Adhere 90: Maintenance Drug List Adhere 90 Drug List.pdfnitrolingual nitro -time . papaverine hcl . contraception/oxytocics (oral) – generics only . altavera

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Adhere 90: Maintenance Drug List

Effective 1/1/2020

1014 Vine Street, Cincinnati, OH 45202 • Phone 800.917.4926 • Fax 866.762.1014 Copyright © 2018 Kroger Prescription Plans, Inc. All Rights Reserved.

Maintenance medications are commonly prescribed and taken continuously to manage chronic conditions, such as high blood pressure, asthma, diabetes and high cholesterol. Adhere 90 is a program that requires members to receive a 90-day supply of certain maintenance medications after their first 2 fills of a prescription. Receiving a 90-day supply of medication helps increase adherence to medication regimens and is convenient for members. 90-day supplies of medications can be filled at a 90-day retail pharmacy or through mail order. The Adhere 90 program only applies to the list above; other medications may be filled at any network pharmacy.

ASTHMA AND COPD ACCOLATE

ADVAIR DISKUS

ADVAIR HFA

AEROSPAN

ALVESCO

ANORO ELLIPTA

ARCAPTA NEOHALER

ARMONAIR RESPICLICK

ARNUITY ELLIPTA

ASMANEX

ASMANEX HFA

ATAZANAVIR

BREO ELLIPTA

BROVANA

BUDESONIDE

COMBIVENT

COMBIVENT RESPIMAT

CROMOLYN SODIUM

DALIRESP

DULERA

DUONEB

FLOVENT DISKUS

FLOVENT HFA

FORADIL

INCRUSE ELLIPTA

IPRATROPIUM-ALBUTEROL

METAPROTERENOL SULFATE

MONTELUKAST SODIUM

PERFOROMIST

PULMICORT

PULMICORT FLEXHALER

QVAR

SEEBRI NEOHALER

SEREVENT DISKUS

SINGULAIR

SPIRIVA

SPIRIVA RESPIMAT

STIOLTO RESPIMAT

STRIVERDI RESPIMAT

SYMBICORT

TRELEGY ELLIPTA

TUDORZA PRESSAIR

UTIBRON NEOHALER

ZAFIRLUKAST

ZILEUTON

ZYFLO

ZYFLO CR

AUTONOMIC NERVOUS SYSTEM

ARICEPT

ARICEPT ODT

DONEPEZIL HCL

DONEPEZIL HCL ODT

EXELON

GALANTAMINE HBR

GALANTAMINE HYDROBROMIDE

MEMANTINE HCL

MEMANTINE HCL ER

MESTINON

NAMENDA

NAMENDA XR

NAMZARIC

PYRIDOSTIGMINE BROMIDE

PYRIDOSTIGMINE BROMIDE ER

RAZADYNE

RAZADYNE ER

RIVASTIGMINE

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Copyright © 2018 Kroger Prescription Plans, Inc. All Rights Reserved.

BEHAVIORAL HEALTH – ANTIDEPRESSANTS

AMITRIPTYLINE HCL

AMOXAPINE

ANAFRANIL

APLENZIN

BRINTELLIX

BUDEPRION SR

BUDEPRION XL

BUPROPION HCL

BUPROPION HCL SR

BUPROPION XL

CELEXA

CHLORDIAZEPOXIDE-AMITRIPTYLINE

CITALOPRAM HBR

CLOMIPRAMINE HCL

CYMBALTA

DESIPRAMINE HCL

DESVENLAFAXINE

DESVENLAFAXINE ER

DESVENLAFAXINE FUMARATE ER

DOXEPIN HCL

DULOXETINE HCL

EFFEXOR XR

ESCITALOPRAM OXALATE

FETZIMA

FLUOXETINE DR

FLUOXETINE HCL

FLUVOXAMINE MALEATE

FLUVOXAMINE MALEATE ER

FORFIVO XL

IMIPRAMINE HCL

IMIPRAMINE PAMOATE

IRENKA

KHEDEZLA

LEXAPRO

LUVOX CR

MAPROTILINE HCL

MARPLAN

MIRTAZAPINE

NARDIL

NEFAZODONE HCL

NORPRAMIN

NORTRIPTYLINE HCL

OLEPTRO ER

PAMELOR

PARNATE

PAROXETINE HCL

PAXIL

PAXIL CR

PERPHENAZINE-AMITRIPTYLINE

PEXEVA

PHENELZINE SULFATE

PRISTIQ ER

PROTRIPTYLINE HCL

PROZAC

PROZAC WEEKLY

REMERON

SARAFEM

SERTRALINE HCL

SURMONTIL

TOFRANIL

TOFRANIL-PM

TRANYLCYPROMINE SULFATE

TRAZODONE HCL

TRIMIPRAMINE MALEATE

TRINTELLIX

VENLAFAXINE HCL

VENLAFAXINE HCL ER

VIIBRYD

VIVACTIL

WELLBUTRIN

WELLBUTRIN SR

WELLBUTRIN XL

ZOLOFT

BEHAVIORAL HEALTH – OTHER

ABILIFY

ACAMPROSATE CALCIUM

ANTABUSE

ARIPIPRAZOLE

ARIPIPRAZOLE ODT

CAMPRAL

CHLORPROMAZINE HCL

DISULFIRAM

EMSAM

3



BEHAVIORAL HEALTH – OTHER (Cont.)

EQUETRO

FANAPT

FAZACLO

FLUPHENAZINE HCL

GEODON

HALOPERIDOL

HALOPERIDOL LACTATE

INVEGA

LATUDA

LITHIUM

LITHIUM CARBONATE

LITHIUM CARBONATE ER

LITHIUM CITRATE

LITHOBID

LOXAPINE

LOXITANE

MOBAN

MOLINDONE HCL

NAVANE

OLANZAPINE

OLANZAPINE ODT

OLANZAPINE-FLUOXETINE HCL

ORAP

PALIPERIDONE ER

PERPHENAZINE

PIMOZIDE

QUETIAPINE FUMARATE

QUETIAPINE FUMARATE XR

REXULTI

RISPERDAL

RISPERDAL M-TAB

RISPERIDONE

RISPERIDONE ODT

SAPHRIS

SEROQUEL

SEROQUEL XR

SYMBYAX

THIORIDAZINE HCL

THIOTHIXENE

TRIFLUOPERAZINE HCL

VERSACLOZ

VRAYLAR

ZIPRASIDONE HCL

ZYPREXA

ZYPREXA ZYDIS

CV DISEASE – ARRHYTHMIA AMIODARONE HCL

CORDARONE

DISOPYRAMIDE PHOSPHATE

FLECAINIDE ACETATE

MEXILETINE HCL

MULTAQ

NORPACE

NORPACE CR

PACERONE

PROPAFENONE HCL

PROPAFENONE HCL ER

QUINIDINE GLUCONATE

QUINIDINE SULFATE

RYTHMOL

RYTHMOL SR

TAMBOCOR

TIKOSYN

CV DISEASE – CARDIAC STIMULANT

DIGITEK

DIGOX

DIGOXIN

LANOXIN

CV DISEASE – HYPERTENSION ACCUPRIL

ACCURETIC

ACEBUTOLOL HCL

ACEON

ADALAT CC

AFEDITAB CR

ALDACTAZIDE

ALDACTONE

ALTACE

AMILORIDE HCL

AMILORIDE-HYDROCHLOROTHIAZIDE

AMLODIPINE BESYLATE

4



CV DISEASE – HYPERTENSION (Cont.)

AMLODIPINE BESYLATE-BENAZEPRIL

AMLODIPINE-OLMESARTAN

AMLODIPINE-VALSARTAN

AMLODIPINE-VALSARTAN-HCTZ

AMTURNIDE

ATACAND

ATACAND HCT

ATENOLOL

ATENOLOL-CHLORTHALIDONE

AVALIDE

AVAPRO

AZOR

BENAZEPRIL HCL

BENAZEPRIL-HYDROCHLOROTHIAZIDE

BENICAR

BENICAR HCT

BETAPACE

BETAPACE AF

BETAXOLOL HCL

BIDIL

BISOPROLOL FUMARATE

BISOPROLOL-HYDROCHLOROTHIAZIDE

BUMETANIDE

BYSTOLIC

CALAN

CALAN SR

CANDESARTAN CILEXETIL

CANDESARTAN-HYDROCHLOROTHIAZID

CAPTOPRIL

CAPTOPRIL-HYDROCHLOROTHIAZIDE

CARDENE SR

CARDIZEM

CARDIZEM CD

CARDIZEM LA

CARDURA

CARDURA XL

CARTIA XT

CARVEDILOL

CARVEDILOL CR

CATAPRES

CATAPRES-TTS 1

CATAPRES-TTS 2

CATAPRES-TTS 3

CHLOROTHIAZIDE

CHLORTHALIDONE

CLONIDINE

CLONIDINE HCL

CLORPRES

COREG

COREG CR

CORGARD

CORZIDE

COVERA-HS

COZAAR

DEMADEX

DILACOR XR

DILT-CD

DILTIA XT

DILTIAZEM 12HR ER

DILTIAZEM 24HR CD

DILTIAZEM 24HR ER

DILTIAZEM ER

DILTIAZEM HCL

DILT-XR

DILTZAC ER

DIOVAN

DIOVAN HCT

DIURIL

DOXAZOSIN MESYLATE

DUTOPROL

DYAZIDE

DYNACIRC CR

DYRENIUM

EDARBI

EDARBYCLOR

EDECRIN

ENALAPRIL MALEATE

ENALAPRIL-HYDROCHLOROTHIAZIDE

EPANED

EPLERENONE

EPROSARTAN MESYLATE

EXFORGE

EXFORGE HCT

FELODIPINE ER

FOSINOPRIL SODIUM

5




FOSINOPRIL-HYDROCHLOROTHIAZIDE

FUROSEMIDE

GUANABENZ ACETATE

GUANFACINE HCL

HYDRALAZINE HCL

HYDROCHLOROTHIAZIDE

HYZAAR

INDAPAMIDE

INDERAL LA

INDERAL XL

INNOPRAN XL

INSPRA

IRBESARTAN

IRBESARTAN-HYDROCHLOROTHIAZIDE

ISOPTIN SR

ISRADIPINE

KERLONE

LABETALOL HCL

LASIX

LEVATOL

LISINOPRIL

LISINOPRIL-HYDROCHLOROTHIAZIDE

LOPRESSOR

LOPRESSOR HCT

LOSARTAN POTASSIUM

LOSARTAN-HYDROCHLOROTHIAZIDE

LOTENSIN

LOTENSIN HCT

LOTREL

MATZIM LA

MAVIK

MAXZIDE

MAXZIDE-25 MG

METHYCLOTHIAZIDE

METHYLDOPA

METHYLDOPA-HYDROCHLOROTHIAZIDE

METOLAZONE

METOPROLOL SUCCINATE

METOPROLOL TARTRATE

METOPROLOL-HYDROCHLOROTHIAZIDE

METOPROLOL SUCCINATE ER HYDROCHLOROTHIAZIDE

MICARDIS

MICARDIS HCT

MICROZIDE

MIDAMOR

MINIPRESS

MINOXIDIL

MOEXIPRIL HCL

MOEXIPRIL-HYDROCHLOROTHIAZIDE

NADOLOL

NADOLOL-BENDROFLUMETHIAZIDE

NEXICLON XR

NICARDIPINE HCL

NIFEDIAC CC

NIFEDICAL XL

NIFEDIPINE

NIFEDIPINE ER

NISOLDIPINE

NORVASC

OLMESARTAN

OLMESARTAN - HYDROCHLOROTHIAZIDE

OLMESARTAN – HYDROCHLOROTHIAZIDE - AMLODIPINE

PERINDOPRIL ERBUMINE

PINDOLOL

PRAZOSIN HCL

PRESTALIA

PRINIVIL

PRINZIDE

PROCARDIA

PROCARDIA XL

PROPRANOLOL HCL

PROPRANOLOL HCL ER

PROPRANOLOL-HYDROCHLOROTHIAZID

QUINAPRIL HCL

QUINAPRIL-HYDROCHLOROTHIAZIDE

RAMIPRIL

RESERPINE

SECTRAL

SORINE

SOTALOL

SOTALOL AF

SOTYLIZE

SPIRONOLACTONE

6




SPIRONOLACTONE-HCTZ

SULAR

TARKA

TAZTIA XT

TEKAMLO

TEKTURNA

TEKTURNA HCT

TELMISARTAN

TELMISARTAN-AMLODIPINE

TELMISARTAN-HYDROCHLOROTHIAZID

TENEX

TENORETIC 100

TENORETIC 50

TENORMIN

TERAZOSIN HCL

TEVETEN

TEVETEN HCT

THALITONE

TIAZAC

TIMOLOL MALEATE

TOPROL XL

TORSEMIDE

TRANDATE

TRANDOLAPRIL

TRANDOLAPRIL-VERAPAMIL

TRANDOLAPRIL-VERAPAMIL ER

TRIAMTERENE W/HCTZ

TRIAMTERENE-HYDROCHLOROTHIAZID

TRIBENZOR

TWYNSTA

UNIRETIC

UNIVASC

VALSARTAN

VALSARTAN-HYDROCHLOROTHIAZIDE

VALTURNA

VASERETIC

VASOTEC

VERAPAMIL ER

VERAPAMIL ER PM

VERAPAMIL HCL

VERAPAMIL SR

VERELAN

VERELAN PM

ZAROXOLYN

ZEBETA

ZESTORETIC

ZESTRIL

ZIAC

CV DISEASE – LIPID IRREGULARITY

ALTOPREV

ANTARA

ATORVASTATIN CALCIUM

CHOLESTYRAMINE

CHOLESTYRAMINE LIGHT

COLESTID

COLESTIPOL HCL

CRESTOR

EZETIMIBE

FENOFIBRATE

FENOFIBRIC ACID

FENOGLIDE

FIBRICOR

FLOLIPID

FLUVASTATIN ER

FLUVASTATIN SODIUM

GEMFIBROZIL

LESCOL

LESCOL XL

LIPITOR

LIPOFEN

LIPTRUZET

LIVALO

LOFIBRA

LOPID

LOVASTATIN

LOVAZA

MEVACOR

NIACIN ER

NIACIN SR 250MG

NIACOR

NIASPAN

OMEGA-3 ACID ETHYL ESTERS

PRAVACHOL

7



CV DISEASE – LIPID IRREGULARITY (Cont.)

PRAVASTATIN SODIUM

PREVALITE

QUESTRAN

QUESTRAN LIGHT

ROSUVASTATIN CALCIUM

SIMVASTATIN

SIMVASTATIN-EZETIMIBE

TRICOR

TRIGLIDE

TRILIPIX

VASCEPA

VYTORIN

WELCHOL

ZETIA

ZOCOR

CV DISEASE – MISC AMLODIPINE-ATORVASTATIN

ASPIRIN

CADUET

CORLANOR

ENTRESTO

RANEXA

CV DISEASE – VASODILATION DILATRATE-SR

ERGOLOID MESYLATES

IMDUR

ISOCHRON

ISODITRATE

ISORDIL

ISORDIL TITRADOSE

ISOSORBIDE DINITRATE

ISOSORBIDE MONONITRATE

ISOSORBIDE MONONITRATE ER

ISOXSUPRINE HCL

MINITRAN

MONOKET

NITRO-BID

NITRO-DUR

NITROGLYCERIN

NITROGLYCERIN PATCH

NITROLINGUAL

NITRO-TIME

PAPAVERINE HCL

CONTRACEPTION/OXYTOCICS (ORAL) – GENERICS ONLY

ALTAVERA

ALYACEN

AMETHIA

AMETHIA LO

AMETHYST

APRI

ARANELLE

ASHLYNA

AUBRA

AVIANE

AZURETTE

BALZIVA

BEKYREE

BEYAZ

BLISOVI 24 FE

BLISOVI FE

BREVICON

BRIELLYN

CAMILA

CAMRESE

CAMRESE LO

CAZIANT

CHATEAL

CRYSELLE

CYCLAFEM

CYCLESSA

CYRED

DASETTA

DAYSEE

DEBLITANE

DELYLA

DEMULEN 1-50-21

DEMULEN 1-50-28

DESOGEN

DESOGESTREL-ETHINYL ESTRADIOL

DESOGESTR-ETH ESTRAD ETH ESTRA

DROSPIRENONE-ETHINYL ESTRADIOL

8



CONTRACEPTION/OXYTOCICS ORAL – GENERICS ONLY (Cont.)

ELINEST

EMOQUETTE

ENPRESSE

ENSKYCE

ERRIN

ESTARYLLA

ESTROSTEP FE

FALMINA

FAYOSIM

FEMCON FE

GENERESS FE

GIANVI

GILDAGIA

GILDESS

GILDESS 24 FE

GILDESS FE

HEATHER

INTROVALE

JENCYCLA

JOLESSA

JOLIVETTE

JULEBER

JUNEL

JUNEL FE

JUNEL FE 24

KAITLIB FE

KARIVA

KELNOR 1-35

KIMIDESS

KURVELO

LARIN

LARIN 24 FE

LARIN FE

LAYOLIS FE

LEENA

LESSINA

LEVONEST

LEVONORGESTREL-ETH ESTRADIOL

LEVONORG-ETH ESTRAD ETH ESTRAD

LEVORA-28

LO LOESTRIN FE

LOESTRIN

LOESTRIN 24 FE

LOESTRIN FE

LOMEDIA 24 FE

LO-OVRAL-28

LO-OVRAL-8

LORYNA

LOSEASONIQUE

LOW-OGESTREL

LUTERA

LYZA

MARLISSA

MIBELAS 24 FE

MICROGESTIN

MICROGESTIN 24 FE

MICROGESTIN FE

MINASTRIN 24 FE

MIRCETTE

MODICON

MONO-LINYAH

MONONESSA

MYZILRA

NATAZIA

NECON

NIKKI

NORA-BE

NORDETTE-28

NORETHINDRONE

NORETHINDRONE-ETHIN ESTRADIOL

NORETHINDRON-ETHINYL ESTRADIOL

NORETHIN-ETH ESTRA-FERROUS FUM

NORGESTIMATE-ETHINYL ESTRADIOL

NORGESTREL-ETHINY ESTRA

NORINYL 1+35

NORINYL 1+50

NORLYROC

NOR-Q-D

NORTREL

OCELLA

OGESTREL

ORSYTHIA

ORTHO MICRONOR

ORTHO TRI-CYCLEN

ORTHO TRI-CYCLEN LO

9



CONTRACEPTION/OXYTOCICS ORAL – GENERICS ONLY (Cont.)

ORTHO-CEPT

ORTHO-CYCLEN

ORTHO-NOVUM

OVCON-35

OVCON-50

PHILITH

PIMTREA

PIRMELLA

PORTIA

PREVIFEM

QUARTETTE

QUASENSE

RECLIPSEN

RIVELSA

SAFYRAL

SEASONALE

SEASONIQUE

SETLAKIN

SHAROBEL

SOLIA

SPRINTEC

SRONYX

SYEDA

TARINA FE

TILIA FE

TRI-ESTARYLLA

TRI-LEGEST FE

TRI-LINYAH

TRI-LO-ESTARYLLA

TRI-LO-MARZIA

TRI-LO-SPRINTEC

TRINESSA

TRINESSA LO

TRI-NORINYL

TRI-PREVIFEM

TRI-SPRINTEC

TRIVORA-28

TYDEMY

VELIVET

VESTURA

VIENVA

VIORELE

VYFEMLA

WERA

WYMZYA FE

YASMIN 28

YAZ

ZARAH

ZENCHENT

ZENCHENT FE

ZEOSA

ZOVIA 1-35E

ZOVIA 1-50E

CONTRACEPTION/ OXYTOCICS – OTHER

DEPO-SUBQ PROVERA 104MG

MEDROXYPROGESTERONE 150MG

NUVARING

ORTHO EVRA

XULANE

DIABETES ACARBOSE

ACTOPLUS MET

ACTOPLUS MET XR

ACTOS

ALOGLIPTIN

ALOGLIPTIN-METFORMIN

ALOGLIPTIN-PIOGLITAZONE

AMARYL

AVANDAMET

AVANDARYL

AVANDIA

CHLORPROPAMIDE

CYCLOSET

DIABETA

DUETACT

FARXIGA

FORTAMET

GLIMEPIRIDE

GLIPIZIDE

GLIPIZIDE ER

GLIPIZIDE XL

GLIPIZIDE-METFORMIN

10



DIABETES (Cont.)

GLUCOPHAGE

GLUCOPHAGE XR

GLUCOTROL

GLUCOTROL XL

GLUCOVANCE

GLUMETZA

GLYBURIDE

GLYBURIDE MICRONIZED

GLYBURIDE-METFORMIN HCL

GLYNASE

GLYSET

GLYXAMBI

INVOKAMET

INVOKANA

JANUMET

JANUMET XR

JANUVIA

JARDIANCE

JENTADUETO

KAZANO

KOMBIGLYZE XR

METFORMIN HCL

METFORMIN HCL ER

NATEGLINIDE

NESINA

ONGLYZA

OSENI

PIOGLITAZONE HCL

PIOGLITAZONE-GLIMEPIRIDE

PIOGLITAZONE-METFORMIN

PRANDIMET

PRANDIN

PRECOSE

PROGLYCEM

QTERN

REPAGLINIDE

REPAGLINIDE-METFORMIN HCL

RIOMET

SEGLUROMET

STARLIX

STEGLATRO

STEGLUJAN

SYNJARDY

SYNJARDY XR

TOLAZAMIDE

TOLBUTAMIDE

TRADJENTA

XIGDUO XR

ELECTROLYTE REGULATION AURYXIA

CALCIUM ACETATE

EFFER-K

ELIPHOS

EPIKLOR

FOSRENOL

K EFFERVESCENT

KAOCHLOR-EFF

KLOR-CON

KLOR-CON 10

KLOR-CON 8

KLOR-CON M10

KLOR-CON M15

KLOR-CON M20

KLOR-CON SPRINKLE

KLOR-CON-EF

K-SOL

K-TAB

K-TAB ER

MICRO-K

PHOSLO

PHOSLYRA

POTASSIUM BICARBONATE

POTASSIUM CHLORIDE

RENAGEL

RENVELA

SEVELAMER CARBONATE

VELPHORO

VELTASSA

ENDOCRINE DISORDERS – OTHER

ACTONEL

ALENDRONATE SODIUM

ATELVIA

BINOSTO

11



ENDOCRINE DISORDERS – OTHER (Cont.)

BONIVA

CABERGOLINE

CALCITONIN-SALMON

DDAVP

DESMOPRESSIN ACETATE

DIDRONEL

DOXERCALCIFEROL

ETIDRONATE DISODIUM

EVISTA

FORTICAL

FOSAMAX

FOSAMAX PLUS D

HECTOROL

IBANDRONATE SODIUM

MIACALCIN

OSPHENA

PARICALCITOL

RALOXIFENE HCL

RISEDRONATE SODIUM

RISEDRONATE SODIUM DR

SKELID

STIMATE

ZEMPLAR

ENDOCRINE DISORDERS – THYROID

ARMOUR THYROID

CYTOMEL

DUMMY NDC ARMOUR THYROID

LEVOTHROID

LEVOTHYROXINE SODIUM

LEVOXYL

LIOTHYRONINE SODIUM

METHIMAZOLE

NATURE-THROID

NP THYROID

PROPYLTHIOURACIL

SYNTHROID

TAPAZOLE

THYROLAR-1

THYROLAR-1/2

THYROLAR-1/4

THYROLAR-2

THYROLAR-3

TIROSINT

UNITHROID

WESTHROID

WESTHROID-P

WP THYROID

EYE – GLAUCOMA ACETAZOLAMIDE

AK-PENTOLATE

ALPHAGAN P

ATROPINE CARE

ATROPINE SULFATE

AZOPT

BETAGAN

BETIMOL

BETOPTIC S

BIMATOPROST

BRIMONIDINE TARTRATE

CARTEOLOL HCL

COMBIGAN

COSOPT

COSOPT PF

CYCLOGYL

CYCLOMYDRIL

CYCLOPENTOLATE HCL

DIAMOX SEQUELS

DORZOLAMIDE HCL

DORZOLAMIDE-TIMOLOL

HOMATROPAIRE

HOMATROPINE HYDROBROMIDE

ISOPTO ATROPINE

ISOPTO CARBACHOL

ISOPTO CARPINE

ISOPTO HOMATROPINE

ISOPTO HYOSCINE

ISTALOL

LATANOPROST

LEVOBUNOLOL HCL

LUMIGAN

METHAZOLAMIDE

METIPRANOLOL

12



EYE – GLAUCOMA (Cont.)

MYDRIACYL

NEPTAZANE

OPTIPRANOLOL

PHOSPHOLINE IODIDE

PILOCARPINE HCL

PILOPINE HS

RESCULA

SIMBRINZA

TIMOPTIC

TIMOPTIC OCUDOSE

TIMOPTIC-XE

TRAVATAN Z

TRAVOPROST

TROPICAMIDE

TRUSOPT

XALATAN

ZIOPTAN

GOUT AND RELATED DISEASES

ALLOPURINOL

COLCHICINE

COLCRYS

DUZALLO

MITIGARE

PROBENECID

ULORIC

ZYLOPRIM

HEMATOLOGICAL DISORDERS

AGGRENOX

ANAGRELIDE HCL

ASPIRIN-DIPYRIDAMOLE ER

BEVYXXA

BRILINTA

CILOSTAZOL

CLOPIDOGREL

DIPYRIDAMOLE

DROXIA

DURLAZA

EFFIENT

ELIQUIS

JANTOVEN

LYSTEDA

PENTOXIFYLLINE

PERSANTINE

PLAVIX

PLETAL

PRADAXA

PRASUGREL

SAVAYSA

TICLOPIDINE HCL

TRANEXAMIC ACID

TRENTAL

XARELTO

ZONTIVITY

HORMONAL DEFICIENCY

ACTIVELLA

ALORA

ANGELIQ

AYGESTIN

CENESTIN

CLIMARA

CLIMARA PRO

COMBIPATCH

DIVIGEL

DUAVEE

ELESTRIN

ENJUVIA

ESTRACE

ESTRADERM

ESTRADIOL TAB/CREAM

ESTRADIOL-NORETHINDRONE ACETAT

ESTRASORB

ESTRING

ESTROGEL

ESTROPIPATE

FEMHRT

FEMRING

FORTESTA

FYAVOLV

JEVANTIQUE

JEVANTIQUE LO

JINTELI

13



HORMONAL DEFICIENCY (Cont.)

LOPREEZA

MEDROXYPROGESTERONE ACETATE

MENEST

MENOSTAR

MIMVEY

MIMVEY LO

MINIVELLE

NORETHINDRONE ACETATE

NORETHINDRON-ETHINYL ESTRADIOL

ORTHO-PREFEST

PREFEST

PREMARIN

PREMPHASE

PREMPRO

PROGESTERONE

PROMETRIUM

PROVERA

VAGIFEM

VIVELLE-DOT

VOGELXO

YUVAFEM

IMMUNOSUPPRESSION/ MODULATION

AZASAN

AZATHIOPRINE

CELLCEPT

CYCLOSPORINE

IMURAN

MYCOPHENOLATE MOFETIL

MYCOPHENOLIC ACID

PROGRAF

TACROLIMUS

INFECTIOUS DISEASE – VIRAL ABACAVIR

ABACAVIR-LAMIVUDINE

ABACAVIR-LAMIVUDINE- ZIDOVUDINE

ACYCLOVIR

APTIVUS

ATRIPLA

BIKTARVY

COMBIVIR

COMPLERA

CRIXIVAN

DESCOVY

DIDANOSINE

EDURANT

EFAVIRENZ

EMTRIVA

EPIVIR

EPIVIR HBV

EPZICOM

EVOTAZ

FUZEON

GENVOYA

INTELENCE

INVIRASE

ISENTRESS

ISENTRESS HD

KALETRA

LAMIVUDINE

LAMIVUDINE-ZIDOVUDINE

LEXIVA

LOPINAVIR-RITONAVIR SLN

NEVIRAPINE

NEVIRAPINE ER

NORVIR

ODEFSEY

PREZCOBIX

PREZISTA

RESCRIPTOR

RETROVIR

REYATAZ

RITONAVIR

SELZENTRY

STRIBILD

STAVUDINE

SUSTIVA

TENOFOVIR

TIVICAY

TRIUMEQ

TRIZIVIR

TRUVADA

TYBOST

14



INFECTIOUS DISEASE – VIRAL (Cont.)

VALACYCLOVIR

VALCYTE

VALGANCICLOVIR HCL

VALTREX

VIDEX

VIDEX EC

VIRACEPT

VIRAMUNE

VIRAMUNE XR

VIREAD

VITEKTA

ZERIT

ZIAGEN

ZIDOVUDINE

ZOVIRAX

INFLAMMATORY DISEASE ARAVA

CORTEF

FLUDROCORTISONE ACETATE

HYDROCORTISONE

LEFLUNOMIDE

RHEUMATREX

LOWER GI DISORDER – BOWEL INFLAMMATION

APRISO

ASACOL

ASACOL HD

AZULFIDINE

CANASA

DELZICOL

DIPENTUM

LIALDA

LINZESS

MESALAMINE

PENTASA

ROWASA

SFROWASA

SULFASALAZINE

SULFASALAZINE DR

TRULANCE

VIBERZI

LOWER GI DISORDER – OTHER

ACTIGALL

AMITIZA

CONSTULOSE

ENULOSE

GENERLAC

KRISTALOSE

LACTULOSE

LOPERAMIDE

URSO

URSO FORTE

URSODIOL

MISCELLANEOUS AGENTS CEVIMELINE HCL

EVOXAC

SALAGEN

NEOPLASTIC DISEASE ANASTROZOLE

ARIMIDEX

AROMASIN

BICALUTAMIDE

CASODEX

EXEMESTANE

FEMARA

FLUTAMIDE

HYDREA

HYDROXYUREA

LETROZOLE

METHOTREXATE

SOLTAMOX

TAMOXIFEN CITRATE

TREXALL

NEUROLOGICAL DISEASE –MISC

HORIZANT

SAVELLA

15



ORAL/PHARYNGEAL DISORDERS

ATROVENT

IPRATROPIUM BROMIDE

OTHER DRUGS CARNITOR

CARNITOR SF

LEVOCARNITINE

MEGACE

MEGACE ES

MEGESTROL ACETATE

PARKINSON’S DISEASE AMANTADINE

AZILECT

BENZTROPINE MESYLATE

BROMOCRIPTINE MESYLATE

CARBIDOPA

CARBIDOPA-LEVODOPA

CARBIDOPA-LEVODOPA ER

CARBIDOPA-LEVODOPA-ENTACAPONE

COMTAN

DUOPA

ELDEPRYL

ENTACAPONE

LODOSYN

MIRAPEX

MIRAPEX ER

NEUPRO

PARCOPA

PARLODEL

PRAMIPEXOLE DIHYDROCHLORIDE

PRAMIPEXOLE ER

REQUIP

REQUIP XL

ROPINIROLE ER

ROPINIROLE HCL

RYTARY

SELEGILINE HCL

SINEMET 10-100

SINEMET 25-100

SINEMET 25-250

SINEMET CR

STALEVO 100

STALEVO 125

STALEVO 150

STALEVO 200

STALEVO 50

STALEVO 75

TASMAR

TOLCAPONE

TRIHEXYPHENIDYL HCL

ZELAPAR

SEIZURE DISORDER APTIOM

BANZEL

CARBAMAZEPINE

CARBAMAZEPINE ER

CARBAMAZEPINE XR

CARBATROL

CELONTIN

DEPAKENE

DEPAKOTE

DEPAKOTE ER

DEPAKOTE SPRINKLE

DILANTIN

DILANTIN-125

DIVALPROEX SODIUM

DIVALPROEX SODIUM ER

EPITOL

ETHOSUXIMIDE

FANATREX

FELBAMATE

FELBATOL

FYCOMPA

GABITRIL

KEPPRA

KEPPRA XR

LAMICTAL

LAMICTAL ODT

LAMICTAL XR

LAMOTRIGINE

LAMOTRIGINE ER

LAMOTRIGINE ODT

LEVETIRACETAM

16



SEIZURE DISORDER (Cont.)

LEVETIRACETAM ER

MYSOLINE

NEURONTIN

OXCARBAZEPINE

OXTELLAR XR

PEGANONE

PHENYTEK

PHENYTOIN

PHENYTOIN SODIUM EXTENDED

POTIGA

PRIMIDONE

QUDEXY XR

ROWEEPRA

SPRITAM

STAVZOR

TEGRETOL

TEGRETOL XR

TIAGABINE HCL

TOPAMAX

TOPIRAGEN

TOPIRAMATE

TOPIRAMATE ER

TRILEPTAL

TROKENDI XR

VALPROIC ACID

VIMPAT

ZARONTIN

ZONEGRAN

ZONISAMIDE

UPPER GI DISORDERS – DIGESTIVE

CREON

PANCREAZE

PANCRELIPASE 5,000

PERTZYE

ULTRESA

VIOKACE

VIOKASE

ZENPEP

UPPER GI DISORDERS – SPASTIC DISEASE

HYOSCYAMINE SULFATE ER

HYOSCYAMINE SULFATE SR

LEVBID

OSCIMIN SR

SYMAX DUOTAB

SYMAX-SR

UPPER GI DISORDERS – ULCER AXID

CARAFATE

CIMETIDINE

CUVPOSA

CYTOTEC

DEPRIZINE

MISOPROSTOL

NIZATIDINE

PEPCID

RANITIDINE 150MG

RANITIDINE HCL

SUCRALFATE

ZANTAC

ZANTAC 25

URINARY TRACT – FUNCTIONAL DISORDERS

ALFUZOSIN HCL ER

AVODART

CYSTAGON

DARIFENACIN ER

DETROL

DETROL LA

DITROPAN XL

DUTASTERIDE

DUTASTERIDE-TAMSULOSIN

ENABLEX

FINASTERIDE

FLAVOXATE HCL

FLOMAX

GELNIQUE

JALYN

MYRBETRIQ

OXYBUTYNIN CHLORIDE

OXYBUTYNIN CHLORIDE ER

17



URINARY TRACT – FUNCTIONAL DISORDERS (Cont.)

OXYTROL

POTASSIUM CITRATE ER

PROSCAR

RAPAFLO

SANCTURA

SANCTURA XR

TAMSULOSIN HCL

TOLTERODINE TARTRATE

TOLTERODINE TARTRATE ER

TOVIAZ

TROSPIUM CHLORIDE

TROSPIUM CHLORIDE ER

UROCIT-K

UROXATRAL

VESICARE

VAGINAL DISORDERS ESTRING

FEMRING

VAGIFEM

VITAMIN/MINERAL DEFICIENCY

ACTIVE OB

ATABEX EC

BAL-CARE DHA

BAL-CARE DHA ESSENTIAL

B-NEXA

CADEAU DHA

CALCITRIOL

CALCIUM PNV

CAVAN-ALPHA KIT

CAVAN-EC SOD DHA

CHOICE-OB + DHA

CITRANATAL 90 DHA

CITRANATAL ASSURE

CITRANATAL B-CALM

CITRANATAL DHA

CITRANATAL HARMONY

CITRANATAL RX

C-NATE DHA

COMPLETE NATAL DHA

COMPLETENATE

CONCEPT DHA

CONCEPT OB

DIALYVITE ZINC

DOTHELLE DHA

DRISDOL

DUET DHA

DUET DHA 400

DUET DHA BALANCED

DUET DHA EC

ELITE OB DHA

ELITE-OB 400

ENBRACE HR

ERGOCALCIFEROL (VITAMIN D2)

EXTRA-VIRT PLUS DHA

FOCALGIN 90 DHA

FOCALGIN CA

FOCALGIN-B

FOLBECAL

FOLCAL DHA

FOLCAPS OMEGA-3

FOLET DHA

FOLET ONE

FOLIC ACID

FOLINATAL PLUS B

FOLIVANE-OB

FOLIVANE-PRX DHA NF

GESTICARE DHA

HEMENATAL OB

HEMENATAL OB + DHA

INATAL ADVANCE

INATAL ULTRA

INFANATE BALANCE

INFANATE PLUS

KOSHER PRENATAL PLUS IRON

LEVOMEFOLATE DHA

L-METHYLFOLATE PNV DHA

LOZI-FLUR

MACNATAL CN DHA

MACUZIN

MARNATAL-F

MAXINATE

M-VIT

18



VITAMIN/MINERAL DEFICIENCY (Cont.)

MYNATAL

MYNATAL ADVANCE

MYNATAL PLUS

MYNATAL-Z

MYNATE 90 PLUS

NASCOBAL

NATA KOMPLETE

NATACHEW

NATAFORT

NATAL-V RX

NATALVIRT 90 DHA

NATALVIRT CA

NATALVIT

NATELLE ONE

NEEVO

NEEVO DHA

NEEVODHA

NEPHPLEX RX

NEPHRO-VITE RX

NESTABS

NESTABS ABC

NESTABS DHA

NEWGEN

NEXA PLUS

NEXA SELECT

NIVA-PLUS

NUTRI-TAB OB

NUTRI-TAB OB + DHA

OB COMPLETE

OB COMPLETE 400

OB COMPLETE GOLD

OB COMPLETE ONE

OB COMPLETE PETITE

OB COMPLETE PREMIER

OB COMPLETE WITH DHA

OBSTETRIX DHA

OBSTETRIX EC

OBTREX

OBTREX DHA

O-CAL FA

O-CAL PRENATAL

PAIRE OB PLUS DHA

PNV 29-1

PNV FOLIC ACID + IRON

PNV OB+DHA

PNV-DHA

PNV-DHA + DOCUSATE

PNV-FERROUS FUMARATE-DOCU-FA

PNV-FIRST

PNV-OB WITH DHA

PNV-OMEGA

PNV-SELECT

PNV-TOTAL

PNV-VP-U

POTABA

PR NATAL 400

PR NATAL 400 EC

PR NATAL 430

PR NATAL 430 EC

PREFERA OB

PREFERA-OB ONE

PREFERA-OB PLUS DHA

PREFOL-DHA

PRENA1

PRENA1 CHEW

PRENA1 PEARL

PRENA1 PLUS

PRENAISSANCE

PRENAISSANCE 90 DHA

PRENAISSANCE BALANCE

PRENAISSANCE DHA

PRENAISSANCE DHA HARMONY

PRENAISSANCE HARMONY DHA

PRENAISSANCE NEXT

PRENAISSANCE NEXT-B

PRENAISSANCE PLUS

PRENAISSANCE PROMISE

PRENAPLUS

PRENATA

PRENATABS FA

PRENATABS RX

PRENATAL 19

PRENATAL AD

PRENATAL LOW IRON

PRENATAL MV & MIN

19




PRENATAL PLUS

PRENATAL VITAMIN PLUS LOW IRON

PRENATAL Z

PRENATAL-U

PRENATE AM

PRENATE CHEWABLE

PRENATE DHA

PRENATE ELITE

PRENATE ENHANCE

PRENATE ESSENTIAL

PRENATE MINI

PRENATE PIXIE

PRENATE RESTORE

PRENATE STAR

PRENEXA

PREPLUS

PREQUE 10

PRETAB

PROTECT NATAL

PROVIDA DHA

PROVIDA OB

PUREFE OB PLUS

PUREFE PLUS

RELNATE DHA

RENA-VITE RX

R-NATAL OB

ROCALTROL

RULAVITE DHA

SELECT-OB

SELECT-OB + DHA

SE-NATAL 19

SE-TAN DHA

SETONET

SETONET-EC

SF

SODIUM FLUORIDE

TARON-BC

TARON-C DHA

TARON-DUO EC

TARON-PREX PRENATAL

THRIVITE 19

THRIVITE RX

TL FOLATE

TL-CARE DHA

TL-SELECT

TL-SELECT DHA

TRI RX

TRIADVANCE

TRICARE

TRICARE PRENATAL COMPLEAT

TRICARE PRENATAL DHA ONE

TRIMESIS RX

TRINATAL GT

TRINATAL RX 1

TRINATAL ULTRA

TRINATE

TRISTART DHA

TRI-TABS DHA

TRIVEEN-DUO DHA

TRIVEEN-ONE

TRIVEEN-PRX RNF

TRIVEEN-TEN

TRIVEEN-U

TRUST NATAL DHA

ULTIMATE OB DHA

ULTIMATECARE ONE

ULTIMATECARE ONE NF

VEMAVITE-PRX 2

VENA-BAL DHA

VENATAL COMPLETE DHA

VENATAL-FA

VINACAL

VINATE AZ

VINATE CALCIUM

VINATE CARE

VINATE DHA

VINATE DHA RF

VINATE GT

VINATE IC

VINATE II

VINATE ONE

VINATE PN CARE

VINATE ULTRA

VINATE-M

VIRT NATE

20




VIRT-ADVANCE

VIRT-BAL DHA

VIRT-BAL DHA PLUS

VIRT-C DHA

VIRT-CARE ONE

VIRT-NATE

VIRT-NATE DHA

VIRT-PN

VIRT-PN DHA

VIRT-PN PLUS

VIRTPREX

VIRT-SELECT

VIRT-VITE GT

VITAFOL FE+

VITAFOL GUMMIES

VITAFOL NANO

VITAFOL ULTRA

VITAFOL-OB

VITAFOL-OB+DHA

VITAFOL-ONE

VITAFOL-PN

VITAMEDMD ONE RX

VITAMEDMD PLUS RX

VITAMEDMD REDICHEW RX

VITAMIN D2

VITAPEARL

VITASPIRE

VITATRUE

VIVA CT

VIVA DHA

V-NATAL

V-NATAL DHA

VOL-CARE RX

VOL-NATE

VOL-PLUS

Adhere 90: Maintenance Drug List Adhere 90 Drug List.pdfnitrolingual nitro -time . papaverine hcl . contraception/oxytocics (oral) – generics only . altavera

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