CareSource Georgia Medicaid, Georgia Pathways and ...

CareSource Georgia Medica id, Georgia Pathways and PeachCare for Kids Effective 1/1/2022

1

CareSource Georgia Medicaid, Georgia Pathways and PeachCare for Kids Preferred Drug List (PDL)

ANTI - INFECTIVES ANTINEOPLASTIC / IMMUNOSUPAUTONOMIC / CNS DRUGS, NEURCARDIOVASCULAR, HYPERTENSDERMATOLOGICALS/TOPICAL TDIAGNOSTICS / MISCELLANEOUSEAR, NOSE / THROAT MEDICATIENDOCRINE/DIABETESGASTROENTEROLOGY IMMUNOLOGY, VACCINES / BIOMUSCULOSKELETAL / RHEUMAOBSTETRICS / GYNECOLOGY . OPHTHALMOLOGY RESPIRATORY AND ALLERGY UROLOGICALSVITAMINS, HEMATINICS / ELECTIndex

Table of Contents

PRESSANT DRUGSOLOGY / PSYCH .ION / LIPIDSHERAPY AGENTS

ONS

TECHNOLOGY TOLOGY

ROLYTES

3 6 7

14 18 22 22 23 25 28 29 30 34 36 39 39 41

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CareSource Georgia Medicaid, Georgia Pathways and PeachCare for Kids Effective 1/1/2022

List of Abbreviations

1: generic

2: brand

ACA: Affordable Care Act.

LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call Customer Service.

OTC: Over the Counter. An OTC drug is a non-prescription drug.

PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we may not cover the drug.

QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

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

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You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table.

3

Drug Name Drug Requirements Tier / Limits

ANTI - INFECTIVES ANTIFUNGAL AGENTS clotrimazole mucous membrane

1

fluconazole 1

griseofulvin microsize

1

griseofulvin ultramicrosize

1

ketoconazole oral 1

nystatin oral suspension

1

nystatin oral tablet 1

terbinaf ine hcl oral 1 QL

voriconazole oral 1 PA

ANTIVIRALS acyclovir oral capsule

1

acyclovir oral suspension 200 mg/5 ml

1

acyclovir oral tablet 1

adefovir 1

amantadine hcl 1

atazanav ir oral capsule 150 mg, 200 mg

1 QL

atazanav ir oral capsule 300 mg

1

BARACLUDE ORAL SOLUTION

2 PA

BIKTARVY 2 QL

DESCOVY 2 PA

entecavir 1 PA

EPIVIR HBV ORAL SOLUTION

2 PA

GENVOYA 2 QL

ISENTRESS 2 QL

lamivudine oral solution

1 QL

lamivudine oral tablet 100 mg

1 PA

lamivudine oral tablet 150 mg, 300 mg

1 QL

MAVYRET 2 PA

NORVIR ORAL POWDER IN PACKET

2 QL

NORVIR ORAL SOLUTION

2 QL

oseltamivir 1 QL

ribavirin oral capsule

1

ribavirin oral tablet 200 mg

1

rimantadine 1

ritonavir 1

SOFOSBUVIR-VELPATASVIR

2 PA

SYMFI LO 2 QL

SYNAGIS 2 PA; QL

tenofovir disoproxil fumarate

1 QL

TRIUMEQ 2 PA; QL

TRUVADA 2 QL

valacyclovir 1




4

VIREAD ORAL POWDER

2 QL

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2 QL

zidovudine oral capsule

1 QL

zidovudine oral syrup

1 QL

zidovudine oral tablet

1

CEPHALOSPORINS cefadroxil oral capsule

1

cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

1

cefadroxil oral tablet 1

cefdinir 1

cefprozil 1

cefuroxime axetil oral tablet

1

cephalexin oral capsule 250 mg, 500 mg

1

cephalexin oral suspension for reconstitution

1

cephalexin oral tablet 250 mg

1

ERYTHROMYCINS / OTHER MACROLIDES azithromycin oral 1

clarithromycin 1


e.e.s. 400 oral tablet 1

ery-tab oral tablet,delayed release (dr/ec) 250 mg, 333 mg

1s

erythrocin (as stearate) oral tablet 250 mg

1

erythromycin ethylsuccinate oral suspension for reconstitution

1

erythromycin ethylsuccinate oral tablet

1

erythromycin oral capsule,delayed release(dr/ec)

1

erythromycin oral tablet

1

MISCELLANEOUS ANTIINFECTIVES albendazole 1 PA

atovaquone 1

atovaquone-proguani l

1 QL

clindamycin hcl 1

clindamycin palmitate hcl

1

clindamycin pediatric

1

COARTEM 2 QL

dapsone oral 1

ethambutol 1

hydroxychloroquine 1 QL




5

isoniazid oral 1

ivermectin oral 1

linezolid 1 PA

mefloquine 1 QL

metronidazole oral 1

neomycin 1

praziquantel 1 PA

pyrazinamide 1

pyrimethamine 1

rifabutin 1

rifampin oral 1

tobramycin in 0.225 % nacl

1 PA

TOBRAMYCIN WITH NEBULIZER

2 PA; QL

PENICILLINS amoxicillin oral capsule

1

amoxicillin oral suspension for reconstitution

1

amoxicillin oral tablet

1

amoxicillin oral tablet,chewable 125 mg, 250 mg

1

amoxicillin-pot clavulanate

1

ampicillin oral capsule 500 mg

1

dicloxacillin 1

penicillin v potassium

1

QUINOLONES


ciprofloxacin 1

ciprofloxacin hcl oral

1

levofloxacin oral 1

ofloxacin oral tablet 300 mg, 400 mg

1 QL

SULFA'S / RELATED A GENTS sulfadiazine 1

sulfamethoxazole-trimethopr im oral

1

sulfatrim 1

TETRACYCLINES avidoxy 1

doxycycl ine hyclate oral capsule

1

doxycycl ine hyclate oral tablet 100 mg, 20 mg

1

doxycycl ine monohy drate oral capsule 100 mg, 50 mg

1

doxycycl ine monohy drate oral suspension for reconstitution

1

doxycycl ine monohy drate oral tablet 100 mg, 50 mg

1

minocycline oral capsule

1

minocycline oral tablet

1

mondox yne nl oral capsule 100 mg

1




6

morgidox 1

tetracycline 1

URINARY TRACT AGENTS nitrofurantoin 1

nitrofurantoin macrocrystal

1

nitrofurantoin monohy d/m-cryst

1

trimethoprim 1

VANCOMYCIN FIRVANQ 2 PA


ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS ADJUNCTIVE AGENTS leucovorin calcium oral

1

ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS abiraterone 1 PA

AFINITOR 2 PA

AFINITOR DISPERZ

2 PA

anas trozole 1

azathioprine 1

bexarotene 1 PA

bicalutamide 1

capecitabine 1 PA

CAPRELSA 2 PA

COMETRIQ ORAL CAPSULE 100 MG/DAY(80 M G

2 PA

X1-20 MG X1)

cyclophos phamide oral capsule

1 PA

cyclosporine modified

1

cyclosporine oral capsule

1

EMPAVELI 2 PA; QL

ERIVEDGE 2 PA

erlotinib 1 PA

etopos ide oral 1

everolimus (immunosuppressive )

1

exemestane 1

flutamide 1

gengraf oral capsule 100 mg, 25 mg

1

gengraf oral solution 1

GILOTRIF 2 PA

hydroxyurea 1

IBRANCE 2 PA

imatinib 1 PA

IMBRUVICA 2 PA; QL

INLYTA 2 PA

JAKAFI 2 PA; QL




7

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 14 MG/DAY(10 MG X 1-4 MG X 1), 18 MG/DAY (10 MG X 1-4 MG X2), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1), 8 MG/DAY (4 MG X 2)

2 PA

letrozole 1 PA

LEUKERAN 2 PA

LYSODREN 2

MATULANE 2

megestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml)

1

megestrol oral suspension 625 mg/5 ml (125 mg/ml)

1 PA

megestrol oral tablet 1

MEKINIST 2 PA

melphalan 1 PA

mercaptopur ine 1

methotrexate sodium oral

1

mycophenolate mofetil

1

mycophenolate sodium

1

MYLERAN 2 PA

NEXAVAR 2 PA


REVLIMID 2 PA

sirolimus oral tablet 1

SUTENT 2 PA

tacrolimus oral 1

TAFINLAR 2 PA

tamoxifen 1

temozolomide 1 PA

THALOMID 2 PA

tretinoin (antineoplastic)

1

TREXALL 2

TYKERB 2 PA

VOTRIENT 2 PA

ZELBORAF 2 PA

ZOLINZA 2 PA


AUTONOMIC / CNS DRUGS, NEUROLOGY / PSYCH ANTICONVULSANTS BANZEL ORAL SUSPENSION

2 PA

BANZEL ORAL TABLET

2 ST

carbamazepine oral capsule, er multiphase 12 hr

1

carbamazepine oral suspension 100 mg/5 ml

1

carbamazepine oral tablet

1

carbamazepine oral tablet extended release 12 hr

1



8

carbamazepine oral tablet,chewable

1

CELONTIN ORAL CAPSULE 300 MG

2

clobazam 1 ST

clonazepam oral tablet

1 QL

diazepam rectal 1

DILANTIN 2

divalproex 1

epitol 1

ethosuximide 1

felbamate 1

FYCOMPA ORAL SUSPENSION

2 ST

FYCOMPA ORAL TABLET

2 ST

gabape ntin oral capsule

1 QL

gabape ntin oral solution

1 QL

gabape ntin oral tablet 600 mg, 800 mg

1 QL

lamotrigine oral tablet

1

lamotrigine oral tablet, chewable dispersible

1

levetiracetam oral 1

oxcarbazepine 1

OXTELLAR XR 2

PEGANONE 2

phenobarbital 1


phenytoin oral suspension

1

phenytoin oral tablet,chewable

1

phenytoin sodium extended

1

pregabal in 1 PA; QL

primidone 1

roweepra 1

roweepra xr 1

subvenite 1

tiagabine 1

topiramate oral capsule, sprinkle

1

topiramate oral tablet

1

valproic acid 1

valproic acid (as sodium salt) oral solution

1

VIMPAT ORAL TABLET

2 ST

zonisamide 1

ANTIPARKINSONISM A GENTS benztropine oral 1

bromocriptine 1

carbidopa -levodopa oral tablet

1

carbidopa -levodopa oral tablet extended release

1

carbidopa -levodopa-entacapone

1

entacapone 1




9

pramipexole oral tablet

1

ropinirole oral tablet 1

selegiline hcl 1

trihexyphenidyl 1

MIGRAINE / CLUSTER HEADACHE THERAPY almotriptan malate 1 QL

ergotamine-caffeine 1

migergot 1

naratriptan 1 QL

rizatriptan 1 QL

sumatriptan 1 QL

sumatriptan succinate oral

1 QL

sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml

1 QL

sumatriptan succinate subcutaneous pen injector 6 mg/0.5 ml

1 QL

sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml

1 QL

zolmitriptan 1 QL

MISCELLANEOUS NEUROLOGICAL THERAPY AUBAGIO 2 PA; QL

AUSTEDO ORAL TABLET 12 MG

2 PA; QL


donepezil oral tablet 10 mg, 5 mg

1

galantamine 1

GILENYA ORAL CAPSULE 0.5 MG

2 PA; QL

glatiramer 1

glatopa 1

memantine oral solution

1

memantine oral tablet

1

MEMANTINE ORAL TABLETS,DOSE PACK

2

rivastigmine tartrate 1

TECFIDERA 2 PA; QL

ZEPOSIA 2 PA; QL

MUSCLE R ELAXANTS / ANTISPASMODIC T HERAPY baclofen oral tablet 10 mg, 20 mg

1

BACLOFEN ORAL TABLET 5 MG

2

chlorzoxazone oral tablet 500 mg

1

cyclobenzaprine oral tablet 10 mg, 5 mg

1

dantrolene oral 1

methocarbamol oral 1

orphenadrine citrate oral

1

pyridostigmine bromide oral syrup

1




10

pyridostigmine bromide oral tablet 60 mg

1

pyridostigmine bromide oral tablet extended release

1

tizanidine oral tablet 1

NARCOTIC AN ALGESICS acetaminophe n-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml

1 QL

acetaminophe n-codeine oral tablet

1 QL

buprenorphine hcl sublingual

1 QL

butalbital-acetaminophe n-caff oral capsule 50-325-40 mg

1 QL

butalbital-acetaminophe n-caff oral tablet 50-325-40 mg

1 QL

butalbital-aspirin-caffeine oral capsule

1 QL

endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 QL

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

1 PA; QL


hydrocodone-acetaminophe n oral solution 7.5-325 mg/15 ml

1 QL

hydrocodone-acetaminophe n oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg

1 QL

hydrocodone-ibuprofen oral tablet 7.5-200 mg

1 QL

hydromorphone oral liquid

1 QL

hydromorphone oral tablet

1 QL

lorcet (hydrocodone) 1 QL

lorcet hd 1 QL

methadone intensol 1 PA

methadone oral concentrate

1 PA

methadone oral solution

1 PA; QL

methadone oral tablet

1 PA; QL

morphine concentrate oral solution

1 QL

morphine oral capsule,extend.relea se pellets 10 mg, 100 mg, 20 mg, 40 mg, 50 mg, 80 mg

1 PA; QL

morphine oral solution

1 QL

morphine oral tablet 1 QL

morphine oral tablet 1 PA; QL extended release




11

morphine rectal 1 QL

oxycodone oral capsule

1 QL

oxycodone oral concentrate

1 QL

oxycodone oral solution

1 QL

oxycodone oral tablet

1 QL

oxycodone-acetaminophe n oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 QL

oxycodone-acetaminophe n oral tablet 2.5-300 mg

1

oxycodone-aspirin 1 QL

oxymorphone oral tablet extended release 12 hr

1 PA; QL

zebutal oral capsule 50-325-40 mg

1 QL

NON-NARCOTIC AN ALGESICS buprenorphine-naloxone sublingual tablet

1 QL

celecoxib 1 ST

diclofenac potassium 1

diclofenac sodium oral

1

diclofenac sodium topical gel 1 %

1 QL

diclofenac-misoprostol

1

diflunisal 1


ec-naproxen 1

etodolac 1

flurbiprofen oral tablet 100 mg

1

ibu 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

ketoprofen oral capsule 50 mg, 75 mg

1

ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg

1

ketorolac oral 1 QL

KLOXXADO 2 QL

meloxicam oral tablet

1

nabumetone 1

naloxone injection solution

1 QL

naloxone injection syringe 1 mg/ml

1

naltrexone 1

naproxen oral tablet 1

naproxen oral tablet,delayed release (dr/ec)

1

naproxen sodium oral tablet 275 mg, 550 mg

1

naproxen-esomeprazole

1




12

NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION

2 QL

oxaprozin 1

sulindac 1

tramadol oral tablet 50 mg

1 QL

tramadol-acetaminophe n

1 QL

VIVITROL 2 QL

PSYCHOTHERAPEUTIC DRUGS ABILIFY MAINTENA

2

alprazolam oral tablet

1 QL

amitriptyline 1

amitriptyline-chlordiazepoxide

1

amoxapine 1

aripiprazole oral tablet

1 QL

ARISTADA 2 QL

ARISTADA INITIO 2 QL

atomoxetine 1 QL

bupropion hcl oral tablet

1

bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg

1 QL

bupropion hcl oral tablet sustained-release 12 hr

1

buspirone 1


chlordiazepoxide hcl 1 QL

chlorpromazine oral 1

citalopram 1

clomipramine 1

clonidine hcl oral tablet extended release 12 hr

1 QL

clorazepate dipotassium

1 QL

clozapine oral tablet 1

desipramine 1

dexmethylphenidate 1 QL

dextroamphetamine oral capsule, extended release

1 QL

dextroamphetamine oral tablet

1 QL

dextroamphetamine-amphetamine

1 QL

diazepam oral tablet 1 QL

doxepin oral 1

duloxetine 1

escitalopram oxalate 1

estazolam 1 QL

fluoxetine oral capsule

1

fluoxetine oral solution

1

fluoxetine oral tablet 1

fluphenazine decanoate

1

fluphenazine hcl 1

fluvoxamine 1




13

guanf acine oral tablet extended release 24 hr

1 QL

haloperidol 1

haloperidol decanoate

1

haloperidol lactate 1

imipramine hcl 1

imipramine pamoate 1

INVEGA SUSTENNA

2

INVEGA TRINZA 2 QL

lithium carbonate 1

lithium citrate oral solution 8 meq/5 ml

1

lorazepam oral tablet

1 QL

loxapine succinate 1

metadate er 1 QL

methylphenidate hcl oral capsule, er biphas ic 30-70

1 QL

methylphenidate hcl oral capsule,er biphas ic 50-50 20 mg, 30 mg, 40 mg

1 QL

methylphenidate hcl oral solution

1 QL

methylphenidate hcl oral tablet

1 QL

methylphenidate hcl oral tablet extended release

1 QL


methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg

1 QL

METHYLPHENID ATE HCL ORAL TABLET EXTENDED RELEASE 24HR 72 MG

2 QL

methylphenidate hcl oral tablet,chewable

1 QL

midazolam (pf) injection solution

1

midazolam (pf) injection syringe

1

midazolam injection 1

mirtazapine 1

nefazodone 1 QL

nortriptyline 1

olanzapine oral tablet

1 QL

oxazepam 1 QL

paliperidone 1 QL

paroxetine hcl oral tablet

1

paroxetine hcl oral tablet extended release 24 hr

1

perphenazine 1

perphenazine-amitriptyline

1

pimozide 1

quetiapine 1 QL

RELEXXII 2 QL




14

RISPERDAL CONSTA

2

risperidone oral solution

1

risperidone oral tablet

1

sertraline 1

thioridazine 1

thiothixene 1

tranylcypromine 1

trazodone oral tablet 100 mg, 150 mg, 50 mg

1

triazolam 1

trifluoperazine 1

trimipramine 1

venlafaxine oral capsule,extended release 24hr

1

venlafaxine oral tablet

1

ZENZEDI ORAL TABLET 2.5 MG

2 QL

ziprasidone hcl 1 QL

zolpidem oral tablet 1 QL


CARDIOVASCULAR, HYPERTENSION / LIPIDS ANTIARRHYTHMIC AGENTS amiodarone oral tablet 200 mg, 400 mg

1

disopyramide phosphate oral capsule

1

dofetilide 1

flecainide 1

NORPACE CR 2

pacerone oral tablet 200 mg, 400 mg

1

propaf enone 1

sorine 1

sotalol af 1

sotalol oral 1

ANTIHYPERTENSIVE THERAPY amiloride 1

amiloride-hydrochlorothiazide

1

amlodipine 1

amlodipine-benazepril

1

amlodipine-olmesartan

1

amlodipine-valsartan

1

amlodipine-valsartan-hcthiazid

1

atenolol 1

atenolol-chlorthalidone

1

benazepril 1

benazepril-hydrochlorothiazide

1

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

bumetanide oral 1

candesartan 1




15

candesartan-hydrochlorothiazid

1

captopril 1

captopril-hydrochlorothiazide

1

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HR 120 MG

2

cartia xt 1

carvedilol 1

chlorthalidone oral tablet 25 mg, 50 mg

1

clonidine 1

clonidine hcl oral tablet

1 QL

diltiazem hcl oral capsule,ext.rel 24h degradable 180 mg, 240 mg

1

diltiazem hcl oral capsule,extended release 12 hr

1

diltiazem hcl oral capsule,extended release 24 hr

1

diltiazem hcl oral capsule,extended release 24hr

1

diltiazem hcl oral tablet

1

diltiazem hcl oral tablet extended release 24 hr

1

dilt-xr 1


doxazosin 1

enalapril maleate 1

enalapril-hydrochlorothiazide

1

EPANED ORAL SOLUTION

2

felodipine 1

fosinopr il 1

fosinopr il-hydrochlorothiazide

1

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

1

furosemide oral tablet

1

guanf acine oral tablet

1

hydralazine oral 1

hydrochlorothiazide 1

indapamide 1

irbesartan 1

irbesartan-hydrochlorothiazide

1

labetalol oral 1

lisinopril 1

lisinopril-hydrochlorothiazide

1

losartan 1

losartan-hydrochlorothiazide

1

matzim la 1

methyldopa 1

metolazone 1




16

metoprolol succinate 1

metoprolol ta-hydrochlorothiaz

1

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

1

metyrosine 1 PA; ST

minoxidil oral 1

nadolol 1

nifedipine oral tablet extended release

1

nifedipine oral tablet extended release 24hr

1

olmesartan 1

olmesartan-amlodipin-hcthiazid

1

olmesartan-hydrochlorothiazide

1

prazosin 1

propranolol oral 1

quinapr il 1

quinapr il-hydrochlorothiazide

1

ramipril 1

spironolactone 1

spironolacton-hydrochlorothiaz

1

taztia xt 1

telmisartan 1

telmisartan-amlodipine

1

telmisartan- 1 hydrochlorothiazid


terazosin 1

torsemide oral 1

trandolapril 1

triamterene-hydrochlorothiazid oral capsule 37.5-25 mg

1

triamterene-hydrochlorothiazid oral tablet 37.5-25 mg

1 QL

triamterene-hydrochlorothiazid oral tablet 75-50 mg

1

valsartan 1

valsartan-hydrochlorothiazide

1

verapamil oral capsule,ext rel. pellets 24 hr

1

verapamil oral tablet 120 mg, 80 mg

1

verapamil oral tablet 40 mg

1 QL

verapamil oral tablet extended release

1

CARDIAC GLYCOSIDES digitek 1

digox 1

digoxin oral solution 50 mcg/ml (0.05 mg/ml)

1

digoxin oral tablet 1

COAGULATION THERAPY BRILINTA 2 ST




17

cilostazol 1

clopidogrel 1

dipyridamole oral 1

ELIQUIS 2

ELIQUIS DVT-PE TREAT 30D START

2

enoxapar in 1

heparin (porcine) injection cartridge

1

heparin (porcine) injection solution 1,000 uni t/ml, 5,000 unit/ml

1

heparin (porcine) injection syringe 5,000 uni t/ml

1

heparin, porcine (pf) injection solution 1,000 uni t/ml

1

jantoven 1

pentoxifylline 1

phytonadione (vitamin k1) oral tablet 5 mg

1 QL

prasugrel 1

PROMACTA ORAL TABLET

2 PA; QL

warfarin 1

XARELTO 2.5 mg 2 ST

XARELTO 10 mg, 15 mg, 20 mg

2

XARELTO DVT-PE TREAT 30D START

2 QL


LIPID/CHOLESTEROL LOWERING AGENTS atorvastatin 1

cholestyramine (with sugar)

1

cholestyramine light 1

colestipol oral tablet 1

ezetimibe 1

fenof ibrate micronized oral capsule 134 mg, 200 mg, 67 mg

1

fenof ibrate nanoc rystallized oral tablet 145 mg, 48 mg

1

fenof ibrate oral tablet 160 mg, 54 mg

1

gemfibrozil 1

lovastatin 1

omega-3 acid ethyl esters

1

pravastatin 1

prevalite 1

REPATHA PUSHTRONEX

2 PA

rosuvastatin 1 ST

simvastatin oral tablet

1

TRIGLIDE ORAL TABLET 160 MG

2

MISCELLANEOUS CARDIOVASCULAR AGENTS ENTRESTO 2 PA




18

ranolazine 1

NITRATES isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

1

isosorbide dinitrate oral tablet extended release

1

isosorbide mononi trate

1

MINITRAN 2

NITRO-DUR 2

nitroglycerin sublingual

1

nitroglycerin transdermal patch 24 hour

1

nitroglycerin translingual spray,non-aerosol

1

nitro-time 1


DERMATOLOGICALS/TOPICA L THERAPY ANTIPSORIATIC / ANTISEBORRHEIC calcipotriene scalp 1 QL

calcipotriene topical cream

1 QL

calcipotriene topical ointment

1 QL

COSENTYX 2 PA; QL

COSENTYX (2 SYRINGES)

2 PA; QL

COSENTYX P EN 2 PA; QL

COSENTYX P EN (2 PENS)

2 PA; QL

SILIQ 2 PA; QL

BURN THERAPY silver sulfadiazine 1

ssd 1

KERATOLYTICS salicylic acid topical cream

1 QL

salicylic acid topical cream,extended release

1 QL

salicylic acid topical lotion

1 QL

salicylic acid topical lotion,extended release

1 QL

salicylic acid topical shampoo

1 QL

MISCELLANEOUS DERMATOLOGICALS ammonium lactate topical lotion

1

DRYSOL 2 QL

DRYSOL DAB-O-MATIC

2 QL

fluorouracil topical cream 5 %

1 QL

fluorouracil topical solution

1 QL

imiquimod topical cream in packet

1 PA; QL

podof ilox 1 QL

tacrolimus topical 1 QL




19

urea topical cream 40 %

1

THERAPY FOR ACNE avar topical cleanser 1 QL

AVAR-E 2

AVAR-E GREEN 2

AVAR-E LS 2 QL

avita topical cream 1 QL

AVITA TOPICAL GEL

2 QL

clindamycin phosphate topical gel

1

CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY

2

clindamycin phosphate topical lotion

1 QL

clindamycin phosphate topical solution

1 QL

ery pads 1

erythromycin with ethanol topical gel

1

erythromycin with ethanol topical solution

1

metronidazole topical cream

1 QL

metronidazole topical gel 0.75 %

1 QL

metronidazole topical lotion

1 QL


rosadan topical cream

1 QL

rosadan topical gel 1 QL

sss 10-5 topical cream

1

sulfacetamide sodium-sulfur topical cleanser 10-5 % (w/w)

1 QL

sulfacetamide sodium-sulfur topical cleanser 9-4 %

1 ST

sulfacetamide sodium-sulfur topical cream 10-2 %

1 QL

sulfacetamide sodium-sulfur topical cream 10-5 % (w/w)

1

sulfacetamide sodium-sulfur topical lotion 10-5 % (w/v), 10-5 % (w/w)

1

sulfacetamide sodium-sulfur topical pads, medicated 10-4 %

1 ST

sulfacetamide sodium-sulfur topical suspension 8-4 %

1 ST

sulfacleanse 8-4 1 ST

tretinoin 1 QL




20

TRETIN-X TOPICAL CREAM 0.075 %

2 QL

TOPICAL A NESTHETICS lidocaine hcl mucous membrane solution 4 % (40 mg/ml)

1

lidocaine hcl topical cream 3 %

1 QL

lidocaine viscous 1 QL

lidocaine-prilocaine topical cream

1 QL

TOPICAL A NTIBACTERIALS CENTANY 2 QL

gentamicin topical 1 QL

mupirocin 1 QL

sulfacetamide sodium (acne)

1 QL

TOPICAL ANTIFUNGALS ciclodan 1 QL

ciclopirox topical cream

1 QL

ciclopirox topical gel

1 QL

ciclopirox topical shampoo

1

ciclopirox topical solution

1 QL

ciclopirox topical suspension

1 QL

clotrimazole topical cream

1 QL

clotrimazole-betamethasone

1 QL

topical cream


ketoconazole topical cream

1 QL

ketoconazole topical shampoo

1 QL

nyamyc 1 QL

nystatin topical 1 QL

nystop 1 QL

TOPICAL ANTIVIRALS acyclovir topical ointment

1 ST; QL

DENAVIR 2 ST; QL

TOPICAL C ORTICOSTEROIDS ala-cort topical cream 1 %

1 QL

alclometasone 1 QL

beser 1 PA; QL

betamethasone dipropionate topical cream

1 QL

betamethasone dipropionate topical lotion

1 QL

betamethasone dipropionate topical ointment

1 ST; QL

betamethasone valerate topical cream

1 QL

betamethasone valerate topical lotion

1 QL

betamethasone valerate topical ointment

1 QL




21

betamethasone, augmented topical cream

1 QL

betamethasone, augmented topical lotion

1 QL

betamethasone, augmented topical ointment

1 QL

clobetasol scalp 1 ST; QL

clobetasol topical cream

1 PA; QL

clobetasol topical gel

1 ST; QL

clobetasol topical ointment

1 QL

clobetasol topical shampoo

1 PA; QL

clobetasol-emollient topical cream

1 QL

clodan 1 ST; QL

desonide topical cream

1 QL

desonide topical ointment

1 QL

desoximetasone topical cream 0.25 %

1 QL

diflorasone 1 PA; QL

fluocinolone 1 QL

fluocinolone and shower cap

1 QL

fluocinonide topical cream 0.05 %

1 PA; QL

fluocinonide topical 1 PA; QL gel


fluocinonide topical ointment

1 PA; QL

fluocinonide topical solution

1 QL

fluocinonide-e 1 QL

fluocinonide-emollient

1 QL

fluticasone propionate topical cream

1 QL

fluticasone propionate topical lotion

1 PA; QL

fluticasone propionate topical ointment

1 QL

hydrocortisone butyrate topical cream

1 QL

hydrocortisone butyrate topical ointment

1 QL

hydrocortisone butyrate topical solution

1 QL

hydrocortisone butyr-emollient

1

hydrocortisone topical cream 1 %, 2.5 %

1 QL

hydrocortisone topical lotion 2.5 %

1 QL

hydrocortisone topical ointment 1 %

1

hydrocortisone topical ointment 2.5

1 QL

%




22

hydrocortisone valerate topical cream

1 QL

mometasone topical 1 QL

prednicarbate topical cream

1 QL

prednicarbate topical ointment

1

triamcinolone acetonide topical cream

1 QL

triamcinolone acetonide topical lotion

1 QL

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

1 QL

triamcinolone acetonide topical ointment 0.05 %

1

triderm topical cream 0.5 %

1 QL

TOPICAL EN ZYMES SANTYL 2 QL

TOPICAL SCABICIDES / PEDICULICIDES lindane topical shampoo

1 QL

malathion 1 QL

permethrin topical cream

1 QL

spinosad 1 PA; QL


DIAGNOSTICS / MISCELLANEOUS AGENTS

MISCELLANEOUS AGENTS acamprosate 1

anagr elide 1

AURYXIA 2

deferasirox oral tablet, dispersible

1 PA

disulfiram 1

kionex (with sorbitol)

1

midodr ine 1

pilocarpine hcl oral 1

sodium polystyrene (sorb free)

1

sodium polystyrene sulfonate oral powder

1

sps (with sorbitol) 1

SMOKING DETERRENTS bupropion hcl (smok ing deter)

1


EAR, NOSE / THROAT MEDICATIONS MISCELLANEOUS AGENTS azelastine nasal spray,non-aerosol

1

chlorhexidine gluconate mucous membrane

1

denta 5000 plus 1

ipratropium bromide nasal

1 QL

oralone 1

paroex oral rinse 1



23

periogard 1

sf 5000 plus 1

sodium fluoride 5000 plus

1

triamcinolone acetonide dental

1

MISCELLANEOUS OTIC PREPARATIONS acetic acid otic (ear) 1

ciprofloxacin hcl otic (ear)

1

hydrocortisone-acetic acid

1 QL

ofloxacin otic (ear) 1

OTIC STEROID / ANTIBIOTIC neomycin-polymyxin-hc otic (ear)

1


ENDOCRINE/DIABETES ADRENAL HORMONES cortisone 1

decadron oral tablet 1

dexamethasone intensol

1

dexamethasone oral elixir

1

dexamethasone oral solution

1

dexamethasone oral tablet

1

DEXONTO 2

fludrocortisone 1

hydrocortisone oral 1

methylprednisolone oral tablet 16 mg, 32 mg, 8 mg

1

methylprednisolone oral tablets,dose pack

1

prednisolone oral solution 15 mg/5 ml

1

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 15 mg/5 ml (5 ml), 5 mg base/5 ml (6.7 mg/5 ml)

1

prednisolone sodium phosphate oral tablet,disintegrating

1

prednisone 1

prednisone intensol 1

ANTITHYROID A GENTS methimazole oral tablet 10 mg, 5 mg

1

propylthiouracil 1

SSKI 2

DIABETES THERAPY acarbose 1

ADMELOG SOLOSTAR U-100 INSULIN

2 QL

ADMELOG U-100 2 QL

ALOGLIPTIN 2

ALOGLIPTIN-METFORMIN

2

ALOGLIPTIN- 2 PIOGLITAZONE




24

BAQSIMI 2 ST; QL

FORA GTEL KETONE TEST STRIP

2 OTC; QL

FREESTYLE FREEDOM LITE

2 PA; OTC; QL

FREESTYLE INSULINX STRIP

2 OTC; QL

FREESTYLE INSULINX TEST STRIPS

2 OTC; QL

FREESTYLE LITE STRIPS

2 PA; OTC; QL

FREESTYLE TEST 2 OTC; QL

glimepiride 1

glipizide 1

glipizide-metformin 1

GLUCAGEN HYPOKIT

2 QL

GLUCAGON (HCL) EMERGENCY KIT

2

GLUCAGON EMERGENCY KIT (HUMAN)

2 QL

glyburide 1 QL

glyburide micronized

1 QL

glyburide-metformin 1 QL

HUMULIN 70/30 U-100 INSULIN

2 QL

HUMULIN 70/30 U-100 KWIKPEN

2 QL

HUMULIN N NPH INSULIN

2 QL

KWIKPEN


HUMULIN N NPH U-100 INSULIN

2 QL

HUMULIN R REGULAR U-100 INSULN

2 QL

HUMULIN R U-500 (CONC) INSULIN

2

HUMULIN R U-500 (CONC) KWIKPEN

2

INVOKAMET ORAL TABLET 150-1,000 MG, 150-500 MG

2 ST

LANCETS 2 OTC; QL

metformin oral solution

1

metformin oral tablet

1

metformin oral tablet extended release 24 hr

1

miglitol 1 ST

nateglinide 1

NOVAMAX PLUS KETONE

2 OTC; QL

NOVOLIN 70/30 U-100 INSULIN

2 QL

NOVOLIN 70-30 FLEXPEN U-100

2 QL

NOVOLIN N NPH U-100 INSULIN

2 QL

NOVOLIN R REGULAR U-100 INSULN

2 QL

pioglitazone 1




25

pioglitazone-metformin

1

PRECISION XTRA TEST

2 OTC; QL

repaglinide 1

RYBELSUS 2 ST; QL

SEGLUROMET 2 ST; QL

SOLIQUA 100/33 2 ST; QL

SEMGLEE 100 UNIT/ML VIAL

1 QL

SEMGLEE 100 UNIT/ML PEN

1 QL

STEGLATRO 2 ST; QL

SYMLINPEN 120 2 ST

SYMLINPEN 60 2 ST

TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML

2 ST; QL

MISCELLANEOUS HORMONES ANADROL-50 2 PA

cabergoline 1

calcitonin (salmon) 1

calcitriol oral 1

danaz ol 1

DDAVP NASAL SOLUTION

2

desmopressin nasal spray with pump

1

desmopressin oral 1

JYNARQUE ORAL TABLET

2


KUVAN ORAL POWDER IN PACKET 500 MG

2 PA

KUVAN ORAL TABLET,SOLUBL E

2 PA

ORILISSA 2 PA; QL

oxandrolone 1 PA

SAMSCA ORAL TABLET 15 MG

2 PA

SYNAREL 2 PA

testosterone transdermal gel

1 PA

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram)

1 PA

THYROID HOR MONES euthyrox 2

levothyroxine oral 1

levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

1

liothyronine oral 1

np thyroid 1

SYNTHROID 2

thyroid (pork) 1

unithroid 1


GASTROENTEROLOGY ANTIDIARRHEALS / ANTISPASMODICS



26

chlordiazepoxide-clidinium

1

CUVPOSA 2 PA

dicyclomine oral capsule

1

dicyclomine oral solution

1

dicyclomine oral tablet

1

diphenoxylate-atropine

1

ed-spaz 1

glycopyrrolate oral tablet 1 mg, 2 mg

1

hyoscyamine sulfate oral

1

hyoscyamine sulfate sublingual

1

loperamide oral capsule

1 QL

oscimin oral tablet 1

oscimin sl 1

oscimin sr 1

symax-sr 1

MISCELLANEOUS GASTROINTESTINAL AGENTS APRISO 2

balsalazide 1

budesonide oral capsule,delayed,exte nd.release

1

CIMZIA 2 PA; QL

CIMZIA POWDER 2 PA; QL FOR RECONST


CIMZIA STARTER KIT

2 PA; QL

constulose 1

CORTIFOAM 2

CREON 2

cromolyn oral 1 PA

enulose 1

gavilyte-c 1

gavilyte-g 1

gavilyte-n 1

generlac 1

GOLYTELY ORAL POWDER IN PACKET

2

granisetron hcl oral 1 QL

hydrocortisone rectal

1

hydrocortisone topical cream with perineal applicator

1

lactulose oral solution

1

lubiprostone capsule 1 PA; QL

meclizine oral tablet 12.5 mg, 25 mg

1

mesalamine oral tablet,delayed release (dr/ec)

1

mesalamine rectal enema

1

metoclopramide hcl oral solution

1

metoclopramide hcl oral tablet

1




27

ondans etron 1

ondans etron hcl oral 1

peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram

1

peg3350 -sod sul-nacl-kcl-asb-c

1

peg-electrolyte soln 1

peg-prep 1

polyethylene glycol 3350

1

prochlorperazine maleate

1

procto-med hc 1

procto-pak 1

proctosol hc topical 1

proctozone-hc 1

sulfasalazine 1

trilyte with flavor packets

1

trimethobenzamide oral

1

ursodiol 1

VIOKACE 2

ULCER THERAPY amoxicil-clarithromy-lansopraz

1

cimetidine 1

cimetidine hcl oral 1


esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg

1

esomeprazole magnesium oral granules dr for susp in packet

1

famotidine oral suspension

1

famotidine oral tablet 20 mg, 40 mg

1

FIRST-OMEPRAZOLE

2 PA

lansoprazole oral capsule,delayed release(dr/ec) 15 mg

1 QL

misoprostol 1 QL

NEXIUM 24HR ORAL CAPSULE,DELAY ED RELEASE(DR/EC)

2 OTC

nizatidine 1

omeprazole oral capsule,delayed release(dr/ec)

1 QL

pantoprazole oral tablet,delayed release (dr/ec)

1 QL

PRILOSEC OTC 2 OTC; QL

ranitidine hcl oral syrup

1

ranitidine hcl oral tablet 150 mg, 300 mg

1




28

sucralfate oral suspension

1

sucralfate oral tablet 1 QL


IMMUNOLOGY, VACCINES / BIOTECHNOLOGY BIOTECHNOLOGY DRUGS AVONEX INTRAMUSCULA R PEN INJECTOR KIT

2 PA; QL

AVONEX INTRAMUSCULA R SYRINGE KIT

2 PA; QL

EXTAVIA 2 PA; QL

INTRON A INJECTION

2 PA

NEULASTA 2 PA; QL

OMNITROPE SUBCUTANEOUS RECON SOLN

2 PA

PEGASYS 2 PA; QL

REBIF (WITH ALBUMIN)

2 PA

REBIF REBIDOSE 2 PA

ZARXIO 2 PA

VACCINES / MISCELLANEOUS IMMUNOLOGICALS ACTHIB (PF) 2

ADACEL(TDAP ADOLESN/ADULT )(PF)

2

AFLURIA QD 2020-21(3YR UP)(PF)

2

AFLURIA QD 2020-21(6-35MO)(PF)

2

AFLURIA QUAD 2020-2021(6MO UP)

2

BEXSERO 2

BOOSTRIX TDAP 2

DAPTACEL (DTAP PEDIATRIC) (PF)

2

ENGERIX-B (P F) 2

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULA R SYRINGE

2

FLUAD 2020-2021 (65 YR UP)(PF)

2

FLUAD QUAD 2020-21(65Y UP)(PF)

2

FLUARIX QUAD 2020-2021 ( PF)

2

FLUBLOK QUAD 2020-2021 ( PF)

2

FLUCELVAX QUAD 2020-2021

2

FLUCELVAX QUAD 2020-2021 (PF)

2

FLULAVAL QUAD 2020-2021 ( PF)

2

FLUMIST QUAD 2020-2021

2

FLUZONE HIGHDOSE QUAD 20-21 P F

2




29

FLUZONE QUAD 2020-2021

2

FLUZONE QUAD 2020-2021 ( PF)

2

GARDASIL 9 (PF) 2

HAVRIX (PF) INTRAMUSCULA R SUSPENSION 1,440 ELISA UNIT/ML

2

HAVRIX (PF) INTRAMUSCULA R SYRINGE

2

HEPLISAV-B (PF) INTRAMUSCULA R SYRINGE

2

HIBERIX (P F) 2

INFANRIX (DTAP) (PF)

2

IPOL 2

KINRIX (PF) 2

MENACTRA (PF) INTRAMUSCULA R SOLUTION

2

MENVEO A-C-Y-W-135-DIP (P F)

2

M-M-R II (PF) 2

PEDIARIX (PF) 2

PEDVAX HIB (PF) 2

PENTACEL (PF) INTRAMUSCULA R KIT 15 LF UNIT-20 MCG-5 LF/0.5 ML

2


PENTACEL (PF) INTRAMUSCULA R KIT 15LF-48MCG-62DU -10 MCG/0.5ML

1

PENTACEL ACTHIB COMPONENT (PF)

2

PNEUMOVAX-23 2

PREVNAR 13 (PF) 2

PROQUAD (PF) 2

QUADRACEL (PF) 2

RECOMBIVAX HB (PF)

2

ROTARIX 2

ROTATEQ VACCINE

2

SHINGRIX (P F) 2

TDVAX 2

TENIVAC (PF) 2

TETANUS,DIPHTH ERIA TOX PED(PF)

2

TRUMENBA 2

TWINRIX (P F) INTRAMUSCULA R SYRINGE

2

VAQTA (PF) 2

VARIVAX (PF) 2

VARIZIG INTRAMUSCULA R SOLUTION

2

ZOSTAVAX (PF) 2


MUSCULOSKELETAL / RHEUMATOLOGY



30

GOUT THERAPY allopur inol 1

colchicine oral tablet

1 QL

probenecid 1

OSTEOPOROSIS THERAPY alendronate oral tablet 10 mg, 35 mg, 5 mg, 70 mg

1

ibandr onate oral 1

raloxifene 1

OTHER R HEUMATOLOGICALS ACTEMRA ACTPEN

2 PA; QL

ENBREL MINI 2 PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

2 PA; QL

ENBREL SUBCUTANEOUS SYRINGE

2 PA; QL

ENBREL SURECLICK

2 PA; QL

KEVZARA SUBCUTANEOUS PEN INJECTOR 150 MG/1.14 ML

2 PA; QL

KEVZARA SUBCUTANEOUS SYRINGE 200 MG/1.14 ML

2 PA; QL

leflunomide 1

OLUMIANT ORAL TABLET 2 MG

2 PA; QL

OTEZLA 2 PA; QL


XELJANZ ORAL TABLET 10 MG

2 PA; QL

XELJANZ XR 2 PA; QL


OBSTETRICS / GYNECOLOGY ESTROGENS / PROGESTINS ALORA 2 PA

amabelz 1

camila 1

COMBIPATCH 2

covaryx 1

covaryx h.s. 1

CRINONE VAGINAL GEL 4 %

2

deblitane 1

dotti transdermal patch semiweek ly 0.025 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

1 PA

eemt 1

eemt hs 1

errin 1

estradiol oral 1

estradiol transdermal patch semiweek ly 0.025 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

1 PA

estradiol transdermal patch

1

week ly



31

estradiol vaginal tablet

1

estradiol-norethindrone acet

1

estrogens-methyltestosterone

1

fyavolv 1

heather 1

incassia 1

jencycla 1

jinteli 1

lopreeza oral tablet 1-0.5 mg

1

lyza 1

medroxyprogesteron e

1

mimvey 1

nora-be 1

norethindrone (contraceptive)

1

norethindrone acetate

1

norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg

1

norlyda 1

progesterone micronized

1

sharobel 1

tulana 1

MISCELLANEOUS OB/GYN


CLEOCIN VAGINAL SUPPOSITORY

2

clindamycin phosphate vaginal

1

eluryng 1

etonoge strel-ethinyl estradiol

1

metronidazole vaginal

1 QL

terconazole 1

vandaz ole 1 QL

xulane 1

zafemy 1

ORAL CONTRACEPTIVES / RELATED A GENTS afirmelle 1

altavera (28) 1

alyacen 1/35 (28) 1

alyacen 7/7/7 (28) 1

amethia 1 QL

amethia lo 1 QL

amethyst (28) 1 QL

apri 1

aranelle (28) 1

ashlyna 1 QL

aubra 1

aubra eq 1

aurovela 1.5/30 (21) 1

aurovela 1/20 (21) 1

aurovela 24 fe 1




32

aurovela fe 1.5/30 (28)

1

aurovela fe 1-20 (28)

1

aviane 1

ayuna 1

azurette (28) 1

balziva (28) 1

bekyree (28) 1

blisovi 24 fe 1

blisovi fe 1.5/30 (28) 1

blisovi fe 1/20 (28) 1

briellyn 1

camrese 1 QL

camrese lo 1 QL

caziant (28) 1

chateal (28) 1

chateal eq (28) 1

cryselle (28) 1

cyclafem 1/35 (28) 1

cyclafem 7/7/7 (28) 1

cyred 1

cyred eq 1

dasetta 1/35 (28) 1

dasetta 7/7/7 (28) 1

daysee 1 QL

desog-e.estradiol/e.estradio l

1

desogestrel-ethinyl estradiol

1


drospirenone-e.estradiol-lm.fa oral tablet 3-0.02-0.451 mg (24) (4)

1 PA

drospirenone-ethinyl estradiol

1

elinest 1

ELLA 2

emoque tte 1

enpresse 1

enskyce 1

estarylla 1

ethynodiol diac-eth estradiol

1

falmina (28) 1

femynor 1

gianvi (28) 1

hailey 24 fe 1

hailey fe 1.5/30 (28) 1

hailey fe 1/20 (28) 1

introvale 1 QL

isibloom 1

jasmiel (28) 1

jolessa 1 QL

juleber 1

junel 1.5/30 (21) 1

junel 1/20 (21) 1

junel fe 1.5/30 (28) 1

junel fe 1/20 (28) 1

junel fe 24 1

kaitlib fe 1

kariva (28) 1




33

kelnor 1/35 (28) 1

kelnor 1-50 1

kurvelo (28) 1

l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7), 0.15 mg-30 mcg (84)/10 mcg (7)

1 QL

larin 1.5/30 (21) 1

larin 1/20 (21) 1

larin 24 fe 1

larin fe 1.5/30 (28) 1

larin fe 1/20 (28) 1

larissia 1

layolis fe 1

leena 28 1

lessina 1

levonest (28) 1

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-0.03 mg

1

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg (28)

1 QL

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month

1 QL

levonorg-eth estrad triphasic

1

levora-28 1


lillow (28) 1

loryna (28) 1

low-ogestrel (28) 1

lo-zumandimine (28) 1

lutera (28) 1

marlissa (28) 1

microgestin 1.5/30 (21)

1

microgestin 1/20 (21)

1

microgestin fe 1.5/30 (28)

1

microgestin fe 1/20 (28)

1

mili 1

mono-linyah 1

necon 0.5/35 (28) 1

nikki (28) 1

noreth-ethinyl estradiol-iron

1

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

1

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg-30 mcg (21)/75 mg (7)

1

norgestimate-ethinyl estradiol

1

nortrel 0.5/35 (28) 1

nortrel 1/35 (21) 1

nortrel 1/35 (28) 1




34

nortrel 7/7/7 (28) 1

ocella 1

orsythia 1

philith 1

pimtrea (28) 1

pirmella 1

portia 28 1

previfem 1

reclipsen (28) 1

setlakin 1 QL

simliya (28) 1

simpesse 1 QL

sprintec (28) 1

sronyx 1

syeda 1

tarina 24 fe 1

tarina fe 1/20 (28) 1

tarina fe 1-20 eq (28)

1

tilia fe 1

tri femynor 1

tri-estarylla 1

tri-legest fe 1

tri-linyah 1

tri-lo-estarylla 1

tri-lo-marzia 1

tri-lo-mili 1

tri-lo-sprintec 1

tri-mili 1

tri-previfem (28) 1


tri-sprintec (28) 1

trivora (28) 1

tri-vylibra 1

tri-vylibra lo 1

velivet triphasic regimen (28)

1

vienva 1

viorele (28) 1

vyfemla (28) 1

vylibra 1

wera (28) 1

wymzya fe 1

zarah 1

zovia 1/35e (28) 1

zumandimine (28) 1

OXYTOCICS methergine 1

methylergonov ine oral

1


OPHTHALMOLOGY ANTIBIOTICS ak -poly-bac 1

bacitracin ophthalmic (eye)

1

bacitracin-polymyxin b ophthalmic (eye)

1

ciprofloxacin hcl ophthalmic (eye)

1

erythromycin ophthalmic (eye)

1



35

gentak ophthalmic (eye) ointment

1

gentamicin ophthalmic (eye) drops

1

moxifloxacin ophthalmic (eye) drops, viscous

1

NATACYN 2 QL

neomycin-bacitracin-polymyxin

1

neomycin-polymyxin-gramicidin

1

neo-polycin 1

ofloxacin ophthalmic (eye)

1 QL

polycin 1

polymyxin b sulf-trimethoprim

1

tobramycin ophthalmic (eye)

1

ANTIVIRALS trifluridine 1

BETA-BLOCKERS betaxolol ophthalmic (eye)

1

levobunol ol ophthalmic (eye) drops 0.5 %

1

metipranolol 1

timolol maleate ophthalmic (eye) drops

1


timolol maleate ophthalmic (eye) gel forming solution

1

TIMOPTIC OCUDOSE (PF) OPHTHALMIC (EYE) DROPPERETTE 0.25 %

2

CYCLOPLEGIC MYDRIATICS atropine ophthalmic (eye) drops

1

atropine ophthalmic (eye) ointment

1

cyclopentolate ophthalmic (eye) drops 1 %, 2 %

1

homatropaire 1

tropicamide 1

DIRECT ACTING MIOTICS pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 %

1

MISCELLANEOUS OPHTHALMOLOGICS azelastine ophthalmic (eye)

1

cromolyn ophthalmic (eye)

1

NON-STEROIDAL A NTI-INFLAMMATORY AGENTS diclofenac sodium ophthalmic (eye)

1

ketorolac ophthalmic (eye)

1 QL

drops 0.4 %




36

ketorolac ophthalmic (eye) drops 0.5 %

1

ORAL DRUGS FOR GLAUCOMA acetazolamide 1

methazolamide 1

OTHER GLAUCOMA DRUGS dorzolamide 1

DORZOLAMIDE (PF)

2

dorzolamide-timolol 1

DORZOLAMIDE-TIMOLOL (PF) OPHTHALMIC (EYE) DROPS

2

latanopr ost 1

LATANOPROST (PF)

2

STEROID-ANTIBIOTIC COMBINATIONS neomycin-bacitracin-poly-hc

1

neomycin-polymyxin b-dexameth

1

neomycin-polymyxin-hc ophthalmic (eye)

1

neo-polycin hc 1

tobramycin-dexamethasone

1

STEROIDS dexamethasone sodium phosphate ophthalmic (eye)

1

fluorometholone 1


prednisolone acetate 1

PREDNISOLONE ACETATE (PF)

2

prednisolone sodium phosphate ophthalmic (eye)

1

STEROID-SULFONAMIDE COMBINATIONS sulfacetamide-prednisolone

1

SULFONAMIDES sulfacetamide sodium ophthalmic (eye) drops

1

SYMPATHOMIMETICS brimonidine ophthalmic (eye) drops 0.2 %

1


RESPIRATORY AND ALLERGY ANTIHISTAMINE / ANTIALLERGENIC AGENTS benzonatate oral capsule 100 mg, 200 mg

1 QL

benzonatate oral capsule 150 mg

1

brompheniramine-pseudoeph-dm oral syrup

1

CAPCOF 2

cetirizine oral solution 1 mg/ml

1

clemastine oral 1 tablet 2.68 mg



37

codeine-guaifenesin 1

cyproheptadine 1

diphenhydramine hcl oral capsule 50 mg

1

EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.15 ML

1 QL

epinephrine injection auto-injector 0.15 mg/0.3 ml, 0.3 mg/0.3 ml

1 QL

g tussin ac 1

guaiatussin ac 1

guaifenesin ac 1

guaifenesin dac 1

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml

1 QL

HYDROCODONE-HOMATROPINE ORAL SYRUP 5-1.5 MG/5 ML (5 ML)

2 QL

hydromet 1 QL

hydroxyzine hcl oral solution 10 mg/5 ml

1

hydroxyzine hcl oral tablet

1

hydroxyzine pamoate

1

levocetirizine 1

promethazine oral 1

promethazine rectal 1

promethazine vc 1


promethazine-codeine

1

promethazine-dm 1

promethazine-phenyleph-codeine

1

promethazine-phenylephrine

1

promethegan 1

virtussin ac 1

virtussin dac 1

PULMONARY A GENTS albuterol sulfate inhalation

1 QL

albuterol sulfate oral 1

ARNUITY ELLIPTA

2 QL

ATROVENT HFA 2 QL

azelastine-fluticasone

1

budesonide inhalation

1 QL

budesonide nasal 1

COMBIVENT RESPIMAT

2 QL

cromolyn inhalation 1 QL

DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION , 200-5 MCG/ACTUATION

2 QL




38

DULERA INHALATION HFA AEROSOL INHALER 50-5 MCG/ACTUATION

2

ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML

2

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL

fluticasone propionate nasal

1

FLUTICASONE PROPION-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED

2 QL

fluticasone propion-salmeterol inhalation blister with device

1 QL

ipratropium bromide inhalation

1 QL

ipratropium-albuterol

1 QL

KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG

2 PA

KALYDECO ORAL TABLET

2 PA

LEVALBUTEROL TARTRATE

2 QL

metaproterenol oral syrup

1

montelukast 1


nebusal inhalation solution for nebulization 3 %

1

OFEV 2 PA

ORKAMBI ORAL GRANULES IN PACKET

2 PA; QL

ORKAMBI ORAL TABLET 200-125 MG

2 PA; QL

pulmosal 1

PULMOZYME 2 PA

SEREVENT DISKUS

2 QL

sildenafil (pulm.hypertension) oral tablet

1 PA; QL

sodium chloride inhalation solution for nebulization 0.9 %, 3 %, 7 %

1

sodium chloride inhalation solution for nebulization 10 %

1 QL

SPIRIVA RESPIMAT

2 QL

STIOLTO RESPIMAT

2 QL

STRIVERDI RESPIMAT

2 QL

SYMDEKO 2 PA, QL

terbutaline oral 1

THEO-24 2




39

theochron oral tablet extended release 12 hr 100 mg, 200 mg

1

theophy lline oral elixir

1

theophy lline oral solution

1

theophy lline oral tablet extended release 12 hr 300 mg, 450 mg

1

theophy lline oral tablet extended release 24 hr

1

TRELEGY ELLIPTA

2 PA; QL

TRIKAFTA 2 PA; QL


UROLOGICALS ANTICHOLINERGICS / ANTISPASMODICS flavoxate 1

oxybutynin chloride 1

tolterodine oral capsule,extended release 24hr

1 ST

tolterodine oral tablet

1

trospium 1 ST

BENIGN PROSTATIC HYPERPLASIA(BPH) THERAPY alfuzosin 1

finasteride oral tablet 5 mg

1

tamsulosin 1

CHOLINERGIC STIMULANTS

bethanechol chloride 1

MISCELLANEOUS UROLOGICALS ELMIRON 2

methen-sod phos -meth blue-hyos

1

phosphasal 1

potassium citrate 1

uretron d-s oral tablet 81.6-10.8-40.8 mg

1

urin ds 1

uro-458 1

uryl 1

ustell 1

utira-c 1

vilevev mb 1

URINARY ANESTHETICS phenazopyridine oral tablet 100 mg, 200 mg

1


VITAMINS, HEMATINICS / ELECTROLYTES ELECTROLYTES calcium acetate(phosphat bind)

1

effer-k oral tablet, effervescent 25 meq

1

klor-con 10 1

klor-con 8 1

klor-con m10 1

klor-con m15 1



40

klor-con m20 1

klor-con/ef 1

potassium chloride oral capsule, extended release

1

potassium chloride oral liquid

1

potassium chloride oral tablet extended release

1

potassium chloride oral tablet,er particles/crystals

1

VITAMINS / HEMATINICS cyanocobalamin (vitamin b-12) injection

1

ergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 uni t)

1

folic acid oral tablet 1 mg

1


KOSHER PRENATAL PLUS IRON

2

m-natal plus 1

mynatal advance 1

mynatal oral tablet 1

pnv 29-1 1

prenatabs fa 1

prenatabs rx 1

prenatal low iron 1

prenatal plus 1

prenatal plus (calcium carb)

1

prenatal vitamin plus low iron

1

preplus 1

se-natal 19 chewable 1

THRIVITE RX 2

TRICARE 2

trinatal rx 1 1

vitamin d2 1




41

Index

A ABILIFY MAINTENA ....... 12 abiraterone ............................ 6 acamprosate ........................ 22 acarbose.............................. 23 acetaminophen-codeine ....... 10 acetazolamide ..................... 36 acetic acid........................... 23 ACTEMRA ACTPEN......... 30 ACTHIB (PF) ..................... 28 acyclovir .......................... 3, 20 ADACEL(TDAP

ADOLESN/ADULT)(PF) 28 adefovir ................................ 3 ADMELOG SOLOSTAR U-

100 INSULIN.................. 23 ADMELOG U-100 INSULIN

LISPRO .......................... 23 AFINITOR ........................... 6 AFINITOR DISPERZ........... 6 afirmelle ............................. 31 AFLURIA QD 2020-21(3YR

UP)(PF) .......................... 28 AFLURIA QD 2020-21(6-

35MO)(PF) ..................... 28 AFLURIA QUAD 2020-

2021(6MO UP) ............... 28 ak-poly-bac ......................... 34 ala-cort ............................... 20 albendazole ........................... 4 albuterol sulfate................... 37 alclometasone ..................... 20 alendronate ......................... 30 alfuzosin ............................. 39 allopurinol .......................... 30 almotriptan malate................. 9 ALOGLIPTIN..................... 23 ALOGLIPTIN-METFORMIN

....................................... 23 ALOGLIPTIN-

PIOGLITAZONE............ 23 ALORA.............................. 30 alprazolam .......................... 12 altavera (28) ........................ 31

alyacen 1/35 (28)................. 31 alyacen 7/7/7 (28)................ 31 amabelz .............................. 30 amantadine hcl ...................... 3 amethia ............................... 31 amethia lo ........................... 31 amethyst (28) ...................... 31 amiloride............................. 14 amiloride-hydrochlorothiazide

....................................... 14 amiodarone ......................... 14 amitriptyline........................ 12 amitriptyline-chlordiazepoxide

....................................... 12 amlodipine .......................... 14 amlodipine-benazepril ......... 14 amlodipine-olmesartan ........ 14 amlodipine-valsartan ........... 14 amlodipine-valsartan-hcthiazid

....................................... 14 ammonium lactate ............... 18 amoxapine .......................... 12 amoxicil-clarithromy-lansopraz

....................................... 27 amoxicillin............................ 5 amoxicillin-pot c lavulanate.... 5 ampicillin.............................. 5 ANADROL-50.................... 25 anagrelide ........................... 22 anastrozole ............................ 6 apri ..................................... 31 APRISO.............................. 26 aranelle (28) ........................ 31 aripiprazole ......................... 12 ARISTADA........................ 12 ARISTADA INITIO............ 12 ARNUITY ELLIPTA.......... 37 ashlyna ............................... 31 atazanavir ............................. 3 atenolol............................... 14 atenolol-chlorthalidone........ 14 atomoxetine ........................ 12 atorvastatin ......................... 17 atovaquone............................ 4

atovaquone-proguanil ............ 4 atropine............................... 35 ATROVENT HFA .............. 37 AUBAGIO............................ 9 aubra................................... 31 aubra eq .............................. 31 aurovela 1.5/30 (21) ............ 31 aurovela 1/20 (21) ............... 31 aurovela 24 fe ..................... 31 aurovela fe 1.5/30 (28)......... 32 aurovela fe 1-20 (28) ........... 32 AURYXIA.......................... 22 AUSTEDO ........................... 9 avar .................................... 19 AVAR-E............................. 19 AVAR-E GREEN ............... 19 AVAR-E LS ....................... 19 aviane ................................ . 32 avidoxy................................ . 5 avita.................................... 19 AVITA ............................... 19 AVONEX........................... 28 ayuna .................................. 32 azathioprine .......................... 6 azelastine ....................... 22, 35 azelastine-fluticasone .......... 37 azithromycin ......................... 4 azurette (28) ........................ 32 B bacitrac in ............................ 34 bacitrac in-polymyxin b........ 34 baclofen................................ 9 BACLOFEN ......................... 9 balsalazide .......................... 26 balziva (28) ......................... 32 BANZEL.............................. 7 BAQSIMI ........................... 24 BARACLUDE...................... 3 bekyree (28) ........................ 32 benazepril ........................... 14 benazepril-hydrochlorothiazide

....................................... 14 benzonatate ......................... 36 benztropine ........................... 8



42

beser................................... 20 betamethasone dipropionate. 20 betamethasone valerate........ 20 betamethasone, augmented .. 21 betaxolol............................. 35 bethanechol chloride............ 39 bexarotene ............................ 6 BEXSERO.......................... 28 bicalutamide.......................... 6 BIKTARVY.......................... 3 bisoprolol fumarate ............. 14 bisoprolol-hydrochlorothiazide

....................................... 14 blisovi 24 fe ........................ 32 blisovi fe 1.5/30 (28) ........... 32 blisovi fe 1/20 (28) .............. 32 BOOSTRIX TDAP ............. 28 briellyn ............................... 32 BRILINTA ......................... 16 brimonidine......................... 36 bromocriptine........................ 8 brompheniramine-pseudoeph-

dm .................................. 36 budesonide..................... 26, 37bumetanide ......................... 14 buprenorphine hcl ............... 10 buprenorphine-naloxone ...... 11 bupropion hcl...................... 12 bupropion hc l (smoking de ter)

....................................... 22 buspirone ............................ 12 butalbital-acetaminophen-caff

....................................... 10 butalbital-aspirin-caffeine .... 10 C cabergoline ......................... 25 calcipotriene........................ 18 calcitonin (salmon).............. 25 calcitriol.............................. 25 calcium acetate(phosphat bind)

....................................... 39 camila ................................ . 30 camrese............................... 32 camrese lo........................... 32 candesartan ......................... 14 candesartan-hydrochlorothiazid

....................................... 15

CAPCOF............................ 36 capecitabine .......................... 6 CAPRELSA.......................... 6 captopril.............................. 15 captopril-hydrochlorothiazide

....................................... 15 carbamazepine .................. 7, 8 carbidopa-levodopa ............... 8 carbidopa-levodopa-

entacapone ........................ 8 CARDIZEM LA ................. 15 cartia xt............................... 15 carvedilol............................ 15 caziant (28) ......................... 32 cefadroxil.............................. 4 cefdinir ................................ . 4 cefprozil................................ 4 cefuroxime axetil................... 4 celecoxib............................. 11 CELONTIN .......................... 8 CENTANY......................... 20 cephalexin............................. 4 cetirizine ............................. 36 chateal (28) ......................... 32 chateal eq (28)..................... 32 chlordiazepoxide hcl............ 12 chlordiazepoxide-clidinium . 26 chlorhexidine gluconate....... 22 chlorpromazine ................... 12 chlorthalidone ..................... 15 chlorzoxazone ....................... 9 cholestyramine (with sugar). 17 cholestyramine light ............ 17 ciclodan .............................. 20 ciclopirox............................ 20 cilostazol............................. 17 cimetidine ........................... 27 cimetidine hcl...................... 27 CIMZIA.............................. 26 CIMZIA POWDER FOR

RECONST...................... 26 CIMZIA STARTER KIT..... 26 ciprofloxacin......................... 5 ciprofloxacin hcl ........ 5, 23, 34 citalopram........................... 12 clarithromycin....................... 4 clemastine ........................... 36

CLEOCIN........................... 31 clindamycin hcl..................... 4 clindamycin palmitate hcl...... 4 clindamycin pediatric ............ 4 clindamycin phosphate ...19, 31 CLINDAMYCIN

PHOSPHATE ................. 19 clobazam............................... 8 clobetasol............................ 21 clobetasol-emollient ............ 21 clodan ................................ . 21 clomipramine ...................... 12 clonazepam........................... 8 clonidine ............................. 15 clonidine hcl .................. 12, 15clopidogrel.......................... 17 clorazepate dipotassium....... 12 clotrimazole ..................... 3, 20clotrimazole-betamethasone. 20 clozapine............................. 12 COARTEM........................... 4 codeine-guaifenesin............. 37 colchicine ........................... 30 colestipol ............................ 17 COMBIPATCH .................. 30 COMBIVENT RESPIMAT. 37 COMETRIQ ......................... 6 constulose ........................... 26 CORTIFOAM..................... 26 cortisone ............................. 23 COSENTYX....................... 18 COSENTYX (2 SYRINGES)

....................................... 18 COSENTYX PEN............... 18 COSENTYX PEN (2 PENS) 18 covaryx............................... 30 covaryx h.s.......................... 30 CREON .............................. 26 CRINONE.......................... 30 cromolyn.................. 26, 35, 37 cryselle (28) ........................ 32 CUVPOSA ......................... 26 cyanocobalamin ( vitamin b -12)

....................................... 40 cyclafem 1/35 (28) .............. 32 cyclafem 7/7/7 (28) ............. 32 cyclobenzaprine .................... 9



43

cyclopentolate ..................... 35 cyclophosphamide................. 6 cyclosporine.......................... 6 cyclosporine modified ........... 6 cyproheptadine.................... 37 cyred................................... 32 cyred eq .............................. 32 D danazol ............................... 25 dantrolene ............................. 9 dapsone................................ . 4 DAPTACEL (DTAP

PEDIATRIC) (PF)........... 28 dasetta 1/35 (28).................. 32 dasetta 7/7/7 (28)................. 32 daysee................................ . 32 DDAVP.............................. 25 deblitane ............................. 30 decadron ............................. 23 deferasirox .......................... 22 DENAVIR.......................... 20 denta 5000 plus ................... 22 DESCOVY ........................... 3 desipramine......................... 12 desmopressin ...................... 25 desog-e.estradiol/e.estradiol. 32desogestrel-ethinyl estradiol 32 desonide.............................. 21 desoximetasone ................... 21 dexamethasone.................... 23 dexamethasone intensol....... 23 dexamethasone sodium

phosphate ........................ 36 dexmethylphenidate ............ 12 DEXONTO......................... 23 dextroamphetamine ............. 12 dextroamphetamine-

amphetamine ................... 12 diazepam.......................... 8, 12 diclofenac potassium ........... 11 diclofenac sodium .......... 11, 35 diclofenac-misoprostol ........ 11 dicloxacillin .......................... 5 dicyclomine ........................ 26 diflorasone .......................... 21 diflunisal............................. 11 digitek ................................ 16

digox .................................. 16 digoxin ............................... 16 DILANTIN........................... 8 diltiazem hcl ....................... 15 dilt-xr.................................. 15 diphenhydramine hcl ........... 37 diphenoxylate-atropine ........ 26 dipyridamole....................... 17 disopyramide phosphate ...... 14 disulfiram ........................... 22 divalproex............................. 8 dofetilide............................. 14 donepezil .............................. 9 dorzolamide ........................ 36 DORZOLAMIDE (PF)........ 36 dorzolamide-timolol ............ 36 DORZOLAMIDE-TIMOLOL

(PF) ................................ 36 dotti .................................... 30 doxazosin............................ 15 doxepin............................... 12 doxycycline hyclate............... 5 doxycycline monohydrate...... 5 drospirenone-e.estradiol-lm.fa

....................................... 32 drospirenone-ethinyl e stradiol

....................................... 32 DRYSOL............................ 18 DRYSOL DAB-O-MATIC.. 18 DULERA....................... 37, 38duloxetine ........................... 12 E e.e.s. 400............................... 4 ec-naproxen ........................ 11 ed-spaz ............................... 26 eemt.................................... 30 eemt hs ............................... 30 effer-k................................ . 39 elinest ................................ . 32 ELIQUIS ............................ 17 ELIQUIS DVT-PE TREAT

30D START.................... 17 ELIXOPHYLLIN................ 38 ELLA ................................ . 32 ELMIRON.......................... 39 eluryng ............................... 31 emoquette ........................... 32

enalapril maleate ................. 15 enalapril-hydrochlorothiazide

....................................... 15 ENBREL ............................ 30 ENBREL MINI................... 30 ENBREL SURECLICK....... 30 endocet ............................... 10 ENGERIX-B (PF) ............... 28 ENGERIX-B P EDIATRIC

(PF) ................................ 28 enoxaparin .......................... 17 enpresse.............................. 32 enskyce............................... 32 entacapone ............................ 8 entecavir ............................... 3 ENTRESTO........................ 17 enulose ............................... 26 EPANED............................ 15 epinephrine ......................... 37 EPINEPHRINE................... 37 epitol .................................... 8 EPIVIR HBV........................ 3 ergocalciferol (vitamin d2) .. 40 ergotamine-caffeine............... 9 ERIVEDGE .......................... 6 erlotinib ................................ 6 errin .................................... 30 ery pads .............................. 19 ery-tab .................................. 4 erythrocin (as stearate)........... 4 erythromycin.................... 4, 34 erythromycin ethylsuccinate .. 4 erythromycin with ethanol ... 19 escitalopram oxalate ............ 12 esomeprazole magnesium .... 27 estarylla .............................. 32 estazolam............................ 12 estradiol ......................... 30, 31estradiol-norethindrone acet. 31 estrogens-methyltestosterone 31 ethambutol ............................ 4 ethosuximide......................... 8 ethynodiol diac-eth estradiol 32 etodolac .............................. 11 etonogestrel-ethinyl estradiol31 etoposide............................... 6 euthyrox.............................. 25



44

everolimus (immunosuppressive)......... 6

exemestane ........................... 6 EXTAVIA .......................... 28 ezetimibe ............................ 17 F falmina (28) ........................ 32 famotidine........................... 27 felbamate .............................. 8 felodipine............................ 15 femynor .............................. 32 fenofibrate .......................... 17 fenofibrate micronized......... 17 fenofibrate nanocrystallized. 17 fentanyl............................... 10 finasteride ........................... 39 FIRVANQ ............................ 6 flavoxate ............................. 39 flecainide ............................ 14 FLOVENT DISKUS ........... 38 FLOVENT HFA ................. 38 FLUAD 2020-2021 (65 YR

UP)(PF) .......................... 28 FLUAD QUAD 2020-21(65Y

UP)(PF) .......................... 28 FLUARIX QUAD 2020-2021

(PF) ................................ 28 FLUBLOK QUAD 2020-2021

(PF) ................................ 28 FLUCELVAX QUAD 2020-

2021................................ 28 FLUCELVAX QUAD 2020-

2021 (PF) ........................ 28 fluconazole ........................... 3 fludrocortisone .................... 23 FLULAVAL QUAD 2020-

2021 (PF) ........................ 28 FLUMIST QUAD 2020-2021

....................................... 28 fluocinolone........................ 21 fluocinolone and shower cap 21 fluocinonide ........................ 21 fluocinonide-e ..................... 21 fluocinonide-emollient......... 21 fluorometholone.................. 36 fluorouracil ......................... 18 fluoxetine............................ 12

fluphenazine decanoate........ 12 fluphenazine hcl.................. 12 flurbiprofen......................... 11 flutamide............................... 6 fluticasone propionate ....21, 38 fluticasone pr opion-salmeterol

....................................... 38 FLUTICASONE PROPION-

SALMETEROL .............. 38 fluvoxamine ........................ 12 FLUZONE HIGHDOSE

QUAD 20-21 PF ............. 28 FLUZONE QUAD 2020-2021

....................................... 29 FLUZONE QUAD 2020-2021

(PF) ................................ 29 folic acid............................. 40 FORA GTEL KETONE TEST

STRIP............................. 24 fosinopril ............................ 15 fosinopril-hydrochlorothiazide

....................................... 15 FREESTYLE FREEDOM

LITE............................... 24 FREESTYLE INSULINX ... 24 FREESTYLE INSULINX

TEST STRIPS................. 24 FREESTYLE LITE STRIPS 24 FREESTYLE TEST ............ 24 furosemide .......................... 15 fyavolv ............................... 31 FYCOMPA........................... 8 G g tussin ac ........................... 37gabapentin ............................ 8 galantamine........................... 9 GARDASIL 9 (PF) ............. 29 gavilyte-c............................ 26 gavilyte-g............................ 26 gavilyte-n............................ 26 gemfibrozil ......................... 17 generlac .............................. 26 gengraf ................................ . 6 gentak................................ . 35 gentamicin ..................... 20, 35 GENVOYA .......................... 3 gianvi (28) .......................... 32

GILENYA ............................ 9 GILOTRIF............................ 6 glatiramer ............................. 9 glatopa .................................. 9 glimepiride.......................... 24 glipizide.............................. 24 glipizide-metformin............. 24 GLUCAGEN HYPOKIT..... 24 GLUCAGON (HCL)

EMERGENCY KIT......... 24 GLUCAGON EMERGENCY

KIT (HUMAN) ............... 24 glyburide............................. 24 glyburide micronized........... 24 glyburide-metformin ........... 24 glycopyrrolate ..................... 26 GOLYTELY ....................... 26 granisetron hcl .................... 26 griseofulvin microsize ........... 3 griseofulvin ultramicrosize .... 3 guaiatussin ac...................... 37 guaifenesin ac ..................... 37 guaifenesin dac ................... 37 guanfacine ..................... 13, 15 H hailey 24 fe ......................... 32 hailey fe 1.5/30 (28) ............ 32 hailey fe 1/20 (28) ............... 32 haloperidol.......................... 13 haloperidol decanoate.......... 13 haloperidol lactate ............... 13 HAVRIX (PF)..................... 29 heather................................ 31 heparin (porcine) ................. 17 heparin, porcine (pf) ............ 17 HEPLISAV-B (PF) ............. 29 HIBERIX (PF) .................... 29 homatropaire ....................... 35 HUMULIN 70/30 U-100

INSULIN ........................ 24 HUMULIN 70/30 U-100

KWIKPEN...................... 24 HUMULIN N NPH INSULIN

KWIKPEN...................... 24 HUMULIN N NPH U-100

INSULIN ........................ 24



45

HUMULIN R REGULAR U-100 INSULN................... 24

HUMULIN R U-500 (CONC) INSULIN ........................ 24

HUMULIN R U-500 (CONC) KWIKPEN...................... 24

hydralazine ......................... 15 hydrochlorothiazide............. 15 hydrocodone-acetaminophen 10 hydrocodone-homatropine ... 37 HYDROCODONE-

HOMATROPINE............ 37 hydrocodone-ibuprofen ....... 10 hydrocortisone ......... 21, 23, 26 hydrocortisone butyrate ....... 21 hydrocortisone but yr-emollient

....................................... 21 hydrocortisone valerate........ 22 hydrocortisone-acetic acid ... 23 hydromet............................. 37 hydromorphone................... 10 hydroxychloroquine .............. 4 hydroxyurea .......................... 6 hydroxyzine hcl................... 37 hydroxyzine pamoate .......... 37 hyoscyamine sulfate ............ 26 I ibandronate ......................... 30 IBRANCE ............................ 6 ibu ...................................... 11 ibuprofen ............................ 11 imatinib ................................ 6 IMBRUVICA ....................... 6 imipramine hcl .................... 13 imipramine pamoate ............ 13 imiquimod .......................... 18 incassia ............................... 31 indapamide ......................... 15 INFANRIX (DTAP) (PF).... 29 INLYTA............................... 6 INTRON A......................... 28 introvale.............................. 32 INVEGA SUSTENNA ........ 13 INVEGA TRINZA.............. 13 INVOKAMET.................... 24 IPOL................................... 29 ipratropium bromide....... 22, 38

ipratropium-albuterol........... 38 irbesartan ............................ 15 irbesartan-hydrochlorothiazide

....................................... 15 ISENTRESS ......................... 3 isibloom.............................. 32 isoniazid ............................... 5 isosorbide dinitrate .............. 18 isosorbide mononitrate ........ 18 ivermect in ............................. 5 J JAKAFI................................ 6 jantoven.............................. 17 jasmiel (28) ......................... 32 jencycla .............................. 31 jinteli .................................. 31 jolessa................................ . 32 juleber ................................ 32 junel 1.5/30 (21).................. 32 junel 1/20 (21)..................... 32 junel fe 1.5/30 (28).............. 32 junel fe 1/20 (28)................. 32 junel fe 24........................... 32 JYNARQUE....................... 25 K kaitlib fe ............................. 32 KALYDECO ...................... 38 kariva (28) .......................... 32 kelnor 1/35 (28)................... 33 kelnor 1-50 ......................... 33 ketoconazole .................... 3, 20ketoprofen........................... 11 ketorolac .................. 11, 35, 36 KEVZARA......................... 30 KINRIX (PF) ...................... 29 kionex (with sorbitol) .......... 22 klor-con 10 ......................... 39 klor-con 8 ........................... 39 klor-con m10....................... 39 klor-con m15....................... 39 klor-con m20....................... 40 klor-con/ef .......................... 40 KOSHER PRENATAL PLUS

IRON.............................. 40 kurvelo (28) ........................ 33 KUVAN ............................. 25

L l norgest/e.estradiol-e.estrad 33 labetalol .............................. 15 lactulose.............................. 26 lamivudine ............................ 3 lamotrigine............................ 8 LANCETS.......................... 24 lansoprazole ........................ 27 larin 1.5/30 (21) .................. 33 larin 1/20 (21) ..................... 33 larin 24 fe ........................... 33 larin fe 1.5/30 (28)............... 33 larin fe 1/20 (28) ................. 33 larissia ................................ 33 latanoprost .......................... 36 LATANOPROST (PF) ........ 36 layolis fe ............................. 33 leena 28 .............................. 33 leflunomide......................... 30 LENVIMA............................ 7 lessina................................ . 33 letrozole................................ 7 leucovorin calcium................ 6 LEUKERAN......................... 7 LEVALBUTEROL

TARTRATE.................... 38 levetiracetam......................... 8 levobunolol ......................... 35 levocetirizine ...................... 37 levofloxacin .......................... 5 levonest (28) ....................... 33 levonorgestrel-ethinyl estrad 33 levonorg-eth estrad triphasic 33 levora-28............................. 33 levothyroxine ...................... 25 levoxyl................................ 25 lidocaine hcl........................ 20 lidocaine viscous ................. 20 lidocaine-prilocaine ............. 20 lillow (28) ........................... 33 lindane ................................ 22 linezolid ................................ 5 liothyronine......................... 25 lisinopril ............................. 15 lisinopril-hydrochlorothiazide

....................................... 15 lithium carbonate................. 13



46

lithium citrate...................... 13 loperamide .......................... 26 lopreeza .............................. 31 lorazepam ........................... 13 lorcet (hydrocodone) ........... 10 lorcet hd.............................. 10 loryna (28) .......................... 33 losartan............................... 15 losartan-hydrochlorothiazide 15 lovastatin ............................ 17 low-ogestrel (28) ................. 33 loxapine succinate ............... 13 lo-zumandimine (28) ........... 33 lutera (28) ........................... 33 LYSODREN......................... 7 lyza..................................... 31 M malathion............................ 22 marlissa (28) ....................... 33 MATULANE........................ 7 matzim la ............................ 15 MAVYRET .......................... 3 meclizine ............................ 26 medroxyprogesterone .......... 31 mefloquine............................ 5 megestrol .............................. 7 MEKINIST ........................... 7 meloxicam .......................... 11 melphalan ............................. 7 memantine ............................ 9 MEMANTINE ...................... 9 MENACTRA (PF) .............. 29 MENVEO A-C-Y-W-135-DIP

(PF) ................................ 29 mercaptopurine ..................... 7 mesalamine ......................... 26 metadate er ......................... 13 metaproterenol .................... 38 metformin........................... 24 methadone .......................... 10 methadone intensol.............. 10 methazolamide .................... 36 methen-sod phos-meth blue-

hyos ................................ 39 methergine .......................... 34 methimazole........................ 23 methocarbamol...................... 9

methotrexate sodium ............. 7 methyldopa ......................... 15 methylergonovine................ 34 methylphenidate hcl ............ 13 METHYLPHENIDATE HCL

....................................... 13 methylprednisolone ............. 23 metipranolol........................ 35 metoclopramide hcl............. 26 metolazone.......................... 15 metoprolol succinate............ 16 metoprolol t a-hydrochlorothiaz

....................................... 16 metoprolol tartrate............... 16 metronidazole ............ 5, 19, 31metyrosine .......................... 16 microgestin 1.5/30 (21)........ 33 microgestin 1/20 (21) .......... 33 microgestin fe 1.5/30 (28).... 33 microgestin fe 1/20 (28)....... 33 midazolam .......................... 13 midazolam (pf).................... 13 midodrine ........................... 22 migergot ............................... 9 miglitol ............................... 24 mili..................................... 33 mimvey............................... 31 MINITRAN ........................ 18 minocycline .......................... 5 minoxidil ............................ 16 mirtazapine ......................... 13 misoprostol ......................... 27 M-M-R II (PF) .................... 29 m-natal plus ........................ 40 mometasone ........................ 22 mondoxyne nl ....................... 5 mono-linyah........................ 33 montelukast......................... 38 morgidox .............................. 6 morphine........................ 10, 11 morphine concentrate .......... 10 moxifloxacin....................... 35 mupirocin ........................... 20 mycophenolate mofetil .......... 7 mycophenolate sodium.......... 7 MYLERAN .......................... 7 mynatal............................... 40

mynatal advance.................. 40 N nabumetone......................... 11 nadolol................................ 16 naloxone ............................. 11 naltrexone ........................... 11 naproxen............................. 11 naproxen sodium................. 11 naproxen-esomeprazole ....... 11 naratriptan............................. 9 NARCAN........................... 12 NATACYN......................... 35 nateglinide .......................... 24 nebusal ............................... 38 necon 0.5/35 (28) ................ 33 nefazodone.......................... 13 neomycin .............................. 5 neomycin-bacitrac in-poly-hc 36 neomycin-bacitracin-

polymyxin....................... 35 neomycin-polymyxin b -

dexameth......................... 36 neomycin-polymyxin-

gramicidin....................... 35 neomycin-polymyxin-hc.23, 36neo-polycin......................... 35 neo-polycin hc .................... 36 NEULASTA ....................... 28 NEXAVAR........................... 7 NEXIUM 24HR .................. 27 nifedipine............................ 16 nikki (28) ............................ 33 NITRO-DUR ...................... 18 nitrofurantoin ........................ 6 nitrofurantoin macrocrystal.... 6 nitrofurantoin m onohyd/m-

cryst.................................. 6 nitroglycerin........................ 18 nitro-time ............................ 18 nizatidine ............................ 27 nora-be ............................... 31 noreth-ethinyl estradiol-iron 33 norethindrone ( contraceptive)

....................................... 31 norethindrone acetate .......... 31 norethindrone a c-eth estradiol

.................................. 31, 33



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norethindrone-e.estradiol-iron ....................................... 33

norgestimate-ethinyl e stradiol ....................................... 33

norlyda ............................... 31 NORPACE CR ................... 14 nortrel 0.5/35 (28) ............... 33 nortrel 1/35 (21) .................. 33 nortrel 1/35 (28) .................. 33 nortrel 7/7/7 (28) ................. 34 nortriptyline ........................ 13 NORVIR .............................. 3 NOVAMAX PLUS KETONE

....................................... 24 NOVOLIN 70/30 U-100

INSULIN ........................ 24 NOVOLIN 70-30 F LEXPEN

U-100.............................. 24 NOVOLIN N NPH U-100

INSULIN ........................ 24 NOVOLIN R REGULAR U-

100 INSULN................... 24 np thyroid ........................... 25 nyamyc ............................... 20 nystatin ............................ 3, 20 nystop................................ . 20 O ocella .................................. 34 OFEV ................................ . 38 ofloxacin.................... 5, 23, 35olanzapine........................... 13 olmesartan .......................... 16 olmesartan-amlodipin-

hcthiazid ......................... 16 olmesartan-

hydrochlorothiazide ......... 16 OLUMIANT....................... 30 omega-3 ac id ethyl esters..... 17 omeprazole ......................... 27 OMNITROPE..................... 28 ondansetron......................... 27 ondansetron hcl ................... 27 oralone................................ 22 ORILISSA .......................... 25 ORKAMBI ......................... 38 orphenadrine c itrate............... 9 orsythia............................... 34

oscimin ............................... 26 oscimin sl............................ 26 oscimin sr ........................... 26 oseltamivir ............................ 3 OTEZLA ............................ 30 oxandrolone ........................ 25 oxaprozin............................ 12 oxazepam............................ 13 oxcarbazepine ....................... 8 OXTELLAR XR ................... 8 oxybutynin chloride............. 39 oxycodone .......................... 11 oxycodone-acetaminophen .. 11 oxycodone-aspirin ............... 11 oxymorphone ...................... 11 P pacerone ............................. 14 paliperidone ........................ 13 pantoprazole........................ 27 paroex oral rinse.................. 22 paroxetine hcl...................... 13 PEDIARIX (PF).................. 29 PEDVAX HIB (PF)............. 29 peg 3350-electrolytes .......... 27 peg3350-sod s ul-nacl-kcl-asb-c

....................................... 27 PEGANONE......................... 8 PEGASYS .......................... 28 peg-electrolyte soln ............. 27 peg-prep.............................. 27 penicillin v potassium............ 5 PENTACEL (PF)................ 29 PENTACEL ACTHIB

COMPONENT (PF) ........ 29 pentoxifylline ...................... 17 periogard............................. 23 permethrin .......................... 22 perphenazine ....................... 13 perphenazine-amitriptyline .. 13 phenazopyridine .................. 39 phenobarbital ........................ 8 phenytoin.............................. 8 phenytoin sodium extended ... 8 philith ................................ . 34 phosphasal .......................... 39 phytonadione (vitamin k1) ... 17 pilocarpine hcl ............... 22, 35

pimozide ............................. 13 pimtrea (28) ........................ 34 pioglitazone ........................ 24 pioglitazone-metformin ....... 25 pirmella .............................. 34 PNEUMOVAX-23.............. 29 pnv 29-1 ............................. 40 podofilox ............................ 18 polycin................................ 35 polyethylene glycol 3350..... 27 polymyxin b sulf-trimethoprim

....................................... 35 portia 28 ............................. 34 potassium chloride .............. 40 potassium citrate ................. 39 pramipexole .......................... 9 prasugrel............................. 17 pravastatin .......................... 17 praziquantel .......................... 5 prazosin .............................. 16 PRECISION XTRA TEST .. 25 prednicarbate ...................... 22 prednisolone........................ 23 prednisolone acetate............ 36 PREDNISOLONE ACETATE

(PF) ................................ 36 prednisolone sodium phos phate

.................................. 23, 36 prednisone .......................... 23 prednisone intensol.............. 23 pregabalin ............................. 8 prenatabs fa......................... 40 prenatabs rx ........................ 40 prenatal low iron ................. 40 prenatal p lus........................ 40 prenatal plus (calcium carb) . 40 prenatal vitamin plus low iron

....................................... 40 preplus ................................ 40 prevalite.............................. 17 previfem ............................. 34 PREVNAR 13 (PF)............. 29 PRILOSEC OTC................. 27 primidone ............................. 8 probenecid .......................... 30 prochlorperazine maleate..... 27 procto-med hc ..................... 27



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procto-pak........................... 27 proctosol hc ........................ 27 proctozone-hc ..................... 27 progesterone micronized...... 31 PROMACTA...................... 17 promethazine ...................... 37 promethazine vc .................. 37 promethazine-codeine.......... 37 promethazine-dm ................ 37 promethazine-phenyleph-

codeine ........................... 37 promethazine-phenylephrine 37 promethegan ....................... 37 propafenone ........................ 14 propranolol ......................... 16 propylthiouracil................... 23 PROQUAD (PF)................. 29 pulmosal ............................. 38 PULMOZYME................... 38 pyrazinamide ........................ 5 pyridostigmine bromide....9, 10 pyrimethamine ...................... 5 Q QUADRACEL (PF)............ 29 quetiapine ........................... 13 quinapril ............................. 16 quinapril-hydrochlorothiazide

....................................... 16 R raloxifene............................ 30 ramipril............................... 16 ranitidine hcl....................... 27 ranolazine ........................... 18 REBIF (WITH ALBUMIN). 28 REBIF REBIDOSE............. 28 reclipsen (28) ...................... 34 RECOMBIVAX HB (PF).... 29 RELEXXII.......................... 13 repaglinide .......................... 25 REPATHA PUSHTRONEX 17 REVLIMID........................... 7 ribavirin................................ 3 rifabutin ................................ 5 rifampin................................ 5 rimantadine ........................... 3 RISPERDAL CONSTA....... 14 risperidone .......................... 14

ritonavir ................................ 3 rivastigmine tartrate............... 9 rizatriptan ............................. 9 ropinirole .............................. 9 rosadan ............................... 19 rosuvastatin ......................... 17 ROTARIX .......................... 29 ROTATEQ VACCINE........ 29 roweepra............................... 8 roweepra xr........................... 8 RYBELSUS........................ 25 S salicylic acid ....................... 18 SAMSCA ........................... 25 SANTYL ............................ 22 SEGLUROMET.................. 25 selegiline hcl......................... 9 se-natal 19 chewable ........... 40 SEREVENT DISKUS ......... 38 sertraline ............................. 14 setlakin ............................... 34 sf 5000 plus......................... 23 sharobel .............................. 31 SHINGRIX (PF) ................. 29 sildenafil ( pulm.hypertension)

....................................... 38 SILIQ ................................ . 18 silver sulfadiazine ............... 18 simliya (28)......................... 34 simpesse ............................. 34 simvastatin .......................... 17 sirolimus ............................... 7 sodium chloride................... 38 sodium fluoride 5000 plus ... 23 sodium polystyrene (sorb free)

....................................... 22 sodium polystyrene s ulfonate

....................................... 22 SOFOSBUVIR-

VELPATASVIR ............... 3 SOLIQUA 100/33 ............... 25 sorine.................................. 14 sotalol................................ . 14 sotalol af ............................. 14 spinosad.............................. 22 SPIRIVA RESPIMAT......... 38 spironolactone..................... 16

spironolacton-hydrochlorothiaz ....................................... 16

sprintec (28)........................ 34 sps (with sorbitol)................ 22 sronyx................................ . 34 ssd ...................................... 18 SSKI................................... 23 sss 10-5............................... 19 STEGLATRO ..................... 25 STIOLTO RESPIMAT........ 38 STRIVERDI RESPIMAT.... 38 subvenite............................... 8 sucralfate ............................ 28 sulfacetamide sodium .......... 36 sulfacetamide sodium (acne) 20 sulfacetamide sodium-sulfur 19 sulfacetamide-prednisolone . 36 sulfacleanse 8-4................... 19 sulfadiazine........................... 5 sulfamethoxazole-trimethoprim

......................................... 5 sulfasalazine........................ 27 sulfatrim ............................... 5 sulindac .............................. 12 sumatriptan ........................... 9 sumatriptan succinate ............ 9 SUTENT............................... 7 syeda .................................. 34 symax-sr ............................. 26 SYMFI LO ........................... 3 SYMLINPEN 120............... 25 SYMLINPEN 60................. 25 SYNAGIS............................. 3 SYNAREL.......................... 25 SYNTHROID ..................... 25 T tacrolimus ........................ 7, 18 TAFINLAR .......................... 7 tamoxifen.............................. 7 tamsulosin........................... 39 tarina 24 fe.......................... 34 tarina fe 1/20 (28)................ 34 tarina fe 1-20 eq (28) ........... 34 taztia xt ............................... 16 TDVAX.............................. 29 TECFIDERA ........................ 9 telmisartan .......................... 16



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telmisartan-amlodipine ........ 16 telmisartan-hydrochlorothiazid

....................................... 16 temozolomide ....................... 7 TENIVAC (PF)................... 29 tenofovir disoproxil fumarate. 3 terazosin ............................. 16 terbinafine hcl ....................... 3 terbutaline ........................... 38 terconazole.......................... 31 testosterone ......................... 25 TETANUS,DIPHTHERIA

TOX PED(PF)................. 29 tetracycline ........................... 6 THALOMID......................... 7 THEO-24............................ 38 theochron............................ 39 theophylline ........................ 39 thioridazine ......................... 14 thiothixene .......................... 14 THRIVITE RX ................... 40 thyroid (pork)...................... 25 tiagabine ............................... 8 tilia fe ................................ . 34 timolol maleate ................... 35 TIMOPTIC OCUDOSE (PF)

....................................... 35 tizanidine ............................ 10 tobramycin.......................... 35 tobramycin in 0.225 % nacl ... 5 TOBRAMYCIN WITH

NEBULIZER .................... 5 tobramycin-dexamethasone . 36 tolterodine........................... 39 topiramate............................. 8 torsemide ............................ 16 tramadol.............................. 12 tramadol-acetaminophen...... 12 trandolapril ......................... 16 tranylcypromine .................. 14 trazodone ............................ 14 TRELEGY ELLIPTA.......... 39 tretinoin .............................. 19 tretinoin (antineoplastic) ........ 7 TRETIN-X.......................... 20 TREXALL ............................ 7 tri femynor .......................... 34

triamcinolone acetonide..22, 23 triamterene-hydrochlorothiazid

....................................... 16 triazolam............................. 14 TRICARE........................... 40 triderm................................ 22 tri-estarylla.......................... 34 trifluoperazine..................... 14 trifluridine........................... 35 TRIGLIDE.......................... 17 trihexyphenidyl ..................... 9 TRIKAFTA ........................ 39 tri-legest fe.......................... 34 tri-linyah............................. 34 tri-lo-estarylla ..................... 34 tri-lo-marzia ........................ 34 tri-lo-mili ............................ 34 tri-lo-sprintec ...................... 34 trilyte with flavor packets .... 27 trimethobenzamide .............. 27 trimethoprim ......................... 6 tri-mili ................................ 34 trimipramine ....................... 14 trinatal rx 1 ......................... 40 tri-previfem (28).................. 34 tri-sprintec (28) ................... 34 TRIUMEQ............................ 3 trivora (28).......................... 34 tri-vylibra............................ 34 tri-vylibra lo ........................ 34 tropicamide ......................... 35 trospium.............................. 39 TRULICITY ....................... 25 TRUMENBA...................... 29 TRUVADA........................... 3 tulana.................................. 31 TWINRIX (PF) ................... 29 TYKERB.............................. 7 U unithroid ............................. 25 urea .................................... 19 uretron d-s........................... 39 urin ds................................ . 39 uro-458 ............................... 39 ursodiol............................... 27 uryl..................................... 39 ustell................................... 39

utira-c ................................ . 39 V valacyclovir .......................... 3 valproic acid ......................... 8 valproic acid (as sodium salt). 8 valsartan ............................. 16 valsartan-hydrochlorothiazide

....................................... 16 vandazole............................ 31 VAQTA (PF)...................... 29 VARIVAX (PF).................. 29 VARIZIG ........................... 29 velivet triphasic r egimen (28)

....................................... 34 venlafaxine ......................... 14 verapamil............................ 16 vienva ................................ . 34 vilevev mb .......................... 39 VIMPAT .............................. 8 VIOKACE.......................... 27 viorele (28) ......................... 34 VIREAD............................... 4 virtussin ac.......................... 37 virtussin dac........................ 37 vitamin d2........................... 40 VIVITROL......................... 12 voriconazole.......................... 3 VOTRIENT .......................... 7 vyfemla (28) ....................... 34 vylibra ................................ 34 W warfarin .............................. 17 wera (28) ............................ 34 wymzya fe .......................... 34 X XARELTO ......................... 17 XARELTO DVT-PE TREAT

30D START .................... 17 XELJANZ .......................... 30 XELJANZ XR .................... 30 xulane ................................ . 31 Z zarah................................... 34 ZARXIO............................. 28 zebutal ................................ 11 ZELBORAF ......................... 7 ZENZEDI ........................... 14



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zidovudine ............................ 4 ziprasidone hcl .................... 14 ZOLINZA............................. 7

GA-MMED-1618b-V.7

zolmitriptan........................... 9 zolpidem............................. 14 zonisamide............................ 8

ZOSTAVAX (PF) ............... 29 zovia 1/35e (28) .................. 34 zumandimine (28) ............... 34

DCH Approved: 6/18/2020

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