AULTCARE Formulary

Transcription

1 2019 Formulary AultCare's formulary is designed to provide value. Only speci ic drugs in each therapeutic class are covered. The formulary design provides adequate options in each therapeut c category and incꢂudes most generics and seꢂected brandsꢃ Med cations not listed on our ormulary are not covered under the planꢃ Certa n med cations may be covered under medical, require pr or author zat on, have step therapyꢄ and/or may have plan limitationsꢃ Prior authorization may ꢂimit the number of days suppꢂy or certain medicationsꢅ Med cations not on our formuꢂary must meet criter a through an exception process n order to be considered for coverage under plan benefits. Please refer to the Pharmacy Summary of Benefits to review co-pays/coinsurance. You can v sit the AultCare webs te at wwwꢅauꢂtcare.com or call the AuꢂtCare Serv ce Center at 330ꢆ or 1ꢆ800ꢆ344ꢇ8858 or any quest ons regarding these processesꢅ All medications listed are coveredꢈ Members pay ꢉ00% up to the deductible and may be subject to coinsurance until the outꢇofꢇpocket maximums are sat sfiedꢈ ꢊlease refer to your prescription drug Summary of Benef ts for plan specifics. 2036/18 AULTCARE

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3 Alphabetical Listing A abacavir oral solution 20 mg/ml abacavir oral tablet 300 mg abacavir-lamivudine oral tablet mg abacavir-lamivudine-zidovudine oral tablet mg ABREVA TOPICAL CREAM 10 % acamprosate oral tablet,delayed release (dr/ec) 333 mg acarbose oral tablet 100 mg, 25 mg, 50 mg acebutolol oral capsule 200 mg, 400 mg acetaminophen-codeine oral solution mg/5 ml (QL) acetaminophen-codeine oral tablet mg, mg, mg (QL) acetazolamide oral capsule, extended release 500 mg acetazolamide oral tablet 125 mg, 250 mg acetazolamide sodium injection recon soln 500 mg acetic acid otic (ear) solution 2 % acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %) acid reducer (omeprazole) oral capsule,delayed release(dr/ec) 20 mg acitretin oral capsule 10 mg, 17.5 mg, 25 mg ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 400 MG/20 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML) (PA) ACTEMRA SUBCUTANEOUS SYRINGE 162 MG/0.9 ML (PA) ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML (PA) acyclovir oral capsule 200 mg acyclovir oral suspension 200 mg/5 ml acyclovir oral tablet 400 mg, 800 mg acyclovir topical ointment 5 % (QL) adapalene topical cream 0.1 % adapalene topical gel 0.1 %, 0.3 % adapalene topical gel with pump 0.3 % adapalene-benzoyl peroxide topical gel with pump % ADCIRCA ORAL TABLET 20 MG (QL) adefovir oral tablet 10 mg (PA) ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG (PA, QL) afeditab cr oral tablet extended release 30 mg, 60 mg AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG (QL) AFLURIA (PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)/0.5 ML AFLURIA INTRAMUSCULAR SUSPENSION 45 MCG (15 MCG X 3)/0.5 ML AFLURIA QUAD (PF) INTRAMUSCULAR SYRINGE 60 MCG/0.5 ML AFLURIA QUAD INTRAMUSCULAR SUSPENSION 60 MCG/0.5 ML AGONEAZE TOPICAL KIT % ak-poly-bac ophthalmic (eye) ointment ,000 unit/gram AKYNZEO (NETUPITANT) ORAL CAPSULE MG (PA, QL) ALAVERT ORAL TABLET,DISINTEGRATING 10 MG albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml, 5 mg/ml albuterol sulfate oral syrup 2 mg/5 ml albuterol sulfate oral tablet 2 mg, 4 mg alclometasone topical cream 0.05 % alclometasone topical ointment 0.05 % alendronate oral tablet 10 mg, 35 mg, 5 mg, 70 mg (QL) alendronate oral tablet 40 mg (QL) alfuzosin oral tablet extended release 24 hr 10 mg ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML ALINIA ORAL TABLET 500 MG ALL DAY ALLERGY (CETIRIZINE) ORAL CAPSULE 10 MG ALL DAY ALLERGY (CETIRIZINE) ORAL SOLUTION 1 MG/ML ALL DAY ALLERGY (CETIRIZINE) ORAL TABLET 10 MG ALL DAY ALLERGY RELIEF(CETIR) ORAL TABLET 10 MG ALLERCLEAR ORAL TABLET 10 MG ALLERGY RELIEF (CETIRIZINE) ORAL CAPSULE 10 MG ALLERGY RELIEF (CETIRIZINE) ORAL SOLUTION 1 MG/ML ALLERGY RELIEF (CETIRIZINE) ORAL TABLET 10 MG ALLERGY RELIEF (LORATADINE) ORAL SOLUTION 5 MG/5 ML ALLERGY RELIEF (LORATADINE) ORAL TABLET 10 MG ALLERGY RELIEF (LORATADINE) ORAL TABLET,DISINTEGRATING 10 MG ALLER-TEC ORAL TABLET 10 MG ALLERGY RELIEF (FLUTICASONE) NASAL SPRAY,SUSPENSION 50 MCG/ACTUATION (QL) allopurinol oral tablet 100 mg, 300 mg almotriptan malate oral tablet 12.5 mg, 6.25 mg (QL) ALOCRIL OPHTHALMIC (EYE) DROPS 2 % ALOMIDE OPHTHALMIC (EYE) DROPS 0.1 % alophen oral tablet,delayed release (dr/ec) 5 mg alosetron oral tablet 0.5 mg, 1 mg alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg ALREX OPHTHALMIC (EYE) DROPS,SUSPENSION 0.2 % (ST) ALTABAX TOPICAL OINTMENT 1 % altavera (28) oral tablet mg alyacen 1/35 (28) oral tablet 1-35 mg-mcg alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg amantadine hcl oral capsule 100 mg amantadine hcl oral solution 50 mg/5 ml amantadine hcl oral tablet 100 mg AMBISOME INTRAVENOUS SUSPENSION FOR RECONSTITUTION 50 MG amcinonide topical cream 0.1 % (ST) amethia lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) amethia oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) amethyst oral tablet mcg amiloride oral tablet 5 mg amiodarone oral tablet 200 mg AMITIZA ORAL CAPSULE 24 MCG, 8 MCG amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg amlodipine oral tablet 10 mg, 2.5 mg, 5 mg amlodipine-benazepril oral capsule mg, mg, mg, 5-10 mg, 5-20 mg, 5-40 mg ammonium lactate topical cream 12 % ammonium lactate topical lotion 12 % amnesteem oral capsule 10 mg, 20 mg, 40 mg amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg amoxicillin oral capsule 250 mg, 500 mg amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml amoxicillin oral tablet 875 mg amoxicillin oral tablet,chewable 125 mg, 250 mg amoxicillin-pot clavulanate oral suspension for reconstitution mg/5 ml, mg/5 ml, mg/5 ml amoxicillin-pot clavulanate oral tablet mg, mg, mg amoxicillin-pot clavulanate oral tablet,chewable mg, mg amphotericin b injection recon soln 50 mg ampicillin oral capsule 250 mg, 500 mg ampicillin-sulbactam injection recon soln 3 gram ampicillin-sulbactam intravenous recon soln 3 gram AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR 10 MG (PA, QL) ANADROL-50 ORAL TABLET 50 MG (PA) anagrelide oral capsule 0.5 mg, 1 mg anastrozole oral tablet 1 mg This list is subject to change. For an up-to-date listing please visit Pg. 2

4 Alphabetical Listing ANGELIQ ORAL TABLET MG, MG ANODYNE LPT TOPICAL KIT % ANORO ELLIPTA INHALATION BLISTER WITH DEVICE MCG/ACTUATION (QL) ANZEMET ORAL TABLET 100 MG, 50 MG (QL) APIDRA SOLOSTAR SUBCUTANEOUS INSULIN PEN 100 UNIT/ML APIDRA SUBCUTANEOUS SOLUTION 100 UNIT/ML APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML (PA) apraclonidine ophthalmic (eye) drops 0.5 % aprepitant oral capsule 125 mg, 40 mg, 80 mg aprepitant oral capsule,dose pack 125 mg (1)- 80 mg (2) apri oral tablet mg APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG APTIVUS ORAL CAPSULE 250 MG APTIVUS ORAL SOLUTION 100 MG/ML aranelle (28) oral tablet 0.5/1/ mg-mcg ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 150 MCG/0.75 ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML (PA, QL) ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML (PA) ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 500 MCG/ML, 60 MCG/0.3 ML (PA, QL) ARCALYST SUBCUTANEOUS RECON SOLN 220 MG ARCAPTA NEOHALER INHALATION CAPSULE, W/INHALATION DEVICE 75 MCG (QL) aripiprazole oral solution 1 mg/ml aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg (QL) armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg ARMONAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 113 MCG/ACTUATION, 232 MCG/ACTUATION, 55 MCG/ACTUATION ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION ARTIFICIAL TEARS (PETRO/MIN) OPHTHALMIC (EYE) OINTMENT % ashlyna oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) ASMANEX HFA INHALATION HFA AEROSOL INHALER 100 MCG/ACTUATION, 200 MCG/ACTUATION (QL) ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 110 MCG (7 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES) (QL) adult aspirin regimen oral tablet,delayed release (dr/ec) 81 mg aspir-81 oral tablet,delayed release (dr/ec) 81 mg aspirin low dose oral tablet,delayed release (dr/ec) 81 mg aspirin oral tablet 325 mg aspirin oral tablet,chewable 81 mg aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg aspir-low oral tablet,delayed release (dr/ec) 81 mg aspir-trin oral tablet,delayed release (dr/ec) 325 mg aspirin-dipyridamole oral capsule, er multiphase 12 hr mg atazanavir oral capsule 150 mg, 200 mg, 300 mg (QL) atenolol oral tablet 100 mg, 25 mg, 50 mg atomoxetine oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg (QL) atovaquone oral suspension 750 mg/5 ml atovaquone-proguanil oral tablet mg, mg ATRIPLA ORAL TABLET MG atropine ophthalmic (eye) drops 1 % ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION (QL) AUBAGIO ORAL TABLET 14 MG, 7 MG (QL) aubra oral tablet mg-mcg AVANDIA ORAL TABLET 2 MG, 4 MG (QL) B aviane oral tablet mg-mcg AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT 30 MCG AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML AZASITE OPHTHALMIC (EYE) DROPS 1 % azathioprine oral tablet 50 mg azelastine nasal aerosol,spray 137 mcg (0.1 %) azelastine nasal spray,non-aerosol 0.15 % (205.5 mcg) (ST) azelastine ophthalmic (eye) drops 0.05 % azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml azithromycin oral tablet 250 mg, 500 mg, 600 mg AZOPT OPHTHALMIC (EYE) DROPS,SUSPENSION 1 % azurette (28) oral tablet mgx21 /0.01 mg x 5 b complex-vitamin b12 oral tablet b complex-vitamin c-folic acid oral tablet 400 mcg bacitracin ophthalmic (eye) ointment 500 unit/gram bacitracin-polymyxin b ophthalmic (eye) ointment ,000 unit/gram baclofen oral tablet 10 mg, 20 mg balanced b-100 complex oral tablet extended release 100 mg balanced b-100 oral tablet 0.4 mg balsalazide oral capsule 750 mg balziva (28) oral tablet mg-mcg BANZEL ORAL SUSPENSION 40 MG/ML BANZEL ORAL TABLET 200 MG, 400 MG BASAGLAR KWIKPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML) bayer aspirin oral tablet 325 mg bekyree (28) oral tablet mgx21 /0.01 mg x 5 BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG (QL) BELVIQ ORAL TABLET 10 MG (PA) benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg benzonatate oral capsule 100 mg, 150 mg, 200 mg benztropine oral tablet 0.5 mg, 1 mg, 2 mg BEPREVE OPHTHALMIC (EYE) DROPS 1.5 % (ST) BERINERT INTRAVENOUS KIT 500 UNIT (10 ML) BESIVANCE OPHTHALMIC (EYE) DROPS,SUSPENSION 0.6 % betamethasone dipropionate topical cream 0.05 % betamethasone dipropionate topical lotion 0.05 % betamethasone dipropionate topical ointment 0.05 % betamethasone valerate topical cream 0.1 % betamethasone valerate topical lotion 0.1 % betamethasone valerate topical ointment 0.1 % betamethasone, augmented topical cream 0.05 % betamethasone, augmented topical gel 0.05 % betamethasone, augmented topical lotion 0.05 % betamethasone, augmented topical ointment 0.05 % BETASERON SUBCUTANEOUS KIT 0.3 MG (QL) betaxolol ophthalmic (eye) drops 0.5 % betaxolol oral tablet 10 mg, 20 mg bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg bexarotene oral capsule 75 mg bicalutamide oral tablet 50 mg BILTRICIDE ORAL TABLET 600 MG bimatoprost ophthalmic (eye) drops 0.03 % (ST) bisacodyl oral tablet,delayed release (dr/ec) 5 mg bisa-lax oral tablet,delayed release (dr/ec) 5 mg Pg. 3 This list is subject to change. For an up-to-date listing please visit

5 Alphabetical Listing C bisoprolol fumarate oral tablet 10 mg, 5 mg bisoprolol-hydrochlorothiazide oral tablet mg, mg, mg blisovi 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) blisovi fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) BREO ELLIPTA INHALATION BLISTER WITH DEVICE MCG/DOSE, MCG/DOSE (QL) briellyn oral tablet mg-mcg BRILINTA ORAL TABLET 60 MG, 90 MG brimonidine ophthalmic (eye) drops 0.15 %, 0.2 % bromfenac ophthalmic (eye) drops 0.09 % bromocriptine oral capsule 5 mg bromocriptine oral tablet 2.5 mg BROVANA INHALATION SOLUTION FOR NEBULIZATION 15 MCG/2 ML (QL) budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml (QL) budesonide inhalation suspension for nebulization 1 mg/2 ml budesonide nasal spray,non-aerosol 32 mcg/actuation budesonide oral capsule,delayed,extend.release 3 mg bumetanide oral tablet 0.5 mg, 1 mg, 2 mg buprenorphine hcl sublingual tablet 2 mg, 8 mg BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 10 MCG/HOUR, 15 MCG/HOUR, 20 MCG/HOUR, 5 MCG/HOUR, 7.5 MCG/HOUR (QL) buprenorphine-naloxone sublingual tablet mg, 8-2 mg (QL) bupropion hcl oral tablet 100 mg, 75 mg bupropion hcl oral tablet extended release 12 hr 100 mg, 150 mg, 200 mg (QL) bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg (QL) buspirone oral tablet 10 mg, 15 mg, 5 mg butalbital-acetaminop-caf-cod oral capsule mg (QL) butalbital-acetaminophen oral tablet mg butalbital-acetaminophen-caff oral tablet mg butorphanol tartrate nasal spray,non-aerosol 10 mg/ml (QL) BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HOUR, 15 MCG/HOUR, 20 MCG/HOUR, 5 MCG/HOUR, 7.5 MCG/HOUR (QL) BYDUREON BCISE SUBCUTANEOUS AUTO-INJECTOR 2 MG/0.85 ML BYDUREON SUBCUTANEOUS PEN INJECTOR 2 MG/0.65 ML (QL) BYDUREON SUBCUTANEOUS SUSPENSION,EXTENDED REL RECON 2 MG (QL) BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML (QL) BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG b-complex with vitamin c oral tablet, mcg-mg cabergoline oral tablet 0.5 mg (QL) calcipotriene scalp solution % calcipotriene topical ointment % calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation CALCITRATE-VITAMIN D ORAL TABLET MG-UNIT calcitriol oral capsule 0.25 mcg, 0.5 mcg calcitriol oral solution 1 mcg/ml calcitriol topical ointment 3 mcg/gram calcium d oral tablet,chewable 500 mg(1,250mg) -400 unit calcium 500 with d oral tablet 500 mg(1,250mg) -400 unit calcium d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit calcium 600 with vitamin d3 oral capsule 600 mg(1,500mg) -400 unit calcium acetate oral capsule 667 mg calcium acetate oral tablet 667 mg calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) unit, 600 mg(1,500mg) -400 unit, 600 mg(1,500mg) -800 unit calcium citrate-vitamin d2 oral tablet 1, mg-unit calcium citrate-vitamin d3 oral tablet mg-unit camila oral tablet 0.35 mg camrese lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) camrese oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) candesartan oral tablet 16mg, 32mg, 4mg, 8mg capecitabine oral tablet 150 mg, 500 mg (QL) CAPRELSA ORAL TABLET 100 MG, 300 MG (QL) captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg CARAFATE ORAL SUSPENSION 100 MG/ML CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg carbamazepine oral suspension 100 mg/5 ml carbamazepine oral tablet 200 mg carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 mg carbamazepine oral tablet,chewable 100 mg carbidopa oral tablet 25 mg carbidopa-levodopa oral tablet mg, mg, mg carbidopa-levodopa oral tablet extended release mg, mg carbidopa-levodopa oral tablet,disintegrating mg, mg, mg carbidopa-levodopa-entacapone oral tablet mg, mg, mg, mg, mg, mg carbinoxamine maleate oral liquid 4 mg/5 ml carbinoxamine maleate oral tablet 4 mg, 6 mg carisoprodol oral tablet 350 mg carteolol ophthalmic (eye) drops 1 % cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg carvedilol oral tablet 12.5 mg, 25 mg, mg, 6.25 mg carvedilol phosphate oral capsule, er multiphase 24 hr 10 mg, 20 mg, 40 mg, 80 mg CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML (QL) caziant (28) oral tablet 0.1/.125/ mg-mcg cefaclor oral capsule 250 mg, 500 mg cefaclor oral suspension for reconstitution 250 mg/5 ml cefadroxil oral capsule 500 mg cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml cefdinir oral capsule 300 mg cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cefditoren pivoxil oral tablet 200 mg, 400 mg cefixime oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml cefotaxime injection recon soln 10 gram, 500 mg cefoxitin intravenous recon soln 10 gram cefpodoxime oral suspension for reconstitution 100 mg/5 ml, 50 mg/5 ml cefpodoxime oral tablet 100 mg, 200 mg cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cefprozil oral tablet 250 mg, 500 mg ceftriaxone injection recon soln 10 gram, 250 mg CEFTRIAXONE INJECTION RECON SOLN 100 GRAM cefuroxime axetil oral tablet 250 mg, 500 mg celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg CELONTIN ORAL CAPSULE 300 MG cephalexin oral capsule 250 mg, 500 mg cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml CERDELGA ORAL CAPSULE 84 MG (PA) CESAMET ORAL CAPSULE 1 MG cetirizine oral solution 1 mg/ml, 5 mg/5 ml cetirizine oral tablet 10mg, 5 mg This list is subject to change. For an up-to-date listing please visit Pg. 4

6 Alphabetical Listing cetirizine oral tablet,chewable 10 mg, 5 mg CETROTIDE SUBCUTANEOUS KIT 0.25 MG cevimeline oral capsule 30 mg CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG (ST) CHANTIX ORAL TABLET 0.5 MG, 1 MG (ST) CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42) (ST) chateal oral tablet mg CHEMET ORAL CAPSULE 100 MG CHILD ALLERGY RELF(CETIRIZINE) ORAL SOLUTION 1 MG/ML CHILDREN'S ALLERGY RELIEF(LOR) ORAL SOLUTION 5 MG/5 ML CHILDREN'S ALLERGY(CETIRIZINE) ORAL SOLUTION 1 MG/ML CHILDREN'S ALLER-TEC ORAL SOLUTION 1 MG/ML children's aspirin oral tablet,chewable 81 mg CHILDREN'S CETIRIZINE ORAL SOLUTION 1 MG/ML CHILDREN'S CETIRIZINE ORAL TABLET,CHEWABLE 10 MG, 5 MG CHILDREN'S FLONASE ALLERGY RLF NASAL SPRAY,SUSPENSION 50 MCG/ACTUATION (QL) CHILDREN'S FLONASE SENSIMIST NASAL SPRAY,SUSPENSION 27.5 MCG/ACTUATION CHILDREN'S NASACORT NASAL AEROSOL,SPRAY 55 MCG CHILDREN'S WAL-ZYR ORAL SOLUTION 1 MG/ML CHILDREN'S WAL-ZYR ORAL TABLET,CHEWABLE 10 MG CHILD'S ALL DAY ALLERGY(CETIR) ORAL SOLUTION 1 MG/ML chlorhexidine gluconate mucous membrane mouthwash 0.12 % chloroquine phosphate oral tablet 250 mg, 500 mg chlorothiazide oral tablet 250 mg, 500 mg chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg chlorpropamide oral tablet 100 mg, 250 mg chlorthalidone oral tablet 25 mg, 50 mg chlorzoxazone oral tablet 250mmg, 500 mg CHOLBAM ORAL CAPSULE 250 MG CHOLBAM ORAL CAPSULE 50 MG (QL) cholecalciferol (vitamin d3) oral capsule 1,000 unit cholecalciferol (vitamin d3) oral drops 400 unit/ml cholecalciferol (vitamin d3) oral tablet 1,000 unit cholestyramine (with sugar) oral powder 4 gram cholestyramine (with sugar) oral powder in packet 4 gram cholestyramine light oral powder 4 gram cholestyramine light oral powder in packet 4 gram CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR RECON SOLN 10,000 UNIT (PA, QL) CIALIS ORAL TABLET 2.5 MG, 5 MG (PA, QL) ciclopirox topical cream 0.77 % ciclopirox topical gel 0.77 % ciclopirox topical shampoo 1 % ciclopirox topical solution 8 % ciclopirox topical suspension 0.77 % ciclopirox-ure-camph-menth-euc topical solution 8 % cilostazol oral tablet 100 mg, 50 mg cimetidine hcl oral solution 300 mg/5 ml cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS) (PA, QL) CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2) (PA, QL) CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML) CIPRO HC OTIC (EAR) DROPS,SUSPENSION % CIPRODEX OTIC (EAR) DROPS,SUSPENSION % ciprofloxacin hcl ophthalmic (eye) drops 0.3 % ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg citalopram oral solution 10 mg/5 ml citalopram oral tablet 10 mg, 20 mg, 40 mg (QL) citrate of magnesia oral solution citrus calcium oral tablet 200 mg calcium -250 unit, mg-unit citroma oral solution claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg CLARISPRAY NASAL SPRAY,SUSPENSION 50 MCG/ACTUATION (QL) clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml clarithromycin oral tablet 250 mg, 500 mg clarithromycin oral tablet extended release 24 hr 500 mg CLARITIN ORAL TABLET 10 MG classic prenatal oral tablet 28 mg iron- 800 mcg cleansing wash topical cleanser % clearlax oral powder 17 gram/dose clearlax oral powder in packet 17 gram clemastine oral tablet 2.68 mg clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg clindamycin palmitate hcl oral recon soln 75 mg/5 ml clindamycin pediatric oral recon soln 75 mg/5 ml clindamycin phosphate topical gel 1 % clindamycin phosphate topical lotion 1 % clindamycin phosphate topical solution 1 % clindamycin phosphate topical swab 1 % clindamycin phosphate vaginal cream 2 % clindamycin-benzoyl peroxide topical gel 1-5 %, 1.2 %(1 % base) -5 % clindamycin-tretinoin topical gel % CLINPRO 5000 DENTAL PASTE 1.1 % clobetasol scalp solution 0.05 % (QL) clobetasol topical cream 0.05 % (QL) clobetasol topical foam 0.05 % (QL) clobetasol topical gel 0.05 %(QL) clobetasol topical lotion 0.05 % (QL) clobetasol topical ointment 0.05 % (QL) clobetasol topical shampoo 0.05 % (QL) clobetasol-emollient topical cream 0.05 % (QL) clobetasol-emollient topical foam 0.05 % (QL) CLOCORTOLONE PIVALATE TOPICAL CREAM 0.1 % clomiphene citrate oral tablet 50 mg clomipramine oral capsule 25 mg, 50 mg, 75 mg clonazepam oral tablet 0.5 mg, 1 mg, 2 mg clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr (QL) clopidogrel oral tablet 300 mg, 75 mg clotrimazole mucous membrane troche 10 mg clotrimazole topical cream 1 % clotrimazole topical solution 1 % clotrimazole-betamethasone topical cream % clotrimazole-betamethasone topical lotion % clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg COARTEM ORAL TABLET MG codeine sulfate oral tablet 15 mg, 30 mg, 60 mg (QL) COLCHICINE ORAL CAPSULE 0.6 MG COLCHICINE ORAL TABLET 0.6 MG colesevelam oral powder in packet 3.75 gram colestipol oral granules 5 gram colestipol oral packet 5 gram colestipol oral tablet 1 gram Pg. 5 This list is subject to change. For an up-to-date listing please visit

7 Alphabetical Listing D colocort rectal enema 100 mg/60 ml COLY-MYCIN S OTIC (EAR) DROPS,SUSPENSION MG/ML COMBIGAN OPHTHALMIC (EYE) DROPS % (ST) COMBIVENT RESPIMAT INHALATION MIST MCG/ACTUATION (QL) complete natal dha oral combo pack mg completenate oral tablet,chewable 29 mg iron- 1 mg complex b-100 oral tablet extended release compro rectal suppository 25 mg constulose oral solution 10 gram/15 ml CONTRAVE ORAL TABLET EXTENDED RELEASE 8-90 MG (PA) CORLANOR ORAL TABLET 5 MG, 7.5 MG cortisone oral tablet 25 mg CORTISPORIN TOPICAL CREAM , MG/G-UNIT/G-% CORTISPORIN TOPICAL OINTMENT 1 % corvita 150 oral tablet mg corvita oral tablet mg COSENTYX (2 SYRINGES) SUBCUTANEOUS SYRINGE 150 MG/ML (PA, QL) COSENTYX PEN (2 PENS) SUBCUTANEOUS PEN INJECTOR 150 MG/ML (PA, QL) COSENTYX PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML (PA, QL) COSENTYX SUBCUTANEOUS SYRINGE 150 MG/ML (PA, QL) CRESEMBA ORAL CAPSULE 186MG (PA) CRIXIVAN ORAL CAPSULE 200 MG, 400 MG cromolyn inhalation solution for nebulization 20 mg/2 ml cromolyn ophthalmic (eye) drops 4 % cromolyn oral concentrate 100 mg/5 ml cryselle (28) oral tablet mg-mcg curity sterile water irrigation solution cyclafem 1/35 (28) oral tablet 1-35 mg-mcg cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg cyclobenzaprine oral tablet 10 mg, 5 mg cyclophosphamide oral capsule 25 mg, 50 mg CYCLOSERINE ORAL CAPSULE 250 MG CYCLOSET ORAL TABLET 0.8 MG cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg cyclosporine modified oral solution 100 mg/ml cyclosporine oral capsule 100 mg, 25 mg CYCLOTENS REFILL COMBO PACK 10 MG CYCLOTENS STARTER COMBO PACK 10 MG cyproheptadine oral syrup 2 mg/5 ml cyproheptadine oral tablet 4 mg cyred oral tablet mg CYSTADANE ORAL POWDER 1 GRAM/1.7 ML CYSTAGON ORAL CAPSULE 150 MG, 50 MG (PA) D3-50 CHOLECALCIFEROL ORAL CAPSULE 50,000 UNIT DALIRESP ORAL TABLET 250 MCG, 500 MCG danazol oral capsule 100 mg, 200 mg, 50 mg dantrolene oral capsule 100 mg, 25 mg, 50 mg dapsone oral tablet 100 mg, 25 mg darifenacin oral tablet extended release 24 hr 15 mg, 7.5 mg dasetta 1/35 (28) oral tablet 1-35 mg-mcg dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg daysee oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) DAYTRANA TRANSDERMAL PATCH 24 HOUR 10 MG/9 HR, 15 MG/9 HR, 20 MG/9 HR, 30 MG/9 HR (QL) DEBACTEROL MUCOUS MEMBRANE SOLUTION % deblitane oral tablet 0.35 mg DECARA ORAL CAPSULE 25,000 UNIT, 50,000 UNIT delta d3 oral tablet 400 unit deltasone oral tablet 20 mg delyla (28) oral tablet mg-mcg demeclocycline oral tablet 150 mg, 300 mg DENAVIR TOPICAL CREAM 1 % (ST) denta 5000 plus dental cream 1.1 % dentagel dental gel 1.1 % DEPEN TITRATABS ORAL TABLET 250 MG DEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MG/ML DERMACINRX PUREFOLIX ORAL TABLET 5,000 UNIT- 1 MG DERMACINRX EMPRICAINE TOPICAL KIT % DERMACINRX SILAZONE TOPICAL KIT 0.1 % DESCOVY ORAL TABLET MG desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg desloratadine oral tablet 5 mg (QL) desloratadine oral tablet,disintegrating 2.5 mg (QL) desloratadine oral tablet,disintegrating 5 mg (QL) desmopressin nasal spray,non-aerosol 10 mcg/spray (0.1 ml) desmopressin oral tablet 0.1 mg, 0.2 mg desog-e.estradiol/e.estradiol oral tablet mgx21 /0.01 mg x 5 desogestrel-ethinyl estradiol oral tablet mg desonide topical cream 0.05 % desonide topical ointment 0.05 % desoximetasone topical cream 0.05 %, 0.25 % (ST) desoximetasone topical gel 0.05 % (ST) desoximetasone topical ointment 0.25 % (ST) DESVENLAFAXINE FUMARATE ORAL TABLET EXTENDED RELEASE 24HR 100 MG, 50 MG DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 50 MG (QL) DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24HR 100 MG (QL) DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24HR 50 MG desvenlafaxine succinate oral tab extended release 24 hr 100 mg, 25 mg, 50 mg (QL) dexamethasone oral elixir 0.5 mg/5 ml dexamethasone oral solution 0.5 mg/5 ml dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg dexamethasone sodium phosphate ophthalmic (eye) drops 0.1 % DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 30 MG (PA, QL) DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 60 MG (PA) dexmethylphenidate oral capsule,er biphasic mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg dextroamphetamine oral tablet 10 mg, 5 mg dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg dialyvite 800 oral tablet 0.8 mg diazepam intensol oral concentrate 5 mg/ml diazepam oral solution 5 mg/5 ml (1 mg/ml) diazepam oral tablet 10 mg, 2 mg, 5 mg diazepam rectal kit mg, 2.5 mg, mg diclofenac potassium oral tablet 50 mg diclofenac sodium ophthalmic (eye) drops 0.1 % diclofenac sodium oral tablet extended release 24 hr 100 mg diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg diclofenac sodium topical gel 1 % (QL) This list is subject to change. For an up-to-date listing please visit Pg. 6

8 Alphabetical Listing diclofenac sodium topical gel 3% (QL) dicloxacillin oral capsule 250 mg, 500 mg DICLOZOR TOPICAL KIT 1 % dicyclomine oral capsule 10 mg dicyclomine oral solution 10 mg/5 ml dicyclomine oral tablet 20 mg didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 mg, 250 mg, 400 mg DIFICID ORAL TABLET 200MG (PA) diflorasone topical cream 0.05 % (ST) diflorasone topical ointment 0.05 % (ST) diflunisal oral tablet 500 mg digitek oral tablet 125 mcg, 250 mcg (PA) digox oral tablet 125 mcg, 250 mcg (PA) digoxin oral solution 50 mcg/ml digoxin oral tablet 125 mcg, 250 mcg dihydroergotamine injection solution 1 mg/ml diltiazem hcl oral capsule,ext.rel 24h degradable 240 mg diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg diltiazem hcl oral capsule,extended release 24 hr 240 mg diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg DIPENTUM ORAL CAPSULE 250 MG (ST) diphenhydramine hcl injection solution 50 mg/ml diphenhydramine hcl injection syringe 50 mg/ml diphenhydramine hcl oral capsule 50 mg diphenhydramine hcl oral elixir 12.5 mg/5 ml diphenoxylate-atropine oral liquid mg/5 ml diphenoxylate-atropine oral tablet mg dipyridamole oral tablet 25 mg, 50 mg, 75 mg disopyramide phosphate oral capsule 100 mg, 150 mg disulfiram oral tablet 250 mg, 500 mg divalproex oral capsule, delayed rel sprinkle 125 mg divalproex oral tablet extended release 24 hr 250 mg, 500 mg divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg DM2 COMBO PACK, TABLET AND STRIP 500 MG dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg donepezil oral tablet 10 mg, 5 mg donepezil oral tablet,disintegrating 10 mg, 5 mg dorzolamide ophthalmic (eye) drops 2 % doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg (QL) doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg doxepin oral concentrate 10 mg/ml doxepin topical cream 5 % doxercalciferol intravenous solution 4 mcg/2 ml doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg doxorubicin intravenous recon soln 10 mg, 50 mg doxorubicin intravenous solution 10 mg/5 ml, 2 mg/ml doxycycline hyclate oral capsule 100 mg, 50 mg doxycycline hyclate oral tablet 100 mg, 20 mg doxycycline monohydrate oral capsule 100 mg, 50 mg doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml doxycycline monohydrate oral tablet 100 mg, 50 mg, 75 mg dronabinol oral capsule 10 mg, 2.5 mg, 5 mg drospirenone-e.estradiol-lm.fa oral tablet mg (24) (4), mg (21) (7) drospirenone-ethinyl estradiol oral tablet mg, mg DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG E DUAVEE ORAL TABLET MG ducodyl oral tablet,delayed release (dr/ec) 5 mg DULERA INHALATION HFA AEROSOL INHALER MCG/ACTUATION, MCG/ACTUATION (QL) duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg (QL) duloxetine oral capsule,delayed release(dr/ec) 40 mg DUPIXENT SUBCUTANEOUS SYRINGE 300 MG/2 ML (PA) DUREZOL OPHTHALMIC (EYE) DROPS 0.05 % (ST) dutasteride oral capsule 0.5 mg DYRENIUM ORAL CAPSULE 100 MG, 50 MG d-vi-sol oral drops 400 unit/ml e.c. prin oral tablet,delayed release (dr/ec) 325 mg e.e.s. 400 oral tablet 400 mg econazole topical cream 1 % econtra ez oral tablet 1.5 mg econtra one-step oral tablet 1.5 mg ecotrin low strength oral tablet,delayed release (dr/ec) 81 mg ecotrin oral tablet,delayed release (dr/ec) 325 mg EDARBI ORAL TABLET 40 MG, 80 MG (ST) EDURANT ORAL TABLET 25 MG efavirenz oral capsule 200 mg, 50 mg efavirenz oral tablet 600 mg effer-k oral tablet, effervescent 25 meq EFFIENT ORAL TABLET 10 MG, 5 MG (ST) eletriptan hbr oral tablet 20 mg, 40 mg (ST, QL) ELIDEL TOPICAL CREAM 1 % (ST, QL) ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 22.5 MG (PA, QL) ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 30 MG (PA, QL) ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG (PA, QL) ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH) (PA) elinest oral tablet mg-mcg ELIQUIS ORAL TABLET 2.5 MG, 5 MG elite-ob oral tablet 50 mg iron mg ELLA ORAL TABLET 30 MG ELMIRON ORAL CAPSULE 100 MG EMADINE OPHTHALMIC (EYE) DROPS 0.05 % EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL MG, MG, MG, 50-2 MG, MG, MG (QL) EMCYT ORAL CAPSULE 140 MG emoquette oral tablet mg EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24 HR, 6 MG/24 HR, 9 MG/24 HR EMTRIVA ORAL CAPSULE 200 MG EMTRIVA ORAL SOLUTION 10 MG/ML EMVERM ORAL TABLET,CHEWABLE 100 MG enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg enalapril-hydrochlorothiazide oral tablet mg, mg ENBREL MINI SUBCUTANEOUS CARTRIDGE 50 MG/ML (0.98 ML) (PA, QL) ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML) (PA) ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML) (PA, QL) ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML) (PA, QL) endocet oral tablet mg, mg, mg, mg (QL) ENDOMETRIN VAGINAL INSERT 100 MG enoxaparin subcutaneous solution 300 mg/3 ml enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml Pg. 7 This list is subject to change. For an up-to-date listing please visit

9 Alphabetical Listing enpresse oral tablet (6)/75-40 (5)/125-30(10) enskyce oral tablet mg entacapone oral tablet 200 mg entecavir oral tablet 0.5 mg, 1 mg ENTRESTO ORAL TABLET MG, MG, MG (QL) enulose oral solution 10 gram/15 ml epinastine ophthalmic (eye) drops 0.05 % EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.15 ML, 0.3 MG/0.3 ML (QL) EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML epinephrine injection solution 1 mg/ml epinephrine injection syringe 0.1 mg/ml eplerenone oral tablet 25 mg, 50 mg EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML (PA, QL) EPOGEN INJECTION SOLUTION 20,000 UNIT/2 ML (PA) eprosartan oral tablet 600 mg EPZICOM ORAL TABLET MG (ST) ergoloid oral tablet 1 mg ERIVEDGE ORAL CAPSULE 150 MG (QL) errin oral tablet 0.35 mg ERTACZO TOPICAL CREAM 2 % ery pads topical swab 2 % erythromycin ethylsuccinate oral tablet 400 mg erythromycin ophthalmic (eye) ointment 5 mg/gram (0.5 %) erythromycin oral tablet 250 mg, 500 mg erythromycin with ethanol topical gel 2 % erythromycin with ethanol topical solution 2 % erythromycin with ethanol topical swab 2 % erythromycin-benzoyl peroxide topical gel 3-5 % ESBRIET ORAL CAPSULE 267 MG (QL) ESBRIET ORAL TABLET 267 MG, 801 MG escitalopram oxalate oral solution 5 mg/5 ml escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg (QL) ESOMEP-EZS ORAL KIT, CAP DR AND SPRAY 20 MG esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg (QL) esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg estarylla oral tablet mg-mcg estradiol oral tablet 0.5 mg, 1 mg, 2 mg estradiol transdermal patch semiweekly mg/24 hr, mg/24 hr, 0.05 mg/24 hr, mg/24 hr, 0.1 mg/24 hr (QL) estradiol transdermal patch weekly mg/24 hr (QL) estradiol transdermal patch weekly mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, mg/24 hr, 0.1 mg/24 hr estradiol vaginal cream 0.01 % (0.1 mg/gram) estradiol vaginal tablet 10 mcg estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml estradiol-norethindrone acet oral tablet mg, mg ESTRING VAGINAL RING 2 MG (7.5 MCG /24 HOUR) estropipate oral tablet 0.75 mg eszopiclone oral tablet 1 mg, 2 mg, 3 mg (QL) ethacrynic acid oral tablet 25 mg ethambutol oral tablet 100 mg, 400 mg ethosuximide oral capsule 250 mg ethosuximide oral solution 250 mg/5 ml ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg, 1-50 mg-mcg etidronate disodium oral tablet 200 mg, 400 mg etodolac oral capsule 200 mg, 300 mg (ST) etodolac oral tablet 400 mg, 500 mg (ST) F etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg (ST) EURAX TOPICAL CREAM 10 % EURAX TOPICAL LOTION 10 % EXELDERM TOPICAL CREAM 1 % EXELDERM TOPICAL SOLUTION 1 % exemestane oral tablet 25 mg EXTAVIA SUBCUTANEOUS KIT 0.3 MG (QL) EXTAVIA SUBCUTANEOUS RECON SOLN 0.3 MG (QL) ezetimibe oral tablet 10 mg FACTIVE ORAL TABLET 320 MG falmina (28) oral tablet mg-mcg famciclovir oral tablet 125 mg, 250 mg, 500 mg (QL) famotidine (pf) intravenous solution 20 mg/2 ml famotidine (pf)-nacl (iso-os) intravenous piggyback 20 mg/50 ml famotidine intravenous solution 10 mg/ml famotidine oral suspension 40 mg/5 ml (8 mg/ml) famotidine oral tablet 20 mg, 40 mg FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG (QL) FANAPT ORAL TABLETS,DOSE PACK 1MG(2)-2MG(2)- 4MG(2)-6MG(2) (QL) FARESTON ORAL TABLET 60 MG FARXIGA ORAL TABLET 10 MG, 5 MG (QL) FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG (QL) fayosim oral tablets,dose pack,3 month 0.15 mg-20 mcg/ 0.15 mg-25 mcg felbamate oral suspension 600 mg/5 ml felbamate oral tablet 400 mg, 600 mg felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg FEMRING VAGINAL RING 0.05 MG/24 HR, 0.1 MG/24 HR femynor oral tablet mg-mcg fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg fenofibrate nanocrystallized oral tablet 145 mg, 48 mg fenofibrate oral tablet 160 mg, 54 mg fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg, 45 mg fenofibric acid oral tablet 105 mg, 35 mg fenoprofen oral tablet 600 mg (ST) fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg (PA, QL) fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr (QL) FERRIPROX ORAL TABLET 500 MG FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG (2)- 40 MG (26) (QL) FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG (QL) FINACEA TOPICAL GEL 15 % finasteride oral tablet 1 mg finasteride oral tablet 5 mg FIRVANQ ORAL RECON SOLN 25 MG/ML, 50 MG/ML flavoxate oral tablet 100 mg flecainide oral tablet 100 mg, 150 mg, 50 mg fleet laxative oral tablet,delayed release (dr/ec) 5 mg FLONASE ALLERGY RELIEF NASAL SPRAY,SUSPENSION 50 MCG/ACTUATION (QL) FLONASE SENSIMIST NASAL SPRAY,SUSPENSION 27.5 MCG/ACTUATION FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION (QL) FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION, 220 MCG/ACTUATION, 44 MCG/ACTUATION (QL) This list is subject to change. For an up-to-date listing please visit Pg. 8

10 Alphabetical Listing FLUAD (65 YR UP)(PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)/0.5 ML FLUARIX QUAD (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML FLUBLOK QUAD (PF) INTRAMUSCULAR SYRINGE 180 MCG (45 MCG X 4)/0.5 ML fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml fluconazole oral tablet 100mg, 150mg, 200mg 50mg flucytosine oral capsule 250 mg, 500 mg fludrocortisone oral tablet 0.1 mg FLULAVAL QUAD (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML FLULAVAL QUAD INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) (QL) fluocinolone acetonide oil otic (ear) drops 0.01 % fluocinolone and shower cap scalp oil 0.01 % fluocinolone topical cream 0.01 %, % fluocinolone topical oil 0.01 % fluocinolone topical ointment % fluocinolone topical solution 0.01 % fluocinonide topical cream 0.05 % (QL) fluocinonide topical gel 0.05 % (QL) fluocinonide topical ointment 0.05 % (QL) fluocinonide topical solution 0.05 % fluocinonide-e topical cream 0.05 % fluoride (sodium) oral drops 0.5 mg (1.1 mg sod.fluorid)/ml fluoride (sodium) oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride) FLUORIDEX DAILY DEFENSE DENTAL PASTE 1.1 % fluoritab oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride) fluorometholone ophthalmic (eye) drops,suspension 0.1 % fluorouracil topical cream 5 % fluorouracil topical solution 2 %, 5 % fluoxetine oral capsule 10 mg, 20 mg, 40 mg fluoxetine oral solution 20 mg/5 ml (4 mg/ml) fluoxetine oral tablet 10 mg, 20 mg (QL) fluphenazine decanoate injection solution 25 mg/ml fluphenazine hcl oral concentrate 5 mg/ml fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg flurandrenolide topical cream 0.05 % flurbiprofen oral tablet 100 mg, 50 mg flurbiprofen sodium ophthalmic (eye) drops 0.03 % flutamide oral capsule 125 mg fluticasone nasal spray,suspension 50 mcg/actuation (QL) fluticasone topical cream 0.05 % fluticasone topical lotion 0.05 % fluticasone topical ointment % FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED MCG/ACTUATION, MCG/ACTUATION, MCG/ACTUATION fluvastatin oral capsule 20 mg, 40 mg (QL) fluvoxamine oral tablet 100 mg, 25 mg, 50 mg (QL) FLUZONE HIGH-DOSE (PF) INTRAMUSCULAR SYRINGE 180 MCG/0.5 ML FLUZONE QUAD (PF) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML FLUZONE QUAD (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML G FLUZONE QUAD INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML FLUZONE QUAD PEDI (PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML folic acid oral tablet 400 mcg, 800 mcg foltabs 800 oral tablet mg-mg-mcg fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml FOR STY RELIEF OPHTHALMIC (EYE) OINTMENT FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE MCG/2.4 ML (PA, QL) fosamprenavir oral tablet 700 mg fosinopril oral tablet 10 mg, 20 mg, 40 mg frovatriptan oral tablet 2.5 mg (QL) full spectrum b-vitamin c oral tablet 0.8 mg furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) furosemide oral tablet 20 mg, 40 mg, 80 mg FUZEON SUBCUTANEOUS RECON SOLN 90 MG (QL) fyavolv oral tablet mg-mcg, 1-5 mg-mcg FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG gabapentin oral capsule 100 mg, 300 mg, 400 mg gabapentin oral solution 250 mg/5 ml gabapentin oral tablet 600 mg, 800 mg galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg galantamine oral solution 4 mg/ml galantamine oral tablet 12 mg, 4 mg, 8 mg GANIRELIX SUBCUTANEOUS SYRINGE 250 MCG/0.5 ML (PA) gatifloxacin ophthalmic (eye) drops 0.5 % gavilax oral powder 17 gram/dose gavilyte-c oral recon soln gram gavilyte-g oral recon soln gram gavilyte-n oral recon soln 420 gram gemfibrozil oral tablet 600 mg generlac oral solution 10 gram/15 ml GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML, 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML (PA) GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MG/ML (36 UNIT/ML), 5 MG/ML (15 UNIT/ML) (PA) gentak ophthalmic (eye) ointment 0.3 % (3 mg/gram) gentamicin ophthalmic (eye) drops 0.3 % gentamicin topical cream 0.1 % gentamicin topical ointment 0.1 % gentle laxative oral tablet,delayed release (dr/ec) 5 mg gentlelax oral powder 17 gram/dose gianvi (28) oral tablet mg GILENYA ORAL CAPSULE 0.5 MG (QL) GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG (QL) glatiramer subcutaneous syringe 20 mg/ml, 40 mg/ml (QL) glatopa subcutaneous syringe 20 mg/ml (QL) glimepiride oral tablet 1 mg, 2 mg, 4 mg glipizide oral tablet 10 mg, 5 mg glipizide oral tablet extended release 24hr 10 mg, 2.5 mg, 5 mg glipizide-metformin oral tablet mg, mg, mg GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN 1 MG/ML GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT 1 MG Pg. 9 This list is subject to change. For an up-to-date listing please visit

11 Alphabetical Listing H GLUCAGON HCL INJECTION RECON SOLN 1 MG glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg glyburide-metformin oral tablet mg, mg, mg glycolax oral powder 17 gram/dose glycopyrrolate injection solution 0.2 mg/ml glycopyrrolate oral tablet 1 mg, 2 mg GONAL-F RFF REDI-JECT SUBCUTANEOUS PEN INJECTOR 300/0.5 UNIT/ML, 450/0.75 UNIT/ML, 900/1.5 UNIT/ML (PA) granisetron hcl oral tablet 1 mg griseofulvin microsize oral suspension 125 mg/5 ml griseofulvin microsize oral tablet 500 mg griseofulvin ultramicrosize oral tablet 125 mg, 250 mg guanfacine oral tablet 1 mg, 2 mg guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg guanidine oral tablet 125 mg GYNAZOLE-1 VAGINAL CREAM 2 % halobetasol propionate topical cream 0.05 % halobetasol propionate topical ointment 0.05 % HALOG TOPICAL CREAM 0.1 % (ST) HALOG TOPICAL OINTMENT 0.1 % (ST) haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml haloperidol lactate injection solution 5 mg/ml haloperidol lactate oral concentrate 2 mg/ml haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg healthylax oral powder in packet 17 gram heartburn treatment 24 hour oral capsule,delayed release(dr/ec) 15 mg heather oral tablet 0.35 mg heparin (porcine) injection cartridge 5,000 unit/ml (1 ml) heparin (porcine) injection solution 1,000 unit/ml, 10,000 unit/ml, 20,000 unit/ml, 5,000 unit/ml heparin (porcine) injection syringe 5,000 unit/ml heparin lockflush(porcine)(pf) intravenous syringe 100 unit/ml heparin, porcine (pf) injection solution 1,000 unit/ml, 5,000 unit/0.5 ml heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml HETLIOZ ORAL CAPSULE 20 MG (PA, QL) HEXALEN ORAL CAPSULE 50 MG HUMALOG JUNIOR KWIKPEN U-100 SUBCUTANEOUS INSULIN PEN, HALF-UNIT 100 UNIT/ML HUMALOG KWIKPEN INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML, 200 UNIT/ML (3 ML) HUMALOG MIX INSULN U-100 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (50-50) HUMALOG MIX KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (50-50) HUMALOG MIX KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (75-25) HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (75-25) HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE 100 UNIT/ML HUMALOG U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML, 80 MG/0.8 ML, 80 MG/0.8 ML-40 MG/0.4 ML (PA) HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML (PA, QL) HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML (PA) HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML (PA, QL) HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML, 40 MG/0.4 ML (PA) HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML (PA., QL) HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30) HUMULIN 70/30 U-100 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30) HUMULIN N NPH INSULIN KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML) HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNIT/ML HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION 500 UNIT/ML HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML) hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg hydrochlorothiazide oral capsule 12.5 mg hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg hydrocodone-acetaminophen oral solution mg/15 ml (QL) hydrocodone-acetaminophen oral tablet mg, mg, mg, mg (QL) hydrocodone-homatropine oral syrup mg/5 ml hydrocodone-ibuprofen oral tablet mg (QL) hydrocortisone butyrate topical cream 0.1 % hydrocortisone butyrate topical ointment 0.1 % hydrocortisone butyrate topical solution 0.1 % hydrocortisone butyr-emollient topical cream 0.1 % hydrocortisone oral tablet 10 mg, 20 mg, 5 mg hydrocortisone rectal enema 100 mg/60 ml hydrocortisone topical cream 1 %, 2.5 % hydrocortisone topical cream with perineal applicator 1 %, 2.5 % hydrocortisone topical lotion 2.5 % hydrocortisone topical ointment 1 %, 2.5 % hydrocortisone valerate topical cream 0.2 % hydrocortisone valerate topical ointment 0.2 % hydrocortisone-min oil-wht pet topical ointment 1 % hydromet oral syrup mg/5 ml hydromorphone oral liquid 1 mg/ml (QL) hydromorphone oral tablet 2 mg, 4 mg, 8 mg (QL) hydromorphone oral tablet extended release 24 hr 12 mg, 16 mg, 32 mg, 8 mg (QL) hydroxychloroquine oral tablet 200 mg hydroxyprogesterone caproate intramuscular oil 250 mg/ml (PA) hydroxyurea oral capsule 500 mg hydroxyzine hcl oral solution 10 mg/5 ml hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg hyoscyamine sulfate oral tablet mg hyoscyamine sulfate oral tablet extended release 12 hr mg hyoscyamine sulfate sublingual tablet mg HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %) (PA) HYSINGLA ER ORAL TABLET,ORAL ONLY,EXT.REL.24 HR 100 MG, 120 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG (QL) HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML (PA, QL) I ibandronate oral tablet 150 mg (QL) This list is subject to change. For an up-to-date listing please visit Pg. 10

12 Alphabetical Listing IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG (QL) ibuprofen oral suspension 100 mg/5 ml ibuprofen oral tablet 400 mg, 600 mg, 800 mg ibuprofen-oxycodone oral tablet mg (QL) ICLUSIG ORAL TABLET 15 MG, 45 MG (QL) imatinib oral tablet 100 mg, 400 mg (QL) IMBRUVICA ORAL CAPSULE 140 MG, 70 MG (QL) IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 MG (QL) imipramine hcl oral tablet 10 mg, 25 mg, 50 mg imiquimod topical cream in packet 5 % IMPAVIDO ORAL CAPSULE 50 MG incassia oral tablet 0.35 mg INCRELEX SUBCUTANEOUS SOLUTION 10 MG/ML (PA) INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 62.5 MCG/ACTUATION indapamide oral tablet 1.25 mg, 2.5 mg indomethacin oral capsule 25 mg, 50 mg indomethacin oral capsule, extended release 75 mg INFLECTRA INTRAVENOUS RECON SOLN 100 MG INSULIN SYRINGE-NEEDLE U-100 SYRINGE 0.5 ML 29 GAUGE X 1/2" INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG (QL) INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML), (PA) INTRON A INJECTION RECON SOLN 18 MILLION UNIT (1 ML), 50 MILLION UNIT (1 ML) (PA, QL) INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML, 6 MILLION UNIT/ML (PA, QL) introvale oral tablets,dose pack,3 month 0.15 mg-30 mcg INVANZ INJECTION RECON SOLN 1 GRAM INVANZ INTRAVENOUS RECON SOLN 1 GRAM INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML, 156 MG/ML, 234 MG/1.5 ML, 39 MG/0.25 ML, 78 MG/0.5 ML INVIRASE ORAL CAPSULE 200 MG (QL) INVIRASE ORAL TABLET 500 MG (QL) INVOKAMET ORAL TABLET 150-1,000 MG, MG, 50-1,000 MG, MG (QL) INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 24HR 150-1,000 MG, MG, 50-1,000 MG, MG (QL) INVOKANA ORAL TABLET 100 MG, 300 MG (QL) ipratropium bromide inhalation solution 0.02 % ipratropium bromide nasal spray,non-aerosol 0.03 %, 0.06 % (QL) ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml (QL) irbesartan oral tablet 150 mg, 300 mg, 75 mg irbesartan-hydrochlorothiazide oral tablet mg, mg ISENTRESS HD ORAL TABLET 600 MG ISENTRESS ORAL TABLET 400 MG isibloom oral tablet mg ISOLYTE S PH 7.4 INTRAVENOUS PARENTERAL SOLUTION ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION isoniazid oral solution 50 mg/5 ml isoniazid oral tablet 100 mg, 300 mg isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg isosorbide dinitrate oral tablet extended release 40 mg isosorbide mononitrate oral tablet 10 mg, 20 mg isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg isradipine oral capsule 2.5 mg, 5 mg itraconazole oral capsule 100mg (QL) ivermectin oral tablet 3 mg J K JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG (QL) jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg JANUMET ORAL TABLET 50-1,000 MG, MG (QL) JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 50-1,000 MG, MG (QL) JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG (QL) JARDIANCE ORAL TABLET 10 MG, 25 MG (QL) jencycla oral tablet 0.35 mg JENTADUETO ORAL TABLET 2.5-1,000 MG, MG, MG (QL) JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG (QL) jinteli oral tablet 1-5 mg-mcg jolessa oral tablets,dose pack,3 month 0.15 mg-30 mcg jolivette oral tablet 0.35 mg juleber oral tablet mg junel 1.5/30 (21) oral tablet mg-mcg junel 1/20 (21) oral tablet 1-20 mg-mcg junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) junel fe 24 oral tablet 1 mg-20 mcg (24)/75 mg (4) kaitlib fe oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4) KALETRA ORAL TABLET MG, MG (PA, QL) KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG (PA, QL) KALYDECO ORAL TABLET 150 MG (PA, QL) kariva (28) oral tablet mgx21 /0.01 mg x 5 k-effervescent oral tablet, effervescent 25 meq kelnor 1/35 (28) oral tablet 1-35 mg-mcg kelnor 1-50 oral tablet 1-50 mg-mcg KERYDIN TOPICAL SOLUTION WITH APPLICATOR 5 % ketoconazole oral tablet 200 mg ketoconazole topical cream 2 % ketoconazole topical shampoo 2 % ketoprofen oral capsule 25 mg, 50 mg, 75 mg ketorolac ophthalmic (eye) drops 0.4 % ketorolac ophthalmic (eye) drops 0.5 % ketorolac oral tablet 10 mg (QL) kionex (with sorbitol) oral suspension gram/60 ml KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML (PA) KITABIS PAK INHALATION SOLUTION FOR NEBULIZATION 300 MG/5 ML (QL) klor-con 10 oral tablet extended release 10 meq klor-con 8 oral tablet extended release 8 meq klor-con m10 oral tablet,er particles/crystals 10 meq klor-con m15 oral tablet,er particles/crystals 15 meq klor-con m20 oral tablet,er particles/crystals 20 meq klor-con/ef oral tablet, effervescent 25 meq kobee oral tablet 0.4 mg k-phos-neutral oral tablet 250 mg kpn oral tablet KPN ORAL TABLET 9 MG IRON- 267 MCG kurvelo oral tablet mg KUVAN ORAL POWDER IN PACKET 500 MG (PA) KUVAN ORAL TABLET,SOLUBLE 100 MG (PA) Pg. 11 This list is subject to change. For an up-to-date listing please visit