Medicaid List of Covered Drugs (Formulary)

Medicaid List of Covered Drugs (Formulary)

UnitedHealthcare Community Plan of Minnesota

Effective Date: 6/1/2022

12700 Whitewater Drive

Minnetonka, MN 55343-9438

Member Services: 888-269-5410, TTY 771

8:00 am - 6:00 pm CST, Monday - Friday

https://www.myuhc.com/CommunityPlan

Families and Children - This is also known as

the Prepaid Medical Assistance Program

(PMAP)

Minnesotacare

The information included in this list of

covered drugs was correct as of 6/1/2022. To get the most current information, go to

https://www.myuhc.com /CommunityPlan. If

you have questions, contact Member

Services at the number listed on this page.

You can ask for a printed copy of this

Medicaid List of Covered Drugs at any

time.

United Healthcare Community Plan

@ 2021 UnitedHealthcare Services, Inc_ All Rights Reserved_


http://www.myuhc.com/


Effective date: 6/1/2022

12700 Whitewater Drive Minnetonka, MN 55343-9438

Member Services: 888-269-5410, TTY 711, 8:00 am - 6:00 pm CST, Monday through Friday


The information included in this list of covered drugs was correct as of 6/2022. To get the most current information, go to https://www.myuhc.com/CommunityPlan. If you have questions, contact Member Services at the number listed on this page. You can ask for a printed copy of this Medicaid List of Covered Drugs at any time.

This list of drugs applies to Medical Assistance and MinnesotaCare members in Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties. DHS Approved TBD.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Members must use UnitedHealthcare Community Plan network pharmacies to receive prescription drug benefits.

This list is subject to change and is not all-inclusive. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. Note to existing members: This list of covered drugs has changed since last year and may change throughout the year. Please review this document to make sure the drugs you take are still on the list. Please contact Member Services at the number listed on this page with questions. You can also find updates to this list at https://www.myuhc.com/CommunityPlan.

If you have Medicare, you need to get most of your prescription drugs through the Medicare Prescription Drug Program (Medicare Part D). You must be enrolled in a Medicare prescription drug plan to get Medicare prescription drug benefits.

http://www.myuhc.com/CommunityPlan



CB5 (MCOs) (5-2020)

Civil Rights Notice

Discrimination is against the law. UnitedHealthcare Community Plan of Minnesota does not discriminate on the basis of any of the following:

• Race

• Color

• National origin

• Creed

• Religion

• Sexual orientation

• Public assistance status

• Age

• Disability (including physical or mental impairment)

• Sex (including sex stereotypes and gender identity)

• Marital status

• Political beliefs

• Medical condition

• Health status

• Receipt of health care services

• Claims experience

• Medical history

• Genetic information

Auxiliary Aids and Services: UnitedHealthcare Community Plan of Minnesota 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 1-888-269-5410.

Language Assistance Services: UnitedHealthcare Community Plan of Minnesota

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 1-888-269-5410.

Civil Rights Complaints

You have the right to file a discrimination complaint if you believe you were treated in a discriminatory

way by UnitedHealthcare Community Plan of Minnesota. You may contact any of the following four 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 (in some cases)

CSMN21MC5015412_000

Contact the OCR directly to file a complaint:

U.S. Department of Health and Human Services Office of Civil Rights 200 Independence Avenue SW, Room 515F, HHH Building Washington, DC 20201

Customer Response Center: Toll-free: 800-368-1019 TDD: 800-537-7697 Email: [email protected]

Minnesota Department of Human Rights (MDHR)

In Minnesota, you have the right to file a complaint with the MDHR if you believe you have been discriminated against because of any of the following:

• Race

• Color

• National origin

• Religion

• Creed

• Sex


• Marital 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

Voice: 651-539-1100 Toll free: 800-657-3704 MN Relay: 711 or 800-627-3529 Fax: 651-296-9042

Email: [email protected]

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

• Creed

• Religion



• Age

• Disability (including physical or mental impairment)


• Marital status



• Health status



• Medical history


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. After we get your complaint, we will review it and notify you in writing about whether we have authority to investigate. If we do, we will investigate the complaint.

mailto:[email protected]


DHS will notify you in writing of the investigation’s outcome. You have the right to appeal the outcome 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 Voice: 651-431-3040 or use your preferred relay service

UnitedHealthcare Community Plan of Minnesota Complaint Notice

You have the right to file a complaint with UnitedHealthcare Community Plan of Minnesota if you believe

you have been discriminated against because of any of the following:


• Health status



• Medical history


• Disability (including mental or physical impairment)

• Marital status

• Age



• National origin

• Race

• Color

• Religion

• Creed



You can file a complaint and ask for help in filing a complaint in person or by mail, phone, fax, or email at:

Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UTAH 84130 Toll Free: 1-888-269-5410, TTY 711 Email: [email protected]

DHS_Approved_08/05/2021

American Indian Health Statement

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.


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i

IMPORTANT INFORMATION

What is a list of covered drugs? A list of covered drugs includes the prescription drugs covered by UnitedHealthcare Community

Plan of Minnesota. The drugs on the list are selected by UnitedHealthcare Community Plan of

Minnesota with the help of a team of doctors and pharmacists. UnitedHealthcare Community

Plan of Minnesota will generally cover the drugs listed in the list of covered drugs as long as the

drug is medically necessary, the prescription is filled at a UnitedHealthcare Community Plan of

Minnesota network pharmacy, and other requirements related to the drug are followed.

Most drugs and certain supplies are available up to a 34-day supply. Certain drugs you take on

a regular basis for a chronic or long-term condition are available up to a 90-day supply and are

listed on the https://mn.gov/dhs/assets/90-day-supply-list_tcm1053-490928.pdf website.

Does the list of covered drugs ever change? The UnitedHealthcare Community Plan of Minnesota list of covered drugs can change during

the course of a calendar year. If changes affect the coverage of a drug you are taking,

UnitedHealthcare Community Plan of Minnesota will make reasonable efforts to contact you

and your prescriber to tell you about the change. UnitedHealthcare Community Plan of

Minnesota will also tell you about alternative drugs that are covered.

Examples of some changes that may occur are:

• A drug you are taking is no longer preferred (go to “What is a Preferred Drug List?” below).

• A drug is removed from the list of covered drugs for safety reasons. • Prior authorization requirements have changed (go to “Are there any restrictions on my

coverage?”).

How are drugs listed in the list of covered drugs? There are two ways to find your prescription drugs in the formulary. You can search by medical condition associated with your drug or by alphabetical listing.

• Search by Medical Condition: Drugs listed by medical condition begin on page 1. The drugs in this formulary are grouped into categories depending on the type of medical conditions they are used to treat. If you know what your drug is used for, look for the category in the list that begins on page 1. Then look under the category name for your drug.

• Search by Alphabetical Listing: If you are not sure what category to look under, you can look for your drug in the Index. The Index gives an alphabetical list of all of the drugs included in the formulary. Both brand name and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information within the formulary.

What is a Preferred Drug List?

https://mn.gov/dhs/assets/90-day-supply-list_tcm1053-490928.pdf

ii

In Minnesota, all health plans are required to use the Minnesota Department of Human Services’ (DHS) Preferred Drug List (PDL). The PDL is created by DHS, in consultation with the Drug Formulary Committee, to let prescribers and members know about drugs or drug classes that are cost effective. Generally, drugs that are “preferred” are more cost effective and drugs that are “non-preferred” are less cost effective. Preferred drugs are available to members with fewer restrictions. Non-preferred drugs require a prior authorization. To get a non-preferred drug, your doctor or health care provider must get prior authorization. The PDL is included as part of UnitedHealthcare Community Plan of Minnesota’s list of covered drugs. UnitedHealthcare Community Plan of Minnesota’s complete list of covered drugs includes other drugs in addition to those on the PDL. The PDL is available on DHS’s website at http://minnesota.magellanmedicaid.com/pdl.asp.

What are generic or biosimilar drugs? A generic drug is approved by the Food and Drug Administration (FDA) and has the same active ingredients as the brand name drug. It produces the same clinical effect as the brand name drug.

A biosimilar drug is an FDA-approved biologic drug (most often an injectable prescription drug) that is highly similar to an already-approved biological product. It has no clinically meaningful differences in terms of safety and effectiveness. Biosimilar drugs are not the same as generic drugs, but like generics, biosimilar drugs may offer more affordable treatment options.

Generic or biosimilar substitution means a generic version or biosimilar version of a drug is given instead of the brand name or non-biosimilar version of the drug.

UnitedHealthcare Community Plan of Minnesota will cover the brand name or non-biosimilar version of the drug only when:

1. Your prescriber informs UnitedHealthcare Community Plan of Minnesota in writing that the brand name or non-biosimilar version of the drug is medically necessary; OR

2. UnitedHealthcare Community Plan of Minnesota may prefer the dispensing of certain brand name versions over the generic or non-biosimilar version over the biosimilar version of the drug; OR

3. Minnesota law requires the dispensing of the brand name or non-biosimilar version of the drug.

Within the list of covered drugs, brand name drugs are listed in capital letters and generic drugs are listed in lower case letters.

What are over-the-counter drugs? Drugs and products that are available for purchase without a prescription are referred to as over-the-counter (OTC). Although an OTC product is available without a prescription, if a doctor writes a prescription for an OTC product, UnitedHealthcare Community Plan of Minnesota may cover it. Within the list of covered drugs, OTC drugs and products are identified by the abbreviation of OTC next to the drug or product.

http://minnesota.magellanmedicaid.com/pdl.asp

http://minnesota.magellanmedicaid.com/pdl.asp

iii

What are specialty drugs? Specialty drugs are used by people with complex or chronic diseases. These drugs often require special handling, dispensing, or monitoring by a specially trained pharmacist.

If you are prescribed a drug that is on the UnitedHealthcare Specialty Drug List, your prescriber will need to send the prescription of that specialty drug to UnitedHealthcare’s Specialty Pharmacy.

Name of Specialty Pharmacy: Optum Specialty Pharmacy

Phone and TTY: 1-855-427-4682, TTY 711

Fax: 1-877-342-4596

Hours of Operation: Available 24 hours a day, seven days a week

Website: specialty.optumrx.com

You will also need to call the specialty pharmacy to set up an account. You will need to have your UnitedHealthcare member identification card when you call the specialty pharmacy.

What if a drug is not on the list of covered drugs? Not all drugs are covered. If a drug you want to take is not listed in the list of covered drugs, you can call Member Services at 888-269-5410, TTY 711 and ask if the drug is covered. If not, it is considered a “non-formulary” drug. If you need a drug that is not included in the list of covered drugs, you have two options:

• You can work with your doctor and ask them to prescribe a similar drug that is covered by UnitedHealthcare Community Plan of Minnesota.

• You can ask your doctor to request an exception for your drug.

Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include the following:

• Prior authorization: UnitedHealthcare Community Plan of Minnesota requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from UnitedHealthcare Community Plan of Minnesota before you fill your prescription. If you don’t get approval, UnitedHealthcare Community Plan of Minnesota may not cover the drug.

• Quantity Limits: For certain drugs, UnitedHealthcare Community Plan of Minnesota limits the amount of the drug that we will cover.

• Age requirements: Some drugs have age requirements. A prior authorization may be needed depending on your age and the specific drug prescribed.

iv

You can find out if your drug requires prior authorization, has quantity limits, or has an age requirement by looking in this list of covered drugs. An exception to a drug restriction or limit can be made if your doctor submits a statement or documentation supporting the request. Go to Prescription Drugs in Section 7: Covered Services of your Member Handbook for more information. You can also get more information about the restrictions applied to specific covered drugs by calling Member Services at 888-269- 5410, TTY 711 or by visiting our website at https://www.myuhc.com/CommunityPlan. Also go to “Can I ask for an exception to the coverage restrictions?”

• Excluded drugs: Some drugs are excluded from the list of covered drugs. This means they are not covered. Excluded drugs include the following:

o Drugs used to treat sexual or erectile dysfunction o Drugs used to enhance fertility o Drugs used for cosmetic purposes, including drugs to treat hair loss o Drugs excluded from coverage by federal or state law o Experimental drugs, investigational drugs, or drugs not approved by the FDA

o Medical cannabis

Can I ask for an exception to the coverage restrictions? Yes. You or your health care provider can get the pharmacy prior authorization forms from https://www.uhcprovider.com/communityplan or by calling Member Services at 888-269-5410, TTY 711. Your provider must return this form to the fax number or address listed on the document. To allow for a thorough review and to ensure that you or your health care provider gets a response within 24 hours, all information requested in the form should be provided, including documentation of which medications have been tried and failed, including the dosages used and the reason for failure (e.g., side effects).

What will a prescription cost? All copay information for prescriptions is listed in the Member Handbook in Section 6: Cost-

Sharing. If you have additional questions, call Member Services at 888-269-5410, TTY 711 or

visit our website at https://www.myuhc.com/CommunityPlan.

Am I able to get a 90-day supply of my drugs at my pharmacy? 90-day fills are covered for certain “maintenance” drugs which are drugs you take on a regular basis for a chronic or long-term medical condition.

Please go to https://mn.gov/dhs/assets/90-day-supply-list_tcm1053-490928.pdf for a list of medications that are eligible for a 90-day supply.


https://www.uhcprovider.com/communityplan


https://mn.gov/dhs/assets/90-day-supply-list_tcm1053-490928.pdf

v

Explanation of Requirements

P Preferred Drug Drugs covered without a prior authorization.

NP Non-Preferred Drug Drugs requiring prior authorization.

CD Covered Drug Additional drugs covered by UnitedHealthcare.

AL Age Limit Drugs that limit use to certain age or age ranges.

PA Prior Authorization

Required

Drugs that require pre-approval before prescription can

be filled.

QL Quantity Limit Drugs with limits to the quantity that may be filled.

SP Specialty Medication Specialty drugs are used to treat complex conditions and

require Specialty Pharmacy to fill your prescription.

OTC Over-the-Counter Drugs that have over-the-counter status (these drugs

can be provided if prescribed by your doctor or

pharmacist).

1


Table of Contents

ANALGESICS - DRUGS TO TREAT PAIN, INFLAMMATION, AND MUSCLE AND JOINT

CONDITIONS .............................................................................................................................................. 5

ANALGESICS ............................................................................................................................................. 5

ANESTHETICS - DRUGS FOR NUMBING ............................................................................................. 10

ANESTHETICS.......................................................................................................................................... 10

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS - DRUGS FOR OVERDOSE OR DETERRENCE .......................................................................................................................................... 10

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS ....................................................... 11

ANTIANDROGENS - HORMONE SUPPRESSANTS ............................................................................. 11

ANTIBACTERIALS - DRUGS TO TREAT BACTERIAL INFECTIONS ................................................. 11

ANTIBACTERIALS ................................................................................................................................... 11

ANTICONVULSANTS - DRUGS TO TREAT SEIZURES ....................................................................... 15

ANTICONVULSANTS ............................................................................................................................... 15

ANTIDEMENTIA AGENTS ....................................................................................................................... 18

ANTIDEPRESSANTS ............................................................................................................................... 18

ANTIEMETICS - DRUGS TO TREAT NAUSEA AND VOMITING ......................................................... 20

ANTIEMETICS........................................................................................................................................... 20

ANTIFUNGALS - DRUGS TO TREAT FUNGAL INFECTIONS ............................................................. 21

ANTIFUNGALS (Oral) .............................................................................................................................. 23

ANTIGOUT AGENTS ................................................................................................................................ 23

ANTI-HIV AGENTS, OTHER - HIV DRUGS ............................................................................................ 24

ANTIMIGRAINE AGENTS - DRUGS TO TREAT MIGRAINES .............................................................. 24

ANTIMIGRAINE AGENTS ........................................................................................................................ 24

ANTIMYASTHENIC AGENTS .................................................................................................................. 25

ANTIMYCOBACTERIALS ........................................................................................................................ 25

ANTINEOPLASTICS - DRUGS TO TREAT CANCER ............................................................................ 25

ANTINEOPLASTICS, OTHER - CHEMOTHERAPY AGENTS .............................................................. 26

ANTINEOPLASTICS ................................................................................................................................. 26

ANTIPARASITICS - DRUGS TO TREAT PARASITIC INFECTIONS .................................................... 29

ANTIPARASITICS..................................................................................................................................... 29

ANTIPARKINSON AGENTS .................................................................................................................... 29

ANTIPSYCHOTICS ................................................................................................................................... 31

ANTISPASMODICS, URINARY - BLADDER CONTROL DRUGS ........................................................ 33

2

ANTISPASTICITY AGENTS ..................................................................................................................... 33

ANTIVIRALS ............................................................................................................................................. 33

ANXIOLYTICS ........................................................................................................................................... 36

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES - ADHD DRUGS ...................................................................................................................................................... 37

BIPOLAR AGENTS................................................................................................................................... 37

BLOOD FORMATION MODIFIERS - BLOOD FORMATION DRUGS ................................................... 37

BLOOD GLUCOSE REGULATORS - DRUGS TO REGULATE BLOOD SUGAR ............................... 38

BLOOD GLUCOSE REGULATORS ........................................................................................................ 38

BLOOD PRODUCTS AND MODIFIERS - DRUGS TO TREAT BLOOD DISORDERS ........................ 41

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS - DRUGS TO TREAT BLOOD

DISORDERS .............................................................................................................................................. 44

CARDIOVASCULAR AGENTS - DRUGS TO TREAT HEART AND CIRCULATION CONDITIONS .. 45

CARDIOVASCULAR AGENTS, OTHER - MISCELLANEOUS CARDIAC DRUGS ............................. 45

CARDIOVASCULAR AGENTS ................................................................................................................ 45

CENTRAL NERVOUS SYSTEM AGENTS .............................................................................................. 53

CYSTIC FIBROSIS AGENTS - DRUGS TO TREAT CYSTIC FIBROSIS .............................................. 56

DENTAL AND ORAL AGENTS ................................................................................................................ 56

DERMATOLOGICAL AGENTS - DRUGS TO TREAT SKIN CONDITIONS.......................................... 56

DERMATOLOGICAL AGENTS ................................................................................................................ 58

DIABETES - GLUCOSE MONITORING .................................................................................................. 63

ELECTROLYTES/MINERALS/METALS/VITAMINS ............................................................................... 66

ENZYME INHIBITORS - CHEMOTHERAPY AGENTS........................................................................... 71

ESTROGENS - HORMONE REPLACEMENT/MODIFYING DRUGS .................................................... 71

GASTROINTESTINAL AGENTS - DRUGS TO TREAT BOWEL, INTESTINE AND STOMACH

CONDITIONS ............................................................................................................................................ 71

GASTROINTESTINAL AGENTS.............................................................................................................. 74

GENETIC OR ENZYME OR PROTEIN DISORDER: REPLACEMENT, MODIFIERS, TREATMENT.. 77

GENITOURINARY AGENTS - DRUGS TO TREAT BLADDER, GENITAL AND KIDNEY

CONDITIONS ............................................................................................................................................ 78

GENITOURINARY AGENTS .................................................................................................................... 78

GLYCEMIC AGENTS - DIABETIC DRUGS ............................................................................................ 80

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL) ............................. 80

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY) - DRUGS TO REGULATE HORMONES ........................................................................................................................ 81

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY) ............................ 81

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PROSTAGLANDINS)............. 81

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS) - DRUGS TO REGULATE HORMONES .................................................................................................. 82

3

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS) .................................................................................................................................................................... 82

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID) ............................... 89

HORMONAL AGENTS, SUPPRESSANT (ADRENAL) .......................................................................... 90

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)......................................................................... 90

HORMONAL AGENTS, SUPPRESSANT (THYROID) - DRUGS TO SUPPRESS THYROID HORMONES .............................................................................................................................................. 91

HORMONAL AGENTS, SUPPRESSANT (THYROID) ........................................................................... 91

IMMUNE SUPPRESSANTS - IMMUNE SYSTEM DRUGS .................................................................... 91

IMMUNOLOGICAL AGENTS - DRUGS THAT STIMULATE OR SUPPRESS THE IMMUNE SYSTEM .................................................................................................................................................................... 91

IMMUNOLOGICAL AGENTS ................................................................................................................... 92

INFLAMMATORY BOWEL DISEASE AGENTS ..................................................................................... 95

METABOLIC BONE DISEASE AGENTS ................................................................................................ 96

MISCELLANEOUS THERAPEUTIC AGENTS ........................................................................................ 96

MOLECULAR TARGET INHIBITORS - CHEMOTHERAPY AGENTS .................................................. 98

MONOCLONAL ANTIBODIES - CHEMOTHERAPY AGENTS .............................................................. 99

MULTIPLE SCLEROSIS AGENTS - MULTIPLE SCLEROSIS DRUGS ................................................ 99

OPHTHALMIC AGENTS - DRUGS TO TREAT EYE CONDITIONS.................................................... 100

OPHTHALMIC AGENTS......................................................................................................................... 101

OTIC AGENTS - DRUGS TO TREAT EAR CONDITIONS ................................................................... 105

OTIC AGENTS ........................................................................................................................................ 105

RESPIRATORY TRACT/PULMONARY AGENTS - DRUGS TO TREAT ALLERGIES, COUGH, COLD AND LUNG CONDITIONS ...................................................................................................................... 105

RESPIRATORY TRACT/PULMONARY AGENTS ................................................................................ 110

SKELETAL MUSCLE RELAXANTS ...................................................................................................... 113

SLEEP DISORDER AGENTS - DRUGS FOR SEDATION AND SLEEP ............................................. 114

SLEEP DISORDER AGENTS ................................................................................................................ 114

WEIGHT LOSS AGENTS ....................................................................................................................... 115

5

Drug Name Drug Tier EDITS & RESTRICTIONS

ANALGESICS - DRUGS TO TREAT PAIN, INFLAMMATION, AND MUSCLE AND JOINT CONDITIONS

Analgesics - Miscellaneous Analgesics

acetaminophen oral liquid 160 mg/5ml, 650 mg/20.3ml CD OTC; QL

acetaminophen oral 325mg, 500mg, 650mg CD OTC; QL

acetaminophen oral tablet chewable 80mg, 160 mg CD OTC; QL

acetaminophen rectal suppositories 80mg, 120mg, 325mg CD OTC; QL

migraine formula oral tablet 250-250-65 mg CD OTC

Nonsteroidal Anti-Inflammatory Drugs - Pain/Anti-Inflammatory Drugs

aspirin ec oral tablet delayed release 325 mg CD OTC; QL

aspirin oral tablet 325 mg CD OTC; QL

aspirin oral tablet chewable 81 mg CD OTC; QL

aspirin oral tablet delayed release 325 mg, 81 mg CD OTC; QL

aspirin rectal suppository 300 mg CD OTC

salsalate oral CD QL

tri-buffered aspirin CD PA; OTC

ANALGESICS

Nonsteroidal Anti-inflammatory Drugs

ARTHROTEC (diclofenac-misoprostol) NP PA; QL

CAMBIA (diclofenac potassium(migraine)) CD PA; QL

CELEBREX (celecoxib) NP PA; QL

celecoxib oral P QL

DAYPRO (oxaprozin) CD PA; QL

DICLOFENAC PATCH 1.3% NP PA; QL

diclofenac potassium tab 25mg CD PA; QL

diclofenac potassium tab 50mg CD QL

diclofenac sodium er tab 100mg P QL

diclofenac sodium external gel 1 % P QL

diclofenac sodium external solution CD PA; QL

6


diclofenac sodium oral tab 25mg, 75mg P QL

diclofenac-misoprostol NP PA; QL

diflunisal oral CD PA; QL

DUEXIS (ibuprofen-famotidine) NP PA; QL

etodolac CD QL

etodolac er CD PA; QL

FELDENE (piroxicam) CD PA; QL

fenoprofen calcium oral capsule 400 mg NP PA

fenoprofen calcium oral tablet NP PA; QL

FLECTOR (diclofenac epolamine) P PA; QL

flurbiprofen oral tablet P QL

ibuprofen childrens oral tablet chewable 100 mg, 200mg CD OTC; QL

ibuprofen oral suspension 50mg/1.25ml, 100mg/5ml CD QL

ibuprofen oral 100mg, 200 mg CD OTC; QL

ibuprofen oral tablet 400 mg, 600 mg, 800 mg P QL

INDOCIN (indomethacin) suspension CD PA; QL

INDOCIN (indomethacin) suppositories CD PA; QL

indomethacin er capsule 75mg CD PA; QL

indomethacin oral capsule 25 mg, 50 mg P QL

ketoprofen er CD PA; QL

ketoprofen oral capsule 50 mg, 75 mg P QL

KETOROLAC TROMETHAMINE NASAL CD PA

ketorolac tromethamine oral P QL

LICART (diclofenac epolamine) CD PA; QL

meclofenamate sodium oral CD PA; QL

mefenamic acid oral NP PA; QL

meloxicam oral capsule CD PA; QL

meloxicam oral tablet P QL

MOBIC (meloxicam) NP PA; QL

7


nabumetone oral P QL

NALFON ORAL CAPSULE (fenoprofen calcium) CD PA

NALFON ORAL TABLET (fenoprofen calcium) CD PA; QL

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG, 750 MG (naproxen sodium)

CD PA

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 500 MG (naproxen sodium)

CD PA; QL

naproxen ec oral tablet P QL

naproxen sodium er oral tablet extended release 24 hour 375 mg, 750mg

CD PA

naproxen sodium er oral tablet extended release 24 hour 500 mg CD PA; QL

naproxen oral tablet P QL

naproxen-esomeprazole CD PA; QL

oxaprozin NP PA; QL

PENNSAID (diclofenac sodium) CD PA; QL

piroxicam oral CD QL

RELAFEN DS (nabumetone) CD PA; QL

SPRIX (ketorolac tromethamine) CD PA

sulindac oral P QL

VIMOVO (naproxen-esomeprazole) NP PA; QL

VIVLODEX (meloxicam) CD PA; QL

ZIPSOR (diclofenac potassium) NP PA; QL

ZORVOLEX (diclofenac) NP PA; QL

Opioid Analgesics, Long-acting

BELBUCA (buprenorphine hcl) P PA; QL

buprenorphine transdermal NP PA; QL

BUTRANS (buprenorphine) CD PA; QL

CONZIP (tramadol hcl) CD PA; QL

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 37.5 mcg/hr, 62.5 mcg/hr, 75 mcg/hr, 87.5 mcg/hr

NP PA; QL

8


fentanyl transdermal patch 72 hour 25 mcg/hr, 50 mcg/hr P QL

hydrocodone bitartrate er NP PA; QL

hydromorphone hcl er NP PA; QL

HYSINGLA ER (hydrocodone bitartrate) NP PA; QL

methadone hcl oral solution NP PA; QL

methadone oral concentrate 10 mg/ml NP PA; QL

methadone tablet for oral susp CD PA; QL

methadone oral tablet NP PA; QL

morphine sulfate er beads NP PA; QL

morphine sulfate er oral capsule extended release 24 hour NP PA; QL

morphine sulfate er oral tablet extended release 100 mg, 15 mg, 30 mg, 60 mg

P QL

morphine sulfate er oral tablet extended release 200 mg P PA; QL

MS CONTIN (morphine sulfate) NP PA; QL

NUCYNTA ER (tapentadol hcl) NP PA; QL

oxycodone hcl er NP PA; QL

OXYCONTIN (oxycodone hcl) NP PA; QL

oxymorphone hcl er NP PA; QL

TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR

CD PA; QL

tramadol hcl er oral tablet extended release 24 hour CD PA; QL

XTAMPZA ER (oxycodone) NP PA; QL

Opioid Analgesics, Short-acting

acetaminophen-codeine sol CD QL

acetaminophen-codeine tab CD QL

ACTIQ (fentanyl citrate) CD PA; QL

apap-caff-dihydrocodeine oral capsule CD QL

ascomp-codeine capsule CD QL

bac tablet CD QL

BENZHYDROCODONE-ACETAMINOPHEN CD PA; QL

butalbital-acetaminophen capsule CD PA; QL

butalbital-acetaminophen oral tablet 50-300 mg CD PA; QL

butalbital-acetaminophen oral tablet 50-325 mg CD QL

9


butalbital-apap-caff-cod CD QL

butalbital-apap-caffeine oral capsule 50-300-40 mg CD PA; QL

butalbital-apap-caffeine oral capsule 50-325-40 mg CD QL

butalbital-apap-caffeine oral tablet CD QL

butalbital-asa-caff-codeine CD QL

butalbital-aspirin-caffeine CD QL

butorphanol tartrate nasal CD QL

codeine sulfate CD QL

DILAUDID ORAL (hydromorphone hcl) CD PA; QL

endocet oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg CD QL

ESGIC (butalbital-apap-caffeine) CD PA; QL

fentanyl citrate buccal lozenge on a handle CD PA; QL

fentanyl citrate buccal tablet CD PA; QL

FENTORA (fentanyl citrate) CD PA; QL

FIORICET (butalbital-apap-caffeine) CD PA; QL

FIORICET/CODEINE (butalbital-apap-caff-cod) CD PA; QL

hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml CD QL

hydrocodone-acetaminophen oral tablet 5-325mg, 7.5-325mg, 10-325mg

CD QL

hydrocodone-acetaminophen oral tablet 5-300mg, 7.5-300mg, 10-300mg

CD PA; QL

hydrocodone-ibuprofen CD PA; QL

hydromorphone hcl oral tablet CD QL

levorphanol tartrate oral CD PA; QL

LORTAB (hydrocodone-acetaminophen) CD PA; QL

meperidine hcl oral CD PA; QL

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml, 10mg/5ml

CD QL

morphine sulfate oral tablet CD QL

morphine sulfate rectal suppositories CD QL

NUCYNTA (tapentadol hcl) CD PA; QL

OXAYDO (oxycodone hcl) 5mg CD QL

OXAYDO (oxycodone hcl) 7.5mg CD PA; QL

oxycodone-acetaminophen oral tablet 2.5-325 mg CD PA; QL

oxycodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5- 325 mg

CD QL

oxycodone hcl oral capsule CD PA; QL

oxycodone hcl oral concentrate 100 mg/5ml CD QL

oxycodone hcl oral solution CD QL

oxycodone hcl oral tablet CD QL

oxymorphone hcl CD QL

10


pentazocine-naloxone hcl CD QL

PERCOCET (oxycodone-acetaminophen) CD PA; QL

QDOLO (tramadol hcl) CD PA; QL

ROXICODONE ORAL TABLET 15 MG, 30 MG (oxycodone hcl) CD PA; QL

tramadol-acetaminophen CD PA; QL

tramadol hcl ir CD QL

ULTRACET (tramadol-acetaminophen) CD PA; QL

ULTRAM (tramadol hcl) CD PA; QL

VTOL LQ (butalbital-apap-caffeine) CD PA; QL

ZEBUTAL (butalbital-apap-caffeine) CD PA; QL

ANESTHETICS - DRUGS FOR NUMBING

Local Anesthetics

cough drops mouth/throat lozenge (menthol lozenge) CD PA; OTC

ANESTHETICS

Local Anesthetics

lidocaine external cream 3 %, CD QL

lidocaine external cream 4 % CD OTC; QL

lidocaine external ointment 5 % CD PA; QL

lidocaine external patch 4 % CD PA; OTC; QL

lidocaine external patch 5 % NP PA; QL

lidocaine hcl viscous solution 2% CD QL

lidocaine hcl mouth/throat CD

lidocaine hcl urethral/mucosal external gel CD QL

lidocaine-prilocaine cream 2.5-2.5% CD QL

LIDODERM (lidocaine) NP PA; QL

PLIAGLIS EXTERNAL CREAM (lidocaine-tetracaine) CD PA; QL

SYNERA (lidocaine-tetracaine) CD PA; QL

ZTLIDO (lidocaine) NP PA; QL

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS - DRUGS FOR OVERDOSE OR DETERRENCE

Smoking Cessation Agents

bupropion hcl er (smoking det) P

nicotine gum 2 mg, 4 mg P OTC; QL

nicotine lozenge 2 mg, 4 mg P OTC; QL

nicotine transdermal patch P OTC; QL

NICOTROL (nicotine) inhaler NP PA; QL

NICOTROL NS (nicotine) NP PA; QL

varenicline tablet CD

apo-varenicline tablet CD

11


ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

Alcohol Deterrents/Anti-craving

acamprosate calcium CD QL

disulfiram oral tablet 250 mg CD QL

naltrexone hcl oral CD

Opioid Dependence

BUNAVAIL (buprenorphine hcl-naloxone hcl) NP PA; QL

buprenorphine sublingual tablet NP PA; QL

buprenorphine hcl-naloxone hcl sublingual film NP PA; QL

buprenorphine hcl-naloxone hcl sublingual tablet P QL

LUCEMYRA (lofexidine hcl) CD PA; QL

SUBLOCADE (buprenorphine) NP PA; QL

SUBOXONE (buprenorphine hcl-naloxone hcl) P QL

ZUBSOLV (buprenorphine hcl-naloxone hcl) NP PA; QL

Opioid Reversal Agents

KLOXXADO (naloxone hcl) nasal spray NP PA; QL

naloxone hcl injection (vial, syringe) P QL

NARCAN (naloxone hcl) nasal spray P QL

ANTIANDROGENS - HORMONE SUPPRESSANTS

Antineoplastics - Drugs to Treat Cancer

ORGOVYX (relugolix) CD SP; QL

ANTIBACTERIALS - DRUGS TO TREAT BACTERIAL INFECTIONS

Antibacterials, Other - Antibiotics

alcohol prep pads external 70 % CD OTC; QL

antibiotic external ointment 500 unit/gm CD OTC; QL

bacitracin zinc external CD OTC; QL

first aid antibiotic external ointment 3.5-400-5000 mg-unit CD OTC; QL

methenamine mandelate oral CD PA

povidone-iodine external solution CD OTC

triple antibiotic CD OTC; QL

Tetracyclines - Antibiotics

MORGIDOX COMBINATION (doxycycline hyclate-cleanser) CD PA

ANTIBACTERIALS

Aminoglycosides

ARIKAYCE (amikacin sulfate liposome) CD PA; SP; QL

neomycin sulfate oral CD QL

paromomycin sulfate oral CD QL

Antibacterials, Other

CLEOCIN (clindamycin hcl) CD QL

12


clindamycin hcl oral 75mg capsule CD PA; QL

clindamycin hcl oral 150mg, 300mg capsule CD QL

clindamycin palmitate hcl solution CD QL

clindamycin phosphate vaginal cream 2% CD QL

CLINDESSE (clindamycin phosphate (1 dose)) CD PA; QL

FIRVANQ (vancomycin hcl) CD PA; QL

FLAGYL (metronidazole) CD QL

fosfomycin tromethamine CD PA

HIPREX (methenamine hippurate) CD PA; QL

linezolid oral suspension reconstituted CD PA; QL

linezolid oral tablet CD PA

MACROBID (nitrofurantoin monohyd macro) CD PA; QL

MACRODANTIN (nitrofurantoin macrocrystal) CD PA; QL

methenamine hippurate CD QL

METROCREAM (metronidazole) CD PA; QL

METROGEL (metronidazole) CD PA; QL

metronidazole external CD QL

metronidazole oral capsule CD PA; QL

metronidazole oral tablet CD QL

metronidazole vaginal gel CD QL

MONUROL (fosfomycin tromethamine) CD PA

nitrofurantoin suspension CD QL; AL

nitrofurantoin macrocrystal CD QL

NORITATE (metronidazole) CD PA

NUVESSA (metronidazole) CD PA; QL

SIVEXTRO ORAL (tedizolid phosphate) CD PA; QL

SOLOSEC (secnidazole) CD PA; QL

tinidazole oral tablet 250 mg CD

tinidazole oral tablet 500 mg CD QL

trimethoprim oral CD QL

VANCOCIN (vancomycin hcl) CD PA; QL

vancomycin hcl oral capsule/solution CD PA; QL

vandazole CD QL

XENLETA ORAL (lefamulin acetate) CD PA; QL

XIFAXAN (rifaximin) CD PA; QL

ZYVOX ORAL SUSPENSION RECONSTITUTED (linezolid) CD PA; QL

ZYVOX ORAL TABLET (linezolid) CD PA

Beta-lactam, Cephalosporins

cefaclor oral tablet er NP PA; QL

13


cefaclor oral capsule P QL

cefaclor oral suspension reconstituted 250 mg/5ml P QL

cefadroxil oral capsule P QL

cefadroxil oral suspension reconstituted P QL

cefadroxil oral tablet NP PA; QL

cefdinir oral capsule P QL

cefdinir oral suspension reconstituted P QL

cefixime oral capsule NP PA; QL

cefixime oral suspension reconstituted NP PA; QL; AL

cefpodoxime proxetil NP PA; QL

cefprozil P QL

cefuroxime axetil P QL

cephalexin oral capsule P QL

cephalexin oral suspension reconstituted P QL

cephalexin oral tablet 250 mg NP PA

cephalexin oral tablet 500 mg NP PA; QL

KEFLEX (cephalexin) NP PA; QL

SUPRAX ORAL CAPSULE (cefixime) P QL

SUPRAX ORAL SUSPENSION RECONSTITUTED 100 MG/5ML, 200 MG/5ML, 500MG/5ML (cefixime)

NP PA; QL

SUPRAX ORAL TABLET CHEWABLE (cefixime) NP PA

Beta-lactam, Penicillins

amoxicillin CD QL

amoxicillin-potassium clavulanate er NP PA; QL

amoxicillin-potassium clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml

P

QL

amoxicillin-potassium clavulanate oral tablet 250-125 mg, 500- 125 mg, 875-125 mg

P QL

amoxicillin-potassium clavulanate oral tablet chewable 200-28.5 mg, 400-57 mg

NP PA; QL

ampicillin CD QL

dicloxacillin sodium CD QL

penicillin v potassium CD QL

Macrolides

azithromycin oral suspension reconstituted P QL

azithromycin oral tablet P QL

azithromycin packet 1 gm oral P QL

clarithromycin er NP PA; QL

clarithromycin oral suspension reconstituted NP PA; QL

clarithromycin oral tablet P QL

14


DIFICID (fidaxomicin) CD PA; QL

E.E.S. GRANULES (erythromycin ethylsuccinate) NP PA; QL

ERYPED (erythromycin ethylsuccinate) suspension NP PA; QL

ERY-TAB (erythromycin base) NP PA; QL

ERYTHROCIN STEARATE (erythromycin stearate) NP QL

erythromycin base oral capsule delayed release particles P QL

erythromycin base oral tablet NP PA; QL

erythromycin ethylsuccinate oral NP PA; QL

erythromycin oral NP PA; QL

ZITHROMAX ORAL (azithromycin) NP PA; QL

ZITHROMAX TRI-PAK (azithromycin) NP PA; QL

ZITHROMAX Z-PAK (azithromycin) NP PA; QL

Quinolones

BAXDELA ORAL (delafloxacin meglumine) NP PA; QL

CIPRO (ciprofloxacin hcl) (tablet/suspension) NP PA; QL

ciprofloxacin hcl oral tablet P QL

ciprofloxacin hcl oral suspension NP QL

levofloxacin oral tablet and solution P QL

moxifloxacin hcl oral NP PA; QL

ofloxacin oral NP PA; QL

Sulfonamides

BACTRIM (sulfamethoxazole-trimethoprim) CD PA; QL

BACTRIM DS (sulfamethoxazole-trimethoprim) CD PA; QL

sulfadiazine oral CD QL

sulfamethoxazole-trimethoprim oral (tablet/suspension) CD QL

sulfatrim pediatric suspension CD QL

Tetracyclines

demeclocycline hcl CD PA; QL

DORYX MPC (doxycycline hyclate) CD PA

DORYX ORAL TABLET DELAYED RELEASE 200 MG, 50 MG(doxycycline hyclate)

CD PA; QL

doxycycline hyclate oral capsule 50mg, 100mg, CD QL

doxycycline hyclate oral tablet 100 mg CD QL

doxycycline hyclate oral tablet 20 mg, 50mg, 75mg, 150mg CD PA

doxycycline hyclate oral tablet delayed release 100 mg, 200 mg, 50 mg, 75mg, 80mg, 120mg, 150mg

CD PA; QL

doxycycline monohydrate oral capsule 100 mg, 50 mg CD QL

doxycycline monohydrate oral capsule 150 mg, 75 mg CD PA

doxycycline monohydrate oral suspension reconstituted CD PA

15


doxycycline monohydrate oral tablet 150mg, 100 mg, 50 mg, 75 mg

CD PA; QL

minocycline hcl er oral tablet extended release 24 hour CD PA

minocycline hcl oral capsule 100 mg, 50 mg CD QL

minocycline hcl oral capsule 75 mg CD PA

minocycline hcl oral tablet 50 mg, 75 mg, 100mg CD PA; QL

MINOLIRA (minocycline hcl) CD PA; QL

morgidox oral CD QL

NUZYRA ORAL (omadacycline tosylate) CD PA; QL

ORACEA (doxycycline) CD PA

SOLODYN (minocycline hcl) CD PA

tetracycline hcl oral CD QL; AL

VIBRAMYCIN ORAL CAPSULE (doxycycline hyclate) CD PA; QL

VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED (doxycycline monohydrate)

CD PA

VIBRAMYCIN ORAL SYRUP (doxycycline calcium) CD PA

XIMINO (minocycline hcl) CD PA; QL

ANTICONVULSANTS - DRUGS TO TREAT SEIZURES

Anticonvulsants, Other

DIACOMIT (stiripentol) NP PA; SP; QL

ANTICONVULSANTS

Anticonvulsants, Other

BRIVIACT ORAL (brivaracetam) NP PA; QL

ELEPSIA XR (levetiracetam) CD PA; QL

EPIDIOLEX (cannabidiol) NP PA; SP; QL

felbamate oral suspension P QL; AL

felbamate oral tablet P QL

FELBATOL ORAL SUSPENSION (felbamate) P QL; AL

FELBATOL ORAL TABLET (felbamate) NP PA; QL

FINTEPLA (fenfluramine hcl) NP PA; QL

FYCOMPA (perampanel) NP PA; QL

KEPPRA ORAL SOLUTION (levetiracetam) NP PA; QL; AL

KEPPRA ORAL TABLET (levetiracetam) NP PA; QL

KEPPRA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 500 MG (levetiracetam)

NP PA; QL

KEPPRA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG (levetiracetam)

NP PA

LAMICTAL ODT (lamotrigine) NP PA; QL

LAMICTAL ORAL TABLET (lamotrigine) NP PA; QL

LAMICTAL ORAL TABLET CHEWABLE (lamotrigine) NP PA; QL; AL

16


LAMICTAL STARTER (lamotrigine) NP PA; QL

LAMICTAL XR (lamotrigine) NP PA; QL

lamotrigine er P PA; QL

lamotrigine orally disintegrating kit NP PA; QL

lamotrigine oral tablet P QL

lamotrigine oral tablet chewable dispersible P QL; AL

lamotrigine orally disintegrating tablet NP PA; QL

lamotrigine starter kit NP PA; QL

levetiracetam er oral tablet extended release 24 hour 500 mg P QL

levetiracetam er oral tablet extended release 24 hour 750 mg P

levetiracetam oral solution P QL; AL

levetiracetam oral tablet P QL

QUDEXY XR ORAL CAPSULE ER 24 HOUR SPRINKLE 100 MG, 25 MG (topiramate)

NP PA; QL

QUDEXY XR ORAL CAPSULE ER 24 HOUR SPRINKLE 150 MG, 200 MG, 50 MG (topiramate)

NP PA

roweepra P QL

SPRITAM (levetiracetam) NP PA

subvenite CD QL

subvenite starter kit CD PA; QL

TOPAMAX (topiramate) NP PA; QL

TOPAMAX SPRINKLE (topiramate) NP PA; QL; AL

topiramate er 24HR sprinkle cap NP PA; QL

topiramate sprinkle cap P QL; AL

topiramate oral tablet P QL

TROKENDI XR (topiramate) NP PA; QL

valproic acid oral P QL

XCOPRI (cenobamate) NP PA; QL

Calcium Channel Modifying Agents

CELONTIN (methsuximide) P QL

ethosuximide oral P QL

ZARONTIN ORAL CAPSULE (ethosuximide) NP PA; QL

ZARONTIN ORAL SOLUTION (ethosuximide) NP QL

Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam oral suspension NP PA; QL

clobazam oral tablet P QL

DIASTAT ACUDIAL (diazepam) P QL

DIASTAT PEDIATRIC (diazepam) P QL

diazepam rectal NP PA; QL

gabapentin oral capsule P QL

17


gabapentin oral solution 250 mg/5ml P QL

gabapentin oral tablet P QL

GABITRIL (tiagabine hcl) P QL; AL

MYSOLINE (primidone) NP PA; QL

NAYZILAM (midazolam (anticonvulsant)) NP PA; QL

NEURONTIN (gabapentin) NP PA; QL

ONFI (clobazam) NP PA; QL

phenobarbital oral CD QL

primidone oral P QL

SABRIL (vigabatrin) NP PA; SP; QL

SYMPAZAN (clobazam) NP PA; QL

tiagabine hcl NP PA; QL; AL

VALTOCO (diazepam) P QL

vigabatrin NP PA; SP; QL

vigadrone CD PA; SP; QL

Sodium Channel Agents

APTIOM (eslicarbazepine acetate) NP PA; QL

BANZEL (rufinamide) NP PA; QL

carbamazepine er oral capsule extended release 12 hour NP PA; QL

carbamazepine er oral tablet extended release 12 hour P QL

carbamazepine oral tablet P QL

CARBATROL (carbamazepine) capsule NP PA; QL

DILANTIN INFATABS (phenytoin) chewable tablet NP PA; QL

DILANTIN ORAL CAPSULE 100 MG (phenytoin sodium extended release)

P QL

DILANTIN ORAL CAPSULE 30 MG (phenytoin sodium extended release)

P

DILANTIN ORAL SUSPENSION (phenytoin) NP PA; QL

EPITOL (carbamazepine) CD QL

oxcarbazepine oral suspension P QL; AL

oxcarbazepine oral tablet P QL

OXTELLAR XR (oxcarbazepine) NP PA; QL

PHENYTEK (phenytoin sodium extended) P QL

phenytoin oral suspension P QL

phenytoin oral tablet chewable P QL

phenytoin sodium extended release capsule P QL

rufinamide oral suspension NP PA; QL

rufinamide oral tablet CD PA; QL

TEGRETOL (carbamazepine) NP PA; QL

TEGRETOL-XR (carbamazepine) NP PA; QL

18


TRILEPTAL ORAL SUSPENSION (oxcarbazepine) NP PA; QL; AL

TRILEPTAL ORAL TABLET (oxcarbazepine) NP PA; QL

VIMPAT ORAL (lacosamide) NP PA; QL; AL

zonisamide oral P QL

ANTIDEMENTIA AGENTS

Antidementia Agents, Other

ergoloid mesylates oral CD QL

NAMZARIC (memantine hcl-donepezil hcl) NP PA; QL; AL

Cholinesterase Inhibitors

ARICEPT (donepezil hcl) NP PA; QL; AL

donepezil hcl oral tablet 10 mg, 5 mg P QL; AL

donepezil hcl oral tablet 23 mg NP PA; QL; AL

donepezil hcl oral tablet dispersible P

EXELON (rivastigmine) NP PA; QL; AL

galantamine hydrobromide NP PA; QL; AL

galantamine hydrobromide er NP PA; AL

RAZADYNE ER (galantamine hydrobromide) NP PA; AL

rivastigmine NP PA; QL; AL

N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl er NP PA; QL; AL

memantine hcl oral solution 2 mg/ml NP PA; QL

memantine hcl oral tablet P QL; AL

NAMENDA TITRATION PAK (memantine hcl) NP PA; QL; AL

NAMENDA XR (memantine hcl) NP PA; QL; AL

ANTIDEPRESSANTS

Antidepressants, Other

APLENZIN (bupropion hbr) NP PA

bupropion hcl er (sr) P QL

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

P QL

BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

NP PA; QL

bupropion hcl oral P QL

chlordiazepoxide-amitriptyline CD PA

FORFIVO XL (bupropion hcl) NP PA; QL

mirtazapine oral tablet P QL

mirtazapine oral tablet dispersible P

olanzapine-fluoxetine hcl NP PA; QL

perphenazine-amitriptyline oral tablet 2-10 mg, 4-10 mg, 4-25 mg, 4-50 mg

CD

19


perphenazine-amitriptyline oral tablet 2-25 mg CD QL

REMERON (mirtazapine) NP PA; QL

REMERON SOLTAB (mirtazapine) NP PA

SYMBYAX (olanzapine-fluoxetine hcl) NP PA; QL

WELLBUTRIN SR (bupropion hcl) NP PA; QL

WELLBUTRIN XL (bupropion hcl) NP PA; QL

Monoamine Oxidase Inhibitors

EMSAM (selegiline) CD PA; QL

MARPLAN (isocarboxazid) CD PA; QL

NARDIL (phenelzine sulfate) CD PA; QL

phenelzine sulfate oral CD PA; QL

tranylcypromine sulfate CD QL

SSRI/SNRI (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors)

BRISDELLE (paroxetine mesylate) NP PA; QL

CELEXA (citalopram hydrobromide) NP PA; QL

citalopram hydrobromide P QL

desvenlafaxine er NP PA; QL

desvenlafaxine succinate er NP PA; QL

EFFEXOR XR (venlafaxine hcl) NP PA; QL

escitalopram oxalate P QL

FETZIMA (levomilnacipran hcl) NP PA; QL

FETZIMA TITRATION (levomilnacipran hcl) NP PA; QL

fluoxetine hcl (pmdd) NP PA

fluoxetine hcl oral capsule P QL

fluoxetine hcl oral capsule delayed release NP PA; QL

fluoxetine hcl oral solution P QL

fluoxetine hcl oral tablet NP PA; QL

fluvoxamine maleate P QL

fluvoxamine maleate er NP PA; QL

LEXAPRO (escitalopram oxalate) NP PA; QL

nefazodone hcl P QL

paroxetine hcl er NP PA; QL

paroxetine hcl oral tablet P QL

paroxetine mesylate NP PA; QL

PAXIL (paroxetine hcl) NP PA; QL

PAXIL CR (paroxetine hcl) NP PA; QL

PEXEVA (paroxetine mesylate) NP PA; QL

PRISTIQ (desvenlafaxine succinate) NP PA; QL

PROZAC (fluoxetine hcl) NP PA; QL

20


sertraline hcl oral P QL

trazodone hcl oral P QL

TRINTELLIX (vortioxetine hbr) NP PA; QL

venlafaxine hcl P QL

venlafaxine hcl er oral capsule extended release 24 hour P QL

venlafaxine hcl er oral tablet extended release 24 hour 150 mg, 225 mg, 75 mg

NP PA

venlafaxine hcl er oral tablet extended release 24 hour 37.5 mg NP PA; QL

VIIBRYD (vilazodone hcl) NP PA; QL

VIIBRYD STARTER PACK (vilazodone hcl) NP PA; QL

ZOLOFT (sertraline hcl) NP PA; QL

Tricyclics

amitriptyline hcl oral CD QL

amoxapine CD QL

ANAFRANIL (clomipramine hcl) CD PA; QL

clomipramine hcl oral CD PA; QL

desipramine hcl oral CD QL

doxepin hcl oral capsule CD QL

doxepin hcl oral concentrate CD QL

imipramine hcl oral CD QL

imipramine pamoate CD PA; QL

NORPRAMIN (desipramine hcl) CD PA; QL

nortriptyline hcl oral CD QL

PAMELOR (nortriptyline hcl) CD PA; QL

protriptyline hcl CD PA; QL

trimipramine maleate oral CD PA; QL

ANTIEMETICS - DRUGS TO TREAT NAUSEA AND VOMITING

Antiemetics, Other - Nausea and Vomiting Drugs

nausea relief oral solution 1.87-1.87-21.5 (fructose-dextrose- phosphoric acid)

CD OTC

ANTIEMETICS

Antiemetics, Other

ANTIVERT (meclizine hcl) CD PA

BONJESTA (doxylamine-pyridoxine) CD PA; QL

DICLEGIS (doxylamine-pyridoxine) CD PA; QL

doxylamine-pyridoxine CD PA; QL

GIMOTI (metoclopramide hcl) NP PA; QL

meclizine hcl oral tablet CD QL

meclizine hcl oral tablet chewable CD OTC

metoclopramide hcl oral solution CD QL

21


metoclopramide hcl oral tablet CD QL

metoclopramide hcl oral tablet dispersible NP PA; QL

motion sickness oral tablet 50 mg (dimenhydrinate) CD OTC

perphenazine oral CD QL

prochlorperazine suppositories CD QL

prochlorperazine maleate oral tablet CD QL

promethazine hcl oral syrup CD QL

promethazine hcl oral tablet CD QL

promethazine hcl rectal CD QL

REGLAN (metoclopramide hcl) CD PA; QL

scopolamine CD PA; QL

TRANSDERM-SCOP (1.5 MG) (scopolamine base) CD PA; QL

trimethobenzamide hcl oral capsule CD QL

Emetogenic Therapy Adjuncts

AKYNZEO ORAL (netupitant-palonosetron) NP PA; QL

aprepitant CD QL

dronabinol CD PA; QL

EMEND ORAL (aprepitant) CD PA; QL

EMEND TRI-PACK (aprepitant) CD PA; QL

granisetron hcl oral NP PA; QL

MARINOL (dronabinol) CD PA; QL

ondansetron hcl oral solution P QL

ondansetron hcl oral tablet 4 mg, 8 mg P QL

ondansetron odt P QL

SANCUSO (granisetron) NP PA; QL

VARUBI (rolapitant hcl) NP PA; QL

ZOFRAN (ondansetron hcl) NP PA; QL

ZUPLENZ (ondansetron) NP PA; QL

ANTIFUNGALS - DRUGS TO TREAT FUNGAL INFECTIONS

ANTIFUNGALS (Topical)

CICLODAN solution (ciclopirox) CD PA; QL

ciclopirox external gel NP PA

ciclopirox external shampoo NP PA

ciclopirox external solution P QL

ciclopirox external suspension P QL

ciclopirox olamine external cream P QL

ciclopirox treatment kit CD PA

clotrimazole-betamethasone external cream P QL

clotrimazole-betamethasone external lotion NP PA; QL

clotrimazole topical solution 1% P

22


clotrimazole external cream 1% P OTC/RX

clotrimazole 3 day vaginal cream 2 % CD OTC

clotrimazole vaginal cream 1% CD OTC; QL

econazole nitrate external cream P QL

ERTACZO (sertaconazole nitrate) CD PA

EXTINA (ketoconazole) external foam CD PA

FUNGOID TINCTURE (miconazole nitrate) CD PA; OTC

GYNAZOLE-1 (butoconazole nitrate (1 dose)) CD PA; QL

JUBLIA (efinaconazole) NP PA; QL

KERYDIN (tavaborole) NP PA; QL

ketoconazole external cream P QL

ketoconazole external foam NP PA

ketoconazole external shampoo P QL

KETODAN (ketoconazole) external foam CD PA

KETODAN EXTERNAL KIT (ketoconazole-cleanser) CD PA

LOPROX EXTERNAL CREAM (ciclopirox olamine) NP PA; QL

LOPROX EXTERNAL SHAMPOO (ciclopirox) NP PA

LOPROX EXTERNAL SUSPENSION (ciclopirox olamine) NP PA; QL

LULICONAZOLE CD PA; QL

LUZU (luliconazole) NP PA; QL

MENTAX (butenafine hcl) cream 1% CD PA

miconazole external cream 2% P OTC

miconazole topical powder P OTC

miconazole 1 kit CD PA; OTC; QL

miconazole vaginal cream 3 day, 7 day CD OTC

miconazole vaginal suppositories 3 day, 7 day CD OTC

naftifine hcl NP PA

NAFTIN (naftifine hcl) NP PA

oxiconazole nitrate NP PA; QL

OXISTAT EXTERNAL CREAM (oxiconazole nitrate) NP PA; QL

OXISTAT EXTERNAL LOTION (oxiconazole nitrate) CD PA

NYAMYC (nystatin powder) CD QL

nystatin external cream P QL

nystatin external ointment P QL

nystatin powder P QL

NYSTOP (nystatin powder) CD QL

nystatin-triamcinolone external cream P QL; AL

nystatin-triamcinolone external ointment NP PA; QL; AL

tavaborole NP PA; QL

terbinafine hydrochloride external cream 1 % P OTC; QL

23


terconazole 0.4%, 0.8% vaginal cream CD QL

terconazole suppositories CD PA; QL

tioconazole-1 day vaginal ointment CD PA; OTC; QL

tolnaftate external cream P OTC; QL

tolnaftate external powder CD OTC

VUSION (miconazole-zinc oxide-petrolat) NP PA; QL

ANTIFUNGALS (Oral)

ANCOBON (flucytosine) NP PA; QL

BREXAFEMME TABLET (ibrexafungerp citrate) CD PA; QL

CRESEMBA ORAL (isavuconazonium sulfate) NP PA; QL

DIFLUCAN (fluconazole) NP PA; QL

fluconazole oral P QL

flucytosine oral NP PA; QL

griseofulvin microsize oral NP PA; QL

griseofulvin ultramicrosize NP PA; QL

itraconazole oral NP PA; QL

ketoconazole oral NP PA; QL

NOXAFIL ORAL SUSPENSION (posaconazole) NP PA

NOXAFIL ORAL TABLET DELAYED RELEASE (posaconazole) NP PA; QL

nystatin mouth/throat suspension P QL

nystatin oral tablet NP PA; QL

ORAVIG (miconazole) NP PA; QL

posaconazole NP PA; QL

SPORANOX (itraconazole) NP PA; QL

SPORANOX PULSEPAK (itraconazole) NP PA; QL

terbinafine hcl oral P QL

TOLSURA NP PA; QL

VFEND (voriconazole) CD PA; QL

voriconazole oral suspension reconstituted CD PA; QL

voriconazole oral tablet CD PA; QL

ANTIGOUT AGENTS

allopurinol oral CD QL

COLCHICINE ORAL CAPSULE CD PA; QL

colchicine oral tablet CD PA; QL

colchicine-probenecid CD PA; QL

COLCRYS (colchicine) CD PA; QL

febuxostat CD PA; QL

GLOPERBA (colchicine) oral solution CD PA; QL

MITIGARE (colchicine) CD QL

probenecid CD QL

24


ULORIC (febuxostat) CD PA; QL

ANTI-HIV AGENTS, OTHER - HIV DRUGS

Antivirals - Drugs to Treat Viral Infections

VOCABRIA CD PA; QL

ANTIMIGRAINE AGENTS - DRUGS TO TREAT MIGRAINES

Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist - Migraine Drugs

NURTEC (rimegepant sulfate) NP PA; QL

UBRELVY (ubrogepant) P PA; QL

Serotonin (5-HT) Receptor Agonists - Migraine Drugs

almotriptan malate NP PA; QL

AMERGE (naratriptan hcl) NP PA; QL

eletriptan hydrobromide NP PA; QL

FROVA (frovatriptan succinate) NP PA; QL

frovatriptan succinate NP PA; QL

IMITREX NASAL (sumatriptan) P QL

IMITREX ORAL (sumatriptan succinate) NP PA; QL

IMITREX STATDOSE REFILL (sumatriptan succinate) P QL

IMITREX STATDOSE SYSTEM (sumatriptan succinate) P QL

MAXALT (rizatriptan benzoate) NP PA; QL

MAXALT-MLT (rizatriptan benzoate) NP PA; QL

naratriptan hcl NP PA; QL

ONZETRA XSAIL (sumatriptan succinate) NP PA; QL

RELPAX (eletriptan hydrobromide) P QL

rizatriptan benzoate P QL

sumatriptan nasal NP PA; QL

sumatriptan succinate oral P QL

sumatriptan succinate refill NP PA; QL

sumatriptan succinate subcutaneous NP PA; QL

sumatriptan-naproxen sodium NP PA; QL

TOSYMRA (sumatriptan) NP PA; QL

TREXIMET (sumatriptan-naproxen sodium) NP PA; QL

ZEMBRACE SYMTOUCH (sumatriptan succinate) NP PA; QL

ZOLMITRIPTAN NASAL CD PA; QL

zolmitriptan oral NP PA; QL

ZOMIG (zolmitriptan) NP PA; QL

ANTIMIGRAINE AGENTS

Acute

REYVOW (lasmiditan succinate) NP PA; QL

Ergot Alkaloids

CAFERGOT (ergotamine-caffeine) CD PA; QL

25


D.H.E. 45 (dihydroergotamine mesylate) CD PA; QL

dihydroergotamine mesylate injection CD QL

dihydroergotamine mesylate nasal CD PA; QL

ERGOMAR (ergotamine tartrate) CD PA

MIGERGOT (ergotamine-caffeine) CD QL

MIGRANAL (dihydroergotamine mesylate) CD PA; QL

TRUDHESA (dihydroergotamine mesylate) CD PA; QL

Prophylactic

AIMOVIG (erenumab-aooe) NP PA; QL

AJOVY (fremanezumab-vfrm) P PA; QL

EMGALITY (galcanezumab-gnlm) 120MG/ML P PA; QL

EMGALITY (galcanezumab-gnlm) 100MG/ML CD PA; QL

timolol maleate oral NP PA; QL

VYEPTI (eptinezumab-jjmr) NP PA; QL

ANTIMYASTHENIC AGENTS

Parasympathomimetics

MESTINON (pyridostigmine bromide) CD PA; QL

pyridostigmine bromide er CD QL

pyridostigmine bromide oral tablet 60mg CD QL

pyridostigmine bromide oral tablet 30mg CD PA; QL

ANTIMYCOBACTERIALS

Antimycobacterials, Other

dapsone oral CD QL

MYCOBUTIN (rifabutin) CD PA; QL

rifabutin CD QL

Antituberculars

cycloserine oral CD QL

ethambutol hcl oral tablet 100 mg CD

ethambutol hcl oral tablet 400 mg CD QL

isoniazid oral CD QL

MYAMBUTOL (ethambutol hcl) CD PA; QL

PASER (aminosalicylic acid) CD QL

PRETOMANID CD PA; QL

PRIFTIN (rifapentine) CD QL

pyrazinamide oral CD QL

rifampin oral CD QL

SIRTURO (bedaquiline fumarate) CD QL

TRECATOR (ethionamide) CD QL

ANTINEOPLASTICS - DRUGS TO TREAT CANCER

26


Alkylating Agents - Chemotherapy Agents

ALKERAN ORAL (melphalan) CD PA

melphalan CD

Antimetabolites - Chemotherapy Agents

capecitabine CD PA; SP

XELODA (capecitabine) CD PA; SP

Molecular Target Inhibitors - Chemotherapy Agents

TEPMETKO (tepotinib hcl) CD PA; SP; QL

ANTINEOPLASTICS, OTHER - CHEMOTHERAPY AGENTS


LUMAKRAS (sotorasib) CD PA; SP; QL

ZYKADIA (ceritinib) CD PA; SP; QL

ANTINEOPLASTICS

Alkylating Agents

cyclophosphamide oral capsule CD

CYCLOPHOSPHAMIDE ORAL TABLET CD

LEUKERAN (chlorambucil) CD

MATULANE (procarbazine hcl) CD SP

MYLERAN (busulfan) CD

TEMODAR ORAL CAPSULE 100 MG, 140 MG (temozolomide) CD PA; SP

TEMODAR ORAL CAPSULE 180 MG, 250 MG (temozolomide) CD PA; SP; QL

temozolomide oral capsule 100 mg, 140 mg CD PA; SP

temozolomide oral capsule 180 mg, 20 mg, 250 mg, 5 mg CD PA; SP; QL

VALCHLOR (mechlorethamine hcl (topical)) CD PA; SP; QL

Antiandrogens

abiraterone acetate oral tablet 250 mg CD PA; SP; QL

abiraterone acetate oral tablet 500 mg CD PA; SP; QL

bicalutamide CD QL

CASODEX (bicalutamide) CD PA; QL

ERLEADA (apalutamide) CD PA; SP; QL

flutamide CD QL

nilutamide CD PA; QL

NUBEQA (darolutamide) CD PA; SP; QL

XTANDI (enzalutamide) CD PA; SP; QL

YONSA (abiraterone acetate) CD PA; SP; QL

ZYTIGA (abiraterone acetate) CD PA; SP; QL

Antiangiogenic Agents

POMALYST (pomalidomide) CD PA; SP; QL

REVLIMID (lenalidomide) CD PA; SP; QL

27


THALOMID (thalidomide) CD PA; SP; QL

Antiestrogens/Modifiers

EMCYT (estramustine phosphate sodium) CD PA; QL

FARESTON (toremifene citrate) CD PA; QL

SOLTAMOX (tamoxifen citrate) CD PA; QL

tamoxifen citrate oral CD QL

toremifene citrate CD QL

Antimetabolites

HYDREA (hydroxyurea) CD PA; QL

hydroxyurea oral CD QL

mercaptopurine oral CD QL

ONUREG (azacitidine) CD PA; SP; QL

PURIXAN (mercaptopurine) suspension CD PA; QL

TABLOID (thioguanine) CD SP

Antineoplastics, Other

IDHIFA (enasidenib mesylate) CD PA; SP; QL

LONSURF (trifluridine-tipiracil) CD PA; SP; QL

NINLARO (ixazomib citrate) CD PA; SP; QL

PEMAZYRE (pemigatinib) CD PA; SP; QL

SYNRIBO (omacetaxine mepesuccinate) CD PA; SP

TAZVERIK (tazemetostat hbr) CD PA; SP; QL

XPOVIO (selinexor) CD PA; SP; QL

ZOLINZA (vorinostat) CD PA; SP; QL

Aromatase Inhibitors, 3rd Generation

anastrozole oral CD QL

ARIMIDEX (anastrozole) CD PA; QL

AROMASIN (exemestane) CD PA; QL

exemestane CD QL

FEMARA (letrozole) CD PA; QL

letrozole oral CD QL

Enzyme Inhibitors

etoposide oral CD

HYCAMTIN ORAL (topotecan hcl) CD PA; SP

Molecular Target Inhibitors

AFINITOR DISPERZ (everolimus) CD PA; SP; QL

AFINITOR ORAL TABLET 10 MG (everolimus) CD PA; SP; QL

AFINITOR ORAL TABLET 2.5 MG, 5 MG (everolimus) CD PA; SP; QL

AFINITOR ORAL TABLET 7.5 MG (everolimus) CD PA; SP

BALVERSA (erdafitinib) CD PA; SP; QL

28


BRAFTOVI (encorafenib) CD PA; SP; QL

COPIKTRA (duvelisib) CD PA; SP; QL

COTELLIC (cobimetinib fumarate) CD PA; SP; QL

DAURISMO (glasdegib maleate) CD PA; SP; QL

ERIVEDGE (vismodegib) CD PA; SP; QL

everolimus oral tablet 2.5 mg, 5 mg CD PA; SP; QL

everolimus oral tablet 7.5 mg CD PA; SP

IBRANCE (palbociclib) CD PA; SP; QL

INQOVI (decitabine-cedazuridine) CD PA; SP; QL

INREBIC (fedratinib hcl) CD PA; SP; QL

JAKAFI (ruxolitinib phosphate) CD PA; SP; QL

KISQALI (ribociclib succinate) CD PA; SP; QL

KISQALI FEMARA (ribociclib-letrozole) CD PA; SP; QL

KOSELUGO (selumetinib sulfate) CD PA; SP; QL

LYNPARZA (olaparib) CD PA; SP; QL

MEKINIST (trametinib dimethyl sulfoxide) CD PA; SP; QL

MEKTOVI (binimetinib) CD PA; SP; QL

NEXAVAR (sorafenib tosylate) CD PA; SP; QL

ODOMZO (sonidegib phosphate) CD PA; SP; QL

PIQRAY (alpelisib) CD PA; SP; QL

ROZLYTREK (entrectinib) CD PA; SP; QL

RUBRACA (rucaparib camsylate) CD PA; SP; QL

RYDAPT (midostaurin) CD PA; SP; QL

STIVARGA (regorafenib) CD PA; SP; QL

SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 50 MG (sunitinib malate)

CD PA; SP; QL

SUTENT ORAL CAPSULE 37.5 MG (sunitinib malate) CD PA; SP

TAFINLAR (dabrafenib mesylate) CD PA; SP; QL

TALZENNA (talazoparib tosylate) CD PA; SP; QL

TIBSOVO (ivosidenib) CD PA; SP; QL

VENCLEXTA (venetoclax) CD PA; SP; QL

VENCLEXTA STARTING PACK (venetoclax) CD PA; SP; QL

VERZENIO (abemaciclib) CD PA; SP; QL

VITRAKVI (larotrectinib sulfate) CD PA; SP; QL

ZEJULA (niraparib tosylate) CD PA; SP; QL

ZELBORAF (vemurafenib) CD PA; SP; QL

ZYDELIG (idelalisib) CD PA; SP; QL

Retinoids

bexarotene CD PA; SP

TARGRETIN EXTERNAL (bexarotene) gel CD PA; SP

29


TARGRETIN ORAL (bexarotene) CD PA; SP

tretinoin oral CD SP

Treatment Adjuncts

leucovorin calcium oral tablet 10 mg CD

leucovorin calcium oral tablet 15 mg, 25 mg, 5 mg CD QL

MESNEX ORAL (mesna) CD SP

ANTIPARASITICS - DRUGS TO TREAT PARASITIC INFECTIONS

Antiprotozoals - Protozoal Infection Drugs

LAMPIT (nifurtimox) CD PA; QL

ANTIPARASITICS

Anthelmintics

albendazole oral CD QL

ALBENZA (albendazole) CD PA; QL

BILTRICIDE (praziquantel) CD PA; QL

EMVERM (mebendazole) CD QL

ivermectin oral CD QL

praziquantel oral CD QL

STROMECTOL (ivermectin) CD PA; QL

Antiprotozoals

atovaquone CD PA; QL

atovaquone-proguanil hcl CD PA; QL

BENZNIDAZOLE CD QL

chloroquine phosphate oral CD QL

COARTEM (artemether-lumefantrine) CD PA

DARAPRIM (pyrimethamine) CD PA; SP; QL

hydroxychloroquine sulfate oral tablet 200 mg CD QL

hydroxychloroquine sulfate oral tablet 100mg, 300mg, 400mg CD PA

KRINTAFEL (tafenoquine succinate) CD QL

MALARONE (atovaquone-proguanil hcl) CD PA; QL

mefloquine hcl CD QL

MEPRON (atovaquone) CD PA; QL

NEBUPENT (pentamidine isethionate) CD PA

nitazoxanide oral CD QL

pentamidine isethionate inhalation CD

primaquine phosphate CD

pyrimethamine oral CD PA; SP; QL

QUALAQUIN (quinine sulfate) CD PA

quinine sulfate oral CD PA

ANTIPARKINSON AGENTS

30


Anticholinergics

benztropine mesylate oral CD QL

trihexyphenidyl hcl CD QL

Antiparkinson Agents, Other

amantadine hcl oral capsule CD QL

amantadine hcl oral syrup CD QL

amantadine hcl oral tablet CD PA

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 25- 100-200 mg, 37.5-150-200 mg

P QL

carbidopa-levodopa-entacapone oral tablet 18.75-75-200 mg, 31.25-125-200 mg, 50-200-200 mg

P

COMTAN (entacapone) CD PA; QL

entacapone P QL

GOCOVRI (amantadine hcl) CD PA; QL

NOURIANZ (istradefylline) CD PA; QL

ONGENTYS (opicapone) NP PA; QL

OSMOLEX ER (amantadine hcl) CD PA; QL

STALEVO (carbidopa-levodopa-entacapone) NP PA; QL

TASMAR (tolcapone) CD PA; QL

tolcapone NP PA; QL

Dopamine Agonists

APOKYN (apomorphine hcl) inj. CD PA; SP; QL

bromocriptine mesylate oral CD PA; QL

KYNMOBI (apomorphine hcl) NP SP; PA; QL

MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR 0.375 MG, 0.75 MG, 1.5 MG, 3 MG, 4.5 MG (pramipexole dihydrochloride)

NP

QL

MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR 2.25 MG, 3.75 MG (pramipexole dihydrochloride)

NP

NEUPRO (rotigotine) CD PA; QL

PARLODEL (bromocriptine mesylate) CD PA; QL

pramipexole dihydrochloride er oral tablet extended release 24 hour 0.375 mg, 0.75 mg, 1.5 mg, 3 mg, 4.5 mg

NP QL

pramipexole dihydrochloride er oral tablet extended release 24 hour 2.25 mg, 3.75 mg

NP

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 1.5 mg

P QL

pramipexole dihydrochloride oral tablet 0.75 mg P

ropinirole hcl P QL

ropinirole hcl er oral tablet extended release 24 hour 12 mg, 6 mg NP

ropinirole hcl er oral tablet extended release 24 hour 2 mg, 4 mg, 8 mg

NP QL

31


Dopamine Precursors and/or L-Amino Acid Decarboxylase Inhibitors

carbidopa oral CD PA; QL

carbidopa-levodopa er P QL

carbidopa-levodopa oral tablet P QL

carbidopa-levodopa oral tablet dispersible P

DUOPA (carbidopa-levodopa) CD PA

INBRIJA (levodopa) NP PA; SP; QL

LODOSYN (carbidopa) CD PA; QL

RYTARY ORAL CAPSULE EXTENDED RELEASE 23.75-95 MG, 36.25-145 MG, 61.25-245 MG (carbidopa-levodopa)

NP PA

RYTARY ORAL CAPSULE EXTENDED RELEASE 48.75-195 MG (carbidopa-levodopa)

NP PA; QL

SINEMET (carbidopa-levodopa) NP PA; QL

Monoamine Oxidase B (MAO-B) Inhibitors

AZILECT (rasagiline mesylate) CD PA

rasagiline mesylate oral CD PA

selegiline hcl oral CD QL

XADAGO (safinamide mesylate) NP PA; QL

ZELAPAR (selegiline hcl) CD PA

ANTIPSYCHOTICS

1st Generation/Typical

chlorpromazine hcl oral tablet CD QL

fluphenazine decanoate injection CD QL

fluphenazine hcl injection CD

fluphenazine hcl oral concentrate CD

fluphenazine hcl oral elixir CD

fluphenazine hcl oral tablet CD QL

HALDOL DECANOATE (haloperidol decanoate) CD PA; QL

haloperidol decanoate intramuscular CD QL

haloperidol lactate oral CD PA; QL

haloperidol oral CD QL

loxapine succinate CD QL

molindone hcl CD PA; QL; AL

pimozide CD QL; AL

thioridazine hcl oral CD QL

thiothixene CD QL

trifluoperazine hcl CD QL

2nd Generation/Atypical

ABILIFY (aripiprazole) NP PA; QL; AL

32


ABILIFY MAINTENA (aripiprazole) P QL; AL

ABILIFY MYCITE (aripiprazole) NP PA; QL; AL

ABILIFY MYCITE MAINTENANCE KIT (aripiprazole) NP PA; QL; AL

ABILIFY MYCITE STARTER KIT (aripiprazole) NP PA; QL; AL

aripiprazole oral solution P QL; AL

aripiprazole oral tablet P QL; AL

aripiprazole oral tablet dispersible NP PA; QL; AL

ARISTADA (aripiprazole lauroxil) NP PA; QL; AL

ARISTADA INITIO (aripiprazole lauroxil) NP PA; QL; AL

asenapine maleate NP PA; QL; AL

CAPLYTA (lumateperone tosylate) NP PA; QL

FANAPT (iloperidone) NP PA; QL; AL

FANAPT TITRATION PACK (iloperidone) NP PA; QL; AL

GEODON INTRAMUSCULAR (ziprasidone mesylate) NP PA

GEODON ORAL (ziprasidone hcl) NP PA; QL; AL

INVEGA (paliperidone) NP PA; QL; AL

INVEGA SUSTENNA (paliperidone palmitate) P QL; AL

INVEGA TRINZA (paliperidone palmitate) P QL; AL

LATUDA (lurasidone hcl) P QL; AL

NUPLAZID (pimavanserin tartrate) NP PA; QL

olanzapine intramuscular P

olanzapine oral tablet P QL; AL

olanzapine oral tablet dispersible NP PA; QL; AL

paliperidone er NP PA; QL; AL

PERSERIS (risperidone) NP PA; QL; AL

quetiapine fumarate P QL; AL

quetiapine fumarate er P QL; AL

REXULTI (brexpiprazole) NP PA; QL; AL

RISPERDAL (risperidone) NP PA; QL; AL

RISPERDAL CONSTA (risperidone microspheres) P QL; AL

risperidone P QL; AL

SAPHRIS (asenapine maleate) NP PA; QL; AL

SECUADO (asenapine) NP PA; QL; AL

SEROQUEL (quetiapine fumarate) NP PA; QL; AL

SEROQUEL XR (quetiapine fumarate) NP PA; QL; AL

VRAYLAR (cariprazine hcl) NP PA; QL; AL

ziprasidone hcl P QL; AL

ziprasidone mesylate NP PA

ZYPREXA INTRAMUSCULAR (olanzapine) NP PA

ZYPREXA ORAL (olanzapine) NP PA; QL; AL

33


ZYPREXA RELPREVV (olanzapine pamoate) NP PA; QL

ZYPREXA ZYDIS (olanzapine) NP PA; QL; AL

Treatment-Resistant

clozapine P QL; AL

CLOZARIL (clozapine) NP PA; QL; AL

VERSACLOZ (clozapine) NP PA; QL; AL

ANTISPASMODICS, URINARY - BLADDER CONTROL DRUGS

Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions

GEMTESA (vibegron) CD PA; QL

ANTISPASTICITY AGENTS

baclofen oral CD QL

DANTRIUM ORAL (dantrolene sodium) CD PA; QL

dantrolene sodium oral CD QL

tizanidine hcl oral capsule 2 mg CD PA; QL

tizanidine hcl oral capsule 4 mg, 6 mg CD PA

tizanidine hcl oral tablet CD QL

ZANAFLEX ORAL CAPSULE 2 MG (tizanidine hcl) CD PA; QL

ZANAFLEX ORAL CAPSULE 4 MG, 6 MG (tizanidine hcl) CD PA

ZANAFLEX ORAL TABLET (tizanidine hcl) CD PA; QL

ANTIVIRALS

Anti-cytomegalovirus (CMV) Agents

LIVTENCITY TABLET (maribavir) CD PA; QL

PREVYMIS ORAL (letermovir) CD PA; QL

VALCYTE (valganciclovir hcl) CD PA; QL

valganciclovir hcl tablet CD QL

valganciclovir hcl oral solution CD PA; QL

ZIRGAN (ganciclovir) CD PA; QL

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil NP PA; SP; QL

BARACLUDE ORAL SOLUTION (entecavir) P SP; QL

BARACLUDE ORAL TABLET (entecavir) NP PA; SP; QL

entecavir P SP; QL

EPIVIR HBV ORAL SOLUTION (lamivudine) P SP; QL

EPIVIR HBV ORAL TABLET (lamivudine) P SP; QL

HEPSERA (adefovir dipivoxil) P SP; QL

lamivudine oral tablet 100 mg P SP; QL

VEMLIDY (tenofovir alafenamide fumarate) NP PA; SP; QL

Anti-hepatitis C (HCV) Agents

EPCLUSA (sofosbuvir-velpatasvir) NP PA; SP; QL

34


HARVONI (ledipasvir-sofosbuvir) NP PA; SP; QL

LEDIPASVIR-SOFOSBUVIR NP PA; SP; QL

MAVYRET (glecaprevir-pibrentasvir) P PA; SP; QL

PEG-INTRON NP PA; SP; QL

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/0.5ML (peginterferon alfa-2a)

P SP; QL

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML (peginterferon alfa-2a)

P SP; QL

ribavirin oral P QL

SOFOSBUVIR-VELPATASVIR NP PA; SP; QL

SOVALDI (sofosbuvir) NP PA; SP; QL

VIEKIRA PAK (ombitas-paritapre-ritona-dasab) NP PA; SP; QL

VOSEVI (sofosbuv-velpatasv-voxilaprev) P PA; SP; QL

ZEPATIER (elbasvir-grazoprevir) NP PA; SP; QL

Antiherpetic Agents

acyclovir external cream NP PA; QL

acyclovir external ointment P QL

acyclovir oral P QL

DENAVIR (penciclovir) P

famciclovir oral NP PA; QL

SITAVIG (acyclovir) NP PA; QL

valacyclovir hcl oral P QL

VALTREX (valacyclovir hcl) NP PA; QL

ZOVIRAX (acyclovir) NP PA; QL

Anti-HIV Agents, Integrase Inhibitors (INSTI)

BIKTARVY (bictegravir-emtricitab-tenofov) CD PA; QL

DOVATO (dolutegravir-lamivudine) CD QL

GENVOYA (elviteg-cobic-emtricit-tenofaf) CD PA; QL

ISENTRESS HD (raltegravir potassium) CD QL

ISENTRESS ORAL PACKET (raltegravir potassium) CD QL; AL

ISENTRESS ORAL TABLET (raltegravir potassium) CD QL

ISENTRESS ORAL TABLET CHEWABLE (raltegravir potassium) CD QL

JULUCA (dolutegravir-rilpivirine) CD QL

STRIBILD (elviteg-cobic-emtricit-tenofdf) CD PA; QL

TIVICAY (dolutegravir sodium) CD QL

TIVICAY PD (dolutegravir sodium) CD QL; AL

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

ATRIPLA (efavirenz-emtricitab-tenofovir) CD PA; QL

COMPLERA (emtricitab-rilpivir-tenofovir) CD PA; QL

DELSTRIGO (doravirin-lamivudin-tenofov df) CD QL

35


EDURANT (rilpivirine hcl) CD QL

efavirenz CD QL

efavirenz-emtricitab-tenofovir CD PA; QL

efavirenz-lamivudine-tenofovir CD QL

etravirine CD QL

INTELENCE (etravirine) CD PA; QL

nevirapine CD QL

nevirapine er CD QL

PIFELTRO (doravirine) CD PA; QL

SUSTIVA (efavirenz) CD PA; QL

SYMFI (efavirenz-lamivudine-tenofovir) CD PA; QL

SYMFI LO (efavirenz-lamivudine-tenofovir) CD PA; QL

VIRAMUNE XR (nevirapine) CD PA; QL

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate CD QL

abacavir sulfate-lamivudine CD QL

abacavir-lamivudine-zidovudine CD QL

CIMDUO (lamivudine-tenofovir) CD PA; QL

COMBIVIR (lamivudine-zidovudine) CD PA; QL

DESCOVY (emtricitabine-tenofovir af) CD PA; QL

emtricitabine CD QL

emtricitabine-tenofovir df CD QL

EMTRIVA (emtricitabine) capsule CD PA; QL

EMTRIVA (emtricitabine) solution CD QL

EPIVIR (lamivudine) CD PA; QL

EPZICOM (abacavir sulfate-lamivudine) CD PA; QL

lamivudine oral solution CD QL

lamivudine oral tablet 150 mg, 300 mg CD QL

lamivudine-zidovudine CD QL

ODEFSEY (emtricitab-rilpivir-tenofov af) CD QL

RETROVIR ORAL (zidovudine) CD PA; QL

TEMIXYS (lamivudine-tenofovir) CD QL

tenofovir disoproxil fumarate CD QL

TRIUMEQ (abacavir-dolutegravir-lamivud) CD QL

TRIZIVIR (abacavir-lamivudine-zidovudine) CD PA; QL

TRUVADA (emtricitabine-tenofovir df) CD PA; QL

VIREAD (tenofovir disoproxil fumarate) CD QL

ZIAGEN (abacavir sulfate) CD PA; QL

zidovudine CD QL

Anti-HIV Agents, Other

36


FUZEON (enfuvirtide) CD QL

RUKOBIA (fostemsavir tromethamine) CD PA; QL

SELZENTRY (maraviroc) CD QL

TYBOST (cobicistat) CD QL

Anti-HIV Agents, Protease Inhibitors (PI)

APTIVUS (tipranavir) CD QL

atazanavir sulfate CD QL

EVOTAZ (atazanavir-cobicistat) CD QL

fosamprenavir calcium CD QL

INVIRASE (saquinavir mesylate) CD QL

KALETRA (lopinavir-ritonavir) CD PA; QL

LEXIVA (fosamprenavir calcium) CD QL

lopinavir-ritonavir CD QL

NORVIR (ritonavir) powder packet CD QL

NORVIR (ritonavir) oral solution CD QL

NORVIR (ritonavir) tablet CD PA; QL

PREZCOBIX (darunavir-cobicistat) CD QL

PREZISTA (darunavir ethanolate) CD QL

REYATAZ ORAL CAPSULE (atazanavir sulfate) CD PA; QL

REYATAZ ORAL PACKET (atazanavir sulfate) CD QL; AL

ritonavir CD QL

SYMTUZA (darun-cobic-emtricit-tenofaf) CD PA; QL

VIRACEPT (nelfinavir mesylate) CD QL

Anti-influenza Agents

oseltamivir phosphate oral capsule P QL

oseltamivir phosphate oral suspension reconstituted P QL; AL

RELENZA DISKHALER (zanamivir) P QL

rimantadine hcl CD QL

TAMIFLU ORAL CAPSULE (oseltamivir phosphate) NP PA; QL

TAMIFLU ORAL SUSPENSION RECONSTITUTED (oseltamivir phosphate)

NP PA; QL; AL

XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY PACK 2 X 20 MG (baloxavir marboxil)

NP PA; QL

XOFLUZA (80 MG DOSE) ORAL TABLET THERAPY PACK 2 X 40 MG (baloxavir marboxil)

NP PA; QL

ANXIOLYTICS

Anxiolytics, Other

buspirone hcl oral CD QL

hydroxyzine hcl oral CD QL

hydroxyzine pamoate oral CD QL

meprobamate CD PA; QL

37


VISTARIL (hydroxyzine pamoate) CD PA; QL

Benzodiazepines

alprazolam er CD PA; QL

alprazolam intensol CD PA; QL

alprazolam oral tablet CD QL

alprazolam xr CD PA; QL

ATIVAN ORAL (lorazepam) CD PA; QL

chlordiazepoxide hcl CD QL

clonazepam oral tablet CD QL

clonazepam oral tablet dispersible CD PA; QL

clorazepate dipotassium CD QL

diazepam concentrate 5mg/ml CD PA; QL

diazepam oral solution 5mg/5ml CD QL

diazepam oral tablet CD QL

KLONOPIN (clonazepam) CD PA; QL

lorazepam oral concentrate 2 mg/ml CD PA; QL

lorazepam oral tablet CD QL

midazolam hcl oral syrup CD PA; QL

oxazepam CD QL

TRANXENE-T (clorazepate dipotassium) CD PA; QL

XANAX (alprazolam) CD PA; QL

XANAX XR (alprazolam) CD PA; QL

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES - ADHD DRUGS

Central Nervous System Agents - Drugs to Treat Nerve Conditions

QELBREE (viloxazine hcl) NP PA; QL; AL

BIPOLAR AGENTS

Mood Stabilizers

DEPAKOTE (divalproex sodium) NP PA; QL

DEPAKOTE ER (divalproex sodium) NP PA; QL

DEPAKOTE SPRINKLES (divalproex sodium) NP PA; QL; AL

divalproex sodium er P QL

divalproex sodium oral capsule delayed release sprinkle P QL; AL

divalproex sodium oral tablet delayed release P QL

EQUETRO (carbamazepine (antipsychotic)) CD PA; QL

lithium carbonate er CD QL

lithium carbonate oral CD QL

LITHOBID (lithium carbonate) CD PA; QL

BLOOD FORMATION MODIFIERS - BLOOD FORMATION DRUGS

Blood Products and Modifiers - Drugs to Treat Blood Disorders

38


EMPAVELI (pegcetacoplan) CD PA; SP; QL

BLOOD GLUCOSE REGULATORS - DRUGS TO REGULATE BLOOD SUGAR

Glycemic Agents - Diabetic Drugs

GLUCOSE ORAL TABLET CHEWABLE 4 GM CD OTC; QL

SOFT GLUCOSE CD OTC; QL

BLOOD GLUCOSE REGULATORS

Antidiabetic Agents

acarbose oral P QL

ACTOPLUS MET (pioglitazone hcl-metformin hcl) CD PA; QL

ACTOS (pioglitazone hcl) CD PA; QL

ADLYXIN (lixisenatide) NP PA; QL

ADLYXIN STARTER PACK (lixisenatide) NP PA; QL

ALOGLIPTIN BENZOATE NP PA; QL

ALOGLIPTIN-METFORMIN HCL NP PA; QL

ALOGLIPTIN-PIOGLITAZONE NP PA; QL

AMARYL (glimepiride) NP PA; QL

BYDUREON BCISE AUTOINJECTOR (exenatide) P QL

BYETTA (exenatide) P QL

CYCLOSET (bromocriptine mesylate) CD PA

DUETACT (pioglitazone hcl-glimepiride) NP PA; QL

FARXIGA (dapagliflozin propanediol) P QL

glimepiride P QL

glipizide er P QL

glipizide ir P QL

glipizide xl P QL

glipizide-metformin hcl CD QL

GLUCOTROL XL (glipizide) NP PA; QL

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG (metformin hcl)

CD PA; QL

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 500 MG (metformin hcl)

CD PA

glyburide micronized P QL

glyburide oral P QL

glyburide-metformin CD QL

GLYNASE (glyburide micronized) NP PA; QL

GLYXAMBI (empagliflozin-linagliptin) NP PA

INVOKAMET (canagliflozin-metformin hcl) NP PA; QL

INVOKAMET XR (canagliflozin-metformin hcl) NP PA; QL

INVOKANA (canagliflozin) P QL

JANUMET (sitagliptin-metformin hcl) P QL

39


JANUMET XR (sitagliptin-metformin hcl) NP PA; QL

JANUVIA (sitagliptin phosphate) P QL

JARDIANCE (empagliflozin) P QL

JENTADUETO (linagliptin-metformin hcl) P QL

JENTADUETO XR (linagliptin-metformin hcl) NP PA; QL

KAZANO (alogliptin-metformin hcl) NP PA; QL

KOMBIGLYZE XR (saxagliptin-metformin) P QL

metformin hcl er (modified) oral tablet extended release 24 hour 1000 mg

CD PA; QL

metformin hcl er (modified) oral tablet extended release 24 hour 500 mg

CD PA

metformin hcl er (osmotic) CD PA; QL

metformin hcl er oral tablet extended release 24 hour 500 mg CD QL

metformin hcl er oral tablet extended release 24 hour 750 mg CD

metformin hcl tablet CD QL

metformin hcl oral solution CD PA; QL

miglitol NP PA; QL

nateglinide CD QL

NESINA (alogliptin benzoate) NP PA; QL

ONGLYZA (saxagliptin hcl) P QL

OSENI (alogliptin-pioglitazone) NP PA; QL

OZEMPIC (semaglutide) NP PA; QL

pioglitazone hcl P QL

pioglitazone hcl-glimepiride NP PA; QL

pioglitazone hcl-metformin hcl NP PA; QL

PRECOSE (acarbose) NP PA; QL

QTERN (dapagliflozin-saxagliptin) NP PA; QL

repaglinide CD QL

RIOMET (metformin hcl) CD PA; QL

RYBELSUS (semaglutide) NP PA; QL

SEGLUROMET (ertugliflozin-metformin hcl) NP PA; QL

SOLIQUA (insulin glargine-lixisenatide) NP PA; QL

STEGLATRO (ertugliflozin l-pyroglutamicac) NP PA; QL

STEGLUJAN (ertugliflozin-sitagliptin) NP PA; QL

SYMLIN PEN (pramlintide acetate) P QL

SYNJARDY (empagliflozin-metformin hcl) NP PA; QL

SYNJARDY XR (empagliflozin-metformin hcl) NP PA; QL

TRADJENTA (linagliptin) P QL

TRIJARDY XR (empagliflozin-linaglip-metform) NP PA; QL

TRULICITY (dulaglutide) NP PA; QL

40


VICTOZA (liraglutide) P QL

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG (dapagliflozin-metformin hcl)

NP PA

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG, 5-1000 MG, 5-500 MG (dapagliflozin-metformin hcl)

NP

PA; QL

XULTOPHY (insulin degludec-liraglutide) NP PA; QL

Glycemic Agents

BAQSIMI (glucagon) CD QL

diazoxide oral CD PA

GLUCAGEN HYPOKIT (glucagon hcl (rdna)) CD QL

GLUCAGON EMERGENCY INJECTION SOLUTION RECONSTITUTED

CD QL

glucagon emergency kit 1 mg injection CD QL

GLUCAGON EMERGENCY KIT 1 MG INJECTION CD QL

GVOKE HYPOPEN (glucagon) CD QL

GVOKE PFS (glucagon) CD QL

PROGLYCEM (diazoxide) CD PA

Insulins

ADMELOG (insulin lispro) NP PA; QL

ADMELOG SOLOSTAR (insulin lispro) NP PA; QL

AFREZZA (insulin regular human) NP PA; QL

APIDRA SOLOSTAR (insulin glulisine) NP PA; QL

APIDRA VIAL (insulin glulisine) NP PA; QL

BASAGLAR KWIKPEN (insulin glargine) NP PA; QL

FIASP (insulin aspart (w/niacinamide)) NP PA; QL

FIASP FLEXTOUCH (insulin aspart (w/niacinamide)) NP PA; QL

FIASP PENFILL (insulin aspart (w/niacinamide)) NP PA; QL

HUMALOG (insulin lispro) P QL

HUMALOG JUNIOR KWIKPEN (insulin lispro) P QL

HUMALOG KWIKPEN (insulin lispro) P QL

HUMALOG MIX 50/50 (insulin lispro prot & lispro) P QL

HUMALOG MIX 50/50 KWIKPEN (insulin lispro prot & lispro) P QL

HUMALOG MIX 75/25 (insulin lispro prot & lispro) P QL

HUMALOG MIX 75/25 KWIKPEN (insulin lispro prot & lispro) P QL

HUMULIN 70/30 KWIKPEN (insulin nph isophane & regular) P OTC; QL

HUMULIN 70/30 VIAL (insulin nph isophane & regular) P OTC; QL

HUMULIN N KWIKPEN (insulin nph human (isophane)) NP PA; OTC; QL

HUMULIN N VIAL (insulin nph human (isophane)) P OTC; QL

HUMULIN R U-500 KWIKPEN (insulin regular human) P QL

41


HUMULIN R U-500 VIAL (CONCENTRATED) (insulin regular human)

P QL

HUMULIN R VIAL (insulin regular human) P OTC; QL

INSULIN ASP PROT & ASP FLEXPEN P QL

INSULIN ASPART P QL

INSULIN ASPART FLEXPEN P QL

INSULIN ASPART PENFILL P QL

INSULIN ASPART PROT & ASPART P QL

INSULIN LISPRO P QL

INSULIN LISPRO (1 UNIT DIAL) P QL

INSULIN LISPRO JUNIOR KWIKPEN P QL

INSULIN LISPRO PROT & LISPRO P QL

LANTUS SOLOSTAR (insulin glargine) P QL

LANTUS U-100 VIAL (insulin glargine) P QL

LEVEMIR U-100 FLEXTOUCH (insulin detemir) P QL

LEVEMIR U-100 VIAL (insulin detemir) P QL

LYUMJEV (insulin lispro-aabc) NP PA; QL

LYUMJEV KWIKPEN (insulin lispro-aabc) NP PA; QL

NOVOLIN 70/30 FLEXPEN (insulin nph isophane & regular) NP PA; OTC; QL

NOVOLIN 70/30 VIAL (insulin nph isophane & regular) NP PA; OTC; QL

NOVOLIN N FLEXPEN (insulin nph human (isophane)) NP PA; OTC; QL

NOVOLIN N VIAL (insulin nph human (isophane)) P OTC; QL

NOVOLIN R FLEXPEN (insulin regular human) NP PA; OTC; QL

NOVOLIN R VIAL (insulin regular human) P OTC; QL

NOVOLOG FLEXPEN (insulin aspart) P QL

NOVOLOG MIX 70/30 FLEXPEN (insulin aspart prot & aspart) P QL

NOVOLOG MIX 70/30 VIAL (insulin aspart prot & aspart) P QL

NOVOLOG PENFILL (insulin aspart) P QL

NOVOLOG U-100 VIAL (insulin aspart) P QL

SEMGLEE (insulin glargine) NP PA; QL

TOUJEO MAX SOLOSTAR (insulin glargine) NP PA; QL

TOUJEO SOLOSTAR (insulin glargine) NP PA; QL

TRESIBA (insulin degludec) NP PA; QL

TRESIBA FLEXTOUCH (insulin degludec) NP PA; QL

BLOOD PRODUCTS AND MODIFIERS - DRUGS TO TREAT BLOOD DISORDERS

Anticoagulants

ARIXTRA SUBCUTANEOUS SOLUTION 10 MG/0.8ML (fondaparinux sodium)

NP PA; QL

ARIXTRA SUBCUTANEOUS SOLUTION 2.5 MG/0.5ML (fondaparinux sodium)

NP PA

42


ARIXTRA SUBCUTANEOUS SOLUTION 5 MG/0.4ML, 7.5 MG/0.6ML (fondaparinux sodium)

P QL

ELIQUIS (apixaban) P QL

ELIQUIS DVT/PE STARTER PACK (apixaban) P QL

enoxaparin sodium P QL

fondaparinux sodium subcutaneous solution 10 mg/0.8ml, 5 mg/0.4ml, 7.5 mg/0.6ml

NP PA; QL

fondaparinux sodium subcutaneous solution 2.5 mg/0.5ml NP PA

FRAGMIN SUBCUTANEOUS SOLUTION 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 (dalteparin sodium)

NP

PA

FRAGMIN SUBCUTANEOUS SOLUTION VIAL 95000 UNIT/3.8ML (dalteparin sodium)

P

heparin sodium (porcine) CD

heparin sodium (porcine) pf CD

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 7.5 mg

P QL

jantoven oral tablet 6 mg P

LOVENOX (enoxaparin sodium) NP PA; QL

PRADAXA (dabigatran etexilate mesylate) P QL

SAVAYSA (edoxaban tosylate) NP PA; QL

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 7.5 mg

P QL

warfarin sodium oral tablet 6 mg P

XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG (rivaroxaban) P QL

XARELTO ORAL TABLET 2.5 MG (rivaroxaban) NP PA; QL

XARELTO STARTER PACK (rivaroxaban) NP PA; QL

ZONTIVITY (vorapaxar sulfate) NP PA; QL

Blood Products and Modifiers, Other

ADAKVEO (crizanlizumab-tmca) P PA

AGRYLIN (anagrelide hcl) CD PA

anagrelide hcl CD

ARANESP (ALBUMIN FREE) INJECTION SOLUTION (darbepoetin alfa)

P SP

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML (darbepoetin alfa)

P SP; QL

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 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 (darbepoetin alfa)

P

SP

DROXIA ORAL CAPSULE 200 MG, 300 MG (hydroxyurea) P

DROXIA ORAL CAPSULE 400 MG (hydroxyurea) P QL

43


ENDARI (glutamine (sickle cell)) P PA; QL

EPOGEN (epoetin alfa) P SP

FULPHILA (pegfilgrastim-jmdb) CD PA; SP

GRANIX (tbo-filgrastim) CD PA; SP

LEUKINE (sargramostim) CD PA; SP

MOZOBIL (plerixafor) CD PA; SP; QL

MULPLETA (lusutrombopag) CD PA; SP; QL

NEULASTA (pegfilgrastim) CD PA; SP

NEULASTA ONPRO (pegfilgrastim) CD PA; SP

NEUPOGEN INJECTION SOLUTION 300 MCG/ML (filgrastim) CD PA; SP

NEUPOGEN INJECTION SOLUTION 480 MCG/1.6ML (filgrastim)

CD PA; SP; QL

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE (filgrastim)

CD PA; SP

NIVESTYM (filgrastim-aafi) CD PA; SP

OXBRYTA (voxelotor) P PA; SP; QL

PROCRIT (epoetin alfa) NP PA; SP

PROMACTA ORAL PACKET 12.5 MG (eltrombopag olamine) CD PA; SP; QL

PROMACTA ORAL PACKET 25 MG (eltrombopag olamine) CD PA; SP; QL

PROMACTA ORAL TABLET (eltrombopag olamine) CD PA; SP; QL

REBLOZYL (luspatercept-aamt) NP PA

RETACRIT (epoetin alfa-epbx) P SP

SIKLOS (hydroxyurea) NP PA; QL

UDENYCA (pegfilgrastim-cbqv) CD PA; SP

ZARXIO (filgrastim-sndz) CD PA; SP

ZIEXTENZO (pegfilgrastim-bmez) CD PA; SP

Hemostasis Agents

AMICAR (aminocaproic acid) CD PA; QL

aminocaproic acid oral CD QL

LYSTEDA (tranexamic acid) CD PA; QL

tranexamic acid oral CD QL

Platelet Modifying Agents

aspirin-dipyridamole er NP PA; QL

BRILINTA (ticagrelor) P QL

CABLIVI (caplacizumab-yhdp) CD PA; SP; QL

cilostazol CD QL

clopidogrel bisulfate oral P QL

dipyridamole oral P QL

DOPTELET (avatrombopag maleate) CD PA; SP; QL

EFFIENT (prasugrel hcl) NP PA; QL

44


PLAVIX (clopidogrel bisulfate) NP PA; QL

prasugrel hcl P QL

TAVALISSE ORAL TABLET 100 MG (fostamatinib disodium) CD PA; SP; QL

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS - DRUGS TO TREAT BLOOD DISORDERS

Blood Formation Modifiers - Blood Formation Drugs

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.3ML, 200 MCG/0.3ML, 50 MCG/0.3ML, 75 MCG/0.3ML (methoxy peg-epoetin beta)

NP

PA; QL

Hemostasis Agents - Drugs to Stop Bleeding

ADVATE (antihemophil factor (rahf-pfm)) P SP

ADYNOVATE P SP

AFSTYLA (antihemophil fact single chain) P SP

ALPHANATE (antihemophilic factor-vwf) P SP

ALPHANINE SD (coagulation factor ix) P SP

ALPROLIX (coagulation factor ix (rfixfc)) P SP

BENEFIX (coagulation factor ix (recomb)) P SP

COAGADEX (coagulation factor x (human)) P SP

CORIFACT (factor xiii concentrate human) P SP

ELOCTATE (antihem fact (bdd-rfviiifc)) P SP

ESPEROCT (antihemoph fact rcmb gpeg-exei) P SP

FEIBA (antiinhibitor coagulant cmplx) P SP

HEMLIBRA (emicizumab-kxwh) P PA; SP; QL

HEMOFIL M (antihemophilic factor) P SP

HUMATE-P (antihemophilic factor-vwf) P SP

IDELVION (coagulation factor ix (rix-fp)) P SP

IXINITY INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 3000 UNIT, 500 UNIT (coagulation factor ix (recomb))

P

SP

JIVI (ahf (bdd-rfviii peg-aucl)) P SP

KOATE (antihemophilic factor) P SP

KOGENATE FS (antihem factor recomb (rfviii)) P SP

KOVALTRY (antihemophil factor (rahf-pfm)) P SP

MONONINE (coagulation factor ix) P SP

NOVOEIGHT (antihemophil fact bd truncated) P SP

NOVOSEVEN RT (coagulation factor viia recomb) P SP

NUWIQ INTRAVENOUS KIT (antihem fact (bdd-rfviii,sim)) P SP

OBIZUR P SP

PROFILNINE (factor ix complex) P SP

REBINYN (coagulation factor ix glycopeg) P SP

RECOMBINATE (antihem factor recomb (rfviii)) P SP

45


RECOTHROM EXTERNAL SOLUTION RECONSTITUTED 5000 UNIT (thrombin (recombinant))

CD PA; SP

RECOTHROM SPRAY KIT (thrombin (recombinant)) CD PA; SP

RIXUBIS P SP

TRETTEN (coagulation factor xiii a-sub) P SP

VONVENDI (von willebrand factor (recomb)) P SP

WILATE (antihemophilic factor-vwf) P SP

XYNTHA (antihem fact (bdd-rfviii,mor)) P SP

XYNTHA SOLOFUSE (antihem fact (bdd-rfviii,mor)) P SP

CARDIOVASCULAR AGENTS - DRUGS TO TREAT HEART AND CIRCULATION CONDITIONS

CARDIOVASCULAR AGENTS, OTHER - MISCELLANEOUS CARDIAC DRUGS

Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions

VERQUVO (vericiguat) CD PA; QL

CARDIOVASCULAR AGENTS

Alpha-adrenergic Agonists

CATAPRES-TTS-1 (clonidine) CD PA; QL



Clonidine transdermal patch CD PA; QL

clonidine hcl oral CD QL

droxidopa CD PA; SP; QL

guanfacine hcl CD QL

methyldopa CD QL

midodrine hcl CD QL

NORTHERA (droxidopa) CD PA; SP; QL

Alpha-adrenergic Blocking Agents

CARDURA (doxazosin mesylate) NP PA; QL

doxazosin mesylate oral P QL

MINIPRESS (prazosin hcl) CD PA; QL

phenoxybenzamine hcl oral CD QL

prazosin hcl oral CD QL

Angiotensin II Receptor Antagonists

ATACAND (candesartan cilexetil) NP PA; QL

AVAPRO (irbesartan) NP PA; QL

BENICAR (olmesartan medoxomil) NP PA; QL

candesartan cilexetil NP PA; QL

COZAAR (losartan potassium) NP PA; QL

DIOVAN (valsartan) NP PA; QL

EDARBI (azilsartan medoxomil) NP PA; QL

46


irbesartan P QL

losartan potassium oral P QL

MICARDIS (telmisartan) NP PA; QL

olmesartan medoxomil oral NP PA; QL

telmisartan NP PA; QL

valsartan P QL

Angiotensin-converting Enzyme (ACE) Inhibitors

ACCUPRIL (quinapril hcl) NP PA; QL

ALTACE (ramipril) NP PA; QL

benazepril hcl oral P QL

captopril oral P QL

enalapril maleate oral tablet P QL

EPANED (enalapril maleate) NP PA; QL; AL

fosinopril sodium P QL

lisinopril oral P QL

LOTENSIN (benazepril hcl) NP PA; QL

moexipril hcl P QL

perindopril erbumine P QL

PRINIVIL (lisinopril) NP PA; QL

QBRELIS (lisinopril) NP PA

quinapril hcl P QL

ramipril P QL

trandolapril P QL

VASOTEC (enalapril maleate) NP PA; QL

ZESTRIL (lisinopril) NP PA; QL

Antiarrhythmics

amiodarone hcl oral CD QL

BETAPACE (sotalol hcl) NP PA; QL

BETAPACE AF (sotalol hcl af) NP PA; QL

disopyramide phosphate CD QL

dofetilide CD QL

flecainide acetate CD QL

mexiletine hcl oral CD QL

MULTAQ (dronedarone hcl) CD PA; QL

NORPACE (disopyramide phosphate) CD PA; QL

NORPACE CR (disopyramide phosphate) CD PA

PACERONE (amiodarone hcl) CD PA; QL

propafenone hcl CD QL

propafenone hcl er oral capsule extended release 12 hour 225 mg, 325 mg

CD QL

47


propafenone hcl er oral capsule extended release 12 hour 425 mg

CD

quinidine gluconate er CD QL

quinidine sulfate CD QL

RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 225 MG, 325 MG (propafenone hcl)

CD PA; QL

RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 425 MG (propafenone hcl)

CD PA

sotalol hcl (af) P QL

sotalol hcl oral P QL

SOTYLIZE (sotalol hcl) NP PA; QL

TIKOSYN (dofetilide) CD PA; QL

Beta-adrenergic Blocking Agents

acebutolol hcl oral NP PA; QL

atenolol oral P QL

betaxolol hcl oral NP PA; QL

bisoprolol fumarate oral P QL

BYSTOLIC (nebivolol hcl) NP PA; QL

carvedilol P QL

carvedilol phosphate er NP PA

COREG (carvedilol) NP PA; QL

COREG CR (carvedilol phosphate) NP PA

CORGARD (nadolol) NP PA; QL

HEMANGEOL (propranolol hcl) NP PA; QL

INDERAL LA (propranolol hcl) NP PA; QL

INDERAL XL (propranolol hcl sr beads) NP PA; QL

INNOPRAN XL (propranolol hcl sr beads) NP PA; QL

KAPSPARGO SPRINKLE (metoprolol succinate) NP PA; QL

labetalol hcl oral P QL

LOPRESSOR (metoprolol tartrate) NP PA; QL

metoprolol succinate er P QL

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg P QL

metoprolol tartrate oral tablet 37.5 mg, 75 mg P

nadolol oral P QL

pindolol P QL

propranolol hcl er P QL

propranolol hcl oral solution 20 mg/5ml P QL

propranolol hcl oral solution 40 mg/5ml P

propranolol hcl oral tablet P QL

TENORMIN (atenolol) NP PA; QL

48


TOPROL XL (metoprolol succinate) NP PA; QL

Calcium Channel Blocking Agents, Dihydropyridines

amlodipine besylate oral P QL

felodipine er P QL

isradipine P QL

KATERZIA (amlodipine benzoate) NP PA; QL

nicardipine hcl oral P QL

nifedipine er P QL

nifedipine er osmotic release P QL

nifedipine oral P QL

nimodipine oral NP PA; QL

nisoldipine er oral tablet extended release 24 hour 17 mg, 25.5 mg, 34 mg, 8.5 mg

NP PA

nisoldipine er oral tablet extended release 24 hour 20 mg, 30 mg, 40 mg

NP PA; QL

NORVASC (amlodipine besylate) NP PA; QL

NYMALIZE SOLUTION 6 MG/ML ORAL (nimodipine) NP PA; QL

NYMALIZE SOLUTION 6 MG/ML ORAL (nimodipine) P QL

PROCARDIA XL (nifedipine) NP PA; QL

SULAR (nisoldipine) NP PA

Calcium Channel Blocking Agents, Nondihydropyridines

CALAN SR (verapamil hcl) NP PA; QL

CARDIZEM (diltiazem hcl) NP PA; QL

CARDIZEM CD (diltiazem hcl coated beads) NP PA; QL

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 360 MG, 420 MG (diltiazem hcl coated beads)

NP

PA; QL

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 300 MG (diltiazem hcl coated beads)

NP PA

diltiazem hcl er P QL

diltiazem hcl er beads P QL

diltiazem hcl er coated beads oral capsule extended release 24 hour

P QL

diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg, 240 mg, 360 mg, 420 mg

P QL

diltiazem hcl er coated beads oral tablet extended release 24 hour 300 mg

P

diltiazem hcl oral P QL

dilt-xr P QL

matzim la oral tablet extended release 24 hour 180 mg, 240 mg, 360 mg, 420 mg

NP PA; QL

matzim la oral tablet extended release 24 hour 300 mg NP PA; QL

49


taztia xt P QL

tiadylt er P QL

TIAZAC (diltiazem hcl er beads) NP PA; QL

verapamil hcl er P QL

verapamil hcl oral P QL

VERELAN (verapamil hcl) NP PA; QL

VERELAN PM (verapamil hcl) NP PA; QL

Cardiovascular Agents, Other

ACCURETIC (quinapril-hydrochlorothiazide) NP PA; QL

acetazolamide er CD QL

acetazolamide oral CD QL

ALDACTAZIDE (spironolactone-hctz) CD PA; QL

aliskiren fumarate NP PA; QL

amiloride-hydrochlorothiazide CD QL

amlodipine besylate-benazepril hcl P QL

amlodipine besylate-valsartan P

amlodipine-atorvastatin NP PA; QL

amlodipine-olmesartan NP PA

amlodipine-valsartan-hctz P

ATACAND HCT (candesartan cilexetil-hctz) NP PA; QL

atenolol-chlorthalidone NP PA; QL

AVALIDE (irbesartan-hydrochlorothiazide) NP PA; QL

AZOR (amlodipine-olmesartan) NP PA

benazepril-hydrochlorothiazide P QL

BENICAR HCT (olmesartan medoxomil-hctz) NP PA; QL

BIDIL (isosorb dinitrate-hydralazine) CD PA; QL

bisoprolol-hydrochlorothiazide NP PA; QL

CADUET (amlodipine-atorvastatin) NP PA; QL

candesartan cilexetil-hctz NP PA; QL

CORLANOR (ivabradine hcl) CD PA; QL

DEMSER (metyrosine) CD PA; QL

digitek CD QL

digox CD QL

digoxin oral solution CD

digoxin oral tablet CD QL

DIOVAN HCT (valsartan-hydrochlorothiazide) NP PA; QL

EDARBYCLOR (azilsartan-chlorthalidone) NP PA; QL

enalapril-hydrochlorothiazide P QL

ENTRESTO (sacubitril-valsartan) P QL

EXFORGE (amlodipine besylate-valsartan) NP PA

50


EXFORGE HCT (amlodipine-valsartan-hctz) NP PA

fosinopril sodium-hctz P QL

HYZAAR (losartan potassium-hctz) NP PA; QL

irbesartan-hydrochlorothiazide P QL

KERENDIA (finerenone) CD PA

lisinopril-hydrochlorothiazide P QL

losartan potassium-hctz P QL

LOTENSIN HCT (benazepril-hydrochlorothiazide) NP PA; QL

LOTREL (amlodipine besy-benazepril hcl) NP PA; QL

MAXZIDE (triamterene-hctz) CD PA; QL

MAXZIDE-25 (triamterene-hctz) CD PA; QL

metoprolol-hydrochlorothiazide NP PA; QL

metyrosine CD QL

MICARDIS HCT (telmisartan-hctz) NP PA; QL

olmesartan medoxomil-hctz NP PA; QL

olmesartan-amlodipine-hctz NP PA; QL

pentoxifylline er CD QL

quinapril-hydrochlorothiazide P QL

RANEXA (ranolazine) CD PA; QL

ranolazine er CD PA; QL

spironolactone-hctz CD QL

TEKTURNA (aliskiren fumarate) NP PA; QL

TEKTURNA HCT (aliskiren-hydrochlorothiazide) P

telmisartan-amlodipine NP PA; QL

telmisartan-hctz NP PA; QL

TENORETIC 100 (atenolol-chlorthalidone) NP PA; QL

TENORETIC 50 (atenolol-chlorthalidone) NP PA; QL

trandolapril-verapamil hcl er oral tablet extended release NP PA; QL

triamterene-hctz CD QL

TRIBENZOR (olmesartan-amlodipine-hctz) NP PA; QL

valsartan-hydrochlorothiazide P QL

VASERETIC (enalapril-hydrochlorothiazide) NP PA; QL

VECAMYL (mecamylamine hcl) CD PA; QL

ZESTORETIC (lisinopril-hydrochlorothiazide) NP PA; QL

ZIAC (bisoprolol-hydrochlorothiazide) NP PA; QL

Diuretics, Loop

bumetanide oral CD QL

EDECRIN (ethacrynic acid) CD PA; QL

ethacrynic acid CD QL

furosemide oral solution 10 mg/ml CD QL

51


furosemide oral solution 8 mg/ml CD

furosemide oral tablet CD QL

LASIX (furosemide) CD PA; QL

torsemide CD QL

Diuretics, Potassium-sparing

ALDACTONE (spironolactone) CD PA; QL

amiloride hcl oral CD QL

CAROSPIR (spironolactone) CD PA; QL

eplerenone CD QL

INSPRA (eplerenone) CD PA; QL

spironolactone oral CD QL

triamterene oral CD

Diuretics, Thiazide

chlorthalidone CD QL

DIURIL (chlorothiazide) CD PA; QL

hydrochlorothiazide oral capsule CD QL

hydrochlorothiazide oral tablet 12.5 mg CD

hydrochlorothiazide oral tablet 25 mg, 50 mg CD QL

indapamide CD QL

metolazone CD QL

Dyslipidemics, Fibric Acid Derivatives

ANTARA (fenofibrate micronized) NP PA; QL

fenofibrate 30mg, 43mg, 90mg,130 mg NP PA

fenofibrate oral capsule (lofibra) 134 mg, 200 mg, 67 mg P PA; QL

fenofibrate oral capsule (lipofen) 150 mg, 50 mg NP PA

fenofibrate oral tablet (fenoglide)120 mg, 40 mg NP PA; QL

fenofibrate oral tablet 145 mg, 48 mg (tricor) P QL

fenofibrate oral tablet 160 mg, 54 mg (lofibra) P PA; QL

fenofibric acid oral (fibricor, trilipix) NP PA; QL

FENOGLIDE (fenofibrate) NP PA; QL

gemfibrozil oral P QL

LIPOFEN (fenofibrate) NP PA

LOPID (gemfibrozil) NP PA; QL

TRICOR (fenofibrate) NP PA; QL

TRILIPIX (choline fenofibrate) NP PA; QL

Dyslipidemics, HMG CoA Reductase Inhibitors

ALTOPREV (lovastatin) NP PA; QL

atorvastatin calcium oral P QL

CRESTOR (rosuvastatin calcium) NP PA; QL

52


EZALLOR SPRINKLE (rosuvastatin calcium) NP PA; QL

fluvastatin sodium er NP PA

fluvastatin sodium oral capsule 20 mg NP PA; QL

fluvastatin sodium oral capsule 40 mg NP PA

LESCOL XL (fluvastatin sodium) NP PA

LIPITOR (atorvastatin calcium) NP PA; QL

LIVALO (pitavastatin calcium) NP PA; QL

lovastatin oral P QL; AL

pravastatin sodium P QL

rosuvastatin calcium P QL

simvastatin oral P QL

ZOCOR (simvastatin) NP PA; QL

ZYPITAMAG (pitavastatin magnesium) NP PA; QL

Dyslipidemics, Other

cholestyramine light P QL

cholestyramine oral P QL

colesevelam hcl oral packet NP PA

colesevelam hcl oral tablet NP PA; QL

COLESTID (colestipol hcl) NP PA; QL

colestipol hcl P QL

EVKEEZA (evinacumab-dgnb) NP PA

ezetimibe P QL

ezetimibe-simvastatin NP PA; QL

icosapent ethyl CD PA; QL

JUXTAPID ORAL CAPSULE (lomitapide mesylate) CD PA; SP; QL

LOVAZA (omega-3-acid ethyl esters) NP PA; QL

NEXLETOL (bempedoic acid) NP PA; QL

NEXLIZET (bempedoic acid-ezetimibe) NP PA; QL

niacin er (antihyperlipidemic) P Rx/OTC; QL

NIASPAN (niacin (antihyperlipidemic)) P QL

omega-3-acid ethyl esters NP PA; QL

PRALUENT (alirocumab) NP PA; SP; QL

QUESTRAN (cholestyramine) NP PA; QL

QUESTRAN LIGHT (cholestyramine light) NP PA; QL

REPATHA (evolocumab) NP PA; SP; QL

VASCEPA (icosapent ethyl) NP PA; QL

VYTORIN (ezetimibe-simvastatin) NP PA; QL

WELCHOL ORAL PACKET (colesevelam hcl) NP PA

WELCHOL ORAL TABLET (colesevelam hcl) NP PA; QL

ZETIA (ezetimibe) NP PA; QL

53


Vasodilators, Direct-acting Arterial/Venous

GONITRO (nitroglycerin) CD PA; QL

ISORDIL TITRADOSE (isosorbide dinitrate) CD PA; QL

isosorbide dinitrate CD QL

isosorbide mononitrate CD QL

isosorbide mononitrate er CD QL

minitran CD QL

NITRO-BID (nitroglycerin) CD QL

NITRO-DUR (nitroglycerin) CD QL

nitroglycerin sublingual CD QL

nitroglycerin transdermal CD QL

nitroglycerin translingual CD QL

NITROLINGUAL (nitroglycerin) CD PA; QL

NITROSTAT (nitroglycerin) CD PA; QL

RECTIV (nitroglycerin) CD PA; QL

Vasodilators, Direct-acting Arterial

hydralazine hcl oral CD QL

minoxidil oral CD QL

CENTRAL NERVOUS SYSTEM AGENTS

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG (methylphenidate hcl)

NP PA; QL

ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 35 MG, 45 MG, 55 MG, 70 MG, 85 MG (methylphenidate hcl)

NP

PA; QL; AL

APTENSIO XR (methylphenidate hcl) NP PA; QL; AL

atomoxetine hcl P QL; AL

AZSTARYS (serdexmethylphenidate-dexmethylphenidate) NP PA; QL; AL

clonidine hcl er NP PA; QL

CONCERTA (methylphenidate hcl) P QL; AL

COTEMPLA XR-ODT (methylphenidate) NP PA; QL; AL

DAYTRANA (methylphenidate) NP PA; QL; AL

dexmethylphenidate hcl P QL; AL

dexmethylphenidate hcl er P QL; AL

FOCALIN (dexmethylphenidate hcl) NP PA; QL; AL

FOCALIN XR (dexmethylphenidate hcl) NP PA; QL; AL

guanfacine hcl er P QL; AL

INTUNIV (guanfacine hcl) NP PA; QL; AL

JORNAY PM (methylphenidate hcl) NP PA; QL; AL

METHYLIN (methylphenidate hcl) solution P QL; AL

54


methylphenidate hcl er (cd) NP PA; QL; AL

methylphenidate hcl er (la) capsule extended release 24 hour NP PA; QL; AL

methylphenidate hcl er (xr) NP PA; QL; AL

methylphenidate hcl er oral tablet extended release 10 mg, 20 mg P QL; AL

methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg, 72 mg

NP PA; QL; AL

methylphenidate hcl oral solution P QL; AL

methylphenidate hcl oral tablet P QL; AL

methylphenidate hcl oral tablet chewable NP PA; AL

QUILLICHEW ER (methylphenidate hcl) NP PA; QL; AL

QUILLIVANT XR (methylphenidate hcl) NP PA; QL; AL

RELEXXII CD PA; QL; AL

RITALIN (methylphenidate hcl) NP PA; QL; AL

RITALIN LA (methylphenidate hcl) P QL; AL

STRATTERA (atomoxetine hcl) NP PA; QL; AL

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

ADDERALL (amphetamine-dextroamphetamine) CD PA; QL; AL

ADDERALL XR (amphetamine-dextroamphetamine) P QL; AL

ADZENYS ER (amphetamine) NP PA; QL; AL

ADZENYS XR-ODT (amphetamine) NP PA; QL; AL

AMPHETAMINE ER NP PA; QL; AL

amphetamine sulfate NP PA; QL; AL

amphetamine-dextroamphetamine P QL; AL

amphetamine-dextroamphetamine er NP PA; QL; AL

DESOXYN (methamphetamine hcl) CD PA; QL; AL

DEXEDRINE (dextroamphetamine sulfate) NP PA; QL; AL

dextroamphetamine sulfate er P QL; AL

dextroamphetamine sulfate oral solution NP PA; QL; AL

dextroamphetamine sulfate oral tablet 10 mg, 5 mg P QL; AL

DYANAVEL XR (amphetamine) NP PA; QL; AL

EVEKEO (amphetamine sulfate) NP PA; QL; AL

EVEKEO ODT (amphetamine sulfate) NP PA; QL; AL

methamphetamine hcl CD PA; QL; AL

MYDAYIS (amphetamine-dextroamphetamine) NP PA; QL; AL

PROCENTRA (dextroamphetamine sulfate) NP PA; QL; AL

VYVANSE ORAL CAPSULE (lisdexamfetamine dimesylate) P QL; AL

VYVANSE ORAL TABLET CHEWABLE (lisdexamfetamine dimesylate)

NP PA; QL; AL

ZENZEDI ORAL TABLET (dextroamphetamine sulfate) NP PA; QL; AL

Central Nervous System, Other

55


AUSTEDO (deutetrabenazine) CD PA; SP; QL

caffeine citrate oral CD QL; AL

EXSERVAN (riluzole) CD PA; QL

FIRDAPSE (amifampridine phosphate) CD PA; SP; QL

GRALISE ORAL TABLET (gabapentin (once-daily)) NP PA; QL

HORIZANT (gabapentin enacarbil) NP PA; QL

INGREZZA (valbenazine tosylate) CD PA; SP; QL

NUEDEXTA (dextromethorphan-quinidine) CD PA; QL

RILUTEK (riluzole) CD PA; QL

riluzole CD QL

RUZURGI (amifampridine) CD PA; SP; QL

tetrabenazine CD PA; SP; QL

TIGLUTIK (riluzole) CD PA; QL

XENAZINE (tetrabenazine) CD PA; SP; QL

Fibromyalgia Agents

CYMBALTA (duloxetine hcl) NP PA; QL

DRIZALMA SPRINKLE (duloxetine hcl) NP PA; QL

duloxetine hcl oral 20mg, 30mg, 60mg P QL

duloxetine hcl oral 40mg capsule NP PA

LYRICA (pregabalin) NP PA; QL

LYRICA CR (pregabalin) NP PA; QL

pregabalin er NP PA; QL

pregabalin oral capsule P QL

pregabalin oral solution NP PA; QL

SAVELLA (milnacipran hcl) P QL

Multiple Sclerosis Agents

AMPYRA (dalfampridine) NP PA; SP; QL

AUBAGIO (teriflunomide) P PA; SP; QL

AVONEX PEN (interferon beta-1a) P SP; QL

AVONEX PREFILLED (interferon beta-1a) P SP; QL

BAFIERTAM (monomethyl fumarate) NP PA; SP; QL

BETASERON (interferon beta-1b) P SP

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML (glatiramer acetate)

P SP; QL

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML (glatiramer acetate)

NP PA; SP; QL

dalfampridine er NP PA; SP; QL

dimethyl fumarate oral NP PA; SP; QL

EXTAVIA (interferon beta-1b) NP PA; SP

GILENYA ORAL CAPSULE 0.5 MG (fingolimod hcl) P PA; SP; QL

56


glatiramer acetate NP PA; SP; QL

glatopa NP PA; SP; QL

KESIMPTA (ofatumumab) NP PA; SP; QL

LEMTRADA (alemtuzumab) NP PA

MAVENCLAD (cladribine) NP PA; SP; QL

MAYZENT (siponimod fumarate) NP PA; SP; QL

PLEGRIDY (peginterferon beta-1a) NP PA; SP; QL

REBIF (interferon beta-1a) P SP; QL

REBIF REBIDOSE (interferon beta-1a) P SP; QL

REBIF REBIDOSE TITRATION PACK (interferon beta-1a) P SP; QL

REBIF TITRATION PACK (interferon beta-1a) P SP; QL

TECFIDERA (dimethyl fumarate) NP PA; SP; QL

TYSABRI (natalizumab) NP PA

VUMERITY (diroximel fumarate) NP PA; SP; QL

ZEPOSIA (ozanimod hcl) NP PA; SP; QL

CYSTIC FIBROSIS AGENTS - DRUGS TO TREAT CYSTIC FIBROSIS

Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions

BRONCHITOL (mannitol (cystic fibrosis)) CD PA; QL

DENTAL AND ORAL AGENTS

cevimeline hcl CD

chlorhexidine gluconate mouth/throat CD QL

EVOXAC (cevimeline hcl) CD PA

oralone CD QL

pilocarpine hcl oral tablet 5 mg CD QL

pilocarpine hcl oral tablet 7.5 mg CD

triamcinolone acetonide mouth/throat CD QL

DERMATOLOGICAL AGENTS - DRUGS TO TREAT SKIN CONDITIONS

advanced healing external ointment CD OTC

alum sulfate-ca acetate CD OTC

AQUAPHILIC (emollient) CD OTC

BOUDREAUXS BABY BUTT SMOOTH (emollient) CD OTC

diaper rash external ointment CD OTC; QL

dibucaine (perianal) CD OTC

DR SMITHS DIAPER (zinc oxide) CD OTC; QL

flanders buttocks CD OTC

hydrocortisone acetate external CD OTC

lidocaine-hydrocort (perianal) CD

lidocaine-hydrocortisone ace rectal kit 2-2 %, 3-1 %, 3-2.5 % CD QL

57


lidocaine-hydrocortisone ace rectal kit 3-0.5 % CD

NEUAC EXTERNAL KIT (clindamycin-benzoyl per-moist) NP PA

sss 10-5 CD

sulfacetamide sodium-sulfur external P

sulfacetamide sodium suspension P

sulfacetamide sodium-sulfur cleanser P

SUMADAN (sulfacetamide-sulfur-cleanser) CD PA

SUMADAN WASH (sulfacetamide sodium-sulfur) CD PA; QL

SUMADAN XLT (sulfacetamide-sulfur-sunscreen) CD PA

SUMAXIN (sulfacetamide sodium-sulfur) CD PA

SUMAXIN CP (sulfacetamide-sulfur-cleanser) CD PA; QL

SYNALAR (CREAM) (fluocinolone-emollient) CD PA; QL

SYNALAR (OINTMENT) (fluocinolone-emollient) CD PA; QL

TOVET EXTERNAL KIT (clobetasol emul foam w/moistcr) CD PA; QL

VANICREAM EXTERNAL OINTMENT (emollient) CD PA; OTC

Dermatological Agents - Skin Agents

BENSAL HP CD PA

BESER EXTERNAL KIT (fluticasone-emollient) CD PA; QL

calamine external lotion , 8-8 % CD OTC

CLINDACIN PAC (clindamycin phos & cleanser) NP PA

CLODAN EXTERNAL KIT (clobetasol prop & cleanser) CD PA

corn & callus remover (salicylic acid) 17% CD OTC

docosanol external CD OTC; QL

gormal (urea) cream 20% CD OTC; QL

gormel 10 (urea) lotion 10% CD OTC; QL

hydrocortisone plus external cream 1 % CD OTC

hydrocortisone-aloe max st external cream 1 % CD OTC

NEO-SYNALAR EXTERNAL KIT (neo-fluocinolone & emollient) CD PA

ROSADAN EXTERNAL KIT (metronidazole-cleanser) CD PA

rosadan external cream (metronidazole) 0.75% CD QL

rosadan external gel (metronidazole) 0.75% CD QL

SALEX (salicylic acid) shampoo 6% CD PA; QL

SCALPICIN (salicylic acid) 3% liquid CD OTC

SYNALAR TS (fluocinolone & cleanser) CD PA; QL

urea external lotion (urea) 40% CD QL

ureacin-10 (urea) lotion 10% CD OTC; QL

ureacin-20 (urea) lotion 20% CD OTC; QL

wart remover external liquid 17 % (salicylic acid) CD OTC

ZILXI (minocycline hcl micronized) 1.5% foam CD PA; QL

58


DERMATOLOGICAL AGENTS

Acne and Rosacea Agents

ABSORICA (isotretinoin) CD PA; QL

ABSORICA LD (isotretinoin micronized) CD PA; QL

ACANYA (clindamycin phos-benzoyl perox) NP PA; QL

acitretin CD PA; QL

adapalene external cream NP PA; QL

adapalene external gel NP PA; QL

adapalene-benzoyl peroxide external gel NP PA; QL

AKLIEF (trifarotene) NP PA; QL

ALTRENO (tretinoin) CD PA; QL

amnesteem CD PA; QL

ARAZLO (tazarotene) CD PA; QL

ATRALIN (tretinoin) NP PA; QL

AVITA (tretinoin) NP PA; QL

azelaic acid external CD QL

BENZACLIN (clindamycin phos-benzoyl perox) NP PA; QL

BENZACLIN WITH PUMP (clindamycin phos-benzoyl perox) NP PA; QL

BENZAMYCIN (benzoyl peroxide-erythromycin) CD PA; QL

benzoyl peroxide cream 10% CD QL

benzoyl peroxide gel 2.5%, 5%, 10% P QL

benzoyl peroxide wash/cleanser 3%, 5%, 6%,10% P QL

benzoyl peroxide wash 2.5%, 4% CD QL

benzoyl peroxide lotion 5%, 8%, 10% P QL

benzoyl peroxide-erythromycin P QL

claravis CD PA; QL

clindamycin phosphate-benzoyl peroxide external gel 1-5 % P QL

clindamycin phosphate-benzoyl peroxide external gel 1-5 % pump

NFP QL

clindamycin phos-benzoyl perox gel 1.2-2.5 % external P QL

clindamycin-tretinoin NP PA; QL

DIFFERIN EXTERNAL CREAM (adapalene) P QL

DIFFERIN EXTERNAL GEL 0.1 % (adapalene) NP PA; OTC; QL

DIFFERIN EXTERNAL GEL PUMP 0.1 % (adapalene) P QL

DIFFERIN EXTERNAL GEL 0.3 % (adapalene) NP PA; QL

DIFFERIN EXTERNAL LOTION (adapalene) P QL

EPIDUO FORTE (adapalene-benzoyl peroxide) NP PA; QL

FABIOR (tazarotene) NP PA; QL

FINACEA (azelaic acid) CD PA; QL

isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg CD PA; QL

59


isotretinoin oral capsule 25 mg, 35 mg CD QL

MIRVASO (brimonidine tartrate) CD PA; QL

myorisan CD PA; QL

neuac external gel NP PA; QL

ONEXTON (clindamycin phos-benzoyl perox) NP PA; QL

RETIN-A (tretinoin) P QL

RETIN-A MICRO GEL 0.04 %, 0.1 % (tretinoin microsphere) NP QL; AL

RETIN-A MICRO PUMP EXTERNAL GEL 0.04 %, 0.06%, 0.08%, 0.1 % (tretinoin microsphere)

NP QL; AL

RHOFADE (oxymetazoline hcl) CD PA; QL

SORIATANE (acitretin) CD PA; QL

tazarotene external cream NP PA; QL

tazarotene external foam CD PA; QL

tretinoin external cream NP PA; QL

tretinoin external gel NP PA; QL

tretinoin microsphere gel NP PA; QL; AL

zenatane CD PA; QL

ZIANA (clindamycin-tretinoin) NP PA; QL

Dermatitis and Pruitus Agents

alclometasone dipropionate CD QL

amcinonide external cream CD

amcinonide external lotion CD QL

ammonium lactate external CD QL

anti-dandruff CD OTC

APEXICON E (diflorasone diacet emoll base) CD PA; QL

BESER external lotion CD PA; QL

betamethasone dipropionate aug CD QL

betamethasone dipropionate external cream CD PA; QL

betamethasone dipropionate external lotion CD

betamethasone dipropionate external ointment CD QL

betamethasone valerate external cream CD QL

betamethasone valerate external foam CD PA; QL

betamethasone valerate external lotion CD

betamethasone valerate external ointment CD QL

BRYHALI (halobetasol propionate) CD PA; QL

CAPEX (fluocinolone acetonide) CD PA; QL

clobetasol prop emollient base cream CD QL

clobetasol propionate emulsion foam CD QL

clobetasol propionate spray, foam, gel, lotion, shampoo CD PA; QL

clobetasol propionate cream, ointment, solution CD QL

60


CLOBEX EXTERNAL SHAMPOO (clobetasol propionate) CD PA; QL

CLOBEX SPRAY (clobetasol propionate) CD PA; QL

clocortolone pivalate CD QL

CLODAN external shampoo CD PA; QL

CLODERM (clocortolone pivalate) CD PA; QL

CUTIVATE (fluticasone propionate) CD PA; QL

dandruff shampoo external lotion CD OTC

DERMA-SMOOTHE/FS BODY (fluocinolone acetonide) CD PA; QL

DERMA-SMOOTHE/FS SCALP (fluocinolone acetonide) CD PA; QL

DESONATE (desonide) CD QL

desonide external cream CD QL

desonide external lotion CD QL

desonide external ointment CD QL

desoximetasone external CD QL

diflorasone diacetate external cream CD QL

diflorasone diacetate external ointment CD

DIPROLENE (betamethasone dipropionate aug) CD PA; QL

doxepin hcl external CD QL

ELIDEL (pimecrolimus) NP PA; QL; AL

EUCRISA (crisaborole) NP PA; QL

fluocinolone acetonide body CD QL

fluocinolone acetonide external CD QL

fluocinolone acetonide scalp CD QL

fluocinonide emulsified base CD QL

fluocinonide external CD QL

flurandrenolide external cream CD QL

flurandrenolide external lotion CD QL

flurandrenolide external ointment CD

fluticasone propionate external CD QL

halcinonide CD QL

halobetasol propionate external cream CD QL

HALOBETASOL PROPIONATE EXTERNAL FOAM CD PA; QL

halobetasol propionate external ointment CD PA; QL

HALOG (halcinonide) CD PA; QL

hydrocortisone butyr lipo base cream CD PA; QL

hydrocortisone butyrate solution, ointment CD QL

hydrocortisone butyrate cream, lotion CD PA; QL

hydrocortisone external cream 0.5 %, 1%, 2.5% CD OTC/RX; QL

hydrocortisone external lotion 1%, 2.5 % CD QL

hydrocortisone external ointment 0.5%, 1 %, 2.5 % CD QL

61


hydrocortisone valerate cream, ointment CD PA; QL

IMPEKLO (clobetasol propionate) CD PA; QL

KENALOG EXTERNAL (triamcinolone acetonide) CD PA; QL

LAC-HYDRIN FIVE (ammonium lactate) CD OTC; QL

LEXETTE (halobetasol propionate) CD PA; QL

LOCOID (hydrocortisone butyrate) CD PA; QL

LOCOID LIPOCREAM (hydrocortisone butyr lipo base) CD PA; QL

LUXIQ (betamethasone valerate) CD PA; QL

mometasone furoate external CD QL

OLUX (clobetasol propionate) CD PA; QL

OLUX-E (clobetasol propionate emulsion) CD PA; QL

PANDEL (hydrocortisone probutate) CD PA

pimecrolimus NP PA; QL; AL

prednicarbate CD

PROTOPIC (tacrolimus) P QL; AL

PRUDOXIN (doxepin hcl (antipruritic)) CD PA; QL

PSORCON CD PA; QL

selenium sulfide external lotion CD QL

selenium sulfide external shampoo CD

SYNALAR (fluocinolone acetonide) CD PA; QL

tacrolimus external NP PA; QL; AL

TEMOVATE (clobetasol propionate) CD PA; QL

TEXACORT (hydrocortisone) CD PA

TOPICORT (desoximetasone) CD PA; QL

TOPICORT SPRAY (desoximetasone) CD PA; QL

TOVET external foam CD PA; QL

triamcinolone acetonide external aerosol solution CD PA; QL

triamcinolone acetonide external cream, lotion CD QL

triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 % CD QL

triamcinolone acetonide external ointment 0.05 % CD PA

TRIANEX (triamcinolone acetonide) CD PA

ULTRAVATE (halobetasol propionate) CD PA; QL

VANOS (fluocinonide) CD PA; QL

ZONALON (doxepin hcl (antipruritic)) CD PA; QL

Dermatological Agents, Other

ALDARA (imiquimod) CD QL

AMELUZ (aminolevulinic acid hcl) CD PA

calcipotriene external cream CD PA; QL

CALCIPOTRIENE EXTERNAL FOAM CD PA; QL

62


calcipotriene external ointment CD PA; QL

calcipotriene external solution CD QL

calcipotriene-betameth diprop CD QL

calcitriol external CD PA; QL

CARAC (fluorouracil) CD PA; QL

CONDYLOX (podofilox) CD PA

diclofenac sodium external gel 3 % CD PA; QL

DOVONEX (calcipotriene) CD PA; QL

DUOBRII (halobetasol prop-tazarotene) CD PA; QL

EFUDEX (fluorouracil) CD PA; QL

ENSTILAR (calcipotriene-betameth diprop) CD PA; QL

EPIFOAM (pramoxine-hc) CD PA

fluorouracil external cream 5 % CD QL

fluorouracil external solution CD

hydrocortisone ace-pramoxine external cream 1-1 % CD

imiquimod external cream CD QL

IMIQUIMOD PUMP CD PA; QL

LEVULAN KERASTICK (aminolevulinic acid hcl) CD PA

methoxsalen rapid CD

NEO-SYNALAR EXTERNAL CREAM (neomycin-fluocinolone) CD PA; QL

podofilox external CD QL

PROCTOFOAM HC (hydrocortisone ace-pramoxine) CD PA

QBREXZA (glycopyrronium tosylate) CD PA; QL

QUTENZA KIT (capsaicin-cleansing gel) NP PA

SILVADENE (silver sulfadiazine) CD PA; QL

silver sulfadiazine external CD QL

SORILUX (calcipotriene) CD PA; QL

SSD (silver sulfadiazine) CD QL

TACLONEX (calcipotriene-betameth diprop) CD PA; QL

VECTICAL (calcitriol) CD PA; QL

VEREGEN (sinecatechins) CD PA; QL

XERESE (acyclovir-hydrocortisone) NP PA; QL

ZYCLARA (imiquimod) CD PA; QL

ZYCLARA PUMP (imiquimod) CD PA; QL

Pediculicides/Scabicides

ivermectin external cream, lotion CD PA; QL

lice treatment creme rinse P OTC

lice treatment external liquid 1 % P OTC

lice treatment external lotion 1 % P OTC

63


lindane lotion/shampoo NP PA; QL

malathion NP PA; QL

NATROBA (spinosad) P QL

OVIDE (malathion) NP PA; QL

permethrin external P QL

SOOLANTRA (ivermectin) cream CD PA; QL

spinosad NP PA; QL

Topical Anti-infectives

AMZEEQ (minocycline hcl micronized) NP PA; QL

CENTANY (mupirocin) NP PA; QL

CENTANY AT (mupirocin) NP PA

CLEOCIN-T (clindamycin phosphate) NP PA; QL

clindacin etz external swab P QL

clindacin-p P QL

CLINDAGEL (clindamycin phosphate) NP PA; QL

clindamycin phosphate external foam NP PA; QL

clindamycin phosphate external lotion P QL

clindamycin phosphate external solution P QL

clindamycin phosphate external swab P QL

CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL NP PA; QL

clindamycin phosphate gel 1 % external P QL

dapsone external gel 5 %, 7.5% NP PA; QL

ERYGEL (erythromycin) NP PA; QL

erythromycin external P QL

EVOCLIN (clindamycin phosphate) NP PA; QL

gentamicin sulfate external cream, ointment CD QL

KLARON (sulfacetamide sodium (acne)) NP PA; QL

mafenide acetate external CD PA

mupirocin calcium cream NP PA; QL

mupirocin ointment P QL

sulfacetamide sodium (acne) NP PA; QL

SULFAMYLON (mafenide acetate) CD PA

XEPI (ozenoxacin) NP PA; QL

DIABETES - GLUCOSE MONITORING

ACCU-CHEK AVIVA DEVICE (blood glucose calibration) CD OTC; QL

ACCU-CHEK AVIVA PLUS STRIP IN VITRO (glucose blood) P OTC; QL

ACCU-CHEK COMPACT PLUS P OTC; QL

ACCU-CHEK FASTCLIX LANCET KIT (lancets misc.) CD OTC; QL

ACCU-CHEK GUIDE TEST STRIPS (blood glucose monitoring suppl)

P OTC; QL

64


ACCU-CHEK GUIDE CONTROL (blood glucose calibration) CD OTC; QL

ACCU-CHECK GUIDE ME P OTC; QL

ACCU-CHEK LINKASSIST (insulin pump accessories) CD

ACCU-CHEK SMARTVIEW (glucose blood) P OTC; QL

ACCU-CHEK SMARTVIEW CONTROL (blood glucose calibration)

CD OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT (lancets misc.) CD OTC; QL

ACCU-CHEK SPIRIT COMBO PACK (insulin pump accessories) CD OTC

PRECISION XTRA DEVICE (blood glucose monitoring suppl) NP PA; OTC; QL

PRECISION XTRA KIT (blood glucose monitoring suppl) NP PA; OTC; QL

PRECISION XTRA MONITOR (blood glucose monitoring suppl) NP PA; OTC; QL

ONETOUCH VERIO IN VITRO SOLUTION HIGH (blood glucose calibration)

CD OTC

TRUE METRIX AIR GLUCOSE METER DEVICE (blood glucose monitoring suppl)

NP PA; OTC; QL

CHEMSTRIP (multiple urine tests) CD OTC

COMFORT TOUCH LANCETS 31G (lancets) CD OTC; QL

COMFORT TOUCH PLUS LANCETS 30G (lancets) CD OTC; QL

CONTOUR MONITOR (blood glucose monitoring suppl) P OTC; QL

CONTOUR NEXT MONITOR KIT W/DEVICE (blood glucose monitoring suppl)

P OTC; QL

CONTOUR NEXT TEST STRIPS (glucose blood) P OTC; QL

CONTOUR TEST STRIPS (glucose blood) P OTC; QL

CONTOUR CONTROL SOLUTION (blood glucose calibration) CD OTC

CONTOUR MONITOR (blood glucose monitoring suppl) P OTC; QL

CONTOUR NEXT ONE KIT (blood glucose monitoring suppl) P OTC; QL

DEXCOM G6 RECEIVER P QL

DEXCOM G6 SENSOR P QL

DEXCOM G6 TRANSMITTER P QL

DEXCOM G5 MOBILE RECEIVER NP PA; QL

DEXCOM G5 MOBILE/G4 PLATINUM SENSOR NP PA; QL

DEXCOM G4 PLATINUM RECEIVER NP PA; QL

DEXCOM G4 PLATINUM TRANSMITTER NP PA; QL

DEXCOM G5 RECEIVER NP PA; QL

FORA G20 BLOOD GLUCOSE MONITOR NP PA; OTC; QL

FORA G20 BLOOD GLUCOSE TEST STRIPS NP PA; OTC; QL

FREESTYLE FREEDOM NP PA; OTC; QL

FREESTYLE FREEDOM LITE NP PA; OTC; QL

FREESTYLE INSULINX BLOOD GLUCOSE MONITOR NP PA; OTC; QL

FREESTYLE INSULINX TEST STRIPS NP PA; OTC; QL

65


FREESTYLE LIBRE 14 DAY READER (continuous blood gluc receiver)

P QL

FREESTYLE LIBRE 14 DAY SENSOR (continuous blood gluc sensor)

P QL

FREESTYLE LIBRE 2 READER (continuous blood gluc receiver) P QL

FREESTYLE LIBRE 2 SENSOR (continuous blood gluc sensor) P QL

FREESTYLE LITE BLOOD GLUCOSE MONITOR NP PA; OTC; QL

FREESTYLE LITE TEST STRIPS NP PA; OTC; QL

FREESTYLE PRECISION NEO SYSTEM (blood glucose monitoring suppl)

NP PA; OTC; QL

FREESTYLE PRECISION NEO TEST (glucose blood) NP PA; OTC; QL

FREESTYLE TEST STRIPS NP PA; OTC; QL

GLUCOCARD 01 BLOOD GLUCOSE METER NP PA; OTC; QL

GLUCOCARD 01 SENSOR PLUS TEST STRIPS NP PA; OTC; QL

GLUCOCARD 01-MINI BLOOD GLUCOSE MONITORING SYSTEM

NP PA; OTC; QL

GLUCOCARD EXPRESSION BLOOD GLUCOSE METER NP PA; OTC; QL

GLUCOCARD EXPRESSION BLOOD GLUCOSE TEST STRIPS NP PA; OTC; QL

GLUCOCARD SHINE BLOOD GLUCOSE METER NP PA; OTC; QL

GLUCOCARD SHINE CONNEX BLOOD GLUCOSE MONITOR NP PA; OTC; QL

GLUCOCARD SHINE EXPRESS BLOOD GLUCOSE MONITOR NP PA; OTC; QL

GLUCOCARD SHINE TEST STRIPS NP PA; OTC; QL

GLUCOCARD SHINE XL NP PA; OTC; QL

KETO-DIASTIX (urine glucose-ketones test) CD OTC; QL

KETONE TEST CD OTC; QL

KETOSTIX (acetone (urine) test) CD OTC; QL

ONETOUCH ULTRA TEST STRIPS (glucose blood) NP PA; OTC; QL

ONETOUCH ULTRA 2 KIT W/DEVICE (blood glucose monitoring suppl)

NP PA; OTC; QL

ONETOUCH ULTRA CONTROL (blood glucose calibration) CD OTC; QL

ONETOUCH ULTRA MINI KIT W/DEVICE (blood glucose monitoring suppl)

NP PA; OTC; QL

ONETOUCH VERIO KIT W/DEVICE (blood glucose monitoring suppl)

NP PA; OTC; QL

ONETOUCH VERIO FLEX SYSTEM (blood glucose monitoring suppl)

NP PA; OTC; QL

ONETOUCH VERIO IN VITRO SOLUTION (blood glucose calibration)

CD OTC; QL

ONETOUCH VERIO TEST STRIPS (glucose blood) NP PA; OTC; QL

ONETOUCH VERIO IQ SYSTEM (blood glucose monitoring suppl)

NP PA; OTC; QL

ONETOUCH VERIO REFLECT (blood glucose monitoring suppl) NP PA; OTC; QL

66


PRECISION XTRA BLOOD GLUCOSE (glucose blood) NP PA; OTC; QL

PRECISION XTRA KIT W/DEVICE (blood glucose monitoring suppl)

NP PA; OTC; QL

PRODIGY AUTOCODE BLOOD GLUCOSE MONITOR NP PA; OTC; QL

PRODIGY NO CODING BLOOD GLUCOSE TEST STRIPS NP PA; OTC; QL

PRODIGY POCKET BLOOD GLUCOSE METER NP PA; OTC; QL

PRODIGY VOICE BLOOD GLUCOSE METER NP PA; OTC; QL

TRUE METRIX AIR GLUCOSE METER KIT (blood glucose monitoring suppl)

NP PA; OTC; QL

TRUE METRIX BLOOD GLUCOSE TEST STRIPS NP PA; OTC; QL

TRUE METRIX GO GLUCOSE METER (blood glucose monitoring suppl)

NP PA; OTC; QL

TRUE METRIX METER KIT (blood glucose monitoring suppl) NP PA; OTC; QL

TRUE METRIX PRO GLUCOSE TEST STRIPS NP PA; OTC; QL

WAVESENSE AMP BLOOD GLUCOSE MONITOR KIT NP PA; OTC; QL

ONETOUCH SURESOFT LANCING DEVICE (lancets misc.) CD OTC; QL

ELECTROLYTES/MINERALS/METALS/VITAMINS

Electrolyte/Mineral Replacement - Vitamin, Mineral and Body Fluid Deficiency Drugs

calcium carbonate tablet 500mg, 600mg CD OTC

calcium citrate tablet 200mg CD PA; OTC

calcium tablet 500mg (oyster shell) CD OTC

calcium carbonate – vitamin D tablet (250-125, 500-125, 500- 200, 600-125, 600-200, 600-400)

CD OTC

calcium citrate – vitamin D tablet (315-200, 315-250) CD OTC

calcium-magnesium-zinc tablet (333-133-5) CD OTC

CALTRATE + D (600-800) CD OTC

folic acid tablet (400mcg, 800mcg, 1mg) CD OTC/RX

ferrous fumarate oral tablet 324MG (106MG elemental) CD OTC

ferrous gluconate oral tablet 324MG (38MG elemental) CD OTC

ferrous sulfate oral tablet 325MG (65MG elemental) CD OTC

ferrous sulfate elixir 220MG/5ML (44MG/5ML elemental) CD OTC

multi vit/fluoride chewable tablets 0.25mg, 0.5mg, 1mg CD

cyanocobalamin injection solution 1000 mcg/ml CD QL

magnesium oxide tablet (250mg, 400mg, 500mg) CD OTC

One-A-Day Multivitamin CD OTC

multivitamin tablet CD OTC

multivitamin tablet/iron CD OTC

multivitamin chewable tablet CD OTC

Flinstones chewable tablet CD OTC

niacin er oral capsule extended release P OTC; QL

niacin er oral tablet extended release P OTC

67


niacin oral tablet 100 mg, 250 mg, 50 mg P OTC

tri-vit/fluoride drops 0.25mg, 0.5mg CD

vitamin b12 tablet er 1000mcg CD OTC

vitamin c tablet 100mg, 250mg, 500mg, 1000mg CD OTC

vitamin c chewable tablet 250mg, 500mg CD OTC

vitamin b-1 oral tablet 100 mg CD OTC; QL

vitamin b6 (pyridoxine) CD OTC; QL

vitamin c cr oral tablet extended release 500 mg CD OTC; QL

vitamin c oral tablet 1000 mg, 250 mg, 500 mg CD OTC; QL

vitamin c oral tablet chewable 100 mg, 250 mg, 500 mg CD OTC; QL

vitamin c/rose hips oral tablet 1000 mg, 500 mg CD OTC; QL

vitamin d3 oral capsule/tablet (400U, 1000U, 2000U, 4000U, 5000U, 10000U

CD OTC; QL

vitamin d3 chewable tablet (400U, 1000U) CD OTC

vitamin d3 oral liquid (400U/ml, 400U/0.03ml, 2000U/0.03ml) CD

vitamin e oral capsule 100 unit, 1000 unit, 200 unit, 450 mg CD OTC

vitamin e oral capsule 400 unit CD OTC; QL

zinc oral tablet 50 mg CD OTC; QL

zinc sulfate oral tablet 220 (50 zn) mg CD OTC

ORALYTE freezer pops CD OTC; QL

ORALYTE electrolyte solution CD OTC; QL

PEDIALYTE FREEZER POPS (oral electrolytes) CD OTC; QL

PEDIALYTE ORAL SOLUTION (oral electrolytes) CD OTC; QL

PEDIALYTE SINGLES (oral electrolytes) CD OTC; QL

Electrolyte/Mineral Replacement

CARBAGLU (carglumic acid) CD PA; SP

DENTA 5000 PLUS (sodium fluoride) CD QL

DENTAGEL (sodium fluoride) CD

ENDARI (glutamine (sickle cell)) P PA; QL

klor-con CD QL

K-TAB (potassium chloride) CD QL

potassium chloride crys er oral tablet extended release 10 meq, 20 meq

CD QL

potassium chloride er CD QL

potassium chloride oral packet CD QL

potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%)

CD QL

potassium citrate er oral tablet extended release 10 meq (1080 mg)

CD QL

potassium citrate er oral tablet extended release 15 meq (1620 mg), 5 meq (540 mg)

CD

68


sodium fluoride 5000 plus CD QL

sodium fluoride 5000 sensitive CD

sodium fluoride dental gel CD

sodium fluoride mouth/throat CD

sodium fluoride oral solution 1.1 (0.5 f) mg/ml CD QL

sodium fluoride oral tablet chewable CD QL

UROCIT-K (potassium citrate) CD QL

Electrolyte/Mineral/Metal Modifiers

CHEMET (succimer) CD QL

clovique CD SP

deferasirox granules CD PA; SP; QL

deferasirox oral packet CD PA; SP; QL

deferasirox oral tablet CD PA; SP; QL

deferasirox oral tablet soluble CD PA; SP

deferiprone CD SP; QL

EXJADE (deferasirox) CD PA; SP

FERRIPROX ORAL SOLUTION (deferiprone) CD PA; SP

FERRIPROX ORAL TABLET (deferiprone) CD PA; SP; QL

FERRIPROX TWICE-A-DAY (deferiprone) CD PA; SP; QL

JADENU (deferasirox) CD PA; SP; QL

JADENU SPRINKLE (deferasirox) CD PA; SP; QL

JYNARQUE ORAL TABLET (tolvaptan) CD PA; SP

JYNARQUE ORAL TABLET THERAPY PACK (tolvaptan) CD PA; SP; QL

SAMSCA (tolvaptan) CD PA; SP

SYPRINE (trientine hcl) CD PA; SP

TOLVAPTAN ORAL TABLET 15 MG CD PA; SP

tolvaptan oral tablet CD PA; SP

trientine hcl CD PA; SP

Phosphate Binders

AURYXIA (ferric citrate) NP PA; QL

calcium acetate capsule (phos binder) P QL

calcium acetate oral tablet 667 mg P QL

FOSRENOL ORAL PACKET (lanthanum carbonate) NP PA; QL

FOSRENOL ORAL TABLET CHEWABLE (lanthanum carbonate) NP PA

lanthanum carbonate NP PA

PHOSLYRA (calcium acetate (phos binder)) P QL

RENAGEL (sevelamer hcl) NP PA; QL

RENVELA (sevelamer carbonate) NP PA; QL

sevelamer carbonate oral packet NP PA; QL

69


sevelamer carbonate oral tablet P QL

sevelamer hcl tablet NP PA; QL

VELPHORO (sucroferric oxyhydroxide) NP PA; QL

Potassium Binders

LOKELMA (sodium zirconium cyclosilicate) CD PA; QL

sodium polystyrene sulfonate CD PA

sps CD QL

VELTASSA (patiromer sorbitex calcium) CD PA; QL

Prenatal Vitamins

CITRANATAL 90 DHA (prenat w/o a-fecbgl-dss-fa-dha) CD QL

CITRANATAL ASSURE (prenat w/o a-fecbgl-dss-fa-dha) CD QL

CITRANATAL B-CALM (prenat w/o a fecbnfeglu-fa &b6) CD

CITRANATAL BLOOM (prenatal-dss-fecb-fegl-fa) CD QL

CITRANATAL BLOOM DHA (prenat w/o a-fecbgl-dss-fa-dha) CD QL

CITRANATAL DHA (prenat w/o a-fecbgl-dss-fa-dha) CD QL

CITRANATAL HARMONY (prenat-fefmcb-dss-fa-dha w/o a) CD

CITRANATAL RX (prenat w/o a-fecb-fegl-dss-fa) CD QL

C-NATE DHA CD

COMPLETE NATAL DHA CD QL

COMPLETENATE CD QL

ELITE-OB (prenatal vit-iron carbonyl-fa) CD

ENBRACE HR (prenat vit-fe gly cys-fa-omega) CD

M-NATAL PLUS CD QL

NESTABS (prenat-fe bisgly-fa-w/o vit a) CD PA; QL

NESTABS DHA (prenat-w/oa-fe bisgly-fa-omega) CD PA

NESTABS ONE (prenat-fe-methylfol-dha w/o a) CD PA; QL

NIVA-PLUS (prenatal vit-fe fumarate-fa) CD QL

OB COMPLETE (prenatal vit-iron carbonyl-fa) CD PA

OB COMPLETE ONE (prenat-fecbn-feaspgl-fa-fish) CD PA

OB COMPLETE PETITE (prenat-fecbn-feaspgl-fa-omega) CD PA

OB COMPLETE PREMIER (prenatal-fe cbn-fe asp gly-fa) CD PA

OB COMPLETE/DHA (prenat-fecbn-feaspgl-fa-omega) CD PA

pnv tabs 29-1 CD QL

pnv-dha CD PA

pnv-dha+docusate CD PA

pnv-omega CD PA

pnv-select CD PA

PRENAISSANCE CD PA

PRENAISSANCE PLUS CD PA

70


prenatal oral tablet 27-1 mg CD QL

prenatal vitamin plus low iron CD QL

PRENATE (prenat mv-min-methylfolate-fa) CD PA

PRENATE AM (prenatal ca-b6-b12-fa-ginger) CD PA

PRENATE DHA (prenat-feasp-meth-fa-dha w/o a) CD PA

PRENATE ELITE (prenatal-feaspgly-methylfol-fa) CD PA

PRENATE ENHANCE (prenat w/o a-fe-methfol-fa-dha) CD PA

PRENATE ESSENTIAL (prenat-feasp-meth-fa-dha w/o a) CD PA

PRENATE MINI (prenat-fecbn-feasp-meth-fa-dha) CD PA

PRENATE PIXIE (prenat-feasp-meth-fa-dha w/o a) CD PA

PRENATE RESTORE (prenat w/o a-fe-methfol-fa-dha) CD PA

preplus CD QL

PRETAB CD QL

PRIMACARE (pren-fe-meth-fa-omeg w/o a) CD QL

SELECT-OB ORAL TABLET CHEWABLE 29-0.6-0.4 MG (prenat vit-fepoly-methylfol-fa)

CD PA

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG (prenatal vit- fe psac cmplx-fa)

CD PA; QL

SELECT-OB+DHA (prenatal vit-fepoly-fa-dha) CD PA; QL

SE-NATAL 19 CD PA; QL

TARON-C DHA (prenat-fefum-fepo-fa-omega 3) CD PA

TARON-PREX (prenat-fefum-dss-fa-dha w/o a) CD PA

TRICARE (prenatal vit-fe fumarate-fa) CD QL

TRICARE PRENATAL DHA ONE (prenatal-fefum-fa-dss-fish oil) CD PA

TRINATAL RX 1 CD QL

TRISTART DHA CD PA

TRISTART ONE (prenat w/o a-fecbn-meth-fa-dha) CD PA; QL

virt-c dha CD PA

virt-caps CD

virt-gard CD PA

virt-nate dha CD PA

virt-pn dha CD PA

virt-pn plus CD PA

VITAFOL FE+ (prenat-fe poly-methfol-fa-dha) CD PA; QL

VITAFOL GUMMIES (prenatal vit-fe phos-fa-omega) CD PA

VITAFOL STRIPS (prenatal-b6-b12-d3-folic acid) CD PA; QL

VITAFOL ULTRA (prenat-fe poly-methfol-fa-dha) CD PA; QL

VITAFOL-OB (prenatal vit-fe fumarate-fa) CD PA; QL

VITAFOL-OB+DHA (prenatal mv-min-fe fum-fa-dha) CD PA; QL

VITAFOL-ONE (prenatal vit-fepoly-fa-dha) CD PA

71


vp-pnv-dha CD PA

westab mini CD PA

WESTAB PLUS CD QL

WESTGEL DHA CD PA

ZATEAN-PN DHA (prenat w/o a-fe-methfol-fa-dha) CD PA

ZATEAN-PN PLUS (prenat w/o a-fe-methf-fa-omega) CD PA

ENZYME INHIBITORS - CHEMOTHERAPY AGENTS


SCEMBLIX TABLET 20 MG, 40 MG (asciminib hcl) CD PA; SP; QL

TRUSELTIQ (infigratinib phosphate) CD PA; SP; QL

ESTROGENS - HORMONE REPLACEMENT/MODIFYING DRUGS

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones

MYFEMBREE (relugolix-estradiol-norethind) CD PA; QL

NEXTSTELLIS (drospirenone-estetrol) CD PA; QL

GASTROINTESTINAL AGENTS - DRUGS TO TREAT BOWEL, INTESTINE AND STOMACH CONDITIONS

Antispasmodics, Gastrointestinal - Bowel Treatment Drugs

belladonna alkaloids-opium CD PA; QL

Gastrointestinal Agents, Other - Miscellaneous Gastrointestinal Drugs

acid gone CD OTC

acidophilus probiotic oral tablet , 0.5 mg CD OTC

ACTIPHLORA (probiotic product) CD PA; OTC; QL

advanced antacid max st CD OTC; QL

almacone double strength CD OTC; QL

alum & mag hydroxide-simeth CD OTC; QL

alumina-magnesia-simethicone CD OTC; QL

alvimopan CD PA

antacid & anti-gas oral suspension 200-200-20 mg/5ml, 400-400- 40 mg/5ml

CD OTC; QL

antacid advanced CD OTC; QL

antacid anti-gas max strength CD OTC; QL

antacid calcium CD OTC

antacid extra strength oral tablet chewable 160-105 mg, 750 mg CD OTC

antacid maximum strength CD OTC; QL

antacid oral tablet chewable 500 mg CD OTC

antacid plus anti-gas relief CD OTC; QL

antacid regular strength oral suspension CD OTC; QL

antacid regular strength oral tablet chewable CD OTC

antacid ultra strength oral tablet chewable 1000 mg CD OTC

72


antacid/anti-gas CD OTC; QL

anti-diarrheal anti-gas CD OTC

BACICAP CD PA; OTC; QL

bismatrol oral tablet chewable CD OTC; QL

bismuth subsalicylate oral suspension CD OTC

BYLVAY CAP 200 MCG (odevixibat pellets cap sprinkle) CD PA; SP; QL

BYLVAY CAP 400 MCG, 1200 MCG (odevixibat) CD PA; SP; QL

calcium antacid ex st oral tablet chewable 750 mg CD OTC

calcium carbonate antacid oral suspension CD OTC; QL

digestive probiotic oral capsule CD OTC

enema ready-to-use CD OTC

enema rectal enema 16-6 gm/133ml, 7-19 gm/118ml CD OTC

FLEET ENEMA (sodium phosphates) CD OTC

gas relief extra strength oral capsule 125 mg CD OTC

gas relief extra strength oral tablet chewable 125 mg CD OTC

gas relief infants drops oral suspension 20 mg/0.3ml CD OTC

gas relief oral capsule 180 mg CD OTC

lactobacillus oral tablet CD OTC

LIVMARLI SOL 9.5 MG/ML (maralixibat chloride oral soln) CD PA; SP; QL

mag-al plus CD OTC; QL

mag-al plus xs CD OTC; QL

milk of magnesia CD OTC

milk of magnesia concentrate CD PA; OTC

mintox maximum strength CD OTC; QL

mintox plus CD OTC

pink bismuth oral tablet chewable 262 mg CD OTC; QL

PROMELLA IN PREBIOTIC CD PA; QL

quad-probiotic CD PA; OTC; QL

saccharomyces boulardii CD OTC

simethicone drops infants CD OTC

simethicone oral tablet chewable 80 mg CD OTC

simethicone ultra strength CD OTC

sodium bicarbonate oral tablet CD OTC

stomach relief extra strength CD OTC

stomach relief oral suspension 262 mg/15ml, 525 mg/30ml CD OTC

stomach relief oral tablet chewable 262 mg CD OTC; QL

Laxatives - Bowel Treatment Drugs

clearlax oral powder 17 gm/scoop CD OTC; QL

COLACE (docusate sodium) CD OTC; QL

docusate sodium oral capsule CD OTC; QL

73


docusate sodium oral liquid 50 mg/5ml CD OTC; QL

docusate sodium oral tablet CD PA; OTC

DOCUSOL MINI (docusate sodium) CD OTC; QL

dok oral capsule CD OTC; QL

dok oral tablet CD PA; OTC

enema mineral oil CD OTC

ENEMEEZ MINI (docusate sodium) CD OTC; QL

fiber laxative CD OTC

fiber laxative + calcium CD OTC

fiber oral tablet 625 mg CD OTC

fiber-caps CD OTC

fiber-lax CD OTC

FLEET OIL (mineral oil) CD OTC

gavilax oral powder CD OTC; QL

glycolax CD OTC; QL

KONSYL DAILY FIBER ORAL POWDER 100 % CD OTC

konsyl daily fiber oral powder 28.3 % CD OTC; QL

mineral oil oral oil CD OTC

mineral oil rectal enema CD OTC

natural fiber oral powder 48.57 % CD OTC

natura-lax CD OTC; QL

PEDIA-LAX ORAL LIQUID (docusate sodium) CD OTC

polyethylene glycol 3350 oral powder CD OTC; QL

silace oral liquid CD OTC; QL

silace oral syrup CD OTC

sorbitol oral CD OTC

stool softener laxative oral capsule CD OTC; QL

stool softener oral capsule 100 mg CD OTC; QL

stool softener oral tablet 100 mg CD OTC

SUTAB (sodium sulfate-mag sulfate-kcl) CD PA

Laxatives - Drugs to treat Constipation

chocolated laxative CD OTC

docusate calcium CD OTC

fiber laxative oral tablet 500 mg CD OTC

fiber oral tablet 500 mg CD OTC

fiber therapy oral tablet 500 mg CD OTC

FLEET PEDIATRIC (sodium phosphates) CD OTC

glycerin (adult) rectal suppository 2 gm CD OTC

glycerin adult CD PA; OTC

glycerin child rectal suppository 1.2 gm CD OTC

74


glycerin childrens CD OTC

glycerin pediatric rectal suppository 1.2 gm CD OTC

laxative max str CD OTC

laxative regular strength CD OTC

magnesium citrate oral solution CD OTC; QL

natural vegetable laxative oral tablet 8.6 mg CD PA; OTC

PEDIA-LAX RECTAL SUPPOSITORY 1 GM (glycerin (laxative)) CD OTC

senexon-s CD OTC

senna lax CD OTC

senna laxative CD OTC

senna oral CD OTC

senna plus oral tablet CD OTC

senna-lax CD OTC

senna-s CD OTC

senna-time CD OTC

senna-time s CD OTC

sennazon CD OTC

SENOKOT (sennosides) CD OTC

SENOKOT EXTRA STRENGTH (sennosides) CD PA; OTC

SENOKOT S (sennosides-docusate sodium) CD OTC

soluble fiber therapy CD OTC

stimulant laxative CD OTC

stool softener oral capsule 240 mg CD OTC

stool softener oral tablet 8.6-50 mg CD OTC

stool softener pls laxative CD OTC

stool softener plus laxative CD OTC

stool softener/laxative oral tablet 8.6-50 mg CD OTC

vegetable lax+stool softener CD OTC

GASTROINTESTINAL AGENTS

Anti-Constipation Agents

AMITIZA (lubiprostone) CD PA; QL

constulose CD QL

enulose CD QL

generlac CD QL

KRISTALOSE (lactulose) CD QL

lactulose encephalopathy CD QL

lactulose oral solution CD QL

LINZESS (linaclotide) CD PA; QL

LUBIPROSTONE CD PA; QL

MOTEGRITY (prucalopride succinate) CD PA; QL

75


MOVANTIK (naloxegol oxalate) CD PA; QL

RELISTOR (methylnaltrexone bromide) CD PA; QL

SYMPROIC (naldemedine tosylate) CD PA; QL

TRULANCE (plecanatide) CD PA; QL

Anti-Diarrheal Agents

alosetron hcl CD

anti-diarrheal oral liquid 1 mg/7.5ml CD OTC

anti-diarrheal oral tablet 2 mg CD OTC

diphenoxylate-atropine CD QL

LOMOTIL (diphenoxylate-atropine) CD PA; QL

loperamide hcl oral capsule CD QL

loperamide hcl oral liquid 1 mg/7.5ml CD OTC

loperamide hcl oral tablet CD OTC

LOTRONEX (alosetron hcl) CD PA

MOTOFEN (difenoxin-atropine) CD QL

MYTESI (crofelemer) CD PA; QL

opium CD QL

VIBERZI (eluxadoline) CD QL

XERMELO (telotristat etiprate) CD SP; QL

Antispasmodics, Gastrointestinal

chlordiazepoxide-clidinium CD QL

CUVPOSA (glycopyrrolate) CD PA; QL

dicyclomine hcl oral capsule CD QL

dicyclomine hcl oral solution CD

dicyclomine hcl oral tablet CD QL

glycopyrrolate oral CD

LIBRAX (chlordiazepoxide-clidinium) CD PA; QL

methscopolamine bromide oral CD

Gastrointestinal Agents, Other

amoxicill-clarithro-lansopraz CD QL

CHENODAL (chenodiol) CD PA; SP

CLENPIQ (sod picosulfate-mag ox-cit acd) CD PA; QL

GATTEX (teduglutide (rdna)) CD PA; SP; QL

gavilyte-c CD QL

gavilyte-g CD QL

gavilyte-n with flavor pack CD QL

GOLYTELY (peg 3350-kcl-nabcb-nacl-nasulf) CD QL

HELIDAC THERAPY (metronid-tetracyc-bis subsal) CD

MOVIPREP (peg-kcl-nacl-nasulf-na asc-c) CD PA; QL

MYALEPT (metreleptin) CD PA; SP; QL

76


NULYTELY LEMON-LIME (peg 3350-kcl-na bicarb-nacl) CD QL

OCALIVA (obeticholic acid) CD PA; SP; QL

OMECLAMOX-PAK (amoxicill-clarithro-omeprazole) CD

OSMOPREP (sod phos mono-sod phos dibasic) CD QL

peg 3350-kcl-na bicarb-nacl CD QL

peg-3350/electrolytes CD QL

peg-3350/electrolytes/ascorbat CD QL

peg-kcl-nacl-nasulf-na asc-c CD QL

PLENVU (peg-kcl-nacl-nasulf-na asc-c) CD QL

PYLERA (bis subcit-metronid-tetracyc) CD

RELTONE (ursodiol) CD QL

SUPREP BOWEL PREP KIT (na sulfate-k sulfate-mg sulf) CD Pal QL

TALICIA (amoxicill-rifabutin-omeprazole) CD QL

URSO 250 (ursodiol) CD

URSO FORTE (ursodiol) CD

ursodiol oral capsule 300 mg CD QL

ursodiol oral tablet CD

Histamine2 (H2) Receptor Antagonists

acid controller oral tablet 10 mg CD OTC; QL

acid reducer oral tablet 10 mg CD OTC; QL

acid reducer oral tablet 200 mg CD OTC

cimetidine hcl CD

cimetidine oral tablet 200 mg CD

cimetidine oral tablet 300 mg, 400 mg, 800 mg CD QL

famotidine oral suspension reconstituted 40 mg/5ml CD QL; AL

famotidine oral tablet 10 mg CD OTC; QL

famotidine oral tablet 20 mg, 40 mg CD QL

famotidine orig st CD OTC; QL

heartburn relief CD OTC; QL

nizatidine oral capsule CD

nizatidine oral solution CD QL

PEPCID (famotidine) CD PA; QL

Protectants

CARAFATE (sucralfate) CD PA; QL

CYTOTEC (misoprostol) CD PA; QL

misoprostol oral CD QL

sucralfate oral CD QL

Proton Pump Inhibitors

ACIPHEX (rabeprazole sodium) NP PA; QL

77


ACIPHEX SPRINKLE (rabeprazole sodium) NP PA; QL

DEXILANT (dexlansoprazole) NP PA; QL

esomeprazole magnesium oral capsule delayed release P QL

esomeprazole magnesium oral packet NP PA; QL; AL

lansoprazole oral capsule delayed release 15mg, 30 mg P QL

lansoprazole oral tablet delayed release dispersible NP PA; QL; AL

NEXIUM ORAL CAPSULE DELAYED RELEASE (esomeprazole magnesium)

NP PA; QL

NEXIUM ORAL PACKET (esomeprazole magnesium) P QL; AL

omeprazole magnesium CD OTC; QL

omeprazole oral capsule delayed release 10 mg, 20 mg, 40 mg P QL

omeprazole oral tablet delayed release 20 mg CD OTC; QL

omeprazole-sodium bicarbonate NP PA; QL

pantoprazole sodium oral packet NP PA; QL

pantoprazole sodium oral tablet delayed release P QL

PREVACID (lansoprazole) NP PA; QL

PREVACID SOLUTAB (lansoprazole) NP PA; QL; AL

PRILOSEC (omeprazole magnesium) NP PA; QL

PROTONIX ORAL (pantoprazole sodium) NP PA; QL

rabeprazole sodium oral tablet delayed release NP PA; QL

ZEGERID (omeprazole-sodium bicarbonate) NP PA; QL

GENETIC OR ENZYME OR PROTEIN DISORDER: REPLACEMENT, MODIFIERS, TREATMENT

BUPHENYL ORAL POWDER (sodium phenylbutyrate) CD PA; SP

BUPHENYL ORAL TABLET (sodium phenylbutyrate) CD PA; SP; QL

CARNITOR ORAL SOLUTION (levocarnitine) CD PA; QL

CARNITOR ORAL TABLET (levocarnitine) CD PA

CARNITOR SF (levocarnitine) CD PA; QL

CERDELGA (eliglustat tartrate) CD PA; SP; QL

CHOLBAM (cholic acid) CD PA; SP; QL

CREON (pancrelipase (lip-prot-amyl)) P

cromolyn sodium oral CD PA; QL

CYSTADANE (betaine) CD PA; SP

CYSTAGON (cysteamine bitartrate) CD SP; QL

EVRYSDI (risdiplam) CD PA; SP; QL

GALAFOLD (migalastat hcl) CD PA; SP; QL

GASTROCROM (cromolyn sodium) CD PA; QL

KEVEYIS (dichlorphenamide) CD PA; SP; QL

KUVAN (sapropterin dihydrochloride) CD PA; SP; QL

levocarnitine oral solution CD PA; QL

levocarnitine oral tablet CD PA

78


levocarnitine sf CD QL

miglustat CD PA; SP; QL

nitisinone CD PA; SP; QL

NITYR (nitisinone) CD PA; SP; QL

ORFADIN (nitisinone) CD PA; SP; QL

PALYNZIQ (pegvaliase-pqpz) CD PA; SP; QL

PANCREAZE (pancrelipase (lip-prot-amyl)) NP PA

PERTZYE (pancrelipase (lip-prot-amyl)) NP PA

PROCYSBI (cysteamine bitartrate) CD PA; SP; QL

RAVICTI (glycerol phenylbutyrate) CD PA; SP; QL

sapropterin dihydrochloride CD PA; SP; QL

sodium phenylbutyrate oral powder CD PA; SP

sodium phenylbutyrate oral tablet CD SP; QL

STRENSIQ (asfotase alfa) CD PA; SP

TEGSEDI (inotersen sodium) CD PA; SP; QL

VIOKACE (pancrelipase (lip-prot-amyl)) NP PA

VOXZOGO INJ 0.4 MG, 0.56 MG, 1.2 MG (vosoritide) CD PA; SP; QL

VYNDAMAX (tafamidis) CD PA; SP; QL

VYNDAQEL (tafamidis meglumine (cardiac)) CD PA; SP; QL

ZAVESCA (miglustat) CD PA; SP; QL

ZENPEP (pancrelipase (lip-prot-amyl)) P

GENITOURINARY AGENTS - DRUGS TO TREAT BLADDER, GENITAL AND KIDNEY CONDITIONS

Genitourinary Agents, Other - Miscellaneous Bladder, Genital, and Kidney Conditions Drugs

me/naphos/mb/hyo1 CD PA

OPTIONS GYNOL II CONTRACEPTIVE (nonoxynol-9) CD OTC

phenazopyridine hcl oral tablet 100 mg, 200 mg CD QL

PYRIDIUM (phenazopyridine hcl) CD QL

TRIMO-SAN VAGINAL GEL 0.025-0.01 % (oxyquinoline-sod lauryl sulf)

CD PA; QL

urinary pain relief oral tablet 95 mg CD OTC

URO-458 CD PA

UROGESIC-BLUE (methen-hyosc-meth blue-na phos) CD PA

uro-mp CD PA

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM (nonoxynol- 9)

CD OTC

GENITOURINARY AGENTS

Antispasmodics, Urinary

darifenacin hydrobromide er NP PA; QL

DETROL (tolterodine tartrate) NP PA; QL

79


DETROL LA (tolterodine tartrate) NP PA; QL

DITROPAN XL (oxybutynin chloride) NP PA; QL

flavoxate hcl NP PA

GELNIQUE (oxybutynin chloride) NP PA; QL

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR (mirabegron)

NP PA; QL

oxybutynin chloride er P QL

oxybutynin chloride oral P QL

OXYTROL (oxybutynin) transdermal P QL

solifenacin succinate P QL

tolterodine tartrate P QL

tolterodine tartrate er P QL

TOVIAZ (fesoterodine fumarate) P QL

trospium chloride NP PA; QL

trospium chloride er NP PA; QL

VESICARE (solifenacin succinate) NP PA; QL

VESICARE LS (solifenacin succinate) NP PA; QL

Benign Prostatic Hypertrophy Agents

alfuzosin hcl er P QL

AVODART (dutasteride) NP PA; QL

CARDURA XL (doxazosin mesylate) NP PA

CIALIS ORAL TABLET 5 MG (tadalafil) CD PA; QL

dutasteride oral P QL

dutasteride-tamsulosin hcl NP PA; QL

finasteride oral tablet 5 mg P QL

FLOMAX (tamsulosin hcl) NP PA; QL

JALYN (dutasteride-tamsulosin hcl) NP PA; QL

PROSCAR (finasteride) NP PA; QL

RAPAFLO (silodosin) NP PA; QL

silodosin NP PA; QL

tadalafil oral tablet 5 mg CD PA; QL

tamsulosin hcl P QL

terazosin hcl P QL

Genitourinary Agents, Other

bethanechol chloride oral CD

CUPRIMINE (penicillamine) CD PA; SP

DEPEN TITRATABS (penicillamine) CD PA; SP; QL

ELMIRON (pentosan polysulfate sodium) CD PA; QL

LITHOSTAT (acetohydroxamic acid) CD PA

80


penicillamine oral capsule CD PA; SP

penicillamine oral tablet CD PA; SP; QL

THIOLA (tiopronin) CD PA; SP

THIOLA EC (tiopronin) CD PA; SP; QL

tiopronin oral CD SP

GLYCEMIC AGENTS - DIABETIC DRUGS

Blood Glucose Regulators - Drugs to Regulate Blood Sugar

ZEGALOGUE (dasiglucagon hcl) CD QL

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

ACTHAR (corticotropin) CD PA; SP; QL

ALKINDI SPRINKLE (hydrocortisone) CD QL

CORTEF (hydrocortisone) CD PA; QL

dexamethasone intensol CD

dexamethasone oral elixir CD QL

dexamethasone oral solution CD QL

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 2 mg CD

dexamethasone oral tablet 1.5 mg, 4 mg, 6 mg CD QL

dexamethasone oral tablet therapy pack CD PA

EMFLAZA ORAL SUSPENSION (deflazacort) CD PA; SP; QL

EMFLAZA ORAL TABLET 18 MG, 30 MG (deflazacort) CD PA; SP

EMFLAZA ORAL TABLET 36 MG, 6 MG (deflazacort) CD PA; SP; QL

fludrocortisone acetate oral CD QL

HEMADY (dexamethasone) CD PA; QL

hydrocortisone oral CD PA; QL

MEDROL ORAL TABLET 16 MG, 32 MG, 4 MG, 8 MG (methylprednisolone)

CD PA; QL

MEDROL ORAL TABLET 2 MG (methylprednisolone) CD PA

MEDROL ORAL TABLET THERAPY PACK (methylprednisolone) CD PA; QL

methylprednisolone oral CD QL

MILLIPRED (prednisolone) CD PA; QL

prednisolone syrup (15mg/5ml) CD QL

prednisolone oral solution 6.7mg/5ml (5mg/5ml base) CD QL

prednisolone sodium phosphate oral solution 10 mg/5ml, 20 mg/5ml, 25 mg/5ml

CD PA; QL

prednisolone sodium phosphate oral tablet dispersible CD PA; QL

prednisone oral solution CD QL

prednisone oral tablet CD QL

prednisone oral tablet therapy pack 10 mg (21) CD QL

prednisone oral tablet therapy pack 10 mg (48), 5 mg (21), 5 mg (48)

CD

81


RAYOS (prednisone) CD PA; QL

TAPERDEX 12-DAY (dexamethasone) CD PA; QL

TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG (21) (dexamethasone)

CD PA

TAPERDEX 7-DAY (dexamethasone) CD PA; QL

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY) - DRUGS TO REGULATE HORMONES

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Hormone Replacement/Modifying Drugs

OVIDREL (choriogonadotropin alfa) CD PA

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

chorionic gonadotropin intramuscular CD PA

DDAVP ORAL (desmopressin acetate) CD PA; QL

desmopressin acetate oral CD QL

desmopressin acetate spray CD QL

EGRIFTA SV (tesamorelin acetate) CD PA; SP; QL

GENOTROPIN (somatropin) NP PA; SP

GENOTROPIN MINIQUICK (somatropin) NP PA; SP

HUMATROPE (somatropin) NP PA; SP

INCRELEX (mecasermin) CD PA; SP

NOCDURNA (desmopressin acetate) CD PA; QL

NORDITROPIN FLEXPRO (somatropin) P PA; SP

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED (chorionic gonadotropin)

CD SP

NUTROPIN AQ NUSPIN (somatropin) P PA; SP

OMNITROPE (somatropin) NP PA; SP

pregnyl CD

SAIZEN (somatropin (non-refrigerated)) NP PA; SP

SAIZENPREP (somatropin (non-refrigerated)) NP PA; SP

SEROSTIM (somatropin (non-refrigerated)) NP PA; SP

ZOMACTON (somatropin) NP PA; SP

ZOMACTON (FOR ZOMA-JET 10) (somatropin) NP PA; SP

ZORBTIVE (somatropin (non-refrigerated)) NP PA; SP

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PROSTAGLANDINS)

CERVIDIL (dinoprostone) CD PA

KORLYM (mifepristone) CD PA; SP; QL

methergine CD QL

methylergonovine maleate oral CD QL

PREPIDIL (dinoprostone) CD PA

82


HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS) - DRUGS TO REGULATE HORMONES

Estrogens - Hormone Replacement/Modifying Drugs

TWIRLA (levonorgestrel-eth estradiol) CD PA; QL

Progestins - Hormone Replacement/Modifying Drugs

econtra ez CD OTC; QL

econtra one-step CD OTC; QL

levonorgestrel CD OTC; QL

my choice CD OTC; QL

my way CD OTC; QL

new day CD OTC; QL

opcicon one-step CD OTC; QL

option 2 CD OTC; QL

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

Anabolic Steroids

oxandrolone oral NP PA; QL

Androgens

ANDRODERM (testosterone) P PA; QL

ANDROGEL PUMP (testosterone) P PA; QL

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 25 MG/2.5GM (1%), 50 MG/5GM (1%) (testosterone)

P PA; QL

ANDROGEL TRANSDERMAL GEL 40.5 MG/2.5GM (1.62%) (testosterone)

P PA

danazol oral CD QL

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MG/ML, 200MG/ML (testosterone cypionate)

CD PA; QL

FORTESTA (testosterone) NP PA

JATENZO (testosterone undecanoate) CD PA; QL

METHITEST CD PA; QL

methyltestosterone oral CD PA; QL

NATESTO (testosterone) NP PA; QL

TESTIM (testosterone) NP PA; QL

testosterone cypionate intramuscular solution 100mg/ml, 200 mg/ml

CD QL

testosterone enanthate intramuscular CD PA; QL

testosterone transdermal gel 1.62 %, 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)

NP

PA; QL

testosterone transdermal gel 10 mg/act (2%), 40.5 mg/2.5gm (1.62%)

NP PA

testosterone transdermal solution CD PA; QL

83


VOGELXO (testosterone) NP PA; QL

VOGELXO PUMP (testosterone) NP PA; QL

XYOSTED (testosterone enanthate) CD PA; QL

Estrogens

ACTIVELLA (estradiol-norethindrone acet) CD PA; QL

afirmelle CD QL

ALORA (estradiol) CD PA; QL

altavera CD QL

alyacen 1/35 CD QL

alyacen 7/7/7 CD QL

amabelz oral tablet 0.5-0.1 mg CD PA

amabelz oral tablet 1-0.5 mg CD PA; QL

amethia CD PA; QL

amethyst CD PA; QL

ANGELIQ (drospirenone-estradiol) CD PA

ANNOVERA (segesterone-ethinyl estradiol) CD PA; QL

apri CD QL

aranelle CD QL

ashlyna CD PA; QL

aubra CD QL

aubra eq CD QL

aurovela 1.5/30 CD QL

aurovela 1/20 CD QL

aurovela 24 fe CD PA; QL

aurovela fe 1.5/30 CD QL

aurovela fe 1/20 CD QL

aviane CD QL

ayuna CD QL

azurette CD QL

BALCOLTRA (levonorgest-eth estrad-fe bisg) CD PA; QL

balziva CD QL

BEYAZ (drospiren-eth estrad-levomefol) CD PA; QL

BIJUVA (estradiol-progesterone) CD PA; QL

blisovi 24 fe CD PA; QL

blisovi fe 1.5/30 CD QL

blisovi fe 1/20 CD QL

briellyn CD QL

camrese CD PA; QL

camrese lo CD PA; QL

caziant CD QL

84


charlotte 24 fe CD PA; QL

chateal CD QL

chateal eq CD QL

CLIMARA (estradiol) CD QL

CLIMARA PRO (estradiol-levonorgestrel) CD PA

COMBIPATCH (estradiol-norethindrone acet) CD PA; QL

cryselle-28 CD QL

cyclafem 1/35 CD QL

cyclafem 7/7/7 CD QL

cyred CD QL

cyred eq CD QL

dasetta 1/35 CD QL

dasetta 7/7/7 CD QL

daysee CD PA; QL

DELESTROGEN (estradiol valerate) CD PA; QL

DEPO-ESTRADIOL (estradiol cypionate) CD QL

desogestrel-ethinyl estradiol CD QL

DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.75 MG/0.75GM, 1.25 MG/1.25GM (estradiol)

CD QL

DIVIGEL TRANSDERMAL GEL 0.5 MG/0.5GM, 1 MG/GM (estradiol)

CD

dolishale CD PA; QL

dotti CD PA; QL

drospiren-eth estrad-levomefol CD PA; QL

drospirenone-ethinyl estradiol CD PA; QL

DUAVEE (conj estrogens-bazedoxifene) CD QL

ELESTRIN (estradiol) CD PA

elinest CD QL

eluryng CD QL

emoquette CD QL

enpresse-28 CD QL

enskyce CD QL

estarylla CD QL

ESTRACE (estradiol) CD PA; QL

estradiol oral CD QL

estradiol transdermal CD QL

estradiol vaginal CD QL

estradiol valerate intramuscular CD QL

estradiol-norethindrone acet oral tablet 0.5-0.1 mg CD PA

estradiol-norethindrone acet oral tablet 1-0.5 mg CD PA; QL

85


ESTRING (estradiol) CD PA; QL

ESTROSTEP FE (norethindron-ethinyl estrad-fe) CD PA; QL

ethynodiol diac-eth estradiol CD QL

etonogestrel-ethinyl estradiol CD QL

EVAMIST (estradiol) CD PA

falmina CD QL

fayosim CD PA; QL

FEMHRT (norethindrone-eth estradiol) CD PA

FEMRING (estradiol acetate) CD QL

femynor CD QL

fyavolv oral tablet 0.5-2.5 mg-mcg CD PA

fyavolv oral tablet 1-5 mg-mcg CD PA; QL

gemmily CD PA; QL

GENERESS FE (norethin-eth estradiol-fe) CD PA; QL

hailey 1.5/30 CD QL

hailey 24 fe CD PA; QL

hailey fe 1.5/30 CD QL

hailey fe 1/20 CD QL

iclevia CD QL

isibloom CD QL

jaimiess CD PA; QL

jasmiel CD PA; QL

jinteli CD PA; QL

jolessa CD QL

juleber CD QL

junel 1.5/30 CD QL

junel 1/20 CD QL

junel fe CD PA; QL

kaitlib fe CD PA; QL

kariva CD QL

kelnor 1/35 CD QL

kelnor 1/50 CD QL

kurvelo CD QL

larin 1.5/30 CD QL

larin 1/20 CD QL

larin 24 fe CD PA; QL

larin fe 1.5/30 CD QL

larin fe 1/20 CD QL

larissia CD QL

layolis fe CD PA; QL

86


leena CD QL

lessina CD QL

levonest CD QL

levonorgest-eth est & eth est CD QL

levonorgest-eth estrad 91-day CD QL

levonorgestrel-ethinyl estrad CD PA; QL

levonorg-eth estrad triphasic CD QL

levora 0.15/30 (28) CD QL

lillow CD QL

LO LOESTRIN FE (norethin-eth estrad-fe biphas) CD PA; QL

LOESTRIN 1.5/30 (21) (norethindrone acet-ethinyl est) CD QL

LOESTRIN 1/20 (21) (norethindrone acet-ethinyl est) CD PA; QL

LOESTRIN FE 1.5/30 (norethin ace-eth estrad-fe) CD PA; QL

LOESTRIN FE 1/20 (norethin ace-eth estrad-fe) CD PA; QL

lojaimiess CD PA; QL

loryna CD PA; QL

LOSEASONIQUE (levonorgest-eth estrad 91-day) CD PA; QL

low-ogestrel CD QL

lo-zumandimine CD PA; QL

lutera CD QL

lyllana CD PA; QL

marlissa CD QL

MENEST (esterified estrogens) CD QL

MENOSTAR (estradiol) CD PA; QL

merzee CD PA; QL

mibelas 24 fe CD PA; QL

microgestin 1.5/30 CD QL

microgestin 1/20 CD QL

microgestin 24 fe CD QL

microgestin fe 1.5/30 CD QL

microgestin fe 1/20 CD QL

mili CD QL

mimvey CD PA; QL

MINASTRIN 24 FE (norethin ace-eth estrad-fe) CD PA; QL

MINIVELLE (estradiol) CD PA; QL

MIRCETTE (desogestrel-ethinyl estradiol) CD PA; QL

mono-linyah CD QL

NATAZIA (estradiol valerate-dienogest) CD PA; QL

necon 0.5/35 (28) CD QL

87


nikki CD PA; QL

norethin ace-eth estrad-fe CD QL

norethindrone acet-ethinyl est CD QL

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg CD PA

norethindrone-eth estradiol oral tablet 1-5 mg-mcg CD PA; QL

norethin-eth estradiol-fe CD QL

norgestimate-eth estradiol CD QL

norgestimate-ethinyl estradiol triphasic CD QL

nortrel 0.5/35 (28) CD QL

nortrel 1/35 (21) CD QL

nortrel 1/35 (28) CD QL

nortrel 7/7/7 CD QL

NUVARING (etonogestrel-ethinyl estradiol) CD PA; QL

nylia 7/7/7 CD QL

nymyo CD QL

ocella CD PA; QL

orsythia CD QL

philith CD QL

pimtrea CD QL

pirmella 1/35 CD QL

pirmella 7/7/7 CD QL

portia-28 CD QL

PREFEST (estradiol-norgestimate) CD PA; QL

PREMARIN ORAL (estrogens conjugated) CD QL

PREMARIN VAGINAL (estrogens, conjugated) CD QL

PREMPHASE (conj estrog-medroxyprogest ace) CD QL

PREMPRO (conj estrog-medroxyprogest ace) CD QL

previfem CD QL

QUARTETTE (levonorgest-eth estrad 91-day) CD PA; QL

reclipsen CD QL

rivelsa CD PA; QL

SAFYRAL (drospiren-eth estrad-levomefol) CD PA; QL

SEASONIQUE (levonorgest-eth estrad 91-day) CD PA; QL

setlakin CD QL

simliya CD QL

simpesse CD PA; QL

sprintec 28 CD QL

sronyx CD QL

syeda CD QL

tarina 24 fe CD PA; QL

88


tarina fe 1/20 CD QL

tarina fe 1/20 eq CD QL

TAYTULLA (norethin ace-eth estrad-fe) CD QL

tilia fe CD QL

tri femynor CD QL

tri-estarylla CD QL

tri-legest fe CD QL

tri-linyah CD QL

tri-lo-estarylla CD PA; QL

tri-lo-marzia CD PA; QL

tri-lo-mili CD PA; QL

tri-lo-sprintec CD PA; QL

tri-mili CD QL

tri-nymyo CD QL

tri-previfem CD QL

tri-sprintec CD QL

trivora (28) CD QL

tri-vylibra CD QL

tri-vylibra lo CD PA; QL

tyblume CD QL

tydemy CD PA; QL

VAGIFEM (estradiol) CD PA; QL

velivet CD QL

vestura CD PA; QL

vienva CD QL

viorele CD QL

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY 0.0375 MG/24HR, 0.05 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR (estradiol)

CD

PA; QL

volnea CD QL

vyfemla CD QL

vylibra CD QL

wera CD QL

wymzya fe CD PA; QL

xulane CD QL

YASMIN 28 (drospirenone-ethinyl estradiol) CD PA; QL

YAZ (drospirenone-ethinyl estradiol) CD PA; QL

yuvafem CD QL

zafemy CD QL

zarah CD PA; QL

89


zovia 1/35 (28) CD QL

zovia 1/35e (28) CD QL

zumandimine CD PA; QL

Progestins

AYGESTIN (norethindrone acetate) CD QL

camila CD QL

CRINONE (progesterone) CD

deblitane CD QL

DEPO-PROVERA (medroxyprogesterone acetate) CD PA; QL

DEPO-SUBQ PROVERA 104 (medroxyprogesterone acetate) CD PA; QL

ELLA (ulipristal acetate) CD PA; QL

errin CD QL

heather CD QL

incassia CD QL

jencycla CD QL

lyleq CD QL

lyza CD QL

medroxyprogesterone acetate intramuscular CD QL

medroxyprogesterone acetate oral CD QL

megestrol acetate oral suspension 40 mg/ml P QL

megestrol acetate oral suspension 625 mg/5ml NP PA; QL

megestrol acetate oral tablet 20 mg P

megestrol acetate oral tablet 40 mg P QL

nora-be CD QL

norethindrone acetate oral CD QL

norethindrone oral CD QL

norlyda CD QL

progesterone intramuscular CD

progesterone oral CD PA; QL

PROMETRIUM (progesterone) CD QL

PROVERA (medroxyprogesterone acetate) CD QL

sharobel CD QL

SLYND (drospirenone) CD PA; QL

tulana CD QL

Selective Estrogen Receptor Modifying Agents

EVISTA (raloxifene hcl) NP PA; QL

OSPHENA (ospemifene) CD PA; QL

raloxifene hcl P QL

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

CYTOMEL (liothyronine sodium) CD PA; QL

90


euthyrox CD QL

levo-t CD QL

LEVOTHYROXINE SODIUM ORAL CAPSULE CD PA; QL

levothyroxine sodium oral tablet CD QL

levoxyl CD QL

liothyronine sodium oral CD QL

SYNTHROID (levothyroxine sodium) CD PA; QL

THYQUIDITY (levothyroxine sodium) CD QL

TIROSINT (levothyroxine sodium) CD PA; QL

unithroid CD QL

HORMONAL AGENTS, SUPPRESSANT (ADRENAL)

ISTURISA (osilodrostat phosphate) CD PA; SP; QL

LYSODREN (mitotane) CD QL

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline CD QL

ELIGARD (leuprolide acetate (6 month)) CD PA; SP; QL

FENSOLVI (6 MONTH) (leuprolide acetate (6 month)) CD PA; SP; QL

leuprolide acetate injection CD PA; SP

LUPANETA PACK COMBINATION KIT 11.25 & 5 MG (leuprolide & norethindrone)

CD PA; SP; QL

LUPANETA PACK COMBINATION KIT 3.75 & 5 MG (leuprolide & norethindrone)

CD PA; SP

LUPRON DEPOT (1-MONTH) (leuprolide acetate) CD PA; SP; QL

LUPRON DEPOT (3-MONTH) (leuprolide acetate (3 month)) CD PA; SP; QL

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG (leuprolide acetate (4 month))

CD PA; SP; QL

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG (leuprolide acetate (6 month))

CD PA; SP; QL

LUPRON DEPOT-PED (1-MONTH) (leuprolide acetate) CD PA; SP; QL

LUPRON DEPOT-PED (3-MONTH) (leuprolide acetate (3 month))

CD PA; SP; QL

MYCAPSSA (octreotide acetate) CD PA; SP; QL

octreotide acetate injection solution 1000 mcg/ml CD SP; QL

octreotide acetate injection solution 200 mcg/ml CD SP

octreotide acetate solution 100 mcg/ml injection CD SP

OCTREOTIDE ACETATE SOLUTION 100 MCG/ML INJECTION CD SP

octreotide acetate solution 50 mcg/ml injection CD SP

OCTREOTIDE ACETATE SOLUTION 50 MCG/ML INJECTION CD SP

octreotide acetate solution 500 mcg/ml injection CD SP; QL

OCTREOTIDE ACETATE SOLUTION 500 MCG/ML INJECTION CD SP; QL

91


ORIAHNN (elagolix-estradiol-norethind) CD PA; QL

ORILISSA (elagolix sodium) CD PA; QL

SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML (octreotide acetate)

CD PA; SP

SANDOSTATIN INJECTION SOLUTION 500 MCG/ML (octreotide acetate)

CD PA; SP; QL

SIGNIFOR (pasireotide diaspartate) CD PA; SP; QL

SOMAVERT (pegvisomant) CD PA; SP; QL

SYNAREL (nafarelin acetate) CD PA

TRIPTODUR (triptorelin pamoate) CD PA; SP; QL

HORMONAL AGENTS, SUPPRESSANT (THYROID) - DRUGS TO SUPPRESS THYROID HORMONES

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Thyroid Replacement Drugs

ARMOUR THYROID (thyroid) CD PA; QL

np thyroid CD PA; QL

HORMONAL AGENTS, SUPPRESSANT (THYROID)

Antithyroid Agents

methimazole oral CD QL

propylthiouracil oral CD QL

TAPAZOLE (methimazole) CD PA; QL

IMMUNE SUPPRESSANTS - IMMUNE SYSTEM DRUGS

Immunological Agents - Drugs that Stimulate or Suppress the Immune System

LUPKYNIS (voclosporin) CD PA; SP; QL

IMMUNOLOGICAL AGENTS - DRUGS THAT STIMULATE OR SUPPRESS THE IMMUNE SYSTEM

Immunizing Agents, Passive - Immune System Drugs

HYPERTET S/D (tetanus immune globulin) CD QL

Vaccines

ADACEL (tetanus-diphth-acell pertussis) CD QL

AFLURIA QUADRIVALENT (influenza vac split quad) CD QL

FLUAD QUADRIVALENT (influenza vac a&b sa adj quad) CD QL

BEXSERO (meningococcal b recomb omv adj) CD QL

BOOSTRIX (tetanus-diphth-acell pertussis) CD QL

COVID-19 VACCINE CD QL

DAPTACEL (diphth-acell pertussis-tetanus) CD QL

DIPHTHERIA-TETANUS TOXOIDS DT CD QL

ENGERIX-B (hepatitis b vac recombinant) CD QL

FLUARIX QUADRIVALENT (influenza vac split quad) CD QL

FLUCELVAX QUADRIVALENT (influenza vac subunit quad) CD QL

FLULAVAL QUADRIVALENT (influenza vac split quad) CD QL

92


HEPLISAV-B (hepatitis b vac recomb adj) CD QL; AL

GARDASIL 9 (hpv 9-valent recomb vaccine) CD QL

HAVRIX (hepatitis a vaccine) CD QL

MENACTRA (meningococcal a c y&w-135 conj) CD QL

MENQUADFI (meningococcal a c y&w-135 conj) CD QL

MENVEO (meningococcal a c y&w-135 olig) CD QL

M-M-R II (measles, mumps & rubella vac) CD QL

PEDIARIX (dtap-hepatitis b recomb-ipv) CD QL

PENTACEL (dtap-ipv-hib vaccine) CD QL

PNEUMOVAX 23 (pneumococcal vac polyvalent) CD QL

PREVNAR 13 (pneumococcal 13-val conj vacc) CD QL

PROQUAD (measles-mumps-rubella-varicell) CD QL

QUADRACEL (dtap-ipv vaccine) CD QL

RECOMBIVAX HB (hepatitis b vac recombinant) CD QL

SHINGRIX (zoster vac recomb adjuvanted) CD QL; AL

TDVAX (tetanus-diphtheria toxoids td) CD QL

TENIVAC (tetanus-diphtheria toxoids td) CD QL

TETANUS-DIPHTHERIA TOXOIDS TD CD QL

TRUMENBA (meningococcal b vac (recomb)) CD QL

TWINRIX (hepatitis a-hep b recomb vac) CD QL

VAQTA (hepatitis a vaccine) CD QL

VARIVAX (varicella virus vaccine live) CD QL

IMMUNOLOGICAL AGENTS

Angioedema Agents

BERINERT (c1 esterase inhibitor (human)) P PA; SP

CINRYZE (c1 esterase inhibitor (human)) NP PA; SP

FIRAZYR (icatibant acetate) NP PA; SP; QL

HAEGARDA (c1 esterase inhibitor (human)) NP PA; SP; QL

icatibant acetate NP PA; SP; QL

KALBITOR (ecallantide) NP PA

RUCONEST (c1 esterase inhibitor (recomb)) NP PA; SP; QL

TAKHZYRO (lanadelumab-flyo) NP PA; SP; QL

Immunological Agents, Other

ACTEMRA ACTPEN (tocilizumab) NP PA; SP; QL

ACTEMRA INTRAVENOUS (tocilizumab) NP PA

ACTEMRA SUBCUTANEOUS (tocilizumab) NP PA; SP; QL

ARCALYST (rilonacept) CD PA; SP; QL

BENLYSTA SUBCUTANEOUS (belimumab) CD PA; SP; QL

COSENTYX SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML (secukinumab)

NP PA; SP; QL

93


COSENTYX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 75MG/0.5ML, 150 MG/ML (secukinumab)

NP PA; SP; QL

DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 MG/2ML (dupilumab)

NP PA; SP; QL

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE (dupilumab)

NP PA; SP; QL

ENTYVIO (vedolizumab) NP PA; QL

ILARIS (canakinumab) NP PA; SP; QL

ILUMYA (tildrakizumab-asmn) NP PA; SP; QL

KEVZARA (sarilumab) NP PA; SP; QL

KINERET (anakinra) NP PA; SP; QL

OLUMIANT (baricitinib) NP PA; SP; QL

ORALAIR (grass mix pollens allergen ext) CD PA; QL

ORENCIA CLICKJECT (abatacept) NP PA; SP; QL

ORENCIA INTRAVENOUS (abatacept) NP PA; QL

ORENCIA SUBCUTANEOUS (abatacept) NP PA; SP; QL

OTEZLA (apremilast) NP PA; SP; QL

RIDAURA (auranofin) CD PA; QL

RINVOQ (upadacitinib) NP PA; SP; QL

SILIQ (brodalumab) NP PA; SP; QL

SKYRIZI (risankizumab-rzaa) NP PA; SP; QL

STELARA INTRAVENOUS (ustekinumab) NP PA

STELARA SUBCUTANEOUS (ustekinumab) NP PA; SP; QL

SYNAGIS (palivizumab) CD PA; SP

TALTZ (ixekizumab) NP PA; SP; QL

TREMFYA (guselkumab) NP PA; SP; QL

XELJANZ (tofacitinib citrate) NP PA; SP; QL

XELJANZ XR (tofacitinib citrate) NP PA; SP; QL

XOLAIR (omalizumab) CD PA; SP; QL

Immunostimulants

ACTIMMUNE (interferon gamma-1b) CD PA; SP

INTRON A (interferon alfa-2b) CD PA; SP

Immunosuppressants

ARAVA (leflunomide) CD PA; QL

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG (tacrolimus)

NP PA; QL

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG (tacrolimus)

NP PA

AVSOLA (infliximab-axxq) NP PA

AZASAN (azathioprine) NP PA

azathioprine oral P QL

94


CELLCEPT ORAL CAPSULE (mycophenolate mofetil) NP PA; QL

CELLCEPT ORAL SUSPENSION RECONSTITUTED (mycophenolate mofetil)

P QL

CELLCEPT ORAL TABLET (mycophenolate mofetil) NP PA; QL

CIMZIA (certolizumab pegol) NP PA; SP; QL

cyclosporine modified P QL

cyclosporine oral P QL

ENBREL (etanercept) P PA; SP; QL

ENSPRYNG (satralizumab-mwge) CD PA; SP; QL

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 0.75 MG, 1 MG (tacrolimus)

NP PA; QL

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG (tacrolimus)

NP PA

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg NP PA

gengraf P QL

HUMIRA PEN-PEDIATRIC UC START (adalimumab) P PA; SP; QL

HUMIRA PEN-PSOR/UVEIT STARTER (adalimumab) P PA; SP; QL

HUMIRA SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, 40 MG/0.8ML, 80 MG/0.8ML (adalimumab)

P PA; SP; QL

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML, 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML (adalimumab)

P

PA; SP; QL

IMURAN (azathioprine) NP PA; QL

INFLECTRA (infliximab-dyyb) NP PA

leflunomide oral CD QL

methotrexate oral CD

methotrexate sodium CD

methotrexate sodium (pf) CD

mycophenolate mofetil oral capsule P QL

mycophenolate mofetil oral suspension reconstituted NP PA; QL

mycophenolate mofetil oral tablet P QL

mycophenolate sodium NP PA; QL

MYFORTIC (mycophenolate sodium) NP PA; QL

NEORAL (cyclosporine modified) NP PA; QL

OTREXUP (methotrexate (anti-rheumatic)) CD PA; QL

PROGRAF ORAL CAPSULE 0.5 MG, 5 MG (tacrolimus) NP PA

PROGRAF ORAL CAPSULE 1 MG (tacrolimus) NP PA; QL

PROGRAF ORAL PACKET (tacrolimus) NP PA

RAPAMUNE ORAL SOLUTION (sirolimus) P QL

RAPAMUNE ORAL TABLET 0.5 MG, 1 MG (sirolimus) P QL

RAPAMUNE ORAL TABLET 2 MG (sirolimus) P

95


RASUVO (methotrexate (anti-rheumatic)) CD PA; QL

REDITREX (methotrexate (anti-rheumatic)) CD PA; QL

REMICADE (infliximab) NP PA

RENFLEXIS (infliximab-abda) NP PA

REZUROCK TAB 200 MG (belumosudil mesylate) CD PA; SP; QL

SANDIMMUNE ORAL (cyclosporine) NP PA; QL

SIMPONI (golimumab) NP PA; SP; QL

SIMPONI ARIA (golimumab) NP PA

sirolimus oral tablet 0.5 mg, 1 mg NP PA; QL

sirolimus oral tablet 2 mg NP PA

sirolimus solution 1 mg/ml oral NP PA; QL

tacrolimus oral capsule 0.5 mg, 5 mg P

tacrolimus oral capsule 1 mg P QL

TREXALL (methotrexate sodium) CD PA

XATMEP (methotrexate) CD PA; QL

ZORTRESS (everolimus) NP PA

INFLAMMATORY BOWEL DISEASE AGENTS

Aminosalicylates

APRISO (mesalamine) P QL

ASACOL HD (mesalamine) NP PA; QL

AZULFIDINE EN-TABS (sulfasalazine) NP PA; QL

AZULFIDINE TABLET 500 MG ORAL (sulfasalazine) NP PA; QL

balsalazide disodium P QL

CANASA (mesalamine) P QL

COLAZAL (balsalazide disodium) NP PA; QL

DELZICOL (mesalamine) P QL

DIPENTUM (olsalazine sodium) NP PA; QL

LIALDA (mesalamine) P QL

mesalamine er oral capsule 0.375 gm NP PA; QL

mesalamine oral NP PA; QL

mesalamine rectal enema NP PA; QL

mesalamine rectal suppository NP PA; QL

PENTASA (mesalamine) P QL

ROWASA (mesalamine-cleanser) P QL

SFROWASA (mesalamine) P QL

sulfasalazine oral P QL

Glucocorticoids

ANUSOL-HC EXTERNAL (hydrocortisone) CD PA; QL

budesonide er oral NP PA; QL

CORTENEMA (hydrocortisone) CD PA; QL

96


CORTIFOAM (hydrocortisone acetate) CD PA; QL

ENTOCORT EC (budesonide) CD PA; QL

hydrocortisone (perianal) cream 2.5% CD QL

ORTIKOS (budesonide) CD PA; QL

PROCTOCORT EXTERNAL (hydrocortisone) CD PA; QL

procto-med hc CD QL

proctozone-hc CD QL

UCERIS (budesonide) NP PA; QL

METABOLIC BONE DISEASE AGENTS

ACTONEL ORAL TABLET 150 MG (risedronate sodium) NP PA

ACTONEL ORAL TABLET 35 MG (risedronate sodium) NP PA; QL

alendronate sodium oral solution P QL

alendronate sodium oral tablet 10 mg, 35 mg, 70 mg P QL

ATELVIA (risedronate sodium) NP PA

BONIVA (ibandronate sodium) NP PA

calcitonin (salmon) nasal P QL

calcitriol oral capsule CD QL

calcitriol oral solution CD AL

cinacalcet hcl CD PA; QL

doxercalciferol oral CD

FORTEO (teriparatide (recombinant)) NP PA; SP; QL

FOSAMAX (alendronate sodium) NP PA; QL

FOSAMAX PLUS D (alendronate-cholecalciferol) NP PA; QL

ibandronate sodium oral P

NATPARA (parathyroid hormone (recomb)) CD PA; SP; QL

paricalcitol oral CD

PROLIA (denosumab) NP PA; QL

RAYALDEE (calcifediol) CD PA; QL

risedronate sodium oral tablet 150 mg NP PA

risedronate sodium oral tablet 30 mg, 35 mg, 5 mg NP PA; QL

risedronate sodium oral tablet delayed release NP PA

ROCALTROL ORAL CAPSULE (calcitriol) CD PA; QL

ROCALTROL ORAL SOLUTION (calcitriol) CD PA; AL

SENSIPAR (cinacalcet hcl) CD PA; QL

TERIPARATIDE (RECOMBINANT) P SP; QL

TYMLOS (abaloparatide) NP PA; SP; QL

ZEMPLAR ORAL (paricalcitol) CD PA

MISCELLANEOUS THERAPEUTIC AGENTS

ACE AEROSOL CLOUD ENHANCER (respiratory therapy supplies)

CD PA; QL

97


acne control cleanser CD OTC

acne medication 10 external lotion P OTC; QL

acne medication 5 external lotion P OTC

ALCOHOL PREP PADS PAD , 70 % CD OTC; QL

ANASPAZ (hyoscyamine sulfate) CD PA; QL

bacitracin external P OTC; QL

BD AUTOSHIELD DUO PEN NEEDLES (insulin pen needle) P QL

BD ULTRA-FINE INSULIN SYRINGES (insulin syringe/needle u- 500)

P QL

BD ULTRA-FINE PEN NEEDLES (insulin pen needle) P QL

bisacodyl ec CD OTC; QL

bisacodyl rectal CD OTC; QL

calamine external lotion CD OTC

capsaicin external cream CD OTC; QL

capsaicin hp CD OTC; QL

capzix CD OTC; QL

CASTIVA WARMING (capsaicin) CD OTC; QL

CAYA (diaphragm arc-spring) CD QL

clearskin CD OTC

coenzyme q10 oral capsule 100 mg CD OTC

CONDOMS CD OTC; QL

COOL MIST HUMIDIFER CD OTC; QL

COVID-19 TEST CD QL

double antibiotic external ointment 500-10000 unit/gm CD OTC

EASIVENT (spacer/aero-holding chambers) CD QL

EASIVENT MASK LARGE (spacer/aero-holding chambers) CD QL

EASIVENT MASK MEDIUM (spacer/aero-holding chambers) CD QL

EASIVENT MASK SMALL (spacer/aero-holding chambers) CD QL

ED-SPAZ (hyoscyamine) CD QL

FLEET BISACODYL (bisacodyl) CD PA; OTC; QL

gentle laxative oral tablet delayed release 5 mg CD OTC; QL

gentle laxative rectal suppository 10 mg CD OTC; QL

GLUCOSE CONTROL SOLUTION IN VITRO LIQUID (blood glucose calibration)

CD OTC

GLUCOSE CONTROL SOLUTIONS (blood glucose calibration) CD OTC

hyoscyamine sulfate oral CD QL

hyoscyamine sulfate sublingual CD QL

INSULIN PEN NEEDLES (insulin pen needle) CD OTC/RX; QL

INSULIN SYRINGES CD OTC; QL

laxative oral tablet delayed release 5 mg CD OTC; QL

98


LEVSIN ORAL (hyoscyamine sulfate) CD PA; QL

LEVSIN/SL (hyoscyamine sulfate) CD PA; QL

MACRILEN (macimorelin acetate) CD PA; SP; QL

MASK VORTEX/CHILD/FROG (spacer/aero-hold chamber mask) CD OTC; QL

MASK VORTEX/TODDLER/LADYBUG (spacer/aero-hold chamber mask)

CD OTC; QL

METOPIRONE (metyrapone) CD PA

NEODOT THERMOMETER CD OTC; QL

NULEV (hyoscyamine sulfate) CD PA; QL

NYVEPRIA (pegfilgrastim-apgf) CD PA; SP

OMNIFLEX DIAPHRAGM (diaphragms) CD QL

OMNIPOD DASH KIT SYSTEM (insulin infusion disposable pump kit)

CD PA

OMNIPOD KIT STARTER (insulin infusion disposable pump kit) CD PA

OMNIPOD MIS 5 PACK (insulin infusion disposable pump supplies)

CD PA

OMNITROPE PEN 5 INJ DEVICE (injection device) CD

ORLADEYO (berotralstat hcl) NP PA; SP; QL

oscimin CD QL

oscimin sr CD QL

PALFORZIA (peanut powder-dnfp) CD SP; QL

PHEXXI (lactic ac-citric ac-pot bitart) CD QL

podocon CD

sulfacetamide sodium external gel NP PA

sulfacetamide sodium external liquid P

V-GO KIT 20, 30, 40 (insulin infusion disposable pump kit) CD PA

VAPORIZER WARM STEAM CD OTC; QL

WIDE-SEAL DIAPHRAGM (diaphragm wide seal) CD QL

ZOKINVY ORAL CAPSULE 50 MG (lonafarnib) CD PA; SP; QL

ZOSTRIX HP (capsaicin) CD PA; OTC; QL

MOLECULAR TARGET INHIBITORS - CHEMOTHERAPY AGENTS


ALECENSA (alectinib hcl) CD PA; SP; QL

ALUNBRIG (brigatinib) CD PA; SP; QL

AYVAKIT (avapritinib) CD SP; QL

BOSULIF (bosutinib) CD PA; SP; QL

BRUKINSA (zanubrutinib) CD PA; SP; QL

CABOMETYX (cabozantinib s-malate) CD PA; SP; QL

CALQUENCE (acalabrutinib) CD PA; SP; QL

CAPRELSA (vandetanib) CD PA; SP; QL

99


COMETRIQ (cabozantinib s-malate) CD PA; SP; QL

erlotinib hcl CD PA; SP; QL

EXKIVITY CAP (mobocertinib succinate) CD PA; SP; QL

FOTIVDA (tivozanib hcl) CD PA; SP; QL

GAVRETO (pralsetinib) CD PA; SP; QL

GILOTRIF (afatinib dimaleate) CD PA; SP; QL

GLEEVEC (imatinib mesylate) CD PA; SP; QL

ICLUSIG (ponatinib hcl) CD PA; SP; QL

imatinib mesylateasciminib CD PA; SP; QL

IMBRUVICA (ibrutinib) CD PA; SP; QL

INLYTA (axitinib) CD PA; SP; QL

IRESSA (gefitinib) CD PA; SP; QL

lapatinib ditosylate CD PA; SP; QL

LENVIMA (lenvatinib mesylate) CD PA; SP; QL

LORBRENA (lorlatinib) CD PA; SP; QL

NERLYNX (neratinib maleate) CD PA; SP; QL

QINLOCK (ripretinib) CD PA; SP; QL

RETEVMO (selpercatinib) CD PA; SP; QL

SPRYCEL (dasatinib) CD PA; SP; QL

TABRECTA (capmatinib hcl) CD PA; SP; QL

TAGRISSO (osimertinib mesylate) CD PA; SP; QL

TARCEVA (erlotinib hcl) CD PA; SP; QL

TASIGNA (nilotinib hcl) CD PA; SP; QL

TUKYSA (tucatinib) CD PA; SP; QL

TURALIO (pexidartinib hcl) CD PA; SP; QL

TYKERB (lapatinib ditosylate) CD PA; SP; QL

UKONIQ (umbralisib tosylate) CD PA; SP; QL

VIZIMPRO (dacomitinib) CD PA; SP; QL

VOTRIENT (pazopanib hcl) CD PA; SP; QL

XALKORI (crizotinib) CD PA; SP; QL

XOSPATA (gilteritinib fumarate) CD PA; SP; QL

MONOCLONAL ANTIBODIES - CHEMOTHERAPY AGENTS


MARGENZA (margetuximab-cmkb) CD PA

TRAZIMERA INTRAVENOUS SOLUTION RECONSTITUTED 150 MG (trastuzumab-qyyp)

CD PA

MULTIPLE SCLEROSIS AGENTS - MULTIPLE SCLEROSIS DRUGS

Central Nervous System Agents - Drugs to Treat Nerve Conditions

PONVORY (ponesimod) NP PA; SP; QL

100


PONVORY STARTER PACK (ponesimod) NP PA; SP; QL

OPHTHALMIC AGENTS - DRUGS TO TREAT EYE CONDITIONS

Ophthalmic Agents, Other - Miscellaneous Eye Drugs

artificial tears ophthalmic ointment CD OTC; QL

artificial tears ophthalmic solution 0.5-0.6 %, 1.4 %, 5-6 mg/ml CD OTC

carboxymethylcellulose sodium ophthalmic CD OTC; QL

eye drops advanced relief CD OTC; QL

eye drops ophthalmic solution 0.05-0.1-1-1 % CD OTC; QL

GENTEAL SEVERE (hypromellose) CD OTC; QL

GENTEAL TEARS MODERATE PF (dextran 70-hypromellose) CD OTC

GENTEAL TEARS NIGHT-TIME (white petrolatum-mineral oil) CD OTC; QL

GENTEAL TEARS OPHTHALMIC SOLUTION 0.1-0.2-0.3 % (artificial tear solution)

CD OTC

GENTEAL TEARS SEVERE DAY/NIGHT (polyethyl glycol-propyl glycol)

CD OTC; QL

ISOPTO TEARS (hypromellose) CD OTC

lubricant drops ophthalmic gel 0.25-0.3 % CD OTC; QL

lubricant eye drops ophthalmic solution 0.4-0.3 %, 0.6 % CD OTC; QL

lubricant eye drops pf 0.5% CD OTC

MURO 128 OPHTHALMIC OINTMENT (sodium chloride (hypertonic))

CD OTC

MURO 128 OPHTHALMIC SOLUTION 5 % (sodium chloride (hypertonic))

CD OTC; QL

REFRESH LACRI-LUBE (white petrolatum-mineral oil) CD OTC; QL

REFRESH OPTIVE OPHTHALMIC SOLUTION (carboxymethylcellul-glycerin)

CD OTC

REFRESH OPTIVE PF (carboxymethylcellul-glycerin) CD OTC

REFRESH P.M. (white petrolatum-mineral oil) CD OTC; QL

REFRESH PLUS (carboxymethylcellulose sodium) CD OTC

REFRESH RELIEVA (carboxymethylcellul-glycerin) CD OTC

REFRESH RELIEVA PF OPHTHALMIC SOLUTION 0.5-0.9 % (carboxymethylcellul-glycerin)

CD OTC

REFRESH TEARS (carboxymethylcellulose sodium) 0.5% CD OTC; QL

sodium chloride (hypertonic) ophthalmic ointment CD OTC

sodium chloride (hypertonic) ophthalmic solution CD OTC; QL

SYSTANE (polyethyl glycol-propyl glycol) CD OTC; QL

SYSTANE COMPLETE (propylene glycol) CD OTC; QL

SYSTANE HYDRATION PF (polyethyl glycol-propyl glycol) CD OTC; QL

SYSTANE NIGHTTIME (white petrolatum-mineral oil) CD OTC; QL

SYSTANE OVERNIGHT THERAPY (hypromellose) CD OTC; QL

SYSTANE PRESERVATIVE FREE (polyethyl glycol-propyl glycol)

CD OTC; QL

101


SYSTANE ULTRA (polyethyl glycol-propyl glycol) CD OTC; QL

SYSTANE ULTRA PF (polyethyl glycol-propyl glycol) CD OTC; QL

Ophthalmic Anti-allergy Agents - Allergy, Infection and Inflammation Drugs

CYCLOMYDRIL (cyclopentolate-phenylephrine) CD PA

ketotifen fumarate ophthalmic P OTC; QL

NAPHCON-A (naphazoline-pheniramine) CD PA; OTC

ZADITOR (ketotifen fumarate) NP PA; OTC; QL

OPHTHALMIC AGENTS

Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophthalmic NP PA; QL

latanoprost ophthalmic P QL

LUMIGAN (bimatoprost) NP PA; QL

TRAVATAN Z (travoprost) P QL

travoprost (bak free) NP PA; QL

VYZULTA (latanoprostene bunod) NP PA; QL

XALATAN (latanoprost) NP PA; QL

XELPROS (latanoprost) NP PA; QL

ZIOPTAN (tafluprost) NP PA; QL

Ophthalmic Agents, Other

atropine sulfate ophthalmic ointment CD

atropine sulfate ophthalmic solution 1 % CD QL

bacitra-neomycin-polymyxin-hc CD QL

BLEPHAMIDE (sulfacetamide-prednisolone) CD PA; QL

BLEPHAMIDE S.O.P. (sulfacetamide-prednisolone) CD PA; QL

CEQUA (cyclosporine) CD PA; QL

COMBIGAN (brimonidine tartrate-timolol) P QL

COSOPT (dorzolamide hcl-timolol mal) NP PA; QL

COSOPT PF (dorzolamide hcl-timolol mal) NP PA

CYCLOGYL OPHTHALMIC SOLUTION 0.5 %, 2 % (cyclopentolate hcl)

CD PA

CYCLOGYL OPHTHALMIC SOLUTION 1 % (cyclopentolate hcl) CD PA; QL

cyclopentolate hcl ophthalmic solution 0.5 %, 2 % CD

cyclopentolate hcl ophthalmic solution 1 % CD QL

CYSTADROPS (cysteamine hcl) CD PA; SP; QL

CYSTARAN (cysteamine hcl) CD PA; SP; QL

dorzolamide hcl-timolol mal P QL

dorzolamide hcl-timolol mal pf NP PA

ISOPTO ATROPINE (atropine sulfate) CD QL

MAXITROL (neomycin-polymyxin-dexameth) CD PA; QL

102


neomycin-polymyxin-dexameth ophthalmic ointment CD QL

neomycin-polymyxin-dexameth ophthalmic suspension 3.5- 10000-0.1

CD QL

neomycin-polymyxin-hc ophthalmic CD QL

neo-polycin hc CD QL

OXERVATE (cenegermin-bkbj) CD PA; SP; QL

phenylephrine hcl ophthalmic CD

PRED-G (gentamicin-prednisolone acet) CD PA; QL

PRED-G S.O.P. (gentamicin-prednisolone acet) CD

RESTASIS (cyclosporine) CD PA; QL

RESTASIS MULTIDOSE (cyclosporine) CD PA; QL

ROCKLATAN (netarsudil-latanoprost) NP PA; QL

sulfacetamide-prednisolone ophthalmic solution CD

TOBRADEX (tobramycin-dexamethasone) CD PA; QL

TOBRADEX ST (tobramycin-dexamethasone) CD PA; QL

tobramycin-dexamethasone CD QL

XIIDRA (lifitegrast) CD PA; QL

ZYLET (loteprednol-tobramycin) CD PA; QL

Ophthalmic Anti-allergy Agents

ALOCRIL (nedocromil sodium) NP PA

ALOMIDE (lodoxamide tromethamine) NP PA

azelastine hcl ophthalmic NP PA

bepotastine besilate NP PA; QL

BEPREVE (bepotastine besilate) NP PA; QL

CYCLOMYDRIL (cyclopentolate-phenylephrine) CD PA

ketotifen fumarate ophthalmic P OTC; QL

NAPHCON-A (naphazoline-pheniramine) CD PA; OTC

ZADITOR (ketotifen fumarate) NP PA; OTC; QL

cromolyn sodium ophthalmic P QL

epinastine hcl NP PA

LASTACAFT (alcaftadine) NP PA

olopatadine hcl ophthalmic P QL

ZERVIATE (cetirizine hcl) NP PA; QL

Ophthalmic Anti-Infectives

ak-poly-bac P QL

AZASITE (azithromycin) NP PA; QL

bacitracin ophthalmic P QL

bacitracin-polymyxin b ophthalmic P QL

BESIVANCE (besifloxacin hcl) NP PA; QL

BLEPH-10 (sulfacetamide sodium) NP PA; QL

103


CILOXAN (ciprofloxacin hcl) NP PA; QL

ciprofloxacin hcl ophthalmic P QL

erythromycin ophthalmic P QL

gatifloxacin ophthalmic NP PA; QL

gentak P QL

gentamicin sulfate ophthalmic P QL

levofloxacin ophthalmic NP PA

MOXEZA (moxifloxacin hcl) NP PA; QL

moxifloxacin hcl (2x day) NP PA; QL

moxifloxacin hcl ophthalmic solution P QL

NATACYN (natamycin) CD PA

neomycin-bacitracin zn-polymyx ophthalmic ointment 5-400- 10000

CD

neomycin-polymyxin-gramicidin CD QL

neo-polycin CD

OCUFLOX (ofloxacin) NP PA; QL

ofloxacin ophthalmic P QL

polycin CD QL

polymyxin b-trimethoprim CD QL

POLYTRIM (polymyxin b-trimethoprim) CD PA; QL

sulfacetamide sodium ophthalmic CD QL

tobramycin ophthalmic CD QL

TOBREX (tobramycin) CD PA; QL

trifluridine CD QL

VIGAMOX (moxifloxacin hcl) NP PA; QL

ZYMAXID (gatifloxacin) NP PA; QL

Ophthalmic Anti-inflammatories

ACULAR (ketorolac tromethamine) NP PA; QL

ACULAR LS (ketorolac tromethamine) NP PA

ACUVAIL (ketorolac tromethamine) NP PA; QL

ALREX (loteprednol etabonate) NP PA; QL

bromfenac sodium (once-daily) NP PA

BROMSITE (bromfenac sodium) NP PA; QL

dexamethasone sodium phosphate ophthalmic CD

diclofenac sodium ophthalmic P QL

DEXYCU (dexamethasone) NP PA

DUREZOL (difluprednate) CD PA; QL

EYSUVIS (loteprednol etabonate) CD PA; QL

FLAREX (fluorometholone acetate) CD PA; QL

fluorometholone P QL

104


flurbiprofen sodium NP PA; QL

FML (fluorometholone) CD PA; QL

FML FORTE (fluorometholone) CD PA; QL

FML LIQUIFILM (fluorometholone) CD PA; QL

ILEVRO (nepafenac) CD PA; QL

ILUVIEN (fluocinolone) implant NP PA

INVELTYS (loteprednol etabonate) NP PA; QL

ketorolac tromethamine ophthalmic solution 0.4 % P

ketorolac tromethamine ophthalmic solution 0.5 % P QL

LOTEMAX OPHTHALMIC GEL (loteprednol etabonate) NP PA; QL

LOTEMAX OPHTHALMIC OINTMENT (loteprednol etabonate) NP PA

LOTEMAX OPHTHALMIC SUSPENSION (loteprednol etabonate) NP PA; QL

LOTEMAX SM (loteprednol etabonate) CD PA; QL

loteprednol etabonate NP PA; QL

MAXIDEX (dexamethasone) CD PA

NEVANAC (nepafenac) NP PA; QL

OZURDEX (dexamethasone) implant NP PA

PRED FORTE (prednisolone acetate) CD PA; QL

PRED MILD (prednisolone acetate) CD PA; QL

prednisolone acetate ophthalmic P QL

PROLENSA (bromfenac sodium) NP PA; QL

RETISERT (fluocinolone) implant NP PA

TRIESENCE (triamcinolone) P

YUTIQ (fluocinolone) implant NP PA

Ophthalmic Beta-Adrenergic Blocking Agents

betaxolol hcl ophthalmic NP PA; QL

BETIMOL (timolol hemihydrate) CD PA; QL

BETOPTIC-S (betaxolol hcl) NP PA; QL

carteolol hcl NP PA

ISTALOL (timolol maleate) NP PA; QL

levobunolol hcl NP PA; QL

timolol maleate ophthalmic gel forming solution P QL

timolol maleate ophthalmic solution P QL

timolol maleate solution (daily) ophthalmic (istalol) NP QL

TIMOPTIC (timolol maleate) NP PA; QL

TIMOPTIC OCUDOSE (timolol maleate) NP PA; QL

TIMOPTIC-XE (timolol maleate) NP PA; QL

Ophthalmic Intraocular Pressure Lowering Agents, Other

ALPHAGAN P (brimonidine tartrate) P QL

apraclonidine hcl NP PA; QL

105


AZOPT (brinzolamide) NP PA

brimonidine tartrate ophthalmic solution 0.15 % NP PA; QL

brimonidine tartrate ophthalmic solution 0.2 % P QL

brinzolamide NP PA

dorzolamide hcl ophthalmic P QL

IOPIDINE (apraclonidine hcl) NP PA

ISOPTO CARPINE (pilocarpine hcl) CD PA

methazolamide oral CD QL

pilocarpine hcl ophthalmic CD

RHOPRESSA (netarsudil dimesylate) NP PA; QL

SIMBRINZA (brinzolamide-brimonidine) NP PA; QL

TRUSOPT (dorzolamide hcl) NP PA; QL

VUITY SOL (pilocarpine hcl) CD PA; QL

OTIC AGENTS - DRUGS TO TREAT EAR CONDITIONS

OTIC AGENTS

acetic acid otic CD QL

CIPRO HC (ciprofloxacin-hydrocortisone) P QL

CIPRODEX (ciprofloxacin-dexamethasone) P QL

ciprofloxacin hcl otic NP QL

ciprofloxacin-dexamethasone suspension 0.3-0.1 % otic NP PA; QL

ciprofloxacin-fluocinolone solution (pf) 0.3%-0.025% % otic NP PA; QL

CORTISPORIN-TC (neomycin-colist-hc-thonzonium) CD PA; QL

DERMOTIC (fluocinolone acetonide) CD PA; QL

earwax removal kit CD OTC

flac oil 0.01% (fluocinolone) CD QL

fluocinolone acetonide otic CD QL

hydrocortisone-acetic acid CD QL

neomycin-polymyxin-hc otic P QL

ofloxacin otic P QL

OTIPRIO (ciprofloxacin) NP PA

OTOVEL (ciprofloxacin-fluocinolone) NP PA; QL

RESPIRATORY TRACT/PULMONARY AGENTS - DRUGS TO TREAT ALLERGIES, COUGH, COLD AND LUNG CONDITIONS

12 hour nasal decongestant nasal CD OTC

12 hour nasal spray CD OTC

AFRIN SALINE NASAL MIST (saline) CD OTC

altamist spray CD OTC

AYR (saline) CD OTC

AYR SALINE NASAL DROPS (saline) CD OTC

benzonatate oral capsule 100 mg, 200 mg CD QL; AL

106


chest congestion relief oral tablet (guaifenesin) CD OTC

cold & flu oral liquid 10-5-325 mg/15ml CD OTC

day time cold & flu oral capsule CD OTC

daytime cold/flu oral liquid 10-5-325 mg/15ml CD OTC

MUCINEX CHILDRENS STUFFY NOSE (oxymetazoline hcl) CD OTC

MUCINEX FAST-MAX CONG HEADACHE (dm-phenylephrine- acetaminophen)

CD OTC

MUCINEX MAXIMUM STRENGTH (guaifenesin) CD OTC; QL; AL

MUCINEX SINUS-MAX CLEAR & COOL (oxymetazoline hcl) CD OTC

MUCINEX SINUS-MAX CONG & PAIN ORAL CAPSULE (dm- phenylephrine-acetaminophen)

CD OTC

MUCINEX SINUS-MAX SINUS/ALLRGY (oxymetazoline hcl) CD OTC

mucus relief max strength oral tablet extended release 12 hour 1200 mg

CD OTC; QL; AL

aprodine CD OTC; AL

capcof CD OTC; QL; AL

chest congestion relief dm oral syrup CD OTC; QL; AL

childrens mucus relief cough CD OTC

cold & cough childrens CD OTC; QL

cold & cough dm childrens oral liquid 2.5-1-5 mg/5ml CD OTC; QL

cold & sinus relief oral tablet 30-200 mg CD OTC; AL

cough dm CD OTC; QL; AL

cough dm childrens CD OTC; QL; AL

cough dm er CD OTC; QL; AL

DELSYM (dextromethorphan polistirex) CD OTC; QL; AL

DELSYM CGH/CHEST CONG DM CHILD (dextromethorphan- guaifenesin)

CD OTC

DELSYM COUGH CHILDRENS (dextromethorphan polistirex) CD OTC; QL; AL

DELSYM COUGH/CHEST CONGEST DM (dextromethorphan- guaifenesin)

CD OTC

dextromethorphan polistirex er CD OTC; QL; AL

dextromethorphan-guaifenesin oral syrup CD OTC; QL; AL

dimaphen dm cold/cough CD OTC; QL

ENDACOF-DM (phenylephrine-bromphen-dm) CD OTC; QL

guaifenesin 100mg/5ml CD OTC

guaifenesin-codeine 100-10mg/5ml CD OTC; QL; AL

guaifenesin-dm oral syrup CD OTC; QL; AL

HISTEX-AC (phenyleph-triprolidine-codeine) CD PA; OTC; QL; AL

hydrocodone-homatropine CD QL; AL

maxi-tuss ac CD OTC; QL; AL

maxi-tuss cd CD PA; OTC

107


maxi-tuss gmx CD OTC; AL

MUCINEX CHILDRENS FREEFROM ORAL LIQUID 5-100 MG/5ML (dextromethorphan-guaifenesin)

CD OTC

MUCINEX COUGH CHILDRENS (dextromethorphan- guaifenesin)

CD OTC

MUCINEX D (pseudoephedrine-guaifenesin) CD OTC; AL

MUCINEX D MAX STRENGTH (pseudoephedrine-guaifenesin) CD OTC; AL

MUCINEX DM (dextromethorphan-guaifenesin) CD OTC; QL; AL

MUCINEX FAST-MAX DM MAX (dextromethorphan-guaifenesin) CD PA; OTC

mucus & cough relief childrens CD OTC

mucus d oral tablet extended release 12 hour 60-600 mg CD PA; OTC; AL

mucus relief d oral tablet extended release 12 hour 60-600 mg CD PA; OTC; AL

mucus relief dm max oral liquid 20-400 mg/20ml CD PA; OTC

mucus relief dm oral liquid CD PA; OTC

mucus relief dm oral tablet extended release 12 hour 30-600 mg CD PA; OTC; QL; AL

NINJACOF-XG (guaifenesin-codeine) CD PA; OTC; QL; AL

promethazine vc/codeine CD QL; AL

promethazine-codeine CD QL; AL

promethazine-phenyleph-codeine CD QL; AL

pseudoephedrine hcl 12 hr CD OTC

pseudoephedrine hcl oral tablet 30 mg, 60mg CD OTC; QL

pseudoephedrine-guaifenesin er CD OTC; AL

rynex dm CD OTC; QL

rynex pe CD OTC; AL

rynex pse CD OTC; AL

siltussin-dm alcohol free CD OTC; QL; AL

sodium chloride inhalation CD

sudogest 12 hour (pseudoephedrine) 120mg CD OTC

sudogest oral tablet (pseudoephedrine) 30 mg, 60mg CD OTC; QL

TUSSICAPS (hydrocod polst-chlorphen polst) CD PA; QL; AL

tussin cough/chest congest oral syrup 100-10 mg/5ml CD OTC; QL; AL

tussin dm max oral liquid 20-400 mg/20ml CD OTC

tussin dm oral syrup 100-10 mg/5ml CD OTC; QL; AL

virtussin a/c CD OTC; QL; AL

virtussin ac w/alc CD OTC; QL; AL

NASAL MOIST NASAL SOLUTION (saline) CD OTC

nasal spray fast acting nasal solution 1 % CD OTC

nasal spray nasal solution 0.05 % CD OTC

nose drops nasal decongest CD OTC

nose drops nasal solution 1 % CD OTC

108


OCEAN NASAL SPRAY (saline) CD OTC

phenylephrine hcl oral tablet 10mg CD OTC

poly-tussin ac CD OTC; QL; AL

promethazine-dm CD QL; AL

pseudoephedrine-bromphen-dm CD QL; AL

robafen cf multi-symptom cold CD OTC; AL

saline nasal spray CD OTC

siltussin sa CD OTC; AL

sinus nasal spray (phenylephrine) CD OTC

TESSALON PERLES (benzonatate) CD PA; QL; AL

tussin adult liquid (guaifenesin) 100mg/5ml

tussin cf cough & cold oral syrup 5-10-100 mg/5ml CD OTC

tussin cough long acting CD OTC; AL

tussin cough oral syrup (dextromethorphan) 15mg/5ml CD OTC; AL

tussin mucus+chest congestion oral syrup CD OTC; AL

virtussin dac CD OTC; QL; AL

Antihistamines - Allergy Drugs

ALAHIST CF (phenylephrine-dexbromphen-dm) CD OTC; QL

ALAHIST DM (phenylephrine-dexbromphen-dm) CD OTC; QL

cetirizine-pseudoephedrine er P OTC; QL; AL

CLARINEX-D 12 HOUR (desloratadine-pseudoephedrine) NP PA

ED A-HIST ORAL LIQUID (chlorpheniramine-phenylephrine) CD OTC; QL; AL

loratadine-d P OTC; AL

nohist-lq CD OTC; QL; AL

rymed CD OTC; QL

azelastine hcl nasal P QL

azelastine-fluticasone NP PA; QL

carbinoxamine maleate oral solution CD PA; QL

carbinoxamine maleate oral tablet 4 mg CD PA; QL

cetirizine hcl oral solution 1 mg/ml P Rx/OTC; QL

cetirizine hcl oral tablet P OTC; QL

cetirizine hcl oral tablet chewable NP OTC; PA; QL

CLARINEX (desloratadine) NP PA; QL

clemastine fumarate oral tablet 2.68 mg CD QL

cyproheptadine hcl oral CD QL

desloratadine oral tablet NP PA; QL

desloratadine oral tablet dispersible NP PA; QL

diphenhydramine hcl oral capsule, tablet, liquid CD OTC; QL

DYMISTA (azelastine-fluticasone) NP PA; QL

KARBINAL ER (carbinoxamine maleate) CD PA; QL

109


levocetirizine dihydrochloride oral solution P

levocetirizine dihydrochloride oral tablet P QL

olopatadine hcl nasal NP PA; QL

PATANASE (olopatadine hcl) NP PA; QL

RYCLORA (dexchlorpheniramine maleate) CD PA; QL

ryvent CD QL

allergy relief oral tablet 4 mg (chlorpheniramine) CD OTC; QL

ed chlorped jr CD OTC; QL

HISTEX PD (triprolidine hcl) CD PA; OTC

loratadine oral solution 5 mg/5ml P OTC; QL

loratadine oral capsule CD OTC

loratadine oral tablet P OTC; QL

loratadine oral tablet dispersible 10 mg P OTC; QL

triprolidine hcl oral liquid 0.313 mg/ml, 2.5 mg/5ml CD OTC; QL

triprolidine hcl oral liquid 0.625 mg/ml, 0.938 mg/ml CD OTC

Anti-Inflammatories, Inhaled Corticosteroids - Asthma/Lung Drugs

nasal allergy 24 hour CD OTC; QL

nasal allergy spray nasal aerosol 55 mcg/act CD OTC; QL

Bronchodilators, Sympathomimetic - Asthma/Lung Drugs

ADVAIR DISKUS (fluticasone-salmeterol) P QL

ADVAIR HFA (fluticasone-salmeterol) P QL

AIRDUO DIGIHALER (fluticasone-salmeterol) CD PA; QL

AIRDUO RESPICLICK 113/14, 232/14, 55/14 (fluticasone- salmeterol)

NP PA; QL

ANORO ELLIPTA (umeclidinium-vilanterol) P QL

BEVESPI AEROSPHERE (glycopyrrolate-formoterol) NP PA; QL

BREO ELLIPTA (fluticasone furoate-vilanterol) NP PA; QL

BREZTRI AEROSPHERE (budeson-glycopyrrol-formoterol) NP PA; QL

BUDESONIDE-FORMOTEROL FUMARATE NP PA; QL; AL

COMBIVENT RESPIMAT (ipratropium-albuterol) P QL

DUAKLIR PRESSAIR (aclidinium br-formoterol fum) NP PA; QL

DULERA (mometasone furo-formoterol fum) P QL

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

NP PA; QL

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

NP

PA; QL

ipratropium-albuterol P QL

S2 (RACEPINEPHRINE) (racepinephrine hcl) CD PA; OTC

STIOLTO RESPIMAT (tiotropium bromide-olodaterol) P QL

SYMBICORT (budesonide-formoterol fumarate) P QL

110


TRELEGY ELLIPTA (fluticasone-umeclidin-vilant) NP PA; QL

wixela inhub CD PA; QL

Mast Cell Stabilizers - Drugs for the Lungs

cromolyn sodium nasal CD OTC; QL

Respiratory Tract Agents, Other - Asthma/Lung Drugs

RESPIRATORY TRACT/PULMONARY AGENTS

Anti-inflammatories, Inhaled Corticosteroids

ALVESCO (ciclesonide) NP PA

ARMONAIR DIGIHALER (fluticasone propionate (inhal)) NP PA; QL

ARNUITY ELLIPTA (fluticasone furoate) NP PA; QL

ASMANEX (mometasone furoate) P QL

ASMANEX HFA (mometasone furoate) NP PA; QL; AL

BECONASE AQ (beclomethasone diprop monohyd) NP PA; QL

budesonide inhalation P QL; AL

FLOVENT DISKUS (fluticasone propionate (inhal)) P QL

FLOVENT HFA (fluticasone propionate hfa) P QL

flunisolide nasal NP PA; QL

fluticasone propionate nasal P QL

mometasone furoate nasal P QL

NASONEX (mometasone furoate) NP PA; QL

OMNARIS (ciclesonide) NP PA; QL

PULMICORT FLEXHALER (budesonide) P QL

PULMICORT SUSPENSION (budesonide) NP PA; QL; AL

QNASL (beclomethasone diprop (nasal)) NP PA; QL

QVAR REDIHALER (beclomethasone diprop hfa) NP PA; QL

SINUVA (mometasone furoate) NP PA

TICANASE NP PA

XHANCE (fluticasone propionate) NP PA; QL

ZETONNA (ciclesonide) NP PA; QL

Antileukotrienes

ACCOLATE (zafirlukast) NP PA; QL

montelukast sodium oral packet NP PA; QL

montelukast sodium oral tablet P QL

montelukast sodium oral tablet chewable P QL

SINGULAIR (montelukast sodium) NP PA; QL

zafirlukast P QL

zileuton er NP PA; QL

ZYFLO (zileuton) NP PA

Bronchodilators, Anticholinergic

111


ATROVENT HFA (ipratropium bromide hfa) P QL

INCRUSE ELLIPTA (umeclidinium bromide) NP PA; QL

ipratropium bromide inhalation P QL

ipratropium bromide nasal P QL

LONHALA MAGNAIR REFILL KIT (glycopyrrolate) NP PA; QL

LONHALA MAGNAIR STARTER KIT (glycopyrrolate) NP PA; QL

SPIRIVA HANDIHALER (tiotropium bromide monohydrate) P QL

SPIRIVA RESPIMAT (tiotropium bromide monohydrate) P QL

TUDORZA PRESSAIR (aclidinium bromide) P QL

YUPELRI (revefenacin) NP PA; QL

Bronchodilators, Sympathomimetic

ADRENALIN INJECTION SOLUTION 1 MG/ML (epinephrine) CD PA; QL

albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

NP PA; QL

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 2.5 mg/0.5ml

P QL

albuterol sulfate inhalation nebulization solution 0.63 mg/3ml, 1.25 mg/3ml

P QL; AL

albuterol sulfate oral syrup P QL

albuterol sulfate oral tablet 2 mg NP PA

albuterol sulfate oral tablet 4 mg NP PA; QL

arformoterol tartrate CD PA; QL

BROVANA (arformoterol tartrate) NP PA; QL

epinephrine injection solution auto-injector 0.15 mg/0.15ml NP PA; QL

epinephrine solution auto-injector 0.15 mg/0.3ml injection P Mylan is Preferred; QL

epinephrine solution auto-injector 0.15 mg/0.3ml injection NP PA; QL

epinephrine solution auto-injector 0.3 mg/0.3ml injection P Mylan is Preferred; QL

epinephrine solution auto-injector 0.3 mg/0.3ml injection NP PA; QL

EPIPEN 2-PAK (epinephrine) NP PA; QL

EPIPEN JR 2-PAK (epinephrine) NP PA; QL

levalbuterol hcl inhalation NP PA; QL

levalbuterol hcl HFA inhalation 45 MCG/ACT CD PA; QL

METAPROTERENOL SYRUP P QL

PERFOROMIST (formoterol fumarate) NP PA; QL

PROAIR DIGIHALER (albuterol sulfate) NP PA; QL

PROAIR HFA (albuterol sulfate) P QL

PROAIR RESPICLICK (albuterol sulfate) NP PA; QL

PROVENTIL HFA (albuterol sulfate) NP PA; QL

SEREVENT DISKUS (salmeterol xinafoate) P QL

STRIVERDI RESPIMAT (olodaterol hcl) NP PA; QL

112


SYMJEPI (epinephrine) P QL

terbutaline sulfate oral CD PA; QL

VENTOLIN HFA (albuterol sulfate) P QL

XOPENEX NEB (levalbuterol hcl) NP PA; QL

XOPENEX CONCENTRATE (levalbuterol hcl) NP PA; QL

XOPENEX HFA (levalbuterol tartrate) P QL

Cystic Fibrosis Agents

BETHKIS (tobramycin) P SP; QL

CAYSTON (aztreonam lysine) NP PA; SP; QL

KALYDECO (ivacaftor) CD PA; SP; QL

KITABIS PAK (tobramycin) P SP; QL

ORKAMBI (lumacaftor-ivacaftor) CD PA; SP; QL

PULMOZYME (dornase alfa) CD PA; SP; QL

SYMDEKO (tezacaftor-ivacaftor) CD PA; SP; QL

TOBI NEBULIZER (tobramycin) NP PA; SP; QL

TOBI PODHALER (tobramycin) NP PA; SP; QL

tobramycin nebulization solution NP PA; SP; QL

TRIKAFTA (elexacaftor-tezacaftor-ivacaft) CD PA; SP; QL

Mast Cell Stabilizers

cromolyn sodium inhalation CD QL

Phosphodiesterase Inhibitors, Airways Disease

DALIRESP (roflumilast) NP PA; QL

THEO-24 (theophylline) CD

theophylline CD QL

theophylline er oral tablet extended release 12 hour 300 mg CD QL

theophylline er oral tablet extended release 12 hour 450 mg CD

theophylline er oral tablet extended release 24 hour 400 mg CD QL

theophylline er oral tablet extended release 24 hour 600 mg CD

Pulmonary Antihypertensives

ADCIRCA (tadalafil (pah)) NP PA; SP; QL

ADEMPAS (riociguat) NP PA; SP; QL

ALYQ (tadalafil) CD PA; SP; QL

ambrisentan P SP; QL

bosentan NP PA; SP; QL

LETAIRIS (ambrisentan) NP PA; SP; QL

OPSUMIT (macitentan) NP PA; SP; QL

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG (treprostinil diolamine)

NP PA; SP

ORENITRAM ORAL TABLET EXTENDED RELEASE 2.5 MG, 5 MG (treprostinil diolamine)

NP PA; SP; QL

113


REVATIO ORAL SUSPENSION RECONSTITUTED (sildenafil citrate)

NP PA; SP; QL

REVATIO ORAL TABLET (sildenafil citrate) NP PA; SP; QL

sildenafil citrate oral suspension reconstituted P PA; SP; QL

sildenafil citrate oral tablet 20 mg P PA; SP; QL

tadalafil (pah) NP PA; SP; QL

TRACLEER 62.5 MG, 125 MG (bosentan) P SP; QL

TRACLEER 32 MG (bosentan) for oral susp NP PA; SP; QL

TYVASO (treprostinil) NP PA

TYVASO REFILL (treprostinil) NP PA

TYVASO STARTER (treprostinil) NP PA

UPTRAVI ORAL (selexipag) NP PA; SP; QL

VENTAVIS INHALATION SOLUTION 10 MCG/ML (iloprost) NP PA; QL

VENTAVIS INHALATION SOLUTION 20 MCG/ML (iloprost) NP PA

Pulmonary Fibrosis Agents

ESBRIET (pirfenidone) CD PA; SP; QL

OFEV (nintedanib esylate) CD PA; SP; QL

Respiratory Tract Agents, Other

acetylcysteine inhalation solution 10 % CD QL

acetylcysteine inhalation solution 20 % CD

CLARINEX-D 12 HOUR (desloratadine-pseudoephedrine) NP PA

FASENRA PEN (benralizumab) CD PA; SP; QL

NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR (mepolizumab)

CD PA; SP; QL

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE (mepolizumab)

CD PA; SP; QL

promethazine vc CD QL; AL

promethazine-phenylephrine CD QL; AL

ribavirin inhalation CD

VIRAZOLE (ribavirin) CD PA

SKELETAL MUSCLE RELAXANTS

AMRIX (cyclobenzaprine hcl) CD PA; QL

carisoprodol oral CD QL

carisoprodol-aspirin-codeine NP PA; QL

chlorzoxazone oral tablet 375 mg, 750 mg CD PA

chlorzoxazone oral tablet 500 mg CD QL

cyclobenzaprine hcl er CD PA; QL

cyclobenzaprine hcl oral tablet 10 mg, 5 mg CD QL

cyclobenzaprine hcl oral tablet 7.5 mg CD PA

FEXMID (cyclobenzaprine hcl) CD PA

114


LORZONE (chlorzoxazone) CD PA

metaxalone oral tablet 400 mg CD PA

metaxalone oral tablet 800 mg CD PA; QL

methocarbamol oral CD QL

NORGESIC FORTE CD PA; QL

orphenadrine citrate er CD QL

SKELAXIN (metaxalone) CD PA; QL

SOMA (carisoprodol) CD PA; QL

SLEEP DISORDER AGENTS - DRUGS FOR SEDATION AND SLEEP

Sleep Disorders, Other - Drugs for Sleeping

sleep aid nighttime oral tablet (diphenhydramine) 25 mg CD OTC; QL

sleep-aid oral (doxylamine) capsule CD OTC, QL

sleeptime oral capsule CD OTC

XYWAV (ca, mg, k, and na oxybates) CD PA; QL

SLEEP DISORDER AGENTS

Sleep Promoting Agents

AMBIEN (zolpidem tartrate) NP PA; QL

AMBIEN CR (zolpidem tartrate) NP PA

BELSOMRA (suvorexant) NP PA

DAYVIGO (lemborexant) NP PA; QL

doxepin hcl oral tablet CD PA; QL

EDLUAR (zolpidem tartrate) NP PA; QL

estazolam CD PA; QL

eszopiclone oral tablet 1 mg P QL

eszopiclone oral tablet 2 mg, 3 mg P

flurazepam hcl CD PA; QL

HALCION (triazolam) CD PA; QL

HETLIOZ (tasimelteon) NP PA; SP; QL

HETLIOZ LQ (tasimelteon) NP PA; SP; QL; AL

LUNESTA ORAL TABLET 1 MG (eszopiclone) NP PA; QL

LUNESTA ORAL TABLET 2 MG, 3 MG (eszopiclone) NP PA

ramelteon NP PA; QL

RESTORIL ORAL CAPSULE 15 MG, 30 MG, 7.5 MG (temazepam)

CD PA; QL

RESTORIL ORAL CAPSULE 22.5 MG (temazepam) CD PA

ROZEREM (ramelteon) P QL

SILENOR (doxepin hcl) CD PA; QL

temazepam oral capsule 15 mg, 30 mg CD QL

temazepam oral capsule 22.5 mg CD PA

115


temazepam oral capsule 7.5 mg CD PA; QL

triazolam CD QL

zaleplon P QL

zolpidem tartrate er NP PA

zolpidem tartrate oral P QL

zolpidem tartrate sublingual NP PA; QL

Wakefulness Promoting Agents

armodafinil CD PA; QL

modafinil CD PA; QL

NUVIGIL (armodafinil) CD PA; QL

PROVIGIL (modafinil) CD PA; QL

SUNOSI (solriamfetol hcl) CD PA; QL

WAKIX (pitolisant hcl) CD PA; QL

XYREM (sodium oxybate) CD PA; SP; QL

WEIGHT LOSS AGENTS

ADIPEX-P (phentermine) capsule/tablet CD PA; QL; AL

benzphetamine tablet CD PA; QL; AL

CONTRAVE (naltrexone-bupropion) tablet CD PA; QL; AL

diethylpropion tablet CD PA; QL; AL

diethylpropion ER 24HR tablet CD PA; QL; AL

phendimetrazine tablet CD PA; QL; AL

phentermine capsule/tablet CD PA; QL; AL

QSYMIA (phentermine-topiramate ER) capsule CD PA; QL; AL

SAXENDA (liraglutide) solution for injection CD PA; QL; AL

WEGOVY (semaglutide) solution for injection CD PA; QL; AL

XENICAL (orlistat) capsule CD PA; QL; AL

116

Index of Drugs 1 12 hour nasal decongestant.103 12 hour nasal spray .............103

A abacavir sulfate .................... 33 abacavir sulfate-lamivudine... 33 abacavir-lamivudine-zidovudine

...........................................33 ABILIFY ............................... 29 ABILIFY MAINTENA............. 30 ABILIFY MYCITE ................. 30 ABILIFY MYCITE

MAINTENANCE KIT ......... 30 ABILIFY MYCITE STARTER

KIT ................................... 30 abiraterone acetate .............. 24 ABSORICA .......................... 56 ABSORICA LD ..................... 56 acamprosate calcium .............. 9 ACANYA .............................. 56 acarbose .............................. 36 ACCOLATE ........................108 ACCU-CHEK AVIVA DEVICE 61 ACCU-CHEK AVIVA PLUS KIT

W/DEVICE ....................... 61 ACCU-CHEK FASTCLIX

LANCET KIT .................... 61 ACCU-CHEK GUIDE

CONTROL ....................... 62 ACCU-CHEK GUIDE TEST

STRIPS ............................ 61 ACCU-CHEK LINKASSIST ... 62 ACCU-CHEK SMARTVIEW .. 62 ACCU-CHEK SMARTVIEW

CONTROL ....................... 62 ACCU-CHEK SOFTCLIX

LANCET DEVICE KIT ....... 62 ACCU-CHEK SPIRIT COMBO

PACK ................................62 ACCUPRIL........................... 44 ACCURETIC ........................ 47 ACE AEROSOL CLOUD

ENHANCER ..................... 94 acebutolol hcl ....................... 45 acetaminophen ...................... 4 acetaminophen-codeine ......... 6 acetaminophen-codeine #2 ..... 6 acetazolamide ...................... 47 acetazolamide er .................. 47 acetic acid ...........................103 acetylcysteine .....................111 acid controller....................... 74 acid gone ............................. 69

acid reducer ..........................74 acidophilus probiotic ..............69 ACIPHEX ..............................74 ACIPHEX SPRINKLE ............74 acitretin .................................56 acne control cleanser ............94 acne medication 10 ...............94 acne medication 5 .................94 ACTEMRA ............................90 ACTEMRA ACTPEN .............90 ACTHAR...............................78 ACTIMMUNE ........................91 ACTIPHLORA .......................69 ACTIQ ................................... 6 ACTIVELLA ..........................80 ACTONEL.............................94 ACTOPLUS MET ..................36 ACTOS .................................36 ACULAR ............................. 101 ACULAR LS ........................ 101 ACUVAIL ............................ 101 acyclovir ...............................32 ADACEL ...............................89 ADAKVEO ............................40 adapalene .............................56 adapalene-benzoyl peroxide . 56 ADCIRCA ........................... 110 ADDERALL ...........................52 ADDERALL XR .....................52 adefovir dipivoxil ...................31 ADEMPAS .......................... 110 ADHANSIA XR......................51 ADLYXIN ..............................36 ADLYXIN STARTER PACK ...36 ADMELOG............................38 ADMELOG SOLOSTAR ........38 ADRENALIN ....................... 108 ADVAIR DISKUS ................ 107 ADVAIR HFA ...................... 107 advanced antacid max st .......69 advanced healing ..................54 ADVATE ...............................42 ADYNOVATE ........................42 ADZENYS ER .......................52 ADZENYS XR-ODT...............52 AFINITOR .............................25 AFINITOR DISPERZ .............25 afirmelle ................................80 AFLURIA QUADRIVALENT ...89 AFREZZA .............................38 AFRIN SALINE NASAL MIST

......................................... 103 AFSTYLA .............................42

AGRYLIN.............................. 40 AIMOVIG .............................. 23 AIRDUO DIGIHALER .......... 107 AIRDUO RESPICLICK 113/14

......................................... 107 AJOVY ................................. 23 AKLIEF ................................. 56 ak-poly-bac ......................... 100 AKYNZEO ............................ 19 ALAHIST CF ....................... 106 ALAHIST DM ...................... 106 albendazole .......................... 27 ALBENZA ............................. 27 albuterol sulfate .................. 109 albuterol sulfate hfa ............. 109 alclometasone dipropionate ... 57 alcohol prep pads ....................9 ALCOHOL PREP PADS ........ 94 ALDACTAZIDE ..................... 47 ALDACTONE ........................ 49 ALDARA ............................... 59 ALECENSA .......................... 96 alendronate sodium ............... 94 alfuzosin hcl er ...................... 77 aliskiren fumarate .................. 47 ALKERAN............................. 24 ALKINDI SPRINKLE.............. 78 allergy relief ........................ 106 allopurinol ............................. 21 almacone double strength ..... 69 almotriptan malate................. 22 ALOCRIL ............................ 100 ALOGLIPTIN BENZOATE ..... 36 ALOGLIPTIN-METFORMIN

HCL .................................. 36 ALOGLIPTIN-PIOGLITAZONE

........................................... 36 ALOMIDE ........................... 100 ALORA ................................. 81 alosetron hcl ......................... 73 ALPHAGAN P ..................... 102 ALPHANATE ........................ 42 ALPHANINE SD.................... 42 alprazolam ............................ 35 alprazolam er ........................ 35 alprazolam intensol ............... 35 alprazolam xr ........................ 35 ALPROLIX ............................ 42 ALREX ............................... 101 ALTACE ............................... 44 altamist spray...................... 103 altavera ................................ 81 ALTOPREV .......................... 49

117

ALTRENO ............................ 56 alum & mag hydroxide-simeth69 alum sulfate-ca acetate ......... 54 alumina-magnesia-simethicone

...........................................69 ALUNBRIG .......................... 96 ALVESCO ...........................107 alvimopan ............................ 69 alyacen 1/35 ........................ 81 alyacen 7/7/7........................ 81 alyq ....................................110 amabelz ............................... 81 amantadine hcl ..................... 28 AMARYL .............................. 36 AMBIEN ..............................112 AMBIEN CR ........................112 ambrisentan ........................110 amcinonide .......................... 57 AMELUZ .............................. 59 AMERGE ............................. 22 amethia................................ 81 amethyst .............................. 81 AMICAR .............................. 41 amiloride hcl ......................... 49 amiloride-hydrochlorothiazide 47 aminocaproic acid ................ 41 amiodarone hcl .................... 44 AMITIZA .............................. 72 amitriptyline hcl .................... 18 amlodipine besylate .............. 46 amlodipine besylate-benazepril

hcl .................................... 47 amlodipine besylate-valsartan47 amlodipine-atorvastatin......... 47 amlodipine-olmesartan ......... 47 amlodipine-valsartan-hctz ..... 47 ammonium lactate ................ 57 amnesteem .......................... 56 amoxapine ........................... 18 amoxicill-clarithro-lansopraz. 73 amoxicillin ............................ 11 amoxicillin-potassium

clavulanate ....................... 11 amoxicillin-potassium

clavulanate er ................... 11 AMPHETAMINE ER ............. 52 amphetamine sulfate ............ 52 amphetamine-

dextroamphetamine .......... 52 amphetamine-

dextroamphetamine er ...... 52 ampicillin .............................. 11 AMPYRA ............................. 53 AMRIX ................................111 AMZEEQ ............................. 61

ANAFRANIL..........................18 anagrelide hcl .......................40 ANASPAZ .............................94 anastrozole ...........................25 ANCOBON ...........................21 ANDRODERM ......................80 ANDROGEL..........................80 ANDROGEL PUMP ...............80 ANGELIQ .............................81 ANNOVERA..........................81 ANORO ELLIPTA................ 107 antacid..................................69 antacid & anti-gas .................69 antacid advanced ..................69 antacid anti-gas max strength 69 antacid calcium .....................69 antacid extra strength ............69 antacid maximum strength .....69 antacid plus anti-gas relief .....69 antacid regular strength .........69 antacid ultra strength .............69 antacid/anti-gas.....................69 ANTARA ...............................49 antibiotic ................................ 9 anti-dandruff .........................57 anti-diarrheal .........................73 anti-diarrheal anti-gas ............70 ANTIVERT ............................18 ANUSOL-HC.........................93 apap-caff-dihydrocodeine ....... 6 APEXICON E ........................57 APIDRA SOLOSTAR.............38 APIDRA VIAL ........................38 APLENZIN ............................16 APOKYN ..............................28 apraclonidine hcl ................. 102 aprepitant .............................19 apri .......................................81 APRISO ................................93 aprodine ............................. 104 APTENSIO XR ......................51 APTIOM................................15 APTIVUS ..............................34 AQUAPHILIC ........................54 aranelle ................................81 ARANESP (ALBUMIN FREE) 40 ARAVA .................................91 ARAZLO ...............................56 ARCALYST ...........................90 arformoterol tartrate............. 109 ARICEPT ..............................16 ARIKAYCE ............................ 9 ARIMIDEX ............................25 aripiprazole ...........................30 ARISTADA............................30

ARISTADA INITIO................. 30 ARIXTRA ........................ 39, 40 armodafinil .......................... 112 ARMONAIR DIGIHALER ..... 108 ARMOUR THYROID ............. 89 ARNUITY ELLIPTA ............. 108 AROMASIN .......................... 25 ARTHROTEC .........................4 artificial tears ........................ 97 ASACOL HD ......................... 93 ascomp-codeine......................6 asenapine maleate ................ 30 ashlyna ................................. 81 ASMANEX (120 METERED

DOSES) .......................... 108 ASMANEX HFA .................. 108 aspirin ....................................4 aspirin ec ................................4 aspirin-dipyridamole er .......... 41 ASTAGRAF XL ..................... 91 ATACAND ............................ 43 ATACAND HCT .................... 47 atazanavir sulfate .................. 34 ATELVIA .............................. 94 atenolol................................. 45 atenolol-chlorthalidone .......... 47 ATIVAN ................................ 35 atomoxetine hcl ..................... 51 atorvastatin calcium .............. 49 atovaquone ........................... 27 atovaquone-proguanil hcl ...... 27 ATRALIN .............................. 56 ATRIPLA .............................. 32 atropine sulfate ..................... 99 ATROVENT HFA ................ 108 AUBAGIO ............................. 53 aubra .................................... 81 aubra eq ............................... 81 aurovela 1.5/30 ..................... 81 aurovela 1/20 ........................ 81 aurovela 24 fe ....................... 81 aurovela fe 1.5/30 ................. 81 aurovela fe 1/20 .................... 81 AURYXIA.............................. 66 AUSTEDO ............................ 53 AVALIDE .............................. 47 AVAPRO .............................. 43 aviane .................................. 81 AVITA ................................... 56 AVODART ............................ 77 AVONEX PEN ...................... 53 AVONEX PREFILLED ........... 53 AVSOLA ............................... 91 AYGESTIN ........................... 86 AYR ................................... 103

118

AYR SALINE NASAL DROPS .........................................103

ayuna .................................. 81 AYVAKIT ............................. 96 AZASAN .............................. 91 AZASITE.............................100 azathioprine ......................... 91 azelaic acid .......................... 56 azelastine hcl .............. 100, 106 azelastine-fluticasone ..........106 AZILECT .............................. 29 azithromycin ......................... 11 AZOPT ...............................102 AZOR .................................. 47 AZULFIDINE ........................ 93 AZULFIDINE EN-TABS. ....... 93 azurette ............................... 81

B b6 ........................................ 65 bac ........................................ 6 BACICAP ............................. 70 bacitracin ...................... 94, 100 bacitracin zinc ........................ 9 bacitracin-polymyxin b .........100 bacitra-neomycin-polymyxin-hc

...........................................99 baclofen ............................... 31 BACTRIM ............................ 12 BACTRIM DS ....................... 12 BAFIERTAM ........................ 53 BALCOLTRA ....................... 81 balsalazide disodium ............ 93 BALVERSA .......................... 25 balziva ................................. 81 BANZEL .............................. 15 BAQSIMI ONE PACK ........... 38 BARACLUDE ....................... 31 BASAGLAR KWIKPEN ......... 38 BAXDELA ............................ 12 BD AUTOSHIELD DUO PEN

NEEDLES ........................ 94 BD ULTRA-FINE INSULIN

SYRINGES ...................... 95 BD ULTRA-FINE PEN

NEEDLES ........................ 95 BECONASE AQ ..................108 BELBUCA .............................. 6 belladonna alkaloids-opium... 69 BELSOMRA ........................112 benazepril hcl ....................... 44 benazepril-hydrochlorothiazide

...........................................47 BENEFIX ............................. 42 BENICAR............................. 43 BENICAR HCT ..................... 47

BENLYSTA ...........................90 BENSAL HP..........................55 BENZACLIN..........................56 BENZACLIN WITH PUMP .....56 BENZAMYCIN ......................56 BENZHYDROCODONE-

ACETAMINOPHEN ............ 6 BENZNIDAZOLE...................27 benzonatate ........................ 103 benzoyl peroxide-erythromycin

........................................... 56 benztropine mesylate ............28 bepotastine besilate ............ 100 BEPREVE........................... 100 BERINERT ...........................90 beser ....................................57 BESER .................................55 BESIVANCE ....................... 100 betamethasone dipropionate . 57 betamethasone dipropionate

aug. ..................................57 betamethasone valerate ........57 BETAPACE ..........................44 BETAPACE AF .....................44 BETASERON ........................53 betaxolol hcl .................. 45, 102 bethanechol chloride .............77 BETHKIS ............................ 109 BETIMOL ............................ 102 BETOPTIC-S ...................... 102 BEVESPI AEROSPHERE.... 107 bexarotene............................26 BEXSERO ............................89 BEYAZ .................................81 bicalutamide .........................24 BIDIL ....................................47 BIJUVA .................................81 BIKTARVY ............................32 BILTRICIDE ..........................27 bimatoprost ...........................99 bisacodyl ..............................95 bisacodyl ec ..........................95 bismatrol ...............................70 bismuth subsalicylate ............70 bisoprolol fumarate ................45 bisoprolol-hydrochlorothiazide47 BLEPH-10........................... 100 BLEPHAMIDE .......................99 BLEPHAMIDE S.O.P. ............99 blisovi 24 fe ...........................81 blisovi fe 1.5/30 .....................81 blisovi fe 1/20 ........................81 BONIVA ................................94 BONJESTA ...........................18 BOOSTRIX ...........................89

bosentan ............................ 110 BOSULIF .............................. 96 BOUDREAUXS BABY BUTT

SMOOTH .......................... 54 BRAFTOVI ........................... 26 BREO ELLIPTA .................. 107 BREXAFEMME TABLET (ibrexafungerp citrate) ……… 22 BREZTRI AEROSPHERE ... 107 briellyn .................................. 81 BRILINTA ............................. 41 brimonidine tartrate ............. 102 brinzolamide ....................... 102 BRISDELLE .......................... 17 BRIVIACT ............................. 13 bromfenac sodium (once-daily)

......................................... 101 bromocriptine mesylate ......... 28 BROMSITE ......................... 101 BRONCHITOL ...................... 54 BROVANA .......................... 109 BRUKINSA ........................... 96 BRYHALI .............................. 57 budesonide ......................... 107 budesonide er ....................... 93 BUDESONIDE-FORMOTEROL

FUMARATE .................... 107 bumetanide ........................... 48 BUNAVAIL ..............................9 BUPHENYL .......................... 75 buprenorphine.........................9 buprenorphine hcl-naloxone hcl

............................................. 9 bupropion hcl ........................ 16 bupropion hcl er (smoking det) 8 bupropion hcl er (sr) .............. 16 bupropion hcl er (xl) .............. 16 BUPROPION HCL ER (XL) ... 16 buspirone hcl ........................ 34 butalbital-acetaminophen.........6 butalbital-apap-caff-cod ...........7 butalbital-apap-caffeine ...........7 butalbital-asa-caff-codeine .......7 butalbital-aspirin-caffeine .........7 butorphanol tartrate .................7 BUTRANS ..............................6 BYDUREON BCISE

AUTOINJECTOR .............. 36 BYETTA 10 MCG PEN .......... 36 BYLVAY CAP 200 MCG (odevixibat pellets cap sprinkle) ............................................ 71 BYLVAY CAP 400 MCG, 1200 MCG (odevixibat) ................. 71 BYSTOLIC ............................ 45

119

C cabergoline .......................... 88 CABLIVI ............................... 41 CABOMETYX ...................... 96 CADUET .............................. 47 CAFERGOT ......................... 22 caffeine citrate ...................... 53

calamine ......................... 55, 95 CALAN SR ........................... 46 calcipotriene.................... 59, 60 CALCIPOTRIENE ................ 59 calcipotriene-betameth diprop 60 calcitonin (salmon) ............... 94 calcitriol .......................... 60, 94 calcium acetate .................... 66 calcium acetate (phos binder) 66 calcium antacid ex st ............ 70 calcium carbonate antacid .... 70 CALQUENCE....................... 96 CAMBIA ................................. 4 camila .................................. 86 camrese ............................... 81 camrese lo ........................... 81 CANASA .............................. 93 candesartan cilexetil ............. 43 candesartan cilexetil-hctz ...... 47 capcof .................................104 capecitabine......................... 24 CAPEX ................................ 57 CAPLYTA ............................ 30 CAPRELSA.......................... 96 capsaicin.............................. 95 capsaicin hp ......................... 95 captopril ............................... 44 capzix .................................. 95 CARAC ................................ 60 CARAFATE.......................... 74 CARBAGLU ......................... 65 carbamazepine .................... 15 carbamazepine er................. 15 CARBATROL ....................... 15 carbidopa ............................. 29 carbidopa-levodopa .............. 29 carbidopa-levodopa er .......... 29 carbidopa-levodopa-entacapone

...........................................28 carbinoxamine maleate........106 carboxymethylcellulose sodium

...........................................97 CARDIZEM .......................... 46 CARDIZEM CD .................... 46 CARDIZEM LA ..................... 46 CARDURA ........................... 43 CARDURA XL ...................... 77 carisoprodol ........................111 carisoprodol-aspirin-codeine 111

CARNITOR ...........................75 CARNITOR SF......................75 CAROSPIR ...........................49 carteolol hcl ........................ 102 carvedilol ..............................45 carvedilol phosphate er..........45

CASODEX ............................24 CASTIVA WARMING ............95 CATAPRES-TTS-1 ................43 CATAPRES-TTS-2 ................43 CATAPRES-TTS-3 ................43 CAYA ...................................95 CAYSTON .......................... 109 caziant ..................................81 cefaclor .................................11 cefaclor er .............................10 cefadroxil ..............................11 cefdinir ..................................11 cefixime ................................11 cefpodoxime proxetil .............11 cefprozil ................................11 cefuroxime axetil ...................11 CELEBREX ........................... 4 celecoxib ............................... 4 CELEXA ...............................17 CELLCEPT ...........................91 CELONTIN ...........................14 CENTANY ............................61 CENTANY AT .......................61 cephalexin ............................11 CEQUA ................................99 CERDELGA ..........................75 CERVIDIL .............................79 cetirizine hcl ........................ 106 cetirizine-pseudoephedrine er

......................................... 106 cevimeline hcl .......................54 charlotte 24 fe .......................81 chateal..................................81 chateal eq .............................81 CHEMET ..............................66 CHEMSTRIP 10 MD ..............62 CHENODAL ..........................73 chest congestion relief ......... 103 chest congestion relief dm ... 104 childrens mucus relief cough105 chlordiazepoxide hcl ..............35 chlordiazepoxide-amitriptyline 16 chlordiazepoxide-clidinium .....73 chlorhexidine gluconate .........54 chloroquine phosphate ..........27 chlorpromazine hcl ................29 chlorthalidone .......................49 chlorzoxazone ..................... 111 chocolated laxative ................71 CHOLBAM ............................75

cholestyramine ...................... 50 cholestyramine light .............. 50 chorionic gonadotropin .......... 79 CIALIS .................................. 77 ciclodan ................................ 19

ciclopirox .............................. 19 ciclopirox olamine ................. 19 ciclopirox treatment ............... 19 cilostazol .............................. 41 CILOXAN............................ 100 CIMDUO ............................... 33 cimetidine ............................. 74 cimetidine hcl ........................ 74 CIMZIA ................................. 91 cinacalcet hcl ........................ 94 CINRYZE.............................. 90 CIPRO .................................. 12 CIPRO HC .......................... 103 CIPRODEX ......................... 103 ciprofloxacin hcl .....12, 100, 103 ciprofloxacin-dexamethasone

......................................... 103 citalopram hydrobromide ....... 17 CITRANATAL 90 DHA........... 67 CITRANATAL ASSURE ........ 67 CITRANATAL B-CALM.......... 67 CITRANATAL BLOOM .......... 67 CITRANATAL BLOOM DHA .. 67 CITRANATAL DHA ............... 67 CITRANATAL HARMONY ..... 67 CITRANATAL RX .................. 67 claravis ................................. 56 CLARINEX ......................... 106 CLARINEX-D 12 HOUR ..... 106,

111 clarithromycin........................ 11 clarithromycin er.................... 11 clearlax ................................. 70 clearskin ............................... 95 clemastine fumarate ............ 106 CLENPIQ.............................. 73 CLEOCIN ...............................9 CLEOCIN-T .......................... 61 CLIMARA ............................. 81 CLIMARA PRO ..................... 81 clindacin etz .......................... 61 CLINDACIN PAC .................. 55 clindacin-p ............................ 61 CLINDAGEL ......................... 61 clindamycin hcl ..................... 10 clindamycin palmitate hcl ....... 10 clindamycin phosphate .... 10, 61 CLINDAMYCIN PHOSPHATE

........................................... 61 clindamycin phosphate-benzoyl

peroxide ............................ 56

120

clindamycin-tretinoin ............. 56 CLINDESSE ........................ 10 clobazam ............................. 14

clobetasol prop emollient base ...........................................57

clobetasol propionate emulsion ...........................................57

CLOBEX .............................. 58 CLOBEX SPRAY ................. 58 clocortolone pivalate ............. 58 clodan .................................. 58 CLODAN.............................. 55 CLODERM ........................... 58 clomipramine hcl .................. 18 clonazepam ......................... 35 clonidine .............................. 43 clonidine hcl ......................... 43 clonidine hcl er ..................... 51 clopidogrel bisulfate .............. 41 clorazepate dipotassium ....... 35 clotrimazole.......................... 20 clotrimazole 3 ....................... 20 clotrimazole-betamethasone . 19 clovique ............................... 66 clozapine ............................. 31 CLOZARIL ........................... 31 C-NATE DHA ....................... 67 COAGADEX ........................ 42 COARTEM ........................... 27 codeine sulfate ....................... 7 coenzyme q10 ...................... 95 COLACE .............................. 70 COLAZAL ............................ 93 colchicine ............................. 21 COLCHICINE ....................... 21 colchicine-probenecid ........... 21 COLCRYS ........................... 21 cold & cough childrens.........104 cold & cough dm childrens ...104 cold & flu .............................103 cold & sinus relief ................104 colesevelam hcl.................... 50 COLESTID ........................... 50 colestipol hcl ........................ 50 COMBIGAN ......................... 99 COMBIPATCH ..................... 81 COMBIVENT RESPIMAT ....107 COMBIVIR ........................... 33 COMETRIQ (100 MG DAILY

DOSE) ............................. 96 COMFORT TOUCH LANCETS

31G.................................. 62 COMFORT TOUCH PLUS

LANCETS 30G ................. 62 COMPLERA ......................... 32 COMPLETE NATAL DHA ..... 67

COMPLETENATE .................67 COMTAN ..............................28

CONCERTA..........................51 CONDOMS ...........................95 CONDYLOX..........................60 constulose ............................72 CONTOUR CONTROL

SOLUTION........................62 CONTOUR MONITOR ..........62 CONTOUR NEXT MONITOR

KIT W/DEVICE ..................62 CONTOUR NEXT ONE KIT ...62 CONTOUR NEXT TEST

STRIPS .............................62 CONTOUR TEST STRIPS.....62 CONZIP ................................. 6 COOL MIST HUMIDIFER ......95 COPAXONE .........................53 COPIKTRA ...........................26 COREG ................................45 COREG CR ..........................45 CORGARD ...........................45 CORIFACT ...........................42 CORLANOR .........................47 corn & callus remover ............55 CORTEF...............................78 CORTENEMA .......................93 CORTIFOAM ........................93 CORTISPORIN-TC ............. 103 COSENTYX ..........................90 COSOPT ..............................99 COSOPT PF .........................99 COTELLIC ............................26 COTEMPLA XR-ODT ............51 cough dm ............................ 104 cough dm childrens ............. 104 cough dm er ........................ 104 cough drops ........................... 8 COVID-19 TEST… ................95 COVID-19 VACCINE .............89 COZAAR ..............................43 CREON ................................75 CRESEMBA..........................21 CRESTOR ............................49 CRINONE .............................86 cromolyn sodium .. 75, 100, 107,

110 cryselle-28 ............................82 CUPRIMINE..........................77 CUTIVATE ............................58 CUVPOSA ............................73 cyanocobalamin ....................64 cyclafem 1/35 ........................82 cyclafem 7/7/7 .......................82 cyclobenzaprine hcl ............. 111 cyclobenzaprine hcl er ......... 111

CYCLOGYL .......................... 99

CYCLOMYDRIL ............ 98, 100 cyclopentolate hcl ................. 99 cyclophosphamide ................ 24 CYCLOPHOSPHAMIDE ........ 24 cycloserine ........................... 23 CYCLOSET .......................... 36 cyclosporine.......................... 91 cyclosporine modified ............ 91 CYMBALTA .......................... 53 cyproheptadine hcl .............. 106 cyred .................................... 82 cyred eq ............................... 82 CYSTADANE ........................ 75 CYSTADROPS ..................... 99 CYSTAGON ......................... 75 CYSTARAN .......................... 99 CYTOMEL ............................ 87 CYTOTEC ............................ 74

D D.H.E. 45 .............................. 23 dalfampridine er .................... 53 DALIRESP .......................... 110 danazol................................. 80 dandruff shampoo ................. 58 DANTRIUM........................... 31 dantrolene sodium................. 31 dapsone ......................... 23, 61 DAPTACEL........................... 89 DARAPRIM........................... 27 darifenacin hydrobromide er .. 76 dasetta 1/35 .......................... 82 dasetta 7/7/7 ......................... 82 DAURISMO .......................... 26 day time cold & flu ............... 103 DAYPRO ................................4 daysee ................................. 82 daytime cold/flu ................... 103 DAYTRANA .......................... 51 DAYVIGO ........................... 112 DDAVP ................................. 79 deblitane ............................... 87 deferasirox ............................ 66 deferasirox granules .............. 66 deferiprone ........................... 66 DELESTROGEN ................... 82 DELSTRIGO ......................... 32 DELSYM ............................ 104 DELSYM CGH/CHEST CONG

DM CHILD ...................... 104 DELSYM COUGH CHILDRENS

......................................... 104 DELSYM COUGH/CHEST

CONGEST DM ................ 104 DELZICOL ............................ 93 demeclocycline hcl ................ 12

121

DEMSER ............................. 47 DENAVIR............................. 32 DENTA 5000 PLUS .............. 65 DENTAGEL ......................... 65 DEPAKOTE ......................... 35 DEPAKOTE ER.................... 35 DEPAKOTE SPRINKLES ..... 35 DEPEN TITRATABS ............ 77 DEPO-ESTRADIOL .............. 82 DEPO-PROVERA ................ 87 DEPO-SUBQ PROVERA 104 87 DEPO-TESTOSTERONE ..... 80 DERMA-SMOOTHE/FS BODY

...........................................58 DERMA-SMOOTHE/FS SCALP

...........................................58 DERMOTIC.........................103 DESCOVY ........................... 33 desipramine hcl .................... 18 desloratadine ......................106 desmopressin acetate .......... 79 desmopressin acetate spray . 79 desogestrel-ethinyl estradiol . 82 DESONATE ......................... 58 desonide .............................. 58 desoximetasone ................... 58 DESOXYN ........................... 52 DESVENLAFAXINE ER ........ 17 desvenlafaxine succinate er .. 17 DETROL .............................. 76 DETROL LA ......................... 76 dexamethasone.................... 78 dexamethasone intensol ....... 78 dexamethasone sodium

phosphate .......................101 DEXEDRINE ........................ 52 DEXILANT ........................... 74 dexmethylphenidate hcl ........ 51 dexmethylphenidate hcl er .... 51 dextroamphetamine sulfate ... 52 dextroamphetamine sulfate er52 dextromethorphan polistirex er

.........................................104 dextromethorphan-guaifenesin

.........................................104 DIACOMIT ........................... 13 diaper rash ........................... 54 DIASTAT ACUDIAL .............. 14 DIASTAT PEDIATRIC .......... 14 diazepam ........................ 14, 35 diazepam intensol ................ 35 diazoxide ............................. 38 dibucaine (perianal) .............. 54 DICLEGIS ............................ 18 DICLOFENAC PATCH 1.3%. .. 4

diclofenac potassium .............. 4 diclofenac sodium ..... 4, 60, 101 diclofenac sodium er .............. 4 diclofenac-misoprostol ............ 4 dicloxacillin sodium................11 dicyclomine hcl......................73 DIFFERIN .............................56 DIFICID ................................12 diflorasone diacetate .............58 DIFLUCAN............................21 diflunisal ................................ 4 digestive probiotic .................70 digitek ...................................47 digox ....................................47 digoxin ..................................47

dihydroergotamine mesylate . 23 DILANTIN .............................15 DILANTIN INFATABS............15 DILAUDID .............................. 7 diltiazem hcl ..........................46 diltiazem hcl er ......................46 diltiazem hcl er beads ............46 diltiazem hcl er coated beads 46 dilt-xr ....................................46 dimaphen dm cold/cough ..... 104 dimethyl fumarate..................53 DIOVAN................................43 DIOVAN HCT ........................47 DIPENTUM ...........................93 diphenhydramine hcl ........... 106 diphenoxylate-atropine ..........73 DIPHTHERIA-TETANUS

TOXOIDS DT ....................89 DIPROLENE .........................58 dipyridamole .........................41 disopyramide phosphate........44 disulfiram ............................... 9 DITROPAN XL ......................76 DIURIL .................................49 divalproex sodium .................35 divalproex sodium er .............35 DIVIGEL ...............................82 docosanol .............................55 docusate calcium ..................71 docusate sodium ...................70 DOCUSOL MINI ....................70 dofetilide ...............................44 dok ................................. 70, 71 dolishale ...............................82 donepezil hcl .........................16 DOPTELET ...........................41 DORYX ................................12 DORYX MPC ........................12 dorzolamide hcl ................... 102 dorzolamide hcl-timolol mal ...99

dorzolamide hcl-timolol mal pf99 dotti ...................................... 82 double antibiotic .................... 95 DOVATO .............................. 32 DOVONEX ........................... 60 doxazosin mesylate ............... 43 doxepin hcl ............. 18, 58, 112 doxercalciferol....................... 94 doxycycline hyclate ............... 12 doxycycline monohydrate 12, 13 doxylamine-pyridoxine ........... 18 DR SMITHS DIAPER ............ 54 DRIZALMA SPRINKLE.......... 53 dronabinol............................. 19 drospiren-eth estrad-levomefol

........................................... 82 drospirenone-ethinyl estradiol 82 DROXIA ............................... 40 droxidopa.............................. 43 DUAKLIR PRESSAIR .......... 107 DUAVEE .............................. 82 DUETACT ............................ 36 DUEXIS ..................................4 DULERA ............................. 107 duloxetine hcl ........................ 53 DUOBRII .............................. 60 DUOPA ................................ 29 DUPIXENT ........................... 90 DUREZOL .......................... 101 dutasteride ............................ 77 dutasteride-tamsulosin hcl ..... 77 DYANAVEL XR ..................... 52 DYMISTA ........................... 106

E E.E.S. GRANULES ............... 12 earwax removal kit .............. 103 EASIVENT ............................ 95 EASIVENT MASK LARGE ..... 95 EASIVENT MASK MEDIUM .. 95 EASIVENT MASK SMALL ..... 95 econazole nitrate ................... 20 econtra ez............................. 79 econtra one-step ................... 80 ED A-HIST .......................... 106 ed chlorped jr ...................... 106 EDARBI ................................ 43 EDARBYCLOR ..................... 47 EDECRIN ............................. 48 EDLUAR ............................. 112 ED-SPAZ .............................. 95 EDURANT ............................ 32 efavirenz ............................... 33 efavirenz-emtricitab-tenofovir 33 efavirenz-lamivudine-tenofovir

........................................... 33

122

EFFEXOR XR ...................... 17 EFFIENT.............................. 41 EFUDEX .............................. 60 EGRIFTA SV ....................... 79 ELEPSIA XR ........................ 13 ELESTRIN ........................... 82 eletriptan hydrobromide ........ 22 ELIDEL ................................ 58 ELIGARD ............................. 88 elinest .................................. 82 ELIQUIS ...............................40 ELIQUIS DVT/PE STARTER

PACK ............................... 40 ELITE-OB ............................ 67 ELLA ................................... 87 ELMIRON ............................ 77 ELOCTATE .......................... 42 eluryng................................. 82 EMCYT ................................ 25 EMEND ............................... 19 EMEND TRI-PACK ............... 19 EMFLAZA ............................ 78 EMGALITY........................... 23 EMGALITY (300 MG DOSE) 23 emoquette ............................ 82 EMPAVELI ........................... 36 EMSAM ............................... 17 emtricitabine ........................ 33 emtricitabine-tenofovir df....... 33 EMTRIVA............................. 33 EMVERM ............................. 27 enalapril maleate .................. 44 enalapril-hydrochlorothiazide .47 ENBRACE HR ..................... 67 ENBREL .............................. 91 ENDACOF-DM ....................104 ENDARI .......................... 41, 65 endocet.................................. 7 enema ................................. 70 enema mineral oil ................. 71 enema ready-to-use ............. 70 ENEMEEZ MINI ................... 71 ENGERIX-B ......................... 89 enoxaparin sodium ............... 40 enpresse-28 ......................... 82 enskyce ............................... 82 ENSPRYNG ......................... 92 ENSTILAR ........................... 60 entacapone .......................... 28 entecavir .............................. 31 ENTOCORT EC ................... 93 ENTRESTO ......................... 47 ENTYVIO ............................. 90 enulose ................................ 72 ENVARSUS XR ................... 92

EPANED...............................44 EPCLUSA .............................31 EPIDIOLEX ...........................13 EPIDUO FORTE ...................56 EPIFOAM .............................60 epinastine hcl ...................... 100 epinephrine ......................... 109 EPIPEN 2-PAK ................... 109 EPIPEN JR 2-PAK .............. 109 epitol ....................................15 EPIVIR .................................33 EPIVIR HBV..........................31 eplerenone............................49 EPOGEN ..............................41 EPZICOM .............................33 EQUETRO ............................35 ergoloid mesylates ................16 ERGOMAR ...........................23 ERIVEDGE ...........................26 ERLEADA .............................24 erlotinib hcl ...........................96 errin ......................................87 ERTACZO ............................20 ERYGEL ...............................61 ERYPED 200 ........................12 ERY-TAB ..............................12 ERYTHROCIN STEARATE ...12 erythromycin ........... 12, 61, 100 erythromycin base .................12 erythromycin ethylsuccinate ...12 ESBRIET ............................ 111 escitalopram oxalate .............17 ESGIC ................................... 7 esomeprazole magnesium ....74,

75 ESPEROCT ..........................42 estarylla ................................82 estazolam ........................... 112 ESTRACE.............................82 estradiol ................................82 estradiol valerate ...................82 estradiol-norethindrone acet ..82 ESTRING .............................82 ESTROSTEP FE ...................82 eszopiclone ......................... 112 ethacrynic acid ......................48 ethambutol hcl ......................23 ethosuximide.........................14 ethynodiol diac-eth estradiol ..82 etodolac ................................. 4 etodolac er ............................. 4 etonogestrel-ethinyl estradiol 82 etoposide ..............................25 etravirine...............................33 EUCRISA .............................58

euthyrox ............................... 87 EVAMIST.............................. 82 EVEKEO .............................. 52 EVEKEO ODT ...................... 52 everolimus ...................... 26, 92 EVISTA ................................ 87 EVOCLIN.............................. 61 EVOTAZ ............................... 34 EVOXAC .............................. 54 EVRYSDI.............................. 75 EXELON ............................... 16 exemestane .......................... 25 EXFORGE ............................ 47 EXFORGE HCT .................... 48 EXJADE ............................... 66 EXKIVITY CAP (mobocertinib succinate) ............................ 97 EXSERVAN .......................... 53 EXTAVIA .............................. 53 EXTINA ................................ 20 eye drops.............................. 97 eye drops advanced relief...... 97 EYSUVIS ............................ 101 EZALLOR SPRINKLE ........... 50 ezetimibe .............................. 50 ezetimibe-simvastatin ............ 50

F FABIOR ................................ 56 falmina.................................. 82 famciclovir ............................ 32 famotidine ............................. 74 famotidine orig st ................... 74 FANAPT ............................... 30 FANAPT TITRATION PACK .. 30 FARESTON .......................... 25 FARXIGA.............................. 36 FASENRA PEN .................. 111 fayosim ................................. 83 febuxostat ............................. 21 FEIBA ................................... 42 felbamate.............................. 13 FELBATOL ........................... 13 FELDENE ...............................4 felodipine er .......................... 46 FEMARA .............................. 25 FEMHRT .............................. 83 FEMRING ............................. 83 femynor ................................ 83 fenofibrate ............................ 49 fenofibrate micronized ........... 49 fenofibric acid........................ 49 FENOGLIDE ......................... 49 fenoprofen calcium ..................4 FENSOLVI (6 MONTH) ......... 88 fentanyl...................................6 fentanyl citrate ........................7

123

FENTANYL CITRATE .............................. 7FENTORA .............................................. 7 FERRIPROX ........................ 66 FERRIPROX TWICE-A-DAY .66 ferrous fumarate ................... 64 FETZIMA ............................. 17 FETZIMA TITRATION .......... 17 FEXMID ..............................111 FIASP .................................. 38 FIASP FLEXTOUCH ............ 38 FIASP PENFILL ................... 38 fiber ..................................... 71 fiber laxative ......................... 71 fiber laxative + calcium ......... 71 fiber therapy ......................... 71 fiber-caps ............................. 71 fiber-lax................................ 71 FINACEA ............................. 56 finasteride ............................ 77 FINTEPLA ............................13 FIORICET .............................. 7 FIORICET/CODEINE ............. 7 FIRAZYR ............................. 90 FIRDAPSE ........................... 53 first aid antibiotic .................... 9 FIRVANQ............................. 10 flac .....................................103 FLAGYL ............................... 10 flanders buttocks .................. 54 FLAREX ............................. 101 flavoxate hcl ......................... 76 flecainide acetate ................. 44 FLECTOR .............................. 4 FLEET BISACODYL ............. 95 FLEET ENEMA .................... 70 FLEET OIL ........................... 71 FLEET PEDIATRIC .............. 71 FLOMAX .............................. 77 FLOVENT DISKUS .............108 FLOVENT HFA ...................108 FLUAD QUADRIVALENT ..... 89 FLUARIX QUADRIVALENT .. 89 FLUCELVAX QUADRIVALENT

...........................................89 fluconazole .......................... 21 flucytosine ............................ 21 fludrocortisone acetate ......... 78 FLULAVAL QUADRIVALENT 89 flunisolide............................107 fluocinolone acetonide ... 58, 103 fluocinolone acetonide body .. 58 fluocinolone acetonide scalp . 58 fluocinonide.......................... 58 fluocinonide emulsified base . 58 fluorometholone ..................101

fluorouracil ............................60

fluoxetine hcl .........................17 fluoxetine hcl (pmdd) .............17 fluphenazine decanoate.........29 fluphenazine hcl ....................29 flurandrenolide ......................58 flurazepam hcl .................... 112 flurbiprofen............................. 4 flurbiprofen sodium .............. 101 flutamide ...............................24 fluticasone propionate ... 58, 108 fluticasone-salmeterol.......... 107 FLUTICASONE-SALMETEROL

......................................... 107 fluvastatin sodium .................50 fluvastatin sodium er .............50 fluvoxamine maleate .............17 fluvoxamine maleate er..........17 FML .................................... 101 FML FORTE ....................... 101 FML LIQUIFILM .................. 101 FOCALIN ..............................51 FOCALIN XR ........................51 fondaparinux sodium .............40 FORFIVO XL ........................16 FORTEO ..............................94 FORTESTA ..........................80 FOSAMAX ............................94 FOSAMAX PLUS D ...............94 fosamprenavir calcium ...........34 fosfomycin tromethamine .......10 fosinopril sodium ...................44 fosinopril sodium-hctz ............48 FOSRENOL ..........................66 FOTIVDA .............................. 96 FRAGMIN .............................40 FREESTYLE LIBRE 14 DAY

READER ...........................63 FREESTYLE LIBRE 14 DAY

SENSOR...........................63 FREESTYLE LIBRE 2 READER

........................................... 63 FREESTYLE LIBRE 2 SENSOR

........................................... 63 FREESTYLE PRECISION NEO

SYSTEM ...........................63 FREESTYLE PRECISION NEO

TEST ................................63 FROVA .................................22 frovatriptan succinate ............22 FULPHILA ............................41 FUNGOID TINCTURE ...........20 furosemide ...................... 48, 49 FUZEON...............................33 fyavolv ..................................83 FYCOMPA ............................13

G gabapentin ...................... 14, 15 GABITRIL ............................. 15 GALAFOLD .......................... 75 galantamine hydrobromide .... 16 galantamine hydrobromide er 16 GARDASIL 9 ........................ 89 gas relief ............................... 70 gas relief extra strength ......... 70 gas relief infants drops .......... 70 GASTROCROM .................... 75 gatifloxacin ......................... 100 GATTEX ............................... 73 gavilax .................................. 71 gavilyte-c .............................. 73 gavilyte-g .............................. 73 gavilyte-n with flavor pack ...... 73 GAVRETO ............................ 96 GELNIQUE ........................... 76 gemfibrozil ............................ 49 gemmily ................................ 83 GEMTESA ............................ 31 GENERESS FE .................... 83 generlac ............................... 72 gengraf ................................. 92 GENOTROPIN ...................... 79 GENOTROPIN MINIQUICK ... 79 gentak ................................ 100 gentamicin sulfate ......... 61, 100 GENTEAL SEVERE .............. 97 GENTEAL TEARS ................ 98

GENTEAL TEARS MODERATE PF .................................... 98

GENTEAL TEARS NIGHT-TIME ........................................... 98

GENTEAL TEARS SEVERE DAY/NIGHT ...................... 98

gentle laxative ....................... 95 GENVOYA ............................ 32 GEODON ............................. 30 GILENYA .............................. 53 GILOTRIF ............................. 96 GIMOTI ................................ 18 glatiramer acetate ................. 54 glatopa ................................. 54 GLEEVEC ............................ 96 glimepiride ............................ 36 glipizide er ............................ 36 glipizide ir ............................. 36 glipizide xl ............................. 36 glipizide-metformin hcl ........... 36 GLOPERBA .......................... 21 GLUCAGEN HYPOKIT.......... 38 glucagon emergency ............. 38 GLUCAGON EMERGENCY .. 38

124

GLUCOSE ........................... 36 GLUCOSE CONTROL

SOLUTION ....................... 95 GLUCOTROL XL ................. 36 GLUMETZA ......................... 36 glyburide .............................. 36 glyburide micronized............. 36 glyburide-metformin .............. 36 glycerin (adult) ..................... 71 glycerin adult ........................ 71 glycerin child ........................ 71 glycerin childrens ................. 71 glycerin pediatric .................. 71 glycolax ............................... 71 glycopyrrolate....................... 73 GLYNASE .............................36 GLYXAMBI .......................... 36 GOCOVRI ............................ 28 GOLYTELY .......................... 73 GONITRO ............................ 51 gormel 10............................. 55 GRALISE ..............................53 granisetron hcl ..................... 19 GRANIX ............................... 41 griseofulvin microsize ........... 21 griseofulvin ultramicrosize ..... 21 guaifenesin-codeine ............104 guaifenesin-dm ...................104 guanfacine hcl ...................... 43 guanfacine hcl er .................. 51 GVOKE HYPOPEN 1-PACK 38 GVOKE PFS ........................ 38 GYNAZOLE-1 ...................... 20

H HAEGARDA ......................... 90 hailey 1.5/30 ........................ 83 hailey 24 fe .......................... 83 hailey fe 1.5/30 ..................... 83 hailey fe 1/20 ....................... 83 halcinonide .......................... 58 HALCION............................112 HALDOL DECANOATE ........ 29 halobetasol propionate ......... 58 HALOBETASOL PROPIONATE

...........................................58 HALOG ................................ 58 haloperidol ........................... 29 haloperidol decanoate .......... 29 haloperidol lactate ................ 29 HARVONI ............................ 31 HAVRIX ............................... 89 heartburn relief ..................... 74 heather ................................ 87 HELIDAC THERAPY ............ 73 HEMADY ............................. 78

HEMANGEOL .......................45 HEMLIBRA ...........................42 HEMOFIL M ..........................42 heparin sodium (porcine) .......40 heparin sodium (porcine) pf ...40 HEPLISAV-B.........................89 HEPSERA ............................31 HETLIOZ ............................ 112 HETLIOZ LQ ....................... 112 HIPREX ................................10 HISTEX PD ......................... 106 HISTEX-AC ........................ 104 HORIZANT ...........................53 HUMALOG ...........................38 HUMALOG JUNIOR KWIKPEN

........................................... 38 HUMALOG KWIKPEN ...........38 HUMALOG MIX 50/50 ...........38 HUMALOG MIX 50/50

KWIKPEN .........................38 HUMALOG MIX 75/25 ...........38 HUMALOG MIX 75/25

KWIKPEN .........................38 HUMATE-P ...........................42 HUMATROPE .......................79 HUMIRA ...............................92 HUMIRA PEN-PEDIATRIC UC

START ..............................92 HUMIRA PEN-PSOR/UVEIT

STARTER .........................92 HUMULIN 70/30 KWIKPEN ...38 HUMULIN 70/30 VIAL ...........38 HUMULIN N KWIKPEN .........38 HUMULIN N VIAL .................38 HUMULIN R U-500 KWIKPEN

........................................... 38 HUMULIN R U-500 VIAL

(CONCENTRATED) ..........39 HUMULIN R VIAL .................39 HYCAMTIN ...........................25 hydralazine hcl ......................51 HYDREA ..............................25 hydrochlorothiazide ...............49 hydrocodone bitartrate er ........ 6 hydrocodone-acetaminophen.. 7 hydrocodone-homatropine ... 104 hydrocodone-ibuprofen ........... 7 hydrocortisone ................ 58, 78 hydrocortisone (perianal) .......93 hydrocortisone ace-pramoxine

........................................... 60 hydrocortisone acetate ..........54 hydrocortisone butyr lipo base

........................................... 58 hydrocortisone butyrate .........58

hydrocortisone plus ............... 55 hydrocortisone valerate ......... 59 hydrocortisone-acetic acid ... 103 hydrocortisone-aloe max st .... 55 hydromorphone hcl .................7 hydromorphone hcl er .............6 hydroxychloroquine sulfate .... 27 hydroxyurea .......................... 25 hydroxyzine hcl ..................... 34 hydroxyzine pamoate ............ 34 hyoscyamine sulfate .............. 95 HYPERTET S/D .................... 89 HYSINGLA ER ........................6 HYZAAR ............................... 48

I ibandronate sodium ............... 94 IBRANCE ............................. 26 ibuprofen ................................5 ibuprofen childrens ..................5 icatibant acetate .................... 90 iclevia ................................... 83 ICLUSIG ............................... 96 icosapent ethyl ...................... 50 IDELVION............................. 42 IDHIFA ................................. 25 ILARIS .................................. 90 ILEVRO .............................. 101 ILUMYA ................................ 90 imatinib mesylate .................. 96 IMBRUVICA.......................... 97 imipramine hcl....................... 18 imipramine pamoate .............. 18 imiquimod ............................. 60 IMIQUIMOD PUMP ............... 60 IMITREX ............................... 22 IMITREX STATDOSE REFILL

........................................... 22 IMITREX STATDOSE SYSTEM

........................................... 22 IMPEKLO ............................. 59 IMURAN ............................... 92 INBRIJA ............................... 29 incassia ................................ 87 INCRELEX ........................... 79 INCRUSE ELLIPTA ............. 108 indapamide ........................... 49 INDERAL LA ......................... 45 INDERAL XL ......................... 45 INDOCIN ................................5 indomethacin ..........................5 indomethacin er ......................5 INFLECTRA.......................... 92 INGREZZA ........................... 53 INLYTA................................. 97 INNOPRAN XL ..................... 45

125

INQOVI ................................ 26 INREBIC .............................. 26 INSPRA ............................... 49 INSULIN ASP PROT & ASP

FLEXPEN......................... 39 INSULIN ASPART ................ 39 INSULIN ASPART FLEXPEN 39 INSULIN ASPART PENFILL . 39 INSULIN ASPART PROT &

ASPART .......................... 39 INSULIN LISPRO ................. 39 INSULIN LISPRO (1 UNIT

DIAL) ............................... 39 INSULIN LISPRO JUNIOR

KWIKPEN ........................ 39 INSULIN LISPRO PROT &

LISPRO............................ 39 INSULIN PEN NEEDLES...... 95 INSULIN SYRINGES ............ 95 INTELENCE ......................... 33 INTRON A ............................91 INTUNIV ...............................51 INVEGA ............................... 30 INVEGA SUSTENNA ........... 30 INVEGA TRINZA .................. 30 INVELTYS .......................... 101 INVIRASE .............................34 INVOKAMET ........................ 36 INVOKAMET XR .................. 36 INVOKANA .......................... 36 IOPIDINE ............................102 ipratropium bromide ............108 ipratropium-albuterol............107 irbesartan............................. 43 irbesartan-hydrochlorothiazide

...........................................48 IRESSA ............................... 97 ISENTRESS ........................ 32 ISENTRESS HD................... 32 isibloom ............................... 83 isoniazid .............................. 23 ISOPTO ATROPINE............. 99 ISOPTO CARPINE. .............102 ISOPTO TEARS ................... 98 ISORDIL TITRADOSE .......... 51 isosorbide dinitrate ............... 51 isosorbide mononitrate ......... 51 isosorbide mononitrate er ..... 51 isotretinoin ...................... 56, 57 isradipine ............................. 46 ISTALOL .............................102 ISTURISA ............................ 88 itraconazole ......................... 21 ivermectin ....................... 27, 60 IXINITY .................................42

J JADENU ...............................66 JADENU SPRINKLE .............66 jaimiess ................................83 JAKAFI .................................26 JALYN ..................................77 jantoven ................................40 JANUMET.............................36 JANUMET XR .......................37 JANUVIA ..............................37 JARDIANCE .........................37 jasmiel ..................................83 JATENZO .............................80 jencycla ................................87 JENTADUETO ......................37 JENTADUETO XR ................37 jinteli .....................................83 JIVI .......................................42 jolessa ..................................83 JORNAY PM .........................51 JUBLIA .................................20 juleber ..................................83 JULUCA ...............................32 junel 1.5/30 ...........................83 junel 1/20 ..............................83 junel fe ..................................83 JUXTAPID ............................50 JYNARQUE ..........................66

K kaitlib fe ................................83 KALBITOR ............................90 KALETRA .............................34 KALYDECO ........................ 110 KAPSPARGO SPRINKLE......45 KARBINAL ER .................... 106 kariva....................................83 KATERZIA ............................46 KAZANO...............................37 KEFLEX................................11 kelnor 1/35 ............................83 kelnor 1/50 ............................83 KENALOG ............................59 KEPPRA ...............................13 KEPPRA XR .........................13 KERENDIA ...........................48 KERYDIN .............................20 KESIMPTA ...........................54 ketoconazole................... 20, 21 ketodan ................................20 KETODAN ............................20 KETO-DIASTIX .....................63 KETONE TEST .....................63 ketoprofen.............................. 5 ketoprofen er.......................... 5 ketorolac tromethamine ... 5, 101

KETOROLAC TROMETHAMINE ...............5

KETOSTIX ............................ 63 ketotifen fumarate ......... 98, 100 KEVEYIS .............................. 75 KEVZARA............................. 91 KINERET .............................. 91 KISQALI (200 MG DOSE) ..... 26 KISQALI FEMARA (400 MG

DOSE). ............................. 26 KITABIS PAK ...................... 110 KLARON .............................. 61 KLONOPIN ........................... 35 klor-con ................................ 65 KLOXXADO ............................9 KOATE ................................. 42 KOGENATE FS .................... 42 KOMBIGLYZE XR ................. 37 konsyl daily fiber ................... 71 KONSYL DAILY FIBER ......... 71 KORLYM .............................. 79 KOSELUGO ......................... 26 KOVALTRY .......................... 42 KRINTAFEL .......................... 27 KRISTALOSE ....................... 72 K-TAB .................................. 65 kurvelo.................................. 83 KUVAN ................................. 75 KYNMOBI ............................. 28

L labetalol hcl........................... 45 LAC-HYDRIN FIVE ............... 59 lactobacillus .......................... 70 lactulose ............................... 72 lactulose encephalopathy ...... 72 LAMICTAL ............................ 13 LAMICTAL ODT .................... 13 LAMICTAL STARTER ........... 14 LAMICTAL XR ...................... 14 lamivudine ...................... 31, 33 lamivudine-zidovudine ........... 33 lamotrigine ............................ 14 lamotrigine er ........................ 14 lamotrigine starter kit-blue ..... 14 LAMPIT ................................ 27 lansoprazole ......................... 75 lanthanum carbonate............. 66 LANTUS SOLOSTAR ............ 39 LANTUS U-100 VIAL............. 39 lapatinib ditosylate................. 97 larin 1.5/30 ............................ 83 larin 1/20 .............................. 83 larin 24 fe.............................. 83 larin fe 1.5/30 ........................ 83 larin fe 1/20 ........................... 83

126

larissia ................................. 83 LASIX ...................................49 LASTACAFT .......................100 latanoprost ........................... 99 LATUDA .............................. 30 laxative ................................ 95 laxative max str .................... 71 laxative regular strength ....... 71 layolis fe .............................. 83 LEDIPASVIR-SOFOSBUVIR .32 leena ................................... 83 leflunomide .......................... 92 LEMTRADA ......................... 54 LENVIMA (10 MG DAILY

DOSE) ............................. 97 LESCOL XL ......................... 50 lessina ................................. 83 LETAIRIS............................110 letrozole ............................... 25 leucovorin calcium ................ 27 LEUKERAN ......................... 24 LEUKINE ............................. 41 leuprolide acetate ................. 88 levalbuterol hcl ....................109 LEVALBUTEROL HFA ........109 LEVEMIR U-100 FLEXTOUCH

...........................................39 LEVEMIR U-100 VIAL .......... 39 levetiracetam ....................... 14 levetiracetam er.................... 14 levobunolol hcl ....................102 levocarnitine......................... 75 levocarnitine sf ..................... 75 levocetirizine dihydrochloride

.........................................106 levofloxacin ................... 12, 100 levonest ............................... 83 levonorgest-eth est & eth est .83 levonorgest-eth estrad 91-day83 levonorgestrel ...................... 80 levonorgestrel-ethinyl estrad 83 levonorg-eth estrad triphasic 84 levora 0.15/30 (28) ............... 84 levorphanol tartrate ................ 7 levo-t ................................... 87 levothyroxine sodium ............ 87 LEVOTHYROXINE SODIUM .87 levoxyl ................................. 87 LEVSIN................................ 95 LEVSIN/SL .......................... 95 LEVULAN KERASTICK ........ 60 LEXAPRO ............................ 17 LEXETTE............................. 59 LEXIVA ................................ 34 LIALDA ................................ 93

LIBRAX ................................73 LICART ................................. 5 lice treatment ........................60 lice treatment creme rinse......60 lidocaine ................................ 8 lidocaine hcl ........................... 8 lidocaine hcl urethral/mucosal . 8 lidocaine-hydrocort (perianal) 54 lidocaine-hydrocortisone ace 54,

55 lidocaine-prilocaine ................ 8 LIDODERM ............................ 8 lillow ..................................... 84 lindane..................................61 linezolid ................................ 10 LINZESS ..............................72 liothyronine sodium ...............87 LIPITOR ...............................50 LIPOFEN .............................. 49 lisinopril ................................44 lisinopril-hydrochlorothiazide . 48 lithium carbonate ...................35 lithium carbonate er ...............35 LITHOBID .............................35 LITHOSTAT ..........................77 LIVALO .................................50 LIVMARLI SOL 9.5 MG/ML (maralixibat chloride oral soln).............................................71 LIVTENCITY TABLET (maribavir) ...........................32 LO LOESTRIN FE .................84 LOCOID................................59 LOCOID LIPOCREAM ...........59 LODOSYN ............................29 LOESTRIN 1.5/30 (21) ..........84 LOESTRIN 1/20 (21) .............84 LOESTRIN FE 1.5/30 ............84 LOESTRIN FE 1/20 ...............84 lojaimiess ..............................84 LOKELMA.............................67 LOMOTIL ..............................73 LONHALA MAGNAIR REFILL

KIT.................................. 108 LONHALA MAGNAIR

STARTER KIT ................. 108 LONSURF ............................25 loperamide hcl ......................73 LOPID ..................................49 lopinavir-ritonavir ...................34 LOPRESSOR .......................45 LOPROX ..............................20 loratadine ............................ 106 loratadine childrens ............. 106 loratadine-d ......................... 106 lorazepam .............................35

LORBRENA .......................... 97 LORTAB .................................7 loryna ................................... 84 LORZONE .......................... 111

losartan potassium ................ 44 losartan potassium-hctz ......... 48 LOSEASONIQUE ................. 84 LOTEMAX .......................... 102 LOTEMAX SM .................... 102 LOTENSIN ........................... 44 LOTENSIN HCT.................... 48 loteprednol etabonate .......... 102 LOTREL ............................... 48 LOTRONEX .......................... 73 lovastatin .............................. 50 LOVAZA ............................... 50 LOVENOX ............................ 40 low-ogestrel .......................... 84 loxapine succinate................. 29 lo-zumandimine .................... 84 LUBIPROSTONE .................. 72 lubricant drops ...................... 98 lubricant eye drops ................ 98 lubricant eye drops pf ............ 98 LUCEMYRA............................9 LULICONAZOLE................... 20 LUMAKRAS .......................... 24 LUMIGAN ............................. 99 LUNESTA ........................... 112 LUPANETA PACK ................ 88 LUPKYNIS ............................ 89 LUPRON DEPOT (1-MONTH)

........................................... 88 LUPRON DEPOT (3-MONTH)

........................................... 88 LUPRON DEPOT (4-MONTH)

INTRAMUSCULAR KIT 30MG................................ 88

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG................................ 88

LUPRON DEPOT-PED (1- MONTH) ........................... 88

LUPRON DEPOT-PED (3- MONTH) ........................... 88

lutera .................................... 84 LUXIQ .................................. 59 LUZU.................................... 20 lyleq ..................................... 87 lyllana ................................... 84 LYNPARZA........................... 26 LYRICA ................................ 53 LYRICA CR .......................... 53 LYSODREN .......................... 88 LYSTEDA ............................. 41 LYUMJEV ............................. 39

127

LYUMJEV KWIKPEN ........... 39 lyza .......................................87

M MACRILEN .......................... 95 MACROBID ......................... 10 MACRODANTIN .................. 10 mafenide acetate .................. 61 mag-al plus .......................... 70 mag-al plus xs ...................... 70 magnesium citrate ................ 72 MALARONE ......................... 27 malathion ............................. 61 MARGENZA ........................ 97 MARINOL ............................ 19 marlissa ............................... 84 MARPLAN ........................... 17 MASK VORTEX/CHILD/FROG

...........................................95 MASK

VORTEX/TODDLER/LADYB UG ................................... 95

MATULANE ......................... 24 matzim la ............................. 46 MAVENCLAD (10 TABS) ...... 54 MAVYRET ........................... 32 MAXALT .............................. 22 MAXALT-MLT ...................... 22 MAXIDEX ...........................102 MAXITROL .......................... 99 maxi-tuss ac ........................104 maxi-tuss cd ........................104 maxi-tuss gmx .....................104 MAXZIDE..............................48 MAXZIDE-25 ........................ 48

MAYZENT ........................... 54 me/naphos/mb/hyo1 ............. 76 meclizine hcl ........................ 18 meclofenamate sodium........... 5 MEDROL ............................. 78 medroxyprogesterone acetate87 mefenamic acid ...................... 5 mefloquine hcl ...................... 27 megestrol acetate ................. 87 MEKINIST ............................ 26 MEKTOVI ............................ 26 meloxicam ............................. 5 melphalan ............................ 24 memantine hcl...................... 16 memantine hcl er .................. 16 MENACTRA ......................... 89 MENEST.............................. 84 MENOSTAR ........................ 84 MENQUADFI ....................... 89 MENTAX.............................. 20 MENVEO ............................. 89 meperidine hcl........................ 7

meprobamate ........................34

MEPRON ..............................27 mercaptopurine .....................25 merzee .................................84 mesalamine ..........................93 mesalamine er oral capsule

0.375 gm ...........................93 MESNEX ..............................27 MESTINON ...........................23 metaxalone ......................... 111 metformin hcl er ....................37 metformin hcl er (mod) ..........37 metformin hcl er (osm) ...........37 metformin hcl ir .....................37 methadone hcl ....................... 6 methadose ............................. 6 methamphetamine hcl ...........52 methazolamide.................... 102 methenamine hippurate .........10 methenamine mandelate ........ 9 methergine............................79 methimazole .........................89 METHITEST .........................80 methocarbamol ................... 111 methotrexate .........................92 methotrexate sodium .............92 methotrexate sodium (pf) .......92 methoxsalen rapid .................60 methscopolamine bromide .....73 methyldopa ...........................43 methylergonovine maleate .....79 METHYLIN ...........................51 methylphenidate hcl ..............52 methylphenidate hcl er ..........52 methylphenidate hcl er (cd) ....52 methylphenidate hcl er (xr) ....52 methylprednisolone ...............78 methyltestosterone ................80 metoclopramide hcl ......... 18, 19 metolazone ...........................49 METOPIRONE ......................95 metoprolol succinate er .........45 metoprolol tartrate .................45 metoprolol-hydrochlorothiazide

........................................... 48 METROCREAM ....................10 METROGEL..........................10 metronidazole .......................10 metyrosine ............................48 mexiletine hcl ........................44 mibelas 24 fe ........................84 MICARDIS ............................44 MICARDIS HCT ....................48 miconazole nitrate .................20 microgestin 1.5/30 .................84 microgestin 1/20 ....................84

microgestin 24 fe ................... 84 microgestin fe 1.5/30 ............. 84 microgestin fe 1/20 ................ 84 midazolam hcl ....................... 35 midodrine hcl ........................ 43 MIGERGOT .......................... 23 miglitol .................................. 37 miglustat ............................... 75 migraine formula .....................4 MIGRANAL ........................... 23 mili ....................................... 84 milk of magnesia ................... 70 milk of magnesia concentrate 70 MILLIPRED........................... 78 mimvey ................................. 84 MINASTRIN 24 FE ................ 84 mineral oil ............................. 71 MINIPRESS .......................... 43 minitran ................................ 51 MINIVELLE ........................... 84 minocycline hcl ..................... 13 minocycline hcl er.................. 13 MINOLIRA ............................ 13 minoxidil ............................... 51 mintox maximum strength...... 70 mintox plus ........................... 70 MIRAPEX ER........................ 28 MIRCERA ............................. 42 MIRCETTE ........................... 84 mirtazapine ........................... 16 MIRVASO ............................. 57 misoprostol ........................... 74 MITIGARE ............................ 21 M-M-R II ............................... 89 M-NATAL PLUS .................... 67 MOBIC ...................................5 modafinil ............................. 112 moexipril hcl.......................... 44 molindone hcl........................ 29 mometasone furoate ..... 59, 108 mono-linyah .......................... 84 MONONINE .......................... 42 montelukast sodium ............ 108 MONUROL ........................... 10 morgidox .............................. 13 MORGIDOX............................9 morphine sulfate .....................7 morphine sulfate (concentrate) 7 morphine sulfate er .................6 morphine sulfate er beads .......6 MOTEGRITY ........................ 72 motion sickness .................... 19 MOTOFEN ........................... 73 MOVANTIK ........................... 72 MOVIPREP........................... 73

128

MOXEZA ............................100 moxifloxacin hcl ............. 12, 100 moxifloxacin hcl (2x day)......100 MOZOBIL ............................ 41 MS CONTIN ........................... 6 MUCINEX CHILDRENS

FREEFROM ....................104 MUCINEX CHILDRENS

STUFFY NOSE ...............103 MUCINEX COUGH

CHILDRENS ...................104 MUCINEX D ........................104 MUCINEX D MAX STRENGTH

.........................................104 MUCINEX DM .....................104 MUCINEX FAST-MAX CONG

HEADACHE ....................103 MUCINEX FAST-MAX DM MAX

.........................................104 MUCINEX MAXIMUM

STRENGTH ....................103 MUCINEX SINUS-MAX CLEAR

& COOL ..........................103 MUCINEX SINUS-MAX CONG

& PAIN ............................104 MUCINEX SINUS-MAX

SINUS/ALLRGY ..............104 mucus & cough relief childrens

...........................................10 mucus d ..............................104 mucus relief d......................104 mucus relief dm ...................105 mucus relief dm max ...........105 mucus relief max strength ....103 MULPLETA .......................... 41 MULTAQ.............................. 44 mupirocin ............................. 61 mupirocin calcium................. 61 MURO 128 ........................... 98 my choice ............................ 80 my way ................................ 80 MYALEPT ............................ 73 MYAMBUTOL ...................... 23 MYCAPSSA ......................... 88 MYCOBUTIN ....................... 23 mycophenolate mofetil .......... 92 mycophenolate sodium ......... 92 MYDAYIS ............................ 52 MYFEMBREE ...................... 69 MYFORTIC .......................... 92 MYLERAN ........................... 24 myorisan .............................. 57 MYRBETRIQ ....................... 77 MYSOLINE .......................... 15 MYTESI ............................... 73

N nabumetone ........................... 5 nadolol..................................45 naftifine hcl ...........................20 NAFTIN ................................20 NALFON ................................ 5 naloxone hcl........................... 9 naltrexone hcl ........................ 9 NAMENDA TITRATION PAK 16 NAMENDA XR ......................16 NAMZARIC ...........................16 NAPHCON-A ................ 98, 100 NAPRELAN ........................... 5 naproxen ............................... 5 naproxen sodium.................... 5 naproxen sodium er................ 5 naproxen-esomeprazole ......... 5 naratriptan hcl .......................22 NARCAN ............................... 9 NARDIL ................................17 nasal allergy 24 hour ........... 107 nasal allergy spray .............. 107 NASAL MOIST .................... 105 nasal spray ......................... 105 nasal spray fast acting ......... 105 NASONEX .......................... 108 NATACYN .......................... 101 NATAZIA ..............................84 nateglinide ............................37 NATESTO.............................80 NATPARA.............................94 NATROBA ............................61 natural fiber ...........................71 natural vegetable laxative ......72 natura-lax .............................71 nausea relief .........................18 NAYZILAM............................15 NEBUPENT ..........................27 necon 0.5/35 (28) ..................84 nefazodone hcl......................17 NEODOT THERMOMETER...95 neomycin sulfate .................... 9 neomycin-bacitracin zn-polymyx

......................................... 101 neomycin-polymyxin-dexameth

........................................... 99 neomycin-polymyxin-gramicidin

......................................... 101 neomycin-polymyxin-hc . 99, 103 neo-polycin ......................... 101 neo-polycin hc .......................99 NEORAL...............................92 NEO-SYNALAR .............. 55, 60 NERLYNX.............................97 NESINA ................................37

NESTABS............................. 67 NESTABS DHA .................... 67 NESTABS ONE .................... 67 neuac ................................... 57 NEUAC................................. 55 NEULASTA........................... 41 NEULASTA ONPRO ............. 41 NEUPOGEN ......................... 41 NEUPRO .............................. 28 NEURONTIN ........................ 15 NEVANAC .......................... 102 nevirapine ............................. 33 nevirapine er ......................... 33 new day ................................ 80 NEXAVAR ............................ 26 NEXIUM ............................... 75 NEXLETOL ........................... 50 NEXLIZET ............................ 50 NEXTSTELLIS ...................... 69 niacin.................................... 65 niacin er ................................ 64 niacin er (antihyperlipidemic) . 50 NIASPAN.............................. 50 nicardipine hcl ....................... 46 nicotine gum ...........................8 nicotine mini............................8 NICOTROL .............................8 NICOTROL NS .......................8 nifedipine .............................. 46 nifedipine er .......................... 46 nifedipine er osmotic release . 46 nikki ...................................... 84 nilutamide ............................. 24 nimodipine ............................ 46 NINJACOF-XG ................... 105 NINLARO ............................. 25 nisoldipine er ........................ 46 nitazoxanide ......................... 27 nitisinone .............................. 75 NITRO-BID ........................... 51 NITRO-DUR ......................... 51 nitrofurantoin ......................... 10 nitrofurantoin macrocrystal .... 10 nitroglycerin .......................... 51 NITROLINGUAL ................... 51 NITROSTAT ......................... 51 NITYR .................................. 76 NIVA-PLUS........................... 67 NIVESTYM ........................... 41 nizatidine .............................. 74 NOCDURNA ......................... 79 nohist-lq .............................. 106 nora-be ................................. 87 NORDITROPIN FLEXPRO .... 79 norethin ace-eth estrad-fe ...... 84

129

norethindrone ....................... 87 norethindrone acetate ........... 87 norethindrone acet-ethinyl est 84 norethindrone-eth estradiol ... 84 norethin-eth estradiol-fe ........ 84 NORGESIC FORTE ............111 norgestimate-eth estradiol .... 84 norgestimate-ethinyl estradiol

triphasic ........................... 85 NORITATE........................... 10 norlyda................................. 87 NORPACE ........................... 44 NORPACE CR ..................... 44 NORPRAMIN ....................... 18 NORTHERA ......................... 43 nortrel 0.5/35 (28) ................. 85 nortrel 1/35 (21).................... 85 nortrel 1/35 (28).................... 85 nortrel 7/7/7.......................... 85 nortriptyline hcl ..................... 18 NORVASC ........................... 46 NORVIR .............................. 34 nose drops ..........................105 nose drops nasal decongest 105 NOURIANZ .......................... 28 NOVAREL ........................... 79 NOVOEIGHT ....................... 42 NOVOLIN 70/30 FLEXPEN... 39 NOVOLIN 70/30 VIAL ........... 39 NOVOLIN N FLEXPEN ......... 39 NOVOLIN N VIAL. ................ 39 NOVOLIN R FLEXPEN ......... 39 NOVOLIN R VIAL. ................ 39 NOVOLOG FLEXPEN. ......... 39 NOVOLOG MIX 70/30

FLEXPEN......................... 39 NOVOLOG MIX 70/30 VIAL .. 39 NOVOLOG PENFILL ............ 39 NOVOLOG U-100 VIAL ........ 39 NOVOSEVEN RT ................. 42 NOXAFIL ............................. 21 np thyroid ............................. 89 NUBEQA ............................. 24 NUCALA .............................111 NUCYNTA ............................. 7 NUCYNTA ER........................ 6 NUEDEXTA ......................... 53 NULEV ................................ 96 NULYTELY LEMON-LIME .... 73 NUPLAZID ........................... 30 NURTEC.............................. 22 NUTROPIN AQ NUSPIN 10 .. 79 NUVARING .......................... 85 NUVESSA ........................... 10 NUVIGIL .............................112

NUWIQ .................................42 NUZYRA...............................13 nyamyc .................................20 nylia 7/7/7 .............................85 NYMALIZE............................46 nymyo...................................85 nystatin ........................... 20, 21 nystatin-triamcinolone............20 nystop...................................20 NYVEPRIA ...........................96

O OB COMPLETE ....................67 OB COMPLETE ONE ............67 OB COMPLETE PETITE .......67 OB COMPLETE PREMIER ....67 OB COMPLETE/DHA ............67 OBIZUR ................................42 OCALIVA ..............................73 OCEAN NASAL SPRAY ...... 105 ocella ....................................85 octreotide acetate..................88 OCTREOTIDE ACETATE ......88 OCUFLOX .......................... 101 ODEFSEY ............................33 ODOMZO .............................26 OFEV ................................. 111 ofloxacin ............... 12, 101, 103 olanzapine ............................30 olanzapine-fluoxetine hcl .......16 olmesartan medoxomil ..........44 olmesartan medoxomil-hctz ...48 olmesartan-amlodipine-hctz ...48 olopatadine hcl ............ 100, 106 OLUMIANT ...........................91 OLUX ...................................59 OLUX-E ................................59 OMECLAMOX-PAK...............73 omega-3-acid ethyl esters......50 omeprazole ...........................75 omeprazole magnesium ........75 omeprazole-sodium bicarbonate

........................................... 75 OMNARIS ........................... 108 OMNIFLEX DIAPHRAGM ......96 OMNIPOD DASH KIT

SYSTEM .......................... 96 OMNIPOD KIT STARTER… 96 OMNIPOD MIS 5 PACK… .... 96 OMNITROPE ........................79 OMNITROPE PEN 5 INJ

DEVICE ............................96 ondansetron hcl ....................19 ondansetron odt ....................19 ONETOUCH SURESOFT

LANCING DEVICE ............64

ONETOUCH ULTRA 2 KIT W/DEVICE ........................ 63

ONETOUCH ULTRA CONTROL ........................ 63

ONETOUCH ULTRA MINI KIT W/DEVICE ........................ 63

ONETOUCH ULTRA TEST STRIPS............................. 63

ONETOUCH VERIO FLEX SYSTEM ........................... 63

ONETOUCH VERIO IQ SYSTEM ........................... 63

ONETOUCH VERIO KIT W/DEVICE .................. 62, 63

ONETOUCH VERIO REFLECT ........................................... 63

ONEXTON ............................ 57 ONFI .................................... 15 ONGENTYS ......................... 28 ONGLYZA ............................ 37 ONUREG.............................. 25 ONZETRA XSAIL .................. 22 opcicon one-step ................... 80 opium ................................... 73 OPSUMIT ........................... 110 option 2 ................................ 80 OPTIONS GYNOL II

CONTRACEPTIVE ............ 76 ORACEA .............................. 13 ORALAIR.............................. 91 oralone ................................. 54 oralyte freezer pops .............. 65 ORAVIG ............................... 21 ORENCIA ............................. 91 ORENCIA CLICKJECT.......... 91 ORENITRAM ...................... 110 ORFADIN ............................. 76 ORGOVYX .............................9 ORIAHNN ............................. 88 ORILISSA ............................. 88 ORKAMBI ........................... 110 ORLADEYO.......................... 96 orphenadrine citrate er ........ 111 orsythia................................. 85 ORTIKOS ............................. 93 oscimin ................................. 96 oscimin sr ............................. 96 oseltamivir phosphate ........... 34 OSENI .................................. 37 OSMOLEX ER ...................... 28 OSMOPREP ......................... 74 OSPHENA ............................ 87 OTEZLA ............................... 91 OTIPRIO ............................ 103 OTOVEL ............................. 103

130

OTREXUP ........................... 92 OVIDE ..................................61 OVIDREL ............................. 79 oxandrolone ......................... 80 oxaprozin ............................... 5 OXAYDO ............................... 7 oxazepam ............................ 35 OXBRYTA ........................... 41 oxcarbazepine...................... 15 OXERVATE ......................... 99 oxiconazole nitrate ............... 20 OXISTAT ............................. 20 OXTELLAR XR .................... 15 oxybutynin chloride ............... 77 oxybutynin chloride er ........... 77 oxycodone hcl ........................ 7 OXYCODONE HCL ER. ......... 6 oxycodone-acetaminophen ..... 7 OXYCONTIN ......................... 6 oxymorphone hcl .................... 7 oxymorphone hcl er ................ 6 OXYTROL ........................... 77 OZEMPIC ............................ 37

P PACERONE ......................... 44 PALFORZIA (12 MG DAILY

DOSE) ............................. 96 paliperidone er ..................... 30 PALYNZIQ ........................... 76 PAMELOR ........................... 18 PANCREAZE ....................... 76 PANDEL .............................. 59 pantoprazole sodium ............ 75 paricalcitol ............................ 94 PARLODEL.......................... 28 paromomycin sulfate .............. 9 paroxetine hcl....................... 17 paroxetine hcl er................... 17 paroxetine mesylate ............. 17 PASER ................................ 23 PATANASE.........................106 PAXIL .................................. 17 PAXIL CR ............................ 17 PEDIA-LAX ..................... 71, 72 PEDIALYTE ......................... 65 PEDIALYTE FREEZER POPS

...........................................65 PEDIALYTE SINGLES ......... 65 PEDIARIX ............................ 89 peg 3350-kcl-na bicarb-nacl .. 74 peg-3350/electrolytes ........... 74 peg-3350/electrolytes/ascorbat

...........................................74 PEGASYS ........................... 32 peg-kcl-nacl-nasulf-na asc-c . 74

PEMAZYRE ..........................25 penicillamine .........................77 penicillin v potassium.............11 PENNSAID ............................ 5 PENTACEL ...........................90 pentamidine isethionate .........27 PENTASA .............................93 pentazocine-naloxone hcl ....... 8 pentoxifylline er .....................48 PEPCID ................................74 PERCOCET ........................... 8 PERFOROMIST .................. 109 perindopril erbumine ..............44 permethrin ............................61 perphenazine ........................19 perphenazine-amitriptyline ....16,

17 PERSERIS ...........................30 PERTZYE .............................76 PEXEVA ...............................17 phenazopyridine hcl ..............76 phenelzine sulfate .................17 phenobarbital ........................15 phenoxybenzamine hcl ..........43 phenylephrine hcl .......... 99, 105 PHENYTEK ..........................15 phenytoin ..............................15 phenytoin sodium extended ...15 PHEXXI ................................96 philith ....................................85 PHOSLYRA ..........................66 PIFELTRO ............................33 pilocarpine hcl ............... 54, 102 pimecrolimus.........................59 pimozide ...............................29 pimtrea .................................85 pindolol .................................45 pink bismuth..........................70 pioglitazone hcl .....................37 pioglitazone hcl-glimepiride ....37 pioglitazone hcl-metformin hcl37 PIQRAY (200 MG DAILY

DOSE) ..............................26 pirmella 1/35 .........................85 pirmella 7/7/7 ........................85 piroxicam ............................... 5 PLAVIX .................................42 PLEGRIDY ...........................54 PLENVU ...............................74 PLIAGLIS .............................. 8 PNEUMOVAX 23 ..................90 pnv tabs 29-1 ........................67 pnv-dha ................................67 pnv-dha+docusate.................67 pnv-omega............................67

pnv-select ............................. 67 podocon ............................... 96 podofilox ............................... 60 polycin ................................ 101 polyethylene glycol 3350 ....... 71 polymyxin b-trimethoprim..... 101 POLYTRIM ......................... 101 poly-tussin ac ...................... 105 POMALYST .......................... 24 PONVORY ........................... 97 PONVORY STARTER PACK 97 portia-28 ............................... 85 posaconazole ....................... 21 potassium chloride ................ 65 potassium chloride crys er ..... 65 potassium chloride er ............ 65 potassium citrate er ............... 65 povidone-iodine ......................9 PRADAXA ............................ 40 PRALUENT .......................... 50 pramipexole dihydrochloride .. 28 pramipexole dihydrochloride er

........................................... 28 prasugrel hcl .......................... 42 pravastatin sodium................. 50 praziquantel .......................... 27 prazosin hcl .......................... 43 PRECISION XTRA .......... 62, 64 PRECISION XTRA BLOOD

GLUCOSE ........................ 64 PRECISION XTRA MONITOR

........................................... 62 PRECOSE ............................ 37 PRED FORTE..................... 102 PRED MILD ........................ 102 PRED-G ............................... 99 PRED-G S.O.P. .................... 99 prednicarbate ........................ 59 prednisolone ......................... 78 prednisolone acetate ........... 102 prednisolone sodium phosphate

........................................... 78 prednisone ............................ 78 PREFEST ............................. 85 pregabalin............................. 53 pregabalin er ......................... 53 pregnyl ................................. 79 PREMARIN........................... 85 PREMPHASE ....................... 85 PREMPRO ........................... 85 PRENAISSANCE .................. 67 PRENAISSANCE PLUS ........ 67 prenatal ................................ 68 prenatal vitamin plus low iron 68 PRENATE ............................ 68

131

PRENATE AM...................... 68 PRENATE DHA.................... 68 PRENATE ELITE ................. 68 PRENATE ENHANCE. ......... 68 PRENATE ESSENTIAL ........ 68 PRENATE MINI.................... 68 PRENATE PIXIE .................. 68 PRENATE RESTORE .......... 68 PREPIDIL ............................ 79 preplus................................. 68 PRETAB .............................. 68 PRETOMANID ..................... 23 PREVACID .......................... 75 PREVACID SOLUTAB.......... 75 previfem ............................... 85 PREVNAR 13....................... 90 PREVYMIS .......................... 31 PREZCOBIX ........................ 34 PREZISTA ........................... 34 PRIFTIN .............................. 23 PRILOSEC........................... 75 PRIMACARE ....................... 68 primaquine phosphate .......... 27 primidone ............................. 15 PRINIVIL.............................. 44 PRISTIQ .............................. 17 PROAIR DIGIHALER ..........109 PROAIR HFA ......................109 PROAIR RESPICLICK.........109 probenecid ........................... 21 PROCARDIA XL .................. 46 PROCENTRA ...................... 52 prochlorperazine .................. 19 prochlorperazine maleate ..... 19 PROCRIT ............................ 41 PROCTOCORT.................... 93 PROCTOFOAM HC.............. 60 procto-med hc ...................... 93 proctozone-hc ...................... 93 PROCYSBI .......................... 76 PROFILNINE ....................... 42 progesterone ........................ 87 PROGLYCEM ...................... 38 PROGRAF ........................... 92 PROLENSA ........................102 PROLIA ............................... 94 PROMACTA ........................ 41 PROMELLA IN PREBIOTIC .. 70 promethazine hcl .................. 19 promethazine vc ..................111 promethazine vc/codeine .....105 promethazine-codeine .........105 promethazine-dm ................105 promethazine-phenyleph-

codeine ...........................105

promethazine-phenylephrine111 PROMETRIUM .....................87 propafenone hcl ....................44 propafenone hcl er .......... 44, 45 propranolol hcl ......................45 propranolol hcl er ..................45 propylthiouracil ......................89 PROQUAD ...........................90 PROSCAR ............................77 PROTONIX ...........................75 PROTOPIC ...........................59 protriptyline hcl ......................18 PROVENTIL HFA................ 109 PROVERA ............................87 PROVIGIL........................... 113 PROZAC ..............................17 PRUDOXIN ...........................59 pseudoephedrine hcl ........... 105 pseudoephedrine hcl 12 hr .. 105 pseudoephedrine-bromphen-dm

......................................... 105 pseudoephedrine-guaifenesin er

......................................... 105 PSORCON ...........................59 PULMICORT FLEXHALER . 108 PULMICORT SUSPENSION108 PULMOZYME ..................... 110 PURIXAN .............................25 PYLERA ............................... 74 pyrazinamide ........................23 PYRIDIUM ............................76 pyridostigmine bromide 23 pyridostigmine bromide er 23 pyrimethamine ......................27

Q QBRELIS .............................. 44 QBREXZA ............................ 60 QDOLO ..................................8 QELBREE............................. 35 QINLOCK ............................. 97 QNASL ............................... 108 QTERN ................................. 37 quad-probiotic .......................70 QUADRACEL .......................90 QUALAQUIN.........................27 QUARTETTE ........................85 QUDEXY XR.........................14 QUESTRAN ..........................50 QUESTRAN LIGHT ...............50 quetiapine fumarate...............30 quetiapine fumarate er ...........30 QUILLICHEW ER ..................52 QUILLIVANT XR ...................52 quinapril hcl ..........................44 quinapril-hydrochlorothiazide 48

quinidine gluconate er ........... 45 quinidine sulfate .................... 45 quinine sulfate....................... 27 QUTENZA ............................ 60 QVAR REDIHALER ............ 108

R rabeprazole sodium ............... 75 raloxifene hcl ........................ 87 ramelteon ........................... 112 ramipril ................................. 44 RANEXA .............................. 48 ranolazine er ......................... 48 RAPAFLO............................. 77 RAPAMUNE ......................... 92 rasagiline mesylate ............... 29 RASUVO .............................. 92 RAVICTI ............................... 76 RAYALDEE .......................... 94 RAYOS................................. 78 RAZADYNE ER .................... 16 REBIF .................................. 54 REBIF REBIDOSE ................ 54 REBIF REBIDOSE TITRATION

PACK................................ 54 REBIF TITRATION PACK ..... 54 REBINYN ............................. 42 REBLOZYL ........................... 41 reclipsen ............................... 85 RECOMBINATE.................... 42 RECOMBIVAX HB ................ 90 RECOTHROM ...................... 43 RECOTHROM SPRAY KIT.... 43 RECTIV ................................ 51 REDITREX ........................... 92 REFRESH LACRI-LUBE ....... 98 REFRESH OPTIVE ............... 98 REFRESH OPTIVE PF.......... 98 REFRESH P.M. .................... 98 REFRESH PLUS .................. 98 REFRESH RELIEVA ............. 98 REFRESH RELIEVA PF ........ 98 REFRESH TEARS ................ 98 REGLAN .............................. 19 RELAFEN DS .........................5 RELENZA DISKHALER ......... 34 relexxii .................................. 52 RELISTOR ........................... 72 RELPAX ............................... 22 RELTONE ............................ 74 REMERON ........................... 17 REMERON SOLTAB ............. 17 REMICADE........................... 92 RENAGEL ............................ 66 RENFLEXIS.......................... 92 RENVELA............................. 66

132

repaglinide ........................... 37 REPATHA ............................ 50 RESTASIS ..........................100 RESTASIS MULTIDOSE .....100 RESTORIL ..........................112 RETACRIT ........................... 41 RETEVMO ........................... 97 RETIN-A ...............................57 RETIN-A MICRO GEL 0.04 %,

0.1 % ............................... 57 RETIN-A MICRO PUMP ....... 57 RETROVIR .......................... 33 REVATIO ............................110 REVLIMID ............................ 24 REXULTI ............................. 30 REYATAZ ............................ 34 REYVOW............................. 22 REZUROCK TAB 200 MG .... 93 RHOFADE ........................... 57 RHOPRESSA .....................103 ribavirin ......................... 32, 111 RIDAURA ............................ 91 rifabutin.................................23 rifampin................................ 23 RILUTEK ............................. 53 riluzole ................................. 53 rimantadine hcl ..................... 34 RINVOQ .............................. 91 RIOMET .............................. 37 risedronate sodium ............... 94 RISPERDAL ........................ 30 RISPERDAL CONSTA ......... 30 risperidone ........................... 30 RITALIN ............................... 52 RITALIN LA.......................... 52 ritonavir................................ 34 rivastigmine.......................... 16 rivelsa .................................. 85 RIXUBIS .............................. 43 rizatriptan benzoate .............. 22 robafen cf multi-symptom cold

.........................................105 ROCALTROL ....................... 94 ROCKLATAN ......................100 ropinirole hcl ........................ 28 ropinirole hcl er .................... 28 rosadan ............................... 55 ROSADAN ........................... 55 rosuvastatin calcium ............. 50 ROWASA............................. 93 roweepra.............................. 14 ROXICODONE ...................... 8 ROZEREM ..........................112 ROZLYTREK ....................... 26 RUBRACA ........................... 26 RUCONEST ......................... 90

rufinamide .............................15 RUKOBIA .............................34 RUZURGI .............................53 RYBELSUS ..........................37 RYCLORA .......................... 106 RYDAPT ...............................26 rymed ................................. 106 rynex dm ............................. 105 rynex pe.............................. 105 rynex pse ............................ 105 RYTARY ...............................29 RYTHMOL SR ......................45 ryvent ................................. 106

S S2 (RACEPINEPHRINE) ..... 107 SABRIL ................................15 saccharomyces boulardii .......70 SAFYRAL .............................85 SAIZEN ................................79 SAIZENPREP .......................79 SALEX ..................................55 saline nasal spray ............... 105 salsalate ................................ 4 SAMSCA .............................. 66 SANCUSO ............................19 SANDIMMUNE .....................92 SANDOSTATIN ....................88 SAPHRIS ..............................30 sapropterin dihydrochloride ....76 SAVAYSA .............................40 SAVELLA .............................53 SCEMBLIX TABLET 20 MG, 40 MG (asciminib hcl) ................70 scopolamine .........................19 SEASONIQUE ......................85 SECUADO ............................30 SEGLUROMET .....................37 SELECT-OB .........................68 SELECT-OB+DHA ................68 selegiline hcl .........................29 selenium sulfide ....................59 SELZENTRY.........................34 SEMGLEE ............................39 SE-NATAL 19 .......................68 senexon-s .............................72 senna ...................................72 senna lax ..............................72 senna laxative .......................72 senna plus ............................72 senna-lax ..............................72 senna-s ................................72 senna-time ............................72 senna-time s .........................72 sennazon ..............................72 SENOKOT ............................72 SENOKOT EXTRA STRENGTH

........................................... 72

SENOKOT S ......................... 72 SENSIPAR ........................... 94 SEREVENT DISKUS........... 109 SEROQUEL.......................... 30 SEROQUEL XR .................... 30 SEROSTIM ........................... 79 sertraline hcl ......................... 18 setlakin ................................. 85 sevelamer carbonate ....... 66, 67 sevelamer hcl........................ 67 SFROWASA ......................... 93 sharobel ............................... 87 SHINGRIX ............................ 90 SIGNIFOR ............................ 88 SIKLOS ................................ 41 silace .................................... 71 sildenafil citrate ................... 110 SILENOR............................ 112 SILIQ .................................... 91 silodosin ............................... 77 siltussin sa .......................... 105 siltussin-dm alcohol free ...... 105 SILVADENE ......................... 60 silver sulfadiazine .................. 60 SIMBRINZA ........................ 103 simethicone .......................... 70 simethicone drops infants ...... 70 simethicone ultra strength ...... 70 simliya .................................. 85 simpesse .............................. 85 SIMPONI .............................. 92 SIMPONI ARIA ..................... 92 simvastatin ........................... 50 SINEMET ............................. 29 SINGULAIR ........................ 108 sinus nasal spray ................ 105 SINUVA .............................. 108 sirolimus ......................... 92, 93 SIRTURO ............................. 23 SITAVIG ............................... 32 SIVEXTRO ........................... 10 SKELAXIN .......................... 111 SKYRIZI ............................... 91 sleep aid nighttime .............. 112 sleep-aid ............................. 112 sleeptime ............................ 112 SLYND ................................. 87 sodium bicarbonate ............... 70 sodium chloride ................... 105 sodium chloride (hypertonic) .. 98 sodium fluoride ..................... 66 sodium fluoride 5000 plus ...... 66 sodium fluoride 5000 sensitive

........................................... 66 sodium phenylbutyrate .......... 76

133

sodium polystyrene sulfonate.67 SOFOSBUVIR-VELPATASVIR

...........................................32 SOFT GLUCOSE ................. 36 solifenacin succinate ............ 77 SOLIQUA............................. 37 SOLODYN ........................... 13 SOLOSEC ........................... 10 SOLTAMOX ......................... 25 soluble fiber therapy ............. 72 SOMA .................................111 SOMAVERT ......................... 88 SOOLANTRA ....................... 61 sorbitol ................................. 71 SORIATANE ........................ 57 SORILUX ............................. 60 sotalol hcl............................. 45 sotalol hcl (af)....................... 45 SOTYLIZE ........................... 45 SOVALDI ............................. 32 spinosad .............................. 61 SPIRIVA HANDIHALER ......108 SPIRIVA RESPIMAT ...........108 spironolactone...................... 49 spironolactone-hctz .............. 48 SPORANOX ........................ 21 SPORANOX PULSEPAK...... 21 sprintec 28 ........................... 85 SPRITAM............................. 14 SPRIX ................................... 5 SPRYCEL ............................ 97 sps ...................................... 67 sronyx .................................. 85 ssd ...................................... 60 sss 10-5 ............................... 55 STALEVO 100 ..................... 28 STEGLATRO ....................... 37 STEGLUJAN ........................ 37 STELARA ............................ 91 stimulant laxative .................. 72 STIOLTO RESPIMAT ..........107 STIVARGA........................... 26 stomach relief....................... 70 stomach relief extra strength 70 stool softener .................. 71, 72 stool softener laxative ........... 71 stool softener pls laxative ...... 72 stool softener plus laxative .... 72 stool softener/laxative ........... 72 STRATTERA ....................... 52 STRENSIQ .......................... 76 STRIBILD ............................ 32 STRIVERDI RESPIMAT ......109 STROMECTOL .................... 27 SUBLOCADE ......................... 9

SUBOXONE .......................... 9 subvenite ..............................14 subvenite starter kit-blue ........14 sucralfate ..............................74 sudogest ............................. 105 sudogest 12 hour ................ 105 SULAR .................................46 sulfacetamide sodium .... 96, 101 sulfacetamide sodium (acne) 61 sulfacetamide sodium-sulfur ..55 sulfacetamide-prednisolone 100 sulfadiazine ...........................12 sulfamethoxazole-trimethoprim

........................................... 12 SULFAMYLON......................61 sulfasalazine .........................93 sulfatrim pediatric ..................12 sulindac ................................. 5 SUMADAN............................55 SUMADAN WASH ................55 SUMADAN XLT ....................55 sumatriptan ...........................22 sumatriptan succinate............22 sumatriptan succinate refill ....22 sumatriptan-naproxen sodium22 SUMAXIN ............................. 55 SUMAXIN CP .......................55 SUNOSI.............................. 113 SUPRAX...............................11 SUPREP BOWEL PREP KIT 74 SUSTIVA ..............................33 SUTAB .................................71 SUTENT ...............................26 syeda ...................................85 SYMBICORT ...................... 107 SYMBYAX ............................17 SYMDEKO.......................... 110 SYMFI ..................................33 SYMFI LO .............................33 SYMJEPI ............................ 109 SYMLINPEN 120 ..................37 SYMPAZAN ..........................15 SYMPROIC ..........................72 SYMTUZA ............................34 SYNAGIS .............................91 SYNALAR .............................59 SYNALAR (CREAM) .............55 SYNALAR (OINTMENT) ........55 SYNALAR TS .......................55 SYNAREL .............................89 SYNERA................................ 8 SYNJARDY ..........................37 SYNJARDY XR .....................37 SYNRIBO .............................25 SYNTHROID.........................87

SYPRINE.............................. 66 SYSTANE............................. 98 SYSTANE COMPLETE ......... 98 SYSTANE HYDRATION PF .. 98 SYSTANE NIGHTTIME ......... 98 SYSTANE OVERNIGHT

THERAPY ......................... 98 SYSTANE PRESERVATIVE

FREE ................................ 98 SYSTANE ULTRA................. 98 SYSTANE ULTRA PF ........... 98

T TABLOID .............................. 25 TABRECTA .......................... 97 TACLONEX .......................... 60 tacrolimus ....................... 59, 93 tadalafil ................................. 77 tadalafil (pah) ...................... 110 TAFINLAR ............................ 26 TAGRISSO ........................... 97 TAKHZYRO .......................... 90 TALICIA ................................ 74 TALTZ .................................. 91 TALZENNA ........................... 26 TAMIFLU .............................. 34 tamoxifen citrate.................... 25 tamsulosin hcl ....................... 77 TAPAZOLE ........................... 89 TAPERDEX 12-DAY ............. 78 TAPERDEX 6-DAY ............... 78 TAPERDEX 7-DAY ............... 78 TARCEVA ............................ 97 TARGRETIN ................... 26, 27 tarina 24 fe ........................... 85 tarina fe 1/20 ......................... 85 tarina fe 1/20 eq .................... 85 TARON-C DHA ..................... 68 TARON-PREX ...................... 68 TASIGNA.............................. 97 TASMAR .............................. 28 tavaborole............................. 20 TAVALISSE .......................... 42 TAYTULLA ........................... 85 tazarotene ............................ 57 taztia xt ................................. 47 TAZVERIK ............................ 25 TDVAX ................................. 90 TECFIDERA ......................... 54 TEGRETOL .......................... 15 TEGRETOL-XR .................... 15 TEGSEDI.............................. 76 TEKTURNA .......................... 48 TEKTURNA HCT .................. 48 telmisartan ............................ 44 telmisartan-amlodipine .......... 48

134

telmisartan-hctz .................... 48 temazepam .........................112 TEMIXYS ............................. 33 TEMODAR ........................... 24 TEMOVATE ......................... 59 temozolomide....................... 24 TENIVAC ............................. 90 tenofovir disoproxil fumarate . 33 TENORETIC 100 ................. 48 TENORETIC 50 ................... 48 TENORMIN.......................... 45 TEPMETKO ......................... 24 terazosin hcl ......................... 77 terbinafine hcl....................... 21 terbinafine hydrochloride....... 20 terbutaline sulfate ................109 TERIPARATIDE

(RECOMBINANT) ............. 94 TESSALON PERLES ..........106 TESTIM ............................... 80 testosterone ......................... 80 testosterone cypionate.......... 80 testosterone enanthate ......... 80 TETANUS-DIPHTHERIA

TOXOIDS TD ................... 90 tetrabenazine ....................... 53 tetracycline hcl ..................... 13 TEXACORT ......................... 59 THALOMID .......................... 25 THEO-24 ............................110 theophylline.........................110 theophylline er .....................110 THIOLA ............................... 77 THIOLA EC .......................... 77 thioridazine hcl ..................... 29 thiothixene ........................... 29 THYQUIDITY ....................... 88 tiadylt er ............................... 47 tiagabine hcl ......................... 15 TIAZAC................................ 47 TIBSOVO............................. 26 TIGLUTIK ............................ 53 TIKOSYN ..............................45 tilia fe ....................................85 timolol maleate .............. 23, 102 TIMOPTIC ..........................102 TIMOPTIC OCUDOSE ........102 TIMOPTIC-XE .....................102 tinidazole ............................. 10 tioconazole-1 ........................21 tiopronin ................................77 TIROSINT ............................ 88 TIVICAY ...............................32 TIVICAY PD ......................... 32 tizanidine hcl ........................ 31

TOBI NEBULIZER ............... 110 TOBI PODHALER ............... 110 TOBRADEX ........................ 100 TOBRADEX ST ................... 100 tobramycin .................. 101, 109 tobramycin-dexamethasone 100 TOBREX............................. 101 tolcapone ..............................28 tolnaftate...............................21 TOLSURA.............................21 tolterodine tartrate .................77 tolterodine tartrate er .............77 tolvaptan ...............................66 TOLVAPTAN ........................66 TOPAMAX ............................14 TOPAMAX SPRINKLE ..........14 TOPICORT ...........................59 TOPICORT SPRAY...............59 topiramate.............................14 topiramate er.........................14 TOPROL XL..........................46 toremifene citrate ..................25 torsemide ..............................49 TOSYMRA ............................22 TOUJEO MAX SOLOSTAR ...39 TOUJEO SOLOSTAR ...........39 tovet .....................................59 TOVET .................................55 TOVIAZ ................................77 TRACLEER ........................ 110 TRADJENTA.........................37 tramadol hcl er ....................... 6 TRAMADOL HCL ER ............. 6 tramadol hcl ir ........................ 8 tramadol-acetaminophen ........ 8 trandolapril ............................44 trandolapril-verapamil hcl er ...48 tranexamic acid .....................41 TRANSDERM-SCOP (1.5 MG)

........................................... 19 TRANXENE-T .......................35 tranylcypromine sulfate ..........17 TRAVATAN Z .......................99 travoprost (bak free) ..............99 TRAZIMERA .........................97 trazodone hcl ........................18 TRECATOR ..........................23 TRELEGY ELLIPTA ............ 107 TREMFYA ............................91 TRESIBA ..............................39 TRESIBA FLEXTOUCH.........39 tretinoin .......................... 27, 57 tretinoin microsphere .............57 TRETTEN .............................43 TREXALL .............................93

TREXIMET ........................... 22 tri femynor ............................ 85 triamcinolone acetonide ... 54, 59 triamterene ........................... 49 triamterene-hctz .................... 48 TRIANEX .............................. 59 triazolam ............................. 112 TRIBENZOR ......................... 48 tri-buffered aspirin ...................4 TRICARE.............................. 68 TRICARE PRENATAL DHA

ONE ................................. 68 TRICOR ............................... 49 trientine hcl ........................... 66 tri-estarylla ............................ 85 trifluoperazine hcl .................. 29 trifluridine ............................ 101 trihexyphenidyl hcl................. 28 TRIJARDY XR ...................... 37 TRIKAFTA .......................... 110 tri-legest fe ............................ 85 TRILEPTAL .......................... 16 tri-linyah ................................ 86 TRILIPIX ............................... 49 tri-lo-estarylla ........................ 86 tri-lo-marzia........................... 86 tri-lo-mili ................................ 86 tri-lo-sprintec ......................... 86 trimethobenzamide hcl .......... 19 trimethoprim.......................... 10 tri-mili ................................... 86 trimipramine maleate ............. 18 TRIMO-SAN ......................... 76 TRINATAL RX 1.................... 68 TRINTELLIX ......................... 18 tri-nymyo .............................. 86 triple antibiotic .........................9 tri-previfem ........................... 86 triprolidine hcl...................... 106 TRIPTODUR ......................... 89 tri-sprintec............................. 86 TRISTART DHA .................... 68 TRISTART ONE.................... 68 TRIUMEQ ............................. 33 trivora (28) ............................ 86 tri-vylibra ............................... 86 tri-vylibra lo ........................... 86 TRIZIVIR .............................. 33 TROKENDI XR ..................... 14 trospium chloride ................... 77 trospium chloride er ............... 77 TRUE METRIX AIR GLUCOSE

METER ....................... 62, 64 TRUE METRIX GO GLUCOSE

METER ............................. 64

135

TRUE METRIX METER ........ 64 TRULANCE ......................... 72 TRULICITY .......................... 37 TRUMENBA ......................... 90 TRUSELTIQ (100MG DAILY

DOSE) ............................. 69 TRUSOPT ..........................103 TRUVADA ............................33 TUDORZA PRESSAIR. .......108 TUKYSA .............................. 97 tulana .................................. 87 TURALIO ............................. 97 TUSSICAPS .......................105 tussin cf cough & cold ..........105 tussin cough ........................105 tussin cough long acting ......105 tussin cough/chest congest 105 tussin dm ............................105 tussin dm max .....................105 tussin mucus+chest congestion

.........................................105 TWINRIX ..............................90 TWIRLA ............................... 79 tyblume ................................ 86 TYBOST .............................. 34 tydemy ................................. 86 TYKERB .............................. 97 TYMLOS .............................. 94 TYSABRI ............................. 54 TYVASO .............................110 TYVASO REFILL ................111 TYVASO STARTER ............111

U UBRELVY ............................ 22 UCERIS ............................... 93 UDENYCA ........................... 41 UKONIQ .............................. 97 ULORIC ............................... 21 ULTRACET ............................ 8 ULTRAM ................................ 8 ULTRAVATE ........................ 59 unithroid ............................... 88 UPTRAVI ............................111 urea ..................................... 55 ureacin-10 ............................ 55 ureacin-20 ............................ 55 urinary pain relief .................. 76 URO-458 ............................. 76 UROCIT-K 10....................... 66 UROGESIC-BLUE................ 76 uro-mp ................................. 76 URSO 250 ........................... 74 URSO FORTE ..................... 74 ursodiol ................................ 74

V V-GO KIT 20, 30, 40… ......... 96 VAGIFEM .............................86 valacyclovir hcl ......................32 VALCHLOR ..........................24 VALCYTE .............................31 valganciclovir hcl ...................31 valproic acid ..........................14 valsartan ...............................44 valsartan-hydrochlorothiazide 48 VALTOCO 10 MG DOSE .......15 VALTREX .............................32 VANCOCIN ...........................10 vancomycin hcl .....................10 vandazole .............................10 VANICREAM ........................55 VANOS ................................. 59 VAPORIZER WARM STEAM 96 VAQTA .................................90 VARIVAX ..............................90 VARUBI (180 MG DOSE) ......19 VASCEPA.............................50 VASERETIC .........................48 VASOTEC ............................44 VCF VAGINAL

CONTRACEPTIVE ............76 VECAMYL ............................48 VECTICAL ............................60 vegetable lax+stool softener ..72 velivet ...................................86 VELPHORO ..........................67 VELTASSA ...........................67 VEMLIDY ..............................31 VENCLEXTA ........................26 VENCLEXTA STARTING PACK

........................................... 26 venlafaxine hcl ......................18 venlafaxine hcl er ..................18 VENTAVIS .......................... 111 VENTOLIN HFA .................. 109 verapamil hcl.........................47 verapamil hcl er .....................47 VEREGEN ............................60 VERELAN .............................47 VERELAN PM .......................47 VERQUVO............................43 VERSACLOZ ........................31 VERZENIO ...........................26 VESICARE ...........................77 VESICARE LS ......................77 vestura .................................86 VFEND .................................21 VIBERZI ...............................73 VIBRAMYCIN .......................13 VICTOZA ..............................38

VIEKIRA PAK ....................... 32 vienva ................................... 86 vigabatrin .............................. 15 vigadrone.............................. 15 VIGAMOX........................... 101 VIIBRYD ............................... 18 VIIBRYD STARTER PACK .... 18 VIMOVO .................................5 VIMPAT ................................ 16 VIOKACE ............................. 76 viorele .................................. 86 VIRACEPT ........................... 34 VIRAMUNE XR ..................... 33 VIRAZOLE .......................... 111 VIREAD ................................ 33 virt-c dha............................... 68 virt-caps ................................ 68 virt-gard ................................ 68 virt-nate dha.......................... 68 virt-pn dha ............................ 68 virt-pn plus ............................ 68 virtussin a/c......................... 105 virtussin ac w/alc ................. 105 virtussin dac........................ 105 VISTARIL ............................. 35 VITAFOL FE+ ....................... 68 VITAFOL GUMMIES ............. 68 VITAFOL STRIPS ................. 68 VITAFOL ULTRA .................. 68 VITAFOL-OB ........................ 68 VITAFOL-OB+DHA ............... 68 VITAFOL-ONE ...................... 68 vitamin b-1 ............................ 65 vitamin c ............................... 65 vitamin c cr ........................... 65 vitamin c/rose hips ................ 65 vitamin e ............................... 65 VITRAKVI ............................. 26 VIVELLE-DOT ...................... 86 VIVLODEX .............................5 VIZIMPRO ............................ 97 VOCABRIA ........................... 22 VOGELXO ............................ 80 VOGELXO PUMP ................. 80 volnea .................................. 86 VONVENDI ........................... 43 voriconazole ......................... 21 VOSEVI ................................ 32 VOTRIENT ........................... 97 VOXZOGO INJ 0.4 MG, 0.56 MG, 1.2 MG .......................... 77 vp-pnv-dha ........................... 69 VRAYLAR............................. 30 VTOL LQ ................................8 VUITY SOL (pilocarpine hcl) 104

136

VUMERITY .......................... 54 VUSION................................21 vyfemla ................................. 86

vylibra .................................. 86 VYNDAMAX ......................... 76 VYNDAQEL ......................... 76 VYTORIN............................. 50 VYVANSE ............................ 52 VYZULTA ............................ 99

W WAKIX ................................113 warfarin sodium .................... 40 wart remover ........................ 55 WELCHOL ........................... 50 WELLBUTRIN SR ................ 17 WELLBUTRIN XL. ................ 17 wera .................................... 86 westab mini .......................... 69 WESTAB PLUS.................... 69 WESTGEL DHA ................... 69 WIDE-SEAL DIAPHRAGM 6096 WILATE ............................... 43 wixela inhub ........................107 wymzya fe ............................ 86

X XADAGO ............................. 29 XALATAN ............................ 99 XALKORI ............................. 97 XANAX ................................ 35 XANAX XR........................... 35 XARELTO ............................ 40 XARELTO STARTER PACK 40 XATMEP .............................. 93 XCOPRI ............................... 14 XELJANZ ............................. 91 XELJANZ XR ....................... 91 XELODA .............................. 24 XELPROS ............................ 99 XENAZINE ............................53 XENLETA ............................ 10 XEPI .................................... 61 XERESE .............................. 60 XERMELO ........................... 73 XHANCE.............................108 XIFAXAN ............................. 10 XIGDUO XR ......................... 38 XIIDRA ...............................100 XIMINO................................ 13 XOFLUZA (40 MG DOSE) .... 34 XOFLUZA (80 MG DOSE) .... 34 XOLAIR ............................... 91 XOPENEX CONCENTRATE109 XOPENEX HFA...................109 XOPENEX NEB ..................109 XOSPATA ............................ 97

XPOVIO (100 MG ONCE WEEKLY)..........................25

XTAMPZA ER ........................ 6 XTANDI ................................24 xulane...................................86 XULTOPHY ..........................38 XYNTHA ...............................43 XYNTHA SOLOFUSE ...........43 XYOSTED ............................80 XYREM .............................. 113 XYWAV .............................. 112

Y YASMIN 28 ...........................86 YAZ ......................................86 YONSA .................................24 YUPELRI ............................ 109 yuvafem ................................86

Z ZADITOR ...................... 98, 100 zafemy ..................................86 zafirlukast ........................... 108 zaleplon .............................. 112 ZANAFLEX ........................... 31 zarah .................................... 86 ZARONTIN ........................... 14 ZARXIO ................................41 ZATEAN-PN DHA .................69 ZATEAN-PN PLUS................69 ZAVESCA .............................76 ZEBUTAL .............................. 8 ZEGALOGUE .......................78 ZEGERID ............................. 75 ZEJULA ................................ 26 ZELAPAR .............................29 ZELBORAF ...........................26 ZEMBRACE SYMTOUCH .....22 ZEMPLAR.............................94 zenatane...............................57 ZENPEP ...............................76 ZENZEDI ..............................52 ZEPATIER ............................32 ZEPOSIA ..............................54 ZERVIATE .......................... 100 ZESTORETIC .......................48 ZESTRIL...............................44 ZETIA ...................................50 ZETONNA .......................... 108 ZIAC ..................................... 48 ZIAGEN ................................33 ZIANA...................................57 zidovudine ............................33 ZIEXTENZO..........................41

zileuton er ........................... 108 ZILXI .................................... 55 zinc ...................................... 65 zinc sulfate ........................... 65 ZIOPTAN .............................. 99 ziprasidone hcl ...................... 30 ziprasidone mesylate............. 30 ZIPSOR ..................................5 ZIRGAN ................................ 31 ZITHROMAX ........................ 12 ZITHROMAX TRI-PAK .......... 12 ZITHROMAX Z-PAK.............. 12 ZOCOR ................................ 50 ZOFRAN .............................. 19 ZOKINVY.............................. 96 ZOLINZA .............................. 25 zolmitriptan ........................... 22 ZOLMITRIPTAN.................... 22 ZOLOFT ............................... 18 zolpidem tartrate ................. 112 zolpidem tartrate er ............. 112 ZOMACTON ......................... 79 ZOMACTON (FOR ZOMA-JET

10) .................................... 79 ZOMIG ................................. 22 ZONALON ............................ 59 zonisamide ........................... 16 ZONTIVITY ........................... 40 ZORBTIVE ........................... 79 ZORTRESS .......................... 93 ZORVOLEX ............................5 ZOSTRIX HP ........................ 96 zovia 1/35 (28) ...................... 86 zovia 1/35e (28) .................... 86 ZOVIRAX.............................. 32 ZTLIDO .................................. 8 ZUBSOLV...............................9 zumandimine ........................ 86 ZUPLENZ ............................. 19 ZYCLARA ............................. 60 ZYCLARA PUMP .................. 60 ZYDELIG .............................. 26 ZYFLO................................ 108 ZYKADIA .............................. 24 ZYLET ................................ 100 ZYMAXID ........................... 101 ZYPITAMAG ......................... 50 ZYPREXA............................. 30 ZYPREXA RELPREVV.......... 31 ZYPREXA ZYDIS .................. 31 ZYTIGA ................................ 24 ZYVOX ................................. 10

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