hometownrx formulary - april 2020 · for plan specific information, call (844) 373-0970, or visit...
TRANSCRIPT
For plan specific information, call (844) 373-0970, or visit us at: www.hometownhealth.com 5
HometownRx Formulary - April 2020
This formulary is intended to assist you to better understand your pharmacy coverage.
Knowing your pharmacy benefit and effective use of the formulary (drug list) will help you be engaged in
your treatment options and health. This document will help you get the answers to these questions:
What medications are covered?
What are my lower cost medication options?
How is this formulary developed to ensure I have the best products?
What can I do if the medication I need is not covered?
Why do I need to obtain an approval (prior authorization) to get what my provider ordered?
What is a Formulary?
The formulary is a list of preferred brand and generic drug products for HometownRx members. The drug
list includes drugs used to treat common diseases or health problems. A team of doctors and pharmacists
(Pharmacy and Therapeutics (P&T) Committee) meet to decide which drugs should be on the drug list. The
P&T Committee reviews new and existing drugs and chooses drugs that work best and are proven to be
safe. Consequently, the formulary is updated regularly and subject to change without notice. The
formulary is a good source for you and your provider to determine the best drug for your condition, at the
lowest out-of-pocket expense to you. Ultimately, specific drug product selection for an individual member
is dependent on your prescriber.
How to Search For Drugs
This document provides an alphabetical listing of medications covered on the HometownRx formulary.
Inclusion on this list does not guarantee coverage and individual plans may vary. Agents listed are
primarily oral, self-injected, inhaled or topical pharmaceutical formulations. Drugs requiring provider
administration are generally covered under the medical benefit and may not appear on this list.
PLEASE NOTE:
Certain specialty medications may only be available through your plan’s preferred specialty
pharmacy.
Some medications may be subject to the Affordable Care Act (ACA) provisions or your plan's
preventive benefit and covered by your plan at 100%.
For plan specific information, call (844) 373-0970, or visit us at: www.hometownhealth.com 6
Individual plans may vary.
For questions regarding plan-specific restrictions, coverage criteria, and cost sharing information,
please log into your member portal and use the “What’s my Cost” feature or call the phone
number printed on your member ID card.
Each medication may have specific coverage requirements not reflected in this document. The key
below explains common coverage indicators present on this file. Drugs shown in lower-case are
generically available and typically covered at the lowest member cost share.
T1 Tier 1 medication, typically generics or drugs available at lowest member cost share.
T2 Tier 2 medication, typically preferred or formulary brand drugs.
T3 Tier 3 medication, typically non-preferred or non-formulary drugs.
T4 Tier 4 medication, typically specialty medications.
PA Drug requires prior authorization to confirm medical necessity prior to coverage.
QL Quantity limits may apply.
BP Brand Penalty: Member may be responsible for the cost difference between brand and generic
SP Specialty Medication: This drug may only be available at the plan's preferred specialty
pharmacy.
ACA Covered by the Plan at 100%.
Benefit Coverage and Limitations
Certain drug products have been excluded from this formulary. If you choose to use an excluded drug
product HometownRx may not reimburse for these drug products and may require you to pay 100% of
the cost. Furthermore, if you choose to use a drug that is not on formulary or excluded, the cost, does not
accumulate towards meeting your annual deductible or out-of-pocket maximums.
Certain classes of medication are not covered under your pharmacy benefit. These medication classes
may include but are not limited to: non-FDA approved drugs, over the counter (OTC) medications, drugs to
treat impotency or sexual disorders, fertility agents, weight loss drugs, hematinics, reusable needles,
disposable syringes, ostomy supplies, infant formulas, dietary supplements, hypopigmentation agents,
diagnostic agents, cosmetic medications, and compounded medications.
An ancillary charge (as know as a Brand Penalty [BP]) may apply to brand medications when an equivalent
generic is available. If a member or provider chooses a brand medication over the generic medication, the
member may be responsible for their copay/coinsurance plus the cost difference between the brand
medication and the generic medication (ancillary charge). Ancillary charges do not accumulate towards
meeting your annual deductible or out-of-pocket maximums.
The formulary applies only to outpatient drugs provided to members, and does not apply to medications
used in inpatient settings.
For plan specific information, call (844) 373-0970, or visit us at: www.hometownhealth.com 7
What if my drug is not listed on the formulary?
To avoid delays in access to your treatment, your provider may check the formulary to prescribe a
covered drug that is best for you. The HometownRx formulary offers a wide coverage of available drugs.
However, in instances where the drug is rejected due to “Drug Not Covered”, you may either:
Ask your pharmacy to contact your provider to change the prescription to a covered formulary
alternative.
If your provider believes the non-covered product is “medically necessary” for your condition, your
provider may request an “Exception” for coverage. See the next section for information on how to
request an exception.
How do I request an exception?
Members or providers can ask HometownRx to make an exception to our coverage rules. Exceptions are
reviewed for medical necessity, your inability to use covered drugs (e.g., side effects, contraindications,
allergies), current covered products may not be effective for you, and new drug entrants that have not yet
been reviewed and placed on the formulary. Reviews will consider superiority of the request over current
covered options.
Exception requests can be submitted by making the request to HometownRx:
You or your provider can call us at 1-844-373-0970, or submit a written request for prior
authorization review via fax at 1-866-521-9916.
Why do some drugs require prior authorization?
Drug coverage review is used to encourage appropriate and cost-effective use of prescription drugs by
allowing coverage only when certain conditions are met. Some reasons for pre-authorization may include:
Compliance with dosing guidelines
Avoid duplicate therapies
Help health care providers check medically accepted criteria that helps ensure high efficacy and
low side effects
HometownRx implements prior authorization criteria based on the Food and Drug Administration (FDA)
approved labelling, evidence-based national best-practice guidelines, and peer-reviewed journals.
For plan specific information, call (844) 373-0970, or visit us at: www.hometownhealth.com 8
What can I expect to pay?
What you expect to pay depends on the type of drugs your provider ordered for you. Each drug is placed
in a tier level; different tiers represent the different levels of payment for covered medications. Tier
structures are developed to encourage you to use quality products at the most cost-effective option to
you. The lower cost option does not represent a lower quality product. Rather it is the best cost option
considering covered products within that treatment category. You can be assured that drugs provided
through your pharmacy benefit has been through rigorous processes to be approved by the FDA.
How can I save on prescriptions?
Here are some other tips to pay less out of pocket for your prescription drugs:
Ask your provider to consider prescribing generic drugs instead of brand-name drugs, and
whether the generic drug is right for you.
Ask your provider to consider prescribing drugs that are on the HometownRx Formulary.
Check to see if your plan includes our mail-order pharmacy service. Depending upon your plan,
mail order may save you money.
What if I have additional questions?
Please contact us:
Phone: 1-844-373-0970
If you have impaired hearing, dial TTY # 711
E-mail: [email protected]
Web site: www.hometownhealth.com
HTH 4 Tier w/LVL April 2020 Formulary - April 2020
Aabacavir solution [T1]
abacavir sulfate tablet [T1]
abacavir tablet [T1]
abacavir-lamivudine tablet [T1]
abacavir-lamivudine-zidovudine tablet
[T1]
ABILIFY MYCITE TABLET [T3] [PA]
ABIRATERONE TABLET [T4] [PA][SP]
ABSORICA CAPSULE [T3]
acamprosate calcium dr tablet
[T1]
ACANYA GEL [T3] [BP]
acarbose tablet [T1]
ACCOLATE TABLET [T3] [BP]
ACCUPRIL TABLET [T3] [BP]
ACCURETIC TABLET [T3] [BP]
ACD FORMULA A SOLUTION [T2]
ACD SOLUTION [T2]
acebutolol capsule [T1]
acetaminophen w/codeine tablet
[T1]
acetaminophen/codeine solution
[T1]
acetaminophen/codeine tablet
[T1]
acetazolamide er capsule [T1]
acetazolamide tablet [T1]
acetic acid 0.25% solution [T1]
acetic acid solution [T1]
acetic acid/hydrocortisone solution
[T1]
acetylcysteine solution [T1]
acitretin capsule [T1]
ACTEMRA ACTPEN INJECTION
[T4] [PA][SP]
ACTEMRA INJECTION [T4] [PA][SP]
ACTHIB SOLUTION [T2] [ACA]
ACTICLATE TABLET [T3] [BP]
ACTICOAT [T3]
ACTICOAT 7 [T3]
ACTICOAT FLEX 3 [T3]
ACTICOAT FLEX 7 [T3]
ACTICOAT MOISTURE CONTROL PADS
[T3]
ACTICOAT SITE [T3]
ACTIGALL CAPSULE [T3] [BP]
ACTIMMUNE SOLUTION [T4] [PA][SP]
ACTIQ LOLLIPOP [T3] [QL][BP]
ACTIVELLA TABLET [T3] [BP]
ACTONEL TABLET [T3] [QL][BP]
ACTOPLUS MET TABLET [T3] [BP]
ACTOS TABLET [T3] [BP]
ACULAR LS SOLUTION [T3] [BP]
ACULAR SOLUTION [T3] [BP]
acyclovir capsule [T1]
acyclovir ointment [T1] [QL]
acyclovir suspension [T1]
acyclovir tablet [T1]
ACZONE GEL [T3] [BP]
ADACEL SUSPENSION [T2] [ACA]
adapalene cream [T1]
adapalene gel [T1]
adapalene pads [T1]
adapalene pump gel [T1]
adapalene solution [T1]
adapalene-benzoyl peroxide gel
[T1]
ADASUVE AEROSOL [T3] [PA]
adc/fluoride solution [T1]
ADDERALL XR 24 HOUR CAP [T3] [QL][BP]
ADEFOVIR DIPIVOXIL TABLET [T4] [PA][SP]
ADEMPAS TABLET [T4] [PA][SP]
adrenalin solution [T1] [QL]
adult aspirin regimen tablet [T1] [ACA]
ADVAIR DISKUS AEROSOL [T3] [QL][BP]
ADVAIR HFA AEROSOL [T2] [QL]
AEMCOLO TABLET [T3]
AFINITOR DISPERZ TABLET [T4] [PA][SP]
AFINITOR TABLET [T4] [PA][SP][BP]
afirmelle tablet [T1] [ACA]
AFLURIA QUAD 2019-20 (3YR UP) INJECTION
[T2] [ACA]
AFLURIA QUAD 2019-20 (6-35MO) INJECTION
[T2] [ACA]
AFLURIA QUAD 2019-2020 SUSPENSION
[T2] [ACA]
AFREZZA POWDER [T3]
aftera tablet [T1] [ACA]
AGGRENOX CAPSULE [T3] [BP]
AGRYLIN CAPSULE [T3] [BP]
AIMOVIG INJECTION [T2] [PA]
AIMSCO LUBRICATED MISC [T2] [ACA]
AIRDUO RESPICLICK 113/14 AEROSOL
[T3] [QL]
AIRDUO RESPICLICK 232/14 AEROSOL
[T3] [QL]
AIRDUO RESPICLICK 55/14 AEROSOL
[T3] [QL]
AJOVY INJECTION [T2] [PA]
AKLIEF CREAM [T3] [PA]
AKTEN GEL [T3]
ALA SCALP LOTION [T3]
ala-cort cream [T1]
albendazole tablet [T1]
ALBENZA TABLET [T3] [BP]
albuterol sulfate er 12 hr tab [T1]
albuterol sulfate hfa aerosol [T1] [QL]
albuterol sulfate nebulized [T1]
albuterol sulfate syrup [T1]
albuterol sulfate tablet [T1]
alclometasone dipropionate cream
[T1]
alclometasone dipropionate ointment
[T1]
ALDACTAZIDE TABLET [T3] [BP]
ALDACTONE TABLET [T3] [BP]
ALDARA CREAM [T3] [BP]
ALECENSA CAPSULE [T4] [PA][SP]
alendronate sodium solution [T1] [QL]
alendronate sodium tablet [T1] [QL]
alfuzosin er 24 hr tab [T1]
ALINIA SUSPENSION [T2]
ALINIA TABLET [T2]
aliskiren tablet [T1]
ALKERAN TABLET [T4] [PA][SP][BP]
allopurinol tablet [T1]
almotriptan malate tablet [T1] [QL]
5www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
almotriptan tablet [T1] [QL]
ALOMIDE SOLUTION [T3]
alophen tablet [T1] [ACA]
ALORA PATCH [T3] [QL]
alosetron tablet [T1]
ALPHAGAN P SOLUTION [T2] [BP]
alprazolam er 24 hr tab [T1]
alprazolam intensol [T1]
alprazolam odt tablet [T1]
alprazolam tablet [T1]
alprazolam xr 24 hr tab [T1]
ALREX SUSPENSION [T2]
ALTACE CAPSULE [T3] [BP]
altafluor benox solution [T1]
altavera tablet [T1] [ACA]
ALUNBRIG TABLET [T4] [PA][SP]
alyacen 1/35 tablet [T1] [ACA]
alyacen 7/7/7 tablet [T1] [ACA]
alyq tablet [T1] [PA]
ALZAIR POWDER [T3]
amabelz tablet [T1]
amantadine capsule [T1]
amantadine syrup [T1]
amantadine tablet [T1]
AMARYL TABLET [T3] [BP]
AMBRISENTAN TABLET [T4] [PA][SP]
AMELUZ GEL [T3]
AMERGE TABLET [T3] [QL][BP]
amethia lo tablet [T1] [ACA]
amethia tablet [T1] [ACA]
amethyst tablet [T1] [ACA]
AMICAR SOLUTION [T2] [BP]
AMICAR TABLET [T3] [BP]
amiloride tablet [T1]
amiloride w/hctz tablet [T1]
aminoacetic acid solution [T1]
aminocaproic acid solution [T1]
aminocaproic acid tablet [T1]
amiodarone tablet [T1]
AMITIZA CAPSULE [T3] [QL]
amitriptyline tablet [T1]
amitriptyline/chlordiazepoxide tablet
[T1]
amitriptyline-perphenazine tablet
[T1]
amlodipine besylate tablet [T1]
amlodipine besylate-benazepril capsule
[T1]
amlodipine-atorvastatin tablet
[T1] [QL]
amlodipine-olmesartan tablet
[T1]
amlodipine-valsartan tablet [T1]
amlodipine-valsartan-hctz tablet
[T1]
amnesteem capsule [T1]
amoxapine tablet [T1]
amoxicillin capsule [T1]
amoxicillin chew tab [T1]
amoxicillin suspension [T1]
amoxicillin tablet [T1]
amoxicillin-clavulanate pot er 12 hr tab
[T1]
amoxicillin-clavulanate potass chew tab
[T1]
amoxicillin-clavulanate potass suspension
[T1]
amoxicillin-clavulanate potass tablet
[T1]
ampicillin capsule [T1]
ANADROL-50 TABLET [T3]
ANAFRANIL CAPSULE [T3] [BP]
anagrelide capsule [T1]
anaspaz tablet [T1]
anastrozole tablet [T1]
ANCOBON CAPSULE [T3] [BP]
ANDROGEL GEL [T3] [QL]
ANDROGEL PUMP GEL [T3] [QL][BP]
ANGELIQ TABLET [T3]
ANNOVERA [T3] [ACA]
ANORO ELLIPTA AEROSOL [T2] [QL]
ANTABUSE TABLET [T3] [BP]
ANZEMET TABLET [T3] [QL]
apap-caffeine-dihydrocodeine capsule
[T1]
APLIGRAF [T3]
APOKYN INJECTION [T4] [PA][SP]
apraclonidine solution [T1]
aprepitant capsule [T1] [QL]
apri tablet [T1] [ACA]
APRISO 24 HOUR CAP [T2] [BP]
APTIOM TABLET [T3]
APTIVUS CAPSULE [T2]
APTIVUS SOLUTION [T2]
ARAKODA TABLET [T3]
aranelle tablet [T1] [ACA]
ARAVA TABLET [T3] [BP]
ARCALYST SOLUTION [T4] [PA][SP]
ARCAPTA NEOHALER CAPSULE
[T3] [QL]
ARICEPT TABLET [T3] [BP]
ARIDOL KIT [T3]
ARIKAYCE SUSPENSION [T4] [PA][SP]
aripiprazole odt tablet [T1]
aripiprazole solution [T1]
aripiprazole tablet [T1]
ARIXTRA SOLUTION [T3] [BP]
armodafinil tablet [T1] [QL]
ARMOUR THYROID TABLET [T2]
ARNUITY ELLIPTA AEROSOL [T2] [QL]
AROMASIN TABLET [T3] [BP]
ARTHROTEC 50 TABLET [T3] [BP]
ARTHROTEC 75 TABLET [T3] [BP]
ARTISS SOLUTION [T3]
asa-butalb-caff-cod capsule [T1]
ascomp/codeine capsule [T1]
ashlyna tablet [T1] [ACA]
ASMANEX AEROSOL [T2] [QL]
ASMANEX HFA AEROSOL [T2] [QL]
aspirin 81 low dose chew tab [T1] [ACA]
aspirin 81 tablet [T1] [ACA]
aspirin adult low dose tablet [T1] [ACA]
aspirin adult tablet [T1] [ACA]
aspirin chew tab [T1] [ACA]
aspirin childrens chew tab [T1] [ACA]
aspirin e.c. tablet [T1] [ACA]
aspirin ec low dose tablet [T1] [ACA]
aspirin ec tablet [T1] [ACA]
aspirin low dose chew tab [T1] [ACA]
aspirin low dose tablet [T1] [ACA]
aspirin low strength chew tab
[T1] [ACA]
aspirin regular strength tablet
[T1] [ACA]
aspirin tablet [T1] [ACA]
aspirin/dipyridamole capsule [T1]
aspirin/dipyridamole er capsule
[T1]
ATABEX EC TABLET [T3]
atazanavir capsule [T1]
atazanavir sulfate capsule [T1]
ATELVIA TABLET [T3] [QL][BP]
atenolol tablet [T1]
6www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
atenolol/chlorthalidone tablet
[T1]
ATIVAN TABLET [T3] [BP]
atomoxetine capsule [T1]
atorvastatin calcium tablet [T1] [ACA][QL]
atovaquone suspension [T1]
atovaquone/proguanil tablet [T1]
atropine sulfate solution [T1]
ATROVENT HFA AEROSOL [T3] [QL]
aubra eq tablet [T1] [ACA]
aubra tablet [T1] [ACA]
AUGMENTIN ES-600 SUSPENSION
[T3]
AUGMENTIN SUSPENSION [T2] [BP]
AUGMENTIN TABLET [T3]
aurovela 1.5/30 tablet [T1] [ACA]
aurovela 1/20 tablet [T1] [ACA]
aurovela 24 fe tablet [T1] [ACA]
aurovela fe 1.5/30 tablet [T1] [ACA]
aurovela fe 1/20 tablet [T1] [ACA]
AURYXIA TABLET [T3]
AUSTEDO TABLET [T4] [PA][SP]
AVANDIA TABLET [T3] [QL]
aviane tablet [T1] [ACA]
avidoxy tablet [T1]
avita cream [T1]
avita gel [T1]
AVITENE FLOUR POWDER [T3]
AVITENE PADS [T3]
avo cream emulsion [T1]
AVONEX INJECTION [T4] [PA][SP]
AVONEX PEN INJECTION [T4] [PA][SP]
AYGESTIN TABLET [T3] [BP]
ayuna tablet [T1] [ACA]
AYVAKIT TABLET
AZACITIDINE SUSPENSION [T4] [PA][SP]
AZASITE SOLUTION [T2]
azathioprine tablet [T1]
azelaic acid gel [T1]
azelastine solution [T1] [QL]
AZELEX CREAM [T3]
AZESCO TABLET [T3]
AZILECT TABLET [T3] [BP]
azithromycin packet [T1]
azithromycin suspension [T1]
azithromycin tablet [T1]
AZOPT SUSPENSION [T3]
AZULFIDINE EN-TABS TABLET [T3] [BP]
AZULFIDINE TABLET [T3] [BP]
azurette tablet [T1] [ACA]
Bbacitracin ointment [T1]
bacitracin/polymyxin b ointment
[T1]
baclofen tablet [T1]
BACTRIM DS TABLET [T3] [BP]
BACTRIM TABLET [T3] [BP]
BAL-CARE DHA MISC [T2]
balsalazide disodium capsule [T1]
BALVERSA TABLET [T4] [PA][SP]
balziva tablet [T1] [ACA]
BANZEL SUSPENSION [T2]
BANZEL TABLET [T2]
BAQSIMI ONE PACK POWDER [T2]
BAQSIMI TWO PACK POWDER
[T2]
BARACLUDE SOLUTION [T4] [PA][SP]
BASAGLAR KWIKPEN INJECTION
[T3] [QL]
BAXDELA TABLET [T2] [PA]
bayer aspirin tablet [T1] [ACA]
bayer chewable low dose chew tab
[T1] [ACA]
bayer low dose tablet [T1] [ACA]
BD MAGNI-GUIDE MAGNIFIER MISC
bekyree tablet [T1] [ACA]
BELBUCA FILM [T2] [QL]
BELSOMRA TABLET [T3] [QL]
benazepril tablet [T1]
benazepril-hctz tablet [T1]
BENLYSTA INJECTION [T4] [PA][SP]
BENZACLIN GEL [T3] [BP]
BENZACLIN WITH PUMP GEL [T3] [BP]
BENZAMYCIN GEL [T3] [BP]
BENZEPRO FOAM [T3]
BENZNIDAZOLE TABLET [T2]
benzonatate capsule [T1]
benztropine mesylate tablet [T1]
BEPREVE SOLUTION [T2]
beser lotion [T1]
BESIVANCE SUSPENSION [T3]
betamethasone dipropionate cream
[T1]
betamethasone dipropionate gel
[T1]
betamethasone dipropionate lotion
[T1]
betamethasone dipropionate ointment
[T1]
betamethasone dp augmented ointment
[T1]
betamethasone valerate cream
[T1]
betamethasone valerate lotion
[T1]
betamethasone valerate ointment
[T1]
BETAPACE AF TABLET [T3] [BP]
BETAPACE TABLET [T3] [BP]
BETASERON KIT [T4] [PA][SP]
betaxolol solution [T1]
betaxolol tablet [T1]
bethanechol chloride tablet [T1]
BETHKIS NEBULIZED [T4] [PA][SP]
BETIMOL SOLUTION [T3]
BETOPTIC-S SUSPENSION [T3]
BEVESPI AEROSPHERE AEROSOL
[T2] [QL]
BEVYXXA CAPSULE [T3]
BEXAROTENE CAPSULE [T4] [PA][SP]
BEXSERO INJECTION [T2] [ACA]
BIAFINE EMULSION [T3]
bicalutamide tablet [T1]
BIDIL TABLET [T3]
BIKTARVY TABLET [T2] [QL]
BILTRICIDE TABLET [T3] [BP]
bimatoprost solution [T1]
BIONECT CREAM [T3]
BIONECT FOAM [T3]
BIONECT GEL [T3]
BIOSTEP [T3]
BIOSTEP AG [T3]
bisacodyl ec tablet [T1] [ACA]
bisoprolol fumarate tablet [T1]
bisoprolol fumarate/hctz tablet
[T1]
BLEPH-10 SOLUTION [T3] [BP]
BLEPHAMIDE S.O.P. OINTMENT
[T3]
BLEPHAMIDE SUSPENSION [T3]
blisovi 24 fe tablet [T1] [ACA]
blisovi fe 1.5/30 tablet [T1] [ACA]
blisovi fe 1/20 tablet [T1] [ACA]
7www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
BONIVA TABLET [T3] [QL][BP]
BOOSTRIX SUSPENSION [T2] [ACA]
BOSENTAN TABLET [T4] [PA][SP]
BOSULIF TABLET [T4] [PA][SP]
BRAFTOVI CAPSULE [T4] [PA][SP]
BREO ELLIPTA AEROSOL [T2] [QL]
briellyn tablet [T1] [ACA]
BRILINTA TABLET [T2]
brimonidine tartrate solution [T1]
BRINEURA KIT [T4] [PA][SP]
BRIVIACT SOLUTION [T3]
BRIVIACT TABLET [T3]
bromfed dm syrup [T1]
bromfenac solution [T1]
bromocriptine mesylate capsule
[T1]
bromocriptine mesylate tablet
[T1]
bromphen/pseudoephedrine syrup
[T1]
BROMSITE SOLUTION [T3]
BROVANA NEBULIZED [T3]
BRUKINSA CAPSULE
budesonide capsule [T1]
budesonide er 24 hr tab [T1]
budesonide suspension [T1]
bumetanide tablet [T1]
BUNAVAIL FILM [T3] [QL]
BUPHENYL POWDER [T4] [PA][SP][BP]
BUPHENYL TABLET [T4] [PA][SP][BP]
buprenorphine patch [T1] [QL]
buprenorphine sl [T1] [QL]
buprenorphine-naloxone film
[T1] [QL]
buprenorphine-naloxone sl [T1] [QL]
bupropion sr 12 hr tab [T1] [ACA]
bupropion tablet [T1]
bupropion xl 24 hr tab [T1] [QL]
buspirone tablet [T1]
butalbital compound capsule [T1]
butalbital compound w/codeine capsule
[T1]
butalbital/apap/caffeine capsule
[T1]
butalbital/apap/caffeine tablet
[T1]
butalbital/caff/apap/codeine capsule
[T1]
butalbital-asp-caffeine capsule
[T1]
butalbital-asp-caffeine tablet [T1]
butorphanol tartrate solution
[T1] [QL]
BYDUREON BCISE INJECTION [T2] [QL]
BYDUREON PEN INJECTION [T2] [QL]
BYETTA INJECTION [T2] [QL]
BYSTOLIC TABLET [T2]
Ccabergoline tablet [T1]
CABOMETYX TABLET [T4] [PA][SP]
CADUET TABLET [T3] [QL][BP]
CAFERGOT TABLET [T3] [BP]
caffeine solution [T1]
CALAN SR TABLET [T3] [BP]
calcipotriene cream [T1]
calcipotriene ointment [T1]
calcipotriene solution [T1]
calcitonin salmon solution [T1]
calcitonin-salmon solution [T1]
calcitrene ointment [T1]
calcitriol capsule [T1]
calcitriol ointment [T1]
calcitriol solution [T1]
calcium capsule [T1]
CALQUENCE CAPSULE [T4] [PA][SP]
camila tablet [T1] [ACA]
camrese lo tablet [T1] [ACA]
camrese tablet [T1] [ACA]
CANASA SUPPOSITORY [T3] [BP]
candesartan cilexetil tablet [T1]
candesartan-hydrochlorothiazid tablet
[T1]
CANTHARIDIN SOLUTION [T3]
CAPECITABINE TABLET [T4] [PA][SP]
CAPRELSA TABLET [T4] [PA][SP]
captopril tablet [T1]
captopril/hydrochlorothiazide tablet
[T1]
CARAFATE SUSPENSION [T2] [BP]
CARAFATE TABLET [T2] [BP]
CARBAGLU TABLET [T4] [PA][SP]
carbamazepine chew tab [T1]
carbamazepine er 12 hr tab [T1]
carbamazepine er capsule [T1]
carbamazepine suspension [T1]
carbamazepine tablet [T1]
CARBATROL CAPSULE [T3] [BP]
carbidopa tablet [T1]
carbidopa/levodopa er tablet [T1]
carbidopa/levodopa odt tablet
[T1]
carbidopa/levodopa tablet [T1]
carbidopa-levodopa-entacapone tablet
[T1]
carbinoxamine maleate solution
[T1]
carbinoxamine maleate tablet
[T1]
cardioplegic solution
CARDIZEM CD 24 HOUR CAP [T3]
CARDIZEM LA 24 HR TAB [T3] [BP]
CARDIZEM TABLET [T3] [BP]
CARDURA TABLET [T3] [BP]
CARDURA XL 24 HR TAB [T3]
carisoprodol tablet [T1]
carisoprodol/aspirin tablet [T1]
carisoprodol-aspirin-codeine tablet
[T1]
CARNITOR SF SOLUTION [T3] [BP]
CARNITOR SOLUTION [T3] [BP]
CARNITOR TABLET [T3] [BP]
CAROSPIR SUSPENSION [T3] [PA]
carteolol solution [T1]
cartia xt 24 hour cap [T1]
carvedilol phosphate 24 hour cap
[T1]
carvedilol tablet [T1]
CASODEX TABLET [T3] [BP]
CATAPRES TABLET [T3] [BP]
CATAPRES-TTS-1 PATCH [T3] [BP]
CATAPRES-TTS-2 PATCH [T3] [BP]
CATAPRES-TTS-3 PATCH [T3] [BP]
CAYA [T3] [ACA]
CAYSTON SOLUTION [T4] [PA][SP]
caziant tablet [T1] [ACA]
cefaclor capsule [T1]
cefaclor er 12 hr tab [T1]
cefaclor suspension [T1]
cefadroxil capsule [T1]
cefadroxil suspension [T1]
cefadroxil tablet [T1]
cefdinir capsule [T1]
cefdinir suspension [T1]
8www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
cefditoren pivoxil tablet [T1]
cefixime capsule [T1]
cefixime suspension [T1]
cefpodoxime proxetil suspension
[T1]
cefpodoxime proxetil tablet [T1]
cefprozil suspension [T1]
cefprozil tablet [T1]
cefuroxime axetil tablet [T1]
celecoxib capsule [T1] [QL]
CELLCEPT CAPSULE [T3] [BP]
CELLCEPT SUSPENSION [T3] [BP]
CELLCEPT TABLET [T3] [BP]
CELONTIN CAPSULE [T2]
CENTANY OINTMENT [T3]
cephalexin capsule [T1]
cephalexin suspension [T1]
cephalexin tablet [T1]
CEQUA SOLUTION [T3] [QL]
CERDELGA CAPSULE [T4] [PA][SP]
CERVIDIL [T3]
cevimeline capsule [T1]
CHANTIX CONTINUING MONTH TABLET
[T2] [ACA]
CHANTIX TABLET [T2] [ACA]
chateal eq tablet [T1] [ACA]
chateal tablet [T1] [ACA]
CHEMET CAPSULE [T2]
CHEMSTRIP BG LOG BOOK MISC
CHENODAL TABLET [T4] [PA][SP]
children's aspirin chew tab [T1] [ACA]
chlordiazepoxide capsule [T1]
chlorhexidine gluconate solution
[T1]
chloroquine phosphate tablet
[T1] [QL]
chlorothiazide tablet [T1]
chlorpromazine tablet [T1]
chlorthalidone tablet [T1]
chlorzoxazone tablet [T1]
CHOLBAM CAPSULE [T4] [PA][SP]
cholestyramine light packet [T1]
cholestyramine light powder [T1]
cholestyramine packet [T1]
cholestyramine powder [T1]
ciclodan solution [T1]
ciclopirox gel [T1]
ciclopirox nail lacquer solution
[T1]
ciclopirox olamine cream [T1]
ciclopirox shampoo [T1]
ciclopirox suspension [T1]
cilostazol tablet [T1]
CILOXAN OINTMENT [T3]
CILOXAN SOLUTION [T3] [BP]
CIMDUO TABLET [T2] [QL]
cimetidine solution [T1]
cimetidine tablet [T1]
CINACALCET TABLET [T4] [PA][SP]
CIPRO HC SUSPENSION [T3]
CIPRO SUSPENSION [T3]
CIPRO TABLET [T3] [BP]
CIPRODEX SUSPENSION [T2]
ciprofloxacin solution [T1]
ciprofloxacin tablet [T1]
citalopram solution [T1]
citalopram tablet [T1]
CITRANATAL 90 DHA MISC [T3]
CITRANATAL ASSURE MISC [T3]
CITRANATAL B-CALM MISC [T3]
CITRANATAL BLOOM TABLET [T3]
CITRANATAL DHA MISC [T3]
CITRANATAL HARMONY CAPSULE
[T3]
CITRANATAL RX TABLET [T3]
citroma solution [T1] [ACA]
claravis capsule [T1]
CLARINEX TABLET [T3] [BP]
CLARINEX-D 12 HOUR TAB [T3]
clarithromycin er 24 hr tab [T1]
clarithromycin suspension [T1]
clarithromycin tablet [T1]
clearlax powder [T1] [ACA]
clemastine fumarate tablet [T1]
CLENPIQ SOLUTION [T2]
CLEOCIN CAPSULE [T3] [BP]
CLEOCIN CREAM [T3] [BP]
CLEOCIN PALMITATE SOLUTION
[T3] [BP]
CLEOCIN SUPPOSITORY [T3]
CLEOCIN-T LOTION [T3] [BP]
clidinium w/chlordiazepoxide capsule
[T1]
CLIMARA PATCH [T3] [QL][BP]
clindacin etz pledgets swab [T1]
clindacin-p swab [T1]
clindamycin capsule [T1]
clindamycin palmitate solution
[T1]
clindamycin pediatric solution
[T1]
clindamycin phosphate cream
[T1]
clindamycin phosphate foam [T1]
clindamycin phosphate lotion
[T1]
clindamycin phosphate solution
[T1]
clindamycin phosphate swab [T1]
clindamycin phos-tretinoin gel
[T1]
clindamycin-benzoyl peroxide gel
[T1]
CLINDESSE CREAM [T3]
clobazam suspension [T1]
clobazam tablet [T1]
clobetasol cream [T1]
clobetasol gel [T1]
clobetasol ointment [T1]
clobetasol solution [T1]
clomipramine capsule [T1]
clonazepam odt tablet [T1]
clonazepam tablet [T1]
clonidine 12 hr tab [T1]
clonidine er 12 hr tab [T1]
clonidine patch [T1]
clonidine tablet [T1]
clopidogrel tablet [T1]
clorazepate dipotassium tablet
[T1]
clotrimazole lozenge [T1]
clotrimazole/betamethasone cream
[T1]
clotrimazole/betamethasone lotion
[T1]
CLOVIQUE CAPSULE [T4] [PA][SP]
clozapine odt tablet [T1]
clozapine tablet [T1]
CLOZARIL TABLET [T3] [BP]
C-NATE DHA CAPSULE [T2]
COARTEM TABLET [T2]
COCAINE SOLUTION [T3]
codeine sulfate tablet [T1] [BP]
COLAZAL CAPSULE [T3] [BP]
colchicine tablet [T1]
9www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
COLCRYS TABLET [T2] [BP]
colesevelam packet [T1]
colesevelam tablet [T1]
COLESTID FLAVORED GRANULES
[T3]
COLESTID FLAVORED PACKET [T3]
COLESTID GRANULES [T3] [BP]
COLESTID PACKET [T3] [BP]
COLESTID TABLET [T3] [BP]
colestipol granules [T1]
colestipol packet [T1]
colestipol tablet [T1]
colocort enema [T1]
COLY-MYCIN S SUSPENSION [T3]
COMBIGAN SOLUTION [T2]
COMBIPATCH PATCH [T2]
COMBIVENT RESPIMAT AEROSOL
[T2] [QL]
COMBIVIR TABLET [T3] [BP]
COMETRIQ KIT [T4] [PA][SP]
COMPLETE NATAL DHA MISC [T2]
COMPLETENATE CHEW TAB [T2]
compro suppository [T1]
COMTAN TABLET [T3] [BP]
CONCEPT DHA CAPSULE [T3]
CONCEPT OB CAPSULE [T3]
CONCEPTROL GEL [T2] [ACA]
CONCERTA TABLET [T3] [QL][BP]
CONDOM MISC [T2] [ACA]
CONDYLOX GEL [T3]
CONSENSI TABLET [T3]
constulose solution [T1]
COPAXONE INJECTION [T4] [PA][SP][BP]
COPIKTRA CAPSULE [T4] [PA][SP]
CORDRAN CREAM [T3]
COREG CR 24 HOUR CAP [T3] [BP]
CORGARD TABLET [T3] [BP]
CORLANOR SOLUTION [T2] [QL]
CORLANOR TABLET [T2] [QL]
correctol tablet [T1] [ACA]
CORTEF TABLET [T3] [BP]
CORTENEMA ENEMA [T3] [BP]
cortisone tablet [T1]
CORTISPORIN CREAM [T3]
CORTISPORIN OINTMENT [T3]
CORTISPORIN-TC SUSPENSION
[T3]
COSENTYX INJECTION [T4] [PA][SP]
COSENTYX SENSOREADY PEN INJECTION
[T4] [PA][SP]
COSOPT PF SOLUTION [T3] [BP]
COTELLIC TABLET [T4] [PA][SP]
COUMADIN TABLET [T3] [BP]
covaryx hs tablet [T1]
covaryx tablet [T1]
CREON CAPSULE [T2]
CRESEMBA CAPSULE [T2] [PA]
CRINONE GEL [T2]
CRIXIVAN CAPSULE [T2]
cromolyn sodium [T1]
cromolyn sodium nebulized [T1]
cromolyn sodium solution [T1]
crotan lotion [T1]
cryselle-28 tablet [T1] [ACA]
CUROSURF SUSPENSION [T3]
CUVPOSA SOLUTION [T3]
cvs aspirin ec tablet [T1] [ACA]
cvs aspirin low dose tablet [T1] [ACA]
cvs aspirin low strength tablet
[T1] [ACA]
cvs aspirin tablet [T1] [ACA]
cvs bisacodyl tablet [T1] [ACA]
cvs folic acid tablet [T1] [ACA]
cvs gentle laxative tablet [T1] [ACA]
cvs magnesium solution [T1] [ACA]
cvs nicotine lozenge [T1] [ACA]
cvs nicotine polacrilex gum [T1] [ACA]
cvs nicotine polacrilex lozenge
[T1] [ACA]
cvs nicotine transdermal patch
[T1] [ACA]
cvs of magnesia solution [T1] [ACA]
cvs purelax packet [T1] [ACA]
cvs purelax powder [T1] [ACA]
cyclafem 1/35 tablet [T1] [ACA]
cyclafem 7/7/7 tablet [T1] [ACA]
cyclobenzaprine 24 hour cap [T1]
cyclobenzaprine tablet [T1]
CYCLOGYL SOLUTION [T3] [BP]
CYCLOMYDRIL SOLUTION [T3]
cyclopentolate solution [T1]
CYCLOPENTOLATE-TROPICAMIDE-PE SOLUTION
[T3]
CYCLOPHOSPHAMIDE CAPSULE
[T4] [PA][SP][BP]
cycloserine capsule [T1]
cyclosporine capsule [T1]
cyclosporine modified capsule
[T1]
cyclosporine modified solution
[T1]
cyproheptadine syrup [T1]
cyproheptadine tablet [T1]
cyred eq tablet [T1] [ACA]
cyred tablet [T1] [ACA]
CYSTADANE POWDER [T4] [PA][SP]
CYSTAGON CAPSULE [T4] [PA][SP]
CYSTARAN SOLUTION [T4] [PA][SP]
CYSTO-CONRAY II SOLUTION [T3]
CYSTOGRAFIN SOLUTION [T3]
CYSTOGRAFIN-DILUTE SOLUTION
[T3]
CYTOTEC TABLET [T3] [BP]
DD.H.E. 45 SOLUTION [T3] [QL][BP]
DALFAMPRIDINE ER 12 HR TAB
[T4] [PA][SP]
DALIRESP TABLET [T2]
danazol capsule [T1]
DANTRIUM CAPSULE [T3] [BP]
dantrolene sodium capsule [T1]
dapsone gel [T1]
dapsone tablet [T1]
DAPTACEL SUSPENSION [T2] [ACA]
DARAPRIM TABLET [T4] [PA][SP][BP]
darifenacin 24 hr tab [T1]
dasetta 1/35 tablet [T1] [ACA]
dasetta 7/7/7 tablet [T1] [ACA]
DAURISMO TABLET [T4] [PA][SP]
DAYPRO TABLET [T3] [BP]
daysee tablet [T1] [ACA]
DAYTRANA PATCH [T2] [QL]
DDAVP SOLUTION [T2] [BP]
DDAVP TABLET [T3] [BP]
deblitane tablet [T1] [ACA]
decadron tablet [T1]
DEFERASIROX TABLET [T4] [PA][SP]
delyla tablet [T1] [ACA]
demeclocycline tablet [T1]
DEMSER CAPSULE [T2]
DENAVIR CREAM [T3]
10www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
DEPAKOTE ER 24 HR TAB [T3] [BP]
DEPAKOTE SPRINKLES CAPSULE
[T3] [BP]
DEPAKOTE TABLET [T3] [BP]
DEPEN TITRATABS TABLET [T2] [BP]
DEPO-PROVERA INJECTION [T3] [BP]
DEPO-PROVERA SUSPENSION [T3] [BP]
DEPO-SUBQ PROVERA 104 INJECTION
[T3] [ACA]
DEPO-TESTOSTERONE SOLUTION
[T3] [BP]
DERMAGRAFT [T3]
DERMOTIC OIL [T3] [BP]
DESCOVY TABLET [T2] [QL]
desflurane solution [T1]
desipramine tablet [T1]
desloratadine odt tablet [T1]
desloratadine tablet [T1]
desmopressin solution [T1]
desmopressin tablet [T1]
desogestrel-ethinyl estradiol tablet
[T1] [ACA]
desogestr-eth estrad eth estra tablet
[T1] [ACA]
DESOXYN TABLET [T3] [BP]
desvenlafaxine er 24 hr tab [T1]
dexamethasone elixir [T1]
dexamethasone intensol [T1]
dexamethasone sodium phosphate solution
[T1]
dexamethasone solution [T1]
dexamethasone tablet [T1]
dexmethylphenidate er 24 hour cap
[T1] [QL]
dexmethylphenidate tablet [T1]
DEXTENZA [T3] [PA]
dextroamphetamine sulfate er 24 hour cap
[T1]
dextroamphetamine sulfate solution
[T1]
dextroamphetamine sulfate tablet
[T1]
dextroamphetamine-amphet er 24 hour cap
[T1] [QL]
dextroamphetamine-amphetamine tablet
[T1]
DIACOMIT CAPSULE [T4] [PA][SP]
DIACOMIT PACKET [T4] [PA][SP]
DIASTAT ACUDIAL GEL [T3]
DIASTAT PEDIATRIC GEL [T3]
diazepam [T1]
diazepam intensol [T1]
diazepam rectal [T1]
diazepam solution [T1]
diazepam tablet [T1]
diazoxide suspension [T1]
DIBENZYLINE CAPSULE [T4] [PA][SP][BP]
diclofenac potassium tablet [T1]
diclofenac sodium dr tablet [T1]
diclofenac sodium er 24 hr tab
[T1]
diclofenac sodium gel [T1] [PA]
diclofenac sodium solution [T1]
diclofenac sodium-misoprostol tablet
[T1]
dicloxacillin sodium capsule [T1]
dicyclomine capsule [T1]
dicyclomine solution [T1]
dicyclomine tablet [T1]
didanosine capsule (delayed release)
[T1]
DIFFERIN CREAM [T3] [BP]
DIFFERIN GEL [T3] [BP]
DIFFERIN LOTION [T3]
DIFICID TABLET [T3]
diflorasone diacetate ointment
[T1]
DIFLUCAN SUSPENSION [T3] [BP]
DIFLUCAN TABLET [T3] [BP]
diflunisal tablet [T1]
digitek tablet [T1]
digox tablet [T1]
digoxin solution [T1]
digoxin tablet [T1]
dihydroergotamine mesylate solution
[T1] [QL]
DILANTIN CAPSULE [T2] [BP]
DILANTIN INFATABS CHEW TAB
[T3] [BP]
DILANTIN-125 SUSPENSION [T3] [BP]
DILATRATE SR CAPSULE [T2]
DILAUDID LIQUID [T3] [BP]
DILAUDID TABLET [T3] [BP]
diltiazem 24hr er (cd) 24 hour cap
[T1]
diltiazem cd 24 hour cap [T1]
diltiazem er 24 hour cap [T1]
diltiazem er 24 hr tab [T1]
diltiazem er capsule [T1]
diltiazem tablet [T1]
dilt-xr 24 hour cap [T1]
DIPENTUM CAPSULE [T3]
diphenhydramine solution
diphenoxylate w/atropine tablet
[T1]
diphenoxylate/atropine liquid
[T1]
diphenoxylate/atropine tablet
[T1]
DIPHTHERIA-TETANUS TOXOIDS-PED SUSPENSION
[T2] [ACA]
DIPROLENE AF CREAM [T3] [BP]
DIPROLENE OINTMENT [T3] [BP]
dipyridamole tablet [T1]
disopyramide phosphate capsule
[T1]
disulfiram tablet [T1]
DITROPAN XL 24 HR TAB [T3] [BP]
DIURIL SUSPENSION [T3]
divalproex sodium capsule [T1]
divalproex sodium dr tablet [T1]
divalproex sodium er 24 hr tab
[T1]
DIVIGEL GEL [T2]
dofetilide capsule [T1]
DOLOPHINE TABLET [T3] [BP]
donepezil tablet [T1]
DOPTELET TABLET [T4] [PA][SP]
DORAL TABLET [T3]
DORYX TABLET [T3] [BP]
dorzolamide solution [T1]
dorzolamide-timolol solution [T1]
dotti patch [T1] [QL]
DOVATO TABLET [T2] [QL]
DOVONEX CREAM [T3] [BP]
doxazosin mesylate tablet [T1]
doxazosin tablet [T1]
doxepin [T1]
doxepin capsule [T1]
doxepin cream [T1] [QL]
doxepin tablet [T1]
doxercalciferol capsule [T1]
doxycycline hyclate capsule [T1]
doxycycline hyclate dr tablet [T1]
doxycycline hyclate tablet [T1]
doxycycline monohydrate capsule
[T1]
11www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
doxycycline monohydrate tablet
[T1]
doxycycline suspension [T1]
doxycycline tablet [T1]
doxylamine succ-pyridoxine tablet
[T1]
DRISDOL CAPSULE [T3] [BP]
dronabinol capsule [T1] [QL]
drospirenone-ethinyl estradiol tablet
[T1] [ACA]
DROXIA CAPSULE [T2]
DUAKLIR PRESSAIR AEROSOL [T3] [PA][QL]
DUAVEE TABLET [T2]
ducodyl tablet [T1] [ACA]
DUET DHA 400 MISC [T3]
DUET DHA BALANCED MISC [T3]
DUETACT TABLET [T3] [BP]
DULERA AEROSOL [T2] [QL]
duloxetine capsule [T1]
DUOPA SUSPENSION [T3]
DUPIXENT INJECTION [T4] [PA][SP]
DURAGESIC PATCH [T3] [QL][BP]
DUREX REALFEEL NONLATEX [T3] [ACA]
DUREZOL EMULSION [T3]
dutasteride capsule [T1]
dutasteride-tamsulosin capsule
[T1]
DYAZIDE CAPSULE [T3] [BP]
DYRENIUM CAPSULE [T3] [BP]
Ee.e.s. 400 tablet [T1]
E.E.S. GRANULES SUSPENSION
[T3] [BP]
EC-NAPROSYN TABLET [T3] [BP]
ec-naproxen tablet [T1] [BP]
econazole nitrate cream [T1]
econtra ez tablet [T1] [ACA]
econtra one-step tablet [T1] [ACA]
ecotrin low strength tablet [T1] [ACA]
ecotrin tablet [T1] [ACA]
ecpirin tablet [T1] [ACA]
EDARBI TABLET [T2]
EDECRIN TABLET [T3] [BP]
ed-spaz tablet [T1]
EDURANT TABLET [T2]
eemt hs tablet [T1]
eemt tablet [T1]
efavirenz capsule [T1]
efavirenz tablet [T1]
EFFER-K TABLET (EFF) [T3]
EFFIENT TABLET [T3] [BP]
EFUDEX CREAM [T3] [BP]
eletriptan tablet [T1] [QL]
ELIGARD KIT
ELIMITE CREAM [T3] [BP]
elinest tablet [T1] [ACA]
ELIQUIS STARTER PACK TABLET
[T2]
ELIQUIS TABLET [T2]
ELITE-OB TABLET [T2]
ELIXOPHYLLIN ELIXIR [T3]
ELLA TABLET [T3] [ACA]
ELMIRON CAPSULE [T2]
eluryng [T1] [ACA][QL]
EMCYT CAPSULE [T4] [PA][SP]
EMGALITY INJECTION [T2] [PA]
emoquette tablet [T1] [ACA]
EMSAM PATCH [T3] [QL]
EMTRIVA CAPSULE [T2]
EMTRIVA SOLUTION [T2]
EMVERM CHEW TAB [T2] [PA]
ENABLEX 24 HR TAB [T3] [BP]
enalapril maleate tablet [T1]
enalapril maleate/hctz tablet [T1]
ENBRACE HR CAPSULE [T3]
ENBREL INJECTION [T4] [PA][SP]
ENBREL MINI INJECTION [T4] [PA][SP]
ENBREL SOLUTION [T4] [PA][SP]
ENBREL SURECLICK INJECTION
[T4] [PA][SP]
ENDARI PACKET [T4] [PA][SP]
ENDO-AVITENE MISC [T3]
endocet tablet [T1]
ENDOFORM [T3]
ENDOFORM DERMAL TEMPLATE
[T3]
ENGERIX-B SUSPENSION [T2] [ACA]
ENLITE GLUCOSE SENSOR MISC
enoxaparin sodium solution [T1]
enpresse-28 tablet [T1] [ACA]
enskyce tablet [T1] [ACA]
entacapone tablet [T1]
ENTECAVIR TABLET [T4] [PA][SP]
ENTEREG CAPSULE [T4] [PA][SP]
ENTOCORT EC CAPSULE [T3] [BP]
ENTRESTO TABLET [T2] [QL]
enulose solution [T1]
EPCLUSA TABLET [T4] [PA][SP]
EPIDIOLEX SOLUTION [T4] [PA][SP]
EPIDUO FORTE GEL [T2]
EPIDUO GEL [T3] [BP]
EPIFIX 14MM [T3]
EPIFIX 2CM X 3CM [T3]
EPIFIX 4CM X 4CM [T3]
EPIFIX 5CM X 6CM [T3]
EPIFIX 7CM X 7CM [T3]
EPIFOAM FOAM [T3]
epinastine solution [T1]
epinephrine injection [T1] [QL]
EPIPEN 2-PAK INJECTION [T2] [QL][BP]
EPIPEN-JR 2-PAK INJECTION [T2] [QL][BP]
epitol tablet [T1]
EPIVIR HBV SOLUTION [T4] [PA][SP]
EPIVIR HBV TABLET [T4] [PA][SP][BP]
EPIVIR SOLUTION [T3] [BP]
EPIVIR TABLET [T3] [BP]
eplerenone tablet [T1]
EPZICOM TABLET [T3] [BP]
eq aspirin low dose chew tab [T1] [ACA]
eq aspirin tablet [T1] [ACA]
eq childrens aspirin chew tab [T1] [ACA]
eq clearlax powder [T1] [ACA]
eq gentle laxative tablet [T1] [ACA]
eq magnesium solution [T1] [ACA]
eq nicotine lozenge [T1] [ACA]
eq nicotine lozenges [T1] [ACA]
eq nicotine patch [T1] [ACA]
eq nicotine polacrilex gum [T1] [ACA]
eq nicotine polacrilex lozenge
[T1] [ACA]
eq nicotine step 3 patch [T1] [ACA]
eql aspirin ec tablet [T1] [ACA]
eql aspirin low dose chew tab
[T1] [ACA]
eql aspirin low dose tablet [T1] [ACA]
eql aspirin tablet [T1] [ACA]
eql clearlax powder [T1] [ACA]
eql gentle laxative tablet [T1] [ACA]
eql magnesium solution [T1] [ACA]
eql nicotine polacrilex gum [T1] [ACA]
12www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
eql nicotine polacrilex lozenge
[T1] [ACA]
ergoloid mesylates tablet [T1]
ERGOMAR SL [T3]
ergotamine-caffeine tablet [T1]
ERIVEDGE CAPSULE [T4] [PA][SP]
ERLEADA TABLET [T4] [PA][SP]
ERLOTINIB TABLET [T4] [PA][SP]
errin tablet [T1] [ACA]
ERTACZO CREAM [T3]
ery pads [T1]
erygel gel [T1] [BP]
ERYPED 200 SUSPENSION [T3] [BP]
ERYPED 400 SUSPENSION [T3] [BP]
ery-tab tablet [T1]
erythrocin stearate tablet [T1]
erythromycin base tablet [T1]
erythromycin capsule [T1]
erythromycin dr tablet [T1]
erythromycin ethylsuccinate suspension
[T1]
erythromycin ethylsuccinate tablet
[T1]
erythromycin gel [T1]
erythromycin ointment [T1]
erythromycin solution [T1]
erythromycin-benzoyl peroxide gel
[T1]
ESBRIET CAPSULE [T4] [PA][SP]
ESBRIET TABLET [T4] [PA][SP]
escitalopram oxalate solution
[T1]
escitalopram oxalate tablet [T1]
ESGIC TABLET [T3] [BP]
esomeprazole magnesium capsule (delayed release)
[T1]
esomeprazole magnesium packet
[T1]
estarylla tablet [T1] [ACA]
estazolam tablet [T1]
ESTRACE CREAM [T3] [BP]
ESTRACE TABLET [T3] [BP]
estradiol cream [T1]
estradiol patch [T1] [QL]
estradiol tablet [T1]
estradiol-norethindrone acetat tablet
[T1]
ESTRING [T2] [QL]
estrogen & methyltestosterone tablet
[T1]
ESTROSTEP FE TABLET [T3] [BP]
eszopiclone tablet [T1] [QL]
ethacrynic acid tablet [T1]
ethambutol tablet [T1]
ethosuximide capsule [T1]
ethosuximide solution [T1]
ethynodiol-ethinyl estradiol tablet
[T1] [ACA]
etodolac capsule [T1]
etodolac er 24 hr tab [T1]
etodolac tablet [T1]
etonogestrelethinyl estradiol
[T1] [ACA][QL]
ETOPOSIDE CAPSULE [T4] [PA][SP]
EUCRISA OINTMENT [T3]
euthyrox tablet [T1]
everolimus tablet [T1] [PA][SP]
EVERSENSE SENSOR/HOLDER MISC
EVERSENSE SMART TRANSMITTER MISC
EVISTA TABLET [T3] [BP]
EVOCLIN FOAM [T3] [BP]
EVOTAZ TABLET [T3]
EVOXAC CAPSULE [T3] [BP]
EXELDERM CREAM [T3]
EXELDERM SOLUTION [T3]
EXELON PATCH [T3] [BP]
exemestane tablet [T1]
ezetimibe tablet [T1] [QL]
ezetimibe/simvastatin tablet [T1] [QL]
E-Z-HD SUSPENSION [T3]
E-Z-PAQUE SUSPENSION [T3]
Ffa-8 capsule [T1] [ACA]
falmina tablet [T1] [ACA]
famciclovir tablet [T1]
famotidine suspension [T1]
famotidine tablet [T1]
FANAPT TABLET [T3] [QL]
FANAPT TITRATION PACK TABLET
[T3] [QL]
FANTASY LUBRICATED MISC [T2] [ACA]
FANTASY MISC [T2] [ACA]
FARESTON TABLET [T3] [BP]
FARXIGA TABLET [T2] [QL]
FARYDAK CAPSULE [T4] [PA][SP]
FASENRA PEN INJECTION [T4] [PA][SP]
fayosim tablet [T1] [ACA]
FC2 FEMALE CONDOM MISC [T2] [ACA]
febuxostat tablet [T1]
felbamate suspension [T1]
felbamate tablet [T1]
FELBATOL SUSPENSION [T3] [BP]
FELBATOL TABLET [T3] [BP]
FELDENE CAPSULE [T3] [BP]
felodipine er 24 hr tab [T1]
FEMARA TABLET [T3] [BP]
FEMCAP [T2] [ACA]
FEMHRT LOW DOSE TABLET [T3] [BP]
femynor tablet [T1] [ACA]
fenofibrate capsule [T1]
fenofibrate micronized capsule
[T1]
fenofibrate tablet [T1]
fenofibric acid dr capsule (delayed release)
[T1]
fenofibric acid tablet [T1]
fenoprofen calcium tablet [T1]
fentanyl lollipop [T1] [QL]
fentanyl patch [T1] [QL]
FERRIPROX SOLUTION [T4] [PA][SP]
FERRIPROX TABLET [T4] [PA][SP]
FETZIMA 24 HOUR CAP [T2] [QL]
FETZIMA TITRATION PACK CAPSULE
[T2] [QL]
FIASP PENFILL INJECTION [T3] [QL]
FIBRICOR TABLET [T3]
FINACEA GEL [T3] [BP]
finasteride tablet [T1]
FIORICET/CODEINE CAPSULE [T3]
FIORINAL CAPSULE [T3] [BP]
FIORINAL/CODEINE #3 CAPSULE
[T3] [BP]
FIRAZYR SOLUTION [T4] [PA][SP][BP]
FIRDAPSE TABLET [T4] [PA][SP]
FIRVANQ SOLUTION [T3]
flac oil [T1]
FLAGYL CAPSULE [T3] [BP]
FLAGYL TABLET [T3] [BP]
FLAREX SUSPENSION [T3]
flavoxate tablet [T1]
flecainide tablet [T1]
FLECTOR PATCH [T2]
13www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
FLOMAX CAPSULE [T3] [BP]
FLORIVA PLUS SOLUTION [T3]
FLOVENT DISKUS AEROSOL [T2] [QL]
FLOVENT HFA AEROSOL [T2] [QL]
FLUAD 2019-2020 INJECTION [T2] [ACA]
FLUARIX INJECTION [T2] [ACA]
FLUBLOK QUAD 2019-2020 INJECTION
[T2] [ACA]
FLUCELVAX QUAD 2019-2020 SUSPENSION
[T2] [ACA]
fluconazole suspension [T1]
fluconazole tablet [T1]
flucytosine capsule [T1]
fludrocortisone tablet [T1]
FLULAVAL INJECTION [T2] [ACA]
FLULAVAL SUSPENSION [T2] [ACA]
flunisolide solution [T1] [QL]
fluocinolone acetonide oil [T1]
fluocinolone acetonide oil [T1]
fluocinolone acetonide ointment
[T1]
fluocinolone acetonide solution
[T1]
fluocinonide cream [T1] [QL]
fluocinonide solution [T1]
fluoride chew tab [T1] [ACA]
fluoritab chew tab [T1] [ACA]
fluorometholone suspension [T1]
FLUOROPLEX CREAM [T3]
fluorouracil cream [T1]
fluorouracil solution [T1]
fluoxetine capsule [T1]
fluoxetine solution [T1]
fluoxetine tablet [T1]
fluphenazine [T1]
fluphenazine elixir [T1]
fluphenazine tablet [T1]
flurazepam capsule [T1]
flurbiprofen sodium solution [T1]
flurbiprofen tablet [T1]
flutamide capsule [T1]
fluticasone cream [T1]
fluticasone ointment [T1]
fluticasone-salmeterol aerosol
[T1] [QL]
fluvastatin capsule [T1] [QL]
fluvoxamine maleate tablet [T1]
FLUZONE HIGH-DOSE INJECTION
[T2] [ACA]
FLUZONE QUAD 2019-2020 INJECTION
[T2] [ACA]
FLUZONE QUAD 2019-2020 SUSPENSION
[T2] [ACA]
FLUZONE QUAD PEDI 2019-2020 INJECTION
[T2] [ACA]
FML LIQUIFILM SUSPENSION [T3]
folate tablet [T1] [ACA]
folbic tablet [T1]
folic acid capsule [T1] [ACA]
folic acid tablet [T1] [ACA]
FOLIVANE-OB CAPSULE [T2]
fondaparinux sodium solution
[T1]
FORA GTEL MULTIFUNCTN MONITOR
FORA V10-V12-D10-D20 KIT
forane solution [T1] [BP]
FORAXA EMULSION [T3]
FORTAVIT CAPSULE
FORTEO INJECTION [T4] [PA][SP]
FOSAMAX TABLET [T3] [QL][BP]
fosamprenavir calcium tablet [T1]
fosinopril sodium tablet [T1]
fosinopril-hydrochlorothiazide tablet
[T1]
FRAGMIN SOLUTION [T2]
FREESTYLE FREEDOM KIT
FREESTYLE FREEDOM LITE KIT
FREESTYLE INSULINX BLOOD KIT
FREESTYLE INSULINX BLOOD STRIP
FREESTYLE LIBRE READER
FREESTYLE LIBRE SENSOR MISC
FREESTYLE LITE METER
FREESTYLE LITE STRIPS
FREESTYLE LITE TEST STRIPS
FREESTYLE TEST STRIPS
FROVA TABLET [T3] [QL][BP]
frovatriptan tablet [T1] [QL]
FULPHILA INJECTION [T4] [PA][SP]
furosemide solution [T1]
furosemide tablet [T1]
FUZEON SOLUTION [T4] [PA][SP]
fyavolv tablet [T1]
FYCOMPA SUSPENSION [T2]
FYCOMPA TABLET [T2]
Ggabapentin capsule [T1]
gabapentin solution [T1]
gabapentin tablet [T1]
GABITRIL TABLET [T3] [BP]
GALAFOLD CAPSULE [T4] [PA][SP]
galantamine 24 hour cap [T1]
galantamine solution [T1]
galantamine tablet [T1]
GALZIN CAPSULE [T3]
GARDASIL 9 INJECTION [T2] [ACA]
GARDASIL 9 SUSPENSION [T2] [ACA]
GASTROCROM [T3] [BP]
GASTROGRAFIN SOLUTION [T3] [BP]
gatifloxacin solution [T1]
gavilax powder [T1] [ACA]
gavilyte-c solution [T1] [ACA]
gavilyte-g solution [T1] [ACA]
gavilyte-h kit [T1] [ACA]
gavilyte-n/flavor pack solution
[T1] [ACA]
GELFILM ENVELOPE FILM [T3]
GEL-FLOW NT INJECTION [T3]
GELFOAM DENTAL PACK MISC
[T3]
GELFOAM MISC [T3]
GELFOAM POWDER [T3]
GELFOAM SPONGE MISC [T3]
GELNIQUE GEL [T2]
gemfibrozil tablet [T1]
GENERESS FE CHEW TAB [T3] [BP]
generlac solution [T1]
gengraf capsule [T1]
gengraf solution [T1]
GENOTROPIN MINIQUICK SOLUTION
[T4] [PA][SP]
GENOTROPIN SOLUTION [T4] [PA][SP]
gentak ointment [T1]
gentamicin sulfate cream [T1]
gentamicin sulfate ointment [T1]
gentamicin sulfate solution [T1]
gentle laxative tablet [T1] [ACA]
gentlelax powder [T1] [ACA]
GENVOYA TABLET [T2] [QL]
14www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
GEODON CAPSULE [T3] [BP]
gianvi tablet [T1] [ACA]
GILENYA CAPSULE [T4] [PA][SP]
GILOTRIF TABLET [T4] [PA][SP]
GLATIRAMER INJECTION [T4] [PA][SP]
GLATOPA INJECTION [T4] [PA][SP]
GLEOLAN SOLUTION [T3]
GLEOSTINE CAPSULE [T4] [PA][SP]
glimepiride tablet [T1]
glipizide er 24 hr tab [T1]
glipizide tablet [T1]
glipizide xl 24 hr tab [T1]
glipizide-metformin tablet [T1]
GLOPERBA SOLUTION
GLUCAGEN DIAGNOSTIC SOLUTION
[T2]
GLUCAGEN HYPOKIT SOLUTION
[T2]
GLUCAGON EMERGENCY KIT [T2]
GLUCOCOM AUTOLINK MISC
GLUCOTROL TABLET [T3] [BP]
GLUCOTROL XL 24 HR TAB [T3] [BP]
glyburide micronized tablet [T1]
glyburide tablet [T1]
glyburide-metformin tablet [T1]
GLYCATE TABLET [T3]
glycine solution [T1]
glycolax powder [T1] [ACA]
glycopyrrolate tablet [T1]
glydo injection [T1]
GLYNASE TABLET [T3] [BP]
GLYSET TABLET [T3] [BP]
GLYXAMBI TABLET [T2]
gnp aspirin low dose tablet [T1] [ACA]
gnp aspirin tablet [T1] [ACA]
gnp bisa-lax tablet [T1] [ACA]
gnp clearlax packet [T1] [ACA]
gnp clearlax powder [T1] [ACA]
gnp folic acid tablet [T1] [ACA]
gnp gentle laxative tablet [T1] [ACA]
gnp laxative tablet [T1] [ACA]
gnp magnesium solution [T1] [ACA]
gnp nicotine gum [T1] [ACA]
gnp nicotine polacrilex gum [T1] [ACA]
gnp nicotine polacrilex lozenge
[T1] [ACA]
gnp nicotine transdermal patch
[T1] [ACA]
GOLYTELY SOLUTION [T3] [BP]
GONITRO PACKET [T3]
goodsense aspirin chew tab [T1] [ACA]
goodsense aspirin tablet [T1] [ACA]
goodsense clearlax powder [T1] [ACA]
goodsense nicotine gum [T1] [ACA]
goodsense nicotine lozenge [T1] [ACA]
GOPRELTO SOLUTION [T3]
GRAFIX CORE 1.5CM X 2CM MISC
[T3]
GRAFIX CORE 16MM MISC [T3]
GRAFIX CORE 2CM X 3CM MISC
[T3]
GRAFIX CORE 3CM X 4CM MISC
[T3]
GRAFIX CORE 5CM X 5CM MISC
[T3]
GRAFIX PRIME 1.5CM X 2CM MISC
[T3]
GRAFIX PRIME 16MM MISC [T3]
GRAFIX PRIME 2CM X 3CM MISC
[T3]
GRAFIX PRIME 3CM X 4CM MISC
[T3]
GRAFIX PRIME 5CM X 5CM MISC
[T3]
GRAFIX XC 7.5 X 15CM MISC [T3]
granisetron tablet [T1] [QL]
griseofulvin microsize suspension
[T1]
griseofulvin microsize tablet [T1]
griseofulvin ultramicrosize tablet
[T1]
guanfacine 24 hr tab [T1] [QL]
guanfacine er 24 hr tab [T1] [QL]
guanfacine tablet [T1]
guanidine tablet [T1]
GUARDIAN CONNECT TRANSMITTER MISC
GUARDIAN LINK 3 MISC
GUARDIAN REAL-TIME KIT
GUARDIAN RT CHARGER MISC
GUARDIAN RT STARTER KIT
GUARDIAN RT SYSTEM
GUARDIAN SENSOR 3 MISC
GUARDIAN TEST PLUG MISC
GVOKE PFS INJECTION [T2]
GYNAZOLE-1 CREAM [T3]
H
HAEGARDA SOLUTION [T4] [PA][SP]
hailey 1.5/30 tablet [T1] [ACA]
hailey 24 fe tablet [T1] [ACA]
halcinonide cream [T1]
HALCION TABLET [T3] [BP]
haloperidol [T1]
haloperidol tablet [T1]
HARVONI TABLET [T4] [PA][SP]
HAVRIX SUSPENSION [T2] [ACA]
hc pramoxine cream [T1]
healthylax packet [T1] [ACA]
heather tablet [T1] [ACA]
HEMANGEOL SOLUTION [T4] [PA][SP]
heparin sodium dcu solution [T1]
HEPARIN SODIUM INJECTION [T3]
heparin sodium solution [T1]
HEPLISAV-B INJECTION [T3] [ACA]
HEPSERA TABLET [T4] [PA][SP][BP]
HETLIOZ CAPSULE [T4] [PA][SP]
HIBERIX SOLUTION [T2] [ACA]
HIPREX TABLET [T3] [BP]
hm aspirin chew tab [T1] [ACA]
hm aspirin ec low dose tablet [T1] [ACA]
hm aspirin ec tablet [T1] [ACA]
hm aspirin tablet [T1] [ACA]
hm clearlax powder [T1] [ACA]
hm folic acid tablet [T1] [ACA]
hm laxative tablet [T1] [ACA]
hm magnesium solution [T1] [ACA]
hm nicotine polacrilex gum [T1] [ACA]
hm nicotine polacrilex lozenge
[T1] [ACA]
hpr foam [T1]
hpr plus foam [T1]
HPR PLUS/MB HYDROGEL KIT [T3]
HUMALOG INJECTION [T2] [QL]
HUMALOG JUNIOR KWIKPEN INJECTION
[T2] [QL]
HUMALOG KWIKPEN INJECTION
[T2] [QL]
HUMALOG MIX 50/50 SUSPENSION
[T2] [QL]
HUMALOG MIX 50-50 SUSPENSION
[T2] [QL]
HUMALOG MIX 75/25 SUSPENSION
[T2] [QL]
HUMALOG MIX 75-25 SUSPENSION
[T2] [QL]
15www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
HUMALOG SOLUTION [T2] [QL]
HUMIRA INJECTION [T4] [PA][SP]
HUMIRA PEDIATRIC INJECTION
[T4] [PA][SP]
HUMIRA PEN INJECTION [T4] [PA][SP]
HUMIRA PEN-PS/UV STARTER INJECTION
[T4] [PA][SP]
HUMULIN 70/30 KWIKPEN SUSPENSION
[T2] [QL]
HUMULIN 70/30 SUSPENSION
[T2] [QL]
HUMULIN N KWIKPEN SUSPENSION
[T2] [QL]
HUMULIN N SUSPENSION [T2] [QL]
HUMULIN R SOLUTION [T2] [QL]
HUMULIN R U-500 KWIKPEN INJECTION
[T2] [QL]
HYCAMTIN CAPSULE [T4] [PA][SP]
HYCLODEX SOLUTION [T3]
hydralazine tablet [T1]
HYDREA CAPSULE [T3] [BP]
hydrochlorothiazide capsule [T1]
hydrochlorothiazide tablet [T1]
hydrocodone bitartrate capsule (cr)
[T1] [QL]
hydrocodone w/acetaminophen solution
[T1]
hydrocodone w/acetaminophen tablet
[T1]
hydrocodone/homatropine syrup
[T1]
hydrocodone/homatropine tablet
[T1]
hydrocodone/ibuprofen tablet
[T1]
hydrocodone-chlorpheniramine suspension
[T1] [QL]
hydrocortisone butyrate cream
[T1]
hydrocortisone butyrate solution
[T1]
hydrocortisone cream [T1]
hydrocortisone enema [T1]
hydrocortisone lotion [T1]
hydrocortisone ointment [T1]
hydrocortisone tablet [T1]
hydromet syrup [T1]
hydromorphone liquid [T1]
hydromorphone tablet [T1]
hydroxychloroquine sulfate tablet
[T1] [QL]
hydroxyurea capsule [T1]
hydroxyzine pamoate capsule
[T1]
hydroxyzine syrup [T1]
hydroxyzine tablet [T1]
HYGEL GEL [T3]
hyoscyamine sulfate elixir [T1]
hyoscyamine sulfate odt tablet
[T1]
hyoscyamine sulfate tablet [T1]
hypocyn solution
HYSINGLA ER 24 HR TAB [T2] [QL]
Iibandronate sodium tablet [T1] [QL]
IBRANCE CAPSULE [T4] [PA][SP]
IBRANCE TABLET [T4] [PA][SP]
ibu tablet [T1]
ibuprofen tablet [T1]
ICATIBANT SOLUTION [T4] [PA][SP]
ICLUSIG TABLET [T4] [PA][SP]
IDHIFA TABLET [T4] [PA][SP]
ILEVRO SUSPENSION [T2]
IMATINIB MESYLATE TABLET [T4] [PA][SP]
IMBRUVICA CAPSULE [T4] [PA][SP]
IMBRUVICA TABLET [T4] [PA][SP]
imipramine pamoate capsule [T1]
imipramine tablet [T1]
imiquimod cream [T1]
IMPAVIDO CAPSULE [T2] [PA]
IMURAN TABLET [T3] [BP]
IMVEXXY MAINTENANCE PACK
[T3]
IMVEXXY STARTER PACK [T3]
INBRIJA CAPSULE [T4] [PA][SP]
incassia tablet [T1] [ACA]
INCRELEX SOLUTION [T4] [PA][SP]
INCRUSE ELLIPTA AEROSOL [T2] [QL]
indapamide tablet [T1]
INDOCIN SUPPOSITORY [T3]
INDOCIN SUSPENSION [T3]
indomethacin capsule [T1]
indomethacin er capsule [T1]
INFANRIX SUSPENSION [T2] [ACA]
INFASURF SUSPENSION [T3]
INLYTA TABLET [T4] [PA][SP]
INREBIC CAPSULE [T4] [PA][SP]
INSPRA TABLET [T3] [BP]
INTELENCE TABLET [T2]
INTRON A SOLUTION [T4] [PA][SP]
introvale tablet [T1] [ACA]
INVEGA 24 HR TAB [T3] [BP]
INVIRASE TABLET [T2]
INVOKAMET TABLET [T2] [QL]
INVOKAMET XR 24 HR TAB [T2] [QL]
INVOKANA TABLET [T2] [QL]
IODOFLEX PADS [T3]
IODOSORB GEL [T3]
IOPIDINE SOLUTION [T3]
IPOL INACTIVATED IPV INJECTION
[T2] [ACA]
ipratropium bromide solution
[T1] [QL]
ipratropium-albuterol solution
[T1]
irbesartan tablet [T1]
irbesartan-hydrochlorothiazide tablet
[T1]
IRESSA TABLET [T4] [PA][SP]
ISENTRESS CHEW TAB [T2]
ISENTRESS HD TABLET [T2]
ISENTRESS PACKET [T2]
ISENTRESS TABLET [T2]
isibloom tablet [T1] [ACA]
isoflurane solution [T1]
isoniazid syrup [T1]
isoniazid tablet [T1]
ISOPTO ATROPINE SOLUTION [T3]
ISOPTO CARPINE SOLUTION [T3] [BP]
ISORDIL TITRADOSE TABLET [T3] [BP]
isosorbide dinitrate tablet [T1]
isosorbide mononitrate 24 hr tab
[T1]
isosorbide mononitrate tablet
[T1]
isotretinoin capsule [T1]
isradipine capsule [T1]
itraconazole capsule [T1]
itraconazole solution [T1]
ivermectin tablet [T1]
Jjaimiess tablet [T1] [ACA]
JAKAFI TABLET [T4] [PA][SP]
jantoven tablet [T1]
16www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
JANUMET TABLET [T2] [QL]
JANUMET XR 24 HR TAB [T2] [QL]
JANUVIA TABLET [T2] [QL]
JARDIANCE TABLET [T2] [QL]
jasmiel tablet [T1] [ACA]
JATENZO CAPSULE
jencycla tablet [T1] [ACA]
JENTADUETO TABLET [T2] [QL]
JENTADUETO XR 24 HR TAB [T2] [QL]
jinteli tablet [T1]
jolessa tablet [T1] [ACA]
juleber tablet [T1] [ACA]
JULUCA TABLET [T2]
junel 1.5/30 tablet [T1] [ACA]
junel 1/20 tablet [T1] [ACA]
junel fe 1.5/30 tablet [T1] [ACA]
junel fe 1/20 tablet [T1] [ACA]
junel fe 24 tablet [T1] [ACA]
JUXTAPID CAPSULE [T4] [PA][SP]
JYNARQUE TABLET [T4] [PA][SP]
KKALETRA SOLUTION [T3] [BP]
KALETRA TABLET [T2]
kalliga tablet [T1] [ACA]
KALYDECO PACKET [T4] [PA][SP]
KALYDECO TABLET [T4] [PA][SP]
KARBINAL ER SUSPENSION [T3]
kariva tablet [T1] [ACA]
KEFLEX CAPSULE [T3] [BP]
kelnor 1/35 tablet [T1] [ACA]
kelnor 1/50 tablet [T1] [ACA]
KERYDIN SOLUTION [T3] [PA]
ketoconazole cream [T1]
ketoconazole shampoo [T1]
ketoconazole tablet [T1]
ketoprofen capsule [T1]
ketoprofen er 24 hour cap [T1]
ketorolac tromethamine solution
[T1]
ketorolac tromethamine tablet
[T1] [QL]
KEVEYIS TABLET [T4] [PA][SP]
KEVZARA INJECTION [T4] [PA][SP]
KIMONO LUBRICATED MISC [T2] [ACA]
KIMONO MICRO THIN MISC [T2] [ACA]
KIMONO MICROTHIN AQUA LUBE MISC
[T2] [ACA]
KIMONO MICROTHIN MISC [T2] [ACA]
KIMONO TEXTURED MISC [T2] [ACA]
KINRIX SUSPENSION [T3] [ACA]
kionex suspension [T1]
KITABIS PAK NEBULIZED [T4] [PA][SP]
KLARON LOTION [T3] [BP]
KLONOPIN TABLET [T3] [BP]
klor-con 10 tablet [T1]
klor-con 8 tablet [T1]
klor-con m10 tablet [T1]
klor-con m15 tablet [T1]
klor-con m20 tablet [T1]
klor-con packet [T1]
klor-con sprinkle capsule [T1]
kls aspirin ec tablet [T1] [ACA]
kls aspirin low dose tablet [T1] [ACA]
kls laxaclear powder [T1] [ACA]
kls quit2 gum [T1] [ACA]
kls quit2 lozenge [T1] [ACA]
kls quit4 gum [T1] [ACA]
kls quit4 lozenge [T1] [ACA]
KORLYM TABLET [T4] [PA][SP]
KOSHER PRENATAL PLUS IRON TABLET
[T3]
kp aspirin tablet [T1] [ACA]
kp bisacodyl tablet [T1] [ACA]
kp folic acid tablet [T1] [ACA]
KRINTAFEL TABLET [T3]
kristalose packet [T1]
k-tab tablet [T1]
KUVAN PACKET [T4] [PA][SP]
KUVAN TABLET [T4] [PA][SP]
Llabetalol tablet [T1]
LACRISERT [T3] [PA]
lactated ringers solution [T1]
lactulose packet [T1]
lactulose solution [T1]
LAMICTAL XR KIT [T3] [QL]
lamivudine solution [T1]
lamivudine tablet [T1] [PA][SP]
lamivudine/zidovudine tablet [T1]
lamotrigine (blue) kit [T1] [QL]
lamotrigine (green) kit [T1] [QL]
lamotrigine (orange) kit [T1] [QL]
lamotrigine chew tab [T1]
lamotrigine er 24 hr tab [T1]
lamotrigine odt tablet [T1]
lamotrigine tablet [T1]
lanoxin tablet [T1] [BP]
lansoprazol-amoxicil-clarithro misc
[T1]
lansoprazole capsule (delayed release)
[T1]
lanthanum carbonate chew tab
[T1]
LANTUS SOLOSTAR INJECTION
[T2] [QL]
LANTUS SOLUTION [T2] [QL]
larin 1.5/30 tablet [T1] [ACA]
larin 1/20 tablet [T1] [ACA]
larin 24 fe tablet [T1] [ACA]
larin fe 1.5/30 tablet [T1] [ACA]
larin fe 1/20 tablet [T1] [ACA]
larissia tablet [T1] [ACA]
LASIX TABLET [T3] [BP]
LASTACAFT SOLUTION [T3]
latanoprost solution [T1]
LATUDA TABLET [T2] [QL]
leena tablet [T1] [ACA]
leflunomide tablet [T1]
LENVIMA 10 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 12MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 14 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 18 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 20 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 24 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 4 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
LENVIMA 8 MG DAILY DOSE CAPSULE
[T4] [PA][SP]
lessina tablet [T1] [ACA]
LETAIRIS TABLET [T4] [PA][SP][BP]
letrozole tablet [T1]
leucovorin calcium tablet [T1]
LEUKERAN TABLET [T2]
LEUPROLIDE KIT [T4] [PA][SP]
levalbuterol nebulized [T1]
17www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
LEVAQUIN TABLET [T3]
LEVEMIR FLEXTOUCH INJECTION
[T2] [QL]
LEVEMIR SOLUTION [T2] [QL]
levetiracetam er 24 hr tab [T1]
levetiracetam solution [T1]
levetiracetam tablet [T1]
levobunolol solution [T1]
levocarnitine sf solution [T1]
levocarnitine solution [T1]
levocarnitine tablet [T1]
levocetirizine dihydrochloride tablet
levofloxacin solution [T1]
levofloxacin tablet [T1]
levonest tablet [T1] [ACA]
levonorgestrel tablet [T1] [ACA]
levonorgestrel-eth estradiol tablet
[T1] [ACA]
levonorg-eth estrad eth estrad tablet
[T1] [ACA]
levora 0.15/30-28 tablet [T1] [ACA]
levo-t tablet [T1]
levothyroxine sodium tablet [T1]
levoxyl tablet [T1]
LEVSIN TABLET [T3]
LEVULAN KERASTICK SOLUTION
[T4] [PA][SP]
LEXIVA SUSPENSION [T2]
LEXIVA TABLET [T3] [BP]
LIALDA TABLET [T3] [BP]
lidocaine injection [T1]
lidocaine jelly gel [T1]
lidocaine jelly injection [T1]
lidocaine patch [T1]
lidocaine solution [T1]
lidocaine viscous solution [T1]
lidocaine/dextrose solution [T1]
lidocaine/prilocaine cream [T1]
LIDOTREX GEL [T3]
lillow tablet [T1] [ACA]
lindane shampoo [T1]
linezolid suspension [T1]
linezolid tablet [T1]
LINZESS CAPSULE [T2] [QL]
liothyronine sodium tablet [T1]
LIPOFEN CAPSULE [T2]
LIQUID E-Z-PAQUE SUSPENSION
[T3]
lisinopril tablet [T1]
lisinopril-hctz tablet [T1]
lithium carbonate capsule [T1] [BP]
lithium carbonate er tablet [T1]
lithium carbonate tablet [T1]
lithium solution [T1]
LITHOBID TABLET [T3] [BP]
LITHOSTAT TABLET [T3]
LMR PLUS KIT [T3]
LO LOESTRIN FE TABLET [T2] [ACA]
LODINE TABLET [T3] [BP]
LODOSYN TABLET [T3] [BP]
lojaimiess tablet [T1] [ACA]
LOKELMA PACKET [T2]
LOMOTIL TABLET [T3] [BP]
LONHALA MAGNAIR REFILL SOLUTION
[T3]
LONHALA MAGNAIR STARTER SOLUTION
[T3]
LONSURF TABLET [T4] [PA][SP]
LOPID TABLET [T3] [BP]
lopinavir/ritonavir solution [T1]
lopreeza tablet [T1]
LOPRESSOR HCT TABLET [T3] [BP]
LOPRESSOR TABLET [T3] [BP]
LOPROX [T3] [BP]
LOPROX CREAM [T3] [BP]
LOPROX SUSPENSION [T3] [BP]
lorazepam [T1]
lorazepam intensol [T1]
lorazepam tablet [T1]
LORBRENA TABLET [T4] [PA][SP]
lorcet hd tablet [T1]
lorcet plus tablet [T1]
lorcet tablet [T1]
loryna tablet [T1] [ACA]
losartan potassium tablet [T1]
losartan-hydrochlorothiazide tablet
[T1]
LOSEASONIQUE TABLET [T3] [BP]
LOTEMAX GEL [T2]
LOTEMAX OINTMENT [T2]
LOTEMAX SM GEL [T2]
LOTEMAX SUSPENSION [T2] [BP]
LOTENSIN HCT TABLET [T3] [BP]
LOTENSIN TABLET [T3] [BP]
loteprednol etabonate suspension
[T1]
LOTRONEX TABLET [T3] [BP]
lovastatin tablet [T1] [ACA][QL]
LOVAZA CAPSULE [T3] [QL][BP]
low dose aspirin tablet [T1] [ACA]
low-ogestrel tablet [T1] [ACA]
loxapine capsule [T1]
lo-zumandimine tablet [T1] [ACA]
ludent chew tab [T1] [ACA]
LUMIGAN SOLUTION [T2]
LUPANETA PACK KIT [T4] [PA][SP]
LUPRON DEPOT (1-MONTH) KIT
LUPRON DEPOT (3-MONTH) KIT
LUPRON DEPOT (4-MONTH) KIT
LUPRON DEPOT-PED KIT [T4] [PA][SP][QL]
lutera tablet [T1] [ACA]
LUZU CREAM [T3]
LYNPARZA TABLET [T4] [PA][SP]
LYSODREN TABLET [T4] [PA][SP]
LYSTEDA TABLET [T3] [BP]
lyza tablet [T1] [ACA]
MMACRILEN PACKET [T4] [PA][SP]
MACROBID CAPSULE [T3] [BP]
MACRODANTIN CAPSULE [T3] [BP]
mafenide packet [T1]
magnesium solution [T1] [ACA]
MALARONE TABLET [T3] [BP]
malathion lotion [T1] [QL]
maprotiline tablet [T1]
marlissa tablet [T1] [ACA]
MARNATAL-F CAPSULE [T3]
MARPLAN TABLET [T3]
MATULANE CAPSULE [T4] [PA][SP]
matzim la 24 hr tab [T1]
MAVENCLAD TABLET [T4] [PA][SP]
MAXITROL OINTMENT [T3] [BP]
MAXITROL SUSPENSION [T3] [BP]
MAXX LUBRICATED MISC [T2] [ACA]
MAXZIDE TABLET [T3] [BP]
MAXZIDE-25 TABLET [T3] [BP]
MAYZENT TABLET [T4] [PA][SP]
18www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
md-gastroview solution [T1]
meclizine tablet
meclofenamate sodium capsule
[T1]
MEDIHONEY WOUND/BURN PASTE
[T3]
MEDROL DOSEPAK TABLET [T3] [BP]
MEDROL TABLET [T3] [BP]
medroxyprogesterone injection
[T1] [ACA]
medroxyprogesterone suspension
[T1] [ACA]
medroxyprogesterone tablet [T1]
mefenamic acid capsule [T1]
mefloquine tablet [T1] [QL]
MEGACE ES SUSPENSION [T3] [BP]
megestrol suspension [T1]
megestrol tablet [T1]
MEKINIST TABLET [T4] [PA][SP]
MEKTOVI TABLET [T4] [PA][SP]
meloxicam tablet [T1]
MELPHALAN TABLET [T4] [PA][SP]
memantine er 24 hour cap [T1]
memantine solution [T1]
memantine tablet [T1]
MEMBRANEBLUE SOLUTION [T3]
MENACTRA INJECTION [T2] [ACA]
MENEST TABLET [T3]
MENOSTAR PATCH [T3] [QL]
MENVEO SOLUTION [T3] [ACA]
meperidine solution [T1]
meperidine tablet [T1]
MEPHYTON TABLET [T3] [BP]
meprobamate tablet [T1]
MEPRON SUSPENSION [T3] [BP]
mercaptopurine tablet [T1]
mesalamine dr capsule (delayed release)
[T1]
mesalamine dr tablet [T1]
mesalamine enema [T1]
mesalamine er 24 hour cap [T1]
mesalamine suppository [T1]
MESNEX TABLET [T4] [PA][SP]
MESTINON SOLUTION [T3] [BP]
MESTINON TABLET [T3] [BP]
MESTINON TIMESPAN TABLET
[T3] [BP]
metadate er tablet [T1]
metaproterenol sulfate syrup [T1]
metaxalone tablet [T1]
metformin er 24 hr tab [T1]
metformin tablet [T1]
methadone [T1]
methadone intensol [T1]
methadone solution [T1] [BP]
methadone tablet [T1]
methadose [T1] [BP]
methadose sugarfree [T1] [BP]
methadose tablet [T1]
methamphetamine tablet [T1]
methazolamide tablet [T1]
methenamine hippurate tablet
[T1]
methergine tablet [T1]
methimazole tablet [T1]
METHITEST TABLET [T2]
methocarbamol tablet [T1]
methotrexate sodium solution
[T1]
methotrexate solution [T1]
methotrexate tablet [T1]
methoxsalen capsule [T1]
methscopolamine bromide tablet
[T1]
methyldopa tablet [T1]
methyldopa/hydrochlorothiazide tablet
[T1]
methylergonovine maleate tablet
[T1]
METHYLIN SOLUTION [T3] [BP]
methylphenidate cd capsule [T1] [QL]
methylphenidate chew tab [T1]
methylphenidate er 24 hour cap
[T1] [QL]
methylphenidate er 24 hr tab
[T1] [QL]
methylphenidate er capsule [T1] [QL]
methylphenidate er tablet [T1] [QL]
methylphenidate la 24 hour cap
[T1] [QL]
methylphenidate solution [T1]
methylphenidate tablet [T1]
methylprednisolone tablet [T1]
methyltestosterone capsule [T1]
metoclopramide solution [T1]
metoclopramide tablet [T1]
metolazone tablet [T1]
METOPIRONE CAPSULE [T3]
metoprolol er 24 hr tab [T1]
metoprolol tartrate tablet [T1]
metoprolol-hydrochlorothiazide tablet
[T1]
METROLOTION LOTION [T3] [BP]
metronidazole capsule [T1]
metronidazole gel [T1]
metronidazole lotion [T1]
metronidazole tablet [T1]
metronidazole vaginal gel [T1]
mexiletine capsule [T1]
miconazole 3 suppository [T1]
MICONAZOLE-ZINC OXIDE-PETROLTM OINTMENT
[T3]
microgestin 1.5/30 tablet [T1] [ACA]
microgestin 1/20 tablet [T1] [ACA]
microgestin fe 1.5/30 tablet [T1] [ACA]
microgestin fe tablet [T1] [ACA]
midazolam syrup [T1]
midodrine tablet [T1]
mifepristone tablet [T1]
migergot suppository [T1]
miglitol tablet [T1]
MIGLUSTAT CAPSULE [T4] [PA][SP]
mili tablet [T1] [ACA]
mimvey tablet [T1]
MINIPRESS CAPSULE [T3] [BP]
minitran patch [T1]
MINIVELLE PATCH [T3] [QL]
MINOCIN CAPSULE [T3] [BP]
minocycline capsule [T1]
minocycline tablet [T1]
minoxidil tablet [T1]
MIRAPEX ER 24 HR TAB [T3] [BP]
MIRAPEX TABLET [T3] [BP]
MIRCETTE TABLET [T3] [BP]
mirtazapine odt tablet [T1]
mirtazapine tablet [T1]
MIRVASO GEL [T2]
misoprostol tablet [T1]
MITIGARE CAPSULE [T2]
MITOSOL KIT [T3]
M-M-R II SOLUTION [T2] [ACA]
M-NATAL PLUS TABLET [T2]
MOBIC TABLET [T3] [BP]
modafinil tablet [T1] [QL]
19www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
moexipril tablet [T1]
molindone tablet [T1]
mometasone furoate cream [T1]
mometasone furoate ointment
[T1]
mometasone furoate solution
[T1]
mometasone furoate suspension
[T1] [QL]
mondoxyne nl capsule [T1]
mono-linyah tablet [T1] [ACA]
montelukast sodium chew tab
[T1]
montelukast sodium packet [T1]
montelukast sodium tablet [T1]
MONUROL PACKET [T3]
morgidox 1x100mg capsule [T1]
morgidox 2x100mg capsule [T1]
MORPHABOND ER 12 HR TAB [T3] [QL]
morphine sulfate er 24 hour cap
[T1] [QL]
morphine sulfate er tablet [T1] [QL]
morphine sulfate solution [T1]
morphine sulfate tablet [T1] [BP]
MOTEGRITY TABLET [T3] [PA]
MOVANTIK TABLET [T2] [QL]
MOVIPREP SOLUTION [T3]
moxifloxacin solution [T1]
moxifloxacin tablet [T1]
MS CONTIN TABLET [T3] [QL][BP]
MULTAQ TABLET [T3]
multivit w/fluoride & iron solution
[T1]
multi-vit/iron/fluoride solution
[T1]
multivitamin w/fluoride & iron solution
[T1]
multivitamin with fluoride chew tab
[T1]
multivitamin with fluoride solution
[T1]
multivitamin/fluoride chew tab
[T1]
multivitamin/fluoride solution
[T1]
mupirocin cream [T1]
mupirocin ointment [T1]
mvc-fluoride chew tab [T1]
my choice tablet [T1] [ACA]
my way tablet [T1] [ACA]
MYAMBUTOL TABLET [T3] [BP]
MYCOBUTIN CAPSULE [T3] [BP]
mycophenolate mofetil capsule
[T1]
mycophenolate mofetil suspension
[T1]
mycophenolate mofetil tablet
[T1]
mycophenolic acid dr tablet [T1]
MYDRIACYL SOLUTION [T3] [BP]
MYFORTIC TABLET [T3] [BP]
MYLERAN TABLET [T4] [PA][SP]
MYNATAL ADVANCE TABLET [T2]
MYNATAL CAPSULE [T2]
MYNATAL PLUS TABLET [T2]
MYNATAL ULTRACAPLET TABLET
[T2]
MYNATAL-Z TABLET [T2]
MYNATE 90 PLUS TABLET [T2]
myorisan capsule [T1]
MYRBETRIQ 24 HR TAB [T2]
MYSOLINE TABLET [T3] [BP]
MYTESI TABLET [T3]
MYXREDLIN SOLUTION [T3]
Nnabumetone tablet [T1]
nadolol tablet [T1]
naftifine gel [T1]
NALFON TABLET [T3]
naltrexone tablet [T1]
NAMENDA TABLET [T3] [BP]
NAMENDA TITRATION PAK TABLET
[T3] [BP]
NAMENDA XR 24 HOUR CAP [T3]
NAMZARIC 24 HOUR CAP [T2]
NAMZARIC CAPSULE [T2]
NAPROSYN SUSPENSION [T3] [BP]
naproxen dr tablet [T1]
naproxen sodium tablet [T1]
naproxen suspension [T1]
naproxen tablet [T1]
naratriptan tablet [T1] [QL]
NARCAN LIQUID [T2]
NARDIL TABLET [T3] [BP]
NATACHEW CHEW TAB [T3]
NATACYN SUSPENSION [T2]
NATAZIA TABLET [T3] [ACA]
nateglinide tablet [T1]
NATPARA INJECTION [T4] [PA][SP]
NATROBA SUSPENSION [T3]
nature-throid nt-2.5 tablet [T1]
nature-throid tablet [T1]
NAYZILAM SOLUTION [T2] [PA][QL]
NEBUPENT SOLUTION [T4] [PA][SP][BP]
necon 0.5/35-28 tablet [T1] [ACA]
NEEVO DHA CAPSULE [T3]
nefazodone tablet [T1]
neo/polymyxin/dexamethasone ointment
[T1]
neo/polymyxin/dexamethasone suspension
[T1]
neomycin sulfate tablet [T1]
neomycin/bacitracin/poly/hc ointment
[T1]
neomycin/bacitracin/polymyxin ointment
[T1]
neomycin/polymyxin/gramicidin solution
[T1]
neomycin/polymyxin/hc solution
[T1]
neomycin/polymyxin/hc suspension
[T1]
neomycin-polymyxin b solution
[T1]
neomycin-polymyxin-dexamethaso ointment
[T1]
neo-polycin hc ointment [T1]
neo-polycin ointment [T1]
NEORAL CAPSULE [T3]
NEORAL SOLUTION [T3]
NERLYNX TABLET [T4] [PA][SP]
NESTABS DHA MISC [T3]
NESTABS ONE CAPSULE [T3]
NESTABS TABLET [T3]
neuac gel [T1]
NEULASTA INJECTION [T4] [PA][SP]
NEULASTA ONPRO KIT INJECTION
[T4] [PA][SP]
NEUPRO PATCH [T3]
nevirapine er 24 hr tab [T1]
nevirapine suspension [T1]
nevirapine tablet [T1]
new day tablet [T1] [ACA]
NEXAVAR TABLET [T4] [PA][SP]
NEXIUM CAPSULE (DELAYED RELEASE)
[T3] [BP]
NEXIUM PACKET [T2] [BP]
niacin er tablet [T1]
20www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
niacin tablet [T1]
NIACOR TABLET [T3]
NIASPAN TABLET [T3] [BP]
nicardipine capsule [T1]
nicotine gum [T1] [ACA]
nicotine kit [T1] [ACA]
nicotine lozenge [T1] [ACA]
nicotine mini lozenge [T1] [ACA]
nicotine patch [T1] [ACA]
nicotine polacrilex gum [T1] [ACA]
nicotine polacrilex lozenge [T1] [ACA]
nicotine step 3 patch [T1] [ACA]
NICOTROL INHALER [T3] [ACA]
NICOTROL NS SOLUTION [T3] [ACA]
nifedipine capsule [T1]
nifedipine er 24 hr tab [T1]
nikki tablet [T1] [ACA]
NILANDRON TABLET [T4] [PA][SP][BP]
NILUTAMIDE TABLET [T4] [PA][SP]
nimodipine capsule [T1]
NINLARO CAPSULE [T4] [PA][SP]
nisoldipine er 24 hr tab [T1]
NITISINONE CAPSULE [T4] [PA][SP]
nitro-bid ointment [T1]
NITRO-DUR PATCH [T3]
nitrofurantoin capsule [T1]
nitrofurantoin macrocrystal capsule
[T1]
nitrofurantoin suspension [T1]
nitroglycerin lingual solution [T1]
nitroglycerin patch [T1]
nitroglycerin sl [T1]
NITROLINGUAL PUMPSPRAY SOLUTION
[T3] [BP]
NITROMIST AEROSOL [T3]
NITROSTAT SL [T3] [BP]
NITYR TABLET [T4] [PA][SP]
NIVA-PLUS TABLET [T3]
NIVESTYM INJECTION [T4] [PA][SP]
NIVESTYM SOLUTION [T4] [PA][SP]
nizatidine capsule [T1]
nizatidine solution [T1]
NIZORAL SHAMPOO [T3] [BP]
nora-be tablet [T1] [ACA]
NORDITROPIN FLEXPRO SOLUTION
[T4] [PA][SP]
norethindrone tablet [T1] [ACA]
norethindrone-ethin estradiol tablet
[T1] [ACA]
norethin-eth estra ferrous fum chew tab
[T1] [ACA]
norethin-eth estra ferrous fum tablet
[T1] [ACA]
NORGESIC FORTE TABLET [T3]
norgestimate-ethinyl estradiol tablet
[T1] [ACA]
norlyda tablet [T1] [ACA]
norlyroc tablet [T1] [ACA]
NORPACE CAPSULE [T3] [BP]
NORPACE CR CAPSULE [T3]
NORPRAMIN TABLET [T3] [BP]
NORTHERA CAPSULE [T4] [PA][SP]
nortrel 0.5/35 (28) tablet [T1] [ACA]
nortrel 1/35 tablet [T1] [ACA]
nortrel 7/7/7 tablet [T1] [ACA]
nortriptyline capsule [T1]
nortriptyline solution [T1]
NORVIR PACKET [T2]
NORVIR SOLUTION [T2]
NORVIR TABLET [T3] [BP]
NOURIANZ TABLET [T4] [PA][SP]
NOXAFIL SUSPENSION [T2] [PA]
NOXAFIL TABLET [T3] [PA][BP]
np thyroid 120 tablet [T1]
np thyroid 15 tablet [T1]
np thyroid 30 tablet [T1]
np thyroid 60 tablet [T1]
np thyroid 90 tablet [T1]
NUBEQA TABLET [T4] [PA][SP]
NUCALA INJECTION [T4] [PA][SP]
NUCYNTA ER 12 HR TAB [T2] [QL]
NUCYNTA TABLET [T2]
NUEDEXTA CAPSULE [T2]
nulev tablet [T1]
NULYTELY/FLAVOR PACKS SOLUTION
[T3] [BP]
NUMBRINO SOLUTION [T3]
NUPLAZID CAPSULE [T4] [PA][SP]
NUPLAZID TABLET [T4] [PA][SP]
NUVARING [T2] [QL][BP]
NUZYRA TABLET [T3]
nyamyc powder [T1]
NYMALIZE SOLUTION [T3]
nystatin cream [T1]
nystatin ointment [T1]
nystatin powder [T1]
nystatin suspension [T1]
nystatin tablet [T1]
nystatin w/triamcinolone cream
[T1]
nystatin w/triamcinolone ointment
[T1]
nystatin/triamcinolone cream
[T1]
nystatin/triamcinolone ointment
[T1]
nystop powder [T1]
OOASIS [T3]
OASIS WOUND MATRIX [T3]
OB COMPLETE ONE CAPSULE [T3]
OB COMPLETE PETITE CAPSULE
[T3]
OB COMPLETE PREMIER TABLET
[T3]
OB COMPLETE TABLET [T3]
OB COMPLETE/DHA CAPSULE [T3]
OBSTETRIX DHA MISC [T2]
OBSTETRIX EC TABLET [T3]
OBSTETRIX ONE CAPSULE [T3]
O-CAL PRENATAL TABLET [T3]
OCALIVA TABLET [T4] [PA][SP]
ocella tablet [T1] [ACA]
OCTREOTIDE SOLUTION [T4] [PA][SP]
OCUFLOX SOLUTION [T3] [BP]
ODEFSEY TABLET [T2] [QL]
ODOMZO CAPSULE [T4] [PA][SP]
OFEV CAPSULE [T4] [PA][SP]
ofloxacin solution [T1]
ofloxacin tablet [T1]
ogestrel tablet [T1] [ACA]
okebo capsule [T1]
olanzapine odt tablet [T1]
olanzapine tablet [T1]
olanzapine/fluoxetine capsule
[T1]
olmesartan medoxomil tablet
[T1]
olmesartan-amlodipine-hctz tablet
[T1]
olmesartan-hydrochlorothiazide tablet
[T1]
olopatadine solution [T1] [QL]
OLUX FOAM [T3]
21www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
OLUX-E FOAM [T3]
omega-3 acid ethyl esters capsule
[T1] [QL]
omeprazole capsule (delayed release)
[T1]
omeprazole dr capsule (delayed release)
[T1]
OMNIPAQUE SOLUTION [T3]
ondansetron odt tablet [T1] [QL]
ondansetron solution [T1]
ondansetron tablet [T1] [QL]
ONE TOUCH VERIO IQ KIT
ONE TOUCH VERIO STRIP
ONE TOUCH VERIO SYNC KIT
ONETOUCH ULTRA 2 KIT
ONETOUCH ULTRA MINI KIT
ONETOUCH ULTRA STRIP
ONETOUCH VERIO FLEX KIT
ONETOUCH VERIO KIT
ONEXTON GEL [T2]
ONFI SUSPENSION [T3] [BP]
ONFI TABLET [T3] [BP]
OPANA TABLET [T3] [BP]
opcicon one-step tablet [T1] [ACA]
OPSUMIT TABLET [T4] [PA][SP]
option 2 tablet [T1] [ACA]
options gynol ii vaginal gel [T1] [ACA]
ORACEA CAPSULE (DELAYED RELEASE)
[T2]
ORALAIR SL
oralone dental paste
ORAVIG TABLET [T3]
ORENITRAM TABLET [T4] [PA][SP]
ORFADIN SUSPENSION [T4] [PA][SP]
ORILISSA TABLET [T2] [PA]
ORKAMBI PACKET [T4] [PA][SP]
ORKAMBI TABLET [T4] [PA][SP]
orphenadrine er 12 hr tab [T1]
orphenadrine-aspirin-caffeine tablet
[T1]
orphengesic forte tablet [T1]
orsythia tablet [T1] [ACA]
ORTHO MICRONOR TABLET [T3]
oscimin tablet [T1]
oseltamivir phosphate capsule
[T1] [QL]
oseltamivir phosphate suspension
[T1]
OSENI TABLET [T3]
OSMOPREP TABLET [T3]
OTEZLA TABLET [T4] [PA][SP]
OTIPRIO SUSPENSION [T3] [PA]
OTREXUP INJECTION [T2]
OVIDE LOTION [T3] [QL]
oxandrolone tablet [T1]
oxaprozin tablet [T1]
oxazepam capsule [T1]
OXBRYTA TABLET
oxcarbazepine suspension [T1]
oxcarbazepine tablet [T1]
OXERVATE SOLUTION [T4] [PA][SP]
oxiconazole nitrate cream [T1]
OXISTAT CREAM [T3] [BP]
OXISTAT LOTION [T3]
OXSORALEN ULTRA CAPSULE [T3] [BP]
OXTELLAR XR 24 HR TAB [T3]
oxybutynin chloride er 24 hr tab
[T1]
oxybutynin chloride syrup [T1]
oxybutynin chloride tablet [T1]
oxycodone [T1]
oxycodone capsule [T1]
oxycodone solution [T1]
oxycodone tablet [T1]
oxycodone/acetaminophen tablet
[T1]
oxycodone/aspirin tablet [T1]
oxycodone/ibuprofen tablet [T1]
OXYCONTIN 12 HR TAB [T2] [QL]
oxymorphone er 12 hr tab [T1] [QL]
oxymorphone tablet [T1]
OZEMPIC INJECTION [T2] [QL]
Ppacerone tablet [T1]
paliperidone er 24 hr tab [T1]
PAMELOR CAPSULE [T3] [BP]
PANRETIN GEL [T3]
pantoprazole sodium dr tablet
[T1]
pantoprazole sodium tablet [T1]
PAREMYD SOLUTION [T3]
paricalcitol capsule [T1]
PARLODEL CAPSULE [T3] [BP]
PARLODEL TABLET [T3] [BP]
PARNATE TABLET [T3] [BP]
paroex solution
paromomycin sulfate capsule [T1]
paroxetine 24 hr tab [T1] [QL]
paroxetine er 24 hr tab [T1] [QL]
paroxetine tablet [T1]
PASER PACKET [T3]
PATANASE SOLUTION [T3] [QL][BP]
PAXIL CR 24 HR TAB [T3] [QL][BP]
PAXIL SUSPENSION [T3]
PAXIL TABLET [T3] [BP]
PAZEO SOLUTION [T2]
PEDIAPRED SOLUTION [T3] [BP]
PEDIARIX SUSPENSION [T2] [ACA]
PEDVAX HIB SUSPENSION [T2] [ACA]
peg 3350 packet [T1] [ACA]
peg 3350 powder [T1] [ACA]
peg 3350-electrolyte solution
[T1] [ACA]
peg3350 powder [T1] [ACA]
peg-3350/electrolytes solution
[T1] [ACA]
PEGANONE TABLET [T2]
PEGASYS PROCLICK SOLUTION
[T4] [PA][SP]
PEGASYS SOLUTION [T4] [PA][SP]
PEGINTRON KIT [T4] [PA][SP]
peg-prep kit [T1] [ACA]
penicillamine capsule [T1]
penicillamine tablet [T1]
penicillin v potassium solution
[T1]
penicillin v potassium tablet [T1]
PENTACEL SUSPENSION [T2] [ACA]
PENTAMIDINE ISETHIONATE SOLUTION
[T4] [PA][SP]
PENTASA CAPSULE [T2]
pentazocine/naloxone tablet [T1]
PENTETATE CALCIUM TRISODIUM SOLUTION
[T3]
PENTETATE ZINC TRISODIUM SOLUTION
[T3]
pentoxifylline er tablet [T1]
PEPCID TABLET [T3] [BP]
PERCOCET TABLET [T3] [BP]
PERFOROMIST NEBULIZED [T2]
perindopril erbumine tablet [T1]
periogard solution
permethrin cream [T1]
perphenazine tablet [T1]
22www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
phenadoz suppository [T1]
phenazopyridine tablet [T1]
phenelzine sulfate tablet [T1]
phenobarbital elixir [T1]
phenobarbital solution [T1]
phenobarbital tablet [T1]
PHENOXYBENZAMINE CAPSULE
[T4] [PA][SP]
phenylephrine solution [T1]
PHENYTEK CAPSULE [T3] [BP]
phenytoin chew tab [T1]
phenytoin infatabs chew tab [T1]
phenytoin sodium capsule [T1]
phenytoin suspension [T1]
philith tablet [T1] [ACA]
PHOSLYRA SOLUTION [T2]
PHOSPHOLINE IODIDE SOLUTION
[T2]
phosphorous tablet [T1]
phospho-trin 250 neutral tablet
[T1]
PHOTREXA CROSS-LINKING INJECTION
[T3]
PHOTREXA VISCOUS INJECTION
[T3]
physiolyte solution [T1]
physiosol irrigation solution [T1]
phytonadione tablet
PICATO GEL [T2]
pilocarpine solution [T1]
pilocarpine tablet [T1]
pimecrolimus cream [T1]
pimozide tablet [T1]
pimtrea tablet [T1] [ACA]
pindolol tablet [T1]
pioglitazone tablet [T1]
pioglitazone-glimepiride tablet
[T1]
pioglitazone-metformin tablet
[T1]
pirmella 1/35 tablet [T1] [ACA]
pirmella 7/7/7 tablet [T1] [ACA]
piroxicam capsule [T1]
PLEGISOL SOLUTION [T3] [BP]
PLEGRIDY INJECTION [T4] [PA][SP]
PLEGRIDY STARTER PACK INJECTION
[T4] [PA][SP]
PLENVU SOLUTION [T3]
PNEUMOVAX 23 INJECTION [T2] [ACA]
PNEUMOVAX 23/1 DOSE INJECTION
[T2] [ACA]
PNV TABS 29-1 TABLET [T2]
PNV-DHA CAPSULE [T2]
PNV-DHA+DOCUSATE CAPSULE
[T2]
PNV-OMEGA CAPSULE [T2]
PNV-SELECT TABLET [T2]
podofilox solution [T1]
polycin ointment [T1]
polyethylene glycol 3350 packet
[T1] [ACA]
polyethylene glycol 3350 powder
[T1] [ACA]
polyethylene glycol powder [T1] [ACA]
polymyxin b sul-trimethoprim solution
[T1]
POLYTRIM SOLUTION [T3] [BP]
POLY-VI-FLOR CHEW TAB [T3]
POLY-VI-FLOR SUSPENSION [T3]
POLY-VI-FLOR/IRON CHEW TAB
[T3]
POLY-VI-FLOR/IRON SUSPENSION
[T3]
POMALYST CAPSULE [T4] [PA][SP]
portia-28 tablet [T1] [ACA]
posaconazole dr tablet [T1] [PA]
potassium chloride cr tablet [T1]
potassium chloride er capsule
[T1]
potassium chloride er tablet [T1]
potassium chloride packet [T1]
potassium chloride solution [T1]
potassium chloride sr tablet [T1]
potassium er tablet [T1]
PR NATAL 400 EC MISC [T2]
PR NATAL 400 MISC [T2]
PR NATAL 430 EC MISC [T2]
PR NATAL 430 MISC [T2]
PRALUENT INJECTION [T4] [PA][SP]
pramipexole di-hcl tablet [T1]
pramipexole er 24 hr tab [T1]
prasugrel tablet [T1]
pravastatin sodium tablet [T1] [QL]
praziquantel tablet [T1]
prazosin capsule [T1]
PRECISION XTRA
PRECISION XTRA KIT
PRECISION XTRA STRIP
PRECOSE TABLET [T3] [BP]
PRED FORTE SUSPENSION [T3]
PRED-G S.O.P. OINTMENT [T3]
PRED-G SUSPENSION [T3]
prednicarbate cream [T1]
prednicarbate ointment [T1]
PREDNISOLONE AC-MOXIFLOX-BROMF SUSPENSION
[T3]
prednisolone sodium phosphate solution
[T1]
prednisolone solution [T1]
prednisolone suspension [T1]
PREDNISOLONE-GATIFLOXACIN SUSPENSION
[T3]
PREDNISOLONE-GATIFLOX-BROMFENC SUSPENSION
[T3]
prednisone intensol [T1]
prednisone solution [T1]
prednisone tablet [T1]
PREFEST TABLET [T3]
pregabalin capsule [T1] [QL]
pregabalin solution [T1] [QL]
PREMARIN CREAM [T2]
PREMARIN TABLET [T2]
PREMPHASE TABLET [T2]
PREMPRO TABLET [T2]
PRENA 1 TRUE MISC [T2]
PRENA1 CHEW CHEW TAB [T2]
PRENA1 PEARL CAPSULE [T2]
PRENAISSANCE CAPSULE [T2]
PRENAISSANCE PLUS CAPSULE
[T2]
PRENATA CHEW TAB [T3]
PRENATABS RX TABLET [T2]
PRENATAL 19 CHEW TAB [T2]
PRENATAL 19 TABLET [T2]
PRENATAL PLUS IRON TABLET
[T2]
PRENATAL PLUS TABLET [T2]
PRENATAL PLUS-DHA MISC [T3]
PRENATAL TABLET [T2]
PRENATAL VITAMIN PLUS LOW IRON TABLET
[T2]
PRENATAL-U CAPSULE [T2]
PRENATE AM TABLET [T3]
PRENATE CHEW TAB [T3]
PRENATE DHA CAPSULE [T3]
PRENATE ELITE TABLET [T3]
23www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
PRENATE ENHANCE CAPSULE [T3]
PRENATE ESSENTIAL CAPSULE
[T3]
PRENATE MINI CAPSULE [T3]
PRENATE PIXIE CAPSULE [T3]
PRENATE RESTORE CAPSULE [T3]
PREPIDIL GEL [T3]
PREPLUS TABLET [T2]
PREPOPIK PACKET [T2]
PRETAB TABLET [T2]
PRETOMANID TABLET
prevalite packet [T1]
prevalite powder [T1]
previfem tablet [T1] [ACA]
PREVNAR 13 SUSPENSION [T2] [ACA]
PREVYMIS TABLET [T4] [PA][SP]
PREZISTA SUSPENSION [T2]
PREZISTA TABLET [T2]
PRIFTIN TABLET [T2]
PRIMACARE CAPSULE [T3]
primaquine phosphate tablet [T1] [BP]
primidone tablet [T1]
PRIMSOL SOLUTION [T3]
PRINIVIL TABLET [T3] [BP]
PROAIR DIGIHALER AEROSOL [T3]
PROAIR HFA AEROSOL [T2] [QL]
PROAIR RESPICLICK AEROSOL [T2] [QL]
probenecid tablet [T1]
probenecid/colchicine tablet [T1]
PROCARDIA CAPSULE [T3] [BP]
PROCARDIA XL 24 HR TAB [T3]
procentra solution [T1]
prochlorperazine maleate tablet
[T1]
prochlorperazine suppository
[T1]
PROCRIT SOLUTION [T4] [PA][SP]
PROCTOCORT CREAM [T3] [BP]
PROCTOFOAM HC FOAM [T3]
procto-med hc cream [T1]
procto-pak cream [T1]
proctosol hc cream [T1]
proctozone-hc cream [T1]
PROCYSBI CAPSULE (DELAYED RELEASE)
[T4] [PA][SP]
PROCYSBI PACKET [T3]
progesterone capsule [T1]
progesterone oil [T1]
PROGLYCEM SUSPENSION [T2] [BP]
PROGRAF CAPSULE [T3] [BP]
PROGRAF PACKET [T2] [PA]
PROMACTA PACKET [T4] [PA][SP]
PROMACTA TABLET [T4] [PA][SP]
promethazine plain syrup [T1]
promethazine solution [T1]
promethazine suppository [T1]
promethazine syrup [T1]
promethazine tablet [T1]
promethazine vc syrup [T1]
promethazine vc w/codeine syrup
[T1]
promethazine w/dm syrup [T1]
promethazine/codeine solution
[T1]
promethazine/codeine syrup [T1]
promethegan suppository [T1]
PROMETRIUM CAPSULE [T3] [BP]
propafenone er capsule [T1]
propafenone tablet [T1]
propantheline bromide tablet
[T1]
proparacaine solution [T1]
propranolol er 24 hour cap [T1]
propranolol solution [T1]
propranolol tablet [T1]
propranolol-hctz tablet [T1]
propylthiouracil tablet [T1]
PROQUAD SUSPENSION [T2] [ACA]
PROSCAR TABLET [T3] [BP]
PROSTIN E2 SUPPOSITORY [T3]
PROTOPIC OINTMENT [T3] [BP]
protriptyline tablet [T1]
PROVERA TABLET [T3] [BP]
PROVIDA OB CAPSULE [T3]
PROVOCHOLINE SOLUTION [T3]
prudoxin cream [T1] [QL]
prutect emulsion [T1]
PULMICORT FLEXHALER AEROSOL
[T2] [QL]
PULMOZYME SOLUTION [T4] [PA][SP]
PURIXAN SUSPENSION [T4] [PA][SP]
px aspirin chew tab [T1] [ACA]
px aspirin tablet [T1] [ACA]
px laxative tablet [T1] [ACA]
px stop smoking aid lozenge [T1] [ACA]
pyrazinamide tablet [T1]
pyridostigmine bromide er tablet
[T1]
pyridostigmine bromide solution
[T1]
pyridostigmine bromide tablet
[T1]
PYRIMETHAMINE TABLET [T4] [PA][SP]
QQBREXZA PADS [T2]
qc aspirin low dose chew tab [T1] [ACA]
qc aspirin low dose tablet [T1] [ACA]
qc aspirin tablet [T1] [ACA]
qc enteric aspirin tablet [T1] [ACA]
qc magnesium solution [T1] [ACA]
qc natura-lax powder [T1] [ACA]
QNASL AEROSOL [T2]
QNASL CHILDRENS AEROSOL [T2]
QTERN TABLET [T3]
QUADRACEL SUSPENSION [T2] [ACA]
QUALAQUIN CAPSULE [T3] [QL][BP]
QUARTETTE TABLET [T3] [BP]
QUAZEPAM TABLET [T3]
QUESTRAN LIGHT POWDER [T3] [BP]
QUESTRAN PACKET [T3] [BP]
QUESTRAN POWDER [T3] [BP]
quetiapine fumarate er 24 hr tab
[T1]
quetiapine fumarate tablet [T1]
QUFLORA FE PEDIATRIC LIQUID
[T3]
QUFLORA GUMMIES CHEW TAB
[T3]
QUFLORA PEDIATRIC CHEW TAB
[T3]
quflora pediatric solution [T1]
QUILLIVANT XR INJECTION [T2] [QL]
quinapril tablet [T1]
quinapril-hydrochlorothiazide tablet
[T1]
quinidine gluconate cr tablet [T1]
quinidine gluconate er tablet [T1]
quinidine sulfate tablet [T1]
quinine sulfate capsule [T1] [QL]
QVAR REDIHALER INHALER [T2] [QL]
Rra aspirin childrens chew tab [T1] [ACA]
ra aspirin ec tablet [T1] [ACA]
24www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
ra aspirin tablet [T1] [ACA]
ra folic acid tablet [T1] [ACA]
ra laxative powder [T1] [ACA]
ra laxative tablet [T1] [ACA]
ra magnesium solution [T1] [ACA]
ra mini nicotine lozenge [T1] [ACA]
ra nicotine gum [T1] [ACA]
ra nicotine patch [T1] [ACA]
ra nicotine polacrilex lozenge [T1] [ACA]
ra womens laxative tablet [T1] [ACA]
rabeprazole sodium tablet [T1]
RADIOGARDASE CAPSULE [T3]
raloxifene tablet [T1] [ACA]
ramelteon tablet [T1] [QL]
ramipril capsule [T1]
RANEXA 12 HR TAB [T3] [BP]
ranolazine er 12 hr tab [T1]
RAPAMUNE SOLUTION [T3] [BP]
RAPAMUNE TABLET [T3] [BP]
rasagiline mesylate tablet [T1]
RASUVO INJECTION [T2]
RAVICTI LIQUID [T4] [PA][SP]
RAZADYNE ER 24 HOUR CAP [T3] [BP]
RAZADYNE TABLET [T3] [BP]
READI-CAT 2 SUSPENSION [T3]
READI-CAT SUSPENSION [T3]
REBIF INJECTION [T4] [PA][SP]
REBIF REBIDOSE INJECTION [T4] [PA][SP]
REBIF REBIDOSE TITRATION INJECTION
[T4] [PA][SP]
REBIF TITRATION PACK INJECTION
[T4] [PA][SP]
reclipsen tablet [T1] [ACA]
RECOMBIVAX HB SUSPENSION
[T2] [ACA]
RECOTHROM SOLUTION [T3]
RECOTHROM SPRAY KIT SOLUTION
[T3]
RECTIV OINTMENT [T2]
REGLAN TABLET [T3] [BP]
REGRANEX GEL [T2]
RELENZA DISKHALER AEROSOL
[T3] [QL]
RELEXXII TABLET [T3]
RELISTOR TABLET [T4] [PA][SP]
RELPAX TABLET [T3] [QL][BP]
REMERON SOLTAB TABLET [T3] [BP]
REMERON TABLET [T3] [BP]
RENACIDIN SOLUTION [T2]
reno caps capsule
RENVELA PACKET [T3] [BP]
RENVELA TABLET [T3] [BP]
repaglinide tablet [T1]
REPATHA INJECTION [T4] [PA][SP]
REPATHA PUSHTRONEX INJECTION
[T4] [PA][SP]
REPATHA SURECLICK INJECTION
[T4] [PA][SP]
REPLACEMENT PEDIATRIC MONITOR
REQUIP XL 24 HR TAB [T3] [BP]
RESECTISOL SOLUTION [T2]
RESTASIS EMULSION [T2] [QL]
RESTASIS MULTIDOSE EMULSION
[T2] [QL]
RESTORIL CAPSULE [T3] [BP]
RETACRIT SOLUTION [T4] [PA][SP]
RETIN-A CREAM [T3] [BP]
RETIN-A GEL [T3] [BP]
RETIN-A MICRO GEL [T3] [BP]
RETIN-A MICRO PUMP GEL [T3] [BP]
RETROVIR CAPSULE [T3] [BP]
RETROVIR SYRUP [T3] [BP]
REVATIO SUSPENSION [T3] [PA][BP]
REVATIO TABLET [T3] [PA][BP]
REVLIMID CAPSULE [T4] [PA][SP]
REXULTI TABLET [T3]
REYATAZ CAPSULE [T3] [BP]
REYATAZ PACKET [T2]
REYVOW TABLET
RHOFADE CREAM [T3]
RHOPRESSA SOLUTION [T2]
RIBAVIRIN CAPSULE [T4] [PA][SP]
RIBAVIRIN SOLUTION [T4] [PA][SP]
RIBAVIRIN TABLET [T4] [PA][SP]
RIDAURA CAPSULE [T2]
rifabutin capsule [T1]
RIFADIN CAPSULE [T3] [BP]
RIFAMATE CAPSULE [T3]
rifampin capsule [T1]
RIFATER TABLET [T3]
RILUTEK TABLET [T4] [PA][SP][BP]
RILUZOLE TABLET [T4] [PA][SP]
rimantadine tablet [T1]
ringers irrigation solution [T1]
RINVOQ 24 HR TAB [T4] [PA][SP]
RIOMET ER INJECTION [T3]
risedronate sodium dr tablet [T1] [QL]
risedronate sodium tablet [T1] [QL]
RISPERDAL SOLUTION [T3] [BP]
RISPERDAL TABLET [T3] [BP]
risperidone odt tablet [T1]
risperidone solution [T1]
risperidone tablet [T1]
RITALIN LA 24 HOUR CAP [T3] [QL]
RITALIN TABLET [T3] [BP]
ritonavir tablet [T1]
rivastigmine tartrate capsule [T1]
rivastigmine transdermal patch
[T1]
rivelsa tablet [T1] [ACA]
rizatriptan benzoate odt tablet
[T1] [QL]
rizatriptan benzoate tablet [T1] [QL]
R-NATAL OB CAPSULE [T3]
ROBAXIN-750 TABLET [T3] [BP]
ROCALTROL CAPSULE [T3] [BP]
ROCALTROL SOLUTION [T3] [BP]
ROCKLATAN SOLUTION [T3]
ropinirole er 24 hr tab [T1]
ropinirole tablet [T1]
rosadan gel [T1]
rosuvastatin calcium tablet [T1] [QL]
ROTARIX SUSPENSION [T3] [ACA]
ROTATEQ SOLUTION [T2] [ACA]
roweepra tablet [T1]
roweepra xr 24 hr tab [T1]
ROXICODONE TABLET [T3] [BP]
ROZEREM TABLET [T3] [QL][BP]
ROZLYTREK CAPSULE [T4] [PA][SP]
RUBRACA TABLET [T4] [PA][SP]
RUZURGI TABLET [T4] [PA][SP]
RYBELSUS TABLET [T2] [QL]
RYDAPT CAPSULE [T4] [PA][SP]
RYTHMOL SR CAPSULE [T3] [BP]
SSABRIL PACKET [T4]
[PA][SP][BP]
SABRIL TABLET [T4] [PA][SP][BP]
SAFYRAL TABLET [T3] [BP]
SALAGEN TABLET [T3] [BP]
25www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
SAMSCA TABLET [T4] [PA][SP]
SANCUSO PATCH [T3] [QL]
SANDIMMUNE CAPSULE [T3]
SANDIMMUNE SOLUTION [T2]
SANDOSTATIN SOLUTION [T4] [PA][SP][BP]
SANTYL OINTMENT [T2]
SAPHRIS SL [T3] [QL]
SARAFEM TABLET [T3]
SAVELLA TABLET [T2]
SAVELLA TITRATION PACK MISC
[T2]
sb aspirin tablet [T1] [ACA]
sb bisacodyl laxative ec tablet
[T1] [ACA]
sb childrens aspirin chew tab [T1] [ACA]
sb low dose asa ec tablet [T1] [ACA]
scopolamine patch [T1]
SEASONIQUE TABLET [T3] [BP]
seconal sodium capsule [T1]
SECUADO PATCH
SEEBRI NEOHALER CAPSULE [T3]
SEGLUROMET TABLET [T2] [QL]
SELECT-OB CHEW TAB [T3]
SELECT-OB+DHA MISC [T3]
selegiline capsule [T1]
selegiline tablet [T1]
selenium sulfide lotion [T1]
SELZENTRY SOLUTION [T2]
SELZENTRY TABLET [T2]
SE-NATAL 19 CHEW TAB [T2]
SE-NATAL 19 TABLET [T2]
SENSIPAR TABLET [T4] [PA][SP][BP]
SEREVENT DISKUS AEROSOL [T2] [QL]
SEROSTIM SOLUTION [T4] [PA][SP]
sertraline [T1]
sertraline tablet [T1]
setlakin tablet [T1] [ACA]
sevelamer carbonate packet [T1]
sevelamer carbonate tablet [T1]
sevelamer tablet [T1]
sevoflurane solution [T1]
SFROWASA ENEMA [T3]
sharobel tablet [T1] [ACA]
SHINGRIX SUSPENSION [T2] [ACA]
SIGNIFOR SOLUTION [T4] [PA][SP]
sildenafil suspension [T1] [PA]
sildenafil tablet [T1] [PA]
SILENOR TABLET [T3] [BP]
silodosin capsule [T1]
SILVADENE CREAM [T3] [BP]
silver sulfadiazine cream [T1]
SILVERSEAL HYDROGEL PADS [T3]
SIMBRINZA SUSPENSION [T3]
simliya tablet [T1] [ACA]
simpesse tablet [T1] [ACA]
SIMPONI INJECTION [T4] [PA][SP]
simvastatin tablet [T1] [ACA][QL]
SINEMET TABLET [T3] [BP]
sirolimus solution [T1]
sirolimus tablet [T1]
SIRTURO TABLET [T2] [PA]
SITZMARKS CAPSULE [T3]
SIVEXTRO TABLET [T3] [PA]
SKELAXIN TABLET [T3] [BP]
SKLICE LOTION [T3] [QL]
SKYRIZI INJECTION [T4] [PA][SP]
SLYND TABLET [T3] [ACA]
sm aspirin low dose chew tab
[T1] [ACA]
sm aspirin tablet [T1] [ACA]
sm childrens aspirin chew tab
[T1] [ACA]
sm clearlax powder [T1] [ACA]
sm folic acid tablet [T1] [ACA]
sm gentle laxative tablet [T1] [ACA]
sm magnesium solution [T1] [ACA]
sm nicotine gum [T1] [ACA]
sm nicotine lozenge [T1] [ACA]
sm nicotine polacrilex gum [T1] [ACA]
sm nicotine polacrilex lozenge
[T1] [ACA]
smooth lax packet [T1] [ACA]
smooth lax powder [T1] [ACA]
sodium chloride 0.9% solution
[T1]
sodium chloride nebulized [T1]
sodium chloride solution [T1]
sodium fluoride chew tab [T1] [ACA]
sodium fluoride solution [T1] [ACA]
SODIUM PHENYLBUTYRATE POWDER
[T4] [PA][SP]
SODIUM PHENYLBUTYRATE TABLET
[T4] [PA][SP]
sodium polystyrene sulfonate powder
[T1]
sodium polystyrene sulfonate suspension
[T1]
SODIUM SOLUTION [T3]
sodium sulfacetamide lotion [T1]
sodium sulfacetamide solution
[T1]
SOF-SENSOR MISC
solifenacin tablet [T1]
SOLIQUA 100/33 INJECTION [T2] [QL]
SOLOSEC PACKET [T3]
SOLTAMOX SOLUTION [T3]
SOMA TABLET [T3] [BP]
SOMAVERT SOLUTION [T4] [PA][SP]
sonafine emulsion [T1]
SORBITOL SOLUTION [T3]
SORBITOL-MANNITOL SOLUTION
[T3]
SORIATANE CAPSULE [T3] [BP]
sorine tablet [T1]
sotalol (af) tablet [T1]
sotalol af tablet [T1]
sotalol hydrocholride tablet [T1]
sotalol tablet [T1]
SOTYLIZE SOLUTION [T2]
SOVALDI TABLET [T4] [PA][SP]
SPECTRACEF TABLET [T3]
spinosad suspension [T1]
spironolactone tablet [T1]
spironolactone w/hctz tablet [T1]
SPORANOX CAPSULE [T3] [BP]
SPORANOX PULSEPAK CAPSULE
[T3] [BP]
SPORANOX SOLUTION [T3] [BP]
sprintec 28 tablet [T1] [ACA]
SPRYCEL TABLET [T4] [PA][SP]
sps suspension [T1]
sronyx tablet [T1] [ACA]
ssd cream [T1]
st joseph aspirin tablet [T1] [ACA]
st. joseph aspirin chew tab [T1] [ACA]
STALEVO 100 TABLET [T3]
STALEVO 125 TABLET [T3]
STALEVO 150 TABLET [T3]
STALEVO 200 TABLET [T3]
STALEVO 50 TABLET [T3]
STALEVO 75 TABLET [T3]
STARLIX TABLET [T3] [BP]
stavudine capsule [T1]
26www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
STEGLATRO TABLET [T2] [QL]
STEGLUJAN TABLET [T3] [QL]
STELARA INJECTION [T4] [PA][SP]
STELARA SOLUTION [T4] [PA][SP]
sterile water irrigation solution
[T1]
STIMATE SOLUTION [T4] [PA][SP]
STIVARGA TABLET [T4] [PA][SP]
STRAVIX [T3]
STROMECTOL TABLET [T3] [BP]
SUBOXONE FILM [T2] [QL][BP]
subvenite kit [T1] [QL]
subvenite tablet [T1]
SUCRAID SOLUTION [T4] [PA][SP]
sucralfate suspension [T1]
sucralfate tablet [T1]
SULAR 24 HR TAB [T3] [BP]
SULCONAZOLE NITRATE CREAM
[T3]
SULCONAZOLE NITRATE SOLUTION
[T3]
sulfacetamide sodium lotion [T1]
sulfacetamide sodium ointment
[T1]
sulfacetamide sodium solution
[T1]
sulfacetamide w/prednisolone solution
[T1]
sulfadiazine tablet [T1]
sulfamethoxazole/trimethoprim suspension
[T1]
sulfamethoxazole/trimethoprim tablet
[T1]
SULFAMYLON CREAM [T2]
SULFAMYLON PACKET [T3] [BP]
sulfasalazine tablet [T1]
sulfatrim pediatric suspension
[T1]
sulindac tablet [T1]
sumatriptan injection [T1] [QL]
sumatriptan solution [T1] [QL]
sumatriptan tablet [T1] [QL]
SUNOSI TABLET [T2] [QL]
SUPRANE SOLUTION [T3] [BP]
SUPRAX CAPSULE [T3] [BP]
SUPRAX SUSPENSION [T3] [BP]
SUPREP BOWEL PREP KIT SOLUTION
[T2]
SURVANTA INTRATRACHEAL SUSPENSION
[T3]
SUSTIVA CAPSULE [T3] [BP]
SUSTIVA TABLET [T3] [BP]
SUTENT CAPSULE [T4] [PA][SP]
syeda tablet [T1] [ACA]
SYMBICORT AEROSOL [T2] [QL]
SYMBYAX CAPSULE [T3] [BP]
SYMDEKO TABLET [T4] [PA][SP]
SYMFI LO TABLET [T2] [QL]
SYMFI TABLET [T2] [QL]
SYMJEPI INJECTION [T2] [QL]
SYMLINPEN 120 INJECTION [T2] [QL]
SYMLINPEN 60 INJECTION [T2] [QL]
SYMPROIC TABLET [T2] [QL]
SYMTUZA TABLET [T2] [QL]
SYNALAR OINTMENT [T3] [BP]
SYNAREL SOLUTION [T4] [PA][SP]
SYNERA PATCH [T3]
SYNJARDY TABLET [T2] [QL]
SYNJARDY XR 24 HR TAB [T2] [QL]
SYNTHROID TABLET [T3] [BP]
SYPRINE CAPSULE [T4] [PA][SP][BP]
SYRINGE AVITENE MISC [T3]
TTABLOID TABLET [T3]
TACHOSIL PATCH [T3]
tacrolimus capsule [T1]
tacrolimus ointment [T1]
tadalafil tablet [T1] [PA]
TAFINLAR CAPSULE [T4] [PA][SP]
TAGITOL V SUSPENSION [T3]
TAGRISSO TABLET [T4] [PA][SP]
take action tablet [T1] [ACA]
TALICIA CAPSULE (DELAYED RELEASE)
TALZENNA CAPSULE [T4] [PA][SP]
TAMIFLU CAPSULE [T3] [QL][BP]
TAMIFLU SUSPENSION [T3] [BP]
tamoxifen tablet [T1] [ACA]
tamsulosin capsule [T1]
TAPAZOLE TABLET [T3] [BP]
TAPERDEX 12-DAY TABLET [T3]
TARCEVA TABLET [T4] [PA][SP][BP]
TARGRETIN CAPSULE [T4] [PA][SP][BP]
TARGRETIN GEL [T4] [PA][SP]
tarina 24 fe tablet [T1] [ACA]
tarina fe 1/20 eq tablet [T1] [ACA]
tarina fe 1/20 tablet [T1] [ACA]
TARKA TABLET [T3] [BP]
TARON-C DHA CAPSULE [T2]
TARON-PREX CAPSULE [T2]
TASIGNA CAPSULE [T4] [PA][SP]
TASMAR TABLET [T3] [BP]
TAVALISSE TABLET [T4] [PA][SP]
tazarotene cream [T1]
TAZORAC CREAM [T2] [BP]
TAZORAC GEL [T2]
taztia xt 24 hour cap [T1]
TAZVERIK TABLET
TC99M SULFUR COLLOID PREP KIT
[T3]
TDVAX SUSPENSION [T2] [ACA]
TECFIDERA CAPSULE (DELAYED RELEASE)
[T4] [PA][SP]
TECFIDERA STARTER PACK MISC
[T4] [PA][SP]
TEGRETOL SUSPENSION [T3] [BP]
TEGRETOL TABLET [T3] [BP]
TEGRETOL-XR 12 HR TAB [T3] [BP]
TEGSEDI INJECTION [T4] [PA][SP]
TEKTURNA HCT TABLET [T2]
TEKTURNA TABLET [T2] [BP]
telmisartan tablet [T1]
telmisartan/amlodipine tablet
[T1]
telmisartan-hydrochlorothiazid tablet
[T1]
temazepam capsule [T1]
TEMIXYS TABLET [T2] [QL]
TEMODAR CAPSULE [T4] [PA][SP][BP]
TEMOVATE OINTMENT [T3] [BP]
TEMOZOLOMIDE CAPSULE [T4] [PA][SP]
TENIVAC INJECTION [T3] [ACA]
tenofovir disoproxil fumarate tablet
[T1]
TENORETIC 100 TABLET [T3] [BP]
TENORETIC 50 TABLET [T3] [BP]
TENORMIN TABLET [T3] [BP]
terazosin capsule [T1]
terbinafine tablet [T1]
terbutaline sulfate solution [T1]
terbutaline sulfate tablet [T1]
terconazole cream [T1]
27www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
terconazole suppository [T1]
terrell solution [T1]
TESSALON PERLES CAPSULE [T3] [BP]
testosterone cypionate solution
[T1]
testosterone enanthate solution
[T1]
testosterone gel [T1] [QL]
testosterone pump gel [T1] [QL]
testosterone solution [T1] [QL]
TETRABENAZINE TABLET [T4] [PA][SP]
tetracaine solution [T1]
tetracycline capsule [T1]
tgt aspirin chew tab [T1] [ACA]
tgt aspirin low dose tablet [T1] [ACA]
tgt aspirin tablet [T1] [ACA]
tgt childrens aspirin chew tab
[T1] [ACA]
tgt gentle laxative tablet [T1] [ACA]
tgt nicotine gum [T1] [ACA]
tgt nicotine polacrilex gum [T1] [ACA]
tgt nicotine polacrilex lozenge
[T1] [ACA]
tgt nicotine step one patch [T1] [ACA]
tgt nicotine step three patch [T1] [ACA]
tgt nicotine step two patch [T1] [ACA]
tgt powderlax [T1] [ACA]
tgt powderlax packet [T1] [ACA]
tgt womens laxative tablet [T1] [ACA]
THALOMID CAPSULE [T4] [PA][SP]
THEO-24 24 HOUR CAP [T3]
theophylline er 12 hr tab [T1]
theophylline er 24 hr tab [T1]
theophylline solution [T1]
THIOLA EC TABLET [T4] [PA][SP]
THIOLA TABLET [T4] [PA][SP]
thioridazine tablet [T1]
thiothixene capsule [T1]
THRIVITE 19 TABLET
THRIVITE RX TABLET [T3]
THROMBI-GEL 10 PADS [T3]
THROMBI-GEL 100 PADS [T3]
THROMBI-GEL 40 PADS [T3]
THROMBIN-JMI DILUENT SOLUTION
[T3]
THROMBIN-JMI EPISTAXIS [T3]
THROMBIN-JMI KIT [T3]
THROMBIN-JMI W/DIL SPRAY KIT
[T3]
THROMBI-PAD PADS [T3]
tiadylt er 24 hour cap [T1]
tiagabine tablet [T1]
TIAZAC 24 HOUR CAP [T3]
TIBSOVO TABLET [T4] [PA][SP]
TIGAN CAPSULE [T3] [BP]
tilia fe tablet [T1] [ACA]
timolol maleate solution [T1]
timolol maleate tablet [T1]
TIMOPTIC SOLUTION [T3] [BP]
TIMOPTIC-XE SOLUTION [T3]
tinidazole tablet [T1]
TIROSINT-SOL SOLUTION [T3]
TISSEEL KIT [T3]
TISSEEL SOLUTION [T3]
tis-u-sol solution [T1]
TIVICAY TABLET [T2]
tizanidine capsule [T1]
tizanidine tablet [T1]
TOBI PODHALER CAPSULE [T4] [PA][SP]
TOBRADEX OINTMENT [T2]
TOBRADEX ST SUSPENSION [T2]
TOBRADEX SUSPENSION [T3] [BP]
TOBRAMYCIN NEBULIZED [T4] [PA][SP]
tobramycin solution [T1]
tobramycin sulfate solution [T1]
tobramycin/dexamethasone suspension
[T1]
TOBREX OINTMENT [T3]
TOBREX SOLUTION [T3] [BP]
TODAY SPONGE MISC [T2] [ACA]
tolbutamide tablet [T1]
tolcapone tablet [T1]
tolmetin sodium capsule [T1]
tolmetin sodium tablet [T1]
tolterodine tartrate er 24 hour cap
[T1]
tolterodine tartrate tablet [T1]
topiramate capsule [T1]
topiramate tablet [T1]
TOPROL XL 24 HR TAB [T3] [BP]
toremifene tablet [T1]
torsemide tablet [T1]
TOUJEO MAX SOLOSTAR INJECTION
[T2] [QL]
TOUJEO SOLOSTAR INJECTION
[T2] [QL]
TOVIAZ 24 HR TAB [T2]
TRACLEER TABLET [T4] [PA][SP][BP]
TRADJENTA TABLET [T2] [QL]
tramadol er 24 hr tab [T1]
tramadol tablet [T1]
tramadol-acetaminophen tablet
[T1]
trandolapril tablet [T1]
trandolapril-verapamil tablet [T1]
tranexamic acid tablet [T1]
TRANSDERM SCOP PATCH [T3] [BP]
TRANSDERM-SCOP PATCH [T3] [BP]
TRANXENE T TABLET [T3]
tranylcypromine sulfate tablet
[T1]
TRAVATAN Z SOLUTION [T2] [BP]
travoprost solution [T1]
trazodone tablet [T1]
TRECATOR TABLET [T3]
TRELEGY ELLIPTA AEROSOL [T2] [QL]
TREMFYA INJECTION [T4] [PA][SP]
TRESIBA FLEXTOUCH INJECTION
[T2] [QL]
TRESIBA SOLUTION [T2] [QL]
TRETINOIN CAPSULE [T4] [PA][SP]
tretinoin cream [T1]
tretinoin gel [T1]
tretinoin microsphere gel [T1]
TREXALL TABLET [T3]
TREZIX CAPSULE [T3]
tri femynor tablet [T1] [ACA]
triamcinolone acetonide cream
[T1]
triamcinolone acetonide lotion
[T1]
triamcinolone acetonide ointment
[T1]
triamcinolone acetonide paste
triamterene capsule [T1]
triamterene w/hctz capsule [T1]
triamterene w/hctz tablet [T1]
triazolam tablet [T1]
TRICARE TABLET [T3]
TRICITRASOL [T2]
triderm cream [T1]
TRIENTINE CAPSULE [T4] [PA][SP]
28www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
tri-estarylla tablet [T1] [ACA]
TRIFERIC PACKET [T3]
TRIFERIC SOLUTION [T3]
trifluoperazine tablet [T1]
trifluridine solution [T1]
TRIGLIDE TABLET [T3]
trihexyphenidyl solution [T1]
trihexyphenidyl tablet [T1]
TRIKAFTA TABLET
tri-legest fe tablet [T1] [ACA]
tri-linyah tablet [T1] [ACA]
TRILIPIX CAPSULE (DELAYED RELEASE)
[T3] [BP]
tri-lo-estarylla tablet [T1] [ACA]
tri-lo-marzia tablet [T1] [ACA]
tri-lo-mili tablet [T1] [ACA]
tri-lo-sprintec tablet [T1] [ACA]
trilyte solution [T1] [ACA]
trimethobenzamide capsule [T1]
trimethoprim tablet [T1]
tri-mili tablet [T1] [ACA]
trimipramine maleate capsule
[T1]
TRINATAL RX 1 TABLET [T2]
TRINATE TABLET [T2]
TRINTELLIX TABLET [T3] [QL]
triphrocaps capsule
tri-previfem tablet [T1] [ACA]
tri-sprintec tablet [T1] [ACA]
TRISTART DHA CAPSULE [T3]
TRIUMEQ TABLET [T2] [QL]
TRIVEEN-DUO DHA MISC [T2]
TRI-VI-FLOR SUSPENSION [T3]
tri-vitamin/fluoride solution [T1]
tri-vite/fluoride solution [T1]
trivora-28 tablet [T1] [ACA]
tri-vylibra lo tablet [T1] [ACA]
tri-vylibra tablet [T1] [ACA]
TRIZIVIR TABLET [T3] [BP]
tropicamide solution [T1]
TROPICAMIDE-CYCLOPENTOLATE-PE SOLUTION
[T3]
TROPICAMIDE-PHENYLEPHRINE SOLUTION
[T3]
trospium chloride er 24 hour cap
[T1]
trospium chloride tablet [T1]
TRULANCE TABLET [T2]
TRULICITY INJECTION [T2] [QL]
TRUMENBA INJECTION [T2] [ACA]
TRUSKIN [T3]
TRUSOPT SOLUTION [T3] [BP]
TRUSTEX LATEX CONDOM MISC
[T2] [ACA]
TRUSTEX LUBRICATED EXTRA MISC
[T2] [ACA]
TRUSTEX LUBRICATED MISC [T2] [ACA]
TRUSTEX NON-LUBRICATED MISC
[T2] [ACA]
TRUSTEX/RIA LUBRICATED MISC
[T2] [ACA]
TRUSTEX-RIA MISC [T2] [ACA]
TRUVADA TABLET [T2] [QL]
tulana tablet [T1] [ACA]
TURALIO CAPSULE [T4] [PA][SP]
TUSSICAPS CAPSULE [T3]
TUZISTRA XR SUSPENSION [T3]
TWINRIX INJECTION [T2] [ACA]
TWYNSTA TABLET [T3] [BP]
TYBOST TABLET [T3]
TYKERB TABLET [T4] [PA][SP]
TYLENOL/CODEINE #3 TABLET
[T3] [BP]
TYMLOS INJECTION [T4] [PA][SP]
TYVASO REFILL SOLUTION [T4] [PA][SP]
TYVASO SOLUTION [T4] [PA][SP]
TYVASO STARTER SOLUTION [T4] [PA][SP]
UUBRELVY TABLET
UCERIS 24 HR TAB [T3] [BP]
UCERIS FOAM [T2]
UDENYCA INJECTION [T4] [PA][SP]
ULORIC TABLET [T3] [BP]
ULTANE SOLUTION [T3] [BP]
ULTRACET TABLET [T3] [BP]
ULTRAFOAM MISC [T3]
ULTRAM TABLET [T3] [BP]
unithroid tablet [T1]
UPTRAVI TABLET [T4] [PA][SP]
URECHOLINE TABLET [T3] [BP]
UROCIT-K 10 TABLET [T3] [BP]
UROCIT-K 15 TABLET [T3] [BP]
UROCIT-K 5 TABLET [T3] [BP]
URSO 250 TABLET [T3] [BP]
URSO FORTE TABLET [T3] [BP]
ursodiol capsule [T1]
ursodiol tablet [T1]
UTIBRON NEOHALER CAPSULE
[T3]
Vvalacyclovir tablet [T1]
VALCHLOR GEL [T4] [PA][SP]
VALCYTE SOLUTION [T3] [BP]
VALCYTE TABLET [T3] [BP]
valganciclovir solution [T1]
valganciclovir tablet [T1]
valproic acid capsule [T1]
valproic acid solution [T1]
valsartan tablet [T1]
valsartan-hydrochlorothiazide tablet
[T1]
VANCOCIN CAPSULE [T3] [BP]
vancomycin capsule [T1]
vancomycin solution [T1]
vandazole gel [T1]
VAQTA SUSPENSION [T3] [ACA]
VARIBAR HONEY SUSPENSION
[T3]
VARIBAR NECTAR SUSPENSION
[T3]
VARIBAR PUDDING PASTE [T3]
VARIBAR THIN HONEY SUSPENSION
[T3]
VARIBAR THIN LIQUID SUSPENSION
[T3]
VARIVAX INJECTION [T2] [ACA]
VARUBI TABLET [T4] [PA][SP]
VASCEPA CAPSULE [T2] [QL]
VASERETIC TABLET [T3] [BP]
VASOTEC TABLET [T3] [BP]
VAXCHORA SUSPENSION [T2]
v-c forte capsule
VCF FILM [T2] [ACA]
vcf foam [T1] [ACA]
vcf gel [T1] [ACA]
VECAMYL TABLET [T3]
VECTICAL OINTMENT [T3]
velivet tablet [T1] [ACA]
VELPHORO CHEW TAB [T2]
VEMLIDY TABLET [T4] [PA][SP]
VENCLEXTA STARTING PACK TABLET
[T4] [PA][SP]
29www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
VENCLEXTA TABLET [T4] [PA][SP]
venlafaxine er 24 hour cap [T1]
venlafaxine tablet [T1]
VENTAVIS SOLUTION [T4] [PA][SP]
VENTOLIN HFA AEROSOL [T2] [QL]
verapamil er 24 hour cap [T1]
verapamil er pm 24 hour cap [T1]
verapamil er tablet [T1]
verapamil sr 24 hour cap [T1]
verapamil tablet [T1]
VEREGEN OINTMENT [T3]
VERELAN 24 HOUR CAP [T3] [BP]
VERELAN PM 24 HOUR CAP [T3]
VERSACLOZ SUSPENSION [T3]
VERZENIO TABLET [T4] [PA][SP]
VESICARE TABLET [T2] [BP]
VFEND SUSPENSION [T3] [BP]
VFEND TABLET [T3] [BP]
VIBERZI TABLET [T2] [PA]
VIBRAMYCIN CAPSULE [T3] [BP]
VIBRAMYCIN SUSPENSION [T3] [BP]
VIBRAMYCIN SYRUP [T3]
vic-forte capsule
VIDAZA SUSPENSION [T4] [PA][SP][BP]
vienva tablet [T1] [ACA]
VIGABATRIN PACKET [T4] [PA][SP]
VIGABATRIN TABLET [T4] [PA][SP]
VIGADRONE PACKET [T4] [PA][SP]
VIGAMOX SOLUTION [T3]
VIIBRYD STARTER PACK KIT [T2] [QL]
VIIBRYD TABLET [T2] [QL]
VIMPAT SOLUTION [T2]
VIMPAT TABLET [T2]
VINATE DHA RF CAPSULE [T3]
VINATE M TABLET [T2]
VINATE ONE TABLET [T2]
VIOKACE TABLET [T2]
viorele tablet [T1] [ACA]
VIRACEPT TABLET [T2]
VIRAMUNE SUSPENSION [T3] [BP]
VIRAMUNE TABLET [T3] [BP]
VIRAMUNE XR 24 HR TAB [T3] [BP]
VIRAZOLE SOLUTION [T4] [PA][SP][BP]
VIREAD POWDER [T2]
VIREAD TABLET [T2] [BP]
VIRT-C DHA CAPSULE [T2]
virt-caps capsule
virt-fefa plus capsule [T1]
VIRT-NATE DHA CAPSULE [T2]
virt-phos 250 neutral tablet [T1]
VIRT-PN DHA CAPSULE [T2]
VIRT-PN PLUS CAPSULE [T2]
VISIONBLUE SOLUTION [T3]
VISTARIL CAPSULE [T3] [BP]
VISTOGARD PACKET [T4] [PA][SP]
VITAFOL FE+ CAPSULE [T3]
VITAFOL GUMMIES CHEW TAB
[T3]
VITAFOL ULTRA CAPSULE [T3]
VITAFOL-NANO TABLET [T3]
VITAFOL-OB TABLET [T3]
VITAFOL-OB+DHA MISC [T3]
VITAFOL-ONE CAPSULE [T3]
VITAMED MD ONE RX CAPSULE
[T3]
VITAMEDMD REDICHEW RX CHEW TAB
[T3]
vitamin d capsule
vitamins a/c/d/fluoride solution
[T1]
VITAPEARL CAPSULE [T3]
VITATRUE MISC [T3]
VITRAKVI CAPSULE [T4] [PA][SP]
VITRAKVI SOLUTION [T4] [PA][SP]
VIVOTIF CAPSULE (DELAYED RELEASE)
[T2]
VIZIMPRO TABLET [T4] [PA][SP]
VOGELXO GEL [T3] [QL]
volnea tablet [T1] [ACA]
VOL-PLUS TABLET [T2]
VOL-TAB RX TABLET [T2]
VOLTAREN GEL [T3] [BP]
voriconazole suspension [T1]
voriconazole tablet [T1]
VOSEVI TABLET [T4] [PA][SP]
VOTRIENT TABLET [T4] [PA][SP]
VP-PNV-DHA CAPSULE [T3]
VRAYLAR CAPSULE [T3]
VUMERITY CAPSULE (DELAYED RELEASE)
[T4] [PA][SP]
VUSION OINTMENT [T3]
vyfemla tablet [T1] [ACA]
vylibra tablet [T1] [ACA]
VYNDAMAX CAPSULE [T4] [PA][SP]
VYNDAQEL CAPSULE [T4] [PA][SP]
VYVANSE CAPSULE [T2] [QL]
VYVANSE CHEW TAB [T2] [QL]
VYZULTA SOLUTION [T3]
WWAKIX TABLET [T4] [PA][SP]
warfarin sodium tablet [T1]
water solution [T1]
WELCHOL PACKET [T3] [BP]
WELCHOL TABLET [T3] [BP]
WELLBUTRIN XL 24 HR TAB [T3] [QL]
wera tablet [T1] [ACA]
westab max tablet [T1]
westab one tablet [T1]
westhroid tablet [T1]
WIDE SEAL DIAPHRAGM [T3] [ACA]
wixela inhub aerosol [T1] [QL]
womans laxative tablet [T1] [ACA]
women's gentle laxative tablet
[T1] [ACA]
womens laxative tablet [T1] [ACA]
WP THYROID TABLET [T3]
wymzya fe chew tab [T1] [ACA]
XXALKORI CAPSULE [T4] [PA][SP]
XARELTO STARTER PACK TABLET
[T2]
XARELTO TABLET [T2]
XELJANZ TABLET [T4] [PA][SP]
XELJANZ XR 24 HR TAB [T4] [PA][SP]
XELODA TABLET [T4] [PA][SP][BP]
XENLETA TABLET [T3] [PA]
XENON XE 133 [T3]
XEPI CREAM [T3]
XERMELO TABLET [T4] [PA][SP]
XEROFORM PADS [T2]
XEROFORM PETROLATUM DRESSING MISC
[T2]
XEROFORM PETROLATUM DRESSING PADS
[T2]
XHANCE [T3] [PA][QL]
XIFAXAN TABLET [T2] [PA]
XIGDUO XR 24 HR TAB [T2] [QL]
XIIDRA SOLUTION [T2] [QL]
30www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
XOFLUZA TABLET [T3] [QL]
XOPENEX CONCENTRATE NEBULIZED
[T3] [BP]
XOPENEX NEBULIZED [T3] [BP]
XOSPATA TABLET [T4] [PA][SP]
XTANDI CAPSULE [T4] [PA][SP]
xulane patch [T1] [ACA][QL]
XULTOPHY 100/3.6 INJECTION
[T2] [QL]
XURIDEN PACKET [T4] [PA][SP]
XYREM SOLUTION [T4] [PA][SP]
YYAZ TABLET [T3] [BP]
YONSA TABLET [T4] [PA][SP]
YUPELRI SOLUTION [T2] [PA]
yuvafem tablet [T1]
Zzafirlukast tablet [T1]
zaleplon capsule [T1] [QL]
ZANAFLEX CAPSULE [T3] [BP]
zarah tablet [T1] [ACA]
ZARONTIN CAPSULE [T3] [BP]
ZARONTIN SOLUTION [T3] [BP]
ZARXIO INJECTION [T4] [PA][SP]
ZATEAN-PN DHA CAPSULE [T2]
ZATEAN-PN PLUS CAPSULE [T2]
ZEJULA CAPSULE [T4] [PA][SP]
ZELAPAR TABLET [T3]
ZELBORAF TABLET [T4] [PA][SP]
ZELNORM TABLET [T3]
ZEMPLAR CAPSULE [T3] [BP]
zenatane capsule [T1]
ZENPEP CAPSULE [T2]
zenzedi tablet [T1]
ZESTORETIC TABLET [T3] [BP]
ZESTRIL TABLET [T3] [BP]
ZIAC TABLET [T3] [BP]
ZIAGEN SOLUTION [T3] [BP]
ZIAGEN TABLET [T3] [BP]
ZIANA GEL [T3] [BP]
zidovudine capsule [T1]
zidovudine syrup [T1]
zidovudine tablet [T1]
ZIEXTENZO INJECTION
zileuton er 12 hr tab [T1]
ZIOPTAN SOLUTION [T2]
ziprasidone capsule [T1]
ZIRGAN GEL [T3]
ZITHROMAX PACKET [T3]
ZITHROMAX SUSPENSION [T3] [BP]
ZITHROMAX TABLET [T3] [BP]
ZITHROMAX TRI-PAK TABLET [T3] [BP]
ZITHROMAX Z-PAK TABLET [T3] [BP]
ZOFRAN TABLET [T3] [QL][BP]
ZOHYDRO ER CAPSULE (CR) [T3] [QL][BP]
ZOLINZA CAPSULE [T4] [PA][SP]
zolmitriptan odt tablet [T1] [QL]
zolmitriptan tablet [T1] [QL]
zolpidem tartrate er tablet [T1] [QL]
zolpidem tartrate sl [T1] [QL]
zolpidem tartrate tablet [T1] [QL]
ZOMIG SOLUTION [T2] [QL]
ZONALON CREAM [T3] [QL]
zonisamide capsule [T1]
ZONTIVITY TABLET [T3]
ZORBTIVE SOLUTION [T4] [PA][SP]
ZORTRESS TABLET [T2] [BP]
ZOSTAVAX SUSPENSION [T3] [ACA]
zovia 1/35e tablet [T1] [ACA]
ZOVIRAX OINTMENT [T3] [QL][BP]
ZOVIRAX SUSPENSION [T3] [BP]
zumandimine tablet [T1] [ACA]
ZYDELIG TABLET [T4] [PA][SP]
ZYFLO TABLET [T3]
ZYKADIA TABLET [T4] [PA][SP]
ZYLOPRIM TABLET [T3] [BP]
ZYMAXID SOLUTION [T3] [BP]
ZYPITAMAG TABLET [T3]
ZYPREXA TABLET [T3] [BP]
ZYPREXA ZYDIS TABLET [T3] [BP]
ZYTIGA TABLET [T4] [PA][SP]
ZYVOX SUSPENSION [T3] [BP]
ZYVOX TABLET [T3] [BP]
31www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
Medications Excluded from Coverage with Covered Alternatives
Alternative Covered OptionsExcluded Drug
ACCU-CHEK SMARTVIEW Onetouch Ultra Meters/strips, Onetouch Verio Meters/strips
ADZENYS XR-ODT Dextroamphetamine Sulfate Er (generic For Dexedrine)
ALVESCO Arnuity Ellipta, Asmanex Hfa/twisthaler, Flovent Diskus/hfa, Pulmicort Flexhalar, Qvar
ANDRODERM Testosterone 1%, 1.62% Transdermal Gel (generic For Androgel)
APIDRA Humalog
APIDRA SOLOSTAR Humalog
ARANESP ALBUMIN FREE Procrit
ATRIPLA Biktarvy, Genvoya, Odefsey, Symfi, Symfi Lo, Triumeq
AUBAGIO Gilenya, Mayzent, Tecfidera
AUVI-Q Epinephrine (generic For Adrenaclick), Epipen, Epipen Jr.
BALCOLTRA Aviane, Levonorgestrel-eth Estradiol, Vienva, Lo Loestrin Fe, Nuvaring,
BIJUVA Estradiol-norethindrone Acetat, Jinteli, Mimvey, Premphase, Prempro
BONJESTA Doxylamine (generic For Unisom), Pyridoxine Hcl (generic For Hexa-betalin)
CAMBIA Sumatriptan Succinate (generic For Imitrex), Diclofenac Tablet (generic For Voltaren)
CIMZIA Actemra, Cosentyx, Enbrel, Humira, Otezla, , Xeljanz/xr
CIMZIA STARTER KIT Actemra, Cosentyx, Enbrel, Humira, Otezla, , Xeljanz/xr
CLIMARA PRO Combipatch
CONTOUR One Touch Ultra Test Strips, One Touch Verio
CONTOUR NEXT One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync
CONTOUR NEXT EZ One Touch Ultra Test Strips, One Touch Verio
CONTOUR NEXT EZ One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync
COTEMPLA XR-ODT Methylphenidate Er (generic For Concerta Er), Methylphenidate Hcl Cd (generic For Metadate Cd)
CYCLOSET Metformin (generic For Glucophage), Glimepiride (generic For Amaryl), Glipizide (generic For Glucotrol)
DEXILANT Esomeprazole Magnesium (generic For Nexium Rx)
DIVIGEL Estradiol Products (generic For Estrace, Climara,or Depo-estradiol)
DORYX MPC Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)
DUEXIS Ibuprofen (generic For Advil), Famotidine (generic For Pepcid)
DYANAVEL XR Amphetamine-dextroamphetamine Tablet (generic For Adderall Or Adderall Xr)
DYMISTA Azelastine 137 Mcg Nasal Spray (generic For Astelin) And Fluticasone Nasal Spray (generic For Flonase) Separately
ECOZA Econazole Nitrate (generic For Spectazole), Ciclopirox (generic For Ciclodan)
EDARBYCLOR Losartan (generic For Cozaar), Valsartan (generic For Diovan), Chlorthalidone Tablet (generic For Thalitone) Separately
32www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
Alternative Covered OptionsExcluded Drug
ELESTRIN Estradiol Products (generic For Estrace, Climara,or Depo-estradiol)
EMFLAZA Prednisone (generic For Deltasone)
ENSTILAR Calcipotriene Cream/ointment/solution (generic For Dovonex), Betamethasone Dip 0.05% Cream (generic For Diprosone)
ENVARSUS XR Tacrolimus (generic For Envarsus)
EPINEPHRINE (Impax) Epinephrine (generic For Epipen ) By Mylan, Epipen
EVAMIST Estradiol Products (generic For Estrace, Climara,or Depo-estradiol)
FABIOR Tazorac (alternative Brand For Fabior)
FIASP Humalog
FIASP FLEXTOUCH Humalog
FREESTYLE PRECISION NEO One Touch Ultra Test Strips, One Touch Verio
GOCOVRI Lokelma
GRALISE Gabapentin (generic For Neurontin), Pregabalin (generic For Lyrica)
GRANIX Nivestym, Zarxio
HORIZANT Gabapentin (generic For Neurontin), Pregabalin (generic For Lyrica)
HUMATROPE Norditropin
HYSINGLA ER Morphine Sulfate Er Tablet (generic For Ms Contin); Oxycodone Er Tablet (generic For Oxycontin)
INGREZZA Tetrabenazine (generic For Xenazine)
INVELTYS Lotemax 0.5% Suspension
JADENU Deferasirox (generic For Exjade)
JORNAY PM Methylphenidate Er (generic For Concerta Er), Methylphenidate Hcl Cd (generic For Metadate Cd)
JUBLIA Ciclopirox(generic For Ciclodan)
KINERET Actemra, Enbrel, Humira, , Xeljanz, Xeljanz Xr
KOMBIGLYZE XR Janumet, Janumet Xr, Jentadueto, Jentadueto Xr
LIVALO Atorvastatin (generic For Lipitor), Rosuvastatin (generic For Crestor), Simvastatin (generic For Zocor)
MAVYRET Epclusa, Harvoni, Vosevi, Sovaldi
MOXEZA Ciprofloxacin (generic For Ciloxan), Moxifloxacin (generic For Vigamox),ofloxacin (generic For Ocuflox)
MYDAYIS Amphetamine-dextroamphetamine Tablet (generic For Adderall, Adderall Xr)
NEUPOGEN Zarxio
NOVOLIN 70/30 Humulin 70-30
NOVOLIN 70/30 RELION Humulin 70-30
NOVOLIN N Humulin N
NOVOLIN N RELION Humulin N
NOVOLIN R Humulin R
NOVOLIN R RELION Humulin R
33www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
Alternative Covered OptionsExcluded Drug
NOVOLOG Humalog
NOVOLOG FLEXPEN Humalog
NOVOLOG MIX 70/30 Humalog Mix
NOVOLOG MIX 70-30 Humalog Mix
NOVOLOG PENFILL Humalog
NUTROPIN AQ NUSPIN 10 Norditropin
NUTROPIN AQ NUSPIN 20 Norditropin
NUTROPIN AQ NUSPIN 5 Norditropin
NUVESSA Metronidazole (generic For Monistat), Clindamycin Phosphate (generic For Cleocin)
OLUMIANT Actemra, Enbrel, Humira, Xeljanz
OMNITROPE Norditropin
ONGLYZA Januvia, Tradjenta
ONZETRA XSAIL Sumatriptan Nasal Spray (generic For Imitrex Nasal Spray), Zomig Nasal Spray
ORENCIA Actemra, Enbrel, Humira, , Xeljanz, Xeljanz Xr
ORENCIA CLICKJECT Actemra, Enbrel, Humira, , Xeljanz, Xeljanz Xr
PENNSAID Diclofenac Sodium Topical (generic For Voltaren), Flector Patch
PIQRAY 300MG DAILY DOSE Ibrance
PRADAXA Eliquis, Xarelto
PREZCOBIX Ritonavir (generic For Norvir), Kaletra Tablets, Prezista
PRODIGY NO CODING One Touch Ultra Test Strips, One Touch Verio
PROLENSA Bromsite 0.075% Solution
PYLERA Metronidazole Tablet (generic For Flagyl), Tetracycline Capsule (generic For Sumycin), Bismuth (otc)
QUILLICHEW ER Methylphenidate Er (generic For Concerta)
RELION PRIME One Touch Ultra Test Strips, One Touch Verio
RHOFADE Mirvaso
SERNIVO Betamethasone Dipropionate Cream (generic For Diprolene )
SEYSARA Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)
SIMPONI Actemra, Cosentyx, Enbrel, Humira, Otezla, , Xeljanz/xr
SPIRIVA HANDIHALER Incruse Ellipta
SPIRIVA RESPIMAT Incruse Ellipta
SPRIX Diclofenac Sodium (generic For Voltaren)
STIOLTO RESPIMAT Anoro Ellipta, Bevespi Aerosphere
STRIBILD Genvoya
TACLONEX Calcipotriene Cream/ointment/solution (generic For Dovonex), Betamethasone Dip 0.05% Cream (generic For Diprosone)
TALTZ Cosentyx, Enbrel, Humira, Otezla,
TAYTULLA Junel Fe, Blisvoi Fe, Larin 24 Fe
34www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at:
Alternative Covered OptionsExcluded Drug
TIROSINT Levothyroxine Sodium (generic For Synthroid), Unithroid
TOLAK Diclofenac Sodium (generic For Voltaren)
TROKENDI XR Topiramate (generic For Topamax)
TRUE METRIX AIR GLUCOSE METER One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync
TRUE METRIX BLOOD GLUCOSE MTR One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync
TRUE METRIX GLUCOSE TEST STRIP One Touch Ultra Test Strips, One Touch Verio
TRUETRACK One Touch Ultra Test Strips, One Touch Verio
TUDORZA PRESSAIR Incruse Ellipta
VELTASSA Lokelma
VELTIN Clindamycin/benzoyl Peroxide (generic For Duac), Clindamycin/tretinoin (generic For Ziana), Onexton
VICTOZA Bydureon, Bydureon Bcise, Byetta, Ozempic, Trulicity
VIMOVO Naproxen (generic For Naprosyn), Omeprazole (generic For Prilosec)
VIVLODEX Diclofenac Sodium (generic For Voltaren), Meloxicam (generic For Mobic), Nabumetone (generic For Relafen)
XPOVIO 60 MG ONCE WEEKLY Revlimid
XTAMPZA ER Morphine Sulfate Er (generic For Ms Contin), Oxycontin
XYOSTED Testosterone Enanthate, Testosterone Cypionate (generic For Depo-testosterone)
ZIOPTAN Bimatoprost (generic For Lumigan), Latanoprost (generic For Xalatan), Travoprost (generic For Travatan), Travatan Z
ZOMACTON Norditropin
ZORVOLEX Diclofenac Sodium (generic For Voltaren)
ZTLIDO Lidocaine 3% Cream (generic For Lidopin)
ZUBSOLV Buprenorphine-naloxone (generic For Suboxone)
ZUPLENZ Ondansetron Odt (generic For Zofran Odt), Ondansetron Hcl (generic For Zofran), Granisetron Hcl (generic For Kytril)
ZYLET Lotemax 0.5% Suspension; Tobramycin Susp (generic For Tobrex)
35www.hometownhealth.comFor plan specific information, call (844) 373-0970, or visit us at: