List of Covered Drugs for SeniorCare Complete and AbilityCare

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2022 List of Covered Drugs (Formulary) SeniorCare Complete (HMO SNP), and AbilityCare (HMO SNP) Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter (OTC) drugs are covered by SeniorCare Complete and AbilityCare. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by SeniorCare Complete and AbilityCare. Key terms and their definitions appear in the last chapter of the Member Handbook or Evidence of Coverage. This List of Covered Drugs is effective 06/01/2022. For more recent information or other questions, contact us at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation: October – March, 7 days a week, 8 a.m. – 8 p.m., April – September, Monday – Friday, 8 a.m. – 8 p.m. or visit www.mnscha.org Formulary ID 22451 Version 12. Updated on 05/17/22 H2419 _5805 Accepted 10/03/2021 / H5703_5805_C (6243)

Transcript of List of Covered Drugs for SeniorCare Complete and AbilityCare

2022 List of Covered Drugs (Formulary) SeniorCare Complete (HMO SNP), and AbilityCare (HMO SNP) Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter (OTC) drugs are covered by SeniorCare Complete and AbilityCare. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by SeniorCare Complete and AbilityCare. Key terms and their definitions appear in the last chapter of the Member Handbook or Evidence of Coverage. This List of Covered Drugs is effective 06/01/2022.

For more recent information or other questions, contact us at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation: October – March, 7 days a week, 8 a.m. – 8 p.m., April – September, Monday – Friday, 8 a.m. – 8 p.m. or visit www.mnscha.org

Formulary ID 22451 Version 12. Updated on 05/17/22 H2419 _5805 Accepted 10/03/2021 / H5703_5805_C (6243)

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مالحظة: إذا أردت مساعدة مجانية لترجمة هذه الوثيقة، اتصل على الرقم أعاله.

သတိ ။ ဤစာရက္စာတမ္းအားအခမဲ့ဘာသာျပန္ေပးျခင္း အကူအညီလုုိအပ္ပါက၊အထက္ပါဖုုန္းနံပါတ္ကုုိေခၚဆုုိပါ။kMNt’sMKal’ . ebIG~k¨tUvkarCMnYyk~¬gkarbkE¨bäksarenHeday²tKit«f sUmehATUrs&BÍtamelxxagelI .請注意,如果您需要免費協助傳譯這份文件,請撥打上面的電話號碼。Attention. Si vous avez besoin d’une aide gratuite pour interpréter le présent document, veuillez appeler au numéro ci-dessus.Thov ua twb zoo nyeem. Yog hais tias koj xav tau kev pab txhais lus rau tsab ntaub ntawv no pub dawb, ces hu rau tus najnpawb xov tooj saum toj no.ymol.ymo;b.wuh>I zJerh>vd.b.w>rRpXRuvDvXw>uusd;xH0J'.vHm wDvHmrDwcgtHRM.<ud;b.

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1-866-567-7242, TTY 1-800-627-3529 or 711

Attention. If you need free help interpreting this document, call the above number.

LB2 (10-20)

CB5 (MCOs) (10-2021)

5874 DHS_Approved_11/23/2021

Civil Rights Notice Discrimination is against the law. South Country Health Alliance (South Country) does not discriminate on the basis of any of the following:

• race• color• national origin• creed• religion• sexual orientation

• public assistancestatus

• age• disability (including

physical or mentalimpairment)

• sex (including sexstereotypes andgender identity)

• marital status• political beliefs• medical condition

• health status• receipt of health care

services• claims experience• medical history• genetic information

You have the right to file a discrimination complaint if you believe you were treated in a discriminatory way by South Country. You can file a complaint and ask for help filing a complaint in person or by mail, phone, fax, or email at:

Civil Rights Coordinator South Country Health Alliance 6380 West Frontage Road, Medford, MN 55049 Toll Free: 866-567-7242 TTY: 800-627-3529 or 711 Fax: 507-444-7774 Email: [email protected]

Auxiliary Aids and Services: South Country provides auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner to ensure an equal opportunity to participate in our health care programs. Contact Member Services at [email protected] or call 866-567-7242, TTY 800-627-3529 or 711.

Language Assistance Services: South Country provides translated documents and spoken language interpreting, free of charge and in a timely manner, when language assistance services are necessary to ensure limited English speakers have meaningful access to our information and services. Contact Member Services at [email protected] or call 866-567-7242, TTY 800-627-3529 or 711.

Civil Rights Complaints You have the right to file a discrimination complaint if you believe you were treated in a discriminatory way by South Country. You may also contact any of the following agencies directly to file a discrimination complaint.

U.S. Department of Health and Human Services Office for Civil Rights (OCR) You have the right to file a complaint with the OCR, a federal agency, if you believe you have been discriminated against because of any of the following:

• race• color

• national origin• age

• disability• sex

• religion (insome cases)

Contact the OCR directly to file a complaint: Office for Civil Rights, U.S. Department of Health and Human Services Midwest Region 233 N. Michigan Avenue, Suite 240 Chicago, IL 60601 Customer Response Center: 800-368-1019, TTY: 800-537-7697 Email: [email protected]

CB5 (MCOs) (10-2021) Minnesota Department of Human Rights (MDHR) In Minnesota, you have the right to file a complaint with the MDHR if you have been discriminated against because of any of the following:

• race• color• national origin• religion

• creed• sex• sexual orientation• marital status

• public assistance status• disability

Contact the MDHR directly to file a complaint: Minnesota Department of Human Rights 540 Fairview Avenue North, Suite 201, St. Paul, MN 55104 651-539-1100 (voice), 800-657-3704 (toll-free), 711 or 800-627-3529 (MN Relay), 651-296-9042 (fax) [email protected] (email)

Minnesota Department of Human Services (DHS) You have the right to file a complaint with DHS if you believe you have been discriminated against in our health care programs because of any of the following:

• race• color• national origin

• religion (insome cases)

• age

• disability (includingphysical or mentalimpairment)

• sex (including sexstereotypes andgender identity)

Complaints must be in writing and filed within 180 days of the date you discovered the alleged discrimination. The complaint must contain your name and address and describe the discrimination you are complaining about. We will review it and notify you in writing about whether we have authority to investigate. If we do, we will investigate the complaint.

DHS will notify you in writing of the investigation’s outcome. You have the right to appeal if you disagree with the decision. To appeal, you must send a written request to have DHS review the investigation outcome. Be brief and state why you disagree with the decision. Include additional information you think is important.

If you file a complaint in this way, the people who work for the agency named in the complaint cannot retaliate against you. This means they cannot punish you in any way for filing a complaint. Filing a complaint in this way does not stop you from seeking out other legal or administrative actions.

Contact DHS directly to file a discrimination complaint: Civil Rights Coordinator Minnesota Department of Human Services Equal Opportunity and Access Division P.O. Box 64997 St. Paul, MN 55164-0997 651-431-3040 (voice) or use your preferred relay service

American Indians can continue or begin to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.

5874 DHS_Approved_11/23/2021

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Table of Contents

A. Disclaimers .................................................................................................................... 2

B. Frequently Asked Questions (FAQ) ............................................................................. 2

B1. What prescription drugs are on the List of Covered Drugs (or ‘Drug List” for short)? ................................................................................................................................... 2

B2. Does the Drug List ever change? .......................................................................................... 2

B3. What happens when there is a change to the Drug List? ....................................................... 3

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs? ...................................................................................................... 4

B5. How will I know if the drug I want has limitations or if there are any actions required to get the drug? ......................................................................................................................... 4

B6. What happens if SeniorCare Complete and AbilityCare changes their rules about some drugs (for example, prior authorization, quantity limits, and/or step therapy restrictions)? ............................................................................................................. 4

B7. How can I find a drug on the Drug List? ................................................................................ 5

B8. What if the drug I want to take is not on the Drug List?.......................................................... 5

B9. What if I am a new SeniorCare Complete or AbilityCare member and can’t find my drug on the Drug List or have a problem getting my drug? .............................................. 5

B10. Can I ask for an exception to cover my drug? ...................................................................... 6

B11. How can I ask for an exception? .......................................................................................... 6

B12. How long does it take to get an exception? ......................................................................... 6

B13. What are generic drugs? ..................................................................................................... 6

B14. What are over-the-counter (OTC) drugs? ............................................................................ 7

B15. Does SeniorCare Complete and AbilityCare cover non-drug OTC products? ....................... 7

B16. Can I get my drugs through Long-Term Supply? ................................................................. 7

B17. What is my copay? .............................................................................................................. 7

C. Overview of the List of Covered Drugs ....................................................................... 7

C1. Drugs Grouped by Drug Type................................................................................................ 8

D. Over-the-Counter (OTC) Drugs by Drug Type ........................................................... 65

E. Index of Covered Drugs ............................................................................................ 158

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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A. Disclaimers

SeniorCare Complete (HMO SNP) and AbilityCare (HMO SNP) are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) programs to provide benefits of both programs to enrollees. Enrollment in SeniorCare Complete and AbilityCare depends on contract renewal.

You can always check SeniorCare Complete’s and AbilityCare’s up-to-date List of Covered Drugs online at www.mnscha.org or call Member Services at the number listed at the bottom of this page.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services at the number listed at the bottom of this page.

To make or change a standing request to get this document, now and in the future, in a language other than English or in an alternate format, call Member Services at the number at the bottom of this page.

B. Frequently Asked Questions (FAQ)

Find answers to questions you have about this List of Covered Drugs. You can read all of the FAQ to learn more or look for a question and answer.

B1. What prescription drugs are on the List of Covered Drugs (or ‘Drug List” for short)? The drugs on the Drug List in Section C are the drugs covered by SeniorCare Complete and AbilityCare. These drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”

● SeniorCare Complete and AbilityCare will cover all medically necessary drugs on the Drug List if: ○ your doctor or other prescriber says you need them to get better or stay healthy, and

○ you fill the prescription at a SeniorCare Complete and AbilityCare network pharmacy.

○ SeniorCare Complete and AbilityCare may have additional steps to access certain drugs. Go to question B4 for more information.

You can also find an up-to-date list of drugs we cover on our website at www.mnscha.org or call Member Services at the number listed at the bottom of this page.

B2. Does the Drug List ever change?

Yes, and SeniorCare Complete and AbilityCare must follow Medicare and Medicaid rules when making changes. We may add or remove drugs on the Drug List during the year.

We may also change our rules about drugs. For example, we could:

● Decide to require or not require prior authorization for a drug. (Prior authorization is permission from SeniorCare Complete and AbilityCare before you can get a drug.)

● Add or change the amount of a drug you can get (called quantity limits).

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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● Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug before we will cover another drug.)

For more information on these drug rules, go to question B4.

If you are taking a drug that is covered at the beginning of the year, we will generally not remove or change coverage of that drug during the rest of the year unless:

● a new, cheaper drug comes on the market that works as well as a drug on the Drug List now, or ● we learn that a drug is not safe, or ● a drug is removed from the market.

Questions B3 and B6 have more information on what happens when the Drug List changes.

● You can always check SeniorCare Complete and AbilityCare’s current Drug List online at www.mnscha.org.

● You can also call Member Services at the number listed at the bottom of this page to check the current Drug List.

B3. What happens when there is a change to the Drug List? Some changes to the Drug List will happen immediately. For example:

● A new generic drug becomes available. Sometimes, a new generic drug comes on the market that works as well as a brand name drug on the Drug List now. When that happens, we may remove the brand name drug and add the new generic drug, but your cost for the new drug will stay the same or will be lower. When we add the new generic drug, we may also decide to keep the brand name drug on the list but change its coverage rules or limits. ○ We may not tell you before we make this change, but we will send you information about the

specific change we made once it happens. ○ You or your provider can ask for an exception from these changes. We will send you a notice with

the steps you can take to ask for an exception. Please go to questions B10-B12 for more information on exceptions.

● A drug is taken off the market. If the Food and Drug Administration (FDA) says a drug you are taking is not safe or the drug’s manufacturer takes a drug off the market, we will take it off the Drug List. If you are taking the drug, we will let you know. We will also send you a letter telling you that. Show the letter to your doctor or other prescriber and ask them about your next steps.

We may make other changes that affect the drugs you take. We will tell you in advance about these other changes to the Drug List. These changes might happen if:

● The FDA provides new guidance or there are new clinical guidelines about a drug. ● We add a generic drug that is not new to the market and

○ Replace a brand name drug currently on the Drug List or ○ Change the coverage rules or limits for the brand name drug.

When these changes happen, we will

● Tell you at least 30 days before we make the change to the Drug List or ● Let you know and give you a 30-day supply of the drug after you ask for a refill.

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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This will give you time to talk to your doctor or other prescriber. They can help you decide:

● If there is a similar drug on the Drug List you can take instead or ● Whether to ask for an exception from these changes. Please go to questions B10-B12 for more

information about exceptions.

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs? Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases you, your doc tor, or other prescriber must do something before you can get the drug. For example:

● Prior authorization: For some drugs, you, your doctor, or other prescriber must get authorization from SeniorCare Complete and AbilityCare before you fill your prescription. Prior authorization means an approval from SeniorCare Complete and AbilityCare to seek services outside of our network or to get services not routinely covered by our network before you get the services. Prior authorization is different from a referral. SeniorCare Complete and AbilityCare may not cover the drug if you do not get authorization.

● Quantity limits: Sometimes SeniorCare Complete and AbilityCare limits the amount of a drug you can get.

● Step therapy: Sometimes SeniorCare Complete and AbilityCare requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If your doctor or other prescriber thinks the first drug doesn’t work for you, then we will cover the second.

You can find out if your drug has any additional requirements or limits by looking in the table in Section C1. You can also get more information by visiting our website at www.mnscha.org. We have posted online documents that explains our prior authorization and step therapy restrictions. You may also ask us to send you a copy.

You can ask for an exception to these limits. You should talk to your doctor or other prescriber. They can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception. Please go to questions B10-B12 for more information about exceptions.

B5. How will I know if the drug I want has limitations or if there are any actions required to get the drug? The table of drugs in Section C1 has a column labeled “Necessary actions, restrictions, or limits on use.” Please go to question B4 for more information about restrictions, limits, or actions to take.

B6. What happens if SeniorCare Complete and AbilityCare changes their rules about some drugs (for example, prior authorization, quantity limits, and/or step therapy restrictions)? In some cases, we will tell you in advance if we add or change prior authorization, quantity limits, and/or step therapy restrictions on a drug. Go to question B3 for more information about this advance notice and situations where we may not be able to tell you in advance when our rules about drugs on the Drug List change.

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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B7. How can I find a drug on the Drug List? There are two ways to find a drug:

● You can search alphabetically by the drug’s name, or ● You can search by drug type.

To search alphabetically, go to the Index of Covered Drugs section. You can find it in Section E. The Index of Covered Drugs is an alphabetical list of all of the drugs included in the Drug List. Brand name drugs, generic drugs, and over-the-counter (OTC) are listed in the index.

To search by drug type, find Section C1 labeled “Drugs Grouped by Drug Type”. The drugs in this section are grouped into categories by type. For example, if you are taking a medicine for migraines, you should look in the “Antimigraine Agents” category. That is where you will find drugs that treat migraines.

B8. What if the drug I want to take is not on the Drug List? If you don’t find your drug on the Drug List, call Member Services at the number listed at the bottom of this page and ask about it. If you learn that SeniorCare Complete and AbilityCare will not cover the drug, you can do one of these things:

● Ask Member Services for a list of drugs like the one you want to take. Then show the list to your doctor or other prescriber. They can prescribe a drug on the Drug List that is like the one you want to take. Or

● You can ask the health plan to make an exception to cover your drug. Go to questions B10-B12 for more information about exceptions.

B9. What if I am a new SeniorCare Complete or AbilityCare member and can’t find my drug on the Drug List or have a problem getting my drug?

We can help. We may cover a temporary 30-day supply of your drug during the first 90 days you are a member of SeniorCare Complete or AbilityCare. This will give you time to talk to your doctor or other prescriber. They can help you decide if there is a similar drug on the Drug List you can take instead, or whether to ask for an exception.

If your prescription is written for fewer days, we will allow multiple refills to provide up to a maximum of 30-days of medication.

We will cover a 30-day supply of your drug if: ● you are taking a drug that is not on our Drug List, or ● health plan rules do not let you get the amount ordered by your prescriber, or ● the drug requires prior authorization by SeniorCare Complete and AbilityCare, or ● you are taking a drug that is part of a step therapy restriction.

If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug List or if you cannot easily get the drug you need, we can help. If you have been in the plan for more than 90-days, live in a long-term care facility, and need a supply right away:

● We will cover one 31-day supply of the drug you need (unless you have a prescription for fewer days), whether or not you are a new SeniorCare Complete and AbilityCare member.

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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● This is in addition to the temporary supply during the first 90 days you are a member of SeniorCare Complete or AbilityCare.

South Country Health Alliance will not apply early refill edits that would limit appropriate and necessary actions to Part D Drugs by enrollees who experience a Level of Care Change. These enrollees will be allowed to obtain a refill of their prescription(s) upon admission to or discharge from a long term care facility.

B10. Can I ask for an exception to cover my drug? Yes. You can ask SeniorCare Complete or AbilityCare to make an exception to cover a drug that is not on the Drug List.

You can also ask us to change the rules on your drug.

● For example, SeniorCare Complete or AbilityCare may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more.

● Other examples: You can ask us to drop step therapy restrictions or prior authorization requirements.

B11. How can I ask for an exception?

To ask for an exception, call Member Services. A Member Services representative will work with you and your provider to help you ask for an exception. You can also read Chapter 9 of the Member Handbook or Evidence of Coverage to learn more about exceptions.

B12. How long does it take to get an exception? After we get a statement from your prescriber supporting your request for an exception, we will give you a decision within 72 hours.

Mail: SeniorCare Complete / AbilityCare 200 Stevens Drive Philadelphia, PA 19113

Fax: Standard Request 1-855-446-7895; Expedited Request 1-855-446-7896

If you have any question, please call Member services at the number at the bottom of the page.

If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision, you can ask for an expedited exception. This is a faster decision. If your prescriber supports your request, we will give you a decision within 24 hours of getting your prescriber’s supporting statement.

B13. What are generic drugs? Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration (FDA).

SeniorCare Complete and AbilityCare covers both brand name drugs and generic drugs.

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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B14. What are over-the-counter (OTC) drugs? OTC stands for “over-the-counter.” SeniorCare Complete and AbilityCare offers some OTC drugs through Medical Assistance (Medicaid) at no cost to you. You need a prescription for OTC drugs to be covered. These OTC drugs are listed in this Drug List in Section D.

B15. Does SeniorCare Complete and AbilityCare cover non-drug OTC products? SeniorCare Complete and AbilityCare covers some non-drug OTC products through Medical Assistance (Medicaid). These non-drug OTC products are listed in this Drug List in Section D.

Examples of non-drug OTC products include THICK NOW ORAL POWDER and VASELINE GEL.

B16. Can I get my drugs through Long-Term Supply? We offer a way to get a long-term supply of “maintenance” drugs on our plan’s Drug List. (Maintenance drugs are drugs that you take on a regular basis, for a chronic or long-term medical condition.)

For more information about getting drugs for a long-term supply, please call Member Services at the number listed at the bottom of this page.

B17. What is my copay? You can read the SeniorCare Complete and AbilityCare Drug List to learn about the copay for each drug. A copay is an amount you may be required to pay as your share of the cost of a prescription drug.

A copay is usually a set amount, rather than a percentage. For example, you might pay $0 to $9.85 for a prescription drug.

SeniorCare Complete and AbilityCare members living in nursing homes or other long-term care facilities will have no copays. Some members getting long-term care in the community will also have no copays.

The Drug List includes copays listed by tiers.

● Tier 1 Generic drugs have the lowest copay. The copay is from $0 to $3.95, depending on your income and level of Medical Assistance (Medicaid) eligibility.

● Tier 1 Brand drugs have a higher copay. The copay is from $0 to $9.85, depending on your income and level of Medical Assistance (Medicaid) eligibility.

● OTCs have a $0 copay. If you have questions, call Member Services at the number at the bottom of this page. We can help you understand what your copays will be.

C. Overview of the List of Covered Drugs

The List of Covered Drugs gives you information about the drugs covered by SeniorCare Complete and AbilityCare. If you have trouble finding your drug in the list, turn to Section E, Index of Covered Drugs. The index alphabetically lists all drugs covered by SeniorCare Complete and AbilityCare.

If you have questions, please call SeniorCare Complete and Ability Member Services at 1-866-567-7242, TTY users call 1-800-627-3529 or 711. Hours of Operation are 8 a.m. to 8 p.m. Monday – Friday (April – September); 8 a.m. to 8 p.m., 7 days a week (October – March). The call is free. For more information, visit www.mnscha.org.

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C1. Drugs Grouped by Drug Type The drugs in this section are grouped into categories by type. For example, if you are taking a medicine for migraines, you should look in the “Antimigraine Agents” category. That is where you will find drugs that treat migraines.

The first column of the table lists the name of the drug. Generic drugs are listed in lower-case italics (e.g., warfarin), brand name drugs are capitalized (e.g., CHANTIX), and OTC drugs and products are listed in lower case (e.g., aspirin). The information in the “Necessary actions, restrictions, or limits on use” column tells you if SeniorCare Complete and AbilityCare has any rules for covering your drug.

Here are the meanings of the codes used in the “Necessary actions, restrictions, or limits on use” column:

B/D = This prescription drug has a Medicare Part B versus Medicare Part D administrative prior authorization requirement. This drug may be covered under Medicare Part B or Medicare Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

QL = Quantity Limit. For certain drugs, SeniorCare Complete and AbilityCare limit the amount of the drug that we will cover. For example, the plan provides twelve tablets per 30-day supply.

ST = Step Therapy. In some cases, SeniorCare Complete and AbilityCare requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, the plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, the plan will then cover Drug B.

PA = Prior Authorization. SeniorCare Complete and AbilityCare requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from the plan before you fill your prescriptions. If you don’t get approval, the plan may not cover the drug.

LA = Limited Availability. This prescription may be available only at certain pharmacies. For more information, please contact Member Services at the number listed at the bottom of this page.

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 9

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

Analgesics - Treatment Of Pain Analgesics ASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MG $0-$3.95 Generic PA BAC ORAL TABLET 50-325-40 MG $0-$3.95 Generic PA butalbital-apap-caff-cod oral capsule 50-325-40-30 mg $0-$3.95 Generic PA butalbital-apap-caffeine oral capsule 50-325-40 mg $0-$3.95 Generic PA butalbital-apap-caffeine oral tablet 50-325-40 mg $0-$3.95 Generic PA butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg $0-$3.95 Generic PA butalbital-asa-caffeine oral capsule 50-325-40 mg $0-$3.95 Generic PA butalbital-aspirin-caffeine oral capsule 50-325-40 mg $0-$3.95 Generic PA carisoprodol-aspirin-codeine oral tablet 200-325-16 mg $0-$3.95 Generic PA ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG $0-$3.95 Generic

nalbuphine hcl injection solution 10 mg/ml $0-$3.95 Generic B/D Nonsteroidal Anti-Inflammatory Drugs celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg $0-$3.95 Generic diclofenac potassium oral tablet 50 mg $0-$3.95 Generic diclofenac sodium er oral tablet extended release 24 hour 100 mg $0-$3.95 Generic diclofenac sodium external gel 1 %, 3 % $0-$3.95 Generic diclofenac sodium oral tablet delayed release 25 mg, 50 mg, 75 mg $0-$3.95 Generic diflunisal oral tablet 500 mg $0-$3.95 Generic ec-naproxen oral tablet delayed release 375 mg, 500 mg $0-$3.95 Generic etodolac er oral tablet extended release 24 hour 400 mg, 500 mg, 600 mg $0-$3.95 Generic

etodolac oral capsule 200 mg, 300 mg $0-$3.95 Generic etodolac oral tablet 400 mg, 500 mg $0-$3.95 Generic flurbiprofen oral tablet 100 mg, 50 mg $0-$3.95 Generic IBU ORAL TABLET 600 MG, 800 MG $0-$3.95 Generic ibuprofen oral suspension 100 mg/5ml $0-$3.95 Generic ibuprofen oral tablet 400 mg, 600 mg, 800 mg $0-$3.95 Generic indomethacin er oral capsule extended release 75 mg $0-$3.95 Generic PA indomethacin oral capsule 25 mg, 50 mg $0-$3.95 Generic PA ketorolac tromethamine oral tablet 10 mg $0-$3.95 Generic PA; QL (20 EA per 30 days) meclofenamate sodium oral capsule 100 mg, 50 mg $0-$3.95 Generic meloxicam oral tablet 15 mg, 7.5 mg $0-$3.95 Generic nabumetone oral tablet 500 mg, 750 mg $0-$3.95 Generic naproxen oral suspension 125 mg/5ml $0-$3.95 Generic naproxen oral tablet 250 mg, 375 mg, 500 mg $0-$3.95 Generic naproxen oral tablet delayed release 375 mg, 500 mg $0-$3.95 Generic naproxen sodium oral tablet 275 mg, 550 mg $0-$3.95 Generic piroxicam oral capsule 10 mg, 20 mg $0-$3.95 Generic sulindac oral tablet 150 mg, 200 mg $0-$3.95 Generic Opioid Analgesics, Long-Acting buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr, 7.5 mcg/hr $0-$3.95 Generic QL (4 EA per 28 days)

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hr, 50 mcg/hr, 62.5 mcg/hr, 75 mcg/hr, 87.5 mcg/hr $0-$3.95 Generic QL (10 EA per 30 days)

methadone hcl oral solution 10 mg/5ml $0-$3.95 Generic QL (1200 ML per 30 days) methadone hcl oral solution 5 mg/5ml $0-$3.95 Generic QL (2400 ML per 30 days) methadone hcl oral tablet 10 mg $0-$3.95 Generic QL (240 EA per 30 days) methadone hcl oral tablet 5 mg $0-$3.95 Generic QL (180 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 10

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

morphine sulfate er oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg $0-$3.95 Generic QL (60 EA per 30 days)

oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg $0-$3.95 Generic PA

Opioid Analgesics, Short-Acting acetaminophen-codeine #2 oral tablet 300-15 mg $0-$3.95 Generic acetaminophen-codeine #3 oral tablet 300-30 mg $0-$3.95 Generic acetaminophen-codeine #4 oral tablet 300-60 mg $0-$3.95 Generic acetaminophen-codeine oral solution 120-12 mg/5ml $0-$3.95 Generic acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg, 300-60 mg $0-$3.95 Generic butalbital-acetaminophen oral tablet 50-325 mg $0-$3.95 Generic PA butorphanol tartrate nasal solution 10 mg/ml $0-$3.95 Generic QL (5 ML per 30 days) fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg $0-$3.95 Generic PA; QL (120 EA per 30 days)

hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg $0-$3.95 Generic

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg $0-$3.95 Generic hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg $0-$3.95 Generic QL (120 EA per 30 days) hydromorphone hcl pf injection solution 1 mg/ml, 10 mg/ml, 4 mg/ml, 50 mg/5ml, 500 mg/50ml $0-$3.95 Generic

meperidine hcl oral solution 50 mg/5ml $0-$3.95 Generic PA; QL (900 ML per 30 days) meperidine hcl oral tablet 50 mg $0-$3.95 Generic PA; QL (180 EA per 30 days) morphine sulfate oral tablet 15 mg, 30 mg $0-$3.95 Generic QL (120 EA per 30 days) oxycodone hcl oral solution 5 mg/5ml $0-$3.95 Generic QL (5400 ML per 30 days) oxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg $0-$3.95 Generic QL (120 EA per 30 days) oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg $0-$3.95 Generic

pentazocine-naloxone hcl oral tablet 50-0.5 mg $0-$3.95 Generic PA tramadol hcl oral tablet 50 mg $0-$3.95 Generic QL (240 EA per 30 days) tramadol-acetaminophen oral tablet 37.5-325 mg $0-$3.95 Generic Anesthetics - Local Treatment Of Pain Local Anesthetics lidocaine external ointment 5 % $0-$3.95 Generic lidocaine external patch 5 % $0-$3.95 Generic PA; QL (90 EA per 30 days) lidocaine hcl external solution 4 % $0-$3.95 Generic lidocaine hcl mouth/throat solution 4 % $0-$3.95 Generic lidocaine hcl urethral/mucosal external gel 2 % $0-$3.95 Generic lidocaine hcl urethral/mucosal external prefilled syringe 2 % $0-$3.95 Generic lidocaine viscous hcl mouth/throat solution 2 % $0-$3.95 Generic lidocaine-prilocaine external cream 2.5-2.5 % $0-$3.95 Generic premium lidocaine external ointment 5 % $0-$3.95 Generic ZTLIDO EXTERNAL PATCH 1.8 % $0-$9.85 Brand PA Anti-Addiction/ Substance Abuse Treatment Agents - Treatment Of Substance Abuse Disorders

Alcohol Deterrents/Anti-Craving acamprosate calcium oral tablet delayed release 333 mg $0-$3.95 Generic disulfiram oral tablet 250 mg, 500 mg $0-$3.95 Generic Opioid Dependence buprenorphine hcl sublingual tablet sublingual 2 mg, 8 mg $0-$3.95 Generic buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-0.5 mg, 8-2 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 11

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

LUCEMYRA ORAL TABLET 0.18 MG $0-$9.85 Brand PA; QL (224 EA per 14 days) naltrexone hcl oral tablet 50 mg $0-$3.95 Generic Opioid Reversal Agents naloxone hcl injection solution 0.4 mg/ml $0-$3.95 Generic naloxone hcl injection solution cartridge 0.4 mg/ml $0-$3.95 Generic naloxone hcl injection solution prefilled syringe 2 mg/2ml $0-$3.95 Generic naloxone hcl nasal liquid 4 mg/0.1ml $0-$3.95 Generic Smoking Cessation Agents bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg $0-$3.95 Generic

CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG $0-$9.85 Brand QL (56 EA per 28 days) CHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 11 & 1 MG X 42 $0-$9.85 Brand QL (56 EA per 28 days)

NICOTROL INHALATION INHALER 10 MG $0-$9.85 Brand NICOTROL NS NASAL SOLUTION 10 MG/ML $0-$9.85 Brand varenicline tartrate oral 0.5 mg x 11 & 1 mg x 42 $0-$3.95 Generic QL (56 EA per 28 days) varenicline tartrate oral tablet 0.5 mg, 1 mg $0-$3.95 Generic QL (56 EA per 28 days) Antibacterials - Treatment Of Bacterial Infections Aminoglycosides amikacin sulfate injection solution 500 mg/2ml $0-$3.95 Generic gentamicin in saline intravenous solution 0.8-0.9 mg/ml-%, 1-0.9 mg/ml-%, 1.2-0.9 mg/ml-%, 1.6-0.9 mg/ml-% $0-$3.95 Generic

gentamicin sulfate external cream 0.1 % $0-$3.95 Generic gentamicin sulfate external ointment 0.1 % $0-$3.95 Generic gentamicin sulfate injection solution 40 mg/ml $0-$3.95 Generic neomycin sulfate oral tablet 500 mg $0-$3.95 Generic paromomycin sulfate oral capsule 250 mg $0-$3.95 Generic streptomycin sulfate intramuscular solution reconstituted 1 gm $0-$3.95 Generic tobramycin sulfate injection solution 1.2 gm/30ml, 10 mg/ml, 2 gm/50ml, 80 mg/2ml $0-$3.95 Generic

tobramycin sulfate injection solution reconstituted 1.2 gm $0-$3.95 Generic Antibacterials, Other aztreonam injection solution reconstituted 1 gm, 2 gm $0-$3.95 Generic clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg $0-$3.95 Generic clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml $0-$3.95 Generic clindamycin phosphate external swab 1 % $0-$3.95 Generic clindamycin phosphate in d5w intravenous solution 300 mg/50ml, 600 mg/50ml, 900 mg/50ml $0-$3.95 Generic

clindamycin phosphate in nacl intravenous solution 300-0.9 mg/50ml-%, 600-0.9 mg/50ml-%, 900-0.9 mg/50ml-% $0-$3.95 Generic

clindamycin phosphate injection solution 300 mg/2ml, 600 mg/4ml, 900 mg/6ml $0-$3.95 Generic

clindamycin phosphate vaginal cream 2 % $0-$3.95 Generic colistimethate sodium (cba) injection solution reconstituted 150 mg $0-$3.95 Generic daptomycin intravenous solution reconstituted 350 mg, 500 mg $0-$3.95 Generic linezolid in sodium chloride intravenous solution 600-0.9 mg/300ml-% $0-$3.95 Generic linezolid intravenous solution 600 mg/300ml $0-$3.95 Generic linezolid oral suspension reconstituted 100 mg/5ml $0-$3.95 Generic linezolid oral tablet 600 mg $0-$3.95 Generic methenamine hippurate oral tablet 1 gm $0-$3.95 Generic metronidazole external cream 0.75 % $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 12

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

metronidazole external gel 0.75 %, 1 % $0-$3.95 Generic metronidazole external lotion 0.75 % $0-$3.95 Generic metronidazole intravenous solution 500 mg/100ml $0-$3.95 Generic metronidazole oral capsule 375 mg $0-$3.95 Generic metronidazole oral tablet 250 mg, 500 mg $0-$3.95 Generic metronidazole vaginal gel 0.75 % $0-$3.95 Generic nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic nitrofurantoin monohyd macro oral capsule 100 mg $0-$3.95 Generic polymyxin b sulfate injection solution reconstituted 500000 unit $0-$3.95 Generic tinidazole oral tablet 250 mg, 500 mg $0-$3.95 Generic trimethoprim oral tablet 100 mg $0-$3.95 Generic vancomycin hcl intravenous solution reconstituted 1 gm, 10 gm, 100 gm, 1000 mg, 5 gm, 500 mg, 750 mg $0-$3.95 Generic

vancomycin hcl oral capsule 125 mg, 250 mg $0-$3.95 Generic Beta-Lactam, Cephalosporins cefaclor er oral tablet extended release 12 hour 500 mg $0-$3.95 Generic cefaclor oral capsule 250 mg, 500 mg $0-$3.95 Generic cefadroxil oral capsule 500 mg $0-$3.95 Generic cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml $0-$3.95 Generic cefadroxil oral tablet 1 gm $0-$3.95 Generic cefazolin sodium injection solution reconstituted 1 gm, 2 gm, 500 mg $0-$3.95 Generic cefazolin sodium intravenous solution reconstituted 1 gm $0-$3.95 Generic cefazolin sodium-dextrose intravenous solution 1-4 gm/50ml-% $0-$3.95 Generic cefazolin sodium-dextrose intravenous solution reconstituted 1-4 gm-%(50ml) $0-$3.95 Generic

cefdinir oral capsule 300 mg $0-$3.95 Generic cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml $0-$3.95 Generic cefepime hcl injection solution reconstituted 1 gm, 2 gm $0-$3.95 Generic cefepime hcl intravenous solution 1 gm/50ml, 2 gm/100ml $0-$3.95 Generic cefepime hcl intravenous solution reconstituted 2 gm $0-$3.95 Generic cefepime-dextrose intravenous solution reconstituted 1-5 gm-%(50ml), 2-5 gm-%(50ml) $0-$3.95 Generic

cefixime oral capsule 400 mg $0-$3.95 Generic cefotaxime sodium injection solution reconstituted 1 gm $0-$3.95 Generic cefoxitin sodium intravenous solution reconstituted 1 gm, 10 gm, 2 gm $0-$3.95 Generic cefoxitin sodium-dextrose intravenous solution reconstituted 1-4 gm-%(50ml), 2-2.2 gm-%(50ml) $0-$3.95 Generic

cefpodoxime proxetil oral suspension reconstituted 100 mg/5ml, 50 mg/5ml $0-$3.95 Generic

cefpodoxime proxetil oral tablet 100 mg, 200 mg $0-$3.95 Generic cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml $0-$3.95 Generic cefprozil oral tablet 250 mg, 500 mg $0-$3.95 Generic ceftazidime and dextrose intravenous solution reconstituted 1-5 gm-%(50ml), 2-5 gm-%(50ml) $0-$3.95 Generic

ceftazidime injection solution reconstituted 1 gm, 6 gm $0-$3.95 Generic ceftazidime intravenous solution reconstituted 2 gm $0-$3.95 Generic ceftriaxone sodium in dextrose intravenous solution 20 mg/ml, 40 mg/ml $0-$3.95 Generic

ceftriaxone sodium injection solution reconstituted 1 gm, 100 gm, 2 gm, 250 mg, 500 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 13

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

ceftriaxone sodium intravenous solution reconstituted 1 gm, 10 gm, 2 gm $0-$3.95 Generic

ceftriaxone sodium-dextrose intravenous solution reconstituted 1-3.74 gm-%(50ml), 2-2.22 gm-%(50ml) $0-$3.95 Generic

cefuroxime axetil oral tablet 250 mg, 500 mg $0-$3.95 Generic cefuroxime sodium injection solution reconstituted 750 mg $0-$3.95 Generic cefuroxime sodium intravenous solution reconstituted 1.5 gm $0-$3.95 Generic cephalexin oral capsule 250 mg, 500 mg $0-$3.95 Generic cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml $0-$3.95 Generic cephalexin oral tablet 250 mg, 500 mg $0-$3.95 Generic TAZICEF INJECTION SOLUTION RECONSTITUTED 1 GM $0-$3.95 Generic TAZICEF INTRAVENOUS SOLUTION RECONSTITUTED 1 GM, 2 GM, 6 GM $0-$3.95 Generic

TEFLARO INTRAVENOUS SOLUTION RECONSTITUTED 400 MG, 600 MG $0-$9.85 Brand PA

Beta-Lactam, Penicillins amoxicillin oral capsule 250 mg, 500 mg $0-$3.95 Generic amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml $0-$3.95 Generic

amoxicillin oral tablet 500 mg, 875 mg $0-$3.95 Generic amoxicillin oral tablet chewable 125 mg, 250 mg $0-$3.95 Generic amoxicillin-pot clavulanate er oral tablet extended release 12 hour 1000-62.5 mg $0-$3.95 Generic

amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml $0-$3.95 Generic

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg $0-$3.95 Generic

amoxicillin-pot clavulanate oral tablet chewable 200-28.5 mg, 400-57 mg $0-$3.95 Generic

ampicillin oral capsule 500 mg $0-$3.95 Generic ampicillin sodium injection solution reconstituted 1 gm, 125 mg $0-$3.95 Generic ampicillin sodium intravenous solution reconstituted 1 gm, 10 gm $0-$3.95 Generic ampicillin-sulbactam sodium injection solution reconstituted 1.5 (1-0.5) gm, 3 (2-1) gm $0-$3.95 Generic

ampicillin-sulbactam sodium intravenous solution reconstituted 1.5 (1-0.5) gm, 15 (10-5) gm, 3 (2-1) gm $0-$3.95 Generic

BICILLIN L-A INTRAMUSCULAR SUSPENSION 2400000 UNIT/4ML $0-$9.85 Brand BICILLIN L-A INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 1200000 UNIT/2ML, 600000 UNIT/ML $0-$9.85 Brand

dicloxacillin sodium oral capsule 250 mg, 500 mg $0-$3.95 Generic nafcillin sodium in dextrose intravenous solution 1 gm/50ml, 2 gm/100ml $0-$3.95 Generic

nafcillin sodium injection solution reconstituted 1 gm, 2 gm $0-$3.95 Generic nafcillin sodium intravenous solution reconstituted 1 gm, 2 gm $0-$3.95 Generic penicillin g procaine intramuscular suspension 600000 unit/ml $0-$3.95 Generic penicillin g sodium injection solution reconstituted 5000000 unit $0-$3.95 Generic penicillin v potassium oral solution reconstituted 125 mg/5ml, 250 mg/5ml $0-$3.95 Generic

penicillin v potassium oral tablet 250 mg, 500 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 14

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

piperacillin sod-tazobactam so intravenous solution reconstituted 13.5 (12-1.5) gm, 2.25 (2-0.25) gm, 3.375 (3-0.375) gm, 4-0.5 gm, 4.5 (4-0.5) gm, 40.5 (36-4.5) gm

$0-$3.95 Generic

Carbapenems ertapenem sodium injection solution reconstituted 1 gm $0-$3.95 Generic imipenem-cilastatin intravenous solution reconstituted 250 mg, 500 mg $0-$3.95 Generic

meropenem intravenous solution reconstituted 1 gm, 500 mg $0-$3.95 Generic meropenem-sodium chloride intravenous solution reconstituted 1 gm/50ml, 500 mg/50ml $0-$3.95 Generic

Macrolides azithromycin intravenous solution reconstituted 500 mg $0-$3.95 Generic azithromycin oral packet 1 gm $0-$3.95 Generic azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml $0-$3.95 Generic azithromycin oral tablet 250 mg, 250 mg (6 pack), 500 mg, 500 mg (3 pack), 600 mg $0-$3.95 Generic

clarithromycin er oral tablet extended release 24 hour 500 mg $0-$3.95 Generic clarithromycin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml $0-$3.95 Generic clarithromycin oral tablet 250 mg, 500 mg $0-$3.95 Generic DIFICID ORAL SUSPENSION RECONSTITUTED 40 MG/ML $0-$9.85 Brand PA DIFICID ORAL TABLET 200 MG $0-$9.85 Brand PA e.e.s. 400 oral tablet 400 mg $0-$3.95 Generic ERYTHROCIN LACTOBIONATE INTRAVENOUS SOLUTION RECONSTITUTED 500 MG $0-$9.85 Brand

ERYTHROCIN STEARATE ORAL TABLET 250 MG $0-$3.95 Generic erythromycin base oral tablet 250 mg, 500 mg $0-$3.95 Generic erythromycin ethylsuccinate oral suspension reconstituted 200 mg/5ml $0-$3.95 Generic erythromycin ethylsuccinate oral tablet 400 mg $0-$3.95 Generic Quinolones ciprofloxacin hcl ophthalmic solution 0.3 % $0-$3.95 Generic ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg $0-$3.95 Generic ciprofloxacin in d5w intravenous solution 200 mg/100ml $0-$3.95 Generic levofloxacin in d5w intravenous solution 500 mg/100ml, 750 mg/150ml $0-$3.95 Generic levofloxacin intravenous solution 25 mg/ml $0-$3.95 Generic levofloxacin oral solution 25 mg/ml $0-$3.95 Generic levofloxacin oral tablet 250 mg, 500 mg, 750 mg $0-$3.95 Generic moxifloxacin hcl in nacl intravenous solution 400 mg/250ml $0-$3.95 Generic moxifloxacin hcl intravenous solution 400 mg/250ml $0-$3.95 Generic moxifloxacin hcl oral tablet 400 mg $0-$3.95 Generic ofloxacin oral tablet 300 mg, 400 mg $0-$3.95 Generic Sulfonamides sulfacetamide sodium (acne) external lotion 10 % $0-$3.95 Generic sulfadiazine oral tablet 500 mg $0-$3.95 Generic sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml $0-$3.95 Generic sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg $0-$3.95 Generic Tetracyclines DOXY 100 INTRAVENOUS SOLUTION RECONSTITUTED 100 MG $0-$3.95 Generic doxycycline hyclate intravenous solution reconstituted 100 mg $0-$3.95 Generic doxycycline hyclate oral capsule 100 mg, 50 mg $0-$3.95 Generic doxycycline hyclate oral tablet 100 mg, 20 mg $0-$3.95 Generic doxycycline monohydrate oral capsule 100 mg, 50 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 15

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

doxycycline monohydrate oral tablet 100 mg, 150 mg, 50 mg, 75 mg $0-$3.95 Generic minocycline hcl oral capsule 100 mg, 50 mg, 75 mg $0-$3.95 Generic minocycline hcl oral tablet 100 mg, 50 mg, 75 mg $0-$3.95 Generic tetracycline hcl oral capsule 250 mg, 500 mg $0-$3.95 Generic Anticonvulsants - Treatment Of Seizures Anticonvulsants, Other BRIVIACT ORAL SOLUTION 10 MG/ML $0-$9.85 Brand BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG $0-$9.85 Brand DIACOMIT ORAL CAPSULE 250 MG, 500 MG $0-$9.85 Brand PA DIACOMIT ORAL PACKET 250 MG, 500 MG $0-$9.85 Brand PA divalproex sodium er oral tablet extended release 24 hour 250 mg, 500 mg $0-$3.95 Generic

divalproex sodium oral capsule delayed release sprinkle 125 mg $0-$3.95 Generic divalproex sodium oral tablet delayed release 125 mg, 250 mg, 500 mg $0-$3.95 Generic

EPIDIOLEX ORAL SOLUTION 100 MG/ML $0-$9.85 Brand PA EPRONTIA ORAL SOLUTION 25 MG/ML $0-$9.85 Brand PA felbamate oral suspension 600 mg/5ml $0-$3.95 Generic felbamate oral tablet 400 mg, 600 mg $0-$3.95 Generic FINTEPLA ORAL SOLUTION 2.2 MG/ML $0-$9.85 Brand PA FYCOMPA ORAL SUSPENSION 0.5 MG/ML $0-$9.85 Brand FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG $0-$9.85 Brand QL (30 EA per 30 days) lamotrigine er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg $0-$3.95 Generic

lamotrigine oral tablet 25 mg $0-$3.95 Generic lamotrigine oral tablet chewable 25 mg, 5 mg $0-$3.95 Generic levetiracetam er oral tablet extended release 24 hour 500 mg, 750 mg $0-$3.95 Generic levetiracetam oral solution 100 mg/ml $0-$3.95 Generic levetiracetam oral tablet 1000 mg, 250 mg, 500 mg, 750 mg $0-$3.95 Generic PEGANONE ORAL TABLET 250 MG $0-$9.85 Brand ROWEEPRA ORAL TABLET 500 MG $0-$3.95 Generic SPRITAM ORAL TABLET DISINTEGRATING SOLUBLE 1000 MG, 250 MG, 500 MG $0-$9.85 Brand ST; QL (60 EA per 30 days)

SPRITAM ORAL TABLET DISINTEGRATING SOLUBLE 750 MG $0-$9.85 Brand ST; QL (120 EA per 30 days) topiramate oral capsule sprinkle 15 mg, 25 mg $0-$3.95 Generic topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg $0-$3.95 Generic valproic acid oral capsule 250 mg $0-$3.95 Generic valproic acid oral solution 250 mg/5ml $0-$3.95 Generic XCOPRI (250 MG DAILY DOSE) ORAL TABLET THERAPY PACK 100 & 150 MG, 50 & 200 MG $0-$9.85 Brand ST

XCOPRI (350 MG DAILY DOSE) ORAL TABLET THERAPY PACK 150 & 200 MG $0-$9.85 Brand ST

XCOPRI ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG $0-$9.85 Brand ST XCOPRI ORAL TABLET THERAPY PACK 14 X 12.5 MG & 14 X 25 MG, 14 X 150 MG & 14 X200 MG, 14 X 50 MG & 14 X100 MG $0-$9.85 Brand ST

Calcium Channel Modifying Agents CELONTIN ORAL CAPSULE 300 MG $0-$9.85 Brand ethosuximide oral capsule 250 mg $0-$3.95 Generic ethosuximide oral solution 250 mg/5ml $0-$3.95 Generic pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 50 mg, 75 mg $0-$3.95 Generic QL (90 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 16

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

pregabalin oral capsule 225 mg, 300 mg $0-$3.95 Generic QL (60 EA per 30 days) pregabalin oral solution 20 mg/ml $0-$3.95 Generic QL (900 ML per 30 days) Gamma-Aminobutyric Acid (Gaba) Augmenting Agents clobazam oral suspension 2.5 mg/ml $0-$3.95 Generic PA; QL (480 ML per 30 days) clobazam oral tablet 10 mg, 20 mg $0-$3.95 Generic PA; QL (60 EA per 30 days) DIASTAT ACUDIAL RECTAL GEL 10 MG, 20 MG $0-$9.85 Brand DIASTAT PEDIATRIC RECTAL GEL 2.5 MG $0-$9.85 Brand diazepam rectal gel 10 mg, 2.5 mg, 20 mg $0-$3.95 Generic gabapentin oral capsule 100 mg, 400 mg $0-$3.95 Generic QL (270 EA per 30 days) gabapentin oral capsule 300 mg $0-$3.95 Generic QL (360 EA per 30 days) gabapentin oral solution 250 mg/5ml, 300 mg/6ml $0-$3.95 Generic QL (2160 ML per 30 days) gabapentin oral tablet 600 mg $0-$3.95 Generic QL (180 EA per 30 days) gabapentin oral tablet 800 mg $0-$3.95 Generic QL (120 EA per 30 days) NAYZILAM NASAL SOLUTION 5 MG/0.1ML $0-$9.85 Brand PA phenobarbital oral elixir 20 mg/5ml $0-$3.95 Generic PA phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg $0-$3.95 Generic PA

primidone oral tablet 250 mg, 50 mg $0-$3.95 Generic SYMPAZAN ORAL FILM 10 MG, 20 MG, 5 MG $0-$9.85 Brand PA; QL (60 EA per 30 days) tiagabine hcl oral tablet 12 mg, 16 mg, 2 mg, 4 mg $0-$3.95 Generic VALTOCO 10 MG DOSE NASAL LIQUID 10 MG/0.1ML $0-$9.85 Brand PA VALTOCO 15 MG DOSE NASAL LIQUID THERAPY PACK 7.5 MG/0.1ML $0-$9.85 Brand PA

VALTOCO 20 MG DOSE NASAL LIQUID THERAPY PACK 10 MG/0.1ML $0-$9.85 Brand PA

VALTOCO 5 MG DOSE NASAL LIQUID 5 MG/0.1ML $0-$9.85 Brand PA vigabatrin oral packet 500 mg $0-$3.95 Generic PA; QL (180 EA per 30 days) vigabatrin oral tablet 500 mg $0-$3.95 Generic PA; QL (180 EA per 30 days) Sodium Channel Agents APTIOM ORAL TABLET 200 MG, 400 MG $0-$9.85 Brand ST; QL (30 EA per 30 days) APTIOM ORAL TABLET 600 MG, 800 MG $0-$9.85 Brand ST; QL (60 EA per 30 days) carbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg $0-$3.95 Generic

carbamazepine oral suspension 100 mg/5ml $0-$3.95 Generic carbamazepine oral tablet 200 mg $0-$3.95 Generic carbamazepine oral tablet chewable 100 mg $0-$3.95 Generic DILANTIN ORAL CAPSULE 30 MG $0-$9.85 Brand EPITOL ORAL TABLET 200 MG $0-$3.95 Generic lacosamide oral tablet 100 mg, 150 mg, 200 mg, 50 mg $0-$3.95 Generic QL (60 EA per 30 days) oxcarbazepine oral suspension 300 mg/5ml $0-$3.95 Generic oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg $0-$3.95 Generic PHENYTOIN INFATABS ORAL TABLET CHEWABLE 50 MG $0-$3.95 Generic phenytoin oral suspension 100 mg/4ml, 125 mg/5ml $0-$3.95 Generic phenytoin oral tablet chewable 50 mg $0-$3.95 Generic phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg $0-$3.95 Generic rufinamide oral suspension 40 mg/ml $0-$3.95 Generic PA; QL (2400 ML per 30 days) rufinamide oral tablet 200 mg, 400 mg $0-$3.95 Generic PA; QL (240 EA per 30 days) VIMPAT ORAL SOLUTION 10 MG/ML $0-$9.85 Brand QL (1200 ML per 30 days) zonisamide oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic Antidementia Agents - Management Of Dementia Antidementia Agents, Other

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 17

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

donepezil hcl oral tablet 10 mg, 5 mg $0-$3.95 Generic donepezil hcl oral tablet dispersible 10 mg, 5 mg $0-$3.95 Generic ergoloid mesylates oral tablet 1 mg $0-$3.95 Generic PA Cholinesterase Inhibitors donepezil hcl oral tablet 23 mg $0-$3.95 Generic galantamine hydrobromide er oral capsule extended release 24 hour 16 mg, 24 mg, 8 mg $0-$3.95 Generic

galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg $0-$3.95 Generic rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg $0-$3.95 Generic rivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hr $0-$3.95 Generic ST

N-Methyl-D-Aspartate (Nmda) Receptor Antagonist memantine hcl er oral capsule extended release 24 hour 14 mg, 21 mg, 28 mg, 7 mg $0-$3.95 Generic QL (30 EA per 30 days)

memantine hcl oral tablet 10 mg, 28 x 5 mg & 21 x 10 mg, 5 mg $0-$3.95 Generic Antidepressants - Treatment Of Depression Antidepressants, Other bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg, 150 mg, 200 mg $0-$3.95 Generic

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg, 450 mg $0-$3.95 Generic

bupropion hcl oral tablet 100 mg, 75 mg $0-$3.95 Generic mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg $0-$3.95 Generic mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg $0-$3.95 Generic perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg $0-$3.95 Generic PA

Monoamine Oxidase Inhibitors EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24HR, 6 MG/24HR, 9 MG/24HR $0-$9.85 Brand

MARPLAN ORAL TABLET 10 MG $0-$9.85 Brand phenelzine sulfate oral tablet 15 mg $0-$3.95 Generic tranylcypromine sulfate oral tablet 10 mg $0-$3.95 Generic Ssris/Snris (Selective Serotonin Reuptake Inhibitors/Serotonin And Norepinephrine Reuptake Inhibitors)

citalopram hydrobromide oral solution 10 mg/5ml $0-$3.95 Generic citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg $0-$3.95 Generic desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg, 25 mg, 50 mg $0-$3.95 Generic

DRIZALMA SPRINKLE ORAL CAPSULE DELAYED RELEASE SPRINKLE 20 MG, 30 MG, 40 MG, 60 MG $0-$9.85 Brand ST

escitalopram oxalate oral solution 5 mg/5ml $0-$3.95 Generic escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg $0-$3.95 Generic FETZIMA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 20 MG, 40 MG, 80 MG $0-$9.85 Brand ST

FETZIMA TITRATION ORAL CAPSULE ER 24 HOUR THERAPY PACK 20 & 40 MG $0-$9.85 Brand ST

fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg $0-$3.95 Generic fluoxetine hcl oral capsule delayed release 90 mg $0-$3.95 Generic fluoxetine hcl oral solution 20 mg/5ml $0-$3.95 Generic fluoxetine hcl oral tablet 10 mg, 20 mg $0-$3.95 Generic fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 18

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

nefazodone hcl oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg $0-$3.95 Generic paroxetine hcl er oral tablet extended release 24 hour 12.5 mg, 25 mg, 37.5 mg $0-$3.95 Generic

paroxetine hcl oral suspension 10 mg/5ml $0-$3.95 Generic paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg $0-$3.95 Generic sertraline hcl oral concentrate 20 mg/ml $0-$3.95 Generic sertraline hcl oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg $0-$3.95 Generic TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG $0-$9.85 Brand venlafaxine hcl er oral capsule extended release 24 hour 150 mg, 37.5 mg, 75 mg $0-$3.95 Generic

venlafaxine hcl er oral tablet extended release 24 hour 150 mg, 225 mg, 37.5 mg, 75 mg $0-$3.95 Generic

venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg $0-$3.95 Generic VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG $0-$9.85 Brand VIIBRYD STARTER PACK ORAL KIT 10 & 20 MG $0-$9.85 Brand Tricyclics amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg $0-$3.95 Generic PA

amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg $0-$3.95 Generic PA clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg $0-$3.95 Generic PA desipramine hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg $0-$3.95 Generic

doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg $0-$3.95 Generic PA

doxepin hcl oral concentrate 10 mg/ml $0-$3.95 Generic PA imipramine hcl oral tablet 10 mg, 25 mg, 50 mg $0-$3.95 Generic PA imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg $0-$3.95 Generic PA nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg $0-$3.95 Generic nortriptyline hcl oral solution 10 mg/5ml $0-$3.95 Generic protriptyline hcl oral tablet 10 mg, 5 mg $0-$3.95 Generic PA trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic PA Antiemetics - Treatment Of Vomiting Or Nausea Antiemetics, Other chlorpromazine hcl oral concentrate 100 mg/ml, 30 mg/ml $0-$3.95 Generic chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg $0-$3.95 Generic meclizine hcl oral tablet 12.5 mg, 25 mg $0-$3.95 Generic metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml $0-$3.95 Generic metoclopramide hcl oral tablet 10 mg, 5 mg $0-$3.95 Generic perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg $0-$3.95 Generic prochlorperazine maleate oral tablet 10 mg, 5 mg $0-$3.95 Generic prochlorperazine rectal suppository 25 mg $0-$3.95 Generic promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg $0-$3.95 Generic PA promethazine hcl rectal suppository 12.5 mg, 25 mg $0-$3.95 Generic PA PROMETHEGAN RECTAL SUPPOSITORY 50 MG $0-$3.95 Generic PA scopolamine transdermal patch 72 hour 1 mg/3days $0-$3.95 Generic trimethobenzamide hcl oral capsule 300 mg $0-$3.95 Generic Emetogenic Therapy Adjuncts aprepitant oral 80 & 125 mg $0-$3.95 Generic B/D aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg, 80 mg $0-$3.95 Generic B/D dronabinol oral capsule 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic B/D

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 19

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

EMEND ORAL SUSPENSION RECONSTITUTED 125 MG/5ML $0-$9.85 Brand B/D granisetron hcl oral tablet 1 mg $0-$3.95 Generic B/D ondansetron hcl oral solution 4 mg/5ml $0-$3.95 Generic B/D ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg $0-$3.95 Generic B/D ondansetron oral tablet dispersible 4 mg, 8 mg $0-$3.95 Generic B/D SYNDROS ORAL SOLUTION 5 MG/ML $0-$9.85 Brand PA Antifungals - Treatment Of Fungal Or Yeast Infections Antifungals ABELCET INTRAVENOUS SUSPENSION 5 MG/ML $0-$9.85 Brand B/D AMBISOME INTRAVENOUS SUSPENSION RECONSTITUTED 50 MG $0-$9.85 Brand B/D

amphotericin b intravenous solution reconstituted 50 mg $0-$3.95 Generic B/D amphotericin b liposome intravenous suspension reconstituted 50 mg $0-$3.95 Generic B/D caspofungin acetate intravenous solution reconstituted 50 mg, 70 mg $0-$3.95 Generic PA ciclopirox olamine external cream 0.77 % $0-$3.95 Generic ciclopirox olamine external suspension 0.77 % $0-$3.95 Generic clotrimazole anti-fungal external cream 1 % $0-$3.95 Generic clotrimazole external cream 1 % $0-$3.95 Generic clotrimazole external solution 1 % $0-$3.95 Generic clotrimazole mouth/throat troche 10 mg $0-$3.95 Generic econazole nitrate external cream 1 % $0-$3.95 Generic fluconazole in sodium chloride intravenous solution 200-0.9 mg/100ml-%, 400-0.9 mg/200ml-% $0-$3.95 Generic

fluconazole oral suspension reconstituted 10 mg/ml, 40 mg/ml $0-$3.95 Generic fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg $0-$3.95 Generic flucytosine oral capsule 250 mg, 500 mg $0-$3.95 Generic griseofulvin microsize oral suspension 125 mg/5ml $0-$3.95 Generic itraconazole oral capsule 100 mg $0-$3.95 Generic itraconazole oral solution 10 mg/ml $0-$3.95 Generic ketoconazole external cream 2 % $0-$3.95 Generic ketoconazole external shampoo 2 % $0-$3.95 Generic ketoconazole oral tablet 200 mg $0-$3.95 Generic MENTAX EXTERNAL CREAM 1 % $0-$9.85 Brand micafungin sodium intravenous solution reconstituted 100 mg, 50 mg $0-$3.95 Generic NOXAFIL ORAL SUSPENSION 40 MG/ML $0-$9.85 Brand PA NYAMYC EXTERNAL POWDER 100000 UNIT/GM $0-$3.95 Generic nystatin external cream 100000 unit/gm $0-$3.95 Generic nystatin external ointment 100000 unit/gm $0-$3.95 Generic nystatin external powder 100000 unit/gm $0-$3.95 Generic nystatin mouth/throat suspension 100000 unit/ml $0-$3.95 Generic nystatin oral tablet 500000 unit $0-$3.95 Generic NYSTOP EXTERNAL POWDER 100000 UNIT/GM $0-$3.95 Generic posaconazole oral tablet delayed release 100 mg $0-$3.95 Generic PA terbinafine hcl oral tablet 250 mg $0-$3.95 Generic terconazole vaginal cream 0.4 %, 0.8 % $0-$3.95 Generic terconazole vaginal suppository 80 mg $0-$3.95 Generic voriconazole intravenous solution reconstituted 200 mg $0-$3.95 Generic PA voriconazole oral suspension reconstituted 40 mg/ml $0-$3.95 Generic voriconazole oral tablet 200 mg, 50 mg $0-$3.95 Generic Antigout Agents - Treatment Or Prevention Of Gouty Arthritis Antigout Agents

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 20

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

allopurinol oral tablet 100 mg, 300 mg $0-$3.95 Generic colchicine oral capsule 0.6 mg $0-$3.95 Generic colchicine oral tablet 0.6 mg $0-$3.95 Generic colchicine-probenecid oral tablet 0.5-500 mg $0-$3.95 Generic febuxostat oral tablet 40 mg, 80 mg $0-$3.95 Generic ST probenecid oral tablet 500 mg $0-$3.95 Generic Antimigraine Agents - Treatment Of Migraine Headaches Antimigraine Agents NURTEC ORAL TABLET DISPERSIBLE 75 MG $0-$9.85 Brand PA; QL (15 EA per 30 days) UBRELVY ORAL TABLET 100 MG, 50 MG $0-$9.85 Brand PA; QL (16 EA per 30 days) Ergot Alkaloids dihydroergotamine mesylate nasal solution 4 mg/ml $0-$3.95 Generic QL (8 ML per 30 days) ergotamine-caffeine oral tablet 1-100 mg $0-$3.95 Generic Prophylactic AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML, 70 MG/ML $0-$9.85 Brand PA

EMGALITY (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML $0-$9.85 Brand PA

EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 120 MG/ML $0-$9.85 Brand PA

EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MG/ML $0-$9.85 Brand PA

Serotonin (5-Ht) Receptor Agonist rizatriptan benzoate oral tablet 10 mg, 5 mg $0-$3.95 Generic QL (12 EA per 30 days) rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg $0-$3.95 Generic QL (12 EA per 30 days) sumatriptan nasal solution 20 mg/act, 5 mg/act $0-$3.95 Generic QL (12 EA per 30 days) sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic QL (9 EA per 30 days) sumatriptan succinate refill subcutaneous solution cartridge 4 mg/0.5ml, 6 mg/0.5ml $0-$3.95 Generic QL (4 ML per 30 days)

sumatriptan succinate subcutaneous solution 6 mg/0.5ml $0-$3.95 Generic QL (4 ML per 30 days) sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml $0-$3.95 Generic QL (4 ML per 30 days)

Antimyasthenic Agents - Treatment Of Myasthenia Parasympathomimetics pyridostigmine bromide er oral tablet extended release 180 mg $0-$3.95 Generic pyridostigmine bromide oral tablet 60 mg $0-$3.95 Generic Antimycobacterials - Treatment For Infections By Tuberculosis-Type Organisms

Antimycobacterials, Other dapsone oral tablet 100 mg, 25 mg $0-$3.95 Generic PRIFTIN ORAL TABLET 150 MG $0-$9.85 Brand rifabutin oral capsule 150 mg $0-$3.95 Generic Antituberculars ethambutol hcl oral tablet 100 mg, 400 mg $0-$3.95 Generic isoniazid oral tablet 100 mg, 300 mg $0-$3.95 Generic PASER ORAL PACKET 4 GM $0-$9.85 Brand PRETOMANID ORAL TABLET 200 MG $0-$9.85 Brand PA pyrazinamide oral tablet 500 mg $0-$3.95 Generic rifampin intravenous solution reconstituted 600 mg $0-$3.95 Generic rifampin oral capsule 150 mg, 300 mg $0-$3.95 Generic SIRTURO ORAL TABLET 100 MG, 20 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 21

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

TRECATOR ORAL TABLET 250 MG $0-$9.85 Brand Antineoplastics - Treatment Of Cancer Alkylating Agents cyclophosphamide oral capsule 25 mg, 50 mg $0-$3.95 Generic B/D cyclophosphamide oral tablet 25 mg, 50 mg $0-$3.95 Generic B/D LEUKERAN ORAL TABLET 2 MG $0-$9.85 Brand MATULANE ORAL CAPSULE 50 MG $0-$9.85 Brand VALCHLOR EXTERNAL GEL 0.016 % $0-$9.85 Brand PA Antiandrogens abiraterone acetate oral tablet 250 mg, 500 mg $0-$3.95 Generic PA bicalutamide oral tablet 50 mg $0-$3.95 Generic ERLEADA ORAL TABLET 60 MG $0-$9.85 Brand PA flutamide oral capsule 125 mg $0-$3.95 Generic nilutamide oral tablet 150 mg $0-$3.95 Generic NUBEQA ORAL TABLET 300 MG $0-$9.85 Brand PA toremifene citrate oral tablet 60 mg $0-$3.95 Generic PA XTANDI ORAL CAPSULE 40 MG $0-$9.85 Brand PA XTANDI ORAL TABLET 40 MG, 80 MG $0-$9.85 Brand PA YONSA ORAL TABLET 125 MG $0-$9.85 Brand PA Antiangiogenic Agents lenalidomide oral capsule 10 mg, 15 mg, 25 mg, 5 mg $0-$3.95 Generic PA POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG $0-$9.85 Brand PA REVLIMID ORAL CAPSULE 2.5 MG, 20 MG $0-$9.85 Brand PA THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG $0-$9.85 Brand PA Antiestrogens/Modifiers EMCYT ORAL CAPSULE 140 MG $0-$9.85 Brand SOLTAMOX ORAL SOLUTION 10 MG/5ML $0-$9.85 Brand tamoxifen citrate oral tablet 10 mg, 20 mg $0-$3.95 Generic Antimetabolites DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG $0-$9.85 Brand hydroxyurea oral capsule 500 mg $0-$3.95 Generic INQOVI ORAL TABLET 35-100 MG $0-$9.85 Brand PA ONUREG ORAL TABLET 200 MG, 300 MG $0-$9.85 Brand PA PURIXAN ORAL SUSPENSION 2000 MG/100ML $0-$9.85 Brand TABLOID ORAL TABLET 40 MG $0-$9.85 Brand PA Antineoplastics, Other BESREMI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 500 MCG/ML $0-$9.85 Brand PA

GAVRETO ORAL CAPSULE 100 MG $0-$9.85 Brand PA IDHIFA ORAL TABLET 100 MG, 50 MG $0-$9.85 Brand PA KISQALI FEMARA (400 MG DOSE) ORAL TABLET THERAPY PACK 200 & 2.5 MG $0-$9.85 Brand PA

KISQALI FEMARA (600 MG DOSE) ORAL TABLET THERAPY PACK 200 & 2.5 MG $0-$9.85 Brand PA

KISQALI FEMARA(200 MG DOSE) ORAL TABLET THERAPY PACK 200 & 2.5 MG $0-$9.85 Brand PA

LONSURF ORAL TABLET 15-6.14 MG, 20-8.19 MG $0-$9.85 Brand PA LUMAKRAS ORAL TABLET 120 MG $0-$9.85 Brand PA LYNPARZA ORAL TABLET 100 MG, 150 MG $0-$9.85 Brand PA LYSODREN ORAL TABLET 500 MG $0-$9.85 Brand NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 22

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

ORGOVYX ORAL TABLET 120 MG $0-$9.85 Brand PA RETEVMO ORAL CAPSULE 40 MG, 80 MG $0-$9.85 Brand PA RYLAZE INTRAMUSCULAR SOLUTION 10 MG/0.5ML $0-$9.85 Brand PA SYNRIBO SUBCUTANEOUS SOLUTION RECONSTITUTED 3.5 MG $0-$9.85 Brand PA TICE BCG INTRAVESICAL SUSPENSION RECONSTITUTED 50 MG $0-$9.85 Brand TUKYSA ORAL TABLET 150 MG, 50 MG $0-$9.85 Brand PA WELIREG ORAL TABLET 40 MG $0-$9.85 Brand PA XPOVIO (100 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG, 50 MG $0-$9.85 Brand PA

XPOVIO (40 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG, 40 MG $0-$9.85 Brand PA

XPOVIO (40 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK 20 MG, 40 MG $0-$9.85 Brand PA

XPOVIO (60 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG, 60 MG $0-$9.85 Brand PA

XPOVIO (60 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK 20 MG $0-$9.85 Brand PA

XPOVIO (80 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG, 40 MG $0-$9.85 Brand PA

XPOVIO (80 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK 20 MG $0-$9.85 Brand PA

ZOLINZA ORAL CAPSULE 100 MG $0-$9.85 Brand PA Aromatase Inhibitors, 3Rd Generation anastrozole oral tablet 1 mg $0-$3.95 Generic exemestane oral tablet 25 mg $0-$3.95 Generic letrozole oral tablet 2.5 mg $0-$3.95 Generic Enzyme Inhibitors IBRANCE ORAL TABLET 100 MG, 125 MG, 75 MG $0-$9.85 Brand PA TIBSOVO ORAL TABLET 250 MG $0-$9.85 Brand PA Molecular Target Inhibitors ALECENSA ORAL CAPSULE 150 MG $0-$9.85 Brand PA ALUNBRIG ORAL TABLET 180 MG, 30 MG, 90 MG $0-$9.85 Brand PA ALUNBRIG ORAL TABLET THERAPY PACK 90 & 180 MG $0-$9.85 Brand PA AYVAKIT ORAL TABLET 100 MG, 200 MG, 25 MG, 300 MG, 50 MG $0-$9.85 Brand PA BALVERSA ORAL TABLET 3 MG, 4 MG, 5 MG $0-$9.85 Brand PA BOSULIF ORAL TABLET 100 MG, 400 MG, 500 MG $0-$9.85 Brand PA BRAFTOVI ORAL CAPSULE 75 MG $0-$9.85 Brand PA BRUKINSA ORAL CAPSULE 80 MG $0-$9.85 Brand PA CABOMETYX ORAL TABLET 20 MG, 40 MG, 60 MG $0-$9.85 Brand PA CALQUENCE ORAL CAPSULE 100 MG $0-$9.85 Brand PA CAPRELSA ORAL TABLET 100 MG, 300 MG $0-$9.85 Brand PA COMETRIQ (100 MG DAILY DOSE) ORAL KIT 80 & 20 MG $0-$9.85 Brand PA COMETRIQ (140 MG DAILY DOSE) ORAL KIT 3 X 20 MG & 80 MG $0-$9.85 Brand PA COMETRIQ (60 MG DAILY DOSE) ORAL KIT 20 MG $0-$9.85 Brand PA COPIKTRA ORAL CAPSULE 15 MG, 25 MG $0-$9.85 Brand PA COTELLIC ORAL TABLET 20 MG $0-$9.85 Brand PA DAURISMO ORAL TABLET 100 MG, 25 MG $0-$9.85 Brand PA ERIVEDGE ORAL CAPSULE 150 MG $0-$9.85 Brand PA erlotinib hcl oral tablet 100 mg, 150 mg, 25 mg $0-$3.95 Generic PA everolimus oral tablet 10 mg, 2.5 mg, 5 mg, 7.5 mg $0-$3.95 Generic PA everolimus oral tablet soluble 3 mg, 5 mg $0-$3.95 Generic PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 23

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

EXKIVITY ORAL CAPSULE 40 MG $0-$9.85 Brand PA FOTIVDA ORAL CAPSULE 0.89 MG, 1.34 MG $0-$9.85 Brand PA GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG $0-$9.85 Brand PA IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG $0-$9.85 Brand PA ICLUSIG ORAL TABLET 10 MG, 15 MG, 30 MG, 45 MG $0-$9.85 Brand PA imatinib mesylate oral tablet 100 mg, 400 mg $0-$3.95 Generic PA IMBRUVICA ORAL CAPSULE 140 MG, 70 MG $0-$9.85 Brand PA IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 MG $0-$9.85 Brand PA INLYTA ORAL TABLET 1 MG, 5 MG $0-$9.85 Brand PA INREBIC ORAL CAPSULE 100 MG $0-$9.85 Brand PA IRESSA ORAL TABLET 250 MG $0-$9.85 Brand PA JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG $0-$9.85 Brand PA KISQALI (200 MG DOSE) ORAL TABLET THERAPY PACK 200 MG $0-$9.85 Brand PA KISQALI (400 MG DOSE) ORAL TABLET THERAPY PACK 200 MG $0-$9.85 Brand PA KISQALI (600 MG DOSE) ORAL TABLET THERAPY PACK 200 MG $0-$9.85 Brand PA KOSELUGO ORAL CAPSULE 10 MG, 25 MG $0-$9.85 Brand PA lapatinib ditosylate oral tablet 250 mg $0-$3.95 Generic PA LENVIMA (10 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 MG $0-$9.85 Brand PA

LENVIMA (12 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 3 X 4 MG $0-$9.85 Brand PA

LENVIMA (14 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 & 4 MG $0-$9.85 Brand PA

LENVIMA (18 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 MG & 2 X 4 MG $0-$9.85 Brand PA

LENVIMA (20 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 2 X 10 MG $0-$9.85 Brand PA

LENVIMA (24 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 2 X 10 MG & 4 MG $0-$9.85 Brand PA

LENVIMA (4 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 4 MG $0-$9.85 Brand PA

LENVIMA (8 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 2 X 4 MG $0-$9.85 Brand PA

LORBRENA ORAL TABLET 100 MG, 25 MG $0-$9.85 Brand PA MEKINIST ORAL TABLET 0.5 MG, 2 MG $0-$9.85 Brand PA MEKTOVI ORAL TABLET 15 MG $0-$9.85 Brand PA NERLYNX ORAL TABLET 40 MG $0-$9.85 Brand PA NEXAVAR ORAL TABLET 200 MG $0-$9.85 Brand PA ODOMZO ORAL CAPSULE 200 MG $0-$9.85 Brand PA PEMAZYRE ORAL TABLET 13.5 MG, 4.5 MG, 9 MG $0-$9.85 Brand PA PIQRAY (200 MG DAILY DOSE) ORAL TABLET THERAPY PACK 200 MG $0-$9.85 Brand PA

PIQRAY (250 MG DAILY DOSE) ORAL TABLET THERAPY PACK 200 & 50 MG $0-$9.85 Brand PA

PIQRAY (300 MG DAILY DOSE) ORAL TABLET THERAPY PACK 2 X 150 MG $0-$9.85 Brand PA

QINLOCK ORAL TABLET 50 MG $0-$9.85 Brand PA ROZLYTREK ORAL CAPSULE 100 MG, 200 MG $0-$9.85 Brand PA RUBRACA ORAL TABLET 200 MG, 250 MG, 300 MG $0-$9.85 Brand PA RYDAPT ORAL CAPSULE 25 MG $0-$9.85 Brand PA SCEMBLIX ORAL TABLET 20 MG, 40 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 24

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG $0-$9.85 Brand PA

STIVARGA ORAL TABLET 40 MG $0-$9.85 Brand PA sunitinib malate oral capsule 12.5 mg, 25 mg, 37.5 mg, 50 mg $0-$3.95 Generic PA TABRECTA ORAL TABLET 150 MG, 200 MG $0-$9.85 Brand PA TAFINLAR ORAL CAPSULE 50 MG, 75 MG $0-$9.85 Brand PA TAGRISSO ORAL TABLET 40 MG, 80 MG $0-$9.85 Brand PA TALZENNA ORAL CAPSULE 0.25 MG, 0.5 MG, 0.75 MG, 1 MG $0-$9.85 Brand PA TASIGNA ORAL CAPSULE 150 MG, 200 MG, 50 MG $0-$9.85 Brand PA TAZVERIK ORAL TABLET 200 MG $0-$9.85 Brand PA TEPMETKO ORAL TABLET 225 MG $0-$9.85 Brand PA TRUSELTIQ (100MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 100 MG $0-$9.85 Brand PA

TRUSELTIQ (125MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 100 & 25 MG $0-$9.85 Brand PA

TRUSELTIQ (50MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 25 MG $0-$9.85 Brand PA

TRUSELTIQ (75MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 25 MG $0-$9.85 Brand PA

TURALIO ORAL CAPSULE 200 MG $0-$9.85 Brand PA UKONIQ ORAL TABLET 200 MG $0-$9.85 Brand PA VENCLEXTA ORAL TABLET 10 MG, 100 MG, 50 MG $0-$9.85 Brand PA VENCLEXTA STARTING PACK ORAL TABLET THERAPY PACK 10 & 50 & 100 MG $0-$9.85 Brand PA

VERZENIO ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG $0-$9.85 Brand PA VITRAKVI ORAL CAPSULE 100 MG, 25 MG $0-$9.85 Brand PA VITRAKVI ORAL SOLUTION 20 MG/ML $0-$9.85 Brand PA VIZIMPRO ORAL TABLET 15 MG, 30 MG, 45 MG $0-$9.85 Brand PA VONJO ORAL CAPSULE 100 MG $0-$9.85 Brand PA VOTRIENT ORAL TABLET 200 MG $0-$9.85 Brand PA XALKORI ORAL CAPSULE 200 MG, 250 MG $0-$9.85 Brand PA XOSPATA ORAL TABLET 40 MG $0-$9.85 Brand PA ZEJULA ORAL CAPSULE 100 MG $0-$9.85 Brand PA ZELBORAF ORAL TABLET 240 MG $0-$9.85 Brand PA ZYDELIG ORAL TABLET 100 MG, 150 MG $0-$9.85 Brand PA ZYKADIA ORAL TABLET 150 MG $0-$9.85 Brand PA Retinoids bexarotene oral capsule 75 mg $0-$3.95 Generic PANRETIN EXTERNAL GEL 0.1 % $0-$9.85 Brand PA TARGRETIN EXTERNAL GEL 1 % $0-$9.85 Brand PA tretinoin oral capsule 10 mg $0-$3.95 Generic Treatment Adjuncts leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg $0-$3.95 Generic MESNEX ORAL TABLET 400 MG $0-$9.85 Brand Antiparasitics - Treatment Of Infections From Parasites Anthelmintics albendazole oral tablet 200 mg $0-$3.95 Generic ivermectin oral tablet 3 mg $0-$3.95 Generic praziquantel oral tablet 600 mg $0-$3.95 Generic Antiprotozoals atovaquone oral suspension 750 mg/5ml $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 25

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 mg $0-$3.95 Generic benznidazole oral tablet 100 mg, 12.5 mg $0-$3.95 Generic PA chloroquine phosphate oral tablet 250 mg, 500 mg $0-$3.95 Generic COARTEM ORAL TABLET 20-120 MG $0-$9.85 Brand hydroxychloroquine sulfate oral tablet 100 mg, 200 mg, 300 mg, 400 mg $0-$3.95 Generic

LAMPIT ORAL TABLET 120 MG, 30 MG $0-$9.85 Brand PA mefloquine hcl oral tablet 250 mg $0-$3.95 Generic nitazoxanide oral tablet 500 mg $0-$3.95 Generic pentamidine isethionate inhalation solution reconstituted 300 mg $0-$3.95 Generic B/D pentamidine isethionate injection solution reconstituted 300 mg $0-$3.95 Generic PA primaquine phosphate oral tablet 26.3 (15 base) mg $0-$3.95 Generic pyrimethamine oral tablet 25 mg $0-$3.95 Generic QL (90 EA per 30 days) quinine sulfate oral capsule 324 mg $0-$3.95 Generic Antiparkinson Agents - Treatment Of Parkinson's Disease Anticholinergics benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg $0-$3.95 Generic trihexyphenidyl hcl oral solution 0.4 mg/ml $0-$3.95 Generic PA trihexyphenidyl hcl oral tablet 2 mg, 5 mg $0-$3.95 Generic PA Antiparkinson Agents, Other amantadine hcl oral capsule 100 mg $0-$3.95 Generic amantadine hcl oral solution 50 mg/5ml $0-$3.95 Generic amantadine hcl oral tablet 100 mg $0-$3.95 Generic carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg

$0-$3.95 Generic

entacapone oral tablet 200 mg $0-$3.95 Generic ONGENTYS ORAL CAPSULE 25 MG, 50 MG $0-$9.85 Brand ST Dopamine Agonists apomorphine hcl subcutaneous solution cartridge 30 mg/3ml $0-$3.95 Generic PA bromocriptine mesylate oral capsule 5 mg $0-$3.95 Generic bromocriptine mesylate oral tablet 2.5 mg $0-$3.95 Generic GOCOVRI ORAL CAPSULE EXTENDED RELEASE 24 HOUR 137 MG, 68.5 MG $0-$9.85 Brand PA

KYNMOBI SUBLINGUAL FILM 10 MG, 15 MG, 20 MG, 25 MG, 30 MG $0-$9.85 Brand PA

NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24HR, 2 MG/24HR, 3 MG/24HR, 4 MG/24HR, 6 MG/24HR, 8 MG/24HR $0-$9.85 Brand

pramipexole dihydrochloride er oral tablet extended release 24 hour 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg $0-$3.95 Generic

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg $0-$3.95 Generic

ropinirole hcl er oral tablet extended release 24 hour 12 mg, 2 mg, 4 mg, 6 mg, 8 mg $0-$3.95 Generic

ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg $0-$3.95 Generic

Dopamine Precursors And/Or L-Amino Acid Decarboxylase Inhibitors

carbidopa oral tablet 25 mg $0-$3.95 Generic carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 26

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg $0-$3.95 Generic carbidopa-levodopa oral tablet dispersible 10-100 mg, 25-100 mg, 25-250 mg $0-$3.95 Generic

Monoamine Oxidase B (Mao-B) Inhibitors rasagiline mesylate oral tablet 0.5 mg, 1 mg $0-$3.95 Generic selegiline hcl oral capsule 5 mg $0-$3.95 Generic selegiline hcl oral tablet 5 mg $0-$3.95 Generic Antipsychotics - Treatment Of Behavioral And Emotional Disorders

1St Generation/Typical fluphenazine decanoate injection solution 25 mg/ml $0-$3.95 Generic fluphenazine hcl injection solution 2.5 mg/ml $0-$3.95 Generic fluphenazine hcl oral concentrate 5 mg/ml $0-$3.95 Generic fluphenazine hcl oral elixir 2.5 mg/5ml $0-$3.95 Generic fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic haloperidol decanoate intramuscular solution 100 mg/ml, 100 mg/ml 1 ml, 50 mg/ml, 50 mg/ml(1ml) $0-$3.95 Generic

haloperidol lactate injection solution 5 mg/ml $0-$3.95 Generic haloperidol lactate oral concentrate 2 mg/ml $0-$3.95 Generic haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg $0-$3.95 Generic loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg $0-$3.95 Generic molindone hcl oral tablet 10 mg, 25 mg, 5 mg $0-$3.95 Generic pimozide oral tablet 1 mg, 2 mg $0-$3.95 Generic thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg $0-$3.95 Generic thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg $0-$3.95 Generic trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg $0-$3.95 Generic 2Nd Generation/Atypical ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG $0-$9.85 Brand PA; QL (1 EA per 28 days)

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG $0-$9.85 Brand PA; QL (1 EA per 28 days)

aripiprazole oral solution 1 mg/ml $0-$3.95 Generic QL (900 ML per 30 days) aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg $0-$3.95 Generic QL (30 EA per 30 days) aripiprazole oral tablet dispersible 10 mg, 15 mg $0-$3.95 Generic QL (60 EA per 30 days) ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG/2.4ML $0-$9.85 Brand PA

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML $0-$9.85 Brand PA; QL (3.9 ML per 56 days)

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 441 MG/1.6ML $0-$9.85 Brand PA; QL (1.6 ML per 28 days)

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 662 MG/2.4ML $0-$9.85 Brand PA; QL (2.4 ML per 28 days)

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 882 MG/3.2ML $0-$9.85 Brand PA; QL (3.2 ML per 28 days)

asenapine maleate sublingual tablet sublingual 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic QL (60 EA per 30 days) CAPLYTA ORAL CAPSULE 42 MG $0-$9.85 Brand PA FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG $0-$9.85 Brand PA; QL (60 EA per 30 days)

FANAPT TITRATION PACK ORAL TABLET 1 & 2 & 4 & 6 MG $0-$9.85 Brand PA INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG/0.75ML $0-$9.85 Brand QL (0.75 ML per 28 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 27

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 156 MG/ML $0-$9.85 Brand QL (1 ML per 28 days)

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 234 MG/1.5ML $0-$9.85 Brand QL (1.5 ML per 28 days)

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 39 MG/0.25ML $0-$9.85 Brand QL (0.25 ML per 28 days)

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 78 MG/0.5ML $0-$9.85 Brand QL (0.5 ML per 28 days)

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 273 MG/0.88ML $0-$9.85 Brand PA; QL (0.875 ML per 84 days)

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 410 MG/1.32ML $0-$9.85 Brand PA; QL (1.315 ML per 84 days)

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 546 MG/1.75ML $0-$9.85 Brand PA; QL (1.75 ML per 84 days)

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 819 MG/2.63ML $0-$9.85 Brand PA; QL (2.625 ML per 84 days)

LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG $0-$9.85 Brand QL (30 EA per 30 days) LATUDA ORAL TABLET 80 MG $0-$9.85 Brand QL (60 EA per 30 days) LYBALVI ORAL TABLET 10-10 MG, 15-10 MG, 20-10 MG, 5-10 MG $0-$9.85 Brand PA NUPLAZID ORAL CAPSULE 34 MG $0-$9.85 Brand PA; QL (30 EA per 30 days) NUPLAZID ORAL TABLET 10 MG $0-$9.85 Brand PA; QL (30 EA per 30 days) olanzapine intramuscular solution reconstituted 10 mg $0-$3.95 Generic QL (90 EA per 30 days) olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg $0-$3.95 Generic QL (30 EA per 30 days) olanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 mg $0-$3.95 Generic QL (30 EA per 30 days) paliperidone er oral tablet extended release 24 hour 1.5 mg, 3 mg, 9 mg $0-$3.95 Generic PA; QL (30 EA per 30 days)

paliperidone er oral tablet extended release 24 hour 6 mg $0-$3.95 Generic PA; QL (60 EA per 30 days) PERSERIS SUBCUTANEOUS PREFILLED SYRINGE 120 MG, 90 MG $0-$9.85 Brand PA; QL (1 EA per 28 days)

quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 200 mg $0-$3.95 Generic QL (30 EA per 30 days)

quetiapine fumarate er oral tablet extended release 24 hour 300 mg, 400 mg, 50 mg $0-$3.95 Generic QL (60 EA per 30 days)

quetiapine fumarate oral tablet 100 mg, 200 mg, 300 mg, 400 mg $0-$3.95 Generic QL (60 EA per 30 days) quetiapine fumarate oral tablet 25 mg, 50 mg $0-$3.95 Generic QL (90 EA per 30 days) REXULTI ORAL TABLET 0.25 MG, 0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG $0-$9.85 Brand PA; QL (30 EA per 30 days)

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 12.5 MG, 25 MG, 37.5 MG, 50 MG $0-$9.85 Brand QL (2 EA per 28 days)

risperidone oral solution 1 mg/ml $0-$3.95 Generic QL (480 ML per 30 days) risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg $0-$3.95 Generic QL (60 EA per 30 days) risperidone oral tablet 4 mg $0-$3.95 Generic QL (120 EA per 30 days) risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg $0-$3.95 Generic QL (60 EA per 30 days) risperidone oral tablet dispersible 4 mg $0-$3.95 Generic QL (120 EA per 30 days) SECUADO TRANSDERMAL PATCH 24 HOUR 3.8 MG/24HR, 5.7 MG/24HR, 7.6 MG/24HR $0-$9.85 Brand PA; QL (30 EA per 30 days)

VRAYLAR ORAL CAPSULE 1.5 MG, 3 MG, 4.5 MG, 6 MG $0-$9.85 Brand PA; QL (30 EA per 30 days) VRAYLAR ORAL CAPSULE THERAPY PACK 1.5 & 3 MG $0-$9.85 Brand PA; QL (14 EA per 365 days) ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg $0-$3.95 Generic QL (60 EA per 30 days) ziprasidone mesylate intramuscular solution reconstituted 20 mg $0-$3.95 Generic B/D; QL (6 EA per 3 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 28

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 210 MG, 300 MG $0-$9.85 Brand PA; QL (2 EA per 28 days)

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 405 MG $0-$9.85 Brand PA; QL (1 EA per 28 days)

Treatment-Resistant clozapine oral tablet 100 mg $0-$3.95 Generic QL (270 EA per 30 days) clozapine oral tablet 200 mg $0-$3.95 Generic QL (120 EA per 30 days) clozapine oral tablet 25 mg, 50 mg $0-$3.95 Generic QL (90 EA per 30 days) clozapine oral tablet dispersible 100 mg $0-$3.95 Generic QL (270 EA per 30 days) clozapine oral tablet dispersible 12.5 mg, 25 mg $0-$3.95 Generic clozapine oral tablet dispersible 150 mg $0-$3.95 Generic QL (180 EA per 30 days) clozapine oral tablet dispersible 200 mg $0-$3.95 Generic QL (120 EA per 30 days) VERSACLOZ ORAL SUSPENSION 50 MG/ML $0-$9.85 Brand QL (540 ML per 30 days) Antispasticity Agents - Treatment Of Muscle Spasms Antispasticity Agents baclofen oral tablet 10 mg, 20 mg, 5 mg $0-$3.95 Generic dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic tizanidine hcl oral tablet 2 mg, 4 mg $0-$3.95 Generic Antivirals - Treatment Of Infections By Viruses Anti-Cytomegalovirus (Cmv) Agents PREVYMIS ORAL TABLET 240 MG, 480 MG $0-$9.85 Brand PA valganciclovir hcl oral solution reconstituted 50 mg/ml $0-$3.95 Generic valganciclovir hcl oral tablet 450 mg $0-$3.95 Generic Anti-Hepatitis B (Hbv) Agents adefovir dipivoxil oral tablet 10 mg $0-$3.95 Generic PA BARACLUDE ORAL SOLUTION 0.05 MG/ML $0-$9.85 Brand entecavir oral tablet 0.5 mg, 1 mg $0-$3.95 Generic EPIVIR HBV ORAL SOLUTION 5 MG/ML $0-$9.85 Brand lamivudine oral solution 10 mg/ml $0-$3.95 Generic lamivudine oral tablet 100 mg, 300 mg $0-$3.95 Generic QL (30 EA per 30 days) lamivudine oral tablet 150 mg $0-$3.95 Generic QL (60 EA per 30 days) tenofovir disoproxil fumarate oral tablet 300 mg $0-$3.95 Generic QL (30 EA per 30 days) VEMLIDY ORAL TABLET 25 MG $0-$9.85 Brand VIREAD ORAL POWDER 40 MG/GM $0-$9.85 Brand VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG $0-$9.85 Brand QL (30 EA per 30 days) Anti-Hepatitis C (Hcv) Agents MAVYRET ORAL PACKET 50-20 MG $0-$9.85 Brand PA MAVYRET ORAL TABLET 100-40 MG $0-$9.85 Brand PA ribavirin oral capsule 200 mg $0-$3.95 Generic ribavirin oral tablet 200 mg $0-$3.95 Generic SOFOSBUVIR-VELPATASVIR ORAL TABLET 400-100 MG $0-$9.85 Brand PA VOSEVI ORAL TABLET 400-100-100 MG $0-$9.85 Brand PA Antiherpetic Agents acyclovir oral capsule 200 mg $0-$3.95 Generic acyclovir oral suspension 200 mg/5ml $0-$3.95 Generic acyclovir oral tablet 400 mg, 800 mg $0-$3.95 Generic acyclovir sodium intravenous solution 50 mg/ml $0-$3.95 Generic B/D famciclovir oral tablet 125 mg, 250 mg, 500 mg $0-$3.95 Generic trifluridine ophthalmic solution 1 % $0-$3.95 Generic valacyclovir hcl oral tablet 1 gm, 500 mg $0-$3.95 Generic Anti-Hiv Agents, Integrase Inhibitors (Insti)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 29

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

BIKTARVY ORAL TABLET 30-120-15 MG, 50-200-25 MG $0-$9.85 Brand QL (30 EA per 30 days) DOVATO ORAL TABLET 50-300 MG $0-$9.85 Brand QL (30 EA per 30 days) GENVOYA ORAL TABLET 150-150-200-10 MG $0-$9.85 Brand QL (30 EA per 30 days) ISENTRESS HD ORAL TABLET 600 MG $0-$9.85 Brand QL (60 EA per 30 days) ISENTRESS ORAL PACKET 100 MG $0-$9.85 Brand QL (60 EA per 30 days) ISENTRESS ORAL TABLET 400 MG $0-$9.85 Brand QL (60 EA per 30 days) ISENTRESS ORAL TABLET CHEWABLE 100 MG, 25 MG $0-$9.85 Brand QL (180 EA per 30 days) STRIBILD ORAL TABLET 150-150-200-300 MG $0-$9.85 Brand QL (30 EA per 30 days) SYMTUZA ORAL TABLET 800-150-200-10 MG $0-$9.85 Brand QL (30 EA per 30 days) TIVICAY ORAL TABLET 10 MG $0-$9.85 Brand QL (120 EA per 30 days) TIVICAY ORAL TABLET 25 MG $0-$9.85 Brand QL (30 EA per 30 days) TIVICAY ORAL TABLET 50 MG $0-$9.85 Brand QL (60 EA per 30 days) TIVICAY PD ORAL TABLET SOLUBLE 5 MG $0-$9.85 Brand QL (180 EA per 30 days) VOCABRIA ORAL TABLET 30 MG $0-$9.85 Brand QL (30 EA per 30 days) Anti-Hiv Agents, Non-Nucleoside Reverse Transcriptase Inhibitors (Nnrti)

COMPLERA ORAL TABLET 200-25-300 MG $0-$9.85 Brand QL (30 EA per 30 days) EDURANT ORAL TABLET 25 MG $0-$9.85 Brand QL (60 EA per 30 days) efavirenz oral capsule 200 mg $0-$3.95 Generic QL (120 EA per 30 days) efavirenz oral capsule 50 mg $0-$3.95 Generic QL (180 EA per 30 days) efavirenz oral tablet 600 mg $0-$3.95 Generic QL (30 EA per 30 days) etravirine oral tablet 100 mg $0-$3.95 Generic QL (120 EA per 30 days) etravirine oral tablet 200 mg $0-$3.95 Generic QL (60 EA per 30 days) INTELENCE ORAL TABLET 25 MG $0-$9.85 Brand QL (120 EA per 30 days) nevirapine er oral tablet extended release 24 hour 100 mg $0-$3.95 Generic QL (120 EA per 30 days) nevirapine er oral tablet extended release 24 hour 400 mg $0-$3.95 Generic QL (30 EA per 30 days) nevirapine oral suspension 50 mg/5ml $0-$3.95 Generic nevirapine oral tablet 200 mg $0-$3.95 Generic QL (60 EA per 30 days) PIFELTRO ORAL TABLET 100 MG $0-$9.85 Brand QL (30 EA per 30 days) Anti-Hiv Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (Nrti)

abacavir sulfate oral solution 20 mg/ml $0-$3.95 Generic abacavir sulfate oral tablet 300 mg $0-$3.95 Generic QL (60 EA per 30 days) abacavir sulfate-lamivudine oral tablet 600-300 mg $0-$3.95 Generic QL (30 EA per 30 days) abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg $0-$3.95 Generic QL (60 EA per 30 days) CIMDUO ORAL TABLET 300-300 MG $0-$9.85 Brand QL (30 EA per 30 days) DELSTRIGO ORAL TABLET 100-300-300 MG $0-$9.85 Brand QL (30 EA per 30 days) DESCOVY ORAL TABLET 120-15 MG, 200-25 MG $0-$9.85 Brand QL (30 EA per 30 days) efavirenz-emtricitab-tenofovir oral tablet 600-200-300 mg $0-$3.95 Generic QL (30 EA per 30 days) efavirenz-lamivudine-tenofovir oral tablet 400-300-300 mg, 600-300-300 mg $0-$3.95 Generic QL (30 EA per 30 days)

emtricitabine oral capsule 200 mg $0-$3.95 Generic QL (30 EA per 30 days) emtricitabine-tenofovir df oral tablet 100-150 mg, 133-200 mg, 167-250 mg, 200-300 mg $0-$3.95 Generic QL (30 EA per 30 days)

EMTRIVA ORAL SOLUTION 10 MG/ML $0-$9.85 Brand JULUCA ORAL TABLET 50-25 MG $0-$9.85 Brand QL (30 EA per 30 days) lamivudine-zidovudine oral tablet 150-300 mg $0-$3.95 Generic QL (60 EA per 30 days) ODEFSEY ORAL TABLET 200-25-25 MG $0-$9.85 Brand QL (30 EA per 30 days) stavudine oral capsule 15 mg, 20 mg $0-$3.95 Generic QL (120 EA per 30 days) stavudine oral capsule 30 mg, 40 mg $0-$3.95 Generic QL (60 EA per 30 days) TEMIXYS ORAL TABLET 300-300 MG $0-$9.85 Brand QL (30 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 30

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

zidovudine oral capsule 100 mg $0-$3.95 Generic QL (180 EA per 30 days) zidovudine oral syrup 50 mg/5ml $0-$3.95 Generic zidovudine oral tablet 300 mg $0-$3.95 Generic QL (60 EA per 30 days) Anti-Hiv Agents, Other FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MG $0-$9.85 Brand maraviroc oral tablet 150 mg $0-$3.95 Generic QL (60 EA per 30 days) maraviroc oral tablet 300 mg $0-$3.95 Generic QL (120 EA per 30 days) RUKOBIA ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG $0-$9.85 Brand QL (60 EA per 30 days) SELZENTRY ORAL SOLUTION 20 MG/ML $0-$9.85 Brand SELZENTRY ORAL TABLET 25 MG $0-$9.85 Brand QL (120 EA per 30 days) SELZENTRY ORAL TABLET 75 MG $0-$9.85 Brand QL (60 EA per 30 days) TRIUMEQ ORAL TABLET 600-50-300 MG $0-$9.85 Brand QL (30 EA per 30 days) TRIUMEQ PD ORAL TABLET SOLUBLE 60-5-30 MG $0-$9.85 Brand QL (180 EA per 30 days) TYBOST ORAL TABLET 150 MG $0-$9.85 Brand QL (30 EA per 30 days) Anti-Hiv Agents, Protease Inhibitors (Pi) APTIVUS ORAL CAPSULE 250 MG $0-$9.85 Brand QL (120 EA per 30 days) APTIVUS ORAL SOLUTION 100 MG/ML $0-$9.85 Brand atazanavir sulfate oral capsule 150 mg, 300 mg $0-$3.95 Generic QL (30 EA per 30 days) atazanavir sulfate oral capsule 200 mg $0-$3.95 Generic QL (60 EA per 30 days) CRIXIVAN ORAL CAPSULE 200 MG $0-$9.85 Brand QL (360 EA per 30 days) CRIXIVAN ORAL CAPSULE 400 MG $0-$9.85 Brand QL (180 EA per 30 days) EVOTAZ ORAL TABLET 300-150 MG $0-$9.85 Brand QL (30 EA per 30 days) fosamprenavir calcium oral tablet 700 mg $0-$3.95 Generic QL (120 EA per 30 days) INVIRASE ORAL TABLET 500 MG $0-$9.85 Brand QL (120 EA per 30 days) LEXIVA ORAL SUSPENSION 50 MG/ML $0-$9.85 Brand lopinavir-ritonavir oral solution 400-100 mg/5ml $0-$3.95 Generic QL (390 ML per 30 days) lopinavir-ritonavir oral tablet 100-25 mg $0-$3.95 Generic QL (300 EA per 30 days) lopinavir-ritonavir oral tablet 200-50 mg $0-$3.95 Generic QL (120 EA per 30 days) NORVIR ORAL PACKET 100 MG $0-$9.85 Brand QL (360 EA per 30 days) NORVIR ORAL SOLUTION 80 MG/ML $0-$9.85 Brand QL (450 ML per 30 days) PREZCOBIX ORAL TABLET 800-150 MG $0-$9.85 Brand QL (30 EA per 30 days) PREZISTA ORAL SUSPENSION 100 MG/ML $0-$9.85 Brand PREZISTA ORAL TABLET 150 MG $0-$9.85 Brand QL (180 EA per 30 days) PREZISTA ORAL TABLET 600 MG $0-$9.85 Brand QL (60 EA per 30 days) PREZISTA ORAL TABLET 75 MG $0-$9.85 Brand QL (300 EA per 30 days) PREZISTA ORAL TABLET 800 MG $0-$9.85 Brand QL (30 EA per 30 days) REYATAZ ORAL PACKET 50 MG $0-$9.85 Brand ritonavir oral tablet 100 mg $0-$3.95 Generic QL (360 EA per 30 days) VIRACEPT ORAL TABLET 250 MG $0-$9.85 Brand QL (300 EA per 30 days) VIRACEPT ORAL TABLET 625 MG $0-$9.85 Brand QL (120 EA per 30 days) Anti-Influenza Agents oseltamivir phosphate oral capsule 30 mg $0-$3.95 Generic QL (84 EA per 180 days) oseltamivir phosphate oral capsule 45 mg, 75 mg $0-$3.95 Generic QL (42 EA per 180 days) oseltamivir phosphate oral suspension reconstituted 6 mg/ml $0-$3.95 Generic QL (540 ML per 180 days) RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 5 MG/BLISTER $0-$9.85 Brand QL (60 EA per 180 days)

rimantadine hcl oral tablet 100 mg $0-$3.95 Generic Antivirals molnupiravir oral capsule 200 mg Tier 1 - $0 QL (40 EA per 5 days) PAXLOVID ORAL TABLET THERAPY PACK 20 X 150 MG & 10 X 100MG Tier 1 - $0 QL (30 EA per 5 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 31

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

Anxiolytics - Treatment Of Anxiety Or Nervousness Anxiolytics, Other buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg $0-$3.95 Generic hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic PA Benzodiazepines ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML $0-$3.95 Generic QL (300 ML per 30 days) alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg $0-$3.95 Generic QL (120 EA per 30 days) alprazolam oral tablet 2 mg $0-$3.95 Generic QL (150 EA per 30 days) clonazepam oral tablet 0.5 mg, 1 mg $0-$3.95 Generic QL (90 EA per 30 days) clonazepam oral tablet 2 mg $0-$3.95 Generic QL (300 EA per 30 days) clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 mg, 1 mg $0-$3.95 Generic QL (90 EA per 30 days) clonazepam oral tablet dispersible 2 mg $0-$3.95 Generic QL (300 EA per 30 days) clorazepate dipotassium oral tablet 15 mg $0-$3.95 Generic QL (180 EA per 30 days) clorazepate dipotassium oral tablet 3.75 mg, 7.5 mg $0-$3.95 Generic QL (90 EA per 30 days) DIAZEPAM INTENSOL ORAL CONCENTRATE 5 MG/ML $0-$3.95 Generic QL (240 ML per 30 days) diazepam oral solution 5 mg/5ml $0-$3.95 Generic QL (1200 ML per 30 days) diazepam oral tablet 10 mg, 2 mg, 5 mg $0-$3.95 Generic QL (120 EA per 30 days) LORAZEPAM INTENSOL ORAL CONCENTRATE 2 MG/ML $0-$3.95 Generic QL (150 ML per 30 days) lorazepam oral concentrate 2 mg/ml $0-$3.95 Generic QL (150 ML per 30 days) lorazepam oral tablet 0.5 mg, 1 mg $0-$3.95 Generic QL (90 EA per 30 days) lorazepam oral tablet 2 mg $0-$3.95 Generic QL (150 EA per 30 days) Bipolar Agents - Treatment For Bipolar Illnesses Mood Stabilizers carbamazepine er oral capsule extended release 12 hour 100 mg, 200 mg, 300 mg $0-$3.95 Generic

EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG $0-$9.85 Brand

lamotrigine oral tablet 100 mg, 150 mg, 200 mg $0-$3.95 Generic lamotrigine starter kit-blue oral kit 35 x 25 mg $0-$3.95 Generic lamotrigine starter kit-green oral kit 84 x 25 mg & 14x100 mg $0-$3.95 Generic lamotrigine starter kit-orange oral kit 42 x 25 mg & 7 x 100 mg $0-$3.95 Generic lithium carbonate er oral tablet extended release 300 mg, 450 mg $0-$3.95 Generic lithium carbonate oral capsule 150 mg, 300 mg, 600 mg $0-$3.95 Generic lithium carbonate oral tablet 300 mg $0-$3.95 Generic lithium oral solution 8 meq/5ml $0-$3.95 Generic Blood Glucose Regulators - Control Of Diabetes Antidiabetic Agents acarbose oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic QL (90 EA per 30 days) glimepiride oral tablet 1 mg $0-$3.95 Generic QL (240 EA per 30 days) glimepiride oral tablet 2 mg $0-$3.95 Generic QL (120 EA per 30 days) glimepiride oral tablet 4 mg $0-$3.95 Generic QL (60 EA per 30 days) glipizide er oral tablet extended release 24 hour 10 mg $0-$3.95 Generic QL (60 EA per 30 days) glipizide er oral tablet extended release 24 hour 2.5 mg $0-$3.95 Generic QL (240 EA per 30 days) glipizide er oral tablet extended release 24 hour 5 mg $0-$3.95 Generic QL (120 EA per 30 days) glipizide oral tablet 10 mg $0-$3.95 Generic QL (120 EA per 30 days) glipizide oral tablet 5 mg $0-$3.95 Generic QL (240 EA per 30 days) glipizide xl oral tablet extended release 24 hour 10 mg $0-$3.95 Generic QL (60 EA per 30 days) glipizide xl oral tablet extended release 24 hour 2.5 mg $0-$3.95 Generic QL (240 EA per 30 days) glipizide xl oral tablet extended release 24 hour 5 mg $0-$3.95 Generic QL (120 EA per 30 days) glipizide-metformin hcl oral tablet 2.5-250 mg $0-$3.95 Generic QL (240 EA per 30 days) glipizide-metformin hcl oral tablet 2.5-500 mg, 5-500 mg $0-$3.95 Generic QL (120 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 32

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

glyburide micronized oral tablet 1.5 mg, 3 mg $0-$3.95 Generic PA; QL (90 EA per 30 days) glyburide micronized oral tablet 6 mg $0-$3.95 Generic PA; QL (60 EA per 30 days) glyburide oral tablet 1.25 mg, 2.5 mg $0-$3.95 Generic PA; QL (60 EA per 30 days) glyburide oral tablet 5 mg $0-$3.95 Generic PA; QL (120 EA per 30 days) glyburide-metformin oral tablet 1.25-250 mg $0-$3.95 Generic PA; QL (240 EA per 30 days) glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg $0-$3.95 Generic PA; QL (120 EA per 30 days) GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG $0-$9.85 Brand QL (30 EA per 30 days) INVOKAMET ORAL TABLET 150-1000 MG, 150-500 MG, 50-1000 MG $0-$9.85 Brand QL (60 EA per 30 days)

INVOKAMET ORAL TABLET 50-500 MG $0-$9.85 Brand QL (120 EA per 30 days) INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG $0-$9.85 Brand QL (60 EA per 30 days)

INVOKANA ORAL TABLET 100 MG, 300 MG $0-$9.85 Brand QL (30 EA per 30 days) JANUMET ORAL TABLET 50-1000 MG, 50-500 MG $0-$9.85 Brand QL (60 EA per 30 days) JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG $0-$9.85 Brand QL (30 EA per 30 days)

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 50-1000 MG, 50-500 MG $0-$9.85 Brand QL (60 EA per 30 days)

JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG $0-$9.85 Brand QL (30 EA per 30 days) JARDIANCE ORAL TABLET 10 MG, 25 MG $0-$9.85 Brand QL (30 EA per 30 days) JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 MG, 2.5-850 MG $0-$9.85 Brand QL (60 EA per 30 days)

JENTADUETO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG $0-$9.85 Brand QL (60 EA per 30 days)

JENTADUETO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 5-1000 MG $0-$9.85 Brand QL (30 EA per 30 days)

metformin hcl er oral tablet extended release 24 hour 500 mg $0-$3.95 Generic QL (120 EA per 30 days) metformin hcl er oral tablet extended release 24 hour 750 mg $0-$3.95 Generic QL (60 EA per 30 days) metformin hcl oral tablet 1000 mg $0-$3.95 Generic QL (75 EA per 30 days) metformin hcl oral tablet 500 mg $0-$3.95 Generic QL (150 EA per 30 days) metformin hcl oral tablet 850 mg $0-$3.95 Generic QL (90 EA per 30 days) nateglinide oral tablet 120 mg, 60 mg $0-$3.95 Generic QL (90 EA per 30 days) OZEMPIC (0.25 OR 0.5 MG/DOSE) SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML $0-$9.85 Brand QL (3 ML per 28 days)

OZEMPIC (1 MG/DOSE) SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML, 4 MG/3ML $0-$9.85 Brand QL (3 ML per 28 days)

pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg $0-$3.95 Generic QL (30 EA per 30 days) pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15-850 mg $0-$3.95 Generic QL (90 EA per 30 days) repaglinide oral tablet 0.5 mg, 1 mg, 2 mg $0-$3.95 Generic RYBELSUS ORAL TABLET 14 MG, 3 MG, 7 MG $0-$9.85 Brand QL (30 EA per 30 days) SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR 2700 MCG/2.7ML $0-$9.85 Brand PA

SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR 1500 MCG/1.5ML $0-$9.85 Brand PA

SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG $0-$9.85 Brand QL (60 EA per 30 days)

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 12.5-1000 MG, 5-1000 MG $0-$9.85 Brand QL (60 EA per 30 days)

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25-1000 MG $0-$9.85 Brand QL (30 EA per 30 days)

TRADJENTA ORAL TABLET 5 MG $0-$9.85 Brand QL (30 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 33

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML, 3 MG/0.5ML, 4.5 MG/0.5ML $0-$9.85 Brand QL (2 ML per 28 days)

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML $0-$9.85 Brand QL (9 ML per 30 days)

Glycemic Agents BAQSIMI ONE PACK NASAL POWDER 3 MG/DOSE $0-$9.85 Brand QL (4 EA per 30 days) BAQSIMI TWO PACK NASAL POWDER 3 MG/DOSE $0-$9.85 Brand QL (4 EA per 30 days) diazoxide oral suspension 50 mg/ml $0-$3.95 Generic GLUCAGEN DIAGNOSTIC INJECTION SOLUTION RECONSTITUTED 1 MG $0-$9.85 Brand QL (4 EA per 30 days)

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG $0-$9.85 Brand QL (4 EA per 30 days)

glucagon emergency injection kit 1 mg $0-$3.95 Generic QL (4 EA per 30 days) glucagon emergency injection solution reconstituted 1 mg/ml $0-$3.95 Generic QL (4 EA per 30 days) glucagon hcl (diagnostic) injection solution reconstituted 1 mg $0-$3.95 Generic QL (4 EA per 30 days) KORLYM ORAL TABLET 300 MG $0-$9.85 Brand PA Insulins gauze external $0-$3.95 Generic gauze external pad $0-$3.95 Generic gauze pad 2"x2" , 4"x4" $0-$3.95 Generic HUMALOG INJECTION SOLUTION 100 UNIT/ML $0-$9.85 Brand HUMALOG JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML $0-$9.85 Brand

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML $0-$9.85 Brand

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (50-50) 100 UNIT/ML $0-$9.85 Brand

HUMALOG MIX 50/50 SUBCUTANEOUS SUSPENSION (50-50) 100 UNIT/ML $0-$9.85 Brand

HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (75-25) 100 UNIT/ML $0-$9.85 Brand

HUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION (75-25) 100 UNIT/ML $0-$9.85 Brand

HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML $0-$9.85 Brand

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML $0-$9.85 Brand

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML $0-$9.85 Brand

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML $0-$9.85 Brand

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML $0-$9.85 Brand HUMULIN R INJECTION SOLUTION 100 UNIT/ML $0-$9.85 Brand HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML $0-$9.85 Brand

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 500 UNIT/ML $0-$9.85 Brand

insulin lispro (1 unit dial) subcutaneous solution pen-injector 100 unit/ml $0-$3.95 Generic

insulin lispro injection solution 100 unit/ml $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 34

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

insulin lispro junior kwikpen subcutaneous solution pen-injector 100 unit/ml $0-$3.95 Generic

insulin lispro prot & lispro subcutaneous suspension pen-injector (75-25) 100 unit/ml $0-$3.95 Generic

insulin syringe 27g x 1/2" 1 ml, 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 15/64" 0.3 ml, 31g x 6mm 0.5 ml, u-100 1 ml

$0-$3.95 Generic

INSULIN SYRINGE 29G 0.3 ML, 29G X 1/2" 1 ML $0-$3.95 Generic LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML $0-$9.85 Brand

LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML $0-$9.85 Brand LEVEMIR FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML $0-$9.85 Brand

LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML $0-$9.85 Brand PEN NEEDLES 29G X 12MM $0-$3.95 Generic pen needles 30g x 8 mm , 31g x 8 mm , 32g x 4 mm , 32g x 5 mm $0-$3.95 Generic SOLIQUA SUBCUTANEOUS SOLUTION PEN-INJECTOR 100-33 UNT-MCG/ML $0-$9.85 Brand QL (30 ML per 30 days)

TOUJEO MAX SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNIT/ML $0-$9.85 Brand

TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNIT/ML $0-$9.85 Brand

Blood Products And Modifiers - Prevention Of Clotting And Increasing Blood Cell Production

Anticoagulants ELIQUIS DVT/PE STARTER PACK ORAL TABLET THERAPY PACK 5 MG $0-$9.85 Brand QL (74 EA per 30 days)

ELIQUIS ORAL TABLET 2.5 MG $0-$9.85 Brand QL (60 EA per 30 days) ELIQUIS ORAL TABLET 5 MG $0-$9.85 Brand QL (120 EA per 30 days) enoxaparin sodium injection solution 300 mg/3ml $0-$3.95 Generic enoxaparin sodium injection solution prefilled syringe 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

$0-$3.95 Generic

fondaparinux sodium subcutaneous solution 10 mg/0.8ml, 2.5 mg/0.5ml, 5 mg/0.4ml, 7.5 mg/0.6ml $0-$3.95 Generic

FRAGMIN SUBCUTANEOUS SOLUTION 95000 UNIT/3.8ML $0-$9.85 Brand FRAGMIN SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML

$0-$9.85 Brand

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 5000 unit/ml $0-$3.95 Generic B/D

JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG $0-$3.95 Generic

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg $0-$3.95 Generic

XARELTO ORAL TABLET 10 MG, 20 MG $0-$9.85 Brand QL (30 EA per 30 days) XARELTO ORAL TABLET 15 MG $0-$9.85 Brand QL (60 EA per 30 days) XARELTO ORAL TABLET 2.5 MG $0-$9.85 Brand QL (120 EA per 30 days) XARELTO STARTER PACK ORAL TABLET THERAPY PACK 15 & 20 MG $0-$9.85 Brand QL (51 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 35

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

Blood Products And Modifiers, Other anagrelide hcl oral capsule 0.5 mg, 1 mg $0-$3.95 Generic ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 25 MCG/ML, 40 MCG/ML, 60 MCG/ML $0-$9.85 Brand PA

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML, 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 500 MCG/ML, 60 MCG/0.3ML

$0-$9.85 Brand PA

EMPAVELI SUBCUTANEOUS SOLUTION 1080 MG/20ML $0-$9.85 Brand PA EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML $0-$9.85 Brand PA

FULPHILA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML $0-$9.85 Brand PA

GRANIX SUBCUTANEOUS SOLUTION 300 MCG/ML, 480 MCG/1.6ML $0-$9.85 Brand PA

GRANIX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML $0-$9.85 Brand PA

LEUKINE INJECTION SOLUTION RECONSTITUTED 250 MCG $0-$9.85 Brand PA NEULASTA ONPRO SUBCUTANEOUS PREFILLED SYRINGE KIT 6 MG/0.6ML $0-$9.85 Brand PA

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML $0-$9.85 Brand PA

NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML $0-$9.85 Brand PA NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML $0-$9.85 Brand PA

NIVESTYM INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML $0-$9.85 Brand PA

NYVEPRIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML $0-$9.85 Brand PA

OXBRYTA ORAL TABLET 500 MG $0-$9.85 Brand PA OXBRYTA ORAL TABLET SOLUBLE 300 MG $0-$9.85 Brand PA PROCRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML $0-$9.85 Brand PA

PROMACTA ORAL PACKET 12.5 MG, 25 MG $0-$9.85 Brand PA PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG $0-$9.85 Brand PA; QL (30 EA per 30 days) RETACRIT INJECTION SOLUTION 10000 UNIT/ML, 10000 UNIT/ML(1ML), 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML

$0-$9.85 Brand PA

TAVNEOS ORAL CAPSULE 10 MG $0-$9.85 Brand PA UDENYCA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML $0-$9.85 Brand PA

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML $0-$9.85 Brand PA

ZIEXTENZO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML $0-$9.85 Brand PA

Hemostasis Agents tranexamic acid oral tablet 650 mg $0-$3.95 Generic Platelet Modifying Agents aspirin-dipyridamole er oral capsule extended release 12 hour 25-200 mg $0-$3.95 Generic

BRILINTA ORAL TABLET 60 MG, 90 MG $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 36

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

cilostazol oral tablet 100 mg, 50 mg $0-$3.95 Generic clopidogrel bisulfate oral tablet 75 mg $0-$3.95 Generic dipyridamole oral tablet 25 mg, 50 mg, 75 mg $0-$3.95 Generic PA DOPTELET ORAL TABLET 20 MG, 20 MG (10 PACK), 20 MG(15 PACK) $0-$9.85 Brand PA

prasugrel hcl oral tablet 10 mg, 5 mg $0-$3.95 Generic Cardiovascular Agents - Treatment Of Conditions Affecting The Heart And Blood Vessels

Alpha-Adrenergic Agonists clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg $0-$3.95 Generic clonidine transdermal patch weekly 0.1 mg/24hr, 0.2 mg/24hr, 0.3 mg/24hr $0-$3.95 Generic

droxidopa oral capsule 100 mg, 200 mg, 300 mg $0-$3.95 Generic guanfacine hcl oral tablet 1 mg, 2 mg $0-$3.95 Generic PA methyldopa oral tablet 250 mg, 500 mg $0-$3.95 Generic PA midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic Alpha-Adrenergic Blocking Agents doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, 8 mg $0-$3.95 Generic phenoxybenzamine hcl oral capsule 10 mg $0-$3.95 Generic PA prazosin hcl oral capsule 1 mg, 2 mg, 5 mg $0-$3.95 Generic terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg $0-$3.95 Generic Angiotensin Ii Receptor Antagonists candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg $0-$3.95 Generic irbesartan oral tablet 150 mg, 300 mg, 75 mg $0-$3.95 Generic losartan potassium oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg $0-$3.95 Generic telmisartan oral tablet 20 mg, 40 mg, 80 mg $0-$3.95 Generic valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg $0-$3.95 Generic Angiotensin-Converting Enzyme (Ace) Inhibitors benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg $0-$3.95 Generic captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg $0-$3.95 Generic enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg $0-$3.95 Generic fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg $0-$3.95 Generic lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg $0-$3.95 Generic moexipril hcl oral tablet 15 mg, 7.5 mg $0-$3.95 Generic perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg $0-$3.95 Generic quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg $0-$3.95 Generic ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic trandolapril oral tablet 1 mg, 2 mg, 4 mg $0-$3.95 Generic Antiarrhythmics amiodarone hcl oral tablet 100 mg, 200 mg, 400 mg $0-$3.95 Generic disopyramide phosphate oral capsule 100 mg, 150 mg $0-$3.95 Generic PA dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg $0-$3.95 Generic flecainide acetate oral tablet 100 mg, 150 mg, 50 mg $0-$3.95 Generic mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg $0-$3.95 Generic MULTAQ ORAL TABLET 400 MG $0-$9.85 Brand NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG, 150 MG $0-$9.85 Brand PA

propafenone hcl oral tablet 150 mg, 225 mg, 300 mg $0-$3.95 Generic quinidine gluconate er oral tablet extended release 324 mg $0-$3.95 Generic quinidine sulfate oral tablet 200 mg, 300 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 37

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

SORINE ORAL TABLET 120 MG, 160 MG, 240 MG, 80 MG $0-$3.95 Generic sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg $0-$3.95 Generic sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg $0-$3.95 Generic Beta-Adrenergic Blocking Agents acebutolol hcl oral capsule 200 mg, 400 mg $0-$3.95 Generic atenolol oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic betaxolol hcl oral tablet 10 mg, 20 mg $0-$3.95 Generic bisoprolol fumarate oral tablet 10 mg, 5 mg $0-$3.95 Generic carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg $0-$3.95 Generic labetalol hcl oral tablet 100 mg, 200 mg, 300 mg $0-$3.95 Generic metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 50 mg $0-$3.95 Generic

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic nadolol oral tablet 20 mg, 40 mg, 80 mg $0-$3.95 Generic nebivolol hcl oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg $0-$3.95 Generic pindolol oral tablet 10 mg, 5 mg $0-$3.95 Generic propranolol hcl er oral capsule extended release 24 hour 120 mg, 160 mg, 60 mg, 80 mg $0-$3.95 Generic

propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml $0-$3.95 Generic propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg $0-$3.95 Generic timolol maleate oral tablet 10 mg, 20 mg, 5 mg $0-$3.95 Generic Calcium Channel Blocking Agents, Dihydropyridines amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic felodipine er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic

isradipine oral capsule 2.5 mg, 5 mg $0-$3.95 Generic nifedipine er oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg $0-$3.95 Generic

nifedipine er osmotic release oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg $0-$3.95 Generic

nifedipine oral capsule 10 mg, 20 mg $0-$3.95 Generic PA nimodipine oral capsule 30 mg $0-$3.95 Generic Calcium Channel Blocking Agents, Nondihydropyridines CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG $0-$3.95 Generic

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg $0-$3.95 Generic

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg $0-$3.95 Generic

diltiazem hcl er oral capsule extended release 12 hour 120 mg, 60 mg, 90 mg $0-$3.95 Generic

diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg $0-$3.95 Generic

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg $0-$3.95 Generic dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg $0-$3.95 Generic verapamil hcl er oral capsule extended release 24 hour 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg $0-$3.95 Generic

verapamil hcl er oral tablet extended release 120 mg, 180 mg, 240 mg $0-$3.95 Generic verapamil hcl oral tablet 120 mg, 40 mg, 80 mg $0-$3.95 Generic Cardiovascular Agents, Other acetazolamide oral tablet 125 mg, 250 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 38

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

aliskiren fumarate oral tablet 150 mg, 300 mg $0-$3.95 Generic amiloride-hydrochlorothiazide oral tablet 5-50 mg $0-$3.95 Generic amlodipine besy-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg $0-$3.95 Generic

amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg $0-$3.95 Generic

amlodipine-olmesartan oral tablet 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg $0-$3.95 Generic

amlodipine-valsartan-hctz oral tablet 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg $0-$3.95 Generic

atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg $0-$3.95 Generic benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg $0-$3.95 Generic

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg $0-$3.95 Generic

candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 mg, 32-25 mg $0-$3.95 Generic

CORLANOR ORAL SOLUTION 5 MG/5ML $0-$9.85 Brand PA CORLANOR ORAL TABLET 5 MG, 7.5 MG $0-$9.85 Brand PA DIGITEK ORAL TABLET 125 MCG $0-$3.95 Generic QL (30 EA per 30 days) DIGITEK ORAL TABLET 250 MCG $0-$3.95 Generic PA DIGOX ORAL TABLET 125 MCG $0-$3.95 Generic QL (30 EA per 30 days) DIGOX ORAL TABLET 250 MCG $0-$3.95 Generic PA digoxin oral solution 0.05 mg/ml $0-$3.95 Generic PA digoxin oral tablet 125 mcg $0-$3.95 Generic QL (30 EA per 30 days) digoxin oral tablet 250 mcg $0-$3.95 Generic PA enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg $0-$3.95 Generic ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG $0-$9.85 Brand QL (60 EA per 30 days) fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg $0-$3.95 Generic hydrochlorothiazide oral tablet 25 mg $0-$3.95 Generic irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg $0-$3.95 Generic lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg $0-$3.95 Generic

losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg $0-$3.95 Generic

metoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100-50 mg, 50-25 mg $0-$3.95 Generic

metyrosine oral capsule 250 mg $0-$3.95 Generic PA NEXLETOL ORAL TABLET 180 MG $0-$9.85 Brand PA NEXLIZET ORAL TABLET 180-10 MG $0-$9.85 Brand PA olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg $0-$3.95 Generic

olmesartan-amlodipine-hctz oral tablet 20-5-12.5 mg, 40-10-12.5 mg, 40-10-25 mg, 40-5-12.5 mg, 40-5-25 mg $0-$3.95 Generic

ORLADEYO ORAL CAPSULE 110 MG, 150 MG $0-$9.85 Brand PA pentoxifylline er oral tablet extended release 400 mg $0-$3.95 Generic quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg $0-$3.95 Generic

ranolazine er oral tablet extended release 12 hour 1000 mg, 500 mg $0-$3.95 Generic spironolactone-hctz oral tablet 25-25 mg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 39

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

TEKTURNA HCT ORAL TABLET 150-12.5 MG, 150-25 MG, 300-12.5 MG, 300-25 MG $0-$9.85 Brand

telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 mg $0-$3.95 Generic triamterene-hctz oral capsule 37.5-25 mg $0-$3.95 Generic triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg $0-$3.95 Generic valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg $0-$3.95 Generic

Diuretics, Loop bumetanide oral tablet 0.5 mg, 1 mg, 2 mg $0-$3.95 Generic furosemide injection solution 10 mg/ml, 10 mg/ml (4ml syringe) $0-$3.95 Generic furosemide oral solution 10 mg/ml, 8 mg/ml $0-$3.95 Generic furosemide oral tablet 20 mg, 40 mg, 80 mg $0-$3.95 Generic torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg $0-$3.95 Generic Diuretics, Potassium-Sparing amiloride hcl oral tablet 5 mg $0-$3.95 Generic eplerenone oral tablet 25 mg, 50 mg $0-$3.95 Generic spironolactone oral tablet 100 mg, 25 mg, 50 mg $0-$3.95 Generic Diuretics, Thiazide chlorthalidone oral tablet 25 mg, 50 mg $0-$3.95 Generic hydrochlorothiazide oral capsule 12.5 mg $0-$3.95 Generic hydrochlorothiazide oral tablet 12.5 mg, 50 mg $0-$3.95 Generic indapamide oral tablet 1.25 mg, 2.5 mg $0-$3.95 Generic metolazone oral tablet 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic Dyslipidemics, Fibric Acid Derivatives fenofibrate micronized oral capsule 134 mg, 200 mg, 43 mg, 67 mg $0-$3.95 Generic fenofibrate oral capsule 134 mg, 200 mg, 67 mg $0-$3.95 Generic fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg $0-$3.95 Generic fenofibric acid oral capsule delayed release 135 mg, 45 mg $0-$3.95 Generic fenofibric acid oral tablet 35 mg $0-$3.95 Generic gemfibrozil oral tablet 600 mg $0-$3.95 Generic Dyslipidemics, Hmg Coa Reductase Inhibitors atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg $0-$3.95 Generic lovastatin oral tablet 10 mg, 20 mg, 40 mg $0-$3.95 Generic pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg $0-$3.95 Generic rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg $0-$3.95 Generic simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg $0-$3.95 Generic Dyslipidemics, Other cholestyramine light oral packet 4 gm $0-$3.95 Generic cholestyramine light oral powder 4 gm/dose $0-$3.95 Generic cholestyramine oral packet 4 gm $0-$3.95 Generic cholestyramine oral powder 4 gm/dose $0-$3.95 Generic colesevelam hcl oral packet 3.75 gm $0-$3.95 Generic colesevelam hcl oral tablet 625 mg $0-$3.95 Generic colestipol hcl oral granules 5 gm $0-$3.95 Generic colestipol hcl oral packet 5 gm $0-$3.95 Generic colestipol hcl oral tablet 1 gm $0-$3.95 Generic ezetimibe oral tablet 10 mg $0-$3.95 Generic ezetimibe-simvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg $0-$3.95 Generic

icosapent ethyl oral capsule 1 gm $0-$3.95 Generic PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 40

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

niacin er (antihyperlipidemic) oral tablet extended release 1000 mg, 500 mg, 750 mg $0-$3.95 Generic

omega-3-acid ethyl esters oral capsule 1 gm $0-$3.95 Generic PRALUENT SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML, 75 MG/ML $0-$9.85 Brand PA

PREVALITE ORAL PACKET 4 GM $0-$3.95 Generic PREVALITE ORAL POWDER 4 GM/DOSE $0-$3.95 Generic REPATHA PUSHTRONEX SYSTEM SUBCUTANEOUS SOLUTION CARTRIDGE 420 MG/3.5ML $0-$9.85 Brand PA

REPATHA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 140 MG/ML $0-$9.85 Brand PA

REPATHA SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML $0-$9.85 Brand PA

VASCEPA ORAL CAPSULE 0.5 GM $0-$9.85 Brand PA Vasodilators, Direct-Acting Arterial hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg $0-$3.95 Generic minoxidil oral tablet 10 mg, 2.5 mg $0-$3.95 Generic Vasodilators, Direct-Acting Arterial/ Venous isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg $0-$3.95 Generic isosorbide mononitrate er oral tablet extended release 24 hour 120 mg, 30 mg, 60 mg $0-$3.95 Generic

isosorbide mononitrate oral tablet 10 mg, 20 mg $0-$3.95 Generic NITRO-BID TRANSDERMAL OINTMENT 2 % $0-$9.85 Brand NITRO-DUR TRANSDERMAL PATCH 24 HOUR 0.3 MG/HR, 0.8 MG/HR $0-$9.85 Brand

nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, 0.6 mg $0-$3.95 Generic nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr $0-$3.95 Generic

nitroglycerin translingual solution 0.4 mg/spray $0-$3.95 Generic RECTIV RECTAL OINTMENT 0.4 % $0-$9.85 Brand Central Nervous System Agents - Treatment Of Disorders Of The Brain And Spinal Column

Attention Deficit Hyperactivity Disorder Agents, Amphetamines amphetamine-dextroamphet er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg $0-$3.95 Generic QL (30 EA per 30 days)

amphetamine-dextroamphetamine oral tablet 10 mg, 20 mg, 30 mg, 5 mg, 7.5 mg $0-$3.95 Generic QL (60 EA per 30 days)

amphetamine-dextroamphetamine oral tablet 12.5 mg $0-$3.95 Generic QL (120 EA per 30 days) amphetamine-dextroamphetamine oral tablet 15 mg $0-$3.95 Generic QL (90 EA per 30 days) dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg $0-$3.95 Generic QL (150 EA per 30 days)

dextroamphetamine sulfate er oral capsule extended release 24 hour 15 mg $0-$3.95 Generic QL (120 EA per 30 days)

dextroamphetamine sulfate er oral capsule extended release 24 hour 5 mg $0-$3.95 Generic QL (90 EA per 30 days)

dextroamphetamine sulfate oral tablet 10 mg, 5 mg $0-$3.95 Generic QL (180 EA per 30 days) Attention Deficit Hyperactivity Disorder Agents, Non-Amphetamines

atomoxetine hcl oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg $0-$3.95 Generic

clonidine hcl er oral tablet extended release 12 hour 0.1 mg $0-$3.95 Generic QL (120 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 41

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

dexmethylphenidate hcl er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg $0-$3.95 Generic QL (30 EA per 30 days)

dexmethylphenidate hcl oral tablet 10 mg $0-$3.95 Generic QL (60 EA per 30 days) dexmethylphenidate hcl oral tablet 2.5 mg, 5 mg $0-$3.95 Generic QL (90 EA per 30 days) guanfacine hcl er oral tablet extended release 24 hour 1 mg, 2 mg, 3 mg, 4 mg $0-$3.95 Generic PA

methylphenidate hcl er (cd) oral capsule extended release 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg $0-$3.95 Generic QL (30 EA per 30 days)

methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg, 60 mg $0-$3.95 Generic QL (30 EA per 30 days)

methylphenidate hcl er (xr) oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg $0-$3.95 Generic QL (30 EA per 30 days)

methylphenidate hcl er oral tablet extended release 10 mg, 54 mg, 72 mg $0-$3.95 Generic QL (30 EA per 30 days)

methylphenidate hcl er oral tablet extended release 18 mg $0-$3.95 Generic QL (120 EA per 30 days) methylphenidate hcl er oral tablet extended release 20 mg, 27 mg $0-$3.95 Generic QL (90 EA per 30 days) methylphenidate hcl er oral tablet extended release 24 hour 18 mg $0-$3.95 Generic QL (120 EA per 30 days) methylphenidate hcl er oral tablet extended release 24 hour 27 mg $0-$3.95 Generic QL (90 EA per 30 days) methylphenidate hcl er oral tablet extended release 24 hour 36 mg $0-$3.95 Generic QL (60 EA per 30 days) methylphenidate hcl er oral tablet extended release 24 hour 54 mg $0-$3.95 Generic QL (30 EA per 30 days) methylphenidate hcl er oral tablet extended release 36 mg $0-$3.95 Generic QL (60 EA per 30 days) methylphenidate hcl oral solution 10 mg/5ml $0-$3.95 Generic QL (900 ML per 30 days) methylphenidate hcl oral solution 5 mg/5ml $0-$3.95 Generic QL (1800 ML per 30 days) methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg $0-$3.95 Generic QL (90 EA per 30 days) methylphenidate hcl oral tablet chewable 10 mg $0-$3.95 Generic QL (180 EA per 30 days) methylphenidate hcl oral tablet chewable 2.5 mg, 5 mg $0-$3.95 Generic QL (90 EA per 30 days) Central Nervous System, Other AUSTEDO ORAL TABLET 12 MG, 6 MG, 9 MG $0-$9.85 Brand PA EVRYSDI ORAL SOLUTION RECONSTITUTED 0.75 MG/ML $0-$9.85 Brand PA FIRDAPSE ORAL TABLET 10 MG $0-$9.85 Brand PA INGREZZA ORAL CAPSULE 40 MG, 60 MG, 80 MG $0-$9.85 Brand PA INGREZZA ORAL CAPSULE THERAPY PACK 40 & 80 MG $0-$9.85 Brand PA NUEDEXTA ORAL CAPSULE 20-10 MG $0-$9.85 Brand PA riluzole oral tablet 50 mg $0-$3.95 Generic tetrabenazine oral tablet 12.5 mg, 25 mg $0-$3.95 Generic PA Fibromyalgia Agents duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg $0-$3.95 Generic

SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG $0-$9.85 Brand SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 MG $0-$9.85 Brand Multiple Sclerosis Agents AUBAGIO ORAL TABLET 14 MG, 7 MG $0-$9.85 Brand PA BAFIERTAM ORAL CAPSULE DELAYED RELEASE 95 MG $0-$9.85 Brand PA BETASERON SUBCUTANEOUS KIT 0.3 MG $0-$9.85 Brand PA dalfampridine er oral tablet extended release 12 hour 10 mg $0-$3.95 Generic PA dimethyl fumarate oral capsule delayed release 120 mg, 240 mg $0-$3.95 Generic PA dimethyl fumarate starter pack oral 120 & 240 mg $0-$3.95 Generic PA EXTAVIA SUBCUTANEOUS KIT 0.3 MG $0-$9.85 Brand PA GILENYA ORAL CAPSULE 0.5 MG $0-$9.85 Brand PA glatiramer acetate subcutaneous solution prefilled syringe 20 mg/ml, 40 mg/ml $0-$3.95 Generic PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 42

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

GLATOPA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML, 40 MG/ML $0-$3.95 Generic PA

KESIMPTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 20 MG/0.4ML $0-$9.85 Brand PA

MAYZENT ORAL TABLET 0.25 MG, 1 MG, 2 MG $0-$9.85 Brand PA MAYZENT STARTER PACK ORAL TABLET THERAPY PACK 0.25 MG, 12 X 0.25 MG $0-$9.85 Brand PA

PONVORY ORAL TABLET 20 MG $0-$9.85 Brand PA PONVORY STARTER PACK ORAL TABLET THERAPY PACK 2-3-4-5-6-7-8-9 & 10 MG $0-$9.85 Brand PA

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 22 MCG/0.5ML, 44 MCG/0.5ML $0-$9.85 Brand PA

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6X8.8 & 6X22 MCG $0-$9.85 Brand PA

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 22 MCG/0.5ML, 44 MCG/0.5ML $0-$9.85 Brand PA

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6X8.8 & 6X22 MCG $0-$9.85 Brand PA

ZEPOSIA 7-DAY STARTER PACK ORAL CAPSULE THERAPY PACK 4 X 0.23MG & 3 X 0.46MG $0-$9.85 Brand PA

ZEPOSIA ORAL CAPSULE 0.92 MG $0-$9.85 Brand PA ZEPOSIA STARTER KIT ORAL CAPSULE THERAPY PACK 0.23MG & 0.46MG & 0.92MG $0-$9.85 Brand PA

Dental And Oral Agents - Treatment Of Mouth And Gum Disorders

Dental And Oral Agents cevimeline hcl oral capsule 30 mg $0-$3.95 Generic chlorhexidine gluconate mouth/throat solution 0.12 % $0-$3.95 Generic PERIOGARD MOUTH/THROAT SOLUTION 0.12 % $0-$3.95 Generic pilocarpine hcl oral tablet 5 mg, 7.5 mg $0-$3.95 Generic triamcinolone acetonide mouth/throat paste 0.1 % $0-$3.95 Generic Dermatological Agents - Treatment Of Skin Conditions Acne And Rosacea Agents acitretin oral capsule 10 mg, 17.5 mg, 25 mg $0-$3.95 Generic PA adapalene external gel 0.1 % $0-$3.95 Generic adapalene-benzoyl peroxide external gel 0.1-2.5 % $0-$3.95 Generic AMNESTEEM ORAL CAPSULE 10 MG, 20 MG, 40 MG $0-$3.95 Generic benzoyl peroxide-erythromycin external gel 5-3 % $0-$3.95 Generic CLARAVIS ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG $0-$3.95 Generic clindamycin phos-benzoyl perox external gel 1-5 %, 1.2-2.5 %, 1.2-5 % $0-$3.95 Generic

isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg $0-$3.95 Generic MYORISAN ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG $0-$3.95 Generic tazarotene external cream 0.1 % $0-$3.95 Generic TAZORAC EXTERNAL CREAM 0.05 % $0-$9.85 Brand TAZORAC EXTERNAL GEL 0.05 %, 0.1 % $0-$9.85 Brand tretinoin (emollient) external cream 0.05 % $0-$3.95 Generic tretinoin external cream 0.025 %, 0.05 %, 0.1 % $0-$3.95 Generic tretinoin external gel 0.01 %, 0.025 % $0-$3.95 Generic ZENATANE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG $0-$3.95 Generic Dermatitis And Pruitus Agents

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 43

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

alclometasone dipropionate external cream 0.05 % $0-$3.95 Generic alclometasone dipropionate external ointment 0.05 % $0-$3.95 Generic ammonium lactate external cream 12 % $0-$3.95 Generic ammonium lactate external lotion 12 % $0-$3.95 Generic betamethasone dipropionate aug external gel 0.05 % $0-$3.95 Generic betamethasone dipropionate aug external lotion 0.05 % $0-$3.95 Generic betamethasone dipropionate aug external ointment 0.05 % $0-$3.95 Generic betamethasone dipropionate external cream 0.05 % $0-$3.95 Generic betamethasone dipropionate external lotion 0.05 % $0-$3.95 Generic betamethasone valerate external cream 0.1 % $0-$3.95 Generic betamethasone valerate external lotion 0.1 % $0-$3.95 Generic betamethasone valerate external ointment 0.1 % $0-$3.95 Generic clobetasol prop emollient base external cream 0.05 % $0-$3.95 Generic clobetasol propionate e external cream 0.05 % $0-$3.95 Generic clobetasol propionate external cream 0.05 % $0-$3.95 Generic clobetasol propionate external gel 0.05 % $0-$3.95 Generic clobetasol propionate external ointment 0.05 % $0-$3.95 Generic clobetasol propionate external solution 0.05 % $0-$3.95 Generic desonide external cream 0.05 % $0-$3.95 Generic desonide external lotion 0.05 % $0-$3.95 Generic desonide external ointment 0.05 % $0-$3.95 Generic desoximetasone external cream 0.05 %, 0.25 % $0-$3.95 Generic desoximetasone external gel 0.05 % $0-$3.95 Generic desoximetasone external ointment 0.05 %, 0.25 % $0-$3.95 Generic doxepin hcl external cream 5 % $0-$3.95 Generic PA; QL (45 GM per 30 days) DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 200 MG/1.14ML, 300 MG/2ML $0-$9.85 Brand PA

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML, 200 MG/1.14ML, 300 MG/2ML $0-$9.85 Brand PA

EUCRISA EXTERNAL OINTMENT 2 % $0-$9.85 Brand PA fluocinolone acetonide external cream 0.01 %, 0.025 % $0-$3.95 Generic fluocinolone acetonide external ointment 0.025 % $0-$3.95 Generic fluocinolone acetonide external solution 0.01 % $0-$3.95 Generic fluocinonide emulsified base external cream 0.05 % $0-$3.95 Generic fluocinonide external cream 0.05 % $0-$3.95 Generic fluocinonide external gel 0.05 % $0-$3.95 Generic fluocinonide external ointment 0.05 % $0-$3.95 Generic fluocinonide external solution 0.05 % $0-$3.95 Generic fluticasone propionate external cream 0.05 % $0-$3.95 Generic fluticasone propionate external lotion 0.05 % $0-$3.95 Generic fluticasone propionate external ointment 0.005 % $0-$3.95 Generic halobetasol propionate external cream 0.05 % $0-$3.95 Generic halobetasol propionate external ointment 0.05 % $0-$3.95 Generic hydrocortisone (perianal) external cream 1 %, 2.5 % $0-$3.95 Generic hydrocortisone butyr lipo base external cream 0.1 % $0-$3.95 Generic hydrocortisone butyrate external cream 0.1 % $0-$3.95 Generic hydrocortisone butyrate external ointment 0.1 % $0-$3.95 Generic hydrocortisone butyrate external solution 0.1 % $0-$3.95 Generic hydrocortisone external cream 1 %, 2.5 % $0-$3.95 Generic hydrocortisone external lotion 2.5 % $0-$3.95 Generic hydrocortisone external ointment 1 %, 2.5 % $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 44

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

hydrocortisone valerate external cream 0.2 % $0-$3.95 Generic hydrocortisone valerate external ointment 0.2 % $0-$3.95 Generic mometasone furoate external cream 0.1 % $0-$3.95 Generic mometasone furoate external ointment 0.1 % $0-$3.95 Generic mometasone furoate external solution 0.1 % $0-$3.95 Generic pimecrolimus external cream 1 % $0-$3.95 Generic ST prednicarbate external ointment 0.1 % $0-$3.95 Generic PROCTO-MED HC EXTERNAL CREAM 2.5 % $0-$3.95 Generic PROCTO-PAK EXTERNAL CREAM 1 % $0-$3.95 Generic PROCTOSOL HC EXTERNAL CREAM 2.5 % $0-$3.95 Generic PROCTOZONE-HC EXTERNAL CREAM 2.5 % $0-$3.95 Generic selenium sulfide external lotion 2.5 % $0-$3.95 Generic tacrolimus external ointment 0.03 %, 0.1 % $0-$3.95 Generic ST triamcinolone acetonide external cream 0.025 %, 0.1 %, 0.5 % $0-$3.95 Generic triamcinolone acetonide external lotion 0.025 %, 0.1 % $0-$3.95 Generic triamcinolone acetonide external ointment 0.025 %, 0.05 %, 0.1 %, 0.5 % $0-$3.95 Generic

triamcinolone in absorbase external ointment 0.05 % $0-$3.95 Generic Dermatological Agents, Other ALCOHOL PAD $0-$3.95 Generic alcohol pad 70 % $0-$3.95 Generic alcohol sheet , 70 % $0-$3.95 Generic calcipotriene external cream 0.005 % $0-$3.95 Generic calcipotriene external ointment 0.005 % $0-$3.95 Generic calcipotriene external solution 0.005 % $0-$3.95 Generic calcitriol external ointment 3 mcg/gm $0-$3.95 Generic clotrimazole-betamethasone external cream 1-0.05 % $0-$3.95 Generic clotrimazole-betamethasone external lotion 1-0.05 % $0-$3.95 Generic fluorouracil external cream 0.5 %, 5 % $0-$3.95 Generic fluorouracil external solution 2 %, 5 % $0-$3.95 Generic imiquimod external cream 5 % $0-$3.95 Generic methoxsalen rapid oral capsule 10 mg $0-$3.95 Generic PA nystatin-triamcinolone external cream 100000-0.1 unit/gm-% $0-$3.95 Generic nystatin-triamcinolone external ointment 100000-0.1 unit/gm-% $0-$3.95 Generic OTEZLA ORAL TABLET 30 MG $0-$9.85 Brand PA podofilox external solution 0.5 % $0-$3.95 Generic REGRANEX EXTERNAL GEL 0.01 % $0-$9.85 Brand PA; QL (15 GM per 30 days) SANTYL EXTERNAL OINTMENT 250 UNIT/GM $0-$9.85 Brand QL (90 GM per 30 days) silver sulfadiazine external cream 1 % $0-$3.95 Generic SSD EXTERNAL CREAM 1 % $0-$3.95 Generic Pediculicides/Scabicides lindane external shampoo 1 % $0-$3.95 Generic malathion external lotion 0.5 % $0-$3.95 Generic permethrin external cream 5 % $0-$3.95 Generic Topical Anti-Infectives acyclovir external cream 5 % $0-$3.95 Generic acyclovir external ointment 5 % $0-$3.95 Generic ciclopirox external solution 8 % $0-$3.95 Generic ciclopirox treatment external kit 8 % $0-$3.95 Generic clindamycin phosphate external gel 1 % $0-$3.95 Generic clindamycin phosphate external lotion 1 % $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 45

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

clindamycin phosphate external solution 1 % $0-$3.95 Generic DENAVIR EXTERNAL CREAM 1 % $0-$9.85 Brand ery external pad 2 % $0-$3.95 Generic erythromycin external gel 2 % $0-$3.95 Generic erythromycin external solution 2 % $0-$3.95 Generic mupirocin external ointment 2 % $0-$3.95 Generic QL (88 GM per 30 days) Electrolytes/Minerals/ Metals/ Vitamins - Products That Supplement Or Replace Electrolytes, Minerals, Metals Or Vitamins

Electrolyte/ Mineral Replacement carglumic acid oral tablet soluble 200 mg $0-$3.95 Generic PA ISOLYTE-S INTRAVENOUS SOLUTION $0-$9.85 Brand ISOLYTE-S PH 7.4 INTRAVENOUS SOLUTION $0-$9.85 Brand kcl in dextrose-nacl intravenous solution 20-5-0.45 meq/l-%-% $0-$3.95 Generic magnesium sulfate injection solution 50 %, 50 % (10ml syringe) $0-$3.95 Generic potassium chloride crys er oral tablet extended release 10 meq, 20 meq $0-$3.95 Generic

potassium chloride er oral capsule extended release 10 meq, 8 meq $0-$3.95 Generic potassium chloride er oral tablet extended release 10 meq, 20 meq, 8 meq $0-$3.95 Generic

potassium chloride intravenous solution 2 meq/ml, 2 meq/ml (20 ml), 40 meq/100ml $0-$3.95 Generic

potassium chloride oral solution 10 %, 20 meq/15ml (10%), 40 meq/15ml (20%) $0-$3.95 Generic

potassium citrate er oral tablet extended release 10 meq (1080 mg), 15 meq (1620 mg), 5 meq (540 mg) $0-$3.95 Generic

sodium chloride (pf) injection solution 0.9 % $0-$3.95 Generic sodium chloride injection solution 0.9 % $0-$3.95 Generic sodium chloride intravenous solution 0.45 %, 0.9 %, 3 % $0-$3.95 Generic sodium chloride irrigation solution 0.9 % $0-$3.95 Generic sodium fluoride oral tablet 2.2 (1 f) mg $0-$3.95 Generic Electrolyte/Mineral/Metal Modifiers deferasirox granules oral packet 180 mg, 360 mg, 90 mg $0-$3.95 Generic PA deferasirox oral packet 180 mg, 360 mg, 90 mg $0-$3.95 Generic PA deferasirox oral tablet 180 mg, 360 mg, 90 mg $0-$3.95 Generic PA deferasirox oral tablet soluble 125 mg, 250 mg, 500 mg $0-$3.95 Generic PA deferiprone oral tablet 1000 mg, 500 mg $0-$3.95 Generic PA FERRIPROX ORAL TABLET 1000 MG $0-$9.85 Brand PA FERRIPROX TWICE-A-DAY ORAL TABLET 1000 MG $0-$9.85 Brand PA JYNARQUE ORAL TABLET 15 MG, 30 MG $0-$9.85 Brand PA JYNARQUE ORAL TABLET THERAPY PACK 15 MG, 30 & 15 MG, 45 & 15 MG, 60 & 30 MG, 90 & 30 MG $0-$9.85 Brand PA

penicillamine oral tablet 250 mg $0-$3.95 Generic PA tolvaptan oral tablet 15 mg, 30 mg $0-$3.95 Generic PA trientine hcl oral capsule 250 mg $0-$3.95 Generic PA Electrolytes/Minerals/Metals/Vitamins AMINOSYN II INTRAVENOUS SOLUTION 15 % $0-$9.85 Brand B/D AMINOSYN-PF 7% INTRAVENOUS SOLUTION 7 % $0-$9.85 Brand B/D AMINOSYN-PF INTRAVENOUS SOLUTION 7 % $0-$9.85 Brand B/D CLINIMIX/DEXTROSE (4.25/10) INTRAVENOUS SOLUTION 4.25 % $0-$3.95 Generic B/D CLINISOL SF INTRAVENOUS SOLUTION 15 % $0-$3.95 Generic B/D

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 46

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

dextrose intravenous solution 10 %, 5 % $0-$3.95 Generic dextrose-nacl intravenous solution 10-0.2 %, 10-0.45 %, 2.5-0.45 %, 5-0.2 %, 5-0.225 %, 5-0.33 %, 5-0.45 %, 5-0.9 % $0-$3.95 Generic

dextrose-sodium chloride intravenous solution 2.5-0.45 %, 5-0.45 %, 5-0.9 % $0-$3.95 Generic

INTRALIPID INTRAVENOUS EMULSION 20 %, 30 % $0-$9.85 Brand B/D ISOLYTE-P IN D5W INTRAVENOUS SOLUTION $0-$9.85 Brand levocarnitine oral solution 1 gm/10ml $0-$3.95 Generic levocarnitine oral tablet 330 mg $0-$3.95 Generic levocarnitine sf oral solution 1 gm/10ml $0-$3.95 Generic NUTRILIPID INTRAVENOUS EMULSION 20 % $0-$3.95 Generic B/D Phosphate Binders calcium acetate (phos binder) oral capsule 667 mg $0-$3.95 Generic FOSRENOL ORAL PACKET 1000 MG, 750 MG $0-$9.85 Brand lanthanum carbonate oral tablet chewable 1000 mg, 500 mg, 750 mg $0-$3.95 Generic sevelamer carbonate oral packet 0.8 gm, 2.4 gm $0-$3.95 Generic sevelamer carbonate oral tablet 800 mg $0-$3.95 Generic Potassium Binders sodium polystyrene sulfonate oral powder $0-$3.95 Generic SPS ORAL SUSPENSION 15 GM/60ML $0-$3.95 Generic Vitamins KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ $0-$3.95 Generic KLOR-CON M10 ORAL TABLET EXTENDED RELEASE 10 MEQ $0-$3.95 Generic KLOR-CON M15 ORAL TABLET EXTENDED RELEASE 15 MEQ $0-$3.95 Generic KLOR-CON M20 ORAL TABLET EXTENDED RELEASE 20 MEQ $0-$3.95 Generic KLOR-CON ORAL TABLET EXTENDED RELEASE 8 MEQ $0-$3.95 Generic m-natal plus oral tablet 27-1 mg $0-$3.95 Generic pnv tabs 29-1 oral tablet 29-1 mg $0-$3.95 Generic potassium chloride crys er oral tablet extended release 15 meq $0-$3.95 Generic prenatal oral tablet 27-0.8 mg, 27-1 mg $0-$3.95 Generic prenatal plus iron oral tablet 29-1 mg $0-$3.95 Generic prenatal vitamin plus low iron oral tablet 27-1 mg $0-$3.95 Generic preplus oral tablet 27-1 mg $0-$3.95 Generic pretab oral tablet 29-1 mg $0-$3.95 Generic thrivite rx oral tablet 29-1 mg $0-$3.95 Generic trinatal rx 1 oral tablet 60-1 mg $0-$3.95 Generic Gastrointestinal Agents - Treatment Of Stomach And Intestinal Conditions

Anti-Constipation Agents constulose oral solution 10 gm/15ml $0-$3.95 Generic enulose oral solution 10 gm/15ml $0-$3.95 Generic GAVILYTE-C ORAL SOLUTION RECONSTITUTED 240 GM $0-$3.95 Generic GAVILYTE-G ORAL SOLUTION RECONSTITUTED 236 GM $0-$3.95 Generic GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED 420 GM $0-$3.95 Generic

generlac oral solution 10 gm/15ml $0-$3.95 Generic lactulose encephalopathy oral solution 10 gm/15ml $0-$3.95 Generic lactulose oral solution 10 gm/15ml, 20 gm/30ml $0-$3.95 Generic LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG $0-$9.85 Brand QL (30 EA per 30 days) lubiprostone oral capsule 24 mcg, 8 mcg $0-$3.95 Generic QL (60 EA per 30 days) peg 3350-kcl-na bicarb-nacl oral solution reconstituted 420 gm $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 47

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

peg-3350/electrolytes oral solution reconstituted 236 gm $0-$3.95 Generic polyethylene glycol 3350 oral packet 17 gm $0-$3.95 Generic polyethylene glycol 3350 oral powder 17 gm/scoop $0-$3.95 Generic polyethylene glycol 3350 powder $0-$3.95 Generic RELISTOR ORAL TABLET 150 MG $0-$9.85 Brand PA RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML, 12 MG/0.6ML (0.6ML SYRINGE), 8 MG/0.4ML $0-$9.85 Brand PA

Anti-Diarrheal Agents alosetron hcl oral tablet 0.5 mg, 1 mg $0-$3.95 Generic QL (60 EA per 30 days) diphenoxylate-atropine oral liquid 2.5-0.025 mg/5ml $0-$3.95 Generic diphenoxylate-atropine oral tablet 2.5-0.025 mg $0-$3.95 Generic loperamide hcl oral capsule 2 mg $0-$3.95 Generic XERMELO ORAL TABLET 250 MG $0-$9.85 Brand PA XIFAXAN ORAL TABLET 200 MG, 550 MG $0-$9.85 Brand PA Antispasmodics, Gastrointestinal dicyclomine hcl oral capsule 10 mg $0-$3.95 Generic dicyclomine hcl oral solution 10 mg/5ml $0-$3.95 Generic dicyclomine hcl oral tablet 20 mg $0-$3.95 Generic glycopyrrolate oral solution 1 mg/5ml $0-$3.95 Generic glycopyrrolate oral tablet 1 mg, 2 mg $0-$3.95 Generic Gastrointestinal Agents, Other GATTEX SUBCUTANEOUS KIT 5 MG $0-$9.85 Brand PA LIVMARLI ORAL SOLUTION 9.5 MG/ML $0-$9.85 Brand PA OCALIVA ORAL TABLET 10 MG, 5 MG $0-$9.85 Brand PA ursodiol oral capsule 300 mg $0-$3.95 Generic ursodiol oral tablet 250 mg, 500 mg $0-$3.95 Generic Histamine2 (H2) Receptor Antagonists cimetidine hcl oral solution 300 mg/5ml, 400 mg/6.67ml $0-$3.95 Generic cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg $0-$3.95 Generic famotidine oral tablet 20 mg, 40 mg $0-$3.95 Generic Protectants misoprostol oral tablet 100 mcg, 200 mcg $0-$3.95 Generic sucralfate oral tablet 1 gm $0-$3.95 Generic Proton Pump Inhibitors lansoprazole oral capsule delayed release 15 mg, 30 mg $0-$3.95 Generic omeprazole oral capsule delayed release 10 mg, 20 mg, 40 mg $0-$3.95 Generic pantoprazole sodium oral tablet delayed release 20 mg, 40 mg $0-$3.95 Generic Genetic Or Enzyme Or Protein Disorder: Replacement, Modifiers, Treatment - Products That Replace, Modify, Or Treat Genetic Or Enzyme Disorders

Genetic Or Enzyme Or Protein Disorder: Replacement, Modifiers, Treatment

ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG, 500 MG $0-$9.85 Brand PA

betaine oral powder $0-$3.95 Generic CERDELGA ORAL CAPSULE 84 MG $0-$9.85 Brand PA CHOLBAM ORAL CAPSULE 250 MG, 50 MG $0-$9.85 Brand PA CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000-114000 UNIT, 6000-19000 UNIT

$0-$9.85 Brand

CYSTAGON ORAL CAPSULE 150 MG, 50 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 48

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

ENDARI ORAL PACKET 5 GM $0-$9.85 Brand PA GALAFOLD ORAL CAPSULE 123 MG $0-$9.85 Brand PA GLASSIA INTRAVENOUS SOLUTION 1000 MG/50ML $0-$9.85 Brand PA KEVEYIS ORAL TABLET 50 MG $0-$9.85 Brand PA miglustat oral capsule 100 mg $0-$3.95 Generic PA nitisinone oral capsule 10 mg, 2 mg, 5 mg $0-$3.95 Generic PA NITYR ORAL TABLET 10 MG, 2 MG, 5 MG $0-$9.85 Brand PA ORFADIN ORAL CAPSULE 20 MG $0-$9.85 Brand PA ORFADIN ORAL SUSPENSION 4 MG/ML $0-$9.85 Brand PA PLENAMINE INTRAVENOUS SOLUTION 15 % $0-$3.95 Generic B/D PROLASTIN-C INTRAVENOUS SOLUTION 1000 MG/20ML $0-$9.85 Brand PA PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG $0-$9.85 Brand PA

RAVICTI ORAL LIQUID 1.1 GM/ML $0-$9.85 Brand PA sapropterin dihydrochloride oral packet 100 mg, 500 mg $0-$3.95 Generic PA sapropterin dihydrochloride oral tablet 100 mg $0-$3.95 Generic PA sodium phenylbutyrate oral powder 3 gm/tsp $0-$3.95 Generic PA sodium phenylbutyrate oral tablet 500 mg $0-$3.95 Generic PA SUCRAID ORAL SOLUTION 8500 UNIT/ML $0-$9.85 Brand PA XURIDEN ORAL PACKET 2 GM $0-$9.85 Brand PA ZEMAIRA INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG $0-$9.85 Brand PA ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-10000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT

$0-$9.85 Brand

Genitourinary Agents - Treatment Of Urinary Tract And Prostate Conditions

Antispasmodics, Urinary darifenacin hydrobromide er oral tablet extended release 24 hour 15 mg, 7.5 mg $0-$3.95 Generic ST

flavoxate hcl oral tablet 100 mg $0-$3.95 Generic MYRBETRIQ ORAL SUSPENSION RECONSTITUTED ER 8 MG/ML $0-$9.85 Brand QL (300 ML per 30 days) MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG, 50 MG $0-$9.85 Brand QL (30 EA per 30 days)

oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 15 mg, 5 mg $0-$3.95 Generic

oxybutynin chloride oral syrup 5 mg/5ml $0-$3.95 Generic oxybutynin chloride oral tablet 5 mg $0-$3.95 Generic solifenacin succinate oral tablet 10 mg, 5 mg $0-$3.95 Generic tolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mg $0-$3.95 Generic ST

tolterodine tartrate oral tablet 1 mg, 2 mg $0-$3.95 Generic trospium chloride er oral capsule extended release 24 hour 60 mg $0-$3.95 Generic ST trospium chloride oral tablet 20 mg $0-$3.95 Generic Benign Prostatic Hypertrophy Agents alfuzosin hcl er oral tablet extended release 24 hour 10 mg $0-$3.95 Generic dutasteride oral capsule 0.5 mg $0-$3.95 Generic finasteride oral tablet 5 mg $0-$3.95 Generic tamsulosin hcl oral capsule 0.4 mg $0-$3.95 Generic Genitourinary Agents, Other bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg $0-$3.95 Generic ELMIRON ORAL CAPSULE 100 MG $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 49

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

THIOLA EC ORAL TABLET DELAYED RELEASE 100 MG, 300 MG $0-$9.85 Brand PA tiopronin oral tablet 100 mg $0-$3.95 Generic PA Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) - Treatment Of Conditions Requiring Steroids

Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) ACTHAR INJECTION GEL 80 UNIT/ML $0-$9.85 Brand PA betamethasone dipropionate aug external cream 0.05 % $0-$3.95 Generic betamethasone dipropionate external ointment 0.05 % $0-$3.95 Generic cortisone acetate oral tablet 25 mg $0-$3.95 Generic fludrocortisone acetate oral tablet 0.1 mg $0-$3.95 Generic hydrocortisone oral tablet 10 mg, 20 mg, 5 mg $0-$3.95 Generic PREDNISONE INTENSOL ORAL CONCENTRATE 5 MG/ML $0-$3.95 Generic Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) - Treatment Of Pituitary Gland Conditions

Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) desmopressin ace spray refrig nasal solution 0.01 % $0-$3.95 Generic desmopressin acetate oral tablet 0.1 mg, 0.2 mg $0-$3.95 Generic desmopressin acetate spray nasal solution 0.01 % $0-$3.95 Generic EGRIFTA SV SUBCUTANEOUS SOLUTION RECONSTITUTED 2 MG $0-$9.85 Brand PA

GENOTROPIN MINIQUICK SUBCUTANEOUS PREFILLED SYRINGE 0.2 MG, 0.4 MG, 0.6 MG, 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG

$0-$9.85 Brand PA

GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MG, 5 MG $0-$9.85 Brand PA HUMATROPE INJECTION CARTRIDGE 12 MG, 24 MG, 6 MG $0-$9.85 Brand PA INCRELEX SUBCUTANEOUS SOLUTION 40 MG/4ML $0-$9.85 Brand PA NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5 MG/1.5ML $0-$9.85 Brand PA

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MG/2ML $0-$9.85 Brand PA

NUTROPIN AQ NUSPIN 20 SUBCUTANEOUS SOLUTION PEN-INJECTOR 20 MG/2ML $0-$9.85 Brand PA

NUTROPIN AQ NUSPIN 5 SUBCUTANEOUS SOLUTION PEN-INJECTOR 5 MG/2ML $0-$9.85 Brand PA

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE 10 MG/1.5ML, 5 MG/1.5ML $0-$9.85 Brand PA

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED 5.8 MG $0-$9.85 Brand PA

ORILISSA ORAL TABLET 150 MG, 200 MG $0-$9.85 Brand PA SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG, 5 MG, 6 MG $0-$9.85 Brand PA

SKYTROFA SUBCUTANEOUS CARTRIDGE 11 MG, 13.3 MG, 3 MG, 3.6 MG, 4.3 MG, 5.2 MG, 6.3 MG, 7.6 MG, 9.1 MG $0-$9.85 Brand PA

Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers) - For The Replacement Or Modification Of Sex Hormones

Anabolic Steroids oxandrolone oral tablet 10 mg, 2.5 mg $0-$3.95 Generic Androgens danazol oral capsule 100 mg, 200 mg, 50 mg $0-$3.95 Generic methyltestosterone oral capsule 10 mg $0-$3.95 Generic PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 50

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

testosterone cypionate injection solution 200 mg/ml $0-$3.95 Generic testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml, 200 mg/ml (1 ml) $0-$3.95 Generic

testosterone enanthate intramuscular solution 200 mg/ml $0-$3.95 Generic testosterone transdermal gel 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)

$0-$3.95 Generic PA

testosterone transdermal solution 30 mg/act $0-$3.95 Generic PA Estrogens estradiol oral tablet 0.5 mg, 1 mg, 2 mg $0-$3.95 Generic estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr $0-$3.95 Generic

estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr $0-$3.95 Generic

estradiol vaginal cream 0.1 mg/gm $0-$3.95 Generic estradiol vaginal tablet 10 mcg $0-$3.95 Generic estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml $0-$3.95 Generic LYLLANA TRANSDERMAL PATCH TWICE WEEKLY 0.025 MG/24HR, 0.0375 MG/24HR, 0.05 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR

$0-$3.95 Generic

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG $0-$9.85 Brand PA MYFEMBREE ORAL TABLET 40-1-0.5 MG $0-$9.85 Brand PA PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG $0-$9.85 Brand

PREMARIN VAGINAL CREAM 0.625 MG/GM $0-$9.85 Brand YUVAFEM VAGINAL TABLET 10 MCG $0-$3.95 Generic Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)

AFIRMELLE ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic ALTAVERA ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic alyacen 1/35 oral tablet 1-35 mg-mcg $0-$3.95 Generic alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg $0-$3.95 Generic AMABELZ ORAL TABLET 0.5-0.1 MG, 1-0.5 MG $0-$3.95 Generic APRI ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG $0-$3.95 Generic AUBRA EQ ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic AUBRA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic AUROVELA 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic AUROVELA FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic AUROVELA FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic AVIANE ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic AYUNA ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic BALZIVA ORAL TABLET 0.4-35 MG-MCG $0-$3.95 Generic BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic briellyn oral tablet 0.4-35 mg-mcg $0-$3.95 Generic CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG $0-$3.95 Generic CHATEAL EQ ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic CHATEAL ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic COMBIPATCH TRANSDERMAL PATCH TWICE WEEKLY 0.05-0.14 MG/DAY, 0.05-0.25 MG/DAY $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 51

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG $0-$3.95 Generic CYCLAFEM 1/35 ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic CYCLAFEM 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG $0-$3.95 Generic CYRED EQ ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic CYRED ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic DELYLA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5), 0.15-30 mg-mcg $0-$3.95 Generic

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg $0-$3.95 Generic ELURYNG VAGINAL RING 0.12-0.015 MG/24HR $0-$3.95 Generic EMOQUETTE ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic ENPRESSE-28 ORAL TABLET 50-30/75-40/ 125-30 MCG $0-$3.95 Generic ENSKYCE ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic ESTARYLLA ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg $0-$3.95 Generic ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg, 1-50 mg-mcg $0-$3.95 Generic etonogestrel-ethinyl estradiol vaginal ring 0.12-0.015 mg/24hr $0-$3.95 Generic FALMINA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic FEMYNOR ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic FYAVOLV ORAL TABLET 0.5-2.5 MG-MCG, 1-5 MG-MCG $0-$3.95 Generic HAILEY 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic HAILEY 24 FE ORAL TABLET 1-20 MG-MCG(24) $0-$3.95 Generic HAILEY FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic HAILEY FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic INCASSIA ORAL TABLET 0.35 MG $0-$3.95 Generic INTROVALE ORAL TABLET 0.15-0.03 MG $0-$3.95 Generic ISIBLOOM ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic JINTELI ORAL TABLET 1-5 MG-MCG $0-$3.95 Generic JULEBER ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic JUNEL 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic JUNEL 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic JUNEL FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic JUNEL FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic KALLIGA ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic KARIVA ORAL TABLET 0.15-0.02/0.01 MG (21/5) $0-$3.95 Generic KELNOR 1/35 ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic KELNOR 1/50 ORAL TABLET 1-50 MG-MCG $0-$3.95 Generic KURVELO ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic LARIN 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic LARIN 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic LARIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic LARIN FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic LARISSIA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic LEENA ORAL TABLET 0.5/1/0.5-35 MG-MCG $0-$3.95 Generic LESSINA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic LEVONEST ORAL TABLET 50-30/75-40/ 125-30 MCG $0-$3.95 Generic levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg, 0.15-0.03 mg $0-$3.95 Generic

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg $0-$3.95 Generic

levonorg-eth estrad triphasic oral tablet 50-30/75-40/ 125-30 mcg $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 52

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

LEVORA 0.15/30 (28) ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic LILLOW ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic LOESTRIN 1.5/30 (21) ORAL TABLET 1.5-30 MG-MCG $0-$9.85 Brand lopreeza oral tablet 1-0.5 mg $0-$3.95 Generic LOW-OGESTREL ORAL TABLET 0.3-30 MG-MCG $0-$3.95 Generic LUTERA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic marlissa oral tablet 0.15-30 mg-mcg $0-$3.95 Generic MICROGESTIN 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic microgestin 24 fe oral tablet 1-20 mg-mcg $0-$3.95 Generic MICROGESTIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG $0-$3.95 Generic MICROGESTIN FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic MILI ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic MIMVEY ORAL TABLET 1-0.5 MG $0-$3.95 Generic NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG $0-$3.95 Generic norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg $0-$3.95 Generic norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg $0-$3.95 Generic

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg $0-$3.95 Generic norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg $0-$3.95 Generic norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg $0-$3.95 Generic NORTREL 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG $0-$3.95 Generic NORTREL 1/35 (21) ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic NORTREL 1/35 (28) ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic NORTREL 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG $0-$3.95 Generic nylia 1/35 oral tablet 1-35 mg-mcg $0-$3.95 Generic NYLIA 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG $0-$3.95 Generic OCELLA ORAL TABLET 3-0.03 MG $0-$3.95 Generic ORSYTHIA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic PIMTREA ORAL TABLET 0.15-0.02/0.01 MG (21/5) $0-$3.95 Generic PIRMELLA 1/35 ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic PORTIA-28 ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic PREMPHASE ORAL TABLET 0.625-5 MG $0-$9.85 Brand PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG $0-$9.85 Brand

PREVIFEM ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic RECLIPSEN ORAL TABLET 0.15-30 MG-MCG $0-$3.95 Generic SETLAKIN ORAL TABLET 0.15-0.03 MG $0-$3.95 Generic SHAROBEL ORAL TABLET 0.35 MG $0-$3.95 Generic SIMLIYA ORAL TABLET 0.15-0.02/0.01 MG (21/5) $0-$3.95 Generic SPRINTEC 28 ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic SRONYX ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic TARINA FE 1/20 EQ ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic TARINA FE 1/20 ORAL TABLET 1-20 MG-MCG $0-$3.95 Generic TRI FEMYNOR ORAL TABLET 0.18/0.215/0.25 MG-35 MCG $0-$3.95 Generic TRI-ESTARYLLA ORAL TABLET 0.18/0.215/0.25 MG-35 MCG $0-$3.95 Generic TRI-LEGEST FE ORAL TABLET 1-20/1-30/1-35 MG-MCG $0-$3.95 Generic TRI-MILI ORAL TABLET 0.18/0.215/0.25 MG-35 MCG $0-$3.95 Generic TRI-SPRINTEC ORAL TABLET 0.18/0.215/0.25 MG-35 MCG $0-$3.95 Generic TRIVORA (28) ORAL TABLET 50-30/75-40/ 125-30 MCG $0-$3.95 Generic TRI-VYLIBRA ORAL TABLET 0.18/0.215/0.25 MG-35 MCG $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 53

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

VELIVET ORAL TABLET 0.1/0.125/0.15 -0.025 MG $0-$3.95 Generic VIENVA ORAL TABLET 0.1-20 MG-MCG $0-$3.95 Generic VOLNEA ORAL TABLET 0.15-0.02/0.01 MG (21/5) $0-$3.95 Generic VYFEMLA ORAL TABLET 0.4-35 MG-MCG $0-$3.95 Generic VYLIBRA ORAL TABLET 0.25-35 MG-MCG $0-$3.95 Generic XULANE TRANSDERMAL PATCH WEEKLY 150-35 MCG/24HR $0-$3.95 Generic ZAFEMY TRANSDERMAL PATCH WEEKLY 150-35 MCG/24HR $0-$3.95 Generic ZOVIA 1/35 (28) ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic ZOVIA 1/35E (28) ORAL TABLET 1-35 MG-MCG $0-$3.95 Generic Progestins CAMILA ORAL TABLET 0.35 MG $0-$3.95 Generic DEBLITANE ORAL TABLET 0.35 MG $0-$3.95 Generic DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE 104 MG/0.65ML $0-$9.85 Brand

ERRIN ORAL TABLET 0.35 MG $0-$3.95 Generic LYZA ORAL TABLET 0.35 MG $0-$3.95 Generic medroxyprogesterone acetate intramuscular suspension 150 mg/ml $0-$3.95 Generic medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mg/ml $0-$3.95 Generic

medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg $0-$3.95 Generic megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml, 625 mg/5ml $0-$3.95 Generic PA

megestrol acetate oral tablet 20 mg, 40 mg $0-$3.95 Generic PA NORA-BE ORAL TABLET 0.35 MG $0-$3.95 Generic norethindrone acetate oral tablet 5 mg $0-$3.95 Generic norethindrone oral tablet 0.35 mg $0-$3.95 Generic NORLYDA ORAL TABLET 0.35 MG $0-$3.95 Generic NORLYROC ORAL TABLET 0.35 MG $0-$3.95 Generic progesterone oral capsule 100 mg, 200 mg $0-$3.95 Generic TULANA ORAL TABLET 0.35 MG $0-$3.95 Generic Selective Estrogen Receptor Modifying Agents DUAVEE ORAL TABLET 0.45-20 MG $0-$9.85 Brand raloxifene hcl oral tablet 60 mg $0-$3.95 Generic Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) - Treatment Of Thyroid Conditions

Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

$0-$9.85 Brand

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

$0-$3.95 Generic

LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG $0-$9.85 Brand

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg $0-$3.95 Generic SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

$0-$9.85 Brand

UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

$0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 54

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

Hormonal Agents, Suppressant (Pituitary) - Treatment Of Or Modification Of Pituitary Hormone Secretion

Hormonal Agents, Suppressant (Pituitary) cabergoline oral tablet 0.5 mg $0-$3.95 Generic ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 MG, 7.5 MG $0-$9.85 Brand PA FIRMAGON (240 MG DOSE) SUBCUTANEOUS SOLUTION RECONSTITUTED 120 MG/VIAL $0-$9.85 Brand PA

FIRMAGON SUBCUTANEOUS SOLUTION RECONSTITUTED 80 MG $0-$9.85 Brand PA

leuprolide acetate injection kit 1 mg/0.2ml $0-$3.95 Generic LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG, 7.5 MG $0-$9.85 Brand PA

LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG $0-$9.85 Brand PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30 MG $0-$9.85 Brand PA LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45 MG $0-$9.85 Brand PA LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 7.5 MG $0-$9.85 Brand PA LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 11.25 MG (PED) $0-$9.85 Brand PA

octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml $0-$3.95 Generic

octreotide acetate subcutaneous solution prefilled syringe 100 mcg/ml, 50 mcg/ml, 500 mcg/ml $0-$3.95 Generic

SIGNIFOR SUBCUTANEOUS SOLUTION 0.3 MG/ML, 0.6 MG/ML, 0.9 MG/ML $0-$9.85 Brand PA

SOMATULINE DEPOT SUBCUTANEOUS SOLUTION 120 MG/0.5ML, 60 MG/0.2ML, 90 MG/0.3ML $0-$9.85 Brand

SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG, 15 MG, 20 MG, 25 MG, 30 MG $0-$9.85 Brand PA

SYNAREL NASAL SOLUTION 2 MG/ML $0-$9.85 Brand PA TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, 3.75 MG $0-$9.85 Brand PA

Hormonal Agents, Suppressant (Thyroid) - Treatment For Overactive Thyroid

Antithyroid Agents methimazole oral tablet 10 mg, 5 mg $0-$3.95 Generic propylthiouracil oral tablet 50 mg $0-$3.95 Generic Immunological Agents - Medications That Alter The Immune System Including Vaccinations

Angioedema Agents CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT $0-$9.85 Brand PA HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED 2000 UNIT, 3000 UNIT $0-$9.85 Brand PA

icatibant acetate subcutaneous solution 30 mg/3ml $0-$3.95 Generic PA Immunoglobulins FLEBOGAMMA DIF INTRAVENOUS SOLUTION 5 GM/50ML $0-$9.85 Brand B/D GAMMAGARD INJECTION SOLUTION 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 30 GM/300ML, 5 GM/50ML $0-$9.85 Brand B/D

GAMMAGARD S/D LESS IGA INTRAVENOUS SOLUTION RECONSTITUTED 10 GM, 5 GM $0-$9.85 Brand B/D

GAMMAKED INJECTION SOLUTION 1 GM/10ML $0-$9.85 Brand B/D

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 55

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

GAMMAPLEX INTRAVENOUS SOLUTION 10 GM/100ML, 10 GM/200ML, 20 GM/200ML, 5 GM/50ML $0-$9.85 Brand B/D

GAMUNEX-C INJECTION SOLUTION 1 GM/10ML $0-$9.85 Brand B/D PRIVIGEN INTRAVENOUS SOLUTION 10 GM/100ML, 20 GM/200ML, 40 GM/400ML, 5 GM/50ML $0-$9.85 Brand B/D

Immunological Agents, Other ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG $0-$9.85 Brand PA

COSENTYX (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML $0-$9.85 Brand PA

COSENTYX SENSOREADY (300 MG) SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML $0-$9.85 Brand PA

COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML $0-$9.85 Brand PA

COSENTYX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML, 75 MG/0.5ML $0-$9.85 Brand PA

ILARIS SUBCUTANEOUS SOLUTION 150 MG/ML $0-$9.85 Brand PA ILUMYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML $0-$9.85 Brand PA

leflunomide oral tablet 10 mg, 20 mg $0-$3.95 Generic OLUMIANT ORAL TABLET 1 MG, 2 MG $0-$9.85 Brand PA ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION AUTO-INJECTOR 125 MG/ML $0-$9.85 Brand PA

ORENCIA INTRAVENOUS SOLUTION RECONSTITUTED 250 MG $0-$9.85 Brand PA ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 125 MG/ML, 50 MG/0.4ML, 87.5 MG/0.7ML $0-$9.85 Brand PA

RINVOQ ORAL TABLET EXTENDED RELEASE 24 HOUR 15 MG, 30 MG, 45 MG $0-$9.85 Brand PA

SILIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 210 MG/1.5ML $0-$9.85 Brand PA

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML $0-$9.85 Brand PA

SKYRIZI (150 MG DOSE) SUBCUTANEOUS PREFILLED SYRINGE KIT 75 MG/0.83ML $0-$9.85 Brand PA

SKYRIZI PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML $0-$9.85 Brand PA

SKYRIZI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML $0-$9.85 Brand PA

STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5ML $0-$9.85 Brand PA STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 45 MG/0.5ML, 90 MG/ML $0-$9.85 Brand PA

TALTZ SUBCUTANEOUS SOLUTION AUTO-INJECTOR 80 MG/ML $0-$9.85 Brand PA TALTZ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 80 MG/ML $0-$9.85 Brand PA

TREMFYA SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 MG/ML $0-$9.85 Brand PA

TREMFYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML $0-$9.85 Brand PA

XELJANZ ORAL SOLUTION 1 MG/ML $0-$9.85 Brand PA XELJANZ ORAL TABLET 10 MG, 5 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 56

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG $0-$9.85 Brand PA

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML, 75 MG/0.5ML $0-$9.85 Brand PA

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG $0-$9.85 Brand PA Immunostimulants ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 UNIT/0.5ML $0-$9.85 Brand PA INTRON A INJECTION SOLUTION 10000000 UNIT/ML, 6000000 UNIT/ML $0-$9.85 Brand PA

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, 18000000 UNIT, 50000000 UNIT $0-$9.85 Brand PA

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML $0-$9.85 Brand PA PEGASYS SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 180 MCG/0.5ML $0-$9.85 Brand PA

Immunosuppressants ACTEMRA ACTPEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 162 MG/0.9ML $0-$9.85 Brand PA

ACTEMRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 162 MG/0.9ML $0-$9.85 Brand PA

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG, 5 MG $0-$9.85 Brand B/D

azathioprine oral tablet 50 mg $0-$3.95 Generic B/D BENLYSTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 200 MG/ML $0-$9.85 Brand PA

BENLYSTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/ML $0-$9.85 Brand PA

CIMZIA PREFILLED SUBCUTANEOUS PREFILLED SYRINGE KIT 2 X 200 MG/ML $0-$9.85 Brand PA

CIMZIA STARTER KIT SUBCUTANEOUS PREFILLED SYRINGE KIT 6 X 200 MG/ML $0-$9.85 Brand PA

CIMZIA SUBCUTANEOUS KIT 2 X 200 MG $0-$9.85 Brand PA cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg $0-$3.95 Generic B/D cyclosporine modified oral solution 100 mg/ml $0-$3.95 Generic B/D cyclosporine oral capsule 100 mg, 25 mg $0-$3.95 Generic B/D ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE 50 MG/ML $0-$9.85 Brand PA

ENBREL SUBCUTANEOUS SOLUTION 25 MG/0.5ML $0-$9.85 Brand PA ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML $0-$9.85 Brand PA

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG $0-$9.85 Brand PA ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML $0-$9.85 Brand PA

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 0.75 MG, 1 MG, 4 MG $0-$9.85 Brand B/D

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg, 1 mg $0-$3.95 Generic B/D everolimus oral tablet soluble 2 mg $0-$3.95 Generic PA GENGRAF ORAL CAPSULE 100 MG, 25 MG $0-$3.95 Generic B/D GENGRAF ORAL SOLUTION 100 MG/ML $0-$3.95 Generic B/D HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

$0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 57

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, 40 MG/0.8ML, 80 MG/0.8ML $0-$9.85 Brand PA

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML $0-$9.85 Brand PA

HUMIRA PEN-PEDIATRIC UC START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML $0-$9.85 Brand PA

HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML $0-$9.85 Brand PA

HUMIRA PEN-PSOR/UVEIT STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML & 40MG/0.4ML $0-$9.85 Brand PA

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML, 40 MG/0.8ML $0-$9.85 Brand PA

KEVZARA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/1.14ML, 200 MG/1.14ML $0-$9.85 Brand PA

KEVZARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/1.14ML, 200 MG/1.14ML $0-$9.85 Brand PA

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.67ML $0-$9.85 Brand PA

LUPKYNIS ORAL CAPSULE 7.9 MG $0-$9.85 Brand PA mercaptopurine oral tablet 50 mg $0-$3.95 Generic methotrexate (anti-rheumatic) oral tablet 2.5 mg $0-$3.95 Generic methotrexate oral tablet 2.5 mg $0-$3.95 Generic methotrexate sodium (pf) injection solution 50 mg/2ml $0-$3.95 Generic methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml $0-$3.95 Generic methotrexate sodium oral tablet 2.5 mg $0-$3.95 Generic mycophenolate mofetil oral capsule 250 mg $0-$3.95 Generic B/D mycophenolate mofetil oral suspension reconstituted 200 mg/ml $0-$3.95 Generic B/D mycophenolate mofetil oral tablet 500 mg $0-$3.95 Generic B/D mycophenolate sodium oral tablet delayed release 180 mg, 360 mg $0-$3.95 Generic B/D NULOJIX INTRAVENOUS SOLUTION RECONSTITUTED 250 MG $0-$9.85 Brand B/D OTEZLA ORAL TABLET THERAPY PACK 10 & 20 & 30 MG $0-$9.85 Brand PA PROGRAF INTRAVENOUS SOLUTION 5 MG/ML $0-$9.85 Brand B/D PROGRAF ORAL PACKET 0.2 MG, 1 MG $0-$9.85 Brand B/D REZUROCK ORAL TABLET 200 MG $0-$9.85 Brand PA SANDIMMUNE ORAL SOLUTION 100 MG/ML $0-$9.85 Brand B/D SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MG/ML, 50 MG/0.5ML $0-$9.85 Brand PA

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MG/0.5ML $0-$9.85 Brand PA

sirolimus oral solution 1 mg/ml $0-$3.95 Generic B/D sirolimus oral tablet 0.5 mg, 1 mg, 2 mg $0-$3.95 Generic B/D tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg $0-$3.95 Generic B/D XATMEP ORAL SOLUTION 2.5 MG/ML $0-$9.85 Brand PA XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 22 MG $0-$9.85 Brand PA

Vaccines ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED $0-$9.85 Brand ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 (PREFILLED SYRINGE), 5-2-15.5 LF-MCG/0.5 $0-$9.85 Brand

BCG VACCINE INJECTION SOLUTION RECONSTITUTED 50 MG $0-$9.85 Brand BEXSERO INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 58

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5 LF-MCG/0.5 $0-$9.85 Brand

BOOSTRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 5-2.5-18.5 LF-MCG/0.5 $0-$9.85 Brand

DAPTACEL INTRAMUSCULAR SUSPENSION 23-15-5 $0-$9.85 Brand DIPHTHERIA-TETANUS TOXOIDS DT INTRAMUSCULAR SUSPENSION 25-5 LFU/0.5ML $0-$9.85 Brand B/D

ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, 20 MCG/ML $0-$9.85 Brand B/D GARDASIL 9 INTRAMUSCULAR SUSPENSION $0-$9.85 Brand GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE $0-$9.85 Brand

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL U/ML, 720 EL U/0.5ML $0-$9.85 Brand

HEPLISAV-B INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 20 MCG/0.5ML $0-$9.85 Brand B/D

HIBERIX INJECTION SOLUTION RECONSTITUTED 10 MCG $0-$9.85 Brand IMOVAX RABIES INTRAMUSCULAR INJECTABLE 2.5 UNIT/ML $0-$9.85 Brand B/D INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10 $0-$9.85 Brand IPOL INJECTION INJECTABLE $0-$9.85 Brand IXIARO INTRAMUSCULAR SUSPENSION $0-$9.85 Brand KINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML $0-$9.85 Brand

MENACTRA INTRAMUSCULAR SOLUTION $0-$9.85 Brand MENQUADFI INTRAMUSCULAR SOLUTION $0-$9.85 Brand MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED $0-$9.85 Brand M-M-R II INJECTION SOLUTION RECONSTITUTED $0-$9.85 Brand PEDIARIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE $0-$9.85 Brand PEDVAX HIB INTRAMUSCULAR SUSPENSION 7.5 MCG/0.5ML $0-$9.85 Brand PENTACEL INTRAMUSCULAR SUSPENSION RECONSTITUTED $0-$9.85 Brand PROQUAD SUBCUTANEOUS SUSPENSION RECONSTITUTED $0-$9.85 Brand QUADRACEL INTRAMUSCULAR SUSPENSION $0-$9.85 Brand RABAVERT INTRAMUSCULAR SUSPENSION RECONSTITUTED $0-$9.85 Brand B/D RECOMBIVAX HB INJECTION SUSPENSION 10 MCG/ML, 10 MCG/ML (1ML SYRINGE), 40 MCG/ML, 5 MCG/0.5ML $0-$9.85 Brand B/D

ROTARIX ORAL SUSPENSION RECONSTITUTED $0-$9.85 Brand ROTATEQ ORAL SOLUTION $0-$9.85 Brand SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG/0.5ML $0-$9.85 Brand QL (2 EA per 999 days)

TDVAX INTRAMUSCULAR SUSPENSION 2-2 LF/0.5ML $0-$9.85 Brand B/D TENIVAC INTRAMUSCULAR INJECTABLE 5-2 LFU $0-$9.85 Brand TETANUS-DIPHTHERIA TOXOIDS TD INTRAMUSCULAR SUSPENSION 2-2 LF/0.5ML $0-$9.85 Brand B/D

TRUMENBA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE $0-$9.85 Brand

TWINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 720-20 ELU-MCG/ML $0-$9.85 Brand

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5ML $0-$9.85 Brand TYPHIM VI INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 25 MCG/0.5ML $0-$9.85 Brand

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT/0.5ML, 25 UNIT/0.5ML 0.5 ML, 50 UNIT/ML, 50 UNIT/ML 1 ML $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 59

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

VARIVAX SUBCUTANEOUS INJECTABLE 1350 PFU/0.5ML $0-$9.85 Brand VARIZIG INTRAMUSCULAR SOLUTION 125 UNIT/1.2ML $0-$9.85 Brand VAXCHORA ORAL SUSPENSION RECONSTITUTED $0-$9.85 Brand VAXELIS INTRAMUSCULAR SUSPENSION $0-$9.85 Brand VAXELIS INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE $0-$9.85 Brand YF-VAX SUBCUTANEOUS INJECTABLE $0-$9.85 Brand ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED 19400 UNT/0.65ML $0-$9.85 Brand QL (1 EA per 999 days)

Inflammatory Bowel Disease Agents - Treatment Of Ulcerative Colitis Or Crohn's Disease

Aminosalicylates balsalazide disodium oral capsule 750 mg $0-$3.95 Generic DIPENTUM ORAL CAPSULE 250 MG $0-$9.85 Brand mesalamine oral capsule delayed release 400 mg $0-$3.95 Generic mesalamine oral tablet delayed release 1.2 gm $0-$3.95 Generic mesalamine rectal enema 4 gm $0-$3.95 Generic mesalamine rectal suppository 1000 mg $0-$3.95 Generic mesalamine-cleanser rectal kit 4 gm $0-$3.95 Generic sulfasalazine oral tablet 500 mg $0-$3.95 Generic sulfasalazine oral tablet delayed release 500 mg $0-$3.95 Generic Glucocorticoids budesonide er oral tablet extended release 24 hour 9 mg $0-$3.95 Generic PA budesonide oral capsule delayed release particles 3 mg $0-$3.95 Generic DEXAMETHASONE INTENSOL ORAL CONCENTRATE 1 MG/ML $0-$3.95 Generic dexamethasone oral elixir 0.5 mg/5ml $0-$3.95 Generic dexamethasone oral solution 0.5 mg/5ml $0-$3.95 Generic dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg $0-$3.95 Generic

dexamethasone sodium phosphate injection solution 120 mg/30ml, 20 mg/5ml, 4 mg/ml $0-$3.95 Generic B/D

hydrocortisone rectal enema 100 mg/60ml $0-$3.95 Generic methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml $0-$3.95 Generic methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg $0-$3.95 Generic methylprednisolone oral tablet therapy pack 4 mg $0-$3.95 Generic prednisolone oral solution 15 mg/5ml $0-$3.95 Generic prednisolone oral syrup 15 mg/5ml $0-$3.95 Generic prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml $0-$3.95 Generic

prednisone oral solution 5 mg/5ml $0-$3.95 Generic prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg $0-$3.95 Generic prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48) $0-$3.95 Generic

Metabolic Bone Disease Agents - Treatment Of Bone Diseases Including Osteoporosis

Metabolic Bone Disease Agents alendronate sodium oral tablet 10 mg, 35 mg, 5 mg, 70 mg $0-$3.95 Generic calcitonin (salmon) nasal solution 200 unit/act $0-$3.95 Generic calcitriol oral capsule 0.25 mcg, 0.5 mcg $0-$3.95 Generic calcitriol oral solution 1 mcg/ml $0-$3.95 Generic cinacalcet hcl oral tablet 30 mg, 60 mg $0-$3.95 Generic QL (60 EA per 30 days) cinacalcet hcl oral tablet 90 mg $0-$3.95 Generic QL (120 EA per 30 days)

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 60

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg $0-$3.95 Generic ibandronate sodium oral tablet 150 mg $0-$3.95 Generic NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG, 25 MCG, 50 MCG, 75 MCG $0-$9.85 Brand PA

paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg $0-$3.95 Generic PROLIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 60 MG/ML $0-$9.85 Brand PA

risedronate sodium oral tablet 150 mg, 30 mg, 35 mg, 35 mg (12 pack), 35 mg (4 pack), 5 mg $0-$3.95 Generic

TERIPARATIDE (RECOMBINANT) SUBCUTANEOUS SOLUTION PEN-INJECTOR 620 MCG/2.48ML $0-$9.85 Brand PA

TYMLOS SUBCUTANEOUS SOLUTION PEN-INJECTOR 3120 MCG/1.56ML $0-$9.85 Brand PA

XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7ML $0-$9.85 Brand PA Ophthalmic Agents - Treatment Of Eye Conditions Ophthalmic Agents, Other atropine sulfate ophthalmic solution 1 % $0-$3.95 Generic cyclosporine ophthalmic emulsion 0.05 % $0-$3.95 Generic QL (60 EA per 30 days) CYSTARAN OPHTHALMIC SOLUTION 0.44 % $0-$9.85 Brand dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 mg/ml $0-$3.95 Generic neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1 $0-$3.95 Generic neomycin-polymyxin-dexameth ophthalmic suspension 0.1 %, 3.5-10000-0.1 $0-$3.95 Generic

neomycin-polymyxin-gramicidin ophthalmic solution 1.75-10000-.025 $0-$3.95 Generic OXERVATE OPHTHALMIC SOLUTION 0.002 % $0-$9.85 Brand PA polymyxin b-trimethoprim ophthalmic solution 10000-0.1 unit/ml-% $0-$3.95 Generic proparacaine hcl ophthalmic solution 0.5 % $0-$3.95 Generic RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 % $0-$9.85 Brand QL (11 ML per 30 days) RESTASIS OPHTHALMIC EMULSION 0.05 % $0-$9.85 Brand QL (60 EA per 30 days) sulfacetamide-prednisolone ophthalmic solution 10-0.23 % $0-$3.95 Generic tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 % $0-$3.95 Generic Ophthalmic Anti-Allergy Agents azelastine hcl ophthalmic solution 0.05 % $0-$3.95 Generic cromolyn sodium ophthalmic solution 4 % $0-$3.95 Generic epinastine hcl ophthalmic solution 0.05 % $0-$3.95 Generic olopatadine hcl ophthalmic solution 0.1 % $0-$3.95 Generic Ophthalmic Anti-Infectives ak-poly-bac ophthalmic ointment 500-10000 unit/gm $0-$3.95 Generic bacitracin ophthalmic ointment 500 unit/gm $0-$3.95 Generic bacitracin-polymyxin b ophthalmic ointment 500-10000 unit/gm $0-$3.95 Generic erythromycin ophthalmic ointment 5 mg/gm $0-$3.95 Generic GENTAK OPHTHALMIC OINTMENT 0.3 % $0-$3.95 Generic gentamicin sulfate ophthalmic solution 0.3 % $0-$3.95 Generic NATACYN OPHTHALMIC SUSPENSION 5 % $0-$9.85 Brand ofloxacin ophthalmic solution 0.3 % $0-$3.95 Generic sulfacetamide sodium ophthalmic ointment 10 % $0-$3.95 Generic sulfacetamide sodium ophthalmic solution 10 % $0-$3.95 Generic tobramycin ophthalmic solution 0.3 % $0-$3.95 Generic Ophthalmic Anti-Inflammatories dexamethasone sodium phosphate ophthalmic solution 0.1 % $0-$3.95 Generic diclofenac sodium ophthalmic solution 0.1 % $0-$3.95 Generic

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 61

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

difluprednate ophthalmic emulsion 0.05 % $0-$3.95 Generic fluorometholone ophthalmic suspension 0.1 % $0-$3.95 Generic flurbiprofen sodium ophthalmic solution 0.03 % $0-$3.95 Generic ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 % $0-$3.95 Generic prednisolone acetate ophthalmic suspension 1 % $0-$3.95 Generic prednisolone sodium phosphate ophthalmic solution 1 % $0-$3.95 Generic Ophthalmic Beta-Adrenergic Blocking Agents carteolol hcl ophthalmic solution 1 % $0-$3.95 Generic levobunolol hcl ophthalmic solution 0.5 % $0-$3.95 Generic timolol maleate ophthalmic solution 0.25 %, 0.5 % $0-$3.95 Generic Ophthalmic Intraocular Pressure Lowering Agents, Other acetazolamide er oral capsule extended release 12 hour 500 mg $0-$3.95 Generic ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % $0-$9.85 Brand brimonidine tartrate ophthalmic solution 0.2 % $0-$3.95 Generic brinzolamide ophthalmic suspension 1 % $0-$3.95 Generic ST COMBIGAN OPHTHALMIC SOLUTION 0.2-0.5 % $0-$9.85 Brand dorzolamide hcl ophthalmic solution 2 % $0-$3.95 Generic methazolamide oral tablet 25 mg, 50 mg $0-$3.95 Generic pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 % $0-$3.95 Generic SIMBRINZA OPHTHALMIC SUSPENSION 1-0.2 % $0-$9.85 Brand Ophthalmic Prostaglandin And Prostamide Analogs latanoprost ophthalmic solution 0.005 % $0-$3.95 Generic LUMIGAN OPHTHALMIC SOLUTION 0.01 % $0-$9.85 Brand RHOPRESSA OPHTHALMIC SOLUTION 0.02 % $0-$9.85 Brand ST travoprost (bak free) ophthalmic solution 0.004 % $0-$3.95 Generic Otic Agents - Treatment Of Ear Conditions Otic Agents acetic acid otic solution 2 % $0-$3.95 Generic hydrocortisone-acetic acid otic solution 1-2 % $0-$3.95 Generic neomycin-polymyxin-hc otic solution 1 %, 3.5-10000-1 $0-$3.95 Generic neomycin-polymyxin-hc otic suspension 3.5-10000-1 $0-$3.95 Generic ofloxacin otic solution 0.3 % $0-$3.95 Generic Respiratory Tract/ Pulmonary Agents - Treatment Of Breathing Conditions

Antihistamines azelastine hcl nasal solution 0.1 %, 0.15 %, 137 mcg/spray $0-$3.95 Generic cetirizine hcl allergy child oral solution 5 mg/5ml $0-$3.95 Generic cetirizine hcl oral solution 1 mg/ml, 5 mg/5ml $0-$3.95 Generic clemastine fumarate oral tablet 2.68 mg $0-$3.95 Generic PA cyproheptadine hcl oral syrup 2 mg/5ml $0-$3.95 Generic PA cyproheptadine hcl oral tablet 4 mg $0-$3.95 Generic PA hydroxyzine hcl oral syrup 10 mg/5ml $0-$3.95 Generic PA hydroxyzine hcl oral tablet 10 mg $0-$3.95 Generic hydroxyzine hcl oral tablet 25 mg, 50 mg $0-$3.95 Generic PA levocetirizine dihydrochloride oral solution 2.5 mg/5ml $0-$3.95 Generic levocetirizine dihydrochloride oral tablet 5 mg $0-$3.95 Generic promethazine hcl oral solution 6.25 mg/5ml $0-$3.95 Generic PA promethazine hcl oral syrup 6.25 mg/5ml $0-$3.95 Generic PA Anti-Inflammatories, Inhaled Corticosteroids ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/ACT, 200 MCG/ACT, 50 MCG/ACT $0-$9.85 Brand

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 62

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml, 1 mg/2ml $0-$3.95 Generic B/D FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 250 MCG/BLIST, 50 MCG/BLIST $0-$9.85 Brand

FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT, 44 MCG/ACT $0-$9.85 Brand

flunisolide nasal solution 25 mcg/act (0.025%) $0-$3.95 Generic fluticasone propionate nasal suspension 50 mcg/act $0-$3.95 Generic mometasone furoate nasal suspension 50 mcg/act $0-$3.95 Generic Antileukotrienes montelukast sodium oral packet 4 mg $0-$3.95 Generic montelukast sodium oral tablet 10 mg $0-$3.95 Generic montelukast sodium oral tablet chewable 4 mg, 5 mg $0-$3.95 Generic zafirlukast oral tablet 10 mg, 20 mg $0-$3.95 Generic ST Bronchodilators, Anticholinergic ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT $0-$9.85 Brand INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5 MCG/INH $0-$9.85 Brand

ipratropium bromide inhalation solution 0.02 % $0-$3.95 Generic B/D ipratropium bromide nasal solution 0.03 %, 0.06 % $0-$3.95 Generic SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG $0-$9.85 Brand SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT, 2.5 MCG/ACT $0-$9.85 Brand

Bronchodilators, Sympathomimetic albuterol sulfate hfa inhalation aerosol solution 108 (90 base) mcg/act, 108 (90 base) mcg/act (nda020503), 108 (90 base) mcg/act (nda020983)

$0-$3.95 Generic

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 mg/3ml, 2.5 mg/0.5ml $0-$3.95 Generic B/D

albuterol sulfate oral syrup 2 mg/5ml $0-$3.95 Generic albuterol sulfate oral tablet 2 mg, 4 mg $0-$3.95 Generic BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 MCG/INH, 200-25 MCG/INH $0-$9.85 Brand

epinephrine injection solution 0.3 mg/0.3ml $0-$3.95 Generic QL (2 EA per 30 days) epinephrine injection solution auto-injector 0.15 mg/0.15ml, 0.15 mg/0.3ml, 0.3 mg/0.3ml $0-$3.95 Generic QL (2 EA per 30 days)

fluticasone-salmeterol inhalation aerosol powder breath activated 113-14 mcg/act, 232-14 mcg/act, 55-14 mcg/act $0-$3.95 Generic

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/3ml $0-$3.95 Generic B/D

PERFOROMIST INHALATION NEBULIZATION SOLUTION 20 MCG/2ML $0-$9.85 Brand B/D

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE $0-$9.85 Brand

STRIVERDI RESPIMAT INHALATION AEROSOL SOLUTION 2.5 MCG/ACT $0-$9.85 Brand

terbutaline sulfate oral tablet 2.5 mg, 5 mg $0-$3.95 Generic VENTOLIN HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT $0-$9.85 Brand

Cystic Fibrosis Agents KALYDECO ORAL PACKET 25 MG, 50 MG, 75 MG $0-$9.85 Brand PA KALYDECO ORAL TABLET 150 MG $0-$9.85 Brand PA

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 63

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

ORKAMBI ORAL PACKET 100-125 MG, 150-188 MG $0-$9.85 Brand PA ORKAMBI ORAL TABLET 100-125 MG, 200-125 MG $0-$9.85 Brand PA PULMOZYME INHALATION SOLUTION 2.5 MG/2.5ML $0-$9.85 Brand B/D SYMDEKO ORAL TABLET THERAPY PACK 100-150 & 150 MG, 50-75 & 75 MG $0-$9.85 Brand PA

tobramycin inhalation nebulization solution 300 mg/5ml $0-$3.95 Generic B/D TRIKAFTA ORAL TABLET THERAPY PACK 100-50-75 & 150 MG, 50-25-37.5 & 75 MG $0-$9.85 Brand PA

Mast Cell Stabilizers cromolyn sodium inhalation nebulization solution 20 mg/2ml $0-$3.95 Generic B/D cromolyn sodium oral concentrate 100 mg/5ml $0-$3.95 Generic Phosphodiesterase Inhibitors, Airways Disease DALIRESP ORAL TABLET 250 MCG, 500 MCG $0-$9.85 Brand theophylline er oral tablet extended release 12 hour 300 mg, 450 mg $0-$3.95 Generic theophylline er oral tablet extended release 24 hour 400 mg, 600 mg $0-$3.95 Generic theophylline oral solution 80 mg/15ml $0-$3.95 Generic Pulmonary Antihypertensives ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG $0-$9.85 Brand PA ambrisentan oral tablet 10 mg, 5 mg $0-$3.95 Generic PA bosentan oral tablet 125 mg, 62.5 mg $0-$3.95 Generic PA sildenafil citrate oral suspension reconstituted 10 mg/ml $0-$3.95 Generic PA sildenafil citrate oral tablet 20 mg $0-$3.95 Generic PA tadalafil (pah) oral tablet 20 mg $0-$3.95 Generic PA UPTRAVI ORAL TABLET 1000 MCG, 1200 MCG, 1400 MCG, 1600 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG $0-$9.85 Brand PA

UPTRAVI ORAL TABLET THERAPY PACK 200 & 800 MCG $0-$9.85 Brand PA VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 MCG/ML $0-$9.85 Brand PA Pulmonary Fibrosis Agents ESBRIET ORAL CAPSULE 267 MG $0-$9.85 Brand PA ESBRIET ORAL TABLET 267 MG, 801 MG $0-$9.85 Brand PA OFEV ORAL CAPSULE 100 MG, 150 MG $0-$9.85 Brand PA Respiratory Tract Agents, Other acetylcysteine inhalation solution 10 %, 20 % $0-$3.95 Generic B/D ADVAIR HFA INHALATION AEROSOL 115-21 MCG/ACT, 230-21 MCG/ACT, 45-21 MCG/ACT $0-$9.85 Brand

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH $0-$9.85 Brand

BEVESPI AEROSPHERE INHALATION AEROSOL 9-4.8 MCG/ACT $0-$9.85 Brand BREZTRI AEROSPHERE INHALATION AEROSOL 160-9-4.8 MCG/ACT $0-$9.85 Brand

budesonide-formoterol fumarate inhalation aerosol 160-4.5 mcg/act, 80-4.5 mcg/act $0-$3.95 Generic

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/act, 250-50 mcg/act, 500-50 mcg/act $0-$3.95 Generic

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT $0-$9.85 Brand

TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-62.5-25 MCG/INH, 200-62.5-25 MCG/INH $0-$9.85 Brand

wixela inhub inhalation aerosol powder breath activated 100-50 mcg/act, 250-50 mcg/act, 500-50 mcg/act $0-$3.95 Generic

Respiratory Tract/ Pulmonary Agents

LIST OF DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 64

Name of Drug What the Tier 1 Drug will cost you

Necessary actions, restrictions, or limits on use

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION 20-100 MCG/ACT $0-$9.85 Brand ST

FASENRA PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 30 MG/ML $0-$9.85 Brand PA

FASENRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 30 MG/ML $0-$9.85 Brand PA

ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3ml $0-$3.95 Generic B/D NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MG/ML $0-$9.85 Brand PA

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/ML $0-$9.85 Brand PA

NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED 100 MG $0-$9.85 Brand PA promethazine vc oral syrup 6.25-5 mg/5ml $0-$3.95 Generic PA promethazine-phenylephrine oral syrup 6.25-5 mg/5ml $0-$3.95 Generic PA Skeletal Muscle Relaxants - Treatment Of Muscle Tightness Skeletal Muscle Relaxants carisoprodol oral tablet 250 mg, 350 mg $0-$3.95 Generic PA; QL (90 EA per 30 days) chlorzoxazone oral tablet 500 mg $0-$3.95 Generic PA; QL (180 EA per 30 days) cyclobenzaprine hcl oral tablet 10 mg, 5 mg $0-$3.95 Generic PA; QL (90 EA per 30 days) metaxalone oral tablet 800 mg $0-$3.95 Generic PA; QL (120 EA per 30 days) methocarbamol oral tablet 500 mg, 750 mg $0-$3.95 Generic PA orphenadrine citrate er oral tablet extended release 12 hour 100 mg $0-$3.95 Generic PA Sleep Disorder Agents - Treatment Of Insomnia Sleep Promoting Agents doxepin hcl oral tablet 3 mg, 6 mg $0-$3.95 Generic QL (30 EA per 30 days) eszopiclone oral tablet 1 mg, 2 mg, 3 mg $0-$3.95 Generic PA; QL (30 EA per 30 days) HETLIOZ LQ ORAL SUSPENSION 4 MG/ML $0-$9.85 Brand PA HETLIOZ ORAL CAPSULE 20 MG $0-$9.85 Brand PA ramelteon oral tablet 8 mg $0-$3.95 Generic QL (30 EA per 30 days) temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg $0-$3.95 Generic PA; QL (30 EA per 30 days) zaleplon oral capsule 10 mg, 5 mg $0-$3.95 Generic PA; QL (30 EA per 30 days) zolpidem tartrate er oral tablet extended release 12.5 mg, 6.25 mg $0-$3.95 Generic PA; QL (30 EA per 30 days) zolpidem tartrate oral tablet 10 mg $0-$3.95 Generic PA; QL (30 EA per 30 days) zolpidem tartrate oral tablet 5 mg $0-$3.95 Generic QL (30 EA per 30 days) Wakefulness Promoting Agents armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg $0-$3.95 Generic PA modafinil oral tablet 100 mg, 200 mg $0-$3.95 Generic PA XYREM ORAL SOLUTION 500 MG/ML $0-$9.85 Brand PA XYWAV ORAL SOLUTION 500 MG/ML $0-$9.85 Brand PA

D. Over-the-Counter (OTC) Drugs Grouped by Drug Type

Drug What the OTC

drug will cost you Necessary actions, restrictions, or limits on use

Antihistamine Drugs Ethanolamine Derivatives acetaminophen pm ex st oral tablet 500-25 mg $0 OTC acetaminophen pm oral tablet $0 OTC aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC allergy childrens oral liquid $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs pain relief pm ex st oral tablet $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC eq acetaminophen pm oral tablet $0 OTC eql acetaminophen pm oral tablet $0 OTC eql nighttime sleep aid oral tablet $0 OTC eql pain relief pm ex st oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC gnp pain relief pm ex st oral tablet 25-500 mg $0 OTC goodsense headache pm oral tablet $0 OTC goodsense pain relief pm ex st oral tablet 25-500 mg $0 OTC HEALTHY MAMA EAZZZE THE PAIN ORAL TABLET $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg $0 OTC hm pain reliever pm ex st oral tablet 25-500 mg $0 OTC m-dryl oral liquid $0 OTC night time pain medicine ex st oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 66

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC non-aspirin pm oral tablet $0 OTC pain relief pm extra strength oral tablet $0 OTC pain reliever pm ex st oral tablet $0 OTC pain reliever pm oral tablet 500-25 mg $0 OTC pharbedryl oral capsule $0 OTC px pain relief pm ex st oral tablet $0 OTC qc complete allergy medicine oral tablet $0 OTC ra acetaminophen pm ex st oral tablet $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb non-aspirin nighttime oral tablet $0 OTC sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC sm pain reliever pm ex st oral tablet $0 OTC total allergy oral tablet $0 OTC TYLENOL PM EXTRA STRENGTH ORAL TABLET $0 OTC Ethylenediamine Derivatives cvs menstrual relief oral tablet $0 OTC eql menstrual relief max st oral tablet $0 OTC menstrual relief max strength oral tablet $0 OTC ra menstrual relief oral tablet $0 OTC First Generation Antihistamines aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC aller-chlor oral tablet $0 OTC allergy childrens oral liquid $0 OTC allergy oral tablet 4 mg $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg, 4 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 67

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC chlorpheniramine maleate oral tablet $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs motion sickness ii oral tablet $0 OTC cvs motion sickness relief oral tablet chewable $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC ed chlorped jr oral syrup $0 OTC eq chlortabs oral tablet $0 OTC eql motion sickness relief oral tablet $0 OTC eql nighttime sleep aid oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC gnp motion sickness relief oral tablet 25 mg $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg, 4 mg $0 OTC hm motion sickness relief oral tablet 25 mg $0 OTC m-dryl oral liquid $0 OTC meclizine hcl oral tablet 12.5 mg, 25 mg $0 OTC meclizine hcl oral tablet chewable $0 OTC motion sickness relief oral tablet chewable $0 OTC motion-time oral tablet chewable $0 OTC night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC pharbedryl oral capsule $0 OTC qc chlor-pheniramine oral tablet $0 OTC qc complete allergy medicine oral tablet $0 OTC ra motion sickness relief oral tablet chewable $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb chlorpheniramine oral tablet $0 OTC sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 68

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy 4 hour oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm motion sickness oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC total allergy oral tablet $0 OTC TRAVEL-EASE ORAL TABLET 25 MG $0 OTC WAL-DRAM II ORAL TABLET $0 OTC Other Antihistamines acid controller max st oral tablet $0 OTC acid controller oral tablet $0 OTC acid reducer maximum strength oral tablet 20 mg $0 OTC acid reducer oral tablet 10 mg $0 OTC cvs acid controller max st oral tablet $0 OTC cvs acid controller oral tablet $0 OTC cvs allergy eye drops ophthalmic solution $0 OTC QL cvs eye itch relief ophthalmic solution $0 OTC QL eq acid reducer oral tablet 10 mg $0 OTC eql heartburn prevention oral tablet $0 OTC eye itch relief ophthalmic solution $0 OTC QL famotidine oral tablet 10 mg $0 OTC famotidine oral tablet 20 mg $0 OTC gnp acid reducer max st oral tablet $0 OTC gnp acid reducer oral tablet 10 mg $0 OTC heartburn relief max st oral tablet 20 mg $0 OTC heartburn relief oral tablet 10 mg $0 OTC hm famotidine oral tablet $0 OTC ketotifen fumarate ophthalmic solution $0 OTC QL kls acid controller max st oral tablet $0 OTC kp ketotifen fumarate ophthalmic solution $0 OTC QL px acid reducer max st oral tablet 20 mg $0 OTC px acid reducer oral tablet 10 mg $0 OTC qc acid controller max st oral tablet $0 OTC qc acid controller oral tablet $0 OTC ra acid reducer max st oral tablet 20 mg $0 OTC ra acid reducer oral tablet 10 mg $0 OTC ra eye itch relief ophthalmic solution $0 OTC QL sm acid reducer max st oral tablet 20 mg $0 OTC sm acid reducer oral tablet 10 mg $0 OTC sm eye itch relief ophthalmic solution $0 OTC QL ZADITOR OPHTHALMIC SOLUTION $0 OTC QL Propylamine Derivatives aller-chlor oral tablet $0 OTC allergy oral tablet 4 mg $0 OTC allergy relief oral tablet 4 mg $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 69

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

childrens cold & allergy oral elixir $0 OTC chlorpheniramine maleate oral tablet $0 OTC cold & cough childrens oral liquid $0 OTC cold/cough childrens oral liquid $0 OTC cvs cold & cough childrens oral liquid $0 OTC DIMAPHEN DM COLD/COUGH ORAL LIQUID $0 OTC DIMETAPP COLD/ALLERGY ORAL ELIXIR $0 OTC DIMETAPP DM COLD/COUGH ORAL LIQUID $0 OTC ed chlorped jr oral syrup $0 OTC ENDACOF-DM ORAL LIQUID $0 OTC eq chlortabs oral tablet $0 OTC eq cold/cough dm childrens oral liquid $0 OTC eql cold/cough oral liquid $0 OTC gnp cold/cough childrens oral liquid $0 OTC hm allergy relief oral tablet 4 mg $0 OTC hm cold & cough childrens oral liquid $0 OTC LOHIST-D ORAL LIQUID $0 OTC px dibromm dm cold/cough child oral liquid $0 OTC qc chlor-pheniramine oral tablet $0 OTC ra cold & cough childrens oral liquid $0 OTC rynex dm oral liquid $0 OTC rynex pe oral elixir $0 OTC rynex pse oral liquid $0 OTC sb chlorpheniramine oral tablet $0 OTC sm allergy 4 hour oral tablet $0 OTC sm cold & cough dm childrens oral liquid $0 OTC SUDOGEST SINUS/ALLERGY ORAL TABLET $0 OTC Second Generation Antihistamines ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

all day allergy childrens oral solution 5 mg/5ml $0 OTC QL all day allergy d oral tablet extended release 12 hour $0 OTC QL all day allergy oral tablet $0 OTC QL all day allergy-d oral tablet extended release 12 hour $0 OTC QL all-day allergy childrens oral solution $0 OTC QL allergy 24hour indoor/outdoor oral tablet $0 OTC QL allergy childrens oral syrup $0 OTC QL allergy relief cetirizine oral tablet $0 OTC QL allergy relief child oral syrup $0 OTC QL allergy relief childrens oral solution 1 mg/ml $0 OTC QL allergy relief d oral tablet extended release 12 hour $0 OTC QL allergy relief d oral tablet extended release 24 hour $0 OTC QL allergy relief d-12 oral tablet extended release 12 hour $0 OTC QL allergy relief d-24 oral tablet extended release 24 hour $0 OTC QL allergy relief oral tablet 10 mg $0 OTC QL allergy relief oral tablet dispersible $0 OTC QL allergy relief/indoor/outdoor oral tablet 10 mg $0 OTC QL allergy relief/nasal decongest oral tablet extended release 24 hour $0 OTC QL allergy relief-d oral tablet extended release 24 hour $0 OTC QL allergy/congestion relief oral tablet extended release 12 hour $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 70

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cetirizine hcl allergy child oral solution $0 OTC QL cetirizine hcl childrens alrgy oral solution $0 OTC QL cetirizine hcl childrens oral solution 5 mg/5ml $0 OTC QL cetirizine hcl oral solution 1 mg/ml $0 OTC QL cetirizine hcl oral tablet $0 OTC QL cetirizine hcl oral tablet chewable $0 OTC QL cetirizine-pseudoephedrine er oral tablet extended release 12 hour $0 OTC QL childrens loratadine oral solution $0 OTC QL childrens loratadine oral syrup $0 OTC QL cvs allergy relief childrens oral solution $0 OTC QL cvs allergy relief childrens oral syrup $0 OTC QL cvs allergy relief childrens oral tablet chewable 5 mg $0 OTC cvs allergy relief oral tablet 10 mg $0 OTC QL cvs allergy relief oral tablet dispersible $0 OTC QL cvs allergy relief-d oral tablet extended release 12 hour $0 OTC QL cvs allergy relief-d oral tablet extended release 24 hour $0 OTC QL cvs allergy relief-d12 oral tablet extended release 12 hour $0 OTC QL cvs indoor/outdoor allergy rlf oral tablet $0 OTC QL eq allergy childrens oral syrup $0 OTC QL eq allergy relief (cetirizine) oral solution $0 OTC QL eq allergy relief (cetirizine) oral tablet $0 OTC QL eq allergy relief childrens oral solution $0 OTC QL eq allergy relief childrens oral syrup $0 OTC QL eq allergy relief oral tablet 10 mg $0 OTC QL eql all day allergy childrens oral solution $0 OTC QL eql all day allergy oral tablet $0 OTC QL eql all day allergy-d oral tablet extended release 12 hour $0 OTC QL eql allergy relief oral tablet 10 mg $0 OTC QL eql allergy/congestion relief oral tablet extended release 24 hour $0 OTC QL gnp all day allergy childrens oral solution $0 OTC QL gnp all day allergy oral tablet $0 OTC QL gnp all day allergy-d oral tablet extended release 12 hour $0 OTC QL gnp allergy & congestion oral tablet extended release 24 hour $0 OTC QL gnp allergy/congestion relief oral tablet extended release 24 hour $0 OTC QL gnp loratadine childrens oral solution $0 OTC QL gnp loratadine oral syrup $0 OTC QL gnp loratadine oral tablet $0 OTC QL goodsense all day allergy oral solution $0 OTC QL goodsense all day allergy oral tablet $0 OTC QL hm all day allergy childrens oral solution $0 OTC QL hm all day allergy oral solution $0 OTC QL hm all day allergy oral tablet $0 OTC QL hm allergy & congestion oral tablet extended release 12 hour $0 OTC QL hm allergy complete-d oral tablet extended release 12 hour $0 OTC QL hm allergy relief/nasal decong oral tablet extended release 24 hour $0 OTC QL hm cetirizine hcl oral tablet $0 OTC QL hm loratadine childrens oral syrup $0 OTC QL hm loratadine oral tablet $0 OTC QL KLS ALLERCLEAR D-12HR ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 71

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

KLS ALLERCLEAR D-24HR ORAL TABLET EXTENDED RELEASE 24 HOUR $0 OTC QL

KLS ALLERCLEAR ORAL TABLET $0 OTC QL KLS ALLER-TEC D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

KLS ALLER-TEC ORAL TABLET $0 OTC QL loradamed oral tablet $0 OTC QL loratadine childrens oral syrup $0 OTC QL loratadine childrens oral tablet chewable $0 OTC QL loratadine oral tablet $0 OTC QL loratadine-d 12hr oral tablet extended release 12 hour $0 OTC QL loratadine-d 24hr oral tablet extended release 24 hour $0 OTC QL meijer allergy relief-d oral tablet extended release 12 hour $0 OTC QL mm cetirizine hcl oral tablet $0 OTC QL px allergy relief cetirizine oral tablet $0 OTC QL px allergy relief d (loratid) oral tablet extended release 12 hour $0 OTC QL px allergy relief d oral tablet extended release 12 hour $0 OTC QL px allergy relief d oral tablet extended release 24 hour $0 OTC QL px allergy relief loratadine oral tablet $0 OTC QL px childrens allergy oral solution $0 OTC QL qc all day allergy oral tablet $0 OTC QL qc allergy relief oral tablet dispersible $0 OTC QL qc childrens allergy oral solution $0 OTC QL qc loratadine allergy relief oral tablet $0 OTC QL qc loratadine-d oral tablet extended release 24 hour $0 OTC QL ra allergy relief (cetirizine) oral tablet $0 OTC QL ra allergy relief (loratadine) oral tablet $0 OTC QL ra allergy relief childrens oral solution 5 mg/5ml $0 OTC QL ra allergy relief childrens oral syrup $0 OTC QL ra allergy relief childrens oral tablet chewable $0 OTC QL ra allergy/congestion relief oral tablet extended release 12 hour $0 OTC QL ra cetiri-d oral tablet extended release 12 hour $0 OTC QL ra lorata-d oral tablet extended release 24 hour $0 OTC QL ra loratadine oral syrup $0 OTC QL ra loratadine oral tablet $0 OTC QL sb allergy oral tablet $0 OTC QL sb loratadine oral tablet $0 OTC QL sm all day allergy childrens oral solution 5 mg/5ml $0 OTC QL sm all day allergy oral tablet $0 OTC QL sm all day allergy-d oral tablet extended release 12 hour $0 OTC QL sm allergy childrens oral syrup $0 OTC QL sm allergy relief oral tablet dispersible $0 OTC QL sm childrens loratadine oral syrup $0 OTC QL sm loratadine allergy relief oral tablet dispersible $0 OTC QL sm loratadine d 12hr oral tablet extended release 12 hour $0 OTC QL sm lorata-dine d oral tablet extended release 24 hour $0 OTC QL sm loratadine oral syrup $0 OTC QL sm loratadine oral tablet $0 OTC QL WAL-ITIN CHILDRENS ORAL SOLUTION $0 OTC QL WAL-ITIN D 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 72

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL WAL-ITIN ORAL SYRUP $0 OTC QL WAL-ITIN ORAL TABLET $0 OTC QL WAL-ITIN ORAL TABLET DISPERSIBLE $0 OTC QL WAL-ZYR ALL DAY ALLERGY CHILD ORAL SOLUTION $0 OTC QL WAL-ZYR CHILDRENS ORAL SOLUTION $0 OTC QL WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE 10 MG $0 OTC QL WAL-ZYR D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL WAL-ZYR ORAL TABLET $0 OTC QL Anti-Infective Agents Hiv Integrase Inhibitor Antiretrovirals BIKTARVY ORAL TABLET 30-120-15 MG Non-$0 OTC QL Hiv Nonnucleoside Rev.Transcrip. Inhib. BIKTARVY ORAL TABLET 30-120-15 MG Non-$0 OTC QL Hiv Nucleoside, Nucleotide Rt Inhibitors BIKTARVY ORAL TABLET 30-120-15 MG Non-$0 OTC QL Autonomic Drugs Alpha- And Beta-Adrenergic Agonists 12 hour decongestant oral tablet extended release 12 hour $0 OTC 12 hour nasal decongestant oral tablet extended release 12 hour $0 OTC ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

all day allergy d oral tablet extended release 12 hour $0 OTC QL all day allergy-d oral tablet extended release 12 hour $0 OTC QL allergy relief d oral tablet extended release 12 hour $0 OTC QL allergy relief d oral tablet extended release 24 hour $0 OTC QL allergy relief d-12 oral tablet extended release 12 hour $0 OTC QL allergy relief d-24 oral tablet extended release 24 hour $0 OTC QL allergy relief/nasal decongest oral tablet extended release 24 hour $0 OTC QL allergy relief-d oral tablet extended release 24 hour $0 OTC QL allergy/congestion relief oral tablet extended release 12 hour $0 OTC QL cetirizine-pseudoephedrine er oral tablet extended release 12 hour $0 OTC QL cvs 12 hour nasal decongestant oral tablet extended release 12 hour $0 OTC cvs allergy relief-d oral tablet extended release 12 hour $0 OTC QL cvs allergy relief-d oral tablet extended release 24 hour $0 OTC QL cvs allergy relief-d12 oral tablet extended release 12 hour $0 OTC QL cvs mucus d extended release oral tablet extended release 12 hour $0 OTC cvs mucus d max st er oral tablet extended release 12 hour $0 OTC QL cvs nasal decongestant oral tablet $0 OTC eql all day allergy-d oral tablet extended release 12 hour $0 OTC QL eql allergy/congestion relief oral tablet extended release 24 hour $0 OTC QL eql nasal decongestant oral tablet $0 OTC gnp all day allergy-d oral tablet extended release 12 hour $0 OTC QL gnp allergy & congestion oral tablet extended release 24 hour $0 OTC QL gnp allergy/congestion relief oral tablet extended release 24 hour $0 OTC QL gnp nasal decongestant oral tablet $0 OTC gnp pseudoephedrine hcl 12 hr oral tablet extended release 12 hour $0 OTC hm allergy & congestion oral tablet extended release 12 hour $0 OTC QL hm allergy complete-d oral tablet extended release 12 hour $0 OTC QL hm allergy relief/nasal decong oral tablet extended release 24 hour $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 73

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

hm nasal decongestant 12 hour oral tablet extended release 12 hour $0 OTC hm nasal decongestant oral tablet $0 OTC KLS ALLERCLEAR D-12HR ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

KLS ALLERCLEAR D-24HR ORAL TABLET EXTENDED RELEASE 24 HOUR $0 OTC QL

KLS ALLER-TEC D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL

kp pseudoephedrine hcl oral tablet $0 OTC LOHIST-D ORAL LIQUID $0 OTC loratadine-d 12hr oral tablet extended release 12 hour $0 OTC QL loratadine-d 24hr oral tablet extended release 24 hour $0 OTC QL meijer allergy relief-d oral tablet extended release 12 hour $0 OTC QL meijer nasal decongestant oral tablet $0 OTC mucus d oral tablet extended release 12 hour 60-600 mg $0 OTC mucus relief d oral tablet extended release 12 hour 60-600 mg $0 OTC nasal decongestant max st oral tablet $0 OTC nasal decongestant oral tablet 30 mg $0 OTC pseudoephedrine hcl er oral tablet extended release 12 hour $0 OTC pseudoephedrine hcl oral tablet 30 mg $0 OTC pseudoephedrine hcl oral tablet 60 mg $0 OTC pseudoephedrine-guaifenesin er oral tablet extended release 12 hour 120-1200 mg $0 OTC QL

pseudoephedrine-guaifenesin er oral tablet extended release 12 hour 60-600 mg $0 OTC

px allergy relief d (loratid) oral tablet extended release 12 hour $0 OTC QL px allergy relief d oral tablet extended release 12 hour $0 OTC QL px allergy relief d oral tablet extended release 24 hour $0 OTC QL px nasal decongestant oral tablet $0 OTC px nasal decongestant oral tablet extended release 12 hour $0 OTC qc loratadine-d oral tablet extended release 24 hour $0 OTC QL qc suphedrine maximum strength oral tablet extended release 12 hour $0 OTC

ra allergy/congestion relief oral tablet extended release 12 hour $0 OTC QL ra cetiri-d oral tablet extended release 12 hour $0 OTC QL ra lorata-d oral tablet extended release 24 hour $0 OTC QL ra mucus relief d max strength oral tablet extended release 12 hour $0 OTC QL ra mucus relief d oral tablet extended release 12 hour 600-60 mg $0 OTC ra suphedrine oral tablet 30 mg $0 OTC ra suphedrine oral tablet extended release 12 hour $0 OTC rynex pse oral liquid $0 OTC sinus 12 hour oral tablet extended release 12 hour $0 OTC sm all day allergy-d oral tablet extended release 12 hour $0 OTC QL sm loratadine d 12hr oral tablet extended release 12 hour $0 OTC QL sm lorata-dine d oral tablet extended release 24 hour $0 OTC QL sm mucus relief d oral tablet extended release 12 hour $0 OTC sm nasal decongestant max st oral tablet $0 OTC sm nasal decongestant oral tablet extended release 12 hour $0 OTC SUDAFED CHILDRENS ORAL LIQUID $0 OTC sudogest 12 hour oral tablet extended release 12 hour $0 OTC SUDOGEST MAXIMUM STRENGTH ORAL TABLET $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 74

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

SUDOGEST ORAL TABLET $0 OTC SUDOGEST SINUS/ALLERGY ORAL TABLET $0 OTC suphedrine 12hour oral tablet extended release 12 hour $0 OTC WAL-ITIN D 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR $0 OTC QL

WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL WAL-PHED 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC

WAL-PHED D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC WAL-PHED ORAL TABLET $0 OTC WAL-ZYR D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC QL Alpha-Adrenergic Agonists childrens cold & allergy oral elixir $0 OTC cold & cough childrens oral liquid $0 OTC cold/cough childrens oral liquid $0 OTC cvs cold & cough childrens oral liquid $0 OTC cvs hemorrhoidal rectal ointment $0 OTC cvs nasal decongestant pe oral tablet $0 OTC cvs sinus pe decongestant oral tablet $0 OTC DIMAPHEN DM COLD/COUGH ORAL LIQUID $0 OTC DIMETAPP COLD/ALLERGY ORAL ELIXIR $0 OTC DIMETAPP DM COLD/COUGH ORAL LIQUID $0 OTC ed bron gp oral liquid $0 OTC QL ENDACOF-DM ORAL LIQUID $0 OTC eq cold/cough dm childrens oral liquid $0 OTC eql cold/cough oral liquid $0 OTC eql hemorrhoidal rectal ointment 0.25-14-74.9 % $0 OTC eql nasal decongestant pe oral tablet $0 OTC gnp cold/cough childrens oral liquid $0 OTC gnp nasal decongestant pe oral tablet $0 OTC hemorrhoidal cooling external gel $0 OTC hemorrhoidal rectal suppository 0.25-3-85.5 % $0 OTC hm cold & cough childrens oral liquid $0 OTC hm daytime cold & flu oral liquid $0 OTC hm nasal decongestant pe oral tablet $0 OTC mucus relief cold/sinus max st oral liquid $0 OTC nasal decongestant pe max st oral tablet $0 OTC nasal decongestant pe oral tablet $0 OTC non-pseudo sinus decongestant oral tablet $0 OTC px dibromm dm cold/cough child oral liquid $0 OTC px hemorrhoidal rectal ointment $0 OTC px hemorrhoidal rectal suppository $0 OTC px nasal decongestant pe oral tablet $0 OTC ra cold & cough childrens oral liquid $0 OTC ra hemorrhoidal rectal ointment $0 OTC ra hemorrhoidal rectal suppository $0 OTC ra nasal decongestant pe oral tablet $0 OTC ra sinus/congestion relief pe oral tablet $0 OTC rynex dm oral liquid $0 OTC rynex pe oral elixir $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 75

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sm cold & cough dm childrens oral liquid $0 OTC sm hemorrhoidal cooling external gel $0 OTC sm nasal decongestant pe oral tablet $0 OTC SUDOGEST PE ORAL TABLET $0 OTC WAL-PHED PE ORAL TABLET $0 OTC Antiparkinsonian Agents aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC allergy childrens oral liquid $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC eql nighttime sleep aid oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg $0 OTC m-dryl oral liquid $0 OTC night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC pharbedryl oral capsule $0 OTC qc complete allergy medicine oral tablet $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 76

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC total allergy oral tablet $0 OTC Autonomic Drugs, Miscellaneous cvs nicotine mouth/throat lozenge $0 OTC QL cvs nicotine polacrilex mouth/throat gum $0 OTC QL cvs nicotine polacrilex mouth/throat lozenge $0 OTC QL cvs nicotine transdermal patch 24 hour $0 OTC QL eq nicotine mouth/throat lozenge $0 OTC QL eq nicotine polacrilex mouth/throat gum $0 OTC QL eq nicotine polacrilex mouth/throat lozenge $0 OTC QL eq nicotine step 3 transdermal patch 24 hour $0 OTC QL eq nicotine transdermal patch 24 hour 14 mg/24hr, 21 mg/24hr $0 OTC QL eql nicotine polacrilex mouth/throat lozenge $0 OTC QL gnp nicotine mini mouth/throat lozenge 2 mg $0 OTC QL gnp nicotine polacrilex mouth/throat gum $0 OTC QL gnp nicotine polacrilex mouth/throat lozenge $0 OTC QL gnp nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr $0 OTC QL goodsense nicotine mouth/throat gum 4 mg $0 OTC QL goodsense nicotine mouth/throat lozenge $0 OTC QL hm nicotine polacrilex mouth/throat gum $0 OTC QL hm nicotine polacrilex mouth/throat lozenge $0 OTC QL hm nicotine transdermal patch 24 hour $0 OTC QL KLS QUIT2 MOUTH/THROAT GUM $0 OTC QL KLS QUIT2 MOUTH/THROAT LOZENGE $0 OTC QL KLS QUIT4 MOUTH/THROAT GUM $0 OTC QL KLS QUIT4 MOUTH/THROAT LOZENGE $0 OTC QL NICODERM CQ TRANSDERMAL PATCH 24 HOUR 21 MG/24HR $0 OTC QL NICORELIEF MOUTH/THROAT GUM 2 MG $0 OTC QL nicotine mini mouth/throat lozenge $0 OTC QL nicotine polacrilex mouth/throat gum $0 OTC QL nicotine polacrilex mouth/throat lozenge $0 OTC QL nicotine step 1 transdermal patch 24 hour $0 OTC QL nicotine step 2 transdermal patch 24 hour $0 OTC QL nicotine step 3 transdermal patch 24 hour $0 OTC QL nicotine transdermal kit $0 OTC QL nicotine transdermal patch 24 hour $0 OTC QL px stop smoking aid mouth/throat lozenge $0 OTC QL ra mini nicotine mouth/throat lozenge $0 OTC QL ra nicotine gum mouth/throat gum 2 mg, 4 mg $0 OTC QL ra nicotine mouth/throat gum $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 77

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra nicotine polacrilex mouth/throat lozenge $0 OTC QL ra nicotine transdermal patch 24 hour 14 mg/24hr, 21 mg/24hr $0 OTC QL sm nicotine mouth/throat gum $0 OTC QL sm nicotine mouth/throat lozenge $0 OTC QL sm nicotine polacrilex mouth/throat gum $0 OTC QL sm nicotine polacrilex mouth/throat lozenge 4 mg $0 OTC QL sm nicotine transdermal patch 24 hour $0 OTC QL Blood Formation, Coagulation, Thrombosis Iron Preparations animal shapes/iron oral tablet chewable $0 OTC BPROTECTED PEDIA IRON ORAL SOLUTION $0 OTC cvs childrens complete oral tablet chewable 18 mg $0 OTC cvs iron oral tablet 240 (27 fe) mg, 325 (65 fe) mg $0 OTC daily multiple vitamins/iron oral tablet $0 OTC daily vitamin formula+iron oral tablet $0 OTC eq slow-release iron oral tablet extended release $0 OTC eql child multivit/minerals oral tablet chewable 18 mg $0 OTC eql iron supplement therapy oral tablet 325 mg $0 OTC eql slow release iron oral tablet extended release $0 OTC EZFE 200 ORAL CAPSULE $0 OTC FEOSOL ORAL TABLET 200 (65 FE) MG $0 OTC FERATE ORAL TABLET 240 (27 FE) MG $0 OTC FERGON ORAL TABLET $0 OTC FEROSUL ORAL TABLET $0 OTC FERREX 150 ORAL CAPSULE $0 OTC QL ferric x-150 oral capsule $0 OTC QL FERROCITE ORAL TABLET $0 OTC QL ferrous fumarate oral tablet 324 (106 fe) mg $0 OTC QL ferrous gluconate oral tablet 240 (27 fe) mg, 324 (38 fe) mg $0 OTC ferrous sulfate oral elixir $0 OTC ferrous sulfate oral liquid $0 OTC ferrous sulfate oral solution 75 (15 fe) mg/ml $0 OTC ferrous sulfate oral tablet 325 (65 fe) mg $0 OTC ferrous sulfate oral tablet delayed release $0 OTC FLINTSTONES COMPLETE ORAL TABLET CHEWABLE 10 MG, 18 MG $0 OTC

gnp childrens chewables/iron oral tablet chewable $0 OTC gnp iron oral tablet 200 (65 fe) mg $0 OTC gnp iron oral tablet extended release $0 OTC gnp prenatal oral tablet $0 OTC iron 27 oral tablet $0 OTC iron high-potency oral tablet $0 OTC iron oral tablet 240 (27 fe) mg, 325 (65 fe) mg $0 OTC iron supplement childrens oral solution $0 OTC kp ferrous sulfate oral tablet $0 OTC kp prenatal multivitamins oral tablet $0 OTC kpn prenatal oral tablet $0 OTC m-natal plus oral tablet $0 OTC multi-day plus iron oral tablet $0 OTC multiple vitamins/iron oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 78

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

one daily multivitamin/iron oral tablet $0 OTC POLY-IRON 150 ORAL CAPSULE $0 OTC QL polysaccharide iron complex oral capsule $0 OTC QL polysaccharide-iron complex oral capsule $0 OTC QL qc prenatal oral tablet $0 OTC ra iron oral tablet 325 (65 fe) mg $0 OTC ra prenatal oral tablet $0 OTC ra slow release iron oral tablet extended release 45 mg $0 OTC SCOOBY-DOO ONE A DAY ORAL TABLET CHEWABLE $0 OTC slow iron oral tablet extended release $0 OTC slow release iron oral tablet extended release 160 (50 fe) mg, 45 mg, 47.5 mg $0 OTC

sm animal shapes complete oral tablet chewable 18 mg $0 OTC sm iron oral tablet 325 (65 fe) mg $0 OTC sm iron slow release oral tablet extended release 160 (50 fe) mg $0 OTC sm multiple vitamins/iron oral tablet $0 OTC sm prenatal vitamins oral tablet $0 OTC sm slow release iron oral tablet extended release 142 (45 fe) mg $0 OTC stress formula/iron oral tablet $0 OTC tab-a-vite/iron oral tablet $0 OTC zoo friends plus iron oral tablet chewable $0 OTC Liver And Stomach Preparations B-12 DOTS ORAL TABLET DISPERSIBLE $0 OTC b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 500 mcg $0 OTC b-12 oral tablet extended release 1000 mcg $0 OTC b-12 tr oral tablet extended release 1000 mcg $0 OTC cvs b-12 oral tablet $0 OTC cvs vitamin b12 oral tablet $0 OTC cvs vitamin b-12 oral tablet 1000 mcg $0 OTC cvs vitamin b12 oral tablet extended release $0 OTC cyanocobalamin injection solution 1000 mcg/ml $0 OTC eql vitamin b-12 oral tablet $0 OTC eql vitamin b-12 tr oral tablet extended release $0 OTC gnp vitamin b-12 oral tablet $0 OTC gnp vitamin b-12 oral tablet extended release $0 OTC hm vitamin b-12 oral tablet $0 OTC kp vitamin b-12 oral tablet $0 OTC ra vitamin b-12 oral tablet $0 OTC ra vitamin b-12 tr oral tablet extended release $0 OTC sm vitamin b-12 oral tablet $0 OTC sm vitamin b12 tr oral tablet extended release 1000 mcg $0 OTC sv vitamin b-12 er oral tablet extended release $0 OTC vitamin b 12 oral tablet $0 OTC vitamin b-12 er oral tablet extended release 1000 mcg $0 OTC vitamin b12 oral tablet 100 mcg $0 OTC vitamin b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 500 mcg $0 OTC vitamin b12 tr oral tablet extended release 1000 mcg $0 OTC Platelet-Aggregation Inhibitors adult aspirin regimen oral tablet delayed release $0 OTC aspirin 81 oral tablet chewable $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 79

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

aspirin adult low dose oral tablet delayed release $0 OTC aspirin adult low strength oral tablet delayed release $0 OTC aspirin childrens oral tablet chewable $0 OTC aspirin ec adult low strength oral tablet delayed release $0 OTC aspirin ec low dose oral tablet delayed release $0 OTC aspirin ec low strength oral tablet delayed release $0 OTC aspirin ec oral tablet delayed release $0 OTC aspirin low dose oral tablet chewable $0 OTC aspirin low dose oral tablet delayed release $0 OTC aspirin low strength oral tablet chewable $0 OTC aspirin oral tablet 325 mg $0 OTC aspirin oral tablet chewable $0 OTC aspirin oral tablet delayed release 325 mg, 81 mg $0 OTC aspirin rectal suppository 300 mg $0 OTC ASPIR-LOW ORAL TABLET DELAYED RELEASE $0 OTC BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC

BAYER ASPIRIN ORAL TABLET $0 OTC BAYER ASPIRIN ORAL TABLET DELAYED RELEASE $0 OTC BAYER LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC BUFFERIN ORAL TABLET $0 OTC childrens aspirin oral tablet chewable $0 OTC cvs aspirin adult low dose oral tablet chewable $0 OTC cvs aspirin adult low strength oral tablet delayed release $0 OTC cvs aspirin ec oral tablet delayed release $0 OTC cvs aspirin low dose oral tablet delayed release $0 OTC cvs aspirin low strength oral tablet delayed release $0 OTC cvs aspirin oral tablet 325 mg $0 OTC ECPIRIN ORAL TABLET DELAYED RELEASE $0 OTC eq aspirin adult low dose oral tablet delayed release $0 OTC eq aspirin low dose oral tablet chewable $0 OTC eq aspirin oral tablet $0 OTC eql aspirin ec oral tablet delayed release 325 mg $0 OTC eql aspirin low dose oral tablet chewable $0 OTC eql aspirin low dose oral tablet delayed release $0 OTC gnp adult aspirin low strength oral tablet chewable $0 OTC gnp aspirin low dose oral tablet delayed release $0 OTC gnp aspirin oral tablet 325 mg $0 OTC gnp aspirin oral tablet delayed release $0 OTC goodsense aspirin adult low st oral tablet chewable $0 OTC goodsense aspirin low dose oral tablet delayed release $0 OTC goodsense aspirin oral tablet $0 OTC goodsense aspirin oral tablet chewable $0 OTC goodsense aspirin oral tablet delayed release $0 OTC hm aspirin ec low dose oral tablet delayed release $0 OTC hm aspirin ec oral tablet delayed release $0 OTC hm aspirin oral tablet $0 OTC hm aspirin oral tablet chewable $0 OTC kls aspirin low dose oral tablet delayed release $0 OTC kp aspirin oral tablet delayed release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 80

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

px aspirin oral tablet $0 OTC px aspirin oral tablet chewable $0 OTC qc aspirin low dose oral tablet chewable $0 OTC qc aspirin low dose oral tablet delayed release $0 OTC qc aspirin oral tablet $0 OTC qc aspirin oral tablet delayed release $0 OTC qc enteric aspirin oral tablet delayed release $0 OTC ra aspirin adult low dose oral tablet chewable $0 OTC ra aspirin adult low strength oral tablet chewable $0 OTC ra aspirin childrens oral tablet chewable $0 OTC ra aspirin ec adult low st oral tablet delayed release $0 OTC ra aspirin ec oral tablet delayed release $0 OTC ra aspirin oral tablet 325 mg $0 OTC sb aspirin ec oral tablet delayed release $0 OTC sb aspirin oral tablet $0 OTC sb childrens aspirin oral tablet chewable $0 OTC sb low dose asa ec oral tablet delayed release $0 OTC sm aspirin adult low strength oral tablet chewable $0 OTC sm aspirin adult low strength oral tablet delayed release $0 OTC sm aspirin ec low strength oral tablet delayed release $0 OTC sm aspirin ec oral tablet delayed release $0 OTC sm aspirin low dose oral tablet chewable $0 OTC sm aspirin oral tablet $0 OTC sm childrens aspirin oral tablet chewable $0 OTC ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE $0 OTC ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC Thrombolytic Agents adult aspirin regimen oral tablet delayed release $0 OTC aspirin 81 oral tablet chewable $0 OTC aspirin adult low dose oral tablet delayed release $0 OTC aspirin adult low strength oral tablet delayed release $0 OTC aspirin childrens oral tablet chewable $0 OTC aspirin ec adult low strength oral tablet delayed release $0 OTC aspirin ec low dose oral tablet delayed release $0 OTC aspirin ec low strength oral tablet delayed release $0 OTC aspirin ec oral tablet delayed release $0 OTC aspirin low dose oral tablet chewable $0 OTC aspirin low dose oral tablet delayed release $0 OTC aspirin low strength oral tablet chewable $0 OTC aspirin oral tablet 325 mg $0 OTC aspirin oral tablet chewable $0 OTC aspirin oral tablet delayed release 325 mg, 81 mg $0 OTC aspirin rectal suppository 300 mg $0 OTC ASPIR-LOW ORAL TABLET DELAYED RELEASE $0 OTC BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC

BAYER ASPIRIN ORAL TABLET $0 OTC BAYER ASPIRIN ORAL TABLET DELAYED RELEASE $0 OTC BAYER LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 81

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

BUFFERIN ORAL TABLET $0 OTC childrens aspirin oral tablet chewable $0 OTC cvs aspirin adult low dose oral tablet chewable $0 OTC cvs aspirin adult low strength oral tablet delayed release $0 OTC cvs aspirin ec oral tablet delayed release $0 OTC cvs aspirin low dose oral tablet delayed release $0 OTC cvs aspirin low strength oral tablet delayed release $0 OTC cvs aspirin oral tablet 325 mg $0 OTC ECPIRIN ORAL TABLET DELAYED RELEASE $0 OTC eq aspirin adult low dose oral tablet delayed release $0 OTC eq aspirin low dose oral tablet chewable $0 OTC eq aspirin oral tablet $0 OTC eql aspirin ec oral tablet delayed release 325 mg $0 OTC eql aspirin low dose oral tablet chewable $0 OTC eql aspirin low dose oral tablet delayed release $0 OTC gnp adult aspirin low strength oral tablet chewable $0 OTC gnp aspirin low dose oral tablet delayed release $0 OTC gnp aspirin oral tablet 325 mg $0 OTC gnp aspirin oral tablet delayed release $0 OTC goodsense aspirin adult low st oral tablet chewable $0 OTC goodsense aspirin low dose oral tablet delayed release $0 OTC goodsense aspirin oral tablet $0 OTC goodsense aspirin oral tablet chewable $0 OTC goodsense aspirin oral tablet delayed release $0 OTC hm aspirin ec low dose oral tablet delayed release $0 OTC hm aspirin ec oral tablet delayed release $0 OTC hm aspirin oral tablet $0 OTC hm aspirin oral tablet chewable $0 OTC kls aspirin low dose oral tablet delayed release $0 OTC kp aspirin oral tablet delayed release $0 OTC px aspirin oral tablet $0 OTC px aspirin oral tablet chewable $0 OTC qc aspirin low dose oral tablet chewable $0 OTC qc aspirin low dose oral tablet delayed release $0 OTC qc aspirin oral tablet $0 OTC qc aspirin oral tablet delayed release $0 OTC qc enteric aspirin oral tablet delayed release $0 OTC ra aspirin adult low dose oral tablet chewable $0 OTC ra aspirin adult low strength oral tablet chewable $0 OTC ra aspirin childrens oral tablet chewable $0 OTC ra aspirin ec adult low st oral tablet delayed release $0 OTC ra aspirin ec oral tablet delayed release $0 OTC ra aspirin oral tablet 325 mg $0 OTC sb aspirin ec oral tablet delayed release $0 OTC sb aspirin oral tablet $0 OTC sb childrens aspirin oral tablet chewable $0 OTC sb low dose asa ec oral tablet delayed release $0 OTC sm aspirin adult low strength oral tablet chewable $0 OTC sm aspirin adult low strength oral tablet delayed release $0 OTC sm aspirin ec low strength oral tablet delayed release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 82

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sm aspirin ec oral tablet delayed release $0 OTC sm aspirin low dose oral tablet chewable $0 OTC sm aspirin oral tablet $0 OTC sm childrens aspirin oral tablet chewable $0 OTC ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE $0 OTC ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC Cardiovascular Drugs Calcium-Channel Block.Agt,Misc(Hypoten) diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg $0 OTC QL

diltiazem hcl er oral capsule extended release 24 hour 120 mg $0 OTC QL dilt-xr oral capsule extended release 24 hour 120 mg $0 OTC QL Calcium-Channel Blocking Agents, Misc. diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg $0 OTC QL

diltiazem hcl er oral capsule extended release 24 hour 120 mg $0 OTC QL dilt-xr oral capsule extended release 24 hour 120 mg $0 OTC QL Class Iv Antiarrhythmics diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg $0 OTC QL

diltiazem hcl er oral capsule extended release 24 hour 120 mg $0 OTC QL dilt-xr oral capsule extended release 24 hour 120 mg $0 OTC QL Vasodilating Agents, Miscellaneous diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg $0 OTC QL

diltiazem hcl er oral capsule extended release 24 hour 120 mg $0 OTC QL dilt-xr oral capsule extended release 24 hour 120 mg $0 OTC QL Central Nervous System Agents Analgesics And Antipyretics, Misc. 8 hour arthritis pain reliever oral tablet extended release $0 OTC 8 hour pain reliever oral tablet extended release $0 OTC 8 hr arthritis pain relief oral tablet extended release $0 OTC 8hr muscle aches & pain oral tablet extended release $0 OTC acetaminophen 8 hour oral tablet extended release $0 OTC acetaminophen childrens oral solution $0 OTC acetaminophen childrens oral suspension 160 mg/5ml $0 OTC acetaminophen childrens oral tablet chewable 160 mg $0 OTC acetaminophen er oral tablet extended release $0 OTC acetaminophen extra strength oral tablet $0 OTC acetaminophen infants oral suspension $0 OTC acetaminophen junior strength oral tablet dispersible $0 OTC acetaminophen oral liquid $0 OTC acetaminophen oral solution 160 mg/5ml, 325 mg/10.15ml, 650 mg/20.3ml $0 OTC

acetaminophen oral suspension 160 mg/5ml, 325 mg/10.15ml, 650 mg/20.3ml $0 OTC

acetaminophen oral tablet 325 mg $0 OTC acetaminophen oral tablet 500 mg $0 OTC acetaminophen oral tablet chewable 160 mg, 80 mg $0 OTC acetaminophen pm ex st oral tablet 500-25 mg $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 83

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

acetaminophen pm oral tablet $0 OTC acetaminophen rectal suppository 120 mg, 650 mg $0 OTC arthritis pain relief oral tablet extended release $0 OTC arthritis pain reliever oral tablet extended release $0 OTC aurophen childrens oral suspension $0 OTC BAYER MIGRAINE ORAL TABLET $0 OTC betatemp childrens oral suspension $0 OTC childrens acetaminophen oral suspension 160 mg/5ml $0 OTC childrens apap oral tablet chewable $0 OTC childrens non-aspirin oral tablet chewable $0 OTC childrens silapap oral liquid $0 OTC cvs 8hr arthritis pain relief oral tablet extended release $0 OTC cvs 8hr muscle aches & pain oral tablet extended release $0 OTC cvs acetaminophen ex st oral liquid $0 OTC cvs acetaminophen ex st oral tablet $0 OTC cvs acetaminophen oral liquid $0 OTC cvs acetaminophen oral tablet $0 OTC cvs arthritis pain relief oral tablet extended release $0 OTC cvs childs non-aspirin oral tablet chewable $0 OTC cvs fever reducing childrens rectal suppository $0 OTC cvs headache relief oral tablet $0 OTC cvs infants pain relief drops oral suspension 160 mg/5ml $0 OTC cvs menstrual relief oral tablet $0 OTC cvs migraine relief oral tablet $0 OTC cvs non-aspirin childrens oral tablet chewable $0 OTC cvs non-aspirin extra strength oral tablet $0 OTC cvs pain & fever childrens oral suspension $0 OTC cvs pain & fever infants oral suspension $0 OTC cvs pain relief childrens oral suspension $0 OTC cvs pain relief childrens oral tablet chewable $0 OTC cvs pain relief extra strength oral tablet $0 OTC cvs pain relief oral tablet $0 OTC cvs pain relief oral tablet extended release $0 OTC cvs pain relief pm ex st oral tablet $0 OTC cvs pain relief regular st oral tablet $0 OTC ed-apap oral liquid $0 OTC eq 8hr arthritis pain relief oral tablet extended release $0 OTC eq acetaminophen oral tablet $0 OTC eq acetaminophen pm oral tablet $0 OTC eq arthritis pain oral tablet extended release $0 OTC eq headache relief oral tablet $0 OTC eq pain & fever childrens oral suspension $0 OTC eq pain & fever childrens oral tablet chewable $0 OTC eq pain & fever infants oral suspension $0 OTC eq pain relief/rapid burst oral liquid $0 OTC eq pain reliever oral tablet $0 OTC eql acetaminophen childrens oral suspension $0 OTC eql acetaminophen ex st oral tablet $0 OTC eql acetaminophen infants oral suspension $0 OTC eql acetaminophen pm oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 84

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

eql menstrual relief max st oral tablet $0 OTC eql migraine formula oral tablet $0 OTC eql pain relief pm ex st oral tablet $0 OTC EXCEDRIN EXTRA STRENGTH ORAL TABLET $0 OTC EXCEDRIN MIGRAINE ORAL TABLET $0 OTC extraprin oral tablet $0 OTC gnp 8 hour arthritis relief oral tablet extended release $0 OTC gnp 8 hour pain reliever oral tablet extended release $0 OTC gnp acetaminophen oral tablet $0 OTC gnp headache relief extra str oral tablet $0 OTC gnp infants pain/fever oral suspension $0 OTC gnp migraine relief oral tablet $0 OTC gnp pain & fever childrens oral suspension 160 mg/5ml $0 OTC gnp pain & fever infants oral suspension $0 OTC gnp pain relief extra strength oral tablet $0 OTC gnp pain relief oral tablet $0 OTC gnp pain relief pm ex st oral tablet 25-500 mg $0 OTC goodsense arthritis pain oral tablet extended release $0 OTC goodsense headache pm oral tablet $0 OTC goodsense migraine formula oral tablet $0 OTC goodsense pain & fever child oral suspension $0 OTC goodsense pain & fever infants oral suspension $0 OTC goodsense pain relief extra st oral tablet $0 OTC goodsense pain relief pm ex st oral tablet 25-500 mg $0 OTC headache relief oral tablet $0 OTC HEALTHY MAMA EAZZZE THE PAIN ORAL TABLET $0 OTC HEALTHY MAMA SHAKE THAT ACHE ORAL TABLET $0 OTC hm acetaminophen childrens oral tablet chewable $0 OTC hm arthritis pain relief oral tablet extended release $0 OTC hm daytime cold & flu oral liquid $0 OTC hm migraine relief oral tablet $0 OTC hm pain & fever childrens oral suspension $0 OTC hm pain & fever infants oral suspension $0 OTC hm pain relief extra strength oral tablet $0 OTC hm pain reliever oral tablet $0 OTC hm pain reliever pm ex st oral tablet 25-500 mg $0 OTC infants pain & fever oral suspension $0 OTC kls acetaminophen ex st oral tablet $0 OTC liquid acetaminophen oral liquid $0 OTC liquid pain relief oral liquid $0 OTC LITTLE REMEDIES FOR FEVER ORAL LIQUID $0 OTC MAPAP ACETAMINOPHEN EXTRA STR ORAL LIQUID $0 OTC mapap arthritis pain oral tablet extended release $0 OTC MAPAP CHILDRENS ORAL TABLET CHEWABLE $0 OTC mapap oral capsule $0 OTC mapap oral liquid $0 OTC mapap oral tablet 325 mg $0 OTC mapap oral tablet chewable $0 OTC menstrual relief max strength oral tablet $0 OTC migraine formula oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 85

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

migraine relief oral tablet $0 OTC m-pap oral liquid $0 OTC mucus relief cold/sinus max st oral liquid $0 OTC night time pain medicine ex st oral tablet $0 OTC non-aspirin childrens oral suspension $0 OTC non-aspirin extra strength oral tablet $0 OTC non-aspirin oral tablet $0 OTC non-aspirin pain relief oral tablet $0 OTC non-aspirin pm oral tablet $0 OTC pain & fever childrens oral suspension $0 OTC pain & fever infants oral suspension $0 OTC pain relief childrens oral suspension $0 OTC pain relief extra strength oral tablet 500 mg $0 OTC pain relief oral liquid $0 OTC pain relief pm extra strength oral tablet $0 OTC pain relief regular strength oral tablet $0 OTC pain reliever extra strength oral tablet $0 OTC pain reliever oral tablet 325 mg $0 OTC pain reliever plus oral tablet $0 OTC pain reliever pm ex st oral tablet $0 OTC pain reliever pm oral tablet 500-25 mg $0 OTC pain reliever/fever reducer rectal suppository $0 OTC pain-off oral tablet $0 OTC PAMPRIN MAX ORAL TABLET $0 OTC PEDIACARE CHILDREN ORAL SUSPENSION $0 OTC PHARBETOL EXTRA STRENGTH ORAL TABLET $0 OTC PHARBETOL ORAL TABLET 325 MG $0 OTC px arthritis pain relief oral tablet extended release $0 OTC px childrens pain relief oral suspension $0 OTC px migraine relief oral tablet $0 OTC px pain relief extra strength oral tablet $0 OTC px pain relief pm ex st oral tablet $0 OTC qc acetaminophen 8 hours oral tablet extended release $0 OTC qc arthritis pain relief oral tablet extended release $0 OTC qc headache relief oral tablet $0 OTC qc non-aspirin 8 hour oral tablet extended release $0 OTC qc non-aspirin childrens oral suspension $0 OTC qc non-aspirin extra strength oral tablet $0 OTC qc pain relief childrens oral suspension $0 OTC qc pain relief extra strength oral tablet $0 OTC qc pain relief infants oral suspension $0 OTC qc pain relief oral tablet $0 OTC ra 8 hour pain relief oral tablet extended release $0 OTC ra acetaminophen childrens oral tablet chewable $0 OTC ra acetaminophen ex st oral tablet $0 OTC ra acetaminophen oral tablet $0 OTC ra acetaminophen pm ex st oral tablet $0 OTC ra arthritis pain relief oral tablet extended release $0 OTC ra childrens fever/pain oral suspension $0 OTC ra fever reducer/pain reliever oral suspension $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 86

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra menstrual relief oral tablet $0 OTC ra migraine relief oral tablet $0 OTC ra pain relief acetaminophen oral tablet $0 OTC ra pain reliever ex st oral tablet $0 OTC sb non-aspirin extra strength oral tablet $0 OTC sb non-aspirin nighttime oral tablet $0 OTC sb non-aspirin oral tablet $0 OTC sb non-aspirin oral tablet chewable 80 mg $0 OTC sb pain relief x-str oral tablet $0 OTC sb pain reliever childrens oral suspension $0 OTC sb pain reliever ex st oral tablet $0 OTC sm 8 hour pain relief oral tablet extended release $0 OTC sm arthritis pain relief oral tablet extended release $0 OTC sm arthritis pain reliever oral tablet extended release $0 OTC sm migraine relief oral tablet $0 OTC sm pain & fever childrens oral suspension $0 OTC sm pain & fever infants oral suspension $0 OTC sm pain relief extra strength oral tablet $0 OTC sm pain reliever ex st oral tablet $0 OTC sm pain reliever ex st oral tablet extended release $0 OTC sm pain reliever oral tablet 325 mg $0 OTC sm pain reliever pm ex st oral tablet $0 OTC tactinal oral tablet $0 OTC TYLENOL 8 HOUR ARTHRITIS PAIN ORAL TABLET EXTENDED RELEASE $0 OTC

TYLENOL EXTRA STRENGTH ORAL TABLET $0 OTC TYLENOL PM EXTRA STRENGTH ORAL TABLET $0 OTC Anticholinergic Agents (Cns) aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC allergy childrens oral liquid $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 87

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC eql nighttime sleep aid oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg $0 OTC m-dryl oral liquid $0 OTC night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC pharbedryl oral capsule $0 OTC qc complete allergy medicine oral tablet $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC total allergy oral tablet $0 OTC Antimigraine Agents, Miscellaneous 8 hour arthritis pain reliever oral tablet extended release $0 OTC 8 hour pain reliever oral tablet extended release $0 OTC 8 hr arthritis pain relief oral tablet extended release $0 OTC 8hr muscle aches & pain oral tablet extended release $0 OTC acetaminophen 8 hour oral tablet extended release $0 OTC acetaminophen childrens oral solution $0 OTC acetaminophen childrens oral suspension 160 mg/5ml $0 OTC acetaminophen childrens oral tablet chewable 160 mg $0 OTC acetaminophen er oral tablet extended release $0 OTC acetaminophen extra strength oral tablet $0 OTC acetaminophen infants oral suspension $0 OTC acetaminophen junior strength oral tablet dispersible $0 OTC acetaminophen oral liquid $0 OTC acetaminophen oral solution 160 mg/5ml, 325 mg/10.15ml, 650 mg/20.3ml $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 88

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

acetaminophen oral suspension 160 mg/5ml, 325 mg/10.15ml, 650 mg/20.3ml $0 OTC

acetaminophen oral tablet 325 mg $0 OTC acetaminophen oral tablet 500 mg $0 OTC acetaminophen oral tablet chewable 160 mg, 80 mg $0 OTC acetaminophen rectal suppository 120 mg, 650 mg $0 OTC ADDAPRIN ORAL TABLET $0 OTC adult aspirin regimen oral tablet delayed release $0 OTC all day pain relief oral tablet $0 OTC all day relief oral tablet $0 OTC arthritis pain relief oral tablet extended release $0 OTC arthritis pain reliever oral tablet extended release $0 OTC aspirin 81 oral tablet chewable $0 OTC aspirin adult low dose oral tablet delayed release $0 OTC aspirin adult low strength oral tablet delayed release $0 OTC aspirin childrens oral tablet chewable $0 OTC aspirin ec adult low strength oral tablet delayed release $0 OTC aspirin ec low dose oral tablet delayed release $0 OTC aspirin ec low strength oral tablet delayed release $0 OTC aspirin ec oral tablet delayed release $0 OTC aspirin low dose oral tablet chewable $0 OTC aspirin low dose oral tablet delayed release $0 OTC aspirin low strength oral tablet chewable $0 OTC aspirin oral tablet 325 mg $0 OTC aspirin oral tablet chewable $0 OTC aspirin oral tablet delayed release 325 mg, 81 mg $0 OTC aspirin rectal suppository 300 mg $0 OTC ASPIR-LOW ORAL TABLET DELAYED RELEASE $0 OTC aurophen childrens oral suspension $0 OTC BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC

BAYER ASPIRIN ORAL TABLET $0 OTC BAYER ASPIRIN ORAL TABLET DELAYED RELEASE $0 OTC BAYER LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC betatemp childrens oral suspension $0 OTC BUFFERIN ORAL TABLET $0 OTC childrens acetaminophen oral suspension 160 mg/5ml $0 OTC CHILDRENS ADVIL ORAL SUSPENSION 100 MG/5ML $0 OTC childrens apap oral tablet chewable $0 OTC childrens aspirin oral tablet chewable $0 OTC childrens ibuprofen 100 oral suspension $0 OTC childrens ibuprofen oral suspension 100 mg/5ml $0 OTC childrens non-aspirin oral tablet chewable $0 OTC childrens silapap oral liquid $0 OTC cvs 8hr arthritis pain relief oral tablet extended release $0 OTC cvs 8hr muscle aches & pain oral tablet extended release $0 OTC cvs acetaminophen ex st oral liquid $0 OTC cvs acetaminophen ex st oral tablet $0 OTC cvs acetaminophen oral liquid $0 OTC cvs acetaminophen oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 89

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs all day pain relief oral tablet $0 OTC cvs arthritis pain relief oral tablet extended release $0 OTC cvs aspirin adult low dose oral tablet chewable $0 OTC cvs aspirin adult low strength oral tablet delayed release $0 OTC cvs aspirin ec oral tablet delayed release $0 OTC cvs aspirin low dose oral tablet delayed release $0 OTC cvs aspirin low strength oral tablet delayed release $0 OTC cvs aspirin oral tablet 325 mg $0 OTC cvs childrens ibuprofen oral suspension $0 OTC cvs childs non-aspirin oral tablet chewable $0 OTC cvs fever reducing childrens rectal suppository $0 OTC cvs ibuprofen childrens oral suspension 100 mg/5ml $0 OTC cvs ibuprofen infants oral suspension $0 OTC cvs ibuprofen junior strength oral tablet chewable $0 OTC cvs ibuprofen oral tablet $0 OTC cvs infants pain relief drops oral suspension 160 mg/5ml $0 OTC cvs naproxen sodium oral tablet $0 OTC cvs non-aspirin childrens oral tablet chewable $0 OTC cvs non-aspirin extra strength oral tablet $0 OTC cvs pain & fever childrens oral suspension $0 OTC cvs pain & fever infants oral suspension $0 OTC cvs pain relief childrens oral suspension $0 OTC cvs pain relief childrens oral tablet chewable $0 OTC cvs pain relief extra strength oral tablet $0 OTC cvs pain relief oral tablet $0 OTC cvs pain relief oral tablet extended release $0 OTC cvs pain relief regular st oral tablet $0 OTC ECPIRIN ORAL TABLET DELAYED RELEASE $0 OTC ed-apap oral liquid $0 OTC eq 8hr arthritis pain relief oral tablet extended release $0 OTC eq acetaminophen oral tablet $0 OTC eq arthritis pain oral tablet extended release $0 OTC eq aspirin adult low dose oral tablet delayed release $0 OTC eq aspirin low dose oral tablet chewable $0 OTC eq aspirin oral tablet $0 OTC eq ibuprofen childrens oral suspension $0 OTC eq ibuprofen junior oral tablet chewable $0 OTC eq ibuprofen oral tablet $0 OTC eq naproxen sodium oral tablet $0 OTC eq pain & fever childrens oral suspension $0 OTC eq pain & fever childrens oral tablet chewable $0 OTC eq pain & fever infants oral suspension $0 OTC eq pain relief/rapid burst oral liquid $0 OTC eq pain reliever oral tablet $0 OTC eql acetaminophen childrens oral suspension $0 OTC eql acetaminophen ex st oral tablet $0 OTC eql acetaminophen infants oral suspension $0 OTC eql aspirin ec oral tablet delayed release 325 mg $0 OTC eql aspirin low dose oral tablet chewable $0 OTC eql aspirin low dose oral tablet delayed release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 90

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

eql childrens ibuprofen oral suspension $0 OTC eql ibuprofen infants oral suspension $0 OTC eql ibuprofen junior strength oral tablet chewable $0 OTC eql ibuprofen oral tablet $0 OTC eql naproxen sodium oral tablet $0 OTC gnp 8 hour arthritis relief oral tablet extended release $0 OTC gnp 8 hour pain reliever oral tablet extended release $0 OTC gnp acetaminophen oral tablet $0 OTC gnp adult aspirin low strength oral tablet chewable $0 OTC gnp aspirin low dose oral tablet delayed release $0 OTC gnp aspirin oral tablet 325 mg $0 OTC gnp aspirin oral tablet delayed release $0 OTC gnp childrens ibuprofen oral suspension $0 OTC gnp ibuprofen infants oral suspension $0 OTC gnp ibuprofen oral tablet $0 OTC gnp infants pain/fever oral suspension $0 OTC gnp naproxen sodium oral tablet $0 OTC gnp pain & fever childrens oral suspension 160 mg/5ml $0 OTC gnp pain & fever infants oral suspension $0 OTC gnp pain relief extra strength oral tablet $0 OTC gnp pain relief oral tablet $0 OTC goodsense arthritis pain oral tablet extended release $0 OTC goodsense aspirin adult low st oral tablet chewable $0 OTC goodsense aspirin low dose oral tablet delayed release $0 OTC goodsense aspirin oral tablet $0 OTC goodsense aspirin oral tablet chewable $0 OTC goodsense aspirin oral tablet delayed release $0 OTC goodsense ibuprofen childrens oral suspension $0 OTC goodsense ibuprofen infants oral suspension $0 OTC goodsense ibuprofen oral tablet $0 OTC goodsense naproxen sodium oral tablet $0 OTC goodsense pain & fever child oral suspension $0 OTC goodsense pain & fever infants oral suspension $0 OTC goodsense pain relief extra st oral tablet $0 OTC HEALTHY MAMA SHAKE THAT ACHE ORAL TABLET $0 OTC hm acetaminophen childrens oral tablet chewable $0 OTC hm arthritis pain relief oral tablet extended release $0 OTC hm aspirin ec low dose oral tablet delayed release $0 OTC hm aspirin ec oral tablet delayed release $0 OTC hm aspirin oral tablet $0 OTC hm aspirin oral tablet chewable $0 OTC hm ibuprofen childrens oral suspension $0 OTC hm ibuprofen ib oral tablet $0 OTC hm ibuprofen ib oral tablet chewable $0 OTC hm ibuprofen infants oral suspension $0 OTC hm ibuprofen oral tablet $0 OTC hm naproxen sodium oral tablet $0 OTC hm pain & fever childrens oral suspension $0 OTC hm pain & fever infants oral suspension $0 OTC hm pain relief extra strength oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 91

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

hm pain reliever oral tablet $0 OTC ibu-200 oral tablet $0 OTC ibuprofen childrens oral suspension $0 OTC ibuprofen infants oral suspension $0 OTC ibuprofen junior strength oral tablet chewable $0 OTC ibuprofen oral suspension $0 OTC ibuprofen oral tablet 200 mg $0 OTC infants ibuprofen oral suspension $0 OTC infants pain & fever oral suspension $0 OTC kls acetaminophen ex st oral tablet $0 OTC kls aspirin low dose oral tablet delayed release $0 OTC kls ibuprofen ib oral tablet $0 OTC kls ibuprofen oral tablet $0 OTC kp aspirin oral tablet delayed release $0 OTC liquid acetaminophen oral liquid $0 OTC liquid pain relief oral liquid $0 OTC LITTLE REMEDIES FOR FEVER ORAL LIQUID $0 OTC MAPAP ACETAMINOPHEN EXTRA STR ORAL LIQUID $0 OTC mapap arthritis pain oral tablet extended release $0 OTC MAPAP CHILDRENS ORAL TABLET CHEWABLE $0 OTC mapap oral capsule $0 OTC mapap oral liquid $0 OTC mapap oral tablet 325 mg $0 OTC mapap oral tablet chewable $0 OTC MEDIPROXEN ORAL TABLET $0 OTC meijer ibuprofen oral tablet $0 OTC MOTRIN IB ORAL TABLET $0 OTC m-pap oral liquid $0 OTC naproxen sodium oral tablet 220 mg $0 OTC non-aspirin childrens oral suspension $0 OTC non-aspirin extra strength oral tablet $0 OTC non-aspirin oral tablet $0 OTC non-aspirin pain relief oral tablet $0 OTC pain & fever childrens oral suspension $0 OTC pain & fever infants oral suspension $0 OTC pain relief childrens oral suspension $0 OTC pain relief extra strength oral tablet 500 mg $0 OTC pain relief oral liquid $0 OTC pain relief regular strength oral tablet $0 OTC pain reliever extra strength oral tablet 500 mg $0 OTC pain reliever oral tablet 325 mg $0 OTC pain reliever/fever reducer rectal suppository $0 OTC PEDIACARE CHILDREN ORAL SUSPENSION $0 OTC PHARBETOL EXTRA STRENGTH ORAL TABLET $0 OTC PHARBETOL ORAL TABLET 325 MG $0 OTC px all day relief oral tablet $0 OTC px arthritis pain relief oral tablet extended release $0 OTC px aspirin oral tablet $0 OTC px aspirin oral tablet chewable $0 OTC px childrens pain relief oral suspension $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 92

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

px childrens profen ib oral suspension $0 OTC px ibuprofen junior strength oral tablet chewable $0 OTC px ibuprofen oral tablet $0 OTC px infants profen ib oral suspension $0 OTC px pain relief extra strength oral tablet $0 OTC qc acetaminophen 8 hours oral tablet extended release $0 OTC qc arthritis pain relief oral tablet extended release $0 OTC qc aspirin low dose oral tablet chewable $0 OTC qc aspirin low dose oral tablet delayed release $0 OTC qc aspirin oral tablet $0 OTC qc aspirin oral tablet delayed release $0 OTC qc childrens ibuprofen oral suspension $0 OTC qc enteric aspirin oral tablet delayed release $0 OTC qc ibuprofen ib oral tablet $0 OTC qc ibuprofen oral tablet $0 OTC qc naproxen sodium oral tablet $0 OTC qc non-aspirin 8 hour oral tablet extended release $0 OTC qc non-aspirin childrens oral suspension $0 OTC qc non-aspirin extra strength oral tablet $0 OTC qc pain relief childrens oral suspension $0 OTC qc pain relief extra strength oral tablet $0 OTC qc pain relief infants oral suspension $0 OTC qc pain relief oral tablet $0 OTC ra 8 hour pain relief oral tablet extended release $0 OTC ra acetaminophen childrens oral tablet chewable $0 OTC ra acetaminophen ex st oral tablet $0 OTC ra acetaminophen oral tablet $0 OTC ra arthritis pain relief oral tablet extended release $0 OTC ra aspirin adult low dose oral tablet chewable $0 OTC ra aspirin adult low strength oral tablet chewable $0 OTC ra aspirin childrens oral tablet chewable $0 OTC ra aspirin ec adult low st oral tablet delayed release $0 OTC ra aspirin ec oral tablet delayed release $0 OTC ra aspirin oral tablet 325 mg $0 OTC ra childrens fever/pain oral suspension $0 OTC ra fever reducer/pain reliever oral suspension $0 OTC ra ibuprofen childrens oral suspension $0 OTC ra ibuprofen infants oral suspension $0 OTC ra ibuprofen junior strength oral tablet chewable $0 OTC ra ibuprofen oral tablet $0 OTC ra naproxen sodium oral tablet $0 OTC ra pain relief acetaminophen oral tablet $0 OTC ra pain relief ibuprofen oral tablet $0 OTC sb aspirin ec oral tablet delayed release $0 OTC sb aspirin oral tablet $0 OTC sb childrens aspirin oral tablet chewable $0 OTC sb ibuprofen oral tablet $0 OTC sb infants ibuprofen oral suspension $0 OTC sb low dose asa ec oral tablet delayed release $0 OTC sb naproxen sodium oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 93

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sb non-aspirin extra strength oral tablet $0 OTC sb non-aspirin oral tablet $0 OTC sb non-aspirin oral tablet chewable 80 mg $0 OTC sb pain reliever childrens oral suspension $0 OTC sb pain reliever ex st oral tablet $0 OTC sm 8 hour pain relief oral tablet extended release $0 OTC sm arthritis pain relief oral tablet extended release $0 OTC sm arthritis pain reliever oral tablet extended release $0 OTC sm aspirin adult low strength oral tablet chewable $0 OTC sm aspirin adult low strength oral tablet delayed release $0 OTC sm aspirin ec low strength oral tablet delayed release $0 OTC sm aspirin ec oral tablet delayed release $0 OTC sm aspirin low dose oral tablet chewable $0 OTC sm aspirin oral tablet $0 OTC sm childrens aspirin oral tablet chewable $0 OTC sm childrens ibuprofen oral suspension $0 OTC sm ibuprofen ib oral tablet $0 OTC sm ibuprofen ib oral tablet chewable $0 OTC sm ibuprofen oral tablet $0 OTC sm infants ibuprofen oral suspension $0 OTC sm naproxen sodium oral tablet $0 OTC sm pain & fever childrens oral suspension $0 OTC sm pain & fever infants oral suspension $0 OTC sm pain relief extra strength oral tablet $0 OTC sm pain reliever ex st oral tablet $0 OTC sm pain reliever ex st oral tablet extended release $0 OTC sm pain reliever oral tablet 325 mg $0 OTC ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE $0 OTC ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC tactinal oral tablet $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC TYLENOL 8 HOUR ARTHRITIS PAIN ORAL TABLET EXTENDED RELEASE $0 OTC

TYLENOL EXTRA STRENGTH ORAL TABLET $0 OTC WAL-PROFEN ORAL TABLET $0 OTC Anxiolytics,Sedatives,And Hypnotics,Misc acetaminophen pm ex st oral tablet 500-25 mg $0 OTC acetaminophen pm oral tablet $0 OTC aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC allergy childrens oral liquid $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 94

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs pain relief pm ex st oral tablet $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC eq acetaminophen pm oral tablet $0 OTC eql acetaminophen pm oral tablet $0 OTC eql nighttime sleep aid oral tablet $0 OTC eql pain relief pm ex st oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC gnp pain relief pm ex st oral tablet 25-500 mg $0 OTC goodsense headache pm oral tablet $0 OTC goodsense pain relief pm ex st oral tablet 25-500 mg $0 OTC HEALTHY MAMA EAZZZE THE PAIN ORAL TABLET $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg $0 OTC hm pain reliever pm ex st oral tablet 25-500 mg $0 OTC m-dryl oral liquid $0 OTC night time pain medicine ex st oral tablet $0 OTC night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC non-aspirin pm oral tablet $0 OTC pain relief pm extra strength oral tablet $0 OTC pain reliever pm ex st oral tablet $0 OTC pain reliever pm oral tablet 500-25 mg $0 OTC pharbedryl oral capsule $0 OTC px pain relief pm ex st oral tablet $0 OTC qc complete allergy medicine oral tablet $0 OTC ra acetaminophen pm ex st oral tablet $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb non-aspirin nighttime oral tablet $0 OTC sb sleep oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 95

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC sm pain reliever pm ex st oral tablet $0 OTC total allergy oral tablet $0 OTC TYLENOL PM EXTRA STRENGTH ORAL TABLET $0 OTC Other Nonsteroidal Anti-Inflam. Agents ADDAPRIN ORAL TABLET $0 OTC all day pain relief oral tablet $0 OTC all day relief oral tablet $0 OTC CHILDRENS ADVIL ORAL SUSPENSION 100 MG/5ML $0 OTC childrens ibuprofen 100 oral suspension $0 OTC childrens ibuprofen oral suspension 100 mg/5ml $0 OTC cvs all day pain relief oral tablet $0 OTC cvs childrens ibuprofen oral suspension $0 OTC cvs ibuprofen childrens oral suspension 100 mg/5ml $0 OTC cvs ibuprofen infants oral suspension $0 OTC cvs ibuprofen junior strength oral tablet chewable $0 OTC cvs ibuprofen oral tablet $0 OTC cvs naproxen sodium oral tablet $0 OTC eq ibuprofen childrens oral suspension $0 OTC eq ibuprofen junior oral tablet chewable $0 OTC eq ibuprofen oral tablet $0 OTC eq naproxen sodium oral tablet $0 OTC eql childrens ibuprofen oral suspension $0 OTC eql ibuprofen infants oral suspension $0 OTC eql ibuprofen junior strength oral tablet chewable $0 OTC eql ibuprofen oral tablet $0 OTC eql naproxen sodium oral tablet $0 OTC gnp childrens ibuprofen oral suspension $0 OTC gnp ibuprofen infants oral suspension $0 OTC gnp ibuprofen oral tablet $0 OTC gnp naproxen sodium oral tablet $0 OTC goodsense ibuprofen childrens oral suspension $0 OTC goodsense ibuprofen infants oral suspension $0 OTC goodsense ibuprofen oral tablet $0 OTC goodsense naproxen sodium oral tablet $0 OTC hm ibuprofen childrens oral suspension $0 OTC hm ibuprofen ib oral tablet $0 OTC hm ibuprofen ib oral tablet chewable $0 OTC hm ibuprofen infants oral suspension $0 OTC hm ibuprofen oral tablet $0 OTC hm naproxen sodium oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 96

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ibu-200 oral tablet $0 OTC ibuprofen childrens oral suspension $0 OTC ibuprofen infants oral suspension $0 OTC ibuprofen junior strength oral tablet chewable $0 OTC ibuprofen oral suspension $0 OTC ibuprofen oral tablet 200 mg $0 OTC infants ibuprofen oral suspension $0 OTC kls ibuprofen ib oral tablet $0 OTC kls ibuprofen oral tablet $0 OTC MEDIPROXEN ORAL TABLET $0 OTC meijer ibuprofen oral tablet $0 OTC MOTRIN IB ORAL TABLET $0 OTC naproxen sodium oral tablet 220 mg $0 OTC px all day relief oral tablet $0 OTC px childrens profen ib oral suspension $0 OTC px ibuprofen junior strength oral tablet chewable $0 OTC px ibuprofen oral tablet $0 OTC px infants profen ib oral suspension $0 OTC qc childrens ibuprofen oral suspension $0 OTC qc ibuprofen ib oral tablet $0 OTC qc ibuprofen oral tablet $0 OTC qc naproxen sodium oral tablet $0 OTC ra ibuprofen childrens oral suspension $0 OTC ra ibuprofen infants oral suspension $0 OTC ra ibuprofen junior strength oral tablet chewable $0 OTC ra ibuprofen oral tablet $0 OTC ra naproxen sodium oral tablet $0 OTC ra pain relief ibuprofen oral tablet $0 OTC sb ibuprofen oral tablet $0 OTC sb infants ibuprofen oral suspension $0 OTC sb naproxen sodium oral tablet $0 OTC sm childrens ibuprofen oral suspension $0 OTC sm ibuprofen ib oral tablet $0 OTC sm ibuprofen ib oral tablet chewable $0 OTC sm ibuprofen oral tablet $0 OTC sm infants ibuprofen oral suspension $0 OTC sm naproxen sodium oral tablet $0 OTC WAL-PROFEN ORAL TABLET $0 OTC Respiratory And Cns Stimulants BAYER MIGRAINE ORAL TABLET $0 OTC cvs headache relief oral tablet $0 OTC cvs menstrual relief oral tablet $0 OTC cvs migraine relief oral tablet $0 OTC eq headache relief oral tablet $0 OTC eql menstrual relief max st oral tablet $0 OTC eql migraine formula oral tablet $0 OTC EXCEDRIN EXTRA STRENGTH ORAL TABLET $0 OTC EXCEDRIN MIGRAINE ORAL TABLET $0 OTC extraprin oral tablet $0 OTC gnp headache relief extra str oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

gnp migraine relief oral tablet $0 OTC goodsense migraine formula oral tablet $0 OTC headache relief oral tablet $0 OTC hm migraine relief oral tablet $0 OTC menstrual relief max strength oral tablet $0 OTC migraine formula oral tablet $0 OTC migraine relief oral tablet $0 OTC pain reliever extra strength oral tablet 250-250-65 mg $0 OTC pain reliever plus oral tablet $0 OTC pain-off oral tablet $0 OTC PAMPRIN MAX ORAL TABLET $0 OTC px migraine relief oral tablet $0 OTC qc headache relief oral tablet $0 OTC ra menstrual relief oral tablet $0 OTC ra migraine relief oral tablet $0 OTC ra pain reliever ex st oral tablet $0 OTC sb pain relief x-str oral tablet $0 OTC sm migraine relief oral tablet $0 OTC Salicylates adult aspirin regimen oral tablet delayed release $0 OTC aspirin 81 oral tablet chewable $0 OTC aspirin adult low dose oral tablet delayed release $0 OTC aspirin adult low strength oral tablet delayed release $0 OTC aspirin childrens oral tablet chewable $0 OTC aspirin ec adult low strength oral tablet delayed release $0 OTC aspirin ec low dose oral tablet delayed release $0 OTC aspirin ec low strength oral tablet delayed release $0 OTC aspirin ec oral tablet delayed release $0 OTC aspirin low dose oral tablet chewable $0 OTC aspirin low dose oral tablet delayed release $0 OTC aspirin low strength oral tablet chewable $0 OTC aspirin oral tablet 325 mg $0 OTC aspirin oral tablet chewable $0 OTC aspirin oral tablet delayed release 325 mg, 81 mg $0 OTC aspirin rectal suppository 300 mg $0 OTC ASPIR-LOW ORAL TABLET DELAYED RELEASE $0 OTC BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC

BAYER ASPIRIN ORAL TABLET $0 OTC BAYER ASPIRIN ORAL TABLET DELAYED RELEASE $0 OTC BAYER LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC BAYER MIGRAINE ORAL TABLET $0 OTC BUFFERIN ORAL TABLET $0 OTC childrens aspirin oral tablet chewable $0 OTC cvs aspirin adult low dose oral tablet chewable $0 OTC cvs aspirin adult low strength oral tablet delayed release $0 OTC cvs aspirin ec oral tablet delayed release $0 OTC cvs aspirin low dose oral tablet delayed release $0 OTC cvs aspirin low strength oral tablet delayed release $0 OTC cvs aspirin oral tablet 325 mg $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs headache relief oral tablet $0 OTC cvs migraine relief oral tablet $0 OTC ECPIRIN ORAL TABLET DELAYED RELEASE $0 OTC eq aspirin adult low dose oral tablet delayed release $0 OTC eq aspirin low dose oral tablet chewable $0 OTC eq aspirin oral tablet $0 OTC eq headache relief oral tablet $0 OTC eql aspirin ec oral tablet delayed release 325 mg $0 OTC eql aspirin low dose oral tablet chewable $0 OTC eql aspirin low dose oral tablet delayed release $0 OTC eql migraine formula oral tablet $0 OTC EXCEDRIN EXTRA STRENGTH ORAL TABLET $0 OTC EXCEDRIN MIGRAINE ORAL TABLET $0 OTC extraprin oral tablet $0 OTC gnp adult aspirin low strength oral tablet chewable $0 OTC gnp aspirin low dose oral tablet delayed release $0 OTC gnp aspirin oral tablet 325 mg $0 OTC gnp aspirin oral tablet delayed release $0 OTC gnp headache relief extra str oral tablet $0 OTC gnp migraine relief oral tablet $0 OTC goodsense aspirin adult low st oral tablet chewable $0 OTC goodsense aspirin low dose oral tablet delayed release $0 OTC goodsense aspirin oral tablet $0 OTC goodsense aspirin oral tablet chewable $0 OTC goodsense aspirin oral tablet delayed release $0 OTC goodsense migraine formula oral tablet $0 OTC headache relief oral tablet $0 OTC hm aspirin ec low dose oral tablet delayed release $0 OTC hm aspirin ec oral tablet delayed release $0 OTC hm aspirin oral tablet $0 OTC hm aspirin oral tablet chewable $0 OTC hm migraine relief oral tablet $0 OTC kls aspirin low dose oral tablet delayed release $0 OTC kp aspirin oral tablet delayed release $0 OTC migraine formula oral tablet $0 OTC migraine relief oral tablet $0 OTC pain reliever extra strength oral tablet 250-250-65 mg $0 OTC pain reliever plus oral tablet $0 OTC pain-off oral tablet $0 OTC PAMPRIN MAX ORAL TABLET $0 OTC px aspirin oral tablet $0 OTC px aspirin oral tablet chewable $0 OTC px migraine relief oral tablet $0 OTC qc aspirin low dose oral tablet chewable $0 OTC qc aspirin low dose oral tablet delayed release $0 OTC qc aspirin oral tablet $0 OTC qc aspirin oral tablet delayed release $0 OTC qc enteric aspirin oral tablet delayed release $0 OTC qc headache relief oral tablet $0 OTC ra aspirin adult low dose oral tablet chewable $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra aspirin adult low strength oral tablet chewable $0 OTC ra aspirin childrens oral tablet chewable $0 OTC ra aspirin ec adult low st oral tablet delayed release $0 OTC ra aspirin ec oral tablet delayed release $0 OTC ra aspirin oral tablet 325 mg $0 OTC ra migraine relief oral tablet $0 OTC ra pain reliever ex st oral tablet $0 OTC sb aspirin ec oral tablet delayed release $0 OTC sb aspirin oral tablet $0 OTC sb childrens aspirin oral tablet chewable $0 OTC sb low dose asa ec oral tablet delayed release $0 OTC sb pain relief x-str oral tablet $0 OTC sm aspirin adult low strength oral tablet chewable $0 OTC sm aspirin adult low strength oral tablet delayed release $0 OTC sm aspirin ec low strength oral tablet delayed release $0 OTC sm aspirin ec oral tablet delayed release $0 OTC sm aspirin low dose oral tablet chewable $0 OTC sm aspirin oral tablet $0 OTC sm childrens aspirin oral tablet chewable $0 OTC sm migraine relief oral tablet $0 OTC ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE $0 OTC ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC Devices Devices ACCU-CHEK GUIDE KIT $0 OTC QL CONTOUR MONITOR DEVICE $0 OTC QL CONTOUR NEXT ONE KIT $0 OTC QL maxi pad ultra thin pad $0 OTC Diagnostic Agents Diabetes Mellitus ACCU-CHEK GUIDE IN VITRO STRIP $0 OTC QL Electrolytic, Caloric, And Water Balance Caloric Agents cvs glucose oral tablet chewable 4-6 gm-mg $0 OTC QL DEX4 GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL DEX4 NATURALS ORAL TABLET CHEWABLE $0 OTC QL DEX4 ORAL TABLET CHEWABLE 4-6 GM-MG $0 OTC QL DEX4 POUCH PACK ORAL TABLET CHEWABLE $0 OTC QL glucose instant energy oral tablet chewable $0 OTC QL glucose oral tablet chewable 4-6 gm-mg $0 OTC QL gnp glucose oral tablet chewable 4-6 gm-mg $0 OTC QL goodsense glucose oral tablet chewable 4-6 gm-mg $0 OTC QL kroger glucose oral tablet chewable $0 OTC QL l-carnitine oral capsule 500 mg $0 OTC l-carnitine oral tablet 500 mg $0 OTC leader glucose oral tablet chewable $0 OTC QL levocarnitine fumarate oral tablet $0 OTC longs glucose oral tablet chewable 4-6 gm-mg $0 OTC QL meijer glucose oral tablet chewable 4-6 gm-mg $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

preferred plus glucose oral tablet chewable $0 OTC QL px glucose oral tablet chewable $0 OTC QL ra glucose oral tablet chewable $0 OTC QL RELION GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL sm glucose oral tablet chewable 4-6 gm-mg $0 OTC QL SMART SENSE GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL tgt glucose oral tablet chewable 4-6 gm-mg $0 OTC QL TRUEPLUS GLUCOSE ON THE GO ORAL TABLET CHEWABLE $0 OTC QL TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL TYR COOLER ORAL LIQUID $0 OTC up & up glucose oral tablet chewable $0 OTC QL walgreens glucose oral tablet chewable 4-6 gm-mg $0 OTC QL Replacement Preparations 50+ adult eye health oral capsule $0 OTC a thru z advanced oral tablet $0 OTC a thru z select 50+ advanced oral tablet $0 OTC a thru z select 50+ mens oral tablet $0 OTC a thru z select advanced oral tablet $0 OTC a thru z select oral tablet $0 OTC a thru z select ultimate women oral tablet $0 OTC a thru z ultimate mens oral tablet $0 OTC ABC PLUS SENIOR ADULTS 50+ ORAL TABLET $0 OTC ADVANTAGE CARE ELECTROLYTE PED ORAL SOLUTION $0 OTC antioxidant a/c/e/selenium oral tablet $0 OTC antioxidant oral capsule $0 OTC BD POSIFLUSH INTRAVENOUS SOLUTION $0 OTC biotin plus/calcium/vit d3 oral tablet $0 OTC BPROTECTED MULTI-VITE ORAL LIQUID $0 OTC CALCITRATE ORAL TABLET 315-250 MG-UNIT $0 OTC cal-citrate plus vitamin d oral tablet $0 OTC calcium 1000 + d oral tablet $0 OTC calcium 500 + d oral tablet 500-125 mg-unit $0 OTC calcium 500 + d3 oral tablet 500-600 mg-unit $0 OTC calcium 500/d oral tablet $0 OTC calcium 500+d high potency oral tablet $0 OTC calcium 500+d oral tablet $0 OTC calcium 500+d3 oral tablet 500-400 mg-unit $0 OTC calcium 600 high potency oral tablet $0 OTC calcium 600 oral tablet $0 OTC calcium 600/vitamin d oral tablet $0 OTC calcium 600/vitamin d oral tablet chewable $0 OTC calcium 600+d high potency oral tablet $0 OTC calcium 600+d oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC calcium 600+d3 oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC calcium 600+d3 plus minerals oral tablet chewable $0 OTC calcium carb-cholecalciferol oral tablet 600-400 mg-unit $0 OTC calcium carbonate oral tablet 1250 (500 ca) mg, 1500 (600 ca) mg, 600 mg $0 OTC

calcium carbonate oral tablet chewable 1250 (500 ca) mg $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

calcium carbonate-vitamin d oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC

calcium citrate + d oral tablet 250-200 mg-unit, 315-200 mg-unit, 315-250 mg-unit $0 OTC

calcium citrate + d3 maximum oral tablet $0 OTC calcium citrate + d3 oral tablet 200-250 mg-unit, 250-200 mg-unit $0 OTC calcium citrate+d3 oral tablet $0 OTC calcium citrate+d3 petites oral tablet $0 OTC calcium citrate-vitamin d oral tablet 315-200 mg-unit, 315-250 mg-unit $0 OTC calcium citrate-vitamin d3 oral tablet $0 OTC calcium extra d3 oral tablet $0 OTC calcium high potency oral tablet 1500 (600 ca) mg $0 OTC calcium high potency/vitamin d oral tablet $0 OTC calcium oral tablet chewable 500-100 mg-unit $0 OTC calcium plus vitamin d3 oral tablet $0 OTC calcium/c/d oral tablet chewable $0 OTC calcium+d3 oral tablet 500-10 mg-mcg, 500-15 mg-mcg $0 OTC calcium-vitamin d oral tablet 500-400 mg-unit, 600-400 mg-unit $0 OTC calcium-vitamin d3 oral tablet 250-125 mg-unit, 500-400 mg-unit, 600-400 mg-unit $0 OTC

centravites 50 plus oral tablet $0 OTC centravites adults oral tablet $0 OTC centravites oral tablet $0 OTC CENTRUM ADULTS ORAL TABLET $0 OTC CENTRUM ORAL LIQUID $0 OTC CENTRUM SILVER ADULT 50+ ORAL TABLET $0 OTC CENTRUM SILVER ORAL TABLET $0 OTC CENTRUM SPECIALIST HEART ORAL TABLET $0 OTC CENTRUM ULTRA WOMENS ORAL TABLET $0 OTC certa plus oral tablet $0 OTC CERTAVITE/ANTIOXIDANTS ORAL TABLET $0 OTC CITRACAL MAXIMUM ORAL TABLET $0 OTC citrus calcium/vitamin d oral tablet 200-250 mg-unit $0 OTC companion oral tablet $0 OTC complete multivitamin/mineral oral liquid $0 OTC cvs calcium 600 + d/minerals oral tablet chewable $0 OTC cvs calcium carbonate oral tablet $0 OTC cvs calcium citrate+d3 oral tablet $0 OTC cvs calcium citrate+d3 petites oral tablet $0 OTC cvs calcium oral tablet 600 mg $0 OTC cvs daily multiple for men oral tablet $0 OTC cvs daily multiple women 50+ oral tablet $0 OTC cvs electrolyte solution oral solution $0 OTC cvs eye health & lutein oral tablet $0 OTC cvs eye health adult 50+ oral capsule $0 OTC cvs gummy dinos oral tablet chewable $0 OTC cvs magnesium oral tablet 500 mg $0 OTC cvs magnesium oxide oral tablet 250 mg $0 OTC cvs one daily essential oral tablet $0 OTC cvs one daily womens formula oral tablet $0 OTC cvs oyster shell calcium-vit d oral tablet 500-125 mg-unit $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs ped electrolyte freeze pop oral solution $0 OTC cvs pediatric electrolyte oral solution $0 OTC cvs spectravite adult 50+ oral tablet $0 OTC cvs spectravite advanced oral tablet $0 OTC cvs spectravite senior oral tablet $0 OTC cvs spectravite ultra men 50+ oral tablet $0 OTC cvs spectravite ultra mens oral tablet $0 OTC cvs spectravite ultra women oral tablet $0 OTC cvs spectravite womens senior oral tablet $0 OTC cvs stress formula/zinc oral tablet $0 OTC cvs womens active daily oral tablet $0 OTC daily multiple vitamins/min oral tablet $0 OTC daily vitamin formula+minerals oral tablet $0 OTC diabetes health formula oral tablet $0 OTC eq calcium 500+d oral tablet $0 OTC eq calcium 600+d oral tablet 600-800 mg-unit $0 OTC eq calcium citrate+d oral tablet $0 OTC eq complete multivit adult 50+ oral tablet $0 OTC eq complete multivitamin-adult oral tablet $0 OTC eq multivitamin gummies oral tablet chewable $0 OTC eq one daily mens health oral tablet $0 OTC eq one daily womens health oral tablet $0 OTC eql calcium citrate/vitamin d oral tablet $0 OTC eql calcium citrate/vitamin d3 oral tablet $0 OTC eql century oral tablet $0 OTC eql one daily mens health oral tablet $0 OTC eql one daily womens 50+ adv oral tablet $0 OTC eql one daily womens oral tablet $0 OTC eql vision formula oral tablet $0 OTC ESSENTIA ORAL TABLET $0 OTC essential one daily multivit oral tablet $0 OTC gnp calcium 500 +d3 oral tablet $0 OTC gnp calcium 600 +d3/minerals oral tablet chewable $0 OTC gnp calcium citrate +d3 oral tablet $0 OTC gnp calcium oral tablet 1500 (600 ca) mg $0 OTC gnp century adults 50+ senior oral tablet $0 OTC gnp century oral tablet $0 OTC gnp century ultimate mens oral tablet $0 OTC gnp century ultimate womens oral tablet $0 OTC gnp hair/skin/nails oral tablet $0 OTC gnp healthy eyes oral tablet $0 OTC gnp healthy eyes supervision oral capsule $0 OTC gnp mega multi for men oral tablet $0 OTC gnp mega multi for women oral tablet $0 OTC gnp one daily mens health 50+ oral tablet $0 OTC gnp one daily mens/lycopene oral tablet $0 OTC gnp one daily womens 50+ oral tablet $0 OTC gnp one daily womens health oral tablet $0 OTC gnp one daily womens oral tablet $0 OTC gnp therapeutic-m oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

GUMMI BEAR MULTIVITAMIN/MIN ORAL TABLET CHEWABLE $0 OTC hair vitamins oral tablet $0 OTC hair/skin/nails oral tablet $0 OTC healthy eyes oral tablet $0 OTC healthy eyes/lutein oral tablet $0 OTC h-e-b oral electrolyte oral solution $0 OTC hm calcium citrate+d3 petite oral tablet $0 OTC hm complete men oral tablet $0 OTC hm complete women oral tablet $0 OTC hm pediatric electrolyte oral solution $0 OTC hm womens 50+ advanced daily oral tablet $0 OTC ICAPS MV ORAL TABLET $0 OTC ICAPS ORAL CAPSULE $0 OTC kp adults 50+ daily formula oral tablet $0 OTC kp adults daily formula oral tablet $0 OTC kp calcium citrate+d oral tablet $0 OTC kp mag-oxide magnesium oral tablet $0 OTC kp mens daily formula oral tablet $0 OTC KP VISION FORMULA/LUTEIN ORAL TABLET $0 OTC kp womens 50+ daily formula oral tablet $0 OTC kp womens daily formula oral tablet $0 OTC K-PAX IMMUNE PROFESSIONAL ST ORAL TABLET $0 OTC kpn prenatal oral tablet $0 OTC LYSIPLEX PLUS ORAL LIQUID $0 OTC MACUVITE/LUTEIN ORAL TABLET $0 OTC MAGDELAY ORAL TABLET DELAYED RELEASE 64 MG $0 OTC mag-g oral tablet $0 OTC magnesium chloride oral tablet delayed release $0 OTC magnesium gluconate oral tablet 27.5 mg, 500 mg $0 OTC magnesium lactate oral tablet extended release $0 OTC magnesium oral capsule 300 mg $0 OTC magnesium oral tablet 250 mg, 400 mg $0 OTC magnesium oxide -mg supplement oral tablet $0 OTC magnesium oxide oral capsule 500 mg $0 OTC magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 mg) mg, 500 mg $0 OTC

MAGNESIUM-OXIDE ORAL TABLET $0 OTC MAG-OXIDE ORAL TABLET 200 MG $0 OTC mega multivitamin for men oral tablet $0 OTC mega multivitamin for women oral tablet $0 OTC mens multi vitamin & mineral oral tablet $0 OTC mgo oral tablet $0 OTC MILLTRIUM SENIOR ORAL TABLET $0 OTC MONOJECT FLUSH SYRINGE INTRAVENOUS SOLUTION $0 OTC MONOJECT SODIUM CHLORIDE FLUSH INTRAVENOUS SOLUTION $0 OTC

multi complete/iron oral tablet $0 OTC multiple vit/minerals/no iron oral tablet $0 OTC multiple vitamins/womens oral tablet $0 OTC multivitamin & mineral oral liquid $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

multivitamin adults 50+ oral tablet $0 OTC multivitamin adults oral tablet $0 OTC multivitamin men 50+ oral tablet $0 OTC multivitamin men oral tablet $0 OTC multivitamin oral liquid $0 OTC multivitamin women 50+ oral tablet $0 OTC multivitamin women oral tablet $0 OTC multi-vitamin/minerals oral tablet $0 OTC multivitamins/minerals adult oral liquid $0 OTC multi-vite oral liquid $0 OTC no iron mult vitamin-minerals oral tablet $0 OTC normal saline flush intravenous solution $0 OTC oceanic selenium oral tablet 50 mcg $0 OTC ocutabs oral tablet $0 OTC ocutabs-lutein oral tablet $0 OTC OCUVITE-LUTEIN ORAL TABLET $0 OTC ONCOVITE ORAL TABLET $0 OTC one daily calcium/iron oral tablet $0 OTC one daily for men 50+ advanced oral tablet $0 OTC one daily for men/lycopene oral tablet $0 OTC one daily for women 50+ adv oral tablet $0 OTC one daily for women oral tablet $0 OTC one daily maximum oral tablet $0 OTC one daily mens health oral tablet $0 OTC one daily mens oral tablet $0 OTC ONE DAILY PLUS IRON ORAL TABLET $0 OTC one daily womens 50 plus oral tablet $0 OTC one daily/minerals oral tablet $0 OTC ONE-A-DAY TEEN ADVANTAGE/HER ORAL TABLET $0 OTC ONE-A-DAY TEEN ADVANTAGE/HIM ORAL TABLET $0 OTC oral electrolytes oral solution $0 OTC ORALYTE FREEZER POPS ORAL SOLUTION $0 OTC ORALYTE ORAL SOLUTION $0 OTC OS-CAL CALCIUM + D3 ORAL TABLET $0 OTC OYSCO 500+D ORAL TABLET $0 OTC oyster calcium oral tablet $0 OTC oyster shell calcium + d oral tablet $0 OTC oyster shell calcium + d3 oral tablet $0 OTC oyster shell calcium 250+d oral tablet $0 OTC oyster shell calcium 500 + d oral tablet 500-125 mg-unit $0 OTC oyster shell calcium oral tablet 500 mg $0 OTC oyster shell calcium plus d oral tablet 500-200 mg-unit $0 OTC oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit, 500-400 mg-unit, 500-5 mg-mcg $0 OTC

oyster shell calcium/d3 oral tablet $0 OTC oyster shell calcium/vitamin d oral tablet $0 OTC OYSTERCAL-D ORAL TABLET $0 OTC ped electrolyte freeze pops oral solution $0 OTC ped electrolyte freezer pops oral solution $0 OTC pediatric electrolyte oral solution $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

pediatric electrolyte-zinc oral solution $0 OTC px complete senior multivits oral tablet $0 OTC qc daily multivit/multimineral oral tablet $0 OTC qc mens daily multivitamin oral tablet $0 OTC quintabs-m oral tablet $0 OTC ra calcium 600 oral tablet 1500 (600 ca) mg $0 OTC ra calcium 600/vitamin d-3 oral tablet $0 OTC ra calcium cit plus vit d-3 oral tablet $0 OTC ra calcium cit-vit d-3 petites oral tablet $0 OTC RA CENTRAL-VITE ORAL TABLET $0 OTC ra central-vite womens mature oral tablet $0 OTC RA HI CAL ORAL TABLET $0 OTC ra magnesium oral capsule $0 OTC ra natural magnesium oral tablet $0 OTC ra one daily maximum oral tablet $0 OTC ra one daily mens/vit d-3 oral tablet $0 OTC ra pediatric electrolyte oral solution $0 OTC ra zinc oral tablet $0 OTC selenium oral capsule $0 OTC selenium oral tablet 100 mcg, 50 mcg $0 OTC senior tabs oral tablet $0 OTC sentry adult oral tablet $0 OTC sentry oral tablet $0 OTC sentry senior oral tablet $0 OTC sm antioxidant vitamins oral tablet $0 OTC sm calcium 500/vitamin d3 oral tablet $0 OTC sm calcium 600/vitamin d oral tablet $0 OTC sm calcium citrate+/vit d3 oral tablet $0 OTC sm calcium citrate+d3 petite oral tablet $0 OTC sm calcium citrate-vit d oral tablet $0 OTC sm calcium/vitamin d oral tablet 500-200 mg-unit $0 OTC sm calcium-vitamin d oral tablet 500-200 mg-unit $0 OTC sm complete 50+ oral tablet $0 OTC sm complete 50+ ultimate mens oral tablet $0 OTC sm complete 50+ ultimate women oral tablet $0 OTC sm complete advanced formula oral tablet $0 OTC sm complete oral tablet $0 OTC sm complete senior formula oral tablet $0 OTC sm hair/skin/nails oral tablet $0 OTC sm magnesium oral tablet $0 OTC sm magnesium oxide oral tablet $0 OTC sm one daily essential oral tablet $0 OTC sm one daily mens oral tablet $0 OTC sm one daily womens oral tablet $0 OTC sm opti-vitamins oral tablet $0 OTC sm oyster shell calcium/vit d oral tablet $0 OTC sm oyster shell calcium/vit d3 oral tablet $0 OTC sm pediatric electrolyte oral solution $0 OTC sm zinc gluconate oral tablet $0 OTC sodium chloride oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

stress b/zinc oral tablet $0 OTC stress formula/iron (mvi) oral tablet $0 OTC super antioxidant oral capsule $0 OTC super calcium 600 + d 400 oral tablet $0 OTC super calcium 600 + d3 oral tablet $0 OTC super calcium oral tablet 1500 (600 ca) mg $0 OTC super multiple oral tablet $0 OTC super thera vite m oral tablet $0 OTC THERAGRAN-M PREMIER 50 PLUS ORAL TABLET $0 OTC thera-m oral tablet $0 OTC therapeutic m oral tablet $0 OTC therapeutic-m oral tablet $0 OTC therapeutic-m/lutein oral tablet $0 OTC THERATRUM COMPLETE 50 PLUS ORAL TABLET $0 OTC THERATRUM COMPLETE ORAL TABLET $0 OTC vision formula eye health oral capsule $0 OTC vision formula/lutein oral tablet $0 OTC vision vitamins oral tablet $0 OTC vitachew multiple vitamin oral tablet chewable $0 OTC VITALETS CHILDRENS ORAL TABLET CHEWABLE $0 OTC vitamins a-d-e/selenium oral tablet $0 OTC VITRUM SENIOR ORAL TABLET $0 OTC womens daily form/fa/ca/fe oral tablet $0 OTC womens daily formula oral tablet $0 OTC womens multivitamin oral tablet $0 OTC womens one daily oral tablet $0 OTC YELETS TEENAGE FORMULA ORAL TABLET $0 OTC zinc chelated oral tablet 50 mg $0 OTC zinc gluconate oral tablet 100 mg, 30 mg, 50 mg $0 OTC zinc oral capsule 220 (50 zn) mg $0 OTC zinc oral tablet 30 mg, 50 mg $0 OTC zinc sulfate oral capsule 220 (50 zn) mg $0 OTC zoo friends oral tablet chewable $0 OTC Eye, Ear, Nose And Throat (Eent) Preps. Antiallergic Agents cromolyn sodium nasal aerosol solution $0 OTC cvs allergy eye drops ophthalmic solution $0 OTC QL cvs eye itch relief ophthalmic solution $0 OTC QL eye itch relief ophthalmic solution $0 OTC QL ketotifen fumarate ophthalmic solution $0 OTC QL kp ketotifen fumarate ophthalmic solution $0 OTC QL ra eye itch relief ophthalmic solution $0 OTC QL sm eye itch relief ophthalmic solution $0 OTC QL ZADITOR OPHTHALMIC SOLUTION $0 OTC QL Contact Lens Solutions B&L SENSITIVE EYES DAILY CLEAN SOLUTION $0 OTC B&L SENSITIVE EYES SOLUTION $0 OTC BIOTRUE SOLUTION $0 OTC BOSTON ADVANCE CLEANER SOLUTION $0 OTC BOSTON ADVANCE CONDITIONING SOLUTION $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

BOSTON CONDITIONING SOLUTION $0 OTC BOSTON ONE STEP CLEANER SOLUTION $0 OTC BOSTON REWETTING SOLUTION $0 OTC BOSTON SIMPLUS SOLUTION $0 OTC cvs contact lens relief/rewet solution $0 OTC cvs multi-purpose no-rub solution $0 OTC gnp multi-purpose solution $0 OTC hm multi-purpose no rub solution $0 OTC multi-purpose no-rub solution $0 OTC multi-purpose solution solution $0 OTC OPTI-FREE DAILY CLEANER SOLUTION $0 OTC OPTI-FREE EXPRESS REWETTING SOLUTION $0 OTC OPTI-FREE EXPRESS SOLUTION $0 OTC OPTI-FREE REPLENISH SOLUTION $0 OTC ra cleaning/disinfecting lens solution $0 OTC ra saline solution solution $0 OTC RENU DISINFECTING SOLUTION $0 OTC RENU MULTIPLUS LUB/REWETTING SOLUTION $0 OTC RENU MULTIPLUS SOLUTION $0 OTC RENU REWETTING DROPS SOLUTION $0 OTC rewetting drops solution $0 OTC saline solution $0 OTC sb multi-purpose solution $0 OTC SENSITIVE EYES PLUS SALINE SOLUTION $0 OTC sm multi-purpose solution $0 OTC sm saline solution solution $0 OTC VISINE FOR CONTACTS SOLUTION $0 OTC Corticosteroids (Eent) cvs nasal allergy spray nasal aerosol $0 OTC eq nasal allergy nasal aerosol $0 OTC gnp 24 hour nasal allergy nasal aerosol $0 OTC goodsense nasal allergy spray nasal aerosol $0 OTC KLS ALLER-CORT NASAL AEROSOL $0 OTC nasal allergy 24 hour nasal aerosol $0 OTC ra nasal allergy nasal aerosol $0 OTC triamcinolone acetonide nasal aerosol $0 OTC Eent Anti-Infectives, Miscellaneous artificial tears ophthalmic solution 0.5-0.6 %, 5-6 mg/ml $0 OTC QL cvs ear drops otic solution $0 OTC cvs ear wax removal system otic solution $0 OTC cvs earwax removal kit otic solution $0 OTC ear drops earwax aid otic solution $0 OTC ear drops otic solution $0 OTC ear wax removal drops otic solution $0 OTC ear wax removal kit otic solution $0 OTC ear wax removal system otic solution $0 OTC earwax removal kit otic solution $0 OTC earwax removal otic solution $0 OTC earwax treatment drops otic solution $0 OTC eq ear wax removal aid otic solution $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 108

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

gnp artificial tears ophthalmic solution $0 OTC QL gnp earwax removal drops otic solution $0 OTC gnp earwax removal kit otic solution $0 OTC goodsense artificial tears ophthalmic solution $0 OTC QL goodsense ear wax removal otic solution $0 OTC px artificial tears ophthalmic solution $0 OTC QL qc artificial tears ophthalmic solution $0 OTC QL ra ear drops otic solution $0 OTC sm ear drops otic solution $0 OTC Eent Drugs, Miscellaneous ALTACHLORE OPHTHALMIC OINTMENT $0 OTC ALTACHLORE OPHTHALMIC SOLUTION $0 OTC altamist spray nasal solution $0 OTC artificial tears ophthalmic solution 0.1-0.3 %, 0.5-0.6 %, 5-6 mg/ml $0 OTC QL artificial tears ophthalmic solution 1 % $0 OTC artificial tears pf ophthalmic solution $0 OTC cromolyn sodium nasal aerosol solution $0 OTC cvs dry-eye relief nighttime ophthalmic ointment $0 OTC cvs eye lubricant ophthalmic ointment $0 OTC cvs lubricant drops fast act ophthalmic solution $0 OTC cvs lubricant drops long last ophthalmic solution $0 OTC cvs lubricant eye drops (pf) ophthalmic solution $0 OTC cvs lubricant eye drops ophthalmic solution 0.4-0.3 % $0 OTC cvs lubricant eye drops ophthalmic solution 0.5 % $0 OTC QL cvs natural tears pf ophthalmic solution $0 OTC cvs saline nasal spray nasal solution $0 OTC cvs sodium chloride ophthalmic ointment $0 OTC cvs sodium chloride ophthalmic solution $0 OTC deep sea nasal spray nasal solution $0 OTC eq lubricant eye drops ophthalmic solution $0 OTC eq restore plus lubricant eye ophthalmic solution $0 OTC EQ RESTORE PM OPHTHALMIC OINTMENT $0 OTC eq restore tears ophthalmic solution $0 OTC QL eq saline nasal spray nasal solution $0 OTC eql saline nasal spray nasal solution $0 OTC eye lubricant ophthalmic ointment $0 OTC for sty relief ophthalmic ointment $0 OTC GENTEAL TEARS OPHTHALMIC SOLUTION 0.1-0.2-0.3 % $0 OTC gnp artificial tears ophthalmic solution $0 OTC QL gnp eye drops long lasting ophthalmic solution $0 OTC gnp lubricating plus eye drops ophthalmic solution $0 OTC gnp nasal moisturizing nasal solution $0 OTC goodsense artificial tears ophthalmic solution $0 OTC QL goodsense lubricating eye drop ophthalmic solution $0 OTC hm lubricating plus ophthalmic solution $0 OTC hm lubricating tears ophthalmic solution $0 OTC hm saline nasal spray nasal solution $0 OTC liquitears ophthalmic solution $0 OTC lubricant eye drops ophthalmic solution 0.4-0.3 % $0 OTC lubricant eye drops ophthalmic solution 0.5 % $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 109

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

lubricant eye drops pf ophthalmic solution $0 OTC lubricant eye nighttime ophthalmic ointment $0 OTC lubricant eye ophthalmic ointment $0 OTC lubricant pm ophthalmic ointment $0 OTC lubricating eye drops ophthalmic solution 0.4-0.3 % $0 OTC lubricating plus eye drops ophthalmic solution $0 OTC lubricating tears eye drops ophthalmic solution $0 OTC MOISTURE EYES OPHTHALMIC SOLUTION $0 OTC MURO 128 OPHTHALMIC OINTMENT $0 OTC MURO 128 OPHTHALMIC SOLUTION 2 % $0 OTC nasal moisturizing spray nasal solution $0 OTC polyvinyl alcohol ophthalmic solution $0 OTC PURE & GENTLE LUBRICANT OPHTHALMIC SOLUTION 3 MG/ML $0 OTC px artificial tears ophthalmic solution $0 OTC QL px saline nasal spray nasal solution $0 OTC qc artificial tears ophthalmic solution $0 OTC QL ra lubricant eye drops ophthalmic solution 0.5 % $0 OTC QL ra lubricant eye ophthalmic solution 0.4-0.3 % $0 OTC ra saline nasal spray nasal solution $0 OTC REFRESH LACRI-LUBE OPHTHALMIC OINTMENT $0 OTC RETAINE CMC OPHTHALMIC SOLUTION $0 OTC RETAINE PM OPHTHALMIC OINTMENT $0 OTC saline mist spray nasal solution $0 OTC saline nasal spray nasal solution $0 OTC sb saline nose nasal solution $0 OTC sm artificial tears ophthalmic solution $0 OTC QL sm lubricant eye drops ophthalmic solution $0 OTC sm lubricating plus ophthalmic solution $0 OTC sm lubricating tears ophthalmic solution $0 OTC sm nasal spray saline nasal solution $0 OTC sodium chloride (hypertonic) ophthalmic ointment $0 OTC sodium chloride (hypertonic) ophthalmic solution $0 OTC SOOTHE HYDRATION OPHTHALMIC SOLUTION $0 OTC SOOTHE XP XTRA PROTECTION OPHTHALMIC SOLUTION $0 OTC QL SYSTANE CONTACTS OPHTHALMIC SOLUTION $0 OTC QL tears pure ophthalmic solution $0 OTC QL ULTRA FRESH OPHTHALMIC SOLUTION $0 OTC QL ULTRA FRESH PM OPHTHALMIC OINTMENT $0 OTC ultra lubricating eye drops ophthalmic solution $0 OTC Vasoconstrictors 12 hour decongestant nasal solution $0 OTC 12 hour nasal decongestant nasal solution $0 OTC 12 hour nasal relief spray nasal solution $0 OTC 12 hour nasal spray nasal solution $0 OTC 4-WAY FAST ACTING NASAL SOLUTION $0 OTC AFRIN NODRIP EXTRA MOISTURE NASAL SOLUTION $0 OTC AFRIN NODRIP SEVERE CONGEST NASAL SOLUTION $0 OTC AFRIN NODRIP SINUS NASAL SOLUTION $0 OTC AFRIN PUMP MIST NASAL SOLUTION $0 OTC anefrin spray nasal solution $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 110

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs nasal mist nasal solution $0 OTC cvs nasal spray nasal solution 0.05 % $0 OTC ephrine nose drops nasal solution $0 OTC eq nasal spray fast acting nasal solution $0 OTC eq nasal spray nasal solution $0 OTC eql nasal spray 12 hour nasal solution $0 OTC eql nasal spray fast acting nasal solution $0 OTC eql nasal spray no drip nasal solution $0 OTC gnp nasal spray extra moist nasal solution $0 OTC gnp nasal spray fast acting nasal solution $0 OTC gnp nasal spray nasal solution $0 OTC gnp no drip nasal spray nasal solution $0 OTC hm nasal spray nasal solution $0 OTC hm nose drops nasal solution $0 OTC hm sinus nasal spray nasal solution $0 OTC MUCINEX SINUS-MAX CLEAR & COOL NASAL SOLUTION $0 OTC MUCINEX SINUS-MAX SINUS/ALLRGY NASAL SOLUTION $0 OTC nasal decongestant spray nasal solution $0 OTC nasal four nasal solution $0 OTC nasal relief nasal solution $0 OTC nasal spray 12 hour nasal solution $0 OTC nasal spray extra moisturizing nasal solution $0 OTC nasal spray nasal solution 0.05 % $0 OTC nasal spray no drip nasal solution $0 OTC nasal spray sinus nasal solution $0 OTC no drip nasal spray nasal solution $0 OTC px nasal four nasal solution $0 OTC px nasal spray moisturizing nasal solution $0 OTC px no drip nasal spray nasal solution $0 OTC px original nasal spray nasal solution $0 OTC QLEARQUIL NASAL SOLUTION $0 OTC ra 12 hour nasal spray nasal solution $0 OTC ra nose drops extra strength nasal solution $0 OTC sb 12hr nasal spray nasal solution $0 OTC sinus nasal spray nasal solution $0 OTC sinus relief extra strength nasal solution $0 OTC sinus relief nasal solution $0 OTC sm nasal spray 12 hour nasal solution $0 OTC sm nasal spray moisturizing nasal solution $0 OTC sm nasal spray nasal solution 0.05 % $0 OTC sm nasal spray sinus nasal solution $0 OTC sm nose drops nasal decongest nasal solution $0 OTC VICKS SINEX 12 HOUR DECONGEST NASAL SOLUTION $0 OTC VICKS SINEX MOISTURIZING NASAL SOLUTION $0 OTC VICKS SINEX SEVERE DECONGEST NASAL SOLUTION $0 OTC WAL-FOUR NASAL SOLUTION $0 OTC Gastrointestinal Drugs Antacids And Adsorbents activated vegetable charcoal oral capsule $0 OTC ALMACONE DOUBLE STRENGTH ORAL SUSPENSION $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

alum & mag hydroxide-simeth oral suspension $0 OTC aluminum hydroxide gel oral suspension 320 mg/5ml $0 OTC antacid advanced oral suspension $0 OTC antacid anti-gas max strength oral suspension $0 OTC antacid anti-gas reg strength oral suspension $0 OTC antacid calcium oral tablet chewable $0 OTC antacid extra strength oral tablet chewable 750 mg $0 OTC antacid fast relief oral suspension $0 OTC ANTACID FLAVOR CHEWS ORAL TABLET CHEWABLE $0 OTC antacid liquid oral suspension $0 OTC antacid m oral suspension $0 OTC antacid maximum oral tablet chewable $0 OTC antacid maximum strength oral suspension 400-400-40 mg/5ml $0 OTC antacid oral suspension 200-200-20 mg/5ml $0 OTC antacid oral tablet chewable 1177 mg, 500 mg $0 OTC antacid plus anti-gas relief oral suspension $0 OTC antacid regular strength oral suspension $0 OTC antacid regular strength oral tablet chewable $0 OTC antacid soft chews oral tablet chewable $0 OTC antacid ultra strength oral tablet chewable 1000 mg $0 OTC bismatrol oral suspension $0 OTC BUFFERIN ORAL TABLET $0 OTC calcium antacid extra strength oral tablet chewable $0 OTC calcium antacid oral tablet chewable $0 OTC calcium carbonate antacid oral suspension $0 OTC calcium carbonate antacid oral tablet chewable 500 mg $0 OTC CAL-GEST ANTACID ORAL TABLET CHEWABLE $0 OTC charcoal activated oral capsule 260 mg $0 OTC charcoal oral capsule 200 mg $0 OTC childrens pepto oral tablet chewable $0 OTC CHILDRENS SOOTHE ORAL TABLET CHEWABLE $0 OTC comfort gel antacid & anti-gas oral suspension $0 OTC comfort gel antacid anti-gas oral suspension 400-400-40 mg/5ml $0 OTC cvs antacid extra strength oral tablet chewable 750 mg $0 OTC cvs antacid kids oral tablet chewable $0 OTC cvs antacid maximum strength oral tablet chewable $0 OTC cvs antacid plus antigas oral suspension $0 OTC cvs antacid soft chews ultr st oral tablet chewable $0 OTC cvs antacid ultra strength oral tablet chewable $0 OTC cvs antacid/anti-gas oral suspension $0 OTC cvs anti-diarrheal oral suspension $0 OTC CVS CHEWY NOT CHALKY FLAVOR ORAL TABLET CHEWABLE $0 OTC cvs smooth antacid extra st oral tablet chewable $0 OTC cvs stomach relief max st oral suspension $0 OTC cvs stomach relief oral suspension 525 mg/15ml, 525 mg/30ml $0 OTC diarrhea oral suspension $0 OTC eq antacid extra strength oral tablet chewable 750 mg $0 OTC eq antacid maximum strength oral suspension $0 OTC eq antacid ultra strength oral tablet chewable $0 OTC eq antacid/anti-gas oral suspension $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 112

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

eq stomach relief oral suspension $0 OTC eql antacid advanced max st oral suspension $0 OTC eql antacid oral tablet chewable $0 OTC eql antacid ultra strength oral tablet chewable $0 OTC eql antacid/anti-gas oral suspension $0 OTC eql stomach relief oral suspension 262 mg/15ml $0 OTC geri-lanta oral suspension $0 OTC geri-mox oral suspension $0 OTC geri-pectate oral suspension $0 OTC gnp antacid & anti-gas oral suspension $0 OTC gnp antacid extra strength oral tablet chewable 750 mg $0 OTC gnp antacid oral tablet chewable 500 mg $0 OTC gnp antacid regular strength oral suspension $0 OTC gnp antacid ultra strength oral tablet chewable $0 OTC gnp magnesium oxide oral tablet $0 OTC gnp stomach relief oral suspension $0 OTC hm advanced antacid max st oral suspension $0 OTC hm antacid anti-gas ex st oral suspension $0 OTC hm antacid oral suspension $0 OTC hm calcium antacid ex st oral tablet chewable $0 OTC hm stomach relief oral suspension 525 mg/30ml $0 OTC HYVEE ADVANCED ANTACID ORAL SUSPENSION $0 OTC KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION $0 OTC KAOPECTATE ORAL SUSPENSION $0 OTC KERR INSTA-CHAR ORAL LIQUID $0 OTC mag-al plus xs oral liquid $0 OTC magnesium oxide (antacid) oral capsule $0 OTC magnesium oxide -mg supplement oral tablet $0 OTC magnesium oxide oral tablet 250 mg, 400 mg $0 OTC meijer antacid oral suspension 400-400-40 mg/5ml $0 OTC mintox maximum strength oral suspension $0 OTC MINTOX ORAL SUSPENSION $0 OTC MYLANTA MAXIMUM STRENGTH ORAL SUSPENSION $0 OTC pink bismuth maximum strength oral suspension $0 OTC pink bismuth oral suspension 262 mg/15ml $0 OTC px antacid extra strength oral tablet chewable $0 OTC px antacid maximum strength oral suspension $0 OTC px antacid maximum strength oral tablet chewable $0 OTC px antacid regular strength oral suspension $0 OTC px calcium antacid oral tablet chewable $0 OTC px stomach relief max st oral suspension $0 OTC px stomach relief oral suspension $0 OTC qc antacid extra strength oral tablet chewable $0 OTC qc antacid oral suspension $0 OTC qc antacid oral tablet chewable $0 OTC qc antacid/anti-gas oral suspension $0 OTC qc diarrhea relief oral suspension $0 OTC ra antacid oral tablet chewable $0 OTC ra antacid ultra strength oral tablet chewable $0 OTC ra antacid/anti-gas max st oral suspension $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra antacid/anti-gas oral suspension $0 OTC ra antacid/gas relief max st oral suspension $0 OTC ra stomach relief oral suspension $0 OTC sb antacid anti-gas oral suspension $0 OTC sb antacid extra strength oral tablet chewable $0 OTC sb antacid oral tablet chewable $0 OTC sm antacid advanced max st oral suspension $0 OTC sm antacid advanced oral suspension $0 OTC sm antacid anti-gas oral suspension $0 OTC sm antacid maximum strength oral suspension $0 OTC sm antacid/antigas oral suspension $0 OTC sm calcium antacid ex st oral tablet chewable $0 OTC sm calcium antacid oral tablet chewable $0 OTC sm foaming antacid oral tablet chewable $0 OTC sm smooth antacid ex st oral tablet chewable $0 OTC sm stomach relief oral suspension 262 mg/15ml, 525 mg/30ml $0 OTC sodium bicarbonate oral tablet 650 mg $0 OTC SOOTHE ORAL SUSPENSION 262 MG/15ML $0 OTC stomach relief oral suspension 525 mg/30ml $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC TUMS CHEWY DELIGHTS ORAL TABLET CHEWABLE $0 OTC Antidiarrhea Agents anti-diarrheal oral capsule $0 OTC anti-diarrheal oral tablet $0 OTC bismatrol oral suspension $0 OTC cvs anti-diarrheal oral capsule $0 OTC cvs anti-diarrheal oral suspension $0 OTC cvs anti-diarrheal oral tablet $0 OTC cvs stomach relief max st oral suspension $0 OTC cvs stomach relief oral suspension 525 mg/15ml, 525 mg/30ml $0 OTC diamode oral tablet $0 OTC diarrhea oral suspension $0 OTC eq anti-diarrheal oral capsule $0 OTC eq anti-diarrheal oral tablet $0 OTC eq stomach relief oral suspension $0 OTC eql anti-diarrheal oral tablet $0 OTC eql stomach relief oral suspension 262 mg/15ml $0 OTC geri-pectate oral suspension $0 OTC gnp anti-diarrheal oral capsule $0 OTC gnp anti-diarrheal oral tablet $0 OTC gnp stomach relief oral suspension $0 OTC hm anti-diarrheal oral tablet $0 OTC hm stomach relief oral suspension 525 mg/30ml $0 OTC KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION $0 OTC KAOPECTATE ORAL SUSPENSION $0 OTC loperamide hcl oral liquid 1 mg/5ml $0 OTC loperamide hcl oral tablet $0 OTC meijer anti-diarrheal oral tablet $0 OTC pink bismuth maximum strength oral suspension $0 OTC pink bismuth oral suspension 262 mg/15ml $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 114

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

px stomach relief max st oral suspension $0 OTC px stomach relief oral suspension $0 OTC qc anti-diarrheal oral capsule $0 OTC qc anti-diarrheal oral tablet $0 OTC qc diarrhea relief oral suspension $0 OTC ra anti-diarrheal oral tablet $0 OTC ra stomach relief oral suspension $0 OTC sb anti-diarrhea oral tablet $0 OTC sm anti-diarrheal oral capsule $0 OTC sm anti-diarrheal oral tablet $0 OTC sm stomach relief oral suspension 262 mg/15ml, 525 mg/30ml $0 OTC SOOTHE ORAL SUSPENSION 262 MG/15ML $0 OTC stomach relief oral suspension 525 mg/30ml $0 OTC Antiflatulents ALMACONE DOUBLE STRENGTH ORAL SUSPENSION $0 OTC alum & mag hydroxide-simeth oral suspension $0 OTC antacid advanced oral suspension $0 OTC antacid anti-gas max strength oral suspension $0 OTC antacid anti-gas reg strength oral suspension $0 OTC antacid fast relief oral suspension $0 OTC antacid liquid oral suspension $0 OTC antacid m oral suspension $0 OTC antacid maximum strength oral suspension 400-400-40 mg/5ml $0 OTC antacid oral suspension 200-200-20 mg/5ml $0 OTC antacid plus anti-gas relief oral suspension $0 OTC antacid regular strength oral suspension $0 OTC comfort gel antacid & anti-gas oral suspension $0 OTC comfort gel antacid anti-gas oral suspension 400-400-40 mg/5ml $0 OTC cvs antacid plus antigas oral suspension $0 OTC cvs antacid/anti-gas oral suspension $0 OTC cvs gas relief extra strength oral tablet chewable $0 OTC cvs gas relief infants oral suspension $0 OTC cvs gas relief oral tablet chewable $0 OTC cvs gas relief ultra strength oral capsule $0 OTC cvs infants gas relief oral suspension $0 OTC drxchoice gas relief oral tablet chewable $0 OTC eq antacid maximum strength oral suspension $0 OTC eq antacid/anti-gas oral suspension $0 OTC eq gas relief extra strength oral tablet chewable $0 OTC eq infants gas relief oral suspension 40 mg/0.6ml $0 OTC eql antacid advanced max st oral suspension $0 OTC eql antacid/anti-gas oral suspension $0 OTC eql gas relief ultra strength oral capsule $0 OTC eql infants gas relief oral suspension $0 OTC gas relief drops infants oral suspension $0 OTC gas relief extra strength oral tablet chewable $0 OTC gas relief infants oral suspension $0 OTC gas relief oral liquid $0 OTC gas relief oral suspension $0 OTC gas relief oral tablet chewable $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 115

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

gas relief ultra strength oral capsule $0 OTC geri-lanta oral suspension $0 OTC geri-mox oral suspension $0 OTC gnp antacid & anti-gas oral suspension $0 OTC gnp antacid regular strength oral suspension $0 OTC gnp anti-gas oral capsule 180 mg $0 OTC gnp gas relief extra strength oral tablet chewable $0 OTC gnp gas relief oral tablet chewable $0 OTC gnp infant gas relief oral suspension $0 OTC goodsense gas relief oral tablet chewable $0 OTC hm advanced antacid max st oral suspension $0 OTC hm antacid anti-gas ex st oral suspension $0 OTC hm antacid oral suspension $0 OTC hm gas relief infants drops oral suspension $0 OTC hm gas relief oral tablet chewable 80 mg $0 OTC HYVEE ADVANCED ANTACID ORAL SUSPENSION $0 OTC infants gas relief oral suspension 20 mg/0.3ml $0 OTC infants simethicone oral suspension 20 mg/0.3ml $0 OTC LITTLE REMEDIES FOR TUMMYS ORAL SUSPENSION $0 OTC mag-al plus xs oral liquid $0 OTC meijer antacid oral suspension 400-400-40 mg/5ml $0 OTC mi-acid gas relief oral tablet chewable $0 OTC mintox maximum strength oral suspension $0 OTC MINTOX ORAL SUSPENSION $0 OTC MYLANTA MAXIMUM STRENGTH ORAL SUSPENSION $0 OTC MYLICON INFANTS GAS RELIEF ORAL SUSPENSION $0 OTC px antacid maximum strength oral suspension $0 OTC px antacid regular strength oral suspension $0 OTC px gas relief infants oral suspension $0 OTC px gas relief ultra strength oral capsule $0 OTC qc antacid oral suspension $0 OTC qc antacid/anti-gas oral suspension $0 OTC qc anti-gas oral capsule $0 OTC qc gas relief extra strength oral tablet chewable $0 OTC ra antacid/anti-gas max st oral suspension $0 OTC ra antacid/anti-gas oral suspension $0 OTC ra antacid/gas relief max st oral suspension $0 OTC ra gas relief extra strength oral tablet chewable $0 OTC ra gas relief oral tablet chewable $0 OTC sb antacid anti-gas oral suspension $0 OTC simethicone oral capsule 180 mg $0 OTC simethicone oral suspension 40 mg/0.6ml $0 OTC simethicone oral tablet chewable $0 OTC sm antacid advanced max st oral suspension $0 OTC sm antacid advanced oral suspension $0 OTC sm antacid anti-gas oral suspension $0 OTC sm antacid maximum strength oral suspension $0 OTC sm antacid/antigas oral suspension $0 OTC sm gas relief antiflatuent oral capsule $0 OTC sm gas relief infants drops oral suspension $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sm gas relief infants oral suspension $0 OTC sm gas relief oral tablet chewable $0 OTC Antihistamines (Gi Drugs) cvs motion sickness ii oral tablet $0 OTC cvs motion sickness relief oral tablet chewable $0 OTC eql motion sickness relief oral tablet $0 OTC gnp motion sickness relief oral tablet 25 mg $0 OTC hm motion sickness relief oral tablet 25 mg $0 OTC meclizine hcl oral tablet 12.5 mg, 25 mg $0 OTC meclizine hcl oral tablet chewable $0 OTC motion sickness relief oral tablet chewable $0 OTC motion-time oral tablet chewable $0 OTC ra motion sickness relief oral tablet chewable $0 OTC sm motion sickness oral tablet 25 mg $0 OTC TRAVEL-EASE ORAL TABLET 25 MG $0 OTC WAL-DRAM II ORAL TABLET $0 OTC Antiulcer Agents And Acid Suppressants aluminum hydroxide gel oral suspension 320 mg/5ml $0 OTC antacid calcium oral tablet chewable $0 OTC antacid extra strength oral tablet chewable 750 mg $0 OTC ANTACID FLAVOR CHEWS ORAL TABLET CHEWABLE $0 OTC antacid maximum oral tablet chewable $0 OTC antacid oral tablet chewable 1177 mg, 500 mg $0 OTC antacid regular strength oral tablet chewable $0 OTC antacid soft chews oral tablet chewable $0 OTC antacid ultra strength oral tablet chewable 1000 mg $0 OTC bismatrol oral suspension $0 OTC calcium antacid extra strength oral tablet chewable $0 OTC calcium antacid oral tablet chewable $0 OTC calcium carbonate antacid oral suspension $0 OTC calcium carbonate antacid oral tablet chewable 500 mg $0 OTC CAL-GEST ANTACID ORAL TABLET CHEWABLE $0 OTC childrens pepto oral tablet chewable $0 OTC CHILDRENS SOOTHE ORAL TABLET CHEWABLE $0 OTC cvs antacid extra strength oral tablet chewable 750 mg $0 OTC cvs antacid kids oral tablet chewable $0 OTC cvs antacid maximum strength oral tablet chewable $0 OTC cvs antacid soft chews ultr st oral tablet chewable $0 OTC cvs antacid ultra strength oral tablet chewable $0 OTC cvs anti-diarrheal oral suspension $0 OTC CVS CHEWY NOT CHALKY FLAVOR ORAL TABLET CHEWABLE $0 OTC cvs smooth antacid extra st oral tablet chewable $0 OTC cvs stomach relief max st oral suspension $0 OTC cvs stomach relief oral suspension 525 mg/15ml, 525 mg/30ml $0 OTC diarrhea oral suspension $0 OTC eq antacid extra strength oral tablet chewable 750 mg $0 OTC eq antacid ultra strength oral tablet chewable $0 OTC eq stomach relief oral suspension $0 OTC eql antacid oral tablet chewable $0 OTC eql antacid ultra strength oral tablet chewable $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 117

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

eql stomach relief oral suspension 262 mg/15ml $0 OTC geri-pectate oral suspension $0 OTC gnp antacid extra strength oral tablet chewable 750 mg $0 OTC gnp antacid oral tablet chewable 500 mg $0 OTC gnp antacid ultra strength oral tablet chewable $0 OTC gnp magnesium oxide oral tablet $0 OTC gnp stomach relief oral suspension $0 OTC hm calcium antacid ex st oral tablet chewable $0 OTC hm stomach relief oral suspension 525 mg/30ml $0 OTC KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION $0 OTC KAOPECTATE ORAL SUSPENSION $0 OTC magnesium oxide (antacid) oral capsule $0 OTC magnesium oxide -mg supplement oral tablet $0 OTC magnesium oxide oral tablet 250 mg, 400 mg $0 OTC pink bismuth maximum strength oral suspension $0 OTC pink bismuth oral suspension 262 mg/15ml $0 OTC px antacid extra strength oral tablet chewable $0 OTC px antacid maximum strength oral tablet chewable $0 OTC px calcium antacid oral tablet chewable $0 OTC px stomach relief max st oral suspension $0 OTC px stomach relief oral suspension $0 OTC qc antacid extra strength oral tablet chewable $0 OTC qc antacid oral tablet chewable $0 OTC qc diarrhea relief oral suspension $0 OTC ra antacid oral tablet chewable $0 OTC ra antacid ultra strength oral tablet chewable $0 OTC ra stomach relief oral suspension $0 OTC sb antacid extra strength oral tablet chewable $0 OTC sb antacid oral tablet chewable $0 OTC sm calcium antacid ex st oral tablet chewable $0 OTC sm calcium antacid oral tablet chewable $0 OTC sm smooth antacid ex st oral tablet chewable $0 OTC sm stomach relief oral suspension 262 mg/15ml, 525 mg/30ml $0 OTC sodium bicarbonate oral tablet 650 mg $0 OTC SOOTHE ORAL SUSPENSION 262 MG/15ML $0 OTC stomach relief oral suspension 525 mg/30ml $0 OTC TUMS CHEWY DELIGHTS ORAL TABLET CHEWABLE $0 OTC Cathartics And Laxatives ALOPHEN ORAL TABLET DELAYED RELEASE $0 OTC bisacodyl ec oral tablet delayed release $0 OTC bisacodyl laxative rectal suppository $0 OTC bisacodyl rectal suppository $0 OTC BUFFERIN ORAL TABLET $0 OTC chocolated laxative oral tablet chewable $0 OTC citrate of magnesia oral solution $0 OTC CITRUCEL ORAL POWDER $0 OTC CITRUCEL ORAL TABLET $0 OTC CLEARLAX ORAL POWDER $0 OTC QL COLACE ORAL CAPSULE 100 MG $0 OTC cvs bisacodyl oral tablet delayed release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 118

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs chocolate laxative pieces oral tablet chewable $0 OTC cvs citrate of magnesia oral solution $0 OTC cvs daily fiber oral capsule $0 OTC cvs enema disposable rectal enema $0 OTC cvs enema ready-to-use rectal enema $0 OTC cvs fiber laxative oral tablet $0 OTC cvs fiber oral capsule $0 OTC cvs gentle laxative oral tablet delayed release $0 OTC cvs gentle laxative rectal suppository $0 OTC cvs gentle laxative womens oral tablet delayed release $0 OTC cvs glycerin adult rectal suppository $0 OTC cvs glycerin child rectal suppository 1 gm $0 OTC cvs laxative dietary supplemnt oral tablet $0 OTC cvs magnesium citrate oral solution $0 OTC cvs milk of magnesia oral suspension $0 OTC cvs mineral oil oral oil $0 OTC cvs natural daily fiber oral powder $0 OTC CVS PURELAX ORAL PACKET $0 OTC CVS PURELAX ORAL POWDER $0 OTC QL cvs senna oral tablet $0 OTC cvs senna plus oral tablet $0 OTC cvs senna-extra oral tablet $0 OTC cvs soluble fiber therapy oral tablet $0 OTC cvs stool softener oral capsule 100 mg, 250 mg, 50 mg $0 OTC cvs stool softener/laxative oral tablet $0 OTC docqlace oral capsule $0 OTC DOC-Q-LAX ORAL TABLET $0 OTC docu oral liquid $0 OTC docusate mini rectal enema $0 OTC docusate sodium oral capsule 100 mg $0 OTC docusate sodium oral capsule 250 mg $0 OTC docusate sodium oral liquid 150 mg/15ml, 50 mg/5ml $0 OTC docusate sodium oral syrup $0 OTC DOCUSOL MINI RECTAL ENEMA $0 OTC docuzen oral tablet $0 OTC dss oral capsule 250 mg $0 OTC DULCOLAX STOOL SOFTENER ORAL CAPSULE $0 OTC easy-lax oral capsule $0 OTC easy-lax plus oral tablet $0 OTC enema disposable rectal enema $0 OTC enema pediatric rectal enema $0 OTC enema ready-to-use rectal enema $0 OTC enema rectal enema $0 OTC EQ CLEARLAX ORAL POWDER $0 OTC QL eq daily fiber oral capsule $0 OTC eq fiber therapy oral capsule $0 OTC eq fiber therapy oral tablet 625 mg $0 OTC eq gentle laxative oral tablet delayed release $0 OTC eq laxative maximum strength oral tablet $0 OTC eq magnesium citrate oral solution $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 119

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

eq mineral oil oral oil $0 OTC eq natural laxative oral tablet $0 OTC eq natural vegetable laxative oral tablet $0 OTC eq senna-s oral tablet $0 OTC eq stool softener oral capsule 100 mg $0 OTC eq stool softener/laxative oral tablet $0 OTC EQL CLEARLAX ORAL POWDER $0 OTC QL eql fiber laxative oral tablet $0 OTC eql fiber therapy oral powder 48.57 % $0 OTC eql fiber therapy oral tablet $0 OTC eql gentle laxative oral tablet delayed release $0 OTC eql laxative maximum strength oral tablet $0 OTC eql laxative oral tablet chewable $0 OTC eql laxative oral tablet delayed release $0 OTC eql magnesium citrate oral solution $0 OTC eql milk of magnesia oral suspension $0 OTC eql ready-to-use enema rectal enema $0 OTC eql senna laxative oral tablet $0 OTC eql senna-s oral tablet $0 OTC eql smooth texture fiber oral powder $0 OTC eql stool softener oral capsule $0 OTC eql stool softener/stimulant oral tablet $0 OTC EVAC-U-GEN ORAL TABLET $0 OTC fiber laxative oral tablet $0 OTC fiber oral tablet $0 OTC fiber therapy oral tablet $0 OTC fiber-lax oral tablet $0 OTC gavilax oral powder $0 OTC QL GAVILYTE-G ORAL SOLUTION RECONSTITUTED $0 OTC GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED $0 OTC

gentle laxative oral tablet delayed release $0 OTC gentle laxative rectal suppository $0 OTC gentlelax oral powder $0 OTC QL geri-kot oral tablet $0 OTC glycerin (adult) rectal suppository 2 gm, 2.1 gm $0 OTC glycerin (child) rectal suppository $0 OTC glycerin (infants & children) rectal suppository $0 OTC glycerin (pediatric) rectal suppository 1 gm $0 OTC glycerin adult rectal suppository $0 OTC glycerin childrens rectal suppository $0 OTC GLYCOLAX ORAL POWDER $0 OTC QL GNP CLEARLAX ORAL PACKET $0 OTC GNP CLEARLAX ORAL POWDER $0 OTC QL gnp fiber therapy oral tablet $0 OTC gnp fiber-caps oral tablet $0 OTC gnp gentle laxative oral tablet delayed release $0 OTC gnp gentle laxative rectal suppository $0 OTC gnp glycerin (adult) rectal suppository $0 OTC gnp glycerin child rectal suppository $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 120

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

gnp milk of magnesia oral suspension $0 OTC gnp mineral oil oral oil $0 OTC gnp natural fiber oral capsule $0 OTC gnp natural fiber oral powder $0 OTC gnp senna lax oral tablet $0 OTC gnp stool softener oral capsule 100 mg, 250 mg $0 OTC gnp stool softener/laxative oral tablet $0 OTC gnp womens gentle laxative oral tablet delayed release $0 OTC goodsense bisacodyl ec oral tablet delayed release $0 OTC GOODSENSE CLEARLAX ORAL POWDER $0 OTC QL goodsense magnesium citrate oral solution $0 OTC goodsense mineral oil oral oil $0 OTC goodsense senna laxative oral tablet 8.6 mg $0 OTC goodsense stimulant laxative oral tablet $0 OTC HEALTHYLAX ORAL PACKET $0 OTC HM CLEARLAX ORAL POWDER $0 OTC QL hm enema rectal enema $0 OTC hm fiber oral tablet $0 OTC hm laxative oral tablet delayed release $0 OTC hm magnesium citrate oral solution $0 OTC hm milk of magnesia oral suspension $0 OTC hm mineral oil oral oil $0 OTC hm senna oral tablet $0 OTC hm senna-s oral tablet $0 OTC hm stool softener oral capsule 100 mg $0 OTC hm stool softener/laxative oral tablet $0 OTC KLS LAXACLEAR ORAL POWDER $0 OTC QL konsyl daily fiber oral powder 28.3 % $0 OTC kp bisacodyl oral tablet delayed release $0 OTC kp senna oral tablet $0 OTC laxacin oral tablet $0 OTC laxative max str oral tablet $0 OTC laxative oral tablet delayed release $0 OTC laxative rectal suppository $0 OTC magnesium citrate oral solution 1.745 gm/30ml $0 OTC medi-laxx oral capsule $0 OTC METAMUCIL MULTIHEALTH FIBER ORAL POWDER 63 % $0 OTC METAMUCIL ORAL POWDER 28.3 %, 48.57 % $0 OTC METAMUCIL SMOOTH TEXTURE ORAL POWDER 28.3 %, 58.6 % $0 OTC milk of magnesia oral suspension $0 OTC mineral oil heavy oil $0 OTC mineral oil heavy oral oil $0 OTC mineral oil light oil $0 OTC mineral oil oral oil $0 OTC natural fiber laxative oral powder 28.3 %, 30.9 %, 48.57 %, 58.6 % $0 OTC natural psyllium seed oral powder $0 OTC natural senna laxative oral tablet 8.6 mg $0 OTC PEDIA-LAX ORAL LIQUID $0 OTC PEDIA-LAX RECTAL SUPPOSITORY 1 GM $0 OTC peg 3350 oral packet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

peg 3350 oral powder $0 OTC QL peg 3350-kcl-na bicarb-nacl oral solution reconstituted $0 OTC peg-3350/electrolytes oral solution reconstituted $0 OTC PHILLIPS ORAL TABLET $0 OTC PHILLIPS STOOL SOFTENER ORAL CAPSULE $0 OTC polyethylene glycol 3350 oral packet 17 gm $0 OTC polyethylene glycol 3350 oral powder $0 OTC QL polyethylene glycol 3350 powder $0 OTC QL px docusate sodium oral capsule $0 OTC px fiber oral capsule $0 OTC px fiber oral tablet $0 OTC px laxative oral tablet delayed release $0 OTC px milk of magnesia oral suspension $0 OTC qc enema rectal enema $0 OTC qc fiber laxative oral capsule $0 OTC qc gentle laxative rectal suppository $0 OTC qc magnesium citrate oral solution $0 OTC qc milk of magnesia oral suspension $0 OTC qc mineral oil heavy oral oil $0 OTC qc natural vegetable laxative oral tablet $0 OTC qc natural vegetable oral powder $0 OTC qc natura-lax oral powder $0 OTC QL qc stool softener oral capsule $0 OTC qc stool softener pls laxative oral tablet 8.6-50 mg $0 OTC ra col-rite oral capsule 100 mg, 250 mg $0 OTC ra enema rectal enema $0 OTC ra fast relief laxative rectal suppository $0 OTC ra glycerin adult rectal suppository $0 OTC ra glycerin child rectal suppository $0 OTC ra laxative oral powder $0 OTC QL ra laxative oral tablet delayed release $0 OTC ra milk of magnesia oral suspension $0 OTC ra mineral oil oral oil $0 OTC ra multihealth fiber oral powder $0 OTC ra p col-rite oral tablet $0 OTC ra stool softener oral capsule $0 OTC ra womens laxative oral tablet delayed release $0 OTC REGULOID ORAL CAPSULE 0.52 GM $0 OTC REGULOID ORAL POWDER 48.57 %, 58.6 % $0 OTC sb bisacodyl laxative ec oral tablet delayed release $0 OTC sb docusate sodium oral capsule $0 OTC sb milk of magnesia oral suspension $0 OTC sb senna-lax oral tablet $0 OTC senexon oral liquid $0 OTC SENEXON-S ORAL TABLET $0 OTC senna lax oral tablet $0 OTC senna laxative oral tablet 8.6 mg $0 OTC senna oral liquid $0 OTC senna oral syrup 8.8 mg/5ml $0 OTC senna oral tablet 8.6 mg $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

senna plus oral tablet $0 OTC senna s oral tablet $0 OTC senna-docusate sodium oral tablet $0 OTC senna-lax oral tablet $0 OTC senna-plus oral tablet $0 OTC senna-s oral tablet $0 OTC senna-tabs oral tablet $0 OTC senna-time oral tablet $0 OTC senna-time s oral tablet $0 OTC sennosides-docusate sodium oral tablet $0 OTC SM CLEARLAX ORAL POWDER $0 OTC QL sm enema rectal enema 7-19 gm/118ml $0 OTC sm fiber laxative oral tablet 500 mg $0 OTC sm fiber oral powder 28.3 %, 48.57 %, 58.6 % $0 OTC sm fiber oral tablet $0 OTC sm fiber powder oral powder 25 % $0 OTC sm gentle laxative oral tablet delayed release $0 OTC sm glycerin pediatric rectal suppository $0 OTC sm laxative maximum strength oral tablet $0 OTC sm laxative rectal suppository $0 OTC sm magnesium citrate oral solution $0 OTC sm milk of magnesia oral suspension 1200 mg/15ml $0 OTC sm mineral oil oral oil $0 OTC sm natural laxative/stool soft oral tablet $0 OTC sm senna laxative oral tablet $0 OTC sm senna-s oral tablet $0 OTC sm stool softener oral capsule 100 mg, 250 mg $0 OTC sm stool softener oral tablet 8.6-50 mg $0 OTC sm stool softener/laxative oral tablet $0 OTC SMOOTH LAX ORAL PACKET $0 OTC SMOOTH LAX ORAL POWDER $0 OTC QL SOLUBLE FIBER THERAPY ORAL POWDER $0 OTC sorbitol rectal solution $0 OTC sorbitol solution 70 % $0 OTC stimulant laxative oral tablet $0 OTC stool softener laxative oral capsule $0 OTC stool softener oral capsule 100 mg, 250 mg $0 OTC stool softener plus laxative oral tablet $0 OTC stool softener/laxative oral tablet $0 OTC THE MAGIC BULLET RECTAL SUPPOSITORY $0 OTC tri-buffered aspirin oral tablet 325 mg $0 OTC vegetable lax+stool softener oral tablet $0 OTC WAL-MUCIL ORAL CAPSULE $0 OTC WAL-MUCIL ORAL POWDER 28.3 %, 48.57 %, 58.6 % $0 OTC womans laxative oral tablet delayed release $0 OTC womens laxative oral tablet delayed release $0 OTC Digestants cvs dairy relief ex st oral tablet $0 OTC cvs dairy relief fast acting oral tablet $0 OTC cvs dairy relief oral tablet chewable $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

dairy digestive oral tablet 9000 unit $0 OTC dairy relief oral tablet $0 OTC eq dairy digestive fast acting oral tablet $0 OTC eq dairy digestive fast acting oral tablet chewable $0 OTC eql dairy digest fast acting oral tablet $0 OTC gnp dairy relief oral tablet $0 OTC gnp fast acting dairy relief oral tablet chewable $0 OTC lactase enzyme oral tablet $0 OTC lactase fast acting oral tablet $0 OTC lactose fast acting relief oral tablet $0 OTC lactose fast acting relief oral tablet chewable $0 OTC px dairy digestive oral tablet $0 OTC ra dairy aid oral tablet $0 OTC ra dairy relief fast acting oral tablet chewable $0 OTC sb dairy relief oral tablet $0 OTC sm ultra dairy digestive oral tablet $0 OTC Histamine H2-Antagonists acid controller max st oral tablet $0 OTC acid controller oral tablet $0 OTC acid reducer maximum strength oral tablet 20 mg $0 OTC acid reducer oral tablet 10 mg $0 OTC cvs acid controller max st oral tablet $0 OTC cvs acid controller oral tablet $0 OTC eq acid reducer oral tablet 10 mg $0 OTC eql heartburn prevention oral tablet $0 OTC famotidine oral tablet 10 mg $0 OTC famotidine oral tablet 20 mg $0 OTC gnp acid reducer max st oral tablet $0 OTC gnp acid reducer oral tablet 10 mg $0 OTC heartburn relief max st oral tablet 20 mg $0 OTC heartburn relief oral tablet 10 mg $0 OTC hm famotidine oral tablet $0 OTC kls acid controller max st oral tablet $0 OTC px acid reducer max st oral tablet 20 mg $0 OTC px acid reducer oral tablet 10 mg $0 OTC qc acid controller max st oral tablet $0 OTC qc acid controller oral tablet $0 OTC ra acid reducer max st oral tablet 20 mg $0 OTC ra acid reducer oral tablet 10 mg $0 OTC sm acid reducer max st oral tablet 20 mg $0 OTC sm acid reducer oral tablet 10 mg $0 OTC Lipotropic Agents mega multiple/chelated mineral oral tablet $0 OTC multi-vitamin hp/minerals oral capsule $0 OTC Proton-Pump Inhibitors acid reducer oral capsule delayed release $0 OTC eq omeprazole magnesium oral capsule delayed release $0 OTC kp omeprazole magnesium oral capsule delayed release $0 OTC omeprazole magnesium oral capsule delayed release $0 OTC qc omeprazole magnesium oral capsule delayed release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

Hormones And Synthetic Substitutes Antihypoglycemic Agents, Miscellaneous cvs glucose oral gel 40 % $0 OTC cvs glucose oral tablet chewable $0 OTC QL cvs soft glucose oral tablet chewable $0 OTC QL DEX4 GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL DEX4 NATURALS ORAL TABLET CHEWABLE $0 OTC QL DEX4 ORAL TABLET CHEWABLE 4-6 GM-MG $0 OTC QL DEX4 POUCH PACK ORAL TABLET CHEWABLE $0 OTC QL DEX4 QUICK DISSOLVE GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL glucose instant energy oral tablet chewable $0 OTC QL glucose oral gel 40 % $0 OTC glucose oral tablet chewable $0 OTC QL GLUTOSE 15 ORAL GEL $0 OTC GLUTOSE 45 ORAL GEL $0 OTC GLUTOSE 5 ORAL GEL $0 OTC gnp glucose oral tablet chewable $0 OTC QL gnp quick dissolve glucose oral tablet chewable $0 OTC QL goodsense glucose oral tablet chewable 4-6 gm-mg $0 OTC QL kroger glucose oral tablet chewable $0 OTC QL leader glucose oral tablet chewable $0 OTC QL leader quick dissolve glucose oral tablet chewable $0 OTC QL longs glucose oral tablet chewable 4-6 gm-mg $0 OTC QL meijer glucose oral tablet chewable 4-6 gm-mg $0 OTC QL preferred plus glucose oral tablet chewable $0 OTC QL px glucose oral tablet chewable $0 OTC QL ra glucose oral tablet chewable $0 OTC QL RELION GLUCOSE ORAL GEL $0 OTC RELION GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL sm glucose oral tablet chewable $0 OTC QL SMART SENSE GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL tgt glucose oral tablet chewable 4-6 gm-mg $0 OTC QL up & up glucose oral tablet chewable $0 OTC QL value plus glucose oral gel $0 OTC walgreens glucose oral tablet chewable $0 OTC QL Miscellaneous Therapeutic Agents Antigout Agents all day pain relief oral tablet $0 OTC all day relief oral tablet $0 OTC cvs all day pain relief oral tablet $0 OTC cvs naproxen sodium oral tablet $0 OTC eq naproxen sodium oral tablet $0 OTC eql naproxen sodium oral tablet $0 OTC gnp naproxen sodium oral tablet $0 OTC goodsense naproxen sodium oral tablet $0 OTC hm naproxen sodium oral tablet $0 OTC MEDIPROXEN ORAL TABLET $0 OTC naproxen sodium oral tablet 220 mg $0 OTC px all day relief oral tablet $0 OTC qc naproxen sodium oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra naproxen sodium oral tablet $0 OTC sb naproxen sodium oral tablet $0 OTC sm naproxen sodium oral tablet $0 OTC Cariostatic Agents GEL-KAM DENTAL GEL $0 OTC Other Miscellaneous Therapeutic Agents charcoal oral capsule 200 mg $0 OTC cvs fish oil oral capsule 1000 mg $0 OTC cvs glucosamine sulfate oral capsule $0 OTC cvs natural fish oil oral capsule 1000 mg $0 OTC enteric fish oil oral capsule delayed release $0 OTC eql fish oil oral capsule 1000 mg $0 OTC fish oil concentrate oral capsule 1000 mg, 300 mg $0 OTC fish oil omega-3 oral capsule $0 OTC fish oil oral capsule 1000 mg $0 OTC fish oil oral capsule delayed release 1000 mg $0 OTC fish oil/super potent/no burp oral capsule $0 OTC genicin oral capsule $0 OTC glucosamine sulfate oral capsule 1000 mg, 500 mg, 750 mg $0 OTC glucosamine sulfate oral tablet 500 mg, 750 mg $0 OTC gnp fish oil oral capsule 1000 mg $0 OTC gnp fish oil oral capsule delayed release 1000 mg $0 OTC hm fish oil oral capsule 1000 mg $0 OTC MAXIMUM EPA ORAL CAPSULE $0 OTC odorless coated fish oil oral capsule delayed release $0 OTC omega 3 oral capsule 1000 mg $0 OTC omega iii epa+dha oral capsule $0 OTC omega-3 fish oil oral capsule 1000 mg, 500 mg $0 OTC omega-3 oral capsule 1000 mg $0 OTC ra fish oil oral capsule 1000 mg $0 OTC ra fish oil oral capsule delayed release 1000 mg $0 OTC ra glucosamine sulfate oral tablet $0 OTC sb omega-3 fish oil oral capsule $0 OTC sm fish oil oral capsule 1000 mg $0 OTC SUPER OMEGA-3 ORAL CAPSULE 1000 MG $0 OTC SYNOVACIN ORAL CAPSULE $0 OTC ULTRA OMEGA 3 ORAL CAPSULE 1000 MG $0 OTC Nonhormonal Contraceptives Nonhormonal Contraceptives aimsco lubricated $0 OTC DUREX REALFEEL DEVICE $0 OTC FANTASY LUBRICATED $0 OTC FANTASY LUBRICATED/SPERMICIDE $0 OTC FC2 FEMALE CONDOM $0 OTC kimono $0 OTC kimono micro thin $0 OTC kimono micro thin plus $0 OTC kimono sensation $0 OTC kimono sensation plus $0 OTC maxx $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

OPTIONS GYNOL II CONTRACEPTIVE VAGINAL GEL $0 OTC premium condoms lubricated $0 OTC TRUSTEX LUB/RIBBED/STUDDED $0 OTC TRUSTEX LUB/SPERMICIDE EX ST $0 OTC TRUSTEX LUB/SPERMICIDE XL $0 OTC TRUSTEX LUBRICATED $0 OTC TRUSTEX LUBRICATED EX LARGE $0 OTC TRUSTEX LUBRICATED EXTRA ST $0 OTC TRUSTEX LUBRICATED/SPERMICIDE $0 OTC TRUSTEX NON-LUBRICATED $0 OTC TRUSTEX RIA LUB/SPERMICIDE $0 OTC TRUSTEX RIA LUBRICATED $0 OTC TRUSTEX RIA NON-LUBRICATED $0 OTC TRUSTEX-NONOXYNOL-9/RIB/STUD $0 OTC VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM $0 OTC Pharmaceutical Aids Pharmaceutical Aids cvs instant food thickener oral powder $0 OTC hemorrhoidal rectal suppository 0.25-3-85.5 % $0 OTC px hemorrhoidal rectal suppository $0 OTC ra hemorrhoidal rectal suppository $0 OTC RESOURCE THICKENUP CLEAR ORAL POWDER $0 OTC THICK NOW ORAL POWDER $0 OTC THICK-IT #2 ORAL POWDER $0 OTC THICK-IT ORAL POWDER $0 OTC Respiratory Tract Agents Alpha And Beta Adrenergic Agonist(Respr) 12 hour decongestant oral tablet extended release 12 hour $0 OTC 12 hour nasal decongestant oral tablet extended release 12 hour $0 OTC cvs 12 hour nasal decongestant oral tablet extended release 12 hour $0 OTC cvs nasal decongestant oral tablet $0 OTC eql nasal decongestant oral tablet $0 OTC gnp nasal decongestant oral tablet $0 OTC gnp pseudoephedrine hcl 12 hr oral tablet extended release 12 hour $0 OTC hm nasal decongestant 12 hour oral tablet extended release 12 hour $0 OTC hm nasal decongestant oral tablet $0 OTC kp pseudoephedrine hcl oral tablet $0 OTC meijer nasal decongestant oral tablet $0 OTC nasal decongestant max st oral tablet $0 OTC nasal decongestant oral tablet 30 mg $0 OTC pseudoephedrine hcl er oral tablet extended release 12 hour $0 OTC pseudoephedrine hcl oral tablet 30 mg $0 OTC pseudoephedrine hcl oral tablet 60 mg $0 OTC px nasal decongestant oral tablet $0 OTC px nasal decongestant oral tablet extended release 12 hour $0 OTC qc suphedrine maximum strength oral tablet extended release 12 hour $0 OTC

ra suphedrine oral tablet 30 mg $0 OTC ra suphedrine oral tablet extended release 12 hour $0 OTC sinus 12 hour oral tablet extended release 12 hour $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sm nasal decongestant max st oral tablet $0 OTC sm nasal decongestant oral tablet extended release 12 hour $0 OTC SUDAFED CHILDRENS ORAL LIQUID $0 OTC sudogest 12 hour oral tablet extended release 12 hour $0 OTC SUDOGEST MAXIMUM STRENGTH ORAL TABLET $0 OTC SUDOGEST ORAL TABLET $0 OTC suphedrine 12hour oral tablet extended release 12 hour $0 OTC WAL-PHED 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC

WAL-PHED D ORAL TABLET EXTENDED RELEASE 12 HOUR $0 OTC WAL-PHED ORAL TABLET $0 OTC Antitussives aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC allergy childrens oral liquid $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC biocotron oral liquid $0 OTC cold & cough childrens oral liquid $0 OTC cold/cough childrens oral liquid $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cough dm childrens oral suspension extended release $0 OTC cough dm oral suspension extended release $0 OTC cough/chest congestion dm oral syrup $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs cold & cough childrens oral liquid $0 OTC cvs cough dm childrens oral suspension extended release $0 OTC cvs cough dm oral suspension extended release $0 OTC cvs mucus dm extended release oral tablet extended release 12 hour $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC cvs tussin dm oral liquid 10-100 mg/5ml, 20-200 mg/10ml, 200-20 mg/10ml $0 OTC

dextromethorphan polistirex er oral suspension extended release $0 OTC dextromethorphan-guaifenesin oral liquid $0 OTC dextromethorphan-guaifenesin oral syrup $0 OTC diabetic siltussin-dm oral liquid $0 OTC DIABETIC TUSSIN DM ORAL LIQUID $0 OTC DIMAPHEN DM COLD/COUGH ORAL LIQUID $0 OTC DIMETAPP DM COLD/COUGH ORAL LIQUID $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dm-guaifenesin er oral tablet extended release 12 hour $0 OTC dye-free allergy relief oral liquid $0 OTC ENDACOF-DM ORAL LIQUID $0 OTC eq cold/cough dm childrens oral liquid $0 OTC eq cough dm oral suspension extended release $0 OTC eq mucus relief dm oral tablet extended release 12 hour $0 OTC eq tussin dm cough/chest oral syrup $0 OTC eql cold/cough oral liquid $0 OTC eql nighttime sleep aid oral tablet $0 OTC eql tussin dm cough/chest cong oral syrup $0 OTC g tussin ac oral solution $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC geri-tussin dm oral syrup 10-100 mg/5ml $0 OTC GILTUSS COUGH & CHEST ORAL LIQUID $0 OTC GILTUSS DIABETIC COUGH & COLD ORAL LIQUID $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC gnp cold/cough childrens oral liquid $0 OTC gnp cough dm er oral suspension extended release $0 OTC gnp mucus dm max strength oral tablet extended release 12 hour $0 OTC gnp tussin dm cough oral liquid $0 OTC goodsense cough dm childrens oral suspension extended release $0 OTC goodsense cough dm oral suspension extended release $0 OTC guaiatussin ac oral syrup $0 OTC guaifenesin ac oral syrup $0 OTC guaifenesin-codeine oral solution $0 OTC guaifenesin-dm oral syrup $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg $0 OTC hm cold & cough childrens oral liquid $0 OTC hm cough dm oral suspension extended release $0 OTC hm daytime cold & flu oral liquid $0 OTC hm tussin adult dm oral liquid 100-10 mg/5ml $0 OTC m-dryl oral liquid $0 OTC mucus relief dm max oral tablet extended release 12 hour $0 OTC mucus relief dm oral tablet extended release 12 hour 30-600 mg $0 OTC mucus-dm max oral tablet extended release 12 hour $0 OTC mucus-dm maximum strength oral tablet extended release 12 hour $0 OTC mucus-dm oral tablet extended release 12 hour $0 OTC night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC pharbedryl oral capsule $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

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Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

px dibromm dm cold/cough child oral liquid $0 OTC px tussin dm oral liquid $0 OTC qc complete allergy medicine oral tablet $0 OTC qc tussin dm cough/congestion oral liquid 10-100 mg/5ml $0 OTC ra cold & cough childrens oral liquid $0 OTC ra cough dm oral suspension extended release $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC ra tussin cgh/chest congest dm oral liquid $0 OTC ra tussin cough oral liquid $0 OTC ra tussin dm oral liquid $0 OTC ROBAFEN DM CGH/CHEST CONGEST ORAL LIQUID $0 OTC ROBAFEN DM COUGH CLEAR ORAL SYRUP $0 OTC ROBAFEN DM COUGH ORAL LIQUID $0 OTC ROBITUSSIN CHILDRENS COUGH LA ORAL SYRUP $0 OTC rynex dm oral liquid $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC siltussin dm das oral liquid $0 OTC siltussin-dm alcohol free oral syrup $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm cold & cough dm childrens oral liquid $0 OTC sm nighttime sleep aid oral tablet $0 OTC sm tussin cough/chest congest oral syrup $0 OTC sm tussin dm oral syrup $0 OTC SORBUGEN NR ORAL LIQUID $0 OTC total allergy oral tablet $0 OTC tusnel diabetic oral liquid $0 OTC tussin dm cough + chest oral liquid 10-100 mg/5ml $0 OTC tussin dm oral liquid $0 OTC tussin dm oral syrup 100-10 mg/5ml $0 OTC virtussin a/c oral solution $0 OTC virtussin ac w/alc oral liquid $0 OTC WAL-TUSSIN COUGH/CHEST DM ORAL SYRUP $0 OTC WAL-TUSSIN DM CGH/CHEST CONG ORAL LIQUID $0 OTC Expectorants biocotron oral liquid $0 OTC chest congestion childrens oral liquid $0 OTC chest congestion relief oral tablet $0 OTC cough/chest congestion dm oral syrup $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 130

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

coughtab oral tablet $0 OTC cvs chest congestion relief oral tablet $0 OTC cvs mucus d extended release oral tablet extended release 12 hour $0 OTC cvs mucus d max st er oral tablet extended release 12 hour $0 OTC QL cvs mucus dm extended release oral tablet extended release 12 hour $0 OTC cvs mucus extended release oral tablet extended release 12 hour $0 OTC QL cvs tussin adult chest congest oral liquid $0 OTC cvs tussin dm oral liquid 10-100 mg/5ml, 20-200 mg/10ml, 200-20 mg/10ml $0 OTC

dextromethorphan-guaifenesin oral liquid $0 OTC dextromethorphan-guaifenesin oral syrup $0 OTC diabetic siltussin-dm oral liquid $0 OTC DIABETIC TUSSIN DM ORAL LIQUID $0 OTC DIABETIC TUSSIN ORAL LIQUID $0 OTC dm-guaifenesin er oral tablet extended release 12 hour $0 OTC ed bron gp oral liquid $0 OTC QL EQ MUCUS ER ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG $0 OTC QL

eq mucus relief dm oral tablet extended release 12 hour $0 OTC eq tussin dm cough/chest oral syrup $0 OTC eql tussin dm cough/chest cong oral syrup $0 OTC eql tussin mucus/chest congest oral liquid $0 OTC g tussin ac oral solution $0 OTC geri-tussin dm oral syrup 10-100 mg/5ml $0 OTC geri-tussin oral liquid $0 OTC GILTUSS COUGH & CHEST ORAL LIQUID $0 OTC GILTUSS DIABETIC COUGH & COLD ORAL LIQUID $0 OTC gnp mucus dm max strength oral tablet extended release 12 hour $0 OTC gnp mucus er oral tablet extended release 12 hour 600 mg $0 OTC QL gnp mucus relief oral tablet $0 OTC gnp tab tussin oral tablet $0 OTC gnp tussin dm cough oral liquid $0 OTC gnp tussin mucus & chest cong oral liquid $0 OTC goodsense mucus relief oral tablet 400 mg $0 OTC guaiatussin ac oral syrup $0 OTC guaifenesin ac oral syrup $0 OTC guaifenesin er oral tablet extended release 12 hour 600 mg $0 OTC QL guaifenesin oral liquid $0 OTC guaifenesin oral solution $0 OTC guaifenesin oral tablet $0 OTC guaifenesin-codeine oral solution $0 OTC guaifenesin-dm oral syrup $0 OTC hm chest congestion relief oral tablet $0 OTC hm tussin adult dm oral liquid 100-10 mg/5ml $0 OTC hm tussin adult oral liquid $0 OTC kls mucus relief chest oral tablet $0 OTC mucosa oral tablet $0 OTC mucus d oral tablet extended release 12 hour 60-600 mg $0 OTC mucus relief chest congestion oral tablet $0 OTC mucus relief cold/sinus max st oral liquid $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 131

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

mucus relief d oral tablet extended release 12 hour 60-600 mg $0 OTC mucus relief dm max oral tablet extended release 12 hour $0 OTC mucus relief dm oral tablet extended release 12 hour 30-600 mg $0 OTC mucus relief er oral tablet extended release 12 hour 600 mg $0 OTC QL mucus relief max st oral tablet extended release 12 hour $0 OTC QL mucus relief oral tablet $0 OTC mucus relief oral tablet extended release 12 hour $0 OTC QL mucus-dm max oral tablet extended release 12 hour $0 OTC mucus-dm maximum strength oral tablet extended release 12 hour $0 OTC mucus-dm oral tablet extended release 12 hour $0 OTC organ-i nr oral tablet $0 OTC pseudoephedrine-guaifenesin er oral tablet extended release 12 hour 120-1200 mg $0 OTC QL

pseudoephedrine-guaifenesin er oral tablet extended release 12 hour 60-600 mg $0 OTC

px tussin dm oral liquid $0 OTC px tussin oral solution $0 OTC qc medifin 400 oral tablet $0 OTC qc mucus relief oral tablet extended release 12 hour $0 OTC QL qc tussin dm cough/congestion oral liquid 10-100 mg/5ml $0 OTC qc tussin mucus/congestion oral liquid $0 OTC ra mucus relief d max strength oral tablet extended release 12 hour $0 OTC QL ra mucus relief d oral tablet extended release 12 hour 600-60 mg $0 OTC ra tussin cgh/chest congest dm oral liquid $0 OTC ra tussin cough oral liquid $0 OTC ra tussin dm oral liquid $0 OTC ra tussin oral syrup $0 OTC refenesen 400 oral tablet $0 OTC ROBAFEN DM CGH/CHEST CONGEST ORAL LIQUID $0 OTC ROBAFEN DM COUGH CLEAR ORAL SYRUP $0 OTC ROBAFEN DM COUGH ORAL LIQUID $0 OTC ROBAFEN MUCUS/CHEST CONGESTION ORAL LIQUID $0 OTC sb cough control oral syrup $0 OTC sb coughtab oral tablet $0 OTC siltussin dm das oral liquid $0 OTC siltussin sa oral syrup $0 OTC siltussin-dm alcohol free oral syrup $0 OTC sm chest congestion relief oral tablet $0 OTC sm mucus relief d oral tablet extended release 12 hour $0 OTC sm mucus relief max strength oral tablet extended release 12 hour $0 OTC QL sm mucus relief oral tablet extended release 12 hour $0 OTC QL sm tussin cough/chest congest oral syrup $0 OTC sm tussin dm oral syrup $0 OTC sm tussin mucus+chest congest oral liquid $0 OTC SORBUGEN NR ORAL LIQUID $0 OTC tusnel diabetic oral liquid $0 OTC TUSNEL-EX ORAL LIQUID $0 OTC tussin dm cough + chest oral liquid 10-100 mg/5ml $0 OTC tussin dm oral liquid $0 OTC tussin dm oral syrup 100-10 mg/5ml $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 132

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

tussin mucus & chest congest oral liquid $0 OTC tussin mucus+chest congestion oral liquid $0 OTC tussin mucus+chest congestion oral syrup $0 OTC virtussin a/c oral solution $0 OTC virtussin ac w/alc oral liquid $0 OTC WAL-TUSSIN CHEST CONGESTION ORAL LIQUID $0 OTC WAL-TUSSIN COUGH/CHEST DM ORAL SYRUP $0 OTC WAL-TUSSIN DM CGH/CHEST CONG ORAL LIQUID $0 OTC First Generation Antihist.(Respir Tract) aler-cap oral capsule $0 OTC alertab oral tablet $0 OTC ALKA-SELTZER PLUS ALLERGY ORAL TABLET $0 OTC aller-chlor oral tablet $0 OTC allergy childrens oral liquid $0 OTC allergy oral tablet 4 mg $0 OTC allergy relief childrens oral liquid $0 OTC allergy relief oral capsule 25 mg $0 OTC allergy relief oral tablet 25 mg, 4 mg $0 OTC aurodryl allergy childrens oral liquid $0 OTC BANOPHEN ORAL CAPSULE $0 OTC BANOPHEN ORAL LIQUID $0 OTC BANOPHEN ORAL TABLET $0 OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID $0 OTC BENADRYL ALLERGY ORAL TABLET $0 OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET $0 OTC chlorpheniramine maleate oral tablet $0 OTC complete allergy medicine oral capsule $0 OTC complete allergy relief oral tablet $0 OTC cvs allergy relief adult oral liquid $0 OTC cvs sleep aid nighttime oral tablet $0 OTC cvs sleep aid oral tablet 25 mg $0 OTC DAYHIST ALLERGY 12 HOUR RELIEF ORAL TABLET $0 OTC diphen oral tablet $0 OTC diphenhydramine hcl oral capsule $0 OTC diphenhydramine hcl oral liquid 12.5 mg/5ml $0 OTC diphenhydramine hcl oral tablet 25 mg $0 OTC dye-free allergy relief oral liquid $0 OTC ed chlorped jr oral syrup $0 OTC eq chlortabs oral tablet $0 OTC eql nighttime sleep aid oral tablet $0 OTC geri-dryl oral liquid $0 OTC geri-dryl oral tablet $0 OTC gnp allergy oral capsule $0 OTC gnp allergy oral tablet 25 mg $0 OTC gnp allergy relief oral capsule $0 OTC gnp childrens allergy oral liquid $0 OTC hm allergy relief childrens oral liquid $0 OTC hm allergy relief oral capsule $0 OTC hm allergy relief oral tablet 25 mg, 4 mg $0 OTC m-dryl oral liquid $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 133

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

night time sleep aid oral tablet $0 OTC nighttime sleep aid oral tablet 25 mg $0 OTC pharbedryl oral capsule $0 OTC qc chlor-pheniramine oral tablet $0 OTC qc complete allergy medicine oral tablet $0 OTC ra complete allergy oral tablet $0 OTC ra nighttime sleep aid oral tablet $0 OTC ra sleep aid (diphenhydramine) oral tablet $0 OTC sb allergy medicine oral liquid $0 OTC sb allergy medicine oral tablet $0 OTC sb allergy oral capsule $0 OTC sb chlorpheniramine oral tablet $0 OTC sb sleep oral tablet $0 OTC siladryl allergy oral liquid $0 OTC SIMPLY SLEEP ORAL TABLET $0 OTC sleep aid (diphenhydramine) oral tablet $0 OTC sleep ii oral tablet $0 OTC sleep-tabs oral tablet $0 OTC sm allergy 4 hour oral tablet $0 OTC sm allergy relief childrens oral liquid $0 OTC sm allergy relief oral capsule $0 OTC sm allergy relief oral liquid $0 OTC sm allergy relief oral tablet 25 mg $0 OTC sm nighttime sleep aid oral tablet $0 OTC total allergy oral tablet $0 OTC WAL-DRYL ALLERGY ORAL CAPSULE $0 OTC Mast-Cell Stabilizers cromolyn sodium nasal aerosol solution $0 OTC Mucolytic Agents altamist spray nasal solution $0 OTC cvs saline nasal spray nasal solution $0 OTC deep sea nasal spray nasal solution $0 OTC eq saline nasal spray nasal solution $0 OTC eql saline nasal spray nasal solution $0 OTC gnp nasal moisturizing nasal solution $0 OTC hm saline nasal spray nasal solution $0 OTC nasal moisturizing spray nasal solution $0 OTC px saline nasal spray nasal solution $0 OTC ra saline nasal spray nasal solution $0 OTC saline mist spray nasal solution $0 OTC saline nasal spray nasal solution $0 OTC sb saline nose nasal solution $0 OTC sm nasal spray saline nasal solution $0 OTC sodium chloride inhalation nebulization solution 0.9 % $0 OTC Nasal Preparations (Steroids) cvs nasal allergy spray nasal aerosol $0 OTC eq nasal allergy nasal aerosol $0 OTC gnp 24 hour nasal allergy nasal aerosol $0 OTC goodsense nasal allergy spray nasal aerosol $0 OTC KLS ALLER-CORT NASAL AEROSOL $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 134

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

nasal allergy 24 hour nasal aerosol $0 OTC ra nasal allergy nasal aerosol $0 OTC triamcinolone acetonide nasal aerosol $0 OTC Second Generation Antihist(Respir Tract) all day allergy childrens oral solution 5 mg/5ml $0 OTC QL all day allergy oral tablet $0 OTC QL all-day allergy childrens oral solution $0 OTC QL allergy 24hour indoor/outdoor oral tablet $0 OTC QL allergy childrens oral syrup $0 OTC QL allergy relief cetirizine oral tablet $0 OTC QL allergy relief child oral syrup $0 OTC QL allergy relief childrens oral solution 1 mg/ml $0 OTC QL allergy relief oral tablet 10 mg $0 OTC QL allergy relief oral tablet dispersible $0 OTC QL allergy relief/indoor/outdoor oral tablet 10 mg $0 OTC QL cetirizine hcl allergy child oral solution $0 OTC QL cetirizine hcl childrens alrgy oral solution $0 OTC QL cetirizine hcl childrens oral solution 5 mg/5ml $0 OTC QL cetirizine hcl oral solution 1 mg/ml $0 OTC QL cetirizine hcl oral tablet $0 OTC QL cetirizine hcl oral tablet chewable $0 OTC QL childrens loratadine oral solution $0 OTC QL childrens loratadine oral syrup $0 OTC QL cvs allergy relief childrens oral solution $0 OTC QL cvs allergy relief childrens oral syrup $0 OTC QL cvs allergy relief childrens oral tablet chewable 5 mg $0 OTC cvs allergy relief oral tablet 10 mg $0 OTC QL cvs allergy relief oral tablet dispersible $0 OTC QL cvs indoor/outdoor allergy rlf oral tablet $0 OTC QL eq allergy childrens oral syrup $0 OTC QL eq allergy relief (cetirizine) oral solution $0 OTC QL eq allergy relief (cetirizine) oral tablet $0 OTC QL eq allergy relief childrens oral solution $0 OTC QL eq allergy relief childrens oral syrup $0 OTC QL eq allergy relief oral tablet 10 mg $0 OTC QL eql all day allergy childrens oral solution $0 OTC QL eql all day allergy oral tablet $0 OTC QL eql allergy relief oral tablet 10 mg $0 OTC QL gnp all day allergy childrens oral solution $0 OTC QL gnp all day allergy oral tablet $0 OTC QL gnp loratadine childrens oral solution $0 OTC QL gnp loratadine oral syrup $0 OTC QL gnp loratadine oral tablet $0 OTC QL goodsense all day allergy oral solution $0 OTC QL goodsense all day allergy oral tablet $0 OTC QL hm all day allergy childrens oral solution $0 OTC QL hm all day allergy oral solution $0 OTC QL hm all day allergy oral tablet $0 OTC QL hm cetirizine hcl oral tablet $0 OTC QL hm loratadine childrens oral syrup $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 135

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

hm loratadine oral tablet $0 OTC QL KLS ALLERCLEAR ORAL TABLET $0 OTC QL KLS ALLER-TEC ORAL TABLET $0 OTC QL loradamed oral tablet $0 OTC QL loratadine childrens oral syrup $0 OTC QL loratadine childrens oral tablet chewable $0 OTC QL loratadine oral tablet $0 OTC QL mm cetirizine hcl oral tablet $0 OTC QL px allergy relief cetirizine oral tablet $0 OTC QL px allergy relief loratadine oral tablet $0 OTC QL px childrens allergy oral solution $0 OTC QL qc all day allergy oral tablet $0 OTC QL qc allergy relief oral tablet dispersible $0 OTC QL qc childrens allergy oral solution $0 OTC QL qc loratadine allergy relief oral tablet $0 OTC QL ra allergy relief (cetirizine) oral tablet $0 OTC QL ra allergy relief (loratadine) oral tablet $0 OTC QL ra allergy relief childrens oral solution 5 mg/5ml $0 OTC QL ra allergy relief childrens oral syrup $0 OTC QL ra allergy relief childrens oral tablet chewable $0 OTC QL ra loratadine oral syrup $0 OTC QL ra loratadine oral tablet $0 OTC QL sb allergy oral tablet $0 OTC QL sb loratadine oral tablet $0 OTC QL sm all day allergy childrens oral solution 5 mg/5ml $0 OTC QL sm all day allergy oral tablet $0 OTC QL sm allergy childrens oral syrup $0 OTC QL sm allergy relief oral tablet dispersible $0 OTC QL sm childrens loratadine oral syrup $0 OTC QL sm loratadine allergy relief oral tablet dispersible $0 OTC QL sm loratadine oral syrup $0 OTC QL sm loratadine oral tablet $0 OTC QL WAL-ITIN CHILDRENS ORAL SOLUTION $0 OTC QL WAL-ITIN ORAL SYRUP $0 OTC QL WAL-ITIN ORAL TABLET $0 OTC QL WAL-ITIN ORAL TABLET DISPERSIBLE $0 OTC QL WAL-ZYR ALL DAY ALLERGY CHILD ORAL SOLUTION $0 OTC QL WAL-ZYR CHILDRENS ORAL SOLUTION $0 OTC QL WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE 10 MG $0 OTC QL WAL-ZYR ORAL TABLET $0 OTC QL Skin And Mucous Membrane Agents Allylamines (Skin And Mucous Membrane) athletes foot (terbinafine) external cream $0 OTC cvs athletes foot external cream $0 OTC cvs jock itch external cream $0 OTC eq athletes foot (terbinafine) external cream $0 OTC eql athletes foot(terbinafine) external cream $0 OTC gnp terbinafine hydrochloride external cream $0 OTC LAMISIL AT EXTERNAL CREAM $0 OTC qc athletes foot external cream $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 136

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra antifungal foot care external cream $0 OTC sm athletes foot external cream $0 OTC terbinafine hcl external cream $0 OTC Antibacterials (Skin, Mucous Membrane) bacitracin external ointment $0 OTC bacitracin zinc external ointment $0 OTC BACITRAYCIN PLUS EXTERNAL OINTMENT 500 UNIT/GM $0 OTC cvs antibiotic external ointment $0 OTC cvs bacitracin external ointment $0 OTC cvs bacitracin zinc external ointment $0 OTC cvs poly bacitracin external ointment $0 OTC cvs triple antibiotic/pain external ointment $0 OTC double antibiotic external ointment $0 OTC eq bacitracin zinc external ointment $0 OTC eq triple antibiotic external ointment $0 OTC eql bacitracin zinc external ointment $0 OTC eql first aid antibiotic external ointment $0 OTC gnp bacitracin zinc external ointment $0 OTC gnp triple antibiotic external ointment $0 OTC gnp triple antibiotic plus external ointment $0 OTC hm bacitracin zinc external ointment $0 OTC hm double antibiotic external ointment 500-10000 unit/gm $0 OTC hm triple antibiotic external ointment $0 OTC hm triple antibiotic max st external ointment $0 OTC kp double antibiotic external ointment $0 OTC NEOSPORIN ORIGINAL EXTERNAL OINTMENT 3.5-400-5000 $0 OTC poly bacitracin external ointment 500-10000 unit/gm $0 OTC px triple external ointment $0 OTC qc bacitracin external ointment $0 OTC qc triple antibiotic max st external ointment $0 OTC ra antibiotic/pain relief external ointment $0 OTC ra bacitracin external ointment $0 OTC ra bacitracin zinc first aid external ointment $0 OTC ra double antibiotic external ointment 500-10000 unit/gm $0 OTC ra triple antibiotic external ointment $0 OTC sb triple antibiotic external ointment 3.5-400-5000 $0 OTC sm antibiotic external ointment $0 OTC sm double antibiotic external ointment 500-10000 unit/gm $0 OTC sm triple antibiotic external ointment 3.5-400-5000 $0 OTC sm triple antibiotic max st external ointment $0 OTC sm triple antibiotic original external ointment $0 OTC triple antibiotic external ointment 3.5-400-5000 , 5-400-5000 $0 OTC triple antibiotic pain relief external ointment $0 OTC triple antibiotic plus external ointment $0 OTC triple antibiotic+pain relief external ointment $0 OTC wal-sporin external ointment $0 OTC Antipruritics And Local Anesthetics ANBESOL MAXIMUM STRENGTH MOUTH/THROAT GEL $0 OTC cvs oral anesthetic max str mouth/throat gel $0 OTC cvs triple antibiotic/pain external ointment $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 137

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

dibucaine (perianal) external ointment $0 OTC eql first aid antibiotic external ointment 1 % $0 OTC gnp triple antibiotic plus external ointment $0 OTC hm triple antibiotic max st external ointment $0 OTC intense toothache pain relief mouth/throat gel $0 OTC oral analgesic max st mouth/throat gel $0 OTC qc triple antibiotic max st external ointment $0 OTC ra antibiotic/pain relief external ointment $0 OTC sm triple antibiotic max st external ointment $0 OTC triple antibiotic pain relief external ointment $0 OTC triple antibiotic plus external ointment $0 OTC triple antibiotic+pain relief external ointment $0 OTC Astringents calamine external lotion $0 OTC calamine-zinc oxide external lotion $0 OTC calamine-zinc oxide external suspension $0 OTC cvs diaper rash external ointment 40 % $0 OTC cvs zinc oxide external ointment $0 OTC diaper rash external ointment $0 OTC diaper rash external paste $0 OTC eql baby basics diaper rash external ointment $0 OTC gnp calamine external lotion $0 OTC gnp zinc oxide external ointment $0 OTC goodsense calamine external suspension $0 OTC hemorrhoidal cooling external gel $0 OTC hm calamine external lotion $0 OTC MEDPURA ZINC OXIDE EXTERNAL OINTMENT $0 OTC qc calamine external lotion $0 OTC ra calamine external suspension $0 OTC ra zinc oxide external ointment $0 OTC sm calamine external lotion $0 OTC sm hemorrhoidal cooling external gel $0 OTC zinc oxide external ointment 20 %, 40 % $0 OTC Azoles (Skin And Mucous Membrane) antifungal clotrimazole external cream $0 OTC anti-fungal external cream 1 % $0 OTC antifungal external cream 2 % $0 OTC antifungal external powder $0 OTC athletes foot (clotrimazole) external cream $0 OTC athletes foot external powder 2 % $0 OTC athletes foot powder spray external aerosol powder 2 % $0 OTC AZOLEN TINCTURE EXTERNAL SOLUTION $0 OTC clotrimazole 3 vaginal cream $0 OTC clotrimazole af external cream $0 OTC clotrimazole anti-fungal external cream $0 OTC clotrimazole athletes foot external cream $0 OTC clotrimazole external cream $0 OTC clotrimazole external solution $0 OTC QL clotrimazole vaginal cream 1 % $0 OTC clotrimazole-7 vaginal cream $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 138

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs athletes foot external aerosol powder $0 OTC cvs clotrimazole 3 vaginal cream $0 OTC cvs clotrimazole external cream $0 OTC cvs clotrimazole external solution $0 OTC QL cvs itch relief external cream 1 % $0 OTC cvs miconazole 1 combo pack vaginal kit $0 OTC cvs miconazole 3 combo pack vaginal kit $0 OTC cvs miconazole 7 vaginal cream $0 OTC cvs ringworm external cream $0 OTC DESENEX EXTERNAL POWDER $0 OTC eq antifungal external cream $0 OTC eq athletes foot external cream $0 OTC eq jock itch external cream $0 OTC eq miconazole 1 vaginal kit $0 OTC eq miconazole 7 day treatment vaginal cream $0 OTC eql antifungal external cream $0 OTC eql athletes foot external cream $0 OTC eql miconazole 3 vaginal kit $0 OTC eql miconazole 7 vaginal cream $0 OTC gnp athletes foot external cream $0 OTC gnp clotrimazole 3 vaginal cream $0 OTC gnp miconazole 3 vaginal kit $0 OTC gnp miconazole 7 vaginal cream $0 OTC gnp miconazorb af external powder $0 OTC jock itch external cream $0 OTC jock itch relief external cream $0 OTC LOTRIMIN AF DEODORANT POWDER EXTERNAL AEROSOL POWDER $0 OTC

LOTRIMIN AF EXTERNAL AEROSOL $0 OTC LOTRIMIN AF JOCK ITCH POWDER EXTERNAL AEROSOL POWDER $0 OTC

LOTRIMIN AF POWDER EXTERNAL AEROSOL POWDER $0 OTC MICATIN EXTERNAL CREAM $0 OTC miconazole 1 vaginal kit $0 OTC miconazole 3 applicator vaginal kit $0 OTC miconazole 3 combo pack app vaginal kit $0 OTC miconazole 3 combo pack vaginal kit $0 OTC miconazole 7 vaginal cream $0 OTC miconazole 7 vaginal suppository $0 OTC miconazole antifungal external cream $0 OTC miconazole nitrate external cream $0 OTC miconazole nitrate vaginal cream $0 OTC MICRO GUARD EXTERNAL POWDER $0 OTC px athletic foot external cream $0 OTC px miconazole 3-day combo vaginal kit $0 OTC qc 3 day vaginal cream $0 OTC qc miconazole 7 vaginal cream $0 OTC ra atheletes foot external aerosol powder $0 OTC ra athletes foot external cream $0 OTC ra clotrimazole 7 vaginal cream $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 139

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra clotrimazole external cream $0 OTC ra jock itch external cream $0 OTC ra miconazole 3 combo pack vaginal kit $0 OTC ra miconazole 7 vaginal cream $0 OTC sm antifungal clotrimazole external cream $0 OTC sm antifungal miconazole external cream $0 OTC sm clotrimazole vaginal vaginal cream $0 OTC sm miconazole 3 vaginal kit $0 OTC sm miconazole 7 vaginal cream $0 OTC sm miconazole 7 vaginal suppository $0 OTC VAGISTAT-3 VAGINAL KIT $0 OTC ZEASORB-AF EXTERNAL POWDER $0 OTC Basic Lotions And Liniments AL12 EXTERNAL LOTION $0 OTC AMLACTIN EXTERNAL LOTION $0 OTC ammonium lactate external lotion $0 OTC cvs skin treatment external lotion $0 OTC lactic acid external lotion $0 OTC Basic Oils And Other Solvents cvs hemorrhoidal rectal ointment $0 OTC eql hemorrhoidal rectal ointment 0.25-14-74.9 % $0 OTC JOHNSONS BABY OIL EXTERNAL OIL $0 OTC MAPO BATH EXTERNAL OIL $0 OTC mineral oil light external oil $0 OTC px hemorrhoidal rectal ointment $0 OTC ra hemorrhoidal rectal ointment $0 OTC Basic Ointments And Protectants calamine external lotion 8-8 % $0 OTC calamine-zinc oxide external suspension $0 OTC CORTIZONE-10 INTENSIVE HEALING EXTERNAL CREAM $0 OTC CORTIZONE-10 PLUS EXTERNAL CREAM $0 OTC CORTIZONE-10/ALOE EXTERNAL CREAM $0 OTC gnp calamine external lotion $0 OTC gnp hydrocortisone/aloe external cream $0 OTC goodsense calamine external suspension $0 OTC hm calamine external lotion $0 OTC hm hydrocortisone plus external cream $0 OTC hm hydrocortisone-aloe max st external cream $0 OTC hydrocortisone-aloe external cream $0 OTC petrolatum white external ointment $0 OTC petroleum jelly external ointment $0 OTC petroleum jelly lip treatment external ointment $0 OTC ra calamine external suspension $0 OTC ra hydrocortisone plus external cream 1 % $0 OTC ra petroleum jelly external ointment $0 OTC sm calamine external lotion $0 OTC sm hydrocortisone plus external cream $0 OTC sm hydrocortisone-aloe max st external cream $0 OTC THERASEAL HAND PROTECTION EXTERNAL LOTION $0 OTC white petrolatum external ointment $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 140

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

Cell Stimulants And Proliferants cvs hemorrhoidal rectal ointment $0 OTC eql hemorrhoidal rectal ointment 0.25-14-74.9 % $0 OTC hemorrhoidal cooling external gel $0 OTC hemorrhoidal rectal suppository 0.25-3-85.5 % $0 OTC px hemorrhoidal rectal ointment $0 OTC px hemorrhoidal rectal suppository $0 OTC ra hemorrhoidal rectal ointment $0 OTC ra hemorrhoidal rectal suppository $0 OTC sm hemorrhoidal cooling external gel $0 OTC Corticosteroids (Skin, Mucous Membrane) anti-itch maximum strength external cream 1 % $0 OTC AQUANIL HC EXTERNAL LOTION $0 OTC beta hc external lotion $0 OTC CORTIZONE-10 DIABETICS SKIN EXTERNAL LOTION $0 OTC CORTIZONE-10 ECZEMA EXTERNAL LOTION $0 OTC CORTIZONE-10 EXTERNAL OINTMENT $0 OTC CORTIZONE-10 HYDRATENSIVE EXTERNAL LOTION $0 OTC CORTIZONE-10 INTENSIVE HEALING EXTERNAL CREAM $0 OTC CORTIZONE-10 PLUS EXTERNAL CREAM $0 OTC CORTIZONE-10/ALOE EXTERNAL CREAM $0 OTC cvs anti-itch maximum strength external cream $0 OTC cvs cortisone intense healing external cream $0 OTC cvs cortisone maximum strength external cream $0 OTC cvs cortisone maximum strength external lotion $0 OTC cvs cortisone maximum strength external ointment $0 OTC cvs eczema anti-itch external cream $0 OTC cvs hydrocortisone anti-itch external cream 1 % $0 OTC cvs hydrocortisone max st external cream $0 OTC DERMAREST ECZEMA EXTERNAL LOTION $0 OTC eq hydrocortisone external cream $0 OTC eq hydrocortisone max st external cream $0 OTC eql anti-itch intensive heal external cream $0 OTC eql anti-itch maximum strength external cream $0 OTC eql anti-itch maximum strength external ointment $0 OTC gnp hydrocortisone external cream 0.5 % $0 OTC gnp hydrocortisone max st external ointment $0 OTC gnp hydrocortisone plus external cream $0 OTC gnp hydrocortisone/aloe external cream $0 OTC hm hydrocortisone plus external cream $0 OTC hm hydrocortisone-aloe max st external cream $0 OTC hydrocortisone acetate external ointment 1 % $0 OTC hydrocortisone anti-itch external cream $0 OTC hydrocortisone external cream 0.5 % $0 OTC hydrocortisone external cream 1 % $0 OTC hydrocortisone external lotion 1 % $0 OTC hydrocortisone external ointment 0.5 % $0 OTC hydrocortisone external ointment 1 % $0 OTC hydrocortisone max st external cream $0 OTC hydrocortisone max st/12 moist external cream $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 141

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

hydrocortisone plus external cream $0 OTC hydrocortisone-aloe external cream $0 OTC instacort 5 external cream $0 OTC kp hydrocortisone max st external ointment $0 OTC MONISTAT SOOTHING CARE ITCH EXTERNAL CREAM $0 OTC PREPARATION H EXTERNAL CREAM 1 % $0 OTC px hydrocream external cream $0 OTC ra anti-itch maximum strength external cream $0 OTC ra anti-itch maximum strength external ointment $0 OTC ra hydrocortisone plus 12 external cream $0 OTC ra hydrocortisone plus external cream 1 % $0 OTC sb hydrocortisone external cream $0 OTC sb hydrocortisone max st external ointment $0 OTC sm hydrocortisone external cream $0 OTC sm hydrocortisone max st external ointment $0 OTC sm hydrocortisone plus external cream $0 OTC sm hydrocortisone-aloe max st external cream $0 OTC Emollients, Demulcents, And Protectants cvs hemorrhoidal rectal ointment $0 OTC cvs petroleum jelly external gel $0 OTC eql hemorrhoidal rectal ointment 0.25-14-74.9 % $0 OTC gnp petroleum jelly gel $0 OTC goodsense petroleum jelly gel $0 OTC hm petroleum jelly gel $0 OTC natural oatmeal bath treatment external packet $0 OTC petroleum jelly external gel $0 OTC petroleum jelly gel $0 OTC px hemorrhoidal rectal ointment $0 OTC ra hemorrhoidal rectal ointment $0 OTC ra renewal soothing bath external packet $0 OTC sm oatmeal bath external packet $0 OTC sm petroleum jelly gel $0 OTC VASELINE GEL $0 OTC white petroleum jelly external gel $0 OTC Keratolytic Agents acne external pad $0 OTC callus removers external pad $0 OTC callus removers extra thick external pad $0 OTC CLEAR AWAY 1-STEP WART REMOVER EXTERNAL PAD $0 OTC COMPOUND W EXTERNAL LIQUID $0 OTC COMPOUND W EXTERNAL PAD $0 OTC COMPOUND W ONE STEP EXTERNAL PAD $0 OTC COMPOUND W ONE STEP INVISIBLE EXTERNAL STRIP $0 OTC corn & callus remover external liquid $0 OTC corn remover one-step external strip $0 OTC cvs corn removers external pad $0 OTC cvs corn/callus remover external kit $0 OTC cvs plantar wart remover external pad $0 OTC cvs wart remover external liquid $0 OTC cvs wart remover external pad $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 142

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs wart remover one step external strip $0 OTC cvs wart remover pen external gel $0 OTC daily face wash external liquid $0 OTC DUOFILM EXTERNAL SOLUTION $0 OTC gel callus removers external pad $0 OTC gnp wart remover external liquid $0 OTC liquid corn & callus remover external liquid $0 OTC medicated callus removers external pad $0 OTC medicated corn removers external pad $0 OTC medicated wart removers external pad $0 OTC NEUTROGENA RAPID CLEAR EXTERNAL PAD $0 OTC ra corn removers ultra thin external pad $0 OTC ra wart remover external gel $0 OTC ra wart remover external pad $0 OTC ra wart remover max strength external liquid $0 OTC sm medicated corn removers external pad $0 OTC ultra thin corn removers external pad $0 OTC wart remover external gel $0 OTC wart remover maximum strength external gel $0 OTC wart remover maximum strength external liquid $0 OTC wart remover maximum strength external strip $0 OTC Keratoplastic Agents cvs therapeutic external shampoo $0 OTC eql therapeutic external shampoo $0 OTC IONIL-T EXTERNAL SHAMPOO $0 OTC sm anti-dandruff coal tar external shampoo $0 OTC TARSUM PROFESSIONAL EXTERNAL SHAMPOO $0 OTC therapeutic external shampoo $0 OTC THERAPEUTIC T+PLUS EXTERNAL SHAMPOO $0 OTC X-SEB T PLUS EXTERNAL SHAMPOO 10 % $0 OTC Local Anti-Infectives, Miscellaneous acne foaming wash external liquid $0 OTC acne medication 5 external gel $0 OTC antiseptic skin cleanser external solution 4 % $0 OTC BENZEPRO CREAMY WASH EXTERNAL LIQUID $0 OTC benzoyl peroxide external gel 2.5 %, 5 % $0 OTC benzoyl peroxide wash external liquid 10 % $0 OTC benzoyl peroxide wash external liquid 5 % $0 OTC BETASEPT SURGICAL SCRUB EXTERNAL LIQUID $0 OTC bp gel external gel 5 % $0 OTC bp wash external liquid 10 %, 2.5 %, 5 %, 7 % $0 OTC bpo external gel $0 OTC CLEARASIL DAILY CLEAR ACNE EXTERNAL CREAM $0 OTC cvs acne control cleanser external cream $0 OTC cvs acne external cream $0 OTC cvs acne foaming face wash external liquid $0 OTC cvs advanced 3-in-1 cleanser external liquid $0 OTC cvs antiseptic skin cleanser external solution $0 OTC cvs creamy acne face wash external liquid $0 OTC cvs foaming acne face wash external liquid $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 143

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs hydrogen peroxide external solution $0 OTC cvs povidone-iodine external solution $0 OTC cvs rubbing alcohol solution $0 OTC DYNA-HEX 4 EXTERNAL SOLUTION $0 OTC eq first aid antiseptic external solution $0 OTC eq povidone-iodine external solution $0 OTC eql hydrogen peroxide external solution $0 OTC eql isopropyl rubbing alcohol solution $0 OTC gnp antiseptic skin cleanser external solution $0 OTC gnp hydrogen peroxide external solution $0 OTC goodsense hydrogen peroxide external solution $0 OTC HIBICLENS EXTERNAL LIQUID $0 OTC hm antiseptic skin cleanser external solution $0 OTC hm hydrogen peroxide external solution $0 OTC hm isopropyl alcohol solution 70 % $0 OTC hm povidone-iodine external solution $0 OTC hydrogen peroxide external solution $0 OTC isopropanol solution $0 OTC isopropyl alcohol (rubbing) solution $0 OTC isopropyl alcohol solution 70 % $0 OTC isopropyl alcohol, rubbing solution $0 OTC PANOXYL CREAMY WASH EXTERNAL LIQUID $0 OTC PANOXYL FOAMING WASH EXTERNAL LIQUID $0 OTC povidone-iodine external pad $0 OTC povidone-iodine external solution 10 % $0 OTC PR BENZOYL PEROXIDE WASH EXTERNAL LIQUID $0 OTC px hydrogen peroxide external solution $0 OTC qc hydrogen peroxide external solution $0 OTC qc povidone iodine external solution $0 OTC ra antiseptic external solution $0 OTC ra daylogic acne foaming wash external foam $0 OTC ra hydrogen peroxide external solution $0 OTC ra isopropyl rubbing alcohol solution $0 OTC sb povidone-iodine external solution $0 OTC sm alcohol solution $0 OTC sm hydrogen peroxide external solution $0 OTC sm isopropyl alcohol solution 70 % $0 OTC sm povidone-iodine external solution $0 OTC Scabicides And Pediculicides cvs lice killing external shampoo $0 OTC CVS LICE SOLUTION COMBINATION KIT $0 OTC cvs lice treatment external liquid $0 OTC eq lice killing max st external shampoo $0 OTC eql lice killing max st external shampoo $0 OTC gnp lice treatment external liquid $0 OTC gnp lice treatment external shampoo $0 OTC hm lice killing max st external shampoo $0 OTC hm lice treatment external liquid $0 OTC lice killing external shampoo $0 OTC lice killing maximum strength external shampoo $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 144

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

lice treatment external liquid 1 % $0 OTC lice treatment external lotion $0 OTC ra lice maximum strength external shampoo $0 OTC ra lice solution combination kit 0.5-0.33-4 % $0 OTC RID EXTERNAL LIQUID $0 OTC RID LICE KILLING SHAMPOO EXTERNAL SHAMPOO $0 OTC sb lice killing max st external shampoo $0 OTC sm lice killing external shampoo $0 OTC sm lice killing max strength external shampoo $0 OTC sm lice solution kit combination kit $0 OTC sm lice treatment external lotion $0 OTC stop lice complete treatment combination kit $0 OTC Skin And Mucous Membrane Agents, Misc. arthritis pain relieving external cream $0 OTC capsaicin external cream 0.025 %, 0.1 % $0 OTC capsaicin hp external cream $0 OTC cvs capsaicin hp external cream $0 OTC MEDI-PAK PERFORMANCE PLUS ABD EXTERNAL PAD $0 OTC ZOSTRIX HP EXTERNAL CREAM 0.1 % $0 OTC Thiocarbamates(Skin And Mucous Membrane) antifungal (tolnaftate) external cream $0 OTC antifungal external cream 1 % $0 OTC anti-fungal external powder $0 OTC athletes foot powder spray external aerosol powder 1 % $0 OTC athletes foot spray external aerosol $0 OTC BLIS-TO-SOL EXTERNAL LIQUID $0 OTC cvs foot & sneaker external aerosol powder $0 OTC eq athletes foot (tolnaftate) external cream $0 OTC eql antifungal (tolnaftate) external cream $0 OTC gnp tolnaftate external cream $0 OTC jock itch spray powder external aerosol powder $0 OTC kp tolnaftate external cream $0 OTC medicated anti-fungal external solution $0 OTC odor control foot & sneaker external aerosol powder $0 OTC qc tolnaftate external cream $0 OTC ra foot care (tolnaftate) external cream $0 OTC ra jock itch max st external aerosol powder $0 OTC sm antifungal tolnaftate external cream $0 OTC TINACTIN EXTERNAL AEROSOL POWDER $0 OTC tolnaftate antifungal external cream $0 OTC tolnaftate external aerosol powder $0 OTC tolnaftate external cream $0 OTC tolnaftate external powder $0 OTC Vitamins Multivitamin Preparations 50+ adult eye health oral capsule $0 OTC a thru z advanced oral tablet $0 OTC a thru z select 50+ advanced oral tablet $0 OTC a thru z select 50+ mens oral tablet $0 OTC a thru z select advanced oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 145

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

a thru z select oral tablet $0 OTC a thru z select ultimate women oral tablet $0 OTC a thru z ultimate mens oral tablet $0 OTC ABC PLUS SENIOR ADULTS 50+ ORAL TABLET $0 OTC animal chews oral tablet chewable $0 OTC animal shapes/iron oral tablet chewable $0 OTC antioxidant a/c/e/selenium oral tablet $0 OTC antioxidant oral capsule $0 OTC b complex-c oral tablet $0 OTC b complex-c-biotin-e-fa oral tablet $0 OTC b complex-c-folic acid oral tablet $0 OTC b-complex/vitamin c oral tablet $0 OTC b-complex-c (w/folic acid) oral tablet $0 OTC b-complex-c oral tablet $0 OTC biotin plus/calcium/vit d3 oral tablet $0 OTC BPROTECTED MULTI-VITE ORAL LIQUID $0 OTC c complex oral tablet extended release $0 OTC calcium/c/d oral tablet chewable $0 OTC centravites 50 plus oral tablet $0 OTC centravites adults oral tablet $0 OTC centravites oral tablet $0 OTC CENTRUM ADULTS ORAL TABLET $0 OTC CENTRUM ORAL LIQUID $0 OTC CENTRUM SILVER ADULT 50+ ORAL TABLET $0 OTC CENTRUM SILVER ORAL TABLET $0 OTC CENTRUM SPECIALIST HEART ORAL TABLET $0 OTC CENTRUM ULTRA WOMENS ORAL TABLET $0 OTC certa plus oral tablet $0 OTC CERTAVITE/ANTIOXIDANTS ORAL TABLET $0 OTC childrens chewable multi vits oral tablet chewable $0 OTC childrens chewable vitamins oral tablet chewable $0 OTC childrens multivitamin oral tablet chewable $0 OTC companion oral tablet $0 OTC complete multivitamin/mineral oral liquid $0 OTC cvs b complex plus c oral tablet $0 OTC cvs childrens complete oral tablet chewable 18 mg $0 OTC cvs daily multiple for men oral tablet $0 OTC cvs daily multiple women 50+ oral tablet $0 OTC cvs eye health & lutein oral tablet $0 OTC cvs eye health adult 50+ oral capsule $0 OTC cvs gummy dinos oral tablet chewable $0 OTC cvs hair/skin/nails oral tablet $0 OTC cvs one daily essential oral tablet $0 OTC cvs one daily womens formula oral tablet $0 OTC cvs spectravite adult 50+ oral tablet $0 OTC cvs spectravite advanced oral tablet $0 OTC cvs spectravite senior oral tablet $0 OTC cvs spectravite ultra men 50+ oral tablet $0 OTC cvs spectravite ultra mens oral tablet $0 OTC cvs spectravite ultra women oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 146

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs spectravite womens senior oral tablet $0 OTC cvs stress formula/zinc oral tablet $0 OTC cvs super b complex/c oral tablet $0 OTC cvs womens active daily oral tablet $0 OTC daily multiple vitamins oral tablet $0 OTC daily multiple vitamins/iron oral tablet $0 OTC daily multiple vitamins/min oral tablet $0 OTC daily value multivitamin oral tablet $0 OTC daily vitamin formula+iron oral tablet $0 OTC daily vitamin formula+minerals oral tablet $0 OTC daily vitamin oral tablet $0 OTC daily vitamins oral tablet $0 OTC daily vite oral tablet $0 OTC diabetes health formula oral tablet $0 OTC DIALYVITE 800 ORAL TABLET $0 OTC DIALYVITE ORAL TABLET $0 OTC eq complete multivit adult 50+ oral tablet $0 OTC eq complete multivitamin-adult oral tablet $0 OTC eq multivitamin gummies oral tablet chewable $0 OTC eq one daily mens health oral tablet $0 OTC eq one daily womens health oral tablet $0 OTC eql century oral tablet $0 OTC eql child multivit/minerals oral tablet chewable 18 mg $0 OTC eql one daily mens health oral tablet $0 OTC eql one daily womens 50+ adv oral tablet $0 OTC eql one daily womens oral tablet $0 OTC eql super b complex/vitamin c oral tablet $0 OTC eql vision formula oral tablet $0 OTC ESSENTIA ORAL TABLET $0 OTC essential one daily multivit oral tablet $0 OTC FLINTSTONES COMPLETE ORAL TABLET CHEWABLE 10 MG, 18 MG $0 OTC

FLINTSTONES/EXTRA C ORAL TABLET CHEWABLE $0 OTC FLINTSTONES/MY FIRST ORAL TABLET CHEWABLE $0 OTC full spectrum b/vitamin c oral tablet $0 OTC gnp century adults 50+ senior oral tablet $0 OTC gnp century energy metabolism oral tablet $0 OTC gnp century oral tablet $0 OTC gnp century ultimate mens oral tablet $0 OTC gnp century ultimate womens oral tablet $0 OTC gnp childrens chewables/iron oral tablet chewable $0 OTC gnp essential one daily oral tablet $0 OTC gnp hair/skin/nails oral tablet $0 OTC gnp healthy eyes oral tablet $0 OTC gnp healthy eyes supervision oral capsule $0 OTC gnp little ones childrens oral tablet chewable $0 OTC gnp mega multi for men oral tablet $0 OTC gnp mega multi for women oral tablet $0 OTC gnp one daily mens health 50+ oral tablet $0 OTC gnp one daily mens/lycopene oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 147

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

gnp one daily womens 50+ oral tablet $0 OTC gnp one daily womens health oral tablet $0 OTC gnp one daily womens oral tablet $0 OTC gnp prenatal oral tablet $0 OTC gnp therapeutic-m oral tablet $0 OTC GUMMI BEAR MULTIVITAMIN/MIN ORAL TABLET CHEWABLE $0 OTC hair vitamins oral tablet $0 OTC hair/skin/nails oral tablet $0 OTC healthy eyes oral tablet $0 OTC healthy eyes/lutein oral tablet $0 OTC hm complete men oral tablet $0 OTC hm complete women oral tablet $0 OTC hm womens 50+ advanced daily oral tablet $0 OTC ICAPS MV ORAL TABLET $0 OTC ICAPS ORAL CAPSULE $0 OTC kp adults 50+ daily formula oral tablet $0 OTC kp adults daily formula oral tablet $0 OTC kp b complex-c oral tablet $0 OTC kp mens daily formula oral tablet $0 OTC kp prenatal multivitamins oral tablet $0 OTC KP VISION FORMULA/LUTEIN ORAL TABLET $0 OTC kp womens 50+ daily formula oral tablet $0 OTC kp womens daily formula oral tablet $0 OTC K-PAX IMMUNE PROFESSIONAL ST ORAL TABLET $0 OTC kpn prenatal oral tablet $0 OTC LYSIPLEX PLUS ORAL LIQUID $0 OTC MACUVITE/LUTEIN ORAL TABLET $0 OTC mega multiple/chelated mineral oral tablet $0 OTC mega multivitamin for men oral tablet $0 OTC mega multivitamin for women oral tablet $0 OTC mens multi vitamin & mineral oral tablet $0 OTC MILLTRIUM SENIOR ORAL TABLET $0 OTC m-natal plus oral tablet $0 OTC multi complete/iron oral tablet $0 OTC multi vitamin daily oral tablet $0 OTC multi-day plus iron oral tablet $0 OTC multiple vit/minerals/no iron oral tablet $0 OTC multiple vitamins oral tablet $0 OTC multiple vitamins/iron oral tablet $0 OTC multiple vitamins/womens oral tablet $0 OTC multivitamin & mineral oral liquid $0 OTC multivitamin adult oral tablet $0 OTC multivitamin adults 50+ oral tablet $0 OTC multivitamin adults oral tablet $0 OTC multivitamin childrens (w/ fa) oral tablet chewable $0 OTC multivitamin childrens oral tablet chewable $0 OTC multi-vitamin daily oral tablet $0 OTC multivitamin gummies childrens oral tablet chewable $0 OTC multi-vitamin hp/minerals oral capsule $0 OTC multivitamin men 50+ oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 148

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

multivitamin men oral tablet $0 OTC multivitamin oral liquid $0 OTC multivitamin oral tablet $0 OTC multi-vitamin oral tablet $0 OTC multivitamin women 50+ oral tablet $0 OTC multivitamin women oral tablet $0 OTC multi-vitamin/minerals oral tablet $0 OTC multi-vitamins oral tablet $0 OTC multivitamins/minerals adult oral liquid $0 OTC multi-vite oral liquid $0 OTC no iron mult vitamin-minerals oral tablet $0 OTC ocutabs oral tablet $0 OTC ocutabs-lutein oral tablet $0 OTC OCUVITE-LUTEIN ORAL TABLET $0 OTC omnicap oral tablet $0 OTC once daily oral tablet $0 OTC ONCOVITE ORAL TABLET $0 OTC one daily calcium/iron oral tablet $0 OTC one daily for men 50+ advanced oral tablet $0 OTC one daily for men/lycopene oral tablet $0 OTC one daily for women 50+ adv oral tablet $0 OTC one daily for women oral tablet $0 OTC one daily maximum oral tablet $0 OTC one daily mens health oral tablet $0 OTC one daily mens oral tablet $0 OTC one daily multivitamin adult oral tablet $0 OTC one daily multivitamin/iron oral tablet $0 OTC one daily oral tablet $0 OTC ONE DAILY PLUS IRON ORAL TABLET $0 OTC one daily womens 50 plus oral tablet $0 OTC one daily/minerals oral tablet $0 OTC ONE-A-DAY ESSENTIAL ORAL TABLET $0 OTC ONE-A-DAY TEEN ADVANTAGE/HER ORAL TABLET $0 OTC ONE-A-DAY TEEN ADVANTAGE/HIM ORAL TABLET $0 OTC one-daily multi vitamins oral tablet $0 OTC one-daily multi-vitamin oral tablet $0 OTC poly-vita oral solution $0 OTC px complete senior multivits oral tablet $0 OTC qc daily multivit/multimineral oral tablet $0 OTC qc mens daily multivitamin oral tablet $0 OTC qc prenatal oral tablet $0 OTC quintabs oral tablet $0 OTC quintabs-m oral tablet $0 OTC RA CENTRAL-VITE ORAL TABLET $0 OTC ra central-vite womens mature oral tablet $0 OTC ra one daily maximum oral tablet $0 OTC ra one daily mens/vit d-3 oral tablet $0 OTC ra prenatal oral tablet $0 OTC ra vitamin c cr oral tablet extended release $0 OTC SCOOBY-DOO ONE A DAY ORAL TABLET CHEWABLE $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 149

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

senior tabs oral tablet $0 OTC sentry adult oral tablet $0 OTC sentry oral tablet $0 OTC sentry senior oral tablet $0 OTC sm animal shapes complete oral tablet chewable 18 mg $0 OTC sm antioxidant vitamins oral tablet $0 OTC sm b super vitamin complex oral tablet $0 OTC sm b-complex/vitamin c oral tablet $0 OTC sm complete 50+ oral tablet $0 OTC sm complete 50+ ultimate mens oral tablet $0 OTC sm complete 50+ ultimate women oral tablet $0 OTC sm complete advanced formula oral tablet $0 OTC sm complete oral tablet $0 OTC sm complete senior formula oral tablet $0 OTC sm hair/skin/nails oral tablet $0 OTC sm multiple vitamins essential oral tablet $0 OTC sm multiple vitamins/iron oral tablet $0 OTC sm one daily essential oral tablet $0 OTC sm one daily mens oral tablet $0 OTC sm one daily womens oral tablet $0 OTC sm opti-vitamins oral tablet $0 OTC sm prenatal vitamins oral tablet $0 OTC sm super b complex/c oral tablet $0 OTC stress b/zinc oral tablet $0 OTC stress formula (folic acid) oral tablet $0 OTC stress formula (w/ minerals) oral tablet $0 OTC stress formula oral tablet $0 OTC stress formula/iron (mvi) oral tablet $0 OTC stress formula/iron oral tablet $0 OTC super antioxidant oral capsule $0 OTC super b complex/fa/vit c oral tablet $0 OTC super b-complex/vit c/fa oral tablet $0 OTC super multiple oral tablet $0 OTC super thera vite m oral tablet $0 OTC TAB-A-VITE ORAL TABLET $0 OTC TAB-A-VITE/BETA CAROTENE ORAL TABLET $0 OTC tab-a-vite/iron oral tablet $0 OTC THERA ORAL TABLET $0 OTC THERAGRAN-M PREMIER 50 PLUS ORAL TABLET $0 OTC thera-m oral tablet $0 OTC therapeutic m oral tablet $0 OTC therapeutic-m oral tablet $0 OTC therapeutic-m/lutein oral tablet $0 OTC thera-tabs oral tablet $0 OTC THERATRUM COMPLETE 50 PLUS ORAL TABLET $0 OTC THERATRUM COMPLETE ORAL TABLET $0 OTC THEREMS ORAL TABLET $0 OTC vision formula eye health oral capsule $0 OTC vision formula/lutein oral tablet $0 OTC vision vitamins oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 150

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

vit e-vit c-beta carotene oral tablet $0 OTC vitachew multiple vitamin oral tablet chewable $0 OTC vitalee oral tablet $0 OTC VITALETS CHILDRENS ORAL TABLET CHEWABLE $0 OTC vitamin b + c complex oral tablet $0 OTC vitamin c oral tablet chewable $0 OTC vitamins a-d-e/selenium oral tablet $0 OTC VITRUM SENIOR ORAL TABLET $0 OTC west-vite w/folic acid oral tablet $0 OTC womens daily form/fa/ca/fe oral tablet $0 OTC womens daily formula oral tablet $0 OTC womens multivitamin oral tablet $0 OTC womens one daily oral tablet $0 OTC YELETS TEENAGE FORMULA ORAL TABLET $0 OTC zoo friends oral tablet chewable $0 OTC zoo friends plus iron oral tablet chewable $0 OTC Vitamin A a-10000 oral capsule 3 mg (10000 ut) $0 OTC beta carotene oral capsule $0 OTC cvs beta carotene oral capsule 15 mg $0 OTC cvs vitamin a oral capsule 2400 mcg (8000 ut) $0 OTC gnp vitamin a oral capsule 3 mg (10000 ut) $0 OTC ra vitamin a oral capsule 3 mg (10000 ut) $0 OTC vitamin a oral capsule 2400 mcg (8000 ut), 3 mg (10000 ut) $0 OTC Vitamin B Complex animal chews oral tablet chewable $0 OTC b complex-c oral tablet $0 OTC b complex-c-biotin-e-fa oral tablet $0 OTC b complex-c-folic acid oral tablet $0 OTC b1 oral tablet $0 OTC b-1 oral tablet 100 mg, 250 mg $0 OTC B-12 DOTS ORAL TABLET DISPERSIBLE $0 OTC b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 500 mcg $0 OTC b-12 oral tablet extended release 1000 mcg $0 OTC b-12 tr oral tablet extended release 1000 mcg $0 OTC b-2 oral tablet 100 mg $0 OTC b6 natural oral tablet $0 OTC b-6 oral tablet 100 mg, 50 mg $0 OTC b-complex/vitamin c oral tablet $0 OTC b-complex-c (w/folic acid) oral tablet $0 OTC b-complex-c oral tablet $0 OTC childrens chewable multi vits oral tablet chewable $0 OTC childrens chewable vitamins oral tablet chewable $0 OTC childrens multivitamin oral tablet chewable $0 OTC cvs b complex plus c oral tablet $0 OTC cvs b-1 oral tablet $0 OTC cvs b-12 oral tablet $0 OTC cvs b6 oral tablet $0 OTC cvs folic acid oral tablet 800 mcg $0 OTC cvs stress formula/zinc oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 151

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

cvs super b complex/c oral tablet $0 OTC cvs vitamin b12 oral tablet $0 OTC cvs vitamin b-12 oral tablet 1000 mcg $0 OTC cvs vitamin b12 oral tablet extended release $0 OTC cvs vitamin b-2 oral tablet $0 OTC cyanocobalamin injection solution 1000 mcg/ml $0 OTC DIALYVITE 800 ORAL TABLET $0 OTC DIALYVITE ORAL TABLET $0 OTC ENDUR-ACIN ORAL TABLET EXTENDED RELEASE $0 OTC eql b-6 oral tablet $0 OTC eql super b complex/vitamin c oral tablet $0 OTC eql vitamin b-12 oral tablet $0 OTC eql vitamin b-12 tr oral tablet extended release $0 OTC FLINTSTONES/EXTRA C ORAL TABLET CHEWABLE $0 OTC FLINTSTONES/MY FIRST ORAL TABLET CHEWABLE $0 OTC folate oral tablet $0 OTC folic acid oral capsule 20 mg $0 OTC folic acid oral tablet 1 mg $0 OTC folic acid oral tablet 400 mcg, 800 mcg $0 OTC full spectrum b/vitamin c oral tablet $0 OTC gnp folic acid oral tablet $0 OTC gnp little ones childrens oral tablet chewable $0 OTC gnp prenatal oral tablet $0 OTC gnp vitamin b-1 oral tablet $0 OTC gnp vitamin b-12 oral tablet $0 OTC gnp vitamin b-12 oral tablet extended release $0 OTC gnp vitamin b-6 oral tablet 100 mg $0 OTC hm folic acid oral tablet $0 OTC hm vitamin b-12 oral tablet $0 OTC kp b complex-c oral tablet $0 OTC kp folic acid oral tablet $0 OTC kp niacin oral tablet $0 OTC kp prenatal multivitamins oral tablet $0 OTC kp vitamin b-12 oral tablet $0 OTC kp vitamin b-6 oral tablet $0 OTC kpn prenatal oral tablet $0 OTC m-natal plus oral tablet $0 OTC multivitamin childrens (w/ fa) oral tablet chewable $0 OTC niacin er oral capsule extended release $0 OTC niacin er oral tablet extended release $0 OTC niacin oral tablet $0 OTC niacinamide oral tablet 500 mg $0 OTC plain niacin oral tablet $0 OTC pyridoxine hcl oral tablet 25 mg, 50 mg $0 OTC qc prenatal oral tablet $0 OTC ra folic acid oral tablet $0 OTC ra niacin oral tablet $0 OTC ra no flush niacin oral tablet $0 OTC ra prenatal oral tablet $0 OTC ra vitamin b-1 oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 152

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

ra vitamin b-12 oral tablet $0 OTC ra vitamin b-12 tr oral tablet extended release $0 OTC ra vitamin b-6 oral tablet $0 OTC SLO-NIACIN ORAL TABLET EXTENDED RELEASE 500 MG $0 OTC sm b super vitamin complex oral tablet $0 OTC sm b-complex/vitamin c oral tablet $0 OTC sm folic acid oral tablet $0 OTC sm niacin cr oral tablet extended release $0 OTC sm prenatal vitamins oral tablet $0 OTC sm super b complex/c oral tablet $0 OTC sm vitamin b1 oral tablet $0 OTC sm vitamin b-12 oral tablet $0 OTC sm vitamin b12 tr oral tablet extended release 1000 mcg $0 OTC sm vitamin b6 oral tablet $0 OTC sm vitamin b-6 oral tablet $0 OTC stress b/zinc oral tablet $0 OTC super b complex/fa/vit c oral tablet $0 OTC super b-complex/vit c/fa oral tablet $0 OTC sv vitamin b-12 er oral tablet extended release $0 OTC thiamine hcl oral tablet $0 OTC thiamine mononitrate oral tablet $0 OTC vitamin b + c complex oral tablet $0 OTC vitamin b 12 oral tablet $0 OTC vitamin b-1 oral tablet $0 OTC vitamin b-12 er oral tablet extended release 1000 mcg $0 OTC vitamin b12 oral tablet 100 mcg $0 OTC vitamin b-12 oral tablet 100 mcg, 1000 mcg, 250 mcg, 500 mcg $0 OTC vitamin b12 tr oral tablet extended release 1000 mcg $0 OTC vitamin b-2 oral tablet 100 mg $0 OTC vitamin b-6 oral tablet 100 mg, 25 mg, 50 mg $0 OTC vitamin b6 oral tablet 100 mg, 50 mg $0 OTC west-vite w/folic acid oral tablet $0 OTC Vitamin C ACEROLA C 500 ORAL WAFER $0 OTC acerola c-500 oral tablet chewable $0 OTC animal chews oral tablet chewable $0 OTC ascorbic acid oral tablet 500 mg $0 OTC b complex-c oral tablet $0 OTC b complex-c-biotin-e-fa oral tablet $0 OTC b complex-c-folic acid oral tablet $0 OTC b-complex/vitamin c oral tablet $0 OTC b-complex-c (w/folic acid) oral tablet $0 OTC b-complex-c oral tablet $0 OTC c 1000 oral tablet $0 OTC c 250 oral tablet $0 OTC c 500 oral tablet $0 OTC c 500 oral tablet chewable $0 OTC c 500/rose hips oral tablet $0 OTC c-1000 oral tablet $0 OTC c-1000 oral tablet extended release $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 153

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

c-1000/rose hips oral tablet $0 OTC c-250 oral tablet $0 OTC c-500 oral tablet $0 OTC c-500 oral tablet chewable $0 OTC c-500/rose hips oral tablet $0 OTC calcium/c/d oral tablet chewable $0 OTC c-chewable oral tablet chewable 500 mg $0 OTC childrens chewable multi vits oral tablet chewable $0 OTC childrens chewable vitamins oral tablet chewable $0 OTC childrens multivitamin oral tablet chewable $0 OTC cvs b complex plus c oral tablet $0 OTC cvs chewable c with rose hips oral tablet chewable $0 OTC cvs glucose oral tablet chewable 4-6 gm-mg $0 OTC QL cvs gummy dinos oral tablet chewable $0 OTC cvs stress formula/zinc oral tablet $0 OTC cvs super b complex/c oral tablet $0 OTC cvs vitamin c oral tablet $0 OTC cvs vitamin c-rose hips oral tablet $0 OTC DEX4 GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL DEX4 NATURALS ORAL TABLET CHEWABLE $0 OTC QL DEX4 ORAL TABLET CHEWABLE 4-6 GM-MG $0 OTC QL DEX4 POUCH PACK ORAL TABLET CHEWABLE $0 OTC QL DIALYVITE 800 ORAL TABLET $0 OTC DIALYVITE ORAL TABLET $0 OTC ENDUR-C ORAL TABLET EXTENDED RELEASE 1000 MG $0 OTC eq multivitamin gummies oral tablet chewable $0 OTC eql super b complex/vitamin c oral tablet $0 OTC eql vitamin c oral tablet $0 OTC eql vitamin c/rose hips oral tablet $0 OTC FLINTSTONES/EXTRA C ORAL TABLET CHEWABLE $0 OTC FLINTSTONES/MY FIRST ORAL TABLET CHEWABLE $0 OTC fruit c 500 oral tablet chewable $0 OTC full spectrum b/vitamin c oral tablet $0 OTC glucose instant energy oral tablet chewable $0 OTC QL glucose oral tablet chewable 4-6 gm-mg $0 OTC QL gnp glucose oral tablet chewable 4-6 gm-mg $0 OTC QL gnp little ones childrens oral tablet chewable $0 OTC gnp vitamin c oral tablet $0 OTC gnp vitamin c oral tablet chewable 500 mg $0 OTC gnp vitamin c w/rose hips oral tablet 500-37 mg $0 OTC gnp vitamin c/rose hips oral tablet $0 OTC goodsense glucose oral tablet chewable 4-6 gm-mg $0 OTC QL GUMMI BEAR MULTIVITAMIN/MIN ORAL TABLET CHEWABLE $0 OTC hm vitamin c oral tablet chewable $0 OTC kp b complex-c oral tablet $0 OTC kroger glucose oral tablet chewable $0 OTC QL leader glucose oral tablet chewable $0 OTC QL longs glucose oral tablet chewable 4-6 gm-mg $0 OTC QL meijer c oral tablet $0 OTC meijer glucose oral tablet chewable 4-6 gm-mg $0 OTC QL

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 154

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

multivitamin childrens (w/ fa) oral tablet chewable $0 OTC natural c/rose hips oral tablet 1000 mg $0 OTC preferred plus glucose oral tablet chewable $0 OTC QL PUREWAY-C ORAL TABLET $0 OTC px glucose oral tablet chewable $0 OTC QL ra glucose oral tablet chewable $0 OTC QL ra vitamin c oral tablet $0 OTC ra vitamin c oral tablet chewable 500 mg $0 OTC ra vitamin c/acerola oral tablet chewable $0 OTC ra vitamin c/rose hips oral tablet $0 OTC RELION GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL sb vitamin c oral tablet $0 OTC sm b super vitamin complex oral tablet $0 OTC sm b-complex/vitamin c oral tablet $0 OTC sm chewable c oral tablet chewable $0 OTC sm chewable vitamin c oral tablet chewable $0 OTC sm glucose oral tablet chewable 4-6 gm-mg $0 OTC QL sm super b complex/c oral tablet $0 OTC sm vit c/rose hips oral tablet $0 OTC sm vitamin c oral tablet $0 OTC sm vitamin c oral tablet chewable $0 OTC sm vitamin c/rose hips oral tablet $0 OTC SMART SENSE GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL stress b/zinc oral tablet $0 OTC super b complex/fa/vit c oral tablet $0 OTC super b-complex/vit c/fa oral tablet $0 OTC tgt glucose oral tablet chewable 4-6 gm-mg $0 OTC QL TRUEPLUS GLUCOSE ON THE GO ORAL TABLET CHEWABLE $0 OTC QL TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL up & up glucose oral tablet chewable $0 OTC QL vitachew multiple vitamin oral tablet chewable $0 OTC VITALETS CHILDRENS ORAL TABLET CHEWABLE $0 OTC vitamin b + c complex oral tablet $0 OTC vitamin c immune health oral tablet chewable $0 OTC vitamin c oral tablet 1000 mg, 250 mg, 500 mg $0 OTC vitamin c oral tablet chewable 500 mg $0 OTC vitamin c plus wild rose hips oral tablet chewable $0 OTC vitamin c/rose hips oral tablet $0 OTC vitamin c/rose hips tr oral tablet extended release $0 OTC vitamin c-rose hips er oral tablet extended release 1000 mg $0 OTC vitamin c-rose hips oral tablet 1000 mg, 500 mg $0 OTC walgreens glucose oral tablet chewable 4-6 gm-mg $0 OTC QL west-vite w/folic acid oral tablet $0 OTC zoo friends oral tablet chewable $0 OTC Vitamin D aqueous vitamin d oral liquid 10 mcg/ml $0 OTC BPROTECTED PEDIA D-VITE ORAL LIQUID 10 MCG/ML $0 OTC CALCIDOL ORAL SOLUTION 200 MCG/ML $0 OTC CALCITRATE ORAL TABLET 315-250 MG-UNIT $0 OTC cal-citrate plus vitamin d oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 155

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

calcium 1000 + d oral tablet $0 OTC calcium 500 + d oral tablet 500-125 mg-unit $0 OTC calcium 500 + d3 oral tablet 500-600 mg-unit $0 OTC calcium 500/d oral tablet $0 OTC calcium 500+d high potency oral tablet $0 OTC calcium 500+d oral tablet $0 OTC calcium 500+d3 oral tablet 500-400 mg-unit $0 OTC calcium 600/vitamin d oral tablet $0 OTC calcium 600/vitamin d oral tablet chewable $0 OTC calcium 600+d high potency oral tablet $0 OTC calcium 600+d oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC calcium 600+d3 oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC calcium 600+d3 plus minerals oral tablet chewable $0 OTC calcium carb-cholecalciferol oral tablet 600-400 mg-unit $0 OTC calcium carbonate-vitamin d oral tablet 600-200 mg-unit, 600-400 mg-unit $0 OTC

calcium citrate + d oral tablet 250-200 mg-unit, 315-200 mg-unit, 315-250 mg-unit $0 OTC

calcium citrate + d3 maximum oral tablet $0 OTC calcium citrate + d3 oral tablet 200-250 mg-unit, 250-200 mg-unit $0 OTC calcium citrate+d3 oral tablet $0 OTC calcium citrate+d3 petites oral tablet $0 OTC calcium citrate-vitamin d oral tablet 315-200 mg-unit, 315-250 mg-unit $0 OTC calcium citrate-vitamin d3 oral tablet $0 OTC calcium extra d3 oral tablet $0 OTC calcium high potency/vitamin d oral tablet $0 OTC calcium oral tablet chewable 500-100 mg-unit $0 OTC calcium plus vitamin d3 oral tablet $0 OTC calcium/c/d oral tablet chewable $0 OTC calcium+d3 oral tablet 500-10 mg-mcg, 500-15 mg-mcg $0 OTC calcium-vitamin d oral tablet 500-400 mg-unit, 600-400 mg-unit $0 OTC calcium-vitamin d3 oral tablet 250-125 mg-unit, 500-400 mg-unit, 600-400 mg-unit $0 OTC

CITRACAL MAXIMUM ORAL TABLET $0 OTC citrus calcium/vitamin d oral tablet 200-250 mg-unit $0 OTC cvs calcium 600 + d/minerals oral tablet chewable $0 OTC cvs calcium citrate+d3 oral tablet $0 OTC cvs calcium citrate+d3 petites oral tablet $0 OTC cvs d3 oral capsule $0 OTC d 1000 oral capsule $0 OTC d 1000 oral tablet $0 OTC d 400 oral tablet $0 OTC d 5000 oral capsule $0 OTC d-1000 extra strength oral tablet $0 OTC d2000 ultra strength oral capsule $0 OTC d3 high potency oral capsule 25 mcg (1000 ut), 50 mcg (2000 ut) $0 OTC d3 high potency oral tablet $0 OTC d3 maximum strength oral capsule $0 OTC d3 super strength oral capsule $0 OTC d3-1000 oral capsule $0 OTC d3-1000 oral tablet $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 156

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

d-3-5 oral capsule $0 OTC D3-50 ORAL CAPSULE $0 OTC d-400 oral tablet $0 OTC DECARA ORAL CAPSULE 1.25 MG (50000 UT) $0 OTC delta d3 oral tablet $0 OTC DIALYVITE VITAMIN D 5000 ORAL CAPSULE $0 OTC D-VI-SOL ORAL LIQUID 10 MCG/ML $0 OTC eq calcium 500+d oral tablet $0 OTC eq calcium 600+d oral tablet 600-800 mg-unit $0 OTC eq calcium citrate+d oral tablet $0 OTC eql calcium citrate/vitamin d oral tablet $0 OTC eql calcium citrate/vitamin d3 oral tablet $0 OTC eql vitamin d3 oral capsule $0 OTC gnp calcium 500 +d3 oral tablet $0 OTC gnp calcium 600 +d3/minerals oral tablet chewable $0 OTC gnp calcium citrate +d3 oral tablet $0 OTC gnp d 1000 oral capsule $0 OTC gnp vitamin d oral tablet 25 mcg (1000 ut) $0 OTC gnp vitamin d3 extra strength oral tablet $0 OTC gnp vitamin d-400 oral tablet 10 mcg (400 unit) $0 OTC hm calcium citrate+d3 petite oral tablet $0 OTC kp calcium citrate+d oral tablet $0 OTC kp vitamin d oral capsule 25 mcg (1000 ut) $0 OTC kp vitamin d3 oral capsule $0 OTC OPTIMAL-D ORAL CAPSULE $0 OTC OS-CAL CALCIUM + D3 ORAL TABLET $0 OTC OYSCO 500+D ORAL TABLET $0 OTC oyster shell calcium + d oral tablet $0 OTC oyster shell calcium + d3 oral tablet $0 OTC oyster shell calcium 250+d oral tablet $0 OTC oyster shell calcium 500 + d oral tablet 500-125 mg-unit $0 OTC oyster shell calcium plus d oral tablet 500-200 mg-unit $0 OTC oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit, 500-400 mg-unit, 500-5 mg-mcg $0 OTC

oyster shell calcium/d3 oral tablet $0 OTC oyster shell calcium/vitamin d oral tablet $0 OTC OYSTERCAL-D ORAL TABLET $0 OTC ra calcium 600/vitamin d-3 oral tablet $0 OTC ra calcium cit plus vit d-3 oral tablet $0 OTC ra calcium cit-vit d-3 petites oral tablet $0 OTC RA HI CAL ORAL TABLET $0 OTC ra vitamin d-3 oral capsule $0 OTC ra vitamin d-3 oral tablet $0 OTC sm calcium 500/vitamin d3 oral tablet $0 OTC sm calcium 600/vitamin d oral tablet $0 OTC sm calcium citrate+/vit d3 oral tablet $0 OTC sm calcium citrate+d3 petite oral tablet $0 OTC sm calcium citrate-vit d oral tablet $0 OTC sm calcium/vitamin d oral tablet 500-200 mg-unit $0 OTC sm calcium-vitamin d oral tablet 500-200 mg-unit $0 OTC

OVER-THE-COUNTER (OTC) DRUGS GROUPED BY DRUG TYPE

You can find information on what the symbols and abbreviations in this table mean by going to page 8 157

Drug What the OTC drug will cost you

Necessary actions, restrictions, or limits on use

sm oyster shell calcium/vit d oral tablet $0 OTC sm oyster shell calcium/vit d3 oral tablet $0 OTC sm vitamin d oral tablet $0 OTC sm vitamin d3 oral capsule 50 mcg (2000 ut) $0 OTC sm vitamin d3 oral tablet $0 OTC super calcium 600 + d 400 oral tablet $0 OTC super calcium 600 + d3 oral tablet $0 OTC TRUEPLUS GLUCOSE ON THE GO ORAL TABLET CHEWABLE $0 OTC QL TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE $0 OTC QL vitamin d (cholecalciferol) oral capsule 10 mcg (400 unit), 25 mcg (1000 ut) $0 OTC

vitamin d (cholecalciferol) oral tablet $0 OTC vitamin d high potency oral capsule $0 OTC vitamin d infant oral liquid 10 mcg/ml $0 OTC vitamin d oral capsule 50 mcg (2000 ut) $0 OTC vitamin d oral liquid 10 mcg/ml $0 OTC vitamin d oral tablet 25 mcg (1000 ut) $0 OTC VITAMIN D-1000 MAX ST ORAL TABLET $0 OTC vitamin d2 oral tablet 10 mcg (400 unit) $0 OTC vitamin d3 maximum strength oral capsule $0 OTC vitamin d-3 oral capsule $0 OTC vitamin d3 oral capsule 1.25 mg (50000 ut), 10 mcg (400 unit), 125 mcg (5000 ut), 25 mcg (1000 ut), 50 mcg (2000 ut) $0 OTC

vitamin d3 oral liquid 10 mcg/ml $0 OTC vitamin d3 oral tablet 10 mcg (400 unit), 25 mcg (1000 ut) $0 OTC vitamin d-400 oral tablet $0 OTC WEEKLY-D ORAL CAPSULE $0 OTC Vitamin E b complex-c-biotin-e-fa oral tablet $0 OTC cvs stress formula/zinc oral tablet $0 OTC e-200 oral capsule 200 unit $0 OTC e-400 oral capsule 400 unit $0 OTC eql vitamin e oral capsule 400 unit $0 OTC gnp vitamin e oral capsule 400 unit $0 OTC stress b/zinc oral tablet $0 OTC vitamin e blend oral capsule 400 unit $0 OTC vitamin e oral capsule 100 unit, 1000 unit, 180 mg (400 unit), 200 unit, 400 unit $0 OTC

E. Index of Covered Drugs

In this section, you can find a drug by searching by its name alphabetically. This will tell you the page number where you can find additional coverage information for your drug.

12 hour decongestant .......... 72, 109, 126 12 hour nasal decongestant . 72, 109, 126 12 hour nasal relief spray ................... 109 12 hour nasal spray ............................ 109 4-WAY FAST ACTING ....................... 109 50+ adult eye health ................... 100, 144 8 hour arthritis pain reliever ............ 82, 87 8 hour pain reliever ........................ 82, 87 8 hr arthritis pain relief .................... 82, 87 8hr muscle aches & pain ................ 82, 87 a thru z advanced....................... 100, 144 a thru z select ............................. 100, 145 a thru z select 50+ advanced ..... 100, 144 a thru z select 50+ mens ............ 100, 144 a thru z select advanced ............ 100, 144 a thru z select ultimate women ... 100, 145 a thru z ultimate mens ................ 100, 145 a-10000 .............................................. 150 abacavir sulfate .................................... 29 abacavir sulfate-lamivudine .................. 29 abacavir-lamivudine-zidovudine ........... 29 ABC PLUS SENIOR ADULTS 50+ ... 100,

145 ABELCET ............................................. 19 ABILIFY MAINTENA ............................ 26 abiraterone acetate .............................. 21 acamprosate calcium ........................... 10 acarbose .............................................. 31 ACCU-CHEK GUIDE ........................... 99 acebutolol hcl ....................................... 37 ACEROLA C 500 ............................... 152 acerola c-500 ..................................... 152 acetaminophen................... 82, 83, 87, 88 acetaminophen 8 hour ................... 82, 87 acetaminophen childrens ............... 82, 87 acetaminophen er .......................... 82, 87 acetaminophen extra strength ........ 82, 87 acetaminophen infants ................... 82, 87 acetaminophen junior strength ....... 82, 87 acetaminophen pm ................... 65, 83, 93 acetaminophen pm ex st .......... 65, 82, 93 acetaminophen-codeine ....................... 10 acetaminophen-codeine #2 .................. 10 acetaminophen-codeine #3 .................. 10 acetaminophen-codeine #4 .................. 10 acetazolamide ...................................... 37 acetazolamide er .................................. 61 acetic acid ............................................ 61 acetylcysteine....................................... 63 acid controller ............................... 68, 123

acid controller max st ................... 68, 123 acid reducer ................................. 68, 123 acid reducer maximum strength... 68, 123 acitretin ................................................ 42 acne ................................................... 141 acne foaming wash ............................ 142 acne medication 5 .............................. 142 ACTEMRA ........................................... 56 ACTEMRA ACTPEN ............................ 56 ACTHAR .............................................. 49 ACTHIB................................................ 57 ACTIMMUNE ....................................... 56 activated vegetable charcoal ............. 110 acyclovir ......................................... 28, 44 acyclovir sodium .................................. 28 ADACEL .............................................. 57 adapalene ............................................ 42 adapalene-benzoyl peroxide ................ 42 ADDAPRIN .................................... 88, 95 adefovir dipivoxil .................................. 28 ADEMPAS ........................................... 63 adult aspirin regimen ......... 78, 80, 88, 97 ADVAIR HFA ....................................... 63 ADVANTAGE CARE ELECTROLYTE

PED............................................... 100 AFIRMELLE ......................................... 50 AFRIN NODRIP EXTRA MOISTURE 109 AFRIN NODRIP SEVERE CONGEST 109 AFRIN NODRIP SINUS ..................... 109 AFRIN PUMP MIST ........................... 109 AIMOVIG ............................................. 20 aimsco lubricated ............................... 125 ak-poly-bac .......................................... 60 AL12 .................................................. 139 ALAVERT ALLERGY/SINUS ......... 69, 72 albendazole ......................................... 24 albuterol sulfate ................................... 62 albuterol sulfate hfa ............................. 62 alclometasone dipropionate ................. 43 alcohol ................................................. 44 ALCOHOL ............................................ 44 ALECENSA .......................................... 22 alendronate sodium ............................. 59 aler-cap ........ 65, 66, 75, 86, 93, 127, 132 alertab .......... 65, 66, 75, 86, 93, 127, 132 alfuzosin hcl er ..................................... 48 aliskiren fumarate ................................ 38 ALKA-SELTZER PLUS ALLERGY 65, 66,

75, 86, 93, 127, 132 all day allergy ............................... 69, 134

all day allergy childrens ................ 69, 134 all day allergy d .............................. 69, 72 all day allergy-d .............................. 69, 72 all day pain relief .................... 88, 95, 124 all day relief ............................ 88, 95, 124 all-day allergy childrens ................ 69, 134 aller-chlor ................................ 66, 68, 132 allergy ..................................... 66, 68, 132 allergy 24hour indoor/outdoor....... 69, 134 allergy childrens .... 65, 66, 69, 75, 86, 93,

127, 132, 134 allergy relief ..... 65, 66, 68, 69, 75, 86, 93,

127, 132, 134 allergy relief cetirizine ................... 69, 134 allergy relief child .......................... 69, 134 allergy relief childrens .. 65, 66, 69, 75, 86,

93, 127, 132, 134 allergy relief d ................................. 69, 72 allergy relief d-12 ............................ 69, 72 allergy relief d-24 ............................ 69, 72 allergy relief/indoor/outdoor .......... 69, 134 allergy relief/nasal decongest ......... 69, 72 allergy relief-d ................................. 69, 72 allergy/congestion relief .................. 69, 72 allopurinol ............................................. 20 ALMACONE DOUBLE STRENGTH .. 110,

114 ALOPHEN .......................................... 117 alosetron hcl ......................................... 47 ALPHAGAN P ...................................... 61 alprazolam ............................................ 31 ALPRAZOLAM INTENSOL .................. 31 ALTACHLORE ................................... 108 altamist spray ............................. 108, 133 ALTAVERA ........................................... 50 alum & mag hydroxide-simeth .... 111, 114 aluminum hydroxide gel ............. 111, 116 ALUNBRIG ........................................... 22 alyacen 1/35 ......................................... 50 alyacen 7/7/7 ........................................ 50 AMABELZ ............................................. 50 amantadine hcl ..................................... 25 AMBISOME .......................................... 19 ambrisentan .......................................... 63 amikacin sulfate .................................... 11 amiloride hcl ......................................... 39 amiloride-hydrochlorothiazide............... 38 AMINOSYN II ....................................... 45 AMINOSYN-PF .................................... 45 AMINOSYN-PF 7% .............................. 45

INDEX

159

amiodarone hcl..................................... 36 amitriptyline hcl .................................... 18 AMLACTIN ......................................... 139 amlodipine besy-benazepril hcl ............ 38 amlodipine besylate ............................. 37 amlodipine besylate-valsartan .............. 38 amlodipine-olmesartan ......................... 38 amlodipine-valsartan-hctz .................... 38 ammonium lactate ........................ 43, 139 AMNESTEEM ...................................... 42 amoxapine ........................................... 18 amoxicillin ............................................ 13 amoxicillin-pot clavulanate ................... 13 amoxicillin-pot clavulanate er ............... 13 amphetamine-dextroamphet er ............ 40 amphetamine-dextroamphetamine ...... 40 amphotericin b...................................... 19 amphotericin b liposome ...................... 19 ampicillin .............................................. 13 ampicillin sodium .................................. 13 ampicillin-sulbactam sodium ................ 13 anagrelide hcl ....................................... 35 anastrozole .......................................... 22 ANBESOL MAXIMUM STRENGTH ... 136 anefrin spray ...................................... 109 animal chews ..................... 145, 150, 152 animal shapes/iron ....................... 77, 145 ANORO ELLIPTA ................................. 63 antacid ............................... 111, 114, 116 antacid advanced ....................... 111, 114 antacid anti-gas max strength .... 111, 114 antacid anti-gas reg strength ...... 111, 114 antacid calcium .......................... 111, 116 antacid extra strength ................. 111, 116 antacid fast relief ........................ 111, 114 ANTACID FLAVOR CHEWS ...... 111, 116 antacid liquid .............................. 111, 114 antacid m ................................... 111, 114 antacid maximum ....................... 111, 116 antacid maximum strength ......... 111, 114 antacid plus anti-gas relief ......... 111, 114 antacid regular strength ..... 111, 114, 116 antacid soft chews...................... 111, 116 antacid ultra strength .................. 111, 116 anti-diarrheal ...................................... 113 antifungal ................................... 137, 144 anti-fungal .......................................... 137 anti-fungal .......................................... 144 antifungal (tolnaftate) ......................... 144 antifungal clotrimazole ....................... 137 anti-itch maximum strength ................ 140 antioxidant .................................. 100, 145 antioxidant a/c/e/selenium .......... 100, 145 antiseptic skin cleanser ...................... 142 apomorphine hcl................................... 25

aprepitant ............................................. 18 APRI .................................................... 50 APTIOM ............................................... 16 APTIVUS ............................................. 30 AQUANIL HC ..................................... 140 aqueous vitamin d .............................. 154 ARALAST NP ...................................... 47 ARANELLE .......................................... 50 ARANESP (ALBUMIN FREE) .............. 35 ARCALYST .......................................... 55 aripiprazole .......................................... 26 ARISTADA ........................................... 26 ARISTADA INITIO ............................... 26 armodafinil ........................................... 64 ARNUITY ELLIPTA .............................. 61 arthritis pain relief .......................... 83, 88 arthritis pain reliever ...................... 83, 88 arthritis pain relieving ......................... 144 artificial tears .............................. 107, 108 artificial tears pf .................................. 108 ASCOMP-CODEINE .............................. 9 ascorbic acid ...................................... 152 asenapine maleate .............................. 26 aspirin ................................ 79, 80, 88, 97 aspirin 81 ........................... 78, 80, 88, 97 aspirin adult low dose ........ 79, 80, 88, 97 aspirin adult low strength ... 79, 80, 88, 97 aspirin childrens ................. 79, 80, 88, 97 aspirin ec ........................... 79, 80, 88, 97 aspirin ec adult low strength ... 79, 80, 88,

97 aspirin ec low dose ............ 79, 80, 88, 97 aspirin ec low strength ....... 79, 80, 88, 97 aspirin low dose ................. 79, 80, 88, 97 aspirin low strength ............ 79, 80, 88, 97 aspirin-dipyridamole er ........................ 35 ASPIR-LOW ....................... 79, 80, 88, 97 ASTAGRAF XL .................................... 56 atazanavir sulfate ................................. 30 atenolol ................................................ 37 atenolol-chlorthalidone ......................... 38 athletes foot ....................................... 137 athletes foot (clotrimazole) ................. 137 athletes foot (terbinafine) ................... 135 athletes foot powder spray ......... 137, 144 athletes foot spray ............................. 144 atomoxetine hcl .................................... 40 atorvastatin calcium ............................. 39 atovaquone .......................................... 24 atovaquone-proguanil hcl .................... 25 atropine sulfate .................................... 60 ATROVENT HFA ................................. 62 AUBAGIO ............................................ 41 AUBRA ................................................ 50 AUBRA EQ .......................................... 50

aurodryl allergy childrens .. 65, 66, 75, 86, 93, 127, 132

aurophen childrens ......................... 83, 88 AUROVELA 1.5/30 ............................... 50 AUROVELA FE 1.5/30 ......................... 50 AUROVELA FE 1/20 ............................ 50 AUSTEDO ............................................ 41 AVIANE ................................................ 50 AYUNA ................................................. 50 AYVAKIT .............................................. 22 azathioprine .......................................... 56 azelastine hcl .................................. 60, 61 azithromycin ......................................... 14 AZOLEN TINCTURE .......................... 137 aztreonam ............................................ 11 b complex-c ........................ 145, 150, 152 b complex-c-biotin-e-fa ...... 145, 150, 152,

157 b complex-c-folic acid ......... 145, 150, 152 B&L SENSITIVE EYES ...................... 106 B&L SENSITIVE EYES DAILY CLEAN

....................................................... 106 b1 150 b-1 ...................................................... 150 b-12 .............................................. 78, 150 B-12 DOTS ................................... 78, 150 b-12 tr ........................................... 78, 150 b-2 ...................................................... 150 b-6 ...................................................... 150 b6 natural ........................................... 150 BAC ........................................................ 9 bacitracin ...................................... 60, 136 bacitracin zinc ..................................... 136 bacitracin-polymyxin b .......................... 60 BACITRAYCIN PLUS ......................... 136 baclofen ................................................ 28 BAFIERTAM ......................................... 41 balsalazide disodium ............................ 59 BALVERSA .......................................... 22 BALZIVA ............................................... 50 BANOPHEN . 65, 66, 75, 86, 93, 127, 132 BAQSIMI ONE PACK ........................... 33 BAQSIMI TWO PACK .......................... 33 BARACLUDE ....................................... 28 BAYER ASPIRIN ................ 79, 80, 88, 97 BAYER ASPIRIN EC LOW DOSE . 79, 80,

88, 97 BAYER LOW DOSE ........... 79, 80, 88, 97 BAYER MIGRAINE .................. 83, 96, 97 BCG VACCINE ..................................... 57 b-complex/vitamin c ............ 145, 150, 152 b-complex-c ........................ 145, 150, 152 b-complex-c (w/folic acid) ... 145, 150, 152 BD POSIFLUSH ................................. 100

INDEX

160

BENADRYL ALLERGY 65, 67, 75, 86, 94, 127, 132

BENADRYL ALLERGY CHILDRENS.. 65, 66, 75, 86, 93, 127, 132

BENADRYL ALLERGY ULTRATABS . 65, 67, 75, 86, 94, 127, 132

benazepril hcl ....................................... 36 benazepril-hydrochlorothiazide ............ 38 BENLYSTA .......................................... 56 BENZEPRO CREAMY WASH ........... 142 benznidazole ........................................ 25 benzoyl peroxide ................................ 142 benzoyl peroxide wash ....................... 142 benzoyl peroxide-erythromycin ............ 42 benztropine mesylate ........................... 25 BESREMI ............................................. 21 beta carotene ..................................... 150 beta hc ............................................... 140 betaine ................................................. 47 betamethasone dipropionate .......... 43, 49 betamethasone dipropionate aug ... 43, 49 betamethasone valerate ....................... 43 BETASEPT SURGICAL SCRUB........ 142 BETASERON ....................................... 41 betatemp childrens ......................... 83, 88 betaxolol hcl ......................................... 37 bethanechol chloride ............................ 48 BEVESPI AEROSPHERE .................... 63 bexarotene ........................................... 24 BEXSERO ............................................ 57 bicalutamide ......................................... 21 BICILLIN L-A ........................................ 13 BIKTARVY ..................................... 29, 72 biocotron .................................... 127, 129 biotin plus/calcium/vit d3 ............ 100, 145 BIOTRUE ........................................... 106 bisacodyl ............................................ 117 bisacodyl ec ....................................... 117 bisacodyl laxative ............................... 117 bismatrol ............................ 111, 113, 116 bisoprolol fumarate ............................... 37 bisoprolol-hydrochlorothiazide ............. 38 BLISOVI FE 1.5/30 ............................... 50 BLISOVI FE 1/20.................................. 50 BLIS-TO-SOL ..................................... 144 BOOSTRIX........................................... 58 bosentan .............................................. 63 BOSTON ADVANCE CLEANER ........ 106 BOSTON ADVANCE CONDITIONING

...................................................... 106 BOSTON CONDITIONING ................ 107 BOSTON ONE STEP CLEANER ....... 107 BOSTON REWETTING ..................... 107 BOSTON SIMPLUS ........................... 107 BOSULIF .............................................. 22

bp gel ................................................. 142 bp wash ............................................. 142 bpo ..................................................... 142 BPROTECTED MULTI-VITE ..... 100, 145 BPROTECTED PEDIA D-VITE .......... 154 BPROTECTED PEDIA IRON............... 77 BRAFTOVI ........................................... 22 BREO ELLIPTA ................................... 62 BREZTRI AEROSPHERE ................... 63 briellyn ................................................. 50 BRILINTA ............................................. 35 brimonidine tartrate .............................. 61 brinzolamide ........................................ 61 BRIVIACT ............................................ 15 bromocriptine mesylate ........................ 25 BRUKINSA .......................................... 22 budesonide .................................... 59, 62 budesonide er ...................................... 59 budesonide-formoterol fumarate .......... 63 BUFFERIN ......... 79, 81, 88, 97, 111, 117 bumetanide .......................................... 39 buprenorphine ........................................ 9 buprenorphine hcl ................................ 10 buprenorphine hcl-naloxone hcl ........... 10 bupropion hcl ....................................... 17 bupropion hcl er (smoking det) ............ 11 bupropion hcl er (sr) ............................. 17 bupropion hcl er (xl) ............................. 17 buspirone hcl ....................................... 31 butalbital-acetaminophen ..................... 10 butalbital-apap-caff-cod ......................... 9 butalbital-apap-caffeine ......................... 9 butalbital-asa-caff-codeine ..................... 9 butalbital-asa-caffeine ............................ 9 butalbital-aspirin-caffeine ....................... 9 butorphanol tartrate ............................. 10 c 1000 ................................................ 152 c 250 .................................................. 152 c 500 .................................................. 152 c 500/rose hips .................................. 152 c complex ........................................... 145 c-1000 ................................................ 152 c-1000/rose hips ................................ 153 c-250 .................................................. 153 c-500 .................................................. 153 c-500/rose hips .................................. 153 cabergoline .......................................... 54 CABOMETYX ...................................... 22 calamine .................................... 137, 139 calamine-zinc oxide ................... 137, 139 CALCIDOL ......................................... 154 calcipotriene ......................................... 44 calcitonin (salmon) ............................... 59 CALCITRATE ............................ 100, 154 cal-citrate plus vitamin d ............ 100, 154

calcitriol .......................................... 44, 59 calcium ....................................... 101, 155 calcium 1000 + d ........................ 100, 155 calcium 500 + d .......................... 100, 155 calcium 500 + d3 ........................ 100, 155 calcium 500/d ............................. 100, 155 calcium 500+d ............................ 100, 155 calcium 500+d high potency ....... 100, 155 calcium 500+d3 .......................... 100, 155 calcium 600 ........................................ 100 calcium 600 high potency ................... 100 calcium 600/vitamin d ................. 100, 155 calcium 600+d ............................ 100, 155 calcium 600+d high potency ....... 100, 155 calcium 600+d3 .......................... 100, 155 calcium 600+d3 plus minerals .... 100, 155 calcium acetate (phos binder) .............. 46 calcium antacid ........................... 111, 116 calcium antacid extra strength .... 111, 116 calcium carb-cholecalciferol ....... 100, 155 calcium carbonate .............................. 100 calcium carbonate antacid .......... 111, 116 calcium carbonate-vitamin d ....... 101, 155 calcium citrate + d ...................... 101, 155 calcium citrate + d3 .................... 101, 155 calcium citrate + d3 maximum .... 101, 155 calcium citrate+d3 ...................... 101, 155 calcium citrate+d3 petites ........... 101, 155 calcium citrate-vitamin d ............. 101, 155 calcium citrate-vitamin d3 ........... 101, 155 calcium extra d3 ......................... 101, 155 calcium high potency .......................... 101 calcium high potency/vitamin d... 101, 155 calcium plus vitamin d3 .............. 101, 155 calcium/c/d ................. 101, 145, 153, 155 calcium+d3 ................................. 101, 155 calcium-vitamin d ........................ 101, 155 calcium-vitamin d3 ...................... 101, 155 CAL-GEST ANTACID ................. 111, 116 callus removers .................................. 141 callus removers extra thick ................. 141 CALQUENCE ....................................... 22 CAMILA ................................................ 53 candesartan cilexetil ............................. 36 candesartan cilexetil-hctz ..................... 38 CAPLYTA ............................................. 26 CAPRELSA .......................................... 22 capsaicin ............................................ 144 capsaicin hp ....................................... 144 captopril ................................................ 36 carbamazepine ..................................... 16 carbamazepine er ........................... 16, 31 carbidopa .............................................. 25 carbidopa-levodopa .............................. 26 carbidopa-levodopa er .......................... 25

INDEX

161

carbidopa-levodopa-entacapone .......... 25 carglumic acid ...................................... 45 carisoprodol.......................................... 64 carisoprodol-aspirin-codeine .................. 9 carteolol hcl .......................................... 61 CARTIA XT .......................................... 37 carvedilol .............................................. 37 caspofungin acetate ............................. 19 CAZIANT .............................................. 50 c-chewable ......................................... 153 cefaclor ................................................ 12 cefaclor er ............................................ 12 cefadroxil .............................................. 12 cefazolin sodium .................................. 12 cefazolin sodium-dextrose ................... 12 cefdinir ................................................. 12 cefepime hcl ......................................... 12 cefepime-dextrose ................................ 12 cefixime ................................................ 12 cefotaxime sodium ............................... 12 cefoxitin sodium ................................... 12 cefoxitin sodium-dextrose .................... 12 cefpodoxime proxetil ............................ 12 cefprozil ................................................ 12 ceftazidime ........................................... 12 ceftazidime and dextrose ..................... 12 ceftriaxone sodium ......................... 12, 13 ceftriaxone sodium in dextrose ............ 12 ceftriaxone sodium-dextrose ................ 13 cefuroxime axetil .................................. 13 cefuroxime sodium ............................... 13 celecoxib ................................................ 9 CELONTIN ........................................... 15 centravites .................................. 101, 145 centravites 50 plus ..................... 101, 145 centravites adults ....................... 101, 145 CENTRUM ................................. 101, 145 CENTRUM ADULTS .................. 101, 145 CENTRUM SILVER ................... 101, 145 CENTRUM SILVER ADULT 50+ 101, 145 CENTRUM SPECIALIST HEART ..... 101,

145 CENTRUM ULTRA WOMENS ... 101, 145 cephalexin ............................................ 13 CERDELGA ......................................... 47 certa plus ................................... 101, 145 CERTAVITE/ANTIOXIDANTS ... 101, 145 cetirizine hcl ........................... 61, 70, 134 cetirizine hcl allergy child ....... 61, 70, 134 cetirizine hcl childrens .................. 70, 134 cetirizine hcl childrens alrgy ......... 70, 134 cetirizine-pseudoephedrine er ........ 70, 72 cevimeline hcl....................................... 42 CHANTIX CONTINUING MONTH PAK 11 CHANTIX STARTING MONTH PAK .... 11

charcoal ..................................... 111, 125 charcoal activated .............................. 111 CHATEAL ............................................ 50 CHATEAL EQ ...................................... 50 chest congestion childrens ................ 129 chest congestion relief ....................... 129 childrens acetaminophen ............... 83, 88 CHILDRENS ADVIL ....................... 88, 95 childrens apap ............................... 83, 88 childrens aspirin ................. 79, 81, 88, 97 childrens chewable multi vits .... 145, 150,

153 childrens chewable vitamins ..... 145, 150,

153 childrens cold & allergy .................. 69, 74 childrens ibuprofen ........................ 88, 95 childrens ibuprofen 100 ................. 88, 95 childrens loratadine ...................... 70, 134 childrens multivitamin ........ 145, 150, 153 childrens non-aspirin ...................... 83, 88 childrens pepto .......................... 111, 116 childrens silapap ............................ 83, 88 CHILDRENS SOOTHE .............. 111, 116 chlorhexidine gluconate ....................... 42 chloroquine phosphate ........................ 25 chlorpheniramine maleate ..... 67, 69, 132 chlorpromazine hcl ............................... 18 chlorthalidone ...................................... 39 chlorzoxazone ...................................... 64 chocolated laxative ............................ 117 CHOLBAM ........................................... 47 cholestyramine ..................................... 39 cholestyramine light ............................. 39 ciclopirox .............................................. 44 ciclopirox olamine ................................ 19 ciclopirox treatment .............................. 44 cilostazol .............................................. 36 CIMDUO .............................................. 29 cimetidine ............................................. 47 cimetidine hcl ....................................... 47 CIMZIA................................................. 56 CIMZIA PREFILLED ............................ 56 CIMZIA STARTER KIT ........................ 56 cinacalcet hcl ....................................... 59 CINRYZE ............................................. 54 ciprofloxacin hcl ................................... 14 ciprofloxacin in d5w ............................. 14 citalopram hydrobromide ..................... 17 CITRACAL MAXIMUM ............... 101, 155 citrate of magnesia ............................ 117 CITRUCEL ......................................... 117 citrus calcium/vitamin d .............. 101, 155 CLARAVIS ........................................... 42 clarithromycin ....................................... 14 clarithromycin er .................................. 14

CLEAR AWAY 1-STEP WART REMOVER .................................... 141

CLEARASIL DAILY CLEAR ACNE .... 142 CLEARLAX ......................................... 117 clemastine fumarate ............................. 61 clindamycin hcl ..................................... 11 clindamycin palmitate hcl ..................... 11 clindamycin phos-benzoyl perox .......... 42 clindamycin phosphate ............. 11, 44, 45 clindamycin phosphate in d5w.............. 11 clindamycin phosphate in nacl.............. 11 CLINIMIX/DEXTROSE (4.25/10) .......... 45 CLINISOL SF ....................................... 45 clobazam .............................................. 16 clobetasol prop emollient base ............. 43 clobetasol propionate ........................... 43 clobetasol propionate e ........................ 43 clomipramine hcl .................................. 18 clonazepam .......................................... 31 clonidine ............................................... 36 clonidine hcl .......................................... 36 clonidine hcl er ..................................... 40 clopidogrel bisulfate .............................. 36 clorazepate dipotassium ....................... 31 clotrimazole .................................. 19, 137 clotrimazole 3 ..................................... 137 clotrimazole af .................................... 137 clotrimazole anti-fungal ................ 19, 137 clotrimazole athletes foot .................... 137 clotrimazole-7 ..................................... 137 clotrimazole-betamethasone ................ 44 clozapine .............................................. 28 COARTEM ........................................... 25 COLACE ............................................. 117 colchicine .............................................. 20 colchicine-probenecid ........................... 20 cold & cough childrens ........... 69, 74, 127 cold/cough childrens ............... 69, 74, 127 colesevelam hcl .................................... 39 colestipol hcl ......................................... 39 colistimethate sodium (cba) .................. 11 COMBIGAN .......................................... 61 COMBIPATCH ..................................... 50 COMBIVENT RESPIMAT ..................... 64 COMETRIQ (100 MG DAILY DOSE) ... 22 COMETRIQ (140 MG DAILY DOSE) ... 22 COMETRIQ (60 MG DAILY DOSE) ..... 22 comfort gel antacid & anti-gas .... 111, 114 comfort gel antacid anti-gas ....... 111, 114 companion .................................. 101, 145 COMPLERA ......................................... 29 complete allergy medicine . 65, 67, 75, 86,

94, 127, 132 complete allergy relief . 65, 67, 75, 86, 94,

127, 132

INDEX

162

complete multivitamin/mineral .... 101, 145 COMPOUND W ................................. 141 COMPOUND W ONE STEP .............. 141 COMPOUND W ONE STEP INVISIBLE

...................................................... 141 constulose ............................................ 46 CONTOUR MONITOR ......................... 99 CONTOUR NEXT ONE ........................ 99 COPIKTRA ........................................... 22 CORLANOR ......................................... 38 corn & callus remover ........................ 141 corn remover one-step ....................... 141 cortisone acetate .................................. 49 CORTIZONE-10 ................................. 140 CORTIZONE-10 DIABETICS SKIN.... 140 CORTIZONE-10 ECZEMA ................. 140 CORTIZONE-10 HYDRATENSIVE .... 140 CORTIZONE-10 INTENSIVE HEALING

.............................................. 139, 140 CORTIZONE-10 PLUS .............. 139, 140 CORTIZONE-10/ALOE .............. 139, 140 COSENTYX ......................................... 55 COSENTYX (300 MG DOSE) .............. 55 COSENTYX SENSOREADY (300 MG) 55 COSENTYX SENSOREADY PEN ....... 55 COTELLIC ........................................... 22 cough dm ........................................... 127 cough dm childrens ............................ 127 cough/chest congestion dm ....... 127, 129 coughtab ............................................ 130 CREON ................................................ 47 CRIXIVAN ............................................ 30 cromolyn sodium .... 60, 63, 106, 108, 133 CRYSELLE-28 ..................................... 51 cvs 12 hour nasal decongestant .. 72, 126 cvs 8hr arthritis pain relief .............. 83, 88 cvs 8hr muscle aches & pain ......... 83, 88 cvs acetaminophen ........................ 83, 88 cvs acetaminophen ex st ................ 83, 88 cvs acid controller ........................ 68, 123 cvs acid controller max st ............. 68, 123 cvs acne ............................................. 142 cvs acne control cleanser ................... 142 cvs acne foaming face wash .............. 142 cvs advanced 3-in-1 cleanser ............ 142 cvs all day pain relief .............. 89, 95, 124 cvs allergy eye drops ................... 68, 106 cvs allergy relief ........................... 70, 134 cvs allergy relief adult 65, 75, 86, 94, 127,

132 cvs allergy relief childrens ............ 70, 134 cvs allergy relief-d .......................... 70, 72 cvs allergy relief-d12 ...................... 70, 72 cvs antacid extra strength .......... 111, 116 cvs antacid kids .......................... 111, 116

cvs antacid maximum strength .. 111, 116 cvs antacid plus antigas ............. 111, 114 cvs antacid soft chews ultr st ..... 111, 116 cvs antacid ultra strength ........... 111, 116 cvs antacid/anti-gas ................... 111, 114 cvs antibiotic ...................................... 136 cvs anti-diarrheal ............... 111, 113, 116 cvs anti-itch maximum strength ......... 140 cvs antiseptic skin cleanser ............... 142 cvs arthritis pain relief .................... 83, 89 cvs aspirin .......................... 79, 81, 89, 97 cvs aspirin adult low dose .. 79, 81, 89, 97 cvs aspirin adult low strength .. 79, 81, 89,

97 cvs aspirin ec ..................... 79, 81, 89, 97 cvs aspirin low dose ........... 79, 81, 89, 97 cvs aspirin low strength ..... 79, 81, 89, 97 cvs athletes foot ......................... 135, 138 cvs b complex plus c .......... 145, 150, 153 cvs b-1 ............................................... 150 cvs b-12 ....................................... 78, 150 cvs b6 ................................................ 150 cvs bacitracin ..................................... 136 cvs bacitracin zinc .............................. 136 cvs beta carotene .............................. 150 cvs bisacodyl ..................................... 117 cvs calcium ........................................ 101 cvs calcium 600 + d/minerals ..... 101, 155 cvs calcium carbonate ....................... 101 cvs calcium citrate+d3 ............... 101, 155 cvs calcium citrate+d3 petites .... 101, 155 cvs capsaicin hp ................................ 144 cvs chest congestion relief ................. 130 cvs chewable c with rose hips............ 153 CVS CHEWY NOT CHALKY FLAVOR

.............................................. 111, 116 cvs childrens complete ................ 77, 145 cvs childrens ibuprofen .................. 89, 95 cvs childs non-aspirin .................... 83, 89 cvs chocolate laxative pieces ............ 118 cvs citrate of magnesia ...................... 118 cvs clotrimazole ................................. 138 cvs clotrimazole 3 .............................. 138 cvs cold & cough childrens .... 69, 74, 127 cvs contact lens relief/rewet ............... 107 cvs corn removers ............................. 141 cvs corn/callus remover ..................... 141 cvs cortisone intense healing ............. 140 cvs cortisone maximum strength ....... 140 cvs cough dm ..................................... 127 cvs cough dm childrens ..................... 127 cvs creamy acne face wash ............... 142 cvs d3 ................................................ 155 cvs daily fiber ..................................... 118 cvs daily multiple for men .......... 101, 145

cvs daily multiple women 50+ ..... 101, 145 cvs dairy relief .................................... 122 cvs dairy relief ex st ............................ 122 cvs dairy relief fast acting ................... 122 cvs diaper rash ................................... 137 cvs dry-eye relief nighttime ................. 108 cvs ear drops ...................................... 107 cvs ear wax removal system .............. 107 cvs earwax removal kit ....................... 107 cvs eczema anti-itch ........................... 140 cvs electrolyte solution ....................... 101 cvs enema disposable ........................ 118 cvs enema ready-to-use ..................... 118 cvs eye health & lutein ............... 101, 145 cvs eye health adult 50+ ............. 101, 145 cvs eye itch relief .......................... 68, 106 cvs eye lubricant ................................. 108 cvs fever reducing childrens ........... 83, 89 cvs fiber .............................................. 118 cvs fiber laxative ................................. 118 cvs fish oil ........................................... 125 cvs foaming acne face wash .............. 142 cvs folic acid ....................................... 150 cvs foot & sneaker .............................. 144 cvs gas relief ...................................... 114 cvs gas relief extra strength................ 114 cvs gas relief infants ........................... 114 cvs gas relief ultra strength................. 114 cvs gentle laxative .............................. 118 cvs gentle laxative womens ................ 118 cvs glucosamine sulfate ..................... 125 cvs glucose ........................... 99, 124, 153 cvs glycerin adult ................................ 118 cvs glycerin child ................................ 118 cvs gummy dinos ................ 101, 145, 153 cvs hair/skin/nails ............................... 145 cvs headache relief .................. 83, 96, 98 cvs hemorrhoidal .......... 74, 139, 140, 141 cvs hydrocortisone anti-itch ................ 140 cvs hydrocortisone max st .................. 140 cvs hydrogen peroxide ....................... 143 cvs ibuprofen .................................. 89, 95 cvs ibuprofen childrens ................... 89, 95 cvs ibuprofen infants ...................... 89, 95 cvs ibuprofen junior strength .......... 89, 95 cvs indoor/outdoor allergy rlf ........ 70, 134 cvs infants gas relief ........................... 114 cvs infants pain relief drops ............ 83, 89 cvs instant food thickener ................... 126 cvs iron ................................................. 77 cvs itch relief ....................................... 138 cvs jock itch ........................................ 135 cvs laxative dietary supplemnt............ 118 cvs lice killing ...................................... 143 CVS LICE SOLUTION ........................ 143

INDEX

163

cvs lice treatment ............................... 143 cvs lubricant drops fast act ................. 108 cvs lubricant drops long last ............... 108 cvs lubricant eye drops ...................... 108 cvs lubricant eye drops (pf) ................ 108 cvs magnesium .................................. 101 cvs magnesium citrate ....................... 118 cvs magnesium oxide ......................... 101 cvs menstrual relief .................. 66, 83, 96 cvs miconazole 1 combo pack ........... 138 cvs miconazole 3 combo pack ........... 138 cvs miconazole 7................................ 138 cvs migraine relief .................... 83, 96, 98 cvs milk of magnesia .......................... 118 cvs mineral oil .................................... 118 cvs motion sickness ii ................... 67, 116 cvs motion sickness relief ............ 67, 116 cvs mucus d extended release ..... 72, 130 cvs mucus d max st er ................. 72, 130 cvs mucus dm extended release 127, 130 cvs mucus extended release .............. 130 cvs multi-purpose no-rub .................... 107 cvs naproxen sodium ............. 89, 95, 124 cvs nasal allergy spray ............... 107, 133 cvs nasal decongestant ................ 72, 126 cvs nasal decongestant pe ................... 74 cvs nasal mist..................................... 110 cvs nasal spray .................................. 110 cvs natural daily fiber ......................... 118 cvs natural fish oil............................... 125 cvs natural tears pf ............................. 108 cvs nicotine .......................................... 76 cvs nicotine polacrilex .......................... 76 cvs non-aspirin childrens ................ 83, 89 cvs non-aspirin extra strength ........ 83, 89 cvs one daily essential ............... 101, 145 cvs one daily womens formula ... 101, 145 cvs oral anesthetic max str ................. 136 cvs oyster shell calcium-vit d .............. 101 cvs pain & fever childrens .............. 83, 89 cvs pain & fever infants .................. 83, 89 cvs pain relief ................................. 83, 89 cvs pain relief childrens .................. 83, 89 cvs pain relief extra strength .......... 83, 89 cvs pain relief pm ex st ............. 65, 83, 94 cvs pain relief regular st ................. 83, 89 cvs ped electrolyte freeze pop ........... 102 cvs pediatric electrolyte ...................... 102 cvs petroleum jelly .............................. 141 cvs plantar wart remover .................... 141 cvs poly bacitracin .............................. 136 cvs povidone-iodine ........................... 143 CVS PURELAX .................................. 118 cvs ringworm ...................................... 138 cvs rubbing alcohol ............................ 143

cvs saline nasal spray ................ 108, 133 cvs senna........................................... 118 cvs senna plus ................................... 118 cvs senna-extra ................................. 118 cvs sinus pe decongestant .................. 74 cvs skin treatment .............................. 139 cvs sleep aid 65, 67, 75, 86, 94, 127, 132 cvs sleep aid nighttime 65, 67, 75, 86, 94,

127, 132 cvs smooth antacid extra st ....... 111, 116 cvs sodium chloride ........................... 108 cvs soft glucose ................................. 124 cvs soluble fiber therapy .................... 118 cvs spectravite adult 50+ ........... 102, 145 cvs spectravite advanced .......... 102, 145 cvs spectravite senior ................ 102, 145 cvs spectravite ultra men 50+ .... 102, 145 cvs spectravite ultra mens ......... 102, 145 cvs spectravite ultra women ...... 102, 145 cvs spectravite womens senior .. 102, 146 cvs stomach relief .............. 111, 113, 116 cvs stomach relief max st .. 111, 113, 116 cvs stool softener ............................... 118 cvs stool softener/laxative .................. 118 cvs stress formula/zinc ..... 102, 146, 150,

153, 157 cvs super b complex/c ....... 146, 151, 153 cvs therapeutic ................................... 142 cvs triple antibiotic/pain ...................... 136 cvs tussin adult chest congest ........... 130 cvs tussin dm ............................. 127, 130 cvs vitamin a ...................................... 150 cvs vitamin b12 ............................ 78, 151 cvs vitamin b-12 ................................... 78 cvs vitamin b-12 ................................. 151 cvs vitamin b-2 ................................... 151 cvs vitamin c ...................................... 153 cvs vitamin c-rose hips ...................... 153 cvs wart remover ............................... 141 cvs wart remover one step ................. 142 cvs wart remover pen ........................ 142 cvs womens active daily ............ 102, 146 cvs zinc oxide .................................... 137 cyanocobalamin ........................... 78, 151 CYCLAFEM 1/35 ................................. 51 CYCLAFEM 7/7/7 ................................ 51 cyclobenzaprine hcl ............................. 64 cyclophosphamide ............................... 21 cyclosporine ................................... 56, 60 cyclosporine modified .......................... 56 cyproheptadine hcl ............................... 61 CYRED ................................................ 51 CYRED EQ .......................................... 51 CYSTAGON ......................................... 47 CYSTARAN ......................................... 60

d 1000 ................................................ 155 d 400 .................................................. 155 d 5000 ................................................ 155 d-1000 extra strength ......................... 155 d2000 ultra strength ........................... 155 d3 high potency .................................. 155 d3 maximum strength ......................... 155 d3 super strength ............................... 155 d3-1000 .............................................. 155 d-3-5 ................................................... 156 D3-50.................................................. 156 d-400 .................................................. 156 daily face wash ................................... 142 daily multiple vitamins ........................ 146 daily multiple vitamins/iron............ 77, 146 daily multiple vitamins/min .......... 102, 146 daily value multivitamin ...................... 146 daily vitamin ........................................ 146 daily vitamin formula+iron ............. 77, 146 daily vitamin formula+minerals ... 102, 146 daily vitamins ...................................... 146 daily vite ............................................. 146 dairy digestive .................................... 123 dairy relief ........................................... 123 dalfampridine er .................................... 41 DALIRESP ............................................ 63 danazol ................................................. 49 dantrolene sodium ................................ 28 dapsone ................................................ 20 DAPTACEL .......................................... 58 daptomycin ........................................... 11 darifenacin hydrobromide er ................. 48 DAURISMO .......................................... 22 DAYHIST ALLERGY 12 HOUR RELIEF

........................................... 65, 67, 132 DEBLITANE ......................................... 53 DECARA ............................................ 156 deep sea nasal spray ................. 108, 133 deferasirox ............................................ 45 deferasirox granules ............................. 45 deferiprone ........................................... 45 DELSTRIGO ......................................... 29 delta d3............................................... 156 DELYLA ................................................ 51 DENAVIR ............................................. 45 DEPO-SUBQ PROVERA 104 .............. 53 DERMAREST ECZEMA ..................... 140 DESCOVY ............................................ 29 DESENEX .......................................... 138 desipramine hcl .................................... 18 desmopressin ace spray refrig ............. 49 desmopressin acetate .......................... 49 desmopressin acetate spray................. 49 desogestrel-ethinyl estradiol ................. 51 desonide ............................................... 43

INDEX

164

desoximetasone ................................... 43 desvenlafaxine succinate er ................. 17 DEX4 .................................... 99, 124, 153 DEX4 GLUCOSE ................. 99, 124, 153 DEX4 NATURALS ................ 99, 124, 153 DEX4 POUCH PACK ........... 99, 124, 153 DEX4 QUICK DISSOLVE GLUCOSE 124 dexamethasone.................................... 59 DEXAMETHASONE INTENSOL .......... 59 dexamethasone sodium phosphate 59, 60 dexmethylphenidate hcl ....................... 41 dexmethylphenidate hcl er ................... 41 dextroamphetamine sulfate .................. 40 dextroamphetamine sulfate er .............. 40 dextromethorphan polistirex er ........... 127 dextromethorphan-guaifenesin .. 127, 130 dextrose ............................................... 46 dextrose-nacl........................................ 46 dextrose-sodium chloride ..................... 46 diabetes health formula .............. 102, 146 diabetic siltussin-dm ................... 127, 130 DIABETIC TUSSIN ............................ 130 DIABETIC TUSSIN DM .............. 127, 130 DIACOMIT ........................................... 15 DIALYVITE ......................... 146, 151, 153 DIALYVITE 800 .................. 146, 151, 153 DIALYVITE VITAMIN D 5000 ............. 156 diamode ............................................. 113 diaper rash ......................................... 137 diarrhea .............................. 111, 113, 116 DIASTAT ACUDIAL ............................. 16 DIASTAT PEDIATRIC .......................... 16 diazepam ....................................... 16, 31 DIAZEPAM INTENSOL ........................ 31 diazoxide .............................................. 33 dibucaine (perianal) ............................ 137 diclofenac potassium .............................. 9 diclofenac sodium ............................ 9, 60 diclofenac sodium er .............................. 9 dicloxacillin sodium .............................. 13 dicyclomine hcl ..................................... 47 DIFICID ................................................ 14 diflunisal ................................................. 9 difluprednate ........................................ 61 DIGITEK ............................................... 38 DIGOX ................................................. 38 digoxin .................................................. 38 dihydroergotamine mesylate ................ 20 DILANTIN ............................................. 16 diltiazem hcl ......................................... 37 diltiazem hcl er ............................... 37, 82 diltiazem hcl er beads .......................... 37 diltiazem hcl er coated beads ......... 37, 82 dilt-xr .............................................. 37, 82

DIMAPHEN DM COLD/COUGH ... 69, 74, 127

DIMETAPP COLD/ALLERGY ........ 69, 74 DIMETAPP DM COLD/COUGH .... 69, 74,

127 dimethyl fumarate ................................ 41 dimethyl fumarate starter pack............. 41 DIPENTUM .......................................... 59 diphen .......... 65, 67, 75, 86, 94, 128, 132 diphenhydramine hcl ... 65, 67, 75, 86, 87,

94, 128, 132 diphenoxylate-atropine ........................ 47 DIPHTHERIA-TETANUS TOXOIDS DT

........................................................ 58 dipyridamole ........................................ 36 disopyramide phosphate ...................... 36 disulfiram ............................................. 10 divalproex sodium ................................ 15 divalproex sodium er ............................ 15 dm-guaifenesin er ...................... 128, 130 docqlace ............................................ 118 DOC-Q-LAX ....................................... 118 docu ................................................... 118 docusate mini ..................................... 118 docusate sodium ................................ 118 DOCUSOL MINI ................................ 118 docuzen ............................................. 118 dofetilide .............................................. 36 donepezil hcl ........................................ 17 DOPTELET .......................................... 36 dorzolamide hcl .................................... 61 dorzolamide hcl-timolol mal ................. 60 double antibiotic ................................. 136 DOVATO .............................................. 29 doxazosin mesylate ............................. 36 doxepin hcl ............................... 18, 43, 64 doxercalciferol ...................................... 60 DOXY 100 ............................................ 14 doxycycline hyclate .............................. 14 doxycycline monohydrate .............. 14, 15 DRIZALMA SPRINKLE ........................ 17 dronabinol ............................................ 18 drospirenone-ethinyl estradiol .............. 51 DROXIA ............................................... 21 droxidopa ............................................. 36 drxchoice gas relief ............................ 114 dss ..................................................... 118 DUAVEE .............................................. 53 DULCOLAX STOOL SOFTENER ...... 118 duloxetine hcl ....................................... 41 DUOFILM ........................................... 142 DUPIXENT ........................................... 43 DUREX REALFEEL ........................... 125 dutasteride ........................................... 48 D-VI-SOL ........................................... 156

dye-free allergy relief ... 65, 67, 75, 87, 94, 128, 132

DYNA-HEX 4 ...................................... 143 e.e.s. 400 .............................................. 14 e-200 .................................................. 157 e-400 .................................................. 157 ear drops ............................................ 107 ear drops earwax aid .......................... 107 ear wax removal drops ....................... 107 ear wax removal kit ............................ 107 ear wax removal system ..................... 107 earwax removal .................................. 107 earwax removal kit ............................. 107 earwax treatment drops ...................... 107 easy-lax .............................................. 118 easy-lax plus ...................................... 118 ec-naproxen ........................................... 9 econazole nitrate .................................. 19 ECPIRIN ............................. 79, 81, 89, 98 ed bron gp .................................... 74, 130 ed chlorped jr .......................... 67, 69, 132 ed-apap .......................................... 83, 89 EDURANT ............................................ 29 efavirenz ............................................... 29 efavirenz-emtricitab-tenofovir ............... 29 efavirenz-lamivudine-tenofovir.............. 29 EGRIFTA SV ........................................ 49 ELIGARD .............................................. 54 ELIQUIS ............................................... 34 ELIQUIS DVT/PE STARTER PACK ..... 34 ELMIRON ............................................. 48 ELURYNG ............................................ 51 EMCYT ................................................. 21 EMEND ................................................ 19 EMGALITY ........................................... 20 EMGALITY (300 MG DOSE) ................ 20 EMOQUETTE ....................................... 51 EMPAVELI ........................................... 35 EMSAM ................................................ 17 emtricitabine ......................................... 29 emtricitabine-tenofovir df ...................... 29 EMTRIVA ............................................. 29 enalapril maleate .................................. 36 enalapril-hydrochlorothiazide................ 38 ENBREL ............................................... 56 ENBREL MINI ...................................... 56 ENBREL SURECLICK ......................... 56 ENDACOF-DM ....................... 69, 74, 128 ENDARI ................................................ 48 ENDOCET .............................................. 9 ENDUR-ACIN ..................................... 151 ENDUR-C ........................................... 153 enema ................................................ 118 enema disposable .............................. 118 enema pediatric .................................. 118

INDEX

165

enema ready-to-use ........................... 118 ENGERIX-B ......................................... 58 enoxaparin sodium ............................... 34 ENPRESSE-28 .................................... 51 ENSKYCE ............................................ 51 entacapone .......................................... 25 entecavir .............................................. 28 enteric fish oil ..................................... 125 ENTRESTO.......................................... 38 enulose ................................................ 46 ENVARSUS XR ................................... 56 ephrine nose drops ............................ 110 EPIDIOLEX .......................................... 15 epinastine hcl ....................................... 60 epinephrine .......................................... 62 EPITOL ................................................ 16 EPIVIR HBV ......................................... 28 eplerenone ........................................... 39 EPOGEN .............................................. 35 EPRONTIA ........................................... 15 eq 8hr arthritis pain relief ................ 83, 89 eq acetaminophen.......................... 83, 89 eq acetaminophen pm .............. 65, 83, 94 eq acid reducer ............................ 68, 123 eq allergy childrens ...................... 70, 134 eq allergy relief ............................. 70, 134 eq allergy relief (cetirizine) ........... 70, 134 eq allergy relief childrens ............. 70, 134 eq antacid extra strength ............ 111, 116 eq antacid maximum strength .... 111, 114 eq antacid ultra strength ............. 111, 116 eq antacid/anti-gas ..................... 111, 114 eq anti-diarrheal ................................. 113 eq antifungal ...................................... 138 eq arthritis pain............................... 83, 89 eq aspirin ........................... 79, 81, 89, 98 eq aspirin adult low dose .... 79, 81, 89, 98 eq aspirin low dose ............ 79, 81, 89, 98 eq athletes foot................................... 138 eq athletes foot (terbinafine) .............. 135 eq athletes foot (tolnaftate) ................ 144 eq bacitracin zinc ............................... 136 eq calcium 500+d ....................... 102, 156 eq calcium 600+d ....................... 102, 156 eq calcium citrate+d ................... 102, 156 eq chlortabs ........................... 67, 69, 132 EQ CLEARLAX .................................. 118 eq cold/cough dm childrens ... 69, 74, 128 eq complete multivit adult 50+.... 102, 146 eq complete multivitamin-adult ... 102, 146 eq cough dm ...................................... 128 eq daily fiber ....................................... 118 eq dairy digestive fast acting .............. 123 eq ear wax removal aid ...................... 107 eq fiber therapy .................................. 118

eq first aid antiseptic .......................... 143 eq gas relief extra strength ................ 114 eq gentle laxative ............................... 118 eq headache relief ................... 83, 96, 98 eq hydrocortisone .............................. 140 eq hydrocortisone max st ................... 140 eq ibuprofen ................................... 89, 95 eq ibuprofen childrens ................... 89, 95 eq ibuprofen junior ......................... 89, 95 eq infants gas relief ............................ 114 eq jock itch ......................................... 138 eq laxative maximum strength ........... 118 eq lice killing max st ........................... 143 eq lubricant eye drops ....................... 108 eq magnesium citrate ........................ 118 eq miconazole 1 ................................. 138 eq miconazole 7 day treatment .......... 138 eq mineral oil ..................................... 119 EQ MUCUS ER ................................. 130 eq mucus relief dm .................... 128, 130 eq multivitamin gummies ... 102, 146, 153 eq naproxen sodium .............. 89, 95, 124 eq nasal allergy .......................... 107, 133 eq nasal spray ................................... 110 eq nasal spray fast acting .................. 110 eq natural laxative .............................. 119 eq natural vegetable laxative ............. 119 eq nicotine ........................................... 76 eq nicotine polacrilex ........................... 76 eq nicotine step 3 ................................. 76 eq omeprazole magnesium ............... 123 eq one daily mens health ........... 102, 146 eq one daily womens health ...... 102, 146 eq pain & fever childrens ............... 83, 89 eq pain & fever infants ................... 83, 89 eq pain relief/rapid burst ................ 83, 89 eq pain reliever .............................. 83, 89 eq povidone-iodine ............................ 143 eq restore plus lubricant eye .............. 108 EQ RESTORE PM ............................. 108 eq restore tears .................................. 108 eq saline nasal spray ................. 108, 133 eq senna-s ......................................... 119 eq slow-release iron ............................. 77 eq stomach relief ............... 112, 113, 116 eq stool softener ................................ 119 eq stool softener/laxative ................... 119 eq triple antibiotic ............................... 136 eq tussin dm cough/chest .......... 128, 130 eql acetaminophen childrens ......... 83, 89 eql acetaminophen ex st ................ 83, 89 eql acetaminophen infants ............. 83, 89 eql acetaminophen pm ............ 65, 83, 94 eql all day allergy ......................... 70, 134 eql all day allergy childrens .......... 70, 134

eql all day allergy-d ........................ 70, 72 eql allergy relief ............................ 70, 134 eql allergy/congestion relief ............ 70, 72 eql antacid .................................. 112, 116 eql antacid advanced max st ...... 112, 114 eql antacid ultra strength ............ 112, 116 eql antacid/anti-gas .................... 112, 114 eql anti-diarrheal ................................. 113 eql antifungal ...................................... 138 eql antifungal (tolnaftate) .................... 144 eql anti-itch intensive heal .................. 140 eql anti-itch maximum strength........... 140 eql aspirin ec ...................... 79, 81, 89, 98 eql aspirin low dose ............ 79, 81, 89, 98 eql athletes foot .................................. 138 eql athletes foot(terbinafine) ............... 135 eql b-6 ................................................ 151 eql baby basics diaper rash ................ 137 eql bacitracin zinc ............................... 136 eql calcium citrate/vitamin d ....... 102, 156 eql calcium citrate/vitamin d3 ..... 102, 156 eql century .................................. 102, 146 eql child multivit/minerals ............. 77, 146 eql childrens ibuprofen ................... 90, 95 EQL CLEARLAX ................................ 119 eql cold/cough ........................ 69, 74, 128 eql dairy digest fast acting .................. 123 eql fiber laxative ................................. 119 eql fiber therapy .................................. 119 eql first aid antibiotic ................... 136, 137 eql fish oil ........................................... 125 eql gas relief ultra strength ................. 114 eql gentle laxative ............................... 119 eql heartburn prevention .............. 68, 123 eql hemorrhoidal ........... 74, 139, 140, 141 eql hydrogen peroxide ........................ 143 eql ibuprofen ................................... 90, 95 eql ibuprofen infants ....................... 90, 95 eql ibuprofen junior strength ........... 90, 95 eql infants gas relief ........................... 114 eql iron supplement therapy ................. 77 eql isopropyl rubbing alcohol .............. 143 eql laxative ......................................... 119 eql laxative maximum strength ........... 119 eql lice killing max st ........................... 143 eql magnesium citrate ........................ 119 eql menstrual relief max st........ 66, 84, 96 eql miconazole 3 ................................ 138 eql miconazole 7 ................................ 138 eql migraine formula ................. 84, 96, 98 eql milk of magnesia ........................... 119 eql motion sickness relief ............. 67, 116 eql naproxen sodium .............. 90, 95, 124 eql nasal decongestant ................ 72, 126 eql nasal decongestant pe ................... 74

INDEX

166

eql nasal spray 12 hour ...................... 110 eql nasal spray fast acting .................. 110 eql nasal spray no drip ....................... 110 eql nicotine polacrilex ........................... 76 eql nighttime sleep aid 65, 67, 75, 87, 94,

128, 132 eql one daily mens health .......... 102, 146 eql one daily womens ................. 102, 146 eql one daily womens 50+ adv ... 102, 146 eql pain relief pm ex st ............. 65, 84, 94 eql ready-to-use enema ..................... 119 eql saline nasal spray ................. 108, 133 eql senna laxative .............................. 119 eql senna-s ........................................ 119 eql slow release iron ............................ 77 eql smooth texture fiber ...................... 119 eql stomach relief ............... 112, 113, 117 eql stool softener ................................ 119 eql stool softener/stimulant ................ 119 eql super b complex/vitamin c ... 146, 151,

153 eql therapeutic.................................... 142 eql tussin dm cough/chest cong . 128, 130 eql tussin mucus/chest congest ......... 130 eql vision formula ....................... 102, 146 eql vitamin b-12 ............................ 78, 151 eql vitamin b-12 tr......................... 78, 151 eql vitamin c ....................................... 153 eql vitamin c/rose hips ........................ 153 eql vitamin d3 ..................................... 156 eql vitamin e ....................................... 157 EQUETRO ........................................... 31 ergoloid mesylates ............................... 17 ergotamine-caffeine ............................. 20 ERIVEDGE........................................... 22 ERLEADA ............................................ 21 erlotinib hcl ........................................... 22 ERRIN .................................................. 53 ertapenem sodium ............................... 14 ery ........................................................ 45 ERYTHROCIN LACTOBIONATE ......... 14 ERYTHROCIN STEARATE ................. 14 erythromycin................................... 45, 60 erythromycin base ................................ 14 erythromycin ethylsuccinate ................. 14 ESBRIET .............................................. 63 escitalopram oxalate ............................ 17 ESSENTIA ................................. 102, 146 essential one daily multivit ......... 102, 146 ESTARYLLA ........................................ 51 estradiol ............................................... 50 estradiol valerate .................................. 50 estradiol-norethindrone acet ................ 51 eszopiclone .......................................... 64 ethambutol hcl ...................................... 20

ethosuximide ........................................ 15 ethynodiol diac-eth estradiol ................ 51 etodolac ................................................. 9 etodolac er ............................................. 9 etonogestrel-ethinyl estradiol ............... 51 etravirine .............................................. 29 EUCRISA ............................................. 43 EVAC-U-GEN .................................... 119 everolimus ..................................... 22, 56 EVOTAZ .............................................. 30 EVRYSDI ............................................. 41 EXCEDRIN EXTRA STRENGTH .. 84, 96,

98 EXCEDRIN MIGRAINE ........... 84, 96, 98 exemestane ......................................... 22 EXKIVITY ............................................. 23 EXTAVIA.............................................. 41 extraprin ................................... 84, 96, 98 eye itch relief ................................ 68, 106 eye lubricant ...................................... 108 ezetimibe ............................................. 39 ezetimibe-simvastatin .......................... 39 EZFE 200 ............................................. 77 FALMINA ............................................. 51 famciclovir ............................................ 28 famotidine .............................. 47, 68, 123 FANAPT............................................... 26 FANAPT TITRATION PACK ................ 26 FANTASY LUBRICATED .................. 125 FANTASY LUBRICATED/SPERMICIDE

...................................................... 125 FASENRA ............................................ 64 FASENRA PEN ................................... 64 FC2 FEMALE CONDOM ................... 125 febuxostat ............................................ 20 felbamate ............................................. 15 felodipine er ......................................... 37 FEMYNOR ........................................... 51 fenofibrate ............................................ 39 fenofibrate micronized ......................... 39 fenofibric acid ....................................... 39 fentanyl .................................................. 9 fentanyl citrate ..................................... 10 FEOSOL .............................................. 77 FERATE............................................... 77 FERGON ............................................. 77 FEROSUL ............................................ 77 FERREX 150 ....................................... 77 ferric x-150 ........................................... 77 FERRIPROX ........................................ 45 FERRIPROX TWICE-A-DAY ............... 45 FERROCITE ........................................ 77 ferrous fumarate .................................. 77 ferrous gluconate ................................. 77 ferrous sulfate ...................................... 77

FETZIMA .............................................. 17 FETZIMA TITRATION .......................... 17 fiber .................................................... 119 fiber laxative ....................................... 119 fiber therapy ....................................... 119 fiber-lax ............................................... 119 finasteride ............................................. 48 FINTEPLA ............................................ 15 FIRDAPSE ........................................... 41 FIRMAGON .......................................... 54 FIRMAGON (240 MG DOSE) ............... 54 fish oil ................................................. 125 fish oil concentrate ............................. 125 fish oil omega-3 .................................. 125 fish oil/super potent/no burp ............... 125 flavoxate hcl ......................................... 48 FLEBOGAMMA DIF ............................. 54 flecainide acetate ................................. 36 FLINTSTONES COMPLETE ........ 77, 146 FLINTSTONES/EXTRA C .. 146, 151, 153 FLINTSTONES/MY FIRST . 146, 151, 153 FLOVENT DISKUS .............................. 62 FLOVENT HFA ..................................... 62 fluconazole ........................................... 19 fluconazole in sodium chloride ............. 19 flucytosine ............................................ 19 fludrocortisone acetate ......................... 49 flunisolide ............................................. 62 fluocinolone acetonide .......................... 43 fluocinonide .......................................... 43 fluocinonide emulsified base ................ 43 fluorometholone .................................... 61 fluorouracil ............................................ 44 fluoxetine hcl ........................................ 17 fluphenazine decanoate ....................... 26 fluphenazine hcl ................................... 26 flurbiprofen ............................................. 9 flurbiprofen sodium ............................... 61 flutamide ............................................... 21 fluticasone propionate .................... 43, 62 fluticasone-salmeterol .................... 62, 63 fluvoxamine maleate ............................ 17 folate................................................... 151 folic acid ............................................. 151 fondaparinux sodium ............................ 34 for sty relief ......................................... 108 fosamprenavir calcium ......................... 30 fosinopril sodium .................................. 36 fosinopril sodium-hctz ........................... 38 FOSRENOL .......................................... 46 FOTIVDA .............................................. 23 FRAGMIN ............................................. 34 fruit c 500 ............................................ 153 full spectrum b/vitamin c ..... 146, 151, 153 FULPHILA ............................................ 35

INDEX

167

furosemide ........................................... 39 FUZEON .............................................. 30 FYAVOLV ............................................ 51 FYCOMPA ........................................... 15 g tussin ac .................................. 128, 130 gabapentin ........................................... 16 GALAFOLD .......................................... 48 galantamine hydrobromide ................... 17 galantamine hydrobromide er .............. 17 GAMMAGARD ..................................... 54 GAMMAGARD S/D LESS IGA ............. 54 GAMMAKED ........................................ 54 GAMMAPLEX ...................................... 55 GAMUNEX-C ....................................... 55 GARDASIL 9 ........................................ 58 gas relief ............................................ 114 gas relief drops infants ....................... 114 gas relief extra strength ...................... 114 gas relief infants ................................. 114 gas relief ultra strength ....................... 115 GATTEX ............................................... 47 gauze ................................................... 33 gavilax ................................................ 119 GAVILYTE-C ........................................ 46 GAVILYTE-G................................ 46, 119 GAVILYTE-N WITH FLAVOR PACK... 46,

119 GAVRETO ........................................... 21 gel callus removers ............................ 142 GEL-KAM ........................................... 125 gemfibrozil ............................................ 39 generlac ............................................... 46 GENGRAF ........................................... 56 genicin ................................................ 125 GENOTROPIN ..................................... 49 GENOTROPIN MINIQUICK ................. 49 GENTAK .............................................. 60 gentamicin in saline .............................. 11 gentamicin sulfate .......................... 11, 60 GENTEAL TEARS ............................. 108 gentle laxative .................................... 119 gentlelax ............................................. 119 GENVOYA ........................................... 29 geri-dryl ........ 65, 67, 75, 87, 94, 128, 132 geri-kot ............................................... 119 geri-lanta .................................... 112, 115 geri-mox ..................................... 112, 115 geri-pectate ........................ 112, 113, 117 geri-tussin .......................................... 130 geri-tussin dm............................. 128, 130 GILENYA ............................................. 41 GILOTRIF ............................................ 23 GILTUSS COUGH & CHEST ..... 128, 130 GILTUSS DIABETIC COUGH & COLD

.............................................. 128, 130

GLASSIA ............................................. 48 glatiramer acetate ................................ 41 GLATOPA ............................................ 42 glimepiride ........................................... 31 glipizide ................................................ 31 glipizide er ............................................ 31 glipizide xl ............................................ 31 glipizide-metformin hcl ......................... 31 GLUCAGEN DIAGNOSTIC ................. 33 GLUCAGEN HYPOKIT ........................ 33 glucagon emergency ........................... 33 glucagon hcl (diagnostic) ..................... 33 glucosamine sulfate ........................... 125 glucose ................................ 99, 124, 153 glucose instant energy ......... 99, 124, 153 GLUTOSE 15 ..................................... 124 GLUTOSE 45 ..................................... 124 GLUTOSE 5 ....................................... 124 glyburide .............................................. 32 glyburide micronized ............................ 32 glyburide-metformin ............................. 32 glycerin (adult) ................................... 119 glycerin (child) .................................... 119 glycerin (infants & children) ............... 119 glycerin (pediatric) ............................. 119 glycerin adult ...................................... 119 glycerin childrens ............................... 119 GLYCOLAX ....................................... 119 glycopyrrolate ...................................... 47 GLYXAMBI .......................................... 32 gnp 24 hour nasal allergy .......... 107, 133 gnp 8 hour arthritis relief ................ 84, 90 gnp 8 hour pain reliever ................. 84, 90 gnp acetaminophen ....................... 84, 90 gnp acid reducer .......................... 68, 123 gnp acid reducer max st .............. 68, 123 gnp adult aspirin low strength . 79, 81, 90,

98 gnp all day allergy ........................ 70, 134 gnp all day allergy childrens ........ 70, 134 gnp all day allergy-d ....................... 70, 72 gnp allergy ... 65, 67, 75, 87, 94, 128, 132 gnp allergy & congestion ............... 70, 72 gnp allergy relief . 65, 67, 75, 87, 94, 128,

132 gnp allergy/congestion relief .......... 70, 72 gnp antacid ................................ 112, 117 gnp antacid & anti-gas ............... 112, 115 gnp antacid extra strength ......... 112, 117 gnp antacid regular strength ...... 112, 115 gnp antacid ultra strength .......... 112, 117 gnp anti-diarrheal ............................... 113 gnp anti-gas ....................................... 115 gnp antiseptic skin cleanser ............... 143 gnp artificial tears ............................... 108

gnp aspirin .......................... 79, 81, 90, 98 gnp aspirin low dose ........... 79, 81, 90, 98 gnp athletes foot ................................. 138 gnp bacitracin zinc .............................. 136 gnp calamine .............................. 137, 139 gnp calcium ........................................ 102 gnp calcium 500 +d3 .................. 102, 156 gnp calcium 600 +d3/minerals .... 102, 156 gnp calcium citrate +d3 .............. 102, 156 gnp century ................................. 102, 146 gnp century adults 50+ senior .... 102, 146 gnp century energy metabolism ......... 146 gnp century ultimate mens ......... 102, 146 gnp century ultimate womens ..... 102, 146 gnp childrens allergy ... 65, 67, 75, 87, 94,

128, 132 gnp childrens chewables/iron ....... 77, 146 gnp childrens ibuprofen .................. 90, 95 GNP CLEARLAX ................................ 119 gnp clotrimazole 3 .............................. 138 gnp cold/cough childrens ........ 69, 74, 128 gnp cough dm er ................................ 128 gnp d 1000 ......................................... 156 gnp dairy relief .................................... 123 gnp earwax removal drops ................. 108 gnp earwax removal kit ...................... 108 gnp essential one daily ....................... 146 gnp eye drops long lasting ................. 108 gnp fast acting dairy relief .................. 123 gnp fiber therapy ................................ 119 gnp fiber-caps ..................................... 119 gnp fish oil .......................................... 125 gnp folic acid ...................................... 151 gnp gas relief ...................................... 115 gnp gas relief extra strength ............... 115 gnp gentle laxative ............................. 119 gnp glucose .......................... 99, 124, 153 gnp glycerin (adult) ............................. 119 gnp glycerin child ................................ 119 gnp hair/skin/nails ....................... 102, 146 gnp headache relief extra str .... 84, 96, 98 gnp healthy eyes ........................ 102, 146 gnp healthy eyes supervision ..... 102, 146 gnp hydrocortisone ............................. 140 gnp hydrocortisone max st ................. 140 gnp hydrocortisone plus ..................... 140 gnp hydrocortisone/aloe ............. 139, 140 gnp hydrogen peroxide ....................... 143 gnp ibuprofen ................................. 90, 95 gnp ibuprofen infants ...................... 90, 95 gnp infant gas relief ............................ 115 gnp infants pain/fever ..................... 84, 90 gnp iron ................................................ 77 gnp lice treatment ............................... 143 gnp little ones childrens ...... 146, 151, 153

INDEX

168

gnp loratadine .............................. 70, 134 gnp loratadine childrens ............... 70, 134 gnp lubricating plus eye drops ........... 108 gnp magnesium oxide ................ 112, 117 gnp mega multi for men ............. 102, 146 gnp mega multi for women ......... 102, 146 gnp miconazole 3 ............................... 138 gnp miconazole 7 ............................... 138 gnp miconazorb af.............................. 138 gnp migraine relief .................... 84, 97, 98 gnp milk of magnesia ......................... 120 gnp mineral oil .................................... 120 gnp motion sickness relief ............ 67, 116 gnp mucus dm max strength ...... 128, 130 gnp mucus er ..................................... 130 gnp mucus relief ................................. 130 gnp multi-purpose .............................. 107 gnp naproxen sodium ............. 90, 95, 124 gnp nasal decongestant ............... 72, 126 gnp nasal decongestant pe .................. 74 gnp nasal moisturizing ............... 108, 133 gnp nasal spray .................................. 110 gnp nasal spray extra moist ............... 110 gnp nasal spray fast acting ................ 110 gnp natural fiber ................................. 120 gnp nicotine .......................................... 76 gnp nicotine mini .................................. 76 gnp nicotine polacrilex .......................... 76 gnp no drip nasal spray ...................... 110 gnp one daily mens health 50+ .. 102, 146 gnp one daily mens/lycopene ..... 102, 146 gnp one daily womens ............... 102, 147 gnp one daily womens 50+ ........ 102, 147 gnp one daily womens health ..... 102, 147 gnp pain & fever childrens .............. 84, 90 gnp pain & fever infants ................. 84, 90 gnp pain relief................................. 84, 90 gnp pain relief extra strength .......... 84, 90 gnp pain relief pm ex st ............ 65, 84, 94 gnp petroleum jelly ............................. 141 gnp prenatal ......................... 77, 147, 151 gnp pseudoephedrine hcl 12 hr .... 72, 126 gnp quick dissolve glucose ................ 124 gnp senna lax ..................................... 120 gnp stomach relief .............. 112, 113, 117 gnp stool softener............................... 120 gnp stool softener/laxative ................. 120 gnp tab tussin ..................................... 130 gnp terbinafine hydrochloride ............. 135 gnp therapeutic-m ...................... 102, 147 gnp tolnaftate ..................................... 144 gnp triple antibiotic ............................. 136 gnp triple antibiotic plus .............. 136, 137 gnp tussin dm cough .................. 128, 130 gnp tussin mucus & chest cong ......... 130

gnp vitamin a ..................................... 150 gnp vitamin b-1 .................................. 151 gnp vitamin b-12 .......................... 78, 151 gnp vitamin b-6 .................................. 151 gnp vitamin c ...................................... 153 gnp vitamin c w/rose hips .................. 153 gnp vitamin c/rose hips ...................... 153 gnp vitamin d ..................................... 156 gnp vitamin d3 extra strength ............ 156 gnp vitamin d-400 .............................. 156 gnp vitamin e ..................................... 157 gnp wart remover ............................... 142 gnp womens gentle laxative .............. 120 gnp zinc oxide .................................... 137 GOCOVRI ............................................ 25 goodsense all day allergy ............ 70, 134 goodsense arthritis pain ................. 84, 90 goodsense artificial tears ................... 108 goodsense aspirin .............. 79, 81, 90, 98 goodsense aspirin adult low st 79, 81, 90,

98 goodsense aspirin low dose ... 79, 81, 90,

98 goodsense bisacodyl ec .................... 120 goodsense calamine .................. 137, 139 GOODSENSE CLEARLAX ................ 120 goodsense cough dm ........................ 128 goodsense cough dm childrens ......... 128 goodsense ear wax removal .............. 108 goodsense gas relief .......................... 115 goodsense glucose .............. 99, 124, 153 goodsense headache pm ........ 65, 84, 94 goodsense hydrogen peroxide .......... 143 goodsense ibuprofen ..................... 90, 95 goodsense ibuprofen childrens ...... 90, 95 goodsense ibuprofen infants .......... 90, 95 goodsense lubricating eye drop ......... 108 goodsense magnesium citrate ........... 120 goodsense migraine formula ... 84, 97, 98 goodsense mineral oil ........................ 120 goodsense mucus relief ..................... 130 goodsense naproxen sodium . 90, 95, 124 goodsense nasal allergy spray .. 107, 133 goodsense nicotine .............................. 76 goodsense pain & fever child ......... 84, 90 goodsense pain & fever infants ..... 84, 90 goodsense pain relief extra st ........ 84, 90 goodsense pain relief pm ex st 65, 84, 94 goodsense petroleum jelly ................. 141 goodsense senna laxative ................. 120 goodsense stimulant laxative ............. 120 granisetron hcl ..................................... 19 GRANIX ............................................... 35 griseofulvin microsize .......................... 19 guaiatussin ac ............................ 128, 130

guaifenesin ......................................... 130 guaifenesin ac ............................ 128, 130 guaifenesin er ..................................... 130 guaifenesin-codeine ................... 128, 130 guaifenesin-dm ........................... 128, 130 guanfacine hcl ...................................... 36 guanfacine hcl er .................................. 41 GUMMI BEAR MULTIVITAMIN/MIN . 103,

147, 153 HAEGARDA ......................................... 54 HAILEY 1.5/30 ...................................... 51 HAILEY 24 FE ...................................... 51 HAILEY FE 1.5/30 ................................ 51 HAILEY FE 1/20 ................................... 51 hair vitamins ............................... 103, 147 hair/skin/nails .............................. 103, 147 halobetasol propionate ......................... 43 haloperidol ............................................ 26 haloperidol decanoate .......................... 26 haloperidol lactate ................................ 26 HAVRIX ................................................ 58 headache relief ......................... 84, 97, 98 healthy eyes ............................... 103, 147 healthy eyes/lutein ...................... 103, 147 HEALTHY MAMA EAZZZE THE PAIN 65,

84, 94 HEALTHY MAMA SHAKE THAT ACHE

................................................... 84, 90 HEALTHYLAX .................................... 120 heartburn relief ............................. 68, 123 heartburn relief max st .................. 68, 123 h-e-b oral electrolyte ........................... 103 hemorrhoidal ........................ 74, 126, 140 hemorrhoidal cooling ............ 74, 137, 140 heparin sodium (porcine) ...................... 34 HEPLISAV-B ........................................ 58 HETLIOZ .............................................. 64 HETLIOZ LQ ........................................ 64 HIBERIX ............................................... 58 HIBICLENS ........................................ 143 hm acetaminophen childrens.......... 84, 90 hm advanced antacid max st ...... 112, 115 hm all day allergy ......................... 70, 134 hm all day allergy childrens .......... 70, 134 hm allergy & congestion ................. 70, 72 hm allergy complete-d .................... 70, 72 hm allergy relief ..... 65, 67, 69, 75, 87, 94,

128, 132 hm allergy relief childrens .. 65, 67, 75, 87,

94, 128, 132 hm allergy relief/nasal decong ........ 70, 72 hm antacid .................................. 112, 115 hm antacid anti-gas ex st ........... 112, 115 hm anti-diarrheal ................................ 113 hm antiseptic skin cleanser ................ 143

INDEX

169

hm arthritis pain relief ..................... 84, 90 hm aspirin .......................... 79, 81, 90, 98 hm aspirin ec ...................... 79, 81, 90, 98 hm aspirin ec low dose ....... 79, 81, 90, 98 hm bacitracin zinc .............................. 136 hm calamine ............................... 137, 139 hm calcium antacid ex st ............ 112, 117 hm calcium citrate+d3 petite ...... 103, 156 hm cetirizine hcl ........................... 70, 134 hm chest congestion relief ................. 130 HM CLEARLAX .................................. 120 hm cold & cough childrens ..... 69, 74, 128 hm complete men....................... 103, 147 hm complete women .................. 103, 147 hm cough dm ..................................... 128 hm daytime cold & flu ............. 74, 84, 128 hm double antibiotic ........................... 136 hm enema .......................................... 120 hm famotidine............................... 68, 123 hm fiber .............................................. 120 hm fish oil ........................................... 125 hm folic acid ....................................... 151 hm gas relief....................................... 115 hm gas relief infants drops ................. 115 hm hydrocortisone plus .............. 139, 140 hm hydrocortisone-aloe max st .. 139, 140 hm hydrogen peroxide ....................... 143 hm ibuprofen .................................. 90, 95 hm ibuprofen childrens ................... 90, 95 hm ibuprofen ib .............................. 90, 95 hm ibuprofen infants ....................... 90, 95 hm isopropyl alcohol .......................... 143 hm laxative ......................................... 120 hm lice killing max st .......................... 143 hm lice treatment................................ 143 hm loratadine ............................... 70, 135 hm loratadine childrens ................ 70, 134 hm lubricating plus ............................. 108 hm lubricating tears ............................ 108 hm magnesium citrate ........................ 120 hm migraine relief ..................... 84, 97, 98 hm milk of magnesia .......................... 120 hm mineral oil ..................................... 120 hm motion sickness relief ............. 67, 116 hm multi-purpose no rub .................... 107 hm naproxen sodium .............. 90, 95, 124 hm nasal decongestant ................ 73, 126 hm nasal decongestant 12 hour ... 73, 126 hm nasal decongestant pe ................... 74 hm nasal spray ................................... 110 hm nicotine ........................................... 76 hm nicotine polacrilex ........................... 76 hm nose drops ................................... 110 hm pain & fever childrens ............... 84, 90 hm pain & fever infants .................. 84, 90

hm pain relief extra strength .......... 84, 90 hm pain reliever ............................. 84, 91 hm pain reliever pm ex st ......... 65, 84, 94 hm pediatric electrolyte ...................... 103 hm petroleum jelly .............................. 141 hm povidone-iodine ........................... 143 hm saline nasal spray ................ 108, 133 hm senna ........................................... 120 hm senna-s ........................................ 120 hm sinus nasal spray ......................... 110 hm stomach relief .............. 112, 113, 117 hm stool softener ............................... 120 hm stool softener/laxative .................. 120 hm triple antibiotic .............................. 136 hm triple antibiotic max st .......... 136, 137 hm tussin adult ................................... 130 hm tussin adult dm ..................... 128, 130 hm vitamin b-12 ........................... 78, 151 hm vitamin c ....................................... 153 hm womens 50+ advanced daily 103, 147 HUMALOG ........................................... 33 HUMALOG JUNIOR KWIKPEN ........... 33 HUMALOG KWIKPEN ......................... 33 HUMALOG MIX 50/50 ......................... 33 HUMALOG MIX 50/50 KWIKPEN ........ 33 HUMALOG MIX 75/25 ......................... 33 HUMALOG MIX 75/25 KWIKPEN ........ 33 HUMATROPE ...................................... 49 HUMIRA ............................................... 57 HUMIRA PEDIATRIC CROHNS START

........................................................ 56 HUMIRA PEN ...................................... 57 HUMIRA PEN-CD/UC/HS STARTER .. 57 HUMIRA PEN-PEDIATRIC UC START 57 HUMIRA PEN-PS/UV/ADOL HS START

........................................................ 57 HUMIRA PEN-PSOR/UVEIT STARTER

........................................................ 57 HUMULIN 70/30 .................................. 33 HUMULIN 70/30 KWIKPEN ................. 33 HUMULIN N ......................................... 33 HUMULIN N KWIKPEN ....................... 33 HUMULIN R ......................................... 33 HUMULIN R U-500 (CONCENTRATED)

........................................................ 33 HUMULIN R U-500 KWIKPEN............. 33 hydralazine hcl ..................................... 40 hydrochlorothiazide ........................ 38, 39 hydrocodone-acetaminophen .............. 10 hydrocodone-ibuprofen ........................ 10 hydrocortisone ................. 43, 49, 59, 140 hydrocortisone (perianal) ..................... 43 hydrocortisone acetate ...................... 140 hydrocortisone anti-itch ...................... 140 hydrocortisone butyr lipo base ............. 43

hydrocortisone butyrate ........................ 43 hydrocortisone max st ........................ 140 hydrocortisone max st/12 moist .......... 140 hydrocortisone plus ............................ 141 hydrocortisone valerate ........................ 44 hydrocortisone-acetic acid .................... 61 hydrocortisone-aloe .................... 139, 141 hydrogen peroxide .............................. 143 hydromorphone hcl ............................... 10 hydromorphone hcl pf ........................... 10 hydroxychloroquine sulfate ................... 25 hydroxyurea .......................................... 21 hydroxyzine hcl ..................................... 61 hydroxyzine pamoate ........................... 31 HYVEE ADVANCED ANTACID .. 112, 115 ibandronate sodium .............................. 60 IBRANCE ....................................... 22, 23 IBU ......................................................... 9 ibu-200 ........................................... 91, 96 ibuprofen .................................... 9, 91, 96 ibuprofen childrens ......................... 91, 96 ibuprofen infants ............................. 91, 96 ibuprofen junior strength ................. 91, 96 ICAPS......................................... 103, 147 ICAPS MV .................................. 103, 147 icatibant acetate ................................... 54 ICLUSIG ............................................... 23 icosapent ethyl ..................................... 39 IDHIFA .................................................. 21 ILARIS .................................................. 55 ILUMYA ................................................ 55 imatinib mesylate .................................. 23 IMBRUVICA ......................................... 23 imipenem-cilastatin ............................... 14 imipramine hcl ...................................... 18 imipramine pamoate ............................. 18 imiquimod ............................................. 44 IMOVAX RABIES ................................. 58 INCASSIA ............................................. 51 INCRELEX ........................................... 49 INCRUSE ELLIPTA .............................. 62 indapamide ........................................... 39 indomethacin .......................................... 9 indomethacin er ...................................... 9 INFANRIX ............................................. 58 infants gas relief ................................. 115 infants ibuprofen ............................. 91, 96 infants pain & fever ......................... 84, 91 infants simethicone ............................. 115 INGREZZA ........................................... 41 INLYTA ................................................. 23 INQOVI ................................................. 21 INREBIC ............................................... 23 instacort 5 ........................................... 141 insulin lispro .......................................... 33

INDEX

170

insulin lispro (1 unit dial) ....................... 33 insulin lispro junior kwikpen .................. 34 insulin lispro prot & lispro ..................... 34 insulin syringe ...................................... 34 INSULIN SYRINGE .............................. 34 INTELENCE ......................................... 29 intense toothache pain relief .............. 137 INTRALIPID ......................................... 46 INTRON A ............................................ 56 INTROVALE ......................................... 51 INVEGA SUSTENNA ..................... 26, 27 INVEGA TRINZA .................................. 27 INVIRASE ............................................ 30 INVOKAMET ........................................ 32 INVOKAMET XR .................................. 32 INVOKANA........................................... 32 IONIL-T .............................................. 142 IPOL ..................................................... 58 ipratropium bromide ............................. 62 ipratropium-albuterol ............................ 64 irbesartan ............................................. 36 irbesartan-hydrochlorothiazide ............. 38 IRESSA ................................................ 23 iron ....................................................... 77 iron 27 .................................................. 77 iron high-potency.................................. 77 iron supplement childrens .................... 77 ISENTRESS ......................................... 29 ISENTRESS HD ................................... 29 ISIBLOOM ............................................ 51 ISOLYTE-P IN D5W ............................. 46 ISOLYTE-S .......................................... 45 ISOLYTE-S PH 7.4 .............................. 45 isoniazid ............................................... 20 isopropanol ........................................ 143 isopropyl alcohol ................................ 143 isopropyl alcohol (rubbing) ................. 143 isopropyl alcohol, rubbing .................. 143 isosorbide dinitrate ............................... 40 isosorbide mononitrate ......................... 40 isosorbide mononitrate er ..................... 40 isotretinoin ............................................ 42 isradipine .............................................. 37 itraconazole .......................................... 19 ivermectin ............................................. 24 IXIARO ................................................. 58 JAKAFI ................................................. 23 JANTOVEN .......................................... 34 JANUMET ............................................ 32 JANUMET XR ...................................... 32 JANUVIA .............................................. 32 JARDIANCE ......................................... 32 JENTADUETO ..................................... 32 JENTADUETO XR ............................... 32 JINTELI ................................................ 51

jock itch .............................................. 138 jock itch relief ..................................... 138 jock itch spray powder ....................... 144 JOHNSONS BABY OIL ..................... 139 JULEBER ............................................. 51 JULUCA ............................................... 29 JUNEL 1.5/30 ...................................... 51 JUNEL 1/20 ......................................... 51 JUNEL FE 1.5/30 ................................. 51 JUNEL FE 1/20 .................................... 51 JYNARQUE ......................................... 45 KALLIGA .............................................. 51 KALYDECO ......................................... 62 KAOPECTATE ................... 112, 113, 117 KAOPECTATE EXTRA STRENGTH 112,

113, 117 KARIVA................................................ 51 kcl in dextrose-nacl .............................. 45 KELNOR 1/35 ...................................... 51 KELNOR 1/50 ...................................... 51 KERR INSTA-CHAR .......................... 112 KESIMPTA ........................................... 42 ketoconazole ........................................ 19 ketorolac tromethamine ................... 9, 61 ketotifen fumarate ........................ 68, 106 KEVEYIS ............................................. 48 KEVZARA ............................................ 57 kimono ............................................... 125 kimono micro thin ............................... 125 kimono micro thin plus ....................... 125 kimono sensation ............................... 125 kimono sensation plus ....................... 125 KINERET ............................................. 57 KINRIX ................................................. 58 KISQALI (200 MG DOSE) ................... 23 KISQALI (400 MG DOSE) ................... 23 KISQALI (600 MG DOSE) ................... 23 KISQALI FEMARA (400 MG DOSE) .... 21 KISQALI FEMARA (600 MG DOSE) .... 21 KISQALI FEMARA(200 MG DOSE) ..... 21 KLOR-CON .......................................... 46 KLOR-CON 10 ..................................... 46 KLOR-CON M10 .................................. 46 KLOR-CON M15 .................................. 46 KLOR-CON M20 .................................. 46 kls acetaminophen ex st ................ 84, 91 kls acid controller max st ............. 68, 123 KLS ALLERCLEAR ...................... 71, 135 KLS ALLERCLEAR D-12HR .......... 70, 73 KLS ALLERCLEAR D-24HR .......... 71, 73 KLS ALLER-CORT .................... 107, 133 KLS ALLER-TEC ......................... 71, 135 KLS ALLER-TEC D ........................ 71, 73 kls aspirin low dose ............ 79, 81, 91, 98 kls ibuprofen .................................. 91, 96

kls ibuprofen ib ............................... 91, 96 KLS LAXACLEAR .............................. 120 kls mucus relief chest ......................... 130 KLS QUIT2 ........................................... 76 KLS QUIT4 ........................................... 76 konsyl daily fiber ................................. 120 KORLYM .............................................. 33 KOSELUGO ......................................... 23 kp adults 50+ daily formula ......... 103, 147 kp adults daily formula ................ 103, 147 kp aspirin ............................ 79, 81, 91, 98 kp b complex-c ................... 147, 151, 153 kp bisacodyl ........................................ 120 kp calcium citrate+d.................... 103, 156 kp double antibiotic ............................. 136 kp ferrous sulfate .................................. 77 kp folic acid ......................................... 151 kp hydrocortisone max st ................... 141 kp ketotifen fumarate .................... 68, 106 kp mag-oxide magnesium .................. 103 kp mens daily formula ................ 103, 147 kp niacin ............................................. 151 kp omeprazole magnesium ................ 123 kp prenatal multivitamins ...... 77, 147, 151 kp pseudoephedrine hcl ............... 73, 126 kp senna ............................................. 120 kp tolnaftate ........................................ 144 KP VISION FORMULA/LUTEIN . 103, 147 kp vitamin b-12 ............................. 78, 151 kp vitamin b-6 ..................................... 151 kp vitamin d ........................................ 156 kp vitamin d3 ...................................... 156 kp womens 50+ daily formula ..... 103, 147 kp womens daily formula ............ 103, 147 K-PAX IMMUNE PROFESSIONAL ST

............................................... 103, 147 kpn prenatal .................. 77, 103, 147, 151 kroger glucose ...................... 99, 124, 153 KURVELO ............................................ 51 KYNMOBI ............................................. 25 labetalol hcl .......................................... 37 lacosamide ........................................... 16 lactase enzyme .................................. 123 lactase fast acting ............................... 123 lactic acid ............................................ 139 lactose fast acting relief ...................... 123 lactulose ............................................... 46 lactulose encephalopathy ..................... 46 LAMISIL AT ........................................ 135 lamivudine ............................................ 28 lamivudine-zidovudine .......................... 29 lamotrigine ...................................... 15, 31 lamotrigine er ........................................ 15 lamotrigine starter kit-blue .................... 31 lamotrigine starter kit-green .................. 31

INDEX

171

lamotrigine starter kit-orange ............... 31 LAMPIT ................................................ 25 lansoprazole ......................................... 47 lanthanum carbonate ........................... 46 LANTUS ............................................... 34 LANTUS SOLOSTAR .......................... 34 lapatinib ditosylate................................ 23 LARIN 1.5/30........................................ 51 LARIN 1/20 .......................................... 51 LARIN FE 1.5/30 .................................. 51 LARIN FE 1/20 ..................................... 51 LARISSIA ............................................. 51 latanoprost ........................................... 61 LATUDA ............................................... 27 laxacin ................................................ 120 laxative ............................................... 120 laxative max str .................................. 120 l-carnitine ............................................. 99 leader glucose ...................... 99, 124, 153 leader quick dissolve glucose ............ 124 LEENA ................................................. 51 leflunomide ........................................... 55 lenalidomide ......................................... 21 LENVIMA (10 MG DAILY DOSE) ......... 23 LENVIMA (12 MG DAILY DOSE) ......... 23 LENVIMA (14 MG DAILY DOSE) ......... 23 LENVIMA (18 MG DAILY DOSE) ......... 23 LENVIMA (20 MG DAILY DOSE) ......... 23 LENVIMA (24 MG DAILY DOSE) ......... 23 LENVIMA (4 MG DAILY DOSE) ........... 23 LENVIMA (8 MG DAILY DOSE) ........... 23 LESSINA .............................................. 51 letrozole ............................................... 22 leucovorin calcium ................................ 24 LEUKERAN .......................................... 21 LEUKINE .............................................. 35 leuprolide acetate ................................. 54 levalbuterol hcl ..................................... 62 LEVEMIR ............................................. 34 LEVEMIR FLEXTOUCH ....................... 34 levetiracetam ........................................ 15 levetiracetam er.................................... 15 levobunolol hcl ..................................... 61 levocarnitine ......................................... 46 levocarnitine fumarate .......................... 99 levocarnitine sf ..................................... 46 levocetirizine dihydrochloride ............... 61 levofloxacin .......................................... 14 levofloxacin in d5w ............................... 14 LEVONEST .......................................... 51 levonorgest-eth estrad 91-day ............. 51 levonorgestrel-ethinyl estrad ................ 51 levonorg-eth estrad triphasic ................ 51 LEVORA 0.15/30 (28) .......................... 52 LEVO-T ................................................ 53

levothyroxine sodium ........................... 53 LEVOXYL ............................................ 53 LEXIVA ................................................ 30 lice killing ........................................... 143 lice killing maximum strength ............. 143 lice treatment ..................................... 144 lidocaine............................................... 10 lidocaine hcl ......................................... 10 lidocaine hcl urethral/mucosal.............. 10 lidocaine viscous hcl ............................ 10 lidocaine-prilocaine .............................. 10 LILLOW................................................ 52 lindane ................................................. 44 linezolid ................................................ 11 linezolid in sodium chloride .................. 11 LINZESS .............................................. 46 liothyronine sodium .............................. 53 liquid acetaminophen ..................... 84, 91 liquid corn & callus remover ............... 142 liquid pain relief .............................. 84, 91 liquitears ............................................ 108 lisinopril ................................................ 36 lisinopril-hydrochlorothiazide................ 38 lithium .................................................. 31 lithium carbonate ................................. 31 lithium carbonate er ............................. 31 LITTLE REMEDIES FOR FEVER .. 84, 91 LITTLE REMEDIES FOR TUMMYS .. 115 LIVMARLI ............................................ 47 LOESTRIN 1.5/30 (21) ........................ 52 LOHIST-D ...................................... 69, 73 longs glucose ....................... 99, 124, 153 LONSURF ............................................ 21 loperamide hcl ............................. 47, 113 lopinavir-ritonavir ................................. 30 lopreeza ............................................... 52 loradamed .................................... 71, 135 loratadine ..................................... 71, 135 loratadine childrens ...................... 71, 135 loratadine-d 12hr ............................ 71, 73 loratadine-d 24hr ............................ 71, 73 lorazepam ............................................ 31 LORAZEPAM INTENSOL .................... 31 LORBRENA ......................................... 23 losartan potassium ............................... 36 losartan potassium-hctz ....................... 38 LOTRIMIN AF .................................... 138 LOTRIMIN AF DEODORANT POWDER

...................................................... 138 LOTRIMIN AF JOCK ITCH POWDER 138 LOTRIMIN AF POWDER ................... 138 lovastatin.............................................. 39 LOW-OGESTREL ................................ 52 loxapine succinate ............................... 26 lubiprostone ......................................... 46

lubricant eye ....................................... 109 lubricant eye drops ............................. 108 lubricant eye drops pf ......................... 109 lubricant eye nighttime ....................... 109 lubricant pm ........................................ 109 lubricating eye drops .......................... 109 lubricating plus eye drops ................... 109 lubricating tears eye drops ................. 109 LUCEMYRA ......................................... 11 LUMAKRAS .......................................... 21 LUMIGAN ............................................. 61 LUPKYNIS ............................................ 57 LUPRON DEPOT (1-MONTH) ............. 54 LUPRON DEPOT (3-MONTH) ............. 54 LUPRON DEPOT (4-MONTH) ............. 54 LUPRON DEPOT (6-MONTH) ............. 54 LUPRON DEPOT-PED (1-MONTH) ..... 54 LUPRON DEPOT-PED (3-MONTH) ..... 54 LUTERA ............................................... 52 LYBALVI ............................................... 27 LYLLANA .............................................. 50 LYNPARZA .......................................... 21 LYSIPLEX PLUS ........................ 103, 147 LYSODREN .......................................... 21 LYZA .................................................... 53 MACUVITE/LUTEIN ................... 103, 147 mag-al plus xs ............................ 112, 115 MAGDELAY ....................................... 103 mag-g ................................................. 103 magnesium ......................................... 103 magnesium chloride ........................... 103 magnesium citrate .............................. 120 magnesium gluconate ........................ 103 magnesium lactate ............................. 103 magnesium oxide ............... 103, 112, 117 magnesium oxide (antacid) ........ 112, 117 magnesium oxide -mg supplement .... 103,

112, 117 magnesium sulfate ............................... 45 MAGNESIUM-OXIDE ......................... 103 MAG-OXIDE ....................................... 103 malathion .............................................. 44 mapap ............................................ 84, 91 MAPAP ACETAMINOPHEN EXTRA STR

................................................... 84, 91 mapap arthritis pain ........................ 84, 91 MAPAP CHILDRENS ..................... 84, 91 MAPO BATH ...................................... 139 maraviroc .............................................. 30 marlissa ................................................ 52 MARPLAN ............................................ 17 MATULANE .......................................... 21 MAVYRET ............................................ 28 maxi pad ultra thin ................................ 99 MAXIMUM EPA .................................. 125

INDEX

172

maxx .................................................. 125 MAYZENT ............................................ 42 MAYZENT STARTER PACK ............... 42 m-dryl ........... 65, 67, 75, 87, 94, 128, 132 meclizine hcl........................... 18, 67, 116 meclofenamate sodium .......................... 9 medicated anti-fungal ......................... 144 medicated callus removers ................ 142 medicated corn removers ................... 142 medicated wart removers ................... 142 medi-laxx ............................................ 120 MEDI-PAK PERFORMANCE PLUS ABD

...................................................... 144 MEDIPROXEN ....................... 91, 96, 124 MEDPURA ZINC OXIDE .................... 137 medroxyprogesterone acetate ............. 53 mefloquine hcl ...................................... 25 mega multiple/chelated mineral . 123, 147 mega multivitamin for men ......... 103, 147 mega multivitamin for women .... 103, 147 megestrol acetate................................. 53 meijer allergy relief-d ...................... 71, 73 meijer antacid ............................. 112, 115 meijer anti-diarrheal ........................... 113 meijer c .............................................. 153 meijer glucose ...................... 99, 124, 153 meijer ibuprofen ............................. 91, 96 meijer nasal decongestant ........... 73, 126 MEKINIST ............................................ 23 MEKTOVI ............................................. 23 meloxicam .............................................. 9 memantine hcl ...................................... 17 memantine hcl er.................................. 17 MENACTRA ......................................... 58 MENEST .............................................. 50 MENQUADFI........................................ 58 mens multi vitamin & mineral ..... 103, 147 menstrual relief max strength ... 66, 84, 97 MENTAX .............................................. 19 MENVEO ............................................. 58 meperidine hcl ...................................... 10 mercaptopurine .................................... 57 meropenem .......................................... 14 meropenem-sodium chloride ................ 14 mesalamine .......................................... 59 mesalamine-cleanser ........................... 59 MESNEX .............................................. 24 METAMUCIL ...................................... 120 METAMUCIL MULTIHEALTH FIBER . 120 METAMUCIL SMOOTH TEXTURE ... 120 metaxalone .......................................... 64 metformin hcl........................................ 32 metformin hcl er ................................... 32 methadone hcl........................................ 9 methazolamide ..................................... 61

methenamine hippurate ....................... 11 methimazole ........................................ 54 methocarbamol .................................... 64 methotrexate ........................................ 57 methotrexate (anti-rheumatic) .............. 57 methotrexate sodium ........................... 57 methotrexate sodium (pf) ..................... 57 methoxsalen rapid ............................... 44 methyldopa .......................................... 36 methylphenidate hcl ............................. 41 methylphenidate hcl er ......................... 41 methylphenidate hcl er (cd) ................. 41 methylphenidate hcl er (la) .................. 41 methylphenidate hcl er (xr) .................. 41 methylprednisolone .............................. 59 methylprednisolone acetate ................. 59 methyltestosterone .............................. 49 metoclopramide hcl .............................. 18 metolazone .......................................... 39 metoprolol succinate er ........................ 37 metoprolol tartrate ................................ 37 metoprolol-hydrochlorothiazide ............ 38 metronidazole ................................ 11, 12 metyrosine ........................................... 38 mexiletine hcl ....................................... 36 mgo .................................................... 103 mi-acid gas relief ................................ 115 micafungin sodium ............................... 19 MICATIN ............................................ 138 miconazole 1 ...................................... 138 miconazole 3 applicator ..................... 138 miconazole 3 combo pack ................. 138 miconazole 3 combo pack app .......... 138 miconazole 7 ...................................... 138 miconazole antifungal ........................ 138 miconazole nitrate .............................. 138 MICRO GUARD ................................. 138 MICROGESTIN 1.5/30 ........................ 52 MICROGESTIN 1/20 ........................... 52 microgestin 24 fe ................................. 52 MICROGESTIN FE 1.5/30 ................... 52 MICROGESTIN FE 1/20 ...................... 52 midodrine hcl ....................................... 36 miglustat .............................................. 48 migraine formula ...................... 84, 97, 98 migraine relief .......................... 85, 97, 98 MILI ...................................................... 52 milk of magnesia ................................ 120 MILLTRIUM SENIOR ................. 103, 147 MIMVEY............................................... 52 mineral oil .......................................... 120 mineral oil heavy ................................ 120 mineral oil light ........................... 120, 139 minocycline hcl .................................... 15 minoxidil ............................................... 40

MINTOX ..................................... 112, 115 mintox maximum strength .......... 112, 115 mirtazapine ........................................... 17 misoprostol ........................................... 47 mm cetirizine hcl ........................... 71, 135 M-M-R II ............................................... 58 m-natal plus .................... 46, 77, 147, 151 modafinil ............................................... 64 moexipril hcl ......................................... 36 MOISTURE EYES .............................. 109 molindone hcl ....................................... 26 molnupiravir .......................................... 30 mometasone furoate ...................... 44, 62 MONISTAT SOOTHING CARE ITCH 141 MONOJECT FLUSH SYRINGE ......... 103 MONOJECT SODIUM CHLORIDE

FLUSH ........................................... 103 montelukast sodium ............................. 62 morphine sulfate ................................... 10 morphine sulfate er ............................... 10 motion sickness relief ................... 67, 116 motion-time ................................... 67, 116 MOTRIN IB ..................................... 91, 96 moxifloxacin hcl .................................... 14 moxifloxacin hcl in nacl ......................... 14 m-pap ............................................. 85, 91 MUCINEX SINUS-MAX CLEAR & COOL

....................................................... 110 MUCINEX SINUS-MAX SINUS/ALLRGY

....................................................... 110 mucosa ............................................... 130 mucus d ........................................ 73, 130 mucus relief ........................................ 131 mucus relief chest congestion ............ 130 mucus relief cold/sinus max st 74, 85, 130 mucus relief d ............................... 73, 131 mucus relief dm .......................... 128, 131 mucus relief dm max .................. 128, 131 mucus relief er .................................... 131 mucus relief max st ............................ 131 mucus-dm ................................... 128, 131 mucus-dm max ........................... 128, 131 mucus-dm maximum strength .... 128, 131 MULTAQ .............................................. 36 multi complete/iron ..................... 103, 147 multi vitamin daily ............................... 147 multi-day plus iron ........................ 77, 147 multiple vit/minerals/no iron ........ 103, 147 multiple vitamins ................................. 147 multiple vitamins/iron .................... 77, 147 multiple vitamins/womens........... 103, 147 multi-purpose no-rub .......................... 107 multi-purpose solution ........................ 107 multivitamin ................................ 104, 148 multi-vitamin ....................................... 148

INDEX

173

multivitamin & mineral ................ 103, 147 multivitamin adult ............................... 147 multivitamin adults ...................... 104, 147 multivitamin adults 50+ .............. 104, 147 multivitamin childrens ......................... 147 multivitamin childrens (w/ fa) ..... 147, 151,

154 multi-vitamin daily ............................... 147 multivitamin gummies childrens ......... 147 multi-vitamin hp/minerals ........... 123, 147 multivitamin men ........................ 104, 148 multivitamin men 50+ ................. 104, 147 multivitamin women .................... 104, 148 multivitamin women 50+ ............ 104, 148 multi-vitamin/minerals ................ 104, 148 multi-vitamins ..................................... 148 multivitamins/minerals adult ....... 104, 148 multi-vite ..................................... 104, 148 mupirocin ............................................. 45 MURO 128 ......................................... 109 mycophenolate mofetil ......................... 57 mycophenolate sodium ........................ 57 MYFEMBREE ...................................... 50 MYLANTA MAXIMUM STRENGTH .. 112,

115 MYLICON INFANTS GAS RELIEF .... 115 MYORISAN .......................................... 42 MYRBETRIQ ........................................ 48 nabumetone ........................................... 9 nadolol ................................................. 37 nafcillin sodium..................................... 13 nafcillin sodium in dextrose .................. 13 nalbuphine hcl ........................................ 9 naloxone hcl ......................................... 11 naltrexone hcl ....................................... 11 naproxen ................................................ 9 naproxen sodium................ 9, 91, 96, 124 nasal allergy 24 hour .................. 107, 134 nasal decongestant ...................... 73, 126 nasal decongestant max st .......... 73, 126 nasal decongestant pe ......................... 74 nasal decongestant pe max st ............. 74 nasal decongestant spray .................. 110 nasal four ........................................... 110 nasal moisturizing spray ............. 109, 133 nasal relief .......................................... 110 nasal spray ......................................... 110 nasal spray 12 hour ............................ 110 nasal spray extra moisturizing ............ 110 nasal spray no drip ............................. 110 nasal spray sinus ............................... 110 NATACYN ............................................ 60 nateglinide ............................................ 32 NATPARA ............................................ 60 natural c/rose hips .............................. 154

natural fiber laxative ........................... 120 natural oatmeal bath treatment .......... 141 natural psyllium seed ......................... 120 natural senna laxative ........................ 120 NAYZILAM ........................................... 16 nebivolol hcl ......................................... 37 NECON 0.5/35 (28) ............................. 52 nefazodone hcl .................................... 18 neomycin sulfate .................................. 11 neomycin-polymyxin-dexameth ........... 60 neomycin-polymyxin-gramicidin ........... 60 neomycin-polymyxin-hc ....................... 61 NEOSPORIN ORIGINAL ................... 136 NERLYNX ............................................ 23 NEULASTA .......................................... 35 NEULASTA ONPRO ............................ 35 NEUPOGEN ........................................ 35 NEUPRO ............................................. 25 NEUTROGENA RAPID CLEAR ......... 142 nevirapine ............................................ 29 nevirapine er ........................................ 29 NEXAVAR ............................................ 23 NEXLETOL .......................................... 38 NEXLIZET ............................................ 38 niacin ................................................. 151 niacin er ............................................. 151 niacin er (antihyperlipidemic) ............... 40 niacinamide ........................................ 151 NICODERM CQ ................................... 76 NICORELIEF ....................................... 76 nicotine ................................................ 76 nicotine mini ......................................... 76 nicotine polacrilex ................................ 76 nicotine step 1 ...................................... 76 nicotine step 2 ...................................... 76 nicotine step 3 ...................................... 76 NICOTROL .......................................... 11 NICOTROL NS .................................... 11 nifedipine ............................................. 37 nifedipine er ......................................... 37 nifedipine er osmotic release ............... 37 night time pain medicine ex st.. 65, 85, 94 night time sleep aid ..... 66, 67, 75, 87, 94,

128, 133 nighttime sleep aid ...... 66, 67, 75, 87, 94,

128, 133 nilutamide ............................................ 21 nimodipine ........................................... 37 NINLARO ............................................. 21 nitazoxanide ......................................... 25 nitisinone.............................................. 48 NITRO-BID .......................................... 40 NITRO-DUR ......................................... 40 nitrofurantoin macrocrystal .................. 12 nitrofurantoin monohyd macro ............. 12

nitroglycerin .......................................... 40 NITYR ................................................... 48 NIVESTYM ........................................... 35 no drip nasal spray ............................. 110 no iron mult vitamin-minerals...... 104, 148 non-aspirin ...................................... 85, 91 non-aspirin childrens ...................... 85, 91 non-aspirin extra strength ............... 85, 91 non-aspirin pain relief ..................... 85, 91 non-aspirin pm .......................... 66, 85, 94 non-pseudo sinus decongestant........... 74 NORA-BE ............................................. 53 NORDITROPIN FLEXPRO................... 49 norethin ace-eth estrad-fe .................... 52 norethindrone ....................................... 53 norethindrone acetate .......................... 53 norethindrone acet-ethinyl est .............. 52 norethindrone-eth estradiol .................. 52 norgestimate-eth estradiol .................... 52 norgestim-eth estrad triphasic .............. 52 NORLYDA ............................................ 53 NORLYROC ......................................... 53 normal saline flush ............................. 104 NORPACE CR ..................................... 36 NORTREL 0.5/35 (28) .......................... 52 NORTREL 1/35 (21) ............................. 52 NORTREL 1/35 (28) ............................. 52 NORTREL 7/7/7 ................................... 52 nortriptyline hcl ..................................... 18 NORVIR ............................................... 30 NOXAFIL .............................................. 19 NUBEQA .............................................. 21 NUCALA ............................................... 64 NUEDEXTA .......................................... 41 NULOJIX .............................................. 57 NUPLAZID ............................................ 27 NURTEC .............................................. 20 NUTRILIPID ......................................... 46 NUTROPIN AQ NUSPIN 10 ................. 49 NUTROPIN AQ NUSPIN 20 ................. 49 NUTROPIN AQ NUSPIN 5 ................... 49 NYAMYC .............................................. 19 nylia 1/35 .............................................. 52 NYLIA 7/7/7 .......................................... 52 nystatin ................................................. 19 nystatin-triamcinolone .......................... 44 NYSTOP ............................................... 19 NYVEPRIA ........................................... 35 OCALIVA .............................................. 47 oceanic selenium ................................ 104 OCELLA ............................................... 52 octreotide acetate ................................. 54 ocutabs ....................................... 104, 148 ocutabs-lutein ............................. 104, 148 OCUVITE-LUTEIN ..................... 104, 148

INDEX

174

ODEFSEY ............................................ 29 ODOMZO ............................................. 23 odor control foot & sneaker ................ 144 odorless coated fish oil ....................... 125 OFEV ................................................... 63 ofloxacin ................................... 14, 60, 61 olanzapine ............................................ 27 olmesartan medoxomil ......................... 36 olmesartan medoxomil-hctz ................. 38 olmesartan-amlodipine-hctz ................. 38 olopatadine hcl ..................................... 60 OLUMIANT........................................... 55 omega 3 ............................................. 125 omega iii epa+dha .............................. 125 omega-3 ............................................. 125 omega-3 fish oil .................................. 125 omega-3-acid ethyl esters .................... 40 omeprazole .......................................... 47 omeprazole magnesium ..................... 123 omnicap ............................................. 148 OMNITROPE ....................................... 49 once daily ........................................... 148 ONCOVITE ................................ 104, 148 ondansetron ......................................... 19 ondansetron hcl.................................... 19 one daily ............................................. 148 one daily calcium/iron ................. 104, 148 one daily for men 50+ advanced 104, 148 one daily for men/lycopene ........ 104, 148 one daily for women ................... 104, 148 one daily for women 50+ adv ..... 104, 148 one daily maximum .................... 104, 148 one daily mens ........................... 104, 148 one daily mens health ................ 104, 148 one daily multivitamin adult ................ 148 one daily multivitamin/iron ............ 78, 148 ONE DAILY PLUS IRON ............ 104, 148 one daily womens 50 plus .......... 104, 148 one daily/minerals ...................... 104, 148 ONE-A-DAY ESSENTIAL .................. 148 ONE-A-DAY TEEN ADVANTAGE/HER

.............................................. 104, 148 ONE-A-DAY TEEN ADVANTAGE/HIM

.............................................. 104, 148 one-daily multi vitamins ...................... 148 one-daily multi-vitamin ....................... 148 ONGENTYS ......................................... 25 ONUREG ............................................. 21 OPTI-FREE DAILY CLEANER ........... 107 OPTI-FREE EXPRESS ...................... 107 OPTI-FREE EXPRESS REWETTING 107 OPTI-FREE REPLENISH ................... 107 OPTIMAL-D........................................ 156 OPTIONS GYNOL II CONTRACEPTIVE

...................................................... 126

oral analgesic max st ......................... 137 oral electrolytes .................................. 104 ORALYTE .......................................... 104 ORALYTE FREEZER POPS ............. 104 ORENCIA ............................................ 55 ORENCIA CLICKJECT ........................ 55 ORFADIN ............................................. 48 organ-i nr ........................................... 131 ORGOVYX ........................................... 22 ORILISSA ............................................ 49 ORKAMBI ............................................ 63 ORLADEYO ......................................... 38 orphenadrine citrate er ......................... 64 ORSYTHIA .......................................... 52 OS-CAL CALCIUM + D3 ............ 104, 156 oseltamivir phosphate .......................... 30 OTEZLA ......................................... 44, 57 oxandrolone ......................................... 49 OXBRYTA ............................................ 35 oxcarbazepine ..................................... 16 OXERVATE ......................................... 60 oxybutynin chloride .............................. 48 oxybutynin chloride er .......................... 48 oxycodone hcl ...................................... 10 oxycodone hcl er .................................. 10 oxycodone-acetaminophen .................. 10 OYSCO 500+D .......................... 104, 156 oyster calcium .................................... 104 oyster shell calcium ........................... 104 oyster shell calcium + d ............. 104, 156 oyster shell calcium + d3 ........... 104, 156 oyster shell calcium 250+d ........ 104, 156 oyster shell calcium 500 + d ...... 104, 156 oyster shell calcium plus d ......... 104, 156 oyster shell calcium/d ................ 104, 156 oyster shell calcium/d3 .............. 104, 156 oyster shell calcium/vitamin d .... 104, 156 OYSTERCAL-D ......................... 104, 156 OZEMPIC (0.25 OR 0.5 MG/DOSE) .... 32 OZEMPIC (1 MG/DOSE) ..................... 32 pain & fever childrens .................... 85, 91 pain & fever infants ........................ 85, 91 pain relief ....................................... 85, 91 pain relief childrens ........................ 85, 91 pain relief extra strength ................ 85, 91 pain relief pm extra strength .... 66, 85, 94 pain relief regular strength ............. 85, 91 pain reliever ................................... 85, 91 pain reliever extra strength 85, 91, 97, 98 pain reliever plus ...................... 85, 97, 98 pain reliever pm ....................... 66, 85, 94 pain reliever pm ex st ............... 66, 85, 94 pain reliever/fever reducer ............. 85, 91 pain-off ..................................... 85, 97, 98 paliperidone er ..................................... 27

PAMPRIN MAX ........................ 85, 97, 98 PANOXYL CREAMY WASH .............. 143 PANOXYL FOAMING WASH ............. 143 PANRETIN ........................................... 24 pantoprazole sodium ............................ 47 paricalcitol ............................................ 60 paromomycin sulfate ............................ 11 paroxetine hcl ....................................... 18 paroxetine hcl er ................................... 18 PASER ................................................. 20 PAXLOVID ........................................... 30 ped electrolyte freeze pops ................ 104 ped electrolyte freezer pops ............... 104 PEDIACARE CHILDREN ............... 85, 91 PEDIA-LAX ......................................... 120 PEDIARIX ............................................. 58 pediatric electrolyte ............................ 104 pediatric electrolyte-zinc ..................... 105 PEDVAX HIB ........................................ 58 peg 3350 .................................... 120, 121 peg 3350-kcl-na bicarb-nacl ......... 46, 121 peg-3350/electrolytes ................... 47, 121 PEGANONE ......................................... 15 PEGASYS ............................................ 56 PEMAZYRE .......................................... 23 pen needles .......................................... 34 PEN NEEDLES .................................... 34 penicillamine ......................................... 45 penicillin g procaine .............................. 13 penicillin g sodium ................................ 13 penicillin v potassium ........................... 13 PENTACEL .......................................... 58 pentamidine isethionate ....................... 25 pentazocine-naloxone hcl ..................... 10 pentoxifylline er .................................... 38 PERFOROMIST ................................... 62 perindopril erbumine ............................. 36 PERIOGARD ........................................ 42 permethrin ............................................ 44 perphenazine ........................................ 18 perphenazine-amitriptyline ................... 17 PERSERIS ........................................... 27 petrolatum white ................................. 139 petroleum jelly ............................ 139, 141 petroleum jelly lip treatment................ 139 pharbedryl .... 66, 67, 75, 87, 94, 128, 133 PHARBETOL .................................. 85, 91 PHARBETOL EXTRA STRENGTH 85, 91 phenelzine sulfate ................................ 17 phenobarbital ........................................ 16 phenoxybenzamine hcl ......................... 36 phenytoin .............................................. 16 PHENYTOIN INFATABS ...................... 16 phenytoin sodium extended ................. 16 PHILLIPS ............................................ 121

INDEX

175

PHILLIPS STOOL SOFTENER .......... 121 PIFELTRO ........................................... 29 pilocarpine hcl ................................ 42, 61 pimecrolimus ........................................ 44 pimozide ............................................... 26 PIMTREA ............................................. 52 pindolol ................................................. 37 pink bismuth ....................... 112, 113, 117 pink bismuth maximum strength 112, 113,

117 pioglitazone hcl .................................... 32 pioglitazone hcl-metformin hcl .............. 32 piperacillin sod-tazobactam so ............. 14 PIQRAY (200 MG DAILY DOSE) ......... 23 PIQRAY (250 MG DAILY DOSE) ......... 23 PIQRAY (300 MG DAILY DOSE) ......... 23 PIRMELLA 1/35 ................................... 52 piroxicam ................................................ 9 plain niacin ......................................... 151 PLENAMINE ........................................ 48 pnv tabs 29-1 ....................................... 46 podofilox ............................................... 44 poly bacitracin .................................... 136 polyethylene glycol 3350 .............. 47, 121 POLY-IRON 150 .................................. 78 polymyxin b sulfate ............................... 12 polymyxin b-trimethoprim ..................... 60 polysaccharide iron complex ................ 78 polysaccharide-iron complex ................ 78 polyvinyl alcohol ................................. 109 poly-vita .............................................. 148 POMALYST.......................................... 21 PONVORY ........................................... 42 PONVORY STARTER PACK ............... 42 PORTIA-28........................................... 52 posaconazole ....................................... 19 potassium chloride ............................... 45 potassium chloride crys er ............. 45, 46 potassium chloride er ........................... 45 potassium citrate er .............................. 45 povidone-iodine .................................. 143 PR BENZOYL PEROXIDE WASH ..... 143 PRALUENT .......................................... 40 pramipexole dihydrochloride ................ 25 pramipexole dihydrochloride er ............ 25 prasugrel hcl......................................... 36 pravastatin sodium ............................... 39 praziquantel ......................................... 24 prazosin hcl .......................................... 36 prednicarbate ....................................... 44 prednisolone......................................... 59 prednisolone acetate ............................ 61 prednisolone sodium phosphate .... 59, 61 prednisone ........................................... 59 PREDNISONE INTENSOL .................. 49

preferred plus glucose ....... 100, 124, 154 pregabalin ...................................... 15, 16 PREMARIN .......................................... 50 premium condoms lubricated ............. 126 premium lidocaine ................................ 10 PREMPHASE ...................................... 52 PREMPRO ........................................... 52 prenatal ................................................ 46 prenatal plus iron ................................. 46 prenatal vitamin plus low iron............... 46 PREPARATION H ............................. 141 preplus ................................................. 46 pretab................................................... 46 PRETOMANID ..................................... 20 PREVALITE ......................................... 40 PREVIFEM .......................................... 52 PREVYMIS .......................................... 28 PREZCOBIX ........................................ 30 PREZISTA ........................................... 30 PRIFTIN ............................................... 20 primaquine phosphate ......................... 25 primidone ............................................. 16 PRIVIGEN ............................................ 55 probenecid ........................................... 20 prochlorperazine .................................. 18 prochlorperazine maleate .................... 18 PROCRIT ............................................. 35 PROCTO-MED HC .............................. 44 PROCTO-PAK ..................................... 44 PROCTOSOL HC ................................ 44 PROCTOZONE-HC ............................. 44 progesterone ........................................ 53 PROGRAF ........................................... 57 PROLASTIN-C ..................................... 48 PROLIA................................................ 60 PROMACTA ........................................ 35 promethazine hcl ........................... 18, 61 promethazine vc .................................. 64 promethazine-phenylephrine ............... 64 PROMETHEGAN ................................. 18 propafenone hcl ................................... 36 proparacaine hcl .................................. 60 propranolol hcl ..................................... 37 propranolol hcl er ................................. 37 propylthiouracil ..................................... 54 PROQUAD ........................................... 58 protriptyline hcl ..................................... 18 pseudoephedrine hcl ................... 73, 126 pseudoephedrine hcl er ............... 73, 126 pseudoephedrine-guaifenesin er . 73, 131 PULMOZYME ...................................... 63 PURE & GENTLE LUBRICANT ......... 109 PUREWAY-C ..................................... 154 PURIXAN ............................................. 21 px acid reducer ............................ 68, 123

px acid reducer max st ................. 68, 123 px all day relief ....................... 91, 96, 124 px allergy relief cetirizine .............. 71, 135 px allergy relief d ............................ 71, 73 px allergy relief d (loratid) ............... 71, 73 px allergy relief loratadine ............ 71, 135 px antacid extra strength ............ 112, 117 px antacid maximum strength.... 112, 115,

117 px antacid regular strength ......... 112, 115 px arthritis pain relief ...................... 85, 91 px artificial tears ......................... 108, 109 px aspirin ............................ 80, 81, 91, 98 px athletic foot .................................... 138 px calcium antacid ...................... 112, 117 px childrens allergy ....................... 71, 135 px childrens pain relief .................... 85, 91 px childrens profen ib ..................... 92, 96 px complete senior multivits ....... 105, 148 px dairy digestive ................................ 123 px dibromm dm cold/cough child ... 69, 74,

129 px docusate sodium ........................... 121 px fiber................................................ 121 px gas relief infants ............................ 115 px gas relief ultra strength .................. 115 px glucose .......................... 100, 124, 154 px hemorrhoidal .... 74, 126, 139, 140, 141 px hydrocream .................................... 141 px hydrogen peroxide ......................... 143 px ibuprofen .................................... 92, 96 px ibuprofen junior strength ............ 92, 96 px infants profen ib ......................... 92, 96 px laxative .......................................... 121 px miconazole 3-day combo ............... 138 px migraine relief ...................... 85, 97, 98 px milk of magnesia ............................ 121 px nasal decongestant ................. 73, 126 px nasal decongestant pe .................... 74 px nasal four ....................................... 110 px nasal spray moisturizing ................ 110 px no drip nasal spray ........................ 110 px original nasal spray ........................ 110 px pain relief extra strength ............ 85, 92 px pain relief pm ex st .............. 66, 85, 94 px saline nasal spray .................. 109, 133 px stomach relief ................ 112, 114, 117 px stomach relief max st ..... 112, 114, 117 px stop smoking aid .............................. 76 px triple ............................................... 136 px tussin ............................................. 131 px tussin dm ............................... 129, 131 pyrazinamide ........................................ 20 pyridostigmine bromide ........................ 20 pyridostigmine bromide er .................... 20

INDEX

176

pyridoxine hcl ..................................... 151 pyrimethamine...................................... 25 qc 3 day ............................................. 138 qc acetaminophen 8 hours ............. 85, 92 qc acid controller .......................... 68, 123 qc acid controller max st .............. 68, 123 qc all day allergy .......................... 71, 135 qc allergy relief ............................. 71, 135 qc antacid ........................... 112, 115, 117 qc antacid extra strength ............ 112, 117 qc antacid/anti-gas ..................... 112, 115 qc anti-diarrheal ................................. 114 qc anti-gas ......................................... 115 qc arthritis pain relief ...................... 85, 92 qc artificial tears ......................... 108, 109 qc aspirin ............................ 80, 81, 92, 98 qc aspirin low dose ............. 80, 81, 92, 98 qc athletes foot ................................... 135 qc bacitracin ....................................... 136 qc calamine ........................................ 137 qc childrens allergy ...................... 71, 135 qc childrens ibuprofen .................... 92, 96 qc chlor-pheniramine .............. 67, 69, 133 qc complete allergy medicine .. 66, 67, 75,

87, 94, 129, 133 qc daily multivit/multimineral ...... 105, 148 qc diarrhea relief ................ 112, 114, 117 qc enema ........................................... 121 qc enteric aspirin ................ 80, 81, 92, 98 qc fiber laxative .................................. 121 qc gas relief extra strength ................. 115 qc gentle laxative ............................... 121 qc headache relief .................... 85, 97, 98 qc hydrogen peroxide ......................... 143 qc ibuprofen ................................... 92, 96 qc ibuprofen ib................................ 92, 96 qc loratadine allergy relief ............ 71, 135 qc loratadine-d ............................... 71, 73 qc magnesium citrate ......................... 121 qc medifin 400 .................................... 131 qc mens daily multivitamin ......... 105, 148 qc miconazole 7 ................................. 138 qc milk of magnesia ........................... 121 qc mineral oil heavy ........................... 121 qc mucus relief ................................... 131 qc naproxen sodium ............... 92, 96, 124 qc natural vegetable ........................... 121 qc natural vegetable laxative .............. 121 qc natura-lax ...................................... 121 qc non-aspirin 8 hour ..................... 85, 92 qc non-aspirin childrens ................. 85, 92 qc non-aspirin extra strength .......... 85, 92 qc omeprazole magnesium ................ 123 qc pain relief ................................... 85, 92 qc pain relief childrens ................... 85, 92

qc pain relief extra strength ........... 85, 92 qc pain relief infants ....................... 85, 92 qc povidone iodine ............................. 143 qc prenatal ........................... 78, 148, 151 qc stool softener ................................ 121 qc stool softener pls laxative .............. 121 qc suphedrine maximum strength 73, 126 qc tolnaftate ....................................... 144 qc triple antibiotic max st ........... 136, 137 qc tussin dm cough/congestion . 129, 131 qc tussin mucus/congestion ............... 131 QINLOCK ............................................. 23 QLEARQUIL ...................................... 110 QUADRACEL ...................................... 58 quetiapine fumarate ............................. 27 quetiapine fumarate er ......................... 27 quinapril hcl .......................................... 36 quinapril-hydrochlorothiazide ............... 38 quinidine gluconate er .......................... 36 quinidine sulfate ................................... 36 quinine sulfate ...................................... 25 quintabs ............................................. 148 quintabs-m ................................. 105, 148 ra 12 hour nasal spray ....................... 110 ra 8 hour pain relief ........................ 85, 92 ra acetaminophen .......................... 85, 92 ra acetaminophen childrens ........... 85, 92 ra acetaminophen ex st ................. 85, 92 ra acetaminophen pm ex st ..... 66, 85, 94 ra acid reducer ............................. 68, 123 ra acid reducer max st ................. 68, 123 ra allergy relief (cetirizine) ............ 71, 135 ra allergy relief (loratadine) .......... 71, 135 ra allergy relief childrens .............. 71, 135 ra allergy/congestion relief ............. 71, 73 ra antacid ................................... 112, 117 ra antacid ultra strength ............. 112, 117 ra antacid/anti-gas ..................... 113, 115 ra antacid/anti-gas max st .......... 112, 115 ra antacid/gas relief max st ........ 113, 115 ra antibiotic/pain relief ................ 136, 137 ra anti-diarrheal .................................. 114 ra antifungal foot care ........................ 136 ra anti-itch maximum strength............ 141 ra antiseptic ....................................... 143 ra arthritis pain relief ...................... 85, 92 ra aspirin ............................ 80, 81, 92, 99 ra aspirin adult low dose .... 80, 81, 92, 98 ra aspirin adult low strength 80, 81, 92, 99 ra aspirin childrens ............. 80, 81, 92, 99 ra aspirin ec ....................... 80, 81, 92, 99 ra aspirin ec adult low st .... 80, 81, 92, 99 ra atheletes foot ................................. 138 ra athletes foot ................................... 138 ra bacitracin ....................................... 136

ra bacitracin zinc first aid .................... 136 ra calamine ................................. 137, 139 ra calcium 600 .................................... 105 ra calcium 600/vitamin d-3.......... 105, 156 ra calcium cit plus vit d-3 ............ 105, 156 ra calcium cit-vit d-3 petites ........ 105, 156 RA CENTRAL-VITE ................... 105, 148 ra central-vite womens mature ... 105, 148 ra cetiri-d ........................................ 71, 73 ra childrens fever/pain .................... 85, 92 ra cleaning/disinfecting lens ............... 107 ra clotrimazole .................................... 139 ra clotrimazole 7 ................................. 138 ra cold & cough childrens ....... 69, 74, 129 ra col-rite ............................................ 121 ra complete allergy ............................. 133 ra corn removers ultra thin.................. 142 ra cough dm ....................................... 129 ra dairy aid .......................................... 123 ra dairy relief fast acting ..................... 123 ra daylogic acne foaming wash .......... 143 ra double antibiotic ............................. 136 ra ear drops ........................................ 108 ra enema ............................................ 121 ra eye itch relief ............................ 68, 106 ra fast relief laxative ........................... 121 ra fever reducer/pain reliever.......... 85, 92 ra fish oil ............................................. 125 ra folic acid ......................................... 151 ra foot care (tolnaftate) ....................... 144 ra gas relief ......................................... 115 ra gas relief extra strength .................. 115 ra glucosamine sulfate ....................... 125 ra glucose ........................... 100, 124, 154 ra glycerin adult .................................. 121 ra glycerin child .................................. 121 ra hemorrhoidal .... 74, 126, 139, 140, 141 RA HI CAL .................................. 105, 156 ra hydrocortisone plus ................ 139, 141 ra hydrocortisone plus 12 ................... 141 ra hydrogen peroxide ......................... 143 ra ibuprofen .................................... 92, 96 ra ibuprofen childrens ..................... 92, 96 ra ibuprofen infants ......................... 92, 96 ra ibuprofen junior strength ............ 92, 96 ra iron ................................................... 78 ra isopropyl rubbing alcohol................ 143 ra jock itch .......................................... 139 ra jock itch max st ............................... 144 ra laxative ........................................... 121 ra lice maximum strength ................... 144 ra lice solution .................................... 144 ra lorata-d ....................................... 71, 73 ra loratadine ................................. 71, 135 ra lubricant eye ................................... 109

INDEX

177

ra lubricant eye drops ......................... 109 ra magnesium .................................... 105 ra menstrual relief .................... 66, 86, 97 ra miconazole 3 combo pack ............. 139 ra miconazole 7 .................................. 139 ra migraine relief ...................... 86, 97, 99 ra milk of magnesia ............................ 121 ra mineral oil....................................... 121 ra mini nicotine ..................................... 76 ra motion sickness relief ............... 67, 116 ra mucus relief d........................... 73, 131 ra mucus relief d max strength ..... 73, 131 ra multihealth fiber .............................. 121 ra naproxen sodium ............... 92, 96, 125 ra nasal allergy ........................... 107, 134 ra nasal decongestant pe ..................... 74 ra natural magnesium ........................ 105 ra niacin ............................................. 151 ra nicotine ...................................... 76, 77 ra nicotine gum..................................... 76 ra nicotine polacrilex ............................ 77 ra nighttime sleep aid .. 66, 67, 75, 87, 94,

129, 133 ra no flush niacin ................................ 151 ra nose drops extra strength .............. 110 ra one daily maximum ................ 105, 148 ra one daily mens/vit d-3 ............ 105, 148 ra p col-rite ......................................... 121 ra pain relief acetaminophen .......... 86, 92 ra pain relief ibuprofen ................... 92, 96 ra pain reliever ex st ................. 86, 97, 99 ra pediatric electrolyte ........................ 105 ra petroleum jelly ................................ 139 ra prenatal ............................ 78, 148, 151 ra renewal soothing bath .................... 141 ra saline nasal spray .................. 109, 133 ra saline solution ................................ 107 ra sinus/congestion relief pe ................ 74 ra sleep aid (diphenhydramine) ..... 66, 67,

75, 87, 94, 129, 133 ra slow release iron .............................. 78 ra stomach relief................. 113, 114, 117 ra stool softener ................................. 121 ra suphedrine ............................... 73, 126 ra triple antibiotic ................................ 136 ra tussin ............................................. 131 ra tussin cgh/chest congest dm .. 129, 131 ra tussin cough ........................... 129, 131 ra tussin dm................................ 129, 131 ra vitamin a ........................................ 150 ra vitamin b-1 ..................................... 151 ra vitamin b-12 ............................. 78, 152 ra vitamin b-12 tr .......................... 78, 152 ra vitamin b-6 ..................................... 152 ra vitamin c ......................................... 154

ra vitamin c cr .................................... 148 ra vitamin c/acerola ............................ 154 ra vitamin c/rose hips ......................... 154 ra vitamin d-3 ..................................... 156 ra wart remover .................................. 142 ra wart remover max strength ............ 142 ra womens laxative ............................ 121 ra zinc ................................................ 105 ra zinc oxide ....................................... 137 RABAVERT ......................................... 58 raloxifene hcl ........................................ 53 ramelteon ............................................. 64 ramipril ................................................. 36 ranolazine er ........................................ 38 rasagiline mesylate .............................. 26 RAVICTI............................................... 48 REBIF .................................................. 42 REBIF REBIDOSE ............................... 42 REBIF REBIDOSE TITRATION PACK 42 REBIF TITRATION PACK ................... 42 RECLIPSEN ........................................ 52 RECOMBIVAX HB ............................... 58 RECTIV................................................ 40 refenesen 400 .................................... 131 REFRESH LACRI-LUBE ................... 109 REGRANEX ......................................... 44 REGULOID ........................................ 121 RELENZA DISKHALER ....................... 30 RELION GLUCOSE ........... 100, 124, 154 RELISTOR ........................................... 47 RENU DISINFECTING ...................... 107 RENU MULTIPLUS ........................... 107 RENU MULTIPLUS LUB/REWETTING

...................................................... 107 RENU REWETTING DROPS ............ 107 repaglinide ........................................... 32 REPATHA ............................................ 40 REPATHA PUSHTRONEX SYSTEM .. 40 REPATHA SURECLICK ...................... 40 RESOURCE THICKENUP CLEAR .... 126 RESTASIS ........................................... 60 RESTASIS MULTIDOSE ..................... 60 RETACRIT ........................................... 35 RETAINE CMC .................................. 109 RETAINE PM ..................................... 109 RETEVMO ........................................... 22 REVLIMID ............................................ 21 rewetting drops .................................. 107 REXULTI .............................................. 27 REYATAZ ............................................ 30 REZUROCK ......................................... 57 RHOPRESSA ...................................... 61 ribavirin ................................................ 28 RID..................................................... 144 RID LICE KILLING SHAMPOO.......... 144

rifabutin ................................................. 20 rifampin ................................................. 20 riluzole .................................................. 41 rimantadine hcl ..................................... 30 RINVOQ ............................................... 55 risedronate sodium ............................... 60 RISPERDAL CONSTA ......................... 27 risperidone ............................................ 27 ritonavir ................................................. 30 rivastigmine .......................................... 17 rivastigmine tartrate .............................. 17 rizatriptan benzoate .............................. 20 ROBAFEN DM CGH/CHEST CONGEST

............................................... 129, 131 ROBAFEN DM COUGH ............. 129, 131 ROBAFEN DM COUGH CLEAR 129, 131 ROBAFEN MUCUS/CHEST

CONGESTION .............................. 131 ROBITUSSIN CHILDRENS COUGH LA

....................................................... 129 ropinirole hcl ......................................... 25 ropinirole hcl er ..................................... 25 rosuvastatin calcium ............................. 39 ROTARIX ............................................. 58 ROTATEQ ............................................ 58 ROWEEPRA ........................................ 15 ROZLYTREK ........................................ 23 RUBRACA ............................................ 23 rufinamide ............................................. 16 RUKOBIA ............................................. 30 RYBELSUS .......................................... 32 RYDAPT ............................................... 23 RYLAZE ............................................... 22 rynex dm ................................. 69, 74, 129 rynex pe .......................................... 69, 74 rynex pse ........................................ 69, 73 saline .................................................. 107 saline mist spray ......................... 109, 133 saline nasal spray ....................... 109, 133 SANDIMMUNE ..................................... 57 SANTYL ............................................... 44 sapropterin dihydrochloride .................. 48 SAVELLA ............................................. 41 SAVELLA TITRATION PACK ............... 41 sb 12hr nasal spray ............................ 110 sb allergy ....... 66, 67, 71, 75, 87, 94, 129,

133, 135 sb allergy medicine ...... 66, 67, 75, 87, 94,

129, 133 sb antacid ................................... 113, 117 sb antacid anti-gas ..................... 113, 115 sb antacid extra strength ............ 113, 117 sb anti-diarrhea .................................. 114 sb aspirin ............................ 80, 81, 92, 99 sb aspirin ec ....................... 80, 81, 92, 99

INDEX

178

sb bisacodyl laxative ec ..................... 121 sb childrens aspirin ............ 80, 81, 92, 99 sb chlorpheniramine ............... 67, 69, 133 sb cough control ................................. 131 sb coughtab ....................................... 131 sb dairy relief ...................................... 123 sb docusate sodium ........................... 121 sb hydrocortisone ............................... 141 sb hydrocortisone max st ................... 141 sb ibuprofen ................................... 92, 96 sb infants ibuprofen ........................ 92, 96 sb lice killing max st ........................... 144 sb loratadine................................. 71, 135 sb low dose asa ec ............. 80, 81, 92, 99 sb milk of magnesia ........................... 121 sb multi-purpose................................. 107 sb naproxen sodium ............... 92, 96, 125 sb non-aspirin................................. 86, 93 sb non-aspirin extra strength .......... 86, 93 sb non-aspirin nighttime ........... 66, 86, 94 sb omega-3 fish oil ............................. 125 sb pain relief x-str ..................... 86, 97, 99 sb pain reliever childrens ............... 86, 93 sb pain reliever ex st ...................... 86, 93 sb povidone-iodine ............................. 143 sb saline nose ............................ 109, 133 sb senna-lax ....................................... 121 sb sleep ........ 66, 67, 76, 87, 94, 129, 133 sb triple antibiotic ............................... 136 sb vitamin c ........................................ 154 SCEMBLIX ........................................... 23 SCOOBY-DOO ONE A DAY ........ 78, 148 scopolamine ......................................... 18 SECUADO ........................................... 27 selegiline hcl......................................... 26 selenium ............................................. 105 selenium sulfide ................................... 44 SELZENTRY ........................................ 30 senexon ............................................. 121 SENEXON-S ...................................... 121 senior tabs ................................. 105, 149 senna ................................................. 121 senna lax ............................................ 121 senna laxative .................................... 121 senna plus .......................................... 122 senna s .............................................. 122 senna-docusate sodium ..................... 122 senna-lax ........................................... 122 senna-plus ......................................... 122 senna-s .............................................. 122 senna-tabs ......................................... 122 senna-time ......................................... 122 senna-time s....................................... 122 sennosides-docusate sodium ............. 122 SENSITIVE EYES PLUS SALINE ...... 107

sentry ......................................... 105, 149 sentry adult ................................ 105, 149 sentry senior .............................. 105, 149 SEREVENT DISKUS ........................... 62 SEROSTIM .......................................... 49 sertraline hcl ........................................ 18 SETLAKIN ........................................... 52 sevelamer carbonate ........................... 46 SHAROBEL ......................................... 52 SHINGRIX ........................................... 58 SIGNIFOR ........................................... 54 siladryl allergy ..... 66, 67, 76, 87, 95, 129,

133 sildenafil citrate .................................... 63 SILIQ.................................................... 55 siltussin dm das ......................... 129, 131 siltussin sa ......................................... 131 siltussin-dm alcohol free ............ 129, 131 silver sulfadiazine ................................ 44 SIMBRINZA ......................................... 61 simethicone ........................................ 115 SIMLIYA............................................... 52 SIMPLY SLEEP .. 66, 67, 76, 87, 95, 129,

133 SIMPONI ........................................ 55, 57 simvastatin ........................................... 39 sinus 12 hour ............................... 73, 126 sinus nasal spray ............................... 110 sinus relief .......................................... 110 sinus relief extra strength ................... 110 sirolimus............................................... 57 SIRTURO ............................................. 20 SKYRIZI ............................................... 55 SKYRIZI (150 MG DOSE) ................... 55 SKYRIZI PEN ...................................... 55 SKYTROFA ......................................... 49 sleep aid (diphenhydramine) .. 66, 68, 76,

87, 95, 129, 133 sleep ii.......... 66, 68, 76, 87, 95, 129, 133 sleep-tabs .... 66, 68, 76, 87, 95, 129, 133 SLO-NIACIN ...................................... 152 slow iron............................................... 78 slow release iron .................................. 78 sm 8 hour pain relief ...................... 86, 93 sm acid reducer ........................... 68, 123 sm acid reducer max st ................ 68, 123 sm alcohol .......................................... 143 sm all day allergy ......................... 71, 135 sm all day allergy childrens .......... 71, 135 sm all day allergy-d ........................ 71, 73 sm allergy 4 hour ................... 68, 69, 133 sm allergy childrens ..................... 71, 135 sm allergy relief ..... 66, 68, 71, 76, 87, 95,

129, 133, 135

sm allergy relief childrens .. 66, 68, 76, 87, 95, 129, 133

sm animal shapes complete ......... 78, 149 sm antacid advanced ................. 113, 115 sm antacid advanced max st ...... 113, 115 sm antacid anti-gas .................... 113, 115 sm antacid maximum strength.... 113, 115 sm antacid/antigas ..................... 113, 115 sm antibiotic ....................................... 136 sm anti-dandruff coal tar ..................... 142 sm anti-diarrheal ................................. 114 sm antifungal clotrimazole .................. 139 sm antifungal miconazole ................... 139 sm antifungal tolnaftate ...................... 144 sm antioxidant vitamins .............. 105, 149 sm arthritis pain relief ..................... 86, 93 sm arthritis pain reliever ................. 86, 93 sm artificial tears ................................ 109 sm aspirin ........................... 80, 82, 93, 99 sm aspirin adult low strength ... 80, 81, 93,

99 sm aspirin ec ...................... 80, 82, 93, 99 sm aspirin ec low strength .. 80, 81, 93, 99 sm aspirin low dose ............ 80, 82, 93, 99 sm athletes foot .................................. 136 sm b super vitamin complex ...... 149, 152,

154 sm b-complex/vitamin c ...... 149, 152, 154 sm calamine ............................... 137, 139 sm calcium 500/vitamin d3 ......... 105, 156 sm calcium 600/vitamin d ........... 105, 156 sm calcium antacid ..................... 113, 117 sm calcium antacid ex st ............ 113, 117 sm calcium citrate+/vit d3 ........... 105, 156 sm calcium citrate+d3 petite ....... 105, 156 sm calcium citrate-vit d ............... 105, 156 sm calcium/vitamin d .................. 105, 156 sm calcium-vitamin d .................. 105, 156 sm chest congestion relief .................. 131 sm chewable c .................................... 154 sm chewable vitamin c ....................... 154 sm childrens aspirin ............ 80, 82, 93, 99 sm childrens ibuprofen ................... 93, 96 sm childrens loratadine ................ 71, 135 SM CLEARLAX .................................. 122 sm clotrimazole vaginal ...................... 139 sm cold & cough dm childrens 69, 75, 129 sm complete ............................... 105, 149 sm complete 50+ ........................ 105, 149 sm complete 50+ ultimate mens . 105, 149 sm complete 50+ ultimate women ..... 105,

149 sm complete advanced formula.. 105, 149 sm complete senior formula ....... 105, 149 sm double antibiotic ............................ 136

INDEX

179

sm ear drops ...................................... 108 sm enema .......................................... 122 sm eye itch relief .......................... 68, 106 sm fiber .............................................. 122 sm fiber laxative ................................. 122 sm fiber powder.................................. 122 sm fish oil ........................................... 125 sm foaming antacid ............................ 113 sm folic acid ....................................... 152 sm gas relief ....................................... 116 sm gas relief antiflatuent .................... 115 sm gas relief infants ........................... 116 sm gas relief infants drops ................. 115 sm gentle laxative .............................. 122 sm glucose ......................... 100, 124, 154 sm glycerin pediatric .......................... 122 sm hair/skin/nails........................ 105, 149 sm hemorrhoidal cooling ...... 75, 137, 140 sm hydrocortisone .............................. 141 sm hydrocortisone max st .................. 141 sm hydrocortisone plus .............. 139, 141 sm hydrocortisone-aloe max st .. 139, 141 sm hydrogen peroxide ........................ 143 sm ibuprofen .................................. 93, 96 sm ibuprofen ib............................... 93, 96 sm infants ibuprofen ....................... 93, 96 sm iron ................................................. 78 sm iron slow release ............................ 78 sm isopropyl alcohol ........................... 143 sm laxative ......................................... 122 sm laxative maximum strength ........... 122 sm lice killing ...................................... 144 sm lice killing max strength ................ 144 sm lice solution kit .............................. 144 sm lice treatment ................................ 144 sm loratadine................................ 71, 135 sm loratadine allergy relief ........... 71, 135 sm lorata-dine d ............................. 71, 73 sm loratadine d 12hr ...................... 71, 73 sm lubricant eye drops ....................... 109 sm lubricating plus ............................. 109 sm lubricating tears ............................ 109 sm magnesium ................................... 105 sm magnesium citrate ........................ 122 sm magnesium oxide ......................... 105 sm medicated corn removers ............. 142 sm miconazole 3 ................................ 139 sm miconazole 7 ................................ 139 sm migraine relief ..................... 86, 97, 99 sm milk of magnesia .......................... 122 sm mineral oil ..................................... 122 sm motion sickness ...................... 68, 116 sm mucus relief .................................. 131 sm mucus relief d ......................... 73, 131 sm mucus relief max strength ............ 131

sm multiple vitamins essential ........... 149 sm multiple vitamins/iron ............. 78, 149 sm multi-purpose ............................... 107 sm naproxen sodium ............. 93, 96, 125 sm nasal decongestant ................ 73, 127 sm nasal decongestant max st .... 73, 127 sm nasal decongestant pe ................... 75 sm nasal spray ................................... 110 sm nasal spray 12 hour ..................... 110 sm nasal spray moisturizing .............. 110 sm nasal spray saline ................ 109, 133 sm nasal spray sinus ......................... 110 sm natural laxative/stool soft ............. 122 sm niacin cr ........................................ 152 sm nicotine ........................................... 77 sm nicotine polacrilex .......................... 77 sm nighttime sleep aid 66, 68, 76, 87, 95,

129, 133 sm nose drops nasal decongest ........ 110 sm oatmeal bath ................................ 141 sm one daily essential ............... 105, 149 sm one daily mens ..................... 105, 149 sm one daily womens ................ 105, 149 sm opti-vitamins ......................... 105, 149 sm oyster shell calcium/vit d ...... 105, 157 sm oyster shell calcium/vit d3 .... 105, 157 sm pain & fever childrens .............. 86, 93 sm pain & fever infants .................. 86, 93 sm pain relief extra strength .......... 86, 93 sm pain reliever ............................. 86, 93 sm pain reliever ex st ..................... 86, 93 sm pain reliever pm ex st ......... 66, 86, 95 sm pediatric electrolyte ...................... 105 sm petroleum jelly .............................. 141 sm povidone-iodine ............................ 143 sm prenatal vitamins ............ 78, 149, 152 sm saline solution .............................. 107 sm senna laxative .............................. 122 sm senna-s ........................................ 122 sm slow release iron ............................ 78 sm smooth antacid ex st ............ 113, 117 sm stomach relief ............... 113, 114, 117 sm stool softener ............................... 122 sm stool softener/laxative .................. 122 sm super b complex/c ........ 149, 152, 154 sm triple antibiotic .............................. 136 sm triple antibiotic max st .......... 136, 137 sm triple antibiotic original ................. 136 sm tussin cough/chest congest .. 129, 131 sm tussin dm .............................. 129, 131 sm tussin mucus+chest congest ........ 131 sm ultra dairy digestive ...................... 123 sm vit c/rose hips ............................... 154 sm vitamin b1 ..................................... 152 sm vitamin b-12 ........................... 78, 152

sm vitamin b12 tr .......................... 78, 152 sm vitamin b6 ..................................... 152 sm vitamin b-6 .................................... 152 sm vitamin c ....................................... 154 sm vitamin c/rose hips ........................ 154 sm vitamin d ....................................... 157 sm vitamin d3 ..................................... 157 sm zinc gluconate ............................... 105 SMART SENSE GLUCOSE100, 124, 154 SMOOTH LAX .................................... 122 sodium bicarbonate .................... 113, 117 sodium chloride .................... 45, 105, 133 sodium chloride (hypertonic) .............. 109 sodium chloride (pf) .............................. 45 sodium fluoride ..................................... 45 sodium phenylbutyrate ......................... 48 sodium polystyrene sulfonate ............... 46 SOFOSBUVIR-VELPATASVIR ............ 28 solifenacin succinate ............................ 48 SOLIQUA ............................................. 34 SOLTAMOX ......................................... 21 SOLUBLE FIBER THERAPY ............. 122 SOMATULINE DEPOT ......................... 54 SOMAVERT ......................................... 54 SOOTHE ............................ 113, 114, 117 SOOTHE HYDRATION ...................... 109 SOOTHE XP XTRA PROTECTION ... 109 sorbitol ................................................ 122 SORBUGEN NR ......................... 129, 131 SORINE ................................................ 37 sotalol hcl ............................................. 37 sotalol hcl (af) ....................................... 37 SPIRIVA HANDIHALER ....................... 62 SPIRIVA RESPIMAT ............................ 62 spironolactone ...................................... 39 spironolactone-hctz .............................. 38 SPRINTEC 28 ...................................... 52 SPRITAM ............................................. 15 SPRYCEL ............................................. 24 SPS ...................................................... 46 SRONYX .............................................. 52 SSD ...................................................... 44 ST JOSEPH LOW DOSE ... 80, 82, 93, 99 stavudine .............................................. 29 STELARA ............................................. 55 stimulant laxative ................................ 122 STIOLTO RESPIMAT ........................... 63 STIVARGA ........................................... 24 stomach relief ..................... 113, 114, 117 stool softener ...................................... 122 stool softener laxative ......................... 122 stool softener plus laxative ................. 122 stool softener/laxative ......................... 122 stop lice complete treatment............... 144 streptomycin sulfate ............................. 11

INDEX

180

stress b/zinc ....... 106, 149, 152, 154, 157 stress formula..................................... 149 stress formula (folic acid) ................... 149 stress formula (w/ minerals) ............... 149 stress formula/iron ........................ 78, 149 stress formula/iron (mvi) ............. 106, 149 STRIBILD ............................................. 29 STRIVERDI RESPIMAT ....................... 62 SUCRAID ............................................. 48 sucralfate ............................................. 47 SUDAFED CHILDRENS .............. 73, 127 SUDOGEST ................................. 74, 127 sudogest 12 hour ......................... 73, 127 SUDOGEST MAXIMUM STRENGTH . 73,

127 SUDOGEST PE ................................... 75 SUDOGEST SINUS/ALLERGY ..... 69, 74 sulfacetamide sodium .......................... 60 sulfacetamide sodium (acne) ............... 14 sulfacetamide-prednisolone ................. 60 sulfadiazine .......................................... 14 sulfamethoxazole-trimethoprim ............ 14 sulfasalazine ........................................ 59 sulindac .................................................. 9 sumatriptan .......................................... 20 sumatriptan succinate .......................... 20 sumatriptan succinate refill ................... 20 sunitinib malate .................................... 24 super antioxidant ........................ 106, 149 super b complex/fa/vit c ..... 149, 152, 154 super b-complex/vit c/fa ..... 149, 152, 154 super calcium ..................................... 106 super calcium 600 + d 400 ......... 106, 157 super calcium 600 + d3 .............. 106, 157 super multiple ............................. 106, 149 SUPER OMEGA-3 ............................. 125 super thera vite m ...................... 106, 149 suphedrine 12hour ....................... 74, 127 sv vitamin b-12 er ......................... 78, 152 SYMDEKO ........................................... 63 SYMLINPEN 120 ................................. 32 SYMLINPEN 60 ................................... 32 SYMPAZAN ......................................... 16 SYMTUZA ............................................ 29 SYNAREL ............................................ 54 SYNDROS ........................................... 19 SYNJARDY .......................................... 32 SYNJARDY XR .................................... 32 SYNOVACIN ...................................... 125 SYNRIBO ............................................. 22 SYNTHROID ........................................ 53 SYSTANE CONTACTS ...................... 109 TAB-A-VITE ....................................... 149 TAB-A-VITE/BETA CAROTENE ........ 149 tab-a-vite/iron ............................... 78, 149

TABLOID ............................................. 21 TABRECTA .......................................... 24 tacrolimus ...................................... 44, 57 tactinal ........................................... 86, 93 tadalafil (pah) ....................................... 63 TAFINLAR ........................................... 24 TAGRISSO .......................................... 24 TALTZ .................................................. 55 TALZENNA .......................................... 24 tamoxifen citrate .................................. 21 tamsulosin hcl ...................................... 48 TARGRETIN ........................................ 24 TARINA FE 1/20 .................................. 52 TARINA FE 1/20 EQ ............................ 52 TARSUM PROFESSIONAL ............... 142 TASIGNA ............................................. 24 TAVNEOS ............................................ 35 tazarotene ............................................ 42 TAZICEF .............................................. 13 TAZORAC ............................................ 42 TAZVERIK ........................................... 24 TDVAX ................................................. 58 tears pure ........................................... 109 TEFLARO ............................................ 13 TEKTURNA HCT ................................. 39 telmisartan ........................................... 36 telmisartan-hctz ................................... 39 temazepam .......................................... 64 TEMIXYS ............................................. 29 TENIVAC ............................................. 58 tenofovir disoproxil fumarate ................ 28 TEPMETKO ......................................... 24 terazosin hcl ......................................... 36 terbinafine hcl .............................. 19, 136 terbutaline sulfate ................................ 62 terconazole .......................................... 19 TERIPARATIDE (RECOMBINANT) ..... 60 testosterone ......................................... 50 testosterone cypionate ......................... 50 testosterone enanthate ........................ 50 TETANUS-DIPHTHERIA TOXOIDS TD

........................................................ 58 tetrabenazine ....................................... 41 tetracycline hcl ..................................... 15 tgt glucose ......................... 100, 124, 154 THALOMID .......................................... 21 THE MAGIC BULLET ........................ 122 theophylline .......................................... 63 theophylline er ..................................... 63 THERA............................................... 149 THERAGRAN-M PREMIER 50 PLUS

.............................................. 106, 149 thera-m ...................................... 106, 149 therapeutic ......................................... 142 therapeutic m ............................. 106, 149

THERAPEUTIC T+PLUS ................... 142 therapeutic-m ............................. 106, 149 therapeutic-m/lutein .................... 106, 149 THERASEAL HAND PROTECTION .. 139 thera-tabs ........................................... 149 THERATRUM COMPLETE ........ 106, 149 THERATRUM COMPLETE 50 PLUS 106,

149 THEREMS .......................................... 149 thiamine hcl ........................................ 152 thiamine mononitrate .......................... 152 THICK NOW ....................................... 126 THICK-IT ............................................ 126 THICK-IT #2 ....................................... 126 THIOLA EC .......................................... 49 thioridazine hcl ..................................... 26 thiothixene ............................................ 26 thrivite rx ............................................... 46 tiagabine hcl ......................................... 16 TIBSOVO ............................................. 22 TICE BCG ............................................ 22 timolol maleate ............................... 37, 61 TINACTIN ........................................... 144 tinidazole .............................................. 12 tiopronin ................................................ 49 TIVICAY ............................................... 29 TIVICAY PD ......................................... 29 tizanidine hcl ......................................... 28 tobramycin ...................................... 60, 63 tobramycin sulfate ................................ 11 tobramycin-dexamethasone ................. 60 tolnaftate ............................................. 144 tolnaftate antifungal ............................ 144 tolterodine tartrate ................................ 48 tolterodine tartrate er ............................ 48 tolvaptan ............................................... 45 topiramate ............................................ 15 toremifene citrate .................................. 21 torsemide .............................................. 39 total allergy ... 66, 68, 76, 87, 95, 129, 133 TOUJEO MAX SOLOSTAR.................. 34 TOUJEO SOLOSTAR .......................... 34 TRADJENTA ........................................ 32 tramadol hcl .......................................... 10 tramadol-acetaminophen ...................... 10 trandolapril ............................................ 36 tranexamic acid .................................... 35 tranylcypromine sulfate ........................ 17 TRAVEL-EASE ............................. 68, 116 travoprost (bak free) ............................. 61 trazodone hcl ........................................ 18 TRECATOR .......................................... 21 TRELEGY ELLIPTA ............................. 63 TRELSTAR MIXJECT .......................... 54 TREMFYA ............................................ 55

INDEX

181

tretinoin .......................................... 24, 42 tretinoin (emollient) ............................... 42 TRI FEMYNOR .................................... 52 triamcinolone acetonide . 42, 44, 107, 134 triamcinolone in absorbase .................. 44 triamterene-hctz ................................... 39 tri-buffered aspirin ..... 80, 82, 93, 99, 113,

122 trientine hcl ........................................... 45 TRI-ESTARYLLA ................................. 52 trifluoperazine hcl ................................. 26 trifluridine ............................................. 28 trihexyphenidyl hcl ................................ 25 TRIKAFTA ............................................ 63 TRI-LEGEST FE .................................. 52 trimethobenzamide hcl ......................... 18 trimethoprim ......................................... 12 TRI-MILI ............................................... 52 trimipramine maleate ............................ 18 trinatal rx 1 ........................................... 46 TRINTELLIX ......................................... 18 triple antibiotic .................................... 136 triple antibiotic pain relief ............ 136, 137 triple antibiotic plus ..................... 136, 137 triple antibiotic+pain relief........... 136, 137 TRI-SPRINTEC .................................... 52 TRIUMEQ ............................................ 30 TRIUMEQ PD....................................... 30 TRIVORA (28) ...................................... 52 TRI-VYLIBRA ....................................... 52 trospium chloride .................................. 48 trospium chloride er .............................. 48 TRUEPLUS GLUCOSE ..... 100, 154, 157 TRUEPLUS GLUCOSE ON THE GO 100,

154, 157 TRULICITY........................................... 33 TRUMENBA ......................................... 58 TRUSELTIQ (100MG DAILY DOSE) ... 24 TRUSELTIQ (125MG DAILY DOSE) ... 24 TRUSELTIQ (50MG DAILY DOSE) ..... 24 TRUSELTIQ (75MG DAILY DOSE) ..... 24 TRUSTEX LUB/RIBBED/STUDDED .. 126 TRUSTEX LUB/SPERMICIDE EX ST 126 TRUSTEX LUB/SPERMICIDE XL ...... 126 TRUSTEX LUBRICATED ................... 126 TRUSTEX LUBRICATED EX LARGE 126 TRUSTEX LUBRICATED EXTRA ST 126 TRUSTEX LUBRICATED/SPERMICIDE

...................................................... 126 TRUSTEX NON-LUBRICATED.......... 126 TRUSTEX RIA LUB/SPERMICIDE .... 126 TRUSTEX RIA LUBRICATED ............ 126 TRUSTEX RIA NON-LUBRICATED ... 126 TRUSTEX-NONOXYNOL-9/RIB/STUD

...................................................... 126

TUKYSA .............................................. 22 TULANA............................................... 53 TUMS CHEWY DELIGHTS ....... 113, 117 TURALIO ............................................. 24 tusnel diabetic ............................ 129, 131 TUSNEL-EX ....................................... 131 tussin dm ................................... 129, 131 tussin dm cough + chest ............ 129, 131 tussin mucus & chest congest ........... 132 tussin mucus+chest congestion ......... 132 TWINRIX .............................................. 58 TYBOST .............................................. 30 TYLENOL 8 HOUR ARTHRITIS PAIN 86,

93 TYLENOL EXTRA STRENGTH ..... 86, 93 TYLENOL PM EXTRA STRENGTH ... 66,

86, 95 TYMLOS .............................................. 60 TYPHIM VI ........................................... 58 TYR COOLER ................................... 100 UBRELVY ............................................ 20 UDENYCA ........................................... 35 UKONIQ............................................... 24 ULTRA FRESH .................................. 109 ULTRA FRESH PM ........................... 109 ultra lubricating eye drops .................. 109 ULTRA OMEGA 3 .............................. 125 ultra thin corn removers ..................... 142 UNITHROID ......................................... 53 up & up glucose ................. 100, 124, 154 UPTRAVI ............................................. 63 ursodiol ................................................ 47 VAGISTAT-3 ...................................... 139 valacyclovir hcl ..................................... 28 VALCHLOR ......................................... 21 valganciclovir hcl .................................. 28 valproic acid ......................................... 15 valsartan .............................................. 36 valsartan-hydrochlorothiazide .............. 39 VALTOCO 10 MG DOSE ..................... 16 VALTOCO 15 MG DOSE ..................... 16 VALTOCO 20 MG DOSE ..................... 16 VALTOCO 5 MG DOSE ....................... 16 value plus glucose ............................. 124 vancomycin hcl .................................... 12 VAQTA................................................. 58 varenicline tartrate ............................... 11 VARIVAX ............................................. 59 VARIZIG .............................................. 59 VASCEPA ............................................ 40 VASELINE ......................................... 141 VAXCHORA ......................................... 59 VAXELIS .............................................. 59 VCF VAGINAL CONTRACEPTIVE .... 126 vegetable lax+stool softener .............. 122

VELIVET ............................................... 53 VEMLIDY .............................................. 28 VENCLEXTA ........................................ 24 VENCLEXTA STARTING PACK .......... 24 venlafaxine hcl ...................................... 18 venlafaxine hcl er ................................. 18 VENTAVIS ............................................ 63 VENTOLIN HFA ................................... 62 verapamil hcl ........................................ 37 verapamil hcl er .................................... 37 VERSACLOZ ........................................ 28 VERZENIO ........................................... 24 VICKS SINEX 12 HOUR DECONGEST

....................................................... 110 VICKS SINEX MOISTURIZING .......... 110 VICKS SINEX SEVERE DECONGEST

....................................................... 110 VICTOZA .............................................. 33 VIENVA ................................................ 53 vigabatrin .............................................. 16 VIIBRYD ............................................... 18 VIIBRYD STARTER PACK................... 18 VIMPAT ................................................ 16 VIRACEPT ........................................... 30 VIREAD ................................................ 28 virtussin a/c ................................ 129, 132 virtussin ac w/alc ........................ 129, 132 VISINE FOR CONTACTS .................. 107 vision formula eye health ............ 106, 149 vision formula/lutein .................... 106, 149 vision vitamins ............................ 106, 149 vit e-vit c-beta carotene ...................... 150 vitachew multiple vitamin .... 106, 150, 154 vitalee ................................................. 150 VITALETS CHILDRENS ..... 106, 150, 154 vitamin a ............................................. 150 vitamin b + c complex ......... 150, 152, 154 vitamin b 12 .................................. 78, 152 vitamin b-1 .......................................... 152 vitamin b12 ................................... 78, 152 vitamin b-12 .......................................... 78 vitamin b-12 ........................................ 152 vitamin b-12 er .............................. 78, 152 vitamin b12 tr ................................ 78, 152 vitamin b-2 .......................................... 152 vitamin b6 ........................................... 152 vitamin b-6 .......................................... 152 vitamin c ..................................... 150, 154 vitamin c immune health ..................... 154 vitamin c plus wild rose hips ............... 154 vitamin c/rose hips .............................. 154 vitamin c/rose hips tr .......................... 154 vitamin c-rose hips ............................. 154 vitamin c-rose hips er ......................... 154 vitamin d ............................................. 157

INDEX

182

vitamin d (cholecalciferol) ................... 157 vitamin d high potency ....................... 157 vitamin d infant ................................... 157 VITAMIN D-1000 MAX ST ................. 157 vitamin d2 ........................................... 157 vitamin d3 ........................................... 157 vitamin d-3 ......................................... 157 vitamin d3 maximum strength ............ 157 vitamin d-400...................................... 157 vitamin e ............................................. 157 vitamin e blend ................................... 157 vitamins a-d-e/selenium ............. 106, 150 VITRAKVI ............................................. 24 VITRUM SENIOR ....................... 106, 150 VIZIMPRO ............................................ 24 VOCABRIA........................................... 29 VOLNEA .............................................. 53 VONJO ................................................. 24 voriconazole ......................................... 19 VOSEVI ................................................ 28 VOTRIENT ........................................... 24 VRAYLAR ............................................ 27 VYFEMLA ............................................ 53 VYLIBRA .............................................. 53 WAL-DRAM II............................... 68, 116 WAL-DRYL ALLERGY ....................... 133 WAL-FOUR ........................................ 110 walgreens glucose ............. 100, 124, 154 WAL-ITIN ..................................... 72, 135 WAL-ITIN CHILDRENS ................ 71, 135 WAL-ITIN D .................................... 72, 74 WAL-ITIN D 24 HOUR ................... 71, 74 WAL-MUCIL ....................................... 122 WAL-PHED .................................. 74, 127 WAL-PHED 12 HOUR .................. 74, 127 WAL-PHED D............................... 74, 127 WAL-PHED PE .................................... 75 WAL-PROFEN ............................... 93, 96 wal-sporin ........................................... 136 WAL-TUSSIN CHEST CONGESTION

...................................................... 132 WAL-TUSSIN COUGH/CHEST DM .. 129,

132 WAL-TUSSIN DM CGH/CHEST CONG

.............................................. 129, 132

WAL-ZYR ..................................... 72, 135 WAL-ZYR ALL DAY ALLERGY CHILD72,

135 WAL-ZYR CHILDRENS ............... 72, 135 WAL-ZYR D ................................... 72, 74 warfarin sodium ................................... 34 wart remover ...................................... 142 wart remover maximum strength ....... 142 WEEKLY-D ........................................ 157 WELIREG ............................................ 22 west-vite w/folic acid .......... 150, 152, 154 white petrolatum ................................ 139 white petroleum jelly .......................... 141 wixela inhub ......................................... 63 womans laxative ................................ 122 womens daily form/fa/ca/fe ........ 106, 150 womens daily formula ................ 106, 150 womens laxative ................................ 122 womens multivitamin ................. 106, 150 womens one daily ...................... 106, 150 XALKORI ............................................. 24 XARELTO ............................................ 34 XARELTO STARTER PACK................ 34 XATMEP .............................................. 57 XCOPRI ............................................... 15 XCOPRI (250 MG DAILY DOSE) ........ 15 XCOPRI (350 MG DAILY DOSE) ........ 15 XELJANZ ............................................. 55 XELJANZ XR ................................. 56, 57 XERMELO ........................................... 47 XGEVA ................................................ 60 XIFAXAN ............................................. 47 XOLAIR................................................ 56 XOSPATA ............................................ 24 XPOVIO (100 MG ONCE WEEKLY) .... 22 XPOVIO (40 MG ONCE WEEKLY) ...... 22 XPOVIO (40 MG TWICE WEEKLY) .... 22 XPOVIO (60 MG ONCE WEEKLY) ...... 22 XPOVIO (60 MG TWICE WEEKLY) .... 22 XPOVIO (80 MG ONCE WEEKLY) ...... 22 XPOVIO (80 MG TWICE WEEKLY) .... 22 X-SEB T PLUS .................................. 142 XTANDI................................................ 21 XULANE .............................................. 53 XURIDEN ............................................. 48

XYREM ................................................. 64 XYWAV ................................................ 64 YELETS TEENAGE FORMULA . 106, 150 YF-VAX ................................................ 59 YONSA ................................................. 21 YUVAFEM ............................................ 50 ZADITOR ...................................... 68, 106 ZAFEMY ............................................... 53 zafirlukast ............................................. 62 zaleplon ................................................ 64 ZARXIO ................................................ 35 ZEASORB-AF .................................... 139 ZEJULA ................................................ 24 ZELBORAF .......................................... 24 ZEMAIRA ............................................. 48 ZENATANE .......................................... 42 ZENPEP ............................................... 48 ZEPOSIA .............................................. 42 ZEPOSIA 7-DAY STARTER PACK ...... 42 ZEPOSIA STARTER KIT...................... 42 zidovudine ............................................ 30 ZIEXTENZO ......................................... 35 zinc ..................................................... 106 zinc chelated ...................................... 106 zinc gluconate .................................... 106 zinc oxide ........................................... 137 zinc sulfate ......................................... 106 ziprasidone hcl ..................................... 27 ziprasidone mesylate ............................ 27 ZOLINZA .............................................. 22 zolpidem tartrate ................................... 64 zolpidem tartrate er .............................. 64 zonisamide ........................................... 16 zoo friends .......................... 106, 150, 154 zoo friends plus iron ..................... 78, 150 ZOSTAVAX .......................................... 59 ZOSTRIX HP ...................................... 144 ZOVIA 1/35 (28) ................................... 53 ZOVIA 1/35E (28) ................................. 53 ZTLIDO ................................................. 10 ZYDELIG .............................................. 24 ZYKADIA .............................................. 24 ZYPREXA RELPREVV ........................ 28

INDEX

183

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