Premium Value Formulary

2022 Premium Value Formulary Effective January 1, 2022
Understanding your formulary

What is a formulary? What are tiers?
A formulary is a list of prescribed medications or other Tiers are the different cost levels you pay for a
pharmacy care products, services or supplies chosen medication. Each tier is assigned a cost, set by your
for their safety, cost, and effectiveness. Medications employer or plan sponsor.
are listed by categories or classes and are placed into
The formulary gives you choices so you and your
cost levels known as tiers. It includes both brand and
doctor can decide your best course of treatment. In
generic prescription medications.
this formulary, brand-name medications are shown in
UPPERCASE (for example, BRAND DRUG). Generic
medications are shown in lowercase (for example,
generic drug).
Reading your formulary
About this formulary Please review your benefit plan documents for full
Where differences exist between this list and your details. Not all formulary alternatives listed in this
benefit plan, the benefit plan documents rule. This document may be appropriate for your specific
is not a complete list of your covered medications. condition. Please talk to your doctor.
Tier information
Drug tier Includes Helpful tips

Tier 1 $ Lower-cost medications
Tier 2 $$ Low-cost medications Brand name and generic medications can be
found in any of the 4 tiers. The lower the tier,
Tier 3 $$$ Mid-range cost medications the less your medications will cost.
Tier 4 $$$$ Higher-cost medications
Drug list information
Prior authorization – Your doctor is required to give OptumRx more information to

PA
determine coverage.
QL Quantity limit – Medication may be limited to a certain quantity.
SP Specialty medication – Medication is designated as specialty.
Step therapy – Must try lower-cost medication(s) before a higher-cost medication can
ST
be covered.
Premium Value Formulary
Table of Contents
Analgesics - Drugs for Pain............................................................................................................................. 4
Analgesics - Drugs for Pain and Inflammation...............................................................................................4
Anesthetics........................................................................................................................................................ 6
Anti-Addiction / Substance Abuse Treatment Agents................................................................................... 7
Antibacterials.....................................................................................................................................................7
Anticoagulants................................................................................................................................................ 10
Anticonvulsants - Drugs for Seizures........................................................................................................... 10
Antidementia Agents - Drugs for Alzheimer's Disease and Dementia.......................................................11
Antidepressants.............................................................................................................................................. 11
Antiemetics - Drugs for Nausea and Vomiting............................................................................................. 12
Antifungals.......................................................................................................................................................13
Antigout Agents.............................................................................................................................................. 13
Antimigraine Agents....................................................................................................................................... 13
Antimyasthenic Agents.................................................................................................................................. 14
Antimycobacterials......................................................................................................................................... 14
Antineoplastics - Drugs for Cancer............................................................................................................... 14
Antiparasitics...................................................................................................................................................18
Antiparkinson Agents..................................................................................................................................... 18
Antiplatelets.....................................................................................................................................................19
Antipsychotics - Drugs for Mood Disorders.................................................................................................19
Antivirals.......................................................................................................................................................... 19
Anxiolytics - Drugs for Anxiety......................................................................................................................21
Bipolar Agents - Drugs for Mood Disorders................................................................................................. 21
Blood Products and Modifiers - Drugs for Blood Disorders....................................................................... 21
Cardiovascular Agents - Drugs for Heart and Circulation Conditions.......................................................22
Central Nervous System Agents - Drugs for Attention Deficit Disorder....................................................26
Central Nervous System Agents - Drugs for Multiple Sclerosis.................................................................26
Central Nervous System Agents - Miscellaneous........................................................................................26
Dental and Oral Agents - Drugs for Mouth and Throat Conditions............................................................ 27
Dermatological Agents - Drugs for Skin Conditions................................................................................... 27
Diabetes - Antidiabetic Agents...................................................................................................................... 30
Diabetes - Glucose Monitoring...................................................................................................................... 30
Diabetes - Glycemic Agents........................................................................................................................... 31
Diabetes - Insulins...........................................................................................................................................31
Electrolytes / Minerals / Metals / Vitamins.................................................................................................... 32
Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer........................................................................ 35
Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions.......................................35
Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment..................................... 36
Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions............................................. 36
Genitourinary Agents - Drugs for Prostate Conditions............................................................................... 37
Hormonal Agents - Adrenal............................................................................................................................37
Hormonal Agents - Men's Health................................................................................................................... 38
Hormonal Agents - Osteoporosis.................................................................................................................. 38
Hormonal Agents - Pituitary...........................................................................................................................38
Hormonal Agents - Prostaglandins............................................................................................................... 39
Hormonal Agents - Sex Hormones and Birth Control................................................................................. 39
Hormonal Agents - Thyroid............................................................................................................................ 42
Immunological Agents - Drugs for Immune System Stimulation or Suppression.................................... 42
Immunological Agents - Drugs for Vaccination........................................................................................... 44
Inflammatory Bowel Disease Agents............................................................................................................ 45
2
Metabolic Bone Disease Agents - Drugs for Osteoporosis........................................................................ 45
Metabolic Bone Disease Agents - Other....................................................................................................... 46
Miscellaneous Therapeutic Agents............................................................................................................... 46
Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation..................................................47
Ophthalmic Agents - Drugs for Glaucoma....................................................................................................48
Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions................................................................. 48
Otic Agents - Drugs for Ear Conditions........................................................................................................ 49
Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold............................................... 49
Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions.........................50
Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis............................................................51
Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension........................................... 52
Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm................................................................ 52
Sleep Disorder Agents....................................................................................................................................52
3
Drug Name Drug Tier Notes Drug Name Drug Tier Notes
Analgesics - Drugs ketoprofen oral capsule
for Pain and 3
50 mg, 75 mg
Inflammation ketorolac tromethamine
1
adult aspirin regimen 1 injection
aspirin adult low ketorolac tromethamine
1 1
strength intramuscular
aspirin childrens 1 ketorolac tromethamine
1 QL
aspirin ec low dose 1 oral
aspirin ec low strength 1 meloxicam oral tablet 1
aspirin ec oral tablet nabumetone oral 1
delayed release 325 1 naproxen oral tablet 1
mg naproxen oral tablet
1
aspirin low dose 1 delayed release
aspirin oral tablet 1 naproxen sodium oral
1
aspirin oral tablet tablet 275 mg, 550 mg
1
delayed release oxaprozin 1
celecoxib oral 1 QL piroxicam oral 1
diclofenac potassium 1 sulindac oral 1
diclofenac sodium er 1 tri-buffered aspirin 1
diclofenac sodium Analgesics - Drugs
1 QL for Pain
external gel 1 %
diclofenac sodium oral 1 acetaminophen-
1 QL
diclofenac-misoprostol 2 codeine
diflunisal oral 1 acetaminophen-
1 QL
codeine #2
etodolac 1
acetaminophen-
etodolac er 1 1 QL
codeine #3
flurbiprofen oral 1 acetaminophen-
1 QL
goodsense aspirin codeine #4
1
adults ascomp-codeine 2
goodsense aspirin low bac 1
1
dose
buprenorphine hcl
ibuprofen 1 4
injection
ibuprofen lysine 1 buprenorphine
ibuprofen oral transdermal patch
1
suspension weekly 10 mcg/hr, 15 2 PA; QL
indomethacin er 1 mcg/hr, 20 mcg/hr, 5
mcg/hr
indomethacin oral
1 buprenorphine
capsule 25 mg, 50 mg
transdermal patch 3 PA; QL
indomethacin sodium 1 weekly 7.5 mcg/hr
For more information regarding the tiers and designations in this drug list, please see the Reading your
formulary section of this booklet.
4
butalbital- meperidine hcl injection 1
acetaminophen oral 2 meperidine hcl oral
tablet 50-325 mg 1 QL
solution
butalbital-apap-caff-cod 1 methadone hcl injection 1
butalbital-apap-caffeine 1 methadone hcl intensol 1
butalbital-asa-caff- methadone hcl oral
2 1
codeine concentrate
butalbital-aspirin- methadone hcl oral
1 1
caffeine solution
butorphanol tartrate methadone hcl oral
1 1 PA
injection tablet
butorphanol tartrate methadone hcl oral
1 QL 2
nasal tablet soluble
carisoprodol-aspirin- methadose oral tablet
1 2
codeine soluble
codeine sulfate 1 QL methadose sugar-free 1
endocet 1 QL morphine sulfate
fentanyl 2 PA; QL (concentrate) oral
1 QL
fentanyl citrate buccal solution 100 mg/5ml,
3 PA; QL 20 mg/ml
lozenge on a handle
hydrocodone bitartrate morphine sulfate (pf) 1
er oral capsule morphine sulfate er
3 PA; QL 3 PA; QL
extended release 12 beads
hour morphine sulfate er oral
hydrocodone- capsule extended 2 PA; QL
1 QL
acetaminophen release 24 hour
hydrocodone-ibuprofen 1 QL morphine sulfate er oral
1 PA; QL
hydromorphone hcl er 3 PA; QL tablet extended release
hydromorphone hcl morphine sulfate
injection solution 2 2 injection solution 2 1
mg/ml, 4 mg/ml mg/ml, 4 mg/ml
HYDROMORPHONE MORPHINE SULFATE
2 INTRAVENOUS 2
HCL INTRAVENOUS
SOLUTION 1 MG/ML
hydromorphone hcl oral 1 QL
morphine sulfate oral 1 QL
hydromorphone hcl pf 2
nalbuphine hcl injection 1
HYDROMORPHONE
HCL SOLUTION 1 2 OXYCODONE HCL ER 3 PA; QL
MG/ML INJECTION oxycodone hcl oral
1 QL
hydromorphone hcl capsule
solution 1 mg/ml 2 oxycodone hcl oral
injection concentrate 100 3 QL
mg/5ml
5
oxycodone hcl oral lidocaine hcl external
1 QL 1
solution solution
oxycodone hcl oral lidocaine hcl injection
1 QL 1
tablet solution 0.5 %
oxycodone- LIDOCAINE HCL
acetaminophen oral INJECTION
tablet 10-325 mg, 2.5- 1 QL SOLUTION 1
325 mg, 5-325 mg, 7.5- PREFILLED SYRINGE
325 mg 10 MG/ML, 60 MG/3ML
oxymorphone hcl 1 QL LIDOCAINE HCL
oxymorphone hcl er 3 PA; QL SOLUTION 1 % 1
INJECTION
pentazocine-naloxone
2 QL lidocaine hcl solution 1
hcl 1
% injection
tramadol hcl er
1 PA; QL LIDOCAINE HCL
(biphasic)
SOLUTION 2 % 1
tramadol hcl er oral INJECTION
tablet extended release 1 PA; QL
24 hour lidocaine hcl solution 2
1
% injection
tramadol hcl ir 1 QL
lidocaine hcl
tramadol- 1
1 QL urethral/mucosal
acetaminophen
lidocaine-epinephrine
Anesthetics injection solution 0.5 %-
bupivacaine 1:200000, 1 %-
1 1
fisiopharma 1:100000, 1.5 %-
bupivacaine hcl (pf) 1 1:200000, 2 %-
1:200000
bupivacaine hcl
injection solution 0.25 1 lidocaine-prilocaine
1
%, 0.5 % external cream
bupivacaine- polocaine-mpf injection

1 1
epinephrine solution 2 %
bupivacaine- ropivacaine hcl

1 1
epinephrine (pf) injection solution
glydo 1 SENSORCAINE 1
lidocaine external patch SENSORCAINE-MPF

2 INJECTION
5% 1
SOLUTION 0.25 %, 0.5
lidocaine hcl (cardiac) %
intravenous solution
1 SENSORCAINE-
prefilled syringe 100
mg/5ml, 50 mg/5ml MPF/EPINEPHRINE
INJECTION 1
lidocaine hcl (cardiac) SOLUTION 0.5% -
1
pf 1:200000
lidocaine hcl (pf) 1
6
XYLOCAINE ARIKAYCE 4 PA; SP
INJECTION 1 AUGMENTIN ORAL
SOLUTION 1 % SUSPENSION
3
XYLOCAINE-MPF RECONSTITUTED
INJECTION 1 125-31.25 MG/5ML
SOLUTION 1 % avidoxy 1
Anti-Addiction / azithromycin
Substance Abuse 1
intravenous
Treatment Agents
azithromycin oral 1
acamprosate calcium 2
aztreonam 2
APO-VARENICLINE 3 QL
BICILLIN L-A 3
buprenorphine hcl
1 QL cefaclor er 2
sublingual
buprenorphine hcl- cefaclor oral capsule 1
2 QL
naloxone hcl cefaclor oral
bupropion hcl er suspension 3
1 QL reconstituted
(smoking det)
CHANTIX 3 QL cefadroxil 1
CHANTIX cefazolin sodium
1
CONTINUING MONTH 3 QL injection
PAK CEFAZOLIN SODIUM
CHANTIX STARTING INTRAVENOUS
3 QL 2
MONTH PAK SOLUTION
PREFILLED SYRINGE
disulfiram oral 1
cefazolin sodium
naloxone hcl injection 1 intravenous solution 1
naltrexone hcl oral 1 reconstituted
NARCAN 2 cefazolin sodium-
SUBLOCADE 3 SP dextrose intravenous
1
solution 1-4 gm/50ml-
VIVITROL 3 SP %, 2-4 gm/100ml-%
Antibacterials cefdinir 1
amikacin sulfate cefepime hcl injection 1
2
injection
cefepime hcl
amoxicillin 1 2
amoxicillin-potassium cefepime-dextrose 2
2
clavulanate er
cefixime oral capsule 1
amoxicillin-potassium
1 cefixime oral
clavulanate oral
suspension 2
ampicillin 1 reconstituted
ampicillin sodium 1 cefotaxime sodium 1
ampicillin-sulbactam cefoxitin sodium 1
1
sodium
7
cefpodoxime proxetil clindamycin phosphate
1
oral suspension 2 vaginal
reconstituted colistimethate sodium
3
cefpodoxime proxetil (cba)
1
oral tablet daptomycin 3
cefprozil 1 demeclocycline hcl 2
ceftazidime and dicloxacillin sodium 1
2
dextrose
DIFICID ORAL
ceftazidime injection 1 4
TABLET
ceftriaxone sodium in doxy 100 2
1
dextrose
doxycycline hyclate
ceftriaxone sodium 2
1 intravenous
injection
doxycycline hyclate oral
ceftriaxone sodium 1
1 capsule
intravenous
doxycycline hyclate oral
ceftriaxone sodium- 1
1 tablet 100 mg, 20 mg
dextrose
doxycycline
cefuroxime axetil 1 monohydrate oral 1
cefuroxime sodium 1 capsule 100 mg, 50 mg
cephalexin 1 doxycycline
CIPRO ORAL monohydrate oral
1
SUSPENSION 2 suspension
RECONSTITUTED reconstituted
ciprofloxacin hcl oral 1 doxycycline
1
monohydrate oral tablet
ciprofloxacin in d5w 1
ertapenem sodium 3
clarithromycin er 2
erythromycin base oral
clarithromycin oral capsule delayed 2
suspension 2 release particles
reconstituted
clarithromycin oral 3
1 tablet
tablet
clindamycin hcl oral 1 2
tablet delayed release
clindamycin palmitate erythromycin
2 3
hcl ethylsuccinate oral
clindamycin phosphate erythromycin oral 2
1
in d5w
FORTAZ INJECTION
CLINDAMYCIN SOLUTION
2 4
PHOSPHATE IN NACL RECONSTITUTED 500
clindamycin phosphate MG
1
injection FORTAZ
4
INTRAVENOUS
8
gentamicin in saline 1 mondoxyne nl oral
1
gentamicin sulfate capsule 100 mg
1
external morgidox oral 1
gentamicin sulfate moxifloxacin hcl in nacl 2
1
injection MOXIFLOXACIN HCL
2
imipenem-cilastatin 3 INTRAVENOUS
levofloxacin in d5w 1 moxifloxacin hcl oral 1
levofloxacin mupirocin external 1
2
intravenous nafcillin sodium 3
levofloxacin oral NAFCILLIN SODIUM
2 3
solution IN DEXTROSE
levofloxacin oral tablet 1 neomycin sulfate oral 1
lincomycin hcl injection 2 neomycin-polymyxin b
1
linezolid in sodium gu
4
chloride nitrofurantoin
1
linezolid intravenous 3 macrocrystal
linezolid oral nitrofurantoin
suspension 3 QL monohydrate 1
reconstituted macrocrystals
linezolid oral tablet 2 QL ofloxacin oral 2
mafenide acetate oxacillin sodium 3
3
external paromomycin sulfate
2
meropenem 2 oral
MEROPENEM- penicillin g potassium 1
2
SODIUM CHLORIDE penicillin v potassium 1
methenamine hippurate 1 piperacillin sod-
1
metronidazole in nacl tazobactam so
intravenous solution 5- silver sulfadiazine
1 1
0.79 mg/ml-%, 500- external
0.79 mg/100ml-%
ssd 1
metronidazole oral
2 streptomycin sulfate
capsule 4
intramuscular
metronidazole oral
1 sulfadiazine oral 3
tablet
metronidazole vaginal 1 sulfamethoxazole-
trimethoprim 2
MINOCIN intravenous
3
INTRAVENOUS
sulfamethoxazole-
minocycline hcl oral 1
1 trimethoprim oral
capsule
sulfatrim pediatric 1
minocycline hcl oral
2 tazicef injection 1
tablet
9
TAZICEF FRAGMIN 3 SP; QL
INTRAVENOUS 2 HEPARIN (PORCINE)
SOLUTION IN NACL
tazicef intravenous INTRAVENOUS 2
1
solution reconstituted SOLUTION 5000-0.9
tetracycline hcl oral 2 UT/500ML-%
tinidazole oral 1 heparin sodium
(porcine) injection 1
tobramycin sulfate solution
1
injection solution
heparin sodium
tobramycin sulfate 1
(porcine) pf
injection solution 4
reconstituted jantoven 1
trimethoprim oral 1 PRADAXA 2 QL
vancomycin hcl in THROMBATE III 3 SP
dextrose intravenous warfarin sodium oral 1
solution 1-5 gm/200ml- 1 XARELTO 2 QL
%, 500-5 mg/100ml-%,
750-5 mg/150ml-% XARELTO STARTER
2 QL
PACK
vancomycin hcl in nacl
intravenous solution 1- Anticonvulsants -
0.9 gm/200ml-%, 500- 2 Drugs for Seizures
0.9 mg/100ml-%, 750- BRIVIACT 3 ST
0.9 mg/150ml-% carbamazepine er 2
vancomycin hcl carbamazepine oral 1
intravenous solution 2
reconstituted CELONTIN 3
vancomycin hcl oral 2 clobazam oral
2 PA
suspension
vandazole 1
clobazam oral tablet 1 PA
XEPI 2
DIACOMIT 3 PA; SP
ZITHROMAX ORAL
1 diazepam rectal 3 QL
PACKET
ZOSYN 1 divalproex sodium er 1
ZYVOX divalproex sodium oral 1
INTRAVENOUS EPIDIOLEX 3 PA; SP
4
SOLUTION 200 epitol 1
MG/100ML
ethosuximide oral 2
Anticoagulants
felbamate 3
ELIQUIS 2 QL
fosphenytoin sodium 1
ELIQUIS DVT/PE
2 QL FYCOMPA 3 ST
STARTER PACK
enoxaparin sodium 2 SP; QL gabapentin oral 1
fondaparinux sodium 3 SP; QL lamotrigine er 2
10
lamotrigine oral kit 3 topiramate oral 1
lamotrigine oral tablet 1 valproate sodium
1
lamotrigine oral tablet intravenous
1
chewable valproic acid oral 1
lamotrigine oral tablet vigabatrin 4 PA; SP
3 ST
dispersible vigadrone 4 PA; SP
lamotrigine starter kit- VIMPAT 3 ST
3
blue
zonisamide oral 1
lamotrigine starter kit-
3 Antidementia Agents
green
- Drugs for
lamotrigine starter kit- Alzheimer's Disease
3
orange and Dementia
levetiracetam er 1 donepezil hcl 1
levetiracetam galantamine
1 1
intravenous hydrobromide er
levetiracetam oral 1 galantamine
oxcarbazepine oral hydrobromide oral 2
2
suspension solution
oxcarbazepine oral galantamine
1
tablet hydrobromide oral 1
phenobarbital oral 1 tablet
phenytoin infatabs 1 memantine hcl er 2 QL
phenytoin oral 1 memantine hcl oral
3 ST
solution
phenytoin sodium
1 memantine hcl oral
extended 1
tablet
phenytoin sodium
1 rivastigmine 2
injection
primidone oral 1 rivastigmine tartrate 1
roweepra 1 Antidepressants
rufinamide 3 PA amitriptyline hcl oral 1

subvenite 1 amoxapine 1
subvenite starter kit- bupropion hcl er (sr) 1 QL
3
blue bupropion hcl er (xl)
subvenite starter kit- oral tablet extended
3 1 QL
green release 24 hour 150
mg, 300 mg
subvenite starter kit-
3 bupropion hcl oral 1
orange
SYMPAZAN 3 PA chlordiazepoxide-
1
amitriptyline
tiagabine hcl 3
citalopram
topiramate er 3 ST 1
hydrobromide
11
clomipramine hcl oral 1 trazodone hcl oral 1
desipramine hcl oral 1 trimipramine maleate
2
desvenlafaxine oral
1 QL
succinate er venlafaxine hcl 1
doxepin hcl oral venlafaxine hcl er oral
1
capsule capsule extended 1
doxepin hcl oral release 24 hour
1
concentrate venlafaxine hcl er oral
duloxetine hcl oral 1 QL tablet extended release 2
24 hour 225 mg
escitalopram oxalate
2 Antiemetics - Drugs
oral solution
for Nausea and
escitalopram oxalate Vomiting
1
oral tablet
aprepitant oral 3 QL
fluoxetine hcl (pmdd) 2
aprepitant oral capsule
fluoxetine hcl oral 2 QL
1 125 mg, 40 mg, 80 mg
capsule
aprepitant oral capsule
fluoxetine hcl oral 3 QL
80 & 125 mg
capsule delayed 2 QL
release CINVANTI 3
fluoxetine hcl oral compro 2
1
solution dronabinol 2 PA; QL
fluoxetine hcl oral tablet granisetron hcl
1 1
10 mg, 60 mg intravenous
fluvoxamine maleate 1 granisetron hcl oral 2 QL
fluvoxamine maleate er 2 QL meclizine hcl oral tablet 1
imipramine hcl oral 1 metoclopramide hcl
1
imipramine pamoate 2 injection
mirtazapine oral 1 metoclopramide hcl
1
oral solution
nefazodone hcl 1
metoclopramide hcl
nortriptyline hcl oral 1 1
oral tablet
olanzapine-fluoxetine metoclopramide hcl
2 QL 2 ST
hcl oral tablet dispersible
paroxetine hcl 1 ondansetron hcl
1
paroxetine hcl er 1 injection
paroxetine mesylate 2 QL ondansetron hcl oral
1 QL
phenelzine sulfate oral 1 solution
protriptyline hcl 2 ondansetron hcl oral

1
tablet 4 mg, 8 mg
sertraline hcl oral 1
ondansetron odt 1
tranylcypromine sulfate 2
12
palonosetron hcl griseofulvin microsize
1 2
intravenous solution oral
palonosetron hcl griseofulvin
2
intravenous solution 2 ultramicrosize
prefilled syringe itraconazole oral
2 PA
perphenazine oral 1 capsule
prochlorperazine 2 itraconazole oral
3 PA
prochlorperazine solution
1
edisylate injection ketoconazole external
1
prochlorperazine cream
1
maleate oral ketoconazole external
1
scopolamine 1 shampoo
trimethobenzamide hcl ketoconazole oral 1
1
oral miconazole 3 1
Antifungals naftifine hcl external
2
ABELCET 3 cream
AMBISOME 3 nyamyc 1
amphotericin b nystatin external 1
3
intravenous nystatin mouth/throat 1
caspofungin acetate 3 nystatin oral 1
ciclodan 1 nystatin-triamcinolone 1
ciclopirox external 1 nystop 1
ciclopirox olamine terbinafine hcl oral 1 QL
1
external terconazole 1
clotrimazole 3 1 voriconazole
4
clotrimazole external 1 intravenous
clotrimazole voriconazole oral
1
mouth/throat suspension 4 PA
clotrimazole- reconstituted
1
betamethasone voriconazole oral tablet 3 PA
CRESEMBA Antigout Agents
4
INTRAVENOUS allopurinol oral 1
CRESEMBA ORAL 4 PA allopurinol sodium 1
cvs clotrimazole 3 1 colchicine oral tablet 2
econazole nitrate colchicine-probenecid 1
1
external
probenecid 1
fluconazole in sodium
1 Antimigraine Agents
chloride
fluconazole oral 1 almotriptan malate 2 QL
flucytosine oral 4
13
dihydroergotamine rifabutin 3
3 PA; QL
mesylate injection rifampin intravenous 2
dihydroergotamine rifampin oral 1
3 PA; QL
mesylate nasal
SIRTURO 4
eletriptan hydrobromide 1 QL
TRECATOR 2
EMGALITY 3 PA; QL
Antineoplastics -
EMGALITY (300 MG Drugs for Cancer
3 PA; QL
DOSE)
abiraterone acetate 3 PA; SP
ergotamine-caffeine 3 PA
ABRAXANE 4 SP
naratriptan hcl 1 QL
ADCETRIS 4 PA; SP
rizatriptan benzoate 1 QL
adriamycin intravenous
sumatriptan nasal 3 ST; QL 1 SP
solution
sumatriptan succinate adriamycin intravenous
1 QL 3 SP
oral solution reconstituted
sumatriptan succinate AFINITOR DISPERZ 4 PA; SP
3 ST; QL
refill
AFINITOR ORAL
sumatriptan succinate 4 PA; SP; QL
1 ST; QL TABLET 10 MG
subcutaneous solution
ALECENSA 4 PA; SP
sumatriptan succinate
subcutaneous solution 3 ST; QL ALIMTA 4 SP
auto-injector ALIQOPA 4 PA; SP
zolmitriptan oral 1 QL ALUNBRIG 4 PA; SP; QL
Antimyasthenic anastrozole oral 1
Agents
ARRANON 3 SP
pyridostigmine bromide arsenic trioxide
3 4 SP
er intravenous
pyridostigmine bromide ARZERRA 4 PA; SP
3
oral solution
AVASTIN 3 PA; SP
pyridostigmine bromide
1 azacitidine 4 SP
oral tablet
Antimycobacterials BALVERSA 4 PA; SP
CAPASTAT SULFATE 4 BELEODAQ 4 PA; SP
dapsone oral 1 BELRAPZO 4 PA; SP
ethambutol hcl oral 1 BENDEKA 4 PA; SP
isoniazid injection 1 bexarotene 4 PA; SP
isoniazid oral syrup 3 bicalutamide 1
isoniazid oral tablet 1 bleomycin sulfate 1 SP
PASER 1 BLINCYTO 4 PA; SP
PRIFTIN 2 BORTEZOMIB 4 PA; SP
pyrazinamide oral 2 BOSULIF 4 PA; SP
14
BRAFTOVI 4 PA; SP doxorubicin hcl
busulfan 4 SP intravenous solution 3 SP
reconstituted
CABOMETYX 4 PA; SP
doxorubicin hcl
CALQUENCE 4 PA; SP 3 SP
liposomal
capecitabine 3 PA; SP DROXIA 1
CAPRELSA ORAL ELITEK 4 SP
4 PA; SP; QL
TABLET 100 MG
EMPLICITI 4 PA; SP
CAPRELSA ORAL
4 PA; SP ENHERTU 4 PA; SP
TABLET 300 MG
carboplatin 1 SP epirubicin hcl 2 SP
carmustine 4 SP ERBITUX 4 PA; SP
cisplatin intravenous ERIVEDGE 4 PA; SP
1 SP
solution ERLEADA 4 PA; SP
cladribine 3 SP erlotinib hcl oral tablet
3 PA; SP
clofarabine 4 SP 100 mg, 150 mg
COMETRIQ 4 PA; SP erlotinib hcl oral tablet
3 PA; SP; QL
25 mg
COPIKTRA 4 PA; SP
ETHYOL 3
COTELLIC 4 PA; SP
ETOPOPHOS 2 SP
cyclophosphamide
3 SP etoposide intravenous 1 SP
injection
cyclophosphamide oral etoposide oral 3 SP
3
capsule everolimus oral tablet
4 PA; SP; QL
CYRAMZA 4 PA; SP 2.5 mg, 5 mg, 7.5 mg
cytarabine 1 SP exemestane 2
cytarabine (pf) 1 SP FARYDAK 4 PA; SP
dacarbazine 2 SP floxuridine injection 4 SP
dactinomycin 4 SP fludarabine phosphate 3 SP
DARZALEX 4 PA; SP fluorouracil intravenous 1 SP
daunorubicin hcl 2 SP flutamide 1
DAURISMO 4 PA; SP FOLOTYN 4 PA; SP
decitabine 4 PA; SP fulvestrant 3 SP
dexrazoxane hcl 3 SP GAVRETO 4 PA; SP
docetaxel intravenous GAZYVA 4 PA; SP
2 SP
concentrate gemcitabine hcl 2 SP
docetaxel intravenous GILOTRIF 4 PA; SP; QL
3 SP
solution GLEOSTINE 3 SP
doxorubicin hcl GLIADEL WAFER 4
1 SP
HALAVEN 4 PA; SP
15
HERCEPTIN 4 PA; SP LENVIMA ORAL
HYCAMTIN ORAL 4 SP CAPSULE THERAPY
PACK 10 & 4 MG, 10
hydroxyurea oral 1 MG, 10 MG & 2 X 4 4 PA; SP
IBRANCE 4 PA; SP MG, 2 X 10 MG, 2 X 10
ICLUSIG ORAL MG & 4 MG, 2 X 4 MG,
TABLET 10 MG, 15 4 PA; SP; QL 3 X 4 MG, 4 MG
MG letrozole oral 1
ICLUSIG ORAL leucovorin calcium
2
TABLET 30 MG, 45 4 PA; SP injection solution
MG leucovorin calcium
idarubicin hcl 4 SP injection solution 1
IDHIFA 4 PA; SP; QL reconstituted
ifosfamide 3 SP leucovorin calcium oral 2
imatinib mesylate 3 PA; SP LEUKERAN 3
IMBRUVICA 4 PA; SP; QL LONSURF 4 PA; SP
IMFINZI 4 PA; SP LORBRENA 4 PA; SP
INLYTA 4 PA; SP LYNPARZA 4 PA; SP
IRESSA 4 PA; SP LYSODREN 3
irinotecan hcl 2 SP MARQIBO 4 SP
IXEMPRA KIT 4 SP MATULANE 3 SP
JAKAFI ORAL TABLET MEKINIST 4 PA; SP

4 PA; SP; QL
10 MG MEKTOVI 4 PA; SP
JAKAFI ORAL TABLET melphalan 2 SP
15 MG, 20 MG, 25 MG, 4 PA; SP melphalan hcl 3 SP
5 MG
mercaptopurine oral 1
JEVTANA 4 PA; SP
mesna 2 SP
KADCYLA 4 PA; SP
MESNEX ORAL 3 SP
KEYTRUDA 4 PA; SP
mitomycin intravenous 3 SP
KISQALI FEMARA 4 PA; SP
mitoxantrone hcl 4 PA; SP
KISQALI ORAL
TABLET THERAPY 4 PA; SP mutamycin 4 SP
PACK 200 MG MYLERAN 3
KOSELUGO 4 PA; SP NAVELBINE 4 SP
KYPROLIS 4 PA; SP NERLYNX 4 PA; SP; QL
lapatinib ditosylate 4 PA; SP NEXAVAR 4 PA; SP
nilutamide 4 SP
NINLARO 4 PA; SP
NIPENT 3 SP
ODOMZO 4 PA; SP
16
ONIVYDE 4 SP TAGRISSO ORAL
4 PA; SP
OPDIVO 4 PA; SP TABLET 80 MG
oxaliplatin intravenous TALZENNA 4 PA; SP
solution 100 mg/20ml, 2 SP tamoxifen citrate oral 1
50 mg/10ml TARGRETIN
4 PA; SP
oxaliplatin intravenous EXTERNAL
3 SP
solution reconstituted TASIGNA 4 PA; SP
paclitaxel 2 SP TECENTRIQ 4 PA; SP
PADCEV 4 PA; SP TEMODAR
4 SP
PANRETIN 4 INTRAVENOUS
paraplatin 1 SP temozolomide 3 PA; SP
PERJETA 4 PA; SP teniposide 4 SP
PIQRAY 4 PA; SP THALOMID 4 PA; SP
POLIVY 4 PA; SP thiotepa injection 3 SP
POMALYST 4 PA; SP TIBSOVO 4 PA; SP
PORTRAZZA 4 PA; SP toposar 1 SP
POTELIGEO 4 PA; SP topotecan hcl
3 SP
PROLEUKIN 4 SP intravenous solution
PURIXAN 3 SP topotecan hcl
intravenous solution 2 SP
QINLOCK 4 PA; SP reconstituted
RETEVMO 4 PA; SP toremifene citrate 3
REVLIMID 4 PA; SP TOTECT 3 SP
RITUXAN 4 PA; SP TRAZIMERA 3 PA; SP
RITUXAN HYCELA 4 PA; SP tretinoin oral 4 SP
RUBRACA 4 PA; SP TUKYSA 4 PA; SP
RUXIENCE 3 PA; SP TURALIO 4 PA; SP
RYDAPT 4 PA; SP UNITUXIN 4 PA; SP
SPRYCEL 4 PA; SP VALCHLOR 4 PA; SP
STIVARGA 4 PA; SP valrubicin 4 SP
sunitinib malate 4 PA; SP VECTIBIX 4 SP
SUTENT 4 PA; SP VELCADE 4 PA; SP
SYLVANT 4 PA; SP VENCLEXTA 4 PA; SP
SYNRIBO 4 PA; SP VENCLEXTA
3 PA; SP
TABLOID 3 SP STARTING PACK
TAFINLAR 4 PA; SP VERZENIO 4 PA; SP
TAGRISSO ORAL vinblastine sulfate 2 SP
4 PA; SP; QL
TABLET 40 MG vincristine sulfate 1 SP
17
vinorelbine tartrate 2 SP lindane 2
VITRAKVI 4 PA; SP malathion 2
VIZIMPRO 4 PA; SP mefloquine hcl 1
VOTRIENT 4 PA; SP nitazoxanide oral 3
VYXEOS 4 PA; SP pentamidine isethionate 2
XALKORI 4 PA; SP permethrin external 1
XOFIGO 4 praziquantel oral 3
XOSPATA 4 PA; SP primaquine phosphate 1
XTANDI 4 PA; SP pyrimethamine oral 4 PA; SP
YERVOY 4 PA; SP quinine sulfate oral 2 PA
YONDELIS 4 SP spinosad 2
YONSA 4 PA; SP Antiparkinson Agents
ZALTRAP 4 PA; SP amantadine hcl oral 1
ZANOSAR 3 SP benztropine mesylate
3
ZEJULA 4 PA; SP injection
ZELBORAF 4 PA; SP benztropine mesylate
1
oral
ZEPZELCA 4 PA; SP
bromocriptine mesylate
ZIRABEV 3 PA; SP 2
oral
ZOLINZA 4 PA; SP carbidopa oral 3
ZYDELIG 4 PA; SP carbidopa-levodopa 1
Antiparasitics carbidopa-levodopa er 1
albendazole oral 3 PA carbidopa-levodopa-
2
ALINIA ORAL entacapone
SUSPENSION 3 entacapone 2
RECONSTITUTED
INBRIJA 3 PA; SP
ARAKODA 2
KYNMOBI 3 PA; SP; QL
atovaquone oral 3
KYNMOBI TITRATION
atovaquone-proguanil 3 PA; SP; QL
2 KIT
hcl
pramipexole
BENZNIDAZOLE 3 1
dihydrochloride
chloroquine phosphate pramipexole
2 3 ST
oral dihydrochloride er
COARTEM 2 rasagiline mesylate oral 3
hydroxychloroquine ropinirole hcl 1
1
sulfate oral
ropinirole hcl er 1
IMPAVIDO 4
selegiline hcl oral 1
ivermectin oral 1
tolcapone 4 ST
KRINTAFEL 2
18
trihexyphenidyl hcl 1 haloperidol decanoate
1
Antiplatelets intramuscular
aspirin-dipyridamole er 2 haloperidol lactate 1
BRILINTA 3 haloperidol oral 1
CABLIVI 4 PA; SP; QL INVEGA SUSTENNA 3
cilostazol 1 INVEGA TRINZA 3
clopidogrel bisulfate LATUDA 3 ST; QL
1
oral loxapine succinate 1
dipyridamole oral 1 olanzapine
1
prasugrel hcl 1 intramuscular
Antipsychotics - olanzapine oral 1 QL
Drugs for Mood paliperidone er 3 ST; QL
Disorders pimozide 2
ABILIFY MAINTENA 3 quetiapine fumarate 1 QL
aripiprazole oral quetiapine fumarate er 1 QL
3 QL
solution
REXULTI 3 QL
aripiprazole oral tablet 1 QL
RISPERDAL CONSTA 3
aripiprazole oral tablet
3 ST; QL risperidone 1 QL
dispersible
ARISTADA 3 thioridazine hcl oral 1
ARISTADA INITIO 3 thiothixene 1
chlorpromazine hcl trifluoperazine hcl 1
3
injection VERSACLOZ 3 QL
chlorpromazine hcl oral VRAYLAR ORAL
2 3 ST; QL
tablet CAPSULE
clozapine oral tablet 1 QL ziprasidone hcl 1 QL
clozapine oral tablet ziprasidone mesylate 1
3 QL
dispersible ZYPREXA RELPREVV 3
FANAPT 3 ST; QL Antivirals
fluphenazine abacavir sulfate oral
1 2
decanoate injection solution
fluphenazine hcl abacavir sulfate oral
2 1
injection tablet
fluphenazine hcl oral abacavir sulfate-
2 2
concentrate lamivudine
fluphenazine hcl oral abacavir-lamivudine-
1 3
elixir zidovudine
fluphenazine hcl oral acyclovir external
2 1
tablet ointment
acyclovir oral capsule 1
19
acyclovir oral ganciclovir sodium
2
suspension intravenous solution 3
acyclovir oral tablet 1 reconstituted
acyclovir sodium 1 GENVOYA 3
adefovir dipivoxil 3 SP HARVONI 4 PA; SP; QL
APTIVUS 3 INTRON A 3 PA; SP
atazanavir sulfate 3 INVIRASE 3
BARACLUDE ORAL ISENTRESS 3
3 SP; QL
SOLUTION ISENTRESS HD 3
BIKTARVY 3 JULUCA 3
cidofovir intravenous 3 lamivudine oral solution 1
CIMDUO 3 lamivudine oral tablet
2 SP
COMPLERA 3 100 mg
CRIXIVAN 3 lamivudine oral tablet
1
150 mg, 300 mg
DELSTRIGO 3
lamivudine-zidovudine 2
DOVATO 3
LEXIVA ORAL
EDURANT 3 3
SUSPENSION
efavirenz 3 lopinavir-ritonavir 3
efavirenz-emtricitab- MAVYRET 4 PA; SP; QL
3
tenofovir
nevirapine er 2
efavirenz-lamivudine-
3 nevirapine oral
tenofovir 3
suspension
emtricitabine 2
nevirapine oral tablet 1
emtricitabine-tenofovir
3 NORVIR ORAL
df 2
PACKET
EMTRIVA ORAL
2 NORVIR ORAL
SOLUTION 2
SOLUTION
entecavir 3 SP; QL
ODEFSEY 3
EPCLUSA 4 PA; SP; QL
oseltamivir phosphate
EPIVIR HBV ORAL 1 QL
2 SP oral capsule
SOLUTION
oseltamivir phosphate
etravirine 3 oral suspension 2 QL
EVOTAZ 3 reconstituted
famciclovir oral 1 PEGASYS 4 PA; SP
fosamprenavir calcium 3 PIFELTRO 3
FUZEON 3 PREVYMIS
2 SP
GANCICLOVIR 4 INTRAVENOUS
ganciclovir sodium PREVYMIS ORAL 4 SP

4
intravenous solution PREZCOBIX 3
20
PREZISTA 3 Anxiolytics - Drugs
RETROVIR for Anxiety
2
INTRAVENOUS alprazolam er 1 QL
REYATAZ ORAL alprazolam intensol 2 QL
3
PACKET alprazolam oral tablet 1 QL
ribavirin oral 2 SP alprazolam xr 1 QL
rimantadine hcl 2 buspirone hcl oral 1
ritonavir 2 chlordiazepoxide hcl 1 QL
SELZENTRY 3 PA clonazepam oral 1 QL
stavudine 2 clorazepate
2 QL
STRIBILD 3 dipotassium
SYMTUZA 3 diazepam intensol 1
TEMIXYS 3 diazepam oral 1
tenofovir disoproxil estazolam 1 QL
2
fumarate hydroxyzine hcl oral 1
TIVICAY 3 hydroxyzine pamoate
1
TRIUMEQ 3 oral
TROGARZO 4 PA lorazepam injection 1
TYBOST 2 lorazepam intensol 1 QL
valacyclovir hcl oral 1 QL lorazepam oral
1 QL
valganciclovir hcl 3 concentrate 2 mg/ml
VEMLIDY 3 SP lorazepam oral tablet 1 QL
VIRACEPT 3 meprobamate 2
VIREAD ORAL oxazepam 1 QL
3
POWDER triazolam 1 QL
VIREAD ORAL Bipolar Agents -
TABLET 150 MG, 200 3 Drugs for Mood
MG, 250 MG Disorders
VOSEVI 4 PA; SP; QL EQUETRO 2
XOFLUZA (40 MG lithium carbonate er 1
2 QL
DOSE) lithium carbonate oral 1
XOFLUZA (80 MG Blood Products and
2 QL
DOSE) Modifiers - Drugs for
ZEPATIER 4 PA; SP; QL Blood Disorders
zidovudine oral capsule 2 ADVATE 4 SP
zidovudine oral syrup 2 ADYNOVATE 4 SP
zidovudine oral tablet 1 AFSTYLA 4 SP
ALPHANATE 4 SP
ALPHANINE SD 4 SP
21
ALPROLIX 4 SP REBINYN
aminocaproic acid INTRAVENOUS
3 SOLUTION 4 SP
intravenous
RECONSTITUTED
aminocaproic acid oral 3 2000 UNIT
anagrelide hcl 3 REBLOZYL 4 PA; SP
ARANESP (ALBUMIN RECOMBINATE 4 SP
3 PA; SP
FREE)
RETACRIT 3 PA; SP
BENEFIX 4 SP
RIASTAP 4 SP
COAGADEX 4 SP
RIXUBIS 4 SP
CORIFACT 4 SP
SOLIRIS 4 PA; SP
DOPTELET 4 PA; SP
TAVALISSE 4 PA; SP
ELOCTATE 4 SP
tranexamic acid
FEIBA 4 SP 1
intravenous
FIBRYGA 4 SP tranexamic acid oral 1
HEMLIBRA 4 SP TRETTEN 4 SP
HEMOFIL M 4 SP VONVENDI 4 SP
HUMATE-P 4 SP WILATE 4 SP
IDELVION 4 SP XYNTHA 4 SP
IXINITY 4 SP XYNTHA SOLOFUSE 4 SP
KOATE 4 SP ZARXIO 3 PA; SP
KOATE-DVI 4 SP Cardiovascular
KOGENATE FS 4 SP Agents - Drugs for
Heart and Circulation
KOVALTRY 4 SP
Conditions
LEUKINE 3 PA; SP
acebutolol hcl oral 1
MOZOBIL 4 PA; SP; QL
acetazolamide sodium 2
NEULASTA 4 PA; SP
adenosine intravenous
NEULASTA ONPRO 4 PA; SP solution 12 mg/4ml, 6 1
NOVOEIGHT 4 SP mg/2ml
NOVOSEVEN RT 4 SP alprostadil injection 2
NPLATE 4 PA; SP amiloride hcl oral 1
NUWIQ 4 SP amiloride-
1
OBIZUR 3 SP hydrochlorothiazide
PANHEMATIN 4 SP amiodarone hcl 1
PROFILNINE 4 SP amlodipine besylate

1
oral
PROMACTA ORAL
4 PA; SP amlodipine besylate-
PACKET 12.5 MG 1
benazepril hcl
PROMACTA ORAL
4 PA; SP
TABLET
22
amlodipine besylate- diltiazem hcl er beads 1
1
valsartan diltiazem hcl er coated
1
amlodipine-olmesartan 1 beads
amlodipine-valsartan- diltiazem hcl er oral
1
hctz capsule extended 2
atenolol oral 1 release 12 hour
atenolol-chlorthalidone 1 diltiazem hcl er oral
capsule extended 1
atorvastatin calcium release 24 hour
1
oral
diltiazem hcl
benazepril hcl oral 1 2
intravenous
benazepril- diltiazem hcl oral 1
1
hydrochlorothiazide
DILTIAZEM HCL-
betaxolol hcl oral 1 2
DEXTROSE
bisoprolol fumarate oral 1 dilt-xr 1
bisoprolol- disopyramide
1 2
hydrochlorothiazide phosphate
bumetanide 1 dobutamine hcl 2
candesartan cilexetil 1 dobutamine in d5w 2
candesartan cilexetil- dofetilide 1
1
hctz
dopamine hcl
captopril oral 1 1
intravenous
cartia xt 1 doxazosin mesylate
1
carvedilol 1 oral
carvedilol phosphate er 2 droxidopa 4 PA; SP
chlorothiazide sodium 1 enalapril maleate oral
1
chlorthalidone 1 tablet
cholestyramine light 2 enalapril-

1
hydrochlorothiazide
cholestyramine oral 2
ENTRESTO 3 QL
clonidine 1
eplerenone 1
clonidine hcl oral 1
ethacrynic acid 3 ST
colestipol hcl oral
2 ezetimibe 1
granules
colestipol hcl oral felodipine er 1
2
packet fenofibrate micronized
colestipol hcl oral tablet 1 oral capsule 134 mg, 1
200 mg, 43 mg, 67 mg
digitek 1
fenofibrate oral capsule
digox 1 1
134 mg, 200 mg, 67 mg
digoxin injection 1
digoxin oral 1
23
fenofibrate oral tablet losartan potassium-hctz 1
145 mg, 160 mg, 48 1 lovastatin oral 1
mg, 54 mg
mannitol intravenous 1
fenofibric acid oral
capsule delayed 1 matzim la 1
release methyldopa 1
flecainide acetate 1 metolazone 1
fosinopril sodium 1 metoprolol succinate er 1
fosinopril sodium-hctz 1 metoprolol tartrate
1
furosemide injection 1 intravenous
furosemide oral 1 metoprolol tartrate oral 1
gemfibrozil oral 1 metoprolol-
1
hydrochlorothiazide
guanfacine hcl 1
mexiletine hcl oral 1
hydralazine hcl
1 midodrine hcl 1
injection
hydralazine hcl oral 1 milrinone lactate 2
hydrochlorothiazide milrinone lactate in
1 2
oral dextrose
ibutilide fumarate 3 minoxidil oral 1
indapamide 1 moexipril hcl 1
irbesartan 1 niacin er
1
(antihyperlipidemic)
irbesartan-
1 nicardipine hcl 2
hydrochlorothiazide
isosorbide dinitrate oral NICARDIPINE HCL IN
tablet 10 mg, 20 mg, 30 1 NACL INTRAVENOUS
2
mg, 5 mg SOLUTION
PREFILLED SYRINGE
isosorbide mononitrate 1
nifedipine er 1
isosorbide mononitrate
1 nifedipine er osmotic
er 1
release
isradipine 1
nifedipine oral 1
JUXTAPID 4 PA; SP; QL
nimodipine oral 3
labetalol hcl
1 nisoldipine er 2
labetalol hcl oral 1 NITRO-DUR 3 ST
LANOXIN ORAL nitroglycerin sublingual 1
3
TABLET 62.5 MCG nitroglycerin
1
lisinopril oral 1 transdermal
lisinopril- nitroglycerin
1 2
hydrochlorothiazide translingual
losartan potassium oral 1 NORTHERA 4 PA; SP
24
olmesartan medoxomil propranolol hcl
1 1
oral intravenous
olmesartan medoxomil- propranolol hcl oral 1
1
hctz quinapril hcl 1
olmesartan-amlodipine- quinapril-
1 1
hctz hydrochlorothiazide
omega-3-acid ethyl quinidine gluconate er 3
1 PA
esters
quinidine sulfate 1
OSMITROL 3
ramipril 1
pentoxifylline er 1
ranolazine er 2
perindopril erbumine 1
REPATHA 3 PA; QL
phenoxybenzamine hcl
4 REPATHA
oral
PUSHTRONEX 3 PA; QL
PHENYLEPHRINE SYSTEM
HCL (PRESSORS)
INTRAVENOUS REPATHA
2 3 PA; QL
SOLUTION SURECLICK
PREFILLED SYRINGE rosuvastatin calcium 1
1 MG/10ML simvastatin oral 1
phenylephrine hcl sorine 1
intravenous solution 10 1
mg/ml sotalol hcl (af) 1
PHENYLEPHRINE SOTALOL HCL
3
HCL INTRAVENOUS INTRAVENOUS
SOLUTION sotalol hcl oral 1
2
PREFILLED SYRINGE SOTYLIZE 3
0.4 MG/10ML, 1
MG/10ML spironolactone oral 1
PHENYLEPHRINE spironolactone-hctz 1
HCL-NACL taztia xt 1
INTRAVENOUS 2 telmisartan 1
SOLUTION 20-0.9
MG/250ML-% telmisartan-hctz 1
pindolol 1 tiadylt er 1
pravastatin sodium 1 timolol maleate oral 1
prazosin hcl oral 1 torsemide 1
prevalite 2 trandolapril 1
procainamide hcl trandolapril-verapamil
2 2
injection hcl er
propafenone hcl 1 triamterene-hctz 1
propafenone hcl er 2 valsartan 1
propranolol hcl er 1 valsartan-
1
hydrochlorothiazide
25
verapamil hcl er 1 methylphenidate hcl
2 PA; QL
verapamil hcl oral tablet chewable
1
intravenous relexxii 2 PA; QL
verapamil hcl oral 1 Central Nervous
WELCHOL 2 System Agents -
Drugs for Multiple
Central Nervous Sclerosis
System Agents -
Drugs for Attention AUBAGIO 4 PA; SP; QL
Deficit Disorder AVONEX PEN 4 PA; SP; QL
ADDERALL XR 1 PA; QL AVONEX PREFILLED 4 PA; SP; QL
amphetamine sulfate 2 PA; QL BETASERON 4 PA; SP; QL
amphetamine- dalfampridine er 3 PA; SP; QL
1 PA; QL
dextroamphetamine dimethyl fumarate oral 4 PA; SP; QL
atomoxetine hcl 2 QL dimethyl fumarate
4 PA; SP; QL
clonidine hcl er 1 starter pack
dexmethylphenidate hcl 1 PA; QL EXTAVIA 4 PA; SP; QL
dexmethylphenidate hcl GILENYA 4 PA; SP; QL
1 PA; QL
er glatiramer acetate 3 PA; SP; QL
dextroamphetamine glatopa 3 PA; SP; QL
2 PA; QL
sulfate er
LEMTRADA 4 PA; SP
dextroamphetamine
2 PA; QL OCREVUS 4 PA; SP; QL
sulfate oral solution
dextroamphetamine REBIF 4 PA; SP; QL
sulfate oral tablet 10 1 PA; QL REBIF REBIDOSE 4 PA; SP; QL
mg, 5 mg REBIF REBIDOSE
4 PA; SP; QL
guanfacine hcl er 1 TITRATION PACK
methylphenidate hcl er REBIF TITRATION
2 PA; QL 4 PA; SP; QL
(cd) PACK
methylphenidate hcl er TYSABRI 4 PA; SP; QL
2 PA; QL
(la) Central Nervous
methylphenidate hcl er System Agents -
oral tablet extended Miscellaneous
release 10 mg, 18 mg, 2 PA; QL AUSTEDO 4 PA; SP; QL
27 mg, 36 mg, 54 mg,
72 mg benzphetamine hcl oral
1 PA
tablet 50 mg
methylphenidate hcl er
oral tablet extended 2 PA; QL caffeine citrate 3
release 24 hour diethylpropion hcl er 1 PA
methylphenidate hcl diethylpropion hcl oral 1 PA
1 PA; QL
oral solution phendimetrazine
1 PA
methylphenidate hcl tartrate
1 PA; QL
oral tablet
26
phendimetrazine PREVIDENT 5000
1 PA 1
tartrate er PLUS
phentermine hcl oral 1 PA PREVIDENT 5000
1
pregabalin oral capsule 1 QL SENSITIVE
RADICAVA 4 PA; SP PREVIDENT DENTAL 1
riluzole 2 PA; QL sf 1
TEGSEDI 4 PA; SP sf 5000 plus 1
tetrabenazine 4 PA; SP sodium fluoride 5000
1
enamel
TIGLUTIK 3 PA; QL
sodium fluoride 5000
Dental and Oral 1
plus
Agents - Drugs for
Mouth and Throat sodium fluoride 5000
1
Conditions ppm
cavarest 1 sodium fluoride 5000
1
sensitive
cevimeline hcl 2
sodium fluoride dental 1
chlorhexidine gluconate
1 triamcinolone acetonide
mouth/throat 1
mouth/throat
CLINPRO 5000 1
Dermatological
DENTA 5000 PLUS 1 Agents - Drugs for
DENTAGEL 1 Skin Conditions
FLUORIDEX 1 accutane 2 PA
FLUORIDEX acitretin 3
ENHANCED 1 adapalene external
WHITENING 2 PA
cream
FLUORIDEX adapalene external gel 1 PA
1
SENSITIVITY RELIEF
adapalene-benzoyl
KEPIVANCE 4 SP 1
peroxide external gel
lidocaine viscous hcl 1 ala-cort 1
oralone 1 alclometasone
1
periogard 1 dipropionate
pilocarpine hcl oral 1 ALTRENO 2 PA
PREVIDENT 5000 ALUMINUM
1
BOOSTER PLUS CHLORIDE 4
PREVIDENT 5000 ANHYDROUS
1
DRY MOUTH ALUMINUM
PREVIDENT 5000 CHLORIDE
1 4
ENAMEL PROTECT HEXAHYDRATE
POWDER
PREVIDENT 5000
1 amcinonide external
ORTHO DEFENSE 3
lotion
27
ammonium lactate clindamycin phos-
1
external benzoyl perox external 1
amnesteem 2 PA gel 1.2-5 %
azelaic acid external 2 clindamycin phosphate-
benzoyl peroxide 2
benzoyl peroxide- external gel 1-5 %
1
erythromycin
clindamycin phosphate
beser external lotion 2 2
external foam
betamethasone clindamycin phosphate
dipropionate aug 1 1
external gel
external cream
clindamycin phosphate
betamethasone 1
external lotion
dipropionate aug 1
external gel clindamycin phosphate
1
external solution
betamethasone
dipropionate aug 2 clindamycin phosphate
1
external lotion external swab
betamethasone clindamycin-tretinoin 3
dipropionate aug 1 clobetasol prop
1
external ointment emollient base
betamethasone clobetasol propionate e 1
1
dipropionate external clobetasol propionate
2
betamethasone emulsion
1
valerate external cream clobetasol propionate
1
betamethasone external cream
2
valerate external foam clobetasol propionate
2
betamethasone external foam
1
valerate external lotion clobetasol propionate
1
betamethasone external gel
valerate external 1 clobetasol propionate
ointment 2
external liquid
CALAMINE 4 clobetasol propionate
2
calcipotriene external external lotion
2
cream clobetasol propionate
1
calcipotriene external external ointment
2
ointment clobetasol propionate
2
calcipotriene external external shampoo
1
solution clobetasol propionate
1
calcitriol external 3 external solution
claravis 2 PA clocortolone pivalate 2
clindacin etz external clodan external
1 2
swab shampoo
clindacin-p 1
28
desonide external halobetasol propionate
1 1
cream external cream
desonide external lotion 2 halobetasol propionate
1
desonide external external ointment
1
ointment hydrocortisone butyrate
2
desoximetasone external cream
1
external cream 0.25 % hydrocortisone butyrate
2
desoximetasone external ointment
2
external gel hydrocortisone butyrate
2
desoximetasone external solution
2
external liquid hydrocortisone external
1
desoximetasone cream 1 %, 2.5 %
external ointment 0.25 2 hydrocortisone external
1
% lotion 2.5 %
DRYSOL 1 hydrocortisone external
1
DUPIXENT 3 PA; SP; QL ointment 1 %, 2.5 %
ery 1 hydrocortisone valerate 1
erythromycin external 1 imiquimod external 1
EUCRISA 3 ST isotretinoin oral capsule
10 mg, 20 mg, 30 mg, 2 PA
finasteride oral tablet 1 40 mg
1
mg
methoxsalen rapid 3
fluocinolone acetonide
1 metronidazole external
body 1
cream
external 1
gel
scalp 2
lotion
fluocinonide emulsified
2 mometasone furoate
base 1
external
fluocinonide external 1
myorisan 2 PA
fluorouracil external
2 neuac external gel 1
cream 5 %
fluorouracil external pimecrolimus 3 ST
1
solution podofilox external 1
fluticasone propionate prednicarbate 1
1
external cream rosadan external cream 1
fluticasone propionate rosadan external gel 1
2
external lotion
SCENESSE 4 PA; SP
fluticasone propionate
1 selenium sulfide
external ointment 1
external lotion
29
sulfacetamide sodium metformin hcl oral
2 3
(acne) solution
tacrolimus external 2 metformin hcl oral
1
tazarotene external tablet
2 PA
cream miglitol 2
tovet external foam 2 nateglinide 1
tretinoin external cream 1 PA NESINA 2 ST
tretinoin external gel 2 PA OSENI 2 ST
tretinoin microsphere 3 PA OZEMPIC 3 ST; QL
tretinoin microsphere pioglitazone hcl 1
3 PA
pump pioglitazone hcl-
2
triamcinolone acetonide glimepiride
1
external cream pioglitazone hcl-
1
triamcinolone acetonide metformin hcl
1
external lotion repaglinide 1
triamcinolone acetonide RYBELSUS 3 ST; QL
external ointment 0.025 1
%, 0.1 %, 0.5 % SOLIQUA 3 ST; QL
TRI-CHLOR 2 SYMLINPEN 120 3 PA
triderm 1 SYMLINPEN 60 3 PA
XERAC AC 1 SYNJARDY 2 ST
zenatane 2 PA SYNJARDY XR 2 ST
Diabetes - tolbutamide 1
Antidiabetic Agents TRULICITY 3 ST; QL
acarbose oral 1 VICTOZA 3 ST; QL
BYDUREON BCISE XIGDUO XR 2 ST
3 ST; QL
AUTOINJECTOR Diabetes - Glucose
FARXIGA 2 ST Monitoring
glimepiride 1 CEQUR SIMPLICITY
1
glipizide er 1 2U
glipizide ir 1 CEQUR SIMPLICITY
1
INSERTER
glipizide xl 1
CEQUR SIMPLICITY
glipizide-metformin hcl 1 1
STARTER
glyburide micronized 1 CONTOUR CONTROL
1
glyburide oral 1 SOLUTION
glyburide-metformin 1 CONTOUR MONITOR
1
JARDIANCE 2 ST DEVICE
KAZANO 2 ST CONTOUR MONITOR
1
KIT W/DEVICE
metformin hcl er 1
30
CONTOUR NEXT INPEN 100-BLUE-
1 1
CONTROL SOLUTION LILLY
CONTOUR NEXT EZ INPEN 100-BLUE-
1 1
KIT W/DEVICE NOVO
CONTOUR NEXT LINK INPEN 100-GRAY-
1 1
KIT W/DEVICE LILLY
CONTOUR NEXT INPEN 100-GREY-
1
MONITOR KIT 1 NOVO
W/DEVICE INPEN 100-PINK-
1
CONTOUR NEXT ONE LILLY
1
KIT INPEN 100-PINK-
1
CONTOUR NEXT NOVO
1 QL
TEST STRIPS NOVOPEN ECHO 1
CONTOUR TEST Diabetes - Glycemic
1 QL
STRIPS Agents
DEXCOM G4 / G5 / G6 diazoxide oral 3
RECEIVER,
TRANSMITTER, GLUCAGON
SENSOR (INCLUDING 1 PA EMERGENCY KIT 3
PLATINUM, INJECTION KIT
PLATINUM Diabetes - Insulins
PEDIATRIC) BD AUTOSHIELD DUO
1
DEXCOM G4 / G5 / G6 PEN NEEDLES
RECEIVER, BD ULTRA-FINE
TRANSMITTER, 1
INSULIN SYRINGES
SENSOR (INCLUDING 1 PA
PLATINUM, BD ULTRA-FINE PEN
1
PLATINUM NEEDLES
PEDIATRIC) DEVICE DROPLET MICRON 1
ENLITE GLUCOSE HUMALOG 2
2 PA
SENSOR HUMALOG KWIKPEN 2
EVERSENSE HUMALOG MIX 50/50
2 PA 2
SENSOR/HOLDER KWIKPEN
EVERSENSE SMART HUMALOG MIX 50/50
2 PA 2
TRANSMITTER VIAL
GUARDIAN CONNECT HUMALOG MIX 75/25
2 PA 2
TRANSMITTER KWIKPEN
GUARDIAN LINK 3 HUMALOG MIX 75/25
2 PA 2
TRANSMITTER VIAL
GUARDIAN SENSOR HUMALOG U-100
2 PA 2
(3) JUNIOR KWIKPEN
GUARDIAN SENSOR HUMULIN 70/30
2 PA 1
3 KWIKPEN
31
HUMULIN 70/30 VIAL 1 CALCIUM
4
HUMULIN N KWIKPEN 1 GLUCONATE
HUMULIN N VIAL 1 CALCIUM
GLUCONATE 4
HUMULIN R U-500 ANHYDROUS
2
KWIKPEN
CALCIUM
HUMULIN R U-500 GLUCONATE 4
2
VIAL MONOHYDRATE
HUMULIN R VIAL 2 CALCIUM LACTATE
4
INSULIN PEN PENTAHYDRATE
1
NEEDLES CALCIUM
4
INSULIN SYRINGES 1 PHOSPHATE DIBASIC
LANTUS SOLOSTAR 1 CALCIUM
LANTUS U-100 VIAL 1 PHOSPHATE 4
TRIBASIC
NOVOFINE
AUTOCOVER PEN 1 CARBAGLU 4 SP
NEEDLE CHOLINE
NOVOFINE PEN BITARTRATE 4
1 POWDER
NEEDLE
NOVOFINE PLUS PEN clovique 4 PA; SP
1
NEEDLE curity sterile saline 1
NOVOTWIST PEN cyanocobalamin
1
NEEDLE injection solution 1000 1
TOUJEO MAX mcg/ml
1
SOLOSTAR CYANOCOBALAMIN
TOUJEO SOLOSTAR 1 INJECTION
3
SOLUTION 2000
ULTIGUARD MCG/ML
SAFEPACK 1
SYR/NEEDLE deferasirox 4 PA
Electrolytes / Minerals deferasirox granules 4 PA
/ Metals / Vitamins dextrose in lactated
1
adc/f (0.5mg/ml) 1 ringers
airavite 1 dextrose-nacl
intravenous solution 5-
ALANINE 4 1
0.2 %, 5-0.33 %, 5-0.45
argyle sterile saline 1 %, 5-0.9 %
argyle sterile water 1 dextrose-sodium
ATABEX OB 1 chloride intravenous
solution 5-0.225 %, 5- 1
bp vit 3 1 0.3 %, 5-0.45 %, 5-0.9
CALCIUM CHLORIDE %
4
DIHYDRATE POWDER DL-ALANINE 4
DL-LEUCINE 4
32
DL-PHENYLALANINE 4 lactated ringers
1
EFFER-K ORAL intravenous
TABLET L-ALANINE 4
1
EFFERVESCENT 10 L-ARGININE 4
MEQ, 20 MEQ
L-CYSTINE 4
effer-k oral tablet
1 levocarnitine oral
effervescent 25 meq 1
solution
ELITE-OB 1
levocarnitine oral tablet 1
ergocalciferol oral
1 levocarnitine sf 1
capsule
fabb 1 L-GLUTAMIC ACID 4
fa-vitamin b-6-vitamin L-HISTIDINE 4
1
b-12 L-HISTIDINE
fluoritab 1 MONOHYDROCHLORI 4
DE POWDER
folbee 1
L-LEUCINE 4
folic acid oral tablet 1
1 L-PHENYLALANINE 4
mg
folplex 2.2 1 L-PROLINE 4
hematinic/folic acid 1 L-TRYPTOPHAN 4
hemocyte-f 1 L-TYROSINE 4
hydroxocobalamin L-VALINE POWDER 4
1
acetate MAGNESIUM
4
JYNARQUE ORAL CARBONATE HEAVY
4 PA; SP; QL
TABLET MAGNESIUM
JYNARQUE ORAL CARBONATE 4
TABLET THERAPY POWDER
PACK 15 MG, 45 & 15 4 PA; SP; QL magnesium chloride
2
MG, 60 & 30 MG, 90 & injection
30 MG M-NATAL PLUS 1
kcl in dextrose-nacl 1 monoject flush syringe 1
klor-con 10 1 monoject sodium
1
klor-con m10 1 chloride flush
klor-con m15 1 multi-vitamin/fluoride 1
klor-con m20 1 multivitamin/fluoride
klor-con oral packet 2 oral tablet chewable 1
0.25 mg, 0.5 mg, 1 mg
klor-con oral tablet
1 na ferric gluc cplx in
extended release 2
sucrose
klor-con/ef 1
nafrinse 1
k-prime 1
nafrinse drops 1
NEONATAL PLUS 1
33
NESTABS 1 sodium fluoride oral
normal saline flush 1 solution 1.1 (0.5 f) 1
mg/ml
nufol 1
sodium fluoride oral
ONE VITE WOMENS 1
1 tablet
PLUS
sodium fluoride oral
PHOSPHA 250 1
1 tablet chewable
NEUTRAL
sodium polystyrene
phosphorous 1 1
sulfonate
phospho-trin 250 sps 1
1
neutral
sterile water for
potassium acetate 1
1 irrigation
intravenous
TAURINE POWDER 4
potassium chloride crys
1 THREONINE 4
er
potassium chloride er 1 TOLVAPTAN ORAL
4 PA; SP; QL
TABLET 15 MG
potassium chloride
2 tolvaptan oral tablet 30
intravenous 4 PA; SP; QL
mg
potassium chloride oral
2 trientine hcl 4 PA; SP
solution
potassium citrate er 1 TRINATE 1
prenatal oral tablet 27- tri-vite/fluoride 1
1
0.8 mg, 27-1 mg TRYPTOPHAN 4
prenatal plus iron 1 UDAMIN SP 1
prenatal vitamin plus VALINE 4
1
low iron VINATE ONE 1
preplus 1 virt-gard 1
PRETAB 1 virt-phos 250 neutral 1
RELNATE DHA 1 vitamin d
SODIUM ASCORBATE (ergocalciferol) oral
4 1
POWDER capsule 1.25 mg
sodium bicarbonate (50000 ut)
1
intravenous vitamins acd-fluoride 1
sodium chloride (pf) 1 vp-pnv-dha 1
sodium chloride flush 1 water for irrigation,
1
sodium chloride sterile
1
injection westab mini 1
sodium chloride westab one 1
1
intravenous WESTAB PLUS 1
sodium chloride
1
irrigation
34
Gastrointestinal atropine sulfate
Agents - Drugs for injection solution 8 1
Acid Reflux and Ulcer mg/20ml
cimetidine hcl 1 atropine sulfate
cimetidine oral 1 injection solution
2
prefilled syringe 0.25
esomeprazole mg/5ml
magnesium oral
1 QL atropine sulfate
capsule delayed 1
release intravenous solution
famotidine intravenous 1 constulose 1
famotidine oral cromolyn sodium oral 3
suspension 1 dicyclomine hcl
1
reconstituted intramuscular
famotidine oral tablet dicyclomine hcl oral 1
1
20 mg, 40 mg diphenoxylate-atropine
3
famotidine premixed 1 oral liquid
lansoprazole oral diphenoxylate-atropine
1
capsule delayed 1 QL oral tablet
release ED-SPAZ 1
misoprostol oral 1 enulose 1
nizatidine oral capsule 1 GATTEX 4 PA; SP
nizatidine oral solution 2 gavilyte-c 1
omeprazole oral gavilyte-g 1
capsule delayed 1 QL
release gavilyte-n with flavor
1
pack
pantoprazole sodium
1 generlac 1
intravenous
pantoprazole sodium glycopyrrolate injection
2
oral tablet delayed 1 QL solution
release glycopyrrolate oral 1
rabeprazole sodium hyoscyamine sulfate
1
oral tablet delayed 1 QL oral
release hyoscyamine sulfate sl 1
sucralfate oral tablet 1 hyoscyamine sulfate
Gastrointestinal 1
sublingual
Agents - Drugs for
hyosyne 1
Bowel, Intestine and
Stomach Conditions lactulose
1
encephalopathy
alosetron hcl 3 PA
lactulose oral solution 1
amoxicill-clarithro-
3 LINZESS 2 ST; QL
lansopraz
ANASPAZ 1
35
loperamide hcl oral NITYR 4 PA; SP
1
capsule NULIBRY 4 PA; SP
methscopolamine OCALIVA 4 PA; SP; QL
1
bromide oral
ORFADIN ORAL
mineral oil heavy oral 1 4 PA; SP
CAPSULE 20 MG
NULEV 1 ORFADIN ORAL
4 PA; SP
peg 3350-kcl-na bicarb- SUSPENSION
1
nacl PALYNZIQ 4 PA; SP; QL
peg-3350/electrolytes 1 RAVICTI 4 PA; SP
SUPREP BOWEL REVCOVI 4 PA; SP
1
PREP KIT
sapropterin
SYMPROIC 2 ST; QL 4 PA; SP
dihydrochloride
ursodiol oral capsule sod benz-sod
2 4
300 mg phenylacet
ursodiol oral tablet 2 sodium phenylbutyrate
4 SP
XERMELO 4 PA; SP; QL oral
Genetic or Enzyme STRENSIQ 4 PA; SP
Disorder - Drugs for SUCRAID 4 SP
Replacement,
Modification, VIMIZIM 4 PA; SP
Treatment VPRIV 4 PA; SP
CERDELGA 4 PA; SP XURIDEN 4 PA; SP; QL
CEREZYME 4 PA; SP ZENPEP 3
CHOLBAM 4 PA; SP Genitourinary Agents
CREON 3 - Drugs for Bladder,
Genital and Kidney
CRYSVITA 4 PA; SP Conditions
CYSTAGON 2 SP acetic acid irrigation 1
ELAPRASE 4 PA; SP bethanechol chloride
1
ELELYSO 4 PA; SP oral
FABRAZYME 4 PA; SP calcium acetate (phos
1
KANUMA 4 PA; SP binder)
L-GLUTAMIC ACID calcium acetate oral
4 1
HCL tablet 667 mg
LUMIZYME 4 PA; SP darifenacin
2
hydrobromide er
MEPSEVII 4 PA; SP
flavoxate hcl 1
miglustat 4 PA; SP
GELNIQUE 3 ST
MYALEPT 4 PA; SP
lanthanum carbonate 3
NAGLAZYME 3 PA; SP
oxybutynin chloride er 1
nitisinone 4 PA; SP
oxybutynin chloride oral 1
36
penicillamine oral tablet 4 SP DEXAMETHASONE
phenazo oral tablet 200 (LA) INJECTION
1 1
mg SUSPENSION 8
MG/ML
phenazopyridine hcl
oral tablet 100 mg, 200 1 dexamethasone oral
1
mg elixir
sevelamer carbonate dexamethasone oral
3 1
oral packet solution
sevelamer carbonate dexamethasone oral
2 1
oral tablet tablet
sevelamer hcl 3 dexamethasone oral
2
tablet therapy pack
sildenafil citrate oral
tablet 100 mg, 25 mg, 1 QL dexamethasone sod
50 mg phosphate pf injection 1
solution
solifenacin succinate 1
dexamethasone
tadalafil oral 1 QL sodium phosphate 1
tiopronin oral 4 SP injection
tolterodine tartrate 1 fludrocortisone acetate
1
tolterodine tartrate er 1 oral
trospium chloride 1 hydrocortisone oral 1
trospium chloride er 2 KENALOG INJECTION

SUSPENSION 10 1
Genitourinary Agents MG/ML
- Drugs for Prostate
Conditions METHYLPREDNISOL
ONE ACETATE
alfuzosin hcl er 1 INJECTION 1
dutasteride oral 1 SUSPENSION 50
dutasteride-tamsulosin MG/ML
2
hcl METHYLPREDNISOL
finasteride oral tablet 5 ONE ACETATE
1 1
mg SUSPENSION 40
MG/ML INJECTION
silodosin 1
methylprednisolone
tamsulosin hcl 1 acetate suspension 40 1
terazosin hcl 1 mg/ml injection
Hormonal Agents - METHYLPREDNISOL
Adrenal ONE ACETATE
1
DEPO-MEDROL SUSPENSION 80
INJECTION MG/ML INJECTION
1
SUSPENSION 20 methylprednisolone
MG/ML acetate suspension 80 1
mg/ml injection
37
methylprednisolone CHORIONIC
1
oral GONADOTROPIN 2 PA; SP
methylprednisolone INTRAMUSCULAR
sodium succ injection clomiphene citrate oral 1
solution reconstituted 1 desmopressin ace
1000 mg, 125 mg, 40 2
spray refrig
mg
desmopressin acetate
prednisolone oral 3
1 injection
solution
prednisolone sodium 1
1 oral
phosphate oral solution
prednisolone sodium 3
pf
phosphate oral tablet 2
dispersible desmopressin acetate
2
spray
prednisone intensol 2
EGRIFTA SV 4 PA; SP; QL
prednisone oral 1
ELIGARD 3 PA; SP; QL
SOLU-CORTEF 1
FENSOLVI (6 MONTH) 4 PA; SP; QL
triamcinolone acetonide
injection suspension 40 1 FIRMAGON 3 PA; SP; QL
mg/ml FIRMAGON (240 MG
3 PA; SP; QL
Hormonal Agents - DOSE)
Men's Health FOLLISTIM AQ 3 PA; SP
ANDRODERM 2 PA GENOTROPIN 3 PA; SP
danazol oral 2 GENOTROPIN
3 PA; SP
METHYLTESTOSTER MINIQUICK
4
ONE HUMATROPE 3 PA; SP
oxandrolone oral 3 PA; QL INCRELEX 4 PA; SP
testosterone cypionate leuprolide acetate
1 PA 3 PA; SP
intramuscular injection
testosterone enanthate LUPANETA PACK 3 PA; SP; QL
1 PA
intramuscular LUPRON DEPOT (1-
3 PA; SP
testosterone MONTH)
2 PA
transdermal LUPRON DEPOT (3-
Hormonal Agents - 3 PA; SP
MONTH)
Osteoporosis
LUPRON DEPOT (4-
raloxifene hcl 1 MONTH)
3 PA; SP
Hormonal Agents - INTRAMUSCULAR KIT
Pituitary 30MG
ACTHAR 4 PA; SP LUPRON DEPOT (6-
MONTH)
cabergoline 1 3 PA; SP
INTRAMUSCULAR KIT
CETROTIDE 3 PA; SP 45MG
38
LUPRON DEPOT-PED aurovela 1/20 1
3 PA; SP
(1-MONTH) aurovela 24 fe 1
LUPRON DEPOT-PED aurovela fe 1.5/30 1
4 PA; SP
(3-MONTH)
aurovela fe 1/20 1
MENOPUR 4 PA; SP
aviane 1
NOCDURNA 2
ayuna 1
NOVAREL 2 PA; SP
azurette 1
octreotide acetate 3 PA; SP
balziva 1
OVIDREL 1 PA; SP
blisovi 24 fe 1
oxytocin injection 1
blisovi fe 1.5/30 1
PREGNYL 2 PA; SP
blisovi fe 1/20 1
SIGNIFOR 4 PA; SP; QL
briellyn 1
SOMATULINE DEPOT 4 PA; SP
camila 1
SOMAVERT 4 PA; SP
camrese 1 QL
SUPPRELIN LA 4 PA; SP; QL
camrese lo 1 QL
TRELSTAR MIXJECT 3 PA; SP; QL
caziant 1
TRIPTODUR 4 PA; SP; QL
charlotte 24 fe 2
VANTAS 3 PA; SP; QL
chateal 1
ZOLADEX 3 SP; QL
chateal eq 1
Hormonal Agents -
Prostaglandins CLIMARA PRO 2
KORLYM 4 PA; SP; QL cryselle-28 1
Hormonal Agents - cyclafem 1/35 1
Sex Hormones and cyclafem 7/7/7 1
Birth Control
cyred 1
afirmelle 1 cyred eq 1
altavera 1 dasetta 1/35 1
alyacen 1/35 1 dasetta 7/7/7 1
alyacen 7/7/7 1 daysee 1 QL
amabelz 1 deblitane 1
amethia 1 QL delyla 1
amethyst 1 desogestrel-ethinyl
1
apri 1 estradiol
aranelle 1 DIVIGEL
ashlyna 1 QL TRANSDERMAL GEL
0.25 MG/0.25GM, 0.5 2
aubra 1 MG/0.5GM, 0.75
aubra eq 1 MG/0.75GM, 1 MG/GM
aurovela 1.5/30 1 dolishale 1
39
dotti 1 jasmiel 1
drospirenone-ethinyl jencycla 1
1
estradiol jinteli 1
elinest 1 jolessa 1 QL
ELLA 1 juleber 1
eluryng 2 junel 1.5/30 1
emoquette 1 junel 1/20 1
enpresse-28 1 junel fe 1.5/30 1
enskyce 1 junel fe 1/20 1
errin 1 junel fe 24 1
estarylla 1 kalliga 1
estradiol oral 1 kariva 1
estradiol transdermal 1 kelnor 1/35 1
estradiol vaginal 1 kelnor 1/50 1
estradiol valerate kurvelo 1
1
intramuscular
larin 1.5/30 1
estradiol-norethindrone
1 larin 1/20 1
acet
ethynodiol diac-eth larin 24 fe 1
1
estradiol larin fe 1.5/30 1
etonogestrel-ethinyl larin fe 1/20 1
2
estradiol larissia 1
falmina 1 leena 1
fayosim 1 QL lessina 1
femynor 1 levonest 1
fyavolv 1 levonorgest-eth est &
1 QL
hailey 1.5/30 1 eth est
hailey 24 fe 1 levonorgest-eth estrad
1 QL
hailey fe 1.5/30 1 91-day
hailey fe 1/20 1 levonorgestrel-ethinyl
1
estrad
heather 1
levonorg-eth estrad
hydroxyprogesterone 1
3 PA; SP triphasic
caproate intramuscular
levora 0.15/30 (28) 1
iclevia 1 QL
lillow 1
incassia 1
lojaimiess 1 QL
introvale 1 QL
loryna 1
isibloom 1
low-ogestrel 1
jaimiess 1 QL
lo-zumandimine 1
40
lutera 1 norethin-eth estradiol-fe
lyleq 1 oral tablet chewable 1
0.4-35 mg-mcg
lyllana 1
norgestimate-eth
lyza 1 1
estradiol
marlissa 1 norgestimate-ethinyl
1
medroxyprogesterone estradiol triphasic
1 QL
acetate intramuscular norlyda 1
medroxyprogesterone norlyroc 1
1
acetate oral
nortrel 0.5/35 (28) 1
megestrol acetate oral
suspension 40 mg/ml, 1 nortrel 1/35 (21) 1
400 mg/10ml nortrel 1/35 (28) 1
megestrol acetate oral nortrel 7/7/7 1
3
suspension 625 mg/5ml nylia 7/7/7 1
megestrol acetate oral nymyo 1
1
tablet
ocella 1
mibelas 24 fe 2
orsythia 1
microgestin 1.5/30 1
philith 1
microgestin 1/20 1
pimtrea 1
microgestin 24 fe 1
pirmella 1/35 1
microgestin fe 1.5/30 1
pirmella 7/7/7 1
microgestin fe 1/20 1
portia-28 1
mili 1
PREMARIN ORAL 2
mimvey 1
PREMPHASE 2
mono-linyah 1
PREMPRO 2
necon 0.5/35 (28) 1
previfem 1
nikki 1
progesterone
nora-be 1 1
intramuscular
norethin ace-eth progesterone oral 1
1
estrad-fe oral tablet
reclipsen 1
norethin ace-eth
estrad-fe oral tablet 2 rivelsa 1 QL
chewable setlakin 1 QL
norethindrone acetate sharobel 1
1
oral simliya 1
norethindrone acet- simpesse 1 QL
1
ethinyl est
sprintec 28 1
norethindrone oral 1
sronyx 1
norethindrone-eth
1 syeda 1
estradiol
41
tarina 24 fe 1 Hormonal Agents -
tarina fe 1/20 1 Thyroid
tarina fe 1/20 eq 1 ARMOUR THYROID 1

tilia fe 1 euthyrox 1
tri femynor 1 levo-t 1
tri-estarylla 1 levothyroxine sodium
intravenous solution 3
tri-legest fe 1 reconstituted
tri-linyah 1 levothyroxine sodium
1
tri-lo-estarylla 1 oral tablet
tri-lo-marzia 1 levoxyl 1
tri-lo-mili 1 liothyronine sodium
1
tri-lo-sprintec 1 intravenous
tri-mili 1 liothyronine sodium oral 1
tri-nymyo 1 methimazole oral 1
tri-previfem 1 NATURE-THROID 1
tri-sprintec 1 np thyroid 1
trivora (28) 1 propylthiouracil oral 1
tri-vylibra 1 unithroid 1
tri-vylibra lo 1 WESTHROID 1
tulana 1 WP THYROID 1
Immunological
tyblume 1
Agents - Drugs for
velivet 1 Immune System
vestura 1 Stimulation or
Suppression
vienva 1
viorele 1 ACTEMRA 4 PA; SP
volnea 1 ACTEMRA ACTPEN 4 PA; SP
vyfemla 1 ACTIMMUNE 4 PA; SP
vylibra 1 ARCALYST 4 PA; SP
wera 1 AVSOLA 3 PA; SP
wymzya fe 1 AZASAN 3
xulane 2 azathioprine oral 1
yuvafem 1 azathioprine sodium 1
zafemy 2 BENLYSTA 4 PA; SP
zarah 1 BERINERT 4 PA; SP; QL
zovia 1/35 (28) 1 BIVIGAM 4 PA; SP
zovia 1/35e (28) 1 CELLCEPT 3 SP
zumandimine 1
42
CIMZIA PREFILLED HUMIRA PEN-
3 PA; SP
KIT PSOR/UVEIT 3 PA; SP
CIMZIA STARTER KIT 3 PA; SP STARTER
CINRYZE 4 PA; SP HYPERRHO S/D 2 SP
CUVITRU 4 PA; SP HYQVIA 4 PA; SP
cyclosporine ILARIS 4 PA; SP; QL
1 SP
intravenous IMURAN 3
cyclosporine modified 2 SP INFLECTRA 3 PA; SP
cyclosporine oral 3 SP KALBITOR 4 PA; SP; QL
CYTOGAM 3 PA; SP KINERET 4 PA; SP
ENTYVIO 4 PA; SP leflunomide oral 1
everolimus oral tablet methotrexate oral 1
0.25 mg, 0.5 mg, 0.75 3 SP methotrexate sodium 1
mg
methotrexate sodium
FLEBOGAMMA DIF 4 PA; SP 1
(pf)
GAMASTAN 2 PA; SP MICRHOGAM ULTRA-
2 SP
GAMIFANT 4 PA; SP FILTERED PLUS
GAMMAGARD 4 PA; SP mycophenolate mofetil
2 SP
GAMMAGARD S/D hcl
4 PA; SP
LESS IGA mycophenolate mofetil
2 SP
GAMMAKED 4 PA; SP intravenous
GAMMAPLEX 4 PA; SP mycophenolate mofetil
2 SP
oral capsule
GAMUNEX-C 4 PA; SP
mycophenolate mofetil
gengraf 2 SP oral suspension 3 SP
HAEGARDA 4 PA; SP reconstituted
HIZENTRA 4 PA; SP mycophenolate mofetil
2 SP
HUMIRA 3 PA; SP oral tablet
HUMIRA PEDIATRIC mycophenolate sodium 3 SP

3 PA; SP
CROHNS START MYFORTIC 3 SP
HUMIRA PEN 3 PA; SP NEORAL 3 SP
HUMIRA PEN- NULOJIX 3 SP
3 PA; SP
CD/UC/HS STARTER OCTAGAM 4 PA; SP
HUMIRA PEN- ORENCIA 4 PA; SP
PEDIATRIC UC 3 PA; SP
START ORENCIA CLICKJECT 4 PA; SP
HUMIRA PEN- OTEZLA 3 PA; SP
PS/UV/ADOL HS 3 PA; SP PRIVIGEN 4 PA; SP
START PROGRAF ORAL
3 SP
PACKET
43
RAPAMUNE ORAL DIPHTHERIA-
3 SP
SOLUTION TETANUS TOXOIDS 1
RHOGAM ULTRA- DT
2 SP
FILTERED PLUS ENGERIX-B 1
RINVOQ 3 PA; SP FLUAD
1
RUCONEST 4 PA; SP; QL QUADRIVALENT
SANDIMMUNE ORAL 3 SP FLUARIX
1
QUADRIVALENT
SIMPONI 3 PA; SP
FLUBLOK
sirolimus oral 3 SP 1
QUADRIVALENT
SKYRIZI 3 PA; SP FLUCELVAX
1
SKYRIZI (150 MG QUADRIVALENT
3 PA; SP
DOSE) FLULAVAL
1
SKYRIZI PEN 3 PA; SP QUADRIVALENT
STELARA FLUMIST
3 PA; SP 1
INTRAVENOUS QUADRIVALENT
STELARA FLUZONE HIGH-
3 PA; SP; QL
SUBCUTANEOUS DOSE 1
SYNAGIS 3 PA; SP QUADRIVALENT
tacrolimus oral 2 SP FLUZONE

1
QUADRIVALENT
TALTZ 4 PA; SP
GARDASIL 9 2
temsirolimus 4 SP
HAVRIX 1
THYMOGLOBULIN 3
HEPLISAV-B 2
TICE BCG 3 SP
HIBERIX 1
TREMFYA 3 PA; SP
IMOVAX RABIES 3
XATMEP 3 ST
INFANRIX 1
XELJANZ 3 PA; SP
IPOL 2
XELJANZ XR 3 PA; SP
IXIARO 3
ZORTRESS 3 SP
JANSSEN COVID-19
Immunological 1
VACCINE
Agents - Drugs for
Vaccination KINRIX 1
ACTHIB 1 MENACTRA 2
ADACEL 1 MENQUADFI 2
AFLURIA MENVEO 2
1
QUADRIVALENT M-M-R II 1
BCG VACCINE 2 MODERNA COVID-19
1
BEXSERO 2 VACCINE
BOOSTRIX 1 PEDIARIX 1
DAPTACEL 1 PEDVAX HIB 1
44
PENTACEL 2 mesalamine oral
PFIZER-BIONTECH capsule delayed 3
1 release 400 mg
COVID-19 VACC
PNEUMOVAX 23 2 mesalamine rectal 3
PREVNAR 13 2 mesalamine-cleanser 3
PREVNAR 20 2 procto-med hc 1
PROQUAD 2 procto-pak 1
QUADRACEL 1 proctozone-hc 1
RABAVERT 3 SFROWASA 3
RECOMBIVAX HB 1 sulfasalazine oral 1
ROTARIX 2 UCERIS RECTAL 3
ROTATEQ 1 Metabolic Bone
Disease Agents -
SHINGRIX 2 Drugs for
STAMARIL 2 Osteoporosis
TDVAX 1 alendronate sodium
2
TENIVAC 1 oral solution
TETANUS- alendronate sodium

1
DIPHTHERIA 1 oral tablet 10 mg, 5 mg
TOXOIDS TD alendronate sodium
TRUMENBA 2 oral tablet 35 mg, 70 1 QL
mg
TWINRIX 2
calcitonin (salmon)
TYPHIM VI 1 1 QL
nasal
VAQTA 1 ibandronate sodium 1 QL
VARIVAX 2 pamidronate disodium 1 SP
VAXCHORA 2 PROLIA 3 PA; SP; QL
YF-VAX 2 RAYALDEE 3
Inflammatory Bowel risedronate sodium oral
Disease Agents 1 QL
tablet 150 mg, 35 mg
APRISO 2 risedronate sodium oral
1
balsalazide disodium 2 tablet 30 mg, 5 mg
budesonide er 3 risedronate sodium oral
2 QL
budesonide oral 2 tablet delayed release
hydrocortisone TERIPARATIDE
1 3 PA; SP
(perianal) (RECOMBINANT)
hydrocortisone rectal 2 TYMLOS 3 PA; SP
LIALDA 2 XGEVA 3 PA; SP

zoledronic acid 2 SP
45
Metabolic Bone BOTOX 3 PA; SP
Disease Agents - BREATHE EASE
Other 1
LARGE
calcitriol intravenous 1 BREATHE EASE
1
calcitriol oral 1 MEDIUM
cinacalcet hcl 3 PA BREATHE EASE
1
doxercalciferol SMALL
3
intravenous BROMELAIN 4
NATPARA 4 PA; SP; QL CETYLCIDE-G 4
paricalcitol intravenous 2 CHARCOAL
4
paricalcitol oral 1 ACTIVATED
Miscellaneous CHLORHEXIDINE
Therapeutic Agents GLUCONATE 2
SOLUTION 20 %
acetylcysteine
3 CLEVER CHOICE
intravenous 1
HOLDING CHAMBER
ADAKVEO 4 PA; SP
COMPACT SPACE
AEROCHAMBER MINI 1
1 CHAMBER
CHAMBER
COMPACT SPACE
AEROCHAMBER MV 1 1
CHAMBER/LG MASK
AEROCHAMBER COMPACT SPACE
1
PLUS FLO-VU CHAMBER/MED 1
AEROCHAMBER MASK
1
PLUS FLOW VU COMPACT SPACE
1
AEROCHAMBER CHAMBER/SM MASK
1
W/FLOWSIGNAL COVID-19 SPECIMEN
1
ALBUKED 25 2 COLLECTION
ALBUKED 5 2 COVID-19 TESTING
1
ALBUMIN HUMAN 2 BY PHARMACIST
ALBUMIN-ZLB 2 deferoxamine mesylate 2
ALBURX 2 dexmedetomidine hcl in

nacl intravenous
ALBUTEIN 2 solution 200 mcg/50ml, 3
ASPARTAME 4 200-0.9 mcg/50ml-%,
ASPARTAME 400 mcg/100ml
4
(NUTRASWEET) DEXMEDETOMIDINE
BD VERITOR SYSTEM HCL INTRAVENOUS
1 SOLUTION 1000 3
SARS-COV-2
MCG/10ML, 400
BINAXNOW COVID-19 MCG/4ML
1
AG CARD
dexmedetomidine hcl
BINAXNOW COVID-19 intravenous solution 1
1
AG HOME TEST 200 mcg/2ml
46
DUROLANE 2 PA; SP PIXEL COVID-19 PCR
1
DYSPORT 3 PA; SP HOME TEST
EASIVENT 1 PLASBUMIN-25 2
ergoloid mesylates oral 3 PLASBUMIN-5 2
EUFLEXXA 2 PA; SP POCKET SPACER 1
FIRDAPSE 4 PA; SP PRO COMFORT
1
SPACER ADULT
FLEXBUMIN 2
PRO COMFORT
FLEXICHAMBER 1 1
SPACER CHILD
flumazenil intravenous 1 PRO COMFORT
1
GELSYN-3 2 PA; SP SPACER INFANT
heparin lock flush 1 PROCARE
heparin sodium lock SPACER/ADULT 1
1 MASK
flush
HUMAN ALBUMIN PROCARE
2 1
GRIFOLS SPACER/CHILD MASK
ID NOW COVID-19 1 QUICKVUE AT-HOME

1
COVID-19 TEST
KEDBUMIN 2
QUICKVUE SARS
LUCIRA COVID-19 1
1 ANTIGEN TEST
ALL-IN-ONE
SACCHARIN 4
LYRA DIRECT SARS-
1 sodium thiosulfate
COV-2 ASSAY 2
intravenous
LYRA SARS-COV-2
1 SOFIA SARS
ASSAY 1
ANTIGEN FIA
methergine 3 QL
SOFIA2 SARS
methylergonovine 1
1 ANTIGEN FIA
maleate injection
VISTOGARD 4
methylergonovine
3 QL VORTEX VALVED
maleate oral 1
HOLDING CHAMBER
MICROCHAMBER 1
XEOMIN 3 PA; SP
MYLAB BOX COVID-
1 XIAFLEX 4 PA; SP
19 TESTING
MYOBLOC 3 PA; SP XPERT XPRESS
1
SARS-COV-2
OPTICHAMBER
1 Ophthalmic Agents -
DIAMOND
Drugs for Eye Allergy,
OPTICHAMBER Infection and
1
DIAMOND-LG MASK Inflammation
OPTICHAMBER azelastine hcl
1 1
DIAMOND-MD MASK ophthalmic
OPTICHAMBER bacitracin ophthalmic 1
1
DIAMOND-SM MASK
47
bromfenac sodium Ophthalmic Agents -
2 QL Drugs for Glaucoma
(once-daily)
ciprofloxacin hcl acetazolamide er 1
1
ophthalmic acetazolamide oral 2
cromolyn sodium apraclonidine hcl 1
1
ophthalmic
betaxolol hcl
dexamethasone 1
ophthalmic
sodium phosphate 1
ophthalmic bimatoprost ophthalmic 2 QL
diclofenac sodium brimonidine tartrate
1 1
ophthalmic ophthalmic
epinastine hcl 1 carteolol hcl 1
erythromycin DORZOLAMIDE HCL
1 SOLUTION 2 % 1
ophthalmic
OPHTHALMIC
fluorometholone 1
dorzolamide hcl
flurbiprofen sodium 1 1
solution 2 % ophthalmic
FML FORTE 2 dorzolamide hcl-timolol
1
gatifloxacin ophthalmic 1 mal
gentak 1 dorzolamide hcl-timolol
1
gentamicin sulfate mal pf
1
ophthalmic KEVEYIS 4 PA; SP; QL
ketorolac tromethamine latanoprost ophthalmic 1
1
ophthalmic levobunolol hcl 1
levofloxacin ophthalmic 2 LUMIGAN 2 QL
moxifloxacin hcl (2x methazolamide oral 3
1
day)
pilocarpine hcl
moxifloxacin hcl 1
1 ophthalmic
ophthalmic solution
timolol maleate
NATACYN 3 1
ophthalmic solution
ofloxacin ophthalmic 1 travoprost (bak free) 2 QL
olopatadine hcl Ophthalmic Agents -
1
ophthalmic Drugs for
prednisolone acetate Miscellaneous Eye
1 Conditions
ophthalmic
prednisolone sodium ak-poly-bac 1
1
phosphate ophthalmic ALTACAINE 1
sulfacetamide sodium altafrin 1
1
ophthalmic
atropine sulfate
tobramycin ophthalmic 1 1
ophthalmic ointment
trifluridine 2
48
atropine sulfate tobramycin-
1 1
ophthalmic solution 1 % dexamethasone
bacitracin-polymyxin b VISUDYNE 3 SP
1
ophthalmic Otic Agents - Drugs
bacitra-neomycin- for Ear Conditions
1
polymyxin-hc acetic acid otic 1
cyclopentolate hcl ciprofloxacin hcl otic 1
1
ophthalmic
flac 1
CYSTADROPS 4 PA; SP; QL
CYSTARAN 4 PA; SP; QL 1
otic
EYLEA 3 PA; SP hydrocortisone-acetic
2
homatropaire 1 acid
LUCENTIS 3 PA; SP neomycin-polymyxin-hc
1
neomycin-bacitracin zn- otic
1
polymyx ofloxacin otic 1
neomycin-polymyxin- Respiratory Tract /
dexameth ophthalmic 1 Pulmonary Agents -
ointment Drugs for Allergies,
neomycin-polymyxin- Cough, Cold
dexameth ophthalmic 12 hour allergy-d 1
1
suspension 3.5-10000- all day allergy d 1
0.1
all day allergy d-12 1
neomycin-polymyxin-
1 allergy (cetirizine) 1
gramicidin
neomycin-polymyxin-hc allergy 24hour
2 1
ophthalmic indoor/outdoor
neo-polycin 1 allergy relief (cetirizine) 1
neo-polycin hc 1 allergy relief cetirizine 1
OXERVATE 4 PA; SP; QL allergy relief childrens
1
oral solution
phenylephrine hcl
1 allergy relief oral tablet
ophthalmic 1
5 mg
polycin 1
allergy
polymyxin b- relief/indoor/outdoor 1
1
trimethoprim oral tablet 10 mg
proparacaine hcl allergy relief/nasal
1
ophthalmic decongest oral tablet
1
sulfacetamide- extended release 12
prednisolone 1 hour
ophthalmic solution azelastine hcl nasal 1 QL
tetracaine hcl azelastine-fluticasone 2
1
ophthalmic
benzonatate 1
49
carbinoxamine maleate NUCALA 4 PA; SP; QL
1
oral solution olopatadine hcl nasal 2 QL
carbinoxamine maleate promethazine hcl
1 1
oral tablet 4 mg injection
cetirizine hcl childrens promethazine hcl oral 1
1
alrgy
promethazine hcl rectal 2
cetirizine hcl oral
1 promethazine vc 1
solution
cetirizine hcl oral tablet 1 promethazine
1 PA; QL
vc/codeine
cetirizine-
1 promethazine-codeine 1 PA; QL
pseudoephedrine er
CINQAIR 3 PA; SP promethazine-dm 1
cyproheptadine hcl oral 1 promethazine-
1 PA; QL
phenyleph-codeine
desloratadine oral
1 promethazine-
tablet 1
phenylephrine
desloratadine oral
2 promethegan 2
tablet dispersible
di-phen 1 pseudoephedrine-
1
bromphen-dm
diphen oral elixir 1
ryvent 1
diphenhydramine hcl
1 sodium chloride
injection 1
inhalation
diphenhydramine hcl
1 XOLAIR 3 PA; SP
oral elixir
FASENRA 4 PA; SP Respiratory Tract /
Pulmonary Agents -
FASENRA PEN 4 PA; SP Drugs for Asthma and
flunisolide nasal 1 QL Other Lung
fluticasone propionate Conditions
1
nasal acetylcysteine
1
goodsense all day inhalation
1
allergy-d ADVAIR DISKUS 2 QL
hydrocodone polst- ADVAIR HFA 2 QL
1 PA; QL
chlorphen polst er susp albuterol sulfate hfa
hydrocodone- aerosol solution 108
1 PA; QL 1 QL
homatropine (90 base) mcg/act
hydromet 1 PA; QL inhalation
ipratropium bromide ALBUTEROL
1 SULFATE HFA
nasal
AEROSOL SOLUTION
levocetirizine 1 QL
1 108 (90 BASE)
dihydrochloride oral MCG/ACT
mometasone furoate INHALATION
1 QL
nasal
50
albuterol sulfate ipratropium bromide
1 QL 1 QL
inhalation inhalation
ANORO ELLIPTA 2 QL ipratropium-albuterol 1 QL
ARALAST NP 4 PA; SP LONHALA MAGNAIR
3 ST; QL
arformoterol tartrate 3 QL REFILL KIT
ARNUITY ELLIPTA 2 QL LONHALA MAGNAIR
3 ST; QL
STARTER KIT
ASMANEX (120
2 QL montelukast sodium
METERED DOSES) 1
oral
ASMANEX (14
2 QL OFEV 4 PA; SP
METERED DOSES)
ASMANEX (30 PROLASTIN-C 4 PA; SP
2 QL
METERED DOSES) QVAR REDIHALER 2 QL
ASMANEX (60 SEREVENT DISKUS 2 QL
2 QL
METERED DOSES) SPIRIVA
2 QL
ASMANEX (7 HANDIHALER
2 QL
METERED DOSES) SPIRIVA RESPIMAT 2 QL
ASMANEX HFA 2 QL STIOLTO RESPIMAT 2 QL
ATROVENT HFA 3 ST; QL STRIVERDI
2 QL
BREO ELLIPTA 2 QL RESPIMAT
BREZTRI SYMBICORT 2 QL
2 QL
AEROSPHERE terbutaline sulfate
1
budesonide inhalation 2 QL injection
COMBIVENT terbutaline sulfate oral 2
2 QL
RESPIMAT theophylline 2
cromolyn sodium theophylline er oral
3
inhalation tablet extended release 2
DALIRESP 3 PA 12 hour
epinephrine injection theophylline er oral
2
solution auto-injector tablet extended release 1
ESBRIET 4 PA; SP 24 hour
FLUTICASONE- TRELEGY ELLIPTA 2 QL
SALMETEROL YUPELRI 3 ST; QL
INHALATION zafirlukast 1
AEROSOL POWDER
2 QL ZEMAIRA 4 PA; SP
BREATH ACTIVATED
113-14 MCG/ACT, 232- Respiratory Tract /
14 MCG/ACT, 55-14 Pulmonary Agents -
MCG/ACT Drugs for Cystic
GLASSIA 4 PA; SP Fibrosis
INCRUSE ELLIPTA 2 QL KALYDECO 4 PA; SP

ORKAMBI 4 PA; SP; QL
51
PULMOZYME 4 PA; SP dantrolene sodium oral 1
SYMDEKO 4 PA; SP; QL methocarbamol
1
tobramycin inhalation 4 SP injection
TRIKAFTA 4 PA; SP; QL methocarbamol oral 1
Respiratory Tract / orphenadrine citrate er 1
Pulmonary Agents - orphenadrine citrate
1
Drugs for Pulmonary injection
Hypertension tizanidine hcl oral 1
ADEMPAS 4 PA; SP; QL Sleep Disorder
alyq 3 PA; SP; QL Agents
ambrisentan 4 PA; SP; QL armodafinil 1 PA; QL
bosentan 4 PA; SP; QL doxepin hcl oral tablet 3 QL
epoprostenol sodium 3 PA; SP eszopiclone 1 QL
OPSUMIT 4 PA; SP; QL flurazepam hcl 1 PA; QL
ORENITRAM 4 PA; SP HETLIOZ 4 PA; SP; QL
sildenafil citrate modafinil 1 PA; QL
2 PA; SP
intravenous temazepam 1 QL
sildenafil citrate oral XYREM 4 PA; SP; QL
suspension 4 PA; SP; QL
reconstituted zaleplon 1 QL
sildenafil citrate oral zolpidem tartrate er 1 QL
1 PA; SP; QL
tablet 20 mg zolpidem tartrate oral 1 QL
tadalafil (pah) 3 PA; SP; QL
TRACLEER 32 MG 4 PA; SP; QL
treprostinil 4 PA; SP
TYVASO 4 PA; SP; QL
TYVASO REFILL 4 PA; SP; QL
TYVASO STARTER 4 PA; SP; QL
UPTRAVI ORAL 4 PA; SP; QL
VENTAVIS 4 PA; SP; QL
Skeletal Muscle
Relaxants - Drugs for
Muscle Pain and
Spasm
baclofen oral 1
carisoprodol oral 1
chlorzoxazone oral
1
tablet 500 mg
cyclobenzaprine hcl
1
oral tablet 10 mg, 5 mg
52
53
Index of Drugs
12 hour allergy-d....................... 49 AEROCHAMBER ALTRENO................................. 27
abacavir sulfate.........................19 W/FLOWSIGNAL...................... 46 ALUMINUM CHLORIDE
abacavir sulfate-lamivudine...... 19 AFINITOR................................. 14 ANHYDROUS........................... 27
abacavir-lamivudine- AFINITOR DISPERZ.................14 ALUMINUM CHLORIDE
zidovudine.................................19 afirmelle.................................... 39 HEXAHYDRATE....................... 27
ABELCET..................................13 AFLURIA QUADRIVALENT......44 ALUNBRIG................................14
ABILIFY MAINTENA................. 19 AFSTYLA.................................. 21 alyacen 1/35..............................39
abiraterone acetate................... 14 airavite...................................... 32 alyacen 7/7/7.............................39
ABRAXANE.............................. 14 ak-poly-bac............................... 48 alyq........................................... 52
acamprosate calcium.................. 7 ala-cort...................................... 27 amabelz.................................... 39
acarbose................................... 30 ALANINE...................................32 amantadine hcl..........................18
accutane................................... 27 albendazole...............................18 AMBISOME...............................13
acebutolol hcl............................ 22 ALBUKED 25............................ 46 ambrisentan.............................. 52
acetaminophen-codeine..............4 ALBUKED 5.............................. 46 amcinonide................................27
acetaminophen-codeine #2.........4 ALBUMIN HUMAN....................46 amethia..................................... 39
acetaminophen-codeine #3.........4 ALBUMIN-ZLB.......................... 46 amethyst................................... 39
acetaminophen-codeine #4.........4 ALBURX....................................46 amikacin sulfate.......................... 7
acetazolamide...........................48 ALBUTEIN................................ 46 amiloride hcl..............................22
acetazolamide er.......................48 albuterol sulfate.........................51 amiloride-hydrochlorothiazide... 22
acetazolamide sodium.............. 22 albuterol sulfate hfa...................50 aminocaproic acid..................... 22
acetic acid........................... 36, 49 ALBUTEROL SULFATE HFA... 50 amiodarone hcl......................... 22
acetylcysteine..................... 46, 50 alclometasone dipropionate...... 27 amitriptyline hcl......................... 11
acitretin..................................... 27 ALECENSA...............................14 amlodipine besylate.................. 22
ACTEMRA................................ 42 alendronate sodium.................. 45 amlodipine besylate-benazepril
ACTEMRA ACTPEN.................42 alfuzosin hcl er.......................... 37 hcl............................................. 22
ACTHAR................................... 38 ALIMTA..................................... 14 amlodipine besylate-valsartan.. 23
ACTHIB.....................................44 ALINIA.......................................18 amlodipine-olmesartan..............23
ACTIMMUNE............................ 42 ALIQOPA.................................. 14 amlodipine-valsartan-hctz......... 23
acyclovir.............................. 19, 20 all day allergy d......................... 49 ammonium lactate.....................28
acyclovir sodium....................... 20 all day allergy d-12....................49 amnesteem............................... 28
ADACEL....................................44 allergy (cetirizine)......................49 amoxapine................................ 11
ADAKVEO.................................46 allergy 24hour indoor/outdoor... 49 amoxicill-clarithro-lansopraz..... 35
adapalene................................. 27 allergy relief...............................49 amoxicillin................................... 7
adapalene-benzoyl peroxide.....27 allergy relief (cetirizine)............. 49 amoxicillin-potassium
adc/f (0.5mg/ml)........................ 32 allergy relief cetirizine............... 49 clavulanate..................................7
ADCETRIS................................14 allergy relief childrens............... 49 amoxicillin-potassium
ADDERALL XR......................... 26 allergy relief/indoor/outdoor...... 49 clavulanate er..............................7
adefovir dipivoxil....................... 20 allergy relief/nasal decongest... 49 amphetamine sulfate.................26
ADEMPAS................................ 52 allopurinol..................................13 amphetamine-
adenosine................................. 22 allopurinol sodium..................... 13 dextroamphetamine.................. 26
adriamycin.................................14 almotriptan malate.................... 13 amphotericin b.......................... 13
adult aspirin regimen...................4 alosetron hcl..............................35 ampicillin..................................... 7
ADVAIR DISKUS...................... 50 ALPHANATE.............................21 ampicillin sodium.........................7
ADVAIR HFA............................ 50 ALPHANINE SD........................21 ampicillin-sulbactam sodium....... 7
ADVATE....................................21 alprazolam................................ 21 anagrelide hcl............................22
ADYNOVATE............................21 alprazolam er............................ 21 ANASPAZ................................. 35
AEROCHAMBER MINI alprazolam intensol................... 21 anastrozole............................... 14
CHAMBER................................ 46 alprazolam xr............................ 21 ANDRODERM.......................... 38
AEROCHAMBER MV............... 46 ALPROLIX................................ 22 ANORO ELLIPTA..................... 51
AEROCHAMBER PLUS FLO- alprostadil..................................22 APO-VARENICLINE................... 7
VU............................................. 46 ALTACAINE.............................. 48 apraclonidine hcl....................... 48
AEROCHAMBER PLUS altafrin....................................... 48 aprepitant.................................. 12
FLOW VU..................................46 altavera..................................... 39 apri............................................ 39
54
APRISO.................................... 45 ATROVENT HFA...................... 51 BENZNIDAZOLE...................... 18
APTIVUS...................................20 AUBAGIO..................................26 benzonatate.............................. 49
ARAKODA................................ 18 aubra.........................................39 benzoyl peroxide-erythromycin. 28
ARALAST NP............................51 aubra eq....................................39 benzphetamine hcl....................26
aranelle..................................... 39 AUGMENTIN.............................. 7 benztropine mesylate................18
ARANESP (ALBUMIN FREE)...22 aurovela 1.5/30......................... 39 BERINERT................................42
ARCALYST............................... 42 aurovela 1/20............................ 39 beser......................................... 28
arformoterol tartrate.................. 51 aurovela 24 fe........................... 39 betamethasone dipropionate.... 28
argyle sterile saline................... 32 aurovela fe 1.5/30..................... 39 betamethasone dipropionate
argyle sterile water....................32 aurovela fe 1/20........................ 39 aug............................................ 28
ARIKAYCE..................................7 AUSTEDO.................................26 betamethasone valerate........... 28
aripiprazole............................... 19 AVASTIN...................................14 BETASERON............................26
ARISTADA................................ 19 aviane....................................... 39 betaxolol hcl........................ 23, 48
ARISTADA INITIO.................... 19 avidoxy........................................7 bethanechol chloride.................36
armodafinil................................ 52 AVONEX PEN...........................26 bexarotene................................ 14
ARMOUR THYROID.................42 AVONEX PREFILLED.............. 26 BEXSERO.................................44
ARNUITY ELLIPTA...................51 AVSOLA....................................42 bicalutamide..............................14
ARRANON................................ 14 ayuna........................................ 39 BICILLIN L-A...............................7
arsenic trioxide..........................14 azacitidine................................. 14 BIKTARVY................................ 20
ARZERRA.................................14 AZASAN....................................42 bimatoprost............................... 48
ascomp-codeine..........................4 azathioprine.............................. 42 BINAXNOW COVID-19 AG
ashlyna......................................39 azathioprine sodium..................42 CARD........................................46
ASMANEX (120 METERED azelaic acid............................... 28 BINAXNOW COVID-19 AG
DOSES).................................... 51 azelastine hcl...................... 47, 49 HOME TEST............................. 46
ASMANEX (14 METERED azelastine-fluticasone............... 49 bisoprolol fumarate................... 23
DOSES).................................... 51 azithromycin................................7 bisoprolol-hydrochlorothiazide.. 23
ASMANEX (30 METERED aztreonam................................... 7 BIVIGAM................................... 42
DOSES).................................... 51 azurette..................................... 39 bleomycin sulfate...................... 14
ASMANEX (60 METERED bac.............................................. 4 BLINCYTO................................ 14
DOSES).................................... 51 bacitracin...................................47 blisovi 24 fe............................... 39
ASMANEX (7 METERED bacitracin-polymyxin b.............. 49 blisovi fe 1.5/30......................... 39
DOSES).................................... 51 bacitra-neomycin-polymyxin-hc 49 blisovi fe 1/20............................ 39
ASMANEX HFA........................ 51 baclofen.................................... 52 BOOSTRIX............................... 44
ASPARTAME............................46 balsalazide disodium.................45 BORTEZOMIB.......................... 14
ASPARTAME BALVERSA............................... 14 bosentan................................... 52
(NUTRASWEET)...................... 46 balziva.......................................39 BOSULIF...................................14
aspirin......................................... 4 BARACLUDE............................ 20 BOTOX..................................... 46
aspirin adult low strength............ 4 BCG VACCINE......................... 44 bp vit 3...................................... 32
aspirin childrens.......................... 4 BD AUTOSHIELD DUO PEN BRAFTOVI................................ 15
aspirin ec.....................................4 NEEDLES................................. 31 BREATHE EASE LARGE......... 46
aspirin ec low dose..................... 4 BD ULTRA-FINE INSULIN BREATHE EASE MEDIUM.......46
aspirin ec low strength................ 4 SYRINGES............................... 31 BREATHE EASE SMALL..........46
aspirin low dose.......................... 4 BD ULTRA-FINE PEN BREO ELLIPTA........................ 51
aspirin-dipyridamole er..............19 NEEDLES................................. 31 BREZTRI AEROSPHERE.........51
ATABEX OB..............................32 BD VERITOR SYSTEM SARS- briellyn.......................................39
atazanavir sulfate......................20 COV-2....................................... 46 BRILINTA..................................19
atenolol..................................... 23 BELEODAQ.............................. 14 brimonidine tartrate................... 48
atenolol-chlorthalidone..............23 BELRAPZO...............................14 BRIVIACT................................. 10
atomoxetine hcl.........................26 benazepril hcl............................23 BROMELAIN.............................46
atorvastatin calcium.................. 23 benazepril-hydrochlorothiazide. 23 bromfenac sodium (once-daily).48
atovaquone............................... 18 BENDEKA.................................14 bromocriptine mesylate.............18
atovaquone-proguanil hcl..........18 BENEFIX...................................22 budesonide......................... 45, 51
atropine sulfate............. 35, 48, 49 BENLYSTA............................... 42 budesonide er........................... 45
55
bumetanide............................... 23 CAPASTAT SULFATE..............14 CEQUR SIMPLICITY
bupivacaine fisiopharma............. 6 capecitabine..............................15 STARTER................................. 30
bupivacaine hcl........................... 6 CAPRELSA...............................15 CERDELGA.............................. 36
bupivacaine hcl (pf).....................6 captopril.................................... 23 CEREZYME.............................. 36
bupivacaine-epinephrine.............6 CARBAGLU.............................. 32 cetirizine hcl.............................. 50
bupivacaine-epinephrine (pf)...... 6 carbamazepine......................... 10 cetirizine hcl childrens alrgy...... 50
buprenorphine.............................4 carbamazepine er..................... 10 cetirizine-pseudoephedrine er...50
buprenorphine hcl................... 4, 7 carbidopa.................................. 18 CETROTIDE............................. 38
buprenorphine hcl-naloxone carbidopa-levodopa.................. 18 CETYLCIDE-G..........................46
hcl............................................... 7 carbidopa-levodopa er.............. 18 cevimeline hcl........................... 27
bupropion hcl............................ 11 carbidopa-levodopa- CHANTIX.................................... 7
bupropion hcl er (smoking det)... 7 entacapone............................... 18 CHANTIX CONTINUING
bupropion hcl er (sr)..................11 carbinoxamine maleate.............50 MONTH PAK...............................7
bupropion hcl er (xl).................. 11 carboplatin................................ 15 CHANTIX STARTING MONTH
buspirone hcl.............................21 carisoprodol.............................. 52 PAK.............................................7
busulfan.................................... 15 carisoprodol-aspirin-codeine.......5 CHARCOAL ACTIVATED.........46
butalbital-acetaminophen............5 carmustine................................ 15 charlotte 24 fe........................... 39
butalbital-apap-caff-cod.............. 5 carteolol hcl...............................48 chateal...................................... 39
butalbital-apap-caffeine...............5 cartia xt..................................... 23 chateal eq................................. 39
butalbital-asa-caff-codeine..........5 carvedilol...................................23 chlordiazepoxide hcl................. 21
butalbital-aspirin-caffeine............ 5 carvedilol phosphate er.............23 chlordiazepoxide-amitriptyline...11
butorphanol tartrate.....................5 caspofungin acetate..................13 chlorhexidine gluconate............ 27
BYDUREON BCISE cavarest.................................... 27 CHLORHEXIDINE
AUTOINJECTOR...................... 30 caziant.......................................39 GLUCONATE............................46
cabergoline............................... 38 cefaclor....................................... 7 chloroquine phosphate..............18
CABLIVI.................................... 19 cefaclor er................................... 7 chlorothiazide sodium............... 23
CABOMETYX........................... 15 cefadroxil.....................................7 chlorpromazine hcl....................19
caffeine citrate...........................26 cefazolin sodium......................... 7 chlorthalidone............................23
CALAMINE................................28 CEFAZOLIN SODIUM................ 7 chlorzoxazone...........................52
calcipotriene..............................28 cefazolin sodium-dextrose.......... 7 CHOLBAM................................ 36
calcitonin (salmon).................... 45 cefdinir........................................ 7 cholestyramine..........................23
calcitriol............................... 28, 46 cefepime hcl................................7 cholestyramine light.................. 23
calcium acetate......................... 36 cefepime-dextrose...................... 7 CHOLINE BITARTRATE...........32
calcium acetate (phos binder)...36 cefixime.......................................7 CHORIONIC
CALCIUM CHLORIDE cefotaxime sodium...................... 7 GONADOTROPIN.................... 38
DIHYDRATE............................. 32 cefoxitin sodium.......................... 7 ciclodan.....................................13
CALCIUM GLUCONATE.......... 32 cefpodoxime proxetil................... 8 ciclopirox................................... 13
CALCIUM GLUCONATE cefprozil.......................................8 ciclopirox olamine..................... 13
ANHYDROUS........................... 32 ceftazidime..................................8 cidofovir.....................................20
CALCIUM GLUCONATE ceftazidime and dextrose............ 8 cilostazol................................... 19
MONOHYDRATE......................32 ceftriaxone sodium......................8 CIMDUO................................... 20
CALCIUM LACTATE ceftriaxone sodium in dextrose... 8 cimetidine..................................35
PENTAHYDRATE.....................32 ceftriaxone sodium-dextrose.......8 cimetidine hcl............................ 35
CALCIUM PHOSPHATE cefuroxime axetil......................... 8 CIMZIA PREFILLED KIT...........43
DIBASIC....................................32 cefuroxime sodium......................8 CIMZIA STARTER KIT............. 43
CALCIUM PHOSPHATE celecoxib..................................... 4 cinacalcet hcl............................ 46
TRIBASIC................................. 32 CELLCEPT............................... 42 CINQAIR................................... 50
CALQUENCE............................15 CELONTIN................................10 CINRYZE.................................. 43
camila........................................39 cephalexin...................................8 CINVANTI................................. 12
camrese.................................... 39 CEQUR SIMPLICITY 2U.......... 30 CIPRO.........................................8
camrese lo................................ 39 CEQUR SIMPLICITY ciprofloxacin hcl.............. 8, 48, 49
candesartan cilexetil................. 23 INSERTER................................30 ciprofloxacin in d5w.....................8
candesartan cilexetil-hctz..........23 cisplatin..................................... 15
56
citalopram hydrobromide.......... 11 COMPACT SPACE CYRAMZA................................ 15
cladribine...................................15 CHAMBER/LG MASK............... 46 cyred......................................... 39
claravis......................................28 COMPACT SPACE cyred eq.................................... 39
clarithromycin..............................8 CHAMBER/MED MASK............46 CYSTADROPS......................... 49
clarithromycin er..........................8 COMPACT SPACE CYSTAGON..............................36
CLEVER CHOICE HOLDING CHAMBER/SM MASK.............. 46 CYSTARAN.............................. 49
CHAMBER................................ 46 COMPLERA..............................20 cytarabine................................. 15
CLIMARA PRO......................... 39 compro...................................... 12 cytarabine (pf)........................... 15
clindacin etz.............................. 28 constulose.................................35 CYTOGAM................................43
clindacin-p.................................28 CONTOUR CONTROL dacarbazine.............................. 15
clindamycin hcl............................8 SOLUTION................................30 dactinomycin............................. 15
clindamycin palmitate hcl............ 8 CONTOUR MONITOR dalfampridine er........................ 26
clindamycin phosphate......... 8, 28 DEVICE.....................................30 DALIRESP................................ 51
clindamycin phosphate in d5w.... 8 CONTOUR MONITOR KIT danazol..................................... 38
CLINDAMYCIN PHOSPHATE W/DEVICE................................ 30 dantrolene sodium.................... 52
IN NACL......................................8 CONTOUR NEXT CONTROL dapsone.................................... 14
clindamycin phosphate- SOLUTION................................31 DAPTACEL............................... 44
benzoyl peroxide.......................28 CONTOUR NEXT EZ KIT daptomycin..................................8
clindamycin-tretinoin................. 28 W/DEVICE................................ 31 darifenacin hydrobromide er..... 36
CLINPRO 5000......................... 27 CONTOUR NEXT LINK KIT DARZALEX............................... 15
clobazam...................................10 W/DEVICE................................ 31 dasetta 1/35.............................. 39
clobetasol prop emollient base. 28 CONTOUR NEXT MONITOR dasetta 7/7/7............................. 39
clobetasol propionate................28 KIT W/DEVICE..........................31 daunorubicin hcl........................15
clobetasol propionate e.............28 CONTOUR NEXT ONE KIT......31 DAURISMO...............................15
clobetasol propionate emulsion 28 CONTOUR NEXT TEST daysee...................................... 39
clocortolone pivalate................. 28 STRIPS..................................... 31 deblitane................................... 39
clodan....................................... 28 CONTOUR TEST STRIPS........31 decitabine..................................15
clofarabine................................ 15 COPIKTRA................................15 deferasirox................................ 32
clomiphene citrate.....................38 CORIFACT................................22 deferasirox granules................. 32
clomipramine hcl....................... 12 COTELLIC................................ 15 deferoxamine mesylate.............46
clonazepam...............................21 COVID-19 SPECIMEN DELSTRIGO............................. 20
clonidine....................................23 COLLECTION........................... 46 delyla.........................................39
clonidine hcl.............................. 23 COVID-19 TESTING BY demeclocycline hcl......................8
clonidine hcl er.......................... 26 PHARMACIST.......................... 46 DENTA 5000 PLUS.................. 27
clopidogrel bisulfate.................. 19 CREON..................................... 36 DENTAGEL...............................27
clorazepate dipotassium........... 21 CRESEMBA..............................13 DEPO-MEDROL....................... 37
clotrimazole...............................13 CRIXIVAN................................. 20 desipramine hcl.........................12
clotrimazole 3............................13 cromolyn sodium...........35, 48, 51 desloratadine............................ 50
clotrimazole-betamethasone.....13 cryselle-28.................................39 desmopressin ace spray refrig..38
clovique.....................................32 CRYSVITA................................ 36 desmopressin acetate...............38
clozapine...................................19 curity sterile saline.................... 32 desmopressin acetate pf...........38
COAGADEX..............................22 CUVITRU.................................. 43 desmopressin acetate spray..... 38
COARTEM................................ 18 cvs clotrimazole 3..................... 13 desogestrel-ethinyl estradiol..... 39
codeine sulfate............................5 cyanocobalamin........................ 32 desonide................................... 29
colchicine.................................. 13 CYANOCOBALAMIN................ 32 desoximetasone........................29
colchicine-probenecid............... 13 cyclafem 1/35............................39 desvenlafaxine succinate er......12
colestipol hcl............................. 23 cyclafem 7/7/7...........................39 dexamethasone........................ 37
colistimethate sodium (cba)........ 8 cyclobenzaprine hcl.................. 52 DEXAMETHASONE (LA)..........37
COMBIVENT RESPIMAT......... 51 cyclopentolate hcl..................... 49 dexamethasone sod
COMETRIQ...............................15 cyclophosphamide.................... 15 phosphate pf............................. 37
COMPACT SPACE cyclosporine.............................. 43 dexamethasone sodium
CHAMBER................................ 46 cyclosporine modified............... 43 phosphate........................... 37, 48
cyproheptadine hcl....................50
57
DEXCOM G4 / G5 / G6 DIVIGEL....................................39 ELIQUIS....................................10
RECEIVER, TRANSMITTER, DL-ALANINE.............................32 ELIQUIS DVT/PE STARTER
SENSOR (INCLUDING DL-LEUCINE.............................32 PACK........................................ 10
PLATINUM, PLATINUM DL-PHENYLALANINE.............. 33 ELITEK......................................15
PEDIATRIC)..............................31 dobutamine hcl..........................23 ELITE-OB..................................33
DEXMEDETOMIDINE HCL...... 46 dobutamine in d5w....................23 ELLA......................................... 40
dexmedetomidine hcl................ 46 docetaxel...................................15 ELOCTATE............................... 22
dexmedetomidine hcl in nacl.....46 dofetilide....................................23 eluryng...................................... 40
dexmethylphenidate hcl............ 26 dolishale....................................39 EMGALITY................................14
dexmethylphenidate hcl er........ 26 donepezil hcl............................. 11 EMGALITY (300 MG DOSE).... 14
dexrazoxane hcl........................15 dopamine hcl.............................23 emoquette................................. 40
dextroamphetamine sulfate.......26 DOPTELET............................... 22 EMPLICITI................................ 15
dextroamphetamine sulfate er.. 26 DORZOLAMIDE HCL............... 48 emtricitabine..............................20
dextrose in lactated ringers.......32 dorzolamide hcl.........................48 emtricitabine-tenofovir df...........20
dextrose-nacl............................ 32 dorzolamide hcl-timolol mal...... 48 EMTRIVA.................................. 20
dextrose-sodium chloride..........32 dorzolamide hcl-timolol mal pf.. 48 enalapril maleate.......................23
DIACOMIT................................ 10 dotti........................................... 40 enalapril-hydrochlorothiazide.... 23
diazepam............................ 10, 21 DOVATO...................................20 endocet....................................... 5
diazepam intensol..................... 21 doxazosin mesylate.................. 23 ENGERIX-B.............................. 44
diazoxide...................................31 doxepin hcl..........................12, 52 ENHERTU.................................15
diclofenac potassium.................. 4 doxercalciferol...........................46 ENLITE GLUCOSE SENSOR...31
diclofenac sodium................. 4, 48 doxorubicin hcl.......................... 15 enoxaparin sodium....................10
diclofenac sodium er................... 4 doxorubicin hcl liposomal..........15 enpresse-28.............................. 40
diclofenac-misoprostol................ 4 doxy 100..................................... 8 enskyce.....................................40
dicloxacillin sodium..................... 8 doxycycline hyclate..................... 8 entacapone............................... 18
dicyclomine hcl..........................35 doxycycline monohydrate........... 8 entecavir................................... 20
diethylpropion hcl...................... 26 dronabinol................................. 12 ENTRESTO.............................. 23
diethylpropion hcl er..................26 DROPLET MICRON................. 31 ENTYVIO.................................. 43
DIFICID....................................... 8 drospirenone-ethinyl estradiol...40 enulose..................................... 35
diflunisal...................................... 4 DROXIA.................................... 15 EPCLUSA................................. 20
digitek........................................23 droxidopa.................................. 23 EPIDIOLEX............................... 10
digox......................................... 23 DRYSOL................................... 29 epinastine hcl............................ 48
digoxin.......................................23 duloxetine hcl............................ 12 epinephrine............................... 51
dihydroergotamine mesylate.....14 DUPIXENT................................29 epirubicin hcl............................. 15
diltiazem hcl.............................. 23 DUROLANE.............................. 47 epitol......................................... 10
diltiazem hcl er.......................... 23 dutasteride................................ 37 EPIVIR HBV..............................20
diltiazem hcl er beads............... 23 dutasteride-tamsulosin hcl........ 37 eplerenone................................ 23
diltiazem hcl er coated beads... 23 DYSPORT.................................47 epoprostenol sodium.................52
DILTIAZEM HCL-DEXTROSE.. 23 EASIVENT................................ 47 EQUETRO................................ 21
dilt-xr......................................... 23 econazole nitrate.......................13 ERBITUX.................................. 15
dimethyl fumarate..................... 26 ED-SPAZ.................................. 35 ergocalciferol.............................33
dimethyl fumarate starter pack..26 EDURANT.................................20 ergoloid mesylates.................... 47
diphen....................................... 50 efavirenz................................... 20 ergotamine-caffeine.................. 14
di-phen...................................... 50 efavirenz-emtricitab-tenofovir....20 ERIVEDGE............................... 15
diphenhydramine hcl.................50 efavirenz-lamivudine-tenofovir.. 20 ERLEADA................................. 15
diphenoxylate-atropine..............35 EFFER-K...................................33 erlotinib hcl................................15
DIPHTHERIA-TETANUS effer-k........................................33 errin...........................................40
TOXOIDS DT............................ 44 EGRIFTA SV.............................38 ertapenem sodium...................... 8
dipyridamole..............................19 ELAPRASE............................... 36 ery............................................. 29
disopyramide phosphate...........23 ELELYSO..................................36 erythromycin................... 8, 29, 48
disulfiram.....................................7 eletriptan hydrobromide............ 14 erythromycin base.......................8
divalproex sodium..................... 10 ELIGARD.................................. 38 erythromycin ethylsuccinate........8
divalproex sodium er.................10 elinest........................................40 ESBRIET...................................51
58
escitalopram oxalate................. 12 fentanyl....................................... 5 fluvoxamine maleate er.............12
esomeprazole magnesium........35 fentanyl citrate.............................5 FLUZONE HIGH-DOSE
estarylla.....................................40 FIBRYGA.................................. 22 QUADRIVALENT...................... 44
estazolam..................................21 finasteride........................... 29, 37 FLUZONE QUADRIVALENT.... 44
estradiol.................................... 40 FIRDAPSE................................ 47 FML FORTE..............................48
estradiol valerate.......................40 FIRMAGON...............................38 folbee........................................ 33
estradiol-norethindrone acet..... 40 FIRMAGON (240 MG DOSE)... 38 folic acid.................................... 33
eszopiclone............................... 52 flac............................................ 49 FOLLISTIM AQ......................... 38
ethacrynic acid.......................... 23 flavoxate hcl.............................. 36 FOLOTYN................................. 15
ethambutol hcl...........................14 FLEBOGAMMA DIF..................43 folplex 2.2..................................33
ethosuximide.............................10 flecainide acetate...................... 24 fondaparinux sodium.................10
ethynodiol diac-eth estradiol..... 40 FLEXBUMIN............................. 47 FORTAZ......................................8
ETHYOL....................................15 FLEXICHAMBER...................... 47 fosamprenavir calcium.............. 20
etodolac...................................... 4 floxuridine..................................15 fosinopril sodium....................... 24
etodolac er.................................. 4 FLUAD QUADRIVALENT......... 44 fosinopril sodium-hctz............... 24
etonogestrel-ethinyl estradiol.... 40 FLUARIX QUADRIVALENT......44 fosphenytoin sodium................. 10
ETOPOPHOS........................... 15 FLUBLOK QUADRIVALENT.....44 FRAGMIN................................. 10
etoposide.................................. 15 FLUCELVAX fulvestrant................................. 15
etravirine................................... 20 QUADRIVALENT...................... 44 furosemide................................ 24
EUCRISA.................................. 29 fluconazole................................13 FUZEON................................... 20
EUFLEXXA............................... 47 fluconazole in sodium chloride..13 fyavolv.......................................40
euthyrox.................................... 42 flucytosine................................. 13 FYCOMPA................................ 10
everolimus...........................15, 43 fludarabine phosphate.............. 15 gabapentin................................ 10
EVERSENSE fludrocortisone acetate..............37 galantamine hydrobromide....... 11
SENSOR/HOLDER...................31 FLULAVAL QUADRIVALENT... 44 galantamine hydrobromide er... 11
EVERSENSE SMART flumazenil..................................47 GAMASTAN..............................43
TRANSMITTER........................ 31 FLUMIST QUADRIVALENT......44 GAMIFANT............................... 43
EVOTAZ....................................20 flunisolide.................................. 50 GAMMAGARD.......................... 43
exemestane.............................. 15 fluocinolone acetonide........ 29, 49 GAMMAGARD S/D LESS IGA..43
EXTAVIA...................................26 fluocinolone acetonide body..... 29 GAMMAKED............................. 43
EYLEA...................................... 49 fluocinolone acetonide scalp.....29 GAMMAPLEX........................... 43
ezetimibe...................................23 fluocinonide...............................29 GAMUNEX-C............................ 43
fabb........................................... 33 fluocinonide emulsified base.....29 GANCICLOVIR......................... 20
FABRAZYME............................ 36 FLUORIDEX............................. 27 ganciclovir sodium.................... 20
falmina...................................... 40 FLUORIDEX ENHANCED GARDASIL 9.............................44
famciclovir................................. 20 WHITENING............................. 27 gatifloxacin................................ 48
famotidine................................. 35 FLUORIDEX SENSITIVITY GATTEX....................................35
famotidine premixed..................35 RELIEF..................................... 27 gavilyte-c...................................35
FANAPT....................................19 fluoritab..................................... 33 gavilyte-g...................................35
FARXIGA.................................. 30 fluorometholone........................ 48 gavilyte-n with flavor pack.........35
FARYDAK................................. 15 fluorouracil.......................... 15, 29 GAVRETO................................ 15
FASENRA................................. 50 fluoxetine hcl............................. 12 GAZYVA................................... 15
FASENRA PEN.........................50 fluoxetine hcl (pmdd).................12 GELNIQUE............................... 36
fa-vitamin b-6-vitamin b-12....... 33 fluphenazine decanoate............19 GELSYN-3................................ 47
fayosim......................................40 fluphenazine hcl........................ 19 gemcitabine hcl......................... 15
FEIBA........................................22 flurazepam hcl...........................52 gemfibrozil.................................24
felbamate.................................. 10 flurbiprofen.................................. 4 generlac.................................... 35
felodipine er.............................. 23 flurbiprofen sodium................... 48 gengraf......................................43
femynor..................................... 40 flutamide................................... 15 GENOTROPIN..........................38
fenofibrate........................... 23, 24 fluticasone propionate.........29, 50 GENOTROPIN MINIQUICK......38
fenofibrate micronized...............23 FLUTICASONE- gentak....................................... 48
fenofibric acid............................24 SALMETEROL..........................51 gentamicin in saline.................... 9
FENSOLVI (6 MONTH).............38 fluvoxamine maleate................. 12 gentamicin sulfate................. 9, 48
59
GENVOYA................................ 20 heparin lock flush...................... 47 hydrocortisone butyrate............ 29
GILENYA.................................. 26 heparin sodium (porcine).......... 10 hydrocortisone valerate.............29
GILOTRIF................................. 15 heparin sodium (porcine) pf...... 10 hydrocortisone-acetic acid........ 49
GLASSIA...................................51 heparin sodium lock flush......... 47 hydromet................................... 50
glatiramer acetate..................... 26 HEPLISAV-B.............................44 hydromorphone hcl..................... 5
glatopa...................................... 26 HERCEPTIN............................. 16 HYDROMORPHONE HCL..........5
GLEOSTINE............................. 15 HETLIOZ...................................52 hydromorphone hcl er................. 5
GLIADEL WAFER.....................15 HIBERIX....................................44 hydromorphone hcl pf................. 5
glimepiride.................................30 HIZENTRA................................ 43 hydroxocobalamin acetate........ 33
glipizide er.................................30 homatropaire.............................49 hydroxychloroquine sulfate....... 18
glipizide ir.................................. 30 HUMALOG................................31 hydroxyprogesterone caproate. 40
glipizide xl................................. 30 HUMALOG KWIKPEN.............. 31 hydroxyurea.............................. 16
glipizide-metformin hcl.............. 30 HUMALOG MIX 50/50 hydroxyzine hcl......................... 21
GLUCAGON EMERGENCY KWIKPEN................................. 31 hydroxyzine pamoate................21
KIT............................................ 31 HUMALOG MIX 50/50 VIAL......31 hyoscyamine sulfate................. 35
glyburide................................... 30 HUMALOG MIX 75/25 hyoscyamine sulfate sl..............35
glyburide micronized................. 30 KWIKPEN................................. 31 hyosyne.....................................35
glyburide-metformin.................. 30 HUMALOG MIX 75/25 VIAL......31 HYPERRHO S/D.......................43
glycopyrrolate............................35 HUMALOG U-100 JUNIOR HYQVIA.................................... 43
glydo........................................... 6 KWIKPEN................................. 31 ibandronate sodium.................. 45
goodsense all day allergy-d...... 50 HUMAN ALBUMIN GRIFOLS... 47 IBRANCE.................................. 16
goodsense aspirin adults............ 4 HUMATE-P............................... 22 ibuprofen..................................... 4
goodsense aspirin low dose........4 HUMATROPE........................... 38 ibuprofen lysine...........................4
granisetron hcl.......................... 12 HUMIRA....................................43 ibutilide fumarate.......................24
griseofulvin microsize................13 HUMIRA PEDIATRIC iclevia........................................ 40
griseofulvin ultramicrosize.........13 CROHNS START......................43 ICLUSIG....................................16
guanfacine hcl...........................24 HUMIRA PEN........................... 43 ID NOW COVID-19................... 47
guanfacine hcl er.......................26 HUMIRA PEN-CD/UC/HS idarubicin hcl............................. 16
GUARDIAN CONNECT STARTER................................. 43 IDELVION................................. 22
TRANSMITTER........................ 31 HUMIRA PEN-PEDIATRIC UC IDHIFA...................................... 16
GUARDIAN LINK 3 START...................................... 43 ifosfamide..................................16
TRANSMITTER........................ 31 HUMIRA PEN-PS/UV/ADOL ILARIS.......................................43
GUARDIAN SENSOR (3)......... 31 HS START................................ 43 imatinib mesylate...................... 16
GUARDIAN SENSOR 3............31 HUMIRA PEN-PSOR/UVEIT IMBRUVICA.............................. 16
HAEGARDA..............................43 STARTER................................. 43 IMFINZI..................................... 16
hailey 1.5/30..............................40 HUMULIN 70/30 KWIKPEN...... 31 imipenem-cilastatin..................... 9
hailey 24 fe................................40 HUMULIN 70/30 VIAL...............32 imipramine hcl...........................12
hailey fe 1.5/30..........................40 HUMULIN N KWIKPEN............ 32 imipramine pamoate................. 12
hailey fe 1/20.............................40 HUMULIN N VIAL..................... 32 imiquimod..................................29
HALAVEN................................. 15 HUMULIN R U-500 KWIKPEN..32 IMOVAX RABIES......................44
halobetasol propionate..............29 HUMULIN R U-500 VIAL.......... 32 IMPAVIDO................................ 18
haloperidol................................ 19 HUMULIN R VIAL..................... 32 IMURAN....................................43
haloperidol decanoate...............19 HYCAMTIN............................... 16 INBRIJA.................................... 18
haloperidol lactate.....................19 hydralazine hcl.......................... 24 incassia..................................... 40
HARVONI..................................20 hydrochlorothiazide...................24 INCRELEX................................ 38
HAVRIX.....................................44 hydrocodone bitartrate er............5 INCRUSE ELLIPTA.................. 51
heather......................................40 hydrocodone polst-chlorphen indapamide............................... 24
hematinic/folic acid....................33 polst er susp..............................50 indomethacin...............................4
HEMLIBRA................................22 hydrocodone-acetaminophen..... 5 indomethacin er.......................... 4
hemocyte-f................................ 33 hydrocodone-homatropine........ 50 indomethacin sodium.................. 4
HEMOFIL M.............................. 22 hydrocodone-ibuprofen............... 5 INFANRIX................................. 44
HEPARIN (PORCINE) IN hydrocortisone.............. 29, 37, 45 INFLECTRA.............................. 43
NACL........................................ 10 hydrocortisone (perianal).......... 45 INLYTA..................................... 16
60
INPEN 100-BLUE-LILLY...........31 JYNARQUE.............................. 33 LANOXIN.................................. 24
INPEN 100-BLUE-NOVO..........31 KADCYLA................................. 16 lansoprazole..............................35
INPEN 100-GRAY-LILLY.......... 31 KALBITOR................................ 43 lanthanum carbonate................ 36
INPEN 100-GREY-NOVO.........31 kalliga........................................40 LANTUS SOLOSTAR............... 32
INPEN 100-PINK-LILLY............31 KALYDECO.............................. 51 LANTUS U-100 VIAL................ 32
INPEN 100-PINK-NOVO...........31 KANUMA...................................36 lapatinib ditosylate.................... 16
INSULIN PEN NEEDLES..........32 kariva........................................ 40 L-ARGININE............................. 33
INSULIN SYRINGES................ 32 KAZANO................................... 30 larin 1.5/30................................ 40
INTRON A.................................20 kcl in dextrose-nacl................... 33 larin 1/20................................... 40
introvale.................................... 40 KEDBUMIN............................... 47 larin 24 fe.................................. 40
INVEGA SUSTENNA................19 kelnor 1/35................................ 40 larin fe 1.5/30............................ 40
INVEGA TRINZA...................... 19 kelnor 1/50................................ 40 larin fe 1/20............................... 40
INVIRASE................................. 20 KENALOG.................................37 larissia.......................................40
IPOL..........................................44 KEPIVANCE............................. 27 latanoprost................................ 48
ipratropium bromide............ 50, 51 ketoconazole.............................13 LATUDA....................................19
ipratropium-albuterol................. 51 ketoprofen................................... 4 L-CYSTINE............................... 33
irbesartan.................................. 24 ketorolac tromethamine........ 4, 48 leena......................................... 40
irbesartan-hydrochlorothiazide..24 KEVEYIS...................................48 leflunomide................................43
IRESSA.....................................16 KEYTRUDA.............................. 16 LEMTRADA.............................. 26
irinotecan hcl.............................16 KINERET.................................. 43 LENVIMA.................................. 16
ISENTRESS..............................20 KINRIX...................................... 44 lessina.......................................40
ISENTRESS HD....................... 20 KISQALI.................................... 16 letrozole.................................... 16
isibloom.....................................40 KISQALI FEMARA.................... 16 leucovorin calcium.................... 16
isoniazid.................................... 14 klor-con..................................... 33 LEUKERAN...............................16
isosorbide dinitrate....................24 klor-con 10................................ 33 LEUKINE...................................22
isosorbide mononitrate..............24 klor-con m10............................. 33 leuprolide acetate......................38
isosorbide mononitrate er......... 24 klor-con m15............................. 33 levetiracetam.............................11
isotretinoin.................................29 klor-con m20............................. 33 levetiracetam er........................ 11
isradipine...................................24 klor-con/ef................................. 33 levobunolol hcl.......................... 48
itraconazole...............................13 KOATE......................................22 levocarnitine..............................33
ivermectin..................................18 KOATE-DVI...............................22 levocarnitine sf.......................... 33
IXEMPRA KIT........................... 16 KOGENATE FS........................ 22 levocetirizine dihydrochloride....50
IXIARO......................................44 KORLYM...................................39 levofloxacin........................... 9, 48
IXINITY..................................... 22 KOSELUGO..............................16 levofloxacin in d5w......................9
jaimiess..................................... 40 KOVALTRY...............................22 levonest.....................................40
JAKAFI......................................16 k-prime...................................... 33 levonorgest-eth est & eth est.... 40
JANSSEN COVID-19 KRINTAFEL.............................. 18 levonorgest-eth estrad 91-day.. 40
VACCINE.................................. 44 kurvelo...................................... 40 levonorgestrel-ethinyl estrad.....40
jantoven.................................... 10 KYNMOBI................................. 18 levonorg-eth estrad triphasic.....40
JARDIANCE..............................30 KYNMOBI TITRATION KIT.......18 levora 0.15/30 (28)....................40
jasmiel.......................................40 KYPROLIS................................ 16 levo-t......................................... 42
jencycla..................................... 40 labetalol hcl............................... 24 levothyroxine sodium................ 42
JEVTANA..................................16 lactated ringers......................... 33 levoxyl....................................... 42
jinteli..........................................40 lactulose....................................35 LEXIVA..................................... 20
jolessa.......................................40 lactulose encephalopathy......... 35 L-GLUTAMIC ACID...................33
juleber....................................... 40 L-ALANINE............................... 33 L-GLUTAMIC ACID HCL.......... 36
JULUCA.................................... 20 lamivudine.................................20 L-HISTIDINE............................. 33
junel 1.5/30............................... 40 lamivudine-zidovudine.............. 20 L-HISTIDINE
junel 1/20.................................. 40 lamotrigine................................ 11 MONOHYDROCHLORIDE....... 33
junel fe 1.5/30........................... 40 lamotrigine er............................ 10 LIALDA......................................45
junel fe 1/20.............................. 40 lamotrigine starter kit-blue.........11 lidocaine......................................6
junel fe 24................................. 40 lamotrigine starter kit-green...... 11 lidocaine hcl................................ 6
JUXTAPID.................................24 lamotrigine starter kit-orange.... 11 LIDOCAINE HCL........................ 6
61
lidocaine hcl (cardiac)................. 6 LUPRON DEPOT-PED (1- metformin hcl ir......................... 30
lidocaine hcl (cardiac) pf............. 6 MONTH)....................................39 methadone hcl............................ 5
lidocaine hcl (pf)..........................6 LUPRON DEPOT-PED (3- methadone hcl intensol............... 5
lidocaine hcl urethral/mucosal.....6 MONTH)....................................39 methadose.................................. 5
lidocaine viscous hcl................. 27 lutera......................................... 41 methadose sugar-free.................5
lidocaine-epinephrine..................6 L-VALINE.................................. 33 methazolamide..........................48
lidocaine-prilocaine..................... 6 lyleq...........................................41 methenamine hippurate.............. 9
lillow.......................................... 40 lyllana........................................41 methergine................................ 47
lincomycin hcl..............................9 LYNPARZA............................... 16 methimazole..............................42
lindane...................................... 18 LYRA DIRECT SARS-COV-2 methocarbamol......................... 52
linezolid....................................... 9 ASSAY...................................... 47 methotrexate............................. 43
linezolid in sodium chloride......... 9 LYRA SARS-COV-2 ASSAY.....47 methotrexate sodium................ 43
LINZESS................................... 35 LYSODREN.............................. 16 methotrexate sodium (pf).......... 43
liothyronine sodium................... 42 lyza............................................41 methoxsalen rapid.....................29
lisinopril..................................... 24 mafenide acetate........................ 9 methscopolamine bromide........36
lisinopril-hydrochlorothiazide.....24 MAGNESIUM CARBONATE.... 33 methyldopa............................... 24
lithium carbonate.......................21 MAGNESIUM CARBONATE methylergonovine maleate........47
lithium carbonate er.................. 21 HEAVY......................................33 methylphenidate hcl.................. 26
L-LEUCINE............................... 33 magnesium chloride..................33 methylphenidate hcl er..............26
lojaimiess.................................. 40 malathion.................................. 18 methylphenidate hcl er (cd).......26
LONHALA MAGNAIR REFILL mannitol.................................... 24 methylphenidate hcl er (la)........26
KIT............................................ 51 marlissa.....................................41 methylprednisolone...................38
LONHALA MAGNAIR MARQIBO................................. 16 METHYLPREDNISOLONE
STARTER KIT...........................51 MATULANE.............................. 16 ACETATE................................. 37
LONSURF.................................16 matzim la...................................24 methylprednisolone acetate...... 37
loperamide hcl...........................36 MAVYRET.................................20 methylprednisolone sodium
lopinavir-ritonavir.......................20 meclizine hcl............................. 12 succ...........................................38
lorazepam................................. 21 medroxyprogesterone acetate.. 41 METHYLTESTOSTERONE...... 38
lorazepam intensol....................21 mefloquine hcl...........................18 metoclopramide hcl...................12
LORBRENA.............................. 16 megestrol acetate..................... 41 metolazone............................... 24
loryna........................................ 40 MEKINIST................................. 16 metoprolol succinate er.............24
losartan potassium....................24 MEKTOVI..................................16 metoprolol tartrate.....................24
losartan potassium-hctz............ 24 meloxicam...................................4 metoprolol-hydrochlorothiazide.24
lovastatin...................................24 melphalan................................. 16 metronidazole....................... 9, 29
low-ogestrel...............................40 melphalan hcl............................16 metronidazole in nacl.................. 9
loxapine succinate.................... 19 memantine hcl...........................11 mexiletine hcl............................ 24
lo-zumandimine.........................40 memantine hcl er...................... 11 mibelas 24 fe.............................41
L-PHENYLALANINE................. 33 MENACTRA..............................44 miconazole 3.............................13
L-PROLINE............................... 33 MENOPUR................................39 MICRHOGAM ULTRA-
L-TRYPTOPHAN...................... 33 MENQUADFI............................ 44 FILTERED PLUS...................... 43
L-TYROSINE............................ 33 MENVEO.................................. 44 MICROCHAMBER.................... 47
LUCENTIS................................ 49 meperidine hcl.............................5 microgestin 1.5/30.....................41
LUCIRA COVID-19 ALL-IN- meprobamate............................21 microgestin 1/20........................41
ONE.......................................... 47 MEPSEVII................................. 36 microgestin 24 fe.......................41
LUMIGAN..................................48 mercaptopurine......................... 16 microgestin fe 1.5/30.................41
LUMIZYME............................... 36 meropenem.................................9 microgestin fe 1/20....................41
LUPANETA PACK.................... 38 MEROPENEM-SODIUM midodrine hcl.............................24
LUPRON DEPOT (1-MONTH).. 38 CHLORIDE................................. 9 miglitol.......................................30
LUPRON DEPOT (3-MONTH).. 38 mesalamine...............................45 miglustat....................................36
LUPRON DEPOT (4-MONTH) mesalamine-cleanser................45 mili.............................................41
INTRAMUSCULAR KIT 30MG..38 mesna....................................... 16 milrinone lactate........................24
LUPRON DEPOT (6-MONTH) MESNEX...................................16 milrinone lactate in dextrose..... 24
INTRAMUSCULAR KIT 45MG..38 metformin hcl er........................ 30 mimvey......................................41
62
mineral oil heavy....................... 36 naftifine hcl................................13 nitrofurantoin monohydrate
MINOCIN.................................... 9 NAGLAZYME............................36 macrocrystals..............................9
minocycline hcl............................9 nalbuphine hcl.............................5 nitroglycerin...............................24
minoxidil.................................... 24 naloxone hcl................................7 NITYR....................................... 36
mirtazapine............................... 12 naltrexone hcl..............................7 nizatidine...................................35
misoprostol................................35 naproxen..................................... 4 NOCDURNA............................. 39
mitomycin..................................16 naproxen sodium........................ 4 nora-be......................................41
mitoxantrone hcl........................16 naratriptan hcl........................... 14 norethin ace-eth estrad-fe.........41
M-M-R II.................................... 44 NARCAN.....................................7 norethindrone............................41
M-NATAL PLUS........................33 NATACYN.................................48 norethindrone acetate............... 41
modafinil....................................52 nateglinide.................................30 norethindrone acet-ethinyl est...41
MODERNA COVID-19 NATPARA................................. 46 norethindrone-eth estradiol....... 41
VACCINE.................................. 44 NATURE-THROID.................... 42 norethin-eth estradiol-fe............ 41
moexipril hcl.............................. 24 NAVELBINE..............................16 norgestimate-eth estradiol........ 41
mometasone furoate........... 29, 50 necon 0.5/35 (28)......................41 norgestimate-ethinyl estradiol
mondoxyne nl..............................9 nefazodone hcl..........................12 triphasic.....................................41
monoject flush syringe.............. 33 neomycin sulfate......................... 9 norlyda...................................... 41
monoject sodium chloride flush.33 neomycin-bacitracin zn- norlyroc..................................... 41
mono-linyah.............................. 41 polymyx.....................................49 normal saline flush.................... 34
montelukast sodium.................. 51 neomycin-polymyxin b gu........... 9 NORTHERA..............................24
morgidox..................................... 9 neomycin-polymyxin-dexameth 49 nortrel 0.5/35 (28)..................... 41
morphine sulfate......................... 5 neomycin-polymyxin- nortrel 1/35 (21)........................ 41
MORPHINE SULFATE............... 5 gramicidin..................................49 nortrel 1/35 (28)........................ 41
morphine sulfate (concentrate)... 5 neomycin-polymyxin-hc............ 49 nortrel 7/7/7...............................41
morphine sulfate (pf)................... 5 NEONATAL PLUS.................... 33 nortriptyline hcl..........................12
morphine sulfate er..................... 5 neo-polycin................................49 NORVIR.................................... 20
morphine sulfate er beads.......... 5 neo-polycin hc...........................49 NOVAREL.................................39
MOXIFLOXACIN HCL.................9 NEORAL................................... 43 NOVOEIGHT............................ 22
moxifloxacin hcl.....................9, 48 NERLYNX................................. 16 NOVOFINE AUTOCOVER
moxifloxacin hcl (2x day)...........48 NESINA.....................................30 PEN NEEDLE........................... 32
moxifloxacin hcl in nacl............... 9 NESTABS................................. 34 NOVOFINE PEN NEEDLE....... 32
MOZOBIL..................................22 neuac........................................ 29 NOVOFINE PLUS PEN
multivitamin/fluoride.................. 33 NEULASTA............................... 22 NEEDLE....................................32
multi-vitamin/fluoride................. 33 NEULASTA ONPRO.................22 NOVOPEN ECHO.....................31
mupirocin.................................... 9 nevirapine................................. 20 NOVOSEVEN RT..................... 22
mutamycin.................................16 nevirapine er............................. 20 NOVOTWIST PEN NEEDLE.... 32
MYALEPT................................. 36 NEXAVAR.................................16 np thyroid.................................. 42
mycophenolate mofetil.............. 43 niacin er (antihyperlipidemic).... 24 NPLATE.................................... 22
mycophenolate mofetil hcl........ 43 nicardipine hcl........................... 24 NUCALA................................... 50
mycophenolate sodium............. 43 NICARDIPINE HCL IN NACL... 24 nufol.......................................... 34
MYFORTIC............................... 43 nifedipine...................................24 NULEV...................................... 36
MYLAB BOX COVID-19 nifedipine er.............................. 24 NULIBRY.................................. 36
TESTING.................................. 47 nifedipine er osmotic release.... 24 NULOJIX...................................43
MYLERAN.................................16 nikki...........................................41 NUWIQ......................................22
MYOBLOC................................ 47 nilutamide..................................16 nyamyc......................................13
myorisan................................... 29 nimodipine.................................24 nylia 7/7/7..................................41
na ferric gluc cplx in sucrose.....33 NINLARO.................................. 16 nymyo....................................... 41
nabumetone................................ 4 NIPENT.....................................16 nystatin......................................13
nafcillin sodium........................... 9 nisoldipine er.............................24 nystatin-triamcinolone............... 13
NAFCILLIN SODIUM IN nitazoxanide..............................18 nystop....................................... 13
DEXTROSE................................ 9 nitisinone...................................36 OBIZUR.................................... 22
nafrinse..................................... 33 NITRO-DUR..............................24 OCALIVA.................................. 36
nafrinse drops........................... 33 nitrofurantoin macrocrystal..........9 ocella.........................................41
63
OCREVUS................................ 26 oxycodone-acetaminophen.........6 phenytoin.................................. 11
OCTAGAM................................43 oxymorphone hcl.........................6 phenytoin infatabs.....................11
octreotide acetate..................... 39 oxymorphone hcl er.................... 6 phenytoin sodium......................11
ODEFSEY.................................20 oxytocin.....................................39 phenytoin sodium extended...... 11
ODOMZO..................................16 OZEMPIC..................................30 philith.........................................41
OFEV........................................ 51 paclitaxel................................... 17 PHOSPHA 250 NEUTRAL........34
ofloxacin..........................9, 48, 49 PADCEV................................... 17 phosphorous............................. 34
olanzapine.................................19 paliperidone er.......................... 19 phospho-trin 250 neutral........... 34
olanzapine-fluoxetine hcl.......... 12 palonosetron hcl........................13 PIFELTRO................................ 20
olmesartan medoxomil..............25 PALYNZIQ................................ 36 pilocarpine hcl..................... 27, 48
olmesartan medoxomil-hctz...... 25 pamidronate disodium...............45 pimecrolimus.............................29
olmesartan-amlodipine-hctz......25 PANHEMATIN.......................... 22 pimozide....................................19
olopatadine hcl....................48, 50 PANRETIN................................17 pimtrea...................................... 41
omega-3-acid ethyl esters.........25 pantoprazole sodium.................35 pindolol......................................25
omeprazole............................... 35 paraplatin.................................. 17 pioglitazone hcl......................... 30
ondansetron hcl........................ 12 paricalcitol................................. 46 pioglitazone hcl-glimepiride.......30
ondansetron odt........................ 12 paromomycin sulfate...................9 pioglitazone hcl-metformin hcl.. 30
ONE VITE WOMENS PLUS..... 34 paroxetine hcl............................12 piperacillin sod-tazobactam so....9
ONIVYDE..................................17 paroxetine hcl er....................... 12 PIQRAY.................................... 17
OPDIVO.................................... 17 paroxetine mesylate..................12 pirmella 1/35............................. 41
OPSUMIT..................................52 PASER......................................14 pirmella 7/7/7............................ 41
OPTICHAMBER DIAMOND......47 PEDIARIX................................. 44 piroxicam.....................................4
OPTICHAMBER DIAMOND- PEDVAX HIB............................ 44 PIXEL COVID-19 PCR HOME
LG MASK.................................. 47 peg 3350-kcl-na bicarb-nacl......36 TEST.........................................47
OPTICHAMBER DIAMOND- peg-3350/electrolytes................36 PLASBUMIN-25........................ 47
MD MASK................................. 47 PEGASYS.................................20 PLASBUMIN-5.......................... 47
OPTICHAMBER DIAMOND- penicillamine............................. 37 PNEUMOVAX 23...................... 45
SM MASK................................. 47 penicillin g potassium..................9 POCKET SPACER................... 47
oralone...................................... 27 penicillin v potassium.................. 9 podofilox....................................29
ORENCIA..................................43 PENTACEL............................... 45 POLIVY..................................... 17
ORENCIA CLICKJECT............. 43 pentamidine isethionate............ 18 polocaine-mpf............................. 6
ORENITRAM............................ 52 pentazocine-naloxone hcl........... 6 polycin.......................................49
ORFADIN..................................36 pentoxifylline er......................... 25 polymyxin b-trimethoprim..........49
ORKAMBI................................. 51 perindopril erbumine................. 25 POMALYST.............................. 17
orphenadrine citrate.................. 52 periogard...................................27 portia-28....................................41
orphenadrine citrate er..............52 PERJETA..................................17 PORTRAZZA............................ 17
orsythia..................................... 41 permethrin.................................18 potassium acetate.....................34
oseltamivir phosphate............... 20 perphenazine............................ 13 potassium chloride.................... 34
OSENI.......................................30 PFIZER-BIONTECH COVID- potassium chloride crys er........ 34
OSMITROL............................... 25 19 VACC................................... 45 potassium chloride er................34
OTEZLA.................................... 43 phenazo.................................... 37 potassium citrate er...................34
OVIDREL.................................. 39 phenazopyridine hcl.................. 37 POTELIGEO............................. 17
oxacillin sodium...........................9 phendimetrazine tartrate........... 26 PRADAXA.................................10
oxaliplatin.................................. 17 phendimetrazine tartrate er.......27 pramipexole dihydrochloride..... 18
oxandrolone.............................. 38 phenelzine sulfate..................... 12 pramipexole dihydrochloride er.18
oxaprozin.................................... 4 phenobarbital............................ 11 prasugrel hcl............................. 19
oxazepam................................. 21 phenoxybenzamine hcl............. 25 pravastatin sodium....................25
oxcarbazepine...........................11 phentermine hcl........................ 27 praziquantel.............................. 18
OXERVATE.............................. 49 phenylephrine hcl................25, 49 prazosin hcl...............................25
oxybutynin chloride................... 36 PHENYLEPHRINE HCL........... 25 prednicarbate............................ 29
oxybutynin chloride er............... 36 PHENYLEPHRINE HCL prednisolone............................. 38
oxycodone hcl......................... 5, 6 (PRESSORS)............................25 prednisolone acetate.................48
OXYCODONE HCL ER.............. 5 PHENYLEPHRINE HCL-NACL.25
64
prednisolone sodium proctozone-hc........................... 45 RAPAMUNE..............................44
phosphate........................... 38, 48 PROFILNINE............................ 22 rasagiline mesylate................... 18
prednisone................................ 38 progesterone.............................41 RAVICTI....................................36
prednisone intensol...................38 PROGRAF................................ 43 RAYALDEE...............................45
pregabalin................................. 27 PROLASTIN-C..........................51 REBIF....................................... 26
PREGNYL.................................39 PROLEUKIN............................. 17 REBIF REBIDOSE....................26
PREMARIN............................... 41 PROLIA.....................................45 REBIF REBIDOSE
PREMPHASE........................... 41 PROMACTA..............................22 TITRATION PACK.................... 26
PREMPRO................................41 promethazine hcl.......................50 REBIF TITRATION PACK.........26
prenatal..................................... 34 promethazine vc........................50 REBINYN.................................. 22
prenatal plus iron...................... 34 promethazine vc/codeine.......... 50 REBLOZYL............................... 22
prenatal vitamin plus low iron....34 promethazine-codeine.............. 50 reclipsen....................................41
preplus...................................... 34 promethazine-dm...................... 50 RECOMBINATE........................22
PRETAB....................................34 promethazine-phenyleph- RECOMBIVAX HB.................... 45
prevalite.................................... 25 codeine..................................... 50 relexxii.......................................26
PREVIDENT............................. 27 promethazine-phenylephrine.... 50 RELNATE DHA.........................34
PREVIDENT 5000 BOOSTER promethegan.............................50 repaglinide................................ 30
PLUS.........................................27 propafenone hcl........................ 25 REPATHA................................. 25
PREVIDENT 5000 DRY propafenone hcl er.................... 25 REPATHA PUSHTRONEX
MOUTH.....................................27 proparacaine hcl....................... 49 SYSTEM................................... 25
PREVIDENT 5000 ENAMEL propranolol hcl.......................... 25 REPATHA SURECLICK........... 25
PROTECT.................................27 propranolol hcl er...................... 25 RETACRIT................................ 22
PREVIDENT 5000 ORTHO propylthiouracil..........................42 RETEVMO................................ 17
DEFENSE................................. 27 PROQUAD................................45 RETROVIR............................... 21
PREVIDENT 5000 PLUS.......... 27 protriptyline hcl..........................12 REVCOVI..................................36
PREVIDENT 5000 SENSITIVE.27 pseudoephedrine-bromphen- REVLIMID................................. 17
previfem.................................... 41 dm............................................. 50 REXULTI...................................19
PREVNAR 13............................45 PULMOZYME........................... 52 REYATAZ................................. 21
PREVNAR 20............................45 PURIXAN.................................. 17 RHOGAM ULTRA-FILTERED
PREVYMIS............................... 20 pyrazinamide.............................14 PLUS.........................................44
PREZCOBIX............................. 20 pyridostigmine bromide.............14 RIASTAP...................................22
PREZISTA................................ 21 pyridostigmine bromide er.........14 ribavirin..................................... 21
PRIFTIN.................................... 14 pyrimethamine.......................... 18 rifabutin..................................... 14
primaquine phosphate.............. 18 QINLOCK..................................17 rifampin..................................... 14
primidone.................................. 11 QUADRACEL............................45 riluzole.......................................27
PRIVIGEN.................................43 quetiapine fumarate.................. 19 rimantadine hcl..........................21
PRO COMFORT SPACER quetiapine fumarate er.............. 19 RINVOQ....................................44
ADULT...................................... 47 QUICKVUE AT-HOME risedronate sodium................... 45
PRO COMFORT SPACER COVID-19 TEST....................... 47 RISPERDAL CONSTA..............19
CHILD....................................... 47 QUICKVUE SARS ANTIGEN risperidone................................ 19
PRO COMFORT SPACER TEST.........................................47 ritonavir..................................... 21
INFANT..................................... 47 quinapril hcl...............................25 RITUXAN.................................. 17
probenecid................................ 13 quinapril-hydrochlorothiazide.... 25 RITUXAN HYCELA...................17
procainamide hcl.......................25 quinidine gluconate er...............25 rivastigmine...............................11
PROCARE SPACER/ADULT quinidine sulfate........................ 25 rivastigmine tartrate.................. 11
MASK........................................47 quinine sulfate...........................18 rivelsa........................................41
PROCARE SPACER/CHILD QVAR REDIHALER.................. 51 RIXUBIS....................................22
MASK........................................47 RABAVERT...............................45 rizatriptan benzoate.................. 14
prochlorperazine....................... 13 rabeprazole sodium.................. 35 ropinirole hcl..............................18
prochlorperazine edisylate........ 13 RADICAVA................................27 ropinirole hcl er......................... 18
prochlorperazine maleate......... 13 raloxifene hcl.............................38 ropivacaine hcl............................ 6
procto-med hc........................... 45 ramipril...................................... 25 rosadan..................................... 29
procto-pak................................. 45 ranolazine er............................. 25 rosuvastatin calcium................. 25
65
ROTARIX.................................. 45 sodium fluoride 5000 plus......... 27 sulindac.......................................4
ROTATEQ.................................45 sodium fluoride 5000 ppm.........27 sumatriptan............................... 14
roweepra................................... 11 sodium fluoride 5000 sensitive..27 sumatriptan succinate............... 14
RUBRACA................................ 17 sodium phenylbutyrate..............36 sumatriptan succinate refill....... 14
RUCONEST..............................44 sodium polystyrene sulfonate... 34 sunitinib malate......................... 17
rufinamide................................. 11 sodium thiosulfate..................... 47 SUPPRELIN LA........................ 39
RUXIENCE............................... 17 SOFIA SARS ANTIGEN FIA.....47 SUPREP BOWEL PREP KIT....36
RYBELSUS...............................30 SOFIA2 SARS ANTIGEN FIA...47 SUTENT....................................17
RYDAPT................................... 17 solifenacin succinate.................37 syeda........................................ 41
ryvent........................................ 50 SOLIQUA.................................. 30 SYLVANT..................................17
SACCHARIN.............................47 SOLIRIS....................................22 SYMBICORT.............................51
SANDIMMUNE......................... 44 SOLU-CORTEF........................ 38 SYMDEKO................................ 52
sapropterin dihydrochloride.......36 SOMATULINE DEPOT............. 39 SYMLINPEN 120...................... 30
SCENESSE.............................. 29 SOMAVERT..............................39 SYMLINPEN 60........................ 30
scopolamine..............................13 sorine........................................ 25 SYMPAZAN.............................. 11
selegiline hcl............................. 18 SOTALOL HCL......................... 25 SYMPROIC...............................36
selenium sulfide........................ 29 sotalol hcl.................................. 25 SYMTUZA.................................21
SELZENTRY.............................21 sotalol hcl (af)............................25 SYNAGIS.................................. 44
SENSORCAINE..........................6 SOTYLIZE.................................25 SYNJARDY...............................30
SENSORCAINE-MPF................. 6 spinosad....................................18 SYNJARDY XR.........................30
SENSORCAINE- SPIRIVA HANDIHALER............51 SYNRIBO..................................17
MPF/EPINEPHRINE................... 6 SPIRIVA RESPIMAT................ 51 TABLOID...................................17
SEREVENT DISKUS................ 51 spironolactone...........................25 tacrolimus............................30, 44
sertraline hcl..............................12 spironolactone-hctz...................25 tadalafil......................................37
setlakin......................................41 sprintec 28................................ 41 tadalafil (pah)............................ 52
sevelamer carbonate................ 37 SPRYCEL................................. 17 TAFINLAR.................................17
sevelamer hcl............................37 sps............................................ 34 TAGRISSO............................... 17
sf............................................... 27 sronyx....................................... 41 TALTZ....................................... 44
sf 5000 plus...............................27 ssd.............................................. 9 TALZENNA............................... 17
SFROWASA............................. 45 STAMARIL................................ 45 tamoxifen citrate........................17
sharobel.................................... 41 stavudine...................................21 tamsulosin hcl........................... 37
SHINGRIX.................................45 STELARA..................................44 TARGRETIN............................. 17
SIGNIFOR.................................39 sterile water for irrigation...........34 tarina 24 fe................................ 42
sildenafil citrate................... 37, 52 STIOLTO RESPIMAT............... 51 tarina fe 1/20............................. 42
silodosin.................................... 37 STIVARGA................................17 tarina fe 1/20 eq........................ 42
silver sulfadiazine........................9 STRENSIQ................................36 TASIGNA.................................. 17
simliya....................................... 41 streptomycin sulfate.................... 9 TAURINE.................................. 34
simpesse...................................41 STRIBILD..................................21 TAVALISSE.............................. 22
SIMPONI...................................44 STRIVERDI RESPIMAT........... 51 tazarotene................................. 30
simvastatin................................ 25 SUBLOCADE..............................7 tazicef....................................9, 10
sirolimus....................................44 subvenite...................................11 TAZICEF................................... 10
SIRTURO..................................14 subvenite starter kit-blue...........11 taztia xt......................................25
SKYRIZI.................................... 44 subvenite starter kit-green........ 11 TDVAX...................................... 45
SKYRIZI (150 MG DOSE).........44 subvenite starter kit-orange...... 11 TECENTRIQ............................. 17
SKYRIZI PEN............................44 SUCRAID..................................36 TEGSEDI.................................. 27
sod benz-sod phenylacet.......... 36 sucralfate.................................. 35 telmisartan................................ 25
SODIUM ASCORBATE............ 34 sulfacetamide sodium............... 48 telmisartan-hctz.........................25
sodium bicarbonate...................34 sulfacetamide sodium (acne).... 30 temazepam............................... 52
sodium chloride...................34, 50 sulfacetamide-prednisolone...... 49 TEMIXYS.................................. 21
sodium chloride (pf).................. 34 sulfadiazine................................. 9 TEMODAR................................ 17
sodium chloride flush................ 34 sulfamethoxazole-trimethoprim...9 temozolomide............................17
sodium fluoride....................27, 34 sulfasalazine............................. 45 temsirolimus..............................44
sodium fluoride 5000 enamel....27 sulfatrim pediatric........................9 teniposide..................................17
66
TENIVAC.................................. 45 TOUJEO SOLOSTAR...............32 trivora (28).................................42
tenofovir disoproxil fumarate.....21 tovet.......................................... 30 tri-vylibra................................... 42
terazosin hcl..............................37 TRACLEER...............................52 tri-vylibra lo................................42
terbinafine hcl............................13 tramadol hcl er............................ 6 TROGARZO..............................21
terbutaline sulfate......................51 tramadol hcl er (biphasic)............6 trospium chloride.......................37
terconazole............................... 13 tramadol hcl ir............................. 6 trospium chloride er.................. 37
TERIPARATIDE tramadol-acetaminophen............ 6 TRULICITY............................... 30
(RECOMBINANT)..................... 45 trandolapril................................ 25 TRUMENBA..............................45
testosterone.............................. 38 trandolapril-verapamil hcl er......25 TRYPTOPHAN......................... 34
testosterone cypionate..............38 tranexamic acid.........................22 TUKYSA....................................17
testosterone enanthate............. 38 tranylcypromine sulfate............. 12 tulana........................................ 42
TETANUS-DIPHTHERIA travoprost (bak free)..................48 TURALIO.................................. 17
TOXOIDS TD............................ 45 TRAZIMERA............................. 17 TWINRIX...................................45
tetrabenazine............................ 27 trazodone hcl............................ 12 tyblume..................................... 42
tetracaine hcl.............................49 TRECATOR.............................. 14 TYBOST....................................21
tetracycline hcl.......................... 10 TRELEGY ELLIPTA..................51 TYMLOS................................... 45
THALOMID............................... 17 TRELSTAR MIXJECT...............39 TYPHIM VI................................ 45
theophylline...............................51 TREMFYA.................................44 TYSABRI...................................26
theophylline er...........................51 treprostinil................................. 52 TYVASO................................... 52
thioridazine hcl.......................... 19 tretinoin............................... 17, 30 TYVASO REFILL...................... 52
thiotepa..................................... 17 tretinoin microsphere................ 30 TYVASO STARTER..................52
thiothixene.................................19 tretinoin microsphere pump...... 30 UCERIS.................................... 45
THREONINE.............................34 TRETTEN................................. 22 UDAMIN SP.............................. 34
THROMBATE III....................... 10 tri femynor................................. 42 ULTIGUARD SAFEPACK
THYMOGLOBULIN...................44 triamcinolone acetonide 27, 30, 38 SYR/NEEDLE........................... 32
tiadylt er.................................... 25 triamterene-hctz........................ 25 unithroid.................................... 42
tiagabine hcl..............................11 triazolam................................... 21 UNITUXIN................................. 17
TIBSOVO.................................. 17 tri-buffered aspirin....................... 4 UPTRAVI.................................. 52
TICE BCG................................. 44 TRI-CHLOR.............................. 30 ursodiol..................................... 36
TIGLUTIK..................................27 triderm.......................................30 valacyclovir hcl..........................21
tilia fe.........................................42 trientine hcl................................34 VALCHLOR...............................17
timolol maleate....................25, 48 tri-estarylla................................ 42 valganciclovir hcl.......................21
tinidazole...................................10 trifluoperazine hcl......................19 VALINE..................................... 34
tiopronin.................................... 37 trifluridine.................................. 48 valproate sodium.......................11
TIVICAY.................................... 21 trihexyphenidyl hcl.................... 19 valproic acid.............................. 11
tizanidine hcl............................. 52 TRIKAFTA.................................52 valrubicin...................................17
tobramycin.......................... 48, 52 tri-legest fe................................ 42 valsartan................................... 25
tobramycin sulfate.....................10 tri-linyah.................................... 42 valsartan-hydrochlorothiazide... 25
tobramycin-dexamethasone......49 tri-lo-estarylla............................ 42 vancomycin hcl......................... 10
tolbutamide............................... 30 tri-lo-marzia............................... 42 vancomycin hcl in dextrose.......10
tolcapone.................................. 18 tri-lo-mili.................................... 42 vancomycin hcl in nacl.............. 10
tolterodine tartrate.....................37 tri-lo-sprintec............................. 42 vandazole..................................10
tolterodine tartrate er.................37 trimethobenzamide hcl..............13 VANTAS....................................39
TOLVAPTAN.............................34 trimethoprim.............................. 10 VAQTA......................................45
tolvaptan................................... 34 tri-mili........................................ 42 VARIVAX.................................. 45
topiramate................................. 11 trimipramine maleate................ 12 VAXCHORA..............................45
topiramate er.............................11 TRINATE...................................34 VECTIBIX..................................17
toposar...................................... 17 tri-nymyo................................... 42 VELCADE................................. 17
topotecan hcl.............................17 tri-previfem................................ 42 velivet........................................42
toremifene citrate...................... 17 TRIPTODUR............................. 39 VEMLIDY.................................. 21
torsemide.................................. 25 tri-sprintec................................. 42 VENCLEXTA.............................17
TOTECT....................................17 TRIUMEQ................................. 21 VENCLEXTA STARTING
TOUJEO MAX SOLOSTAR...... 32 tri-vite/fluoride........................... 34 PACK........................................ 17
67
venlafaxine hcl.......................... 12 wymzya fe................................. 42 ZITHROMAX.............................10
venlafaxine hcl er...................... 12 XALKORI.................................. 18 ZOLADEX................................. 39
VENTAVIS................................ 52 XARELTO................................. 10 zoledronic acid.......................... 45
verapamil hcl.............................26 XARELTO STARTER PACK.....10 ZOLINZA...................................18
verapamil hcl er.........................26 XATMEP................................... 44 zolmitriptan................................14
VERSACLOZ............................ 19 XELJANZ.................................. 44 zolpidem tartrate....................... 52
VERZENIO................................17 XELJANZ XR............................ 44 zolpidem tartrate er................... 52
vestura...................................... 42 XEOMIN....................................47 zonisamide................................11
VICTOZA.................................. 30 XEPI..........................................10 ZORTRESS.............................. 44
vienva........................................42 XERAC AC................................30 ZOSYN......................................10
vigabatrin.................................. 11 XERMELO................................ 36 zovia 1/35 (28).......................... 42
vigadrone.................................. 11 XGEVA......................................45 zovia 1/35e (28)........................ 42
VIMIZIM.................................... 36 XIAFLEX................................... 47 zumandimine.............................42
VIMPAT.....................................11 XIGDUO XR..............................30 ZYDELIG...................................18
VINATE ONE............................ 34 XOFIGO.................................... 18 ZYPREXA RELPREVV............. 19
vinblastine sulfate..................... 17 XOFLUZA (40 MG DOSE)........ 21 ZYVOX......................................10
vincristine sulfate...................... 17 XOFLUZA (80 MG DOSE)........ 21
vinorelbine tartrate.................... 18 XOLAIR.....................................50
viorele....................................... 42 XOSPATA................................. 18
VIRACEPT................................ 21 XPERT XPRESS SARS-COV-
VIREAD.....................................21 2................................................ 47
virt-gard.....................................34 XTANDI.....................................18
virt-phos 250 neutral................. 34 xulane....................................... 42
VISTOGARD.............................47 XURIDEN..................................36
VISUDYNE................................49 XYLOCAINE............................... 7
vitamin d (ergocalciferol)...........34 XYLOCAINE-MPF.......................7
vitamins acd-fluoride................. 34 XYNTHA................................... 22
VITRAKVI..................................18 XYNTHA SOLOFUSE...............22
VIVITROL....................................7 XYREM..................................... 52
VIZIMPRO.................................18 YERVOY................................... 18
volnea....................................... 42 YF-VAX..................................... 45
VONVENDI............................... 22 YONDELIS................................18
voriconazole..............................13 YONSA..................................... 18
VORTEX VALVED HOLDING YUPELRI...................................51
CHAMBER................................ 47 yuvafem.................................... 42
VOSEVI.....................................21 zafemy...................................... 42
VOTRIENT................................18 zafirlukast..................................51
vp-pnv-dha................................ 34 zaleplon.....................................52
VPRIV....................................... 36 ZALTRAP..................................18
VRAYLAR................................. 19 ZANOSAR.................................18
vyfemla......................................42 zarah......................................... 42
vylibra........................................42 ZARXIO.....................................22
VYXEOS................................... 18 ZEJULA.....................................18
warfarin sodium.........................10 ZELBORAF............................... 18
water for irrigation, sterile..........34 ZEMAIRA.................................. 51
WELCHOL................................ 26 zenatane................................... 30
wera.......................................... 42 ZENPEP....................................36
westab mini............................... 34 ZEPATIER................................ 21
westab one................................34 ZEPZELCA............................... 18
WESTAB PLUS........................ 34 zidovudine.................................21
WESTHROID............................ 42 ziprasidone hcl.......................... 19
WILATE.....................................22 ziprasidone mesylate................ 19
WP THYROID........................... 42 ZIRABEV...................................18
68
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Understanding your formulary

Drug tier Includes Helpful tips

Drug list information

Prior authorization – Your doctor is required to give OptumRx more information to

SP Specialty medication – Medication is designated as specialty.

bupivacaine- polocaine-mpf injection

bupivacaine- ropivacaine hcl

lidocaine external patch SENSORCAINE-MPF

rufinamide 3 PA amitriptyline hcl oral 1

protriptyline hcl 2 ondansetron hcl oral

ifosfamide 3 SP leucovorin calcium oral 2

imatinib mesylate 3 PA; SP LEUKERAN 3

IMBRUVICA 4 PA; SP; QL LONSURF 4 PA; SP

IMFINZI 4 PA; SP LORBRENA 4 PA; SP

INLYTA 4 PA; SP LYNPARZA 4 PA; SP

IRESSA 4 PA; SP LYSODREN 3

irinotecan hcl 2 SP MARQIBO 4 SP

IXEMPRA KIT 4 SP MATULANE 3 SP

JAKAFI ORAL TABLET MEKINIST 4 PA; SP

ganciclovir sodium PREVYMIS ORAL 4 SP

PANHEMATIN 4 SP amiodarone hcl 1

PROFILNINE 4 SP amlodipine besylate

cholestyramine light 2 enalapril-

trospium chloride 1 hydrocortisone oral 1

trospium chloride er 2 KENALOG INJECTION

tarina fe 1/20 eq 1 ARMOUR THYROID 1

tri-mili 1 liothyronine sodium oral 1

tri-nymyo 1 methimazole oral 1

trivora (28) 1 propylthiouracil oral 1

volnea 1 ACTEMRA ACTPEN 4 PA; SP

vyfemla 1 ACTIMMUNE 4 PA; SP

vylibra 1 ARCALYST 4 PA; SP

wera 1 AVSOLA 3 PA; SP

xulane 2 azathioprine oral 1

yuvafem 1 azathioprine sodium 1

zafemy 2 BENLYSTA 4 PA; SP

zarah 1 BERINERT 4 PA; SP; QL

zovia 1/35 (28) 1 BIVIGAM 4 PA; SP

zovia 1/35e (28) 1 CELLCEPT 3 SP

HUMIRA PEDIATRIC mycophenolate sodium 3 SP

tacrolimus oral 2 SP FLUZONE

DAPTACEL 1 PEDVAX HIB 1

TETANUS- alendronate sodium

hydrocortisone rectal 2 TYMLOS 3 PA; SP

LIALDA 2 XGEVA 3 PA; SP

ALBUMIN-ZLB 2 deferoxamine mesylate 2

ALBURX 2 dexmedetomidine hcl in

ID NOW COVID-19 1 QUICKVUE AT-HOME

INCRUSE ELLIPTA 2 QL KALYDECO 4 PA; SP

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