Molina Healthcare of Ohio Preferred Drug List (Formulary)

(10/01/2019)

INTRODUCTION ...... 4 PREFACE ...... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...... 4 DRUG LIST PRODUCT DESCRIPTIONS ...... 4 GENERIC SUBSTITUTION ...... 4 PLAN DESIGN ...... 5 NON-COVERED MEDICATIONS ...... 5 STEP THERAPY (ST) ...... 5 LEGEND ...... 5 NOTICE ...... 5 ANALGESICS ...... 6 ANALGESICS, OTHER ...... 6 NSAIDs ...... 6 NSAIDs, TOPICAL ...... 6 COX-2 INHIBITORS...... 6 GOUT ...... 6 OPIOID ANALGESICS ...... 6 NON-OPIOID ANALGESICS ...... 7 VISCOSUPPLEMENTS ...... 7 ANTI-INFECTIVES ...... 7 ANTIBACTERIALS...... 7 ANTIFUNGALS ...... 8 ANTIMALARIALS ...... 8 ANTIRETROVIRAL AGENTS ...... 8 ANTITUBERCULAR AGENTS ...... 9 ANTIVIRALS ...... 10 MISCELLANEOUS...... 10 ANTINEOPLASTIC AGENTS ...... 11 ALKYLATING AGENTS ...... 11 ANTIMETABOLITES ...... 11 CYTOPROTECTIVE AGENTS ...... 11 HORMONAL ANTINEOPLASTIC AGENTS ...... 11 IMMUNOMODULATORS ...... 11 KINASE INHIBITORS ...... 11 TOPOISOMERASE INHIBITORS ...... 12 MISCELLANEOUS...... 12 CARDIOVASCULAR...... 12 ACE INHIBITORS ...... 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 12 ACE INHIBITOR/DIURETIC COMBINATIONS...... 12 ADRENOLYTICS, CENTRAL ...... 12 ALDOSTERONE RECEPTOR ANTAGONISTS ...... 13 ALPHA BLOCKERS ...... 13 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ...... 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ...... 13 ANTIARRHYTHMICS...... 13 ANTILIPEMICS ...... 13 BETA-BLOCKERS ...... 14 BETA-BLOCKER/DIURETIC COMBINATIONS ...... 14 CALCIUM CHANNEL BLOCKERS ...... 14 DIGITALIS GLYCOSIDES ...... 15 DIURETICS ...... 15 HEART FAILURE ...... 15 NITRATES ...... 15 PULMONARY ARTERIAL HYPERTENSION ...... 16 MISCELLANEOUS...... 16

1 CENTRAL NERVOUS SYSTEM ...... 16 AMYOTROPHIC LATERAL SCLEROSIS ...... 16 ANTIANXIETY ...... 16 ANTICONVULSANTS ...... 16 ANTIDEMENTIA ...... 17 ANTIDEPRESSANTS ...... 17 ANTIPARKINSONIAN AGENTS ...... 18 ANTIPSYCHOTICS...... 18 ATTENTION DEFICIT HYPERACTIVITY DISORDER ...... 19 HUNTINGTON'S DISEASE AGENTS ...... 19 HYPNOTICS ...... 19 MIGRAINE ...... 19 MOOD STABILIZERS ...... 20 MULTIPLE SCLEROSIS AGENTS ...... 20 MUSCULOSKELETAL THERAPY AGENTS ...... 20 MYASTHENIA GRAVIS ...... 20 NARCOLEPSY/CATAPLEXY ...... 20 PSYCHOTHERAPEUTIC-MISCELLANEOUS ...... 20 MISCELLANEOUS...... 21 ENDOCRINE AND METABOLIC ...... 21 ACROMEGALY ...... 21 ANDROGENS ...... 21 ANTIDIABETICS ...... 21 CALCIUM RECEPTOR ANTAGONISTS ...... 23 CALCIUM REGULATORS ...... 23 CARNITINE DEFICIENCY AGENTS ...... 23 CONTRACEPTIVES ...... 23 ENDOMETRIOSIS ...... 24 ESTROGENS ...... 24 ESTROGEN/PROGESTINS ...... 25 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ...... 25 GAUCHER DISEASE...... 25 GLUCOCORTICOIDS ...... 25 GLUCOSE ELEVATING AGENTS ...... 25 HEREDITARY TYROSINEMIA TYPE 1 AGENTS ...... 25 HUMAN GROWTH HORMONES ...... 25 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ...... 25 INSULIN-LIKE GROWTH FACTOR ...... 25 PHOSPHATE BINDER AGENTS ...... 25 POTASSIUM-REMOVING AGENTS ...... 26 PROGESTINS ...... 26 SELECTIVE ESTROGEN RECEPTOR MODULATORS ...... 26 THYROID AGENTS ...... 26 UREA CYCLE DISORDERS ...... 26 VASOPRESSIN RECEPTOR ANTAGONISTS ...... 26 VASOPRESSINS ...... 26 MISCELLANEOUS...... 26 GASTROINTESTINAL ...... 26 ANTACIDS ...... 26 ANTIDIARRHEALS ...... 26 ANTIEMETICS ...... 27 ANTISPASMODICS ...... 27 CHOLELITHOLYTICS ...... 27 H2 RECEPTOR ANTAGONISTS ...... 27 INFLAMMATORY BOWEL DISEASE ...... 27 IRRITABLE BOWEL SYNDROME ...... 28 LAXATIVES/STOOL SOFTENERS ...... 28 PANCREATIC ENZYMES ...... 28 PROSTAGLANDINS ...... 28 PROTON PUMP INHIBITORS ...... 28 SALIVA STIMULANTS ...... 29 STEROIDS, RECTAL ...... 29 ULCER THERAPY COMBINATIONS ...... 29 MISCELLANEOUS...... 29 GENITOURINARY...... 29

2 BENIGN PROSTATIC HYPERPLASIA ...... 29 URINARY ANTISPASMODICS ...... 29 VAGINAL ANTI-INFECTIVES ...... 29 MISCELLANEOUS...... 30 HEMATOLOGIC ...... 30 ANTICOAGULANTS ...... 30 HEMATOPOIETIC GROWTH FACTORS ...... 30 HEMOPHILIA A AGENTS ...... 30 HEMOPHILIA B AGENTS ...... 30 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ...... 30 PLATELET AGGREGATION INHIBITORS...... 30 PLATELET SYNTHESIS INHIBITORS ...... 31 THROMBOCYTOPENIA AGENTS ...... 31 MISCELLANEOUS...... 31 IMMUNOLOGIC AGENTS ...... 31 ALLERGENIC EXTRACTS ...... 31 AUTOIMMUNE AGENTS ...... 31 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ...... 31 IMMUNE GLOBULINS ...... 31 IMMUNOMODULATORS ...... 31 IMMUNOSUPPRESSANTS ...... 32 VACCINES ...... 32 NUTRITIONAL/SUPPLEMENTS ...... 32 ELECTROLYTES ...... 32 VITAMINS AND MINERALS ...... 32 RESPIRATORY ...... 34 ANAPHYLAXIS TREATMENT AGENTS ...... 34 ANTICHOLINERGICS...... 34 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ...... 34 ANTIHISTAMINES, LOW SEDATING ...... 34 ANTIHISTAMINES, NONSEDATING ...... 34 ANTIHISTAMINES, SEDATING ...... 34 ANTIHISTAMINE/DECONGESTANT COMBINATIONS ...... 35 ANTITUSSIVES ...... 35 ANTITUSSIVE COMBINATIONS ...... 35 BETA AGONISTS ...... 35 CYSTIC FIBROSIS ...... 35 DECONGESTANTS ...... 36 DECONGESTANT/EXPECTORANT COMBINATIONS ...... 36 EXPECTORANTS ...... 36 LEUKOTRIENE MODULATORS ...... 36 MAST CELL STABILIZERS ...... 36 MEDICAL SUPPLIES...... 36 NASAL ANTIHISTAMINES ...... 36 NASAL DECONGESTANTS ...... 36 NASAL STEROIDS ...... 36 PHOSPHODIESTERASE-4 INHIBITORS ...... 36 RESPIRATORY SYNCYTIAL VIRUS ...... 36 SEVERE ASTHMA AGENTS ...... 37 STEROID/BETA AGONIST COMBINATIONS...... 37 STEROID INHALANTS ...... 37 XANTHINES ...... 37 XANTHINE COMBINATIONS ...... 37 MISCELLANEOUS...... 37 TOPICAL ...... 37 DERMATOLOGY ...... 37 MOUTH/THROAT/DENTAL AGENTS ...... 40 OPHTHALMIC ...... 40 OTIC ...... 42 VAGINAL ...... 43 NON-DISCRIMINATION STATEMENT ...... 44 INDEX ...... 46

INTRODUCTION We are pleased to provide the 2019 Molina Healthcare of Ohio Preferred Drug List (Formulary) as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients.

The drugs represented have been reviewed by a Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The document is reflective of current medical practice as of the date of review.

The information contained in this document and its appendices is provided solely for the convenience of medical providers and is not intended to be comprehensive in nature. All the information in the document is provided as a reference for drug therapy selection.

The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable.

We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information. PREFACE The document is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless the cited drug is available as an injectable or an exception is specifically noted, generally, all applicable dosage forms and strengths of the drug cited are included in the document. PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The services of a Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an advisory body of clinical professionals. The P&T Committee's voting members include physicians and pharmacists, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers. DRUG LIST PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms on the document are covered, general principles are noted below.

• Listed products on the document generally include all strengths and dosage forms of the cited brand-name product. • When a strength or dosage form is specified, only the specified strength and dosage form is on the document. Other strengths/dosage forms, including injectable dosage forms of the reference product are not. • If the OTC and Prescription versions of the product are covered, then both are listed. • Extended-release and delayed-release products require their own entry. • Dosage forms on the document will be consistent with the category and use where listed. GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product to the market. However, the document is subject to state specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate.

Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:

• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs.

• Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. • Manufactured in the same strength and dosage form as the brand-name drugs.

When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence). PLAN DESIGN The document represents a closed formulary plan design. The medications listed on the document are covered by the plan as represented. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity. If a medication is not listed on the document, a formulary exception may be requested for coverage. Medical necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non- formulary prescription request criteria. Log in to www.molinahealthcare.com to check coverage. NON-COVERED MEDICATIONS Please note that certain medications are not covered. This includes, but is not limited to:

• Fertility enhancing drugs • Weight loss drugs • Drugs and other agents used for cosmetic purposes or for hair growth • Sexual dysfunction drugs • Pharmaceuticals determined by the Federal Drug Administration (FDA) to be less than effective and identical, related or similar drugs (frequently referred to as “DESI 5 and 6” drugs) STEP THERAPY (ST) Step therapy (ST) drugs are covered after an adequate trial of a first-line drug has been tried and failed. Step therapy (ST) drugs may also be requested through the prior authorization process. Step therapy drug requests are reviewed based on medical necessity which takes into account the needs of different patient populations. LEGEND

AL Age Limit HRM High Risk Medications require PA for members age 65 and older OTC Over the counter PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit SP Specialty Drug; these drugs must be obtained through a specialty pharmacy ST Step Therapy † Specific NDCs may not be reimbursable under the Molina Pharmacy Program boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers.

ANALGESICS ANALGESICS, OTHER acetaminophen OTC, QL TYLENOL

NSAIDs ibuprofen OTC ADVIL naproxen sodium OTC ALEVE diclofenac potassium diclofenac sodium delayed-rel diclofenac sodium delayed-rel/misoprostol PA ARTHROTEC diclofenac sodium ext-rel diflunisal etodolac etodolac ext-rel fenoprofen 600 mg flurbiprofen ibuprofen ketoprofen ketoprofen ext-rel ketorolac QL meclofenamate meloxicam MOBIC nabumetone naproxen NAPROSYN oxaprozin DAYPRO piroxicam FELDENE sulindac tolmetin 200 mg, 400 mg

NSAIDs, TOPICAL diclofenac sodium gel 1% QL VOLTAREN GEL

COX-2 INHIBITORS celecoxib PA CELEBREX

GOUT allopurinol ZYLOPRIM colchicine tabs QL COLCRYS colchicine/probenecid febuxostat PA ULORIC probenecid

OPIOID ANALGESICS All Opioid Analgesics are subject to Ohio Department of Medicaid Opioid Policy:

butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg QL, * butorphanol nasal spray QL, * codeine sulfate QL, * codeine/acetaminophen QL, * TYLENOL w/CODEINE fentanyl citrate buccal PA, QL, * FENTORA fentanyl lozenge PA, QL, * ACTIQ fentanyl sublingual PA, QL, * ABSTRAL fentanyl transdermal PA, QL DURAGESIC hydrocodone/acetaminophen QL, * NORCO hydrocodone/acetaminophen soln 7.5-325 mg/15 mL PA, QL, * hydromorphone oral soln 1 mg/mL QL, * DILAUDID-5 hydromorphone tabs QL, * DILAUDID

morphine QL, * morphine ext-rel PA, QL KADIAN morphine ext-rel PA, QL MS CONTIN morphine supp QL, * oxycodone QL, * oxycodone QL, * ROXICODONE oxycodone ext-rel PA, QL OXYCONTIN oxycodone/acetaminophen QL, * oxycodone/aspirin QL, * PERCODAN oxymorphone QL, * OPANA pentazocine/naloxone PA, QL, *

QL* all immediate-release opioid analgesics = Max quantity limit of 7 days supply per fill; Max quantity limit of 14 days supply per 45 days; Prior authorization required for existing utilizers dose > 60 mg morphine equivalent; new utilizers dose ≥ 30 mg morphine equivalent.

NON-OPIOID ANALGESICS butalbital/acetaminophen 50/325 mg butalbital/acetaminophen/caffeine 50/325/40 mg QL ESGIC butalbital/aspirin/caffeine QL FIORINAL tramadol ext-rel tabs PA tramadol immediate-release QL ULTRAM tramadol/acetaminophen QL ULTRACET

VISCOSUPPLEMENTS hylan G-F 20 PA, SP SYNVISC-ONE

ANTI-INFECTIVES ANTIBACTERIALS Aminoglycosides neomycin

Cephalosporins First Generation cefadroxil QL cephalexin caps 250 mg, 500 mg KEFLEX cephalexin caps 750 mg PA KEFLEX cephalexin susp KEFLEX

Second Generation cefaclor QL cefaclor ext-rel CEFACLOR ER cefprozil cefuroxime axetil

Third Generation cefdinir QL cefpodoxime

Erythromycins/Macrolides azithromycin ZITHROMAX clarithromycin clarithromycin ext-rel erythromycin delayed-rel ERY-TAB erythromycin ethylsuccinate E.E.S. erythromycin ethylsuccinate 200 mg/5 mL ERYPED erythromycin stearate ERYTHROCIN

Fluoroquinolones ciprofloxacin QL CIPRO levofloxacin QL LEVAQUIN moxifloxacin PA AVELOX

Penicillins amoxicillin QL amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL AUGMENTIN amoxicillin/clavulanate chew tabs, tabs AUGMENTIN ampicillin dicloxacillin penicillin VK

Sulfonamides sulfadiazine sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS

Tetracyclines doxycycline calcium syrup VIBRAMYCIN SYRUP doxycycline hyclate caps 50 mg, 100 mg VIBRAMYCIN doxycycline hyclate tabs 20 mg, 100 mg doxycycline monohydrate minocycline MINOCIN tetracycline

ANTIFUNGALS clotrimazole troches fluconazole QL DIFLUCAN griseofulvin microsize griseofulvin ultramicrosize itraconazole SPORANOX itraconazole oral soln PA SPORANOX ORAL SOLUTION ketoconazole nystatin terbinafine tabs QL

ANTIMALARIALS artemether/lumefantrine COARTEM atovaquone/proguanil MALARONE chloroquine mefloquine primaquine PRIMAQUINE

ANTIRETROVIRAL AGENTS Antiretroviral Adjuvants cobicistat TYBOST

Antiretroviral Combinations abacavir/dolutegravir/lamivudine TRIUMEQ abacavir/lamivudine EPZICOM abacavir/lamivudine/zidovudine TRIZIVIR atazanavir/cobicistat EVOTAZ bictegravir/emtricitabine/tenofovir alafenamide QL BIKTARVY darunavir/cobicistat PREZCOBIX dolutegravir/rilpivirine QL JULUCA efavirenz/lamivudine/tenofovir disoproxil fumarate QL SYMFI, SYMFI LO

elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide GENVOYA elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate STRIBILD emtricitabine/rilpivirine/tenofovir alafenamide ODEFSEY emtricitabine/rilpivirine/tenofovir disoproxil fumarate COMPLERA emtricitabine/tenofovir alafenamide DESCOVY emtricitabine/tenofovir disoproxil fumarate TRUVADA lamivudine/tenofovir disoproxil fumarate QL CIMDUO lamivudine/zidovudine COMBIVIR

Chemokine Receptor Antagonists maraviroc SELZENTRY

Fusion Inhibitors enfuvirtide PA, SP FUZEON

Integrase Inhibitors dolutegravir TIVICAY raltegravir ISENTRESS raltegravir ISENTRESS HD

Non-nucleoside Reverse Transcriptase Inhibitors efavirenz SUSTIVA etravirine INTELENCE nevirapine VIRAMUNE nevirapine ext-rel 100 mg PA VIRAMUNE XR nevirapine ext-rel 400 mg VIRAMUNE XR rilpivirine EDURANT

Nucleoside Reverse Transcriptase Inhibitors abacavir ZIAGEN didanosine delayed-rel VIDEX EC didanosine soln VIDEX emtricitabine EMTRIVA lamivudine EPIVIR stavudine zidovudine RETROVIR

Nucleotide Reverse Transcriptase Inhibitors tenofovir disoproxil fumarate powder VIREAD tenofovir disoproxil fumarate tabs VIREAD

Protease Inhibitors atazanavir caps REYATAZ atazanavir powder REYATAZ darunavir PREZISTA fosamprenavir susp LEXIVA fosamprenavir tabs LEXIVA indinavir CRIXIVAN lopinavir/ritonavir soln KALETRA lopinavir/ritonavir tabs KALETRA nelfinavir VIRACEPT ritonavir caps, soln NORVIR ritonavir tabs NORVIR saquinavir mesylate INVIRASE tipranavir APTIVUS

ANTITUBERCULAR AGENTS bedaquiline PA SIRTURO

cycloserine PA ethambutol MYAMBUTOL ethionamide TRECATOR isoniazid syrup QL isoniazid tabs pyrazinamide rifampin RIFADIN rifapentine PRIFTIN

ANTIVIRALS Cytomegalovirus Agents valganciclovir PA VALCYTE

Hepatitis Agents Hepatitis B adefovir dipivoxil HEPSERA entecavir soln BARACLUDE entecavir tabs BARACLUDE lamivudine soln EPIVIR-HBV lamivudine tabs EPIVIR-HBV

Hepatitis C ledipasvir/sofosbuvir PA, SP, * HARVONI ribavirin caps 200 mg PA, SP REBETOL ribavirin oral soln 40 mg/mL PA, SP REBETOL ribavirin tabs 200 mg PA, SP sofosbuvir/velpatasvir PA, SP, * EPCLUSA sofosbuvir/velpatasvir/voxilaprevir PA, SP VOSEVI

* ledipasvir/sofosbuvir and sofosbuvir/velpatasvir are the preferred agents

Herpes Agents acyclovir caps, susp, tabs ZOVIRAX famciclovir valacyclovir VALTREX

Influenza Agents oseltamivir QL TAMIFLU rimantadine FLUMADINE zanamivir QL RELENZA

MISCELLANEOUS pyrantel OTC REESES PINWORM MEDICINE albendazole PA ALBENZA atovaquone MEPRON clindamycin CLEOCIN dapsone ivermectin PA STROMECTOL linezolid PA ZYVOX metronidazole FLAGYL nitazoxanide susp PA ALINIA nitazoxanide tabs ALINIA nitrofurantoin ext-rel HRM MACROBID nitrofurantoin macrocrystals HRM MACRODANTIN nitrofurantoin susp HRM FURADANTIN paromomycin praziquantel PA BILTRICIDE rifabutin MYCOBUTIN

rifaximin PA XIFAXAN trimethoprim vancomycin oral soln FIRVANQ

ANTINEOPLASTIC AGENTS ALKYLATING AGENTS busulfan MYLERAN chlorambucil LEUKERAN cyclophosphamide caps PA estramustine PA EMCYT lomustine GLEOSTINE mechlorethamine gel PA VALCHLOR melphalan ALKERAN temozolomide PA, SP TEMODAR

ANTIMETABOLITES capecitabine PA, SP XELODA mercaptopurine methotrexate TREXALL methotrexate inj thioguanine TABLOID

CYTOPROTECTIVE AGENTS leucovorin calcium LEUCOVORIN

HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens bicalutamide CASODEX flutamide nilutamide NILANDRON

Antiestrogens tamoxifen QL toremifene FARESTON

Aromatase Inhibitors anastrozole ARIMIDEX exemestane AROMASIN letrozole FEMARA

Progestins megestrol acetate susp 40 mg/mL, tabs

IMMUNOMODULATORS lenalidomide PA, SP REVLIMID pomalidomide PA, SP POMALYST thalidomide PA, SP THALOMID

KINASE INHIBITORS afatinib PA, SP GILOTRIF axitinib PA, SP INLYTA bosutinib PA, SP BOSULIF cabozantinib PA, SP COMETRIQ dabrafenib PA, SP TAFINLAR dasatinib PA, SP SPRYCEL erlotinib PA, SP TARCEVA everolimus PA, SP AFINITOR

everolimus tablets for oral suspension PA, SP AFINITOR DISPERZ ibrutinib PA, SP IMBRUVICA idelalisib PA, SP ZYDELIG imatinib mesylate PA, SP GLEEVEC lapatinib PA, SP TYKERB nilotinib PA, SP TASIGNA pazopanib PA, SP VOTRIENT regorafenib PA, SP STIVARGA ruxolitinib PA, SP JAKAFI sorafenib PA, SP NEXAVAR sunitinib PA, SP SUTENT trametinib PA, SP MEKINIST vandetanib PA, SP CAPRELSA

TOPOISOMERASE INHIBITORS topotecan PA, SP HYCAMTIN

MISCELLANEOUS aldesleukin PA, SP PROLEUKIN bexarotene caps TARGRETIN caps etoposide hydroxyurea DROXIA hydroxyurea HYDREA mitotane LYSODREN procarbazine MATULANE tretinoin caps vorinostat PA, SP ZOLINZA

CARDIOVASCULAR ACE INHIBITORS benazepril LOTENSIN captopril enalapril VASOTEC fosinopril lisinopril ZESTRIL moexipril perindopril quinapril ACCUPRIL ramipril ALTACE trandolapril

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/benazepril QL LOTREL trandolapril/verapamil ext-rel TARKA

ACE INHIBITOR/DIURETIC COMBINATIONS benazepril/hydrochlorothiazide LOTENSIN HCT captopril/hydrochlorothiazide enalapril/hydrochlorothiazide VASERETIC fosinopril/hydrochlorothiazide lisinopril/hydrochlorothiazide ZESTORETIC quinapril/hydrochlorothiazide ACCURETIC

ADRENOLYTICS, CENTRAL clonidine CATAPRES clonidine transdermal PA CATAPRES TTS guanfacine

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone PA INSPRA spironolactone ALDACTONE

ALPHA BLOCKERS doxazosin CARDURA prazosin MINIPRESS terazosin

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS candesartan PA ATACAND candesartan/hydrochlorothiazide PA ATACAND HCT eprosartan PA irbesartan AVAPRO irbesartan/hydrochlorothiazide AVALIDE losartan COZAAR losartan/hydrochlorothiazide HYZAAR olmesartan PA BENICAR olmesartan/hydrochlorothiazide PA BENICAR HCT telmisartan PA MICARDIS telmisartan/hydrochlorothiazide PA MICARDIS HCT valsartan DIOVAN valsartan/hydrochlorothiazide QL DIOVAN HCT

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan PA AZOR amlodipine/valsartan PA EXFORGE amlodipine/valsartan/hydrochlorothiazide PA EXFORGE HCT

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS olmesartan/amlodipine/hydrochlorothiazide PA TRIBENZOR

ANTIARRHYTHMICS amiodarone disopyramide NORPACE disopyramide ext-rel NORPACE CR dofetilide SP TIKOSYN dronedarone MULTAQ flecainide propafenone propafenone ext-rel RYTHMOL SR sotalol BETAPACE sotalol BETAPACE AF

ANTILIPEMICS Bile Acid Resins cholestyramine QUESTRAN/QUESTRAN LIGHT colestipol packets, tabs COLESTID

Cholesterol Absorption Inhibitors ezetimibe ST * ZETIA

ST * Requires prior use of a HMG-CoA Reductase Inhibitor

Fibrates choline fenofibrate delayed-rel 45 mg TRILIPIX fenofibrate caps 150 mg LIPOFEN

fenofibrate tabs 48 mg PA TRICOR fenofibrate tabs 54 mg, 160 mg fenofibrate tabs 145 mg TRICOR gemfibrozil LOPID

HMG-CoA Reductase Inhibitors atorvastatin 10 mg, 20 mg, 40 mg LIPITOR atorvastatin 80 mg QL LIPITOR lovastatin pravastatin PRAVACHOL rosuvastatin QL CRESTOR simvastatin ZOCOR

Microsomal Triglyceride Transfer Protein Inhibitors lomitapide PA JUXTAPID

Niacins niacin ext-rel PA NIASPAN

Omega-3 Fatty Acids omega-3 acid ethyl esters PA LOVAZA

PCSK9 Inhibitors evolocumab PA, SP, QL REPATHA evolocumab PA, SP, QL REPATHA PUSHTRONEX

Miscellaneous mipomersen PA KYNAMRO

BETA-BLOCKERS acebutolol atenolol betaxolol bisoprolol carvedilol COREG labetalol TRANDATE metoprolol succinate ext-rel TOPROL-XL metoprolol tartrate 25 mg, 50 mg LOPRESSOR nadolol CORGARD pindolol propranolol propranolol ext-rel INDERAL LA timolol

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol/chlorthalidone bisoprolol/hydrochlorothiazide ZIAC metoprolol/hydrochlorothiazide LOPRESSOR HCT

CALCIUM CHANNEL BLOCKERS Dihydropyridines amlodipine NORVASC felodipine ext-rel nicardipine nifedipine PROCARDIA nifedipine ext-rel ADALAT CC nifedipine ext-rel PROCARDIA XL nimodipine NIMOTOP

nisoldipine ext-rel SULAR

Nondihydropyridines diltiazem CARDIZEM diltiazem ext-rel diltiazem ext-rel CARDIZEM CD diltiazem ext-rel TIAZAC diltiazem ext-rel, except 120 mg CARDIZEM LA verapamil ext-rel tabs CALAN SR

DIGITALIS GLYCOSIDES digoxin LANOXIN digoxin ped elixir AL

DIURETICS Carbonic Anhydrase Inhibitors acetazolamide acetazolamide ext-rel methazolamide

Loop Diuretics bumetanide furosemide LASIX torsemide DEMADEX

Potassium-sparing Diuretics amiloride

Thiazides and Thiazide-like Diuretics chlorthalidone hydrochlorothiazide indapamide metolazone chlorothiazide

Diuretic Combinations amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide ALDACTAZIDE triamterene/hydrochlorothiazide DYAZIDE triamterene/hydrochlorothiazide MAXZIDE

HEART FAILURE isosorbide dinitrate/hydralazine BIDIL

NITRATES Oral isosorbide dinitrate ext-rel tabs isosorbide dinitrate oral ISORDIL isosorbide mononitrate isosorbide mononitrate ext-rel

Sublingual nitroglycerin sublingual NITROSTAT

Transdermal nitroglycerin transdermal QL nitroglycerin transdermal QL NITRO-DUR

PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists ambrisentan PA, SP, QL LETAIRIS bosentan PA, SP TRACLEER macitentan PA, SP, QL OPSUMIT

Phosphodiesterase Inhibitors sildenafil PA, SP REVATIO

Prostacyclin Receptor Agonists selexipag PA, SP, QL UPTRAVI

Prostaglandin Vasodilators epoprostenol PA, SP VELETRI epoprostenol sodium PA, SP FLOLAN iloprost PA, SP VENTAVIS treprostinil PA, SP REMODULIN treprostinil PA, SP TYVASO

Soluble Guanylate Cyclase Stimulators riociguat PA, SP ADEMPAS

MISCELLANEOUS hydralazine methyldopa methyldopa/hydrochlorothiazide metyrosine PA DEMSER midodrine minoxidil tabs phentolamine inj ranolazine ext-rel RANEXA

CENTRAL NERVOUS SYSTEM AMYOTROPHIC LATERAL SCLEROSIS riluzole PA RILUTEK

ANTIANXIETY Benzodiazepines alprazolam XANAX alprazolam ext-rel PA XANAX XR chlordiazepoxide clonazepam tabs KLONOPIN clorazepate diazepam VALIUM lorazepam ATIVAN oxazepam

Miscellaneous buspirone QL clomipramine ANAFRANIL fluvoxamine meprobamate

ANTICONVULSANTS carbamazepine TEGRETOL carbamazepine ext-rel CARBATROL carbamazepine ext-rel TEGRETOL-XR

clobazam PA ONFI diazepam rectal gel DIASTAT divalproex sodium delayed-rel DEPAKOTE divalproex sodium ext-rel DEPAKOTE ER ethosuximide ZARONTIN ethotoin PEGANONE felbamate FELBATOL gabapentin QL NEURONTIN lacosamide PA VIMPAT lamotrigine QL LAMICTAL levetiracetam KEPPRA levetiracetam ext-rel KEPPRA XR methsuximide CELONTIN oxcarbazepine QL TRILEPTAL perampanel PA FYCOMPA phenobarbital QL phenytoin DILANTIN INFATABS phenytoin sodium extended DILANTIN pregabalin PA, QL LYRICA primidone MYSOLINE rufinamide PA BANZEL tiagabine GABITRIL topiramate sprinkle caps, tabs QL TOPAMAX valproic acid DEPAKENE zonisamide ZONEGRAN

ANTIDEMENTIA donepezil ARICEPT galantamine RAZADYNE galantamine ext-rel RAZADYNE ER memantine NAMENDA rivastigmine

ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder.

Monoamine Oxidase Inhibitors (MAOIs) isocarboxazid MARPLAN phenelzine NARDIL tranylcypromine PARNATE

Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram CELEXA escitalopram soln LEXAPRO escitalopram tabs LEXAPRO fluoxetine caps 10 mg, 20 mg, 40 mg PROZAC paroxetine HCl susp PAXIL paroxetine HCl tabs PAXIL sertraline ZOLOFT

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) duloxetine delayed-rel 20 mg, 30 mg, 60 mg CYMBALTA venlafaxine ext-rel EFFEXOR XR venlafaxine tabs

Tricyclic Antidepressants (TCAs) amitriptyline QL

amoxapine QL desipramine NORPRAMIN doxepin imipramine HCl TOFRANIL imipramine pamoate nortriptyline PAMELOR protriptyline trimipramine SURMONTIL

Miscellaneous Agents bupropion bupropion ext-rel PA APLENZIN bupropion ext-rel QL WELLBUTRIN SR bupropion ext-rel QL WELLBUTRIN XL chlordiazepoxide/amitriptyline loxapine maprotiline mirtazapine REMERON thioridazine trazodone 50 mg, 100 mg, 150 mg

ANTIPARKINSONIAN AGENTS amantadine QL benztropine QL bromocriptine PARLODEL carbidopa/levodopa SINEMET carbidopa/levodopa ext-rel SINEMET CR carbidopa/levodopa/entacapone ST * STALEVO entacapone ST * COMTAN pramipexole MIRAPEX ropinirole selegiline selegiline orally disintegrating tablets ZELAPAR trihexyphenidyl QL

ST * Requires prior use of carbidopa/levodopa

ANTIPSYCHOTICS Atypicals aripiprazole QL ABILIFY aripiprazole ext-rel inj ABILIFY MAINTENA aripiprazole lauroxil ext-rel inj ARISTADA aripiprazole lauroxil ext-rel inj ARISTADA INITIO asenapine PA, * SAPHRIS clozapine CLOZARIL iloperidone PA, * FANAPT lurasidone PA, * LATUDA olanzapine ZYPREXA olanzapine pamoate ext-rel inj ZYPREXA RELPREVV paliperidone ext-rel PA, * INVEGA paliperidone palmitate ext-rel inj INVEGA SUSTENNA paliperidone palmitate ext-rel inj PA, * INVEGA TRINZA quetiapine SEROQUEL quetiapine ext-rel PA, * SEROQUEL XR risperidone RISPERDAL risperidone long-acting inj RISPERDAL CONSTA ziprasidone QL GEODON

* Psychiatrists exempt from PA

Miscellaneous chlorpromazine fluphenazine haloperidol perphenazine perphenazine/amitriptyline pimozide thiothixene trifluoperazine

ATTENTION DEFICIT HYPERACTIVITY DISORDER amphetamine/dextroamphetamine mixed salts AL, QL ADDERALL amphetamine/dextroamphetamine mixed salts ext-rel AL, QL ADDERALL XR atomoxetine AL, ST * STRATTERA clonidine ext-rel AL, PA KAPVAY dexmethylphenidate AL FOCALIN dexmethylphenidate ext-rel AL, PA FOCALIN XR dextroamphetamine 5 mg, 10 mg AL, QL dextroamphetamine ext-rel AL, QL DEXEDRINE SPANSULE guanfacine ext-rel AL, PA INTUNIV lisdexamfetamine AL, PA, QL VYVANSE methylphenidate AL METHYLIN methylphenidate AL RITALIN methylphenidate ext-rel AL, QL CONCERTA methylphenidate ext-rel AL, QL METADATE CD methylphenidate ext-rel 10 mg AL, QL methylphenidate ext-rel 10 mg, 60 mg AL, PA, QL RITALIN LA methylphenidate ext-rel 20 mg AL, QL METADATE ER methylphenidate ext-rel 20 mg, 30 mg, 40 mg AL, QL RITALIN LA

ST * Requires prior use of methylphenidate or an amphetamine

HUNTINGTON'S DISEASE AGENTS tetrabenazine PA XENAZINE

HYPNOTICS Benzodiazepines estazolam temazepam QL RESTORIL triazolam QL

Nonbenzodiazepines zolpidem QL AMBIEN

MIGRAINE Ergotamine Derivatives dihydroergotamine spray QL MIGRANAL ergotamine/caffeine CAFERGOT

Selective Serotonin Agonists almotriptan PA, QL naratriptan QL AMERGE rizatriptan QL MAXALT rizatriptan orally disintegrating tabs QL MAXALT-MLT sumatriptan QL IMITREX sumatriptan inj QL IMITREX

sumatriptan nasal spray QL IMITREX

MOOD STABILIZERS carbamazepine ext-rel EQUETRO lithium carbonate lithium carbonate ext-rel tabs 300 mg LITHOBID lithium carbonate ext-rel tabs 450 mg

MULTIPLE SCLEROSIS AGENTS dalfampridine ext-rel PA, SP AMPYRA dimethyl fumarate delayed-rel PA, SP TECFIDERA fingolimod PA, SP GILENYA glatiramer 20 mg/mL PA, SP COPAXONE interferon beta-1a PA, SP AVONEX interferon beta-1b PA, SP EXTAVIA teriflunomide PA, SP AUBAGIO

MUSCULOSKELETAL THERAPY AGENTS baclofen 10 mg, 20 mg carisoprodol/aspirin QL carisoprodol/aspirin/codeine PA chlorzoxazone 500 mg cyclobenzaprine 5 mg, 10 mg QL dantrolene DANTRIUM methocarbamol ROBAXIN orphenadrine ext-rel orphenadrine/aspirin/caffeine PA tizanidine tabs ZANAFLEX

MYASTHENIA GRAVIS pyridostigmine MESTINON

NARCOLEPSY/CATAPLEXY armodafinil PA NUVIGIL modafinil PA, QL PROVIGIL sodium oxybate PA XYREM

PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents acamprosate calcium disulfiram ANTABUSE

Opioid Antagonists naloxone inj naloxone nasal spray NARCAN naltrexone

Partial Opioid Agonists buprenorphine ext-rel inj PA SUBLOCADE buprenorphine sublingual

Partial Opioid Agonist/Opioid Antagonist Combinations buprenorphine/naloxone buccal film BUNAVAIL buprenorphine/naloxone sublingual film SUBOXONE buprenorphine/naloxone sublingual tabs buprenorphine/naloxone sublingual tabs ZUBSOLV

Pseudobulbar Affect dextromethorphan/quinidine PA NUEDEXTA

Smoking Deterrents nicotine polacrilex gum OTC, QL NICORETTE nicotine polacrilex lozenge OTC NICORETTE nicotine transdermal OTC, QL bupropion ext-rel ZYBAN varenicline ST * CHANTIX

ST * Requires prior use of nicotine or bupropion ext-rel

MISCELLANEOUS guanidine PA

ENDOCRINE AND METABOLIC ACROMEGALY octreotide acetate SANDOSTATIN pegvisomant PA, SP SOMAVERT

ANDROGENS oxandrolone PA oxymetholone PA ANADROL-50 testosterone cypionate PA DEPO-TESTOSTERONE testosterone enanthate PA DELATESTRYL testosterone gel PA ANDROGEL testosterone gel PA FORTESTA

ANTIDIABETICS Alpha-glucosidase Inhibitors acarbose PRECOSE miglitol GLYSET

Amylin Analogs pramlintide ST * SYMLINPEN

ST * Requires prior use of insulin therapy

Biguanides metformin GLUCOPHAGE metformin ext-rel GLUCOPHAGE XR

Biguanide/Sulfonylurea Combinations glipizide/metformin glyburide/metformin HRM

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors alogliptin ST * NESINA

ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations alogliptin/metformin ST * KAZANO

ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Insulin Sensitizer Combinations alogliptin/pioglitazone ST * OSENI

ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination

Incretin Mimetic Agents liraglutide ST * VICTOZA semaglutide PA OZEMPIC

ST * Requires prior use of metformin AND an oral hypoglycemic agent

Insulins insulin human OTC, QL HUMULIN R insulin human OTC, QL NOVOLIN R insulin isophane human OTC HUMULIN N insulin isophane human OTC NOVOLIN N insulin isophane human 70%/regular 30% OTC HUMULIN 70/30 insulin isophane human 70%/regular 30% OTC NOVOLIN 70/30 insulin aspart protamine 70%/insulin aspart 30% NOVOLOG MIX 70/30 insulin glargine BASAGLAR insulin glargine PA, QL TOUJEO SOLOSTAR insulin human inhalation powder PA AFREZZA insulin human vial PA, QL HUMULIN R U-500 VIAL insulin lispro QL ADMELOG insulin lispro QL ADMELOG SOLOSTAR insulin lispro protamine/insulin lispro HUMALOG MIX

Insulin Sensitizers pioglitazone ACTOS

Insulin Sensitizer/Biguanide Combinations pioglitazone/metformin ACTOPLUS MET pioglitazone/metformin ext-rel PA ACTOPLUS MET XR

Insulin Sensitizer/Sulfonylurea Combinations pioglitazone/glimepiride PA DUETACT

Meglitinides nateglinide STARLIX repaglinide PRANDIN

Meglitinide/Biguanide Combinations repaglinide/metformin PA

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors ertugliflozin ST * STEGLATRO

ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations ertugliflozin/metformin ST * SEGLUROMET

ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination

Sulfonylureas glimepiride AMARYL glipizide GLUCOTROL glipizide ext-rel GLUCOTROL XL glyburide HRM glyburide micronized HRM GLYNASE

tolbutamide

Supplies alcohol swabs OTC, QL blood glucose monitoring kits OTC TRUE METRIX AIR kits blood glucose monitoring kits OTC TRUE METRIX kits blood glucose test strips OTC TRUE METRIX test strips insulin syringes, needles OTC lancets OTC insulin infusion disposable pump PA OMNIPOD INSULIN INFUSION PUMP

CALCIUM RECEPTOR ANTAGONISTS cinacalcet PA SENSIPAR

CALCIUM REGULATORS Bisphosphonates alendronate tabs FOSAMAX alendronate soln ibandronate PA BONIVA

Calcitonins calcitonin-salmon spray MIACALCIN

Parathyroid Hormones abaloparatide PA, SP TYMLOS

Miscellaneous denosumab PA, SP PROLIA

CARNITINE DEFICIENCY AGENTS levocarnitine oral soln, tabs CARNITOR

CONTRACEPTIVES EE = ethinyl estradiol

Monophasic 20 mcg Estrogen levonorgestrel/EE 0.1/20 norethindrone acetate/EE 1/20 LOESTRIN 1/20 norethindrone acetate/EE 1/20 and iron LOESTRIN FE 1/20

30 mcg Estrogen desogestrel/EE 0.15/30 APRI drospirenone/EE 3/30 YASMIN levonorgestrel/EE 0.15/30 norethindrone acetate/EE 1.5/30 LOESTRIN 1.5/30 norethindrone acetate/EE 1.5/30 and iron LOESTRIN FE 1.5/30 norgestrel/EE 0.3/30

35 mcg Estrogen ethynodiol diacetate/EE 1/35 norethindrone/EE 0.5/35 norethindrone/EE 1/35 ORTHO-NOVUM 1/35 norgestimate/EE 0.25/35

50 mcg Estrogen ethynodiol diacetate/EE 1/50 KELNOR 1/50 norgestrel/EE 0.5/50 OGESTREL

Biphasic desogestrel/EE MIRCETTE

Triphasic desogestrel/EE CAZIANT, VELIVET levonorgestrel/EE norethindrone/EE QL ORTHO-NOVUM 7/7/7 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg norgestimate/EE ORTHO TRI-CYCLEN LO norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg

Extended Cycle levonorgestrel/EE 0.1/20 and EE 10 QL AMETHIA LO, CAMRESE LO levonorgestrel/EE 0.15/30 QL INTROVALE, JOLESSA, SETLAKIN

Continuous levonorgestrel/EE 0.09/20

Progestin Only norethindrone norethindrone ORTHO MICRONOR

Emergency Contraception levonorgestrel OTC, QL PLAN B ONE-STEP ulipristal QL ELLA

Implant etonogestrel implant SP NEXPLANON

Injectable medroxyprogesterone acetate vial 150 mg/mL DEPO-PROVERA

Progestin Intrauterine Device levonorgestrel-releasing IUD SP, QL KYLEENA levonorgestrel-releasing IUD SP, QL LILETTA levonorgestrel-releasing IUD SP, QL MIRENA levonorgestrel-releasing IUD SP, QL SKYLA

Transdermal norelgestromin/EE QL XULANE

Vaginal etonogestrel/EE ring NUVARING

Miscellaneous condoms, male OTC, QL nonoxynol-9 OTC GYNOL II

ENDOMETRIOSIS danazol nafarelin PA SYNAREL

ESTROGENS Oral estradiol HRM ESTRACE estrogens, esterified PA MENEST

Transdermal estradiol PA ALORA estradiol HRM CLIMARA

Vaginal estradiol vaginal crm ESTRACE CREAM estradiol vaginal tabs PA VAGIFEM

ESTROGEN/PROGESTINS Oral EE/norethindrone acetate JINTELI EE/norethindrone acetate 0.5 mg/2.5 mcg FEMHRT estradiol/norethindrone acetate PA ACTIVELLA estradiol/norgestimate PREFEST

ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS conjugated estrogens/bazedoxifene PA DUAVEE

GAUCHER DISEASE miglustat PA ZAVESCA

GLUCOCORTICOIDS cortisone acetate dexamethasone dexamethasone concentrate 1 mg/mL DEXAMETHASONE INTENSOL fludrocortisone hydrocortisone CORTEF methylprednisolone MEDROL methylprednisolone 2 mg MEDROL prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5 mL prednisolone syrup prednisone prednisone concentrate 5 mg/mL PREDNISONE INTENSOL

GLUCOSE ELEVATING AGENTS glucose tablets OTC diazoxide PROGLYCEM glucagon, human recombinant QL GLUCAGEN HYPOKIT glucagon, human recombinant QL GLUCAGON EMERGENCY KIT

HEREDITARY TYROSINEMIA TYPE 1 AGENTS nitisinone PA ORFADIN

HUMAN GROWTH HORMONES somatropin PA, SP OMNITROPE

HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol (1,25-D3) QL ROCALTROL doxercalciferol HECTOROL paricalcitol ZEMPLAR

INSULIN-LIKE GROWTH FACTOR mecasermin PA, SP INCRELEX

PHOSPHATE BINDER AGENTS calcium acetate lanthanum chew tabs PA FOSRENOL lanthanum powder PA FOSRENOL

POTASSIUM-REMOVING AGENTS sodium polystyrene sulfonate SPS

PROGESTINS Oral medroxyprogesterone acetate PROVERA norethindrone acetate AYGESTIN progesterone, micronized PROMETRIUM

Vaginal progesterone gel PA CRINONE progesterone supp FIRST-PROGESTERONE VGS progesterone vaginal inserts ENDOMETRIN

SELECTIVE ESTROGEN RECEPTOR MODULATORS raloxifene EVISTA

THYROID AGENTS Antithyroid Agents methimazole TAPAZOLE propylthiouracil

Thyroid Supplements levothyroxine levothyroxine LEVOXYL levothyroxine SYNTHROID liothyronine CYTOMEL liotrix THYROLAR thyroid ARMOUR THYROID

UREA CYCLE DISORDERS sodium phenylbutyrate BUPHENYL

VASOPRESSIN RECEPTOR ANTAGONISTS tolvaptan PA, SP SAMSCA

VASOPRESSINS desmopressin spray PA STIMATE desmopressin spray, tabs DDAVP

MISCELLANEOUS cabergoline methylergonovine METHERGINE

GASTROINTESTINAL ANTACIDS alumina/magnesia OTC MAALOX alumina/magnesia/simethicone OTC MAALOX alumina/magnesia/simethicone OTC MYLANTA aluminum hydroxide OTC calcium carbonate OTC sodium bicarbonate OTC

ANTIDIARRHEALS bismuth subsalicylate OTC PEPTO-BISMOL loperamide OTC diphenoxylate/atropine LOMOTIL

loperamide

ANTIEMETICS dextrose/fructose/phosphoric acid OTC EMETROL dimenhydrinate OTC DRAMAMINE meclizine OTC aprepitant caps PA EMEND aprepitant susp PA EMEND dronabinol PA MARINOL granisetron tabs ST*, QL meclizine metoclopramide REGLAN metoclopramide orally-disintegrating tabs PA ondansetron QL ZOFRAN prochlorperazine promethazine HRM promethazine supp 12.5 mg, 25 mg HRM scopolamine transdermal TRANSDERM SCOP trimethobenzamide caps TIGAN

ST * Requires prior use of ondansetron

ANTISPASMODICS dicyclomine BENTYL glycopyrrolate tabs 1 mg, 2 mg hyoscyamine sulfate ext-rel caps hyoscyamine sulfate ext-rel tabs LEVBID hyoscyamine sulfate oral soln, elixir hyoscyamine sulfate orally disintegrating tabs ANASPAZ hyoscyamine sulfate orally disintegrating tabs LEVSIN methscopolamine bromide propantheline

CHOLELITHOLYTICS ursodiol ACTIGALL ursodiol URSO

H2 RECEPTOR ANTAGONISTS cimetidine OTC TAGAMET HB famotidine OTC PEPCID ranitidine OTC ZANTAC cimetidine famotidine PEPCID nizatidine ranitidine ZANTAC

INFLAMMATORY BOWEL DISEASE Oral Agents balsalazide budesonide delayed-rel caps ENTOCORT EC mesalamine delayed-rel PA DELZICOL mesalamine delayed-rel tabs ASACOL HD mesalamine delayed-rel tabs PA LIALDA mesalamine ext-rel caps APRISO olsalazine DIPENTUM sulfasalazine AZULFIDINE sulfasalazine delayed-rel AZULFIDINE EN-TABS

Rectal Agents hydrocortisone acetate foam CORTIFOAM hydrocortisone enema mesalamine rectal susp ROWASA mesalamine supp CANASA

IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation lubiprostone PA AMITIZA

Irritable Bowel Syndrome with Diarrhea alosetron ST * LOTRONEX

ST * Requires prior use of Metamucil, psyllium and dicyclomine

LAXATIVES/STOOL SOFTENERS bisacodyl OTC DULCOLAX bisacodyl enema OTC FLEET docusate calcium OTC docusate sodium OTC COLACE karaya gum OTC KARAYA GUM magnesium citrate OTC magnesium hydroxide OTC MILK OF MAGNESIA methylcellulose OTC CITRUCEL mineral oil OTC FLEET MINERAL OIL ENEMA polyethylene glycol 3350 powder OTC MIRALAX psyllium powder OTC KONSYL senna OTC sennosides OTC SENOKOT sennosides/docusate sodium OTC SENNA PLUS sodium phosphates OTC lactulose packets KRISTALOSE lactulose soln peg 3350/electrolytes COLYTE peg 3350/electrolytes COLYTE FLAVORED peg 3350/electrolytes GOLYTELY peg 3350/electrolytes NULYTELY

PANCREATIC ENZYMES pancrelipase delayed-rel CREON pancrelipase delayed-rel PANCREAZE pancrelipase delayed-rel ZENPEP

PROSTAGLANDINS misoprostol CYTOTEC

PROTON PUMP INHIBITORS esomeprazole magnesium delayed-rel OTC, QL NEXIUM 24HR lansoprazole delayed-rel OTC, QL PREVACID 24HR omeprazole magnesium delayed-rel OTC, QL PRILOSEC OTC omeprazole/sodium bicarbonate OTC, QL, PA ZEGERID OTC lansoprazole delayed-rel QL PREVACID lansoprazole delayed-rel orally-disintegrating tabs QL, PA PREVACID omeprazole delayed-rel QL omeprazole powder for suspension QL PRILOSEC pantoprazole delayed-rel packets for suspension QL, PA PROTONIX pantoprazole delayed-rel tabs QL PROTONIX

SALIVA STIMULANTS cevimeline EVOXAC pilocarpine tabs SALAGEN

STEROIDS, RECTAL petrolatum/mineral oil/shark liver oil/phenylephrine oint OTC PREPARATION H pramoxine/phenylephrine/glycerin/petrolatum OTC PREPARATION H hydrocortisone crm ANUSOL-HC 2.5% hydrocortisone crm PROCTOCORT 1%

ULCER THERAPY COMBINATIONS lansoprazole + amoxicillin + clarithromycin

MISCELLANEOUS loperamide/simethicone OTC IMODIUM simethicone OTC cholic acid PA CHOLBAM cromolyn sodium GASTROCROM glycopyrrolate PA CUVPOSA sucralfate susp CARAFATE sucralfate tabs CARAFATE

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin ext-rel PA UROXATRAL doxazosin CARDURA doxazosin ext-rel PA CARDURA XL dutasteride PA AVODART dutasteride/tamsulosin PA JALYN finasteride 5 mg PROSCAR silodosin PA RAPAFLO tamsulosin FLOMAX terazosin

URINARY ANTISPASMODICS oxybutynin transdermal OTC, PA OXYTROL FOR WOMEN oxybutynin oxybutynin ext-rel DITROPAN XL tolterodine PA DETROL tolterodine ext-rel PA DETROL LA trospium trospium ext-rel PA

VAGINAL ANTI-INFECTIVES clotrimazole OTC GYNE-LOTRIMIN miconazole OTC tioconazole OTC VAGISTAT-1 clindamycin CLINDESSE clindamycin crm CLEOCIN clindamycin vaginal supp CLEOCIN clotrimazole metronidazole METROGEL-VAGINAL miconazole nystatin vaginal tab terconazole crm, supp

MISCELLANEOUS acetohydroxamic acid PA LITHOSTAT bethanechol URECHOLINE methenamine mandelate pentosan polysulfate sodium ELMIRON potassium citrate UROCIT-K potassium citrate/citric acid CYTRA-K potassium citrate/sodium citrate/citric acid CYTRA-3 potassium/sodium acid phosphates PA K-PHOS sodium citrate/citric acid CYTRA-2

HEMATOLOGIC ANTICOAGULANTS Injectable dalteparin QL*, PA FRAGMIN enoxaparin QL*, PA LOVENOX

QL* Ten days supply allowed unless a PA is initiated

Oral apixaban PA ELIQUIS rivaroxaban PA XARELTO warfarin COUMADIN

Synthetic Heparinoid-like Agents fondaparinux QL*, PA ARIXTRA

QL* Ten days supply allowed unless a PA is initiated

HEMATOPOIETIC GROWTH FACTORS darbepoetin alfa PA, SP ARANESP epoetin alfa PA, SP EPOGEN epoetin alfa PA, SP PROCRIT filgrastim PA, SP NEUPOGEN filgrastim-sndz PA, SP ZARXIO pegfilgrastim PA, SP NEULASTA sargramostim PA, SP LEUKINE

HEMOPHILIA A AGENTS antihemophilic factor, recombinant PA, SP ADVATE antihemophilic factor, recombinant PA, SP HELIXATE FS antihemophilic factor, recombinant PA, SP KOGENATE FS antihemophilic factor/von Willebrand factor complex (human) PA, SP HUMATE-P

HEMOPHILIA B AGENTS factor IX concentrate PA, SP BENEFIX

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS eculizumab PA, SP SOLIRIS

PLATELET AGGREGATION INHIBITORS aspirin OTC clopidogrel PLAVIX dipyridamole ext-rel/aspirin AGGRENOX dipyridamole tabs prasugrel PA EFFIENT

PLATELET SYNTHESIS INHIBITORS anagrelide AGRYLIN

THROMBOCYTOPENIA AGENTS eltrombopag PA, SP PROMACTA

MISCELLANEOUS aminocaproic acid soln AMICAR aminocaproic acid tabs AMICAR cilostazol deferasirox PA, SP EXJADE pentoxifylline ext-rel succimer CHEMET

IMMUNOLOGIC AGENTS ALLERGENIC EXTRACTS ragweed pollen allergen extract PA RAGWITEK timothy grass pollen allergen extract PA GRASTEK

AUTOIMMUNE AGENTS adalimumab PA, SP HUMIRA apremilast PA, SP OTEZLA etanercept PA, SP ENBREL sarilumab PA, SP KEVZARA

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) auranofin RIDAURA hydroxychloroquine PLAQUENIL leflunomide ARAVA methotrexate penicillamine CUPRIMINE penicillamine PA DEPEN TITRA

IMMUNE GLOBULINS cytomegalovirus immune globulin PA, SP CYTOGAM hepatitis B immune globulin PA, SP HEPAGAM B immune globulin PA, SP CARIMUNE immune globulin PA, SP FLEBOGAMMA immune globulin PA, SP GAMMAGARD immune globulin PA, SP GAMUNEX-C immune globulin PA, SP HIZENTRA immune globulin PA, SP PRIVIGEN immune globulin PA, SP WINRHO SDF immune globulin, gamma (IGG) PA, SP GAMASTAN S/D lymphocyte immune globulin anti-thymocyte G PA ATGAM rabies immune globulin PA, SP HYPERRAB S/D rho D immune globulin PA, SP HYPERRHO rho D immune globulin RHOGAM rho D immune globulin PA, SP RHOPHYLAC

IMMUNOMODULATORS Interferons interferon alfa-2b PA, SP INTRON A interferon gamma-1b PA, SP ACTIMMUNE peginterferon alfa-2a PA, SP PEGASYS

Miscellaneous canakinumab PA, SP ILARIS rilonacept PA, SP ARCALYST

IMMUNOSUPPRESSANTS Antimetabolites azathioprine AZASAN azathioprine IMURAN mycophenolate mofetil CELLCEPT

Calcineurin Inhibitors cyclosporine QL SANDIMMUNE cyclosporine, modified NEORAL tacrolimus QL PROGRAF

Rapamycin Derivatives mycophenolate sodium delayed-rel MYFORTIC sirolimus QL RAPAMUNE

VACCINES pneumococcal vaccine QL PNEUMOVAX 23 pneumococcal vaccine QL PREVNAR 13 zoster vaccine AL* ZOSTAVAX zoster vaccine recombinant AL**, QL SHINGRIX

AL* Covered for ages 60 years and older AL** Covered for ages 50 years and older

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium potassium chloride ext-rel potassium chloride liquid

VITAMINS AND MINERALS Folic Acid folic acid

Prenatal Vitamins and Supplements docosahexaenoic acid OTC PRENATAL DHA prenatal vitamins fast dissolving tabs OTC CALNA prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg OTC PRENATAL FORMULA A-FREE prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg OTC EZFE FORTE prenatal vitamins/carbonyl iron/folic acid tabs PRENATABS RX prenatal vitamins/carbonyl iron/folic acid tabs PRENATAL PLUS IRON prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg † PRENATAL 19 prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg MYNATE 90 PLUS prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg † MYNATAL, MYNATAL ADVANCE prenatal vitamins/ferrous bisglycinate chelate/folic acid ATABEX OB, VINATE II prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel OTC BE WELL ROUNDED PAK prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg OTC PRENATAL TAB prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg OTC PERRY PRENATAL prenatal vitamins/ferrous fumarate/folic acid 15-1 mg O-CAL PRENATAL prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg OTC CENTRUM SPECIALIST PRENATAL PAK, SIMILAC PRENATAL EARLY SHIELD prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg OTC THERANATAL COMPLETE

prenatal vitamins/ferrous fumarate/folic acid 27-1 mg † M-VIT, NIVA-PLUS, PRENATAL TAB 27-1 MG, PNV FOLIC ACID + IRON, O- CAL FA, PRENATAL VITAMIN TAB LOW IRON, PNV PRENATAL PLUS prenatal vitamins/ferrous fumarate/folic acid 27-1 mg OTC, † THERANATAL prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg OTC COMPLETE PRENATAL + DHA, PRENATAL + DHA, PRENATAL + DHA WOMENS prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg OTC ONE-A-DAY PRENATAL PAK prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg OTC ONE-A-DAY PRENATAL PAK, GNP DAILY PRENATAL, RA ONE DAILY PRENATAL, SM ONE DAILY PRENATAL, HM ONE DAILY PRENATAL prenatal vitamins/ferrous fumarate/folic acid 29-1 mg † CO-NATAL FA prenatal vitamins/ferrous fumarate/folic acid 60-1 mg VINATE ONE, TRINATAL RX1 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg VITAFOL-OB, MYNATAL-Z, MYNATAL PLUS prenatal vitamins/ferrous fumarate/folic acid 75-1 mg NATALVIT prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg COMPLETENATE, SE-NATAL 19, PRENATAL 19 prenatal vitamins/ferrous fumarate/folic acid/fish oil OTC PRENATAL OMEGA-3, YOUR LIFE PRENATAL prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg OTC PRENATAL MULTI + DHA prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg OTC PRENATAL FORMULA prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg † TL FOLATE prenatal vitamins/ferrous succinate/folic acid OTC NUTRIENTS PRENATAL prenatal vitamins/iron carbonyl/folic acid 29-1 mg † PRENATAL + FE prenatal vitamins/iron carbonyl/folic acid + DHA OTC BRAINSTRONG PRENATAL prenatal vitamins/l-methylfolate + fish oil/choline OTC PRENATAL DHA PAK MULTI prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA OTC PRENATAL MULTI + DHA prenatal vitamins/minerals/folic acid/fish oil chew tabs OTC CVS PRENATAL CHEW GUMMY prenatal vitamins/minerals/iron/folic acid 0.1 mg OTC KPN PRENATAL prenatal vitamins/minerals/iron/folic acid 1 mg MYNATAL prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg OTC PRENATAL FORMULA prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg VINATE M

Miscellaneous acidophilus/pectin OTC arginine OTC ascorbic acid OTC VITAMIN C b-complex/vitamin c/folic acid caps OTC calcium OTC calcium/vitamin D OTC cholecalciferol (D3) OTC VITAMIN D coenzyme Q10-vitamin E OTC LIQ-10 electrolyte soln, oral OTC PEDIALYTE ferrous fumarate OTC ferrous gluconate OTC FERGON ferrous sulfate OTC, QL FEOSOL inositol niacinate OTC NIACIN FLUSH FREE magnesium chloride ex-rel OTC SLOW-MAG magnesium oxide OTC MAG-OX 400 niacin OTC niacin ext-rel OTC omega-3 fatty acids OTC FISH OIL omega-3 fatty acids OTC SEA-OMEGA pediatric multivitamin liquid OTC MULTI-DELYN, PEDIAVIT

polysaccharide iron complex caps, drops OTC NOVAFERRUM polysaccharide iron complex/cholecalciferol liq OTC NOVAFERRUM pyridoxine 25 mg, 50 mg OTC VITAMIN B-6 riboflavin tabs 100 mg OTC VITAMIN B-2 tocopherols-tocotrienols OTC AQUA-E ubidecarenone OTC COENZYME Q10 ubiquinol liposomal OTC CYTO-Q vitamin E OTC VITAMIN E zinc OTC cyanocobalamin inj ergocalciferol (D2) ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE SOFTGEL fluoride drops, tabs multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs phytonadione MEPHYTON polysaccharide iron forte vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops vitamin B complex/vitamin C/folic acid NEPHROCAPS zinc sulfate

RESPIRATORY ANAPHYLAXIS TREATMENT AGENTS epinephrine QL EPIPEN epinephrine QL EPIPEN JR.

ANTICHOLINERGICS ipratropium soln QL ipratropium, CFC-free aerosol QL ATROVENT HFA umeclidinium QL INCRUSE ELLIPTA

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting ipratropium/albuterol soln QL ipratropium/albuterol, CFC-free aerosol QL COMBIVENT RESPIMAT

Long Acting tiotropium/olodaterol PA STIOLTO RESPIMAT umeclidinium/vilanterol QL ANORO ELLIPTA

ANTIHISTAMINES, LOW SEDATING cetirizine OTC ZYRTEC cetirizine levocetirizine PA

ANTIHISTAMINES, NONSEDATING fexofenadine tabs 180 mg OTC ALLEGRA loratadine caps OTC, PA CLARITIN loratadine tabs OTC CLARITIN

ANTIHISTAMINES, SEDATING chlorpheniramine OTC clemastine OTC diphenhydramine OTC BENADRYL carbinoxamine PA

clemastine cyproheptadine diphenhydramine hydroxyzine HCl hydroxyzine pamoate VISTARIL

ANTIHISTAMINE/DECONGESTANT COMBINATIONS cetirizine/pseudoephedrine ext-rel OTC ZYRTEC-D 12 Hour fexofenadine/pseudoephedrine ext-rel OTC, PA ALLEGRA-D loratadine/pseudoephedrine ext-rel OTC CLARITIN-D triprolidine/pseudoephedrine liq, syp OTC acrivastine/pseudoephedrine SEMPREX-D chlorpheniramine/phenylephrine susp promethazine/phenylephrine

ANTITUSSIVES dextromethorphan syrup 15 mg/5 mL OTC benzonatate 100 mg. 200 mg QL TESSALON

ANTITUSSIVE COMBINATIONS Opioid codeine/guaifenesin liquid OTC codeine/guaifenesin/pseudoephedrine OTC codeine/chlorpheniramine/phenylephrine PA CAPCOF codeine/promethazine codeine/promethazine/phenylephrine hydrocodone/homatropine

Non-opioid dextromethorphan/guaifenesin ext-rel OTC MUCINEX DM dextromethorphan/guaifenesin liq, soln, syp OTC dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30 mg/5 mL OTC dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen OTC ROBITUSSIN COLD/FLU dextromethorphan/promethazine dextromethorphan/pyrilamine OTC CAPRON DM

BETA AGONISTS Inhalants Short Acting albuterol soln QL albuterol sulfate, CFC-free aerosol QL, * PROAIR HFA albuterol sulfate, CFC-free aerosol QL, * VENTOLIN HFA

* Both brand and generic VENTOLIN HFA and PROAIR HFA are covered

Long Acting Hand-held Active Inhalation salmeterol xinafoate QL SEREVENT

Oral Agents albuterol albuterol ext-rel metaproterenol terbutaline

CYSTIC FIBROSIS aztreonam lysine inhalation soln PA CAYSTON dornase alfa PA, SP PULMOZYME

tobramycin inhalation powder PA, SP TOBI PODHALER tobramycin inhalation soln PA, SP BETHKIS tobramycin inhalation soln PA, SP TOBI

DECONGESTANTS phenylephrine OTC SUDAFED PE pseudoephedrine OTC SUDAFED pseudoephedrine ext-rel OTC SUDAFED

DECONGESTANT/EXPECTORANT COMBINATIONS pseudoephedrine/guaifenesin ext-rel OTC MUCINEX D

EXPECTORANTS guaifenesin ext-rel OTC MUCINEX guaifenesin liq OTC DIABETIC TUSSIN guaifenesin liq, syp, tabs OTC ROBITUSSIN

LEUKOTRIENE MODULATORS montelukast SINGULAIR montelukast granules ST * SINGULAIR zafirlukast ACCOLATE zileuton ST * ZYFLO zileuton ext-rel ST *

ST * Requires prior use of inhaled corticosteroid therapy

MAST CELL STABILIZERS cromolyn sodium nasal spray OTC NASALCROM cromolyn soln for inhalation QL

MEDICAL SUPPLIES mask OTC, QL MASK spacer OTC, QL AEROCHAMBER vaporizer OTC, QL VAPORIZER peak flow meter TRUZONE peak flow meter sodium chloride for inhalation

NASAL ANTIHISTAMINES azelastine spray QL

NASAL DECONGESTANTS oxymetazoline spray OTC AFRIN phenylephrine spray OTC NEO-SYNEPHRINE epinephrine nasal soln 0.1% ADRENALIN 1:1000

NASAL STEROIDS fluticasone spray OTC FLONASE ALLERGY RELIEF triamcinolone acetonide spray OTC, PA flunisolide spray QL fluticasone spray QL

PHOSPHODIESTERASE-4 INHIBITORS roflumilast PA DALIRESP

RESPIRATORY SYNCYTIAL VIRUS palivizumab PA, SP SYNAGIS

SEVERE ASTHMA AGENTS omalizumab PA, SP XOLAIR

STEROID/BETA AGONIST COMBINATIONS budesonide/formoterol AL*, QL SYMBICORT fluticasone/salmeterol QL AIRDUO RESPICLICK fluticasone/salmeterol QL WIXELA INHUB

* Covered for ages under 12 years old

STEROID INHALANTS beclomethasone breath-activated aerosol QL QVAR REDIHALER budesonide inhalation susp AL PULMICORT RESPULES fluticasone furoate QL ARNUITY ELLIPTA fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg AL*, QL FLOVENT HFA mometasone QL ASMANEX TWISTHALER mometasone, CFC-free aerosol QL ASMANEX HFA

AL* Covered for ages 11 years old and under

XANTHINES aminophylline theophylline elixir ELIXOPHYLLIN theophylline ext-rel caps THEO-24 theophylline ext-rel tabs theophylline liquid

XANTHINE COMBINATIONS dyphylline/guaifenesin PA

MISCELLANEOUS sodium chloride soln OTC OCEAN acetylcysteine caffeine citrate soln AL*, QL ephedrine HCl OTC EPHEDRINE HCL ipratropium nasal spray

AL* Covered for ages 1 year old and under

TOPICAL DERMATOLOGY Acne Oral isotretinoin PA

Topical adapalene gel 0.1% OTC, AL, QL DIFFERIN OTC benzoyl peroxide OTC, AL adapalene AL, PA DIFFERIN benzoyl peroxide AL clindamycin gel, lotion AL, QL, ST* CLEOCIN T clindamycin soln AL clindamycin/benzoyl peroxide BENZACLIN erythromycin soln AL sulfacetamide lotion 10% KLARON sulfacetamide/sulfur crm, gel, lotion, pads tretinoin crm 0.025%, 0.05%, 0.1% AL, ST** RETIN-A tretinoin gel 0.01%, 0.025% AL, ST** RETIN-A

ST * Requires prior use of clindamycin soln or erythromycin soln ST ** Requires prior use of DIFFERIN OTC

Actinic Keratosis fluorouracil EFUDEX fluorouracil soln

Antibiotics bacitracin/polymyxin B OTC POLYSPORIN neomycin/bacitracin/polymyxin B OTC NEOSPORIN neomycin/bacitracin/polymyxin/pramoxine OTC NEOSPORIN+PN gentamicin mupirocin polymyxin B/bacitracin POLYSPORIN silver sulfadiazine SILVADENE

Antifungals clotrimazole 1% OTC clotrimazole oint OTC, PA ALEVAZOL miconazole OTC FUNGOID TINCTURE miconazole OTC MICATIN terbinafine OTC LAMISIL AT tolnaftate OTC TINACTIN ciclopirox LOPROX ciclopirox topical soln 8% PENLAC clotrimazole econazole ketoconazole crm, shampoo 2% nystatin

Anti-infective/Anti-inflammatory Combinations neomycin/polymyxin B/bacitracin/hydrocortisone oint CORTISPORIN OINTMENT

Antipsoriatics Topical calcipotriene crm, oint, soln 0.005% DOVONEX tazarotene crm 0.05%, gel 0.05%, 0.1% TAZORAC tazarotene crm 0.1% TAZORAC

Antiseborrheics coal tar shampoo OTC NEUTROGENA salicylic acid/sulfur shampoo OTC SEBULEX selenium sulfide shampoo 1% OTC SELSUN BLUE ketoconazole shampoo 2% NIZORAL SHAMPOO sulfacetamide sodium

Atopic Dermatitis Topical pimecrolimus PA ELIDEL tacrolimus PA PROTOPIC

Corticosteroids Low Potency hydrocortisone crm, gel, lotion, oint, soln 1% OTC CORTIZONE-10 hydrocortisone oint 0.5% OTC hydrocortisone/aloe vera crm 0.5%, 1% OTC alclometasone crm, oint 0.05% QL

desonide crm, oint 0.05% QL DESOWEN desonide lotion 0.05% PA, QL DESOWEN fluocinolone acetonide soln 0.01% hydrocortisone crm, lotion, oint 2.5%

Medium Potency betamethasone valerate crm, lotion, oint 0.1% desoximetasone crm 0.05% TOPICORT LP fluocinolone acetonide crm, oint 0.025% fluocinolone acetonide oil 0.01% DERMA-SMOOTHE-FS flurandrenolide tape CORDRAN fluticasone propionate crm 0.05%, oint 0.005% CUTIVATE hydrocortisone butyrate crm, oint, soln 0.1% LOCOID hydrocortisone valerate crm, oint 0.2% mometasone crm, oint 0.1% QL ELOCON mometasone lotion 0.1% ELOCON prednicarbate crm, oint 0.1% PA triamcinolone acetonide crm, lotion, oint 0.025% triamcinolone acetonide crm, lotion, oint 0.1%

High Potency amcinonide crm, lotion, oint 0.1% betamethasone dipropionate augmented crm 0.05% DIPROLENE AF betamethasone dipropionate augmented lotion 0.05% QL DIPROLENE betamethasone dipropionate crm, lotion, oint 0.05% QL desoximetasone crm 0.25% TOPICORT diflorasone diacetate crm 0.05% diflorasone diacetate emollient crm 0.05% fluocinonide crm 0.05% QL fluocinonide gel, oint 0.05% fluocinonide soln 0.05% QL triamcinolone acetonide crm, oint 0.5%

Very High Potency betamethasone dipropionate augmented gel, oint 0.05% QL DIPROLENE clobetasol propionate crm, gel, oint, soln 0.05% TEMOVATE clobetasol propionate foam 0.05% OLUX clobetasol propionate shampoo 0.05% CLOBEX diflorasone diacetate oint 0.05%

Emollients emollient lotion OTC DML mineral oil-hydrophilic petrolatum OTC PETROLATUM ammonium lactate 12% LAC-HYDRIN

Local Analgesics lidocaine patch 4% OTC, QL LIDOCARE lidocaine patch 5% PA LIDODERM

Local Anesthetics lidocaine crm 4% OTC LMX 4 lidocaine 5% crm lidocaine/prilocaine

Rosacea metronidazole crm 0.75% METROCREAM metronidazole gel 0.75% metronidazole gel 1% METROGEL

metronidazole lotion 0.75% METROLOTION sulfacetamide/sulfur

Scabicides and Pediculicides permethrin OTC pyrethrins/piperonyl butoxide OTC RID SHAMPOO crotamiton crm EURAX crotamiton lotion EURAX malathion OVIDE permethrin spinosad NATROBA

Wound Care Agents becaplermin PA REGRANEX

Miscellaneous Skin and Mucous Membrane aluminum hydroxide OTC DERMAGRAN calamine lotion OTC capsaicin OTC ZOSTRIX capsaicin/menthol/methyl salicylate OTC ZIKS dimethicone 1% crm OTC 4-N-1 CREAM diphenhydramine/zinc acetate OTC BENADRYL docosanol OTC ABREVA lidocaine OTC BACTINE nail scrub OTC NAIL SCRUB LIQ W/BRUSH povidone-iodine OTC BETADINE salicylic acid OTC sodium chloride soln OTC zinc acetate OTC DERMAFIX acyclovir crm, oint 5% PA ZOVIRAX bexarotene gel TARGRETIN collagen/lidocaine/aloe vera/vit E REGENECARE collagenase PA, QL SANTYL imiquimod PA ALDARA mafenide SULFAMYLON podofilox soln CONDYLOX trypsin/balsam/castor oil

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous

Steroids - Mouth/Throat triamcinolone paste

Miscellaneous chlorhexidine PERIDEX sodium fluoride PREVIDENT 5000

OPHTHALMIC Antiallergics ketotifen OTC, QL azelastine PA cromolyn sodium phenylephrine

Antifungals natamycin NATACYN

Anti-infectives bacitracin ciprofloxacin ophth oint CILOXAN ciprofloxacin ophth soln CILOXAN erythromycin gentamicin levofloxacin 0.5% moxifloxacin PA VIGAMOX neomycin/polymyxin B/gramicidin ofloxacin OCUFLOX polymyxin B/bacitracin polymyxin B/trimethoprim POLYTRIM sulfacetamide soln 10% BLEPH-10 tobramycin TOBREX tobramycin oint TOBREX tobramycin soln TOBREX

Anti-infective/Anti-inflammatory Combinations gentamicin/prednisolone acetate PRED-G neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/dexamethasone MAXITROL neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25% tobramycin/dexamethasone oint 0.3%/0.1% TOBRADEX tobramycin/dexamethasone susp 0.3%/0.05% TOBRADEX ST tobramycin/dexamethasone susp 0.3%/0.1% TOBRADEX

Anti-inflammatories Nonsteroidal bromfenac sodium PA diclofenac sodium flurbiprofen ketorolac 0.4% ACULAR LS ketorolac 0.5% ACULAR

Steroidal dexamethasone MAXIDEX dexamethasone sodium phosphate fluorometholone 0.1% susp FML LIQUIFILM fluorometholone 0.25% FML FORTE prednisolone acetate 0.12% PRED MILD prednisolone acetate 1% PRED FORTE prednisolone phosphate 1%

Antivirals ganciclovir PA ZIRGAN trifluridine

Beta-blockers Nonselective carteolol levobunolol timolol hemihydrate BETIMOL timolol maleate TIMOPTIC timolol maleate gel TIMOPTIC-XE

Selective betaxolol 0.25% BETOPTIC S betaxolol 0.5%

Carbonic Anhydrase Inhibitors Topical brinzolamide AZOPT dorzolamide TRUSOPT

Carbonic Anhydrase Inhibitor/Beta-blocker Combinations dorzolamide/timolol maleate COSOPT

Dry Eye Disease lifitegrast ST* XIIDRA

ST * Requires prior use of OTC lubricant and ointment

Immunomodulators cyclosporine RESTASIS

Mydriatics atropine cyclopentolate CYCLOGYL cyclopentolate/phenylephrine CYCLOMYDRIL homatropine tropicamide

Parasympathomimetics pilocarpine ISOPTO CARPINE

Prostaglandins latanoprost XALATAN

Sympathomimetics brimonidine 0.15% ALPHAGAN P

Sympathomimetic/Beta-blocker Combinations brimonidine/timolol COMBIGAN

Miscellaneous artificial tears OTC ARTIFICIAL TEARS carboxymethylcellulose sodium OTC REFRESH sodium chloride OTC MURO-128 echothiophate iodide PHOSPHOLINE IODIDE naphazoline 0.1% proparacaine 0.5% tetracaine 0.5%

OTIC Anti-infectives acetic acid ciprofloxacin otic CETRAXAL ofloxacin otic

Anti-infective/Anti-inflammatory Combinations acetic acid/hydrocortisone neomycin/polymyxin B/hydrocortisone CORTISPORIN OTIC

Miscellaneous carbamide peroxide 6.5% OTC DEBROX fluocinolone acetonide DERMOTIC

VAGINAL acetic acid soln OTC

NON-DISCRIMINATION STATEMENT

INDEX

4 AIRDUO RESPICLICK, 37 albendazole, 10 4-N-1 CREAM, 40 ALBENZA, 10 A albuterol, 35 abacavir, 9 albuterol ext-rel, 35 abacavir/dolutegravir/lamivudine, 8 albuterol soln, 35 abacavir/lamivudine, 8 albuterol sulfate, CFC-free aerosol, 35 abacavir/lamivudine/zidovudine, 8 alclometasone crm, oint 0.05%, 38 abaloparatide, 23 alcohol swabs, 23 ABILIFY, 18 ALDACTAZIDE, 15 ABILIFY MAINTENA, 18 ALDACTONE, 13 ABREVA, 40 ALDARA, 40 ABSTRAL, 6 aldesleukin, 12 acamprosate calcium, 20 alendronate soln, 23 acarbose, 21 alendronate tabs, 23 ACCOLATE, 36 ALEVAZOL, 38 ACCUPRIL, 12 ALEVE, 6 ACCURETIC, 12 alfuzosin ext-rel, 29 acebutolol, 14 ALINIA, 10 acetaminophen, 6 ALKERAN, 11 acetazolamide, 15 ALLEGRA, 34 acetazolamide ext-rel, 15 ALLEGRA-D, 35 acetic acid, 42 allopurinol, 6 acetic acid soln, 43 almotriptan, 19 acetic acid/hydrocortisone, 42 alogliptin, 21 acetohydroxamic acid, 30 alogliptin/metformin, 21 acetylcysteine, 37 alogliptin/pioglitazone, 21 acidophilus/pectin, 33 ALORA, 25 acrivastine/pseudoephedrine, 35 alosetron, 28 ACTIGALL, 27 ALPHAGAN P, 42 ACTIMMUNE, 31 alprazolam, 16 ACTIQ, 6 alprazolam ext-rel, 16 ACTIVELLA, 25 ALTACE, 12 ACTOPLUS MET, 22 alumina/magnesia, 26 ACTOPLUS MET XR, 22 alumina/magnesia/simethicone, 26 ACTOS, 22 aluminum hydroxide, 26, 40 ACULAR, 41 amantadine, 18 ACULAR LS, 41 AMARYL, 22 acyclovir caps, susp, tabs, 10 AMBIEN, 19 acyclovir crm, oint 5%, 40 ambrisentan, 16 ADALAT CC, 14 amcinonide crm, lotion, oint 0.1%, 39 adalimumab, 31 AMERGE, 19 adapalene, 37 AMETHIA LO, 24 adapalene gel 0.1%, 37 AMICAR, 31 ADDERALL, 19 amiloride, 15 ADDERALL XR, 19 amiloride/hydrochlorothiazide, 15 adefovir dipivoxil, 10 aminocaproic acid soln, 31 ADEMPAS, 16 aminocaproic acid tabs, 31 ADMELOG, 22 aminophylline, 37 ADMELOG SOLOSTAR, 22 amiodarone, 13 ADRENALIN 1 AMITIZA, 28 1000, 36 amitriptyline, 17 ADVATE, 30 amlodipine, 14 ADVIL, 6 amlodipine/benazepril, 12 AEROCHAMBER, 36 amlodipine/olmesartan, 13 afatinib, 11 amlodipine/valsartan, 13 AFINITOR, 11 amlodipine/valsartan/hydrochlorothiazide, 13 AFINITOR DISPERZ, 12 ammonium lactate 12%, 39 AFREZZA, 22 amoxapine, 18 AFRIN, 36 amoxicillin, 8 AGGRENOX, 30 amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL, 8 AGRYLIN, 31 amoxicillin/clavulanate chew tabs, tabs, 8 amphetamine/dextroamphetamine mixed salts, 19

46 amphetamine/dextroamphetamine mixed salts ext-rel, 19 AUBAGIO, 20 ampicillin, 8 AUGMENTIN, 8 AMPYRA, 20 auranofin, 31 ANADROL-50, 21 AVALIDE, 13 ANAFRANIL, 16 AVAPRO, 13 anagrelide, 31 AVELOX, 8 ANASPAZ, 27 AVODART, 29 anastrozole, 11 AVONEX, 20 ANDROGEL, 21 axitinib, 11 ANORO ELLIPTA, 34 AYGESTIN, 26 ANTABUSE, 20 AZASAN, 32 antihemophilic factor, recombinant, 30 azathioprine, 32 antihemophilic factor/von Willebrand factor complex (human), 30 azelastine, 40 ANUSOL-HC 2.5%, 29 azelastine spray, 36 apixaban, 30 azithromycin, 7 APLENZIN, 18 AZOPT, 42 apremilast, 31 AZOR, 13 aprepitant caps, 27 aztreonam lysine inhalation soln, 35 aprepitant susp, 27 AZULFIDINE, 27 APRI, 23 AZULFIDINE EN-TABS, 27 APRISO, 27 B APTIVUS, 9 bacitracin, 41 AQUA-E, 34 bacitracin/polymyxin B, 38 ARANESP, 30 baclofen 10 mg, 20 mg, 20 ARAVA, 31 BACTINE, 40 ARCALYST, 32 balsalazide, 27 arginine, 33 BANZEL, 17 ARICEPT, 17 BARACLUDE, 10 ARIMIDEX, 11 BASAGLAR, 22 aripiprazole, 18 b-complex/vitamin c/folic acid caps, 33 aripiprazole ext-rel inj, 18 BE WELL ROUNDED PAK, 32 aripiprazole lauroxil ext-rel inj, 18 becaplermin, 40 ARISTADA, 18 beclomethasone breath-activated aerosol, 37 ARISTADA INITIO, 18 bedaquiline, 9 ARIXTRA, 30 BENADRYL, 34, 40 armodafinil, 20 benazepril, 12 ARMOUR THYROID, 26 benazepril/hydrochlorothiazide, 12 ARNUITY ELLIPTA, 37 BENEFIX, 30 AROMASIN, 11 BENICAR, 13 artemether/lumefantrine, 8 BENICAR HCT, 13 ARTHROTEC, 6 BENTYL, 27 artificial tears, 42 BENZACLIN, 37 ARTIFICIAL TEARS, 42 benzonatate 100 mg. 200 mg, 35 ASACOL HD, 27 benzoyl peroxide, 37 ascorbic acid, 33 benztropine, 18 asenapine, 18 BETADINE, 40 ASMANEX HFA, 37 betamethasone dipropionate augmented crm 0.05%, 39 ASMANEX TWISTHALER, 37 betamethasone dipropionate augmented gel, oint 0.05%, 39 aspirin, 30 betamethasone dipropionate augmented lotion 0.05%, 39 ATABEX OB, 32 betamethasone dipropionate crm, lotion, oint 0.05%, 39 ATACAND, 13 betamethasone valerate crm, lotion, oint 0.1%, 39 ATACAND HCT, 13 BETAPACE, 13 atazanavir caps, 9 BETAPACE AF, 13 atazanavir powder, 9 betaxolol, 14 atazanavir/cobicistat, 8 betaxolol 0.25%, 41 atenolol, 14 betaxolol 0.5%, 42 atenolol/chlorthalidone, 14 bethanechol, 30 ATGAM, 31 BETHKIS, 36 ATIVAN, 16 BETIMOL, 41 atomoxetine, 19 BETOPTIC S, 41 atorvastatin 10 mg, 20 mg, 40 mg, 14 bexarotene caps, 12 atorvastatin 80 mg, 14 bexarotene gel, 40 atovaquone, 10 bicalutamide, 11 atovaquone/proguanil, 8 bictegravir/emtricitabine/tenofovir alafenamide, 8 atropine, 42 BIDIL, 15 ATROVENT HFA, 34

BIKTARVY, 8 capsaicin/menthol/methyl salicylate, 40 BILTRICIDE, 10 captopril, 12 bisacodyl, 28 captopril/hydrochlorothiazide, 12 bisacodyl enema, 28 CARAFATE, 29 bismuth subsalicylate, 26 carbamazepine, 16 bisoprolol, 14 carbamazepine ext-rel, 16, 20 bisoprolol/hydrochlorothiazide, 14 carbamide peroxide 6.5%, 42 BLEPH-10, 41 CARBATROL, 16 blood glucose monitoring kits, 23 carbidopa/levodopa, 18 blood glucose test strips, 23 carbidopa/levodopa ext-rel, 18 BONIVA, 23 carbidopa/levodopa/entacapone, 18 bosentan, 16 carbinoxamine, 34 BOSULIF, 11 carboxymethylcellulose sodium, 42 bosutinib, 11 CARDIZEM, 15 BRAINSTRONG PRENATAL, 33 CARDIZEM CD, 15 brimonidine 0.15%, 42 CARDIZEM LA, 15 brimonidine/timolol, 42 CARDURA, 13, 29 brinzolamide, 42 CARDURA XL, 29 bromfenac sodium, 41 CARIMUNE, 31 bromocriptine, 18 carisoprodol/aspirin, 20 budesonide delayed-rel caps, 27 carisoprodol/aspirin/codeine, 20 budesonide inhalation susp, 37 CARNITOR, 23 budesonide/formoterol, 37 carteolol, 41 bumetanide, 15 carvedilol, 14 BUNAVAIL, 20 CASODEX, 11 BUPHENYL, 26 CATAPRES, 12 buprenorphine ext-rel inj, 20 CATAPRES TTS, 12 buprenorphine sublingual, 20 CAYSTON, 35 buprenorphine/naloxone buccal film, 20 CAZIANT, 24 buprenorphine/naloxone sublingual film, 20 cefaclor, 7 buprenorphine/naloxone sublingual tabs, 20 CEFACLOR ER, 7 bupropion, 18 cefaclor ext-rel, 7 bupropion ext-rel, 18, 21 cefadroxil, 7 buspirone, 16 cefdinir, 7 busulfan, 11 cefpodoxime, 7 butalbital/acetaminophen 50/325 mg, 7 cefprozil, 7 butalbital/acetaminophen/caffeine 50/325/40 mg, 7 cefuroxime axetil, 7 butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg, 6 CELEBREX, 6 butalbital/aspirin/caffeine, 7 celecoxib, 6 butorphanol nasal spray, 6 CELEXA, 17 C CELLCEPT, 32 CELONTIN, 17 cabergoline, 26 CENTRUM SPECIALIST PRENATAL PAK, 32 cabozantinib, 11 cephalexin caps 250 mg, 500 mg, 7 CAFERGOT, 19 cephalexin caps 750 mg, 7 caffeine citrate soln, 37 cephalexin susp, 7 calamine lotion, 40 cetirizine, 34 CALAN SR, 15 cetirizine/pseudoephedrine ext-rel, 35 calcipotriene crm, oint, soln 0.005%, 38 CETRAXAL, 42 calcitonin-salmon spray, 23 cevimeline, 29 calcitriol (1,25-D3), 25 CHANTIX, 21 calcium, 33 CHEMET, 31 calcium acetate, 25 chlorambucil, 11 calcium carbonate, 26 chlordiazepoxide, 16 calcium/vitamin D, 33 chlordiazepoxide/amitriptyline, 18 CALNA, 32 chlorhexidine, 40 CAMRESE LO, 24 chloroquine, 8 canakinumab, 32 chlorothiazide, 15 CANASA, 28 chlorpheniramine, 34 candesartan, 13 chlorpheniramine/phenylephrine susp, 35 candesartan/hydrochlorothiazide, 13 chlorpromazine, 19 CAPCOF, 35 chlorthalidone, 15 capecitabine, 11 chlorzoxazone 500 mg, 20 CAPRELSA, 12 CHOLBAM, 29 CAPRON DM, 35 cholecalciferol (D3), 33 capsaicin, 40 cholestyramine, 13

48 cholic acid, 29 colestipol packets, tabs, 13 choline fenofibrate delayed-rel 45 mg, 13 collagen/lidocaine/aloe vera/vit E, 40 ciclopirox, 38 collagenase, 40 ciclopirox topical soln 8%, 38 COLYTE, 28 cilostazol, 31 COLYTE FLAVORED, 28 CILOXAN, 41 COMBIGAN, 42 CIMDUO, 9 COMBIVENT RESPIMAT, 34 cimetidine, 27 COMBIVIR, 9 cinacalcet, 23 COMETRIQ, 11 CIPRO, 8 COMPLERA, 9 ciprofloxacin, 8 COMPLETE PRENATAL + DHA, 33 ciprofloxacin ophth oint, 41 COMPLETENATE, 33 ciprofloxacin ophth soln, 41 COMTAN, 18 ciprofloxacin otic, 42 CO-NATAL FA, 33 citalopram, 17 CONCERTA, 19 CITRUCEL, 28 condoms, male, 24 clarithromycin, 7 CONDYLOX, 40 clarithromycin ext-rel, 7 conjugated estrogens/bazedoxifene, 25 CLARITIN, 34 COPAXONE, 20 CLARITIN-D, 35 CORDRAN, 39 clemastine, 34 COREG, 14 CLEOCIN, 10, 29 CORGARD, 14 CLEOCIN T, 37 CORTEF, 25 CLIMARA, 25 CORTIFOAM, 28 clindamycin, 10, 29 cortisone acetate, 25 clindamycin crm, 29 CORTISPORIN OINTMENT, 38 clindamycin gel, lotion, 37 CORTISPORIN OTIC, 42 clindamycin soln, 37 CORTIZONE-10, 38 clindamycin vaginal supp, 29 COSOPT, 42 clindamycin/benzoyl peroxide, 37 COUMADIN, 30 CLINDESSE, 29 COZAAR, 13 clobazam, 17 CREON, 28 clobetasol propionate crm, gel, oint, soln 0.05%, 39 CRESTOR, 14 clobetasol propionate foam 0.05%, 39 CRINONE, 26 clobetasol propionate shampoo 0.05%, 39 CRIXIVAN, 9 CLOBEX, 39 cromolyn sodium, 29, 40 clomipramine, 16 cromolyn sodium nasal spray, 36 clonazepam tabs, 16 cromolyn soln for inhalation, 36 clonidine, 12 crotamiton crm, 40 clonidine ext-rel, 19 crotamiton lotion, 40 clonidine transdermal, 12 CUPRIMINE, 31 clopidogrel, 30 CUTIVATE, 39 clorazepate, 16 CUVPOSA, 29 clotrimazole, 29, 38 CVS PRENATAL CHEW GUMMY, 33 clotrimazole 1%, 38 cyanocobalamin inj, 34 clotrimazole oint, 38 cyclobenzaprine 5 mg, 10 mg, 20 clotrimazole troches, 8 CYCLOGYL, 42 clozapine, 18 CYCLOMYDRIL, 42 CLOZARIL, 18 cyclopentolate, 42 coal tar shampoo, 38 cyclopentolate/phenylephrine, 42 COARTEM, 8 cyclophosphamide caps, 11 cobicistat, 8 cycloserine, 10 codeine sulfate, 6 cyclosporine, 32, 42 codeine/acetaminophen, 6 cyclosporine, modified, 32 codeine/chlorpheniramine/phenylephrine, 35 CYMBALTA, 17 codeine/guaifenesin liquid, 35 cyproheptadine, 35 codeine/guaifenesin/pseudoephedrine, 35 CYTOGAM, 31 codeine/promethazine, 35 cytomegalovirus immune globulin, 31 codeine/promethazine/phenylephrine, 35 CYTOMEL, 26 COENZYME Q10, 34 CYTO-Q, 34 coenzyme Q10-vitamin E, 33 CYTOTEC, 28 COLACE, 28 CYTRA-2, 30 colchicine tabs, 6 CYTRA-3, 30 colchicine/probenecid, 6 CYTRA-K, 30 COLCRYS, 6 COLESTID, 13

D diazepam, 16 dabrafenib, 11 diazepam rectal gel, 17 dalfampridine ext-rel, 20 diazoxide, 25 DALIRESP, 36 diclofenac potassium, 6 dalteparin, 30 diclofenac sodium, 41 danazol, 24 diclofenac sodium delayed-rel, 6 DANTRIUM, 20 diclofenac sodium delayed-rel/misoprostol, 6 dantrolene, 20 diclofenac sodium ext-rel, 6 dapsone, 10 diclofenac sodium gel 1%, 6 darbepoetin alfa, 30 dicloxacillin, 8 darunavir, 9 dicyclomine, 27 darunavir/cobicistat, 8 didanosine delayed-rel, 9 dasatinib, 11 didanosine soln, 9 DAYPRO, 6 DIFFERIN, 37 DDAVP, 26 DIFFERIN OTC, 37 DEBROX, 42 diflorasone diacetate crm 0.05%, 39 deferasirox, 31 diflorasone diacetate emollient crm 0.05%, 39 DELATESTRYL, 21 diflorasone diacetate oint 0.05%, 39 DELZICOL, 27 DIFLUCAN, 8 DEMADEX, 15 diflunisal, 6 DEMSER, 16 digoxin, 15 denosumab, 23 digoxin ped elixir, 15 DEPAKENE, 17 dihydroergotamine spray, 19 DEPAKOTE, 17 DILANTIN, 17 DEPAKOTE ER, 17 DILANTIN INFATABS, 17 DEPEN TITRA, 31 DILAUDID, 6 DEPO-PROVERA, 24 DILAUDID-5, 6 DEPO-TESTOSTERONE, 21 diltiazem, 15 DERMAFIX, 40 diltiazem ext-rel, 15 DERMAGRAN, 40 diltiazem ext-rel, except 120 mg, 15 DERMA-SMOOTHE-FS, 39 dimenhydrinate, 27 DERMOTIC, 43 dimethicone 1% crm, 40 DESCOVY, 9 dimethyl fumarate delayed-rel, 20 desipramine, 18 DIOVAN, 13 desmopressin spray, 26 DIOVAN HCT, 13 desmopressin spray, tabs, 26 DIPENTUM, 27 desogestrel/EE, 24 diphenhydramine, 34, 35 desogestrel/EE 0.15/30, 23 diphenhydramine/zinc acetate, 40 desonide crm, oint 0.05%, 38 diphenoxylate/atropine, 26 desonide lotion 0.05%, 38 DIPROLENE, 39 DESOWEN, 38 DIPROLENE AF, 39 desoximetasone crm 0.05%, 39 dipyridamole ext-rel/aspirin, 30 desoximetasone crm 0.25%, 39 dipyridamole tabs, 30 DETROL, 29 disopyramide, 13 DETROL LA, 29 disopyramide ext-rel, 13 dexamethasone, 25, 41 disulfiram, 20 dexamethasone concentrate 1 mg/mL, 25 DITROPAN XL, 29 DEXAMETHASONE INTENSOL, 25 divalproex sodium delayed-rel, 17 dexamethasone sodium phosphate, 41 divalproex sodium ext-rel, 17 DEXEDRINE SPANSULE, 19 DML, 39 dexmethylphenidate, 19 docosahexaenoic acid, 32 dexmethylphenidate ext-rel, 19 docosanol, 40 dextroamphetamine 5 mg, 10 mg, 19 docusate calcium, 28 dextroamphetamine ext-rel, 19 docusate sodium, 28 dextromethorphan syrup 15 mg/5 mL, 35 dofetilide, 13 dextromethorphan/guaifenesin ext-rel, 35 dolutegravir, 9 dextromethorphan/guaifenesin liq, soln, syp, 35 dolutegravir/rilpivirine, 8 dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30 donepezil, 17 mg/5 mL, 35 dornase alfa, 35 dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen, 35 dorzolamide, 42 dextromethorphan/promethazine, 35 dorzolamide/timolol maleate, 42 dextromethorphan/pyrilamine, 35 DOVONEX, 38 dextromethorphan/quinidine, 21 doxazosin, 13, 29 dextrose/fructose/phosphoric acid, 27 doxazosin ext-rel, 29 DIABETIC TUSSIN, 36 doxepin, 18 DIASTAT, 17 doxercalciferol, 25

50 doxycycline calcium syrup, 8 epinephrine nasal soln 0.1%, 36 doxycycline hyclate caps 50 mg, 100 mg, 8 EPIPEN, 34 doxycycline hyclate tabs 20 mg, 100 mg, 8 EPIPEN JR., 34 doxycycline monohydrate, 8 EPIVIR, 9 DRAMAMINE, 27 EPIVIR-HBV, 10 dronabinol, 27 eplerenone, 13 dronedarone, 13 epoetin alfa, 30 drospirenone/EE 3/30, 23 EPOGEN, 30 DROXIA, 12 epoprostenol, 16 DUAVEE, 25 epoprostenol sodium, 16 DUETACT, 22 eprosartan, 13 DULCOLAX, 28 EPZICOM, 8 duloxetine delayed-rel 20 mg, 30 mg, 60 mg, 17 EQUETRO, 20 DURAGESIC, 6 ergocalciferol (D2), 34 dutasteride, 29 ergotamine/caffeine, 19 dutasteride/tamsulosin, 29 erlotinib, 11 DYAZIDE, 15 ertugliflozin, 22 dyphylline/guaifenesin, 37 ertugliflozin/metformin, 22 E ERYPED, 7 ERY-TAB, 7 E.E.S., 7 ERYTHROCIN, 7 echothiophate iodide, 42 erythromycin, 41 econazole, 38 erythromycin delayed-rel, 7 eculizumab, 30 erythromycin ethylsuccinate, 7 EDURANT, 9 erythromycin ethylsuccinate 200 mg/5 mL, 7 EE/norethindrone acetate, 25 erythromycin soln, 37 EE/norethindrone acetate 0.5 mg/2.5 mcg, 25 erythromycin stearate, 7 efavirenz, 9 escitalopram soln, 17 efavirenz/lamivudine/tenofovir disoproxil fumarate, 8 escitalopram tabs, 17 EFFEXOR XR, 17 ESGIC, 7 EFFIENT, 30 esomeprazole magnesium delayed-rel, 28 EFUDEX, 38 estazolam, 19 electrolyte soln, oral, 33 ESTRACE, 24 ELIDEL, 38 ESTRACE CREAM, 25 ELIQUIS, 30 estradiol, 24, 25 ELIXOPHYLLIN, 37 estradiol vaginal crm, 25 ELLA, 24 estradiol vaginal tabs, 25 ELMIRON, 30 estradiol/norethindrone acetate, 25 ELOCON, 39 estradiol/norgestimate, 25 eltrombopag, 31 estramustine, 11 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, 9 estrogens, esterified, 24 elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate, 9 etanercept, 31 EMCYT, 11 ethambutol, 10 EMEND, 27 ethionamide, 10 EMETROL, 27 ethosuximide, 17 emollient lotion, 39 ethotoin, 17 emtricitabine, 9 ethynodiol diacetate/EE 1/35, 23 emtricitabine/rilpivirine/tenofovir alafenamide, 9 ethynodiol diacetate/EE 1/50, 23 emtricitabine/rilpivirine/tenofovir disoproxil fumarate, 9 etodolac, 6 emtricitabine/tenofovir alafenamide, 9 etodolac ext-rel, 6 emtricitabine/tenofovir disoproxil fumarate, 9 etonogestrel implant, 24 EMTRIVA, 9 etonogestrel/EE ring, 24 enalapril, 12 etoposide, 12 enalapril/hydrochlorothiazide, 12 etravirine, 9 ENBREL, 31 EURAX, 40 ENDOMETRIN, 26 everolimus, 11 enfuvirtide, 9 everolimus tablets for oral suspension, 12 enoxaparin, 30 EVISTA, 26 entacapone, 18 evolocumab, 14 entecavir soln, 10 EVOTAZ, 8 entecavir tabs, 10 EVOXAC, 29 ENTOCORT EC, 27 exemestane, 11 EPCLUSA, 10 EXFORGE, 13 ephedrine HCl, 37 EXFORGE HCT, 13 EPHEDRINE HCL, 37 EXJADE, 31 epinephrine, 34 EXTAVIA, 20

51 ezetimibe, 13 fluorometholone 0.25%, 41 EZFE FORTE, 32 fluorouracil, 38 F fluorouracil soln, 38 fluoxetine caps 10 mg, 20 mg, 40 mg, 17 factor IX concentrate, 30 fluphenazine, 19 famciclovir, 10 flurandrenolide tape, 39 famotidine, 27 flurbiprofen, 6, 41 FANAPT, 18 flutamide, 11 FARESTON, 11 fluticasone furoate, 37 febuxostat, 6 fluticasone propionate crm 0.05%, oint 0.005%, 39 felbamate, 17 fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg, 37 FELBATOL, 17 fluticasone spray, 36 FELDENE, 6 fluticasone/salmeterol, 37 felodipine ext-rel, 14 fluvoxamine, 16 FEMARA, 11 FML FORTE, 41 FEMHRT, 25 FML LIQUIFILM, 41 fenofibrate caps 150 mg, 13 FOCALIN, 19 fenofibrate tabs 145 mg, 14 FOCALIN XR, 19 fenofibrate tabs 48 mg, 14 folic acid, 32 fenofibrate tabs 54 mg, 160 mg, 14 fondaparinux, 30 fenoprofen 600 mg, 6 FORTESTA, 21 fentanyl citrate buccal, 6 FOSAMAX, 23 fentanyl lozenge, 6 fosamprenavir susp, 9 fentanyl sublingual, 6 fosamprenavir tabs, 9 fentanyl transdermal, 6 fosinopril, 12 FENTORA, 6 fosinopril/hydrochlorothiazide, 12 FEOSOL, 33 FOSRENOL, 25 FERGON, 33 FRAGMIN, 30 FERROGELS FORTE, 34 FUNGOID TINCTURE, 38 FERROGELS FORTE SOFTGEL, 34 FURADANTIN, 10 ferrous fumarate, 33 furosemide, 15 ferrous fumarate/vitamin C/vitamin B12/folic acid, 34 FUZEON, 9 ferrous gluconate, 33 FYCOMPA, 17 ferrous sulfate, 33 fexofenadine tabs 180 mg, 34 G fexofenadine/pseudoephedrine ext-rel, 35 gabapentin, 17 filgrastim, 30 GABITRIL, 17 filgrastim-sndz, 30 galantamine, 17 finasteride 5 mg, 29 galantamine ext-rel, 17 fingolimod, 20 GAMASTAN S/D, 31 FIORINAL, 7 GAMMAGARD, 31 FIRST-PROGESTERONE VGS, 26 GAMUNEX-C, 31 FIRVANQ, 11 ganciclovir, 41 FISH OIL, 33 GASTROCROM, 29 FLAGYL, 10 gemfibrozil, 14 FLEBOGAMMA, 31 gentamicin, 38, 41 flecainide, 13 gentamicin/prednisolone acetate, 41 FLEET, 28 GENVOYA, 9 FLEET MINERAL OIL ENEMA, 28 GEODON, 18 FLOLAN, 16 GILENYA, 20 FLOMAX, 29 GILOTRIF, 11 FLONASE ALLERGY RELIEF, 36 glatiramer 20 mg/mL, 20 FLOVENT HFA, 37 GLEEVEC, 12 fluconazole, 8 GLEOSTINE, 11 fludrocortisone, 25 glimepiride, 22 FLUMADINE, 10 glipizide, 22 flunisolide spray, 36 glipizide ext-rel, 22 fluocinolone acetonide, 43 glipizide/metformin, 21 fluocinolone acetonide crm, oint 0.025%, 39 GLUCAGEN HYPOKIT, 25 fluocinolone acetonide oil 0.01%, 39 GLUCAGON EMERGENCY KIT, 25 fluocinolone acetonide soln 0.01%, 39 glucagon, human recombinant, 25 fluocinonide crm 0.05%, 39 GLUCOPHAGE, 21 fluocinonide gel, oint 0.05%, 39 GLUCOPHAGE XR, 21 fluocinonide soln 0.05%, 39 glucose tablets, 25 fluoride drops, tabs, 34 GLUCOTROL, 22 fluorometholone 0.1% susp, 41 GLUCOTROL XL, 22

52 glyburide, 22 hyoscyamine sulfate oral soln, elixir, 27 glyburide micronized, 22 hyoscyamine sulfate orally disintegrating tabs, 27 glyburide/metformin, 21 HYPERRAB S/D, 31 glycopyrrolate, 29 HYPERRHO, 31 glycopyrrolate tabs 1 mg, 2 mg, 27 HYZAAR, 13 GLYNASE, 22 I GLYSET, 21 ibandronate, 23 GNP DAILY PRENATAL, 33 ibrutinib, 12 GOLYTELY, 28 ibuprofen, 6 granisetron tabs, 27 idelalisib, 12 GRASTEK, 31 ILARIS, 32 griseofulvin microsize, 8 iloperidone, 18 griseofulvin ultramicrosize, 8 iloprost, 16 guaifenesin ext-rel, 36 imatinib mesylate, 12 guaifenesin liq, 36 IMBRUVICA, 12 guaifenesin liq, syp, tabs, 36 imipramine HCl, 18 guanfacine, 12 imipramine pamoate, 18 guanfacine ext-rel, 19 imiquimod, 40 guanidine, 21 IMITREX, 19, 20 GYNE-LOTRIMIN, 29 immune globulin, 31 GYNOL II, 24 immune globulin, gamma (IGG), 31 H IMODIUM, 29 haloperidol, 19 IMURAN, 32 HARVONI, 10 INCRELEX, 25 HECTOROL, 25 INCRUSE ELLIPTA, 34 HELIXATE FS, 30 indapamide, 15 HEPAGAM B, 31 INDERAL LA, 14 hepatitis B immune globulin, 31 indinavir, 9 HEPSERA, 10 INLYTA, 11 HIZENTRA, 31 inositol niacinate, 33 HM ONE DAILY PRENATAL, 33 INSPRA, 13 homatropine, 42 insulin aspart protamine 70%/insulin aspart 30%, 22 HUMALOG MIX, 22 insulin glargine, 22 HUMATE-P, 30 insulin human, 22 HUMIRA, 31 insulin human inhalation powder, 22 HUMULIN 70/30, 22 insulin human vial, 22 HUMULIN N, 22 insulin infusion disposable pump, 23 HUMULIN R, 22 insulin isophane human, 22 HUMULIN R U-500 VIAL, 22 insulin isophane human 70%/regular 30%, 22 HYCAMTIN, 12 insulin lispro, 22 hydralazine, 16 insulin lispro protamine/insulin lispro, 22 HYDREA, 12 insulin syringes, needles, 23 hydrochlorothiazide, 15 INTELENCE, 9 hydrocodone/acetaminophen, 6 interferon alfa-2b, 31 hydrocodone/acetaminophen soln 7.5-325 mg/15 mL, 6 interferon beta-1a, 20 hydrocodone/homatropine, 35 interferon beta-1b, 20 hydrocortisone, 25 interferon gamma-1b, 31 hydrocortisone acetate foam, 28 INTRON A, 31 hydrocortisone butyrate crm, oint, soln 0.1%, 39 INTROVALE, 24 hydrocortisone crm, 29 INTUNIV, 19 hydrocortisone crm, gel, lotion, oint, soln 1%, 38 INVEGA, 18 hydrocortisone crm, lotion, oint 2.5%, 39 INVEGA SUSTENNA, 18 hydrocortisone enema, 28 INVEGA TRINZA, 18 hydrocortisone oint 0.5%, 38 INVIRASE, 9 hydrocortisone valerate crm, oint 0.2%, 39 ipratropium nasal spray, 37 hydrocortisone/aloe vera crm 0.5%, 1%, 38 ipratropium soln, 34 hydromorphone oral soln 1 mg/mL, 6 ipratropium, CFC-free aerosol, 34 hydromorphone tabs, 6 ipratropium/albuterol soln, 34 hydroxychloroquine, 31 ipratropium/albuterol, CFC-free aerosol, 34 hydroxyurea, 12 irbesartan, 13 hydroxyzine HCl, 35 irbesartan/hydrochlorothiazide, 13 hydroxyzine pamoate, 35 ISENTRESS, 9 hylan G-F 20, 7 ISENTRESS HD, 9 hyoscyamine sulfate ext-rel caps, 27 isocarboxazid, 17 hyoscyamine sulfate ext-rel tabs, 27 isoniazid syrup, 10

53 isoniazid tabs, 10 LANOXIN, 15 ISOPTO CARPINE, 42 lansoprazole + amoxicillin + clarithromycin, 29 ISORDIL, 15 lansoprazole delayed-rel, 28 isosorbide dinitrate ext-rel tabs, 15 lansoprazole delayed-rel orally-disintegrating tabs, 28 isosorbide dinitrate oral, 15 lanthanum chew tabs, 25 isosorbide dinitrate/hydralazine, 15 lanthanum powder, 25 isosorbide mononitrate, 15 lapatinib, 12 isosorbide mononitrate ext-rel, 15 LASIX, 15 isotretinoin, 37 latanoprost, 42 itraconazole, 8 LATUDA, 18 itraconazole oral soln, 8 ledipasvir/sofosbuvir, 10 ivermectin, 10 leflunomide, 31 J lenalidomide, 11 LETAIRIS, 16 JAKAFI, 12 letrozole, 11 JALYN, 29 LEUCOVORIN, 11 JINTELI, 25 leucovorin calcium, 11 JOLESSA, 24 LEUKERAN, 11 JULUCA, 8 LEUKINE, 30 JUXTAPID, 14 LEVAQUIN, 8 K LEVBID, 27 KADIAN, 7 levetiracetam, 17 KALETRA, 9 levetiracetam ext-rel, 17 KAPVAY, 19 levobunolol, 41 karaya gum, 28 levocarnitine oral soln, tabs, 23 KARAYA GUM, 28 levocetirizine, 34 KAZANO, 21 levofloxacin, 8 KEFLEX, 7 levofloxacin 0.5%, 41 KELNOR 1/50, 23 levonorgestrel, 24 KEPPRA, 17 levonorgestrel/EE, 24 KEPPRA XR, 17 levonorgestrel/EE 0.09/20, 24 ketoconazole, 8 levonorgestrel/EE 0.1/20, 23 ketoconazole crm, shampoo 2%, 38 levonorgestrel/EE 0.1/20 and EE 10, 24 ketoconazole shampoo 2%, 38 levonorgestrel/EE 0.15/30, 23, 24 ketoprofen, 6 levonorgestrel-releasing IUD, 24 ketoprofen ext-rel, 6 levothyroxine, 26 ketorolac, 6 LEVOXYL, 26 ketorolac 0.4%, 41 LEVSIN, 27 ketorolac 0.5%, 41 LEXAPRO, 17 ketotifen, 40 LEXIVA, 9 KEVZARA, 31 LIALDA, 27 KLARON, 37 lidocaine, 40 KLONOPIN, 16 lidocaine 5% crm, 39 KOGENATE FS, 30 lidocaine crm 4%, 39 KONSYL, 28 lidocaine patch 4%, 39 K-PHOS, 30 lidocaine patch 5%, 39 KPN PRENATAL, 33 lidocaine viscous, 40 KRISTALOSE, 28 lidocaine/prilocaine, 39 KYLEENA, 24 LIDOCARE, 39 KYNAMRO, 14 LIDODERM, 39 L lifitegrast, 42 LILETTA, 24 labetalol, 14 linezolid, 10 LAC-HYDRIN, 39 liothyronine, 26 lacosamide, 17 liotrix, 26 lactulose packets, 28 LIPITOR, 14 lactulose soln, 28 LIPOFEN, 13 LAMICTAL, 17 LIQ-10, 33 LAMISIL AT, 38 liraglutide, 22 lamivudine, 9 lisdexamfetamine, 19 lamivudine soln, 10 lisinopril, 12 lamivudine tabs, 10 lisinopril/hydrochlorothiazide, 12 lamivudine/tenofovir disoproxil fumarate, 9 lithium carbonate, 20 lamivudine/zidovudine, 9 lithium carbonate ext-rel tabs 300 mg, 20 lamotrigine, 17 lithium carbonate ext-rel tabs 450 mg, 20 lancets, 23 LITHOBID, 20

LITHOSTAT, 30 meclofenamate, 6 LMX 4, 39 MEDROL, 25 LOCOID, 39 medroxyprogesterone acetate, 26 LOESTRIN 1.5/30, 23 medroxyprogesterone acetate vial 150 mg/mL, 24 LOESTRIN 1/20, 23 mefloquine, 8 LOESTRIN FE 1.5/30, 23 megestrol acetate susp 40 mg/mL, tabs, 11 LOESTRIN FE 1/20, 23 MEKINIST, 12 lomitapide, 14 meloxicam, 6 LOMOTIL, 26 melphalan, 11 lomustine, 11 memantine, 17 loperamide, 26, 27 MENEST, 24 loperamide/simethicone, 29 MEPHYTON, 34 LOPID, 14 meprobamate, 16 lopinavir/ritonavir soln, 9 MEPRON, 10 lopinavir/ritonavir tabs, 9 mercaptopurine, 11 LOPRESSOR, 14 mesalamine delayed-rel, 27 LOPRESSOR HCT, 14 mesalamine delayed-rel tabs, 27 LOPROX, 38 mesalamine ext-rel caps, 27 loratadine caps, 34 mesalamine rectal susp, 28 loratadine tabs, 34 mesalamine supp, 28 loratadine/pseudoephedrine ext-rel, 35 MESTINON, 20 lorazepam, 16 METADATE CD, 19 losartan, 13 METADATE ER, 19 losartan/hydrochlorothiazide, 13 metaproterenol, 35 LOTENSIN, 12 metformin, 21 LOTENSIN HCT, 12 metformin ext-rel, 21 LOTREL, 12 methazolamide, 15 LOTRONEX, 28 methenamine mandelate, 30 lovastatin, 14 METHERGINE, 26 LOVAZA, 14 methimazole, 26 LOVENOX, 30 methocarbamol, 20 loxapine, 18 methotrexate, 11, 31 lubiprostone, 28 methotrexate inj, 11 lurasidone, 18 methscopolamine bromide, 27 lymphocyte immune globulin anti-thymocyte G, 31 methsuximide, 17 LYRICA, 17 methylcellulose, 28 LYSODREN, 12 methyldopa, 16 M methyldopa/hydrochlorothiazide, 16 methylergonovine, 26 MAALOX, 26 METHYLIN, 19 macitentan, 16 methylphenidate, 19 MACROBID, 10 methylphenidate ext-rel, 19 MACRODANTIN, 10 methylphenidate ext-rel 10 mg, 19 mafenide, 40 methylphenidate ext-rel 10 mg, 60 mg, 19 magnesium chloride ex-rel, 33 methylphenidate ext-rel 20 mg, 19 magnesium citrate, 28 methylphenidate ext-rel 20 mg, 30 mg, 40 mg, 19 magnesium hydroxide, 28 methylprednisolone, 25 magnesium oxide, 33 methylprednisolone 2 mg, 25 MAG-OX 400, 33 metoclopramide, 27 MALARONE, 8 metoclopramide orally-disintegrating tabs, 27 malathion, 40 metolazone, 15 maprotiline, 18 metoprolol succinate ext-rel, 14 maraviroc, 9 metoprolol tartrate 25 mg, 50 mg, 14 MARINOL, 27 metoprolol/hydrochlorothiazide, 14 MARPLAN, 17 METROCREAM, 39 mask, 36 METROGEL, 39 MASK, 36 METROGEL-VAGINAL, 29 MATULANE, 12 METROLOTION, 39 MAXALT, 19 metronidazole, 10, 29 MAXALT-MLT, 19 metronidazole crm 0.75%, 39 MAXIDEX, 41 metronidazole gel 0.75%, 39 MAXITROL, 41 metronidazole gel 1%, 39 MAXZIDE, 15 metronidazole lotion 0.75%, 39 mecasermin, 25 metyrosine, 16 mechlorethamine gel, 11 MIACALCIN, 23 meclizine, 27 MICARDIS, 13

MICARDIS HCT, 13 naloxone inj, 20 MICATIN, 38 naloxone nasal spray, 20 miconazole, 29, 38 naltrexone, 20 midodrine, 16 NAMENDA, 17 miglitol, 21 naphazoline 0.1%, 42 miglustat, 25 NAPROSYN, 6 MIGRANAL, 19 naproxen, 6 MILK OF MAGNESIA, 28 naproxen sodium, 6 mineral oil, 28 naratriptan, 19 mineral oil-hydrophilic petrolatum, 39 NARCAN, 20 MINIPRESS, 13 NARDIL, 17 MINOCIN, 8 NASALCROM, 36 minocycline, 8 NATACYN, 40 minoxidil tabs, 16 NATALVIT, 33 mipomersen, 14 natamycin, 40 MIRALAX, 28 nateglinide, 22 MIRAPEX, 18 NATROBA, 40 MIRCETTE, 24 nelfinavir, 9 MIRENA, 24 neomycin, 7 mirtazapine, 18 neomycin/bacitracin/polymyxin B, 38 misoprostol, 28 neomycin/bacitracin/polymyxin/pramoxine, 38 mitotane, 12 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 38, 41 MOBIC, 6 neomycin/polymyxin B/dexamethasone, 41 modafinil, 20 neomycin/polymyxin B/gramicidin, 41 moexipril, 12 neomycin/polymyxin B/hydrocortisone, 42 mometasone, 37 neomycin/polymyxin B/hydrocortisone susp, 41 mometasone crm, oint 0.1%, 39 NEORAL, 32 mometasone lotion 0.1%, 39 NEOSPORIN, 38 mometasone, CFC-free aerosol, 37 NEOSPORIN+PN, 38 montelukast, 36 NEO-SYNEPHRINE, 36 montelukast granules, 36 NEPHROCAPS, 34 morphine, 7 NESINA, 21 morphine ext-rel, 7 NEULASTA, 30 morphine supp, 7 NEUPOGEN, 30 moxifloxacin, 8, 41 NEURONTIN, 17 MS CONTIN, 7 NEUTROGENA, 38 MUCINEX, 36 nevirapine, 9 MUCINEX D, 36 nevirapine ext-rel 100 mg, 9 MUCINEX DM, 35 nevirapine ext-rel 400 mg, 9 MULTAQ, 13 NEXAVAR, 12 MULTI-DELYN, 33 NEXIUM 24HR, 28 multivitamins/fluoride drops, tabs, 34 NEXPLANON, 24 multivitamins/fluoride/iron drops, tabs, 34 niacin, 33 mupirocin, 38 niacin ext-rel, 14, 33 MURO-128, 42 NIACIN FLUSH FREE, 33 M-VIT, 32 NIASPAN, 14 MYAMBUTOL, 10 nicardipine, 14 MYCOBUTIN, 10 NICORETTE, 21 mycophenolate mofetil, 32 nicotine polacrilex gum, 21 mycophenolate sodium delayed-rel, 32 nicotine polacrilex lozenge, 21 MYFORTIC, 32 nicotine transdermal, 21 MYLANTA, 26 nifedipine, 14 MYLERAN, 11 nifedipine ext-rel, 14 MYNATAL, 32, 33 NILANDRON, 11 MYNATAL ADVANCE, 32 nilotinib, 12 MYNATAL PLUS, 33 nilutamide, 11 MYNATAL-Z, 33 nimodipine, 14 MYNATE 90 PLUS, 32 NIMOTOP, 14 MYSOLINE, 17 nisoldipine ext-rel, 15 N nitazoxanide susp, 10 nitazoxanide tabs, 10 nabumetone, 6 nitisinone, 25 nadolol, 14 NITRO-DUR, 15 nafarelin, 24 nitrofurantoin ext-rel, 10 nail scrub, 40 nitrofurantoin macrocrystals, 10 NAIL SCRUB LIQ W/BRUSH, 40 nitrofurantoin susp, 10

56 nitroglycerin sublingual, 15 omeprazole/sodium bicarbonate, 28 nitroglycerin transdermal, 15 OMNIPOD INSULIN INFUSION PUMP, 23 NITROSTAT, 15 OMNITROPE, 25 NIVA-PLUS, 32 ondansetron, 27 nizatidine, 27 ONE-A-DAY PRENATAL PAK, 33 NIZORAL SHAMPOO, 38 ONFI, 17 nonoxynol-9, 24 OPANA, 7 NORCO, 6 OPSUMIT, 16 norelgestromin/EE, 24 ORFADIN, 25 norethindrone, 24 orphenadrine ext-rel, 20 norethindrone acetate, 26 orphenadrine/aspirin/caffeine, 20 norethindrone acetate/EE 1.5/30, 23 ORTHO MICRONOR, 24 norethindrone acetate/EE 1.5/30 and iron, 23 ORTHO TRI-CYCLEN LO, 24 norethindrone acetate/EE 1/20, 23 ORTHO-NOVUM 1/35, 23 norethindrone acetate/EE 1/20 and iron, 23 ORTHO-NOVUM 7/7/7, 24 norethindrone/EE, 24 oseltamivir, 10 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg, 24 OSENI, 21 norethindrone/EE 0.5/35, 23 OTEZLA, 31 norethindrone/EE 1/35, 23 OVIDE, 40 norgestimate/EE, 24 oxandrolone, 21 norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg, 24 oxaprozin, 6 norgestimate/EE 0.25/35, 23 oxazepam, 16 norgestrel/EE 0.3/30, 23 oxcarbazepine, 17 norgestrel/EE 0.5/50, 23 oxybutynin, 29 NORPACE, 13 oxybutynin ext-rel, 29 NORPACE CR, 13 oxybutynin transdermal, 29 NORPRAMIN, 18 oxycodone, 7 nortriptyline, 18 oxycodone ext-rel, 7 NORVASC, 14 oxycodone/acetaminophen, 7 NORVIR, 9 oxycodone/aspirin, 7 NOVAFERRUM, 33, 34 OXYCONTIN, 7 NOVOLIN 70/30, 22 oxymetazoline spray, 36 NOVOLIN N, 22 oxymetholone, 21 NOVOLIN R, 22 oxymorphone, 7 NOVOLOG MIX 70/30, 22 OXYTROL FOR WOMEN, 29 NUEDEXTA, 21 OZEMPIC, 22 NULYTELY, 28 P NUTRIENTS PRENATAL, 33 paliperidone ext-rel, 18 NUVARING, 24 paliperidone palmitate ext-rel inj, 18 NUVIGIL, 20 palivizumab, 36 nystatin, 8, 38 PAMELOR, 18 nystatin vaginal tab, 29 PANCREAZE, 28 O pancrelipase delayed-rel, 28 O-CAL FA, 33 pantoprazole delayed-rel packets for suspension, 28 O-CAL PRENATAL, 32 pantoprazole delayed-rel tabs, 28 OCEAN, 37 paricalcitol, 25 octreotide acetate, 21 PARLODEL, 18 OCUFLOX, 41 PARNATE, 17 ODEFSEY, 9 paromomycin, 10 ofloxacin, 41 paroxetine HCl susp, 17 ofloxacin otic, 42 paroxetine HCl tabs, 17 OGESTREL, 23 PAXIL, 17 olanzapine, 18 pazopanib, 12 olanzapine pamoate ext-rel inj, 18 peak flow meter, 36 olmesartan, 13 PEDIALYTE, 33 olmesartan/amlodipine/hydrochlorothiazide, 13 pediatric multivitamin liquid, 33 olmesartan/hydrochlorothiazide, 13 PEDIAVIT, 33 olsalazine, 27 peg 3350/electrolytes, 28 OLUX, 39 PEGANONE, 17 omalizumab, 36 PEGASYS, 31 omega-3 acid ethyl esters, 14 pegfilgrastim, 30 omega-3 fatty acids, 33 peginterferon alfa-2a, 31 omeprazole delayed-rel, 28 pegvisomant, 21 omeprazole magnesium delayed-rel, 28 penicillamine, 31 omeprazole powder for suspension, 28 penicillin VK, 8

PENLAC, 38 pravastatin, 14 pentazocine/naloxone, 7 praziquantel, 10 pentosan polysulfate sodium, 30 prazosin, 13 pentoxifylline ext-rel, 31 PRECOSE, 21 PEPCID, 27 PRED FORTE, 41 PEPTO-BISMOL, 26 PRED MILD, 41 perampanel, 17 PRED-G, 41 PERCODAN, 7 prednicarbate crm, oint 0.1%, 39 PERIDEX, 40 prednisolone acetate 0.12%, 41 perindopril, 12 prednisolone acetate 1%, 41 permethrin, 40 prednisolone phosphate 1%, 41 perphenazine, 19 prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5 perphenazine/amitriptyline, 19 mL, 25 PERRY PRENATAL, 32 prednisolone syrup, 25 PETROLATUM, 39 prednisone, 25 petrolatum/mineral oil/shark liver oil/phenylephrine oint, 29 prednisone concentrate 5 mg/mL, 25 phenelzine, 17 PREDNISONE INTENSOL, 25 phenobarbital, 17 PREFEST, 25 phentolamine inj, 16 pregabalin, 17 phenylephrine, 36, 40 PRENATABS RX, 32 phenylephrine spray, 36 PRENATAL + DHA, 33 phenytoin, 17 PRENATAL + DHA WOMENS, 33 phenytoin sodium extended, 17 PRENATAL + FE, 33 PHOSPHOLINE IODIDE, 42 PRENATAL 19, 32, 33 phytonadione, 34 PRENATAL DHA, 32 pilocarpine, 42 PRENATAL DHA PAK MULTI, 33 pilocarpine tabs, 29 PRENATAL FORMULA, 33 pimecrolimus, 38 PRENATAL FORMULA A-FREE, 32 pimozide, 19 PRENATAL MULTI + DHA, 33 pindolol, 14 PRENATAL OMEGA-3, 33 pioglitazone, 22 PRENATAL PLUS IRON, 32 pioglitazone/glimepiride, 22 PRENATAL TAB, 32 pioglitazone/metformin, 22 PRENATAL TAB 27-1 MG, 33 pioglitazone/metformin ext-rel, 22 PRENATAL VITAMIN TAB LOW IRON, 33 piroxicam, 6 prenatal vitamins fast dissolving tabs, 32 PLAN B ONE-STEP, 24 prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg, 32 PLAQUENIL, 31 prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg, PLAVIX, 30 32 pneumococcal vaccine, 32 prenatal vitamins/carbonyl iron/folic acid tabs, 32 PNEUMOVAX 23, 32 prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg, 32 PNV FOLIC ACID + IRON, 33 prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg, 32 PNV PRENATAL PLUS, 33 prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg, 32 podofilox soln, 40 prenatal vitamins/ferrous bisglycinate chelate/folic acid, 32 polyethylene glycol 3350 powder, 28 prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel, 32 polymyxin B/bacitracin, 38, 41 prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg, 32 polymyxin B/trimethoprim, 41 prenatal vitamins/ferrous fumarate/folic acid 15-1 mg, 32 polysaccharide iron complex caps, drops, 33 prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg, 32 polysaccharide iron complex/cholecalciferol liq, 34 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg, 32, 33 polysaccharide iron forte, 34 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg, 32 POLYSPORIN, 38 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg, POLYTRIM, 41 33 pomalidomide, 11 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg, POMALYST, 11 33 potassium chloride ext-rel, 32 prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg, 33 potassium chloride liquid, 32 prenatal vitamins/ferrous fumarate/folic acid 29-1 mg, 33 potassium citrate, 30 prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg, 32 potassium citrate/citric acid, 30 prenatal vitamins/ferrous fumarate/folic acid 60-1 mg, 33 potassium citrate/sodium citrate/citric acid, 30 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg, 33 potassium/sodium acid phosphates, 30 prenatal vitamins/ferrous fumarate/folic acid 75-1 mg, 33 povidone-iodine, 40 prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg, 33 pramipexole, 18 prenatal vitamins/ferrous fumarate/folic acid/fish oil, 33 pramlintide, 21 prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg, 33 pramoxine/phenylephrine/glycerin/petrolatum, 29 prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg, 33 PRANDIN, 22 prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg, 33 prasugrel, 30 prenatal vitamins/ferrous succinate/folic acid, 33 PRAVACHOL, 14 prenatal vitamins/iron carbonyl/folic acid + DHA, 33

58 prenatal vitamins/iron carbonyl/folic acid 29-1 mg, 33 pyridostigmine, 20 prenatal vitamins/l-methylfolate + fish oil/choline, 33 pyridoxine 25 mg, 50 mg, 34 prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA, 33 Q prenatal vitamins/minerals/folic acid/fish oil chew tabs, 33 QUESTRAN/QUESTRAN LIGHT, 13 prenatal vitamins/minerals/iron/folic acid 0.1 mg, 33 quetiapine, 18 prenatal vitamins/minerals/iron/folic acid 1 mg, 33 quetiapine ext-rel, 18 prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg, 33 quinapril, 12 prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg, 33 quinapril/hydrochlorothiazide, 12 PREPARATION H, 29 QVAR REDIHALER, 37 PREVACID, 28 PREVACID 24HR, 28 R PREVIDENT 5000, 40 RA ONE DAILY PRENATAL, 33 PREVNAR 13, 32 rabies immune globulin, 31 PREZCOBIX, 8 ragweed pollen allergen extract, 31 PREZISTA, 9 RAGWITEK, 31 PRIFTIN, 10 raloxifene, 26 PRILOSEC, 28 raltegravir, 9 PRILOSEC OTC, 28 ramipril, 12 primaquine, 8 RANEXA, 16 PRIMAQUINE, 8 ranitidine, 27 primidone, 17 ranolazine ext-rel, 16 PRIVIGEN, 31 RAPAFLO, 29 PROAIR HFA, 35 RAPAMUNE, 32 probenecid, 6 RAZADYNE, 17 procarbazine, 12 RAZADYNE ER, 17 PROCARDIA, 14 REBETOL, 10 PROCARDIA XL, 14 REESES PINWORM MEDICINE, 10 prochlorperazine, 27 REFRESH, 42 PROCRIT, 30 REGENECARE, 40 PROCTOCORT 1%, 29 REGLAN, 27 progesterone gel, 26 regorafenib, 12 progesterone supp, 26 REGRANEX, 40 progesterone vaginal inserts, 26 RELENZA, 10 progesterone, micronized, 26 REMERON, 18 PROGLYCEM, 25 REMODULIN, 16 PROGRAF, 32 repaglinide, 22 PROLEUKIN, 12 repaglinide/metformin, 22 PROLIA, 23 REPATHA, 14 PROMACTA, 31 REPATHA PUSHTRONEX, 14 promethazine, 27 RESTASIS, 42 promethazine supp 12.5 mg, 25 mg, 27 RESTORIL, 19 promethazine/phenylephrine, 35 RETIN-A, 37 PROMETRIUM, 26 RETROVIR, 9 propafenone, 13 REVATIO, 16 propafenone ext-rel, 13 REVLIMID, 11 propantheline, 27 REYATAZ, 9 proparacaine 0.5%, 42 rho D immune globulin, 31 propranolol, 14 RHOGAM, 31 propranolol ext-rel, 14 RHOPHYLAC, 31 propylthiouracil, 26 ribavirin caps 200 mg, 10 PROSCAR, 29 ribavirin oral soln 40 mg/mL, 10 PROTONIX, 28 ribavirin tabs 200 mg, 10 PROTOPIC, 38 riboflavin tabs 100 mg, 34 protriptyline, 18 RID SHAMPOO, 40 PROVERA, 26 RIDAURA, 31 PROVIGIL, 20 rifabutin, 10 PROZAC, 17 RIFADIN, 10 pseudoephedrine, 36 rifampin, 10 pseudoephedrine ext-rel, 36 rifapentine, 10 pseudoephedrine/guaifenesin ext-rel, 36 rifaximin, 11 psyllium powder, 28 rilonacept, 32 PULMICORT RESPULES, 37 rilpivirine, 9 PULMOZYME, 35 RILUTEK, 16 pyrantel, 10 riluzole, 16 pyrazinamide, 10 rimantadine, 10 pyrethrins/piperonyl butoxide, 40 riociguat, 16

RISPERDAL, 18 silver sulfadiazine, 38 RISPERDAL CONSTA, 18 simethicone, 29 risperidone, 18 SIMILAC PRENATAL EARLY SHIELD, 32 risperidone long-acting inj, 18 simvastatin, 14 RITALIN, 19 SINEMET, 18 RITALIN LA, 19 SINEMET CR, 18 ritonavir caps, soln, 9 SINGULAIR, 36 ritonavir tabs, 9 sirolimus, 32 rivaroxaban, 30 SIRTURO, 9 rivastigmine, 17 SKYLA, 24 rizatriptan, 19 SLOW-MAG, 33 rizatriptan orally disintegrating tabs, 19 SM ONE DAILY PRENATAL, 33 ROBAXIN, 20 sodium bicarbonate, 26 ROBITUSSIN, 36 sodium chloride, 42 ROBITUSSIN COLD/FLU, 35 sodium chloride for inhalation, 36 ROCALTROL, 25 sodium chloride soln, 37, 40 roflumilast, 36 sodium citrate/citric acid, 30 ropinirole, 18 sodium fluoride, 40 rosuvastatin, 14 sodium oxybate, 20 ROWASA, 28 sodium phenylbutyrate, 26 ROXICODONE, 7 sodium phosphates, 28 rufinamide, 17 sodium polystyrene sulfonate, 26 ruxolitinib, 12 sofosbuvir/velpatasvir, 10 RYTHMOL SR, 13 sofosbuvir/velpatasvir/voxilaprevir, 10 S SOLIRIS, 30 somatropin, 25 SALAGEN, 29 SOMAVERT, 21 salicylic acid, 40 sorafenib, 12 salicylic acid/sulfur shampoo, 38 sotalol, 13 salmeterol xinafoate, 35 spacer, 36 SAMSCA, 26 spinosad, 40 SANDIMMUNE, 32 spironolactone, 13 SANDOSTATIN, 21 spironolactone/hydrochlorothiazide, 15 SANTYL, 40 SPORANOX, 8 SAPHRIS, 18 SPORANOX ORAL SOLUTION, 8 saquinavir mesylate, 9 SPRYCEL, 11 sargramostim, 30 SPS, 26 sarilumab, 31 STALEVO, 18 scopolamine transdermal, 27 STARLIX, 22 SEA-OMEGA, 33 stavudine, 9 SEBULEX, 38 STEGLATRO, 22 SEGLUROMET, 22 STIMATE, 26 selegiline, 18 STIOLTO RESPIMAT, 34 selegiline orally disintegrating tablets, 18 STIVARGA, 12 selenium sulfide shampoo 1%, 38 STRATTERA, 19 selexipag, 16 STRIBILD, 9 SELSUN BLUE, 38 STROMECTOL, 10 SELZENTRY, 9 SUBLOCADE, 20 semaglutide, 22 SUBOXONE, 20 SEMPREX-D, 35 succimer, 31 SE-NATAL 19, 33 sucralfate susp, 29 senna, 28 sucralfate tabs, 29 SENNA PLUS, 28 SUDAFED, 36 sennosides, 28 SUDAFED PE, 36 sennosides/docusate sodium, 28 SULAR, 15 SENOKOT, 28 sulfacetamide lotion 10%, 37 SENSIPAR, 23 sulfacetamide sodium, 38 SEREVENT, 35 sulfacetamide soln 10%, 41 SEROQUEL, 18 sulfacetamide/prednisolone phosphate 10%/0.25%, 41 SEROQUEL XR, 18 sulfacetamide/sulfur, 39 sertraline, 17 sulfacetamide/sulfur crm, gel, lotion, pads, 37 SETLAKIN, 24 sulfadiazine, 8 SHINGRIX, 32 sulfamethoxazole/trimethoprim, 8 sildenafil, 16 sulfamethoxazole/trimethoprim DS, 8 silodosin, 29 SULFAMYLON, 40 SILVADENE, 38 sulfasalazine, 27

60 sulfasalazine delayed-rel, 27 THERANATAL, 33 sulindac, 6 THERANATAL COMPLETE, 32 sumatriptan, 19 thioguanine, 11 sumatriptan inj, 19 thioridazine, 18 sumatriptan nasal spray, 20 thiothixene, 19 sunitinib, 12 thyroid, 26 SURMONTIL, 18 THYROLAR, 26 SUSTIVA, 9 tiagabine, 17 SUTENT, 12 TIAZAC, 15 SYMBICORT, 37 TIGAN, 27 SYMFI, 8 TIKOSYN, 13 SYMFI LO, 8 timolol, 14 SYMLINPEN, 21 timolol hemihydrate, 41 SYNAGIS, 36 timolol maleate, 41 SYNAREL, 24 timolol maleate gel, 41 SYNTHROID, 26 TIMOPTIC, 41 SYNVISC-ONE, 7 TIMOPTIC-XE, 41 T timothy grass pollen allergen extract, 31 TINACTIN, 38 TABLOID, 11 tioconazole, 29 tacrolimus, 32, 38 tiotropium/olodaterol, 34 TAFINLAR, 11 tipranavir, 9 TAGAMET HB, 27 TIVICAY, 9 TAMIFLU, 10 tizanidine tabs, 20 tamoxifen, 11 TL FOLATE, 33 tamsulosin, 29 TOBI, 36 TAPAZOLE, 26 TOBI PODHALER, 35 TARCEVA, 11 TOBRADEX, 41 TARGRETIN, 40 TOBRADEX ST, 41 TARGRETIN caps, 12 tobramycin, 41 TARKA, 12 tobramycin inhalation powder, 35 TASIGNA, 12 tobramycin inhalation soln, 36 tazarotene crm 0.05%, gel 0.05%, 0.1%, 38 tobramycin oint, 41 tazarotene crm 0.1%, 38 tobramycin soln, 41 TAZORAC, 38 tobramycin/dexamethasone oint 0.3%/0.1%, 41 TECFIDERA, 20 tobramycin/dexamethasone susp 0.3%/0.05%, 41 TEGRETOL, 16 tobramycin/dexamethasone susp 0.3%/0.1%, 41 TEGRETOL-XR, 16 TOBREX, 41 telmisartan, 13 tocopherols-tocotrienols, 34 telmisartan/hydrochlorothiazide, 13 TOFRANIL, 18 temazepam, 19 tolbutamide, 23 TEMODAR, 11 tolmetin 200 mg, 400 mg, 6 TEMOVATE, 39 tolnaftate, 38 temozolomide, 11 tolterodine, 29 tenofovir disoproxil fumarate powder, 9 tolterodine ext-rel, 29 tenofovir disoproxil fumarate tabs, 9 tolvaptan, 26 terazosin, 13, 29 TOPAMAX, 17 terbinafine, 38 TOPICORT, 39 terbinafine tabs, 8 TOPICORT LP, 39 terbutaline, 35 topiramate sprinkle caps, tabs, 17 terconazole crm, supp, 29 topotecan, 12 teriflunomide, 20 TOPROL-XL, 14 TESSALON, 35 toremifene, 11 testosterone cypionate, 21 torsemide, 15 testosterone enanthate, 21 TOUJEO SOLOSTAR, 22 testosterone gel, 21 TRACLEER, 16 tetrabenazine, 19 tramadol ext-rel tabs, 7 tetracaine 0.5%, 42 tramadol immediate-release, 7 tetracycline, 8 tramadol/acetaminophen, 7 thalidomide, 11 trametinib, 12 THALOMID, 11 TRANDATE, 14 THEO-24, 37 trandolapril, 12 theophylline elixir, 37 trandolapril/verapamil ext-rel, 12 theophylline ext-rel caps, 37 TRANSDERM SCOP, 27 theophylline ext-rel tabs, 37 tranylcypromine, 17 theophylline liquid, 37 trazodone 50 mg, 100 mg, 150 mg, 18

TRECATOR, 10 VALIUM, 16 treprostinil, 16 valproic acid, 17 tretinoin caps, 12 valsartan, 13 tretinoin crm 0.025%, 0.05%, 0.1%, 37 valsartan/hydrochlorothiazide, 13 tretinoin gel 0.01%, 0.025%, 37 VALTREX, 10 TREXALL, 11 vancomycin oral soln, 11 triamcinolone acetonide crm, lotion, oint 0.025%, 39 vandetanib, 12 triamcinolone acetonide crm, lotion, oint 0.1%, 39 vaporizer, 36 triamcinolone acetonide crm, oint 0.5%, 39 VAPORIZER, 36 triamcinolone acetonide spray, 36 varenicline, 21 triamcinolone paste, 40 VASERETIC, 12 triamterene/hydrochlorothiazide, 15 VASOTEC, 12 triazolam, 19 VELETRI, 16 TRIBENZOR, 13 VELIVET, 24 TRICOR, 14 venlafaxine ext-rel, 17 trifluoperazine, 19 venlafaxine tabs, 17 trifluridine, 41 VENTAVIS, 16 trihexyphenidyl, 18 VENTOLIN HFA, 35 TRILEPTAL, 17 verapamil ext-rel tabs, 15 TRILIPIX, 13 VIBRAMYCIN, 8 trimethobenzamide caps, 27 VIBRAMYCIN SYRUP, 8 trimethoprim, 11 VICTOZA, 22 trimipramine, 18 VIDEX, 9 TRINATAL RX1, 33 VIDEX EC, 9 triprolidine/pseudoephedrine liq, syp, 35 VIGAMOX, 41 TRIUMEQ, 8 VIMPAT, 17 TRIZIVIR, 8 VINATE II, 32 tropicamide, 42 VINATE M, 33 trospium, 29 VINATE ONE, 33 trospium ext-rel, 29 VIRACEPT, 9 TRUE METRIX AIR kits, 23 VIRAMUNE, 9 TRUE METRIX kits, 23 VIRAMUNE XR, 9 TRUE METRIX test strips, 23 VIREAD, 9 TRUSOPT, 42 VISTARIL, 35 TRUVADA, 9 VITAFOL-OB, 33 TRUZONE peak flow meter, 36 vitamin ADC/fluoride drops, 34 trypsin/balsam/castor oil, 40 vitamin ADC/fluoride/iron drops, 34 TYBOST, 8 vitamin B complex/vitamin C/folic acid, 34 TYKERB, 12 VITAMIN B-2, 34 TYLENOL, 6 VITAMIN B-6, 34 TYLENOL w/CODEINE, 6 VITAMIN C, 33 TYMLOS, 23 VITAMIN D, 33 TYVASO, 16 vitamin E, 34 U VITAMIN E, 34 VOLTAREN GEL, 6 ubidecarenone, 34 vorinostat, 12 ubiquinol liposomal, 34 VOSEVI, 10 ulipristal, 24 VOTRIENT, 12 ULORIC, 6 VYVANSE, 19 ULTRACET, 7 ULTRAM, 7 W umeclidinium, 34 warfarin, 30 umeclidinium/vilanterol, 34 WELLBUTRIN SR, 18 UPTRAVI, 16 WELLBUTRIN XL, 18 URECHOLINE, 30 WINRHO SDF, 31 UROCIT-K, 30 WIXELA INHUB, 37 UROXATRAL, 29 X URSO, 27 XALATAN, 42 ursodiol, 27 XANAX, 16 V XANAX XR, 16 VAGIFEM, 25 XARELTO, 30 VAGISTAT-1, 29 XELODA, 11 valacyclovir, 10 XENAZINE, 19 VALCHLOR, 11 XIFAXAN, 11 VALCYTE, 10 XIIDRA, 42 valganciclovir, 10 XOLAIR, 36

XULANE, 24 zinc acetate, 40 XYREM, 20 zinc sulfate, 34 Y ziprasidone, 18 ZIRGAN, 41 YASMIN, 23 ZITHROMAX, 7 YOUR LIFE PRENATAL, 33 ZOCOR, 14 Z ZOFRAN, 27 zafirlukast, 36 ZOLINZA, 12 ZANAFLEX, 20 ZOLOFT, 17 zanamivir, 10 zolpidem, 19 ZANTAC, 27 ZONEGRAN, 17 ZARONTIN, 17 zonisamide, 17 ZARXIO, 30 ZOSTAVAX, 32 ZAVESCA, 25 zoster vaccine, 32 ZEGERID OTC, 28 zoster vaccine recombinant, 32 ZELAPAR, 18 ZOSTRIX, 40 ZEMPLAR, 25 ZOVIRAX, 10, 40 ZENPEP, 28 ZUBSOLV, 20 ZESTORETIC, 12 ZYBAN, 21 ZESTRIL, 12 ZYDELIG, 12 ZETIA, 13 ZYFLO, 36 ZIAC, 14 ZYLOPRIM, 6 ZIAGEN, 9 ZYPREXA, 18 zidovudine, 9 ZYPREXA RELPREVV, 18 ZIKS, 40 ZYRTEC, 34 zileuton, 36 ZYRTEC-D 12 Hour, 35 zileuton ext-rel, 36 ZYVOX, 10 zinc, 34