Contract Drugs List Part 4 – Therapeutic Classifications Page Updated: November 2020

drugs cdl p4 1 Drugs: Contract Drugs List Part 4 – Therapeutic Classifications Page updated: November 2020

This section provides a quick reference to common drug classifications. The referenced pages include a staggered list that organizes drugs with respect to their use or form. Refer to the Contract Drugs List sections in this manual for a full list of drugs and their specific utilization controls.

Index Section Name Page Number Adrenergic Agents (Sympathomimetics) 14 Adrenergic Blocking Agents (Sympatholytics) 14 Amebacide 5 Amyotrophic Lateral Sclerosis Agent 29 Analgesics ‹‹16›› Androgens 22 Antacids and Adsorbents 21 Anthelmintics 5 Anti-Alcoholism 29 Antianxiety ‹‹17›› Antiasthmatics 12 Antibiotics 5 Anticholinergic Agents (Parasympatholytics) 14 Anticoagulant Antagonist ‹‹15›› Anticoagulants ‹‹15›› Anticonvulsants ‹‹17›› Antidepressants 17 Anti-Diarrhea Agents 21 Anti-Emetics 13 Anti-Fungals 6 Anti-Glaucoma Agents 25 Anti-Gout 29 Antihistamine and Decongestant Combinations 30 Antihistamine Containing Combinations 13 Antihistamines 13 Anti-Hyperkinetics ‹‹18›› Antihypertensives 19 Anti-Infectives 5 Anti-Inflammatory ‹‹(Analgesics)›› ‹‹16›› ‹‹Anti-Inflammatory Agents (Gastro-Intestinal Drugs)›› ‹‹21›› Anti-Lipidemic Agents 30

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Index (continued) Section Name Page Number Anti-Malarials 6 Anti-Neoplastics 9 Anti-Parkinsonism 14 Anti-Platelet 15 Anti-Platelet Agents 30 Anti-Protozoal 6 Antipruritics 14 Anti-Tuberculars 6 Anti-Virals 7 Appetite Stimulant 18 Autonomic Drugs 12 Bile Acid Modifier 21 Bisphosphonates 30 Blood Modifiers 15 Broncho-Pulmonary Secretion Modifiers 31 Calcimimetic Agent 31 Calcium Supplements and Vitamin D Analogs 24 Cardiac Drugs 20 Central Nervous System Drugs 17 Chelating Agent 31 Cholinergic Agents (Parasympathomimetics) 14 Contraceptives 22 Decongestants 31 Dermatological Preparations 28 Digestant Preparations 21 Diuretics 20 Diuretics and Cardio-Vasculars 19 ‹‹Drugs to Treat Movement Disorders 18›› Electrolyte Solutions 31 Estrogens and Combinations ‹‹23›› Expectorants and Cough Preparations 31 Fluoride 25 Gallstone Dissolving Agent 31 Gastro-Intestinal Drugs 21 G.I. Stimulant 21 Glucocorticoids 23 Gold Compounds 31 Gonadotropin-Releasing Hormone and Combinations 23

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Index (continued) Section Name Page Number H + /K + ATPase Enzyme System Inhibitors 21 ‹‹Helicobacter Pylori Treatment 21›› Hematinics 15 Hematopoietic 15 Hemorheologic Agents 32 Histamine H2-Receptor Antagonists ‹‹22›› Hormones 22 Hypoglycemics 23 Hypoglycemic Shock 24 Hypoprolactinemic Agent 32 Immunomodulators 32 Immunosuppressive Agent 32 Interstitial Cystitis Agent 32 Intravenous Solutions 33 Irrigating Solutions 8 Laxatives 22 Local Anesthetic Injection 33 Metabolic Supplements 24 Migraine 14 Miscellaneous 29 Miscellaneous (Central Nervous System Drugs) 18 Narcotic Antagonists 16 Narcotics 16 Nasal Anti-Inflammatories 33 Non-Narcotics 16 Ophthalmic Anesthetic 25 Ophthalmic Antibiotics 26 Ophthalmic Antihistamines 26 Ophthalmic Anti-Inflammatories 26 Ophthalmic Anti-Virals 26 Ophthalmic Mast Cell Stabilizers 26 Ophthalmic Miotics 27 Ophthalmic Miscellaneous 27 Ophthalmic Mydriatics 27 Ophthalmic Preparations 25 Ophthalmic Sulfonamide 27 Ophthalmic Vasoconstrictors and Combinations 27 Otic Preparations 27 Oxytocics 32

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Index (continued) Section Name Page Number Parasympatholytic Agents (Anticholinergic) 14 Parasympathomimetic Agents (Cholinergic) 15 Parathyroid 24 Phosphate Binders 33 Pituitary 24 Potassium Supplement 25 Progestins and Combinations 24 Prostaglandin Analog 22 Prostate Agents 33 Psychotropics 18 ‹‹Recombinant Human Growth Hormone 28›› Rectal Preparations 28 Sedatives and Hypnotics 18 Skeletal Muscle Relaxants 33 Smoking Deterrents 33 Sulfonamides 8 Sympatholytic Agents (Adrenergic Blocking) 15 Sympathomimetic Agents (Adrenergic) 15 Thrombocytopenic 15 Thyroid and Antithyroid 24 Topical and Local Preparations 28 Trichomonacide 8 Ulcer Adherent 22 Urinary Tract Anti-Infectives 9 Urinary Tract Antispasmodics 33 Vaccines 29 Vaginal Preparations 29 Vasodilating Agents 20 Vitamins 25

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Anti-Infectives

Amebacide Paromomycin

Anthelmintics Mebendazole Pyrantel Pamoate

Antibiotics Amikacin Sulfate Dicloxacillin Amoxicillin Doxycycline Amoxicillin/Clavulanate Doxycycline Hyclate Potassium Erythromycin Base Amoxicillin Trihydrate Erythromycin Ethylsuccinate Ampicillin Erythromycin Stearate Azithromycin Gentamicin Benzathine Pencillin G Griseofulvin Cefaclor Levofloxacin Cefazolin Metronidazole Cefdinir Moxifloxacin Cefixime ‹‹Mupirocin›› Cefpodoxime Proxetil Nafcillin Ceftazidime Neomycin Ceftriaxone Sodium Nystatin Cephalexin Ofloxacin Chloramphenicol Penicillin G Ciprofloxacin Penicillin G Procaine Ciprofloxacin HCl Penicillin V (K) Clarithromycin Piperacillin Sodium Clindamycin Secnidazole

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Antibiotics (continued) Streptomycin Tobramycin Tetracycline Vancomycin Tinidazole

Anti-Fungals Amphotericin B Ketoconazole Butoconazole Nitrate Miconazole Nitrate Clotrimazole Nystatin Econazole Nitrate Terbinafine HCl Fluconazole Terconazole Itraconazole

Anti-Malarials Chloroquine Primaquine Hydroxychloroquine Pyrimethamine

Anti-Protozoal Atovaquone Pentamidine Pyrimethamine

Anti-Tuberculars Azithromycin Rifabutin Clarithromycin Rifampin Cycloserine Rifampin and Isoniazid Ethambutol Rifampin, Isoniazid and Pyrazinamide Ethionamide Rifapentine Isoniazid Streptomycin Pyrazinamide

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Anti-Virals Abacavir Sulfate Doravirine/Lamivudine/Tenofovir Abacavir Sulfate and Lamivudine Disoproxil Fumarate Abacavir Sulfate/Dolutegravir/Lamivudine Efavirenz Abacavir Sulfate, Lamivudine and Efavirenz, Emtricitabine and Tenofovir Zidovudine Disoproxil Fumarate Acyclovir Efavirenz/Lamivudine/Tenofovir Disoproxil Fumarate Amantadine Elbasvir/Grazoprevir Atazanavir/Cobicistat Elvitegravir Atazanavir Sulfate Elvitegravir/Cobicistat/Emtricitabine/ Baloxavir Marboxil Tenofovir Alafenamide Bictegravir/Emtricitabine/Tenofovir Elvitegravir/Cobicistat/Emtricitabine/ Alafenamide Tenofovir Disoproxil Fumarate ‹‹Cabotegravir/Rilpivirine›› Emtricitabine Cidofovir Emtricitabine/Rilpivirine/Tenofovir Cobicistat Alafenamide Cobicistat/Darunavir Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate Darunavir Emtricitabine/Tenofovir Alafenamide Darunavir/Cobicistat/Emtricitabine/ Tenofovir Alafenamide Entecavir Delaviridine Mesylate Etravirine Didanosine Fosamprenavir Calcium Dolutegravir Foscarnet Sodium Dolutegravir/Lamivudine Fostemsavir Dolutegravir/Rilpivirine Ganciclovir Doravirine Ganciclovir Sodium Glecaprevir/Pibrentasvir

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Anti-Virals (continued) Ibalizumab-Uiyk Ribavirin Indinavir Sulfate Rilpivirine Lamivudine Ritonavir Lamivudine and Zidovudine Saquinavir Lamivudine/Tenofovir Disoproxil Fumarate Saquinavir Mesylate Ledipasvir/Sofosbuvir Sofosbuvir Lopinavir and Ritonavir Sofosbuvir/Velpatasvir Maraviroc Stavudine Nelfinavir Mesylate Tenofovir Alafenamide Nevirapine Tenofovir Disoproxil Fumarate Ombitasvir/Paritaprevir/Ritonavir and Tipranavir Dasabuvir Valacyclovir HCl Oseltamivir Phosphate Valganciclovir HCl Peginterferon Alfa-2a Zanamivir Peginterferon Alfa-2b Zidovudine Raltegravir

Irrigating Solutions Acetic Acid Neomycin and Polymyxin Sodium Chloride

Sulfonamides Dapsone Sulfasalazine Sulfadiazine Trimethoprim and Sulfamethoxazole

Trichomonacide Metronidazole

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Urinary Tract Anti-Infectives Methenamine Hippurate Trimethoprim Methenamine Mandelate Trimethoprim and Sulfamethoxazole Nitrofurantoin

Anti-Neoplastics Abemaciclib Bleomycin Sulfate Abiraterone Acetate Blinatumomab Acalabrutinib Bortezomib Ado-Trastuzumab Emtansine Bosutinib Afatinib Brigatinib Aldesleukin Busulfan Alectinib Cabazitaxel Alitretinoin Cabozantinib S-Malate Alpelisib Capecitabine Altretamine Capmatinib Amivantamab-vmjw Carboplatin Anastrozole Carfilzomib Apalutamide Carmustine Arsenic Trioxide Cemiplimab-rwlc ‹‹Asparaginase Erwinia Chrysanthemi Ceritinib (Recombinant)-rywn›› Cetuximab Atezolizumab Chlorambucil Avapritinib Cisplatin Avelumab Cladribine Axitinib Cobimetinib Belantamab Mafodotin-blmf Copanlisib Bendamustine HCl Crizotinib Bevacizumab Cyclophosphamide Bexarotene Cytarabine Bicalutamide Dabrafenib Binimetinib

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Anti-Neoplastics (continued) Dacarbazine Fam-Trastuzumab Deruxtecan-nxki Dacomitinib Floxuridine Daratumumab Fludarabine Phosphate Daratumumab and Hyaluronidase-fihj Fluorouracil Darolutamide Fluoxymesterone Dasatinib Flutamide Daunorubicin Citrate Liposome Fulvestrant Daunorubicin HCl Gefitinib Decitabine Gemcitabine HCl Degarelix Gemtuzumab Ozogamicin Docetaxel Gilteritinib Dostarlimab-gxly Glasdegib Doxorubicin HCl Goserelin Acetate Doxorubicin HCl Liposome Hydroxyurea Durvalumab Ibrutinib Duvelisib Idelalisib Elotuzumab Ifosfamide Encorafenib Ifosfamide with Mesna Entrectinib Imatinib Mesylate Enzalutamide ‹‹Infigratinib›› Epirubicin HCl Inotuzumab Ozogamcin Erdafitinib Interferon Alfa-2a Eribulin Mesylate Interferon Alfa-2b Erlotinib Ipilimumab Estradiol Irinotecan HCl Estramustine Phosphate Irinotecan Liposome Etoposide Isatuximab-irfc Etoposide Phosphate Ivosidenib Everolimus Ixabepilone Exemestane

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Anti-Neoplastics (continued) Ixazomib Ofatumumab Lanreotide Acetate Olaparib Lapatinib Olaratumab Larotrectinib Omacetaxine Mepesuccinate Lenvatinib Osimertinib Letrozole Oxaliplatin Leuprolide Acetate Paclitaxel Lomustine Palbociclib ‹‹Loncastuximab Tesirine-lpyl›› Panitumumab Lorlatinib Panobinostat Margetuximab-Cmkb Pazopanib HCl Mechlorethamine HCl Pegaspargase Medroxyprogesterone Acetate Peginterferon Alfa-2b Megestrol Acetate Pembrolizumab Melphalan Pemetrexed Melphalan Flufenamide Pentostatin Mercaptopurine Pertuzumab Midostaurin Pertuzumab, Trastuzumab and Hyaluronidase-zzxf Mitomycin Pexidartinib Mitotane Polatuzumab Vedotin-piiq Mitoxantrone Ponatinib Moxetumomab Pasudotox-tdfk Porfimer Sodium Necitumumab Pralsetinib Nelarabine Procarbazine Nilotinib Ramucirumab Nilutamide Relugolix Niraparib Regorafenib Nivolumab Ribociclib Obinutuzumab

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Anti-Neoplastics (continued) Ribociclib and Letrozole Thiotepa Ripretinib Tivozanib Rituximab Topotecan HCl Rituximab-abbs Trabectedin Rituximab and Hyaluronidase Human Trametinib Sacituzumab Govitecan-hziy Trastuzumab Selpercatinib Trastuzumab-pkrb Sonidegib Trastuzumab and Hyaluronidase-oysk Sorafenib Trastuzumab-dttb ‹‹Sotorasib›› Tretinoin Streptozocin Triptorelin Pamoate Sunitinib Malate Umbralisib Talazoparib Vandetanib Talimogene Laherparepvec Vemurafenib Tamoxifen Citrate Venetoclax Tazemetostat Vinblastine Sulfate Temozolomide Vincristine Sulfate Temsirolimus Vinorelbine Tartrate Teniposide Vismodegib Tepotinib Vorinostat Testosterone Zanubrutinib Thioguanine Ziv-Aflibercept

Autonomic Drugs

Antiasthmatics Albuterol Sulfate Budesonide/Formoterol Fumarate Aminophylline Dihydrate Cromolyn Sodium Beclomethasone Dipropionate Budesonide Epinephrine

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Antiasthmatics (continued) Flunisolide Mometasone Furoate and Formoterol Fluticasone Furoate Fumarate Dihydrate Fluticasone Propionate Montelukast Sodium Fluticasone Propionate and Salmeterol Salmeterol Xinafoate Glycopyrrolate and Formoterol Fumarate Terbutaline Ipratropium Bromide and Albuterol Sulfate Theophylline Tiotropium Bromide Levalbuterol Metaproterenol Triamcinolone Mometasone Furoate Monohydrate

Anti-Emetics Aprepitant Meclizine HCl Chlorpromazine Ondansetron Diphenhydramine Palonosetron HCl Dolasetron Mesylate Perphenazine Doxylamine/Pyridoxine HCl Prochlorperazine Granisetron HCl Promethazine

Antihistamine Containing Combinations See Expectorants and Cough Preparations.

Antihistamines Azelastine HCl Loratadine Brompheniramine Maleate Olopatadine HCl Cetirizine HCl Olodaterol HCl Chlorpheniramine Maleate Promethazine Cyproheptadine Tiotropium Br/Olodaterol HCl Dexbrompheniramine Maleate Triprolidine Diphenhydramine HCl

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Anti-Parkinsonism Amantadine Entacapone Benztropine Mesylate Pramipexole Dihydrochloride Carbidopa and Levodopa Ropinirole HCl Carbidopa and Levodopa and Entacapone Selegiline HCl Diphenhydramine HCl Trihexyphenidyl HCl

Antipruritics – also see Antihistamines Diphenhydramine Hydrochloride Hydroxyzine Promethazine

Migraine Ergotamine Tartrate and Caffeine Rimegepant ‹‹Fremanezumab-vfrm›› Rizatriptan Isometheptene Mucate, Sumatriptan Dichloralphenazone and APAP Sumatriptan Succinate Galcanezumab-Gnlm Ubrogepant Lasmiditan Succinate

Parasympatholytic (Anticholinergic) Agents Atropine Glycopyrrolate Dicyclomine Propantheline Bromide

Parasympathomimetic (Cholinergic) Agents – also see Ophthalmic Miotics Bethanechol Chloride Pyridostigmine Donepezil HCl Rivastigmine Galantamine Hydrobromide Rivastigmine Tartrate Pilocarpine

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Sympatholytic (Adrenergic Blocking) Agents Ergotamine Tartrate and Caffeine Propranolol

Sympathomimetic (Adrenergic) Agents – also see Ophthalmic Vasoconstrictors Epinephrine

Blood Modifiers

Anticoagulant Antagonist Phytonadione

Anticoagulants Apixaban Heparin Lock Flush Solution Dabigatran Etexilate Mesylate Rivaroxaban Enoxaparin Sodium Warfarin Sodium Heparin Anti-Platelet Clopidogrel Prasugrel Ticagrelor

Hematinics Ferrous Sulfate Iron Dextran Injection

Hematopoietic Epoetin Alfa

Thrombocytopenic Anagrelide Hydrochloride

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Analgesics

Anti-Inflammatory – also see Glucocorticoids Aspirin Indomethacin Celecoxib Meloxicam Colchicine Nabumetone Diclofenac Sodium Naproxen Diflunisal Piroxicam Fenoprofen Salsalate Flurbiprofen Sulindac Ibuprofen Tolmetin

Narcotic Antagonists Glucocorticoids Buprenorphine Naloxone HCl Buprenorphine/Naloxone Naltrexone HCl

Narcotics Codeine and Acetaminophen Morphine Sulfate Fentanyl Oxycodone and Acetaminophen Hydrocodone and Acetaminophen Oxycodone HCl Hydromorphone Oxycodone HCl and Aspirin Levorphanol Tartrate Oxymorphone Meperidine HCl

Non-Narcotics Acetaminophen Phenazopyridine HCl Aspirin Tramadol HCl Lidocaine

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Central Nervous System Drugs

Antianxiety Buspirone Hydroxyzine Pamoate Chlordiazepoxide HCl Lorazepam Hydroxyzine HCl

Anticonvulsants Carbamazepine Phenobarbital Clonazepam Phenytoin Diazepam Pregabalin Divalproex Sodium Primidone Ethosuximide Tiagabine HCl Gabapentin Topiramate Lamotrigine Valproic Acid Oxcarbazepine Zonisamide ‹‹Perampanel››

Antidepressants Amitriptyline Fluvoxamine Maleate Amitriptyline HCl, Perphenazine Imipramine Bupropion HCl Mirtazapine Citalopram HBr Nortriptyline HCl Clomipramine HCl Paroxetine HCl Desipramine HCl Protriptyline Desvenlafaxine Succinate Sertraline HCl Doxepin Trazodone Duloxetine HCl Venlafaxine HCl Escitalopram Oxalate Vortioxetine Fluoxetine HCl

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Anti-Hyperkinetics Atomoxetine HCl Lisdexamfetamine Dimesylate Dexmethylphenidate HCl Methylphenidate HCl Dextroamphetamine Sulfate Guanfacine HCl Extended-Release

Appetite Stimulant Dronabinol

‹‹Drugs to Treat Movement Disorders Deutetrabenazine››

Miscellaneous Milnacipran HCl

Psychotropics Aripiprazole Lurasidone Hydrochloride Asenapine Molindone Hydrochloride Chlorpromazine Olanzapine Clozapine Perphenazine Fluphenazine Quetiapine Fumarate Haloperidol Risperidone Iloperidone Thioridazine Lithium Carbonate Thiothixene Lithium Citrate Trifluoperazine Loxapine Ziprasidone HCl

Sedatives and Hypnotics The Department of Health Care Services (DHCS) recommends that a patient’s use of a hypnotic in insomnia therapy be occasional rather than continuous. Flurazepam Ramelteon Pentobarbital Temazepam Phenobarbital Triazolam

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Diuretics and Cardiovasculars

Antihypertensives – also see Diuretics Acebutolol Losartan and Hydrochlorothiazide Amlodipine/Benazepril HCl Methyldopa Amlodipine Besylate Methyldopa with Hydrochlorothiazide Amlodipine/Valsartan Metoprolol Succinate Amlodipine/Valsartan Hydrochlorothiazide Metoprolol Tartrate Atenolol Nicardipine Benazepril HCl Nisoldipine Benazepril HCl and Hydrochlorothiazide Penbutolol Sulfate Bisoprolol Fumarate Pindolol Captopril Prazosin HCl Clonidine Hydrochloride Propranolol Diltiazem HCl Propranolol Hydrochloride Doxazosin Mesylate Ramipril Enalapril Maleate Sildenafil Citrate Guanfacine HCl Telmisartan Hydralazine Telmisartan and Hydrochlorothiazide Isradipine Terazosin Hydrochloride Labetalol HCl Timolol Maleate Lisinopril Valsartan Lisinopril and Hydrochlorothiazide Valsartan/Hydrochlorothiazide Losartan Verapamil HCl

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Cardiac Drugs Amiodarone Metoprolol Tartrate Betaxolol Mexiletine Hydrochloride Captopril Procainamide Carvedilol Propranolol Carvedilol Phosphate Quinidine Gluconate Digoxin Quinidine Sulfate Enalapril Maleate Sotalol HCl ‹‹Flecainide Acetate›› Timolol Maleate Metoprolol Succinate

Diuretics Acetazolamide Methazolamide ‹‹Bumetanide›› Metolazone Chlorthalidone Spironolactone Ethacrynic Acid Spironolactone with Hydrochlorothiazide Furosemide Triamterene Hydrochlorothiazide Triamterene with Hydrochlorothiazide Indapamide

Vasodilating Agents Amlodipine Besylate and Atorvastatin Niacin Calcium Nicardipine Diltiazem HCl Nifedipine Isosorbide Dinitrate Nitroglycerin Isosorbide Dinitrate and Hydralazine Verapamil HCl Hydrochloride Isosorbide Mononitrate

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Gastro-Intestinal Drugs

Antacids and Adsorbents Aluminum and Magnesium Hydroxide Gel Aluminum Hydroxide, Magnesium Aluminum Hydroxide and Magnesium Hydroxide, and Simethicone Trisilicate Gel Calcium Carbonate and Magnesium Aluminum Hydroxide Gel Carbonate

Anti-Diarrhea Agents Bismuth Subsalicylate Paregoric Diphenoxylate HCl with Atropine Sulfate Paregoric and Protective

Anti-Inflammatory Agents Balsalazide Disodium Sulfasalazine

Bile Acid Modifier Ursodiol

Digestant Preparations Pancrelipase Pancrelipase (Amylase/ Lipase/Protease)

G.I. Stimulant Metoclopramide HCl

H + /K + ATPase Enzyme System Inhibitors Dexlansoprazole Esomeprazole Magnesium Omeprazole

‹‹Helicobacter Pylori Treatment Bismuth Subcitrate Potassium, Metronidazole, and Tetracycline HCl Omeprazole, Amoxicillin, and Rifabutin››

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Histamine H2-Receptor Antagonists Cimetidine Famotidine Ranitidine HCl

Laxatives Bisacodyl Polyethylene Glycol 3350 Docusate Sodium Polyethylene Glycol 3350 and Electrolytes Naloxegol Oxalate

Prostaglandin Analog Misoprostol

Ulcer Adherent Sucralfate

Hormones

Androgens Fluoxymesterone Methyl Testosterone Testosterone

Contraceptives Desogestrel and Ethinyl Estradiol Nonoxynol 9 Drospirenone and Ethinyl Estradiol Norelgestromin and Ethinyl Estradiol Estradiol Valerate and Dienogest Norethindrone Ethynodiol Diacetate and Ethinyl Estradiol Norethindrone and Ethinyl Estradiol Etonogestrel and Ethinyl Estradiol Norethindrone and Mestranol Lactic Acid, Citric Acid and Potassium Norgestimate and Ethinyl Estradiol Bitartrate Norgestrel and Ethinyl Estradiol Levonorgestrel Segesterone Acetate and Ethinyl Estradiol Levonorgestrel and Ethinyl Estradiol Ulipristal Acetate

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Estrogens and Combinations Estradiol Estrogens, Conjugated and Estrogens, Conjugated Medroxyprogesterone Acetate Estrogens, Esterified

Glucocorticoids Cortisone Prednisolone Dexamethasone Prednisolone Sodium Phosphate Fludrocortisone Acetate Prednisone Hydrocortisone Triamcinolone Methylprednisolone

Gonadotropin-Releasing Hormone and Combinations Elagolix Elagolix, Estradiol and Norethindrone Acetate

Hypoglycemics Acarbose Glyburide Alogliptin Glyburide and Metformin HCl Alogliptin/Metformin HCl Insulin Alogliptin/Pioglitazone Insulin Aspart (Niacinamide) Chlorpropamide Insulin Aspart Protamine/Insulin Aspart, Dapagliflozin (rDNA Origin) Dapagliflozin/Metformin HCl Insulin Degludec Extended-Release Insulin Detemir Dulaglutide Insulin Lispro Protamine/Insulin Lispro Empagliflozin (rDNA Origin) Empagliflozin/Linagliptin Insulin Glargine (rDNA Origin) Empagliflozin/Linagliptin/Metformin HCl Linagliptin Empagliflozin/Metformin HCl Linagliptin/Metformin HCl Exenatide Liraglutide Glimepiride Metformin HCl Glipizide Miglitol

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Hypoglycemics (continued) Nateglinide Saxagliptin/Metformin HCl Pioglitazone HCl Extended-Release Pioglitazone HCl /Glimepiride Semaglutide Pioglitazone HCl /Metformin HCl Sitagliptin Pramlintide Acetate Sitagliptin/Metformin HCl Rosiglitazone Maleate Tolazamide Saxagliptin Tolbutamid

Hypoglycemic Shock Glucagon (R-DNA Origin) Glucagon (synthetic)

Parathyroid Calcitonin-Salmon

Pituitary Desmopressin Acetate

Progestins and Combinations Medroxyprogesterone Acetate Progesterone Norethindrone Acetate and Ethinyl Estradiol Thyroid and Antithyroid Levothyroxine Sodium Propylthiouracil Thyroid Methimazole

Metabolic Supplements

Calcium Supplements and Vitamin D Analogs Calcitriol Calcium Lactate Calcium Acetate Doxercalciferol Calcium Carbonate Ergocalciferol Calcium Gluconate

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Fluoride Sodium Fluoride

Potassium Supplement Potassium Bicarbonate/Citric Acid Potassium Citrate Potassium Chloride

Vitamins Cyanocobalamin Thiamine Hydrochloride Folic Acid Vitamins A, D, C Leucovorin Calcium Vitamins A, D, C, with Iron Levocarnitine Vitamins A, D, C, with Sodium Fluoride Niacin Vitamins – Minerals, Combination Pyridoxine Products, Prenatal Only, Nonprescription Only

Ophthalmic Preparations

Anti-Glaucoma Agents Acetazolamide Dorzolamide HCl Apraclonidine HCl Dorzolamide HCl and Timolol Maleate Betaxolol HCl Latanoprost Bimatoprost Methazolamide Brimonidine Tartrate Netarsudil Brimonidine Tartrate/Timolol Maleate Netarsudil/Latanoprost Brinzolamide Timolol Maleate Brinzolamide/Brimonidine Tartrate Travoprost Carteolol HCl

Ophthalmic Anesthetic Proparacaine HCl

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Ophthalmic Antibiotics Azithromycin Neomycin, Bacitracin and Polymyxin Bacitracin Neomycin, Polymyxin and Gramicidin Chloramphenicol Ofloxacin Ciprofloxacin HCl Polymyxin, Bacitracin Erythromycin Ophthalmic Ointment Tobramycin Gentamicin Trimethoprim Sulfate and Polymyxin B Sulfate Moxifloxacin HCl Natamycin

Ophthalmic Antihistamines Alcaftadine Azelastine HCl Olopatadine HCl

Ophthalmic Anti-Inflammatories Bromfenac Ketorolac Tromethamine Dexamethasone Loteprednol Etabonate Dexamethasone with Neomycin and Loteprednol Etabonate/Tobramycin Polymyxin Prednisolone Dexamethasone with Tobramycin Prednisolone with Sulfacetamide Diclofenac Sodium Rimexolone Fluorometholone

Ophthalmic Anti-Virals Ganciclovir Trifluridine

Ophthalmic Mast Cell Stabilizers Cromolyn Sodium Lodoxamide

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Ophthalmic Miotics Echothiophate Pilocarpine

Ophthalmic Miscellaneous Sodium Chloride Tyloxapol with Benzalkonium Chloride

Ophthalmic Mydriatics Atropine Phenylephrine Cyclopentolate Tropicamide

Ophthalmic Sulfonamide Sulfacetamide Sodium

Ophthalmic Vasoconstrictors and Combinations Naphazoline HCl Phenylephrine

Otic Preparations Acetic Acid with Aluminum Acetate Ciprofloxacin Acetic Acid with Hydrocortisone Hydrochloride/Hydrocortisone Ciprofloxacin HCl /Dexamethasone Hydrocortisone with Polymyxin B and Neomycin Ofloxacin

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Topical and Local Preparations

Dermatological Preparations Alclometasone Dipropionate Ketoconazole Alitretinoin Lidocaine Aluminum Acetate Malathion Bacitracin Topical Ointment Miconazole Nitrate Benzoyl Peroxide Gel Mupirocin Butenafine HCl Nystatin Calamine Lotion Permethrin Calcipotriene Podofilox Clindamycin Phosphate Topical Solution Polymyxin, Bacitracin Topical Ointment Clotrimazole Prednicarbate Collagenase Pyrethrins, Piperonyl Butoxide, Petroleum Crotamiton Distillate Diclofenac Sodium Silver Sulfadiazine Cream Econazole Nitrate Spinosad Erythromycin Topical Solution Tazarotene Fluocinolone Tolnaftate Fluocinonide Triamcinolone Hydrocortisone Topical Tretinoin Ivermectin

‹‹Recombinant Human Growth Hormone Somatropin››

Rectal Preparations Hydrocortisone Acetate Rectal Foam Hydrocortisone Retention Enema Mesalamine

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Vaccines ‹‹Corona Virus Disease 2019 Vaccine Meningococcal Polysaccharide Diphtheria (COVID-19) Pfizer-BioNtech and Conjugate Vaccine Moderna›› Meningococcal Polysaccharide Vaccine Diphtheria/Pertussis/Tetanus Vaccine Pneumococcal Vaccine, 13-Valent, Hepatitis A Virus Vaccine Conjugated Hepatitis A & B Virus Vaccine Pneumococcal Vaccine, 23-Valent, Non-Conjugated Hepatitis B Virus Vaccine Rabies Vaccine Human Papillomavirus Vaccine Tetanus and Diphtheria Toxoids Adsorbed Influenza Virus Vaccine Vaccine Measles, Mumps, and Rubella Virus Varicella Virus Vaccine Vaccine Varicella Zoster Vaccine Meningococcal Group B Vaccine Zoster Vaccine Meningococcal Oligosaccharide Diphtheria Conjugate Vaccine

Vaginal Preparations Butoconazole Nitrate Miconazole Nitrate Clotrimazole Nystatin Metronidazole Terconazole

Miscellaneous

Amyotrophic Lateral Sclerosis Agent Riluzole

Anti-Alcoholism Acamprosate Calcium Disulfiram

Anti-Gout Allopurinol Probenecid Colchicine Probenecid with Colchicine

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Antihistamine and Decongestant Combinations Phenylephrine Hydrochloride Pseudoephedrine Hydrochloride Brompheniramine Maleate Brompheniramine Maleate Phenylephrine Hydrochloride Pseudoephedrine Hydrochloride Chlorpheniramine Maleate Chlorpheniramine Maleate Phenylephrine Hydrochloride Pseudoephedrine Hydrochloride Diphenhydramine Hydrochloride Dexbrompheniramine Maleate Phenylephrine Hydrochloride Doxylamine Pseudoephedrine Hydrochloride Succinate Doxylamine Succinate Phenylephrine Hydrochloride Pyrilamine Pseudoephedrine Hydrochloride Maleate Triprolidine Hydrochloride Phenylephrine Hydrochloride Triprolidine

Anti-Lipidemic Agents Atorvastatin Calcium Fenofibrate Atorvastatin Calcium and Amlodipine Fenofibric Acid Besylate Fluvastatin Cholestyramine Gemfibrozil Colesevelam HCl Niacin Colestipol Hydrochloride Pravastatin ‹‹Evolocumab›› Rosuvastatin Calcium Ezetimibe Simvastatin Ezetimibe/Simvastatin

Anti-Platelet Agents Aspirin Aspirin/Extended-Release Dipyridamole

Bisphosphonates Alendronate Sodium Pamidronate Disodium Alendronate Sodium/Cholecalciferol Risedronate Sodium Ibandronate Sodium Zoledronic Acid

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Broncho-Pulmonary Secretion Modifiers Acetylcysteine Propylene Glycol Sodium Chloride Solution

Calcimimetic Agent Cinacalcet HCl

Chelating Agent Sodium Polystyrene Sulfate ‹‹Sodium Zirconium Cyclosilicate›› Succimer

Decongestants Phenylephrine Hydrochloride Pseudoephedrine Hydrochloride

Electrolyte Solutions Electrolytes, Oral Maintenance Solutions

Expectorants and Cough Preparations Benzonatate Promethazine with Codeine Chlorpheniramine Maleate with Promethazine with Dextromethorphan Pseudoephedrine HCl and Codeine Promethazine with Phenylephrine Guaifenesin with Codeine Promethazine with Phenylephrine and Potassium Iodide Saturated Solution Codeine (S.S.K.I.)

Gallstone Dissolving Agent Ursodiol

Gold Compounds Auranofin

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Hemorheologic Agents Cilostazol Pentoxifylline

Hypoprolactinemic Agent Bromocriptine Mesylate

Immunomodulators ‹‹Apremilast›› ‹‹Etanercept›› Leflunomide

Immunosuppressive Agent Azathioprine Sirolimus Cyclosporine, Modified Tacrolimus Mycophenolate Mofetil

Interstitial Cystitis Agent Pentosan Polysulfate Sodium

Intravenous Solutions Intravenous Solutions of Other Unlisted Separately Administered Intravenous Drugs Lipids Intravenous Solutions of Unlisted Simple Intravenous Solutions Antibiotics Parenteral Nutrition Solutions (TPN or Hyperalimentation)

Laxatives Lactulose

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Local Anesthetic Injection Lidocaine Hydrochloride

Nasal Anti-Inflammatories Mometasone Furoate Monohydrate

Oxytocics Methylergonovine Maleate

Prostate Agents Alfuzosin HCl Prazosin HCl Doxazosin Mesylate Tamsulosin HCl Dutasteride Terazosin Hydrochloride

Phosphate Binders Aluminum Hydroxide Gel Calcium Carbonate Calcium Acetate Sevelamer Hydrochloride

Skeletal Muscle Relaxants Baclofen Methocarbamol Cyclobenzaprine Tizanidine Dantrolene Sodium

Smoking Deterrents Bupropion HCl Nicotine Polacrilex Nicotine Varenicline Tartrate

Urinary Tract Antispasmodics Fesoterodine Fumarate Solifenacin Succinate Oxybutynin Tolterodine Tartrate Oxybutynin Chloride

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‹‹Legend›› ‹‹Symbols used in the document above are explained in the following table.›› Symbol Description ‹‹ This is a change mark symbol. It is used to indicate where on the page the most recent change begins. ›› This is a change mark symbol. It is used to indicate where on the page the most recent change ends.

Part 2 – Drugs: Contract Drugs List Part 4 – Therapeutic Classifications