drug tier notes - premera blue cross essentials formulary (e4).pdf2 = preferred brand drugs. 3 =...

E4- Premera Essentials Formulary

Formulary ID 3114

CURRENT AS OF 8/1/2019

lowercase italics = Generic drugsUPPERCASE BOLD = Brand name drugs

Tier1 = Preferred Generic Drugs2 = Preferred Brand Drugs3 = Preferred Specialty Drugs4 = Non Preferred Drugs (all)EX = ExcludedMB = Covered under Medical benefit.PV = Preventive Drug

NotesCN = Coverage NoteOCH = Oral Chemo DrugPA = Prior Authorization RequiredQL = Quantity Limit AppliesSP = Specialty Pharmacy Drug

Drug Tier NotesAntihistamine Drugs

ANTIVERT ORAL TABLET 12.5 MG, 25 MG 4

carbinoxamine maleate EX

CENTERGY 1

CENTERGY DM 1

cetirizine oral solution 1 mg/ml 1

CLARINEX ORAL TABLET EX

CLARINEX-D 12 HOUR EX

clemastine oral tablet EX

cyproheptadine 1

desloratadine 1

diphenhydramine hcl injection solution 50 mg/ml 1

diphenhydramine hcl injection syringe MB

diphenhydramine hcl oral capsule 50 mg 1

diphenhydramine hcl oral elixir 1

fexofenadine oral tablet 180 mg, 60 mg EX

fexofenadine-pseudoephedrine EX

HISTEX-AC 1

hydrocodone-chlorpheniramine 1

hydroxyzine hcl intramuscular solution 50 mg/ml MB

hydroxyzine hcl oral 1

hydroxyzine pamoate 1

KARBINAL ER EX

levocetirizine 1

meclizine oral tablet 12.5 mg, 25 mg 1

PHENADOZ 1

PHENERGAN RECTAL 4

promethazine injection solution25 mg/ml 4

promethazine oral 1

promethazine rectal 1

PROMETHAZINE VC 1

Drug Tier Notespromethazine-dm 1

promethazine-phenyleph-codeine 1

promethazine-phenylephrine 1

PROMETHEGAN 1

RESPA-AR 4

RYCLORA EX

RYDEX 1

RYVENT EX

SEMPREX-D EX

TUSSICAPS 4

VISTARIL 4

XYZAL ORAL TABLET EX

Anti-Infective Agents

abacavir 1

abacavir-lamivudine 4

abacavir-lamivudine-zidovudine 1

ACTICLATE EX

acyclovir oral 1

adefovir 1

AEMCOLO 4 PA

albendazole 4

ALBENZA 4

ALFERON N 4

ALINIA 4

amantadine hcl 1

amikacin injection solution 500 mg/2 ml 4

amoxicil-clarithromy-lansopraz 1

amoxicillin oral capsule 1

amoxicillin oral suspension for reconstitution 1

amoxicillin oral tablet 1

amoxicillin oral tablet,chewable125 mg, 250 mg 1

amoxicillin-pot clavulanate 1

amphotericin b 4

ampicillin oral capsule 1

ampicillin-sulbactam injection recon soln 15 gram 4

ANCOBON 4

APTIVUS 2

ARAKODA 4

ARIKAYCE MB SP

atazanavir 1

atovaquone 1

atovaquone-proguanil 1

ATRIPLA EX

AUGMENTIN ES-600 4

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML, 250-62.5 MG/5 ML

4

AUGMENTIN ORAL TABLET500-125 MG, 875-125 MG 4

1

Drug Tier NotesAUGMENTIN XR 4

AVIDOXY EX PA

AVIDOXY DK EX

azithromycin oral 1

AZULFIDINE 4

AZULFIDINE EN-TABS 4

BACIIM 4

BACTRIM 4

BACTRIM DS 4

BARACLUDE 4

BAXDELA ORAL 4

benznidazole 4

BENZODOX 30 EX

BENZODOX 60 EX

BETHKIS 3 PA; SP

BIKTARVY 2

BILTRICIDE 4

CAPASTAT 4

CAYSTON 4 SP

cefaclor oral capsule 1

cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml

1

cefaclor oral tablet extended release 12 hr 4

cefadroxil oral capsule 1

cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

1

cefadroxil oral tablet 1

cefdinir 1

cefditoren pivoxil 1

cefixime 1

cefpodoxime 1

cefprozil 1

cefuroxime axetil oral suspension for reconstitution 125 mg/5 ml 1

cefuroxime axetil oral tablet 1

cephalexin 1

chloroquine phosphate 1

CIMDUO 4

CIPRO ORAL SUSPENSION,MICROCAPSULE RECON

4

CIPRO ORAL TABLET 250 MG, 500 MG 4

CIPRO XR 4

ciprofloxacin 1

ciprofloxacin (mixture) 1

ciprofloxacin hcl oral 1

clarithromycin 1

CLEOCIN HCL 4

CLEOCIN PEDIATRIC 4

clindamycin hcl 1

Drug Tier Notesclindamycin palmitate hcl 1

CLINDAMYCIN PEDIATRIC 1

COARTEM 4

colistin (colistimethate na) 4

COMBIVIR 4

COMPLERA 2

COREMINO 4

CRESEMBA ORAL 4

CRIXIVAN ORAL CAPSULE200 MG, 400 MG 2

cycloserine 2

CYTOVENE MB SP

dapsone oral 1

DARAPRIM 4 SP

DELSTRIGO EX

demeclocycline 1

DESCOVY 4

dicloxacillin 1

didanosine 1

DIFICID 4

DIFLUCAN 4

DORYX MPC EX

DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 200 MG, 50 MG

EX

DOVATO ORAL TABLET 50-300 MG 2 SP

DOVATO ORAL TABLET 50-300 MG 4 SP

doxycycline hyclate oral capsule 1

doxycycline hyclate oral tablet100 mg, 150 mg, 50 mg, 75 mg 1

doxycycline hyclate oral tablet,delayed release (dr/ec)100 mg, 150 mg, 200 mg, 50 mg, 75 mg

1

doxycycline hyclate oral tablet,delayed release (dr/ec) 80 mg

EX

doxycycline monohydrate oral capsule 1

doxycycline monohydrate oral capsule,ir - delay rel,biphase EX

doxycycline monohydrate oral suspension for reconstitution 1

doxycycline monohydrate oral tablet 1

E.E.S. 400 ORAL TABLET 1

E.E.S. GRANULES 4

EDURANT 2

efavirenz 1

EMTRIVA 2

EMVERM 4

entecavir 1

EPCLUSA 3 PA; SP

EPIVIR 4

2

Drug Tier NotesEPIVIR HBV ORAL SOLUTION 2

EPIVIR HBV ORAL TABLET 4

EPZICOM 4

ERYPED 200 EX

ERYPED 400 EX

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 250 MG, 333 MG

1

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG

4

ERYTHROCIN (AS STEARATE) ORAL TABLET 250 MG 1

erythromycin ethylsuccinate oral suspension for reconstitution 4

erythromycin ethylsuccinate oral tablet 1

erythromycin oral capsule,delayed release(dr/ec) 1

erythromycin oral tablet 1

erythromycin stearate oral tablet250 mg 4

ethambutol 1

EVOTAZ 4

FACTIVE 4

famciclovir 1

FIRVANQ 4

FLAGYL 4

fluconazole 1

flucytosine 1

FLUMADINE ORAL TABLET 4

fosamprenavir 1

FURADANTIN 4

FUZEON SUBCUTANEOUS RECON SOLN 3 SP

ganciclovir intravenous MB SP

ganciclovir sodium intravenous recon soln MB SP

GENVOYA 2

GOCOVRI EX SP

griseofulvin microsize 1

griseofulvin ultramicrosize 4

HARVONI 3 PA; SP

HEPSERA 4

HIPREX 4

hydroxychloroquine 1

HYOPHEN 1

IMPAVIDO 4

INTELENCE 2

INTRON A INJECTION 3 SP

INVIRASE ORAL TABLET 2

ISENTRESS HD 2

ISENTRESS ORAL POWDER IN PACKET 4

ISENTRESS ORAL TABLET 2

Drug Tier NotesISENTRESS ORAL TABLET,CHEWABLE 2

isoniazid oral 1

itraconazole oral capsule 1

itraconazole oral solution 4

ivermectin 1

JULUCA 2

KALETRA ORAL SOLUTION 4

KALETRA ORAL TABLET 2

KEFLEX ORAL CAPSULE 4

ketoconazole oral 1

KITABIS PAK 4 PA; SP

KRINTAFEL EX

lamivudine 1

lamivudine-zidovudine 1

ledipasvir-sofosbuvir 4 PA; SP

LEVAQUIN ORAL TABLET 500 MG, 750 MG 4

levofloxacin oral 1

LEXIVA ORAL SUSPENSION 2

LEXIVA ORAL TABLET 4

LINCOCIN 4

linezolid 1

lopinavir-ritonavir 1

LUGOLS ORAL 1

MACROBID 4

MACRODANTIN 4

MALARONE 4

MALARONE PEDIATRIC 4

MAVYRET 3 PA; SP

mefloquine 1

MEPRON 4

methenamine hippurate 1

methenamine mandelate 1

metronidazole oral 1

MINOCIN ORAL CAPSULE 50 MG EX PA

minocycline oral capsule 1

minocycline oral tablet 1

minocycline oral tablet extended release 24 hr 105 mg, 115 mg, 55 mg, 65 mg, 80 mg

EX

minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg

EX PA

MINOLIRA ER EX

MODERIBA 3 SP

MONDOXYNE NL 4

MONODOX EX

MONUROL 4

MORGIDOX EX PA

MORGIDOX 1X 50 EX

MORGIDOX 1X100 EX

MORGIDOX 2X100 EX

3

Drug Tier NotesMOXATAG 4

moxifloxacin oral 1

MYAMBUTOL ORAL TABLET400 MG 4

MYCOBUTIN 4

NEBUPENT 4

neomycin 1

nevirapine 1

nitrofurantoin 1

nitrofurantoin macrocrystal 1

nitrofurantoin monohyd/m-cryst 1

NORVIR ORAL CAPSULE 2

NORVIR ORAL POWDER IN PACKET 2

NORVIR ORAL SOLUTION 2

NORVIR ORAL TABLET 4

NOXAFIL ORAL 4

NUZYRA (7 DAY WITH LOAD DOSE) 4

NUZYRA (7 DAY) 4

NUZYRA ORAL 4

nystatin oral suspension 1

nystatin oral tablet 1

ODEFSEY 2

ofloxacin oral tablet 300 mg, 400 mg 1

OKEBO ORAL CAPSULE 75 MG 4

OMECLAMOX-PAK 2

ONMEL 4

ORACEA EX

oseltamivir 1

OSMOLEX ER EX

paromomycin 1

PASER 4

PEGASYS 3 SP

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 180 MCG/0.5 ML

3 SP

PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5 ML 3 SP

penicillin v potassium 1

PHOSPHASAL 1

PIFELTRO EX

PLAQUENIL EX

polymyxin b sulfate 4

praziquantel 4

PREVYMIS ORAL 4

PREZCOBIX 4

PREZISTA ORAL SUSPENSION 2

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG 2

PRIFTIN 4

primaquine 4

Drug Tier NotesPRIMSOL 4

PYLERA 4

pyrazinamide 1

QUALAQUIN 4

quinidine gluconate oral 1

quinidine sulfate oral tablet 1

quinine sulfate 1

REBETOL ORAL SOLUTION 4 SP

RELENZA DISKHALER 4 QL (2 EA per 365 days)

RESCRIPTOR ORAL TABLET 4

RETROVIR ORAL CAPSULE 4

RETROVIR ORAL SYRUP 4

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG 4

REYATAZ ORAL POWDER IN PACKET 4

RIBASPHERE ORAL CAPSULE 3 SP

RIBASPHERE ORAL TABLET600 MG 3 SP

RIBASPHERE RIBAPAK ORAL TABLETS,DOSE PACK 600 MG (7)- 400 MG (7), 600 MG (7)- 600 MG (7), 600-400 MG (28)-MG (28), 600-600 MG (28)-MG (28)

3 SP

ribavirin oral capsule 3 SP

ribavirin oral tablet 200 mg 3 SP

rifabutin 1

RIFADIN ORAL 4

RIFAMATE 4

rifampin oral 1

RIFATER 4

rimantadine 1

ritonavir 1

SELZENTRY 2

SEYSARA EX

SIRTURO 4

SITAVIG EX

SIVEXTRO ORAL 4

sofosbuvir-velpatasvir 4 PA; SP

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR105 MG, 115 MG, 55 MG, 65 MG, 80 MG

EX

SOLOSEC 4

SOLOXIDE 1

SOVALDI 3 PA; SP

SPECTRACEF ORAL TABLET400 MG 4

SPORANOX 4

SPORANOX PULSEPAK 4

SSKI 2

stavudine oral capsule 1

streptomycin 2

STRIBILD 4

4

Drug Tier NotesSTROMECTOL 4

STRONG IODINE ORAL 1

sulfadiazine 1

sulfamethoxazole-trimethoprim oral 1

sulfasalazine 1

SULFATRIM 1

SUPRAX ORAL CAPSULE 4

SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 4

SUPRAX ORAL TABLET,CHEWABLE 4

SUSTIVA 4

SYLATRON 4 SP

SYMFI 2

SYMFI LO 2

SYMTUZA EX

SYNAGIS MB SP

TAMIFLU ORAL CAPSULE 30 MG 4 QL (40 EA per 365

days)

TAMIFLU ORAL CAPSULE 45 MG, 75 MG 4 QL (20 EA per 365

days)

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 4 QL (360 ML per 365

days)

TARGADOX EX

tenofovir disoproxil fumarate 1

terbinafine hcl oral 1

tetracycline 4

tinidazole 1

TIVICAY 2

TOBI EX SP

TOBI PODHALER EX SP

tobramycin in 0.225 % nacl 3 SP

tobramycin sulfate 4

tobramycin with nebulizer 3 PA; SP

TOLSURA EX

TRECATOR 4

triacetin 4

trimethoprim 1

TRIMPEX 4

TRIUMEQ 2

TRIZIVIR 4

TROGARZO MB SP

TRUVADA 2

UR N-C 1

URELLE 4

URETRON D-S ORAL TABLET81.6-10.8-40.8 MG 1

URIBEL 4

URIMAR-T 1

URIN DS 1

UROGESIC-BLUE 4

URO-MP 1

UROQID-ACID NO.2 4

Drug Tier NotesURYL 1

USTELL 1

UTIRA-C 1

valacyclovir 1

VALCYTE 4

valganciclovir oral recon soln 4

valganciclovir oral tablet 1

VALTREX EX

VANCOCIN 4

vancomycin oral capsule 4

VEMLIDY 4

VFEND 4

VIBRAMYCIN ORAL CAPSULE100 MG EX

VIBRAMYCIN ORAL SUSPENSION FOR RECONSTITUTION

EX

VIBRAMYCIN ORAL SYRUP EX

VIDEX 2 GRAM PEDIATRIC 2

VIDEX EC 4

VIEKIRA PAK 4 PA; SP

VIRACEPT ORAL TABLET 2

VIRAMUNE 4

VIRAMUNE XR 4

VIREAD ORAL POWDER 4

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG 2

VIREAD ORAL TABLET 300 MG 4

voriconazole oral 1

VOSEVI 3 PA; SP

XIFAXAN 4 PA; QL (60 EA per 30 days)

XIMINO EX

XOFLUZA 4 PA

ZEPATIER 4 PA; SP

ZERIT ORAL CAPSULE 30 MG 4

ZIAGEN 4

zidovudine 1

ZITHROMAX ORAL PACKET 4

ZITHROMAX ORAL SUSPENSION FOR RECONSTITUTION

4

ZITHROMAX ORAL TABLET250 MG, 500 MG 4

ZITHROMAX TRI-PAK 4

ZITHROMAX Z-PAK 4

ZOVIRAX ORAL 4

ZYVOX ORAL 4

Antineoplastic Agents

abiraterone 3 PA; SP; OCH

ABRAXANE MB SP

ADCETRIS MB SP

AFINITOR 4 PA; SP; OCH

5

Drug Tier NotesAFINITOR DISPERZ 4 PA; SP; OCH

ALECENSA 4 PA; SP; OCH

ALFERON N 4

ALIQOPA MB SP

ALKERAN 4 OCH

ALUNBRIG 4 PA; SP; OCH

anastrozole 1 OCH

ARIMIDEX EX OCH

AROMASIN 4 OCH

ARRANON MB SP

ARZERRA MB SP

AVASTIN MB SP

azacitidine 4 SP

AZEDRA DOSIMETRIC MB SP

AZEDRA THERAPEUTIC MB SP

BALVERSA 4 PA; SP; OCH

BAVENCIO MB SP

BELEODAQ MB SP

bendamustine MB SP

BENDEKA MB SP

BESPONSA MB SP

bexarotene 1 PA; OCH

bicalutamide 1 OCH

BLINCYTO INTRAVENOUS KIT MB SP

bortezomib MB SP

BOSULIF 4 PA; SP; OCH

BRAFTOVI EX SP; OCH

CABOMETYX 4 PA; SP; OCH

CALQUENCE 4 PA; SP; OCH

capecitabine 3 SP; OCH

CAPRELSA 4 PA; SP; OCH

CARAC EX

CASODEX 4 OCH

COMETRIQ 4 PA; OCH

COPIKTRA EX SP; OCH

COTELLIC 4 PA; SP; OCH

cyclophosphamide oral capsule 4 OCH

CYRAMZA MB SP

DACOGEN MB SP

DARZALEX MB SP

DAURISMO 4 PA; SP; OCH

decitabine MB SP

diclofenac sodium topical gel 3 % 4

DROXIA 2

EFUDEX TOPICAL CREAM 4

ELIGARD 3 SP

ELIGARD (3 MONTH) 3 SP



ELZONRIS MB SP

EMCYT 2 OCH

Drug Tier NotesEMPLICITI MB SP

ERBITUX MB SP

ERIVEDGE 4 PA; SP; OCH

ERLEADA 4 PA; SP; OCH

erlotinib 3 PA; SP

ERWINAZE 4

etoposide oral 1 OCH

EVOMELA MB SP

exemestane 1 OCH

FARESTON 4 OCH

FARYDAK 4 SP; OCH

FASLODEX 4

FEMARA 4 OCH

FIRMAGON KIT W DILUENT SYRINGE 4 SP

FLUOROPLEX EX

fluorouracil topical cream 0.5 % EX

fluorouracil topical cream 5 % 4

fluorouracil topical solution 1

flutamide 1 OCH

FOLOTYN MB SP

fulvestrant 4

GAZYVA MB SP

GILOTRIF 4 PA; SP; OCH

GLEEVEC 4 SP; OCH

GLEOSTINE 2 OCH

HALAVEN MB SP

HERCEPTIN HYLECTA MB SP

HERCEPTIN INTRAVENOUS RECON SOLN 150 MG MB SP

HYCAMTIN ORAL 3 SP; OCH

HYDREA 4 OCH

hydroxyurea 1 OCH

IBRANCE 4 PA; SP; OCH

ICLUSIG 4 PA; SP; OCH

IDHIFA 4 PA; SP; OCH

imatinib 3 SP; OCH

IMBRUVICA 4 PA; SP; OCH

IMFINZI MB SP

IMLYGIC 4 SP

INFUGEM MB

INLYTA 4 PA; SP; OCH


IRESSA 4 PA; SP; OCH

ISTODAX MB SP

IXEMPRA MB SP

JAKAFI 4 SP; OCH

JEVTANA MB SP

KADCYLA MB SP

KEYTRUDA INTRAVENOUS SOLUTION MB SP

KISQALI 4 PA; SP; OCH

6

Drug Tier NotesKISQALI FEMARA CO-PACK 4 PA; SP; OCH

KYMRIAH MB SP

KYPROLIS MB SP

LARTRUVO MB SP

LENVIMA 4 PA; SP; OCH

letrozole 1 OCH

LEUKERAN 2 OCH

leuprolide subcutaneous kit 4 SP

LIBTAYO MB SP

LONSURF 4 PA; SP; OCH

LORBRENA 4 PA; SP; OCH

LUMOXITI MB SP

LUPANETA PACK (1 MONTH) 4 PA; SP


LUPRON DEPOT 4 SP

LUPRON DEPOT (3 MONTH) 4 SP



LUPRON DEPOT-PED 4 SP

LUPRON DEPOT-PED (3 MONTH) 4 SP

LUTATHERA MB SP

LYNPARZA ORAL TABLET 4 PA; SP; OCH

LYSODREN 2 OCH

MATULANE 4 OCH

megestrol oral suspension 1

megestrol oral tablet 1 OCH

MEKINIST 4 PA; SP; OCH

MEKTOVI EX SP; OCH

melphalan 1 OCH

mercaptopurine 1 OCH

methotrexate sodium (pf) 1

methotrexate sodium injection 1

methotrexate sodium oral 1 OCH

mitoxantrone MB SP

MYLERAN 2 OCH

MYLOTARG MB SP

NERLYNX 4 PA; SP; OCH

NEXAVAR 4 PA; SP; OCH

NILANDRON 4 OCH

nilutamide 4 OCH

NINLARO 4 PA; SP; OCH

ODOMZO 4 PA; SP; OCH

ONIVYDE MB SP

OPDIVO MB SP

OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.4 ML, 12.5 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML

2

PANRETIN 4

PERJETA MB SP

Drug Tier NotesPICATO EX

PIQRAY EX

POLIVY MB SP

POMALYST 4 PA; SP; OCH

PORTRAZZA MB SP

POTELIGEO MB SP

PROLEUKIN MB SP

PURIXAN 4 SP; OCH

RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML

2

REVLIMID 3 PA; SP; OCH

RITUXAN MB SP

RITUXAN HYCELA MB SP

romidepsin MB SP

RUBRACA 4 PA; SP; OCH

RYDAPT 4 PA; SP; OCH

SIKLOS 4

SOLARAZE EX

SOLTAMOX 4 OCH

SPRYCEL 3 PA; SP; OCH

STIVARGA 4 PA; SP; OCH

SUPPRELIN LA 4 SP

SUTENT 3 PA; SP; OCH

SYLATRON 4 SP

SYLVANT MB SP

SYNRIBO 4 PA; SP

TABLOID 2 OCH

TAFINLAR 4 PA; SP; OCH

TAGRISSO 4 PA; SP; OCH

TALZENNA EX SP; OCH

tamoxifen 1 OCH

TARCEVA 3 PA; SP; OCH

TARGRETIN ORAL 4 PA; OCH

TARGRETIN TOPICAL 2 PA

TASIGNA 4 PA; SP; OCH

TECENTRIQ MB SP

TEMODAR INTRAVENOUS MB SP

TEMODAR ORAL 4 SP; OCH

temozolomide 3 SP; OCH

temsirolimus MB SP

TEPADINA 4

TIBSOVO EX SP; OCH

TOLAK 4

toremifene 1 OCH

TORISEL MB SP

TREANDA INTRAVENOUS RECON SOLN MB SP

7

Drug Tier NotesTRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

MB

tretinoin (chemotherapy) 1 OCH

TREXALL 4 OCH

TRIPTODUR MB SP

TYKERB 4 PA; SP; OCH

UNITUXIN MB SP

VALCHLOR 4 PA; SP

VANTAS 4 SP

VECTIBIX MB SP

VELCADE MB SP

VENCLEXTA 4 PA; SP; OCH

VENCLEXTA STARTING PACK 4 PA; SP; OCH

VERZENIO 4 PA; SP; OCH

VIDAZA 4 SP

VITRAKVI 4 PA; SP; OCH

VIZIMPRO EX SP; OCH

VOTRIENT 4 PA; SP; OCH

VYXEOS MB SP

XALKORI 4 PA; SP; OCH

XATMEP 4 OCH

XELODA 4 SP; OCH

XOSPATA 4 PA; SP; OCH

XTANDI 3 PA; SP; OCH

YERVOY MB SP

YESCARTA MB SP

YONDELIS MB SP

YONSA 3 PA; SP; OCH

ZALTRAP MB SP

ZEJULA 4 PA; SP; OCH

ZELBORAF 4 PA; SP; OCH

ZOLADEX MB SP

ZOLINZA 4 PA; SP; OCH

ZYDELIG 4 SP; OCH

ZYKADIA ORAL CAPSULE 4 PA; SP; OCH

ZYKADIA ORAL TABLET 4 PA; SP

ZYTIGA ORAL TABLET 250 MG 4 PA; SP; OCH

ZYTIGA ORAL TABLET 500 MG 3 PA; SP; OCH

Antitoxins,Immune Glob,Toxoids,Vaccines

ACTHIB (PF) 2

ADACEL(TDAP ADOLESN/ADULT)(PF) 2

bcg vaccine, live (pf) MB

BEXSERO 2

BIOTHRAX 2

BIVIGAM MB SP

BOOSTRIX TDAP 2

CUVITRU MB SP

CYTOGAM INTRAVENOUS SOLUTION 50 MG/ML MB SP

Drug Tier NotesDAPTACEL (DTAP PEDIATRIC) (PF) 2

ENGERIX-B (PF) 2

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 2

FLEBOGAMMA DIF MB SP

GAMASTAN MB SP

GAMASTAN S/D MB SP

GAMMAGARD LIQUID MB SP

GAMMAGARD S-D (IGA < 1 MCG/ML) MB SP

GAMMAKED MB SP

GAMMAPLEX MB SP

GAMMAPLEX (WITH SORBITOL) MB SP

GAMUNEX-C MB SP

GARDASIL 9 (PF) 2

GRASTEK 4

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML

2

HAVRIX (PF) INTRAMUSCULAR SYRINGE 2

HEPLISAV-B (PF) 2

HIBERIX (PF) 2

HIZENTRA MB SP

HYPERRHO S/D MB SP

HYQVIA MB SP

IMOVAX RABIES VACCINE (PF) 2

INFANRIX (DTAP) (PF) 2

IPOL 2

IXIARO (PF) 2

KINRIX (PF) 2

MENACTRA (PF) INTRAMUSCULAR SOLUTION 2

MENVEO A-C-Y-W-135-DIP (PF) 2

MICRHOGAM ULTRA-FILTERED PLUS MB SP

M-M-R II (PF) 2

OCTAGAM MB SP

ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY, 100 IR (3) /300 IR (6)

MB

ORALAIR SUBLINGUAL TABLET 300 INDX REACTIVITY 4 SP

PANZYGA MB SP

PEDIARIX (PF) 2

PEDVAX HIB (PF) 2

PENTACEL (PF) 2

PENTACEL ACTHIB COMPONENT (PF) 2

PENTACEL DTAP-IPV COMPNT (PF) 4

8

Drug Tier NotesPNEUMOVAX 23 2

PREVNAR 13 (PF) 2

PRIVIGEN MB SP

PROQUAD (PF) 2

QUADRACEL (PF) 4

RABAVERT (PF) 2

RAGWITEK 4

RECOMBIVAX HB (PF) 2

RHOGAM ULTRA-FILTERED PLUS MB SP

RHOPHYLAC MB SP

ROTARIX 2

ROTATEQ VACCINE 2

SHINGRIX (PF) 2

SHINGRIX GE ANTIGEN COMPONENT 2

STAMARIL (PF) 4

TDVAX 2

TENIVAC (PF) 2

tetanus,diphtheria tox ped(pf) 2

TRUMENBA 2

TWINRIX (PF) INTRAMUSCULAR SYRINGE 2

TYPHIM VI 2

VAQTA (PF) 2

VARIVAX (PF) 2

VAXCHORA ACTIVE COMPONENT 2

VAXCHORA VACCINE 2

VIVOTIF 2

WINRHO SDF MB SP

YF-VAX (PF) 2

ZOSTAVAX (PF) 2

Autonomic Drugs

acebutolol 1

ADRENALIN INJECTION 1

ADVAIR DISKUS 4

ADVAIR HFA 2

AIRDUO RESPICLICK 4

albuterol sulfate inhalation hfa aerosol inhaler 4

albuterol sulfate inhalation solution for nebulization 1

albuterol sulfate oral 1

alfuzosin 1

AMRIX EX

ANASPAZ 1

ANORO ELLIPTA 2

ARCAPTA NEOHALER 4

ARICEPT 4

atenolol 1

atenolol-chlorthalidone 1

atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 4

Drug Tier NotesATROVENT HFA 4

AUVI-Q EX

baclofen oral tablet 10 mg, 20 mg 1

baclofen oral tablet 5 mg 4

BENTYL INTRAMUSCULAR 4

benztropine injection 4

benztropine oral 1

BETAPACE 4

BETAPACE AF 4

betaxolol oral 1

bethanechol chloride 1

BEVESPI AEROSPHERE 4

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide 1

BOTOX MB SP

BREO ELLIPTA 2

BROMFED DM 4

brompheniramine-pseudoeph-dm oral syrup 4

BROVANA EX

BYSTOLIC 4

CAFERGOT EX

CARDURA 4

CARDURA XL 4

carisoprodol 1

carisoprodol-asa-codeine 1 PA

carisoprodol-aspirin 1

carvedilol 1

carvedilol phosphate 1

CATAPRES 4

CATAPRES-TTS-1 4

CATAPRES-TTS-2 4

CATAPRES-TTS-3 4

CENTERGY 1

CENTERGY DM 1

cevimeline 1

CHANTIX CONTINUING MONTH BOX PV CN; QL (180 EA per

365 days)

CHANTIX ORAL TABLET 0.5 MG PV CN; QL (180 Days

per 365 days)

CHANTIX ORAL TABLET 1 MG PV CN; QL (180 EA per 365 days)

CHANTIX STARTING MONTH BOX PV CN; QL (180 EA per

365 days)

chlordiazepoxide-clidinium 4

chlorzoxazone oral tablet 250 mg, 375 mg, 750 mg 1 PA

chlorzoxazone oral tablet 500 mg 1


clonidine 4

clonidine hcl 1

CLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1

9

Drug Tier NotesCLORPRES ORAL TABLET0.3-15 MG 2

COMBIVENT RESPIMAT 2

COMFORT PAC-CYCLOBENZAPRINE EX

COMFORT PAC-TIZANIDINE EX

COREG EX

COREG CR 4

CORGARD 4

CUVPOSA 4

cyclobenzaprine oral capsule,extended release 24hr EX

cyclobenzaprine oral tablet 1

CYCLOTENS REFILL EX

CYCLOTENS STARTER EX

D.H.E.45 EX

DANTRIUM ORAL CAPSULE25 MG, 50 MG 4

dantrolene 1

DIBENZYLINE 4

dicyclomine intramuscular 1

dicyclomine oral capsule 1

dicyclomine oral solution 1

dicyclomine oral tablet 1

dihydroergotamine injection 1

dihydroergotamine nasal 4 QL (8 Vials per 30 days)

diphenoxylate-atropine 1

donepezil 1

DONNATAL ORAL ELIXIR 16.2 MG-0.1037 MG/5 ML (5 ML), 16.2-0.1037 -0.0194 MG/5 ML

4

DONNATAL ORAL TABLET 4

doxazosin 1

DULERA 2

dutasteride-tamsulosin 1

DUTOPROL 4

DYSPORT 4 SP

ED-SPAZ 1

epinephrine 0.3 mg auto-inject 2

epinephrine 0.3 mg auto-inject inner, suv 1

epinephrine 0.3 mg auto-inject latex-free, sdv 2

epinephrine 0.3 mg auto-inject latex-free, suv 2

epinephrine 0.3 mg auto-inject outer, suv 1

epinephrine 0.3 mg auto-inject outer, suv, 1

epinephrine 0.3 mg auto-inject suv, outer 2

epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.15 mg/0.3 ml

2

epinephrine injection solution 1

Drug Tier Notesepinephrine injection syringe 0.1 mg/ml 1

EPIPEN 2 PA

EPIPEN 2-PAK 2 PA

EPIPEN JR 2 PA

EPIPEN JR 2-PAK 2 PA

EPISNAP 2 PA

ergoloid 1

ERGOMAR EX

ergotamine-caffeine 1

EVOXAC 4

EXELON TRANSDERMAL 4

FEXMID EX


FLOMAX 4

fluticasone propion-salmeterol inhalation aerosol powdr breath activated

4

fluticasone propion-salmeterol inhalation blister with device 1

galantamine 1

GLYCATE 4

glycopyrrolate oral 1

GUAIFENESIN DAC 1

guanidine 1

HEMANGEOL EX SP

HISTEX-AC 1

HYDROCODONE COMPOUND 1

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 1

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml (5 ml) 2

hydrocodone-homatropine oral tablet 1

HYDROMET 1

hyoscyamine sulfate 1

HYOSYNE 1

INCRUSE ELLIPTA 2

INDERAL LA EX

INDERAL XL 4

INNOPRAN XL EX

ipratropium bromide inhalation 1

ipratropium-albuterol 1

JALYN 4

KAPSPARGO SPRINKLE 2

KAPVAY 4

labetalol oral 1

levalbuterol hcl EX

levalbuterol tartrate EX

LEVBID 4

LEVSIN ORAL 4

LEVSIN/SL 4

LIBRAX (WITH CLIDINIUM) EX

LOMOTIL 4

10

Drug Tier NotesLONHALA MAGNAIR REFILL 4

LONHALA MAGNAIR STARTER 4

LOPRESSOR HCT 4

LOPRESSOR ORAL 4

LORTUSS EX ORAL SYRUP 1

LORZONE 4 PA

LUCEMYRA EX PA

MESTINON ORAL 4

MESTINON TIMESPAN 4

metaproterenol oral syrup 1

metaproterenol oral tablet 10 mg 1

METAXALL 4

metaxalone 4

methocarbamol oral 1

methscopolamine 1

methyldopa 1

methyldopa-hydrochlorothiazide 4

metoprolol succinate 1

metoprolol su-hydrochlorothiaz oral tablet extended release 24 hr 100-12.5 mg, 25-12.5 mg

4

metoprolol ta-hydrochlorothiaz 1

metoprolol tartrate oral 1

midodrine 1

MIGERGOT 1

MIGRANAL EX QL (8 Vials per 30 days)

MINIPRESS 4

MYOBLOC MB SP

nadolol 4

nadolol-bendroflumethiazide oral tablet 80-5 mg 4

NAMZARIC 4

NICORELIEF PV CN

NICORETTE BUCCAL GUM 4 MG PV

nicotine (polacrilex) buccal gum PV CN

nicotine (polacrilex) buccal lozenge 2 mg PV

nicotine (polacrilex) buccal lozenge 4 mg PV CN

nicotine (polacrilex) buccal mini lozenge 2 mg PV CN

nicotine (polacrilex) buccal mini lozenge 4 mg PV

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr

PV CN

nicotine transdermal patch, td daily, sequential PV CN

NICOTROL PV CN

NICOTROL NS PV CN

NORGESIC FORTE EX

NORTHERA 4 SP

NULEV 4

Drug Tier Notesorphenadrine citrate injection 4

orphenadrine citrate oral 1

OSCIMIN 1

OSCIMIN SL 1

OSCIMIN SR 1

PERFOROMIST 2

phenobarb-hyoscy-atropine-scop oral elixir 4

phenobarb-hyoscy-atropine-scop oral tablet 1

PHENOHYTRO ORAL ELIXIR 4

PHENOHYTRO ORAL TABLET 1

phenoxybenzamine 4

pilocarpine hcl oral 1

pindolol 1

prazosin 1

PROAIR HFA 2

PROAIR RESPICLICK 2

PROMETHAZINE VC 1



propantheline 1

propranolol oral 1

propranolol-hydrochlorothiazid 4

PROVENTIL HFA EX

pyridostigmine bromide oral syrup 1

pyridostigmine bromide oral tablet 30 mg 4

pyridostigmine bromide oral tablet 60 mg 1

pyridostigmine bromide oral tablet extended release 1

QBREXZA 4 PA

QUIT 2 BUCCAL GUM PV CN

QUIT 4 BUCCAL GUM PV CN

RAPAFLO EX

RAZADYNE ER 4

RAZADYNE ORAL TABLET 4

RESPA-AR 4

rivastigmine 1

rivastigmine tartrate 1

ROBAXIN 4

ROBAXIN-750 4

RYDEX 1

SALAGEN (PILOCARPINE) 4

SEEBRI NEOHALER 4

SEMPREX-D EX

SEREVENT DISKUS 2

silodosin 1

SKELAXIN 4

SOMA 4

SORINE 1

11

Drug Tier NotesSOTALOL AF 1

sotalol oral 1

SOTYLIZE 4

SPIRIVA RESPIMAT 2

SPIRIVA WITH HANDIHALER 2

STIOLTO RESPIMAT 4

STOP SMOKING AID PV CN

STRIVERDI RESPIMAT 4

SYMAX DUOTAB 4

SYMAX FASTABS 1

SYMAX-SL 4

SYMAX-SR 4

SYMBICORT 2

tamsulosin 1

TENORETIC 100 4

TENORETIC 50 4

TENORMIN 4

terazosin 1

terbutaline 1

timolol maleate oral 1

tizanidine 1

TOPROL XL 2

TRELEGY ELLIPTA 2

trihexyphenidyl 1

TUDORZA PRESSAIR 4

TUSNEL C 1

URECHOLINE 4

UROXATRAL EX

UTIBRON NEOHALER 4

VENTOLIN HFA 4

VIRTUSSIN DAC 1

WIXELA INHUB 1

XEOMIN 4 SP

XOPENEX EX

XOPENEX CONCENTRATE EX

XOPENEX HFA EX

YUPELRI 4

ZANAFLEX 4

ZIAC 4

Blood Formation, Coagulation, Thrombosis

ACD-A 4

ADULT ASPIRIN REGIMEN PV CN

ADULT LOW DOSE ASPIRIN PV CN

ADVATE MB SP

ADYNOVATE MB SP

AFSTYLA MB SP

AGGRENOX 4

AGRYLIN 4

ALPHANATE MB SP

ALPHANINE SD MB SP

ALPROLIX MB SP

Drug Tier NotesAMICAR 4

aminocaproic acid oral tablet 4

anagrelide 1

ARANESP (IN POLYSORBATE) 4 SP; OCH

ARIXTRA 4 SP

ASPIR-81 PV CN

ASPIRIN CHILDRENS PV CN

ASPIRIN LOW DOSE PV CN

aspirin oral tablet PV CN

aspirin oral tablet,chewable PV CN

aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg PV CN

aspirin-dipyridamole 4

ASPIR-LOW PV CN

ASPIR-TRIN PV CN

AZESCO EX

BAL-CARE DHA 1

BAL-CARE DHA ESSENTIAL 4

BAYER ASPIRIN PV CN

BAYER CHEWABLE ASPIRIN PV CN

BENEFIX MB SP

BEVYXXA EX

BRILINTA 2

butalbital-aspirin-caffeine 1

CABLIVI 3 PA; SP

CADEAU DHA EX

CALCIUM PNV 4

CENTRATEX 1

CHILDREN'S ASPIRIN PV CN

CHILDREN'S IRON PV CN

cilostazol 1

CITRANATAL (DUAL-IRON) 4

CITRANATAL 90 DHA (ALGAL OIL) 4

CITRANATAL ASSURE ORAL COMBO PACK 35 MG IRON-1 MG -50 MG-300 MG

4

CITRANATAL B-CALM (FE GLUC) 4

CITRANATAL BLOOM 4

CITRANATAL DHA (ALGAL OIL) 4

CITRANATAL HARMONY (IRON FUM) 4

clopidogrel 1

C-NATE DHA 4

COAGADEX MB SP

COMPLETENATE 4

CONCEPT DHA 4

CONCEPT OB 4

CORIFACT MB SP

CORVITA 150 1

COUMADIN ORAL 2

DDAVP INJECTION 4

12

Drug Tier NotesDDAVP NASAL SOLUTION 4

DDAVP ORAL 4

desmopressin injection 4

desmopressin nasal spray,non-aerosol 1

desmopressin oral 1

dipyridamole oral 1

DOPTELET (10 TAB PACK) 4 PA; SP; OCH

DOPTELET (15 TAB PACK) 4 PA; SP; OCH

DUET DHA BALANCED ORAL COMBO PACK 25 MG IRON-1 MG -267 MG-233 MG

4

DUET DHA WITH OMEGA-3 ORAL COMBO PACK 25 MG IRON-1 MG -400 MG

4

DURLAZA 4

E.C. PRIN PV CN

ECOTRIN PV CN

ECOTRIN LOW STRENGTH PV CN

EFFIENT 4

ELIQUIS 2

ELITE-OB 4

ELITE-OB 400 1

ELOCTATE MB SP

ENBRACE HR 4

enoxaparin 3 SP

ENTERIC COATED ASPIRIN PV CN

EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML

4 SP; OCH

ESCAVITE PV

ESCAVITE D PV

ESCAVITE LQ PV

EXTRA-VIRT PLUS DHA 4

FE C PLUS 1

FEIBA NF MB SP

FER-IN-SOL PV CN

FEROCON 1

FERRAPLUS 90 1

FERREX 150 FORTE EX

FERROCITE PLUS 1

ferrous sulfate oral drops PV CN

FIBRYGA MB SP

FIORINAL EX

FOLET ONE 4

FOLIVANE-F 1

FOLIVANE-OB 1

FOLIVANE-PLUS 1

fondaparinux 4 SP

FRAGMIN SUBCUTANEOUS SOLUTION 4 SP

FRAGMIN SUBCUTANEOUS SYRINGE 4 SP

Drug Tier NotesFULPHILA MB SP; OCH

GRANIX 3 SP; OCH

HELIXATE FS MB SP

HEMATINIC PLUS VIT/MINERALS 1

HEMATINIC/FOLIC ACID 1

HEMATOGEN 1

HEMATOGEN FA 1

HEMATOGEN FORTE 1

HEMENATAL OB 1

HEMENATAL OB + DHA 1

HEMETAB 1

HEMLIBRA 4 PA; SP

HEMOFIL M HIGH MB SP

HEMOFIL M LOW MB SP

HEMOFIL M MID MB SP

HEMOFIL M SUPER HIGH MB SP

heparin (porcine) injection cartridge 1

heparin (porcine) injection solution 1

HEPARIN LOCK MB

heparin lock flush (porcine) intravenous syringe 100 unit/ml MB

heparin, porcine (pf) injection 1

HUMATE-P MB SP

IDELVION MB SP

IFEREX 150 FORTE EX

IRONUP PV CN

IXINITY MB SP

JANTOVEN 1

JIVI MB SP

KOATE MB SP

KOGENATE FS MB SP

KOSHER PRENATAL PLUS IRON 4

KOVALTRY MB SP

LEUKINE INJECTION RECON SOLN 4 SP; OCH

LITE COAT ASPIRIN PV CN

LOVENOX EX SP

LYSTEDA 4

MARNATAL-F 4

MIRCERA 4 SP; OCH

M-NATAL PLUS 1

MONONINE MB SP

MOZOBIL 4 SP; OCH

MULPLETA EX SP; OCH

MULTIGEN FOLIC 1

MULTIGEN PLUS 1

MULTI-VIT WITH FLUORIDE-IRON PV CN

MYFERON 150 FORTE EX

MYNATAL ADVANCE 1

13

Drug Tier NotesMYNATAL ORAL CAPSULE 1

MYNATAL PLUS 1

MYNATAL-Z 1

NATACHEW (FE BIS-GLYCINATE) 4

NEEVODHA (WITH ALGAL OIL) 4

NESTABS 4

NESTABS ABC 4

NESTABS DHA 4

NESTABS ONE 4

NEULASTA 4 PA; SP; OCH

NEUPOGEN 4 PA; SP; OCH

NEWGEN 4

NEXA PLUS 4

NIVESTYM 3 SP; OCH

NOCDURNA (MEN) 4

NOCDURNA (WOMEN) 4

NOCTIVA EX

NOVAFERRUM ORAL DROPS PV CN

NOVOEIGHT MB SP

NOVOSEVEN RT MB SP

NPLATE 4 SP; OCH

NUWIQ MB SP

OB COMPLETE ONE EX

OB COMPLETE ORAL TABLET EX

OB COMPLETE PETITE EX

OB COMPLETE PREMIER EX

OB COMPLETE WITH DHA EX

OBIZUR MB SP

OBSTETRIX DHA 1

OBSTETRIX EC 4

OBSTETRIX ONE 4

OBTREX DHA 4

O-CAL PRENATAL 4

PEDIA IRON PV CN

pentoxifylline 1

PLAVIX ORAL TABLET 75 MG EX

PNV 29-1 1

PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 1

PNV-DHA 1

PNV-DHA + DOCUSATE 1

PNV-FERROUS FUMARATE-DOCU-FA 1

PNV-OMEGA 1

PNV-SELECT 1

POLY-IRON 150 FORTE EX

POLY-VI-FLOR WITH IRON PV

PR NATAL 400 1

PR NATAL 400 EC 1

PR NATAL 430 1

PR NATAL 430 EC 1

Drug Tier NotesPRADAXA EX

prasugrel 1

PREFERA-OB 4

PREFERA-OB ONE 4

PREFERA-OB PLUS DHA 4

PRENA1 PEARL 1

PRENA1 TRUE 1

PRENAISSANCE 1

PRENAISSANCE PLUS 1

PRENATA 4

PRENATABS FA 1

PRENATABS RX 1

PRENATAL LOW IRON 1

PRENATAL PLUS 1

PRENATAL PLUS (CALCIUM CARB) 1

PRENATAL PLUS DHA ORAL COMBO PACK 4

PRENATAL VITAMIN PLUS LOW IRON 1

PRENATE DHA 4

PRENATE DHA (FERR ASP GLYCIN) 4

PRENATE ELITE 4

PRENATE ELITE (IRON ASP GLYC) 4

PRENATE ENHANCE 4

PRENATE ESSENTIAL 4

PRENATE ESSENTIAL(IRON-ASP-GL) 4

PRENATE MINI (FERR ASP GLYCIN) 4

PRENATE PIXIE 4

PRENATE RESTORE 4

PRENATE STAR 4

PREPLUS 1

PRETAB 1

PRIMACARE 4

PROCRIT 4 SP; OCH

PROFILNINE MB SP

PROMACTA 4 PA; SP; OCH

PROVIDA DHA 4

PROVIDA OB 4

PUREFE OB PLUS 4

PUREVIT DUALFE PLUS 1

QUFLORA FE PV

QUFLORA FE (FERROUS SULFATE) PV

REBINYN MB SP

RECOMBINATE MB SP

RETACRIT 4 SP

RIASTAP MB SP

RIXUBIS MB SP

R-NATAL OB 4

14

Drug Tier NotesSAVAYSA EX

SELECT-OB 4

SELECT-OB (FOLIC ACID) 4

SELECT-OB + DHA 4

SE-NATAL 19 1

SE-NATAL 19 (WITH DOCUSATE) 1

SE-TAN PLUS 1

ST JOSEPH ASPIRIN PV

STIMATE 4 SP

TARON FORTE 1

TARON-C DHA 1

TARON-PREX PRENATAL-DHA 1

TAVALISSE 4 PA; SP

THRIVITE RX 4

THRIVITE-19 1

TL-SELECT 1

tranexamic acid oral 1

TRETTEN MB SP

TRIADVANCE 1

TRICARE 4

TRICON 1

TRIGELS-F FORTE 1

TRINATAL RX 1 1

TRINATE 1

TRISTART DHA 4

TRIVEEN-DUO DHA 1

TRIVEEN-ONE 1

TRIVEEN-PRX RNF 1

UDENYCA 4 PA; SP; OCH

VENA-BAL DHA 1

VINACAL 1

VINATE CARE 1

VINATE DHA RF EX

VINATE GT 1

VINATE M 1

VINATE ONE 1

VINATE ULTRA 1

VIRT-ADVANCE 1

VIRT-C DHA 1

VIRT-NATE DHA 4

VIRT-PN DHA 1

VIRT-PN PLUS 1

VIRTPREX 4

VIRT-SELECT 1

VIRT-VITE GT 1

VITAFOL FE+ (WITH DOCUSATE) 4

VITAFOL GUMMIES 4

VITAFOL NANO 4

VITAFOL ULTRA 4

VITAFOL-OB 4

Drug Tier NotesVITAFOL-OB+DHA 4

VITAFOL-ONE 4

VITAMED MD ONE RX 4

VITAPEARL 4

VITATRUE 4

VONVENDI MB SP

VP-CH PLUS 4

VP-CH-PNV 1

VP-PNV-DHA 4

warfarin 1

WILATE MB SP

XARELTO 2

XYNTHA MB SP

XYNTHA SOLOFUSE MB SP

YOSPRALA EX

ZARXIO 4 PA; SP; OCH

ZATEAN-PN DHA 1

ZATEAN-PN PLUS 1

ZONTIVITY 4

Cardiovascular Drugs

ACCUPRIL 4

ACCURETIC 4

acebutolol 1

acetazolamide 1

ADALAT CC 4

ADCIRCA 4 PA; SP

ADEMPAS 4 SP

AFEDITAB CR 1

AGGRENOX 4

ALDACTAZIDE 4

ALDACTONE 4

aliskiren 4

ALTACE 4

ALTOPREV EX

ALYQ 3 SP

ambrisentan 3 SP

amiloride 1

amiloride-hydrochlorothiazide 1

amiodarone oral 1

amlodipine 1

amlodipine-atorvastatin 4

amlodipine-benazepril 1

amlodipine-olmesartan 4

amlodipine-valsartan 1

amlodipine-valsartan-hcthiazid 1

ANTARA ORAL CAPSULE 30 MG, 90 MG 4


ATACAND EX

ATACAND HCT EX

atenolol 1


15

Drug Tier Notesatorvastatin oral tablet 10 mg, 20 mg PV CN

atorvastatin oral tablet 40 mg, 80 mg 1

AVALIDE EX

AVAPRO EX

AZOR EX

benazepril 1

benazepril-hydrochlorothiazide 1

BENICAR EX

BENICAR HCT EX

BETAPACE 4

BETAPACE AF 4

betaxolol oral 1

BIDIL 4

bisoprolol fumarate 1


bosentan 4 SP

bumetanide injection 4

bumetanide oral 1

BYSTOLIC 4

CADUET ORAL TABLET 10-10 MG, 10-20 MG, 10-40 MG, 10-80 MG, 5-10 MG, 5-20 MG, 5-40 MG, 5-80 MG

4

CALAN 4

CALAN SR 4

candesartan 1

candesartan-hydrochlorothiazid 1

captopril 1

captopril-hydrochlorothiazide 1

CARDIZEM CD 4

CARDIZEM LA 4

CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG 4

CARDURA 4

CARDURA XL 4

CAROSPIR EX

CARTIA XT 1

carvedilol 1

carvedilol phosphate 1

CATAPRES 4

CATAPRES-TTS-1 4

CATAPRES-TTS-2 4

CATAPRES-TTS-3 4

chlorothiazide 1

chlorthalidone oral tablet 25 mg, 50 mg 1

cholestyramine (with sugar) 1

CHOLESTYRAMINE LIGHT 1

CIALIS EX

cilostazol 1

clonidine 4

clonidine hcl 1

Drug Tier NotesCLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1

CLORPRES ORAL TABLET0.3-15 MG 2

colesevelam 4

COLESTID 4

COLESTID FLAVORED 4

colestipol 1

COREG EX

COREG CR 4

CORGARD 4

CORLANOR 4 PA

COZAAR EX

CRESTOR EX

DEMADEX ORAL TABLET 20 MG 4

DIBENZYLINE 4

DIGITEK 1

DIGOX 1

digoxin injection 4

digoxin oral solution 50 mcg/ml 1

digoxin oral tablet 1

DILANTIN 2

DILANTIN EXTENDED 2

DILANTIN INFATABS 4

DILANTIN KAPSEAL ORAL CAPSULE 100 MG 2

DILANTIN-125 2

DILATRATE-SR 2

diltiazem hcl oral 1

DILT-XR 1

DIOVAN EX

DIOVAN HCT EX

dipyridamole oral 1

disopyramide phosphate oral capsule 1

DIURIL 4

dofetilide 4

doxazosin 1

DUTOPROL 4

DYAZIDE 4

DYRENIUM 4

EDARBI EX

EDARBYCLOR EX

EDECRIN 4

ELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4

enalapril maleate 1

enalapril-hydrochlorothiazide 1

ENTRESTO 2 PA

EPANED ORAL SOLUTION 4

eplerenone 1

epoprostenol (glycine) MB SP

16

Drug Tier Noteseprosartan 1

ethacrynic acid 4

EXFORGE EX

EXFORGE HCT EX

EZALLOR SPRINKLE EX

ezetimibe 1

ezetimibe-simvastatin 1

felodipine 1

fenofibrate micronized 1

fenofibrate nanocrystallized oral tablet 145 mg, 48 mg 1

fenofibrate nanocrystallized oral tablet 160 mg 4

fenofibrate oral capsule 2

fenofibrate oral tablet 1

fenofibric acid 1

fenofibric acid (choline) 1

FENOGLIDE 4

FIBRICOR 4

flecainide 1

FLOLAN MB SP

FLOLIPID EX

fluvastatin PV CN

fosinopril 1

fosinopril-hydrochlorothiazide 1

furosemide injection solution 4

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 1

furosemide oral solution 40 mg/4 ml 2

furosemide oral tablet 1

gemfibrozil 1

GONITRO 4

guanfacine 1

HEMANGEOL EX SP

hydralazine oral 1

hydrochlorothiazide 1

HYZAAR EX

indapamide 1

INDERAL LA EX

INDERAL XL 4

INNOPRAN XL EX

INSPRA 4

INTUNIV ER 4

irbesartan 1

irbesartan-hydrochlorothiazide 1

ISOCHRON 4

ISORDIL 4

ISORDIL TITRADOSE ORAL TABLET 5 MG 4

isosorbide dinitrate oral 1

isosorbide mononitrate 1

isoxsuprine 1

Drug Tier Notesisradipine 1

JUXTAPID 4 PA; SP

KAPSPARGO SPRINKLE 2

KAPVAY 4

labetalol oral 1

LANOXIN ORAL 4

LANOXIN PEDIATRIC 4

LASIX 4

LESCOL 4

LESCOL XL 4

LETAIRIS 3 SP

LEVATOL 4

LEVITRA ORAL TABLET 10 MG, 2.5 MG, 20 MG EX

LIPITOR EX

LIPOFEN 4

lisinopril 1

lisinopril-hydrochlorothiazide 1

LIVALO EX

LOPID 4

LOPRESSOR HCT 4

LOPRESSOR ORAL 4

losartan 1

losartan-hydrochlorothiazide 1

LOTENSIN HCT 4

LOTENSIN ORAL TABLET 10 MG, 20 MG, 40 MG 4

LOTREL ORAL CAPSULE 10-20 MG, 10-40 MG, 5-10 MG, 5-20 MG, 5-40 MG

EX

lovastatin PV CN

LOVAZA 4

MATZIM LA 1

MAXZIDE 4

MAXZIDE-25MG 4

methyclothiazide 4

methyldopa 1


metolazone 1

metoprolol succinate 1


4


metoprolol tartrate oral 1

mexiletine 1

MICARDIS EX

MICARDIS HCT EX

MICROZIDE 4

MINIPRESS 4

MINITRAN 2

minoxidil oral 1

moexipril 1

17

Drug Tier NotesMULTAQ 4

nadolol 4

nadolol-bendroflumethiazide oral tablet 80-5 mg 4

niacin oral tablet 500 mg 4

niacin oral tablet extended release 24 hr 1

NIACOR 4

NIASPAN EXTENDED-RELEASE 4

nicardipine oral 1

nifedipine 1

nimodipine 1

nisoldipine 4

NITRO-BID 1

NITRO-DUR 4

nitroglycerin oral 1

nitroglycerin sublingual 1

nitroglycerin transdermal patch 24 hour 1

nitroglycerin translingual spray,non-aerosol 1

NITROLINGUAL 4

NITROMIST 4

NITROSTAT 4

NITRO-TIME 1

NORPACE 4

NORPACE CR 4

NORVASC EX

NYMALIZE 4

olmesartan 1

olmesartan-amlodipin-hcthiazid 4

olmesartan-hydrochlorothiazide 1

omega-3 acid ethyl esters 4

OPSUMIT 4 SP

ORENITRAM 4 SP

PACERONE ORAL TABLET100 MG, 200 MG, 400 MG 1

perindopril erbumine 1

phenoxybenzamine 4

PHENYTEK 4

phenytoin oral suspension 1

phenytoin oral tablet,chewable 1

phenytoin sodium extended 1

pindolol 1

PRALUENT PEN 2 PA

PRAVACHOL ORAL TABLET20 MG, 40 MG, 80 MG 4

pravastatin PV CN

prazosin 1

PRESTALIA 4

PREVALITE ORAL POWDER 4

PREVALITE ORAL POWDER IN PACKET 1

Drug Tier NotesPRINIVIL ORAL TABLET 10 MG, 20 MG, 5 MG 4

procainamide injection 4

PROCARDIA 4

PROCARDIA XL 4

propafenone 1

propranolol oral 1


QBRELIS 4

QUESTRAN 4

QUESTRAN LIGHT ORAL POWDER 4

quinapril 1

quinapril-hydrochlorothiazide 1

quinidine gluconate oral 1

quinidine sulfate oral tablet 1

ramipril 1

RANEXA 4

ranolazine 4

REMODULIN 4 SP

REPATHA PUSHTRONEX 2 PA

REPATHA SURECLICK 2 PA

REPATHA SYRINGE 2 PA

REVATIO INTRAVENOUS MB SP

REVATIO ORAL SUSPENSION FOR RECONSTITUTION 3 SP

REVATIO ORAL TABLET 4 PA; SP

rosuvastatin oral tablet 10 mg, 5 mg PV CN

rosuvastatin oral tablet 20 mg, 40 mg 1

RYTHMOL SR 4

sildenafil EX

sildenafil (antihypertensive) intravenous MB SP

sildenafil (antihypertensive) oral suspension for reconstitution 3 SP

sildenafil (antihypertensive) oral tablet 4 PA; SP

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg PV CN

simvastatin oral tablet 80 mg 1

SORINE 1

SOTALOL AF 1

sotalol oral 1

SOTYLIZE 4

spironolactone 1

spironolacton-hydrochlorothiaz 1

STAXYN EX

STENDRA EX

SULAR ORAL TABLET EXTENDED RELEASE 24 HR17 MG, 34 MG, 8.5 MG

4

tadalafil EX

tadalafil (antihypertensive) 3 PA; SP

18

Drug Tier NotesTARKA ORAL TABLET, IR - ER, BIPHASIC 24HR 2-180 MG, 2-240 MG, 4-240 MG

4

TAZTIA XT 1

TEKTURNA 4

TEKTURNA HCT 4

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hydrochlorothiazid 1

TENORETIC 100 4

TENORETIC 50 4

TENORMIN 4

terazosin 1

THEO-24 4

THEOCHRON 1

theophylline oral elixir 1

theophylline oral solution 1

theophylline oral tablet extended release 12 hr 1


TIAZAC 4

TIKOSYN 4


TOPROL XL 2

torsemide oral 1

TRACLEER 3 SP

trandolapril 1

trandolapril-verapamil 4

treprostinil sodium 4 SP

triamterene-hydrochlorothiazid 1

TRIBENZOR EX

TRICOR EX

TRIGLIDE ORAL TABLET 160 MG 4

TRIKLO 4

TRILIPIX 4

TWYNSTA 4

TYVASO 4 SP

TYVASO INSTITUTIONAL START KIT 4 SP

TYVASO REFILL KIT 4 SP

TYVASO STARTER KIT 4 SP

UPTRAVI 4 SP

valsartan 1

valsartan-hydrochlorothiazide 1

vardenafil EX

VARITHENA MB SP

VASCEPA EX

VASERETIC 4

VASOTEC 4

VECAMYL 4

VELETRI MB SP

Drug Tier NotesVENTAVIS 4 SP

verapamil oral 1

VERELAN 4

VERELAN PM 4

VIAGRA EX

VIT 3 1

VYNDAQEL EX

VYTORIN 10-10 EX

VYTORIN 10-20 EX

VYTORIN 10-40 EX

VYTORIN 10-80 EX

WELCHOL EX

ZESTORETIC 4

ZESTRIL 4

ZETIA EX

ZIAC 4

ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 80 MG EX

ZYPITAMAG EX PA

Cellular And Gene Therapy

KYMRIAH MB SP

LUXTURNA MB SP

YESCARTA MB SP

ZOLGENSMA MB SP

Central Nervous System Agents

ABILIFY MAINTENA 4

ABILIFY MYCITE 4

ABILIFY ORAL TABLET 4

ABSTRAL EX

acamprosate 1

acetaminophen-caff-dihydrocod oral capsule 1 PA

acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml

1 PA

acetaminophen-codeine oral tablet 1 PA

ACTIQ EX

ACTIVE-PAC EX

ADASUVE 4

ADDERALL 4

ADDERALL XR 4

ADDYI 4

ADHANSIA XR 4 PA

ADULT ASPIRIN REGIMEN PV CN

ADULT LOW DOSE ASPIRIN PV CN

ADZENYS ER 4 PA

ADZENYS XR-ODT 4 PA

AGGRENOX 4

AIMOVIG AUTOINJECTOR 2 PA

AJOVY EX

19

Drug Tier NotesALLZITAL EX

almotriptan malate 1 QL (18 Tablets per 30 days)

alprazolam 1

ALPRAZOLAM INTENSOL 4

ALSUMA 4 QL (8 ML per 30 days)

amantadine hcl 1

AMBIEN 4

AMBIEN CR 4

AMERGE EX QL (18 EA per 30 days)

amitriptyline 1

amitriptyline-chlordiazepoxide 1

amoxapine 1

amphetamine sulfate 4

ANAFRANIL 4

ANAPROX DS 4

APADAZ 4 PA

APLENZIN 4 PA

APOKYN 4 SP

APTENSIO XR 4 PA

APTIOM 4

aripiprazole 1

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML, 662 MG/2.4 ML, 882 MG/3.2 ML

4

armodafinil 4

ARTHROTEC 50 4

ARTHROTEC 75 4

ARYMO ER 4 PA; QL (90 EA per 30 days)

ASCOMP WITH CODEINE 1 PA

ASPIR-81 PV CN

ASPIRIN CHILDRENS PV CN

ASPIRIN LOW DOSE PV CN

aspirin oral tablet PV CN

aspirin oral tablet,chewable PV CN

aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg PV CN


ASPIR-LOW PV CN

ASPIR-TRIN PV CN

ATIVAN ORAL 4

atomoxetine 1

AUSTEDO 4 PA; SP

AZILECT 4

BANZEL 4

BAYER ASPIRIN PV CN

BAYER CHEWABLE ASPIRIN PV CN

BELBUCA 4 PA

belladonna alkaloids-opium 1 PA

BELSOMRA 4 PA

Drug Tier Notesbenzhydrocodone-acetaminophen 4 PA

benztropine injection 4

benztropine oral 1

BRISDELLE EX

BRIVIACT ORAL 4

bromocriptine 1

BUNAVAIL BUCCAL FILM 2.1-0.3 MG, 4.2-0.7 MG 4 QL (90 EA Max Qty

Per Fill Retail)

BUNAVAIL BUCCAL FILM 6.3-1 MG 4 QL (60 EA Max Qty

Per Fill Retail)

BUPAP ORAL TABLET 50-300 MG EX

BUPRENEX MB PA

buprenorphine 4 PA

buprenorphine hcl injection MB PA

buprenorphine hcl sublingual 1 PA

buprenorphine-naloxone sublingual film 12-3 mg 1 QL (60 EA Max Qty

Per Fill Retail)

buprenorphine-naloxone sublingual film 2-0.5 mg, 4-1 mg, 8-2 mg

1 QL (90 EA Max Qty Per Fill Retail)

buprenorphine-naloxone sublingual tablet 1 QL (90 EA per 30

days)

bupropion hcl (smoking deter) PV CN

bupropion hcl oral tablet 1

bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg

1

bupropion hcl oral tablet extended release 24 hr 450 mg 4 PA

bupropion hcl oral tablet sustained-release 12 hr 1

buspirone 1

BUTALBITAL COMPOUND W/CODEINE 1 PA

butalbital-acetaminop-caf-cod 4 PA

butalbital-acetaminophen EX

butalbital-acetaminophen-caff oral capsule 1

butalbital-acetaminophen-caff oral tablet 50-325-40 mg 1

butalbital-aspirin-caffeine 1

BUTISOL ORAL TABLET 30 MG 4

butorphanol tartrate injection 4 PA

butorphanol tartrate nasal 1 PA; QL (5 ML per 30 days)

BUTRANS EX PA

cabergoline 1

CAFERGOT EX

caffeine citrate oral 1

CAMBIA EX

CAPSFENAC PAK EX

CAPXIB EX

carbamazepine 1

CARBATROL 4

20

Drug Tier Notescarbidopa 1

carbidopa-levodopa 1

carbidopa-levodopa-entacapone 1

carisoprodol-asa-codeine 1 PA

carisoprodol-aspirin 1

CELEBREX EX

celecoxib 1

CELEXA ORAL TABLET EX

CELONTIN ORAL CAPSULE300 MG 4

CHERATUSSIN AC 1

CHILDREN'S ASPIRIN PV CN

chlordiazepoxide hcl 1

chlordiazepoxide-clidinium 4

chlorpromazine 4

choline,magnesium salicylate 1

citalopram 1

clobazam 4

clomipramine 1

clonazepam 1

clorazepate dipotassium 1

clozapine oral tablet 1

clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 25 mg

1

clozapine oral tablet,disintegrating 150 mg, 200 mg

2

CLOZARIL 4

codeine sulfate oral tablet 1 PA

codeine-butalbital-asa-caff 1 PA

codeine-guaifenesin 1

CODITUSSIN AC 4

COMFORT PAC-IBUPROFEN EX

COMFORT PAC-MELOXICAM EX

COMFORT PAC-NAPROXEN EX

COMPAZINE 4

COMPRO 1

COMTAN 4

CONCERTA 4

CONZIP 4 PA

COTEMPLA XR-ODT 4 PA

CYCLOSET 4

CYMBALTA 4

D.H.E.45 EX

DAYPRO 4

DAYTRANA 4 PA

DEMEROL ORAL TABLET 100 MG 4 PA

DEPAKENE ORAL CAPSULE 4

DEPAKOTE 4

DEPAKOTE ER 4

DEPAKOTE SPRINKLES 4

Drug Tier NotesDERMACINRX LEXITRAL EX

desipramine 1

DESOXYN 4

desvenlafaxine 4 PA

desvenlafaxine succinate 4

DEXEDRINE SPANSULE 4

dexmethylphenidate 1

dextroamphetamine 1

dextroamphetamine-amphetamine 1

DIACOMIT EX SP

DIASTAT EX

DIASTAT ACUDIAL 4

diazepam injection solution 1

diazepam injection syringe MB

DIAZEPAM INTENSOL 1

diazepam oral 1

DICLO GEL EX

DICLO GEL-XRYLIX SHEET EX

diclofenac epolamine EX

diclofenac potassium 1

diclofenac sodium oral 1

diclofenac sodium topical drops 4

diclofenac sodium topical gel 1 % 4

diclofenac-misoprostol 4

DICLOFEX DC EX

DICLOFONO EX

DICLOPAK EX PA

DICLOPR EX PA

DICLOTRAL EX

DICLOVIX EX

DICLOZOR EX

diflunisal 1

dihydroergotamine injection 1

dihydroergotamine nasal 4 QL (8 Vials per 30 days)

DILANTIN 2

DILANTIN EXTENDED 2

DILANTIN INFATABS 4

DILANTIN KAPSEAL ORAL CAPSULE 100 MG 2

DILANTIN-125 2

DILAUDID 4 PA

DISALCID 4

DISKETS 1 PA

DITHOL EX

divalproex 1

DOLOPHINE ORAL 4 PA

DONNATAL ORAL ELIXIR 16.2 MG-0.1037 MG/5 ML (5 ML), 16.2-0.1037 -0.0194 MG/5 ML

4

DONNATAL ORAL TABLET 4

DORAL 4

21

Drug Tier Notesdoxepin oral 1

DUEXIS EX

duloxetine 1

DUOPA MB SP

DURAGESIC EX PA

DURLAZA 4

DVORAH 4 PA

DYANAVEL XR 4 PA

E.C. PRIN PV CN

EC-NAPROSYN 4

EC-NAPROXEN 1

ECOTRIN PV CN

ECOTRIN LOW STRENGTH PV CN

EDLUAR 4 PA

EFFEXOR XR 4

ELDEPRYL 4

eletriptan 1 QL (18 EA per 30 days)

EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL

EX PA; QL (90 Tablets per 30 days)

EMGALITY PEN 2 PA

EMGALITY SYRINGE 2 PA

EMSAM 4

ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG

1 PA

entacapone 1

ENTERIC COATED ASPIRIN PV CN

EPIDIOLEX 4 PA; SP

EPITOL 1

EQUETRO 4

ERGOMAR EX

ergotamine-caffeine 1

escitalopram oxalate 1

ESGIC EX

estazolam 1

eszopiclone 4

ethosuximide 1

etodolac 1

EVEKEO 4 PA

EVEKEO ODT 4 PA

EVZIO INJECTION AUTO-INJECTOR 2 MG/0.4 ML EX

EXALGO ER ORAL TABLET EXTENDED RELEASE 24 HR16 MG

4 PA; QL (60 EA per 30 days)

FANAPT 4 PA

FAZACLO 4

felbamate 1

FELBATOL 4

FELDENE EX

fenoprofen oral capsule EX PA

fenoprofen oral tablet EX

Drug Tier NotesFENORTHO ORAL CAPSULE200 MG EX

fentanyl 1 PA

fentanyl citrate buccal lozenge on a handle 4 PA

fentanyl citrate buccal tablet, effervescent EX

FENTORA EX

FETZIMA 4 PA

FIORICET ORAL CAPSULE EX

FIORINAL EX

FIORINAL-CODEINE #3 EX PA

FLECTOR EX

FLEXIPAK EX PA

fluoxetine oral capsule 1

fluoxetine oral capsule,delayed release(dr/ec) 1

fluoxetine oral solution 1

fluoxetine oral tablet 10 mg, 20 mg 1

fluoxetine oral tablet 60 mg 1 PA

fluphenazine hcl injection 4

fluphenazine hcl oral 1

flurazepam 1

flurbiprofen 1

fluvoxamine 1

FOCALIN 4

FOCALIN XR 4

FORFIVO XL 4 PA

FROVA EX QL (18 EA per 30 days)

frovatriptan 1 QL (18 EA per 30 days)

FYCOMPA ORAL SUSPENSION 4

FYCOMPA ORAL TABLET 4

gabapentin oral capsule 1

gabapentin oral solution 1

gabapentin oral tablet 600 mg, 800 mg 1

GABITRIL 4

GEODON 4

GOCOVRI EX SP

GRALISE 4 PA

GRALISE 30-DAY STARTER PACK 4 PA

GUAIATUSSIN AC 1

GUAIFENESIN AC 1

GUAIFENESIN DAC 1

guanfacine 1

HALCION ORAL TABLET 0.25 MG 4

HALDOL 4

haloperidol 1

haloperidol lactate injection 4

22

Drug Tier Noteshaloperidol lactate oral 1

HEMANGEOL EX SP

HETLIOZ 4 PA; SP

HISTEX-AC 1

HORIZANT EX

HYCET 4 PA


hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 7.5-325 mg/15 ml

1 PA

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

1 PA





hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg

1 PA

HYDROMET 1

hydromorphone (pf) injection solution 10 mg/ml MB

hydromorphone injection syringe0.5 mg/0.5 ml EX

hydromorphone oral liquid 1 PA

hydromorphone oral tablet 1 PA

hydromorphone oral tablet extended release 24 hr 1 PA; QL (60 EA per

30 days)

hydromorphone rectal 1 PA

hydroxyzine hcl intramuscular solution 50 mg/ml MB

hydroxyzine hcl oral 1

hydroxyzine pamoate 1

HYSINGLA ER 4 PA

IBU 1

IBUDONE 4 PA

ibuprofen oral suspension 1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg 1

ibuprofen-oxycodone 1 PA

imipramine hcl 1

imipramine pamoate 4

IMITREX NASAL EX QL (18 EA per 30 days)

IMITREX ORAL EX QL (18 EA per 30 days)

IMITREX STATDOSE PEN EX QL (8 Injections per 30 days)

IMITREX STATDOSE REFILL EX QL (8 Injections per 30 days)

IMITREX SUBCUTANEOUS EX QL (8 Injections per 30 days)

INBRIJA 4 PA; SP

Drug Tier NotesINDERAL LA EX

INDERAL XL 4

INDOCIN ORAL EX PA

INDOCIN RECTAL EX

indomethacin oral 1

INFLAMMACIN EX

INFLAMMA-K EX

INGREZZA 4 PA; SP

INGREZZA INITIATION PACK 4 PA; SP

INNOPRAN XL EX

INTERMEZZO 4

INTUNIV ER 4

INVEGA 4

INVEGA SUSTENNA 4

INVEGA TRINZA 4

isometh-dichloral-acetaminophn 1

JORNAY PM 4 PA

KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG


KEPPRA ORAL 4

KEPPRA XR 4

ketoprofen oral capsule 4

ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg 4

ketorolac injection cartridge 4

ketorolac injection solution 1

ketorolac intramuscular solution 1

ketorolac intramuscular syringe 4

ketorolac oral 1

KHEDEZLA 4 PA

KLONOPIN 4

LAMICTAL ODT 4

LAMICTAL ODT STARTER (BLUE) 4

LAMICTAL ODT STARTER (GREEN) 4

LAMICTAL ODT STARTER (ORANGE) 4

LAMICTAL ORAL TABLET 4

LAMICTAL ORAL TABLET, CHEWABLE DISPERSIBLE 25 MG, 5 MG

4

LAMICTAL STARTER (BLUE) KIT 4

LAMICTAL STARTER (GREEN) KIT 4

LAMICTAL STARTER (ORANGE) KIT 4

LAMICTAL XR 4

LAMICTAL XR STARTER (BLUE) 4

LAMICTAL XR STARTER (GREEN) 4

23

Drug Tier NotesLAMICTAL XR STARTER (ORANGE) 4

lamotrigine 1

LATUDA 4 PA

LAZANDA EX

levetiracetam oral 1

levorphanol tartrate EX

LEXAPRO ORAL TABLET EX

LEXIXRYL EX

LIBRAX (WITH CLIDINIUM) EX

LIDOXIB EX

LITE COAT ASPIRIN PV CN

lithium carbonate 1

lithium citrate 1

LITHOBID 4

LODINE ORAL TABLET 4

LODOSYN 4

LORAZEPAM INTENSOL 1

lorazepam oral 1

LORCET (HYDROCODONE) 1 PA

LORCET HD 1 PA

LORCET PLUS ORAL TABLET7.5-325 MG 4 PA

LORTAB ELIXIR ORAL SOLUTION 10-300 MG/15 ML 4 PA


loxapine succinate 1

LUNESTA 4

LYRICA 4 PA

LYRICA CR 4 PA

maprotiline 1

MARPLAN 4

MAXALT ORAL TABLET 10 MG EX QL (18 EA per 30 days)

MAXALT-MLT EX QL (18 EA per 30 days)

meclofenamate 4

mefenamic acid 4

meloxicam 1

memantine oral capsule,sprinkle,er 24hr 4

memantine oral solution 1

memantine oral tablet 1

memantine oral tablets,dose pack 2

meperidine injection cartridge 4 PA

meperidine oral 1 PA

meprobamate 4

METADATE ER 4

METHADONE INTENSOL 1 PA

methadone oral concentrate 1 PA

methadone oral solution 1 PA

methadone oral tablet 1 PA

methadone oral tablet,soluble 1 PA

Drug Tier NotesMETHADOSE ORAL CONCENTRATE 4 PA

METHADOSE ORAL TABLET,SOLUBLE 1 PA

methamphetamine 1

METHYLIN ORAL SOLUTION 4

methylphenidate hcl oral capsule, er biphasic 30-70 1

methylphenidate hcl oral capsule,er biphasic 50-50 1

methylphenidate hcl oral solution 1

methylphenidate hcl oral tablet 1

methylphenidate hcl oral tablet extended release 1

methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg

1

methylphenidate hcl oral tablet extended release 24hr 72 mg 4 PA

methylphenidate hcl oral tablet,chewable 1

midazolam oral syrup 10 mg/5 ml (2 mg/ml) 4

midazolam oral syrup 2 mg/ml 1

MIGERGOT 1

MIGRANAL EX QL (8 Vials per 30 days)

MIGRANOW EX

MIRAPEX 4

MIRAPEX ER 4

mirtazapine oral tablet 1

mirtazapine oral tablet,disintegrating 4

MOBIC ORAL TABLET 4

modafinil 4

molindone 1

MORPHABOND ER 4 PA; QL (60 EA per 30 days)

morphine concentrate oral solution 1 PA

morphine concentrate oral syringe 10 mg/0.5 ml 4 PA

morphine concentrate oral syringe 20 mg/ml EX

morphine intramuscular EX

morphine oral capsule, er multiphase 24 hr 1 PA; QL (60 EA per

30 days)

morphine oral capsule,extend.release pellets 1 PA; QL (90 EA per

30 days)

morphine oral solution 1 PA

morphine oral tablet 1 PA

morphine oral tablet extended release 100 mg, 200 mg 1 PA; QL (120 EA per

30 days)

morphine oral tablet extended release 15 mg, 30 mg, 60 mg 1 PA; QL (60 EA per

30 days)

morphine rectal 1 PA

MS CONTIN 4 PA; QL (120 EA per 30 days)

24

Drug Tier NotesMYDAYIS 4 PA

MYSOLINE 4

nabumetone 1

NALFON ORAL CAPSULE 400 MG EX

NALFON ORAL TABLET EX

NALOCET 4 PA

naloxone 1

naltrexone 1

NAMENDA ORAL TABLET 4

NAMENDA TITRATION PAK 4

NAMENDA XR EX

NAMZARIC 4

NAPRELAN CR EX

NAPROSYN ORAL SUSPENSION 4

NAPROSYN ORAL TABLET500 MG 4

naproxen 1

naproxen sodium oral tablet 275 mg, 550 mg 1

naproxen sodium oral tablet, er multiphase 24 hr EX

naratriptan 1 QL (18 EA per 30 days)

NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 4

NARDIL 4

nefazodone 4

NEUPRO EX

NEURONTIN 4

NORCO ORAL TABLET 10-325 MG EX PA

NORCO ORAL TABLET 5-325 MG, 7.5-325 MG EX

NORGESIC FORTE EX

NORPRAMIN ORAL TABLET10 MG, 25 MG 4

nortriptyline 1

NUCYNTA 4 PA; QL (181 EA Max Qty Per Fill Retail)

NUCYNTA ER 4 PA; QL (60 EA per 30 days)

NUDICLO SOLUPAK EX

NUDICLO TABPAK EX

NUDROXIPAK EX

NUDROXIPAK DSDR-50 EX


NUDROXIPAK E-400 EX

NUDROXIPAK I-800 EX

NUDROXIPAK N-500 EX

NUEDEXTA 4

NUPLAZID ORAL CAPSULE 4 PA; SP

NUPLAZID ORAL TABLET 10 MG 4 PA; SP

NUVIGIL EX

Drug Tier NotesOBREDON EX

olanzapine intramuscular 4

olanzapine oral 1

olanzapine-fluoxetine 1

ONFI ORAL SUSPENSION 4

ONFI ORAL TABLET 10 MG, 20 MG 4

ONZETRA XSAIL EX QL (16 units per 30 days)

OPANA ORAL EX PA

opium tincture 4

ORAP 4

OSMOLEX ER EX

oxaprozin 1

OXAYDO 4 PA

oxazepam 1

oxcarbazepine 1

OXTELLAR XR 4

oxycodone oral capsule 1 PA

oxycodone oral concentrate 1 PA

oxycodone oral solution 1 PA

oxycodone oral syringe 4 PA

oxycodone oral tablet 1 PA

oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg

EX PA; QL (90 EA per 30 days)

oxycodone oral tablet,oral only,ext.rel.12 hr 60 mg, 80 mg EX PA; QL (120 EA per

30 days)

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 PA

oxycodone-aspirin 1 PA

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG


OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 60 MG, 80 MG


oxymorphone oral tablet 1 PA

oxymorphone oral tablet extended release 12 hr 1 PA; QL (90 EA per

30 days)

paliperidone 1

PAMELOR 4

PARLODEL 4

PARNATE 4

paroxetine hcl oral tablet 1

paroxetine hcl oral tablet extended release 24 hr 1

paroxetine mesylate(menop.sym) 1

PAXIL 4

PAXIL CR 4

PEGANONE 4

PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP

EX

25

Drug Tier Notespentazocine-naloxone 1 PA

PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG

EX PA

perphenazine 1

perphenazine-amitriptyline 1

PERSERIS EX

PEXEVA 4 PA

PHENADOZ 1

phenelzine 1

PHENERGAN RECTAL 4

phenobarb-hyoscy-atropine-scop oral elixir 4

phenobarb-hyoscy-atropine-scop oral tablet 1

phenobarbital 1

PHENOHYTRO ORAL ELIXIR 4

PHENOHYTRO ORAL TABLET 1

PHENYTEK 4

phenytoin oral suspension 1

phenytoin oral tablet,chewable 1

phenytoin sodium extended 1

PHRENILIN FORTE(WITH CAFFEINE) EX

pimozide 1

piroxicam 1

pramipexole 1

PRIALT MB SP

primidone 1

PRIMLEV 4 PA

PRISTIQ 4

PROBUPHINE MB SP

PROCENTRA 1

prochlorperazine 1

prochlorperazine edisylate 4

prochlorperazine maleate 1


promethazine oral 1

promethazine rectal 1

promethazine-codeine 1


PROMETHEGAN 1

propranolol oral 1

protriptyline 1

PROVIGIL 4

PROZAC ORAL CAPSULE EX

QMIIZ ODT EX

quazepam 4

QUDEXY XR 4

quetiapine oral tablet 1

quetiapine oral tablet extended release 24 hr 4

QUILLICHEW ER 4 PA

Drug Tier NotesQUILLIVANT XR 4 PA

RADICAVA MB SP

rasagiline 4

RELEXXII 4 PA

RELPAX EX QL (18 EA per 30 days)

REMERON ORAL TABLET 15 MG, 30 MG 4

REMERON SOLTAB 4

REPREXAIN ORAL TABLET2.5-200 MG 1

REQUIP ORAL TABLET 0.25 MG, 3 MG, 5 MG 4

REQUIP XL 4

RESTORIL 4

REVIA 4

REXULTI 4 PA

RILUTEK 4

riluzole 1

RISPERDAL 4

RISPERDAL CONSTA 4

risperidone oral solution 1

risperidone oral syringe 4

risperidone oral tablet 1

risperidone oral tablet,disintegrating 1

RITALIN 4

RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-5010 MG, 20 MG, 30 MG, 40 MG

4

rizatriptan 1 QL (18 EA per 30 days)

ropinirole 1

ROWEEPRA 1

ROWEEPRA XR 1

ROXICODONE EX PA

ROXYBOND 4 PA

ROZEREM 4 PA

RYDEX 1

RYTARY EX

SABRIL 4 SP

salsalate 1

SAPHRIS 4 PA

SARAFEM ORAL TABLET 10 MG, 20 MG 4

SAVELLA 4 PA

SECONAL SODIUM 1

selegiline hcl 1

SEROQUEL 4

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 4

sertraline 1

SILENOR 4

SINEMET 4

SINEMET CR 4

26

Drug Tier NotesSMARTRX GABAKIT EX

SMARTRX GABA-V KIT EX

SOLUPAK EX

SPRAVATO MB SP

SPRITAM 4

SPRIX EX SP

ST JOSEPH ASPIRIN PV

STALEVO 100 4

STALEVO 125 4

STALEVO 150 4

STALEVO 200 4

STALEVO 50 4

STALEVO 75 4

STRATTERA 4

SUBLOCADE MB SP

SUBOXONE SUBLINGUAL FILM 12-3 MG 4 QL (60 EA Max Qty

Per Fill Retail)

SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG 4 QL (90 EA Max Qty

Per Fill Retail)

SUBSYS EX

SUBVENITE 4

SUBVENITE STARTER (BLUE) KIT 4

SUBVENITE STARTER (GREEN) KIT 4

SUBVENITE STARTER (ORANGE) KIT 4

sulindac 1

sumatriptan 1 QL (18 UNITS per 30 days)

sumatriptan succinate oral 1 QL (18 EA per 30 days)

sumatriptan succinate subcutaneous cartridge 1 QL (8 Injections per

30 days)

sumatriptan succinate subcutaneous pen injector 1 QL (8 Injections per

30 days)

sumatriptan succinate subcutaneous solution 1 QL (8 Injections per

30 days)

sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml

1 QL (8 ML per 30 days)

sumatriptan-naproxen EX PA; QL (18 EA per 30 Days)

SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 4 MG/0.5 ML

EX QL (8 ML per 30 days)

SUNOSI 4 PA; QL (30 EA per 30 days)

SURE RESULT DSS PREMIUM PACK EX

SYMBYAX ORAL CAPSULE 12-50 MG, 3-25 MG, 6-25 MG, 6-50 MG

4

SYMPAZAN 4 PA

TASMAR ORAL TABLET 100 MG 4

TEGRETOL ORAL SUSPENSION 4

Drug Tier NotesTEGRETOL ORAL TABLET 4

TEGRETOL XR 4

temazepam 1

TENCON ORAL TABLET 50-325 MG 1

tetrabenazine 4 SP

thioridazine 1

thiothixene 1

tiagabine 1


TIVORBEX EX

TOFRANIL 4

tolcapone 1

tolmetin 1

TOPAMAX 4

topiramate oral capsule, sprinkle 1

topiramate oral capsule,sprinkle,er 24hr 4

topiramate oral tablet 1

tramadol oral capsule,er biphase 24 hr 17-83 4 PA

tramadol oral capsule,er biphase 24 hr 25-75 4 PA

tramadol oral tablet 1 PA

tramadol oral tablet extended release 24 hr 1 PA

tramadol oral tablet, er multiphase 24 hr 1 PA

tramadol-acetaminophen 1 PA

TRANXENE T-TAB ORAL TABLET 7.5 MG 4

tranylcypromine 1

trazodone 1

TREXIMET ORAL TABLET 85-500 MG EX PA; QL (18 EA per

30 days)

TREZIX ORAL CAPSULE 320.5-30-16 MG 4 PA

triazolam 1

trifluoperazine 1

trihexyphenidyl 1

TRILEPTAL 4

trimipramine 1

TRINTELLIX 4 PA

TRIXYLITRAL EX

TROKENDI XR 4

TUSNEL C 1

TUSSICAPS 4

TYLENOL-CODEINE #3 4 PA

TYLENOL-CODEINE #4 4 PA

ULTRACET 4 PA

ULTRAM 4 PA

ULTRAM ER ORAL TABLET EXTENDED RELEASE 24 HR300 MG

4 PA

VALIUM 4

27

Drug Tier Notesvalproic acid 1

valproic acid (as sodium salt) oral solution 1

VANATOL LQ EX

VANATOL S EX

venlafaxine 1

VERDROCET 1 PA

VERSACLOZ 4 PA

VICODIN 4 PA

VICODIN ES 4 PA

VICODIN HP 4 PA

vigabatrin 3 SP

VIGADRONE 3 SP

VIIBRYD ORAL TABLET 4 PA

VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)

4 PA

VIMOVO EX

VIMPAT ORAL SOLUTION 4

VIMPAT ORAL TABLET 4

VIRTUSSIN AC 1

VIRTUSSIN DAC 1

VISTARIL 4

VIVITROL MB SP

VIVLODEX EX

VOLTAREN TOPICAL 4

VOLTAREN-XR 4

VRAYLAR 4 PA

VYVANSE 4 PA

WELLBUTRIN SR 4

WELLBUTRIN XL 4

WPR PLUS EX

XADAGO EX

XANAX 4

XANAX XR 4

XELITRAL EX

XENAFLAMM EX

XENAZINE EX SP

XRYLIX (DICLOFENAC-KINES TAPE) EX

XTAMPZA ER 4 PA

XYLON 10 4 PA

XYREM 4 PA; QL (540 ML per 30 days)

YOSPRALA EX

zaleplon 1

ZARONTIN 4

ZEBUTAL ORAL CAPSULE 50-325-40 MG EX

ZELAPAR 4

ZEMBRACE SYMTOUCH EX PA; QL (8 Injections per 30 days)

ZENZEDI ORAL TABLET 10 MG, 5 MG 4

Drug Tier NotesZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

4 PA

ziprasidone hcl 1

ZIPSOR EX

ZOHYDRO ER ORAL CAPSULE, ORAL ONLY, ER 12HR


zolmitriptan 1 QL (18 EA per 30 days)

ZOLOFT EX

zolpidem 1

ZOLPIMIST 4 PA

ZOMIG NASAL EX PA; QL (18 UNITS per 30 days)

ZOMIG ORAL EX QL (18 EA per 30 days)

ZOMIG ZMT EX QL (18 EA per 30 days)

ZONEGRAN ORAL CAPSULE100 MG, 25 MG EX

zonisamide 1

ZORVOLEX 4 PA

ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 1.4-0.36 MG, 2.9-0.71 MG, 5.7-1.4 MG

EX QL (90 EA per 30 days)

ZUBSOLV SUBLINGUAL TABLET 11.4-2.9 MG EX QL (30 EA per 30

days)

ZUBSOLV SUBLINGUAL TABLET 8.6-2.1 MG EX QL (60 EA per 30

days)

ZYBAN 4

ZYPREXA 4

ZYPREXA RELPREVV 4

ZYPREXA ZYDIS 4

Contraceptives (E.G. Foams, Devices)

CAYA CONTOURED PV CN

FC2 FEMALE CONDOM PV CN

FEMCAP PV CN

GYNOL II PV CN

TODAY CONTRACEPTIVE SPONGE PV CN

VAGINAL CONTRACEPTIVE FILM PV CN

VAGINAL CONTRACEPTIVE FOAM PV CN

VCF CONTRACEPTIVE FILM PV CN

VCF CONTRACEPTIVE GEL PV CN

WIDE-SEAL DIAPHRAGM 60 PV CN








28

Drug Tier NotesDevices

1ST TIER UNIFINE PENTIPS 2

1ST TIER UNIFINE PENTIPS PLUS 2

1ST TIER UNILET COMFORTOUCH 2

2TEK CONTROL (HIGH-NORMAL) 2

ACCUCAINE KIT EX

ACCU-CHEK AVIVA CONTROL SOLN 2

ACCU-CHEK COMP BLUE CONT, M-H 2

ACCU-CHEK COMPACT PLUS CONTROL 2

ACCU-CHEK FASTCLIX LANCET DRUM 2

ACCU-CHEK GUIDE L1-L2 CTRL SOL 2

ACCU-CHEK MULTICLIX LANCET 2

ACCU-CHEK SAFE-T-PRO 2

ACCU-CHEK SAFE-T-PRO PLUS 2

ACCU-CHEK SMARTVIEW CONTRL SOL 2

ACCU-CHEK SOFTCLIX LANCETS 2

ACCUTREND GLUCOSE CONTROL 2

ACE AEROSOL CLOUD ENHANCER 2

ACTI-LANCE LANCETS 2

ACUICYN 1

ADVANCED TRAVEL LANCETS 2

ADVOCATE CONTROL SOLUTION HIGH 2

ADVOCATE LANCET 2

ADVOCATE LOW CONTROL 2

ADVOCATE PEN NEEDLE 2

ADVOCATE REDI-CODE+ CTRL HIGH 2

ADVOCATE REDI-CODE+ CTRL LOW 2

ADVOCATE SYRINGES 2

AEROCHAMBER PLUS FLOW-VU 2

AEROCHAMBER PLUS FLOW-VU,L MSK 2

AEROCHAMBER PLUS FLOW-VU,M MSK 2

AEROCHAMBER PLUS FLOW-VU,S MSK 2

AEROGEAR ACTION ASTHMA KIT 4

AEROTRACH PLUS 4

AGAMATRIX CONTROL HIGH 2

Drug Tier NotesAGAMATRIX CONTROL NORM-HI 2

AIRZONE PEAK FLOW METER 4

ALEVICYN PLUS EX

ALLERGIST TRAY 1/2 ML 27GX3/8" SYRINGE 2

ALLERGIST TRAY INTRADERMAL BEV SYRINGE 2

ALLERGIST TRAY REGULAR BEVEL SYRINGE 2

ALLERGY SYRINGE SYRINGE1 ML 27 GAUGE X 3/8", 1 ML 27 X 1/2"

2

ALTERNATE SITE LANCET 2

AQUORAL EX

ASSURE 4 CONTROL SOLUTION 2

ASSURE DOSE NORMAL CONTROL 2

ASSURE DOSE NORM-HI CONTROL 2

ASSURE HAEMOLANCE PLUS18 GAUGE, 21 GAUGE, 25 GAUGE, 28 GAUGE

2

ASSURE ID INSULIN SAFETY 2

ASSURE ID PEN NEEDLE 2

ASSURE LANCE 2

ASSURE LANCE PLUS 2

ASSURE PRISM CONTROL 1-2 SOLN 2

ASTERO EX

ASTHMA CHECK METER 4

ATOPICLAIR EX

ATRAPRO CP EX

ATRAPRO DERMAL SPRAY EX

ATRAPRO HYDROGEL EX

AUTOJECT 2 INJECTION DEVICE 4

AUTOPEN 1 TO 21 UNITS 4

AUTOPEN 2 TO 42 UNITS 4

AVENOVA EX

AVO CREAM EX

BD ALLERGIST TRAY REG BEVEL SYRINGE 2

BD ALLERGIST TRAY REG BEVEL TRAY 1/2 ML 27 X 1/2" 2

BD ALLERGY SYRINGE SYRINGE 1 ML 28 GAUGE X 1/2"

2

BD AUTOSHIELD DUO PEN NEEDLE 2

BD BULK LUER-LOK NON-STERILE SYRINGE 20 ML, 5 ML, 60 ML

2

BD BULK SLIP TIP NON-STERILE SYRINGE 10 ML, 20 ML, 60 ML

2

BD BULK SYRINGE SLIP TIP 2

BD ECCENTRIC TIP SYRINGE 2

29

Drug Tier NotesBD ECLIPSE 2

BD ECLIPSE LUER-LOK 2

BD FILTER NEEDLE 5-MICRON NOKO 2

BD FILTER NEEDLE-5 MICRON 2

BD INSULIN SYRINGE 2

BD INSULIN SYRINGE HALF UNIT SYRINGE 0.3 ML 31 GAUGE X 5/16"

2

BD INSULIN SYRINGE MICRO-FINE SYRINGE 1 ML 28 GAUGE X 1/2"

2

BD INSULIN SYRINGE SAFETY-LOK 2

BD INSULIN SYRINGE SLIP TIP 2

BD INSULIN SYRINGE U-500 2

BD INSULIN SYRINGE ULTRA-FINE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 1/2", 0.5 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 31 GAUGE X 5/16

2

BD INTEGRA NEEDLE 2

BD INTEGRA SYRINGE SYRINGE 3 ML 21 GAUGE X 1 1/2", 3 ML 22 GAUGE X 1 1/2", 3 ML 23 GAUGE X 1", 3 ML 25 GAUGE X 1", 3 ML 25 GAUGE X 5/8"

2

BD INTRADERMAL BEVEL NEEDLES 2

BD LAB ECCENTRIC NON-STERILE 2

BD LO-DOSE MICRO-FINE IV SYRINGE 1/2 ML 28 GAUGE X 1/2"

2

BD LO-DOSE ULTRA-FINE SYRINGE 0.5 ML 29 GAUGE X 1/2"

2

BD LUER-LOK BULK SYRINGE 2

BD LUER-LOK SYRINGE SYRINGE 1 ML, 1 ML 20 GAUGE X 1", 10 ML, 10 ML 20 X 1 1/2", 10 ML 20 X 1", 10 ML 21 GAUGE X 1", 10 ML 21 X 1 1/2", 10 ML 22 X 1", 10 ML 23X 1 1/4 ", 20 ML, 3 ML, 3 ML 18 X 1 1/2", 3 ML 20 GAUGE X 1 1/2", 3 ML 20 GAUGE X 1", 3 ML 21 GAUGE X 1 1/2", 3 ML 21 GAUGE X 1", 3 ML 22 GAUGE X 1", 3 ML 22 X 1 1/2", 3 ML 23 GAUGE X 1 1/2", 3 ML 23 X 1", 3 ML 25 GAUGE X 1", 3 ML 25 X 1 1/2 ", 3 ML 25 X 5/8", 3 ML 26 X 5/8", 5 ML, 5 ML 20 X 1 1/2", 5 ML 20 X 1", 5 ML 21 GAUGE X 1 1/2", 5 ML 21 GAUGE X 1", 60 ML

2

BD LUER-LOK TIP CONTROL SYRING 2

BD MICROTAINER LANCET 2

BD NANO 2ND GEN PEN NEEDLE 2

Drug Tier NotesBD NOKOR ADMIX NEEDLE 2

BD PRECISIONGLIDE 2

BD PRECISIONGLIDE NON-STERILE 2

BD PRE-FILLED NORMAL SALINE 1

BD REGULAR BEVEL NEEDLES 2

BD SAFETYGLIDE ALLERGIST TRAY 2

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 31 GAUGE X 15/64", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 15/64", 1 ML 29 GAUGE X 1/2", 1 ML 31 GAUGE X 15/64"

2

BD SAFETYGLIDE NEEDLE 2

BD SAFETYGLIDE SHIELDING REG 2

BD SAFETYGLIDE SYRINGE 2

BD SAFETYGLIDE TB REG BEVEL 2

BD SAFETYGLIDE TUBERCULIN 2

BD SAFETY-LOK DETACHABLE NEEDL 2

BD SAFETY-LOK TUBERCULIN 2

BD SAFETY-LOK WITH LUER-LOK 2

BD SHORT BEVEL NEEDLES 2

BD SHORT BEVEL THIN WALL 2

B-D SLIP TIP SYRINGE 2

BD SLIP TIP SYRINGE SYRINGE 1 ML 26 GAUGE X 5/8", 10 ML, 3 ML

2

BD SPECIALTY USE NEEDLES NEEDLE 16 GAUGE X 1 1/2", 16 GAUGE X 1", 21 GAUGE X 2", 23 GAUGE X 1 1/4", 25 GAUGE X 7/8", 27 GAUGE X 1 1/4", 30 GAUGE X 1/2"

2

BD SPECIALTY USE NEEDLES NEEDLE 30 GAUGE X 1" 1

BD SYRINGE BULK STERILE PAK 2

BD SYRINGE SYRINGE 1 ML, 60 ML 2

BD TUBERCULIN SLIP-TIP 2

BD TUBERCULIN SYRINGE SYRINGE 1 ML 21 GAUGE X 1", 1 ML 25 GAUGE X 5/8", 1 ML 26 GAUGE X 3/8", 1 ML 27 X 1/2", 1/2 ML 27 X 1/2 "

2

BD ULTRA FINE LANCETS 2

BD ULTRA-FINE II LANCETS 2

BD ULTRA-FINE MICRO PEN NEEDLE 2

BD ULTRA-FINE MINI PEN NEEDLE 2

30

Drug Tier NotesBD ULTRA-FINE NANO PEN NEEDLE 2

BD ULTRA-FINE ORIG PEN NEEDLE 2

BD ULTRA-FINE SHORT PEN NEEDLE 2

BD VEO INSULIN SYR HALF UNIT 2

BD VEO INSULIN SYRINGE UF 2

BEAU RX EX

BIAFINE EMULSION EX

BIONECT TOPICAL CREAM EX

BIONECT TOPICAL FOAM EX

BIONECT TOPICAL GEL EX

BREATHERITE MDI SPACER 4

BREATHERITE VALVED MDI CHAMBER 4

BREATHERITE VALVED MDI SPACER 4

BREEZE 2 CONTROL SOLUTION, NML 2

BULLSEYE MINI SAFETY LANCETS 2

CAPHOSOL EX

CAREFINE PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"

2

CAREONE THIN LANCET 2

CAREONE ULTRA THIN LANCET 2

CARESENS LANCETS 2

CARETOUCH INSULIN SYRINGE 2

CARETOUCH PEN NEEDLE 2

CARETOUCH TWIST LANCET 2

CELACYN POST PROCEDURE EX

CERAMAX TOPICAL CREAM EX

CLEVER CHEK LANCETS 2

CLEVER CHOICE LEVEL 1 CONTROL 2



CLICKFINE PEN NEEDLE 2

COAGUCHEK LANCETS 2

COLOR LANCETS 2

COMFORT EZ INSULIN SYRINGE 2

COMFORT EZ LANCETS 21 GAUGE, 28 GAUGE 2

COMFORT EZ PEN NEEDLES 2

COMFORT LANCETS 2

CONTOUR CONTROL SOLUTION, LOW 2

Drug Tier NotesCONTOUR NEXT LEV 1 CONTROL SOL 2

CONTOUR NEXT LEV 2 CONTROL SOL 2

COOL CONTROL A SOLUTION 2

COOL CONTROL B SOLUTION 2

CYCLOTENS REFILL EX

CYCLOTENS STARTER EX

DIATRUE CONTROL SOLN NORMAL 2

DIATRUE CONTROL SOLUTION HIGH 2

DIATRUE CONTROL SOLUTION LOW 2

DROPLET INSULIN SYRINGE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 15/64", 0.3 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 31 GAUGE X 15/64", 1 ML 31 GAUGE X 5/16

2

DROPLET LANCETS 2

DROPLET PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"

2

DUROLANE MB SP

EASIVENT HOLDING CHAMBER 4

EASIVENT MASK LARGE 4

EASIVENT MASK MEDIUM 4

EASIVENT MASK SMALL 4

EASY COMFORT INSULIN SYRINGE 2

EASY COMFORT LANCETS 2

EASY COMFORT PEN NEEDLES 2

EASY GLIDE CATHETER TIP SYRING 2

EASY GLIDE INSULIN SYRINGE 2

EASY GLIDE LUER LOCK SYRINGE SYRINGE 3 ML, 60 ML

2

EASY PLUS II HIGH CONTROL 2

EASY TOUCH FLIPLOCK SYRINGE SYRINGE 3 ML 22 GAUGE X 1"

2

EASY TOUCH FLURINGE FLIPLOCK SYRINGE 1 ML 25 GAUGE X 5/8"

2

EASY TOUCH FLURINGE SHEATHLOCK SYRINGE 1 ML 25 GAUGE X 5/8"

2

EASY TOUCH FLURINGE SYRINGE 1 ML 25 GAUGE X 1" 2

EASY TOUCH HIGH-LOW CONTROL 2

31

Drug Tier NotesEASY TOUCH INSULIN SYRINGE 2

EASY TOUCH LANCETS 2

EASY TOUCH LUER LOCK INSULIN 2

EASY TOUCH LUER LOCK SYRINGE SYRINGE 3 ML, 5 ML 2

EASY TOUCH NEEDLE 2

EASY TOUCH SAFETY LANCETS 2

EASY TOUCH SHEATHLOCK SYRG-NDL SYRINGE 3 ML 22 GAUGE X 1"

2

EASY TOUCH SHEATHLOCK SYRINGE SYRINGE 3 ML, 5 ML 2

EASY TOUCH SYRINGE 1 ML 25 GAUGE X 1", 3 ML 22 X 1 1/2"

2

EASY TOUCH TUBERCULIN SHEATHLK SYRINGE 1 ML 25 GAUGE X 5/8"

2

EASY TOUCH TWIST LANCETS 2

EASY TOUCH UNI-SLIP SYRINGE 1 ML, 3 ML, 5 ML 2

EASY TRAK HIGH CONTROL 2

EASY TRAK LOW CONTROL 2

EASY TWIST AND CAP LANCETS 2

EASYMAX LOW CONTROL 2

EASYMAX NORMAL CONTROL 2

ELEMENT COMPACT HIGH CONTROL 2

ELEMENT COMPACT NORMAL CONTROL 2

ELEMENT HIGH CONTROL 2

ELEMENT LOW CONTROL 2

ELEMENT NORMAL CONTROL 2

ELETONE EX

EMBRACE GLUCOSE CONTROL HIGH 2

EMBRACE LANCETS 2

EMULSION SB EX

EPICERAM EX

EPISIL EX

EUFLEXXA MB SP

EVENCARE G3 CONTROL 2

EVOLUTION NORMAL CONTROL 2

EXEL HYPODERMIC NEEDLES NEEDLE 21 GAUGE X 1" 2

EXEL INSULIN SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 1 ML 30 GAUGE X 5/16, 1/2 ML 28 GAUGE X 1/2"

2

EXEL SYRINGE SYRINGE 3 ML 23 GAUGE X 1 1/2" 2

E-Z JECT LANCETS 2

Drug Tier NotesE-Z JECT THIN LANCETS 2

EZ SMART LANCETS 2

FEMCAP PV CN

FIFTY50 SAFETY SEAL LANCETS 2

FINE 30 UNIVERSAL LANCETS 2

FINGERSTIX LANCETS 2

FORA GTEL KETONE TEST STRIP EX

FORA GTEL MULTI-FUNCTN MONITOR EX

FORA HIGH CONTROL 2

FORA LOW CONTROL 2

FORA NORMAL CONTROL 2

FORA V10-V12-D10-D20 STRP-LNCT 4 PA

FORACARE GDH HIGH CONTROL 2

FORACARE GDH LOW CONTROL 2

FORACARE GDH NORMAL CONTROL 2

FORACARE LANCETS 2

FREESTYLE CONTROL 2

FREESTYLE LANCETS 2

FREESTYLE LIBRE 10 DAY READER MB

FREESTYLE LIBRE 10 DAY SENSOR 4

FREESTYLE LIBRE 14 DAY READER MB

FREESTYLE LIBRE 14 DAY SENSOR 4

FREESTYLE PRECISION 2

FREESTYLE UNISTIK 2 2

GE100 CONTROL SOLUTION NORMAL 2

GELCLAIR EX

GEL-ONE MB SP

GELSYN-3 MB SP

GELX EX

GENADUR EX

GENADUR (WITH LEXINAL) EX

GENVISC 850 MB SP

GLUCOCARD 01 NORMAL CONTROL 2

GLUCOCARD SHINE 2

GLUCOCOM LANCETS 2

GLUCOSE CONTROL 2

HEALTHWISE INSULIN SYRINGE 2

HEALTHWISE PEN NEEDLE 2

HEALTHY ACCENTS UNIFINE PENTIP 2

HEALTHY ACCENTS UNILET LANCET 2

HEPARIN LOCK MB

32

Drug Tier Notesheparin lock flush (porcine) intravenous syringe 100 unit/ml MB

HPR EX

HPR PLUS EX

HPR PLUS HYDROGEL EX

HPR PLUS-MB HYDROGEL EX

huber safety needles (disp.) 2

HYALGAN MB SP

HYLATOPIC EX

HYLATOPICPLUS TOPICAL CREAM EX

HYLATOPICPLUS TOPICAL FOAM EX

HYMOVIS MB SP

HYPER-SAL 4

INCONTROL PEN NEEDLE 2

INCONTROL SUPER THIN LANCETS 2

INCONTROL ULTRA THIN LANCETS 2

INFINITY CONTROL SOLUTION HIGH 2

INFINITY CONTROL SOLUTION LOW 2

INFINITY CONTROL SOLUTION NORM 2

INJECT EASE LANCETS 2

insulin syr/ndl u100 half mark 2

INSULIN SYRINGE MICROFINE SYRINGE 1/2 ML 28 GAUGE X 1/2"

2

insulin syringe needleless 2

INSULIN SYRINGE SYRINGE0.5 ML 29 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2"

2

insulin syringe-needle u-100 syringe 0.3 ml 29 gauge, 0.3 ml 29 gauge x 1/2", 0.3 ml 30, 0.3 ml 30 gauge x 1/2", 0.3 ml 30 gauge x 5/16", 0.3 ml 31 gauge x 1/4", 0.3 ml 31 gauge x 15/64", 0.3 ml 31 gauge x 5/16", 0.5 ml 29 gauge x 1/2", 0.5 ml 30 gauge x 1/2", 0.5 ml 30 gauge x 5/16", 0.5 ml 31 gauge x 5/16", 1 ml 28 gauge, 1 ml 28 gauge x 1/2", 1 ml 29 gauge x 1/2", 1 ml 29 gauge x 7/16", 1 ml 30 gauge x 1/2", 1 ml 30 gauge x 3/8", 1 ml 30 gauge x 5/16, 1 ml 30 gauge x 7/16", 1 ml 31 gauge x 1/4", 1 ml 31 gauge x 15/64", 1 ml 31 gauge x 5/16, 1/2 ml 28 gauge, 1/2 ml 28 gauge x 1/2", 1/2 ml 29 , 1/2 ml 30 gauge, 1/2 ml 31 gauge x 1/4", 1/2 ml 31 gauge x 15/64"

2

INSUPEN NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32", 33 GAUGE X 5/32"

2

INVACARE LANCETS 2

Drug Tier NotesKAMDOY EX

lancets 2

LANCETS, SUPER THIN 2

LANCETS,THIN 2

LANCETS,ULTRA THIN 2

LDO PLUS EX

LIDOTREX EX

LIDOTREX (WITH VITAMIN E) EX

LITE TOUCH INSULIN PEN NEEDLES 2

LITE TOUCH INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 28 GAUGE, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 30 GAUGE X 7/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 29 , 1/2 ML 30 GAUGE

2

LITE TOUCH LANCETS 2

LITEAIRE MDI CHAMBER 4

LITETOUCH-LARGE MASK 4

LITETOUCH-SMALL MASK 4

LOUTREX EX

LUER LOCK SYRINGE 2

LYCELLE EX

MAXI-COMFORT INSULIN SYRINGE 2

MB HYDROGEL EX

MB HYDROGEL (CYCLOMETHICONE) EX

MEDISENSE MID CONTROL 2

MEDISENSE THIN LANCETS 2

MEDLANCE PLUS LANCETS 2

MEDPOINT NORMAL CONTROL 2

MICRO THIN LANCETS 2

MICROCHAMBER 4

MICROCYN EX

MICROCYN HYDROGEL EX

MICRODOT HIGH-LOW CONTROL 2

MICRODOT INSULIN PEN NEEDLE NEEDLE 31 GAUGE X 1/4", 32 GAUGE X 5/32"

2

MICRODOT NORMAL CONTROL 2

MICROLET LANCET 2

MICROSPACER 4

MINI ULTRA-THIN II 2

MONOJECT ALLERGY TRAY TRAY 1 ML 28 X 1/2" 2

33

Drug Tier NotesMONOJECT DISPOSABLE SYRINGE 2

MONOJECT HYPODERMIC NEEDLES NEEDLE 14 GAUGE X 1"

2

MONOJECT INSULIN SAFETY SYRING 2

MONOJECT INSULIN SYRINGE 2

MONOJECT LUER-LOCK TIP SYRINGE 3 ML 2

MONOJECT MAGELLAN SYRINGE SYRINGE 1 ML 25 GAUGE X 5/8"

2

MONOJECT PHARMACY TRAY LUER SYRINGE 20 ML, 3 ML, 60 ML

2

MONOJECT REG TIP NON-STERILE SYRINGE 20 ML, 3 ML

2

MONOJECT SAFETY LUER LOCK TIP 2

MONOJECT SAFETY SYRINGES SYRINGE 3 ML 21 GAUGE X 1 1/2", 3 ML 22 GAUGE X 1", 3 ML 23 GAUGE X 1"

2

MONOJECT SYRINGE ECCENTRI LUER 2

MONOJECT SYRINGE LUER LOK SYRINGE 60 ML 2

MONOJECT SYRINGE REGULAR LUER 2

MONOJECT SYRINGE SYRINGE 1/2 ML 28 GAUGE, 3 ML, 3 ML 20 GAUGE X 1 1/2", 3 ML 21 GAUGE X 1 1/2", 3 ML 22 X 1 1/2"

2

MONOJECT SYRINGE TOOMEY TYPE 2

MONOJECT TUBERCULIN SYRINGE SYRINGE 1 ML 26 GAUGE X 3/8"

2

MONOJECT ULTRA COMFORT INSULIN 2

MONOLET LANCETS 2

MONOLET THIN LANCETS 2

MONOVISC MB SP

MUGARD 4

MYGLUCOHEALTH CONTROL SOLUTION 2

MYGLUCOHEALTH LANCETS 2

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %

4

needle (disp) 16 g 2



needle (disp) 23 gauge 1

NEOSALUS EX

NEUTRASAL MUCOUS MEMBRANE POWDER IN PACKET

EX

Drug Tier NotesNIVATOPIC PLUS EX

NOKOR NEEDLE 2

NORMAL SALINE FLUSH 1

NORM-JECT SYRINGE 10 ML, 20 ML 2

NOVA MAX GLUCOSE CONTROL 2

NOVA SAFETY LANCETS 2

NOVA SUREFLEX LANCETS 2

NOVOFINE 32 2

NOVOFINE PLUS 2

NOVOPEN ECHO 4

NUVAIL EX

ON CALL LANCET 2

ON CALL PLUS CONTROL 2

ON CALL PLUS LANCET 2

ON CALL VIVID CONTROL 2

ONETOUCH DELICA LANCETS 2

ONETOUCH SURESOFT LANCING DEV 21 GAUGE, 28 GAUGE

2

ONETOUCH ULTRA CONTROL 2

ONETOUCH ULTRASOFT LANCETS 2

ONETOUCH VERIO HIGH CONTROL 2

ONETOUCH VERIO MID CONTROL 2

ON-THE-GO LANCETS 2

OPTICHAMBER ADULT MASK-LARGE 4

OPTICHAMBER DIAMOND LG MASK 4

OPTICHAMBER DIAMOND-MED MSK 4

OPTICHAMBER DIAMOND-SML MASK 4

ORAMAGICRX EX

ORTHOVISC MB SP

PANDA MASK 4

PEDIATRIC PANDA MASK 4

PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"

2

pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 1/4", 31 gauge x 3/16", 31 gauge x 5/16", 32 gauge x 1/4", 32 gauge x 3/16", 32 gauge x 5/32"

2

PENTIPS 2

PISTON SYRINGE WITH ENFIT 2

POCKET CHAMBER 4

POLY HUB NEEDLE NEEDLE18 GAUGE X 1 1/2", 18 GAUGE X 1", 23 GAUGE X 1"

2

PR CREAM EX

34

Drug Tier NotesPRECISION XTRA B-KETONE 4

PRESERA EX

PRESSURE ACTIVATED LANCETS 2

PRIMEAIRE 4

PRO COMFORT INSULIN SYRINGE 2

PRO COMFORT LANCET 30 GAUGE 2

PRO COMFORT PEN NEEDLE 2

PROCHAMBER 4

PRODIGY CONTROL SOLUTION, LOW 2

PRODIGY CONTROL SOLUTION,HIGH 2

PRODIGY INSULIN SYRINGE 2

PRODIGY LANCETS 2

PRODIGY TWIST TOP LANCET 2

PROMISEB EX

PROTHELIAL MB SP

PRUCLAIR EX

PRUMYX EX

PRUTECT EX

PULMOSAL 4

PUSH BUTTON SAFETY LANCETS 2

RADIAPLEXRX EX

READYLANCE SAFETY LANCETS 21 GAUGE, 26 GAUGE, 28 GAUGE, 30 GAUGE

2

RECEDO EX

REFUAH PLUS GLUCOSE CONTROL 2

REGENECARE EX

REGENECARE WITH ALOE EX

RELIAMED LANCET 28 GAUGE, 30 GAUGE 2

RELIAMED SAFETY SEAL LANCETS 2

RELIAMED TWIST AND CAP LANCET 2

RELION NEEDLES 2

RELION PEN NEEDLES 2

RELION THIN LANCETS 2

RELION ULTRA THIN PLUS LANCETS 2

RIGHTEST CONTROL SOLUTION HIGH 2

RIGHTEST CONTROL SOLUTION NORM 2

RIGHTEST GL300 LANCETS 2

SAFESNAP INSULIN SYRINGE SYRINGE 0.3 ML 30 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 1 ML 28 GAUGE X 1/2"

2

Drug Tier NotesSAFESNAP SYRINGE SYRINGE 1 ML 25 GAUGE X 5/8"

2

SAFETY LANCETS 2

safety needles 2

SAFETY SEAL LANCETS 2

SAFETY-LET LANCETS 2

SALIVAMAX EX

SIDESTREAM PEDIATRIC FACE MASK 4

SILVRSTAT 2

SINGLE-LET 2

SMART SENSE LANCETS 2

SMARTEST CONTROL 2

SMARTEST LANCET 2

sodium chloride 0.9 % (flush) injection syringe MB

sodium chloride inhalation 1

SOFT TOUCH LANCETS 2

SOLUS V2 CONTROL SOLUTION, LOW 2

SOLUS V2 CONTROL SOLUTION,HIGH 2

SOLUS V2 LANCETS 2

SONAFINE EX

SP ANTIPRURITIC EX

SPRAY AND STRETCH 4

STERILANCE TL 30 GAUGE 2

SUPARTZ FX MB SP

SUPER THIN LANCETS , 28 GAUGE, 30 GAUGE 2

SURE COMFORT INS. SYR. U-100 2

SURE COMFORT INSULIN SYRINGE 2

SURE COMFORT LANCETS 21 GAUGE, 28 GAUGE, 30 GAUGE

2

SURE COMFORT PEN NEEDLE 2

SURE-FINE PEN NEEDLES 2

SURE-JECT INSULIN SYRINGE 2

SURE-LANCE 2

SURE-LANCE ULTRA THIN 2

SURE-TOUCH LANCET 2

SURGUARD2 SAFETY NEEDLE 18 GAUGE X 1 1/2" 2

SURGUARD2 SAFETY SYRINGE 1 ML 25 GAUGE X 5/8", 3 ML 22 GAUGE X 1"

2

SUVICORT EX

SYNVISC MB SP

SYNVISC-ONE MB SP

syringe (disposable) 2

syringe (reusable) 2

SYRINGE 3CC/21GX1-1/2" 2

syringe with needle 2

35

Drug Tier Notessyringe with needle, safety 2

TECHLITE INSULIN SYRINGE 2

TECHLITE LANCETS 2

TECHLITE PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32"

2

TELCARE CONTROL 2

TELCARE LANCETS 2

TERUMO INSULIN SYRINGE SYRINGE 0.3 ML 30 X 3/8", 0.5 ML 29 GAUGE X 1/2", 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1/2 ML 28 GAUGE X 1/2", 1/2 ML 30 X 3/8"

2

TERUMO SYRINGE SYRINGE 3 ML 23 GAUGE X 1 1/2", 30 ML 2

THIN LANCETS 2

THINPRO INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 X 3/8", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 31 X 3/8", 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 3/8", 1/2 ML 28 GAUGE X 1/2", 1/2 ML 30 X 3/8"

2

TOPCARE CLICKFINE 2

TOPCARE ULTRA COMFORT 2

TOPCARE UNIVERSAL1 LANCET 2

TRIVISC MB SP

TRUE COMFORT INSULIN SYRINGE 2

TRUE COMFORT LANCET 2

TRUE COMFORT PEN NEEDLE 2

TRUEPLUS INSULIN 2

TRUEPLUS LANCETS 2

TRUEPLUS PEN NEEDLE 2

TUBERCULIN SYRINGE SYRINGE 1 ML 25 GAUGE X 1", 1 ML 27 X 1/2"

2

tuberculin-allergy syringes 2

TWIST LANCETS 30 GAUGE 2

ULTICARE INSULIN SYR HALF UNIT 2

ULTICARE INSULIN SYRINGE 2

ULTICARE PEN NEEDLE 2

ULTICARE SAFETY SYRINGE SYRINGE 3 ML 22 GAUGE X 1" 2

ULTICARE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 1/2", 0.5 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 31 GAUGE X 5/16

2

ULTILET BASIC LANCETS 2

ULTILET CLASSIC LANCETS 2

Drug Tier NotesULTILET INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE, 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 31 GAUGE X 5/16, 1/2 ML 29

2

ULTILET LANCETS 2

ULTILET PEN NEEDLE 2

ULTRA COMFORT INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30, 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 28 GAUGE, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 30 GAUGE X 7/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 29 , 1/2 ML 30 GAUGE

2

ULTRA FINE LANCETS 2

ULTRA FLO PEN NEEDLE 2

ULTRA THIN II LANCETS 2

ULTRA THIN LANCETS , 28 GAUGE, 30 GAUGE, 33 GAUGE

2

ULTRA THIN PLUS LANCETS 2

ULTRA TLC LANCETS 2

ULTRACARE INSULIN SYRINGE 2

ULTRA-CARE LANCETS 2

ULTRACARE PEN NEEDLE NEEDLE 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"

2

ULTRALANCE LANCETS 2

ULTRA-THIN II (SHORT) INS SYR 2

ULTRA-THIN II (SHORT) PEN NDL 2

ULTRA-THIN II INS PEN NEEDLES 2

ULTRA-THIN II INSULIN SYRINGE SYRINGE 0.5 ML 29 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2"

2

ULTRA-THIN II LANCETS 28 GAUGE 2

ULTRATRAK HIGH-LOW CONTROL 2

ULTRATRAK NORMAL CONTROL 2

36

Drug Tier NotesUNIFINE PENTIPS NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32"

2

UNIFINE PENTIPS PLUS NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"

2

UNILET COMFORTOUCH LANCET 2

UNILET EXCELITE II LANCET 2

UNILET EXCELITE LANCET 2

UNILET GP LANCET 2

UNILET LANCET 28 GAUGE, 33 GAUGE 2

UNILET LANCETS 2

UNILET SUPER THIN LANCETS 2

UNISTIK 3 COMFORT LANCET 2

UNISTIK 3 EXTRA LANCET 2

UNISTIK 3 GENTLE 2

UNISTIK 3 LANCETS 2

UNISTIK 3 NORMAL LANCET 2

UNISTIK CZT LANCET 2

UNISTIK PRO LANCET 2

UNISTIK SAFETY 2

UNISTIK TOUCH LANCETS 2

UNISTRIP HIGH CONTROL 2

UNISTRIP LOW CONTROL 2

UNIVERSAL 1 LANCETS 2

VANISHPOINT SYRINGE SYRINGE 0.5 ML 30 GAUGE X 1/2", 1 ML 25 GAUGE X 1", 1 ML 29 GAUGE X 1/2", 3 ML 21 GAUGE X 1 1/2", 3 ML 22 X 1 1/2", 3 ML 23 GAUGE X 1 1/2"

2

VARITHENA ADMINISTRATION PACK MB SP

VERASENS CONTROL SOLN-LEVEL 1 2

VERIFINE PEN NEEDLE 2

VEXASYN EX PA

VISCO-3 MB SP

VIVAGUARD LANCET 2

VORTEX VHC FROG MASK-CHILD 4

VORTEX VHC LADYBUG MASK-TODDLR 4

WAVESENSE CONTROL SOLUTION 2

XCLAIR EX

Diagnostic Agents

ACCU-CHEK AVIVA PLUS TEST STRP 4 PA

ACCU-CHEK COMPACT PLUS TEST 4 PA

ACCU-CHEK GUIDE 4 PA

Drug Tier NotesACCU-CHEK SMARTVIEW TEST STRIP 4 PA

ACCUTREND GLUCOSE 4 PA

ADVANCED GLUC METER TEST STRIP 4 PA

ADVOCATE REDI-CODE 4 PA

ADVOCATE REDI-CODE PLUS STRIP 4 PA

ADVOCATE TEST STRIPS 4 PA

AGAMATRIX AMP TEST STRIPS 4 PA

ASSURE 4 STRIPS 4 PA

ASSURE PLATINUM STRIP 4 PA

ASSURE PRISM MULTI STRIP 4 PA



BIONIME RIGHTEST TEST STRIPS 4 PA

BLOOD GLUCOSE TEST 4 PA

BREEZE 2 TEST STRIPS 4 PA

CARESENS N TEST STRIPS 4 PA

CARETOUCH TEST STRIP 4 PA

CHOICEDM CLARUS STRIP 4 PA

CLEVER CHOICE MICRO TEST STRIP 4 PA

CLEVER CHOICE PRO STRIP 4 PA

CLEVER CHOICE TALK TEST 4 PA

CLEVER CHOICE TEST STRIPS 4 PA

CLEVER CHOICE VOICE+ TEST 4 PA

CONTOUR NEXT TEST STRIPS 4 PA

CONTOUR TEST STRIPS 4 PA

COOL GLUCOSE TEST STRIP 4 PA

DARIO BLOOD GLUCOSE TEST STRIP 4 PA

DIATRUE PLUS TEST STRIP 4 PA

DM2 4 PA

EASY GLUCO G2 4 PA

EASY PLUS II TEST 4 PA

EASY STEP 4 PA

EASY TALK GLUCOSE TEST 4 PA

EASY TOUCH TEST STRIP 4 PA

EASY TRAK GLUCOSE TEST 4 PA

EASYGLUCO PLUS STRIP 4 PA

EASYGLUCO TEST 4 PA

EASYMAX 4 PA

EASYMAX 15 4 PA

ELEMENT COMPACT TEST STRIPS 4 PA

ELEMENT TEST STRIPS 4 PA

EMBRACE BLOOD GLUCOSE SYSTEM STRIP 4 PA

EMBRACE EVO TEST STRIPS 4 PA

EMBRACE PRO TEST STRIPS 4 PA

37

Drug Tier NotesEMBRACE TALK TEST STRIPS 4 PA

EVENCARE G2 STRIP 4 PA

EVENCARE G3 TEST 4 PA

EVENCARE MINI GLUCOSE TEST STR 4 PA

EVENCARE PROVIEW TEST STRIP 4 PA

EVENCARE TEST 4 PA

EVOLUTION TEST STRIPS 4 PA

EZ SMART PLUS TEST 4 PA

EZ SMART TEST 4 PA

FIFTY50 TEST STRIP 4 PA

FLUCAINE 1

fluorescein-proparacaine 1

FORA 6 CONNECT GLUCOSE STRIP 4 PA

FORA D15G STRIPS 4 PA

FORA D20 STRIP 4 PA

FORA D40-G31 TEST STRIPS 4 PA

FORA G20 STRIP 4 PA

FORA G30-PREMIUM V10 TEST STRP 4 PA

FORA GD50 TEST STRIPS 4 PA

FORA GTEL GLUCOSE TEST STRIP 4 PA

FORA TEST STRIP 4 PA

FORA TN'G VOICE TEST STRIPS 4 PA

FORA V10 STRIP 4 PA

FORA V10-V12-D10-D20 STRIPS 4 PA

FORA V12 GLUCOSE 4 PA

FORA V20 STRIP 4 PA

FORA V30A STRIP 4 PA

FORACARE GD20 4 PA

FORACARE GD40 4 PA

FORTISCARE GLUCOSE TEST STRIPS 4 PA

FREESTYLE INSULINX STRIP 4 PA

FREESTYLE INSULINX TEST STRIPS 4 PA

FREESTYLE LITE STRIPS 4 PA

FREESTYLE PRECISION NEO STRIPS 4 PA

FREESTYLE TEST 4 PA

GE100 BLOOD GLUCOSE TEST STRIP 4 PA

GENSTRIP TEST STRIP 4 PA

GENULTIMATE TEST STRIP 4 PA

GLUCAGEN DIAGNOSTIC KIT 4

GLUCO NAVII TEST STRIP 4 PA

GLUCOCARD 01 SENSOR PLUS 4 PA

GLUCOCARD EXPRESSION STRIP 4 PA

Drug Tier NotesGLUCOCARD SHINE TEST STRIPS 4 PA

GLUCOCARD VITAL SENSOR 4 PA

GLUCOCARD VITAL TEST STRIPS 4 PA

GLUCOCOM GLUCOSE 4 PA

GM100 STRIP 4 PA

GOODLIFE AC-302 TEST STRIP 4 PA

HARMONY GLUCOSE TEST STRIP 4 PA

HEALTHPRO TEST STRIPS 4 PA

IGLUCOSE TEST STRIP 4 PA

INFINITY TEST STRIPS 4 PA

INFINITY VOICE TEST STRIP 4 PA

isosulfan blue 1

MACRILEN EX SP

MD-GASTROVIEW 1

MICRO BLOOD GLUCOSE 4 PA

MICRODOT BLOOD GLUCOSE SYSTEM STRIP 4 PA

MICRODOT XTRA BLOOD GLUCOSE 4 PA

MYGLUCOHEALTH STRIP 4 PA

NEUTEK 2TEK TEST STRIPS 4 PA

NOVA MAX GLUCOSE TEST 4 PA

ON CALL EXPRESS TEST STRIP 4 PA

ON CALL PLUS TEST STRIP 4 PA

ON CALL VIVID TEST STRIP 4 PA

ONETOUCH ULTRA BLUE TEST STRIP 2

ONETOUCH VERIO 2

OPTIUM EZ 4 PA

OPTIUM TEST 4 PA

OPTUMRX STRIP 4 PA

PHARMACIST CHOICE 4 PA

PRECISION PCX PLUS TEST 4 PA

PRECISION PCX TEST 4 PA

PRECISION POINT OF CARE TEST 4 PA

PRECISION Q-I-D TEST 4 PA

PRECISION XTRA TEST 4 PA

PREMIER TEST STRIP 4 PA

PREMIUM V10 STRIP 4 PA

PRO VOICE V8-V9 TEST STRIP 4 PA

PRODIGY NO CODING 4 PA

QUINTET AC STRIP 4 PA

QUINTET GLUCOSE TEST STRIPS 4 PA

REFUAH PLUS 4 PA

RELION CONFIRM-MICRO 4 PA

RELION PRIME TEST STRIPS 4 PA

RELION ULTIMA 4 PA

REVEAL TEST STRIP 4 PA

38

Drug Tier NotesRIGHTEST GS250S TEST STRIPS 4 PA

RIGHTEST GS260 TEST STRIPS 4 PA

RIGHTEST GS550 TEST STRIPS 4 PA

SMART SENSE TEST STRIPS 4 PA

SMARTEST TEST 4 PA

SOLUS V2 TEST STRIPS 4 PA

SURE-TEST EASYPLUS MINI STRIP 4 PA

TD GOLD TEST STRIP 4 PA

TELCARE TEST STRIPS 4 PA

TEST N'GO TEST 4 PA

TRUE METRIX GLUCOSE TEST STRIP 4 PA

TRUE METRIX PRO TEST STRIP 4 PA

TRUETEST TEST STRIPS 4 PA

TRUETRACK TEST 4 PA

ULTIMA TEST STRIPS 4 PA

ULTRATRAK 4 PA

ULTRATRAK ULTIMATE STRIP 4 PA

UNISTRIP1 TEST STRIP 4 PA

VERASENS TEST STRIP 4 PA

VIVAGUARD INO TEST STRIP 4 PA

WAVESENSE JAZZ 4 PA

WAVESENSE PRESTO STRIP 4 PA

Electrolytic, Caloric, And Water Balance

ACCURETIC 4

acetazolamide 1

acetic acid irrigation 4

ALDACTAZIDE 4

ALDACTONE 4

amiloride 1

amiloride-hydrochlorothiazide 1

amlodipine-valsartan-hcthiazid 1

ammonium chloride MB

ATACAND HCT EX


AURYXIA 4 PA

AVALIDE EX

AV-PHOS 250 NEUTRAL 1

BAL-CARE DHA 1

BD PRE-FILLED NORMAL SALINE 1

benazepril-hydrochlorothiazide 1

BENICAR HCT EX


bumetanide injection 4

bumetanide oral 1

BUPHENYL 4

Drug Tier NotesCALCIUM 600 WITH VITAMIN D3 ORAL TABLET PV CN

calcium acetate oral capsule 1

calcium acetate oral tablet 667 mg 1

CALCIUM PNV 4

CALCIUM-FOLIC ACID-VITAMIN D 1

candesartan-hydrochlorothiazid 1

captopril-hydrochlorothiazide 1

CARBAGLU 4 SP

CAROSPIR EX

chlorothiazide 1

chlorthalidone oral tablet 25 mg, 50 mg 1

CLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1

CLORPRES ORAL TABLET0.3-15 MG 2

CONSTULOSE 1

CRYSVITA MB PA; SP

CYTRA K CRYSTALS 1

CYTRA-2 1

CYTRA-3 1

CYTRA-K 1

DEMADEX ORAL TABLET 20 MG 4

DIOVAN HCT EX

DIURIL 4

DUTOPROL 4

DUZALLO EX

DYAZIDE 4

DYRENIUM 4

EDARBYCLOR EX

EDECRIN 4

EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ

2

EFFER-K ORAL TABLET, EFFERVESCENT 25 MEQ 1


enalapril-hydrochlorothiazide 1

ENULOSE 1

ethacrynic acid 4

EXFORGE HCT EX

FOLGARD OS EX

fosinopril-hydrochlorothiazide 1

FOSRENOL EX

furosemide injection solution 4

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 1

furosemide oral solution 40 mg/4 ml 2

furosemide oral tablet 1

GENERLAC 1

39

Drug Tier NotesGLYCINE UROLOGIC 4

glycine urologic solution 4

hydrochlorothiazide 1

HYPER-SAL 4

HYZAAR EX

indapamide 1

irbesartan-hydrochlorothiazide 1

JYNARQUE 4 PA; SP

KLOR-CON 1

KLOR-CON 10 1

KLOR-CON 8 1

KLOR-CON M10 1

KLOR-CON M15 1

KLOR-CON M20 1

KLOR-CON SPRINKLE ORAL CAPSULE, EXTENDED RELEASE 8 MEQ

1

KLOR-CON/EF 4

K-PHOS NO 2 2

K-PHOS ORIGINAL 4

K-PHOS-NEUTRAL 1

KRISTALOSE EX

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 20 MEQ

2

K-TAB ORAL TABLET EXTENDED RELEASE 8 MEQ 1

lactulose oral packet 4

lactulose oral solution 1

lanthanum 1

LASIX 4

lisinopril-hydrochlorothiazide 1

LITHOSTAT 4

LOKELMA EX

LOPRESSOR HCT 4

losartan-hydrochlorothiazide 1

LOTENSIN HCT 4

MARNATAL-F 4

MAXZIDE 4

MAXZIDE-25MG 4

methyclothiazide 4


metolazone 1


4


MICARDIS HCT EX

MICROZIDE 4

M-NATAL PLUS 1

MYNATAL ADVANCE 1

MYNATAL ORAL CAPSULE 1

MYNATAL PLUS 1

MYNATAL-Z 1

Drug Tier Notesnadolol-bendroflumethiazide oral tablet 80-5 mg 4

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %

4

NESTABS 4

NESTABS DHA 4

NEWGEN 4

NORMAL SALINE FLUSH 1

OB COMPLETE ONE EX


O-CAL PRENATAL 4

olmesartan-amlodipin-hcthiazid 4

olmesartan-hydrochlorothiazide oral tablet 20-12.5 mg, 40-12.5 mg

1

olmesartan-hydrochlorothiazide oral tablet 40-25 mg 4

ORACIT 4

PHOSLYRA 4 PA

PHOSPHA 250 NEUTRAL 1

PHYSIOLYTE 4

PHYSIOSOL IRRIGATION 4

PNV 29-1 1



PNV-OMEGA 1

potassium chloride oral 1

potassium citrate 1

potassium citrate-citric acid oral solution 1

PR NATAL 400 1

PR NATAL 400 EC 1

PR NATAL 430 1

PR NATAL 430 EC 1

PRENAISSANCE 1

PRENAISSANCE PLUS 1

PRENATABS FA 1

PRENATABS RX 1

PRENATAL LOW IRON 1

PRENATAL PLUS 1

PRENATAL PLUS (CALCIUM CARB) 1


PRENATE CHEWABLE 4

PREPLUS 1

PRETAB 1

probenecid 1

probenecid-colchicine 1


PULMOSAL 4

quinapril-hydrochlorothiazide 1

RAVICTI 4 PA; SP

40

Drug Tier NotesRENAGEL ORAL TABLET 800 MG EX

RENVELA 4 PA

ringer's irrigation 4

SAMSCA 4 SP

sevelamer carbonate oral powder in packet 4

sevelamer carbonate oral tablet 1

sevelamer hcl 4

SHOHL'S MODIFIED 4

sodium chloride 0.9 % (flush) injection syringe MB

sodium chloride inhalation 1

sodium citrate-citric acid 1

sodium phenylbutyrate 4

sodium polystyrene sulfonate oral powder 4

sodium polystyrene sulfonate oral suspension 1

sodium polystyrene sulfonate rectal enema 30 gram/120 ml 4

spironolactone 1

spironolacton-hydrochlorothiaz 1

SPS (WITH SORBITOL) ORAL 1

SPS (WITH SORBITOL) RECTAL 4

TEKTURNA HCT 4

telmisartan-hydrochlorothiazid 1

TENORETIC 100 4

TENORETIC 50 4

THEO-24 4

THEOCHRON 1





THRIVITE RX 4

TL-SELECT 1

torsemide oral 1

TRIADVANCE 1

triamterene-hydrochlorothiazid 1

TRIBENZOR EX

TRICITRATES 1

TRINATAL RX 1 1

TRINATE 1

TRIVEEN-DUO DHA 1

TRIVEEN-ONE 1

TRIVEEN-PRX RNF 1

UROCIT-K 10 4

UROCIT-K 15 4

UROCIT-K 5 4

valsartan-hydrochlorothiazide 1

Drug Tier NotesVASERETIC 4

VELPHORO 4 PA

VELTASSA 4 SP

VENA-BAL DHA 1

VINACAL 1

VINATE ONE 1

VINATE ULTRA 1

VIRT-ADVANCE 1

VIRT-PHOS 250 NEUTRAL 1

VIRT-PN PLUS 1

VIRTPREX 4

VIRTRATE-2 1

VIRTRATE-K 1

VIRT-SELECT 1

VITAFOL GUMMIES 4

VITAFOL-OB 4

VITAFOL-OB+DHA 4

ZATEAN-PN PLUS 1

ZESTORETIC 4

ZIAC 4

ZINGIBER 4

Enzymes

ALDURAZYME MB SP

BRINEURA MB SP

CEREZYME INTRAVENOUS RECON SOLN 400 UNIT MB SP

ELAPRASE MB SP

ELELYSO MB SP

FABRAZYME MB SP

HYQVIA HY COMPONENT MB

KANUMA MB SP

LUMIZYME MB SP

MEPSEVII MB SP

NAGLAZYME MB SP

PALYNZIQ 4 PA; SP

PULMOZYME 4 SP

REVCOVI 4 PA; SP

STRENSIQ 4 PA; SP

SUCRAID 4

VIMIZIM MB SP

VPRIV MB SP

XIAFLEX MB PA; SP

Eye, Ear, Nose And Throat (Eent) Preps.

acetazolamide 1

acetic acid otic (ear) 1

ACULAR 4

ACULAR LS 4

ACUVAIL (PF) EX

ADRENALIN NASAL 4

ADVANCED DNA MEDICATED COLLECT EX

41

Drug Tier NotesAK-POLY-BAC 1

AKTEN (PF) 4

ALOCRIL EX

ALOMIDE EX

ALPHAGAN P 4

ALREX 4

ALTACAINE 1

apraclonidine 1

ASTEPRO NASAL SPRAY,NON-AEROSOL 4

atropine ophthalmic (eye) drops 1

atropine ophthalmic (eye) ointment 1

AZASITE 4

azelastine 1

AZOPT 4

bacitracin ophthalmic (eye) 1

bacitracin-polymyxin b ophthalmic (eye) 1

BECONASE AQ EX

BEPREVE 4

BESIVANCE 4

BETADINE OPHTHALMIC PREP 2

betaxolol ophthalmic (eye) 1

BETIMOL 4

BETOPTIC S 4

bevacizumab intravitreal syringe2.5 mg/0.1 ml MB SP

bimatoprost ophthalmic (eye) 1

BLEPH-10 4

BLEPHAMIDE 4

BLEPHAMIDE S.O.P. 4

brimonidine 1

brimonidine-dorzolamide (pf) 4

bromfenac 1

BROMSITE 4

budesonide nasal EX

carteolol 4

CEQUA 4 PA

CETRAXAL EX

chlorhexidine gluconate mucous membrane 1

CILOXAN 4

CIPRO HC 4

CIPRODEX 4

ciprofloxacin hcl ophthalmic (eye) 1

ciprofloxacin hcl otic (ear) 1

COLY-MYCIN S 4

COMBIGAN 4

CORTANE-B TOPICAL 4

COSOPT EX

COSOPT (PF) EX

Drug Tier Notescromolyn ophthalmic (eye) 1

CYCLOGYL 2

CYCLOMYDRIL 4

cyclopentolate 1

cyclopen-tropic-phenyleph-watr MB

CYCLOSPORINE IN KLARITY 4

CYSTARAN 4 SP

DERMOTIC OIL 4

dexamethasone sodium phosphate ophthalmic (eye) 1

diclofenac sodium ophthalmic (eye) 1

dorzolamide 1

dorzolamide (pf) 4

dorzolamide-timolol 1

dorzolamide-timolol (pf) ophthalmic (eye) dropperette 1

dorzolamide-timolol (pf) ophthalmic (eye) drops 4

doxycycline hyclate oral tablet 20 mg 1

DUREZOL 4

DYMISTA EX

epinastine 1

erythromycin ophthalmic (eye) 1

EYLEA MB SP

FLAC OTIC OIL 4

FLAREX EX

FLUCAINE 1

flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) EX

fluocinolone acetonide oil 1

fluorescein-proparacaine 1

fluorometholone 1

flurbiprofen sodium 1

fluticasone propionate nasal 1

FML FORTE EX

FML LIQUIFILM EX

FML S.O.P. EX

gatifloxacin 1

gatifloxacin-dexamethasone 4

GELFILM OPHTHALMIC (EYE) 4

GENTAK OPHTHALMIC (EYE) OINTMENT 1

gentamicin ophthalmic (eye) 1

GLYDO 1

GONIOVISC EX

HOMATROPAIRE 1

homatropine hbr 1

hydrocortisone-acetic acid 1

ILEVRO 4

ILUVIEN MB SP

INVELTYS 4

42

Drug Tier NotesIOPIDINE OPHTHALMIC (EYE) DROPPERETTE 4

ipratropium bromide nasal 1

ISOPTO CARPINE 4

ISTALOL EX

JETREA (PF) INTRAVITREAL SOLUTION 0.125 MG/0.1 ML (1.25 MG/ML)

MB SP

ketorolac ophthalmic (eye) 1

KLARITY (CHONDROITIN) 4

LACRISERT 4

LASTACAFT 4

latanoprost 1

latanoprost (pf) 4 PA

levobunolol ophthalmic (eye) drops 0.5 % 1

levofloxacin ophthalmic (eye) 1

lidocaine hcl mucous membrane jelly 1

lidocaine hcl mucous membrane jelly in applicator 1

lidocaine hcl mucous membrane solution 4 % (40 mg/ml) 1

LIDOCAINE VISCOUS 1

LOTEMAX 4

LOTEMAX SM 4

loteprednol etabonate 4

LUCENTIS MB SP

LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 % 4 PA

MACUGEN MB SP

MAXIDEX EX

MAXITROL 4

methazolamide 4

metipranolol 1

MITOSOL MB

mometasone nasal EX

MOXEZA 4

moxifloxacin ophthalmic (eye) 1

MYDRIACYL 4

NASONEX EX

NATACYN 4

neomycin-bacitracin-poly-hc 1

neomycin-bacitracin-polymyxin 1

neomycin-polymyxin b-dexameth 1

neomycin-polymyxin-gramicidin 1

neomycin-polymyxin-hc 1

NEO-POLYCIN 1

NEO-POLYCIN HC 1

NEVANAC EX

OCUFLOX 4

ofloxacin ophthalmic (eye) 1

ofloxacin otic (ear) 1

olopatadine nasal 4

Drug Tier Notesolopatadine ophthalmic (eye) 1

OMNARIS EX

OTIPRIO 4

OTOVEL 4

OXERVATE 4 SP

OZURDEX MB SP

PAREMYD 4

PAROEX ORAL RINSE 1

PATADAY 4

PATANASE 4

PATANOL 4

PAZEO 4

PERIDEX 4

PERIOGARD 1

phenylephrine hcl ophthalmic (eye) 1

PHOSPHOLINE IODIDE 2

pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 % 1

POLYCIN 1

polymyxin b sulf-trimethoprim 1

POLYTRIM 4

PRED FORTE 4

PRED MILD EX

PRED-G 4

PRED-G S.O.P. 4

prednisol ace-gatiflox-bromfen 4

prednisoln sp-gatiflox-bromfen 4

prednisolone acetate 1

prednisolone acetate (pf) 4

prednisolone acetate-bromfenac 4

prednisolone acetate-nepafenac 4

prednisolone acet-gatifloxacin 2

prednisolone sod ph-bromfenac 4

prednisolone sod ph-gatifloxac 4

prednisolone sodium phosphate ophthalmic (eye) 1

prednisolone-moxiflo-nepafenac 4

prednisolone-moxifloxacin hcl 4

PROLENSA 4

proparacaine 1

QNASL EX

RESTASIS 4

RESTASIS MULTIDOSE 4

RETISERT MB SP

RHOPRESSA 4 PA

ROCKLATAN 4 PA

SIMBRINZA 4

SINUVA MB SP

sulfacetamide sodium ophthalmic (eye) 1

sulfacetamide-prednisolone 1

TETCAINE 1

43

Drug Tier Notestetracaine hcl 1

tetracaine hcl (pf) ophthalmic (eye) 1

TETRAVISC 4

TETRAVISC FORTE 4

TICALAST EX

TICANASE EX

TICASPRAY EX

timol-brimon-dorzo-latanop(pf) 4

timolol maleate ophthalmic (eye) 1

timolol-brimonidi-dorzolam(pf) 4

timolol-dorzolamid-latanop(pf) 4

timolol-latanoprost(pf) 4

TIMOPTIC EX

TIMOPTIC OCUDOSE (PF) EX

TIMOPTIC-XE EX

TOBRADEX 4

TOBRADEX ST 4

tobramycin 1

tobramycin-dexamethasone 1

TOBREX 4

TRAVATAN Z 4 PA

triamcinolone acetonide nasal EX

trifluridine 1

tropicamide 1

TRUSOPT 4

TYZINE 4

VIGAMOX 4

VISUDYNE MB SP

VYZULTA EX

XALATAN EX

XELPROS 4 PA

XHANCE EX

XIIDRA 4

YUTIQ MB SP

ZETONNA EX

ZIOPTAN (PF) EX

ZIRGAN 4

ZYLET 4

ZYMAXID 4

Gastrointestinal Drugs

ACIPHEX EX

ACIPHEX SPRINKLE EX

ACTIGALL 4

AKYNZEO (NETUPITANT) 4

alosetron 4

AMITIZA 4 PA

amoxicil-clarithromy-lansopraz 1

ANTIVERT ORAL TABLET 12.5 MG, 25 MG 4

aprepitant 1

APRISO 2

Drug Tier NotesARTHROTEC 50 4

ARTHROTEC 75 4

ASACOL HD EX

AZULFIDINE 4


balsalazide 1

BONJESTA EX

CANASA 4

CARAFATE 4

CESAMET 4

CHENODAL 4 SP

CHOLBAM 4 SP

cimetidine EX

cimetidine hcl oral EX

CIMZIA 4 PA; SP; QL (1 EA per 30 days)

CIMZIA POWDER FOR RECONST 4 PA; SP; QL (1 EA per

30 days)

CIMZIA STARTER KIT 4 PA; SP; QL (1 EA per 30 days)



4


CLENPIQ PV CN

COLAZAL EX

COLYTE WITH FLAVOR PACKS ORAL RECON SOLN240-22.72-6.72 -5.84 GRAM

4

COMPAZINE 4

COMPRO 1

CREON 2

CYTOTEC 4

DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) EX

DEXILANT EX

DICLEGIS 4

diclofenac-misoprostol 4

DIPENTUM EX


doxylamine-pyridoxine (vit b6) 4

dronabinol 4

DUEXIS EX

EMEND 4

ENDARI EX SP

ENTEREG 4

ENTYVIO MB SP

ESOMEP-EZS EX

esomeprazole magnesium EX

esomeprazole strontium oral capsule,delayed release(dr/ec)49.3 mg

EX

44

Drug Tier Notesfamotidine oral suspension 1

famotidine oral tablet 20 mg, 40 mg 1

GATTEX 30-VIAL 4 SP

GATTEX ONE-VIAL 4 SP

GAVILYTE-C PV CN; QL (2 Preps per 365 days)

GAVILYTE-G PV CN; QL (2 Preps per 365 days)

GAVILYTE-N PV CN; QL (2 Preps per 365 days)

GIALAX EX

GOLYTELY ORAL POWDER IN PACKET PV CN; QL (2 PREPS

per 365 days)

GOLYTELY ORAL RECON SOLN 4

granisetron hcl oral 1

HUMIRA PEDIATRIC CROHNS START 3 PA; SP; QL (3 EA per

30 days)

HUMIRA PEN 3 PA; SP; QL (6 EA per 30 days)

HUMIRA PEN CROHNS-UC-HS START 3 PA; SP; QL (6 EA per

30 days)

HUMIRA PEN PSOR-UVEITS-ADOL HS 3 PA; SP; QL (4 EA per

30 days)

HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML

3 PA; SP; QL (4 EA per 30 days)

HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML 3 PA; SP; QL (2 EA per

30 days)

HUMIRA(CF) 3 PA; SP; QL (2 EA per 30 days)

HUMIRA(CF) PEDI CROHNS STARTER 3 PA; SP; QL (2 EA per

30 days)

HUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per

30 days)

HUMIRA(CF) PEN PSOR-UV-ADOL HS 3 PA; SP; QL (2 EA per

30 days)

HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML


INFLECTRA MB SP

lansoprazole EX

LIALDA 4

LINZESS 4 PA

LOMOTIL 4

loperamide oral capsule 1

LOTRONEX 4

MARINOL 4

meclizine oral tablet 12.5 mg, 25 mg 1

mesalamine 1

mesalamine with cleansing wipe 1 PA

metoclopramide hcl injection solution 1

metoclopramide hcl injection syringe 4

metoclopramide hcl oral 1

misoprostol 1

Drug Tier NotesMOTEGRITY 4 PA

MOTOFEN 4

MOVANTIK 4 PA

MOVIPREP PV CN; QL (2 PREPS per 365 days)

MYTESI 4

NEXIUM EX

NEXIUM PACKET EX

nizatidine EX

NULYTELY WITH FLAVOR PACKS 4

OBSTETRIX EC 4

OCALIVA 4 SP

OMECLAMOX-PAK 2

OMEPPI EX

omeprazole oral capsule,delayed release(dr/ec) 1

omeprazole-sodium bicarbonate EX

ondansetron 1

ondansetron hcl oral 1

opium tincture 4

OSMOPREP PV CN; QL (2 PREPS per 365 days)

PANCREAZE ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,500-35,500- 61,500 UNIT, 16,800-56,800- 98,400 UNIT, 2,600-6,200- 10,850 UNIT, 21,000-54,700- 83,900 UNIT, 4,200-14,200- 24,600 UNIT

EX

pantoprazole oral 1

paregoric 1

peg 3350-electrolytes PV CN; QL (2 Preps per 365 days)

PEG-3350 WITH FLAVOR PACKS PV QL (2 Preps per 365

days)

peg-electrolyte soln PV CN; QL (2 Preps per 365 days)

PEG-PREP PV CN; QL (2 PREPS per 365 days)

PENTASA 2

PEPCID ORAL TABLET EX

PERTZYE EX

PLENVU PV



polyethylene glycol 3350 oral powder PV CN; QL (2 Preps per

365 days)

polyethylene glycol 3350 oral powder in packet PV CN; QL (2 PREPS

per 365 days)

PRENAISSANCE 1

PRENAISSANCE PLUS 1

PREPOPIK PV CN; QL (2 PREPS per 365 days)

PREVACID EX

PREVACID SOLUTAB EX

45

Drug Tier NotesPRILOSEC ORAL SUSP,DELAYED RELEASE FOR RECON

EX

prochlorperazine 1

prochlorperazine edisylate 4

prochlorperazine maleate 1

PROTONIX ORAL EX

PYLERA 4

rabeprazole oral tablet,delayed release (dr/ec) EX

ranitidine hcl oral capsule 1

ranitidine hcl oral syrup 1

ranitidine hcl oral tablet 150 mg, 300 mg 1

REGLAN ORAL 4

RELISTOR ORAL 4

RELISTOR SUBCUTANEOUS SOLUTION 4

RELISTOR SUBCUTANEOUS SYRINGE 4

REMICADE MB SP

RENFLEXIS MB SP

ROWASA RECTAL ENEMA KIT 4 PA

SANCUSO EX

scopolamine base 1


SFROWASA 4

SIMPONI 4 PA; SP

SIMPONI ARIA MB SP

sucralfate 1

sulfasalazine 1

SUPREP BOWEL PREP KIT PV CN; QL (2 PREPS per 365 days)

SUSTOL 4

SYMPROIC 4

SYNDROS 4


TIGAN ORAL CAPSULE 300 MG 1

TL-SELECT 1

TRANSDERM-SCOP 2

TRILYTE WITH FLAVOR PACKETS PV CN; QL (2 Preps per

365 days)

trimethobenzamide oral 1

TRIVEEN-PRX RNF 1

TRULANCE EX PA

URSO 250 4

URSO FORTE 4

ursodiol 1

VARUBI ORAL 4

VIBERZI 2

VIMOVO EX

VINACAL 1

VINATE ULTRA 1

Drug Tier NotesVIOKACE EX

VIRTPREX 4

VIRT-SELECT 1

VP-CH PLUS 4

XERMELO 4 PA; SP

YOSPRALA EX

ZANTAC ORAL TABLET EX

ZEGERID EX

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

2

ZOFRAN ORAL TABLET 4

ZUPLENZ EX

Gold Compounds

RIDAURA 4

Heavy Metal Antagonists

CHEMET 4

CUPRIMINE 2

deferasirox 4 SP

DEPEN TITRATABS 2

D-PENAMINE 4

EXJADE 4 PA; SP

FERRIPROX 4

JADENU 4 PA; SP

JADENU SPRINKLE 4 PA; SP

penicillamine 1

SYPRINE 4

trientine 4

Hormones And Synthetic Substitutes

acarbose 1

ACTIVELLA 4

ACTOPLUS MET 4

ACTOPLUS MET XR 4

ACTOS 4

ADLYXIN EX PA

ADMELOG SOLOSTAR U-100 INSULIN EX

ADMELOG U-100 INSULIN LISPRO EX

ADVAIR DISKUS 4

ADVAIR HFA 2

AEROSPAN 4

AFIRMELLE PV

AFREZZA INHALATION CARTRIDGE WITH INHALER12 UNIT, 4 UNIT, 4 UNIT (90)/ 8 UNIT (90), 4 UNIT/8 UNIT/ 12 UNIT (60), 8 UNIT, 8 UNIT (90)/ 12 UNIT (90)

EX

46

Drug Tier NotesAFTERA PV CN

A-HYDROCORT 4

AIRDUO RESPICLICK 4

alogliptin EX

alogliptin-metformin EX

alogliptin-pioglitazone EX

ALORA 4 QL (8 EA per 30 days)

ALTAVERA (28) PV CN

ALVESCO EX

ALYACEN 1/35 (28) PV CN

ALYACEN 7/7/7 (28) PV CN

AMABELZ 1

AMARYL 4

AMETHIA PV CN

AMETHIA LO PV CN

AMETHYST (28) PV CN

ANADROL-50 4

anastrozole 1 OCH

ANDRODERM 2

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP20.25 MG/1.25 GRAM (1.62 %)

EX

ANDROGEL TRANSDERMAL GEL IN PACKET EX

ANDROID EX

ANGELIQ 4

APIDRA SOLOSTAR U-100 INSULIN EX

APIDRA U-100 INSULIN EX

APRI PV CN

ARANELLE (28) PV CN

ARIMIDEX EX OCH

ARMONAIR RESPICLICK 4

ARMOUR THYROID 2

ARNUITY ELLIPTA 2

AROMASIN 4 OCH

ASHLYNA PV CN

ASMANEX HFA 2

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)

2

AUBRA PV CN

AUBRA EQ PV

AUROVELA 1.5/30 (21) PV

AUROVELA 1/20 (21) PV

AUROVELA 24 FE PV

AUROVELA FE 1.5/30 (28) PV

AUROVELA FE 1-20 (28) PV

AVANDAMET ORAL TABLET2-1,000 MG 4

Drug Tier NotesAVANDIA ORAL TABLET 2 MG, 4 MG 4

AVEED EX SP

AVIANE PV CN

AYGESTIN 4

AYUNA PV

AZURETTE (28) PV CN

BALCOLTRA PV

BALZIVA (28) PV CN

BASAGLAR KWIKPEN U-100 INSULIN 2

BEKYREE (28) PV CN

BETA-1 EX

BEYAZ PV CN

BIJUVA EX

BLISOVI 24 FE PV CN

BLISOVI FE 1.5/30 (28) PV CN

BLISOVI FE 1/20 (28) PV CN

BREO ELLIPTA 2

BREVICON (28) PV CN

BRIELLYN PV CN

budesonide inhalation 1

budesonide oral capsule,delayed,extend.release 1

budesonide oral tablet,delayed and ext.release 4

BYDUREON BCISE 2 PA

BYDUREON SUBCUTANEOUS PEN INJECTOR 2 PA

BYETTA 2 PA

calcitonin (salmon) 1

CAMILA PV CN

CAMRESE PV CN

CAMRESE LO PV CN

CAZIANT (28) PV CN

CHATEAL (28) PV CN

CHATEAL EQ (28) PV

chlorpropamide 4

cinacalcet 1

CLIMARA 4 QL (4 EA per 30 days)

CLIMARA PRO EX QL (4 EA per 30 days)

colesevelam 4

COMBIPATCH 2

CORTEF 4

cortisone 1

COVARYX 1

COVARYX H.S. 1

CRINONE VAGINAL GEL 4 % 4

CRYSELLE (28) PV CN

CYCLAFEM 1/35 (28) PV CN

CYCLAFEM 7/7/7 (28) PV CN

CYCLESSA (28) PV CN

47

Drug Tier NotesCYRED PV CN

CYRED EQ PV

CYTOMEL EX

danazol 4

DASETTA 1/35 (28) PV CN

DASETTA 7/7/7 (28) PV CN

DAYSEE PV CN

DDAVP 4

DEBLITANE PV CN

DECADRON 4

DELESTROGEN 4

DELTASONE ORAL TABLET20 MG 1

DELYLA (28) PV CN

DEPO-ESTRADIOL 2

DEPO-MEDROL 2

DEPO-SUBQ PROVERA 104 PV CN

DEPO-TESTOSTERONE INTRAMUSCULAR OIL 100 MG/ML

2

DEPO-TESTOSTERONE INTRAMUSCULAR OIL 200 MG/ML

4

desmopressin injection 4

desmopressin nasal spray with pump 1

desmopressin nasal spray,non-aerosol 1

desmopressin oral 1

desog-e.estradiol/e.estradiol PV CN

desogestrel-ethinyl estradiol PV CN

DEXAMETHASONE INTENSOL 1

dexamethasone oral elixir 1

dexamethasone oral solution 1

dexamethasone oral tablet 1

dexamethasone oral tablets,dose pack 4

dexamethasone sodium phos (pf) 1

dexamethasone sodium phosphate injection 1

DEXONTO MB

DEXPAK 10 DAY 4

DEXPAK 13 DAY 4

DEXPAK 6 DAY 4

DIVIGEL 2

DM2 EX

DOTTI 1

DOUBLEDEX (PF) EX

drospirenone-e.estradiol-lm.fa PV CN

drospirenone-ethinyl estradiol PV CN

DUAVEE 4

DUETACT 4

DULERA 2

DXEVO EX

Drug Tier NotesECONTRA EZ PV CN

ECONTRA ONE-STEP PV CN

EEMT 1

EEMT HS 1

EGRIFTA SUBCUTANEOUS RECON SOLN 1 MG MB SP

ELESTRIN 4

ELIGARD 3 SP




ELINEST PV CN

ELLA PV CN

EMFLAZA EX PA; SP

EMOQUETTE PV CN

ENPRESSE PV CN

ENSKYCE PV CN

ENTOCORT EC 4

ERRIN PV CN

ESTARYLLA PV CN

ESTRACE 4

estradiol oral 1

estradiol transdermal patch semiweekly 1 QL (8 EA per 30

days)

estradiol transdermal patch weekly 1 QL (4 EA per 30

days)

estradiol vaginal 1

estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml 1

estradiol-norethindrone acet 1

ESTRING 2

ESTROGEL EX

estrogens-methyltestosterone 1

ESTROSTEP FE-28 PV CN

ethynodiol diac-eth estradiol PV CN

EUTHYROX 4

EVAMIST 4

EVISTA 4

exemestane 1 OCH

FALMINA (28) PV CN

FARESTON 4 OCH

FARXIGA 2 PA

FAYOSIM PV CN

FEMARA 4 OCH

FEMHRT LOW DOSE 4

FEMRING EX

FEMYNOR PV CN

FIASP FLEXTOUCH U-100 INSULIN 2

FIASP U-100 INSULIN 2


FLOVENT DISKUS 4

48

Drug Tier NotesFLOVENT HFA 4

fludrocortisone 1


4


FORTAMET EX

FORTEO 3 PA; SP

FORTESTA EX

FYAVOLV 1

GENERESS FE PV CN

GENOTROPIN 3 PA; SP

GENOTROPIN MINIQUICK 3 PA; SP

GIANVI (28) PV CN

glimepiride 1

glipizide 1

glipizide-metformin 1

GLUCAGEN DIAGNOSTIC KIT 4

GLUCAGEN HYPOKIT 4

GLUCAGON EMERGENCY KIT (HUMAN) 2

GLUCOPHAGE EX

GLUCOPHAGE XR EX

GLUCOTROL 4

GLUCOTROL XL 4

GLUMETZA EX

glyburide 1

glyburide micronized 1

glyburide-metformin 1

GLYNASE 4

GLYSET 4

GLYXAMBI EX PA

HAILEY 24 FE PV

HEATHER PV CN

HIDEX 4

HUMALOG JUNIOR KWIKPEN U-100 EX

HUMALOG KWIKPEN INSULIN EX

HUMALOG MIX 50-50 INSULN U-100 EX

HUMALOG MIX 50-50 KWIKPEN EX

HUMALOG MIX 75-25 KWIKPEN EX

HUMALOG MIX 75-25(U-100)INSULN EX

HUMALOG U-100 INSULIN EX

HUMATROPE EX SP

HUMULIN 70/30 U-100 INSULIN EX

HUMULIN 70/30 U-100 KWIKPEN EX

HUMULIN N NPH INSULIN KWIKPEN EX

Drug Tier NotesHUMULIN N NPH U-100 INSULIN EX

HUMULIN R REGULAR U-100 INSULN EX

HUMULIN R U-500 (CONC) INSULIN 2

HUMULIN R U-500 (CONC) KWIKPEN 2

hydrocortisone oral 1

hydroxyprogest(pf)(preg presv) MB SP

hydroxyprogesterone cap(ppres) MB SP

hydroxyprogesterone caproate 4

IMVEXXY MAINTENANCE PACK 4

IMVEXXY STARTER PACK 4

INCASSIA PV

INCRELEX 4 PA; SP

insulin lispro EX

INTRAROSA MB

INTROVALE PV CN

INVOKAMET 2

INVOKAMET XR 4

INVOKANA 2 PA

ISIBLOOM PV CN

JANUMET 2

JANUMET XR 2

JANUVIA 2 PA

JARDIANCE 2 PA

JASMIEL (28) PV

JENCYCLA PV CN

JENTADUETO EX

JENTADUETO XR EX

JINTELI 1

JOLESSA PV CN

JULEBER PV CN

JUNEL 1.5/30 (21) PV CN

JUNEL 1/20 (21) PV CN

JUNEL FE 1.5/30 (28) PV CN

JUNEL FE 1/20 (28) PV CN

JUNEL FE 24 PV CN

KAITLIB FE PV CN

KALLIGA PV

KARIVA (28) PV CN

KAZANO EX

KELNOR 1/35 (28) PV CN

KELNOR 1-50 PV CN

KISQALI FEMARA CO-PACK 4 PA; SP; OCH

KOMBIGLYZE XR 2

KORLYM 4 PA; SP

KURVELO (28) PV CN

KYLEENA PV SP; CN

l norgest/e.estradiol-e.estrad PV CN

49

Drug Tier NotesLANTUS SOLOSTAR U-100 INSULIN 2

LANTUS U-100 INSULIN 2

LARIN 1.5/30 (21) PV CN

LARIN 1/20 (21) PV CN

LARIN 24 FE PV CN

LARIN FE 1.5/30 (28) PV CN

LARIN FE 1/20 (28) PV CN

LARISSIA PV CN

LAYOLIS FE PV CN

LEENA 28 PV CN

LESSINA PV CN

letrozole 1 OCH

leuprolide subcutaneous kit 4 SP

LEVEMIR FLEXTOUCH U-100 INSULN 2

LEVEMIR U-100 INSULIN 2

LEVONEST (28) PV CN

levonorgestrel oral tablet 1.5 mg PV

levonorgestrel-ethinyl estrad PV CN

levonorg-eth estrad triphasic PV CN

LEVORA-28 PV CN

LEVO-T 4

levothyroxine oral 1

LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

1

LILETTA PV SP; CN

LILLOW (28) PV CN

liothyronine oral 1

LO LOESTRIN FE PV CN

LOESTRIN 1.5/30 (21) PV CN

LOESTRIN 1/20 (21) PV CN

LOESTRIN FE 1.5/30 (28-DAY) PV CN

LOESTRIN FE 1/20 (28-DAY) PV CN

LOPREEZA 1

LORYNA (28) PV CN

LOSEASONIQUE PV CN

LOW-OGESTREL (28) PV CN

LO-ZUMANDIMINE (28) PV

LUGOLS ORAL 1



LUPRON DEPOT 4 SP




LUPRON DEPOT-PED 4 SP

LUPRON DEPOT-PED (3 MONTH) 4 SP

LUTERA (28) PV CN

LYZA PV CN

Drug Tier NotesMAKENA MB SP

MAKENA (PF) 4 SP

MARLISSA (28) PV CN

MAS CARE-PAK (PF) EX

MEDROL 4

MEDROL (PAK) 4

medroxyprogesterone intramuscular PV CN

medroxyprogesterone oral 1

megestrol oral suspension 1

megestrol oral tablet 1 OCH

MELODETTA 24 FE PV CN

MENEST 4

MENOSTAR 4 QL (4 EA per 30 days)

metformin oral solution 4 PA

metformin oral tablet 1

metformin oral tablet extended release 24 hr 1

metformin oral tablet extended release 24hr EX

metformin oral tablet,er gast.retention 24 hr EX

methimazole oral tablet 10 mg, 5 mg 1

METHITEST EX

methylprednisolone 1

methylprednisolone acetate 1

methyltestosterone oral capsule 1

MIACALCIN INJECTION 4

MIBELAS 24 FE PV CN

MICROGESTIN 1.5/30 (21) PV CN

MICROGESTIN 1/20 (21) PV CN

MICROGESTIN 24 FE PV CN

MICROGESTIN FE 1.5/30 (28) PV CN

MICROGESTIN FE 1/20 (28) PV CN

miglitol 1

MILI PV CN

MILLIPRED DP 1

MILLIPRED ORAL TABLET 1

MIMVEY 1

MIMVEY LO 1

MINASTRIN 24 FE PV CN

MINIVELLE 4 QL (8 EA per 30 days)

MIRCETTE (28) PV CN

MIRENA PV CN

MONO-LINYAH PV CN

MY CHOICE PV CN

MY WAY PV CN

MYALEPT 4 SP

NATAZIA PV CN

nateglinide 4

NATESTO EX

50

Drug Tier NotesNATPARA 4 PA; SP

NATURE-THROID 1

NECON 0.5/35 (28) PV CN

NESINA EX

NEW DAY PV

NEXPLANON PV CN

NEXT CHOICE ONE DOSE PV CN

NIKKI (28) PV CN

NOCDURNA (MEN) 4

NOCDURNA (WOMEN) 4

NOCTIVA EX

NORA-BE PV CN

NORDITROPIN FLEXPRO EX SP

noreth-ethinyl estradiol-iron PV CN

norethindrone (contraceptive) PV CN

norethindrone acetate 1

norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg

1

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg PV CN

norethindrone-e.estradiol-iron PV CN

norgestimate-ethinyl estradiol PV CN

norgestrel-ethinyl estradiol PV CN

NORLYDA PV CN

NORLYROC PV CN

NORTREL 0.5/35 (28) PV CN

NORTREL 1/35 (21) PV CN

NORTREL 1/35 (28) PV CN

NORTREL 7/7/7 (28) PV CN

NOVOLIN 70/30 U-100 INSULIN 2

NOVOLIN 70-30 FLEXPEN U-100 2

NOVOLIN N NPH U-100 INSULIN 2

NOVOLIN R REGULAR U-100 INSULN 2

NOVOLOG FLEXPEN U-100 INSULIN 2

NOVOLOG MIX 70-30 U-100 INSULN 2

NOVOLOG MIX 70-30FLEXPEN U-100 2

NOVOLOG PENFILL U-100 INSULIN 2

NOVOLOG U-100 INSULIN ASPART 2

NP THYROID 1

NUTROPIN AQ NUSPIN EX SP

NUVARING PV CN

OCELLA PV CN

octreotide acetate 3 SP

OGESTREL (28) PV CN

OMNITROPE 3 PA; SP

ONGLYZA 2 PA

Drug Tier NotesOPCICON ONE-STEP PV CN

OPTION-2 PV CN

ORAPRED ODT 4

ORILISSA 4 PA

ORSYTHIA PV CN

ORTHO MICRONOR PV CN

ORTHO TRI-CYCLEN (28) PV CN

ORTHO-NOVUM 1/35 (28) PV CN

ORTHO-NOVUM 7/7/7 (28) PV CN

OSENI EX

OSPHENA 4

OXANDRIN 4

oxandrolone 1

OZEMPIC 2 PA

PARAGARD T 380A PV CN

PHILITH PV CN

PIMTREA (28) PV CN

pioglitazone 1

pioglitazone-glimepiride 1

pioglitazone-metformin 1

PIRMELLA PV CN

PLAN B ONE-STEP PV CN

PORTIA 28 PV CN

PRANDIN ORAL TABLET 1 MG, 2 MG 4

PRECOSE 4

prednisolone oral solution 15 mg/5 ml 1

prednisolone sodium phosphate oral 1

prednisone 1

PREDNISONE INTENSOL 1

PREFEST 4

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 4

PREMPRO 4

PREVIFEM PV CN

progesterone 1

progesterone micronized 1

PROGLYCEM 2

PROMETRIUM 4

propylthiouracil 1

PROVERA 4

PULMICORT EX

PULMICORT FLEXHALER 2

QTERN 2 PA

QUARTETTE PV CN

QVAR REDIHALER 2

RAJANI PV CN

raloxifene 1 OCH

RAYOS EX

51

Drug Tier NotesRECLIPSEN (28) PV CN

repaglinide oral tablet 0.5 mg, 1 mg 1

repaglinide oral tablet 2 mg 4

repaglinide-metformin 1

RIOMET 4 PA

RIVELSA PV CN

SAFYRAL PV CN

SAIZEN EX SP

SAIZEN SAIZENPREP EX PA; SP

SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML

4 SP

SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

3 SP

SAXENDA EX

SEASONIQUE PV CN

SEGLUROMET 4

SENSIPAR 4 SP

SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG

4 PA; SP

SETLAKIN PV CN

SHAROBEL PV CN

SIGNIFOR 4 PA; SP

SIGNIFOR LAR 4 PA; SP

SIMLIYA (28) PV

SIMPESSE PV

SKYLA PV CN

SOLIQUA 100/33 4 PA

SOLTAMOX 4 OCH

SOMATULINE DEPOT 4 SP

SOMAVERT 4 SP

SPRINTEC (28) PV CN

SRONYX PV CN

SSKI 2

STARLIX 4

STEGLATRO 4 PA

STEGLUJAN 4 PA

STIMATE 4 SP

STRIANT 4


SUPPRELIN LA 4 SP

SYEDA PV CN

SYMBICORT 2

SYMLINPEN 120 2 PA

SYMLINPEN 60 2 PA

SYNAREL 4

SYNJARDY 2

SYNJARDY XR 2

SYNTHROID 2

TAKE ACTION PV CN

Drug Tier Notestamoxifen 1 OCH

TAPAZOLE 4

TAPERDEX EX

TARINA 24 FE PV

TARINA FE 1/20 (28) PV CN

TARINA FE 1-20 EQ (28) PV

TAYTULLA PV CN

TESTIM EX

TESTOPEL MB

testosterone 12.5 mg/1.25 gram 1

testosterone 12.5 mg/1.25 gram inner 1

testosterone 12.5 mg/1.25 gram inner EX

testosterone 12.5 mg/1.25 gram outer 1

testosterone 12.5 mg/1.25 gram outer EX

testosterone 50 mg/5 gram pkt 1

testosterone 50 mg/5 gram pkt inner 1

testosterone 50 mg/5 gram pkt inner EX

testosterone 50 mg/5 gram pkt outer 1

testosterone 50 mg/5 gram pkt outer EX

testosterone cypionate 1

testosterone enanthate 4

testosterone transdermal gel 1

testosterone transdermal gel in metered-dose pump 10 mg/0.5 gram /actuation

EX

testosterone transdermal gel in metered-dose pump 20.25 mg/1.25 gram (1.62 %)

1

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1.62 % (20.25 mg/1.25 gram), 1.62 % (40.5 mg/2.5 gram)

1

testosterone transdermal solution in metered pump w/app 1

TESTRED EX

thyroid (pork) 1

THYROLAR-1 2

THYROLAR-1/2 2

THYROLAR-1/4 2

THYROLAR-2 2

THYROLAR-3 2

TILIA FE PV CN

TIROSINT EX

TIROSINT-SOL EX

tolazamide 1

tolbutamide 1

toremifene 1 OCH

TOUJEO MAX U-300 SOLOSTAR 2

52

Drug Tier NotesTOUJEO SOLOSTAR U-300 INSULIN 2

TRADJENTA EX

TRELEGY ELLIPTA 2

TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

MB

TRESIBA FLEXTOUCH U-100 2

TRESIBA FLEXTOUCH U-200 2

TRESIBA U-100 INSULIN 2

TRI FEMYNOR PV CN

TRI-ESTARYLLA PV CN

TRI-LEGEST FE PV CN

TRI-LINYAH PV CN

TRI-LO-ESTARYLLA PV CN

TRI-LO-MARZIA PV CN

TRI-LO-MILI PV

TRI-LO-SPRINTEC PV CN

TRI-MILI PV CN

TRI-PREVIFEM (28) PV CN

TRIPTODUR MB SP

TRI-SPRINTEC (28) PV CN

TRIVORA (28) PV CN

TRI-VYLIBRA PV CN

TRI-VYLIBRA LO PV

TRULICITY EX

TULANA PV CN

TYDEMY PV CN

TYMLOS 3 PA; SP

UCERIS 4

UNITHROID 1

VAGIFEM EX

VANTAS 4 SP

VELIVET TRIPHASIC REGIMEN (28) PV CN

VERIPRED 20 1

VICTOZA 2-PAK 2 PA

VICTOZA 3-PAK 2 PA

VIENVA PV CN

VIORELE (28) PV CN

VIVELLE-DOT EX QL (8 EA per 30 days)

VOGELXO EX

VYFEMLA (28) PV CN

VYLIBRA PV CN

WELCHOL EX

WERA (28) PV CN

WESTHROID ORAL TABLET130 MG, 195 MG, 32.5 MG, 65 MG, 97.5 MG

1

WIXELA INHUB 1

WP THYROID 2

WYMZYA FE PV CN

XIGDUO XR 2

Drug Tier NotesXULANE PV CN

XULTOPHY 100/3.6 2 PA

XYOSTED EX

YASMIN (28) PV CN

YAZ (28) PV CN

YUVAFEM 1

ZARAH PV CN

ZENCHENT (28) PV CN

ZILRETTA MB SP

ZOLADEX MB SP

ZOMACTON EX SP

ZORBTIVE 4 PA; SP

ZOVIA 1/35E (28) PV CN

ZUMANDIMINE (28) PV

Local Anesthetics (Parenteral)

ACCUCAINE KIT EX

lidocaine hcl injection solution 10 mg/ml (1 %) MB

XYLOCAINE INJECTION SOLUTION 10 MG/ML (1 %) 4

Miscellaneous Therapeutic Agents

acetylcysteine MB

ACTEMRA ACTPEN 3 PA; SP

ACTEMRA INTRAVENOUS MB SP

ACTEMRA SUBCUTANEOUS 3 PA; SP

ACTIMMUNE 4 SP

ACTONEL ORAL TABLET 150 MG, 35 MG, 5 MG 4

alendronate 1

allopurinol 1

AMPYRA 4 PA; SP; QL (60 EA per 30 days)

ANAPROX DS 4

ANTABUSE 4

ARAVA 4

ARCALYST 4 SP

ASTAGRAF XL 4

ATELVIA 4

AUBAGIO 4 PA; SP

AVODART EX

AVONEX (WITH ALBUMIN) 3 SP; QL (4 EA per 30 days)

AVONEX INTRAMUSCULAR PEN INJECTOR KIT 3 SP; QL (4 EA per 30

days)

AVONEX INTRAMUSCULAR SYRINGE KIT 3 SP; QL (4 EA per 30

days)

AZASAN 4

azathioprine 1

AZULFIDINE 4


BENLYSTA INTRAVENOUS MB SP

BENLYSTA SUBCUTANEOUS 3 PA; SP

BERINERT INTRAVENOUS KIT MB SP

53

Drug Tier NotesBETASERON SUBCUTANEOUS KIT 3 SP; QL (30 EA per

30 days)

BETASERON SUBCUTANEOUS RECON SOLN

3

BINOSTO 4

BONIVA ORAL 4

BOTOX MB SP

calcitonin (salmon) 1

CARNITOR (SUGAR-FREE) 4

CARNITOR ORAL 4

CELLCEPT 4

CERDELGA 4 SP

CHEMET 4

CIMZIA 4 PA; SP; QL (1 EA per 30 days)

CIMZIA POWDER FOR RECONST 4 PA; SP; QL (1 EA per

30 days)

CIMZIA STARTER KIT 4 PA; SP; QL (1 EA per 30 days)

cinacalcet 1

CINRYZE MB SP

CLINPRO 5000 4

colchicine 2

COLCRYS 2


COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML 4 SP; QL (30 ML per

30 days)

COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML 4 SP; QL (12 ML per

30 days)

CRYOSERV 1

CUPRIMINE 2

cyclophosphamide oral capsule 4 OCH

cyclosporine modified 1

cyclosporine oral capsule 1

CYSTADANE 4 SP

CYSTAGON 4 SP

dalfampridine 4 PA; SP; QL (60 EA per 30 days)

DEMSER 2

DENTA 5000 PLUS 1

DENTAGEL 1

DEPEN TITRATABS 2

disulfiram 1

dutasteride 1

dutasteride-tamsulosin 1

DUZALLO EX

DYSPORT 4 SP

EC-NAPROSYN 4

EC-NAPROXEN ORAL TABLET,DELAYED RELEASE (DR/EC) 375 MG

1

EC-NAPROXEN ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG

2

ELIDEL 4

Drug Tier NotesELMIRON 2

ENBREL 3 PA; SP; QL (4 EA per 30 days)

ENBREL MINI 3 PA; SP; QL (4 ML per 30 days)

ENBREL SURECLICK 3 PA; SP; QL (4 ML per 30 days)

ENDARI EX SP

ENTYVIO MB SP

ENVARSUS XR 4

ESCAVITE PV

ESCAVITE D PV

ESCAVITE LQ PV

etidronate disodium 1

EVENITY 4 PA; SP

EVISTA 4

EVOTAZ 4

EVZIO INJECTION AUTO-INJECTOR 2 MG/0.4 ML EX

EXONDYS 51 MB SP

EXTAVIA SUBCUTANEOUS KIT EX SP; QL (15 Kits per

30 days)

EXTAVIA SUBCUTANEOUS RECON SOLN EX SP; QL (15 EA per

30 days)

febuxostat 4

finasteride oral tablet 5 mg 1

FIRAZYR 3 PA; SP

FIRDAPSE 4 PA; SP


FLORIVA PV

FLORIVA (FLUORIDE-VITAMIN D3) PV

FLORIVA PLUS PV

FLUORABON PV

fluoride (sodium) dental gel 1

fluoride (sodium) oral drops PV CN

fluoride (sodium) oral tablet,chewable PV CN

FLUORIDEX DAILY DEFENSE DENTAL PASTE 4

FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE 4

FLUORITAB ORAL TABLET,CHEWABLE PV CN

FLURA-DROPS PV

FORTEO 3 PA; SP

FOSAMAX ORAL TABLET 70 MG 4

FOSAMAX PLUS D 4

FOSRENOL EX

GALAFOLD 3 PA; SP

GAMIFANT MB SP

GENGRAF ORAL CAPSULE100 MG, 25 MG 1

GENGRAF ORAL SOLUTION 1

54

Drug Tier NotesGILENYA 3 PA; SP

glatiramer 4 SP

GLATOPA SUBCUTANEOUS SYRINGE 20 MG/ML 4 SP; QL (30 Syringes

per 30 days)

GLATOPA SUBCUTANEOUS SYRINGE 40 MG/ML 4 SP

GLUCAGEN HYPOKIT 4

GLUCAGON EMERGENCY KIT (HUMAN) 2

GRASTEK 4

HAEGARDA 4 SP


30 days)



30 days)


30 days)




30 days)


HUMIRA(CF) PEDI CROHNS STARTER 3 PA; SP; QL (2 EA per

30 days)

HUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per

30 days)


30 days)



hydroxychloroquine 1

ibandronate oral 1

ILARIS (PF) SUBCUTANEOUS SOLUTION MB SP

IMURAN 4

INDOCIN ORAL EX PA

INDOCIN RECTAL EX

indomethacin oral 1

INFLECTRA MB SP


JALYN 4

KALBITOR 4 SP

KEVEYIS 4 SP

KEVZARA 4 PA; SP

KINERET EX PA; SP

KRYSTEXXA MB SP

KUVAN 4 SP

lanthanum 1

leflunomide 1

LEMTRADA MB SP

leucovorin calcium injection recon soln 100 mg, 200 mg, 50 mg, 500 mg

4

Drug Tier Notesleucovorin calcium oral 1

levocarnitine (with sugar) 1

levocarnitine oral tablet 1

LIPOCHOL PLUS 4

LUDENT FLUORIDE PV CN

LUGOLS ORAL 1

MAVENCLAD (10 TABLET PACK) EX SP







MAYZENT 4 PA; SP

MAYZENT STARTER PACK 4 PA; SP

MEPHYTON 4

mercaptopurine 1 OCH

MESNEX ORAL 4

methotrexate sodium (pf) 1

methotrexate sodium injection 1

methotrexate sodium oral 1 OCH

MIACALCIN INJECTION 4

miglustat 4 SP

MITIGARE 2


MULTIVITAMIN WITH FLUORIDE PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL DROPS PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG

PV

MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG

PV

MVC-FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MVC-FLUORIDE ORAL TABLET,CHEWABLE 1 MG PV

mycophenolate mofetil 1

mycophenolate sodium 1

MYFORTIC 4

55

Drug Tier NotesMYOBLOC MB SP

naloxone 1

naltrexone 1

NAPRELAN CR EX

NAPROSYN ORAL SUSPENSION 4

NAPROSYN ORAL TABLET500 MG 4

naproxen 1

naproxen sodium oral tablet 275 mg, 550 mg 1

naproxen sodium oral tablet, er multiphase 24 hr EX

NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 4

NATPARA 4 PA; SP

NEORAL 4

NICAZEL EX

NITYR 4 SP

NULOJIX MB SP

OCREVUS MB SP

octreotide acetate 3 SP

OLUMIANT 4 PA; SP

ONPATTRO MB SP

ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY, 100 IR (3) /300 IR (6)

MB

ORALAIR SUBLINGUAL TABLET 300 INDX REACTIVITY 4 SP

ORENCIA 4 PA; SP; QL (4 ML per 30 days)

ORENCIA (WITH MALTOSE) MB SP

ORENCIA CLICKJECT 4 PA; SP; QL (4 ML per 30 days)

ORFADIN 4 SP

OTEZLA 3 PA; SP

OTEZLA STARTER 3 PA; SP

OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.4 ML, 12.5 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML

2

penicillamine 1

phytonadione (vitamin k1) oral tablet 5 mg 1

pimecrolimus 1

PLAQUENIL EX

PLEGRIDY 3 SP; QL (1 ML per 30 days)

POLY-VI-FLOR PV


POMALYST 4 PA; SP; OCH

POTABA ORAL CAPSULE 4

PREVIDENT 4

PREVIDENT 5000 BOOSTER PLUS 4

Drug Tier NotesPREVIDENT 5000 DRY MOUTH 4

PREVIDENT 5000 ENAMEL PROTECT 4

PREVIDENT 5000 PLUS 4

PREVIDENT 5000 SENSITIVE 4

PREZCOBIX 4

probenecid 1

probenecid-colchicine 1

PROCYSBI 4 SP

PROGRAF ORAL 4

PROLEUKIN MB SP

PROLIA 4 SP

PROSCAR 4

PURIXAN 4 SP; OCH

QUFLORA PV

QUFLORA FE PV


QUFLORA PEDIATRIC PV

QUFLORA PEDIATRIC DROPS PV

RAGWITEK 4

raloxifene 1 OCH

RAPAMUNE 4

RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML

2

REBIF (WITH ALBUMIN) 3 SP; QL (6 ML per 30 days)

REBIF REBIDOSE 3 SP; QL (6 ML per 30 days)

REBIF TITRATION PACK 3 SP; QL (5 ML per 30 days)

REMICADE MB SP

RENAGEL ORAL TABLET 800 MG EX

RENFLEXIS MB SP

RENVELA 4 PA

REVIA 4

REVLIMID 3 PA; SP; OCH

RIDAURA 4

risedronate 1

RUCONEST MB SP

RUZURGI EX

SANDIMMUNE ORAL 4

SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML

4 SP

SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

3 SP

SENSIPAR 4 SP

56

Drug Tier Notessevelamer carbonate oral powder in packet 4

sevelamer carbonate oral tablet 1

sevelamer hcl 4

SF 1

SF 5000 PLUS 1

SIMPONI 4 PA; SP

SIMPONI ARIA MB SP

sirolimus 1

SODIUM FLUORIDE 5000 PLUS 1

sodium polystyrene sulfonate oral powder 4

sodium polystyrene sulfonate oral suspension 1

sodium polystyrene sulfonate rectal enema 30 gram/120 ml 4

SOLIRIS MB SP

SPINRAZA (PF) MB SP

SPS (WITH SORBITOL) ORAL 1

SPS (WITH SORBITOL) RECTAL 4

SSKI 2

STELARA INTRAVENOUS MB SP

STELARA SUBCUTANEOUS 3 PA; SP


sulfasalazine 1

SYMTUZA EX

tacrolimus oral 1

TAKHZYRO MB SP

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG


TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46), 240 MG


TEGSEDI EX SP

THALOMID 3 SP; OCH

THIOLA 4 SP

TIVORBEX EX

TREXALL 4 OCH

TRIPLE VITAMIN WITH FLUORIDE PV CN

TRI-VI-FLOR PV

TRI-VITAMIN WITH FLUORIDE PV CN

TRI-VITE WITH FLUORIDE PV

TYBOST 2

TYMLOS 3 PA; SP

TYSABRI MB SP

ULORIC 4

ULTOMIRIS MB SP

VISTOGARD 4 SP; OCH

VITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.25 MG FLUOR. (0.55 MG)/ML

PV CN

Drug Tier NotesVITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.5 MG FLUORIDE (1.1 MG)/ML

PV

VIVITROL MB SP

XATMEP 4 OCH

XELJANZ 3 PA; SP

XELJANZ XR 3 PA; SP

XEOMIN 4 SP

XGEVA 4 SP

XURIDEN 4 SP

ZAVESCA 4 SP

ZORTRESS 2

ZYLOPRIM 4

Oxytocics

METHERGINE 4

methylergonovine oral 1

PREPIDIL 4

PROSTIN E2 4

Pharmaceutical Aids

DILUENT FOR EPOPROSTENOL/FLOLA MB SP

FORMA-RAY 1

LUMOXITI IV SOLN STABILIZER MB SP

PH 12 DILUENT FOR FLOLAN MB SP

RADIAGEL MB

Radioactive Agents



LUTATHERA MB SP

XOFIGO MB SP

Respiratory Tract Agents

ACCOLATE 4

acetylcysteine MB

ADCIRCA 4 PA; SP

ADEMPAS 4 SP

ADRENALIN INJECTION 1

ADVAIR DISKUS 4

ADVAIR HFA 2

AEROSPAN 4

AIRDUO RESPICLICK 4

albuterol sulfate inhalation hfa aerosol inhaler 4

albuterol sulfate inhalation solution for nebulization 1

albuterol sulfate oral 1

ALOCRIL EX

ALVESCO EX

ALYQ 3 PA; SP

ambrisentan 3 SP

ANORO ELLIPTA 2

ARALAST NP MB SP

ARCAPTA NEOHALER 4

57

Drug Tier NotesARMONAIR RESPICLICK 4

ARNUITY ELLIPTA 2

ASMANEX HFA 2

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)

2

atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 4

ATROVENT HFA 4

AUVI-Q EX

BECONASE AQ EX

benzonatate 1

BEVESPI AEROSPHERE 4

BONJESTA EX

bosentan 4 SP

BREO ELLIPTA 2

BROMFED DM 4

brompheniramine-pseudoeph-dm oral syrup 4

BROVANA EX

budesonide inhalation 1

budesonide nasal EX

carbinoxamine maleate EX

CENTERGY 1

CENTERGY DM 1

cetirizine oral solution 1 mg/ml 1

CHERATUSSIN AC 1

CINQAIR MB SP

CLARINEX ORAL TABLET EX


clemastine oral tablet EX

codeine sulfate oral tablet 1 PA

codeine-guaifenesin 1

CODITUSSIN AC 4

COMBIVENT RESPIMAT 2

cromolyn ophthalmic (eye) 1

cromolyn oral 1

cyproheptadine 1

DALIRESP 4

desloratadine 1

DICLEGIS 4

diphenhydramine hcl injection solution 50 mg/ml 1

diphenhydramine hcl injection syringe MB

diphenhydramine hcl oral capsule 50 mg 1

diphenhydramine hcl oral elixir 1



DULERA 2

Drug Tier NotesDUPIXENT 4 PA; SP

DYMISTA EX


epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.15 mg/0.3 ml

2

epinephrine injection solution 1

epinephrine injection syringe 0.1 mg/ml 1

EPIPEN 2 PA

EPIPEN 2-PAK 2 PA

EPIPEN JR 2 PA

EPIPEN JR 2-PAK 2 PA

EPISNAP 2 PA

epoprostenol (glycine) MB SP

ESBRIET 4 PA; SP

FASENRA MB SP

fexofenadine oral tablet 180 mg, 60 mg EX


FLOLAN MB SP

FLOVENT DISKUS 4

FLOVENT HFA 4

flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) EX

fluticasone propionate nasal 1


4


GASTROCROM 4

GLASSIA MB SP

GUAIATUSSIN AC 1

GUAIFENESIN AC 1

GUAIFENESIN DAC 1

HISTEX-AC 1






HYDROMET 1

INCRUSE ELLIPTA 2

ipratropium bromide inhalation 1

ipratropium-albuterol 1

KALYDECO 3 PA; SP

KARBINAL ER EX

LETAIRIS 3 SP

levalbuterol hcl EX

levalbuterol tartrate EX

58

Drug Tier Noteslevocetirizine 1

LOMOTIL 4


LUGOLS ORAL 1

metaproterenol oral syrup 1

metaproterenol oral tablet 10 mg 1

mometasone nasal EX

montelukast 1

NASONEX EX

NUCALA SUBCUTANEOUS AUTO-INJECTOR 4 PA; SP

NUCALA SUBCUTANEOUS RECON SOLN MB SP

NUCALA SUBCUTANEOUS SYRINGE 4 PA; SP

NUEDEXTA 4

OBREDON EX

OFEV 4 PA; SP

OMNARIS EX

OPSUMIT 4 SP

ORENITRAM 4 SP

ORKAMBI 3 PA; SP

PERFOROMIST 2

PROAIR HFA 2

PROAIR RESPICLICK 2

PROLASTIN-C MB SP


promethazine oral 1

PROMETHAZINE VC 1

promethazine-codeine 1

promethazine-dm 1



PROVENTIL HFA EX

PULMICORT EX

PULMICORT FLEXHALER 2

PULMOZYME 4 SP

QNASL EX

QVAR REDIHALER 2

REMODULIN 4 SP

RESPA-AR 4

REVATIO INTRAVENOUS MB SP

REVATIO ORAL SUSPENSION FOR RECONSTITUTION 3 SP

REVATIO ORAL TABLET 4 PA; SP

RYCLORA EX

RYDEX 1

RYVENT EX

SEMPREX-D EX

SEREVENT DISKUS 2

sildenafil (antihypertensive) intravenous MB SP

Drug Tier Notessildenafil (antihypertensive) oral suspension for reconstitution 3 SP

sildenafil (antihypertensive) oral tablet 4 PA; SP

SINGULAIR EX

SINUVA MB SP

SPIRIVA RESPIMAT 2

SPIRIVA WITH HANDIHALER 2

SSKI 2

STRIVERDI RESPIMAT 4


SURFAXIN 4

SYMBICORT 2

SYMDEKO 3 PA; SP

tadalafil (antihypertensive) 3 PA; SP

terbutaline 1

TESSALON PERLES 4

THEO-24 4

THEOCHRON 1





TICALAST EX

TICANASE EX

TICASPRAY EX

TRACLEER 3 SP

TRELEGY ELLIPTA 2

treprostinil sodium 4 SP

triamcinolone acetonide nasal EX

TUDORZA PRESSAIR 4

TUSNEL C 1

TUSSICAPS 4

TYVASO 4 SP

TYVASO INSTITUTIONAL START KIT 4 SP

TYVASO REFILL KIT 4 SP

TYVASO STARTER KIT 4 SP

UPTRAVI 4 SP

UTIBRON NEOHALER 4

VELETRI MB SP

VENTAVIS 4 SP

VENTOLIN HFA 4

VIRTUSSIN AC 1

VIRTUSSIN DAC 1

WIXELA INHUB 1

XHANCE EX

XOLAIR MB SP

XOPENEX EX

XOPENEX CONCENTRATE EX

XOPENEX HFA EX

59

Drug Tier NotesXYZAL ORAL TABLET EX

zafirlukast 4

ZEMAIRA MB SP

ZETONNA EX

zileuton 4 PA

ZYFLO 4 PA

Skin And Mucous Membrane Agents

ABSORICA EX

ACANYA TOPICAL GEL WITH PUMP 4

ACCUCAINE KIT EX

acitretin 4

acyclovir topical 1

ACZONE 4 PA

adapalene EX

adapalene-benzoyl peroxide EX

ADAZIN EX

ADVANCED ALLERGY COLLECT KIT EX PA

AGONEAZE EX

AKTIPAK EX

ALA-CORT TOPICAL CREAM 1 % 1

ALA-QUIN EX

ALA-SCALP 4

alclometasone 1

ALCOHOL PADS 2

ALCOHOL PREP PADS 2

alcohol swabs 2

ALCOHOL WIPES 2

ALCORTIN A EX

ALDARA 4

ALTABAX 4

ALTRENO EX

amcinonide 4

ammonium lactate 1

AMNESTEEM 1

ANACAINE EX

ANA-LEX KIT EX PA

ANALPRAM-HC RECTAL CREAM 4

ANALPRAM-HC SINGLES RECTAL CREAM 2.5-1 % (4G) 4

ANALPRAM-HC TOPICAL 4

ANASTIA EX

ANODYNE LPT EX

ANUCORT-HC 4

ANUSOL-HC RECTAL SUPPOSITORY EX

ANUSOL-HC TOPICAL EX

APEXICON E 1

APRIZIO PAK EX

AQUA GLYCOLIC HC EX PA

Drug Tier NotesASTERO EX

ATOPICLAIR EX

ATRALIN 4

AVAGE EX

AVAR LS EX

AVAR TOPICAL CLEANSER EX

AVAR TOPICAL PADS, MEDICATED EX

AVAR-E EX

AVAR-E GREEN EX

AVAR-E LS EX

AVC VAGINAL 4

AVITA TOPICAL CREAM 1

AVITA TOPICAL GEL 4 PA

AVO CREAM EX

azelaic acid 4

AZELEX 4 PA

BENSAL HP TOPICAL OINTMENT 3 % EX

BENZACLIN EX

BENZACLIN PUMP EX

BENZAMYCIN 4

BENZEPRO TOPICAL TOWELETTE 1

BENZODOX 30 EX

BENZODOX 60 EX

benzoyl peroxide topical cleanser7 % 1

benzoyl peroxide topical foam EX

BESER 4

BESER KIT EX

betamethasone dipropionate 1

betamethasone valerate 1

betamethasone, augmented 1

BIAFINE EMULSION EX

BP 10-1 4

BPO TOPICAL GEL 1

BPO TOPICAL TOWELETTE 6 % 1

BRYHALI 4 PA

calcipotriene 1

calcipotriene-betamethasone 4

CALCITRENE 1

calcitriol topical 1

CALICYLIC EX

CAPEX 4 PA

CAPSFENAC PAK EX

CAPXIB EX

CARAC EX

CELACYN EX

CEM-UREA 1

CENTANY EX

CENTANY AT EX

60

Drug Tier NotesCERACADE EX

CETACAINE 4

CICLODAN KIT TOPICAL COMBO PACK EX PA

CICLODAN KIT TOPICAL SOLUTION EX

CICLODAN TOPICAL CREAM EX

CICLODAN TOPICAL SOLUTION 1

ciclopirox 1

ciclopirox-ure-camph-menth-euc 4

CLARAVIS 1

CLEANSING WASH TOPICAL CLEANSER 1

CLEOCIN T 4

CLEOCIN VAGINAL 4

CLINDACIN ETZ EX

CLINDACIN P EX

CLINDACIN PAC EX

CLINDAGEL EX

clindamycin phosphate topical foam 1

clindamycin phosphate topical gel 1

clindamycin phosphate topical gel, once daily EX

clindamycin phosphate topical lotion 1

clindamycin phosphate topical solution 1

clindamycin phosphate topical swab 1

clindamycin phosphate vaginal 1

clindamycin-benzoyl peroxide topical gel 4

clindamycin-benzoyl peroxide topical gel with pump 1.2-2.5 % 1

clindamycin-benzoyl peroxide topical gel with pump 1-5 % 4

clindamycin-tretinoin 4

CLINDESSE 4

clobetasol 4

clobetasol-emollient 4

CLOBEX 4

clocortolone pivalate 4 PA

CLODAN EX

CLODAN KIT EX

CLODERM 4 PA

clotrimazole mucous membrane 1

clotrimazole topical solution 1

clotrimazole-betamethasone 1


CONDYLOX TOPICAL GEL EX

CORDRAN TAPE LARGE ROLL EX

CORDRAN TOPICAL CREAM EX

CORDRAN TOPICAL LOTION EX

Drug Tier NotesCORDRAN TOPICAL OINTMENT EX

COREMINO 4

CORMAX SCALP 1

CORTENEMA 4

CORTIFOAM EX

CORTISPORIN TOPICAL 4

COSENTYX 3 PA; SP

COSENTYX (2 SYRINGES) 3 PA; SP

COSENTYX PEN 3 PA; SP

COSENTYX PEN (2 PENS) 3 PA; SP

CROTAN 4

CURITY ALCOHOL SWABS 2

CUTIVATE TOPICAL CREAM 4

CUTIVATE TOPICAL LOTION 4

dapsone topical 4

DEBACTEROL 4

DENAVIR EX

DERMACINRX CLORHEXACIN EX

DERMACINRX EMPRICAINE EX

DERMACINRX LEXITRAL EX

DERMACINRX PHN PAK EX

DERMACINRX PRIZOPAK EX

DERMACINRX SILAPAK EX

DERMACINRX SURGICAL PHARMAPAK EX

DERMACINRX THERAZOLE PAK EX

DERMACINRX ZRM PAK EX

DERMA-SMOOTHE/FS BODY OIL 4

DERMA-SMOOTHE/FS SCALP OIL 4

DERMASORB HC COMPLETE KIT EX PA

DERMASORB TA COMPLETE KIT EX

DERMATOP TOPICAL OINTMENT 4

DERMAWERX SDS EX

DERMAWERX SURGICAL PLUS PAK EX

DERMAZENE TOPICAL CREAM 1

DERMAZYL KIT EX

DESONATE 4 PA

desonide 4

DESOWEN 4

desoximetasone topical cream 4

desoximetasone topical gel 4

desoximetasone topical ointment 4

desoximetasone topical spray,non-aerosol EX

DEXERYL EX

DICLO GEL EX

61

Drug Tier NotesDICLO GEL-XRYLIX SHEET EX

diclofenac epolamine EX

diclofenac sodium topical 4

DICLOFEX DC EX

DICLOFONO EX

DICLOPAK EX PA

DICLOPR EX PA

DICLOTRAL EX

DICLOVIX EX

DICLOZOR EX

DIFFERIN EX

diflorasone 4

DIPROLENE TOPICAL OINTMENT 4

DITHOL EX

DOLOTRANZ EX

DOVONEX TOPICAL 4

doxepin topical EX

doxycycline monohydrate oral capsule,ir - delay rel,biphase EX

DRITHOCREME HP 4

DRYSOL 4

DRYSOL DAB-O-MATIC 4

DUAC EX

DUOBRII EX

DUPIXENT 4 PA; SP

EASY TOUCH ALCOHOL PREP PADS 2

econazole 1

ECOZA 4

EFUDEX TOPICAL CREAM 4

ELETONE EX

ELIDEL 4

ELIMITE 4

ELLZIA PAK EX PA

ELOCON TOPICAL CREAM 4

ENBREL 3 PA; SP; QL (4 EA per 30 days)

ENBREL MINI 3 PA; SP; QL (4 ML per 30 days)

ENBREL SURECLICK 3 PA; SP; QL (4 ML per 30 days)

ENSTILAR EX

EPIDUO FORTE EX

EPIDUO TOPICAL GEL WITH PUMP EX

EPIFOAM 4

ERTACZO EX

ERY PADS 1

ERYGEL 4

erythromycin with ethanol 1

erythromycin-benzoyl peroxide 1

ESKATA EX

ethyl chloride 1

Drug Tier NotesEUCRISA 4

EURAX 4

EVOCLIN 4

EXELDERM 4

EXODERM 4

EXTINA 4

FABIOR EX

FEM PH 1

FINACEA 4 PA

FLECTOR EX

FLEXIPAK EX PA

fluocinolone 1

fluocinolone and shower cap 1

fluocinonide 4

FLUOCINONIDE-E 4

fluocinonide-emollient EX

FLUOROPLEX EX

fluorouracil topical cream 0.5 % EX

fluorouracil topical cream 5 % 4

fluorouracil topical solution 1

flurandrenolide topical cream 1

flurandrenolide topical lotion 4

flurandrenolide topical ointment 4

fluticasone propionate topical 1

FORMADON TOPICAL SOLUTION 1

FROTEK EX

gentamicin topical 1

GYNAZOLE-1 4

halobetasol propionate topical cream 1

halobetasol propionate topical foam EX PA

halobetasol propionate topical ointment 1

HALOG EX

HEMMOREX-HC 4

HPR PLUS-MB HYDROGEL EX


30 days)



30 days)


30 days)




30 days)


HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML


62

Drug Tier NotesHUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per

30 days)


30 days)



HYDRO 35 EX

HYDRO 40 4

hydrocortisone acetate rectal 1

hydrocortisone butyrate 4

hydrocortisone butyr-emollient 4

hydrocortisone rectal 1

hydrocortisone topical cream 1 %, 2.5 % 1

hydrocortisone topical cream with perineal applicator 1

hydrocortisone topical lotion 2.5 % 1

hydrocortisone topical ointment 1 %, 2.5 % 1

hydrocortisone valerate 1

hydrocortisone-iodoquinl-aloe2 4 PA

hydrocortisone-iodoquinol 1

hydrocortisone-iodoquinol-aloe 1

hydrocortisone-pramoxine rectal 1

hydrocortisone-pramoxine topical 4

ILUMYA EX SP

imiquimod topical cream in metered-dose pump EX

imiquimod topical cream in packet 1

IMPOYZ EX

INFLAMMACIN EX

INFLAMMA-K EX

INFLECTRA MB SP

INOVA EX

INOVA 4-1 EX

INOVA 8-2 EX

isotretinoin 4

JUBLIA EX

KENALOG TOPICAL 4

KERAFOAM 4

KERALAC EX

KERALYT RX 4

KERALYT SCALP COMPLETE EX PA

KERYDIN EX

ketoconazole topical 1

KLARON 4

L.E.T. (LIDO-EPINEPH-TETRA) 4 PA

LDO PLUS EX

LEVA SET EX

LEVULAN 4

LEXETTE EX PA

LEXIXRYL EX

Drug Tier Noteslidocaine hcl laryngotracheal 1

lidocaine hcl topical cream 3 %, 3.88 % EX

lidocaine hcl topical lotion EX

lidocaine hcl-hydrocortison ac rectal cream 3-0.5 % 1

lidocaine hcl-hydrocortison ac rectal gel 4

lidocaine hcl-hydrocortison ac rectal kit 2 %-2 % (7 gram) EX

lidocaine hcl-hydrocortison ac rectal kit 3-0.5 %, 3-1 % (7 gram) EX PA

lidocaine hcl-hydrocortison ac topical 1

lidocaine topical adhesive patch,medicated 1

lidocaine topical ointment 1

lidocaine-hydrocortisone-aloe rectal gel 1

lidocaine-hydrocortisone-aloe rectal kit 3-2.5 % (7 gram) EX PA

lidocaine-prilocaine topical cream 1

lidocaine-prilocaine topical kit EX

lidocaine-racepinep-tetracaine 4 PA

lidocaine-tetracaine 4 PA

LIDODERM EX

LIDO-K EX

LIDOPAC EX

LIDOPATCH EX

LIDOPIN EX

LIDOPRIL EX

LIDOPRIL XR EX

LIDO-PRILO CAINE PACK EX

LIDOPRO PATCH EX

LIDOPURE PATCH EX

LIDORX EX

LIDOTRAL EX

LIDOTRANS 5 PAK EX

LIDOVEX EX

LIDOXIB EX

LIDOZION EX

LIDTOPIC MAX EX

LIMENCIN (LIDOCAINE-MENTHOL) EX

lindane topical shampoo 1

LIPROZONEPAK EX

LIVIXIL PAK EX

LOCOID LIPOCREAM 4 PA

LOCOID TOPICAL CREAM 4

LOCOID TOPICAL LOTION 4

LOCOID TOPICAL SOLUTION 4

LOPROX (AS OLAMINE) 4

LOPROX KIT EX PA

LOPROX TOPICAL SHAMPOO 4

LOTRISONE TOPICAL CREAM 4

63

Drug Tier NotesLUGOLS TOPICAL 1

luliconazole 4

LUXAMEND EX

LUXIQ 4

LUZU 4

mafenide acetate 1

malathion 4

MB HYDROGEL EX

MEDOLOR PAK EX

MENTAX 4

MENTHO-CAINE EX

methoxsalen 1

METROCREAM 4

METROGEL TOPICAL GEL 1 % 4

METROGEL TOPICAL GEL WITH PUMP 4

METROGEL VAGINAL 4

METROLOTION 4

metronidazole topical 1

metronidazole vaginal 1

miconazole nitrate-zinc ox-pet 4

MICONAZOLE-3 VAGINAL SUPPOSITORY 1

MICORT-HC 4

MIGRANOW EX

minocycline oral tablet extended release 24 hr 105 mg, 115 mg, 55 mg, 65 mg, 80 mg

EX

minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg

EX PA

MINOLIRA ER EX

MIRVASO EX

mometasone topical 1

MORGIDOX 1X 50 EX

MORGIDOX 1X100 EX

MORGIDOX 2X100 EX

mupirocin 1

mupirocin calcium 1

MYORISAN 1

naftifine topical cream 1 % 4

naftifine topical cream 2 % 1

naftifine topical gel 4

NAFTIN TOPICAL CREAM 2 % 4

NAFTIN TOPICAL GEL 4

NATROBA 4

NEO-SYNALAR EX

NEO-SYNALAR KIT EX

NEUAC EX

NEUAC KIT EX

NEURAPTINE EX

NEURCAINE EX

NIZORAL TOPICAL SHAMPOO 4

Drug Tier NotesNOLIX EX

NORITATE EX

NOVACORT EX

NOXIPAK EX

NUCORT 4 PA

NUDICLO SOLUPAK EX

NUDICLO TABPAK EX

NUDROXIPAK EX



NUDROXIPAK E-400 EX

NUDROXIPAK I-800 EX

NUDROXIPAK N-500 EX

NUMBONEX EX

NUSURGEPAK SURGICAL PREP EX PA

NUTRIARX EX

NUVAKAAN EX

NUVESSA 4

NYAMYC 1

nystatin topical cream 1

nystatin topical ointment 1

nystatin topical powder 4

nystatin-triamcinolone 1

NYSTOP 1

OLUX 4

OLUX-E 4

ONEXTON EX

ORACEA EX

ORALONE 1

ORAVIG EX

OTEZLA 3 PA; SP

OTEZLA STARTER 3 PA; SP

OVACE 4

OVACE PLUS SHAMPOO EX

OVACE PLUS TOPICAL CLEANSER EX

OVACE PLUS TOPICAL CREAM EX

OVACE PLUS TOPICAL FOAM EX

OVACE PLUS TOPICAL LOTION EX

OVACE PLUS WASH EX

OVIDE 4

oxiconazole 1

OXISTAT 4

OXSORALEN ULTRA 4

PACNEX 4

PACNEX HP 4

PACNEX LP 4

PAINGO KFT EX

PANDEL EX

PANRETIN 4

64

Drug Tier NotesPENLAC 4

PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP

EX

permethrin topical cream 1

phenazopyridine oral tablet 100 mg, 200 mg 1

PICATO EX

pimecrolimus 1

PLEXION EX

PLEXION CLEANSING CLOTHS EX

PLIAGLIS 4 PA

PODOCON 2

podofilox 1

PONTOCAINE 4

PRAMOSONE 4

prednicarbate 4

PRIKAAN EX

PRIKAAN LITE EX

PRILOLID EX

PRILOVIX EX

PRILOVIX LITE EX

PRILOVIX PLUS EX

PROCORT 4

PROCTOCORT 4

PROCTOFOAM HC 4

PROCTO-MED HC 1

PROCTO-PAK 1

PROCTOSOL HC TOPICAL 1

PROCTOZONE-HC 1

PROTOPIC 4

PRUCLAIR EX

PRUDOXIN 4

PRUTECT EX

PSORCON EX

PYRIDIUM 4

QBREXZA 4 PA

QUTENZA EX SP

RECTIV 4

REGRANEX 4

RELADOR PAK EX

RELADOR PAK PLUS EX

RELAGARD 4

REMICADE MB SP

RENFLEXIS MB SP

RESTIZAN EX

RETIN-A 4

RETIN-A MICRO EX

RETIN-A MICRO PUMP EX

RHOFADE 4

ROSADAN TOPICAL CREAM 4

ROSADAN TOPICAL GEL 4

Drug Tier NotesROSADAN TOPICAL KIT, CLEANSER AND GEL EX PA

ROSADAN TOPICAL KIT,CLEANSER AND CREAM EX PA

ROSANIL 4

ROSULA EX

ROSULA CLEANSING CLOTHS EX

RYNODERM EX

SALEX EX

salicylic acid er-ceramides topical kit,cleanser and cream er EX PA

salicylic acid topical cream 1

salicylic acid topical cream,extended release 1

salicylic acid topical film forming liquid w/appl 1

salicylic acid topical film-forming soln er w/ appl 1

salicylic acid topical foam 1

salicylic acid topical gel 1

salicylic acid topical liquid 26 % 1

salicylic acid topical lotion 1

salicylic acid topical lotion,extended release 1

salicylic acid topical shampoo 1

SALIMEZ 4

SALIMEZ FORTE EX

SALKERA 4

SALVAX EX

SALVAX DUO PLUS EX

SANADERMRX EX

SANTYL 2

SCALACORT 1

SCALACORT DK EX PA

selenium sulfide topical lotion 1

selenium sulfide topical shampoo2.25 %, 2.3 % 1

SELRX EX

SERNIVO 4 PA

SILALITE PAK EX

SILAZONE-II EX

SILIQ EX PA; SP

SILVADENE 2

silver nitrate 1

silver nitrate applicators 1

silver sulfadiazine 1

SKLICE 4

SKYRIZI 3 PA; SP

SOLARAZE EX

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR105 MG, 115 MG, 55 MG, 65 MG, 80 MG

EX

SOLUPAK EX

SONAFINE EX

65

Drug Tier NotesSOOLANTRA 4

SORIATANE ORAL CAPSULE10 MG, 17.5 MG, 25 MG 4

SORILUX EX

SP SCAR MANAGEMENT EX

spinosad 1

SPRAY AND STRETCH 4

SSD 1

SSS 10-5 1

STELARA INTRAVENOUS MB SP

STELARA SUBCUTANEOUS 3 PA; SP

sulfacetamide sodium (acne) 1

sulfacetamide sodium topical 1

sulfacetamide sodium-sulfur topical cleanser 4

sulfacetamide sodium-sulfur topical cream 4

sulfacetamide sodium-sulfur topical lotion 4

sulfacetamide sodium-sulfur topical pads, medicated 10-4 % EX

sulfacetamide sodium-sulfur topical suspension 10-5 % 4

sulfacetamide sodium-sulfur topical suspension 8-4 % 1

sulfacetamide sod-sulfur-urea topical cleanser 4

sulfacetamide-sulfur-cleansr23 EX PA

SULFACLEANSE 8-4 EX

sulfact na-sul-avobnz-otn-ocsa EX

SULFAMYLON 4

SUMADAN EX

SUMADAN XLT EX

SUMAXIN EX

SUMAXIN CP EX

SUMAXIN TS 4

SURE COMFORT ALCOHOL PREP PADS 2

SURE RESULT DSS PREMIUM PACK EX

SURE RESULT TAC PAK EX

SYNALAR EX

SYNALAR CREAM KIT EX PA

SYNALAR OINTMENT KIT EX PA

SYNALAR TS EX

SYNERA 4 PA

SYNVEXIA TC EX

TACLONEX EX

tacrolimus topical 1

TALTZ AUTOINJECTOR EX PA; SP

TALTZ AUTOINJECTOR (2 PACK) EX PA; SP

TALTZ AUTOINJECTOR (3 PACK) EX PA; SP

TALTZ SYRINGE EX PA; SP

Drug Tier NotesTARGRETIN TOPICAL 2 PA

tazarotene 4

TAZORAC EX

TEMOVATE TOPICAL CREAM 4

TEMOVATE TOPICAL OINTMENT 4

terconazole 1

TEROCIN (LIDOCAINE-MENTHOL) EX

TERSI FOAM 4

TETRIX EX

TEXACORT 4 PA

TOLAK 4

TOPICORT EX

TRANZAREL EX

TREMFYA 3 PA; SP

tretinoin 1

tretinoin (emollient) EX

tretinoin microspheres 1

TRETIN-X CREAM KIT EX

TRETIN-X TOPICAL CREAM0.075 % EX PA

triamcinolone acetonide dental 1

triamcinolone acetonide topical aerosol 1

triamcinolone acetonide topical cream 1

triamcinolone acetonide topical lotion 1

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 % 1

TRIANEX EX

TRI-CHLOR 1

TRIDERM TOPICAL CREAM 0.1 % 1

TRIDERM TOPICAL CREAM 0.5 % 4

TRIDESILON 4

TRIPLE DYE 4

ULESFIA 4

ULTILET ALCOHOL SWAB 2

ULTRASAL-ER 4

ULTRAVATE TOPICAL CREAM EX

ULTRAVATE TOPICAL LOTION EX PA

ULTRAVATE TOPICAL OINTMENT EX

ULTRAVATE X EX

UMECTA TOPICAL FOAM 1

URAMAXIN EX

URAMAXIN GT EX

UREA NAIL STICK 1

urea topical cream 39 %, 40 %, 45 %, 47 %, 50 % 1

urea topical cream 41 % 4

urea topical foam 1

66

Drug Tier Notesurea topical gel 45 % 1

urea topical lotion 40 % 2

URE-K EX

UREVAZ EX

UTOPIC EX

UVADEX 4

VALCHLOR 4 PA; SP

VANDAZOLE 1

VANOS 4

VANOXIDE-HC 2

VASELINE WHITE PETROLEUM EX

VECTICAL EX

VELTIN EX

VERDESO EX

VEREGEN EX

VIRASAL 4

VOLTAREN TOPICAL 4

VUSION 4

VYTONE EX

WEBCOL 2

WHYTEDERM SURGIPAK EX

WHYTEDERM TDPAK EX

WHYTEDERM TRILASIL PAK EX

WPR PLUS EX

XCLAIR EX

XELITRAL EX

XENAFLAMM EX

XEPI EX

XERESE EX

XILAPAK EX

XIMINO EX

XOLEGEL EX

XRYLIDERM EX

XRYLIX (DICLOFENAC-KINES TAPE) EX

ZENATANE 1

ZEYOCAINE EX

ZIANA EX

ZITHRANOL 4

ZONALON EX

ZOVIRAX TOPICAL 4

ZTLIDO EX PA

ZYCLARA EX

ZYPRAM EX

Smooth Muscle Relaxants

darifenacin 1

DETROL EX

DETROL LA EX

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24HR 10 MG, 5 MG

4

Drug Tier NotesELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4

ENABLEX 4

flavoxate 1

GELNIQUE TRANSDERMAL GEL IN METERED-DOSE PUMP100 MG/GRAM (10 %)

EX

GELNIQUE TRANSDERMAL GEL IN PACKET EX

MYRBETRIQ EX

oxybutynin chloride 1

OXYTROL EX

solifenacin 1

THEO-24 4

THEOCHRON 1





tolterodine 1

TOVIAZ EX

trospium 1

VESICARE EX

Vitamins

AZESCO EX

B COMPLEX 100 INJECTION 4

B-12 COMPLIANCE EX

BAL-CARE DHA 1

BAL-CARE DHA ESSENTIAL 4

BONJESTA EX

CADEAU DHA EX

calcitriol oral 1

CALCIUM 600 WITH VITAMIN D3 ORAL TABLET PV CN

CALCIUM PNV 4

CENTRATEX 1

CIFEREX EX

CITRANATAL (DUAL-IRON) 4



4

CITRANATAL B-CALM (FE GLUC) 4

CITRANATAL BLOOM 4

CITRANATAL DHA (ALGAL OIL) 4


C-NATE DHA 4

COMPLETE NATAL DHA 1

COMPLETENATE 4

CORVITA 1

67

Drug Tier NotesCORVITA 150 1

cyanocobalamin (vitamin b-12) injection 1

DERMACINRX PUREFOLIX EX

DICLEGIS 4

doxercalciferol oral 4


DRISDOL ORAL CAPSULE 4

DUET DHA BALANCED ORAL COMBO PACK 25 MG IRON-1 MG -267 MG-233 MG

4

DUET DHA WITH OMEGA-3 ORAL COMBO PACK 25 MG IRON-1 MG -400 MG

4

DURACHOL EX

ELITE OB WITH DHA 1

ELITE-OB 4

ELITE-OB 400 1

ENBRACE HR 4

ergocalciferol (vitamin d2) oral capsule 50,000 unit 1

ESCAVITE PV

ESCAVITE D PV

ESCAVITE LQ PV

EXTRA-VIRT PLUS DHA 4

FA-8 PV CN

FABB EX

FE C PLUS 1

FERRAPLUS 90 1

FERREX 150 FORTE EX

FERROCITE PLUS 1

FLORIVA PV

FLORIVA (FLUORIDE-VITAMIN D3) PV

FLORIVA PLUS PV

FOLBEE EX

FOLBIC EX

FOLET ONE 4

FOLGARD RX EX

folic acid injection 1

folic acid oral capsule 0.8 mg PV CN

folic acid oral tablet 1 mg 1

folic acid oral tablet 400 mcg, 800 mcg PV CN

FOLIVANE-F 1

FOLIVANE-OB 1

FOLIVANE-PLUS 1

FOLIXAPURE EX

FOLPLEX 2.2 EX

FOLTRATE EX

FOSAMAX PLUS D 4

GENADUR (WITH LEXINAL) EX

HEMATINIC PLUS VIT/MINERALS 1

Drug Tier NotesHEMATINIC/FOLIC ACID 1

HEMATOGEN FA 1

HEMATOGEN FORTE 1

HEMENATAL OB 1

HEMENATAL OB + DHA 1

HEMETAB 1

hydroxocobalamin 1

IFEREX 150 FORTE EX

KOSHER PRENATAL PLUS IRON 4

MARNATAL-F 4

MEPHYTON 4

M-NATAL PLUS 1

MULTIGEN FOLIC 1

MULTIGEN PLUS 1


MULTIVITAMIN WITH FLUORIDE PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL DROPS PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG

PV

MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG

PV

MVC-FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG

PV CN

MVC-FLUORIDE ORAL TABLET,CHEWABLE 1 MG PV

MYFERON 150 FORTE EX

MYNATAL 1

MYNATAL ADVANCE 1

MYNATAL PLUS 1

MYNATAL-Z 1

MYNATE 90 PLUS 1

MYNEPHRON EX

NASCOBAL EX

NATACHEW (FE BIS-GLYCINATE) 4

NEEVODHA (WITH ALGAL OIL) 4

NEPHPLEX RX 1

NEPHRO-VITE RX 1

NESTABS 4

NESTABS ABC 4

NESTABS DHA 4

NESTABS ONE 4

68

Drug Tier NotesNEURIN-SL EX

NEWGEN 4

NEXA PLUS 4

NICAZEL EX

NIVA-FOL EX

NOXIFOL-D3 EX

OB COMPLETE ONE EX

OB COMPLETE ORAL TABLET EX

OB COMPLETE PETITE EX


OB COMPLETE WITH DHA EX

OBSTETRIX DHA 1

OBSTETRIX EC 4

OBSTETRIX ONE 4

OBTREX DHA 4

O-CAL PRENATAL 4

ORTHO DF EX

paricalcitol hemodialysis port injection solution 5 mcg/ml 4

paricalcitol oral 1

PHYSICIANS EZ USE B-12 EX

phytonadione (vitamin k1) oral tablet 5 mg 1

PNV 29-1 1


PNV-DHA 1


PNV-FERROUS FUMARATE-DOCU-FA 1

PNV-OMEGA 1

PNV-SELECT 1

PNV-VP-U 1

POLY-IRON 150 FORTE EX

POLY-VI-FLOR PV


PR NATAL 400 1

PR NATAL 400 EC 1

PR NATAL 430 1

PR NATAL 430 EC 1

PREFERA-OB 4

PREFERA-OB ONE 4

PREFERA-OB PLUS DHA 4

PRENA1 CHEW 1

PRENA1 PEARL 1

PRENA1 TRUE 1

PRENAISSANCE 1

PRENAISSANCE PLUS 1

PRENATA 4

PRENATABS FA 1

PRENATABS RX 1

PRENATAL LOW IRON 1

PRENATAL PLUS 1

Drug Tier NotesPRENATAL PLUS (CALCIUM CARB) 1

PRENATAL PLUS DHA ORAL COMBO PACK 4


PRENATAL-U 1

PRENATE AM 4

PRENATE CHEWABLE 4

PRENATE DHA 4

PRENATE DHA (FERR ASP GLYCIN) 4

PRENATE ELITE 4

PRENATE ELITE (IRON ASP GLYC) 4

PRENATE ENHANCE 4

PRENATE ESSENTIAL 4

PRENATE ESSENTIAL(IRON-ASP-GL) 4

PRENATE MINI (FERR ASP GLYCIN) 4

PRENATE PIXIE 4

PRENATE RESTORE 4

PRENATE STAR 4

PREPLUS 1

PRETAB 1

PRIMACARE 4

PROVIDA DHA 4

PROVIDA OB 4

PUREFE OB PLUS 4

QUFLORA PV

QUFLORA FE PV


QUFLORA PEDIATRIC PV

QUFLORA PEDIATRIC DROPS PV

RAYALDEE 4

RENAL CAPS 1

RENA-VITE RX 1

RENO CAPS 1

REVESTA EX

R-NATAL OB 4

ROCALTROL 4

ROXIFOL-D EX

SELECT-OB 4

SELECT-OB + DHA 4

SE-NATAL 19 1


TARON FORTE 1

TARON-C DHA 1


THRIVITE RX 4

THRIVITE-19 1

69

Drug Tier NotesTL-SELECT 1

TRIADVANCE 1

TRICARE 4

TRIGELS-F FORTE 1

TRINATAL RX 1 1

TRINATE 1

TRIPHROCAPS 1

TRIPLE VITAMIN WITH FLUORIDE PV CN

TRISTART DHA 4

TRIVEEN-DUO DHA 1

TRIVEEN-ONE 1

TRIVEEN-PRX RNF 1

TRI-VI-FLOR PV

TRI-VITAMIN WITH FLUORIDE PV CN

TRI-VITE WITH FLUORIDE PV

TRUST NATAL DHA 1

V-C FORTE 1

VENA-BAL DHA 1

VIC-FORTE 1

VINACAL 1

VINATE CARE 1

VINATE DHA RF EX

VINATE GT 1

VINATE II 1

VINATE M 1

VINATE ONE 1

VINATE PN CARE 1

VINATE ULTRA 1

VIRT-ADVANCE 1

VIRT-C DHA 1

VIRT-GARD EX

VIRT-NATE DHA 4

VIRT-PN DHA 1

VIRT-PN PLUS 1

VIRTPREX 4

VIRT-SELECT 1

VIRT-VITE EX

VIRT-VITE GT 1

VIT 3 1

VITAFOL FE+ (WITH DOCUSATE) 4

VITAFOL GUMMIES 4

VITAFOL NANO 4

VITAFOL ULTRA 4

VITAFOL-OB 4

VITAFOL-OB+DHA 4

VITAFOL-ONE 4

VITAMED MD ONE RX 4

VITAMEDMD REDICHEW RX 4

VITAMIN D2 1

Drug Tier NotesVITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.25 MG FLUOR. (0.55 MG)/ML

PV CN

VITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.5 MG FLUORIDE (1.1 MG)/ML

PV

VITAPEARL 4

VITATRUE 4

VP-CH PLUS 4

VP-CH-PNV 1

VP-PNV-DHA 4

VP-VITE RX 1

ZATEAN-PN DHA 1

ZATEAN-PN PLUS 1

ZAVARA EX

ZEMPLAR ORAL CAPSULE 1 MCG, 2 MCG 4

ZINGIBER 4

70

Index1ST TIER UNIFINE PENTIPS ......................... 291ST TIER UNIFINE PENTIPS PLUS .............. 291ST TIER UNILET COMFORTOUCH ............. 292TEK CONTROL (HIGH-NORMAL) ............... 29abacavir ............................................................. 1abacavir-lamivudine ...........................................1abacavir-lamivudine-zidovudine ........................ 1ABILIFY ...........................................................19ABILIFY MAINTENA .......................................19ABILIFY MYCITE ............................................ 19abiraterone ........................................................ 5ABRAXANE ...................................................... 5ABSORICA ..................................................... 60ABSTRAL ....................................................... 19acamprosate ....................................................19ACANYA ......................................................... 60acarbose ..........................................................46ACCOLATE .....................................................57ACCUCAINE KIT ................................ 29, 53, 60ACCU-CHEK AVIVA CONTROL SOLN ......... 29ACCU-CHEK AVIVA PLUS TEST STRP ....... 37ACCU-CHEK COMP BLUE CONT, M-H ........ 29ACCU-CHEK COMPACT PLUS CONTROL .. 29ACCU-CHEK COMPACT PLUS TEST ...........37ACCU-CHEK FASTCLIX LANCET DRUM .....29ACCU-CHEK GUIDE ...................................... 37ACCU-CHEK GUIDE L1-L2 CTRL SOL .........29ACCU-CHEK MULTICLIX LANCET ............... 29ACCU-CHEK SAFE-T-PRO ............................29ACCU-CHEK SAFE-T-PRO PLUS ................. 29ACCU-CHEK SMARTVIEW CONTRL SOL ... 29ACCU-CHEK SMARTVIEW TEST STRIP ...... 37ACCU-CHEK SOFTCLIX LANCETS .............. 29ACCUPRIL ...................................................... 15ACCURETIC ............................................. 15, 39ACCUTREND GLUCOSE ............................... 37ACCUTREND GLUCOSE CONTROL ............ 29ACD-A ............................................................. 12ACE AEROSOL CLOUD ENHANCER ........... 29acebutolol .................................................... 9, 15acetaminophen-caff-dihydrocod ...................... 19acetaminophen-codeine .................................. 19acetazolamide ..................................... 15, 39, 41acetic acid ..................................................39, 41acetylcysteine ............................................ 53, 57ACIPHEX .........................................................44ACIPHEX SPRINKLE ..................................... 44acitretin ............................................................ 60ACTEMRA .......................................................53ACTEMRA ACTPEN .......................................53ACTHIB (PF) ..................................................... 8ACTICLATE ...................................................... 1ACTIGALL ...................................................... 44ACTI-LANCE LANCETS .................................29ACTIMMUNE ...................................................53ACTIQ ............................................................. 19ACTIVELLA .................................................... 46ACTIVE-PAC ...................................................19ACTONEL ....................................................... 53ACTOPLUS MET ............................................ 46ACTOPLUS MET XR ...................................... 46ACTOS ............................................................ 46ACUICYN ........................................................ 29ACULAR ......................................................... 41ACULAR LS ....................................................41ACUVAIL (PF) .................................................41acyclovir .......................................................1, 60ACZONE ......................................................... 60ADACEL(TDAP ADOLESN/ADULT)(PF) .........8ADALAT CC ....................................................15adapalene ........................................................60adapalene-benzoyl peroxide ........................... 60ADASUVE ....................................................... 19ADAZIN ........................................................... 60ADCETRIS ........................................................ 5ADCIRCA .................................................. 15, 57ADDERALL .....................................................19

ADDERALL XR ...............................................19ADDYI ............................................................. 19adefovir ..............................................................1ADEMPAS .................................................15, 57ADHANSIA XR ................................................19ADLYXIN .........................................................46ADMELOG SOLOSTAR U-100 INSULIN ....... 46ADMELOG U-100 INSULIN LISPRO ..............46ADRENALIN ......................................... 9, 41, 57ADULT ASPIRIN REGIMEN ..................... 12, 19ADULT LOW DOSE ASPIRIN .................. 12, 19ADVAIR DISKUS .................................. 9, 46, 57ADVAIR HFA ........................................ 9, 46, 57ADVANCED ALLERGY COLLECT KIT ......... 60ADVANCED DNA MEDICATED COLLECT ... 41ADVANCED GLUC METER TEST STRIP ......37ADVANCED TRAVEL LANCETS ...................29ADVATE ..........................................................12ADVOCATE CONTROL SOLUTION HIGH .... 29ADVOCATE LANCET .....................................29ADVOCATE LOW CONTROL ........................ 29ADVOCATE PEN NEEDLE ............................ 29ADVOCATE REDI-CODE ............................... 37ADVOCATE REDI-CODE PLUS .....................37ADVOCATE REDI-CODE+ CTRL HIGH .........29ADVOCATE REDI-CODE+ CTRL LOW ......... 29ADVOCATE SYRINGES .................................29ADVOCATE TEST STRIPS ............................ 37ADYNOVATE .................................................. 12ADZENYS ER ................................................. 19ADZENYS XR-ODT .........................................19AEMCOLO ........................................................ 1AEROCHAMBER PLUS FLOW-VU ............... 29AEROCHAMBER PLUS FLOW-VU,L MSK ... 29AEROCHAMBER PLUS FLOW-VU,M MSK .. 29AEROCHAMBER PLUS FLOW-VU,S MSK ... 29AEROGEAR ACTION ASTHMA KIT ..............29AEROSPAN .............................................. 46, 57AEROTRACH PLUS ....................................... 29AFEDITAB CR ................................................ 15AFINITOR ..........................................................5AFINITOR DISPERZ ......................................... 6AFIRMELLE .................................................... 46AFREZZA ........................................................46AFSTYLA ........................................................ 12AFTERA .......................................................... 47AGAMATRIX AMP TEST STRIPS ..................37AGAMATRIX CONTROL HIGH ...................... 29AGAMATRIX CONTROL NORM-HI ............... 29AGGRENOX ........................................12, 15, 19AGONEAZE .................................................... 60AGRYLIN ........................................................ 12A-HYDROCORT ..............................................47AIMOVIG AUTOINJECTOR ............................19AIRDUO RESPICLICK ..........................9, 47, 57AIRZONE PEAK FLOW METER .................... 29AJOVY ............................................................ 19AK-POLY-BAC ............................................... 42AKTEN (PF) .................................................... 42AKTIPAK .........................................................60AKYNZEO (NETUPITANT) .............................44ALA-CORT ......................................................60ALA-QUIN ....................................................... 60ALA-SCALP ....................................................60albendazole ....................................................... 1ALBENZA ......................................................... 1albuterol sulfate ........................................... 9, 57alclometasone ................................................. 60ALCOHOL PADS ............................................60ALCOHOL PREP PADS ................................. 60alcohol swabs .................................................. 60ALCOHOL WIPES .......................................... 60ALCORTIN A .................................................. 60ALDACTAZIDE ......................................... 15, 39ALDACTONE ............................................ 15, 39ALDARA ......................................................... 60ALDURAZYME ............................................... 41

ALECENSA .......................................................6alendronate ......................................................53ALEVICYN PLUS ............................................29ALFERON N ..................................................1, 6alfuzosin ............................................................ 9ALINIA ...............................................................1ALIQOPA .......................................................... 6aliskiren ........................................................... 15ALKERAN ......................................................... 6ALLERGIST TRAY 1/2 ML 27GX3/8" ............ 29ALLERGIST TRAY INTRADERMAL BEV ......29ALLERGIST TRAY REGULAR BEVEL ..........29ALLERGY SYRINGE ...................................... 29allopurinol ........................................................ 53ALLZITAL ....................................................... 20almotriptan malate ........................................... 20ALOCRIL ...................................................42, 57alogliptin .......................................................... 47alogliptin-metformin ......................................... 47alogliptin-pioglitazone ...................................... 47ALOMIDE ........................................................ 42ALORA ............................................................47alosetron ..........................................................44ALPHAGAN P .................................................42ALPHANATE .................................................. 12ALPHANINE SD ..............................................12alprazolam ....................................................... 20ALPRAZOLAM INTENSOL ............................ 20ALPROLIX ...................................................... 12ALREX ............................................................ 42ALSUMA ......................................................... 20ALTABAX ....................................................... 60ALTACAINE ....................................................42ALTACE .......................................................... 15ALTAVERA (28) ..............................................47ALTERNATE SITE LANCET .......................... 29ALTOPREV ..................................................... 15ALTRENO ....................................................... 60ALUNBRIG ........................................................6ALVESCO ................................................. 47, 57ALYACEN 1/35 (28) ........................................47ALYACEN 7/7/7 (28) .......................................47ALYQ .........................................................15, 57AMABELZ ....................................................... 47amantadine hcl ............................................ 1, 20AMARYL ......................................................... 47AMBIEN .......................................................... 20AMBIEN CR .................................................... 20ambrisentan ...............................................15, 57amcinonide ...................................................... 60AMERGE .........................................................20AMETHIA ........................................................ 47AMETHIA LO .................................................. 47AMETHYST (28) ............................................. 47AMICAR .......................................................... 12amikacin ............................................................ 1amiloride .................................................... 15, 39amiloride-hydrochlorothiazide ....................15, 39aminocaproic acid ............................................12amiodarone ......................................................15AMITIZA .......................................................... 44amitriptyline ..................................................... 20amitriptyline-chlordiazepoxide ......................... 20amlodipine ....................................................... 15amlodipine-atorvastatin ................................... 15amlodipine-benazepril ..................................... 15amlodipine-olmesartan .................................... 15amlodipine-valsartan ....................................... 15amlodipine-valsartan-hcthiazid .................. 15, 39ammonium chloride ......................................... 39ammonium lactate ........................................... 60AMNESTEEM ..................................................60amoxapine ....................................................... 20amoxicil-clarithromy-lansopraz .................... 1, 44amoxicillin .......................................................... 1amoxicillin-pot clavulanate .................................1amphetamine sulfate ....................................... 20

71

amphotericin b ................................................... 1ampicillin ............................................................1ampicillin-sulbactam .......................................... 1AMPYRA ......................................................... 53AMRIX ............................................................... 9ANACAINE ......................................................60ANADROL-50 ................................................. 47ANAFRANIL ....................................................20anagrelide ........................................................12ANA-LEX KIT ..................................................60ANALPRAM-HC ..............................................60ANALPRAM-HC SINGLES .............................60ANAPROX DS ...........................................20, 53ANASPAZ ......................................................... 9ANASTIA .........................................................60anastrozole .................................................. 6, 47ANCOBON ........................................................ 1ANDRODERM .................................................47ANDROGEL .................................................... 47ANDROID ........................................................47ANGELIQ ........................................................ 47ANODYNE LPT ...............................................60ANORO ELLIPTA ....................................... 9, 57ANTABUSE .....................................................53ANTARA ......................................................... 15ANTIVERT ...................................................1, 44ANUCORT-HC ................................................ 60ANUSOL-HC ................................................... 60APADAZ ..........................................................20APEXICON E .................................................. 60APIDRA SOLOSTAR U-100 INSULIN ............47APIDRA U-100 INSULIN .................................47APLENZIN .......................................................20APOKYN ......................................................... 20apraclonidine ................................................... 42aprepitant .........................................................44APRI ................................................................ 47APRISO ...........................................................44APRIZIO PAK ................................................. 60APTENSIO XR ................................................ 20APTIOM ...........................................................20APTIVUS ........................................................... 1AQUA GLYCOLIC HC .................................... 60AQUORAL ...................................................... 29ARAKODA ........................................................ 1ARALAST NP ................................................. 57ARANELLE (28) ..............................................47ARANESP (IN POLYSORBATE) ....................12ARAVA ............................................................53ARCALYST ..................................................... 53ARCAPTA NEOHALER ..............................9, 57ARICEPT ...........................................................9ARIKAYCE ........................................................1ARIMIDEX ................................................... 6, 47aripiprazole ...................................................... 20ARISTADA ...................................................... 20ARIXTRA .........................................................12armodafinil ....................................................... 20ARMONAIR RESPICLICK ........................ 47, 58ARMOUR THYROID ....................................... 47ARNUITY ELLIPTA ...................................47, 58AROMASIN ................................................. 6, 47ARRANON ........................................................ 6ARTHROTEC 50 ....................................... 20, 44ARTHROTEC 75 ....................................... 20, 44ARYMO ER ..................................................... 20ARZERRA ......................................................... 6ASACOL HD ................................................... 44ASCOMP WITH CODEINE ............................. 20ASHLYNA ....................................................... 47ASMANEX HFA ........................................ 47, 58ASMANEX TWISTHALER ........................ 47, 58ASPIR-81 .................................................. 12, 20aspirin ........................................................ 12, 20ASPIRIN CHILDRENS .............................. 12, 20ASPIRIN LOW DOSE ............................... 12, 20aspirin-dipyridamole ............................ 12, 15, 20ASPIR-LOW .............................................. 12, 20ASPIR-TRIN .............................................. 12, 20

ASSURE 4 CONTROL SOLUTION ................ 29ASSURE 4 STRIPS .........................................37ASSURE DOSE NORMAL CONTROL ...........29ASSURE DOSE NORM-HI CONTROL ...........29ASSURE HAEMOLANCE PLUS .................... 29ASSURE ID INSULIN SAFETY ...................... 29ASSURE ID PEN NEEDLE ............................. 29ASSURE LANCE ............................................ 29ASSURE LANCE PLUS ..................................29ASSURE PLATINUM ...................................... 37ASSURE PRISM CONTROL 1-2 SOLN ......... 29ASSURE PRISM MULTI STRIP ......................37ASTAGRAF XL ............................................... 53ASTEPRO ....................................................... 42ASTERO ....................................................29, 60ASTHMA CHECK METER ..............................29ATACAND .......................................................15ATACAND HCT ........................................ 15, 39atazanavir .......................................................... 1ATELVIA ......................................................... 53atenolol ........................................................ 9, 15atenolol-chlorthalidone .......................... 9, 15, 39ATIVAN ........................................................... 20atomoxetine ..................................................... 20ATOPICLAIR .............................................29, 60atorvastatin ...................................................... 16atovaquone ........................................................1atovaquone-proguanil ........................................1ATRALIN .........................................................60ATRAPRO CP .................................................29ATRAPRO DERMAL SPRAY ......................... 29ATRAPRO HYDROGEL ................................. 29ATRIPLA ........................................................... 1atropine ..................................................9, 42, 58ATROVENT HFA ........................................ 9, 58AUBAGIO ........................................................53AUBRA ............................................................47AUBRA EQ ..................................................... 47AUGMENTIN .....................................................1AUGMENTIN ES-600 ........................................1AUGMENTIN XR ...............................................2AUROVELA 1.5/30 (21) .................................. 47AUROVELA 1/20 (21) ..................................... 47AUROVELA 24 FE ..........................................47AUROVELA FE 1.5/30 (28) ............................ 47AUROVELA FE 1-20 (28) ............................... 47AURYXIA ........................................................ 39AUSTEDO ....................................................... 20AUTOJECT 2 INJECTION DEVICE ................29AUTOPEN 1 TO 21 UNITS ............................. 29AUTOPEN 2 TO 42 UNITS ............................. 29AUVI-Q ........................................................ 9, 58AVAGE ............................................................60AVALIDE ...................................................16, 39AVANDAMET ..................................................47AVANDIA ........................................................ 47AVAPRO ......................................................... 16AVAR .............................................................. 60AVAR LS .........................................................60AVAR-E ...........................................................60AVAR-E GREEN ............................................. 60AVAR-E LS ..................................................... 60AVASTIN ...........................................................6AVC VAGINAL ................................................60AVEED ............................................................ 47AVENOVA .......................................................29AVIANE ........................................................... 47AVIDOXY .......................................................... 2AVIDOXY DK .................................................... 2AVITA ..............................................................60AVO CREAM .............................................29, 60AVODART .......................................................53AVONEX ......................................................... 53AVONEX (WITH ALBUMIN) ........................... 53AV-PHOS 250 NEUTRAL ............................... 39AYGESTIN ...................................................... 47AYUNA ............................................................47azacitidine ..........................................................6AZASAN ..........................................................53

AZASITE ......................................................... 42azathioprine ..................................................... 53AZEDRA DOSIMETRIC ........................ 6, 37, 57AZEDRA THERAPEUTIC ..................... 6, 37, 57azelaic acid ......................................................60azelastine ........................................................ 42AZELEX .......................................................... 60AZESCO ....................................................12, 67AZILECT ......................................................... 20azithromycin ...................................................... 2AZOPT ............................................................ 42AZOR .............................................................. 16AZULFIDINE ......................................... 2, 44, 53AZULFIDINE EN-TABS ........................ 2, 44, 53AZURETTE (28) .............................................. 47B COMPLEX 100 ............................................ 67B-12 COMPLIANCE ........................................67BACIIM ..............................................................2bacitracin ......................................................... 42bacitracin-polymyxin b ..................................... 42baclofen ............................................................. 9BACTRIM .......................................................... 2BACTRIM DS .................................................... 2BAL-CARE DHA ................................. 12, 39, 67BAL-CARE DHA ESSENTIAL ..................12, 67BALCOLTRA .................................................. 47balsalazide .......................................................44BALVERSA .......................................................6BALZIVA (28) ..................................................47BANZEL .......................................................... 20BARACLUDE ....................................................2BASAGLAR KWIKPEN U-100 INSULIN ........ 47BAVENCIO ........................................................6BAXDELA ......................................................... 2BAYER ASPIRIN ...................................... 12, 20BAYER CHEWABLE ASPIRIN .................12, 20bcg vaccine, live (pf) ..........................................8BD ALLERGIST TRAY REG BEVEL ............. 29BD ALLERGY SYRINGE ................................ 29BD AUTOSHIELD DUO PEN NEEDLE .......... 29BD BULK LUER-LOK NON-STERILE ........... 29BD BULK SLIP TIP NON-STERILE ............... 29BD BULK SYRINGE SLIP TIP ........................29BD ECCENTRIC TIP SYRINGE ......................29BD ECLIPSE ................................................... 30BD ECLIPSE LUER-LOK ............................... 30BD FILTER NEEDLE 5-MICRON NOKO ........30BD FILTER NEEDLE-5 MICRON ................... 30BD INSULIN SYRINGE ...................................30BD INSULIN SYRINGE HALF UNIT ...............30BD INSULIN SYRINGE MICRO-FINE ............ 30BD INSULIN SYRINGE SAFETY-LOK ...........30BD INSULIN SYRINGE SLIP TIP ................... 30BD INSULIN SYRINGE U-500 ........................ 30BD INSULIN SYRINGE ULTRA-FINE ............ 30BD INTEGRA NEEDLE ...................................30BD INTEGRA SYRINGE ................................. 30BD INTRADERMAL BEVEL NEEDLES ......... 30BD LAB ECCENTRIC NON-STERILE ............30BD LO-DOSE MICRO-FINE IV ....................... 30BD LO-DOSE ULTRA-FINE ........................... 30BD LUER-LOK BULK SYRINGE ....................30BD LUER-LOK SYRINGE ...............................30BD LUER-LOK TIP CONTROL SYRING ........30BD MICROTAINER LANCET ......................... 30BD NANO 2ND GEN PEN NEEDLE ...............30BD NOKOR ADMIX NEEDLE .........................30BD PRECISIONGLIDE ....................................30BD PRECISIONGLIDE NON-STERILE .......... 30BD PRE-FILLED NORMAL SALINE ........ 30, 39BD REGULAR BEVEL NEEDLES ..................30BD SAFETYGLIDE ALLERGIST TRAY ......... 30BD SAFETYGLIDE INSULIN SYRINGE .........30BD SAFETYGLIDE NEEDLE ..........................30BD SAFETYGLIDE SHIELDING REG ............30BD SAFETYGLIDE SYRINGE ........................ 30BD SAFETYGLIDE TB REG BEVEL ..............30BD SAFETYGLIDE TUBERCULIN .................30BD SAFETY-LOK DETACHABLE NEEDL .... 30

72

BD SAFETY-LOK TUBERCULIN ................... 30BD SAFETY-LOK WITH LUER-LOK ..............30BD SHORT BEVEL NEEDLES .......................30BD SHORT BEVEL THIN WALL .................... 30BD SLIP TIP SYRINGE ...................................30B-D SLIP TIP SYRINGE ................................. 30BD SPECIALTY USE NEEDLES ....................30BD SYRINGE .................................................. 30BD SYRINGE BULK STERILE PAK .............. 30BD TUBERCULIN SLIP-TIP ........................... 30BD TUBERCULIN SYRINGE ..........................30BD ULTRA FINE LANCETS ........................... 30BD ULTRA-FINE II LANCETS ........................30BD ULTRA-FINE MICRO PEN NEEDLE ........30BD ULTRA-FINE MINI PEN NEEDLE ............ 30BD ULTRA-FINE NANO PEN NEEDLE ......... 31BD ULTRA-FINE ORIG PEN NEEDLE ...........31BD ULTRA-FINE SHORT PEN NEEDLE ....... 31BD VEO INSULIN SYR HALF UNIT ............... 31BD VEO INSULIN SYRINGE UF .................... 31BEAU RX ........................................................ 31BECONASE AQ ........................................42, 58BEKYREE (28) ................................................47BELBUCA ....................................................... 20BELEODAQ ...................................................... 6belladonna alkaloids-opium ............................. 20BELSOMRA .................................................... 20benazepril ........................................................ 16benazepril-hydrochlorothiazide ..................16, 39bendamustine .................................................... 6BENDEKA .........................................................6BENEFIX ......................................................... 12BENICAR ........................................................ 16BENICAR HCT ..........................................16, 39BENLYSTA ..................................................... 53BENSAL HP ....................................................60BENTYL ............................................................ 9BENZACLIN ....................................................60BENZACLIN PUMP ........................................ 60BENZAMYCIN .................................................60BENZEPRO .....................................................60benzhydrocodone-acetaminophen .................. 20benznidazole ..................................................... 2BENZODOX 30 ........................................... 2, 60BENZODOX 60 ........................................... 2, 60benzonatate .....................................................58benzoyl peroxide ............................................. 60benztropine ..................................................9, 20BEPREVE ....................................................... 42BERINERT ...................................................... 53BESER ............................................................ 60BESER KIT ..................................................... 60BESIVANCE ....................................................42BESPONSA ...................................................... 6BETA-1 ............................................................47BETADINE OPHTHALMIC PREP .................. 42betamethasone dipropionate ........................... 60betamethasone valerate .................................. 60betamethasone, augmented ............................60BETAPACE .................................................9, 16BETAPACE AF ........................................... 9, 16BETASERON .................................................. 54betaxolol ................................................ 9, 16, 42bethanechol chloride ......................................... 9BETHKIS ...........................................................2BETIMOL ........................................................ 42BETOPTIC S ................................................... 42bevacizumab ................................................... 42BEVESPI AEROSPHERE ...........................9, 58BEVYXXA ....................................................... 12bexarotene .........................................................6BEXSERO ......................................................... 8BEYAZ ............................................................ 47BIAFINE EMULSION ................................ 31, 60bicalutamide ...................................................... 6BIDIL ............................................................... 16BIJUVA ........................................................... 47BIKTARVY ........................................................ 2BILTRICIDE ...................................................... 2

bimatoprost ......................................................42BINOSTO ........................................................ 54BIONECT ........................................................ 31BIONIME RIGHTEST TEST STRIPS ..............37BIOTHRAX ........................................................8bisoprolol fumarate ...................................... 9, 16bisoprolol-hydrochlorothiazide ...............9, 16, 39BIVIGAM ........................................................... 8BLEPH-10 ....................................................... 42BLEPHAMIDE .................................................42BLEPHAMIDE S.O.P. ..................................... 42BLINCYTO ........................................................ 6BLISOVI 24 FE ................................................47BLISOVI FE 1.5/30 (28) .................................. 47BLISOVI FE 1/20 (28) ..................................... 47BLOOD GLUCOSE TEST ...............................37BONIVA ...........................................................54BONJESTA ......................................... 44, 58, 67BOOSTRIX TDAP ............................................. 8bortezomib .........................................................6bosentan ....................................................16, 58BOSULIF ...........................................................6BOTOX ........................................................9, 54BP 10-1 ........................................................... 60BPO .................................................................60BRAFTOVI ........................................................ 6BREATHERITE MDI SPACER ....................... 31BREATHERITE VALVED MDI CHAMBER .... 31BREATHERITE VALVED MDI SPACER ........31BREEZE 2 CONTROL SOLUTION, NML .......31BREEZE 2 TEST STRIPS ...............................37BREO ELLIPTA .................................... 9, 47, 58BREVICON (28) .............................................. 47BRIELLYN .......................................................47BRILINTA ........................................................12brimonidine ...................................................... 42brimonidine-dorzolamide (pf) ...........................42BRINEURA ......................................................41BRISDELLE .................................................... 20BRIVIACT ........................................................20BROMFED DM ............................................9, 58bromfenac ........................................................42bromocriptine ...................................................20brompheniramine-pseudoeph-dm ............... 9, 58BROMSITE ......................................................42BROVANA .................................................. 9, 58BRYHALI .........................................................60budesonide .......................................... 42, 47, 58BULLSEYE MINI SAFETY LANCETS ............31bumetanide ................................................16, 39BUNAVAIL ...................................................... 20BUPAP ............................................................ 20BUPHENYL .....................................................39BUPRENEX .....................................................20buprenorphine ................................................. 20buprenorphine hcl ............................................20buprenorphine-naloxone ..................................20bupropion hcl ................................................... 20bupropion hcl (smoking deter) ......................... 20buspirone .........................................................20BUTALBITAL COMPOUND W/CODEINE ......20butalbital-acetaminop-caf-cod ......................... 20butalbital-acetaminophen ................................ 20butalbital-acetaminophen-caff ......................... 20butalbital-aspirin-caffeine ...........................12, 20BUTISOL .........................................................20butorphanol tartrate ......................................... 20BUTRANS ....................................................... 20BYDUREON .................................................... 47BYDUREON BCISE ........................................ 47BYETTA .......................................................... 47BYSTOLIC .................................................. 9, 16cabergoline ...................................................... 20CABLIVI .......................................................... 12CABOMETYX ....................................................6CADEAU DHA .......................................... 12, 67CADUET ..........................................................16CAFERGOT ................................................ 9, 20caffeine citrate ................................................. 20

CALAN ............................................................ 16CALAN SR ...................................................... 16calcipotriene .................................................... 60calcipotriene-betamethasone .......................... 60calcitonin (salmon) .....................................47, 54CALCITRENE ................................................. 60calcitriol ......................................................60, 67CALCIUM 600 WITH VITAMIN D3 ........... 39, 67calcium acetate ................................................39CALCIUM PNV ....................................12, 39, 67CALCIUM-FOLIC ACID-VITAMIN D ...............39CALICYLIC ..................................................... 60CALQUENCE ....................................................6CAMBIA .......................................................... 20CAMILA ...........................................................47CAMRESE .......................................................47CAMRESE LO .................................................47CANASA ......................................................... 44candesartan .....................................................16candesartan-hydrochlorothiazid ................ 16, 39CAPASTAT ....................................................... 2capecitabine ...................................................... 6CAPEX ............................................................ 60CAPHOSOL .................................................... 31CAPRELSA .......................................................6CAPSFENAC PAK ....................................20, 60captopril ........................................................... 16captopril-hydrochlorothiazide .....................16, 39CAPXIB ..................................................... 20, 60CARAC ........................................................6, 60CARAFATE .....................................................44CARBAGLU .................................................... 39carbamazepine ................................................ 20CARBATROL ..................................................20carbidopa .........................................................21carbidopa-levodopa ......................................... 21carbidopa-levodopa-entacapone ..................... 21carbinoxamine maleate ............................... 1, 58CARDIZEM ......................................................16CARDIZEM CD ............................................... 16CARDIZEM LA ................................................16CARDURA .................................................. 9, 16CARDURA XL .............................................9, 16CAREFINE PEN NEEDLE .............................. 31CAREONE THIN LANCET ..............................31CAREONE ULTRA THIN LANCET ................ 31CARESENS LANCETS ...................................31CARESENS N TEST STRIPS .........................37CARETOUCH INSULIN SYRINGE ................. 31CARETOUCH PEN NEEDLE ..........................31CARETOUCH TEST STRIP ............................37CARETOUCH TWIST LANCET ......................31carisoprodol ....................................................... 9carisoprodol-asa-codeine ............................ 9, 21carisoprodol-aspirin ..................................... 9, 21CARNITOR ......................................................54CARNITOR (SUGAR-FREE) .......................... 54CAROSPIR ................................................16, 39carteolol ........................................................... 42CARTIA XT ..................................................... 16carvedilol ..................................................... 9, 16carvedilol phosphate ....................................9, 16CASODEX .........................................................6CATAPRES .................................................9, 16CATAPRES-TTS-1 ......................................9, 16CATAPRES-TTS-2 ......................................9, 16CATAPRES-TTS-3 ......................................9, 16CAYA CONTOURED ...................................... 28CAYSTON ......................................................... 2CAZIANT (28) ................................................. 47cefaclor .............................................................. 2cefadroxil ........................................................... 2cefdinir ............................................................... 2cefditoren pivoxil ................................................2cefixime ............................................................. 2cefpodoxime ...................................................... 2cefprozil ............................................................. 2cefuroxime axetil ................................................2CELACYN ....................................................... 60

73

CELACYN POST PROCEDURE .................... 31CELEBREX ..................................................... 21celecoxib ..........................................................21CELEXA .......................................................... 21CELLCEPT ......................................................54CELONTIN ...................................................... 21CEM-UREA ..................................................... 60CENTANY ....................................................... 60CENTANY AT ................................................. 60CENTERGY .............................................1, 9, 58CENTERGY DM ...................................... 1, 9, 58CENTRATEX .............................................12, 67cephalexin ......................................................... 2CEQUA ............................................................42CERACADE .................................................... 61CERAMAX ...................................................... 31CERDELGA .................................................... 54CEREZYME .....................................................41CESAMET ....................................................... 44CETACAINE ....................................................61cetirizine ...................................................... 1, 58CETRAXAL ..................................................... 42cevimeline ..........................................................9CHANTIX ...........................................................9CHANTIX CONTINUING MONTH BOX ............9CHANTIX STARTING MONTH BOX ................ 9CHATEAL (28) ................................................ 47CHATEAL EQ (28) ..........................................47CHEMET ................................................... 46, 54CHENODAL .................................................... 44CHERATUSSIN AC .................................. 21, 58CHILDREN'S ASPIRIN ............................. 12, 21CHILDREN'S IRON .........................................12chlordiazepoxide hcl ........................................ 21chlordiazepoxide-clidinium .......................... 9, 21chlorhexidine gluconate ...................................42chloroquine phosphate ...................................... 2chlorothiazide ............................................ 16, 39chlorpromazine ................................................ 21chlorpropamide ................................................47chlorthalidone ............................................ 16, 39chlorzoxazone ................................................... 9CHOICEDM CLARUS ..................................... 37CHOLBAM ...................................................... 44cholestyramine (with sugar) .............................16CHOLESTYRAMINE LIGHT ........................... 16choline,magnesium salicylate ..........................21CIALIS .............................................................16CICLODAN ......................................................61CICLODAN KIT ...............................................61ciclopirox ..........................................................61ciclopirox-ure-camph-menth-euc ..................... 61CIFEREX ......................................................... 67cilostazol ....................................................12, 16CILOXAN ........................................................ 42CIMDUO ............................................................ 2cimetidine ........................................................ 44cimetidine hcl ...................................................44CIMZIA ...................................................... 44, 54CIMZIA POWDER FOR RECONST ..........44, 54CIMZIA STARTER KIT ............................. 44, 54cinacalcet ...................................................47, 54CINQAIR ......................................................... 58CINRYZE .........................................................54CIPRO ............................................................... 2CIPRO HC ....................................................... 42CIPRO XR ......................................................... 2CIPRODEX ......................................................42ciprofloxacin .......................................................2ciprofloxacin (mixture) ....................................... 2ciprofloxacin hcl ........................................... 2, 42citalopram ........................................................ 21CITRANATAL (DUAL-IRON) ....................12, 67CITRANATAL 90 DHA (ALGAL OIL) .12, 44, 67CITRANATAL ASSURE ..................... 12, 44, 67CITRANATAL B-CALM (FE GLUC) ......... 12, 67CITRANATAL BLOOM ............................. 12, 67CITRANATAL DHA (ALGAL OIL) ............12, 67

CITRANATAL HARMONY (IRON FUM)............................................................. 12, 44, 67CLARAVIS ...................................................... 61CLARINEX .................................................. 1, 58CLARINEX-D 12 HOUR ..........................1, 9, 58clarithromycin .................................................... 2CLEANSING WASH ....................................... 61clemastine ................................................... 1, 58CLENPIQ .........................................................44CLEOCIN ........................................................ 61CLEOCIN HCL .................................................. 2CLEOCIN PEDIATRIC ...................................... 2CLEOCIN T ..................................................... 61CLEVER CHEK LANCETS .............................31CLEVER CHOICE LEVEL 1 CONTROL .........31CLEVER CHOICE LEVEL 2 CONTROL .........31CLEVER CHOICE LEVEL 3 CONTROL .........31CLEVER CHOICE MICRO TEST STRIP ........ 37CLEVER CHOICE PRO .................................. 37CLEVER CHOICE TALK TEST ...................... 37CLEVER CHOICE TEST STRIPS ...................37CLEVER CHOICE VOICE+ TEST ...................37CLICKFINE PEN NEEDLE ............................. 31CLIMARA ........................................................ 47CLIMARA PRO ............................................... 47CLINDACIN ETZ ............................................. 61CLINDACIN P ................................................. 61CLINDACIN PAC ............................................ 61CLINDAGEL ....................................................61clindamycin hcl .................................................. 2clindamycin palmitate hcl ...................................2CLINDAMYCIN PEDIATRIC ............................. 2clindamycin phosphate .................................... 61clindamycin-benzoyl peroxide ......................... 61clindamycin-tretinoin ........................................61CLINDESSE .................................................... 61CLINPRO 5000 ............................................... 54clobazam ......................................................... 21clobetasol ........................................................ 61clobetasol-emollient .........................................61CLOBEX ..........................................................61clocortolone pivalate ........................................61CLODAN ......................................................... 61CLODAN KIT .................................................. 61CLODERM ...................................................... 61clomipramine ................................................... 21clonazepam ..................................................... 21clonidine ...................................................... 9, 16clonidine hcl .................................................9, 16clopidogrel ....................................................... 12clorazepate dipotassium ..................................21CLORPRES .....................................9, 10, 16, 39clotrimazole ..................................................... 61clotrimazole-betamethasone ........................... 61clozapine ......................................................... 21CLOZARIL ...................................................... 21C-NATE DHA ............................................ 12, 67COAGADEX ....................................................12COAGUCHEK LANCETS ............................... 31COARTEM ........................................................ 2codeine sulfate .......................................... 21, 58codeine-butalbital-asa-caff .............................. 21codeine-guaifenesin .................................. 21, 58CODITUSSIN AC ...................................... 21, 58COLAZAL ....................................................... 44colchicine .........................................................54COLCRYS ....................................................... 54colesevelam ...............................................16, 47COLESTID ...................................................... 16COLESTID FLAVORED ..................................16colestipol ..........................................................16colistin (colistimethate na) ................................. 2COLOR LANCETS ..........................................31COLY-MYCIN S .............................................. 42COLYTE WITH FLAVOR PACKS .................. 44COMBIGAN .....................................................42COMBIPATCH ................................................ 47COMBIVENT RESPIMAT ......................... 10, 58COMBIVIR .........................................................2

COMETRIQ ....................................................... 6COMFORT EZ INSULIN SYRINGE ................ 31COMFORT EZ LANCETS ...............................31COMFORT EZ PEN NEEDLES ...................... 31COMFORT LANCETS .................................... 31COMFORT PAC-CYCLOBENZAPRINE .........10COMFORT PAC-IBUPROFEN ....................... 21COMFORT PAC-MELOXICAM .......................21COMFORT PAC-NAPROXEN ............ 21, 54, 61COMFORT PAC-TIZANIDINE ........................ 10COMPAZINE ............................................. 21, 44COMPLERA ...................................................... 2COMPLETE NATAL DHA ...............................67COMPLETENATE .....................................12, 67COMPRO .................................................. 21, 44COMTAN .........................................................21CONCEPT DHA .............................................. 12CONCEPT OB .................................................12CONCERTA .................................................... 21CONDYLOX .................................................... 61CONSTULOSE ................................................39CONTOUR CONTROL SOLUTION, LOW ......31CONTOUR NEXT LEV 1 CONTROL SOL ......31CONTOUR NEXT LEV 2 CONTROL SOL ......31CONTOUR NEXT TEST STRIPS ....................37CONTOUR TEST STRIPS .............................. 37CONZIP ........................................................... 21COOL CONTROL A SOLUTION .................... 31COOL CONTROL B SOLUTION .................... 31COOL GLUCOSE TEST STRIP ......................37COPAXONE .................................................... 54COPIKTRA ........................................................6CORDRAN ...................................................... 61CORDRAN TAPE LARGE ROLL ................... 61COREG ..................................................... 10, 16COREG CR ............................................... 10, 16COREMINO .................................................2, 61CORGARD ................................................ 10, 16CORIFACT ...................................................... 12CORLANOR ....................................................16CORMAX .........................................................61CORTANE-B ................................................... 42CORTEF ..........................................................47CORTENEMA ................................................. 61CORTIFOAM ...................................................61cortisone .......................................................... 47CORTISPORIN ................................................61CORVITA ........................................................ 67CORVITA 150 ........................................... 12, 68COSENTYX .....................................................61COSENTYX (2 SYRINGES) ............................61COSENTYX PEN ............................................ 61COSENTYX PEN (2 PENS) ............................ 61COSOPT ......................................................... 42COSOPT (PF) ................................................. 42COTELLIC .........................................................6COTEMPLA XR-ODT ......................................21COUMADIN .....................................................12COVARYX .......................................................47COVARYX H.S. ...............................................47COZAAR ......................................................... 16CREON ............................................................44CRESEMBA ...................................................... 2CRESTOR ....................................................... 16CRINONE ........................................................ 47CRIXIVAN ......................................................... 2cromolyn .................................................... 42, 58CROTAN ......................................................... 61CRYOSERV .................................................... 54CRYSELLE (28) .............................................. 47CRYSVITA ...................................................... 39CUPRIMINE .............................................. 46, 54CURITY ALCOHOL SWABS .......................... 61CUTIVATE .......................................................61CUVITRU ...........................................................8CUVPOSA .......................................................10cyanocobalamin (vitamin b-12) ........................68CYCLAFEM 1/35 (28) ..................................... 47CYCLAFEM 7/7/7 (28) .................................... 47

74

CYCLESSA (28) ..............................................47cyclobenzaprine ...............................................10CYCLOGYL .....................................................42CYCLOMYDRIL .............................................. 42cyclopentolate ..................................................42cyclopen-tropic-phenyleph-watr .......................42cyclophosphamide .......................................6, 54cycloserine .........................................................2CYCLOSET ..................................................... 21cyclosporine .....................................................54CYCLOSPORINE IN KLARITY .......................42cyclosporine modified ...................................... 54CYCLOTENS REFILL ...............................10, 31CYCLOTENS STARTER .......................... 10, 31CYMBALTA .................................................... 21cyproheptadine ............................................ 1, 58CYRAMZA .........................................................6CYRED ............................................................ 48CYRED EQ ......................................................48CYSTADANE .................................................. 54CYSTAGON .................................................... 54CYSTARAN .....................................................42CYTOGAM ........................................................ 8CYTOMEL ....................................................... 48CYTOTEC ....................................................... 44CYTOVENE .......................................................2CYTRA K CRYSTALS .................................... 39CYTRA-2 ......................................................... 39CYTRA-3 ......................................................... 39CYTRA-K ........................................................ 39D.H.E.45 .................................................... 10, 21DACOGEN ........................................................ 6dalfampridine ................................................... 54DALIRESP ...................................................... 58danazol ............................................................ 48DANTRIUM ..................................................... 10dantrolene ........................................................10dapsone .......................................................2, 61DAPTACEL (DTAP PEDIATRIC) (PF) ............. 8DARAPRIM ....................................................... 2darifenacin ....................................................... 67DARIO BLOOD GLUCOSE TEST STRIP ...... 37DARZALEX ....................................................... 6DASETTA 1/35 (28) ........................................ 48DASETTA 7/7/7 (28) ....................................... 48DAURISMO ....................................................... 6DAYPRO ......................................................... 21DAYSEE ..........................................................48DAYTRANA .................................................... 21DDAVP ................................................ 12, 13, 48DEBACTEROL ................................................61DEBLITANE .................................................... 48DECADRON ....................................................48decitabine .......................................................... 6deferasirox .......................................................46DELESTROGEN ............................................. 48DELSTRIGO ......................................................2DELTASONE .................................................. 48DELYLA (28) ...................................................48DELZICOL .......................................................44DEMADEX .................................................16, 39demeclocycline .................................................. 2DEMEROL .......................................................21DEMSER ......................................................... 54DENAVIR ........................................................ 61DENTA 5000 PLUS .........................................54DENTAGEL .....................................................54DEPAKENE .....................................................21DEPAKOTE .....................................................21DEPAKOTE ER ...............................................21DEPAKOTE SPRINKLES ............................... 21DEPEN TITRATABS .................................46, 54DEPO-ESTRADIOL ........................................ 48DEPO-MEDROL ..............................................48DEPO-SUBQ PROVERA 104 ......................... 48DEPO-TESTOSTERONE ................................48DERMACINRX CLORHEXACIN .....................61DERMACINRX EMPRICAINE .........................61DERMACINRX LEXITRAL ........................21, 61

DERMACINRX PHN PAK ............................... 61DERMACINRX PRIZOPAK .............................61DERMACINRX PUREFOLIX ...........................68DERMACINRX SILAPAK ............................... 61DERMACINRX SURGICAL PHARMAPAK .... 61DERMACINRX THERAZOLE PAK .................61DERMACINRX ZRM PAK ...............................61DERMA-SMOOTHE/FS BODY OIL ................ 61DERMA-SMOOTHE/FS SCALP OIL .............. 61DERMASORB HC COMPLETE KIT ............... 61DERMASORB TA COMPLETE KIT ............... 61DERMATOP .................................................... 61DERMAWERX SDS ........................................ 61DERMAWERX SURGICAL PLUS PAK ..........61DERMAZENE ..................................................61DERMAZYL KIT ..............................................61DERMOTIC OIL .............................................. 42DESCOVY ......................................................... 2desipramine ..................................................... 21desloratadine ............................................... 1, 58desmopressin ............................................ 13, 48desog-e.estradiol/e.estradiol ........................... 48desogestrel-ethinyl estradiol ............................48DESONATE .....................................................61desonide .......................................................... 61DESOWEN ...................................................... 61desoximetasone .............................................. 61DESOXYN ....................................................... 21desvenlafaxine .................................................21desvenlafaxine succinate ................................ 21DETROL ..........................................................67DETROL LA .................................................... 67dexamethasone ............................................... 48DEXAMETHASONE INTENSOL .................... 48dexamethasone sodium phos (pf) ................... 48dexamethasone sodium phosphate ...........42, 48DEXEDRINE SPANSULE ............................... 21DEXERYL ........................................................61DEXILANT .......................................................44dexmethylphenidate ........................................ 21DEXONTO .......................................................48DEXPAK 10 DAY ............................................ 48DEXPAK 13 DAY ............................................ 48DEXPAK 6 DAY .............................................. 48dextroamphetamine .........................................21dextroamphetamine-amphetamine ..................21DIACOMIT .......................................................21DIASTAT ......................................................... 21DIASTAT ACUDIAL ........................................21DIATRUE CONTROL SOLN NORMAL .......... 31DIATRUE CONTROL SOLUTION HIGH ........ 31DIATRUE CONTROL SOLUTION LOW .........31DIATRUE PLUS TEST STRIP ........................ 37diazepam ......................................................... 21DIAZEPAM INTENSOL ...................................21DIBENZYLINE ...........................................10, 16DICLEGIS ............................................44, 58, 68DICLO GEL ............................................... 21, 61DICLO GEL-XRYLIX SHEET ....................21, 62diclofenac epolamine .................................21, 62diclofenac potassium ....................................... 21diclofenac sodium ............................6, 21, 42, 62diclofenac-misoprostol ...............................21, 44DICLOFEX DC .......................................... 21, 62DICLOFONO ............................................. 21, 62DICLOPAK ................................................21, 62DICLOPR .................................................. 21, 62DICLOTRAL ..............................................21, 62DICLOVIX ..................................................21, 62dicloxacillin ........................................................ 2DICLOZOR ................................................21, 62dicyclomine ......................................................10didanosine ......................................................... 2DIFFERIN ........................................................ 62DIFICID ..............................................................2diflorasone ....................................................... 62DIFLUCAN ........................................................ 2diflunisal ...........................................................21DIGITEK .......................................................... 16

DIGOX ............................................................. 16digoxin ............................................................. 16dihydroergotamine .....................................10, 21DILANTIN ..................................................16, 21DILANTIN EXTENDED ............................. 16, 21DILANTIN INFATABS ...............................16, 21DILANTIN KAPSEAL ................................16, 21DILANTIN-125 ...........................................16, 21DILATRATE-SR .............................................. 16DILAUDID ....................................................... 21diltiazem hcl .....................................................16DILT-XR .......................................................... 16DILUENT FOR EPOPROSTENOL/FLOLA .... 57DIOVAN ...........................................................16DIOVAN HCT ............................................ 16, 39DIPENTUM ......................................................44diphenhydramine hcl ................................... 1, 58diphenoxylate-atropine ........................ 10, 44, 58DIPROLENE ....................................................62dipyridamole .............................................. 13, 16DISALCID ........................................................21DISKETS ......................................................... 21disopyramide phosphate ................................. 16disulfiram ......................................................... 54DITHOL ..................................................... 21, 62DITROPAN XL ................................................ 67DIURIL .......................................................16, 39divalproex ........................................................ 21DIVIGEL .......................................................... 48DM2 ........................................................... 37, 48dofetilide .......................................................... 16DOLOPHINE ................................................... 21DOLOTRANZ .................................................. 62donepezil ......................................................... 10DONNATAL .............................................. 10, 21DOPTELET (10 TAB PACK) .......................... 13DOPTELET (15 TAB PACK) .......................... 13DORAL ............................................................21DORYX ..............................................................2DORYX MPC .....................................................2dorzolamide ..................................................... 42dorzolamide (pf) ...............................................42dorzolamide-timolol ......................................... 42dorzolamide-timolol (pf) ................................... 42DOTTI ..............................................................48DOUBLEDEX (PF) .......................................... 48DOVATO ........................................................... 2DOVONEX .......................................................62doxazosin .................................................. 10, 16doxepin ...................................................... 22, 62doxercalciferol ................................................. 68doxycycline hyclate ......................................2, 42doxycycline monohydrate ............................ 2, 62doxylamine-pyridoxine (vit b6) .............44, 58, 68D-PENAMINE ..................................................46DRISDOL ........................................................ 68DRITHOCREME HP ........................................62dronabinol ........................................................44DROPLET INSULIN SYRINGE .......................31DROPLET LANCETS ..................................... 31DROPLET PEN NEEDLE ............................... 31drospirenone-e.estradiol-lm.fa .........................48drospirenone-ethinyl estradiol ......................... 48DROXIA .............................................................6DRYSOL ..........................................................62DRYSOL DAB-O-MATIC ................................ 62DUAC .............................................................. 62DUAVEE ..........................................................48DUET DHA BALANCED ...........................13, 68DUET DHA WITH OMEGA-3 .................... 13, 68DUETACT ....................................................... 48DUEXIS ..................................................... 22, 44DULERA ..............................................10, 48, 58duloxetine ........................................................ 22DUOBRII ......................................................... 62DUOPA ............................................................22DUPIXENT ................................................ 58, 62DURACHOL .................................................... 68DURAGESIC ................................................... 22

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DUREZOL ....................................................... 42DURLAZA ................................................. 13, 22DUROLANE .................................................... 31dutasteride .......................................................54dutasteride-tamsulosin .............................. 10, 54DUTOPROL ........................................ 10, 16, 39DUZALLO ................................................. 39, 54DVORAH ......................................................... 22DXEVO ............................................................ 48DYANAVEL XR ...............................................22DYAZIDE ...................................................16, 39DYMISTA .................................................. 42, 58DYRENIUM ............................................... 16, 39DYSPORT ................................................. 10, 54E.C. PRIN .................................................. 13, 22E.E.S. 400 ......................................................... 2E.E.S. GRANULES ........................................... 2EASIVENT HOLDING CHAMBER ..................31EASIVENT MASK LARGE ............................. 31EASIVENT MASK MEDIUM ........................... 31EASIVENT MASK SMALL ..............................31EASY COMFORT INSULIN SYRINGE ........... 31EASY COMFORT LANCETS ..........................31EASY COMFORT PEN NEEDLES ................. 31EASY GLIDE CATHETER TIP SYRING .........31EASY GLIDE INSULIN SYRINGE .................. 31EASY GLIDE LUER LOCK SYRINGE ............31EASY GLUCO G2 ........................................... 37EASY PLUS II HIGH CONTROL .................... 31EASY PLUS II TEST ....................................... 37EASY STEP .................................................... 37EASY TALK GLUCOSE TEST ....................... 37EASY TOUCH ................................................. 32EASY TOUCH ALCOHOL PREP PADS ........ 62EASY TOUCH FLIPLOCK SYRINGE .............31EASY TOUCH FLURINGE ..............................31EASY TOUCH FLURINGE FLIPLOCK ...........31EASY TOUCH FLURINGE SHEATHLOCK ....31EASY TOUCH HIGH-LOW CONTROL ...........31EASY TOUCH INSULIN SYRINGE ................ 32EASY TOUCH LANCETS ............................... 32EASY TOUCH LUER LOCK INSULIN ............32EASY TOUCH LUER LOCK SYRINGE ..........32EASY TOUCH SAFETY LANCETS ................32EASY TOUCH SHEATHLOCK SYRG-NDL ... 32EASY TOUCH SHEATHLOCK SYRINGE ......32EASY TOUCH TEST STRIP ........................... 37EASY TOUCH TUBERCULIN SHEATHLK .... 32EASY TOUCH TWIST LANCETS ...................32EASY TOUCH UNI-SLIP .................................32EASY TRAK GLUCOSE TEST .......................37EASY TRAK HIGH CONTROL ....................... 32EASY TRAK LOW CONTROL ........................32EASY TWIST AND CAP LANCETS ............... 32EASYGLUCO PLUS ....................................... 37EASYGLUCO TEST ........................................37EASYMAX .......................................................37EASYMAX 15 ..................................................37EASYMAX LOW CONTROL ...........................32EASYMAX NORMAL CONTROL ................... 32EC-NAPROSYN ........................................ 22, 54EC-NAPROXEN ........................................ 22, 54econazole ........................................................ 62ECONTRA EZ ................................................. 48ECONTRA ONE-STEP ................................... 48ECOTRIN .................................................. 13, 22ECOTRIN LOW STRENGTH .................... 13, 22ECOZA ............................................................ 62EDARBI ...........................................................16EDARBYCLOR ......................................... 16, 39EDECRIN .................................................. 16, 39EDLUAR ..........................................................22ED-SPAZ .........................................................10EDURANT ......................................................... 2EEMT ...............................................................48EEMT HS .........................................................48efavirenz ............................................................ 2EFFER-K ......................................................... 39EFFEXOR XR ..................................................22

EFFIENT ..........................................................13EFUDEX ...................................................... 6, 62EGRIFTA .........................................................48ELAPRASE ..................................................... 41ELDEPRYL ..................................................... 22ELELYSO ........................................................41ELEMENT COMPACT HIGH CONTROL ....... 32ELEMENT COMPACT NORMAL CONTROL .32ELEMENT COMPACT TEST STRIPS ............ 37ELEMENT HIGH CONTROL ...........................32ELEMENT LOW CONTROL ........................... 32ELEMENT NORMAL CONTROL ....................32ELEMENT TEST STRIPS ............................... 37ELESTRIN .......................................................48ELETONE ..................................................32, 62eletriptan ..........................................................22ELIDEL ......................................................54, 62ELIGARD .................................................... 6, 48ELIGARD (3 MONTH) .................................6, 48ELIGARD (4 MONTH) .................................6, 48ELIGARD (6 MONTH) .................................6, 48ELIMITE .......................................................... 62ELINEST ......................................................... 48ELIQUIS .......................................................... 13ELITE OB WITH DHA ..................................... 68ELITE-OB ..................................................13, 68ELITE-OB 400 ...........................................13, 68ELIXOPHYLLIN ............................ 16, 39, 58, 67ELLA ............................................................... 48ELLZIA PAK ................................................... 62ELMIRON ........................................................ 54ELOCON ......................................................... 62ELOCTATE ..................................................... 13ELZONRIS ........................................................ 6EMBEDA ......................................................... 22EMBRACE BLOOD GLUCOSE SYSTEM ......37EMBRACE EVO TEST STRIPS ......................37EMBRACE GLUCOSE CONTROL HIGH .......32EMBRACE LANCETS .................................... 32EMBRACE PRO TEST STRIPS ..................... 37EMBRACE TALK TEST STRIPS ....................38EMCYT .............................................................. 6EMEND ............................................................44EMFLAZA ....................................................... 48EMGALITY PEN ..............................................22EMGALITY SYRINGE .....................................22EMOQUETTE ..................................................48EMPLICITI .........................................................6EMSAM ........................................................... 22EMTRIVA .......................................................... 2EMULSION SB ................................................32EMVERM ...........................................................2ENABLEX ....................................................... 67enalapril maleate ............................................. 16enalapril-hydrochlorothiazide .....................16, 39ENBRACE HR ...........................................13, 68ENBREL ....................................................54, 62ENBREL MINI ........................................... 54, 62ENBREL SURECLICK ..............................54, 62ENDARI .....................................................44, 54ENDOCET ....................................................... 22ENGERIX-B (PF) ...............................................8ENGERIX-B PEDIATRIC (PF) .......................... 8enoxaparin .......................................................13ENPRESSE ..................................................... 48ENSKYCE ....................................................... 48ENSTILAR .......................................................62entacapone ......................................................22entecavir ............................................................ 2ENTEREG ....................................................... 44ENTERIC COATED ASPIRIN ................... 13, 22ENTOCORT EC .............................................. 48ENTRESTO ..................................................... 16ENTYVIO ...................................................44, 54ENULOSE ....................................................... 39ENVARSUS XR ...............................................54EPANED ..........................................................16EPCLUSA ......................................................... 2EPICERAM ......................................................32

EPIDIOLEX ..................................................... 22EPIDUO ...........................................................62EPIDUO FORTE ..............................................62EPIFOAM ........................................................ 62epinastine ........................................................ 42epinephrine ................................................10, 58EPIPEN ..................................................... 10, 58EPIPEN 2-PAK ..........................................10, 58EPIPEN JR ................................................10, 58EPIPEN JR 2-PAK .................................... 10, 58EPISIL ............................................................. 32EPISNAP ...................................................10, 58EPITOL ............................................................22EPIVIR ...............................................................2EPIVIR HBV ...................................................... 3eplerenone .......................................................16EPOGEN ......................................................... 13epoprostenol (glycine) ............................... 16, 58eprosartan ....................................................... 17EPZICOM .......................................................... 3EQUETRO .......................................................22ERBITUX ...........................................................6ergocalciferol (vitamin d2) ............................... 68ergoloid ............................................................10ERGOMAR ................................................10, 22ergotamine-caffeine ...................................10, 22ERIVEDGE ........................................................ 6ERLEADA ......................................................... 6erlotinib .............................................................. 6ERRIN ............................................................. 48ERTACZO ....................................................... 62ERWINAZE ....................................................... 6ERY PADS ...................................................... 62ERYGEL ..........................................................62ERYPED 200 .....................................................3ERYPED 400 .....................................................3ERY-TAB ...........................................................3ERYTHROCIN (AS STEARATE) ...................... 3erythromycin ................................................ 3, 42erythromycin ethylsuccinate .............................. 3erythromycin stearate ........................................ 3erythromycin with ethanol ................................62erythromycin-benzoyl peroxide ........................62ESBRIET ......................................................... 58ESCAVITE ...........................................13, 54, 68ESCAVITE D ....................................... 13, 54, 68ESCAVITE LQ .....................................13, 54, 68escitalopram oxalate ........................................22ESGIC ............................................................. 22ESKATA ..........................................................62ESOMEP-EZS ................................................. 44esomeprazole magnesium .............................. 44esomeprazole strontium .................................. 44ESTARYLLA ................................................... 48estazolam ........................................................ 22ESTRACE ....................................................... 48estradiol ........................................................... 48estradiol valerate ............................................. 48estradiol-norethindrone acet ............................48ESTRING .........................................................48ESTROGEL .....................................................48estrogens-methyltestosterone ......................... 48ESTROSTEP FE-28 ........................................ 48eszopiclone ......................................................22ethacrynic acid ...........................................17, 39ethambutol .........................................................3ethosuximide ................................................... 22ethyl chloride ................................................... 62ethynodiol diac-eth estradiol ............................48etidronate disodium ......................................... 54etodolac ........................................................... 22etoposide ........................................................... 6EUCRISA ........................................................ 62EUFLEXXA ..................................................... 32EURAX ............................................................ 62EUTHYROX .....................................................48EVAMIST .........................................................48EVEKEO ..........................................................22EVEKEO ODT ................................................. 22

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EVENCARE G2 ...............................................38EVENCARE G3 CONTROL ............................ 32EVENCARE G3 TEST .....................................38EVENCARE MINI GLUCOSE TEST STR .......38EVENCARE PROVIEW TEST STRIP .............38EVENCARE TEST .......................................... 38EVENITY ......................................................... 54EVISTA ......................................................48, 54EVOCLIN .........................................................62EVOLUTION NORMAL CONTROL ................ 32EVOLUTION TEST STRIPS ........................... 38EVOMELA .........................................................6EVOTAZ ...................................................... 3, 54EVOXAC ......................................................... 10EVZIO ........................................................22, 54EXALGO ER ................................................... 22EXEL HYPODERMIC NEEDLES ....................32EXEL INSULIN ................................................32EXEL SYRINGE .............................................. 32EXELDERM .....................................................62EXELON ..........................................................10exemestane ................................................. 6, 48EXFORGE ....................................................... 17EXFORGE HCT .........................................17, 39EXJADE .......................................................... 46EXODERM ...................................................... 62EXONDYS 51 .................................................. 54EXTAVIA ......................................................... 54EXTINA ........................................................... 62EXTRA-VIRT PLUS DHA ..........................13, 68EYLEA .............................................................42E-Z JECT LANCETS .......................................32E-Z JECT THIN LANCETS ............................. 32EZ SMART LANCETS .................................... 32EZ SMART PLUS TEST ................................. 38EZ SMART TEST ............................................ 38EZALLOR SPRINKLE .................................... 17ezetimibe ......................................................... 17ezetimibe-simvastatin ...................................... 17FA-8 .................................................................68FABB ...............................................................68FABIOR ...........................................................62FABRAZYME .................................................. 41FACTIVE ........................................................... 3FALMINA (28) ................................................. 48famciclovir ..........................................................3famotidine ........................................................ 45FANAPT .......................................................... 22FARESTON .................................................6, 48FARXIGA ........................................................ 48FARYDAK ......................................................... 6FASENRA ....................................................... 58FASLODEX ....................................................... 6FAYOSIM ........................................................ 48FAZACLO ....................................................... 22FC2 FEMALE CONDOM .................................28FE C PLUS ................................................13, 68febuxostat ........................................................ 54FEIBA NF ........................................................ 13felbamate .........................................................22FELBATOL ..................................................... 22FELDENE ........................................................22felodipine ......................................................... 17FEM PH ........................................................... 62FEMARA ..................................................... 6, 48FEMCAP ................................................... 28, 32FEMHRT LOW DOSE ..................................... 48FEMRING ........................................................ 48FEMYNOR .......................................................48fenofibrate ........................................................17fenofibrate micronized ..................................... 17fenofibrate nanocrystallized .............................17fenofibric acid .................................................. 17fenofibric acid (choline) ....................................17FENOGLIDE ....................................................17fenoprofen ....................................................... 22FENORTHO .................................................... 22fentanyl ............................................................ 22fentanyl citrate ................................................. 22

FENTORA ....................................................... 22FER-IN-SOL .................................................... 13FEROCON .......................................................13FERRAPLUS 90 ........................................13, 68FERREX 150 FORTE ................................13, 68FERRIPROX ....................................................46FERROCITE PLUS ................................... 13, 68ferrous sulfate ..................................................13FETZIMA ......................................................... 22FEXMID ........................................................... 10fexofenadine ................................................ 1, 58fexofenadine-pseudoephedrine ............. 1, 10, 58FIASP FLEXTOUCH U-100 INSULIN .............48FIASP U-100 INSULIN ....................................48FIBRICOR ....................................................... 17FIBRYGA ........................................................ 13FIFTY50 SAFETY SEAL LANCETS ...............32FIFTY50 TEST STRIP .....................................38FINACEA .........................................................62finasteride ........................................................ 54FINE 30 UNIVERSAL LANCETS ....................32FINGERSTIX LANCETS ................................. 32FIORICET ........................................................22FIORINAL ..................................................13, 22FIORINAL-CODEINE #3 ................................. 22FIRAZYR ......................................................... 54FIRDAPSE ...................................................... 54FIRMAGON KIT W DILUENT SYRINGE............................................................... 6, 48, 54FIRVANQ .......................................................... 3FLAC OTIC OIL .............................................. 42FLAGYL ............................................................ 3FLAREX .......................................................... 42flavoxate .......................................................... 67FLEBOGAMMA DIF ..........................................8flecainide ......................................................... 17FLECTOR ..................................................22, 62FLEXIPAK .................................................22, 62FLOLAN .................................................... 17, 58FLOLIPID ........................................................ 17FLOMAX ......................................................... 10FLORIVA ...................................................54, 68FLORIVA (FLUORIDE-VITAMIN D3) ....... 54, 68FLORIVA PLUS ........................................ 54, 68FLOVENT DISKUS ................................... 48, 58FLOVENT HFA ......................................... 49, 58FLUCAINE ................................................ 38, 42fluconazole ........................................................ 3flucytosine ..........................................................3fludrocortisone ................................................. 49FLUMADINE ..................................................... 3flunisolide ...................................................42, 58fluocinolone ..................................................... 62fluocinolone acetonide oil ................................ 42fluocinolone and shower cap ........................... 62fluocinonide ..................................................... 62FLUOCINONIDE-E ..........................................62fluocinonide-emollient ......................................62FLUORABON ..................................................54fluorescein-proparacaine ........................... 38, 42fluoride (sodium) ..............................................54FLUORIDEX DAILY DEFENSE ...................... 54FLUORIDEX SENSITIVITY RELIEF ............... 54FLUORITAB ....................................................54fluorometholone ...............................................42FLUOROPLEX ............................................ 6, 62fluorouracil ................................................... 6, 62fluoxetine ......................................................... 22fluphenazine hcl ...............................................22FLURA-DROPS .............................................. 54flurandrenolide .................................................62flurazepam .......................................................22flurbiprofen .......................................................22flurbiprofen sodium .......................................... 42flutamide ............................................................ 6fluticasone propionate ......................... 42, 58, 62fluticasone propion-salmeterol .............10, 49, 58fluvastatin ........................................................ 17fluvoxamine ..................................................... 22

FML FORTE .................................................... 42FML LIQUIFILM .............................................. 42FML S.O.P. ......................................................42FOCALIN .........................................................22FOCALIN XR ...................................................22FOLBEE .......................................................... 68FOLBIC ........................................................... 68FOLET ONE .............................................. 13, 68FOLGARD OS .................................................39FOLGARD RX .................................................68folic acid ...........................................................68FOLIVANE-F ............................................. 13, 68FOLIVANE-OB ..........................................13, 68FOLIVANE-PLUS ......................................13, 68FOLIXAPURE ................................................. 68FOLOTYN ......................................................... 6FOLPLEX 2.2 .................................................. 68FOLTRATE ..................................................... 68fondaparinux ....................................................13FORA 6 CONNECT GLUCOSE STRIP .......... 38FORA D15G STRIPS ...................................... 38FORA D20 .......................................................38FORA D40-G31 TEST STRIPS .......................38FORA G20 .......................................................38FORA G30-PREMIUM V10 TEST STRP ........ 38FORA GD50 TEST STRIPS ............................38FORA GTEL GLUCOSE TEST STRIP ........... 38FORA GTEL KETONE TEST STRIP .............. 32FORA GTEL MULTI-FUNCTN MONITOR ......32FORA HIGH CONTROL ..................................32FORA LOW CONTROL .................................. 32FORA NORMAL CONTROL ...........................32FORA TEST STRIP .........................................38FORA TN'G VOICE TEST STRIPS .................38FORA V10 ....................................................... 38FORA V10-V12-D10-D20 STRIPS ..................38FORA V10-V12-D10-D20 STRP-LNCT .......... 32FORA V12 GLUCOSE .................................... 38FORA V20 ....................................................... 38FORA V30A .................................................... 38FORACARE GD20 ..........................................38FORACARE GD40 ..........................................38FORACARE GDH HIGH CONTROL .............. 32FORACARE GDH LOW CONTROL ............... 32FORACARE GDH NORMAL CONTROL ........32FORACARE LANCETS .................................. 32FORFIVO XL ................................................... 22FORMADON ................................................... 62FORMA-RAY ...................................................57FORTAMET .....................................................49FORTEO ....................................................49, 54FORTESTA ..................................................... 49FORTISCARE GLUCOSE TEST STRIPS ...... 38FOSAMAX .......................................................54FOSAMAX PLUS D .................................. 54, 68fosamprenavir ....................................................3fosinopril .......................................................... 17fosinopril-hydrochlorothiazide ....................17, 39FOSRENOL ...............................................39, 54FRAGMIN ........................................................13FREESTYLE CONTROL .................................32FREESTYLE INSULINX ..................................38FREESTYLE INSULINX TEST STRIPS ......... 38FREESTYLE LANCETS ................................. 32FREESTYLE LIBRE 10 DAY READER ..........32FREESTYLE LIBRE 10 DAY SENSOR ..........32FREESTYLE LIBRE 14 DAY READER ..........32FREESTYLE LIBRE 14 DAY SENSOR ..........32FREESTYLE LITE STRIPS .............................38FREESTYLE PRECISION ...............................32FREESTYLE PRECISION NEO STRIPS ........38FREESTYLE TEST ......................................... 38FREESTYLE UNISTIK 2 ................................. 32FROTEK ..........................................................62FROVA ............................................................ 22frovatriptan .......................................................22FULPHILA .......................................................13fulvestrant .......................................................... 6FURADANTIN ................................................... 3

77

furosemide .................................................17, 39FUZEON ............................................................3FYAVOLV ........................................................49FYCOMPA .......................................................22gabapentin .......................................................22GABITRIL ........................................................22GALAFOLD .....................................................54galantamine ..................................................... 10GAMASTAN ......................................................8GAMASTAN S/D ...............................................8GAMIFANT ......................................................54GAMMAGARD LIQUID .....................................8GAMMAGARD S-D (IGA < 1 MCG/ML)................................. 8GAMMAKED ..................................................... 8GAMMAPLEX ................................................... 8GAMMAPLEX (WITH SORBITOL) ................... 8GAMUNEX-C .................................................... 8ganciclovir ..........................................................3ganciclovir sodium ............................................. 3GARDASIL 9 (PF) .............................................8GASTROCROM .............................................. 58gatifloxacin .......................................................42gatifloxacin-dexamethasone ............................42GATTEX 30-VIAL ............................................45GATTEX ONE-VIAL ........................................45GAVILYTE-C ...................................................45GAVILYTE-G ...................................................45GAVILYTE-N ...................................................45GAZYVA ............................................................6GE100 BLOOD GLUCOSE TEST STRIP .......38GE100 CONTROL SOLUTION NORMAL ...... 32GELCLAIR ...................................................... 32GELFILM .........................................................42GELNIQUE ......................................................67GEL-ONE ........................................................ 32GELSYN-3 .......................................................32GELX ...............................................................32gemfibrozil ....................................................... 17GENADUR ...................................................... 32GENADUR (WITH LEXINAL) ................... 32, 68GENERESS FE ............................................... 49GENERLAC .................................................... 39GENGRAF .......................................................54GENOTROPIN ................................................ 49GENOTROPIN MINIQUICK ............................ 49GENSTRIP TEST STRIP ................................ 38GENTAK ......................................................... 42gentamicin ................................................. 42, 62GENULTIMATE TEST STRIP .........................38GENVISC 850 ................................................. 32GENVOYA .........................................................3GEODON .........................................................22GIALAX ........................................................... 45GIANVI (28) .....................................................49GILENYA .........................................................55GILOTRIF ..........................................................6GLASSIA .........................................................58glatiramer .........................................................55GLATOPA ....................................................... 55GLEEVEC ......................................................... 6GLEOSTINE ......................................................6glimepiride ....................................................... 49glipizide ............................................................49glipizide-metformin .......................................... 49GLUCAGEN DIAGNOSTIC KIT ................38, 49GLUCAGEN HYPOKIT ............................. 49, 55GLUCAGON EMERGENCY KIT (HUMAN)................................................................... 49, 55GLUCO NAVII TEST STRIP ........................... 38GLUCOCARD 01 NORMAL CONTROL .........32GLUCOCARD 01 SENSOR PLUS ................. 38GLUCOCARD EXPRESSION .........................38GLUCOCARD SHINE ..................................... 32GLUCOCARD SHINE TEST STRIPS ............. 38GLUCOCARD VITAL SENSOR ......................38GLUCOCARD VITAL TEST STRIPS ..............38GLUCOCOM GLUCOSE ................................ 38GLUCOCOM LANCETS ................................. 32GLUCOPHAGE ...............................................49

GLUCOPHAGE XR .........................................49GLUCOSE CONTROL .................................... 32GLUCOTROL ..................................................49GLUCOTROL XL ............................................ 49GLUMETZA .....................................................49glyburide .......................................................... 49glyburide micronized ........................................49glyburide-metformin .........................................49GLYCATE ....................................................... 10GLYCINE UROLOGIC .................................... 40glycine urologic solution .................................. 40glycopyrrolate .................................................. 10GLYDO ............................................................42GLYNASE ....................................................... 49GLYSET .......................................................... 49GLYXAMBI ......................................................49GM100 .............................................................38GOCOVRI ....................................................3, 22GOLYTELY ..................................................... 45GONIOVISC .................................................... 42GONITRO ........................................................17GOODLIFE AC-302 TEST STRIP ...................38GRALISE .........................................................22GRALISE 30-DAY STARTER PACK ..............22granisetron hcl ................................................. 45GRANIX ...........................................................13GRASTEK ................................................... 8, 55griseofulvin microsize ........................................ 3griseofulvin ultramicrosize ................................. 3GUAIATUSSIN AC ....................................22, 58GUAIFENESIN AC ....................................22, 58GUAIFENESIN DAC ........................... 10, 22, 58guanfacine ................................................. 17, 22guanidine ......................................................... 10GYNAZOLE-1 ................................................. 62GYNOL II .........................................................28HAEGARDA ....................................................55HAILEY 24 FE .................................................49HALAVEN ......................................................... 6HALCION ........................................................ 22HALDOL ..........................................................22halobetasol propionate .................................... 62HALOG ............................................................62haloperidol ....................................................... 22haloperidol lactate ..................................... 22, 23HARMONY GLUCOSE TEST STRIP ............. 38HARVONI .......................................................... 3HAVRIX (PF) ..................................................... 8HEALTHPRO TEST STRIPS .......................... 38HEALTHWISE INSULIN SYRINGE ................ 32HEALTHWISE PEN NEEDLE .........................32HEALTHY ACCENTS UNIFINE PENTIP ........32HEALTHY ACCENTS UNILET LANCET ........32HEATHER ....................................................... 49HELIXATE FS ................................................. 13HEMANGEOL ..................................... 10, 17, 23HEMATINIC PLUS VIT/MINERALS ..........13, 68HEMATINIC/FOLIC ACID ......................... 13, 68HEMATOGEN ................................................. 13HEMATOGEN FA ..................................... 13, 68HEMATOGEN FORTE .............................. 13, 68HEMENATAL OB ......................................13, 68HEMENATAL OB + DHA ..........................13, 68HEMETAB .................................................13, 68HEMLIBRA ......................................................13HEMMOREX-HC ............................................. 62HEMOFIL M HIGH .......................................... 13HEMOFIL M LOW ........................................... 13HEMOFIL M MID .............................................13HEMOFIL M SUPER HIGH ............................. 13heparin (porcine) ............................................. 13HEPARIN LOCK ....................................... 13, 32heparin lock flush (porcine) ....................... 13, 33heparin, porcine (pf) ........................................ 13HEPLISAV-B (PF) .............................................8HEPSERA ......................................................... 3HERCEPTIN ......................................................6HERCEPTIN HYLECTA ....................................6HETLIOZ ......................................................... 23

HIBERIX (PF) .................................................... 8HIDEX ..............................................................49HIPREX ............................................................. 3HISTEX-AC ..................................... 1, 10, 23, 58HIZENTRA ........................................................ 8HOMATROPAIRE ........................................... 42homatropine hbr .............................................. 42HORIZANT ...................................................... 23HPR ................................................................. 33HPR PLUS ...................................................... 33HPR PLUS HYDROGEL ................................. 33HPR PLUS-MB HYDROGEL .................... 33, 62huber safety needles (disp.) ............................ 33HUMALOG JUNIOR KWIKPEN U-100 ...........49HUMALOG KWIKPEN INSULIN .....................49HUMALOG MIX 50-50 INSULN U-100 ........... 49HUMALOG MIX 50-50 KWIKPEN .................. 49HUMALOG MIX 75-25 KWIKPEN .................. 49HUMALOG MIX 75-25(U-100)INSULN ...........49HUMALOG U-100 INSULIN ............................49HUMATE-P ......................................................13HUMATROPE ................................................. 49HUMIRA .............................................. 45, 55, 62HUMIRA PEDIATRIC CROHNS START............................................................. 45, 55, 62HUMIRA PEN ......................................45, 55, 62HUMIRA PEN CROHNS-UC-HS START............................................................. 45, 55, 62HUMIRA PEN PSOR-UVEITS-ADOL HS............................................................. 45, 55, 62HUMIRA(CF) ....................................... 45, 55, 62HUMIRA(CF) PEDI CROHNS STARTER............................................................. 45, 55, 62HUMIRA(CF) PEN ...............................45, 55, 63HUMIRA(CF) PEN CROHNS-UC-HS . 45, 55, 63HUMIRA(CF) PEN PSOR-UV-ADOL HS............................................................. 45, 55, 63HUMULIN 70/30 U-100 INSULIN ....................49HUMULIN 70/30 U-100 KWIKPEN ................. 49HUMULIN N NPH INSULIN KWIKPEN .......... 49HUMULIN N NPH U-100 INSULIN ..................49HUMULIN R REGULAR U-100 INSULN ........ 49HUMULIN R U-500 (CONC) INSULIN ............ 49HUMULIN R U-500 (CONC) KWIKPEN ..........49HYALGAN .......................................................33HYCAMTIN ........................................................6HYCET ............................................................ 23hydralazine ...................................................... 17HYDREA ........................................................... 6HYDRO 35 .......................................................63HYDRO 40 .......................................................63hydrochlorothiazide ................................... 17, 40HYDROCODONE COMPOUND ......... 10, 23, 58hydrocodone-acetaminophen .......................... 23hydrocodone-chlorpheniramine ............. 1, 23, 58hydrocodone-homatropine ...................10, 23, 58hydrocodone-ibuprofen ....................................23hydrocortisone ........................................... 49, 63hydrocortisone acetate .................................... 63hydrocortisone butyrate ................................... 63hydrocortisone butyr-emollient ........................ 63hydrocortisone valerate ................................... 63hydrocortisone-acetic acid ...............................42hydrocortisone-iodoquinl-aloe2 ....................... 63hydrocortisone-iodoquinol ............................... 63hydrocortisone-iodoquinol-aloe ....................... 63hydrocortisone-pramoxine ............................... 63HYDROMET ........................................ 10, 23, 58hydromorphone ............................................... 23hydromorphone (pf) ......................................... 23hydroxocobalamin ........................................... 68hydroxychloroquine ..................................... 3, 55hydroxyprogest(pf)(preg presv) ....................... 49hydroxyprogesterone cap(ppres) .....................49hydroxyprogesterone caproate ........................49hydroxyurea .......................................................6hydroxyzine hcl ............................................1, 23hydroxyzine pamoate .................................. 1, 23HYLATOPIC ....................................................33

78

HYLATOPICPLUS .......................................... 33HYMOVIS ........................................................ 33HYOPHEN .........................................................3hyoscyamine sulfate ........................................ 10HYOSYNE ....................................................... 10HYPERRHO S/D ............................................... 8HYPER-SAL ..............................................33, 40HYQVIA .............................................................8HYQVIA HY COMPONENT ............................ 41HYSINGLA ER ................................................ 23HYZAAR ....................................................17, 40ibandronate ......................................................55IBRANCE .......................................................... 6IBU .................................................................. 23IBUDONE ........................................................ 23ibuprofen ..........................................................23ibuprofen-oxycodone ....................................... 23ICLUSIG ............................................................ 6IDELVION ........................................................13IDHIFA ...............................................................6IFEREX 150 FORTE ................................. 13, 68IGLUCOSE TEST STRIP ................................ 38ILARIS (PF) .....................................................55ILEVRO ........................................................... 42ILUMYA ...........................................................63ILUVIEN .......................................................... 42imatinib .............................................................. 6IMBRUVICA ...................................................... 6IMFINZI ..............................................................6imipramine hcl ................................................. 23imipramine pamoate ........................................ 23imiquimod ........................................................ 63IMITREX .......................................................... 23IMITREX STATDOSE PEN ............................. 23IMITREX STATDOSE REFILL ........................23IMLYGIC ............................................................6IMOVAX RABIES VACCINE (PF) .....................8IMPAVIDO .........................................................3IMPOYZ ...........................................................63IMURAN .......................................................... 55IMVEXXY MAINTENANCE PACK ..................49IMVEXXY STARTER PACK ........................... 49INBRIJA .......................................................... 23INCASSIA ....................................................... 49INCONTROL PEN NEEDLE ........................... 33INCONTROL SUPER THIN LANCETS .......... 33INCONTROL ULTRA THIN LANCETS ...........33INCRELEX ...................................................... 49INCRUSE ELLIPTA .................................. 10, 58indapamide ................................................ 17, 40INDERAL LA .......................................10, 17, 23INDERAL XL ....................................... 10, 17, 23INDOCIN ................................................... 23, 55indomethacin ............................................. 23, 55INFANRIX (DTAP) (PF) .................................... 8INFINITY CONTROL SOLUTION HIGH ......... 33INFINITY CONTROL SOLUTION LOW ..........33INFINITY CONTROL SOLUTION NORM ....... 33INFINITY TEST STRIPS ................................. 38INFINITY VOICE TEST STRIP ........................38INFLAMMACIN ......................................... 23, 63INFLAMMA-K ............................................23, 63INFLECTRA ........................................ 45, 55, 63INFUGEM .......................................................... 6INGREZZA ...................................................... 23INGREZZA INITIATION PACK ....................... 23INJECT EASE LANCETS ............................... 33INLYTA ..............................................................6INNOPRAN XL ....................................10, 17, 23INOVA ............................................................. 63INOVA 4-1 ....................................................... 63INOVA 8-2 ....................................................... 63INSPRA ........................................................... 17insulin lispro .....................................................49insulin syr/ndl u100 half mark .......................... 33INSULIN SYRINGE ......................................... 33INSULIN SYRINGE MICROFINE ....................33insulin syringe needleless ................................33insulin syringe-needle u-100 ............................33

INSUPEN .........................................................33INTELENCE ...................................................... 3INTERMEZZO ................................................. 23INTRAROSA ................................................... 49INTRON A ............................................... 3, 6, 55INTROVALE ....................................................49INTUNIV ER .............................................. 17, 23INVACARE LANCETS ....................................33INVEGA ...........................................................23INVEGA SUSTENNA ...................................... 23INVEGA TRINZA .............................................23INVELTYS ....................................................... 42INVIRASE ..........................................................3INVOKAMET ................................................... 49INVOKAMET XR ............................................. 49INVOKANA ..................................................... 49IOPIDINE .........................................................43IPOL .................................................................. 8ipratropium bromide .............................10, 43, 58ipratropium-albuterol ..................................10, 58irbesartan .........................................................17irbesartan-hydrochlorothiazide .................. 17, 40IRESSA ............................................................. 6IRONUP ...........................................................13ISENTRESS ...................................................... 3ISENTRESS HD ................................................ 3ISIBLOOM .......................................................49ISOCHRON ..................................................... 17isometh-dichloral-acetaminophn ......................23isoniazid .............................................................3ISOPTO CARPINE ..........................................43ISORDIL .......................................................... 17ISORDIL TITRADOSE .................................... 17isosorbide dinitrate .......................................... 17isosorbide mononitrate .................................... 17isosulfan blue ...................................................38isotretinoin ....................................................... 63isoxsuprine ...................................................... 17isradipine ......................................................... 17ISTALOL ......................................................... 43ISTODAX ...........................................................6itraconazole ....................................................... 3ivermectin .......................................................... 3IXEMPRA .......................................................... 6IXIARO (PF) ...................................................... 8IXINITY ............................................................ 13JADENU ..........................................................46JADENU SPRINKLE .......................................46JAKAFI ..............................................................6JALYN .......................................................10, 55JANTOVEN ..................................................... 13JANUMET ....................................................... 49JANUMET XR ................................................. 49JANUVIA .........................................................49JARDIANCE ....................................................49JASMIEL (28) ..................................................49JENCYCLA ..................................................... 49JENTADUETO ................................................ 49JENTADUETO XR .......................................... 49JETREA (PF) .................................................. 43JEVTANA ..........................................................6JINTELI ........................................................... 49JIVI .................................................................. 13JOLESSA ........................................................49JORNAY PM ................................................... 23JUBLIA ............................................................63JULEBER ........................................................49JULUCA ............................................................ 3JUNEL 1.5/30 (21) .......................................... 49JUNEL 1/20 (21) ............................................. 49JUNEL FE 1.5/30 (28) .....................................49JUNEL FE 1/20 (28) ........................................49JUNEL FE 24 .................................................. 49JUXTAPID .......................................................17JYNARQUE .....................................................40KADCYLA ......................................................... 6KADIAN ...........................................................23KAITLIB FE .....................................................49KALBITOR ...................................................... 55

KALETRA ......................................................... 3KALLIGA .........................................................49KALYDECO .................................................... 58KAMDOY .........................................................33KANUMA .........................................................41KAPSPARGO SPRINKLE ........................ 10, 17KAPVAY ....................................................10, 17KARBINAL ER ............................................1, 58KARIVA (28) ................................................... 49KAZANO ......................................................... 49KEFLEX ............................................................ 3KELNOR 1/35 (28) .......................................... 49KELNOR 1-50 ................................................. 49KENALOG .......................................................63KEPPRA ..........................................................23KEPPRA XR ....................................................23KERAFOAM ....................................................63KERALAC ....................................................... 63KERALYT RX ..................................................63KERALYT SCALP COMPLETE ..................... 63KERYDIN ........................................................ 63ketoconazole ............................................... 3, 63ketoprofen ........................................................23ketorolac .................................................... 23, 43KEVEYIS ......................................................... 55KEVZARA ....................................................... 55KEYTRUDA .......................................................6KHEDEZLA ..................................................... 23KINERET .........................................................55KINRIX (PF) ...................................................... 8KISQALI ............................................................ 6KISQALI FEMARA CO-PACK ....................7, 49KITABIS PAK ....................................................3KLARITY (CHONDROITIN) ............................ 43KLARON ......................................................... 63KLONOPIN ......................................................23KLOR-CON ..................................................... 40KLOR-CON 10 ................................................ 40KLOR-CON 8 .................................................. 40KLOR-CON M10 ............................................. 40KLOR-CON M15 ............................................. 40KLOR-CON M20 ............................................. 40KLOR-CON SPRINKLE .................................. 40KLOR-CON/EF ................................................40KOATE ............................................................ 13KOGENATE FS ...............................................13KOMBIGLYZE XR ...........................................49KORLYM ......................................................... 49KOSHER PRENATAL PLUS IRON .......... 13, 68KOVALTRY .....................................................13K-PHOS NO 2 ................................................. 40K-PHOS ORIGINAL ........................................ 40K-PHOS-NEUTRAL ........................................ 40KRINTAFEL ...................................................... 3KRISTALOSE ................................................. 40KRYSTEXXA ...................................................55K-TAB ............................................................. 40KURVELO (28) ................................................49KUVAN ............................................................55KYLEENA ....................................................... 49KYMRIAH ....................................................7, 19KYPROLIS ........................................................ 7l norgest/e.estradiol-e.estrad ........................... 49L.E.T. (LIDO-EPINEPH-TETRA) .....................63labetalol ..................................................... 10, 17LACRISERT .................................................... 43lactulose .......................................................... 40LAMICTAL ...................................................... 23LAMICTAL ODT ..............................................23LAMICTAL ODT STARTER (BLUE) .............. 23LAMICTAL ODT STARTER (GREEN) ........... 23LAMICTAL ODT STARTER (ORANGE) ........ 23LAMICTAL STARTER (BLUE) KIT ................ 23LAMICTAL STARTER (GREEN) KIT ............. 23LAMICTAL STARTER (ORANGE) KIT .......... 23LAMICTAL XR ................................................ 23LAMICTAL XR STARTER (BLUE) ................. 23LAMICTAL XR STARTER (GREEN) .............. 23LAMICTAL XR STARTER (ORANGE) ........... 24

79

lamivudine ......................................................... 3lamivudine-zidovudine ....................................... 3lamotrigine ....................................................... 24lancets ............................................................. 33LANCETS, SUPER THIN ................................33LANCETS,THIN .............................................. 33LANCETS,ULTRA THIN ................................. 33LANOXIN ........................................................ 17LANOXIN PEDIATRIC .................................... 17lansoprazole .................................................... 45lanthanum ..................................................40, 55LANTUS SOLOSTAR U-100 INSULIN ...........50LANTUS U-100 INSULIN ................................50LARIN 1.5/30 (21) ........................................... 50LARIN 1/20 (21) .............................................. 50LARIN 24 FE ................................................... 50LARIN FE 1.5/30 (28) ......................................50LARIN FE 1/20 (28) .........................................50LARISSIA ........................................................50LARTRUVO .......................................................7LASIX ........................................................ 17, 40LASTACAFT ................................................... 43latanoprost .......................................................43latanoprost (pf) ................................................ 43LATUDA ..........................................................24LAYOLIS FE ................................................... 50LAZANDA ....................................................... 24LDO PLUS ................................................ 33, 63ledipasvir-sofosbuvir ..........................................3LEENA 28 ....................................................... 50leflunomide ...................................................... 55LEMTRADA .................................................... 55LENVIMA .......................................................... 7LESCOL .......................................................... 17LESCOL XL .................................................... 17LESSINA ......................................................... 50LETAIRIS .................................................. 17, 58letrozole ....................................................... 7, 50leucovorin calcium ........................................... 55LEUKERAN .......................................................7LEUKINE .........................................................13leuprolide ..................................................... 7, 50LEVA SET ....................................................... 63levalbuterol hcl ...........................................10, 58levalbuterol tartrate ....................................10, 58LEVAQUIN ........................................................ 3LEVATOL ........................................................17LEVBID ........................................................... 10LEVEMIR FLEXTOUCH U-100 INSULN ........ 50LEVEMIR U-100 INSULIN .............................. 50levetiracetam ................................................... 24LEVITRA ......................................................... 17levobunolol ...................................................... 43levocarnitine .................................................... 55levocarnitine (with sugar) .................................55levocetirizine ................................................1, 59levofloxacin ..................................................3, 43LEVONEST (28) ..............................................50levonorgestrel .................................................. 50levonorgestrel-ethinyl estrad ........................... 50levonorg-eth estrad triphasic ........................... 50LEVORA-28 .................................................... 50levorphanol tartrate ..........................................24LEVO-T ........................................................... 50levothyroxine ................................................... 50LEVOXYL ........................................................50LEVSIN ............................................................10LEVSIN/SL ...................................................... 10LEVULAN ........................................................63LEXAPRO ....................................................... 24LEXETTE ........................................................ 63LEXIVA ..............................................................3LEXIXRYL ................................................. 24, 63LIALDA ........................................................... 45LIBRAX (WITH CLIDINIUM) ..................... 10, 24LIBTAYO ...........................................................7lidocaine .......................................................... 63lidocaine hcl .........................................43, 53, 63lidocaine hcl-hydrocortison ac ......................... 63

LIDOCAINE VISCOUS ....................................43lidocaine-hydrocortisone-aloe ..........................63lidocaine-prilocaine ..........................................63lidocaine-racepinep-tetracaine ........................ 63lidocaine-tetracaine ......................................... 63LIDODERM ..................................................... 63LIDO-K ............................................................ 63LIDOPAC ........................................................ 63LIDOPATCH ....................................................63LIDOPIN .......................................................... 63LIDOPRIL ........................................................63LIDOPRIL XR ..................................................63LIDO-PRILO CAINE PACK ............................ 63LIDOPRO PATCH ...........................................63LIDOPURE PATCH .........................................63LIDORX ........................................................... 63LIDOTRAL ...................................................... 63LIDOTRANS 5 PAK ........................................ 63LIDOTREX ...................................................... 33LIDOTREX (WITH VITAMIN E) .......................33LIDOVEX .........................................................63LIDOXIB .................................................... 24, 63LIDOZION ....................................................... 63LIDTOPIC MAX ...............................................63LILETTA ..........................................................50LILLOW (28) ................................................... 50LIMENCIN (LIDOCAINE-MENTHOL) ............. 63LINCOCIN ......................................................... 3lindane ............................................................. 63linezolid ..............................................................3LINZESS ......................................................... 45liothyronine ...................................................... 50LIPITOR .......................................................... 17LIPOCHOL PLUS ........................................... 55LIPOFEN ......................................................... 17LIPROZONEPAK ............................................ 63lisinopril ............................................................17lisinopril-hydrochlorothiazide ..................... 17, 40LITE COAT ASPIRIN ................................ 13, 24LITE TOUCH INSULIN PEN NEEDLES ......... 33LITE TOUCH INSULIN SYRINGE .................. 33LITE TOUCH LANCETS ................................. 33LITEAIRE MDI CHAMBER ............................. 33LITETOUCH-LARGE MASK ...........................33LITETOUCH-SMALL MASK ...........................33lithium carbonate ............................................. 24lithium citrate ................................................... 24LITHOBID ........................................................24LITHOSTAT .................................................... 40LIVALO ........................................................... 17LIVIXIL PAK ....................................................63LO LOESTRIN FE ...........................................50LOCOID ...........................................................63LOCOID LIPOCREAM .................................... 63LODINE ........................................................... 24LODOSYN .......................................................24LOESTRIN 1.5/30 (21) .................................... 50LOESTRIN 1/20 (21) ....................................... 50LOESTRIN FE 1.5/30 (28-DAY) ......................50LOESTRIN FE 1/20 (28-DAY) .........................50LOKELMA .......................................................40LOMOTIL ............................................ 10, 45, 59LONHALA MAGNAIR REFILL ....................... 11LONHALA MAGNAIR STARTER ...................11LONSURF ......................................................... 7loperamide .......................................................45LOPID ..............................................................17lopinavir-ritonavir ............................................... 3LOPREEZA ..................................................... 50LOPRESSOR ............................................ 11, 17LOPRESSOR HCT ..............................11, 17, 40LOPROX ......................................................... 63LOPROX (AS OLAMINE) ............................... 63LOPROX KIT ...................................................63lorazepam ........................................................24LORAZEPAM INTENSOL ...............................24LORBRENA ...................................................... 7LORCET (HYDROCODONE) ..........................24LORCET HD ....................................................24

LORCET PLUS ............................................... 24LORTAB ELIXIR ............................................. 24LORTUSS EX ......................................11, 24, 59LORYNA (28) .................................................. 50LORZONE ....................................................... 11losartan ............................................................17losartan-hydrochlorothiazide ..................... 17, 40LOSEASONIQUE ............................................50LOTEMAX ....................................................... 43LOTEMAX SM .................................................43LOTENSIN ...................................................... 17LOTENSIN HCT ........................................ 17, 40loteprednol etabonate ......................................43LOTREL .......................................................... 17LOTRISONE ....................................................63LOTRONEX .....................................................45LOUTREX ....................................................... 33lovastatin ......................................................... 17LOVAZA ..........................................................17LOVENOX ....................................................... 13LOW-OGESTREL (28) ....................................50loxapine succinate ........................................... 24LO-ZUMANDIMINE (28) ................................. 50LUCEMYRA .................................................... 11LUCENTIS .......................................................43LUDENT FLUORIDE .......................................55LUER LOCK SYRINGE .................................. 33LUGOLS ....................................3, 50, 55, 59, 64luliconazole ......................................................64LUMIGAN ........................................................43LUMIZYME ......................................................41LUMOXITI ......................................................... 7LUMOXITI IV SOLN STABILIZER ..................57LUNESTA ........................................................24LUPANETA PACK (1 MONTH) .................. 7, 50LUPANETA PACK (3 MONTH) .................. 7, 50LUPRON DEPOT ........................................ 7, 50LUPRON DEPOT (3 MONTH) .................... 7, 50LUPRON DEPOT (4 MONTH) .................... 7, 50LUPRON DEPOT (6 MONTH) .................... 7, 50LUPRON DEPOT-PED ............................... 7, 50LUPRON DEPOT-PED (3 MONTH) ............7, 50LUTATHERA ...............................................7, 57LUTERA (28) ...................................................50LUXAMEND .................................................... 64LUXIQ ..............................................................64LUXTURNA .....................................................19LUZU ............................................................... 64LYCELLE ........................................................ 33LYNPARZA ....................................................... 7LYRICA ........................................................... 24LYRICA CR ..................................................... 24LYSODREN .......................................................7LYSTEDA ........................................................13LYZA ............................................................... 50MACRILEN ......................................................38MACROBID .......................................................3MACRODANTIN ............................................... 3MACUGEN ...................................................... 43mafenide acetate ............................................. 64MAKENA .........................................................50MAKENA (PF) .................................................50MALARONE ......................................................3MALARONE PEDIATRIC ................................. 3malathion ......................................................... 64maprotiline ....................................................... 24MARINOL ........................................................45MARLISSA (28) .............................................. 50MARNATAL-F .....................................13, 40, 68MARPLAN .......................................................24MAS CARE-PAK (PF) .....................................50MATULANE ...................................................... 7MATZIM LA .....................................................17MAVENCLAD (10 TABLET PACK) ................55MAVENCLAD (4 TABLET PACK) ..................55MAVENCLAD (5 TABLET PACK) ..................55MAVENCLAD (6 TABLET PACK) ..................55MAVENCLAD (7 TABLET PACK) ..................55MAVENCLAD (8 TABLET PACK) ..................55

80

MAVENCLAD (9 TABLET PACK) ..................55MAVYRET ......................................................... 3MAXALT ..........................................................24MAXALT-MLT ................................................. 24MAXI-COMFORT INSULIN SYRINGE ............33MAXIDEX ........................................................ 43MAXITROL ......................................................43MAXZIDE .................................................. 17, 40MAXZIDE-25MG ....................................... 17, 40MAYZENT ....................................................... 55MAYZENT STARTER PACK .......................... 55MB HYDROGEL ........................................33, 64MB HYDROGEL (CYCLOMETHICONE) ........ 33MD-GASTROVIEW ......................................... 38meclizine ......................................................1, 45meclofenamate ................................................ 24MEDISENSE MID CONTROL ......................... 33MEDISENSE THIN LANCETS ........................ 33MEDLANCE PLUS LANCETS ........................33MEDOLOR PAK ..............................................64MEDPOINT NORMAL CONTROL .................. 33MEDROL ......................................................... 50MEDROL (PAK) .............................................. 50medroxyprogesterone ......................................50mefenamic acid ............................................... 24mefloquine ......................................................... 3megestrol .....................................................7, 50MEKINIST ......................................................... 7MEKTOVI .......................................................... 7MELODETTA 24 FE ........................................50meloxicam ....................................................... 24melphalan .......................................................... 7memantine .......................................................24MENACTRA (PF) .............................................. 8MENEST ..........................................................50MENOSTAR .................................................... 50MENTAX ......................................................... 64MENTHO-CAINE .............................................64MENVEO A-C-Y-W-135-DIP (PF) ..................... 8meperidine .......................................................24MEPHYTON .............................................. 55, 68meprobamate .................................................. 24MEPRON ...........................................................3MEPSEVII ........................................................41mercaptopurine ............................................7, 55mesalamine ..................................................... 45mesalamine with cleansing wipe ..................... 45MESNEX ......................................................... 55MESTINON ......................................................11MESTINON TIMESPAN .................................. 11METADATE ER ...............................................24metaproterenol .......................................... 11, 59METAXALL ..................................................... 11metaxalone ...................................................... 11metformin .........................................................50methadone .......................................................24METHADONE INTENSOL .............................. 24METHADOSE ..................................................24methamphetamine ...........................................24methazolamide ................................................ 43methenamine hippurate .....................................3methenamine mandelate ................................... 3METHERGINE .................................................57methimazole .................................................... 50METHITEST .................................................... 50methocarbamol ................................................11methotrexate sodium ................................... 7, 55methotrexate sodium (pf) .............................7, 55methoxsalen .................................................... 64methscopolamine ............................................ 11methyclothiazide ........................................17, 40methyldopa ................................................ 11, 17methyldopa-hydrochlorothiazide ..........11, 17, 40methylergonovine ............................................ 57METHYLIN ...................................................... 24methylphenidate hcl .........................................24methylprednisolone ......................................... 50methylprednisolone acetate .............................50methyltestosterone .......................................... 50

metipranolol ..................................................... 43metoclopramide hcl ......................................... 45metolazone ................................................ 17, 40metoprolol succinate ..................................11, 17metoprolol su-hydrochlorothiaz ........... 11, 17, 40metoprolol ta-hydrochlorothiaz ............ 11, 17, 40metoprolol tartrate ..................................... 11, 17METROCREAM .............................................. 64METROGEL .................................................... 64METROGEL VAGINAL ................................... 64METROLOTION .............................................. 64metronidazole .............................................. 3, 64mexiletine ........................................................ 17MIACALCIN .............................................. 50, 55MIBELAS 24 FE ..............................................50MICARDIS .......................................................17MICARDIS HCT ........................................ 17, 40miconazole nitrate-zinc ox-pet .........................64MICONAZOLE-3 ............................................. 64MICORT-HC .................................................... 64MICRHOGAM ULTRA-FILTERED PLUS ......... 8MICRO BLOOD GLUCOSE ............................38MICRO THIN LANCETS ................................. 33MICROCHAMBER .......................................... 33MICROCYN ..................................................... 33MICROCYN HYDROGEL ................................33MICRODOT BLOOD GLUCOSE SYSTEM .... 38MICRODOT HIGH-LOW CONTROL ...............33MICRODOT INSULIN PEN NEEDLE ..............33MICRODOT NORMAL CONTROL ................. 33MICRODOT XTRA BLOOD GLUCOSE ......... 38MICROGESTIN 1.5/30 (21) .............................50MICROGESTIN 1/20 (21) ................................50MICROGESTIN 24 FE .....................................50MICROGESTIN FE 1.5/30 (28) ....................... 50MICROGESTIN FE 1/20 (28) .......................... 50MICROLET LANCET ...................................... 33MICROSPACER ..............................................33MICROZIDE .............................................. 17, 40midazolam ....................................................... 24midodrine .........................................................11MIGERGOT ............................................... 11, 24miglitol ............................................................. 50miglustat .......................................................... 55MIGRANAL ............................................... 11, 24MIGRANOW ..............................................24, 64MILI ................................................................. 50MILLIPRED ..................................................... 50MILLIPRED DP ............................................... 50MIMVEY .......................................................... 50MIMVEY LO .................................................... 50MINASTRIN 24 FE .......................................... 50MINI ULTRA-THIN II ....................................... 33MINIPRESS ...............................................11, 17MINITRAN ....................................................... 17MINIVELLE ..................................................... 50MINOCIN ........................................................... 3minocycline ..................................................3, 64MINOLIRA ER .............................................3, 64minoxidil ...........................................................17MIRAPEX ........................................................ 24MIRAPEX ER .................................................. 24MIRCERA ........................................................13MIRCETTE (28) ...............................................50MIRENA .......................................................... 50mirtazapine ...................................................... 24MIRVASO ........................................................64misoprostol ...................................................... 45MITIGARE ....................................................... 55MITOSOL ........................................................ 43mitoxantrone ......................................................7M-M-R II (PF) .....................................................8M-NATAL PLUS ..................................13, 40, 68MOBIC .............................................................24modafinil .......................................................... 24MODERIBA ....................................................... 3moexipril .......................................................... 17molindone ........................................................ 24mometasone ........................................43, 59, 64

MONDOXYNE NL ............................................. 3MONODOX ........................................................3MONOJECT ALLERGY TRAY ....................... 33MONOJECT DISPOSABLE SYRINGE ...........34MONOJECT HYPODERMIC NEEDLES .........34MONOJECT INSULIN SAFETY SYRING .......34MONOJECT INSULIN SYRINGE ....................34MONOJECT LUER-LOCK TIP ....................... 34MONOJECT MAGELLAN SYRINGE ..............34MONOJECT PHARMACY TRAY LUER .........34MONOJECT REG TIP NON-STERILE ........... 34MONOJECT SAFETY LUER LOCK TIP ........ 34MONOJECT SAFETY SYRINGES ................. 34MONOJECT SYRINGE ................................... 34MONOJECT SYRINGE ECCENTRI LUER .....34MONOJECT SYRINGE LUER LOK ................34MONOJECT SYRINGE REGULAR LUER ..... 34MONOJECT SYRINGE TOOMEY TYPE ........ 34MONOJECT TUBERCULIN SYRINGE ...........34MONOJECT ULTRA COMFORT INSULIN .... 34MONOLET LANCETS .....................................34MONOLET THIN LANCETS ........................... 34MONO-LINYAH ...............................................50MONONINE .....................................................13MONOVISC ..................................................... 34montelukast ..................................................... 59MONUROL ........................................................ 3MORGIDOX .......................................................3MORGIDOX 1X 50 ...................................... 3, 64MORGIDOX 1X100 ..................................... 3, 64MORGIDOX 2X100 ..................................... 3, 64MORPHABOND ER ........................................ 24morphine ..........................................................24morphine concentrate ......................................24MOTEGRITY ................................................... 45MOTOFEN .......................................................45MOVANTIK ..................................................... 45MOVIPREP ......................................................45MOXATAG ........................................................ 4MOXEZA ......................................................... 43moxifloxacin .................................................4, 43MOZOBIL ........................................................ 13MS CONTIN .................................................... 24MUGARD ........................................................ 34MULPLETA ..................................................... 13MULTAQ ......................................................... 18MULTIGEN FOLIC .................................... 13, 68MULTIGEN PLUS ..................................... 13, 68MULTI-VIT WITH FLUORIDE-IRON ... 13, 55, 68MULTIVITAMIN WITH FLUORIDE ........... 55, 68MULTI-VITAMIN WITH FLUORIDE .......... 55, 68MULTIVITAMINS WITH FLUORIDE .........55, 68mupirocin ......................................................... 64mupirocin calcium ............................................64MVC-FLUORIDE ....................................... 55, 68MY CHOICE .................................................... 50MY WAY ..........................................................50MYALEPT ....................................................... 50MYAMBUTOL ................................................... 4MYCOBUTIN .....................................................4mycophenolate mofetil .....................................55mycophenolate sodium ....................................55MYDAYIS ........................................................ 25MYDRIACYL ................................................... 43MYFERON 150 FORTE ............................ 13, 68MYFORTIC ......................................................55MYGLUCOHEALTH ........................................38MYGLUCOHEALTH CONTROL SOLUTION . 34MYGLUCOHEALTH LANCETS ......................34MYLERAN .........................................................7MYLOTARG ...................................................... 7MYNATAL ........................................... 14, 40, 68MYNATAL ADVANCE ........................ 13, 40, 68MYNATAL PLUS ................................ 14, 40, 68MYNATAL-Z ........................................14, 40, 68MYNATE 90 PLUS ..........................................68MYNEPHRON ................................................. 68MYOBLOC ................................................ 11, 56MYORISAN ..................................................... 64

81

MYRBETRIQ ................................................... 67MYSOLINE ......................................................25MYTESI ........................................................... 45nabumetone .....................................................25nadolol ....................................................... 11, 18nadolol-bendroflumethiazide ............... 11, 18, 40naftifine ............................................................ 64NAFTIN ........................................................... 64NAGLAZYME ..................................................41NALFON ..........................................................25NALOCET ....................................................... 25naloxone .................................................... 25, 56naltrexone ..................................................25, 56NAMENDA ...................................................... 25NAMENDA TITRATION PAK ......................... 25NAMENDA XR ................................................ 25NAMZARIC ............................................... 11, 25NAPRELAN CR ........................................ 25, 56NAPROSYN .............................................. 25, 56naproxen ....................................................25, 56naproxen sodium ....................................... 25, 56naratriptan ....................................................... 25NARCAN ................................................... 25, 56NARDIL ........................................................... 25NASCOBAL .................................................... 68NASONEX .................................................43, 59NATACHEW (FE BIS-GLYCINATE) .........14, 68NATACYN ....................................................... 43NATAZIA .........................................................50nateglinide ....................................................... 50NATESTO ....................................................... 50NATPARA ................................................. 51, 56NATROBA .......................................................64NATURE-THROID ...........................................51NEBUPENT .......................................................4NEBUSAL ................................................. 34, 40NECON 0.5/35 (28) ......................................... 51needle (disp) 16 g ............................................34needle (disp) 18 g ............................................34needle (disp) 19 g ............................................34needle (disp) 23 gauge ....................................34NEEVODHA (WITH ALGAL OIL) ............. 14, 68nefazodone ......................................................25neomycin ........................................................... 4neomycin-bacitracin-poly-hc ............................43neomycin-bacitracin-polymyxin ....................... 43neomycin-polymyxin b-dexameth .................... 43neomycin-polymyxin-gramicidin ...................... 43neomycin-polymyxin-hc ................................... 43NEO-POLYCIN ................................................43NEO-POLYCIN HC ......................................... 43NEORAL ......................................................... 56NEOSALUS .....................................................34NEO-SYNALAR .............................................. 64NEO-SYNALAR KIT ....................................... 64NEPHPLEX RX ............................................... 68NEPHRO-VITE RX .......................................... 68NERLYNX ......................................................... 7NESINA ........................................................... 51NESTABS ........................................... 14, 40, 68NESTABS ABC .........................................14, 68NESTABS DHA ...................................14, 40, 68NESTABS ONE .........................................14, 68NEUAC ............................................................64NEUAC KIT ..................................................... 64NEULASTA ..................................................... 14NEUPOGEN .................................................... 14NEUPRO ......................................................... 25NEURAPTINE ................................................. 64NEURCAINE ................................................... 64NEURIN-SL ..................................................... 69NEURONTIN ................................................... 25NEUTEK 2TEK TEST STRIPS ....................... 38NEUTRASAL .................................................. 34NEVANAC .......................................................43nevirapine .......................................................... 4NEW DAY ........................................................51NEWGEN ............................................ 14, 40, 69NEXA PLUS .............................................. 14, 69

NEXAVAR ......................................................... 7NEXIUM ...........................................................45NEXIUM PACKET ...........................................45NEXPLANON .................................................. 51NEXT CHOICE ONE DOSE ............................ 51niacin ............................................................... 18NIACOR .......................................................... 18NIASPAN EXTENDED-RELEASE ..................18nicardipine ....................................................... 18NICAZEL ................................................... 56, 69NICORELIEF ...................................................11NICORETTE ....................................................11nicotine ............................................................ 11nicotine (polacrilex) ..........................................11NICOTROL ......................................................11NICOTROL NS ................................................11nifedipine ......................................................... 18NIKKI (28) ....................................................... 51NILANDRON ..................................................... 7nilutamide .......................................................... 7nimodipine ....................................................... 18NINLARO .......................................................... 7nisoldipine ........................................................18NITRO-BID ...................................................... 18NITRO-DUR .................................................... 18nitrofurantoin ......................................................4nitrofurantoin macrocrystal ................................ 4nitrofurantoin monohyd/m-cryst ......................... 4nitroglycerin ..................................................... 18NITROLINGUAL ............................................. 18NITROMIST .....................................................18NITROSTAT .................................................... 18NITRO-TIME ....................................................18NITYR ..............................................................56NIVA-FOL ........................................................69NIVATOPIC PLUS .......................................... 34NIVESTYM ...................................................... 14nizatidine ......................................................... 45NIZORAL .........................................................64NOCDURNA (MEN) .................................. 14, 51NOCDURNA (WOMEN) ............................ 14, 51NOCTIVA .................................................. 14, 51NOKOR NEEDLE ............................................34NOLIX ..............................................................64NORA-BE ........................................................51NORCO ........................................................... 25NORDITROPIN FLEXPRO ............................. 51noreth-ethinyl estradiol-iron ............................. 51norethindrone (contraceptive) ..........................51norethindrone acetate ......................................51norethindrone ac-eth estradiol .........................51norethindrone-e.estradiol-iron ......................... 51NORGESIC FORTE .................................. 11, 25norgestimate-ethinyl estradiol ..........................51norgestrel-ethinyl estradiol .............................. 51NORITATE ...................................................... 64NORLYDA .......................................................51NORLYROC .................................................... 51NORMAL SALINE FLUSH ........................34, 40NORM-JECT ................................................... 34NORPACE .......................................................18NORPACE CR ................................................ 18NORPRAMIN .................................................. 25NORTHERA .................................................... 11NORTREL 0.5/35 (28) .....................................51NORTREL 1/35 (21) ........................................51NORTREL 1/35 (28) ........................................51NORTREL 7/7/7 (28) .......................................51nortriptyline ...................................................... 25NORVASC .......................................................18NORVIR .............................................................4NOVA MAX GLUCOSE CONTROL ................34NOVA MAX GLUCOSE TEST ........................ 38NOVA SAFETY LANCETS ............................. 34NOVA SUREFLEX LANCETS ........................ 34NOVACORT .................................................... 64NOVAFERRUM ...............................................14NOVOEIGHT ................................................... 14NOVOFINE 32 .................................................34

NOVOFINE PLUS ........................................... 34NOVOLIN 70/30 U-100 INSULIN .................... 51NOVOLIN 70-30 FLEXPEN U-100 ..................51NOVOLIN N NPH U-100 INSULIN ..................51NOVOLIN R REGULAR U-100 INSULN .........51NOVOLOG FLEXPEN U-100 INSULIN .......... 51NOVOLOG MIX 70-30 U-100 INSULN ........... 51NOVOLOG MIX 70-30FLEXPEN U-100 ......... 51NOVOLOG PENFILL U-100 INSULIN ............ 51NOVOLOG U-100 INSULIN ASPART ............ 51NOVOPEN ECHO ........................................... 34NOVOSEVEN RT ............................................ 14NOXAFIL ...........................................................4NOXIFOL-D3 ...................................................69NOXIPAK ........................................................ 64NP THYROID .................................................. 51NPLATE .......................................................... 14NUCALA ......................................................... 59NUCORT ......................................................... 64NUCYNTA ....................................................... 25NUCYNTA ER ................................................. 25NUDICLO SOLUPAK ................................25, 64NUDICLO TABPAK .................................. 25, 64NUDROXIPAK .......................................... 25, 64NUDROXIPAK DSDR-50 .......................... 25, 64NUDROXIPAK DSDR-75 .......................... 25, 64NUDROXIPAK E-400 ................................25, 64NUDROXIPAK I-800 ................................. 25, 64NUDROXIPAK N-500 ................................25, 64NUEDEXTA ...............................................25, 59NULEV ............................................................ 11NULOJIX ......................................................... 56NULYTELY WITH FLAVOR PACKS .............. 45NUMBONEX ....................................................64NUPLAZID ...................................................... 25NUSURGEPAK SURGICAL PREP ................ 64NUTRIARX ...................................................... 64NUTROPIN AQ NUSPIN .................................51NUVAIL ........................................................... 34NUVAKAAN .................................................... 64NUVARING ..................................................... 51NUVESSA ....................................................... 64NUVIGIL .......................................................... 25NUWIQ ............................................................ 14NUZYRA ............................................................4NUZYRA (7 DAY WITH LOAD DOSE) ............. 4NUZYRA (7 DAY) ..............................................4NYAMYC ......................................................... 64NYMALIZE ...................................................... 18nystatin ........................................................ 4, 64nystatin-triamcinolone ......................................64NYSTOP ..........................................................64OB COMPLETE ........................................ 14, 69OB COMPLETE ONE ......................... 14, 40, 69OB COMPLETE PETITE ...........................14, 69OB COMPLETE PREMIER .................14, 40, 69OB COMPLETE WITH DHA ..................... 14, 69OBIZUR ...........................................................14OBREDON ................................................ 25, 59OBSTETRIX DHA ..................................... 14, 69OBSTETRIX EC .................................. 14, 45, 69OBSTETRIX ONE ..................................... 14, 69OBTREX DHA ...........................................14, 69O-CAL PRENATAL .............................14, 40, 69OCALIVA ........................................................ 45OCELLA ..........................................................51OCREVUS .......................................................56OCTAGAM ........................................................ 8octreotide acetate ...................................... 51, 56OCUFLOX ....................................................... 43ODEFSEY ......................................................... 4ODOMZO .......................................................... 7OFEV ...............................................................59ofloxacin ...................................................... 4, 43OGESTREL (28) ............................................. 51OKEBO ............................................................. 4olanzapine ....................................................... 25olanzapine-fluoxetine .......................................25olmesartan .......................................................18

82

olmesartan-amlodipin-hcthiazid .................18, 40olmesartan-hydrochlorothiazide ................ 18, 40olopatadine ...................................................... 43OLUMIANT ......................................................56OLUX ...............................................................64OLUX-E ........................................................... 64OMECLAMOX-PAK .................................... 4, 45omega-3 acid ethyl esters ............................... 18OMEPPI ...........................................................45omeprazole ......................................................45omeprazole-sodium bicarbonate ..................... 45OMNARIS ..................................................43, 59OMNITROPE ...................................................51ON CALL EXPRESS TEST STRIP .................38ON CALL LANCET ......................................... 34ON CALL PLUS CONTROL ........................... 34ON CALL PLUS LANCET .............................. 34ON CALL PLUS TEST STRIP ........................ 38ON CALL VIVID CONTROL ........................... 34ON CALL VIVID TEST STRIP ........................ 38ondansetron .....................................................45ondansetron hcl ............................................... 45ONETOUCH DELICA LANCETS ....................34ONETOUCH SURESOFT LANCING DEV ......34ONETOUCH ULTRA BLUE TEST STRIP ...... 38ONETOUCH ULTRA CONTROL .................... 34ONETOUCH ULTRASOFT LANCETS ........... 34ONETOUCH VERIO ........................................38ONETOUCH VERIO HIGH CONTROL ........... 34ONETOUCH VERIO MID CONTROL ............. 34ONEXTON .......................................................64ONFI ................................................................ 25ONGLYZA ....................................................... 51ONIVYDE .......................................................... 7ONMEL ..............................................................4ONPATTRO .................................................... 56ON-THE-GO LANCETS .................................. 34ONZETRA XSAIL ............................................25OPANA ............................................................25OPCICON ONE-STEP .................................... 51OPDIVO .............................................................7opium tincture ............................................ 25, 45OPSUMIT .................................................. 18, 59OPTICHAMBER ADULT MASK-LARGE ....... 34OPTICHAMBER DIAMOND LG MASK .......... 34OPTICHAMBER DIAMOND-MED MSK ......... 34OPTICHAMBER DIAMOND-SML MASK ....... 34OPTION-2 ........................................................51OPTIUM EZ ..................................................... 38OPTIUM TEST ................................................ 38OPTUMRX .......................................................38ORACEA ..................................................... 4, 64ORACIT ...........................................................40ORALAIR .................................................... 8, 56ORALONE .......................................................64ORAMAGICRX ................................................34ORAP .............................................................. 25ORAPRED ODT .............................................. 51ORAVIG .......................................................... 64ORENCIA ........................................................ 56ORENCIA (WITH MALTOSE) .........................56ORENCIA CLICKJECT ...................................56ORENITRAM .............................................18, 59ORFADIN ........................................................ 56ORILISSA ........................................................51ORKAMBI ....................................................... 59orphenadrine citrate .........................................11ORSYTHIA ...................................................... 51ORTHO DF ......................................................69ORTHO MICRONOR .......................................51ORTHO TRI-CYCLEN (28) ............................. 51ORTHO-NOVUM 1/35 (28) ..............................51ORTHO-NOVUM 7/7/7 (28) .............................51ORTHOVISC ................................................... 34OSCIMIN ......................................................... 11OSCIMIN SL ....................................................11OSCIMIN SR ................................................... 11oseltamivir ......................................................... 4OSENI ............................................................. 51

OSMOLEX ER .............................................4, 25OSMOPREP ....................................................45OSPHENA .......................................................51OTEZLA .................................................... 56, 64OTEZLA STARTER .................................. 56, 64OTIPRIO ..........................................................43OTOVEL ..........................................................43OTREXUP (PF) ........................................... 7, 56OVACE ............................................................64OVACE PLUS ................................................. 64OVACE PLUS SHAMPOO ..............................64OVACE PLUS WASH ..................................... 64OVIDE ............................................................. 64OXANDRIN ..................................................... 51oxandrolone .....................................................51oxaprozin ......................................................... 25OXAYDO ......................................................... 25oxazepam ........................................................ 25oxcarbazepine ................................................. 25OXERVATE .....................................................43oxiconazole ......................................................64OXISTAT ......................................................... 64OXSORALEN ULTRA .....................................64OXTELLAR XR ............................................... 25oxybutynin chloride ..........................................67oxycodone ....................................................... 25oxycodone-acetaminophen ............................. 25oxycodone-aspirin ........................................... 25OXYCONTIN ................................................... 25oxymorphone ...................................................25OXYTROL ....................................................... 67OZEMPIC ........................................................ 51OZURDEX ....................................................... 43PACERONE .................................................... 18PACNEX ..........................................................64PACNEX HP ....................................................64PACNEX LP .................................................... 64PAINGO KFT .................................................. 64paliperidone ..................................................... 25PALYNZIQ ...................................................... 41PAMELOR .......................................................25PANCREAZE .................................................. 45PANDA MASK ................................................ 34PANDEL ..........................................................64PANRETIN .................................................. 7, 64pantoprazole ....................................................45PANZYGA ......................................................... 8PARAGARD T 380A ....................................... 51paregoric ..........................................................45PAREMYD .......................................................43paricalcitol ........................................................69PARLODEL .....................................................25PARNATE ....................................................... 25PAROEX ORAL RINSE .................................. 43paromomycin ..................................................... 4paroxetine hcl .................................................. 25paroxetine mesylate(menop.sym) ................... 25PASER .............................................................. 4PATADAY ....................................................... 43PATANASE .....................................................43PATANOL ....................................................... 43PAXIL .............................................................. 25PAXIL CR ........................................................25PAZEO ............................................................ 43PEDIA IRON ....................................................14PEDIARIX (PF) ..................................................8PEDIATRIC PANDA MASK ............................34PEDVAX HIB (PF) .............................................8peg 3350-electrolytes ...................................... 45PEG-3350 WITH FLAVOR PACKS ................ 45PEGANONE .................................................... 25PEGASYS ......................................................... 4PEGASYS PROCLICK ..................................... 4peg-electrolyte soln ......................................... 45PEGINTRON ..................................................... 4PEG-PREP ...................................................... 45PEN NEEDLE ..................................................34pen needle, diabetic ........................................ 34penicillamine ..............................................46, 56

penicillin v potassium .........................................4PENLAC ..........................................................65PENNSAID ................................................ 25, 65PENTACEL (PF) ............................................... 8PENTACEL ACTHIB COMPONENT (PF) ........ 8PENTACEL DTAP-IPV COMPNT (PF) .............8PENTASA ....................................................... 45pentazocine-naloxone ..................................... 26PENTIPS ......................................................... 34pentoxifylline ....................................................14PEPCID ........................................................... 45PERCOCET .....................................................26PERFOROMIST ........................................ 11, 59PERIDEX .........................................................43perindopril erbumine ........................................18PERIOGARD ...................................................43PERJETA .......................................................... 7permethrin ....................................................... 65perphenazine ...................................................26perphenazine-amitriptyline .............................. 26PERSERIS ...................................................... 26PERTZYE ........................................................ 45PEXEVA .......................................................... 26PH 12 DILUENT FOR FLOLAN ......................57PHARMACIST CHOICE ..................................38PHENADOZ ................................................ 1, 26phenazopyridine .............................................. 65phenelzine ....................................................... 26PHENERGAN ..............................................1, 26phenobarb-hyoscy-atropine-scop .............. 11, 26phenobarbital ...................................................26PHENOHYTRO ......................................... 11, 26phenoxybenzamine ................................... 11, 18phenylephrine hcl ............................................ 43PHENYTEK ............................................... 18, 26phenytoin ................................................... 18, 26phenytoin sodium extended .......................18, 26PHILITH ...........................................................51PHOSLYRA .....................................................40PHOSPHA 250 NEUTRAL ..............................40PHOSPHASAL ..................................................4PHOSPHOLINE IODIDE ................................. 43PHRENILIN FORTE(WITH CAFFEINE) ......... 26PHYSICIANS EZ USE B-12 ............................69PHYSIOLYTE ..................................................40PHYSIOSOL IRRIGATION ............................. 40phytonadione (vitamin k1) ......................... 56, 69PICATO ....................................................... 7, 65PIFELTRO .........................................................4pilocarpine hcl ............................................11, 43pimecrolimus ............................................. 56, 65pimozide .......................................................... 26PIMTREA (28) ................................................. 51pindolol ...................................................... 11, 18pioglitazone ..................................................... 51pioglitazone-glimepiride ...................................51pioglitazone-metformin .................................... 51PIQRAY .............................................................7PIRMELLA ...................................................... 51piroxicam ......................................................... 26PISTON SYRINGE WITH ENFIT .................... 34PLAN B ONE-STEP ........................................51PLAQUENIL ................................................4, 56PLAVIX ............................................................14PLEGRIDY ...................................................... 56PLENVU .......................................................... 45PLEXION .........................................................65PLEXION CLEANSING CLOTHS ...................65PLIAGLIS ........................................................ 65PNEUMOVAX 23 .............................................. 9PNV 29-1 ............................................. 14, 40, 69PNV OB+DHA ...............................14, 40, 45, 69PNV-DHA .................................................. 14, 69PNV-DHA + DOCUSATE ..............14, 40, 45, 69PNV-FERROUS FUMARATE-DOCU-FA . 14, 69PNV-OMEGA ...................................... 14, 40, 69PNV-SELECT ............................................14, 69PNV-VP-U ....................................................... 69POCKET CHAMBER ...................................... 34

83

PODOCON ...................................................... 65podofilox .......................................................... 65POLIVY ............................................................. 7POLY HUB NEEDLE ...................................... 34POLYCIN .........................................................43polyethylene glycol 3350 ................................. 45POLY-IRON 150 FORTE .......................... 14, 69polymyxin b sulfate ............................................ 4polymyxin b sulf-trimethoprim ..........................43POLYTRIM ...................................................... 43POLY-VI-FLOR ......................................... 56, 69POLY-VI-FLOR WITH IRON ............... 14, 56, 69POMALYST .................................................7, 56PONTOCAINE .................................................65PORTIA 28 ...................................................... 51PORTRAZZA .................................................... 7POTABA ......................................................... 56potassium chloride ...........................................40potassium citrate ............................................. 40potassium citrate-citric acid ............................. 40POTELIGEO ......................................................7PR CREAM ..................................................... 34PR NATAL 400 ................................... 14, 40, 69PR NATAL 400 EC ............................. 14, 40, 69PR NATAL 430 ................................... 14, 40, 69PR NATAL 430 EC ............................. 14, 40, 69PRADAXA .......................................................14PRALUENT PEN .............................................18pramipexole ..................................................... 26PRAMOSONE ................................................. 65PRANDIN ........................................................ 51prasugrel ..........................................................14PRAVACHOL ..................................................18pravastatin ....................................................... 18praziquantel ....................................................... 4prazosin ..................................................... 11, 18PRECISION PCX PLUS TEST ........................38PRECISION PCX TEST .................................. 38PRECISION POINT OF CARE TEST ............. 38PRECISION Q-I-D TEST .................................38PRECISION XTRA B-KETONE ...................... 35PRECISION XTRA TEST ................................38PRECOSE ....................................................... 51PRED FORTE ................................................. 43PRED MILD .....................................................43PRED-G ...........................................................43PRED-G S.O.P. ............................................... 43prednicarbate ...................................................65prednisol ace-gatiflox-bromfen ........................ 43prednisoln sp-gatiflox-bromfen ........................ 43prednisolone .................................................... 51prednisolone acetate ....................................... 43prednisolone acetate (pf) .................................43prednisolone acetate-bromfenac ..................... 43prednisolone acetate-nepafenac ..................... 43prednisolone acet-gatifloxacin ......................... 43prednisolone sod ph-bromfenac ...................... 43prednisolone sod ph-gatifloxac ........................43prednisolone sodium phosphate ................43, 51prednisolone-moxiflo-nepafenac ..................... 43prednisolone-moxifloxacin hcl ......................... 43prednisone .......................................................51PREDNISONE INTENSOL ..............................51PREFERA-OB ...........................................14, 69PREFERA-OB ONE .................................. 14, 69PREFERA-OB PLUS DHA ....................... 14, 69PREFEST ........................................................ 51PREMARIN ..................................................... 51PREMIER TEST STRIP .................................. 38PREMIUM V10 ................................................ 38PREMPHASE ..................................................51PREMPRO ...................................................... 51PRENA1 CHEW .............................................. 69PRENA1 PEARL .......................................14, 69PRENA1 TRUE ......................................... 14, 69PRENAISSANCE .......................... 14, 40, 45, 69PRENAISSANCE PLUS ............... 14, 40, 45, 69PRENATA ................................................. 14, 69PRENATABS FA ................................ 14, 40, 69

PRENATABS RX ................................ 14, 40, 69PRENATAL LOW IRON ......................14, 40, 69PRENATAL PLUS .............................. 14, 40, 69PRENATAL PLUS (CALCIUM CARB)............................................................. 14, 40, 69PRENATAL PLUS DHA ............................14, 69PRENATAL VITAMIN PLUS LOW IRON............................................................. 14, 40, 69PRENATAL-U ................................................. 69PRENATE AM .................................................69PRENATE CHEWABLE ............................40, 69PRENATE DHA .........................................14, 69PRENATE DHA (FERR ASP GLYCIN) .... 14, 69PRENATE ELITE ...................................... 14, 69PRENATE ELITE (IRON ASP GLYC) ...... 14, 69PRENATE ENHANCE ...............................14, 69PRENATE ESSENTIAL ............................ 14, 69PRENATE ESSENTIAL(IRON-ASP-GL) .. 14, 69PRENATE MINI (FERR ASP GLYCIN) .....14, 69PRENATE PIXIE ....................................... 14, 69PRENATE RESTORE ............................... 14, 69PRENATE STAR .......................................14, 69PREPIDIL ........................................................ 57PREPLUS ............................................14, 40, 69PREPOPIK ...................................................... 45PRESERA ....................................................... 35PRESSURE ACTIVATED LANCETS ............. 35PRESTALIA .................................................... 18PRETAB ..............................................14, 40, 69PREVACID ...................................................... 45PREVACID SOLUTAB ....................................45PREVALITE .................................................... 18PREVIDENT .................................................... 56PREVIDENT 5000 BOOSTER PLUS ..............56PREVIDENT 5000 DRY MOUTH .................... 56PREVIDENT 5000 ENAMEL PROTECT .........56PREVIDENT 5000 PLUS ................................ 56PREVIDENT 5000 SENSITIVE ....................... 56PREVIFEM ...................................................... 51PREVNAR 13 (PF) ............................................ 9PREVYMIS ........................................................ 4PREZCOBIX ................................................4, 56PREZISTA .........................................................4PRIALT ............................................................26PRIFTIN .............................................................4PRIKAAN ........................................................ 65PRIKAAN LITE ............................................... 65PRILOLID ........................................................65PRILOSEC ...................................................... 46PRILOVIX ........................................................65PRILOVIX LITE ............................................... 65PRILOVIX PLUS ............................................. 65PRIMACARE .............................................14, 69primaquine .........................................................4PRIMEAIRE .....................................................35primidone .........................................................26PRIMLEV .........................................................26PRIMSOL .......................................................... 4PRINIVIL ......................................................... 18PRISTIQ .......................................................... 26PRIVIGEN ......................................................... 9PRO COMFORT INSULIN SYRINGE ............. 35PRO COMFORT LANCET .............................. 35PRO COMFORT PEN NEEDLE ......................35PRO VOICE V8-V9 TEST STRIP ....................38PROAIR HFA ............................................ 11, 59PROAIR RESPICLICK ..............................11, 59probenecid .................................................40, 56probenecid-colchicine ................................40, 56PROBUPHINE .................................................26procainamide ................................................... 18PROCARDIA ...................................................18PROCARDIA XL ............................................. 18PROCENTRA ..................................................26PROCHAMBER .............................................. 35prochlorperazine ........................................26, 46prochlorperazine edisylate .........................26, 46prochlorperazine maleate .......................... 26, 46PROCORT .......................................................65

PROCRIT ........................................................ 14PROCTOCORT ............................................... 65PROCTOFOAM HC ........................................ 65PROCTO-MED HC ..........................................65PROCTO-PAK ................................................ 65PROCTOSOL HC ............................................65PROCTOZONE-HC .........................................65PROCYSBI ......................................................56PRODIGY CONTROL SOLUTION, LOW ....... 35PRODIGY CONTROL SOLUTION,HIGH ........35PRODIGY INSULIN SYRINGE ....................... 35PRODIGY LANCETS ...................................... 35PRODIGY NO CODING .................................. 38PRODIGY TWIST TOP LANCET ....................35PROFILNINE ...................................................14progesterone ................................................... 51progesterone micronized ................................. 51PROGLYCEM ................................................. 51PROGRAF .......................................................56PROLASTIN-C ................................................ 59PROLENSA .....................................................43PROLEUKIN ............................................... 7, 56PROLIA ........................................................... 56PROMACTA ....................................................14promethazine .........................................1, 26, 59PROMETHAZINE VC ............................1, 11, 59promethazine-codeine ............................... 26, 59promethazine-dm .........................................1, 59promethazine-phenyleph-codeine ... 1, 11, 26, 59promethazine-phenylephrine ................. 1, 11, 59PROMETHEGAN ........................................ 1, 26PROMETRIUM ................................................ 51PROMISEB ..................................................... 35propafenone .................................................... 18propantheline ...................................................11proparacaine ....................................................43propranolol ...........................................11, 18, 26propranolol-hydrochlorothiazid ............ 11, 18, 40propylthiouracil ................................................ 51PROQUAD (PF) ................................................ 9PROSCAR .......................................................56PROSTIN E2 ................................................... 57PROTHELIAL ..................................................35PROTONIX ......................................................46PROTOPIC ......................................................65protriptyline ...................................................... 26PROVENTIL HFA ......................................11, 59PROVERA .......................................................51PROVIDA DHA ......................................... 14, 69PROVIDA OB ............................................14, 69PROVIGIL ....................................................... 26PROZAC ......................................................... 26PRUCLAIR ................................................ 35, 65PRUDOXIN ......................................................65PRUMYX ......................................................... 35PRUTECT ..................................................35, 65PSORCON ...................................................... 65PULMICORT ............................................. 51, 59PULMICORT FLEXHALER .......................51, 59PULMOSAL .............................................. 35, 40PULMOZYME ............................................41, 59PUREFE OB PLUS ................................... 14, 69PUREVIT DUALFE PLUS ...............................14PURIXAN .................................................... 7, 56PUSH BUTTON SAFETY LANCETS ............. 35PYLERA ...................................................... 4, 46pyrazinamide ..................................................... 4PYRIDIUM ....................................................... 65pyridostigmine bromide ................................... 11QBRELIS .........................................................18QBREXZA ................................................. 11, 65QMIIZ ODT ...................................................... 26QNASL ...................................................... 43, 59QTERN ............................................................ 51QUADRACEL (PF) ............................................9QUALAQUIN .....................................................4QUARTETTE ...................................................51quazepam ........................................................26QUDEXY XR ................................................... 26

84

QUESTRAN .................................................... 18QUESTRAN LIGHT .........................................18quetiapine ........................................................ 26QUFLORA .................................................56, 69QUFLORA FE ..................................... 14, 56, 69QUFLORA FE (FERROUS SULFATE)............................................................. 14, 56, 69QUFLORA PEDIATRIC ............................ 56, 69QUFLORA PEDIATRIC DROPS ...............56, 69QUILLICHEW ER ............................................26QUILLIVANT XR ............................................. 26quinapril ........................................................... 18quinapril-hydrochlorothiazide .....................18, 40quinidine gluconate ......................................4, 18quinidine sulfate ...........................................4, 18quinine sulfate ................................................... 4QUINTET AC ...................................................38QUINTET GLUCOSE TEST STRIPS ..............38QUIT 2 ............................................................. 11QUIT 4 ............................................................. 11QUTENZA ....................................................... 65QVAR REDIHALER .................................. 51, 59RABAVERT (PF) ...............................................9rabeprazole ......................................................46RADIAGEL ......................................................57RADIAPLEXRX ...............................................35RADICAVA ......................................................26RAGWITEK ................................................. 9, 56RAJANI ........................................................... 51raloxifene ................................................... 51, 56ramipril .............................................................18RANEXA ......................................................... 18ranitidine hcl .................................................... 46ranolazine ........................................................ 18RAPAFLO ....................................................... 11RAPAMUNE ....................................................56rasagiline ......................................................... 26RASUVO (PF) ............................................. 7, 56RAVICTI .......................................................... 40RAYALDEE .....................................................69RAYOS ............................................................51RAZADYNE .....................................................11RAZADYNE ER ...............................................11READYLANCE SAFETY LANCETS .............. 35REBETOL ......................................................... 4REBIF (WITH ALBUMIN) ................................56REBIF REBIDOSE .......................................... 56REBIF TITRATION PACK .............................. 56REBINYN ........................................................ 14RECEDO ......................................................... 35RECLIPSEN (28) .............................................52RECOMBINATE ..............................................14RECOMBIVAX HB (PF) .................................... 9RECTIV ........................................................... 65REFUAH PLUS ............................................... 38REFUAH PLUS GLUCOSE CONTROL ......... 35REGENECARE ............................................... 35REGENECARE WITH ALOE .......................... 35REGLAN ......................................................... 46REGRANEX .................................................... 65RELADOR PAK .............................................. 65RELADOR PAK PLUS ....................................65RELAGARD .................................................... 65RELENZA DISKHALER ....................................4RELEXXII ........................................................ 26RELIAMED LANCET ...................................... 35RELIAMED SAFETY SEAL LANCETS .......... 35RELIAMED TWIST AND CAP LANCET .........35RELION CONFIRM-MICRO ............................ 38RELION NEEDLES ......................................... 35RELION PEN NEEDLES .................................35RELION PRIME TEST STRIPS ...................... 38RELION THIN LANCETS ................................35RELION ULTIMA ............................................ 38RELION ULTRA THIN PLUS LANCETS ........35RELISTOR ...................................................... 46RELPAX .......................................................... 26REMERON ...................................................... 26REMERON SOLTAB ...................................... 26

REMICADE ......................................... 46, 56, 65REMODULIN .............................................18, 59RENAGEL ................................................. 41, 56RENAL CAPS ................................................. 69RENA-VITE RX ............................................... 69RENFLEXIS ........................................ 46, 56, 65RENO CAPS ................................................... 69RENVELA ................................................. 41, 56repaglinide ....................................................... 52repaglinide-metformin ......................................52REPATHA PUSHTRONEX ............................. 18REPATHA SURECLICK ................................. 18REPATHA SYRINGE ...................................... 18REPREXAIN ....................................................26REQUIP ...........................................................26REQUIP XL ..................................................... 26RESCRIPTOR ................................................... 4RESPA-AR ............................................1, 11, 59RESTASIS .......................................................43RESTASIS MULTIDOSE ................................ 43RESTIZAN .......................................................65RESTORIL ...................................................... 26RETACRIT ...................................................... 14RETIN-A .......................................................... 65RETIN-A MICRO ............................................. 65RETIN-A MICRO PUMP ..................................65RETISERT .......................................................43RETROVIR ........................................................ 4REVATIO ...................................................18, 59REVCOVI ........................................................ 41REVEAL TEST STRIP .................................... 38REVESTA ........................................................69REVIA ........................................................26, 56REVLIMID ................................................... 7, 56REXULTI ......................................................... 26REYATAZ ..........................................................4RHOFADE .......................................................65RHOGAM ULTRA-FILTERED PLUS ................9RHOPHYLAC ....................................................9RHOPRESSA ..................................................43RIASTAP .........................................................14RIBASPHERE ................................................... 4RIBASPHERE RIBAPAK ..................................4ribavirin .............................................................. 4RIDAURA .................................................. 46, 56rifabutin ..............................................................4RIFADIN ............................................................ 4RIFAMATE ........................................................ 4rifampin ..............................................................4RIFATER ........................................................... 4RIGHTEST CONTROL SOLUTION HIGH ...... 35RIGHTEST CONTROL SOLUTION NORM .... 35RIGHTEST GL300 LANCETS ........................ 35RIGHTEST GS250S TEST STRIPS ................39RIGHTEST GS260 TEST STRIPS .................. 39RIGHTEST GS550 TEST STRIPS .................. 39RILUTEK ......................................................... 26riluzole ............................................................. 26rimantadine ........................................................4ringer's .............................................................41RIOMET ...........................................................52risedronate .......................................................56RISPERDAL ....................................................26RISPERDAL CONSTA ....................................26risperidone .......................................................26RITALIN .......................................................... 26RITALIN LA .....................................................26ritonavir ..............................................................4RITUXAN ...........................................................7RITUXAN HYCELA ...........................................7rivastigmine ..................................................... 11rivastigmine tartrate ......................................... 11RIVELSA ......................................................... 52RIXUBIS .......................................................... 14rizatriptan .........................................................26R-NATAL OB ............................................ 14, 69ROBAXIN ........................................................ 11ROBAXIN-750 .................................................11ROCALTROL .................................................. 69

ROCKLATAN ..................................................43romidepsin ......................................................... 7ropinirole ..........................................................26ROSADAN ...................................................... 65ROSANIL ........................................................ 65ROSULA ......................................................... 65ROSULA CLEANSING CLOTHS ................... 65rosuvastatin ..................................................... 18ROTARIX .......................................................... 9ROTATEQ VACCINE ........................................9ROWASA ........................................................ 46ROWEEPRA ................................................... 26ROWEEPRA XR ............................................. 26ROXICODONE ................................................ 26ROXIFOL-D .....................................................69ROXYBOND ....................................................26ROZEREM .......................................................26RUBRACA ........................................................ 7RUCONEST .................................................... 56RUZURGI ........................................................ 56RYCLORA ...................................................1, 59RYDAPT ............................................................7RYDEX ............................................ 1, 11, 26, 59RYNODERM ....................................................65RYTARY ..........................................................26RYTHMOL SR .................................................18RYVENT ...................................................... 1, 59SABRIL ........................................................... 26SAFESNAP INSULIN SYRINGE .................... 35SAFESNAP SYRINGE ....................................35SAFETY LANCETS ........................................ 35safety needles ................................................. 35SAFETY SEAL LANCETS ..............................35SAFETY-LET LANCETS ................................ 35SAFYRAL ........................................................52SAIZEN ........................................................... 52SAIZEN SAIZENPREP ................................... 52SALAGEN (PILOCARPINE) ........................... 11SALEX .............................................................65salicylic acid .....................................................65salicylic acid er-ceramides ...............................65SALIMEZ .........................................................65SALIMEZ FORTE ............................................65SALIVAMAX ................................................... 35SALKERA ....................................................... 65salsalate .......................................................... 26SALVAX .......................................................... 65SALVAX DUO PLUS ...................................... 65SAMSCA ......................................................... 41SANADERMRX ...............................................65SANCUSO .......................................................46SANDIMMUNE ................................................56SANDOSTATIN .........................................52, 56SANDOSTATIN LAR DEPOT ...................52, 56SANTYL .......................................................... 65SAPHRIS .........................................................26SARAFEM .......................................................26SAVAYSA ....................................................... 15SAVELLA ........................................................26SAXENDA ....................................................... 52SCALACORT .................................................. 65SCALACORT DK ............................................65scopolamine base ............................................46SEASONIQUE .................................................52SECONAL SODIUM ........................................26SEEBRI NEOHALER ...................................... 11SEGLUROMET ............................................... 52SELECT-OB ..............................................15, 69SELECT-OB (FOLIC ACID) ............................15SELECT-OB + DHA ..................................15, 69selegiline hcl .................................................... 26selenium sulfide ...............................................65SELRX .............................................................65SELZENTRY ..................................................... 4SEMPREX-D ......................................... 1, 11, 59SE-NATAL 19 ........................................... 15, 69SE-NATAL 19 (WITH DOCUSATE) ....15, 46, 69SENSIPAR ................................................ 52, 56SEREVENT DISKUS .................................11, 59

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SERNIVO ........................................................ 65SEROQUEL .................................................... 26SEROQUEL XR .............................................. 26SEROSTIM ......................................................52sertraline ..........................................................26SE-TAN PLUS .................................................15SETLAKIN .......................................................52sevelamer carbonate ................................. 41, 57sevelamer hcl ............................................ 41, 57SEYSARA ......................................................... 4SF .................................................................... 57SF 5000 PLUS ................................................ 57SFROWASA ....................................................46SHAROBEL .................................................... 52SHINGRIX (PF) ................................................. 9SHINGRIX GE ANTIGEN COMPONENT ......... 9SHOHL'S MODIFIED ...................................... 41SIDESTREAM PEDIATRIC FACE MASK ...... 35SIGNIFOR ....................................................... 52SIGNIFOR LAR ...............................................52SIKLOS ............................................................. 7SILALITE PAK ................................................ 65SILAZONE-II ................................................... 65sildenafil ...........................................................18sildenafil (antihypertensive) ....................... 18, 59SILENOR .........................................................26SILIQ ............................................................... 65silodosin ...........................................................11SILVADENE .................................................... 65silver nitrate ..................................................... 65silver nitrate applicators ...................................65silver sulfadiazine ............................................ 65SILVRSTAT .....................................................35SIMBRINZA .....................................................43SIMLIYA (28) ...................................................52SIMPESSE ...................................................... 52SIMPONI ................................................... 46, 57SIMPONI ARIA ..........................................46, 57simvastatin .......................................................18SINEMET .........................................................26SINEMET CR .................................................. 26SINGLE-LET ................................................... 35SINGULAIR .....................................................59SINUVA ..................................................... 43, 59sirolimus .......................................................... 57SIRTURO .......................................................... 4SITAVIG ............................................................ 4SIVEXTRO ........................................................ 4SKELAXIN ...................................................... 11SKLICE ........................................................... 65SKYLA ............................................................ 52SKYRIZI .......................................................... 65SMART SENSE LANCETS .............................35SMART SENSE TEST STRIPS ...................... 39SMARTEST CONTROL .................................. 35SMARTEST LANCET ..................................... 35SMARTEST TEST ...........................................39SMARTRX GABAKIT ..................................... 27SMARTRX GABA-V KIT .................................27sodium chloride ......................................... 35, 41sodium chloride 0.9 % (flush) .................... 35, 41sodium citrate-citric acid .................................. 41SODIUM FLUORIDE 5000 PLUS ................... 57sodium phenylbutyrate .................................... 41sodium polystyrene sulfonate .................... 41, 57sofosbuvir-velpatasvir ........................................4SOFT TOUCH LANCETS ............................... 35SOLARAZE .................................................7, 65solifenacin ........................................................67SOLIQUA 100/33 ............................................ 52SOLIRIS .......................................................... 57SOLODYN ...................................................4, 65SOLOSEC ......................................................... 4SOLOXIDE ........................................................ 4SOLTAMOX ................................................ 7, 52SOLUPAK ................................................. 27, 65SOLUS V2 CONTROL SOLUTION, LOW ...... 35SOLUS V2 CONTROL SOLUTION,HIGH ...... 35SOLUS V2 LANCETS .....................................35

SOLUS V2 TEST STRIPS ...............................39SOMA ..............................................................11SOMATULINE DEPOT ................................... 52SOMAVERT .................................................... 52SONAFINE ................................................ 35, 65SOOLANTRA ..................................................66SORIATANE ................................................... 66SORILUX .........................................................66SORINE .....................................................11, 18sotalol ........................................................ 12, 18SOTALOL AF ............................................12, 18SOTYLIZE ................................................. 12, 18SOVALDI ...........................................................4SP ANTIPRURITIC ......................................... 35SP SCAR MANAGEMENT ............................. 66SPECTRACEF .................................................. 4spinosad .......................................................... 66SPINRAZA (PF) .............................................. 57SPIRIVA RESPIMAT .................................12, 59SPIRIVA WITH HANDIHALER ................. 12, 59spironolactone ........................................... 18, 41spironolacton-hydrochlorothiaz ..................18, 41SPORANOX ...................................................... 4SPORANOX PULSEPAK ................................. 4SPRAVATO .....................................................27SPRAY AND STRETCH ........................... 35, 66SPRINTEC (28) ............................................... 52SPRITAM ........................................................ 27SPRIX ..............................................................27SPRYCEL ..........................................................7SPS (WITH SORBITOL) ........................... 41, 57SRONYX ......................................................... 52SSD ................................................................. 66SSKI ................................................ 4, 52, 57, 59SSS 10-5 ......................................................... 66ST JOSEPH ASPIRIN ...............................15, 27STALEVO 100 .................................................27STALEVO 125 .................................................27STALEVO 150 .................................................27STALEVO 200 .................................................27STALEVO 50 ...................................................27STALEVO 75 ...................................................27STAMARIL (PF) ................................................ 9STARLIX ......................................................... 52stavudine ........................................................... 4STAXYN .......................................................... 18STEGLATRO .................................................. 52STEGLUJAN ...................................................52STELARA ..................................................57, 66STENDRA ....................................................... 18STERILANCE TL ............................................ 35STIMATE ...................................................15, 52STIOLTO RESPIMAT ..................................... 12STIVARGA ........................................................ 7STOP SMOKING AID ..................................... 12STRATTERA ...................................................27STRENSIQ ...................................................... 41streptomycin ...................................................... 4STRIANT ......................................................... 52STRIBILD .......................................................... 4STRIVERDI RESPIMAT ............................12, 59STROMECTOL ................................................. 5STRONG IODINE ............................5, 52, 57, 59SUBLOCADE ..................................................27SUBOXONE .................................................... 27SUBSYS ..........................................................27SUBVENITE .................................................... 27SUBVENITE STARTER (BLUE) KIT .............. 27SUBVENITE STARTER (GREEN) KIT ........... 27SUBVENITE STARTER (ORANGE) KIT ........ 27SUCRAID ........................................................ 41sucralfate ......................................................... 46SULAR ............................................................ 18sulfacetamide sodium ................................43, 66sulfacetamide sodium (acne) ...........................66sulfacetamide sodium-sulfur ............................66sulfacetamide sod-sulfur-urea ......................... 66sulfacetamide-prednisolone .............................43sulfacetamide-sulfur-cleansr23 ........................66

SULFACLEANSE 8-4 ..................................... 66sulfact na-sul-avobnz-otn-ocsa ........................66sulfadiazine ........................................................5sulfamethoxazole-trimethoprim ......................... 5SULFAMYLON ................................................66sulfasalazine ..........................................5, 46, 57SULFATRIM ......................................................5sulindac ........................................................... 27SUMADAN ...................................................... 66SUMADAN XLT .............................................. 66sumatriptan ......................................................27sumatriptan succinate ......................................27sumatriptan-naproxen ......................................27SUMAVEL DOSEPRO .................................... 27SUMAXIN ........................................................ 66SUMAXIN CP .................................................. 66SUMAXIN TS .................................................. 66SUNOSI ...........................................................27SUPARTZ FX .................................................. 35SUPER THIN LANCETS .................................35SUPPRELIN LA .......................................... 7, 52SUPRAX ............................................................5SUPREP BOWEL PREP KIT ..........................46SURE COMFORT ALCOHOL PREP PADS ...66SURE COMFORT INS. SYR. U-100 ............... 35SURE COMFORT INSULIN SYRINGE ...........35SURE COMFORT LANCETS ......................... 35SURE COMFORT PEN NEEDLE ................... 35SURE RESULT DSS PREMIUM PACK ....27, 66SURE RESULT TAC PAK .............................. 66SURE-FINE PEN NEEDLES ...........................35SURE-JECT INSULIN SYRINGE ....................35SURE-LANCE ................................................. 35SURE-LANCE ULTRA THIN .......................... 35SURE-TEST EASYPLUS MINI ....................... 39SURE-TOUCH LANCET ................................. 35SURFAXIN ...................................................... 59SURGUARD2 SAFETY ...................................35SUSTIVA ........................................................... 5SUSTOL .......................................................... 46SUTENT ............................................................ 7SUVICORT ...................................................... 35SYEDA ............................................................ 52SYLATRON ...................................................5, 7SYLVANT ..........................................................7SYMAX DUOTAB ........................................... 12SYMAX FASTABS ..........................................12SYMAX-SL ...................................................... 12SYMAX-SR ......................................................12SYMBICORT ....................................... 12, 52, 59SYMBYAX .......................................................27SYMDEKO ...................................................... 59SYMFI ................................................................5SYMFI LO ..........................................................5SYMLINPEN 120 .............................................52SYMLINPEN 60 ...............................................52SYMPAZAN .................................................... 27SYMPROIC ..................................................... 46SYMTUZA ................................................... 5, 57SYNAGIS .......................................................... 5SYNALAR ....................................................... 66SYNALAR CREAM KIT .................................. 66SYNALAR OINTMENT KIT .............................66SYNALAR TS ..................................................66SYNAREL ....................................................... 52SYNDROS .......................................................46SYNERA ..........................................................66SYNJARDY ..................................................... 52SYNJARDY XR ............................................... 52SYNRIBO .......................................................... 7SYNTHROID ................................................... 52SYNVEXIA TC .................................................66SYNVISC .........................................................35SYNVISC-ONE ................................................35SYPRINE .........................................................46syringe (disposable) ........................................ 35syringe (reusable) ............................................35SYRINGE 3CC/21GX1-1/2" ............................ 35syringe with needle ..........................................35

86

syringe with needle, safety .............................. 36TABLOID ...........................................................7TACLONEX .....................................................66tacrolimus .................................................. 57, 66tadalafil ............................................................ 18tadalafil (antihypertensive) .........................18, 59TAFINLAR .........................................................7TAGRISSO ........................................................7TAKE ACTION ................................................ 52TAKHZYRO .....................................................57TALTZ AUTOINJECTOR ................................66TALTZ AUTOINJECTOR (2 PACK) ............... 66TALTZ AUTOINJECTOR (3 PACK) ............... 66TALTZ SYRINGE ............................................ 66TALZENNA ....................................................... 7TAMIFLU ...........................................................5tamoxifen ..................................................... 7, 52tamsulosin ....................................................... 12TAPAZOLE ..................................................... 52TAPERDEX ..................................................... 52TARCEVA ......................................................... 7TARGADOX ...................................................... 5TARGRETIN ................................................7, 66TARINA 24 FE ................................................ 52TARINA FE 1/20 (28) ...................................... 52TARINA FE 1-20 EQ (28) ................................52TARKA ............................................................ 19TARON FORTE .........................................15, 69TARON-C DHA ......................................... 15, 69TARON-PREX PRENATAL-DHA ....... 15, 46, 69TASIGNA .......................................................... 7TASMAR ......................................................... 27TAVALISSE .................................................... 15TAYTULLA ......................................................52tazarotene ........................................................66TAZORAC ....................................................... 66TAZTIA XT ...................................................... 19TD GOLD TEST STRIP ...................................39TDVAX .............................................................. 9TECENTRIQ ......................................................7TECFIDERA .................................................... 57TECHLITE INSULIN SYRINGE ...................... 36TECHLITE LANCETS ..................................... 36TECHLITE PEN NEEDLE ............................... 36TEGRETOL ..................................................... 27TEGRETOL XR ............................................... 27TEGSEDI .........................................................57TEKTURNA .....................................................19TEKTURNA HCT ...................................... 19, 41TELCARE CONTROL .....................................36TELCARE LANCETS ......................................36TELCARE TEST STRIPS ............................... 39telmisartan ....................................................... 19telmisartan-amlodipine .................................... 19telmisartan-hydrochlorothiazid ...................19, 41temazepam ......................................................27TEMODAR ........................................................ 7TEMOVATE .....................................................66temozolomide .................................................... 7temsirolimus ...................................................... 7TENCON ......................................................... 27TENIVAC (PF) ...................................................9tenofovir disoproxil fumarate ............................. 5TENORETIC 100 .................................12, 19, 41TENORETIC 50 ...................................12, 19, 41TENORMIN ............................................... 12, 19TEPADINA ........................................................ 7terazosin .................................................... 12, 19terbinafine hcl .................................................... 5terbutaline ..................................................12, 59terconazole ...................................................... 66TEROCIN (LIDOCAINE-MENTHOL) .............. 66TERSI FOAM .................................................. 66TERUMO INSULIN SYRINGE ........................ 36TERUMO SYRINGE ........................................36TESSALON PERLES ......................................59TEST N'GO TEST ........................................... 39TESTIM ........................................................... 52TESTOPEL ......................................................52

testosterone .....................................................52testosterone cypionate .................................... 52testosterone enanthate ....................................52TESTRED ........................................................52tetanus,diphtheria tox ped(pf) ............................9TETCAINE .......................................................43tetrabenazine ...................................................27tetracaine hcl ................................................... 44tetracaine hcl (pf) .............................................44tetracycline ........................................................ 5TETRAVISC .................................................... 44TETRAVISC FORTE ....................................... 44TETRIX ............................................................66TEXACORT .....................................................66THALOMID ......................................................57THEO-24 ....................................... 19, 41, 59, 67THEOCHRON ............................... 19, 41, 59, 67theophylline ................................... 19, 41, 59, 67THIN LANCETS .............................................. 36THINPRO INSULIN SYRINGE ........................36THIOLA ........................................................... 57thioridazine ...................................................... 27thiothixene ....................................................... 27THRIVITE RX ...................................... 15, 41, 69THRIVITE-19 ............................................. 15, 69thyroid (pork) ................................................... 52THYROLAR-1 ................................................. 52THYROLAR-1/2 .............................................. 52THYROLAR-1/4 .............................................. 52THYROLAR-2 ................................................. 52THYROLAR-3 ................................................. 52tiagabine .......................................................... 27TIAZAC ........................................................... 19TIBSOVO .......................................................... 7TICALAST .................................................44, 59TICANASE ................................................ 44, 59TICASPRAY ..............................................44, 59TIGAN ............................................................. 46TIKOSYN .........................................................19TILIA FE .......................................................... 52timol-brimon-dorzo-latanop(pf) ........................ 44timolol maleate .............................. 12, 19, 27, 44timolol-brimonidi-dorzolam(pf) ......................... 44timolol-dorzolamid-latanop(pf) ......................... 44timolol-latanoprost(pf) ......................................44TIMOPTIC ....................................................... 44TIMOPTIC OCUDOSE (PF) ............................ 44TIMOPTIC-XE ................................................. 44tinidazole ........................................................... 5TIROSINT ........................................................52TIROSINT-SOL ............................................... 52TIVICAY ............................................................ 5TIVORBEX ................................................ 27, 57tizanidine ......................................................... 12TL-SELECT ...................................15, 41, 46, 70TOBI .................................................................. 5TOBI PODHALER .............................................5TOBRADEX .................................................... 44TOBRADEX ST ...............................................44tobramycin ....................................................... 44tobramycin in 0.225 % nacl ............................... 5tobramycin sulfate ............................................. 5tobramycin with nebulizer .................................. 5tobramycin-dexamethasone ............................ 44TOBREX ..........................................................44TODAY CONTRACEPTIVE SPONGE ............28TOFRANIL ...................................................... 27TOLAK ........................................................ 7, 66tolazamide ....................................................... 52tolbutamide ...................................................... 52tolcapone ......................................................... 27tolmetin ............................................................ 27TOLSURA ......................................................... 5tolterodine ........................................................67TOPAMAX .......................................................27TOPCARE CLICKFINE ...................................36TOPCARE ULTRA COMFORT .......................36TOPCARE UNIVERSAL1 LANCET ................36TOPICORT ...................................................... 66

topiramate ........................................................27TOPROL XL .............................................. 12, 19toremifene ....................................................7, 52TORISEL ........................................................... 7torsemide ...................................................19, 41TOUJEO MAX U-300 SOLOSTAR ................. 52TOUJEO SOLOSTAR U-300 INSULIN ...........53TOVIAZ ........................................................... 67TRACLEER ............................................... 19, 59TRADJENTA ...................................................53tramadol ...........................................................27tramadol-acetaminophen .................................27trandolapril .......................................................19trandolapril-verapamil ...................................... 19tranexamic acid ............................................... 15TRANSDERM-SCOP ...................................... 46TRANXENE T-TAB ......................................... 27tranylcypromine ............................................... 27TRANZAREL ...................................................66TRAVATAN Z ..................................................44trazodone .........................................................27TREANDA ......................................................... 7TRECATOR .......................................................5TRELEGY ELLIPTA ............................12, 53, 59TRELSTAR ................................................. 8, 53TREMFYA ....................................................... 66treprostinil sodium ..................................... 19, 59TRESIBA FLEXTOUCH U-100 ....................... 53TRESIBA FLEXTOUCH U-200 ....................... 53TRESIBA U-100 INSULIN ...............................53tretinoin ............................................................66tretinoin (chemotherapy) ....................................8tretinoin (emollient) .......................................... 66tretinoin microspheres ..................................... 66TRETIN-X ........................................................ 66TRETIN-X CREAM KIT ................................... 66TRETTEN ........................................................ 15TREXALL .................................................... 8, 57TREXIMET ...................................................... 27TREZIX ............................................................27TRI FEMYNOR ................................................53triacetin .............................................................. 5TRIADVANCE ..................................... 15, 41, 70triamcinolone acetonide .......................44, 59, 66triamterene-hydrochlorothiazid .................. 19, 41TRIANEX .........................................................66triazolam .......................................................... 27TRIBENZOR ..............................................19, 41TRICARE ...................................................15, 70TRI-CHLOR .....................................................66TRICITRATES .................................................41TRICON ...........................................................15TRICOR ...........................................................19TRIDERM ........................................................ 66TRIDESILON ...................................................66trientine ............................................................46TRI-ESTARYLLA ............................................ 53trifluoperazine .................................................. 27trifluridine ......................................................... 44TRIGELS-F FORTE .................................. 15, 70TRIGLIDE ........................................................19trihexyphenidyl ...........................................12, 27TRIKLO ........................................................... 19TRI-LEGEST FE ..............................................53TRILEPTAL .....................................................27TRI-LINYAH .................................................... 53TRILIPIX ..........................................................19TRI-LO-ESTARYLLA ......................................53TRI-LO-MARZIA ............................................. 53TRI-LO-MILI .................................................... 53TRI-LO-SPRINTEC ......................................... 53TRILYTE WITH FLAVOR PACKETS ............. 46trimethobenzamide .......................................... 46trimethoprim .......................................................5TRI-MILI .......................................................... 53trimipramine .....................................................27TRIMPEX ...........................................................5TRINATAL RX 1 ..................................15, 41, 70TRINATE ............................................. 15, 41, 70

87

TRINTELLIX ....................................................27TRIPHROCAPS .............................................. 70TRIPLE DYE ................................................... 66TRIPLE VITAMIN WITH FLUORIDE ........ 57, 70TRI-PREVIFEM (28) ........................................53TRIPTODUR ................................................8, 53TRI-SPRINTEC (28) ........................................ 53TRISTART DHA ........................................ 15, 70TRIUMEQ .......................................................... 5TRIVEEN-DUO DHA ........................... 15, 41, 70TRIVEEN-ONE .................................... 15, 41, 70TRIVEEN-PRX RNF ...................... 15, 41, 46, 70TRI-VI-FLOR ............................................. 57, 70TRIVISC .......................................................... 36TRI-VITAMIN WITH FLUORIDE ............... 57, 70TRI-VITE WITH FLUORIDE ...................... 57, 70TRIVORA (28) ................................................. 53TRI-VYLIBRA ..................................................53TRI-VYLIBRA LO ............................................53TRIXYLITRAL ................................................. 27TRIZIVIR ............................................................5TROGARZO ...................................................... 5TROKENDI XR ................................................27tropicamide ...................................................... 44trospium ...........................................................67TRUE COMFORT INSULIN SYRINGE ........... 36TRUE COMFORT LANCET ............................ 36TRUE COMFORT PEN NEEDLE ....................36TRUE METRIX GLUCOSE TEST STRIP ........39TRUE METRIX PRO TEST STRIP ..................39TRUEPLUS INSULIN ......................................36TRUEPLUS LANCETS ................................... 36TRUEPLUS PEN NEEDLE ............................. 36TRUETEST TEST STRIPS ............................. 39TRUETRACK TEST ........................................ 39TRULANCE .....................................................46TRULICITY ......................................................53TRUMENBA ...................................................... 9TRUSOPT ....................................................... 44TRUST NATAL DHA .......................................70TRUVADA ......................................................... 5TUBERCULIN SYRINGE ................................ 36tuberculin-allergy syringes ...............................36TUDORZA PRESSAIR ..............................12, 59TULANA ..........................................................53TUSNEL C ...........................................12, 27, 59TUSSICAPS .......................................... 1, 27, 59TWINRIX (PF) ................................................... 9TWIST LANCETS ........................................... 36TWYNSTA .......................................................19TYBOST .......................................................... 57TYDEMY ..........................................................53TYKERB ............................................................8TYLENOL-CODEINE #3 ................................. 27TYLENOL-CODEINE #4 ................................. 27TYMLOS ....................................................53, 57TYPHIM VI .........................................................9TYSABRI .........................................................57TYVASO ....................................................19, 59TYVASO INSTITUTIONAL START KIT ....19, 59TYVASO REFILL KIT ............................... 19, 59TYVASO STARTER KIT ........................... 19, 59TYZINE ............................................................44UCERIS ........................................................... 53UDENYCA .......................................................15ULESFIA ......................................................... 66ULORIC ...........................................................57ULTICARE ...................................................... 36ULTICARE INSULIN SYR HALF UNIT ...........36ULTICARE INSULIN SYRINGE ......................36ULTICARE PEN NEEDLE .............................. 36ULTICARE SAFETY SYRINGE ...................... 36ULTILET ALCOHOL SWAB ........................... 66ULTILET BASIC LANCETS ............................36ULTILET CLASSIC LANCETS ....................... 36ULTILET INSULIN SYRINGE ......................... 36ULTILET LANCETS ........................................36ULTILET PEN NEEDLE ..................................36ULTIMA TEST STRIPS ...................................39

ULTOMIRIS .....................................................57ULTRA COMFORT INSULIN SYRINGE .........36ULTRA FINE LANCETS ................................. 36ULTRA FLO PEN NEEDLE ............................ 36ULTRA THIN II LANCETS .............................. 36ULTRA THIN LANCETS ................................. 36ULTRA THIN PLUS LANCETS ...................... 36ULTRA TLC LANCETS .................................. 36ULTRACARE INSULIN SYRINGE ..................36ULTRA-CARE LANCETS ............................... 36ULTRACARE PEN NEEDLE .......................... 36ULTRACET ..................................................... 27ULTRALANCE LANCETS .............................. 36ULTRAM ......................................................... 27ULTRAM ER ................................................... 27ULTRASAL-ER ............................................... 66ULTRA-THIN II (SHORT) INS SYR ................ 36ULTRA-THIN II (SHORT) PEN NDL ............... 36ULTRA-THIN II INS PEN NEEDLES .............. 36ULTRA-THIN II INSULIN SYRINGE ............... 36ULTRA-THIN II LANCETS ..............................36ULTRATRAK .................................................. 39ULTRATRAK HIGH-LOW CONTROL ............ 36ULTRATRAK NORMAL CONTROL ...............36ULTRATRAK ULTIMATE ............................... 39ULTRAVATE ...................................................66ULTRAVATE X ............................................... 66UMECTA ......................................................... 66UNIFINE PENTIPS ..........................................37UNIFINE PENTIPS PLUS ............................... 37UNILET COMFORTOUCH LANCET .............. 37UNILET EXCELITE II LANCET ...................... 37UNILET EXCELITE LANCET ......................... 37UNILET GP LANCET ......................................37UNILET LANCET ............................................ 37UNILET LANCETS ..........................................37UNILET SUPER THIN LANCETS ...................37UNISTIK 3 COMFORT LANCET .................... 37UNISTIK 3 EXTRA LANCET .......................... 37UNISTIK 3 GENTLE ........................................37UNISTIK 3 LANCETS ..................................... 37UNISTIK 3 NORMAL LANCET .......................37UNISTIK CZT LANCET ...................................37UNISTIK PRO LANCET ..................................37UNISTIK SAFETY ........................................... 37UNISTIK TOUCH LANCETS .......................... 37UNISTRIP HIGH CONTROL ........................... 37UNISTRIP LOW CONTROL ............................37UNISTRIP1 TEST STRIP ................................ 39UNITHROID .....................................................53UNITUXIN ..........................................................8UNIVERSAL 1 LANCETS ...............................37UPTRAVI ...................................................19, 59UR N-C .............................................................. 5URAMAXIN ..................................................... 66URAMAXIN GT ............................................... 66urea ........................................................... 66, 67UREA NAIL STICK ......................................... 66URECHOLINE .................................................12URE-K ............................................................. 67URELLE ............................................................ 5URETRON D-S ..................................................5UREVAZ ..........................................................67URIBEL ............................................................. 5URIMAR-T .........................................................5URIN DS ............................................................5UROCIT-K 10 .................................................. 41UROCIT-K 15 .................................................. 41UROCIT-K 5 .................................................... 41UROGESIC-BLUE ............................................ 5URO-MP ............................................................ 5UROQID-ACID NO.2 .........................................5UROXATRAL .................................................. 12URSO 250 ....................................................... 46URSO FORTE ................................................. 46ursodiol ............................................................ 46URYL .................................................................5USTELL .............................................................5UTIBRON NEOHALER ............................. 12, 59

UTIRA-C ............................................................5UTOPIC ........................................................... 67UVADEX ..........................................................67VAGIFEM ........................................................ 53VAGINAL CONTRACEPTIVE FILM ............... 28VAGINAL CONTRACEPTIVE FOAM ............. 28valacyclovir ........................................................ 5VALCHLOR .................................................8, 67VALCYTE ..........................................................5valganciclovir ..................................................... 5VALIUM ...........................................................27valproic acid .....................................................28valproic acid (as sodium salt) .......................... 28valsartan .......................................................... 19valsartan-hydrochlorothiazide ....................19, 41VALTREX ..........................................................5VANATOL LQ ................................................. 28VANATOL S ....................................................28VANCOCIN ....................................................... 5vancomycin ........................................................5VANDAZOLE .................................................. 67VANISHPOINT SYRINGE ...............................37VANOS ............................................................67VANOXIDE-HC ............................................... 67VANTAS ......................................................8, 53VAQTA (PF) ...................................................... 9vardenafil ......................................................... 19VARITHENA ....................................................19VARITHENA ADMINISTRATION PACK ........ 37VARIVAX (PF) ...................................................9VARUBI ...........................................................46VASCEPA ....................................................... 19VASELINE WHITE PETROLEUM .................. 67VASERETIC .............................................. 19, 41VASOTEC ....................................................... 19VAXCHORA ACTIVE COMPONENT ............... 9VAXCHORA VACCINE .....................................9V-C FORTE ..................................................... 70VCF CONTRACEPTIVE FILM ........................ 28VCF CONTRACEPTIVE GEL ......................... 28VECAMYL ....................................................... 19VECTIBIX .......................................................... 8VECTICAL .......................................................67VELCADE ......................................................... 8VELETRI ................................................... 19, 59VELIVET TRIPHASIC REGIMEN (28) ............ 53VELPHORO .................................................... 41VELTASSA ..................................................... 41VELTIN ............................................................67VEMLIDY ...........................................................5VENA-BAL DHA ................................. 15, 41, 70VENCLEXTA .....................................................8VENCLEXTA STARTING PACK ...................... 8venlafaxine ...................................................... 28VENTAVIS .................................................19, 59VENTOLIN HFA ........................................ 12, 59verapamil ......................................................... 19VERASENS CONTROL SOLN-LEVEL 1 ....... 37VERASENS TEST STRIP ............................... 39VERDESO ....................................................... 67VERDROCET .................................................. 28VEREGEN ....................................................... 67VERELAN ....................................................... 19VERELAN PM ................................................. 19VERIFINE PEN NEEDLE ................................ 37VERIPRED 20 ................................................. 53VERSACLOZ .................................................. 28VERZENIO ........................................................ 8VESICARE ...................................................... 67VEXASYN ....................................................... 37VFEND .............................................................. 5VIAGRA ...........................................................19VIBERZI .......................................................... 46VIBRAMYCIN ....................................................5VIC-FORTE ..................................................... 70VICODIN ..........................................................28VICODIN ES ....................................................28VICODIN HP ....................................................28VICTOZA 2-PAK ............................................. 53

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VICTOZA 3-PAK ............................................. 53VIDAZA ............................................................. 8VIDEX 2 GRAM PEDIATRIC ............................ 5VIDEX EC ..........................................................5VIEKIRA PAK ................................................... 5VIENVA ........................................................... 53vigabatrin ......................................................... 28VIGADRONE ...................................................28VIGAMOX ........................................................44VIIBRYD .......................................................... 28VIMIZIM ........................................................... 41VIMOVO .................................................... 28, 46VIMPAT ........................................................... 28VINACAL .......................................15, 41, 46, 70VINATE CARE .......................................... 15, 70VINATE DHA RF .......................................15, 70VINATE GT ............................................... 15, 70VINATE II ........................................................ 70VINATE M ................................................. 15, 70VINATE ONE .......................................15, 41, 70VINATE PN CARE .......................................... 70VINATE ULTRA ............................ 15, 41, 46, 70VIOKACE ........................................................ 46VIORELE (28) ................................................. 53VIRACEPT ........................................................ 5VIRAMUNE ....................................................... 5VIRAMUNE XR ................................................. 5VIRASAL .........................................................67VIREAD ............................................................. 5VIRT-ADVANCE ................................. 15, 41, 70VIRT-C DHA ..............................................15, 70VIRT-GARD .....................................................70VIRT-NATE DHA .......................................15, 70VIRT-PHOS 250 NEUTRAL ............................41VIRT-PN DHA ........................................... 15, 70VIRT-PN PLUS ....................................15, 41, 70VIRTPREX .....................................15, 41, 46, 70VIRTRATE-2 ................................................... 41VIRTRATE-K ...................................................41VIRT-SELECT ............................... 15, 41, 46, 70VIRTUSSIN AC ......................................... 28, 59VIRTUSSIN DAC .................................12, 28, 59VIRT-VITE ....................................................... 70VIRT-VITE GT ........................................... 15, 70VISCO-3 .......................................................... 37VISTARIL .................................................... 1, 28VISTOGARD ................................................... 57VISUDYNE ...................................................... 44VIT 3 .......................................................... 19, 70VITAFOL FE+ (WITH DOCUSATE) ..........15, 70VITAFOL GUMMIES ........................... 15, 41, 70VITAFOL NANO ........................................15, 70VITAFOL ULTRA ...................................... 15, 70VITAFOL-OB .......................................15, 41, 70VITAFOL-OB+DHA .............................15, 41, 70VITAFOL-ONE .......................................... 15, 70VITAMED MD ONE RX ............................. 15, 70VITAMEDMD REDICHEW RX ........................ 70VITAMIN D2 .................................................... 70VITAMINS A,C,D AND FLUORIDE .......... 57, 70VITAPEARL .............................................. 15, 70VITATRUE .................................................15, 70VITRAKVI ..........................................................8VIVAGUARD INO TEST STRIP ......................39VIVAGUARD LANCET ................................... 37VIVELLE-DOT .................................................53VIVITROL .................................................. 28, 57VIVLODEX ...................................................... 28VIVOTIF .............................................................9VIZIMPRO ......................................................... 8VOGELXO .......................................................53VOLTAREN ...............................................28, 67VOLTAREN-XR ...............................................28VONVENDI ......................................................15voriconazole ...................................................... 5VORTEX VHC FROG MASK-CHILD .............. 37VORTEX VHC LADYBUG MASK-TODDLR ...37VOSEVI ............................................................. 5VOTRIENT ........................................................ 8

VP-CH PLUS .......................................15, 46, 70VP-CH-PNV ...............................................15, 70VP-PNV-DHA ............................................ 15, 70VPRIV ..............................................................41VP-VITE RX .....................................................70VRAYLAR ....................................................... 28VUSION ...........................................................67VYFEMLA (28) ................................................ 53VYLIBRA .........................................................53VYNDAQEL .....................................................19VYTONE ..........................................................67VYTORIN 10-10 .............................................. 19VYTORIN 10-20 .............................................. 19VYTORIN 10-40 .............................................. 19VYTORIN 10-80 .............................................. 19VYVANSE ....................................................... 28VYXEOS ............................................................8VYZULTA ........................................................ 44warfarin ............................................................15WAVESENSE CONTROL SOLUTION ........... 37WAVESENSE JAZZ ........................................39WAVESENSE PRESTO ..................................39WEBCOL .........................................................67WELCHOL ................................................ 19, 53WELLBUTRIN SR ...........................................28WELLBUTRIN XL ........................................... 28WERA (28) ...................................................... 53WESTHROID ...................................................53WHYTEDERM SURGIPAK ............................. 67WHYTEDERM TDPAK ....................................67WHYTEDERM TRILASIL PAK ....................... 67WIDE-SEAL DIAPHRAGM 60 ........................ 28WIDE-SEAL DIAPHRAGM 65 ........................ 28WIDE-SEAL DIAPHRAGM 70 ........................ 28WIDE-SEAL DIAPHRAGM 75 ........................ 28WIDE-SEAL DIAPHRAGM 80 ........................ 28WIDE-SEAL DIAPHRAGM 85 ........................ 28WIDE-SEAL DIAPHRAGM 90 ........................ 28WIDE-SEAL DIAPHRAGM 95 ........................ 28WILATE ...........................................................15WINRHO SDF ................................................... 9WIXELA INHUB .................................. 12, 53, 59WP THYROID ..................................................53WPR PLUS ................................................28, 67WYMZYA FE ................................................... 53XADAGO .........................................................28XALATAN ....................................................... 44XALKORI .......................................................... 8XANAX ............................................................ 28XANAX XR ...................................................... 28XARELTO ....................................................... 15XATMEP ......................................................8, 57XCLAIR ..................................................... 37, 67XELITRAL ................................................. 28, 67XELJANZ ........................................................ 57XELJANZ XR .................................................. 57XELODA ............................................................8XELPROS ....................................................... 44XENAFLAMM ............................................28, 67XENAZINE ...................................................... 28XEOMIN .................................................... 12, 57XEPI ................................................................ 67XERESE .......................................................... 67XERMELO .......................................................46XGEVA ............................................................ 57XHANCE ................................................... 44, 59XIAFLEX ......................................................... 41XIFAXAN ...........................................................5XIGDUO XR .................................................... 53XIIDRA ............................................................ 44XILAPAK .........................................................67XIMINO ........................................................5, 67XOFIGO ...........................................................57XOFLUZA ..........................................................5XOLAIR ........................................................... 59XOLEGEL ....................................................... 67XOPENEX ................................................. 12, 59XOPENEX CONCENTRATE .....................12, 59XOPENEX HFA .........................................12, 59

XOSPATA ......................................................... 8XRYLIDERM ................................................... 67XRYLIX (DICLOFENAC-KINES TAPE) ....28, 67XTAMPZA ER ................................................. 28XTANDI ............................................................. 8XULANE ..........................................................53XULTOPHY 100/3.6 ........................................ 53XURIDEN ........................................................ 57XYLOCAINE ....................................................53XYLON 10 ....................................................... 28XYNTHA ..........................................................15XYNTHA SOLOFUSE ..................................... 15XYOSTED ....................................................... 53XYREM ............................................................28XYZAL .........................................................1, 60YASMIN (28) ................................................... 53YAZ (28) .......................................................... 53YERVOY ............................................................8YESCARTA .................................................8, 19YF-VAX (PF) ..................................................... 9YONDELIS ........................................................ 8YONSA ..............................................................8YOSPRALA .........................................15, 28, 46YUPELRI ......................................................... 12YUTIQ ..............................................................44YUVAFEM ....................................................... 53zafirlukast ........................................................ 60zaleplon ........................................................... 28ZALTRAP ..........................................................8ZANAFLEX ..................................................... 12ZANTAC ..........................................................46ZARAH ............................................................ 53ZARONTIN ...................................................... 28ZARXIO ........................................................... 15ZATEAN-PN DHA ..................................... 15, 70ZATEAN-PN PLUS ............................. 15, 41, 70ZAVARA ..........................................................70ZAVESCA ....................................................... 57ZEBUTAL ........................................................28ZEGERID .........................................................46ZEJULA .............................................................8ZELAPAR ........................................................28ZELBORAF ....................................................... 8ZEMAIRA ........................................................ 60ZEMBRACE SYMTOUCH ...............................28ZEMPLAR ....................................................... 70ZENATANE ..................................................... 67ZENCHENT (28) ..............................................53ZENPEP .......................................................... 46ZENZEDI ......................................................... 28ZEPATIER .........................................................5ZERIT ................................................................ 5ZESTORETIC ............................................19, 41ZESTRIL ..........................................................19ZETIA .............................................................. 19ZETONNA ................................................. 44, 60ZEYOCAINE ....................................................67ZIAC .................................................... 12, 19, 41ZIAGEN ............................................................. 5ZIANA ..............................................................67zidovudine ......................................................... 5zileuton ............................................................ 60ZILRETTA ....................................................... 53ZINGIBER ................................................. 41, 70ZIOPTAN (PF) .................................................44ziprasidone hcl .................................................28ZIPSOR ........................................................... 28ZIRGAN ...........................................................44ZITHRANOL ....................................................67ZITHROMAX ..................................................... 5ZITHROMAX TRI-PAK ......................................5ZITHROMAX Z-PAK ......................................... 5ZOCOR ............................................................19ZOFRAN ..........................................................46ZOHYDRO ER .................................................28ZOLADEX ................................................... 8, 53ZOLGENSMA ..................................................19ZOLINZA ........................................................... 8zolmitriptan ...................................................... 28

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ZOLOFT .......................................................... 28zolpidem .......................................................... 28ZOLPIMIST ..................................................... 28ZOMACTON ....................................................53ZOMIG .............................................................28ZOMIG ZMT .................................................... 28ZONALON .......................................................67ZONEGRAN .................................................... 28zonisamide ...................................................... 28ZONTIVITY ......................................................15ZORBTIVE ...................................................... 53ZORTRESS ..................................................... 57ZORVOLEX .....................................................28ZOSTAVAX (PF) ............................................... 9ZOVIA 1/35E (28) ............................................53ZOVIRAX .....................................................5, 67ZTLIDO ............................................................67ZUBSOLV ....................................................... 28ZUMANDIMINE (28) ........................................53ZUPLENZ ........................................................ 46ZYBAN ............................................................ 28ZYCLARA ....................................................... 67ZYDELIG ........................................................... 8ZYFLO .............................................................60ZYKADIA ...........................................................8ZYLET ............................................................. 44ZYLOPRIM ...................................................... 57ZYMAXID ........................................................ 44ZYPITAMAG ................................................... 19ZYPRAM ......................................................... 67ZYPREXA ........................................................28ZYPREXA RELPREVV ................................... 28ZYPREXA ZYDIS ............................................ 28ZYTIGA ............................................................. 8ZYVOX .............................................................. 5

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drug tier notes - premera blue cross essentials formulary (e4).pdf2 = preferred brand drugs. 3 =...

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