may 2022 expanded drug list
TRANSCRIPT
Therapeutic Drug Classes Requirements & Limits
g B
B B
B g
g g
B B
B g
g B
B B
g g
g g
Bg
B
Bold type = Brand-name drug[Plain type = Generic drug]E = May be excluded from coverage1Coverage is provided for oral formulations.2SSRIs are included only for employer groups who have specifically requested coverage.
Pharmacy | PDL | Expanded Drug List
2022 Preventive Medication List for Consumer Driven Health Plans Expanded List
This is a list of Preventive Medications that may be covered under your plan. If your plan covers these Preventive Medications, your insurance benefit is applied before you meet your deductible.
Some medications may have other requirements or limits depending on your benefit plan and are noted below. To find out if a drug is covered, please check your plan benefits on the health plan’s member website. Or, call the toll-free phone number on your member ID card. This list may not be all-inclusive. Brand and generic drugs may not always be available due to market changes.
CDH preventive drug lists may also be used with non-CDH plans
Effective May 1, 2022
Therapeutic Drug Classes Requirements & Limits
g Breast Cancer Prevention
Anastrozole
Arimidex E
Aromasin E
Exemestane
Fareston E
Femara E
Letrozole
Soltamox E
Tamoxifen
Toremifene
B Cardiovascular/Heart Disease: Blood Clot/Platelet Therapy Cg
Aspirin-Dipyridamole
Bevyxxa
Brilinta
Cilostazol
Clopidogrel
Coumadin
Dipyridamole
Effient E
Eliquis
Enoxaparin
Fondaparinux
Fragmin
Aggrenox
Arixtra E
Heparin
Jantoven
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B B
B g
B g
B B
B B
g B
B g
g g
g B
B B
B g
B
B g
B g
g g
B B
B B
g B
B B
B g
g g
B g
g g
g B
g B
g B
g B
g B
B
gg
gg
Bg
B
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Lovenox E
Persantine
Plavix E
Pletal
Pradaxa
Prasugrel
Savaysa
Ticlopidine
Warfarin
Xarelto
Zontivity
Cardiovascular/Heart Disease: High Blood Pressure
Accupril E
Accuretic
Acebutolol
Aceon
Adalat CC
Afeditab
Aldactazide
Aldactone E
Aliskiren
Altace E
Amiloride
Amiloride-Hydrochlorothiazide
Amlodipine
Amlodipine-Benazepril
Amlodipine-Olmesartan E
Amlodipine-Olmesartan-Hydrochlorothiazide
E
Atacand HCT E
Atenolol
Atenolol-Chlorthalidone
Avalide E
Avapro E
Azor E
Benazepril
Benazepril-Hydrochlorothiazide
Benicar E
Benicar HCT 1
E
Betaxolol
Bidil
Bisoprolol
Bisoprolol-Hydrochlorothiazide
Bumetanide
Bystolic E
Byvalson
Calan
Calan SR
Candesartan
Candesartan-Hydrochlorothiazide
Captopril
Captopril-Hydrochlorothiazide
Cardene SR
Cardizem E
Cardizem CD E
Cardizem LA E
Cardura
Amlodipine-Valsartan
Amlodipine-Valsartan-Hydrochlorothiazide E
Amturnide E
Atacand E
Carospir
Cartia XT
Carvedilol
Carvedilol ER E
specifically requested coverage.2
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B g
B B
g g
g g
g g
B B
B B
B g
B g
B g
B g
B g
B g
B g
B B
g g
g B
g B
g B
g B
g B
B g
B g
B B
g g
B B
B B
B g
B B
B B
B g
B g
g B
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Catapres
Catapres TTS E
Chlorothiazide
Clonidine
Clonidine Patch
Clorpress
Conjupri E
Coreg E
Coreg CR E
Corgard
Corzide
Covera HS
Cozaar E
Demadex
Dilacor XR
Dilt CD
Dilt XR
Diltia XT
Diltiazem
Diltiazem ER
Diltzac ER
Diovan E
Diovan HCT E
Diuril
Doxazosin
Dutoprol E
Dyazide
Dynacirc CR
Dyrenium E
Edarbi
Edarbyclor
Edecrin E
Enalapril
Enalapril-Hydrochlorothiazide
Epaned
Eplerenone
Eprosartan
Ethacrynic Acid
Exforge E
Exforge HCT E
Felodipine ER
Fosinopril
Fosinopril-Hydrochlorothiazide
Furosemide
Guanfacine
Hydralazine
Hydrochlorothiazide
Hyzaar E
Indapamide
Inderal
Inderal LA E
Inderal XL E
Innopran XL E
Inspra E
Irbesartan
Irbesartan - Hydrochlorothiazide
Isoptin SR
Isradipine
Kapspargo
Katerzia
Labetalol
Lasix
Levatol
Lisinopril
Lisinopril-Hydrochlorothiazide
Lopressor
specifically requested coverage.3
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B g
g g
g g
B g
B g
B B
g B
B B
B B
g g
g g
g B
g g
g g
g g
g g
g B
B g
B g
B B
B B
B g
g B
g B
g g
g g
g g
g B
g B
g B
g g
g B
g B
B
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Lopressor HCT
Losartan
Losartan-Hydrochlorothiazide
Lotensin
Lotensin HCT
Lotrel E
Matzim LA
Mavik
Maxzide
Methyclothiazide
Methyldopa
Methyldopa-Hydrochlorothiazide
Metolazone
Metoprolol 37.5, 75 mg E
Metoprolol Succinate
Metoprolol Tartrate
Metoprolol-Hydrochlorothiazide
Micardis E
Micardis HCT E
Microzide
Midamor
Minipress
Minoxidil
Moexipril
Moexipril-Hydrochlorothiazide
Nadolol
Nadolol-Bendroflumethazide
Nebivolol E
Nicardipine
Nifedipine
Nifedipine ER
Nimodipine
Nisoldipine
Norvasc E
Olmesartan
Olmesartan-Hydrochlorothiazide
Perindopril
Pindolol
Prazosin
Prestalia E
Prinivil
Procardia
Procardia XL E
Propranolol
Propranolol-Hydrochlorothiazide
Qbrelis E
Quinapril
Quinapril-Hydrochlorothiazide
Ramipril
Reserpine
Sectral
Spironolactone
Spironolactone-Hydrochlorothiazide
Sular
Tarka E
Taztia XT
Tekturna
Tekturna HCT
Telmisartan
Telmisartan-Amlodipine E
Telmisartan-Hydrochlorothiazide
Tenex
Tenoretic E
Tenormin E
Terazosin
Teveten
Teveten HCT
specifically requested coverage.4
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B g
B B
B
Bg
gB
Bg
BB
gg
Bg
gg
gg
Bg
Bg
BB
BB
gB
gg
Bg
Bg
gg
gB
gB
BB
BB
BB
BB
BB
Bg
B
BB
BB
gB
gg
g
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Thalitone 15 mg E
Thalitone 25 mg
Tiazac 1 Timolol
Toprol XL
Torsemide
Trandate
Trandolapril
Trandolapril-Verapamil
Triamterene
E
Triamterene-Hydrochlorothiazide
Tribenzor E
Twynsta E
Uniretic
Univasc
Valsartan
Valsartan-Hydrochlorothiazide
Vaseretic E
Vasotec E
Verapamil
Verapamil ER
Verelan
Verelan PM
Zaroxolyn
Zebeta
Zestoretic E
Zestril E
Ziac
Cardiovascular/Heart Disease: High Cholesterol
Altoprev E
Antara E
Atorvastatin
Cholestyramine
Cholestyramine Light
Choline Fenofibrate E
Colesevelam Tablets, Powder for Suspension
E
Colestid
Colestipol
Crestor E
Ezallor Sprinkle
Ezetimibe
Ezetimibe/Rosuvastain E
Fenofibrate 30, 43, 50, 67, 75, 90, 130, 134, 150, 200 mg Capsule
E
Fenofibrate 40, 48, 120 mg Tablet E
Fenofibrate 54, 145, 160 mg Tablet
Fenofibric Acid E
Fenoglide E
Fibricor E
Flolipid
Fluvastatin
Fluvastatin ER
Gemfibrozil
Icosapent E
Lescol
Lescol XL E
Lipitor E
Lipofen E
Livalo E
Lofibra E
Lopid
Lovastatin
Lovaza E
Mevacor
Nexletol
Nexlizet
Niacin Extended-Release
specifically requested coverage.5
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B B
B B
g g
B B
g g
g g
B g
B g
g g
B g
g B
g B
B g
B B
B B
B B
B B
B g
B g
B g
B B
B
B g
g g
g
B B
g B
g B
B B
B g
B g
g g
B B
g
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Niacor E
Niaspan E
Omega-3 Acid Ethyl Esters
Pravachol E
Pravastatin
Prevalite
Questran
Questran Light
Rosuvastatin
Roszet E
Simvastatin
Simvastatin/Ezetimibe
Tricor E
Triglide E
Trilipix E
Vascepa E
Vytorin E
Welchol
Zetia E
Zocor E
Zypitamag E
Central Nervous System: Mental Health
Abilify, Abilify Mycite E
Aripiprazole
Asenapine E
Caplyta
Chlorpromazine
Clozapine
Clozaril
Fanapt
FazaClo
Fluphenazine
Geodon E
Haloperidol
Central Nervous System: Multiple Sclerosis
Invega E
Latuda
Loxapine
Lybalvi E
Molindone
Olanzapine
Paliperidone ER
Perphenazine
Quetiapine
Quetiapine ER
Rexulti
Risperdal E
Risperidone
Saphris
Secuado E
Seroquel E
Seroquel XR E
Thioridazine
Thiothixene
Trifluoperazine
Vraylar
Versacloz E
Ziprasidone
Zyprexa E
Aubagio
Avonex
Bafiertam
Betaseron
Copaxone E
Dimethyl Fumarate (generic Tecfidera)
Extavia E
Gilenya
specifically requested coverage.6
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
g B
g B
B B
B B
B g
B g
B B
B B
B
B B
B B
B
B
BB
gB
gB
gB
gB
gB
gB
gB
BB
gB
gB
BB
BB
BB
BB
B
g B
B B
B
B B
B B
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Glatiramer Acetate (generic Copaxone)
Glatopa
Kesimpta
Mavenclad
Mayzent
Plegridy
Ponvory E
Rebif E
Tecfidera E
Vumerity E
Zeposia
Depression: Selective Serotonin Reuptake Inhibitors 2 (SSRIs)
Celexa E
Citalopram
Escitalopram
Fluoxetine Capsules
Fluoxetine 10 mg, 20 mg Tablets
Fluoxetine 60 mg Tablets E
Fluvoxamine
Fluvoxamine Extended-Release
Lexapro E
Paroxetine
Paroxetine Extended-Release
Paxil E
Paxil CR E
Pexeva E
Prozac E
Sertraline Capsules 150 mg, 200 mg E
Sertraline Tablets
Zoloft E
Diabetes: Diabetic Supplies
Accu-Chek Guide Meters
Accu-Chek Guide Test Strips
Diabetes: Insulin
Contour Next EZ Meters
Contour Next Meters
Contour Next One Meters
Contour Next Test Strips
Diabetic Testing - Lancets
Insulin Needles/Syringes
OneTouch Diabetic Meters
OneTouch Diabetic Test Strips
Admelog, Admelog SoloStar E
Afrezza E
Apidra, Apidra SoloStar E
Basaglar E
Fiasp, Fiasp FlexTouch E
Humalog
Humalog Junior
Humalog Mix 50/50
Humalog Mix 75/25
Humulin 50/50
Humulin 70/30
Humulin N
Humulin R
Insulin Aspart E
Insulin Aspart Protamine/Insulin Aspart E
Insulin Glargine E
Insulin Lispro E
Insulin Lispro Jr. E
Insulin Lispro Protamine/Insulin Lispro 75/25
E
Lantus
Levemir E
Lyumjev
Novolin 70/30 E
Novolin N E
specifically requested coverage.7
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B B
B B
B B
B g
B g
B g
B B
B
g B
B B
B B
B B
B B
B B
B B
BB
BB
BB
BB
BB
gB
gB
gB
gB
gB
gB
gg
Bg
Bg
Bg
BB
gB
gB
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Novolin R E
Novolog E
Novolog Mix 70/30 E
Semglee E
Soliqua
Toujeo
Tresiba E
Diabetes: Non-Insulin
Acarbose
ACTOplus Met
ACTOplus Met XR
Actos E
Adlyxin
Alogliptin E
Alogliptin-Metformin
Alogliptin-Pioglitazone
E
E
Amaryl E
Avandia
Bydureon
Bydureon BCise
Byetta
Cycloset
Diabeta
Duetact
Farxiga E
Fortamet E
Glimepiride
Glipizide
Glipizide ER
Glipizide-Metformin
Glucophage
Glucophage XR
Glucotrol
Glucotrol XL
Glucovance
Glumetza E
Glyburide
Glyburide Micronized
Glyburide-Metformin
Glynase
Glyset
Glyxambi
Invokamet E
Invokamet XR E
Invokana E
Janumet E
Janumet XR E
Januvia E
Jardiance
Jentadueto
Jentadueto XR
Kazano
Kombiglyze XR
Metformin
Metformin ER (generic Fortamet) E
Metformin ER (generic Glucophage XR)
Metformin ER (generic Glumetza) E
Metformin Solution (generic Riomet)
Miglitol
Nateglinide
Nesina
Onglyza
Oseni
Ozempic
Pioglitazone
Pioglitazone-Glimepiride
specifically requested coverage.8
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
g B
B B
B B
B B
B B
g g
g B
B B
B g
B g
B
gB
Bg
Bg
B
B B
B B
g B
B g
B B
B g
B B
B B
B B
B
g B
g B
g B
B B
g g
B g
B B
B g
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Pioglitazone-Metformin
PrandiMet
Prandin
Precose
Qtern E
Repaglinide
Repaglinide-Metformin
Riomet E
Riomet ER
Rybelsus
Segluromet
Starlix
E
Steglatro
Steglujan
SymlinPen
E
E
Synjardy
Synjardy XR
Tolbutamide
Tradjenta
Trijardy XR
Trulicity
Victoza
Xigduo XR E
Xultophy E
HIV
Abacavir
Abacavir-Lamivudine
Abacavir-Lamivudine-Zidovudine
Aptivus
Atazanavir
Atripla E
Biktarvy
Cimduo
Combivir
Complera
Crixivan
Delstrigo
Descovy E
Didanosine
Dovato
Edurant
Efavirenz
Efavirenz-Emtricitabine-Tenofovir Disoproxil Fumarate (generic Atripla)
E
Efavirenz-Lamivudine (generic Symfi, Symfi Lo)
Emtricitabine
Emtricitabine-Tenofovir Disoproxil Fumarate (generic Truvada)
Emtriva
Epivir
Epzicom E
Etravirine
Evotaz
Fosamprenavir
Fuzeon
Genvoya
Intelence
Invirase
Isentress
Isentress HD
Juluca
Kaletra
Lamivudine
Lamivudine-Zidovudine
Lexiva E
Lopinavir-Ritonavir
specifically requested coverage.9
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
g B
g B
B B
B g
B
B B
B B
B g
B B
B g
B B
B g
B g
g B
B g
B g
B B
B B
B B
B B
g B
B g
B g
B B
B
B B
B g
B B
B B
B B
B g
B B
B g
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Nevirapine
Nevirapine Extended-Release
Norvir Tablet E
Odefsey
Pifeltro
Prezcobix
Prezista
Rescriptor
Retrovir
Reyataz E
Ritonavir
Rukobia
Selzentry
Stavudine
Stribild
Sustiva E
Symfi
Symfi Lo
Symtuza E
Temixys E
Tenofovir
Tivicay
Tivicay PD
Triumeq
Trizivir E
Truvada E
Videx
Videx EC
Viracept
Viramune E
Viramune XR E
Viread E
Viteka
Immunosuppressant: Organ Rejection
Musculoskeletal: Osteoporosis
Vocabria E
Zerit
Ziagen
Zidovudine
Astagraf XL E
Azasan
Azathioprine
Cellcept E
Cyclosporine
Envarsus XR E
Everolimus
Gengraf
Imuran E
Mycophenolate
Mycophenolic Acid
Myfortic E
Neoral E
Prograf
Rapamune E
Sandimmune E
Sirolimus
Tacrolimus
Zortress E
Actonel E
Alendronate
Atelvia E
Binosto E
Boniva E
Calcitonin (salmon)
Didronel
Etidronate
specifically requested coverage.10
Therapeutic Drug Classes Requirements Therapeutic Drug Classes Requirements & Limits & Limits
B B Bevespi Aerosphere
B B Breo Ellipta
B B Breztri Aerosphere
B B Brovana
B B Budesonide/Formoterol (Symbicort EAuthorized Generic)g
g Budesonide Nebulized SolutionB
B Combivent Respimatg
g Cromolyng
B DalirespB
B Duaklir Pressair EB
B Dulera E
B DuonebB
B ElixophyllinB
B Flovent DiskusB
B Flovent HFAB
g Fluticasone/Salmeterol Diskus EB
g Fluticasone/Salmeterol RespiClickB
B ForadilB
g Formoterol Nebulized SolutionB B Gastrocrom E
B Incruse Ellipta Eg
g Ipratropiumg
g Ipratropium/AlbuterolB
B Levalbuterol HFAg
g Levalbuterol Nebulized Solution B
B Lonhala Magnair Eg
B LufyllinB
g MetaproterenolB
g MontelukastB
B PerforomistB
B ProAir Digihaler EB
B Proair HFA EB
B Proair RespiClick E
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Evista E
Forteo E
Fortical
Fosamax
Fosamax Plus D
Ibandronate
Miacalcin
Raloxifene
Risedronate
Teriparatide
Tymlos
Respiratory: Asthma/COPD
Accolate
Accuneb
Advair Diskus
Advair HFA
AirDuo Digihaler
AirDuo RespiClick
Albuterol HFA (generic ProAir HFA, Proventil HFA)
E
E
Albuterol HFA (Ventolin HFA authorized generic)
E
Albuterol Nebulized Solution
Albuterol Oral Tablet
Alvesco E
Aminophylline
Anoro Ellipta
Arformoterol Nebulized Solution
ArmonAir Digihaler E
ArmonAir RespiClick E
Arnuity Ellipta
Asmanex HFA E
Asmanex Twisthaler E
Atrovent HFA
specifically requested coverage.11
Therapeutic Drug Classes Requirements & Limits
B
B
B
B
B
B
B
B
B
B
B
g
B
g
g
B
B
B
B
B
B
B
g
B
B
g
g
Bold type = Brand-name drug E = May be excluded from coverage or subject to prior [Plain type = Generic drug] authorization (sometimes referred to as precertification) 1 2 Coverage is provided for oral formulations SSRIs are included only for employer groups who have
Proventil HFA E
Pulmicort Flexhaler
Pulmicort Nebulized Solution E
QVAR Redihaler E
Serevent Diskus
Singulair E
Spiriva HandiHaler
Spiriva Respimat
Stiolto Respimat
Striverdi Respimat
Symbicort
Terbutaline
Theo-24
Theophylline
Theophylline/Guaifenesin
Trelegy Ellipta
Tudorza Pressair E
Ventolin HFA E
VoSpire ER
Yupelri
Xopenex HFA
Xopenex Nebulized Solution E
Zafirlukast
Zyflo
Zyflo CR
Vitamins
Pediatric Flouride Preparations (for example: Florvite, Poly-Vi-Flor, Tri-Vi-Flor) - Brand Name and Generic Products
Prenatal Vitamins (for example: Citranatal Assure, Prenate DHA, Stuartnatal) - Brand Name and Generic Products
specifically requested coverage.12
IndexA
Abacavir ................................................ 9Abacavir-Lamivudine............................ 9Abacavir-Lamivudine-Zidovudine ....... 9Abilify, Abilify Mycite ............................ 6Acarbose ............................................... 8Accolate .............................................. 11Accu-Chek Guide Meters .................... 7Accu-Chek Guide Test Strips .............. 7Accuneb .............................................. 11Accupril ................................................. 2Accuretic ............................................... 2Acebutolol ............................................. 2Aceon .................................................... 2Actonel ................................................ 10ACTOplus Met ...................................... 8ACTOplus Met XR ................................ 8Actos ...................................................... 8Adalat CC .............................................. 2Adlyxin ................................................... 8Admelog, Admelog SoloStar ............... 7Advair Diskus ...................................... 11Advair HFA .......................................... 11Afeditab ................................................. 2Afrezza ................................................... 7Aggrenox ............................................... 1AirDuo Digihaler ................................. 11AirDuo RespiClick .............................. 11Albuterol HFA ...................................... 11Albuterol Nebulized Solution ............ 11Albuterol Oral Tablet .......................... 11Aldactazide ........................................... 2Aldactone .............................................. 2Alendronate......................................... 10Aliskiren ................................................. 2Alogliptin ............................................... 8Alogliptin-Metformin............................. 8Alogliptin-Pioglitazone ......................... 8Altace ..................................................... 2Altoprev ................................................. 5Alvesco ................................................ 11Amaryl ................................................... 8Amiloride ............................................... 2Amiloride-Hydrochlorothiazide ........... 2Aminophylline ..................................... 11Amlodipine ............................................ 2Amlodipine-Benazepril ........................ 2Amlodipine-Olmesartan....................... 2
Amlodipine-Olmesartan-Hydrochlorothiazide ......................... 2
Amlodipine-Valsartan ........................... 2Amlodipine-Valsartan-
Hydrochlorothiazide ......................... 2Amturnide .............................................. 2Anastrozole ........................................... 1Anoro Ellipta ........................................ 11Antara .................................................... 5Apidra, Apidra SoloStar ....................... 7Aptivus ................................................... 9Arformoterol Nebulized Solution ...... 11Arimidex ................................................ 1Aripiprazole ........................................... 6Arixtra .................................................... 1ArmonAir Digihaler ............................. 11ArmonAir RespiClick .......................... 11Arnuity Ellipta ...................................... 11Aromasin ............................................... 1Asenapine ............................................. 6Asmanex HFA ..................................... 11Asmanex Twisthaler ........................... 11Aspirin-Dipyridamole............................ 1Astagraf XL ......................................... 10Atacand ................................................. 2Atacand HCT ........................................ 2Atazanavir .............................................. 9Atelvia .................................................. 10Atenolol ................................................. 2Atenolol-Chlorthalidone ....................... 2Atorvastatin ........................................... 5Atripla .................................................... 9Atrovent HFA ....................................... 11Aubagio ................................................. 6Avalide ................................................... 2Avandia .................................................. 8Avapro ................................................... 2Avonex ................................................... 6Azasan ................................................. 10Azathioprine ........................................ 10Azor ........................................................ 2
B
Bafiertam ............................................... 6Basaglar ................................................ 7Benazepril ............................................. 2Benazepril-Hydrochlorothiazide ......... 2Benicar .................................................. 2Benicar HCT.......................................... 2
Betaseron .............................................. 6Betaxolol ............................................... 2Bevespi Aerosphere ........................... 11Bevyxxa ................................................. 1Bidil ........................................................ 2Biktarvy ................................................. 9Binosto ................................................ 10Bisoprolol .............................................. 2Bisoprolol-Hydrochlorothiazide .......... 2Boniva .................................................. 10Breo Ellipta .......................................... 11Breztri Aerosphere ............................. 11Brilinta.................................................... 1Brovana ............................................... 11Budesonide Nebulized Solution ....... 11Budesonide/Formoterol .................... 11Bumetanide ........................................... 2Bydureon ............................................... 8Bydureon BCise .................................... 8Byetta .................................................... 8Bystolic .................................................. 2Byvalson ................................................ 2
C
Calan ...................................................... 2Calan SR ............................................... 2Calcitonin (salmon) ............................. 10Candesartan ......................................... 2Candesartan-Hydrochlorothiazide ..... 2Caplyta .................................................. 6Captopril ................................................ 2Captopril-Hydrochlorothiazide ............ 2Cardene SR ........................................... 2Cardizem ............................................... 2Cardizem CD ......................................... 2Cardizem LA ......................................... 2Cardura .................................................. 2Carospir ................................................. 2Cartia XT ............................................... 2Carvedilol .............................................. 2Carvedilol ER ........................................ 2Catapres ................................................ 3Catapres TTS ........................................ 3Celexa .................................................... 7Cellcept E ............................................ 10Chlorothiazide ....................................... 3Chlorpromazine .................................... 6Cholestyramine .................................... 5Cholestyramine Light ........................... 5
13
Choline Fenofibrate .............................. 5Cilostazol ............................................... 1Cimduo .................................................. 9Citalopram ............................................. 7Clonidine ............................................... 3Clonidine Patch .................................... 3Clopidogrel ........................................... 1Clorpress ............................................... 3Clozapine .............................................. 6Clozaril ................................................... 6Colesevelam Tablets, Powder for
Suspension ........................................ 5Colestid ................................................. 5Colestipol .............................................. 5Combivent Respimat.......................... 11Combivir ................................................ 9Complera ............................................... 9Conjupri ................................................. 3Contour Next EZ Meters ...................... 7Contour Next Meters ............................ 7Contour Next One Meters ................... 7Contour Next Test Strips ..................... 7Copaxone .......................................... 6, 7Coreg ..................................................... 3Coreg CR .............................................. 3Corgard ................................................. 3Corzide .................................................. 3Coumadin .............................................. 1Covera HS ............................................. 3Cozaar ................................................... 3Crestor ................................................... 5Crixivan .................................................. 9Cromolyn ............................................. 11Cycloset ................................................. 8Cyclosporine ....................................... 10
D
Daliresp ............................................... 11Delstrigo ................................................ 9Demadex ............................................... 3Descovy ................................................. 9Diabeta .................................................. 8Diabetic Testing - Lancets ................... 7Didanosine ............................................ 9Didronel ............................................... 10Dilacor XR ............................................. 3Dilt CD ................................................... 3Dilt XR .................................................... 3Diltia XT ................................................. 3Diltiazem ................................................ 3Diltiazem ER .......................................... 3
Diltzac ER .............................................. 3Dimethyl Fumarate ............................... 6Diovan .................................................... 3Diovan HCT ........................................... 3Dipyridamole ......................................... 1Diuril ....................................................... 3Dovato ................................................... 9Doxazosin .............................................. 3Duaklir Pressair .................................. 11Duetact .................................................. 8Dulera .................................................. 11Duoneb ................................................ 11Dutoprol ................................................. 3Dyazide .................................................. 3Dynacirc CR .......................................... 3Dyrenium ............................................... 3
E
Edarbi .................................................... 3Edarbyclor ............................................. 3Edecrin .................................................. 3Edurant .................................................. 9Efavirenz ................................................ 9Efavirenz-Emtricitabine-Tenofovir
Disoproxil Fumarate ......................... 9Efavirenz-Lamivudine ........................... 9Efment ..................................................... 1Eliquis .................................................... 1Elixophyllin .......................................... 11Emtricitabine ......................................... 9Emtricitabine-Tenofovir Disoproxil
Fumarate ............................................ 9Emtriva ................................................... 9Enalapril ................................................. 3Enalapril-Hydrochlorothiazide ............. 3Enoxaparin ............................................ 1Envarsus XR ........................................ 10Epaned .................................................. 3Epivir ...................................................... 9Eplerenone ............................................ 3Eprosartan ............................................ 3Epzicom ................................................. 9Escitalopram ......................................... 7Ethacrynic Acid ..................................... 3Etidronate ............................................ 10Etravirine ............................................... 9Everolimus ........................................... 10Evista ................................................... 11Evotaz .................................................... 9Exemestane .......................................... 1Exforge .................................................. 3
Exforge HCT ......................................... 3Extavia ................................................... 6Ezallor Sprinkle ..................................... 5Ezetimibe ........................................... 5, 6Ezetimibe/Rosuvastain ........................ 5
F
Fanapt .................................................... 6Fareston ................................................ 1Farxiga ................................................... 8FazaClo.................................................. 6Felodipine ER ........................................ 3Femara................................................... 1Fenofibrate 40, 48, 120 mg Tablet ...... 5Fenofibrate 30, 43, 50 , 67, 75, 90,
130, 134, 150, 200 mg Capsule ....... 5Fenofibrate 54, 145, 160 mg Tablet .... 5Fenofibric Acid ...................................... 5Fenoglide ............................................... 5Fiasp, Fiasp FlexTouch ......................... 7Fibricor .................................................. 5Flolipid ................................................... 5Flovent Diskus .................................... 11Flovent HFA ......................................... 11Fluoxetine 10 mg, 20 mg Tablets ........ 7Fluoxetine 60 mg Tablets ..................... 7Fluoxetine Capsules ............................. 7Fluphenazine ........................................ 6Fluticasone/Salmeterol Diskus ......... 11Fluticasone/Salmeterol RespiClick .. 11Fluvastatin ............................................. 5Fluvastatin ER ....................................... 5Fluvoxamine .......................................... 7Fluvoxamine Extended-Release ......... 7Fondaparinux ........................................ 1Foradil .................................................. 11Formoterol Nebulized Solution ......... 11Fortamet ................................................ 8Forteo .................................................. 11Fortical ................................................. 11Fosamax .............................................. 11Fosamax Plus D .................................. 11Fosamprenavir ...................................... 9Fosinopril ............................................... 3Fosinopril-Hydrochlorothiazide ........... 3Fragmin.................................................. 1Furosemide ........................................... 3Fuzeon ................................................... 9
G
Gastrocrom ......................................... 11
14
Gemfibrozil ............................................ 5Gengraf ................................................ 10Genvoya................................................. 9Geodon .................................................. 6Gilenya ................................................... 6Glatiramer Acetate ............................... 7Glatopa .................................................. 7Glimepiride ............................................ 8Glipizide ................................................. 8Glipizide ER ........................................... 8Glipizide-Metformin .............................. 8Glucophage .......................................... 8Glucophage XR .................................... 8Glucotrol ................................................ 8Glucotrol XL .......................................... 8Glucovance ........................................... 8Glumetza ............................................... 8Glyburide ............................................... 8Glyburide Micronized ........................... 8Glyburide-Metformin ............................ 8Glynase .................................................. 8Glyset ..................................................... 8Glyxambi ............................................... 8Guanfacine ............................................ 3
H
Haloperidol ............................................ 6Heparin .................................................. 1Humalog ................................................ 7Humalog Junior .................................... 7Humalog Mix 50/50 .............................. 7Humalog Mix 75/25 .............................. 7Humulin 50/50 ...................................... 7Humulin 70/30 ...................................... 7Humulin N ............................................. 7Humulin R .............................................. 7Hydralazine ........................................... 3Hydrochlorothiazide ............................. 3Hyzaar.................................................... 3
I
Ibandronate ......................................... 11Icosapent .............................................. 5Imuran.................................................. 10Incruse Ellipta ..................................... 11Indapamide ........................................... 3Inderal .................................................... 3Inderal LA .............................................. 3Inderal XL .............................................. 3Innopran XL ........................................... 3Inspra ..................................................... 3
Insulin Aspart ........................................ 7Insulin Aspart Protamine/
Insulin Aspart .................................... 7Insulin Glargine .................................... 7Insulin Lispro ......................................... 7Insulin Lispro Jr. .................................... 7Insulin Lispro Protamine/Insulin
Lispro 75/25 ...................................... 7Insulin Needles/Syringes ..................... 7Intelence ................................................ 9Invega .................................................... 6Invirase .................................................. 9Invokamet .............................................. 8Invokamet XR ........................................ 8Invokana ................................................ 8Ipratropium .......................................... 11Ipratropium/Albuterol ......................... 11Irbesartan .............................................. 3Irbesartan - Hydrochlorothiazide ........ 3Isentress ................................................ 9Isentress HD ......................................... 9Isoptin SR .............................................. 3Isradipine ............................................... 3
J
Jantoven ................................................ 1Janumet ................................................. 8Janumet XR ........................................... 8Januvia .................................................. 8Jardiance ............................................... 8Jentadueto ............................................ 8Jentadueto XR ...................................... 8Juluca .................................................... 9
K
Kaletra ................................................... 9Kapspargo ............................................. 3Katerzia .................................................. 3Kazano ................................................... 8Kesimpta ............................................... 7Kombiglyze XR ..................................... 8
L
Labetalol ................................................ 3Lamivudine ............................................ 9Lamivudine-Zidovudine ....................... 9Lantus .................................................... 7Lasix....................................................... 3Latuda .................................................... 6Lescol .................................................... 5Lescol XL ............................................... 5
Letrozole ................................................ 1Levalbuterol HFA ................................ 11Levalbuterol Nebulized Solution ....... 11Levatol ................................................... 3Levemir .................................................. 7Lexapro.................................................. 7Lexiva ..................................................... 9Lipitor ..................................................... 5Lipofen ................................................... 5Lisinopril ................................................ 3Lisinopril-Hydrochlorothiazide ............ 3Livalo...................................................... 5Lofibra ................................................... 5Lonhala Magnair ................................. 11Lopid ...................................................... 5Lopinavir-Ritonavir ................................ 9Lopressor .......................................... 3, 4Lopressor HCT ..................................... 4Losartan ................................................ 4Losartan-Hydrochlorothiazide ............ 4Lotensin ................................................. 4Lotensin HCT ........................................ 4Lotrel ...................................................... 4Lovastatin .............................................. 5Lovaza ................................................... 5Lovenox ................................................. 2Loxapine ................................................ 6Lufyllin ................................................. 11Lybalvi ................................................... 6Lyumjev ................................................. 7
M
Matzim LA ............................................. 4Mavenclad ............................................. 7Mavik ..................................................... 4Maxzide ................................................. 4Mayzent ................................................. 7Metaproterenol ................................... 11Metformin .............................................. 8Metformin ER ........................................ 8Metformin Solution ............................... 8Methyclothiazide .................................. 4Methyldopa ........................................... 4Methyldopa-Hydrochlorothiazide ....... 4Metolazone ........................................... 4Metoprolol 37.5, 75 mg ........................ 4Metoprolol Succinate ........................... 4Metoprolol Tartrate ............................... 4Metoprolol-Hydrochlorothiazide ......... 4Mevacor ................................................. 5Miacalcin ............................................. 11
15
Micardis ................................................. 4Micardis HCT ........................................ 4Microzide ............................................... 4Midamor ................................................ 4Miglitol ................................................... 8Minipress ............................................... 4Minoxidil ................................................ 4Moexipril ................................................ 4Moexipril-Hydrochlorothiazide ............ 4Molindone ............................................. 6Montelukast ........................................ 11Mycophenolate ................................... 10Mycophenolic Acid ............................. 10Myfortic ............................................... 10
N
Nadolol .................................................. 4Nadolol-Bendroflumethazide .............. 4Nateglinide ............................................ 8Nebivolol .............................................. 4Neoral .................................................. 10Nesina .................................................... 8Nevirapine ........................................... 10Nevirapine Extended-Release .......... 10Nexletol .................................................. 5Nexlizet .................................................. 5Niacin Extended-Release .................... 5Niacor .................................................... 6Niaspan ................................................. 6Nicardipine ............................................ 4Nifedipine .............................................. 4Nifedipine ER ........................................ 4Nimodipine ............................................ 4Nisoldipine ............................................ 4Norvasc ................................................. 4Norvir Tablet ........................................ 10Novolin 70/30 ........................................ 7Novolin N ............................................... 7Novolin R ............................................... 8Novolog ................................................. 8Novolog Mix 70/30 ............................... 8
O
Odefsey ............................................... 10Olanzapine ............................................ 6Olmesartan ........................................... 4Olmesartan-Hydrochlorothiazide........ 4Omega-3 Acid Ethyl Esters .................. 6OneTouch Diabetic Meters .................. 7OneTouch Diabetic Test Strips ............ 7Onglyza ................................................. 8
Oseni...................................................... 8Ozempic ................................................ 8
P
Paliperidone ER .................................... 6Paroxetine ............................................. 7Paroxetine Extended-Release ............. 7Paxil ....................................................... 7Paxil CR ................................................. 7Pediatric Flouride Preparations ........ 12Perforomist ......................................... 11Perindopril ............................................. 4Perphenazine ........................................ 6Persantine ............................................. 2Pexeva ................................................... 7Pifeltro ................................................. 10Pindolol .................................................. 4Pioglitazone .......................................... 8Pioglitazone-Glimepiride ..................... 8Pioglitazone-Metformin ....................... 9Plavix ...................................................... 2Plegridy.................................................. 7Pletal ...................................................... 2Ponvory ................................................. 7Pradaxa ................................................. 2PrandiMet .............................................. 9Prandin .................................................. 9Prasugrel ............................................... 2Pravachol ............................................... 6Pravastatin ............................................ 6Prazosin ................................................. 4Precose ................................................. 9Prenatal Vitamins ............................... 12Prestalia ................................................. 4Prevalite ................................................. 6Prezcobix ............................................. 10Prezista ................................................ 10Prinivil .................................................... 4ProAir Digihaler ................................... 11Proair HFA ........................................... 11ProAir HFA, Proventil HFA ................. 11Proair RespiClick ................................ 11Procardia ............................................... 4Procardia XL ......................................... 4Prograf ................................................. 10Propranolol ........................................... 4Propranolol-Hydrochlorothiazide ........ 4Proventil HFA ................................ 11, 12Prozac .................................................... 7Pulmicort Flexhaler ............................ 12Pulmicort Nebulized Solution ............ 12
Q
Qbrelis ................................................... 4Qtern ...................................................... 9Questran ................................................ 6Questran Light ...................................... 6Quetiapine ............................................. 6Quetiapine ER ....................................... 6Quinapril ................................................ 4Quinapril-Hydrochlorothiazide ............ 4QVAR Redihaler .................................. 12
R
Raloxifene ........................................... 11Ramipril ................................................. 4Rapamune ........................................... 10Rebif ...................................................... 7Repaglinide ........................................... 9Repaglinide-Metformin ........................ 9Rescriptor ............................................ 10Reserpine .............................................. 4Retrovir ................................................ 10Rexulti .................................................... 6Reyataz ................................................ 10Riomet ............................................... 8, 9Riomet ER ............................................. 9Risedronate ......................................... 11Risperdal ............................................... 6Risperidone ........................................... 6Ritonavir .............................................. 10Rosuvastatin ......................................... 6Roszet .................................................... 6Rukobia ............................................... 10Rybelsus ................................................ 9
S
Sandimmune ....................................... 10Saphris .................................................. 6Savaysa ................................................. 2Sectral ................................................... 4Secuado ................................................ 6Segluromet ............................................ 9Selzentry .............................................. 10Semglee ................................................ 8Serevent Diskus .................................. 12Seroquel ................................................ 6Seroquel XR .......................................... 6Sertraline Tablets.................................. 7Sertraline Capsules 150 mg,
200 mg .............................................. 7Simvastatin ............................................ 6Simvastatin/Ezetimibe ......................... 6
16
Singulair............................................... 12Sirolimus .............................................. 10Soliqua ................................................... 8Soltamox ............................................... 1Spiriva HandiHaler.............................. 12Spiriva Respimat ................................ 12Spironolactone ..................................... 4Spironolactone-
Hydrochlorothiazide ......................... 4Starlix ..................................................... 9Stavudine ............................................ 10Steglatro ................................................ 9Steglujan ............................................... 9Stiolto Respimat ................................. 12Stribild ................................................. 10Striverdi Respimat .............................. 12Sular ....................................................... 4Sustiva ................................................. 10Symbicort ...................................... 11, 12Symfi ................................................ 9, 10Symfi Lo........................................... 9, 10Symfi, Symfi Lo ..................................... 9SymlinPen ............................................. 9Symtuza ............................................... 10Synjardy ................................................. 9Synjardy XR ........................................... 9
T
Tacrolimus ........................................... 10Tamoxifen .............................................. 1Tarka ...................................................... 4Taztia XT ................................................ 4Tecfidera............................................ 6, 7Tekturna ................................................ 4Tekturna HCT ........................................ 4Telmisartan............................................ 4Telmisartan-Amlodipine ....................... 4Telmisartan-Hydrochlorothiazide ........ 4Temixys................................................ 10Tenex ..................................................... 4Tenofovir .............................................. 10Tenoretic ................................................ 4Tenormin ............................................... 4Terazosin ............................................... 4Terbutaline .......................................... 12Teriparatide ......................................... 11Teveten .................................................. 4Teveten HCT ......................................... 4Thalitone 15 mg .................................... 5Thalitone 25 mg .................................... 5Theo-24 ............................................... 12
Theophylline........................................ 12Theophylline/Guaifenesin .................. 12Thioridazine .......................................... 6Thiothixene ............................................ 6Tiazac .................................................... 5Ticlopidine ............................................. 2Timolol ................................................... 5Tivicay .................................................. 10Tivicay PD............................................ 10Tolbutamide .......................................... 9Toprol XL ............................................... 5Toremifene ............................................ 1Torsemide ............................................. 5Toujeo .................................................... 8Tradjenta ............................................... 9Trandate ................................................ 5Trandolapril ........................................... 5Trandolapril-Verapamil ......................... 5Trelegy Ellipta ...................................... 12Tresiba ................................................... 8Triamterene ........................................... 5Triamterene-Hydrochlorothiazide ....... 5Tribenzor ............................................... 5Tricor ...................................................... 6Trifluoperazine ...................................... 6Triglide ................................................... 6Trijardy XR ............................................. 9Trilipix..................................................... 6Triumeq ............................................... 10Trizivir ................................................... 10Trulicity .................................................. 9Truvada ............................................ 9, 10Tudorza Pressair ................................. 12Twynsta ................................................. 5Tymlos ................................................. 11
U
Uniretic .................................................. 5Univasc .................................................. 5
V
Valsartan ............................................... 5Valsartan-Hydrochlorothiazide ............ 5Vascepa ................................................. 6Vaseretic ................................................ 5Vasotec .................................................. 5Ventolin HFA ................................. 11, 12Verapamil .............................................. 5Verapamil ER ........................................ 5Verelan ................................................... 5Verelan PM ............................................ 5
Versacloz ............................................... 6Victoza ................................................... 9Videx .................................................... 10Videx EC .............................................. 10Viracept ............................................... 10Viramune ............................................. 10Viramune XR ....................................... 10Viread .................................................. 10Viteka ................................................... 10Vocabria .............................................. 10VoSpire ER .......................................... 12Vraylar .................................................... 6Vumerity ................................................ 7Vytorin ................................................... 6
W
Warfarin ................................................. 2Welchol .................................................. 6
X
Xarelto ................................................... 2Xigduo XR ............................................. 9Xopenex HFA ...................................... 12Xopenex Nebulized Solution ............. 12Xultophy ................................................. 9
Y
Yupelri .................................................. 12
Z
Zafirlukast ........................................... 12Zaroxolyn ............................................... 5Zebeta ................................................... 5Zeposia .................................................. 7Zerit ...................................................... 10Zestoretic .............................................. 5Zestril ..................................................... 5Zetia ....................................................... 6Ziac ........................................................ 5Ziagen .................................................. 10Zidovudine .......................................... 10Ziprasidone ........................................... 6Zocor ..................................................... 6Zoloft ..................................................... 7Zontivity ................................................. 2Zortress ............................................... 10Zyflo ..................................................... 12Zyflo CR ............................................... 12Zypitamag ............................................. 6Zyprexa .................................................. 6
17
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