2023 NJ Formulary

FRO 1 '-.
'-WellCare·
of New Jersey
2023 Formulary
Effective January 1, 2023
Ambetter.WellCareNewJersey.com
Formulary Introduction
FORMULARY
The Ambetter from Wellcare of New Jersey Formulary, or Prescription Drug List, is a guide to available brand and
generic drugs that are approved by the Food and Drug Administration (FDA) and covered through your prescription
drug benefit. Generic drugs have the same active ingredients as their brand name counterparts and should be
considered the first line of treatment. The FDA requires generics to be safe and work the same as brand name drugs.
If there is no generic available, there may be more than one brand name drug to treat a condition. Preferred brand
name drugs are listed on Tier 2 to help identify brand drugs that are clinically appropriate, safe, and cost-effective
treatment options, if a generic medication on the formulary is not suitable for your condition.
Please note, the Formulary is not meant to be a complete list of the drugs covered under your prescription benefit.
Not all dosage forms or strengths of a drug may be covered. This list is periodically reviewed and updated and may
be subject to change. Drugs may be added or removed, or additional requirements may be added in order to approve
continued usage of a specific drug.
Specific prescription benefit plan designs may not cover certain products or categories, regardless of their appearance
in this document. Please check your benefits for coverage limitations and your share of cost for your drugs.
Drug List Key:

Brand name drugs are listed in CAPS and generic drugs are lower case.
Drugs are covered under different copay tiers depending on your benefit:
Tier 0 - No copayment for those drugs that are used for prevention and are mandated by the Affordable Care Act. Select
oral contraceptives, vitamin D, folic acid for women of child bearing age, over-the-counter (OTC) aspirin, and
smoking cessation products may be covered under this tier. Certain age limits may apply.
Tier 1 - Lowest copayment for select drugs that offer the greatest value compared to other drugs used to treat similar
conditions. Select over-the-counter (OTC) drugs may be covered under this tier.
Tier 2 - Medium copayment covers brand name drugs that are generally more affordable, or may be preferred
compared to other drugs to treat the same conditions.
Tier 3 - High copayment covers higher cost brand name and non-preferred generic drugs. This tier may also cover
non-specialty drugs that are not on the Prescription Drug List but approval has been granted for coverage
Tier 4 - Highest copayment is for “specialty” drugs used to treat complex, chronic conditions that may require special
handling, storage or clinical management. Prescription drugs covered under the specialty tier may require
fulfillment at a pharmacy that participates in Ambetter’s “specialty” or “hemophilia” networks. For additional
information on which pharmacies are within our “specialty” or “hemophilia” networks, please consult
Ambetter website’s pharmacy information section.
Prior Authorization for Non-Formulary Drugs
To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form.
Pharmacy Services will respond via fax or phone within 24 hours of receipt of all necessary information for urgent
requests, and within 72 hours for non-urgent requests, unless state law requires faster response. If the request is
disapproved, the notice of disapproval will contain a clear explanation of the specific reasons for disapproving the
prior authorization request, or if the request was incomplete, the explanation will identify the missing material
information that is necessary to complete the request.
Formulary Abbreviations:
Abbreviation Term What it means
AL Age Limit Some drugs are only covered for certain ages.
QL Quantity Limit Some drugs are only covered for a certain amount.
Your doctor must ask for approval from Ambetter before some
PA Prior Authorization
drugs will be covered.
This product is not covered unless you or your provider request

NF Non-formulary an exception. Alternative medications are listed next to non-
covered product
These drugs are made in both prescription form and Over-

RX/OTC Prescription and OTC
the-counter (OTC) form.
These products are Specialty Drugs that may have special

SP Specialty Drug
fill requirements.
Initially, certain medications may only be available in 15-

SF Split Fill day-supply increments until you are stabilized on the
medication. After you have been taking the medication for
90 days, this restriction may no longer apply.
Opioid Medications:
Medications identified on the formulary by "New starts limited to 7 day supply” allow up to two 7 day fills during any 28 day
period and up to a total of 28 day non-consecutive supply in any 90 day period. This limit applies cumulatively to all opioid
medications filled. For fills exceeding these limits, your providers may submit a Prior Authorization request.
Drug Name Drug Requirements/ Drug Name Drug Requirements/
Tier Limits Tier Limits
ADHD/ANTI-NARCOLEPSY/ANTI- methamphetamine hcl 1 QL(5 ea daily);
AL(At least 6
OBESITY/ANOREXIANTS - Drugs to Treat ADHD, yrs old)
Sleep and Eating Disorders VYVANSE CAPS 3 QL(1 ea daily);
(lisdexamfetamine PA
Amphetamines dimesylate)
amphetamine sulfate 3 PA Anorexiants Non-Amphetamine
TABS
phendimetrazine tartrate 1 PA
amphetamine- 1 QL(1 ea daily)
TABS
dextroamphetamine CP24
1.25 MG-1.25 MG-1.25 phentermine hcl CAPS 1 PA
MG-1.25 MG, 2.5 MG-2.5 Anti-Obesity Agents
MG-2.5 MG-2.5 MG
amphetamine- 1 CONTRAVE 3 QL(4 ea daily);
dextroamphetamine CP24 PA
3.75 MG-3.75 MG-3.75 Attention-Deficit/Hyperactivity Disorder (ADHD)
MG-3.75 MG
Agents
dextroamphetamine CP24 atomoxetine hcl 60 MG, 1 QL(1 ea daily);
5 MG-5 MG-5 MG-5 MG, 80 MG, 100 MG AL(At least 6
6.25 MG-6.25 MG-6.25 yrs old)
MG-6.25 MG, 7.5 MG-7.5 atomoxetine hcl 10 MG, 1 QL(2 ea daily);
MG-7.5 MG-7.5 MG 18 MG, 25 MG, 40 MG AL(At least 6
yrs old)
clonidine hcl (adhd) TB12 1
dextroamphetamine TABS
7.5 MG-7.5 MG-7.5 MG- guanfacine hcl (adhd) 1
QL(1 ea daily);
7.5 MG AL(At least 6
yrs old)
dextroamphetamine TABS Dopamine and Norepinephrine Reuptake
1.25 MG-1.25 MG-1.25 Inhibitors (DNRIs)
MG-1.25 MG, 1.875 MG-
1.875 MG-1.875 MG- SUNOSI 150 MG 3 QL(1 ea daily);
1.875 MG, 2.5 MG-2.5 PA
MG-2.5 MG-2.5 MG, SUNOSI 75 MG 3 QL(2 ea daily);
3.125 MG-3.125 MG- PA
3.125 MG-3.125 MG, 3.75 Stimulants - Misc.
MG-3.75 MG-3.75 MG-
3.75 MG, 5 MG-5 MG-5 armodafinil 1 QL(1 ea daily);
MG-5 MG AL(At least 17
1 QL(4 ea daily) yrs old); PA
dextroamphetamine 3 QL(1 ea daily);
sulfate CP24 10 MG, 15 DAYTRANA PTCH
(methylphenidate) PA
MG
1 dexmethylphenidate hcl 1 QL(1 ea daily)
dextroamphetamine
sulfate CP24 5 MG CP24
1 QL(4 ea daily) dexmethylphenidate hcl 1 QL(2 ea daily);
dextroamphetamine AL(At least 6
sulfate TABS 5 MG, 10 TABS
yrs old)
MG
Ambetter New Jersey Formulary Updated September 1, 2023
1
methylphenidate hcl CP24 1 QL(3 ea daily); AMINOGLYCOSIDES - Drugs to Treat Bacterial
30 MG AL(At least 6
yrs old) Infections
methylphenidate hcl CP24 1 AL(At least 6 Aminoglycosides
20 MG, 40 MG yrs old)
1 amikacin sulfate SOLN 1 1
methylphenidate hcl CP24
GM/4ML, 500 MG/2ML
methylphenidate hcl 1 QL(1 ea daily);
AL(At least 6 ARIKAYCE 4 PA
CPCR
yrs old) gentamicin in saline 0.8 1
methylphenidate hcl 1 QL(30 ml MG/ML-0.9 %, 1 MG/ML-
SOLN daily); AL(At 0.9 %, 1.2 MG/ML-0.9 %,
least 6 yrs old) 1.6 MG/ML-0.9 %
methylphenidate hcl 1 QL(6 ea daily); gentamicin sulfate IJ 40 1
TABS 5 MG AL(At least 6 MG/ML, 80 MG/2ML
yrs old)
1 QL(5 ea daily); neomycin sulfate TABS 1
methylphenidate hcl
TABS 10 MG, 20 MG AL(At least 6 paromomycin sulfate 1
yrs old) streptomycin sulfate 3
methylphenidate hcl TB24 1 QL(1 ea daily); SOLR
27 MG AL(At least 6
yrs old) tobramycin sulfate SOLN 1
methylphenidate hcl TB24 1 QL(2 ea daily); IJ 10 MG/ML, 40 MG/ML,
36 MG, 54 MG AL(At least 6 80 MG/2ML
yrs old) tobramycin NEBU 4 PA
AL(At least 6 ANALGESICS - ANTI-INFLAMMATORY - Drugs to
TBCR 10 MG, 20 MG
yrs old) Treat Pain, Swelling, Muscle and Joint Conditions
TBCR 18 MG, 27 MG AL(At least 6 Antirheumatic - Enzyme Inhibitors
yrs old) RINVOQ 4 QL(1 ea daily);
methylphenidate hcl 1 QL(2 ea daily); PA
TBCR 36 MG, 54 MG AL(At least 6 XELJANZ XR TB24 4 QL(1 ea daily);
yrs old) PA
methylphenidate PTCH 1 QL(1 ea daily); XELJANZ SOLN 4 QL(20 ml
PA daily); PA
modafinil 100 MG 1 QL(1 ea daily); XELJANZ TABS 4 QL(2 ea daily);
PA PA
modafinil 200 MG 1 QL(2 ea daily);
PA Antirheumatic Antimetabolites
ALLERGENIC EXTRACTS/BIOLOGICALS MISC METHOTREXATE 4 QL(1.714 ea
daily); PA
Allergenic Extracts Anti-TNF-alpha - Monoclonal Antibodies
GRASTEK SUBL 3 PA 4 QL(0.086 ml
ADALIMUMAB-ADAZ
AMEBICIDES SOAJ daily); PA
Amebicides AMJEVITA SOAJ 4 QL(0.172 ml
daily); PA
SOLOSEC 3 PA
2
AMJEVITA SOSY 20 4 QL(0.029 ml HUMIRA PSKT 4 QL(0.143 ea
MG/0.4ML daily); PA daily); PA
HADLIMA PUSHTOUCH 4 QL(0.172 ml Gold Compounds
SOAJ daily); MP; PA
RIDAURA 3 QL(3 ea daily)
HADLIMA PUSHTOUCH 4 QL(0.086 ml
SOAJ daily); MP; PA Interleukin-1 Blockers
HADLIMA SOSY 4 QL(0.086 ml ARCALYST 4 QL(0.286 ea
daily); MP; PA daily); PA
HADLIMA SOSY 4 QL(0.172 ml Interleukin-6 Receptor Inhibitors
daily); MP; PA
HUMIRA PEDIATRIC 4 1 rtl pack lmt KEVZARA SOAJ 4 QL(0.082 ml
CROHNS DISEASE amt; 180 rtl daily); PA
STARTER PACK PSKT 80 pack lmt KEVZARA SOSY 4 QL(0.082 ml
MG/0.8ML day(s); 1 mail daily); PA
pack lmt amt; Nonsteroidal Anti-inflammatory Agents (NSAIDs)
180 mail pack
lmt day(s); PA celecoxib 1 QL(2 ea daily)
HUMIRA PEN-CD/UC/HS 4 QL(0.143 ea diclofenac potassium 1
STARTER PNKT 40 daily); PA TABS 50 MG
MG/0.8ML 1
diclofenac sodium TB24
HUMIRA PEN-CD/UC/HS 4 1 rtl pack lmt
amt; 180 rtl diclofenac sodium TBEC 1
STARTER PNKT 80
MG/0.8ML pack lmt diclofenac w/ misoprostol 1
day(s); 1 mail TBEC
pack lmt amt; etodolac CAPS 1
180 mail pack
lmt day(s); PA etodolac TABS 1
HUMIRA PEN-PEDIATRIC 4 1 rtl pack lmt fenoprofen calcium TABS 1 QL(4 ea daily);
UC STARTER PACK amt; 180 rtl PA
PNKT pack lmt flurbiprofen TABS 1
day(s); 1 mail 1 RX/OTC
pack lmt amt; ibuprofen SUSP 100
180 mail pack MG/5ML
lmt day(s); PA ibuprofen TABS 400 MG, 1
HUMIRA PEN PNKT 4 QL(0.143 ea 600 MG, 800 MG
daily); PA indomethacin CAPS 25 1
HUMIRA PEN PNKT 80 4 QL(0.072 ea MG, 50 MG
MG/0.8ML daily); PA 1
indomethacin CPCR
HUMIRA PEN-PS/UV 4 1 rtl pack lmt 1
amt; 180 rtl ketoprofen CAPS 50 MG,
STARTER PNKT 75 MG
pack lmt
day(s); 1 mail ketorolac tromethamine 1 QL(0.667 ea
pack lmt amt; TABS daily)
180 mail pack meclofenamate sodium 1
lmt day(s); PA CAPS
HUMIRA PEN-PS/UV 4 QL(0.143 ea
STARTER PNKT daily); PA
3
mefenamic acid CAPS 1 Must try Analgesic Combinations
ibuprofen.;
QL(5 ea daily); butalbital-acetaminophen- 1
PA caffeine CAPS 40 MG-50
meloxicam TABS 1 QL(1 ea daily) MG-300 MG, 40 MG-50
1 MG-325 MG
nabumetone
butalbital-acetaminophen- 1
naproxen sodium TABS 1
caffeine TABS 40 MG-50
550 MG MG-325 MG
naproxen SUSP 1 PA 1
butalbital-acetaminophen
naproxen TABS 1 TABS 50 MG-325 MG
naproxen TBEC 500 MG 1 QL(3 ea daily) butalbital-aspirin-caffeine 1
oxaprozin 1 CAPS
piroxicam CAPS 1 Salicylates
sulindac TABS 1 aspirin CHEW 0 AL(At least 45
tolmetin sodium CAPS 1 yrs old - Up to
79 yrs old)
tolmetin sodium TABS 1
aspirin TABS 325 MG 0 AL(At least 45
600 MG yrs old - Up to
Phosphodiesterase 4 (PDE4) Inhibitors 79 yrs old)
aspirin TBEC 81 MG 0 AL(At least 45
OTEZLA TABS 4 QL(2 ea daily); yrs old - Up to
PA 79 yrs old)
OTEZLA TBPK 4 1 rtl pack lmt diflunisal TABS 1
amt; 180 rtl
pack lmt salsalate 1
day(s); PA ANALGESICS - OPIOID - Drugs to Treat Pain,
Pyrimidine Synthesis Inhibitors Muscle and Joint Conditions
leflunomide 1 QL(1 ea daily)
Opioid Agonists
Soluble Tumor Necrosis Factor Receptor Agents codeine sulfate TABS 30 1 New starts
ENBREL MINI SOCT 4 QL(0.15 ml MG limited to 7 day
daily); PA supply
ENBREL SURECLICK 4 QL(0.143 ml CODEINE SULFATE 1 New starts
SOAJ daily); PA TABS limited to 7 day
supply
ENBREL SOLN 4 QL(0.146 ml 1 QL(4 ea daily);
daily); PA fentanyl citrate LPOP
PA
ENBREL SOLR 4 QL(0.286 ea 1 QL(0.34 ea
daily); PA fentanyl PT72 12
MCG/HR, 25 MCG/HR, 50 daily)
ENBREL SOSY 25 4 QL(0.146 ml
daily); PA MCG/HR, 75 MCG/HR,
MG/0.5ML 100 MCG/HR
ENBREL SOSY 50 4 QL(0.28 ml 1 New starts
daily); PA hydromorphone hcl LIQD
MG/ML limited to 7 day
ANALGESICS - NonNarcotic - Drugs to Treat Pain, supply
Muscle and Joint Conditions
4
hydromorphone hcl SOLN 1 morphine sulfate SOLN 1 New starts
IJ 10 MG/ML, 50 OR 10 MG/5ML limited to 7 day
MG/5ML, 500 MG/50ML supply; QL(100
1 New starts ml daily)
hydromorphone hcl TABS 1 New starts
limited to 7 day morphine sulfate SOLN
supply; QL(8 OR 20 MG/5ML limited to 7 day
ea daily) supply; QL(50
1 QL(1 ea daily); ml daily)
hydromorphone hcl TB24 1
32 MG PA morphine sulfate SOLN IJ
0.5 MG/ML, 1 MG/ML
hydromorphone hcl TB24 1 QL(2 ea daily);
PA morphine sulfate TABS 1 New starts
8 MG, 12 MG, 16 MG limited to 7 day
levorphanol tartrate TABS 1 New starts supply; QL(6
2 MG limited to 7 day ea daily)
supply 1 QL(2 ea daily)
morphine sulfate TBCR
meperidine hcl SOLN OR 1 New starts
limited to 7 day NUCYNTA ER TB12 2 QL(2 ea daily);
50 MG/5ML PA
supply; QL(500
ml per fill retail) NUCYNTA TABS 2 QL(6 ea daily);
1 PA
meperidine hcl SOLN IJ
25 MG/ML, 50 MG/ML, oxycodone hcl T12A 3 QL(2 ea daily);
100 MG/ML PA
oxycodone hcl TABS 1 New starts
meperidine hcl TABS 50 1 New starts limited to 7 day
MG limited to 7 day supply; QL(12
supply; QL(6 ea daily)
ea daily) 1 QL(12 ea
methadone hcl CONC 1 QL(10 ml daily) oxymorphone hcl TABS daily); PA
methadone hcl SOLN OR 1 QL(50 ml daily) oxymorphone hcl TB12 40 1 QL(4 ea daily);
10 MG/5ML MG PA
methadone hcl SOLN IJ 1 oxymorphone hcl TB12 5 1 QL(2 ea daily);
10 MG/ML MG, 7.5 MG, 10 MG, 15 PA
methadone hcl SOLN OR 1 QL(100 ml MG, 20 MG, 30 MG
5 MG/5ML daily) SUBSYS LIQD 800 MCG, 3 QL(8 ea daily);
1 1200 MCG, 1600 MCG PA
METHADONE HCL SOLN
IJ SUBSYS LIQD 100 MCG 3 QL(3 ea daily);
1 QL(4 ea daily) PA
methadone hcl TABS 5
MG SUBSYS LIQD 200 MCG, 3 QL(4 ea daily);
PA
methadone hcl TABS 10 1 QL(10 ea daily) 400 MCG, 600 MCG
MG tramadol hcl TABS 50 MG 1 New starts
limited to 7 day
methadone hcl TBSO 1 QL(2 ea daily) supply; QL(8
morphine sulfate CP24 20 1 QL(2 ea daily); ea daily)
MG, 30 MG, 50 MG, 60 PA tramadol hcl TB24 1 QL(1 ea daily)
MG, 80 MG, 100 MG XTAMPZA ER 2 QL(2 ea daily);
PA
Opioid Combinations
5
acetaminophen w/ 1 New starts hydrocodone- 1 New starts
codeine SOLN limited to 7 day acetaminophen TABS 300 limited to 7 day
supply; QL(75 MG-10 MG, 300 MG-5 supply; QL(13
ml daily) MG, 300 MG-7.5 MG ea daily)
acetaminophen w/ 1 New starts 1 PA
limited to 7 day hydrocodone-ibuprofen 10
codeine TABS 60 MG-300 MG-200 MG, 5 MG-200
MG supply; QL(6
ea daily) MG
1 New starts hydrocodone-ibuprofen 1 New starts
acetaminophen w/ limited to 7 day
codeine TABS 15 MG-300 limited to 7 day 7.5 MG-200 MG
supply; QL(13 supply; QL(5
MG ea daily)
ea daily)
1 New starts oxycodone w/ 1 New starts
acetaminophen w/ limited to 7 day
codeine TABS 30 MG-300 limited to 7 day acetaminophen TABS 325
supply; QL(12 MG-10 MG, 325 MG-5 supply; QL(12
MG ea daily)
ea daily) MG, 325 MG-7.5 MG
acetaminophen-caff- 1 New starts tramadol-acetaminophen 1 New starts
dihydrocod CAPS 30 MG- limited to 7 day limited to 7 day
320.5 MG-16 MG supply supply; QL(8
3 New starts ea daily)
acetaminophen-caff-
dihydrocod CAPS 30 MG- limited to 7 day Opioid Partial Agonists
320.5 MG-16 MG supply; PA
buprenorphine hcl- 1 QL(2 ea daily)
butalbital-acetaminophen- 1 New starts naloxone hcl dihydrate
caffeine w/ codeine 30 limited to 7 day FILM SL 2 MG-8 MG, 3
MG-40 MG-50 MG-325 supply; QL(6 MG-12 MG
MG ea daily)
buprenorphine hcl- 1 QL(3 ea daily)
butalbital-acetaminophen- 1 New starts naloxone hcl dihydrate
caffeine w/ codeine 30 limited to 7 day FILM SL 0.5 MG-2 MG, 1
MG-40 MG-50 MG-300 supply MG-4 MG
MG 1 QL(3 ea daily)
buprenorphine hcl-
butalbital-aspirin-caffeine 1 New starts naloxone hcl dihydrate
w/cod limited to 7 day SUBL
supply; QL(6
ea daily) buprenorphine hcl SOLN 1
hydrocodone- 1 New starts buprenorphine hcl SUBL 1 QL(3 ea daily)
acetaminophen SOLN limited to 7 day buprenorphine PTWK 1 QL(0.143 ea
108 MG/5ML-2.5 supply; QL(180 daily); PA
MG/5ML, 217 MG/10ML-5 ml daily) butorphanol tartrate NA 1 QL(0.34 ml
MG/10ML, 325 MG/15ML- 10 MG/ML daily); PA
7.5 MG/15ML 1
butorphanol tartrate IJ 1
hydrocodone- 1 New starts MG/ML, 2 MG/ML
acetaminophen SOLN limited to 7 day
325 MG/15ML-10 supply nalbuphine hcl 1 QL(8 ml daily)
MG/15ML pentazocine w/ naloxone 1 New starts
hydrocodone- 1 New starts hcl limited to 7 day
acetaminophen TABS 325 limited to 7 day supply
MG-10 MG, 325 MG-5 supply; QL(12 ANDROGENS-ANABOLIC - Drugs to Regulate
MG, 325 MG-7.5 MG ea daily) Hormones
6
Anabolic Steroids ivermectin 1 1 rtl MAX fill; 75
rtl day(s)
oxandrolone 1 supply; 1 mail
MAX fill; QL(9
Androgens ea per fill retail;
ANDRODERM PT24 2 2 QL(1 ea daily); 9 per fill mail)
MG/24HR, 4 MG/24HR PA praziquantel 1 PA
danazol CAPS 1 ANTIANGINAL AGENTS - Drugs to Treat Chest
METHITEST TABS 3 Pain
testosterone cypionate 1
Antianginals-Other
SOLN IM
testosterone enanthate 1 ranolazine TB12 500 MG 1 QL(3 ea daily)
SOLN IM ranolazine TB12 1000 MG 1 QL(2 ea daily)
ANORECTAL AND RELATED PRODUCTS - Nitrates
Rectal Drugs to Treat Pain, Swelling and Itching isosorbide dinitrate TABS 1
Intrarectal Steroids 5 MG, 10 MG, 20 MG, 30
MG
budesonide (intrarectal) 4 QL(3.2 gm 1
daily); PA isosorbide mononitrate
1 TABS
hydrocortisone
(intrarectal) isosorbide mononitrate 1
4 QL(3.2 gm TB24
UCERIS (budesonide
(intrarectal)) daily); PA NITRO-BID OINT 3
nitroglycerin CPCR 1 QL(4 ea daily)
Rectal Steroids
nitroglycerin PT24 1
hydrocortisone (rectal) EX 1
NITROGLYCERIN SOLN 1
hydrocortisone acetate 1 IV
(rectal) 1
nitroglycerin SUBL
Vasodilating Agents ANTIANXIETY AGENTS - Drugs to Treat Anxiety
RECTIV 3 QL(2 gm daily)
Antianxiety Agents - Misc.
ANTHELMINTICS - Drugs to Treat Worm
buspirone hcl 1
Infections 1
hydroxyzine hcl SOLN 50
Anthelmintics MG/ML
1 PA hydroxyzine hcl SYRP 1
albendazole
2 1 rtl MAX fill; 60 hydroxyzine hcl TABS 1
EMVERM CHEW
rtl day(s) hydroxyzine pamoate 1
supply; 1 mail CAPS
MAX fill; QL(2 1 QL(6 ea daily)
ea daily; 6 ea meprobamate
per fill retail; 6 Benzodiazepines
per fill mail)
alprazolam TABS 1 QL(4 ea daily)
7
alprazolam TB24 1 Antiasthmatic - Monoclonal Antibodies
alprazolam TBDP 1
FASENRA PEN SOAJ 4 QL(0.036 ml
chlordiazepoxide hcl 1 daily); PA
CAPS FASENRA SOSY 4 QL(0.036 ml
clorazepate dipotassium 1 daily); PA
TABS NUCALA SOAJ 4 QL(0.1073 ml
daily); PA
diazepam CONC 1
NUCALA SOLR 4 QL(0.1073 ea
diazepam SOLN OR 5 1 daily); PA
MG/5ML NUCALA SOSY 100 4 QL(0.1073 ml
diazepam TABS 1 QL(4 ea daily) MG/ML daily); PA
lorazepam CONC 1 NUCALA SOSY 40 4 QL(0.0144 ml
MG/0.4ML daily); PA
lorazepam TABS 1 MG 1 QL(4 ea daily)
XOLAIR SOLR 4 QL(0.286 ea
lorazepam TABS 0.5 MG, 1 QL(3 ea daily) daily); PA
2 MG XOLAIR SOSY 150 4 QL(0.286 ml
oxazepam CAPS 1 MG/ML daily); PA
ANTIARRHYTHMICS - Drugs to treat abnormal XOLAIR SOSY 75 4 QL(0.036 ml
MG/0.5ML daily); PA
heart rhythms
Anti-Inflammatory Agents
Antiarrhythmics Type I-A
cromolyn sodium NEBU 1 QL(8 ml daily)
disopyramide phosphate 1
CAPS Bronchodilators - Anticholinergics
procainamide hcl SOLN 1 ATROVENT HFA 3 QL(0.44 gm
500 MG/ML daily)
quinidine sulfate TABS 1 INCRUSE ELLIPTA 2 QL(1 ea daily)
Antiarrhythmics Type I-B ipratropium bromide 1 QL(15 ml daily)
SOLN 0.02 %
mexiletine hcl 1 2 QL(1 ea daily)
SPIRIVA HANDIHALER
Antiarrhythmics Type I-C CAPS (tiotropium bromide
monohydrate)
flecainide acetate 1
SPIRIVA RESPIMAT 2 QL(0.14 gm
propafenone hcl CP12 1 AERS daily)
propafenone hcl TABS 1 tiotropium bromide 1 QL(1 ea daily)
Antiarrhythmics Type III monohydrate CAPS
amiodarone hcl SOLN 50 1 Leukotriene Modulators

MG/ML montelukast sodium 1 QL(1 ea daily)
amiodarone hcl TABS 1 CHEW
dofetilide 1 montelukast sodium 1 QL(1 ea daily)
PACK
ANTIASTHMATIC AND BRONCHODILATOR
montelukast sodium 1 QL(1 ea daily)
AGENTS - Drugs to Treat Lung Conditions TABS
8
zafirlukast 1 QL(2 ea daily) FLOVENT DISKUS AEPB 2 30 rtl pack lmt
1 QL(4 ea daily) 100 MCG/BLIST, 250 day(s); 4 rtl
zileuton TB12 pack lmt per fill;
MCG/BLIST
Selective Phosphodiesterase 4 (PDE4) Inhibitors 30 mail pack
lmt day(s); 4
DALIRESP 250 MCG 3 30 rtl MAX mail pack lmt
(roflumilast) day(s) supply; per fill
180 rtl lmt 2 30 rtl pack lmt
day(s); 30 mail FLOVENT DISKUS AEPB
50 MCG/BLIST day(s); 3 rtl
MAX day(s) pack lmt per fill;
supply; 180 30 mail pack
mail lmt day(s); lmt day(s); 3
QL(1 ea daily) mail pack lmt
DALIRESP 500 MCG 3 QL(1 ea daily) per fill
(roflumilast) FLOVENT HFA 2 30 rtl pack lmt
roflumilast 250 MCG 1 30 rtl MAX day(s); 2 rtl
day(s) supply; pack lmt per fill;
180 rtl lmt 30 mail pack
day(s); 30 mail lmt day(s); 2
MAX day(s) mail pack lmt
supply; 180 per fill
mail lmt day(s); PULMICORT 2 30 rtl pack lmt
QL(1 ea daily) FLEXHALER AEPB day(s); 3 rtl
roflumilast 500 MCG 1 QL(1 ea daily) pack lmt per fill;
30 mail pack
Steroid Inhalants lmt day(s); 3
ALVESCO 3 30 rtl pack lmt mail pack lmt
day(s); 3 rtl per fill
pack lmt per fill; QVAR REDIHALER 2 30 rtl pack lmt
30 mail pack day(s); 2 rtl
lmt day(s); 3 pack lmt per fill;
mail pack lmt 30 mail pack
per fill; PA lmt day(s); 2
ARNUITY ELLIPTA 50 2 30 rtl pack lmt mail pack lmt
MCG/ACT day(s); 3 rtl per fill
pack lmt per fill; Sympathomimetics
30 mail pack
lmt day(s); 3 ADVAIR HFA AERO 1 1 rtl pack lmt
mail pack lmt amt; 30 rtl pack
per fill lmt day(s); 1
2 30 rtl pack lmt mail pack lmt
ARNUITY ELLIPTA 100 amt; 30 mail
MCG/ACT, 200 MCG/ACT day(s); 1 rtl
pack lmt per fill; pack lmt day(s)
30 mail pack albuterol sulfate AERS 1 Limit 2 inhalers
lmt day(s); 1 per month; 1 rtl
mail pack lmt pack lmt per fill;
per fill 2 rtl MAX fill; 30
1 QL(4 ml daily); rtl day(s)
budesonide (inhalation) supply
SUSP PA
9
albuterol sulfate NEBU 1 QL(15 ml daily) formoterol fumarate 1 QL(4 ml daily)
0.083 %, 0.63 MG/3ML, NEBU
1.25 MG/3ML ipratropium-albuterol 1 QL(18 ml daily)
albuterol sulfate NEBU 1 SOLN
0.5 %, 2.5 MG/0.5ML levalbuterol hcl 1 QL(12 ml daily)
albuterol sulfate SYRP 1 1
levalbuterol hcl 1.25
albuterol sulfate TABS 1 MG/0.5ML
ANORO ELLIPTA 2 QL(2 ea daily) levalbuterol tartrate 1 QL(0.5 gm
1 QL(4 ml daily) daily)
arformoterol tartrate 2 30 rtl pack lmt
SEREVENT DISKUS
BEVESPI AEROSPHERE 2 QL(0.36 gm day(s); 1 rtl
daily) pack lmt per fill;
BREO ELLIPTA 1 1 rtl pack lmt 30 mail pack
amt; 30 rtl pack lmt day(s); 1
lmt day(s); 1 mail pack lmt
mail pack lmt per fill
amt; 30 mail STRIVERDI RESPIMAT 2
pack lmt day(s)
2 QL(0.38 gm terbutaline sulfate SOLN 1
BREZTRI AEROSPHERE
daily) terbutaline sulfate TABS 1
budesonide-formoterol 1 30 rtl pack lmt TRELEGY ELLIPTA 2 QL(2 ea daily)
fumarate dihydrate day(s); 1 rtl
pack lmt per fill; Xanthines
30 mail pack
lmt day(s); 1 aminophylline SOLN 1
mail pack lmt theophylline ELIX 1
per fill; QL(0.34 1 QL(56 ml daily)
gm daily) theophylline SOLN
fluticasone furoate- 1 1 rtl pack lmt theophylline TB12 300 1
vilanterol amt; 30 rtl pack MG, 450 MG
lmt day(s); 1 theophylline TB24 1
mail pack lmt
amt; 30 mail ANTICOAGULANTS - Blood Thinners
pack lmt day(s) Coumarin Anticoagulants
fluticasone-salmeterol 1 30 rtl pack lmt
AEPB 100 MCG/ACT-50 day(s); 1 rtl warfarin sodium TABS 1
MCG/ACT, 250 pack lmt per fill;
MCG/ACT-50 MCG/ACT, 30 mail pack Direct Factor Xa Inhibitors
500 MCG/ACT-50 lmt day(s); 1 ELIQUIS STARTER PACK 2 1 rtl MAX fill;
MCG/ACT mail pack lmt TBPK 180 rtl day(s)
per fill supply; 1 mail
fluticasone-salmeterol 1 1 rtl pack lmt MAX fill;
AERO amt; 30 rtl pack QL(2.47 ea
lmt day(s); 1 daily)
mail pack lmt ELIQUIS TABS 2 QL(2 ea daily)
amt; 30 mail 2 1 rtl MAX fill;
pack lmt day(s) XARELTO STARTER 365 rtl day(s)
PACK TBPK
supply
10
XARELTO SUSR 2 QL(900 ml per HEPARIN SODIUM/NACL 1
30 days retail; 0.45% SOLN IV 0.45 %-
900 ml per 30 12500 UNIT/250ML
days mail)
XARELTO TABS 2.5 MG, 2 QL(2 ea daily) ANTICONVULSANTS - Drugs to Treat Seizures
15 MG AMPA Glutamate Receptor Antagonists
XARELTO TABS 10 MG, 2 QL(1 ea daily) 3 QL(2 ea daily);
FYCOMPA TABS 6 MG
20 MG PA
Heparins And Heparinoid-Like Agents FYCOMPA TABS 8 MG, 3 QL(1 ea daily);
10 MG, 12 MG PA
enoxaparin sodium SOLN 4 QL(6 ml daily)
FYCOMPA TABS 4 MG 3 QL(3 ea daily);
IJ 300 MG/3ML PA
enoxaparin sodium SOSY 4 QL(2 ml daily) FYCOMPA TABS 2 MG 3 QL(6 ea daily);
100 MG/ML, 150 MG/ML PA
enoxaparin sodium SOSY 4 QL(1.6 ml Anticonvulsants - Benzodiazepines
80 MG/0.8ML, 120 daily)
MG/0.8ML clobazam SUSP 1 QL(16 ml
daily); PA
enoxaparin sodium SOSY 4 QL(0.6 ml 1 QL(2 ea daily);
daily) clobazam TABS
30 MG/0.3ML PA
enoxaparin sodium SOSY 4 QL(0.8 ml daily; clonazepam TABS 1
40 MG/0.4ML 30 Day(s) limit) 3
diazepam (anticonvulsant)
enoxaparin sodium SOSY 4 QL(1.2 ml daily; GEL
60 MG/0.6ML 30 Day(s) limit) 3 QL(10 ea per
NAYZILAM
fondaparinux sodium 2.5 4 QL(4.5 ml per 30 days retail);
MG/0.5ML 180 days retail; PA
4 ml per 180 VALTOCO 10 MG DOSE 4 QL(10 ea per
days mail) LIQD 30 days retail);
fondaparinux sodium 7.5 4 QL(5.4 ml per PA
MG/0.6ML 180 days retail; VALTOCO 15 MG DOSE 4 QL(10 ea per
5 ml per 180 LQPK 30 days retail);
days mail) PA
fondaparinux sodium 5 4 QL(3.6 ml per VALTOCO 20 MG DOSE 4 QL(10 ea per
MG/0.4ML 180 days retail; LQPK 30 days retail);
3 ml per 180 PA
days mail) VALTOCO 5 MG DOSE 4 QL(10 ea per
fondaparinux sodium 10 4 QL(7.2 ml per LIQD 30 days retail);
MG/0.8ML 180 days retail; PA
7 ml per 180
days mail) Anticonvulsants - Misc.
FRAGMIN SOSY 4 PA APTIOM 3 QL(2 ea daily);
1 PA
heparin sodium (porcine)
SOLN IJ 5000 UNIT/ML, BANZEL TABS 200 MG 2 QL(2 ea daily);
10000 UNIT/ML, 20000 (rufinamide) PA
UNIT/ML BANZEL TABS 400 MG 2 QL(8 ea daily);
(rufinamide) PA
11
BRIVIACT SOLN OR 10 3 QL(20 ml levetiracetam TABS 500 1 QL(6 ea daily)
MG/ML daily); PA MG
BRIVIACT TABS 3 QL(2 ea daily); levetiracetam TABS 1000 1 QL(3 ea daily)
PA MG
carbamazepine CHEW 1 1 QL(4 ea daily)
levetiracetam TB24
carbamazepine CP12 300 1 QL(4 ea daily) 1 QL(40 ml daily)
oxcarbazepine SUSP
MG
oxcarbazepine TABS 150 1 QL(3 ea daily)
carbamazepine CP12 100 1 MG, 300 MG
MG
oxcarbazepine TABS 600 1 QL(4 ea daily)
carbamazepine CP12 200 1 QL(6 ea daily) MG
MG
pregabalin CAPS 225 3 QL(2 ea daily);
carbamazepine SUSP 1 PA
MG, 300 MG
carbamazepine TABS 1 3 QL(3 ea daily);
pregabalin CAPS 25 MG,
carbamazepine TB12 100 1 QL(4 ea daily) 50 MG, 75 MG, 100 MG, PA
MG, 400 MG 150 MG, 200 MG
carbamazepine TB12 200 1 QL(6 ea daily) pregabalin SOLN 3 QL(30 ml
MG daily); PA
4 QL(6 ea daily); primidone 50 MG, 250 1
DIACOMIT CAPS 500 MG
PA MG
DIACOMIT CAPS 250 MG 4 QL(12 ea rufinamide SUSP 1 QL(80 ml
daily); PA daily); PA
DIACOMIT PACK 250 MG 4 QL(12 ea rufinamide TABS 200 MG 1 QL(2 ea daily);
daily); PA PA
DIACOMIT PACK 500 MG 4 QL(6 ea daily); rufinamide TABS 400 MG 1 QL(8 ea daily);
PA PA
EPIDIOLEX 3 PA TEGRETOL SUSP 2
gabapentin CAPS 1 (carbamazepine)
1 QL(60 ml daily) TEGRETOL TABS 2
gabapentin SOLN
(carbamazepine)
gabapentin TABS 600 1
topiramate CPSP 15 MG 1 QL(6 ea daily)
MG, 800 MG
1 QL(40 ml daily) topiramate CPSP 25 MG 1 QL(8 ea daily)
lacosamide SOLN OR 10
MG/ML topiramate CS24 3 PA
lacosamide TABS 1 QL(2 ea daily) topiramate TABS 200 MG 1 QL(2 ea daily)
lamotrigine CHEW 25 MG 1 QL(20 ea daily) topiramate TABS 25 MG, 1 QL(4 ea daily)
lamotrigine CHEW 5 MG 1 QL(100 ea 100 MG
daily) topiramate TABS 50 MG 1 QL(6 ea daily)
lamotrigine TABS 1 zonisamide CAPS 1 QL(6 ea daily)
lamotrigine TBDP 1 QL(1 ea daily)
Carbamates
levetiracetam SOLN IV 1 QL(30 ml daily)
500 MG/5ML felbamate SUSP 1 QL(30 ml daily)
levetiracetam TABS 250 1 QL(4 ea daily) felbamate TABS 400 MG 1 QL(9 ea daily)
MG, 750 MG felbamate TABS 600 MG 1 QL(6 ea daily)
12
GABA Modulators Alpha-2 Receptor Antagonists (Tetracyclics)
tiagabine hcl 1 mirtazapine TABS 30 MG 1 QL(1.5 ea
4 QL(6 ea daily); daily)
vigabatrin PACK 1 QL(3 ea daily)
PA mirtazapine TABS 15 MG
vigabatrin TABS 4 QL(6 ea daily); mirtazapine TABS 7.5 1 QL(1 ea daily)
PA MG, 45 MG
Hydantoins mirtazapine TBDP 15 MG 1 QL(3 ea daily)
DILANTIN 2 mirtazapine TBDP 30 MG 1 QL(1.5 ea
daily)
DILANTIN (phenytoin 2 1 QL(1 ea daily)
sodium extended) mirtazapine TBDP 45 MG
DILANTIN INFATABS 2 Antidepressants - Misc.
CHEW (phenytoin) bupropion hcl TABS 1 QL(3 ea daily)
DILANTIN-125 SUSP 2 1 QL(2 ea daily)
bupropion hcl TB12 200
(phenytoin) MG
fosphenytoin sodium 1 1 QL(4 ea daily)
PHENYTEK (phenytoin 2 MG
sodium extended) bupropion hcl TB12 150 1 QL(3 ea daily)
phenytoin sodium 1 MG
extended 100 MG, 200 bupropion hcl TB24 300 1 QL(1 ea daily)
MG, 300 MG MG
phenytoin sodium SOLN 1 1 QL(3 ea daily)
phenytoin CHEW 1 MG
phenytoin SUSP 1 Monoamine Oxidase Inhibitors (MAOIs)
Succinimides EMSAM 3 QL(1 ea daily)
CELONTIN 3 QL(4 ea daily) MARPLAN 2 QL(6 ea daily)
(methsuximide) phenelzine sulfate 1
ethosuximide CAPS 1 QL(6 ea daily) 1
tranylcypromine sulfate
ethosuximide SOLN 1 QL(30 ml daily)
N-Methyl-D-aspartic acid (NMDA) Receptor
methsuximide 1 QL(4 ea daily)
ZARONTIN CAPS 2 QL(6 ea daily) Antagonists
(ethosuximide) SPRAVATO 56MG DOSE 4 PA
Valproic Acid SPRAVATO 84MG DOSE 4 PA
divalproex sodium TB24 1 Selective Serotonin Reuptake Inhibitors (SSRIs)

divalproex sodium TBEC 1 citalopram hydrobromide 1 QL(20 ml daily)
valproate sodium SOLN 1 SOLN
OR 250 MG/5ML citalopram hydrobromide 1 QL(2 ea daily)
valproic acid CAPS 1 TABS 20 MG
citalopram hydrobromide 1 QL(4 ea daily)
ANTIDEPRESSANTS - Drugs to Treat Depression
TABS 10 MG
13
citalopram hydrobromide 1 QL(1 ea daily) sertraline hcl TABS 25 1 QL(4 ea daily)
TABS 40 MG MG, 50 MG
escitalopram oxalate 1 QL(20 ml daily) Serotonin Modulators
SOLN
1 QL(4 ea daily) nefazodone hcl 1
escitalopram oxalate
TABS 5 MG trazodone hcl TABS 1
escitalopram oxalate 1 QL(1 ea daily) TRINTELLIX 3 QL(1 ea daily);
TABS 20 MG PA
1 QL(2 ea daily) VIIBRYD STARTER PACK 3 1 rtl pack lmt
escitalopram oxalate amt; 180 rtl
TABS 10 MG KIT
pack lmt day(s)
fluoxetine hcl CAPS 20 1 QL(3 ea daily) vilazodone hcl TABS 1 QL(1 ea daily)
MG
1 QL(1 ea daily) Serotonin-Norepinephrine Reuptake Inhibitors
fluoxetine hcl CAPS 10
MG (SNRIs)
fluoxetine hcl CAPS 40 1 QL(2 ea daily) desvenlafaxine succinate 1 QL(1 ea daily)
MG 25 MG, 50 MG
fluoxetine hcl CPDR 1 desvenlafaxine succinate 1 QL(4 ea daily)
fluoxetine hcl SOLN 1 QL(20 ml daily) 100 MG
fluoxetine hcl TABS 20 1 QL(3 ea daily) duloxetine hcl CPEP 40 1
MG MG
fluoxetine hcl TABS 10 1 QL(1 ea daily) duloxetine hcl CPEP 20 1 QL(2 ea daily)
MG, 60 MG MG, 30 MG, 60 MG
fluvoxamine maleate 1 QL(2 ea daily) FETZIMA TITRATION 3 PA
TABS 25 MG, 50 MG PACK C4PK
fluvoxamine maleate 1 QL(3 ea daily) FETZIMA CP24 3 PA
TABS 100 MG venlafaxine hcl CP24 37.5 1 QL(4 ea daily)
paroxetine hcl SUSP 1 QL(30 ml daily) MG
paroxetine hcl TABS 10 1 QL(6 ea daily) venlafaxine hcl CP24 150 1 QL(2 ea daily)
MG MG
paroxetine hcl TABS 20 1 QL(3 ea daily) venlafaxine hcl CP24 75 1 QL(5 ea daily)
MG MG
paroxetine hcl TABS 30 1 QL(2 ea daily) venlafaxine hcl TABS 1 QL(3 ea daily)
MG venlafaxine hcl TB24 150 1 QL(2 ea daily)
paroxetine hcl TABS 40 1 QL(1 ea daily) MG
MG venlafaxine hcl TB24 37.5 1 QL(1 ea daily)
paroxetine hcl TB24 12.5 1 QL(1 ea daily) MG, 75 MG, 225 MG
MG Tricyclic Agents
paroxetine hcl TB24 25 1 QL(2 ea daily)
MG, 37.5 MG amitriptyline hcl TABS 1
sertraline hcl CONC 1 QL(10 ml daily) amoxapine 1
sertraline hcl TABS 100 1 QL(2 ea daily) clomipramine hcl 1
MG desipramine hcl TABS 1
14
doxepin hcl CAPS 1 SYNJARDY XR TB24 2 QL(1 ea daily)
doxepin hcl CONC 1 1000 MG-25 MG
1 SYNJARDY XR TB24 2 QL(2 ea daily)
imipramine hcl TABS
1000 MG-10 MG, 1000
imipramine pamoate 1 MG-12.5 MG, 1000 MG-5
nortriptyline hcl CAPS 1 MG
nortriptyline hcl SOLN 1 SYNJARDY TABS 2 QL(2 ea daily)
protriptyline hcl 1 TRIJARDY XR 1000 MG-5 2 QL(1 ea daily)
1 MG-10 MG, 1000 MG-5
trimipramine maleate MG-25 MG
CAPS
TRIJARDY XR 1000 MG- 2 QL(2 ea daily)
ANTIDIABETICS - Drugs to Regulate Blood Sugar 2.5 MG-12.5 MG, 1000
Alpha-Glucosidase Inhibitors MG-2.5 MG-5 MG
XIGDUO XR 1000 MG-10 3 QL(1 ea daily);
acarbose 1 QL(3 ea daily) PA
MG, 500 MG-10 MG, 500
miglitol 1 QL(3 ea daily) MG-5 MG
Antidiabetic - Amylin Analogs XIGDUO XR 1000 MG-2.5 3 QL(2 ea daily);
MG, 1000 MG-5 MG PA
SYMLINPEN 120 SOPN 2 QL(0.36 ml
daily); PA XULTOPHY 100/3.6 2 QL(0.5 ml
2 QL(0.2 ml daily); PA
SYMLINPEN 60 SOPN
daily); PA Biguanides
Antidiabetic Combinations metformin hcl TABS 1000 1 QL(2.5 ea
1 QL(2 ea daily) MG daily)
glipizide-metformin hcl
250 MG-2.5 MG, 500 MG- metformin hcl TABS 850 0 QL(3 ea daily)
2.5 MG MG
glipizide-metformin hcl 1 QL(4 ea daily) metformin hcl TABS 500 1 QL(5 ea daily)
500 MG-5 MG MG
glyburide-metformin 250 1 QL(2 ea daily) metformin hcl TB24 500 1 QL(4 ea daily)
MG-1.25 MG MG
glyburide-metformin 500 1 QL(4 ea daily) metformin hcl TB24 750 1 QL(3 ea daily)
MG-2.5 MG, 500 MG-5 MG
MG
Diabetic Other
GLYXAMBI 2 QL(1 ea daily)
diazoxide 3
JANUMET XR TB24 1000 2 QL(2 ea daily)
MG-50 MG, 500 MG-50 glucagon (rdna) 1 QL(0.035 ea
MG daily)
JANUMET XR TB24 1000 2 QL(1 ea daily) Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
MG-100 MG alogliptin benzoate 1 QL(1 ea daily)
JANUMET TABS 2 QL(2 ea daily) JANUVIA 2 QL(1 ea daily)
pioglitazone hcl- 1 QL(1 ea daily)
glimepiride Incretin Mimetic Agents
pioglitazone hcl-metformin 1 QL(2 ea daily) OZEMPIC SOPN 2 2 QL(0.054 ml
hcl TABS MG/1.5ML daily); PA
15
OZEMPIC SOPN 2 QL(0.108 ml NOVOLIN R RELION 2
daily); PA SOLN IJ
TRULICITY 2 QL(0.143 ml 2
NOVOLIN R SOLN IJ
daily); PA
2 QL(0.3 ml NOVOLOG FLEXPEN 2
VICTOZA
daily); PA RELION SOPN
Insulin NOVOLOG FLEXPEN 1
SOPN
APIDRA SOLOSTAR 3 PA 2
NOVOLOG MIX 70/30
SOPN PREFILLED FLEXPEN
APIDRA SOLN 3 PA RELION SUPN
BASAGLAR KWIKPEN 2 NOVOLOG MIX 70/30 2
SOPN PREFILLED FLEXPEN
FIASP FLEXTOUCH 2 SUPN
SOPN NOVOLOG MIX 70/30 2
FIASP PENFILL SOCT 2 SUSP
FIASP PUMPCART SOCT 2 NOVOLOG PENFILL 1
2 SOCT
FIASP SOLN
NOVOLOG SOLN IJ 1
HUMULIN R U-500 2 QL(1.34 ml
(CONCENTRATED) daily) TRESIBA FLEXTOUCH 2
SOLN SC SOPN
HUMULIN R U-500 2 QL(1.34 ml TRESIBA SOLN 2
KWIKPEN SOPN SC daily)
Insulin Sensitizing Agents
LEVEMIR FLEXPEN 2
pioglitazone hcl 1 QL(1 ea daily)
SOPN
LEVEMIR FLEXTOUCH 2 Meglitinide Analogues
SOPN 1 QL(3 ea daily)
nateglinide
LEVEMIR SOLN 2
repaglinide 0.5 MG, 1 MG 1 QL(4 ea daily)
NOVOLIN 70/30 2
repaglinide 2 MG 1 QL(8 ea daily)
FLEXPEN RELION SUPN
NOVOLIN 70/30 2 Sodium-Glucose Co-Transporter 2 (SGLT2)
FLEXPEN SUPN Inhibitors
NOVOLIN 70/30 RELION 2
FARXIGA 3 QL(1 ea daily);
SUSP PA
NOVOLIN 70/30 SUSP 2 JARDIANCE 2 QL(1 ea daily)
NOVOLIN N FLEXPEN 2
Sulfonylureas
RELION SUPN
NOVOLIN N FLEXPEN 2 glimepiride 4 MG 1 QL(2 ea daily)
SUPN glimepiride 1 MG, 2 MG 1 QL(4 ea daily)
NOVOLIN N RELION 2 glipizide TABS 1 QL(4 ea daily)
SUSP glipizide TB24 1 QL(2 ea daily)
NOVOLIN N SUSP 2
16
glyburide micronized 1.5 1 QL(4 ea daily) granisetron hcl SOLN IV 1 1
MG, 3 MG, 6 MG MG/ML
glyburide TABS 1 QL(4 ea daily) granisetron hcl TABS 1 QL(0.34 ea
1 QL(6 ea daily) daily)
tolbutamide 1
ondansetron hcl SOLN IJ
ANTIDIARRHEAL/PROBIOTIC AGENTS - Drugs 4 MG/2ML
to Treat Diarrhea ondansetron hcl SOLN 1 QL(3.34 ml
OR 4 MG/5ML daily)
Antiperistaltic Agents
ondansetron hcl SOSY 1
diphenoxylate w/ atropine 1 1 QL(4 ea daily;
ondansetron hcl TABS 4
LIQD MG 60 ea per fill
diphenoxylate w/ atropine 1 retail; 60 per fill
TABS mail)
loperamide hcl CAPS 1 RX/OTC ondansetron hcl TABS 8 1 QL(3 ea daily;
MG 45 ea per fill
MOTOFEN 3 retail; 45 per fill
ANTIDOTES AND SPECIFIC ANTAGONISTS mail)
ondansetron hcl TABS 24 1 QL(0.143 ea
Antidotes - Chelating Agents MG daily)
CHEMET 3 ondansetron TBDP 4 MG 1 QL(1 ea daily)
deferasirox PACK 4 PA ondansetron TBDP 8 MG 1
deferasirox TABS 1 PA palonosetron hcl SOLN 1
deferasirox TBSO 1 PA Antiemetics - Anticholinergic
deferiprone TABS 500 1
meclizine hcl TABS 12.5 1 RX/OTC
MG
MG, 25 MG
Antidotes and Specific Antagonists scopolamine 1 QL(0.34 ea
1 PA daily)
VISTOGARD
trimethobenzamide hcl 1
Opioid Antagonists CAPS
naloxone hcl LIQD 1 2 rtl MAX fill; 30 Antiemetics - Miscellaneous
rtl day(s)
supply; QL(2 AKYNZEO 3 PA
ea per fill doxylamine-pyridoxine 1 3 rtl MAX fill;
retail); RX/OTC TBEC 365 rtl day(s)
naloxone hcl SOLN 0.4 1 supply; 3 mail
MG/ML, 4 MG/10ML MAX fill; QL(4
1 ea daily); PA
naltrexone hcl 1
dronabinol CAPS
ANTIEMETICS - Drugs to Treat Nausea and
Substance P/Neurokinin 1 (NK1) Receptor
Vomiting
Antagonists
5-HT3 Receptor Antagonists
aprepitant CAPS 1 PA
ANZEMET TABS 50 MG 3 QL(0.167 ea
daily); PA aprepitant CAPS 80 MG 1 QL(0.134 ea
daily); PA
17
aprepitant CAPS 40 MG, 1 QL(0.067 ea Antihistamines - Alkylamines
125 MG daily); PA
1 PA dexchlorpheniramine 1
aprepitant MISC maleate SOLN
VARUBI TBPK 3 PA
Antihistamines - Ethanolamines
ANTIFUNGALS - Drugs to Treat Fungal Infections
carbinoxamine maleate 1
Antifungal - Glucan Synthesis Inhibitors SOLN
caspofungin acetate 1 carbinoxamine maleate 1
ERAXIS 3 TABS 4 MG
1 PA clemastine fumarate 1
micafungin sodium
SYRP
Antifungals clemastine fumarate 1
ABELCET 3 TABS 2.68 MG
AMBISOME 3 diphenhydramine hcl 1
(amphotericin b liposome) CAPS 50 MG
amphotericin b IV 3 diphenhydramine hcl ELIX 1
1
12.5 MG/5ML
amphotericin b liposome
diphenhydramine hcl 1
flucytosine 1 LIQD 12.5 MG/5ML, 25
griseofulvin microsize 1 AL(At least 2 MG/10ML, 50 MG/20ML
SUSP yrs old) diphenhydramine hcl 1
griseofulvin microsize 1 SOLN 50 MG/ML
TABS
Antihistamines - Non-Sedating
griseofulvin ultramicrosize 1
cetirizine hcl TABS 1 QL(1 ea daily)
nystatin TABS 1
1
terbinafine hcl TABS QL(1 ea daily) CLARITIN TABS
1
(loratadine)
Imidazole-Related Antifungals desloratadine TABS 1 QL(1 ea daily)
CRESEMBA CAPS 3 PA desloratadine TBDP 2.5 1 QL(1 ea daily)
fluconazole SUSR 1 MG
1 levocetirizine 1 QL(10 ml
fluconazole TABS daily); RX/OTC
dihydrochloride SOLN
itraconazole CAPS 1 QL(4 ea daily);
PA levocetirizine 1 QL(1 ea daily);
1 QL(20 ml dihydrochloride TABS RX/OTC
itraconazole SOLN
daily); PA loratadine CAPS 1
ketoconazole 1 loratadine CHEW 1
NOXAFIL SUSP 3 QL(20 ml daily) loratadine SOLN 1
(posaconazole) 1
loratadine TABS
posaconazole SUSP 1 QL(20 ml daily)
loratadine TBDP 1
TOLSURA CAPS 4 PA
QUZYTTIR SOLN IV 3 PA
voriconazole TABS 1 QL(4 ea daily)
ZYRTEC ALLERGY TABS 1 QL(1 ea daily)
ANTIHISTAMINES - Drugs to Treat Allergies (cetirizine hcl)
18
Antihistamines - Phenothiazines Fibric Acid Derivatives
promethazine hcl SOLN 1 choline fenofibrate 1 QL(1 ea daily)
25 MG/ML, 50 MG/ML fenofibrate micronized 67 1 QL(1 ea daily)
promethazine hcl SUPP 1 MG, 134 MG, 200 MG
50 MG fenofibrate TABS 48 MG, 1 QL(1 ea daily)
promethazine hcl SUPP 1 QL(6 ea daily) 54 MG, 145 MG, 160 MG
12.5 MG, 25 MG gemfibrozil TABS 1 QL(2 ea daily)
promethazine hcl SYRP 1
HMG CoA Reductase Inhibitors
promethazine hcl TABS 1
atorvastatin calcium TABS 1 QL(1 ea daily)
Antihistamines - Piperidines 1 QL(1 ea daily)
fluvastatin sodium CAPS
cyproheptadine hcl SYRP 1 20 MG
cyproheptadine hcl TABS 1 fluvastatin sodium CAPS 1 QL(2 ea daily)
ANTIHYPERLIPIDEMICS - Drugs to Treat High 40 MG
lovastatin TABS 10 MG, 1 $0 copay for
Cholesterol 20 MG generic only,
Adenosine Triphosphate-Citrate Lyase (ACL) age 40 to 76;
QL(1 ea daily);
Inhibitors PV
1 PA lovastatin TABS 40 MG 1 $0 copay for
NEXLETOL generic only,
Antihyperlipidemics - Combinations age 40 to 76;
QL(2 ea daily);
ezetimibe-simvastatin 1 QL(1 ea daily) PV
Antihyperlipidemics - Misc. pravastatin sodium 1 QL(1 ea daily)
1 QL(4 ea daily); rosuvastatin calcium 3 QL(1 ea daily)
icosapent ethyl 1 GM TABS
PA
omega-3-acid ethyl esters 1 QL(4 ea daily) simvastatin TABS 1 QL(1 ea daily)
Bile Acid Sequestrants Intestinal Cholesterol Absorption Inhibitors
cholestyramine light 1 QL(6 ea daily) ezetimibe 1 QL(1 ea daily)
PACK Nicotinic Acid Derivatives
cholestyramine light 1 QL(24 gm
POWD daily) niacin (antihyperlipidemic) 1 QL(2 ea daily)
1 QL(6 ea daily) TBCR
cholestyramine PACK
cholestyramine POWD 1 QL(25.2 gm Proprotein Convertase Subtilisin/Kexin Type 9
daily) Inhibitors
colesevelam hcl PACK 1 QL(1 ea daily);
PA REPATHA PUSHTRONEX 1 QL(0.25 ml
1 QL(7 ea daily) SYSTEM SOCT daily); PA
colesevelam hcl TABS
1 QL(6 gm daily) REPATHA SURECLICK 1 QL(0.0714 ml
colestipol hcl GRAN daily); PA
SOAJ
colestipol hcl PACK 1 QL(6 ea daily)
REPATHA SOSY 1 QL(0.0714 ml
colestipol hcl TABS 1 QL(16 ea daily) daily); PA
19
ANTIHYPERTENSIVES - Drugs to Treat High doxazosin mesylate 1
Blood Pressure guanfacine hcl 1
methyldopa TABS 1 QL(6 ea daily)
ACE Inhibitors
prazosin hcl CAPS 1 QL(4 ea daily)
benazepril hcl 1
terazosin hcl 1
captopril 25 MG, 50 MG, 1 QL(3 ea daily)
100 MG Antihypertensive Combinations
captopril 12.5 MG 1 amlodipine besylate- 1
enalapril maleate TABS 1 benazepril hcl
fosinopril sodium 1 amlodipine besylate- 1 PA
olmesartan medoxomil
lisinopril TABS 2.5 MG, 5 1
MG, 10 MG, 20 MG, 30 amlodipine besylate- 1 QL(1 ea daily)
MG, 40 MG valsartan
moexipril hcl 1 QL(2 ea daily) amlodipine-valsartan- 3
hydrochlorothiazide
perindopril erbumine 2 1 QL(2 ea daily)
MG, 8 MG atenolol & chlorthalidone 1
perindopril erbumine 4 1 benazepril & 1
MG hydrochlorothiazide 12.5
MG-20 MG, 6.25 MG-5
quinapril hcl 5 MG, 10 MG 1 QL(2 ea daily) MG
quinapril hcl 20 MG, 40 1 benazepril & 1 QL(1 ea daily)
MG hydrochlorothiazide 12.5
ramipril CAPS 1 MG-10 MG, 25 MG-20
trandolapril 1 MG, 2 MG 1 QL(1 ea daily) MG
1 QL(2 ea daily) bisoprolol & 1 QL(2 ea daily)
trandolapril 4 MG
hydrochlorothiazide
Agents for Pheochromocytoma candesartan cilexetil- 1
phenoxybenzamine hcl 3 PA hydrochlorothiazide
enalapril maleate & 1
Angiotensin II Receptor Antagonists hydrochlorothiazide 25
candesartan cilexetil 1 QL(1 ea daily) MG-10 MG
EDARBI 3 QL(1 ea daily); enalapril maleate & 1 QL(2 ea daily)
PA hydrochlorothiazide 12.5
irbesartan 1 QL(1 ea daily) MG-5 MG
losartan potassium 1 QL(1 ea daily) fosinopril sodium & 1 QL(1 ea daily)
1 QL(1 ea daily) hydrochlorothiazide
olmesartan medoxomil
1
telmisartan 1 QL(1 ea daily) irbesartan-
hydrochlorothiazide
valsartan TABS 1 QL(1 ea daily) 1
lisinopril &
Antiadrenergic Antihypertensives hydrochlorothiazide
3 QL(0.15 ea losartan potassium & 1 QL(2 ea daily)
clonidine hydrochlorothiazide 12.5
daily)
clonidine hcl TABS 1 QL(8 ea daily) MG-50 MG
20
losartan potassium & 1 QL(1 ea daily) eplerenone 1
hydrochlorothiazide 12.5
MG-100 MG, 25 MG-100 Vasodilators
MG hydralazine hcl SOLN 1
metoprolol & 1 hydralazine hcl TABS 1
hydrochlorothiazide TABS 1
25 MG-100 MG, 50 MG- minoxidil 2.5 MG, 10 MG
100 MG ANTI-INFECTIVE AGENTS - MISC. - Drugs to
metoprolol & 1 QL(1 ea daily) Treat Bacterial Infections
hydrochlorothiazide TABS
25 MG-50 MG Anti-infective Agents - Misc.
olmesartan medoxomil- 1 PA bacitracin 3
amlodipine- 3 QL(3 ea daily);
hydrochlorothiazide IMPAVIDO
PA
olmesartan medoxomil- 1 metronidazole TABS 1
hydrochlorothiazide 1
trimethoprim TABS
quinapril- 1 QL(4 ea daily)
XIFAXAN 3 QL(3 ea daily);
hydrochlorothiazide 12.5 AL(At least 12
MG-20 MG yrs old); PA
quinapril- 1 QL(2 ea daily)
hydrochlorothiazide 25 Anti-infective Misc. - Combinations
MG-20 MG sulfamethoxazole- 1
quinapril- 1 QL(3 ea daily) trimethoprim SOLN
hydrochlorothiazide 12.5 sulfamethoxazole- 1
MG-10 MG trimethoprim SUSP
telmisartan-amlodipine 1 QL(1 ea daily) sulfamethoxazole- 1
telmisartan- 1 QL(1 ea daily) trimethoprim TABS
hydrochlorothiazide Antiprotozoal Agents
trandolapril-verapamil hcl 3
ALINIA SUSR 2 PA
180 MG-2 MG, 240 MG-1
MG atovaquone 1
trandolapril-verapamil hcl 3 QL(1 ea daily) nitazoxanide TABS 1 PA
240 MG-2 MG, 240 MG-4
MG Carbapenems
valsartan- 1 QL(1 ea daily) ertapenem sodium IJ 1
hydrochlorothiazide imipenem-cilastatin IV 1
Antihypertensives - Misc. meropenem 1
VECAMYL 3 PA Chloramphenicols
Direct Renin Inhibitors chloramphenicol sodium 4 PA
1 QL(1 ea daily) succinate
aliskiren fumarate
Cyclic Lipopeptides
Selective Aldosterone Receptor Antagonists
daptomycin 500 MG 1
(SARAs)
21
Glycopeptides nitrofurantoin 1
macrocrystal 50 MG, 100
vancomycin hcl CAPS 1 QL(4 ea daily; MG
40 ea per fill 1
retail) nitrofurantoin monohyd
vancomycin hcl SOLR OR 1 QL(300 ml per macro
25 MG/ML, 50 MG/ML, fill retail) ANTIMALARIALS - Drugs to Treat Malaria
250 MG/5ML (Parasitic Infections)
vancomycin hcl SOLR IV 1
1 GM, 10 GM, 500 MG, Antimalarial Combinations
1000 MG atovaquone-proguanil hcl 1 Covered for
Leprostatics malaria
treatment only.
dapsone 1 Limit 1 fill every
180 days; 1 rtl
Lincosamides MAX fill; 180 rtl
clindamycin hcl 1 day(s) supply;
1 mail MAX fill;
clindamycin palmitate 1 QL(12 ea per
hydrochloride fill retail; 12 per
clindamycin phosphate 1 fill mail)
SOLN IJ 9 GM/60ML, 300 COARTEM 2 Covered for
MG/2ML, 600 MG/4ML, malaria
900 MG/6ML, 9000 treatment only.
MG/60ML Limit 1 fill every
lincomycin hcl 1 180 days; 1 rtl
MAX fill; 180 rtl
Monobactams day(s) supply;
1 1 mail MAX fill;
aztreonam 1 GM QL(24 ea per
CAYSTON 4 QL(3 ml daily); fill retail; 24 per
PA fill mail)
Oxazolidinones Antimalarials
linezolid SUSR 1 chloroquine phosphate 1
linezolid TABS 1 QL(2 ea daily); TABS 500 MG
PA chloroquine phosphate 1 QL(3 ea daily)
SIVEXTRO TABS 3 PA TABS 250 MG
Polymyxins hydroxychloroquine 1 QL(3 ea daily)
sulfate 200 MG
polymyxin b sulfate SOLR 1
KRINTAFEL 3 QL(2 ea per 30
Urinary Anti-infectives days retail)
fosfomycin tromethamine 1
methenamine hippurate 1
nitrofurantoin 1
22
mefloquine hcl 1 Covered for PRIFTIN 3
malaria 1
treatment only. pyrazinamide
Limit 1 fill every rifabutin 1 PA
180 days; 1 rtl rifampin CAPS 1
MAX fill; 180 rtl
rifampin SOLR 1
day(s) supply;
1 mail MAX fill; SIRTURO 3 PA
QL(5 ea daily) TRECATOR 3 QL(4 ea daily)
primaquine phosphate 3
TABS ANTINEOPLASTICS AND ADJUNCTIVE
pyrimethamine 1 QL(3 ea daily); THERAPIES - Drugs to Treat Cancer
PA
1 PA Alkylating Agents
quinine sulfate CAPS 324
MG bendamustine hcl SOLR 4 PA
ANTIMYASTHENIC/CHOLINERGIC AGENTS busulfan SOLN 4 PA
Antimyasthenic/Cholinergic Agents carboplatin SOLN 50 4 SP; PA
MG/5ML
FIRDAPSE 4 PA 4 PA
carmustine
neostigmine methylsulfate 3 PA 4 SP; PA
cisplatin SOLN 100
SOSY MG/100ML
NEOSTIGMINE 3 PA 1 PA
cyclophosphamide CAPS
METHYLSULFATE SOSY
3 MG/3ML cyclophosphamide SOLR 4 SP; PA
1 IJ
pyridostigmine bromide
SOLN OR GLEOSTINE 10 MG 4 PA
pyridostigmine bromide 1 GLEOSTINE 40 MG, 100 4 PA
TABS 60 MG MG
pyridostigmine bromide 1 ifosfamide SOLN 1 4 SP; PA
TBCR GM/20ML
RUZURGI 4 QL(10 ea ifosfamide SOLR 4 PA
daily); PA LEUKERAN 4 PA
ANTIMYCOBACTERIAL AGENTS - Drugs to Treat melphalan 1
Tuberculosis (Bacterial Infections) melphalan hcl 1
Antimycobacterial Agents MYLERAN TABS 4 PA
CAPASTAT SULFATE 3 oxaliplatin SOLN 50 4 PA
MG/10ML, 100 MG/20ML
cycloserine 1 QL(4 ea daily)
TEMODAR SOLR 4 PA
ethambutol hcl TABS 1
temozolomide CAPS 4 PA
isoniazid SOLN 1
thiotepa 15 MG 4 PA
isoniazid SYRP 1
TREANDA SOLR 4 PA
isoniazid TABS 1 (bendamustine hcl)
PASER PACK 3 QL(3 ea daily) ZANOSAR 4 PA
23
Antimetabolites LENVIMA 12MG DAILY 4 QL(3 ea daily);
DOSE PA
ALIMTA SOLR 500 MG 4 PA 4 QL(2 ea daily);
LENVIMA 14 MG DAILY
(pemetrexed disodium) DOSE PA
azacitidine SUSR 4 PA 4 QL(3 ea daily);
LENVIMA 18 MG DAILY
capecitabine 4 PA DOSE PA
clofarabine 4 PA LENVIMA 20 MG DAILY 4 QL(2 ea daily);
cytarabine SOLN 4 SP; PA DOSE PA
decitabine 4 PA LENVIMA 24 MG DAILY 4 QL(3 ea daily);
DOSE PA
floxuridine 4 SP; PA
LENVIMA 4 MG DAILY 4 QL(1 ea daily);
fludarabine phosphate 4 SP; PA PA
DOSE
SOLN
LENVIMA 8 MG DAILY 4 QL(2 ea daily);
fludarabine phosphate 4 PA PA
DOSE
SOLR
MVASI 4 PA
fluorouracil 500 MG/10ML 4 SP; PA
ZALTRAP 100 MG/4ML 4 PA
FOLOTYN 4 PA
ZIRABEV 4 PA
gemcitabine hcl SOLR 4 PA
200 MG Antineoplastic - Antibodies
gemcitabine hcl SOLR 2 4 SP; PA ADCETRIS 4 PA
GM 4 PA
ARZERRA
mercaptopurine TABS 1
RUXIENCE 4 PA
methotrexate sodium 1
TRUXIMA 4 PA
SOLN 50 MG/2ML, 250
MG/10ML YERVOY 4 PA
methotrexate sodium 1 Antineoplastic - Anti-HER2 Agents
SOLR
1 KANJINTI 4 PA
methotrexate sodium
TABS 2.5 MG OGIVRI 4 PA
nelarabine 4 SP; PA PERJETA 4 PA
pemetrexed disodium 4 PA TRAZIMERA 4 PA
SOLR 500 MG TUKYSA 4 PA
pralatrexate 20 MG/ML 4 PA
Antineoplastic - EGFR Inhibitors
TABLOID 4 PA
ERBITUX 4 PA
TREXALL TABS 5 MG, 4 PA
7.5 MG, 10 MG, 15 MG erlotinib hcl 4 QL(1 ea daily);
PA
Antineoplastic - Angiogenesis Inhibitors gefitinib 4 PA
INLYTA 4 QL(2 ea daily); GILOTRIF 4 QL(1 ea daily);
PA PA
LENVIMA 10 MG DAILY 4 QL(1 ea daily); IRESSA (gefitinib) 4 PA
DOSE PA TAGRISSO 4 PA
24
VECTIBIX 100 MG/5ML 4 PA LYSODREN 4 PA
VIZIMPRO 4 PA megestrol acetate SUSP 1
Antineoplastic - Hedgehog Pathway Inhibitors megestrol acetate TABS 1
nilutamide 1 QL(2 ea daily)
DAURISMO 4 PA
NUBEQA 4 QL(4 ea daily);
ERIVEDGE 4 QL(1 ea daily); PA
PA
tamoxifen citrate TABS 0
ODOMZO 4 QL(1 ea daily);
PA tamoxifen citrate TABS 0
Antineoplastic - Hormonal and Related Agents toremifene citrate 1
abiraterone acetate 250 4 QL(4 ea daily); TRELSTAR MIXJECT 4 PA
MG PA XTANDI CAPS 4 QL(4 ea daily);
abiraterone acetate 500 4 QL(2 ea daily); PA
MG PA XTANDI TABS 80 MG 4 QL(2 ea daily);
PA
anastrozole 1 QL(1 ea daily) 4 QL(4 ea daily);
XTANDI TABS 40 MG
bicalutamide 4 QL(1 ea daily); PA
PA YONSA 4 QL(4 ea daily);
ELIGARD SC 22.5 MG, 30 4 PA PA
MG, 45 MG ZOLADEX 3.6 MG 4 QL(0.0357 ea
ELIGARD KIT SC 7.5 MG 4 QL(0.0089 ea daily); PA
daily); PA ZOLADEX 10.8 MG 4 QL(0.0119 ea
EMCYT 4 PA daily); PA
ERLEADA 60 MG 4 QL(4 ea daily); Antineoplastic - Immunomodulators
PA POMALYST 4 QL(1 ea daily);
ERLEADA 240 MG 4 QL(1 ea daily); PA
PA
4 QL(1 ea daily) Antineoplastic - PDGFR-alpha Inhibitors
exemestane
FIRMAGON 4 QL(0.143 ea AYVAKIT 4 QL(1 ea daily);
daily); PA PA
flutamide 4 QL(6 ea daily); Antineoplastic - XPO1 Inhibitors
SP; PA
4 QL(0.357 ml XPOVIO 80 MG TWICE 4 PA
fulvestrant SOSY
daily); PA WEEKLY
letrozole 1 Antineoplastic Antibiotics
leuprolide acetate KIT IJ 1 4 SP; PA 4 SP; PA
bleomycin sulfate 15 UNIT
MG/0.2ML
dactinomycin 4 PA
LUPRON DEPOT (1- 4 QL(0.0357 ea
MONTH) KIT IM daily); PA doxorubicin hcl liposomal 4 PA
LUPRON DEPOT (3- 4 PA doxorubicin hcl SOLN 4 SP; PA
MONTH) KIT IM doxorubicin hcl SOLR 10 4 PA
LUPRON DEPOT (4- 4 QL(0.1339 ea MG, 50 MG
MONTH) IM daily); PA epirubicin hcl SOLN 50 4 PA
LUPRON DEPOT (6- 4 QL(0.0089 ea MG/25ML
MONTH) IM daily); PA
25
idarubicin hcl 5 MG/5ML, 4 PA COMETRIQ KIT 4 QL(4 ea daily);
10 MG/10ML PA
4 PA COPIKTRA 4 PA
idarubicin hcl 20
MG/20ML everolimus TABS 4 QL(1 ea daily);
4 SP; PA PA
mitomycin SOLR IV 20
MG IBRANCE CAPS 3 PA
mitoxantrone hcl 2 MG/ML 4 SP; PA IBRANCE TABS 3 PA
valrubicin 4 PA ICLUSIG 4 QL(1 ea daily);
PA
Antineoplastic Combinations imatinib mesylate 4 QL(2 ea daily);
PA
KISQALI FEMARA 200 3 PA
IMBRUVICA CAPS 70 MG 4 QL(1 ea daily);
DOSE PA
KISQALI FEMARA 400 3 PA IMBRUVICA CAPS 140 4 QL(3 ea daily);
DOSE MG PA
KISQALI FEMARA 600 3 PA IMBRUVICA SUSP 4 QL(8 ml daily);
DOSE PA
IMBRUVICA TABS 4 QL(1 ea daily);
Antineoplastic Enzyme Inhibitors PA
ALECENSA 4 QL(4 ea daily); INREBIC 4 PA
PA 4 PA
4 QL(1 ea daily); ISTODAX (OVERFILL)
ALUNBRIG TABS SOLR (romidepsin)
PA
ALUNBRIG TBPK 4 QL(1 ea daily); JAKAFI 5 MG, 15 MG, 25 4 QL(2 ea daily);
PA MG PA
BALVERSA 4 PA JAKAFI 10 MG, 20 MG 4 QL(2 ea daily);
4 PA SP; PA
bortezomib SOLR IJ
KISQALI 3 PA
BORTEZOMIB SOLR IV 4 PA
3.5 MG KOSELUGO 4 PA
BOSULIF 4 QL(1 ea daily); KYPROLIS 4 PA
PA lapatinib ditosylate 4 QL(6 ea daily);
BRAFTOVI 75 MG 4 PA PA
BRUKINSA 4 PA LORBRENA 4 QL(1 ea daily);
PA
CABOMETYX TABS 4 QL(1 ea daily); 4 QL(4 ea daily);
PA LYNPARZA TABS
PA
CALQUENCE 4 QL(2 ea daily); 4 QL(3 ea daily);
PA MEKINIST TABS 0.5 MG
PA
CALQUENCE 4 QL(2 ea daily); 4 QL(1 ea daily);
PA MEKINIST TABS 2 MG
PA
CAPRELSA 4 QL(1 ea daily); 4 PA
PA MEKTOVI
COMETRIQ KIT 4 QL(2 ea daily); NEXAVAR (sorafenib 4 QL(4 ea daily);
PA tosylate) PA
COMETRIQ KIT 4 QL(3 ea daily); NINLARO 4 QL(0.143 ea
PA daily); PA
26
PEMAZYRE 4 QL(1 ea daily); XALKORI 4 QL(2 ea daily);
PA PA
PIQRAY 200MG DAILY 4 PA XOSPATA 4 PA
DOSE ZEJULA CAPS 4 QL(3 ea daily);
PIQRAY 250MG DAILY 4 PA PA
DOSE ZELBORAF 4 PA
PIQRAY 300MG DAILY 4 PA ZOLINZA 4 QL(4 ea daily);
DOSE PA
QINLOCK 4 PA ZYDELIG 4 QL(2 ea daily);
PA
RETEVMO 4 PA
Antineoplastic Enzymes
romidepsin SOLR 4 PA
4 PA ERWINASE 4 PA
ROZLYTREK
4 QL(4 ea daily); ONCASPAR 4 PA
RUBRACA
PA Antineoplastics Misc.
sorafenib tosylate 4 QL(4 ea daily);
PA ACTIMMUNE 4 PA
SPRYCEL 4 QL(1 ea daily); arsenic trioxide 10 4 SP; PA
PA MG/10ML
STIVARGA 4 QL(4 ea daily); 4 PA
PA bexarotene
sunitinib malate 12.5 MG, 4 QL(1 ea daily); dacarbazine SOLR 200 4 SP; PA
25 MG, 50 MG SP; PA MG
TABRECTA 4 PA hydroxyurea 1
TAFINLAR CAPS 4 QL(4 ea daily); INTRON A SOLR 4 PA
PA 18000000 UNIT
TALZENNA 0.25 MG, 0.5 4 QL(1 ea daily); MATULANE 4 PA
MG, 0.75 MG, 1 MG PA 4 PA
PHOTOFRIN
TASIGNA 4 QL(4 ea daily); 4 PA
PA PROLEUKIN
TAZVERIK 4 PA SYNRIBO 4 PA
temsirolimus 4 QL(0.143 ml tretinoin (chemotherapy) 1
daily); PA UVADEX 4 PA
TIBSOVO 4 PA
4 AC; PA Chemotherapy Adjuncts
TURALIO
4 PA KEPIVANCE 4 PA
TURALIO
VELCADE SOLR IJ 4 PA Chemotherapy Rescue/Antidote/Protective Agents
(bortezomib) leucovorin calcium SOLR 1
VERZENIO 4 PA 1
leucovorin calcium TABS
VITRAKVI CAPS 4 PA 4 PA
VORAXAZE
VITRAKVI SOLN 4 PA
VOTRIENT 4 QL(4 ea daily); Mitotic Inhibitors
PA ABRAXANE 4 PA
27
docetaxel CONC 20 4 PA trihexyphenidyl hcl TABS 1
MG/ML
Antiparkinson COMT Inhibitors
docetaxel SOLN 20 4 SP; PA
MG/2ML entacapone 1 QL(8 ea daily)
ETOPOPHOS 4 PA tolcapone 1
etoposide CAPS 4 PA Antiparkinson Dopaminergics
etoposide SOLN 1 4 SP; PA 1
amantadine hcl CAPS
GM/50ML, 100 MG/5ML,
500 MG/25ML amantadine hcl SOLN 1
HALAVEN 4 PA amantadine hcl TABS 1
IXEMPRA KIT 15 MG 4 PA APOKYN SOCT 4 PA
JEVTANA 4 PA apomorphine 4 PA
4 PA hydrochloride SOCT
paclitaxel 150 MG/25ML
bromocriptine mesylate 1
paclitaxel 6 MG/ML, 100 4 SP; PA
CAPS
MG/16.7ML
bromocriptine mesylate 1
paclitaxel protein-bound 4 PA
TABS 2.5 MG
particles
carbidopa-levodopa- 1
PACLITAXEL PROTEIN- 4 PA
entacapone
BOUNDPARTICLES
carbidopa-levodopa TABS 1
TENIPOSIDE 4 PA
carbidopa-levodopa 1
vincristine sulfate 4 PA
TBCR
vinorelbine tartrate 10 4 PA 1
carbidopa-levodopa TBDP
MG/ML
NEUPRO 2
Topoisomerase I Inhibitors 1
pramipexole
HYCAMTIN CAPS 4 PA dihydrochloride TABS
irinotecan hcl 40 MG/2ML, 4 PA 0.25 MG, 0.5 MG, 0.75
100 MG/5ML MG, 1 MG, 1.5 MG
4 PA pramipexole 1 QL(4 ea daily)
topotecan hcl SOLR dihydrochloride TABS
ANTIPARKINSON AND RELATED THERAPY 0.125 MG
AGENTS - Drugs to Treat Parkinson's Disease ropinirole hydrochloride 1
TABS
Antiparkinson Adjunctive Therapy 1 QL(1 ea daily);
ropinirole hydrochloride
carbidopa 1 TB24 2 MG, 4 MG, 6 MG PA
Antiparkinson Anticholinergics ropinirole hydrochloride 1 QL(2 ea daily);
TB24 8 MG, 12 MG PA
benztropine mesylate 1
SOLN Antiparkinson Monoamine Oxidase Inhibitors
benztropine mesylate 1 rasagiline mesylate 1 QL(1 ea daily);
TABS PA
1 selegiline hcl CAPS 1
trihexyphenidyl hcl SOLN
selegiline hcl TABS 1
28
ANTIPSYCHOTICS/ANTIMANIC AGENTS - Drugs haloperidol decanoate 1 QL(0.036 ml
daily)
to Treat Mood Disorders haloperidol lactate CONC 1
Antimanic Agents haloperidol lactate SOLN 1
lithium carbonate CAPS 1 haloperidol TABS 1
lithium carbonate TABS 1 Dibenzapines
lithium carbonate TBCR 1 1 QL(2 ea daily);
asenapine maleate 5 MG,
Antipsychotics - Misc. 10 MG PA
1 QL(4 ea daily);
EQUETRO 200 MG 3 QL(8 ea daily); asenapine maleate 2.5 PA
PA MG
EQUETRO 300 MG 3 QL(4 ea daily); clozapine TABS 1
PA clozapine TBDP 100 MG 1 QL(9 ea daily)
EQUETRO 100 MG 3 QL(2 ea daily);
PA clozapine TBDP 25 MG 1 QL(3 ea daily)
LATUDA 80 MG 3 QL(2 ea daily) clozapine TBDP 12.5 MG 1 QL(6 ea daily)
(lurasidone hcl) clozapine TBDP 150 MG 1
LATUDA 20 MG, 40 MG, 3 QL(1 ea daily) clozapine TBDP 200 MG 1 QL(4 ea daily)
60 MG, 120 MG 1
(lurasidone hcl) loxapine succinate
1 QL(2 ea daily) olanzapine SOLR 1 QL(0.215 ea
lurasidone hcl 80 MG daily)
lurasidone hcl 20 MG, 40 1 QL(1 ea daily) olanzapine TABS 2.5 MG, 1 QL(4 ea daily)
MG, 60 MG, 120 MG 5 MG
ziprasidone hcl 1 QL(2 ea daily); olanzapine TABS 7.5 MG, 1 QL(2 ea daily)
AL(At least 18 10 MG, 15 MG, 20 MG
yrs old)
olanzapine TBDP 20 MG 1 QL(1 ea daily)
Benzisoxazoles
olanzapine TBDP 5 MG, 1 QL(2 ea daily)
FANAPT 2 QL(2 ea daily); 10 MG, 15 MG
PA 1 QL(4 ea daily);
2 PA quetiapine fumarate TABS
FANAPT TITRATION 25 MG, 50 MG, 100 MG, AL(At least 10
PACK 200 MG yrs old)
paliperidone 6 MG 1 QL(2 ea daily) 1 QL(2 ea daily);
quetiapine fumarate TABS
paliperidone 1.5 MG, 3 1 QL(1 ea daily) 300 MG, 400 MG AL(At least 10
MG, 9 MG yrs old)
PERSERIS PRSY 2 QL(0.072 ea quetiapine fumarate TB24 1 QL(1 ea daily);
daily); PA 50 MG, 150 MG, 200 MG PA
RISPERDAL CONSTA 2 QL(0.072 ea quetiapine fumarate TB24 1 QL(2 ea daily);
daily); PA 300 MG, 400 MG PA
risperidone SOLN 1 QL(8 ml daily)
Phenothiazines
risperidone TABS 1 QL(4 ea daily)
1 QL(4 ea daily) chlorpromazine hcl SOLN 3
risperidone TBDP
chlorpromazine hcl TABS 1
Butyrophenones 1
fluphenazine hcl CONC
29
fluphenazine hcl ELIX 1 DELSTRIGO 3 QL(1 ea daily)
fluphenazine hcl SOLN 1 DOVATO 2 QL(1 ea daily)
fluphenazine hcl TABS 1 EDURANT 2 QL(1 ea daily)
perphenazine TABS 1 efavirenz CAPS 200 MG 1 QL(2 ea daily)
prochlorperazine 1 efavirenz CAPS 50 MG 1 QL(3 ea daily)
prochlorperazine maleate 1 efavirenz-emtricitabine- 1 QL(1 ea daily)
TABS tenofovir disoproxil
thioridazine hcl 1 fumarate
1 efavirenz-lamivudine- 1 QL(1 ea daily)
trifluoperazine hcl TABS
tenofovir disoproxil
Quinolinone Derivatives fumarate
aripiprazole SOLN OR 1 QL(30 ml efavirenz TABS 1 QL(1 ea daily)
daily); AL(At emtricitabine CAPS 1 QL(1 ea daily)
least 6 yrs old) 1 QL(1 ea daily)
1 QL(1 ea daily); emtricitabine-tenofovir
aripiprazole TABS disoproxil fumarate 100
AL(At least 6
yrs old) MG-150 MG, 133 MG-200
3 PA MG, 167 MG-250 MG
REXULTI
emtricitabine-tenofovir 0 QL(1 ea daily)
Thioxanthenes disoproxil fumarate 200
thiothixene 1 MG-300 MG
EMTRIVA CAPS 2 QL(1 ea daily)
ANTIVIRALS - Drugs to Treat Viral Infections (emtricitabine)
Antiretrovirals EMTRIVA SOLN 2 QL(24 ml daily)
abacavir sulfate- 1 QL(1 ea daily) etravirine 100 MG 1 QL(4 ea daily)
lamivudine etravirine 200 MG 1 QL(2 ea daily)
abacavir sulfate- 1 QL(2 ea daily) EVOTAZ 3 QL(1 ea daily)
lamivudine-zidovudine 1 QL(4 ea daily)
fosamprenavir calcium
abacavir sulfate SOLN 1 QL(32 ml daily) TABS
abacavir sulfate TABS 1 QL(2 ea daily) FUZEON SOLR 4 PA
APTIVUS CAPS 2 QL(4 ea daily) GENVOYA 3 QL(1 ea daily)
atazanavir sulfate CAPS 1 QL(2 ea daily) INTELENCE 25 MG 2 QL(8 ea daily)
200 MG 2 QL(4 ea daily)
INVIRASE TABS
atazanavir sulfate CAPS 1 QL(1 ea daily)
ISENTRESS HD TABS 2 QL(2 ea daily)
150 MG, 300 MG
3 QL(1 ea daily) ISENTRESS CHEW 2 QL(6 ea daily)
BIKTARVY
2 QL(1 ea daily); ISENTRESS TABS 2 QL(2 ea daily)
CIMDUO
PA JULUCA 3 QL(1 ea daily)
COMPLERA 3 QL(1 ea daily) lamivudine SOLN 1 QL(30 ml daily)
CRIXIVAN 400 MG 2 QL(6 ea daily) lamivudine TABS 300 MG 1 QL(1 ea daily)
darunavir TABS 600 MG 1 QL(2 ea daily) lamivudine TABS 150 MG 1 QL(2 ea daily)
darunavir TABS 800 MG 1 QL(1 ea daily) lamivudine-zidovudine 1 QL(2 ea daily)
30
LEXIVA SUSP 2 QL(56 ml daily) TRIUMEQ TABS 3 QL(1 ea daily)
lopinavir-ritonavir SOLN 1 QL(12.5 ml TRIZIVIR 2 QL(2 ea daily)
daily) 2 QL(1 ea daily)
TYBOST
lopinavir-ritonavir TABS 1 QL(4 ea daily)
VIRACEPT TABS 250 MG 2 QL(10 ea daily)
maraviroc TABS 300 MG 1 QL(4 ea daily)
VIRACEPT TABS 625 MG 2 QL(4 ea daily)
maraviroc TABS 150 MG 1 QL(2 ea daily)
VIREAD POWD 2 QL(7.5 gm
nevirapine SUSP 1 QL(40 ml daily) daily)
nevirapine TABS 1 QL(2 ea daily) VIREAD TABS 150 MG, 2 QL(1 ea daily)
nevirapine TB24 100 MG 1 QL(3 ea daily) 200 MG, 250 MG
1 QL(1 ea daily) zidovudine CAPS 1 QL(6 ea daily)
nevirapine TB24 400 MG
2 QL(12 ea daily) zidovudine SYRP 1 QL(60 ml daily)
NORVIR PACK
2 QL(15 ml daily) zidovudine TABS 1 QL(2 ea daily)
NORVIR SOLN
ODEFSEY 3 QL(1 ea daily) CMV Agents
PIFELTRO 2 QL(1 ea daily) cidofovir 3
PREZCOBIX 2 QL(1 ea daily) ganciclovir sodium SOLR 1
PREZISTA SUSP 2 QL(12 ml daily) valganciclovir hcl TABS 1 QL(4 ea daily);
PREZISTA TABS 800 MG 2 QL(1 ea daily) PA
(darunavir) Hepatitis Agents
PREZISTA TABS 75 MG, 2 QL(2 ea daily) adefovir dipivoxil 4 QL(1 ea daily);
150 MG, 600 MG PA
PREZISTA TABS 2 QL(2 ea daily) BARACLUDE SOLN 4 QL(20 ml
(darunavir) daily); PA
1 entecavir TABS 4 QL(1 ea daily);
RETROVIR IV INFUSION PA
SOLN
EPCLUSA PACK 4 QL(1 ea daily);
ritonavir TABS 1 QL(12 ea daily) PA
RUKOBIA 4 PA EPCLUSA TABS 100 MG- 4 MO
SELZENTRY SOLN 2 QL(30 ml daily) 400 MG
2 QL(4 ea daily) EPCLUSA TABS 50 MG- 4 QL(1 ea daily);
SELZENTRY TABS 300 PA
MG (maraviroc) 200 MG
2 QL(2 ea daily) EPIVIR HBV SOLN 4 QL(60 ml
SELZENTRY TABS daily); PA
(maraviroc) 1 QL(3 ea daily)
lamivudine (hbv) TABS
SELZENTRY TABS 25 2 QL(2 ea daily)
PEGASYS SOLN 1 QL(0.0714 ml
MG, 75 MG, 150 MG daily); PA
stavudine CAPS 1 QL(2 ea daily) PEGASYS SOSY 4 QL(0.072 ml
STRIBILD 3 QL(1 ea daily) daily); PA
2 QL(1 ea daily); ribavirin (hepatitis c) 1 QL(7 ea daily)
TEMIXYS
PA CAPS
tenofovir disoproxil 1 ribavirin (hepatitis c) 1 QL(7 ea daily)
fumarate TABS TABS 200 MG
TIVICAY TABS 3 QL(2 ea daily)
31
SOVALDI TABS 4 QL(1 ea daily); labetalol hcl SOLN 1
PA 1
QL(1 ea daily); labetalol
4 hcl TABS 100
VOSEVI MG, 200 MG
PA
labetalol hcl TABS 300 1 QL(8 ea daily)
Herpes Agents MG
acyclovir CAPS 1 QL(5 ea daily;
50 ea per fill Beta Blockers Cardio-Selective
retail; 50 per fill acebutolol hcl CAPS 1
mail) 1
acyclovir SUSP 1 QL(13.34 ml atenolol TABS
daily) betaxolol hcl 1
acyclovir TABS OR 1 QL(5 ea daily) bisoprolol fumarate 1
famciclovir 500 MG 1 QL(4 ea daily) metoprolol succinate 1
famciclovir 125 MG, 250 1 QL(3 ea daily) TB24 25 MG, 50 MG, 100
MG MG
valacyclovir hcl 500 MG 1 QL(2 ea daily) metoprolol succinate 1 QL(2 ea daily)
1 QL(4 ea daily) TB24 200 MG
valacyclovir hcl 1 GM,
1000 MG metoprolol tartrate SOLN 1
IV 5 MG/5ML
Influenza Agents metoprolol tartrate TABS 1
oseltamivir phosphate 1 Limit 1 fill every 25 MG, 50 MG, 100 MG
CAPS 90 days.; 1 rtl nebivolol hcl 2.5 MG, 5 3 QL(1 ea daily)
MAX fill; 90 rtl MG, 10 MG
day(s) supply;
1 mail MAX fill; nebivolol hcl 20 MG 3 QL(2 ea daily)
QL(10 ea per Beta Blockers Non-Selective
fill retail; 10 per
fill mail) HEMANGEOL SOLN OR 4 QL(75 ml
oseltamivir phosphate 1 Limit 1 fill every daily); PA
SUSR 90 days.; 1 rtl nadolol TABS 80 MG 1
MAX fill; 90 rtl nadolol TABS 20 MG 1 QL(3 ea daily)
day(s) supply;
QL(125 ml per nadolol TABS 40 MG 1 QL(6 ea daily)
fill retail) pindolol TABS 1
RELENZA DISKHALER 2 1 rtl pack lmt propranolol hcl CP24 1 QL(2 ea daily)
amt; 30 rtl pack
lmt day(s) propranolol hcl SOLN OR 1
rimantadine hydrochloride 1 QL(2 ea daily) 20 MG/5ML, 40 MG/5ML
TABS propranolol hcl TABS 1
BETA BLOCKERS - Drugs to Treat High Blood sotalol hcl (afib/afl) 1
Pressure sotalol hcl TABS 240 MG 1
sotalol hcl TABS 80 MG, 1 QL(2 ea daily)
Alpha-Beta Blockers 120 MG, 160 MG
carvedilol 1 timolol maleate TABS 1
carvedilol phosphate 3 QL(1 ea daily) CALCIUM CHANNEL BLOCKERS - Drugs to Treat
32
High Blood Pressure verapamil hcl TABS 1
verapamil hcl TBCR 1
Calcium Channel Blockers
1 CARDIOTONICS - Drugs to Treat Heart Failure
amlodipine besylate TABS
diltiazem hcl coated 1 QL(2 ea daily) and Abnormal Heart Rhythm
beads CP24 180 MG, 240 Cardiac Glycosides
MG
1 digoxin SOLN OR 0.05 1
diltiazem hcl coated MG/ML
beads CP24 120 MG, 300
MG, 360 MG digoxin TABS 0.0625 MG, 1
diltiazem hcl extended 1 0.125 MG, 0.25 MG, 62.5
release beads 120 MG, MCG, 125 MCG, 250
180 MG, 240 MG, 300 MCG
MG, 360 MG LANOXIN SOLN IJ 2
diltiazem hcl CP12 1 QL(2 ea daily) (digoxin)
1 LANOXIN TABS 62.5 2
diltiazem hcl CP24 MCG, 125 MCG, 250
diltiazem hcl SOLN 50 1 MCG (digoxin)
MG/10ML
CARDIOVASCULAR AGENTS - MISC. - Drugs to
DILTIAZEM HCL SOLR 1
1 Treat Heart and Circulation Conditions
diltiazem hcl TABS
diltiazem hcl TB24 1 Cardiovascular Agents Misc. - Combinations
felodipine 1 amlodipine besylate- 1 QL(1 ea daily)
isradipine CAPS 1 atorvastatin calcium
1 BIDIL (isosorbide 2
nicardipine hcl CAPS
dinitrate-hydralazine hcl)
nicardipine hcl SOLN 1
ENTRESTO 3 QL(2 ea daily);
nifedipine CAPS 10 MG 1 PA
nifedipine CAPS 20 MG 1 QL(9 ea daily) isosorbide dinitrate- 1
1 QL(2 ea daily) hydralazine hcl
nifedipine TB24 60 MG
nifedipine TB24 90 MG 1 QL(1 ea daily) Impotence Agents
nifedipine TB24 1 sildenafil citrate 1 QL(0.1334 ea
1 daily); PA
nimodipine CAPS 1 BPH Only;
tadalafil 5 MG
nisoldipine 8.5 MG, 17 1 QL(1 ea daily);
MG, 20 MG, 30 MG, 34 PA
MG, 40 MG
Prostaglandin Vasodilators
verapamil hcl CP24 120 1 QL(1 ea daily)
MG, 180 MG, 240 MG, epoprostenol sodium 4 PA
360 MG ORENITRAM TBCR 4 PA
verapamil hcl CP24 100 1 treprostinil SOLN IJ 4 PA
MG, 200 MG, 300 MG 4 PA
TYVASO REFILL SOLN
verapamil hcl SOLN 2.5 1 IN
MG/ML
33
TYVASO STARTER 4 PA Sinus Node Inhibitors
SOLN IN
4 PA CORLANOR SOLN 3 QL(15 ml
TYVASO SOLN IN daily); PA
Pulmonary Hypertension - Endothelin Receptor CORLANOR TABS 3 QL(2 ea daily);
PA
Antagonists
Transthyretin Stabilizers
ambrisentan 4
QL(1 ea daily);
PA VYNDAMAX 1
QL(1 ea daily);
4 QL(2 ea daily); PA
bosentan TABS
PA VYNDAQEL 4 QL(4 ea daily);
4 QL(1 ea daily); PA
OPSUMIT
PA CEPHALOSPORINS - Drugs to Treat Bacterial
TRACLEER TBSO 4 QL(2 ea daily); Infections
PA
Pulmonary Hypertension - Phosphodiesterase Cephalosporins - 1st Generation
Inhibitors cefadroxil CAPS 1
4 QL(37.5 ml cefadroxil SUSR 1
sildenafil citrate
(pulmonary hypertension) daily); PA cefadroxil TABS 1
SOLN cefazolin sodium SOLR IJ 1
sildenafil citrate 4 QL(6 ml daily); 1 GM, 10 GM, 500 MG
(pulmonary hypertension) PA cephalexin CAPS 1
SUSR 1
cephalexin SUSR
sildenafil citrate 4 QL(3 ea daily);
(pulmonary hypertension) PA cephalexin TABS 1
TABS Cephalosporins - 2nd Generation
tadalafil (pulmonary 4 QL(2 ea daily);
PA cefaclor CAPS 1
hypertension) TABS
cefaclor SUSR 125 1
Pulmonary Hypertension - Prostacyclin Receptor MG/5ML, 250 MG/5ML,
Agonist 375 MG/5ML
4 1 rtl MAX fill; cefotetan disodium IJ 1 1
UPTRAVI TITRATION
PACK TBPK 180 rtl day(s) GM, 2 GM
supply; PA cefoxitin sodium IV 1
UPTRAVI TABS 200 MCG 4 PA cefprozil SUSR 1
UPTRAVI TABS 400 4 QL(2 ea daily); cefprozil TABS 1
MCG, 600 MCG, 800 PA
cefuroxime axetil TABS 1
MCG, 1000 MCG, 1200
MCG, 1400 MCG, 1600 cefuroxime sodium IJ 750 1
MCG MG
Pulmonary Hypertension - Sol Guanylate Cyclase Cephalosporins - 3rd Generation
Stimulator cefdinir CAPS 1
ADEMPAS 4 QL(3 ea daily); cefdinir SUSR 1
PA cefixime CAPS 1
34
cefixime SUSR 1 PA levonorgestrel-ethinyl 0
cefotaxime sodium IJ 1 1 estradiol (91-day) 0.03
GM, 2 GM MG-0.15 MG
2 levonorgestrel-ethinyl 0
CEFOTAXIME SODIUM IJ
1 GM estradiol (continuous)
1 levonorgestrel-ethinyl 0
cefpodoxime proxetil
SUSR estradiol-ferrous
bisglycinate
cefpodoxime proxetil 1
LO LOESTRIN FE TABS 0
TABS
1 NATAZIA 0
ceftazidime IV 2 GM, 6
GM NEXTSTELLIS 0 QL(1 ea daily)
ceftriaxone sodium IJ 1 1 norethin acet & estrad-fe 0
GM, 2 GM, 250 MG, 500 CAPS
MG norethin acet & estrad-fe 0
Cephalosporins - 4th Generation CHEW
norethin acet & estrad-fe 0
cefepime hcl SOLR IV 2 1
GM TABS 1 MG-20 MCG-75
MG, 1.5 MG-30 MCG-75
Cephalosporins - 5th Generation MG
3 norethindrone & eth 0
TEFLARO
estradiol
CONTRACEPTIVES - Drugs to Prevent Pregnancy 0
norethindrone & ethinyl
Combination Contraceptives - Oral estradiol-fe
0 norethindrone acet & eth 0
BALCOLTRA
estra
desogestrel & ethinyl 0
norethindrone acetate- 0
estradiol
ethinyl estradiol-fe
desogestrel-ethinyl 0
norethindrone-eth 0
estradiol (biphasic)
estradiol (triphasic)
desogestrel-ethinyl 0
norgestimate-ethinyl 0
estradiol
drospirenone-ethinyl 0
norgestimate-ethinyl 0
estradiol
drospirenone-ethinyl 0
norgestrel & ethinyl 0
estradiol-levomefolate
calcium estradiol 30 MCG-0.3 MG
0 TYBLUME CHEW 0
ethynodiol diacet & eth
estrad Combination Contraceptives - Transdermal
FALESSA 0 0
norelgestromin-ethinyl
levonorgestrel & eth 0 estradiol
estradiol TABS TWIRLA 0 QL(3 ea per 28
levonorgestrel-eth 0 days retail)
estradiol (triphasic) Combination Contraceptives - Vaginal
35
ANNOVERA 0 PA methylprednisolone 1
etonogestrel-ethinyl 0 QL(0.05 ea acetate SUSP
estradiol daily) methylprednisolone sod 1
succ 40 MG, 125 MG, 500
Emergency Contraceptives MG, 1000 MG
ELLA 0 methylprednisolone TABS 1
levonorgestrel 0 methylprednisolone TBPK 1
(emergency oc) 1.5 MG prednisolone sodium 1
Progestin Contraceptives - Injectable phosphate SOLN 5
MG/5ML, 6.7 MG/5ML, 10
DEPO-SUBQ PROVERA 0 MG/5ML, 15 MG/5ML, 25
104 SUSY SC MG/5ML
medroxyprogesterone 0 1 rtl MAX fill; 90 prednisolone sodium 3
acetate (contraceptive) rtl day(s) phosphate TBDP
SUSP IM supply
prednisolone SOLN 1
medroxyprogesterone 0 QL(90 Day(s)
limit ; 1 ml per prednisolone TABS 1
acetate (contraceptive)
SUSY IM 90 days retail) prednisone SOLN 1
Progestin Contraceptives - Oral prednisone TABS 1
prednisone TBPK 1
norethindrone 0
(contraceptive) SOLU-CORTEF 100 MG, 3 2 rtl MAX fill; 30
rtl day(s)
SLYND 0 QL(1 ea daily) 500 MG, 1000 MG supply
CORTICOSTEROIDS - Steroid Hormone Drugs to SOLU-CORTEF 250 MG 3
Treat Systemic Swelling Conditions SOLU-MEDROL 2 GM 3
triamcinolone acetonide 1
Glucocorticosteroids
SUSP 40 MG/ML, 200
budesonide CPEP 1 QL(3 ea daily) MG/5ML, 400 MG/10ML
DEPO-MEDROL SUSP 3 Mineralocorticoids
DEXAMETHASONE 1 1
fludrocortisone acetate
INTENSOL CONC TABS
dexamethasone sodium 1
phosphate SOLN IJ 4 COUGH/COLD/ALLERGY - Drugs to Treat Cough,
MG/ML, 20 MG/5ML, 120 Cold and Allergy Symptoms
MG/30ML
1 Antitussives
dexamethasone ELIX
1 benzonatate 200 MG 1 QL(3 ea daily)
dexamethasone SOLN
1 benzonatate 100 MG 1 QL(6 ea daily)
dexamethasone TABS
4 PA benzonatate 150 MG 1 QL(4 ea daily)
EMFLAZA SUSP
EMFLAZA TABS 4 PA Cough/Cold/Allergy Combinations
hydrocortisone TABS 1 cetirizine- 1 QL(2 ea daily)
MEDROL TABS 3 pseudoephedrine
36
fexofenadine- 1 QL(2 ea daily) benzoyl peroxide GEL 10 1 AL(At least 12
pseudoephedrine TB12 % yrs old)
fexofenadine- 1 QL(1 ea daily) benzoyl peroxide GEL 5 1 QL(3 gm daily);
pseudoephedrine TB24 % AL(At least 12
1 yrs old)
hydrocodone polistirex- 1 AL(At least 12
chlorpheniramine benzoyl peroxide LIQD 4
%, 7 %, 10 % yrs old)
polistirex SUER
1 QL(2 ea daily) clindamycin phosphate 1 AL(At least 12
loratadine & yrs old); PA
pseudoephedrine TB12 (topical) FOAM
1 QL(1 ea daily) clindamycin phosphate 1 QL(8 gm daily);
loratadine & AL(At least 12
pseudoephedrine TB24 (topical) GEL
yrs old)
TUZISTRA XR 2 PA 1 AL(At least 12
clindamycin phosphate
Misc. Respiratory Inhalants (topical) LOTN yrs old)
clindamycin phosphate 1 QL(4 ml daily);
HYPERSAL NEBU 1 AL(At least 12
(topical) SOLN
NEBUSAL NEBU 1 yrs old)
sodium chloride (inhalant) 1 clindamycin phosphate 1 AL(At least 12
NEBU 7 % (topical) SWAB yrs old)
clindamycin phosphate- 1 AL(At least 12
Mucolytics benzoyl peroxide yrs old); PA
acetylcysteine SOLN 1 (refrigerate)
DERMATOLOGICALS - Drugs to Treat Skin clindamycin phosphate- 1 AL(At least 12
benzoyl peroxide GEL 5 yrs old); PA
Conditions %-1 %
Acne Products clindamycin phosphate- 1 AL(At least 12
tretinoin yrs old); PA
adapalene-benzoyl 1 AL(At least 12
peroxide GEL 2.5 %-0.1 yrs old); PA DIFFERIN LOTN 2 AL(At least 12
% yrs old); PA
erythromycin (acne aid) 1 AL(At least 12
adapalene CREA 1 AL(At least 12 yrs old)
yrs old); PA PADS
adapalene GEL 1 AL(At least 12 erythromycin (acne aid) 1 AL(At least 12
yrs old); PA SOLN yrs old)
AZELEX 3 AL(At least 12 isotretinoin 10 MG, 20 3 AL(At least 12
yrs old); PA MG, 30 MG, 40 MG yrs old); PA
BENZEPRO CREAMY 2 AL(At least 12 2 AL(At least 12
yrs old); PR BENZOYL PEROXIDE
WASH LIQD WASH LIQD yrs old);
RX/OTC RX/OTC
BENZOYL PEROXIDE 2 AL(At least 12 1 AL(At least 12
yrs old) sulfacetamide sodium
CLEANSER LIQD (acne) yrs old)
benzoyl peroxide- 1 AL(At least 12 1 AL(At least 12
yrs old); PA sulfacetamide sodium w/
erythromycin GEL sulfur CREA 10 %-5 % yrs old)
benzoyl peroxide FOAM 1 AL(At least 12 1 AL(At least 12
yrs old); sulfacetamide sodium w/
5.3 %, 9.8 % sulfur LIQD 9 %-4.5 % yrs old); PA
RX/OTC
37
sulfacetamide sodium w/ 1 AL(At least 12 clotrimazole (topical) 1 QL(10 ml
sulfur LIQD 10 %-5 % yrs old) SOLN daily); RX/OTC
sulfacetamide sodium- 1 AL(At least 12 clotrimazole w/ 1 QL(8 gm daily)
sulfur in urea vehicle yrs old) betamethasone CREA
EMUL 10 %-10 %-4 % clotrimazole w/ 1
tretinoin microsphere 0.1 1 QL(3 gm daily); betamethasone LOTN
% AL(At least 12 1 QL(85 gm per
yrs old - Up to econazole nitrate CREA fill retail; 85 per
30 yrs old); PA fill mail)
tretinoin CREA 0.025 %, 1 QL(3 gm daily); 3 QL(2.15 gm
0.05 %, 0.1 % AL(At least 12 ERTACZO daily)
yrs old - Up to 3 PA
30 yrs old) JUBLIA
tretinoin GEL 0.01 %, 1 QL(3 gm daily); ketoconazole (topical) 1 QL(10 gm
0.025 % AL(At least 12 CREA daily)
yrs old - Up to ketoconazole (topical) 1 QL(20 ml daily)
30 yrs old) SHAM 2 %
Agents for External Genital and Perianal Warts luliconazole 1 PA
VEREGEN 3 QL(1 gm daily) naftifine hcl CREA 2 % 1 1 rtl MAX fill;
180 rtl day(s)
Antibiotics - Topical supply; 1 mail
ALTABAX 2 MAX fill; QL(2
gm daily)
gentamicin sulfate 1 QL(1 gm daily) 1 1 rtl MAX fill;
naftifine hcl CREA 1 %
(topical) CREA 180 rtl day(s)
gentamicin sulfate 1 supply; 1 mail
(topical) OINT MAX fill; QL(3
1 QL(6 gm daily) gm daily)
mupirocin OINT 1 1 rtl MAX fill;
naftifine hcl GEL 1 %
NEO-SYNALAR 3 PA 180 rtl day(s)
supply; 1 mail
Antifungals - Topical MAX fill; QL(3
butenafine hcl 1 QL(6 gm daily); gm daily)
RX/OTC nystatin (topical) CREA 1 QL(10 gm
ciclopirox olamine CREA 1 1 rtl MAX fill; 30 daily)
rtl day(s) nystatin (topical) OINT 1 QL(6 gm daily)
supply; QL(90 1 QL(10 gm
gm per fill nystatin (topical) POWD
EX daily)
retail)
ciclopirox olamine SUSP 1 nystatin-triamcinolone 1 QL(10 gm
CREA daily)
ciclopirox GEL 1 QL(3.35 gm
daily) nystatin-triamcinolone 1 QL(4 gm daily)
ciclopirox SHAM 1 QL(10 ml daily) OINT
ciclopirox SOLN 1 QL(0.22 ml
daily)
clotrimazole (topical) 1 QL(4.5 gm
CREA daily); RX/OTC
38
oxiconazole nitrate CREA 1 Limit 1 Fill per Antipsoriatics
180 days; 1 rtl
MAX fill; 180 rtl acitretin 25 MG 1 QL(2 ea daily)
day(s) supply; acitretin 10 MG, 17.5 MG 1 QL(1 ea daily)
1 mail MAX fill;
QL(3 gm daily) calcipotriene CREA 1 QL(4 gm daily);
2 Limit 1 Fill per PA
OXISTAT LOTN 1 QL(4 gm daily);
180 days; 1 rtl calcipotriene OINT
MAX fill; 180 rtl PA
day(s) supply; calcipotriene SOLN 1 QL(4 ml daily);
1 mail MAX fill; PA
QL(2 ml daily) calcitriol (topical) 1 QL(3.34 gm
sulconazole nitrate CREA 1 daily)
COSENTYX 4 QL(0.072 ml
sulconazole nitrate SOLN 1 1 rtl MAX fill; 90 daily); PA
rtl day(s) SENSOREADY PEN
supply; 1 mail SOAJ
MAX fill COSENTYX UNOREADY 4 QL(0.072 ml
tavaborole 1 PA SOAJ daily); PA
COSENTYX SOSY 75 4 QL(0.18 ml
Anti-inflammatory Agents - Topical MG/0.5ML daily); PA
diclofenac epolamine 1 QL(2 ea daily); COSENTYX SOSY 150 4 QL(0.072 ml
PTCH EX PA MG/ML daily); PA
diclofenac sodium 1 QL(3.34 gm COSENTYX SOSY 150 4 QL(0.036 ml
(topical) GEL EX daily); RX/OTC MG/ML daily); PA
Antineoplastic or Premalignant Lesion Agents - methoxsalen rapid 1 QL(4 ea daily)
Topical SKYRIZI PEN SOAJ 4 QL(0.025 ml
daily); PA
bexarotene (topical) 4 PA SKYRIZI PSKT 4 QL(0.025 ea
diclofenac sodium (actinic 1 QL(3.34 gm daily); PA
keratoses) EX daily); PA SKYRIZI SOSY 4 QL(0.025 ml
daily); PA
fluorouracil (topical) 1 QL(4 gm daily)
STELARA SOSY 90 4 QL(0.018 ml
CREA 5 % daily); PA
MG/ML
fluorouracil (topical) SOLN 1 QL(2 ml daily)
STELARA SOSY 45 4 QL(0.012 ml
PANRETIN 3 MG/0.5ML daily); PA
TARGRETIN (bexarotene 4 PA tazarotene CREA 1 QL(1 gm daily)
(topical)) 4 QL(0.018 ml
TREMFYA SOPN
Antipruritics - Topical daily); PA
TREMFYA SOSY 4 QL(0.018 ml
doxepin hcl (antipruritic) 3 Limit 1 fill every daily); PA
180 days; 1 rtl
MAX fill; 180 rtl Antiseborrheic Products
day(s) supply; selenium sulfide LOTN 1
1 mail MAX fill; 2.5 %
QL(45 gm per
fill retail; 45 per Antivirals - Topical
fill mail); PA
39
acyclovir topical CREA 1 1 mail pack lmt betamethasone 1 QL(3.5 gm
day(s); 1 mail dipropionate augmented daily)
pack lmt per fill OINT
acyclovir topical OINT 1 1 rtl pack lmt 1 QL(2.5 gm
per fill; 1 mail betamethasone valerate
CREA daily)
pack lmt per fill
3 QL(0.18 gm betamethasone valerate 1 QL(1.67 gm
DENAVIR (penciclovir)
daily) FOAM daily)
penciclovir 1 QL(0.18 gm betamethasone valerate 1 QL(5 ml daily)
daily) LOTN
Burn Products betamethasone valerate 1 QL(3 gm daily)
3 OINT
mafenide acetate PACK
calcipotriene- 1 PA
silver sulfadiazine 1 QL(20 gm
daily) betamethasone
3 dipropionate OINT
SULFAMYLON CREA
calcipotriene- 1 PA
Corticosteroids - Topical betamethasone
alclometasone 1 QL(2 gm daily) dipropionate SUSP
dipropionate CREA clobetasol propionate 1 QL(1 gm daily);
1 QL(3 gm daily) emollient base 0.05 % PA
alclometasone
dipropionate OINT clobetasol propionate 1 QL(3 gm daily);
1 1 rtl MAX fill; 30 CREA 0.05 % PA
amcinonide CREA
rtl day(s) clobetasol propionate 1 QL(3 gm daily);
supply; 1 mail FOAM PA
MAX fill; QL(60 clobetasol propionate 1 QL(2 gm daily);
gm per fill GEL 0.05 % PA
retail; 60 per fill
mail) clobetasol propionate 1 QL(1 gm daily);
3 OINT 0.05 % PA
amcinonide LOTN
3 clobetasol propionate 1 QL(3.34 ml
AMCINONIDE OINT daily); PA
SOLN 0.05 %
betamethasone 1 QL(3 gm daily)
clocortolone pivalate 3 QL(3 gm daily)
dipropionate (topical)
CREA CORDRAN TAPE 3 30 rtl pack lmt
1 day(s); 1 rtl
betamethasone pack lmt per fill;
dipropionate (topical) 30 mail pack
LOTN lmt day(s); 1
betamethasone 1 QL(3 gm daily) mail pack lmt
dipropionate (topical) per fill
OINT desonide CREA 1 QL(4 gm daily)
betamethasone 1 QL(3.5 gm desonide LOTN 1 QL(4 ml daily)
dipropionate augmented daily)
desonide OINT 1 QL(3 gm daily)
CREA
1 QL(5 ml daily) desoximetasone CREA 1 QL(4 gm daily)
betamethasone
dipropionate augmented 0.25 %
LOTN desoximetasone GEL 1 QL(3 gm daily)
40
desoximetasone OINT 1 QL(4 gm daily) hydrocortisone (topical) 1 QL(15.15 gm
0.25 % OINT 1 %, 2.5 % daily); RX/OTC
diflorasone diacetate 1 PA hydrocortisone butyrate 1 QL(3 gm daily)
CREA CREA
diflorasone diacetate 1 PA hydrocortisone butyrate 1 QL(3 gm daily)
OINT OINT
fluocinolone acetonide 1 QL(4 gm daily) hydrocortisone butyrate 1 QL(5 ml daily)
CREA 0.025 % SOLN
fluocinolone acetonide 1 hydrocortisone valerate 1
CREA 0.01 % CREA
fluocinolone acetonide 1 QL(8 ml daily) hydrocortisone valerate 1
OIL OINT
fluocinolone acetonide 1 QL(4 gm daily) mometasone furoate 1 QL(3 gm daily)
OINT CREA
fluocinolone acetonide 1 QL(4 ml daily) mometasone furoate 1 QL(4 gm daily)
SOLN OINT
fluocinonide emulsified 1 QL(2 gm daily) mometasone furoate 1 QL(5 ml daily)
base SOLN
fluocinonide CREA 0.05 1 QL(2 gm daily) prednicarbate OINT 1
% triamcinolone acetonide 1 QL(3.34 gm
fluocinonide GEL 1 (topical) CREA 0.1 % daily)
fluocinonide OINT 1 QL(2 gm daily) triamcinolone acetonide 1 QL(15.15 gm
1 QL(2 ml daily) (topical) CREA 0.025 % daily)
fluocinonide SOLN
2 QL(2 gm daily) triamcinolone acetonide 1 QL(5 gm daily)
flurandrenolide CREA
(topical) CREA 0.5 %
flurandrenolide LOTN 2 QL(2 ml daily)
triamcinolone acetonide 1 QL(6 ml daily)
fluticasone propionate 1 QL(4 gm daily) (topical) LOTN 0.1 %
CREA 0.05 % 1
triamcinolone acetonide
fluticasone propionate 1 QL(6 ml daily) (topical) LOTN 0.025 %
LOTN 1 QL(6 gm daily)
fluticasone propionate 1 QL(4 gm daily) (topical) OINT 0.5 %
OINT 1 QL(15.15 gm
halcinonide CREA 1 PA (topical) OINT 0.025 %, daily)
halobetasol propionate 1 QL(3.5 gm 0.1 %
CREA daily) triamcinolone acetonide- 1 PA
halobetasol propionate 1 QL(3.5 gm dimethicone-silicone
OINT daily)
Emollients
HALOG OINT 3 PA
1 QL(12.9 gm
hydrocortisone (topical) 1 QL(15.15 gm lactic acid (ammonium daily); RX/OTC
CREA 1 %, 2.5 % daily); RX/OTC lactate) CREA
lactic acid (ammonium 1 RX/OTC
hydrocortisone (topical) 1
lactate) LOTN 12 %
LOTN 2.5 %
Enzymes - Topical
41
SANTYL OINT 3 PA metronidazole (topical) 1
LOTN
Immunomodulating Agents - Topical
MIRVASO (brimonidine 3 QL(1 gm daily);
imiquimod 5 % 1 QL(12 ea per tartrate (topical)) PA
fill retail; 12 per
fill mail) Scabicides & Pediculicides
Immunosuppressive Agents - Topical crotamiton LOTN 1 PA
pimecrolimus 1 QL(3 gm daily); ivermectin (pediculicide) 1 PA; RX/OTC
AL(At least 2 lindane SHAM 1
yrs old); PA
1 AL(At least 2 malathion 1
tacrolimus (topical) OINT
yrs old); PA permethrin CREA 1
Keratolytic/Antimitotic Agents permethrin LIQD EX 1
podofilox SOLN 1 spinosad 1 PA
Local Anesthetics - Topical Wound Care Products

lidocaine hcl GEL 2 % 1 QL(4 ml daily) REGRANEX 3 QL(0.5 gm
daily)
lidocaine hcl PRSY 1 QL(4 ml daily)
DIAGNOSTIC PRODUCTS
lidocaine hcl SOLN 1QL(10 ml daily)
1QL(1 gm daily) Diagnostic Drugs
lidocaine-prilocaine CREA
lidocaine PTCH 5 % 1 PA GLUCAGEN 3 QL(0.035 ea
DIAGNOSTIC daily)
SYNERA PTCH 31 rtl MAX fill; 30
rtl day(s) THYROGEN 0.9 MG 3 1 rtl MAX fill;
supply; 1 mail 365 rtl day(s)
MAX fill; QL(10 supply; 1 mail
ea per fill retail; MAX fill; PA
10 per fill mail) Diagnostic Tests
Phosphodiesterase 4 (PDE4) Inhibitors - Topical CHEMSTRIP-K STRP 1
EUCRISA 3 QL(2 gm daily); FORA GTEL BLOOD 1
PA KETONE TEST STRIPS
Rosacea Agents FORA TEST N' GO 1
azelaic acid GEL 1 QL(1.67 gm ADVANCE/VOICE/6
daily) CONNECT
brimonidine tartrate 3 QL(1 gm daily); GOJJI BLOOD KETONE 1
(topical) PA TEST STRIPS
metronidazole (topical) 1 QL(3 gm daily) KETONE TEST STRIPS 1
CREA STRP
metronidazole (topical) 1 QL(5 gm daily) KETONE STRP 1
GEL 1 % KETOSTIX STRP 1
metronidazole (topical) 1 QL(3 gm daily) NOVA MAX PLUS 1
GEL 0.75 % KETONE TESTSTRIPS
PRECISION XTRA 1
42
PTS PANELS KETONE 1 amiloride & 1
TEST hydrochlorothiazide
RELION KETONE TEST 1 spironolactone & 1
STRIPS STRP hydrochlorothiazide
TRUE METRIX BLOOD 1 Limit 100 per triamterene & 1
GLUCOSETEST STRIPS month; QL(3.34 hydrochlorothiazide CAPS
STRP ea daily); 25 MG-37.5 MG
RX/OTC 1
Limit 100 per triamterene
1 &
TRUETRACK TEST STRP hydrochlorothiazide TABS
month; QL(3.34
ea daily); Loop Diuretics
RX/OTC
bumetanide SOLN 0.25 1
DIGESTIVE AIDS - Drugs to Treat Low Digestive MG/ML
Enzymes bumetanide TABS 1 QL(5 ea daily)
Digestive Enzymes ethacrynic acid 1 QL(16 ea daily)
PANCREAZE CPEP 3 Non-FDA furosemide SOLN OR 10 1
149900 UNIT-97300 approved uses MG/ML, 40 MG/5ML
UNIT-37000 UNIT, 15200 require Prior furosemide TABS 1
UNIT-8800 UNIT-2600 Authorization 1
torsemide TABS
UNIT, 24600 UNIT-14200
UNIT-4200 UNIT, 61500 Potassium Sparing Diuretics
UNIT-35500 UNIT-10500
UNIT, 83900 UNIT-54700 amiloride hcl TABS 1
UNIT-21000 UNIT, 98400 spironolactone TABS 1
UNIT-56800 UNIT-16800 triamterene CAPS 1 QL(3 ea daily)
UNIT
DIURETICS - Drugs to Treat Heart, Circulation Thiazides and Thiazide-Like Diuretics
Conditions and Blood Pressure chlorthalidone 25 MG, 50 1
MG
Carbonic Anhydrase Inhibitors DIURIL SUSP 2 QL(20 ml daily)
acetazolamide sodium 1 hydrochlorothiazide CAPS 1 QL(2 ea daily)
acetazolamide CP12 1 QL(2 ea daily) hydrochlorothiazide TABS 1 QL(2 ea daily)
acetazolamide TABS 125 1 QL(8 ea daily) indapamide TABS 1.25 1 QL(1 ea daily)
MG MG
acetazolamide TABS 250 1 QL(4 ea daily) indapamide TABS 2.5 MG 1 QL(2 ea daily)
MG 1 QL(2 ea daily)
metolazone
dichlorphenamide 4 QL(4 ea daily);
PA ENDOCRINE AND METABOLIC AGENTS - MISC.
KEVEYIS 4 QL(4 ea daily); - Drugs to Treat Bone Disease and Regulate
(dichlorphenamide) PA
Hormones
methazolamide TABS 1 QL(6 ea daily)
Bone Density Regulators
Diuretic Combinations
43
alendronate sodium TABS 1 QL(1 ea daily) Growth Hormone Receptor Antagonists
5 MG, 10 MG
1 QL(0.143 ea SOMAVERT 10 MG, 15 4 PA
alendronate sodium TABS MG, 20 MG
35 MG, 70 MG daily)
calcitonin (salmon) NA 1 QL(0.14 ml Growth Hormone Releasing Hormones (GHRH)
daily) 4 PA
3 QL(0.143 ea EGRIFTA 2 MG
FOSAMAX PLUS D
daily); PA EGRIFTA SV 4 PA
ibandronate sodium 4 PA Growth Hormones
SOLN
1 QL(0.036 ea HUMATROPE CART IJ 1 SP; PA
ibandronate sodium TABS
daily) NORDITROPIN FLEXPRO 1 PA
pamidronate disodium 4 SP; PA SOPN 5 MG/1.5ML, 10
SOLN 30 MG/10ML, 90 MG/1.5ML, 15 MG/1.5ML
MG/10ML NORDITROPIN FLEXPRO 1 PA
PAMIDRONATE 4 PA SOPN 30 MG/3ML
DISODIUM SOLN ZORBTIVE SC 4 PA
PROLIA SOSY 4 1 rtl MAX fill;
180 rtl day(s) Hormone Receptor Modulators
supply; PA OSPHENA 3 PA
risedronate sodium TABS 1 QL(1 ea daily); 0 QL(1 ea daily)
PA raloxifene hcl
5 MG, 30 MG
risedronate sodium TABS 1 QL(0.036 ea Insulin-Like Growth Factors (Somatomedins)
150 MG daily); PA 1 PA
INCRELEX
risedronate sodium TABS 1 QL(0.143 ea
35 MG daily); PA LHRH/GnRH Agonist Analog Pituitary
risedronate sodium TBEC 1 PA Suppressants
TERIPARATIDE SOPN 4 QL(0.09 ml FENSOLVI SC 4 PA
daily); PA 4 PA
4 PA LUPRON DEPOT-PED (1-
TYMLOS MONTH)
XGEVA SOLN 4 PA 4 PA
LUPRON DEPOT-PED (3-
zoledronic acid CONC 4 PA MONTH) 11.25 MG
zoledronic acid SOLN 4 PA LUPRON DEPOT-PED (3- 4 PA
MONTH) 30 MG
Corticotropin
SYNAREL 4 PA
ACTHAR 3 PA
Metabolic Modifiers
Fertility Regulators
ALDURAZYME 4 PA
CHORIONIC 4 30 rtl day(s) 4 PA
supply; PA betaine
GONADOTROPIN IM
calcitriol CAPS 1
NOVAREL IM 10000 UNIT 4 30 rtl day(s)
supply; PA calcitriol SOLN IV 1
GnRH/LHRH Antagonists cinacalcet hcl 4 QL(4 ea daily);
PA
ganirelix acetate 4 PA
44
CYSTADANE (betaine) 4 PA mifepristone 1 1 rtl MAX fill; 30
1 rtl day(s)
doxercalciferol CAPS supply; 1 mail
doxercalciferol SOLN 1 MAX fill; QL(1
ELAPRASE 4 PA ea per fill retail;
1 per fill mail)
GALAFOLD 4 QL(0.5 ea
daily); PA Prolactin Inhibitors
LUMIZYME 4 PA 1
cabergoline
MYALEPT 4 PA
Somatostatic Agents
NAGLAZYME 4 PA
4 PA LANREOTIDE ACETATE 4 QL(0.0179 ml
nitisinone CAPS 2 MG, 5 daily); PA
MG, 10 MG 4 PA
octreotide acetate SOLN
paricalcitol CAPS 1
octreotide acetate SOSY 4
paricalcitol SOLN 1
SANDOSTATIN LAR 4 PA
sapropterin 4 PA DEPOT KIT
dihydrochloride PACK 4 PA
SIGNIFOR
sapropterin 4 PA
SOMATULINE DEPOT 4 QL(0.0179 ml
dihydrochloride TABS daily); PA
120 MG/0.5ML
sodium phenylbutyrate 1 PA
SOMATULINE DEPOT 60 4 QL(0.0075 ml
POWD daily); PA
MG/0.2ML
sodium phenylbutyrate 1 PA
SOMATULINE DEPOT 90 4 QL(0.011 ml
TABS daily); PA
MG/0.3ML
Posterior Pituitary Hormones
Vasopressin Receptor Antagonists
desmopressin acetate 1
tolvaptan TABS 1 QL(2 ea daily);
spray PA
desmopressin acetate 1 ESTROGENS - Hormone Replacement/Modifying
spray refrigerated
1 PA Drugs
desmopressin acetate
SOLN IJ Estrogen Combinations
DESMOPRESSIN 4 PA 3
CLIMARA PRO
ACETATE SOLN NA
DUAVEE 3 PA
desmopressin acetate 1 QL(8 ea daily)
TABS 0.2 MG norethindrone acetate- 1
1 QL(6 ea daily) ethinyl estradiol
desmopressin acetate
TABS 0.1 MG PREMPHASE 2
STIMATE SOLN NA 4 PA PREMPRO 2 QL(1 ea daily)
Progesterone Receptor Antagonists Estrogens

DELESTROGEN 10 1
MG/ML (estradiol
valerate)
DEPO-ESTRADIOL 3
45
DIVIGEL GEL (estradiol) 3 Bile Acid Synthesis Disorder Agents
ELESTRIN GEL 3
CHOLBAM 1 PA
estradiol valerate 1
1 Gallstone Solubilizing Agents
estradiol GEL
1 QL(0.286 ea ursodiol CAPS 1 QL(3 ea daily)
estradiol PTTW
daily) ursodiol TABS 1
estradiol PTWK 1
Gastrointestinal Chloride Channel Activators
estradiol TABS 1
lubiprostone 1 QL(2 ea daily)
ESTROGEL GEL 3
EVAMIST SOLN 3 Gastrointestinal Stimulants
MENEST 3 metoclopramide hcl SOLN 1 QL(60 ml daily)
MENOSTAR PTWK 3 OR 5 MG/5ML, 10
MG/10ML
PREMARIN SOLR 2
metoclopramide hcl SOLN 1
PREMARIN TABS 2 QL(1 ea daily) IJ 5 MG/ML
FLUOROQUINOLONES - Drugs to Treat Bacterial metoclopramide hcl TABS 1 QL(6 ea daily)
Infections Inflammatory Bowel Agents
Fluoroquinolones AVSOLA 4 PA
BAXDELA SOLR 3 PA balsalazide disodium 1 QL(9 ea daily)
BAXDELA TABS 3 PA CAPS
1 DIPENTUM 2
ciprofloxacin hcl TABS
3 INFLECTRA 4 PA
ciprofloxacin in d5w 5 %-
200 MG/100ML mesalamine CP24 1
ciprofloxacin SUSR 5 1 2 rtl MAX fill; 30 mesalamine CPDR 1
GM/100ML, 500 MG/5ML rtl day(s) mesalamine ENEM 3
supply
2 2 rtl MAX fill; 30 mesalamine SUPP 3
CIPRO SUSR
rtl day(s) mesalamine TBEC 1.2 3
supply GM
levofloxacin in d5w 5 %- 1 3 QL(6 ea daily)
mesalamine TBEC 800
500 MG/100ML MG
levofloxacin SOLN OR 1 4 PA
RENFLEXIS
levofloxacin TABS 1 4 QL(0.043 ml
SKYRIZI SOCT
moxifloxacin hcl in sodium 1 daily); PA
chloride STELARA 130 MG/26ML 4 PA
moxifloxacin hcl TABS 1 sulfasalazine TABS 1
ofloxacin 300 MG, 400 1 sulfasalazine TBEC 1
MG
Intestinal Acidifiers
GASTROINTESTINAL AGENTS - MISC. -
lactulose 1
Miscellaneous Gastrointestinal Drugs (encephalopathy)
46
Irritable Bowel Syndrome (IBS) Agents sodium chloride (gu 1
irrigant) 0.9 %
alosetron hcl 1 QL(2 ea daily) 1
SORBITOL 3 %
LINZESS 2 QL(1 ea daily); 1
PA SORBITOL/MANNITOL
IRRIGATION
Peripheral Opioid Receptor Antagonists
Interstitial Cystitis Agents
alvimopan 1
ELMIRON CAPS 2 QL(3 ea daily)
MOVANTIK 3 QL(1 ea daily);
PA Prostatic Hypertrophy Agents
RELISTOR SOLN 3 PA
alfuzosin hcl 1 QL(1 ea daily)
Phosphate Binder Agents dutasteride 1 QL(1 ea daily)
calcium acetate 1 dutasteride-tamsulosin hcl 3 PA
(phosphate binder) CAPS 1 5 mg only
finasteride
calcium acetate 1 RX/OTC
silodosin 1
(phosphate binder) TABS
1 tamsulosin hcl 1
lanthanum carbonate
CHEW Urinary Analgesics
PHOSLYRA SOLN 2 1
phenazopyridine hcl
sevelamer carbonate 1 TABS 100 MG, 100 MG,
PACK 200 MG
sevelamer carbonate 1 Urinary Stone Agents
TABS
3 PA THIOLA EC TBEC 100 3 QL(3 ea daily);
VELPHORO PA
MG
GENITOURINARY AGENTS - MISCELLANEOUS - THIOLA EC TBEC 300 3 QL(10 ea
Miscellaneous Drugs to Treat Reproductive MG daily); PA
Organs and Urinary System GOUT AGENTS - Drugs to Treat Gout
Alkalinizers Gout Agent Combinations
potassium citrate 1 colchicine w/ probenecid 1
(alkalinizer) TBCR 10
MEQ, 1080 MG Gout Agents
sodium citrate & citric acid 1 RX/OTC allopurinol 1
colchicine TABS 1 QL(1 ea daily)
Cystinosis Agents
febuxostat 1 QL(1 ea daily);
CYSTAGON CAPS 3 PA PA
Genitourinary Irrigants Uricosurics
acetic acid 0.25 % 1 probenecid 1
glycine (gu irrigant) SOLN 1 HEMATOLOGICAL AGENTS - MISC. - Drugs to
1.5 %
Treat Blood Disorders
Bradykinin B2 Receptor Antagonists
47
icatibant acetate SOLN 1 QL(9 ml daily); folic acid TABS 1 MG, 400 0 RX/OTC
PA MCG
icatibant acetate SOSY 1 QL(9 ml daily);
PA Hematopoietic Growth Factors
Complement Inhibitors ARANESP ALBUMIN 4 PA
FREE SOLN 40 MCG/ML,
HAEGARDA SOLR SC 4 PA 60 MCG/ML, 100 MCG/ML
RUCONEST 1 QL(0.143 ea ARANESP ALBUMIN 4
daily); PA FREE SOLN 25 MCG/ML
Hematorheologic Agents ARANESP ALBUMIN 4 PA
pentoxifylline 1 QL(3 ea daily) FREE SOSY 150
MCG/0.3ML, 200
Platelet Aggregation Inhibitors MCG/0.4ML, 300
1 MCG/0.6ML, 500 MCG/ML
anagrelide hcl
4 QL(3 ea daily);
aspirin-dipyridamole 1 QL(2 ea daily); DOPTELET PA
PA
4 SP; PA
BRILINTA 2 QL(2 ea daily) EPOGEN 2000 UNIT/ML,
3000 UNIT/ML, 4000
CABLIVI 4 PA UNIT/ML, 10000 UNIT/ML,
cilostazol 1 20000 UNIT/ML
clopidogrel bisulfate 75 1 QL(1 ea daily) LEUKINE SOLR IJ 1 PA
MG MIRCERA 30 MCG/0.3ML, 4 PA
clopidogrel bisulfate 300 1 50 MCG/0.3ML, 75
MG MCG/0.3ML, 100
1 MCG/0.3ML, 150
dipyridamole MCG/0.3ML, 200
prasugrel hcl 1 QL(1 ea daily) MCG/0.3ML
ZONTIVITY 3 PA MULPLETA 4 QL(1 ea daily);
PA
HEMATOPOIETIC AGENTS - Drugs to Treat 4 SP; PA
PROCRIT 2000 UNIT/ML,
Blood Disorders 3000 UNIT/ML, 4000
UNIT/ML, 10000 UNIT/ML,
Agents for Gaucher Disease 20000 UNIT/ML
CERDELGA 1 QL(2 ea daily); PROCRIT 40000 UNIT/ML 4 PA
PA 4 PA
1 PA RETACRIT
CEREZYME 400 UNIT
4 PA
miglustat 4 QL(3 ea daily); RETACRIT
PA UDENYCA SOAJ 4 PA
Agents for Sickle Cell Disease UDENYCA SOSY 4 PA
3 ZARXIO 300 MCG/0.5ML 1 30 rtl lmt
DROXIA CAPS day(s); 30 mail
OXBRYTA TABS 500 MG 4 PA lmt day(s); PA
ZARXIO 480 MCG/0.8ML 1 PA
Cobalamins
4 PA
cyanocobalamin SOLN IJ 1 QL(1 ml daily) ZIEXTENZO
Hematopoietic Mixtures
Folic Acid/Folates
48
ferrous fumarate-folic acid 1 QL(1 ea daily) zaleplon 5 MG 1 QL(1 ea daily);
AL(At least 18
Iron yrs old)
ferrous sulfate SOLN 0 AL(Up to 1 yrs zaleplon 10 MG 1 QL(2 ea daily);
old) AL(At least 18
ferrous sulfate TABS 65 0 yrs old)
MG, 325 MG zolpidem tartrate TABS 1 QL(1 ea daily);
AL(At least 18
ferrous sulfate TBEC 0 yrs old)
Stem Cell Mobilizers zolpidem tartrate TBCR 1 QL(1 ea daily)
MOZOBIL (plerixafor) 4 PA Orexin Receptor Antagonists
plerixafor 4 PA BELSOMRA 3 PA
HEMOSTATICS - Drugs to Stop Bleeding/Treat Selective Melatonin Receptor Agonists
Blood Disorders ramelteon 1 QL(1 ea daily);
AL(At least 18
Hemostatics - Systemic yrs old)
aminocaproic acid TABS 1 PA LAXATIVES - Bowel Treatment Drugs
tranexamic acid SOLN 1
Bulk Laxatives
1000 MG/10ML
tranexamic acid TABS 1 calcium polycarbophil 1
TABS
HYPNOTICS/SEDATIVES/SLEEP DISORDER
Laxative Combinations
AGENTS
peg 3350-kcl-nacl-na 1
Barbiturate Hypnotics sulfate-na ascorbate-
phenobarbital ELIX 1 ascorbic acid
phenobarbital TABS 15 1 peg 3350-kcl-sod bicarb- 0
MG, 16.2 MG, 30 MG, sod chloride-sod sulfate
32.4 MG, 64.8 MG, 97.2 SOLR 6.74 GM-2.97 GM-
MG, 100 MG 5.86 GM-22.74 GM-236
GM
Hypnotics - Tricyclic Agents peg 3350-potassium 1 PA
doxepin hcl (sleep) 1 QL(1 ea daily); chloride-sod bicarbonate-
PA sod chloride
Non-Barbiturate Hypnotics sodium sulfate-potassium 1
sulfate-magnesium sulfate
estazolam 1
SUPREP BOWEL PREP 3
eszopiclone 1 QL(1 ea daily); KIT (sodium sulfate-
AL(At least 18 potassium sulfate-
yrs old); PA magnesium sulfate)
flurazepam hcl 1 PA
temazepam 1 QL(1 ea daily) Laxatives - Miscellaneous
triazolam 1 lactulose SOLN 1
Saline Laxatives
49
OSMOPREP 3 PA erythromycin 1
ethylsuccinate SUSR
Stimulant Laxatives
erythromycin 3
bisacodyl TBEC 1 ethylsuccinate TABS
Surfactant Laxatives Fidaxomicin
docusate calcium 1 QL(1 ea daily) DIFICID TABS 2
docusate sodium CAPS 1 QL(4 ea daily) MEDICAL DEVICES AND SUPPLIES
100 MG
docusate sodium CAPS 1 Contraceptives
250 MG AIMSCO LUBRICATED 0 QL(2 ea daily)
LOCAL ANESTHETICS-Parenteral - Drugs for MISC
CAYA DPRH 0
Numbing
DUREX EXTRA 0 QL(2 ea daily)
Local Anesthetics - Amides SENSITIVE THIN DEVI
lidocaine hcl (local 1 FANTASY 0 QL(2 ea daily)
anesth.) SOLN 0.5 %, 1 LUBRICATED/SPERMICI
%, 2 % DE MISC
MACROLIDES - Drugs to Treat Bacterial Infections FANTASY LUBRICATED 0 QL(2 ea daily)
MISC
Azithromycin 0 1 rtl MAX fill; 90
FC2 FEMALE CONDOM
azithromycin PACK 1 rtl day(s)
1 supply; 1 mail
azithromycin SOLR MAX fill; QL(12
azithromycin SUSR 1 ea per fill retail;
azithromycin TABS 250 1 QL(6 ea per fill 12 per fill mail)
MG retail; 6 per fill FEMCAP DEVI 0
mail) KAMELEON 0 QL(2 ea daily)
azithromycin TABS 500 1 QL(4 ea per fill LUBRICATED MISC
MG retail; 4 per fill
mail) KIMONO COLORS DEVI 0 QL(2 ea daily)
azithromycin TABS 600 1 QL(0.286 ea KIMONO LUBRICATED 0 QL(2 ea daily)
MG daily) MISC
KIMONO MICRO THIN 0 QL(2 ea daily)
Clarithromycin
PLUS SPERMICIDE
clarithromycin SUSR 1 LUBRICATED MISC
clarithromycin TABS 1 KIMONO PLUS 0 QL(2 ea daily)
clarithromycin TB24 1 SPERMICIDE
LUBRICATED MISC
Erythromycins KIMONO PLUS 0 QL(2 ea daily)
erythromycin base CPEP 3 SPERMICIDE/LUBRICAT
3 ED MISC
erythromycin base TABS
KIMONO PS 0 QL(2 ea daily)
erythromycin base TBEC 1
LUBRICATED MISC
50
KIMONO PS PLUS 0 QL(2 ea daily) TRUSTEX 0 QL(2 ea daily)
SPERMICIDE/LUBRICAT LUBRICATED/SPERMICI
ED MISC DE EXTRA STRENGTH
KIMONO SENSATION 0 QL(2 ea daily) MISC
LUBRICATED MISC TRUSTEX 0 QL(2 ea daily)
KIMONO SENSATION 0 QL(2 ea daily) LUBRICATED/SPERMICI
PLUS SPERMICIDE DE MISC
LUBRICATED MISC TRUSTEX LUBRICATED 0 QL(2 ea daily)
KIMONO SPECIAL DEVI 0 QL(2 ea daily) MISC
0 QL(2 ea daily) TRUSTEX NATURAL 0 QL(2 ea daily)
K-Y ME & YOU EXTRA
LUBRICATED DEVI CONDOMS
+LUBE/LUBRICATED
K-Y ME & YOU INTENSE 0 QL(2 ea daily) MISC
DEVI 0 QL(2 ea daily)
TRUSTEX WITH
MAXX LUBRICATED 0 QL(2 ea daily) NONOXYNOL-
MISC 9/RIBBED/STUDDED
MAXX PLUS 0 QL(2 ea daily) MISC
SPERMICIDE TRUSTEX/RIA 0 QL(2 ea daily)
LUBRICATED MISC LUBRICATED
OMNIFLEX DIAPHRAGM 0 SPERMICIDE MISC
PREMIUM CONDOMS 0 QL(2 ea daily) TRUSTEX/RIA 0 QL(2 ea daily)
LUBRICATED MISC LUBRICATED/SPERMICI
0 QL(2 ea daily) DE MISC
REALITY LATEX
CONDOMS/LUBRICATED TRUSTEX/RIA 0 QL(2 ea daily)
MISC LUBRICATED MISC
REALITY LATEX/ULTRA 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
TEXTURED DEVI DIAPHRAGM KIT 60
REALITY LATEX/ULTRA 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
THIN DEVI DIAPHRAGM KIT 65
TRUSTEX COLOR 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
CONDOMS + LUBE MISC DIAPHRAGM KIT 70
TRUSTEX LUBRICATED 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
EXTRALARGE MISC DIAPHRAGM KIT 75
TRUSTEX LUBRICATED 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
EXTRASTRENGTH MISC DIAPHRAGM KIT 80
TRUSTEX 0 QL(2 ea daily) WIDE-SEAL SILICONE 0
LUBRICATED/RIBBED/ST DIAPHRAGM KIT 85
UDDED MISC WIDE-SEAL SILICONE 0
TRUSTEX 0 QL(2 ea daily) DIAPHRAGM KIT 90
LUBRICATED/SPERMICI WIDE-SEAL SILICONE 0
DE EXTRA LARGE MISC DIAPHRAGM KIT 95
Diabetic Supplies
51
FREESTYLE LIBRE 14 3 PA ergotamine w/ caffeine 1
DAY/READER/FLASH TABS
MONITORING SYSTEM sumatriptan-naproxen 3 QL(10 ea per
FREESTYLE LIBRE 14 3 QL(0.072 ea sodium 30 days retail;
DAY/SENSOR/FLASH daily); PA 10 ea per 30
MONITORING SYSTEM days mail)
FREESTYLE LIBRE 3 PA Migraine Products
2/READER/FLASH 1
GLUCOSE MONITORING dihydroergotamine
SYSTEM mesylate SOLN IJ 1
MG/ML
FREESTYLE LIBRE 3 QL(0.072 ea
daily); PA dihydroergotamine 1 QL(0.267 ml
2/SENSOR/FLASH daily)
GLUCOSE MONITORING mesylate SOLN NA 4
SYSTEM MG/ML
3 QL(0.072 ea ERGOMAR SUBL 3 QL(0.667 ea
FREESTYLE LIBRE daily)
3/SENSOR/GLUCOSE daily); PA
MONITORING SYSTEM Serotonin Agonists
FREESTYLE 3 PA almotriptan malate 12.5 1 QL(0.4 ea
LIBRE/READER/FLASH MG daily); AL(At
MONITORING SYSTEM least 12 yrs
SELECT LANCETS 1 6.66/day old); PA
almotriptan malate 6.25 1 QL(0.3 ea
TRUE METRIX CONTROL 1 daily); AL(At
MG
SOLUTION LEVEL 3 least 12 yrs
SOLN old); PA
Parenteral Therapy Supplies eletriptan hydrobromide 1 QL(0.2 ea
daily); AL(At
SELECT INSULIN 1 5/day least 18 yrs
SYRINGES old); PA
MIGRAINE PRODUCTS - Drugs to Treat Migraine frovatriptan succinate 1 QL(0.4 ea
daily); AL(At
Headaches least 18 yrs
old); PA
Calcitonin Gene-Related Peptide (CGRP) 1 QL(0.3 ea
naratriptan hcl
Receptor Antag daily); AL(At
least 18 yrs
AIMOVIG 2 QL(0.04 ml old)
daily); PA 1 QL(0.4 ea
2 QL(0.07 ml rizatriptan benzoate TABS
EMGALITY SOAJ 5 MG daily); AL(At
daily); PA least 6 yrs old)
EMGALITY SOSY 120 2 QL(0.07 ml 1 QL(0.6 ea
daily); PA rizatriptan benzoate TABS
MG/ML 10 MG daily); AL(At
EMGALITY SOSY 100 3 QL(0.1 ml least 6 yrs old)
MG/ML daily); PA rizatriptan benzoate TBDP 1 QL(0.4 ea
UBRELVY 3 QL(10 ea per 5 MG daily); AL(At
30 days retail) least 6 yrs old)
Migraine Combinations
52
rizatriptan benzoate TBDP 1 QL(0.6 ea dextrose in lactated 1
10 MG daily); AL(At ringers
least 6 yrs old) 1
1 QL(0.2 ea electrolyte-148
sumatriptan
daily); AL(At electrolyte-a 1
least 18 yrs IONOSOL- 1
old) MB/DEXTROSE 5%
sumatriptan succinate 1 QL(0.134 ml 1
daily); AL(At ISOLYTE-P/DEXTROSE
SOAJ 5%
least 18 yrs
old) ISOLYTE-S 1
sumatriptan succinate 1 QL(0.134 ml KCL 0.3%/D5W/NACL 1
SOCT daily); AL(At 0.9% (potassium chloride
least 18 yrs in dextrose & sodium
old) chloride)
sumatriptan succinate 1 QL(0.134 ml 1
daily); AL(At lactated ringer's
SOLN 6 MG/0.5ML
least 18 yrs NORMOSOL-M/D5W 1
old) NORMOSOL-R 1
sumatriptan succinate 1 QL(0.3 ea
daily); AL(At PLASMA-LYTE A 1
TABS
least 18 yrs (electrolyte-a)
old) PLASMA-LYTE-148 1
zolmitriptan SOLN 1 QL(0.2 ea (electrolyte-148)
daily); AL(At potassium chloride in 1
least 12 yrs dextrose 5 %-20 MEQ/L
old); PA
1 QL(0.3 ea potassium chloride in 1
zolmitriptan TABS
daily); AL(At dextrose & sodium
least 12 yrs chloride 5 %-0.075 %-
old); PA 0.45 %, 5 %-0.15 %-0.9
zolmitriptan TBDP 1 QL(0.3 ea %, 5 %-10 MEQ/L-0.45 %,
daily); AL(At 5 %-20 MEQ/L-0.2 %, 5
least 12 yrs %-20 MEQ/L-0.45 %, 5
old); PA %-20 MEQ/L-0.9 %, 5 %-
30 MEQ/L-0.45 %, 5 %-40
MINERALS & ELECTROLYTES MEQ/L-0.45 %, 5 %-40
Bicarbonates MEQ/L-0.9 %
potassium chloride in nacl 1
sodium acetate SOLN 1
POTASSIUM 1
SODIUM ACETATE SOLN 1
CHLORIDE/DEXTROSE/L
(sodium acetate) ACTATED RINGERS
Calcium POTASSIUM 1
calcium chloride 1 CHLORIDE/SODIUM
(dihydrate) SOLN CHLORIDE 20 MEQ/L-
0.45 % (potassium
Electrolyte Mixtures chloride in nacl)
ringer's 1
53
Fluoride trientine hcl 4 QL(8 ea daily);
PA
sodium fluoride CHEW 0 QL(1 ea daily)
Immunomodulators
0.25 MG, 0.5 MG, 1 MG,
2.2 MG lenalidomide 2.5 MG, 5 4 QL(1 ea daily);
MG, 10 MG, 15 MG, 25 PA
Magnesium MG
magnesium sulfate IJ 50 1 lenalidomide 20 MG 4 PA
% 4 QL(1 ea daily);
REVLIMID 2.5 MG, 5 MG,
Phosphate 10 MG, 15 MG, 25 MG PA
1 REVLIMID 20 MG 4 PA
potassium phosphates
236 MG/ML-224 MG/ML THALOMID 4 QL(3 ea daily);
PA
Potassium
Immunosuppressive Agents
potassium acetate SOLN 1
2 MEQ/ML ATGAM 4 PA
potassium bicarbonate 1 AZATHIOPRINE 1
TBEF azathioprine TABS 1
potassium chloride 1 cyclosporine modified (for 1
microencapsulated microemulsion) CAPS
crystals er cyclosporine modified (for 1
potassium chloride CPCR 1 microemulsion) SOLN
potassium chloride PACK 1 PA cyclosporine CAPS 1
OR 20 MEQ cyclosporine SOLN IV 50 1
potassium chloride SOLN 1 MG/ML
IV 2 MEQ/ML, 10 ENSPRYNG 4 PA
MEQ/50ML, 20
MEQ/50ML everolimus 4 QL(20 ea
(immunosuppressant) daily); PA
POTASSIUM CHLORIDE 1
0.25 MG, 0.5 MG, 0.75
SOLN IV 10 MEQ/50ML MG
(potassium chloride)
mycophenolate mofetil 1
potassium chloride TBCR 1
CAPS
8 MEQ, 10 MEQ
mycophenolate mofetil 1
Sodium TABS
sodium chloride SOLN IV 1 mycophenolate sodium 1
0.45 %, 0.9 %, 3 %, 4 NULOJIX 4 PA
MEQ/ML, 5 %
PROGRAF PACK 2 PA
MISCELLANEOUS THERAPEUTIC CLASSES 2
PROGRAF SOLN
Chelating Agents SIMULECT 3
penicillamine CAPS 1 PA sirolimus TABS 1
penicillamine TABS 1 QL(8 ea daily) tacrolimus CAPS 1
THYMOGLOBULIN 4 PA
54
Irrigation Solutions Ped MV w/ Fluoride
irrigation solutions, 1 pediatric multivitamins w/fl 1 RX/OTC
physiological CHEW
lactated ringer's 1 Prenatal Vitamins
(irrigation)
1 CLASSIC PRENATAL 2 QL(1 ea daily)
ringer's irrigation TABS
water for irrigation, sterile 1
CVS PRENATAL TABS 2 QL(1 ea daily)
Potassium Removing Agents 100 MG-2.6 MG-800
MCG-400 UNIT-4 MCG-
LOKELMA 3 QL(1 ea daily); 1.7 MG-18 MG-27 MG-1.5
PA MG-25 MG-263 MG-11
sodium polystyrene 1 UNIT-4000 UNIT
sulfonate POWD 2 QL(1 ea daily)
EQL PRENATAL
sodium polystyrene 1 FORMULA TABS
sulfonate SUSP OR 15 2 QL(1 ea daily)
GM/60ML GNP PRENATAL TABS
KP PRENATAL 2 QL(1 ea daily)
MOUTH/THROAT/DENTAL AGENTS MULTIVITAMINS TABS
Anesthetics Topical Oral MASONATAL TABS 2 QL(1 ea daily)
lidocaine hcl (mouth- 1 M-NATAL PLUS TABS 2 QL(1 ea daily);
throat) 4 % RX/OTC
1 QL(4 ml daily) MULTI PRENATAL TABS 2 QL(1 ea daily)
lidocaine hcl (mouth-
throat) 2 % NEONATAL COMPLETE 2 QL(1 ea daily);
TABS 120 MG-10 MG-9.2 RX/OTC
Anti-infectives - Throat MG-1000 MCG-10 MCG-
clotrimazole 1 12 MCG-3 MG-5 MG-20
MG-27 MG-200 MG-1.84
nystatin (mouth-throat) 1 MG-25 MG-2 MG-1200
Antiseptics - Mouth/Throat MCG-2 MG-0.2 MG
NEONATAL PLUS TABS 2 QL(1 ea daily);
chlorhexidine gluconate 1 RX/OTC
(mouth-throat) NEONATAL PRENATAL 2 QL(1 ea daily)
DEBACTEROL 2 VITAMIN TABS
Dental Products NEONATAL VITAMIN 2 QL(1 ea daily)
TABS
stannous fluoride CONC 0 RX/OTC
NIVA-PLUS TABS 2 QL(1 ea daily);
Steroids - Mouth/Throat/Dental RX/OTC
ONE VITE WOMENS 2 QL(1 ea daily);
triamcinolone acetonide 1 RX/OTC
PRENATALVITAMIN
(mouth) PLUS TABS
Throat Products - Misc. ONE VITE WOMENS 2 QL(1 ea daily)
1 PRENATALVITAMIN
cevimeline hcl TABS
pilocarpine hcl (oral) 1
MULTIVITAMINS
55
PRENATAL 2 QL(1 ea daily) VITATHELY/GINGER 2 QL(1 ea daily);
MULTIVITAMIN TABS TABS RX/OTC
PRENATAL ONE DAILY 2 QL(1 ea daily) WESTAB PLUS TABS 2 QL(1 ea daily);
TABS RX/OTC
PRENATAL PLUS 2 QL(1 ea daily); MUSCULOSKELETAL THERAPY AGENTS -
VITAMIN ANDMINERAL RX/OTC Drugs to Treat Spasms
TABS
PRENATAL PLUS TABS 2 QL(1 ea daily); Central Muscle Relaxants
RX/OTC baclofen TABS 10 MG, 20 1
PRENATAL VITAMIN & 2 QL(1 ea daily) MG
MINERAL TABS 1
carisoprodol TABS
PRENATAL 2 QL(1 ea daily)
chlorzoxazone TABS 500 1 QL(6 ea daily)
VITAMIN/IRON TABS
MG
PRENATAL VITAMINS 2 QL(1 ea daily);
RX/OTC cyclobenzaprine hcl TABS 1 QL(3 ea daily)
PLUS LOW IRON TABS
5 MG, 10 MG
PRENATAL VITAMINS 2 QL(1 ea daily)
metaxalone 800 MG 1 QL(4 ea daily)
TABS 120 MG-2.6 MG-
800 MCG-400 UNIT-8 methocarbamol TABS 1
MCG-1.7 MG-20 MG-28 orphenadrine citrate TB12 1 QL(2 ea daily)
MG-200 MG-1.8 MG-25
MG-4000 UNIT-30 UNIT tizanidine hcl CAPS 1
PRENATAL VITAMIN 2 QL(1 ea daily) tizanidine hcl TABS 1
TABS Direct Muscle Relaxants
PRENATAL TABS 2 QL(1 ea daily)
dantrolene sodium CAPS 1 QL(4 ea daily)
PRENATRIX TABS 2 QL(1 ea daily);
RX/OTC NASAL AGENTS - SYSTEMIC AND TOPICAL -
PRENATRYL TABS 2 QL(1 ea daily); Drugs to treat the Nose or Sinus
RX/OTC
PREPLUS TABS 2 QL(1 ea daily); Nasal Antiallergy
RX/OTC 1 RX/OTC
2 QL(1 ea daily) azelastine hcl
PX PRENATAL
MULTIVITAMINS TABS olopatadine hcl (nasal) 1
QC PRENATAL TABS 2 QL(1 ea daily) Nasal Anticholinergics
RA PRENATAL 2 QL(1 ea daily) ipratropium bromide 1 QL(1 ml daily)
FORMULA/FOLICACID (nasal) 0.03 %
TABS 1
ipratropium bromide
RA PRENATAL TABS 2 QL(1 ea daily) (nasal) 0.06 %
SM PRENATAL 2 QL(1 ea daily)
VITAMINS TABS Nasal Steroids
THERANATAL CORE 2 QL(1 ea daily); budesonide (nasal) 1
NUTRITION TABS RX/OTC flunisolide (nasal) 0.025 % 1 1 rtl pack lmt
TRICARE TABS 2 QL(1 ea daily); per fill
RX/OTC
56
fluticasone propionate 1 Limit 2 inhalers carteolol hcl (ophth) 1
(nasal) SUSP per month; 1
QL(32 ml per dorzolamide hcl-timolol
30 days retail); maleate
RX/OTC levobunolol hcl 0.5 % 1
mometasone furoate 1 QL(1.14 gm timolol maleate (ophth) 1
(nasal) SUSP daily); PA; SOLG
RX/OTC 1
1 timolol maleate (ophth)
triamcinolone acetonide SOLN
(nasal) AERO
XHANCE EXHU 3 PA Cycloplegic Mydriatics
NEUROMUSCULAR AGENTS - Drugs to tropicamide SOLN 1 % 1
Relax/Paralyze Muscles tropicamide SOLN 0.5 % 1 QL(2.5 ml
daily)
ALS Agents Miotics
riluzole TABS 3 PHOSPHOLINE IODIDE 3
Neuromuscular Blocking Agent - Neurotoxins pilocarpine hcl SOLN 1 %, 1
3 PA 2 %, 4 %
BOTOX IJ
DYSPORT 3 PA Ophthalmic Adrenergic Agents
XEOMIN 3 PA apraclonidine hcl 1
brimonidine tartrate 1
Nondepolarizing Muscle Relaxants
IOPIDINE 3
atracurium besylate 100 3 PA
MG/10ML Ophthalmic Anti-infectives
NUTRIENTS AZASITE 3
Proteins bacitracin (ophthalmic) 3
3 BESIVANCE 3 PA
CLINIMIX
4.25%/DEXTROSE 10% ciprofloxacin hcl (ophth) 1
CLINIMIX 3 SOLN
4.25%/DEXTROSE 5% erythromycin (ophth) 1
CLINIMIX E 3 gatifloxacin (ophth) 1
5%/DEXTROSE 20% gentamicin sulfate (ophth) 1
OPHTHALMIC AGENTS - Drugs to Treat the Eye OINT
gentamicin sulfate (ophth) 1
Artificial Tears and Lubricants
SOLN
LACRISERT 3 KLARITY-A 3
Beta-blockers - Ophthalmic levofloxacin (ophth) 0.5 % 1
betaxolol hcl (ophth) 1 moxifloxacin hcl (ophth) 1
SOLN SOLN OP
brimonidine tartrate- 1 NATACYN 2
timolol maleate
57
neomycin-bacitracin zn- 1 prednisolone acetate 1
polymyxin (ophth)
ofloxacin (ophth) 1 PREDNISOLONE 3
polymyxin b-trimethoprim 1 SODIUM PHOSPHATE
1 sulfacetamide sod- 3 PA
sulfacetamide sodium
(ophth) SOLN prednisolone SOLN
1 tobramycin- 1
tobramycin (ophth) SOLN
dexamethasone SUSP
trifluridine 1
ZYLET 3 PA
ZIRGAN GEL 2
Ophthalmic Surgical Aids
Ophthalmic Immunomodulators
HEALON PRO SOSY 3 PA
cyclosporine (ophth) 3 PA
PROVISC SOSY 3 PA
EMUL
Ophthalmic Local Anesthetics Ophthalmics - Misc.
1 ALOCRIL 3 PA
proparacaine hcl
ALOMIDE 3 PA
Ophthalmic Steroids
azelastine hcl (ophth) 1
ALREX SUSP 3 PA 3 PA
bepotastine besilate
dexamethasone sodium 1 QL(0.4 ml 1
phosphate (ophth) daily) brinzolamide
bromfenac sodium (ophth) 1
difluprednate 1 PA
cromolyn sodium (ophth) 1
fluorometholone (ophth) 1
SUSP CYSTARAN 2 QL(2.143 ml
daily); PA
FML FORTE SUSP 3 PA
diclofenac sodium (ophth) 1
FML OINT 3 PA
dorzolamide hcl 1
LOTEMAX OINT 3 PA
epinastine hcl (ophth) 1
loteprednol etabonate 1 PA
flurbiprofen sodium 1
GEL
1 PA ILEVRO 3 QL(0.2 ml
loteprednol etabonate daily); PA
SUSP 1
ketorolac tromethamine
MAXIDEX SUSP OP 3 PA (ophth)
neomycin-polymy- 1 ketotifen fumarate (ophth) 1
dexameth OINT 0.025 %
neomycin-polymy- 1 LASTACAFT 3 PA; RX/OTC
dexameth SUSP 3 QL(0.2 ml
NEVANAC
neomycin-polymyxin-hc 1 QL(2.5 ml daily); PA
(ophth) daily) olopatadine hcl 0.1 % 1 QL(0.34 ml
PRED MILD 3 PA daily); RX/OTC
3 PA olopatadine hcl 0.2 % 1 RX/OTC
PRED-G SUSP
ZERVIATE 3 PA
58
Prostaglandins - Ophthalmic GAMMAGARD LIQUID 1 1 PA
GM/10ML, 2.5 GM/25ML,
bimatoprost SOLN 3 5 GM/50ML, 10
latanoprost SOLN 1 GM/100ML, 20 GM/200ML
tafluprost 1 GAMMAGARD S/D IGA 4 PA
1 LESS THAN 1MCG/ML
travoprost SOLR
ZIOPTAN (tafluprost) 2 1 PA
GAMMAKED 1 GM/10ML,
OTIC AGENTS - Drugs to Treat the Ear 5 GM/50ML, 10
GM/100ML, 20 GM/200ML
Otic Agents - Miscellaneous 1 PA
GAMUNEX-C
acetic acid (otic) 1 QL(0.5 ml HIZENTRA SOLN 1 PA
daily)
Otic Anti-infectives Passive Immunizing Agents - Combinations
1 HYQVIA 1 PA
ciprofloxacin hcl (otic)
ofloxacin (otic) 1 PENICILLINS - Drugs to Treat Bacterial Infections
Otic Combinations Aminopenicillins
ciprofloxacin- 1 PA amoxicillin CAPS 1
dexamethasone amoxicillin CHEW 125 1
ciprofloxacin-fluocinolone 1 QL(0.5 ea MG, 250 MG
acetonide daily); PA amoxicillin SUSR 1
CORTISPORIN-TC 3 amoxicillin TABS 1
neomycin-polymyxin-hc 1 QL(2 ml daily) ampicillin sodium IJ 1 GM 1
(otic) SOLN 1
ampicillin CAPS 500 MG
neomycin-polymyxin-hc 1
(otic) SUSP Natural Penicillins
Otic Steroids penicillin g potassium 1
5000000 UNIT
fluocinolone acetonide 1
PENICILLIN G 1
(otic)
POTASSIUM IN ISO-
hydrocortisone w/acetic 1 OSMOTIC DEXTROSE
acid 40000 UNIT/ML, 60000
PASSIVE IMMUNIZING AND TREATMENT UNIT/ML
PENICILLIN G 3
AGENTS - Antibody Drugs to Treat Low Immune
PROCAINE
System penicillin g sodium 3
Immune Serums penicillin v potassium 1
CUVITRU SOLN 1 1 PA SOLR
GM/5ML, 2 GM/10ML, 4 penicillin v potassium 1
GM/20ML, 10 GM/50ML TABS
GAMMAGARD LIQUID 30 1 PA Penicillin Combinations
GM/300ML
59
amoxicillin & pot 1 donepezil hydrochloride 1 QL(2 ea daily)
clavulanate CHEW TABS 10 MG
clavulanate SUSR TABS 5 MG
clavulanate TABS TBDP 10 MG
clavulanate TB12 TBDP 5 MG
ampicillin & sulbactam 1 galantamine 1 QL(1 ea daily)
sodium IJ 1 GM-0.5 GM, 2 hydrobromide CP24
GM-1 GM galantamine 1 QL(6 ml daily)
piperacillin sodium- 1 hydrobromide SOLN
tazobactam sodium galantamine 1 QL(2 ea daily)
Penicillinase-Resistant Penicillins hydrobromide TABS
memantine hcl TABS 1
dicloxacillin sodium 1
memantine hcl TABS 1 QL(2 ea daily)
nafcillin sodium IV 10 GM 1
rivastigmine tartrate 1
oxacillin sodium IV 10 GM 1
CAPS
PROGESTINS - Hormone Replacement/Modifying
Combination Psychotherapeutics
Drugs
chlordiazepoxide- 1
Progestins amitriptyline
medroxyprogesterone 1 perphenazine-amitriptyline 1 QL(4 ea daily)
acetate 2.5 MG, 5 MG, 10 Fibromyalgia Agents
MG
megestrol acetate 1 PA SAVELLA TITRATION 2 1 rtl MAX fill;
(appetite) PACK MISC 365 rtl day(s)
supply; PA
norethindrone acetate 0 2 QL(2 ea daily);
SAVELLA TABS
TABS PA
progesterone CAPS 1 Movement Disorder Drug Therapy
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AUSTEDO TABS 1 QL(4 ea daily);
AGENTS - MISC. - Drugs to Treat Mental and PA
INGREZZA CAPS 4 QL(1 ea daily);
Emotional Conditions PA
Agents for Chemical Dependency INGREZZA CPPK 4 1 rtl MAX fill;
180 rtl day(s)
acamprosate calcium 1 supply; PA
disulfiram 1 tetrabenazine 1 QL(3 ea daily);
PA
LUCEMYRA 3 QL(224 ea per
14 days retail); Multiple Sclerosis Agents
PA 4 QL(1 ea daily);
AUBAGIO (teriflunomide)
Antidementia Agents PA
60
AVONEX PEN AJKT 4 QL(0.0714 ml Postherpetic Neuralgia (PHN)/Neuropathic Pain
daily); PA
AVONEX PSKT 4 QL(0.0714 ml Agents
daily); PA 3 QL(1 ea daily);
pregabalin (once-daily)
BETASERON KIT 4 SP 82.5 MG, 165 MG PA
COPAXONE SOSY 40 3 QL(0.43 ml pregabalin (once-daily) 3 QL(2 ea daily);
MG/ML (glatiramer daily); PA 330 MG PA
acetate)
COPAXONE SOSY 20 3 QL(1 ml daily); Pseudobulbar Affect (PBA) Agents
MG/ML (glatiramer PA NUEDEXTA 3 PA
acetate)
1 QL(2 ea daily); Psychotherapeutic and Neurological Agents -
dalfampridine
PA Misc.
dimethyl fumarate CPDR 1 QL(2 ea daily);
PA ergoloid mesylates TABS 1
dimethyl fumarate MISC 1 QL(2 ea daily); pimozide 1
PA
4 QL(1 ea daily); Restless Leg Syndrome (RLS) Agents
fingolimod hcl
PA HORIZANT 3 QL(2 ea daily);
GILENYA 4 QL(1 ea daily); PA
PA
Smoking Deterrents
glatiramer acetate SOSY 3 QL(0.43 ml
40 MG/ML daily); PA APO-VARENICLINE 0 QL(2 ea daily)
glatiramer acetate SOSY 3 QL(1 ml daily); TABS
20 MG/ML PA bupropion hcl (smoking 0 QL(2 ea daily)
KESIMPTA 4 QL(0.0144 ml deterrent)
daily); PA nicotine polacrilex GUM 0
PLEGRIDY STARTER 4 QL(0.036 ml nicotine polacrilex LOZG 0
PACK SOPN daily); PA
NICOTINE 0
PLEGRIDY STARTER 4 QL(0.0357 ml TRANSDERMAL SYSTEM
PACK SOSY SC daily); PA KIT
PLEGRIDY SOPN 4 QL(0.036 ml nicotine PT24 7 0 QL(1 ea daily)
daily); PA MG/24HR, 14 MG/24HR,
PLEGRIDY SOSY SC 4 QL(0.036 ml 21 MG/24HR
daily); PA
4 1 rtl MAX fill; NICOTROL INHALER 0
REBIF REBIDOSE
TITRATIONPACK SOAJ 365 rtl day(s) INHA
supply; SP; PA NICOTROL NS SOLN 0
REBIF REBIDOSE SOAJ 4 QL(0.214 ml varenicline tartrate TABS 0 QL(2 ea daily)
daily); PA
4 1 rtl MAX fill; varenicline tartrate TBPK 0
REBIF TITRATION PACK
SOSY 365 rtl day(s) Transthyretin Amyloidosis Agents
supply; SP; PA
REBIF SOSY 4 QL(0.214 ml TEGSEDI 1 PA
daily); PA RESPIRATORY AGENTS - MISC. - Drugs to Treat
teriflunomide 4 QL(1 ea daily);
PA Lung Conditions
61
Alpha-Proteinase Inhibitor (Human) demeclocycline hcl TABS 1
doxycycline 1 QL(2 ea daily)
PROLASTIN-C SOLN 1 PA
(monohydrate) CAPS 50
PROLASTIN-C SOLR 4 PA MG, 100 MG
Cystic Fibrosis Agents doxycycline 1
(monohydrate) CAPS 75
KALYDECO TABS 4 QL(2 ea daily); MG
PA
4 QL(2 ea daily); doxycycline 1 QL(2 ea daily)
ORKAMBI PACK 125 MG-
100 MG, 188 MG-150 MG PA (monohydrate) TABS 100
MG
ORKAMBI TABS 4 QL(4 ea daily);
PA doxycycline 1
PULMOZYME 4 QL(2.5 ml (monohydrate) TABS 50
daily); PA MG
TRIKAFTA TBPK 100 MG- 4 QL(3 ea daily); doxycycline hyclate CAPS 1 QL(2 ea daily)
50 MG PA doxycycline hyclate SOLR 1
Pulmonary Fibrosis Agents doxycycline hyclate TABS 1 QL(2 ea daily)
4
QL(1 ea daily); 20 MG, 100 MG
ESBRIET CAPS
(pirfenidone) PA minocycline hcl CAPS 1 QL(3 ea daily)
ESBRIET TABS 4 QL(1 ea daily); minocycline hcl TABS 1 QL(3 ea daily)
(pirfenidone) PA tetracycline hcl CAPS 1
OFEV 4 QL(2 ea daily); THYROID AGENTS - Drugs to Regulate Thyroid
PA
pirfenidone CAPS 4 QL(1 ea daily); Hormones
PA
Antithyroid Agents
pirfenidone TABS 267 4 QL(1 ea daily);
MG, 801 MG PA methimazole TABS 1
pirfenidone TABS 534 MG 4 QL(3 ea daily); propylthiouracil 1
PA
Thyroid Hormones
SULFONAMIDES - Drugs to Treat Bacterial
ADTHYZA TABS 2
Infections
ARMOUR THYROID 2 QL(1 ea daily)
Sulfonamides TABS
sulfadiazine TABS 1 levothyroxine sodium 1
TETRACYCLINES - Drugs to Treat Bacterial TABS
liothyronine sodium SOLN 1
Infections
liothyronine sodium TABS 1
Fluorocyclines NP THYROID 120 TABS 1 QL(1 ea daily)
XERAVA 4 PA NP THYROID 15 TABS 1 QL(1 ea daily)
Glycylcyclines NP THYROID 30 TABS 1 QL(1 ea daily)
tigecycline 1 NP THYROID 60 TABS 1 QL(1 ea daily)
NP THYROID 90 TABS 1 QL(1 ea daily)
Tetracyclines
TOXOIDS
62
Toxoid Combinations H-2 Antagonists
ADACEL SUSP 0 cimetidine hcl OR 300 1 QL(20 ml daily)
BOOSTRIX SUSP 0 MG/5ML, 400 MG/6.67ML
0 cimetidine TABS 1 RX/OTC
BOOSTRIX SUSY
0 famotidine in nacl SOLN 1
DAPTACEL
0 famotidine SOLN 20 1
DIPHTHERIA/TETANUS
TOXOIDS ADSORBED MG/2ML, 40 MG/4ML,
PEDIATRIC SUSP 200 MG/20ML
0 famotidine SUSR 1 QL(10 ml daily)
INFANRIX
0 famotidine TABS 20 MG, 1 RX/OTC
KINRIX SUSY
40 MG
PEDIARIX SUSY 0
nizatidine CAPS 1
PENTACEL 0
nizatidine SOLN 1 QL(20 ml daily)
QUADRACEL SUSP 0
ranitidine hcl TABS 150 1
QUADRACEL SUSY 0 MG
TDVAX SUSP 0
Misc. Anti-Ulcer
TENIVAC INJ 0
sucralfate SUSP 1 QL(40 ml daily)
TETANUS/DIPHTHERIA 0
TOXOIDS-ADSORBED sucralfate TABS 1 QL(4 ea daily)
ADULT SUSP Proton Pump Inhibitors
ULCER DRUGS - Drugs to Treat Bowel, Intestine 3 QL(1 ea daily)
dexlansoprazole
and Stomach Conditions esomeprazole magnesium 3 QL(1 ea daily)
Antispasmodics CPDR 40 MG
esomeprazole magnesium 1 QL(2 ea daily);
atropine sulfate SOLN IJ 1 RX/OTC
CPDR 20 MG
0.4 MG/ML, 1 MG/ML
esomeprazole magnesium 1 QL(2 ea daily)
atropine sulfate SOSY IJ 1
TBEC
0.25 MG/5ML
lansoprazole CPDR 15 1 QL(2 ea daily);
chlordiazepoxide hcl- 1 RX/OTC
MG
clidinium bromide
lansoprazole CPDR 30 1
dicyclomine hcl CAPS 1
MG
dicyclomine hcl SOLN OR 1 1 QL(2 ea daily)
NEXIUM 24HR TBEC
dicyclomine hcl TABS 1 (esomeprazole
glycopyrrolate SOLN IJ 4 1 magnesium)
MG/20ML omeprazole magnesium 1 QL(4 ea daily)
glycopyrrolate TABS 1 1 CPDR
MG omeprazole CPDR 1 QL(2 ea daily)
glycopyrrolate TABS 2 1 QL(6 ea daily) omeprazole TBEC 1 QL(2 ea daily)
MG pantoprazole sodium 1 QL(1 ea daily)
methscopolamine bromide 1 TBEC 20 MG
63
pantoprazole sodium 1 bethanechol chloride 25 1
TBEC 40 MG MG
rabeprazole sodium TBEC 3 QL(1 ea daily) Urinary Antispasmodics - Direct Muscle Relaxants
Ulcer Drugs - Prostaglandins flavoxate hcl 1
misoprostol 1 QL(4 ea daily) VACCINES
Ulcer Therapy Combinations Bacterial Vaccines
amoxicillin-clarithromycin 1 14 rtl MAX ACTHIB SOLR IM 0
w/ lansoprazole THPK day(s) supply;
365 rtl lmt BEXSERO 0
day(s); 14 mail HIBERIX SOLR IJ 0
MAX day(s) MENACTRA 0
supply; 365
mail lmt day(s) MENQUADFI 0
omeprazole-sodium 1 QL(1 ea daily); MENVEO SOLR 0
bicarbonate CAPS 1100 RX/OTC 0
PEDVAX HIB SUSP
MG-20 MG
PNEUMOVAX 23 0
URINARY ANTISPASMODICS - Drugs to Treat
PNEUMOVAX 23/1 DOSE 0
Miscellaneous Bladder Spasms 0
PREVNAR 13
Urinary Antispasmodic - Antimuscarinics PREVNAR 20 0 1 rtl MAX fill;
(Anticholinergic) 999 rtl day(s)
supply
darifenacin hydrobromide 1 QL(1 ea daily) TRUMENBA 0
fesoterodine fumarate 1 QL(1 ea daily); VAXNEUVANCE 0 4 rtl MAX fill;
PA 999 rtl day(s)
oxybutynin chloride SYRP 1 supply
oxybutynin chloride TABS 1 Viral Vaccines
5 MG 0 Limit 1 dose
AFLURIA
oxybutynin chloride TB24 1 QUADRIVALENT 2021- per season; 1
solifenacin succinate 1 QL(1 ea daily); 2022 SUSP rtl MAX fill; 180
TABS PA rtl day(s)
supply
tolterodine tartrate CP24 1 QL(1 ea daily)
AFLURIA 0 Limit 1 dose
tolterodine tartrate TABS 1 QUADRIVALENT 2021- per season; 1
TOVIAZ (fesoterodine 3 QL(1 ea daily); 2022 SUSY rtl MAX fill; 180
fumarate) PA rtl day(s)
supply
trospium chloride CP24 1 QL(1 ea daily) 0 Limit 1 dose
AFLURIA
trospium chloride TABS 1 QL(3 ea daily) QUADRIVALENT 2022- per season; 1
2023 SUSP rtl MAX fill; 180
Urinary Antispasmodics - Cholinergic Agonists rtl day(s)
bethanechol chloride 5 1 QL(4 ea daily) supply
MG, 10 MG, 50 MG
64
AFLURIA 0 Limit 1 dose FLUBLOK 0 Limit 1 dose
QUADRIVALENT 2022- per season; 1 QUADRIVALENT 2021- per season; 1
2023 SUSY rtl MAX fill; 180 2022 rtl MAX fill; 180
rtl day(s) rtl day(s)
supply supply
2024 SUSP rtl MAX fill; 180 2023 rtl MAX fill; 180
supply supply
2024 SUSY rtl MAX fill; 180 2024 rtl MAX fill; 180
supply supply
ENGERIX-B SUSP 20 0 3 rtl MAX fill; FLUCELVAX 0 Limit 1 dose
MCG/ML 365 rtl day(s) QUADRIVALENT 2021- per season; 1
supply; 3 mail 2022 SUSP rtl MAX fill; 180
MAX fill rtl day(s)
ENGERIX-B SUSY 0 3 rtl MAX fill; supply
365 rtl day(s) FLUCELVAX 0 Limit 1 dose
supply; 3 mail QUADRIVALENT 2021- per season; 1
MAX fill 2022 SUSY rtl MAX fill; 180
FLUAD QUADRIVALENT 0 1 rtl MAX fill; rtl day(s)
2021-2022 180 rtl day(s) supply
supply FLUCELVAX 0 Limit 1 dose
FLUAD QUADRIVALENT 0 1 rtl MAX fill; QUADRIVALENT 2022- per season; 1
2022-2023 180 rtl day(s) 2023 SUSP rtl MAX fill; 180
supply rtl day(s)
FLUAD QUADRIVALENT 0 1 rtl MAX fill; supply
2023-2024 180 rtl day(s) FLUCELVAX 0 Limit 1 dose
supply QUADRIVALENT 2022- per season; 1
FLUARIX 0 Limit 1 dose 2023 SUSY rtl MAX fill; 180
QUADRIVALENT 2021- per season; 1 rtl day(s)
2022 SUSY rtl MAX fill; 180 supply
rtl day(s) FLUCELVAX 0 Limit 1 dose
FLUARIX 0 Limit 1 dose 2024 SUSP rtl MAX fill; 180
rtl day(s) FLUCELVAX 0 Limit 1 dose
FLUARIX 0 Limit 1 dose 2024 SUSY rtl MAX fill; 180
rtl day(s) FLULAVAL 0 Limit 1 dose
2022 SUSY rtl MAX fill; 180
rtl day(s)
supply
65
FLULAVAL 0 Limit 1 dose FLUZONE 0 Limit 1 dose
2023 SUSY rtl MAX fill; 180 2024 SUSY rtl MAX fill; 180
supply supply
FLULAVAL 0 Limit 1 dose GARDASIL 9 SUSP 0 3 rtl MAX fill;
QUADRIVALENT 2023- per season; 1 365 rtl day(s)
rtl day(s) GARDASIL 9 SUSY 0 3 rtl MAX fill;
supply 365 rtl day(s)
FLUMIST 0 Limit 1 dose supply
QUADRIVALENT per season; 1 HAVRIX 0
rtl MAX fill; 180 0 2 rtl MAX fill;
rtl day(s) HEPLISAV-B SOSY
365 rtl day(s)
supply supply; 2 mail
FLUZONE HIGH-DOSE 0 1 rtl MAX fill; MAX fill
PF 2021-2022 180 rtl day(s) 0
supply IPOL INACTIVATED IPV
FLUZONE HIGH-DOSE 0 1 rtl MAX fill; M-M-R II SOLR 0 1 rtl MAX fill;
PF 2022-2023 180 rtl day(s) 365 rtl day(s)
supply supply
FLUZONE HIGH-DOSE 0 1 rtl MAX fill; PREHEVBRIO 0 3 rtl MAX fill;
PF 2023-2024 180 rtl day(s) 365 rtl day(s)
supply supply
FLUZONE 0 Limit 1 dose PRIORIX SUSR 0 3 rtl MAX fill;
2022 SUSP rtl MAX fill; 180 supply
rtl day(s) RECOMBIVAX HB SUSP 0
supply RECOMBIVAX HB SUSY 0
FLUZONE 0 Limit 1 dose
ROTARIX SUSP 0
QUADRIVALENT 2021- per season; 1
2022 SUSY rtl MAX fill; 180 ROTARIX SUSR 0
rtl day(s) ROTATEQ SOLN 0
supply
0 Limit 1 dose SHINGRIX 0 2 rtl MAX fill;
FLUZONE 999 rtl day(s)
rtl MAX fill; 180 supply
2023 SUSP 0
rtl day(s) TWINRIX SUSY
supply VAQTA 0
FLUZONE 0 Limit 1 dose 0 2 rtl MAX fill;
VARIVAX INJ
rtl day(s)
supply VAGINAL AND RELATED PRODUCTS
FLUZONE 0 Limit 1 dose Miscellaneous Vaginal Products
2024 SUSP rtl MAX fill; 180 INTRAROSA 3 PA
rtl day(s)
supply Spermicides
TODAY SPONGE MISC 0
66
Vaginal Anti-infectives cholecalciferol TABS 400 0
UNIT
clindamycin phosphate 1 0
vaginal CREA ergocalciferol CAPS
ergocalciferol SOLN OR 1
clotrimazole vaginal 1
CREA 1 % VITAMIN D2 TABS 400 0 AL(At least 65
UNIT yrs old)
GYNAZOLE-1 3
metronidazole vaginal 1 Water Soluble Vitamins
miconazole nitrate vaginal 1 NIACIN TR TBCR 1
SUPP 200 MG niacinamide TABS 1
terconazole vaginal CREA 1 1
niacin CPCR 250 MG,
terconazole vaginal SUPP 1 500 MG
Vaginal Contraceptive - pH Modulators niacin TABS 1
niacin TBCR 1
PHEXXI 0 PV
SLO-NIACIN TBCR 500 1
Vaginal Estrogens MG, 750 MG (niacin)
estradiol vaginal CREA 1 QL(2 gm daily)
estradiol vaginal TABS 1
FEMRING 3 PA
PREMARIN 2
QL(1.5 gm
daily)
VASOPRESSORS - Drugs to Treat Heart and
Circulation Conditions
Anaphylaxis Therapy Agents
epinephrine (anaphylaxis) 1 2 rtl MAX fill;
SOAJ 0.15 MG/0.3ML 365 rtl day(s)
supply; 2 mail
MAX fill; QL(2
ea per fill retail;
2 per fill mail)
epinephrine (anaphylaxis) 2 2 rtl MAX fill;
SOAJ 0.3 MG/0.3ML 365 rtl day(s)
supply; QL(2
ea per fill retail)
Vasopressors
midodrine hcl 1
VITAMINS
Oil Soluble Vitamins
cholecalciferol CAPS 1.25 1
MG, 1.25 MG, 50000
UNIT
67
INDEX
abacavir sulfate SOLN 30 ACTIMMUNE 27 albendazole 7
abacavir sulfate TABS 30 acyclovir CAPS 32 albuterol sulfate AERS 9
abacavir sulfate-lamivudine 30 acyclovir SUSP 32 albuterol sulfate NEBU 0.083 %, 0.63

MG/3ML, 1.25 MG/3ML 10
abacavir sulfate-lamivudine- acyclovir TABS OR 32
zidovudine 30 albuterol sulfate NEBU 0.5 %, 2.5
acyclovir topical CREA 40
MG/0.5ML 10
ABELCET 18
acyclovir topical OINT 40
albuterol sulfate SYRP 10
abiraterone acetate 250 MG 25
ADACEL SUSP 63
albuterol sulfate TABS 10
abiraterone acetate 500 MG 25
ADALIMUMAB-ADAZ SOAJ 2
alclometasone dipropionate CREA 40
ABRAXANE 27
adapalene CREA 37
alclometasone dipropionate OINT 40
acamprosate calcium 60
adapalene GEL 37
ALDURAZYME 44
acarbose 15
adapalene-benzoyl peroxide GEL 2.5
ALECENSA 26
acebutolol hcl CAPS 32 %-0.1 % 37
alendronate sodium TABS 35 MG, 70
acetaminophen w/ codeine SOLN 6 ADCETRIS 24
MG 44
acetaminophen w/ codeine TABS 15 adefovir dipivoxil 31
alendronate sodium TABS 5 MG, 10
MG-300 MG 6
ADEMPAS 34 MG 44
acetaminophen w/ codeine TABS 30
ADTHYZA TABS 62 alfuzosin hcl 47
MG-300 MG 6
ADVAIR HFA AERO 9 ALINIA SUSR 21
acetaminophen w/ codeine TABS 60
MG-300 MG 6 AFLURIA QUADRIVALENT 2021- aliskiren fumarate 21
2022 SUSP 64
acetaminophen-caff-dihydrocod allopurinol 47
CAPS 30 MG-320.5 MG-16 MG 6 AFLURIA QUADRIVALENT 2021-
almotriptan malate 12.5 MG 52
2022 SUSY 64
acetazolamide CP12 43
almotriptan malate 6.25 MG 52
AFLURIA QUADRIVALENT 2022-
acetazolamide sodium 43
2023 SUSP 64 ALOCRIL 58
acetazolamide TABS 125 MG 43
AFLURIA QUADRIVALENT 2022- alogliptin benzoate 15
acetazolamide TABS 250 MG 43 2023 SUSY 65
ALOMIDE 58
acetic acid (otic) 59 AFLURIA QUADRIVALENT 2023-
alosetron hcl 47
2024 SUSP 65
acetic acid 0.25 % 47
alprazolam TABS 7
AFLURIA QUADRIVALENT 2023-
acetylcysteine SOLN 37
2024 SUSY 65 alprazolam TB24 8
acitretin 10 MG, 17.5 MG 39
AIMOVIG 52 alprazolam TBDP 8
acitretin 25 MG 39
AIMSCO LUBRICATED MISC 50 ALREX SUSP 58
ACTHAR 44
AKYNZEO 17 ALTABAX 38
ACTHIB SOLR IM 64
Index 1
ALUNBRIG TABS 26 amoxapine 14 amphotericin b IV 18
ALUNBRIG TBPK 26 amoxicillin & pot clavulanate CHEW amphotericin b liposome 18

60
ALVESCO 9 ampicillin & sulbactam sodium IJ 1
amoxicillin & pot clavulanate SUSR GM-0.5 GM, 2 GM-1 GM 60
alvimopan 47
60
ampicillin CAPS 500 MG 59
amantadine hcl CAPS 28
amoxicillin & pot clavulanate TABS
ampicillin sodium IJ 1 GM 59
amantadine hcl SOLN 28 60
anagrelide hcl 48
amantadine hcl TABS 28 amoxicillin & pot clavulanate TB12 60
anastrozole 25
ambrisentan 34 amoxicillin CAPS 59
ANDRODERM PT24 2 MG/24HR, 4
amcinonide CREA 40 amoxicillin CHEW 125 MG, 250 MG
MG/24HR 7
59
amcinonide LOTN 40
ANNOVERA 36
amoxicillin SUSR 59
AMCINONIDE OINT 40
ANORO ELLIPTA 10
amoxicillin TABS 59
amikacin sulfate SOLN 1 GM/4ML,
ANZEMET TABS 50 MG 17
500 MG/2ML 2 amoxicillin-clarithromycin w/
lansoprazole THPK 64 APIDRA SOLN 16
amiloride & hydrochlorothiazide 43
amphetamine sulfate TABS 1 APIDRA SOLOSTAR SOPN 16
amiloride hcl TABS 43
amphetamine-dextroamphetamine APOKYN SOCT 28
aminocaproic acid TABS 49
CP24 1.25 MG-1.25 MG-1.25 MG-
apomorphine hydrochloride SOCT 28
aminophylline SOLN 10 1.25 MG, 2.5 MG-2.5 MG-2.5 MG-2.5
MG 1 APO-VARENICLINE TABS 61
amiodarone hcl SOLN 50 MG/ML 8
amphetamine-dextroamphetamine apraclonidine hcl 57
amiodarone hcl TABS 8
CP24 3.75 MG-3.75 MG-3.75 MG-
aprepitant CAPS 40 MG, 125 MG 18
amitriptyline hcl TABS 14 3.75 MG 1
aprepitant CAPS 80 MG 17
AMJEVITA SOAJ 2 amphetamine-dextroamphetamine
CP24 5 MG-5 MG-5 MG-5 MG, 6.25 aprepitant CAPS 17
AMJEVITA SOSY 20 MG/0.4ML 3 MG-6.25 MG-6.25 MG-6.25 MG, 7.5
amlodipine besylate TABS 33 MG-7.5 MG-7.5 MG-7.5 MG 1 aprepitant MISC 18
amphetamine-dextroamphetamine APTIOM 11
amlodipine besylate-atorvastatin
calcium 33 TABS 1.25 MG-1.25 MG-1.25 MG- APTIVUS CAPS 30
1.25 MG, 1.875 MG-1.875 MG-1.875
amlodipine besylate-benazepril hcl MG-1.875 MG, 2.5 MG-2.5 MG-2.5 ARANESP ALBUMIN FREE SOLN
20 MG-2.5 MG, 3.125 MG-3.125 MG- 25 MCG/ML 48
amlodipine besylate-olmesartan 3.125 MG-3.125 MG, 3.75 MG-3.75

ARANESP ALBUMIN FREE SOLN
medoxomil 20 MG-3.75 MG-3.75 MG, 5 MG-5 MG-5 40 MCG/ML, 60 MCG/ML, 100
MG-5 MG 1 MCG/ML 48
amlodipine besylate-valsartan 20
amphetamine-dextroamphetamine ARANESP ALBUMIN FREE SOSY
amlodipine-valsartan- TABS 7.5 MG-7.5 MG-7.5 MG-7.5 150 MCG/0.3ML, 200 MCG/0.4ML,
hydrochlorothiazide 20 MG 1
Index 2
300 MCG/0.6ML, 500 MCG/ML 48 atovaquone-proguanil hcl 22 BALCOLTRA 35
ARCALYST 3 atracurium besylate 100 MG/10ML balsalazide disodium CAPS 46

57
arformoterol tartrate 10 BALVERSA 26
atropine sulfate SOLN IJ 0.4 MG/ML,
ARIKAYCE 2 BARACLUDE SOLN 31
1 MG/ML 63
aripiprazole SOLN OR 30 BASAGLAR KWIKPEN SOPN 16
atropine sulfate SOSY IJ 0.25
aripiprazole TABS 30 MG/5ML 63 BAXDELA SOLR 46
armodafinil 1 ATROVENT HFA 8 BAXDELA TABS 46
ARMOUR THYROID TABS 62 AUSTEDO TABS 60 BELSOMRA 49
ARNUITY ELLIPTA 100 MCG/ACT, AVONEX PEN AJKT 61 benazepril & hydrochlorothiazide
200 MCG/ACT 9 12.5 MG-10 MG, 25 MG-20 MG 20
AVONEX PSKT 61
ARNUITY ELLIPTA 50 MCG/ACT 9 benazepril & hydrochlorothiazide
AVSOLA 46
12.5 MG-20 MG, 6.25 MG-5 MG 20
arsenic trioxide 10 MG/10ML 27
AYVAKIT 25
benazepril hcl 20
ARZERRA 24
azacitidine SUSR 24
bendamustine hcl SOLR 23
asenapine maleate 2.5 MG 29
AZASITE 57
BENZEPRO CREAMY WASH LIQD
asenapine maleate 5 MG, 10 MG 29
AZATHIOPRINE 54 37
aspirin CHEW 4
azathioprine TABS 54 benzonatate 100 MG 36
aspirin TABS 325 MG 4
azelaic acid GEL 42 benzonatate 150 MG 36
aspirin TBEC 81 MG 4
azelastine hcl (ophth) 58 benzonatate 200 MG 36
aspirin-dipyridamole 48
azelastine hcl 56 BENZOYL PEROXIDE CLEANSER
atazanavir sulfate CAPS 150 MG, LIQD 37
AZELEX 37
300 MG 30
benzoyl peroxide FOAM 5.3 %, 9.8 %
azithromycin PACK 50
atazanavir sulfate CAPS 200 MG 30 37
azithromycin SOLR 50
atenolol & chlorthalidone 20 benzoyl peroxide GEL 10 % 37
azithromycin SUSR 50
atenolol TABS 32 benzoyl peroxide GEL 5 % 37
azithromycin TABS 250 MG 50
ATGAM 54 benzoyl peroxide LIQD 4 %, 7 %, 10
azithromycin TABS 500 MG 50 % 37
atomoxetine hcl 10 MG, 18 MG, 25
MG, 40 MG 1 azithromycin TABS 600 MG 50 benzoyl peroxide-erythromycin GEL
37
atomoxetine hcl 60 MG, 80 MG, 100 aztreonam 1 GM 22
MG 1 benztropine mesylate SOLN 28
bacitracin (ophthalmic) 57
atorvastatin calcium TABS 19 benztropine mesylate TABS 28
bacitracin 21
atovaquone 21 bepotastine besilate 58
baclofen TABS 10 MG, 20 MG 56
Index 3
BESIVANCE 57 bisoprolol & hydrochlorothiazide 20 dihydrate 10
betaine 44 bisoprolol fumarate 32 bumetanide SOLN 0.25 MG/ML 43
betamethasone dipropionate (topical) bleomycin sulfate 15 UNIT 25 bumetanide TABS 43

CREA 40
BOOSTRIX SUSP 63 buprenorphine hcl SOLN 6
betamethasone dipropionate (topical)
BOOSTRIX SUSY 63 buprenorphine hcl SUBL 6
LOTN 40
bortezomib SOLR IJ 26 buprenorphine hcl-naloxone hcl
betamethasone dipropionate (topical)
dihydrate FILM SL 0.5 MG-2 MG, 1
OINT 40 BORTEZOMIB SOLR IV 3.5 MG 26
MG-4 MG 6
betamethasone dipropionate bosentan TABS 34
buprenorphine hcl-naloxone hcl
augmented CREA 40
BOSULIF 26 dihydrate FILM SL 2 MG-8 MG, 3
betamethasone dipropionate MG-12 MG 6
BOTOX IJ 57
augmented LOTN 40
buprenorphine hcl-naloxone hcl
BRAFTOVI 75 MG 26
betamethasone dipropionate dihydrate SUBL 6
augmented OINT 40 BREO ELLIPTA 10
buprenorphine PTWK 6
betamethasone valerate CREA 40 BREZTRI AEROSPHERE 10
bupropion hcl (smoking deterrent) 61
betamethasone valerate FOAM 40 BRILINTA 48
bupropion hcl TABS 13
betamethasone valerate LOTN 40 brimonidine tartrate (topical) 42
bupropion hcl TB12 100 MG 13
betamethasone valerate OINT 40 brimonidine tartrate 57
BETASERON KIT 61 brimonidine tartrate-timolol maleate
57
betaxolol hcl (ophth) SOLN 57
brinzolamide 58
betaxolol hcl 32
BRIVIACT SOLN OR 10 MG/ML 12
bethanechol chloride 25 MG 64
buspirone hcl 7
BRIVIACT TABS 12
bethanechol chloride 5 MG, 10 MG,
busulfan SOLN 23
50 MG 64 bromfenac sodium (ophth) 58
butalbital-acetaminophen TABS 50
BEVESPI AEROSPHERE 10 bromocriptine mesylate CAPS 28
MG-325 MG 4
bexarotene (topical) 39 bromocriptine mesylate TABS 2.5
butalbital-acetaminophen-caffeine
MG 28
bexarotene 27 CAPS 40 MG-50 MG-300 MG, 40
BRUKINSA 26 MG-50 MG-325 MG 4
BEXSERO 64
budesonide (inhalation) SUSP 9 butalbital-acetaminophen-caffeine
bicalutamide 25
TABS 40 MG-50 MG-325 MG 4
budesonide (intrarectal) 7
BIKTARVY 30
butalbital-acetaminophen-caffeine w/
budesonide (nasal) 56
bimatoprost SOLN 59 codeine 30 MG-40 MG-50 MG-300
budesonide CPEP 36 MG 6
bisacodyl TBEC 50
budesonide-formoterol fumarate butalbital-acetaminophen-caffeine w/
Index 4
codeine 30 MG-40 MG-50 MG-325 CAPASTAT SULFATE 23 cefaclor CAPS 34
MG 6
capecitabine 24 cefaclor SUSR 125 MG/5ML, 250
butalbital-aspirin-caffeine CAPS 4 MG/5ML, 375 MG/5ML 34
CAPRELSA 26
butalbital-aspirin-caffeine w/cod 6 cefadroxil CAPS 34
captopril 12.5 MG 20
butenafine hcl 38 cefadroxil SUSR 34
captopril 25 MG, 50 MG, 100 MG 20
butorphanol tartrate IJ 1 MG/ML, 2 cefadroxil TABS 34
carbamazepine CHEW 12
MG/ML 6
cefazolin sodium SOLR IJ 1 GM, 10
carbamazepine CP12 100 MG 12
butorphanol tartrate NA 10 MG/ML 6 GM, 500 MG 34
cabergoline 45 cefdinir CAPS 34
CABLIVI 48 cefdinir SUSR 34
carbamazepine SUSP 12
CABOMETYX TABS 26 cefepime hcl SOLR IV 2 GM 35
carbamazepine TABS 12
calcipotriene CREA 39 cefixime CAPS 34
carbamazepine TB12 100 MG, 400
calcipotriene OINT 39 cefixime SUSR 35
MG 12
calcipotriene SOLN 39 cefotaxime sodium IJ 1 GM, 2 GM 35
carbamazepine TB12 200 MG 12
calcipotriene-betamethasone CEFOTAXIME SODIUM IJ 1 GM 35
carbidopa 28
dipropionate OINT 40
cefotetan disodium IJ 1 GM, 2 GM 34
carbidopa-levodopa TABS 28
calcipotriene-betamethasone
cefoxitin sodium IV 34
dipropionate SUSP 40 carbidopa-levodopa TBCR 28
cefpodoxime proxetil SUSR 35
calcitonin (salmon) NA 44 carbidopa-levodopa TBDP 28
cefpodoxime proxetil TABS 35
calcitriol (topical) 39 carbidopa-levodopa-entacapone 28
cefprozil SUSR 34
calcitriol CAPS 44 carbinoxamine maleate SOLN 18
cefprozil TABS 34
calcitriol SOLN IV 44 carbinoxamine maleate TABS 4 MG
18 ceftazidime IV 2 GM, 6 GM 35
calcium acetate (phosphate binder)
CAPS 47 carboplatin SOLN 50 MG/5ML 23 ceftriaxone sodium IJ 1 GM, 2 GM,
250 MG, 500 MG 35
calcium acetate (phosphate binder) carisoprodol TABS 56
TABS 47 cefuroxime axetil TABS 34
carmustine 23
calcium chloride (dihydrate) SOLN 53 cefuroxime sodium IJ 750 MG 34
carteolol hcl (ophth) 57
calcium polycarbophil TABS 49 celecoxib 3
carvedilol 32
CALQUENCE 26 cephalexin CAPS 34
carvedilol phosphate 32
candesartan cilexetil 20 cephalexin SUSR 34
caspofungin acetate 18
candesartan cilexetil- cephalexin TABS 34
CAYA DPRH 50
CERDELGA 48
CAYSTON 22
Index 5
CEREZYME 400 UNIT 48 44 clarithromycin SUSR 50
cetirizine hcl TABS 18 ciclopirox GEL 38 clarithromycin TABS 50
cetirizine-pseudoephedrine 36 ciclopirox olamine CREA 38 clarithromycin TB24 50
cevimeline hcl 55 ciclopirox olamine SUSP 38 CLASSIC PRENATAL TABS 55
CHEMET 17 ciclopirox SHAM 38 clemastine fumarate SYRP 18
CHEMSTRIP-K STRP 42 ciclopirox SOLN 38 clemastine fumarate TABS 2.68 MG

18
chloramphenicol sodium succinate cidofovir 31
21 CLIMARA PRO 45
cilostazol 48
chlordiazepoxide hcl CAPS 8 clindamycin hcl 22
CIMDUO 30
chlordiazepoxide hcl-clidinium clindamycin palmitate hydrochloride
cimetidine hcl OR 300 MG/5ML, 400
bromide 63 22
MG/6.67ML 63
chlordiazepoxide-amitriptyline 60 clindamycin phosphate (topical)
cimetidine TABS 63
FOAM 37
chlorhexidine gluconate (mouth-
cinacalcet hcl 44
throat) 55 clindamycin phosphate (topical) GEL
CIPRO SUSR 46 37
chloroquine phosphate TABS 250
MG 22 ciprofloxacin hcl (ophth) SOLN 57 clindamycin phosphate (topical)
LOTN 37
chloroquine phosphate TABS 500 ciprofloxacin hcl (otic) 59
MG 22 clindamycin phosphate (topical)
ciprofloxacin hcl TABS 46
SOLN 37
chlorpromazine hcl SOLN 29
ciprofloxacin in d5w 5 %-200
clindamycin phosphate (topical)
chlorpromazine hcl TABS 29 MG/100ML 46
SWAB 37
chlorthalidone 25 MG, 50 MG 43 ciprofloxacin SUSR 5 GM/100ML,
clindamycin phosphate SOLN IJ 9
500 MG/5ML 46
chlorzoxazone TABS 500 MG 56 GM/60ML, 300 MG/2ML, 600
ciprofloxacin-dexamethasone 59 MG/4ML, 900 MG/6ML, 9000
CHOLBAM 46
MG/60ML 22
ciprofloxacin-fluocinolone acetonide
cholecalciferol CAPS 1.25 MG, 1.25
59 clindamycin phosphate vaginal CREA
MG, 50000 UNIT 67
67
cisplatin SOLN 100 MG/100ML 23
cholecalciferol TABS 400 UNIT 67
clindamycin phosphate-benzoyl
citalopram hydrobromide SOLN 13
cholestyramine light PACK 19 peroxide (refrigerate) 37
citalopram hydrobromide TABS 10
cholestyramine light POWD 19 clindamycin phosphate-benzoyl
MG 13
peroxide GEL 5 %-1 % 37
cholestyramine PACK 19
citalopram hydrobromide TABS 20
clindamycin phosphate-tretinoin 37
cholestyramine POWD 19 MG 13
CLINIMIX 4.25%/DEXTROSE 10%
choline fenofibrate 19 citalopram hydrobromide TABS 40
57
MG 14
CHORIONIC GONADOTROPIN IM
CLINIMIX 4.25%/DEXTROSE 5% 57
Index 6
CLINIMIX E 5%/DEXTROSE 20% clozapine TABS 29 CRIXIVAN 400 MG 30
57
clozapine TBDP 100 MG 29 cromolyn sodium (ophth) 58
clobazam SUSP 11
clozapine TBDP 12.5 MG 29 cromolyn sodium NEBU 8
clobazam TABS 11
clozapine TBDP 150 MG 29 crotamiton LOTN 42
clobetasol propionate CREA 0.05 %
clozapine TBDP 200 MG 29 CUVITRU SOLN 1 GM/5ML, 2
40
GM/10ML, 4 GM/20ML, 10 GM/50ML
clozapine TBDP 25 MG 29
clobetasol propionate emollient base 59
0.05 % 40 COARTEM 22
CVS PRENATAL TABS 100 MG-2.6
clobetasol propionate FOAM 40 codeine sulfate TABS 30 MG 4 MG-800 MCG-400 UNIT-4 MCG-1.7
MG-18 MG-27 MG-1.5 MG-25 MG-
clobetasol propionate GEL 0.05 % 40 CODEINE SULFATE TABS 4
263 MG-11 UNIT-4000 UNIT 55
clobetasol propionate OINT 0.05 % colchicine TABS 47
cyanocobalamin SOLN IJ 48
40
colchicine w/ probenecid 47
cyclobenzaprine hcl TABS 5 MG, 10
clobetasol propionate SOLN 0.05 %
colesevelam hcl PACK 19 MG 56
40
colesevelam hcl TABS 19 cyclophosphamide CAPS 23
clocortolone pivalate 40
colestipol hcl GRAN 19 cyclophosphamide SOLR IJ 23
clofarabine 24
colestipol hcl PACK 19 cycloserine 23
clomipramine hcl 14
colestipol hcl TABS 19 cyclosporine (ophth) EMUL 58
clonazepam TABS 11
COMETRIQ KIT 26 cyclosporine CAPS 54
clonidine 20
COMPLERA 30 cyclosporine modified (for
clonidine hcl (adhd) TB12 1
microemulsion) CAPS 54
CONTRAVE 1
clonidine hcl TABS 20
cyclosporine modified (for
COPIKTRA 26
clopidogrel bisulfate 300 MG 48 microemulsion) SOLN 54
CORDRAN TAPE 40
clopidogrel bisulfate 75 MG 48 cyclosporine SOLN IV 50 MG/ML 54
CORLANOR SOLN 34
clorazepate dipotassium TABS 8 cyproheptadine hcl SYRP 19
CORLANOR TABS 34
clotrimazole (topical) CREA 38 cyproheptadine hcl TABS 19
CORTISPORIN-TC 59
clotrimazole (topical) SOLN 38 CYSTAGON CAPS 47
COSENTYX SENSOREADY PEN
clotrimazole 55 CYSTARAN 58
SOAJ 39
clotrimazole vaginal CREA 1 % 67 cytarabine SOLN 24
COSENTYX SOSY 150 MG/ML 39
clotrimazole w/ betamethasone dacarbazine SOLR 200 MG 27
COSENTYX SOSY 75 MG/0.5ML 39
CREA 38
dactinomycin 25
COSENTYX UNOREADY SOAJ 39
clotrimazole w/ betamethasone
dalfampridine 61
LOTN 38 CRESEMBA CAPS 18
danazol CAPS 7
Index 7
dantrolene sodium CAPS 56 desmopressin acetate TABS 0.2 MG dextroamphetamine sulfate CP24 5
45 MG 1
dapsone 22
desogestrel & ethinyl estradiol 35 dextroamphetamine sulfate TABS 5
DAPTACEL 63
MG, 10 MG 1
desogestrel-ethinyl estradiol
daptomycin 500 MG 21
(biphasic) 35 dextrose in lactated ringers 53
darifenacin hydrobromide 64
desogestrel-ethinyl estradiol DIACOMIT CAPS 250 MG 12
darunavir TABS 600 MG 30 (triphasic) 35
DIACOMIT CAPS 500 MG 12
darunavir TABS 800 MG 30 desonide CREA 40
DIACOMIT PACK 250 MG 12
DAURISMO 25 desonide LOTN 40
DIACOMIT PACK 500 MG 12
DEBACTEROL 55 desonide OINT 40
diazepam (anticonvulsant) GEL 11
decitabine 24 desoximetasone CREA 0.25 % 40
diazepam CONC 8
deferasirox PACK 17 desoximetasone GEL 40
diazepam SOLN OR 5 MG/5ML 8
deferasirox TABS 17 desoximetasone OINT 0.25 % 41
diazepam TABS 8
deferasirox TBSO 17 desvenlafaxine succinate 100 MG 14
diazoxide 15
deferiprone TABS 500 MG 17 desvenlafaxine succinate 25 MG, 50
dichlorphenamide 43
MG 14
DELSTRIGO 30
diclofenac epolamine PTCH EX 39
dexamethasone ELIX 36
demeclocycline hcl TABS 62
diclofenac potassium TABS 50 MG 3
DEXAMETHASONE INTENSOL
DEPO-ESTRADIOL 45
CONC 36 diclofenac sodium (actinic keratoses)
DEPO-MEDROL SUSP 36 EX 39
dexamethasone sodium phosphate
DEPO-SUBQ PROVERA 104 SUSY (ophth) 58 diclofenac sodium (ophth) 58
SC 36
dexamethasone sodium phosphate diclofenac sodium (topical) GEL EX
desipramine hcl TABS 14 SOLN IJ 4 MG/ML, 20 MG/5ML, 120 39
MG/30ML 36
desloratadine TABS 18 diclofenac sodium TB24 3
dexamethasone SOLN 36
desloratadine TBDP 2.5 MG 18 diclofenac sodium TBEC 3
dexamethasone TABS 36
desmopressin acetate SOLN IJ 45 diclofenac w/ misoprostol TBEC 3
dexchlorpheniramine maleate SOLN
DESMOPRESSIN ACETATE SOLN dicloxacillin sodium 60
18
NA 45
dicyclomine hcl CAPS 63
dexlansoprazole 63
desmopressin acetate spray 45
dicyclomine hcl SOLN OR 63
dexmethylphenidate hcl CP24 1
desmopressin acetate spray
dicyclomine hcl TABS 63
refrigerated 45 dexmethylphenidate hcl TABS 1
DIFFERIN LOTN 37
desmopressin acetate TABS 0.1 MG dextroamphetamine sulfate CP24 10
45 MG, 15 MG 1 DIFICID TABS 50
Index 8
diflorasone diacetate CREA 41 diphenhydramine hcl LIQD 12.5 doxazosin mesylate 20
MG/5ML, 25 MG/10ML, 50 MG/20ML
diflorasone diacetate OINT 41 doxepin hcl (antipruritic) 39
18
diflunisal TABS 4 doxepin hcl (sleep) 49
diphenhydramine hcl SOLN 50
difluprednate 58 MG/ML 18 doxepin hcl CAPS 15
digoxin SOLN OR 0.05 MG/ML 33 diphenoxylate w/ atropine LIQD 17 doxepin hcl CONC 15
digoxin TABS 0.0625 MG, 0.125 MG, diphenoxylate w/ atropine TABS 17 doxercalciferol CAPS 45
0.25 MG, 62.5 MCG, 125 MCG, 250
DIPHTHERIA/TETANUS TOXOIDS doxercalciferol SOLN 45
MCG 33
ADSORBED PEDIATRIC SUSP 63
doxorubicin hcl liposomal 25
dihydroergotamine mesylate SOLN IJ
dipyridamole 48
1 MG/ML 52 doxorubicin hcl SOLN 25
disopyramide phosphate CAPS 8
dihydroergotamine mesylate SOLN doxorubicin hcl SOLR 10 MG, 50 MG
NA 4 MG/ML 52 disulfiram 60 25
DILANTIN 13 DIURIL SUSP 43 doxycycline (monohydrate) CAPS 50

MG, 100 MG 62
diltiazem hcl coated beads CP24 120 divalproex sodium TB24 13
MG, 300 MG, 360 MG 33 doxycycline (monohydrate) CAPS 75
divalproex sodium TBEC 13
MG 62
diltiazem hcl coated beads CP24 180
docetaxel CONC 20 MG/ML 28
MG, 240 MG 33 doxycycline (monohydrate) TABS
docetaxel SOLN 20 MG/2ML 28 100 MG 62
diltiazem hcl CP12 33
docusate calcium 50 doxycycline (monohydrate) TABS 50
diltiazem hcl CP24 33
MG 62
docusate sodium CAPS 100 MG 50
diltiazem hcl extended release beads
doxycycline hyclate CAPS 62
120 MG, 180 MG, 240 MG, 300 MG, docusate sodium CAPS 250 MG 50
360 MG 33 doxycycline hyclate SOLR 62
dofetilide 8
diltiazem hcl SOLN 50 MG/10ML 33 doxycycline hyclate TABS 20 MG,
donepezil hydrochloride TABS 10
100 MG 62
DILTIAZEM HCL SOLR 33 MG 60
doxylamine-pyridoxine TBEC 17
diltiazem hcl TABS 33 donepezil hydrochloride TABS 5 MG
60 dronabinol CAPS 17
diltiazem hcl TB24 33
donepezil hydrochloride TBDP 10 drospirenone-ethinyl estradiol 35
dimethyl fumarate CPDR 61
MG 60
drospirenone-ethinyl estradiol-
dimethyl fumarate MISC 61
donepezil hydrochloride TBDP 5 MG levomefolate calcium 35
DIPENTUM 46 60
DROXIA CAPS 48
diphenhydramine hcl CAPS 50 MG DOPTELET 48
DUAVEE 45
18
dorzolamide hcl 58
duloxetine hcl CPEP 20 MG, 30 MG,
diphenhydramine hcl ELIX 12.5
dorzolamide hcl-timolol maleate 57 60 MG 14
MG/5ML 18
DOVATO 30 duloxetine hcl CPEP 40 MG 14
Index 9
DUREX EXTRA SENSITIVE THIN EMFLAZA TABS 36 enoxaparin sodium SOSY 40
DEVI 50 MG/0.4ML 11
EMGALITY SOAJ 52
dutasteride 47 enoxaparin sodium SOSY 60
EMGALITY SOSY 100 MG/ML 52
MG/0.6ML 11
dutasteride-tamsulosin hcl 47
EMGALITY SOSY 120 MG/ML 52
enoxaparin sodium SOSY 80
DYSPORT 57
EMSAM 13 MG/0.8ML, 120 MG/0.8ML 11
econazole nitrate CREA 38
emtricitabine CAPS 30 ENSPRYNG 54
EDARBI 20
emtricitabine-tenofovir disoproxil entacapone 28
EDURANT 30 fumarate 100 MG-150 MG, 133 MG-
entecavir TABS 31
200 MG, 167 MG-250 MG 30
efavirenz CAPS 200 MG 30
ENTRESTO 33
emtricitabine-tenofovir disoproxil
efavirenz CAPS 50 MG 30
fumarate 200 MG-300 MG 30 EPCLUSA PACK 31
efavirenz TABS 30
EMTRIVA SOLN 30 EPCLUSA TABS 100 MG-400 MG 31
efavirenz-emtricitabine-tenofovir
EMVERM CHEW 7 EPCLUSA TABS 50 MG-200 MG 31
disoproxil fumarate 30
enalapril maleate & EPIDIOLEX 12
efavirenz-lamivudine-tenofovir
hydrochlorothiazide 12.5 MG-5 MG
disoproxil fumarate 30 epinastine hcl (ophth) 58
20
EGRIFTA 2 MG 44 epinephrine (anaphylaxis) SOAJ 0.15
enalapril maleate &
MG/0.3ML 67
EGRIFTA SV 44 hydrochlorothiazide 25 MG-10 MG 20
epinephrine (anaphylaxis) SOAJ 0.3
ELAPRASE 45 enalapril maleate TABS 20
MG/0.3ML 67
electrolyte-148 53 ENBREL MINI SOCT 4
epirubicin hcl SOLN 50 MG/25ML 25
electrolyte-a 53 ENBREL SOLN 4
EPIVIR HBV SOLN 31
ELESTRIN GEL 46 ENBREL SOLR 4
eplerenone 21
eletriptan hydrobromide 52 ENBREL SOSY 25 MG/0.5ML 4
EPOGEN 2000 UNIT/ML, 3000
ELIGARD KIT SC 7.5 MG 25 ENBREL SOSY 50 MG/ML 4 UNIT/ML, 4000 UNIT/ML, 10000
UNIT/ML, 20000 UNIT/ML 48
ELIGARD SC 22.5 MG, 30 MG, 45 ENBREL SURECLICK SOAJ 4
MG 25 epoprostenol sodium 33
ENGERIX-B SUSP 20 MCG/ML 65
ELIQUIS STARTER PACK TBPK 10 EQL PRENATAL FORMULA TABS
ENGERIX-B SUSY 65
55
ELIQUIS TABS 10
enoxaparin sodium SOLN IJ 300
EQUETRO 100 MG 29
ELLA 36 MG/3ML 11
EQUETRO 200 MG 29
ELMIRON CAPS 47 enoxaparin sodium SOSY 100
MG/ML, 150 MG/ML 11 EQUETRO 300 MG 29
EMCYT 25
enoxaparin sodium SOSY 30 ERAXIS 18
EMFLAZA SUSP 36
MG/0.3ML 11
ERBITUX 24
Index 10
ergocalciferol CAPS 67 estazolam 49 ezetimibe 19
ergocalciferol SOLN OR 67 estradiol GEL 46 ezetimibe-simvastatin 19
ergoloid mesylates TABS 61 estradiol PTTW 46 FALESSA 35
ERGOMAR SUBL 52 estradiol PTWK 46 famciclovir 125 MG, 250 MG 32
ergotamine w/ caffeine TABS 52 estradiol TABS 46 famciclovir 500 MG 32
ERIVEDGE 25 estradiol vaginal CREA 67 famotidine in nacl SOLN 63
ERLEADA 240 MG 25 estradiol vaginal TABS 67 famotidine SOLN 20 MG/2ML, 40

MG/4ML, 200 MG/20ML 63
ERLEADA 60 MG 25 estradiol valerate 46
famotidine SUSR 63
erlotinib hcl 24 ESTROGEL GEL 46
famotidine TABS 20 MG, 40 MG 63
ERTACZO 38 eszopiclone 49
FANAPT 29
ertapenem sodium IJ 21 ethacrynic acid 43
FANAPT TITRATION PACK 29
ERWINASE 27 ethambutol hcl TABS 23
FANTASY LUBRICATED MISC 50
erythromycin (acne aid) PADS 37 ethosuximide CAPS 13
FANTASY
erythromycin (acne aid) SOLN 37 ethosuximide SOLN 13
LUBRICATED/SPERMICIDE MISC
erythromycin (ophth) 57 ethynodiol diacet & eth estrad 35 50
erythromycin base CPEP 50 etodolac CAPS 3 FARXIGA 16
erythromycin base TABS 50 etodolac TABS 3 FASENRA PEN SOAJ 8
erythromycin base TBEC 50 etonogestrel-ethinyl estradiol 36 FASENRA SOSY 8
erythromycin ethylsuccinate SUSR ETOPOPHOS 28 FC2 FEMALE CONDOM 50

50
etoposide CAPS 28 febuxostat 47
erythromycin ethylsuccinate TABS 50
etoposide SOLN 1 GM/50ML, 100 felbamate SUSP 12
escitalopram oxalate SOLN 14 MG/5ML, 500 MG/25ML 28
felbamate TABS 400 MG 12
escitalopram oxalate TABS 10 MG etravirine 100 MG 30
felbamate TABS 600 MG 12
14
etravirine 200 MG 30
felodipine 33
escitalopram oxalate TABS 20 MG
EUCRISA 42
14 FEMCAP DEVI 50
EVAMIST SOLN 46
escitalopram oxalate TABS 5 MG 14 FEMRING 67
everolimus (immunosuppressant)
esomeprazole magnesium CPDR 20 fenofibrate micronized 67 MG, 134
0.25 MG, 0.5 MG, 0.75 MG 54
MG 63 MG, 200 MG 19
everolimus TABS 26
esomeprazole magnesium CPDR 40 fenofibrate TABS 48 MG, 54 MG, 145
MG 63 EVOTAZ 30 MG, 160 MG 19
esomeprazole magnesium TBEC 63 exemestane 25 fenoprofen calcium TABS 3

Index 11
FENSOLVI SC 44 floxuridine 24 fludarabine phosphate SOLR 24
fentanyl citrate LPOP 4 FLUAD QUADRIVALENT 2021-2022 fludrocortisone acetate TABS 36

65
fentanyl PT72 12 MCG/HR, 25 FLULAVAL QUADRIVALENT 2021-
MCG/HR, 50 MCG/HR, 75 MCG/HR, FLUAD QUADRIVALENT 2022-2023 2022 SUSY 65
100 MCG/HR 4 65
FLULAVAL QUADRIVALENT 2022-
ferrous fumarate-folic acid 49 FLUAD QUADRIVALENT 2023-2024 2023 SUSY 66
65
ferrous sulfate SOLN 49 FLULAVAL QUADRIVALENT 2023-
FLUARIX QUADRIVALENT 2021- 2024 SUSY 66
ferrous sulfate TABS 65 MG, 325 MG
2022 SUSY 65
49 FLUMIST QUADRIVALENT 66
FLUARIX QUADRIVALENT 2022-
ferrous sulfate TBEC 49 flunisolide (nasal) 0.025 % 56
2023 SUSY 65
fesoterodine fumarate 64 fluocinolone acetonide (otic) 59
FLUARIX QUADRIVALENT 2023-
FETZIMA CP24 14 2024 SUSY 65 fluocinolone acetonide CREA 0.01 %
41
FETZIMA TITRATION PACK C4PK FLUBLOK QUADRIVALENT 2021-
14 2022 65 fluocinolone acetonide CREA 0.025
% 41
fexofenadine-pseudoephedrine TB12 FLUBLOK QUADRIVALENT 2022-
37 2023 65 fluocinolone acetonide OIL 41
fexofenadine-pseudoephedrine TB24 FLUBLOK QUADRIVALENT 2023- fluocinolone acetonide OINT 41

37 2024 65
fluocinolone acetonide SOLN 41
FIASP FLEXTOUCH SOPN 16 FLUCELVAX QUADRIVALENT
fluocinonide CREA 0.05 % 41
2021-2022 SUSP 65
FIASP PENFILL SOCT 16
fluocinonide emulsified base 41
FLUCELVAX QUADRIVALENT
FIASP PUMPCART SOCT 16
2021-2022 SUSY 65 fluocinonide GEL 41
FIASP SOLN 16
FLUCELVAX QUADRIVALENT fluocinonide OINT 41
finasteride 47 2022-2023 SUSP 65
fluocinonide SOLN 41
fingolimod hcl 61 FLUCELVAX QUADRIVALENT
fluorometholone (ophth) SUSP 58
2022-2023 SUSY 65
FIRDAPSE 23
fluorouracil (topical) CREA 5 % 39
FLUCELVAX QUADRIVALENT
FIRMAGON 25
2023-2024 SUSP 65 fluorouracil (topical) SOLN 39
flavoxate hcl 64
FLUCELVAX QUADRIVALENT fluorouracil 500 MG/10ML 24
flecainide acetate 8 2023-2024 SUSY 65
fluoxetine hcl CAPS 10 MG 14
FLOVENT DISKUS AEPB 100 fluconazole SUSR 18
MCG/BLIST, 250 MCG/BLIST 9
fluconazole TABS 18
FLOVENT DISKUS AEPB 50
flucytosine 18
MCG/BLIST 9 fluoxetine hcl CPDR 14
fludarabine phosphate SOLN 24
FLOVENT HFA 9 fluoxetine hcl SOLN 14
Index 12
fluoxetine hcl TABS 10 MG, 60 MG FLUZONE HIGH-DOSE PF 2022- fosfomycin tromethamine 22
14 2023 66
fosinopril sodium &
fluoxetine hcl TABS 20 MG 14 FLUZONE HIGH-DOSE PF 2023- hydrochlorothiazide 20
2024 66
fluphenazine hcl CONC 29 fosinopril sodium 20
FLUZONE QUADRIVALENT 2021-
fluphenazine hcl ELIX 30 fosphenytoin sodium 13
2022 SUSP 66
fluphenazine hcl SOLN 30 FRAGMIN SOSY 11
fluphenazine hcl TABS 30 2022 SUSY 66 FREESTYLE LIBRE 14
DAY/READER/FLASH
flurandrenolide CREA 41 FLUZONE QUADRIVALENT 2022-
MONITORING SYSTEM 52
2023 SUSP 66
flurandrenolide LOTN 41
FREESTYLE LIBRE 14
flurazepam hcl 49 DAY/SENSOR/FLASH
2023 SUSY 66
flurbiprofen sodium 58
FREESTYLE LIBRE
flurbiprofen TABS 3 2024 SUSP 66
2/READER/FLASH GLUCOSE
flutamide 25 FLUZONE QUADRIVALENT 2023- MONITORING SYSTEM 52
2024 SUSY 66
fluticasone furoate-vilanterol 10 FREESTYLE LIBRE
FML FORTE SUSP 58 2/SENSOR/FLASH GLUCOSE
fluticasone propionate (nasal) SUSP
57 FML OINT 58
FREESTYLE LIBRE
fluticasone propionate CREA 0.05 % folic acid TABS 1 MG, 400 MCG 48
3/SENSOR/GLUCOSE
41
FOLOTYN 24 MONITORING SYSTEM 52
fluticasone propionate LOTN 41
fondaparinux sodium 10 MG/0.8ML FREESTYLE
fluticasone propionate OINT 41 11 LIBRE/READER/FLASH
fluticasone-salmeterol AEPB 100 fondaparinux sodium 2.5 MG/0.5ML
MCG/ACT-50 MCG/ACT, 250 11 frovatriptan succinate 52
MCG/ACT-50 MCG/ACT, 500
fondaparinux sodium 5 MG/0.4ML 11 fulvestrant SOSY 25
MCG/ACT-50 MCG/ACT 10
fondaparinux sodium 7.5 MG/0.6ML furosemide SOLN OR 10 MG/ML, 40
fluticasone-salmeterol AERO 10
11 MG/5ML 43
fluvastatin sodium CAPS 20 MG 19
FORA GTEL BLOOD KETONE TEST furosemide TABS 43
fluvastatin sodium CAPS 40 MG 19 STRIPS 42
FUZEON SOLR 30
fluvoxamine maleate TABS 100 MG FORA TEST N' GO
FYCOMPA TABS 2 MG 11
14 ADVANCE/VOICE/6 CONNECT 42
FYCOMPA TABS 4 MG 11
fluvoxamine maleate TABS 25 MG, formoterol fumarate NEBU 10
50 MG 14 FYCOMPA TABS 6 MG 11
FOSAMAX PLUS D 44
FLUZONE HIGH-DOSE PF 2021- FYCOMPA TABS 8 MG, 10 MG, 12
fosamprenavir calcium TABS 30
2022 66 MG 11
Index 13
gabapentin CAPS 12 gentamicin sulfate (topical) CREA 38 glycopyrrolate TABS 1 MG 63
gabapentin SOLN 12 gentamicin sulfate (topical) OINT 38 glycopyrrolate TABS 2 MG 63
gabapentin TABS 600 MG, 800 MG gentamicin sulfate IJ 40 MG/ML, 80 GLYXAMBI 15

12 MG/2ML 2
GNP PRENATAL TABS 55
GALAFOLD 45 GENVOYA 30
GOJJI BLOOD KETONE TEST
galantamine hydrobromide CP24 60 GILENYA 61 STRIPS 42
galantamine hydrobromide SOLN 60 GILOTRIF 24 granisetron hcl SOLN IV 1 MG/ML 17
galantamine hydrobromide TABS 60 glatiramer acetate SOSY 20 MG/ML granisetron hcl TABS 17
61
GAMMAGARD LIQUID 1 GM/10ML, GRASTEK SUBL 2
2.5 GM/25ML, 5 GM/50ML, 10 glatiramer acetate SOSY 40 MG/ML
griseofulvin microsize SUSP 18
GM/100ML, 20 GM/200ML 59 61
griseofulvin microsize TABS 18
GAMMAGARD LIQUID 30 GLEOSTINE 10 MG 23
GM/300ML 59 griseofulvin ultramicrosize 18
GLEOSTINE 40 MG, 100 MG 23
GAMMAGARD S/D IGA LESS THAN guanfacine hcl (adhd) 1
glimepiride 1 MG, 2 MG 16
1MCG/ML SOLR 59
guanfacine hcl 20
glimepiride 4 MG 16
GAMMAKED 1 GM/10ML, 5
GYNAZOLE-1 67
GM/50ML, 10 GM/100ML, 20 glipizide TABS 16
GM/200ML 59 HADLIMA PUSHTOUCH SOAJ 3
glipizide TB24 16
GAMUNEX-C 59 HADLIMA SOSY 3
glipizide-metformin hcl 250 MG-2.5
ganciclovir sodium SOLR 31 MG, 500 MG-2.5 MG 15 HAEGARDA SOLR SC 48
ganirelix acetate 44 glipizide-metformin hcl 500 MG-5 MG HALAVEN 28

15
GARDASIL 9 SUSP 66 halcinonide CREA 41
GLUCAGEN DIAGNOSTIC 42
GARDASIL 9 SUSY 66 halobetasol propionate CREA 41
glucagon (rdna) 15
gatifloxacin (ophth) 57 halobetasol propionate OINT 41
glyburide micronized 1.5 MG, 3 MG,
gefitinib 24 HALOG OINT 41
6 MG 17
gemcitabine hcl SOLR 2 GM 24 haloperidol decanoate 29
glyburide TABS 17
gemcitabine hcl SOLR 200 MG 24 haloperidol lactate CONC 29
glyburide-metformin 250 MG-1.25
gemfibrozil TABS 19 MG 15 haloperidol lactate SOLN 29
gentamicin in saline 0.8 MG/ML-0.9 glyburide-metformin 500 MG-2.5 MG, haloperidol TABS 29
%, 1 MG/ML-0.9 %, 1.2 MG/ML-0.9 500 MG-5 MG 15
HAVRIX 66
%, 1.6 MG/ML-0.9 % 2
glycine (gu irrigant) SOLN 1.5 % 47
HEALON PRO SOSY 58
gentamicin sulfate (ophth) OINT 57
glycopyrrolate SOLN IJ 4 MG/20ML
HEMANGEOL SOLN OR 32
gentamicin sulfate (ophth) SOLN 57 63
Index 14
heparin sodium (porcine) SOLN IJ hydrocodone polistirex- hydromorphone hcl SOLN IJ 10
5000 UNIT/ML, 10000 UNIT/ML, chlorpheniramine polistirex SUER 37 MG/ML, 50 MG/5ML, 500 MG/50ML
20000 UNIT/ML 11 5
hydrocodone-acetaminophen SOLN
HEPARIN SODIUM/NACL 0.45% 108 MG/5ML-2.5 MG/5ML, 217 hydromorphone hcl TABS 5
SOLN IV 0.45 %-12500 UNIT/250ML MG/10ML-5 MG/10ML, 325
hydromorphone hcl TB24 32 MG 5
11 MG/15ML-7.5 MG/15ML 6
hydromorphone hcl TB24 8 MG, 12
HEPLISAV-B SOSY 66 hydrocodone-acetaminophen SOLN
MG, 16 MG 5
325 MG/15ML-10 MG/15ML 6
HIBERIX SOLR IJ 64
hydroxychloroquine sulfate 200 MG
hydrocodone-acetaminophen TABS
HIZENTRA SOLN 59 22
300 MG-10 MG, 300 MG-5 MG, 300
HORIZANT 61 MG-7.5 MG 6 hydroxyurea 27
HUMATROPE CART IJ 44 hydrocodone-acetaminophen TABS hydroxyzine hcl SOLN 50 MG/ML 7

325 MG-10 MG, 325 MG-5 MG, 325
HUMIRA PEDIATRIC CROHNS hydroxyzine hcl SYRP 7
MG-7.5 MG 6
DISEASE STARTER PACK PSKT 80
hydroxyzine hcl TABS 7
MG/0.8ML 3 hydrocodone-ibuprofen 10 MG-200
MG, 5 MG-200 MG 6 hydroxyzine pamoate CAPS 7
HUMIRA PEN PNKT 80 MG/0.8ML 3
hydrocodone-ibuprofen 7.5 MG-200 HYPERSAL NEBU 37
HUMIRA PEN PNKT 3
MG 6
HYQVIA 59
HUMIRA PEN-CD/UC/HS STARTER
hydrocortisone (intrarectal) 7
PNKT 40 MG/0.8ML 3 ibandronate sodium SOLN 44
hydrocortisone (rectal) EX 7
HUMIRA PEN-CD/UC/HS STARTER ibandronate sodium TABS 44
PNKT 80 MG/0.8ML 3 hydrocortisone (topical) CREA 1 %,
IBRANCE CAPS 26
2.5 % 41
HUMIRA PEN-PEDIATRIC UC
IBRANCE TABS 26
STARTER PACK PNKT 3 hydrocortisone (topical) LOTN 2.5 %
41 ibuprofen SUSP 100 MG/5ML 3
HUMIRA PEN-PS/UV STARTER
PNKT 3 hydrocortisone (topical) OINT 1 %, ibuprofen TABS 400 MG, 600 MG,
2.5 % 41 800 MG 3
HUMIRA PSKT 3
hydrocortisone acetate (rectal) 7 icatibant acetate SOLN 48
HUMULIN R U-500
(CONCENTRATED) SOLN SC 16 hydrocortisone butyrate CREA 41 icatibant acetate SOSY 48
HUMULIN R U-500 KWIKPEN SOPN hydrocortisone butyrate OINT 41 ICLUSIG 26

SC 16
hydrocortisone butyrate SOLN 41 icosapent ethyl 1 GM 19
HYCAMTIN CAPS 28
hydrocortisone TABS 36 idarubicin hcl 20 MG/20ML 26
hydralazine hcl SOLN 21
hydrocortisone valerate CREA 41 idarubicin hcl 5 MG/5ML, 10
hydralazine hcl TABS 21 MG/10ML 26
hydrocortisone valerate OINT 41
hydrochlorothiazide CAPS 43 ifosfamide SOLN 1 GM/20ML 23
hydrocortisone w/acetic acid 59
hydrochlorothiazide TABS 43 ifosfamide SOLR 23
hydromorphone hcl LIQD 4
Index 15
ILEVRO 58 ipratropium bromide (nasal) 0.03 % IXEMPRA KIT 15 MG 28
56
imatinib mesylate 26 JAKAFI 10 MG, 20 MG 26
ipratropium bromide (nasal) 0.06 %
IMBRUVICA CAPS 140 MG 26 JAKAFI 5 MG, 15 MG, 25 MG 26
56
IMBRUVICA CAPS 70 MG 26 JANUMET TABS 15
ipratropium bromide SOLN 0.02 % 8
IMBRUVICA SUSP 26 JANUMET XR TB24 1000 MG-100
ipratropium-albuterol SOLN 10
MG 15
IMBRUVICA TABS 26
irbesartan 20
JANUMET XR TB24 1000 MG-50
imipenem-cilastatin IV 21
irbesartan-hydrochlorothiazide 20 MG, 500 MG-50 MG 15
imipramine hcl TABS 15
irinotecan hcl 40 MG/2ML, 100 JANUVIA 15
imipramine pamoate 15 MG/5ML 28
JARDIANCE 16
imiquimod 5 % 42 irrigation solutions, physiological 55
JEVTANA 28
IMPAVIDO 21 ISENTRESS CHEW 30
JUBLIA 38
INCRELEX 44 ISENTRESS HD TABS 30
JULUCA 30
INCRUSE ELLIPTA 8 ISENTRESS TABS 30
KALYDECO TABS 62
indapamide TABS 1.25 MG 43 ISOLYTE-P/DEXTROSE 5% 53
KAMELEON LUBRICATED MISC 50
indapamide TABS 2.5 MG 43 ISOLYTE-S 53
KANJINTI 24
indomethacin CAPS 25 MG, 50 MG 3 isoniazid SOLN 23
KEPIVANCE 27
indomethacin CPCR 3 isoniazid SYRP 23
KESIMPTA 61
INFANRIX 63 isoniazid TABS 23
ketoconazole (topical) CREA 38
INFLECTRA 46 isosorbide dinitrate TABS 5 MG, 10
ketoconazole (topical) SHAM 2 % 38
MG, 20 MG, 30 MG 7
INGREZZA CAPS 60
ketoconazole 18
isosorbide dinitrate-hydralazine hcl
INGREZZA CPPK 60
33 KETONE STRP 42
INLYTA 24
isosorbide mononitrate TABS 7 KETONE TEST STRIPS STRP 42
INREBIC 26
isosorbide mononitrate TB24 7 ketoprofen CAPS 50 MG, 75 MG 3
INTELENCE 25 MG 30
isotretinoin 10 MG, 20 MG, 30 MG, ketorolac tromethamine (ophth) 58
INTRAROSA 66 40 MG 37
ketorolac tromethamine TABS 3
INTRON A SOLR 18000000 UNIT 27 isradipine CAPS 33
KETOSTIX STRP 42
INVIRASE TABS 30 itraconazole CAPS 18
ketotifen fumarate (ophth) 0.025 %
IONOSOL-MB/DEXTROSE 5% 53 itraconazole SOLN 18 58
IOPIDINE 57 ivermectin (pediculicide) 42 KEVZARA SOAJ 3
IPOL INACTIVATED IPV 66 ivermectin 7 KEVZARA SOSY 3
Index 16
KIMONO COLORS DEVI 50 labetalol hcl SOLN 32 leflunomide 4
KIMONO LUBRICATED MISC 50 labetalol hcl TABS 100 MG, 200 MG lenalidomide 2.5 MG, 5 MG, 10 MG,
32 15 MG, 25 MG 54
KIMONO MICRO THIN PLUS
SPERMICIDE LUBRICATED MISC labetalol hcl TABS 300 MG 32 lenalidomide 20 MG 54
50
lacosamide SOLN OR 10 MG/ML 12 LENVIMA 10 MG DAILY DOSE 24
KIMONO PLUS SPERMICIDE
lacosamide TABS 12 LENVIMA 12MG DAILY DOSE 24
LUBRICATED MISC 50
LACRISERT 57 LENVIMA 14 MG DAILY DOSE 24
KIMONO PLUS
SPERMICIDE/LUBRICATED MISC lactated ringer's (irrigation) 55 LENVIMA 18 MG DAILY DOSE 24
50
lactated ringer's 53 LENVIMA 20 MG DAILY DOSE 24
KIMONO PS LUBRICATED MISC 50
lactic acid (ammonium lactate) CREA LENVIMA 24 MG DAILY DOSE 24
KIMONO PS PLUS 41
LENVIMA 4 MG DAILY DOSE 24
SPERMICIDE/LUBRICATED MISC
lactic acid (ammonium lactate) LOTN
51 LENVIMA 8 MG DAILY DOSE 24
12 % 41
KIMONO SENSATION letrozole 25
lactulose (encephalopathy) 46
LUBRICATED MISC 51
leucovorin calcium SOLR 27
lactulose SOLN 49
KIMONO SENSATION PLUS
leucovorin calcium TABS 27
SPERMICIDE LUBRICATED MISC lamivudine (hbv) TABS 31
51 LEUKERAN 23
lamivudine SOLN 30
KIMONO SPECIAL DEVI 51 LEUKINE SOLR IJ 48
lamivudine TABS 150 MG 30
KINRIX SUSY 63 leuprolide acetate KIT IJ 1 MG/0.2ML
lamivudine TABS 300 MG 30
25
KISQALI 26
lamivudine-zidovudine 30
levalbuterol hcl 10
KISQALI FEMARA 200 DOSE 26
lamotrigine CHEW 25 MG 12
levalbuterol hcl 1.25 MG/0.5ML 10
lamotrigine CHEW 5 MG 12
levalbuterol tartrate 10
lamotrigine TABS 12
LEVEMIR FLEXPEN SOPN 16
KLARITY-A 57
lamotrigine TBDP 12
LEVEMIR FLEXTOUCH SOPN 16
KOSELUGO 26
LANREOTIDE ACETATE 45
LEVEMIR SOLN 16
KP PRENATAL MULTIVITAMINS
lansoprazole CPDR 15 MG 63
TABS 55 levetiracetam SOLN IV 500 MG/5ML
lansoprazole CPDR 30 MG 63 12
KRINTAFEL 22
lanthanum carbonate CHEW 47 levetiracetam TABS 1000 MG 12
K-Y ME & YOU EXTRA
LUBRICATED DEVI 51 lapatinib ditosylate 26 levetiracetam TABS 250 MG, 750
MG 12
K-Y ME & YOU INTENSE DEVI 51 LASTACAFT 58
levetiracetam TABS 500 MG 12
KYPROLIS 26 latanoprost SOLN 59
Index 17
levetiracetam TB24 12 lidocaine PTCH 5 % 42 lorazepam TABS 1 MG 8
levobunolol hcl 0.5 % 57 lidocaine-prilocaine CREA 42 LORBRENA 26
levocetirizine dihydrochloride SOLN lincomycin hcl 22 losartan potassium &

18 hydrochlorothiazide 12.5 MG-100
lindane SHAM 42
MG, 25 MG-100 MG 21
levocetirizine dihydrochloride TABS
linezolid SUSR 22
18 losartan potassium &
linezolid TABS 22 hydrochlorothiazide 12.5 MG-50 MG
levofloxacin (ophth) 0.5 % 57
20
LINZESS 47
levofloxacin in d5w 5 %-500
losartan potassium 20
MG/100ML 46 liothyronine sodium SOLN 62
LOTEMAX OINT 58
levofloxacin SOLN OR 46 liothyronine sodium TABS 62
loteprednol etabonate GEL 58
levofloxacin TABS 46 lisinopril & hydrochlorothiazide 20
loteprednol etabonate SUSP 58
levonorgestrel & eth estradiol TABS lisinopril TABS 2.5 MG, 5 MG, 10
35 MG, 20 MG, 30 MG, 40 MG 20 lovastatin TABS 10 MG, 20 MG 19
levonorgestrel (emergency oc) 1.5 lithium carbonate CAPS 29 lovastatin TABS 40 MG 19

MG 36
lithium carbonate TABS 29 loxapine succinate 29
levonorgestrel-eth estradiol
lithium carbonate TBCR 29 lubiprostone 46
(triphasic) 35
LO LOESTRIN FE TABS 35 LUCEMYRA 60
levonorgestrel-ethinyl estradiol (91-
day) 0.03 MG-0.15 MG 35 LOKELMA 55 luliconazole 38
levonorgestrel-ethinyl estradiol loperamide hcl CAPS 17 LUMIZYME 45

(continuous) 35
lopinavir-ritonavir SOLN 31 LUPRON DEPOT (1-MONTH) KIT IM
levonorgestrel-ethinyl estradiol- 25
lopinavir-ritonavir TABS 31
ferrous bisglycinate 35
LUPRON DEPOT (3-MONTH) KIT IM
loratadine & pseudoephedrine TB12
levorphanol tartrate TABS 2 MG 5 25
37
levothyroxine sodium TABS 62 LUPRON DEPOT (4-MONTH) IM 25
loratadine & pseudoephedrine TB24
LEXIVA SUSP 31 37 LUPRON DEPOT (6-MONTH) IM 25
lidocaine hcl (local anesth.) SOLN loratadine CAPS 18 LUPRON DEPOT-PED (1-MONTH)
0.5 %, 1 %, 2 % 50 44
loratadine CHEW 18
lidocaine hcl (mouth-throat) 2 % 55 LUPRON DEPOT-PED (3-MONTH)
loratadine SOLN 18
11.25 MG 44
lidocaine hcl (mouth-throat) 4 % 55
loratadine TABS 18
LUPRON DEPOT-PED (3-MONTH)
lidocaine hcl GEL 2 % 42
loratadine TBDP 18 30 MG 44
lidocaine hcl PRSY 42
lorazepam CONC 8 lurasidone hcl 20 MG, 40 MG, 60
lidocaine hcl SOLN 42 MG, 120 MG 29
lorazepam TABS 0.5 MG, 2 MG 8
Index 18
lurasidone hcl 80 MG 29 MEKTOVI 26 methadone hcl SOLN IJ 10 MG/ML 5
LYNPARZA TABS 26 meloxicam TABS 4 METHADONE HCL SOLN IJ 5
LYSODREN 25 melphalan 23 methadone hcl SOLN OR 10

MG/5ML 5
mafenide acetate PACK 40 melphalan hcl 23
methadone hcl SOLN OR 5 MG/5ML
magnesium sulfate IJ 50 % 54 memantine hcl TABS 60
5
malathion 42 MENACTRA 64
methadone hcl TABS 10 MG 5
maraviroc TABS 150 MG 31 MENEST 46
methadone hcl TABS 5 MG 5
maraviroc TABS 300 MG 31 MENOSTAR PTWK 46
methadone hcl TBSO 5
MARPLAN 13 MENQUADFI 64
methamphetamine hcl 1
MASONATAL TABS 55 MENVEO SOLR 64
methazolamide TABS 43
MATULANE 27 meperidine hcl SOLN IJ 25 MG/ML,
methenamine hippurate 22
50 MG/ML, 100 MG/ML 5
MAXIDEX SUSP OP 58
methimazole TABS 62
meperidine hcl SOLN OR 50
MAXX LUBRICATED MISC 51
MG/5ML 5 METHITEST TABS 7
MAXX PLUS SPERMICIDE
meperidine hcl TABS 50 MG 5 methocarbamol TABS 56
LUBRICATED MISC 51
meprobamate 7 METHOTREXATE 2
meclizine hcl TABS 12.5 MG, 25 MG
17 mercaptopurine TABS 24 methotrexate sodium SOLN 50
MG/2ML, 250 MG/10ML 24
meclofenamate sodium CAPS 3 meropenem 21
methotrexate sodium SOLR 24
MEDROL TABS 36 mesalamine CP24 46
methotrexate sodium TABS 2.5 MG
medroxyprogesterone acetate mesalamine CPDR 46
24
(contraceptive) SUSP IM 36
mesalamine ENEM 46
methoxsalen rapid 39
medroxyprogesterone acetate
mesalamine SUPP 46
(contraceptive) SUSY IM 36 methscopolamine bromide 63
mesalamine TBEC 1.2 GM 46
medroxyprogesterone acetate 2.5 methsuximide 13
MG, 5 MG, 10 MG 60 mesalamine TBEC 800 MG 46
methyldopa TABS 20
mefenamic acid CAPS 4 metaxalone 800 MG 56
methylphenidate hcl CP24 20 MG, 40
mefloquine hcl 23 metformin hcl TABS 1000 MG 15 MG 2
megestrol acetate (appetite) 60 metformin hcl TABS 500 MG 15 methylphenidate hcl CP24 30 MG 2
megestrol acetate SUSP 25 metformin hcl TABS 850 MG 15 methylphenidate hcl CP24 2
megestrol acetate TABS 25 metformin hcl TB24 500 MG 15 methylphenidate hcl CPCR 2
MEKINIST TABS 0.5 MG 26 metformin hcl TB24 750 MG 15 methylphenidate hcl SOLN 2
MEKINIST TABS 2 MG 26 methadone hcl CONC 5 methylphenidate hcl TABS 10 MG,

Index 19
20 MG 2 metoprolol tartrate TABS 25 MG, 50 mitoxantrone hcl 2 MG/ML 26
MG, 100 MG 32
methylphenidate hcl TABS 5 MG 2 M-M-R II SOLR 66
metronidazole (topical) CREA 42
methylphenidate hcl TB24 27 MG 2 M-NATAL PLUS TABS 55
metronidazole (topical) GEL 0.75 %
methylphenidate hcl TB24 36 MG, 54 modafinil 100 MG 2
42
MG 2
modafinil 200 MG 2
metronidazole (topical) GEL 1 % 42
methylphenidate hcl TBCR 10 MG,
moexipril hcl 20
20 MG 2 metronidazole (topical) LOTN 42
mometasone furoate (nasal) SUSP
methylphenidate hcl TBCR 18 MG, metronidazole TABS 21
57
27 MG 2
metronidazole vaginal 67
mometasone furoate CREA 41
methylphenidate hcl TBCR 36 MG,
mexiletine hcl 8
54 MG 2 mometasone furoate OINT 41
micafungin sodium 18
methylphenidate PTCH 2 mometasone furoate SOLN 41
miconazole nitrate vaginal SUPP 200
methylprednisolone acetate SUSP 36 montelukast sodium CHEW 8
MG 67
methylprednisolone sod succ 40 MG, montelukast sodium PACK 8
midodrine hcl 67
125 MG, 500 MG, 1000 MG 36
montelukast sodium TABS 8
mifepristone 45
methylprednisolone TABS 36
morphine sulfate CP24 20 MG, 30
miglitol 15
methylprednisolone TBPK 36 MG, 50 MG, 60 MG, 80 MG, 100 MG
miglustat 48 5
metoclopramide hcl SOLN IJ 5
MG/ML 46 minocycline hcl CAPS 62 morphine sulfate SOLN IJ 0.5
MG/ML, 1 MG/ML 5
metoclopramide hcl SOLN OR 5 minocycline hcl TABS 62
MG/5ML, 10 MG/10ML 46 morphine sulfate SOLN OR 10
minoxidil 2.5 MG, 10 MG 21
MG/5ML 5
metoclopramide hcl TABS 46
MIRCERA 30 MCG/0.3ML, 50
morphine sulfate SOLN OR 20
metolazone 43 MCG/0.3ML, 75 MCG/0.3ML, 100
MG/5ML 5
MCG/0.3ML, 150 MCG/0.3ML, 200
metoprolol & hydrochlorothiazide
MCG/0.3ML 48 morphine sulfate TABS 5
TABS 25 MG-100 MG, 50 MG-100
MG 21 mirtazapine TABS 15 MG 13 morphine sulfate TBCR 5
metoprolol & hydrochlorothiazide mirtazapine TABS 30 MG 13 MOTOFEN 17

TABS 25 MG-50 MG 21
mirtazapine TABS 7.5 MG, 45 MG 13 MOVANTIK 47
metoprolol succinate TB24 200 MG
mirtazapine TBDP 15 MG 13 moxifloxacin hcl (ophth) SOLN OP 57
32
mirtazapine TBDP 30 MG 13 moxifloxacin hcl in sodium chloride
metoprolol succinate TB24 25 MG,
46
50 MG, 100 MG 32 mirtazapine TBDP 45 MG 13
moxifloxacin hcl TABS 46
metoprolol tartrate SOLN IV 5 misoprostol 64
MG/5ML 32 MULPLETA 48
mitomycin SOLR IV 20 MG 26
Index 20
MULTI PRENATAL TABS 55 NAYZILAM 11 nevirapine TABS 31
mupirocin OINT 38 nebivolol hcl 2.5 MG, 5 MG, 10 MG nevirapine TB24 100 MG 31
32
MVASI 24 nevirapine TB24 400 MG 31
nebivolol hcl 20 MG 32
MYALEPT 45 NEXLETOL 19
NEBUSAL NEBU 37
mycophenolate mofetil CAPS 54 NEXTSTELLIS 35
nefazodone hcl 14
mycophenolate mofetil TABS 54 niacin (antihyperlipidemic) TBCR 19
nelarabine 24
mycophenolate sodium 54 niacin CPCR 250 MG, 500 MG 67
neomycin sulfate TABS 2
MYLERAN TABS 23 niacin TABS 67
neomycin-bacitracin zn-polymyxin 58
nabumetone 4 niacin TBCR 67
neomycin-polymy-dexameth OINT 58
nadolol TABS 20 MG 32 NIACIN TR TBCR 67
neomycin-polymy-dexameth SUSP
nadolol TABS 40 MG 32 niacinamide TABS 67
58
nadolol TABS 80 MG 32 nicardipine hcl CAPS 33
neomycin-polymyxin-hc (ophth) 58
nafcillin sodium IV 10 GM 60 nicardipine hcl SOLN 33
neomycin-polymyxin-hc (otic) SOLN
naftifine hcl CREA 1 % 38 59 nicotine polacrilex GUM 61
naftifine hcl CREA 2 % 38 neomycin-polymyxin-hc (otic) SUSP nicotine polacrilex LOZG 61

59
naftifine hcl GEL 1 % 38 nicotine PT24 7 MG/24HR, 14
NEONATAL COMPLETE TABS 120 MG/24HR, 21 MG/24HR 61
NAGLAZYME 45
MG-10 MG-9.2 MG-1000 MCG-10
NICOTINE TRANSDERMAL
nalbuphine hcl 6 MCG-12 MCG-3 MG-5 MG-20 MG-
SYSTEM KIT 61
27 MG-200 MG-1.84 MG-25 MG-2
naloxone hcl LIQD 17
MG-1200 MCG-2 MG-0.2 MG 55 NICOTROL INHALER INHA 61
naloxone hcl SOLN 0.4 MG/ML, 4
NEONATAL PLUS TABS 55 NICOTROL NS SOLN 61
MG/10ML 17
NEONATAL PRENATAL VITAMIN nifedipine CAPS 10 MG 33
naltrexone hcl 17
TABS 55
nifedipine CAPS 20 MG 33
naproxen sodium TABS 550 MG 4
NEONATAL VITAMIN TABS 55
nifedipine TB24 60 MG 33
naproxen SUSP 4
NEOSTIGMINE METHYLSULFATE
nifedipine TB24 90 MG 33
naproxen TABS 4 SOSY 3 MG/3ML 23
nifedipine TB24 33
naproxen TBEC 500 MG 4 neostigmine methylsulfate SOSY 23
nilutamide 25
naratriptan hcl 52 NEO-SYNALAR 38
nimodipine CAPS 33
NATACYN 57 NEUPRO 28
NINLARO 26
NATAZIA 35 NEVANAC 58
nisoldipine 8.5 MG, 17 MG, 20 MG,
nateglinide 16 nevirapine SUSP 31
30 MG, 34 MG, 40 MG 33
Index 21
nitazoxanide TABS 21 estradiol 45 NOVOLOG FLEXPEN SOPN 16
nitisinone CAPS 2 MG, 5 MG, 10 MG norethindrone acetate-ethinyl NOVOLOG MIX 70/30 PREFILLED
45 estradiol-fe 35 FLEXPEN RELION SUPN 16
NITRO-BID OINT 7 norethindrone-eth estradiol (triphasic) NOVOLOG MIX 70/30 PREFILLED

35 FLEXPEN SUPN 16
nitrofurantoin 22
norgestimate-ethinyl estradiol NOVOLOG MIX 70/30 SUSP 16
nitrofurantoin macrocrystal 50 MG,
(triphasic) 35
100 MG 22 NOVOLOG PENFILL SOCT 16
norgestimate-ethinyl estradiol 35
nitrofurantoin monohyd macro 22 NOVOLOG SOLN IJ 16
norgestrel & ethinyl estradiol 30
nitroglycerin CPCR 7 NP THYROID 120 TABS 62
MCG-0.3 MG 35
nitroglycerin PT24 7 NP THYROID 15 TABS 62
NORMOSOL-M/D5W 53
NITROGLYCERIN SOLN IV 7 NP THYROID 30 TABS 62
NORMOSOL-R 53
nitroglycerin SUBL 7 NP THYROID 60 TABS 62
nortriptyline hcl CAPS 15
NIVA-PLUS TABS 55 NP THYROID 90 TABS 62
nortriptyline hcl SOLN 15
nizatidine CAPS 63 NUBEQA 25
NORVIR PACK 31
nizatidine SOLN 63 NUCALA SOAJ 8
NORVIR SOLN 31
NORDITROPIN FLEXPRO SOPN 30 NUCALA SOLR 8
NOVA MAX PLUS KETONE
MG/3ML 44
TESTSTRIPS 42 NUCALA SOSY 100 MG/ML 8
NORDITROPIN FLEXPRO SOPN 5
NOVAREL IM 10000 UNIT 44 NUCALA SOSY 40 MG/0.4ML 8
MG/1.5ML, 10 MG/1.5ML, 15
MG/1.5ML 44 NOVOLIN 70/30 FLEXPEN RELION NUCYNTA ER TB12 5
SUPN 16
norelgestromin-ethinyl estradiol 35 NUCYNTA TABS 5
NOVOLIN 70/30 FLEXPEN SUPN 16
norethin acet & estrad-fe CAPS 35 NUEDEXTA 61
NOVOLIN 70/30 RELION SUSP 16
norethin acet & estrad-fe CHEW 35 NULOJIX 54
NOVOLIN 70/30 SUSP 16
norethin acet & estrad-fe TABS 1 nystatin (mouth-throat) 55
MG-20 MCG-75 MG, 1.5 MG-30 NOVOLIN N FLEXPEN RELION
nystatin (topical) CREA 38
MCG-75 MG 35 SUPN 16
nystatin (topical) OINT 38
norethindrone & eth estradiol 35 NOVOLIN N FLEXPEN SUPN 16
nystatin (topical) POWD EX 38
norethindrone & ethinyl estradiol-fe NOVOLIN N RELION SUSP 16
35 nystatin TABS 18
NOVOLIN N SUSP 16
norethindrone (contraceptive) 36 nystatin-triamcinolone CREA 38
NOVOLIN R RELION SOLN IJ 16
norethindrone acet & eth estra 35 nystatin-triamcinolone OINT 38
NOVOLIN R SOLN IJ 16
norethindrone acetate TABS 60 octreotide acetate SOLN 45
NOVOLOG FLEXPEN RELION
norethindrone acetate-ethinyl SOPN 16 octreotide acetate SOSY 45
Index 22
ODEFSEY 31 ondansetron hcl SOLN OR 4 oxcarbazepine TABS 150 MG, 300
MG/5ML 17 MG 12
ODOMZO 25
ondansetron hcl SOSY 17 oxcarbazepine TABS 600 MG 12
OFEV 62
ondansetron hcl TABS 24 MG 17 oxiconazole nitrate CREA 39
ofloxacin (ophth) 58
ondansetron hcl TABS 4 MG 17 OXISTAT LOTN 39
ofloxacin (otic) 59
ondansetron hcl TABS 8 MG 17 oxybutynin chloride SYRP 64
ofloxacin 300 MG, 400 MG 46
ondansetron TBDP 4 MG 17 oxybutynin chloride TABS 5 MG 64
OGIVRI 24
ondansetron TBDP 8 MG 17 oxybutynin chloride TB24 64
olanzapine SOLR 29
ONE VITE WOMENS oxycodone hcl T12A 5
olanzapine TABS 2.5 MG, 5 MG 29
PRENATALVITAMIN PLUS TABS 55
oxycodone hcl TABS 5
olanzapine TABS 7.5 MG, 10 MG, 15
ONE VITE WOMENS
MG, 20 MG 29 oxycodone w/ acetaminophen TABS
PRENATALVITAMIN TABS 55
325 MG-10 MG, 325 MG-5 MG, 325
olanzapine TBDP 20 MG 29
OPSUMIT 34 MG-7.5 MG 6
olanzapine TBDP 5 MG, 10 MG, 15
ORENITRAM TBCR 33 oxymorphone hcl TABS 5
MG 29
ORKAMBI PACK 125 MG-100 MG, oxymorphone hcl TB12 40 MG 5
olmesartan medoxomil 20
188 MG-150 MG 62
oxymorphone hcl TB12 5 MG, 7.5
olmesartan medoxomil-amlodipine-
ORKAMBI TABS 62 MG, 10 MG, 15 MG, 20 MG, 30 MG 5
orphenadrine citrate TB12 56 OZEMPIC SOPN 2 MG/1.5ML 15
olmesartan medoxomil-
hydrochlorothiazide 21 oseltamivir phosphate CAPS 32 OZEMPIC SOPN 16
olopatadine hcl (nasal) 56 oseltamivir phosphate SUSR 32 paclitaxel 150 MG/25ML 28
olopatadine hcl 0.1 % 58 OSMOPREP 50 paclitaxel 6 MG/ML, 100 MG/16.7ML

28
olopatadine hcl 0.2 % 58 OSPHENA 44
paclitaxel protein-bound particles 28
omega-3-acid ethyl esters 19 OTEZLA TABS 4
PACLITAXEL PROTEIN-
omeprazole CPDR 63 OTEZLA TBPK 4
BOUNDPARTICLES 28
omeprazole magnesium CPDR 63 oxacillin sodium IV 10 GM 60
paliperidone 1.5 MG, 3 MG, 9 MG 29
omeprazole TBEC 63 oxaliplatin SOLN 50 MG/10ML, 100
paliperidone 6 MG 29
MG/20ML 23
omeprazole-sodium bicarbonate
palonosetron hcl SOLN 17
CAPS 1100 MG-20 MG 64 oxandrolone 7
pamidronate disodium SOLN 30
OMNIFLEX DIAPHRAGM 51 oxaprozin 4
MG/10ML, 90 MG/10ML 44
ONCASPAR 27 oxazepam CAPS 8
PAMIDRONATE DISODIUM SOLN
ondansetron hcl SOLN IJ 4 MG/2ML OXBRYTA TABS 500 MG 48 44
17
oxcarbazepine SUSP 12 PANCREAZE CPEP 149900 UNIT-
Index 23
97300 UNIT-37000 UNIT, 15200 PEGASYS SOLN 31 phenobarbital ELIX 49
UNIT-8800 UNIT-2600 UNIT, 24600
PEGASYS SOSY 31 phenobarbital TABS 15 MG, 16.2
UNIT-14200 UNIT-4200 UNIT, 61500
MG, 30 MG, 32.4 MG, 64.8 MG, 97.2
UNIT-35500 UNIT-10500 UNIT, PEMAZYRE 27
MG, 100 MG 49
83900 UNIT-54700 UNIT-21000
pemetrexed disodium SOLR 500 MG
UNIT, 98400 UNIT-56800 UNIT- phenoxybenzamine hcl 20
24
16800 UNIT 43
phentermine hcl CAPS 1
penciclovir 40
PANRETIN 39
phenytoin CHEW 13
penicillamine CAPS 54
pantoprazole sodium TBEC 20 MG
phenytoin sodium extended 100 MG,
63 penicillamine TABS 54
200 MG, 300 MG 13
pantoprazole sodium TBEC 40 MG penicillin g potassium 5000000 UNIT
phenytoin sodium SOLN 13
64 59
phenytoin SUSP 13
paricalcitol CAPS 45 PENICILLIN G POTASSIUM IN ISO-
OSMOTIC DEXTROSE 40000 PHEXXI 67
paricalcitol SOLN 45
UNIT/ML, 60000 UNIT/ML 59
PHOSLYRA SOLN 47
paromomycin sulfate 2
PENICILLIN G PROCAINE 59
PHOSPHOLINE IODIDE 57
paroxetine hcl SUSP 14
penicillin g sodium 59
PHOTOFRIN 27
paroxetine hcl TABS 10 MG 14
penicillin v potassium SOLR 59
PIFELTRO 31
penicillin v potassium TABS 59
pilocarpine hcl (oral) 55
PENTACEL 63
pilocarpine hcl SOLN 1 %, 2 %, 4 %
pentazocine w/ naloxone hcl 6 57
paroxetine hcl TB24 12.5 MG 14
pentoxifylline 48 pimecrolimus 42
paroxetine hcl TB24 25 MG, 37.5 MG
perindopril erbumine 2 MG, 8 MG 20 pimozide 61
14
perindopril erbumine 4 MG 20 pindolol TABS 32
PASER PACK 23
PERJETA 24 pioglitazone hcl 16
PEDIARIX SUSY 63
permethrin CREA 42 pioglitazone hcl-glimepiride 15
pediatric multivitamins w/fl CHEW 55
permethrin LIQD EX 42 pioglitazone hcl-metformin hcl TABS
PEDVAX HIB SUSP 64
15
perphenazine TABS 30
peg 3350-kcl-nacl-na sulfate-na
piperacillin sodium-tazobactam
ascorbate-ascorbic acid 49 perphenazine-amitriptyline 60
sodium 60
peg 3350-kcl-sod bicarb-sod PERSERIS PRSY 29
PIQRAY 200MG DAILY DOSE 27
chloride-sod sulfate SOLR 6.74 GM-
phenazopyridine hcl TABS 100 MG,
2.97 GM-5.86 GM-22.74 GM-236 GM PIQRAY 250MG DAILY DOSE 27
100 MG, 200 MG 47
49
PIQRAY 300MG DAILY DOSE 27
phendimetrazine tartrate TABS 1
peg 3350-potassium chloride-sod
pirfenidone CAPS 62
bicarbonate-sod chloride 49 phenelzine sulfate 13
Index 24
pirfenidone TABS 267 MG, 801 MG microencapsulated crystals er 54 prednisolone sodium phosphate
62 SOLN 5 MG/5ML, 6.7 MG/5ML, 10
potassium chloride PACK OR 20
MG/5ML, 15 MG/5ML, 25 MG/5ML
pirfenidone TABS 534 MG 62 MEQ 54
36
piroxicam CAPS 4 potassium chloride SOLN IV 2
prednisolone sodium phosphate
MEQ/ML, 10 MEQ/50ML, 20
PLEGRIDY SOPN 61 TBDP 36
MEQ/50ML 54
PLEGRIDY SOSY SC 61 prednisolone SOLN 36
potassium chloride TBCR 8 MEQ, 10
PLEGRIDY STARTER PACK SOPN MEQ 54 prednisolone TABS 36
61
POTASSIUM prednisone SOLN 36
PLEGRIDY STARTER PACK SOSY CHLORIDE/DEXTROSE/LACTATED
prednisone TABS 36
SC 61 RINGERS 53
prednisone TBPK 36
plerixafor 49 potassium citrate (alkalinizer) TBCR
10 MEQ, 1080 MG 47 pregabalin (once-daily) 330 MG 61
PNEUMOVAX 23 64
potassium phosphates 236 MG/ML- pregabalin (once-daily) 82.5 MG, 165
PNEUMOVAX 23/1 DOSE 64
224 MG/ML 54 MG 61
podofilox SOLN 42
PR BENZOYL PEROXIDE WASH pregabalin CAPS 225 MG, 300 MG
polymyxin b sulfate SOLR 22 LIQD 37 12
polymyxin b-trimethoprim 58 pralatrexate 20 MG/ML 24 pregabalin CAPS 25 MG, 50 MG, 75

MG, 100 MG, 150 MG, 200 MG 12
POMALYST 25 pramipexole dihydrochloride TABS
0.125 MG 28 pregabalin SOLN 12
posaconazole SUSP 18
pramipexole dihydrochloride TABS PREHEVBRIO 66
potassium acetate SOLN 2 MEQ/ML
0.25 MG, 0.5 MG, 0.75 MG, 1 MG,
54 PREMARIN 67
1.5 MG 28
potassium bicarbonate TBEF 54 PREMARIN SOLR 46
prasugrel hcl 48
potassium chloride CPCR 54 PREMARIN TABS 46
pravastatin sodium 19
potassium chloride in dextrose & PREMIUM CONDOMS
praziquantel 7
sodium chloride 5 %-0.075 %-0.45 LUBRICATED MISC 51
%, 5 %-0.15 %-0.9 %, 5 %-10 prazosin hcl CAPS 20
PREMPHASE 45
MEQ/L-0.45 %, 5 %-20 MEQ/L-0.2
PRECISION XTRA 42
%, 5 %-20 MEQ/L-0.45 %, 5 %-20 PREMPRO 45
MEQ/L-0.9 %, 5 %-30 MEQ/L-0.45 PRED MILD 58
PRENATAL MULTIVITAMIN TABS
%, 5 %-40 MEQ/L-0.45 %, 5 %-40
PRED-G SUSP 58 56
MEQ/L-0.9 % 53
prednicarbate OINT 41 PRENATAL ONE DAILY TABS 56
potassium chloride in dextrose 5 %-
20 MEQ/L 53 prednisolone acetate (ophth) 58 PRENATAL PLUS TABS 56
potassium chloride in nacl 53 PREDNISOLONE SODIUM PRENATAL PLUS VITAMIN

PHOSPHATE 58 ANDMINERAL TABS 56
potassium chloride
Index 25
PRENATAL TABS 56 PROCRIT 40000 UNIT/ML 48 pyridostigmine bromide SOLN OR 23
PRENATAL VITAMIN & MINERAL progesterone CAPS 60 pyridostigmine bromide TABS 60 MG

TABS 56 23
PROGRAF PACK 54
PRENATAL VITAMIN TABS 56 pyridostigmine bromide TBCR 23
PROGRAF SOLN 54
PRENATAL VITAMIN/IRON TABS 56 pyrimethamine 23
PROLASTIN-C SOLN 62
PRENATAL VITAMINS PLUS LOW QC PRENATAL TABS 56
PROLASTIN-C SOLR 62
IRON TABS 56
QINLOCK 27
PROLEUKIN 27
PRENATAL VITAMINS TABS 120
QUADRACEL SUSP 63
MG-2.6 MG-800 MCG-400 UNIT-8 PROLIA SOSY 44
MCG-1.7 MG-20 MG-28 MG-200 QUADRACEL SUSY 63
promethazine hcl SOLN 25 MG/ML,
MG-1.8 MG-25 MG-4000 UNIT-30
50 MG/ML 19 quetiapine fumarate TABS 25 MG, 50
UNIT 56
MG, 100 MG, 200 MG 29
promethazine hcl SUPP 12.5 MG, 25
PRENATRIX TABS 56
MG 19 quetiapine fumarate TABS 300 MG,
PRENATRYL TABS 56 400 MG 29
promethazine hcl SUPP 50 MG 19
PREPLUS TABS 56 quetiapine fumarate TB24 300 MG,
promethazine hcl SYRP 19
400 MG 29
PREVNAR 13 64
promethazine hcl TABS 19
quetiapine fumarate TB24 50 MG,
PREVNAR 20 64
propafenone hcl CP12 8 150 MG, 200 MG 29
PREZCOBIX 31
propafenone hcl TABS 8 quinapril hcl 20 MG, 40 MG 20
PREZISTA SUSP 31
proparacaine hcl 58 quinapril hcl 5 MG, 10 MG 20
PREZISTA TABS 75 MG, 150 MG,
propranolol hcl CP24 32 quinapril-hydrochlorothiazide 12.5
600 MG 31
MG-10 MG 21
propranolol hcl SOLN OR 20
PRIFTIN 23
MG/5ML, 40 MG/5ML 32 quinapril-hydrochlorothiazide 12.5
primaquine phosphate TABS 23 MG-20 MG 21
propranolol hcl TABS 32
primidone 50 MG, 250 MG 12 quinapril-hydrochlorothiazide 25 MG-
propylthiouracil 62
20 MG 21
PRIORIX SUSR 66
protriptyline hcl 15
quinidine sulfate TABS 8
probenecid 47
PROVISC SOSY 58
quinine sulfate CAPS 324 MG 23
procainamide hcl SOLN 500 MG/ML
PTS PANELS KETONE TEST 43
8 QUZYTTIR SOLN IV 18
PULMICORT FLEXHALER AEPB 9
prochlorperazine 30 QVAR REDIHALER 9
PULMOZYME 62
prochlorperazine maleate TABS 30 RA PRENATAL
PX PRENATAL MULTIVITAMINS FORMULA/FOLICACID TABS 56
PROCRIT 2000 UNIT/ML, 3000
TABS 56
UNIT/ML, 4000 UNIT/ML, 10000 RA PRENATAL TABS 56
UNIT/ML, 20000 UNIT/ML 48 pyrazinamide 23
rabeprazole sodium TBEC 64
Index 26
raloxifene hcl 44 REPATHA SURECLICK SOAJ 19 rizatriptan benzoate TABS 10 MG 52
ramelteon 49 RETACRIT 48 rizatriptan benzoate TABS 5 MG 52
ramipril CAPS 20 RETEVMO 27 rizatriptan benzoate TBDP 10 MG 53
ranitidine hcl TABS 150 MG 63 RETROVIR IV INFUSION SOLN 31 rizatriptan benzoate TBDP 5 MG 52
ranolazine TB12 1000 MG 7 REVLIMID 2.5 MG, 5 MG, 10 MG, 15 roflumilast 250 MCG 9
MG, 25 MG 54
ranolazine TB12 500 MG 7 roflumilast 500 MCG 9
REVLIMID 20 MG 54
rasagiline mesylate 28 romidepsin SOLR 27
REXULTI 30
REALITY LATEX ropinirole hydrochloride TABS 28
CONDOMS/LUBRICATED MISC 51 ribavirin (hepatitis c) CAPS 31
ropinirole hydrochloride TB24 2 MG,
REALITY LATEX/ULTRA ribavirin (hepatitis c) TABS 200 MG 4 MG, 6 MG 28
TEXTURED DEVI 51 31
ropinirole hydrochloride TB24 8 MG,
REALITY LATEX/ULTRA THIN DEVI RIDAURA 3 12 MG 28
51
rifabutin 23 rosuvastatin calcium TABS 19
REBIF REBIDOSE SOAJ 61
rifampin CAPS 23 ROTARIX SUSP 66
REBIF REBIDOSE TITRATIONPACK
rifampin SOLR 23 ROTARIX SUSR 66
SOAJ 61
riluzole TABS 57 ROTATEQ SOLN 66
REBIF SOSY 61
rimantadine hydrochloride TABS 32 ROZLYTREK 27
REBIF TITRATION PACK SOSY 61
ringer's 53 RUBRACA 27
RECOMBIVAX HB SUSP 66
ringer's irrigation 55 RUCONEST 48
RECOMBIVAX HB SUSY 66
RINVOQ 2 rufinamide SUSP 12
RECTIV 7
risedronate sodium TABS 150 MG 44 rufinamide TABS 200 MG 12
REGRANEX 42
risedronate sodium TABS 35 MG 44 rufinamide TABS 400 MG 12
RELENZA DISKHALER 32
risedronate sodium TABS 5 MG, 30 RUKOBIA 31
RELION KETONE TEST STRIPS
MG 44
STRP 43 RUXIENCE 24
risedronate sodium TBEC 44
RELISTOR SOLN 47 RUZURGI 23
RISPERDAL CONSTA 29
RENFLEXIS 46 salsalate 4
risperidone SOLN 29
repaglinide 0.5 MG, 1 MG 16 SANDOSTATIN LAR DEPOT KIT 45
risperidone TABS 29
repaglinide 2 MG 16 SANTYL OINT 42
risperidone TBDP 29
REPATHA PUSHTRONEX SYSTEM sapropterin dihydrochloride PACK 45
SOCT 19 ritonavir TABS 31
sapropterin dihydrochloride TABS 45
REPATHA SOSY 19 rivastigmine tartrate CAPS 60
SAVELLA TABS 60
Index 27
SAVELLA TITRATION PACK MISC SIRTURO 23 SOMATULINE DEPOT 60 MG/0.2ML
60 45
SIVEXTRO TABS 22
scopolamine 17 SOMATULINE DEPOT 90 MG/0.3ML
SKYRIZI PEN SOAJ 39
45
SELECT INSULIN SYRINGES 52
SKYRIZI PSKT 39
SOMAVERT 10 MG, 15 MG, 20 MG
SELECT LANCETS 52
SKYRIZI SOCT 46 44
selegiline hcl CAPS 28
SKYRIZI SOSY 39 sorafenib tosylate 27
selegiline hcl TABS 28
SLYND 36 SORBITOL 3 % 47
selenium sulfide LOTN 2.5 % 39
SM PRENATAL VITAMINS TABS 56 SORBITOL/MANNITOL IRRIGATION
SELZENTRY SOLN 31 47
sodium acetate SOLN 53
SELZENTRY TABS 25 MG, 75 MG, sotalol hcl (afib/afl) 32
sodium chloride (gu irrigant) 0.9 % 47
150 MG 31
sotalol hcl TABS 240 MG 32
sodium chloride (inhalant) NEBU 7 %
SEREVENT DISKUS 10
37 sotalol hcl TABS 80 MG, 120 MG,
sertraline hcl CONC 14 160 MG 32
sodium chloride SOLN IV 0.45 %, 0.9
sertraline hcl TABS 100 MG 14 %, 3 %, 4 MEQ/ML, 5 % 54 SOVALDI TABS 32
sertraline hcl TABS 25 MG, 50 MG sodium citrate & citric acid 47 spinosad 42
14
sodium fluoride CHEW 0.25 MG, 0.5 SPIRIVA RESPIMAT AERS 8
sevelamer carbonate PACK 47 MG, 1 MG, 2.2 MG 54
spironolactone & hydrochlorothiazide
sevelamer carbonate TABS 47 sodium phenylbutyrate POWD 45 43
SHINGRIX 66 sodium phenylbutyrate TABS 45 spironolactone TABS 43
SIGNIFOR 45 sodium polystyrene sulfonate POWD SPRAVATO 56MG DOSE 13

55
sildenafil citrate (pulmonary SPRAVATO 84MG DOSE 13
hypertension) SOLN 34 sodium polystyrene sulfonate SUSP
SPRYCEL 27
OR 15 GM/60ML 55
sildenafil citrate (pulmonary
stannous fluoride CONC 55
hypertension) SUSR 34 sodium sulfate-potassium sulfate-
magnesium sulfate 49 stavudine CAPS 31
sildenafil citrate (pulmonary
hypertension) TABS 34 solifenacin succinate TABS 64 STELARA 130 MG/26ML 46
sildenafil citrate 33 SOLOSEC 2 STELARA SOSY 45 MG/0.5ML 39
silodosin 47 SOLU-CORTEF 100 MG, 500 MG, STELARA SOSY 90 MG/ML 39

1000 MG 36
silver sulfadiazine 40 STIMATE SOLN NA 45
SOLU-CORTEF 250 MG 36
SIMULECT 54 STIVARGA 27
SOLU-MEDROL 2 GM 36
simvastatin TABS 19 streptomycin sulfate SOLR 2
SOMATULINE DEPOT 120
sirolimus TABS 54 STRIBILD 31
MG/0.5ML 45
Index 28
STRIVERDI RESPIMAT 10 sumatriptan 53 TALZENNA 0.25 MG, 0.5 MG, 0.75
MG, 1 MG 27
SUBSYS LIQD 100 MCG 5 sumatriptan succinate SOAJ 53
tamoxifen citrate TABS 25
SUBSYS LIQD 200 MCG, 400 MCG, sumatriptan succinate SOCT 53
600 MCG 5 tamsulosin hcl 47
sumatriptan succinate SOLN 6
SUBSYS LIQD 800 MCG, 1200 MG/0.5ML 53 TASIGNA 27
MCG, 1600 MCG 5
sumatriptan succinate TABS 53 tavaborole 39
sucralfate SUSP 63
sumatriptan-naproxen sodium 52 tazarotene CREA 39
sucralfate TABS 63
sunitinib malate 12.5 MG, 25 MG, 50 TAZVERIK 27
sulconazole nitrate CREA 39 MG 27
TDVAX SUSP 63
sulconazole nitrate SOLN 39 SUNOSI 150 MG 1
TEFLARO 35
sulfacetamide sodium (acne) 37 SUNOSI 75 MG 1
TEGSEDI 61
sulfacetamide sodium (ophth) SOLN SYMLINPEN 120 SOPN 15
telmisartan 20
58
SYMLINPEN 60 SOPN 15
telmisartan-amlodipine 21
sulfacetamide sodium w/ sulfur
SYNAREL 44
CREA 10 %-5 % 37 telmisartan-hydrochlorothiazide 21
SYNERA PTCH 42
sulfacetamide sodium w/ sulfur LIQD temazepam 49
10 %-5 % 38 SYNJARDY TABS 15
TEMIXYS 31
sulfacetamide sodium w/ sulfur LIQD SYNJARDY XR TB24 1000 MG-10
TEMODAR SOLR 23
9 %-4.5 % 37 MG, 1000 MG-12.5 MG, 1000 MG-5
MG 15 temozolomide CAPS 23
sulfacetamide sodium-sulfur in urea
vehicle EMUL 10 %-10 %-4 % 38 SYNJARDY XR TB24 1000 MG-25 temsirolimus 27
MG 15
sulfacetamide sod-prednisolone TENIPOSIDE 28
SOLN 58 SYNRIBO 27
TENIVAC INJ 63
sulfadiazine TABS 62 TABLOID 24
tenofovir disoproxil fumarate TABS
sulfamethoxazole-trimethoprim SOLN TABRECTA 27 31
21
tacrolimus (topical) OINT 42 terazosin hcl 20
sulfamethoxazole-trimethoprim SUSP
tacrolimus CAPS 54 terbinafine hcl TABS 18
21
tadalafil (pulmonary hypertension) terbutaline sulfate SOLN 10
sulfamethoxazole-trimethoprim TABS
TABS 34
21 terbutaline sulfate TABS 10
tadalafil 5 MG 33
SULFAMYLON CREA 40 terconazole vaginal CREA 67
TAFINLAR CAPS 27
sulfasalazine TABS 46 terconazole vaginal SUPP 67
tafluprost 59
sulfasalazine TBEC 46 teriflunomide 61
TAGRISSO 24
sulindac TABS 4 TERIPARATIDE SOPN 44
Index 29
testosterone cypionate SOLN IM 7 tizanidine hcl TABS 56 trandolapril-verapamil hcl 180 MG-2
MG, 240 MG-1 MG 21
testosterone enanthate SOLN IM 7 tobramycin (ophth) SOLN 58
trandolapril-verapamil hcl 240 MG-2
TETANUS/DIPHTHERIA TOXOIDS- tobramycin NEBU 2
MG, 240 MG-4 MG 21
ADSORBED ADULT SUSP 63
tobramycin sulfate SOLN IJ 10
tranexamic acid SOLN 1000
tetrabenazine 60 MG/ML, 40 MG/ML, 80 MG/2ML 2
MG/10ML 49
tetracycline hcl CAPS 62 tobramycin-dexamethasone SUSP
tranexamic acid TABS 49
58
THALOMID 54
tranylcypromine sulfate 13
TODAY SPONGE MISC 66
theophylline ELIX 10
travoprost 59
tolbutamide 17
theophylline SOLN 10
TRAZIMERA 24
tolcapone 28
theophylline TB12 300 MG, 450 MG
trazodone hcl TABS 14
10 tolmetin sodium CAPS 4
TRECATOR 23
theophylline TB24 10 tolmetin sodium TABS 600 MG 4
TRELEGY ELLIPTA 10
THERANATAL CORE NUTRITION TOLSURA CAPS 18
TABS 56 TRELSTAR MIXJECT 25
tolterodine tartrate CP24 64
THIOLA EC TBEC 100 MG 47 TREMFYA SOPN 39
tolterodine tartrate TABS 64
THIOLA EC TBEC 300 MG 47 TREMFYA SOSY 39
tolvaptan TABS 45
thioridazine hcl 30 treprostinil SOLN IJ 33
topiramate CPSP 15 MG 12
thiotepa 15 MG 23 TRESIBA FLEXTOUCH SOPN 16
topiramate CPSP 25 MG 12
thiothixene 30 TRESIBA SOLN 16
topiramate CS24 12
THYMOGLOBULIN 54 tretinoin (chemotherapy) 27
topiramate TABS 200 MG 12
THYROGEN 0.9 MG 42 tretinoin CREA 0.025 %, 0.05 %, 0.1
topiramate TABS 25 MG, 100 MG 12
% 38
tiagabine hcl 13
topiramate TABS 50 MG 12
tretinoin GEL 0.01 %, 0.025 % 38
TIBSOVO 27
topotecan hcl SOLR 28
tretinoin microsphere 0.1 % 38
tigecycline 62
toremifene citrate 25
TREXALL TABS 5 MG, 7.5 MG, 10
timolol maleate (ophth) SOLG 57
torsemide TABS 43 MG, 15 MG 24
timolol maleate (ophth) SOLN 57
TRACLEER TBSO 34 triamcinolone acetonide (mouth) 55
timolol maleate TABS 32
tramadol hcl TABS 50 MG 5 triamcinolone acetonide (nasal)
tiotropium bromide monohydrate AERO 57
tramadol hcl TB24 5
CAPS 8
triamcinolone acetonide (topical)
tramadol-acetaminophen 6
TIVICAY TABS 31 CREA 0.025 % 41
trandolapril 1 MG, 2 MG 20
tizanidine hcl CAPS 56 triamcinolone acetonide (topical)
trandolapril 4 MG 20 CREA 0.1 % 41
Index 30
triamcinolone acetonide (topical) trimipramine maleate CAPS 15 TRUSTEX NATURAL CONDOMS
CREA 0.5 % 41 +LUBE/LUBRICATED MISC 51
TRINTELLIX 14
triamcinolone acetonide (topical) TRUSTEX WITH NONOXYNOL-
TRIUMEQ TABS 31
LOTN 0.025 % 41 9/RIBBED/STUDDED MISC 51
TRIZIVIR 31
triamcinolone acetonide (topical) TRUSTEX/RIA LUBRICATED MISC
LOTN 0.1 % 41 tropicamide SOLN 0.5 % 57 51
triamcinolone acetonide (topical) tropicamide SOLN 1 % 57 TRUSTEX/RIA LUBRICATED

OINT 0.025 %, 0.1 % 41 SPERMICIDE MISC 51
trospium chloride CP24 64
triamcinolone acetonide (topical) TRUSTEX/RIA
trospium chloride TABS 64
OINT 0.5 % 41 LUBRICATED/SPERMICIDE MISC
TRUE METRIX BLOOD 51
triamcinolone acetonide SUSP 40
GLUCOSETEST STRIPS STRP 43
MG/ML, 200 MG/5ML, 400 MG/10ML TRUXIMA 24
36 TRUE METRIX CONTROL
TUKYSA 24
SOLUTION LEVEL 3 SOLN 52
triamcinolone acetonide-dimethicone-
TURALIO 27
silicone 41 TRUETRACK TEST STRP 43
TUZISTRA XR 37
triamterene & hydrochlorothiazide TRULICITY 16
CAPS 25 MG-37.5 MG 43 TWINRIX SUSY 66
TRUMENBA 64
triamterene & hydrochlorothiazide TWIRLA 35
TRUSTEX COLOR CONDOMS +
TABS 43
LUBE MISC 51 TYBLUME CHEW 35
triamterene CAPS 43
TRUSTEX LUBRICATED TYBOST 31
triazolam 49 EXTRALARGE MISC 51
TYMLOS 44
TRICARE TABS 56 TRUSTEX LUBRICATED
TYVASO REFILL SOLN IN 33
EXTRASTRENGTH MISC 51
trientine hcl 54
TYVASO SOLN IN 34
TRUSTEX LUBRICATED MISC 51
trifluoperazine hcl TABS 30
TYVASO STARTER SOLN IN 34
TRUSTEX
trifluridine 58
LUBRICATED/RIBBED/STUDDED UBRELVY 52
trihexyphenidyl hcl SOLN 28 MISC 51
UDENYCA SOAJ 48
trihexyphenidyl hcl TABS 28 TRUSTEX
UDENYCA SOSY 48
LUBRICATED/SPERMICIDE EXTRA
TRIJARDY XR 1000 MG-2.5 MG-
LARGE MISC 51 UPTRAVI TABS 200 MCG 34
12.5 MG, 1000 MG-2.5 MG-5 MG 15
TRUSTEX UPTRAVI TABS 400 MCG, 600
TRIJARDY XR 1000 MG-5 MG-10
LUBRICATED/SPERMICIDE EXTRA MCG, 800 MCG, 1000 MCG, 1200
MG, 1000 MG-5 MG-25 MG 15
STRENGTH MISC 51 MCG, 1400 MCG, 1600 MCG 34
TRIKAFTA TBPK 100 MG-50 MG 62
TRUSTEX UPTRAVI TITRATION PACK TBPK
trimethobenzamide hcl CAPS 17 LUBRICATED/SPERMICIDE MISC 34
51
trimethoprim TABS 21 ursodiol CAPS 46
Index 31
ursodiol TABS 46 venlafaxine hcl CP24 75 MG 14 VIZIMPRO 25
UVADEX 27 venlafaxine hcl TABS 14 VORAXAZE 27
valacyclovir hcl 1 GM, 1000 MG 32 venlafaxine hcl TB24 150 MG 14 voriconazole TABS 18
valacyclovir hcl 500 MG 32 venlafaxine hcl TB24 37.5 MG, 75 VOSEVI 32

MG, 225 MG 14
valganciclovir hcl TABS 31 VOTRIENT 27
verapamil hcl CP24 100 MG, 200
valproate sodium SOLN OR 250 VYNDAMAX 34
MG, 300 MG 33
MG/5ML 13
VYNDAQEL 34
verapamil hcl CP24 120 MG, 180
valproic acid CAPS 13
MG, 240 MG, 360 MG 33 warfarin sodium TABS 10
valrubicin 26
verapamil hcl SOLN 2.5 MG/ML 33 water for irrigation, sterile 55
valsartan TABS 20
verapamil hcl TABS 33 WESTAB PLUS TABS 56
valsartan-hydrochlorothiazide 21
verapamil hcl TBCR 33 WIDE-SEAL SILICONE
VALTOCO 10 MG DOSE LIQD 11 DIAPHRAGM KIT 60 51
VEREGEN 38
VALTOCO 15 MG DOSE LQPK 11 WIDE-SEAL SILICONE
VERZENIO 27
DIAPHRAGM KIT 65 51
VALTOCO 20 MG DOSE LQPK 11
VICTOZA 16
WIDE-SEAL SILICONE
VALTOCO 5 MG DOSE LIQD 11
vigabatrin PACK 13 DIAPHRAGM KIT 70 51
vancomycin hcl CAPS 22
vigabatrin TABS 13 WIDE-SEAL SILICONE
vancomycin hcl SOLR IV 1 GM, 10 DIAPHRAGM KIT 75 51
VIIBRYD STARTER PACK KIT 14
GM, 500 MG, 1000 MG 22
WIDE-SEAL SILICONE
vilazodone hcl TABS 14
vancomycin hcl SOLR OR 25 DIAPHRAGM KIT 80 51
MG/ML, 50 MG/ML, 250 MG/5ML 22 vincristine sulfate 28
WIDE-SEAL SILICONE
VAQTA 66 vinorelbine tartrate 10 MG/ML 28 DIAPHRAGM KIT 85 51
varenicline tartrate TABS 61 VIRACEPT TABS 250 MG 31 WIDE-SEAL SILICONE

DIAPHRAGM KIT 90 51
varenicline tartrate TBPK 61 VIRACEPT TABS 625 MG 31
WIDE-SEAL SILICONE
VARIVAX INJ 66 VIREAD POWD 31
DIAPHRAGM KIT 95 51
VARUBI TBPK 18 VIREAD TABS 150 MG, 200 MG,
XALKORI 27
250 MG 31
VAXNEUVANCE 64
XARELTO STARTER PACK TBPK
VISTOGARD 17
VECAMYL 21 10
VITAMIN D2 TABS 400 UNIT 67
VECTIBIX 100 MG/5ML 25 XARELTO SUSR 11
VITATHELY/GINGER TABS 56
VELPHORO 47 XARELTO TABS 10 MG, 20 MG 11
VITRAKVI CAPS 27
venlafaxine hcl CP24 150 MG 14 XARELTO TABS 2.5 MG, 15 MG 11
VITRAKVI SOLN 27
venlafaxine hcl CP24 37.5 MG 14 XELJANZ SOLN 2
Index 32
XELJANZ TABS 2 ZEJULA CAPS 27
XELJANZ XR TB24 2 ZELBORAF 27
XEOMIN 57 ZERVIATE 58
XERAVA 62 zidovudine CAPS 31
XGEVA SOLN 44 zidovudine SYRP 31
XHANCE EXHU 57 zidovudine TABS 31
XIFAXAN 21 ZIEXTENZO 48
XIGDUO XR 1000 MG-10 MG, 500 zileuton TB12 9

MG-10 MG, 500 MG-5 MG 15
ziprasidone hcl 29
XIGDUO XR 1000 MG-2.5 MG, 1000
ZIRABEV 24
MG-5 MG 15
ZIRGAN GEL 58
XOLAIR SOLR 8
ZOLADEX 10.8 MG 25
XOLAIR SOSY 150 MG/ML 8
ZOLADEX 3.6 MG 25
XOLAIR SOSY 75 MG/0.5ML 8
zoledronic acid CONC 44
XOSPATA 27
zoledronic acid SOLN 44
XPOVIO 80 MG TWICE WEEKLY
25 ZOLINZA 27
XTAMPZA ER 5 zolmitriptan SOLN 53
XTANDI CAPS 25 zolmitriptan TABS 53
XTANDI TABS 40 MG 25 zolmitriptan TBDP 53
XTANDI TABS 80 MG 25 zolpidem tartrate TABS 49
XULTOPHY 100/3.6 15 zolpidem tartrate TBCR 49
YERVOY 24 zonisamide CAPS 12
YONSA 25 ZONTIVITY 48
zafirlukast 9 ZORBTIVE SC 44
zaleplon 10 MG 49 ZYDELIG 27
zaleplon 5 MG 49 ZYLET 58
ZALTRAP 100 MG/4ML 24
ZANOSAR 23
ZARXIO 300 MCG/0.5ML 48
ZARXIO 480 MCG/0.8ML 48
Index 33
Ambetter from WellCare of New Jersey is underwritten by WellCare Health
Insurance Company of New Jersey, Inc.© 2022 WellCare Health Insurance
AMB22-NJ-C-00074 Company of New Jersey, Inc. All rights reserved.

2023 NJ Formulary

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FRO 1 '-.

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Abbreviation Term What it means

This product is not covered unless you or your provider request

These drugs are made in both prescription form and Over-

These products are Specialty Drugs that may have special

Initially, certain medications may only be available in 15-

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divalproex sodium TB24 1 Selective Serotonin Reuptake Inhibitors (SSRIs)

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abacavir sulfate TABS 30 acyclovir CAPS 32 albuterol sulfate AERS 9

abacavir sulfate-lamivudine 30 acyclovir SUSP 32 albuterol sulfate NEBU 0.083 %, 0.63

ALUNBRIG TBPK 26 amoxicillin & pot clavulanate CHEW amphotericin b liposome 18

amlodipine besylate-olmesartan 3.125 MG-3.125 MG, 3.75 MG-3.75

ARCALYST 3 atracurium besylate 100 MG/10ML balsalazide disodium CAPS 46

armodafinil 1 ATROVENT HFA 8 BAXDELA TABS 46

ARMOUR THYROID TABS 62 AUSTEDO TABS 60 BELSOMRA 49

betaine 44 bisoprolol fumarate 32 bumetanide SOLN 0.25 MG/ML 43

betamethasone dipropionate (topical) bleomycin sulfate 15 UNIT 25 bumetanide TABS 43

cetirizine hcl TABS 18 ciclopirox GEL 38 clarithromycin TABS 50

cetirizine-pseudoephedrine 36 ciclopirox olamine CREA 38 clarithromycin TB24 50