMIN 2

HEP SOD/NACL INJ 25000 3

HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML

2

heparin sod inj 1000u/ml 1 B/D

HEPARIN SOD INJ 2000U/ML

2 B/D

HEPARIN SOD INJ 2500U/ML

3 B/D

Drug Name Drug Tier

Requirements/Limits

heparin sod inj 5000u/0.5ml 1 B/D




HEPARIN SODIUM/D5W 1

HEPARIN SODIUM/SODIUM CHL

1

jantoven (generic of COUMADIN)

1

LOVENOX 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 300mg/3ml

2

LOVENOX 80mg/0.8ml, 100mg/ml, 120mg/0.8ml, 150mg/ml

3

PRADAXA 2

warfarin sodium (generic of COUMADIN)

1

XARELTO 2

HEMATOPOIETIC GROWTH FACTORS ARANESP ALBUMIN FREE 2 PA

EPOGEN 2 PA

GRANIX 3 PA

LEUKINE 2 PA

MOZOBIL 2 PA

NEULASTA 2 PA

NEUMEGA 2 PA

NEUPOGEN 2 PA

PROCRIT 2 PA

MISCELLANEOUS AGRYLIN 2

anagrelide hcl 1mg 1

anagrelide hcl (generic of AGRYLIN) .5mg

1

cilostazol (generic of PLETAL) 1

CYKLOKAPRON 3

LYSTEDA 3

pentoxifylline TBCR 1

PLETAL 2

PROMACTA 2 LA PA

tranexamic acid (generic of CYKLOKAPRON) SOLN

1

tranexamic acid (generic of LYSTEDA) TABS

1

PLATELET AGGREGATION INHIBITORS AGGRENOX 2



40

Drug Name Drug Tier

Requirements/Limits

BRILINTA 2

clopidogrel bisulfate (generic of PLAVIX)

1

dipyridamole (generic of PERSANTINE) TABS

1 PA

EFFIENT 2

PERSANTINE 2 PA

PLAVIX 3

ZONTIVITY 3

IMMUNOLOGIC AGENTS DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS) ACTEMRA 3 PA

ACTEMRA INJ 162/0.9 2 PA

ARAVA 10mg 2

ARAVA 20mg 3

CIMZIA 3 PA

ENBREL 2 PA

ENBREL SURECLICK 2 PA

HUMIRA 2 PA

HUMIRA PEN 2 PA

HUMIRA PEN-CROHNS STARTER KIT

2 PA

HUMIRA PEN-PSORIASIS STARTER KIT

2 PA

hydroxychloroquine sulfate (generic of PLAQUENIL)

1

KINERET 3 PA

leflunomide (generic of ARAVA) TABS

1

methotrexate sodium tabs 1

ORENCIA 3 PA

OTEZLA 3 PA

PLAQUENIL 2

REMICADE 3 PA

RHEUMATREX 2

SIMPONI 3 PA

SIMPONI ARIA 3 PA

trexall 2 B/D

XELJANZ 3 PA

IMMUNOGLOBULINS BIVIGAM 10gm/100ml 3 PA

CARIMUNE NANOFILTERED 3gm

2 PA

CARIMUNE NANOFILTERED 6gm, 12gm

3 PA

CYTOGAM 2 PA

Drug Name Drug Tier

Requirements/Limits

FLEBOGAMMA 2 PA

FLEBOGAMMA DIF 2 PA

GAMASTAN S/D 2 B/D

GAMMAGARD LIQUID 2 PA

GAMMAGARD S/D 2.5gm 3 PA

GAMMAGARD S/D 5gm, 10gm

2 PA

GAMMAKED 2 PA

GAMMAPLEX 2.5gm/50ml, 5gm/100ml, 10gm/200ml

2 PA

GAMUNEX 2 PA

GAMUNEX-C 1GM/10ML 2 PA

GAMUNEX-C 2.5GM/25ML 2 PA




HIZENTRA 1gm/5ml 2 PA

OCTAGAM 1gm/20ml, 2.5gm/50ml, 5gm/100ml, 10gm/200ml, 25gm/500ml

2 PA

PRIVIGEN 2 PA

IMMUNOMODULATORS ACTIMMUNE 2 LA PA

ARCALYST 2 PA

GRASTEK 3

INFERGEN 2 PA

INTRON-A 2 B/D

INTRON-A W/DILUENT 2 B/D

PEG-INTRON 50mcg/0.5ml 1 PA

PEG-INTRON 80mcg/0.5ml, 120mcg/0.5ml, 150mcg/0.5ml

2 PA

PEG-INTRON REDIPEN 1 PA

PEGASYS 2 PA

PEGASYS PROCLICK 2 PA

RAGWITEK 3

REVLIMID 2 LA

THALOMID 2

IMMUNOSUPPRESSANTS ASTAGRAF XL 2 B/D

ATGAM 2 B/D

azasan 2 B/D

azathioprine (generic of IMURAN) TABS

1 B/D

CELLCEPT CAPS; TABS 3 B/D

CELLCEPT SUSR 2 B/D

CELLCEPT INTRAVENOUS 2 B/D



41

Drug Name Drug Tier

Requirements/Limits

cyclosporine (generic of SANDIMMUNE) CAPS; SOLN

1 B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) CAPS 25mg, 100mg

1 B/D

cyclosporine modified (for microemulsion) CAPS 50mg

1 B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) SOLN

1 B/D

gengraf (generic of NEORAL) 1 B/D

IMURAN 2 B/D

mycophenolate mofetil (generic of CELLCEPT)

1 B/D

mycophenolate sodium (generic of MYFORTIC)

1 B/D

MYFORTIC 3 B/D

NEORAL 2 B/D

NULOJIX 2 B/D

PROGRAF CAPS 5mg 3 B/D

PROGRAF CAPS .5mg, 1mg

2 B/D

PROGRAF SOLN 2 B/D

RAPAMUNE 2 B/D

SANDIMMUNE CAPS 2 B/D

SANDIMMUNE INJ 3 B/D

SANDIMMUNE SOLN 2 B/D

SIMULECT 2 B/D

sirolimus tab 0.5 mg (generic of RAPAMUNE)

1 B/D

tacrolimus (generic of PROGRAF) CAPS

1 B/D

THYMOGLOBULIN 2 B/D

ZORTRESS 2 B/D

VACCINES ACTHIB 1

ADACEL 1

BCG VACCINE 2

BOOSTRIX 1

CERVARIX 1

COMVAX 1

DAPTACEL 1

DECAVAC 1 B/D

DIPHTHERIA/TETANUS TOXOID

1 B/D

Drug Name Drug Tier

Requirements/Limits

ENGERIX-B SUSP 1 B/D

GARDASIL 1

HAVRIX 1

HIBERIX 1

IMOVAX RABIES (H.D.C.V.) 2

INFANRIX 1

IPOL INACTIVATED IPV 1

IXIARO 3

M-M-R II W/DILUENT 10 DOS

1

MENACTRA 1

MENHIBRIX 1

MENOMUNE-A/C/Y/W-135 1

MENVEO 1

PEDVAX HIB 1

PROQUAD 1

RABAVERT 2

RECOMBIVAX HB 1 B/D

ROTARIX 1

ROTATEQ 1

SYNAGIS 2

TENIVAC 1 B/D

TETANUS TOXOID ADSORBED

1 B/D

TETANUS/DIPHTHERIA TOXOID

1 B/D

TWINRIX 1

TYPHIM VI 2

VAQTA 1

VARIVAX 1

YF-VAX 2

ZOSTAVAX 1

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES ammonium chloride SOLN 2

K-TAB 10meq 2

K-TAB 20meq 3

KLOR-CON 8 1

KLOR-CON 10 1

klor-con m15 1

klor-con m20 1

klor-con pow 20meq 1

MAGNESIUM SULFATE SOLN 40mg/ml, 80mg/ml

3



42

Drug Name Drug Tier

Requirements/Limits

magnesium sulfate SOLN 50%

1

MAGNESIUM SULFATE IN D5W 1%

2

MAGNESIUM SULFATE IN D5W 2%

3

MICRO-K 2

potassium chloride LIQD 1

POTASSIUM CHLORIDE TBCR

1

potassium chloride caps er (generic of MICRO-K)

1

potassium chloride microencapsulated crystals cr

1

SOD FLUORIDE 2.2MG TAB 1

SODIUM CHLORIDE SOLN 2.5meq/ml

1

TPN ELECTROLYTES 1 B/D

IV NUTRITION AMINOSYN 2 B/D

AMINOSYN 7%/ELECTROLYTES

2 B/D

AMINOSYN II 2 B/D

AMINOSYN II 3 B/D

AMINOSYN II 8.5%/ELECTROL

1 B/D

AMINOSYN INJ 8.5/LYTE 1 B/D

AMINOSYN M 2 B/D

AMINOSYN-HBC 2 B/D

AMINOSYN-PF 2 B/D

AMINOSYN-PF 7% 2 B/D

AMINOSYN-RF 2 B/D

CLINIMIX 2.75%/DEXTROSE 5%

2 B/D


2 B/D


2 B/D


2 B/D


2 B/D

CLINIMIX 5%/DEXTROSE 15%

2 B/D


2 B/D


2 B/D

Drug Name Drug Tier

Requirements/Limits

CLINIMIX E 2.75%/DEXTROSE 5%

2 B/D


2 B/D

CLINIMIX E 4.25%/DEXTROSE

2 B/D


2 B/D


2 B/D

CLINIMIX E 5%/DEXTROSE 15%

2 B/D


2 B/D


2 B/D

clinisol 15 1 B/D

FREAMINE HBC 6.9% 2 B/D

FREAMINE III 2 B/D

HEPATAMINE 1 B/D

hepatasol 8 1 B/D

INTRALIPID INJ 20% 1 B/D

INTRALIPID INJ 30% 3 B/D

LIPOSYN II 3 B/D

LIPOSYN III 3 B/D

NEPHRAMINE 2 B/D

premasol 6% 1 B/D

premasol 10% 2 B/D

PROCALAMINE 2 B/D

PROSOL 2 B/D

travasol 10 2 B/D

TROPHAMINE 2 B/D

TROPHAMINE 3 B/D

IV REPLACEMENT SOLUTIONS DEXTROSE SOLN 50% 1

dextrose SOLN 70% 1

DEXTROSE 2.5%/NACL 0.45%

1

DEXTROSE 5% 1

DEXTROSE 5% /ELECTROLYTE

2

DEXTROSE 5%/LACTATED RING

1

DEXTROSE 5%/NACL 0.2% 1






43

Drug Name Drug Tier

Requirements/Limits


DEXTROSE 5%/NACL 0.225%

1

DEXTROSE 5%/POTASSIUM CHL

1

DEXTROSE 10% FLEX CONTAIN

1

DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%

2

DEXTROSE 10%/NACL 0.45%

1

ELECTROLYTE-R IN DEXTROSE

2

IONOSOL-B/DEXTROSE 5% 3

IONOSOL-MB/DEXTROSE 5%

2

ISOLYTE P 2

isolyte s 2

KCL0.15%/D5W/NACL0.2% 1

KCL0.15%/D5W/NACL0.225%

2

kcl 0.3%/d5w/lr iv lac ri 3

KCL 0.3%/D5W/NACL 0.9% 1

KCL 0.3%/D5W/NACL 0.45% 1

KCL 0.15%/D5W/LR 3

KCL 0.15%/D5W/NACL 0.9% 1

KCL 0.075%/D5W/NACL 0.45%

1

KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ

1

kcl 20 meq/l (0.15%) in nacl 0.45% inj

1

KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ

1


1


1

KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ

1

LACTATED RINGERS VIAFLEX

1

normosol-m 1

NORMOSOL-R 2

Drug Name Drug Tier

Requirements/Limits

PLASMA-LYTE A 2

PLASMA-LYTE-56/D5W 2

PLASMA-LYTE-148 2

POTASSIUM CHLORIDE SOLN 10meq/100ml, 20meq/100ml

1

potassium chloride SOLN .4meq/ml, 2meq/ml, 10meq/50ml, 40meq/100ml

1

POTASSIUM CHLORIDE 0.3%/D

1

POTASSIUM CHLORIDE 0.15%

1

POTASSIUM CHLORIDE 0.22%

1

POTASSIUM CHLORIDE INJ 30 MEQ/100 ML

1

RINGER'S 1

SODIUM CHLORIDE SOLN .9%, 3%, 5%

1

SODIUM CHLORIDE 0.45% VIA

1

VITAMINS calcitriol (generic of ROCALTROL) CAPS

1 B/D

calcitriol SOLN 1mcg/ml 1 B/D

calcitriol (generic of ROCALTROL) SOLN 1mcg/ml

1 B/D

doxercalciferol (generic of HECTOROL)

1 B/D

HECTOROL 2 B/D

paricalcitol (generic of ZEMPLAR)

1 B/D

PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC)

1

ROCALTROL 2 B/D

ZEMPLAR CAPS 3 B/D

ZEMPLAR SOLN 2 B/D

OPHTHALMIC ANTI-INFECTIVE/ANTI-INFLAMMATORY bacitracin-poly-neomycin-hc 1

blephamide OINT 3

BLEPHAMIDE SUSP 3

MAXITROL 3

neomycin-polymy-dexameth (generic of MAXITROL)

1



44

Drug Name Drug Tier

Requirements/Limits

neomycin-polymyxin-hc (ophth)

1

PRED-G 3

PRED-G S.O.P. 3

sulfacetamide sod-prednisolone

1

TOBRADEX 2

TOBRADEX ST 2

tobramycin-dexamethasone (generic of TOBRADEX)

1

ZYLET 2

ANTI-INFECTIVES AZASITE 3

bacitracin (ophthalmic) 1

bacitracin-polymyxin b (ophth) 1

BESIVANCE 2

BLEPH-10 3

CILOXAN OIN 0.3% OP 3

CILOXAN SOL 0.3% OP 3

ciprofloxacin hcl (ophth) (generic of CILOXAN)

1

erythromycin (ophth) 1

garamycin 3

gatifloxacin (ophth) (generic of ZYMAXID)

1

gentak 1

gentamicin sulfate (ophth) OINT

1

gentamicin sulfate (ophth) (generic of GARAMYCIN) SOLN

1

levofloxacin (ophth) 1

MOXEZA 2

NATACYN 2

neomycin-bacitracin zn-polymyxin

1

neomycin-polymy-gramicid (generic of NEOSPORIN)

1

neosporin solution 3

OCUFLOX 3

ofloxacin (ophth) (generic of OCUFLOX)

1

polymyxin b-trimethoprim (generic of POLYTRIM)

1

POLYTRIM 3

Drug Name Drug Tier

Requirements/Limits

sulfacetamide sodium (ophth) OINT

1

sulfacetamide sodium (ophth) (generic of BLEPH-10) SOLN

1

tobramycin sulfate (ophth) (generic of TOBREX)

1

TOBREX OINT 0.3% 3

TOBREX SOL 0.3% OP 3

trifluridine (generic of VIROPTIC) SOLN

1

VIGAMOX 2

VIROPTIC 2

ZIRGAN 3

ZYMAXID 3

ANTI-INFLAMMATORIES ACULAR 3

ACULAR LS 3

ACUVAIL 3

ALREX 2

BROMDAY 2

bromfenac sodium (ophth) 1

BROMFENAC SODIUM (OPHTH)(ONCE-DAILY)

1

dexamethasone sodium phosphate (ophth)

1

diclofenac sodium (ophth) 1

DUREZOL 2

FLAREX 3

FLUOROMETHOLONE 1

FLUOROMETHOLONE (OPHTH)

1

flurbiprofen sodium (generic of OCUFEN)

1

FML 3

FML FORTE 3

FML LIQUIFILM 3

ILEVRO 3

ketorolac tromethamine (ophth) (generic of ACULAR LS) .4%

1

ketorolac tromethamine (ophth) (generic of ACULAR) .5%

1

LOTEMAX 2

MAXIDEX 3



45

Drug Name Drug Tier

Requirements/Limits

NEVANAC 3

OCUFEN 3

OMNIPRED 3

PRED FORTE 3

PRED MILD 3

PREDNISOLONE ACETATE SUSP

1

prednisolone sodium phosphate (ophth)

2

VEXOL 3

ANTIALLERGICS ALOCRIL 3

ALOMIDE 3

azelastine hcl (ophth) (generic of OPTIVAR)

1

BEPREVE 3

cromolyn sodium (ophth) 1

ELESTAT 3

EMADINE 3

epinastine hcl (ophth) (generic of ELESTAT)

1

LASTACAFT 3

OPTIVAR 3

PATADAY 2

PATANOL 2

ANTIGLAUCOMA ALPHAGAN P 0.1% 2

ALPHAGAN P 0.15% 2

AZOPT 2

BETAGAN 3

betaxolol hcl (ophth) 1

BETIMOL 2

BETOPTIC-S 2

brimonidine sol 0.2% 1

BRIMONIDINE SOL 0.15% 1

carteolol hcl (ophth) 1

COMBIGAN 2

COSOPT 3

COSOPT PF 2

dorzolamide hcl (generic of TRUSOPT)

1

dorzolamide hcl-timolol maleate (generic of COSOPT)

1

ISOPTO CARPINE 3

ISTALOL 3

Drug Name Drug Tier

Requirements/Limits

latanoprost (generic of XALATAN)

1

levobunolol hcl (generic of BETAGAN) .5%

1

LEVOBUNOLOL HCL .25% 1

LUMIGAN 3

metipranolol 1

OPTIPRANOLOL 3

PHOSPHOLINE IODIDE 2

PILOCARPINE HCL SOLN 1

SIMBRINZA 2

timolol maleate (ophth) (generic of TIMOPTIC)

1

TIMOLOL MALEATE GEL 1

TIMOPTIC 3

TIMOPTIC OCUDOSE 3

TIMOPTIC-XE 3

TRAVATAN Z 2

TRUSOPT 3

XALATAN 3

ZIOPTAN 2

MISCELLANEOUS ak-con 1

alcaine 3

BOTOX 2 PA

LACRISERT 2

PROLENSA 3

proparacaine hcl (generic of ALCAINE) SOLN

1

RESTASIS 2

XEOMIN 2 PA

RESPIRATORY ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ANORO ELLIPTA 3

COMBIVENT RESPIMAT 2

DUONEB 3 B/D

ipratropium-albuterol 1 B/D

ANTICHOLINERGICS ATROVENT 2

ATROVENT HFA 3

ipratropium bromide (nasal) (generic of ATROVENT)

1

ipratropium sol inhal 1 B/D

SPIRIVA HANDIHALER 2



46

Drug Name Drug Tier

Requirements/Limits

TUDORZA PRESSAIR 3

ANTIHISTAMINE/DECONGESTANT COMBINATIONS CLARINEX-D 3

SEMPREX-D 3

ANTIHISTAMINES ASTELIN 3

ASTEPRO 2

azelastine hcl SOLN 1

azelastine hcl nasal spray 0.15% (205.5 mcg/spray) (generic of ASTEPRO)

1

cetirizine syrup 1

CLARINEX 3

cyproheptadine hcl SYRP; TABS

1 PA

desloratadine (generic of CLARINEX) TABS

1

desloratadine (generic of CLARINEX REDITABS) TBDP

1

diphenhydram inj 50mg/ml 1

hydroxyzine hcl SOLN; TABS

1 PA

hydroxyzine pamoate (generic of VISTARIL) CAPS 25mg, 50mg

1 PA

hydroxyzine pamoate CAPS 100mg

1 PA

levocetirizine soln 2.5mg/5ml (generic of XYZAL)

1

levocetirizine tab 5 mg (generic of XYZAL)

1

PATANASE 2

VISTARIL 3 PA

XYZAL 2

BETA AGONISTS albuterol sulfate NEBU 1 B/D

albuterol sulfate SYRP; TABS

1

albuterol sulfate er (generic of VOSPIRE ER)

1

ARCAPTA NEOHALER 2

BROVANA 3 B/D

FORADIL AEROLIZER 2

Drug Name Drug Tier

Requirements/Limits

levalbuterol conc 1.25mg/0.5ml (generic of XOPENEX CONCENTRATE)

1 B/D

LEVALBUTEROL HCL 1 B/D

PERFOROMIST 2 B/D

PROAIR HFA 1

PROVENTIL HFA 2

SEREVENT DISKUS 2

terbutaline sulfate SOLN; TABS

1

VENTOLIN HFA 3

vospire 2

XOPENEX 3 B/D

XOPENEX CONCENTRATE 3 B/D

XOPENEX HFA 3

LEUKOTRIENE RECEPTOR ANTAGONISTS ACCOLATE 3

montelukast sodium (generic of SINGULAIR) CHEW; PACK; TABS

1

SINGULAIR 3

zafirlukast (generic of ACCOLATE)

1

ZYFLO CR 3

MAST CELL STABILIZERS cromolyn sodium NEBU 1 B/D

MISCELLANEOUS acetylcysteine SOLN 10%, 20%

1 B/D

ADRENACLICK .3mg/0.3ml 2

ADRENACLICK .15mg/0.15ml

3

ARALAST NP 2 LA PA

AUVI-Q 2

CAYSTON 2 LA PA

DALIRESP 2

DYMISTA 3

EPINEPHRINE INJ 0.3MG 1

EPINEPHRINE INJ 0.15MG 1

EPIPEN 2-PAK 2

EPIPEN-JR 2-PAK 2

GLASSIA 2 LA PA

PROLASTIN-C 2 LA PA

PULMOZYME 2 B/D

tyzine .05% 3



47

Drug Name Drug Tier

Requirements/Limits

XOLAIR 2 LA PA

ZEMAIRA 2 LA PA

NASAL STEROIDS BECONASE AQ 3

budesonide (nasal) (generic of RHINOCORT AQUA)

1

FLONASE 3

flunisolide (nasal) 1

fluticasone propionate (nasal) (generic of FLONASE)

1

NASACORT AQ 3

NASONEX 2

OMNARIS 3

QNASL 3

RHINOCORT AQUA 3

triamcinolone acetonide (nasal)

1

VERAMYST 3

ZETONNA 3

STEROID INHALANTS AEROSPAN 3

ALVESCO 3

ASMANEX 1

ASMANEX 14 METERED DOSES

1

budesonide (inhalation) (generic of PULMICORT)

1 B/D

FLOVENT DISKUS 1

FLOVENT HFA 1

PULMICORT FLEXHALER 1

PULMICORT INH SUSP 3 B/D

QVAR 1

STEROID/BETA-AGONIST COMBINATIONS ADVAIR DISKUS 2

ADVAIR HFA 2

BREO ELLIPTA 3

DULERA 2

SYMBICORT 2

XANTHINES aminophylline inj 1

elixophyllin 2

LUFYLLIN 3

theo-24 2

theophylline TB12; TB24 1

Drug Name Drug Tier

Requirements/Limits

TOPICAL DERMATOLOGY, ACNE ABSORICA 10mg, 20mg, 30mg, 40mg

3

ACANYA 2

ACZONE 3

adapalene (generic of DIFFERIN) CREA

1

adapalene (generic of DIFFERIN) GEL .1%

1

ADAPALENE GEL .3% 1

AKNE-MYCIN 3

amnesteem 1

ATRALIN 2 PA

AVITA CREA 1 PA

AVITA GEL 1 PA

AZELEX 3

BENZACLIN 2

BENZAMYCIN 3

benzoyl peroxide-erythromycin (generic of BENZAMYCIN)

1

claravis 1

CLEOCIN-T 3

CLINDAGEL 3

clindamycin phosphate (topical) (generic of EVOCLIN) FOAM

1

clindamycin phosphate (topical) (generic of CLEOCIN-T) GEL; LOTN; SOLN; SWAB

1

clindamycin phosphate-benzoyl peroxide (generic of BENZACLIN)

1

DIFFERIN 2

EPIDUO 2

erygel 3

erythromycin (acne aid) (generic of ERYGEL) GEL

1

erythromycin (acne aid) PADS; SOLN

1

EVOCLIN 3

FABIOR 3 PA

KLARON 3

myorisan 1



48

Drug Name Drug Tier

Requirements/Limits

RETIN-A 3 PA

RETIN-A MICRO 3 PA

RETIN-A MICRO PUMP 3 PA

sulfacetamide sodium (acne) (generic of KLARON)

1

tretin x 3 PA

tretin-x 3 PA

tretinoin (generic of RETIN-A) CREA; GEL

1 PA

TRETINOIN MICROSPHERE 1 PA

VELTIN 3 PA

zenatane 1

ZIANA 3 PA

DERMATOLOGY, ACTINIC KERATOSIS CARAC 2

diclofenac sodium (actinic keratoses) (generic of SOLARAZE)

1

EFUDEX 3

fluorouracil (topical) (generic of EFUDEX) CREA

1

fluorouracil (topical) SOLN 1

PICATO 2

SOLARAZE 3

DERMATOLOGY, ANTIBIOTICS ALTABAX 2

BACTROBAN 2

BACTROBAN NASAL 2

CENTANY 3

CORTISPORIN CREA 2

CORTISPORIN OINT 3

gentamicin sulfate (topical) 1

mafenide acetate (generic of SULFAMYLON) PACK

1

mupirocin (generic of BACTROBAN) OINT

1

mupirocin calcium (topical) (generic of BACTROBAN)

1

PHISOHEX 3

SILVADENE 2

SILVER SULFADIAZINE CREA

1

SSD 1

SULFAMYLON 3

THERMAZENE 1

DERMATOLOGY, ANTIFUNGALS

Drug Name Drug Tier

Requirements/Limits

ciclopirox GEL 1

ciclopirox cre 0.77% 1

ciclopirox shampoo 1% (generic of LOPROX SHAMPOO)

1

ciclopirox sus 0.77% 1

clotrimazole (topical) 1

econazole nitrate CREA 1

ERTACZO 3

EXELDERM 3

EXTINA 3

ketoconazole (topical) CREA 1

ketoconazole (topical) (generic of EXTINA) FOAM

1

LOPROX SHAMPOO 2

LUZU 3

MENTAX 2

NAFTIN 3

nyamyc 1

nystatin (topical) 1

nystatin pow 100000 1

nystop 1

OXISTAT 2

pedi-dri 1

DERMATOLOGY, ANTIPRURITIC anusol hc 2

CORTIFOAM 2

procto-pak 1

proctocream (generic of ANUSOL-HC)

1

proctozone hc (generic of ANUSOL-HC)

1

PRUDOXIN CRE 5% 1

ZONALON 3

DERMATOLOGY, ANTIPSORIATICS acitretin (generic of SORIATANE)

1

calcipotriene (generic of DOVONEX) CREA

1

calcipotriene OINT; SOLN 1

CALCITRIOL OINT 1

DOVONEX 3

methoxsalen rapid (generic of OXSORALEN ULTRA)

1

8-MOP 2



49

Drug Name Drug Tier

Requirements/Limits

OXSORALEN ULTRA 2

SORIATANE 3

SORILUX 2

STELARA 3 PA

TAZORAC 2 PA

VECTICAL 3

DERMATOLOGY, ANTISEBORRHEICS ketoconazole shampoo (generic of NIZORAL)

1

NIZORAL 2

selenium sulfide LOTN 1

DERMATOLOGY, ANTIVIRALS acyclovir topical (generic of ZOVIRAX)

1

DENAVIR 3

XERESE 3

ZOVIRAX CREA 3

ZOVIRAX OINT 3

DERMATOLOGY, CORTICOSTEROIDS aclovate 2

ala-cort 1

ala-scalp 2

alclometasone dipropionate (generic of ACLOVATE) CREA

1

alclometasone dipropionate OINT

1

amcinonide CREA; LOTN 1

amcinonide OINT 3

apexicon 3

betamethasone dipropionate (topical)

1

betamethasone dipropionate augmented (generic of DIPROLENE AF) CREA

1

betamethasone dipropionate augmented GEL

1

betamethasone dipropionate augmented (generic of DIPROLENE) LOTN; OINT

1

betamethasone valerate CREA; LOTN; OINT

1

betamethasone valerate (generic of LUXIQ) FOAM

1

Drug Name Drug Tier

Requirements/Limits

calcipotriene-betamethasone dipropionate (generic of TACLONEX)

1

CAPEX 2

clobetasol propionate (generic of TEMOVATE) CREA; GEL; OINT; SOLN

1

clobetasol propionate (generic of OLUX) FOAM

1

clobetasol propionate (generic of CLOBEX) LOTN; SHAM

1

clobetasol propionate emollient base (generic of TEMOVATE E)

1

clobetasol propionate emulsion (generic of OLUX-E)

1

CLOBEX LIQD 3

CLOBEX LOTN; SHAM 2

CLOCORTOLONE PIVALATE 1

CLODERM PUMP 2

CORDRAN TAPE 3

CUTIVATE CREA; LOTN 3

CUTIVATE OINT 2

DERMA-SMOOTHE/FS BODY OIL

2

DERMATOP 3

DESONATE 3

DESONIDE CREA 1

desonide (generic of DESOWEN) LOTN; OINT

1

DESOWEN CREA 2

desowen LOTN 2

desowen oint kit 0.05% 2

desoximetasone (generic of TOPICORT) CREA

1

desoximetasone (generic of TOPICORT) GEL

1

DESOXIMETASONE OINT .05%

1

desoximetasone (generic of TOPICORT) OINT .25%

1

diflorasone diacetate 1

DIPROLENE LOTN 3

DIPROLENE OINT 2

DIPROLENE AF 3

ELOCON CREA; LOTN 3



50

Drug Name Drug Tier

Requirements/Limits

ELOCON OINT 2

fluocinolone acetonide CREA .01%

1

fluocinolone acetonide (generic of SYNALAR) CREA .025%

1

fluocinolone acetonide (generic of DERMA-SMOOTHE/FS BODY) OIL

1

fluocinolone acetonide (generic of SYNALAR) OINT

1

fluocinolone acetonide (generic of SYNALAR) SOLN

1

fluocinonide (generic of VANOS) CREA .1%

1

fluocinonide CREA .05% 1

fluocinonide GEL 1

fluocinonide OINT 1

fluocinonide SOLN 1

fluocinonide emulsified base 1

fluticasone propionate (generic of CUTIVATE) CREA; LOTN; OINT

1

halobetasol propionate (generic of ULTRAVATE)

1

HALOG 3

hydrocortisone (topical) 1

hydrocortisone butyrate (generic of LOCOID)

1

hydrocortisone butyrate hydrophilic lipo base (generic of LOCOID LIPOCREAM)

1

hydrocortisone valerate CREA

1

hydrocortisone valerate (generic of WESTCORT) OINT

1

KENALOG 3

LOCOID LOTN 2

LOCOID LIPOCREAM 3

LOKARA LOTN 0.05% 1

LUXIQ 3

mometasone furoate (generic of ELOCON) CREA; OINT; SOLN

1

Drug Name Drug Tier

Requirements/Limits

OLUX 3

OLUX-E 3

PANDEL 3

PREDNICARBATE CREA 1

prednicarbate (generic of DERMATOP) OINT

1

SYNALAR CREA; OINT 3

SYNALAR SOLN 2

TACLONEX 3

TEMOVATE CREA; GEL; OINT

2

TEMOVATE SOLN 3

TEMOVATE E 2

texacort 2

topicort CREA 3

topicort GEL 2

TOPICORT LIQD 3

TOPICORT OINT .05% 2

topicort OINT .25% 2

triamcinolone acetonide (topical)

1

triderm 1

u-cort 1

ULTRAVATE 2

VANOS 3

DERMATOLOGY, LOCAL ANESTHETICS EMLA 3 B/D

lidocaine OINT 1

lidocaine (generic of LIDODERM) PTCH

1

lidocaine hcl GEL 1

lidocaine hcl (generic of XYLOCAINE) SOLN 4%

1

lidocaine-prilocaine (generic of EMLA)

1 B/D

LIDODERM 3

SYNERA 3

XYLOCAINE 4% 3

DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE ALDARA 3

ammonium lactate (generic of LAC-HYDRIN) CREA; LOTN

1

CONDYLOX 2



51

Drug Name Drug Tier

Requirements/Limits

diclofenac sodium (topical) (generic of PENNSAID)

1

ELIDEL 2

FINACEA 2

imiquimod (generic of ALDARA) CREA

1

LAC-HYDRIN 2

laclotion lotn 12% (generic of LAC-HYDRIN)

1

METROCREAM 3

METROGEL 3

METROLOTION 3

metronidazole (topical) (generic of METROCREAM) CREA

1

metronidazole (topical) (generic of METROGEL) GEL 1%

1

metronidazole (topical) GEL .75%

1

metronidazole (topical) (generic of METROLOTION) LOTN

1

NORITATE 3

ORACEA 2

OXSORALEN 3

PANRETIN 2

PENNSAID 2

podofilox (generic of CONDYLOX) SOLN

1

PROTOPIC 2

RECTIV 3

rosadan cre 0.75% (generic of METROCREAM)

1

TARGRETIN GEL 2

VALCHLOR 3 LA

VOLTAREN GEL 1% 2

ZYCLARA 3

DERMATOLOGY, SCABICIDES AND PEDICULIDES EURAX 2

malathion (generic of OVIDE) 1

OVIDE 2

permethrin (generic of ELIMITE) CREA

1

SKLICE 3

Drug Name Drug Tier

Requirements/Limits

ULESFIA 3

DERMATOLOGY, WOUND CARE AGENTS acetic acid .25% 1

neomycin/polymyxin b gu (generic of NEOSPORIN GU IRRIGANT)

1

REGRANEX 2

SANTYL 3

SODIUM CHLORIDE 0.9% 1

STERILE WATER IRRIGATION

1

MOUTH/THROAT/DENTAL AGENTS cevimeline hcl (generic of EVOXAC)

1

chlorhexidine gluconate (mouth-throat) (generic of PERIDEX)

1

clotrimazole TROC 1

EVOXAC 2

lidocaine hcl (mouth-throat) 1

nystatin (mouth-throat) 1

periogard sol 0.12% (generic of PERIDEX)

1

pilocarpine hcl (oral) (generic of SALAGEN)

1

SALAGEN 2

triamcinolone acetonide (mouth)

1

OTIC acetasol hc (generic of VOSOL HC)

1

acetic acid (otic) 1

acetic acid sol/hc (generic of VOSOL HC)

1

acetic acid-aluminum acetate 1

CIPRO HC 2

CIPRODEX 2

COLY-MYCIN S 3

CORTISPORIN SOLN 2

CORTISPORIN-TC 3

DERMOTIC 3

fluocinolone acetonide (otic) (generic of DERMOTIC)

1

neomycin-polymyxin-hc (otic) (generic of CORTISPORIN) SOLN

1



52

Drug Name Drug Tier

Requirements/Limits

neomycin-polymyxin-hc (otic) SUSP

1

ofloxacin (otic) 1

_BONUS DRUGS COUGH AND COLD benzonatate (generic of TESSALON PERLES) 100mg

1

cheratussin 1

hydromet 1

iophen c-nr 1

promethazine dm 1

promethazine vc 1

promethazine/codeine 1

ERECTILE DYSFUNCTION CAVERJECT

QL (6 tabs / 30 days) 3 QL

CIALIS QL (6 tabs / 30 days)

3 QL

LEVITRA TAB QL (6 tabs / 30 days)

3 QL

MUSE QL (6 ea / 30 days)

3 QL

STAXYN QL (6 tabs / 30 days)

3 QL

VIAGRA QL (6 tabs / 30 days)

2 QL

HEMORRHOIDS hydrocortisone acetate (rx) 1

hydrocortisone/pramoxine (rx) 1

INFLAMMATION salsalate TABS 1

IRRITABLE BOWEL hyoscyamine 1

NUTRITIONAL SUPPLEMENTS CEREFOLIN TAB 3

DEPLIN 3

folic acid TABS 1mg 1

FOLTX 2

L-METHYL-MC 3

METANX 3

vitamin d (generic of DRISDOL) CAPS 50000unit

1

WEIGHT LOSS benzphetamine (generic of DIDREX)

1 PA

Drug Name Drug Tier

Requirements/Limits

diethylpropion 1 PA

phendimetrazine CP24 1 PA

phendimetrazine (generic of BONTRIL PDM) TABS

1 PA

phentermine CAPS 15mg, 30mg

1 PA

phentermine (generic of ADIPEX-P) CAPS 37.5mg

1 PA

phentermine (generic of ADIPEX-P) TABS

1 PA


53

Index 8 8-MOP .............................. 48 A abacavir sulfate ...................6 abacavir sulfate-lamivudine-zidovudine ..........................................7 ABELCET............................6 ABILIFY............................. 24 ABILIFY DISCMELT ......... 24 ABILIFY INJ ...................... 24 ABILIFY MAINTENA ......... 24 ABRAXANE ...................... 11 ABSORICA ....................... 47 ABSTRAL............................3 acamprosate calcium ........ 28 ACANYA ........................... 47 acarbose ........................... 29 ACCOLATE ....................... 46

see zafirlukast ............... 46 ACCUPRIL ........................ 14

see quinapril hcl ............ 14 ACCURETIC ..................... 13

see quinapril-hydrochlorothiazide .................................. 13

acebutolol hcl .................... 16 ACEON

see perindopril erbumine ...................................... 14

acetaminophen w/ codeine .1 acetasol hc ........................ 51 acetazolamide ................... 18 acetazolamide sodium ...... 18 acetic acid ......................... 51 acetic acid (otic) ................ 51 acetic acid sol/hc ............... 51 acetic acid-aluminum acetate .......................................... 51 acetylcysteine ................... 46 ACIPHEX .......................... 38

see rabeprazole sodium 38 ACIPHEX SPR CAP 10MG .......................................... 38 ACIPHEX SPR CAP 5MG . 38 acitretin ............................. 48 aclovate............................. 49

ACLOVATE see alclometasone dipropionate .................. 49

ACTEMRA ........................ 40 ACTEMRA INJ 162/0.9 ..... 40 ACTHAR HP ..................... 34 ACTHIB ............................. 41 ACTIGALL ........................ 37

see ursodiol ................... 37 ACTIMMUNE .................... 40 ACTIQ ................................. 3

see fentanyl citrate .......... 3 ACTIVELLA

see estradiol & norethindrone acetate ... 33 see mimvey lo 28 day .... 33

ACTONEL ......................... 30 see risedronate sodium . 30

ACTOPLUS MET see pioglitazone hcl-metformin hcl ........... 30

ACTOPLUS MET TAB 15-500MG ......................... 29 ACTOPLUS MET TAB 15-850MG ......................... 29 ACTOPLUS MET XR 15-1000MG ....................... 29 ACTOPLUS MET XR 30-1000MG ....................... 29 ACTOS ............................. 29

see pioglitazone hcl ....... 30 ACULAR ........................... 44

see ketorolac tromethamine (ophth) .... 44

ACULAR LS ...................... 44 see ketorolac tromethamine (ophth) .... 44

ACUVAIL .......................... 44 acyclovir .............................. 7 acyclovir sodium ................. 7 acyclovir topical ................ 49 ACZONE ........................... 47 ADACEL ........................... 41 ADAGEN ........................... 33 ADALAT CC ...................... 17

see afeditab cr ............... 17 see nifedipine ................ 17

adapalene ......................... 47 ADAPALENE .................... 47 ADCIRCA ......................... 19 adderall ............................. 25 ADDERALL

see amphetamine-dextroamphetamine tab 10 mg ........ 25 see amphetamine-dextroamphetamine tab 12.5 mg ..... 25 see amphetamine-dextroamphetamine tab 15 mg ........ 25 see amphetamine-dextroamphetamine tab 20 mg ........ 25 see amphetamine-dextroamphetamine tab 30 mg ........ 25 see amphetamine-dextroamphetamine tab 5 mg .......... 25 see amphetamine-dextroamphetamine tab 7.5 mg ....... 25

adderall tab 10mg ............. 25 adderall tab 12.5mg .......... 25 adderall tab 15mg ............. 25 adderall tab 30mg ............. 25 adderall tab 5mg ............... 25 adderall tab 7.5mg ............ 25 ADDERALL XR

see amphetamine-dextroamphetamine cap sr 24hr 10 mg ...................................... 25 see amphetamine-dextroamphetamine cap sr 24hr 15 mg ...................................... 25 see amphetamine-dextroamphetamine cap sr 24hr 20 mg ...................................... 25 see amphetamine-dextroamph


54

etamine cap sr 24hr 25 mg ...................................... 25 see amphetamine-dextroamphetamine cap sr 24hr 30 mg ...................................... 25 see amphetamine-dextroamphetamine cap sr 24hr 5 mg ...................................... 25

ADDERALL XR CAP 10MG .......................................... 25 ADDERALL XR CAP 15MG .......................................... 25 ADDERALL XR CAP 20MG .......................................... 25 ADDERALL XR CAP 25MG .......................................... 25 ADDERALL XR CAP 30MG .......................................... 25 ADDERALL XR CAP 5MG 25 adefovir dipivoxil .................7 ADEMPAS ........................ 19 ADIPEX-P

see phentermine ............ 52 adoxa ................................ 10 ADOXA

see doxycycline (monohydrate) ............... 10

ADOXA PAK 1/150 see doxycycline (monohydrate) ............... 10

ADRENACLICK ................ 46 adriamycin......................... 11 adrucil ............................... 11 ADVAIR DISKUS .............. 47 ADVAIR HFA .................... 47 ADVICOR.......................... 15 AEROSPAN ...................... 47 afeditab cr ......................... 17 AFINITOR ......................... 12 AFINITOR DISPERZ ......... 12 AGGRENOX ..................... 39 AGRYLIN .......................... 39

see anagrelide hcl ......... 39 a-hydrocort inj 100mg ....... 33 ak-con ............................... 45 AKNE-MYCIN ................... 47

ala-cort .............................. 49 ala-scalp ........................... 49 ALBENZA ........................... 5 albuterol sulfate ................ 46 albuterol sulfate er ............ 46 alcaine .............................. 45 ALCAINE

see proparacaine hcl ..... 45 alclometasone dipropionate .......................................... 49 ALCOHOL PREPS ........... 28 ALDACTAZIDE ................. 18

see spironolactone & hydrochlorothiazide ....... 18

ALDACTONE .................... 14 see spironolactone ........ 14

ALDARA ........................... 50 see imiquimod ............... 51

ALDURAZYME ................. 33 alendronate sodium .......... 30 alfuzosin hcl ...................... 38 ALIMTA ............................. 11 ALINIA ................................ 5 ALKERAN ......................... 11

see melphalan hcl ......... 11 ALLOPURINOL SODIUM ... 1 allopurinol tab ..................... 1 ALOCRIL .......................... 45 ALOMIDE .......................... 45 ALORA .............................. 33 ALOXI ............................... 35 ALPHAGAN P 0.1% .......... 45 ALPHAGAN P 0.15% ........ 45 alprazolam ........................ 19 ALREX .............................. 44 ALSUMA ........................... 26 ALTABAX .......................... 48 ALTACE ............................ 14

see ramipril .................... 14 altavera ............................. 30 ALTOPREV ....................... 15 ALVESCO ......................... 47 amantadine hcl ................. 23 AMARYL ........................... 29

see glimepiride .............. 29 AMBIEN ............................ 25

see zolpidem tartrate ..... 26 AMBIEN CR ...................... 25

see zolpidem tartrate ..... 26 AMBISOME ........................ 6 amcinonide ....................... 49 AMERGE .......................... 26

see naratriptan hcl ......... 26 amethia 91 day ................. 30 amethyst 28 day ............... 30 amifostine crystalline ........ 13 amikacin sulfate .................. 4 amiloride & hydrochlorothiazide ........... 18 amiloride hcl ..................... 18 aminophylline inj ............... 47 AMINOSYN ...................... 42 AMINOSYN 7%/ELECTROLYTES ....... 42 AMINOSYN II ................... 42 AMINOSYN II 8.5%/ELECTROL.............. 42 AMINOSYN INJ 8.5/LYTE 42 AMINOSYN M .................. 42 AMINOSYN-HBC .............. 42 AMINOSYN-PF ................. 42 AMINOSYN-PF 7% ........... 42 AMINOSYN-RF................. 42 amiodarone hcl ................. 15 amiodarone inj 50mg/ml ... 15 AMITIZA ........................... 37 amitriptyline hcl ................. 22 amlodipine besylate .......... 17 AMLODIPINE BESYLATE/ATORV .......... 17 amlodipine besylate-benazepril hcl ..... 13 ammonium chloride .......... 41 ammonium lactate ............ 50 amnesteem ....................... 47 amoxapine ........................ 22 amoxicillin ........................... 9 amoxicillin & pot clavulanate...................................... 9, 10 amoxicillin-clarithromycin w/ lansoprazole ..................... 37 amphetamine-dextroamphetamine cap sr 24hr 10 mg .. 25 amphetamine-dextroamphetamine cap sr 24hr 15 mg .. 25 amphetamine-dextroamphet


55

amine cap sr 24hr 20 mg .. 25 amphetamine-dextroamphetamine cap sr 24hr 25 mg .. 25 amphetamine-dextroamphetamine cap sr 24hr 30 mg .. 25 amphetamine-dextroamphetamine cap sr 24hr 5 mg .... 25 amphetamine-dextroamphetamine tab 10 mg ............... 25 amphetamine-dextroamphetamine tab 12.5 mg ............ 25 amphetamine-dextroamphetamine tab 15 mg ............... 25 amphetamine-dextroamphetamine tab 20 mg ............... 25 amphetamine-dextroamphetamine tab 30 mg ............... 25 amphetamine-dextroamphetamine tab 5 mg ................. 25 amphetamine-dextroamphetamine tab 7.5 mg .............. 25 AMPHOTEC ........................6 amphotericin b ....................6 ampicillin ........................... 10 ampicillin & sulbactam sodium .............................. 10 ampicillin inj ....................... 10 ampicillin sodium ............... 10 AMPYRA ........................... 27 AMRIX .............................. 27 AMTURNIDE ..................... 18 ANAFRANIL ...................... 22

see clomipramine hcl ..... 22 anagrelide hcl .................... 39 ANAPROX ..........................1

see naproxen sodium ......1 ANAPROX DS ....................1

see naproxen sodium ......1 anastrozole ....................... 12 ANCOBON ..........................6

see flucytosine .................6 ANDRODERM .................. 28 ANDROGEL 1% ................ 28 ANDROGEL 1.62% ........... 28 androxy ............................. 28 ANORO ELLIPTA ............. 45 antabuse ........................... 28 ANTABUSE

see disulfiram ................ 28 ANTARA ........................... 15 ANTIVERT ........................ 35 anusol hc .......................... 48 ANUSOL-HC

see proctocream ........... 48 see proctozone hc ......... 48

apexicon ........................... 49 APIDRA ............................ 28 APIDRA SOLOSTAR ........ 28 APLENZIN ........................ 22 APOKYN ........................... 23 apri 28 day ........................ 30 APRISO ............................ 36 APTIOM ............................ 20 APTIVUS ............................ 6 ARALAST NP ................... 46 ARALEN

see chloroquine phosphate ....................... 6

aranelle 28 ........................ 30 ARANESP ALBUMIN FREE .......................................... 39 ARAVA .............................. 40

see leflunomide ............. 40 ARCALYST ....................... 40 ARCAPTA NEOHALER .... 46 ARICEPT .......................... 22

see donepezil tab hcl 23mg ............................. 22 see donepezil tabs 10mg ...................................... 22 see donepezil tabs 5mg 22

ARICEPT ODT .................. 22 see donepezil odt 10mg 22

ARIMIDEX ........................ 12 see anastrozole ............. 12

ARIXTRA .......................... 39 see fondaparinux sodium ...................................... 39

AROMASIN ....................... 12 see exemestane ............ 12

ARRANON ........................ 11 ARTHROTEC ..................... 1 ARTHROTEC 50

see diclofenac w/ misoprostol ...................... 1

ARTHROTEC 75

see diclofenac w/ misoprostol ...................... 1

ARZERRA ........................ 12 ASACOL HD ..................... 36 ASMANEX ........................ 47 ASMANEX 14 METERED DOSES ............................. 47 ASTAGRAF XL ................. 40 ASTELIN ........................... 46 ASTEPRO ........................ 46

see azelastine hcl nasal spray 0.15% (205.5 mcg/spray) .................... 46

ATACAND ........................ 14 see candesartan cilexetil ...................................... 14

ATACAND HCT ................ 14 see candesartan cilexetil-hydrochlorothiazide .................................... 14

ATELVIA ........................... 30 atenolol ............................. 16 atenolol & chlorthalidone .. 16 ATGAM ............................. 40 ATIVAN ............................. 19

see lorazepam............... 19 atorvastatin calcium .......... 15 atovaquone ......................... 5 atovaquone-proguanil hcl tab 250-100 mg ........................ 6 ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG ...... 6 ATRALIN .......................... 47 ATRIPLA ............................. 7 ATROPINE SULFATE ...... 36 ATROVENT ...................... 45

see ipratropium bromide (nasal) ........................... 45

ATROVENT HFA .............. 45 AUBAGIO ......................... 27 AUGMENTIN .................... 10

see amoxicillin & pot clavulanate ................ 9, 10

AUGMENTIN ES-600 ....... 10 see amoxicillin & pot clavulanate .................... 10

AUGMENTIN XR .............. 10 see amoxicillin & pot


56

clavulanate .................... 10 AUVI-Q ............................. 46 AVALIDE ........................... 14

see irbesartan-hydrochlorothiazide ................................ 14

AVAPRO ........................... 14 see irbesartan ................ 15

AVASTIN........................... 12 AVELOX..............................9

see moxifloxacin hcl ........9 AVELOX ABC PACK ..........9 aviane 28 .......................... 30 AVINZA ...............................3

see morphine sulfate beads cap sr ....................3

AVITA ............................... 47 AVODART ......................... 38 AVONEX ........................... 27 AVONEX PEN ................... 27 AXERT .............................. 26 AXID ................................. 36

see nizatidine ................ 36 AXIRON ............................ 28 aygestin............................. 35 AYGESTIN

see norethindrone acetate ...................................... 35

azacitidine ......................... 11 AZACTAM ...........................5

see aztreonam .................5 AZACTAM/DEX INJ 1GM ...5 AZACTAM/DEX INJ 2GM ...5 azasan .............................. 40 AZASITE ........................... 44 azathioprine ...................... 40 azelastine hcl .................... 46 azelastine hcl (ophth) ........ 45 azelastine hcl nasal spray 0.15% (205.5 mcg/spray) .. 46 AZELEX ............................ 47 AZILECT ........................... 23 azithromycin ........................9 AZITHROMYCIN .................9 AZOPT .............................. 45 AZOR ................................ 14 aztreonam ...........................5 AZULFIDINE ..................... 36

see sulfasalazine ir ........ 37 AZULFIDINE EN-TABS .... 36

see sulfasalazine dr....... 37 B bacitracin (ophthalmic) ...... 44 bacitracin-polymyxin b (ophth) .............................. 44 bacitracin-poly-neomycin-hc .......................................... 43 baclofen ............................ 27 BACTOCILL IN DEXTROSE .......................................... 10 BACTRIM ............................ 5

see sulfamethoxazole-trimethoprim ................................. 5

BACTRIM DS ...................... 5 see sulfamethoxazole-trimethoprim ................................. 5

BACTROBAN ................... 48 see mupirocin ................ 48 see mupirocin calcium (topical) ......................... 48

BACTROBAN NASAL ....... 48 balsalazide disodium......... 36 balziva 28 day ................... 30 BANZEL ............................ 20 BARACLUDE ...................... 7 BCG VACCINE ................. 41 BECONASE AQ ................ 47 benazepril & hydrochlorothiazide ........... 13 benazepril hcl .................... 14 BENICAR .......................... 14 BENICAR HCT ................. 14 BENTYL ............................ 36

see dicyclomine hcl ....... 36 BENZACLIN ...................... 47

see clindamycin phosphate-benzoyl peroxide ........................ 47

BENZAMYCIN .................. 47 see benzoyl peroxide-erythromycin ... 47

benzonatate ...................... 52 benzoyl peroxide-erythromycin ...... 47

benzphetamine ................. 52 benztropine mesylate ........ 23 BEPREVE ......................... 45 BESIVANCE ..................... 44 BETAGAN ........................ 45

see levobunolol hcl ........ 45 betamethasone dipropionate (topical) ............................. 49 betamethasone dipropionate augmented ........................ 49 betamethasone valerate ... 49 BETAPACE ...................... 15

see sorine ..................... 15 see sotalol hcl ............... 15

BETAPACE AF ................. 15 see sotalol hcl (afib/afl) . 15

BETASERON ................... 27 betaxolol hcl ...................... 16 betaxolol hcl (ophth) ......... 45 bethanechol chloride ......... 38 BETHKIS ............................ 4 BETIMOL .......................... 45 BETOPTIC-S .................... 45 BEYAZ .............................. 30 BIAXIN ................................ 9

see clarithromycin ........... 9 BIAXIN XL .......................... 9

see clarithromycin ........... 9 BIAXIN XL PAC .................. 9 bicalutamide ..................... 12 BICILLIN C-R .................... 10 BICILLIN L-A .................... 10 BICNU .............................. 11 BIDIL ................................. 18 BILTRICIDE ........................ 5 BINOSTO ......................... 30 bisoprolol & hydrochlorothiazide ........... 16 bisoprolol fumarate ........... 16 BIVIGAM ........................... 40 bleomycin sulfate .............. 11 BLEPH-10 ......................... 44

see sulfacetamide sodium (ophth) ........................... 44

blephamide ....................... 43 BLEPHAMIDE .................. 43 BONIVA ............................ 30

see ibandronate sodium 30


57

BONTRIL PDM see phendimetrazine ..... 52

BOOSTRIX ....................... 41 BOSULIF........................... 12 BOTOX ............................. 45 BREO ELLIPTA ................ 47 BREVICON-28 .................. 30

see necon 0.5/35 28 day ...................................... 32 see nortrel 0.5/35 28 day ...................................... 32

briellyn 28 day ................... 31 BRILINTA .......................... 40 BRIMONIDINE SOL 0.15% .......................................... 45 brimonidine sol 0.2% ......... 45 BRINTELLIX ..................... 22 BRISDELLE ...................... 27 BROMDAY ........................ 44 bromfenac sodium (ophth) 44 BROMFENAC SODIUM (OPHTH)(ONCE-DAILY) ... 44 bromocriptine mesylate ..... 23 BROVANA ........................ 46 budeprion .......................... 22 budesonide ....................... 36 budesonide (inhalation) ..... 47 budesonide (nasal) ........... 47 bumetanide ....................... 18 BUPHENYL ....................... 33

see sodium phenylbutyrate ...................................... 33

BUPHENYL TAB 500MG .. 33 buprenorphine hcl ............. 28 buprenorphine hcl-naloxone hcl sl .................................. 28 buproban ........................... 28 bupropion hcl .................... 22 buspirone hcl ..................... 19 BUSULFEX ....................... 11 butorphanol nasal spray ......1 butorphanol tartrate .............1 BUTRANS ...........................2 BYDUREON ...................... 28 BYETTA ............................ 29 BYSTOLIC ........................ 16 C cabergoline ....................... 34

CADUET ........................... 17 cafergot tab 1-100mg ........ 26 CALAN .............................. 17

see verapamil hcl .......... 17 CALAN SR ........................ 17

see verapamil hcl .......... 18 calcipotriene ...................... 48 calcipotriene-betamethasone dipropionate ...................... 49 calcitonin (salmon) nasal spray ................................. 34 calcitriol ............................. 43 CALCITRIOL ..................... 48 calcium acetate (phosphate binder) ............................... 35 camila 28 day .................... 31 CAMPRAL ........................ 28

see acamprosate calcium ...................................... 28

CAMPTOSAR ................... 13 see irinotecan hcl .......... 13

CAMRESE LO TAB .......... 31 CANASA ........................... 36 CANCIDAS ......................... 6 candesartan cilexetil ......... 14 candesartan cilexetil-hydrochlorothiazide .......................................... 14 CANTIL ............................. 36 CAPASTAT SULFATE ........ 7 CAPEX .............................. 49 capital

and codeine ..................... 2 CAPRELSA ....................... 12 captopril ............................ 14 captopril & hydrochlorothiazide ........... 13 CARAC ............................. 48 CARAFATE ....................... 37

see sucralfate ................ 37 CARBAGLU ...................... 33 carbamazepine ................. 20 CARBATROL .................... 20

see carbamazepine ....... 20 carbidopa .......................... 23 CARBIDOPA/LEVODOPA/ENTACA .............................. 23 carbidopa-levodopa .......... 23

carboplatin ........................ 13 CARDIZEM ....................... 17

see diltiazem hcl ............ 17 CARDIZEM CD ................. 17

see cartia xt ................... 17 see dilt-cd ...................... 17 see dilt-cd cap 120mg ... 17 see diltiazem hcl coated beads ............................ 17

CARDIZEM LA.................. 17 see matzim la ................ 17

CARDURA ........................ 14 see doxazosin mesylate 14

CARDURA XL .................. 38 CARIMUNE NANOFILTERED .............. 40 carisoprodol ...................... 28 CARNITOR ....................... 33

see levocarnitine (metabolic modifiers) ..... 33

carteolol hcl (ophth) .......... 45 cartia xt ............................. 17 carvedilol .......................... 16 CASODEX ........................ 12

see bicalutamide ........... 12 CATAFLAM ........................ 1

see diclofenac potassium 1 CATAPRES ...................... 18

see clonidine hcl ............ 18 CATAPRES-TTS .............. 18 CATAPRES-TTS-1

see clonidine hcl ............ 18 CATAPRES-TTS-2

see clonidine hcl ............ 18 CATAPRES-TTS-3

see clonidine hcl ............ 18 CAVERJECT .................... 52 CAYSTON ........................ 46 CEDAX ............................... 8 CEENU ............................. 11 cefaclor ............................... 8 cefaclor monohydrate ......... 8 cefadroxil ............................ 8 cefazolin inj ......................... 8 cefazolin sodium ................. 8 cefazolin/dextrose ............... 8 cefdinir ................................ 8 CEFEPIME 1GM SOLN ...... 8


58

CEFEPIME 2GM SOLN ......8 cefepime inj 1gm .................8 cefepime inj 2gm .................8 cefotaxime sodium ..............8 cefotetan disodium ..............8 cefoxitin sodium ..................8 CEFOXITIN SODIUM IN DEXTROSE ........................8 cefpodoxime proxetil ...........8 cefprozil...............................8 ceftazidime ..........................8 CEFTAZIDIME/DEXTROSE ............................................8 ceftibuten ............................8 CEFTIN ...............................8

see cefuroxime axetil .......8 ceftriaxone sodium ..............8 cefuroxime axetil .................8 cefuroxime sodium ..............8 cefuroxime sodium 7.5mg soln .....................................8 CELEBREX .........................1 CELEXA ............................ 22

see citalopram hydrobromide ................ 22

CELLCEPT ....................... 40 see mycophenolate mofetil ...................................... 41

CELLCEPT INTRAVENOUS .......................................... 40 CELONTIN ........................ 20 CENTANY ......................... 48 cephalexin ...........................8 CEREFOLIN TAB ............. 52 CEREZYME ...................... 33 CERVARIX ........................ 41 CESAMET ......................... 35 cetirizine syrup .................. 46 cevimeline hcl ................... 51 CHANTIX .......................... 28 CHANTIX STARTER PACK .......................................... 28 CHEMET ........................... 30 cheratussin ........................ 52 chlorhexidine gluconate (mouth-throat) ................... 51 chloroquine phosphate ........6 chlorothiazide .................... 18

chlorpromaz inj 25mg/ml ... 24 chlorpromazine hcl ............ 24 chlorthalidone ................... 18 chlorzoxazone ................... 28 cholestyramine .................. 15 cholestyramine light .......... 15 choline fenofibrate ............ 15 CHORIONIC GONADOTROPIN ............ 34 CIALIS .............................. 52 ciclopirox ........................... 48 ciclopirox cre 0.77% .......... 48 ciclopirox shampoo 1% ..... 48 ciclopirox sus 0.77% ......... 48 cidofovir .............................. 7 cilostazol ........................... 39 CILOXAN

see ciprofloxacin hcl (ophth) ........................... 44

CILOXAN OIN 0.3% OP ... 44 CILOXAN SOL 0.3% OP ... 44 cimetidine .......................... 36 cimetidine sol 300/5ml ...... 36 CIMZIA .............................. 40 CIPRO ................................ 9

see ciprofloxacin ............. 9 see ciprofloxacin hcl ........ 9

CIPRO HC ........................ 51 CIPRO I.V.-IN D5W ............ 9

see ciprofloxacin in d5w .. 9 CIPRO XR

see ciprofloxacin er ......... 9 CIPRODEX ....................... 51 ciprofloxacin ........................ 9 ciprofloxacin er .................... 9 ciprofloxacin hcl .................. 9 ciprofloxacin hcl (ophth) .... 44 ciprofloxacin in d5w ............ 9 ciprofloxacn inj .................... 9 cisplatin ............................. 13 citalopram hydrobromide .. 22 cladribine .......................... 11 claforan ............................... 8 CLAFORAN ........................ 8

see cefotaxime sodium .... 8 claravis .............................. 47 CLARINEX ........................ 46

see desloratadine .......... 46

CLARINEX REDITABS see desloratadine .......... 46

CLARINEX-D .................... 46 clarithromycin ..................... 9 cleocin ................................ 5 CLEOCIN ...................... 5, 39

see clindamycin cre 2% vag ................................ 39 see clindamycin hcl ......... 5

CLEOCIN CAP 75MG ......... 5 CLEOCIN IN D5W .............. 5

see clindamycin phosphate in d5w ............ 5

CLEOCIN INJ ..................... 5 CLEOCIN PEDIATRIC GRANULE

see clindamycin palmitate hydrochloride................... 5

CLEOCIN PHOSPHATE ..... 5 see clindamycin phosphate ....................... 5

CLEOCIN VAG SUPP 100MG .............................. 39 CLEOCIN-T ...................... 47

see clindamycin phosphate (topical) ........ 47

CLIMARA .......................... 33 see estradiol .................. 33

CLINDAGEL ..................... 47 clindamycin cre 2% vag .... 39 clindamycin hcl ................... 5 clindamycin palmitate hydrochloride ...................... 5 clindamycin phosphate ....... 5 clindamycin phosphate (topical) ............................. 47 clindamycin phosphate in d5w ..................................... 5 clindamycin phosphate-benzoyl peroxide.......................................... 47 CLINIMIX 2.75%/DEXTROSE 5% ..... 42 CLINIMIX 4.25%/DEXTROSE 10% ... 42 CLINIMIX 4.25%/DEXTROSE 20% ... 42 CLINIMIX


59

4.25%/DEXTROSE 25% ... 42 CLINIMIX 4.25%/DEXTROSE 5% ..... 42 CLINIMIX 5%/DEXTROSE 15% ................................... 42 CLINIMIX 5%/DEXTROSE 20% ................................... 42 CLINIMIX 5%/DEXTROSE 25% ................................... 42 CLINIMIX E 2.75%/DEXTROSE 10% ... 42 CLINIMIX E 2.75%/DEXTROSE 5% ..... 42 CLINIMIX E 4.25%/DEXTROSE ........... 42 CLINIMIX E 4.25%/DEXTROSE 25% ... 42 CLINIMIX E 4.25%/DEXTROSE 5% ..... 42 CLINIMIX E 5%/DEXTROSE 15% ................................... 42 CLINIMIX E 5%/DEXTROSE 20% ................................... 42 CLINIMIX E 5%/DEXTROSE 25% ................................... 42 clinisol 15 .......................... 42 clobetasol propionate ........ 49 clobetasol propionate emollient base ................... 49 clobetasol propionate emulsion............................ 49 CLOBEX ........................... 49

see clobetasol propionate ...................................... 49

CLOCORTOLONE PIVALATE ......................... 49 CLODERM PUMP ............. 49 CLOLAR............................ 11 clomipramine hcl ............... 22 clonazepam ....................... 20 clonidine hcl ...................... 18 clopidogrel bisulfate .......... 40 clorazepate dipotassium ... 20 clorpres 0.1/15 .................. 19 clorpres 0.2/15 .................. 19 clorpres 0.3/15 .................. 19 clotrimazole ....................... 51 clotrimazole (topical) ......... 48

CLOZAPINE ODT ............. 24 clozapine tab ..................... 24 CLOZARIL ........................ 24

see clozapine tab .......... 24 COARTEM .......................... 6 codeine

and capital ....................... 2 CODEINE SULFATE .......... 3 COGENTIN ....................... 23

see benztropine mesylate ...................................... 23

COLAZAL ......................... 36 see balsalazide disodium ...................................... 36

colchicine w/ probenecid ..... 1 COLCRYS .......................... 1 COLESTID ........................ 15

see colestipol hcl ........... 15 colestipol hcl ..................... 15 colistimethate sodium ......... 5 colocort ............................. 36 COLY-MYCIN M ................. 5

see colistimethate sodium ........................................ 5

COLY-MYCIN S ................ 51 COLYTE-FLAVOR PACKS .......................................... 37

see gavilyte-c ................ 37 COMBIGAN ...................... 45 COMBIPATCH .................. 33 COMBIVENT RESPIMAT . 45 COMBIVIR .......................... 7

see lamivudine-zidovudine ........................................ 7

COMETRIQ ...................... 12 COMPAZINE

see prochlorperazine maleate ......................... 36

COMPLERA ........................ 7 compro supp ..................... 35 COMTAN .......................... 23 COMVAX .......................... 41 CONCERTA ...................... 25

see methylphenidate hcl er ...................................... 25

CONDYLOX ...................... 50 see podofilox ................. 51

constulose ......................... 37

CONZIP .............................. 2 COPAXONE ..................... 27 COPAXONE INJ 40MG/ML.......................................... 27 COPEGUS .......................... 7

see moderiba tab 200mg 8 see ribasphere ................ 8 see ribavirin 200mg ......... 8

CORDARONE see amiodarone hcl ....... 15 see pacerone ................ 15

CORDRAN ....................... 49 COREG ............................ 16

see carvedilol ................ 16 COREG CR ...................... 16 CORGARD ....................... 16

see nadolol .................... 17 CORTEF ........................... 33

see hydrocortisone ........ 33 CORTENEMA ................... 36

see colocort ................... 36 CORTIFOAM .................... 48 cortisone acetate .............. 33 CORTISPORIN ........... 48, 51

see neomycin-polymyxin-hc (otic) .............................. 51

CORTISPORIN-TC ........... 51 CORZIDE ......................... 16

see nadolol & bendroflumethiazide ...... 16

COSMEGEN ..................... 11 COSOPT .......................... 45

see dorzolamide hcl-timolol maleate ........ 45

COSOPT PF ..................... 45 COUMADIN ...................... 39

see jantoven .................. 39 see warfarin sodium ...... 39

COUMADIN INJ ................ 39 COZAAR ........................... 14

see losartan potassium . 15 CREON ............................. 38 CRESTOR ........................ 15 CRINONE ......................... 35 CRIXIVAN ........................... 6 cromolyn sodium............... 46 cromolyn sodium


60

(mastocytosis) ................... 37 cromolyn sodium (ophth) .. 45 cryselle 28 ......................... 31 CUBICIN .............................5 CUTIVATE ........................ 49

see fluticasone propionate ...................................... 50

CUVPOSA ........................ 36 cyclafem 1/35 28 day ........ 31 cyclafem 7/7/7 28 day ....... 31 CYCLESSA ....................... 31

see velivet 28 day .......... 32 cyclobenzaprine hcl .......... 28 cyclophosphamide ............ 11 CYCLOPHOSPHAMIDE ... 11 cycloserine ..........................7 cyclosporine ...................... 41 cyclosporine modified (for microemulsion) .................. 41 CYKLOKAPRON ............... 39

see tranexamic acid ...... 39 CYMBALTA ....................... 22

see duloxetine hcl .......... 22 cyproheptadine hcl ............ 46 CYSTADANE .................... 33 CYSTAGON ...................... 33 cytarabine inj ..................... 11 CYTOGAM ........................ 40 CYTOMEL ......................... 35

see liothyronine sodium . 35 CYTOTEC ......................... 37

see misoprostol ............. 37 CYTOVENE ........................7

see ganciclovir inj 500mg 8 D D.H.E. 45 .......................... 26

see dihydroergotamine mesylate ........................ 26

dacarbazine ...................... 11 DACOGEN ........................ 11

see decitabine ............... 11 DALIRESP ........................ 46 danazol ............................. 33 DANTRIUM ....................... 28

see dantrolene sodium .. 28 dantrolene sodium ............ 28 dapsone ..............................5 DAPTACEL ....................... 41

DARAPRIM ......................... 5 daunorubicin hcl ................ 11 daunorubicin hcl for inj 20 mg ..................................... 11 DAYPRO ............................. 1

see oxaprozin .................. 1 DAYTRANA ...................... 25 DDAVP ............................. 35

see desmopressin acetate ...................................... 35 see desmopressin acetate inj................................... 35 see desmopressin acetate spray ............................. 35

DECAVAC ........................ 41 decitabine ......................... 11 DELATESTRYL ................ 28 DELESTROGEN ............... 33

see estradiol valerate .... 33 DELZICOL ........................ 36 DEMADEX ........................ 18

see torsemide tabs ........ 18 demeclocycline hcl ............ 10 DEMSER .......................... 19 DENAVIR .......................... 49 DEPACON ........................ 20

see valproate sodium .... 21 DEPAKENE ...................... 20

see valproate sodium .... 21 see valproic acid ........... 21

DEPAKOTE ...................... 20 see divalproex sodium ... 20

DEPAKOTE ER ................ 20 see divalproex sodium ... 20

DEPAKOTE SPRINKLES . 20 see divalproex sodium ... 20

DEPLIN ............................. 52 depo-estradiol ................... 33 DEPO-MEDROL ............... 33

see methylprednisolone acetate .......................... 34

DEPO-PROVERA CONTRACEPTIV .............. 31

see medroxyprogesterone acetate (contraceptive) .. 31

DEPO-PROVERA INJ 400/ML .............................. 12 DEPO-SUBQ PROVERA

104 .................................... 31 depo-testosterone ............. 28 DEPO-TESTOSTERONE

see testosterone cypionate ...................................... 28

DERMA-SMOOTHE/FS BODY

see fluocinolone acetonide ...................................... 50

DERMA-SMOOTHE/FS BODY OIL ......................... 49 DERMATOP ..................... 49

see prednicarbate ......... 50 DERMOTIC ...................... 51

see fluocinolone acetonide (otic) .............................. 51

desipramine hcl................. 22 desloratadine .................... 46 desmopressin acetate ....... 35 DESMOPRESSIN ACETATE.......................................... 35 desmopressin acetate inj .. 35 desmopressin acetate spray.......................................... 35 desmopressin acetate spray refrigerated ....................... 35 DESOGEN ........................ 31

see apri 28 day.............. 30 see emoquette .............. 31 see reclipsen 28 day ..... 32

DESONATE ...................... 49 desonide ........................... 49 DESONIDE ....................... 49 desowen ........................... 49 DESOWEN ....................... 49

see desonide ................. 49 desowen oint kit 0.05% ..... 49 desoximetasone................ 49 DESOXIMETASONE ........ 49 DETROL ........................... 38

see tolterodine tartrate .. 38 DETROL LA ...................... 38 dexamethasone ................ 33 dexamethasone sodium phosphate ......................... 33 dexamethasone sodium phosphate (ophth)............. 44 DEXILANT ........................ 38


61

dexpak taperpak 13 day .... 33 dexrazoxane ..................... 13 dextrose ............................ 42 DEXTROSE ...................... 42 DEXTROSE 10% FLEX CONTAIN .......................... 43 DEXTROSE 10% W/ SODIUM CHLORIDE 0.2% .......................................... 43 DEXTROSE 10%/NACL 0.45% ................................ 43 DEXTROSE 2.5%/NACL 0.45% ................................ 42 DEXTROSE 5% ................ 42 DEXTROSE 5% /ELECTROLYTE ............... 42 DEXTROSE 5%/LACTATED RING ................................. 42 DEXTROSE 5%/NACL 0.2% .......................................... 42 DEXTROSE 5%/NACL 0.225% .............................. 43 DEXTROSE 5%/NACL 0.3% .......................................... 42 DEXTROSE 5%/NACL 0.33% ................................ 42 DEXTROSE 5%/NACL 0.45% ................................ 43 DEXTROSE 5%/NACL 0.9% .......................................... 42 DEXTROSE 5%/POTASSIUM CHL ...... 43 DIABETA........................... 29 DIAMOX ............................ 18

see acetazolamide ........ 18 DIASTAT ACUDIAL .......... 20 DIASTAT PEDIATRIC ....... 20 diazepam .......................... 20 DIAZEPAM GEL ............... 20 diazepam inj ...................... 20 DIBENZYLINE .................. 19 diclofenac potassium ..........1 diclofenac sodium ...............1 diclofenac sodium (actinic keratoses) ......................... 48 diclofenac sodium (ophth) . 44 diclofenac sodium (topical) 51 diclofenac w/ misoprostol ....1

dicloxacillin sodium ........... 10 dicyclomine hcl ................. 36 didanosine .......................... 6 DIDREX

see benzphetamine ....... 52 diethylpropion ................... 52 DIFFERIN ......................... 47

see adapalene ............... 47 DIFICID ............................... 9 diflorasone diacetate ......... 49 DIFLUCAN .......................... 6

see fluconazole ............... 6 diflunisal .............................. 1 digoxin .............................. 18 digoxin inj .......................... 18 DIGOXIN SOL 50MCG/ML .......................................... 18 dihydroergotamine mesylate .......................................... 26 DIHYDROERGOTAMINE MESYLATE ....................... 26 dilacor ............................... 17 dilantin .............................. 20 DILANTIN ......................... 20

see phenytoin ................ 21 see phenytoin sodium extended ....................... 21

DILANTIN INFATABS see phenytoin ................ 21

DILATRATE SR ................ 19 DILAUDID

see hydromorphone hcl ... 3 DILAUDID INJ ..................... 3 DILAUDID TAB ................... 3 DILAUDID-5 ORAL LIQD .... 3 DILAUDID-HP

see hydromorphone hcl ... 3 DILAUDID-HP INJ .............. 3 dilt-cd ................................ 17 dilt-cd cap 120mg ............. 17 diltiazem cap 120mg/24hr . 17 diltiazem cap er/12hr......... 17 diltiazem hcl ...................... 17 diltiazem hcl coated beads 17 DILTIAZEM HCL ER ......... 17 diltiazem hcl extended release beads ................... 17 dilt-xr ................................. 17

diltzac ............................... 17 DIOVAN ............................ 14

see valsartan ................. 15 DIOVAN HCT ................... 14

see valsartan-hydrochlorothiazide .................................. 14

DIPENTUM ....................... 36 diphenhydram inj 50mg/ml 46 diphenoxylate w/ atropine . 37 DIPHTHERIA/TETANUS TOXOID ............................ 41 DIPROLENE ..................... 49

see betamethasone dipropionate augmented 49

DIPROLENE AF ............... 49 see betamethasone dipropionate augmented 49

dipyridamole ..................... 40 disopyramide phosphate ... 15 disulfiram .......................... 28 DITROPAN XL .................. 38

see oxybutynin chloride . 38 DIURIL SUS 250/5ML ....... 18 divalproex sodium ............. 20 docetaxel .......................... 12 DOCETAXEL .............. 11, 12 DOLOPHINE ...................... 3

see methadone hcl .......... 3 DOLOPHINE HCL

see methadone hcl .......... 3 donepezil odt 10mg .......... 22 donepezil odt 5mg ............ 22 donepezil tab hcl 23mg ..... 22 donepezil tabs 10mg ......... 22 donepezil tabs 5mg ........... 22 DORIBAX ........................... 5 DORYX ............................. 10

see doxycycline hyclate 10 dorzolamide hcl................. 45 dorzolamide hcl-timolol maleate ............................. 45 DOVONEX ........................ 48

see calcipotriene ........... 48 doxazosin mesylate .......... 14 doxepin hcl ....................... 22 doxercalciferol .................. 43 DOXIL ............................... 11


62

see doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml ........... 11

doxorubicin hcl .................. 11 doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml ..... 11 doxycycline (monohydrate) .......................................... 10 doxycycline hyclate ........... 10 DRISDOL

see vitamin d ................. 52 dronabinol ......................... 35 drospirenone-ethinyl estradiol ............................ 31 DROXIA ............................ 13 DUETACT ......................... 29

see pioglitazone hcl-glimepiride ............... 30

DUEXIS...............................1 DULERA ........................... 47 duloxetine hcl .................... 22 DUONEB........................... 45 DURAGESIC .......................3

see fentanyl patch ...........3 DURAMORPH ....................3 DUREZOL ......................... 44 DUTOPROL ...................... 16 DYAZIDE .......................... 18

see triamterene & hydrochlorothiazide cap 37.5-25 mg .................... 18

DYMISTA .......................... 46 dynacin ............................. 10 DYRENIUM ....................... 18 E e.e.s. ...................................9 E.E.S. GRANULES .............9 EC-NAPROSYN ..................1

see naproxen ...................1 econazole nitrate ............... 48 EDARBI............................. 14 EDARBYCLOR ................. 14 EDECRIN .......................... 18 EDLUAR ........................... 25 EDURANT ...........................6 EFFEXOR XR ................... 22

see venlafaxine cap er .. 23 EFFIENT ........................... 40

EFUDEX ........................... 48 see fluorouracil (topical) 48

EGRIFTA .......................... 34 ELAPRASE ....................... 33 ELDEPRYL ....................... 23

see selegiline hcl ........... 24 ELECTROLYTE-R IN DEXTROSE ...................... 43 ELELYSO ......................... 33 ELESTAT .......................... 45

see epinastine hcl (ophth) ...................................... 45

ELIDEL ............................. 51 ELIGARD .......................... 12 ELIMITE

see permethrin .............. 51 eliphos .............................. 35 ELIPHOS

see calcium acetate (phosphate binder) ........ 35

ELIQUIS ............................ 39 ELITEK ............................. 13 elixophyllin ........................ 47 ELLA ................................. 31 ELLENCE ......................... 11

see epirubicin inj 200mg 11 see epirubicin inj 50mg/25ml .................... 11

ELMIRON ......................... 38 ELOCON ..................... 49, 50

see mometasone furoate ...................................... 50

ELOXATIN ........................ 13 EMADINE ......................... 45 EMCYT ............................. 11 EMEND ............................. 35 EMEND PAK 80 & 125 ..... 35 EMLA ................................ 50

see lidocaine-prilocaine . 50 emoquette ......................... 31 EMSAM ............................. 22 EMTRIVA ............................ 6 ENABLEX ......................... 38 enalapril maleate .............. 14 enalapril maleate & hydrochlorothiazide ........... 13 ENBREL ........................... 40 ENBREL SURECLICK ...... 40

endocet 10/325 ................... 3 endocet 5/325 ..................... 3 endocet 7.5/325 .................. 3 ENDODAN .......................... 3 ENDOMETRIN.................. 35 ENGERIX-B ...................... 41 enoxaparin sodium ........... 39 enpresse 28 day ............... 31 ENTACAPONE ................. 23 ENTOCORT EC................ 36

see budesonide ............. 36 ENTYVIO .......................... 37 enulose ............................. 37 EPIDUO ............................ 47 epinastine hcl (ophth) ....... 45 EPINEPHRINE INJ 0.15MG.......................................... 46 EPINEPHRINE INJ 0.3MG 46 EPIPEN 2-PAK ................. 46 EPIPEN-JR 2-PAK ............ 46 epirubicin inj 200mg .......... 11 EPIRUBICIN INJ 50MG .... 11 epirubicin inj 50mg/25ml ... 11 epitol ................................. 20 EPIVIR

see lamivudine ................ 7 EPIVIR HBV ....................... 7

see lamivudine ................ 8 EPIVIR SOL 10MG/ML ....... 6 EPIVIR TABS ..................... 6 eplerenone ........................ 14 EPOGEN .......................... 39 eprosartan mesylate ......... 15 EPZICOM ........................... 7 EQUETRO ........................ 27 ERAXIS .............................. 6 ERBITUX .......................... 12 ergomar ............................ 26 ERIVEDGE ....................... 12 errin 28 day ....................... 31 ERTACZO ........................ 48 erygel ................................ 47 ERYGEL

see erythromycin (acne aid) ................................ 47

ERYPED 200 ...................... 9 ERYPED 400 ...................... 9 ery-tab ................................ 9


63

erythrocin lactobionate ........9 erythrocin stearate ..............9 erythromycin (acne aid) .... 47 erythromycin (ophth) ......... 44 erythromycin base ...............9 erythromycin ethylsuccinate 9 erythromycin-sulfisoxazole for susp 200-600 mg/5ml ....5 escitalopram oxalate ......... 22 esomeprazole sodium inj .. 38 estrace .............................. 33 ESTRACE

see estradiol .................. 33 estradiol ............................ 33 estradiol & norethindrone acetate .............................. 33 estradiol valerate ............... 33 ESTRADIOL VALERATE .. 33 ESTRING .......................... 33 estropipate ........................ 33 ESTROSTEP FE ............... 31

see tri-legest 28 day ...... 32 eszopiclone ....................... 26 ethambutol hcl .....................7 ethosuximide ..................... 20 ETHYOL

see amifostine crystalline ...................................... 13

etodolac ..............................1 etodolac er ..........................1 ETOPOPHOS ................... 13 etoposide .......................... 13 EURAX ............................. 51 EVISTA ............................. 35

see raloxifene hcl .......... 35 EVOCLIN .......................... 47

see clindamycin phosphate (topical) ........ 47

EVOXAC ........................... 51 see cevimeline hcl ......... 51

EXALGO .............................3 see hydromorphone hcl ...3

EXELDERM ...................... 48 EXELON ........................... 22

see rivastigmine tartrate 22 EXELON PATCHES ......... 22 exemestane ...................... 12 EXFORGE ........................ 14

EXFORGE HCT ................ 14 EXJADE ............................ 30 EXTAVIA ........................... 27 EXTINA ............................. 48

see ketoconazole (topical) ...................................... 48

F FABIOR ............................ 47 FABRAZYME .................... 33 FACTIVE ............................. 9 famciclovir ........................... 7 famotidine ......................... 36 famotidine inj ..................... 36 FAMVIR .............................. 7

see famciclovir ................ 7 FANAPT ............................ 24 FANAPT TITRATION PACK .......................................... 24 FARESTON ...................... 12 FARXIGA .......................... 29 FASLODEX ....................... 12 FAZACLO ......................... 24 felbamate .......................... 20 FELBATOL ....................... 20

see felbamate ................ 20 FELDENE ........................... 1

see piroxicam .................. 1 felodipine .......................... 17 FEMARA ........................... 12

see letrozole .................. 12 FEMCON FE ..................... 31

see zenchent fe 28 day . 32 FEMRING ......................... 33 fenofibrate ......................... 16 FENOFIBRATE ................. 15 FENOFIBRATE CAP ........ 16 fenofibrate micronized....... 16 FENOFIBRATE MICRONIZED ................... 16 FENOFIBRIC ACID........... 16 FENOGLIDE ..................... 16 fenoprofen calcium ............. 1 fentanyl citrate .................... 3 fentanyl patch ..................... 3 FENTORA ........................... 3 FERRIPROX ..................... 30 FETZIMA .......................... 22 FETZIMA TITRATION PACK

.......................................... 22 fexmid ............................... 28 FEXMID

see cyclobenzaprine hcl 28 FIBRICOR ........................ 16 FINACEA .......................... 51 finasteride ......................... 38 FIRMAGON ...................... 12 FLAGYL .............................. 5

see metronidazole ........... 5 FLAGYL ER ........................ 5 FLAREX ............................ 44 FLEBOGAMMA ................ 40 FLEBOGAMMA DIF .......... 40 flecainide acetate .............. 15 FLOLAN INJ ..................... 19 FLOMAX ........................... 38

see tamsulosin hcl ......... 38 FLONASE ......................... 47

see fluticasone propionate (nasal) ........................... 47

FLO-PRED ....................... 33 FLOVENT DISKUS ........... 47 FLOVENT HFA ................. 47 fluconazole ......................... 6 fluconazole in dextrose ....... 6 fluconazole in nacl 100mg .. 6 fluconazole in nacl 200mg .. 6 fluconazole in nacl 400mg .. 6 flucytosine ........................... 6 FLUDARA

see fludarabine phosphate ...................................... 11

fludarabine phosphate ...... 11 fludrocortisone acetate ..... 33 FLUMADINE ....................... 8

see rimantadine hydrochloride................... 8

flunisolide (nasal) .............. 47 fluocinolone acetonide ...... 50 fluocinolone acetonide (otic).......................................... 51 fluocinonide ...................... 50 fluocinonide emulsified base.......................................... 50 FLUOROMETHOLONE .... 44 FLUOROMETHOLONE (OPHTH) ........................... 44


64

fluorouracil ........................ 11 fluorouracil (topical) ........... 48 fluoxetine hcl ..................... 22 FLUOXETINE HCL ........... 22 fluphenazine decanoate .... 24 fluphenazine hcl ................ 24 flurbiprofen ..........................1 flurbiprofen sodium ........... 44 flutamide ........................... 12 fluticasone propionate ....... 50 fluticasone propionate (nasal) ............................... 47 fluvastatin sodium ............. 15 fluvoxamine maleate ......... 19 fluvoxamine maleate er ..... 19 fluvoxamine tabs ............... 19 FML ................................... 44 FML FORTE ...................... 44 FML LIQUIFILM ................ 44 folic acid ............................ 52 FOLTX .............................. 52 fondaparinux sodium ......... 39 FORADIL AEROLIZER ..... 46 FORFIVO XL ..................... 22 FORTAMET ...................... 29

see metformin hcl .......... 30 FORTAZ..............................8

see ceftazidime ...............8 see tazicef vial .................9

FORTEO ........................... 34 FORTESTA ....................... 28 FORTICAL SPR 200/ACT . 34 FOSAMAX ........................ 30

see alendronate sodium 30 FOSAMAX PLUS D .......... 30 foscarnet sodium .................8 fosinopril sodium ............... 14 fosinopril sodium & hydrochlorothiazide ........... 13 FOSRENOL ...................... 35 FRAGMIN ......................... 39 FREAMINE HBC 6.9% ...... 42 FREAMINE III ................... 42 FROVA TAB 2.5MG .......... 26 FURADANTIN .....................5

see nitrofurantoin .............5 furosemide ........................ 18 furosemide inj .................... 18

furosemide oral soln 8 mg/ml .......................................... 18 FUZEON ............................. 6 FYCOMPA ........................ 20 G gabapentin ........................ 20 GABITRIL ......................... 20

see tiagabine hcl ........... 21 galantamine hydrobromide 22 GAMASTAN S/D ............... 40 GAMMAGARD LIQUID ..... 40 GAMMAGARD S/D ........... 40 GAMMAKED ..................... 40 GAMMAPLEX ................... 40 GAMUNEX ........................ 40 GAMUNEX-C 10GM/100ML .......................................... 40 GAMUNEX-C 1GM/10ML . 40 GAMUNEX-C 2.5GM/25ML .......................................... 40 GAMUNEX-C 20GM/200ML .......................................... 40 GAMUNEX-C 5GM/50ML . 40 ganciclovir inj 500mg .......... 8 garamycin ......................... 44 GARAMYCIN

see gentamicin sulfate (ophth) ........................... 44

GARDASIL ........................ 41 GASTROCROM ................ 37

see cromolyn sodium (mastocytosis) ............... 37

gatifloxacin (ophth) ........... 44 GATTEX ........................... 37 GAUZE PADS 2X2 ........... 29 gaviltye-g .......................... 37 gavilyte-c ........................... 37 gavilyte-n .......................... 37 GELNIQUE ....................... 38 GEMCITABINE ................. 11 gemcitabine hcl ................. 11 gemfibrozil ........................ 16 GEMZAR .......................... 11

see gemcitabine hcl....... 11 GENERESS FE ................ 31 generlac ............................ 37 gengraf .............................. 41 GENOTROPIN .................. 34

GENOTROPIN MINIQUICK.......................................... 34 gentak ............................... 44 gentamicin in saline 0.9mg/ml ............................. 4 gentamicin in saline 1.4mg/ml ............................. 4 gentamicin in saline 100mg 4 gentamicin in saline 60mg .. 4 gentamicin in saline 80mg .. 4 gentamicin sulfate ............... 4 gentamicin sulfate (ophth) 44 gentamicin sulfate (topical).......................................... 48 GEODON .......................... 24

see ziprasidone hcl ....... 24 GEODON INJ ................... 24 GIANVI ............................. 31 GIAZO .............................. 37 gildagia ............................. 31 GILENYA .......................... 27 GILOTRIF ......................... 12 GLASSIA .......................... 46 GLEEVEC ......................... 12 glimepiride ........................ 29 glipizide ............................. 29 glipizide er ........................ 29 glipizide-metformin 2.5-250mg ........................ 29 glipizide-metformin 2.5-500mg ........................ 29 glipizide-metformin 5-500mg.......................................... 29 GLUCAGEN HYPOKIT ..... 34 GLUCAGON EMERGENCY KIT .................................... 34 GLUCOPHAGE ................ 29

see metformin hcl .......... 30 GLUCOPHAGE XR .......... 29

see metformin er ........... 30 GLUCOTROL ................... 29

see glipizide .................. 29 GLUCOTROL XL .............. 29

see glipizide er .............. 29 GLUCOVANCE

see glyburide-metformin 1.25-250mg ................... 29 see glyburide-metformin


65

2.5-500mg ..................... 29 see glyburide-metformin 5-500mg ........................ 29

GLUCOVANCE 1.25-250MG .......................................... 29 GLUCOVANCE 2.5-500MG .......................................... 29 GLUCOVANCE 5-500MG . 29 GLUMETZA ...................... 29 glyburide ........................... 29 glyburide micronized ......... 29 glyburide-metformin 1.25-250mg ....................... 29 glyburide-metformin 2.5-500mg ......................... 29 glyburide-metformin 5-500mg ............................ 29 glycate .............................. 36 glycopyrrolate .................... 36 GLYNASE ......................... 29

see glyburide micronized ...................................... 29

GLYSET ............................ 29 GOLYTELY ....................... 37

see gaviltye-g ................ 37 see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 37

GRALISE .......................... 27 GRALISE STARTER ......... 27 granisetron hcl .................. 35 granisol ............................. 35 GRANIX ............................ 39 GRASTEK ......................... 40 GRIFULVIN V

see griseofulvin microsize ........................................6

griseofulvin microsize ..........6 griseofulvin ultramicrosize ...6 GRIS-PEG ..........................6

see griseofulvin ultramicrosize ..................6

guanfacine hcl ................... 19 H HALAVEN ......................... 13 HALDOL............................ 24

see haloperidol lactate .. 24 HALDOL DECANOATE 100

.......................................... 24 see haloperidol decanoate ...................................... 24

HALDOL DECANOATE 50 .......................................... 24

see haloperidol decanoate ...................................... 24

HALFLYTELY BOWEL PREP/FLA ........................ 37 halobetasol propionate...... 50 HALOG ............................. 50 haloperidol ........................ 24 haloperidol decanoate....... 24 haloperidol lactate ............. 24 HAVRIX ............................ 41 heather tab 0.35mg ........... 31 HECTOROL ...................... 43

see doxercalciferol ........ 43 HEP SOD/NACL INJ 25000 .......................................... 39 HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML ........................... 39 heparin sod inj 10000u/ml . 39 heparin sod inj 1000u/ml ... 39 heparin sod inj 20000u/ml . 39 HEPARIN SOD INJ 2000U/ML ......................... 39 HEPARIN SOD INJ 2500U/ML ......................... 39 heparin sod inj 5000u/0.5ml .......................................... 39 heparin sod inj 5000u/ml ... 39 HEPARIN SODIUM/D5W .. 39 HEPARIN SODIUM/SODIUM CHL .... 39 HEPATAMINE .................. 42 hepatasol 8 ....................... 42 HEPSERA ........................... 8

see adefovir dipivoxil ....... 7 HERCEPTIN ..................... 12 HEXALEN ......................... 11 HIBERIX ........................... 41 HIPREX .............................. 5

see methenamine hippurate ......................... 5

HIZENTRA ........................ 40 HORIZANT ....................... 27

HUMALOG ....................... 29 HUMALOG KWIKPEN ...... 29 HUMALOG MIX 50/50 ...... 29 HUMALOG MIX 50/50 KWIKPEN ......................... 29 HUMALOG MIX 75/25 ...... 29 HUMALOG MIX 75/25 KWIKPEN ......................... 29 HUMATROPE ................... 34 HUMATROPE COMBO PACK ................................ 34 HUMIRA ........................... 40 HUMIRA PEN ................... 40 HUMIRA PEN-CROHNS STARTER KIT .................. 40 HUMIRA PEN-PSORIASIS STARTER KIT .................. 40 HUMULIN 70/30 ............... 29 HUMULIN 70/30 PEN ....... 29 HUMULIN N ...................... 29 HUMULIN N U-100 PEN ... 29 HUMULIN R ...................... 29 HUMULIN R U-500 (CONCENTRATE) ............ 29 HYCAMTIN ....................... 13

see topotecan hcl .......... 13 hycet ................................... 2 HYCET

see hydrocodone-acetaminophen 7.5-325 mg/15ml ........ 2

hydralazine hcl .................. 19 HYDREA ........................... 13

see hydroxyurea ............ 13 hydrochlorothiazide ........... 18 hydrocodone-acetaminophen 10-300mg ........................... 2 hydrocodone-acetaminophen 2.5-325mg .......................... 2 hydrocodone-acetaminophen 5-300mg ............................. 2 hydrocodone-acetaminophen 5-325mg ............................. 2 hydrocodone-acetaminophen 7.5-300mg .......................... 2 hydrocodone-acetaminophen 7.5-325 mg/15ml ................. 2 hydrocodone-acetaminophen


66

7.5-325mg ...........................2 hydrocodone-acetaminophen tab 10-325mg ......................2 hydrocodone-ibuprofen 2.5-200mg ...........................2 hydrocodone-ibuprofen 7.5-200mg ...........................2 hydrocortisone .................. 33 HYDROCORTISONE (INTRARECTAL) ............... 37 hydrocortisone (topical) ..... 50 hydrocortisone acetate (rx) .......................................... 52 hydrocortisone butyrate .... 50 hydrocortisone butyrate hydrophilic lipo base ......... 50 hydrocortisone valerate ..... 50 hydrocortisone/pramoxine (rx) .................................... 52 hydromet ........................... 52 hydromorphone hcl .............3 HYDROMORPHONE HCL ..3 hydroxychloroquine sulfate .......................................... 40 hydroxyurea ...................... 13 hydroxyzine hcl ................. 46 hydroxyzine pamoate ........ 46 hyoscyamine ..................... 52 HYZAAR ........................... 14

see losartan potassium & hydrochlorothiazide ....... 14

I ibandronate sodium .......... 30 ibudone tab 5-200mg ..........2 ibuprofen .............................1 ICLUSIG............................ 12 IDAMYCIN PFS ................ 11

see idarubicin hcl ........... 11 idarubicin hcl ..................... 11 IFEX .................................. 11

see ifosfamide ............... 11 IFEX INJ 3GM ................... 11 ifosfamide.......................... 11 IFOSFAMIDE

see ifosfamide ............... 11 IFOSFAMIDE FOR INJ 3 GM .................................... 11 ILEVRO ............................. 44

IMBRUVICA ...................... 12 imdur ................................. 19 IMDUR

see isosorbide mononitrate ................... 19

imipenem-cilastatin ............. 5 imipramine hcl ................... 22 imipramine pamoate ......... 22 imiquimod ......................... 51 IMITREX ........................... 26

see sumatriptan succinate ...................................... 27 see sumatriptan succinate inj................................... 27

IMITREX STATDOSE REFILL .............................. 26 IMITREX STATDOSE SYSTEM ........................... 26

see sumatriptan succinate inj................................... 27

IMOVAX RABIES (H.D.C.V.) .......................................... 41 IMURAN ............................ 41

see azathioprine ............ 40 INCIVEK ............................. 8 INCRELEX ........................ 34 indapamide ....................... 18 INDERAL LA ..................... 16

see propranolol hcl er .... 17 INFANRIX ......................... 41 INFERGEN ....................... 40 INFUMORPH 200 ............... 3 INFUMORPH 500 ............... 3 INLYTA ............................. 12 INSPRA ............................ 14

see eplerenone ............. 14 INSULIN PEN NEEDLES .. 29 INSULIN SAFETY NEEDLES ......................... 29 INSULIN SYRINGES ........ 29 INTELENCE ........................ 6 INTERMEZZO .................. 26 INTRALIPID INJ 20%........ 42 INTRALIPID INJ 30%........ 42 INTRON-A ........................ 40 INTRON-A W/DILUENT .... 40 introvale 91 day ................ 31 INTUNIV ........................... 25

INVANZ .............................. 5 INVEGA ............................ 24 INVEGA SUSTENNA ........ 24 INVIRASE ........................... 7 INVOKANA ....................... 29 IONOSOL-B/DEXTROSE 5% .................................... 43 IONOSOL-MB/DEXTROSE 5% .................................... 43 iophen c-nr ........................ 52 IPOL INACTIVATED IPV .. 41 ipratropium bromide (nasal).......................................... 45 ipratropium sol inhal .......... 45 ipratropium-albuterol ......... 45 irbesartan .......................... 15 irbesartan-hydrochlorothiazide........................................ 14 IRESSA ............................ 12 irinotecan hcl .................... 13 ISENTRESS ....................... 7 ISOLYTE P ....................... 43 isolyte s ............................. 43 isoniazid .............................. 7 isoniazid tabs ...................... 7 ISOPTO CARPINE ........... 45 ISORDIL TITRADOSE ...... 19

see isosorbide dinitrate . 19 isosorbide dinitrate ............ 19 isosorbide dinitrate sl tab 2.5 mg ..................................... 19 isosorbide mononitrate ..... 19 isradipine .......................... 17 ISTALOL ........................... 45 ISTODAX .......................... 12 itraconazole ........................ 6 IXEMPRA KIT ................... 13 IXIARO ............................. 41 J JAKAFI ............................. 12 JALYN .............................. 38 jantoven ............................ 39 JANUMET ......................... 29 JANUMET XR TAB 100-1000 .......................... 30 JANUMET XR TAB 50-1000.......................................... 30 JANUMET XR TAB


67

50-500MG ......................... 30 JANUVIA ........................... 30 JENTADUETO .................. 30 jinteli .................................. 33 JOLIVETTE ....................... 31 junel 1.5/30 21 day ............ 31 junel 1/20 21 day ............... 31 junel fe 1.5/30 28 day ........ 31 junel fe 1/20 28 day ........... 31 K KADCYLA ......................... 12 KADIAN...............................3

see morphine sulfate .......3 KALETRA SOL ...................7 KALETRA TAB 100-25MG ..7 KALETRA TAB 200-50MG ..7 kariva 28 day ..................... 31 KAYEXALATE ................... 30

see kionex ..................... 30 KAZANO ........................... 30 KCL 0.075%/D5W/NACL 0.45% ................................ 43 KCL 0.15%/D5W/LR ......... 43 KCL 0.15%/D5W/NACL 0.9% .................................. 43 kcl 0.3%/d5w/lr iv lac ri ...... 43 KCL 0.3%/D5W/NACL 0.45% ................................ 43 KCL 0.3%/D5W/NACL 0.9% .......................................... 43 KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 43 kcl 20 meq/l (0.15%) in nacl 0.45% inj ........................... 43 KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ ............... 43 KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 43 KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 43 KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ ................. 43 KCL0.15%/D5W/NACL0.2% .......................................... 43 KCL0.15%/D5W/NACL0.225

% ...................................... 43 KEFLEX .............................. 8

see cephalexin ................ 8 kelnor 1/35 28 day ............ 31 KENALOG ........................ 50 KEPIVANCE ..................... 13 KEPPRA ........................... 20

see levetiracetam .......... 21 KEPPRA XR ..................... 20

see levetiracetam .......... 21 KERLONE

see betaxolol hcl ........... 16 ketoconazole ....................... 6 ketoconazole (topical) ....... 48 ketoconazole shampoo ..... 49 ketoprofen ........................... 1 ketorolac tromethamine (ophth) .............................. 44 KINERET .......................... 40 kionex ............................... 30 KLARON ........................... 47

see sulfacetamide sodium (acne) ............................ 48

KLONOPIN ................. 20, 21 see clonazepam ............ 20

KLOR-CON 10 .................. 41 KLOR-CON 8 .................... 41 klor-con m15 ..................... 41 klor-con m20 ..................... 41 klor-con pow 20meq ......... 41 KOMBIGLYZE XR 2.5-1000MG ...................... 30 KOMBIGLYZE XR 5-1000MG ......................... 30 KOMBIGLYZE XR 5-500MG .......................................... 30 KORLYM ........................... 34 kristalose ........................... 37 K-TAB ............................... 41 KUVAN ............................. 33 L labetalol hcl ....................... 16 LAC-HYDRIN .................... 51

see ammonium lactate .. 50 see laclotion lotn 12% ... 51

laclotion lotn 12% .............. 51 LACRISERT ...................... 45 LACTATED RINGERS

VIAFLEX ........................... 43 lactulose ........................... 37 lactulose (encephalopathy).......................................... 37 LAMICTAL ........................ 21

see lamotrigine .............. 21 LAMICTAL CHEWABLE DISPERS .......................... 21

see lamotrigine .............. 21 LAMICTAL ODT................ 21 LAMICTAL STARTER ...... 21 LAMICTAL XR .................. 21

see lamotrigine .............. 21 LAMISIL .............................. 6

see terbinafine hcl ........... 6 lamivudine ...................... 7, 8 lamivudine-zidovudine ........ 7 lamotrigine ........................ 21 LANOXIN

see digoxin .................... 18 see digoxin inj ............... 18

LANOXIN INJ 0.25MG/ML 18 LANOXIN PEDIATRIC ...... 18 LANOXIN TAB .................. 18 lansoprazole ..................... 38 LANTUS ........................... 29 LANTUS SOLOSTAR ....... 29 larin 1/20 ........................... 31 larin fe 1.5/30 .................... 31 larin fe 1/20 ....................... 31 LASIX ............................... 18

see furosemide.............. 18 LASTACAFT ..................... 45 latanoprost ........................ 45 LATUDA ........................... 24 LAZANDA ........................... 3 LEENA .............................. 31 leflunomide ....................... 40 LESCOL ........................... 15

see fluvastatin sodium ... 15 LESCOL XL ...................... 15 lessina 28 day ................... 31 LETAIRIS .......................... 19 letrozole ............................ 12 leucovor ca inj ................... 13 leucovorin calcium ............ 13 leucovorin calcium inj 10 mg/ml ................................ 13


68

LEUKERAN ....................... 11 LEUKINE........................... 39 leuprolide acetate .............. 12 levalbuterol conc 1.25mg/0.5ml .................... 46 LEVALBUTEROL HCL ...... 46 LEVAQUIN ..........................9

see levofloxacin ...............9 see levofloxacin in d5w....9

LEVAQUIN INJ ...................9 LEVEMIR .......................... 29 LEVEMIR FLEXPEN ......... 29 LEVEMIR FLEXTOUCH.... 29 levetiracetam ..................... 21 LEVITRA TAB ................... 52 levobunolol hcl .................. 45 LEVOBUNOLOL HCL ....... 45 levocarnitine (metabolic modifiers) .......................... 33 levocetirizine soln 2.5mg/5ml .......................................... 46 levocetirizine tab 5 mg ...... 46 levofloxacin .........................9 levofloxacin (ophth) ........... 44 levofloxacin in d5w ..............9 levonest 28 day ................. 31 levonorgestrel (emergency oc) ..................................... 31 levonorgestrel-ethinyl estradiol (91-day) .............. 31 levora 0.15/30 28 day ....... 31 levorphanol tartrate .............3 levothyroxine sodium ........ 35 LEVOXYL.......................... 35 LEXAPRO ......................... 22

see escitalopram oxalate ...................................... 22

LEXIVA ...............................7 LIALDA ............................. 37 lidocaine ............................ 50 lidocaine hcl ...................... 50 lidocaine hcl (local anesth.) .4 lidocaine hcl (mouth-throat) .......................................... 51 lidocaine inj 0.5% ................4 lidocaine inj 1% ...................4 lidocaine inj 1.5% ................4 lidocaine inj 2% ...................4

lidocaine-prilocaine ........... 50 LIDODERM ....................... 50

see lidocaine ................. 50 LINZESS CAP 145MCG ... 37 LINZESS CAP 290MCG ... 37 liothyronine sodium ........... 35 LIPITOR ............................ 15

see atorvastatin calcium 15 LIPOFEN .......................... 16 LIPOSYN II ....................... 42 LIPOSYN III ...................... 42 LIPTRUZET ...................... 16 lisinopril ............................. 14 lisinopril & hydrochlorothiazide ........... 13 lithium carbonate .............. 27 LITHIUM CITRATE ........... 27 LITHOBID ......................... 27

see lithium carbonate .... 27 LIVALO ............................. 15 L-METHYL-MC ................. 52 LO LOESTRIN FE ............ 31 LO MINASTRIN FE ........... 31 LOCOID ............................ 50

see hydrocortisone butyrate ......................... 50

LOCOID LIPOCREAM ...... 50 see hydrocortisone butyrate hydrophilic lipo base .............................. 50

LODOSYN ........................ 23 see carbidopa ................ 23

loestrin 1.5/30-21 .............. 31 LOESTRIN 1.5/30-21

see junel 1.5/30 21 day . 31 see microgestin 1.5/30 21 day ................................ 31

loestrin 1/20-21 ................. 31 LOESTRIN 1/20-21

see junel 1/20 21 day .... 31 see larin 1/20 ................. 31 see microgestin 1/20 21 day ................................ 31

LOESTRIN 24 FE ............. 31 loestrin fe 1.5/30 ............... 31 LOESTRIN FE 1.5/30

see junel fe 1.5/30 28 day ...................................... 31

see larin fe 1.5/30 .......... 31 see microgestin fe 1.5/30 28 day ........................... 31

loestrin fe 1/20 .................. 31 LOESTRIN FE 1/20

see junel fe 1/20 28 day 31 see larin fe 1/20............. 31 see microgestin fe 1/20 28 day ................................ 32

lofibra ................................ 16 LOFIBRA

see fenofibrate .............. 16 see fenofibrate micronized ...................................... 16

LOKARA LOTN 0.05% ..... 50 lomedia 24 fe .................... 31 LOMOTIL .......................... 37

see diphenoxylate w/ atropine ......................... 37

LOMUSTINE ..................... 11 loperamide hcl .................. 37 LOPID ............................... 16

see gemfibrozil .............. 16 LOPRESSOR ................... 16

see metoprolol tartrate . 16, 17

LOPRESSOR HCT ........... 16 see metoprolol & hctz tab 100-25mg ...................... 16 see metoprolol & hctz tab 50-25mg ........................ 16

LOPROX SHAMPOO ....... 48 see ciclopirox shampoo 1% ................................. 48

lorazepam ......................... 19 lorcet ................................... 2 lorcet plus tab 7.5-325 ........ 2 lortab ................................... 2 lortab elx 10-300mg ............ 2 loryna 28 day .................... 31 losartan potassium ............ 15 losartan potassium & hydrochlorothiazide ........... 14 LOSEASONIQUE ............. 31 LOTEMAX ........................ 44 LOTENSIN ........................ 14

see benazepril hcl ......... 14 LOTENSIN HCT ............... 13


69

see benazepril & hydrochlorothiazide ....... 13

LOTREL ............................ 13 see amlodipine besylate-benazepril hcl .. 13

LOTRONEX ...................... 37 lovastatin ........................... 15 LOVAZA ............................ 16 LOVENOX......................... 39

see enoxaparin sodium . 39 low-ogestrel 28 day ........... 31 loxapine succinate ............ 24 loxitane ............................. 24 LUFYLLIN ......................... 47 LUMIGAN.......................... 45 LUMIZYME ....................... 33 LUNESTA ......................... 26

see eszopiclone ............. 26 LUPANETA PACK ............ 33 LUPR DEP-PED INJ 11.25MG (3-MONTH) ....... 12 LUPR DEP-PED INJ 30MG (3-MONTH) ....................... 12 LUPRON DEPOT .............. 12 LUPRON DEPOT INJ 22.5MG (3-MONTH) ......... 12 LUPRON DEPOT INJ 30MG (3-MONTH) ....................... 12 LUPRON DEPOT-PED ..... 12 lutera 28 day ..................... 31 LUVOX CR ........................ 19

see fluvoxamine maleate er ................................... 19

LUXIQ ............................... 50 see betamethasone valerate.......................... 49

LUZU ................................ 48 LYRICA ............................. 21 LYSODREN ...................... 12 LYSTEDA.......................... 39

see tranexamic acid ...... 39 lyza ................................... 31 M MACROBID .........................5

see nitrofurantoin monohyd macro ...............5

MACRODANTIN .................5 see nitrofurantoin

macrocrystal .................... 5 mafenide acetate .............. 48 magnesium sulfate ............ 42 MAGNESIUM SULFATE ... 41 MAGNESIUM SULFATE IN D5W 1% ............................ 42 MAGNESIUM SULFATE IN D5W 2% ............................ 42 MAKENA ........................... 35 MALARONE ........................ 6

see atovaquone-proguanil hcl tab 250-100 mg.......... 6

malathion .......................... 51 maprotiline hcl ................... 22 MARINOL ......................... 35

see dronabinol ............... 35 marlissa 28 day ................. 31 MARPLAN ........................ 22 MATULANE ...................... 13 matzim la .......................... 17 MAVIK ............................... 14

see trandolapril .............. 14 MAXALT ........................... 26

see rizatriptan benzoate 26 MAXALT-MLT ................... 26

see rizatriptan benzoate 26 MAXIDEX .......................... 44 MAXIPIME .......................... 9

see cefepime inj 1gm ...... 8 see cefepime inj 2gm ...... 8

MAXITROL ....................... 43 see neomycin-polymy-dexameth .................................... 43

MAXZIDE .......................... 18 see triamterene & hydrochlorothiazide tab 75-50 mg ....................... 18

MAXZIDE-25 ..................... 18 see triamterene & hydrochlorothiazide tab 37.5-25 mg .................... 18

meclizine hcl ..................... 35 MEDROL .......................... 34

see methylprednisolone 34 MEDROL DOSEPAK ........ 34

see methylprednisolone 34 medroxyprogesterone

acetate .............................. 35 medroxyprogesterone acetate (contraceptive) ..... 31 mefenamic acid................... 1 mefloquine hcl .................... 6 MEGACE ES .................... 12 MEGACE ORAL ............... 12

see megestrol acetate ... 12 megestrol acetate ............. 12 MEKINIST ......................... 12 MELOXICAM SUSP 7.5 MG/5ML .............................. 1 meloxicam tabs ................... 1 melphalan hcl ................... 11 MENACTRA ..................... 41 menest .............................. 33 MENHIBRIX ...................... 41 MENOMUNE-A/C/Y/W-135.......................................... 41 MENOSTAR ..................... 33 MENTAX ........................... 48 MENVEO .......................... 41 MEPRON ............................ 5

see atovaquone............... 5 mercaptopurine ................. 11 meropenem ........................ 5 MERREM ............................ 5

see meropenem .............. 5 mesalamine enema .......... 37 mesalamine enema kit ...... 37 mesna ............................... 13 MESNEX .......................... 13

see mesna .................... 13 MESTINON

see pyridostigmine bromide ......................... 27

MESTINON SYRUP ......... 27 MESTINON TAB ............... 27 MESTINON TIMESPAN ... 27 METADATE CD ................ 25

see methylphenidate hcl 25 metadate tab 20mg er ....... 25 METANX ........................... 52 metformin er ..................... 30 metformin hcl .................... 30 methadone hcl .................... 3 METHADONE INJ 10MG/ML............................................ 3


70

METHADOSE .....................3 see methadone hcl ..........3

methazolamide .................. 18 methenamine hippurate ......5 METHERGINE

see methylergonovine maleate.......................... 34

methimazole ...................... 35 methocarbamol ................. 28 methotrexate sodium inj .... 11 methotrexate sodium tabs . 40 methoxsalen rapid ............. 48 methscopolamine bromide 36 methyclothiazide ............... 18 methylergonovine maleate 34 METHYLIN ........................ 25

see methylphenidate hcl 25 METHYLIN CHEW TAB .... 25 methylphenidate hcl .......... 25 methylphenidate hcl er ...... 25 METHYLPHENIDATE HCL ER ..................................... 25 methylphenidate tab 10mg er .......................................... 25 methylphenidate tab 20mg er .......................................... 25 methylprednisolone ........... 34 methylprednisolone acetate .......................................... 34 methylprednisolone sod succ .......................................... 34 metipranolol ...................... 45 metoclopramide hcl ........... 35 metoclopramide hcl inj 5 mg/ml ................................ 35 metolazone ....................... 18 metoprolol & hctz tab 100-25mg .......................... 16 metoprolol & hctz tab 100-50mg .......................... 16 metoprolol & hctz tab 50-25mg ............................ 16 metoprolol succinate ......... 16 metoprolol tartrate ....... 16, 17 METOZOLV ODT .............. 35 METRO IV ...........................5 METROCREAM ................ 51

see metronidazole

(topical) ......................... 51 see rosadan cre 0.75% . 51

METROGEL ...................... 51 see metronidazole (topical) ......................... 51

METROGEL-VAGINAL ..... 39 see metronidazole vaginal ...................................... 39

METROLOTION ............... 51 see metronidazole (topical) ......................... 51

metronidazole ..................... 5 metronidazole (topical)...... 51 metronidazole inj ................. 5 metronidazole vaginal ....... 39 MEVACOR ........................ 15

see lovastatin ................ 15 mexiletine hcl .................... 15 MIACALCIN

see calcitonin (salmon) nasal spray .................... 34

MIACALCIN INJ 200U/ML 34 MIACALCIN SPR 200/ACT .......................................... 34 MICARDIS ........................ 15 MICARDIS HCT ................ 14 miconazole nitrate vaginal 39 microgestin 1.5/30 21 day . 31 microgestin 1/20 21 day .... 31 microgestin fe 1.5/30 28 day .......................................... 31 microgestin fe 1/20 28 day 32 MICRO-K .......................... 42

see potassium chloride caps er .......................... 42

MICROZIDE ...................... 18 see hydrochlorothiazide 18

midodrine hcl .................... 19 migergot ............................ 26 MIGRANAL ....................... 26 millipred ............................ 34 mimvey lo 28 day .............. 33 MINASTRIN 24 FE ........... 32 MINIPRESS ...................... 14

see prazosin hcl ............ 14 minitran ............................. 19 MINIVELLE ....................... 33 MINOCIN .......................... 10

see minocycline hcl ....... 10 MINOCIN KIT ................... 10 minocycline hcl ........... 10, 11 minoxidil ............................ 19 MIRAPEX ......................... 23

see pramipexole dihydrochloride .............. 24

MIRAPEX ER ................... 23 MIRCETTE

see kariva 28 day .......... 31 see pimtrea pack ........... 32 see viorele ..................... 32

mirtazapine ....................... 22 misoprostol ....................... 37 mitomycin ......................... 11 mitoxantrone hcl ............... 13 M-M-R II W/DILUENT 10 DOS .................................. 41 MOBIC ................................ 1

see meloxicam tabs ........ 1 modafinil ........................... 28 moderiba pak ...................... 8 moderiba tab 200mg ........... 8 MODICON ........................ 32 moexipril hcl ...................... 14 moexipril-hydrochlorothiazide........................................ 13 mometasone furoate ......... 50 MONODOX

see doxycycline (monohydrate) ............... 10

MONONESSA .................. 32 montelukast sodium .......... 46 MORPHINE SUL 20MG/ML ORAL SOL .......................... 3 morphine sulfate ................. 3 MORPHINE SULFATE ....... 3 morphine sulfate beads cap sr ......................................... 3 morphine sulfate ext-rel tab 3 morphine sulfate inj ............. 3 MORPHINE SULFATE INJ . 3 MOVIPREP ....................... 37 MOXATAG ........................ 10 MOXEZA .......................... 44 moxifloxacin hcl .................. 9 MOZOBIL ......................... 39 MS CONTIN ....................... 3


71

see morphine sulfate ext-rel tab ........................3

MULTAQ ........................... 15 mupirocin .......................... 48 mupirocin calcium (topical) 48 MUSE ............................... 52 MUSTARGEN ................... 11 my way .............................. 32 MYAMBUTOL .....................7

see ethambutol hcl ..........7 MYCAMINE .........................6 MYCOBUTIN ......................7

see rifabutin .....................7 mycophenolate mofetil ...... 41 mycophenolate sodium ..... 41 MYFORTIC ....................... 41

see mycophenolate sodium ........................... 41

myorisan ........................... 47 MYOZYME ........................ 33 MYRBETRIQ ..................... 38 MYSOLINE ....................... 21

see primidone ................ 21 myzilra .............................. 32 N nabumetone ........................1 nadolol .............................. 17 nadolol & bendroflumethiazide .......... 16 nafcillin sodium ................. 10 NAFTIN ............................. 48 NAGLAZYME .................... 33 NALFON .............................1 NALLPEN ISO-OSMOTIC IN DE ..................................... 10 NALLPEN/DEXTROSE ..... 10 naloxone hcl ...................... 28 naltrexone hcl .................... 28 NAMENDA ........................ 22 NAMENDA TITRATION PAK .......................................... 22 NAMENDA XR .................. 22 NAMENDA XR TITRATION PACK ................................ 22 NAPRELAN .........................1 NAPROSYN ........................1

see naproxen ...................1 naproxen .............................1

naproxen sodium ................ 1 naratriptan hcl ................... 26 NARDIL ............................. 22

see phenelzine sulfate ... 23 NASACORT AQ ................ 47 NASONEX ........................ 47 NATACYN ......................... 44 nateglinide ........................ 30 NAVANE ........................... 24 NAVELBINE

see vinorelbine tartrate .. 12 NEBUPENT ........................ 5 necon 0.5/35 28 day ......... 32 necon 1/35 28 day ............ 32 NECON 1/50-28 ................ 32 necon 10/11 28 day .......... 32 NECON 7/7/7 .................... 32 nefazodone hcl ................. 22 neomycin sulfate ................. 4 neomycin/polymyxin b gu .. 51 neomycin-bacitracin zn-polymyxin ..................... 44 neomycin-polymy-dexameth .......................................... 43 neomycin-polymy-gramicid .......................................... 44 neomycin-polymyxin-hc (ophth) .............................. 44 neomycin-polymyxin-hc (otic) .................................... 51, 52 NEORAL ........................... 41

see cyclosporine modified (for microemulsion)........ 41 see gengraf ................... 41

NEOSPORIN see neomycin-polymy-gramicid ...................................... 44

NEOSPORIN GU IRRIGANT see neomycin/polymyxin b gu .................................. 51

neosporin solution ............. 44 NEPHRAMINE .................. 42 NEPTAZANE

see methazolamide ....... 18 NESINA ............................ 30 NEULASTA ....................... 39 NEUMEGA ........................ 39

NEUPOGEN ..................... 39 NEUPRO .......................... 23 NEURONTIN .................... 21

see gabapentin.............. 20 NEVANAC ........................ 45 nevirapine ........................... 7 NEVIRAPINE ...................... 7 NEXAVAR ........................ 12 NEXIUM ............................ 38 NEXIUM GRANULES 10MG DR .................................... 38 NEXIUM GRANULES 2.5MG DR .................................... 38 NEXIUM GRANULES 20MG DR .................................... 38 NEXIUM GRANULES 40MG DR .................................... 38 NEXIUM GRANULES 5MG DR .................................... 38 NEXIUM I.V. ..................... 38

see esomeprazole sodium inj .................................. 38

next choice tab 1.5mg ....... 32 niacin er ............................ 16 niacor ................................ 16 NIASPAN .......................... 16

see niacin er .................. 16 nicardipine hcl ................... 17 NICOTROL INHALER ....... 28 NICOTROL NS ................. 28 nifedical ............................ 17 nifedipine .......................... 17 nifedipine er ...................... 17 NILANDRON .................... 12 nimodipine ........................ 17 NIPENT ............................ 11 nisoldipine ......................... 17 nitro-bid ............................. 19 NITRO-DUR ..................... 19

see minitran .................. 19 nitrofurantoin ....................... 5 nitrofurantoin macrocrystal . 5 nitrofurantoin monohyd macro .................................. 5 NITROGLYCERIN ............ 19 NITROGLYCERIN LINGUAL.......................................... 19 nitroglycerin patches ......... 19


72

NITROLINGUAL SPR PUMPSPRA ...................... 19 NITROMIST ...................... 19 NITROSTAT ...................... 19 nizatidine ........................... 36 NIZORAL .......................... 49

see ketoconazole shampoo ........................ 49

NORA-BE.......................... 32 NORCO

see hydrocodone-acetaminophen 5-325mg .....................2 see hydrocodone-acetaminophen 7.5-325mg ..................2 see hydrocodone-acetaminophen tab 10-325mg .............2 see lorcet .........................2 see lorcet plus tab 7.5-325 ........................................2 see lortab .........................2

norco 10/325 .......................2 norco 5/325 .........................2 norco 7.5/325 ......................2 NORDITROPIN FLEXPRO .......................................... 34 NORDITROPIN NORDIFLEX PEN ............. 34 norethindrone (contraceptive) .................. 32 norethindrone acetate ....... 35 norgestimate-ethinyl estradiol (triphasic) ............ 32 NORINYL 1+35 ................. 32

see cyclafem 1/35 28 day ...................................... 31 see necon 1/35 28 day .. 32 see nortrel 1/35 21 day .. 32 see nortrel 1/35 28 day .. 32 see pirmella 1/35 28 day ...................................... 32

NORINYL 1+50 ................. 32 NORITATE ........................ 51 normosol-m ....................... 43 NORMOSOL-R ................. 43 NOROXIN ...........................9

NORPACE ........................ 15 see disopyramide phosphate ..................... 15

NORPACE CR .................. 15 NORPRAMIN .................... 22

see desipramine hcl ...... 22 NOR-QD ........................... 32

see camila 28 day ......... 31 see heather tab 0.35mg 31 see norethindrone (contraceptive) .............. 32

nortrel 0.5/35 28 day ......... 32 nortrel 1/35 21 day ............ 32 nortrel 1/35 28 day ............ 32 nortrel 7/7/7 28 day ........... 32 nortriptyline hcl ............ 22, 23 NORVASC ........................ 17

see amlodipine besylate 17 NORVIR .............................. 7 NOVAREL INJ 10000UNT 34 NOVOLIN 70/30 ................ 29 NOVOLIN 70/30 RELION . 29 NOVOLIN N ...................... 29 NOVOLIN N RELION ........ 29 NOVOLIN R ...................... 29 NOVOLIN R RELION ........ 29 NOVOLOG ........................ 29 NOVOLOG FLEXPEN ...... 29 NOVOLOG MIX 70/30 ...... 29 NOVOLOG MIX 70/30 PREFILL ........................... 29 NOVOLOG PENFILL ........ 29 NOXAFIL ............................ 6 NUCYNTA .......................... 4 NUCYNTA ER .................... 4 NUEDEXTA ...................... 27 NULOJIX ........................... 41 NULYTELY/FLAVOR PACKS .............................. 37

see gavilyte-n ................ 37 see peg 3350-potassium chloride-sod bicarbonate-sod chloride ...................................... 37 see trilyte ....................... 37

NUTROPIN ....................... 34 NUTROPIN AQ NUSPIN 5 34 NUTROPIN AQ PEN......... 34

NUVARING ....................... 32 NUVIGIL ........................... 28 nyamyc ............................. 48 NYMALIZE ........................ 17 nystatin ............................... 6 nystatin (mouth-throat) ...... 51 nystatin (topical)................ 48 nystatin pow 100000 ......... 48 nystop ............................... 48 O OCELLA ........................... 32 OCTAGAM ....................... 40 octreotide acetate ............. 34 OCUFEN .......................... 45

see flurbiprofen sodium . 44 OCUFLOX ........................ 44

see ofloxacin (ophth) ..... 44 ofloxacin (ophth) ............... 44 ofloxacin (otic) .................. 52 ogestrel 28 day ................. 32 olanzapine ........................ 24 olanzapine odt .................. 24 OLEPTRO ........................ 23 OLUX ................................ 50


OLUX-E ............................ 50 see clobetasol propionate emulsion ........................ 49

OLYSIO .............................. 8 OMECLAMOX-PAK .......... 37 omega-3-acid ethyl esters 16 omeprazole ....................... 38 OMNARIS ......................... 47 OMNIPRED ...................... 45 OMNITROPE 10MG ......... 34 OMNITROPE 5.8MG ........ 34 OMNITROPE 5MG ........... 34 ondansetron hcl ................ 35 ondansetron hcl inj............ 36 ondansetron hcl oral soln .. 36 ondansetron odt ................ 36 ONFI ................................. 21 ONGLYZA ........................ 30 ONMEL ............................... 6 OPANA ............................... 4

see oxymorphone hcl ...... 4 OPANA ER (CRUSH


73

RESISTANT ........................4 OPSUMIT.......................... 19 OPTIPRANOLOL .............. 45 OPTIVAR .......................... 45

see azelastine hcl (ophth) ...................................... 45

ORACEA ........................... 51 ORAP ................................ 24 orapred ............................. 34 ORAPRED ODT ................ 34 ORENCIA.......................... 40 ORENITRAM .................... 19 ORFADIN .......................... 33 orsythia 28 day .................. 32 ORTHO EVRA .................. 32

see xulane ..................... 32 ORTHO MICRONOR ........ 32

see errin 28 day ............. 31 see lyza ......................... 31

ORTHO TRI-CYCLEN see norgestimate-ethinyl estradiol (triphasic) ........ 32 see tri-previfem 28 day .. 32 see tri-sprintec 28 day ... 32

ORTHO TRI-CYCLEN LO . 32 ORTHO-CEPT .................. 32 ORTHO-CYCLEN ............. 32

see previfem 28 day ...... 32 see sprintec 28 day ....... 32

ORTHO-NOVUM 1/35 ...... 32 ORTHO-NOVUM 7/7/7 ..... 32

see cyclafem 7/7/7 28 day ...................................... 31 see nortrel 7/7/7 28 day . 32

OSENI TAB 12.5-15MG .... 30 OSENI TAB 12.5-30MG .... 30 OSENI TAB 12.5-45MG .... 30 OSENI TAB 25-15MG ....... 30 OSENI TAB 25-30MG ....... 30 OSENI TAB 25-45MG ....... 30 OSMOPREP ..................... 37 OTEZLA ............................ 40 ovcon 35 28 day ................ 32 OVCON-35

see balziva 28 day ......... 30 see briellyn 28 day ........ 31 see gildagia ................... 31 see philith ...................... 32

see vyfemla ................... 32 see zenchent 28 day ..... 32

OVIDE ............................... 51 see malathion ................ 51

oxacillin sodium ................ 10 oxaliplatin .......................... 13 OXANDRIN

see oxandrolone ............ 28 oxandrolone ...................... 28 oxaprozin ............................ 1 oxcarbazepine .................. 21 OXECTA ............................. 4 OXISTAT .......................... 48 OXSORALEN ................... 51 OXSORALEN ULTRA ....... 49

see methoxsalen rapid .. 48 OXTELLAR XR ................. 21 oxybutynin chloride ........... 38 oxycodone hcl ..................... 4 OXYCODONE HCL ............ 4 oxycodone w/ acetaminophen 10-325mg .. 4 oxycodone w/ acetaminophen 2.5-325mg . 4 oxycodone w/ acetaminophen 5-325mg .... 4 oxycodone w/ acetaminophen 7.5-325mg . 4 oxycodone-aspirin ............... 4 oxycodone-ibuprofen .......... 4 OXYCONTIN ...................... 4 oxymorphone hcl ................ 4 OXYTROL ......................... 38 P pacerone ........................... 15 paclitaxel ........................... 12 PAMELOR ........................ 23

see nortriptyline hcl ....... 22 pamidronate disodium....... 30 PAMINE ............................ 36

see methscopolamine bromide ......................... 36

PAMINE FORTE ............... 36 see methscopolamine bromide ......................... 36

PANCREAZE .................... 38 PANDEL ........................... 50 PANRETIN ........................ 51

pantoprazole sodium ........ 38 PARAFON FORTE DSC ... 28

see chlorzoxazone ........ 28 parcopa 10/100 ................. 23 parcopa 25/100 ................. 23 parcopa 25/250 ................. 23 paricalcitol ......................... 43 PARLODEL ...................... 23

see bromocriptine mesylate ........................ 23

PARNATE ......................... 23 see tranylcypromine sulfate ........................... 23

paromomycin sulfate ........... 4 paroxetine er tab ............... 23 paroxetine hcl ................... 23 paser d/r ............................. 7 PATADAY ......................... 45 PATANASE ...................... 46 PATANOL ......................... 45 PAXIL ............................... 23

see paroxetine hcl ......... 23 PAXIL CR ......................... 23

see paroxetine er tab .... 23 PCE .................................... 9 pediapred .......................... 34 PEDIAPRED

see prednisolone sodium phosphate ..................... 34

pedi-dri .............................. 48 PEDVAX HIB .................... 41 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ........... 37 PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE.......................................... 37 peg 3350-potassium chloride-sod bicarbonate-sod chloride ............................. 37 PEGANONE ..................... 21 PEGASYS ........................ 40 PEGASYS PROCLICK ..... 40 PEG-INTRON ................... 40 PEG-INTRON REDIPEN .. 40 PENICILLIN G POT IN DEXTROSE ...................... 10 penicillin g potassium ........ 10


74

PENICILLIN G POTASSIUM .......................................... 10 penicillin g procaine .......... 10 penicillin g sodium ............. 10 penicillin v potassium ........ 10 PENNSAID ........................ 51

see diclofenac sodium (topical).......................... 51

PENTAM 300 ......................5 PENTASA ......................... 37 pentoxifylline ..................... 39 PEPCID............................. 36

see famotidine ............... 36 PERCOCET

see endocet 10/325 .........3 see endocet 5/325 ...........3 see endocet 7.5/325 ........3 see oxycodone w/ acetaminophen 10-325mg ........................................4 see oxycodone w/ acetaminophen 2.5-325mg ........................................4 see oxycodone w/ acetaminophen 5-325mg .4 see oxycodone w/ acetaminophen 7.5-325mg ........................................4 see roxicet tab 5-325mg ..4

percocet 10/325 ..................4 percocet 2.5/325 .................4 percocet 5/325 ....................4 percocet 7.5/325 .................4 PERCODAN ........................4

see oxycodone-aspirin ....4 PERFOROMIST ................ 46 PERIDEX

see chlorhexidine gluconate (mouth-throat) ...................................... 51 see periogard sol 0.12% 51

perindopril erbumine ......... 14 periogard sol 0.12% .......... 51 permethrin ......................... 51 perphenazine .................... 24 PERSANTINE ................... 40

see dipyridamole ........... 40 PERTZYE ......................... 38

PEXEVA ........................... 23 pfizerpen ........................... 10 phenadoz .......................... 36 phendimetrazine ............... 52 phenelzine sulfate ............. 23 phenergan ......................... 36 PHENERGAN

see promethazine hcl .... 36 phenobarbital .................... 21 phenobarbital sodium........ 21 PHENOBARBITAL SODIUM .......................................... 21 phentermine ...................... 52 phenytek ........................... 21 PHENYTEK

see phenytoin sodium extended ....................... 21

phenytoin .......................... 21 phenytoin inj 50mg/ml ....... 21 phenytoin sodium extended .......................................... 21 philith ................................ 32 PHISOHEX ....................... 48 PHOSLO ........................... 35

see calcium acetate (phosphate binder) ........ 35

PHOSLYRA ...................... 35 PHOSPHOLINE IODIDE ... 45 PICATO ............................ 48 PILOCARPINE HCL.......... 45 pilocarpine hcl (oral).......... 51 pimtrea pack ..................... 32 pindolol ............................. 17 pioglitazone hcl ................. 30 pioglitazone hcl-glimepiride .......................................... 30 pioglitazone hcl-metformin hcl ..................................... 30 piperacillin sodium-tazobactam sodium .......................................... 10 pirmella 1/35 28 day ......... 32 piroxicam ............................ 1 PLAN B

see levonorgestrel (emergency oc) ............. 31

PLAN B ONE-STEP see levonorgestrel

(emergency oc) ............. 31 see my way ................... 32 see next choice tab 1.5mg ...................................... 32

PLAQUENIL ..................... 40 see hydroxychloroquine sulfate ........................... 40

PLASMA-LYTE A.............. 43 PLASMA-LYTE-148 .......... 43 PLASMA-LYTE-56/D5W ... 43 PLAVIX ............................. 40

see clopidogrel bisulfate 40 PLETAL ............................ 39

see cilostazol................. 39 podofilox ........................... 51 polyethylene glycol 3350 .. 37 polymyxin b sulfate ............. 5 polymyxin b-trimethoprim .. 44 POLYTRIM ....................... 44

see polymyxin b-trimethoprim ............... 44

POMALYST CAP .............. 13 PONSTEL ........................... 1

see mefenamic acid ........ 1 portia 28 day ..................... 32 potassium chloride ...... 42, 43 POTASSIUM CHLORIDE 42, 43 POTASSIUM CHLORIDE 0.15% ............................... 43 POTASSIUM CHLORIDE 0.22% ............................... 43 POTASSIUM CHLORIDE 0.3%/D .............................. 43 potassium chloride caps er.......................................... 42 POTASSIUM CHLORIDE INJ 30 MEQ/100 ML ......... 43 potassium chloride microencapsulated crystals cr ....................................... 42 POTASSIUM CITRATE (ALKALINIZER) ................ 38 POTIGA ............................ 21 PRADAXA ........................ 39 pramipexole dihydrochloride.................................... 23, 24 PRANDIMET .................... 30


75

PRANDIN .......................... 30 see repaglinide .............. 30

PRAVACHOL .................... 15 see pravastatin sodium.. 15

pravastatin sodium ............ 15 prazosin hcl ....................... 14 PRECOSE ........................ 30

see acarbose ................. 29 PRED FORTE ................... 45 PRED MILD ...................... 45 PRED-G ............................ 44 PRED-G S.O.P. ................ 44 prednicarbate .................... 50 PREDNICARBATE ........... 50 prednisolone ..................... 34 PREDNISOLONE ACETATE .......................................... 45 prednisolone sodium phosphate ......................... 34 prednisolone sodium phosphate (ophth) ............. 45 prednisone ........................ 34 PREGNYL W/DILUENT BENZYL ............................ 34 PRELONE

see prednisolone ........... 34 PREMARIN ....................... 33 PREMARIN CREAM ......... 33 PREMARIN INJ ................. 33 premasol 10% ................... 42 premasol 6% ..................... 42 PREMPHASE ................... 33 PREMPRO ........................ 33 PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) .......................................... 43 PREPOPIK ........................ 37 PREVACID ........................ 38

see lansoprazole ........... 38 PREVACID SOLUTAB ...... 38 prevalite ............................ 16 previfem 28 day ................ 32 PREVPAC ......................... 37

see amoxicillin-clarithromycin w/ lansoprazole ............. 37

PREZISTA ..........................7 PRIFTIN ..............................7

PRILOSEC ........................ 38 see omeprazole ............. 38

PRIMAQUINE PHOSPHATE ............................................ 6 PRIMAXIN .......................... 5 PRIMAXIN IV

see imipenem-cilastatin ... 5 primidone .......................... 21 PRIMSOL SOL 50MG/5ML . 5 PRINIVIL ........................... 14

see lisinopril .................. 14 PRISTIQ ........................... 23 PRIVIGEN ......................... 40 PROAIR HFA .................... 46 probenecid .......................... 1 PROCALAMINE ................ 42 PROCARDIA XL ............... 17

see nifedical .................. 17 see nifedipine er ............ 17

prochlorperazine inj 5 mg/ml .......................................... 36 prochlorperazine maleate . 36 prochlorperazine supp ...... 36 PROCRIT .......................... 39 proctocream ...................... 48 procto-pak ......................... 48 proctozone hc ................... 48 PROCYSBI ....................... 33 progesterone micronized .. 35 PROGLYCEM ................... 34 PROGRAF ........................ 41

see tacrolimus ............... 41 PROLASTIN-C .................. 46 PROLENSA ...................... 45 PROLEUKIN ..................... 12 PROLIA ............................. 34 PROMACTA ..................... 39 promethazine dm .............. 52 promethazine hcl .............. 36 promethazine vc ............... 52 promethazine/codeine....... 52 promethegan ..................... 36 PROMETRIUM ................. 35

see progesterone micronized ..................... 35

propafenone hcl ................ 15 proparacaine hcl ............... 45 propranolol &

hydrochlorothiazide ........... 16 propranolol hcl er .............. 17 propranolol inj 1mg/ml ...... 17 propranolol sol .................. 17 propranolol tab .................. 17 propylthiouracil ................. 35 PROQUAD ....................... 41 PROSCAR ........................ 38

see finasteride ............... 38 PROSOL ........................... 42 PROTONIX ....................... 38

see pantoprazole sodium ...................................... 38

PROTONIX INJ................. 38 PROTOPIC ....................... 51 protriptyline hcl ................. 23 PROVENTIL HFA ............. 46 PROVERA ........................ 35

see medroxyprogesterone acetate .......................... 35

PROVIGIL ......................... 28 see modafinil ................. 28

PROZAC ........................... 23 see fluoxetine hcl .......... 22

PROZAC WEEKLY ........... 23 see fluoxetine hcl .......... 22

PRUDOXIN CRE 5% ........ 48 PULMICORT

see budesonide (inhalation) .................... 47

PULMICORT FLEXHALER.......................................... 47 PULMICORT INH SUSP ... 47 PULMOZYME ................... 46 PURINETHOL .................. 11

see mercaptopurine ...... 11 PYLERA ........................... 37 pyrazinamide ...................... 7 pyridostigmine bromide ..... 27 Q QNASL ............................. 47 QUALAQUIN ...................... 6

see quinine sulfate .......... 6 QUARTETTE .................... 32 quasense 91 day .............. 32 QUDEXY XR .................... 21 questran ............................ 16 QUESTRAN


76

see cholestyramine ....... 15 questran light .................... 16 QUESTRAN LIGHT

see prevalite .................. 16 quetiapine fumarate .......... 24 QUILLIVANT XR ............... 25 quinapril hcl ....................... 14 quinapril-hydrochlorothiazide .......................................... 13 quinidine gluconate er ....... 15 quinidine sulfate ................ 15 quinine sulfate .....................6 QVAR ................................ 47 R RABAVERT ....................... 41 rabeprazole sodium .......... 38 RAGWITEK ....................... 40 raloxifene hcl ..................... 35 ramipril .............................. 14 RANEXA ........................... 19 ranitidine hcl ...................... 36 RAPAFLO ......................... 38 RAPAMUNE ...................... 41

see sirolimus tab 0.5 mg 41 RAYOS ............................. 34 RAZADYNE ...................... 22

see galantamine hydrobromide ................ 22

RAZADYNE ER ................ 22 see galantamine hydrobromide ................ 22

REBETOL ...........................8 see ribasphere .................8 see ribavirin 200mg .........8

REBIF ............................... 27 REBIF TITRATION PACK . 27 reclipsen 28 day ................ 32 RECOMBIVAX HB ............ 41 RECTIV ............................. 51 REGLAN ........................... 36

see metoclopramide hcl. 35 REGRANEX ...................... 51 RELENZA DISKHALER ......8 RELISTOR ........................ 37 RELPAX ............................ 26 REMERON ........................ 23

see mirtazapine ............. 22 REMERON SOLTAB ........ 23

see mirtazapine ............. 22 REMICADE ....................... 40 REMODULIN .................... 19 RENAGEL ......................... 35 RENVELA ......................... 35 repaglinide ........................ 30 REPREXAIN

see hydrocodone-ibuprofen 2.5-200mg ....................... 2 see ibudone tab 5-200mg 2

reprexain 10/200 ................. 2 reprexain 2.5/200 ................ 2 reprexain 5/200 ................... 2 REQUIP ............................ 24

see ropinirole hydrochloride ................. 24

REQUIP XL ....................... 24 see ropinirole hydrochloride ................. 24

RESCRIPTOR .................... 7 RESTASIS ........................ 45 RESTORIL ........................ 26

see temazepam ............. 26 RETIN-A ........................... 48

see tretinoin ................... 48 RETIN-A MICRO .............. 48 RETIN-A MICRO PUMP ... 48 RETROVIR

see zidovudine ................ 7 RETROVIR CAPS .............. 7 RETROVIR IV INFUSION ... 7 RETROVIR SYRP .............. 7 REVATIO .......................... 19

see sildenafil citrate (pulmonary hypertension) ...................................... 19

revia .................................. 28 REVIA

see naltrexone hcl ......... 28 REVLIMID ......................... 40 REYATAZ ........................... 7 RHEUMATREX ................. 40 RHINOCORT AQUA ......... 47

see budesonide (nasal) . 47 ribapak mis 600/day ............ 8 ribasphere ........................... 8 ribasphere ribapak 1000 ..... 8

ribasphere ribapak 1200 ..... 8 ribasphere ribapak 800 ....... 8 ribavirin 200mg ................... 8 rifabutin ............................... 7 rifadin .................................. 7 RIFADIN ............................. 7

see rifampin .................... 7 rifamate ............................... 7 rifampin ............................... 7 RIFATER ............................ 7 RILUTEK .......................... 27

see riluzole .................... 27 riluzole .............................. 27 rimantadine hydrochloride .. 8 RINGER'S ......................... 43 RIOMET ............................ 30 risedronate sodium ........... 30 RISPERDAL ..................... 24

see risperidone.............. 24 RISPERDAL CONSTA ..... 24 RISPERDAL M-TAB ......... 24

see risperidone odt ........ 24 risperidone ........................ 24 risperidone odt .................. 24 RITALIN ............................ 25

see methylphenidate hcl 25 RITALIN LA ...................... 25

see methylphenidate hcl 25 RITALIN SR ...................... 25

see metadate tab 20mg er ...................................... 25 see methylphenidate tab 20mg er ......................... 25

RITUXAN .......................... 12 rivastigmine tartrate .......... 22 rizatriptan benzoate .......... 26 ROBAXIN

see methocarbamol ....... 28 ROBAXIN-750

see methocarbamol ....... 28 ROBINUL .......................... 36

see glycopyrrolate ......... 36 ROBINUL FORTE ............. 36

see glycopyrrolate ......... 36 ROCALTROL .................... 43

see calcitriol .................. 43 rocephin .............................. 9 ROCEPHIN


77

see ceftriaxone sodium....8 ropinirole hydrochloride ..... 24 rosadan cre 0.75% ............ 51 ROTARIX .......................... 41 ROTATEQ ......................... 41 ROWASA .......................... 37

see mesalamine enema kit ...................................... 37

roxicet .................................4 roxicet tab 5-325mg ............4 ROXICODONE ...................4

see oxycodone hcl ...........4 ROZEREM ........................ 26 RYTHMOL ........................ 15

see propafenone hcl ...... 15 RYTHMOL SR .................. 15

see propafenone hcl ...... 15 S SABRIL ............................. 21 SAIZEN ............................. 34 SAIZEN CLICK.EASY ....... 34 SALAGEN ......................... 51

see pilocarpine hcl (oral) ...................................... 51

salsalate ............................ 52 SAMSCA ........................... 34 SANCTURA ...................... 38 SANCTURA XR ................ 38 SANCUSO ........................ 36 SANDIMMUNE

see cyclosporine ............ 41 SANDIMMUNE CAPS ....... 41 SANDIMMUNE INJ ........... 41 SANDIMMUNE SOLN ....... 41 SANDOSTATIN ................ 34

see octreotide acetate ... 34 SANDOSTATIN LAR DEPOT ............................. 34 SANTYL ............................ 51 SAPHRIS .......................... 24 SARAFEM ......................... 28 SAVELLA .......................... 27 SAVELLA TITRATION PACK ................................ 27 SEASONIQUE .................. 32

see amethia 91 day ....... 30 SECTRAL ......................... 17

see acebutolol hcl .......... 16

selegiline hcl ..................... 24 selenium sulfide ................ 49 SELZENTRY ....................... 7 SEMPREX-D .................... 46 SENSIPAR ........................ 30 SEREVENT DISKUS ........ 46 seromycin ........................... 7 SEROQUEL ...................... 24

see quetiapine fumarate 24 SEROQUEL XR ................ 24 SEROSTIM ....................... 34 sertraline hcl ..................... 23 SFROWASA ..................... 37 SIGNIFOR ........................ 34 sildenafil citrate (pulmonary hypertension) .................... 19 SILENOR .......................... 26 SILVADENE ...................... 48 SILVER SULFADIAZINE .. 48 SIMBRINZA ...................... 45 SIMCOR ........................... 16 SIMPONI ........................... 40 SIMPONI ARIA ................. 40 SIMULECT ........................ 41 simvastatin ........................ 15 SINEMET .......................... 24

see carbidopa-levodopa 23 SINEMET CR .................... 24

see carbidopa-levodopa 23 SINGULAIR ...................... 46

see montelukast sodium 46 sirolimus tab 0.5 mg .......... 41 SIRTURO ............................ 7 SIVEXTRO .......................... 5 SKLICE ............................. 51 SOD FLUORIDE 2.2MG TAB ................................... 42 SODIUM CHLORIDE .. 42, 43 SODIUM CHLORIDE 0.45% VIA .................................... 43 SODIUM CHLORIDE 0.9% .......................................... 51 SODIUM DIURIL ............... 18 sodium phenylbutyrate ...... 33 sodium polystyrene sulfonate .......................................... 30 SOLARAZE ....................... 48

see diclofenac sodium

(actinic keratoses) ......... 48 SOLIA ............................... 32 SOLODYN ........................ 11 SOLTAMOX ...................... 12 SOLU-CORTEF 1000MG . 34 SOLU-CORTEF 100MG ... 34 SOLU-CORTEF 250MG ... 34 SOLU-CORTEF 500MG ... 34 SOLU-MEDROL ............... 34

see methylprednisolone sod succ ........................ 34

SOMA ............................... 28 see carisoprodol ............ 28

SOMATULINE DEPOT ..... 34 SOMAVERT ..................... 34 SONATA ........................... 26

see zaleplon .................. 26 SORIATANE ..................... 49

see acitretin ................... 48 SORILUX .......................... 49 sorine ................................ 15 sotalol hcl .......................... 15 sotalol hcl (afib/afl) ............ 15 SOVALDI ............................ 8 SPIRIVA HANDIHALER ... 45 spironolactone .................. 14 spironolactone & hydrochlorothiazide ........... 18 SPORANOX ....................... 6

see itraconazole .............. 6 SPORANOX PULSEPAK ... 6 SPORANOX SOL 10MG/ML............................................ 6 sprintec 28 day ................. 32 SPRYCEL ......................... 12 sps sus 15gm/60ml ........... 30 sronyx 28 day ................... 32 SSD .................................. 48 STALEVO ......................... 24 STARLIX ........................... 30

see nateglinide .............. 30 stavudine ............................ 7 STAVZOR ......................... 21 STAXYN ........................... 52 STELARA ......................... 49 STERILE WATER IRRIGATION ..................... 51 STIMATE .......................... 35


78

STIVARGA ........................ 12 STRATTERA ..................... 25 streptomycin sulfate ............4 STRIANT........................... 28 STRIBILD ............................7 STROMECTOL ...................5 SUBOXONE MIS 12-3MG 28 SUBOXONE MIS 2-0.5MG .......................................... 28 SUBOXONE MIS 4-1MG .. 28 SUBOXONE MIS 8-2MG .. 28 SUBSYS .............................4 SUCLEAR ......................... 37 SUCRAID .......................... 37 sucralfate .......................... 37 SULAR .............................. 17

see nisoldipine ............... 17 sulfacetamide sodium (acne) .......................................... 48 sulfacetamide sodium (ophth) .............................. 44 sulfacetamide sod-prednisolone .............. 44 sulfadiazine .........................4 sulfamethoxazole-trimethoprim .........................................5 sulfamethoxazole-trimethoprim inj ....................................6 SULFAMYLON .................. 48

see mafenide acetate .... 48 sulfasalazine dr ................. 37 sulfasalazine ir .................. 37 sulindac ...............................1 sumatriptan succinate ....... 27 SUMATRIPTAN SUCCINATE ..................... 27 sumatriptan succinate inj .. 27 SUMATRIPTAN SUCCINATE INJ ............... 27 SUMAVEL DOSEPRO ...... 27 suprax .................................9 SUPRAX .............................9 SUPREP BOWEL PREP... 37 SURMONTIL ..................... 23 SUSTIVA.............................7 SUTENT............................ 13 syeda ................................ 32 SYLATRON ....................... 13

SYMBICORT .................... 47 SYMLINPEN 120 .............. 29 SYMLINPEN 60 ................ 29 SYNAGIS .......................... 41 SYNALAR ......................... 50

see fluocinolone acetonide ...................................... 50

SYNALGOS-DC .................. 2 SYNAREL ......................... 33 SYNERA ........................... 50 SYNERCID ......................... 6 SYNTHROID ..................... 35

see levothyroxine sodium ...................................... 35

SYPRINE .......................... 30 T TABLOID .......................... 11 TACLONEX ...................... 50

see calcipotriene-betamethasone dipropionate ............. 49

tacrolimus ......................... 41 TAFINLAR ........................ 13 TAMBOCOR ..................... 15 TAMIFLU ............................ 8 tamoxifen citrate ............... 12 tamsulosin hcl ................... 38 TANZEUM ........................ 29 tapazole ............................ 35 TAPAZOLE

see methimazole ........... 35 TARCEVA ......................... 13 TARGRETIN ............... 13, 51 TARKA .............................. 14 TASIGNA .......................... 13 TAXOTERE ...................... 12 tazicef vial ........................... 9 TAZORAC ......................... 49 taztia xt ............................. 17 TECFIDERA ..................... 27 TECFIDERA STARTER PACK ................................ 27 TEFLARO ........................... 9 TEGRETOL ...................... 21

see carbamazepine ....... 20 see epitol ....................... 20

TEGRETOL-XR ................ 21 see carbamazepine ....... 20

TEKAMLO ........................ 18 TEKTURNA ...................... 18 TEKTURNA HCT .............. 18 TELMISARTAN................. 15 telmisartan-amlodipine ...... 14 TELMISARTAN-HYDROCHLOROTHIAZIDE ................. 14 temazepam ....................... 26 TEMOVATE ...................... 50


TEMOVATE E .................. 50 see clobetasol propionate emollient base ............... 49

TENEX .............................. 19 see guanfacine hcl ........ 19

TENIVAC .......................... 41 TENORETIC ..................... 16 TENORETIC 100

see atenolol & chlorthalidone ................ 16

TENORETIC 50 see atenolol & chlorthalidone ................ 16

TENORMIN ...................... 17 see atenolol ................... 16

TERAZOL 3 ...................... 39 see terconazole vaginal 39

TERAZOL 7 ...................... 39 see terconazole vaginal 39 see zazole ..................... 39

terazosin hcl ..................... 14 terbinafine hcl ..................... 6 terbutaline sulfate ............. 46 terconazole vaginal ........... 39 TESSALON PERLES

see benzonatate............ 52 TESTIM ............................ 28 testosterone cypionate ...... 28 testosterone enanthate ..... 28 TETANUS TOXOID ADSORBED ..................... 41 TETANUS/DIPHTHERIA TOXOID ............................ 41 TETRACYCLINE HCL ...... 11 TEVETEN ......................... 15

see eprosartan mesylate ...................................... 15


79

TEVETEN HCT ................. 14 TEV-TROPIN .................... 34 texacort ............................. 50 THALOMID ....................... 40 theo-24 .............................. 47 theophylline ....................... 47 THERMAZENE ................. 48 thioridazine hcl .................. 24 thiothixene......................... 24 THYMOGLOBULIN ........... 41 tiagabine hcl ...................... 21 TIAZAC ............................. 17

see diltiazem hcl extended release beads ................ 17 see diltzac ..................... 17 see taztia xt ................... 17

TIKOSYN .......................... 15 TIMENTIN ......................... 10 TIMENTIN INJ 3.1GM ....... 10 timolol maleate .................. 17 timolol maleate (ophth) ..... 45 TIMOLOL MALEATE GEL 45 TIMOPTIC ......................... 45

see timolol maleate (ophth) ........................... 45

TIMOPTIC OCUDOSE ...... 45 TIMOPTIC-XE ................... 45 TIROSINT ......................... 35 TIVICAY ..............................7 tizanidine ........................... 28 TOBI

see tobramycin ................5 TOBI NEB ...........................4 TOBI PODHALER ...............4 TOBRADEX ...................... 44

see tobramycin-dexamethasone .................................... 44

TOBRADEX ST ................. 44 tobramycin ..........................5 tobramycin sulfate ...............5 tobramycin sulfate (ophth). 44 tobramycin sulfate in saline .5 tobramycin-dexamethasone .......................................... 44 TOBREX

see tobramycin sulfate (ophth) ........................... 44

TOBREX OINT 0.3% ........ 44 TOBREX SOL 0.3% OP .... 44 tofranil ............................... 23 TOFRANIL

see imipramine hcl ........ 22 TOFRANIL-PM ................. 23

see imipramine pamoate ...................................... 22

tolmetin sodium ................... 1 tolterodine tartrate ............. 38 TOLTERODINE TARTRATE ER ..................................... 38 TOPAMAX ........................ 21

see topiramate .............. 21 TOPAMAX SPRINKLE ...... 21

see topiramate .............. 21 topicort .............................. 50 TOPICORT ....................... 50

see desoximetasone ..... 49 topiramate ......................... 21 TOPIRAMATE ER ............ 21 toposar .............................. 13 topotecan hcl .................... 13 TOPROL XL ...................... 17

see metoprolol succinate ...................................... 16

TORISEL .......................... 12 torsemide inj ..................... 18 torsemide tabs .................. 18 TOVIAZ ............................. 39 TPN ELECTROLYTES ..... 42 TRACLEER ....................... 19 TRADJENTA ..................... 30 tramadol hcl er .................... 2 TRAMADOL HCL ER .......... 2 TRAMADOL HCL ER (BIPHASIC) 100MG ............ 2 TRAMADOL HCL ER (BIPHASIC) 200MG ............ 2 tramadol hcl er (biphasic) 300mg ................................. 2 tramadol hcl tab 50 mg ....... 2 tramadol-acetaminophen .... 2 TRANDATE ...................... 17

see labetalol hcl ............ 16 trandolapril ........................ 14 tranexamic acid ................. 39 TRANSDERM-SCOP ........ 36

TRANXENE T ................... 21 see clorazepate dipotassium ................... 20

tranylcypromine sulfate ..... 23 travasol 10 ........................ 42 TRAVATAN Z ................... 45 trazodone hcl .................... 23 TREANDA ........................ 11 TRECATOR ........................ 7 TRELSTAR DEPOT MIXJECT .......................... 12 TRELSTAR LA MIXJECT . 12 TRELSTAR MIXJECT ....... 12 tretin x ............................... 48 tretinoin ....................... 13, 48 TRETINOIN MICROSPHERE ............... 48 tretin-x ............................... 48 trexall ................................ 40 TREXIMET ....................... 27 triamcinolone acetonide (mouth) ............................. 51 triamcinolone acetonide (nasal) ............................... 47 triamcinolone acetonide (topical) ............................. 50 triamterene & hydrochlorothiazide ........... 18 triamterene & hydrochlorothiazide cap 37.5-25 mg ....................... 18 triamterene & hydrochlorothiazide tab 37.5-25 mg ....................... 18 triamterene & hydrochlorothiazide tab 75-50 mg .......................... 18 TRIBENZOR ..................... 14 TRICOR ............................ 16

see fenofibrate .............. 16 triderm .............................. 50 trifluoperazine hcl.............. 24 trifluridine .......................... 44 TRIGLIDE ......................... 16 trihexyphenidyl hcl ............ 24 tri-legest 28 day ................ 32 TRILEPTAL ...................... 21

see oxcarbazepine ........ 21


80

TRILEPTAL SUSP ............ 21 TRILIPIX ........................... 16

see choline fenofibrate .. 15 trilyte ................................. 37 trimethoprim ........................6 trimipramine maleate ........ 23 TRINESSA ........................ 32 TRI-NORINYL 28 .............. 32

see aranelle 28 .............. 30 TRIOSTAT ........................ 35

see liothyronine sodium . 35 tri-previfem 28 day ............ 32 TRISENOX ........................ 13 tri-sprintec 28 day ............. 32 trivora 28 day .................... 32 TRIZIVIR .............................7

see abacavir sulfate-lamivudine-zidovudine ...................................7

TROKENDI XR ................. 21 TROPHAMINE .................. 42 trospium chloride ............... 39 TRUSOPT ......................... 45

see dorzolamide hcl ...... 45 TRUVADA ...........................7 TUDORZA PRESSAIR ..... 46 TWINRIX ........................... 41 TWYNSTA ........................ 14

see telmisartan-amlodipine ...................................... 14

TYGACIL.............................6 TYKERB............................ 13 tylenol with codeine #3 ........2 tylenol with codeine #4 ........2 TYLENOL/CODEINE #3

see acetaminophen w/ codeine ............................1

TYLENOL/CODEINE #4 see acetaminophen w/ codeine ............................1

TYPHIM VI ........................ 41 TYSABRI........................... 27 TYZEKA ..............................8 tyzine ................................ 46 U UCERIS ............................ 37 u-cort ................................. 50 ULESFIA ........................... 51

ULORIC .............................. 1 ULTRACET ......................... 2

see tramadol-acetaminophen . 2

ULTRAM ............................. 2 see tramadol hcl tab 50 mg ................................... 2

ULTRAM ER ....................... 2 see tramadol hcl er .......... 2

ULTRAVATE ..................... 50 see halobetasol propionate ..................... 50

ULTRESA ......................... 38 UNASYN ........................... 10

see ampicillin & sulbactam sodium ........................... 10

UNASYN BULK PACK ...... 10 see ampicillin & sulbactam sodium ........................... 10

UNIRETIC ......................... 14 see moexipril-hydrochlorothiazide .................................. 13

UNITHROID ...................... 35 UNIVASC .......................... 14

see moexipril hcl ........... 14 urecholine ......................... 38 URECHOLINE

see bethanechol chloride ...................................... 38

UROCIT-K ........................ 38 UROXATRAL .................... 38

see alfuzosin hcl ............ 38 URSO 250 ........................ 37

see ursodiol ................... 37 URSO FORTE .................. 37

see ursodiol ................... 38 ursodiol ....................... 37, 38 UVADEX ........................... 13 V VAGIFEM .......................... 33 valacyclovir hcl .................... 8 VALCHLOR ...................... 51 VALCYTE ........................... 8 VALIUM ............................ 21

see diazepam ................ 20 valproate sodium .............. 21 valproic acid ...................... 21

valsartan ........................... 15 valsartan-hydrochlorothiazide........................................ 14 VALTREX ........................... 8

see valacyclovir hcl ......... 8 VANCOCIN HCL................. 6

see vancomycin hcl ......... 6 vancomycin hcl ................... 6 VANDAZOLE .................... 39 VANOS ............................. 50

see fluocinonide ............ 50 VAQTA ............................. 41 VARIVAX .......................... 41 VASCEPA ......................... 16 VASERETIC ..................... 14

see enalapril maleate & hydrochlorothiazide ....... 13

VASOTEC ........................ 14 see enalapril maleate .... 14

VECTIBIX ......................... 12 VECTICAL ........................ 49 VELCADE ......................... 12 velivet 28 day .................... 32 VELPHORO ...................... 35 VELTIN ............................. 48 venlafaxine cap er............. 23 VENLAFAXINE HCL ER

see venlafaxine tab er ... 23 VENLAFAXINE HCL ER TAB (VERT) ...................... 23 venlafaxine tab ................. 23 VENLAFAXINE TAB 225MG ER ..................................... 23 venlafaxine tab er ............. 23 VENTAVIS ........................ 19 VENTOLIN HFA................ 46 VERAMYST ...................... 47 verapamil hcl .............. 17, 18 VERAPAMIL HCL ............. 17 VERELAN ......................... 18

see verapamil hcl .......... 17 VERELAN PM .................. 18

see verapamil hcl .......... 17 veripred ............................. 34 VERSACLOZ .................... 24 VESICARE ....................... 39 vestura .............................. 32 VEXOL .............................. 45


81

VFEND ................................6 see voriconazole .............6

VFEND IV ...........................6 see voriconazole inj 200mg .............................6

VFEND SUS 40MG/ML .......6 VIAGRA ............................ 52 VIBATIV ..............................6 VIBRAMYCIN .................... 11

see doxycycline (monohydrate) ............... 10 see doxycycline hyclate . 10

vicodin .................................2 vicodin es ............................2 vicodin hp ............................3 VICOPROFEN ....................3

see hydrocodone-ibuprofen 7.5-200mg .......................2

VICTOZA .......................... 29 VICTRELIS .........................8 VIDAZA ............................. 11

see azacitidine ............... 11 VIDEX EC ...........................7

see didanosine ................6 VIDEX PEDIATRIC .............7 VIGAMOX ......................... 44 VIIBRYD............................ 23 VIMIZIM ............................ 33 VIMOVO..............................1 VIMPAT............................. 21 vinblastine sulfate ............. 12 vincasar............................. 12 vincristine sulfate .............. 12 vinorelbine tartrate ............ 12 VIOKACE 10440 UNIT ...... 38 VIOKACE 20880 UNIT ...... 38 viorele ............................... 32 VIRACEPT ..........................7 VIRAMUNE .........................7

see nevirapine .................7 VIRAMUNE XR ...................7

see nevirapine .................7 VIREAD...............................7 VIROPTIC ......................... 44

see trifluridine ................ 44 VISICOL ............................ 37 VISTARIL .......................... 46

see hydroxyzine pamoate ...................................... 46

VISTIDE .............................. 8 see cidofovir .................... 7

vitamin d ........................... 52 vivactil ............................... 23 VIVACTIL

see protriptyline hcl ....... 23 VIVELLE-DOT .................. 33 VIVITROL ......................... 28 VOGELXO ........................ 28 VOGELXO PUMP ............. 28 VOLTAREN GEL 1% ........ 51 VOLTAREN-XR .................. 1

see diclofenac sodium ..... 1 voriconazole ........................ 6 voriconazole inj 200mg ....... 6 VOSOL HC

see acetasol hc ............. 51 see acetic acid sol/hc .... 51

vospire .............................. 46 VOSPIRE ER

see albuterol sulfate er .. 46 VOTRIENT ........................ 13 VPRIV ............................... 33 vyfemla ............................. 32 VYTORIN .......................... 16 VYVANSE ......................... 25 W warfarin sodium ................ 39 WELCHOL ........................ 16 WELLBUTRIN ................... 23

see bupropion hcl .......... 22 WELLBUTRIN SR ............. 23

see budeprion ............... 22 see bupropion hcl .......... 22

WELLBUTRIN XL ............. 23 see bupropion hcl .......... 22

WESTCORT see hydrocortisone valerate ......................... 50

X XALATAN ......................... 45

see latanoprost .............. 45 XALKORI .......................... 13 XANAX ........................ 19, 20

see alprazolam .............. 19 XARELTO ......................... 39

XARTEMIS XR ................... 4 XELJANZ .......................... 40 XENAZINE ........................ 27 XEOMIN ........................... 45 XERESE ........................... 49 XGEVA ............................. 34 XIFAXAN TAB 200MG ........ 6 XIFAXAN TAB 550MG ...... 38 XODOL

see hydrocodone-acetaminophen 10-300mg ................... 2 see hydrocodone-acetaminophen 5-300mg ..................... 2 see hydrocodone-acetaminophen 7.5-300mg .................. 2 see vicodin ...................... 2 see vicodin es ................. 2 see vicodin hp ................. 3

xodol 10/300 ....................... 3 xodol 5/300 ......................... 3 xodol 7.5/300 ...................... 3 XOLAIR ............................ 47 XOPENEX ........................ 46 XOPENEX CONCENTRATE.......................................... 46

see levalbuterol conc 1.25mg/0.5ml ................ 46

XOPENEX HFA ................ 46 XTANDI ............................ 12 xulane ............................... 32 XYLOCAINE ................. 4, 50

see lidocaine hcl ............ 50 see lidocaine hcl (local anesth.) ........................... 4 see lidocaine inj 1% ........ 4 see lidocaine inj 2% ........ 4

XYLOCAINE INJ 1% ........... 4 XYLOCAINE-MPF .............. 4

see lidocaine hcl (local anesth.) ........................... 4 see lidocaine inj 0.5% ..... 4 see lidocaine inj 1% ........ 4 see lidocaine inj 1.5% ..... 4 see lidocaine inj 2% ........ 4

XYREM ............................. 28


82

XYZAL .............................. 46 see levocetirizine soln 2.5mg/5ml ...................... 46 see levocetirizine tab 5 mg ...................................... 46

Y YASMIN 28 ....................... 32

see drospirenone-ethinyl estradiol ......................... 31 see syeda ...................... 32 see zarah ....................... 32

YAZ ................................... 32 see loryna 28 day .......... 31 see vestura .................... 32

YF-VAX ............................. 41 Z zafirlukast .......................... 46 zaleplon ............................ 26 zamicet ...............................3 ZANAFLEX ....................... 28

see tizanidine ................ 28 ZANOSAR ......................... 11 ZANTAC............................ 36

see ranitidine hcl ........... 36 zarah ................................. 32 zarontin ............................. 21 ZARONTIN ........................ 21

see ethosuximide .......... 20 ZAROXOLYN .................... 18

see metolazone ............. 18 ZAVESCA ......................... 33 zazole ............................... 39 ZAZOLE ............................ 39 ZEBETA ............................ 17

see bisoprolol fumarate . 16 ZEGERID .......................... 38 ZELAPAR.......................... 24 ZELBORAF ....................... 13 ZEMAIRA .......................... 47 ZEMPLAR ......................... 43

see paricalcitol ............... 43 zenatane ........................... 48 zenchent 28 day ................ 32 zenchent fe 28 day ............ 32 ZENPEP............................ 38

ZERIT ................................. 7 see stavudine .................. 7

ZESTORETIC ................... 14 see lisinopril & hydrochlorothiazide ....... 13

ZESTRIL ........................... 14 see lisinopril .................. 14

ZETIA ................................ 16 ZETONNA ......................... 47 ZIAC.................................. 16

see bisoprolol & hydrochlorothiazide ....... 16

ZIAGEN .............................. 7 see abacavir sulfate ........ 6

ZIANA ............................... 48 zidovudine ........................... 7 ZINACEF ............................ 9

see cefuroxime sodium ... 8 ZINECARD ....................... 13

see dexrazoxane ........... 13 ZIOPTAN .......................... 45 ziprasidone hcl .................. 24 ZIPSOR .............................. 1 ZIRGAN ............................ 44 ZITHROMAX ....................... 9

see azithromycin ............. 9 ZITHROMAX TRI-PAK ........ 9 ZITHROMAX Z-PAK ........... 9 ZMAX .................................. 9 ZOCOR ............................. 15

see simvastatin ............. 15 ZOFRAN ........................... 36

see ondansetron hcl ...... 35 see ondansetron hcl oral soln ................................ 36

ZOFRAN ODT .................. 36 see ondansetron odt...... 36

zoledronic inj 4mg/5ml ...... 30 ZOLINZA ........................... 12 zolmitriptan ....................... 27 zolmitriptan odt ................. 27 ZOLOFT ............................ 23

see sertraline hcl ........... 23 zolpidem tartrate ............... 26 ZOLPIMIST ....................... 26

ZOMETA ........................... 30 see zoledronic inj 4mg/5ml ...................................... 30

ZOMIG .............................. 27 see zolmitriptan ............. 27

ZOMIG NASAL SPRAY .... 27 ZOMIG ZMT ..................... 27

see zolmitriptan odt ....... 27 ZONALON ........................ 48 ZONEGRAN ..................... 21

see zonisamide ............. 22 zonisamide ....................... 22 ZONTIVITY ....................... 40 ZORBTIVE ........................ 34 ZORTRESS ...................... 41 ZORVOLEX ........................ 1 ZOSTAVAX ...................... 41 ZOSYN ............................. 10

see piperacillin sodium-tazobactam sodium .......................... 10

zovia 1/35e 28 day............ 32 zovia 1/50e 28 day............ 33 ZOVIRAX ...................... 8, 49

see acyclovir ................... 7 see acyclovir topical ...... 49

ZUBSOLV ......................... 28 ZYBAN .............................. 28

see buproban ................ 28 ZYCLARA ......................... 51 ZYFLO CR ........................ 46 ZYKADIA .......................... 13 ZYLET .............................. 44 ZYLOPRIM ......................... 1

see allopurinol tab ........... 1 ZYMAXID .......................... 44

see gatifloxacin (ophth) . 44 ZYPREXA ......................... 24

see olanzapine .............. 24 ZYPREXA ZYDIS ............. 24

see olanzapine odt ........ 24 ZYTIGA ............................. 12 ZYVOX ............................... 6

drug requirements/ drug name drug requirements/ …...2014/10/01 · ponstel) caps 1 meloxicam susp...

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