Preferred Drug List (PDL)

New Jersey – MLTSS Effective Date: 7/15/2021

UnitedHealthcare Community Plan does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UTAH 84130 [email protected]

You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free member phone number listed on your health plan member ID card, TTY 711, 24 hours a day, 7 days a week. You can also file a complaint with the U.S. Dept. of Health and Human Services.

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD)

Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201

If you need help with your complaint, please call the toll-free member phone number listed on your member ID card. We provide free services to help you communicate with us, such as letters in other languages or large print. You can also ask for an interpreter. To ask for help, please call the toll-free member phone number listed on your health plan member ID card, TTY 711, 24 hours a day, 7 days a week.

CSNJ19MC4421731_000 UnitedHealthcare Community Plan no da un tratamiento diferente a sus miembros en base a su sexo, edad, raza, color, discapacidad u origen nacional. Si usted piensa que ha sido tratado injustamente por razones como su sexo, edad, raza, color, discapacidad o origen nacional, puede enviar una queja a: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UTAH 84130 [email protected]

Usted tiene que enviar la queja dentro de los 60 días de la fecha cuando se enteró de ella. Se le enviará la decisión en un plazo de 30 días. Si no está de acuerdo con la decisión, tiene 15 días para solicitar que la consideremos de nuevo. Si usted necesita ayuda con su queja, por favor llame al número de teléfono gratuito para miembros que aparece en su tarjeta de identificación del plan de salud, TTY 711, 24 horas al día, 7 días a la semana. Usted también puede presentar una queja con el Departamento de Salud y Servicios Humanos de los Estados Unidos.

Internet: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Formas para las quejas se encuentran disponibles en: http://www.hhs.gov/ocr/office/file/index.html

Teléfono: Llamada gratuita, 1-800-368-1019, 1-800-537-7697 (TDD)

Correo: U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201

Si necesita ayuda para presentar su queja, por favor llame al número gratuito para miembros anotado en su tarjeta de identificación como miembro. Ofrecemos servicios gratuitos para ayudarle a comunicarse con nosotros, tales como, cartas en otros idiomas o en letra grande. O bien, puede solicitar un intérprete. Para pedir ayuda, por favor llame al número de teléfono gratuito para miembros que aparece en su tarjeta de identificación del plan de salud, TTY 711, 24 horas al día, 7 días a la semana.

UnitedHealthcare Community Plan List of Preferred Drugs

Frequently Asked Questions (FAQ) Find answers here to questions you have about this UnitedHealthcare Community Plan List of Preferred Drugs. You can read all of the FAQ to learn more, or look for a question and answer.

1 What drugs are on the Preferred Drug List? (We call the Preferred Drug List the “Drug List” for short.) The drugs on Preferred Drug List that start on page <3> are the drugs covered by UnitedHealthcare Community Plan. These drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”

UnitedHealthcare will cover all medically necessary drugs if: · your doctor or other prescriber says you need them to get better or stay healthy, and · you fill the prescription at a UnitedHealthcare Community Plan network pharmacy. UnitedHealthcare may have additional steps to access certain drugs (see question <#5> below). You can also see an up-to-date drug list on our website at or call Member Services at < 1-800-941-4647> TTY 711.

2 Does the Drug List ever change? Yes. UnitedHealthcare Community Plan may add or remove drugs on the Drug List during the year. Generally, the Drug List will only change if: · a cheaper drug comes along that works as well as a drug on the Drug List now, or · we learn that a drug is not safe. We may also change our rules about drugs. For example, we could: · Decide to require or not require prior approval for a drug. (Prior approval is permission from UnitedHealthcare Community Plan before you can get a drug.) · Add or change the amount of a drug you can get (called “quantity limits”).

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· Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug before we will cover another drug.) For more information on these drug rules, see pages <4, 5 and 9>. Questions 3, 4, and 7 below have more information on what happens when the Drug List changes. You can always check the up-to-date Drug List online at You can also call Member Services to check the current Drug List at < 1-800-941-4647, TTY 711>.

3 What happens when another drug comes along that works as well as a drug on the Drug List now? If you are taking a drug that is removed because another drug that works just as well is available, we will tell you. You will get a letter letting you know about the change. We will also tell you what alternate drugs are available to you. Contact your doctor or other prescriber to make sure another drug will work for you.

4 What happens when we find out a drug is not safe? If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will take it off the Drug List right away. We will also send you a letter telling you that. Contact your doctor or other prescriber and ask about your other options.

5 Are there any restrictions or limits on drug coverage? Or are there any required actions to take in order to get certain drugs? Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases your doctor must do something before you can get the drug. For example: · Prior approval (or prior authorization): For some drugs, your doctor or other prescriber must get approval from UnitedHealthcare before you fill your prescription. If you don’t get approval, UnitedHealthcare may not cover the drug. · Quantity limits: Sometimes UnitedHealthcare limits the amount of a drug you can get. · Step therapy: Sometimes UnitedHealthcare requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If

082-17-14 your doctor thinks the first drug doesn’t work for you, then we will cover the second. You can find out if your drug has any additional requirements or limits by looking in the tables on pages <3-107>. You can also get more information by visiting our website at . We have posted online documents that explain our prior authorization and step therapy restrictions. You may also call Member Services and ask us to send you information about our prior authorization and step therapy restrictions.

6 How will you know if the drug you want has limitations or if there are required actions to take to get the drug? The Preferred Drug List on pages <3-107> has a column labeled “Requirements and Limits.”

7 What happens if we change our rules on how we cover some drugs? For example, if we add prior authorization (approval), quantity limits, and/or step therapy restrictions on a drug. We will tell you if we add prior approval, quantity limits, and/or step therapy restrictions on a drug. We will tell you before the restriction is added.. This gives you time to talk to your doctor or other prescriber about what to do next.

8 How can you find a drug on the Drug List? There are two ways to find a drug: · You can search by medical condition. To search by medical condition, find the section labeled “List of drugs by medical condition” on pages <3-107>. The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular Agents. That is where you will find drugs that treat heart conditions. · You can also search for drugs alphabetically. To search alphabetically, go to the starting on page <108> Find the name of your drug. The page number where you can find the drug will be next to it.

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9 What if the drug you want to take is not on the Drug List? If you don’t see your drug on the Drug List, call Member Services and ask about it. If you learn that UnitedHealthcare does not prefer the drug, you can do one of these things: · Ask Member Services for a list of drugs that are similar to the one you want to take. Then show the list to your doctor or other prescriber. He or she can prescribe a drug on the Drug List that is like the one you want to take. Or · You can ask the health plan to make an exception to cover your drug. Please see question 11 for more information about exceptions.

10 What if you just joined UnitedHealthcare Community Plan and can’t find your drug on the Drug List or have a problem getting your drug? We can help. We may cover a temporary 30-day supply of your drug during the first 90 days you are a member of UnitedHealthcare. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead, or whether to request an exception.

11Can you ask for an exception to cover your drug? Yes. Your doctor can ask UnitedHealthcare Community Plan to make an exception to cover a drug that is not on the Drug List. Your doctor can also ask us to change the rules on your drug. · For example, we may limit the amount of a drug we will cover. If your drug has a limit, your doctor can ask us to change the limit and cover more. · Other examples: Your doctor can ask us to drop step therapy restrictions or prior approval requirements.

12 How long does it take to get an exception? First, we must receive some information from your doctor supporting your request for an exception. After we receive the information, we will give you a decision on your exception request within the timeframes required by the state, generally within 24 hours.

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13 How can you ask for an exception? To ask for an exception, you can do one of two things: - Call Member Services. A Member Services representative will work with you and your doctor to help ask for an exception. - Call your doctor and ask them to request an exception by calling the Prior Notification Service at <1-800-310-6826<, or they can fax a request to<866-940- 7328>.

14 What are generic drugs? Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration (FDA). In most instances UnitedHealthcare covers generic drugs first. If your doctor feels a brand name drug is medically necessary, you will need to ask your doctor to submit for prior approval.

15 What are OTC drugs? OTC stands for “over-the-counter.” UnitedHealthcare prefers some OTC drugs when they are written as prescriptions by your provider. You can read the UnitedHealthcare Community Plan Drug List to see what OTC drugs are preferred.

16 Does UnitedHealthcare cover OTC non-drug products? UnitedHealthcare covers some OTC non-drug products when they are written as prescriptions by your provider. You can read the UnitedHealthcare Community Plan Drug List to see what OTC non- drug products are covered.

17 What is a Specialty Pharmacy Medication? A specialty pharmacy medication is a drug that generally has one or more of the following characteristics:  It’s used by a small number of people

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 It treats rare, chronic, and/or potentially life-threatening diseases  It has special storage or handling requirements such as needing to be refrigerated  It may need close monitoring, ongoing clinical support and management, and complete patient education and engagement  It’s a high cost medication  It may not be available at retail pharmacies  It may be oral, injectable, or inhaled

Specialty pharmacy medications are available through our specialty pharmacy network. If you have questions, call Member Services at <1-800-941-4647, TTY 711>.

List of Preferred Drugs The List of Preferred Drugs that begins gives you information about the drugs covered by UnitedHealthcare Community Plan. If you have trouble finding your drug in the list, turn to the Index that begins on page <108> . The first column of the chart lists the generic name of the drug. The second column of the chart lists brand name drugs. Brand name drugs are capitalized (e.g., CRESTOR). The third column in the list tells you if the preferred drug covered is the brand or generic version. The information in the “Requirements & Limits” column tells you if UnitedHealthcare has any rules for covering your drug.

Utilization Management Restrictions

PA - Prior approval (or prior authorization) For some drugs, your doctor or other prescriber must get approval from UnitedHealthcare Community Plan before you fill your prescription. If you don’t get approval, UnitedHealthcare may not cover the drug. QL - Quantity limits Sometimes UnitedHealthcare Community Plan limits the amount of a drug you can get.

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ST - Step therapy Sometimes UnitedHealthcare Community Plan requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If your doctor thinks the first drug doesn’t work for you, then your doctor can ask for approval to cover the second.

Other special requirements for coverage

SP – Specialty Pharmacy Drug needs to be accessed through a network Specialty Pharmacy. Specialty Pharmacy Drugs may require extra handling, provider coordination or patient education that can’t be done at a network retail pharmacy.

Drug Tiers

The drugs listed in the PDL have different tiers. The tiers are listed in the grid below.

Tier Name Drug Tier Tier 1 Generic Tier 2 Brand

[ABBREVIATIONS]

OTC = Over the Counter PA = Prior Authorization required QL = Quantity Limit ST = Step Therapy SP = Specialty Pharmacy * = Available without PA for participating Behavioral Health Prescribers

[You can find information on what the symbols and abbreviations in this table mean by going to page <3-107 in the footnotes>]

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Table of Contents Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions ...... 3 Anesthetics - Drugs for Numbing ...... 12 Anti-Addiction/Substance Abuse Treatment Agents - Drugs for Overdose or Deterrence ...... 12 Antibacterials ...... 14 Antibacterials - Drugs to Treat Bacterial Infections ...... 15 Anticonvulsants - Drugs to Treat Seizures ...... 19 Antidementia Agents - Drugs to Treat Alzheimer's Disease and Dementia ...... 21 Antidepressants - Drugs to Treat Depression ...... 22 Antiemetics - Drugs to Treat Nausea and Vomiting ...... 23 Antifungals - Drugs to Treat Fungal Infections ...... 24 Antigout Agents - Drugs to Treat Gout ...... 27 Antimigraine Agents - Drugs to Treat Migraines...... 27 Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis ...... 28 Antimycobacterials - Drugs to Treat Infections ...... 28 Antineoplastics - Drugs to Treat Cancer ...... 29 Antiparasitics - Drugs to Treat Parasitic Infections ...... 33 Antiparkinson Agents - Drugs to Treat Parkinson's Disease ...... 35 Antipsychotics - Drugs to Treat Mood Disorders ...... 36 Antivirals - Drugs to Treat Viral Infections ...... 38 Anxiolytics - Drugs to Treat Anxiety ...... 41 Bipolar Agents - Drugs to Treat Mood Disorders ...... 42 Blood Glucose Regulators - Drugs to Regulate Blood Sugar ...... 42 Blood Products and Modifiers ...... 45 Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders ...... 45 Cardiovascular Agents ...... 47 Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions ...... 47

1 Central Nervous System Agents ...... 52 Central Nervous System Agents - Drugs to Treat Nerve Conditions ...... 53 Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions ...... 55 Dermatological Agents - Drugs to Treat Skin Conditions ...... 55 Electrolytes/Minerals/Metals/Vitamins ...... 61 Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions ...... 76 Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment ...... 92 Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions ...... 93 Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) - Drugs to Regulate Hormones ...... 94 Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Drugs to Regulate Hormones ...... 95 Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) - Drugs to Regulate Hormones ...... 96 Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones ...... 96 Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Drugs to Replace Thyroid Hormones ...... 102 Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones ...... 102 Hormonal Agents, Suppressant (Pituitary) - Drugs to Regulate Hormones ...... 103 Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones ...... 103 Immunological Agents - Drugs that Stimulate or Suppress the Immune System ...... 103 Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease ...... 106 Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions ...... 107 Metabolic Bone Disease Agents - Other ...... 107 Miscellaneous Therapeutic Agents ...... 107 Ophthalmic Agents - Drugs to Treat Eye Conditions ...... 111 Otic Agents - Drugs to Treat Ear Conditions ...... 117 Regulators - Drugs to Regulate Blood Sugar ...... 118 Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions ...... 118 Skeletal Muscle Relaxants - Drugs to Treat Muscle Tension and Spasm ...... 139 Sleep Disorder Agents - Drugs for Sedation and Sleep ...... 139 Therapeutic Nutrients/Minerals/Electrolytes - Drugs to Treat Vitamin, Mineral and Body Fluid Deficiencies ...... 140 2 Preferred Agents Non-Preferred Agents Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions Analgesics - Miscellaneous Analgesics 8 hour arthritis pain reliever (generic for TYLENOL 8 HOUR) - Tier 1; QL 8 hour arthritis relief (generic for TYLENOL 8 HOUR) - Tier 1; QL 8 hour pain relief oral tablet extended release 650 mg (generic for TYLENOL 8 HOUR) - Tier 1; QL 8 hour pain reliever (generic for TYLENOL 8 HOUR) - Tier 1; QL 8 hr arthritis pain relief (generic for TYLENOL 8 HOUR) - Tier 1; QL 8hr arthritis pain relief (generic for TYLENOL 8 HOUR) - Tier 1; QL 8hr muscle aches & pain (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen 8 hour (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen 8 hours (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen 8hr arth pain (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen 8hr musc ache (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen childrens - Tier 1; QL acetaminophen childrens oral suspension 160 mg/5ml (generic for PANADOL CHILDRENS) - Tier 1; QL acetaminophen childrens oral tablet chewable 160 mg (generic for MAPAP CHILDRENS) - Tier 1; QL acetaminophen er (generic for TYLENOL 8 HOUR) - Tier 1; QL acetaminophen ex st oral liquid 500 mg/15ml (generic for MAPAP ACETAMINOPHEN EXTRA STR) - Tier 1 acetaminophen ex st oral tablet 500 mg (generic for PANADOL EXTRA STRENGTH) - Tier 1; QL acetaminophen extra strength (generic for PANADOL EXTRA STRENGTH) - Tier 1; QL acetaminophen infants oral suspension 160 mg/5ml (generic for PANADOL CHILDRENS) - Tier 1; QL acetaminophen oral liquid 500 mg/15ml (generic for MAPAP ACETAMINOPHEN EXTRA STR) - Tier 1

Nonsteroidal Anti-Inflammatory Drugs - Pain/Anti-Inflammatory Drugs addaprin (generic for ADDAPRIN) - Tier 1; QL ADVIL JUNIOR STRENGTH (brand for sm ibuprofen jr) - Tier 2; QL ADVIL ORAL TABLET (brand for qc ibuprofen) - Tier 2; QL ALEVE ORAL TABLET (brand for cvs all day pain relief) - Tier 2; QL all day pain relief (generic for MEDIPROXEN) - Tier 1; QL all day relief (generic for MEDIPROXEN) - Tier 1; QL aspirin childrens (generic for ST JOSEPH LOW DOSE) - Tier 1; QL aspirin ec (generic for BAYER ASPIRIN) - Tier 1; QL aspirin ec oral tablet 325 mg (generic for BAYER ASPIRIN) - Tier 1; QL aspirin oral (generic for ST JOSEPH LOW DOSE) - Tier 1; QL ASPIRIN ORAL TABLET DELAYED RELEASE 81 MG (brand for adult aspirin regimen) - Tier 2; QL aspirin rectal - Tier 1 BAYER ASPIRIN (brand for sm aspirin) - Tier 2; QL celecoxib oral (generic for CELEBREX) - Tier 1; PA; QL childrens aspirin oral tablet chewable 81 mg (generic for ST JOSEPH LOW DOSE) - Tier 1; QL diclofenac potassium (generic for CATAFLAM) - Tier 1; QL diclofenac sodium er - Tier 1; QL

Opioid Analgesics, Long-acting - Opioid Pain Relievers buprenorphine transdermal (generic for BUTRANS) - Tier 1; PA; QL HYSINGLA ER (brand for hydrocodone bitartrate er) - Tier 2; PA; QL fentanyl transdermal patch 72 hour 100 mcg/hr (generic for NUCYNTA ER - Tier 2; PA; QL DURAGESIC-100) - Tier 1; PA; QL OXYCONTIN (brand for oxycodone hcl er) - Tier 2; PA; QL fentanyl transdermal patch 72 hour 12 mcg/hr (generic for DURAGESIC- ZOHYDRO ER (brand for hydrocodone bitartrate er) - Tier 2; PA; QL 12) - Tier 1; PA; QL fentanyl transdermal patch 72 hour 25 mcg/hr (generic for DURAGESIC- 25) - Tier 1; PA; QL fentanyl transdermal patch 72 hour 50 mcg/hr (generic for DURAGESIC- 50) - Tier 1; PA; QL fentanyl transdermal patch 72 hour 75 mcg/hr (generic for DURAGESIC- 75) - Tier 1; PA; QL

Opioid Analgesics, Short-acting - Opioid Pain Relievers acetaminophen-codeine - Tier 1; QL apap-caff-dihydrocodeine oral capsule (generic for TREZIX) - Tier 1; PA; acetaminophen-codeine #2 - Tier 1; QL QL acetaminophen-codeine #3 - Tier 1; QL TREZIX (brand for apap-caff-dihydrocodeine) - Tier 2; PA; QL acetaminophen-codeine #4 - Tier 1; QL ascomp-codeine (generic for ASCOMP-CODEINE) - Tier 1; QL butalbital-apap-caff-cod oral capsule 50-325-40-30 mg - Tier 1; QL butalbital-asa-caff-codeine (generic for ASCOMP-CODEINE) - Tier 1; QL butorphanol tartrate nasal - Tier 1; QL codeine sulfate - Tier 1; QL endocet oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg (generic for ENDOCET) - Tier 1; QL fentanyl citrate (pf) - Tier 1; QL hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml - Tier 1; QL hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg - Tier 1; QL hydromorphone hcl oral (generic for DILAUDID) - Tier 1; QL hydromorphone hcl rectal - Tier 1; QL morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml - Tier 1; QL morphine sulfate injection solution 2 mg/ml, 4 mg/ml - Tier 1 morphine sulfate intravenous solution 50 mg/ml - Tier 1

Anesthetics - Drugs for Numbing Local Anesthetics 7T LIDO - Tier 2; QL anecream external cream (generic for ANECREAM) - Tier 1; QL blue tube/ aloe (generic for ANECREAM) - Tier 1; QL glydo (generic for GLYDO) - Tier 1; QL lidocaine external cream 4 % (generic for ANECREAM) - Tier 1; QL lidocaine external patch 5 % (generic for LIDODERM) - Tier 1; DX2RX; QL lidocaine hcl external cream 3 % - Tier 1; QL lidocaine hcl urethral/mucosal - Tier 1; QL lidocaine viscous hcl - Tier 1; QL lidocaine-prilocaine external cream - Tier 1; QL lidopin external cream 3 % - Tier 1; QL LMX 4 (brand for blue tube/ aloe) - Tier 2; QL

Anti-Addiction/Substance Abuse Treatment Agents - Drugs for Overdose or Deterrence

Opioid Dependence Treatments - Antidotes/Deterrents/Protectants buprenorphine hcl sublingual - Tier 1; QL BUNAVAIL - Tier 2; PA; ^; QL buprenorphine hcl-naloxone hcl - Tier 1; QL SUBLOCADE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG/0.5ML - Tier 2; PA; ^; QL SUBOXONE (brand for buprenorphine hcl-naloxone hcl) - Tier 2; PA; QL ZUBSOLV - Tier 2; PA; ^; QL

Opioid Reversal Agents - Antidotes/Deterrents/Protectants naloxone hcl injection solution - Tier 1; QL naloxone hcl injection solution cartridge - Tier 1; QL naloxone hcl injection solution prefilled syringe - Tier 1; ^; QL NARCAN - Tier 2; QL

Smoking Cessation Agents - Deterrents bupropion hcl er (smoking det) - Tier 1 CHANTIX - Tier 2; QL CHANTIX CONTINUING MONTH PAK - Tier 2; QL CHANTIX STARTING MONTH PAK - Tier 2; QL habitrol (generic for HABITROL) - Tier 1; QL mini nicotine (generic for KLS QUIT2) - Tier 1; QL NICODERM CQ (brand for gnp nicotine) - Tier 2; QL NICORETTE (brand for ra nicotine gum) - Tier 2; QL NICORETTE MINI (brand for gnp nicotine mini) - Tier 2; QL NICORETTE STARTER KIT (brand for ra nicotine gum) - Tier 2; QL

Antibacterials Antibacterials, Other methenamine hippurate (generic for HIPREX) - Tier 1; QL

Antibacterials - Drugs to Treat Bacterial Infections Aminoglycosides - Antibiotics gentamicin sulfate external - Tier 1; QL neomycin sulfate oral - Tier 1; QL paromomycin sulfate oral (generic for HUMATIN) - Tier 1; QL

Antibacterials, Other - Antibiotics antibiotic (generic for NEOSPORIN ORIGINAL) - Tier 1; QL CLEOCIN VAGINAL SUPPOSITORY - Tier 2; PA; QL antiseptic (generic for SCRUB CARE POVIDONE-IODINE) - Tier 1; QL CLINDESSE - Tier 2; PA; QL bacitracin external (generic for BACITRAYCIN PLUS) - Tier 1; QL FLAGYL (brand for metronidazole) - Tier 2; PA; QL bacitracin zinc external - Tier 1; QL METROGEL (brand for metronidazole) - Tier 2; PA; QL bacitracin zinc first aid - Tier 1; QL NORITATE - Tier 2; PA; QL clindamycin hcl oral capsule 150 mg, 300 mg (generic for CLEOCIN) - VANCOCIN (brand for vancomycin hcl) - Tier 2; PA; QL Tier 1; QL XENLETA ORAL - Tier 2; PA; QL clindamycin palmitate hcl (generic for CLEOCIN) - Tier 1; QL clindamycin phosphate vaginal (generic for CLEOCIN) - Tier 1; QL colistimethate sodium (cba) (generic for COLY-MYCIN M) - Tier 1; QL daptomycin solution reconstituted 500 mg intravenous (generic for CUBICIN) - Tier 1; QL double antibiotic (generic for POLYSPORIN) - Tier 1; QL first aid antibiotic external ointment 3.5-400-5000 , 3.5-400-5000 mg-unit (generic for NEOSPORIN ORIGINAL) - Tier 1; QL first aid antiseptic external solution 10 % (generic for SCRUB CARE POVIDONE-IODINE) - Tier 1; QL FIRVANQ (brand for vancomycin hcl) - Tier 2; DX2RX; QL

Beta-Lactam, Cephalosporins - Antibiotics cefaclor - Tier 1; QL cefadroxil - Tier 1; QL cefazolin sodium injection solution reconstituted 1 gm - Tier 1; QL cefazolin sodium solution reconstituted 10 gm injection - Tier 1; QL cefdinir - Tier 1; QL

Beta-Lactam, Other - Antibiotics ertapenem sodium (generic for INVANZ) - Tier 1; QL meropenem solution reconstituted 500 mg intravenous - Tier 1; QL MEROPENEM-SODIUM CHLORIDE INTRAVENOUS SOLUTION RECONSTITUTED 1 GM/50ML - Tier 2; QL

Beta-Lactam, Penicillins - Antibiotics amoxicillin oral capsule - Tier 1; QL amoxicillin oral suspension reconstituted - Tier 1; QL amoxicillin oral tablet 875 mg - Tier 1; QL amoxicillin oral tablet chewable - Tier 1; QL amoxicillin-potassium clavulanate oral (generic for AUGMENTIN) - Tier 1; QL ampicillin - Tier 1; QL ampicillin-sulbactam sodium solution reconstituted 3 (2-1) gm injection (generic for UNASYN) - Tier 1; QL dicloxacillin sodium - Tier 1; QL nafcillin sodium solution reconstituted 1 gm injection - Tier 1; QL penicillin v potassium - Tier 1; QL piperacillin sod-tazobactam so intravenous solution reconstituted 4.5 (4- 0.5) gm - Tier 1; QL

Macrolides - Antibiotics azithromycin oral suspension reconstituted (generic for ZITHROMAX) - Tier 1; QL azithromycin oral tablet - Tier 1; QL clarithromycin er - Tier 1; QL clarithromycin oral - Tier 1; QL DIFICID - Tier 2; PA; QL E.E.S. GRANULES (brand for erythromycin ethylsuccinate) - Tier 2; QL ERYPED 200 (brand for erythromycin ethylsuccinate) - Tier 2; QL ERYTHROCIN STEARATE (brand for erythromycin stearate) - Tier 2; QL erythromycin base - Tier 1; QL erythromycin ethylsuccinate oral (generic for E.E.S. GRANULES) - Tier 1; QL erythromycin oral (generic for ERY-TAB) - Tier 1; QL

Quinolones - Antibiotics CIPRO ORAL SUSPENSION RECONSTITUTED - Tier 2; QL MOXEZA (brand for moxifloxacin hcl (2x day)) - Tier 2; PA; QL ciprofloxacin hcl oral - Tier 1; QL VIGAMOX (brand for moxifloxacin hcl) - Tier 2; PA; QL levofloxacin oral tablet (generic for LEVAQUIN) - Tier 1; QL XEPI - Tier 2; PA; QL ofloxacin oral - Tier 1; QL

Sulfonamides - Antibiotics silver sulfadiazine external (generic for SSD) - Tier 1; QL ssd (generic for SSD) - Tier 1; QL sulfacetamide sodium ophthalmic (generic for BLEPH-10) - Tier 1; QL sulfamethoxazole-trimethoprim oral (generic for BACTRIM) - Tier 1; QL sulfatrim pediatric (generic for SULFATRIM PEDIATRIC) - Tier 1; QL

Tetracyclines - Antibiotics

Anticonvulsants - Drugs to Treat Seizures Anticonvulsants, Other - Seizure Control Drugs levetiracetam oral solution (generic for KEPPRA) - Tier 1; Maximum age BRIVIACT ORAL - Tier 2; PA; QL of 9 years for solution; QL; AL EPIDIOLEX - Tier 2; PA; SP; QL levetiracetam oral tablet (generic for KEPPRA) - Tier 1; QL XCOPRI (250 MG DAILY DOSE) ORAL TABLET THERAPY PACK 50 & NAYZILAM - Tier 2; PA; QL 200 MG - Tier 2; PA; QL phenobarbital oral tablet - Tier 1; QL XCOPRI (350 MG DAILY DOSE) - Tier 2; PA; QL roweepra (generic for ROWEEPRA) - Tier 1; QL XCOPRI ORAL TABLET - Tier 2; PA; QL XCOPRI ORAL TABLET THERAPY PACK - Tier 2; PA

Calcium Channel Modifying Agents - Seizure Control Drugs CELONTIN - Tier 2; QL ethosuximide oral (generic for ZARONTIN) - Tier 1; QL zonisamide oral (generic for ZONEGRAN) - Tier 1; QL

Gamma-Aminobutyric Acid (GABA) Augmenting Agents - Seizure Control Drugs clobazam (generic for ONFI) - Tier 1; DX2RX; QL SYMPAZAN - Tier 2; PA; QL

Glutamate Reducing Agents - Seizure Control Drugs felbamate oral suspension (generic for FELBATOL) - Tier 1; Members FYCOMPA - Tier 2; PA; QL >= 8 years of age will require PA; QL; AL felbamate oral tablet (generic for FELBATOL) - Tier 1; QL lamotrigine oral tablet (generic for SUBVENITE) - Tier 1; QL lamotrigine oral tablet chewable (generic for LAMICTAL) - Tier 1; Members >= 8 years of age will require PA; QL; AL lamotrigine starter kit-blue (generic for SUBVENITE STARTER KIT- BLUE) - Tier 1; *; QL lamotrigine starter kit-green (generic for SUBVENITE STARTER KIT- GREEN) - Tier 1; *; QL lamotrigine starter kit-orange (generic for SUBVENITE STARTER KIT- ORANGE) - Tier 1; *; QL subvenite (generic for SUBVENITE) - Tier 1; QL subvenite starter kit-blue (generic for SUBVENITE STARTER KIT- BLUE) - Tier 1; *; QL subvenite starter kit-green (generic for SUBVENITE STARTER KIT- GREEN) - Tier 1; *; QL subvenite starter kit-orange (generic for SUBVENITE STARTER KIT- ORANGE) - Tier 1; *; QL topiramate oral capsule sprinkle (generic for TOPAMAX SPRINKLE) - Tier 1; Members >= 8 years of age will require PA; QL; AL topiramate oral tablet (generic for TOPAMAX) - Tier 1; QL

Sodium Channel Agents - Seizure Control Drugs carbamazepine er (generic for CARBATROL) - Tier 1; QL APTIOM - Tier 2; PA; QL carbamazepine oral - Tier 1; QL DILANTIN ORAL CAPSULE 30 MG - Tier 2 epitol (generic for EPITOL) - Tier 1; QL oxcarbazepine oral suspension (generic for TRILEPTAL) - Tier 1; Maximum age of 9 years for solution; QL; AL oxcarbazepine oral tablet (generic for TRILEPTAL) - Tier 1; QL phenytoin infatabs (generic for PHENYTOIN INFATABS) - Tier 1; QL phenytoin oral suspension 125 mg/5ml (generic for DILANTIN) - Tier 1; QL phenytoin oral tablet chewable (generic for PHENYTOIN INFATABS) - Tier 1; QL phenytoin sodium extended (generic for DILANTIN) - Tier 1; QL rufinamide (generic for BANZEL) - Tier 1; DX2RX; QL TEGRETOL ORAL SUSPENSION (brand for carbamazepine) - Tier 2; QL VIMPAT ORAL - Tier 2; PA; QL; AL

Antidementia Agents - Drugs to Treat Alzheimer's Disease and Dementia Cholinesterase Inhibitors - Alzheimer's Disease and Dementia Drugs donepezil hcl oral tablet 10 mg, 5 mg (generic for ARICEPT) - Tier 1; Members <18 years of age will require PA; QL; AL donepezil hcl oral tablet 23 mg (generic for ARICEPT) - Tier 1; ST; Members <18 years of age will require PA; QL; AL galantamine hydrobromide oral solution - Tier 1; QL; AL galantamine hydrobromide oral tablet 12 mg, 8 mg - Tier 1; QL; AL galantamine hydrobromide oral tablet 4 mg - Tier 1; Members <18 years of age will require PA; QL; AL

N-methyl-D-aspartate (NMDA) Receptor Antagonist - Alzheimer's Disease and Dementia Drugs memantine hcl oral solution 2 mg/ml - Tier 1; QL memantine hcl oral tablet (generic for NAMENDA) - Tier 1; Members <18 years of age will require PA; QL; AL

Antidepressants - Drugs to Treat Depression Antidepressants, Other - Antidepressants bupropion hcl er (sr) (generic for WELLBUTRIN SR) - Tier 1; QL SPRAVATO (56 MG DOSE) - Tier 2; PA; ^; QL bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg (generic for WELLBUTRIN XL) - Tier 1; ^; QL bupropion hcl oral - Tier 1; QL mirtazapine oral tablet 15 mg, 30 mg (generic for REMERON) - Tier 1; Tabs (not soltabs); QL mirtazapine oral tablet 45 mg, 7.5 mg - Tier 1; QL perphenazine-amitriptyline oral tablet 2-10 mg, 4-10 mg, 4-25 mg, 4-50 mg - Tier 1 perphenazine-amitriptyline oral tablet 2-25 mg - Tier 1; QL

Monoamine Oxidase Inhibitors - Antidepressants tranylcypromine sulfate (generic for PARNATE) - Tier 1; QL

SSRI/SNRI (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) citalopram hydrobromide (generic for CELEXA) - Tier 1; QL CYMBALTA (brand for duloxetine hcl) - Tier 2; PA; QL FETZIMA - Tier 2; PA; ^; QL

Tricyclics - Antidepressants amitriptyline hcl oral - Tier 1; QL amoxapine - Tier 1; QL desipramine hcl oral (generic for NORPRAMIN) - Tier 1; QL doxepin hcl oral capsule - Tier 1; QL doxepin hcl oral concentrate - Tier 1; QL imipramine hcl oral - Tier 1; QL nortriptyline hcl oral (generic for PAMELOR) - Tier 1; QL

Antiemetics - Drugs to Treat Nausea and Vomiting Antiemetics, Other - Nausea and Vomiting Drugs anti-nausea - Tier 1 BONINE (brand for cvs motion sickness relief) - Tier 2 compro (generic for COMPRO) - Tier 1; QL driminate (generic for DRIMINATE) - Tier 1

Emetogenic Therapy Adjuncts - Nausea and Vomiting Drugs aprepitant (generic for EMEND) - Tier 1; QL AKYNZEO ORAL - Tier 2; PA; QL dronabinol (generic for MARINOL) - Tier 1; PA; QL EMEND ORAL (brand for aprepitant) - Tier 2; PA; QL ondansetron hcl oral tablet (generic for ZOFRAN) - Tier 1; QL ondansetron odt - Tier 1; QL VARUBI (180 MG DOSE) - Tier 2; QL

Antifungals - Drugs to Treat Fungal Infections Antifungals - Fungal Infection Drugs 3 day (generic for MONISTAT 3) - Tier 1; QL DIFLUCAN (brand for fluconazole) - Tier 2; PA; QL 3 day vaginal (generic for GYNE-LOTRIMIN 3) - Tier 1; QL GYNAZOLE-1 - Tier 2; PA; QL 3-day vaginal vaginal cream 2 % (generic for GYNE-LOTRIMIN 3) - Tier 1; QL ALOE VESTA CLEAR ANTIFUNGAL - Tier 2; QL antifungal (tolnaftate) (generic for TINACTIN) - Tier 1; QL

Antigout Agents - Drugs to Treat Gout Antigout Agents - Gout Drugs allopurinol oral (generic for ZYLOPRIM) - Tier 1; QL COLCHICINE ORAL CAPSULE - Tier 2; PA; QL febuxostat (generic for ULORIC) - Tier 1; ST; QL colchicine oral tablet (generic for COLCRYS) - Tier 1; PA; QL MITIGARE (brand for colchicine) - Tier 2; QL COLCRYS (brand for colchicine) - Tier 2; PA; QL probenecid - Tier 1; QL

Antimigraine Agents - Drugs to Treat Migraines Ergot Alkaloids - Migraine Drugs

Prophylactic - Migraine Drugs AIMOVIG - Tier 2; PA; QL AJOVY SUBCUTANEOUS SOLUTION AUTO-INJECTOR - Tier 2; PA; QL EMGALITY - Tier 2; PA; QL REYVOW - Tier 2; PA; QL EMGALITY (300 MG DOSE) - Tier 2; PA; QL UBRELVY - Tier 2; PA; QL NURTEC - Tier 2; PA; QL

Serotonin (5-HT) 1b/1d Receptor Agonists - Migraine Drugs naratriptan hcl (generic for AMERGE) - Tier 1; ST; QL rizatriptan benzoate - Tier 1; QL sumatriptan nasal (generic for IMITREX) - Tier 1; QL sumatriptan succinate oral (generic for IMITREX) - Tier 1; QL sumatriptan succinate refill (generic for IMITREX STATDOSE REFILL) - Tier 1; QL sumatriptan succinate subcutaneous (generic for IMITREX) - Tier 1; QL

Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis Parasympathomimetics - Myasthenia Gravis Drugs pyridostigmine bromide er (generic for MESTINON) - Tier 1; QL pyridostigmine bromide oral solution (generic for MESTINON) - Tier 1; QL pyridostigmine bromide oral tablet 60 mg (generic for MESTINON) - Tier 1; QL

Antimycobacterials - Drugs to Treat Infections

Antituberculars - Tuberculosis Drugs cycloserine oral - Tier 1; QL ethambutol hcl oral tablet 100 mg - Tier 1 ethambutol hcl oral tablet 400 mg (generic for MYAMBUTOL) - Tier 1; QL isoniazid oral - Tier 1; QL PASER - Tier 2; QL PRIFTIN - Tier 2; QL pyrazinamide oral - Tier 1; QL rifampin oral - Tier 1; QL SIRTURO - Tier 2; QL TRECATOR - Tier 2; QL

Antineoplastics - Drugs to Treat Cancer Alkylating Agents - Chemotherapy Agents cyclophosphamide oral capsule - Tier 1 CYCLOPHOSPHAMIDE ORAL TABLET - Tier 2 GLEOSTINE - Tier 2 LEUKERAN - Tier 2 MATULANE - Tier 2; SP melphalan (generic for ALKERAN) - Tier 1 MYLERAN - Tier 2 temozolomide oral capsule 100 mg, 180 mg, 250 mg (generic for TEMODAR) - Tier 1; PA; SP; QL temozolomide oral capsule 140 mg (generic for TEMODAR) - Tier 1; PA; SP temozolomide oral capsule 20 mg, 5 mg - Tier 1; PA; SP; QL

Antiandrogens - Hormone Suppressants abiraterone acetate (generic for ZYTIGA) - Tier 1; PA; SP; QL XTANDI ORAL CAPSULE - Tier 2; PA; SP; QL bicalutamide (generic for CASODEX) - Tier 1; QL YONSA - Tier 2; PA; SP; QL ERLEADA - Tier 2; PA; SP; QL ZYTIGA (brand for abiraterone acetate) - Tier 2; PA; SP; QL flutamide - Tier 1; QL NUBEQA - Tier 2; PA; SP; QL

Antiangiogenic Agents - Chemotherapy Agents POMALYST - Tier 2; PA; SP; QL REVLIMID - Tier 2; PA; SP; QL THALOMID - Tier 2; PA; SP; QL

Antiestrogens/Modifiers - Chemotherapy Agents tamoxifen citrate oral - Tier 1; QL toremifene citrate (generic for FARESTON) - Tier 1; QL

Antimetabolites - Chemotherapy Agents capecitabine (generic for XELODA) - Tier 1; SP XELODA (brand for capecitabine) - Tier 2; PA; SP DROXIA ORAL CAPSULE 200 MG, 300 MG - Tier 2 DROXIA ORAL CAPSULE 400 MG - Tier 2; QL hydroxyurea oral (generic for HYDREA) - Tier 1; QL mercaptopurine oral - Tier 1; QL TABLOID - Tier 2; SP

Antineoplastics, Other - Chemotherapy Agents leucovorin calcium oral tablet 10 mg - Tier 1 KISQALI (200 MG DOSE) - Tier 2; PA; SP; QL leucovorin calcium oral tablet 15 mg, 25 mg, 5 mg - Tier 1; QL KISQALI (400 MG DOSE) - Tier 2; PA; SP; QL LONSURF - Tier 2; PA; SP; QL KISQALI (600 MG DOSE) - Tier 2; PA; SP; QL

Aromatase Inhibitors, 3rd Generation - Chemotherapy Agents anastrozole oral (generic for ARIMIDEX) - Tier 1; QL exemestane (generic for AROMASIN) - Tier 1; QL letrozole oral (generic for FEMARA) - Tier 1; QL

Enzyme Inhibitors - Chemotherapy Agents BALVERSA - Tier 2; PA; SP; QL etoposide oral - Tier 1 HYCAMTIN ORAL - Tier 2; PA; SP RUBRACA - Tier 2; PA; SP; QL ZEJULA - Tier 2; PA; SP; QL

Molecular Target Inhibitors - Chemotherapy Agents AFINITOR DISPERZ - Tier 2; PA; SP; QL LORBRENA - Tier 2; PA; SP; QL AFINITOR ORAL TABLET 10 MG - Tier 2; PA; SP; QL ALECENSA - Tier 2; PA; SP; QL ALUNBRIG - Tier 2; PA; SP; QL BOSULIF - Tier 2; PA; SP; QL BRUKINSA - Tier 2; PA; SP CABOMETYX - Tier 2; PA; SP; QL CALQUENCE - Tier 2; PA; SP; QL CAPRELSA - Tier 2; PA; SP; QL

Retinoids - Chemotherapy Agents bexarotene (generic for TARGRETIN) - Tier 1; PA; SP PANRETIN - Tier 2; PA; QL TARGRETIN EXTERNAL - Tier 2; PA; SP; QL tretinoin oral - Tier 1; SP; QL

Treatment Adjuncts - Supportive Chemotherapy Drugs MESNEX ORAL - Tier 2; SP

Antiparasitics - Drugs to Treat Parasitic Infections Anthelmintics - Worm Infection Drugs albendazole oral (generic for ALBENZA) - Tier 1; DX2RX; QL ivermectin oral (generic for STROMECTOL) - Tier 1; QL praziquantel oral (generic for BILTRICIDE) - Tier 1; DX2RX; QL

Pediculicides/Scabicides - Scabies and Lice Drugs crotan - Tier 1; QL lice killing (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL lice killing max st (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL lice killing max strength (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL lice killing maximum strength (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL lice maximum strength (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL lice treatment - Tier 1; QL lice treatment creme rinse (generic for NIX CREME RINSE) - Tier 1; QL lice treatment external shampoo 0.33-4 % (generic for RID LICE KILLING SHAMPOO) - Tier 1; QL malathion (generic for OVIDE) - Tier 1; QL permethrin external (generic for ELIMITE) - Tier 1; QL

Antiparkinson Agents - Drugs to Treat Parkinson's Disease Anticholinergics - Parkinson's Disease Drugs benztropine mesylate oral - Tier 1; QL trihexyphenidyl hcl - Tier 1; QL

Antiparkinson Agents, Other - Parkinson's Disease Drugs amantadine hcl oral capsule - Tier 1; QL amantadine hcl oral syrup - Tier 1; QL entacapone (generic for COMTAN) - Tier 1; QL tolcapone (generic for TASMAR) - Tier 1; QL

Dopamine Agonists - Parkinson's Disease Drugs pramipexole dihydrochloride oral tablet 0.125 mg, 0.5 mg, 1 mg (generic for MIRAPEX) - Tier 1; QL pramipexole dihydrochloride oral tablet 0.25 mg, 1.5 mg - Tier 1; QL pramipexole dihydrochloride oral tablet 0.75 mg (generic for MIRAPEX) - Tier 1 ropinirole hcl - Tier 1; QL

Dopamine Precursors/L-Amino Acid Decarboxylase Inhibitors - Parkinson's Disease Drugs carbidopa-levodopa er - Tier 1; QL carbidopa-levodopa oral tablet (generic for SINEMET) - Tier 1; QL

Antipsychotics - Drugs to Treat Mood Disorders 1st Generation/Typical - Mood Disorder Drugs chlorpromazine hcl oral - Tier 1; DX2RX; QL fluphenazine decanoate injection - Tier 1; DX2RX; QL fluphenazine hcl injection - Tier 1; DX2RX; QL fluphenazine hcl oral concentrate - Tier 1; DX2RX; QL fluphenazine hcl oral elixir - Tier 1; DX2RX fluphenazine hcl oral tablet - Tier 1; DX2RX; QL haloperidol decanoate intramuscular (generic for HALDOL DECANOATE) - Tier 1; DX2RX; QL haloperidol oral - Tier 1; DX2RX; QL loxapine succinate - Tier 1; DX2RX; QL pimozide - Tier 1; DX2RX; QL; AL prochlorperazine maleate oral - Tier 1; QL thioridazine hcl oral - Tier 1; DX2RX; QL thiothixene - Tier 1; DX2RX; QL trifluoperazine hcl - Tier 1; DX2RX; QL

2nd Generation/Atypical - Mood Disorder Drugs ABILIFY MAINTENA - Tier 2; DX2RX; ^; QL; AL ABILIFY (brand for aripiprazole) - Tier 2; DX2RX; QL; AL aripiprazole oral tablet (generic for ABILIFY) - Tier 1; DX2RX; QL; AL aripiprazole oral solution - Tier 1; DX2RX; ^; QL; AL ARISTADA - Tier 2; DX2RX; ^; QL; AL aripiprazole oral tablet dispersible - Tier 1; DX2RX; ^; QL; AL INVEGA SUSTENNA - Tier 2; DX2RX; ^; QL; AL ARISTADA INITIO - Tier 2; DX2RX; ^; QL; AL INVEGA TRINZA - Tier 2; DX2RX; ST; ^; QL; AL FANAPT - Tier 2; DX2RX; ^; QL; AL olanzapine oral tablet (generic for ZYPREXA) - Tier 1; DX2RX; QL; AL GEODON INTRAMUSCULAR (brand for ziprasidone mesylate) - Tier 2; PERSERIS - Tier 2; DX2RX; ^; QL; AL PA; ^; QL quetiapine fumarate (generic for SEROQUEL) - Tier 1; DX2RX; QL; AL GEODON ORAL (brand for ziprasidone hcl) - Tier 2; DX2RX; QL; AL

Treatment-Resistant - Mood Disorder Drugs clozapine oral tablet 100 mg, 25 mg, 50 mg (generic for CLOZARIL) - CLOZARIL ORAL TABLET 100 MG, 25 MG (brand for clozapine) - Tier 2; Tier 1; DX2RX; QL; AL DX2RX; QL; AL CLOZARIL ORAL TABLET 200 MG (brand for clozapine) - Tier 2; DX2RX; ^; QL; AL CLOZARIL ORAL TABLET 50 MG (brand for clozapine) - Tier 2; DX2RX; QL; AL

Anti-hepatitis B (HBV) Agents - Hepatitis B Drugs BARACLUDE ORAL SOLUTION - Tier 2; SP; QL VEMLIDY - Tier 2; PA; SP; QL entecavir (generic for BARACLUDE) - Tier 1; SP; QL EPIVIR HBV ORAL SOLUTION - Tier 2; SP; QL lamivudine oral tablet 100 mg (generic for EPIVIR HBV) - Tier 1; SP; QL

Anti-hepatitis C (HCV) Agents, Direct Acting Agents - Hepatitis C Drugs MAVYRET - Tier 2; PA; Preferred for Genotypes 1, 2, 3, 4, 5,& 6; SP; EPCLUSA (brand for sofosbuvir-velpatasvir) - Tier 2; PA; SP; QL QL HARVONI (brand for ledipasvir-sofosbuvir) - Tier 2; PA; SP; QL SOFOSBUVIR-VELPATASVIR - Tier 2; PA; SP; QL LEDIPASVIR-SOFOSBUVIR - Tier 2; PA; SP; QL ZEPATIER - Tier 2; PA; SP; QL SOVALDI - Tier 2; PA; SP; QL VIEKIRA PAK - Tier 2; PA; SP; QL VOSEVI - Tier 2; PA; SP; QL

Anti-hepatitis C (HCV) Agents, Other - Hepatitis C Drugs INTRON A - Tier 2; PA; SP PEGASYS - Tier 2; PA; SP; QL ribavirin oral - Tier 1; QL

Antiherpetic Agents - Herpes Drugs ABREVA (brand for gnp docosanol) - Tier 2; QL acyclovir oral - Tier 1; QL docosanol external (generic for ABREVA) - Tier 1; QL

Anti-HIV Agents, Integrase Inhibitors (INSTI) - HIV Drugs DOVATO - Tier 2; DX2RX; QL GENVOYA - Tier 2; PA; QL ISENTRESS HD - Tier 2; DX2RX; QL ISENTRESS ORAL PACKET - Tier 2; DX2RX; Members >= 2 years of age will require PA; QL; AL ISENTRESS ORAL TABLET - Tier 2; DX2RX; QL ISENTRESS ORAL TABLET CHEWABLE - Tier 2; DX2RX; QL STRIBILD - Tier 2; PA; QL TIVICAY - Tier 2; DX2RX; QL TIVICAY PD - Tier 2; DX2RX; QL; AL TRIUMEQ - Tier 2; DX2RX; QL TYBOST - Tier 2; DX2RX; QL

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) - HIV Drugs COMPLERA - Tier 2; PA; QL ATRIPLA (brand for efavirenz-emtricitab-tenofovir) - Tier 2; PA; QL DELSTRIGO - Tier 2; DX2RX; QL efavirenz-emtricitab-tenofovir (generic for ATRIPLA) - Tier 1; PA; QL EDURANT - Tier 2; DX2RX; QL INTELENCE ORAL TABLET 200 MG (brand for etravirine) - Tier 2; DX2RX; efavirenz (generic for SUSTIVA) - Tier 1; DX2RX; QL QL efavirenz-lamivudine-tenofovir (generic for SYMFI) - Tier 1; DX2RX; QL PIFELTRO - Tier 2; PA; QL etravirine (generic for INTELENCE) - Tier 1; DX2RX; QL SYMFI (brand for efavirenz-lamivudine-tenofovir) - Tier 2; DX2RX; QL INTELENCE ORAL TABLET 25 MG - Tier 2; DX2RX; QL SYMFI LO (brand for efavirenz-lamivudine-tenofovir) - Tier 2; DX2RX; QL JULUCA - Tier 2; DX2RX; QL nevirapine - Tier 1; DX2RX; QL nevirapine er (generic for VIRAMUNE XR) - Tier 1; DX2RX; QL ODEFSEY - Tier 2; DX2RX; QL VIRAMUNE (brand for nevirapine) - Tier 2; DX2RX; QL

Anti-HIV Agents, Other - HIV Drugs FUZEON - Tier 2; DX2RX; QL SELZENTRY - Tier 2; DX2RX; QL

Anti-HIV Agents, Protease Inhibitors - HIV Drugs APTIVUS - Tier 2; DX2RX; QL KALETRA (brand for lopinavir-ritonavir) - Tier 2; DX2RX; QL atazanavir sulfate (generic for REYATAZ) - Tier 1; DX2RX; QL REYATAZ ORAL CAPSULE (brand for atazanavir sulfate) - Tier 2; DX2RX; CRIXIVAN - Tier 2; DX2RX; QL QL EVOTAZ - Tier 2; DX2RX; QL SYMTUZA - Tier 2; PA; QL fosamprenavir calcium (generic for LEXIVA) - Tier 1; DX2RX; QL INVIRASE - Tier 2; DX2RX; QL

Anti-Influenza Agents - Flu Drugs oseltamivir phosphate oral capsule (generic for TAMIFLU) - Tier 1; QL TAMIFLU ORAL CAPSULE (brand for oseltamivir phosphate) - Tier 2; PA; oseltamivir phosphate oral suspension reconstituted (generic for QL TAMIFLU) - Tier 1; QL; AL TAMIFLU ORAL SUSPENSION RECONSTITUTED (brand for oseltamivir RELENZA DISKHALER - Tier 2; QL phosphate) - Tier 2; PA; QL; AL rimantadine hcl - Tier 1; QL XOFLUZA (40 MG DOSE) - Tier 2; PA; QL XOFLUZA (80 MG DOSE) - Tier 2; PA; QL

Anxiolytics - Drugs to Treat Anxiety Anxiolytics, Other - Anxiety Drugs buspirone hcl oral - Tier 1; QL hydroxyzine hcl oral - Tier 1; QL

Benzodiazepines - Anxiety Drugs alprazolam oral tablet (generic for XANAX) - Tier 1; QL chlordiazepoxide hcl - Tier 1; QL clonazepam oral tablet (generic for KLONOPIN) - Tier 1; QL clorazepate dipotassium - Tier 1; QL diazepam oral solution - Tier 1; QL diazepam oral tablet (generic for VALIUM) - Tier 1; QL

Bipolar Agents - Drugs to Treat Mood Disorders Mood Stabilizers - Mood Disorder Drugs divalproex sodium oral capsule delayed release sprinkle (generic for DEPAKOTE SPRINKLES) - Tier 1; Members >= 8 years of age will require PA; QL; AL divalproex sodium oral tablet delayed release (generic for DEPAKOTE) - Tier 1; Minimum age of 2 years; QL lithium - Tier 1; QL lithium carbonate er (generic for LITHOBID) - Tier 1; QL lithium carbonate oral - Tier 1; QL

Blood Glucose Regulators - Drugs to Regulate Blood Sugar Antidiabetic Agents - Diabetic Drugs acarbose oral (generic for PRECOSE) - Tier 1; QL BYDUREON BCISE AUTOINJECTOR - Tier 2; PA; QL ADLYXIN - Tier 2; ST; QL BYETTA 10 MCG PEN - Tier 2; PA; QL ADLYXIN STARTER PACK - Tier 2; ST; QL BYETTA 5 MCG PEN - Tier 2; PA; QL ALOGLIPTIN BENZOATE - Tier 2; ST; QL GLYXAMBI - Tier 2; PA ALOGLIPTIN-METFORMIN HCL - Tier 2; ST; QL INVOKAMET - Tier 2; PA; QL ALOGLIPTIN-PIOGLITAZONE - Tier 2; ST; QL INVOKAMET XR - Tier 2; PA; QL FARXIGA - Tier 2; PA; QL INVOKANA - Tier 2; PA; QL glimepiride (generic for AMARYL) - Tier 1; QL JANUMET - Tier 2; PA; QL glipizide er (generic for GLUCOTROL XL) - Tier 1; QL JANUMET XR - Tier 2; PA; QL glipizide ir - Tier 1; QL JANUVIA - Tier 2; PA; QL glipizide xl (generic for GLUCOTROL XL) - Tier 1; QL JARDIANCE - Tier 2; PA; QL glyburide micronized (generic for GLYNASE) - Tier 1; QL JENTADUETO - Tier 2; PA; QL glyburide oral - Tier 1; QL JENTADUETO XR - Tier 2; PA; QL

Glycemic Agents - Diabetic Drugs BAQSIMI ONE PACK - Tier 2; QL GLUCAGON EMERGENCY KIT 1 MG INJECTION - Tier 2; PA; QL BAQSIMI TWO PACK - Tier 2; QL GLUCAGEN HYPOKIT - Tier 2; QL GLUCAGON EMERGENCY INJECTION SOLUTION RECONSTITUTED - Tier 2; QL glucagon emergency kit 1 mg injection - Tier 1; QL glucose oral tablet chewable 4 gm (generic for DEX4 QUICK DISSOLVE GLUCOSE) - Tier 1; QL GVOKE HYPOPEN 1-PACK - Tier 2; QL GVOKE HYPOPEN 2-PACK - Tier 2; QL

Insulins - Diabetic Drugs ADMELOG (brand for insulin lispro) - Tier 2; QL AFREZZA - Tier 2; PA; QL ADMELOG SOLOSTAR (brand for insulin lispro (1 unit dial)) - Tier 2; APIDRA SOLOSTAR - Tier 2; PA; QL PA; QL APIDRA VIAL - Tier 2; PA; QL BASAGLAR KWIKPEN - Tier 2; QL FIASP - Tier 2; PA; QL HUMALOG MIX 50/50 - Tier 2; QL FIASP FLEXTOUCH - Tier 2; PA; QL HUMALOG MIX 75/25 - Tier 2; QL HUMALOG (brand for insulin lispro) - Tier 2; PA; QL HUMULIN 70/30 VIAL - Tier 2; QL HUMALOG JUNIOR KWIKPEN (brand for insulin lispro junior kwikpen) - HUMULIN N VIAL - Tier 2; QL Tier 2; PA; QL HUMULIN R VIAL - Tier 2; QL HUMALOG KWIKPEN (brand for insulin lispro (1 unit dial)) - Tier 2; PA; QL INSULIN ASPART PROT & ASPART - Tier 2; QL HUMALOG MIX 50/50 KWIKPEN - Tier 2; PA; QL NOVOLIN 70/30 RELION - Tier 2; QL HUMALOG MIX 75/25 KWIKPEN (brand for insulin lispro prot & lispro) - NOVOLIN 70/30 VIAL - Tier 2; QL Tier 2; PA; QL NOVOLIN N RELION - Tier 2; QL HUMULIN 70/30 KWIKPEN - Tier 2; PA; QL NOVOLIN N VIAL - Tier 2; QL HUMULIN N KWIKPEN - Tier 2; PA; QL NOVOLIN R RELION - Tier 2; QL HUMULIN R U-500 KWIKPEN - Tier 2; PA; QL NOVOLIN R VIAL - Tier 2; QL HUMULIN R U-500 VIAL (CONCENTRATED) - Tier 2; PA; QL SEMGLEE - Tier 2; QL INSULIN ASP PROT & ASP FLEXPEN - Tier 2; PA; QL INSULIN ASPART - Tier 2; PA; QL INSULIN LISPRO - Tier 2; PA; QL INSULIN LISPRO (1 UNIT DIAL) - Tier 2; PA; QL LANTUS SOLOSTAR - Tier 2; PA; QL LANTUS U-100 VIAL - Tier 2; PA; QL LEVEMIR U-100 FLEXTOUCH - Tier 2; PA; QL LEVEMIR U-100 VIAL - Tier 2; PA; QL NOVOLIN 70/30 FLEXPEN - Tier 2; PA; QL NOVOLIN N FLEXPEN - Tier 2; PA; QL NOVOLIN R FLEXPEN - Tier 2; PA; QL NOVOLOG FLEXPEN (brand for insulin aspart flexpen) - Tier 2; PA; QL

Blood Products and Modifiers Blood Products and Modifiers, Other NYVEPRIA - Tier 2; PA; SP

Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders Anticoagulants - Blood Thinners CATHFLO ACTIVASE - Tier 2; QL PRADAXA - Tier 2; PA; QL ELIQUIS - Tier 2; QL XARELTO - Tier 2; PA; QL ELIQUIS DVT/PE STARTER PACK - Tier 2; QL XARELTO STARTER PACK - Tier 2; PA; QL enoxaparin sodium (generic for LOVENOX) - Tier 1; QL heparin sodium (porcine) - Tier 1; QL heparin sodium (porcine) pf injection solution 5000 unit/0.5ml - Tier 1; QL heparin sodium (porcine) pf injection solution 5000 unit/ml - Tier 1 jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 7.5 mg (generic for JANTOVEN) - Tier 1; QL jantoven oral tablet 6 mg (generic for JANTOVEN) - Tier 1 SAVAYSA - Tier 2; QL

Blood Formation Modifiers - Blood Formation Drugs anagrelide hcl (generic for AGRYLIN) - Tier 1 DOPTELET - Tier 2; PA; SP; QL ARANESP (ALBUMIN FREE) INJECTION SOLUTION - Tier 2; PA; SP EPOGEN - Tier 2; PA; SP ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED FULPHILA - Tier 2; PA; SP SYRINGE 10 MCG/0.4ML - Tier 2; PA; SP; QL GRANIX - Tier 2; PA; SP ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 SYRINGE 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.3ML, 200 MCG/0.3ML, 50 MCG/0.3ML, 75 MCG/0.3ML - Tier 2; PA MCG/0.42ML, 300 MCG/0.6ML, 40 MCG/0.4ML, 500 MCG/ML, 60 NEUPOGEN INJECTION SOLUTION 300 MCG/ML - Tier 2; PA; SP MCG/0.3ML - Tier 2; PA; SP NEUPOGEN INJECTION SOLUTION 480 MCG/1.6ML - Tier 2; PA; SP; QL LEUKINE - Tier 2; PA; SP NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE - Tier 2; PA; MOZOBIL - Tier 2; PA; SP; QL SP MULPLETA - Tier 2; PA; SP; QL NIVESTYM - Tier 2; PA; SP NEULASTA - Tier 2; PA; SP OXBRYTA - Tier 2; PA; QL NEULASTA ONPRO - Tier 2; PA; SP PROCRIT - Tier 2; PA; SP PROMACTA ORAL PACKET 25 MG - Tier 2; PA; SP; QL UDENYCA - Tier 2; PA; SP PROMACTA ORAL TABLET - Tier 2; PA; SP; QL ZIEXTENZO - Tier 2; PA; SP RETACRIT - Tier 2; PA; SP ZARXIO - Tier 2; PA; SP

Hemostasis Agents - Drugs to Stop Bleeding aminocaproic acid oral (generic for AMICAR) - Tier 1; QL HEMLIBRA - Tier 2; PA; SP; QL tranexamic acid oral (generic for LYSTEDA) - Tier 1; DX2RX; QL

Platelet Modifying Agents - Platelet Modifying Drugs BRILINTA - Tier 2; DX2RX; QL CABLIVI - Tier 2; PA; SP; QL

Cardiovascular Agents Cardiovascular Agents, Other NEXLIZET - Tier 2; PA; QL

Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions Alpha-adrenergic Agonists - Blood Pressure Drugs clonidine hcl oral - Tier 1; QL guanfacine hcl - Tier 1; QL methyldopa - Tier 1; QL midodrine hcl - Tier 1; QL

Alpha-adrenergic Blocking Agents - Blood Pressure Drugs doxazosin mesylate oral (generic for CARDURA) - Tier 1; QL prazosin hcl oral (generic for MINIPRESS) - Tier 1; QL

Angiotensin II Receptor Antagonists - Blood Pressure Drugs losartan potassium oral (generic for COZAAR) - Tier 1; QL EDARBI - Tier 2; PA; QL

Angiotensin-Converting Enzyme (ACE) Inhibitors - Blood Pressure Drugs benazepril hcl oral (generic for LOTENSIN) - Tier 1; QL captopril oral - Tier 1; QL

Antiarrhythmics - Heart Regulation Drugs amiodarone hcl oral tablet 200 mg, 400 mg (generic for PACERONE) - BETAPACE (brand for sotalol hcl) - Tier 2; PA; QL Tier 1; QL BETAPACE AF (brand for sotalol hcl (af)) - Tier 2; PA; QL disopyramide phosphate (generic for NORPACE) - Tier 1; QL MULTAQ - Tier 2; PA; QL dofetilide (generic for TIKOSYN) - Tier 1; QL NORPACE (brand for disopyramide phosphate) - Tier 2; PA; QL flecainide acetate - Tier 1; QL PACERONE (brand for amiodarone hcl) - Tier 2; PA; QL mexiletine hcl oral - Tier 1; QL RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 225 NORPACE CR - Tier 2 MG, 325 MG (brand for propafenone hcl er) - Tier 2; PA; QL propafenone hcl - Tier 1; QL RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 425 quinidine gluconate er - Tier 1; QL MG (brand for propafenone hcl er) - Tier 2; PA quinidine sulfate - Tier 1; QL TIKOSYN (brand for dofetilide) - Tier 2; PA; QL sotalol hcl (af) (generic for BETAPACE AF) - Tier 1; QL sotalol hcl oral (generic for BETAPACE) - Tier 1; QL

Beta-adrenergic Blocking Agents - Blood Pressure Drugs acebutolol hcl oral - Tier 1; QL HEMANGEOL - Tier 2; PA; QL atenolol oral (generic for TENORMIN) - Tier 1; QL betaxolol hcl oral - Tier 1; QL bisoprolol fumarate oral - Tier 1; QL carvedilol (generic for COREG) - Tier 1; QL labetalol hcl oral - Tier 1; QL metoprolol succinate er (generic for TOPROL XL) - Tier 1; QL metoprolol tartrate oral tablet 100 mg, 50 mg (generic for LOPRESSOR) - Tier 1; QL

Calcium Channel Blocking Agents - Blood Pressure Drugs amlodipine besylate oral (generic for NORVASC) - Tier 1; QL cartia xt (generic for CARTIA XT) - Tier 1; QL diltiazem hcl er - Tier 1; QL diltiazem hcl er beads (generic for TAZTIA XT) - Tier 1; QL diltiazem hcl er coated beads oral capsule extended release 24 hour (generic for CARTIA XT) - Tier 1; QL diltiazem hcl oral (generic for CARDIZEM) - Tier 1; QL dilt-xr - Tier 1; QL felodipine er - Tier 1; QL nifedipine er (generic for AFEDITAB CR) - Tier 1; QL nifedipine er osmotic release (generic for PROCARDIA XL) - Tier 1; QL nifedipine oral - Tier 1; QL nimodipine oral - Tier 1; QL NYMALIZE - Tier 2; QL taztia xt (generic for TAZTIA XT) - Tier 1; QL tiadylt er (generic for TAZTIA XT) - Tier 1; QL verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg (generic for VERELAN) - Tier 1; QL verapamil hcl er oral tablet extended release (generic for CALAN SR) - Tier 1; QL verapamil hcl oral - Tier 1; QL

Cardiovascular Agents, Other - Miscellaneous Cardiac Drugs amiloride-hydrochlorothiazide - Tier 1; QL BIDIL - Tier 2; PA; QL atenolol-chlorthalidone (generic for TENORETIC 100) - Tier 1; QL CORLANOR - Tier 2; PA; QL

Diuretics, Carbonic Anhydrase Inhibitors - Cardiac Drugs methazolamide oral - Tier 1; QL

Diuretics, Loop - Cardiac Drugs bumetanide oral (generic for BUMEX) - Tier 1; QL furosemide oral solution 10 mg/ml - Tier 1; QL furosemide oral tablet (generic for LASIX) - Tier 1; QL torsemide - Tier 1; QL

Diuretics, Potassium-sparing - Cardiac Drugs

Diuretics, Thiazide - Cardiac Drugs chlorthalidone - Tier 1; QL DIURIL - Tier 2; QL hydrochlorothiazide oral capsule - Tier 1; QL hydrochlorothiazide oral tablet 12.5 mg - Tier 1 hydrochlorothiazide oral tablet 25 mg, 50 mg - Tier 1; QL indapamide - Tier 1; QL metolazone - Tier 1; QL

Dyslipidemics, Fibric Acid Derivatives - Cholesterol Control Drugs fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg - Tier 1; ST; QL fenofibrate oral capsule 134 mg, 200 mg, 67 mg - Tier 1; ST; QL fenofibrate oral tablet 160 mg, 54 mg - Tier 1; PA; ST; QL gemfibrozil oral (generic for LOPID) - Tier 1; QL

Dyslipidemics, HMG CoA Reductase Inhibitors - Cholesterol Control Drugs atorvastatin calcium oral (generic for LIPITOR) - Tier 1; QL lovastatin oral - Tier 1; QL; AL rosuvastatin calcium (generic for CRESTOR) - Tier 1; QL simvastatin oral (generic for ZOCOR) - Tier 1; QL

Dyslipidemics, Other - Miscellaneous Cholesterol Control Drugs cholestyramine light oral powder (generic for PREVALITE) - Tier 1; QL NEXLETOL - Tier 2; PA; QL cholestyramine oral powder (generic for QUESTRAN) - Tier 1; Only the PRALUENT - Tier 2; PA; NDC starting w/72733 Preferred w/PA; SP; QL bulk products are covered (cans) Individual packets are not covered; QL

Vasodilators, Direct-acting Arterial - Chest Pain Drugs hydralazine hcl oral - Tier 1; QL minoxidil oral - Tier 1; QL

Vasodilators, Direct-acting Arterial/Venous - Chest Pain Drugs isosorbide dinitrate - Tier 1; QL isosorbide mononitrate - Tier 1; QL isosorbide mononitrate er - Tier 1; QL minitran (generic for MINITRAN) - Tier 1; QL NITRO-BID - Tier 2; QL NITRO-DUR (brand for nitroglycerin) - Tier 2; QL nitroglycerin sublingual (generic for NITROSTAT) - Tier 1; QL nitroglycerin transdermal (generic for MINITRAN) - Tier 1; QL nitroglycerin translingual (generic for NITROLINGUAL) - Tier 1; QL RECTIV - Tier 2; DX2RX; QL

Central Nervous System Agents Fibromyalgia Agents ZEPOSIA - Tier 2; PA; SP; QL

Multiple Sclerosis Agents BAFIERTAM - Tier 2; PA; SP; QL

Central Nervous System Agents - Drugs to Treat Nerve Conditions Attention Deficit Hyperactivity Disorder Agents, Amphetamines - ADHD Drugs amphetamine-dextroamphetamine (generic for ADDERALL) - Tier 1; ADZENYS XR-ODT - Tier 2; DX2RX; ^; QL; AL DX2RX; QL; AL DYANAVEL XR - Tier 2; DX2RX; ^; QL; AL amphetamine-dextroamphetamine er (generic for ADDERALL XR) - Tier EVEKEO (brand for amphetamine sulfate) - Tier 2; DX2RX; ^; QL; AL 1; DX2RX; QL; AL EVEKEO ODT - Tier 2; PA; ^; QL; AL MYDAYIS - Tier 2; DX2RX; ^; QL; AL VYVANSE ORAL CAPSULE - Tier 2; PA; ^; QL; AL VYVANSE ORAL TABLET CHEWABLE - Tier 2; PA; ^; QL ZENZEDI - Tier 2; DX2RX; ^; QL; AL

Attention Deficit Hyperactivity Disorder Agents, Non- amphetamines - ADHD Drugs atomoxetine hcl (generic for STRATTERA) - Tier 1; DX2RX; QL; AL APTENSIO XR (brand for methylphenidate hcl er (xr)) - Tier 2; DX2RX; ^; guanfacine hcl er (generic for INTUNIV) - Tier 1; DX2RX; QL; AL QL; AL methylphenidate hcl er (cd) - Tier 1; DX2RX; QL; AL CONCERTA (brand for methylphenidate hcl er) - Tier 2; DX2RX; ^; QL; AL methylphenidate hcl er (la) oral capsule extended release 24 hour 20 COTEMPLA XR-ODT - Tier 2; DX2RX; ^; QL; AL mg, 30 mg, 40 mg (generic for RITALIN LA) - Tier 1; DX2RX; QL; AL DAYTRANA - Tier 2; DX2RX; ^; QL; AL methylphenidate hcl er oral tablet extended release 10 mg, 20 mg - Tier FOCALIN (brand for dexmethylphenidate hcl) - Tier 2; DX2RX; ^; QL; AL 1; DX2RX; QL; AL JORNAY PM - Tier 2; PA; ^; QL; AL methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 KAPVAY (brand for clonidine hcl er) - Tier 2; DX2RX; ^; QL; AL mg, 54 mg (generic for CONCERTA) - Tier 1; DX2RX; ^; QL; AL METHYLIN (brand for methylphenidate hcl) - Tier 2; DX2RX; ^; QL; AL methylphenidate hcl er oral tablet extended release 24 hour - Tier 1; RITALIN (brand for methylphenidate hcl) - Tier 2; DX2RX; QL; AL DX2RX; Mallinckrodt and Kremers Urban labelers; QL; AL STRATTERA (brand for atomoxetine hcl) - Tier 2; DX2RX; QL; AL methylphenidate hcl oral tablet (generic for RITALIN) - Tier 1; DX2RX; QL; AL

Fibromyalgia Agents - Drugs to Treat Muscle and Soft Tissue Pain pregabalin oral (generic for LYRICA) - Tier 1; QL

Multiple Sclerosis Agents - Multiple Sclerosis Drugs AUBAGIO - Tier 2; DX2RX; SP; QL AMPYRA (brand for dalfampridine er) - Tier 2; PA; SP; QL dimethyl fumarate oral (generic for TECFIDERA) - Tier 1; DX2RX; SP; AVONEX PEN - Tier 2; PA; SP; QL QL AVONEX PREFILLED - Tier 2; PA; SP; QL dimethyl fumarate starter pack (generic for TECFIDERA) - Tier 1; BETASERON - Tier 2; PA; SP; QL DX2RX; SP; QL COPAXONE (brand for glatiramer acetate) - Tier 2; DX2RX; SP; QL GILENYA - Tier 2; DX2RX; SP; QL EXTAVIA - Tier 2; PA; SP; QL glatiramer acetate (generic for GLATOPA) - Tier 1; DX2RX; SP; QL MAVENCLAD (10 TABS) - Tier 2; PA; SP; QL glatopa (generic for GLATOPA) - Tier 1; DX2RX; SP; QL MAVENCLAD (4 TABS) - Tier 2; PA; SP; QL MAYZENT - Tier 2; PA; SP; QL MAVENCLAD (5 TABS) - Tier 2; PA; SP; QL PLEGRIDY STARTER PACK - Tier 2; DX2RX; SP; QL MAVENCLAD (6 TABS) - Tier 2; PA; SP; QL PLEGRIDY SUBCUTANEOUS - Tier 2; DX2RX; SP; QL MAVENCLAD (7 TABS) - Tier 2; PA; SP; QL MAVENCLAD (8 TABS) - Tier 2; PA; SP; QL MAVENCLAD (9 TABS) - Tier 2; PA; SP; QL REBIF - Tier 2; PA; SP; QL REBIF REBIDOSE - Tier 2; PA; SP; QL REBIF REBIDOSE TITRATION PACK - Tier 2; PA; SP; QL REBIF TITRATION PACK - Tier 2; PA; SP; QL TECFIDERA (brand for dimethyl fumarate) - Tier 2; DX2RX; SP; QL VUMERITY - Tier 2; PA; SP; QL

Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions cavarest (generic for CAVAREST) - Tier 1; QL chlorhexidine gluconate mouth/throat (generic for PERIOGARD) - Tier 1; QL DENTA 5000 PLUS (brand for sodium fluoride 5000 plus) - Tier 2; QL DENTAGEL (brand for sodium fluoride) - Tier 2; QL easygel - Tier 1; QL fluoridex daily renewal - Tier 1; QL oralone (generic for ORALONE) - Tier 1; QL periogard (generic for PERIOGARD) - Tier 1; QL pilocarpine hcl oral tablet 5 mg (generic for SALAGEN) - Tier 1; QL pilocarpine hcl oral tablet 7.5 mg (generic for SALAGEN) - Tier 1 PREVIDENT 5000 DRY MOUTH (brand for sodium fluoride) - Tier 2; QL PREVIDENT 5000 PLUS (brand for sodium fluoride 5000 plus) - Tier 2; QL PREVIDENT DENTAL (brand for sodium fluoride) - Tier 2; QL sf (generic for CAVAREST) - Tier 1; QL sf 5000 plus (generic for DENTA 5000 PLUS) - Tier 1; QL sodium fluoride 5000 plus (generic for DENTA 5000 PLUS) - Tier 1; QL sodium fluoride 5000 ppm dental cream (generic for DENTA 5000 PLUS) - Tier 1; QL sodium fluoride dental (generic for CAVAREST) - Tier 1; QL triamcinolone acetonide mouth/throat (generic for ORALONE) - Tier 1; QL

Dermatological Agents - Drugs to Treat Skin Conditions accutane (generic for ACCUTANE) - Tier 1; PA; QL ABSORICA (brand for isotretinoin) - Tier 2; PA; QL acitretin (generic for SORIATANE) - Tier 1; PA; QL ABSORICA LD - Tier 2; PA; QL acne (generic for CLEARSKIN) - Tier 1; QL ACANYA (brand for clindamycin phos-benzoyl perox) - Tier 2; PA; QL acne control cleanser (generic for CLEARSKIN) - Tier 1; QL ACZONE EXTERNAL GEL 7.5 % (brand for dapsone) - Tier 2; PA; QL

Tier 1: Generic; Tier 2: Brand; ^: Medical Office Attestation Needed if Prescribed by Behavioral Health Provider, Full Prior Authorization Needed if Prescribed by Non-Behavioral Health Provider; *: Available without PA for participating Behavioral Health Prescribers; AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Limit; SP: Specialty Medication; ST: Step Therapy 55 Preferred Agents Non-Preferred Agents acne medication 10 external lotion - Tier 1; QL ALDARA (brand for imiquimod) - Tier 2; PA; QL acne medication 5 external lotion - Tier 1; QL AMZEEQ - Tier 2; PA adv acne spot treatment (generic for NEUTROGENA OIL-FREE ACNE ATRALIN (brand for tretinoin) - Tier 2; PA; QL; AL WASH) - Tier 1; QL BENZACLIN (brand for clindamycin phos-benzoyl perox) - Tier 2; PA; QL advanced healing external ointment (generic for FLANDERS BENZACLIN WITH PUMP (brand for clindamycin phos-benzoyl perox) - BUTTOCKS) - Tier 1; QL Tier 2; PA; QL ala-cort (generic for AVEENO ANTI-ITCH MAX ST) - Tier 1; QL BENZAMYCIN (brand for benzoyl peroxide-erythromycin) - Tier 2; PA; QL alclometasone dipropionate external ointment - Tier 1; QL CARAC (brand for fluorouracil) - Tier 2; PA; QL alum sulfate-ca acetate (generic for DOMEBORO) - Tier 1; QL CLOBEX (brand for clobetasol propionate) - Tier 2; PA; QL amcinonide external ointment - Tier 1; QL CLOBEX SPRAY (brand for clobetasol propionate) - Tier 2; PA; QL ammonium lactate external (generic for AL12) - Tier 1; QL DIFFERIN EXTERNAL CREAM (brand for adapalene) - Tier 2; PA; QL amnesteem (generic for AMNESTEEM) - Tier 1; PA; QL DIFFERIN EXTERNAL GEL 0.3 % (brand for adapalene) - Tier 2; PA; QL arthritis pain relieving - Tier 1; QL DIFFERIN EXTERNAL LOTION - Tier 2; PA; QL astringent solution (generic for DOMEBORO) - Tier 1; QL DOVONEX (brand for calcipotriene) - Tier 2; PA; ST; QL AVAR-E EMOLLIENT (brand for sulfacetamide sodium-sulfur) - Tier 2; DUPIXENT - Tier 2; PA; SP; QL QL EFUDEX (brand for fluorouracil) - Tier 2; PA; QL AVAR-E GREEN (brand for sulfacetamide sodium-sulfur) - Tier 2; QL ELIDEL (brand for pimecrolimus) - Tier 2; PA; ST; Minimum age of 2 years; AVITA EXTERNAL CREAM (brand for tretinoin) - Tier 2; ST; QL; AL QL; AL azelaic acid external (generic for FINACEA) - Tier 1; QL ENSTILAR - Tier 2; PA; QL baby basics diaper rash (generic for BOUDREAUXS BUTT PASTE) - EPIDUO (brand for adapalene-benzoyl peroxide) - Tier 2; PA; QL Tier 1; QL EPIDUO FORTE - Tier 2; PA; QL beauty 360 pure glycerin - Tier 1 FABIOR (brand for tazarotene) - Tier 2; PA; QL beauty 360 soothing bath (generic for AVEENO BABY BATH FINACEA (brand for azelaic acid) - Tier 2; PA; QL TREATMENT) - Tier 1; QL LUXIQ (brand for betamethasone valerate) - Tier 2; PA; QL BENZAC AC WASH (brand for benzoyl peroxide wash) - Tier 2; QL MIRVASO - Tier 2; PA; QL betamethasone dipropionate aug (generic for DIPROLENE AF) - Tier 1; OLUX (brand for clobetasol propionate) - Tier 2; PA; QL QL OLUX-E (brand for clobetasol propionate emulsion) - Tier 2; PA; QL betamethasone dipropionate external lotion - Tier 1; QL ONEXTON - Tier 2; PA; QL betamethasone dipropionate external ointment - Tier 1; QL PROTOPIC EXTERNAL OINTMENT 0.03 % (brand for tacrolimus) - Tier 2; betamethasone valerate external cream - Tier 1; QL PA; ST; Minimum age of 2 years; QL; AL betamethasone valerate external lotion - Tier 1; QL PROTOPIC EXTERNAL OINTMENT 0.1 % (brand for tacrolimus) - Tier 2; betamethasone valerate external ointment - Tier 1; QL PA; ST; Minimum age of 16 years; QL; AL boro-packs (generic for DOMEBORO) - Tier 1; QL QBREXZA - Tier 2; PA; QL RETIN-A EXTERNAL CREAM (brand for tretinoin) - Tier 2; PA; ST; QL; AL

Tier 1: Generic; Tier 2: Brand; ^: Medical Office Attestation Needed if Prescribed by Behavioral Health Provider, Full Prior Authorization Needed if Prescribed by Non-Behavioral Health Provider; *: Available without PA for participating Behavioral Health Prescribers; AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Limit; SP: Specialty Medication; ST: Step Therapy 56 Preferred Agents Non-Preferred Agents BOUDREAUXS BUTT PASTE EXTERNAL OINTMENT 40 % (brand for RETIN-A EXTERNAL GEL (brand for tretinoin) - Tier 2; PA; QL; AL diaper rash) - Tier 2; QL RETIN-A MICRO GEL 0.04 %, 0.1 % (brand for tretinoin microsphere) - bp 10-1 - Tier 1; QL Tier 2; PA; QL; AL bp wash external liquid 2.5 % (generic for PANOXYL) - Tier 1; QL RETIN-A MICRO PUMP EXTERNAL GEL 0.06 % - Tier 2; PA; QL; AL calamine external lotion , 8-8 % - Tier 1; QL RHOFADE - Tier 2; PA; QL calamine-zinc oxide external lotion - Tier 1; QL SERNIVO - Tier 2; PA; QL calcipotriene external cream (generic for DOVONEX) - Tier 1; ST; QL SILIQ - Tier 2; PA; SP; QL calcipotriene external ointment (generic for CALCITRENE) - Tier 1; ST; SOOLANTRA (brand for ivermectin) - Tier 2; PA; QL QL SORILUX (brand for calcipotriene) - Tier 2; PA; QL calcipotriene external solution - Tier 1; QL TACLONEX (brand for calcipotriene-betameth diprop) - Tier 2; PA; QL calcitriol external (generic for VECTICAL) - Tier 1; ST; QL TALTZ - Tier 2; PA; SP; QL capsaicin external cream 0.1 % (generic for ZOSTRIX HP) - Tier 1; QL TAZORAC EXTERNAL CREAM - Tier 2; PA; QL capsaicin hp (generic for ZOSTRIX HP) - Tier 1; QL TAZORAC EXTERNAL GEL 0.1 % - Tier 2; PA; QL capzix (generic for ZOSTRIX HP) - Tier 1; QL TEMOVATE (brand for clobetasol propionate) - Tier 2; PA; QL cerovel (generic for CEROVEL) - Tier 1; QL TOPICORT SPRAY (brand for desoximetasone) - Tier 2; PA; QL claravis (generic for AMNESTEEM) - Tier 1; PA; QL TREMFYA - Tier 2; PA; SP; QL clearskin (generic for CLEARSKIN) - Tier 1; QL VANOS (brand for fluocinonide) - Tier 2; PA; QL clindacin etz external swab (generic for CLINDACIN ETZ) - Tier 1; QL VECTICAL (brand for calcitriol) - Tier 2; PA; ST; QL clindacin-p (generic for CLINDACIN ETZ) - Tier 1; QL VELTIN (brand for clindamycin-tretinoin) - Tier 2; PA; QL clindamycin phosphate external gel (generic for CLINDAGEL) - Tier 1; ZIANA (brand for clindamycin-tretinoin) - Tier 2; PA; QL QL ZYCLARA (brand for imiquimod pump) - Tier 2; PA; QL clindamycin phosphate external lotion (generic for CLEOCIN-T) - Tier 1; QL clindamycin phosphate external solution - Tier 1; QL clindamycin phosphate external swab (generic for CLINDACIN ETZ) - Tier 1; QL clobetasol prop emollient base - Tier 1; QL clobetasol propionate e - Tier 1; QL clobetasol propionate external solution - Tier 1; QL clotrimazole-betamethasone - Tier 1; QL corn & callus remover (generic for COMPOUND W) - Tier 1; QL COSENTYX - Tier 2; PA; SP; QL daily acne wash (generic for NEUTROGENA OIL-FREE ACNE WASH) - Tier 1; QL

Dermatological Agents - Skin Agents ZILXI - Tier 2; PA; QL

Electrolytes/Minerals/Metals/Vitamins Electrolyte/Mineral Replacement - Vitamin, Mineral and Body Fluid Deficiency Drugs BPROTECTED PEDIA IRON (brand for ferrous sulfate) - Tier 2; QL CHOICE DM (brand for goodsense nutrisure original) - Tier 2; PA cal mag zinc +d3 (generic for ADVANCED CALCIUM/D/MAGNESIUM) - Tier 1; QL calcium 500/d oral tablet (generic for RA HI CAL) - Tier 1; QL calcium 500/vitamin d3 - Tier 1 calcium 600 oral tablet 1500 (600 ca) mg - Tier 1; QL calcium 600/vit d/minerals oral tablet 600-200 mg-unit - Tier 1; QL calcium 600/vit d/minerals oral tablet chewable 600-400 mg-unit - Tier 1

Electrolyte/Mineral/Metal Modifiers CHEMET - Tier 2; QL deferasirox granules (generic for JADENU SPRINKLE) - Tier 1; PA; SP; QL deferasirox oral packet (generic for JADENU SPRINKLE) - Tier 1; PA; SP; QL

Phosphate Binders - Phosphate-Removing Agents calcium acetate (phos binder) oral tablet (generic for CALPHRON) - Tier AURYXIA - Tier 2; PA; QL 1; QL VELPHORO - Tier 2; PA; QL calcium acetate oral tablet 667 mg (generic for CALPHRON) - Tier 1; QL sevelamer carbonate oral tablet (generic for RENVELA) - Tier 1; ST; QL

Vitamins a-25 - Tier 1; QL adc/f (0.5mg/ml) - Tier 1; QL animal shapes complete (generic for CEROVITE JR) - Tier 1; QL animal shapes kids first (generic for DINO-LIFE) - Tier 1; QL animal shapes/iron (generic for CEROVITE JR) - Tier 1; QL AQUADEKS - Tier 2; DX2RX; QL aqueous vitamin d (generic for BPROTECTED PEDIA D-VITE) - Tier 1; QL ascorbic acid oral tablet 500 mg (generic for PUREWAY-C) - Tier 1; QL ATABEX OB - Tier 2; QL b-1 - Tier 1; QL b6 - Tier 1; QL b-complex oral tablet - Tier 1 b-complex with b-12 - Tier 1 b-complex/b-12 oral - Tier 1 biocel (generic for LYSIPLEX PLUS) - Tier 1; QL b-plex plus (generic for LYSIPLEX PLUS) - Tier 1; QL BPROTECTED PEDIA D-VITE (brand for vitamin d) - Tier 2; QL

Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions Antispasmodics, Gastrointestinal - Stomach and Intestine Drugs ANASPAZ (brand for hyoscyamine sulfate) - Tier 2; QL dicyclomine hcl oral capsule - Tier 1; QL dicyclomine hcl oral solution - Tier 1 dicyclomine hcl oral tablet - Tier 1; QL ED-SPAZ - Tier 2; QL glycopyrrolate oral tablet 1 mg, 2 mg - Tier 1 hyoscyamine sulfate er (generic for LEVBID) - Tier 1; QL hyoscyamine sulfate oral - Tier 1; QL hyoscyamine sulfate sl (generic for LEVSIN/SL) - Tier 1; QL hyoscyamine sulfate sublingual (generic for LEVSIN/SL) - Tier 1; QL hyosyne - Tier 1; QL LEVBID (brand for hyoscyamine sulfate er) - Tier 2; QL NULEV (brand for hyoscyamine sulfate) - Tier 2; QL oscimin (generic for LEVSIN) - Tier 1; QL oscimin sr (generic for LEVBID) - Tier 1; QL SYMAX-SR (brand for hyoscyamine sulfate er) - Tier 2; QL

Gastrointestinal Agents, Other - Miscellaneous Gastrointestinal Drugs

Histamine2 (H2) Receptor Antagonists - Ulcer and Stomach Acid Drugs acid controller (generic for PEPCID AC) - Tier 1; QL acid reducer oral tablet 10 mg (generic for PEPCID AC) - Tier 1; QL acid reducer oral tablet 200 mg (generic for TAGAMET HB) - Tier 1 cimetidine hcl - Tier 1 cimetidine oral tablet 200 mg (generic for TAGAMET HB) - Tier 1 cimetidine oral tablet 300 mg, 400 mg, 800 mg - Tier 1; QL famotidine oral suspension reconstituted 40 mg/5ml - Tier 1; QL; AL famotidine oral tablet 10 mg (generic for PEPCID AC) - Tier 1; QL famotidine oral tablet 20 mg (generic for MM ACID-PEP MAXIMUM STRENGTH) - Tier 1; QL famotidine oral tablet 40 mg (generic for PEPCID) - Tier 1; QL famotidine orig st (generic for PEPCID AC) - Tier 1; QL

Irritable Bowel Syndrome Agents - Bowel Treatment Drugs LUBIPROSTONE - Tier 2; DX2RX; ST; QL AMITIZA (brand for lubiprostone) - Tier 2; DX2RX; ST; QL LINZESS - Tier 2; PA; QL

Laxatives - Drugs to treat Constipation bisacodyl ec (generic for EX-LAX ULTRA) - Tier 1; QL bisacodyl laxative (generic for THE MAGIC BULLET) - Tier 1; QL bisacodyl rectal (generic for THE MAGIC BULLET) - Tier 1; QL citrate of magnesia (generic for CITROMA) - Tier 1 citroma (generic for CITROMA) - Tier 1 CITRUCEL ORAL POWDER - Tier 2; QL CITRUCEL ORAL TABLET (brand for fiber therapy) - Tier 2 c-lax laxative (generic for EX-LAX ULTRA) - Tier 1; QL clearlax oral powder 17 gm/scoop (generic for CLEARLAX) - Tier 1; ONLY powder bottle; QL COLACE (brand for eq stool softener) - Tier 2; QL col-rite oral capsule 250 mg - Tier 1; QL constulose - Tier 1; QL daily fiber oral capsule 0.52 gm (generic for MEDI-MUCIL) - Tier 1 docu (generic for DOCU LIQUID) - Tier 1; QL docu liquid (generic for DOCU LIQUID) - Tier 1; QL docusate calcium (generic for SURFAK) - Tier 1 docusate mini (generic for DOCUSOL MINI) - Tier 1; QL docusate sodium oral capsule (generic for DOK) - Tier 1; QL docusate sodium oral liquid 50 mg/5ml (generic for DOCU LIQUID) - Tier 1; QL docusate sodium oral syrup - Tier 1

Protectants - Ulcer and Stomach Acid Drugs misoprostol oral (generic for CYTOTEC) - Tier 1; QL sucralfate oral suspension (generic for CARAFATE) - Tier 1; Members 10 years of age up to 65 years of age will require PA; QL sucralfate oral tablet (generic for CARAFATE) - Tier 1; QL

Proton Pump Inhibitors - Ulcer and Stomach Acid Drugs acid reducer oral capsule delayed release 20.6 (20 base) mg - Tier 1; ACIPHEX (brand for rabeprazole sodium) - Tier 2; PA; QL QL DEXILANT - Tier 2; PA; QL esomeprazole magnesium oral packet (generic for NEXIUM) - Tier 1; esomeprazole magnesium oral capsule delayed release (generic for Members >= 2 years of age will require PA; QL; AL NEXIUM) - Tier 1; PA; QL lansoprazole oral capsule delayed release 15 mg (generic for NEXIUM ORAL CAPSULE DELAYED RELEASE (brand for hm PREVACID 24HR) - Tier 1; QL esomeprazole magnesium dr) - Tier 2; PA; QL lansoprazole oral capsule delayed release 30 mg (generic for NEXIUM ORAL PACKET 10 MG, 20 MG, 40 MG (brand for esomeprazole PREVACID) - Tier 1; QL magnesium) - Tier 2; PA; Members >= 2 years of age will require PA; QL; lansoprazole oral tablet delayed release dispersible 15 mg (generic for AL PREVACID SOLUTAB) - Tier 1; QL; AL omeprazole magnesium oral tablet delayed release (generic for PRILOSEC lansoprazole oral tablet delayed release dispersible 30 mg (generic for OTC) - Tier 1; PA; QL PREVACID SOLUTAB) - Tier 1; Members >= 2 years of age will require omeprazole oral tablet delayed release 20 mg - Tier 1; PA; QL PA; QL; AL pantoprazole sodium oral packet (generic for PROTONIX) - Tier 1; PA; QL NEXIUM ORAL PACKET 2.5 MG, 5 MG - Tier 2; Members >= 2 years of PREVACID ORAL CAPSULE DELAYED RELEASE 30 MG (brand for age will require PA; QL; AL lansoprazole) - Tier 2; PA; QL omeprazole magnesium oral capsule delayed release - Tier 1; QL PRILOSEC - Tier 2; PA; QL omeprazole oral capsule delayed release 10 mg, 20 mg, 20.6 (20 base) ZEGERID (brand for omeprazole-sodium bicarbonate) - Tier 2; PA; QL mg, 40 mg - Tier 1; QL pantoprazole sodium oral tablet delayed release (generic for PROTONIX) - Tier 1; QL PREVACID 24HR (brand for cvs lansoprazole) - Tier 2; QL

Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions Antispasmodics, Urinary - Bladder Control Drugs oxybutynin chloride er (generic for DITROPAN XL) - Tier 1; QL DETROL (brand for tolterodine tartrate) - Tier 2; PA; ST; QL oxybutynin chloride oral - Tier 1; QL DETROL LA (brand for tolterodine tartrate er) - Tier 2; PA; QL OXYTROL FOR WOMEN - Tier 2; QL DITROPAN XL (brand for oxybutynin chloride er) - Tier 2; PA; QL tolterodine tartrate (generic for DETROL) - Tier 1; ST; QL MYRBETRIQ - Tier 2; PA; QL trospium chloride - Tier 1; ST; QL TOVIAZ - Tier 2; PA; QL VESICARE (brand for solifenacin succinate) - Tier 2; PA; QL

Benign Prostatic Hypertrophy Agents - Prostate Drugs alfuzosin hcl er (generic for UROXATRAL) - Tier 1; QL finasteride oral tablet 5 mg (generic for PROSCAR) - Tier 1; QL tamsulosin hcl (generic for FLOMAX) - Tier 1; QL terazosin hcl - Tier 1; QL

Genitourinary Agents, Other - Miscellaneous Bladder, Genital, and Kidney Conditions Drugs azo (generic for PHENAZO) - Tier 1 CUPRIMINE (brand for penicillamine) - Tier 2; PA; SP

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) - Drugs to Regulate Hormones Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) - Hormone Replacement/Modifying Drugs DECADRON ORAL TABLET 0.5 MG, 0.75 MG (brand for EMFLAZA ORAL TABLET 6 MG - Tier 2; PA; SP; QL dexamethasone) - Tier 2 DECADRON ORAL TABLET 4 MG, 6 MG (brand for dexamethasone) - Tier 2; QL dexamethasone intensol - Tier 1; QL dexamethasone oral elixir - Tier 1; QL dexamethasone oral solution - Tier 1; QL dexamethasone oral tablet 0.5 mg, 0.75 mg (generic for DECADRON) - Tier 1 dexamethasone oral tablet 1 mg, 2 mg - Tier 1 dexamethasone oral tablet 1.5 mg - Tier 1; QL

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Drugs to Regulate Hormones Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Hormone Replacement/Modifying Drugs chorionic gonadotropin intramuscular (generic for NOVAREL) - Tier 1; GENOTROPIN - Tier 2; PA; SP DX2RX; QL HUMATROPE INJECTION SOLUTION RECONSTITUTED 12 MG, 24 MG, desmopressin ace spray refrig - Tier 1; QL 6 MG - Tier 2; PA; SP desmopressin acetate oral (generic for DDAVP) - Tier 1; QL NORDITROPIN FLEXPRO - Tier 2; PA; SP desmopressin acetate spray - Tier 1; QL NUTROPIN AQ NUSPIN 10 - Tier 2; PA; SP INCRELEX - Tier 2; PA; SP NUTROPIN AQ NUSPIN 20 - Tier 2; PA; SP NOCDURNA - Tier 2; PA; QL NUTROPIN AQ NUSPIN 5 - Tier 2; PA; SP novarel intramuscular solution reconstituted 10000 unit (generic for OMNITROPE - Tier 2; PA; SP NOVAREL) - Tier 1; DX2RX; QL SAIZEN - Tier 2; PA; SP NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT - Tier 2; DX2RX OVIDREL - Tier 2; DX2RX pregnyl (generic for NOVAREL) - Tier 1; DX2RX; QL ZOMACTON - Tier 2; PA; SP ZOMACTON (FOR ZOMA-JET 10) - Tier 2; PA; SP

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones Androgens - Hormone Replacement/Modifying Drugs danazol oral - Tier 1; QL testosterone cypionate intramuscular (generic for DEPO- TESTOSTERONE) - Tier 1; QL testosterone enanthate intramuscular - Tier 1; QL testosterone transdermal gel 12.5 mg/act (1%) (generic for VOGELXO PUMP) - Tier 1; PA; QL testosterone transdermal gel 25 mg/2.5gm (1%), 50 mg/5gm (1%) (generic for ANDROGEL) - Tier 1; PA; QL

Estrogens - Hormone Replacement/Modifying Drugs afirmelle (generic for AFIRMELLE) - Tier 1; QL; GE ACTIVELLA (brand for estradiol-norethindrone acet) - Tier 2; PA; QL altavera (generic for ALTAVERA) - Tier 1; QL; GE ALORA (brand for estradiol) - Tier 2; PA; QL alyacen 1/35 (generic for CYCLAFEM 1/35) - Tier 1; QL; GE ANGELIQ - Tier 2; PA; QL alyacen 7/7/7 (generic for CYCLAFEM 7/7/7) - Tier 1; QL; GE CLIMARA (brand for estradiol) - Tier 2; PA; QL apri (generic for APRI) - Tier 1; QL; GE CLIMARA PRO - Tier 2; PA; QL aranelle - Tier 1; QL; GE COMBIPATCH - Tier 2; PA; QL aubra (generic for AFIRMELLE) - Tier 1; QL; GE DIVIGEL - Tier 2; PA; QL aubra eq (generic for AFIRMELLE) - Tier 1; QL; GE ELESTRIN - Tier 2; PA; QL aurovela 1.5/30 (generic for AUROVELA 1.5/30) - Tier 1; QL; GE ESTRACE (brand for estradiol) - Tier 2; PA; QL aurovela 1/20 (generic for AUROVELA 1/20) - Tier 1; QL; GE estradiol transdermal patch twice weekly (generic for ALORA) - Tier 1; PA; aurovela fe 1.5/30 (generic for AUROVELA FE 1.5/30) - Tier 1; QL; GE QL

Tier 1: Generic; Tier 2: Brand; ^: Medical Office Attestation Needed if Prescribed by Behavioral Health Provider, Full Prior Authorization Needed if Prescribed by Non-Behavioral Health Provider; *: Available without PA for participating Behavioral Health Prescribers; AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Limit; SP: Specialty Medication; ST: Step Therapy 96 Preferred Agents Non-Preferred Agents aurovela fe 1/20 (generic for AUROVELA FE 1/20) - Tier 1; QL; GE estradiol-norethindrone acet oral tablet 1-0.5 mg (generic for MIMVEY) - aviane (generic for AFIRMELLE) - Tier 1; QL; GE Tier 1; PA; QL ayuna (generic for ALTAVERA) - Tier 1; QL; GE ESTRING - Tier 2; PA; QL azurette (generic for AZURETTE) - Tier 1; QL; GE ESTROGEL - Tier 2; PA; QL balziva (generic for BALZIVA) - Tier 1; QL; GE EVAMIST - Tier 2; PA; QL bekyree (generic for AZURETTE) - Tier 1; QL; GE FEMRING - Tier 2; PA; QL blisovi fe 1.5/30 (generic for AUROVELA FE 1.5/30) - Tier 1; QL; GE fyavolv - Tier 1; PA; QL blisovi fe 1/20 (generic for AUROVELA FE 1/20) - Tier 1; QL; GE jinteli - Tier 1; PA; QL briellyn (generic for BALZIVA) - Tier 1; QL; GE MENEST - Tier 2; PA; QL caziant - Tier 1; QL MENOSTAR - Tier 2; PA; QL chateal (generic for ALTAVERA) - Tier 1; QL; GE mimvey (generic for MIMVEY) - Tier 1; PA; QL chateal eq (generic for ALTAVERA) - Tier 1; QL; GE MINIVELLE (brand for estradiol) - Tier 2; PA; QL cryselle-28 - Tier 1; QL; GE PREFEST - Tier 2; PA; QL cyclafem 1/35 (generic for CYCLAFEM 1/35) - Tier 1; QL; GE PREMARIN VAGINAL - Tier 2; PA; QL cyclafem 7/7/7 (generic for CYCLAFEM 7/7/7) - Tier 1; QL; GE VAGIFEM (brand for estradiol) - Tier 2; PA; QL cyred (generic for APRI) - Tier 1; QL; GE VIVELLE-DOT (brand for estradiol) - Tier 2; PA; QL cyred eq (generic for APRI) - Tier 1; QL; GE dasetta 1/35 (generic for CYCLAFEM 1/35) - Tier 1; QL; GE dasetta 7/7/7 (generic for CYCLAFEM 7/7/7) - Tier 1; QL; GE delyla (generic for AFIRMELLE) - Tier 1; QL; GE DEPO-ESTRADIOL - Tier 2; QL desogestrel-ethinyl estradiol (generic for AZURETTE) - Tier 1; QL; GE DUAVEE - Tier 2; QL elinest - Tier 1; QL; GE eluryng (generic for ELURYNG) - Tier 1; QL; GE emoquette (generic for APRI) - Tier 1; QL; GE enpresse-28 (generic for ENPRESSE-28) - Tier 1; QL; GE enskyce (generic for APRI) - Tier 1; QL; GE estarylla (generic for ESTARYLLA) - Tier 1; QL; GE estradiol oral (generic for ESTRACE) - Tier 1; QL estradiol transdermal patch weekly (generic for CLIMARA) - Tier 1; QL estradiol vaginal (generic for ESTRACE) - Tier 1; QL ethynodiol diac-eth estradiol (generic for KELNOR 1/35) - Tier 1; QL; GE etonogestrel-ethinyl estradiol (generic for ELURYNG) - Tier 1; QL; GE

Progestins - Hormone Replacement/Modifying Drugs aftera (generic for AFTERA) - Tier 1; QL; GE DEPO-SUBQ PROVERA 104 - Tier 2; PA; QL camila (generic for CAMILA) - Tier 1; QL; GE deblitane (generic for CAMILA) - Tier 1; QL; GE econtra ez (generic for AFTERA) - Tier 1; QL; GE econtra one-step (generic for AFTERA) - Tier 1; QL; GE errin (generic for CAMILA) - Tier 1; QL; GE heather (generic for CAMILA) - Tier 1; QL; GE incassia (generic for CAMILA) - Tier 1; QL; GE jencycla (generic for CAMILA) - Tier 1; QL; GE levonorgestrel (generic for AFTERA) - Tier 1; QL; GE lyleq (generic for CAMILA) - Tier 1; QL; GE lyza (generic for CAMILA) - Tier 1; QL; GE medroxyprogesterone acetate intramuscular (generic for DEPO- PROVERA) - Tier 1; QL; GE medroxyprogesterone acetate oral (generic for PROVERA) - Tier 1; QL megestrol acetate oral suspension 40 mg/ml - Tier 1; QL megestrol acetate oral tablet 20 mg - Tier 1 megestrol acetate oral tablet 40 mg - Tier 1; QL my choice (generic for AFTERA) - Tier 1; QL; GE my way (generic for AFTERA) - Tier 1; QL; GE new day (generic for AFTERA) - Tier 1; QL; GE nora-be (generic for CAMILA) - Tier 1; QL; GE norethindrone acetate oral (generic for AYGESTIN) - Tier 1; QL norethindrone oral (generic for CAMILA) - Tier 1; QL; GE norlyda (generic for CAMILA) - Tier 1; QL; GE norlyroc (generic for CAMILA) - Tier 1; QL; GE opcicon one-step (generic for AFTERA) - Tier 1; QL; GE option 2 (generic for AFTERA) - Tier 1; QL; GE

Selective Estrogen Receptor Modifying Agents - Hormone Replacement/Modifying Drugs raloxifene hcl (generic for EVISTA) - Tier 1; QL OSPHENA - Tier 2; PA; QL; GE

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Drugs to Replace Thyroid Hormones Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Thyroid Replacement Drugs euthyrox (generic for EUTHYROX) - Tier 1; QL levo-t (generic for EUTHYROX) - Tier 1; QL levothyroxine sodium oral tablet (generic for EUTHYROX) - Tier 1; QL levoxyl (generic for EUTHYROX) - Tier 1; QL liothyronine sodium oral (generic for CYTOMEL) - Tier 1; QL unithroid (generic for EUTHYROX) - Tier 1; QL

Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones Hormonal Agents, Suppressant (Adrenal) - Hormone Suppressants LYSODREN - Tier 2; QL

Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones Antithyroid Agents - Thyroid Suppressing Drugs methimazole oral (generic for TAPAZOLE) - Tier 1; QL propylthiouracil oral - Tier 1; QL

Immunological Agents - Drugs that Stimulate or Suppress the Immune System Angioedema Agents - Drugs to Treat Swelling Underneath the Skin

Immune Suppressants - Immune System Drugs azathioprine oral (generic for IMURAN) - Tier 1; QL ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 1 MG - CIMZIA - Tier 2; PA; SP; QL Tier 2; PA; QL cyclosporine modified (generic for GENGRAF) - Tier 1; QL ORENCIA CLICKJECT - Tier 2; PA; SP; QL cyclosporine oral (generic for SANDIMMUNE) - Tier 1; QL ORENCIA SUBCUTANEOUS - Tier 2; PA; SP; QL ENBREL - Tier 2; PA; SP; QL OTREXUP - Tier 2; PA; QL everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg (generic for RASUVO - Tier 2; PA; QL ZORTRESS) - Tier 1 REDITREX - Tier 2; PA; QL gengraf oral capsule (generic for GENGRAF) - Tier 1; QL SIMPONI - Tier 2; PA; SP; QL HUMIRA PEN-PEDIATRIC UC START - Tier 2; PA; SP; QL SKYRIZI (150 MG DOSE) - Tier 2; PA; SP; QL HUMIRA PEN-PSOR/UVEIT STARTER - Tier 2 STELARA SUBCUTANEOUS - Tier 2; PA; SP; QL HUMIRA SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML, 40 XELJANZ ORAL TABLET - Tier 2; PA; SP; QL MG/0.8ML - Tier 2; PA; SP; QL XELJANZ XR - Tier 2; PA; SP; QL HUMIRA SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML - Tier 2; PA; SP; QL HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML, 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML - Tier 2; PA; SP; QL KINERET - Tier 2; PA; SP; QL methotrexate oral - Tier 1 methotrexate sodium (pf) - Tier 1; QL methotrexate sodium injection - Tier 1; QL methotrexate sodium oral - Tier 1 mycophenolate mofetil oral (generic for CELLCEPT) - Tier 1; QL mycophenolate sodium (generic for MYFORTIC) - Tier 1; QL OLUMIANT - Tier 2; PA; SP; QL sirolimus oral solution (generic for RAPAMUNE) - Tier 1; QL sirolimus oral tablet 0.5 mg, 1 mg (generic for RAPAMUNE) - Tier 1; QL sirolimus oral tablet 2 mg (generic for RAPAMUNE) - Tier 1

Immunomodulators - Immune System Drugs ACTIMMUNE - Tier 2; PA; SP ACTEMRA ACTPEN - Tier 2; PA; SP; QL ILARIS - Tier 2; PA; SP; QL ACTEMRA SUBCUTANEOUS - Tier 2; PA; SP; QL KEVZARA - Tier 2; PA; SP; QL BENLYSTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR - Tier 2; PA; leflunomide oral (generic for ARAVA) - Tier 1; QL SP; QL OTEZLA - Tier 2; PA; SP; QL RINVOQ - Tier 2; PA; SP; QL SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML - Tier 2; PA; SP SYNAGIS INTRAMUSCULAR SOLUTION 50 MG/0.5ML - Tier 2; PA; SP; QL XOLAIR - Tier 2; PA; SP; QL

Vaccines ADACEL - Tier 2; QL BEXSERO - Tier 2; QL BOOSTRIX - Tier 2; QL DAPTACEL - Tier 2; QL DIPHTHERIA-TETANUS TOXOIDS DT - Tier 2; QL ENGERIX-B - Tier 2; QL GARDASIL 9 - Tier 2; QL HAVRIX - Tier 2; QL HEPLISAV-B - Tier 2; QL; AL HYPERTET S/D - Tier 2; QL INFANRIX - Tier 2; QL JANSSEN COVID-19 VACCINE - Tier 2; ST; QL MENACTRA - Tier 2; QL MENQUADFI - Tier 2; QL MENVEO - Tier 2; QL M-M-R II - Tier 2; QL

Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease Aminosalicylates - Inflammatory Bowel Disease Drugs balsalazide disodium (generic for COLAZAL) - Tier 1; QL APRISO (brand for mesalamine er) - Tier 2; PA; QL mesalamine oral capsule delayed release 400 mg (generic for ASACOL HD (brand for mesalamine) - Tier 2; PA; QL DELZICOL) - Tier 1; QL COLAZAL (brand for balsalazide disodium) - Tier 2; PA; QL mesalamine rectal - Tier 1; QL DELZICOL (brand for mesalamine) - Tier 2; PA; QL SFROWASA - Tier 2; QL DIPENTUM - Tier 2; PA; QL LIALDA (brand for mesalamine) - Tier 2; PA; QL PENTASA - Tier 2; PA; QL

Glucocorticoids - Drugs to Treat Inflammation budesonide oral (generic for ENTOCORT EC) - Tier 1; DX2RX; QL CORTIFOAM - Tier 2; PA; QL hydrocortisone (perianal) external cream 2.5 % (generic for PROCTO- PROCTOFOAM HC - Tier 2; PA; QL MED HC) - Tier 1; QL hydrocortisone rectal enema 100 mg/60ml (generic for CORTENEMA) - Tier 1; QL procto-med hc (generic for PROCTO-MED HC) - Tier 1; QL proctozone-hc (generic for PROCTO-MED HC) - Tier 1; QL

Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions Metabolic Bone Disease Agents - Osteoporosis (Bone Loss) Drugs alendronate sodium - Tier 1; QL FORTEO (brand for teriparatide (recombinant)) - Tier 2; PA; SP; QL calcitonin (salmon) nasal (generic for MIACALCIN) - Tier 1; QL TERIPARATIDE (RECOMBINANT) - Tier 2; PA; SP; QL cinacalcet hcl (generic for SENSIPAR) - Tier 1; PA; QL TYMLOS - Tier 2; PA; SP; QL

Metabolic Bone Disease Agents - Other calcitriol oral capsule (generic for ROCALTROL) - Tier 1; QL calcitriol oral solution (generic for ROCALTROL) - Tier 1; Members >= 8 years of age will require PA; QL; AL

Miscellaneous Therapeutic Agents ACCU-CHEK AVIVA DEVICE (brand for glucose control) - Tier 2; QL ACCU-CHEK AVIVA PLUS TEST STRIPS (brand for easy talk blood ACCU-CHEK COMPACT PLUS CONTROL (brand for glucose control) - glucose test) - Tier 2; PA; QL Tier 2; QL ACCU-CHEK COMPACT PLUS (brand for easy talk blood glucose test) - ACCU-CHEK GUIDE CONTROL (brand for glucose control) - Tier 2; QL Tier 2; PA; QL ACCU-CHEK MULTICLIX LANCETS (brand for lancets micro thin 33g) - ACCU-CHEK FASTCLIX LANCET KIT (brand for select-lite device/lancets) Tier 2; QL - Tier 2; PA; QL ACCU-CHEK SMARTVIEW CONTROL (brand for glucose control) - Tier ACCU-CHEK GUIDE TEST STRIPS (brand for ge100 blood glucose 2; QL system) - Tier 2; PA; QL ACCUTREND GLUCOSE CONTROL (brand for glucose control) - Tier ACCU-CHEK MULTICLIX LANCETS (brand for lancets micro thin 33g) - 2; QL Tier 2; PA; QL ALCOHOL PREP PADS PAD - Tier 2; QL ACCU-CHEK SMARTVIEW (brand for easy talk blood glucose test) - Tier 2; ALCOHOL PREP PADS PAD 70 % - Tier 2; QL PA; QL antifungal external powder (generic for DESENEX) - Tier 1; QL ACCU-CHEK SOFTCLIX LANCET DEVICE KIT (brand for select-lite device/lancets) - Tier 2; PA; QL

Tier 1: Generic; Tier 2: Brand; ^: Medical Office Attestation Needed if Prescribed by Behavioral Health Provider, Full Prior Authorization Needed if Prescribed by Non-Behavioral Health Provider; *: Available without PA for participating Behavioral Health Prescribers; AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Limit; SP: Specialty Medication; ST: Step Therapy 107 Preferred Agents Non-Preferred Agents anti-fungal external powder (generic for ODOR EATERS ANTIFUNGAL) AJOVY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE - Tier 2; PA; - Tier 1; QL QL athletes foot (generic for DESENEX) - Tier 1; QL CONTOUR NEXT TEST STRIPS (brand for easy talk blood glucose test) - BD AUTOSHIELD DUO PEN NEEDLES (brand for pen needles) - Tier Tier 2; PA; QL 2; QL CONTOUR TEST STRIPS (brand for easy talk blood glucose test) - Tier 2; BD ULTRA-FINE INSULIN SYRINGES - Tier 2; QL PA; QL BD ULTRA-FINE PEN NEEDLES (brand for gnp ulticare pen needles) - FREESTYLE PRECISION NEO TEST (brand for easy talk blood glucose Tier 2; QL test) - Tier 2; PA; QL CARETOUCH CONTROL SOL LEVEL 2 (brand for glucose control) - INSULIN PEN NEEDLES 30G X 8 MM (brand for pen needles) - Tier 2; PA; Tier 2; QL QL CAYA - Tier 2; QL INSULIN PEN NEEDLES 32G X 4 MM (brand for drug mart unifine pentips) CHEMSTRIP 10 MD - Tier 2; QL - Tier 2; PA; QL CHEMSTRIP 10/SG - Tier 2; QL INSULIN PEN NEEDLES 32G X 6 MM (brand for gnp ulticare pen needles) CHEMSTRIP 2 GP - Tier 2; QL - Tier 2; PA; QL CHEMSTRIP 5 OB - Tier 2; QL NOVOTWIST PEN NEEDLE (brand for true comfort pro pen needles) - Tier CHEMSTRIP 7 - Tier 2; QL 2; PA; QL CHEMSTRIP 9 - Tier 2; QL ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE (brand for ge100 CHEMSTRIP K (brand for ketone test) - Tier 2; QL blood glucose system) - Tier 2; PA; QL CHEMSTRIP UGK - Tier 2; QL ONETOUCH VERIO REFLECT KIT W/DEVICE (brand for ge100 blood CONDOMS - Tier 2; QL glucose system) - Tier 2; PA; QL COOL MIST HUMIDIFER - Tier 2; QL PRECISION LINK (brand for ge100 blood glucose system) - Tier 2; PA; QL DESENEX EXTERNAL POWDER (brand for gnp miconazorb af) - Tier PRECISION PCX PLUS TEST (brand for easy talk blood glucose test) - 2; QL Tier 2; PA; QL EASIVENT (brand for eq space chamber anti-static m) - Tier 2; QL PRECISION POINT OF CARE TEST (brand for easy talk blood glucose EASIVENT MASK LARGE (brand for eq space chamber anti-static m) - test) - Tier 2; PA; QL Tier 2; QL PRECISION QID MONITOR (brand for pro voice v9 glucose system) - Tier EASIVENT MASK MEDIUM (brand for eq space chamber anti-static m) 2; PA; QL - Tier 2; QL PRECISION QID TEST (brand for easy talk blood glucose test) - Tier 2; PA; EASIVENT MASK SMALL (brand for eq space chamber anti-static m) - QL Tier 2; QL PRECISION SOF-TACT MONITOR (brand for pro voice v9 glucose EASYMAX 15 LEVEL 2 CONTROL (brand for glucose control) - Tier 2; system) - Tier 2; PA; QL QL PRECISION XTRA BLOOD GLUCOSE (brand for easy talk blood glucose EASYMAX 15 LEVEL 2-3 CONTROL (brand for glucose control) - Tier test) - Tier 2; PA; QL 2; QL

Ophthalmic Agents - Drugs to Treat Eye Conditions Ophthalmic Agents, Other - Miscellaneous Eye Drugs ak-poly-bac (generic for POLYCIN) - Tier 1; QL CEQUA - Tier 2; PA; QL altachlore (generic for ALTACHLORE) - Tier 1; QL RESTASIS - Tier 2; PA; QL altafrin (generic for ALTAFRIN) - Tier 1; QL RESTASIS MULTIDOSE - Tier 2; PA; QL altalube (generic for ALTALUBE) - Tier 1; QL TOBRADEX ST - Tier 2; PA; QL artificial eye (generic for ALTALUBE) - Tier 1; QL ZYLET - Tier 2; PA; QL artificial tears ophthalmic ointment (generic for ALTALUBE) - Tier 1; QL artificial tears ophthalmic solution (generic for GENTEAL TEARS) - Tier 1; QL artificial tears ophthalmic solution 1.4 % - Tier 1; QL astringent eye drops (generic for VISINE-AC) - Tier 1; QL atropine sulfate ophthalmic ointment - Tier 1; QL atropine sulfate ophthalmic solution 1 % (generic for ISOPTO ATROPINE) - Tier 1; QL bacitracin-polymyxin b ophthalmic (generic for POLYCIN) - Tier 1; QL

Ophthalmic Anti-allergy Agents - Allergy, Infection and Inflammation Drugs azelastine hcl ophthalmic - Tier 1; ST; QL cromolyn sodium ophthalmic - Tier 1; QL eye drops ophthalmic solution 0.05 % (generic for VISINE RED EYE COMFORT) - Tier 1; QL NAPHCON-A (brand for eye allergy relief) - Tier 2; QL olopatadine hcl ophthalmic (generic for PATADAY) - Tier 1; QL PATADAY OPHTHALMIC SOLUTION 0.1 % (brand for gnp olopatadine hcl) - Tier 2; QL PATADAY OPHTHALMIC SOLUTION 0.2 % (brand for olopatadine hcl) - Tier 2; QL redness relief ophthalmic solution 0.012-0.2 % (generic for CLEAR EYES REDNESS RELIEF) - Tier 1; QL VASOCLEAR-A - Tier 2; QL VISINE (brand for eye allergy relief) - Tier 2; QL

Ophthalmic Antibiotics - Drugs to treat Eye Infections

Ophthalmic Antiglaucoma Agents - Glaucoma Drugs acetazolamide er - Tier 1; QL ALPHAGAN P (brand for brimonidine tartrate) - Tier 2; PA; QL acetazolamide oral - Tier 1; QL AZOPT (brand for brinzolamide) - Tier 2; PA; QL apraclonidine hcl - Tier 1; QL BETIMOL - Tier 2; PA; QL betaxolol hcl ophthalmic - Tier 1; QL BETOPTIC-S - Tier 2; PA; QL brimonidine tartrate ophthalmic - Tier 1; QL COMBIGAN - Tier 2; PA; QL carteolol hcl - Tier 1; QL COSOPT (brand for dorzolamide hcl-timolol mal) - Tier 2; PA; QL DORZOLAMIDE HCL SOLUTION 2 % OPHTHALMIC - Tier 2; QL COSOPT PF (brand for dorzolamide hcl-timolol mal pf) - Tier 2; PA; QL dorzolamide hcl solution 2 % ophthalmic (generic for TRUSOPT) - Tier ISTALOL (brand for timolol maleate) - Tier 2; PA; QL 1; QL SIMBRINZA - Tier 2; PA; QL dorzolamide hcl-timolol mal (generic for COSOPT) - Tier 1; QL TIMOPTIC (brand for timolol maleate) - Tier 2; PA; QL levobunolol hcl - Tier 1; QL TIMOPTIC-XE (brand for timolol maleate) - Tier 2; PA; QL pilocarpine hcl ophthalmic (generic for ISOPTO CARPINE) - Tier 1; QL TRUSOPT (brand for dorzolamide hcl) - Tier 2; PA; QL timolol maleate ophthalmic solution 0.25 %, 0.5 % (generic for TIMOPTIC) - Tier 1; QL

Ophthalmic Anti-Inflammatories - Allergy, Infection and Inflammation Drugs ALAWAY (brand for hm eye itch relief) - Tier 2; QL ACULAR LS (brand for ketorolac tromethamine) - Tier 2; PA; QL ALAWAY CHILDRENS ALLERGY (brand for hm eye itch relief) - Tier 2; ACUVAIL - Tier 2; PA; QL QL ILEVRO - Tier 2; PA; QL allergy eye drops (generic for ALAWAY) - Tier 1; QL NEVANAC - Tier 2; PA; QL CLARITIN EYE (brand for hm eye itch relief) - Tier 2; QL PROLENSA - Tier 2; PA; QL dexamethasone sodium phosphate ophthalmic - Tier 1; QL

Ophthalmic Prostaglandin and Prostamide Analogs - Glaucoma Drugs latanoprost ophthalmic (generic for XALATAN) - Tier 1; QL LUMIGAN - Tier 2; PA; QL TRAVATAN Z (brand for travoprost (bak free)) - Tier 2; PA; QL XALATAN (brand for latanoprost) - Tier 2; PA; QL ZIOPTAN - Tier 2; PA; QL

Otic Agents - Drugs to Treat Ear Conditions ofloxacin otic - Tier 1; QL

Otic Agents - Drugs for the Ear acetic acid otic - Tier 1; QL ciprofloxacin-dexamethasone (generic for CIPRODEX) - Tier 1; DX2RX; QL CLEARCANAL EARWAX SOFTENER (brand for earwax removal) - Tier 2; QL

Regulators - Drugs to Regulate Blood Sugar Insulins - Diabetic Drugs LYUMJEV - Tier 2; PA; QL

Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions Antihistamines - Allergy Drugs

Antihistamines - Drugs to Treat Allergies ALAVERT (brand for qc allergy relief) - Tier 2; QL all day allergy oral tablet 10 mg (generic for KLS ALLER-TEC) - Tier 1; QL allerclear (generic for KLS ALLERCLEAR) - Tier 1; QL allergy 24hour indoor/outdoor (generic for KLS ALLER-TEC) - Tier 1; QL allergy childrens (generic for RA DIPHEDRYL ALLERGY) - Tier 1; QL allergy medication (generic for BANOPHEN) - Tier 1; QL allergy oral capsule 25 mg (generic for BANOPHEN) - Tier 1; QL allergy oral liquid 12.5 mg/5ml (generic for RA DIPHEDRYL ALLERGY) - Tier 1; QL allergy oral tablet 25 mg (generic for BANOPHEN) - Tier 1; QL allergy rel child (loratadine) (generic for CLARITIN ALLERGY CHILDRENS) - Tier 1; QL allergy relief (cetirizine) oral tablet 10 mg (generic for KLS ALLER-TEC) - Tier 1; QL allergy relief adult (generic for RA DIPHEDRYL ALLERGY) - Tier 1; QL allergy relief cetirizine (generic for KLS ALLER-TEC) - Tier 1; QL allergy relief child (generic for CLARITIN ALLERGY CHILDRENS) - Tier 1; QL allergy relief childrens oral liquid 12.5 mg/5ml (generic for RA DIPHEDRYL ALLERGY) - Tier 1; QL

Anti-Inflammatories, Inhaled Corticosteroids - Asthma/Lung Drugs 24 hour nasal allergy (generic for KLS ALLER-CORT) - Tier 1; QL ALVESCO - Tier 2; PA; QL aller-cort (generic for KLS ALLER-CORT) - Tier 1; QL ASMANEX (120 METERED DOSES) - Tier 2; PA; QL allergy spray 24 hour nasal aerosol (generic for KLS ALLER-CORT) - ASMANEX (14 METERED DOSES) - Tier 2; PA; QL Tier 1; QL ASMANEX (30 METERED DOSES) - Tier 2; PA; QL ARNUITY ELLIPTA - Tier 2; QL ASMANEX (60 METERED DOSES) - Tier 2; PA; QL ASMANEX HFA - Tier 2; Members >= 8 years of age will require PA; ASMANEX (7 METERED DOSES) - Tier 2; PA; QL QL; AL FLOVENT DISKUS - Tier 2; PA; QL budesonide inhalation (generic for PULMICORT) - Tier 1; Members >= 5 FLOVENT HFA - Tier 2; PA; QL years of age will require PA; QL; AL OMNARIS - Tier 2; PA; QL fluticasone propionate nasal (generic for CLARISPRAY) - Tier 1; QL PULMICORT FLEXHALER - Tier 2; PA; QL NASACORT ALLERGY 24HR (brand for eq nasal allergy) - Tier 2; QL ZETONNA - Tier 2; PA; QL NASACORT ALLERGY 24HR CHILDREN (brand for eq nasal allergy) - Tier 2; QL nasal allergy 24 hour (generic for KLS ALLER-CORT) - Tier 1; QL nasal allergy nasal aerosol 55 mcg/act (generic for KLS ALLER-CORT) - Tier 1; QL nasal allergy spray (generic for KLS ALLER-CORT) - Tier 1; QL QVAR REDIHALER - Tier 2; QL

Antileukotrienes - Asthma/Lung Drugs montelukast sodium oral (generic for SINGULAIR) - Tier 1; QL

Bronchodilators, Anticholinergic - Asthma/Lung Drugs ATROVENT HFA - Tier 2; QL SPIRIVA HANDIHALER - Tier 2; PA; QL INCRUSE ELLIPTA - Tier 2; QL SPIRIVA RESPIMAT - Tier 2; PA; QL ipratropium bromide inhalation - Tier 1; QL TUDORZA PRESSAIR - Tier 2; PA; QL ipratropium bromide nasal - Tier 1; QL

Bronchodilators, Sympathomimetic - Asthma/Lung Drugs albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation AUVI-Q (brand for epinephrine) - Tier 2; PA; QL (generic for PROAIR HFA) - Tier 1; QL BROVANA (brand for arformoterol tartrate) - Tier 2; PA; QL ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) EPIPEN 2-PAK (brand for epinephrine) - Tier 2; PA; QL MCG/ACT INHALATION - Tier 2; QL EPIPEN JR 2-PAK (brand for epinephrine) - Tier 2; PA; QL albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, PERFOROMIST (brand for formoterol fumarate) - Tier 2; PA; QL 2.5 mg/0.5ml - Tier 1; QL PROAIR HFA (brand for albuterol sulfate hfa) - Tier 2; PA; QL albuterol sulfate inhalation nebulization solution 0.63 mg/3ml, 1.25 PROVENTIL HFA (brand for albuterol sulfate hfa) - Tier 2; PA; QL mg/3ml - Tier 1; Members >= 8 years of age will require PA; QL; AL SEREVENT DISKUS - Tier 2; PA; QL ALBUTEROL SULFATE NEBULIZATION SOLUTION (5 MG/ML) 0.5% VENTOLIN HFA (brand for albuterol sulfate hfa) - Tier 2; PA; QL INHALATION - Tier 2; QL XOPENEX HFA (brand for levalbuterol tartrate) - Tier 2; PA; QL albuterol sulfate nebulization solution (5 mg/ml) 0.5% inhalation - Tier 1; QL albuterol sulfate oral syrup - Tier 1; QL epinephrine injection solution auto-injector (generic for AUVI-Q) - Tier 1; QL levalbuterol hcl inhalation (generic for XOPENEX) - Tier 1; ST; QL STRIVERDI RESPIMAT - Tier 2; QL SYMJEPI - Tier 2; QL

Cystic Fibrosis Agents - Drugs to treat Cystic Fibrosis CAYSTON - Tier 2; DX2RX; SP; QL BETHKIS (brand for tobramycin) - Tier 2; DX2RX; SP; QL KALYDECO - Tier 2; PA; SP; QL KITABIS PAK (brand for tobramycin) - Tier 2; PA; SP; QL ORKAMBI - Tier 2; PA; SP; QL TOBI NEBULIZER (brand for tobramycin) - Tier 2; PA; SP; QL SYMDEKO - Tier 2; PA; SP; QL TOBI PODHALER - Tier 2; PA; SP; QL tobramycin inhalation nebulization solution 300 mg/4ml (generic for tobramycin nebulization solution 300 mg/5ml inhalation (generic for BETHKIS) - Tier 1; DX2RX; SP; QL KITABIS PAK) - Tier 1; PA; SP; QL TRIKAFTA ORAL TABLET THERAPY PACK 100-50-75 & 150 MG - TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION - Tier 2; PA; SP; QL Tier 2; PA; SP; QL

Mast Cell Stabilizers - Drugs for the Lungs

Phosphodiesterase Inhibitors, Airways Disease - Drugs for the Lungs ELIXOPHYLLIN - Tier 2; QL THEO-24 - Tier 2 theophylline - Tier 1; QL theophylline er oral tablet extended release 12 hour 300 mg - Tier 1; QL theophylline er oral tablet extended release 12 hour 450 mg - Tier 1 theophylline er oral tablet extended release 24 hour 400 mg - Tier 1; QL theophylline er oral tablet extended release 24 hour 600 mg - Tier 1

Pulmonary Antihypertensives - Asthma/Lung Drugs ADEMPAS - Tier 2; DX2RX; SP; QL LETAIRIS (brand for ambrisentan) - Tier 2; DX2RX; SP; QL ambrisentan (generic for LETAIRIS) - Tier 1; DX2RX; SP; QL tadalafil (pah) (generic for ADCIRCA) - Tier 1; PA; SP; QL bosentan (generic for TRACLEER) - Tier 1; DX2RX; SP; QL TRACLEER (brand for bosentan) - Tier 2; DX2RX; SP; QL OPSUMIT - Tier 2; DX2RX; SP; QL sildenafil citrate oral suspension reconstituted (generic for REVATIO) - Tier 1; DX2RX; SP; QL sildenafil citrate oral tablet 20 mg (generic for REVATIO) - Tier 1; DX2RX; SP; QL

Pulmonary Fibrosis Agents - Drugs to treat Pulmonary Fibrosis ESBRIET - Tier 2; PA; SP; QL OFEV - Tier 2; PA; SP; QL

Respiratory Tract Agents, Other - Asthma/Lung Drugs 12 hour allergy-d (generic for KLS ALLER-TEC D) - Tier 1; QL; AL ADVAIR DISKUS (brand for fluticasone-salmeterol) - Tier 2; PA; QL

Skeletal Muscle Relaxants - Drugs to Treat Muscle Tension and Spasm Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm baclofen oral - Tier 1; QL chlorzoxazone oral tablet 500 mg - Tier 1; QL cyclobenzaprine hcl oral tablet 10 mg, 5 mg - Tier 1; QL dantrolene sodium oral - Tier 1; QL methocarbamol oral - Tier 1; QL orphenadrine citrate er - Tier 1; QL tizanidine hcl oral tablet - Tier 1; QL

Sleep Disorder Agents - Drugs for Sedation and Sleep GABA Receptor Modulators - Drugs for Sleeping temazepam oral capsule 15 mg, 30 mg (generic for RESTORIL) - Tier 1; AMBIEN (brand for zolpidem tartrate) - Tier 2; PA; QL QL AMBIEN CR (brand for zolpidem tartrate er) - Tier 2; PA zaleplon - Tier 1; QL LUNESTA ORAL TABLET 1 MG (brand for eszopiclone) - Tier 2; PA; QL zolpidem tartrate oral (generic for AMBIEN) - Tier 1; QL LUNESTA ORAL TABLET 2 MG, 3 MG (brand for eszopiclone) - Tier 2; PA zolpidem tartrate sublingual - Tier 1; PA; QL

Sleep Disorders, Other - Drugs for Sleeping

Therapeutic Nutrients/Minerals/Electrolytes - Drugs to Treat Vitamin, Mineral and Body Fluid Deficiencies Electrolyte/Mineral Replacement - Vitamin, Mineral and Body Fluid Deficiency Drugs prenatal gummy oral tablet chewable 0.4-25 mg (generic for ALIVE PRENATAL) - Tier 1; QL

Title Drugs Impacted Prior Authorization Criteria / Class Criteria

1 abiraterone acetate ...... acetaminophen oral liquid 500 mg/15ml ...... 12 hour allergy-d ...... ABREVA ...... acetaminophen oral solution 160 mg/5ml, 12 hour decongestant nasal ...... ABSORICA ...... 325 mg/10.15ml, 650 mg/20.3ml ...... 12 hour decongestant oral ...... ABSORICA LD ...... acetaminophen oral suspension 160 12 hour mucus relief oral tablet extended acamprosate calcium ...... mg/5ml, 650 mg/20.3ml ...... release 12 hour 1200 mg ...... ACANYA ...... acetaminophen oral tablet 325 mg ...... 12 hour nasal decongestant ...... acarbose oral ...... acetaminophen oral tablet 500 mg ...... 12 hour nasal decongestant nasal ...... ACCU-CHEK AVIVA DEVICE ...... acetaminophen oral tablet chewable 160 mg 12 hour nasal relief spray ...... ACCU-CHEK AVIVA PLUS TEST STRIPS .. acetaminophen rectal suppository 120 mg .... 12 hour nasal spray ...... ACCU-CHEK COMPACT PLUS ...... acetaminophen rectal suppository 650 mg .... 2 ACCU-CHEK COMPACT PLUS CONTROL. acetaminophen-codeine ...... 24 hour nasal allergy ...... ACCU-CHEK FASTCLIX LANCET KIT...... acetaminophen-codeine #2 ...... 3 ACCU-CHEK GUIDE CONTROL ...... acetaminophen-codeine #3 ...... 3 day ...... ACCU-CHEK GUIDE TEST STRIPS ...... acetaminophen-codeine #4 ...... 3 day vaginal ...... ACCU-CHEK MULTICLIX LANCETS ...... , acetazolamide er ...... 3-day vaginal vaginal cream 2 % ...... ACCU-CHEK SMARTVIEW ...... acetazolamide oral ...... 4 ACCU-CHEK SMARTVIEW CONTROL ...... acetic acid otic ...... 4-WAY FAST ACTING ...... ACCU-CHEK SOFTCLIX LANCET DEVICE acetylcysteine inhalation ...... 4-WAY MENTHOL ...... KIT ...... acid controller ...... 7 accutane ...... acid gone ...... 7T LIDO ...... ACCUTREND GLUCOSE CONTROL ...... acid reducer oral capsule delayed release 8 acebutolol hcl oral ...... 20.6 (20 base) mg...... 8 hour arthritis pain reliever...... acetaminophen 8 hour ...... acid reducer oral tablet 10 mg ...... 8 hour arthritis relief ...... acetaminophen 8 hours ...... acid reducer oral tablet 200 mg ...... 8 hour pain relief oral tablet extended acetaminophen 8hr arth pain ...... acidophilus lactobacillus oral ...... release 650 mg ...... acetaminophen 8hr musc ache ...... acidophilus oral capsule , 10 mg ...... 8 hour pain reliever ...... acetaminophen childrens ...... acidophilus probiotic oral capsule 10 mg ...... 8 hr arthritis pain relief ...... acetaminophen childrens oral suspension acidophilus probiotic oral tablet , 0.5 mg ...... 8hr arthritis pain relief ...... 160 mg/5ml ...... acidophilus/l-sporogenes ...... 8hr muscle aches & pain ...... acetaminophen childrens oral tablet ACIPHEX ...... A chewable 160 mg ...... acitretin ...... a-25 ...... acetaminophen er ...... acne ...... abacavir sulfate ...... acetaminophen ex st oral liquid 500 mg/15ml acne control cleanser ...... abacavir sulfate-lamivudine ...... acne medication 10 external lotion ...... abacavir-lamivudine-zidovudine ...... acetaminophen ex st oral tablet 500 mg ...... acne medication 5 external lotion ...... abatinex ...... acetaminophen extra strength ...... ACTEMRA ACTPEN ...... ABILIFY ...... acetaminophen infants oral suspension 160 ACTEMRA SUBCUTANEOUS ...... ABILIFY MAINTENA ...... mg/5ml ...... ACTIMMUNE ......

142 ACTIVELLA ...... AJOVY SUBCUTANEOUS SOLUTION all day allergy-d oral tablet extended release ACULAR LS ...... PREFILLED SYRINGE ...... 12 hour 5-120 mg ...... ACUVAIL ...... ak-poly-bac ...... all day pain relief ...... acyclovir oral ...... AKYNZEO ORAL ...... all day relief ...... ACZONE EXTERNAL GEL 7.5 % ...... ala-cort ...... allerclear ...... ADACEL ...... ALAVERT ...... allerclear d-12hr ...... adc/f (0.5mg/ml) ...... ALAVERT ALLERGY/SINUS ...... allerclear d-24hr ...... addaprin ...... ALAWAY ...... aller-cort ...... ADEMPAS ...... ALAWAY CHILDRENS ALLERGY ...... allergy & congestion ...... ADLYXIN ...... albendazole oral ...... allergy 24hour indoor/outdoor ...... ADLYXIN STARTER PACK ...... albuterol sulfate hfa aerosol solution 108 (90 allergy childrens ...... ADMELOG ...... base) mcg/act inhalation ...... allergy complete-d ...... ADMELOG SOLOSTAR...... ALBUTEROL SULFATE HFA AEROSOL allergy eye drops ...... adult 50+ probiotic ...... SOLUTION 108 (90 BASE) MCG/ACT allergy medication ...... adult probiotic ...... INHALATION ...... allergy oral capsule 25 mg ...... adult tussin cough & chest ...... albuterol sulfate inhalation nebulization allergy oral liquid 12.5 mg/5ml ...... adv acne spot treatment ...... solution (2.5 mg/3ml) 0.083%, 2.5 allergy oral tablet 25 mg ...... ADVAIR DISKUS ...... mg/0.5ml ...... allergy oral tablet extended release 12 mg .... ADVAIR HFA ...... albuterol sulfate inhalation nebulization allergy rel child (loratadine) ...... advanced antacid max st ...... solution 0.63 mg/3ml, 1.25 mg/3ml ...... allergy relief (cetirizine) oral tablet 10 mg ...... advanced healing external ointment ...... albuterol sulfate nebulization solution (5 allergy relief adult ...... ADVIL COLD/SINUS ...... mg/ml) 0.5% inhalation ...... allergy relief cetirizine ...... ADVIL JUNIOR STRENGTH ...... ALBUTEROL SULFATE NEBULIZATION allergy relief child ...... ADVIL ORAL TABLET ...... SOLUTION (5 MG/ML) 0.5% allergy relief childrens oral liquid 12.5 ADZENYS XR-ODT ...... INHALATION ...... mg/5ml ...... AFINITOR DISPERZ ...... albuterol sulfate oral syrup ...... allergy relief childrens oral syrup 5 mg/5ml ... AFINITOR ORAL TABLET 10 MG ...... alclometasone dipropionate external allergy relief d oral tablet extended release afirmelle ...... ointment ...... 12 hour ...... AFREZZA ...... ALCOHOL PREP PADS PAD ...... allergy relief d-12 ...... AFRIN NODRIP ORIGINAL ...... ALCOHOL PREP PADS PAD 70 % ...... allergy relief d-24 ...... AFRIN SALINE NASAL MIST ...... ALDARA ...... allergy relief oral capsule 25 mg ...... AFRIN SINUS ...... ALECENSA ...... allergy relief oral liquid 12.5 mg/5ml, 25 aftera ...... alendronate sodium ...... mg/10ml ...... AIMOVIG ...... ALEVE ORAL TABLET ...... allergy relief oral tablet 10 mg ...... AIRDUO RESPICLICK 113/14 ...... alfuzosin hcl er ...... allergy relief oral tablet 25 mg ...... AIRDUO RESPICLICK 232/14 ...... ALINIA ORAL SUSPENSION allergy relief oral tablet chewable 12.5 mg .... AIRDUO RESPICLICK 55/14 ...... RECONSTITUTED ...... allergy relief oral tablet dispersible 10 mg ..... AJOVY SUBCUTANEOUS SOLUTION all day allergy d ...... allergy relief oral tablet extended release 12 AUTO-INJECTOR ...... all day allergy d-12 ...... hour 5-120 mg ...... all day allergy oral tablet 10 mg ......

143 allergy relief oral tablet extended release 12 ALVESCO ...... ANORO ELLIPTA ...... mg ...... alyacen 1/35 ...... antacid & anti-gas oral suspension 200-200- allergy relief(cetirizine) ...... alyacen 7/7/7 ...... 20 mg/5ml ...... allergy relief/indoor/outdoor oral tablet 10 mg amantadine hcl oral capsule ...... antacid & anti-gas oral suspension 400-400- ...... amantadine hcl oral syrup ...... 40 mg/5ml ...... allergy relief/nasal decong ...... AMBIEN ...... antacid & gas relief ...... allergy relief/nasal decongest oral tablet AMBIEN CR ...... antacid advanced ...... extended release 12 hour ...... ambrisentan ...... antacid advanced max st ...... allergy relief/nasal decongest oral tablet amcinonide external ointment ...... antacid anti-gas ...... extended release 24 hour ...... amiloride hcl oral ...... antacid anti-gas ex st oral suspension 400- allergy relief-d oral tablet extended release amiloride-hydrochlorothiazide ...... 400-40 mg/5ml ...... 12 hour 5-120 mg ...... , aminocaproic acid oral ...... antacid anti-gas max strength ...... allergy relief-d oral tablet extended release amiodarone hcl oral tablet 200 mg, 400 mg . antacid anti-gas reg strength ...... 24 hour 10-240 mg ...... AMITIZA ...... antacid calcium ...... allergy relief-d12 ...... amitriptyline hcl oral ...... antacid calcium rich ...... allergy spray 24 hour nasal aerosol ...... amlodipine besylate oral ...... antacid extra ...... allergy/congestion relief ...... ammonium lactate external ...... antacid extra strength oral suspension ...... aller-tec ...... amnesteem ...... antacid extra strength oral tablet chewable aller-tec d ...... amoxapine ...... 160-105 mg...... allopurinol oral ...... amoxicillin oral capsule ...... antacid extra strength oral tablet chewable almacone double strength ...... amoxicillin oral suspension reconstituted ..... 750 mg ...... ALOE VESTA CLEAR ANTIFUNGAL ...... amoxicillin oral tablet 875 mg ...... antacid fast relief ...... ALOGLIPTIN BENZOATE...... amoxicillin oral tablet chewable ...... antacid i ...... ALOGLIPTIN-METFORMIN HCL ...... amoxicillin-potassium clavulanate oral ...... antacid iii ...... ALOGLIPTIN-PIOGLITAZONE ...... amphetamine-dextroamphetamine ...... antacid kids ...... ALORA ...... amphetamine-dextroamphetamine er ...... antacid liquid ...... ALPHAGAN P ...... ampicillin ...... antacid m ...... alprazolam oral tablet ...... ampicillin-sulbactam sodium solution antacid maximum ...... altachlore ...... reconstituted 3 (2-1) gm injection ...... antacid maximum strength ...... altafrin ...... AMPYRA ...... antacid maximum strength oral tablet altalube ...... AMZEEQ ...... chewable 1000 mg ...... altamist spray ...... anagrelide hcl ...... antacid oral suspension 200-200-20 mg/5ml, altarussin ...... ANASPAZ ...... 400-400-40 mg/10ml...... altarussin dm ...... anastrozole oral ...... antacid oral tablet chewable 1000 mg ...... altarussin-pe ...... anecream external cream ...... antacid oral tablet chewable 500 mg ...... altavera ...... anefrin spray ...... antacid oral tablet chewable 750 mg ...... alum & mag hydroxide-simeth...... ANGELIQ ...... antacid plus antigas ...... alum sulfate-ca acetate ...... animal shapes complete ...... antacid plus anti-gas relief ...... alumina-magnesia-simethicone ...... animal shapes kids first ...... antacid regular strength oral suspension ...... ALUNBRIG ...... animal shapes/iron ...... antacid regular strength oral tablet chewable

144 antacid supreme ...... aranelle ...... aspirin ec oral tablet 325 mg ...... antacid ultra strength oral tablet chewable ARANESP (ALBUMIN FREE) INJECTION aspirin oral ...... 1000 mg ...... SOLUTION ...... ASPIRIN ORAL TABLET DELAYED antacid/anti-gas ...... ARANESP (ALBUMIN FREE) INJECTION RELEASE 81 MG ...... antacid/anti-gas max st ...... SOLUTION PREFILLED SYRINGE 10 aspirin rectal ...... antacid/antigas oral suspension 200-200-20 MCG/0.4ML ...... astringent eye drops ...... mg/5ml ...... ARANESP (ALBUMIN FREE) INJECTION astringent solution ...... antacid/gas relief max st ...... SOLUTION PREFILLED SYRINGE 100 ATABEX OB ...... antibiotic ...... MCG/0.5ML, 150 MCG/0.3ML, 200 atazanavir sulfate ...... anti-diarr/ant-gas ...... MCG/0.4ML, 25 MCG/0.42ML, 300 atenolol oral ...... anti-diarrheal anti-gas ...... MCG/0.6ML, 40 MCG/0.4ML, 500 atenolol-chlorthalidone ...... anti-diarrheal oral liquid 1 mg/5ml ...... MCG/ML, 60 MCG/0.3ML ...... atheletes foot ...... anti-diarrheal oral suspension 262 mg/15ml . aripiprazole oral solution ...... athletes foot ...... anti-diarrheal oral tablet 2 mg ...... aripiprazole oral tablet ...... athletes foot (terbinafine) ...... antifungal (tolnaftate) ...... aripiprazole oral tablet dispersible ...... athletes foot (tolnaftate) external aerosol antifungal external cream ...... ARISTADA ...... powder 1 % ...... antifungal external powder ...... ARISTADA INITIO ...... athletes foot (tolnaftate) external cream 1 % . anti-fungal external powder ...... armodafinil ...... athletes foot external aerosol powder 2 % .... antifungal foot care ...... ARNUITY ELLIPTA ...... athletes foot external cream 1 % ...... antifungal miconazole ...... arthritis pain oral tablet extended release athletes foot powder spray ...... antifungal tolnaftate ...... 650 mg ...... athletes foot spray ...... anti-gas oral capsule 180 mg ...... arthritis pain relief oral tablet extended athletes foot spray external aerosol 2 % ...... anti-hist allergy ...... release 650 mg ...... atomoxetine hcl ...... anti-nausea ...... arthritis pain reliever oral ...... atorvastatin calcium oral ...... antiseptic ...... arthritis pain relieving ...... atovaquone oral ...... apap-caff-dihydrocodeine oral capsule ...... artificial eye ...... ATRALIN ...... APIDRA SOLOSTAR ...... artificial tears ophthalmic ointment ...... ATRIPLA ...... APIDRA VIAL ...... artificial tears ophthalmic solution ...... atropine sulfate ophthalmic ointment ...... apra ...... artificial tears ophthalmic solution 1.4 % ...... atropine sulfate ophthalmic solution 1 % ...... apraclonidine hcl ...... ASACOL HD ...... ATROVENT HFA ...... aprepitant ...... ascomp-codeine ...... AUBAGIO ...... apri ...... ascorbic acid oral tablet 500 mg ...... aubra ...... APRISO ...... ASMANEX (120 METERED DOSES) ...... aubra eq ...... aprodine ...... ASMANEX (14 METERED DOSES) ...... aurodryl allergy childrens ...... APTENSIO XR ...... ASMANEX (30 METERED DOSES) ...... aurophen childrens ...... APTIOM ...... ASMANEX (60 METERED DOSES) ...... aurovela 1.5/30 ...... APTIVUS ...... ASMANEX (7 METERED DOSES) ...... aurovela 1/20 ...... AQUADEKS ...... ASMANEX HFA ...... aurovela fe 1.5/30 ...... aqueous vitamin d ...... aspirin childrens ...... aurovela fe 1/20 ...... ARAKODA ...... aspirin ec ...... AURYXIA ......

145 AUSTEDO ...... balziva ...... betamethasone dipropionate external AUVI-Q ...... banophen oral capsule 25 mg ...... ointment ...... AVAR-E EMOLLIENT ...... banophen oral tablet ...... betamethasone valerate external cream ...... AVAR-E GREEN ...... BAQSIMI ONE PACK ...... betamethasone valerate external lotion ...... aviane ...... BAQSIMI TWO PACK ...... betamethasone valerate external ointment ... AVITA EXTERNAL CREAM ...... BARACLUDE ORAL SOLUTION ...... BETAPACE ...... AVONEX PEN ...... BASAGLAR KWIKPEN ...... BETAPACE AF ...... AVONEX PREFILLED...... BAYER ASPIRIN ...... BETASERON ...... AYR ...... b-complex oral tablet ...... betatemp childrens ...... AYR NASAL MIST ALLERGY/SINUS ...... b-complex with b-12 ...... betaxolol hcl ophthalmic ...... AYR SALINE NASAL DROPS ...... b-complex/b-12 oral ...... betaxolol hcl oral ...... ayuna ...... BD AUTOSHIELD DUO PEN NEEDLES ...... bethanechol chloride oral ...... AZASITE ...... BD ULTRA-FINE INSULIN SYRINGES ...... BETHKIS ...... azathioprine oral ...... BD ULTRA-FINE PEN NEEDLES ...... BETIMOL ...... azelaic acid external ...... beauty 360 pure glycerin ...... BETOPTIC-S ...... azelastine hcl nasal solution 0.1 %, 137 beauty 360 soothing bath ...... BEVESPI AEROSPHERE ...... mcg/spray ...... bekyree ...... bexarotene ...... azelastine hcl ophthalmic ...... BENADRYL ALLERGY CHILDRENS ORAL BEXSERO ...... azithromycin oral suspension reconstituted .. LIQUID ...... bicalutamide ...... azithromycin oral tablet ...... BENADRYL ALLERGY CHILDRENS ORAL BIDIL ...... azo ...... TABLET CHEWABLE ...... BIKTARVY ...... azo tabs ...... BENADRYL ALLERGY ORAL TABLET ...... biocel ...... AZOPT ...... BENADRYL ALLERGY ULTRATABS ...... BIOLLE TEARS ...... azurette ...... benazepril hcl oral ...... biotinex ...... B benazepril-hydrochlorothiazide ...... bisacodyl ec ...... b-1 ...... BENLYSTA SUBCUTANEOUS SOLUTION bisacodyl laxative ...... b6 ...... AUTO-INJECTOR ...... bisacodyl rectal ...... BABY AYR SALINE ...... BENZAC AC WASH ...... bismatrol maximum strength ...... baby basics diaper rash ...... BENZACLIN ...... bismatrol oral tablet chewable ...... bac ...... BENZACLIN WITH PUMP ...... bismuth ...... bacitracin external ...... BENZAMYCIN ...... bismuth subsalicylate oral suspension ...... bacitracin ophthalmic ...... BENZNIDAZOLE ...... bismuth subsalicylate oral tablet chewable ... bacitracin zinc external ...... benzonatate oral capsule 100 mg ...... bisoprolol fumarate oral ...... bacitracin zinc first aid ...... benzonatate oral capsule 200 mg ...... bisoprolol-hydrochlorothiazide ...... bacitracin-polymyxin b ophthalmic ...... benztropine mesylate oral ...... blisovi fe 1.5/30 ...... bacitra-neomycin-polymyxin-hc ...... BERINERT ...... blisovi fe 1/20 ...... baclofen oral ...... BESIVANCE ...... blue tube/ aloe ...... BAFIERTAM ...... betamethasone dipropionate aug ...... BONINE ...... balsalazide disodium ...... betamethasone dipropionate external lotion . BOOSTRIX ...... BALVERSA ...... boro-packs ......

146 bosentan ...... butalbital-aspirin-caffeine ...... calcium antacid extra strength ...... BOSULIF ...... butorphanol tartrate nasal ...... calcium carb-cholecalciferol oral tablet 600- BOUDREAUXS BUTT PASTE EXTERNAL BYDUREON BCISE AUTOINJECTOR ...... 400 mg-unit ...... OINTMENT 40 % ...... BYETTA 10 MCG PEN ...... calcium carbonate antacid oral suspension ... bp 10-1 ...... BYETTA 5 MCG PEN ...... calcium carbonate antacid oral tablet ...... bp wash external liquid 2.5 % ...... C calcium carbonate antacid oral tablet b-plex plus ...... c 250 oral tablet ...... chewable ...... BPROTECTED PEDIA D-VITE ...... c 500/rose hips ...... calcium carbonate oral tablet 1500 (600 ca) BPROTECTED PEDIA IRON ...... c-1000/rose hips ...... mg ...... BPROTECTED PEDIA POLY-VITE ...... cabergoline ...... calcium carbonate oral tablet chewable 1250 BPROTECTED PEDIA POLY-VITE/FE ...... CABLIVI ...... (500 ca) mg...... BPROTECTED VITAMIN C ...... CABOMETYX ...... calcium carbonate oral tablet chewable 500 BREO ELLIPTA ...... caffeine citrate oral ...... mg ...... briellyn ...... cal mag zinc +d3 ...... calcium carbonate-vitamin d oral tablet 600- BRILINTA ...... calamine external lotion , 8-8 % ...... 200 mg-unit ...... brimonidine tartrate ophthalmic ...... calamine-zinc oxide external lotion ...... calcium carbonate-vitamin d oral tablet 600- BRIVIACT ORAL ...... calcidol ...... 400 mg-unit ...... BROVANA ...... calcipotriene external cream ...... calcium carbonate-vitamin d3 ...... BRUKINSA ...... calcipotriene external ointment ...... calcium cit plus vit d-3 ...... budesonide inhalation ...... calcipotriene external solution ...... calcium citrate + d oral tablet 315-250 mg- budesonide oral ...... calcitonin (salmon) nasal ...... unit ...... bumetanide oral ...... calcitriol external ...... calcium citrate + d3 maximum ...... BUNAVAIL ...... calcitriol oral capsule ...... calcium citrate +d3 ...... buprenorphine hcl sublingual ...... calcitriol oral solution ...... calcium citrate plus vit d ...... buprenorphine hcl-naloxone hcl ...... calcium 500/d oral tablet ...... calcium citrate+d oral tablet 315-250 mg-unit buprenorphine transdermal ...... calcium 500/vitamin d3 ...... calcium citrate+d3 oral tablet 315-250 mg- bupropion hcl er (smoking det)...... calcium 600 oral tablet 1500 (600 ca) mg ..... unit ...... bupropion hcl er (sr) ...... calcium 600/vit d/minerals oral tablet 600- calcium citrate+d3 w/magne ...... bupropion hcl er (xl) oral tablet extended 200 mg-unit ...... calcium citrate-vit d ...... release 24 hour 150 mg, 300 mg ...... calcium 600/vit d/minerals oral tablet calcium citrate-vitamin d oral tablet 315-200 bupropion hcl oral ...... chewable 600-400 mg-unit ...... mg-unit ...... buspirone hcl oral ...... calcium 600/vitamin d ...... calcium fast dissolution ...... butalbital-acetaminophen oral tablet 50-325 calcium 600/vitamin d-3 ...... calcium high potency ...... mg ...... calcium 600+d oral tablet 600-200 mg-unit, calcium high potency/vitamin d ...... butalbital-apap-caff-cod oral capsule 50-325- 600-400 mg-unit ...... calcium oral tablet 1500 (600 ca) mg ...... 40-30 mg ...... calcium 600+d oral tablet 600-400 mg-unit ... calcium oyster shell oral tablet 1250 (500 ca) butalbital-apap-caffeine oral capsule 50-325- calcium acetate (phos binder) oral tablet ...... mg ...... 40 mg ...... calcium acetate oral tablet 667 mg ...... calcium plus 600 +d ...... butalbital-apap-caffeine oral tablet ...... calcium antacid ...... calcium plus vitamin d oral tablet 500-5 mg- butalbital-asa-caff-codeine ...... calcium antacid ex st ...... mcg ......

147 calcium plus vitamin d oral tablet 600-200 CAYSTON ...... CHEMSTRIP K ...... mg-unit ...... caziant ...... CHEMSTRIP UGK ...... calcium plus vitamin d oral tablet 600-400 cefaclor ...... chest congest/cough child ...... mg-unit ...... cefadroxil ...... chest congestion relief dm ...... calcium plus vitamin d3 ...... cefazolin sodium injection solution chest congestion relief oral syrup ...... calcium soft chews oral tablet chewable 500- reconstituted 1 gm ...... chest congestion relief oral tablet ...... 200-40 mg-unt-mcg ...... cefazolin sodium solution reconstituted 10 chewable c ...... calcium/minerals/vitamin d ...... gm injection ...... chewable c with rose hips ...... calcium-magnesium-zinc oral tablet 333- cefdinir ...... chewable childrens vitamin ...... 133-5 mg, 333.33-133.33-5 mg ...... cefepime hcl solution reconstituted 2 gm chewy not chalky flavor ...... calcium-vitamin d oral tablet 600-400 mg- injection ...... childrens acetaminophen ...... unit ...... cefixime oral capsule ...... childrens allergy oral liquid 12.5 mg/5ml ...... calcium-vitamin d3 oral tablet 600-400 mg- cefprozil ...... childrens animal shapes ...... unit ...... ceftriaxone sodium injection solution childrens apap ...... cal-gest antacid ...... reconstituted 1 gm, 2 gm, 500 mg ...... childrens aspirin oral tablet chewable 81 mg . CALQUENCE ...... cefuroxime axetil ...... childrens chewable vitamins ...... camila ...... celecoxib oral ...... childrens chewables/ex c ...... capecitabine ...... CELONTIN ...... childrens chewables/iron ...... CAPRELSA ...... cephalexin oral capsule ...... childrens cold & allergy ...... capsaicin external cream 0.025 % ...... cephalexin oral suspension reconstituted ..... childrens complete oral tablet chewable 18 capsaicin external cream 0.1 % ...... CEQUA ...... mg ...... capsaicin hp ...... CERDELGA ...... childrens cough ...... captopril oral ...... cerovel ...... childrens loratadine ...... capzix ...... cerovite jr ...... childrens mucus relief cough ...... CARAC ...... cetiri-d ...... childrens non-aspirin ...... CARBAGLU ...... cetirizine hcl oral solution ...... childrens silapap ...... carbamazepine er ...... cetirizine hcl oral tablet ...... childrens soothe ...... carbamazepine oral ...... cetirizine-pseudoephedrine er ...... childrens vitamins/extra c ...... carbidopa-levodopa er ...... CHANTIX ...... childrens vitamins/iron ...... carbidopa-levodopa oral tablet ...... CHANTIX CONTINUING MONTH PAK ...... childs non-aspirin ...... carboxymethylcellulose sodium ophthalmic .. CHANTIX STARTING MONTH PAK...... chlordiazepoxide hcl ...... CARETOUCH CONTROL SOL LEVEL 2 ..... chateal ...... chlorhexidine gluconate mouth/throat ...... carteolol hcl ...... chateal eq ...... chloroquine phosphate oral ...... cartia xt ...... CHEMET ...... chlorpheniramine maleate er ...... carvedilol ...... CHEMSTRIP 10 MD ...... chlorpromazine hcl oral ...... CASTIVA WARMING ...... CHEMSTRIP 10/SG ...... chlorthalidone ...... CATHFLO ACTIVASE ...... CHEMSTRIP 2 GP ...... CHLOR-TRIMETON ALLERGY ...... cavarest ...... CHEMSTRIP 5 OB ...... CHLOR-TRIMETON ORAL SYRUP ...... CAVILON ...... CHEMSTRIP 7 ...... chlorzoxazone oral tablet 500 mg ...... CAYA ...... CHEMSTRIP 9 ...... CHOICE DM ......

148 CHOLBAM ...... clemastine fumarate oral syrup ...... colchicine oral tablet ...... cholestyramine light oral powder...... clemastine fumarate oral tablet 2.68 mg ...... COLCRYS ...... cholestyramine oral powder ...... CLEOCIN VAGINAL SUPPOSITORY ...... cold & allergy ...... chorionic gonadotropin intramuscular ...... CLIMARA ...... cold & allergy childrens oral elixir 1-15 ciclodan ...... CLIMARA PRO ...... mg/5ml ...... ciclopirox external solution ...... clindacin etz external swab ...... cold & cough childrens oral liquid 2.5-1-5 cilostazol ...... clindacin-p ...... mg/5ml ...... CILOXAN ...... clindamycin hcl oral capsule 150 mg, 300 cold & cough dm childrens oral liquid 2.5-1-5 CIMDUO ...... mg ...... mg/5ml ...... cimetidine hcl ...... clindamycin palmitate hcl ...... cold & sinus relief oral tablet 30-200 mg ...... cimetidine oral tablet 200 mg ...... clindamycin phosphate external gel ...... cold/cough ...... cimetidine oral tablet 300 mg, 400 mg, 800 clindamycin phosphate external lotion ...... cold/cough childrens ...... mg ...... clindamycin phosphate external solution ...... cold/cough dm childrens oral liquid 2.5-1-5 CIMZIA ...... clindamycin phosphate external swab ...... mg/5ml ...... cinacalcet hcl ...... clindamycin phosphate vaginal ...... cold/cough dm oral liquid 2.5-1-5 mg/5ml ...... CIPRO ORAL SUSPENSION CLINDESSE ...... colistimethate sodium (cba) ...... RECONSTITUTED ...... clobazam ...... col-rite oral capsule 250 mg ...... ciprofloxacin hcl ophthalmic ...... clobetasol prop emollient base ...... COMBIGAN ...... ciprofloxacin hcl oral ...... clobetasol propionate e ...... COMBIPATCH ...... ciprofloxacin-dexamethasone ...... clobetasol propionate external solution ...... COMBIVENT RESPIMAT ...... citalopram hydrobromide ...... CLOBEX ...... COMETRIQ (100 MG DAILY DOSE) ...... citrate of magnesia ...... CLOBEX SPRAY ...... COMETRIQ (140 MG DAILY DOSE) ...... citroma ...... clonazepam oral tablet ...... COMETRIQ (60 MG DAILY DOSE) ...... CITRUCEL ORAL POWDER ...... clonidine hcl oral ...... comfort gel ...... CITRUCEL ORAL TABLET ...... clopidogrel bisulfate oral ...... comfort gel antacid anti-gas oral suspension claravis ...... clorazepate dipotassium ...... 400-400-40 mg/5ml...... clarithromycin er ...... clotrimazole 3 ...... COMPLERA ...... clarithromycin oral ...... clotrimazole 7 ...... complete allergy ...... CLARITIN ALLERGY CHILDRENS ...... clotrimazole external ...... complete allergy medicine oral capsule ...... CLARITIN EYE ...... clotrimazole mouth/throat ...... complete allergy relief ...... CLARITIN ORAL TABLET ...... clotrimazole vaginal ...... , COMPLETE NATAL DHA ...... CLARITIN REDITABS ORAL TABLET clotrimazole-betamethasone ...... compro ...... DISPERSIBLE 10 MG ...... clozapine oral tablet 100 mg, 25 mg, 50 mg . CO-NATAL FA ...... CLARITIN-D 12 HOUR ...... CLOZARIL ORAL TABLET 100 MG, 25 MG CONCERTA ...... CLARITIN-D 24 HOUR ...... CLOZARIL ORAL TABLET 200 MG ...... CONDOMS ...... classic prenatal ...... CLOZARIL ORAL TABLET 50 MG ...... constulose ...... c-lax laxative ...... codeine sulfate ...... CONTOUR NEXT TEST STRIPS ...... CLEARCANAL EARWAX SOFTENER ...... COLACE ...... CONTOUR TEST STRIPS ...... clearlax oral powder 17 gm/scoop ...... COLAZAL ...... COOL MIST HUMIDIFER ...... clearskin ...... COLCHICINE ORAL CAPSULE ...... COPAXONE ......

149 CORICIDIN HBP COUGH/COLD ...... cyclosporine modified ...... DAYHIST ALLERGY 12 HOUR RELIEF ...... CORLANOR ...... cyclosporine oral ...... DAYTRANA ...... corn & callus remover ...... CYMBALTA ...... deblitane ...... CORTIFOAM ...... cyproheptadine hcl oral ...... DECADRON ORAL TABLET 0.5 MG, 0.75 COSENTYX ...... cyred ...... MG ...... COSOPT ...... cyred eq ...... DECADRON ORAL TABLET 4 MG, 6 MG .... COSOPT PF ...... CYSTAGON ...... DECARA ORAL CAPSULE 1.25 MG (50000 COTELLIC ...... CYSTARAN ...... UT) ...... COTEMPLA XR-ODT...... D DECARA ORAL CAPSULE 250 MCG cough & chest congestion ...... d 1000 oral tablet ...... (10000 UT)...... cough & cold ...... d 400 oral tablet ...... DECARA ORAL CAPSULE 625 MCG cough & cold hbp ...... d 400 oral tablet chewable ...... (25000 UT)...... cough childrens ...... d 5000 oral tablet ...... decongestant 12hour max st ...... cough dm ...... d3 high potency oral capsule 25 mcg (1000 deep sea nasal spray ...... cough dm childrens ...... ut) ...... deferasirox granules ...... cough dm er ...... d3 oral capsule 10 mcg (400 unit), 50 mcg deferasirox oral packet ...... cough relief oral syrup 15 mg/5ml ...... (2000 ut)...... deferasirox oral tablet ...... cough/chest congestion dm ...... d3 oral capsule 125 mcg (5000 ut) ...... deferasirox oral tablet soluble ...... cough/chest dm childrens oral liquid ...... d3 oral capsule 25 mcg (1000 ut) ...... DELSTRIGO ...... cough/cold hbp ...... d3 super strength ...... DELSYM ...... CREON ...... d-3-5 ...... DELSYM CGH/CHEST CONG DM CHILD.... CRIXIVAN ...... d3-50 ...... DELSYM COUGH CHILDRENS ...... cromolyn sodium inhalation ...... daily acne wash ...... DELSYM COUGH/CHEST CONGEST DM ... cromolyn sodium nasal ...... daily fiber oral capsule 0.52 gm ...... delyla ...... cromolyn sodium ophthalmic...... daily multiple vitamins ...... DELZICOL ...... crotan ...... daily multivitamins/iron ...... DENTA 5000 PLUS ...... CRUEX PRESCRIPTION STRENGTH ...... daily vitamin formula+iron ...... DENTAGEL ...... cryselle-28 ...... daily vitamins ...... DEPEN TITRATABS ...... CUPRIMINE ...... daily vite ...... DEPO-ESTRADIOL ...... cyanocobalamin injection solution 1000 daily vites ...... DEPO-SUBQ PROVERA 104 ...... mcg/ml ...... daily-vite ...... DERMAPHOR ...... CYANOCOBALAMIN INJECTION danazol oral ...... DESCOVY ...... SOLUTION 2000 MCG/ML ...... dantrolene sodium oral ...... DESENEX EXTERNAL POWDER ...... cyclafem 1/35 ...... dapsone oral ...... DESENEX JOCK ITCH ...... cyclafem 7/7/7 ...... DAPTACEL ...... desgen dm oral liquid ...... cyclobenzaprine hcl oral tablet 10 mg, 5 mg . daptomycin solution reconstituted 500 mg desipramine hcl oral ...... cyclopentolate hcl ophthalmic solution 1 %... intravenous ...... desmopressin ace spray refrig ...... cyclophosphamide oral capsule ...... dasetta 1/35 ...... desmopressin acetate oral ...... CYCLOPHOSPHAMIDE ORAL TABLET ...... dasetta 7/7/7 ...... desmopressin acetate spray ...... cycloserine oral ...... DAURISMO ...... desogestrel-ethinyl estradiol ......

150 DETROL ...... digestive probiotic oral capsule 250 mg ...... DIURIL ...... DETROL LA ...... digitek ...... divalproex sodium oral capsule delayed dexamethasone intensol ...... digox ...... release sprinkle...... dexamethasone oral elixir ...... digoxin oral solution ...... divalproex sodium oral tablet delayed dexamethasone oral solution ...... digoxin oral tablet ...... release ...... dexamethasone oral tablet 0.5 mg, 0.75 mg . dihydroergotamine mesylate injection ...... DIVIGEL ...... dexamethasone oral tablet 1 mg, 2 mg ...... DILANTIN ORAL CAPSULE 30 MG ...... dm maximum adult ...... dexamethasone oral tablet 1.5 mg ...... diltiazem hcl er ...... docosanol external ...... dexamethasone oral tablet 4 mg, 6 mg ...... diltiazem hcl er beads ...... docu ...... dexamethasone sodium phosphate diltiazem hcl er coated beads oral capsule docu liquid ...... ophthalmic ...... extended release 24 hour ...... docusate calcium ...... DEXILANT ...... diltiazem hcl oral ...... docusate mini ...... dextromethorphan polistirex er ...... dilt-xr ...... docusate sodium oral capsule ...... dextromethorphan-guaifenesin oral syrup ..... dimaphen dm cold/cough ...... docusate sodium oral liquid 50 mg/5ml ...... DIABETIC TUSSIN MAX ST ...... DIMETAPP COLD RELIEF CHILDRENS ..... docusate sodium oral syrup ...... DIALYVITE 800 ORAL TABLET ...... DIMETAPP COLD/ALLERGY ...... DOCUSOL MINI ...... DIALYVITE VITAMIN D 5000...... DIMETAPP DM COLD/COUGH...... docuzen ...... diamode ...... dimethyl fumarate oral ...... dofetilide ...... diaper rash external ointment ...... dimethyl fumarate starter pack ...... dok oral capsule ...... diarrhea ...... dino-life ...... donepezil hcl oral tablet 10 mg, 5 mg ...... diarrhea relief ...... dino-life w/extra c ...... donepezil hcl oral tablet 23 mg ...... diazepam oral solution ...... diotame instydose ...... DOPTELET ...... diazepam oral tablet ...... DIPENTUM ...... dorzolamide hcl solution 2 % ophthalmic ...... diazepam rectal ...... diphedryl allergy ...... DORZOLAMIDE HCL SOLUTION 2 % diclofenac potassium ...... diphen ...... OPHTHALMIC ...... diclofenac sodium er ...... di-phen ...... dorzolamide hcl-timolol mal ...... diclofenac sodium external gel 1 %...... diphenhist ...... double antibiotic ...... diclofenac sodium ophthalmic ...... diphenhydramine hcl injection ...... DOVATO ...... diclofenac sodium oral ...... diphenhydramine hcl oral capsule ...... DOVONEX ...... dicloxacillin sodium ...... diphenhydramine hcl oral elixir ...... doxazosin mesylate oral ...... dicyclomine hcl oral capsule ...... diphenhydramine hcl oral liquid 12.5 mg/5ml doxepin hcl oral capsule ...... dicyclomine hcl oral solution ...... diphenhydramine hcl oral tablet ...... doxepin hcl oral concentrate ...... dicyclomine hcl oral tablet ...... diphenhydramine hcl oral tablet chewable .... doxy 100 ...... DIFFERIN EXTERNAL CREAM ...... diphenoxylate-atropine ...... doxycycline hyclate oral capsule ...... DIFFERIN EXTERNAL GEL 0.1 % ...... DIPHTHERIA-TETANUS TOXOIDS DT ...... doxycycline hyclate oral tablet 100 mg ...... DIFFERIN EXTERNAL GEL 0.3 % ...... dipyridamole oral ...... doxycycline monohydrate oral capsule 100 DIFFERIN EXTERNAL LOTION ...... disopyramide phosphate ...... mg ...... DIFICID ...... disulfiram oral tablet 250 mg ...... doxycycline monohydrate oral capsule 50 DIFLUCAN ...... disulfiram oral tablet 500 mg ...... mg ...... digestive probiotic oral capsule ...... DITROPAN XL ......

151 DR SMITHS ADULT BARRIER EXTERNAL ec-naproxen ...... enema ...... OINTMENT ...... econtra ez ...... enema disposable ...... DR SMITHS DIAPER ...... econtra one-step ...... enema mineral oil ...... driminate ...... ED A-HIST ORAL LIQUID ...... enema ready-to-use ...... dronabinol ...... ed bron gp ...... enema rectal enema 16-6 gm/133ml, 19-7 DROXIA ORAL CAPSULE 200 MG, 300 MG ed chlorped jr ...... gm/118ml ...... DROXIA ORAL CAPSULE 400 MG ...... ed-apap ...... ENEMEEZ MINI ...... dry-eye relief nighttime ...... EDARBI ...... ENFAMIL ENFALYTE ...... dss ...... EDARBYCLOR ...... ENFAMIL EXPECTA ...... DUAVEE ...... ED-SPAZ ...... ENGERIX-B ...... DULERA ...... EDURANT ...... enoxaparin sodium ...... duloxetine hcl oral capsule delayed release efavirenz ...... enpresse-28 ...... particles 20 mg, 30 mg, 60 mg ...... efavirenz-emtricitab-tenofovir ...... enskyce ...... DUPIXENT ...... efavirenz-lamivudine-tenofovir ...... ENSTILAR ...... D-VI-SOL ...... effer-k oral tablet effervescent 25 meq ...... entacapone ...... d-vite pediatric ...... EFUDEX ...... entecavir ...... DYANAVEL XR ...... EGRIFTA SV ...... enteric aspirin ...... dye-free allergy relief ...... electrolyte solution ...... ENTRESTO ...... E ELESTRIN ...... enulose ...... e ELIDEL ...... ENVARSUS XR ORAL TABLET E.E.S. GRANULES ...... elinest ...... EXTENDED RELEASE 24 HOUR 1 MG ... e-400-clear ...... ELIQUIS ...... EPANED ...... ear drops ...... ELIQUIS DVT/PE STARTER PACK ...... EPCLUSA ...... ear drops earwax aid ...... ELIXOPHYLLIN ...... ephrine nose drops ...... ear wax kit ...... ELMIRON ...... EPIDIOLEX ...... ear wax removal ...... eluryng ...... EPIDUO ...... ear wax removal drops ...... EMEND ORAL ...... EPIDUO FORTE ...... ear wax removal kit ...... EMFLAZA ORAL TABLET 6 MG ...... epinephrine injection solution auto-injector ... ear wax removal system ...... EMGALITY ...... EPIPEN 2-PAK ...... earwax removal ...... EMGALITY (300 MG DOSE) ...... EPIPEN JR 2-PAK ...... earwax removal drops ...... emoquette ...... epitol ...... earwax removal kit otic solution 6.5 % ...... emtricitabine ...... EPIVIR HBV ORAL SOLUTION ...... EASIVENT ...... emtricitabine-tenofovir df ...... EPOGEN ...... EASIVENT MASK LARGE ...... EMTRIVA ORAL SOLUTION ...... ergocalciferol oral ...... EASIVENT MASK MEDIUM...... enalapril maleate oral ...... ergotamine-caffeine ...... EASIVENT MASK SMALL ...... enalapril-hydrochlorothiazide ...... ERIVEDGE ...... easygel ...... ENBREL ...... ERLEADA ...... easy-lax plus ...... ENDACOF-DM ...... erlotinib hcl ...... EASYMAX 15 LEVEL 2 CONTROL ...... endocet oral tablet 10-325 mg, 5-325 mg, errin ...... EASYMAX 15 LEVEL 2-3 CONTROL ...... 7.5-325 mg ...... ertapenem sodium ......

152 ERYPED 200 ...... everolimus oral tablet 2.5 mg, 5 mg, 7.5 mg . fenofibrate oral capsule 134 mg, 200 mg, 67 ERYTHROCIN STEARATE ...... EVOTAZ ...... mg ...... erythromycin base ...... EXCEDRIN EXTRA STRENGTH...... fenofibrate oral tablet 160 mg, 54 mg ...... erythromycin ethylsuccinate oral ...... EXCEDRIN MIGRAINE ...... FENSOLVI (6 MONTH) ...... erythromycin external ...... exemestane ...... fentanyl citrate (pf) ...... erythromycin ophthalmic ...... EX-LAX ULTRA ...... fentanyl transdermal patch 72 hour 100 erythromycin oral ...... EXTAVIA ...... mcg/hr ...... ESBRIET ...... eye drops advanced relief ...... fentanyl transdermal patch 72 hour 12 escitalopram oxalate oral tablet ...... eye drops allergy relief ...... mcg/hr ...... esomeprazole magnesium oral capsule eye drops long lasting ...... fentanyl transdermal patch 72 hour 25 delayed release ...... eye drops ophthalmic solution 0.05 % ...... mcg/hr ...... esomeprazole magnesium oral packet ...... eye drops ophthalmic solution 0.05-0.1-1-1 fentanyl transdermal patch 72 hour 50 essential one daily ...... % ...... mcg/hr ...... essentials ...... eye itch relief ophthalmic solution 0.025 % ... fentanyl transdermal patch 72 hour 75 estarylla ...... eye lubricant ...... mcg/hr ...... ESTRACE ...... ezetimibe ...... ferate ...... estradiol oral ...... EZFE 200 ...... FER-IN-SOL ...... estradiol transdermal patch twice weekly ...... F ferocon ...... estradiol transdermal patch weekly ...... FABIOR ...... ferosul ...... estradiol vaginal ...... falmina ...... ferotrinsic ...... estradiol-norethindrone acet oral tablet 1-0.5 famotidine oral suspension reconstituted 40 ferretts ...... mg ...... mg/5ml ...... ferrex 150 ...... ESTRING ...... famotidine oral tablet 10 mg ...... ferric x-150 ...... ESTROGEL ...... famotidine oral tablet 20 mg ...... ferrous fumarate oral tablet 324 (106 fe) mg . ethambutol hcl oral tablet 100 mg ...... famotidine oral tablet 40 mg ...... ferrous gluconate oral tablet 240 (27 fe) mg .. ethambutol hcl oral tablet 400 mg ...... famotidine orig st ...... ferrous gluconate oral tablet 324 (37.5 fe) ethosuximide oral ...... FANAPT ...... mg ...... ethynodiol diac-eth estradiol ...... FARXIGA ...... ferrous gluconate oral tablet 324 (38 fe) mg .. etodolac ...... FARYDAK ...... ferrous sulfate oral elixir ...... etonogestrel-ethinyl estradiol ...... FASENRA PEN ...... ferrous sulfate oral solution 75 (15 fe) mg/ml etoposide oral ...... fast relief laxative ...... ferrous sulfate oral tablet 325 (65 fe) mg ...... etravirine ...... febuxostat ...... ferrous sulfate oral tablet delayed release ..... EUCRISA ...... felbamate oral suspension ...... FETZIMA ...... euthyrox ...... felbamate oral tablet ...... fever reducer/pain reliever ...... EVAC ...... felodipine er ...... fever reducing childrens ...... EVAMIST ...... FEMRING ...... feverall adults ...... EVEKEO ...... femynor ...... feverall childrens ...... EVEKEO ODT ...... fenofibrate micronized oral capsule 134 mg, FEVERALL INFANTS ...... everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 200 mg, 67 mg ...... FEVERALL JUNIOR STRENGTH ...... mg ...... fe-vite iron ......

153 FIASP ...... fluocinolone acetonide external cream 0.025 foot & sneaker ...... FIASP FLEXTOUCH ...... % ...... foot care (terbinafine) ...... fiber laxative ...... fluocinolone acetonide external ointment ..... for sty relief ...... fiber laxative + calcium ...... fluocinolone acetonide external solution ...... FORMULA 3 THE TREATMENT ...... fiber laxative oral capsule 0.52 gm...... fluocinolone acetonide scalp ...... FORMULA 7 THE SOLUTION ...... fiber laxative oral tablet 500 mg ...... fluocinonide emulsified base ...... FORTEO ...... fiber oral capsule 0.52 gm ...... fluocinonide external solution ...... fosamprenavir calcium ...... fiber oral powder 28.3 %, 48.57 % ...... fluoridex daily renewal ...... fosinopril sodium ...... fiber oral powder 30.9 % ...... fluoritab ...... fosinopril sodium-hctz ...... fiber oral powder 58.6 % ...... fluorometholone ...... FREESTYLE PRECISION NEO TEST ...... fiber oral tablet 500 mg ...... fluorouracil external cream 5 % ...... freeze dried acidophilus ...... fiber oral tablet 625 mg ...... fluorouracil external solution ...... fruity c ...... fiber therapy oral capsule 0.52 gm ...... fluoxetine hcl oral capsule 10 mg, 20 mg ..... full spectrum b/vitamin c ...... fiber therapy oral powder 28.3 % ...... fluoxetine hcl oral capsule 40 mg ...... FULPHILA ...... fiber therapy oral tablet 500 mg ...... fluoxetine hcl oral solution ...... fungi-guard ...... fiber therapy oral tablet 625 mg ...... fluphenazine decanoate injection ...... furosemide oral solution 10 mg/ml ...... fiber-caps ...... fluphenazine hcl injection ...... furosemide oral tablet ...... fiber-lax ...... fluphenazine hcl oral concentrate ...... FUZEON ...... FINACEA ...... fluphenazine hcl oral elixir ...... fyavolv ...... finasteride oral tablet 5 mg ...... fluphenazine hcl oral tablet ...... FYCOMPA ...... FIRAZYR ...... flurbiprofen sodium ...... G first aid antibiotic external ointment 3.5-400- flutamide ...... g tussin ac ...... 5000 , 3.5-400-5000 mg-unit ...... fluticasone propionate external cream ...... gabapentin oral capsule ...... first aid antiseptic external solution 10 % ...... fluticasone propionate external ointment ...... gabapentin oral tablet ...... FIRVANQ ...... fluticasone propionate nasal ...... galantamine hydrobromide oral solution ...... FLAGYL ...... fluticasone-salmeterol inhalation aerosol galantamine hydrobromide oral tablet 12 mg, flanders buttocks ...... powder breath activated 100-50 8 mg ...... flecainide acetate ...... mcg/dose, 250-50 mcg/dose, 500-50 galantamine hydrobromide oral tablet 4 mg .. FLEET BISACODYL ...... mcg/dose ...... GARDASIL 9 ...... FLEET ENEMA ...... FLUTICASONE-SALMETEROL gas relief antiflatuent ...... FLEET OIL ...... INHALATION AEROSOL POWDER gas relief drops infants ...... FLEET PEDIATRIC ...... BREATH ACTIVATED 113-14 MCG/ACT, gas relief extra strength ...... floranex tablet oral ...... 232-14 MCG/ACT, 55-14 MCG/ACT ...... gas relief extstrength ...... FLORANEX TABLET ORAL ...... fluvoxamine maleate ...... gas relief infants ...... FLOVENT DISKUS ...... foaming antacid oral tablet chewable 80-20 gas relief infants drops ...... FLOVENT HFA ...... mg ...... gas relief oral capsule 125 mg ...... fluconazole oral ...... FOCALIN ...... gas relief oral suspension 20 mg/0.3ml ...... fludrocortisone acetate oral ...... folic acid oral tablet 1 mg ...... gas relief oral tablet chewable 125 mg ...... fluocinolone acetonide body ...... folic acid oral tablet 400 mcg, 800 mcg ...... gas relief oral tablet chewable 80 mg ...... foltrin ...... gas relief ultra strength ......

154 gas relief ultstrength ...... geri-pectate ...... gormel ...... GAS-X EXTRA STRENGTH ORAL geri-tussin dm ...... gormel 10 ...... CAPSULE ...... GILENYA ...... GRANIX ...... GAS-X EXTRA STRENGTH ORAL TABLET GILOTRIF ...... griseofulvin microsize oral ...... CHEWABLE ...... giltuss severe sinus ...... griseofulvin ultramicrosize ...... GAS-X ULTRA STRENGTH ...... glatiramer acetate ...... guaiatussin ac ...... GATTEX ...... glatopa ...... guaicon dms ...... gavilax oral powder ...... GLEOSTINE ...... guaifenesin ac ...... gavilyte-c ...... glimepiride ...... guaifenesin er oral tablet extended release gavilyte-n with flavor pack ...... glipizide er ...... 12 hour 1200 mg ...... GAVISCON EXTRA RELIEF FORMULA ...... glipizide ir ...... guaifenesin oral tablet 400 mg ...... GAVISCON EXTRA STRENGTH ...... glipizide xl ...... guaifenesin-codeine ...... GAVISCON ORAL SUSPENSION ...... GLUCAGEN HYPOKIT ...... guaifenesin-dm oral syrup ...... GELUSIL ...... GLUCAGON EMERGENCY INJECTION guanfacine hcl ...... gemfibrozil oral ...... SOLUTION RECONSTITUTED ...... guanfacine hcl er ...... genaphed ...... glucagon emergency kit 1 mg injection ...... GVOKE HYPOPEN 1-PACK ...... generlac ...... GLUCAGON EMERGENCY KIT 1 MG GVOKE HYPOPEN 2-PACK ...... gengraf oral capsule ...... INJECTION ...... GVOKE PFS ...... GENOTROPIN ...... GLUCOSE CONTROL SOLUTION IN GYNAZOLE-1 ...... gentak ...... VITRO SOLUTION ...... GYNE-LOTRIMIN ...... gentamicin sulfate external ...... GLUCOSE CONTROL SOLUTIONS ...... GYNE-LOTRIMIN 3 ...... gentamicin sulfate ophthalmic ...... glucose oral tablet chewable 4 gm ...... H GENTEAL SEVERE ...... glyburide micronized ...... habitrol ...... GENTEAL TEARS MODERATE PF ...... glyburide oral ...... HAEGARDA ...... GENTEAL TEARS NIGHT-TIME ...... glyburide-metformin ...... hailey 1.5/30 ...... GENTEAL TEARS OPHTHALMIC glycerin (adult) rectal suppository 2 gm ...... hailey fe 1.5/30 ...... SOLUTION 0.1-0.2-0.3 % ...... glycerin (infants & children) rectal hailey fe 1/20 ...... GENTEAL TEARS PF ...... suppository 1 gm ...... halobetasol propionate external cream ...... GENTEAL TEARS SEVERE DAY/NIGHT .... glycerin (pediatric) rectal suppository 1 gm .. haloperidol decanoate intramuscular ...... gentle laxative ...... glycerin adult rectal suppository 2 gm ...... haloperidol oral ...... gentle laxative womens ...... glycerin child rectal suppository 1 gm ...... HARVONI ...... gentlelax ...... glycerin child rectal suppository 1.2 gm ...... HAVRIX ...... GENVOYA ...... glycerin childrens ...... headache formula ...... GEODON INTRAMUSCULAR ...... glycerin external ...... headache relief ...... GEODON ORAL ...... glycerin external liquid 99.5 % ...... headache relief extra str ...... geri-dryl ...... glycerin pediatric rectal suppository 1.2 gm .. healthy hair/skin/nails ...... geri-kot ...... glycolax ...... heartburn antacid ...... geri-lanta ...... glycopyrrolate oral tablet 1 mg, 2 mg ...... heartburn antacid ex st ...... geri-lanta supreme ...... glydo ...... heartburn prevention oral tablet 10 mg ...... geri-mox ...... GLYXAMBI ...... heartburn relief ex st ......

155 heartburn relief oral tablet 10 mg ...... 80 MG/0.8ML, 80 MG/0.8ML & hydrocortisone-acetic acid ...... heartburn relief oral tablet 200 mg ...... 40MG/0.4ML ...... hydrocortisone-aloe ...... heartburn relief oral tablet chewable 160-105 HUMULIN 70/30 KWIKPEN ...... hydrocortisone-aloe max st ...... mg ...... HUMULIN 70/30 VIAL ...... hydrolatum ...... heather ...... HUMULIN N KWIKPEN ...... hydromet ...... h-e-b aspirin ...... HUMULIN N VIAL ...... hydromorphone hcl oral ...... h-e-b childrens allergy ...... HUMULIN R U-500 KWIKPEN...... hydromorphone hcl rectal ...... HELIDAC THERAPY ...... HUMULIN R U-500 VIAL hydroxychloroquine sulfate oral ...... HEMANGEOL ...... (CONCENTRATED) ...... hydroxyurea oral ...... HEMLIBRA ...... HUMULIN R VIAL ...... hydroxyzine hcl oral ...... hemorrhoidal rectal suppository 0.25-3-85.5 HYCAMTIN ORAL ...... hydroxyzine pamoate oral ...... % ...... hydralazine hcl oral ...... hyoscyamine sulfate er ...... heparin sodium (porcine) ...... hydrochlorothiazide oral capsule ...... hyoscyamine sulfate oral ...... heparin sodium (porcine) pf injection solution hydrochlorothiazide oral tablet 12.5 mg ...... hyoscyamine sulfate sl ...... 5000 unit/0.5ml ...... hydrochlorothiazide oral tablet 25 mg, 50 mg hyoscyamine sulfate sublingual ...... heparin sodium (porcine) pf injection solution hydrocodone bitartrate er oral capsule hyosyne ...... 5000 unit/ml ...... extended release 12 hour 10 mg ...... HYPERSAL INHALATION NEBULIZATION HEPLISAV-B ...... hydrocodone-acetaminophen oral solution SOLUTION 7 % ...... hi cal ...... 7.5-325 mg/15ml ...... HYPERTET S/D ...... high potency probiotic ...... hydrocodone-acetaminophen oral tablet 10- HYPOTEARS ...... HUMALOG ...... 325 mg, 5-325 mg, 7.5-325 mg ...... HYSINGLA ER ...... HUMALOG JUNIOR KWIKPEN ...... hydrocodone-homatropine ...... I HUMALOG KWIKPEN ...... hydrocortisone (perianal) external cream 2.5 IBRANCE ORAL CAPSULE ...... HUMALOG MIX 50/50 ...... % ...... IBRANCE ORAL TABLET ...... HUMALOG MIX 50/50 KWIKPEN ...... hydrocortisone anti-itch external cream 0.5 ibu ...... HUMALOG MIX 75/25 ...... % ...... ibu-200 ...... HUMALOG MIX 75/25 KWIKPEN ...... hydrocortisone butyrate external ointment .... ibuprofen childrens oral tablet chewable 100 HUMATROPE INJECTION SOLUTION hydrocortisone butyrate external solution ..... mg ...... RECONSTITUTED 12 MG, 24 MG, 6 MG hydrocortisone external cream 0.5 %, 2.5 % ibuprofen cold & sinus ...... HUMIRA PEN-PEDIATRIC UC START ...... hydrocortisone external cream 1 % ...... ibuprofen cold/sinus oral tablet 30-200 mg .... HUMIRA PEN-PSOR/UVEIT STARTER ...... hydrocortisone external lotion 2.5 % ...... ibu-profen cold/sinus oral tablet 30-200 mg .. HUMIRA SUBCUTANEOUS PEN- hydrocortisone external ointment 0.5 %, 2.5 ibuprofen ib childrens ...... INJECTOR KIT 40 MG/0.4ML, 40 % ...... ibuprofen ib oral tablet 200 mg ...... MG/0.8ML ...... hydrocortisone external ointment 1 % ...... ibuprofen ib oral tablet chewable 100 mg ...... HUMIRA SUBCUTANEOUS PEN- hydrocortisone oral tablet 10 mg, 20 mg, 5 ibuprofen infants oral suspension 50 INJECTOR KIT 80 MG/0.8ML ...... mg ...... mg/1.25ml ...... HUMIRA SUBCUTANEOUS PREFILLED hydrocortisone plus external cream 1 % ...... ibuprofen jr oral tablet 100 mg ...... SYRINGE KIT 10 MG/0.1ML, 20 hydrocortisone rectal enema 100 mg/60ml ... ibuprofen junior ...... MG/0.2ML, 40 MG/0.4ML, 40 MG/0.8ML, hydrocortisone/aloe ...... ibuprofen junior strength ...... hydrocortisone/aloe max str ...... ibuprofen oral suspension 100 mg/5ml ......

156 ibuprofen oral tablet 200 mg ...... INSULIN ASP PROT & ASP FLEXPEN ...... ISTALOL ...... ibuprofen oral tablet 400 mg, 600 mg, 800 INSULIN ASPART ...... itraconazole oral ...... mg ...... INSULIN ASPART PROT & ASPART ...... ivermectin oral ...... icatibant acetate ...... INSULIN LISPRO ...... J iclevia ...... INSULIN LISPRO (1 UNIT DIAL) ...... JAKAFI ...... ICLUSIG ...... INSULIN PEN NEEDLES 30G X 8 MM ...... JANSSEN COVID-19 VACCINE ...... IDHIFA ...... INSULIN PEN NEEDLES 32G X 4 MM ...... jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 iferex 150 forte ...... INSULIN PEN NEEDLES 32G X 6 MM ...... mg, 3 mg, 4 mg, 5 mg, 7.5 mg ...... ILARIS ...... INTELENCE ORAL TABLET 200 MG ...... jantoven oral tablet 6 mg ...... ILEVRO ...... INTELENCE ORAL TABLET 25 MG ...... JANUMET ...... ILUMYA ...... INTRON A ...... JANUMET XR ...... imatinib mesylate ...... introvale ...... JANUVIA ...... IMBRUVICA ...... INVEGA ...... JARDIANCE ...... imipramine hcl oral ...... INVEGA SUSTENNA ...... jencycla ...... imiquimod external cream 5 % ...... INVEGA TRINZA ...... JENTADUETO ...... IMODIUM A-D ORAL TABLET...... INVIRASE ...... JENTADUETO XR ...... IMODIUM MULTI-SYMPTOM RELIEF ...... INVOKAMET ...... jinteli ...... IMPAVIDO ...... INVOKAMET XR ...... jock itch external cream 1 % ...... INATAL GT ...... INVOKANA ...... jock itch max st ...... incassia ...... ipratropium bromide inhalation ...... jock itch spray powder ...... INCRELEX ...... ipratropium bromide nasal ...... jolessa ...... INCRUSE ELLIPTA...... ipratropium-albuterol ...... JORNAY PM ...... indapamide ...... IRESSA ...... juleber ...... indomethacin oral capsule 25 mg, 50 mg ..... iron oral tablet 240 (27 fe) mg ...... JULUCA ...... indoor/outdoor allergy rlf ...... iron oral tablet 325 (65 fe) mg ...... junel 1.5/30 ...... INFANRIX ...... iron supplement ...... junel 1/20 ...... infant gas relief ...... iron supplement childrens ...... junel fe oral tablet 1.5-30 mg-mcg ...... INFANTS ADVIL ...... ISENTRESS HD ...... junel fe oral tablet 1-20 mg-mcg ...... infants gas relief ...... ISENTRESS ORAL PACKET ...... K infants ibuprofen ...... ISENTRESS ORAL TABLET ...... KALETRA ...... infants pain & fever ...... ISENTRESS ORAL TABLET CHEWABLE ... kalliga ...... infants pain relief drops ...... isibloom ...... KALYDECO ...... infants pain/fever ...... isoniazid oral ...... KAPVAY ...... infants simethicone ...... ISOPTO ATROPINE ...... kariva ...... INFUVITE ADULT ...... isosorbide dinitrate ...... KAZANO ...... INGREZZA ...... isosorbide mononitrate ...... kelnor 1/35 ...... INLYTA ...... isosorbide mononitrate er ...... kelnor 1/50 ...... INSPIREASE ...... isotretinoin oral capsule 10 mg ...... KESIMPTA ...... INSPIREASE RESERVOIR BAGS ...... isotretinoin oral capsule 20 mg, 30 mg, 40 ketoconazole external cream ...... instacort 5 ...... mg ...... ketoconazole external shampoo ......

157 ketoconazole oral ...... lactulose oral solution ...... laxative rectal suppository 10 mg ...... KETO-DIASTIX ...... LAMISIL AT EXTERNAL CREAM ...... laxative regular strength ...... KETONE CARE ...... LAMISIL AT JOCK ITCH ...... LEDIPASVIR-SOFOSBUVIR ...... KETONE TEST ...... lamivudine oral solution ...... leena ...... ketoprofen oral ...... lamivudine oral tablet 100 mg ...... leflunomide oral ...... ketorolac tromethamine ophthalmic ...... lamivudine oral tablet 150 mg, 300 mg ...... LENVIMA (10 MG DAILY DOSE) ...... ketorolac tromethamine oral ...... lamivudine-zidovudine ...... LENVIMA (12 MG DAILY DOSE) ...... ketorolac tromethamine solution 30 mg/ml lamotrigine oral tablet ...... LENVIMA (14 MG DAILY DOSE) ...... injection ...... lamotrigine oral tablet chewable ...... LENVIMA (18 MG DAILY DOSE) ...... KETOROLAC TROMETHAMINE lamotrigine starter kit-blue ...... LENVIMA (20 MG DAILY DOSE) ...... SOLUTION 30 MG/ML INJECTION ...... lamotrigine starter kit-green ...... LENVIMA (24 MG DAILY DOSE) ...... KETOSTIX ...... lamotrigine starter kit-orange ...... LENVIMA (4 MG DAILY DOSE) ...... ketotifen fumarate ophthalmic ...... LANCETS ...... LENVIMA (8 MG DAILY DOSE) ...... KEVZARA ...... lansoprazole oral capsule delayed release lessina ...... KINERET ...... 15 mg ...... LETAIRIS ...... KISQALI (200 MG DOSE) ...... lansoprazole oral capsule delayed release letrozole oral ...... KISQALI (400 MG DOSE) ...... 30 mg ...... leucovorin calcium oral tablet 10 mg ...... KISQALI (600 MG DOSE) ...... lansoprazole oral tablet delayed release leucovorin calcium oral tablet 15 mg, 25 mg, KITABIS PAK ...... dispersible 15 mg ...... 5 mg ...... klor-con ...... lansoprazole oral tablet delayed release LEUKERAN ...... klor-con 10 ...... dispersible 30 mg ...... LEUKINE ...... klor-con m10 ...... LANTUS SOLOSTAR ...... leuprolide acetate injection ...... klor-con m20 ...... LANTUS U-100 VIAL ...... levalbuterol hcl inhalation ...... klor-con/ef ...... lapatinib ditosylate ...... LEVBID ...... KOMBIGLYZE XR ...... larin 1.5/30 ...... LEVEMIR U-100 FLEXTOUCH ...... KONSYL DAILY FIBER ORAL POWDER larin 1/20 ...... LEVEMIR U-100 VIAL ...... 100 % ...... larin fe 1.5/30 ...... levetiracetam oral solution ...... konsyl daily fiber oral powder 28.3 %...... larin fe 1/20 ...... levetiracetam oral tablet ...... KORLYM ...... larissia ...... levobunolol hcl ...... K-PHOS ...... latanoprost ophthalmic ...... levocetirizine dihydrochloride oral tablet ...... k-prime ...... LATUDA ...... levofloxacin oral tablet ...... KRINTAFEL ...... laxacin ...... levonest ...... kurvelo ...... laxaclear ...... levonorgest-eth estrad 91-day oral tablet L laxative max str ...... 0.15-0.03 mg...... labetalol hcl oral ...... laxative maximum strength oral tablet 25 mg levonorgestrel ...... LAC-HYDRIN FIVE ...... laxative oral powder 17 gm/scoop ...... levonorgestrel-ethinyl estrad oral tablet 0.1- lactic acid external ...... laxative oral tablet delayed release 5 mg ..... 20 mg-mcg ...... lactobacillus oral tablet ...... laxative pills ...... levonorgestrel-ethinyl estrad oral tablet 0.15- lacto-pectin ...... laxative pills max st ...... 30 mg-mcg ...... lactulose encephalopathy ...... laxative pills oral tablet 25 mg ...... levonorg-eth estrad triphasic ......

158 levora 0.15/30 (28) ...... long lasting nasal spray ...... lubricant eye drops ophthalmic solution 0.6 levo-t ...... LONSURF ...... % ...... levothyroxine sodium oral tablet...... loperamide hcl oral capsule ...... lubricant eye drops pf ...... levoxyl ...... loperamide hcl oral tablet ...... lubricant eye nighttime ...... LEXIVA ORAL SUSPENSION ...... lopinavir-ritonavir ...... lubricant eye ophthalmic solution 0.4-0.3 % .. LIALDA ...... loradamed ...... lubricant eye pm ...... lice killing ...... lorata-d ...... lubricant pm ...... lice killing max st ...... loratadine allergy relief oral tablet 10 mg ...... lubricating eye drop ...... lice killing max strength ...... loratadine allergy relief oral tablet dispersible lubricating eye drops ophthalmic solution lice killing maximum strength ...... 10 mg ...... 0.4-0.3 % ...... lice maximum strength ...... loratadine childrens oral solution 5 mg/5ml .. lubricating eye/overnight ...... lice treatment ...... loratadine childrens oral syrup 5 mg/5ml ...... lubricating plus ...... lice treatment creme rinse ...... lorata-dine d ...... lubricating plus eye drops ...... lice treatment external shampoo 0.33-4 %.... loratadine d 12hr ...... lubricating tears ...... lidocaine external cream 4 % ...... loratadine oral syrup 5 mg/5ml ...... lubricating tears eye drops ...... lidocaine external patch 5 % ...... loratadine oral tablet ...... LUMIGAN ...... lidocaine hcl external cream 3 % ...... loratadine oral tablet dispersible 10 mg ...... LUNESTA ORAL TABLET 1 MG ...... lidocaine hcl urethral/mucosal ...... loratadine-d ...... LUNESTA ORAL TABLET 2 MG, 3 MG ...... lidocaine viscous hcl ...... loratadine-d 12hr ...... LUPANETA PACK ...... lidocaine-prilocaine external cream ...... loratadine-d 24hr ...... LUPRON DEPOT (1-MONTH) ...... lidopin external cream 3 % ...... lorazepam injection solution 2 mg/ml ...... LUPRON DEPOT (3-MONTH) ...... lillow ...... lorazepam oral tablet ...... LUPRON DEPOT (4-MONTH) linezolid oral suspension reconstituted ...... LORBRENA ...... INTRAMUSCULAR KIT 30MG ...... linezolid oral tablet ...... losartan potassium oral ...... LUPRON DEPOT (6-MONTH) LINZESS ...... losartan potassium-hctz ...... INTRAMUSCULAR KIT 45MG ...... liothyronine sodium oral ...... LOTRIMIN AF EXTERNAL POWDER ...... LUPRON DEPOT-PED (1-MONTH) ...... liquibid ...... lovastatin oral ...... LUPRON DEPOT-PED (3-MONTH) ...... liquid acetaminophen ...... low-ogestrel ...... lutera ...... liquid allergy relief ...... loxapine succinate ...... LUXIQ ...... liquid pain relief ...... LUBIPROSTONE ...... lyleq ...... lisinopril oral ...... lubricant drops fast act ...... LYNPARZA ...... lisinopril-hydrochlorothiazide ...... lubricant drops long last ...... lysiplex plus oral tablet ...... lithium ...... lubricant drops ophthalmic gel 0.25-0.3 % .... LYSODREN ...... lithium carbonate er ...... lubricant drops ophthalmic solution ...... LYUMJEV ...... lithium carbonate oral ...... lubricant eye drops (pf) ...... lyza ...... little ones childrens ...... lubricant eye drops ophthalmic solution 0.4- M LMX 4 ...... 0.3 % ...... MAALOX ...... LOKELMA ...... lubricant eye drops ophthalmic solution 0.5 MAALOX CHILDRENS ...... long acting nasal spray ...... % ...... MAALOX MAX ORAL SUSPENSION ...... long lasting antacid ...... MAALOX MULTI SYMPTOM MAX ST ......

159 mag-al plus ...... medi-first triple antibiotic ...... metformin hcl er oral tablet extended release mag-al plus xs ...... mediproxen ...... 24 hour 750 mg ...... magnesium citrate oral solution ...... MEDISENSE GLUCOSE KETONE CONTR. metformin hcl oral tablet ...... magnesium oral tablet 500 mg ...... MEDISENSE HI/MID/LOW CONTROL ...... methadone hcl oral tablet soluble ...... magnesium oxide oral tablet 400 (241.3 mg) MEDISENSE HIGH/LOW CONTROL ...... methadose oral tablet soluble ...... mg ...... MEDISENSE MID CONTROL ...... methazolamide oral ...... magnesium oxide oral tablet 400 mg ...... MEDROL ORAL TABLET 2 MG ...... methenamine hippurate ...... magnesium oxide oral tablet 420 mg ...... medroxyprogesterone acetate intramuscular methergine ...... magnesium oxide oral tablet 500 mg ...... medroxyprogesterone acetate oral ...... methimazole oral ...... magnesium-oxide ...... mefloquine hcl ...... methocarbamol oral ...... malathion ...... mega probiotic ...... methotrexate oral ...... MAOX ...... megestrol acetate oral suspension 40 mg/ml methotrexate sodium (pf) ...... mapap acetaminophen extra str...... megestrol acetate oral tablet 20 mg ...... methotrexate sodium injection ...... mapap arthritis pain ...... megestrol acetate oral tablet 40 mg ...... methotrexate sodium oral ...... mapap childrens ...... meijer allergy relief-d ...... methoxsalen rapid ...... mapap oral capsule ...... meijer antacid ...... methyldopa ...... maprotiline hcl oral tablet 25 mg ...... meijer anti-diarrheal ...... methyldopa-hydrochlorothiazide ...... maprotiline hcl oral tablet 50 mg, 75 mg ...... MEKINIST ...... methylergonovine maleate oral ...... marlissa ...... meloxicam oral tablet ...... METHYLIN ...... MASK VORTEX/CHILD/FROG ...... melphalan ...... methylphenidate hcl er (cd) ...... MASK VORTEX/TODDLER/LADYBUG ...... memantine hcl oral solution 2 mg/ml ...... methylphenidate hcl er (la) oral capsule MATULANE ...... memantine hcl oral tablet ...... extended release 24 hour 20 mg, 30 mg, MAVENCLAD (10 TABS) ...... MENACTRA ...... 40 mg ...... MAVENCLAD (4 TABS) ...... MENEST ...... methylphenidate hcl er oral tablet extended MAVENCLAD (5 TABS) ...... MENOSTAR ...... release 10 mg, 20 mg ...... MAVENCLAD (6 TABS) ...... MENQUADFI ...... methylphenidate hcl er oral tablet extended MAVENCLAD (7 TABS) ...... MENVEO ...... release 18 mg, 27 mg, 36 mg, 54 mg ...... MAVENCLAD (8 TABS) ...... mercaptopurine oral ...... methylphenidate hcl er oral tablet extended MAVENCLAD (9 TABS) ...... meropenem solution reconstituted 500 mg release 24 hour ...... MAVYRET ...... intravenous ...... methylphenidate hcl oral tablet ...... maxi-tuss ac ...... MEROPENEM-SODIUM CHLORIDE methylprednisolone oral ...... maxi-tuss gmx ...... INTRAVENOUS SOLUTION metoclopramide hcl oral solution ...... maxi-tuss pe max ...... RECONSTITUTED 1 GM/50ML ...... metoclopramide hcl oral tablet ...... MAYZENT ...... mesalamine oral capsule delayed release metolazone ...... m-clear wc ...... 400 mg ...... metoprolol succinate er ...... m-dryl ...... mesalamine rectal ...... metoprolol tartrate oral tablet 100 mg, 50 mg meclizine hcl oral tablet 12.5 mg ...... MESNEX ORAL ...... metoprolol tartrate oral tablet 25 mg ...... meclizine hcl oral tablet 25 mg ...... metformin hcl er (osm) ...... METROGEL ...... meclizine hcl oral tablet chewable ...... metformin hcl er oral tablet extended release metronidazole external ...... medifin 400 ...... 24 hour 500 mg ...... metronidazole oral tablet ......

160 metronidazole vaginal ...... mintox plus ...... MOTRIN IB ORAL TABLET ...... mexiletine hcl oral ...... MIRALAX ORAL POWDER ...... MOTRIN INFANTS DROPS ...... mi-acid gas relief ...... MIRCERA INJECTION SOLUTION MOVANTIK ...... micaderm ...... PREFILLED SYRINGE 100 MCG/0.3ML, MOXEZA ...... miconazole 3 ...... 200 MCG/0.3ML, 50 MCG/0.3ML, 75 MOZOBIL ...... miconazole 3 applicator vaginal kit 200 & 2 MCG/0.3ML ...... m-pap ...... mg-% (9gm) ...... mirtazapine oral tablet 15 mg, 30 mg ...... MUCINEX CHILDRENS FREEFROM ORAL miconazole 3 combo pack app...... mirtazapine oral tablet 45 mg, 7.5 mg ...... LIQUID 5-100 MG/5ML ...... miconazole 3 combo pack vaginal kit 200 & MIRVASO ...... MUCINEX CHILDRENS STUFFY NOSE ...... 2 mg-% (9gm) ...... misoprostol oral ...... MUCINEX COUGH CHILDRENS ...... miconazole 7 day treatment ...... MITIGARE ...... MUCINEX D ...... miconazole 7 vaginal cream 2 % ...... mm arthritis pain ...... MUCINEX D MAX STRENGTH ...... miconazole 7 vaginal suppository 100 mg .... mm cetirizine hcl ...... MUCINEX DM ...... miconazole antifungal ...... mm clearlax ...... MUCINEX FAST-MAX DM MAX ...... miconazole nitrate external ...... mm stool softener laxative ...... MUCINEX MAXIMUM STRENGTH ...... miconazole nitrate vaginal ...... M-M-R II ...... MUCINEX SINUS-MAX CLEAR & COOL ..... miconazorb af ...... M-NATAL PLUS ...... MUCINEX SINUS-MAX SINUS/ALLRGY ...... microgestin 1.5/30 ...... mometasone furoate external ...... mucus & cough relief child ...... microgestin 1/20 ...... mondoxyne nl oral capsule 100 mg ...... mucus & cough relief childrens ...... microgestin fe 1.5/30 ...... mono-linyah ...... mucus d ...... microgestin fe 1/20 ...... montelukast sodium oral ...... mucus d extended release ...... midodrine hcl ...... mood support probiotic ...... mucus d max st er ...... MIGERGOT ...... morgidox oral ...... mucus dm ...... migraine formula ...... morphine sulfate (concentrate) oral solution mucus er oral tablet extended release 12 migraine relief ...... 100 mg/5ml, 20 mg/ml ...... hour 1200 mg ...... mili ...... morphine sulfate er oral tablet extended mucus extended release oral tablet milk of magnesia ...... release ...... extended release 12 hour 1200 mg ...... mimvey ...... morphine sulfate injection solution 2 mg/ml, mucus relief chest oral tablet 400 mg ...... mineral oil enema ...... 4 mg/ml ...... mucus relief cough children ...... mineral oil heavy oral ...... morphine sulfate intravenous solution 50 mucus relief cough childrens ...... mineral oil oral oil ...... mg/ml ...... mucus relief d max strength ...... MINERAL OIL ORAL OIL ...... morphine sulfate oral ...... mucus relief d oral tablet extended release mineral oil rectal enema ...... morphine sulfate rectal ...... 12 hour 60-600 mg ...... mini nicotine ...... MOTEGRITY ...... mucus relief dm max oral liquid ...... minitran ...... motion sickness oral tablet 50 mg ...... mucus relief dm oral liquid ...... MINIVELLE ...... motion sickness relief oral tablet 50 mg ...... mucus relief dm oral tablet extended release minocycline hcl oral capsule 100 mg ...... motion sickness relief oral tablet chewable 12 hour 30-600 mg ...... minocycline hcl oral capsule 50 mg ...... 25 mg ...... mucus relief er oral tablet extended release minoxidil oral ...... motion-time ...... 12 hour 1200 mg ...... mintox maximum strength ...... MOTRIN CHILDRENS ...... mucus relief max st ......

161 mucus relief max strength oral tablet N nasal spray extra moist ...... extended release 12 hour 1200 mg ...... nabumetone oral ...... nasal spray extra moisturizing ...... mucus relief oral tablet ...... nafcillin sodium solution reconstituted 1 gm nasal spray fast acting ...... mucus-d ...... injection ...... nasal spray moisturizing ...... mucus-dm ...... nafrinse ...... nasal spray no drip ...... mucus-er oral tablet extended release 12 nafrinse drops ...... nasal spray saline ...... hour 1200 mg ...... naloxone hcl injection solution ...... nasal spray sinus ...... MULPLETA ...... naloxone hcl injection solution cartridge ...... NASALCROM ...... MULTAQ ...... naloxone hcl injection solution prefilled nateglinide ...... multi vitamin ...... syringe ...... natural daily fiber ...... multi vitamin w/d-3 ...... naltrexone hcl oral ...... natural fiber laxative oral powder 58.6 % ...... multiple vitamin-folic acid ...... NAPHCON-A ...... natural fiber oral capsule 0.52 gm ...... multiple vitamins essential ...... naproxen oral ...... natural fiber oral powder 28.3 %, 48.57 % .... multiple vitamins/iron ...... naproxen sodium oral tablet 220 mg ...... natural fiber oral powder 58.6 % ...... MULTIPRO ...... NARAMIN ...... natural fiber supplement ...... multi-vit/iron/fluoride ...... naratriptan hcl ...... natural laxative ...... multi-vitamin ...... NARCAN ...... natural laxative/stool soft ...... multi-vitamin/fluoride ...... NASACORT ALLERGY 24HR ...... natural senna laxative ...... multivitamin/fluoride oral solution ...... NASACORT ALLERGY 24HR CHILDREN ... natural tears pf ...... multivitamin/fluoride oral tablet chewable nasal allergy 24 hour ...... natural vegetable ...... 0.25 mg, 0.5 mg, 1 mg ...... nasal allergy nasal aerosol 55 mcg/act ...... natural vegetable fiber ...... multi-vitamin/fluoride/iron ...... nasal allergy spray ...... natural vegetable laxative ...... multi-vitamin/iron ...... nasal decongestant 12 hour ...... natural vitamin e ...... mupirocin external ...... nasal decongestant 12hr ...... natura-lax ...... MURO 128 OPHTHALMIC OINTMENT ...... nasal decongestant max st ...... nausea control ...... MURO 128 OPHTHALMIC SOLUTION 5 % . nasal decongestant oral tablet 30 mg ...... nausea relief ...... my choice ...... nasal decongestant oral tablet extended NAYZILAM ...... my way ...... release 12 hour 120 mg ...... necon 0.5/35 (28) ...... mycophenolate mofetil oral ...... nasal decongestant pe max st ...... NEODOT THERMOMETER ...... mycophenolate sodium ...... nasal decongestant pe oral tablet 10 mg ...... NEOMULTIVITE ...... MYCOZYL AP ...... nasal decongestant spray ...... neomycin sulfate oral ...... MYDAYIS ...... nasal four ...... neomycin-bacitracin zn-polymyx ...... myferon 150 ...... nasal mist nasal solution ...... neomycin-polymyxin-dexameth ophthalmic myferon 150 forte ...... NASAL MOIST NASAL SOLUTION...... ointment ...... MYLERAN ...... nasal moisturizing spray ...... neomycin-polymyxin-dexameth ophthalmic mynephrocaps ...... nasal relief ...... suspension 3.5-10000-0.1 ...... MYNEPHRON ...... nasal relief moisturizing ...... neomycin-polymyxin-gramicidin ...... myorisan ...... nasal spray ...... neomycin-polymyxin-hc otic ...... MYRBETRIQ ...... nasal spray 12 hour ...... NEONATAL COMPLETE ...... MYTESI ...... nasal spray anti-drip ...... NEONATAL PLUS ......

162 NEONATAL VITAMIN ...... niacor ...... nitroglycerin translingual ...... neo-polycin ...... NICODERM CQ ...... NITYR ...... neo-polycin hc ...... NICORETTE ...... NIVA-PLUS ...... NEOSPORIN ORIGINAL ...... NICORETTE MINI ...... NIVESTYM ...... NEO-SYNEPHRINE COLD/ALLRG MILD .... NICORETTE STARTER KIT ...... no drip nasal relief ...... NEO-SYNEPHRINE COLD/ALLRGY EXT .... nicotine gum mouth/throat gum 2 mg ...... no drip nasal spray ...... NEO-SYNEPHRINE COLD/ALLRGY REG ... nicotine gum mouth/throat gum 4 mg ...... NOCDURNA ...... nephro vitamins ...... nicotine gum mouth/throat lozenge 2 mg ...... nohist-lq ...... NEPHRO-VITE ...... nicotine gum mouth/throat lozenge 4 mg ...... non-aspirin ...... NESINA ...... nicotine mini ...... non-aspirin 8 hour ...... NEULASTA ...... nicotine mouth/throat gum 2 mg ...... non-aspirin childrens ...... NEULASTA ONPRO ...... nicotine mouth/throat gum 4 mg ...... non-aspirin extra strength ...... NEUPOGEN INJECTION SOLUTION 300 nicotine mouth/throat lozenge 2 mg ...... non-aspirin jr strength ...... MCG/ML ...... nicotine mouth/throat lozenge 4 mg ...... non-aspirin pain relief ...... NEUPOGEN INJECTION SOLUTION 480 nicotine polacrilex mini ...... non-pseudo sinus decongestant ...... MCG/1.6ML ...... nicotine polacrilex mouth/throat ...... nora-be ...... NEUPOGEN INJECTION SOLUTION nicotine step 1 ...... NORDITROPIN FLEXPRO ...... PREFILLED SYRINGE ...... nicotine step 2 ...... norethin ace-eth estrad-fe oral tablet ...... NEUTEK 2TEK CONTROL ...... nicotine step 3 ...... norethindrone acetate oral ...... NEUTROGENA OIL-FREE ACNE WASH .... nicotine transdermal patch 24 hour 14 norethindrone acet-ethinyl est ...... NEVANAC ...... mg/24hr, 7 mg/24hr ...... norethindrone oral ...... nevirapine ...... nicotine transdermal patch 24 hour 21 norgestimate-eth estradiol ...... nevirapine er ...... mg/24hr ...... norgestimate-ethinyl estradiol triphasic oral new day ...... nicotine transdermal system ...... tablet 0.18/0.215/0.25 mg-35 mcg ...... NEXAVAR ...... NICOTROL ...... NORITATE ...... NEXIUM ORAL CAPSULE DELAYED NICOTROL NS ...... norlyda ...... RELEASE ...... nifedipine er ...... norlyroc ...... NEXIUM ORAL PACKET 10 MG, 20 MG, 40 nifedipine er osmotic release ...... NORPACE ...... MG ...... nifedipine oral ...... NORPACE CR ...... NEXIUM ORAL PACKET 2.5 MG, 5 MG ...... nighttime dry-eye relief ...... nortrel 0.5/35 (28) ...... NEXLETOL ...... nimodipine oral ...... nortrel 1/35 (21) ...... NEXLIZET ...... NINLARO ...... nortrel 1/35 (28) ...... niacin (antihyperlipidemic) ...... nitazoxanide ...... nortrel 7/7/7 ...... niacin er (antihyperlipidemic) ...... NITRO-BID ...... nortriptyline hcl oral ...... niacin er oral capsule extended release 250 NITRO-DUR ...... NORVIR ORAL PACKET ...... mg ...... nitrofurantoin ...... NORVIR ORAL SOLUTION ...... niacin er oral capsule extended release 500 nitrofurantoin macrocrystal ...... nose drops extstrength ...... mg ...... nitrofurantoin monohydrate macrocrystals .... nose drops nasal decongest ...... niacin er oral tablet extended release ...... nitroglycerin sublingual ...... nose drops nasal solution 1 % ...... niacin oral tablet 100 mg, 250 mg, 50 mg ..... nitroglycerin transdermal ...... NOVAMV PEDIATRIC MULTI-VITAMIN ......

163 novarel intramuscular solution reconstituted nystatin mouth/throat ...... ONE VITE WOMENS ...... 10000 unit ...... nystatin oral ...... ONE VITE WOMENS PLUS ...... NOVAREL INTRAMUSCULAR SOLUTION nystop ...... one-daily multi vitamins ...... RECONSTITUTED 5000 UNIT ...... NYVEPRIA ...... one-daily multi-vitamin oral tablet ...... NOVOLIN 70/30 FLEXPEN ...... O one-daily multi-vitamin/iron ...... NOVOLIN 70/30 RELION...... O-CAL PRENATAL ...... one-daily/iron ...... NOVOLIN 70/30 VIAL ...... OCEAN FOR KIDS ...... ONETOUCH ULTRA ...... NOVOLIN N FLEXPEN ...... OCEAN NASAL SPRAY ...... ONETOUCH ULTRA 2 KIT W/DEVICE ...... NOVOLIN N RELION ...... octreotide acetate ...... ONETOUCH ULTRA CONTROL ...... NOVOLIN N VIAL...... ODEFSEY ...... ONETOUCH ULTRA MINI KIT W/DEVICE ... NOVOLIN R FLEXPEN ...... ODOMZO ...... ONETOUCH VERIO FLEX SYSTEM KIT NOVOLIN R RELION ...... OFEV ...... W/DEVICE ...... , NOVOLIN R VIAL...... ofloxacin ophthalmic ...... ONETOUCH VERIO IN VITRO SOLUTION .. NOVOLOG FLEXPEN...... ofloxacin oral ...... ONETOUCH VERIO IQ SYSTEM ...... NOVOLOG MIX 70/30 FLEXPEN ...... ofloxacin otic ...... ONETOUCH VERIO KIT W/DEVICE ...... NOVOLOG MIX 70/30 VIAL ...... ointment base ...... ONETOUCH VERIO REFLECT KIT NOVOLOG PENFILL ...... olanzapine intramuscular ...... W/DEVICE ...... , NOVOLOG U-100 VIAL ...... olanzapine oral tablet ...... ONETOUCH VERIO SYNC SYSTEM ...... NOVOTWIST PEN NEEDLE...... olanzapine oral tablet dispersible ...... ONETOUCH VERIO TEST STRIPS ...... NUBEQA ...... olopatadine hcl ophthalmic ...... ONEXTON ...... NUCALA SUBCUTANEOUS SOLUTION OLUMIANT ...... ONGLYZA ...... AUTO-INJECTOR ...... OLUX ...... opcicon one-step ...... NUCALA SUBCUTANEOUS SOLUTION OLUX-E ...... OPSUMIT ...... PREFILLED SYRINGE ...... OMECLAMOX-PAK ...... option 2 ...... NUCYNTA ER ...... omega-3-acid ethyl esters ...... ORACEA ...... NUEDEXTA ...... omeprazole magnesium oral capsule oralone ...... NU-IRON ...... delayed release...... oralyte freezer pops ...... NULEV ...... omeprazole magnesium oral tablet delayed ORENCIA CLICKJECT ...... NURTEC ...... release ...... ORENCIA SUBCUTANEOUS ...... NUTRAPLUS ...... omeprazole oral capsule delayed release 10 ORFADIN ...... nutrifac zx ...... mg, 20 mg, 20.6 (20 base) mg, 40 mg ...... ORIAHNN ...... NUTROPIN AQ NUSPIN 10 ...... omeprazole oral tablet delayed release 20 ORILISSA ...... NUTROPIN AQ NUSPIN 20 ...... mg ...... ORKAMBI ...... NUTROPIN AQ NUSPIN 5 ...... OMNARIS ...... orphenadrine citrate er ...... NUZYRA ORAL ...... OMNIFLEX DIAPHRAGM ...... orsythia ...... nyamyc ...... OMNITROPE ...... OS-CAL CALCIUM + D3 ...... nylia 7/7/7 ...... once daily ...... oscimin ...... NYMALIZE ...... ondansetron hcl oral tablet ...... oscimin sr ...... nymyo ...... ondansetron odt ...... oseltamivir phosphate oral capsule ...... nystatin external ...... one daily ......

164 oseltamivir phosphate oral suspension OZEMPIC SUBCUTANEOUS SOLUTION pain-off ...... reconstituted ...... PEN-INJECTOR 2 MG/1.5ML ...... paliperidone er ...... OSENI ...... P PANADOL CHILDRENS ...... OSPHENA ...... p col-rite ...... PANADOL EXTRA STRENGTH ...... OTEZLA ...... PACERONE ...... PANADOL INFANTS ...... OTREXUP ...... pain & fever child ...... PANCREAZE ORAL CAPSULE DELAYED OVACE PLUS WASH EXTERNAL LIQUID .. pain & fever childrens oral suspension 160 RELEASE PARTICLES 10500-35500 OVACE WASH ...... mg/5ml ...... UNIT, 16800-56800 UNIT, 21000-54700 OVIDREL ...... pain & fever infants ...... UNIT, 4200-14200 UNIT ...... oxaprozin ...... pain relief childrens oral suspension 160 PANOXYL ...... oxazepam ...... mg/5ml ...... PANRETIN ...... OXBRYTA ...... pain relief childrens oral tablet chewable 160 pantoprazole sodium oral packet ...... oxcarbazepine oral suspension ...... mg ...... pantoprazole sodium oral tablet delayed oxcarbazepine oral tablet ...... pain relief extra st ...... release ...... oxybutynin chloride er ...... pain relief extra strength ...... paromomycin sulfate oral ...... oxybutynin chloride oral ...... pain relief infants oral suspension 160 paroxetine hcl ...... oxycodone hcl oral concentrate 100 mg/5ml . mg/5ml ...... PASER ...... oxycodone hcl oral solution ...... pain relief oral liquid 500 mg/15ml ...... PATADAY OPHTHALMIC SOLUTION 0.1 % oxycodone hcl oral tablet 10 mg, 20 mg ...... pain relief oral tablet 325 mg ...... PATADAY OPHTHALMIC SOLUTION 0.2 % oxycodone hcl oral tablet 15 mg, 30 mg ...... pain relief oral tablet 500 mg ...... ped electrolyte freeze pop ...... oxycodone-acetaminophen oral tablet 10- pain relief oral tablet extended release 650 ped electrolyte freezer pops ...... 325 mg, 5-325 mg, 7.5-325 mg ...... mg ...... PEDIA-LAX ORAL LIQUID ...... oxycodone-aspirin ...... pain relief regular st ...... PEDIA-LAX RECTAL SUPPOSITORY 1 GM OXYCONTIN ...... pain relief regular strength ...... PEDIALYTE FREEZER POPS ...... oxymorphone hcl er ...... pain relief/rapid burst ...... PEDIALYTE ORAL SOLUTION ...... OXYTROL FOR WOMEN ...... pain relieve child dye-free ...... PEDIALYTE SINGLES ...... oysco 500+d ...... pain reliever childrens oral suspension 160 pediatric electrolyte oral solution ...... oyster shell calcium 500 + d ...... mg/5ml ...... pediavit ...... oyster shell calcium oral tablet 500 mg ...... pain reliever ex st oral liquid 500 mg/15ml ... peg 3350 oral powder ...... oyster shell calcium plus d oral tablet 500- pain reliever ex st oral tablet 500 mg ...... peg 3350-kcl-na bicarb-nacl ...... 200 mg-unit ...... pain reliever ex st oral tablet extended peg-3350/electrolytes ...... oyster shell calcium/d oral tablet 250-125 release 650 mg ...... PEGASYS ...... mg-unit ...... pain reliever extra strength oral tablet 250- penicillamine oral tablet ...... oyster shell calcium/d oral tablet 250-250 250-65 mg ...... penicillin v potassium ...... mg-unit, 500-400 mg-unit ...... pain reliever extra strength oral tablet 500 pentamidine isethionate inhalation ...... oyster shell calcium/d oral tablet 500-200 mg ...... PENTASA ...... mg-unit ...... pain reliever infants oral suspension 160 pentazocine-naloxone hcl ...... oyster shell calcium/vit d ...... mg/5ml ...... pentoxifylline er ...... oyster shell calcium/vitamin d oral tablet...... pain reliever oral tablet ...... peptic relief ...... pain reliever plus ......

165 PEPTO-BISMOL ORAL SUSPENSION 524 pilocarpine hcl oral tablet 7.5 mg ...... potassium chloride crys er ...... MG/30ML ...... pimecrolimus ...... potassium chloride er oral capsule extended PERDIEM OVERNIGHT RELIEF ...... pimozide ...... release 10 meq ...... PERFOROMIST ...... pimtrea ...... potassium chloride er oral tablet extended periogard ...... pink bismuth maximum strength ...... release ...... permethrin external ...... pink bismuth oral suspension 262 mg/15ml .. potassium chloride oral packet ...... perphenazine oral ...... pink bismuth oral tablet 262 mg ...... potassium chloride oral solution 20 perphenazine-amitriptyline oral tablet 2-10 pink bismuth oral tablet chewable 262 mg .... meq/15ml (10%), 40 meq/15ml (20%) ...... mg, 4-10 mg, 4-25 mg, 4-50 mg ...... pink-bismuth ...... potassium citrate er oral tablet extended perphenazine-amitriptyline oral tablet 2-25 pioglitazone hcl ...... release 10 meq (1080 mg) ...... mg ...... piperacillin sod-tazobactam so intravenous potassium citrate er oral tablet extended PERSERIS ...... solution reconstituted 4.5 (4-0.5) gm ...... release 15 meq (1620 mg) ...... pharbedryl ...... PIQRAY (200 MG DAILY DOSE) ...... potassium citrate er oral tablet extended PHARBETOL EXTRA STRENGTH ...... PIQRAY (250 MG DAILY DOSE) ...... release 5 meq (540 mg) ...... PHARBETOL ORAL TABLET 325 MG ...... PIQRAY (300 MG DAILY DOSE) ...... potassium citrate-citric acid ...... pharbinex ...... pirmella 1/35 ...... povidone iodine ...... PHAZYME ...... pirmella 7/7/7 ...... povidone-iodine external solution ...... PHAZYME ULTRA STRENGTH ...... piroxicam oral ...... PRADAXA ...... phenazo oral tablet 200 mg ...... PLAN B ONE-STEP ...... PRALUENT ...... phenazo oral tablet 95 mg ...... PLEGRIDY STARTER PACK ...... pramipexole dihydrochloride oral tablet phenazopyridine hcl oral tablet 100 mg ...... PLEGRIDY SUBCUTANEOUS ...... 0.125 mg, 0.5 mg, 1 mg ...... phenazopyridine hcl oral tablet 200 mg ...... PNEUMOVAX 23 ...... pramipexole dihydrochloride oral tablet 0.25 phenobarbital oral elixir ...... pnv tabs 29-1 ...... mg, 1.5 mg ...... phenobarbital oral tablet ...... podofilox external ...... pramipexole dihydrochloride oral tablet 0.75 phenylephrine hcl ophthalmic ...... poly bacitracin ...... mg ...... phenylephrine hcl oral ...... polycin ...... prasugrel hcl ...... phenytoin infatabs ...... polyethylene glycol 3350 oral powder ...... praziquantel oral ...... phenytoin oral suspension 125 mg/5ml ...... polyethylene glycol 3350-grx oral powder..... prazosin hcl oral ...... phenytoin oral tablet chewable ...... poly-iron 150 ...... PRECISION GLUCOSE CONTROL ...... phenytoin sodium extended ...... poly-iron 150 forte ...... PRECISION GLUCOSE CONTROL SOLN ... philith ...... polymyxin b-trimethoprim ...... PRECISION GLUCOSE KETONE CONTR ... PHILLIPS MILK OF MAGNESIA ORAL polysaccharide iron complex ...... PRECISION GLUCOSE/KETONE CONTR ... SUSPENSION 400 MG/5ML ...... polysaccharide iron forte ...... PRECISION LINK ...... phosphorous ...... polysaccharide-iron complex ...... PRECISION PCX PLUS TEST ...... phospho-trin 250 neutral ...... POLYSPORIN ...... PRECISION POINT OF CARE TEST ...... phytonadione injection solution 10 mg/ml ..... polyvinyl alcohol ophthalmic ...... PRECISION QID MONITOR ...... phytonadione oral ...... POLY-VI-SOL ...... PRECISION QID TEST ...... PIFELTRO ...... POLY-VITE PEDIATRIC ...... PRECISION SOF-TACT MONITOR ...... pilocarpine hcl ophthalmic ...... POMALYST ...... PRECISION XTRA BLOOD GLUCOSE ...... pilocarpine hcl oral tablet 5 mg ...... portia-28 ...... PRECISION XTRA DEVICE ......

166 PRECISION XTRA MONITOR ...... prevalite oral powder ...... promethazine-phenyleph-codeine ...... PRED MILD ...... PREVIDENT 5000 DRY MOUTH ...... promethazine-phenylephrine ...... PRED-G S.O.P...... PREVIDENT 5000 PLUS ...... promethegan ...... prednisolone acetate ophthalmic ...... PREVIDENT DENTAL ...... PRONUTRIENTS VITAMIN D3 ...... prednisolone acetate p-f ...... PREVIDENT MOUTH/THROAT ...... propafenone hcl ...... prednisolone oral solution ...... previfem ...... propranolol hcl er ...... prednisolone sodium phosphate ophthalmic . PREVNAR 13 ...... propranolol hcl oral solution 20 mg/5ml ...... prednisolone sodium phosphate oral solution PREZCOBIX ...... propranolol hcl oral solution 40 mg/5ml ...... 15 mg/5ml ...... PREZISTA ...... propranolol hcl oral tablet ...... prednisolone sodium phosphate oral solution PRIFTIN ...... propranolol-hctz ...... 6.7 (5 base) mg/5ml ...... PRILOSEC ...... propylthiouracil oral ...... prednisone oral ...... primaquine phosphate oral tablet 26.3 mg ... PROTOPIC EXTERNAL OINTMENT 0.03 % PREFEST ...... primidone oral ...... PROTOPIC EXTERNAL OINTMENT 0.1 % .. pregabalin oral ...... PRISTIQ ...... PROVENTIL HFA ...... pregnyl ...... PROAIR HFA ...... pseudoephedrine hcl 12 hr ...... PREMARIN ORAL ...... probenecid ...... pseudoephedrine hcl er ...... PREMARIN VAGINAL ...... pro-biotic blend ...... pseudoephedrine hcl oral tablet 30 mg ...... PREMIUM CONDOMS LUBRICATED ...... probiotic colon care ...... pseudoephedrine-bromphen-dm ...... PREMPHASE ...... probiotic complex ...... pseudoephedrine-guaifenesin er ...... PREMPRO ...... probiotic maximum strength ...... psyldex ...... PRENATABS RX ...... probiotic oral capsule ...... PULMICORT FLEXHALER ...... prenatal formula oral tablet 28-0.8 mg ...... probiotic oral capsule 250 mg ...... PULMOZYME ...... prenatal gummy oral tablet chewable 0.4-25 probiotic pearls ex st ...... PURALUBE ...... mg ...... prochlorperazine ...... pure & gentle lubricant ...... prenatal multi+dha ...... prochlorperazine maleate oral ...... purelax oral powder ...... prenatal multivitamins ...... PROCRIT ...... PYLERA ...... prenatal oral tablet 27-0.8 mg ...... PROCTOFOAM HC ...... pyrazinamide oral ...... prenatal oral tablet 27-1 mg ...... procto-med hc ...... PYRIDIUM ...... prenatal oral tablet 28-0.8 mg ...... proctozone-hc ...... pyridostigmine bromide er ...... prenatal plus iron ...... progesterone oral ...... pyridostigmine bromide oral solution ...... prenatal vitamin plus low iron ...... PROLENSA ...... pyridostigmine bromide oral tablet 60 mg ...... prenatal vitamins oral tablet 28-0.8 mg ...... PROMACTA ORAL PACKET 25 MG ...... pyridoxine hcl oral ...... prenatal/iron ...... PROMACTA ORAL TABLET ...... pyrimethamine oral ...... PRENATAL-U ...... promethazine hcl injection solution 25 mg/ml Q PRENATVITE RX ...... promethazine hcl oral ...... QBREXZA ...... preplus ...... promethazine hcl rectal ...... QSYMIA ...... PRETAB ...... promethazine vc ...... QTERN ...... PREVACID 24HR ...... promethazine vc/codeine ...... quetiapine fumarate ...... PREVACID ORAL CAPSULE DELAYED promethazine-codeine ...... quetiapine fumarate er ...... RELEASE 30 MG ...... promethazine-dm ......

167 QUFLORA PEDIATRIC ORAL SOLUTION RENAL MULTIVITAMIN FORMULA ...... ritonavir ...... 0.5 MG/ML ...... renal-vite ...... rivastigmine ...... quinapril hcl ...... rena-vite ...... rivastigmine tartrate ...... quinapril-hydrochlorothiazide ...... renewal soothing bath ...... rizatriptan benzoate ...... quinidine gluconate er ...... repaglinide ...... robafen cf multi-symptom cold ...... quinidine sulfate ...... REPATHA ...... ROBITUSSIN 12 HOUR COUGH ...... QUINTET CONTROL HIGH/NORMAL ...... RESTASIS ...... ROBITUSSIN 12 HOUR COUGH CHILD ...... quit2 ...... RESTASIS MULTIDOSE ...... ROBITUSSIN CHILD COUGH/COLD LA ...... quit4 ...... RESTORA ...... ROBITUSSIN CHILDRENS COUGH LA ...... QVAR REDIHALER ...... RESTORA RX ...... ROBITUSSIN COUGH+CHEST CONG DM R restore plus lubricant eye ...... ORAL LIQUID 20-400 MG/20ML ...... radiance platinum vitamin d3 ...... restore pm ...... ROBITUSSIN NIGHTTIME COUGH ...... raloxifene hcl ...... RETACRIT ...... ROBITUSSIN PEAK COLD MULTI-SYM ...... ramipril ...... RETIN-A EXTERNAL CREAM ...... ropinirole hcl ...... ranolazine er ...... RETIN-A EXTERNAL GEL ...... rosadan external cream ...... RASUVO ...... RETIN-A MICRO GEL 0.04 %, 0.1 % ...... rosadan external gel ...... RAVICTI ...... RETIN-A MICRO PUMP EXTERNAL GEL rosuvastatin calcium ...... react ...... 0.06 % ...... roweepra ...... ready-to-use enema rectal enema ...... REVLIMID ...... ROZEREM ...... REBIF ...... REXULTI ...... ROZLYTREK ...... REBIF REBIDOSE ...... REYATAZ ORAL CAPSULE ...... RUBRACA ...... REBIF REBIDOSE TITRATION PACK ...... REYATAZ ORAL PACKET ...... RUCONEST ...... REBIF TITRATION PACK ...... REYVOW ...... rufinamide ...... reclipsen ...... RHOFADE ...... RUZURGI ...... RECOMBIVAX HB ...... ribavirin oral ...... RYBELSUS ...... RECTIV ...... RID LICE KILLING SHAMPOO ...... RYDAPT ...... REDITREX ...... rifabutin ...... rynex dm ...... redness relief ophthalmic solution 0.012-0.2 rifampin oral ...... rynex pe ...... % ...... riluzole ...... rynex pse ...... refenesen 400 ...... rimantadine hcl ...... RYTHMOL SR ORAL CAPSULE REFRESH LACRI-LUBE ...... RINVOQ ...... EXTENDED RELEASE 12 HOUR 225 REFRESH P.M...... RISAQUAD ...... MG, 325 MG ...... REFRESH PLUS ...... RISAQUAD-2 ...... RYTHMOL SR ORAL CAPSULE REFRESH TEARS ...... RISPERDAL CONSTA ...... EXTENDED RELEASE 12 HOUR 425 MG REGRANEX ...... RISPERDAL ORAL SOLUTION ...... REHYDRALYTE ...... RISPERDAL ORAL TABLET ...... S RELENZA DISKHALER ...... risperidone oral solution ...... saccharomyces boulardii ...... relief eye drops ...... risperidone oral tablet ...... SAIZEN ...... RELISTOR ...... risperidone oral tablet dispersible ...... saline enema ...... RENAL ...... RITALIN ...... saline mist spray ......

168 saline nasal spray ...... SEREVENT DISKUS ...... sinus/congestion relief pe ...... salsalate oral ...... SERNIVO ...... sirolimus oral solution ...... SANTYL ...... SEROQUEL ...... sirolimus oral tablet 0.5 mg, 1 mg ...... SAPHRIS ...... SEROQUEL XR ...... sirolimus oral tablet 2 mg ...... sapropterin dihydrochloride ...... sertraline hcl oral ...... SIRTURO ...... SAVAYSA ...... setlakin ...... SKYRIZI (150 MG DOSE) ...... sb allergy medicine oral tablet...... sevelamer carbonate oral tablet ...... SLO-NIACIN ...... sb arthritis pain relief ...... sf smooth antacid ex st oral tablet chewable sb aspirin oral tablet delayed release ...... sf 5000 plus ...... 750 mg ...... sb docusate sodium/senna ...... SFROWASA ...... smooth antacid extra st ...... sb lice killing max st ...... sharobel ...... smooth lax oral powder ...... sb mucus relief ...... SHINGRIX ...... sod citrate-citric acid ...... sb pain reliever childrens ...... SHUR-SEAL CONTRACEPTIVE ...... sodium bicarbonate oral tablet ...... sb pain reliever ex st ...... SIGNIFOR ...... sodium chloride ...... SCRUB CARE POVIDONE-IODINE ...... silace oral liquid ...... sodium chloride (hypertonic) ...... SEGLUROMET ...... silace oral syrup ...... sodium chloride (pf) ...... selegiline hcl oral ...... siladryl allergy ...... sodium chloride inhalation ...... selenium sulfide external lotion ...... sildenafil citrate oral suspension sodium chloride intravenous solution 0.45 %, SELZENTRY ...... reconstituted ...... 0.9 % ...... SEMGLEE ...... sildenafil citrate oral tablet 20 mg ...... sodium fluoride 5000 plus ...... senexon-s ...... SILENOR ...... sodium fluoride 5000 ppm dental cream ...... senior probiotic ...... SILIQ ...... sodium fluoride dental ...... senna lax ...... siltussin sa ...... sodium fluoride mouth/throat ...... senna laxative ...... siltussin-dm alcohol free ...... sodium fluoride oral solution 1.1 (0.5 f) senna oral liquid ...... silver sulfadiazine external ...... mg/ml ...... senna oral syrup ...... SIMBRINZA ...... sodium fluoride oral tablet 1.1 (0.5 f) mg ...... senna oral tablet ...... simeped ...... sodium fluoride oral tablet chewable ...... senna plus oral tablet ...... simethicone oral capsule ...... sodium phenylbutyrate oral powder ...... senna s ...... simethicone oral suspension ...... sodium sulfacetamide wash ...... senna smooth ...... simethicone oral tablet chewable ...... SOFOSBUVIR-VELPATASVIR ...... senna-docusate sodium ...... simethicone ultra strength ...... soft glucose ...... senna-lax ...... simliya ...... SOLARTEK GLUCOSE CONTROL ...... senna-plus ...... SIMPONI ...... SOLIQUA ...... senna-s ...... simvastatin oral ...... SOLODYN ...... senna-tabs ...... sinus 12 hour ...... soluble fiber therapy ...... senna-time ...... sinus congestion max strength ...... SOMAVERT ...... senna-time s ...... sinus nasal spray ...... SOOLANTRA ...... sennazon ...... sinus pe decongestant ...... soothe maximum strength ...... SENOKOT ...... sinus relief ext st ...... soothe oral suspension ...... SENOKOT S ...... sinus relief extra strength ...... soothe oral tablet ......

169 soothe oral tablet chewable ...... stool softener oral capsule 240 mg ...... sulfacetamide sodium-sulfur external liquid sorbitol oral ...... stool softener oral capsule 250 mg ...... 9-4.5 % ...... SORILUX ...... stool softener oral capsule 50 mg ...... sulfacetamide sodium-sulfur external lotion sotalol hcl (af) ...... stool softener oral tablet 8.6-50 mg ...... 10-5 % ...... sotalol hcl oral ...... stool softener pls laxative ...... sulfacetamide sodium-sulfur external SOVALDI ...... stool softener plus laxative ...... suspension 10-5 % ...... spinosad ...... stool softener/laxative ...... sulfacetamide sod-sulfur wash external SPIRIVA HANDIHALER ...... stool softener/stimulant ...... liquid 9-4.5 % ...... SPIRIVA RESPIMAT ...... STRATTERA ...... sulfacetamide-prednisolone ophthalmic spironolactone oral ...... STRENSIQ ...... solution ...... spironolactone-hctz ...... stress formula ...... sulfamethoxazole-trimethoprim oral ...... SPRAVATO (56 MG DOSE) ...... stress formula/iron ...... sulfamez wash ...... sprintec 28 ...... STRIBILD ...... sulfasalazine oral ...... SPRYCEL ...... STRIVERDI RESPIMAT ...... sulfatrim pediatric ...... sps ...... SUBLOCADE SUBCUTANEOUS sulindac oral ...... sronyx ...... SOLUTION PREFILLED SYRINGE 100 SUMADAN WASH ...... ssd ...... MG/0.5ML ...... sumatriptan nasal ...... sss 10-5 external cream ...... SUBOXONE ...... sumatriptan succinate oral ...... ST JOSEPH LOW DOSE ...... subvenite ...... sumatriptan succinate refill ...... stavudine ...... subvenite starter kit-blue ...... sumatriptan succinate subcutaneous ...... STEGLATRO ...... subvenite starter kit-green ...... suphedrine maximum strength ...... STEGLUJAN ...... subvenite starter kit-orange ...... suphedrine oral tablet 30 mg ...... STELARA SUBCUTANEOUS ...... SUCRAID ...... suphedrine oral tablet extended release 12 stimulant laxative oral tablet 8.6-50 mg...... sucralfate oral suspension ...... hour 120 mg...... STIOLTO RESPIMAT ...... sucralfate oral tablet ...... sure result sr relief ...... STIVARGA ...... SUDAFED ...... SUTENT ...... stomach relief extra strength ...... SUDAFED CHILDRENS ...... SYMAX-SR ...... stomach relief max st oral suspension 525 SUDAFED CONGESTION ...... SYMBICORT ...... mg/15ml ...... SUDAFED PE CONGESTION ORAL SYMDEKO ...... stomach relief max strength ...... TABLET 10 MG ...... SYMFI ...... stomach relief oral suspension 1050 SUDAFED PE SINUS CONGESTION ...... SYMFI LO ...... mg/30ml, 525 mg/15ml ...... SUDAFED SINUS CONGESTION ...... SYMJEPI ...... stomach relief oral suspension 262 mg/15ml, SUDAFED SINUS CONGESTION 12HR ..... SYMLINPEN 120 ...... 525 mg/30ml, 527 mg/30ml ...... sudogest 12 hour ...... SYMLINPEN 60 ...... stomach relief oral tablet 262 mg ...... sudogest maximum strength ...... SYMPAZAN ...... stomach relief oral tablet chewable 262 mg .. sudogest oral tablet 30 mg ...... SYMPROIC ...... stomach relief plus ...... sulfacetamide sodium external liquid ...... SYMTUZA ...... stomach relief ultra ...... sulfacetamide sodium ophthalmic ...... SYNAGIS INTRAMUSCULAR SOLUTION stool softener laxative oral capsule ...... sulfacetamide sodium-sulfur external cream 100 MG/ML ...... stool softener oral capsule 100 mg ...... 10-5 %......

170 SYNAGIS INTRAMUSCULAR SOLUTION taztia xt ...... theophylline er oral tablet extended release 50 MG/0.5ML ...... TDVAX ...... 12 hour 300 mg ...... SYNAREL ...... TEARS AGAIN ...... theophylline er oral tablet extended release SYNJARDY ...... TEARS AGAIN ADVANCED EYELID 12 hour 450 mg ...... SYNJARDY XR ...... OPHTHALMIC ...... theophylline er oral tablet extended release SYSTANE ...... tears pure ...... 24 hour 400 mg ...... SYSTANE COMPLETE...... TECFIDERA ...... theophylline er oral tablet extended release SYSTANE CONTACTS...... TEFLARO SOLUTION RECONSTITUTED 24 hour 600 mg ...... SYSTANE HYDRATION PF...... 600 MG INTRAVENOUS ...... thera ...... SYSTANE NIGHTTIME...... TEGRETOL ORAL SUSPENSION ...... thera-tabs ...... SYSTANE OVERNIGHT THERAPY ...... TEGSEDI ...... thiamine hcl oral ...... SYSTANE PRESERVATIVE FREE ...... temazepam oral capsule 15 mg, 30 mg ...... thiamine mononitrate oral ...... SYSTANE ULTRA ...... TEMIXYS ...... thioridazine hcl oral ...... SYSTANE ULTRA PF ...... TEMOVATE ...... thiothixene ...... T temozolomide oral capsule 100 mg, 180 mg, THRIVE ...... tab tussin ...... 250 mg ...... THRIVITE RX ...... tab-a-vite ...... temozolomide oral capsule 140 mg ...... tiadylt er ...... tab-a-vite/beta carotene ...... temozolomide oral capsule 20 mg, 5 mg ...... tiagabine hcl ...... tab-a-vite/iron ...... TENCON ...... TIBSOVO ...... TABLOID ...... TENIVAC ...... tigecycline ...... TACLONEX ...... tenofovir disoproxil fumarate ...... TIKOSYN ...... tacrolimus external ointment 0.03 % ...... terazosin hcl ...... tilia fe ...... tacrolimus external ointment 0.1 % ...... terbinafine hcl external ...... timolol maleate ophthalmic solution 0.25 %, tacrolimus oral capsule 0.5 mg, 5 mg ...... terbinafine hcl oral ...... 0.5 % ...... tacrolimus oral capsule 1 mg ...... terbinafine hydrochloride external cream 1 % TIMOPTIC ...... tadalafil (pah) ...... TIMOPTIC-XE ...... TAFINLAR ...... terconazole vaginal cream ...... TINACTIN EXTERNAL AEROSOL ...... take action ...... TERIPARATIDE (RECOMBINANT) ...... TINACTIN EXTERNAL CREAM ...... TALTZ ...... testosterone cypionate intramuscular ...... tinaspore ...... TAMIFLU ORAL CAPSULE ...... testosterone enanthate intramuscular ...... TIVICAY ...... TAMIFLU ORAL SUSPENSION testosterone transdermal gel 12.5 mg/act TIVICAY PD ...... RECONSTITUTED ...... (1%) ...... tizanidine hcl oral tablet ...... tamoxifen citrate oral ...... testosterone transdermal gel 25 mg/2.5gm TOBI NEBULIZER ...... tamsulosin hcl ...... (1%), 50 mg/5gm (1%) ...... TOBI PODHALER ...... TARGRETIN EXTERNAL ...... TETANUS-DIPHTHERIA TOXOIDS TD ...... TOBRADEX OPHTHALMIC OINTMENT ...... tarina fe 1/20 ...... tetrabenazine ...... TOBRADEX ST ...... tarina fe 1/20 eq ...... THALOMID ...... tobramycin inhalation nebulization solution TASIGNA ...... the magic bullet ...... 300 mg/4ml ...... TAZORAC EXTERNAL CREAM ...... THEO-24 ...... tobramycin nebulization solution 300 mg/5ml TAZORAC EXTERNAL GEL 0.1 %...... theophylline ...... inhalation ......

171 TOBRAMYCIN NEBULIZATION SOLUTION triamcinolone acetonide external lotion ...... TRULANCE ...... 300 MG/5ML INHALATION ...... triamcinolone acetonide external ointment TRULICITY ...... tobramycin ophthalmic ...... 0.025 %, 0.1 %, 0.5 % ...... TRUMENBA ...... tobramycin-dexamethasone ...... triamcinolone acetonide mouth/throat ...... TRUSOPT ...... tolcapone ...... TRIAMINIC ALLERCHEWS ...... TRUVADA ORAL TABLET 200-300 MG ...... tolnaftate antifungal ...... triamterene-hctz ...... TUDORZA PRESSAIR ...... tolnaftate external cream ...... triazolam ...... tulana ...... tolnaftate external powder ...... TRICON ...... TUMS ...... tolterodine tartrate ...... triderm ...... TUMS CHEWY BITES ...... TOPICORT SPRAY ...... tri-estarylla ...... TUMS E-X 750 ...... topiramate oral capsule sprinkle ...... trifluoperazine hcl ...... TUMS EXTRA STRENGTH 750 ...... topiramate oral tablet ...... trifluridine ...... TUMS LASTING EFFECTS ...... toremifene citrate ...... trihexyphenidyl hcl ...... TUMS SMOOTHIES ...... torsemide ...... TRIJARDY XR ...... TUMS ULTRA 1000 ...... total allergy ...... TRIKAFTA ORAL TABLET THERAPY TURALIO ...... total allergy medicine ...... PACK 100-50-75 & 150 MG ...... tussin adult dm oral liquid 10-200 mg/5ml ..... TOUJEO MAX SOLOSTAR ...... tri-legest fe ...... tussin adult multi-symptom ...... TOUJEO SOLOSTAR ...... tri-linyah ...... tussin cf cough & cold oral liquid 5-10-100 TOVIAZ ...... trimethobenzamide hcl oral ...... mg/5ml ...... TRACLEER ...... trimethoprim oral ...... tussin cf multi-symptom cold ...... TRADJENTA ...... tri-mili ...... tussin cf oral liquid 30-10-100 mg/5ml ...... tramadol hcl oral tablet 50 mg ...... TRINATAL RX 1 ...... tussin cf oral liquid 5-10-100 mg/5ml ...... trandolapril ...... TRINATE ...... tussin chest congestion oral syrup 100 tranexamic acid oral ...... TRINTELLIX ...... mg/5ml ...... tranylcypromine sulfate ...... tri-nymyo ...... tussin cough dm sugar free ...... TRAVATAN Z ...... triphrocaps ...... tussin cough long acting ...... travel ease ...... triple antibiotic ...... tussin cough long-acting ...... trazodone hcl oral tablet 100 mg, 150 mg, 50 triple antibiotic original ...... tussin cough oral syrup ...... mg ...... tri-previfem ...... tussin cough/chest congest oral syrup 100- trazodone hcl oral tablet 300 mg ...... TRIPTODUR ...... 10 mg/5ml ...... TRECATOR ...... tri-sprintec ...... tussin cough/chest dm max oral liquid 10- TRELEGY ELLIPTA ...... TRIUMEQ ...... 200 mg/5ml ...... TREMFYA ...... tri-vite pediatric ...... tussin dm cough/chest cong ...... TRESIBA ...... tri-vite/fluoride ...... tussin dm cough/chest oral syrup 10-100 TRESIBA FLEXTOUCH ...... trivora (28) ...... mg/5ml ...... tretinoin external cream ...... tri-vylibra ...... tussin dm max adult ...... tretinoin oral ...... trospium chloride ...... tussin dm max daytime ...... TREZIX ...... TRUECONTROL GLUCOSE CONT LEV 0 .. tussin dm max oral liquid 10-200 mg/5ml ...... tri femynor ...... TRUECONTROL GLUCOSE CONT LEV 1 .. tussin dm max oral liquid 20-400 mg/20ml .... triamcinolone acetonide external cream ...... TRUETRACK TEST ...... tussin dm max st ......

172 tussin dm oral syrup 100-10 mg/5ml ...... VALTOCO 10 MG DOSE ...... vigabatrin oral packet ...... tussin maximum strength oral syrup 15 VALTOCO 15 MG DOSE ...... vigadrone ...... mg/5ml ...... VALTOCO 20 MG DOSE ...... VIGAMOX ...... tussin mucus+chest congestion oral syrup ... VALTOCO 5 MG DOSE ...... VIIBRYD ...... tussin multi-symptom cold cf ...... VANCOCIN ...... VIMPAT ORAL ...... tussin oral syrup 100 mg/5ml ...... vandazole ...... VINATE II ...... TWINRIX ...... VANOS ...... VINATE ONE ...... tyblume ...... VAPORIZER WARM STEAM ...... viorele ...... TYBOST ...... VAQTA ...... VIRACEPT ...... TYLENOL ORAL SUSPENSION 160 VARIVAX ...... VIRAMUNE ...... MG/5ML ...... VARUBI (180 MG DOSE) ...... VIREAD ORAL POWDER ...... TYLENOL ORAL TABLET 325 MG ...... VASOCLEAR-A ...... VIREAD ORAL TABLET 150 MG, 200 MG, TYLENOL ORAL TABLET 500 MG ...... v-c forte ...... 250 MG ...... TYLENOL ORAL TABLET CHEWABLE 160 VCF VAGINAL CONTRACEPTIVE virt-caps ...... MG ...... VAGINAL FOAM ...... virt-phos 250 neutral ...... TYLENOL ORAL TABLET EXTENDED VECTICAL ...... virtussin a/c ...... RELEASE 650 MG ...... vegetable lax+stool softener ...... virtussin ac w/alc ...... TYMLOS ...... velivet ...... virtussin dac ...... U VELPHORO ...... VISBIOME HIGH POTENCY ORAL UBRELVY ...... VELTASSA ...... CAPSULE ...... UDENYCA ...... VELTIN ...... VISINE ...... ultra fresh ...... VEMLIDY ...... VISINE ADVANCED RELIEF ...... ultra fresh pm ...... VENCLEXTA ...... VISTA GEL DRY EYE RELIEF ...... ultra lubricant drop ...... VENCLEXTA STARTING PACK ...... VISTA MEIBO TEARS ...... ultra lubricating eye drops ...... venlafaxine hcl ...... VISTA TEARS ...... unithroid ...... venlafaxine hcl er oral capsule extended VISTOGARD ...... urea 20 intensive hydrating ...... release 24 hour ...... vit c/rose hips ...... urea external lotion ...... VENTOLIN HFA ...... vita s forte ...... ureacin-10 ...... verapamil hcl er oral capsule extended vitacel ...... ureacin-20 ...... release 24 hour 120 mg, 180 mg, 240 mg, vitamin a oral capsule 2400 mcg (8000 ut), 3 urin ds ...... 360 mg ...... mg (10000 ut) ...... urinary pain relief oral tablet 95 mg ...... verapamil hcl er oral tablet extended release vitamin b-1 oral tablet 100 mg, 250 mg ...... ursodiol oral capsule ...... verapamil hcl oral ...... vitamin b-12 er oral tablet extended release ursodiol oral tablet ...... VERZENIO ...... 1000 mcg ...... UTIRA-C ...... VESICARE ...... vitamin b12 oral tablet extended release V vic-forte ...... 1000 mcg ...... VAGIFEM ...... VICTOZA SOLUTION PEN-INJECTOR 18 vitamin b-12 tr oral tablet extended release valacyclovir hcl oral ...... MG/3ML SUBCUTANEOUS ...... , 1000 mcg ...... valganciclovir hcl oral tablet ...... VIEKIRA PAK ...... vitamin b-6 ...... valproic acid oral ...... vienva ...... vitamin b-6 er ......

173 vitamin c cr oral tablet extended release 500 vitamin d3 oral tablet chewable 10 mcg (400 WEST-VITE W/FOLIC ACID ...... mg ...... unit) ...... WIDE-SEAL DIAPHRAGM 60 ...... vitamin c er oral tablet extended release vitamin d3 oral tablet chewable 25 mcg, 25 WIDE-SEAL DIAPHRAGM 65 ...... 1500 mg ...... mcg (1000 ut) ...... WIDE-SEAL DIAPHRAGM 70 ...... vitamin c oral liquid 500 mg/5ml ...... vitamin d-400 ...... WIDE-SEAL DIAPHRAGM 75 ...... vitamin c oral tablet 1000 mg, 250 mg ...... vitamin e natural ...... WIDE-SEAL DIAPHRAGM 80 ...... vitamin c oral tablet 500 mg ...... vitamin e oral capsule 100 unit, 1000 unit, WIDE-SEAL DIAPHRAGM 85 ...... vitamin c oral tablet chewable 100 mg, 250 200 unit, 450 mg ...... WIDE-SEAL DIAPHRAGM 90 ...... mg ...... vitamin e oral capsule 400 unit ...... WIDE-SEAL DIAPHRAGM 95 ...... vitamin c oral tablet chewable 500 mg ...... vitamin k1 injection solution 10 mg/ml ...... wixela inhub ...... vitamin c/acerola ...... vitamin-b complex ...... womans laxative ...... vitamin c/rose hips oral tablet 1000 mg ...... vitamins acd-fluoride ...... womens gentle laxative ...... vitamin c/rose hips oral tablet 500 mg ...... vitamins complete childrens ...... womens laxative ...... vitamin c-rose hips oral tablet ...... VITATHELY WITH GINGER ...... womens prenatal+dha ...... vitamin d (cholecalciferol) oral tablet 10 mcg VITRAKVI ...... X (400 unit) ...... VIVELLE-DOT ...... XALATAN ...... vitamin d (cholecalciferol) oral tablet 25 mcg VIVITROL ...... XALKORI ...... (1000 ut) ...... volnea ...... XARELTO ...... vitamin d (ergocalciferol) oral capsule 1.25 voriconazole oral tablet ...... XARELTO STARTER PACK ...... mg (50000 ut) ...... VOSEVI ...... XCOPRI (250 MG DAILY DOSE) ORAL vitamin d oral capsule 25 mcg (1000 ut) ...... VOTRIENT ...... TABLET THERAPY PACK 50 & 200 MG .. vitamin d oral liquid ...... VRAYLAR ...... XCOPRI (350 MG DAILY DOSE) ...... vitamin d oral tablet 25 mcg (1000 ut) ...... VUMERITY ...... XCOPRI ORAL TABLET ...... vitamin d oral tablet 50 mcg (2000 ut) ...... vyfemla ...... XCOPRI ORAL TABLET THERAPY PACK ... vitamin d oral tablet chewable 10 mcg (400 vylibra ...... XELJANZ ORAL TABLET ...... unit) ...... VYNDAMAX ...... XELJANZ XR ...... vitamin d3 oral capsule 1.25 mg (50000 ut) .. VYNDAQEL ...... XELODA ...... vitamin d3 oral capsule 125 mcg (5000 ut) ... VYVANSE ORAL CAPSULE ...... XENLETA ORAL ...... vitamin d-3 oral capsule 125 mcg (5000 ut) .. VYVANSE ORAL TABLET CHEWABLE ...... XEPI ...... vitamin d3 oral capsule 25 mcg (1000 ut) ..... W XIGDUO XR ORAL TABLET EXTENDED vitamin d3 oral capsule 250 mcg (10000 ut) . WAKIX ORAL TABLET 4.45 MG ...... RELEASE 24 HOUR 10-1000 MG, 10-500 vitamin d3 oral capsule 50 mcg (2000 ut) ..... warfarin sodium oral tablet 1 mg, 10 mg, 2 MG ...... vitamin d-3 oral capsule 50 mcg (2000 ut) .... mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 7.5 mg ..... XIGDUO XR ORAL TABLET EXTENDED vitamin d3 oral liquid 10 mcg/ml ...... warfarin sodium oral tablet 6 mg ...... RELEASE 24 HOUR 2.5-1000 MG, 5- vitamin d3 oral tablet 10 mcg (400 unit) ...... wart remover external liquid 17 % ...... 1000 MG, 5-500 MG ...... vitamin d3 oral tablet 125 mcg (5000 ut) ...... wart remover maximum strength external XIIDRA ...... vitamin d3 oral tablet 25 mcg (1000 ut) ...... liquid...... XIMINO ...... vitamin d-3 oral tablet 25 mcg (1000 ut)...... weekly-d ...... XOFLUZA (40 MG DOSE) ...... vitamin d3 oral tablet 50 mcg (2000 ut) ...... wera ...... XOFLUZA (80 MG DOSE) ...... WESTAB PLUS ...... XOLAIR ......

174 XOPENEX HFA ...... ZENPEP ORAL CAPSULE DELAYED zoo friends gummies ...... XPECT ...... RELEASE PARTICLES 3000-10000 UNIT zoo friends plus extra c ...... XTANDI ORAL CAPSULE ...... ZENZEDI ...... zoo friends plus iron ...... xulane ...... ZEPATIER ...... ZORTRESS ORAL TABLET 1 MG ...... XULTOPHY ...... ZEPOSIA ...... ZOSTRIX HP ...... XYREM ...... ZETONNA ...... zovia 1/35 (28) ...... Y ZIANA ...... zovia 1/35e (28) ...... YONSA ...... zidovudine ...... ZUBSOLV ...... yuvafem ...... ZIEXTENZO ...... ZYCLARA ...... Z ZILXI ...... ZYDELIG ...... zaclir cleansing ...... zinc chelated oral tablet 50 mg ...... ZYKADIA ...... ZADITOR ...... zinc oral tablet 50 mg ...... ZYLET ...... zafemy ...... zinc oxide external ointment 40 % ...... ZYMAXID ...... zaleplon ...... ZIOPTAN ...... ZYPREXA INTRAMUSCULAR ...... ZARXIO ...... ziprasidone hcl ...... ZYPREXA ORAL ...... ZAVESCA ...... ZOHYDRO ER ...... ZYPREXA RELPREVV ...... ZEASORB-AF ...... ZOLINZA ...... ZYPREXA ZYDIS ...... ZEGERID ...... zolpidem tartrate oral ...... ZYRTEC ALLERGY ORAL TABLET ...... ZEJULA ...... zolpidem tartrate sublingual ...... ZYRTEC-D ALLERGY & CONGESTION ...... ZELAC ...... ZOMACTON ...... ZYTIGA ...... ZELBORAF ...... ZOMACTON (FOR ZOMA-JET 10) ...... ZYVANA ...... zenatane ...... zonisamide oral ......

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