Prescription Drug Formulary (Tier 5)

Transcription

1 Get More Than Original Medicare 08 Prescription Drug Formulary (Tier ) Ofered by This formulary was updated on 04/0/08. For more recent information or other questions, please contact Community Health Plan of Washington Customer Service at or for T-T-Y users, toll free at 7--, 7 days a week, 8 a.m. to 8 p.m. or visit our website at healthfrst.chpw.org. H86_RX_96_08_v_0_Formulary_Tier_Apr

2 Community HealthFirst TM Medicare Advantage Plans 08 Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID , Version This formulary was updated on 04/0/08. For more recent information or other questions, please contact Community Health Plan of Washington Customer Service at or, for TTY users, Toll-free at 7--, 7 days a week, 8 a.m. to 8 p.m. or visit our website at healthfirst.chpw.org. Community Health Plan of Washington is an HMO Plan with a Medicare contract. Enrollment in Community Health Plan of Washington depends on contract renewal. Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 7--). H86_RX_96_08_v_0_Formulary_Tier_Apr

3 Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to we, us, or our, it means Community Health Plan of Washington. When it refers to plan or our plan, it means Community HealthFirst TM Medicare Advantage Plan. This document includes a list of the drugs (formulary) for our plan which is current as of 04/0/08. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January, 08, and from time to time during the year. What is the Community HealthFirst TM Medicare Advantage Plan Formulary? A formulary is a list of covered drugs selected by Community HealthFirst TM Medicare Advantage Plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Community HealthFirst TM Medicare Advantage Plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Community HealthFirst TM Medicare Advantage Plan network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 08 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 08 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 04/0/08. To get updated information about the drugs covered by Community HealthFirst TM Medicare Advantage Plan, please contact us. Our contact information appears on the front and back cover pages. The notice of these changes is posted monthly at healthfirst.org.

4 How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular, Hypertension/Lipids. If you know what your drug is used for, look for the category name in the list that begins on page. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 8. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? Community HealthFirst TM Medicare Advantage Plan covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.

5 Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: Community HealthFirst TM Medicare Advantage Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from our plan before you fill your prescriptions. If you don t get approval, our plan may not cover the drug. Quantity : For certain drugs, our plan limits the amount of the drug that we will cover. For example, our plan provides citalopram 0mg tablets (different quantity limits for different strengths) per prescription for 0 tablets. This may be in addition to a standard one-month or three-month supply. Step Therapy: In some cases, our plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page. You can also get more information about the restrictions applied to specific covered drugs by visiting our Web site. We have posted on line documents that explain our prior authorization restriction and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to the Community HealthFirst TM Medicare Advantage Plan formulary? on page for information about how to request an exception. 4

6 What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Customer Service and ask if your drug is covered. If you learn that Community HealthFirst TM Medicare Advantage Plan does not cover your drug, you have two options: You can ask Customer Services for a list of similar drugs that are covered by Community HealthFirst TM Medicare Advantage Plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan. You can ask us to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to the Community HealthFirst TM Medicare Advantage Plan Formulary? You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, our plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the specialty tier. If approved, this would lower the amount you must pay for your drug. Generally, we will only approve your request for an exception if the alternative drugs included on the plan s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you request a formulary tiering or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 7 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 7 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 4 hours after we get a supporting statement from your doctor or other prescriber.

7 What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 4-day supply (unless you have a prescription written for fewer when you go to a network pharmacy. After your first 4-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with 9-day transition supply, consistent with dispensing increment, (unless you have a prescription written for fewer. We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 4-day emergency supply of that drug (unless you have a prescription for fewer while you pursue a formulary exception. For more information For more detailed information about your Community HealthFirst TM Medicare Advantage Plan prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Community HealthFirst TM Medicare Advantage Plan, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at -800-MEDICARE ( ) 4 hours a day/7 days a week. TTY users should call Or, visit medicare.gov. 6

8 Community HealthFirst TM Medicare Advantage Plan's Formulary The formulary that begins on page provides coverage information about the drugs covered by our plan. If you have trouble finding your drug in the list, turn to the index that begins on page 8. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., ADAGEN) and generic drugs are listed in lower-case italics (e.g., warfarin ). The information in the Requirements/ column tells you if our plan has any special requirements for coverage of your drug. List of Abbreviations B/D PA: This prescription drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination. LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call Customer Service. MO: Mail-Order Drug. This prescription drug is available through our mail-order service, as well as through our retail network pharmacies. Consider using mail order for your long-term (maintenance) medications (such as high blood pressure medications). Retail network pharmacies may be more appropriate for shortterm prescriptions (such as antibiotics). PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you don t get approval, we may not cover the drug. QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover. ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B. 7

9 Plan Community HealthFirst Medicare Advantage Formulario 08 Lista de medicamentos cubiertos LEER: ESTE DOCUMENTO CONTIENE INFORMACIÓN ACERCA DE LOS MEDICAMENTOS QUE SE CUBREN EN ESTE PLAN Formulario aprobado por la HPMS; Ident. de presentación del formulario: , versión Este formulario fue actualizado el 04/0/08. Para obtener información actualizada o hacer alguna pregunta, comuníquese con el Servicio al cliente de Community Health Plan of Washington al (los usuarios de TTY deben llamar al 7--, sin cargo), los 7 días de la semana de 8:00 a. m. a 8:00 p. m. También puede visitar nuestro sitio web en healthfirst.chpw.org. Community Health Plan of Washington es un plan HMO que tiene un contrato con Medicare y un contrato. La inscripción en Community Health Plan of Washington depende de la renovación del contrato. 8

10 Nota a los miembros existentes: Este formulario ha cambiado desde el año pasado. Revise este documento para asegurarse de que todavía incluye los medicamentos que usted toma. Cuando esta lista de medicamentos (formulario) dice nosotros nos o nuestro, hace referencia a Community Health Plan of Washington. Cuando menciona plan o nuestro plan, se refiere al Plan Community HealthFirst TM Medicare Advantage. Este documento incluye una lista de los medicamentos (formulario) para nuestro plan que rige a partir del 04/0/08. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, aparece en la portada y la contraportada. En general, usted debe utilizar farmacias de nuestra red para aprovechar sus beneficios de medicamentos con receta. Los beneficios, el formulario, la red de farmacias o los copagos/coseguros pueden cambiar el de enero de 08, u ocasionalmente durante el año. Qué es el formulario del Plan Community HealthFirst TM Medicare Advantage? Un formulario es una lista de medicamentos cubiertos seleccionados por el Plan Community HealthFirst TM Medicare Advantage, en colaboración con un equipo de proveedores de atención médica, que representa las terapias con receta que se consideran una parte necesaria de un programa de tratamiento de calidad. El Plan Community HealthFirst TM Medicare Advantage generalmente cubrirá los medicamentos que se mencionan en nuestro formulario, siempre y cuando el medicamento sea médicamente necesario, la receta se presente en una farmacia de la red del Plan Community HealthFirst TM Medicare Advantage, y se cumpla con otras normas del plan. Para obtener más información sobre cómo surtir sus recetas, revise su Evidencia de cobertura. El formulario (lista de medicamentos) puede cambiar? En general, si usted toma un medicamento que se encuentra en nuestro formulario de 07 que estaba cubierto a principio de año, no suspenderemos ni reduciremos la cobertura del medicamento durante el año de cobertura 08, a menos que un nuevo medicamento genérico más económico esté disponible, o cuando se divulgue información negativa sobre la seguridad o eficiencia de un medicamento. Otros tipos de cambios en el formulario, como la eliminación de un medicamento de nuestro formulario, no afectarán a los miembros que actualmente estén en tratamiento con ese medicamento. Seguirá disponible con el mismo costo compartido para los miembros que lo utilicen durante el resto del año de cobertura. Creemos que es importante que continúe teniendo acceso durante el resto del año de cobertura a los medicamentos del formulario que estaban disponibles cuando eligió nuestro plan, excepto en los casos en que usted pueda ahorrar más dinero o que nosotros podamos garantizar su seguridad. 9

11 Si eliminamos medicamentos de nuestro formulario, o agregamos la autorización previa, restricciones de tratamiento escalonado o límites de cantidad a un medicamento, debemos notificar a aquellos miembros afectados por el cambio al menos 60 días antes de que el cambio entre en vigencia, o en el momento en que el miembro solicite un resurtido del medicamento, momento en el que el miembro recibirá un suministro por 60 días de dicho medicamento. Si la Administración de Drogas y Alimentos (FDA) considera que un medicamento de nuestro formulario no es seguro, o si el fabricante del medicamento lo quita del mercado, eliminaremos inmediatamente dicho medicamento de nuestro formulario y enviaremos un aviso a los miembros que toman ese medicamento. El formulario adjunto rige a partir del 04/0/08. Para obtener información actualizada sobre los medicamentos cubiertos por el Plan Community HealthFirst TM MA Special Needs, comuníquese con nosotros. Nuestra información de contacto figura en la portada y la contraportada. Regularmente revisamos y actualizamos el formulario. El aviso de estos cambios se publica mensualmente en Cómo utilizo el formulario? Existen dos maneras de encontrar su medicamento dentro del formulario: Afección médica El formulario comienza en la página. Los medicamentos en este formulario están agrupados en dos categorías según el tipo de afecciones médicas que tratan. Por ejemplo, los medicamentos que se utilizan para tratar una afección cardíaca se enumeran bajo la categoría: Cardiovascular, hipertensión/lípidos. Si usted sabe para qué se utiliza su medicamento, busque el nombre de la categoría en la lista que comienza en la página. Luego busque su medicamento bajo el nombre de la categoría. Lista por orden alfabético Si usted no está seguro en qué categoría debe buscar, busque su medicamento en el índice que comienza en la página 8. El índice ofrece una lista por orden alfabético de todos los medicamentos incluidos en este documento. En el índice se enumeran los medicamentos de marca y los medicamentos genéricos. Busque en el índice y encuentre su medicamento. Al lado del nombre de su medicamento, verá el número de página donde puede encontrar información de cobertura. Diríjase a la página que figura en el índice y encuentre el nombre de su medicamento en la primera columna de la lista. Qué son los medicamentos genéricos? El Plan Community HealthFirst TM Medicare Advantage cubre medicamentos de marca y medicamentos genéricos. Un medicamento genérico está aprobado por la FDA y tiene el mismo ingrediente activo que el medicamento de marca. En general, los medicamentos genéricos cuestan menos que los medicamentos de marca. 0

12 Existe alguna restricción en mi cobertura? Algunos medicamentos cubiertos tienen requisitos adicionales o límites en la cobertura. Estos requisitos pueden incluir lo siguiente: Autorización previa: El Plan Community HealthFirst TM Medicare Advantage requiere que usted obtenga una autorización previa para ciertos medicamentos. Esto significa que deberá obtener nuestra aprobación antes de surtir sus recetas. Si usted no obtiene la aprobación, puede que nuestro plan no cubra el medicamento. Límites de cantidades: para ciertos medicamentos, nuestro plan limita la cantidad de medicamento que cubriremos. Por ejemplo, nuestro plan ofrece citalopram de 0 mg (límites de cantidad diferentes para diferentes dosis) por receta de 0 tabletas. Esto puede ser adicional a un surtido de un mes o de meses. Tratamiento escalonado: en algunos casos, nuestro plan requiere que primero pruebe ciertos medicamentos para tratar su afección médica antes de que cubramos otro medicamento para su afección. Por ejemplo, si el medicamento A y el medicamento B tratan la misma afección médica, es posible que no cubramos el medicamento B a menos que pruebe el medicamento A primero. Si el medicamento A no funciona para usted, entonces cubriremos el medicamento B. Puede averiguar si su medicamento tiene límites o requisitos adicionales al consultar el formulario que comienza en la página. También puede obtener más información sobre las restricciones que se aplican a medicamentos cubiertos específicos si visita nuestro sitio web. Hemos publicado documentos en línea que explican nuestras restricciones de autorización previa y tratamiento escalonado. También puede solicitar que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, aparece en la portada y la contraportada. Puede solicitar que hagamos una excepción a estos límites o restricciones, o que le demos una lista de medicamentos similares que puedan utilizarse para tratar su afección médica. Consulte la sección Cómo solicito una excepción al formulario del Plan Community HealthFirst TM Medicare Advantage? en la página para obtener más información sobre cómo solicitar una excepción.

13 Qué pasa si mi medicamento no está en el formulario? Si su medicamento no está incluido en este formulario (lista de medicamentos cubiertos), primero debe comunicarse con Servicio al cliente y preguntar si su medicamento está cubierto. Si se le comunica que el Plan Community HealthFirst TM Medicare Advantage no cubre su medicamento, tiene dos opciones: Puede solicitar a Servicio al cliente una lista de medicamentos similares cubiertos por el Plan Community HealthFirst TM Medicare Advantage. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que cubra nuestro plan. Puede solicitar que hagamos una excepción y cubramos su medicamento. Consulte la siguiente información sobre cómo solicitar una excepción. Cómo solicito una excepción al formulario del Plan Community HealthFirst TM Medicare Advantage? Puede solicitar que hagamos una excepción a nuestras normas de cobertura. Hay varios tipos de excepciones que puede solicitarnos. Puede pedirnos que cubramos un medicamento incluso si no se encuentra en nuestro formulario. Si se aprueba, este medicamento se cubrirá a un nivel de costo compartido predeterminado, y usted no podrá solicitarnos que proporcionemos el medicamento a un nivel de costo compartido menor. Nos puede pedir que no apliquemos los límites o restricciones de cobertura impuestos de su medicamento. Por ejemplo, para ciertos medicamentos, nuestro plan limita la cantidad de medicamento que cubriremos. Si su medicamento tiene un límite de cantidad, nos puede solicitar que renunciemos al límite y que cubramos una cantidad mayor. En general, solo aprobaremos su solicitud de excepción si los medicamentos alternativos incluidos en el formulario del plan, o las restricciones de uso adicionales, no son tan efectivos para el tratamiento de su afección o si estos pueden causarle efectos médicos adversos. Debe comunicarse con nosotros para solicitarnos una decisión de cobertura inicial sobre una excepción a nuestro formulario o a las restricciones de uso. Cuando solicita una excepción a nuestro formulario o a las restricciones de uso, debe presentar una declaración de su médico o una persona autorizada a emitir recetas que respalde su solicitud. En general, debemos tomar nuestra decisión dentro de las 7 horas de haber recibido la declaración de respaldo de la persona autorizada a emitir recetas. Puede solicitar una apelación acelerada (rápida) si usted o su médico creen que su salud podría verse gravemente perjudicada si espera hasta 7 horas para que se tome una decisión. Si se le otorga la apelación acelerada, debemos comunicarle una decisión antes de las 4 horas después de haber recibido la declaración de respaldo de su médico u otra persona autorizada a emitir recetas.

14 Qué debo hacer antes de que pueda hablar con mi médico sobre cambiar mis medicamentos o solicitar una excepción? Como miembro nuevo o existente de nuestro plan, es posible que tome medicamentos que no están en nuestro formulario. O tal vez está tomando un medicamento que se encuentra en nuestro formulario, pero tiene acceso limitado para obtenerlo. Por ejemplo, tal vez necesite nuestra autorización previa antes de surtir su receta. Debe consultar con su médico para decidir si debe cambiar a un medicamento apropiado que cubramos o solicitar una excepción a nuestro formulario para que cubramos el medicamento que toma. Mientras consulta con su médico para determinar la acción correcta para usted, es posible que en ciertos casos cubramos su medicamento durante los primeros 90 días de su membresía en nuestro plan. Para cada uno de los medicamentos que no estén en nuestro formulario, o si su acceso a estos medicamentos es limitado, cubriremos un suministro temporal de 4 días (a menos que tenga una receta escrita para menos días) en una farmacia de nuestra red. Luego de su primer suministro de 4 días, no pagaremos por estos medicamentos, incluso si usted ha sido miembro del plan durante menos de 90 días. Si usted es residente de un centro de atención a largo plazo, le permitiremos que resurta su receta hasta que le hayamos proporcionado un suministro temporal de 9 días, de acuerdo con un aumento del suministro (a menos que tenga una receta escrita para menos días). Cubriremos más de un resurtido de estos medicamentos durante los primeros 90 días de su membresía en nuestro plan. Si necesita un medicamento que no está en nuestro formulario, o si su acceso a estos medicamentos es limitado, pero ya ha superado los primeros 90 días como miembro de nuestro plan, cubriremos un suministro de emergencia de 4 días de ese medicamento (a menos que tenga una receta para menos días) mientras usted intenta obtener una excepción al formulario. El Plan Community HealthFirst TM Medicare Advantage extenderá una anulación para los afiliados actuales que experimenten cambios en el nivel de atención, como un cambio en las características del tratamiento. Esta concesión se realizará durante un período de 0 días posteriores al cambio en el nivel de atención. Para más información Para obtener información más detallada sobre la cobertura de medicamentos con receta del Plan Community HealthFirst TM Medicare Advantage, revise su Evidencia de cobertura y otros materiales del plan. Si tiene alguna pregunta sobre el Plan Community HealthFirst TM Medicare Advantage, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, aparece en la portada y la contraportada. Si tiene preguntas generales sobre la cobertura de medicamentos de Medicare, llame a Medicare al -800-MEDICARE ( ), las 4 horas, los 7 días de la semana. Los usuarios de TTY deben llamar al O visite medicare.gov.

15 Formulario del Plan Community HealthFirst TM Medicare Advantage El formulario que comienza en la próxima página ofrece información de cobertura sobre los medicamentos cubiertos en nuestro plan. Si tiene problemas para encontrar su medicamento en la lista, diríjase al índice que comienza en la página 8. La primera columna de la tabla menciona el nombre del medicamento. Los medicamentos de marca están escritos en mayúscula (por ejemplo, ADAGEN) y los medicamentos genéricos están escritos en minúscula cursiva (por ejemplo, warfarina). La información en la columna de Requisitos/límites indica si su plan tiene algún requisito especial para la cobertura de su medicamento. A continuación, presentamos una lista de abreviaturas que pueden aparecer en la columna de Requisitos/límites que indica si existe algún requisito especial para la cobertura de su medicamento. Lista de abreviaturas B/D PA: este medicamento con receta puede estar cubierto por la Parte B o D de Medicare según las circunstancias. Es posible que se deba presentar información que describa el uso y la administración de un medicamento para tomar una determinación. LA (Limited Availability): disponibilidad limitada. Es posible que este medicamento solo esté disponible en determinadas farmacias. Para obtener más información, comuníquese con Servicio al cliente. MO (Mail-Order): medicamento de venta por correo. Este medicamento con receta está disponible a través de nuestro servicio de pedido por correo, así como a través de nuestras farmacias minoristas de la red. Considere utilizar el servicio de pedido por correo para sus medicamentos a largo plazo (medicamentos de mantenimiento), como los medicamentos para la presión arterial alta. Las farmacias minoristas de la red pueden ser más adecuadas para medicamentos a corto plazo (como los antibióticos). PA (Prior Authorization): autorización previa. El Plan requiere que usted o su médico obtengan autorización previa para ciertos medicamentos. Esto significa que usted deberá obtener aprobación antes de surtir sus recetas. Si usted no obtiene la aprobación, puede que no cubramos el medicamento. QL (Quantity Limit): límite de cantidades. Para ciertos medicamentos, el Plan limita la cantidad del medicamento que cubriremos. ST (Step Therapy): tratamiento escalonado. En algunos casos, el Plan requiere que usted pruebe ciertos medicamentos para tratar su afección médica antes de que cubramos otro medicamento para su afección. Por ejemplo, si el medicamento A y el medicamento B tratan la misma afección médica, es posible que no cubramos el medicamento B a menos que pruebe el medicamento A primero. Si el medicamento A no funciona para usted, entonces cubriremos el medicamento B. 4

16 COMMUNITY HEALTH PLAN OF WASHINGTON 08 PRESCRIPTION DRUG FORMULARY (TIER ) Drug Name ANALGESICS ANALGESICS Formulary Detail CURRENT AS OF 4/0/08 acetaminophen-codeine oral solution 0- mg/ ml acetaminophen-codeine oral tablet 00- mg, 00-0 mg acetaminophen-codeine oral tablet mg ENDOCET ORAL TABLET 0- MG, - MG, 7.- MG hydrocodoneacetaminophen oral solution 7.- mg/ ml hydrocodoneacetaminophen oral tablet 0-00 mg, -00 mg, mg hydrocodoneacetaminophen oral tablet 0- mg,.- mg, - mg, 7.- mg hydrocodone-ibuprofen oral tablet 0-00 mg, -00 mg, mg LORCET (HYDROCODONE) LORCET HD QL (400 ML QL (60 EA QL (80 EA QL (60 EA QL (0 ML QL (90 EA QL (60 EA QL (0 EA per QL (60 EA QL (60 EA Drug Name LORCET PLUS ORAL TABLET 7.- MG oxycodoneacetaminophen oral tablet 0- mg,.- mg, - mg, 7.- mg oxycodone-aspirin tramadolacetaminophen VICODIN VICODIN ES VICODIN HP NONSTEROIDAL ANTI- INFLAMMATORY DRUGS celecoxib ST diclofenac potassium ST diclofenac sodium oral ST diclofenac sodium topical drops diclofenac sodium topical gel % diclofenac-misoprostol ST diflunisal etodolac ST fenoprofen oral tablet ST flurbiprofen ST ibuprofen oral suspension ibuprofen oral tablet 400 mg, 600 mg, 800 mg ibuprofen-oxycodone ST ST QL (60 EA QL (60 EA QL (60 EA QL (40 EA QL (90 EA QL (90 EA QL (90 EA ST; QL (00 ML per 8 PA; QL (00 GM per 8 QL (8 EA per

17 Drug Name ketoprofen oral capsule ST ketoprofen oral capsule,ext rel. pellets 4 hr 00 mg ST meclofenamate ST mefenamic acid ST meloxicam oral tablet mg meloxicam oral tablet 7. mg ST nabumetone ST naproxen oral suspension ST naproxen oral tablet ST naproxen oral tablet,delayed release (dr/ec) naproxen sodium oral tablet 7 mg, 0 mg naproxen sodium oral tablet, er multiphase 4 hr ST ST ST oxaprozin ST piroxicam ST PROFENO ST sulindac ST tolmetin oral capsule ST tolmetin oral tablet 600 mg VOLTAREN TOPICAL OPIOID ANALGESICS, LONG-ACTING buprenorphine hcl injection buprenorphine hcl sublingual tablet mg ST ST; QL (0 EA ST; QL (000 GM per 8 QL (66 ML QL (00 EA Drug Name buprenorphine hcl sublingual tablet 8 mg DURAMORPH (PF) INJECTION SOLUTION 0. MG/ML DURAMORPH (PF) INJECTION SOLUTION MG/ML fentanyl citrate fentanyl transdermal patch 7 hour 00 mcg/hr, mcg/hr, mcg/hr, 0 mcg/hr, 7 mcg/hr hydromorphone (pf) hydromorphone injection syringe mg/ml hydromorphone oral tablet extended release 4 hr mg, 8 mg hydromorphone oral tablet extended release 4 hr 6 mg, mg levorphanol tartrate methadone injection solution methadone oral solution 0 mg/ ml methadone oral solution mg/ ml methadone oral tablet 0 mg QL ( EA per QL (4000 ML QL (000 ML PA; QL (0 EA per 0 PA; QL (0 EA QL (40 ML QL (00 ML PA; QL (60 EA PA; QL (60 EA QL (0 EA QL (0 ML PA; QL (600 ML per 0 PA; QL (00 ML per 0 PA; QL (0 EA per 0 6

18 Drug Name methadone oral tablet mg morphine concentrate oral solution morphine injection syringe mg/ml morphine oral capsule, er multiphase 4 hr morphine oral capsule,extend.release pellets morphine oral solution morphine oral tablet morphine oral tablet extended release 00 mg morphine oral tablet extended release mg, 00 mg, 0 mg, 60 mg oxymorphone oral tablet extended release hr tramadol oral tablet extended release 4 hr 00 mg, 00 mg tramadol oral tablet, er multiphase 4 hr OPIOID ANALGESICS, SHORT-ACTING butorphanol tartrate injection solution mg/ml butorphanol tartrate injection solution mg/ml butorphanol tartrate nasal codeine sulfate oral tablet PA; QL (40 EA per 0 QL (900 ML QL (400 ML PA; QL (60 EA PA; QL (90 EA QL (900 ML QL (80 EA PA; QL (60 EA PA; QL (0 EA per 0 PA; QL (90 EA PA; QL (0 EA PA; QL (0 EA QL (87 ML QL (48 ML QL (0 ML per 8 QL (80 EA Drug Name fentanyl citrate fentanyl transdermal patch 7 hour 00 mcg/hr, mcg/hr, mcg/hr, 0 mcg/hr, 7 mcg/hr hydrocodoneacetaminophen oral tablet.- mg hydromorphone (pf) hydromorphone oral liquid hydromorphone oral tablet morphine concentrate oral solution morphine intravenous syringe mg/ml morphine intravenous syringe 4 mg/ml morphine oral solution morphine oral tablet nalbuphine injection solution 0 mg/ml nalbuphine injection solution 0 mg/ml oxycodone oral capsule oxycodone oral concentrate oxycodone oral solution oxycodone oral tablet 0 mg, mg, 0 mg, 0 mg oxycodone oral tablet mg PA; QL (0 EA per 0 PA; QL (0 EA QL (60 EA QL (40 ML QL (400 ML QL (80 EA QL (900 ML QL (000 ML QL (00 ML QL (900 ML QL (80 EA QL (00 ML QL (00 ML QL (60 EA QL (80 ML QL (00 ML QL (80 EA QL (60 EA 7

19 Drug Name oxymorphone oral tablet 0 mg oxymorphone oral tablet mg tramadol oral tablet ANESTHETICS LOCAL ANESTHETICS lidocaine (pf) injection solution 0 mg/ml ( %), mg/ml (0. %) lidocaine hcl injection solution 0 mg/ml ( %) lidocaine hcl mucous membrane jelly lidocaine hcl mucous membrane solution 4 % (40 mg/ml) lidocaine topical adhesive patch,medicated lidocaine topical ointment LIDOCAINE VISCOUS lidocaine-prilocaine topical cream ANTI - ADDICTION/ SUBSTANCE ABUSE TREATMENT AGENTS ALCOHOL DETERRENTS/AN TI-CRAVING acamprosate 4 PA 4 QL (60 EA QL (80 EA QL (40 EA QL (60 ML per QL (6 GM per QL (0 GM per Drug Name OPIOID DEPENDENCE TREATMENTS buprenorphine hcl injection buprenorphine hcl sublingual tablet mg buprenorphine hcl sublingual tablet 8 mg buprenorphinenaloxone sublingual tablet -0. mg buprenorphinenaloxone sublingual tablet 8- mg naltrexone SUBOXONE SUBLINGUAL FILM - MG SUBOXONE SUBLINGUAL FILM -0. MG SUBOXONE SUBLINGUAL FILM 4- MG, 8- MG OPIOID REVERSAL AGENTS naloxone NARCAN NASAL SPRAY,NON- AEROSOL 4 MG/ACTUATION SMOKING CESSATION AGENTS bupropion hcl (smoking deter) CHANTIX QL (66 ML QL (00 EA QL ( EA per QL (60 EA QL (90 EA per QL (60 EA per QL (60 EA QL (90 EA per QL ( EA per 8 8

20 disulfiram naltrexone CONTINUING MONTH BOX 9

21 Drug Name CHANTIX STARTING MONTH BOX NICOTROL 4 NICOTROL NS 4 ANTIBACTERIA LS AMINOGLYCOSID ES amikacin injection solution 00 mg/ ml BETHKIS GENTAK OPHTHALMIC (EYE) OINTMENT gentamicin in nacl (isoosm) intravenous piggyback 00 mg/00 ml, 60 mg/0 ml, 80 mg/00 ml, 80 mg/0 ml gentamicin injection solution 40 mg/ml gentamicin ophthalmic (eye) drops gentamicin topical neomycin neomycin-polymyxin b gu paromomycin 4 streptomycin tobramycin tobramycin in 0. % nacl tobramycin sulfate injection solution ZANOSAR 4 BvD BvD; QL (4 ML per 8 BvD; QL (80 ML per 8 Drug Name ANTIBACTERIALS colistin (colistimethate na) SYNERCID ANTIBACTERIALS, OTHER acetic acid otic (ear) ALCOHOL PADS BACIIM bacitracin intramuscular bacitracin ophthalmic (eye) chloramphenicol sod succinate CLINDACIN P clindamycin hcl clindamycin in % dextrose clindamycin palmitate hcl clindamycin phosphate injection clindamycin phosphate intravenous solution 600 mg/4 ml clindamycin phosphate topical clindamycin phosphate vaginal daptomycin lincomycin linezolid methenamine hippurate metronidazole in nacl (iso-os) metronidazole oral 0

22 metronidazole topical cream

23 Drug Name metronidazole topical gel metronidazole topical lotion metronidazole vaginal mupirocin mupirocin calcium nitrofurantoin nitrofurantoin macrocrystal nitrofurantoin monohyd/m-cryst polymyxin b sulfate SIVEXTRO INTRAVENOUS SULFAMYLON tinidazole trimethoprim TYGACIL vancomycin intravenous recon soln,000 mg, 0 gram, 00 mg vancomycin oral capsule VANDAZOLE XIFAXAN ORAL TABLET 00 MG XIFAXAN ORAL TABLET 0 MG BETA-LACTAM, CEPHALOSPORIN S cefaclor oral capsule cefaclor oral suspension for reconstitution QL (9 EA per QL (60 EA per Drug Name cefadroxil oral suspension for reconstitution 0 mg/ ml, 00 mg/ ml cefadroxil oral tablet cefazolin injection recon soln gram, 0 gram, 00 mg cefdinir cefepime cefixime cefotaxime injection recon soln gram, gram, 00 mg cefotetan injection cefoxitin cefpodoxime cefprozil ceftazidime ceftriaxone injection recon soln gram, 0 gram, gram, 0 mg, 00 mg cefuroxime axetil oral tablet cefuroxime sodium injection recon soln 70 mg cefuroxime sodium intravenous cephalexin SUPRAX ORAL CAPSULE SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 00 MG/ ML 4 4

24 mg/ ml, 0 mg/ ml, 7 mg/ ml cefaclor oral tablet extended release hr cefadroxil oral capsule SUPRAX ORAL TABLET,CHEWABLE TEFLARO 4

25 Drug Name BETA-LACTAM, OTHER aztreonam injection recon soln gram CAYSTON imipenem-cilastatin INVANZ INJECTION 4 meropenem BETA-LACTAM, PENICILLINS amoxicillin oral capsule amoxicillin oral suspension for reconstitution amoxicillin oral tablet amoxicillin oral tablet,chewable mg, 0 mg amoxicillin-pot clavulanate ampicillin oral capsule 00 mg ampicillin sodium injection recon soln gram, 0 gram, mg ampicillin-sulbactam injection AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION -. MG/ ML BICILLIN C-R BICILLIN L-A dicloxacillin nafcillin injection recon soln gram LA; QL (84 ML per 8 Drug Name oxacillin in dextrose(iso-osm) intravenous piggyback gram/0 ml oxacillin in dextrose(iso-osm) intravenous piggyback gram/0 ml oxacillin injection recon soln 0 gram oxacillin injection recon soln gram penicillin g potassium injection recon soln 0 million unit penicillin g procaine intramuscular syringe. million unit/ ml penicillin g sodium penicillin v potassium piperacillin-tazobactam intravenous recon soln. gram,.7 gram, 4. gram, 40. gram MACROLIDES azithromycin clarithromycin E.E.S. 400 ORAL TABLET ERY PADS ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 0 MG, MG ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 00 MG ERYTHROCIN (AS 4

26 nafcillin injection recon soln 0 gram STEARATE) ORAL TABLET 0 MG

27 Drug Name ERYTHROCIN INTRAVENOUS RECON SOLN 00 MG erythromycin ethylsuccinate oral suspension for reconstitution erythromycin ethylsuccinate oral tablet erythromycin ophthalmic (eye) erythromycin oral capsule,delayed release(dr/ec) erythromycin oral tablet erythromycin with ethanol topical gel erythromycin with ethanol topical solution QUINOLONES BAXDELA INTRAVENOUS ciprofloxacin ciprofloxacin (mixture) ciprofloxacin hcl ophthalmic (eye) ciprofloxacin hcl oral ciprofloxacin in % dextrose intravenous piggyback 00 mg/00 ml ciprofloxacin lactate intravenous solution 400 mg/40 ml gatifloxacin levofloxacin levofloxacin in dw Drug Name moxifloxacin ofloxacin ophthalmic (eye) ofloxacin oral tablet 400 mg ofloxacin otic (ear) SULFONAMIDES silver sulfadiazine SSD sulfacetamide sodium (acne) sulfacetamide sodium ophthalmic (eye) sulfadiazine 4 sulfamethoxazoletrimethoprim TETRACYCLINES demeclocycline 4 DOXY-00 doxycycline hyclate oral capsule doxycycline hyclate oral tablet 00 mg, 0 mg, 0 mg, 7 mg doxycycline hyclate oral tablet,delayed release (dr/ec) doxycycline monohydrate oral capsule doxycycline monohydrate oral suspension for reconstitution doxycycline monohydrate oral tablet minocycline oral capsule 6 4

28 intravenous piggyback 00 mg/00 ml, 70 mg/0 ml minocycline oral tablet 7

29 Drug Name minocycline oral tablet extended release 4 hr mg, 6 mg minocycline oral tablet extended release 4 hr mg, 4 mg, 90 mg MORGIDOX ORAL CAPSULE 0 MG tetracycline ANTICONVULS ANTS ANTICONVULSAN TS, OTHER BRIVIACT INTRAVENOUS BRIVIACT ORAL DIASTAT 4 DIASTAT ACUDIAL 4 DIAZEPAM INTENSOL diazepam oral solution mg/ ml ( mg/ml) 4 4 PAns PAns diazepam oral tablet PAns diazepam rectal kit. mg, mg levetiracetam in nacl (iso-os) levetiracetam intravenous levetiracetam oral solution 00 mg/ml levetiracetam oral tablet levetiracetam oral tablet extended release 4 hr ROWEEPRA SPRITAM 4 Drug Name CALCIUM CHANNEL MODIFYING AGENTS CELONTIN ORAL CAPSULE 00 MG ethosuximide LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE 0 MG LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE MG LYRICA ORAL CAPSULE MG LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE 0 MG LYRICA ORAL CAPSULE 7 MG LYRICA ORAL SOLUTION zonisamide PAns GAMMA- AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS PAns; QL (80 EA per 0 PAns; QL (0 EA per 0 PAns; QL (90 EA per 0 PAns; QL (8 EA per 0 PAns; QL (70 EA per 0 PAns; QL (60 EA per 0 PAns; QL (60 EA per 0 PAns; QL (40 EA per 0 PAns; QL (900 ML per 0 8

30 clonazepam PAns clorazepate dipotassium PAns 9

31 Drug Name DIASTAT 4 DIASTAT ACUDIAL 4 DIAZEPAM INTENSOL diazepam oral solution mg/ ml ( mg/ml) PAns PAns diazepam oral tablet PAns diazepam rectal kit. mg, mg divalproex oral capsule, delayed rel sprinkle divalproex oral tablet extended release 4 hr divalproex oral tablet,delayed release (dr/ec) gabapentin oral capsule 00 mg gabapentin oral capsule 00 mg gabapentin oral capsule 400 mg gabapentin oral solution 0 mg/ ml gabapentin oral tablet 600 mg gabapentin oral tablet 800 mg GABITRIL ORAL TABLET MG, 6 MG lamotrigine oral tablet,disintegrating lorazepam oral PA ONFI ORAL SUSPENSION ONFI ORAL TABLET 0 MG, 0 MG 4 PAns PAns phenobarbital PAns QL (080 EA QL (60 EA QL (70 EA QL (60 ML QL (80 EA QL ( EA Drug Name SABRIL LA tiagabine oral tablet mg, 4 mg valproate sodium valproic acid valproic acid (as sodium salt) oral solution 0 mg/ ml vigabatrin GLUTAMATE REDUCING AGENTS felbamate oral suspension felbamate oral tablet FYCOMPA ORAL SUSPENSION FYCOMPA ORAL TABLET lamotrigine oral tablet lamotrigine oral tablet extended release 4hr lamotrigine oral tablet, chewable dispersible topiramate oral capsule, sprinkle 4 PAns topiramate oral tablet PAns SODIUM CHANNEL AGENTS APTIOM ORAL TABLET 00 MG, 400 MG, 800 MG APTIOM ORAL TABLET 600 MG BANZEL ORAL SUSPENSION BANZEL ORAL 4 0

32 primidone TABLET 00 MG

33 Drug Name BANZEL ORAL TABLET 400 MG carbamazepine oral suspension 00 mg/ ml carbamazepine oral tablet carbamazepine oral tablet extended release hr carbamazepine oral tablet,chewable DILANTIN EPITOL fosphenytoin injection solution 00 mg pe/ ml oxcarbazepine PEGANONE phenytoin oral suspension mg/ ml phenytoin oral tablet,chewable phenytoin sodium extended phenytoin sodium intravenous solution VIMPAT INTRAVENOUS VIMPAT ORAL SOLUTION VIMPAT ORAL TABLET ANTIDEMENTI A AGENTS ANTIDEMENTIA AGENTS, OTHER ergoloid 4 Drug Name donepezil oral tablet mg donepezil oral tablet,disintegrating galantamine rivastigmine rivastigmine tartrate N-METHYL-D- ASPARTATE (NMDA) RECEPTOR ANTAGONIST memantine oral capsule,sprinkle,er 4hr 4 PA memantine oral solution PA memantine oral tablet PA NAMENDA XR PA NAMZARIC PA ANTIDEPRESSA NTS ANTIDEPRESSANT S fluoxetine oral tablet 60 mg olanzapine-fluoxetine ANTIDEPRESSANT S, OTHER ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTEN DED REL RECON 00 MG ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTEN DED REL SYRING CHOLINESTERAS aripiprazole oral solution

34 E INHIBITORS donepezil oral tablet 0 mg, mg aripiprazole oral tablet 0 mg QL (90 EA per

35 Drug Name aripiprazole oral tablet mg aripiprazole oral tablet mg aripiprazole oral tablet 0 mg aripiprazole oral tablet 0 mg aripiprazole oral tablet mg aripiprazole oral tablet,disintegrating 0 mg aripiprazole oral tablet,disintegrating mg bupropion hcl oral tablet bupropion hcl oral tablet extended release hr 00 mg bupropion hcl oral tablet extended release hr 0 mg bupropion hcl oral tablet extended release hr 00 mg bupropion hcl oral tablet extended release 4 hr 0 mg bupropion hcl oral tablet extended release 4 hr 00 mg maprotiline mirtazapine oral tablet mirtazapine oral tablet,disintegrating nefazodone quetiapine oral tablet 00 mg QL (60 EA per QL (40 EA QL (60 EA per QL (0 EA per QL (80 EA QL (90 EA per QL (60 EA per QL (0 EA QL (90 EA per QL (60 EA per QL (90 EA per QL (60 EA per QL (40 EA Drug Name quetiapine oral tablet mg quetiapine oral tablet 00 mg quetiapine oral tablet 400 mg quetiapine oral tablet 0 mg quetiapine oral tablet extended release 4 hr 0 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 400 mg quetiapine oral tablet extended release 4 hr 0 mg trazodone MONOAMINE OXIDASE INHIBITORS EMSAM MARPLAN phenelzine tranylcypromine 4 SSRIS/ SNRIS citalopram oral solution citalopram oral tablet 0 mg citalopram oral tablet 0 mg citalopram oral tablet 40 mg QL (90 EA QL (8 EA per QL (60 EA per QL (480 EA QL (60 EA QL (0 EA QL (8 EA per QL (60 EA per QL (480 EA QL (0 EA QL (60 EA per QL (0 EA per 4

36 quetiapine oral tablet 00 mg QL (0 EA

37 Drug Name desvenlafaxine succinate oral tablet extended release 4 hr 00 mg desvenlafaxine succinate oral tablet extended release 4 hr mg desvenlafaxine succinate oral tablet extended release 4 hr 0 mg duloxetine oral capsule,delayed release(dr/ec) 0 mg duloxetine oral capsule,delayed release(dr/ec) 0 mg duloxetine oral capsule,delayed release(dr/ec) 40 mg duloxetine oral capsule,delayed release(dr/ec) 60 mg escitalopram oxalate oral solution escitalopram oxalate oral tablet 0 mg escitalopram oxalate oral tablet 0 mg escitalopram oxalate oral tablet mg FETZIMA ORAL CAPSULE,EXT REL 4HR DOSE PACK FETZIMA ORAL CAPSULE,EXTENDE D RELEASE 4 HR 0 MG 4 4 QL (0 EA QL (480 EA QL (40 EA QL (80 EA QL (0 EA QL (90 EA per QL (60 EA per QL (60 EA per QL (0 EA per QL (0 EA QL (8 EA per 8 QL (0 EA per Drug Name FETZIMA ORAL CAPSULE,EXTENDE D RELEASE 4 HR 40 MG FETZIMA ORAL CAPSULE,EXTENDE D RELEASE 4 HR 80 MG fluoxetine oral capsule 0 mg fluoxetine oral capsule 0 mg fluoxetine oral capsule 40 mg fluoxetine oral capsule,delayed release(dr/ec) fluoxetine oral solution fluoxetine oral tablet 0 mg fluoxetine oral tablet 0 mg fluvoxamine oral capsule,extended release 4hr 00 mg fluvoxamine oral capsule,extended release 4hr 0 mg fluvoxamine oral tablet 00 mg fluvoxamine oral tablet mg fluvoxamine oral tablet 0 mg KHEDEZLA ORAL TABLET EXTENDED RELEASE 4HR 00 MG QL (90 EA per QL (4 EA per QL (40 EA QL (60 EA per QL (4 EA per 8 QL (40 EA QL (90 EA per QL (60 EA per QL (90 EA per QL (60 EA QL (80 EA QL (0 EA 6

38 FETZIMA ORAL CAPSULE,EXTENDE D RELEASE 4 HR 0 MG 4 QL (80 EA TABLET EXTENDED RELEASE 4HR 0 MG 4 QL (40 EA 7

39 Drug Name paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 40 mg paroxetine hcl oral tablet extended release 4 hr. mg paroxetine hcl oral tablet extended release 4 hr mg paroxetine hcl oral tablet extended release 4 hr 7. mg paroxetine mesylate(menop.sym) PAXIL ORAL SUSPENSION sertraline oral concentrate sertraline oral tablet 00 mg sertraline oral tablet mg sertraline oral tablet 0 mg TRINTELLIX ORAL TABLET 0 MG TRINTELLIX ORAL TABLET 0 MG TRINTELLIX ORAL TABLET MG venlafaxine oral capsule,extended release 4hr 0 mg 4 QL (80 EA QL (90 EA per QL (60 EA per QL (4 EA per QL (80 EA QL (90 EA per QL (60 EA per QL (0 EA per QL (60 EA per QL (40 EA QL (0 EA QL (60 EA per QL (0 EA per QL (0 EA QL (60 EA per Drug Name venlafaxine oral capsule,extended release 4hr 7 mg venlafaxine oral tablet 00 mg, 7 mg venlafaxine oral tablet mg venlafaxine oral tablet 7. mg venlafaxine oral tablet 0 mg VIIBRYD ORAL TABLET 0 MG VIIBRYD ORAL TABLET 0 MG VIIBRYD ORAL TABLET 40 MG VIIBRYD ORAL TABLETS,DOSE PACK 0 MG (7)- 0 MG () TRICYCLICS amitriptyline PAns amoxapine clomipramine 4 PAns desipramine doxepin oral 4 PAns imipramine hcl 4 PAns imipramine pamoate 4 PAns nortriptyline protriptyline PRUDOXIN trimipramine 4 PAns ANTIEMETICS ANTIEMETICS, OTHER QL (90 EA per QL (90 EA per QL (70 EA QL (80 EA QL (0 EA QL (0 EA QL (60 EA per QL (0 EA per QL (0 EA per 80 venlafaxine oral QL (80 EA capsule,extended chlorpromazine 8

40 release 4hr 7. mg COMPRO 9

41 Drug Name diphenhydramine hcl injection solution 0 mg/ml hydroxyzine hcl oral tablet meclizine oral tablet. mg, mg metoclopramide hcl injection solution metoclopramide hcl oral solution metoclopramide hcl oral tablet metoclopramide hcl oral tablet,disintegrating perphenazine prochlorperazine prochlorperazine edisylate injection solution 0 mg/ ml ( mg/ml) prochlorperazine maleate promethazine injection solution PA promethazine oral 4 PA scopolamine base TRANSDERM-SCOP 4 EMETOGENIC THERAPY ADJUNCTS ALOXI aprepitant BvD CELLCEPT INTRAVENOUS dronabinol oral capsule 0 mg 4 BvD BvD Drug Name EMEND ORAL SUSPENSION FOR RECONSTITUTION granisetron (pf) intravenous solution 00 mcg/ml granisetron hcl intravenous BvD granisetron hcl oral BvD ondansetron BvD ondansetron hcl (pf) ondansetron hcl oral BvD VARUBI ORAL BvD ANTIFUNGALS ANTIFUNGALS ABELCET BvD AMBISOME BvD amphotericin b 4 BvD CANCIDAS BvD caspofungin intravenous recon soln 0 mg ciclopirox clotrimazole mucous membrane clotrimazole topical CRESEMBA econazole fluconazole fluconazole in nacl (isoosm) intravenous piggyback 00 mg/00 ml, 400 mg/00 ml flucytosine griseofulvin microsize griseofulvin ultramicrosize BvD dronabinol oral capsule 4 BvD. mg, mg itraconazole 40

42 ketoconazole 4

43 Drug Name MICONAZOLE- VAGINAL SUPPOSITORY MYCAMINE naftifine NATACYN NOXAFIL ORAL NYAMYC nystatin oral suspension nystatin oral tablet nystatin topical NYSTOP SPORANOX ORAL SOLUTION terbinafine hcl oral terconazole voriconazole intravenous voriconazole oral ZOLINZA ANTIGOUT AGENTS ANTIGOUT AGENTS allopurinol ST allopurinol sodium ALOPRIM COLCRYS 4 ST MITIGARE ST probenecid probenecid-colchicine ULORIC ST Drug Name ANTI - INFLAMMATOR Y AGENTS GLUCOCORTICOI DS betamethasone dipropionate betamethasone valerate betamethasone, augmented BLEPHAMIDE 4 BLEPHAMIDE S.O.P. 4 cortisone DEXAMETHASONE INTENSOL dexamethasone oral elixir dexamethasone oral tablet dexamethasone sodium phosphate injection solution hydrocortisone oral tablet 0 mg, mg methylprednisolone acetate methylprednisolone oral tablet methylprednisolone sodium succ injection recon soln mg, 40 mg methylprednisolone sodium succ intravenous MILLIPRED ORAL TABLET prednisolone acetate BvD 4 BvD 4

44 prednisolone oral solution mg/ ml 4

45 Drug Name prednisolone sodium phosphate ophthalmic (eye) prednisolone sodium phosphate oral solution mg/ ml ( mg/ml), mg base/ ml (6.7 mg/ ml) PREDNISONE INTENSOL prednisone oral solution BvD prednisone oral tablet BvD prednisone oral tablets,dose pack sulfacetamideprednisolone triamcinolone acetonide topical aerosol VERIPRED 0 NONSTEROIDAL ANTI- INFLAMMATORY DRUGS celecoxib ST diclofenac potassium ST diclofenac sodium oral ST diflunisal etodolac oral capsule 00 mg ST etodolac oral tablet ST etodolac oral tablet extended release 4 hr ST fenoprofen oral tablet ST flurbiprofen ST ibuprofen oral suspension ibuprofen oral tablet 400 mg, 600 mg, 800 mg ibuprofen-oxycodone ST ST QL (8 EA per Drug Name ketoprofen oral capsule ST ketoprofen oral capsule,ext rel. pellets 4 hr 00 mg ST meclofenamate ST mefenamic acid ST meloxicam oral tablet mg meloxicam oral tablet 7. mg ST nabumetone ST naproxen oral suspension ST naproxen oral tablet ST naproxen oral tablet,delayed release (dr/ec) naproxen sodium oral tablet 7 mg, 0 mg naproxen sodium oral tablet, er multiphase 4 hr ST ST ST oxaprozin ST piroxicam ST PROFENO ST sulindac ST tolmetin oral capsule ST tolmetin oral tablet 600 mg ANTIMIGRAINE AGENTS ANTIMIGRAINE AGENTS sumatriptan-naproxen ERGOT ALKALOIDS dihydroergotamine injection ST ST; QL (0 EA 44

46 Drug Name dihydroergotamine nasal ergotamine-caffeine MIGERGOT PROPHYLACTIC BOTOX PA divalproex oral capsule, delayed rel sprinkle divalproex oral tablet extended release 4 hr divalproex oral tablet,delayed release (dr/ec) timolol maleate oral topiramate oral capsule, sprinkle PAns topiramate oral tablet PAns valproic acid valproic acid (as sodium salt) oral solution 0 mg/ ml SEROTONIN (- HT) B/D RECEPTOR AGONISTS almotriptan malate oral tablet. mg almotriptan malate oral tablet 6. mg eletriptan frovatriptan naratriptan rizatriptan QL (8 ML per 8 QL (4 EA per 8 QL (8 EA per 8 QL (8 EA per 8 QL (7 EA per 8 QL (8 EA per 8 QL (6 EA per 8 Drug Name sumatriptan nasal spray,non-aerosol mg/actuation sumatriptan succinate oral sumatriptan succinate subcutaneous cartridge sumatriptan succinate subcutaneous pen injector sumatriptan succinate subcutaneous solution sumatriptan-naproxen zolmitriptan ANTIMYASTHE NIC AGENTS PARASYMPATHO MIMETICS guanidine MESTINON ORAL SYRUP pyridostigmine bromide ANTIMYCOBAC TERIALS ANTIMYCOBACTE RIALS, OTHER dapsone oral PRIFTIN rifabutin ANTITUBERCULA RS CAPASTAT 4 ethambutol isoniazid QL (6 EA per 8 QL (8 EA per 8 QL (8 ML per 8 QL (8 ML per 8 QL (8 ML per 8 QL (8 EA per 8 PASER 4

47 sumatriptan nasal spray,non-aerosol 0 mg/actuation QL (8 EA per 8 pyrazinamide rifampin 46

48 Drug Name SIRTURO LA TRECATOR ANTINEOPLAST ICS ALKYLATING AGENTS busulfan BvD BUSULFEX BvD cyclophosphamide oral capsule HEXALEN LEUKERAN MATULANE BvD melphalan hcl BvD thiotepa BvD VALCHLOR ANTIANDROGENS bicalutamide ERLEADA PAns flutamide nilutamide XTANDI ZYTIGA ORAL TABLET 0 MG ZYTIGA ORAL TABLET 00 MG ANTIANGIOGENI C AGENTS POMALYST LA REVLIMID ORAL CAPSULE 0 MG, MG, MG, MG PAns; QL (0 EA per 0 PAns; QL (0 EA per 0 PA; QL (60 EA PAns; LA THALOMID PAns Drug Name ANTIESTROGENS/ MODIFIERS EMCYT FARESTON SOLTAMOX tamoxifen ANTIMETABOLIT ES DROXIA gemcitabine intravenous recon soln gram hydroxyurea BvD LONSURF PAns PURIXAN TABLOID ANTINEOPLASTIC S ADRIAMYCIN INTRAVENOUS SOLUTION 0 MG/0 ML ADRUCIL INTRAVENOUS SOLUTION 00 MG/0 ML ALIMTA INTRAVENOUS RECON SOLN 00 MG BvD BvD BvD ARRANON BvD AVASTIN BvD azacitidine BvD BELEODAQ BvD BICNU BvD bleomycin injection recon soln 0 unit BvD bortezomib BvD carboplatin intravenous solution BvD 47

49 cisplatin BvD 48

50 Drug Name cladribine BvD clofarabine BvD CLOLAR BvD COSMEGEN BvD cytarabine BvD cytarabine (pf) injection solution gram/0 ml (00 mg/ml) dacarbazine intravenous recon soln 00 mg BvD BvD dactinomycin BvD daunorubicin intravenous solution BvD decitabine BvD dexrazoxane hcl intravenous recon soln 0 mg docetaxel intravenous solution 60 mg/6 ml (0 mg/ml), 80 mg/4 ml (0 mg/ml) doxorubicin intravenous solution 0 mg/ ml doxorubicin, pegliposomal ELITEK epirubicin intravenous solution 00 mg/00 ml ERBITUX INTRAVENOUS SOLUTION 00 MG/0 ML BvD BvD BvD BvD BvD ERWINAZE BvD FASLODEX BvD FOLOTYN INTRAVENOUS SOLUTION 40 MG/ ML (0 MG/ML) BvD Drug Name HERCEPTIN BvD idarubicin BvD ifosfamide intravenous recon soln gram irinotecan intravenous solution 00 mg/ ml BvD BvD ISTODAX BvD JEVTANA BvD KADCYLA PAns levoleucovorin intravenous solution LYNPARZA PAns mesna MESNEX ORAL mitomycin intravenous recon soln 0 mg, mg mitomycin intravenous recon soln 40 mg BvD BvD MUSTARGEN 4 BvD MYLOTARG BvD NINLARO ORAL CAPSULE. MG NINLARO ORAL CAPSULE MG NINLARO ORAL CAPSULE 4 MG oxaliplatin intravenous recon soln 00 mg oxaliplatin intravenous solution 00 mg/0 ml BvD BvD paclitaxel BvD PERJETA BvD PROLEUKIN BvD RUBRACA ORAL PAns; QL (6 EA per 8 PAns; QL (4 EA per 8 PAns; QL ( EA per 8 PAns; LA; QL 49

51 GLEOSTINE HALAVEN BvD TABLET 00 MG (80 EA per 0 0

52 Drug Name RUBRACA ORAL TABLET 00 MG TREANDA INTRAVENOUS RECON SOLN TRISENOX INTRAVENOUS SOLUTION MG/ML VECTIBIX INTRAVENOUS SOLUTION 00 MG/ ML (0 MG/ML) BvD BvD BvD VELCADE BvD VENCLEXTA ORAL TABLET 0 MG, 0 MG VENCLEXTA ORAL TABLET 00 MG VENCLEXTA STARTING PACK vinblastine intravenous solution VINCASAR PFS INTRAVENOUS SOLUTION MG/ML vincristine intravenous solution mg/ml vinorelbine intravenous solution 0 mg/ ml PAns; LA; QL (0 EA per 0 PAns; LA PAns; LA BvD BvD BvD BvD VYXEOS BvD YONDELIS BvD ZEJULA ANTINEOPLASTIC S, OTHER ABRAXANE BvD PAns; LA; QL (4 EA per 80 PAns; LA; QL (90 EA per 0 Drug Name leucovorin calcium injection recon soln 00 mg, 0 mg leucovorin calcium oral mitoxantrone BvD REVLIMID ORAL CAPSULE. MG, 0 MG SYLATRON PAns; LA SYNRIBO BvD YERVOY INTRAVENOUS SOLUTION 0 MG/0 ML ( MG/ML) ZALTRAP INTRAVENOUS SOLUTION 00 MG/4 ML ( MG/ML) AROMATASE INHIBITORS, RD GENERATION anastrozole exemestane letrozole ENZYME INHIBITORS BvD BvD ALIQOPA BvD ETOPOPHOS 4 BvD etoposide intravenous BvD FARYDAK ORAL CAPSULE 0 MG FARYDAK ORAL CAPSULE MG, 0 MG IBRANCE PAns; QL ( EA per PAns; QL (6 EA per PAns; QL ( EA per 8

53 fludarabine intravenous recon soln BvD IDHIFA ORAL TABLET 00 MG PAns; QL (0 EA per 0

54 Drug Name IDHIFA ORAL TABLET 0 MG KISQALI PAns KISQALI FEMARA CO-PACK PAns TOPOSAR BvD topotecan intravenous recon soln VERZENIO ORAL TABLET 00 MG VERZENIO ORAL TABLET 0 MG VERZENIO ORAL TABLET 00 MG VERZENIO ORAL TABLET 0 MG ZOLINZA ZYDELIG MOLECULAR TARGET INHIBITORS AFINITOR ORAL TABLET 0 MG AFINITOR ORAL TABLET. MG, MG, 7. MG ALECENSA ALUNBRIG ORAL TABLET 80 MG BvD PAns PAns; QL (60 EA per 0 PAns; QL (0 EA per 0 PAns; QL (80 EA per 0 PAns; QL (60 EA per 0 PA; QL (40 EA per 0 PAns; QL (90 EA per 0 PAns; QL (60 EA per 0 PAns; QL (40 EA per 0 PAns; QL (0 EA per 0 Drug Name ALUNBRIG ORAL TABLET 0 MG ALUNBRIG ORAL TABLET 90 MG ALUNBRIG ORAL TABLETS,DOSE PACK BOSULIF ORAL TABLET 00 MG BOSULIF ORAL TABLET 400 MG, 00 MG PAns PAns; QL (80 EA per 0 PAns; QL (60 EA per 0 PAns; QL (0 EA per 0 PAns; QL (0 EA per 0 CABOMETYX PAns; LA CALQUENCE CAPRELSA ORAL TABLET 00 MG CAPRELSA ORAL TABLET 00 MG COMETRIQ PAns COTELLIC ERIVEDGE GILOTRIF ORAL TABLET 0 MG GILOTRIF ORAL TABLET 0 MG GILOTRIF ORAL TABLET 40 MG ICLUSIG ORAL TABLET MG PAns; QL (60 EA per 0 PAns; LA; QL (90 EA per 0 PAns; LA; QL (0 EA per 0 PAns; LA; QL (6 EA per 8 PAns; QL (0 EA per 0 PAns; QL (60 EA per 0 PAns; QL (40 EA per 0 PAns; QL (0 EA per 0 PAns; QL (90 EA per 0

55 Drug Name ICLUSIG ORAL TABLET 4 MG imatinib oral tablet 00 mg imatinib oral tablet 400 mg IMBRUVICA ORAL CAPSULE 40 MG INLYTA ORAL TABLET MG INLYTA ORAL TABLET MG IRESSA JAKAFI ORAL TABLET 0 MG, MG, 0 MG, MG JAKAFI ORAL TABLET MG PAns PAns PAns KYPROLIS BvD LENVIMA PAns MEKINIST ORAL TABLET 0. MG MEKINIST ORAL TABLET MG NERLYNX NEXAVAR ODOMZO OFEV PAns; QL (0 EA per 0 PAns; QL (60 EA per 0 PAns; QL (0 EA per 0 PAns; QL (0 EA per 0 PAns; QL (0 EA per 0 PAns; QL (60 EA per 0 PAns; QL (0 EA per 0 PAns; QL (0 EA per 0 PAns; LA; QL (0 EA per 0 PAns; LA; QL (0 EA per 0 PA; QL (60 EA Drug Name RYDAPT PAns SPRYCEL ORAL TABLET 00 MG, 0 MG, 0 MG, 80 MG SPRYCEL ORAL TABLET 40 MG SPRYCEL ORAL TABLET 70 MG STIVARGA SUTENT ORAL CAPSULE. MG SUTENT ORAL CAPSULE MG, 7. MG SUTENT ORAL CAPSULE 0 MG TAFINLAR ORAL CAPSULE 0 MG TAFINLAR ORAL CAPSULE 7 MG TAGRISSO ORAL TABLET 40 MG TAGRISSO ORAL TABLET 80 MG TARCEVA ORAL TABLET 00 MG, MG TARCEVA ORAL TABLET 0 MG TASIGNA ORAL CAPSULE 0 MG PAns PAns PAns PAns PAns; QL (0 EA per 0 PAns; QL (60 EA per 0 PAns; QL (84 EA per 8 PAns; QL (60 EA per 0 PAns; QL (0 EA per 0 PAns; QL (80 EA per 0 PAns; QL (0 EA per 0 PAns; LA; QL (60 EA per 0 PAns; LA; QL (0 EA per 0 PAns; QL (0 EA per 0 4

56 Drug Name TASIGNA ORAL CAPSULE 00 MG TYKERB VOTRIENT XALKORI ORAL CAPSULE 00 MG XALKORI ORAL CAPSULE 0 MG ZELBORAF ZYKADIA MONOCLONAL ANTIBODY/ANTIB ODY-DRUG CONJUGATE PAns PAns; QL ( EA per 8 PAns; LA; QL (80 EA per 0 PAns; QL (0 EA per 0 PAns; QL (60 EA per 0 PAns; QL (40 EA per 0 PAns; QL (0 EA per 0 BAVENCIO BvD; LA CYRAMZA BvD DARZALEX BvD; LA EMPLICITI BvD IMFINZI BvD; LA KEYTRUDA INTRAVENOUS SOLUTION PAns LARTRUVO BvD; LA OPDIVO INTRAVENOUS SOLUTION 00 MG/0 ML, 40 MG/4 ML PAns RITUXAN PAns SYLVANT Drug Name TECENTRIQ BvD; LA RETINOIDS AVITA TOPICAL CREAM bexarotene PANRETIN TARGRETIN TOPICAL tretinoin (chemotherapy) PA tretinoin topical cream PA tretinoin topical gel 0.0 %, 0.0 % ANTIPARASITI CS ANTHELMINTICS ALBENZA BILTRICIDE EMVERM ivermectin ANTIPROTOZOAL S ALINIA ORAL SUSPENSION FOR RECONSTITUTION ALINIA ORAL TABLET atovaquone atovaquone-proguanil chloroquine phosphate COARTEM hydroxychloroquine mefloquine NEBUPENT PENTAM PA 4 BvD; QL ( EA per 8

57 INTRAVENOUS RECON SOLN 00 MG BvD primaquine quinine sulfate 6

58 Drug Name PEDICULICIDES/S CABICIDES lindane topical shampoo malathion permethrin topical cream ANTIPARKINSO N AGENTS ANTICHOLINERGI CS benztropine injection benztropine oral PA diphenhydramine hcl injection solution 0 mg/ml ANTIPARKINSON AGENTS carbidopa carbidopa-levodopaentacapone ANTIPARKINSON AGENTS, OTHER amantadine hcl entacapone tolcapone DOPAMINE AGONISTS APOKYN LA bromocriptine 4 NEUPRO 4 pramipexole ropinirole DOPAMINE PRECURSORS/ L- AMINO ACID DECARBOXYLASE INHIBITORS 4 Drug Name MONOAMINE OXIDASE B (MAO- B) INHIBITORS rasagiline selegiline hcl ANTIPSYCHOTI CS ST GENERATION/TYP ICAL chlorpromazine fluphenazine decanoate fluphenazine hcl haloperidol haloperidol decanoate haloperidol lactate loxapine succinate perphenazine pimozide prochlorperazine edisylate injection solution 0 mg/ ml ( mg/ml) prochlorperazine maleate thioridazine 4 thiothixene trifluoperazine ND GENERATION/AT YPICAL ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTEN DED REL RECON 00 MG 7

59 carbidopa-levodopa 8

60 Drug Name ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTEN DED REL SYRING aripiprazole oral solution aripiprazole oral tablet 0 mg aripiprazole oral tablet mg aripiprazole oral tablet mg aripiprazole oral tablet 0 mg aripiprazole oral tablet 0 mg aripiprazole oral tablet mg aripiprazole oral tablet,disintegrating 0 mg aripiprazole oral tablet,disintegrating mg ARISTADA FANAPT ORAL TABLET MG FANAPT ORAL TABLET 0 MG, 8 MG FANAPT ORAL TABLET MG FANAPT ORAL TABLET MG FANAPT ORAL TABLET 4 MG FANAPT ORAL TABLET 6 MG FANAPT ORAL TABLETS,DOSE PACK QL (90 EA per QL (60 EA per QL (40 EA QL (60 EA per QL (0 EA per QL (80 EA QL (90 EA per QL (60 EA per QL (70 EA QL (90 EA per QL (60 EA per QL (60 EA QL (80 EA QL (0 EA QL (8 EA per 8 Drug Name INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 7 MG/0.7 ML, 6 MG/ML, 4 MG/. ML, 78 MG/0. ML INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 9 MG/0. ML INVEGA TRINZA LATUDA ORAL TABLET 0 MG LATUDA ORAL TABLET 0 MG LATUDA ORAL TABLET 40 MG LATUDA ORAL TABLET 60 MG, 80 MG NUPLAZID olanzapine intramuscular olanzapine oral tablet 0 mg olanzapine oral tablet mg, 0 mg olanzapine oral tablet. mg olanzapine oral tablet mg olanzapine oral tablet 7. mg olanzapine oral tablet,disintegrating 0 mg olanzapine oral tablet,disintegrating mg, 0 mg olanzapine oral QL (0 EA per QL (40 EA QL (0 EA QL (60 EA per QL (60 EA per QL (0 EA per QL (40 EA QL (0 EA QL (8 EA per QL (60 EA per QL (0 EA per QL (0 EA 9

61 GEODON INTRAMUSCULAR 4 tablet,disintegrating mg 60

62 Drug Name paliperidone oral tablet extended release 4hr. mg paliperidone oral tablet extended release 4hr mg paliperidone oral tablet extended release 4hr 6 mg paliperidone oral tablet extended release 4hr 9 mg quetiapine oral tablet 00 mg quetiapine oral tablet 00 mg quetiapine oral tablet mg quetiapine oral tablet 00 mg quetiapine oral tablet 400 mg quetiapine oral tablet 0 mg quetiapine oral tablet extended release 4 hr 0 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 400 mg quetiapine oral tablet extended release 4 hr 0 mg REXULTI ORAL TABLET 0. MG QL (40 EA QL (0 EA QL (60 EA per QL (4 EA per QL (40 EA QL (0 EA QL (90 EA QL (8 EA per QL (60 EA per QL (480 EA QL (60 EA QL (0 EA QL (8 EA per QL (60 EA per QL (480 EA QL (480 EA Drug Name REXULTI ORAL TABLET 0. MG REXULTI ORAL TABLET MG REXULTI ORAL TABLET MG REXULTI ORAL TABLET MG REXULTI ORAL TABLET 4 MG RISPERDAL CONSTA INTRAMUSCULAR SYRINGE. MG/ ML, MG/ ML RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 7. MG/ ML, 0 MG/ ML risperidone oral solution risperidone oral tablet 0. mg risperidone oral tablet 0. mg risperidone oral tablet mg risperidone oral tablet mg risperidone oral tablet mg risperidone oral tablet 4 mg risperidone oral tablet,disintegrating 0. mg risperidone oral tablet,disintegrating 0. mg risperidone oral tablet,disintegrating mg QL (40 EA QL (0 EA QL (60 EA per QL (40 EA per QL (0 EA per QL (480 ML QL (90 EA QL (960 EA QL (480 EA QL (40 EA QL (6 EA QL (0 EA QL (90 EA QL (960 EA QL (480 EA 6

63 Drug Name risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating 4 mg SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 0 MG SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET. MG SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET MG VRAYLAR ORAL CAPSULE. MG VRAYLAR ORAL CAPSULE MG VRAYLAR ORAL CAPSULE 4. MG VRAYLAR ORAL CAPSULE 6 MG VRAYLAR ORAL CAPSULE,DOSE PACK ziprasidone hcl oral capsule 0 mg ziprasidone hcl oral capsule 40 mg ziprasidone hcl oral capsule 60 mg ziprasidone hcl oral capsule 80 mg QL (40 EA QL (6 EA QL (0 EA QL (60 EA per QL (40 EA QL (0 EA QL (0 EA QL (60 EA per QL (40 EA per QL (0 EA per QL (7 EA per QL (40 EA QL (0 EA QL (80 EA per QL (60 EA per Drug Name ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 0 MG TREATMENT- RESISTANT clozapine oral tablet clozapine oral tablet,disintegrating 00 mg,. mg, mg FAZACLO ORAL TABLET,DISINTEGR ATING 0 MG, 00 MG VERSACLOZ ANTISPASTICIT Y AGENTS ANTISPASTICITY AGENTS baclofen BOTOX PA dantrolene LIORESAL INTRATHECAL SOLUTION,000 MCG/ML, 00 MCG/ML tizanidine ANTIVIRALS ANTI- CYTOMEGALOVI RUS (CMV) AGENTS 4 BvD cidofovir BvD ganciclovir sodium intravenous recon soln BvD PREVYMIS 6

64 valganciclovir 6

65 Drug Name ZIRGAN 4 ANTI-HEPATITIS B (HBV) AGENTS adefovir BARACLUDE ORAL SOLUTION entecavir EPIVIR HBV ORAL SOLUTION INTRON A INJECTION RECON SOLN 0 MILLION UNIT ( ML) INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML lamivudine RIBASPHERE ORAL CAPSULE RIBASPHERE ORAL TABLET 00 MG, 400 MG RIBASPHERE ORAL TABLET 600 MG RIBASPHERE RIBAPAK ORAL TABLETS,DOSE PACK 00 MG (7)- 400 MG (7) ribavirin oral capsule ribavirin oral tablet 00 mg tenofovir disoproxil fumarate VEMLIDY VIREAD BvD BvD Drug Name ANTI-HEPATITIS C (HCV) AGENTS, DIRECT ACTING EPCLUSA HARVONI ZEPATIER ANTI-HEPATITIS C (HCV) AGENTS, OTHERS EPCLUSA HARVONI INTRON A INJECTION RECON SOLN 0 MILLION UNIT ( ML) INTRON A INJECTION RECON SOLN 8 MILLION UNIT ( ML), 0 MILLION UNIT ( ML) INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML MODERIBA MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK MG (8)-MG (8) MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK MG (8)-MG (8) BvD BvD BvD PA; QL (8 EA per 8 PA; QL (8 EA per 8 PA; QL (8 EA per 8 PA; QL (8 EA per 8 PA; QL (8 EA per 8 64

66 PEGASYS PROCLICK QL ( ML per 8 6

67 Drug Name PEGASYS SUBCUTANEOUS SOLUTION PEGASYS SUBCUTANEOUS SYRINGE RIBASPHERE ORAL CAPSULE RIBASPHERE ORAL TABLET 00 MG, 400 MG RIBASPHERE ORAL TABLET 600 MG RIBASPHERE RIBAPAK ORAL TABLETS,DOSE PACK MG (8)-MG (8), MG (8)-MG (8), MG (8)-MG (8) ribavirin oral capsule ribavirin oral tablet 00 mg SYLATRON ZEPATIER ANTIHERPETIC AGENTS acyclovir oral capsule acyclovir oral suspension 00 mg/ ml QL (4 ML per 8 QL ( ML per 8 PA; QL (8 EA per 8 Drug Name valacyclovir oral tablet gram valacyclovir oral tablet 00 mg ZOVIRAX TOPICAL CREAM ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI) BIKTARVY GENVOYA ISENTRESS HD ISENTRESS ORAL POWDER IN PACKET ISENTRESS ORAL TABLET ISENTRESS ORAL TABLET,CHEWABLE 00 MG ISENTRESS ORAL TABLET,CHEWABLE MG STRIBILD TIVICAY ORAL TABLET 0 MG TIVICAY ORAL TABLET MG, 0 MG QL (0 EA QL (60 EA per PA; QL ( GM acyclovir oral tablet ANTI-HIV AGENTS, NONacyclovir sodium 4 BvD NUCLEOSIDE intravenous solution REVERSE PA; QL (0 TRANSCRIPTASE acyclovir topical 4 GM per 0 INHIBITORS (NNRTI) DENAVIR COMPLERA famciclovir EDURANT trifluridine 66

68 efavirenz oral capsule 00 mg 67

69 Drug Name efavirenz oral capsule 0 mg efavirenz oral tablet INTELENCE ORAL TABLET 00 MG, 00 MG INTELENCE ORAL TABLET MG nevirapine oral tablet nevirapine oral tablet extended release 4 hr RESCRIPTOR SUSTIVA ORAL CAPSULE 00 MG SUSTIVA ORAL CAPSULE 0 MG SUSTIVA ORAL TABLET ANTI-HIV AGENTS, NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI) abacavir abacavir-lamivudine abacavir-lamivudinezidovudine ATRIPLA DESCOVY didanosine oral capsule,delayed release(dr/ec) 00 mg, 0 mg, 400 mg EMTRIVA JULUCA Drug Name ODEFSEY RETROVIR INTRAVENOUS stavudine oral capsule tenofovir disoproxil fumarate TRUVADA VIDEX 4 GRAM PEDIATRIC VIDEX EC ORAL CAPSULE,DELAYED RELEASE(DR/EC) MG VIREAD ZERIT ORAL RECON SOLN ZIAGEN ORAL SOLUTION zidovudine ANTI-HIV AGENTS, OTHER FUZEON SUBCUTANEOUS RECON SOLN SELZENTRY TRIUMEQ ANTI-HIV AGENTS, PROTEASE INHIBITORS APTIVUS atazanavir oral capsule 0 mg, 00 mg atazanavir oral capsule 00 mg CRIXIVAN ORAL CAPSULE 00 MG, 400 MG

70 lamivudine lamivudine-zidovudine EVOTAZ fosamprenavir 69

71 Drug Name INVIRASE KALETRA ORAL TABLET 00- MG KALETRA ORAL TABLET 00-0 MG LEXIVA ORAL SUSPENSION LEXIVA ORAL TABLET lopinavir-ritonavir NORVIR PREZCOBIX PREZISTA ORAL SUSPENSION PREZISTA ORAL TABLET 0 MG, 7 MG PREZISTA ORAL TABLET 600 MG, 800 MG REYATAZ ORAL CAPSULE 0 MG, 00 MG, 00 MG REYATAZ ORAL POWDER IN PACKET VIRACEPT ORAL TABLET ANTI-INFLUENZA AGENTS amantadine hcl oseltamivir RELENZA DISKHALER rimantadine TAMIFLU ANXIOLYTICS ANXIOLYTICS, Drug Name doxepin oral 4 PAns hydroxyzine hcl oral tablet BENZODIAZEPINE S PA clonazepam PAns clorazepate dipotassium PAns DIASTAT 4 DIASTAT ACUDIAL 4 DIAZEPAM INTENSOL diazepam oral solution mg/ ml ( mg/ml) PAns PAns diazepam oral tablet PAns diazepam rectal kit. mg, mg lorazepam oral PA SSRIS/ SNRIS duloxetine oral capsule,delayed release(dr/ec) 0 mg duloxetine oral capsule,delayed release(dr/ec) 0 mg duloxetine oral capsule,delayed release(dr/ec) 40 mg duloxetine oral capsule,delayed release(dr/ec) 60 mg escitalopram oxalate oral solution escitalopram oxalate oral tablet 0 mg escitalopram oxalate oral tablet 0 mg escitalopram oxalate oral tablet mg QL (80 EA QL (0 EA QL (90 EA per QL (60 EA per QL (60 EA per QL (0 EA per QL (0 EA 70

72 OTHER buspirone paroxetine hcl oral tablet 0 mg QL (80 EA 7

73 Drug Name Drug Name paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 40 mg paroxetine hcl oral tablet extended release 4 hr. mg QL (90 EA per QL (60 EA per QL (4 EA per QL (80 EA BIPOLAR AGENTS BIPOLAR AGENTS, OTHER GEODON INTRAMUSCULAR olanzapine intramuscular 4 paroxetine hcl oral tablet extended release 4 hr mg paroxetine hcl oral tablet extended release 4 hr 7. mg QL (90 EA per QL (60 EA per olanzapine oral tablet 0 mg olanzapine oral tablet mg, 0 mg olanzapine oral tablet. mg QL (60 EA per QL (0 EA per QL (40 EA PAXIL ORAL SUSPENSION 4 olanzapine oral tablet mg QL (0 EA sertraline oral concentrate olanzapine oral tablet 7. mg QL (8 EA per sertraline oral tablet 00 mg sertraline oral tablet mg sertraline oral tablet 0 mg venlafaxine oral capsule,extended release 4hr 0 mg venlafaxine oral capsule,extended release 4hr 7. mg venlafaxine oral capsule,extended release 4hr 7 mg QL (60 EA per QL (40 EA QL (0 EA QL (60 EA per QL (80 EA QL (90 EA per olanzapine oral tablet,disintegrating 0 mg olanzapine oral tablet,disintegrating mg, 0 mg olanzapine oral tablet,disintegrating mg quetiapine oral tablet 00 mg quetiapine oral tablet 00 mg quetiapine oral tablet mg QL (60 EA per QL (0 EA per QL (0 EA QL (40 EA QL (0 EA QL (90 EA venlafaxine oral tablet 00 mg, 7 mg QL (90 EA per quetiapine oral tablet 00 mg QL (8 EA per venlafaxine oral tablet mg QL (70 EA quetiapine oral tablet 400 mg QL (60 EA per venlafaxine oral tablet 7. mg QL (80 EA quetiapine oral tablet 0 mg QL (480 EA 7

74 venlafaxine oral tablet 0 mg QL (0 EA 7

75 Drug Name quetiapine oral tablet extended release 4 hr 0 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 00 mg quetiapine oral tablet extended release 4 hr 400 mg quetiapine oral tablet extended release 4 hr 0 mg RISPERDAL CONSTA INTRAMUSCULAR SYRINGE. MG/ ML, MG/ ML RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 7. MG/ ML, 0 MG/ ML risperidone oral solution risperidone oral tablet 0. mg risperidone oral tablet 0. mg risperidone oral tablet mg risperidone oral tablet mg risperidone oral tablet mg risperidone oral tablet 4 mg risperidone oral tablet,disintegrating 0. mg risperidone oral tablet,disintegrating 0. mg QL (60 EA QL (0 EA QL (8 EA per QL (60 EA per QL (480 EA QL (480 ML QL (90 EA QL (960 EA QL (480 EA QL (40 EA QL (6 EA QL (0 EA QL (90 EA QL (960 EA Drug Name risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating 4 mg SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 0 MG SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET. MG SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET MG VRAYLAR ORAL CAPSULE. MG VRAYLAR ORAL CAPSULE MG VRAYLAR ORAL CAPSULE 4. MG VRAYLAR ORAL CAPSULE 6 MG VRAYLAR ORAL CAPSULE,DOSE PACK ziprasidone hcl oral capsule 0 mg ziprasidone hcl oral capsule 40 mg ziprasidone hcl oral capsule 60 mg QL (480 EA QL (40 EA QL (6 EA QL (0 EA QL (60 EA per QL (40 EA QL (0 EA QL (0 EA QL (60 EA per QL (40 EA per QL (0 EA per QL (7 EA per QL (40 EA QL (0 EA QL (80 EA per ziprasidone hcl oral QL (60 EA per capsule 80 mg 74

76 Drug Name ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 0 MG MOOD STABILIZERS carbamazepine oral capsule, er multiphase hr carbamazepine oral suspension 00 mg/ ml carbamazepine oral tablet carbamazepine oral tablet extended release hr 00 mg carbamazepine oral tablet,chewable divalproex oral capsule, delayed rel sprinkle divalproex oral tablet extended release 4 hr divalproex oral tablet,delayed release (dr/ec) EPITOL lamotrigine oral tablet lamotrigine oral tablet extended release 4hr 0 mg lamotrigine oral tablet, chewable dispersible lamotrigine oral tablet,disintegrating lithium carbonate lithium citrate oral solution 8 meq/ ml 4 4 Drug Name valproic acid (as sodium salt) oral solution 0 mg/ ml BLOOD GLUCOSE REGULATORS ANTIDIABETIC AGENTS acarbose oral tablet 00 mg acarbose oral tablet mg acarbose oral tablet 0 mg BYDUREON BYDUREON BCISE BYETTA SUBCUTANEOUS PEN INJECTOR 0 MCG/DOSE(0 MCG/ML).4 ML BYETTA SUBCUTANEOUS PEN INJECTOR MCG/DOSE (0 MCG/ML). ML CYCLOSET 4 glimepiride oral tablet mg glimepiride oral tablet mg glimepiride oral tablet 4 mg glipizide oral tablet 0 mg QL (90 EA per QL (60 EA QL (80 EA PA; QL (4 EA per 8 PA; QL (4 ML per 8 PA; QL (.4 ML per 0 PA; QL (. ML per 0 QL (80 EA QL (40 EA QL (0 EA QL (60 EA per QL (0 EA glipizide oral tablet QL (40 EA valproic acid mg 7

77 Drug Name glipizide oral tablet extended release 4hr 0 mg glipizide oral tablet extended release 4hr. mg glipizide oral tablet extended release 4hr mg INVOKAMET ORAL TABLET 0-,000 MG, 0-00 MG, 0-,000 MG INVOKAMET ORAL TABLET 0-00 MG INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 4HR 0-,000 MG, 0-00 MG, 0-,000 MG INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 4HR 0-00 MG INVOKANA ORAL TABLET 00 MG INVOKANA ORAL TABLET 00 MG JANUVIA JARDIANCE JENTADUETO JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 4HR.-,000 MG JENTADUETO XR QL (60 EA per QL (40 EA QL (0 EA QL (60 EA per QL (0 EA QL (60 EA per QL (0 EA QL (90 EA per QL (0 EA per QL (0 EA per QL (0 EA per QL (60 EA per QL (60 EA per Drug Name metformin oral tablet,000 mg metformin oral tablet 00 mg metformin oral tablet 80 mg metformin oral tablet extended release 4 hr 00 mg metformin oral tablet extended release 4 hr 70 mg miglitol oral tablet 00 mg miglitol oral tablet mg miglitol oral tablet 0 mg nateglinide oral tablet 0 mg nateglinide oral tablet 60 mg pioglitazone repaglinide oral tablet 0. mg repaglinide oral tablet mg repaglinide oral tablet mg RIOMET SYMLINPEN 0 SYMLINPEN 60 QL (7 EA per QL (0 EA QL (90 EA per QL (0 EA QL (7 EA per QL (90 EA per QL (60 EA QL (80 EA QL (90 EA per QL (80 EA QL (0 EA per QL (960 EA QL (480 EA QL (40 EA QL (76 ML PA; QL (0.8 ML per 0 PA; QL (6 ML 76

78 ORAL TABLET, IR - ER, BIPHASIC 4HR -,000 MG QL (0 EA per SYNJARDY ORAL TABLET.-,000 MG,.-00 MG, -,000 MG QL (60 EA per 77

79 Drug Name SYNJARDY ORAL TABLET -00 MG TANZEUM 4 tolazamide oral tablet 0 mg tolazamide oral tablet 00 mg tolbutamide TRADJENTA TRULICITY 4 VICTOZA -PAK BLOOD GLUCOSE REGULATORS glipizide-metformin oral tablet.-0 mg glipizide-metformin oral tablet.-00 mg, -00 mg JANUMET JANUMET XR ORAL TABLET, ER MULTIPHASE 4 HR 00-,000 MG, 0-00 MG JANUMET XR ORAL TABLET, ER MULTIPHASE 4 HR 0-,000 MG JENTADUETO JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 4HR.-,000 MG QL (0 EA PA; QL (4 EA per 8 QL (0 EA QL (60 EA per QL (80 EA QL (0 EA per PA; QL ( ML per 8 PA; QL (9 ML QL (40 EA QL (0 EA QL (60 EA per QL (0 EA per QL (60 EA per QL (60 EA per QL (60 EA per Drug Name JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 4HR -,000 MG pioglitazone-glimepiride pioglitazone-metformin repaglinide-metformin GLYCEMIC AGENTS GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT (HUMAN) KORLYM PROGLYCEM INSULINS ASSURE ID INSULIN SAFETY SYRINGE ML 9 GAUGE X /" GAUZE PAD TOPICAL BANDAGE X " HUMALOG JUNIOR KWIKPEN U-00 HUMALOG KWIKPEN INSULIN HUMALOG MIX 0-0 INSULN U-00 HUMALOG MIX 0-0 KWIKPEN HUMALOG MIX 7- KWIKPEN HUMALOG MIX 7- (U-00)INSULN HUMALOG U-00 INSULIN QL (0 EA per QL (0 EA per QL (90 EA per QL (0 EA 78

80 Drug Name HUMULIN 70/0 U- 00 INSULIN HUMULIN 70/0 U- 00 KWIKPEN HUMULIN N NPH INSULIN KWIKPEN HUMULIN N NPH U- 00 INSULIN HUMULIN R REGULAR U-00 INSULN HUMULIN R U-00 (CONC) INSULIN HUMULIN R U-00 (CONC) KWIKPEN insulin syringe-needle u-00 syringe 0. ml 9 gauge, ml 9 gauge x /", / ml 8 gauge LANTUS SOLOSTAR U-00 INSULIN LANTUS U-00 INSULIN LEVEMIR FLEXTOUCH U-00 INSULN LEVEMIR U-00 INSULIN pen needle, diabetic needle 9 gauge x /" TOUJEO SOLOSTAR U-00 INSULIN BLOOD PRODUCTS/ MODIFIERS/ VOLUME EXPANDERS ANTICOAGULANT Drug Name fondaparinux subcutaneous syringe 0 mg/0.8 ml, mg/0.4 ml, 7. mg/0.6 ml fondaparinux subcutaneous syringe. mg/0. ml heparin (porcine) in % dex intravenous parenteral solution 0,000 unit/00 ml (40 unit/ml),,000 unit/0 ml(00 unit/ml),,000 unit/00 ml (0 unit/ml) heparin (porcine) injection solution JANTOVEN PRADAXA 4 warfarin XARELTO BLOOD FORMATION MODIFIERS anagrelide GRANIX PA LEUKINE INJECTION RECON SOLN MOZOBIL NEULASTA SUBCUTANEOUS SYRINGE PA NEUPOGEN PA PROCRIT INJECTION SOLUTION 0,000 UNIT/ML,,000 UNIT/ML,,000 UNIT/ML, 4,000 UNIT/ML PA 79

81 S ELIQUIS enoxaparin 80

82 Drug Name PROCRIT INJECTION SOLUTION 0,000 UNIT/ML, 40,000 UNIT/ML PA PROMACTA PA; LA ZARXIO PA HEMOSTASIS AGENTS tranexamic acid intravenous tranexamic acid oral 4 PLATELET MODIFYING AGENTS aspirin-dipyridamole BRILINTA cilostazol clopidogrel dipyridamole oral prasugrel CARDIOVASCU LAR AGENTS ALPHA- ADRENERGIC AGONISTS clonidine 4 clonidine hcl oral tablet methyldopa midodrine NORTHERA PA ALPHA- ADRENERGIC BLOCKING AGENTS doxazosin oral tablet QL (4 EA per 8 QL (0 EA per Drug Name phenoxybenzamine prazosin terazosin oral capsule mg, mg, mg terazosin oral capsule 0 mg ANGIOTENSIN II RECEPTOR ANTAGONISTS candesartan ENTRESTO eprosartan irbesartan losartan olmesartan telmisartan valsartan olmesartanhydrochlorothiazide ANGIOTENSIN- CONVERTING ENZYME (ACE) INHIBITORS benazepril captopril enalapril maleate fosinopril lisinopril moexipril perindopril erbumine quinapril ramipril trandolapril ANTIARRHYTHMI CS QL (0 EA per QL (60 EA per QL (60 EA per 8

83 mg, mg, 4 mg doxazosin oral tablet 8 mg QL (60 EA per amiodarone intravenous solution BvD 8

84 Drug Name amiodarone oral dofetilide flecainide mexiletine PACERONE ORAL TABLET 00 MG, 00 MG, 400 MG procainamide injection propafenone quinidine gluconate quinidine sulfate oral tablet SORINE SOTALOL AF ORAL TABLET 0 MG sotalol oral tablet 60 mg, 40 mg, 80 mg SOTYLIZE BETA- ADRENERGIC BLOCKING AGENTS acebutolol atenolol betaxolol oral bisoprolol fumarate carvedilol carvedilol phosphate labetalol intravenous solution labetalol oral metoprolol succinate metoprolol tartrate intravenous metoprolol tartrate oral tablet 00 mg, mg, 0 mg nadolol pindolol Drug Name propranolol intravenous propranolol oral capsule,extended release 4 hr propranolol oral solution propranolol oral tablet timolol maleate oral CALCIUM CHANNEL BLOCKING AGENTS AFEDITAB CR amlodipine CARTIA XT diltiazem hcl intravenous diltiazem hcl oral capsule,extended release hr diltiazem hcl oral capsule,extended release 4 hr 60 mg, 40 mg diltiazem hcl oral capsule,extended release 4hr 0 mg, 80 mg, 40 mg, 00 mg diltiazem hcl oral tablet DILT-XR felodipine isradipine MATZIM LA nicardipine intravenous solution nicardipine oral nifedipine oral tablet extended release nifedipine oral tablet extended release 4hr 8

85 Drug Name nimodipine nisoldipine TAZTIA XT verapamil intravenous solution verapamil oral CARDIOVASCULA R AGENTS amlodipine-atorvastatin amlodipine-benazepril amlodipine-olmesartan amlodipine-valsartan atenolol-chlorthalidone DEMSER ezetimibe-simvastatin QL (0 EA per QL (0 EA per Drug Name TEKTURNA HCT telmisartan-amlodipine trandolapril-verapamil metoprolol tahydrochlorothiaz moexiprilhydrochlorothiazide nadololbendroflumethiazide olmesartan-amlodipinhcthiazid olmesartanhydrochlorothiazide propranololhydrochlorothiazid quinaprilhydrochlorothiazide spironolactonhydrochlorothiaz telmisartanhydrochlorothiazid triamterenehydrochlorothiazid valsartanhydrochlorothiazide CARDIOVASCULA R AGENTS, OTHER CORLANOR PA DIGITEK DIGOX digoxin oral solution 0 mcg/ml digoxin oral tablet amiloridehydrochlorothiazide amlodipine-valsartanhcthiazid benazeprilhydrochlorothiazide bisoprololhydrochlorothiazide candesartanhydrochlorothiazid captoprilhydrochlorothiazide enalaprilhydrochlorothiazide fosinoprilhydrochlorothiazide irbesartanhydrochlorothiazide LANOXIN ORAL TABLET 87. MCG, lisinoprilhydrochlorothiazide 6. MCG pentoxifylline losartanhydrochlorothiazide RANEXA 84

86 TEKTURNA 8

87 Drug Name UPTRAVI PA; LA DIURETICS, CARBONIC ANHYDRASE INHIBITORS acetazolamide acetazolamide sodium methazolamide DIURETICS, LOOP bumetanide injection bumetanide oral ethacrynate sodium ethacrynic acid furosemide injection furosemide oral solution 0 mg/ml, 40 mg/ ml (8 mg/ml) furosemide oral tablet torsemide oral DIURETICS, POTASSIUM- SPARING amiloride eplerenone spironolactone DIURETICS, THIAZIDE chlorothiazide chlorothiazide sodium chlorthalidone oral tablet mg, 0 mg hydrochlorothiazide indapamide irbesartanhydrochlorothiazide Drug Name DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES fenofibrate micronized fenofibrate nanocrystallized fenofibrate oral tablet fenofibric acid fenofibric acid (choline) gemfibrozil DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS atorvastatin fluvastatin oral capsule 0 mg fluvastatin oral capsule 40 mg fluvastatin oral tablet extended release 4 hr lovastatin oral tablet 0 mg lovastatin oral tablet 0 mg, 40 mg pravastatin rosuvastatin simvastatin DYSLIPIDEMICS, OTHER cholestyramine (with sugar) oral powder in packet methyclothiazide CHOLESTYRAMINE 86 QL (0 EA per QL (0 EA per QL (60 EA per QL (0 EA per QL (0 EA per QL (60 EA per QL (0 EA per QL (0 EA per QL (0 EA per

88 metolazone LIGHT ORAL POWDER 87

89 Drug Name colestipol oral packet colestipol oral tablet ezetimibe JUXTAPID PA; LA niacin oral tablet extended release 4 hr PRALUENT PEN SUBCUTANEOUS PEN INJECTOR 0 MG/ML PRALUENT PEN SUBCUTANEOUS PEN INJECTOR 7 MG/ML PREVALITE ORAL POWDER IN PACKET REPATHA PUSHTRONEX REPATHA SURECLICK REPATHA SYRINGE VASCEPA 4 VASODILATORS, DIRECT-ACTING ARTERIAL hydralazine minoxidil oral VASODILATORS, DIRECT-ACTING ARTERIAL/ VENOUS isosorbide dinitrate oral isosorbide mononitrate NITRO-BID nitroglycerin intravenous BvD PA; QL ( ML per 8 PA; QL (4 ML per 8 PA; QL (. ML per 8 PA; QL ( ML per 8 PA; QL ( ML per 8 Drug Name nitroglycerin transdermal patch 4 hour RECTIV CENTRAL NERVOUS SYSTEM AGENTS ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES dextroamphetamine oral capsule, extended release dextroamphetamine oral tablet nitroglycerin translingual spray,nonaerosol dextroamphetamineamphetamine methamphetamine PA PROCENTRA ZENZEDI ORAL TABLET 0 MG, MG ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON- AMPHETAMINES atomoxetine clonidine hcl oral tablet extended release hr dexmethylphenidate 88

90 nitroglycerin sublingual 89

91 Drug Name methylphenidate hcl oral capsule, er biphasic 0-70 methylphenidate hcl oral capsule,er biphasic mg, 0 mg, 40 mg, 60 mg methylphenidate hcl oral solution methylphenidate hcl oral tablet methylphenidate hcl oral tablet extended release methylphenidate hcl oral tablet extended release 4hr 8 mg, 7 mg, 6 mg, 4 mg methylphenidate hcl oral tablet,chewable CENTRAL NERVOUS SYSTEM, OTHER NUEDEXTA RADICAVA riluzole tetrabenazine oral tablet. mg tetrabenazine oral tablet mg VECAMYL FIBROMYALGIA AGENTS duloxetine oral capsule,delayed release(dr/ec) 0 mg duloxetine oral capsule,delayed release(dr/ec) 0 mg PA; QL (40 EA per 0 PA; QL (0 EA per 0 QL (80 EA QL (0 EA Drug Name duloxetine oral capsule,delayed release(dr/ec) 40 mg duloxetine oral capsule,delayed release(dr/ec) 60 mg LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE 0 MG LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE MG LYRICA ORAL CAPSULE MG LYRICA ORAL CAPSULE 00 MG LYRICA ORAL CAPSULE 0 MG LYRICA ORAL CAPSULE 7 MG LYRICA ORAL SOLUTION MULTIPLE SCLEROSIS AGENTS QL (90 EA per QL (60 EA per PAns; QL (80 EA per 0 PAns; QL (0 EA per 0 PAns; QL (90 EA per 0 PAns; QL (8 EA per 0 PAns; QL (70 EA per 0 PAns; QL (60 EA per 0 PAns; QL (60 EA per 0 PAns; QL (40 EA per 0 PAns; QL (900 ML per 0 AMPYRA PA; LA AVONEX (WITH ALBUMIN) AVONEX INTRAMUSCULAR PEN INJECTOR KIT PA; QL (4 EA per 8 PA; QL (4 EA per 8 90

92 Drug Name AVONEX INTRAMUSCULAR SYRINGE KIT BETASERON SUBCUTANEOUS KIT GILENYA PA glatiramer subcutaneous syringe 0 mg/ml glatiramer subcutaneous syringe 40 mg/ml GLATOPA SUBCUTANEOUS SYRINGE 0 MG/ML mitoxantrone BvD PLEGRIDY SUBCUTANEOUS PEN INJECTOR MCG/0. ML PLEGRIDY SUBCUTANEOUS PEN INJECTOR 6 MCG/0. ML- 94 MCG/0. ML PLEGRIDY SUBCUTANEOUS SYRINGE MCG/0. ML REBIF (WITH ALBUMIN) REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR MCG/0. ML, 44 MCG/0. ML REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.ML- MCG/0.ML (6) PA; QL (4 EA per 8 PA; QL ( EA per 8 PA; QL (0 ML per 0 PA; QL ( ML per 8 PA; QL (0 ML per 0 PA; QL ( ML per 8 PA; QL ( ML per 80 PA; QL ( ML per 8 PA; QL (6 ML per 8 PA; QL (6 ML per 8 PA; QL (4. ML per 80 Drug Name REBIF TITRATION PACK PA; QL (4. ML per 80 TECFIDERA PA; LA TYSABRI PA; LA DENTAL AND ORAL AGENTS DENTAL AND ORAL AGENTS cevimeline chlorhexidine gluconate mucous membrane doxycycline hyclate oral capsule doxycycline hyclate oral tablet 00 mg, 0 mg, 0 mg, 7 mg doxycycline hyclate oral tablet,delayed release (dr/ec) 00 mg, 0 mg doxycycline monohydrate oral tablet 0 mg, 7 mg KEPIVANCE minocycline oral capsule minocycline oral tablet minocycline oral tablet extended release 4 hr mg, 6 mg minocycline oral tablet extended release 4 hr mg, 4 mg, 90 mg PERIOGARD pilocarpine hcl oral triamcinolone acetonide dental 4 4 9

93 Drug Name DERMATOLOGI CAL AGENTS DERMATOLOGIC AL AGENTS acitretin oral capsule 0 mg acitretin oral capsule 7. mg, mg adapalene topical cream 4 PA adapalene topical gel 4 PA adapalene-benzoyl peroxide ammonium lactate AMNESTEEM APEXICON E AVITA TOPICAL CREAM betamethasone dipropionate topical lotion calcipotriene scalp calcipotriene topical cream calcipotriene topical ointment calcipotrienebetamethasone calcitriol topical 4 CLARAVIS 4 clindamycin-benzoyl peroxide topical gel PA PA clindamycin-tretinoin PA clobetasol topical spray,non-aerosol 4 QL ( ML per 8 Drug Name diclofenac sodium topical gel % diclofenac sodium topical gel % doxepin topical doxycycline hyclate oral capsule 0 mg doxycycline hyclate oral tablet,delayed release (dr/ec) 00 mg, 0 mg, 7 mg doxycycline monohydrate oral capsule 00 mg, 0 mg doxycycline monohydrate oral tablet 00 mg, 0 mg DUPIXENT PA ERYGEL erythromycin-benzoyl peroxide fluocinonide topical cream 0. % fluorouracil intravenous solution gram/00 ml fluorouracil topical cream % fluorouracil topical solution flurandrenolide topical cream flurandrenolide topical ointment fluticasone topical cream 4 BvD ST; QL (000 GM per 8 PA; QL (00 GM per 8 QL (0 GM 9

94 clotrimazolebetamethasone dapsone topical fluticasone topical lotion fluticasone topical ointment 4 9

95 Drug Name imiquimod isotretinoin methoxsalen MYORISAN NATROBA NEUAC NOLIX nystatin-triamcinolone oxiconazole podofilox prednicarbate topical cream PRUDOXIN REGRANEX SANTYL selenium sulfide topical lotion tacrolimus topical tazarotene PA TAZORAC TOPICAL CREAM 0.0 % TAZORAC TOPICAL GEL PA PA tretinoin PA tretinoin microspheres topical gel TRIANEX VALCHLOR VOLTAREN TOPICAL ZENATANE 4 4 PA PA; QL (00 GM per 0 ST; QL (000 GM per 8 Drug Name ELECTROLYT E S/MINERALS/M ETALS/VITAMI NS ELECTROLYTE/ MINERAL REPLACEMENT CARBAGLU LA ISOLYTE-S KLOR-CON 0 KLOR-CON 8 KLOR-CON M0 KLOR-CON M KLOR-CON M0 KLOR-CON SPRINKLE K-TAB ORAL TABLET EXTENDED RELEASE 8 MEQ magnesium sulfate injection NORMOSOL-R PH 7.4 PLASMA-LYTE 48 PLASMA-LYTE A potassium chloride in 0.9%nacl intravenous parenteral solution 0 meq/l, 40 meq/l potassium chloride in water intravenous piggyback 0 meq/00 ml, 0 meq/00 ml, 40 meq/00 ml potassium chloride intravenous potassium chloride oral capsule, extended release 94

96 potassium chloride oral liquid 9

97 Drug Name potassium chloride oral tablet extended release potassium chloride oral tablet,er particles/crystals potassium chloride-0.4 % nacl sodium chloride 0.4 % intravenous parenteral solution sodium chloride 0.9 % intravenous piggyback sodium chloride % sodium chloride % sodium chloride intravenous parenteral solution. meq/ml sodium chloride irrigation ELECTROLYTE/M INERAL/METAL MODIFIERS AMINOSYN 7 % WITH ELECTROLYTES BvD AMINOSYN-RF. % BvD Drug Name trientine PA VELTASSA ELECTROLYTES/ MINERALS/META LS/VITAMINS AMINOSYN 8. %- ELECTROLYTES BvD AMINOSYN II 0 % BvD AMINOSYN II % BvD AMINOSYN II 8. % BvD AMINOSYN II 8. %- ELECTROLYTES BvD AMINOSYN-HBC 7% BvD AMINOSYN-PF 0 % BvD AMINOSYN-PF 7 % (SULFITE-FREE) BvD CLINIMIX %/DW SULFITE FREE CLINIMIX %/DW SULFITE-FREE CLINIMIX.7%/DW SULFIT FREE CLINIMIX 4.%/D0W SULF FREE BvD BvD BvD BvD EXJADE PA; LA CLINIMIX 4.%- D0W SULF-FREE FERRIPROX PA CHEMET PA CLINIMIX 4.%/DW DEPEN TITRATABS SULFIT FREE BvD BvD JADENU PA CLINIMIX 4.%- DW SULF-FREE BvD JADENU SPRINKLE PA CLINIMIX %- KLOR-CON D0W(SULFITE- BvD PLENAMINE BvD FREE) SAMSCA PA d0 %-0.4 % sodium chloride sodium polystyrene 96

98 sulfonate oral powder SPS (WITH SORBITOL) ORAL SYPRINE PA d. %-0.4 % sodium chloride d % and 0.9 % sodium chloride 97

99 Drug Name d %-0.4 % sodium chloride dextrose 0 % and 0. % nacl dextrose 0 % in water (d0w) dextrose % in water (dw) intravenous piggyback dextrose %-lactated ringers dextrose %-0. % sod chloride dextrose %-0. % sod.chloride fomepizole HEPATAMINE 8% BvD INTRALIPID INTRAVENOUS EMULSION 0 % IONOSOL-MB IN DW ISOLYTE-P IN % DEXTROSE lactated ringers levocarnitine (with sugar) levocarnitine oral tablet BvD NEPHRAMINE.4 % BvD NORMOSOL-R IN % DEXTROSE PLENAMINE BvD potassium chlorid-d- 0.4%nacl potassium chloride in Drug Name potassium chloride in lr-d intravenous parenteral solution 0 meq/l potassium chloride-d- 0.%nacl intravenous parenteral solution 0 meq/l potassium chloride-d- 0.%nacl intravenous parenteral solution 0 meq/l potassium chloride-d- 0.9%nacl PREMASOL 0 % BvD PREMASOL 6 % BvD PRENATAL VITAMIN PLUS LOW IRON ringer's sodium lactate TRAVASOL 0 % 4 BvD TROPHAMINE 0 % BvD TROPHAMINE 6% BvD water for irrigation, sterile VITAMINS doxercalciferol KLOR-CON 0 KLOR-CON 8 KLOR-CON M0 KLOR-CON M KLOR-CON M0 KLOR-CON SPRINKLE 98

100 % dex intravenous parenteral solution 0 meq/l, 40 meq/l 99

101 Drug Name GASTROINTEST INAL AGENTS ANTISPASMODICS, GASTROINTESTIN AL atropine injection syringe 0.0 mg/ml dicyclomine intramuscular dicyclomine oral capsule dicyclomine oral solution dicyclomine oral tablet glycopyrrolate injection glycopyrrolate oral tablet mg, mg scopolamine base TRANSDERM-SCOP 4 GASTROINTESTIN AL AGENTS amoxicil-clarithromylansopraz UCERIS ORAL GASTROINTESTIN AL AGENTS, OTHER QL ( EA CHENODAL PA; LA CHOLBAM ORAL CAPSULE 0 MG CHOLBAM ORAL CAPSULE 0 MG diphenoxylate-atropine GATTEX 0-VIAL PA PA; QL (0 EA per 0 Drug Name metoclopramide hcl oral solution metoclopramide hcl oral tablet metoclopramide hcl oral tablet,disintegrating MOVANTIK OCALIVA PROCTOZONE-HC RELISTOR SUBCUTANEOUS SOLUTION RELISTOR SUBCUTANEOUS SYRINGE UCERIS ORAL ursodiol XERMELO XIFAXAN ORAL TABLET 00 MG HISTAMINE (H) RECEPTOR ANTAGONISTS cimetidine cimetidine hcl oral famotidine (pf) famotidine (pf)-nacl (iso-os) famotidine oral suspension famotidine oral tablet 0 mg, 40 mg nizatidine PA; LA; QL (0 EA per 0 PA; LA; QL (90 EA per 0 QL (9 EA per loperamide oral capsule ranitidine hcl injection metoclopramide hcl solution 0 mg/ ml ( injection solution mg/ml) 00

102 Drug Name ranitidine hcl oral capsule ranitidine hcl oral syrup ranitidine hcl oral tablet 0 mg, 00 mg IRRITABLE BOWEL SYNDROME AGENTS alosetron budesonide oral LINZESS UCERIS ORAL VIBERZI LAXATIVES CONSTULOSE ENULOSE GAVILYTE-C GAVILYTE-G GAVILYTE-N GENERLAC lactulose oral solution 0 gram/ ml peg 0-electrolytes peg-electrolyte soln polyethylene glycol 0 oral powder TRILYTE WITH FLAVOR PACKETS PROTECTANTS misoprostol sucralfate oral tablet PROTON PUMP INHIBITORS esomeprazole Drug Name esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg esomeprazole sodium lansoprazole oral capsule,delayed release(dr/ec) mg lansoprazole oral capsule,delayed release(dr/ec) 0 mg omeprazole oral capsule,delayed release(dr/ec) 0 mg, 0 mg omeprazole oral capsule,delayed release(dr/ec) 40 mg omeprazole-sodium bicarbonate oral capsule 0-. mg-gram omeprazole-sodium bicarbonate oral capsule 40-. mg-gram omeprazole-sodium bicarbonate oral packet 0-,680 mg omeprazole-sodium bicarbonate oral packet 40-,680 mg pantoprazole intravenous pantoprazole oral tablet,delayed release (dr/ec) 0 mg pantoprazole oral tablet,delayed release (dr/ec) 40 mg rabeprazole QL (0 EA per QL (0 EA per QL (0 EA per QL (0 EA per QL (0 EA per 0

103 magnesium oral capsule,delayed release(dr/ec) 0 mg QL (0 EA per 0

104 Drug Name GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT GENETIC OR ENZYME DISORDER: REPLACEMENT, MODIFIERS, TREATMENT ADAGEN ALDURAZYME BUPHENYL ORAL TABLET CERDELGA CEREZYME INTRAVENOUS RECON SOLN 400 UNIT CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC),000-8,000-60,000 UNIT, 4,000-76,000-0,000 UNIT,,000-9,00-,000 UNIT, 6,000-9,000-0,000 UNIT CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 6,000-4,000-80,000 UNIT CYSTADANE CYSTAGON LA ELAPRASE FABRAZYME Drug Name KANUMA KUVAN NAGLAZYME LA ORFADIN ORAL CAPSULE 0 MG, MG, MG ORFADIN ORAL SUSPENSION RAVICTI sodium phenylbutyrate oral tablet LA LA STRENSIQ LA SUCRAID VIOKACE XURIDEN ZAVESCA LA GENITOURINA RY AGENTS ANTISPASMODICS, URINARY darifenacin flavoxate oxybutynin chloride tolterodine trospium BENIGN PROSTATIC HYPERTROPHY AGENTS alfuzosin doxazosin oral tablet mg, mg, 4 mg doxazosin oral tablet 8 mg dutasteride dutasteride-tamsulosin QL (0 EA per QL (60 EA per 0

105 INTRAVENOUS RECON SOLN MG finasteride oral tablet mg 04

106 Drug Name phenoxybenzamine prazosin tamsulosin terazosin oral capsule mg, mg, mg terazosin oral capsule 0 mg GENITOURINARY AGENTS, OTHER bethanechol chloride CUPRIMINE DEPEN TITRATABS ELMIRON potassium citrate sodium phenylbutyrate oral powder THIOLA PHOSPHATE BINDERS calcium acetate oral capsule calcium acetate oral tablet 667 mg lanthanum RENVELA ORAL TABLET sevelamer carbonate oral powder in packet sevelamer carbonate oral tablet QL (0 EA per QL (60 EA per Drug Name HORMONAL AGENTS, STIMULANT/ REPLACEMENT / MODIFYING (ADRENAL) HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (ADRENAL) ALA-CORT TOPICAL CREAM alclometasone amcinonide 4 betamethasone dipropionate topical cream betamethasone dipropionate topical ointment betamethasone valerate betamethasone, augmented clobetasol scalp clobetasol topical foam clobetasol topical gel clobetasol topical lotion clobetasol topical ointment clobetasol topical shampoo clobetasol-emollient topical cream QL (00 ML per 8 QL (00 GM per 8 QL (0 GM per 8 QL (8 ML per 8 QL (0 GM per 8 QL (6 ML per 8 QL (0 GM per 8 0

107 Drug Name CLODAN 4 cortisone desonide topical cream 4 desonide topical lotion 4 desonide topical ointment desoximetasone 4 DEXAMETHASONE INTENSOL dexamethasone oral elixir dexamethasone oral tablet dexamethasone sodium phosphate injection solution diflorasone 4 fludrocortisone fluocinolone acetonide oil fluocinolone and shower cap fluocinolone topical cream fluocinolone topical ointment fluocinolone topical solution fluocinonide topical cream 0. % fluocinonide topical gel fluocinonide topical ointment QL (6 ML per 8 QL (0 GM QL (0 GM QL (0 GM Drug Name flurandrenolide topical lotion flurandrenolide topical ointment fluticasone topical cream fluticasone topical lotion fluticasone topical ointment halobetasol propionate hydrocortisone butyrate topical cream hydrocortisone butyrate topical ointment hydrocortisone butyrate topical solution hydrocortisone oral hydrocortisone topical cream %,. % hydrocortisone topical lotion. % hydrocortisone topical ointment %,. % hydrocortisone valerate methylprednisolone acetate methylprednisolone oral tablet methylprednisolone oral tablets,dose pack methylprednisolone sodium succ injection recon soln mg, 40 mg 4 4 BvD methylprednisolone fluocinonide topical QL (0 ML sodium succ intravenous solution MILLIPRED ORAL QL (0 GM 4 BvD FLUOCINONIDE-E TABLET 06

108 mometasone topical 07

109 Drug Name prednicarbate topical ointment prednisolone oral solution mg/ ml prednisolone sodium phosphate oral solution 0 mg/ ml, 0 mg/ ml (4 mg/ml), mg/ ml ( mg/ml), mg base/ ml (6.7 mg/ ml) prednisolone sodium phosphate oral tablet,disintegrating PREDNISONE INTENSOL prednisone oral solution BvD BvD prednisone oral tablet BvD prednisone oral tablets,dose pack PROCTO-PAK PROCTOZONE-HC triamcinolone acetonide nasal triamcinolone acetonide topical aerosol triamcinolone acetonide topical cream triamcinolone acetonide topical lotion triamcinolone acetonide topical ointment 0.0 %, 0. %, 0. % TRIDERM TOPICAL CREAM 0. % VERIPRED 0 QL (6. ML Drug Name HORMONAL AGENTS, STIMULANT/ REPLACEMENT / MODIFYING (PITUITARY) HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (PITUITARY) desmopressin injection desmopressin nasal spray,non-aerosol desmopressin oral INCRELEX LA MYALEPT PA; LA OMNITROPE PA STIMATE HORMONAL AGENTS, STIMULANT/ REPLACEMENT / MODIFYING (PROSTAGLAN DINS) HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (PROSTAGLANDIN S) misoprostol oral tablet 00 mcg 08

110 Drug Name HORMONAL AGENTS, STIMULANT/ REPLACEMENT / MODIFYING (SEX HORMONES/ MODIFIERS) ANABOLIC STEROIDS ANADROL-0 PA oxandrolone oral tablet 0 mg oxandrolone oral tablet. mg ANDROGENS ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP 0. MG/. GRAM (.6 %) ANDROGEL TRANSDERMAL GEL IN PACKET.6 % (0. MG/. GRAM),.6 % (40. MG/. GRAM) danazol 4 methyltestosterone oral capsule testosterone cypionate testosterone enanthate testosterone transdermal gel in metered-dose pump. mg/. gram ( %) PA PA PA PA PA Drug Name testosterone transdermal solution in metered pump w/app ESTROGENS ESTRACE VAGINAL PA estradiol oral 4 PA estradiol transdermal patch semiweekly estradiol transdermal patch weekly estradiol vaginal estradiol valerate intramuscular oil 0 mg/ml MARLISSA MENEST ORAL TABLET 0. MG, 0.6 MG,. MG YUVAFEM HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (SEX HORMONES/ MODIFIERS) ALTAVERA (8) ALYACEN / (8) AMETHIA AMETHIA LO APRI ARANELLE (8) ASHLYNA AUBRA AVIANE testosterone transdermal gel in PA BALZIVA (8) BEKYREE (8) 09 PA PA; QL (8 EA per 8 PA; QL (4 EA per 8

111 packet BLISOVI 4 FE 0

112 Drug Name BLISOVI FE./0 (8) BLISOVI FE /0 (8) BRIELLYN budesonide oral CAMRESE LO CAZIANT (8) CRYSELLE (8) CYCLAFEM / (8) CYCLAFEM 7/7/7 (8) DEBLITANE DELYLA (8) desogestrel-ethinyl estradiol desoge.estradiol/e.estradiol drospirenonee.estradiol-lm.fa oral tablet mg (4) (4) drospirenone-ethinyl estradiol EMOQUETTE ENPRESSE ENSKYCE estradiol valerate intramuscular oil 40 mg/ml estradiol-norethindrone acet PA Drug Name JUNEL./0 () JUNEL /0 () JUNEL FE./0 (8) JUNEL FE /0 (8) JUNEL FE 4 KAITLIB FE KARIVA (8) KELNOR / (8) KIMIDESS (8) KURVELO l norgest/e.estradiole.estrad LARIN./0 () LARIN /0 () LARIN FE./0 (8) LARIN FE /0 (8) LARISSIA LAYOLIS FE LEENA 8 LESSINA LEVONEST (8) levonorgestrel-ethinyl estrad levonorg-eth estrad triphasic LEVORA-8 LORYNA (8) LOW-OGESTREL (8) ethynodiol diac-eth LUTERA (8) estradiol MARLISSA

113 FALMINA (8) FAYOSIM FEMYNOR GIANVI (8) INTROVALE ISIBLOOM JULEBER MIBELAS 4 FE MICROGESTIN./0 () MICROGESTIN /0 () MICROGESTIN FE./0 (8)

114 Drug Name MICROGESTIN FE /0 (8) MONONESSA (8) NECON 0./ (8) NECON 7/7/7 (8) NIKKI (8) NORA-BE noreth-ethinyl estradioliron norethindrone ac-eth estradiol oral tablet - 0 mg-mcg norethindrone ac-eth estradiol oral tablet 0.-. mg-mcg, - mgmcg norethindronee.estradiol-iron oral tablet mg-0 mcg (4)/7 mg (4) norethindronee.estradiol-iron oral tablet,chewable norgestimate-ethinyl estradiol NORLYROC NORTREL 0./ (8) NORTREL / () NORTREL / (8) 4 PA Drug Name RECLIPSEN (8) RIVELSA SETLAKIN SHAROBEL SPRINTEC (8) SRONYX TARINA FE /0 (8) TRI-LEGEST FE TRI-LO-ESTARYLLA TRI-LO-SPRINTEC TRINESSA (8) TRI-PREVIFEM (8) TRI-SPRINTEC (8) TRIVORA (8) VELIVET TRIPHASIC REGIMEN (8) VESTURA (8) VIENVA VYFEMLA (8) WYMZYA FE XULANE ZARAH ZENCHENT (8) ZOVIA /E (8) PROGESTINS CAMILA NORTREL 7/7/7 (8) DEPO-PROVERA OCELLA INTRAMUSCULAR SUSPENSION 400 OGESTREL (8) MG/ML ORSYTHIA ERRIN PIMTREA (8) hydroxyprogesterone

115 PIRMELLA ORAL TABLET - MG- MCG PORTIA caproate JOLIVETTE LYZA PREVIFEM QUASENSE 4

116 Drug Name MAKENA INTRAMUSCULAR OIL 0 MG/ML ( ML) MARLISSA medroxyprogesterone megestrol oral suspension 400 mg/0 ml (40 mg/ml), 6 mg/ ml PA megestrol oral tablet PAns norethindrone (contraceptive) norethindrone acetate progesterone micronized SELECTIVE ESTROGEN RECEPTOR MODIFYING AGENTS raloxifene HORMONAL AGENTS, STIMULANT/ REPLACEMENT / MODIFYING (THYROID) HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (THYROID) levothyroxine oral Drug Name LEVOXYL ORAL TABLET 00 MCG, MCG, MCG, 7 MCG, 0 MCG, 7 MCG, 00 MCG, MCG, 0 MCG, 7 MCG, 88 MCG liothyronine UNITHROID ORAL TABLET 00 MCG, MCG, MCG, 0 MCG, 7 MCG, 00 MCG, MCG, 00 MCG, 0 MCG, 7 MCG, 88 MCG HORMONAL AGENTS, SUPPRESSANT (ADRENAL) HORMONAL AGENTS, SUPPRESSANT (ADRENAL) LYSODREN HORMONAL AGENTS, SUPPRESSANT (PITUITARY) HORMONAL AGENTS, SUPPRESSANT (PITUITARY) bromocriptine 4 cabergoline FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 0 MG BvD

117 Drug Name FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG leuprolide subcutaneous kit BvD LUPRON DEPOT PAns LUPRON DEPOT ( MONTH) LUPRON DEPOT (4 MONTH) LUPRON DEPOT (6 MONTH) LUPRON DEPOT-PED ( MONTH) INTRAMUSCULAR SYRINGE KIT 0 MG LUPRON DEPOT-PED INTRAMUSCULAR KIT. MG, MG octreotide acetate injection solution,000 mcg/ml, 00 mcg/ml octreotide acetate injection solution 00 mcg/ml, 00 mcg/ml, 0 mcg/ml SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTEN DED REL RECON SIGNIFOR SOMATULINE DEPOT SOMAVERT SUBCUTANEOUS RECON SOLN MG, 0 MG, MG, 0 MG PAns PAns PAns PAns PAns Drug Name HORMONAL AGENTS, SUPPRESSANT (THYROID) ANTITHYROID AGENTS methimazole oral tablet 0 mg, mg propylthiouracil IMMUNOLOGIC AL AGENTS ANGIOEDEMA AGENTS CINRYZE PA FIRAZYR PA IMMUNE SUPPRESSANTS ACTEMRA INTRAVENOUS SOLUTION 400 MG/0 ML (0 MG/ML), 80 MG/4 ML (0 MG/ML) ACTEMRA SUBCUTANEOUS PA PA AFINITOR DISPERZ PAns AFINITOR ORAL TABLET. MG PAns azathioprine BvD azathioprine sodium BvD BENLYSTA CELLCEPT INTRAVENOUS cyclosporine intravenous BvD BvD cyclosporine modified BvD SYNAREL cyclosporine oral BvD capsule TRELSTAR 6

118 INTRAMUSCULAR BvD SYRINGE DEPEN TITRATABS 7

119 Drug Name ENBREL SUBCUTANEOUS RECON SOLN ENBREL SUBCUTANEOUS SYRINGE ENBREL SURECLICK GENGRAF ORAL CAPSULE 00 MG, MG GENGRAF ORAL SOLUTION HUMIRA PEDIATRIC CROHN'S START HUMIRA PEN HUMIRA PEN CROHN'S-UC-HS START HUMIRA PEN PSORIASIS-UVEITIS HUMIRA SUBCUTANEOUS SYRINGE KIT 0 MG/0. ML, 0 MG/0.4 ML HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML BvD BvD INFLECTRA PA mercaptopurine methotrexate sodium BvD methotrexate sodium (pf) mycophenolate mofetil hcl BvD BvD PA; QL (6 EA per 8 PA; QL (8 ML per 8 PA; QL (8 ML per 8 PA; QL ( EA per 80 PA; QL (4 EA per 8 PA; QL (6 EA per 80 PA; QL (4 EA per 80 PA; QL ( EA per 8 PA; QL (4 EA per 8 Drug Name mycophenolate mofetil oral suspension for reconstitution mycophenolate mofetil oral tablet BvD BvD mycophenolate sodium BvD NULOJIX BvD ORENCIA PA ORENCIA (WITH MALTOSE) ORENCIA CLICKJECT PA PA OTEZLA PA OTEZLA STARTER ORAL TABLETS,DOSE PACK 0 MG (4)-0 MG (4)-0 MG (47) PROGRAF INTRAVENOUS RAPAMUNE ORAL SOLUTION PA BvD BvD REMICADE PA SANDIMMUNE ORAL SOLUTION SIMULECT INTRAVENOUS RECON SOLN 0 MG sirolimus oral tablet 0. mg, mg sirolimus oral tablet mg BvD BvD BvD BvD tacrolimus oral BvD TORISEL BvD XATMEP BvD ZORTRESS BvD IMMUNIZING mycophenolate mofetil BvD AGENTS, PASSIVE 8

120 oral capsule IMOGAM RABIES-HT (PF) 9

121 Drug Name PRIVIGEN PA SYNAGIS INTRAMUSCULAR SOLUTION 0 MG/0. ML IMMUNOLOGICA L AGENTS leflunomide SYNAGIS INTRAMUSCULAR SOLUTION 0 MG/0. ML IMMUNOMODULA TORS ACTEMRA INTRAVENOUS LA LA PA ACTIMMUNE BvD ARCALYST PA KEYTRUDA INTRAVENOUS SOLUTION leflunomide RIDAURA SYLVANT INTRAVENOUS RECON SOLN 00 MG PAns BvD QL (0 EA per QL (0 EA per TYSABRI PA; LA VACCINES ACTHIB (PF) ADACEL(TDAP ADOLESN/ADULT)(P F) bcg vaccine, live (pf) BEXSERO BOOSTRIX TDAP DAPTACEL (DTAP PEDIATRIC) (PF) Drug Name ENGERIX-B (PF) INTRAMUSCULAR SYRINGE ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE GARDASIL 9 (PF) HAVRIX (PF) HIBERIX (PF) IMOVAX RABIES VACCINE (PF) INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION IPOL IXIARO (PF) KINRIX (PF) MENACTRA (PF) INTRAMUSCULAR SOLUTION MENVEO A-C-Y-W- -DIP (PF) M-M-R II (PF) PEDIARIX (PF) PEDVAX HIB (PF) PROQUAD (PF) QUADRACEL (PF) RABAVERT (PF) RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 0 MCG/ML, 40 MCG/ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE BvD BvD BvD BvD ROTARIX 0

122 ROTATEQ VACCINE

123 Drug Name SHINGRIX (PF) TENIVAC (PF) INTRAMUSCULAR SYRINGE tetanus,diphtheria tox ped(pf) tetanus-diphtheria toxoids-td TRUMENBA TWINRIX (PF) INTRAMUSCULAR SYRINGE TYPHIM VI VAQTA (PF) VARIVAX (PF) VARIZIG INTRAMUSCULAR SOLUTION YF-VAX (PF) ZOSTAVAX (PF) INFLAMMATOR Y BOWEL DISEASE AGENTS AMINOSALICYLA TES balsalazide DIPENTUM LIALDA mesalamine oral tablet,delayed release (dr/ec). gram mesalamine rectal PENTASA ORAL CAPSULE, EXTENDED RELEASE 0 MG Drug Name PENTASA ORAL CAPSULE, EXTENDED RELEASE 00 MG GLUCOCORTICOI DS budesonide oral COLOCORT cortisone DEXAMETHASONE INTENSOL dexamethasone oral elixir dexamethasone oral tablet hydrocortisone oral hydrocortisone rectal methylprednisolone acetate methylprednisolone oral tablet methylprednisolone oral tablets,dose pack methylprednisolone sodium succ intravenous MILLIPRED ORAL TABLET prednisolone acetate prednisolone oral solution mg/ ml prednisolone sodium phosphate oral solution 0 mg/ ml, 0 mg/ ml (4 mg/ml), mg base/ ml (6.7 mg/ ml) prednisolone sodium phosphate oral tablet,disintegrating BvD 4 BvD BvD

124 INTENSOL prednisone oral solution

125 Drug Name prednisone oral tablet BvD PROCTO-MED HC PROCTOSOL HC TOPICAL VERIPRED 0 SULFONAMIDES sulfasalazine METABOLIC BONE DISEASE AGENTS METABOLIC BONE DISEASE AGENTS alendronate oral solution alendronate oral tablet 0 mg, 40 mg, mg alendronate oral tablet mg, 70 mg calcitonin (salmon) calcitriol intravenous solution mcg/ml calcitriol oral capsule calcitriol oral solution doxercalciferol etidronate disodium FORTEO ibandronate intravenous solution ibandronate oral MIACALCIN INJECTION PA 4 QL (86 ML QL (0 EA per QL (4 EA per 8 PA; QL (.4 ML per 8 QL ( EA per Drug Name paricalcitol oral 4 NON -FRF PROLIA PA risedronate oral tablet 0 mg risedronate oral tablet 0 mg, mg risedronate oral tablet mg risedronate oral tablet,delayed release (dr/ec) SENSIPAR ORAL TABLET 0 MG SENSIPAR ORAL TABLET 60 MG, 90 MG TYMLOS XGEVA BvD zoledronic acid intravenous solution zoledronic acidmannitol-water NON-FRF BvD PA AMINOSYN II 7 % BvD ampicillin oral capsule 0 mg ARALAST NP INTRAVENOUS RECON SOLN 00 MG bromfenac budesonide nasal ceftriaxone intravenous LA QL ( EA per QL (0 EA per QL (4 EA per 8 QL (4 EA per 8 PA; QL (.6 ML per 0 QL (7. ML NATPARA PA; LA cholestyramine (with pamidronate sugar) oral powder 4

126 intravenous solution paricalcitol intravenous CLINDAMYCIN PEDIATRIC

127 Drug Name colestipol oral granules CORMAX SCALP dextrose % in water (dw) intravenous parenteral solution diazepam rectal kit. mg, mg didanosine oral capsule,delayed release(dr/ec) mg diltiazem hcl oral capsule,extended release 4 hr 80 mg docetaxel intravenous solution 80 mg/8 ml (0 mg/ml) NF ELIPHOS fluocinolone topical oil fluorouracil intravenous solution. gram/0 ml GENGRAF ORAL CAPSULE 0 MG gentamicin sulfate (pf) intravenous solution 00 mg/0 ml GRASTEK hydrocortisone butyremollient BvD BvD BvD NF KIONEX LIORESAL INTRATHECAL SOLUTION 0 MCG/ML LORAZEPAM INTENSOL mesalamine with cleansing wipe 4 BvD PA QL (00 ML per 8 Drug Name MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK 400 MG (7)- 400 MG (7) MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK 600 MG (7)- 600 MG (7) nevirapine oral suspension penicillin g potassium injection recon soln million unit prednisolone sodium phosphate oral solution mg/ ml ( mg/ml) PREVALITE ORAL POWDER PRIMSOL 4 RAGWITEK sodium chloride 0.9 % intravenous parenteral solution SODIUM POLYSTYRENE (SORB FREE) NF TRUEPLUS INSULIN VIDEX GRAM PEDIATRIC OPHTHALMIC AGENTS OPHTHALMIC AGENTS bacitracin-polymyxin b ophthalmic (eye) BLEPHAMIDE 4 BLEPHAMIDE S.O.P. 4 6

128 neomycin-bacitracinpoly-hc 7

129 Drug Name neomycin-polymyxin b- dexameth neomycin-bacitracinpolymyxin neomycin-polymyxingramicidin neomycin-polymyxin-hc ophthalmic (eye) sulfacetamide sodium ophthalmic (eye) ointment polymyxin b sulftrimethoprim sulfacetamideprednisolone tobramycindexamethasone OPHTHALMIC AGENTS, OTHER atropine ophthalmic (eye) drops CYSTARAN RESTASIS sulfacetamide sodium ophthalmic (eye) ointment OPHTHALMIC ANTI-ALLERGY AGENTS azelastine ophthalmic (eye) cromolyn ophthalmic (eye) epinastine olopatadine ophthalmic (eye) QL (60 EA per Drug Name OPHTHALMIC ANTIGLAUCOMA AGENTS acetazolamide oral tablet ALPHAGAN P OPHTHALMIC (EYE) DROPS 0. % apraclonidine betaxolol ophthalmic (eye) bimatoprost ophthalmic (eye) brimonidine carteolol dorzolamide dorzolamide-timolol levobunolol ophthalmic (eye) drops 0. % methazolamide metipranolol PHOSPHOLINE IODIDE pilocarpine hcl ophthalmic (eye) drops %, %, 4 % timolol maleate ophthalmic (eye) drops timolol maleate ophthalmic (eye) drops, once daily timolol maleate ophthalmic (eye) gel forming solution OPHTHALMIC ANTI- INFLAMMATORIE S 4 8

130 dexamethasone sodium phosphate ophthalmic (eye) 9

131 Drug Name diclofenac sodium ophthalmic (eye) fluorometholone flurbiprofen sodium FML S.O.P. ketorolac ophthalmic (eye) prednisolone acetate prednisolone sodium phosphate ophthalmic (eye) OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS bimatoprost ophthalmic (eye) latanoprost OTIC AGENTS OTIC AGENTS CIPRODEX FLOXIN OTIC (EAR) DROPS hydrocortisone-acetic acid neomycin-polymyxin-hc otic (ear) ofloxacin oral tablet 00 mg RESPIRATORY TRACT/ PULMONARY AGENTS ANTIHISTAMINES azelastine nasal QL (60 ML per Drug Name desloratadine diphenhydramine hcl injection solution 0 mg/ml hydroxyzine hcl oral tablet levocetirizine oral solution levocetirizine oral tablet olopatadine nasal promethazine injection solution PA promethazine oral 4 PA ANTI- INFLAMMATORIE S, INHALED CORTICOSTEROI DS ASMANEX HFA ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 0 MCG (0 DOSES), 0 MCG (0 DOSES), 0 MCG (60 DOSES) ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 0 MCG (0 DOSES) budesonide inhalation BvD flunisolide nasal 4 QL (0 EA per QL (0 EA per QL (0. GM QL ( GM per QL ( EA per QL ( EA per 0

132 cetirizine oral solution mg/ml spray,non-aerosol mcg (0.0 %)

133 Drug Name fluticasone nasal fluticasone topical lotion mometasone nasal QVAR QVAR REDIHALER TRELEGY ELLIPTA ANTILEUKOTRIE NES montelukast zafirlukast zileuton BRONCHODILATO RS, ANTICHOLINERGI C ATROVENT HFA INCRUSE ELLIPTA ipratropium bromide inhalation ipratropium bromide nasal SPIRIVA RESPIMAT SPIRIVA WITH HANDIHALER BRONCHODILATO RS, SYMPATHOMIME TIC ADRENALIN INJECTION SOLUTION MG/ML ( ML) 4 BvD QL (6 GM per QL (4 GM per QL (7.4 GM QL (60 EA per QL (.8 GM QL (0 EA per QL (0 ML per QL (4 GM per QL (90 EA per 90 Drug Name albuterol sulfate inhalation solution for nebulization 0.6 mg/ ml,. mg/ ml,. mg / ml (0.08 %), mg/ml albuterol sulfate oral syrup albuterol sulfate oral tablet albuterol sulfate oral tablet extended release hr ARCAPTA NEOHALER DULERA epinephrine injection auto-injector 0. mg/0. ml, 0. mg/0. ml EPIPEN -PAK EPIPEN JR -PAK BvD levalbuterol hcl BvD metaproterenol PERFOROMIST BvD PROAIR HFA PROAIR RESPICLICK SEREVENT DISKUS STRIVERDI RESPIMAT terbutaline TRELEGY ELLIPTA 4 4 QL (0 EA per QL ( GM per QL (4 EA per QL (4 EA per QL (4 EA per QL (7 GM per QL ( EA per QL (60 EA per QL (4 GM per QL (60 EA per

134 Drug Name CYSTIC FIBROSIS AGENTS CAYSTON KALYDECO ORAL GRANULES IN PACKET KALYDECO ORAL TABLET ORKAMBI PULMOZYME BvD SYMDEKO PA MAST CELL STABILIZERS cromolyn inhalation BvD cromolyn oral PHOSPHODIESTE RASE INHIBITORS, AIRWAYS DISEASE aminophylline intravenous solution 0 mg/0 ml DALIRESP ORAL TABLET 00 MCG THEO-4 theophylline oral solution theophylline oral tablet extended release hr 00 mg, 00 mg, 00 mg theophylline oral tablet extended release 4 hr 4 PA LA; QL (84 ML per 8 PA; QL (6 EA per 8 PA; QL (60 EA PA; QL ( EA per 8 Drug Name PULMONARY ANTIHYPERTENSI VES ADCIRCA PA; QL (60 EA ADEMPAS PA; LA LETAIRIS PA; LA OPSUMIT PA; LA REMODULIN PA; LA sildenafil (antihypertensive) intravenous sildenafil (antihypertensive) oral TRACLEER ORAL TABLET RESPIRATORY TRACT AGENTS, OTHER PA PA; QL (90 EA PA; LA acetylcysteine BvD ARALAST NP INTRAVENOUS RECON SOLN,000 MG LA GRASTEK NF PA INCRUSE ELLIPTA LUMIZYME PROLASTIN-C INTRAVENOUS RECON SOLN RESPIRATORY TRACT/ PULMONARY AGENTS COMBIVENT RESPIMAT LA QL (0 EA per QL (8 GM per

135 ESBRIET ORAL CAPSULE PA; QL (70 EA per 0 4

136 Drug Name ESBRIET ORAL TABLET 67 MG ESBRIET ORAL TABLET 80 MG FASENRA PA ipratropium-albuterol BvD NUCALA OFEV PULMOZYME BvD SYMBICORT TRELEGY ELLIPTA XOLAIR SKELETAL MUSCLE RELAXANTS SKELETAL MUSCLE RELAXANTS cyclobenzaprine oral tablet tizanidine oral capsule SLEEP DISORDER AGENTS GABA RECEPTOR MODULATORS eszopiclone 4 zaleplon oral capsule 0 mg zaleplon oral capsule mg 4 PA 4 4 PA; QL (70 EA per 0 PA; QL (90 EA PA; LA; QL ( EA per 8 PA; QL (60 EA QL (0. GM QL (60 EA per PA; LA; QL (6 EA per 8 ST; QL (0 EA ST; QL (60 EA ST; QL (0 EA Drug Name zolpidem oral tablet zolpidem oral tablet,ext release multiphase SLEEP DISORDERS, OTHER armodafinil 4 PA doxepin oral capsule 0 mg, 00 mg, mg, 0 mg, 7 mg 4 PAns doxepin oral concentrate HETLIOZ 4 4 PAns ST; QL (0 EA ST; QL (0 EA PA; QL (0 EA modafinil PA ROZEREM ST; QL (0 EA XYREM PA; LA

137 Index abacavir... 4 abacavir-lamivudine... 4 abacavir-lamivudine-zidovudine 4 ABELCET... 9 ABILIFY MAINTENA.., 9, 40 ABRAXANE... acamprosate... 8 acarbose acebutolol... 4 acetaminophen-codeine... acetazolamide... 6, 80 acetazolamide sodium... 6 acetic acid... 9 acetylcysteine... 8 acitretin ACTEMRA...74, 76 ACTHIB (PF) ACTIMMUNE acyclovir acyclovir sodium ADACEL(TDAP ADOLESN/ADULT)(PF) ADAGEN adapalene adapalene-benzoyl peroxide ADCIRCA... 8 adefovir... 4 ADEMPAS... 8 ADRENALIN... 8 ADRIAMYCIN... ADRUCIL... AFEDITAB CR... 4 AFINITOR...6, 74 AFINITOR DISPERZ ALA-CORT ALBENZA... 8 albuterol sulfate... 8 alclometasone ALCOHOL PADS... 9 ALDURAZYME ALECENSA... 6 alendronate alfuzosin ALIMTA... ALINIA... 8 ALIQOPA... allopurinol... 0 allopurinol sodium... 0 almotriptan malate... ALOPRIM...0 alosetron...6 ALOXI...9 ALPHAGAN P...80 ALTAVERA (8)...70 ALUNBRIG...6 ALYACEN / (8)...70 amantadine hcl...9, 46 AMBISOME...9 amcinonide...67 AMETHIA...70 AMETHIA LO...70 amikacin...9 amiloride...6 amiloride-hydrochlorothiazide... aminophylline...8 AMINOSYN 7 % WITH ELECTROLYTES...6 AMINOSYN 8. %- ELECTROLYTES...6 AMINOSYN II 0 %...6 AMINOSYN II %...6 AMINOSYN II 7 %...78 AMINOSYN II 8. %...6 AMINOSYN II 8. %- ELECTROLYTES...6 AMINOSYN-HBC 7%...6 AMINOSYN-PF 0 %...6 AMINOSYN-PF 7 % (SULFITE-FREE)...6 AMINOSYN-RF. %...6 amiodarone..., 4 amitriptyline...8 amlodipine...4 amlodipine-atorvastatin... amlodipine-benazepril... amlodipine-olmesartan... amlodipine-valsartan... amlodipine-valsartan-hcthiazid.. ammonium lactate...60 AMNESTEEM...60 amoxapine...8 amoxicil-clarithromy-lansopraz. 64 amoxicillin... amoxicillin-pot clavulanate... amphotericin b...9 ampicillin..., 78 ampicillin sodium... ampicillin-sulbactam... AMPYRA...8 ANADROL anagrelide... anastrozole... ANDROGEL...70 APEXICON E...60 APOKYN...9 apraclonidine...80 aprepitant...9 APRI...70 APTIOM...4 APTIVUS...4 ARALAST NP...78, 8 ARANELLE (8)...70 ARCALYST...76 ARCAPTA NEOHALER...8 aripiprazole..., 6, 40 ARISTADA...40 armodafinil...84 ARRANON... ASHLYNA...70 ASMANEX HFA...8 ASMANEX TWISTHALER...8 aspirin-dipyridamole... ASSURE ID INSULIN SAFETY... atazanavir...4 atenolol...4 atenolol-chlorthalidone... atomoxetine...7 atorvastatin...6 atovaquone...8 atovaquone-proguanil...8 ATRIPLA...4 atropine...64, 80 ATROVENT HFA...8 AUBRA...70 AUGMENTIN... AVASTIN... AVIANE...70 AVITA... 8, 60 AVONEX...8, 9 AVONEX (WITH ALBUMIN)..8 azacitidine... azathioprine...74 azathioprine sodium...74 azelastine... 80, 8 azithromycin... aztreonam... 6

138 BACIIM... 9 bacitracin... 9 bacitracin-polymyxin b baclofen... 4 balsalazide BALZIVA (8) BANZEL...4, BARACLUDE... 4 BAVENCIO... 8 BAXDELA... bcg vaccine, live (pf) BEKYREE (8) BELEODAQ... benazepril... benazepril-hydrochlorothiazide.. BENLYSTA benztropine... 9 betamethasone dipropionate...0, 60, 67 betamethasone valerate... 0, 67 betamethasone, augmented...0, 67 BETASERON... 9 betaxolol... 4, 80 bethanechol chloride BETHKIS... 9 bexarotene... 8 BEXSERO bicalutamide... BICILLIN C-R... BICILLIN L-A... BICNU... BIKTARVY BILTRICIDE... 8 bimatoprost... 80, 8 bisoprolol fumarate... 4 bisoprolol-hydrochlorothiazide.. bleomycin... BLEPHAMIDE...0, 79 BLEPHAMIDE S.O.P... 0, 79 BLISOVI 4 FE BLISOVI FE./0 (8)... 7 BLISOVI FE /0 (8)... 7 BOOSTRIX TDAP bortezomib... BOSULIF... 6 BOTOX..., 4 BRIELLYN... 7 BRILINTA... brimonidine BRIVIACT... bromfenac...78 bromocriptine... 9, 7 budesonide... 6, 7, 77, 78, 8 bumetanide...6 BUPHENYL...66 buprenorphine hcl...6, 8 buprenorphine-naloxone...8 bupropion hcl...6 bupropion hcl (smoking deter)...8 buspirone...46 busulfan... BUSULFEX... butorphanol tartrate...7 BYDUREON...49 BYDUREON BCISE...49 BYETTA...49 cabergoline...7 CABOMETYX...6 calcipotriene...60 calcipotriene-betamethasone...60 calcitonin (salmon)...78 calcitriol...60, 78 calcium acetate...67 CALQUENCE...6 CAMILA...7 CAMRESE LO...7 CANCIDAS...9 candesartan... candesartan-hydrochlorothiazid. CAPASTAT... CAPRELSA...6 captopril... captopril-hydrochlorothiazide... CARBAGLU...6 carbamazepine..., 49 carbidopa...9 carbidopa-levodopa...9 carbidopa-levodopa-entacapone 9 carboplatin... carteolol...80 CARTIA XT...4 carvedilol...4 carvedilol phosphate...4 caspofungin...9 CAYSTON..., 8 CAZIANT (8)...7 cefaclor...0 cefadroxil...0 cefazolin...0 cefdinir...0 cefepime...0 cefixime...0 cefotaxime...0 cefotetan...0 cefoxitin...0 cefpodoxime...0 cefprozil...0 ceftazidime...0 ceftriaxone... 0, 78 cefuroxime axetil...0 cefuroxime sodium...0 celecoxib..., CELLCEPT INTRAVENOUS...9, 74 CELONTIN... cephalexin...0 CERDELGA...66 CEREZYME...66 cetirizine...8 cevimeline...9 CHANTIX...8 CHANTIX CONTINUING MONTH BOX...8 CHANTIX STARTING MONTH BOX...9 CHEMET...6 CHENODAL...64 chloramphenicol sod succinate...9 chlorhexidine gluconate...9 chloroquine phosphate...8 chlorothiazide...6 chlorothiazide sodium...6 chlorpromazine... 8, 9 chlorthalidone...6 CHOLBAM...64 cholestyramine (with sugar). 6, 78 CHOLESTYRAMINE LIGHT...6 ciclopirox...9 cidofovir...4 cilostazol... cimetidine...64 cimetidine hcl...64 CINRYZE...74 CIPRODEX...8 ciprofloxacin... ciprofloxacin (mixture)... ciprofloxacin hcl... ciprofloxacin in % dextrose... ciprofloxacin lactate... cisplatin... 7

139 citalopram... 6 cladribine... 4 CLARAVIS clarithromycin... CLINDACIN P... 9 clindamycin hcl... 9 clindamycin in % dextrose... 9 clindamycin palmitate hcl... 9 CLINDAMYCIN PEDIATRIC.. 78 clindamycin phosphate... 9 clindamycin-benzoyl peroxide clindamycin-tretinoin CLINIMIX %/DW SULFITE FREE... 6 CLINIMIX %/DW SULFITE-FREE... 6 CLINIMIX.7%/DW SULFIT FREE... 6 CLINIMIX 4.%/D0W SULF FREE... 6 CLINIMIX 4.%/DW SULFIT FREE... 6 CLINIMIX 4.%-D0W SULF-FREE... 6 CLINIMIX 4.%-DW SULF-FREE... 6 CLINIMIX %- D0W(SULFITE-FREE)... 6 clobetasol... 60, 67 clobetasol-emollient CLODAN clofarabine... 4 CLOLAR... 4 clomipramine... 8 clonazepam..., 46 clonidine... clonidine hcl..., 7 clopidogrel... clorazepate dipotassium..., 46 clotrimazole... 9 clotrimazole-betamethasone clozapine... 4 COARTEM... 8 codeine sulfate... 7 COLCRYS... 0 colestipol...7, 79 colistin (colistimethate na)... 9 COLOCORT COMBIVENT RESPIMAT... 8 COMETRIQ... 6 COMPLERA...44 COMPRO...8 CONSTULOSE...6 CORLANOR... CORMAX...79 cortisone... 0, 68, 77 COSMEGEN...4 COTELLIC...6 CREON...66 CRESEMBA...9 CRIXIVAN...4 cromolyn... 80, 8 CRYSELLE (8)...7 CUPRIMINE...67 CYCLAFEM / (8)...7 CYCLAFEM 7/7/7 (8)...7 cyclobenzaprine...84 cyclophosphamide... CYCLOSET...49 cyclosporine...74 cyclosporine modified...74 CYRAMZA...8 CYSTADANE...66 CYSTAGON...66 CYSTARAN...80 cytarabine...4 cytarabine (pf)...4 d0 %-0.4 % sodium chloride...6 d. %-0.4 % sodium chloride..6 d % and 0.9 % sodium chloride...6 d %-0.4 % sodium chloride...6 dacarbazine...4 dactinomycin...4 DALIRESP...8 danazol...70 dantrolene...4 dapsone..., 60 DAPTACEL (DTAP PEDIATRIC) (PF)...76 daptomycin...9 darifenacin...66 DARZALEX...8 daunorubicin...4 DEBLITANE...7 decitabine...4 DELYLA (8)...7 demeclocycline... DEMSER... DENAVIR...44 DEPEN TITRATABS... 6, 67, 74 DEPO-PROVERA...7 DESCOVY...4 desipramine...8 desloratadine... 8 desmopressin...69 desog-e.estradiol/e.estradiol...7 desogestrel-ethinyl estradiol...7 desonide...68 desoximetasone...68 desvenlafaxine succinate...7 dexamethasone...0, 68, 77 DEXAMETHASONE INTENSOL...0, 68, 77 dexamethasone sodium phosphate... 0, 68, 80 dexmethylphenidate...7 dexrazoxane hcl...4 dextroamphetamine...7 dextroamphetamineamphetamine...7 dextrose 0 % and 0. % nacl...6 dextrose 0 % in water (d0w)... 6 dextrose % in water (dw). 6, 79 dextrose %-lactated ringers... 6 dextrose %-0. % sod chloride. 6 dextrose %-0. % sod.chloride. 6 DIASTAT..., 4, 46 DIASTAT ACUDIAL..., 4, 46 diazepam..., 4, 46, 79 DIAZEPAM INTENSOL, 4, 46 diclofenac potassium..., diclofenac sodium...,, 60, 8 diclofenac-misoprostol... dicloxacillin... dicyclomine...64 didanosine...4, 79 diflorasone...68 diflunisal..., DIGITEK... DIGOX... digoxin... dihydroergotamine..., DILANTIN... diltiazem hcl...4, 79 DILT-XR...4 DIPENTUM...77 diphenhydramine hcl...9, 9, 8 diphenoxylate-atropine...64 dipyridamole... 8

140 disulfiram... 8 divalproex... 4,, 49 docetaxel... 4, 79 dofetilide... 4 donepezil... dorzolamide dorzolamide-timolol doxazosin..., 66 doxepin...8, 46, 60, 84 doxercalciferol... 6, 78 doxorubicin... 4 doxorubicin, peg-liposomal... 4 DOXY doxycycline hyclate..., 9, 60 doxycycline monohydrate, 9, 60 dronabinol... 9 drospirenone-e.estradiol-lm.fa... 7 drospirenone-ethinyl estradiol... 7 DROXIA... DULERA... 8 duloxetine...7, 46, 8 DUPIXENT DURAMORPH (PF)... 6 dutasteride dutasteride-tamsulosin E.E.S econazole... 9 EDURANT efavirenz...44, 4 ELAPRASE eletriptan... ELIPHOS ELIQUIS... ELITEK... 4 ELMIRON EMCYT... EMEND... 9 EMOQUETTE... 7 EMPLICITI... 8 EMSAM... 6 EMTRIVA... 4 EMVERM... 8 enalapril maleate... enalapril-hydrochlorothiazide... ENBREL... 7 ENBREL SURECLICK... 7 ENDOCET... ENGERIX-B (PF) ENGERIX-B PEDIATRIC (PF).76 enoxaparin... ENPRESSE...7 ENSKYCE...7 entacapone...9 entecavir...4 ENTRESTO... ENULOSE...6 EPCLUSA...4 epinastine...80 epinephrine...8 EPIPEN -PAK...8 EPIPEN JR -PAK...8 epirubicin...4 EPITOL..., 49 EPIVIR HBV...4 eplerenone...6 eprosartan... ERBITUX...4 ergoloid... ergotamine-caffeine... ERIVEDGE...6 ERLEADA... ERRIN...7 ERWINAZE...4 ERY PADS... ERYGEL...60 ERY-TAB... ERYTHROCIN... ERYTHROCIN (AS STEARATE)... erythromycin... erythromycin ethylsuccinate... erythromycin with ethanol... erythromycin-benzoyl peroxide...60 ESBRIET... 8, 84 escitalopram oxalate...7, 46 esomeprazole magnesium...6 esomeprazole sodium...6 ESTRACE...70 estradiol...70 estradiol valerate... 70, 7 estradiol-norethindrone acet...7 eszopiclone...84 ethacrynate sodium...6 ethacrynic acid...6 ethambutol... ethosuximide... ethynodiol diac-eth estradiol...7 etidronate disodium...78 etodolac..., ETOPOPHOS... etoposide... EVOTAZ...4 exemestane... EXJADE...6 ezetimibe...7 ezetimibe-simvastatin... FABRAZYME...66 FALMINA (8)...7 famciclovir...44 famotidine...64 famotidine (pf)...64 famotidine (pf)-nacl (iso-os)...64 FANAPT...40 FARESTON... FARYDAK... FASENRA...84 FASLODEX...4 FAYOSIM...7 FAZACLO...4 felbamate...4 felodipine...4 FEMYNOR...7 fenofibrate...6 fenofibrate micronized...6 fenofibrate nanocrystallized...6 fenofibric acid...6 fenofibric acid (choline)...6 fenoprofen..., fentanyl... 6, 7 fentanyl citrate... 6, 7 FERRIPROX...6 FETZIMA...7 finasteride...66 FIRAZYR...74 FIRMAGON KIT W DILUENT SYRINGE... 7, 74 flavoxate...66 flecainide...4 FLOXIN...8 fluconazole...9 fluconazole in nacl (iso-osm)...9 flucytosine...9 fludarabine... fludrocortisone...68 flunisolide...8 fluocinolone... 68, 79 fluocinolone acetonide oil...68 fluocinolone and shower cap...68 fluocinonide... 60, 68 FLUOCINONIDE-E

141 fluorometholone... 8 fluorouracil... 60, 79 fluoxetine..., 7 fluphenazine decanoate... 9 fluphenazine hcl... 9 flurandrenolide... 60, 68 flurbiprofen..., flurbiprofen sodium... 8 flutamide... fluticasone...60, 68, 8 fluvastatin... 6 fluvoxamine... 7 FML S.O.P FOLOTYN... 4 fomepizole... 6 fondaparinux... FORTEO fosamprenavir... 4 fosinopril... fosinopril-hydrochlorothiazide... fosphenytoin... frovatriptan... furosemide... 6 FUZEON... 4 FYCOMPA... 4 gabapentin... 4 GABITRIL... 4 galantamine... ganciclovir sodium... 4 GARDASIL 9 (PF) gatifloxacin... GATTEX 0-VIAL GAUZE PAD... GAVILYTE-C... 6 GAVILYTE-G... 6 GAVILYTE-N... 6 gemcitabine... gemfibrozil... 6 GENERLAC... 6 GENGRAF... 7, 79 GENTAK... 9 gentamicin... 9 gentamicin in nacl (iso-osm)... 9 gentamicin sulfate (pf) GENVOYA GEODON...40, 47 GIANVI (8)... 7 GILENYA... 9 GILOTRIF... 6 glatiramer... 9 GLATOPA...9 GLEOSTINE...4 glimepiride...49 glipizide...49, 0 glipizide-metformin... GLUCAGEN HYPOKIT... GLUCAGON EMERGENCY KIT (HUMAN)... glycopyrrolate...64 granisetron (pf)...9 granisetron hcl...9 GRANIX... GRASTEK... 79, 8 griseofulvin microsize...9 griseofulvin ultramicrosize...9 guanidine... HALAVEN...4 halobetasol propionate...68 haloperidol...9 haloperidol decanoate...9 haloperidol lactate...9 HARVONI...4 HAVRIX (PF)...76 heparin (porcine)... heparin (porcine) in % dex... HEPATAMINE 8%...6 HERCEPTIN...4 HETLIOZ...84 HEXALEN... HIBERIX (PF)...76 HUMALOG JUNIOR KWIKPEN U HUMALOG KWIKPEN INSULIN... HUMALOG MIX 0-0 INSULN U HUMALOG MIX 0-0 KWIKPEN... HUMALOG MIX 7- KWIKPEN... HUMALOG MIX 7-(U- 00)INSULN... HUMALOG U-00 INSULIN... HUMIRA...7 HUMIRA PEDIATRIC CROHN'S START...7 HUMIRA PEN...7 HUMIRA PEN CROHN'S-UC- HS START...7 HUMIRA PEN PSORIASIS- UVEITIS...7 HUMULIN 70/0 U-00 INSULIN... HUMULIN 70/0 U-00 KWIKPEN... HUMULIN N NPH INSULIN KWIKPEN... HUMULIN N NPH U-00 INSULIN... HUMULIN R REGULAR U- 00 INSULN... HUMULIN R U-00 (CONC) INSULIN... HUMULIN R U-00 (CONC) KWIKPEN... hydralazine...7 hydrochlorothiazide... 6 hydrocodone-acetaminophen, 7 hydrocodone-ibuprofen... hydrocortisone... 0, 68, 77 hydrocortisone butyrate...68 hydrocortisone butyr-emollient...79 hydrocortisone valerate...68 hydrocortisone-acetic acid... 8 hydromorphone...6, 7 hydromorphone (pf)... 6, 7 hydroxychloroquine...8 hydroxyprogesterone caproate... 7 hydroxyurea... hydroxyzine hcl... 9, 46, 8 ibandronate...78 IBRANCE... ibuprofen..., ibuprofen-oxycodone..., ICLUSIG...6, 7 idarubicin...4 IDHIFA..., 6 ifosfamide...4 imatinib...7 IMBRUVICA...7 IMFINZI...8 imipenem-cilastatin... imipramine hcl...8 imipramine pamoate...8 imiquimod...6 IMOGAM RABIES-HT (PF)...7 IMOVAX RABIES VACCINE (PF)...76 INCRELEX

142 INCRUSE ELLIPTA... 8, 8 indapamide... 6 INFANRIX (DTAP) (PF) INFLECTRA... 7 INLYTA... 7 insulin syringe-needle u INTELENCE... 4 INTRALIPID... 6 INTRON A... 4 INTROVALE... 7 INVANZ... INVEGA SUSTENNA INVEGA TRINZA INVIRASE INVOKAMET... 0 INVOKAMET XR... 0 INVOKANA... 0 IONOSOL-MB IN DW... 6 IPOL ipratropium bromide... 8 ipratropium-albuterol irbesartan... irbesartan-hydrochlorothiazide..., 6 IRESSA... 7 irinotecan... 4 ISENTRESS ISENTRESS HD ISIBLOOM... 7 ISOLYTE-P IN % DEXTROSE... 6 ISOLYTE-S... 6 isoniazid... isosorbide dinitrate... 7 isosorbide mononitrate... 7 isotretinoin... 6 isradipine... 4 ISTODAX... 4 itraconazole... 9 ivermectin... 8 IXIARO (PF) JADENU... 6 JADENU SPRINKLE... 6 JAKAFI... 7 JANTOVEN... JANUMET... JANUMET XR... JANUVIA... 0 JARDIANCE... 0 JENTADUETO...0, JENTADUETO XR... 0, JEVTANA...4 JOLIVETTE...7 JULEBER...7 JULUCA...4 JUNEL./0 ()...7 JUNEL /0 ()...7 JUNEL FE./0 (8)...7 JUNEL FE /0 (8)...7 JUNEL FE JUXTAPID...7 KADCYLA...4 KAITLIB FE...7 KALETRA...46 KALYDECO...8 KANUMA...66 KARIVA (8)...7 KELNOR / (8)...7 KEPIVANCE...9 ketoconazole...9 ketoprofen... 6, ketorolac...8 KEYTRUDA... 8, 76 KHEDEZLA...7 KIMIDESS (8)...7 KINRIX (PF)...76 KIONEX...79 KISQALI...6 KISQALI FEMARA CO-PACK 6 KLOR-CON...6 KLOR-CON 0...6, 6 KLOR-CON 8...6, 6 KLOR-CON M0... 6, 6 KLOR-CON M... 6, 6 KLOR-CON M0... 6, 6 KLOR-CON SPRINKLE...6, 6 KORLYM... K-TAB...6 KURVELO...7 KUVAN...66 KYPROLIS...7 l norgest/e.estradiol-e.estrad...7 labetalol...4 lactated ringers...6 lactulose...6 lamivudine...4, 4 lamivudine-zidovudine...4 lamotrigine...4, 49 LANOXIN... lansoprazole...6 lanthanum...67 LANTUS SOLOSTAR U-00 INSULIN... LANTUS U-00 INSULIN... LARIN./0 ()...7 LARIN /0 ()...7 LARIN FE./0 (8)...7 LARIN FE /0 (8)...7 LARISSIA...7 LARTRUVO...8 latanoprost...8 LATUDA...40 LAYOLIS FE...7 LEENA leflunomide...76 LENVIMA...7 LESSINA...7 LETAIRIS...8 letrozole... leucovorin calcium... LEUKERAN... LEUKINE... leuprolide...74 levalbuterol hcl...8 LEVEMIR FLEXTOUCH U- 00 INSULN... LEVEMIR U-00 INSULIN... levetiracetam... levetiracetam in nacl (iso-os)... levobunolol...80 levocarnitine...6 levocarnitine (with sugar)...6 levocetirizine...8 levofloxacin... levofloxacin in dw... levoleucovorin...4 LEVONEST (8)...7 levonorgestrel-ethinyl estrad...7 levonorg-eth estrad triphasic...7 LEVORA levorphanol tartrate...6 levothyroxine...7 LEVOXYL...7 LEXIVA...46 LIALDA...77 lidocaine...8 lidocaine (pf)...8 lidocaine hcl...8 LIDOCAINE VISCOUS...8 lidocaine-prilocaine...8 4

143 lincomycin... 9 lindane... 9 linezolid... 9 LINZESS... 6 LIORESAL... 4, 79 liothyronine... 7 lisinopril... lisinopril-hydrochlorothiazide... lithium carbonate lithium citrate LONSURF... loperamide lopinavir-ritonavir lorazepam... 4, 46 LORAZEPAM INTENSOL LORCET (HYDROCODONE).. LORCET HD... LORCET PLUS... LORYNA (8)... 7 losartan... losartan-hydrochlorothiazide... lovastatin... 6 LOW-OGESTREL (8)... 7 loxapine succinate... 9 LUMIZYME... 8 LUPRON DEPOT LUPRON DEPOT ( MONTH). 74 LUPRON DEPOT (4 MONTH). 74 LUPRON DEPOT (6 MONTH). 74 LUPRON DEPOT-PED LUPRON DEPOT-PED ( MONTH) LUTERA (8)... 7 LYNPARZA... 4 LYRICA..., 8 LYSODREN... 7 LYZA... 7 magnesium sulfate... 6 MAKENA... 7 malathion... 9 maprotiline... 6 MARLISSA... 70, 7, 7 MARPLAN... 6 MATULANE... MATZIM LA... 4 meclizine... 9 meclofenamate... 6, medroxyprogesterone... 7 mefenamic acid... 6, mefloquine... 8 megestrol...7 MEKINIST...7 meloxicam... 6, melphalan hcl... memantine... MENACTRA (PF)...76 MENEST...70 MENVEO A-C-Y-W--DIP (PF)...76 mercaptopurine...7 meropenem... mesalamine...77 mesalamine with cleansing wipe 79 mesna...4 MESNEX...4 MESTINON... METADATE ER...7 metaproterenol...8 metformin...0 methadone...6, 7 methamphetamine...7 methazolamide... 6, 80 methenamine hippurate...9 methimazole...74 methotrexate sodium...7 methotrexate sodium (pf)...7 methoxsalen...6 methyclothiazide...6 methyldopa... methylphenidate hcl...8 methylprednisolone...0, 68, 77 methylprednisolone acetate...0, 68, 77 methylprednisolone sodium succ...0, 68, 77 methyltestosterone...70 metipranolol...80 metoclopramide hcl...9, 64 metolazone...6 metoprolol succinate...4 metoprolol ta-hydrochlorothiaz.. metoprolol tartrate...4 metronidazole... 9, 0 metronidazole in nacl (iso-os)...9 mexiletine...4 MIACALCIN...78 MIBELAS 4 FE...7 MICONAZOLE-...0 MICROGESTIN./0 ()...7 MICROGESTIN /0 ()...7 MICROGESTIN FE./0 (8).7 MICROGESTIN FE /0 (8)...7 midodrine... MIGERGOT... miglitol...0 MILLIPRED... 0, 68, 77 minocycline...,, 9 minoxidil...7 mirtazapine...6 misoprostol... 6, 69 MITIGARE...0 mitomycin...4 mitoxantrone..., 9 M-M-R II (PF)...76 modafinil...84 MODERIBA...4 MODERIBA DOSE PACK.. 4, 79 moexipril... moexipril-hydrochlorothiazide... mometasone... 68, 8 MONONESSA (8)...7 montelukast...8 MORGIDOX... morphine...7 morphine concentrate... 7 MOVANTIK...64 moxifloxacin... MOZOBIL... mupirocin...0 mupirocin calcium...0 MUSTARGEN...4 MYALEPT...69 MYCAMINE...0 mycophenolate mofetil...7 mycophenolate mofetil hcl...7 mycophenolate sodium...7 MYLOTARG...4 MYORISAN...6 nabumetone...6, nadolol...4 nadolol-bendroflumethiazide... nafcillin... naftifine...0 NAGLAZYME...66 nalbuphine...7 naloxone...8 naltrexone...8 NAMENDA XR... NAMZARIC... naproxen... 6, 4

144 naproxen sodium...6, naratriptan... NARCAN... 8 NATACYN... 0 nateglinide... 0 NATPARA NATROBA... 6 NEBUPENT... 8 NECON 0./ (8)... 7 NECON 7/7/7 (8)... 7 nefazodone... 6 neomycin... 9 neomycin-bacitracin-poly-hc neomycin-bacitracin-polymyxin..80 neomycin-polymyxin b gu... 9 neomycin-polymyxin b- dexameth neomycin-polymyxin-gramicidin 80 neomycin-polymyxin-hc... 80, 8 NEPHRAMINE.4 %... 6 NERLYNX... 7 NEUAC... 6 NEULASTA... NEUPOGEN... NEUPRO... 9 nevirapine... 4, 79 NEXAVAR... 7 niacin... 7 nicardipine... 4 NICOTROL... 9 NICOTROL NS... 9 nifedipine... 4 NIKKI (8)... 7 nilutamide... nimodipine... NINLARO... 4 nisoldipine... NITRO-BID... 7 nitrofurantoin... 0 nitrofurantoin macrocrystal... 0 nitrofurantoin monohyd/m-cryst. 0 nitroglycerin... 7 nizatidine NOLIX... 6 NORA-BE... 7 noreth-ethinyl estradiol-iron... 7 norethindrone (contraceptive)... 7 norethindrone acetate... 7 norethindrone ac-eth estradiol... 7 norethindrone-e.estradiol-iron... 7 norgestimate-ethinyl estradiol...7 NORLYROC...7 NORMOSOL-R IN % DEXTROSE...6 NORMOSOL-R PH NORTHERA... NORTREL 0./ (8)...7 NORTREL / ()...7 NORTREL / (8)...7 NORTREL 7/7/7 (8)...7 nortriptyline...8 NORVIR...46 NOXAFIL...0 NUCALA...84 NUEDEXTA...8 NULOJIX...7 NUPLAZID...40 NYAMYC...0 nystatin...0 nystatin-triamcinolone...6 NYSTOP...0 OCALIVA...64 OCELLA...7 octreotide acetate...74 ODEFSEY...4 ODOMZO...7 OFEV... 7, 84 ofloxacin..., 8 OGESTREL (8)...7 olanzapine...40, 47 olanzapine-fluoxetine... olmesartan... olmesartan-amlodipin-hcthiazid. olmesartan-hydrochlorothiazide..., olopatadine... 80, 8 omeprazole...6 omeprazole-sodium bicarbonate.6 OMNITROPE...69 ondansetron...9 ondansetron hcl...9 ondansetron hcl (pf)...9 ONFI...4 OPDIVO...8 OPSUMIT...8 ORENCIA...7 ORENCIA (WITH MALTOSE).7 ORENCIA CLICKJECT...7 ORFADIN...66 ORKAMBI...8 ORSYTHIA...7 oseltamivir...46 OTEZLA...7 OTEZLA STARTER...7 oxacillin... oxacillin in dextrose(iso-osm)... oxaliplatin...4 oxandrolone...70 oxaprozin... 6, oxcarbazepine... oxiconazole...6 oxybutynin chloride...66 oxycodone...7 oxycodone-acetaminophen... oxycodone-aspirin... oxymorphone...7, 8 PACERONE...4 paclitaxel...4 paliperidone... 4 pamidronate...78 PANRETIN...8 pantoprazole... 6 paricalcitol...78 paromomycin...9 paroxetine hcl... 8, 46, 47 paroxetine mesylate(menop.sym)...8 PASER... PAXIL...8, 47 PEDIARIX (PF)...76 PEDVAX HIB (PF)...76 peg 0-electrolytes...6 PEGANONE... PEGASYS...44 PEGASYS PROCLICK...4 peg-electrolyte soln...6 pen needle, diabetic... penicillin g potassium..., 79 penicillin g procaine... penicillin g sodium... penicillin v potassium... PENTAM...8 PENTASA...77 pentoxifylline... PERFOROMIST...8 perindopril erbumine... PERIOGARD...9 PERJETA...4 permethrin...9 perphenazine...9, 9 4

145 phenelzine... 6 phenobarbital... 4 phenoxybenzamine..., 67 phenytoin... phenytoin sodium... phenytoin sodium extended... PHOSPHOLINE IODIDE pilocarpine hcl... 9, 80 pimozide... 9 PIMTREA (8)... 7 pindolol... 4 pioglitazone... 0 pioglitazone-glimepiride... pioglitazone-metformin... piperacillin-tazobactam... PIRMELLA... 7 piroxicam... 6, PLASMA-LYTE PLASMA-LYTE A... 6 PLEGRIDY... 9 PLENAMINE... 6, 6 podofilox... 6 polyethylene glycol polymyxin b sulfate... 0 polymyxin b sulf-trimethoprim POMALYST... PORTIA... 7 potassium chlorid-d- 0.4%nacl... 6 potassium chloride...6, 6 potassium chloride in 0.9%nacl. 6 potassium chloride in % dex 6 potassium chloride in lr-d... 6 potassium chloride in water... 6 potassium chloride-0.4 % nacl. 6 potassium chloride-d- 0.%nacl... 6 potassium chloride-d- 0.%nacl... 6 potassium chloride-d- 0.9%nacl... 6 potassium citrate PRADAXA... PRALUENT PEN... 7 pramipexole... 9 prasugrel... pravastatin... 6 prazosin..., 67 prednicarbate...6, 69 prednisolone... 0, 69, 77 prednisolone acetate... 0, 77, 8 prednisolone sodium phosphate..., 69, 77, 79, 8 prednisone..., 69, 77, 78 PREDNISONE INTENSOL..., 69, 77 PREMASOL 0 %...6 PREMASOL 6 %...6 PRENATAL VITAMIN PLUS LOW IRON...6 PREVALITE...7, 79 PREVIFEM...7 PREVYMIS...4 PREZCOBIX...46 PREZISTA...46 PRIFTIN... primaquine...8 primidone...4 PRIMSOL...79 PRIVIGEN...76 PROAIR HFA...8 PROAIR RESPICLICK...8 probenecid...0 probenecid-colchicine...0 procainamide...4 PROCENTRA...7 prochlorperazine...9 prochlorperazine edisylate... 9, 9 prochlorperazine maleate... 9, 9 PROCRIT..., PROCTO-MED HC...78 PROCTO-PAK...69 PROCTOSOL HC...78 PROCTOZONE-HC... 64, 69 PROFENO... 6, progesterone micronized...7 PROGLYCEM... PROGRAF...7 PROLASTIN-C...8 PROLEUKIN...4 PROLIA...78 PROMACTA... promethazine...9, 8 propafenone...4 propranolol...4 propranolol-hydrochlorothiazid. propylthiouracil...74 PROQUAD (PF)...76 protriptyline...8 PRUDOXIN...8, 6 PULMOZYME... 8, 84 PURIXAN... pyrazinamide... pyridostigmine bromide... QUADRACEL (PF)...76 QUASENSE...7 quetiapine... 6, 4, 47, 48 quinapril... quinapril-hydrochlorothiazide... quinidine gluconate...4 quinidine sulfate...4 quinine sulfate...8 QVAR...8 QVAR REDIHALER...8 RABAVERT (PF)...76 rabeprazole...6 RADICAVA...8 RAGWITEK...79 raloxifene...7 ramipril... RANEXA... ranitidine hcl...64, 6 RAPAMUNE...7 rasagiline...9 RAVICTI...66 REBIF (WITH ALBUMIN)...9 REBIF REBIDOSE...9 REBIF TITRATION PACK...9 RECLIPSEN (8)...7 RECOMBIVAX HB (PF)...76 RECTIV...7 REGRANEX... 6 RELENZA DISKHALER...46 RELISTOR...64 REMICADE...7 REMODULIN...8 RENVELA...67 repaglinide...0 repaglinide-metformin... REPATHA PUSHTRONEX...7 REPATHA SURECLICK...7 REPATHA SYRINGE...7 RESCRIPTOR...4 RESTASIS...80 RETROVIR...4 REVLIMID..., REXULTI...4 REYATAZ...46 RIBASPHERE... 4, 44 RIBASPHERE RIBAPAK... 4, 44 44

146 ribavirin... 4, 44 RIDAURA rifabutin... rifampin... riluzole... 8 rimantadine ringer's... 6 RIOMET... 0 risedronate RISPERDAL CONSTA...4, 48 risperidone... 4, 4, 48 RITUXAN... 8 rivastigmine... rivastigmine tartrate... RIVELSA... 7 rizatriptan... ropinirole... 9 rosuvastatin... 6 ROTARIX ROTATEQ VACCINE ROWEEPRA... ROZEREM RUBRACA... 4, RYDAPT... 7 SABRIL... 4 SAMSCA... 6 SANDIMMUNE... 7 SANDOSTATIN LAR DEPOT..74 SANTYL... 6 SAPHRIS (BLACK CHERRY)...4, 48 scopolamine base...9, 64 selegiline hcl... 9 selenium sulfide... 6 SELZENTRY... 4 SENSIPAR SEREVENT DISKUS... 8 sertraline...8, 47 SETLAKIN... 7 sevelamer carbonate SHAROBEL... 7 SHINGRIX (PF) SIGNIFOR sildenafil (antihypertensive)... 8 silver sulfadiazine... SIMULECT... 7 simvastatin... 6 sirolimus... 7 SIRTURO... SIVEXTRO... 0 sodium chloride...6 sodium chloride 0.4 %...6 sodium chloride 0.9 %... 6, 79 sodium chloride %...6 sodium chloride %...6 sodium lactate...6 sodium phenylbutyrate...66, 67 SODIUM POLYSTYRENE (SORB FREE)...79 sodium polystyrene sulfonate...6 SOLTAMOX... SOMATULINE DEPOT...74 SOMAVERT...74 SORINE...4 sotalol...4 SOTALOL AF...4 SOTYLIZE...4 SPIRIVA RESPIMAT...8 SPIRIVA WITH HANDIHALER...8 spironolactone...6 spironolacton-hydrochlorothiaz. SPORANOX...0 SPRINTEC (8)...7 SPRITAM... SPRYCEL...7 SPS (WITH SORBITOL)...6 SRONYX...7 SSD... stavudine...4 STIMATE...69 STIVARGA...7 STRENSIQ...66 streptomycin...9 STRIBILD...44 STRIVERDI RESPIMAT...8 SUBOXONE...8 SUCRAID...66 sucralfate...6 sulfacetamide sodium..., 80 sulfacetamide sodium (acne)... sulfacetamide-prednisolone.., 80 sulfadiazine... sulfamethoxazole-trimethoprim.. SULFAMYLON...0 sulfasalazine...78 sulindac...6, sumatriptan... sumatriptan succinate... sumatriptan-naproxen..., SUPRAX...0 SUSTIVA...4 SUTENT...7 SYLATRON..., 44 SYLVANT...8, 76 SYMBICORT...84 SYMDEKO...8 SYMLINPEN SYMLINPEN SYNAGIS...76 SYNAREL...74 SYNERCID...9 SYNJARDY... 0, SYNRIBO... SYPRINE...6 TABLOID... tacrolimus... 6, 7 TAFINLAR...7 TAGRISSO...7 TAMIFLU...46 tamoxifen... tamsulosin...67 TANZEUM... TARCEVA...7 TARGRETIN...8 TARINA FE /0 (8)...7 TASIGNA...7, 8 tazarotene...6 TAZORAC...6 TAZTIA XT... TECENTRIQ...8 TECFIDERA...9 TEFLARO...0 TEKTURNA... TEKTURNA HCT... telmisartan... telmisartan-amlodipine... telmisartan-hydrochlorothiazid.. TENIVAC (PF)...77 tenofovir disoproxil fumarate4, 4 terazosin..., 67 terbinafine hcl...0 terbutaline...8 terconazole...0 testosterone...70 testosterone cypionate...70 testosterone enanthate...70 tetanus,diphtheria tox ped(pf)...77 tetanus-diphtheria toxoids-td...77 tetrabenazine...8 4

147 tetracycline... THALOMID... THEO theophylline... 8 THIOLA thioridazine... 9 thiotepa... thiothixene... 9 tiagabine... 4 timolol maleate..., 4, 80 tinidazole... 0 TIVICAY tizanidine...4, 84 tobramycin... 9 tobramycin in 0. % nacl... 9 tobramycin sulfate... 9 tobramycin-dexamethasone tolazamide... tolbutamide... tolcapone... 9 tolmetin... 6, tolterodine topiramate...4, TOPOSAR... 6 topotecan... 6 TORISEL... 7 torsemide... 6 TOUJEO SOLOSTAR U-00 INSULIN... TRACLEER... 8 TRADJENTA... tramadol...7, 8 tramadol-acetaminophen... trandolapril... trandolapril-verapamil... tranexamic acid... TRANSDERM-SCOP... 9, 64 tranylcypromine... 6 TRAVASOL 0 %... 6 trazodone... 6 TREANDA... TRECATOR... TRELEGY ELLIPTA... 8, 84 TRELSTAR tretinoin...8, 6 tretinoin (chemotherapy)... 8 tretinoin microspheres... 6 triamcinolone acetonide., 9, 69 triamterene-hydrochlorothiazid.. TRIANEX... 6 TRIDERM...69 trientine...6 trifluoperazine...9 trifluridine...44 TRI-LEGEST FE...7 TRI-LO-ESTARYLLA...7 TRI-LO-SPRINTEC...7 TRILYTE WITH FLAVOR PACKETS...6 trimethoprim...0 trimipramine...8 TRINESSA (8)...7 TRINTELLIX...8 TRI-PREVIFEM (8)...7 TRISENOX... TRI-SPRINTEC (8)...7 TRIUMEQ...4 TRIVORA (8)...7 TROPHAMINE 0 %...6 TROPHAMINE 6%...6 trospium...66 TRUEPLUS INSULIN...79 TRULICITY... TRUMENBA...77 TRUVADA...4 TWINRIX (PF)...77 TYGACIL...0 TYKERB...8 TYMLOS...78 TYPHIM VI...77 TYSABRI... 9, 76 UCERIS... 64, 6 ULORIC...0 UNITHROID...7 UPTRAVI...6 ursodiol...64 valacyclovir...44 VALCHLOR..., 6 valganciclovir...4 valproate sodium...4 valproic acid... 4,, 49 valproic acid (as sodium salt)...4,, 49 valsartan... valsartan-hydrochlorothiazide... vancomycin...0 VANDAZOLE...0 VAQTA (PF)...77 VARIVAX (PF)...77 VARIZIG...77 VARUBI...9 VASCEPA...7 VECAMYL...8 VECTIBIX... VELCADE... VELIVET TRIPHASIC REGIMEN (8)...7 VELTASSA...6 VEMLIDY...4 VENCLEXTA... VENCLEXTA STARTING PACK... venlafaxine... 8, 47 verapamil... VERIPRED 0..., 69, 78 VERSACLOZ...4 VERZENIO...6 VESTURA (8)...7 VIBERZI...6 VICODIN... VICODIN ES... VICODIN HP... VICTOZA -PAK... VIDEX GRAM PEDIATRIC.. 79 VIDEX 4 GRAM PEDIATRIC.. 4 VIDEX EC...4 VIENVA...7 vigabatrin...4 VIIBRYD...8 VIMPAT... vinblastine... VINCASAR PFS... vincristine... vinorelbine... VIOKACE...66 VIRACEPT...46 VIREAD... 4, 4 VOLTAREN...6, 6 voriconazole...0 VOTRIENT...8 VRAYLAR... 4, 48 VYFEMLA (8)...7 VYXEOS... warfarin... water for irrigation, sterile...6 WYMZYA FE...7 XALKORI...8 XARELTO... XATMEP...7 XERMELO

148 XGEVA XIFAXAN... 0, 64 XOLAIR XTANDI... XULANE... 7 XURIDEN XYREM YERVOY... YF-VAX (PF) YONDELIS... YUVAFEM zafirlukast... 8 zaleplon ZALTRAP... ZANOSAR... 9 ZARAH... 7 ZARXIO... ZAVESCA ZEJULA... ZELBORAF... 8 ZENATANE... 6 ZENCHENT (8)... 7 ZENZEDI... 7 ZEPATIER... 4, 44 ZERIT... 4 ZIAGEN... 4 zidovudine... 4 zileuton... 8 ziprasidone hcl...4, 48 ZIRGAN... 4 zoledronic acid zoledronic acid-mannitol-water..78 ZOLINZA... 0, 6 zolmitriptan... zolpidem zonisamide... ZORTRESS... 7 ZOSTAVAX (PF) ZOVIA /E (8)... 7 ZOVIRAX ZYDELIG... 6 ZYKADIA... 8 ZYPREXA RELPREVV... 4, 49 ZYTIGA... 47

149