Prior Authorization Drug Criteria Cross Reference PA Drug Name Generic Name PA Summary Name Epaned enalapril ACE Inhibitors and Combinations Perindopril perindopril ACE Inhibitors and Combinations Prestalia perindopril/amlodipine ACE Inhibitors and Combinations Qbrelis lisinopril ACE Inhibitors and Combinations Trandolapril/Verapamil ER by Greenstone trandolapril/verapamil ER ACE Inhibitors and Combinations Absorica/LD, Amnesteem, Claravis, isotretinoin Acne Agents, Oral Isotretinoin, Myorisan, Zenatane Acanya clindamycin/benzoyl peroxide Acne and Rosacea Agents, Topical Aczone dapsone Acne and Rosacea Agents, Topical Aklief trifarotene Acne and Rosacea Agents, Topical Altreno, Avita, Tretinoin, Retin-A Micro tretinoin Acne and Rosacea Agents, Topical Amzeeq minocycline Acne and Rosacea Agents, Topical Azelex, Finacea azelaic acid Acne and Rosacea Agents, Topical Clindamycin, Clindacin, Evoclin clindamycin Acne and Rosacea Agents, Topical Clindamycin 1%/Benzoyl Peroxide 5%, clindamycin/benzoyl peroxide Acne and Rosacea Agents, Topical Neuac, Onexton Differin, Adapalene adapalene Acne and Rosacea Agents, Topical Epiduo, Epidue Forte adalpalene/benzoyl peroxide Acne and Rosacea Agents, Topical Ery Pad, erythromycin pad erythromycin Acne and Rosacea Agents, Topical Erythromycin/Benzoyl Peroxide erythromycin/benzoyl peroxide Acne and Rosacea Agents, Topical Metrogel, Metronidazole, Noritate, Rosadan metronidazole Acne and Rosacea Agents, Topical Fabior, Tazorac tazarotene Acne and Rosacea Agents, Topical Soolantra ivermectin Acne and Rosacea Agents, Topical Ziana tretinoin/clindamycin Acne and Rosacea Agents, Topical BP 10-1%, Sulfacetamide Sodium/Sulfur, sodium sulfacetamide/sulfur Acne and Rosacea Agents, Topical Sumaxin Sulfacetamide sodium sulfacetamide sodium Acne and Rosacea Agents, Topical Octreotide, Sandostatin LAR octreotide/octreotide ER Acromegaly Agents Signifor LAR pasireotide ER Acromegaly Agents Somatuline Depot lanreotide ER Acromegaly Agents Somavert pegvisomant Acromegaly Agents Afinitor everolimus Afinitor Tekturna aliskiren Aliskiren and Combinations Tekturna HCT aliskiren/HCTZ Aliskiren and Combinations Grastek timothy grass pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy Oralair mixed grass pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy Ragwitek short ragweed pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy Donepezil 23 mg donepezil Alzheimer's Agents Memantine oral solution memantine Alzheimer's Agents Memantine ER, Namenda XR Titration Pak memantine extended-release Alzheimer's Agents Namzaric, Titration Pak memantine/donepezil Alzheimer's Agents Tiglutik riluzole Amyotrophic Lateral Sclerosis Agents Arymo ER, Kadian, Morphabond ER, morphine ER Analgesics, Narcotics Long Morphine ER capsules Belbuca buprenorphine Analgesics, Narcotics Long Fentanyl Patch 37.5, 62.5, 87.5 mcg/hour fentanyl Analgesics, Narcotics Long Hydromorphone ER hydromorphone ER Analgesics, Narcotics Long Hysingla ER, Zohydro ER hydrocodone ER Analgesics, Narcotics Long Levorphanol levorphanol Analgesics, Narcotics Long Nucynta ER tapentadol ER Analgesics, Narcotics Long OxyContin, Xtampza ER oxycodone ER Analgesics, Narcotics Long Oxymorphone ER oxymorphone ER Analgesics, Narcotics Long Acetaminophen/caffeine/dihydrocodeine acetaminophen/caffeine/dihydrocodeine Analgesics, Narcotics Short Benzhydrocodone/acetaminophen benzhydrocodone/acetaminophen Analgesics, Narcotics Short Butalbital/Acetaminophen/Caffeine/Codeine butalbital/acetaminophen/caffeine/codeine Analgesics, Narcotics Short Butalbital/Aspirin/Caffeine/Codeine butalbital/aspirin/caffeine/codeine Analgesics, Narcotics Short Butorphanol Nasal Spray QLL butorphanol Analgesics, Narcotics Short Codeine codeine Analgesics, Narcotics Short Dilaudid Oral Liquid, Hydromorphone Rectal hydromorphone Analgesics, Narcotics Short Suppository Hydrocodone/Ibuprofen, Ibudone hydrocodone/ibuprofen Analgesics, Narcotics Short Meperidine meperidine Analgesics, Narcotics Short Morphine Rectal Suppository morphine Analgesics, Narcotics Short Nalocet, Primlev oxycodone/acetaminophen Analgesics, Narcotics Short Nucynta tapentadol Analgesics, Narcotics Short Oxaydo, Oxycodone QLL, Oxycodone oxycodone Analgesics, Narcotics Short Concentrate Oral Solution Oxycodone/Aspirin oxycodone/aspirin Analgesics, Narcotics Short Oxycodone/Ibuprofen oxycodone/ibuprofen Analgesics, Narcotics Short Oxymorphone oxymorphone Analgesics, Narcotics Short Diflunisal diflunisal Analgesics, Salicylates Salsalate salsalate Analgesics, Salicylates Testosterone Injection testosterone cypionate Androgenic Agents, Injectable Testosterone Injection, Xyosted testosterone enanthate Androgenic Agents, Injectable Anadrol-50 oxymetholone Androgenic Agents, Oral Danazol danazol Androgenic Agents, Oral Jatenzo testosterone undecanoate Androgenic Agents, Oral Methitest, Methyltestosterone methyltestosterone Androgenic Agents, Oral Oxandrolone oxandrolone Androgenic Agents, Oral Androderm, Striant, Testosterone testosterone Androgenic Agents, Topical Trandermal Candesartan candesartan Angiotensin Receptor Blockers and Combinations Edarbi azilsartan Angiotensin Receptor Blockers and Combinations Eprosartan eprosartan Angiotensin Receptor Blockers and Combinations Micardis, Telmisartan telmisartan Angiotensin Receptor Blockers and Combinations Amlodipine/Valsartan amlodipine/valsartan Angiotensin Receptor Blockers and Combinations Amlodipine/Valsartan/HCTZ amlodipine/valsartan/HCTZ Angiotensin Receptor Blockers and Combinations Amlodipine/olmesartan amlodipine/olmesartan Angiotensin Receptor Blockers and Combinations Entresto sacubitril/valsartan Angiotensin Receptor Blockers and Combinations Tribenzor olmesartan/amlodipine/HCTZ Angiotensin Receptor Blockers and Combinations Candesartan/HCTZ candesartan/HCTZ Angiotensin Receptor Blockers and Combinations Edarbyclor azilsartan/HCTZ Angiotensin Receptor Blockers and Combinations Micardis, Telmisartan/HCTZ telmisartan/HCTZ Angiotensin Receptor Blockers and Combinations Telmisartan/Amlodipine, Twynsta telmisartan/amlodipine Angiotensin Receptor Blockers and Combinations Albendazole albendazole Anthelmintics Emverm mebendazole Anthelmintics Stromectol ivermectin Anthelmintics Dificid fidaxomicin Antibiotics, GI Paromomycin paromomycin Antibiotics, GI Xifaxan rifamixin Antibiotics, GI Tobi Podhaler, Tobramycin Nebulized tobramycin Antibiotics, Inhaled Cleocin Ovules, Clindamycin Vaginal Cream clindamycin Antibiotics, Vaginal (7-day) Solosec secnidazole Antibiotics, Vaginal Chlordiazepoxide/Clidinium chlordiazepoxide/clidinium Anticholinergics-Antispasmodics Cuvposa, Glycate, Glycopyrrolate Injection glycopyrrolate Anticholinergics-Antispasmodics Methscopolamine methscopolamine Anticholinergics-Antispasmodics Proprantheline proprantheline Anticholinergics-Antispasmodics Bevyxxa betrixaban Anticoagulants Savaysa edoxaban Anticoagulants Fondaparinux fondaparinux Anticoagulants Fragmin Syringes dalteparin Anticoagulants Aptiom eslicarbazepine Anticonvulsants Banzel rufinamide Anticonvulsants Briviact brivaracetam Anticonvulsants Clobazam oral suspension, Sympazan clobazam Anticonvulsants Diazepam Rectal diazepam rectal Anticonvulsants Diacomit stiripentol Anticonvulsants Epidiolex cannabidiol Anticonvulsants Equetro carbamazepine extended-release Anticonvulsants Felbamate felbamate Anticonvulsants Fycompa perampanel Anticonvulsants Gabitril, Tiagabine tiagabine Anticonvulsants Lamictal Kits/ODT, Lamotrigine ER/ODT/kits lamotrigine Anticonvulsants Levetiracetam ER levetiracetam extended-release Anticonvulsants Lyrica CR pregabalin extended-release Anticonvulsants Nayzilam midazolam Anticonvulsants Oxtellar XR oxcarbazepine Anticonvulsants Qudexy XR, Topiramate ER, Trokendi XR topiramate extended-release Anticonvulsants Sabril vigabatrin Anticonvulsants Stavzor, Valproic Acid Capsules valproic acid Anticonvulsants Vimpat Injection lacosamide Anticonvulsants Brisdelle, Paxil Suspension, Pexeva paroxetine Antidepressants Escitalopram Oral Solution escitalopram Antidepressants Fluoxetine 10 mg, 20 mg Tablets fluoxetine Antidepressants Fluoxetine 90 mg Delayed-Release fluoxetine DR Antidepressants Fluoxetine [PMDD], Sarafem fluoxetine [PMDD] Antidepressants Fluvoxamine ER fluvoxamine extended-release Antidepressants Paroxetine ER paroxetine extended-release Antidepressants Desvenlafaxine ER desvenlafaxine extended-release Antidepressants Drizalma, Duloxetine 40 mg duloxetine Antidepressants Fetzima levomilnacipran Antidepressants Savella milnacipran Antidepressants Trintellix (previously Brintellix) vortioxetine Antidepressants Venlafaxine ER Tablets venlafaxine extended-release Antidepressants Nefazodone nefazodone Antidepressants Trazodone 300 mg trazodone Antidepressants Viibryd viladazone Antidepressants Emsam selegiline Antidepressants Marplan isocarboxazid Antidepressants Phenylzine phenylzine Antidepressants Tranylcypromine tranylcypromine Antidepressants Imipramine Capsules imipramine pamoate Antidepressants Protriptyline protriptyline Antidepressants Trimipramine trimipramine Antidepressants Aplenzin, Forfivo XL bupropion extended-release Antidepressants Maprotiline maprotiline Antidepressants Spravato esketamine Antidepressants Alogliptin 6.25, 12.5mg, Nesina 25mg alogliptin Antidiabetic Agents Alogliptin/Metformin alogliptin/metformin Antidiabetic Agents Alogliptin/Pioglitazone alogliptin/pioglitazone Antidiabetic Agents Janumet XR sitagliptin/metformin ER Antidiabetic Agents Jentadueto XR linagliptin/metformin ER Antidiabetic Agents Prandimet, Repaglinide/Metformin repaglinide/metformin Antidiabetic Agents Fortamet, Metformin ER (generic Fortamet), metformin ER Antidiabetic Agents Riomet ER Glyxambi empagliflozin/linagliptin Antidiabetic Agents Invokamet XR canagliflozin/metformin ER Antidiabetic Agents Qtern dapagliflozin/saxagliptin Antidiabetic Agents Segluromet ertugliflozin/metformin Antidiabetic Agents Steglatro ertugliflozin Antidiabetic Agents Steglujan ertugliflozin/sitagliptin Antidiabetic Agents Synjardy, Synjardy XR empaglifozin/metformin, ER Antidiabetic Agents Chlorpropamide chlorpropamide Antidiabetic Agents Tolazamide tolazamide Antidiabetic Agents Tolbutamide tolbutamide Antidiabetic Agents Actoplus Met XR pioglitazone/metformin ER Antidiabetic Agents Avandia rosiglitazone Antidiabetic Agents Avandamet rosiglitazone/metformin Antidiabetic Agents Pioglitazone/Glimepride pioglitazone/glimepiride Antidiabetic Agents Pioglitazone/Metformin pioglitazone/metformin Antidiabetic Agents Bydureon/Bydureon BCise exenatide ER Antidiabetic Agents Byetta exenatide Antidiabetic Agents Symlin Pen pramlintide acetate Antidiabetic Agents Victoza liraglutide Antidiabetic Agents Adlyxin lixisenatide Antidiabetic Agents Cycloset bromocriptine Antidiabetic Agents Ozempic, Rybelsus semaglutide Antidiabetic Agents Soliqua insulin glargine/lixisenatide Antidiabetic Agents Tanzeum albiglutide Antidiabetic Agents Trulicity dulaglutide Antidiabetic Agents Xultophy insulin degludec/liraglutide Antidiabetic Agents Alosetron alosetron Antidiarrheals Motofen difenoxin/atropine Antidiarrheals Mytesi crofelemer Antidiarrheals Opium tincture opium tincture Antidiarrheals Viberzi eluxadoline Antidiarrheals Xermelo telotristat Antidiarrheals Akynzeo netupitant/palonosetron Antiemetic/Antivertigo Agents Anzemet dolasetron Antiemetic/Antivertigo Agents Cesamet nabilone Antiemetic/Antivertigo Agents Compro prochlorperazine Antiemetic/Antivertigo Agents Dimenhydrinate Injection dimenhydrinate Antiemetic/Antivertigo Agents Dronabinol, Syndros dronabinol Antiemetic/Antivertigo Agents Emend Suspension aprepitant Antiemetic/Antivertigo Agents Granisetron, Sancuso granisetron Antiemetic/Antivertigo Agents Metoclopramide ODT metoclopramide Antiemetic/Antivertigo Agents Ondansetron Injection, Zuplenz ondansetron Antiemetic/Antivertigo Agents Promethazine 50 mg Suppository promethazine Antiemetic/Antivertigo Agents Trimethobenzamide trimethobenzamide Antiemetic/Antivertigo Agents Varubi rolapitant Antiemetic/Antivertigo Agents Fluconazole Injection fluconazole Antifungals, Injectable Ambisome amphotericin B liposome Antifungals, Injectable Cancidas caspofungin Antifungals, Injectable Voriconazole Injection voriconazole Antifungals, Injectable Cresemba isavuconazonium Antifungals, Oral Flucytosine flucytosine Antifungals, Oral Griseofulvin griseofulvin Antifungals, Oral Lamisil Granules terbinafine Antifungals, Oral Noxafil posaconazole Antifungals, Oral Itraconazole, Omnel, Sporanox Solution Itraconazole Antifungals, Oral Oravig miconazole Antifungals, Oral Vfend Suspension voriconazole Antifungals, Oral Bensal HP salicylic acid Antifungals, Topical Ciclodan Kit, CNL8 Kit, Ciclopirox, Loprox Kit ciclopirox Antifungals, Topical Clotrimazole/Betamethasone Lotion clotrimazole/betamethasone Antifungals, Topical Extina, Ketoconazole Foam ketoconazole Antifungals, Topical Jublia efinaconazole Antifungals, Topical Kerydin tavaborole Antifungals, Topical Luzu luliconazole Antifungals, Topical Naftifine naftifine Antifungals, Topical Nystatin/triamcinolone cream nystatin/triamcinolone Antifungals, Topical Vusion miconazole/zinc oxide/petrolatum Antifungals, Topical Clarinex-D desloratadine/pseudoephedrine Antihistamines Clarinex Syrup, Desloratadine desloratadine Antihistamines Karbinal ER, Ryvent carbinoxamine ER Antihistamines Levocetirizine Solution levocetirizine Antihistamines Ryvent carbinoxamine Antihistamines Clonidine TTS clonidine TTS Antihypertensives, Sympatholytics Colchicine QLL, Colchicine Tablets, Gloperba colchicine Antihyperuricemics Uloric febuxostat Antihyperuricemics Krintafel tafenoquine Antimalarials Atovaquone/Proguanil, Malarone atovaquone/proguanil Antimalarials Coartem artemether/lumefantrine Antimalarials Quinine Sulfate quinine sulfate Antimalarials Aimovig erenumab-aooe Antimigraine Agents, Other Ajovy fremanezumab-vfrm Antimigraine Agents, Other Emgality galcanezumab-gnlm Antimigraine Agents, Other Almotriptan almotriptan Antimigraine Agents, Triptans Dihydroergotamine, Migranal dihydroergotamine mesylate Antimigraine Agents, Triptans Eletriptan eletriptan Antimigraine Agents, Triptans Ergomar ergotamine Antimigraine Agents, Triptans Frova frovatriptan Antimigraine Agents, Triptans Migergot ergotamine/caffeine Antimigraine Agents, Triptans Nazatriptan nazatriptan Antimigraine Agents, Triptans Onzetra Xsail, Sumatriptan Injection, sumatriptan Antimigraine Agents, Triptans Tosymra, Zembrace Treximet sumatriptan/naproxen Antimigraine Agents, Triptans Zolmitriptan, Zomig, Zomig ZMT zolmitriptan Antimigraine Agents, Triptans Pretomanid pretomanid Antimycobacterium Agents Sirturo bedaquiline Antimycobacterium Agents Eurax crotamiton Antiparasitics, Topical Lindane lindane Antiparasitics, Topical Malathion, Ovide malathion Antiparasitics, Topical Natroba, Spinosad spinosad Antiparasitics, Topical Sklice ivermectin Antiparasitics, Topical Apokyn apomorphine Antiparkinson Agents Carbidopa/Levodopa ODT, Rytary carbidopa/levodopa Antiparkinson Agents Gocovri amantadine extended-release Antiparkinson Agents Inbrija levodopa Antiparkinson Agents Mirapex ER, Pramipexole ER pramipexole Antiparkinson Agents Neupro rotigotine Antiparkinson Agents Nourianz istradefylline Antiparkinson Agents Requip XL, Ropinirole ER ropinirole Antiparkinson Agents Tolcapone tolcapone Antiparkinson Agents Xadago safinamide Antiparkinson Agents Zelapar selegiline Antiparkinson Agents Aspirin/Dipyridamole aspirin/dipyridamole Antiplatelet Drugs Clopidogrel 300 mg clopidogrel Antiplatelet Drugs Yosprala aspirin/omeprazole Antiplatelet Drugs Zontivity vorapaxar Antiplatelet Drugs Alinia Quantity Level Limit nitazoxanide Antiprotozoals Benznidazole benznidazole Antiprotozoals Daraprim pyrimethamine Antiprotozoals Flagyl 375 mg, Metronidazole 375 mg metronidazole Antiprotozoals Tinidazole tinidazole Antiprotozoals Doxepin Cream, Prudoxin, Zonalon doxepin Antipruritics, Topical Calcipotriene ointment, Sorilux calcipotriene Antipsoriatic Agents Calcipotriene/betamethasone, Enstilar, calcipotriene/betamethasone Antipsoriatic Agents Taclonex Calcitriol, Vectical calcitriol Antipsoriatic Agents Methoxsalen methoxsalen Antipsoriatic Agents Cytovene Injection, Ganciclovir Injection ganciclovir Antivirals, General Prevymis letermovir Antivirals, General Valcyte Powder, Valganciclovir Powder valganciclovir Antivirals, General Valacyclovir QLL valacyclovir Antivirals, Oral Sitavig acyclovir Antivirals, Oral Xofluza baloxivir Antivirals, Oral Acyclovir Ointment acyclovir Antivirals, Topical Denavir penciclovir Antivirals, Topical Xerese acyclovir/hydrocortisone Antivirals, Topical Meprobamate meprobamate Anxiolytics Benzodiazepines and Barbiturates Alprazolam, Alprazolam ER, ODT alprazolam Anxiolytics Benzodiazepines and Barbiturates Chlordiazepoxide chlordiazepoxide Anxiolytics Benzodiazepines and Barbiturates Clonazepam ODT clonazepam Anxiolytics Benzodiazepines and Barbiturates Clorazepate clorazepate Anxiolytics Benzodiazepines and Barbiturates Diazepam diazepam Anxiolytics Benzodiazepines and Barbiturates Lorazepam lorazepam Anxiolytics Benzodiazepines and Barbiturates Oxazepam oxazepam Anxiolytics Benzodiazepines and Barbiturates Estazolam estazolam Anxiolytics Benzodiazepines and Barbiturates Flurazepam flurazepam Anxiolytics Benzodiazepines and Barbiturates Midazolam midazolam Anxiolytics Benzodiazepines and Barbiturates Temazepam temazepam Anxiolytics Benzodiazepines and Barbiturates Triazolam triazolam Anxiolytics Benzodiazepines and Barbiturates Amytal amobarbital Anxiolytics Benzodiazepines and Barbiturates Butisol butabarbital Anxiolytics Benzodiazepines and Barbiturates Phenobarbital Injection phenobarbital Anxiolytics Benzodiazepines and Barbiturates Seconal secobarbital Anxiolytics Benzodiazepines and Barbiturates Arikayce amikacin liposome inhalation suspension Arikayce Anoro Ellipta umeclidinium/vilanterol Asthma and COPD Agents Bevespi Aerosphere glycopyrrolate/formoterol Asthma and COPD Agents Duaklir Pressair aclidinium/formotoerol Asthma and COPD Agents Incruse Ellipta umeclidinium Asthma and COPD Agents Lonhala Magnair, Seebri Neohaler glycopyrrolate Asthma and COPD Agents Spiriva Respimat tiotropium Asthma and COPD Agents Tudorza Pressair aclidinium Asthma and COPD Agents Utibron Neohaler glycopyrrolate/indacaterol Asthma and COPD Agents Yupelri revefenacin Asthma and COPD Agents Albuterol Inhalation 0.021%, 0.042% albuterol Asthma and COPD Agents Albuterol Tablets albuterol Asthma and COPD Agents Arcapta Neohaler indacaterol Asthma and COPD Agents Brovana aformoterol Asthma and COPD Agents Levalbuterol, Xopenex HFA levalbuterol Asthma and COPD Agents Metaproterenol metaproterenol Asthma and COPD Agents Perforomist formoterol Asthma and COPD Agents ProAir Digihaler and Respiclick albuterol Asthma and COPD Agents Striverdi Respimat oladaterol Asthma and COPD Agents Terbutaline terbutaline Asthma and COPD Agents Alvesco ciclesonide Asthma and COPD Agents Armonair Respiclick fluticasone propionate Asthma and COPD Agents Arnuity Ellipta fluticasone furoate Asthma and COPD Agents Asmanex Twisthaler/HFA mometasone Asthma and COPD Agents Qvar Redihaler beclomethasone Asthma and COPD Agents AirDuo, Fluticasone/Salmeterol fluticasone/salmeterol Asthma and COPD Agents Breo Ellipta fluticasone/vilanterol Asthma and COPD Agents Trelegy Ellipta fluticasone/umeclidinium/vilanterol Asthma and COPD Agents Daliresp roflumilast Asthma and COPD Agents Abilify Maintena, Aripiprazole, aripiprazole Atypical Antipsychotics Aristada/Aristada Initio Clozapine, Clozapine ODT, Versacloz clozapine Atypical Antipsychotics Fanapt iloperidone Atypical Antipsychotics Invega Sustenna, Invega Trinza, Paliperidone paliperidone Atypical Antipsychotics Latuda lurasidone Atypical Antipsychotics Nuplazid pimavanserin Atypical Antipsychotics Olanzapine, Zyprexa Relprevv olanzapine Atypical Antipsychotics Olanzapine/Fluoxetine olanzapine/fluoxetine Atypical Antipsychotics Quetiapine IR and ER quetiapine Atypical Antipsychotics Rexulti brexpiprazole Atypical Antipsychotics Risperdal Consta, Risperidone risperidone Atypical Antipsychotics Saphris, Secuado asenapine Atypical Antipsychotics Vraylar cariprazine Atypical Antipsychotics Ziprasidone ziprasidone Atypical Antipsychotics Amoxicillin/Clavulanate chewable tablets, amoxicillin/clavulanate Augmentin Products 250/125 mg tablets Amoxicillin/Clavulanate ER amoxicillin/clavulanate extended-release Augmentin Products Amoxicillin/clavulanate 250-62.5 mg/5 ml, amoxicillin/clavulanate Augmentin Products Augmentin 125-31.25 mg/5 mL Aztreonam injection, Azactam Injection aztreonam Aztreonam Balversa larotrectinib Balversa Erivedge vismodegib Basal Cell Carcinoma Agents Odomzo sonidegib Basal Cell Carcinoma Agents Bystolic nebivolol Beta Blockers Coreg CR carvedilol extended-release Beta Blockers Corzide nadolol/bendroflurmethiazide Beta Blockers Innopran XL propranolol extended-release Beta Blockers Metoprolol/Hydrochlorothiazide metoprolol/hydrochlorothiazide Beta Blockers Sotylize sotalol Beta Blockers Timolol timolol Beta Blockers BiDil isosorbide dinitrate/hydralazine HCl BiDil Cholestyramine, cholestyramine lite, cholestyramine Bile Acid Sequestrants Prevalite powder packets Colestid and colestipol granules and packets colestipol Bile Acid Sequestrants Welchol colesevelam Bile Acid Sequestrants Arcalyst rilonacept Biologic Immunomodulators Benlysta Subcutaneous belimumab Biologic Immunomodulators Enbrel/Mini/SureClick etanercept Biologic Immunomodulators Humira adalimumab Biologic Immunomodulators Ilaris canakinumab Biologic Immunomodulators Xeljanz tofacitinib Biologic Immunomodulators Xeljanz XR tofacitinib extended-release Biologic Immunomodulators Actemra Subcutaneous tocilizumab Biologic Immunomodulators Cimzia certolizumab Biologic Immunomodulators Cosentyx secukinumab Biologic Immunomodulators Dupixent dupilumab Biologic Immunomodulators Fasenra Pen benralizumab Biologic Immunomodulators Kevzara sarilumab Biologic Immunomodulators Kineret anakinra Biologic Immunomodulators Nucala Pen mepolizumab Biologic Immunomodulators Olumiant baricitinib Biologic Immunomodulators Orencia Subcutaneous abatacept Biologic Immunomodulators Otezla apremilast Biologic Immunomodulators Rinvoq upadacitinib Biologic Immunomodulators Siliq brodalumab Biologic Immunomodulators Simponi golimumab Biologic Immunomodulators Skyrizi risankizumab Biologic Immunomodulators Stelara ustekinumab Biologic Immunomodulators Taltz ixekizumab Biologic Immunomodulators Tremfya guselkumab Biologic Immunomodulators Enablex darifenacin Bladder Relaxant Preparations Flavoxate flavoxate Bladder Relaxant Preparations Gelnique oxybutunin Bladder Relaxant Preparations Myrbetriq mirabegron Bladder Relaxant Preparations Sanctura XR, Trospium IR and ER trospium Bladder Relaxant Preparations Tolterodine IR, Tolterodine ER tolterodine tartrate Bladder Relaxant Preparations Actonel 5 mg and 30 mg, Atelvia, risedronate Bone Resorption Suppression and Related Agents Risedronate Alendronate Oral Solution, Binosto alendronate Bone Resorption Suppression and Related Agents Forteo teriparatide Bone Resorption Suppression and Related Agents Fosamax Plus D alendronate with vitamin D Bone Resorption Suppression and Related Agents Ibandronate ibandronate Bone Resorption Suppression and Related Agents Miacalcin Injection calcitonin-salmon Bone Resorption Suppression and Related Agents Risedronate Delayed-Release risedronate DR Bone Resorption Suppression and Related Agents Tymlos abaloparatide Bone Resorption Suppression and Related Agents Cardura XL doxazosin BPH Agents Cialis 2.5 mg, 5 mg tadalafil BPH Agents Dutasteride/Tamsulosin dutasteride/tamsulosin BPH Agents Rapaflo silodosin BPH Agents Cabometyx cabozantinib Cabometyx Isradipine isradipine Calcium Channel Blockers Katerzia amlodipine Calcium Channel Blockers Nisoldipine ER nisoldipine ER Calcium Channel Blockers Nymalize nimodipine Calcium Channel Blockers Diltiazem CD 360 mg, Matzim LA diltiazem ER Calcium Channel Blockers Verapamil ER PM verapamil ER Calcium Channel Blockers Capecitabine capecitabine Capecitabine Carbaglu carglumic acid Carbaglu Doribax doripenem Carbapenems Meropenem meropenem Carbapenems Meropenem/Sodium Chloride meropenem/sodium chloride Carbapenems Primaxin, Imipenem/Cilastin imipenem/cilastin Carbapenems Celestone Soluspan betamethasone Celestone Soluspan Cefadroxil Tablets cefadroxil Cephalosporins and Related Antibiotics Cephalexin 750 mg and Tablets cephalexin Cephalosporins and Related Antibiotics Cefaclor ER, Suspension cefaclor Cephalosporins and Related Antibiotics Cefixime, Suprax cefixime Cephalosporins and Related Antibiotics Cefpodoxime cefpodoxime Cephalosporins and Related Antibiotics Avycaz ceftazidime/avibactam Cephalosporins, Injectable Teflaro ceftaroline Cephalosporins, Injectable Zerbaxa ceftolozane/tazobactam Cephalosporins, Injectable Depen Titratabs penicillamine Chelating Agents Ferriprox deferiprone Chelating Agents Jadenu deferasirox Chelating Agents Chenodal chenodiol Chenodal Cholbam cholic acid Cholbam Fulphila, Neulasta, Udenyca, Ziextenzo pegfilgrastim Colony Stimulating Factors Granix tbo filgastrim Colony Stimulating Factors Leukine sargramostim Colony Stimulating Factors Neupogen, Nivestym, Zarxio filgrastim Colony Stimulating Factors Amethia, Amethia Lo, Amethyst, Camrese, ethinyl estradiol/levonorgestrel Contraceptives Camrese Lo, Quartette, generics Annovera segesterone acetate/ethinyl estradiol Contraceptives Aranelle, Leena, generics ethinyl estradiol/norethindrone Contraceptives levonorgestrel/ethinyl estradiol/ferrous Balcoltra Contraceptives biglycinate ethinyl estradiol/drospirenone/ Generics, Safyral Contraceptives levomefolate calcium Gianvi, Ocella, Zarah, generics ethinyl 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Test Strips blood glucose test strips Diabetic Supplies Insulin Pens Humalog Pens insulin lispro Diabetic Supplies Insulin Pens Humulin Pens, Novolin Pens insulin Diabetic Supplies Insulin Pens Insulin Syringes insulin syringes Diabetic Supplies Insulin Pens Lancet Device and Lancets lancets Diabetic Supplies Insulin Pens Novolog Pens insulin aspart Diabetic Supplies Insulin Pens Pen Needles pen needles Diabetic Supplies Insulin Pens Precision Ketone Test Strips ketone test strips Diabetic Supplies Insulin Pens Apidra Pens insulin glulisine Diabetic Supplies Insulin Pens Baqsimi, Gvoke PFS glucagon Diabetic Supplies Insulin Pens Basaglar, Toujeo Pens insulin glargine Diabetic Supplies Insulin Pens Fiasp Pens insulin aspart with niacinamide Diabetic Supplies Insulin Pens Tresiba Pens insulin degludec Diabetic Supplies Insulin Pens Bumetanide Bumetanide Diuretics Carospir spirinolactone suspension Diuretics Eplerenone eplerenone Diuretics Ethacrynic Acid ethacryinic acid Diuretics 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Prevacid Rx Solutab lansoprazole Proton Pump Inhibitors Prilosec Rx Powder for Oral Suspension omeprazole Proton Pump Inhibitors Omeprazole/Sodium Bicarbonate Rx, Zegerid omeprazole/sodium bicarbonate Proton Pump Inhibitors Rx Powder Protonix Pak pantoprazole Proton Pump Inhibitors Adempas riociguat Pulmonary Arterial Hypertension Agents Flolan, Veletri epoprostenol Pulmonary Arterial Hypertension Agents Opsumit macitentan Pulmonary Arterial Hypertension Agents Orenitram, Remodulin, Tyvaso trepostinil Pulmonary Arterial Hypertension Agents Revatio Suspension, Sildenafil 20 mg tablets sildenafil Pulmonary Arterial Hypertension Agents Tadalafil 20 mg tablets tadalafil Pulmonary Arterial Hypertension Agents Tracleer for Oral Suspension bosentan Pulmonary Arterial Hypertension Agents Uptravi selexipag Pulmonary Arterial Hypertension Agents Ventavis iloprost Pulmonary Arterial Hypertension Agents Esbriet pirfenidone Pulmonary Fibrosis Agents Ofev nintedinab Pulmonary Fibrosis Agents Pyridostigmine pyridostigmine Pyridostigmine Pyridostigmine Extended-Release pyridostigmine extended-release Pyridostigmine Ranolazine ranolazine Ranolazine Ravicti glycerol phenylbutyrate Ravicti Sodium Phenylbutyrate Powder sodium phenylbutyrate Ravicti Rectiv nitroglycerin Rectiv Regranex becaplermin Regranex Santyl collagenase Santyl Ambien, Edular, Zolpidem Sublingual, zolpidem Sedative Hypnotics Zolpimist Ambien CR, Zolpidem ER zolpidem ER Sedative Hypnotics Belsomra suvorexant Sedative Hypnotics Eszopiclone, Lunesta eszopiclone Sedative Hypnotics Rozerem ramelteon Sedative Hypnotics Sonata zaleplon Sedative Hypnotics Hetlioz tasimelteon Sedative Hypnotics Silenor doxepin Sedative Hypnotics Serostim somatotropin(recombinant) Serostim Endari l-glutamine Sickle Cell Agents Oxbryta voxelotor Sickle Cell Agents Sicklos hydroxyurea tablets Sickle Cell Agents Signifor pasireotide Signifor Amrix cyclobenzaprine ER Skeletal Muscle Relaxants Carisoprodol 250 mg carisoprodol Skeletal Muscle Relaxants Carisoprodol/Aspirin/Codeine carisoprodol/aspirin/codeine Skeletal Muscle Relaxants Cyclobenzaprine 7.5 mg cyclobenzaprine Skeletal Muscle Relaxants Lorzone chlorzoxazone Skeletal Muscle Relaxants Tizanidine capsules, Zanaflex Capsules tizanidine Skeletal Muscle Relaxants Adzenys XR, Amphetamine ER oral amphetamine Stimulants and Related Agents suspension, Dyanavel XR, Evekeo Amphetamine/Dextroamphetamine IR/ER, amphetamine/dextroamphetamine IR/ER Stimulants and Related Agents Mydayis Dextroamphetamine IR/ER, Zenzedi dextroamphetamine IR/ER Stimulants and Related Agents Adhansia XR, Aptensio XR, Concerta, Cotempla XR, Daytrana, Jornay PM, methylphenidate IR/ER Stimulants and Related Agents Methylin, Methylphenidate, Quillichew ER, Quillivant XR, Ritalin LA 10 mg Armodafinil armodafinil Stimulants and Related Agents Atomoxetine atomoxetine Stimulants and Related Agents Clonidine ER clonidine ER Stimulants and Related Agents Desoxyn, Methamphetamine methamphetamine Stimulants and Related Agents Dexmethylphenidate IR/ER, Focalin XR dexmethylphenidate IR/ER Stimulants and Related Agents Guanfacine ER guanfacine ER Stimulants and Related Agents Modafinil modafinil Stimulants and Related Agents Sunosi solriamfetol Stimulants and Related Agents Vyvanse lisdexamfetamine Stimulants and Related Agents Stivarga regorafenib Stivarga Strensiq asfotase alfa Strensiq Sulfadiazine sulfadiazine Sulfonamides Sutent sunitinib Sutent Synagis palivizumab Synagis Synribo omacetaxine Synribo Temozolomide temozolomide Temozolomide Doryx, Doryx MCP, Doxycycline Hyclate DR doxycycline hyclate delayed-release Tetracyclines Doxycycline Hyclate IR 75, 150 mg tablets doxycycline hyclate immediate-release Tetracyclines Doxycycline Monohydrate 75 mg and 150 mg doxycycline monohydrate Tetracyclines capsules Doxycycline [rosacea] DR, Oracea doxycycline [rosacea] delayed-release Tetracyclines Minocycline IR tablets, Minocycline ER, minocycline Tetracyclines Minolira, Solodyn Morgidox Kit doxycycline and cleanser Tetracyclines Nuzyra omadacycline Tetracyclines Thiola and Thiola EC tiopronin/tiopronin delayed-release Thiola Doptelet avatrombopag Thrombopoiesis Stimulating Proteins Mulpleta lusutrombopag Thrombopoiesis Stimulating Proteins Promacta eltrombopag Thrombopoiesis Stimulating Proteins Tavalisse fostamatinib Thrombopoiesis Stimulating Proteins Nplate romisplostim Thrombopoiesis Stimulating Proteins Levothyroxine Injection, Tirosint levothyroxine Thyroid Hormones Liothyronine Injection liothyronine Thyroid Hormones Tibsovo ivosidenib Tibsovo Bupropion [smoking deterrent] bupropion SR Tobacco Cessation Nicotrol Inhaler, Nicotrol Nasal Spray nicotine Tobacco Cessation Mupirocin Cream mupirocin Topical Antibacterials Neo-Synalar neomycin/fluocinolone Topical Antibacterials Neo-Synalar Kit neomycin/fluocinolone/emollient cream Topical Antibacterials Valchlor mechlorethamine Topical Antineoplastic and Genital Warts Therapy Diclofenac 3% Gel diclofenac Topical Antineoplastic and Genital Warts Therapy Picato ingenol mebutate Topical Antineoplastic and Genital Warts Therapy Podofilox Solution podofilox Topical Antineoplastic and Genital Warts Therapy Veregen sinecatechins Topical Antineoplastic and Genital Warts Therapy Zyclara imiquimod Topical Antineoplastic and Genital Warts Therapy Tacrolimus Ointment tacrolimus Topical Immunomodulators Tranexamic Acid Injection tranexamic acid Tranexamic Acid Injection Tranexamic Acid tablets tranexamic acid Tranexamic Acid Oral Abstral fentanyl citrate sublingual tablets Transmucosal Fentanyl Citrate Actiq fentanyl citrate oral lozenges Transmucosal Fentanyl Citrate Fentora fentanyl citrate buccal tablets Transmucosal Fentanyl Citrate Onsolis fentanyl citrate buccal films Transmucosal Fentanyl Citrate Subsys fentanyl citrate sublingual spray Transmucosal Fentanyl Citrate Trelstar Depot, Trelstar LA triptorelin pamoate Trelstar Turalio pexidartinib Turalio Tygacil tigecycline Tygacil Cometriq cabozantinib Tyrosine Kinase Inhibitors for Thyroid Cancer Lenvima levatinib Tyrosine Kinase Inhibitors for Thyroid Cancer Caprelsa vandetanib Tyrosine Kinase Inhibitors for Thyroid Cancer Mesalamine DR mesalamine delayed-release Ulcerative Colitis Agents Mesalamine Rectal Enema, SFRowasa mesalamine Ulcerative Colitis Agents Giazo balsalazide Ulcerative Colitis Agents Uceris budesonide Ulcerative Colitis Agents Kerafoam, Kerol, Laxtrix, Umecta, Uralytic, urea Urea Products Uramaxin, Urea Methenamine hippurate methenamine hippurate Urinary Antiinfectives Nitrofurantoin Suspension nitrofurantoin Urinary Antiinfectives Urimar-T, Urogesic Blue hyoscamine combination Urinary Antiinfectives Potassium Citrate ER, Urocit-K potassium citrate Urocit-K Femring, Imvexxy estradiol Vaginal Estrogen Preparations Intrarosa prasterone Vaginal Estrogen Preparations GoNitro, Nitroglycerin Spray, Nitromist nitroglycerin Vasodilators, Coronary Vecamyl mecamylamine Vecamyl Vimizim elosulfase alfa Vimizim Doxercalciferol, Hectorol doxercalciferol Vitamin D and ESRD Products Paricalcitol 4 mcg paricalcitol Vitamin D and ESRD Products Rayaldee calcifediol Vitamin D and ESRD Products Sensipar cinacalet Vitamin D and ESRD Products Aluminum Hydroxide aluminum hydroxide Vitamin D and ESRD Products Calcium Carbonate calcium carbonate Vitamin D and ESRD Products Calcium Lactate calcium lactate Vitamin D and ESRD Products Docusate Calcium docusate calcium Vitamin D and ESRD Products Docusate Sodium docusate sodium Vitamin D and ESRD Products Magnebind calcium carbonate/magnesium carbonate Vitamin D and ESRD Products Magnesium Carbonate magnesium carbonate Vitamin D and ESRD Products Niacin niacin Vitamin D and ESRD Products Pyridoxine pyridoxine Vitamin D and ESRD Products Sodium Bicarbonate sodium bicarbonate Vitamin D and ESRD Products Thiamine Hydrochloride thiamine hydrochloride Vitamin D and ESRD Products Dialyvite, Nephplex Rx, Nephron FA, Renal, Reno Caps, Triphrocaps, Virt-Caps, Virt-Vite vitamin B complex/folic acid and/or zinc Vitamin D and ESRD Products Plus, Vital-D Rx, Vol-Care Rx Vitrakvi larotrectinib Vitrakvi Votrient pazopanib Votrient Vyndaqel, Vyndamax tafamidis Vyndaqel-Vyndamax Xenical orlistat Xenical Xospata gilteritinib Xospata Xyrem sodium oxybate Xyrem