Formulario Comprensivo

Transcription

1 Formulario Comprensivo 2016 Lista de Medicamentos cubiertos Actualizado diciembre 1, 2016 Viva Saludable! Elija HEALTH CHOICE HealthChoiceEssential.com

2 Formulario integral de 2016 Introducción Health Choice Insurance Co. utiliza un Comité Farmacéutico y Terapéutico (Comité P&T) compuesto por médicos, farmacéuticos y enfermeros para ayudarnos a asegurarnos de que nuestra lista de medicamentos (formulario) sea médicamente adecuada y que apoye a la salud de los pacientes. Este comité revisa y evalúa medicamentos del formulario basándose en la seguridad y eficacia para ayudar a mantener la integridad clínica en todas las categorías terapéuticas. Los medicamentos recetados cubiertos por Health Choice Insurance Co. deben ser recetados por su médico y deben ser productos aprobados por la FDA (Administración de Alimentos y Medicamentos de los EE. UU.). Lista de medicamentos (Formulario) El formulario de Health Choice Insurance Co es de carácter cerrado, lo cual significa que si el medicamento no se encuentra en el formulario (lista de medicamentos cubiertos), no será cubierto a menos que su médico explique el motivo por el cual los otros medicamentos del formulario no surtirán efecto para su afección médica. El formulario es muy exhaustivo y tiene muchos medicamentos genéricos y de marca que tratan muchas afecciones médicas. Los medicamentos se encuentran en niveles, los cuales determinan su costo. Los medicamentos que se encuentran en los niveles más altos generalmente son más costosos. : Medicamentos genéricos : Medicamentos de marca preferidos : Medicamentos no preferidos Nivel 4: Medicamentos de especialidad Nivel 5: Medicamentos orales de especialidad contra el cáncer : Sin costo compartido, Medicamentos de salud preventiva Dentro de cada categoría y clase de medicamentos, los medicamentos se listan en orden alfabético, por nombre del producto farmacológico. Los medicamentos en cursiva y minúscula son medicamentos genéricos (como glipizida) y los incluidos en mayúscula (como JANUVIA) son medicamentos de marca. Los medicamentos de marca están incluidos en la lista como productos de marca preferidos (), productos de marca no preferidos (), medicamentos de especialidad (Nivel 4) y medicamentos orales de especialidad contra el cáncer, genéricos y medicamentos de marca (Nivel 5). i

3 Los medicamentos de salud preventiva para hombres, mujeres y niños del Nivel 6 están cubiertos según los requisitos de la Ley de Atención de Salud Asequible de Estos medicamentos están cubiertos sin costo, sin copago y sin tener que alcanzar el deducible del plan cuando se cumplen ciertos criterios. Para los medicamentos recetados para los que existe un producto genérico, el producto genérico se encontrará en la lista pero no el producto de marca. Para evitar costos adicionales, los afiliados deben pedir a sus médicos que les receten los medicamentos genéricos equivalentes que estén disponibles. La mayoría de los medicamentos de la lista tienen un copago o coaseguro. El copago o coaseguro es una porción del costo que el afiliado debe pagar por algún medicamento cubierto en la lista. Para obtener información sobre los copagos de los medicamentos recetados, consulte el Programa de Beneficios de Health Choice Insurance. Terminología común de medicamentos recetados Medicamentos genéricos: los medicamentos comercializados sin marca son por lo general más baratos que los medicamentos de marca registrada. Son idénticos a los medicamentos de marca, desde el punto de vista químico, y cumplen con los mismos estándares de la FDA (Administración de Alimentos y Medicamentos de los EE. UU.) en cuanto a seguridad, pureza y eficacia. Medicamentos preferidos de marca: medicamentos que se encuentran en la lista (formulario) con un nombre de marca y están protegidos por una patente. Estos medicamentos cumplen con los estándares de la FDA sobre seguridad, pureza y eficacia. Estos medicamentos de marca se prefieren en comparación con otros medicamentos de marca por su mayor eficacia o menor costo. Estos medicamentos se usan cuando no hay un medicamento genérico disponible para tratar su problema de salud. Medicamentos de marca no preferidos: medicamentos que se encuentran en el formulario con un nombre de marca y están protegidos por una patente. Estos medicamentos cumplen con los estándares de la FDA sobre seguridad, pureza y eficacia. Estos medicamentos se usan generalmente cuando no hay un medicamento preferido de marca o genérico disponible para tratar su problema médico. El costo de estos medicamentos suele ser mayor que el de los medicamentos genéricos o de los medicamentos preferidos de marca que se pueden utilizar para tratar su afección. Medicamentos de especialidades: medicamentos que son únicos o medicamentos con un costo muy alto que se utilizan para tratar problemas médicos raros o complejos. Los medicamentos orales contra el cáncer son de ii

4 especialidad. Medicamentos de salud preventiva: medicamentos cubiertos por la Ley de Atención de Salud Asequible. La Ley de Atención de Salud Asequible de 2010 exige la cobertura de ciertos medicamentos preventivos para hombres, mujeres y niños. Estos medicamentos están incluidos en el formulario y son cubiertos sin costo, sin un copago, ni es necesario cumplir con el deducible del plan cuando se cumplen ciertos criterios específicos. Estos medicamentos preventivos incluyen productos como aspirina, ácido fólico, hierro y complementos de flúor, ciertos anticonceptivos y vacunas. Administración de medicamentos Algunos de los medicamentos del formulario están sujetos a restricciones de administración de medicamentos. Estas restricciones promueven el uso seguro y eficaz de los medicamentos. Las restricciones incluyen límites a la edad (AL), género (GL) y/o cantidad (QL), terapia escalonada (ST) y autorización previa (PA). Las restricciones de administración de medicamentos están sujetas a cambios de acuerdo con lo requerido por la evidencia clínica. Nuestro formulario indica si un medicamento necesita PA, ST, QL, GL o AL. A continuación se indican las restricciones más comunes sobre la administración de medicamentos. Autorización previa: para surtir una receta es necesario que usted o su médico obtengan una aprobación previa. Si no obtiene la aprobación, puede que Health Choice no cubra el medicamento. Los criterios de la autorización previa toman como punto de partida los lineamientos reconocidos en toda la nación; las indicaciones aprobadas de la FDA (Administración de Alimentos y Medicamentos de los EE. UU.) y los estándares de prácticas aceptados. La autorización previa es común para medicamentos de especialidad. Terapia escalonada: se necesita que primero pruebe un medicamento determinado para tratar su problema de salud antes de que cubramos otro medicamento para esa afección. Por ejemplo, si un Medicamento A y un medicamento B sirven para tratar su afección, es posible que Health Choice no cubra el medicamento B a menos que usted pruebe primero con el medicamento A. Si el medicamento A no hace efecto, entonces cubriremos el medicamento B. Límites de cantidad: limitan la cantidad del medicamento cubierto por cada surtido de 30 días. Para obtener información detallada sobre los medicamentos que requieren una aprobación previa, terapia escalonada o tienen límites en la cantidad, ingrese a nuestro sitio web iii

5 Administración de medicamentos de especialidad Ciertos medicamentos utilizados para tratar enfermedades complejas son manejados a través de nuestra farmacia de especialidad, Orchard Specialty. El propósito de la farmacia de especialidad es ayudarle mediante la supervisión de sus necesidades de medicamentos para afecciones como esclerosis múltiple, artritis reumatoide, cáncer, hepatitis, psoriasis y trasplantes, y brindar educación a los pacientes. El programa ayuda a los afiliados con el uso de medicamentos que requieren métodos de administración complejos, almacenamiento y manipulación especiales, además de requerir supervisión estrecha del paciente para asegurar que el medicamento funcione para el afiliado. Los medicamentos solo se pueden obtener a través de Orchard Speciality y solo se despachan en suministros de 30 días. Un representante de la farmacia de especialidades podrá comunicarse con usted para ayudarle a registrarse en el programa de especialidades. El personal capacitado de la farmacia de especialidades se encuentra disponible para ayudarlo las 24 horas del día, los 7 días de la semana. iv

6 Compania de Seguros de Health Choice 2016 Formulario--Actualizado diciembre 2016 Table of Contents Agentes Antidemencia (Nervio Condición Drogas)... 3 Agentes Antiespásticos (Drogas Musculares Y Articulares)... 3 Agentes Antigout (Dolor, Inflamación, Músculo, Condición Común De Drogas)... 4 Agentes Antiinflamatorios (Dolor, Inflamación, Músculo, Condición Común De Drogas)... 4 Agentes Antiparkinsonianos (Nervio Condición Drogas)... 5 Agentes Bipolares (Nervio Condición Drogas)... 6 Agentes Cardiovasculares (Corazón Y Circulación Condición Drogas)... 7 Agentes De Desorden De Sueño (Sueño Condición Drogas) Agentes De Enfermedad Inflamatoria Intestinal (Fármacos Del Intestino, Instestine Y Condición Del Estómago) Agentes De Enfermedad Metabólica Del Hueso (Medicamentos Hormonales Y Hueso) Agentes De Las Vías Respiratorias (Alergias, Tos, Frío Y Medicamentos De Condición De Pulmón) Agentes De Tratamiento De Abuso De Sustancias-Addiction Agentes De Tratamiento De Aciduria Orótica Hereditaria Agentes Del Sistema Nervioso Central (Nervio Condición Drogas) Agentes Dentales Y Orales Agentes Dentales Y Orales (Medicamentos Para La Boca) Agentes Dermatológicos (Drogas Que Afectan La Piel) Agentes Gastrointestinales (Fármacos Del Intestino, Instestine Y Condición Del Estómago) Agentes Genitourinarios (Vejiga, Genitales Y Afección Renal Fármacos) Agentes Hematopoyéticos Agentes Hormonales Estimulante / Reemplazo / Modificar (Suprarrenales) Agentes Hormonales, Estimulante / Reemplazo / Modificadores (Hormonas Sexuales / Modificadores) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Estimulante / Reemplazo / Modificar (Suprarrenales) Agentes Hormonales, Estimulante/Reemplazo/Modificar (Paratiroides) Agentes Hormonales, Estimulante/Reemplazo/Modificar (Pituitaria) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Estimulante/Reemplazo/Modificar (Tiroides) (Fármacos Hormonas Y Diabetes) Agentes Hormonales, Supresor (Paratiroides) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Supresor (Pituitaria) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Supresor (Tiroides) (Fármacos Hormonas Y Diabetes) Agentes Inmunológicos (Drogas Que Afectan El Sistema Inmunológico) Agentes Oftálmicos (Medicamentos Para Los Ojos) Agentes Óticos (Oído Drogas) Agentes Pulmonares Y Vías Respiratorias Agentes Pulmonares Y Vías Respiratorias (Alergias, Tos, Frío Y Medicamentos De Condición De Pulmón) Analgésicos (Dolor, Inflamación, Músculo, Condición Común De Drogas) Anestésicos (Medicamentos De Anestesia) Ansiolíticos (Medicamentos De Condición De Nervio) Antibacterianos (Infección Lucha Contra Drogas) Anticonceptivos Anticonvulsivos (Medicamentos De Condición De Nervio)

7 Antidepresivos Antidepresivos (Medicamentos De Condición De Nervio) Antieméticos (Medicamentos Del Intestino, Instestine Y Condición Del Estómago) Antifúngicos (Infección Lucha Contra Drogas) Antimicobacterianos (Infección Lucha Contra Drogas) Antimigraine Agentes (Medicamentos De Condición De Nervio) Antimyasthenic Agentes (Medicamentos De Condición De Nervio) Antineoplásicos (Fármacos Contra El Cáncer) Antiparasitarios (Infección Lucha Contra Drogas) Antipsicóticos (Medicamentos De Condición De Nervio) Antivirales (Infección Lucha Contra Drogas) Miscellaneous (Misceláneos) Nutrientes Terapéuticos / Minerales / Electrolitos (Soluciones De Reemplazo Y Multivitaminas) Reemplazo De Enzimas / Modificadores (Medicamentos De Hormonas Y Enzimas) Reguladores De Glucosa De Sangre (Hormonas Y Diabetes Drogas) Relajantes De Músculo Esquelético (Drogas Musculares Y Articulares) Sangre Productos/Modificadores/Expansores De Volumen (Sangre Trastorno Medicamentos) Tos/Resfriado/Alergia

8 Compania de Seguros de Health Choice 2016 Formulario--Actualizado diciembre 2016 Drug Status Notes Agentes Antidemencia (Nervio Condición Drogas) Agentes Antidemencia, Otros (De Alzeimer Y Demencia) ergoloid mesylates oral tablet Antagonista De Los Receptores N-Metil-D-Aspartato (Nmda) (De Alzeimer Y Demencia) NAMENDA ORAL SOLUTION NAMENDA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR NAMENDA XR TITRATION PACK ORAL CAPSULE EXTENDED RELEASE 24 HOUR Inhibidores De La Colinesterasa (De Alzeimer Y Demencia) donepezil hcl oral tablet donepezil hcl oral tablet dispersible galantamine hydrobromide er oral capsule extended release 24 hour galantamine hydrobromide oral solution galantamine hydrobromide oral tablet rivastigmine tartrate oral capsule rivastigmine transdermal patch 24 hr Agentes Antiespásticos (Drogas Musculares Y Articulares) Agentes Antiespásticos (Drogas Musculares Y Articulares) GABLOFEN INTRATHECAL* SOLUTION 50 MCG/ML 3

9 Agentes Antigout (Dolor, Inflamación, Músculo, Condición Común De Drogas) Antigout Agentes (Medicamentos De Gota) allopurinol oral tablet COLCRYS ORAL TABLET probenecid oral tablet ULORIC ORAL TABLET ST Agentes Antiinflamatorios (Dolor, Inflamación, Músculo, Condición Común De Drogas) Antiinflamatorios No Esteroideos (Dolor, Antiinflamatorios) celecoxib oral capsule diclofenac potassium oral tablet diclofenac sodium er oral tablet extended release 24 hr* diclofenac sodium oral tablet delayed release diclofenac-misoprostol oral tablet delayed release etodolac er oral tablet extended release 24 hr* etodolac oral capsule etodolac oral tablet fenoprofen calcium oral tablet flurbiprofen oral tablet ibuprofen childrens oral suspension OTC ibuprofen oral tablet 400 mg, 600 mg, 800 mg indomethacin er oral capsule extended release* indomethacin oral capsule ketoprofen er oral capsule extended release 24 hour ketoprofen oral capsule ketorolac tromethamine injection solution ketorolac tromethamine intramuscular* solution 60 mg/2ml 4

10 ketorolac tromethamine oral tablet QL (20 EA per 5 days) meclofenamate sodium oral capsule mefenamic acid oral capsule meloxicam oral tablet nabumetone oral tablet naproxen dr oral tablet delayed release naproxen oral suspension naproxen oral tablet naproxen sodium oral tablet 275 mg, 550 mg oxaprozin oral tablet piroxicam oral capsule sulindac oral tablet tolmetin sodium oral capsule tolmetin sodium oral tablet 600 mg Salicilatos adult aspirin low strength oral tablet dispersible aspirin adult low dose oral tablet delayed release OTC OTC aspirin ec oral tablet delayed release 325 mg OTC aspirin low dose oral tablet chewable OTC aspirin oral tablet 325 mg OTC BAYER ASPIRIN EXTRA STRENGTH ORAL TABLET diflunisal oral tablet OTC tri-buffered aspirin oral tablet 325 mg OTC Agentes Antiparkinsonianos (Nervio Condición Drogas) Agentes Antiparkinsonianos Otros (Medicamentos De La Enfermedad De Parkinson) amantadine hcl oral capsule amantadine hcl oral syrup amantadine hcl oral tablet entacapone oral tablet Agonistas De La Dopamina (Droga De La Enfermedad De Parkinson) APOKYN SUBCUTANEOUS* SOLUTION Nivel 4 5

11 bromocriptine mesylate oral capsule bromocriptine mesylate oral tablet pramipexole dihydrochloride oral tablet ropinirole hcl er oral tablet extended release 24 hr* ropinirole hcl oral tablet Anticolinérgicos (Medicamentos De La Enfermedad De Parkinson) benztropine mesylate injection solution benztropine mesylate oral tablet trihexyphenidyl hcl oral elixir trihexyphenidyl hcl oral tablet Inhibidores De La Monoaminooxidasa B (Mao-B) (Enfermedad De Parkinson Medicamentos) AZILECT ORAL TABLET selegiline hcl oral capsule selegiline hcl oral tablet Precursores De La Dopamina / L-Aminoácido Descarboxilasa Inhibidores (Medicamentos De La Enfermedad De Parkinson) carbidopa-levodopa er oral tablet extendedrelease* mg, mg carbidopa-levodopa oral tablet carbidopa-levodopa oral tablet dispersible carbidopa-levodopa-entacapone oral tablet Agentes Bipolares (Nervio Condición Drogas) Estabilizadores Del Ánimo (Nervio Varios Medicamentos De Condición) lithium carbonate er oral tablet extendedrelease* lithium carbonate oral capsule lithium carbonate oral tablet 6

12 Agentes Cardiovasculares (Corazón Y Circulación Condición Drogas) Acción Directa De Vasodilatadores Arteriales (Fármacos Misceláneo Corazón Y Circulación) hydralazine hcl injection solution hydralazine hcl oral tablet minoxidil oral tablet Agentes Cardiovasculares, Otros digoxin injection solution digoxin oral solution digoxin oral tablet PA epinephrine hcl pf intravenous* solution midodrine hcl oral tablet pentoxifylline er oral tablet extendedrelease* RANEXA ORAL TABLET EXTENDED RELEASE 12 HR* TEKTURNA ORAL TABLET Agentes De Bloqueo Alfa-Adrenérgico (Fármacos Para La Presión Arterial) clonidine hcl oral tablet clonidine hcl transdermal patch weekly doxazosin mesylate oral tablet guanfacine hcl oral tablet methyldopa oral tablet methyldopate hcl intravenous* solution prazosin hcl oral capsule terazosin hcl oral capsule Agentes De Bloqueo Beta-Adrenérgicos (Fármacos Para La Presión Arterial) acebutolol hcl oral capsule atenolol oral tablet betaxolol hcl oral tablet bisoprolol fumarate oral tablet carvedilol oral tablet 7

13 INNOPRAN XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR labetalol hcl intravenous* solution labetalol hcl oral tablet metoprolol succinate er oral tablet extended release 24 hr* metoprolol tartrate intravenous* solution 1 mg/ml metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg nadolol oral tablet 20 mg, 40 mg, 80 mg pindolol oral tablet propranolol hcl er oral capsule extended release 24 hour propranolol hcl intravenous* solution propranolol hcl oral solution propranolol hcl oral tablet sotalol hcl (af) oral tablet sotalol hcl oral tablet timolol maleate oral tablet Antagonistas De Los Receptores De Angiotensina Ii (Fármacos Para La Presión Arterial) ATACAND ORAL TABLET 16 MG, 32 MG candesartan cilexetil oral tablet candesartan cilexetil-hctz oral tablet EDARBI ORAL TABLET ST eprosartan mesylate oral tablet irbesartan oral tablet losartan potassium oral tablet olmesartan medoxomil oral tablet telmisartan oral tablet valsartan oral tablet Antiarrítmicos (Medicamentos De Regulación Del Corazón) amiodarone hcl intravenous* solution amiodarone hcl oral tablet disopyramide phosphate oral capsule 8

14 dofetilide oral capsule flecainide acetate oral tablet mexiletine hcl oral capsule MULTAQ ORAL TABLET PACERONE ORAL TABLET 100 MG, 200 MG, 400 MG procainamide hcl injection solution 100 mg/ml propafenone hcl er oral capsule extended release 12 hour propafenone hcl oral tablet quinidine gluconate er oral tablet extendedrelease* quinidine sulfate er oral tablet extendedrelease* quinidine sulfate oral tablet Canales De Calcio Bloqueando A Agentes (Medicamentos De La Presión Arterial) amlodipine besylate oral tablet diltiazem cd oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg diltiazem hcl er beads oral capsule extended release 24 hour diltiazem hcl er coated beads oral capsule extended release 24 hour 300 mg, 360 mg diltiazem hcl er coated beads oral tablet extended release 24 hr* diltiazem hcl er oral capsule extended release 12 hour diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg diltiazem hcl intravenous* solution diltiazem hcl oral tablet felodipine er oral tablet extended release 24 hr* isradipine oral capsule nicardipine hcl oral capsule NIFEDIAC CC ORAL TABLET EXTENDED RELEASE 24 HR* 90 MG 9

15 nifedipine er oral tablet extended release 24 hr* 30 mg, 60 mg nifedipine er osmotic release oral tablet extended release 24 hr* nifedipine oral capsule nimodipine oral capsule Nivel 4 nisoldipine er oral tablet extended release 24 hr* verapamil hcl er oral capsule extended release 24 hour verapamil hcl er oral tablet extendedrelease* 120 mg, 180 mg, 240 mg verapamil hcl intravenous* solution verapamil hcl oral tablet Combinaciones De Antihipertensivos (Fármacos Para La Presión Arterial) amiloride-hydrochlorothiazide oral tablet amlodipine besy-benazepril hcl oral capsule amlodipine besylate-valsartan oral tablet amlodipine-atorvastatin oral tablet mg amlodipine-olmesartan oral tablet amlodipine-valsartan-hctz oral tablet AMTURNIDE ORAL TABLET atenolol-chlorthalidone oral tablet benazepril-hydrochlorothiazide oral tablet bisoprolol-hydrochlorothiazide oral tablet captopril-hydrochlorothiazide oral tablet EDARBYCLOR ORAL TABLET ST enalapril-hydrochlorothiazide oral tablet fosinopril sodium-hctz oral tablet irbesartan-hydrochlorothiazide oral tablet lisinopril-hydrochlorothiazide oral tablet losartan potassium-hctz oral tablet methyldopa-hydrochlorothiazide oral tablet metoprolol-hydrochlorothiazide oral tablet moexipril-hydrochlorothiazide oral tablet nadolol-bendroflumethiazide oral tablet 10

16 olmesartan medoxomil-hctz oral tablet olmesartan-amlodipine-hctz oral tablet propranolol-hctz oral tablet quinapril-hydrochlorothiazide oral tablet spironolactone-hctz oral tablet TEKAMLO ORAL TABLET TEKTURNA HCT ORAL TABLET telmisartan-amlodipine oral tablet telmisartan-hctz oral tablet TEVETEN HCT ORAL TABLET trandolapril-verapamil hcl er oral tablet extendedrelease* triamterene-hctz oral capsule triamterene-hctz oral tablet valsartan-hydrochlorothiazide oral tablet Diuréticos De Asa [Presión Arterial Medicamentos (Píldoras De Agua)] bumetanide injection solution bumetanide oral tablet furosemide injection solution 10 mg/ml furosemide oral solution 10 mg/ml, 8 mg/ml furosemide oral tablet torsemide oral tablet Diuréticos Inhibidores De La Anhidrasa Carbónica [Presión Arterial Medicamentos (Píldoras De Agua)] acetazolamide er oral capsule extended release 12 hour acetazolamide oral tablet methazolamide oral tablet NEPTAZANE ORAL TABLET Diuréticos Potasio-Escasamente [Presión Arterial Medicamentos (Píldoras De Agua)] amiloride hcl oral tablet DYRENIUM ORAL CAPSULE eplerenone oral tablet 11

17 spironolactone oral tablet Diuréticos Tiazídicos [Presión Arterial Medicamentos (Píldoras De Agua)] chlorothiazide oral tablet chlorthalidone oral tablet 25 mg, 50 mg hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet indapamide oral tablet methyclothiazide oral tablet metolazone oral tablet Dyslipidemics Derivados Del Ácido Fíbrico (Colesterol Medicamentos) fenofibrate micronized oral capsule fenofibrate oral capsule fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg fenofibric acid oral capsule delayed release gemfibrozil oral tablet LIPOFEN ORAL CAPSULE Dyslipidemics Hmg Coa Reductasa Inhibidores (Colesterol Medicamentos) ADVICOR ORAL TABLET EXTENDED RELEASE 24 HR* ALTOPREV ORAL TABLET EXTENDED RELEASE 24 HR* atorvastatin calcium oral tablet fluvastatin sodium er oral tablet extended release 24 hr* fluvastatin sodium oral capsule LESCOL XL ORAL TABLET EXTENDED RELEASE 24 HR* LIVALO ORAL TABLET lovastatin oral tablet pravastatin sodium oral tablet rosuvastatin calcium oral tablet simvastatin oral tablet 12

18 Dyslipidemics Otros (Colesterol Medicamentos) cholestyramine light oral packet cholestyramine light oral powder cholestyramine oral packet cholestyramine oral powder colestipol hcl oral granules colestipol hcl oral packet colestipol hcl oral tablet JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 5 MG Nivel 4 LOVAZA ORAL CAPSULE niacin er (antihyperlipidemic) oral tablet extendedrelease* NIACOR ORAL TABLET omega-3-acid ethyl esters oral capsule VYTORIN ORAL TABLET WELCHOL ORAL PACKET WELCHOL ORAL TABLET ZETIA ORAL TABLET Enzima Conversora De Angiotensina (Fármacos Para La Presión Arterial) benazepril hcl oral tablet captopril oral tablet enalapril maleate oral tablet fosinopril sodium oral tablet lisinopril oral tablet moexipril hcl oral tablet perindopril erbumine oral tablet quinapril hcl oral tablet ramipril oral capsule trandolapril oral tablet Vasodilatadores De Acción Directa Arterial/Venosa (Medicamentos De Dolor De Pecho) isosorbide dinitrate er oral tablet extendedrelease* 13

19 isosorbide dinitrate oral tablet isosorbide mononitrate er oral tablet extended release 24 hr* isosorbide mononitrate oral tablet nitroglycerin intravenous* solution nitroglycerin transdermal patch 24 hr nitroglycerin translingual aerosol, solution nitroglycerin translingual solution NITROLINGUAL TRANSLINGUAL SOLUTION NITROSTAT SUBLINGUAL TABLET SUBLINGUAL Agentes De Desorden De Sueño (Sueño Condición Drogas) Barbitúricos (Drogas De Sedación Y Sueño) SECONAL ORAL CAPSULE Benzodiazepinas (Fármacos De Sedación Y Sueño) estazolam oral tablet flurazepam hcl oral capsule temazepam oral capsule triazolam oral tablet Moduladores De Los Receptores De Gaba (Drogas De Sedación Y Sueño) eszopiclone oral tablet zaleplon oral capsule zolpidem tartrate oral tablet QL (30 EA per 30 days) Trastornos Del Sueño (Otras Drogas Sedación Y Sueño) modafinil oral tablet PA NUVIGIL ORAL TABLET 250 MG, 50 MG sleep-aid maximum strength oral capsule OTC XYREM ORAL SOLUTION Nivel 4 14

20 Agentes De Enfermedad Inflamatoria Intestinal (Fármacos Del Intestino, Instestine Y Condición Del Estómago) Aminosalicilatos (Medicamentos De Tratamiento Del Intestino) APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR ASACOL HD ORAL TABLET DELAYED RELEASE balsalazide disodium oral capsule mesalamine enema mesalamine-cleanser kit ROWASA KIT SFROWASA ENEMA Sulfonamidas (Medicamentos De Tratamiento Del Intestino) DIPENTUM ORAL CAPSULE sulfasalazine oral tablet sulfasalazine oral tablet delayed release Agentes De Enfermedad Metabólica Del Hueso (Medicamentos Hormonales Y Hueso) * Los Bifosfonatos *** alendronate sodium oral tablet 10 mg, 40 mg, 5 mg QL (30 EA per 30 days) alendronate sodium oral tablet 35 mg QL (8 EA per 28 days) alendronate sodium oral tablet 70 mg QL (4 EA per 28 days) FOSAMAX PLUS D ORAL TABLET ibandronate sodium oral tablet pamidronate disodium intravenous* solution Agentes De Enfermedad Metabólica Del Hueso (Osteoporosis Medicamentos) calcitonin (salmon) nasal solution calcitriol intravenous* solution 1 mcg/ml calcitriol oral capsule calcitriol oral solution 15

21 doxercalciferol oral capsule FORTEO SUBCUTANEOUS* SOLUTION 600 MCG/2.4ML pamidronate disodium intravenous* solution reconstituted Nivel 4 paricalcitol intravenous* solution paricalcitol oral capsule PROLIA SUBCUTANEOUS* SOLUTION Nivel 4 RECLAST INTRAVENOUS* SOLUTION Nivel 4 risedronate sodium oral tablet 150 mg risedronate sodium oral tablet delayed release XGEVA SUBCUTANEOUS* SOLUTION Nivel 4 ZEMPLAR INTRAVENOUS* SOLUTION zoledronic acid intravenous* concentrate zoledronic acid intravenous* solution 5 mg/100ml zoledronic acid intravenous* solution reconstituted Agentes De Las Vías Respiratorias (Alergias, Tos, Frío Y Medicamentos De Condición De Pulmón) Antihistamínicos (Medicamentos De Alergias, Pulmón) ARBINOXA ORAL SOLUTION PA carbinoxamine maleate oral solution cetirizine hcl oral solution clemastine fumarate oral syrup clemastine fumarate oral tablet 2.68 mg cyproheptadine hcl oral syrup cyproheptadine hcl oral tablet desloratadine oral tablet desloratadine oral tablet dispersible diphenhydramine hcl injection solution diphenhydramine hcl oral capsule 25 mg OTC diphenhydramine hcl oral capsule 50 mg OTC diphenhydramine hcl oral elixir OTC diphenhydramine hcl oral liquid OTC 16

22 levocetirizine dihydrochloride oral solution levocetirizine dihydrochloride oral tablet WAL-DRYL ALLERGY CHILDRENS ORAL LIQUID Antiinflamatorios Inhalan Corticosteroides (Medicamentos De Asma, Pulmón) AEROSPAN INHALATION AEROSOL, SOLUTION budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml FLOVENT DISKUS INHALATION AEROSOL POWDER, BREATH ACTIVATED FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT FLOVENT HFA INHALATION AEROSOL 44 MCG/ACT PULMICORT FLEXHALER INHALATION AEROSOL POWDER, BREATH ACTIVATED QVAR INHALATION AEROSOL, SOLUTION 40 MCG/ACT, 80 MCG/ACT Antileucotrienos (Fármacos De Asma, Pulmón) montelukast sodium oral packet montelukast sodium oral tablet montelukast sodium oral tablet chewable zafirlukast oral tablet ZYFLO CR ORAL TABLET EXTENDED RELEASE 12 HR* ZYFLO ORAL TABLET Broncodilatadores Anticolinérgicos (Medicamentos De Asma, Pulmón) ATROVENT HFA INHALATION AEROSOL, SOLUTION INCRUSE ELLIPTA INHALATION AEROSOL POWDER, BREATH ACTIVATED ipratropium bromide inhalation solution SPIRIVA HANDIHALER INHALATION CAPSULE OTC QL (60 EA per 30 days) QL (24 GM per 30 days) QL (22 GM per 30 days) QL (15 GM per 30 days) QL (13 GM per 30 days) QL (30 EA per 30 days) 17

23 Broncodilatadores Simpaticomiméticos (Medicamentos De Asma, Pulmón) ADVAIR DISKUS INHALATION AEROSOL POWDER, BREATH ACTIVATED QL (60 EA per 30 days) ADVAIR HFA INHALATION AEROSOL QL (12 GM per 30 days) albuterol sulfate er oral tablet extended release 12 hr* albuterol sulfate inhalation nebulization solution albuterol sulfate oral syrup albuterol sulfate oral tablet BREO ELLIPTA INHALATION AEROSOL POWDER, BREATH ACTIVATED MCG/INH COMBIVENT RESPIMAT INHALATION AEROSOL, SOLUTION DULERA INHALATION AEROSOL epinephrine hcl injection solution 1 mg/ml ipratropium-albuterol inhalation solution levalbuterol hcl inhalation nebulization solution metaproterenol sulfate oral syrup PROAIR HFA INHALATION AEROSOL, SOLUTION SEREVENT DISKUS INHALATION AEROSOL POWDER, BREATH ACTIVATED STIOLTO RESPIMAT INHALATION AEROSOL, SOLUTION QL (4 GM per 30 days) QL (17 GM per 30 days) QL (60 EA per 30 days) SYMBICORT INHALATION AEROSOL QL (11 GM per 30 days) terbutaline sulfate injection solution VENTOLIN HFA INHALATION AEROSOL, SOLUTION Estabilizadores De Mastocitos (Medicamentos De Asma, Pulmón) cromolyn sodium inhalation nebulization solution QL (36 GM per 30 days) 18

24 Inhibidores De La Fosfodiesterasa De Broncodilatadores [Las Xantinas (Pulmón Asma Medicamentos)] aminophylline intravenous* solution theophylline er oral tablet extended release 12 hr* theophylline er oral tablet extended release 24 hr* 600 mg Nasal Agentes (Medicamentos De La Alergia Nasal) ASTEPRO NASAL SOLUTION 0.15 % azelastine hcl nasal solution budesonide nasal suspension OTC flunisolide nasal solution 25 mcg/act (0.025%) fluticasone propionate nasal suspension OTC ipratropium bromide nasal solution olopatadine hcl nasal solution triamcinolone acetonide nasal aerosol OTC TYZINE NASAL SOLUTION 0.05 % Pulmonar Antihipertensivos (Fármacos Pulmonares) LETAIRIS ORAL TABLET Nivel 4 OPSUMIT ORAL TABLET Nivel 4 TRACLEER ORAL TABLET Nivel 4 VENTAVIS INHALATION SOLUTION Vías Respiratorias Agentes Otros (Varios Medicamentos Respiratorios) acetylcysteine inhalation solution ARALAST NP INTRAVENOUS* SOLUTION 1000 MG, 500 MG cromolyn sodium oral concentrate DALIRESP ORAL TABLET ESBRIET ORAL CAPSULE Nivel 4 PA KALYDECO ORAL TABLET Nivel 4 PA NUCALA SUBCUTANEOUS* SOLUTION Nivel 4 PA 19

25 ORKAMBI ORAL TABLET MG Nivel 4 PA PROLASTIN-C INTRAVENOUS* SOLUTION 1000 MG Nivel 4 PULMOZYME INHALATION SOLUTION Nivel 4 QL (150 ML per 30 days) sildenafil citrate oral tablet PA; QL (90 EA per 30 days) sodium chloride inhalation nebulization solution 0.9 % XOLAIR SUBCUTANEOUS* SOLUTION Agentes De Tratamiento De Abuso De Sustancias-Addiction Agentes De Cesación De Fumar bupropion hcl er (smoking det) oral tablet extended release 12 hr* CHANTIX CONTINUING MONTH PAK ORAL TABLET Nivel 4 CHANTIX ORAL TABLET CHANTIX STARTING MONTH PAK ORAL TABLET nicotine mini mouth/throat lozenge OTC nicotine polacrilex mouth/throat gum OTC nicotine polacrilex mouth/throat lozenge OTC nicotine transdermal patch 24 hr OTC Agentes De Reversión De Opiáceos naloxone hcl injection solution 0.4 mg/ml, 1 mg/ml Alcohol Disuasivos/Anti-Craving disulfiram oral tablet naltrexone hcl oral tablet Antagonistas De Los Opioides buprenorphine hcl injection solution 0.3 mg/ml buprenorphine hcl sublingual tablet sublingual buprenorphine hcl-naloxone hcl sublingual tablet sublingual QL (90 EA per 30 days) SUBOXONE SUBLINGUAL FILM 12-3 MG QL (90 EA per 30 days) SUBOXONE SUBLINGUAL FILM 4-1 MG QL (240 EA per 30 days) 20

26 ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL MG, MG Agentes De Tratamiento De Aciduria Orótica Hereditaria * Tratamiento De La Aciduria Orótico Hereditaria - Agentes ** XURIDEN ORAL PACKET Agentes Del Sistema Nervioso Central (Nervio Condición Drogas) Agentes De La Esclerosis Múltiple (Esclerosis Múltiple Fármacos) AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR* Nivel 4 AUBAGIO ORAL TABLET Nivel 4 ST BETASERON SUBCUTANEOUS* KIT Nivel 4 COPAXONE SUBCUTANEOUS* 20 MG/ML Nivel 4 EXTAVIA SUBCUTANEOUS* KIT Nivel 4 GILENYA ORAL CAPSULE Nivel 4 LEMTRADA INTRAVENOUS* SOLUTION Nivel 4 PA REBIF REBIDOSE SUBCUTANEOUS* Nivel 4 REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS* Nivel 4 REBIF SUBCUTANEOUS* Nivel 4 REBIF TITRATION PACK SUBCUTANEOUS* Nivel 4 TYSABRI INTRAVENOUS* CONCENTRATE Nivel 4 Agentes De La Fibromialgia LYRICA ORAL CAPSULE LYRICA ORAL SOLUTION SAVELLA ORAL TABLET SAVELLA TITRATION PACK ORAL Déficit De Atención Hiperactividad Desorden Agentes, Anfetaminas (Drogas De Tdah) amphetamine-dextroamphet er oral capsule extended release 24 hour amphetamine-dextroamphetamine oral tablet QL (90 EA per 30 days) 21

27 dextroamphetamine sulfate er oral capsule extended release 24 hour dextroamphetamine sulfate oral tablet Déficit De Atención Hiperactividad Trastorno Agentes, No Anfetaminas (Drogas De Tdah) CONCERTA ORAL TABLET EXTENDEDRELEASE* dexmethylphenidate hcl er oral capsule extended release 24 hour 15 mg, 30 mg, 40 mg dexmethylphenidate hcl oral tablet guanfacine hcl er oral tablet extended release 24 hr* methylphenidate hcl er (cd) oral capsule extended release* methylphenidate hcl er (la) oral capsule extended release 24 hour methylphenidate hcl er oral tablet extendedrelease* methylphenidate hcl oral solution methylphenidate hcl oral tablet methylphenidate hcl oral tablet chewable STRATTERA ORAL CAPSULE Sistema Nervioso Central, Otros NUEDEXTA ORAL CAPSULE riluzole oral tablet tetrabenazine oral tablet Nivel 4 XENAZINE ORAL TABLET Nivel 4 Agentes Dentales Y Orales Fluoruro De fluoritab oral tablet chewable FLURA-DROPS ORAL SOLUTION LUDENT ORAL TABLET CHEWABLE sodium fluoride oral solution sodium fluoride oral tablet 1.1 (0.5 f) mg sodium fluoride oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg PA 22

28 Fluoruro De Productos Dentales ACT ANTICAVITY FLUORIDE RINSE MOUTH/THROAT SOLUTION CAVIRINSE MOUTH/THROAT SOLUTION CLINPRO 5000 DENTAL PASTE DENTA 5000 PLUS DENTAL CREAM DENTAGEL DENTAL GEL FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE Agentes Dentales Y Orales (Medicamentos Para La Boca) Agentes Dentales Y Orales (Fármacos De Boca/Garganta/Dental) chlorhexidine gluconate mouth/throat solution OTC cold sore treatment external liquid OTC pilocarpine hcl oral tablet triamcinolone acetonide mouth/throat paste Agentes Dermatológicos (Drogas Que Afectan La Piel) * Los Anestésicos Locales - Actualidad *** lidocaine external ointment lidocaine external patch 5 % lidocaine hcl external gel 2 % lidocaine hcl external solution LIDODERM EXTERNAL PATCH Agentes Dermatológicos (Drogas Que Afectan La Piel) 8-MOP ORAL CAPSULE acitretin oral capsule acyclovir external ointment adapalene external cream adapalene external gel alclometasone dipropionate external cream alclometasone dipropionate external ointment amcinonide external cream 23

29 amcinonide external lotion amcinonide external ointment ammonium lactate external lotion OTC benzoyl peroxide-erythromycin external gel betamethasone dipropionate aug external cream betamethasone dipropionate aug external lotion betamethasone dipropionate aug external ointment betamethasone dipropionate external cream betamethasone dipropionate external lotion betamethasone dipropionate external ointment betamethasone valerate external cream betamethasone valerate external foam betamethasone valerate external lotion betamethasone valerate external ointment bp wash external liquid 2.5 %, 7 % calcipotriene external cream calcipotriene external ointment calcipotriene external solution CICLODAN CREAM EXTERNAL KIT CICLODAN SOLUTION EXTERNAL KIT ciclopirox external gel ciclopirox external shampoo ciclopirox external solution ciclopirox olamine external cream ciclopirox olamine external suspension ciclopirox treatment external kit ciclopirox-vitamin e external kit CLARAVIS ORAL CAPSULE 10 MG, 20 MG, 40 MG CLARAVIS ORAL CAPSULE 30 MG CLINDACIN PAC EXTERNAL KIT clindamycin phos-benzoyl perox external gel clindamycin phosphate external gel clindamycin phosphate external lotion 24

30 clindamycin phosphate external solution clindamycin phosphate external swab clobetasol propionate e external cream clobetasol propionate emulsion external foam clobetasol propionate external cream clobetasol propionate external foam clobetasol propionate external gel clobetasol propionate external lotion clobetasol propionate external ointment clobetasol propionate external shampoo CLODERM PUMP EXTERNAL CREAM clotrimazole external cream OTC clotrimazole external solution OTC clotrimazole-betamethasone external cream clotrimazole-betamethasone external lotion CONDYLOX EXTERNAL GEL CORMAX SCALP APPLICATION EXTERNAL SOLUTION DERMAZENE EXTERNAL CREAM desonide external cream desonide external lotion desonide external ointment desoximetasone external cream desoximetasone external gel desoximetasone external ointment 0.25 % diclofenac sodium transdermal gel 3 % diclofenac sodium transdermal solution diflorasone diacetate external cream diflorasone diacetate external ointment econazole nitrate external cream ELIDEL EXTERNAL CREAM erythromycin external gel erythromycin external pad erythromycin external solution EURAX EXTERNAL CREAM EXODERM EXTERNAL LOTION fluocinolone acetonide body external oil 25

31 fluocinolone acetonide external cream fluocinolone acetonide external ointment fluocinolone acetonide external solution fluocinolone acetonide scalp external oil fluocinonide external cream fluocinonide external gel fluocinonide external ointment fluocinonide external solution fluocinonide-e external cream fluorouracil external cream 5 % fluorouracil external solution fluticasone propionate external cream fluticasone propionate external lotion fluticasone propionate external ointment gentamicin sulfate external cream gentamicin sulfate external ointment halobetasol propionate external cream halobetasol propionate external ointment HEMMOREX-HC SUPPOSITORY 30 MG hydrocortisone ace-pramoxine cream hydrocortisone ace-pramoxine kit hydrocortisone acetate external cream OTC hydrocortisone acetate suppository 30 mg hydrocortisone butyr lipo base external cream hydrocortisone butyrate external cream hydrocortisone butyrate external ointment hydrocortisone butyrate external solution hydrocortisone cream 2.5 % hydrocortisone enema hydrocortisone external cream 1 % OTC hydrocortisone external cream 2.5 % hydrocortisone external lotion 1 % OTC hydrocortisone external lotion 2.5 % hydrocortisone external ointment 1 % OTC hydrocortisone external ointment 2.5 % hydrocortisone valerate external cream 26

32 hydrocortisone valerate external ointment hydrocortisone-aloe external cream 1 % OTC hydroquinone external cream hydroquinone time release external cream imiquimod external cream isopropyl alcohol wipes external OTC iv prep wipes external pad 70 % OTC ketoconazole external cream ketoconazole external foam ketoconazole external shampoo KETODAN EXTERNAL KIT lindane external shampoo LUZU EXTERNAL CREAM mafenide acetate external packet malathion external lotion methoxsalen rapid oral capsule metronidazole external cream metronidazole external gel metronidazole external lotion mometasone furoate external cream mometasone furoate external ointment mometasone furoate external solution mupirocin calcium external cream mupirocin external ointment NEUAC EXTERNAL GEL NEUAC EXTERNAL KIT nystatin external cream nystatin external ointment nystatin external powder nystatin-triamcinolone external cream nystatin-triamcinolone external ointment OXSORALEN ULTRA ORAL CAPSULE Nivel 4 PANRETIN EXTERNAL GEL permethrin external cream PICATO EXTERNAL GEL podofilox external solution prednicarbate external ointment 27

33 PROCTO-PAK CREAM PROCTOZONE-HC CREAM RECTIV OINTMENT REGRANEX EXTERNAL GEL PA ROSADAN EXTERNAL KIT 0.75 % (CREAM) ROSULA EXTERNAL PAD salicylic acid external cream salicylic acid external foam salicylic acid external lotion salicylic acid-cleanser external kit SANTYL EXTERNAL OINTMENT scalacort external lotion selenium sulfide external lotion selenium sulfide external shampoo silver sulfadiazine external cream sodium chloride irrigation solution 0.9 % sodium sulfacetamide external shampoo sodium sulfacetamide wash external liquid SOLARAZE TRANSDERMAL GEL SORIATANE ORAL CAPSULE 10 MG, 17.5 MG spinosad external suspension sss 10-5 external foam sulfacetamide sodium (acne) external lotion sulfacetamide sodium external gel sulfacetamide sodium external liquid sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 % sulfacetamide sodium-sulfur external emulsion sulfacetamide sodium-sulfur external liquid % sulfacetamide sodium-sulfur external lotion 10-5 % sulfacetamide sodium-sulfur external pad 10-4 % sulfacetamide sodium-sulfur external suspension 28

34 sulfacetamide sod-sulfur wash external kit sulfacetamide-sulfur in urea external emulsion sulfacetamide-sulfur-sunscreen external kit TARGRETIN EXTERNAL GEL TAZORAC EXTERNAL CREAM TAZORAC EXTERNAL GEL terbinafine hcl external cream OTC tretinoin (emollient) external cream tretinoin external cream tretinoin external gel 0.01 %, % tretinoin microsphere external gel triamcinolone acetonide external cream %, 0.5 % triamcinolone acetonide external lotion triamcinolone acetonide external ointment TRIDERM EXTERNAL CREAM U-CORT EXTERNAL CREAM ULESFIA EXTERNAL LOTION urea external cream 40 % urea external lotion 40 % urea nail film external suspension WOUND WASH SALINE EXTERNAL SOLUTION Agentes Gastrointestinales (Fármacos Del Intestino, Instestine Y Condición Del Estómago) Agentes De Síndrome Del Intestino Irritable (Intestino Tratamiento Fármacos) alosetron hcl oral tablet AMITIZA ORAL CAPSULE Agentes Gastrointestinales Otros (Sistema Digestivo Varios Fármacos) CHOLBAM ORAL CAPSULE Nivel 4 diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet 29 OTC

35 FULYZAQ ORAL TABLET DELAYED RELEASE loperamide hcl oral capsule metoclopramide hcl injection solution metoclopramide hcl oral solution 5 mg/5ml metoclopramide hcl oral tablet MOVANTIK ORAL TABLET RELISTOR SUBCUTANEOUS* SOLUTION 12 MG/0.6ML ursodiol oral capsule ursodiol oral tablet Antiespasmódicos Gastrointestinales (Medicamentos De Tratamiento Del Intestino) atropine sulfate injection solution 0.05 mg/ml, 0.1 mg/ml belladonna alkaloids-opium suppository dicyclomine hcl oral capsule dicyclomine hcl oral solution dicyclomine hcl oral tablet glycopyrrolate oral tablet hyoscyamine sulfate er oral tablet extended release 12 hr* hyoscyamine sulfate oral elixir hyoscyamine sulfate oral solution hyoscyamine sulfate oral tablet hyoscyamine sulfate oral tablet dispersible hyoscyamine sulfate sublingual tablet sublingual methscopolamine bromide oral tablet 2.5 mg SYMAX DUOTAB ORAL TABLET EXTENDEDRELEASE* SYMAX-SR ORAL TABLET EXTENDED RELEASE 12 HR* Enzimas Digestivas (Aparato Digestivo Varios Fármacos) CREON ORAL CAPSULE DELAYED RELEASE PARTICLES UNIT PA 30

36 ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES UNIT, UNIT, UNIT, UNIT, UNIT, 5000 UNIT Fumigadores (Sistema Digestivo Varios Fármacos) CARAFATE ORAL SUSPENSION misoprostol oral tablet sucralfate oral tablet Histamine2 Antagonistas De Los Receptores (H2) (Úlcera Y Estómago Ácidos Medicamentos) cimetidine 200 oral tablet OTC cimetidine hcl oral solution cimetidine oral tablet 300 mg, 400 mg, 800 mg famotidine intravenous* solution 20 mg/2ml, 200 mg/20ml, 40 mg/4ml, 500 mg/50ml famotidine oral suspension reconstituted famotidine oral tablet 20 mg, 40 mg ranitidine hcl injection solution 150 mg/6ml, 50 mg/2ml ranitidine hcl oral capsule ranitidine hcl oral syrup 15 mg/ml ranitidine hcl oral tablet 150 mg OTC ranitidine hcl oral tablet 300 mg Inhibidores De La Bomba De Protones (Medicamentos Ácidos Úlcera Y El Estómago) amoxicill-clarithro-lansopraz oral DEXILANT ORAL CAPSULE DELAYED RELEASE esomeprazole magnesium oral capsule delayed release 40 mg lansoprazole oral capsule delayed release 15 mg lansoprazole oral capsule delayed release 30 mg omeprazole magnesium oral capsule delayed release 31 OTC OTC; QL (60 EA per 30 days)

37 omeprazole oral capsule delayed release QL (60 EA per 30 days) omeprazole-sodium bicarbonate oral capsule mg omeprazole-sodium bicarbonate oral capsule mg pantoprazole sodium intravenous* solution reconstituted pantoprazole sodium oral tablet delayed release rabeprazole sodium oral tablet delayed release Laxantes (Estreñimiento Drogas) lactulose encephalopathy oral solution lactulose oral solution 10 gm/15ml OTC peg 3350 oral powder OTC polyethylene glycol 3350 oral packet OTC Ppaca Preparación Intestinal (Intestino Tratamiento Fármacos) COLYTE WITH FLAVOR PACKS ORAL SOLUTION 240 GM GAVILYTE-C ORAL SOLUTION GAVILYTE-G ORAL SOLUTION GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION GOLYTELY ORAL SOLUTION MOVIPREP ORAL SOLUTION NULYTELY WITH FLAVOR PACKS ORAL SOLUTION peg 3350/electrolytes oral solution reconstituted peg 3350-kcl-na bicarb-nacl oral solution reconstituted peg-3350/electrolytes oral solution reconstituted PREPOPIK ORAL PACKET SUPREP BOWEL PREP ORAL SOLUTION PA PA PA PA PA PA PA 32

38 TRILYTE ORAL SOLUTION Agentes Genitourinarios (Vejiga, Genitales Y Afección Renal Fármacos) Agentes De La Hipertrofia Prostática Benigna (Próstata Drogas) AVODART ORAL CAPSULE CIALIS ORAL TABLET 2.5 MG, 5 MG PA; QL (30 EA per 30 days) dutasteride-tamsulosin hcl oral capsule finasteride oral tablet 5 mg RAPAFLO ORAL CAPSULE tamsulosin hcl oral capsule Antiespasmódicos Urinarios (Relajantes De Músculo De La Vejiga) bethanechol chloride oral tablet 10 mg darifenacin hydrobromide er oral tablet extended release 24 hr* HYOPHEN ORAL TABLET MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR* oxybutynin chloride er oral tablet extended release 24 hr* oxybutynin chloride oral syrup oxybutynin chloride oral tablet tolterodine tartrate er oral capsule extended release 24 hour tolterodine tartrate oral tablet trospium chloride er oral capsule extended release 24 hour trospium chloride oral tablet URECHOLINE ORAL TABLET 10 MG UTA ORAL CAPSULE UTIRA-C ORAL TABLET VESICARE ORAL TABLET ST ST 33

39 Captadores De Fosfato (Fosfato Eliminación De Fármacos) calcium acetate (phos binder) oral capsule FOSRENOL ORAL TABLET CHEWABLE 1000 MG, 500 MG, 750 MG Nivel 4 RENVELA ORAL PACKET Nivel 4 RENVELA ORAL TABLET Nivel 4 Génito-Urinarias Agentes Otros (Fármacos Miscelánea Vejiga, Genitales Y Afección Renal) CYSTAGON ORAL CAPSULE ELMIRON ORAL CAPSULE neomycin-polymyxin b gu irrigation solution phenazopyridine hcl oral tablet 100 mg, 200 mg potassium citrate er oral tablet extendedrelease* 10 meq (1080 mg), 5 meq (540 mg) Productos Vaginales (Medicamentos De Sustitución/Modificación Hormonal) PREMARIN VAGINAL CREAM Vaginal (Infección Vaginal Medicamentos) Los Productos clindamycin phosphate vaginal cream metronidazole vaginal gel miconazole 3 combo pack vaginal kit OTC miconazole 3 vaginal suppository terconazole vaginal cream terconazole vaginal suppository Agentes Hematopoyéticos * Factor Estimulante De Colonias Granulocito Macrófago LEUKINE INTRAVENOUS* SOLUTION Nivel 4 34

40 * Granulocitos Factores Estimuladores De Colonias (G-Csf) *** NEUPOGEN INJECTION Nivel 4 NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML Agentes Hematopoyéticos, Otros NEUMEGA SUBCUTANEOUS* SOLUTION Erythropoietins PROCRIT INJECTION SOLUTION UNIT/ML, UNIT/ML, 3000 UNIT/ML, UNIT/ML PROCRIT INJECTION SOLUTION 2000 UNIT/ML, 4000 UNIT/ML Agentes Hormonales Estimulante / Reemplazo / Modificar (Suprarrenales) Glucocorticoides/Mineralocorticoid es (Antiinflamatorios) budesonide oral capsule delayed release particles Nivel 4 Nivel 4 Nivel 4 cortisone acetate oral tablet dexamethasone oral solution dexamethasone oral tablet dexamethasone sodium phosphate injection solution 120 mg/30ml, 20 mg/5ml, 4 mg/ml hydrocortisone oral tablet methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml methylprednisolone oral tablet methylprednisolone sodium succ injection solution reconstituted 1000 mg, 125 mg, 40 mg prednisolone oral solution prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml prednisone oral 10 mg (48), 5 mg (21), 5 mg (48) prednisone oral tablet 10 mg 35 PA PA

41 UCERIS ORAL TABLET EXTENDED RELEASE 24 HR* Agentes Hormonales, Estimulante / Reemplazo / Modificadores (Hormonas Sexuales / Modificadores) (Medicamentos Hormonales Y Diabetes) Agentes De Modificación Del Receptor De Estrógeno Selectivo Nivel 4 raloxifene hcl oral tablet PA Andrógenos (Hormona Masculina Drogas) ANDRODERM TRANSDERMAL PATCH 24 HR 2 MG/24HR, 4 MG/24HR ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%) ANDROID ORAL CAPSULE Nivel 4 PA ANDROXY ORAL TABLET danazol oral capsule testosterone cypionate intramuscular* solution 100 mg/ml, 200 mg/ml testosterone enanthate intramuscular* solution testosterone transdermal gel 50 mg/5gm (1%) Esteroides Anabólicos (Hormonas Fármacos) oxandrolone oral tablet 10 mg Nivel 4 oxandrolone oral tablet 2.5 mg Estrógenos (Hormona Sustitución/Modificación De Medicamentos) estradiol oral tablet estradiol transdermal patch weekly estropipate oral tablet MENEST ORAL TABLET PREMARIN INJECTION SOLUTION PREMARIN ORAL TABLET 36 ST

42 PREMPHASE ORAL TABLET PREMPRO ORAL TABLET Ppaca Anticonceptivos Orales (Control De La Natalidad Medicamentos) norethindrone-eth estradiol oral tablet 1-5 mg-mcg Progestinas (Medicamentos De Sustitución/Modificación Hormonal) DEPO-PROVERA INTRAMUSCULAR* SUSPENSION 400 MG/ML Nivel 5 medroxyprogesterone acetate oral tablet MEGACE ES ORAL SUSPENSION megestrol acetate oral suspension 625 mg/5ml norethindrone acetate oral tablet progesterone micronized oral capsule Agentes Hormonales, Estimulante / Reemplazo / Modificar (Suprarrenales) Glucocorticoides/Mineralocorticoid es (Antiinflamatorios) fludrocortisone acetate oral tablet prednisone oral 10 mg (21) prednisone oral solution prednisone oral tablet 1 mg, 2.5 mg, 20 mg, 5 mg, 50 mg Agentes Hormonales, Estimulante/Reemplazo/Modificar (Paratiroides) Agentes Hormonales, Estimulante/Reemplazo / [(Paratiroides) Hormona Sustitución/Modificación Drogas] NATPARA SUBCUTANEOUS* PA 37

43 Agentes Hormonales, Estimulante/Reemplazo/Modificar (Pituitaria) (Medicamentos Hormonales Y Diabetes) * Antagonistas Del Receptor De Progesterona *** KORLYM ORAL TABLET Nivel 4 PA * Insulina-Como Factores De Crecimiento (Somatomedinas) *** INCRELEX SUBCUTANEOUS* SOLUTION Nivel 4 * Las Hormonas De Crecimiento *** HUMATROPE INJECTION SOLUTION 12 MG, 24 MG NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS* SOLUTION NUTROPIN AQ NUSPIN 20 SUBCUTANEOUS* SOLUTION NUTROPIN AQ NUSPIN 5 SUBCUTANEOUS* SOLUTION NUTROPIN AQ PEN SUBCUTANEOUS* SOLUTION SAIZEN CLICK.EASY INJECTION SOLUTION SAIZEN INJECTION SOLUTION Agentes Hormonales, Estimulante/Reemplazo / [(Pituitaria) Hormona Sustitución/Modificación Drogas] chorionic gonadotropin intramuscular* solution reconstituted Nivel 4 Nivel 4 Nivel 4 Nivel 4 Nivel 4 Nivel 4 Nivel 4 desmopressin ace rhinal tube nasal solution desmopressin ace spray refrig nasal solution desmopressin acetate injection solution desmopressin acetate oral tablet desmopressin acetate spray nasal solution SIGNIFOR SUBCUTANEOUS* SOLUTION PA PA PA PA PA PA PA 38

44 Agentes Hormonales, Estimulante/Reemplazo/Modificar (Tiroides) (Fármacos Hormonas Y Diabetes) Reemplazo Tiroideo LEVO-T ORAL TABLET 88 MCG LEVOTHROID ORAL TABLET 125 MCG levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg SYNTHROID ORAL TABLET Agentes Hormonales, Supresor (Paratiroides) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Supresor [(Paratiroides) Fármacos Para Tratar Altos De Calcio] SENSIPAR ORAL TABLET 30 MG SENSIPAR ORAL TABLET 60 MG, 90 MG Nivel 4 Agentes Hormonales, Supresor (Pituitaria) (Medicamentos Hormonales Y Diabetes) Agentes Hormonales, Supresor [(Pituitaria) Drogas De Diversas Hormonas Y Diabetes] LUPRON DEPOT-PED INTRAMUSCULAR* KIT MG (PED), 30 MG (PED), 7.5 MG LUPRON DEPOT-PED INTRAMUSCULAR* KIT MG, 15 MG octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 500 mcg/ml octreotide acetate injection solution 200 mcg/ml, 50 mcg/ml SANDOSTATIN LAR DEPOT INTRAMUSCULAR* KIT SOMATULINE DEPOT SUBCUTANEOUS* SOLUTION SOMAVERT SUBCUTANEOUS* SOLUTION 10 MG, 15 MG, 20 MG Nivel 5 Nivel 4 Nivel 4 Nivel 4 Nivel 4 Nivel 4 SYNAREL NASAL SOLUTION Nivel 4 39

45 Agentes Hormonales, Supresor (Tiroides) (Fármacos Hormonas Y Diabetes) * Agentes Antitiroideos *** methimazole oral tablet propylthiouracil oral tablet Reemplazo Tiroideo levothyroxine sodium oral tablet 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg liothyronine sodium oral tablet NATURE-THROID ORAL TABLET MG np thyroid oral tablet 30 mg, 60 mg, 90 mg UNITHROID ORAL TABLET Agentes Inmunológicos (Drogas Que Afectan El Sistema Inmunológico) * Anti-Tnf-Alfa - Monoclonoal Anticuerpos *** HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS* 40 MG/0.8ML Nivel 4 HUMIRA PEN SUBCUTANEOUS* Nivel 4 HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS* HUMIRA PEN-PSORIASIS STARTER SUBCUTANEOUS* HUMIRA SUBCUTANEOUS* 20 MG/0.4ML, 40 MG/0.8ML Nivel 4 Nivel 4 Nivel 4 KINERET SUBCUTANEOUS* Nivel 4 ST SIMPONI ARIA INTRAVENOUS* SOLUTION Nivel 4 SIMPONI SUBCUTANEOUS* Nivel 4 * Coestimulación Selectivo Moduladores *** ORENCIA INTRAVENOUS* SOLUTION Nivel 4 ORENCIA SUBCUTANEOUS* Nivel 4 ST * Inhibidores Del Receptor De La Interleucina-6 *** ACTEMRA INTRAVENOUS* SOLUTION Nivel 4 ST ST 40

46 ACTEMRA SUBCUTANEOUS* Nivel 4 ST * Soluble Tumor Necrosis Factor Receptor Agentes *** ENBREL SUBCUTANEOUS* Nivel 4 ENBREL SURECLICK SUBCUTANEOUS* Nivel 4 Agentes Inmunizantes, Pasivo (Medicamentos Del Sistema Inmunológico) ATGAM INTRAVENOUS* INJECTABLE Nivel 4 CARIMUNE NF INTRAVENOUS* SOLUTION Nivel 4 GAMMAGARD INJECTION SOLUTION Nivel 4 GAMMAGARD S/D INTRAVENOUS* SOLUTION 2.5 GM GAMMAGARD S/D LESS IGA INTRAVENOUS* SOLUTION Nivel 4 Nivel 4 GAMMAPLEX INTRAVENOUS* SOLUTION Nivel 4 THYMOGLOBULIN INTRAVENOUS* SOLUTION Angioedema (Hae) Agentes (Medicamentos Del Sistema Inmunológico) Nivel 4 FIRAZYR SUBCUTANEOUS* SOLUTION Nivel 4 Antipsoratics--Sistémica COSENTYX SENSOREADY PEN SUBCUTANEOUS* 150 MG/ML Nivel 4 COSENTYX SUBCUTANEOUS* Nivel 4 Factor De Necrosis Tumoral Alfa Bloqueadores CIMZIA PREFILLED SUBCUTANEOUS* KIT Nivel 4 ST CIMZIA STARTER KIT SUBCUTANEOUS* KIT Nivel 4 CIMZIA SUBCUTANEOUS* KIT 2 X 200 MG Nivel 4 ST REMICADE INTRAVENOUS* SOLUTION Nivel 4 ST ST 41

47 Inmunomoduladores (Medicamentos Del Sistema Inmunológico) ARAVA ORAL TABLET ARCALYST SUBCUTANEOUS* SOLUTION Nivel 4 leflunomide oral tablet RIDAURA ORAL CAPSULE Ppaca Niño Vac (Vacunas) ACTHIB INTRAMUSCULAR* SOLUTION CERVARIX INTRAMUSCULAR* SUSPENSION COMVAX INTRAMUSCULAR* SUSPENSION ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, 20 MCG/ML GARDASIL INTRAMUSCULAR* SUSPENSION HAVRIX INTRAMUSCULAR* SUSPENSION IPOL INJECTION INJECTABLE MENACTRA INTRAMUSCULAR* INJECTABLE MENOMUNE SUBCUTANEOUS* INJECTABLE MENVEO INTRAMUSCULAR* SOLUTION M-M-R II SUBCUTANEOUS* INJECTABLE PEDVAX HIB INTRAMUSCULAR* SUSPENSION PROQUAD SUBCUTANEOUS* INJECTABLE RECOMBIVAX HB INJECTION SUSPENSION 10 MCG/ML, 40 MCG/ML, 5 MCG/0.5ML ROTARIX ORAL SUSPENSION ROTATEQ ORAL SOLUTION tetanus toxoid adsorbed intramuscular* solution 42

48 TWINRIX INTRAMUSCULAR* SUSPENSION VAQTA INTRAMUSCULAR* SUSPENSION 25 UNIT/0.5ML, 50 UNIT/ML VARIVAX SUBCUTANEOUS* INJECTABLE Ppaca Vac Adultos (Vacunas) ZOSTAVAX SUBCUTANEOUS* SOLUTION Suppressants Inmunes (Medicamentos Del Sistema Inmunológico) ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR AZASAN ORAL TABLET azathioprine oral tablet BENLYSTA INTRAVENOUS* SOLUTION CELLCEPT INTRAVENOUS INTRAVENOUS* SOLUTION Nivel 4 cyclosporine intravenous* solution cyclosporine modified oral capsule cyclosporine modified oral solution ENBREL SUBCUTANEOUS* SOLUTION Nivel 4 GENGRAF ORAL CAPSULE GENGRAF ORAL SOLUTION ILARIS SUBCUTANEOUS* SOLUTION mycophenolate mofetil oral capsule mycophenolate mofetil oral suspension reconstituted mycophenolate mofetil oral tablet mycophenolic acid oral tablet delayed release MYFORTIC ORAL TABLET DELAYED RELEASE NULOJIX INTRAVENOUS* SOLUTION Nivel 4 PROGRAF INTRAVENOUS* SOLUTION 43

49 RAPAMUNE ORAL SOLUTION RHEUMATREX ORAL TABLET 2.5 MG SANDIMMUNE ORAL CAPSULE SANDIMMUNE ORAL SOLUTION SIMPONI ARIA INTRAVENOUS* SOLUTION Nivel 4 sirolimus oral tablet tacrolimus oral capsule 0.5 mg, 1 mg tacrolimus oral capsule 5 mg ZORTRESS ORAL TABLET 0.25 MG ZORTRESS ORAL TABLET 0.5 MG, 0.75 MG Vacunas (Vacunas) Nivel 4 ADACEL INTRAMUSCULAR* SUSPENSION AFLURIA INTRAMUSCULAR* SUSPENSION AFLURIA PRESERVATIVE FREE INTRAMUSCULAR* bcg vaccine injection injectable BOOSTRIX INTRAMUSCULAR* SUSPENSION DAPTACEL INTRAMUSCULAR* SUSPENSION EZ FLU SHOT-FLUCELVAX INTRAMUSCULAR* FLUARIX INTRAMUSCULAR* FLUARIX QUADRIVALENT INTRAMUSCULAR* FLUBLOK INTRAMUSCULAR* SOLUTION FLUCELVAX INTRAMUSCULAR* FLULAVAL QUADRIVALENT INTRAMUSCULAR* FLULAVAL QUADRIVALENT INTRAMUSCULAR* SUSPENSION FLUMIST QUADRIVALENT NASAL SUSPENSION FLUVIRIN INTRAMUSCULAR* FLUVIRIN INTRAMUSCULAR* SUSPENSION FLUVIRIN PRESERVATIVE FREE INTRAMUSCULAR* 44

50 FLUZONE HIGH-DOSE INTRAMUSCULAR* FLUZONE PRESERVATIVE FREE INTRAMUSCULAR* SUSPENSION FLUZONE QUADRIVALENT INTRADERMAL* FLUZONE QUADRIVALENT INTRAMUSCULAR* FLUZONE QUADRIVALENT INTRAMUSCULAR* SUSPENSION, 0.5 ML IMOVAX RABIES INTRAMUSCULAR* INJECTABLE INFANRIX INTRAMUSCULAR* SUSPENSION IXIARO INTRAMUSCULAR* SUSPENSION PNEUMOVAX 23 INJECTION INJECTABLE PREVNAR 13 INTRAMUSCULAR* SUSPENSION RABAVERT INTRAMUSCULAR* SUSPENSION tetanus-diphtheria toxoids td intramuscular* suspension TYPHIM VI INTRAMUSCULAR* SOLUTION 25 MCG/0.5ML YF-VAX SUBCUTANEOUS* INJECTABLE Agentes Oftálmicos (Medicamentos Para Los Ojos) Agentes Antialérgicos Oftálmicos (Medicamentos Para La Alergia Los Ojos) azelastine hcl ophthalmic solution BEPREVE OPHTHALMIC SOLUTION cromolyn sodium ophthalmic solution ELESTAT OPHTHALMIC SOLUTION EMADINE OPHTHALMIC SOLUTION epinastine hcl ophthalmic solution PATADAY OPHTHALMIC SOLUTION PATANOL OPHTHALMIC SOLUTION 45

51 Agentes Antiglaucoma Oftálmico (Medicamentos De Glaucoma) ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % apraclonidine hcl ophthalmic solution AZOPT OPHTHALMIC SUSPENSION betaxolol hcl ophthalmic solution brimonidine tartrate ophthalmic solution carteolol hcl ophthalmic solution COMBIGAN OPHTHALMIC SOLUTION dorzolamide hcl ophthalmic solution dorzolamide hcl-timolol mal ophthalmic solution levobunolol hcl ophthalmic solution 0.5 % metipranolol ophthalmic solution PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 % PROLENSA OPHTHALMIC SOLUTION timolol maleate ophthalmic gel forming solution timolol maleate ophthalmic solution Oftálmica Agentes Otros (Ojo Varios Medicamentos) atropine sulfate ophthalmic ointment atropine sulfate ophthalmic solution cyclopentolate hcl ophthalmic solution 1 %, 2 % HOMATROPAIRE OPHTHALMIC SOLUTION LACRISERT OPHTHALMIC INSERT naphazoline hcl ophthalmic solution phenylephrine hcl ophthalmic solution 10 %, 2.5 % proparacaine hcl ophthalmic solution RESTASIS OPHTHALMIC EMULSION tropicamide ophthalmic solution 46

52 Oftalmológicos Anti-Inflamatorios (Inflamación Medicamentos Para Los Ojos) BROMDAY OPHTHALMIC SOLUTION bromfenac sodium (once-daily) ophthalmic solution bromfenac sodium ophthalmic solution dexamethasone sodium phosphate ophthalmic solution diclofenac sodium ophthalmic solution DUREZOL OPHTHALMIC EMULSION eye wash ophthalmic solution OTC fluorometholone ophthalmic suspension flurbiprofen sodium ophthalmic solution ketorolac tromethamine ophthalmic solution neomycin-polymyxin-dexameth ophthalmic ointment neomycin-polymyxin-dexameth ophthalmic suspension neomycin-polymyxin-hc ophthalmic suspension NEO-POLYCIN HC OPHTHALMIC OINTMENT NEVANAC OPHTHALMIC SUSPENSION prednisolone acetate ophthalmic suspension prednisolone sodium phosphate ophthalmic solution sulfacetamide-prednisolone ophthalmic solution TOBRADEX OPHTHALMIC OINTMENT tobramycin-dexamethasone ophthalmic suspension VEXOL OPHTHALMIC SUSPENSION Ophthalmic Anti Infectives (Infección Medicamentos Para Los Ojos) bacitracin ophthalmic ointment bacitracin-polymyxin b ophthalmic ointment unit/gm 47

53 BESIVANCE OPHTHALMIC SUSPENSION ciprofloxacin hcl ophthalmic solution erythromycin ophthalmic ointment gatifloxacin ophthalmic solution GENTAK OPHTHALMIC OINTMENT gentamicin sulfate ophthalmic ointment gentamicin sulfate ophthalmic solution levofloxacin ophthalmic solution MOXEZA OPHTHALMIC SOLUTION neomycin-bacitracin zn-polymyx ophthalmic ointment neomycin-polymyxin-gramicidin ophthalmic solution ofloxacin ophthalmic solution POLYCIN OPHTHALMIC OINTMENT polymyxin b-trimethoprim ophthalmic solution sulfacetamide sodium ophthalmic solution tobramycin ophthalmic solution trifluridine ophthalmic solution VIGAMOX OPHTHALMIC SOLUTION ZIRGAN OPHTHALMIC GEL ZYMAXID OPHTHALMIC SOLUTION Prostaglandinas Oftálmicos Y Prostamide Análogos (Medicamentos De Glaucoma) latanoprost ophthalmic solution LUMIGAN OPHTHALMIC SOLUTION 0.01 % TRAVATAN Z OPHTHALMIC SOLUTION travoprost ophthalmic solution Agentes Óticos (Oído Drogas) Agentes Óticos (Oído Drogas) acetic acid otic solution acetic acid-aluminum acetate otic solution antipyrine-benzocaine otic solution mg/ml CIPRODEX OTIC SUSPENSION CORTANE-B AQUEOUS OTIC SOLUTION 48

54 fluocinolone acetonide otic oil hydrocortisone-acetic acid otic solution neomycin-polymyxin-hc otic solution 1 % neomycin-polymyxin-hc otic suspension ofloxacin otic solution otomax-hc otic solution PRAMOTIC OTIC LIQUID Agentes Pulmonares Y Vías Respiratorias Tratamiento Anapylaxis ADRENALIN INJECTION SOLUTION 1 MG/ML epinephrine injection 0.15 mg/0.15ml, 0.3 mg/0.3ml EPIPEN 2-PAK INJECTION EPIPEN JR 2-PAK INJECTION Agentes Pulmonares Y Vías Respiratorias (Alergias, Tos, Frío Y Medicamentos De Condición De Pulmón) Pulmonar Antihipertensivos (Medicamento Pulmonar) sildenafil citrate intravenous* solution PA Analgésicos (Dolor, Inflamación, Músculo, Condición Común De Drogas) Analgésicos Opiáceos, Acción Corta (Analgésicos Narcóticos) acetaminophen-codeine #3 oral tablet QL (390 EA per 30 days) acetaminophen-codeine #4 oral tablet QL (390 EA per 30 days) acetaminophen-codeine oral solution QL (980 ML per 30 days) acetaminophen-codeine oral tablet mg butalbital-apap-caff-cod oral capsule mg butalbital-asa-caff-codeine oral capsule FENTORA BUCCAL TABLET 200 MCG, 400 MCG, 600 MCG, 800 MCG QL (390 EA per 30 days) QL (360 EA per 30 days) PA; QL (120 EA per 30 days) 49

55 hydrocodone-acetaminophen oral solution mg/15ml hydrocodone-acetaminophen oral tablet mg, mg, mg hydrocodone-acetaminophen oral tablet mg, mg, mg hydrocodone-ibuprofen oral tablet hydromorphone hcl oral tablet hydromorphone hcl pf injection solution 500 mg/50ml isometheptene-caffeine-apap oral tablet mg isometheptene-dichloral-apap oral capsule morphine sulfate (concentrate) oral solution 100 mg/5ml morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml morphine sulfate oral solution morphine sulfate oral tablet nalbuphine hcl injection solution NUCYNTA ORAL TABLET oxycodone hcl oral capsule oxycodone hcl oral concentrate 100 mg/5ml oxycodone hcl oral solution oxycodone hcl oral tablet oxycodone-acetaminophen oral tablet mg, mg, mg, mg oxycodone-aspirin oral tablet mg oxycodone-ibuprofen oral tablet oxymorphone hcl oral tablet 10 mg pentazocine-naloxone hcl oral tablet REPREXAIN ORAL TABLET MG tramadol hcl er (biphasic) oral tablet extended release 24 hr* tramadol hcl er oral tablet extended release 24 hr* tramadol hcl oral tablet tramadol-acetaminophen oral tablet QL (400 ML per 30 days) QL (360 EA per 30 days) QL (360 EA per 30 days) 50

56 Analgésicos Opiáceos, Acción Prolongada (Analgésicos Narcóticos) fentanyl transdermal patch 72 hr 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr methadone hcl injection solution methadone hcl oral concentrate methadone hcl oral solution methadone hcl oral tablet methadone hcl oral tablet soluble morphine sulfate er beads oral capsule extended release 24 hour morphine sulfate er oral capsule extended release 24 hour morphine sulfate er oral tablet extendedrelease* morphine sulfate suppository 30 mg NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HR* OPANA ER ORAL 10 MG, 20 MG, 30 MG, 40 MG, 5 MG ST; QL (10 EA per 30 days) OPANA ER ORAL 15 MG, 7.5 MG QL (60 EA per 30 days) oxymorphone hcl er oral tablet extended release 12 hr* 10 mg, 20 mg, 30 mg, 5 mg oxymorphone hcl er oral tablet extended release 12 hr* 15 mg, 7.5 mg oxymorphone hcl er oral tablet extended release 12 hr* 40 mg oxymorphone hcl oral tablet 5 mg Antagonistas De Los Opioides BUTRANS TRANSDERMAL PATCH WEEKLY 15 MCG/HR Combinaciones De Analgésicos butalbital-acetaminophen oral tablet butalbital-apap-caffeine oral capsule butalbital-apap-caffeine oral tablet mg butalbital-asa-caffeine oral capsule QL (60 EA per 30 days) QL (120 EA per 30 days) 51

57 Combinaciones De Salicilato choline & mag trisalicylate oral tablet 1000 mg choline-mag trisalicylate oral liquid Anestésicos (Medicamentos De Anestesia) Anestésicos Locales - Parenteral lidocaine hcl (pf) injection solution 0.5 %, 1 % lidocaine hcl injection solution 0.5 %, 1 % Anestésicos Locales (Local Medicamentos Adormece) lidocaine viscous mouth/throat solution Combinaciones De Anestésicos Tópicos lidocaine-prilocaine external cream lidocaine-prilocaine external kit Ansiolíticos (Medicamentos De Condición De Nervio) Ansiolíticos Otros (Medicamentos De Ansiedad) buspirone hcl oral tablet hydroxyzine hcl intramuscular* solution hydroxyzine hcl oral syrup hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule meprobamate oral tablet Benzodiazepinas (Medicamentos De Ansiedad) alprazolam er oral tablet extended release 24 hr* 0.5 mg, 3 mg ALPRAZOLAM INTENSOL ORAL CONCENTRATE alprazolam oral tablet alprazolam oral tablet dispersible alprazolam xr oral tablet extended release 24 hr* 1 mg, 2 mg chlordiazepoxide hcl oral capsule clorazepate dipotassium oral tablet 52

58 diazepam oral concentrate diazepam oral solution 1 mg/ml diazepam oral tablet lorazepam oral concentrate lorazepam oral tablet oxazepam oral capsule Antibacterianos (Infección Lucha Contra Drogas) Aminoglucósidos (Infección Bacteriana Los Medicamentos (Antibióticos) amikacin sulfate injection solution 1 gm/4ml, 500 mg/2ml gentamicin sulfate injection solution neomycin sulfate oral tablet paromomycin sulfate oral capsule streptomycin sulfate intramuscular* solution reconstituted tobramycin inhalation nebulization solution QL (280 ML per 30 days) tobramycin sulfate injection solution 1.2 gm/30ml, 2 gm/50ml, 80 mg/2ml tobramycin sulfate injection solution 10 mg/ml tobramycin sulfate injection solution reconstituted Antibacteriano (Inyecciones) aztreonam injection solution reconstituted bacitracin intramuscular* solution reconstituted chloramphenicol sod succinate intravenous* solution reconstituted clindamycin palmitate hcl oral solution reconstituted clindamycin phosphate injection solution 300 mg/2ml, 600 mg/4ml, 900 mg/6ml, 9000 mg/60ml colistimethate sodium injection solution reconstituted Nivel 4 lincomycin hcl injection solution QL (10 ML per 5 days) QL (240 ML per 365 days) QL (10 EA per 5 days) 53

59 linezolid intravenous* solution 600 mg/300ml meropenem intravenous* solution reconstituted metronidazole in nacl intravenous* solution mg/100ml-% vancomycin hcl intravenous* solution reconstituted Antibacterianos, Otros clindamycin hcl oral capsule linezolid oral suspension reconstituted linezolid oral tablet methenamine hippurate oral tablet methenamine mandelate oral tablet 1 gm metronidazole oral capsule metronidazole oral tablet MONUROL ORAL PACKET nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg nitrofurantoin monohyd macro oral capsule tinidazole oral tablet trimethoprim oral tablet vancomycin hcl oral capsule XIFAXAN ORAL TABLET 550 MG Antibióticos De Cefalosporina cefaclor er oral tablet extended release 12 hr* cefaclor oral capsule cefadroxil oral capsule cefadroxil oral suspension reconstituted cefadroxil oral tablet cefdinir oral capsule cefdinir oral suspension reconstituted cefditoren pivoxil oral tablet cefixime oral suspension reconstituted 200 mg/5ml cefpodoxime proxetil oral suspension reconstituted cefpodoxime proxetil oral tablet 100 mg 54

60 cefprozil oral suspension reconstituted cefprozil oral tablet cefuroxime axetil oral tablet cephalexin oral capsule cephalexin oral suspension reconstituted cephalexin oral tablet SUPRAX ORAL CAPSULE Antiinfecciosos, Otros CAYSTON INHALATION SOLUTION INVANZ INJECTION SOLUTION Cefalosporina (Inyección) cefazolin sodium injection solution reconstituted Nivel 4 cefepime hcl injection solution reconstituted cefoxitin sodium injection solution reconstituted cefoxitin sodium intravenous* solution reconstituted cefpodoxime proxetil oral tablet 200 mg ceftazidime injection solution reconstituted 1 gm, 2 gm, 6 gm ceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 500 mg cefuroxime sodium injection solution reconstituted 1.5 gm, 7.5 gm, 750 mg cefuroxime sodium intravenous* solution reconstituted 1.5 gm Combinación De Penicilina Antibióticos amoxicillin-pot clavulanate er oral tablet extended release 12 hr* amoxicillin-pot clavulanate oral suspension reconstituted amoxicillin-pot clavulanate oral tablet amoxicillin-pot clavulanate oral tablet chewable 55

61 Combinaciones De Cefalosporinas (Inyección) AVYCAZ INTRAVENOUS* SOLUTION Combinaciones De Penicilina (Inyección) ampicillin-sulbactam sodium injection solution reconstituted 15 (10-5) gm ampicillin-sulbactam sodium intravenous* solution reconstituted 15 (10-5) gm piperacillin sod-tazobactam so intravenous* solution reconstituted Macrólidos azithromycin oral packet azithromycin oral suspension reconstituted azithromycin oral tablet 250 mg, 500 mg, 600 mg clarithromycin er oral tablet extended release 24 hr* clarithromycin oral suspension reconstituted clarithromycin oral tablet DIFICID ORAL TABLET Nivel 4 ST ERYTHROCIN STEARATE ORAL TABLET 250 MG erythromycin ethylsuccinate oral tablet KETEK ORAL TABLET Macrólidos (Inyección) azithromycin intravenous* solution reconstituted 500 mg ERYTHROCIN LACTOBIONATE INTRAVENOUS* SOLUTION 500 MG Penicilinas amoxicillin oral capsule amoxicillin oral suspension reconstituted amoxicillin oral tablet amoxicillin oral tablet chewable 125 mg, 250 mg ampicillin oral capsule 56

62 ampicillin oral suspension reconstituted dicloxacillin sodium oral capsule penicillin v potassium oral tablet Penicilinas (Inyección) ampicillin sodium injection solution reconstituted ampicillin sodium intravenous* solution reconstituted 2 gm nafcillin sodium injection solution reconstituted oxacillin sodium injection solution reconstituted 1 gm, 2 gm penicillin g potassium injection solution reconstituted penicillin g sodium injection solution reconstituted penicillin v potassium oral solution reconstituted Quinolonas ciprofloxacin hcl oral tablet ciprofloxacin oral suspension reconstituted ciprofloxacin-ciproflox hcl er oral tablet extended release 24 hr* levofloxacin oral solution levofloxacin oral tablet ofloxacin oral tablet Quinolonas (Inyección) ciprofloxacin intravenous* solution 200 mg/20ml, 400 mg/40ml levofloxacin intravenous* solution Sulfamidas sulfadiazine oral tablet QL (30 EA per 30 days) sulfamethoxazole-trimethoprim intravenous* solution sulfamethoxazole-trimethoprim oral suspension mg/5ml sulfamethoxazole-trimethoprim oral tablet Tetraciclinas demeclocycline hcl oral tablet 57

63 doxycycline hyclate oral capsule doxycycline hyclate oral tablet 100 mg, 20 mg doxycycline hyclate oral tablet delayed release 100 mg, 150 mg, 75 mg doxycycline monohydrate oral capsule doxycycline monohydrate oral suspension reconstituted doxycycline monohydrate oral tablet minocycline hcl er oral tablet extended release 24 hr* minocycline hcl oral capsule minocycline hcl oral tablet tetracycline hcl oral capsule 250 mg Tetraciclinas (Inyección) DOXY 100 INTRAVENOUS* SOLUTION Anticonceptivos * Combinación Anticonceptivos - Transdérmica *** XULANE TRANSDERMAL PATCH WEEKLY * Emergencia Anticonceptivos *** ELLA ORAL TABLET levonorgestrel oral tablet 1.5 mg OTC Anticonceptivos Intrauterinos MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE DEVICE SKYLA INTRAUTERINE INTRAUTERINE DEVICE Anticonceptivos Intravaginales CAYA VAGINAL DIAPHRAGM NUVARING VAGINAL RING OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM OPTIONS CONCEPTROL VAGINAL GEL OTC OPTIONS GYNOL II CONTRACEPTIVE VAGINAL GEL 58 OTC

64 PRENTIF FITTING SET VAGINAL TODAY SPONGE VAGINAL OTC VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM VCF VAGINAL CONTRACEPTIVE VAGINAL GEL Condones, Mujer OTC OTC FC2 FEMALE CONDOM OTC Implantes Anticonceptivos NEXPLANON SUBCUTANEOUS* IMPLANT Los Anticonceptivos Inyectables DEPO-SUBQ PROVERA 104 SUBCUTANEOUS* SUSPENSION medroxyprogesterone acetate intramuscular* suspension Los Anticonceptivos Orales ALTAVERA ORAL TABLET alyacen 1/35 oral tablet alyacen 7/7/7 oral tablet AMETHIA LO ORAL TABLET AMETHIA ORAL TABLET AMETHYST ORAL TABLET APRI ORAL TABLET ARANELLE ORAL TABLET ASHLYNA ORAL TABLET AUBRA ORAL TABLET AVIANE ORAL TABLET AZURETTE ORAL TABLET BEKYREE ORAL TABLET BEYAZ ORAL TABLET BLISOVI 24 FE ORAL TABLET BLISOVI FE 1.5/30 ORAL TABLET BLISOVI FE 1/20 ORAL TABLET briellyn oral tablet CAMRESE LO ORAL TABLET CAMRESE ORAL TABLET CAZIANT ORAL TABLET 59

65 CESIA ORAL TABLET CHATEAL ORAL TABLET CRYSELLE-28 ORAL TABLET CYCLAFEM 1/35 ORAL TABLET CYCLAFEM 7/7/7 ORAL TABLET CYRED ORAL TABLET DASETTA 1/35 ORAL TABLET DASETTA 7/7/7 ORAL TABLET DAYSEE ORAL TABLET DEBLITANE ORAL TABLET DELYLA ORAL TABLET desogestrel-ethinyl estradiol oral tablet drospirenone-ethinyl estradiol oral tablet ELINEST ORAL TABLET EMOQUETTE ORAL TABLET ENPRESSE-28 ORAL TABLET ENSKYCE ORAL TABLET ESTARYLLA ORAL TABLET estradiol-norethindrone acet oral tablet FALMINA ORAL TABLET GIANVI ORAL TABLET GILDAGIA ORAL TABLET GILDESS 1.5/30 ORAL TABLET GILDESS 1/20 ORAL TABLET GILDESS FE 1.5/30 ORAL TABLET GILDESS FE 1/20 ORAL TABLET HEATHER ORAL TABLET INTROVALE ORAL TABLET JENCYCLA ORAL TABLET jevantique lo oral tablet JINTELI ORAL TABLET JOLESSA ORAL TABLET JOLIVETTE ORAL TABLET JULEBER ORAL TABLET JUNEL 1.5/30 ORAL TABLET JUNEL FE 1.5/30 ORAL TABLET JUNEL FE 1/20 ORAL TABLET 60

66 JUNEL FE 24 ORAL TABLET KAITLIB FE ORAL TABLET CHEWABLE KARIVA ORAL TABLET KELNOR 1/35 ORAL TABLET KIMIDESS ORAL TABLET KURVELO ORAL TABLET LARIN 1.5/30 ORAL TABLET LARIN 1/20 ORAL TABLET LARIN 24 FE ORAL TABLET LARIN FE 1.5/30 ORAL TABLET LARIN FE 1/20 ORAL TABLET LAYOLIS FE ORAL TABLET CHEWABLE LEENA ORAL TABLET LESSINA ORAL TABLET LEVONEST ORAL TABLET levonorgest-eth estrad 91-day oral tablet levonorgestrel-ethinyl estrad oral tablet levonorg-eth estrad triphasic oral tablet LEVORA 0.15/30 (28) ORAL TABLET LO LOESTRIN FE ORAL TABLET LOMEDIA 24 FE ORAL TABLET LORYNA ORAL TABLET LOW-OGESTREL ORAL TABLET LUTERA ORAL TABLET LYZA ORAL TABLET marlissa oral tablet MICROGESTIN 1.5/30 ORAL TABLET MICROGESTIN 1/20 ORAL TABLET MICROGESTIN 24 FE ORAL TABLET MICROGESTIN FE 1.5/30 ORAL TABLET MICROGESTIN FE 1/20 ORAL TABLET MINASTRIN 24 FE ORAL TABLET CHEWABLE MONO-LINYAH ORAL TABLET MONONESSA ORAL TABLET MYZILRA ORAL TABLET NATAZIA ORAL TABLET 61

67 NECON 0.5/35 (28) ORAL TABLET NECON 1/35 (28) ORAL TABLET NECON 1/50 (28) ORAL TABLET NECON 10/11 (28) ORAL TABLET NECON 7/7/7 ORAL TABLET NIKKI ORAL TABLET NORA-BE ORAL TABLET norethin ace-eth estrad-fe oral tablet norethindrone acet-ethinyl est oral tablet norethindrone oral tablet norethindrone-eth estradiol oral tablet mg-mcg norethin-eth estradiol-fe oral tablet chewable mg-mcg norgestimate-eth estradiol oral tablet mg-mcg norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg NORLYROC ORAL TABLET NORTREL 0.5/35 (28) ORAL TABLET NORTREL 1/35 (21) ORAL TABLET NORTREL 1/35 (28) ORAL TABLET NORTREL 7/7/7 ORAL TABLET OCELLA ORAL TABLET OGESTREL ORAL TABLET ORSYTHIA ORAL TABLET ORTHO TRI-CYCLEN LO ORAL TABLET PHILITH ORAL TABLET PIMTREA ORAL TABLET PIRMELLA 1/35 ORAL TABLET PIRMELLA 7/7/7 ORAL TABLET PORTIA-28 ORAL TABLET PREVIFEM ORAL TABLET QUARTETTE ORAL TABLET QUASENSE ORAL TABLET RECLIPSEN ORAL TABLET SAFYRAL ORAL TABLET SETLAKIN ORAL TABLET 62

68 SHAROBEL ORAL TABLET SOLIA ORAL TABLET SPRINTEC 28 ORAL TABLET SRONYX ORAL TABLET SYEDA ORAL TABLET TARINA FE 1/20 ORAL TABLET TILIA FE ORAL TABLET TRI-ESTARYLLA ORAL TABLET TRI-LEGEST FE ORAL TABLET TRI-LINYAH ORAL TABLET TRINESSA (28) ORAL TABLET TRI-PREVIFEM ORAL TABLET TRI-SPRINTEC ORAL TABLET TRIVORA (28) ORAL TABLET VELIVET ORAL TABLET VESTURA ORAL TABLET VIENVA ORAL TABLET viorele oral tablet VYFEMLA ORAL TABLET WERA ORAL TABLET WYMZYA FE ORAL TABLET CHEWABLE ZARAH ORAL TABLET ZENCHENT FE ORAL TABLET CHEWABLE ZENCHENT ORAL TABLET ZOVIA 1/50E (28) ORAL TABLET Anticonvulsivos (Medicamentos De Condición De Nervio) Ácido Gamma - Aminobutírico (Gaba) Aumentar A Agentes (Incautación Drogas De Control) divalproex sodium er oral tablet extended release 24 hr* divalproex sodium oral divalproex sodium oral tablet delayed release FYCOMPA ORAL TABLET 2 MG, 4 MG, 6 MG, 8 MG gabapentin oral capsule 63

69 gabapentin oral solution 250 mg/5ml gabapentin oral tablet GABITRIL ORAL TABLET 12 MG, 16 MG primidone oral tablet SABRIL ORAL PACKET Nivel 4 SABRIL ORAL TABLET Nivel 4 valproate sodium intravenous* solution 100 mg/ml valproic acid oral capsule valproic acid oral syrup Agentes Reductores De Glutamato (Incautación Drogas De Control) felbamate oral suspension felbamate oral tablet lamotrigine er oral tablet extended release 24 hr* lamotrigine oral tablet lamotrigine oral tablet chewable topiramate oral capsule sprinkle topiramate oral tablet TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR Anticonvulsivantes Otros (Incautación Drogas De Control) levetiracetam er oral tablet extended release 24 hr* levetiracetam intravenous* solution levetiracetam oral solution levetiracetam oral tablet POTIGA ORAL TABLET tiagabine hcl oral tablet Barbitúricos (Medicamentos De Control De Asimiento) BUTISOL SODIUM ORAL TABLET 30 MG phenobarbital oral solution phenobarbital oral tablet 64

70 Benzodiazepinas (Medicamentos De Control De Asimiento) clonazepam oral tablet clonazepam oral tablet dispersible DIASTAT PEDIATRIC GEL PA diazepam gel 10 mg, 20 mg PA ONFI ORAL SUSPENSION ONFI ORAL TABLET 10 MG, 20 MG Canal De Sodio Agentes (Incautación Drogas De Control) BANZEL ORAL SUSPENSION BANZEL ORAL TABLET carbamazepine er oral capsule extended release 12 hour carbamazepine er oral tablet extended release 12 hr* carbamazepine oral suspension carbamazepine oral tablet carbamazepine oral tablet chewable fosphenytoin sodium injection solution oxcarbazepine oral suspension oxcarbazepine oral tablet OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HR* PEGANONE ORAL TABLET phenytoin oral suspension 125 mg/5ml phenytoin oral tablet chewable phenytoin sodium extended oral capsule phenytoin sodium injection solution VIMPAT INTRAVENOUS* SOLUTION VIMPAT ORAL SOLUTION VIMPAT ORAL TABLET Canales De Calcio Modificando A Agentes (Incautación Drogas De Control) CELONTIN ORAL CAPSULE ethosuximide oral capsule ethosuximide oral solution 65

71 zonisamide oral capsule Antidepresivos Antidepresivos, Otros nefazodone hcl oral tablet trazodone hcl oral tablet VIIBRYD ORAL TABLET VIIBRYD STARTER PACK ORAL KIT Antidepresivos (Medicamentos De Condición De Nervio) Antidepresivos Del Inhibidor De La Monoaminooxidasa EMSAM TRANSDERMAL PATCH 24 HR MARPLAN ORAL TABLET phenelzine sulfate oral tablet tranylcypromine sulfate oral tablet Antidepresivos Tricíclicos amitriptyline hcl oral tablet amoxapine oral tablet clomipramine hcl oral capsule desipramine hcl oral tablet doxepin hcl oral capsule doxepin hcl oral concentrate imipramine hcl oral tablet imipramine pamoate oral capsule nortriptyline hcl oral capsule nortriptyline hcl oral solution protriptyline hcl oral tablet trimipramine maleate oral capsule Antidepresivos Tricíclicos (Medicamentos Depresión) chlordiazepoxide-amitriptyline oral tablet Antidepresivos, Otros APLENZIN ORAL TABLET EXTENDED RELEASE 24 HR* 174 MG, 348 MG BUDEPRION SR ORAL TABLET EXTENDED RELEASE 12 HR* 100 MG 66

72 bupropion hcl er (sr) oral tablet extended release 12 hr* bupropion hcl er (xl) oral tablet extended release 24 hr* bupropion hcl oral tablet FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 HR* maprotiline hcl oral tablet mirtazapine oral tablet mirtazapine oral tablet dispersible TRINTELLIX ORAL TABLET ST Inhibidores De La Recaptación De Serotonina (Isrs) citalopram hydrobromide oral solution citalopram hydrobromide oral tablet escitalopram oxalate oral solution escitalopram oxalate oral tablet fluoxetine hcl oral capsule fluoxetine hcl oral capsule delayed release fluoxetine hcl oral solution fluoxetine hcl oral tablet 10 mg, 20 mg fluoxetine hcl oral tablet 60 mg fluvoxamine maleate er oral capsule extended release 24 hour fluvoxamine maleate oral tablet paroxetine hcl er oral tablet extended release 24 hr* paroxetine hcl oral tablet PAXIL ORAL SUSPENSION PEXEVA ORAL TABLET sertraline hcl oral concentrate sertraline hcl oral tablet Inhibidores De La Recaptación De Serotonina Y Norepinefrina (Depresión Drogas) BRISDELLE ORAL CAPSULE fluoxetine hcl (pmdd) oral capsule olanzapine-fluoxetine hcl oral capsule 67

73 TRINTELLIX ORAL TABLET ST Inhibidores De La Recaptación De Serotonina Y Norepinefrina (Irsn) desvenlafaxine er oral tablet extended release 24 hr* desvenlafaxine fumarate er oral tablet extended release 24 hr* duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg FETZIMA ORAL CAPSULE EXTENDED RELEASE 24 HOUR FETZIMA TITRATION ORAL KHEDEZLA ORAL TABLET EXTENDED RELEASE 24 HR* PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR* 100 MG, 50 MG venlafaxine hcl er oral capsule extended release 24 hour venlafaxine hcl er oral tablet extended release 24 hr* venlafaxine hcl oral tablet Antieméticos (Medicamentos Del Intestino, Instestine Y Condición Del Estómago) Adyuvantes De La Terapia Emetógena (Náuseas Y Vómitos Medicamentos) dronabinol oral capsule 10 mg dronabinol oral capsule 2.5 mg, 5 mg EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG EMEND ORAL CAPSULE 80 & 125 MG Nivel 4 granisetron hcl intravenous* solution granisetron hcl oral tablet QL (30 EA per 30 days) ondansetron hcl injection solution 4 mg/2ml, 40 mg/20ml Nivel 4 QL (50 ML per 30 days) ondansetron hcl oral solution QL (50 ML per 30 days) ondansetron hcl oral tablet QL (30 EA per 30 days) ondansetron oral tablet dispersible QL (30 EA per 30 days) 68

74 SANCUSO TRANSDERMAL PATCH VARUBI ORAL TABLET Antieméticos Otros (Náuseas Y Vómitos Medicamentos) meclizine hcl oral tablet OTC promethazine hcl oral syrup promethazine hcl oral tablet promethazine hcl suppository 12.5 mg, 25 mg trimethobenzamide hcl oral capsule Antifúngicos (Infección Lucha Contra Drogas) Antifúngicos (Hongos Infección Medicamentos) ABELCET INTRAVENOUS* SUSPENSION QL (60 ML per 30 days) amphotericin b injection solution reconstituted CANCIDAS INTRAVENOUS* SOLUTION 50 MG CANCIDAS INTRAVENOUS* SOLUTION 70 MG clotrimazole mouth/throat troche CRESEMBA INTRAVENOUS* SOLUTION CRESEMBA ORAL CAPSULE ERAXIS INTRAVENOUS* SOLUTION fluconazole in dextrose intravenous* solution fluconazole in sodium chloride intravenous* solution fluconazole oral suspension reconstituted 10 mg/ml fluconazole oral suspension reconstituted 40 mg/ml QL (60 EA per 30 days) QL (21 EA per 30 days) QL (50 EA per 30 days) QL (150 ML per 30 days) QL (60 ML per 30 days) fluconazole oral tablet 100 mg QL (22 EA per 30 days) fluconazole oral tablet 150 mg, 200 mg QL (24 EA per 30 days) fluconazole oral tablet 50 mg QL (60 EA per 30 days) flucytosine oral capsule 250 mg QL (60 EA per 30 days) flucytosine oral capsule 500 mg QL (15 EA per 30 days) 69

75 griseofulvin microsize oral suspension QL (150 ML per 30 days) griseofulvin microsize oral tablet griseofulvin ultramicrosize oral tablet itraconazole oral capsule QL (240 EA per 365 days) ketoconazole oral tablet QL (60 EA per 30 days) MYCAMINE INTRAVENOUS* SOLUTION 100 MG MYCAMINE INTRAVENOUS* SOLUTION 50 MG QL (30 EA per 30 days) QL (50 EA per 30 days) NOXAFIL ORAL SUSPENSION QL (21 ML per 30 days) NOXAFIL ORAL TABLET DELAYED RELEASE nystatin mouth/throat suspension nystatin oral powder QL (21 EA per 30 days) nystatin oral tablet QL (60 EA per 30 days) terbinafine hcl oral tablet voriconazole oral suspension reconstituted Nivel 4 QL (21 ML per 30 days) voriconazole oral tablet 200 mg Nivel 4 QL (21 EA per 30 days) voriconazole oral tablet 50 mg Antimicobacterianos (Infección Lucha Contra Drogas) Antimicobacterianos Otras (Infección Varios Lucha Contra Drogas) dapsone oral tablet MYCOBUTIN ORAL CAPSULE QL (4 EA per 30 days) rifabutin oral capsule Antituberculars (Medicamentos Para La Tuberculosis) CAPASTAT SULFATE INJECTION SOLUTION cycloserine oral capsule QL (30 EA per 30 days) ethambutol hcl oral tablet 100 mg QL (4 EA per 28 days) ethambutol hcl oral tablet 400 mg QL (90 EA per 30 days) isoniazid injection solution QL (60 ML per 30 days) isoniazid oral syrup QL (30 ML per 30 days) isoniazid oral tablet 100 mg QL (30 EA per 30 days) isoniazid oral tablet 300 mg QL (13 EA per 30 days) 70

76 PASER ORAL PACKET QL (30 EA per 30 days) PRIFTIN ORAL TABLET QL (12 EA per 30 days) pyrazinamide oral tablet RIFAMATE ORAL CAPSULE rifampin intravenous* solution reconstituted QL (12 EA per 30 days) rifampin oral capsule QL (11 EA per 30 days) RIFATER ORAL TABLET QL (12 EA per 30 days) SIRTURO ORAL TABLET QL (8 EA per 28 days) TRECATOR ORAL TABLET QL (30 EA per 30 days) Antimigraine Agentes (Medicamentos De Condición De Nervio) (5-Ht) 1B/1D De Serotonina Agonistas Del Receptor (Medicamentos De Migraña) naratriptan hcl oral tablet RELPAX ORAL TABLET QL (9 EA per 30 days) rizatriptan benzoate oral tablet rizatriptan benzoate oral tablet dispersible sumatriptan nasal solution sumatriptan succinate oral tablet QL (9 EA per 30 days) sumatriptan succinate refill subcutaneous* 6 mg/0.5ml sumatriptan succinate subcutaneous* 6 mg/0.5ml sumatriptan succinate subcutaneous* solution 6 mg/0.5ml zolmitriptan oral tablet zolmitriptan oral tablet dispersible 2.5 mg Alcaloides Del Cornezuelo De Centeno (Medicamentos De Migraña) dihydroergotamine mesylate injection solution ERGOMAR SUBLINGUAL TABLET SUBLINGUAL XELJANZ ORAL TABLET Nivel 4 ST QL (3 ML per 30 days) QL (3 ML per 30 days) QL (3 ML per 30 days) 71

77 Antimyasthenic Agentes (Medicamentos De Condición De Nervio) Parasimpaticomiméticos (Nervio Varios Medicamentos De Condición) guanidine hcl oral tablet MESTINON ORAL SYRUP pyridostigmine bromide oral tablet Antineoplásicos (Fármacos Contra El Cáncer) Agentes Alquilantes (Fármacos De Quimioterapia) BICNU INTRAVENOUS* SOLUTION Nivel 5 BUSULFEX INTRAVENOUS* SOLUTION Nivel 5 carboplatin intravenous* solution carboplatin intravenous* solution reconstituted 150 mg cisplatin intravenous* solution cyclophosphamide oral tablet Nivel 5 GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG Nivel 5 HEXALEN ORAL CAPSULE Nivel 5 IFEX INTRAVENOUS* SOLUTION Nivel 5 ifosfamide intravenous* solution reconstituted Nivel 5 LEUKERAN ORAL TABLET Nivel 5 melphalan hcl intravenous* solution reconstituted MUSTARGEN INJECTION SOLUTION Nivel 5 Nivel 5 oxaliplatin intravenous* solution thiotepa injection solution reconstituted TREANDA INTRAVENOUS* SOLUTION Agentes Antiangiogénicos (Fármacos De Quimioterapia) Nivel 5 AVASTIN INTRAVENOUS* SOLUTION Nivel 5 72

78 REVLIMID ORAL CAPSULE Nivel 5 THALOMID ORAL CAPSULE Nivel 5 Antimetabolitos (Fármacos De Quimioterapia) ALIMTA INTRAVENOUS* SOLUTION Nivel 5 ARRANON INTRAVENOUS* SOLUTION Nivel 5 azacitidine injection suspension reconstituted Nivel 5 capecitabine oral tablet Nivel 5 cladribine intravenous* solution 10 mg/10ml CLOLAR INTRAVENOUS* SOLUTION Nivel 5 cytarabine (pf) injection solution cytarabine injection solution DACOGEN INTRAVENOUS* SOLUTION Nivel 5 daunorubicin hcl intravenous* injectable decitabine intravenous* solution reconstituted doxorubicin hcl intravenous* solution doxorubicin hcl intravenous* solution reconstituted ELLENCE INTRAVENOUS* SOLUTION Nivel 5 epirubicin hcl intravenous* solution 200 mg/100ml, 50 mg/25ml epirubicin hcl intravenous* solution reconstituted ERWINAZE INJECTION SOLUTION Nivel 5 fludarabine phosphate intravenous* solution fludarabine phosphate intravenous* solution reconstituted fluorouracil intravenous* solution FOLOTYN INTRAVENOUS* SOLUTION Nivel 5 gemcitabine hcl intravenous* solution reconstituted IDAMYCIN PFS INTRAVENOUS* SOLUTION 10 MG/10ML, 5 MG/5ML idarubicin hcl intravenous* solution 10 mg/10ml, 5 mg/5ml Nivel 5 Nivel 5 mercaptopurine oral tablet Nivel 5 PA 73

79 methotrexate oral tablet Nivel 5 methotrexate sodium (pf) injection solution 50 mg/2ml methotrexate sodium injection solution 50 mg/2ml methotrexate sodium injection solution reconstituted Nivel 5 Nivel 5 mitomycin intravenous* solution reconstituted mitoxantrone hcl intravenous* concentrate TABLOID ORAL TABLET Nivel 5 TREXALL ORAL TABLET Nivel 5 UVADEX INJECTION SOLUTION Nivel 5 Antineoplásicos (Quimioterapia Varios Fármacos) ABRAXANE INTRAVENOUS* SUSPENSION ACTIMMUNE SUBCUTANEOUS* SOLUTION AFINITOR DISPERZ ORAL TABLET SOLUBLE Nivel 5 Nivel 5 Nivel 5 AFINITOR ORAL TABLET Nivel 5 ALECENSA ORAL CAPSULE Nivel 5 PA amifostine intravenous* solution reconstituted Nivel 5 ARZERRA INTRAVENOUS* CONCENTRATE Nivel 5 bexarotene oral capsule Nivel 5 bicalutamide oral tablet Nivel 5 bleomycin sulfate injection solution reconstituted BLINCYTO INTRAVENOUS* SOLUTION Nivel 5 BOSULIF ORAL TABLET Nivel 5 PA CAPRELSA ORAL TABLET Nivel 5 COMETRIQ (100 MG DAILY DOSE) ORAL KIT COMETRIQ (140 MG DAILY DOSE) ORAL KIT COMETRIQ (60 MG DAILY DOSE) ORAL KIT Nivel 5 Nivel 5 Nivel 5 PA 74

80 COSMEGEN INTRAVENOUS* SOLUTION Nivel 5 COTELLIC ORAL TABLET Nivel 5 PA dacarbazine intravenous* solution reconstituted DARZALEX INTRAVENOUS* SOLUTION Nivel 5 PA dexrazoxane intravenous* solution reconstituted DOCEFREZ INTRAVENOUS* SOLUTION docetaxel intravenous* concentrate 140 mg/7ml, 160 mg/8ml, 20 mg/ml, 80 mg/4ml Nivel 5 Nivel 5 Nivel 5 docetaxel intravenous* solution Nivel 5 ELIGARD SUBCUTANEOUS* KIT Nivel 5 ELITEK INTRAVENOUS* SOLUTION Nivel 5 EMCYT ORAL CAPSULE Nivel 5 EMPLICITI INTRAVENOUS* SOLUTION Nivel 5 ERBITUX INTRAVENOUS* SOLUTION Nivel 5 ERIVEDGE ORAL CAPSULE Nivel 5 ETOPOPHOS INTRAVENOUS* SOLUTION etoposide intravenous* solution 1 gm/50ml, 100 mg/5ml, 500 mg/25ml Nivel 5 etoposide oral capsule Nivel 5 FARESTON ORAL TABLET Nivel 5 FARYDAK ORAL CAPSULE Nivel 5 PA FASLODEX INTRAMUSCULAR* SOLUTION 250 MG/5ML FIRMAGON SUBCUTANEOUS* SOLUTION Nivel 5 Nivel 5 flutamide oral capsule Nivel 5 FUSILEV INTRAVENOUS* SOLUTION Nivel 5 GILOTRIF ORAL TABLET Nivel 5 PA HALAVEN INTRAVENOUS* SOLUTION Nivel 5 HERCEPTIN INTRAVENOUS* SOLUTION Nivel 5 hydroxyurea oral capsule Nivel 5 75 PA

81 IBRANCE ORAL CAPSULE Nivel 5 PA IDAMYCIN PFS INTRAVENOUS* SOLUTION 20 MG/20ML idarubicin hcl intravenous* solution 20 mg/20ml Nivel 5 imatinib mesylate oral tablet Nivel 5 IMBRUVICA ORAL CAPSULE Nivel 5 PA INLYTA ORAL TABLET Nivel 5 INTRON A INJECTION SOLUTION Nivel 5 INTRON A INJECTION SOLUTION UNIT Nivel 5 irinotecan hcl intravenous* solution Nivel 5 ISTODAX INTRAVENOUS* SOLUTION IXEMPRA KIT INTRAVENOUS* SOLUTION Nivel 5 Nivel 5 JAKAFI ORAL TABLET Nivel 5 JEVTANA INTRAVENOUS* SOLUTION Nivel 5 KADCYLA INTRAVENOUS* SOLUTION KEPIVANCE INTRAVENOUS* SOLUTION Nivel 5 Nivel 5 LENVIMA 10 MG DAILY DOSE ORAL Nivel 5 LENVIMA 14 MG DAILY DOSE ORAL Nivel 5 LENVIMA 18 MG DAILY DOSE ORAL Nivel 5 LENVIMA 20 MG DAILY DOSE ORAL Nivel 5 LENVIMA 24 MG DAILY DOSE ORAL Nivel 5 LENVIMA 8 MG DAILY DOSE ORAL Nivel 5 leucovorin calcium injection solution reconstituted leucovorin calcium oral tablet Nivel 5 leuprolide acetate injection kit LONSURF ORAL TABLET Nivel 4 PA LUPRON DEPOT INTRAMUSCULAR* KIT Nivel 5 LYNPARZA ORAL CAPSULE Nivel 5 PA LYSODREN ORAL TABLET Nivel 5 MATULANE ORAL CAPSULE Nivel 5 megestrol acetate oral suspension 40 mg/ml megestrol acetate oral tablet 76

82 MEKINIST ORAL TABLET Nivel 5 mesna intravenous* solution MESNEX ORAL TABLET Nivel 5 NEXAVAR ORAL TABLET Nivel 5 NILANDRON ORAL TABLET Nivel 5 NINLARO ORAL CAPSULE Nivel 5 PA ODOMZO ORAL CAPSULE Nivel 5 PA ONCASPAR INJECTION SOLUTION Nivel 5 OPDIVO INTRAVENOUS* SOLUTION Nivel 5 PA paclitaxel intravenous* concentrate PERJETA INTRAVENOUS* SOLUTION Nivel 5 POMALYST ORAL CAPSULE Nivel 5 PORTRAZZA INTRAVENOUS* SOLUTION Nivel 5 PA PROLEUKIN INTRAVENOUS* SOLUTION Nivel 5 RITUXAN INTRAVENOUS* SOLUTION Nivel 5 SOLTAMOX ORAL SOLUTION SPRYCEL ORAL TABLET Nivel 5 STIVARGA ORAL TABLET Nivel 5 PA SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 50 MG SYLATRON SUBCUTANEOUS* KIT 200 MCG, 300 MCG, 600 MCG SYNRIBO SUBCUTANEOUS* SOLUTION Nivel 5 Nivel 5 Nivel 5 TAFINLAR ORAL CAPSULE Nivel 5 TAGRISSO ORAL TABLET Nivel 5 PA TARCEVA ORAL TABLET Nivel 5 TARGRETIN ORAL CAPSULE Nivel 5 TASIGNA ORAL CAPSULE Nivel 5 TAXOTERE INTRAVENOUS* CONCENTRATE 20 MG/ML, 80 MG/4ML Nivel 5 temozolomide oral capsule Nivel 5 topotecan hcl intravenous* solution reconstituted TORISEL INTRAVENOUS* SOLUTION Nivel 5 TRELSTAR MIXJECT INTRAMUSCULAR* SUSPENSION Nivel 5 tretinoin oral capsule Nivel 5 77

83 TRISENOX INTRAVENOUS* SOLUTION Nivel 5 TYKERB ORAL TABLET Nivel 5 UNITUXIN INTRAVENOUS* SOLUTION Nivel 5 PA VECTIBIX INTRAVENOUS* SOLUTION 100 MG/5ML, 400 MG/20ML VELCADE INJECTION SOLUTION Nivel 5 Nivel 5 vinblastine sulfate intravenous* solution vinblastine sulfate intravenous* solution reconstituted VINCASAR PFS INTRAVENOUS* SOLUTION vinorelbine tartrate intravenous* solution VOTRIENT ORAL TABLET Nivel 5 VRAYLAR ORAL ST; QL (7 EA per 7 days) VRAYLAR ORAL CAPSULE 1.5 MG ST; QL (60 EA per 30 days) VRAYLAR ORAL CAPSULE 3 MG, 4.5 MG ST; QL (30 EA per 30 days) VRAYLAR ORAL CAPSULE 6 MG XALKORI ORAL CAPSULE Nivel 5 PA XTANDI ORAL CAPSULE Nivel 5 PA YERVOY INTRAVENOUS* SOLUTION Nivel 5 YONDELIS INTRAVENOUS* SOLUTION Nivel 5 ZALTRAP INTRAVENOUS* SOLUTION Nivel 5 ZELBORAF ORAL TABLET Nivel 5 ZOLINZA ORAL CAPSULE Nivel 5 ZYTIGA ORAL TABLET Nivel 5 Inhibidores De La Aromatasa 3ª Generación (Fármacos De Quimioterapia Hormonal) anastrozole oral tablet Nivel 5 exemestane oral tablet Nivel 5 letrozole oral tablet Nivel 5 Ppaca Prev Mama Ca (Fármacos Contra El Cáncer) tamoxifen citrate oral tablet PA 78

84 Antiparasitarios (Infección Lucha Contra Drogas) Antihelmínticos (Infección Varios Lucha Contra Drogas) ALBENZA ORAL TABLET ivermectin oral tablet SKLICE EXTERNAL LOTION Antiprotozoals (Drogas De La Malaria) ALINIA ORAL SUSPENSION ALINIA ORAL TABLET atovaquone oral suspension atovaquone-proguanil hcl oral tablet chloroquine phosphate oral tablet DARAPRIM ORAL TABLET Nivel 4 hydroxychloroquine sulfate oral tablet mefloquine hcl oral tablet MEPRON ORAL SUSPENSION NEBUPENT INHALATION SOLUTION PENTAM INJECTION SOLUTION primaquine phosphate oral tablet Antipsicóticos (Medicamentos De Condición De Nervio) 1 º Generación/Típica (Estado De Ánimo Trastorno Medicamentos) chlorpromazine hcl injection solution chlorpromazine hcl 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 haloperidol lactate injection solution 79

85 haloperidol lactate oral concentrate haloperidol oral tablet loxapine succinate oral capsule ORAP ORAL TABLET perphenazine oral tablet perphenazine-amitriptyline oral tablet prochlorperazine edisylate injection solution prochlorperazine maleate oral tablet prochlorperazine suppository thioridazine hcl oral tablet thiothixene oral capsule trifluoperazine hcl oral tablet 2Da Generación/Atípicos (Estado De Ánimo Trastorno Medicamentos) ABILIFY MAINTENA INTRAMUSCULAR* SUSPENSION 300 MG, 400 MG aripiprazole oral solution aripiprazole oral tablet aripiprazole oral tablet dispersible ARISTADA INTRAMUSCULAR* 441 MG/1.6ML ARISTADA INTRAMUSCULAR* 662 MG/2.4ML ARISTADA INTRAMUSCULAR* 882 MG/3.2ML FANAPT ORAL TABLET FANAPT TITRATION PACK ORAL TABLET GEODON INTRAMUSCULAR* SOLUTION INVEGA ORAL TABLET EXTENDED RELEASE 24 HR* INVEGA SUSTENNA INTRAMUSCULAR* SUSPENSION LATUDA ORAL TABLET olanzapine intramuscular* solution reconstituted olanzapine oral tablet olanzapine oral tablet dispersible 80 ST; QL (1.8 ML per 28 days) ST; QL (2.4 ML per 28 days) ST; QL (3.2 ML per 28 days)

86 quetiapine fumarate er oral tablet extended release 24 hr* quetiapine fumarate oral tablet RISPERDAL CONSTA INTRAMUSCULAR* SUSPENSION RISPERIDONE M-TAB ORAL TABLET DISPERSIBLE 0.5 MG, 1 MG, 3 MG, 4 MG RISPERIDONE M-TAB ORAL TABLET DISPERSIBLE 2 MG risperidone oral solution risperidone oral tablet risperidone oral tablet dispersible 0.25 mg SAPHRIS SUBLINGUAL TABLET SUBLINGUAL 10 MG, 5 MG ziprasidone hcl oral capsule Resistentes Al Tratamiento (Medicamentos De Trastorno Estado De Ánimo) clozapine oral tablet FAZACLO ORAL TABLET DISPERSIBLE 100 MG, 12.5 MG, 25 MG Antivirales (Infección Lucha Contra Drogas) Agentes Antiherpéticos (Virus Infección Medicamentos) acyclovir oral capsule acyclovir oral suspension acyclovir oral tablet acyclovir sodium intravenous* solution acyclovir sodium intravenous* solution reconstituted famciclovir oral tablet valacyclovir hcl oral tablet Agentes Anti-Influenza (Virus Infección Medicamentos) rimantadine hcl oral tablet TAMIFLU ORAL CAPSULE 30 MG, 45 MG TAMIFLU ORAL CAPSULE 75 MG QL (10 EA per 5 days) 81

87 TAMIFLU ORAL SUSPENSION 6 MG/ML Agentes Anti-Vih, Inhibidores No Nucleósidos De La Transcriptasa Inversa (Retrovirus Infección Medicamentos) EDURANT ORAL TABLET INTELENCE ORAL TABLET nevirapine er oral tablet extended release 24 hr* nevirapine oral suspension nevirapine oral tablet RESCRIPTOR ORAL TABLET SUSTIVA ORAL CAPSULE SUSTIVA ORAL TABLET VIRAMUNE ORAL SUSPENSION Agentes Anti-Vih, Nucleósidos Y Nucleótidos Inhibidores De La Transcriptasa Inversa (Retrovirus Infección Medicamentos) abacavir sulfate oral tablet QL (390 EA per 30 days) abacavir sulfate-lamivudine oral tablet Nivel 4 abacavir-lamivudine-zidovudine oral tablet didanosine oral capsule delayed release 125 mg didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg QL (980 EA per 30 days) QL (360 EA per 30 days) EMTRIVA ORAL CAPSULE QL (360 EA per 30 days) EMTRIVA ORAL SOLUTION QL (400 ML per 30 days) EPIVIR HBV ORAL SOLUTION QL (9 ML per 30 days) lamivudine oral solution lamivudine oral tablet 150 mg, 300 mg QL (9 EA per 30 days) lamivudine-zidovudine oral tablet RETROVIR INTRAVENOUS* SOLUTION stavudine oral capsule 15 mg QL (9 EA per 30 days) stavudine oral capsule 20 mg, 30 mg QL (3 EA per 30 days) stavudine oral capsule 40 mg QL (60 EA per 30 days) stavudine oral solution reconstituted QL (60 ML per 30 days) 82

88 TRUVADA ORAL TABLET MG VIDEX ORAL SOLUTION VIREAD ORAL POWDER VIREAD ORAL TABLET QL (390 ML per 30 days) ZIAGEN ORAL SOLUTION QL (390 ML per 30 days) zidovudine oral capsule zidovudine oral syrup zidovudine oral tablet Anti-Citomegalovirus (Cmv) Agentes (Virus Infección Medicamentos) FOSCAVIR INTRAVENOUS* SOLUTION 6000 MG/250ML ganciclovir sodium intravenous* solution reconstituted VALCYTE ORAL SOLUTION valganciclovir hcl oral tablet Antihepatitis Agentes (Virus Infección Medicamentos) adefovir dipivoxil oral tablet Nivel 4 BARACLUDE ORAL SOLUTION entecavir oral tablet HARVONI ORAL TABLET Nivel 4 PA lamivudine oral tablet 100 mg QL (20 EA per 5 days) PEGASYS PROCLICK SUBCUTANEOUS* SOLUTION 135 MCG/0.5ML Nivel 4 PEGASYS SUBCUTANEOUS* SOLUTION Nivel 4 RIBASPHERE ORAL TABLET 400 MG RIBASPHERE RIBAPAK ORAL TABLET 400 & 600 MG, 400 MG Nivel 4 ribavirin oral capsule ribavirin oral tablet 200 mg SOVALDI ORAL TABLET Nivel 4 PA TYZEKA ORAL TABLET VICTRELIS ORAL CAPSULE Nivel 4 PA 83

89 Anti-Hiv Agents Otros (Retrovirus Infección Medicamentos) ATRIPLA ORAL TABLET COMPLERA ORAL TABLET FUZEON SUBCUTANEOUS* SOLUTION Nivel 4 GENVOYA ORAL TABLET Nivel 4 QL (60 EA per 30 days) ISENTRESS ORAL TABLET QL (10 EA per 30 days) ISENTRESS ORAL TABLET CHEWABLE 100 MG ISENTRESS ORAL TABLET CHEWABLE 25 MG QL (180 EA per 30 days) QL (10 EA per 30 days) SELZENTRY ORAL TABLET 150 MG Nivel 4 QL (30 EA per 30 days) SELZENTRY ORAL TABLET 300 MG Nivel 4 QL (10 EA per 30 days) STRIBILD ORAL TABLET Inhibidores De Proteasas Anti-Hiv Agents (Retrovirus Infección Medicamentos) APTIVUS ORAL CAPSULE QL (360 EA per 30 days) APTIVUS ORAL SOLUTION QL (360 ML per 30 days) CRIXIVAN ORAL CAPSULE 200 MG, 400 MG QL (90 EA per 30 days) INVIRASE ORAL CAPSULE QL (360 EA per 30 days) INVIRASE ORAL TABLET QL (360 EA per 30 days) KALETRA ORAL SOLUTION KALETRA ORAL TABLET LEXIVA ORAL SUSPENSION QL (90 ML per 30 days) LEXIVA ORAL TABLET QL (90 EA per 30 days) NORVIR ORAL CAPSULE QL (360 EA per 30 days) NORVIR ORAL SOLUTION QL (360 ML per 30 days) NORVIR ORAL TABLET QL (360 EA per 30 days) PREZISTA ORAL SUSPENSION QL (120 ML per 30 days) PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG QL (60 EA per 30 days) QL (120 EA per 30 days) TIVICAY ORAL TABLET 50 MG QL (10 EA per 30 days) VIRACEPT ORAL TABLET 250 MG QL (240 EA per 30 days) 84

90 VIRACEPT ORAL TABLET 625 MG QL (90 EA per 30 days) Miscellaneous (Misceláneos) * Agujas Y Jeringas *** insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1" 0.3 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 1/2" 0.5 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml OTC insulin syringe/needle OTC pen needles 1/2" OTC pen needles 29g x 12mm, 31g x 5 mm, 31g x 6 mm, 32g x 4 mm OTC pen needles 3/16" OTC pen needles 5/16" OTC ULTRA-THIN II PEN NEEDLES OTC * Aplicadores, Algodones, Etc. *** alcohol pads pad OTC alcohol swabs pad 70 % OTC Antídotos PRAXBIND INTRAVENOUS* SOLUTION Productos De Diagnóstico BAYER BREEZE 2 TEST IN VITRO DISK OTC; QL (300 EA per 30 days) BAYER CONTOUR NEXT TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) BAYER CONTOUR TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) EXACTECH R-S-G TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) EXACTECH TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) FREESTYLE INSULINX TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) FREESTYLE LITE TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) FREESTYLE PRECISION NEO TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) FREESTYLE TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) PRECISION PCX IN VITRO STRIP OTC; QL (300 EA per 30 days) PRECISION PCX PLUS TEST IN VITRO STRIP PRECISION POINT OF CARE TEST IN VITRO STRIP 85 OTC; QL (300 EA per 30 days) OTC; QL (300 EA per 30 days)

91 PRECISION QID TEST IN VITRO STRIP OTC; QL (300 EA per 30 days) PRECISION SOF-TACT TEST IN VITRO STRIP PRECISION XTRA BLOOD GLUCOSE IN VITRO STRIP PRECISION XTRA KETONE IN VITRO STRIP Varios (Miscellaneous Herida Cuidado Fármacos) lactated ringers irrigation solution PHYSIOSOL IRRIGATION IRRIGATION SOLUTION ringers irrigation irrigation solution Nutrientes Terapéuticos / Minerales / Electrolitos (Soluciones De Reemplazo Y Multivitaminas) * Prenatal Mv & Min W/Fe-Fa *** prenatal low iron oral tablet mg OTC prenatal one daily oral tablet OTC prenatal vitamin oral tablet OTC RIGHT STEP PRENATAL ORAL TABLET OTC Modificadores De Electrolitos Y Minerales (Antídotos/Productos) CHEMET ORAL CAPSULE EXJADE ORAL TABLET SOLUBLE Nivel 4 KIONEX ORAL POWDER KIONEX ORAL SUSPENSION sodium polystyrene sulfonate oral powder sodium polystyrene sulfonate oral suspension sodium polystyrene sulfonate suspension 50 gm/200ml Modificadores De Electrolitos Y Minerales (Electrolitos De Reemplazo) SAMSCA ORAL TABLET Nivel 4 PA OTC; QL (30 EA per 300 days) OTC; QL (300 EA per 30 days) OTC; QL (300 EA per 30 days) 86

92 Nutrientes (Reemplazo De Líquidos) AMINOSYN INTRAVENOUS* SOLUTION 10 %, 8.5 % AMINOSYN M INTRAVENOUS* SOLUTION AMINOSYN/ELECTROLYTES INTRAVENOUS* SOLUTION 8.5 % AMINOSYN-PF INTRAVENOUS* SOLUTION 7 % CLINIMIX E/DEXTROSE (2.75/10) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (2.75/5) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (4.25/25) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (4.25/5) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (5/15) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (5/20) INTRAVENOUS* SOLUTION CLINIMIX E/DEXTROSE (5/25) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (2.75/5) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (4.25/10) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (4.25/20) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (4.25/25) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (4.25/5) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (5/15) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (5/20) INTRAVENOUS* SOLUTION CLINIMIX/DEXTROSE (5/25) INTRAVENOUS* SOLUTION dextrose intravenous* solution 10 %, 5 % FER-IN-SOL ORAL SOLUTION OTC ferrous sulfate oral elixir OTC 87

93 ferrous sulfate oral liquid OTC ferrous sulfate oral solution 75 (15 fe) mg/ml OTC folic acid oral tablet 1 mg OTC HEPATASOL INTRAVENOUS* SOLUTION INTRALIPID INTRAVENOUS* EMULSION 20 % iron chews pediatric oral tablet chewable OTC NEPHRAMINE INTRAVENOUS* SOLUTION PREMASOL INTRAVENOUS* SOLUTION 6 % PROCALAMINE INTRAVENOUS* SOLUTION PROSOL INTRAVENOUS* SOLUTION Ppaca Fólico (Vitaminas) calcium pnv oral capsule CITRANATAL B-CALM ORAL CONCEPT OB ORAL CAPSULE folcal dha oral capsule mg FOLIVANE-OB ORAL CAPSULE FOLIVANE-PRX DHA NF ORAL CAPSULE GESTICARE DHA ORAL 27-1 & 250 MG INATAL ADVANCE ORAL TABLET INATAL GT ORAL TABLET INATAL ULTRA ORAL TABLET multi prenatal oral tablet OTC MYNATAL ADVANCE ORAL TABLET MYNATAL ORAL TABLET NATELLE ONE ORAL CAPSULE MG pnv fe fum/docusate/folic acid oral tablet pnv-dha oral capsule pnv-dha+docusate oral capsule prenaissance oral capsule prenatal 19 oral tablet rulavite dha oral capsule se-natal 19 oral tablet TARON-BC ORAL TARON-PREX ORAL CAPSULE 88

94 thrivite 19 oral tablet tl-select oral capsule triadvance oral tablet trinatal gt oral tablet ultra tabs oral tablet VEMAVITE-PRX 2 ORAL CAPSULE VINACAL B ORAL virt-advance oral tablet virt-pn dha oral capsule virt-select oral capsule virt-vite gt oral tablet VITAFOL-ONE ORAL CAPSULE ZATEAN-PN DHA ORAL CAPSULE Reemplazo De Electrolitos Y Minerales (Electrolitos De Reemplazo) CARBAGLU ORAL TABLET Nivel 4 chromic chloride intravenous* solution effervescent pot chloride oral tablet effervescent gnp vitamin d-400 oral tablet OTC HYPERLYTE-CR INTRAVENOUS* SOLUTION kcl in dextrose-nacl intravenous* solution meq/l-%-%, meq/l-%-% k-effervescent oral tablet effervescent KLOR-CON 10 ORAL TABLET EXTENDEDRELEASE* KLOR-CON M10 ORAL TABLET EXTENDEDRELEASE* KLOR-CON M15 ORAL TABLET EXTENDEDRELEASE* KLOR-CON M20 ORAL TABLET EXTENDEDRELEASE* KLOR-CON ORAL PACKET KLOR-CON ORAL TABLET EXTENDEDRELEASE* magnesium chloride injection solution magnesium sulfate injection solution 50 % 89

95 nutrilyte intravenous* concentrate pot bicarb-pot chloride oral tablet effervescent potassium acetate intravenous* solution potassium bicarbonate oral tablet effervescent potassium chloride crys er oral tablet extendedrelease* potassium chloride er oral capsule extended release* potassium chloride er oral tablet extendedrelease* potassium chloride in nacl intravenous* solution meq/l-% potassium chloride intravenous* solution potassium chloride oral packet potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%) sodium chloride injection solution sodium chloride intravenous* solution 0.9 %, 4 meq/ml sodium lactate intravenous* solution 5 meq/ml virt-phos 250 neutral oral tablet zinc sulfate oral capsule OTC Reemplazo De Electrolitos Y Minerales (Reemplazo De Líquidos) dextrose in lactated ringers intravenous* solution dextrose-nacl intravenous* solution %, %, %, %, %, % ISOLYTE-P IN D5W INTRAVENOUS* SOLUTION ISOLYTE-S INTRAVENOUS* SOLUTION ISOLYTE-S PH 7.4 INTRAVENOUS* SOLUTION kcl in d5w lactated ringers intravenous* solution 90

96 kcl in dextrose-nacl intravenous* solution meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-% kcl-lactated ringers-d5w intravenous* solution lactated ringers intravenous* solution NORMOSOL-M IN D5W INTRAVENOUS* SOLUTION NORMOSOL-R IN D5W INTRAVENOUS* SOLUTION NORMOSOL-R INTRAVENOUS* SOLUTION NORMOSOL-R PH 7.4 INTRAVENOUS* SOLUTION PLASMA-LYTE 148 INTRAVENOUS* SOLUTION PLASMA-LYTE-56 IN D5W INTRAVENOUS* SOLUTION potassium chloride in dextrose intravenous* solution 20-5 meq/l-%, 40-5 meq/l-% potassium chloride in nacl intravenous* solution meq/l-%, meq/l-% ringers intravenous* solution saline flush intravenous* solution sodium chloride bacteriostatic injection solution sodium chloride flush intravenous* solution sodium chloride intravenous* solution 0.45 %, 3 %, 5 % Vitaminas (Vitaminas) aqueous vitamin d oral liquid OTC bp folinatal plus b oral tablet multi-vit/fluoride oral solution 0.5 mg/ml multi-vitamin/fluoride oral solution multivitamin/fluoride oral tablet chewable 0.5 mg, 1 mg MVC-FLUORIDE ORAL TABLET CHEWABLE 0.25 MG niacin er oral tablet extendedrelease* 500 mg, 750 mg OTC one-daily multi vitamins oral tablet OTC 91

97 triple-vitamin/fluoride oral solution tri-vitamin/fluoride oral solution 0.5 mg/ml vitamin d (cholecalciferol) oral tablet 400 unit OTC vitamin d oral liquid OTC Reemplazo De Enzimas / Modificadores (Medicamentos De Hormonas Y Enzimas) Reemplazo De Enzimas / Modificadores (Fármacos De Deficiencia De La Enzima) ADAGEN INTRAMUSCULAR* SOLUTION Nivel 4 ALDURAZYME INTRAVENOUS* SOLUTION Nivel 4 CEREZYME INTRAVENOUS* SOLUTION 400 UNIT Nivel 4 CYSTADANE ORAL POWDER Nivel 4 ELAPRASE INTRAVENOUS* SOLUTION Nivel 4 FABRAZYME INTRAVENOUS* SOLUTION Nivel 4 KANUMA INTRAVENOUS* SOLUTION Nivel 4 PA KUVAN ORAL PACKET 100 MG Nivel 4 KUVAN ORAL TABLET SOLUBLE Nivel 4 levocarnitine intravenous* solution levocarnitine oral solution OTC levocarnitine oral tablet LUMIZYME INTRAVENOUS* SOLUTION Nivel 4 NAGLAZYME INTRAVENOUS* SOLUTION Nivel 4 ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG ZAVESCA ORAL CAPSULE Nivel 4 Reguladores De Glucosa De Sangre (Hormonas Y Diabetes Drogas) * Alfa-Glucosidasa Inhibidores *** acarbose oral tablet * Diabéticos Otros *** GLUCAGEN DIAGNOSTIC INJECTION SOLUTION 92

98 GLUCAGEN HYPOKIT INJECTION SOLUTION GLUCAGON EMERGENCY INJECTION KIT glucose oral tablet chewable 4-6 gm-mg OTC PROGLYCEM ORAL SUSPENSION Nivel 4 * Inhibidores De Dipeptidil Peptidasa-4 (Dpp-4) *** NESINA ORAL TABLET ONGLYZA ORAL TABLET Agentes Antidiabéticos (Diabetes Inyectables, Medicamentos De Azúcar En La Sangre) BYETTA 10 MCG PEN SUBCUTANEOUS* BYETTA 5 MCG PEN SUBCUTANEOUS* SYMLINPEN 120 SUBCUTANEOUS* SYMLINPEN 60 SUBCUTANEOUS* Agentes Antidiabéticos (Orales Para La Diabetes, Azúcar En La Sangre Las Drogas) glipizide-metformin hcl oral tablet glyburide oral tablet 2.5 mg, 5 mg glyburide-metformin oral tablet OSENI ORAL TABLET pioglitazone hcl-glimepiride oral tablet PRANDIMET ORAL TABLET PRANDIN ORAL TABLET tolazamide oral tablet tolbutamide oral tablet Antidiabéticos Biguanida metformin hcl er (mod) oral tablet extended release 24 hr* metformin hcl er (osm) oral tablet extended release 24 hr* metformin hcl er oral tablet extended release 24 hr* metformin hcl oral tablet RIOMET ORAL SOLUTION 93

99 Antidiabéticos, Otros CYCLOSET ORAL TABLET nateglinide oral tablet repaglinide oral tablet Combinación De Inhibidor De La Dipeptidil Peptidasa-4 (Dpp-4) JANUMET ORAL TABLET JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HR* KAZANO ORAL TABLET KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HR* Combinaciones De Thiazolindinedione (Tzd) ACTOPLUS MET XR ORAL TABLET EXTENDED RELEASE 24 HR* AVANDAMET ORAL TABLET pioglitazone hcl-metformin hcl oral tablet Inhibidores De La Dipeptidil Peptidasa-4 (Dpp-4) JANUVIA ORAL TABLET Insulinas (Diabetes Inyectables, Medicamentos De Azúcar En La Sangre) APIDRA INJECTION SOLUTION APIDRA SOLOSTAR SUBCUTANEOUS* LANTUS SOLOSTAR SUBCUTANEOUS* LANTUS SUBCUTANEOUS* SOLUTION LEVEMIR FLEXTOUCH SUBCUTANEOUS* LEVEMIR SUBCUTANEOUS* SOLUTION NOVOLIN 70/30 RELION SUBCUTANEOUS* SUSPENSION NOVOLIN 70/30 SUBCUTANEOUS* SUSPENSION NOVOLIN N RELION SUBCUTANEOUS* SUSPENSION NOVOLIN N SUBCUTANEOUS* SUSPENSION OTC OTC OTC OTC NOVOLIN R INJECTION SOLUTION OTC 94

100 NOVOLIN R RELION INJECTION SOLUTION NOVOLOG FLEXPEN SUBCUTANEOUS* NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS* NOVOLOG MIX 70/30 SUBCUTANEOUS* SUSPENSION NOVOLOG PENFILL SUBCUTANEOUS* NOVOLOG SUBCUTANEOUS* SOLUTION OTC TOUJEO SOLOSTAR SUBCUTANEOUS* QL (21 ML per 30 days) TRESIBA FLEXTOUCH SUBCUTANEOUS* Sulfonilureas (Antidiabéticos) chlorpropamide oral tablet DIABETA ORAL TABLET glimepiride oral tablet glipizide er oral tablet extended release 24 hr* glipizide oral tablet glipizide xl oral tablet extended release 24 hr* glyburide micronized oral tablet glyburide oral tablet 1.25 mg Tiazolidinedionas (Tzd) AVANDIA ORAL TABLET pioglitazone hcl oral tablet Transporte De Sodio-Glucosa Co 2 (Sglt2) Inhibidores (Antidiabético) FARXIGA ORAL TABLET INVOKANA ORAL TABLET Relajantes De Músculo Esquelético (Drogas Musculares Y Articulares) Relajantes De Músculo Esquelético (Drogas Musculares Y Articulares) baclofen oral tablet chlorzoxazone oral tablet 500 mg cyclobenzaprine hcl oral tablet dantrolene sodium oral capsule metaxalone oral tablet 800 mg 95

101 methocarbamol oral tablet orphenadrine citrate er oral tablet extended release 12 hr* orphenadrine citrate injection solution tizanidine hcl oral capsule tizanidine hcl oral tablet Sangre Productos/Modificadores/Expansor es De Volumen (Sangre Trastorno Medicamentos) Agentes Hematopoyéticos, Otros PROMACTA ORAL TABLET Nivel 4 Anticoagulantes (Diluyentes De La Sangre) ELIQUIS ORAL TABLET enoxaparin sodium injection solution enoxaparin sodium subcutaneous* solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 60 mg/0.6ml, 80 mg/0.8ml enoxaparin sodium subcutaneous* solution 30 mg/0.3ml, 40 mg/0.4ml Nivel 4 fondaparinux sodium subcutaneous* solution Nivel 4 heparin (porcine) in d5w intravenous* solution heparin (porcine) in nacl injection solution heparin lock flush intravenous* solution heparin sod (porcine) in d5w intravenous* solution heparin sodium (porcine) injection solution 1000 unit/ml, unit/ml, unit/ml, 5000 unit/ml heparin sodium (porcine) pf injection solution PRADAXA ORAL CAPSULE 150 MG, 75 MG sash kit intravenous* kit unit/ml-% SAVAYSA ORAL TABLET warfarin sodium oral tablet XARELTO ORAL TABLET XARELTO STARTER PACK ORAL 96

102 Erythropoietins PROCRIT INJECTION SOLUTION UNIT/ML Modificadores De La Formación De Sangre (Sangre Formación Fármacos) tranexamic acid intravenous* solution 1000 mg/10ml Plaquetaria Modificando A Agentes (Diluyentes De La Sangre) AGGRENOX ORAL CAPSULE EXTENDED RELEASE 12 HOUR Nivel 4 anagrelide hcl oral capsule aspirin-dipyridamole er oral capsule extended release 12 hour cilostazol oral tablet clopidogrel bisulfate oral tablet dipyridamole oral tablet EFFIENT ORAL TABLET ticlopidine hcl oral tablet Tos/Resfriado/Alergia Antitusivo (Narcótico) hydrocodone-homatropine oral syrup hydrocodone-homatropine oral tablet Antitusivos (No Narcótico) benzonatate oral capsule 100 mg, 200 mg Combinación Antitusivo (Narcótico) hydrocod polst-cpm polst er oral promethazine vc/codeine oral syrup promethazine-codeine oral syrup pseudoeph-chlorphen-hydrocod oral solution Combinación Antitusivo (No Narcótico) DESGEN PEDIATRIC ORAL LIQUID OTC promethazine-dm oral syrup pseudoeph-bromphen-dm oral syrup mg/5ml PA OTC TUSSLIN PEDIATRIC ORAL LIQUID OTC 97

103 Descongestivo-Antihistamínico cold & allergy oral elixir OTC promethazine vc plain oral syrup 98

104 Index 8-MOP abacavir sulfate abacavir sulfate-lamivudine abacavir-lamivudine-zidovudine ABELCET ABILIFY MAINTENA ABRAXANE acarbose acebutolol hcl... 7 acetaminophen-codeine acetaminophen-codeine # acetaminophen-codeine # acetazolamide acetazolamide er acetic acid acetic acid-aluminum acetate acetylcysteine acitretin ACT ANTICAVITY FLUORIDE RINSE ACTEMRA... 40, 41 ACTHIB ACTIMMUNE ACTOPLUS MET XR acyclovir... 23, 81 acyclovir sodium ADACEL ADAGEN adapalene adefovir dipivoxil ADRENALIN adult aspirin low strength... 5 ADVAIR DISKUS ADVAIR HFA ADVICOR AEROSPAN AFINITOR AFINITOR DISPERZ AFLURIA AFLURIA PRESERVATIVE FREE AGGRENOX ALBENZA albuterol sulfate albuterol sulfate er alclometasone dipropionate alcohol pads alcohol swabs ALDURAZYME ALECENSA alendronate sodium ALIMTA ALINIA allopurinol... 4 alosetron hcl ALPHAGAN P alprazolam alprazolam er ALPRAZOLAM INTENSOL alprazolam xr ALTAVERA ALTOPREV alyacen 1/ alyacen 7/7/ amantadine hcl... 5 amcinonide... 23, 24 AMETHIA AMETHIA LO AMETHYST amifostine amikacin sulfate amiloride hcl amiloride-hydrochlorothiazide aminophylline AMINOSYN AMINOSYN M AMINOSYN/ELECTROLYTES AMINOSYN-PF amiodarone hcl... 8 AMITIZA amitriptyline hcl amlodipine besy-benazepril hcl amlodipine besylate... 9 amlodipine besylate-valsartan amlodipine-atorvastatin amlodipine-olmesartan amlodipine-valsartan-hctz ammonium lactate amoxapine amoxicill-clarithro-lansopraz amoxicillin amoxicillin-pot clavulanate amoxicillin-pot clavulanate er amphetamine-dextroamphet er amphetamine-dextroamphetami ne amphotericin b ampicillin... 56, 57 ampicillin sodium ampicillin-sulbactam sodium AMPYRA AMTURNIDE anagrelide hcl anastrozole ANDRODERM ANDROGEL ANDROID ANDROXY antipyrine-benzocaine APIDRA APIDRA SOLOSTAR APLENZIN APOKYN... 5 apraclonidine hcl APRI APRISO APTIVUS aqueous vitamin d ARALAST NP ARANELLE ARAVA ARBINOXA ARCALYST aripiprazole ARISTADA ARRANON ARZERRA ASACOL HD ASHLYNA aspirin... 5 aspirin adult low dose... 5 aspirin ec... 5 aspirin low dose... 5 aspirin-dipyridamole er ASTAGRAF XL ASTEPRO ATACAND... 8 atenolol... 7 atenolol-chlorthalidone ATGAM atorvastatin calcium atovaquone atovaquone-proguanil hcl ATRIPLA atropine sulfate... 30, 46 ATROVENT HFA AUBAGIO AUBRA AVANDAMET AVANDIA AVASTIN AVIANE... 59

105 AVODART AVYCAZ azacitidine AZASAN azathioprine azelastine hcl... 19, 45 AZILECT... 6 azithromycin AZOPT aztreonam AZURETTE bacitracin... 47, 53 bacitracin-polymyxin b baclofen balsalazide disodium BANZEL BARACLUDE BAYER ASPIRIN EXTRA STRENGTH... 5 BAYER BREEZE 2 TEST BAYER CONTOUR NEXT TEST BAYER CONTOUR TEST bcg vaccine BEKYREE belladonna alkaloids-opium benazepril hcl benazepril-hydrochlorothiazide BENLYSTA benzonatate benzoyl peroxide-erythromycin benztropine mesylate... 6 BEPREVE BESIVANCE betamethasone dipropionate betamethasone dipropionate aug betamethasone valerate BETASERON betaxolol hcl... 7, 46 bethanechol chloride bexarotene BEYAZ bicalutamide BICNU bisoprolol fumarate... 7 bisoprolol-hydrochlorothiazide bleomycin sulfate BLINCYTO BLISOVI 24 FE BLISOVI FE 1.5/ BLISOVI FE 1/ BOOSTRIX BOSULIF bp folinatal plus b bp wash BREO ELLIPTA briellyn brimonidine tartrate BRISDELLE BROMDAY bromfenac sodium bromfenac sodium (once-daily) bromocriptine mesylate... 6 BUDEPRION SR budesonide... 17, 19, 35 bumetanide buprenorphine hcl buprenorphine hcl-naloxone hcl bupropion hcl bupropion hcl er (smoking det) bupropion hcl er (sr) bupropion hcl er (xl) buspirone hcl BUSULFEX butalbital-acetaminophen butalbital-apap-caff-cod butalbital-apap-caffeine butalbital-asa-caff-codeine butalbital-asa-caffeine BUTISOL SODIUM BUTRANS BYETTA 10 MCG PEN BYETTA 5 MCG PEN calcipotriene calcitonin (salmon) calcitriol calcium acetate (phos binder) calcium pnv CAMRESE CAMRESE LO CANCIDAS candesartan cilexetil... 8 candesartan cilexetil-hctz... 8 CAPASTAT SULFATE capecitabine CAPRELSA captopril captopril-hydrochlorothiazide CARAFATE CARBAGLU carbamazepine carbamazepine er carbidopa-levodopa... 6 carbidopa-levodopa er... 6 carbidopa-levodopa-entacapon e... 6 carbinoxamine maleate carboplatin CARIMUNE NF carteolol hcl carvedilol... 7 CAVIRINSE CAYA CAYSTON CAZIANT cefaclor cefaclor er cefadroxil cefazolin sodium cefdinir cefditoren pivoxil cefepime hcl cefixime cefoxitin sodium cefpodoxime proxetil... 54, 55 cefprozil ceftazidime ceftriaxone sodium cefuroxime axetil cefuroxime sodium celecoxib... 4 CELLCEPT INTRAVENOUS CELONTIN cephalexin CEREZYME CERVARIX CESIA cetirizine hcl CHANTIX CHANTIX CONTINUING MONTH PAK CHANTIX STARTING MONTH PAK CHATEAL CHEMET chloramphenicol sod succinate chlordiazepoxide hcl chlordiazepoxide-amitriptyline chlorhexidine gluconate chloroquine phosphate chlorothiazide chlorpromazine hcl... 79

106 chlorpropamide chlorthalidone chlorzoxazone CHOLBAM cholestyramine cholestyramine light choline & mag trisalicylate choline-mag trisalicylate chorionic gonadotropin chromic chloride CIALIS CICLODAN CREAM CICLODAN SOLUTION ciclopirox ciclopirox olamine ciclopirox treatment ciclopirox-vitamin e cilostazol cimetidine cimetidine cimetidine hcl CIMZIA CIMZIA PREFILLED CIMZIA STARTER KIT CIPRODEX ciprofloxacin ciprofloxacin hcl... 48, 57 ciprofloxacin-ciproflox hcl er cisplatin citalopram hydrobromide CITRANATAL B-CALM cladribine CLARAVIS clarithromycin clarithromycin er clemastine fumarate CLINDACIN PAC clindamycin hcl clindamycin palmitate hcl clindamycin phos-benzoyl perox clindamycin phosphate... 24, 25, 34, 53 CLINIMIX E/DEXTROSE (2.75/10) CLINIMIX E/DEXTROSE (2.75/5) CLINIMIX E/DEXTROSE (4.25/25) CLINIMIX E/DEXTROSE (4.25/5) CLINIMIX E/DEXTROSE (5/15) CLINIMIX E/DEXTROSE (5/20) CLINIMIX E/DEXTROSE (5/25) CLINIMIX/DEXTROSE (2.75/5) CLINIMIX/DEXTROSE (4.25/10) CLINIMIX/DEXTROSE (4.25/20) CLINIMIX/DEXTROSE (4.25/25) CLINIMIX/DEXTROSE (4.25/5) CLINIMIX/DEXTROSE (5/15) CLINIMIX/DEXTROSE (5/20) CLINIMIX/DEXTROSE (5/25) CLINPRO clobetasol propionate clobetasol propionate e clobetasol propionate emulsion CLODERM PUMP CLOLAR clomipramine hcl clonazepam clonidine hcl... 7 clopidogrel bisulfate clorazepate dipotassium clotrimazole... 25, 69 clotrimazole-betamethasone clozapine COLCRYS... 4 cold & allergy cold sore treatment colestipol hcl colistimethate sodium COLYTE WITH FLAVOR PACKS COMBIGAN COMBIVENT RESPIMAT COMETRIQ (100 MG DAILY DOSE) COMETRIQ (140 MG DAILY DOSE) COMETRIQ (60 MG DAILY DOSE) COMPLERA COMVAX CONCEPT OB CONCERTA CONDYLOX COPAXONE CORMAX SCALP APPLICATION CORTANE-B AQUEOUS cortisone acetate COSENTYX COSENTYX SENSOREADY PEN COSMEGEN COTELLIC CREON CRESEMBA CRIXIVAN cromolyn sodium... 18, 19, 45 CRYSELLE CYCLAFEM 1/ CYCLAFEM 7/7/ cyclobenzaprine hcl cyclopentolate hcl cyclophosphamide cycloserine CYCLOSET cyclosporine cyclosporine modified cyproheptadine hcl CYRED CYSTADANE CYSTAGON cytarabine cytarabine (pf) dacarbazine DACOGEN DALIRESP danazol dantrolene sodium dapsone DAPTACEL DARAPRIM darifenacin hydrobromide er DARZALEX DASETTA 1/ DASETTA 7/7/ daunorubicin hcl DAYSEE DEBLITANE decitabine DELYLA demeclocycline hcl DENTA 5000 PLUS DENTAGEL DEPO-PROVERA DEPO-SUBQ PROVERA

107 DERMAZENE DESGEN PEDIATRIC desipramine hcl desloratadine desmopressin ace rhinal tube desmopressin ace spray refrig desmopressin acetate desmopressin acetate spray desogestrel-ethinyl estradiol desonide desoximetasone desvenlafaxine er desvenlafaxine fumarate er dexamethasone dexamethasone sodium phosphate... 35, 47 DEXILANT dexmethylphenidate hcl dexmethylphenidate hcl er dexrazoxane dextroamphetamine sulfate dextroamphetamine sulfate er dextrose dextrose in lactated ringers dextrose-nacl DIABETA DIASTAT PEDIATRIC diazepam... 53, 65 diclofenac potassium... 4 diclofenac sodium... 4, 25, 47 diclofenac sodium er... 4 diclofenac-misoprostol... 4 dicloxacillin sodium dicyclomine hcl didanosine DIFICID diflorasone diacetate diflunisal... 5 digoxin... 7 dihydroergotamine mesylate diltiazem cd... 9 diltiazem hcl... 9 diltiazem hcl er... 9 diltiazem hcl er beads... 9 diltiazem hcl er coated beads... 9 DIPENTUM diphenhydramine hcl diphenoxylate-atropine dipyridamole disopyramide phosphate... 8 disulfiram divalproex sodium divalproex sodium er DOCEFREZ docetaxel dofetilide... 9 donepezil hcl... 3 dorzolamide hcl dorzolamide hcl-timolol mal doxazosin mesylate... 7 doxepin hcl doxercalciferol doxorubicin hcl DOXY doxycycline hyclate doxycycline monohydrate dronabinol drospirenone-ethinyl estradiol DULERA duloxetine hcl DUREZOL dutasteride-tamsulosin hcl DYRENIUM econazole nitrate EDARBI... 8 EDARBYCLOR EDURANT effervescent pot chloride EFFIENT ELAPRASE ELESTAT ELIDEL ELIGARD ELINEST ELIQUIS ELITEK ELLA ELLENCE ELMIRON EMADINE EMCYT EMEND EMOQUETTE EMPLICITI EMSAM EMTRIVA enalapril maleate enalapril-hydrochlorothiazide ENBREL... 41, 43 ENBREL SURECLICK ENGERIX-B enoxaparin sodium ENPRESSE ENSKYCE entacapone... 5 entecavir epinastine hcl epinephrine epinephrine hcl epinephrine hcl pf... 7 EPIPEN 2-PAK EPIPEN JR 2-PAK epirubicin hcl EPIVIR HBV eplerenone eprosartan mesylate... 8 ERAXIS ERBITUX ergoloid mesylates... 3 ERGOMAR ERIVEDGE ERWINAZE ERYTHROCIN LACTOBIONATE ERYTHROCIN STEARATE erythromycin... 25, 48 erythromycin ethylsuccinate ESBRIET escitalopram oxalate esomeprazole magnesium ESTARYLLA estazolam estradiol estradiol-norethindrone acet estropipate eszopiclone ethambutol hcl ethosuximide etodolac... 4 etodolac er... 4 ETOPOPHOS etoposide EURAX EXACTECH R-S-G TEST EXACTECH TEST exemestane EXJADE EXODERM EXTAVIA eye wash EZ FLU SHOT-FLUCELVAX FABRAZYME FALMINA... 60

108 famciclovir famotidine FANAPT FANAPT TITRATION PACK FARESTON FARXIGA FARYDAK FASLODEX FAZACLO FC2 FEMALE CONDOM felbamate felodipine er... 9 fenofibrate fenofibrate micronized fenofibric acid fenoprofen calcium... 4 fentanyl FENTORA FER-IN-SOL ferrous sulfate... 87, 88 FETZIMA FETZIMA TITRATION finasteride FIRAZYR FIRMAGON flecainide acetate... 9 FLOVENT DISKUS FLOVENT HFA FLUARIX FLUARIX QUADRIVALENT FLUBLOK FLUCELVAX fluconazole fluconazole in dextrose fluconazole in sodium chloride flucytosine fludarabine phosphate fludrocortisone acetate FLULAVAL QUADRIVALENT FLUMIST QUADRIVALENT flunisolide fluocinolone acetonide... 26, 49 fluocinolone acetonide body fluocinolone acetonide scalp fluocinonide fluocinonide-e FLUORIDEX SENSITIVITY RELIEF fluoritab fluorometholone fluorouracil... 26, 73 fluoxetine hcl fluoxetine hcl (pmdd) fluphenazine decanoate fluphenazine hcl FLURA-DROPS flurazepam hcl flurbiprofen... 4 flurbiprofen sodium flutamide fluticasone propionate... 19, 26 fluvastatin sodium fluvastatin sodium er FLUVIRIN FLUVIRIN PRESERVATIVE FREE fluvoxamine maleate fluvoxamine maleate er FLUZONE HIGH-DOSE FLUZONE PRESERVATIVE FREE FLUZONE QUADRIVALENT folcal dha folic acid FOLIVANE-OB FOLIVANE-PRX DHA NF FOLOTYN fondaparinux sodium FORFIVO XL FORTEO FOSAMAX PLUS D FOSCAVIR fosinopril sodium fosinopril sodium-hctz fosphenytoin sodium FOSRENOL FREESTYLE INSULINX TEST FREESTYLE LITE TEST FREESTYLE PRECISION NEO TEST FREESTYLE TEST FULYZAQ furosemide FUSILEV FUZEON FYCOMPA gabapentin... 63, 64 GABITRIL GABLOFEN... 3 galantamine hydrobromide galantamine hydrobromide er... 3 GAMMAGARD GAMMAGARD S/D GAMMAGARD S/D LESS IGA GAMMAPLEX ganciclovir sodium GARDASIL gatifloxacin GAVILYTE-C GAVILYTE-G GAVILYTE-N WITH FLAVOR PACK gemcitabine hcl gemfibrozil GENGRAF GENTAK gentamicin sulfate... 26, 48, 53 GENVOYA GEODON GESTICARE DHA GIANVI GILDAGIA GILDESS 1.5/ GILDESS 1/ GILDESS FE 1.5/ GILDESS FE 1/ GILENYA GILOTRIF GLEOSTINE glimepiride glipizide glipizide er glipizide xl glipizide-metformin hcl GLUCAGEN DIAGNOSTIC GLUCAGEN HYPOKIT GLUCAGON EMERGENCY glucose glyburide... 93, 95 glyburide micronized glyburide-metformin glycopyrrolate gnp vitamin d GOLYTELY granisetron hcl griseofulvin microsize griseofulvin ultramicrosize guanfacine hcl... 7 guanfacine hcl er guanidine hcl HALAVEN halobetasol propionate... 26

109 haloperidol haloperidol decanoate haloperidol lactate... 79, 80 HARVONI HAVRIX HEATHER HEMMOREX-HC heparin (porcine) in d5w heparin (porcine) in nacl heparin lock flush heparin sod (porcine) in d5w heparin sodium (porcine) heparin sodium (porcine) pf HEPATASOL HERCEPTIN HEXALEN HOMATROPAIRE HUMATROPE HUMIRA HUMIRA PEDIATRIC CROHNS START HUMIRA PEN HUMIRA PEN-CROHNS STARTER HUMIRA PEN-PSORIASIS STARTER hydralazine hcl... 7 hydrochlorothiazide hydrocod polst-cpm polst er hydrocodone-acetaminophen hydrocodone-homatropine hydrocodone-ibuprofen hydrocortisone... 26, 35 hydrocortisone ace-pramoxine hydrocortisone acetate hydrocortisone butyr lipo base hydrocortisone butyrate hydrocortisone valerate... 26, 27 hydrocortisone-acetic acid hydrocortisone-aloe hydromorphone hcl hydromorphone hcl pf hydroquinone hydroquinone time release hydroxychloroquine sulfate hydroxyurea hydroxyzine hcl hydroxyzine pamoate HYOPHEN hyoscyamine sulfate hyoscyamine sulfate er HYPERLYTE-CR ibandronate sodium IBRANCE ibuprofen... 4 ibuprofen childrens... 4 IDAMYCIN PFS... 73, 76 idarubicin hcl... 73, 76 IFEX ifosfamide ILARIS imatinib mesylate IMBRUVICA imipramine hcl imipramine pamoate imiquimod IMOVAX RABIES INATAL ADVANCE INATAL GT INATAL ULTRA INCRELEX INCRUSE ELLIPTA indapamide indomethacin... 4 indomethacin er... 4 INFANRIX INLYTA INNOPRAN XL... 8 insulin syringe insulin syringe/needle INTELENCE INTRALIPID INTRON A INTROVALE INVANZ INVEGA INVEGA SUSTENNA INVIRASE INVOKANA IPOL ipratropium bromide... 17, 19 ipratropium-albuterol irbesartan... 8 irbesartan-hydrochlorothiazide irinotecan hcl iron chews pediatric ISENTRESS ISOLYTE-P IN D5W ISOLYTE-S ISOLYTE-S PH isometheptene-caffeine-apap isometheptene-dichloral-apap isoniazid isopropyl alcohol wipes isosorbide dinitrate isosorbide dinitrate er isosorbide mononitrate isosorbide mononitrate er isradipine... 9 ISTODAX itraconazole iv prep wipes ivermectin IXEMPRA KIT IXIARO JAKAFI JANUMET JANUMET XR JANUVIA JENCYCLA jevantique lo JEVTANA JINTELI JOLESSA JOLIVETTE JULEBER JUNEL 1.5/ JUNEL FE 1.5/ JUNEL FE 1/ JUNEL FE JUXTAPID KADCYLA KAITLIB FE KALETRA KALYDECO KANUMA KARIVA KAZANO kcl in d5w lactated ringers kcl in dextrose-nacl... 89, 91 kcl-lactated ringers-d5w k-effervescent KELNOR 1/ KEPIVANCE KETEK ketoconazole... 27, 70 KETODAN ketoprofen... 4 ketoprofen er... 4 ketorolac tromethamine... 4, 5, 47 KHEDEZLA KIMIDESS KINERET KIONEX KLOR-CON KLOR-CON

110 KLOR-CON M KLOR-CON M KLOR-CON M KOMBIGLYZE XR KORLYM KURVELO KUVAN labetalol hcl... 8 LACRISERT lactated ringers... 86, 91 lactulose lactulose encephalopathy lamivudine... 82, 83 lamivudine-zidovudine lamotrigine lamotrigine er lansoprazole LANTUS LANTUS SOLOSTAR LARIN 1.5/ LARIN 1/ LARIN 24 FE LARIN FE 1.5/ LARIN FE 1/ latanoprost LATUDA LAYOLIS FE LEENA leflunomide LEMTRADA LENVIMA 10 MG DAILY DOSE LENVIMA 14 MG DAILY DOSE LENVIMA 18 MG DAILY DOSE LENVIMA 20 MG DAILY DOSE LENVIMA 24 MG DAILY DOSE LENVIMA 8 MG DAILY DOSE LESCOL XL LESSINA LETAIRIS letrozole leucovorin calcium LEUKERAN LEUKINE leuprolide acetate levalbuterol hcl LEVEMIR LEVEMIR FLEXTOUCH levetiracetam levetiracetam er levobunolol hcl levocarnitine levocetirizine dihydrochloride levofloxacin... 48, 57 LEVONEST levonorgest-eth estrad 91-day levonorgestrel levonorgestrel-ethinyl estrad levonorg-eth estrad triphasic LEVORA 0.15/30 (28) LEVO-T LEVOTHROID levothyroxine sodium... 39, 40 LEXIVA lidocaine lidocaine hcl... 23, 52 lidocaine hcl (pf) lidocaine viscous lidocaine-prilocaine LIDODERM lincomycin hcl lindane linezolid liothyronine sodium LIPOFEN lisinopril lisinopril-hydrochlorothiazide lithium carbonate... 6 lithium carbonate er... 6 LIVALO LO LOESTRIN FE LOMEDIA 24 FE LONSURF loperamide hcl lorazepam LORYNA losartan potassium... 8 losartan potassium-hctz lovastatin LOVAZA LOW-OGESTREL loxapine succinate LUDENT LUMIGAN LUMIZYME LUPRON DEPOT LUPRON DEPOT-PED LUTERA LUZU LYNPARZA LYRICA LYSODREN LYZA mafenide acetate magnesium chloride magnesium sulfate malathion maprotiline hcl marlissa MARPLAN MATULANE meclizine hcl meclofenamate sodium... 5 medroxyprogesterone acetate... 37, 59 mefenamic acid... 5 mefloquine hcl MEGACE ES megestrol acetate... 37, 76 MEKINIST meloxicam... 5 melphalan hcl MENACTRA MENEST MENOMUNE MENVEO meprobamate MEPRON mercaptopurine meropenem mesalamine mesalamine-cleanser mesna MESNEX MESTINON metaproterenol sulfate metaxalone metformin hcl metformin hcl er metformin hcl er (mod) metformin hcl er (osm) methadone hcl methazolamide methenamine hippurate methenamine mandelate methimazole methocarbamol methotrexate methotrexate sodium methotrexate sodium (pf) methoxsalen rapid methscopolamine bromide methyclothiazide methyldopa... 7

111 methyldopa-hydrochlorothiazide methyldopate hcl... 7 methylphenidate hcl methylphenidate hcl er methylphenidate hcl er (cd) methylphenidate hcl er (la) methylprednisolone methylprednisolone acetate methylprednisolone sodium succ metipranolol metoclopramide hcl metolazone metoprolol succinate er... 8 metoprolol tartrate... 8 metoprolol-hydrochlorothiazide metronidazole... 27, 34, 54 metronidazole in nacl mexiletine hcl... 9 miconazole miconazole 3 combo pack MICROGESTIN 1.5/ MICROGESTIN 1/ MICROGESTIN 24 FE MICROGESTIN FE 1.5/ MICROGESTIN FE 1/ midodrine hcl... 7 MINASTRIN 24 FE minocycline hcl minocycline hcl er minoxidil... 7 MIRENA (52 MG) mirtazapine misoprostol mitomycin mitoxantrone hcl M-M-R II modafinil moexipril hcl moexipril-hydrochlorothiazide mometasone furoate MONO-LINYAH MONONESSA montelukast sodium MONUROL morphine sulfate... 50, 51 morphine sulfate (concentrate) morphine sulfate (pf) morphine sulfate er morphine sulfate er beads MOVANTIK MOVIPREP MOXEZA MULTAQ... 9 multi prenatal multi-vit/fluoride multivitamin/fluoride multi-vitamin/fluoride mupirocin mupirocin calcium MUSTARGEN MVC-FLUORIDE MYCAMINE MYCOBUTIN mycophenolate mofetil mycophenolic acid MYFORTIC MYNATAL MYNATAL ADVANCE MYRBETRIQ MYZILRA nabumetone... 5 nadolol... 8 nadolol-bendroflumethiazide nafcillin sodium NAGLAZYME nalbuphine hcl naloxone hcl naltrexone hcl NAMENDA... 3 NAMENDA XR... 3 NAMENDA XR TITRATION PACK... 3 naphazoline hcl naproxen... 5 naproxen dr... 5 naproxen sodium... 5 naratriptan hcl NATAZIA nateglinide NATELLE ONE NATPARA NATURE-THROID NEBUPENT NECON 0.5/35 (28) NECON 1/35 (28) NECON 1/50 (28) NECON 10/11 (28) NECON 7/7/ nefazodone hcl neomycin sulfate neomycin-bacitracin zn-polymyx neomycin-polymyxin b gu neomycin-polymyxin-dexameth neomycin-polymyxin-gramicidin neomycin-polymyxin-hc... 47, 49 NEO-POLYCIN HC NEPHRAMINE NEPTAZANE NESINA NEUAC NEUMEGA NEUPOGEN NEVANAC nevirapine nevirapine er NEXAVAR NEXPLANON niacin er niacin er (antihyperlipidemic) NIACOR nicardipine hcl... 9 nicotine nicotine mini nicotine polacrilex NIFEDIAC CC... 9 nifedipine nifedipine er nifedipine er osmotic release NIKKI NILANDRON nimodipine NINLARO nisoldipine er nitrofurantoin macrocrystal nitrofurantoin monohyd macro nitroglycerin NITROLINGUAL NITROSTAT NORA-BE norethin ace-eth estrad-fe norethindrone norethindrone acetate norethindrone acet-ethinyl est norethindrone-eth estradiol... 37, 62 norethin-eth estradiol-fe norgestimate-eth estradiol norgestim-eth estrad triphasic NORLYROC NORMOSOL-M IN D5W... 91

112 NORMOSOL-R NORMOSOL-R IN D5W NORMOSOL-R PH NORTREL 0.5/35 (28) NORTREL 1/35 (21) NORTREL 1/35 (28) NORTREL 7/7/ nortriptyline hcl NORVIR NOVOLIN 70/ NOVOLIN 70/30 RELION NOVOLIN N NOVOLIN N RELION NOVOLIN R NOVOLIN R RELION NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70/ NOVOLOG MIX 70/30 FLEXPEN NOVOLOG PENFILL NOXAFIL np thyroid NUCALA NUCYNTA NUCYNTA ER NUEDEXTA NULOJIX NULYTELY WITH FLAVOR PACKS nutrilyte NUTROPIN AQ NUSPIN NUTROPIN AQ NUSPIN NUTROPIN AQ NUSPIN NUTROPIN AQ PEN NUVARING NUVIGIL nystatin... 27, 70 nystatin-triamcinolone OCELLA octreotide acetate ODOMZO ofloxacin... 48, 49, 57 OGESTREL olanzapine olanzapine-fluoxetine hcl olmesartan medoxomil... 8 olmesartan medoxomil-hctz olmesartan-amlodipine-hctz olopatadine hcl omega-3-acid ethyl esters omeprazole omeprazole magnesium omeprazole-sodium bicarbonate OMNIFLEX DIAPHRAGM ONCASPAR ondansetron ondansetron hcl one-daily multi vitamins ONFI ONGLYZA OPANA ER OPDIVO OPSUMIT OPTIONS CONCEPTROL OPTIONS GYNOL II CONTRACEPTIVE ORAP ORENCIA ORFADIN ORKAMBI orphenadrine citrate orphenadrine citrate er ORSYTHIA ORTHO TRI-CYCLEN LO OSENI otomax-hc oxacillin sodium oxaliplatin oxandrolone oxaprozin... 5 oxazepam oxcarbazepine OXSORALEN ULTRA OXTELLAR XR oxybutynin chloride oxybutynin chloride er oxycodone hcl oxycodone-acetaminophen oxycodone-aspirin oxycodone-ibuprofen oxymorphone hcl... 50, 51 oxymorphone hcl er PACERONE... 9 paclitaxel pamidronate disodium... 15, 16 PANRETIN pantoprazole sodium PARAGARD INTRAUTERINE COPPER paricalcitol paromomycin sulfate paroxetine hcl paroxetine hcl er PASER PATADAY PATANOL PAXIL PEDVAX HIB peg peg 3350/electrolytes peg 3350-kcl-na bicarb-nacl peg-3350/electrolytes PEGANONE PEGASYS PEGASYS PROCLICK pen needles pen needles 1/2" pen needles 3/16" pen needles 5/16" penicillin g potassium penicillin g sodium penicillin v potassium PENTAM pentazocine-naloxone hcl pentoxifylline er... 7 perindopril erbumine PERJETA permethrin perphenazine perphenazine-amitriptyline PEXEVA phenazopyridine hcl phenelzine sulfate phenobarbital phenylephrine hcl phenytoin phenytoin sodium phenytoin sodium extended PHILITH PHOSPHOLINE IODIDE PHYSIOSOL IRRIGATION PICATO pilocarpine hcl... 23, 46 PIMTREA pindolol... 8 pioglitazone hcl pioglitazone hcl-glimepiride pioglitazone hcl-metformin hcl piperacillin sod-tazobactam so PIRMELLA 1/ PIRMELLA 7/7/ piroxicam... 5 PLASMA-LYTE PLASMA-LYTE-56 IN D5W PNEUMOVAX pnv fe fum/docusate/folic acid... 88

113 pnv-dha pnv-dha+docusate podofilox POLYCIN polyethylene glycol polymyxin b-trimethoprim POMALYST PORTIA PORTRAZZA pot bicarb-pot chloride potassium acetate potassium bicarbonate potassium chloride potassium chloride crys er potassium chloride er potassium chloride in dextrose potassium chloride in nacl... 90, 91 potassium citrate er POTIGA PRADAXA pramipexole dihydrochloride... 6 PRAMOTIC PRANDIMET PRANDIN pravastatin sodium PRAXBIND prazosin hcl... 7 PRECISION PCX PRECISION PCX PLUS TEST PRECISION POINT OF CARE TEST PRECISION QID TEST PRECISION SOF-TACT TEST PRECISION XTRA BLOOD GLUCOSE PRECISION XTRA KETONE prednicarbate prednisolone prednisolone acetate prednisolone sodium phosphate... 35, 47 prednisone... 35, 37 PREMARIN... 34, 36 PREMASOL PREMPHASE PREMPRO prenaissance prenatal prenatal low iron prenatal one daily prenatal vitamin PRENTIF FITTING SET PREPOPIK PREVIFEM PREVNAR PREZISTA PRIFTIN primaquine phosphate primidone PRISTIQ PROAIR HFA probenecid... 4 procainamide hcl... 9 PROCALAMINE prochlorperazine prochlorperazine edisylate prochlorperazine maleate PROCRIT... 35, 97 PROCTO-PAK PROCTOZONE-HC progesterone micronized PROGLYCEM PROGRAF PROLASTIN-C PROLENSA PROLEUKIN PROLIA PROMACTA promethazine hcl promethazine vc plain promethazine vc/codeine promethazine-codeine promethazine-dm propafenone hcl... 9 propafenone hcl er... 9 proparacaine hcl propranolol hcl... 8 propranolol hcl er... 8 propranolol-hctz propylthiouracil PROQUAD PROSOL protriptyline hcl pseudoeph-bromphen-dm pseudoeph-chlorphen-hydrocod PULMICORT FLEXHALER PULMOZYME pyrazinamide pyridostigmine bromide QUARTETTE QUASENSE quetiapine fumarate quetiapine fumarate er quinapril hcl quinapril-hydrochlorothiazide quinidine gluconate er... 9 quinidine sulfate... 9 quinidine sulfate er... 9 QVAR RABAVERT rabeprazole sodium raloxifene hcl ramipril RANEXA... 7 ranitidine hcl RAPAFLO RAPAMUNE REBIF REBIF REBIDOSE REBIF REBIDOSE TITRATION PACK REBIF TITRATION PACK RECLAST RECLIPSEN RECOMBIVAX HB RECTIV REGRANEX RELISTOR RELPAX REMICADE RENVELA repaglinide REPREXAIN RESCRIPTOR RESTASIS RETROVIR REVLIMID REYATAZ RHEUMATREX RIBASPHERE RIBASPHERE RIBAPAK ribavirin RIDAURA rifabutin RIFAMATE rifampin RIFATER RIGHT STEP PRENATAL riluzole rimantadine hcl ringers ringers irrigation RIOMET risedronate sodium RISPERDAL CONSTA risperidone RISPERIDONE M-TAB RITUXAN... 77

114 rivastigmine... 3 rivastigmine tartrate... 3 rizatriptan benzoate ropinirole hcl... 6 ropinirole hcl er... 6 ROSADAN ROSULA rosuvastatin calcium ROTARIX ROTATEQ ROWASA rulavite dha SABRIL SAFYRAL SAIZEN SAIZEN CLICK.EASY salicylic acid salicylic acid-cleanser saline flush SAMSCA SANCUSO SANDIMMUNE SANDOSTATIN LAR DEPOT SANTYL SAPHRIS sash kit SAVAYSA SAVELLA SAVELLA TITRATION PACK scalacort SECONAL selegiline hcl... 6 selenium sulfide SELZENTRY se-natal SENSIPAR SEREVENT DISKUS sertraline hcl SETLAKIN SFROWASA SHAROBEL SIGNIFOR sildenafil citrate... 20, 49 silver sulfadiazine SIMPONI SIMPONI ARIA... 40, 44 simvastatin sirolimus SIRTURO SKLICE SKYLA sleep-aid maximum strength sodium chloride... 20, 28, 90, 91 sodium chloride bacteriostatic sodium chloride flush sodium fluoride sodium lactate sodium polystyrene sulfonate sodium sulfacetamide sodium sulfacetamide wash SOLARAZE SOLIA SOLTAMOX SOMATULINE DEPOT SOMAVERT SORIATANE sotalol hcl... 8 sotalol hcl (af)... 8 SOVALDI spinosad SPIRIVA HANDIHALER spironolactone spironolactone-hctz SPRINTEC SPRYCEL SRONYX sss stavudine STIOLTO RESPIMAT STIVARGA STRATTERA streptomycin sulfate STRIBILD SUBOXONE sucralfate sulfacetamide sodium... 28, 48 sulfacetamide sodium (acne) sulfacetamide sodium-sulfur sulfacetamide sod-sulfur wash sulfacetamide-prednisolone sulfacetamide-sulfur in urea sulfacetamide-sulfur-sunscreen sulfadiazine sulfamethoxazole-trimethoprim sulfasalazine sulindac... 5 sumatriptan sumatriptan succinate sumatriptan succinate refill SUPRAX SUPREP BOWEL PREP SUSTIVA SUTENT SYEDA SYLATRON SYMAX DUOTAB SYMAX-SR SYMBICORT SYMLINPEN SYMLINPEN SYNAREL SYNRIBO SYNTHROID TABLOID tacrolimus TAFINLAR TAGRISSO TAMIFLU... 81, 82 tamoxifen citrate tamsulosin hcl TARCEVA TARGRETIN... 29, 77 TARINA FE 1/ TARON-BC TARON-PREX TASIGNA TAXOTERE TAZORAC TEKAMLO TEKTURNA... 7 TEKTURNA HCT telmisartan... 8 telmisartan-amlodipine telmisartan-hctz temazepam temozolomide terazosin hcl... 7 terbinafine hcl... 29, 70 terbutaline sulfate terconazole testosterone testosterone cypionate testosterone enanthate tetanus toxoid adsorbed tetanus-diphtheria toxoids td tetrabenazine tetracycline hcl TEVETEN HCT THALOMID theophylline er thioridazine hcl thiotepa... 72

115 thiothixene thrivite THYMOGLOBULIN tiagabine hcl ticlopidine hcl TILIA FE timolol maleate... 8, 46 tinidazole TIVICAY tizanidine hcl tl-select TOBRADEX tobramycin... 48, 53 tobramycin sulfate tobramycin-dexamethasone TODAY SPONGE tolazamide tolbutamide tolmetin sodium... 5 tolterodine tartrate tolterodine tartrate er topiramate topotecan hcl TORISEL torsemide TOUJEO SOLOSTAR TRACLEER tramadol hcl tramadol hcl er tramadol hcl er (biphasic) tramadol-acetaminophen trandolapril trandolapril-verapamil hcl er tranexamic acid tranylcypromine sulfate TRAVATAN Z travoprost trazodone hcl TREANDA TRECATOR TRELSTAR MIXJECT TRESIBA FLEXTOUCH tretinoin... 29, 77 tretinoin (emollient) tretinoin microsphere TREXALL triadvance triamcinolone acetonide... 19, 23, 29 triamterene-hctz triazolam tri-buffered aspirin... 5 TRIDERM TRI-ESTARYLLA trifluoperazine hcl trifluridine trihexyphenidyl hcl... 6 TRI-LEGEST FE TRI-LINYAH TRILYTE trimethobenzamide hcl trimethoprim trimipramine maleate trinatal gt TRINESSA (28) TRINTELLIX... 67, 68 triple-vitamin/fluoride TRI-PREVIFEM TRISENOX TRI-SPRINTEC tri-vitamin/fluoride TRIVORA (28) TROKENDI XR tropicamide trospium chloride trospium chloride er TRUVADA TUSSLIN PEDIATRIC TWINRIX TYKERB TYPHIM VI TYSABRI TYZEKA TYZINE UCERIS U-CORT ULESFIA ULORIC... 4 ultra tabs ULTRA-THIN II PEN NEEDLES UNITHROID UNITUXIN urea urea nail film URECHOLINE ursodiol UTA UTIRA-C UVADEX valacyclovir hcl VALCYTE valganciclovir hcl valproate sodium valproic acid valsartan... 8 valsartan-hydrochlorothiazide vancomycin hcl VAQTA VARIVAX VARUBI VCF VAGINAL CONTRACEPTIVE VECTIBIX VELCADE VELIVET VEMAVITE-PRX venlafaxine hcl venlafaxine hcl er VENTAVIS VENTOLIN HFA verapamil hcl verapamil hcl er VESICARE VESTURA VEXOL VICTRELIS VIDEX VIENVA VIGAMOX VIIBRYD VIIBRYD STARTER PACK VIMPAT VINACAL B vinblastine sulfate VINCASAR PFS vinorelbine tartrate viorele VIRACEPT... 84, 85 VIRAMUNE VIREAD virt-advance virt-phos 250 neutral virt-pn dha virt-select virt-vite gt VITAFOL-ONE vitamin d vitamin d (cholecalciferol) voriconazole VOTRIENT VRAYLAR VYFEMLA VYTORIN WAL-DRYL ALLERGY CHILDRENS warfarin sodium WELCHOL WERA WOUND WASH SALINE WYMZYA FE XALKORI... 78

116 XARELTO XARELTO STARTER PACK XELJANZ XENAZINE XGEVA XIFAXAN XOLAIR XTANDI XULANE XURIDEN XYREM YERVOY YF-VAX YONDELIS zafirlukast zaleplon ZALTRAP ZARAH ZATEAN-PN DHA ZAVESCA ZELBORAF ZEMPLAR ZENCHENT ZENCHENT FE ZENPEP ZETIA ZIAGEN zidovudine zinc sulfate ziprasidone hcl ZIRGAN zoledronic acid ZOLINZA zolmitriptan zolpidem tartrate zonisamide ZORTRESS ZOSTAVAX ZOVIA 1/50E (28) ZUBSOLV ZYFLO ZYFLO CR ZYMAXID ZYTIGA

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