Medicaid-Approved Preferred Drug List

Transcription

1 Florida Healthy Kids Medicaid-Approved Preferred Drug List Effective November 1, 2017 Legend In each class, drugs are listed alphabetically by either brand name or generic name. Brand name drug: Uppercase in bold type Generic drug: Lowercase in plain type : Age Limit Restrictions DO: Dose Optimization Program GR: Gender Restriction : Over the counter medication available with a prescription. (Prescribers please indicate on the prescription) PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled. : Quantity limits; certain prescription medications have specific quantity limits per prescription or per month. SP: Specialty Pharmacy ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized.

2 lowercase = Generic drugs UPPERCASE BOLD = Brand name drugs Notes Drug Name Reference Notes TERNATIVE THERAPY TERNATIVE THERAPY - ANTIOXIDANT antioxidant a/c/e/selenium oral capsule antioxidant vitamins oral tablet ; e-400 c-500 and beta carotene oral tablet eye health plus lutein oral tablet healthy eyes oral tablet healthy eyes supervision oral capsule ICAPS AREDS OR CAPSULE i-vite oral tablet i-vite protect oral tablet MACUVITE WITH LUTEIN OR TABLET multi-betic oral tablet OCUVITE LUTEIN AND ZEAXANTHIN OR CAPSULE OCUVITE OR CAPSULE OCUVITE WITH LUTEIN OR TABLET opti-vitamins oral tablet PRESERVISION AREDS OR CAPSULE PRESERVISION AREDS OR TABLET prosight oral tablet SAVISION OR TABLET super antioxidant oral capsule ultra antioxidant formula oral tablet vision formula (with lutein) oral tablet TERNATIVE THERAPY - UNCLASSIFIED CHEW Q OR TABLET,CHEWABLE CHEW Q OR WAFER co q-10 (with vit e) oral capsule co q-10 oral capsule coenzyme q10 oral capsule coenzyme q10 oral tablet ; ; ; ; ; ; ; ; ; ; ; coenzyme q10-vitamin e oral capsule Co Q-10 (with Vit E) coq-10 oral capsule echinacea herb oral capsule 1

3 echinacea oral capsule echinacea purp leaf-ang rt ext oral capsule echinacea purpurea aerial oral capsule effervescent formula oral tablet, effervescent goldenseal root oral capsule h2q oral capsule healthy heart complex oral tablet melatonin (with b6) oral tablet ; melatonin-pyridoxine (vit b6) oral tablet Melatonin (with B6) ; mg-plus-protein oral tablet q-gel forte oral capsule q-gel mega oral capsule q-gel oral capsule q-gel ultra oral capsule q-sorb co q-10 oral capsule q-up oral liquid SYSTANE VITAMIN OR CAPSULE ESTROGENIC AGENTS MENOPAUSE SUPPORT OR TABLET ANGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC ANGESIC/ANTIPYRETICS, SICYLATES added strength headache relief oral tablet adult low dose aspirin oral tablet,delayed release (dr/ec) antacid and pain relief oral tablet, effervescent aspir-81 oral tablet,delayed release (dr/ec) aspirin childrens oral tablet,chewable aspirin low dose oral tablet,delayed release (dr/ec) ; ; ; ; aspirin oral tablet Bayer Aspirin ; aspirin oral tablet,chewable Aspirin Childrens ; aspirin oral tablet,delayed release (dr/ec) 325 mg aspirin oral tablet,delayed release (dr/ec) 500 mg, 650 mg aspirin oral tablet,delayed release (dr/ec) 81 mg aspirin rectal suppository Aspir-Trin Adult Low Dose Aspirin ; ; aspirin, buffered oral tablet Buffered Aspirin 2

4 aspir-low oral tablet,delayed release (dr/ec) aspir-trin oral tablet,delayed release (dr/ec) back and body pain reliever oral tablet bayer advanced oral tablet bayer aspirin oral tablet bufferin oral tablet butalbital-aspirin-caffeine oral capsule Fiorinal butalbital-aspirin-caffeine oral tablet children's aspirin oral tablet,chewable choline,magnesium salicylate oral liquid diflunisal oral tablet e.c. prin oral tablet,delayed release (dr/ec) efferves pain relief antacid oral tablet, effervescent enteric coated aspirin oral tablet,delayed release (dr/ec) headache relief (asa-acet-caf) oral tablet lite coat aspirin oral tablet lo-dose aspirin oral tablet,delayed release (dr/ec) migraine formula oral tablet migraine relief oral tablet pain relief (acetamin-asp-caf) oral tablet pain reliever (acetam-aspirin) oral tablet pain reliever plus oral tablet pain-off oral tablet pamprin max oral tablet salsalate oral tablet super pain relief oral tablet tri-buffered aspirin oral tablet ANGESICS, NARCOTICS acetaminophen-codeine oral solution 120 mg- 12 mg /5 ml (5 ml), mg/5 ml acetaminophen-codeine oral solution 240 mg- 24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml acetaminophen-codeine oral tablet mg Disalcid acetaminophen-codeine oral tablet mg Tylenol-Codeine #3 acetaminophen-codeine oral tablet mg Tylenol-Codeine #4 ascomp with codeine oral capsule aspirin-caffeine-dihydrocodein oral capsule Synalgos-DC butalbital compound w/codeine oral capsule ; ; ; ; ; ; ; ; 3

5 butalbital compound-codeine oral capsule butalbital-acetaminop-caf-cod oral capsule butorphanol tartrate nasal spray,non-aerosol codeine sulfate oral tablet 15 mg, 30 mg, 60 mg codeine-butalbital-asa-caff oral capsule Ascomp with Codeine diskets oral tablet,soluble endocet oral tablet PA; fentanyl citrate buccal lozenge on a handle Actiq PA; fentanyl transdermal patch 72 hour Duragesic PA; hydrocodone-acetaminophen oral solution Hycet hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-acetaminophen oral tablet mg hydrocodone-ibuprofen oral tablet Vicodin HP Lorcet HD Verdrocet Vicodin Lorcet (hydrocodone) Vicodin ES Lorcet Plus hydromorphone oral liquid Dilaudid hydromorphone oral tablet 2 mg, 4 mg, 8 mg Dilaudid hydromorphone rectal suppository meperidine oral solution meperidine oral tablet 100 mg Demerol meperidine oral tablet 50 mg methadone intensol oral concentrate PA; methadone oral concentrate Methadone Intensol PA; methadone oral solution 10 mg/5 ml, 5 mg/5 ml PA; methadone oral tablet 10 mg, 5 mg Dolophine PA; methadone oral tablet,soluble Diskets PA; methadose oral concentrate methadose oral tablet,soluble morphine concentrate oral solution PA; PA; 4

6 morphine oral solution 10 mg/5 ml, 20 mg/5 ml (4 mg/ml) morphine oral tablet 15 mg, 30 mg morphine oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg morphine rectal suppository oxycodone oral capsule oxycodone oral concentrate oxycodone oral solution oxycodone oral tablet 10 mg, 20 mg MS Contin oxycodone oral tablet 15 mg, 30 mg, 5 mg Roxicodone oxycodone-acetaminophen oral tablet Endocet oxycodone-aspirin oral tablet pentazocine-naloxone oral tablet tramadol oral tablet Ultram tramadol-acetaminophen oral tablet Ultracet vicodin es oral tablet vicodin hp oral tablet vicodin oral tablet zamicet oral solution ANGESICS, NON-NARCOTIC 8 hour pain reliever oral tablet extended release acephen rectal suppository acetaminophen extra strength oral tablet PA; ; ; acetaminophen oral drops,suspension Infant's Pain Relief ; acetaminophen oral elixir Non-Aspirin acetaminophen oral liquid Children's Pain-Fever Relief acetaminophen oral solution Mapap (acetaminophen) acetaminophen oral suspension 160 mg/5 ml BetaTemp ; acetaminophen oral suspension 160 mg/5 ml (5 ml) Children's Acetaminophen acetaminophen oral tablet 325 mg Athenol acetaminophen oral tablet 500 mg Acetaminophen Extra Strength ; acetaminophen oral tablet extended release 8 Hour Pain Reliever ; acetaminophen oral tablet,chewable Children's Acetaminophen ; acetaminophen oral tablet,disintegrating Children's Acetaminophen acetaminophen pain relief oral tablet ; acetaminophen rectal suppository Acephen arthritis pain relief (acetam) oral tablet extended release ; 5

7 arthritis pain reliever oral tablet extended release athenol oral tablet betatemp oral suspension butalbital-acetaminophen oral tablet Marten-Tab butalbital-acetaminophen-caff oral capsule Capacet butalbital-acetaminophen-caff oral tablet Esgic capacet oral capsule child pain rel-fever reducer rectal suppository children's acetaminophen oral suspension children's acetaminophen oral tablet,chewable children's acetaminophen oral tablet,disintegrating children's easy-melts oral tablet,disintegrating children's fever reducing rectal suppository children's mapap oral tablet,disintegrating children's non-aspirin oral suspension children's non-aspirin oral tablet,chewable children's non-aspirin pain oral tablet,chewable children's pain relief oral suspension children's pain reliever oral suspension children's pain reliever oral tablet,disintegrating children's pain-fever relief oral liquid children's pain-fever relief oral suspension children's pain-fever relief oral tablet,chewable children's pain-fever relief oral tablet,disintegrating children's silapap oral liquid children's tactinal oral tablet,chewable ed-apap oral liquid fever reducer an pain reliever oral suspension fever reducer rectal suppository feverall rectal suppository infant fever reducer-pain relf oral suspension infant pain reliever oral suspension infant's non-aspirin oral drops,suspension infants' pain and fever oral suspension infant's pain relief oral drops,suspension infants' pain relief oral suspension 6 ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;

8 infant's pain relief oral suspension infant's pain reliever oral drops,suspension jr. acetaminophen oral tablet,disintegrating jr. str non-aspirin pain oral tablet,disintegrating jr. strength pain reliever oral tablet,disintegrating junior mapap oral tablet,disintegrating little remedies fever and pain oral liquid mapap (acetaminophen) oral capsule mapap (acetaminophen) oral drops,suspension mapap (acetaminophen) oral liquid mapap (acetaminophen) oral suspension mapap (acetaminophen) oral tablet mapap (acetaminophen) oral tablet,chewable mapap arthritis pain oral tablet extended release mapap extra strength oral tablet marten-tab oral tablet masophen oral tablet 325 mg masophen oral tablet 500 mg non-aspirin childrens oral drops non-aspirin children's oral tablet,chewable non-aspirin extra strength oral liquid non-aspirin extra strength oral tablet non-aspirin jr strength oral tablet,chewable non-aspirin oral elixir non-aspirin oral suspension non-aspirin oral tablet non-aspirin oral tablet,chewable non-aspirin pain relief oral tablet 325 mg non-aspirin pain relief oral tablet 500 mg nortemp oral drops nortemp oral suspension pain and fever oral tablet 325 mg pain and fever oral tablet 500 mg pain relief adult oral liquid pain relief extra strength oral tablet pain relief oral liquid pain relief oral tablet ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; 7

9 pain relief oral tablet extended release pain relief regular strength oral tablet pain reliever extra strength oral tablet pain reliever jr strength oral tablet,chewable pain reliever oral capsule pain reliever oral tablet 325 mg pain reliever oral tablet 500 mg pediacare fever reducer oral suspension pharbetol oral tablet 325 mg pharbetol oral tablet 500 mg pre-menstrual relief oral tablet premsyn pms oral tablet tactinal extra strength oral tablet tactinal oral tablet tencon oral tablet mg tencon oral tablet mg tylophen oral capsule ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR ENBREL SUBCUTANEOUS RECON SOLN ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML) ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT HUMIRA SUBCUTANEOUS SYRINGE KIT ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR ; ; ; ; ; ; ; ; ; PA; PA; PA; PA; PA; PA; PA; PA; leflunomide oral tablet RIDAURA OR CAPSULE CHELATING AGENTS DEPEN TITRATABS OR TABLET minocycline oral capsule minocycline oral tablet Arava Minocin PA 8

10 sulfasalazine oral tablet Azulfidine sulfasalazine oral tablet,delayed release (dr/ec) DMARD - ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITING AGENTS Azulfidine EN-tabs ENBREL SUBCUTANEOUS RECON SOLN ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML) ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT HUMIRA SUBCUTANEOUS SYRINGE KIT IMMUNOSUPRESSANTS PA; PA; PA; PA; PA; PA; PA; PA; cyclosporine modified oral capsule cyclosporine modified oral solution cyclosporine oral capsule gengraf oral capsule gengraf oral solution mycophenolate mofetil oral suspension for reconstitution SANDIMMUNE OR SOLUTION NSAIDS advil oral tablet advil oral tablet,chewable all day pain relief oral tablet all day relief oral tablet child ibuprofen oral suspension children's advil oral suspension children's ibuprofen oral suspension children's profen ib oral suspension diclofenac potassium oral tablet diclofenac sodium oral tablet extended release 24 hr Gengraf Gengraf Sandimmune CellCept Voltaren-XR ; ; ; ; ; ; ; PA 9

11 diclofenac sodium oral tablet,delayed release (dr/ec) etodolac oral capsule etodolac oral tablet etodolac oral tablet extended release 24 hr Lodine fenoprofen oral tablet ProFeno flanax (naproxen) oral tablet flurbiprofen oral tablet ibu-drops oral drops,suspension ibuprofen ib oral tablet ibuprofen ib oral tablet,chewable ibuprofen jr strength oral tablet,chewable ; ; ; ; ibuprofen oral capsule Advil Liqui-Gel PA; ibuprofen oral drops,suspension Ibu-Drops ; ibuprofen oral suspension Child Ibuprofen ; ibuprofen oral tablet 100 mg Advil ibuprofen oral tablet 200 mg Advil ; ibuprofen oral tablet 400 mg, 600 mg, 800 mg ibuprofen pm oral tablet ibuprofen-diphenhydramine cit oral tablet Advil PM indomethacin oral capsule indomethacin oral capsule, extended release infants ibu-drops oral drops,suspension infant's ibuprofen oral drops,suspension infants profenib oral drops,suspension i-prin oral tablet ketoprofen oral capsule ketoprofen oral capsule,ext rel. pellets 24 hr ketorolac oral tablet meclofenamate oral capsule 100 mg, 50 mg mediproxen oral tablet meloxicam oral suspension meloxicam oral tablet 15 mg Mobic meloxicam oral tablet 7.5 mg Mobic PA motrin pm oral tablet nabumetone oral tablet naproxen oral suspension Naprosyn PA naproxen oral tablet naproxen oral tablet,delayed release (dr/ec) EC-Naprosyn PA ; ; ; ; ; naproxen sodium oral capsule Aleve 10

12 naproxen sodium oral tablet 220 mg Aleve ; naproxen sodium oral tablet 275 mg naproxen sodium oral tablet 550 mg Anaprox DS oxaprozin oral tablet Daypro piroxicam oral capsule Feldene PA provil oral tablet ; sulindac oral tablet tolmetin oral capsule tolmetin oral tablet wal-profen oral capsule PA; wal-profen oral tablet ; wal-proxen oral tablet ; ANESTHETICS TOPIC ANESTHETICS lidocaine hcl laryngotracheal solution LTA Pre-Attached lidocaine topical ointment ANORECT PREPARATIONS HEMORRHOID PREPARATIONS anu-med rectal suppository hemorrhoid rectal ointment hemorrhoidal (phenyleph-cocoa) rectal suppository hemorrhoidal rectal ointment hemorrhoidal rectal suppository hemorrhoidal suppository rectal suppository hydrocortisone topical cream with perineal applicator proctosol hc topical cream with perineal applicator proctozone-hc topical cream with perineal applicator ANTIDOTES AND OTHER REVERS AGENTS CHELATING AGENTS CHEMET OR CAPSULE deferoxamine injection recon soln DEPEN TITRATABS OR TABLET SYPRINE OR CAPSULE NARCOTIC ANTAGONISTS naloxone injection solution Anusol-HC Desferal PA PA PA; 11

13 naloxone injection syringe naltrexone oral tablet NARCAN NAS SPRAY,NON-AEROSOL ANTI-INFECTIVE AGENTS ABSORBABLE SULFONAMIDES sulfamethoxazole-trimethoprim oral suspension sulfamethoxazole-trimethoprim oral tablet trimethoprim oral tablet AMEBICIDES Sulfatrim Bactrim paromomycin oral capsule AMINOGLYCOSIDES neomycin oral tablet ANAEROBIC ANTIPROTOZO ANTIBACTERI AGENTS metronidazole oral capsule metronidazole oral tablet tinidazole oral tablet 250 mg Flagyl Flagyl tinidazole oral tablet 500 mg Tindamax ANTHELMINTICS BENZA OR TABLET BILTRICIDE OR TABLET ivermectin oral tablet pin-x oral suspension pin-x oral tablet,chewable reese's pinworm medicine oral suspension ANTIFUNG ANTIBIOTICS Stromectol fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg flucytosine oral capsule griseofulvin microsize oral suspension griseofulvin ultramicrosize oral tablet Diflucan Diflucan Ancobon Gris-PEG (ultramicrosize) itraconazole oral capsule Sporanox PA ketoconazole oral tablet nystatin oral powder nystatin oral tablet terbinafine hcl oral tablet Lamisil voriconazole intravenous solution Vfend IV PA 12

14 voriconazole oral suspension for reconstitution Vfend voriconazole oral tablet 200 mg Vfend PA; voriconazole oral tablet 50 mg Vfend PA ANTIMYCOBACTERIUM AGENTS PA ethambutol oral tablet isoniazid oral solution isoniazid oral tablet PRIFTIN OR TABLET pyrazinamide oral tablet rifabutin oral capsule rifampin oral capsule RIFATER OR TABLET sulfadiazine oral tablet ANTIVIRS, GENER Myambutol Mycobutin Rifadin acyclovir oral capsule acyclovir oral suspension acyclovir oral tablet famciclovir oral tablet 125 mg, 250 mg, 500 mg Zovirax Zovirax Zovirax oseltamivir oral capsule 30 mg, 45 mg, 75 mg Tamiflu oseltamivir oral suspension for reconstitution Tamiflu RELENZA DISKHER INHATION BLISTER WITH DEVICE rimantadine oral tablet TAMIFLU OR SUSPENSION FOR RECONSTITUTION Flumadine valacyclovir oral tablet Valtrex valganciclovir oral recon soln valganciclovir oral tablet ANTIVIRS, HIV SPECIFIC Valcyte Valcyte abacavir oral solution abacavir oral tablet abacavir-lamivudine oral tablet abacavir-lamivudine-zidovudine oral tablet APTIVUS OR CAPSULE APTIVUS OR SOLUTION CRIXIVAN OR CAPSULE DESCOVY OR TABLET didanosine oral capsule,delayed release(dr/ec) Ziagen Ziagen Epzicom Trizivir Videx EC 13

15 EDURANT OR TABLET EMTRIVA OR CAPSULE EMTRIVA OR SOLUTION EVOTAZ OR TABLET FUZEON SUBCUTANEOUS RECON SOLN GENVOYA OR TABLET INTELENCE OR TABLET ISENTRESS HD OR TABLET ISENTRESS OR POWDER IN PACKET ISENTRESS OR TABLET ISENTRESS OR TABLET,CHEWABLE KETRA OR TABLET lamivudine oral solution Epivir lamivudine oral tablet lamivudine-zidovudine oral tablet lopinavir-ritonavir oral solution nevirapine oral suspension nevirapine oral tablet nevirapine oral tablet extended release 24 hr NORVIR OR CAPSULE NORVIR OR SOLUTION NORVIR OR TABLET PREZCOBIX OR TABLET PREZISTA OR SUSPENSION PREZISTA OR TABLET RESCRIPTOR OR TABLET RESCRIPTOR OR TABLET, DISPERSIBLE RETROVIR INTRAVENOUS SOLUTION REYATAZ OR CAPSULE REYATAZ OR POWDER IN PACKET SELZENTRY OR SOLUTION SELZENTRY OR TABLET stavudine oral capsule stavudine oral recon soln STRIBILD OR TABLET TIVICAY OR TABLET TRIUMEQ OR TABLET TRUVADA OR TABLET Epivir Combivir Kaletra Viramune Viramune Viramune XR Zerit Zerit PA 14

16 VIDEX 2 GRAM PEDIATRIC OR RECON SOLN VIDEX 4 GRAM PEDIATRIC OR RECON SOLN VIRACEPT OR TABLET VIREAD OR POWDER VIREAD OR TABLET zidovudine oral capsule zidovudine oral syrup zidovudine oral tablet CEPHOSPORINS cefaclor oral capsule cefaclor oral suspension for reconstitution cefaclor oral tablet extended release 12 hr cefadroxil oral capsule cefadroxil oral suspension for reconstitution cefadroxil oral tablet cefdinir oral capsule cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cefpodoxime oral suspension for reconstitution cefpodoxime oral tablet cefprozil oral suspension for reconstitution cefprozil oral tablet CEFTIN OR SUSPENSION FOR RECONSTITUTION ceftriaxone injection recon soln 1 gram, 2 gram, 250 mg, 500 mg ceftriaxone injection recon soln 10 gram cefuroxime axetil oral tablet cephalexin oral capsule cephalexin oral suspension for reconstitution cephalexin oral tablet CHEMOTHERAPEUTICS, ANTIBACTERI, MISCELLANEOUS dapsone oral tablet HEPATITIS B TREATMENT AGENTS Retrovir Retrovir Keflex PA; PA; adefovir oral tablet Hepsera PA; BARACLUDE OR SOLUTION PA; entecavir oral tablet Baraclude PA; 15

17 EPIVIR HBV OR SOLUTION PA; lamivudine oral tablet Epivir HBV PA; HEPATITIS C TREATMENT AGENTS EPCLUSA OR TABLET MAVYRET OR TABLET PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR PEGASYS SUBCUTANEOUS SOLUTION PEGASYS SUBCUTANEOUS SYRINGE PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT PEGINTRON SUBCUTANEOUS KIT PA; PA PA PA; ribavirin oral capsule Ribasphere PA; ribavirin oral tablet Copegus PA; SOVDI OR TABLET ZEPATIER OR TABLET LINCOSAMIDES PA PA PA PA; PA; clindamycin hcl oral capsule clindamycin palmitate hcl oral recon soln clindamycin pediatric oral recon soln MACROLIDES Cleocin HCl Cleocin Pediatric azithromycin oral packet Zithromax azithromycin oral suspension for reconstitution azithromycin oral tablet 250 mg, 500 mg, 600 mg clarithromycin oral suspension for reconstitution clarithromycin oral tablet clarithromycin oral tablet extended release 24 hr e.e.s. 400 oral tablet ery-tab oral tablet,delayed release (dr/ec) erythrocin (as stearate) oral tablet Zithromax Zithromax erythromycin ethylsuccinate oral tablet E.E.S. 400 erythromycin oral capsule,delayed release(dr/ec) erythromycin oral tablet PENICILLINS amoxicillin oral capsule amoxicillin oral suspension for reconstitution 16

18 amoxicillin oral tablet amoxicillin oral tablet,chewable amoxicillin-pot clavulanate oral suspension for reconstitution amoxicillin-pot clavulanate oral tablet amoxicillin-pot clavulanate oral tablet extended release 12 hr amoxicillin-pot clavulanate oral tablet,chewable ampicillin oral capsule dicloxacillin oral capsule penicillin v potassium oral recon soln penicillin v potassium oral tablet PLASMOCIDES atovaquone-proguanil oral tablet chloroquine phosphate oral tablet hydroxychloroquine oral tablet mefloquine oral tablet PRIMAQUINE OR TABLET QUINOLONES ciprofloxacin hcl oral tablet levofloxacin oral solution levofloxacin oral tablet ofloxacin oral tablet 300 mg, 400 mg TETRACYCLINES demeclocycline oral tablet doxycycline monohydrate oral capsule 100 mg, 50 mg doxycycline monohydrate oral capsule 150 mg doxycycline monohydrate oral capsule 75 mg doxycycline monohydrate oral suspension for reconstitution minocycline oral capsule minocycline oral tablet tetracycline oral capsule VANCOMYCIN AND DERIVATIVES Augmentin ES-600 Augmentin XR Malarone Pediatric Plaquenil Levaquin Mondoxyne NL Mondoxyne NL Vibramycin Minocin linezolid oral suspension for reconstitution Zyvox PA; linezolid oral tablet Zyvox PA; vancomycin oral capsule Vancocin PA 17

19 ANTINEOPLASTICS ANTINEOPLASTIC - ANTIANDROGENIC AGENTS bicalutamide oral tablet flutamide oral capsule ANTINEOPLASTIC/IMMUNOSUPPRESS ANT DRUGS Casodex anastrozole oral tablet Arimidex EMCYT OR CAPSULE exemestane oral tablet Aromasin HEXEN OR CAPSULE hydroxyurea oral capsule Hydrea imatinib oral tablet 100 mg, 400 mg Gleevec PA; IRESSA OR TABLET letrozole oral tablet Femara leucovorin calcium injection recon soln leucovorin calcium oral tablet megestrol oral tablet melphalan oral tablet MESNEX OR TABLET mitoxantrone intravenous concentrate MYLERAN OR TABLET PROLEUKIN INTRAVENOUS RECON SOLN tamoxifen oral tablet tretinoin (chemotherapy) oral capsule VANTAS IMPLANT KIT ANTISEPTICS AND DISINFECTANTS ANTISEPTICS, GENER alcohol pads topical pads, medicated alcohol prep pads topical pads, medicated Alkeran PA PA PA; PA PA alcohol swabs topical pads, medicated Alcohol Pads alcohol wipes topical pads, medicated alcoh-wipe towelette antiseptic skin clnsr(chlorhe) topical liquid betasept surgical scrub topical liquid ; ; chlorhexidine gluconate topical liquid Hand Wash curity alcohol swabs topical pads, medicated easy touch alcohol prep pads topical pads, medicated hibiclens topical liquid 18 ;

20 hydrogen peroxide solution sure comfort alcohol prep pads topical pads, medicated webcol topical pads, medicated BIOLOGICS IMMUNE GLOBULINS GAMUNEX-C INJECTION SOLUTION OCTAGAM INTRAVENOUS SOLUTION IMMUNOLOGICS VACCINES AFLURIA (PF) INTRAMUSCULAR SYRINGE AFLURIA INTRAMUSCULAR SUSPENSION AFLURIA QUAD (PF) INTRAMUSCULAR SYRINGE AFLURIA QUAD INTRAMUSCULAR SUSPENSION FLUAD (65 YR UP)(PF) INTRAMUSCULAR SYRINGE FLUARIX QUAD (PF) INTRAMUSCULAR SYRINGE FLUBLOK (PF) INTRAMUSCULAR SOLUTION FLUBLOK QUAD (PF) INTRAMUSCULAR SYRINGE FLUCELVAX QUAD (PF) INTRAMUSCULAR SYRINGE FLUCELVAX QUAD INTRAMUSCULAR SUSPENSION FLULAV QUAD (PF) INTRAMUSCULAR SYRINGE FLULAV QUAD INTRAMUSCULAR SUSPENSION FLUVIRIN (PF) INTRAMUSCULAR SYRINGE FLUVIRIN INTRAMUSCULAR SUSPENSION FLUZONE HIGH-DOSE (PF) INTRAMUSCULAR SYRINGE FLUZONE INTRADERM QUAD INTRADERM SYRINGE FLUZONE QUAD (PF) INTRAMUSCULAR SUSPENSION PA PA 19

21 FLUZONE QUAD (PF) INTRAMUSCULAR SYRINGE FLUZONE QUAD INTRAMUSCULAR SUSPENSION FLUZONE QUAD PEDI (PF) INTRAMUSCULAR SYRINGE SYNAGIS INTRAMUSCULAR SOLUTION VACCINE BACTERI - GRAM POSITIVE COCCI PA PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE CARDIOVASCULAR THERAPY AGENTS HYPOTENSIVES, SYMPATHOLYTIC methyldopa-hydrochlorothiazide oral tablet ACE INHIBITOR/CCIUM CHANNEL BLOCK COMBINATION amlodipine-benazepril oral capsule ADRENERGIC VASOPRESSOR midodrine oral tablet DOSTERONE RECEPTOR ANTAGONISTS spironolactone oral tablet PHA/BETA-ADRENERGIC BLOCKING AGENTS carvedilol oral tablet 12.5 mg, 25 mg, mg, 6.25 mg labetalol oral tablet PHA-ADRENERGIC BLOCKING AGENTS Aldactone Coreg doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg Cardura prazosin oral capsule terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg ANAPHYLAXIS THERAPY AGENTS Minipress epinephrine injection auto-injector EpiPen Jr epinephrine injection solution ANTIARRHYTHMICS Adrenalin amiodarone oral tablet 200 mg Pacerone amiodarone oral tablet 400 mg disopyramide phosphate oral capsule flecainide oral tablet 100 mg, 150 mg, 50 mg 20 Pacerone Norpace

22 mexiletine oral capsule pacerone oral tablet 200 mg pacerone oral tablet 400 mg propafenone oral capsule,extended release 12 hr propafenone oral tablet quinidine gluconate oral tablet extended release quinidine sulfate oral tablet sorine oral tablet sotalol af oral tablet Rythmol SR sotalol oral tablet Betapace verapamil oral tablet BETA-ADRENERGIC BLOCKING AGENTS acebutolol oral capsule atenolol oral tablet betaxolol oral tablet bisoprolol fumarate oral tablet metoprolol succinate oral tablet extended release 24 hr Tenormin Toprol XL metoprolol tartrate oral tablet 100 mg, 50 mg Lopressor metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg nadolol oral tablet 20 mg, 40 mg Corgard nadolol oral tablet 80 mg Corgard PA pindolol oral tablet propranolol oral capsule,extended release 24 hr propranolol oral solution propranolol oral tablet sorine oral tablet sotalol af oral tablet Inderal LA sotalol oral tablet Betapace timolol maleate oral tablet CCIUM CHANNEL BLOCKING AGENTS afeditab cr oral tablet extended release 30 mg afeditab cr oral tablet extended release 60 mg amlodipine oral tablet 10 mg Norvasc DO; amlodipine oral tablet 2.5 mg, 5 mg Norvasc DO; 21

23 cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg cartia xt oral capsule,extended release 24hr 300 mg diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg diltiazem hcl oral capsule,ext.rel 24h degradable 240 mg diltiazem hcl oral capsule,extended release 12 hr diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg diltiazem hcl oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg diltiazem hcl oral capsule,extended release 24 hr 420 mg diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg diltiazem hcl oral capsule,extended release 24hr 300 mg, 360 mg DILT-XR DILT-XR Taztia XT Taztia XT Tiazac Cardizem CD Cardizem CD diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg Cardizem diltiazem hcl oral tablet 90 mg diltiazem hcl oral tablet extended release 24 hr 180 mg, 240 mg diltiazem hcl oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg dilt-xr oral capsule,ext.rel 24h degradable 240 mg felodipine oral tablet extended release 24 hr 10 mg felodipine oral tablet extended release 24 hr 2.5 mg, 5 mg isradipine oral capsule 2.5 mg, 5 mg matzim la oral tablet extended release 24 hr 180 mg, 240 mg matzim la oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg nicardipine oral capsule 20 mg, 30 mg nifedipine oral capsule nifedipine oral tablet extended release 24hr 30 mg nifedipine oral tablet extended release 24hr 60 mg, 90 mg 22 Cardizem LA Cardizem LA Procardia XL Procardia XL DO; DO; DO; DO; DO; DO; DO; DO; DO;

24 nifedipine oral tablet extended release 30 mg Adalat CC DO; nifedipine oral tablet extended release 60 mg, 90 mg taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg taztia xt oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg Adalat CC DO; verapamil oral capsule, 24 hr er pellet ct Verelan PM DO; verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg verapamil oral capsule,ext rel. pellets 24 hr 240 mg, 360 mg verapamil oral tablet Verelan Verelan verapamil oral tablet extended release Calan SR DIGITIS GLYCOSIDES DO; digox oral tablet digoxin injection solution digoxin injection syringe digoxin oral solution digoxin oral tablet LANOXIN INJECTION SOLUTION LANOXIN PEDIATRIC INJECTION SOLUTION DIURETIC - CARBONIC ANHYDRASE INHIBITORS Lanoxin Digitek acetazolamide oral capsule, extended release Diamox Sequels acetazolamide oral tablet methazolamide oral tablet HYPOTENSIVES, ACE INHIBITORS, COMBINATIONS benazepril oral tablet benazepril-hydrochlorothiazide oral tablet captopril oral tablet captopril-hydrochlorothiazide oral tablet Neptazane enalapril maleate oral tablet Vasotec enalapril-hydrochlorothiazide oral tablet fosinopril oral tablet fosinopril-hydrochlorothiazide oral tablet lisinopril oral tablet 10 mg, 20 mg, 5 mg Prinivil DO; lisinopril oral tablet 2.5 mg Zestril DO; lisinopril oral tablet 30 mg, 40 mg Zestril 23

25 lisinopril-hydrochlorothiazide oral tablet mg lisinopril-hydrochlorothiazide oral tablet mg, mg moexipril oral tablet moexipril-hydrochlorothiazide oral tablet perindopril erbumine oral tablet Zestoretic Zestoretic quinapril oral tablet Accupril quinapril-hydrochlorothiazide oral tablet Accuretic ramipril oral capsule Altace trandolapril oral tablet HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST candesartan oral tablet candesartan-hydrochlorothiazid oral tablet Atacand Atacand HCT DO; irbesartan oral tablet 150 mg, 75 mg Avapro DO; irbesartan oral tablet 300 mg Avapro irbesartan-hydrochlorothiazide oral tablet mg, mg Avalide losartan oral tablet Cozaar losartan-hydrochlorothiazide oral tablet mg, mg losartan-hydrochlorothiazide oral tablet mg Hyzaar Hyzaar valsartan oral tablet Diovan valsartan-hydrochlorothiazide oral tablet HYPOTENSIVES, MISCELLANEOUS Diovan HCT atenolol-chlorthalidone oral tablet Tenoretic 100 bisoprolol-hydrochlorothiazide oral tablet metoprolol ta-hydrochlorothiaz oral tablet mg, mg metoprolol ta-hydrochlorothiaz oral tablet mg Ziac Lopressor HCT nadolol-bendroflumethiazide oral tablet Corzide propranolol-hydrochlorothiazid oral tablet HYPOTENSIVES, SYMPATHOLYTIC DO; clonidine hcl oral tablet guanfacine oral tablet methyldopa oral tablet HYPOTENSIVES, VASODILATORS Catapres hydralazine oral tablet 24

26 minoxidil oral tablet LIPOTROPICS G-900 DHA OR CAPSULE ; atorvastatin oral tablet 10 mg, 20 mg, 40 mg Lipitor DO; atorvastatin oral tablet 80 mg Lipitor cholestyramine (with sugar) oral powder cholestyramine (with sugar) oral powder in packet cholestyramine light oral powder cholestyramine light oral powder in packet colestipol oral granules colestipol oral packet colestipol oral tablet DHA G-900 OR CAPSULE fenofibrate micronized oral capsule 130 mg, 200 mg, 43 mg fenofibrate micronized oral capsule 134 mg fenofibrate micronized oral capsule 67 mg Questran Questran Colestid Colestid Colestid fenofibrate nanocrystallized oral tablet Tricor fenofibrate oral tablet fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg fenofibric acid (choline) oral capsule,delayed release(dr/ec) 45 mg Trilipix Trilipix ; PA; PA; fenofibric acid oral tablet Fibricor PA; fish oil concentrate oral capsule fish oil oral capsule 1,000 mg (120 mg-180 mg), ,000 mg, mg, ,000 mg, 300 mg, 300-1,000 mg, mg, 340-1,000 mg fish oil oral capsule 360-1,200 mg fish oil oral capsule,delayed release(dr/ec) mg, 300-1,000 mg, mg, mg, 900 ( ) mg, 900-1,400 mg fish oil oral capsule,delayed release(dr/ec) 360 mg-144 mg- 216 mg-1,200 mg, 360-1,200 mg fish oil-dha-epa oral capsule gemfibrozil oral tablet GRAM-O-LECI OR TABLET,CHEWABLE inositol oral tablet lecithin oral capsule Lopid ; ; 25

27 lecithin, soy oral capsule lovastatin oral tablet maxepa oral capsule niacin oral tablet Niacor omega 3-dha-epa-fish oil oral capsule omega-3 (with dpa) oral capsule omega oral capsule ; omega-3 fatty acids oral capsule Fish Oil Concentrate omega-3 fatty acids oral tablet,chewable omega-3 fatty acids-fish oil oral capsule 300-1,000 mg omega-3 fatty acids-fish oil oral capsule 360-1,200 mg omega-3 fatty acids-fish oil oral capsule mg omega-3 fish oil oral capsule omega-3s-dha-epa-fish oil oral capsule,delayed release(dr/ec) one-per-day omega-3 oral capsule,delayed release(dr/ec) pravastatin oral tablet prevalite oral powder prevalite oral powder in packet salmon oil-omega-3 fatty acids oral capsule sea-omega 30 oral capsule simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg Fish Oil Fish Oil Pravachol Zocor PA; ; ; ; ; DO; simvastatin oral tablet 80 mg Zocor PA; super omega-3 oral capsule super twin epa-dha oral capsule THEROMEGA OR CAPSULE vitamin e oral capsule LOOP DIURETICS bumetanide oral tablet furosemide oral solution furosemide oral tablet torsemide oral tablet PCSK-9 INHIBITORS Lasix Demadex REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR PA; 26

28 REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR REPATHA SYRINGE SUBCUTANEOUS SYRINGE POTASSIUM SPARING DIURETICS PA; PA; amiloride oral tablet amiloride-hydrochlorothiazide oral tablet spironolactone oral tablet spironolacton-hydrochlorothiaz oral tablet triamterene-hydrochlorothiazid oral capsule triamterene-hydrochlorothiazid oral tablet PULMONARY ARTERI HYPERTENSION Aldactone Aldactazide Maxzide-25mg LETAIRIS OR TABLET THIAZIDE AND RELATED DIURETICS PA; chlorothiazide oral tablet chlorthalidone oral tablet hydrochlorothiazide oral capsule Microzide hydrochlorothiazide oral tablet 12.5 mg hydrochlorothiazide oral tablet 25 mg, 50 mg indapamide oral tablet metolazone oral tablet VASODILATING DRUGS ADCIRCA OR TABLET PA; sildenafil (antihypertensive) oral tablet Revatio PA; VASODILATORS, CORONARY isosorbide dinitrate oral tablet isosorbide dinitrate oral tablet extended release isosorbide mononitrate oral tablet isosorbide mononitrate oral tablet extended release 24 hr nitro-bid transdermal ointment NITRO-DUR TRANSDERM PATCH 24 HOUR nitroglycerin oral capsule, extended release nitroglycerin sublingual tablet nitroglycerin transdermal patch 24 hour nitro-time oral capsule, extended release ISOCHRON Nitro-Time Nitrostat Minitran 27

29 CENTR NERVOUS SYSTEM AGENTS PHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS mirtazapine oral tablet mirtazapine oral tablet,disintegrating ANTI-ANXIETY DRUGS alprazolam oral tablet alprazolam oral tablet,disintegrating buspirone oral tablet chlordiazepoxide hcl oral capsule clonazepam oral tablet clonazepam oral tablet,disintegrating clorazepate dipotassium oral tablet diazepam intensol oral concentrate diazepam oral concentrate diazepam oral solution diazepam oral tablet hydroxyzine hcl oral solution hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule lorazepam oral tablet oxazepam oral capsule ANTICONVULSANTS Remeron Remeron SolTab Xanax Klonopin Diazepam Intensol Valium Ativan carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg carbamazepine oral suspension carbamazepine oral tablet carbamazepine oral tablet extended release 12 hr carbamazepine oral tablet,chewable clonazepam oral tablet clonazepam oral tablet,disintegrating Carbatrol Tegretol Epitol Tegretol XR Klonopin diazepam rectal kit Diastat divalproex oral capsule, delayed rel sprinkle Depakote Sprinkles divalproex oral tablet extended release 24 hr 250 mg, 500 mg divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg divalproex oral tablet,delayed release (dr/ec) 500 mg 28 Depakote ER Depakote Depakote

30 epitol oral tablet ethosuximide oral capsule ethosuximide oral solution felbamate oral suspension felbamate oral tablet gabapentin oral capsule 100 mg, 300 mg, 400 mg gabapentin oral solution Zarontin Zarontin Felbatol Felbatol Neurontin Neurontin gabapentin oral tablet 600 mg, 800 mg Neurontin lamotrigine oral tablet lamotrigine oral tablet disintegrating, dose pk lamotrigine oral tablet extended release 24hr lamotrigine oral tablet, chewable dispersible lamotrigine oral tablet,disintegrating 100 mg, 200 mg, 25 mg Lamictal Lamictal ODT Starter (Orange) Lamictal XR Lamictal Lamictal ODT lamotrigine oral tablet,disintegrating 50 mg Lamictal ODT lamotrigine oral tablets,dose pack levetiracetam oral solution levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg oxcarbazepine oral suspension oxcarbazepine oral tablet phenobarbital oral elixir phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg phenobarbital oral tablet 32.4 mg phenytoin oral suspension phenytoin oral tablet,chewable phenytoin sodium extended oral capsule primidone oral tablet ROWEEPRA OR TABLET 1,000 MG, 500 MG, 750 MG tiagabine oral tablet topiramate oral capsule, sprinkle topiramate oral tablet valproic acid (as sodium salt) oral solution Lamictal Starter (Blue) Kit Keppra Keppra Keppra XR Trileptal Trileptal Dilantin-125 Dilantin Infatabs Phenytek Mysoline Gabitril Topamax Topamax Depakene valproic acid oral capsule Depakene zonisamide oral capsule 100 mg Zonegran zonisamide oral capsule 25 mg Zonegran 29

31 zonisamide oral capsule 50 mg ANTIMANIA DRUGS lithium carbonate oral capsule lithium carbonate oral tablet lithium carbonate oral tablet extended release Lithobid lithium citrate oral solution 8 meq/5 ml lithium citrate oral solution 8 meq/5 ml (5 ml) ANTIMIGRAINE PREPARATIONS divalproex oral tablet extended release 24 hr 250 mg, 500 mg ergotamine-caffeine oral tablet isometh-dichloral-acetaminophn oral capsule migergot rectal suppository Depakote ER Cafergot Nodolor naratriptan oral tablet Amerge nodolor oral capsule sumatriptan nasal spray,non-aerosol Imitrex PA; sumatriptan succinate oral tablet Imitrex sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml, 6 mg/0.5 ml Imitrex STATdose Kit Refill Imitrex STATdose Pen PA; PA; sumatriptan succinate subcutaneous solution Imitrex PA; sumatriptan succinate subcutaneous syringe ANTIPARKINSONISM DRUGS, ANTICHOLINERGIC benztropine oral tablet trihexyphenidyl oral elixir trihexyphenidyl oral tablet ANTIPARKINSONISM DRUGS, OTHER PA; amantadine hcl oral capsule amantadine hcl oral solution amantadine hcl oral tablet bromocriptine oral capsule bromocriptine oral tablet carbidopa-levodopa oral tablet carbidopa-levodopa oral tablet extended release carbidopa-levodopa oral tablet,disintegrating carbidopa-levodopa-entacapone oral tablet mg Parlodel Parlodel Sinemet Sinemet CR Stalevo 50 30

32 carbidopa-levodopa-entacapone oral tablet mg carbidopa-levodopa-entacapone oral tablet mg carbidopa-levodopa-entacapone oral tablet mg carbidopa-levodopa-entacapone oral tablet mg carbidopa-levodopa-entacapone oral tablet mg entacapone oral tablet Stalevo 75 Stalevo 100 Stalevo 125 Stalevo 150 Stalevo 200 Comtan pramipexole oral tablet Mirapex ropinirole oral tablet selegiline hcl oral capsule selegiline hcl oral tablet ANTIPSYCHOTICS, ATYPIC DOPAMINE, AND SEROTONIN ANTAGONISTS ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING Requip Eldepryl PA; ; PA; aripiprazole oral tablet Abilify PA; ; ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING PA; clozapine oral tablet 100 mg, 25 mg Clozaril ; clozapine oral tablet 200 mg, 50 mg 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 INVEGA TRINZA INTRAMUSCULAR SYRINGE olanzapine intramuscular recon soln Zyprexa olanzapine oral tablet Zyprexa paliperidone oral tablet extended release 24hr Invega quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg Seroquel quetiapine oral tablet 300 mg, 400 mg Seroquel RISPERD CONSTA INTRAMUSCULAR SYRINGE ; PA; ; PA; ; ; PA; ; risperidone oral solution Risperdal ; risperidone oral tablet 0.25 mg, 1 mg, 2 mg, 3 mg, 4 mg Risperdal ; 31

33 risperidone oral tablet 0.5 mg Risperdal ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION ANTIPSYCHOTICS, TYPIC chlorpromazine oral tablet fluphenazine decanoate injection solution fluphenazine hcl injection solution fluphenazine hcl oral concentrate fluphenazine hcl oral elixir fluphenazine hcl oral tablet haloperidol decanoate intramuscular solution 100 mg/ml haloperidol decanoate intramuscular solution 50 mg/ml Geodon Haldol Decanoate Haldol Decanoate haloperidol lactate injection solution Haldol haloperidol lactate oral concentrate haloperidol oral tablet loxapine succinate oral capsule perphenazine oral tablet prochlorperazine maleate oral tablet thioridazine oral tablet thiothixene oral capsule trifluoperazine oral tablet ATTENTION DEFICIT - HYPERACTIVITY (ADHD)/NARCOLEPSY atomoxetine oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg caffeine citrate intravenous solution caffeine citrate oral solution clonidine hcl oral tablet extended release 12 hr dexmethylphenidate oral capsule,er biphasic mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg dexmethylphenidate oral capsule,er biphasic mg, 35 mg Compazine Strattera Cafcit Kapvay Focalin XR Focalin XR dexmethylphenidate oral tablet 10 mg, 2.5 mg Focalin PA; ; PA; ; PA; DO; PA; ; PA; ; PA; PA; dexmethylphenidate oral tablet 5 mg Focalin PA; ; dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg Dexedrine Spansule PA; ; 32

34 dextroamphetamine oral tablet 10 mg, 5 mg Zenzedi PA; ; dextroamphetamine-amphetamine oral capsule,extended release 24hr Adderall XR PA; ; dextroamphetamine-amphetamine oral tablet Adderall PA; metadate er oral tablet extended release methylphenidate hcl oral capsule, er biphasic mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg methylphenidate hcl oral capsule,er biphasic mg, 30 mg, 40 mg methylphenidate hcl oral capsule,er biphasic mg Ritalin LA PA; ; PA; ; PA; ; PA; methylphenidate hcl oral solution Methylin PA; methylphenidate hcl oral tablet Ritalin PA; methylphenidate hcl oral tablet extended release 10 mg methylphenidate hcl oral tablet extended release 20 mg methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg BENZODIAZEPINES amitriptyline-chlordiazepoxide oral tablet diazepam intensol oral concentrate diazepam oral concentrate diazepam oral solution diazepam oral tablet Metadate ER Concerta Diazepam Intensol Valium diazepam rectal kit Diastat AcuDial lorazepam oral tablet MAO INHIBITORS Ativan PA; PA; ; PA; ; phenelzine oral tablet tranylcypromine oral tablet NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIBITORS (NDRIS) bupropion hcl oral tablet bupropion hcl oral tablet extended release 12 hr bupropion hcl oral tablet extended release 24 hr SEDATIVE-HYPNOTIC - ANTIHISTAMINES Nardil Parnate Wellbutrin SR Wellbutrin XL alka-seltzer plus allergy oral tablet diphenhydramine hcl oral capsule 25 mg Aler-Cap ; 33

35 diphenhydramine hcl oral capsule 50 mg Banophen diphenhydramine hcl oral tablet Alka-Seltzer Plus Allergy ; nightime sleep oral capsule nighttime sleep aid (diphen) oral capsule nighttime sleep aid (diphen) oral tablet rest simply nighttime sleep oral tablet restfully sleep oral tablet sleep aid (diphenhydramine) oral capsule sleep aid (diphenhydramine) oral liquid sleep aid (diphenhydramine) oral tablet sleep aid (doxylamine) oral tablet sleep aid max str (diphenhydr) oral capsule sleep ii oral tablet sleep oral tablet sleep tablet (diphenhydramine) oral tablet sleep-tabs oral tablet ultra sleep (doxylamine succ) oral tablet UNISOM (DIPHENHYDRAMINE) OR LIQUID UNISOM SLEEPGELS OR CAPSULE wal-sleep z oral liquid wal-som (diphenhydramine) oral capsule ZZZQUIL OR CAPSULE ZZZQUIL OR LIQUID SEDATIVE-HYPNOTICS, BARBITURATES phenobarbital oral elixir phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg phenobarbital oral tablet 32.4 mg SEDATIVE-HYPNOTICS, NON- BARBITURATES estazolam oral tablet flurazepam oral capsule melatonin (with b6) oral tablet ; melatonin-pyridoxine (vit b6) oral tablet Melatonin (with B6) ; temazepam oral capsule 15 mg, 30 mg Restoril temazepam oral capsule 22.5 mg, 7.5 mg Restoril triazolam oral tablet Halcion zaleplon oral capsule Sonata 34

36 zolpidem oral tablet Ambien SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) citalopram oral solution citalopram oral tablet escitalopram oxalate oral solution escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg Celexa Lexapro fluoxetine oral capsule 10 mg, 20 mg, 40 mg Prozac fluoxetine oral capsule,delayed release(dr/ec) fluoxetine oral solution fluoxetine oral tablet fluvoxamine oral tablet Sarafem paroxetine hcl oral tablet 10 mg, 20 mg Paxil paroxetine hcl oral tablet 30 mg, 40 mg paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 37.5 mg paroxetine hcl oral tablet extended release 24 hr 25 mg Paxil Paxil CR Paxil CR sertraline oral concentrate Zoloft sertraline oral tablet 100 mg Zoloft sertraline oral tablet 25 mg, 50 mg Zoloft SEROTONIN-2 ANTAGONIST REUPTAKE INHIBITORS (SARIS) nefazodone oral tablet trazodone oral tablet SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 mg venlafaxine oral tablet venlafaxine oral tablet extended release 24hr TRICYCLIC ANTIDEPRESSANT/BENZODIAZEPINE COMBINATIONS amitriptyline-chlordiazepoxide oral tablet TRICYCLIC ANTIDEPRESSANT/PHENOTHIAZINE COMBINATIONS perphenazine-amitriptyline oral tablet Effexor XR 35

37 TRICYCLIC ANTIDEPRESSANTS AND RELATED NON-SELECT REUPTAKE INHIBITORS amitriptyline oral tablet amoxapine oral tablet clomipramine oral capsule desipramine oral tablet doxepin oral capsule doxepin oral concentrate imipramine hcl oral tablet imipramine pamoate oral capsule maprotiline oral tablet nortriptyline oral capsule nortriptyline oral solution protriptyline oral tablet trimipramine oral capsule CHEMIC DEPENDENCY, AGENTS TO TREAT COHOL ANTAGONIST acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet NARCOTIC ANTAGONISTS buprenorphine hcl sublingual tablet 2 mg, 8 mg buprenorphine-naloxone sublingual tablet mg, 8-2 mg SUBOXONE SUBLINGU FILM 12-3 MG, MG, 4-1 MG, 8-2 MG SMOKING DETERRENT AGENTS Anafranil Norpramin Tofranil Pamelor Surmontil Antabuse PA; PA; bupropion hcl (smoking deter) oral tablet extended release 12 hr bupropion hcl oral tablet extended release 12 hr nicorelief buccal gum NICORETTE BUCC LOZENGE NICORETTE BUCC MINI LOZENGE Zyban Wellbutrin SR ; ; ; nicotine (polacrilex) buccal gum Nicorelief ; nicotine (polacrilex) buccal lozenge Nicorette ; nicotine (polacrilex) buccal mini lozenge Nicorette ; nicotine transdermal patch 24 hour Nicoderm CQ ; 36

38 nts step 1 transdermal patch 24 hour quit 2 buccal gum quit 4 buccal gum stop smoking aid buccal lozenge CHEMICS-PHARMACEUTIC ADJUVANTS CHEMICS - SOLVENTS alcohol, rubbing solution isopropyl alcohol solution PHARMACEUTIC ADJUVANT - CREAM/OINTMENT VEHICLES ; ; ; ; dermafix topical ointment petrolatum topical ointment petroleum jelly topical gel petroleum jelly, white topical gel white petrolatum topical gel Lip Treatment white petroleum jelly topical gel PHARMACEUTIC ADJUVANT - INHATION VEHICLES HYPER-S INHATION SOLUTION FOR NEBULIZATION NEBUS INHATION SOLUTION FOR NEBULIZATION pulmosal inhalation solution for nebulization sodium chloride inhalation solution for nebulization COGNITIVE DISORDER THERAPY CHOLINESTERASE INHIBITORS NebuSal donepezil oral tablet 10 mg, 5 mg Aricept donepezil oral tablet 23 mg Aricept PA; donepezil oral tablet,disintegrating galantamine oral capsule,ext rel. pellets 24 hr galantamine oral solution galantamine oral tablet memantine oral solution memantine oral tablet memantine oral tablets,dose pack NAMENDA TITRATION PAK OR TABLETS,DOSE PACK rivastigmine tartrate oral capsule Razadyne ER Razadyne Namenda Namenda Titration Pak 37

39 CONTRACEPTIVES CONTRACEPTIVES altavera (28) oral tablet ; alyacen 1/35 (28) oral tablet alyacen 7/7/7 (28) oral tablet amethia lo oral tablets,dose pack,3 month ; amethia oral tablets,dose pack,3 month ; amethyst oral tablet apri oral tablet aranelle (28) oral tablet ashlyna oral tablets,dose pack,3 month ; aubra oral tablet aviane oral tablet azurette (28) oral tablet balziva (28) oral tablet bekyree (28) oral tablet blisovi 24 fe oral tablet blisovi fe 1.5/30 (28) oral tablet blisovi fe 1/20 (28) oral tablet briellyn oral tablet camila oral tablet camrese lo oral tablets,dose pack,3 month ; camrese oral tablets,dose pack,3 month ; caziant (28) oral tablet chateal oral tablet ; cryselle (28) oral tablet cyclafem 1/35 (28) oral tablet cyclafem 7/7/7 (28) oral tablet cyred oral tablet dasetta 1/35 (28) oral tablet dasetta 7/7/7 (28) oral tablet daysee oral tablets,dose pack,3 month ; deblitane oral tablet delyla (28) oral tablet desog-e.estradiol/e.estradiol oral tablet Azurette (28) desogestrel-ethinyl estradiol oral tablet Apri drospirenone-e.estradiol-lm.fa oral tablet Beyaz drospirenone-ethinyl estradiol oral tablet Ocella elinest oral tablet 38