v Department of Human Services IOWA Medicaid Program Preferred / Recommended Only Drug List (Two Drug Columns) Effective October 1, 2017

Highlighted categories denote new changes to the PDL since previous update

Column Header Explanations: B, G or O: P, N, R, or NR: B = Brand P = Preferred G = Generic N = Non-Preferred O = OTC R = Recommended NR = Non-Recommended 3 BUSPIRONE 30mg - Use 2 BUSPIRONE 15mg 86 Preferred product is authorized generic distributed by tablets Watson/Actavis. PA Required >= 21 yo. 6 FLUOXETINE HCL 20mg TABS - Use FLUOXETINE 87 No manual PA required if HMG-CoA reductase HCL 20mg CAPS instead inhibitor found in member’s pharmacy claims history 11 PA Required in past 12 months. 13 PA Required > 90 days 88 No manual PA required if a preferred agent of a 16 Grandfathered for Existing Users with previous Actos different chemical entity is found in member’s use or CHF diagnosis pharmacy claims history in past 12 months 17 PA Required> 12 Units/30 Days supply 89 PA Required < 7 years of age 19 Preferred < 8yo 90 No manual PA required if a preferred injectable MS 21 PROZAC,FLUOXETINE HCL 40mg CAPS - Use two agent is found in member’s pharmacy claims history FLUOXETINE HCL 20mg CAPS instead in past 12 months 22 RHEUMATREX - Write METHOTREXATE instead 91 Authorized Generic Distributed by Teva 23 ULTRACET - Use Tramadol & Acetaminophen Pharmaceuticals is Preferred with Prior Authorization separately 92 Preferred for ages 19 through 64 24 PA Required >= 21 yo. 93 No PA required for members 6 years of age or older 25 PA Required: > 14 Units/30Days Supply when dosed within established quantity limits 27 PA required for quantities exceeding 12-40mg 94 Preferred product is authorized generic distributed by capsules and 8-80mg capsules labeler 61314 28 PA required for quantities exceeding 60-4mg tabs, 96 Preferred product is authorized generic distributed by 60-8mg tabs, 4-20ml vials, and 8-2ml vials. labeler 59212. PA Required 29 PA required for quantities exceeding 60-4mg tabs, 97 Preferred product is authorized generic distributed by 60-8mg tabs. labeler 62175. PA Required >= 21 yo. 34 PA required, Limit of 144 for initial fill 98 PA required. Preferred for plaque psoriasis diagnosis 36 Payable for members who are 12 years of age and only. Non-preferred for all other diagnoses. older. Quantity limitations of 12 packets/4 weeks (28 99 Preferred product is authorized generic of EpiPen days) or a total of 48 packets/16 weeks (112 days). distributed by labeler 49502 37 Restricted to persons 40 years of age and older. 100 Preferred < 12 years of age 39 Grandfather Existing Users 101 Preferred product is authorized generic distributed by 43 PA required for concurrent therapy with long acting labeler 66993. PA Required >= 21 yo. injectable and oral antispychotics of the same chemical entity after 12 weeks (84 days) of concomitant therapy. 44 PA required if ACE-I not previously filled.PA required if ACE-I not previously filled. PA required if ACE-I not previously filled. 46 Grandfather for seizure disorder. 47 Preferred with Conditions and allow a one time fill. 48 Those 0-18 should be referred to the Vaccines for Children Program. 49 Preferred for ages 0-12, PA Required ages 13-18, Not covered ages 19 and above. 50 Requires a Selected Brand Name Drug PA 52 Imipramine Pamoate - Use Imipramine HCL 58 PA required limited to package size of #14 for initial fill 59 PA required limited to package size of #110 for initial fill 63 Initial fill limited to 15 day supply. 64 Use Multiples of Phenytoin Sodium 100mg Capsules. 67 PA required limited to package size 168 for intial fill 68 PA required limited to package size 40ml for initial fill 69 Payable for members who are 18 years of age and older. Quantity limitations of 30 grams/4 weeks (28 days) or a total of 120 grams/16 weeks (112 days) 70 Payable for members 50 years of age and older without prior authorization 72 Preferred < 2 years of age 74 PA Required < 4 years of age 76 PA Required < 15 years of age 77 PA Required < 6 years of age 78 PA Required < 9 years of age 80 PA Required < 18 years of age 83 PA Required > 12 years of age Iowa Medicaid Preferred Drug List (PDL) New Drug Process

New Drug Entities

New drug entities (including new generics), and new drug product dosage forms of existing drug entities) will be identified weekly and immediately be coded as "Non-preferred-Prior Authorization required" until presented at the next scheduled P&T Committee meeting. These prior authorization restrictions will continue through the review process, including while committee recommendations are being made, and lasting until DHS makes a final determination.

Exceptions to the Non-preferred default policy for new PDL drugs

There are two major potential exceptions to the non-preferred default policy for new PDL drugs:

A). If a new medication is classified as a priority drug by the FDA, the State may indicate that such a drug is preferred, until the drug is reviewed by the P&T Committee at the nearest scheduled meeting.

B). The State may decide to designate a new drug as "draft preferred" and provide immediate access and increased therapeutic choice to physicians until the drug is reviewed by the P&T Committee at the nearest scheduled meeting if: - a new drug is therapeutically equivalent or superior to existing preferred or non-preferred choices, and - is as safe or safer than existing preferred or non-preferred choices, and - the net cost, adjusted for all rebates, is less expensive than all existing preferred choices.

Existing PDL Drugs

Although the State discourages supplemental rebate offers on existing PDL drugs between annual bidding periods, it may entertain such bids and may accept them if they are determined to represent significant additional savings or if they would replace a delinquent manufacturer's product or a preferred drug pulled from the marketplace or significantly restricted by the FDA. This interim preferred status will remain in effect until the drug is reviewed by the P&T Committee at the next scheduled meeting. Supplemental rebates will only be invoiced for approved drugs under contract. Draft preferred drugs with supplemental rebates will not be invoiced until approved by the Committee and accepted by the State. At that time, the supplemental rebates will be invoiced back to the effective date of the agreement, which is the date the drug began to benefit from preferred status. B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P gentamicin sulfate ACE AND THIAZIDE COMBO'S G P gentamicin in saline

G P benazepril & hydrochlorothiazide G P neomycin sulfate

G P captopril & hydrochlorothiazide G P paromomycin sulfate

G P enalapril maleate & hydrochlorothiazide G P streptomycin sulfate

G P lisinopril & hydrochlorothiazide B P KITABIS PAK G P tobramycin sulfate

ACE INHIBITORS

G P benazepril hcl ANALGESICS - MISC.

G P captopril O P aspirin

G P enalapril maleate G P diflunisal

B 100 P EPANED G P salsalate

G P fosinopril sodium O P aspirin buffered

G P lisinopril O P acetaminophen

G P quinapril hcl G P butalbital-acetaminophen tab 50-325 mg

G P ramipril G P butalbital-acetaminophen-caffeine cap 50-325-40 mg

G P trandolapril G P butalbital-acetaminophen-caffeine tab 50-325-40 mg G P butalbital-aspirin-caffeine

ACE INHIBITORS AND CALCIUM CHANNEL BLOCKERS

G P amlodipine besylate-benazepril hcl ANAPHYLAXIS THERAPY

G P trandolapril-verapamil hcl G 99 P epinephrine auto-injector

ACNE PRODUCTS: ISOTRETINOIN ANDROGENS - ANABOLICS

G 11 P isotretinoin B P ANDROXY B 11 P METHITEST

AGENTS FOR FABRYS DISEASE G 11 P testosterone cypionate

B P FABRAZYME G 11 P testosterone enanthate

AGENTS FOR PHEOCHROMOCYTOMA ANDROGENS -TOPICAL

G P phentolamine mesylate B 11 P ANDRODERM B 11 P ANDROGEL 1% PACKETS

ALCOHOL DETERRENTS

G P acamprosate calcium ANORECTAL - MISC.

G P disulfiram G P hydrocortisone (rectal) G P hydrocortisone (intrarectal)

ALPHA-PROTEINASE INHIBITOR

B 11 P PROLASTIN C ANTHELMINTICS B P ALBENZA

ALS DRUG G P ivermectin

G 11 P riluzole B P BILTRICIDE

ALZHEIMER - CHOLINOMIMETICS ANTI INFECTIVE COMBO'S - MISC.

G 37 P donepezil hydrochloride G P sulfamethoxazole-trimethoprim

G 37 P galantamine tabs

G 37 P rivastigmine cap ANTIANGINALS--ISOSORBIDE NITRATE

G 37 P memantine G P isosorbide dinitrate G P isosorbide mononitrate

AMINO GLYCOSIDES

G P amikacin sulfate

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories ANTIASTHMATIC - MISC. RESPIRATORY INHALANTS ANTIARRHYTHMICS ND P sodium chloride soln nebu 0.9%

G P disopyramide phosphate

G P procainamide hcl ANTIASTHMATIC - MIXED ADRENERGICS

G P quinidine gluconate G P epinephrine hcl

G P quinidine sulfate

G P mexiletine hcl ANTIASTHMATIC - MUCOLYTICS

G P flecainide acetate G P acetylcysteine

G P propafenone hcl

G P amiodarone hcl tab 200 mg ANTIASTHMATIC - NASAL MISC.

G P dofetilide G P ipratropium bromide (nasal) soln 0.03%

B P MULTAQ ANTIASTHMATIC - STEROID INHALANTS

ANTIASTHMATIC - ADRENERGIC COMBOS B P QVAR

B P COMBIVENT RESPIMAT B P PULMICORT INHALER

G P ipratropium-albuterol B 19 P PULMICORT SUS

B P SYMBICORT B P FLOVENT

B P ADVAIR B P ASMANEX 120 AER 220MCG

B P ADVAIR HFA B P ASMANEX 14 AER 220MCG

B P DULERA B 83 P ASMANEX 30 AER 110MCG B P ASMANEX 30 AER 220MCG

ANTIASTHMATIC - ANTI-CHOLINERGICS B P ASMANEX 60 AER 220MCG

G P ipratropium bromide

B P ATROVENT HFA ANTIASTHMATIC - XANTHINES

B P SPIRIVA HANDIHALER G P aminophylline B P ELIXOPHYLLIN

ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS B P THEO-24

G P cromolyn sodium G P theophylline

ANTIASTHMATIC - BETA - ADRENERGICS ANTIBIOTICS - MISC.

G 72 P albuterol sulfate nebu 0.63mg/3 G P sulfadiazine

G P albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) B P AZACTAM

G P albuterol sulfate soln nebu 0.5% (5 mg/ml) B 89 P CAYSTON

G P albuterol sulfate syrup 2 mg/5ml G P colistimethate sodium

G P albuterol sulfate tab sr 12hr 4 mg G P metronidazole tab 250 mg

G P albuterol sulfate tab sr 12hr 8 mg G P metronidazole tab 500 mg

B P PROAIR HFA B P METRO IV

B P PROVENTIL HFA G P metronidazole in nacl

B P VENTOLIN HFA B P NEBUPENT

B 74 P SEREVENT DISKUS B P PENTAM 300

G P terbutaline sulfate tab 2.5 mg G P trimethoprim

G P terbutaline sulfate tab 5 mg B P VANCOCIN HCL G P vancomycin hcl ANTIASTHMATIC - LEUKOTRIENE RECEPTOR ANTAGONISTS G P vancomycin hcl in dextrose

G P montelukast sodium chew tab 4 mg (base equiv) B P TYGACIL

G P montelukast sodium chew tab 5 mg (base equiv)

G P montelukast sodium tab 10 mg (base equiv)

G 72 P montelukast granules

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories ANTIDEPRESSANTS - MAO INHIBITORS ANTICOAGULANTS G P phenelzine sulfate G P heparin sodium (porcine) G P tranylcypromine sulfate G P heparin (porcine) in sodium chloride

G P enoxaparin sodium syringes ANTIDEPRESSANTS - SELECTED SSRI'S G P enoxaparin sodium vials G P mirtazapine G P warfarin sodium G 63 P nefazodone hcl B P PRADAXA G P trazodone hcl B P ELIQUIS G P citalopram hydrobromide B P XARELTO G P escitalopram oxalate

ANTICONVULSANTS G P fluoxetine hcl G P fluvoxamine maleate G P clonazepam G P paroxetine hcl B P DIASTAT G P paroxetine hcl er B P GABITRIL B P PAXIL SUSP G P phenytoin susp G P sertraline hcl G P phenytoin infatab G P duloxetine hcl G P phenytoin sodium G P venlafaxine hcl B P DILANTIN CAPS 30MG G P venlafaxine hcl cap sr 24hr 150 mg (base equivalent) G P phenytoin sodium extended cap 100 mg G P venlafaxine hcl cap sr 24hr 37.5 mg (base equivalent) G P ethosuximide soln 250 mg/5ml G P venlafaxine hcl cap sr 24hr 75 mg (base equivalent) B P ZARONTIN G 63 P maprotiline hcl G P divalproex sodium G P bupropion hcl tab 100 mg G P divalproex sodium cap sprinkle G P bupropion hcl tab 75 mg G P divalproex sodium tablet er 24hr G P bupropion hcl tab sr 12hr 100 mg G P valproate sodium G P bupropion hcl tab sr 12hr 150 mg G P valproic acid G P bupropion hcl tab sr 12hr 200 mg G P carbamazepine G P bupropion hcl tab sr 24hr 150 mg G P carbamazepine capsule er 12hr G P bupropion hcl tab sr 24hr 300 mg B P TEGRETOL B P WELLBUTRIN B P TEGRETOL SUSP

B P TEGRETOL XR ANTIDEPRESSANTS - TRI-CYCLICS G P gabapentin cap 100 mg G P amitriptyline hcl G P gabapentin cap 300 mg G P amoxapine G P gabapentin cap 400 mg G 63 P clomipramine hcl G P gabapentin oral soln 250 mg/5ml G P doxepin hcl G P gabapentin tab 600 mg G P imipramine hcl G P gabapentin tab 800 mg G P nortriptyline hcl B 88 P VIMPAT B P SURMONTIL G P lamotrigine

G P lamotrigine chewable tablet ANTIDOTES G P levetiracetam G P deferoxamine mesylate G P oxcarbazepine susp

G P oxcarbazepine tab 150 mg ANTIDOTES - CHELATING AGENTS G P oxcarbazepine tab 300 mg

G P oxcarbazepine tab 600 mg B 11 P EXJADE

G P primidone B P CHEMET

G P topiramate

G P zonisamide

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B P RECOMBINATE ANTIEMETIC - 5-HT3 RECEPTOR ANTAGONISTS/ SUBSTANCE P NEUROKININB P NOVOEIGHT

G 29 P ondansetron odt B P XYNTHA

G 28 P ondansetron hcl ANTIHEMOPHILIA FACTOR VON WILLEBRAND FACTOR AGENTS B 27 P EMEND B P ALPHANATE

ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC B P HUMATE-P

G P promethazine hcl suppos 12.5 mg B P WILATE

G P promethazine hcl suppos 25 mg ANTIHISTAMINES - NON-SEDATING G P promethazine hcl syrup 6.25 mg/5ml

G P promethazine hcl tab 25 mg O P cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)

G P promethazine hcl tab 50 mg O P cetirizine hcl tab 10 mg

O P meclizine hcl O P cetirizine hcl tab 5 mg

G P meclizine hcl O P loratadine syrup 5 mg/5ml

B P TRANSDERM-SCOP O P loratadine tab 10 mg

G P trimethobenzamide hcl G P azelastine spr 0.1% B P PATANASE

ANTIFUNGALS - ASSORTED ANTIHISTAMINES - OTHER B 13 P AMBISOME

B 13 P ANCOBON O P chlorpheniramine maleate

G 13 P griseofulvin sus G P diphenhydramine hcl

G P nystatin G P hydroxyzine hcl soln

G 13 P terbinafine hcl G P hydroxyzine hcl syrp

G 13 P fluconazole G P hydroxyzine hcl tab 25 mg

G 13 P fluconazole in nacl G P hydroxyzine hcl tab 50 mg

G 13 P fluconazole in dextrose G P hydroxyzine hcl tabs 10mg

B 13 P VFEND IV G P hydroxyzine pamoate

G 13 P voriconazole G P prochlorperazine supp

B 13 P CANCIDAS G P prochlorperazine maleate

B P MYCAMINE G P prochlorperazine edisylate

G 13 P clotrimazole troche ANTIHYPERTENSIVE COMBOS

ANTIHEMOPHILIA FACTOR IX AGENTS G P methyldopa & hydrochlorothiazide

B P ALPHANINE SD ANTIHYPERTENSIVES - CENTRAL B P MONONINE

B P BENEFIX B P CATAPRES-TTS

B P BEBULIN G P clonidine hcl tab 0.1 mg

B P PROFILNINE SD G P clonidine hcl tab 0.2 mg G P clonidine hcl tab 0.3 mg

ANTIHEMOPHILIA FACTOR VII AGENTS G P guanfacine hcl

B P NOVOSEVEN G P methyldopa G P prazosin hcl

ANTIHEMOPHILIA FACTOR VIII AGENTS G P reserpine

B P HEMOFIL M G P hydralazine hcl

B P KOATE-DVI G P minoxidil

B P MONOCLATE-P

B P HELIXATE FS

B P KOGENATE FS

B P KOGENATE FS BIO-SET

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P quetiapine fumarate ANTI-INFLAMMATORIES, NON-NSAID G P olanzapine

B 11 P HUMIRA G P aripiprazole

B 11 P HUMIRA PEN B P LATUDA

B 47 P HUMIRA PEN-CROHNS DISEASESTARTER G P ziprasidone hcl

B 47 P HUMIRA PEN-PSORIASIS STARTER

B 11 P ENBREL ANTIPSYCHOTICS - SPECIAL ATYPICALS

B 98 P COSENTYX G P clozapine

ANTILEPROTIC ANTIPSYCHOTICS - TYPICAL

B P THALOMID G 43 P haloperidol G 43 P haloperidol lactate

ANTIMALARIAL AGENTS G 43 P haloperidol decanoate

G P chloroquine phosphate G P loxapine succinate

G P hydroxychloroquine sulfate G 43 P fluphenazine hcl

G P mefloquine hcl G 43 P fluphenazine decanoate

G P atovaquone-proguanil G P perphenazine G P thioridazine hcl

ANTIMYCOBACTERIALS / ANTITUBERCULOSIS G P trifluoperazine hcl

G P ethambutol hcl G P thiothixene

B P TRECATOR ANTISPASMODICS G P isoniazid

G P pyrazinamide G P oxybutynin syp 5mg/5ml

G P rifampin G P oxybutynin tab 5mg

B P PRIFTIN G 63 P flavoxate hcl

ANTI-PARKINSONIAN DRUGS ANTISPASMODICS - LONG ACTING

G P amantadine hcl cap 100 mg G P oxybutynin chloride er

G P amantadine hcl syrup 50 mg/5ml B 63 P VESICARE

B P PARLODEL

G P bromocriptine mesylate 2.5mg tabs ANTITHYROID THERAPIES

G P carbidopa-levodopa G P methimazole

G P carbidopa-levodopa-entacapone G P propylthiouracil

G P selegiline hcl ANXIOLYTICS - BENZODIAZEPINES

ANTIPROTOZOAL AGENTS G P alprazolam

G P atovaquone B P ALPRAZOLAM INTENSOL

B P ALINIA G P chlordiazepoxide hcl G 78 P clorazepate dipotassium

ANTI-PSORIATICS - NON-BIOLOGICALS G P diazepam

G P calcipotriene G P lorazepam

B 11 P TAZORAC G 77 P oxazepam

B P OXSORALEN ULTRA

ANTIPSYCHOTICS - ATYPICALS

B 43 P INVEGA SUSTENNA

B 43 P INVEGA TRINZA

G 43 P risperidone

B 43 P RISPERDAL CONSTA

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P sotalol hcl (afib/afl) ANXIOLYTICS - MISC. G P timolol maleate

G P buspirone hcl tab 10 mg

G P buspirone hcl tab 15 mg BETA BLOCKERS AND DIURETIC COMBO'S

G P buspirone hcl tab 5 mg G P atenolol & chlorthalidone

G P buspirone hcl tab 7.5 mg G P bisoprolol & hydrochlorothiazide

G P droperidol G P propranolol & hydrochlorothiazide

G P meprobamate BETA-LACTAMS / CLAVULANATE COMBO'S

ARB/CCB G P penicillin g potassium

G 44 P amlodipine-olmesartan B P PFIZERPEN-G

G 44 P amlodipine besylate-valsartan G P penicillin g pot in dextrose B P BICILLIN

ARB/CCB PLUS DIURETICS G P penicillin v potassium

G 44 P amlodipine-valsartan-hydrochlorothiazide G P amoxicillin (trihydrate) cap 250 mg G P amoxicillin (trihydrate) chew tab 125 mg

ARB'S G P amoxicillin (trihydrate) chew tab 250 mg

G 44 P irbesartan G P amoxicillin (trihydrate) for susp 125 mg/5ml

G 44 P losartan potassium G P amoxicillin (trihydrate) for susp 200 mg/5ml

G 44 P valsartan G P amoxicillin (trihydrate) for susp 250 mg/5ml G P amoxicillin (trihydrate) for susp 400 mg/5ml

ARB'S AND DIURETICS G P amoxicillin (trihydrate) tab 500 mg

G 44 P irbesartan-hydrochlorothiazide G P amoxicillin (trihydrate) tab 875 mg

G 44 P losartan potassium & hydrochlorothiazide G P ampicillin

G 44 P valsartan-hydrochlorothiazide G P dicloxacillin sodium G P nafcillin sodium

ARTHRITIS - MISC. G P oxacillin sodium

B P RIDAURA B P BACTOCILL IN DEXTROSE G P amoxicillin & k clavulanate chew tab 400-57 mg

ARTIFICIAL SALIVA/STIMULANTS G P amoxicillin & k clavulanate for susp 200-28.5 mg/5ml

G P pilocarpine hcl (oral) G P amoxicillin & k clavulanate for susp 400-57 mg/5ml G P amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

BETA BLOCKERS - ALPHA / BETA G P amoxicillin & k clavulanate tab 500-125 mg G P amoxicillin & k clavulanate tab 875-125 mg G P carvedilol G P ampicillin & sulbactam sodium G P labetalol hcl B P TIMENTIN

BETA BLOCKERS - CARDIO SELECTIVE G P piperacillin sodium-tazobactam sodium B P ZOSYN G P acebutolol hcl

G P atenolol BPH G P bisoprolol fumarate G P doxazosin mesylate G P metoprolol succinate G P terazosin hcl G P metoprolol tartrate G P alfuzosin hcl

BETA BLOCKERS - NON SELECTIVE G P finasteride G P tamsulosin hcl G P nadolol

B P LEVATOL CALCIUM CHANNEL BLOCKERS--AMLODIPINES G P pindolol G P amlodipine besylate G P propranolol hcl

G P sotalol hcl

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P ceftazidime CALCIUM CHANNEL BLOCKERS--DILTIAZEMS G P ceftriaxone sodium

G P diltiazem hcl G P ceftriaxone sodium in dextrose

G P diltiazem hcl extended release beads G P cefepime hcl

CALCIUM CHANNEL BLOCKERS--NIFEDIPINES CHELATING AGENTS

G P nifedipine B P SYPRINE

G P nifedipine tab sr 24hr 30 mg B P DEPEN TITRATABS

G P nifedipine tab sr 24hr 60 mg

G P nifedipine tab sr 24hr 90 mg CHOLESTEROL - BILE SEQUESTRANTS G P cholestyramine

CALCIUM CHANNEL BLOCKERS--VERAPAMILS G P cholestyramine light

G P verapamil hcl G P colestipol hcl

G P verapamil hcl er tab CHOLESTEROL - FIBRIC ACID DERIVATIVES

CARBAPENEMS G P fenofibrate nanocrystallized 48mg tabs

B P INVANZ G P fenofibrate nanocrystallized 145mg tabs

G P meropenem G P gemfibrozil

CARDIAC GLYCOSIDES CHOLESTEROL - HMG COA + ABSORB INHIBITORS: HIGH POTENCY DRUGS/COMBINATIONS

G P digoxin G P atorvastatin calcium G P rosuvastatin

CARNITINE REPLENISHER - AGENTS G P simvastatin tab 10 mg

B P CARNITOR SOL 1GM/10ML G P simvastatin tab 20 mg

B P CARNITOR TAB 330MG G P simvastatin tab 40 mg

B P CARNITOR SF SOL 1GM/10ML G P simvastatin tab 5 mg

G P levocarnitine inj 200 mg/ml B P VYTORIN

CENTRAL PRECOCIOUS PUBERTY AGENTS CHOLESTEROL - HMG COA + ABSORB INHIBITORS: LOW POTENCY DRUGS/COMBINATIONS

B 11 P LUPR DEP-PED INJ 11.25MG B 87 P ZETIA

B 11 P LUPR DEP-PED INJ 15MG B P LESCOL XL

B 11 P LUPR DEP-PED INJ 7.5MG G P lovastatin

B 11 P LUPRON DEPOT-PED KIT 11.25MG G P pravastatin sodium

B 11 P LUPRON DEPOT-PED KIT 30MG CHOLINERGIC

CEPHALOSPORINS G P bethanechol chloride

G P cefadroxil cap 500 mg COMPOUNDING MATERIALS G P cefadroxil for susp 250 mg/5ml

G P cefadroxil for susp 500 mg/5ml ND P sterile dilu sol flolan

G P cefazolin sodium ND P water for inject, bacteriostatic parabens

G P cefazolin in d5w ND P saline, bacteriostatic

G P cephalexin

G P cephalexin caps 750mg CONTRACEPTIVES - EMERGENCY CONTRACEPTIVE

G P cefprozil G P levonorgestrel (emergency oc)

G P cefuroxime axetil tab 250 mg B P ELLA

G P cefuroxime axetil tab 500 mg

G P cefuroxime sodium CONTRACEPTIVES - INJECTABLE

G P cefdinir G P medroxyprogesterone acetate (contraceptive)

B P CLAFORAN

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories O P pseudoephedrine hcl tab 60 mg CONTRACEPTIVES - MONOPHASIC COMBINATION O/C'S COX 2 INHIBITORS - SELECTIVE B P DESOGEN

G P desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg G P meloxicam

G P drospirenone-ethinyl estradiol tab 3-0.03 mg G P nabumetone

G P gianvi CYSTIC FIBROSIS AGENTS G P ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg

B P ZOVIA 1/50E B 11 P PULMOZYME

G P levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg

G P levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg CYTO-MEGALOVIRUS AGENTS

G P norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg G P valganciclovir hcl

G P norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

G P norethindrone & ethinyl estradiol tab 1 mg-35 mcg DENTAL PRODUCTS

G P norethindrone & ethinyl estradiol tab 1 mg-20 mcg G P sodium fluoride (dental)

G P norethindrone & ethinyl estradiol tab 1.5 mg-30 mcg G P stannous fluoride

B P NECON 1/50-28

B P NORINYL TAB 1+50-28 DIABETIC - ALPHAGLUCOSIDASE

G P norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg B P GLYSET

B P FEMCON FE

B P GENERESS FE CHW DIABETIC - INSULIN

G P norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg B P LANTUS INJ 100/ML

G P norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg B P HUMALOG

G P desogestrel-ethinyl estradiol (biphasic) B P LEVEMIR

G P levonorgestrel-ethinyl estradiol (91-day) tabs B P HUMULIN R

B P SEASONIQUE O P humulin n B P HUMALOG MIX 50/50

CONTRACEPTIVES - PATCHES/ VAGINAL PRODUCTS B P HUMALOG MIX 75/25

B P ORTHO EVRA O P humulin 70/30

G P xulane

B P NUVARING DIABETIC - INSULIN PENFILLS B 11 P NOVOLOG

CONTRACEPTIVES - PROGESTIN ONLY B P LANTUS SOLOSTAR

G P norethindrone (contraceptive) B P LEVEMIR

B P ORTHO MICRONOR DIABETIC - MEGLITINIDES

CONTRACEPTIVES - TRI-PHASIC COMBINATIONS G P nateglinide

G P desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg

G P levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg DIABETIC - NON-INSULIN INJECTABLES

G P norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg B 11 P TANZEUM

G P norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg B 11 P BYETTA

G P norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg

B P ORTHO TRI-CYCLEN DIABETIC - ORAL BIGUANIDES

B P ESTROSTEP FE G P metformin hcl G P metformin hcl tab sr COUGH/COLD - ANTITUSSIVE-EXPECTORANT

O P dextromethorphan-guaifenesin syrup 10-100 mg/5ml

COUGH/COLD - SYSTEMIC DECONGESTANTS

O P pseudoephedrine hcl tab 30 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P cabergoline DIABETIC - ORAL SULFONYLUREAS EAR G P chlorpropamide

G P glimepiride G P acetic acid (otic)

G P glipizide B 19 P CIPRODEX

B P DIABETA B P CIPRO HC

G P glyburide G P ciprofloxacin otic

G P glyburide micronized G P neomycin-polymyxin-hc (otic)

G P tolazamide G P antipyrine-benzocaine

DIABETIC - OTHER ELECTROLYTES/ NUTRITIONALS

B P GLUCAGEN ND P *oral electrolyte solution***

B P PROGLYCEM G P lactated ringer's

B 11 P TRADJENTA G P potassium chloride in nacl

B 11 P JANUVIA G P potassium chloride in dextrose

B 11 P JENTADUETO G P dextrose w/ sodium chloride

B 11 P JANUMET G P dextrose in lactated ringers

B 11 P JANUMET XR G P potassium chloride in dextrose & sodium chloride G P dextrose

DIABETIC - SULFONYLUREA / BIGUANIDE B P LIPOSYN

G P glipizide-metformin hcl G P amino acid infusion soln 6%

G P glyburide-metformin B P AMINOSYN B P AMINOSYN II

DIABETIC - THIAZOL B P PREMASOL B P TRAVASOL G P pioglitazone hcl G P amino acid electrolyte infusion

DIURETICS ERYTHROPOEISIS STIMULATING AGENTS G 11 P eplerenone B 11 P PROCRIT G P acetazolamide

B P DIAMOX ESTROGEN COMBOS G P bumetanide

B P EDECRIN B P PREMPHASE

G P furosemide B P PREMPRO

G P torsemide ESTROGENS - PATCHES G P amiloride hcl

G P spironolactone B P ALORA

G P chlorothiazide tab G P estradiol weekly

G P chlorthalidone B P VIVELLE

G P hydrochlorothiazide ESTROGENS - TABS G P indapamide

G P methyclothiazide B P PREMARIN

G P metolazone B P CENESTIN

B P ZAROXOLYN B P MENEST

G P amiloride & hydrochlorothiazide G P estradiol

B P ALDACTAZIDE TABS 50/50 B P DEPO-ESTRADIOL

G P spironolactone & hydrochlorothiazide G P estropipate

G P triamterene & hydrochlorothiazide

DOPAMINE RECEPTOR AGONISTS

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P cimetidine FLUOROQUINOLONES G P ranitidine hcl inj 150 mg/6ml (25 mg/ml)

G P ciprofloxacin iv soln 200 mg/20ml (1%) G P ranitidine hcl inj 50 mg/2ml (25 mg/ml)

G P ciprofloxacin iv soln 400 mg/40ml (1%) G P ranitidine hcl syrup 15 mg/ml (75 mg/5ml)

G P ciprofloxacin-ciprofloxacin hcl G P ranitidine hcl tab 150 mg

G P ciprofloxacin hcl tab 100 mg (base equiv) G P ranitidine hcl tab 300 mg

G P ciprofloxacin hcl tab 250 mg (base equiv) G P famotidine tab 20 mg

G P ciprofloxacin hcl tab 500 mg (base equiv) G P famotidine tab 40 mg

G P ciprofloxacin hcl tab 750 mg (base equiv) GI - INFLAMMATORY BOWEL AGENTS G P levofloxacin G P balsalazide disodium

GI - ANTI - FLATULENTS / GI STIMULANTS B P APRISO CAP 0.375GM

O P sennosides tab 8.6 mg B P CANASA

G P lactulose G P mesalamine rectal

O 49 P polyethylene glycol 3350 B P PENTASA CAP 250MG CR

G P polyethylene glycol 3350 pack 3350 nf G P sulfasalazine

B P NULYTELY GI - MISC. G P peg 3350-potassium chloride-sod bicarbonate-sod chloride

B P COLYTE O P magnesium hydroxide susp 400 mg/5ml

B P GOLYTELY O P sennosides syrup 8.8 mg/5ml

G P peg 3350-kcl-sod bicarb-sod chloride-sod sulfate O P sennosides-docusate sodium tab 8.6-50 mg

G P cromolyn sodium (mastocytosis) G P ursodiol

B P GASTROCROM GI - MISC. ANTI-ULCER G P metoclopramide hcl

G P lactulose (encephalopathy) G P sucralfate tab 1 gm

GI - ANTIDIARRHEAL / ANTACID - MISC. GI - PROSTAGLANDINS

ND 11 P sodium bicarbonate (antacid) tabs G P misoprostol

ND 11 P magnesium oxide tab 400 mg

G P atropine sulfate GI - PROTON PUMP INHIBITOR

B P ANASPAZ B P DEXILANT

G P hyoscyamine sulfate G P omeprazole

G P glycopyrrolate tabs G P pantoprazole sodium

G P methscopolamine bromide

G P propantheline bromide GI - ULCER ANTI-INFECTIVE

G P dicyclomine hcl B P PYLERA

GI - ANTIPERISTALTIC AGENTS

G P diphenoxylate w/ atropine

G P loperamide hcl cap 2 mg

O P loperamide hcl liq 1 mg/5ml (0.2 mg/ml)

O P loperamide hcl tab 2 mg

GI - DIGESTIVE ENZYMES

B P CREON

G P pancrelipase (lipase-protease-amylase)

B P ZENPEP

GI - H2-ANTAGONISTS

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P ribavirin tab 200 mg GLUCOCORTICOIDS - MINERALOCORTICOIDS B 11 P SOVALDI

G P budesonide B 11 P ZEPATIER

G P cortisone acetate B 11 P MAVYRET

G P dexamethasone B 11 P HARVONI

B P DEXAMETHASONE INTENSOL B 11 P EPCLUSA

G P dexamethasone sodium phosphate B 11 P TECHNIVIE

B P CORTEF B 11 P VIEKIRA PAK

G P hydrocortisone B 11 P VIEKIRA XR

B P A-HYDROCORT HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS B P SOLU-CORTEF

B P MEDROL PAK 4MG B P ORFADIN

B P MEDROL TAB 4MG

G P methylprednisolone tab 4 mg HERPES AGENTS

G P methylprednisolone acetate G P acyclovir

G P methylprednisolone sod succ G P acyclovir susp

B P SOLU-MEDROL G P acyclovir sodium

G P prednisolone G P valacyclovir hcl

G P prednisolone sodium phosphate

G P prednisone HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS

B P KENALOG G P calcitriol

G P fludrocortisone acetate IMMUNE SERUMS

GOUT B P HYPERHEP B S/D SOLN

G P allopurinol B P NABI-HB

B P MITIGARE B P BIVIGAM

G P probenecid B P CARIMUNE NANOFILTERED

G P colchicine w/ probenecid B P FLEBOGAMMA B P GAMMAGARD

GRANULOCYTE CSF B P GAMUNEX-C

B 11 P NEUPOGEN B P HYPERRHO S/D B P MICRHOGAM ULTRA-FILTEREDPLUS

GROWTH HORMONE B P RHOGAM ULTRA-FILTERED PLUS

B 11 P NORDITROPIN B P RHOPHYLAC

B 11 P NUTROPIN AQ B P WINRHO SDF B P HYPERTET S/D

HEMOSTATIC B P HYQVIA

G P aminocaproic acid

B P AMICAR

HEPATITIS B ONLY

B P HEPSERA

G P entecavir

HEPATITIS C AGENTS

B P PEGASYS

B P PEGASYS PROCLICK

B P PEG-INTRON

G P ribavirin cap 200 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P azithromycin powd pack for susp 1 gm IMMUNOSUPPRESSANTS G P azithromycin tab 250 mg

G P cyclosporine G P azithromycin tab 500 mg

B P SANDIMMUNE G P azithromycin tab 600 mg

G P cyclosporine modified (for microemulsion) G P clarithromycin for susp 125 mg/5ml

G P gengraf G P clarithromycin for susp 250 mg/5ml

B P CELLCEPT SUSR G P clarithromycin tab 250 mg

G P mycophenolate mofetil tabs G P clarithromycin tab 500 mg

G P mycophenolate mofetil caps MIGRAINE - ERGOT COMBINATIONS B P MYFORTIC

B P RAPAMUNE B P MIGERGOT

G P sirolimus MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)--INJECTABLES G P tacrolimus G 17 P sumatriptan spray

INFLUENZA AGENTS B 17 P IMITREX STATDOSE REFILL

G P rimantadine hydrochloride B 17 P IMITREX STATDOSE SYSTEM

B 25 P TAMIFLU MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)--TABS B P RELENZA DISKHALER

B 48 P AFLURIA PF 2017-18 G 17 P naratriptan hcl

B 48 P FLULAVAL QUAD 2017-18 G 17 P rizatriptan benzoate

B 48 P AFLURIA 2017-18 G 17 P rizatriptan benzoate tablet disperse

B 48 P FLUZONE HD INJ PF 2017-18 G 17 P sumatriptan succinate

B 48 P FLUARIX QUAD 2017-18

B 48 P FLUZONE QUAD INJ 2017-18

B 48 P AFLURIA QUAD 2017-18

B 48 P FLUVIRIN INJ 2017-18

B 48 P FLUAD INJ 2017-18

B 48 P FLUCLVX QUAD INJ 2017-18

K REMOVING RESINS

G P sodium polystyrene sulfonate

LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS

G P clindamycin hcl cap 150 mg

G P clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)

B P CLEOCIN IN D5W

G 91 P linezolid

G P dapsone

LITHIUM

G P lithium carbonate cap 150 mg

G P lithium carbonate cap 300 mg

G P lithium carbonate tab 300 mg

G P lithium carbonate tab cr 300 mg

G P lithium carbonate tab cr 450 mg

MACROLIDES / ERYTHROMYCIN'S / KETOLIDES

G P azithromycin for susp 100 mg/5ml

G P azithromycin for susp 200 mg/5ml

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories MINERALS MOUTH ANTI-INFECTIVES G P nystatin susp 100000 unit/ml ND 11 P calcium carbonate (antacid)

G P sodium acetate inj 2 meq/ml MOUTH ANTISEPTICS G P sodium bicarbonate inj 4.2% G P chlorhexidine gluconate soln 0.12% G P sodium bicarbonate inj 7.5%

G P sodium bicarbonate inj 8.4% MUCOPOLYSACCHARIDOSIS ND 11 P calcium carbonate

ND 11 P calcium carbonate tab 600 mg B P ALDURAZYME

ND 11 P calcium carbonate-vitamin d tab 500 mg-200 unit MULTIPLE SCLEROSIS AGENTS – INTERFERONS G P sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

G P sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf) B P AVONEX

G P sodium fluoride chew tab 1 mg f (from 2.2 mg naf) B P AVONEX PEN

G P sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop naf) B P REBIF

G P sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf) B P REBIF REBIDOSE

B P SSKI B P REBIF REBIDOSE TITRATIONPACK

G P magnesium sulfate inj 4% B P BETASERON

G P magnesium sulfate inj 50% MULTIPLE SCLEROSIS AGENTS – NON-INTERFERONS G P magnesium sulfate inj 8%

B 11 P MAGNEBIND 400 B P COPAXONE SOSY 20MG/ML

G P sodium phosphate inj 3 mmole/ml B 90 P GILENYA

G P pot phosphate monobasic w/ sod phosphate dibasic & monobasic

G P potassium acetate inj 2 meq/ml MUSCLE RELAXANTS

G P potassium bicarbonate effer tab 25 meq G P baclofen

B P MICRO-K B P GABLOFEN

G P potassium chloride inj 10 meq/100 ml B P LIORESAL INTRATHECAL

G P potassium chloride inj 10 meq/50 ml G P chlorzoxazone

G P potassium chloride inj 2 meq/ml G P cyclobenzaprine hcl

G P potassium chloride tab cr 10 meq G P methocarbamol

G P potassium chloride tab cr 8 meq (600 mg) G P orphenadrine citrate

G P potassium chloride tablet er 20meq er G P tizanidine hcl

G P sodium chloride inj 0.45%

ND P sodium chloride inj 0.9% NARCOTIC - ANTAGONISTS

G P sodium chloride inj 3% B P NARCAN

ND P sodium chloride iv soln 0.9% G P naloxone hcl

G P trace minerals (cr-cu-mn-se-zn) G P naltrexone hcl

ND P ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe)

ND P ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe)

ND P ferrous sulfate tab 325 mg (65 mg elemental fe)

ND P ferrous gluconate tab 324 mg (38 mg elemental iron)

ND P ferrous fumarate tab 325 mg (106 mg elemental fe)

G P iron dextran

ND P saline w/ benzyl alcohol

MOUTH - ANESTHETICS TOPICAL ORAL

G P lidocaine hcl viscous soln 2%

MOUTH - STEROIDS

G P triamcinolone acetonide dental paste 0.1%

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B P MESTINON TIMESPAN NARCOTICS - MISC. G P pyridostigmine bromide B P REGONOL G 80 P codeine sulfate

G P fentanyl citrate soln NICOTINE REPLACEMENT THERAPY G P hydromorphone hcl tab 2 mg

G P hydromorphone hcl tab 4 mg O 58 P nicotine td patch 24hr 14 mg/24hr

G P hydromorphone hcl tab 8 mg O 58 P nicotine td patch 24hr 21 mg/24hr

G P meperidine hcl tab 100 mg O 58 P nicotine td patch 24hr 7 mg/24hr

G P meperidine hcl tab 50 mg O 59 P nicotine polacrilex

G P morphine sulfate O 34 P nicotine polacrilex lozg

G P oxycodone hcl NITRO - OINTMENT/CAP/CR B 11 P SUBOXONE

G P oxycodone w/ acetaminophen tab 5-325 mg B P NITRO-BID

G P oxycodone w/ acetaminophen tabs 2.5-325 G P nitroglycerin

G P oxycodone-aspirin NITRO - PATCHES B P PERCODAN

G 80 P acetaminophen w/ codeine B P NITRO-DUR DIS 0.8MG/HR

G P butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg G P nitroglycerin

G P hydrocodone-acetaminophen NITRO - SUBLINGUAL/ SPRAY

NARCOTICS - SELECTED B P NITROSTAT

G P tramadol hcl

G 11 P butorphanol tartrate NSAIDS

G P nalbuphine hcl G P diclofenac potassium G P diclofenac sodium

NARCOTICS -LONG ACTING G P etodolac tab 400 mg

G P fentanyl 25mcg G P etodolac tab 500 mg

G P fentanyl 50mcg G P flurbiprofen

G P fentanyl 75mcg O P ibuprofen susp 100 mg/5ml

G P fentanyl 100mcg O P ibuprofen tab 200 mg

G P morphine sul tab er G P ibuprofen tab 400 mg

G P morphine sulfate G P ibuprofen tab 600 mg

B P KADIAN 20MG G P ibuprofen tab 800 mg

B P KADIAN 30MG G P indomethacin

B P KADIAN 50MG G P ketoprofen

B P KADIAN 60MG B P NAPROSYN SUSP

B P KADIAN 70MG G P naproxen

B P KADIAN 80MG G P naproxen sodium tab 550 mg

B P KADIAN 100MG G P sulindac

B P KADIAN 200MG

B P EMBEDA OP. ANTIALLERGICS - ANTIHISTAMINES G 94 P olopatadine (ophth)

NASAL STEROIDS G P azelastine hcl (ophth)

G P fluticasone propionate (nasal) OP. ANTIALLERGICS - MAST CELL STABILIZERS

NEUROLOGICS - MISC. G P cromolyn sodium (ophth)

G P ergoloid mesylates

B P ORAP

B P MESTINON SYP 60MG/5ML

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories OP. MIOTICS - DIRECT ACTING OP. ANTIBIOTICS G P pilocarpine hcl

G P erythromycin (ophth) B P PILOPINE HS

G P gentamicin sulfate (ophth) B P PHOSPHOLINE IODIDE

G P tobramycin (ophth)

G P trifluridine OP. MISC

G P bacitracin-polymyxin b (ophth) O P artificial tear solution

G P polymyxin b-trimethoprim O P artificial tear ointment G P naphazoline hcl OP. ANTIINFLAMMATORY / STEROIDS OPHTH. B P MYDFRIN

B P MAXIDEX G P phenylephrine hcl (ophth)

G P dexamethasone sodium phosphate (ophth) G P proparacaine hcl

B P DUREZOL G P tetracaine hcl (ophth)

G P fluorometholone (ophth) O P sodium chloride hypertonic ophth oint 5%

B P FML O P sodium chloride hypertonic ophth soln 5%

B P FLAREX

B P ALREX OP. NSAID'S

B P LOTEMAX G P diclofenac sodium (ophth)

B P PRED MILD G P flurbiprofen sodium

G P prednisolone acetate (ophth) G P ketorolac tromethamine (ophth)

G P prednisolone sodium phosphate (ophth) B P ILEVRO

B P VEXOL

B P PRED-G OP. PROSTAGLANDINS

B P ZYLET G P latanoprost

B P BLEPHAMIDE B P TRAVATAN Z

B P BLEPHAMIDE S.O.P.

G P sulfacetamide sod-prednisolone OP. QUINOLONES

B P TOBRADEX B P BESIVANCE

G P neomycin-polymy-dexameth G P ciprofloxacin hcl (ophth) G P ofloxacin (ophth) OP. BETA - BLOCKERS

B P BETOPTIC-S OP. QUINOLONES FOURTH GENERATION

G P carteolol hcl (ophth) B P VIGAMOX

G P metipranolol

G P levobunolol hcl OP. SELECTIVE ALPHA ADRENERGIC AGONISTS

G P timolol maleate ophth soln 0.25% B P ALPHAGAN P SOL 0.1%

G P timolol maleate ophth soln 0.5% B P ALPHAGAN P SOLN 0.15% G P brimonidine tartrate ophth soln 0.2%

OP. CARBONIC ANHYDRASE INHIBITORS/COMBO B P SIMBRINZA

B P COMBIGAN

G P dorzolamide hcl-timolol maleate OSTEOPOROSIS

B P AZOPT G P alendronate sodium

G P dorzolamide hcl G P calcitonin (salmon)

OP. CYCLOPLEGICS OXYTOCICS

G P atropine sulfate (ophthalmic) G P methylergonovine maleate

G P cyclopentolate hcl

G P tropicamide

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P perphenazine-amitriptyline PARKINSONS - ANTICHOLINERGICS

G P benztropine mesylate tab 0.5 mg PULMONARY ANTI-HYPERTENSIVES

G P benztropine mesylate tab 1 mg G 11 P sildenafil citrate (pulmonary hypertension)

G P benztropine mesylate tab 2 mg G 11 P epoprostenol sodium

G P trihexyphenidyl hcl B 11 P VENTAVIS

PARKINSONS - COMT INHIBITORS PULMONARY ANTI-HYPERTENSIVES-ENDOTHELIN RECEPTOR ANTAGONIST

G P entacapone B 11 P LETAIRIS B 11 P TRACLEER

PARKINSONS - SELECTED DOPAMIN AGONISTS

B P APOKYN PURINE ANALOG

G P pramipexole dihydrochloride B P AZASAN

G P ropinirole hydrochloride G P azathioprine

PERIPHERAL VASODILATORS RHEUMATOID ARTHRITIS - NON-BIOLOGICALS

G P papaverine hcl G P leflunomide

PHOSPHATE BINDERS RSV AGENTS

G P calcium acetate (phosphate binder) B 11 P SYNAGIS

B P ELIPHOS

B P PHOSLYRA SEDATIVE/HYPNOTICS - BARBITURATE

B P RENAGEL TAB 400MG G P phenobarbital

B P RENAGEL TAB 800MG SEDATIVE/HYPNOTICS - BENZODIAZEPINES

PLATELET AGGR. INHIBITORS / COMBO'S - MISC. G P estazolam

G P cilostazol G 76 P flurazepam hcl

G P anagrelide hcl G P midazolam hcl syrp

B P AGGRENOX G P temazepam cap 15 mg

G P pentoxifylline G P temazepam cap 30 mg

PLATELET AGGREGATION INHIBITORS SEDATIVE/HYPNOTICS - NON-BENZODIAZEPINES

G P dipyridamole G P eszopiclone

G P clopidogrel bisulfate G P zaleplon G P zolpidem tartrate POWDERS

ND P progesterone powder SMOKING CESSATION (ORAL)

ND P progesterone micronized powder G 11 P bupropion hcl (smoking deterrent)

ND P metronidazole powder B 11 P CHANTIX B 11 P CHANTIX CONTINUING MONTHPAK PRESSORS B 11 P CHANTIX STARTING MONTH PAK

G P midodrine hcl SOMATOSTATIC AGENTS

PROGESTINS B P SANDOSTATIN

G P medroxyprogesterone acetate

G P norethindrone acetate tab 5 mg STIMULANTS B 24 P ADZENYS XR ODT PSYCHOTHERAPEUTIC COMBINATION

G P chlordiazepoxide-amitriptyline

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P levothyroxine sodium tab 25 mcg STIMULANTS - AMPHETAMINES - LONG ACTING G P levothyroxine sodium tab 300 mcg

B 24 P VYVANSE G P levothyroxine sodium tab 50 mcg

G 24 P amphetamine-dextroamphetamine er G P levothyroxine sodium tab 75 mcg G P levothyroxine sodium tab 88 mcg

STIMULANTS - AMPHETAMINES - SHORT ACTING B P CYTOMEL

G 24 P amphetamine-dextroamphetamine B P TRIOSTAT B P THYROLAR

STIMULANTS - METHYLPHENIDATE TISSUE PLASMINOGEN ACTIVATOR G 24 P dexmethylphenidate hcl

G 24 P methylphenidate hcl B P ACTIVASE

B 24 P METHYLIN ORAL SOLUTION B P CATHFLO ACTIVASE

B 24 P QUILLICHEW ER TOPICAL - ACNE PREPARATIONS

STIMULANTS - METHYLPHENIDATE - LONG ACTING B 11 P DIFFERIN CRE 0.1%

G 24 P dexmethylphenidate er B 11 P DIFFERIN GEL 0.1%

B 24 P DAYTRANA B 11 P DIFFERIN GEL 0.3%

G 97 P methylphenidate hcl er capsule (cd) B 11 P DIFFERIN LOTN

G 86 P methylphenidate hcl tab sa osm 18 mg G 11 P adapalene gel 0.1%

G 86 P methylphenidate hcl tab sa osm 27 mg G 11 P adapalene gel 0.3%

G 86 P methylphenidate hcl tab sa osm 36 mg B 11 P AZELEX

G 86 P methylphenidate hcl tab sa osm 54 mg O P benzoyl peroxide

G 24 P methylphenidate hcl er capsule (la) B 11 P BENZOYL PEROXIDE 7% CLEANSER G 11 P clindamycin phosphate (topical)

STIMULANTS - OTHER STIMULANTS / LIKE STIMULANTS G 11 P erythromycin (acne aid)

G 96 P clonidine hcl (adhd) B 11 P EPIDUO

G 11 P guanfacine er B 11 P ACANYA

G 101 P atomoxetine B 11 P METROGEL

G 24 P modafinil B 11 P METROLOTION G 11 P metronidazole cream 0.75%

TETRACYCLINES TOPICAL - ANTIBIOTIC G P doxycycline (monohydrate) caps 100mg

G P doxycycline (monohydrate) caps 50mg O P bacitracin (topical)

B P VIBRAMYCIN SYRP G P gentamicin sulfate (topical)

G P minocycline hcl cap 100 mg G P mupirocin oint

G P minocycline hcl cap 50 mg O P neomycin-bacitracin-polymyxin

G P minocycline hcl cap 75 mg TOPICAL - ANTIFUNGALS

THROMBOPOEITIN RECEPTOR AGONISTS G P ciclopirox solution 8%

B 11 P PROMACTA G P ciclopirox olamine G P nystatin oint 100000 unit/gm

THYROID HORMONES O P tolnaftate G P clotrimazole (topical) G P levothyroxine sodium tab 100 mcg G P ketoconazole (topical) G P levothyroxine sodium tab 112 mcg O P miconazole nitrate cream 2% G P levothyroxine sodium tab 125 mcg G P clotrimazole w/ betamethasone G P levothyroxine sodium tab 137 mcg

G P levothyroxine sodium tab 150 mcg

G P levothyroxine sodium tab 175 mcg

G P levothyroxine sodium tab 200 mcg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P mometasone furoate TOPICAL - ANTINEOPLASTICS G P triamcinolone acetonide (topical)

B P EFUDEX G P triamcinolone acetonide (topical) lotn

G P fluorouracil soln 2%

G P fluorouracil soln 5% TOPICAL - EMOLLIENTS ND P lactic acid (ammonium lactate) lotion 12%

TOPICAL - ANTIPRURITICS G P urea lotion 40%

B P ZONALON TOPICAL - ENZYMES / KERATOLYTICS / UREA

TOPICAL - ANTISEBORRHEICS B P SANTYL

G P selenium sulfide G P salicylic acid cream 6%

G P sulfacetamide sodium liquid 10% G P salicylic acid lotion 6%

G P selenium sulfide-pyrithione zinc in urea vehicle G P salicylic acid shampoo 6% G P salicylic acid soln 26%

TOPICAL - ASTRINGENTS / PROTECTANTS

B P XERAC AC TOPICAL - GENITAL WARTS B 69 P VEREGEN

TOPICAL - BURN PRODUCTS G 36 P imiquimod

G P silver sulfadiazine TOPICAL - LOCAL ANESTHETICS

TOPICAL - CAUTERIZING AGENTS B P MARCAINE

G P silver nitrate B P MARCAINE W/O EPI G P lidocaine hcl local inj 1%

TOPICAL - CORTICOSTEROIDS - HIGH POTENCY G P lidocaine hcl local inj 1.5%

G P betamethasone dipropionate (topical) oint G P lidocaine hcl local inj 2%

G P betamethasone dipropionate cream 0.05% G P lidocaine hcl local inj 4%

G P betamethasone dipropionate augmented cream 0.05% G P lidocaine hcl local preservative free (pf) inj 0.5%

G P clobetasol propionate G P lidocaine hcl local preservative free (pf) inj 1%

G P clobetasol propionate soln G P lidocaine hcl local preservative free (pf) inj 2%

B P CLOBEX G P lidocaine w/ epinephrine

G P clobetasol propionate emollient base B P XYLOCAINE/EPINEPHRINE

G P clobetasol propionate emulsion foam G P lidocaine oint 5%

G P fluocinonide cream 0.05% G P lidocaine hcl cream 3%

G P fluocinonide gel 0.05% G P lidocaine hcl gel 2%

G P fluocinonide oint 0.05% G P lidocaine hcl lotion 3%

G P fluocinonide soln 0.05% G P lidocaine hcl soln 4%

G P fluocinonide emulsified base G P lidocaine-prilocaine

TOPICAL - CORTICOSTEROIDS - LOW POTENCY TOPICAL - NASAL ANTIBIOTICS

G P hydrocortisone cream 1% B P BACTROBAN NASAL

G P hydrocortisone cream 2.5% TOPICAL - SCABICIDES AND PEDICULICIDES G P hydrocortisone lotion 2.5%

G P hydrocortisone oint 1% B P NATROBA

G P hydrocortisone oint 2.5% G P permethrin cream 5% O P permethrin lotion 1%

TOPICAL - CORTICOSTEROIDS - MEDIUM POTENCY O P pyrethrins-piperonyl butoxide

G P betamethasone valerate

B P CAPEX

G P fluticasone propionate

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G 11 P desmopressin acetate spray TOPICAL - STEROID LOCAL ANESTHETICS

G P lidocaine-hydrocortisone acetate (rectal) VITAMINS G P thiamine hcl

TOPICAL - TRETINOIDS B P MEPHYTON

B 11 P RETIN-A G P phytonadione G P cyanocobalamin inj 1000 mcg/ml

UROLOGICAL - MISC. G P folic acid tab 1 mg

G P methenamine mandelate VITAMINS - MISC. G P nitrofurantoin suspension

G P nitrofurantoin macrocrystal 50mg ND 11 P *b-complex w/ c & folic acid tab 1 mg***

G P nitrofurantoin macrocrystal 100mg ND 11 P b-complex w/ c & folic acid

G P nitrofurantoin monohyd macro B 11 P DIALYVITE/ TAB ZINC

B P K-PHOS TAB NO 2 B 11 P NEPHPLEX RX

G P potassium citrate (alkalinizer) ND 11 P dekas

B P UROCIT ND 11 P aquadeks

B P ORACIT ND 11 P pediatric multiple vitamin w/ minerals & c

G P sodium citrate & citric acid B P PNV FOLIC AC TAB + IRON

G P phenazopyridine hcl B P PRENATAL VIT TAB PLUS

B P RENACIDIN B P TRINATAL RX 1

G P acetic acid B P VOL-NATE

G P sodium chloride (gu irrigant) B P VOL-PLUS TAB

G P neomycin/polymyxin b gu B P TRINATAL GT

B P NEOSPORIN GU IRRIGANT B P PNV FERROUS FUMARATE/DOCUSATE/FOLIC ACID B P SE-NATAL 19 CHEW TABLET

VACCINES G 11 P ferrous fumarate w/ b12-vit c-fa-ifc

B 70 P ZOSTAVAX INJ

B 92 P PNEUMOVAX

B 92 P TENIVAC

VAGINAL - ANTI FUNGALS

O P miconazole nitrate vaginal cream 2%

O P miconazole nitrate vaginal suppos 100 mg

G P terconazole vaginal cream 0.4%

G P terconazole vaginal cream 0.8%

VAGINAL - ANTIBACTERIALS

B P CLEOCIN SUP 100MG

G P clindamycin phosphate vaginal

G P metronidazole vaginal

VAGINAL - ESTROGENS

B P PREMARIN

VASOPRESSINS

G 93 P desmopressin acetate

B 11 P STIMATE

G 11 P desmopressin acetate refrigerated

G 11 P desmopressin acetate spray refrigerated

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

RDL Categories ANTINEOPLASTICS - ALKYLATING AGENTS ANTINEOPLASTICS - ESTROGEN RECEPTOR ANTAGONIST

B R BUSULFEX B R FASLODEX

B R MYLERAN

G R cisplatin ANTINEOPLASTICS - ESTROGENS B R EMCYT

ANTINEOPLASTICS - ANTIADRENALS

B R LYSODREN ANTINEOPLASTICS - FOLIC ACID ANTAGONISTS RESCUE AGENTS G R leucovorin calcium

ANTINEOPLASTICS - ANTIANDROGENS

G R bicalutamide ANTINEOPLASTICS - IMIDAZOTETRAZINES

B R NILANDRON G 11 P temozolomide

ANTINEOPLASTICS - ANTIBIOTICS ANTINEOPLASTICS - INTERLEUKINS

G R bleomycin sulfate B R PROLEUKIN

G R doxorubicin hcl

B R DOXIL ANTINEOPLASTICS - LHRH ANALOGS B R ZOLADEX

ANTINEOPLASTICS - ANTIESTROGENS B 80 R ELIGARD

G R tamoxifen citrate B 11 R LUPRON DEPOT

B R FARESTON B R TRELSTAR

ANTINEOPLASTICS - ANTIMETABOLITES ANTINEOPLASTICS - MISC.

B R VIDAZA G P hydroxyurea

B 11 P XELODA B R MATULANE

G R fluorouracil B 11 R REVLIMID

G P gemcitabine hcl

G P mercaptopurine ANTINEOPLASTICS - MITOTIC INHIBITORS

G P methotrexate sodium B R TAXOTERE

B R ARRANON B R ABRAXANE

B R ALIMTA G R vincristine sulfate

B R FOLOTYN G R vinblastine sulfate

B R TABLOID G P vinorelbine tartrate

B R AVASTIN

B 11 R ERBITUX ANTINEOPLASTICS - NITROGEN MUSTARDS

B 11 R HERCEPTIN B R LEUKERAN B R ALKERAN ANTINEOPLASTICS - AROMATASE INHIBITORS

G R anastrozole ANTINEOPLASTICS - NITROSOUREAS

G P exemestane B R GLIADEL WAFER

G 70 P letrozole ANTINEOPLASTICS - PROGESTINS

ANTINEOPLASTICS - CARDIAC PROTECTIVE AGENTS B R DEPO-PROVERA

G R dexrazoxane G R megestrol acetate

B R ZINECARD G 11 R hydroxyprogesterone caproate

ANTINEOPLASTICS - COMBINATIONS

G R ifosfamide & mesna

B 11 R KISQALI PAK FEMARA

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

RDL Categories B R NORVIR CAP 100MG ANTINEOPLASTICS - PROTEIN-TYROSINE KINASE INHIBITORS B R NORVIR SOL 80MG/ML

B 11 R IBRANCE B R NORVIR TABS

B 11 R KISQALI

B 11 R AFINITOR ANTIRETROVIRALS - RTI - NON - NUCLEOSIDE ANALOGUES

B 11 R SUTENT B R SUSTIVA

B 11 R TARCEVA B 80 P EDURANT

B 11 P GLEEVEC

B 11 R TASIGNA ANTIRETROVIRALS - RTI - NUCLEOSIDE/NUCLEOTIDE ANALOGUES

B 11 R VOTRIENT G P abacavir sulfate

B 63 R CAPRELSA B R EMTRIVA

B R VELCADE G P lamivudine

B 80 R JAKAFI G R stavudine G R zidovudine

ANTINEOPLASTICS - RETINOIDS B R VIREAD

G 11 R tretinoin (chemotherapy)

ANTINEOPLASTICS - SELECTIVE RETINOID X RECEPTOR AGONISTS

B 63 P TARGRETIN

ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS

G P irinotecan hcl

B 11 R HYCAMTIN

ANTINEOPLASTICS - URINARY TRACT PROTECTIVE AGENTS

B R MESNEX

ANTIRETROVIRALS - COMBINATIONS

G P abacavir-lamivudine

B P EPZICOM

B P EVOTAZ

B P DESCOVY

B P TRUVADA

G P lamivudine-zidovudine

B P KALETRA

G P lopinavir-ritonavir

B R ATRIPLA

B P GENVOYA

ANTIRETROVIRALS - INTEGRASE INHIBITORS

B P ISENTRESS CHW 100MG

B P ISENTRESS CHW 25MG

B P ISENTRESS TABS

B P TIVICAY

ANTIRETROVIRALS - PROTEASE INHIBITORS

B R REYATAZ

B R PREZISTA

B R VIRACEPT

RT43025