2017 Non-HSA Zero Cost Share Formulary Drug List

Transcription

1 One mission: you 207 Non-HSA Zero Cost Share Formulary Drug List 206 Blue Cross of Idaho is an Independent Licensee of the Blue Cross and Blue Shield Association Form No. 3-9NI (-6)

2 To provide our members with the best value for our covered prescription drugs, Blue Cross of Idaho offers certain preventive and maintenance drugs at zero cost. These medications include those mandated by the Affordable Care Act (), as well as a number of other drugs that Blue Cross of Idaho considers safe and effective for reducing future health conditions. The drugs listed below are available with a prescription at no cost to members, regardless of plan deductible. For our members: Visit an in-network pharmacy to receive this benefit. Present your Blue Cross of Idaho member ID card to ensure you receive the complete benefit. You or your doctor may be asked to provide supporting documentation that the drug you are taking is being used for prevention. For our healthcare providers: Please prescribe preventive drugs from this list and allow generic substitutions when medically appropriate. Note: A drug s appearance on this list does not guarantee coverage. Not all drugs listed are covered by all prescription drug plans. Certain drug plans may cover additional drugs at a preventive benefit that are not listed below. Check your benefit materials for the specific drugs covered and the cost share information for your prescription drug benefit program. This list may not include all prescription drugs intended for preventive purposes. This list is periodically reviewed by clinical experts. Medications may be added or removed from this list based on clinical review of the medication s intended purpose and its availability. How to use this list: Generic drugs are listed in lower case letters, example: atenolol. Generic medications contain the same active ingredients as their corresponding brand name counterparts; though they may look different in shape or color, they have been FDA-approved under the same strict standards. Brand name drugs are listed in CAPITAL letters, example: BENICAR. When brand name drugs lose their patents and become available generically, only the generic equivalent will be eligible under this preventive benefit.

3 *Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants* *Adhd Agent - Selective Alpha Adrenergic Agonists*** guanfacine hcl er oral tablet extended release 24 hr* Intuniv *Aminoglycosides* *Aminoglycosides*** neomycin sulfate oral tablet *Analgesics - Anti-Inflammatory* *Nonsteroidal Anti-Inflammatory Agents (Nsaids)*** ibuprofen oral suspension Childrens Advil ibuprofen oral tablet 400 mg, 600 mg, 800 mg nabumetone oral tablet naproxen dr oral tablet delayed release EC-Naprosyn naproxen kit oral tablet Naprosyn naproxen oral suspension Naprosyn naproxen oral tablet Naprosyn naproxen sodium er oral tablet extended release 24 hr* Naprelan naproxen sodium oral tablet 275 mg Anaprox naproxen sodium oral tablet 550 mg Anaprox DS sulindac oral tablet *Analgesics - Nonnarcotic* *Salicylate Combinations*** choline & mag trisalicylate oral tablet 000 mg choline-mag trisalicylate oral liquid LastUpdated //206

4 *Salicylates*** adult aspirin ec low strength oral tablet Bayer Low Dose delayed release AL; QL aspir-8 oral tablet delayed release Bayer Low Dose AL; QL aspirin adult low dose oral tablet delayed release Bayer Low Dose AL; QL aspirin adult low strength oral tablet chewable St Joseph Aspirin AL; QL aspirin adult low strength oral tablet delayed release Bayer Low Dose AL; QL aspirin childrens oral tablet chewable St Joseph Aspirin AL; QL aspirin ec low dose oral tablet delayed release Bayer Low Dose AL; QL aspirin ec low strength oral tablet delayed release Bayer Low Dose AL; QL aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL aspirin low dose oral tablet chewable St Joseph Aspirin AL; QL aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL aspirin low strength oral tablet chewable St Joseph Aspirin AL; QL aspirin oral tablet 325 mg Bayer Aspirin AL; QL aspirin oral tablet chewable St Joseph Aspirin AL; QL aspirin oral tablet delayed release 325 mg Bayer Aspirin Regimen AL; QL aspirin oral tablet delayed release 8 mg Bayer Low Dose AL; QL ASPIR-LOW ORAL TABLET DELAYED RELEASE Bayer Low Dose AL; QL aspirtab oral tablet delayed release Bayer Aspirin Regimen AL; QL BAYER ADVANCED ASPIRIN REG ST ORAL TABLET AL; QL BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE AL; QL BAYER ASPIRIN ORAL TABLET AL; QL BAYER ASPIRIN ORAL TABLET DELAYED RELEASE AL; QL BAYER ASPIRIN REGIMEN ORAL TABLET DELAYED RELEASE AL; QL 2 LastUpdated //206

5 BAYER LOW DOSE ORAL TABLET CHEWABLE AL; QL BAYER LOW DOSE ORAL TABLET DELAYED RELEASE AL; QL childrens aspirin low strength oral tablet chewable St Joseph Aspirin AL; QL childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL cvs aspirin adult low dose oral tablet chewable St Joseph Aspirin AL; QL cvs aspirin adult low strength oral tablet delayed release Bayer Low Dose AL; QL cvs aspirin child oral tablet chewable St Joseph Aspirin AL; QL cvs aspirin ec oral tablet delayed release Bayer Low Dose AL; QL cvs aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL cvs aspirin oral tablet 325 mg Bayer Aspirin AL; QL cvs aspirin oral tablet delayed release Bayer Low Dose AL; QL cvs childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL diflunisal oral tablet ec-8 aspirin oral tablet delayed release Bayer Low Dose AL; QL ECOTRIN LOW STRENGTH ORAL TABLET DELAYED RELEASE AL; QL ECOTRIN ORAL TABLET DELAYED RELEASE AL; QL ECPIRIN ORAL TABLET DELAYED RELEASE AL; QL eq adult aspirin low strength oral tablet Bayer Low Dose delayed release AL; QL eq aspirin adult low dose oral tablet delayed release Bayer Low Dose AL; QL eq aspirin low dose oral tablet chewable St Joseph Aspirin AL; QL eq aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL eq aspirin oral tablet Bayer Aspirin AL; QL eq aspirin oral tablet delayed release 325 mg Bayer Aspirin Regimen AL; QL eq childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL LastUpdated //206 3

6 eql aspirin ec oral tablet delayed release Bayer Aspirin Regimen 325 mg AL; QL eql aspirin low dose oral tablet chewable St Joseph Aspirin AL; QL eql aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL gnp adult aspirin low strength oral tablet chewable St Joseph Aspirin AL; QL gnp adult aspirin low strength oral tablet delayed release Bayer Low Dose AL; QL gnp aspirin low dose oral tablet delayed Bayer Low Dose release AL; QL gnp aspirin oral tablet 325 mg Bayer Aspirin AL; QL gnp aspirin oral tablet delayed release Bayer Low Dose AL; QL goodsense aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL hm aspirin ec low dose oral tablet delayed release Bayer Low Dose AL; QL hm aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL hm aspirin oral tablet Bayer Aspirin AL; QL hm aspirin oral tablet chewable St Joseph Aspirin AL; QL kls aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL kls aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL kp aspirin oral tablet delayed release Bayer Low Dose AL; QL meijer aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL MINIPRIN LOW DOSE ORAL TABLET DELAYED RELEASE AL; QL mm aspirin oral tablet Bayer Aspirin AL; QL NORWICH ASPIRIN ORAL TABLET 325 MG AL; QL px aspirin oral tablet Bayer Aspirin AL; QL px aspirin oral tablet chewable St Joseph Aspirin AL; QL px enteric aspirin oral tablet delayed release Bayer Aspirin Regimen AL; QL qc aspirin low dose oral tablet chewable St Joseph Aspirin AL; QL qc aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL LastUpdated //206 4

7 qc aspirin oral tablet Bayer Aspirin AL; QL qc aspirin oral tablet delayed release Bayer Aspirin Regimen AL; QL qc childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL ra aspirin adult low dose oral tablet chewable St Joseph Aspirin AL; QL ra aspirin adult low strength oral tablet St Joseph Aspirin chewable AL; QL ra aspirin adult low strength oral tablet Bayer Low Dose delayed release AL; QL ra aspirin childrens oral tablet chewable St Joseph Aspirin AL; QL ra aspirin ec adult low st oral tablet delayed release Bayer Low Dose AL; QL ra aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL ra aspirin oral tablet 325 mg Bayer Aspirin AL; QL ra childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL salsalate oral tablet Disalcid sb aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL sb aspirin oral tablet Bayer Aspirin AL; QL sb aspirin oral tablet delayed release Bayer Low Dose AL; QL sb childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL sb low dose asa ec oral tablet delayed release Bayer Low Dose AL; QL sm aspirin adult low strength oral tablet chewable St Joseph Aspirin AL; QL sm aspirin adult low strength oral tablet delayed release Bayer Low Dose AL; QL sm aspirin ec low strength oral tablet delayed release Bayer Low Dose AL; QL sm aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL sm aspirin oral tablet Bayer Aspirin AL; QL sm childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL ST JOSEPH ASPIRIN ORAL TABLET CHEWABLE AL; QL LastUpdated //206 5

8 ST JOSEPH ASPIRIN ORAL TABLET DELAYED RELEASE AL; QL ST JOSEPH LOW DOSE ORAL TABLET CHEWABLE AL; QL tgt aspirin ec oral tablet delayed release Bayer Aspirin Regimen AL; QL tgt aspirin low dose oral tablet delayed release Bayer Low Dose AL; QL tgt aspirin oral tablet Bayer Aspirin AL; QL tgt aspirin oral tablet chewable St Joseph Aspirin AL; QL tgt aspirin oral tablet delayed release Bayer Low Dose AL; QL tgt childrens aspirin oral tablet chewable St Joseph Aspirin AL; QL *Analgesics - Opioid* *Codeine Combinations*** acetaminophen-codeine #2 oral tablet QL acetaminophen-codeine #3 oral tablet Tylenol with Codeine #3 QL acetaminophen-codeine #4 oral tablet Tylenol with Codeine #4 QL acetaminophen-codeine oral solution QL acetaminophen-codeine oral tablet mg QL acetaminophen-codeine oral tablet mg Tylenol with Codeine #3 QL acetaminophen-codeine oral tablet mg Tylenol with Codeine #4 QL *Opioid Agonists*** tramadol hcl er (biphasic) oral tablet extended release 24 hr* 00 mg, 300 mg QL tramadol hcl er oral tablet extended release 24 hr* Ultram ER QL tramadol hcl oral tablet Ultram QL *Opioid Partial Agonists*** pentazocine-naloxone hcl oral tablet *Tramadol Combinations*** tramadol-acetaminophen oral tablet Ultracet QL 6 LastUpdated //206

9 *Antianginal Agents* *Nitrates*** isosorbide dinitrate er oral tablet extendedrelease* isosorbide dinitrate oral tablet Isordil Titradose isosorbide mononitrate er oral tablet extended release 24 hr* Imdur isosorbide mononitrate oral tablet *Antianxiety Agents* *Antianxiety Agents - Misc.*** hydroxyzine hcl intramuscular* solution hydroxyzine hcl oral solution hydroxyzine hcl oral syrup hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule Vistaril *Benzodiazepines*** chlordiazepoxide hcl oral capsule *Antiarrhythmics* *Antiarrhythmics Type I-A*** quinidine gluconate er oral tablet extendedrelease* quinidine sulfate er oral tablet extendedrelease* quinidine sulfate oral tablet *Antiasthmatic And Bronchodilator Agents* *Beta Adrenergics*** levalbuterol hcl inhalation nebulization Xopenex solution metaproterenol sulfate oral syrup metaproterenol sulfate oral tablet terbutaline sulfate oral tablet *Leukotriene Receptor Antagonists*** montelukast sodium oral packet Singulair montelukast sodium oral tablet Singulair LastUpdated //206 7

10 montelukast sodium oral tablet chewable Singulair *Xanthines*** ELIXOPHYLLIN ORAL ELIXIR THEOCHRON ORAL TABLET EXTENDED RELEASE 2 HR* 00 MG, 200 MG, 300 MG theophylline er oral tablet extended release 2 hr* Theochron theophylline er oral tablet extended release 24 hr* theophylline oral solution *Anticoagulants* *Coumarin Anticoagulants*** JANTOVEN ORAL TABLET warfarin sodium oral tablet Coumadin *Antidepressants* *Alpha-2 Receptor Antagonists (Tetracyclics)*** mirtazapine oral tablet Remeron mirtazapine oral tablet dispersible Remeron SolTab *Antidepressants - Misc.*** bupropion hcl er (sr) oral tablet extended release 2 hr* Wellbutrin SR bupropion hcl er (xl) oral tablet extended release 24 hr* Wellbutrin XL bupropion hcl oral tablet Wellbutrin maprotiline hcl oral tablet *Modified Cyclics*** trazodone hcl oral tablet *Monoamine Oxidase Inhibitors (Maois)*** phenelzine sulfate oral tablet Nardil tranylcypromine sulfate oral tablet Parnate *Selective Serotonin Reuptake Inhibitors (Ssris)*** citalopram hydrobromide oral solution citalopram hydrobromide oral tablet CeleXA escitalopram oxalate oral solution Lexapro 8 LastUpdated //206

11 escitalopram oxalate oral tablet Lexapro fluoxetine hcl oral capsule PROzac fluoxetine hcl oral capsule delayed release PROzac Weekly fluoxetine hcl oral solution fluoxetine hcl oral tablet 0 mg, 20 mg fluvoxamine maleate er oral capsule extended release 24 hour Luvox CR fluvoxamine maleate oral tablet paroxetine hcl er oral tablet extended release 24 hr* Paxil CR paroxetine hcl oral tablet Paxil sertraline hcl oral concentrate Zoloft sertraline hcl oral tablet Zoloft *Serotonin-Norepinephrine Reuptake Inhibitors (Snris)*** duloxetine hcl oral capsule delayed release particles Cymbalta IRENKA ORAL CAPSULE DELAYED RELEASE PARTICLES venlafaxine hcl er oral capsule extended Effexor XR release 24 hour venlafaxine hcl er oral tablet extended release 24 hr* venlafaxine hcl oral tablet *Tricyclic Agents*** amitriptyline hcl oral tablet 0 mg, 00 mg, 50 mg, 50 mg, 75 mg QL amitriptyline hcl oral tablet 25 mg Elavil QL amoxapine oral tablet 00 mg, 50 mg, 25 mg, 50 mg QL clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg Anafranil QL desipramine hcl oral tablet 0 mg, 00 mg, 50 mg, 25 mg, 50 mg, 75 mg Norpramin QL doxepin hcl oral capsule 0 mg, 00 mg, 50 mg, 25 mg, 50 mg, 75 mg QL doxepin hcl oral concentrate QL imipramine hcl oral tablet Tofranil QL LastUpdated //206 9

12 imipramine pamoate oral capsule Tofranil-PM QL nortriptyline hcl oral capsule 0 mg, 25 mg, 50 mg, 75 mg Pamelor QL nortriptyline hcl oral solution QL protriptyline hcl oral tablet Vivactil QL *Antidiabetics* *Alpha-Glucosidase Inhibitors*** acarbose oral tablet Precose *Biguanides*** metformin hcl er (osm) oral tablet extended release 24 hr* Fortamet metformin hcl er oral tablet extended release 24 hr* Glucophage XR metformin hcl oral tablet Glucophage *Meglitinide Analogues*** nateglinide oral tablet Starlix repaglinide oral tablet Prandin *Sulfonylurea-Biguanide Combinations*** glipizide-metformin hcl oral tablet glyburide-metformin oral tablet Glucovance *Sulfonylureas*** chlorpropamide oral tablet glimepiride oral tablet Amaryl glipizide er oral tablet extended release 24 hr* GlipiZIDE XL glipizide oral tablet Glucotrol glipizide xl oral tablet extended release 24 hr* GlipiZIDE XL glyburide micronized oral tablet Glynase glyburide oral tablet Diabeta tolazamide oral tablet tolbutamide oral tablet *Sulfonylurea-Thiazolidinedione Combinations*** pioglitazone hcl-glimepiride oral tablet Duetact 0 LastUpdated //206

13 *Thiazolidinedione-Biguanide Combinations*** pioglitazone hcl-metformin hcl oral tablet Actoplus Met *Thiazolidinediones*** pioglitazone hcl oral tablet Actos *Antidiarrheals* *Antiperistaltic Agents*** diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet Lonox lofene oral tablet Lonox LOPERAMIDE A-D ORAL TABLET loperamide hcl oral capsule Imodium A-D *Antiemetics* *Antiemetics - Anticholinergic*** meclizine hcl oral tablet Antivert meclizine hcl oral tablet chewable trimethobenzamide hcl oral capsule Tigan *Antihistamines* *Antihistamines - Alkylamines*** brompheniramine tannate oral tablet chewable *Antihistamines - Ethanolamines*** ARBINOXA ORAL SOLUTION ARBINOXA ORAL TABLET carbinoxamine maleate oral solution Palgic carbinoxamine maleate oral tablet Arbinoxa *Antihistamines - Piperidines*** cyproheptadine hcl oral syrup cyproheptadine hcl oral tablet *Antihyperlipidemics* *Bile Acid Sequestrants*** cholestyramine light oral packet Questran Light cholestyramine light oral powder Questran Light cholestyramine oral packet Questran LastUpdated //206

14 cholestyramine oral powder Questran PREVALITE ORAL PACKET PREVALITE ORAL POWDER *Fibric Acid Derivatives*** gemfibrozil oral tablet Lopid *Hmg Coa Reductase Inhibitors*** atorvastatin calcium oral tablet Lipitor fluvastatin sodium oral capsule Lescol lovastatin oral tablet Mevacor pravastatin sodium oral tablet simvastatin oral tablet Zocor *Antihypertensives* *Ace Inhibitor & Calcium Channel Blocker Combinations*** amlodipine besy-benazepril hcl oral capsule Lotrel trandolapril-verapamil hcl er oral tablet extendedrelease* Tarka *Ace Inhibitors & Thiazide/Thiazide-Like*** benazepril-hydrochlorothiazide oral tablet Lotensin HCT captopril-hydrochlorothiazide oral tablet enalapril-hydrochlorothiazide oral tablet fosinopril sodium-hctz oral tablet lisinopril-hydrochlorothiazide oral tablet Zestoretic moexipril-hydrochlorothiazide oral tablet Uniretic quinapril-hydrochlorothiazide oral tablet Accuretic *Ace Inhibitors*** benazepril hcl oral tablet Lotensin captopril oral tablet enalapril maleate oral tablet Vasotec fosinopril sodium oral tablet 2 LastUpdated //206

15 lisinopril oral tablet Zestril moexipril hcl oral tablet Univasc perindopril erbumine oral tablet Aceon quinapril hcl oral tablet Accupril ramipril oral capsule Altace trandolapril oral tablet Mavik *Angiotensin Ii Receptor Antag & Ca Channel Blocker Comb*** amlodipine besylate-valsartan oral tablet Exforge telmisartan-amlodipine oral tablet Twynsta *Angiotensin Ii Receptor Antag & Thiazide/Thiazide-Like*** candesartan cilexetil-hctz oral tablet Atacand HCT irbesartan-hydrochlorothiazide oral tablet Avalide losartan potassium-hctz oral tablet Hyzaar telmisartan-hctz oral tablet Micardis HCT valsartan-hydrochlorothiazide oral tablet Diovan HCT *Angiotensin Ii Receptor Antagonists*** candesartan cilexetil oral tablet Atacand eprosartan mesylate oral tablet Teveten irbesartan oral tablet Avapro losartan potassium oral tablet Cozaar telmisartan oral tablet Micardis valsartan oral tablet Diovan *Angiotensin Ii Receptor Ant-Ca Channel Blocker-Thiazides*** amlodipine-valsartan-hctz oral tablet Exforge HCT *Antiadrenergics - Centrally Acting*** guanfacine hcl oral tablet Tenex methyldopa oral tablet *Antiadrenergics - Peripherally Acting*** doxazosin mesylate oral tablet Cardura prazosin hcl oral capsule Minipress terazosin hcl oral capsule LastUpdated //206 3

16 *Beta Blocker & Diuretic Combinations*** atenolol-chlorthalidone oral tablet Tenoretic 50 bisoprolol-hydrochlorothiazide oral tablet Ziac metoprolol-hydrochlorothiazide oral tablet Lopressor HCT propranolol-hctz oral tablet *Reserpine*** reserpine oral tablet *Vasodilators*** hydralazine hcl oral tablet minoxidil oral tablet *Anti-Infective Agents - Misc.* *Anti-Infective Agents - Misc.*** trimethoprim oral tablet *Anti-Infective Misc. - Combinations*** sulfamethoxazole-trimethoprim oral suspension mg/5ml Sulfatrim Pediatric sulfamethoxazole-trimethoprim oral tablet Bactrim SULFATRIM PEDIATRIC ORAL SUSPENSION *Leprostatics*** dapsone oral tablet *Oxazolidinones*** linezolid oral suspension reconstituted Zyvox PA linezolid oral tablet Zyvox PA *Antimyasthenic Agents* *Antimyasthenic Agents*** pyridostigmine bromide er oral tablet extendedrelease* Mestinon pyridostigmine bromide oral tablet Mestinon *Antimyasthenic/Cholinergic Agents*** pyridostigmine bromide er oral tablet extendedrelease* Mestinon 4 LastUpdated //206

17 pyridostigmine bromide oral tablet Mestinon *Antimyasthenic/Cholinergic Agents* pyridostigmine bromide er oral tablet extendedrelease* Mestinon pyridostigmine bromide oral tablet Mestinon *Antimycobacterial Agents* *Antimycobacterial Agents*** ethambutol hcl oral tablet Myambutol isoniazid oral syrup isoniazid oral tablet pyrazinamide oral tablet *Antineoplastics And Adjunctive Therapies* *Antiestrogens*** tamoxifen citrate oral tablet AL *Antineoplastics Misc.*** hydroxyurea oral capsule Hydrea *Nitrosoureas*** lomustine oral capsule CeeNU *Progestins-Antineoplastic*** megestrol acetate oral suspension 40 mg/ml, 400 mg/0ml Megace Oral megestrol acetate oral tablet *Antiparkinson Agents* *Antiparkinson Anticholinergics*** benztropine mesylate oral tablet trihexyphenidyl hcl oral elixir trihexyphenidyl hcl oral tablet *Antiparkinson Dopaminergics*** amantadine hcl oral capsule amantadine hcl oral syrup amantadine hcl oral tablet *Antiparkinson Monoamine Oxidase Inhibitors*** selegiline hcl oral capsule Eldepryl selegiline hcl oral tablet LastUpdated //206 5

18 *Levodopa Combinations*** carbidopa-levodopa er oral tablet Sinemet CR extendedrelease* mg, mg carbidopa-levodopa oral tablet Sinemet carbidopa-levodopa oral tablet dispersible Parcopa carbidopa-levodopa-entacapone oral tablet Stalevo 50 *Antipsychotics/Antimanic Agents* *Antimanic Agents*** lithium carbonate er oral tablet extendedrelease* Lithobid lithium carbonate oral capsule lithium carbonate oral tablet *Antipsychotics - Misc.*** ziprasidone hcl oral capsule Geodon *Benzisoxazoles*** paliperidone er oral tablet extended release 24 hr* 3 mg, 6 mg, 9 mg Invega ST risperidone oral solution RisperDAL risperidone oral tablet RisperDAL risperidone oral tablet dispersible RisperiDONE M-TAB *Butyrophenones*** haloperidol decanoate intramuscular* solution Haldol Decanoate haloperidol lactate oral concentrate haloperidol oral tablet *Dibenzodiazepines*** clozapine oral tablet clozapine oral tablet dispersible FazaClo *Dibenzothiazepines*** quetiapine fumarate oral tablet SEROquel *Dibenzoxazepines*** loxapine succinate oral capsule Loxitane 6 LastUpdated //206

19 *Phenothiazines*** chlorpromazine hcl oral tablet fluphenazine hcl oral concentrate fluphenazine hcl oral elixir fluphenazine hcl oral tablet perphenazine oral tablet thioridazine hcl oral tablet trifluoperazine hcl oral tablet *Quinolinone Derivatives*** aripiprazole oral solution Abilify aripiprazole oral tablet Abilify *Thienbenzodiazepines*** olanzapine oral tablet ZyPREXA olanzapine oral tablet dispersible ZyPREXA Zydis *Thioxanthenes*** thiothixene oral capsule *Assorted Classes* *Potassium Removing Resins*** KIONEX ORAL POWDER KIONEX ORAL SUSPENSION sodium polystyrene sulfonate oral powder Kayexalate sodium polystyrene sulfonate oral suspension SPS sodium polystyrene sulfonate suspension SPS ORAL SUSPENSION *Purine Analogs*** azathioprine oral tablet Imuran *Beta Blockers* *Alpha-Beta Blockers*** carvedilol oral tablet Coreg labetalol hcl oral tablet Trandate *Beta Blockers Cardio-Selective*** acebutolol hcl oral capsule Sectral LastUpdated //206 7

20 atenolol oral tablet Tenormin betaxolol hcl oral tablet Kerlone bisoprolol fumarate oral tablet Zebeta metoprolol succinate er oral tablet extended release 24 hr* Toprol XL metoprolol tartrate oral tablet 00 mg, 50 mg Lopressor metoprolol tartrate oral tablet 25 mg *Beta Blockers Non-Selective*** pindolol oral tablet propranolol hcl er oral capsule extended release 24 hour Inderal LA propranolol hcl oral solution propranolol hcl oral tablet SORINE ORAL TABLET sotalol hcl (af) oral tablet Betapace AF sotalol hcl oral tablet Sorine timolol maleate oral tablet *Calcium Channel Blockers* *Calcium Channel Blockers*** AFEDITAB CR ORAL TABLET EXTENDED RELEASE 24 HR* amlodipine besylate oral tablet Norvasc CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR diltiazem cd oral capsule extended Cardizem CD release 24 hour 20 mg, 80 mg, 240 mg diltiazem hcl er beads oral capsule extended release 24 hour Tiazac diltiazem hcl er coated beads oral capsule extended release 24 hour Cardizem CD diltiazem hcl er coated beads oral tablet Cardizem LA extended release 24 hr* diltiazem hcl er oral capsule extended release 2 hour diltiazem hcl er oral capsule extended release 24 hour 20 mg, 80 mg 8 LastUpdated //206

21 diltiazem hcl er oral capsule extended release 24 hour 240 mg Dilacor XR diltiazem hcl oral tablet Cardizem dilt-xr oral capsule extended release 24 hour Dilacor XR felodipine er oral tablet extended release 24 hr* isradipine oral capsule MATZIM LA ORAL TABLET EXTENDED RELEASE 24 HR* nicardipine hcl oral capsule NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HR* nifedipine er oral tablet extended release 24 hr* Nifediac CC nifedipine er osmotic release oral tablet Nifedical XL extended release 24 hr* nifedipine oral capsule Procardia nimodipine oral capsule Nimotop TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR verapamil hcl er oral capsule extended release 24 hour Verelan verapamil hcl er oral tablet extendedrelease* 20 mg, 80 mg, 240 Calan SR mg verapamil hcl oral tablet Calan *Cardiovascular Agents - Misc.* *Calcium Channel Blocker & Hmg Coa Reductase Inhibit Comb*** amlodipine-atorvastatin oral tablet Caduet *Cephalosporins* *Cephalosporins - St Generation*** cephalexin oral capsule Keflex cephalexin oral suspension reconstituted cephalexin oral tablet LastUpdated //206 9

22 *Contraceptives* *Biphasic Contraceptives - Oral*** AZURETTE ORAL TABLET BEKYREE ORAL TABLET desogestrel-ethinyl estradiol oral tablet /0.0 mg (2/5) Kariva KARIVA ORAL TABLET KIMIDESS ORAL TABLET PIMTREA ORAL TABLET viorele oral tablet Kariva *Combination Contraceptives - Oral*** ALTAVERA ORAL TABLET alyacen /35 oral tablet Necon /35 (28) APRI ORAL TABLET AUBRA ORAL TABLET AVIANE ORAL TABLET BALZIVA ORAL TABLET BLISOVI 24 FE ORAL TABLET BLISOVI FE.5/30 ORAL TABLET BLISOVI FE /20 ORAL TABLET briellyn oral tablet Philith CHATEAL ORAL TABLET CRYSELLE-28 ORAL TABLET CYCLAFEM /35 ORAL TABLET CYRED ORAL TABLET DASETTA /35 ORAL TABLET DELYLA ORAL TABLET desogestrel-ethinyl estradiol oral tablet mg-mcg Emoquette drospirenone-ethinyl estradiol oral tablet Ocella ELINEST ORAL TABLET EMOQUETTE ORAL TABLET ENSKYCE ORAL TABLET ESTARYLLA ORAL TABLET FALMINA ORAL TABLET LastUpdated //206 20

23 GIANVI ORAL TABLET GILDAGIA ORAL TABLET GILDESS.5/30 ORAL TABLET GILDESS /20 ORAL TABLET GILDESS 24 FE ORAL TABLET GILDESS FE.5/30 ORAL TABLET GILDESS FE /20 ORAL TABLET JULEBER ORAL TABLET JUNEL.5/30 ORAL TABLET JUNEL /20 ORAL TABLET JUNEL FE.5/30 ORAL TABLET JUNEL FE /20 ORAL TABLET JUNEL FE 24 ORAL TABLET KAITLIB FE ORAL TABLET CHEWABLE KELNOR /35 ORAL TABLET KURVELO ORAL TABLET LARIN.5/30 ORAL TABLET LARIN /20 ORAL TABLET LARIN 24 FE ORAL TABLET LARIN FE.5/30 ORAL TABLET LARIN FE /20 ORAL TABLET LAYOLIS FE ORAL TABLET CHEWABLE LESSINA ORAL TABLET levonorgestrel-ethinyl estrad oral tablet mg-mcg Lessina-28 levonorgestrel-ethinyl estrad oral tablet mg-mcg Kurvelo LEVORA 0.5/30 (28) ORAL TABLET LOMEDIA 24 FE ORAL TABLET LORYNA ORAL TABLET LOW-OGESTREL ORAL TABLET LUTERA ORAL TABLET marlissa oral tablet Kurvelo MICROGESTIN.5/30 ORAL TABLET LastUpdated //206 2

24 MICROGESTIN /20 ORAL TABLET MICROGESTIN 24 FE ORAL TABLET MICROGESTIN FE.5/30 ORAL TABLET MICROGESTIN FE /20 ORAL TABLET MONO-LINYAH ORAL TABLET MONONESSA ORAL TABLET NECON 0.5/35 (28) ORAL TABLET NECON /35 (28) ORAL TABLET NECON /50 (28) ORAL TABLET NIKKI ORAL TABLET norethin ace-eth estrad-fe oral tablet Loestrin 24 Fe norethindrone acet-ethinyl est oral tablet Gildess /20 norethin-eth estradiol-fe oral tablet chewable mg-mcg Generess FE norgestimate-eth estradiol oral tablet mg-mcg Mono-Linyah NORTREL 0.5/35 (28) ORAL TABLET NORTREL /35 (2) ORAL TABLET NORTREL /35 (28) ORAL TABLET OCELLA ORAL TABLET OGESTREL ORAL TABLET ORSYTHIA ORAL TABLET PHILITH ORAL TABLET PIRMELLA /35 ORAL TABLET PORTIA-28 ORAL TABLET PREVIFEM ORAL TABLET RECLIPSEN ORAL TABLET SPRINTEC 28 ORAL TABLET SRONYX ORAL TABLET SYEDA ORAL TABLET TARINA FE /20 ORAL TABLET VESTURA ORAL TABLET VIENVA ORAL TABLET 22 LastUpdated //206

25 VYFEMLA ORAL TABLET WERA ORAL TABLET WYMZYA FE ORAL TABLET CHEWABLE ZARAH ORAL TABLET ZENCHENT FE ORAL TABLET CHEWABLE ZENCHENT ORAL TABLET ZOVIA /35E (28) ORAL TABLET ZOVIA /50E (28) ORAL TABLET *Combination Contraceptives - Transdermal*** XULANE TRANSDERMAL PATCH WEEKLY *Combination Contraceptives - Vaginal*** NUVARING VAGINAL RING *Continuous Contraceptives - Oral*** AMETHYST ORAL TABLET levonorgestrel-ethinyl estrad oral tablet mcg Amethyst *Emergency Contraceptives*** AFTERA ORAL TABLET ECONTRA EZ ORAL TABLET ELLA ORAL TABLET FALLBACK SOLO ORAL TABLET levonorgestrel oral tablet.5 mg Next Choice One Dose MY WAY ORAL TABLET NEXT CHOICE ONE DOSE ORAL TABLET OPCICON ONE-STEP ORAL TABLET REACT ORAL TABLET TAKE ACTION ORAL TABLET *Extended-Cycle Contraceptives - Oral*** AMETHIA LO ORAL TABLET AMETHIA ORAL TABLET ASHLYNA ORAL TABLET CAMRESE LO ORAL TABLET LastUpdated //206 23

26 CAMRESE ORAL TABLET DAYSEE ORAL TABLET INTROVALE ORAL TABLET JOLESSA ORAL TABLET levonorgest-eth estrad 9-day oral tablet Introvale QUASENSE ORAL TABLET SETLAKIN ORAL TABLET *Progestin Contraceptives - Injectable*** medroxyprogesterone acetate intramuscular* Depo-Provera QL medroxyprogesterone acetate intramuscular* suspension Depo-Provera QL *Progestin Contraceptives - Oral*** CAMILA ORAL TABLET DEBLITANE ORAL TABLET ERRIN ORAL TABLET HEATHER ORAL TABLET JENCYCLA ORAL TABLET JOLIVETTE ORAL TABLET LYZA ORAL TABLET NORA-BE ORAL TABLET norethindrone oral tablet Jolivette NORLYROC ORAL TABLET SHAROBEL ORAL TABLET *Triphasic Contraceptives - Oral*** alyacen 7/7/7 oral tablet Nortrel 7/7/7 ARANELLE ORAL TABLET CAZIANT ORAL TABLET CYCLAFEM 7/7/7 ORAL TABLET DASETTA 7/7/7 ORAL TABLET ENPRESSE-28 ORAL TABLET LEENA ORAL TABLET LEVONEST ORAL TABLET levonorg-eth estrad triphasic oral tablet Myzilra MYZILRA ORAL TABLET LastUpdated //206 24

27 NECON 7/7/7 ORAL TABLET norgestim-eth estrad triphasic oral tablet Tri-Linyah NORTREL 7/7/7 ORAL TABLET PIRMELLA 7/7/7 ORAL TABLET TILIA FE ORAL TABLET TRI-ESTARYLLA ORAL TABLET TRI-LEGEST FE ORAL TABLET TRI-LINYAH ORAL TABLET TRI-LO-ESTARYLLA ORAL TABLET TRI-LO-MARZIA ORAL TABLET TRI-LO-SPRINTEC ORAL TABLET TRINESSA (28) ORAL TABLET TRINESSA LO ORAL TABLET TRI-PREVIFEM ORAL TABLET TRI-SPRINTEC ORAL TABLET TRIVORA (28) ORAL TABLET VELIVET ORAL TABLET *Corticosteroids* *Glucocorticosteroids*** DELTASONE ORAL TABLET prednisolone oral solution Prelone prednisolone oral syrup 5 mg/5ml Prelone prednisolone sodium phosphate oral solution 5 mg/5ml Orapred prednisolone sodium phosphate oral solution 25 mg/5ml prednisolone sodium phosphate oral solution 6.7 (5 base) mg/5ml Pediapred prednisone oral prednisone oral solution prednisone oral tablet *Mineralocorticoids*** fludrocortisone acetate oral tablet LastUpdated //206 25

28 *Cough/Cold/Allergy* *Antitussive - Nonnarcotic*** benzonatate oral capsule Tessalon Perles *Antitussive-Expectorant*** cheratussin ac oral syrup *Antitussive-Expectorants-Decongestant*** biotuss oral liquid BIOTUSS PEDIATRIC ORAL LIQUID GILTUSS PEDIATRIC ORAL LIQUID MG/ML NORTUSS-DE ORAL LIQUID *Misc. Respiratory Inhalants*** NEBUSAL INHALATION NEBULIZATION SOLUTION 3 % PULMOSAL INHALATION NEBULIZATION SOLUTION sodium chloride inhalation nebulization solution 0.9 %, 0 % sodium chloride inhalation nebulization Nebusal solution 3 % sodium chloride inhalation nebulization HyperSal solution 7 % *Mucolytics*** acetylcysteine inhalation solution *Non-Narc Antitussive-Decongestant-Antihistamine*** BROMFED DM ORAL SYRUP pseudoeph-bromphen-dm oral syrup mg/5ml Dimetane DX tgq 50pse/3brm/30dm oral syrup Neo DM tgq 7.5peh/4brm/5dm oral liquid Alahist DM *Dermatologicals* *Acne Combinations*** benzoyl peroxide-erythromycin external Benzamycin gel bp cleansing wash external emulsion Claris Clarifying Wash 26 LastUpdated //206

29 CLARIS CLARIFYING WASH EXTERNAL EMULSION *Acne Products*** BENZIQ WASH EXTERNAL LIQUID bp wash external liquid 5.25 % Benziq Wash *Antifungals - Topical*** NYAMYC EXTERNAL POWDER nystatin external powder Nyamyc NYSTOP EXTERNAL POWDER *Antipruritics - Topical*** doxepin hcl external cream Zonalon *Antipsoriatics*** calcitriol external ointment Vectical *Antiseborrheic Products*** selenium sulfide external lotion Selsun *Burn Products*** silver sulfadiazine external cream Thermazene SSD EXTERNAL CREAM *Corticosteroids - Topical*** amcinonide external cream amcinonide external lotion amcinonide external ointment mometasone furoate external cream Elocon mometasone furoate external ointment Elocon mometasone furoate external solution Elocon prednicarbate external cream Dermatop prednicarbate external ointment Dermatop scalacort external lotion Ala Scalp *Emollients*** ammonium lactate external cream Lac-Hydrin ammonium lactate external lotion LAClotion lactic acid external lotion *Imidazole-Related Antifungals - Topical*** econazole nitrate external cream LastUpdated //206 27

30 *Scabicides & Pediculicides*** malathion external lotion Ovide permethrin external cream Elimite spinosad external suspension Natroba *Diuretics* *Carbonic Anhydrase Inhibitors*** methazolamide oral tablet Neptazane *Diuretic Combinations*** amiloride-hydrochlorothiazide oral tablet spironolactone-hctz oral tablet Aldactazide triamterene-hctz oral capsule Dyazide triamterene-hctz oral tablet Maxzide *Loop Diuretics*** bumetanide oral tablet Bumex furosemide oral solution 0 mg/ml furosemide oral tablet Lasix torsemide oral tablet Demadex *Potassium Sparing Diuretics*** amiloride hcl oral tablet spironolactone oral tablet Aldactone *Thiazides And Thiazide-Like Diuretics*** chlorothiazide oral tablet chlorthalidone oral tablet hydrochlorothiazide oral capsule Microzide hydrochlorothiazide oral tablet indapamide oral tablet methyclothiazide oral tablet metolazone oral tablet Zaroxolyn *Endocrine And Metabolic Agents - Misc.* *Bisphosphonates*** alendronate sodium oral solution alendronate sodium oral tablet Fosamax ibandronate sodium oral tablet Boniva 28 LastUpdated //206

31 risedronate sodium oral tablet 50 mg, 30 mg, 35 mg, 5 mg Actonel risedronate sodium oral tablet delayed release Atelvia *Carnitine Replenisher - Agents*** levocarnitine oral solution Carnitor SF levocarnitine oral tablet Carnitor *Hyperparathyroid Treatment - Vitamin D Analogs*** calcitriol oral capsule Rocaltrol calcitriol oral solution Rocaltrol *Selective Estrogen Receptor Modulators (Serms)*** raloxifene hcl oral tablet Evista AL *Estrogens* *Estrogens*** estropipate oral tablet Ortho-Est.25 ORTHO-EST ORAL TABLET ORTHO-EST.25 ORAL TABLET *Gastrointestinal Agents - Misc.* *Gastrointestinal Stimulants*** metoclopramide hcl oral solution 0 mg/0ml, 5 mg/5ml metoclopramide hcl oral tablet Reglan *Inflammatory Bowel Agents*** balsalazide disodium oral capsule Colazal sulfasalazine oral tablet Azulfidine sulfasalazine oral tablet delayed release Sulfazine EC *Phosphate Binder Agents*** calcium acetate (phos binder) oral capsule PhosLo calcium acetate (phos binder) oral tablet Eliphos calcium acetate oral capsule PhosLo *Genitourinary Agents - Miscellaneous* *5-Alpha Reductase Inhibitors*** dutasteride oral capsule Avodart LastUpdated //206 29

32 *Citrates*** citric acid-sodium citrate oral solution Shohls Modified cytra-2 oral solution Shohls Modified pot & sod cit-cit ac oral solution potassium citrate er oral tablet extendedrelease* Urocit-K 0 sod citrate-citric acid oral solution Shohls Modified tricitrates oral solution virtrate-2 oral solution Shohls Modified virtrate-3 oral solution *Genitourinary Irrigants*** ARGYLE STERILE SALINE IRRIGATION SOLUTION CURITY STERILE SALINE IRRIGATION SOLUTION sodium chloride irrigation solution 0.9 % Curity Sterile Saline *Gout Agents* *Gout Agents*** allopurinol oral tablet Zyloprim *Uricosurics*** probenecid oral tablet *Hematological Agents - Misc.* *Hematorheologic Agents*** pentoxifylline er oral tablet extendedrelease* TRENtal *Phosphodiesterase Iii Inhibitors*** cilostazol oral tablet Pletal *Platelet Aggregation Inhibitor Combinations*** aspirin-dipyridamole er oral capsule extended release 2 hour Aggrenox *Platelet Aggregation Inhibitors*** dipyridamole oral tablet Persantine *Quinazoline Agents*** anagrelide hcl oral capsule 30 LastUpdated //206

33 *Thienopyridine Derivatives*** clopidogrel bisulfate oral tablet Plavix *Hematopoietic Agents* *Folic Acid/Folate Combinations*** AIRAVITE ORAL TABLET av-vite fb oral tablet Airavite fabb oral tablet Folgard RX folbee oral tablet Airavite NUFOL ORAL TABLET tl gard rx oral tablet Folgard RX VIRT-GARD ORAL TABLET virt-vite oral tablet Airavite *Folic Acid/Folates*** cvs folic acid oral tablet 800 mcg FA-8 AL; QL FA-8 ORAL TABLET AL; QL folic acid oral tablet mg folic acid oral tablet 400 mcg AL; QL folic acid oral tablet 800 mcg FA-8 AL; QL gnp folic acid oral tablet AL; QL hm folic acid oral tablet AL; QL kp folic acid oral tablet FA-8 AL; QL px folic acid oral tablet AL; QL ra folic acid oral tablet FA-8 AL; QL sm folic acid oral tablet AL; QL yl folic acid oral tablet AL; QL *Iron Combinations*** ferocon oral capsule Tricon ferotrinsic oral capsule Tricon foltrin oral capsule Tricon IFEREX 50 FORTE ORAL CAPSULE myferon 50 forte oral capsule iferex 50 Forte poly-iron 50 forte oral capsule iferex 50 Forte polysaccharide iron forte oral capsule iferex 50 Forte tl icon oral capsule Tricon TRICON ORAL CAPSULE LastUpdated //206 3

34 trigels-f forte oral capsule Hematogen Forte *Iron*** BPROTECTED PEDIA IRON ORAL SOLUTION FER-IN-SOL ORAL SOLUTION fer-iron oral solution Fer-In-Sol FEROSUL ORAL ELIXIR ferrous sulfate oral elixir FeroSul ferrous sulfate oral liquid ferrous sulfate oral solution 75 (5 fe) mg/ml Fer-In-Sol ferrous sulfate oral syrup ICAR ORAL SUSPENSION iron supplement childrens oral solution Fer-In-Sol MYKIDZ IRON 0 ORAL SUSPENSION wee care oral suspension Icar *Hypnotics* *Barbiturate Hypnotics*** phenobarbital oral elixir phenobarbital oral solution phenobarbital oral tablet *Benzodiazepine Hypnotics*** triazolam oral tablet QL *Laxatives* *Bowel Evacuant Combinations*** GAVILYTE-C ORAL SOLUTION RECONSTITUTED GAVILYTE-G ORAL SOLUTION RECONSTITUTED GAVILYTE-H ORAL KIT AL GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED MOVIPREP ORAL SOLUTION RECONSTITUTED AL 32 LastUpdated //206

35 peg 3350/electrolytes oral solution reconstituted peg 3350-kcl-na bicarb-nacl oral solution reconstituted peg-3350/electrolytes oral solution reconstituted Colyte with Flavor Packs Nulytely with Flavor Packs Golytely PEG-PREP ORAL KIT AL PREPOPIK ORAL PACKET SUPREP BOWEL PREP ORAL SOLUTION TRILYTE ORAL SOLUTION RECONSTITUTED *Laxatives - Miscellaneous*** constulose oral solution lactulose oral solution peg 3350 oral powder MiraLax polyethylene glycol 3350 oral packet CVS Purelax *Medical Devices* *Cervical Caps*** FEMCAP VAGINAL DEVICE PRENTIF CAVITY-RIM CERV CAP VAGINAL DEVICE PRENTIF FITTING SET VAGINAL *Condoms - Female*** FC FEMALE CONDOM FC2 FEMALE CONDOM *Diaphragms*** CAYA VAGINAL DIAPHRAGM OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM ORTHO DIAPHRAGM COIL VAGINAL KIT ORTHO DIAPHRAGM FLAT VAGINAL KIT WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM LastUpdated //206 33

36 WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM *Minerals & Electrolytes* *Fluoride*** FLUORABON ORAL SOLUTION AL FLUOR-A-DAY ORAL SOLUTION AL fluoritab oral solution Flura-Drops AL fluoritab oral tablet chewable 0.55 (0.25 Luride f) mg,. (0.5 f) mg AL fluoritab oral tablet chewable 2.2 ( f) mg Luride FLURA-DROPS ORAL SOLUTION AL KARIDIUM ORAL SOLUTION AL LUDENT ORAL TABLET CHEWABLE 0.55 (0.25 F) MG,. (0.5 F) MG AL LUDENT ORAL TABLET CHEWABLE 2.2 ( F) MG LURIDE ORAL SOLUTION AL LURIDE ORAL TABLET CHEWABLE 0.55 (0.25 F) MG,. (0.5 F) MG AL NAFRINSE DROPS ORAL SOLUTION AL NAFRINSE ORAL TABLET CHEWABLE sodium fluoride oral solution Luride AL sodium fluoride oral tablet. (0.5 f) mg AL 34 LastUpdated //206

37 sodium fluoride oral tablet 2.2 ( f) mg sodium fluoride oral tablet chewable 0.55 (0.25 f) mg,. (0.5 f) mg Luride AL sodium fluoride oral tablet chewable 2.2 Luride ( f) mg *Potassium Combinations*** effervescent pot chloride oral tablet effervescent pot bicarb-pot chloride oral tablet effervescent *Potassium*** EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ k-effervescent oral tablet effervescent Klor-Con/EF KLOR-CON 0 ORAL TABLET EXTENDEDRELEASE* KLOR-CON M0 ORAL TABLET EXTENDEDRELEASE* KLOR-CON M20 ORAL TABLET EXTENDEDRELEASE* KLOR-CON ORAL PACKET 20 MEQ KLOR-CON ORAL TABLET EXTENDEDRELEASE* KLOR-CON SPRINKLE ORAL CAPSULE EXTENDED RELEASE* KLOR-CON/EF ORAL TABLET EFFERVESCENT K-PRIME ORAL TABLET EFFERVESCENT K-SOL ORAL SOLUTION k-vescent oral tablet effervescent Klor-Con/EF potassium bicarbonate oral tablet effervescent Klor-Con/EF potassium chloride crys er oral tablet extendedrelease* Klor-Con M20 potassium chloride er oral capsule extended release* Micro-K potassium chloride er oral tablet extendedrelease* Klor-Con LastUpdated //206 35

38 potassium chloride intravenous* solution 20 meq/00ml, 40 meq/00ml potassium chloride oral packet Klor-Con potassium chloride oral solution 20 meq/5ml (0%), 40 meq/5ml (20%) K-Sol *Zinc*** zinc sulfate oral capsule Orazinc *Mouth/Throat/Dental Agents* *Antiseptics - Mouth/Throat*** chlorhexidine gluconate mouth/throat solution Periogard PAROEX MOUTH/THROAT SOLUTION PERIOGARD MOUTH/THROAT SOLUTION *Fluoride Dental Products*** CAVAREST DENTAL GEL CONTROLRX DENTAL CREAM DENTA 5000 PLUS DENTAL CREAM DENTAGEL DENTAL GEL FLUORIDEX DAILY DEFENSE DENTAL GEL FLUORIDEX ENHANCED WHITENING DENTAL GEL KARIGEL DENTAL GEL KARIGEL-N DENTAL GEL NEUTRAGARD ADVANCED DENTAL GEL PHOS-FLUR DENTAL GEL sf 5000 plus dental cream Denta 5000 Plus sf dental gel NeutraGard Advanced *Multivitamins* *B-Complex W/ C & Folic Acid*** b-plex oral tablet Milco-B-Forte DIALYVITE ORAL TABLET folbee plus oral tablet 36 LastUpdated //206

39 mynephrocaps oral capsule Nephrocaps NEPHRONEX ORAL TABLET RENAL ORAL CAPSULE rena-vite rx oral tablet Dialyvite reno caps oral capsule Nephrocaps triphrocaps oral capsule Nephrocaps virt-caps oral capsule Nephrocaps virt-vite plus oral tablet vol-care rx oral tablet Dialyvite vp-vite rx oral tablet Dialyvite *Ped Multi Vitamins W/Fl & Fe*** escavite lq oral liquid multi-vit/fluoride/iron oral solution Escavite LQ multi-vitamin/fluoride/iron oral solution Escavite LQ *Ped Mv W/ Fluoride*** FLORIVA PLUS ORAL SOLUTION multi vitamin/fluoride oral tablet chewable MVC-Fluoride multi-vit/fluoride oral solution Quflora Pediatric multi-vitamin/fluoride oral solution Quflora Pediatric multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, mg MVC-Fluoride multi-vitamin/fluoride oral tablet chewable 0.5 mg MVC-Fluoride multi-vitamins/fluoride oral solution 0.5 Quflora Pediatric mg/ml multivitamins/fluoride oral tablet chewable MVC-Fluoride MVC-FLUORIDE ORAL TABLET CHEWABLE QUFLORA PEDIATRIC ORAL SOLUTION *Ped Vitamins Acd W/ Fluoride*** triple-vitamin/fluoride oral solution tri-vit/fluoride oral solution tri-vitamin/fluoride oral solution LastUpdated //206 37

40 vitamins acd-fluoride oral solution *Prenatal Vitamins*** bp folinatal plus b oral tablet Folbecal prenaissance next oral tablet B-Nexa prenaissance next-b oral tablet B-Nexa vp-ggr-b6 prenatal oral tablet B-Nexa *Musculoskeletal Therapy Agents* *Central Muscle Relaxants*** chlorzoxazone oral tablet 500 mg Parafon Forte DSC methocarbamol oral tablet Robaxin-750 *Direct Muscle Relaxants*** dantrolene sodium oral capsule Dantrium *Nasal Agents - Systemic And Topical* *Nasal Steroids*** mometasone furoate nasal suspension Nasonex QL *Ophthalmic Agents* *Cycloplegic Mydriatics*** mydral ophthalmic solution tropicamide ophthalmic solution *Ophthalmic Antiallergic*** olopatadine hcl ophthalmic solution Patanol *Ophthalmic Antibiotics*** tobramycin ophthalmic solution Tobrex *Ophthalmic Anti-Infective Combinations*** polymyxin b-trimethoprim ophthalmic solution Polytrim *Ophthalmic Antivirals*** trifluridine ophthalmic solution Viroptic *Ophthalmic Decongestants*** naphazoline hcl ophthalmic solution *Ophthalmic Steroids*** prednisolone acetate ophthalmic suspension Pred Forte 38 LastUpdated //206

41 *Otic Agents* *Otic Agents - Miscellaneous*** acetic acid otic solution VoSol acetic acid-aluminum acetate otic solution *Penicillins* *Aminopenicillins*** amoxicillin oral capsule amoxicillin oral suspension reconstituted amoxicillin oral tablet amoxicillin oral tablet chewable 25 mg, 250 mg ampicillin oral capsule ampicillin oral suspension reconstituted *Natural Penicillins*** penicillin v potassium oral solution reconstituted penicillin v potassium oral tablet *Penicillinase-Resistant Penicillins*** dicloxacillin sodium oral capsule *Potassium Removing Agents*** *Potassium Removing Agents*** KIONEX ORAL POWDER KIONEX ORAL SUSPENSION sodium polystyrene sulfonate oral powder Kayexalate sodium polystyrene sulfonate oral suspension SPS sodium polystyrene sulfonate suspension SPS ORAL SUSPENSION *Progestins* *Progestins*** medroxyprogesterone acetate oral tablet Provera LastUpdated //206 39

42 norethindrone acetate oral tablet Aygestin *Psychotherapeutic And Neurological Agents - Misc.* *Alcohol Deterrents*** acamprosate calcium oral tablet delayed release Campral PA *Benzodiazepines & Tricyclic Agents*** chlordiazepoxide-amitriptyline oral tablet *Phenothiazines & Tricyclic Agents*** perphenazine-amitriptyline oral tablet *Smoking Deterrents*** bupropion hcl er (smoking det) oral tablet extended release 2 hr* Buproban QL CHANTIX CONTINUING MONTH PAK ORAL TABLET QL CHANTIX ORAL TABLET QL CHANTIX STARTING MONTH PAK ORAL TABLET QL cvs nicotine mouth/throat lozenge Commit QL cvs nicotine polacrilex mouth/throat gum KLS Quit4 QL cvs nicotine polacrilex mouth/throat lozenge Commit QL cvs nicotine transdermal patch 24 hr 4 mg/24hr, 7 mg/24hr Nicoderm CQ QL cvs nts step transdermal patch 24 hr Nicoderm CQ QL eq nicotine mouth/throat gum 4 mg KLS Quit4 QL eq nicotine mouth/throat lozenge Nicorette QL eq nicotine polacrilex mouth/throat gum Nicorette QL eq nicotine polacrilex mouth/throat lozenge Nicorette QL eq nicotine step 3 transdermal patch 24 Nicoderm CQ hr QL eq nicotine transdermal patch 24 hr Nicoderm CQ QL eql nicotine polacrilex mouth/throat gum Nicorette QL 40 LastUpdated //206

43 eql nicotine polacrilex mouth/throat lozenge Commit QL gnp nicotine mini mouth/throat lozenge Commit QL gnp nicotine polacrilex mouth/throat gum Nicorette QL gnp nicotine polacrilex mouth/throat lozenge Nicorette QL goodsense nicotine mouth/throat gum KLS Quit4 QL hm nicotine polacrilex mouth/throat gum KLS Quit4 QL hm nicotine polacrilex mouth/throat lozenge Commit QL hm nicotine transdermal patch 24 hr Nicoderm CQ QL KLS QUIT2 MOUTH/THROAT GUM QL KLS QUIT2 MOUTH/THROAT LOZENGE QL KLS QUIT4 MOUTH/THROAT GUM QL KLS QUIT4 MOUTH/THROAT LOZENGE QL NICORELIEF MOUTH/THROAT GUM QL nicotine mini mouth/throat lozenge Commit QL nicotine polacrilex mouth/throat gum Nicorette QL nicotine polacrilex mouth/throat lozenge Commit QL nicotine step transdermal patch 24 hr Nicoderm CQ QL nicotine step 2 transdermal patch 24 hr Nicoderm CQ QL nicotine step 3 transdermal patch 24 hr Nicoderm CQ QL nicotine transdermal patch 24 hr Nicoderm CQ QL NICOTROL INHALATION INHALER QL NICOTROL NS NASAL SOLUTION QL px stop smoking aid mouth/throat gum Nicorette QL px stop smoking aid mouth/throat lozenge Nicorette QL qc nicotine polacrilex mouth/throat gum KLS Quit4 QL ra mini nicotine mouth/throat lozenge Commit QL ra nicotine mouth/throat gum KLS Quit4 QL ra nicotine polacrilex mouth/throat gum KLS Quit4 QL LastUpdated //206 4

44 ra nicotine polacrilex mouth/throat lozenge Nicorette QL ra nicotine transdermal patch 24 hr Nicoderm CQ QL sm nicotine mouth/throat gum KLS Quit4 QL sm nicotine mouth/throat lozenge Commit QL sm nicotine polacrilex mouth/throat gum Nicorette QL sm nicotine polacrilex mouth/throat lozenge Nicorette QL sm nicotine transdermal patch 24 hr Nicoderm CQ QL sr nicotine mouth/throat gum Nicorette QL sw nicotine polacrilex mouth/throat gum KLS Quit4 QL sw nicotine polacrilex mouth/throat lozenge Nicorette QL tgt nicotine mouth/throat gum Nicorette QL tgt nicotine polacrilex mouth/throat gum KLS Quit4 QL tgt nicotine polacrilex mouth/throat lozenge Commit QL tgt nicotine step one transdermal patch 24 hr Nicoderm CQ QL tgt nicotine step three transdermal patch 24 hr Nicoderm CQ QL tgt nicotine step two transdermal patch 24 hr Nicoderm CQ QL THRIVE MOUTH/THROAT GUM 2 MG QL *Serotonin Modulators*** *Serotonin Modulators*** trazodone hcl oral tablet *Thyroid Agents* *Antithyroid Agents*** methimazole oral tablet Tapazole propylthiouracil oral tablet *Thyroid Hormones*** liothyronine sodium oral tablet Cytomel 42 LastUpdated //206

45 np thyroid oral tablet 30 mg, 60 mg, 90 mg Armour Thyroid *Ulcer Drugs* *Anticholinergic Combinations*** chlordiazepoxide-clidinium oral capsule Librax *Antispasmodics*** dicyclomine hcl oral capsule Bentyl dicyclomine hcl oral solution dicyclomine hcl oral tablet Bentyl *Belladonna Alkaloids*** ed-spaz oral tablet dispersible NuLev hyoscyamine sulfate er oral tablet extended release 2 hr* Levbid hyoscyamine sulfate oral elixir hyoscyamine sulfate oral solution hyoscyamine sulfate oral tablet Levsin hyoscyamine sulfate oral tablet dispersible NuLev hyoscyamine sulfate sublingual tablet sublingual HyoMax-SL hyosyne oral elixir hyosyne oral solution NULEV ORAL TABLET DISPERSIBLE oscimin oral tablet Levsin oscimin oral tablet dispersible NuLev oscimin sr oral tablet extended release 2 hr* Levbid oscimin sublingual tablet sublingual HyoMax-SL SYMAX-SL SUBLINGUAL TABLET SUBLINGUAL SYMAX-SR ORAL TABLET EXTENDED RELEASE 2 HR* *H-2 Antagonists*** ranitidine hcl oral capsule ranitidine hcl oral syrup Zantac ranitidine hcl oral tablet 300 mg Zantac LastUpdated //206 43

46 *Misc. Anti-Ulcer*** sucralfate oral tablet Carafate *Quaternary Anticholinergics*** propantheline bromide oral tablet *Ulcer Drugs - Prostaglandins*** misoprostol oral tablet Cytotec *Urinary Anti-Infectives* *Urinary Anti-Infectives*** methenamine hippurate oral tablet Urex methenamine mandelate oral tablet *Urinary Antiseptic-Antispasmodic &/Or Analgesics*** HYOLEV MB ORAL TABLET ur n-c oral tablet Utrona-C URAMIT MB ORAL CAPSULE URELLE ORAL TABLET URIBEL ORAL CAPSULE uro-458 oral tablet Urelle uroav-8 oral tablet Urelle uroav-b oral capsule Uribel uro-l oral tablet Urelle uro-mp oral capsule Uribel *Urinary Antispasmodics* *Urinary Antispasmodics - Cholinergic Agonists*** bethanechol chloride oral tablet Urecholine *Urinary Antispasmodics - Cholinergic Agonists*** (New) bethanechol chloride oral tablet Urecholine *Urinary Antispasmodics - Direct Muscle Relaxants*** flavoxate hcl oral tablet *Urinary Antispasmodics - Direct Muscle Relaxants*** (New) flavoxate hcl oral tablet *Vaccines* *Bacterial Vaccines*** PNEUMOVAX 23 INJECTION INJECTABLE 44 LastUpdated //206