Pharmacy Formulary

Applicable to: Medi-Cal Alliance Care IHSS Health Plans

June 1, 2021 This formulary and other plan-specific coverage documents are accessible online at: http://www.ccah-alliance.org/pharmacy.html Link to the Medi-Cal and Alliance Care IHSS members’ homepage: http://ccah-alliance.org/members.html Notice: This formulary is subject to change and all previous versions of the formulary are no longer in effect. Notice of non-discrimination Discrimination is against the law. Central California Alliance for Health (the Alliance) complies with applicable federal and State civil rights laws and does not discriminate (exclude or treat people differently) on the basis of race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups defined in Penal Code 422.56, and the Alliance will provide all Covered Services in a culturally and linguistically appropriate manner. The Alliance: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (braille, large print, audio, accessible electronic formats, and other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Member Services. If you believe that the Alliance has failed to provide these services or discriminated in another way on the basis of race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups defined in Penal Code 422.56, you can file a grievance with: Central California Alliance for Health Attn: Grievance Department 1600 Green Hills Road, Scotts Valley, CA 95066 800-700-3874 x5816 / (TTY: 1-800-735-2929)

Fax: 831-430-5579 Email: [email protected] You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Member Services or a Grievance Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at https://www.hhs.gov/ocr/filing-with-ocr.

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LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau [1-800-700-3874] (TTY: [1-800-735-2929]).

ਚ ਸਹਾਇਤਾ ਸੇ ਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ।ﹱ ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਧ 800-700-3874 (TTY: 1-800-735-2929) 'ਤੇ ਕਾਲ ਕਰੋ।

فإن خدمات المساعدة اللغویة تتوافرﻚﻟ بالمجان. اتصل ﻢﻗﺮﺑ 800-700-3874 )رقم هاتف الصم والبكم :2929-735-800-1). ملحوظة: إذا كنت تتحدث اذكر اللغة،

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ប្រយ័㿒ន៖ បរ ើសិនᾶ诒នកនិ架យ 徶羶ខ្មែ , ប ស玶ជំនួយខ្មែនក徶羶 រោយមិនគិ㿒⏒ន ួល គឺ讶ច掶នសំ殶រ់រំរ ើ诒នក។ ចូ ទូ ស័寒ទ 800-700-3874 (TTY: 1-800-735-2929)។

ໂປດຊາບ:ຖ້ າວ່ າ ທ່ ານເ ວ້ າພາສາ ລາວ,ການໍບິລການຊ່ ວຍເຫ ອດ້ ານພາສາ, ໂດຍໍ່ບເສັ ຽຄ່ າ, ແມ່ ນີມ ພ້ ອມໃຫ້ ທ່ ານ. ໂທຣ 800-700-3874 (TTY: 1-800-735-2929

Table of Contents

Informational Section ...... 2 Analgesic, Anti-Inflammatory Or Antipyretic - Drugs For Pain And Fever ...... 24 Anesthetics - Drugs For Pain And Fever ...... 33 Anorectal Preparations - Rectal Preparations ...... 33 Antidotes And Other Reversal Agents - Drugs For Overdose Or Poisoning ...... 33 Anti-Infective Agents - Drugs For Infections ...... 34 Antineoplastics - Drugs For Cancer ...... 42 Antiseptics And Disinfectants - Antiseptics And Disinfectants ...... 52 Biologicals - Biological Agents ...... 52 Cardiovascular Therapy Agents - Drugs For The Heart ...... 62 Central Nervous System Agents - Drugs For The Nervous System ...... 70 Chemical Dependency, Agents To Treat - Drugs For Addiction ...... 82 Chemicals-Pharmaceutical Adjuvants ...... 83 Cognitive Disorder Therapy - Drugs For The Nervous System ...... 85 Contraceptives - Drugs For Women ...... 85 Dermatological - Drugs For The Skin ...... 99 Eating Disorder Therapy - Drugs For Eating Disorders...... 112 Electrolyte Balance-Nutritional Products - Drugs For Nutrition ...... 113 Endocrine - Hormones ...... 135 Gastrointestinal Therapy Agents - Drugs For The Stomach ...... 144 Genitourinary Therapy - Drugs For The Urinary System ...... 161 Gout And Hyperuricemia Therapy - Drugs For Pain And Fever ...... 164 Hematological Agents - Drugs For The Blood ...... 164 Immunosuppressive Agents - Drugs For Organ Transplants ...... 168 Locomotor System - Drugs For Muscles, Ligaments, Tendons, And Bones ...... 168 Medical Supplies And Durable Medical Equipment (Dme) - Medical Supplies And Durable Medical Equipment ...... 169 Medical Supply, Fdb Superset ...... 181 Metabolic Modifiers - Drugs That Alter Metabolism ...... 193 Mouth-Throat-Dental - Preparations - Drugs For The Mouth And Throat ...... 193 Ophthalmic Agents - Drugs For The Eye ...... 195 Otic (Ear) - Drugs For The Ear ...... 203 Respiratory Therapy Agents - Drugs For The Lungs ...... 204 Vaginal Products - Drugs For Women ...... 224

TOC-1 Informational Section

2 Introduction

Alliance Member Services Contact Information

If you have any questions about this handbook, your benefits or how to get care, please call us at 1-800-700-3874 (TTY for the hearing-impaired at 1-800-735-2929). It is our job to help you understand your health plan and how to use it. Our Representatives speak English and Spanish. We use a telephone language line for members who speak other languages.

You can reach one of our Member Services Representatives Monday-Friday between 8:00 a.m. and 6:00 p.m. You can also visit our Web site, www.ccah-alliance.org.

Message from Alliance pharmacy department

Central California Alliance for Health (The Alliance), with direction from the Pharmacy & Therapeutics (P&T) Committee, has developed this formulary to be used by Alliance providers and Medi-Cal and Alliance Care IHSS members.

The P&T committee will continue to update and revise this formulary based on quality of care considerations and sound financial principles. The Alliance’s contract with the State of California requires mandatory generic substitution whenever an equivalent product is available. By Alliance policy, the only prescription drugs not requiring mandatory generic substitution are Coumadin, Dilantin, and Lanoxin. However, clinicians may prescribe a Brand Name drug with a “do not substitute” order when there is clinical justification for doing so. In the latter case, a Prior Authorization must be submitted to the Alliance for consideration prior to dispensing the drug to an Alliance member.

Over-the-counter (OTC) drugs are not a covered benefit for Alliance Care IHSS health plan, except for loratadine, cetirizine, fexofenadine, ketotifen, prenatal vitamins, nicotine patches and gum, OTC contraceptives and diabetic supplies. These OTC drugs are denoted in the Formulary with the “OTC” symbol. OTC drugs that are Medi-Cal benefits only are denoted with the symbol “OTC MediCal”. There is more information about symbols used in the formulary in the Informational section.

The formulary can be changed every month and changes are effective on the 1st of the month after quarterly P&T committee meetings. Formulary changes are published in the Alliance Member bulletins, provider bulletins and in this formulary guide. Changes to the formulary may include: adding or removing coverage requirements or limits, addition of/ or removal of prior authorization requirements. See the Informational section for more details on the formulary symbols and what they mean.

The Alliance will not make changes to the drug tiers as a result of P&T committee, that would result in a higher copayment amount, please see drug tier section for more information.

4 Definitions

Brand Name Drug A drug that is marketed under a proprietary, trademark protected name. The brand name drug shall be listed in all CAPITAL letters.

Coinsurance A percentage of the cost of a covered health care benefit that an enrollee pays after the enrollee has paid the deductible, if a deductible applies to the health care benefit, such as the prescription drug benefit.

Copayment A fixed dollar amount that an enrollee pays for a covered health care benefit after the enrollee has paid the deductible, if a deductible applies to the health care benefit, such as a prescription drug benefit. Coordination of Benefits Means that if you have more than one insurance carrier, there is a specific order as to which insurance will pay first and which will pay last. The one that is billed first is your primary insurance. The insurance that is billed next is your secondary insurance. Even if you have more than one insurance carrier, the provider cannot collect more than the rate set by the insurance carriers. If you have questions about which insurance is your primary, please call Member Services.

Deductible Is the amount an enrollee pays for covered health care benefits before the enrollee's health plan begins payment for all or part of the cost of the health care benefit under the terms of the policy.

Drug Tier Is a group of prescription drugs that corresponds to a specified cost sharing tier in the health plan's prescription drug coverage. The tier in which a prescription drug is placed determines the enrollee's portion of the cost for the drug.

Enrollee Is a person enrolled in a health plan who is entitled to receive services from the plan. All references to enrollees in this formulary template shall also include subscribers as defined in this section below.

Exception request Is a request for coverage of a prescription drug. If an enrollee, his or her designee, or prescribing health care provider submits an exception request for coverage of a prescription drug, the health plan must cover the prescription drug when the drug is determined to be medically necessary to treat the enrollee's condition.

Exigent circumstances When an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function, or when an enrollee is undergoing a current course of treatment using a nonformulary drug.

Formulary The complete list of drugs preferred for use and eligible for coverage under a health plan product, and includes all drugs covered under the outpatient prescription drug benefit of the health plan product. Formulary is also known as a prescription drug list.

Generic drug Is the same drug as its brand name equivalent in dosage, safety, strength, how it is taken, quality, performance, and intended use. A generic drug is listed in bold and italicized lowercase letters.

Medical Supplies The pharmacy department will review authorization requests for blood glucose meters, test strips, lancets, syringes, needles and sharps containers. All other requests for medical supplies will need to be sent to the Utilization Management department. The fax number for the Utilization Management department is (831) 430-5850.

Medically Necessary Those health care, mental health care and substance use disorder services or products that are (a) furnished in accordance with professionally recognized standards of practice; (b) determined by the treating provider to be consistent with the medical condition, mental illness or substance use disorder; and (c) furnished at the most appropriate type, supply and level of service that consider the potential risks, benefits and alternatives.

Member A person who becomes enrolled (enrollee) in Central California Alliance for Health to receive health care. In this formulary, a Member is also referred to as “you.”

Nonformulary drug A prescription drug that is not listed on the health plan's formulary.

Out-of-pocket cost Are copayments, coinsurance, and the applicable deductible, plus all costs for health care services that are not covered by the health plan.

Over the counter A medicine or product available for retail sale, but which can be considered for payment by the plan with a valid prescription.

6 Prescribing provider A health care provider authorized to write a prescription to treat a medical condition for a health plan enrollee.

Prescription Is an oral, written, or electronic order by a prescribing provider for a specific enrollee that contains the name of the prescription drug, the quantity of the prescribed drug, the date of issue, the name and contact information of the prescribing provider, the signature of the prescribing provider if the prescription is in writing, and if requested by the enrollee, the medical condition or purpose for which the drug is being prescribed.

Prescription drug A drug that is prescribed by the enrollee's prescribing provider and requires a prescription under applicable law.

Prior Authorization A health plan's requirement that the enrollee or the enrollee's prescribing provider obtain the health plan's authorization for a prescription drug before the health plan will cover the drug. The health plan shall grant a prior authorization when it is medically necessary for the enrollee to obtain the drug.

Step Therapy A process specifying the sequence in which different prescription drugs for a given medical condition and medically appropriate for a particular patient are prescribed. The health plan may require the enrollee to try one or more drugs to treat the enrollee's medical condition before the health plan will cover a particular drug for the condition pursuant to a step therapy request. If the enrollee's prescribing provider submits a request for step therapy exception, the health plans shall make exceptions to step therapy when the criteria is met.

Subscriber Means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan.

Using Your Health Plan Formulary

There are a few ways to look up a drug in the formulary: 1. You can find a drug by looking for the therapeutic category of the drug in the categorical list of prescription drugs. This is list is in the Table of contents. If you choose a therapeutic class in the Table of contents, you can double click on the name and it will take you to the drugs in the class listing.

a. If you are using an electronic version of the drug list, you can also use the PDF Search Function by pressing Ctrl + F on your computer keyboard. Type the name of the therapeutic class you are looking for in the search box.

b. If you are using a print version of the drug list, you can search for the name of the therapeutic class in the Table of contents or the Index at the end of this guide.

2. If you have the generic or brand name of the drugs, you can also use the Index of prescription drugs. You can find the Index in the Table of contents.

a. If you are using an electronic version of the drug list, you can use the PDF Search Function by pressing Ctrl + F on your computer keyboard. Type the generic or brand name of the drug you are looking for in the search box.

b. If you are using a print version of the drug list, you can search for the generic or brand name of the drug in the Index at the end of this guide.

c. If a generic equivalent of a brand name drug is not available or is not covered, the drug will not be listed separately by its generic name in the formulary.

3. You can call member services and ask them to help you find out if your drug is covered on the formulary. You can request a paper copy of the formulary by contacting member services.

4. You can ask your doctor to call our pharmacy department ask if a drug is covered or ask your doctor to look up the formulary document online. The Alliance formulary is located on the member services webpage but it is also available for providers on the provider webpage.

8 How drugs are listed in the categorical list of prescriptions drugs: 1. Drugs are listed alphabetically by its brand and generic names in the therapeutic category and class to which it belongs.

2. The generic name of a brand name drug is included after the brand name in parenthesis and all bold and italicized lowercase letters.

3. If a generic equivalent for a brand name drug is available, and both the brand name and generic equivalents are covered, the generic drug will be listed separately from the brand name drug in all bold and italicized lowercase letters.

4. In the event a generic drug is marketed under a proprietary, trademark protected brand name, the brand name will be listed in all CAPITAL letters after the generic name in parentheses and regular typeface with first letter of each word capitalized.

a. example: Wixela Inhub Inhaler

Drug Tiers (Alliance Care IHSS Health Plan only)

Tier copayment amounts apply: ▪ per prescription for a 30-day supply of generic drugs, per prescription for a 30-day supply of brand name drugs. ▪ per prescription for a 90-day supply of maintenance drugs of generic drugs, per prescription for a 90-day supply of brand name drugs. ▪ If the cost of drug is lower than the copayment, member will pay for the lower cost. ▪ No copayment for prescription drugs provided in an inpatient setting. No copayment for drugs administered in the doctor’s office or in an outpatient facility. ▪ Copayment may be less for a “partial fill”, please see “What your doctor can prescribe” section of more information on what “partial fill” means Tier Copayment Description Tier 1 $5.00 * Generic and Specialty generic drugs Tier 2 $15.00 * Brand and Specialty brand drugs *coinsurance amounts in accordance with Health and safety code 1367.656.

10 Formulary Symbols Key

Symbol Description and/or Coverage Requirements and Limits Age Age limits apply. We only pay for this drug or dosage form for certain age groups based on information about the drug’s safety, efficacy, and cost. CT Contraceptives, zero copay for Alliance Care IHSS health plan DD Diabetes Drugs/Devices IHSS Drugs that are covered benefits under the Alliance Care IHSS health plan.

Drugs that are carved-out benefits for the Medi-Cal health plan and State Fee for service Medi-Cal is responsible for payment. OCH Orally administered cancer drugs OTC Over-the-Counter drugs that are covered by Alliance Care IHSS health plan and Medi-Cal health plan OTC MediCal Over-the-Counter drugs that are covered on the drug list with a valid prescription from a provider for Medi-Cal health plan only.

Requires a prior authorization for coverage under Alliance Care IHSS health plan. PA Prior Authorization is required. We require advanced approval of coverage on some drugs before they will be paid for. If Prior Authorization is required for a drug or dosage form, providers must show you have a medically accepted use for the drug and other treatments have not worked or are not appropriate. Other requirements may apply depending on the drug. PA NSO Prior Authorization is required for a member who has been newly started on the drug. QL Quantity Limits apply. We will pay for a maximum daily amount based on information about the drug’s medically accepted use and cost. ST Step Therapy is required. If we have paid for you to have the required step therapy drug(s) in the past, this drug will be paid for at the pharmacy without need for a Prior Authorization or step therapy exception request. The drug list will show you which drugs are required first. SP Drug is a specialty drug and can only be dispensed by US Bioservices pharmacy (exceptions for medical necessity are considered on a case by case basis)

Getting Pharmacy Benefits

Drugs given in a doctor’s office or drugs covered under the medical benefit Your doctor will know what drugs these are. If your doctor prescribes these, your doctor can contact us for more information about obtaining these drugs for you. These drugs can be given to you in different ways, sometimes through an injection in your vein, skin or other body part. There are no coinsurance amounts for these drugs on the Alliance care IHSS health plan or the Medi-Cal health plan. Your doctor can ask about coverage restrictions or submit a prior authorization by calling Alliance provider services at 831-430-5504 or by calling Pharmacy prior authorizations at 831-430-5507. Your doctor can also fax a prior authorization to us, or use our online prior authorization portal. If you have questions about coverage for drugs given to you in a doctor’s office, you can call member services at (800) 700-3874. These drugs are not listed on the Formulary. What Your Doctor Can Prescribe Your PCP has a list of drugs that are approved by the Plan. This list is called a formulary. A group of doctors and pharmacists reviews and updates the formulary list every year to make sure that the drugs on it are safe and useful. If your doctor thinks that you need to take a drug that isn’t on this list, or if your doctor feels you need a drug that isn’t usually prescribed for the specific medical condition you have, your doctor can send us a request for prior authorization. The presence of a prescription drug on the formulary does not guarantee that it will be prescribed by your doctor for a particular medical condition. You or your doctor can request that the pharmacy fill only part of the prescription at one time. You would get the rest of the prescribed amount later. This is called a “partial fill” and applies only to what are called Schedule 2 drugs. These are drugs like opioids and stimulants. Your copayment on a partial fill will be prorated and will be less than the copayment stated in the drug tier section. Your pharmacy can call MedImpact to ask for a 5 day emergency supply override for you at any time. How to get prior authorization for a drug Drugs that require a prior authorization are noted with the symbol “PA” on the formulary guide. The request for prior authorization lets us know why you need that drug. Prior authorization means that both your doctor and the Plan or the Plan’s Contractor agree

12 that the services you will receive are medically necessary. We will need to approve the request before covering that drug for you. When there is more than one drug that is appropriate for the treatment of a medical condition, we may require your doctor to try the preferred drug first, before requesting authorization to prescribe any of the others. This is known as “step therapy.” Your provider may request an exception to the step therapy process for a prescription drug. When we get a request for prior authorization for a drug, we will reply to your doctor within 24-hours from the time the request was received. If we do not respond within 24- hours, the request is considered to be approved. Authorization requests for exigent circumstances will be given priority and a 72-hour supply of the covered outpatient drug will be dispensed until a determination has been made or the 24-hour period has expired. Please see the “Definitions” section of this document for an explanation of the term “exigent circumstances.” If we approve the request, then you can get the drug. If we deny the request, you have the right to file a complaint. As part of the grievance process, you, your personal representative or your provider may ask for an external exception review. This means we would send the authorization request and the information we received from your provider to an outside physician who would review our decision. For more information on how to file a complaint or asking for an external exception review, please call member services at 1-800-700-3874. The Alliance Care IHSS health plan and Medi-Cal member handbooks contain all of your appeal rights and procedures too. The Plan will not limit or exclude coverage for a drug you are taking if the drug had been previously approved for coverage by the Plan and your doctor continues to prescribe the drug, as long as the drug is appropriately prescribed and is considered safe and effective for treating your medical condition. This does not mean that your doctor cannot choose to prescribe a different drug or that a generic equivalent of the drug cannot be substituted. How to find a pharmacy If you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with the Alliance. We contract with a company called MedImpact for pharmacy services and we use their network of pharmacies. You must go to one of these pharmacies for your prescription drugs. Some of the pharmacies have locations throughout California. You can find a list of pharmacies that work with the Alliance in the Alliance Provider Directory at http://www.ccah-alliance.org/aspnetforms/MedimpactLocator.aspx. You can also find a pharmacy near you by calling Member Services at 800-700-3874 (TTY 800-735-2929 or 711). Once you choose a pharmacy, take your prescription to the pharmacy. Give the pharmacy your prescription with your Alliance ID card. Make sure the pharmacy knows

about all drugs you are taking and any allergies you have. If you have any questions about your prescription, make sure you ask the pharmacist. If you need to get a prescription filled at an out-of-area pharmacy because of an emergency or for treatment of an urgent medical condition, please ask the pharmacy to call us at 1-800-700-3874. We will explain to the pharmacy how they can bill us for the drug. Your pharmacy can also call MedImpact to get a 5 day emergency supply of drugs for you. If there is a State of emergency issued in your local area, your pharmacy can also call MedImpact to get an emergency override for your drugs. Some drugs are known as specialty drugs. These drugs may have special handling or storage requirements or you will need extra guidance from a care team at the pharmacy for that drug. The Alliance has a preferred Specialty pharmacy called US Bioservices pharmacy, which is also shown in our Alliance Provider directory. The specialty drugs which are required to be filled at US Bioservices are shown on the formulary with an “SP” symbol. You may request an exception to using US Bioservices pharmacy by calling member services. The Alliance may allow you to use a different specialty pharmacy besides US Bioservices pharmacy but not the retail pharmacy of your choice. This is because only specialty pharmacies carry these drugs and sometimes only one or two pharmacies have access to dispense that drug. The Alliance also offers a mail order pharmacy program. Did you know you can get a 90-day supply of most prescription drugs mailed to you through MedImpact Direct? Talk to your doctor about getting a 90-day supply with free standard delivery. To set-up mail order for your drugs, visit https://www.medimpact.com or call 855-873-8739.

14 Address

Santa Cruz County Main Monterey County Office Merced County Office Office 950 East Blanco Road, 530 West 16th Street, 1600 Green Hills Road, Suite 101 Suite B Suite 101 Salinas, CA 93901-3400 Merced, CA 95340-4710 Scotts Valley, CA 95066- (831) 755-6000 (209) 381-5300 4981 Hours: M-F, 8am-5pm Hours: M-F, 8am-5pm (831) 430-5500 Hours: M-F, 8am-5pm

Phone Directory

Automated System (831) 430-5501 Authorizations – Pharmacy (831) 430-5507 Authorizations – Non-Pharmacy (831) 430-5506 Status Requests for Non-Pharmacy (831) 430-5511 Care Management (831) 430-5512 Claims Inquiries (831) 430-5503 EDI Support Line (831) 430-5510 Health Education (831) 430-5580 Member Services (831) 430-5505 Provider Services (831) 430-5504

Department Fax Numbers

Administration (831) 430-5852 Claims (831) 430-5858 Finance (831) 430-5853 Health Services PA and RAFs (831) 430-5850 Member Services (831) 430-5856 Pharmacy Authorizations (831) 430-5851 Provider Services (831) 430-5857

Carve-out Drugs (applies to Medi-Cal health plan only)

The following drugs are carved out from the Alliance formulary for AIDS and Hep B indications. They are to be billed to State Medi-Cal via EDS, not the Alliance. Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing. These are denoted with the Formulary symbol “IHSS” as they are benefits for Alliance Care health plan.

AIDS Drugs ( and Hep B )Drugs TAR Required (Y/N) Abacavir/Lamivudine N Abacavir Sulfate N Abacavir Sulfate/Dolutegravir/Lamivudine (Triumeq) N Atazanavir Sulfate N Atazanavir/Cobicistat (Evotaz) N Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy) N Cabotegravir/Rilpivirine (Cabenuva) Y Cobicistat (Tybost) N Darunavir Ethanolate N Darunavir/Cobicistat (Prezcobix) N Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide N (Symtuza) Delavirdine Mesylate N Dolutegravir (Tivicay) N Dolutegravir (Tivicay PD) Y Dolutegravir/ Lamivudine (Dovato) N Dolutegravir/ Rilpivirine (Juluca) N Doravine (Pifeltro) N Doravirine/ Lamivudine/ Tenofovir disoproxil fumarate N (Delstrigo) Efavirenz N Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate ( N Atripla) Efavirenz/Lamivudine/Tenofovir Disoproxil Fumarate ( Symfi N LO) Efavirenz/Lamivudine/Tenofovir Disoproxil Fumarate ( Symfi ) N Elvitegravir (Vitekta) N Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil N Fumarate (Stribild)

16 AIDS Drugs ( and Hep B )Drugs Continued TAR Required (Y/N) Elvitegravir/Cobicistat/Emtricitabine/Tenofovir alafenamide N (Genvoya) Emtricitabine/Rilpivirine/Tenofovir Alafenamide (Odefsey) N Emtricitabine/Rilpivirine/ Tenofovir Disoproxil Fumarate N (Complera) Emtricitabine/Tenofovir Alafenamide ( Descovy) N Emtricitabine N Enfuvirtide Y Etravirine N Fosamprenavir Calcium N Fostemsavir (Rukobia) Y Ibalizumab-uiyk ( Trogarzo ) N Indinavir Sulfate N Lamivudine N Lamivudine/ Tenofovir disoproxil fumarate ( Cimduo) N Lopinavir/Ritonavir N Maraviroc N Nelfinavir Mesylate N Nevirapine N Raltegravir Potassium N Rilpivirine Hydrochloride N Ritonavir N Saquinavir N Saquinavir Mesylate N Stavudine N Tenofovir Alafenamide (Vemlidy) N Tenofovir Disoproxil-Emtricitabine N Tenofovir Disoproxil Fumarate N Tipranavir N Zidovudine/Lamivudine N Zidovudine/Lamivudine/ Abacavir Sulfate N

Carve-out Drugs (applies to Medi-Cal health plan only) The following drugs are carved out from the Alliance formulary for Mental Health indications. They are to be billed to State Medi-Cal via EDS, not the Alliance. Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing. These are denoted with the Formulary symbol “IHSS” as they are benefits for Alliance Care health plan.

Psychiatric Drugs TAR Requirement (Y/N) Amantadine HCl N Amantadine HCl ER Y Aripiprazole Y(Age 0-17) Aripiprazole lauroxil (Aristada Initio) Y Asenapine (Saphris) Y(Age 0-17) Benztropine Mesylate N Brexpiprazole Y Cariprazine Y Chlorpromazine HCl Y(Age 0-17) Clozapine Y(Age 0-17) Fluphenazine Decanoate Y Fluphenazine HCl Y(Age 0-17) Haloperidol Y(Age 0-17) Haloperidol Decanoate Y(Age 0-17) Haloperidol Lactate Y(Age 0-17) Iloperidone (Fanapt) Y(Age 0-17) Isocarboxazid Y Lithium Carbonate N Lithium Citrate N Loxapine Aerosol Powder Breath Activated (Adasuve) Y Loxapine Succinate Y(Age 0-17) Lumateperone (Caplyta) Y Lurasidone Hydrochloride Y(Age 0-17) Molindone HCl Y(Age 0-17) Olanzapine Y(Age 0-17) Olanzapine Fluoxetine HCl Y Olanzapine Pamoate Monohydrate (Zyprexa Relprevv) Y

Psychiatric Drugs Continued TAR Requiremen t (Y/N) Paliperidone (Invega) Y Paliperidone Palmitate (Invega Sustenna) Y Paliperidone Palmitate (Invega Trinza) Y Perphenazine Y(Age 0-17) Phenelzine Sulfate Y Pimavanserin (Nuplazid) Y Pimozide Y Quetiapine Y(Age 0-17) Risperidone Y(Age 0-17) Risperidone ER injectable suspension (Perseris) Y Risperidone Microspheres Y Selegiline (transdermal only) Y Thioridazine HCl Y(Age 0-17) Thiothixene Y(Age 0-17) Thiothixene HCl Y(Age 0-17) Tranylcypromine Sulfate Y Trifluoperazine HCl Y(Age 0-17) Trihexyphenidyl N Ziprasidone HCl Y(Age 0-17) Ziprasidone Mesylate Y

Carve-out Drugs (applies to Medi-Cal health plan only)

The following drugs are carved out from the Alliance formulary for Opioid Detoxification indication. They are to be billed to State Medi-Cal via EDS, not the Alliance. Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal and approved prior to dispensing. These are denoted with the Formulary symbol “IHSS” as they are benefits for Alliance Care health plan.

Alcohol, Heroin Detoxification and Dependency TAR Requirement Treatment Drugs (Y/N) Acamprosate Calcium N Buprenorphine HCl ( Does not require a TAR, except for N the drugs below) Buprenorphine Extended-Release Inj (Sublocade) N Buprenorphine HCl (Belbuca) * Y Buprenorphine Implant (Probuphine) Y Buprenorphine/Naloxone HCl N Naloxone HCl N Naltrexone (oral) N Naltrexone Microsphere Injectable Suspension (Vivitrol) N Lofexidine Hydrochloride (Lucemyra) Y Disulfiram (Antabuse) N

20 Carve-out Drugs (applies to Medi-Cal health plan only)

The following drugs are carved out from the Alliance formulary for Blood and Coagulation Factors. They are to be billed to State Medi-Cal via EDS, not the Alliance. Some of the drugs may require a TREATMENT AUTHORIZATION REQUEST (TAR) submitted to State Medi-Cal prior to dispensing. These are denoted with the Formulary symbol “IHSS” as they are benefits for Alliance Care health plan.

Blood and Coagulation Factors Antihemophilic factor VIII/von Willebrand factor complex (human) Anti-inhibitor Coagulation factor X (human) Emicizumab (Hemlibra) Factor VIIa (antihemophilic factor, recombinant) Factor VIIa (antihemophilic factor, recombinant)-jncw (Sevenfact), per mcg Factor VIII (antihemophilic factor, human) Factor VIII (antihemophilic factor, recombinant) Factor VIII (antihemophilic factor, recombinant) (Afstyla), per IU Factor VIII (antihemophilic factor, recombinant) (Novoeight) Factor VIII (antihemophilic factor, recombinant) (Nuwiq), per IU Factor VIII (antihemophilic factor, recombinant) PEGylated, per IU Factor VIII (Recombinant), GlycoPEGylated-exei Factor VIII, antihemophilic factor (recombinant), glycopegylated-exei (Esperoct), per IU Factor IX (antihemophilic factor, purified, nonrecombinant) Factor IX (antihemophilic factor, recombinant) Factor IX (antihemophilic factor, recombinant) (Rixubis) Factor IX, albumin fusion protein, (recombinant), (Idelvion) per IU Factor IX complex Factor X (human), per IU Factor XIII (antihemophilic factor, human) Factor XIII A-Subunit (recombinant) Hemophilia clotting factor, not otherwise classified Injection, factor VIII (antihemophilic factor, recombinant) (Obizur) Injection, factor VIII, fc fusion protein (recombinant) Injection Factor IX, (antihemophilic factor, recombinant), glycopegylated, (Rebinyn), 1 IU Injection, factor IX fusion protein (recombinant)

Von Willebrand factor (recombinant) (Vonvendi), per IU Von Willebrand factor complex (human), Wilate Von Willebrand factor complex (Humate-P)

22 Nutritional Supplements (applies Medi-Cal health plan only) The Alliance covers oral nutritional supplements and enteral formulas for Medi-Cal health plan members when medically necessary.

A prior authorization will need to be submitted via the Alliance Portal or by fax to the Alliance Pharmacy Department at (831)430-5851.

Please include the following when submitting a Prior Authorization: • Copy of prescribing provider’s prescription • Completed Prior Authorization request form • Recent chart notes that address medical justification as to why the member is unable to meet his/her nutritional needs with standard or fortified foods • Growth charts for pediatric members or relevant weight history for adult members

Conditions that may necessitate oral nutritional supplements or enteral formulas include, but are not limited to: • Increased metabolic needs • Cow’s milk allergy/intolerance to standard formulas in infancy • Preterm birth • Cancer with significant weight loss • Decubitus ulcers • ESRD on HD or PD • Severe swallowing or chewing difficulty • Conditions impairing digestion and absorption • Failure to Thrive • Underweight status or unintended weight loss defined by the Medi-Cal guidelines

The Alliance will not authorize oral nutrition supplements when used for convenience or preference of the member or provider.

All requests will be reviewed for medical necessity by the Alliance’s Registered Dietitian (RD).

For a list of covered products, please see the Medi-Cal Enteral Formulary, available here.

The Alliance’s Enteral Nutrition policy can be accessed here.

Coverage Prescription Drug Name Drug Tier Requirements and Limits Analgesic, Anti-Inflammatory Or Antipyretic - Drugs For Pain And Fever Analgesic Opioid Agonists - Arthritis And Pain Drugs hydromorphone oral tablet 2 mg 1 QL (6 per 1 day) hydromorphone oral tablet 4 mg 1 QL (3 per 1 day) methadone oral tablet 10 mg, 5 mg 1 PA morphine oral solution 10 mg/5 ml 1 QL (25 per 1 day) MORPHINE ORAL TABLET 15 MG 1 QL (3 per 1 day) morphine oral tablet extended release 100 mg, 200 mg, PA NSO; QL (60 per 30 1 30 mg, 60 mg days) morphine oral tablet extended release 15 mg 1 QL (60 per 30 days) oxycodone oral solution 5 mg/5 ml 1 QL (30 per 1 day) oxycodone oral tablet 10 mg 1 QL (3 per 1 day) oxycodone oral tablet 5 mg 1 QL (6 per 1 day) tramadol oral tablet 100 mg 1 QL (6 per 1 day) tramadol oral tablet 50 mg 1 QL (6 per 1 day) Analgesic Opioid Codeine Combinations - Arthritis And Pain Drugs acetaminophen-codeine oral solution 120-12 mg/5 ml 2 QL (500 per 1 day) acetaminophen-codeine oral tablet 300-15 mg, 300-30 1 QL (5 per 1 day) mg, 300-60 mg Analgesic Opioid Hydrocodone And Non-Salicylate Combinations - Arthritis And Pain Drugs hydrocodone-acetaminophen oral solution 10-325 1 QL (65 per 1 day) mg/15 ml(15 ml) hydrocodone-acetaminophen oral solution 7.5-325 1 QL (65 per 1 day) mg/15 ml hydrocodone-acetaminophen oral tablet 10-325 mg, 7.5- 1 QL (5 per 1 day) 325 mg hydrocodone-acetaminophen oral tablet 2.5-325 mg 1 QL (10 per 1 day) hydrocodone-acetaminophen oral tablet 5-325 mg 1 QL (9 per 1 day) hydrocodone bitartrate/acetaminophen (Lorcet 1 QL (9 per 1 day) (Hydrocodone) Oral Tablet 5-325 Mg) hydrocodone bitartrate/acetaminophen (Lorcet Hd Oral 1 QL (5 per 1 day) Tablet 10-325 Mg)

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 33 Coverage Prescription Drug Name Drug Tier Requirements and Limits Antidote - Acetaminophen Poisoning - Drugs For Overdose Or Poisoning acetylcysteine intravenous solution 200 mg/ml (20 %) 1 acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 1 %) Chelating Agents - Copper - Drugs For Overdose Or Poisoning CUPRIMINE ORAL CAPSULE 250 MG (penicillamine) 2 DEPEN TITRATABS ORAL TABLET 250 MG 2 (penicillamine) d-penamine oral tablet 125 mg 1 penicillamine oral capsule 250 mg 1 penicillamine oral tablet 250 mg 1 Chelating Agents - Lead Poisoning - Drugs For Overdose Or Poisoning CHEMET ORAL CAPSULE 100 MG (succimer) 2 Anti-Infective Agents - Drugs For Infections Amebicides - Drugs For Parasites paromomycin oral capsule 250 mg 1 Aminoglycoside Antibiotic - Antibiotics neomycin oral tablet 500 mg 1 Aminopenicillin Antibiotic - Antibiotics amoxicillin oral capsule 250 mg, 500 mg 1 amoxicillin oral suspension for reconstitution 125 mg/5 1 QL (500 per 1 day) ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml amoxicillin oral tablet 500 mg, 875 mg 1 amoxicillin oral tablet,chewable 125 mg, 250 mg 1 ampicillin oral capsule 250 mg, 500 mg 1 Aminopenicillin Antibiotic - Beta-Lactamase Inhibitor Combinations - Antibiotics amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 250-62.5 mg/5 ml, 400- 1 QL (500 per 1 day) 57 mg/5 ml, 600-42.9 mg/5 ml amoxicillin-pot clavulanate oral tablet 250-125 mg, 500- 1 125 mg, 875-125 mg amoxicillin-pot clavulanate oral tablet,chewable 200- 1 28.5 mg, 400-57 mg Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 34 Coverage Prescription Drug Name Drug Tier Requirements and Limits AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML 2 QL (500 per 1 day) (amoxicillin/potassium clavulanate) Anthelmintic Agents - Benzimidazole Derivatives - Drugs For Parasites albendazole oral tablet 200 mg 1 PA Anthelmintic Agents - Macrocyclic Lactones - Drugs For Parasites ivermectin oral tablet 3 mg 1 Anthelmintic Agents Other - Drugs For Parasites ivermectin oral tablet 3 mg 1 OTC Medical; QL (100 per 1 pinworm treatment oral suspension 50 mg/ml 1 day) pin-x oral suspension 50 mg/ml 1 QL (100 per 1 day) PIN-X ORAL TABLET,CHEWABLE 250 MG (pyrantel 2 pamoate) OTC Medical; QL (100 per 1 reese's pinworm medicine oral suspension 50 mg/ml 1 day) Antibacterial Folate Antagonist - Other Combinations - Antibiotics sulfamethoxazole-trimethoprim oral suspension 200-40 1 QL (500 per 1 day) mg/5 ml sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 1 800-160 mg sulfatrim oral suspension 200-40 mg/5 ml 1 QL (500 per 1 day) Antibacterial Folate Antagonist Others - Antibiotics trimethoprim oral tablet 100 mg 1 Antibacterial Nitrofuran Derivatives - Antibiotics nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 1 50 mg nitrofurantoin monohyd/m-cryst oral capsule 100 mg 1 nitrofurantoin oral suspension 25 mg/5 ml 1 QL (500 per 1 day) Antifungal - Allylamines - Drugs For Fungus terbinafine hcl oral tablet 250 mg 1 QL (31 per 1 day) Antifungal - Amphoteric Polyene Macrolides - Drugs For Fungus amphotericin b injection recon soln 50 mg 1 PA Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 35 Coverage Prescription Drug Name Drug Tier Requirements and Limits NYSTATIN (BULK) POWDER 50 MILLION UNIT 2 NYSTATIN (BULK) POWDER 500 MILLION UNIT 1 QL (500 per 1 day) nystatin oral tablet 500,000 unit 1 Antifungal - Fluorinated Pyrimidine-Type Agents - Drugs For Fungus flucytosine oral capsule 250 mg, 500 mg 1 Antifungal - Imidazoles - Drugs For Fungus ketoconazole oral tablet 200 mg 1 Antifungal - Triazoles - Drugs For Fungus fluconazole oral suspension for reconstitution 10 1 QL (500 per 1 day) mg/ml, 40 mg/ml fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg 1 itraconazole oral capsule 100 mg 1 Antifungal Other - Drugs For Fungus flucytosine oral capsule 250 mg, 500 mg 1 griseofulvin microsize oral suspension 125 mg/5 ml 1 QL (500 per 1 day) griseofulvin microsize oral tablet 500 mg 1 griseofulvin ultramicrosize oral tablet 125 mg, 250 mg 1 Antileprotic - Sulfone Agents - Antibiotics dapsone oral tablet 100 mg, 25 mg 1 Antimalarials - Drugs For Parasites PA NSO; QL (40 per 10 chloroquine phosphate oral tablet 250 mg 1 days) PA NSO; QL (20 per 10 chloroquine phosphate oral tablet 500 mg 1 days) hydroxychloroquine oral tablet 200 mg 1 QL (3 per 1 day) PRIMAQUINE ORAL TABLET 26.3 MG 2 pyrimethamine oral tablet 25 mg 1 quinine sulfate oral capsule 324 mg 1 PA NSO Antiprotozoal Agents - Other - Drugs For Parasites atovaquone oral suspension 750 mg/5 ml 1 Antiprotozoal-Antibacterial 1St Generation 2-Methyl-5-Nitroimidazole - Drugs For Infections Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 36 Coverage Prescription Drug Name Drug Tier Requirements and Limits metronidazole oral tablet 250 mg, 500 mg 1 Antiretroviral - Hiv-1 Integrase Strand Transfer Inhibitors - Drugs For Viral Infections ISENTRESS ORAL TABLET 400 MG (raltegravir 2 IHSS; QL (2 per 1 day) potassium) TIVICAY ORAL TABLET 50 MG (dolutegravir sodium) 2 IHSS; QL (1 per 1 day) Antiretroviral - Nucleoside And Nucleotide Analog Rtis Combinations - Drugs For Viral Infections DESCOVY ORAL TABLET 200-25 MG 2 IHSS; QL (1 per 1 day) (emtricitabine/tenofovir alafenamide fumarate) TRUVADA ORAL TABLET 200-300 MG 2 IHSS; QL (1 per 1 day) (emtricitabine/tenofovir disoproxil fumarate) Antiretroviral - Nucleoside Reverse Transcriptase Inhibitors (Nrti) - Drugs For Viral Infections didanosine oral capsule,delayed release(dr/ec) 125 mg, 1 QL (1 per 1 day) 200 mg, 250 mg, 400 mg zidovudine oral tablet 300 mg 1 QL (2 per 1 day) Antitubercular - D-Alanine Analogs - Antibiotics cycloserine oral capsule 250 mg 1 Antitubercular - Isonicotinic Acid Derivatives - Antibiotics isoniazid oral solution 50 mg/5 ml 1 QL (500 per 1 day) isoniazid oral tablet 100 mg, 300 mg 1 Antitubercular - Niacinamide Derivatives - Antibiotics pyrazinamide oral tablet 500 mg 1 Antitubercular - Rifamycin And Derivatives - Antibiotics PRIFTIN ORAL TABLET 150 MG (rifapentine) 2 rifampin oral capsule 150 mg, 300 mg 1 Antitubercular Agents Other - Antibiotics ethambutol oral tablet 100 mg, 400 mg 1 TRECATOR ORAL TABLET 250 MG (ethionamide) 2 Carbapenem Antibiotics (Thienamycins) - Antibiotics ertapenem injection recon soln 1 gram 1 QL (1 per 1 day)

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 42 Coverage Prescription Drug Name Drug Tier Requirements and Limits Antineoplastic - Cyp17 (17 Alpha-Hydroxylase/C17,20-Lyase) Inhibitor - Drugs For Cancer abiraterone oral tablet 250 mg 1 PA; SP abiraterone oral tablet 500 mg 1 PA; OCH ZYTIGA ORAL TABLET 250 MG, 500 MG (abiraterone 2 PA; SP acetate) Antineoplastic - 1St Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer erlotinib oral tablet 100 mg, 150 mg, 25 mg 1 PA; SP; QL (1 per 1 day) IRESSA ORAL TABLET 250 MG (gefitinib) 2 PA; SP TARCEVA ORAL TABLET 100 MG, 150 MG, 25 MG 2 PA; SP; QL (1 per 1 day) (erlotinib hcl) Antineoplastic - 2Nd Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG (afatinib 2 PA; OCH dimaleate) Antineoplastic - 3Rd Generation Egfr Tyrosine Kinase Inhibitor - Drugs For Cancer TAGRISSO ORAL TABLET 40 MG, 80 MG (osimertinib 2 PA; SP mesylate) Antineoplastic - Alkylating Agent - Alkyl Sulfonates - Drugs For Cancer busulfan intravenous solution 60 mg/10 ml 2 SP; QL (500 per 1 day) BUSULFEX INTRAVENOUS SOLUTION 60 MG/10 ML 2 SP; QL (500 per 1 day) (busulfan) MYLERAN ORAL TABLET 2 MG (busulfan) 2 SP Antineoplastic - Alkylating Agent - Ethylenimines And Methylmelamines - Drugs For Cancer HEXALEN ORAL CAPSULE 50 MG (altretamine) 2 SP thiotepa injection recon soln 100 mg, 15 mg 1 Antineoplastic - Alkylating Agent - Methylhydrazines - Drugs For Cancer MATULANE ORAL CAPSULE 50 MG (procarbazine hcl) 2 OCH Antineoplastic - Alkylating Agent - Nitrogen Mustard With Rescue Agent - Drugs For Cancer Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 43 Coverage Prescription Drug Name Drug Tier Requirements and Limits ifosfamide-mesna intravenous kit 1-1 gram, 3,000-1,000 1 mg Antineoplastic - Alkylating Agent - Nitrogen Mustards - Drugs For Cancer ALKERAN ORAL TABLET 2 MG (melphalan) 2 OCH cyclophosphamide intravenous recon soln 1 gram, 2 1 PA gram, 500 mg cyclophosphamide intravenous solution 200 mg/ml 1 PA CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG, 50 MG 2 PA; SP (cyclophosphamide) cyclophosphamide oral tablet 25 mg, 50 mg 1 PA; OCH ifosfamide intravenous recon soln 1 gram, 3 gram 1 ifosfamide intravenous solution 1 gram/20 ml, 3 1 gram/60 ml LEUKERAN ORAL TABLET 2 MG (chlorambucil) 2 OCH melphalan oral tablet 2 mg 1 OCH Antineoplastic - Alkylating Agent - Nitrosoureas - Drugs For Cancer BICNU INTRAVENOUS RECON SOLN 100 MG 2 (carmustine) Antineoplastic - Alkylating Agent - Triazenes - Drugs For Cancer dacarbazine intravenous recon soln 100 mg, 200 mg 1 PA TEMODAR INTRAVENOUS RECON SOLN 100 MG 1 SP (temozolomide) temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 1 PA; SP mg, 250 mg, 5 mg Antineoplastic - Anaplastic Lymphoma Kinase (Alk) Inhibitors - Drugs For Cancer ALECENSA ORAL CAPSULE 150 MG (alectinib hcl) 2 PA; SP ALUNBRIG ORAL TABLET 180 MG, 30 MG, 90 MG 2 PA; OCH (brigatinib) ALUNBRIG ORAL TABLETS,DOSE PACK 90 MG (7)- 180 2 PA; OCH MG (23) (brigatinib) XALKORI ORAL CAPSULE 200 MG, 250 MG (crizotinib) 2 PA; SP ZYKADIA ORAL CAPSULE 150 MG (ceritinib) 2 PA; SP Antineoplastic - Antiadrenals - Drugs For Cancer Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 44 Coverage Prescription Drug Name Drug Tier Requirements and Limits LYSODREN ORAL TABLET 500 MG (mitotane) 2 PA; OCH Antineoplastic - Antiandrogens - Drugs For Cancer abiraterone oral tablet 250 mg 1 PA; SP abiraterone oral tablet 500 mg 1 PA; OCH bicalutamide oral tablet 50 mg 1 OCH flutamide oral capsule 125 mg 1 SP XTANDI ORAL CAPSULE 40 MG (enzalutamide) 2 PA; SP XTANDI ORAL TABLET 40 MG, 80 MG (enzalutamide) 2 PA; OCH ZYTIGA ORAL TABLET 250 MG, 500 MG (abiraterone 2 PA; SP acetate) Antineoplastic - Antimetabolite - Folic Acid Analogs - Drugs For Cancer methotrexate sodium (pf) injection solution 25 mg/ml 1 methotrexate sodium injection solution 25 mg/ml 1 methotrexate sodium oral tablet 2.5 mg 1 OCH XATMEP ORAL SOLUTION 2.5 MG/ML (methotrexate) 2 OCH; AGE (Max 11 Years) Antineoplastic - Antimetabolite - Purine Analogs - Drugs For Cancer ARRANON INTRAVENOUS SOLUTION 250 MG/50 ML 2 (nelarabine) cladribine intravenous solution 10 mg/10 ml 1 mercaptopurine oral tablet 50 mg 1 OCH NIPENT INTRAVENOUS RECON SOLN 10 MG 2 (pentostatin) PURIXAN ORAL SUSPENSION 20 MG/ML 2 OCH; AGE (Max 11 Years) (mercaptopurine) TABLOID ORAL TABLET 40 MG (thioguanine) 2 PA; SP Antineoplastic - Antimetabolite - Pyrimidine Analogs - Drugs For Cancer fluorouracil (Adrucil Intravenous Solution 2.5 Gram/50 Ml, 1 PA 500 Mg/10 Ml) capecitabine oral tablet 150 mg, 500 mg 1 PA; SP floxuridine injection recon soln 0.5 gram 1 fluorouracil intravenous solution 1 gram/20 ml 1 fluorouracil intravenous solution 5 gram/100 ml 1 fluorouracil intravenous solution 500 mg/10 ml 1 PA NSO Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 45 Coverage Prescription Drug Name Drug Tier Requirements and Limits gemcitabine intravenous recon soln 1 gram, 200 mg 1 gemcitabine intravenous recon soln 2 gram 1 gemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 100 mg/ml, 2 gram/52.6 ml (38 mg/ml), 200 1 mg/5.26 ml (38 mg/ml) GEMZAR INTRAVENOUS RECON SOLN 1 GRAM, 200 2 MG (gemcitabine hcl) Antineoplastic - Antimetabolite - Urea Derivatives - Drugs For Cancer hydroxyurea oral capsule 500 mg 1 OCH Antineoplastic - Aromatase Inhibitors - Drugs For Cancer anastrozole oral tablet 1 mg 1 OCH exemestane oral tablet 25 mg 1 OCH letrozole oral tablet 2.5 mg 1 OCH Antineoplastic - Braf Kinase Inhibitors - Drugs For Cancer TAFINLAR ORAL CAPSULE 50 MG, 75 MG (dabrafenib 2 PA; SP mesylate) Antineoplastic - Bruton's Tyrosine Kinase (Btk) Inhibitor - Drugs For Cancer CALQUENCE ORAL CAPSULE 100 MG (acalabrutinib) 2 PA; OCH IMBRUVICA ORAL CAPSULE 140 MG, 70 MG (ibrutinib) 2 PA; OCH IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 2 PA; OCH 560 MG (ibrutinib) Antineoplastic - Cd20 Specific Recombinant Monoclonal Antibody Agents - Drugs For Cancer ARZERRA INTRAVENOUS SOLUTION 1,000 MG/50 ML, 2 PA; SP 100 MG/5 ML (ofatumumab) GAZYVA INTRAVENOUS SOLUTION 1,000 MG/40 ML 2 PA; SP (obinutuzumab) RITUXAN HYCELA SUBCUTANEOUS SOLUTION 1400 MG/11.7 ML (120 MG/ML), 1600 MG/13.4 ML (120 MG/ML) 2 PA; SP (rituximab/hyaluronidase, human recombinant) RITUXAN INTRAVENOUS CONCENTRATE 10 MG/ML 2 PA; SP (rituximab) Antineoplastic - Cyclin-Dependent Kinase (Cdk) 4/6 Inhibitors - Drugs For Cancer Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 46 Coverage Prescription Drug Name Drug Tier Requirements and Limits IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG 2 PA; OCH (palbociclib) IBRANCE ORAL TABLET 100 MG, 125 MG, 75 MG 2 PA; OCH (palbociclib) KISQALI ORAL TABLET 200 MG/DAY (200 MG X 1), 400 MG/DAY (200 MG X 2), 600 MG/DAY (200 MG X 3) 2 PA; SP (ribociclib succinate) VERZENIO ORAL TABLET 100 MG, 150 MG, 200 MG, 50 2 PA; SP MG (abemaciclib) Antineoplastic - Epipodophyllotoxins - Drugs For Cancer etoposide intravenous solution 20 mg/ml 1 etoposide oral capsule 50 mg 1 OCH teniposide intravenous solution 50 mg/5 ml 1 SP; QL (500 per 1 day) etoposide (Toposar Intravenous Solution 20 Mg/Ml) 1 Antineoplastic - Estrogens - Drugs For Cancer EMCYT ORAL CAPSULE 140 MG (estramustine 2 PA; SP phosphate sodium) Antineoplastic - Interferons - Drugs For Cancer SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 2 PA; SP 600 MCG (peginterferon alfa-2b) Antineoplastic - Lhrh (Gnrh) Agonist Analog Pituitary Suppressants - Drugs For Cancer LUPRON DEPOT (3 MONTH) INTRAMUSCULAR 2 PA; SP SYRINGE KIT 22.5 MG (leuprolide acetate) LUPRON DEPOT (4 MONTH) INTRAMUSCULAR 2 PA; SP SYRINGE KIT 30 MG (leuprolide acetate) LUPRON DEPOT (6 MONTH) INTRAMUSCULAR 2 PA; SP SYRINGE KIT 45 MG (leuprolide acetate) LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 7.5 2 PA; SP MG (leuprolide acetate) Antineoplastic - Mast Cell Stabilizers - Drugs For Cancer cromolyn oral concentrate 100 mg/5 ml 1 QL (500 per 1 day) Antineoplastic - Mek1 And Mek2 Kinase Inhibitors - Drugs For Cancer

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 70 Coverage Prescription Drug Name Drug Tier Requirements and Limits lorazepam oral tablet 0.5 mg, 1 mg, 2 mg 1 Antianxiety Agent - Non-Benzodiazepine - Drugs For Anxiety buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg 1 Anticonvulsant - Barbiturates And Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) 1 QL (500 per 1 day) phenobarbital oral tablet 100 mg, 16.2 mg, 32.4 mg, 64.8 1 mg, 97.2 mg phenobarbital oral tablet 15 mg, 30 mg, 60 mg 1 primidone oral tablet 250 mg, 50 mg 1 Anticonvulsant - Benzodiazepines - Drugs For Seizures /Personality Disorder/Nerve Pain clonazepam oral tablet 0.5 mg, 1 mg, 2 mg 1 clonazepam oral tablet,disintegrating 0.125 mg, 0.25 QL (3 per 1 day); AGE (Max 1 mg, 0.5 mg, 1 mg, 2 mg 11 Years) diazepam rectal kit 12.5-15-17.5-20 mg, 2.5 mg, 5-7.5-10 1 QL (2 per 365 days) mg NAYZILAM NASAL SPRAY,NON-AEROSOL 5 MG/SPRAY 2 (0.1 ML) (midazolam) VALTOCO NASAL SPRAY,NON-AEROSOL 10 MG/SPRAY (0.1 ML), 15 MG/2 SPRAY (7.5/0.1ML X 2), 20 MG/2 2 SPRAY (10MG/0.1ML X2), 5 MG/SPRAY (0.1 ML) (diazepam) Anticonvulsant - Carboxylic Acid Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain divalproex oral capsule, delayed rel sprinkle 125 mg 1 divalproex oral tablet extended release 24 hr 250 mg, 1 500 mg divalproex oral tablet,delayed release (dr/ec) 125 mg, 1 250 mg, 500 mg valproic acid (as sodium salt) oral solution 250 mg/5 ml 1 QL (1500 per 1 day) valproic acid oral capsule 250 mg 1 Anticonvulsant - Gaba Analogs - Drugs For Seizures /Personality Disorder/Nerve Pain Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 71 Coverage Prescription Drug Name Drug Tier Requirements and Limits gabapentin oral capsule 100 mg, 300 mg, 400 mg 1 gabapentin oral solution 250 mg/5 ml 1 QL (500 per 1 day) gabapentin oral tablet 600 mg, 800 mg 1 pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 1 QL (3 per 1 day) 50 mg, 75 mg pregabalin oral capsule 225 mg, 300 mg 1 QL (2 per 1 day) pregabalin oral solution 20 mg/ml 1 QL (900 per 1 day) Anticonvulsant - Gaba Re-Uptake Inhibitor, Nipecotic Acid Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain tiagabine oral tablet 12 mg, 16 mg, 2 mg, 4 mg 1 PA Anticonvulsant - Hydantoins - Drugs For Seizures /Personality Disorder/Nerve Pain phenytoin sodium extended (Dilantin Extended Oral 2 Capsule 100 Mg) phenytoin (Dilantin Infatabs Oral Tablet,Chewable 50 Mg) 2 DILANTIN-125 ORAL SUSPENSION 125 MG/5 ML 2 QL (500 per 1 day) (phenytoin) PEGANONE ORAL TABLET 250 MG (ethotoin) 2 phenytoin sodium extended (Phenytek Oral Capsule 200 2 Mg, 300 Mg) phenytoin oral suspension 125 mg/5 ml 1 QL (500 per 1 day) phenytoin oral tablet,chewable 50 mg 1 phenytoin sodium extended oral capsule 100 mg, 200 1 mg, 300 mg Anticonvulsant - Iminostilbene Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain carbamazepine oral capsule, er multiphase 12 hr 100 1 mg, 200 mg, 300 mg carbamazepine oral suspension 100 mg/5 ml 1 QL (1500 per 1 day) carbamazepine oral tablet 200 mg 1 carbamazepine oral tablet extended release 12 hr 100 1 mg, 200 mg, 400 mg carbamazepine oral tablet,chewable 100 mg 1 carbamazepine (Epitol Oral Tablet 200 Mg) 1 Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 72 Coverage Prescription Drug Name Drug Tier Requirements and Limits oxcarbazepine oral suspension 300 mg/5 ml (60 mg/ml) 1 QL (500 per 1 day) oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg 1 Anticonvulsant - Monosaccharide Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain topiramate oral capsule, sprinkle 15 mg, 25 mg 1 topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg 1 Anticonvulsant - Phenyltriazine Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg 1 lamotrigine oral tablet, chewable dispersible 25 mg, 5 1 mg Anticonvulsant - Pyrrolidine Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain levetiracetam oral solution 100 mg/ml 1 QL (1500 per 1 day) levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 1 mg SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG, 1 250 MG, 500 MG, 750 MG (levetiracetam) Anticonvulsant - Succinimides - Drugs For Seizures /Personality Disorder/Nerve Pain CELONTIN ORAL CAPSULE 300 MG (methsuximide) 2 ethosuximide oral capsule 250 mg 1 ethosuximide oral solution 250 mg/5 ml 1 QL (500 per 1 day) Anticonvulsant - Sulfonamide Derivatives - Drugs For Seizures /Personality Disorder/Nerve Pain zonisamide oral capsule 100 mg, 25 mg, 50 mg 1 Antidepressant - Alpha-2 Receptor Antagonists (Nassa) - Drugs For Depression mirtazapine oral tablet 15 mg, 30 mg, 45 mg 1 mirtazapine oral tablet 7.5 mg 1 mirtazapine oral tablet,disintegrating 15 mg, 30 mg, 45 1 QL (1 per 1 day) mg Antidepressant - Selective Serotonin Reuptake Inhibitors (Ssris) - Drugs For Depression Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 73 Coverage Prescription Drug Name Drug Tier Requirements and Limits citalopram oral solution 10 mg/5 ml 1 QL (20 per 1 day) citalopram oral tablet 10 mg 1 QL (4 per 1 day) citalopram oral tablet 20 mg, 40 mg 1 escitalopram oxalate oral solution 5 mg/5 ml 1 QL (500 per 1 day) escitalopram oxalate oral tablet 10 mg, 20 mg 1 QL (2 per 1 day) escitalopram oxalate oral tablet 5 mg 1 QL (3 per 1 day) fluoxetine oral capsule 10 mg, 20 mg, 40 mg 1 fluoxetine oral solution 20 mg/5 ml (4 mg/ml) 1 QL (500 per 1 day) AGE (Min 2 Years and Max fluoxetine oral tablet 10 mg 1 12 Years) fluvoxamine oral tablet 100 mg, 25 mg, 50 mg 1 paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg 1 sertraline oral concentrate 20 mg/ml 1 QL (500 per 1 day) sertraline oral tablet 100 mg, 25 mg, 50 mg 1 Antidepressant - Serotonin-2 Antagonist-Reuptake Inhibitors (Saris) - Drugs For Depression nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 1 50 mg trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg 1 Antidepressant - Serotonin-Norepinephrine Reuptake Inhibitors (Snris) - Drugs For Depression desvenlafaxine succinate oral tablet extended release 1 QL (1 per 1 day) 24 hr 100 mg, 50 mg desvenlafaxine succinate oral tablet extended release 1 QL (3 per 1 day) 24 hr 25 mg duloxetine oral capsule,delayed release(dr/ec) 20 mg, 1 QL (2 per 1 day) 60 mg duloxetine oral capsule,delayed release(dr/ec) 30 mg 1 QL (3 per 1 day) venlafaxine oral capsule,extended release 24hr 150 mg, 1 QL (2 per 1 day) 37.5 mg venlafaxine oral capsule,extended release 24hr 75 mg 1 QL (3 per 1 day) venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg 1 QL (2 per 1 day) venlafaxine oral tablet 75 mg 1 QL (3 per 1 day)

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 112 Coverage Prescription Drug Name Drug Tier Requirements and Limits megestrol oral suspension 400 mg/10 ml (40 mg/ml) 1 PA; QL (500 per 1 day) Electrolyte Balance-Nutritional Products - Drugs For Nutrition B-Complex Vitamin Combinations - Drugs For Nutrition b complex-vitamin c-folic acid oral tablet 400 mcg 1 OTC Medical b-complex with vitamin c oral tablet 1 OTC Medical b-complex with vitamin c oral tablet extended release 1 OTC Medical DIALYVITE 800 WITH ZINC 15 ORAL TABLET 0.8-15 MG 2 OTC Medical (vitamin b complex with vitamin c/folic acid/zinc citrate) DIALYVITE 800 WITH ZINC 50 ORAL TABLET 0.8-50 MG 2 OTC Medical (vitamin b complex with vitamin c/folic acid/zinc citrate) dialyvite oral tablet 100-1 mg 1 full spectrum b-vitamin c oral tablet 0.8 mg 1 OTC Medical mynephrocaps oral capsule 1 mg 1 nephro-vite oral tablet 0.8 mg 1 OTC Medical renal caps oral capsule 1 mg 1 renal vitamin oral tablet 0.8 mg 1 OTC Medical renal-vite oral tablet 0.8 mg 1 OTC Medical rena-vite oral tablet 0.8 mg 1 OTC Medical reno caps oral capsule 1 mg 1 super b complex-vitamin c oral tablet 1 OTC Medical superplex-t oral tablet 1 OTC Medical triphrocaps oral capsule 1 mg 1 virt-caps oral capsule 1 mg 1 west-vite with folic acid oral tablet 0.8 mg 1 OTC Medical B-Complex Vitamins - Drugs For Nutrition vitamin b complex oral capsule 1 OTC Medical vitamins b complex oral capsule 1 OTC Medical B-Complex Vitamins And Combinations - Drugs For Nutrition dialyvite oral tablet 1-100-300-50 mg-mg-mcg-mg 1 nephplex rx oral tablet 1-60-300-12.5 mg-mg-mcg-mg 1 nephro-vite rx oral tablet 1-60-300 mg-mg-mcg 1 rena-vite rx oral tablet 1-60-300 mg-mg-mcg 1 Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 113 Coverage Prescription Drug Name Drug Tier Requirements and Limits vol-care rx oral tablet 1-60-300 mg-mg-mcg 1 vp-vite rx oral tablet 1-60-300 mg-mg-mcg 1 Bioflavonoid Combinations - Drugs For Nutrition ear health formula oral tablet , 200-100 mg 1 OTC Medical Dextrose And Lactated Ringer's Solutions - Drugs For Nutrition dextrose 5 %-lactated ringers intravenous parenteral 1 PA solution Dextrose And Sodium Chloride Solutions - Drugs For Nutrition d10 %-0.45 % sodium chloride intravenous parenteral 1 PA solution d2.5 %-0.45 % sodium chloride intravenous parenteral 1 PA solution d5 % and 0.9 % sodium chloride intravenous parenteral 1 PA solution d5 %-0.45 % sodium chloride intravenous parenteral 1 PA solution dextrose 10 % and 0.2 % nacl intravenous parenteral 1 PA solution dextrose 5%-0.2 % sod chloride intravenous parenteral 1 PA solution dextrose 5%-0.3 % sod.chloride intravenous parenteral 1 PA solution Dextrose Solutions - Drugs For Nutrition dextrose 10 % in water (d10w) intravenous parenteral 1 PA solution 10 % dextrose 20 % in water (d20w) intravenous parenteral 1 PA solution 20 % dextrose 25 % in water (d25w) intravenous syringe 1 PA dextrose 30 % in water (d30w) intravenous parenteral 1 PA solution dextrose 40 % in water (d40w) intravenous parenteral 1 PA solution 40 % dextrose 5 % in water (d5w) intravenous parenteral 1 PA solution dextrose 5 % in water (d5w) intravenous piggyback 5 % 1 PA Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 114 Coverage Prescription Drug Name Drug Tier Requirements and Limits dextrose 50 % in water (d50w) intravenous parenteral 1 PA solution dextrose 50 % in water (d50w) intravenous syringe 1 PA dextrose 70 % in water (d70w) intravenous parenteral 1 PA solution Dextrose Solutions, Concentrated - Drugs For Nutrition dextrose 20 % in water (d20w) intravenous parenteral 1 PA solution 20 % dextrose 25 % in water (d25w) intravenous syringe 1 PA dextrose 30 % in water (d30w) intravenous parenteral 1 PA solution dextrose 40 % in water (d40w) intravenous parenteral 1 PA solution 40 % dextrose 50 % in water (d50w) intravenous syringe 1 PA Diluents - Sodium Chloride - Drugs For Nutrition sodium chloride 0.9 % injection solution 1 sodium chloride injection syringe 0.9 % 1 Electrolyte Depleters - Ion Exchange Resin - Drugs For Nutrition kionex (with sorbitol) oral suspension 15-19.3 gram/60 1 QL (500 per 1 day) ml sodium polystyrene sulfonate (Kionex Oral Powder) 1 QL (500 per 1 day) sodium polystyrene (sorb free) oral suspension 15 1 QL (500 per 1 day) gram/60 ml sodium polystyrene sulfonate oral powder 1 QL (500 per 1 day) sodium polystyrene sulfonate/sorbitol solution (Sps 1 QL (500 per 1 day) (With Sorbitol) Oral Suspension 15-20 Gram/60 Ml) Irrigation Solutions - Drugs For Nutrition LACTATED RINGERS IRRIGATION SOLUTION (ringer's 2 PA solution,lactated) ringer's irrigation solution 1 PA sodium chloride irrigation solution 0.9 % 1 Minerals And Electrolytes - Calcium Replacement - Drugs For Nutrition calci-chew oral tablet,chewable 500 mg calcium (1,250 1 OTC Medical mg) Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 115 Coverage Prescription Drug Name Drug Tier Requirements and Limits calci-mix oral capsule 500 mg calcium (1,250 mg) 1 OTC Medical calcium 600 oral tablet 600 mg calcium (1,500 mg) 1 OTC Medical CALCIUM ACETATE ORAL TABLET 667 MG 2 calcium acetate(phosphat bind) oral tablet 667 mg 1 calcium carbonate oral suspension 500 mg/5 ml (1,250 OTC Medical; QL (500 per 1 1 mg/5 ml) day) calcium carbonate oral tablet 500 mg calcium (1,250 1 OTC Medical mg), 600 mg calcium (1,500 mg) calcium carbonate oral tablet,chewable 500 mg calcium 1 OTC Medical (1,250 mg) calcium citrate oral tablet 200 mg (950 mg) 1 OTC Medical CALCIUM CITRATE ORAL TABLET 250 MG CALCIUM 1 OTC Medical (calcium citrate) calcium gluconate oral tablet 60 mg calcium (650 mg) 1 OTC Medical calcium lactate oral tablet 84 mg (648 mg) 1 OTC Medical coral calcium oral tablet 390 mg calcium (1,000 mg) 1 OTC Medical natural calcium oral tablet 500 mg calcium (1,250 mg) 1 OTC Medical oysco-500 oral tablet 500 mg calcium (1,250 mg) 1 OTC Medical super calcium oral tablet 600 mg calcium (1,500 mg) 1 OTC Medical Minerals And Electrolytes - Calcium Replacement Combinations - Drugs For Nutrition calcium carbonate-vit d3-min oral tablet 600 mg 1 OTC Medical calcium- 400 unit calcium carbonate-vit d3-min oral tablet,chewable 600 1 OTC Medical mg (1,500 mg)-200 unit Minerals And Electrolytes - Calcium Replacement/Vitamin D Combinations - Drugs For Nutrition calcium 500 + d (d3) oral tablet 500 mg(1,250mg) -125 1 OTC Medical unit calcium 500 + d oral tablet 500 mg(1,250mg) -200 unit 1 OTC Medical calcium 500 + d oral tablet,chewable 500 mg(1,250mg) - 1 OTC Medical 400 unit calcium 600 + d(3) oral capsule 600 mg calcium- 200 1 OTC Medical unit

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 135 Coverage Prescription Drug Name Drug Tier Requirements and Limits Androgen - Single Agents - Drugs For Men androxy oral tablet 10 mg 1 Antidiuretic And Vasopressor Hormones - Hormones desmopressin nasal spray with pump 10 mcg/spray (0.1 1 ml) desmopressin oral tablet 0.1 mg, 0.2 mg 1 Antihyperglycemic - Alpha-Glucosidase Inhibitors - Drugs For Diabetes acarbose oral tablet 100 mg, 25 mg, 50 mg 1 DD Antihyperglycemic - Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors - Drugs For Diabetes alogliptin oral tablet 12.5 mg, 25 mg, 6.25 mg 1 DD; QL (1 per 1 day) Antihyperglycemic - Meglitinide Analogs - Drugs For Diabetes repaglinide oral tablet 0.5 mg, 1 mg, 2 mg 1 DD Antihyperglycemic - Sglt-2 Inhibitor And Biguanide Combinations - Drugs For Diabetes SEGLUROMET ORAL TABLET 2.5-1,000 MG, 2.5-500 MG, 7.5-1,000 MG, 7.5-500 MG (ertugliflozin 2 PA NSO; DD pidolate/metformin hcl) Antihyperglycemic - Sglt-2 Inhibitor And Dpp-4 Inhibitor Combinations - Drugs For Diabetes STEGLUJAN ORAL TABLET 15-100 MG, 5-100 MG 2 PA NSO; DD (ertugliflozin pidolate/sitagliptin phosphate) Antihyperglycemic - Sodium Glucose Cotransporter-2 (Sglt2) Inhibitors - Drugs For Diabetes STEGLATRO ORAL TABLET 15 MG (ertugliflozin 2 DD; QL (1 per 1 day) pidolate) STEGLATRO ORAL TABLET 5 MG (ertugliflozin pidolate) 2 DD; QL (2 per 1 day) Antihyperglycemic - Sulfonylurea And Biguanide Combinations - Drugs For Diabetes glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 1 DD mg, 5-500 mg Antihyperglycemic - Sulfonylurea Derivatives - Drugs For Diabetes glimepiride oral tablet 1 mg, 2 mg, 4 mg 1 DD Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 136 Coverage Prescription Drug Name Drug Tier Requirements and Limits glipizide oral tablet 10 mg, 5 mg 1 DD glipizide oral tablet extended release 24hr 10 mg, 2.5 1 DD mg, 5 mg glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg 1 DD glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg 1 DD Antihyperglycemic, Amylin Analog-Type - Drugs For Diabetes SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2 PA; DD 2,700 MCG/2.7 ML (pramlintide acetate) SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 2 PA; DD MCG/1.5 ML (pramlintide acetate) Antihyperglycemic, Incretin Mimetic,Glp-1 Receptor Agonist Analog-Type - Drugs For Diabetes ADLYXIN SUBCUTANEOUS PEN INJECTOR 10 MCG/0.2 2 ST; DD ML- 20 MCG/0.2 ML, 20 MCG/0.2 ML (lixisenatide) BYDUREON BCISE SUBCUTANEOUS AUTO-INJECTOR 2 ST; DD 2 MG/0.85 ML (exenatide microspheres) BYDUREON SUBCUTANEOUS PEN INJECTOR 2 2 ST; DD MG/0.65 ML (exenatide microspheres) BYDUREON SUBCUTANEOUS SUSPENSION,EXTENDED REL RECON 2 MG (exenatide 2 ST; DD microspheres) BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 2 ST; DD MCG/ML) 1.2 ML (exenatide) OZEMPIC SUBCUTANEOUS PEN INJECTOR 0.25 MG OR 0.5 MG(2 MG/1.5 ML), 1 MG/DOSE (2 MG/1.5 ML), 1 2 ST; DD MG/DOSE (4 MG/3 ML) (semaglutide) RYBELSUS ORAL TABLET 14 MG, 3 MG, 7 MG 2 ST; DD (semaglutide) TANZEUM SUBCUTANEOUS PEN INJECTOR 30 MG/0.5 2 PA; DD ML, 50 MG/0.5 ML (albiglutide) TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML, 3 MG/0.5 ML, 4.5 MG/0.5 ML 2 ST; DD; QL (6 per 84 days) (dulaglutide) VICTOZA SUBCUTANEOUS PEN INJECTOR 0.6 MG/0.1 2 ST; DD; QL (9 per 30 days) ML (18 MG/3 ML) (liraglutide) Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 137 Coverage Prescription Drug Name Drug Tier Requirements and Limits Antihyperglycemic-Dipeptidyl Peptidase-4 Inhibit And Thiazolidinedione - Drugs For Diabetes alogliptin-pioglitazone oral tablet 12.5-15 mg, 12.5-30 1 DD; QL (1 per 1 day) mg, 12.5-45 mg, 25-15 mg, 25-30 mg, 25-45 mg Antihyperglycemic-Dipeptidyl Peptidase-4(Dpp-4)Inhibitor And Biguanide - Drugs For Diabetes alogliptin-metformin oral tablet 12.5-1,000 mg, 12.5-500 1 DD; QL (2 per 1 day) mg Antithyroid Agents, Thionamides - Imidazole Derivatives - Drugs For Thyroid methimazole oral tablet 10 mg, 5 mg 1 Antithyroid Agents, Thionamides - Thiouracil Derivatives - Drugs For Thyroid propylthiouracil oral tablet 50 mg 1 Bone Resorption Inhibitors - Bisphosphonates - Drugs For Menopause And Bone Loss alendronate oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 1 mg ibandronate oral tablet 150 mg 1 Calcimimetic, Parathyroid Calcium Receptor Sensitivity Enhancer - Drugs For Menopause And Bone Loss cinacalcet oral tablet 30 mg, 60 mg, 90 mg 1 PA Calcitonins - Drugs For Menopause And Bone Loss calcitonin (salmon) nasal spray,non-aerosol 200 1 unit/actuation Estrogen-Progestin - Drugs For Women norethindrone acetate-ethinyl estradiol (Fyavolv Oral 1 Tablet 0.5-2.5 Mg-Mcg, 1-5 Mg-Mcg) norethindrone acetate-ethinyl estradiol (Jinteli Oral 1 Tablet 1-5 Mg-Mcg) lopreeza oral tablet 0.5-0.1 mg, 1-0.5 mg 1 norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg- 1 mcg, 1-5 mg-mcg Estrogens - Drugs For Women estradiol oral tablet 0.5 mg, 1 mg, 2 mg 1 Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 138 Coverage Prescription Drug Name Drug Tier Requirements and Limits estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 1 QL (8 per 30 days) mg/24 hr estradiol transdermal patch weekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 1 mg/24 hr, 0.1 mg/24 hr Fertility Enhancer - Preterm Birth Prevention, Progesterone-Type - Drugs For Women hydroxyprogest(pf)(preg presv) intramuscular oil 250 1 PA mg/ml (1 ml) hydroxyprogesterone cap(ppres) intramuscular oil 250 1 PA mg/ml MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR 275 2 PA MG/1.1 ML (hydroxyprogesterone caproate/pf) MAKENA INTRAMUSCULAR OIL 250 MG/ML 2 PA (hydroxyprogesterone caproate) MAKENA INTRAMUSCULAR OIL 250 MG/ML (1 ML) 2 PA (hydroxyprogesterone caproate/pf) Glucocorticoids - Drugs For Inflammation cortisone oral tablet 25 mg 1 prednisone (Deltasone Oral Tablet 20 Mg) 1 DEXAMETHASONE INTENSOL ORAL DROPS 1 MG/ML 2 AGE (Max 11 Years) (dexamethasone) dexamethasone oral elixir 0.5 mg/5 ml 1 QL (500 per 1 day) dexamethasone oral tablet 0.5 mg, 0.75 mg, 1.5 mg, 4 1 mg, 6 mg dexamethasone oral tablet 1 mg, 2 mg 1 dexamethasone sodium phos (pf) injection solution 10 1 mg/ml dexamethasone sodium phos (pf) injection syringe 10 1 mg/ml dexamethasone sodium phosphate injection solution 1 10 mg/ml, 4 mg/ml dexamethasone sodium phosphate injection syringe 4 1 mg/ml

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 173 Coverage Prescription Drug Name Drug Tier Requirements and Limits ONETOUCH VERIO HIGH CONTROL SOLUTION (blood 2 DD glucose calibration control solution, high) ONETOUCH VERIO MID CONTROL SOLUTION (blood 2 DD glucose calibration control solution, normal) ON-THE-GO LANCETS 30 GAUGE (lancets) 2 DD PIP LANCET 28 GAUGE, 30 GAUGE (lancets) 2 DD PRESSURE ACTIVATED LANCETS 21 GAUGE, 28 2 DD GAUGE (lancets) PRO COMFORT LANCET 30 GAUGE, 31 GAUGE 2 DD (lancets) PRODIGY LANCETS 26 GAUGE, 28 GAUGE (lancets) 2 DD PRODIGY LANCING DEVICE (lancing device) 2 DD PRODIGY TWIST TOP LANCET 28 GAUGE (lancets) 2 DD PURE COMFORT LANCETS 30 GAUGE (lancets) 1 DD PURE COMFORT SAFETY LANCETS 30 GAUGE 1 DD (lancets) PUSH BUTTON SAFETY LANCETS 21 GAUGE, 28 2 DD GAUGE (lancets) READYLANCE SAFETY LANCETS 21 GAUGE, 23 2 DD GAUGE, 26 GAUGE, 28 GAUGE, 30 GAUGE (lancets) RELIAMED LANCET 23 GAUGE, 28 GAUGE, 30 GAUGE 2 DD (lancets) RELIAMED MINI LANCING DEVICE (lancing device) 2 DD RELIAMED SAFETY SEAL LANCETS 28 GAUGE, 30 2 DD GAUGE (lancets) RELION THIN LANCETS 26 GAUGE (lancets) 2 DD RELION ULTRA THIN PLUS LANCETS (lancets) 2 DD RIGHTEST GD500 LANCING DEVICE (lancing device) 2 DD RIGHTEST GL300 LANCETS 30 GAUGE (lancets) 2 DD SAFETY LANCETS 21 GAUGE, 26 GAUGE, 28 GAUGE 2 DD (lancets) SAFETY SEAL LANCETS 28 GAUGE, 30 GAUGE 2 DD (lancets) SAFETY-LET LANCETS 30 GAUGE (lancets) 2 DD SINGLE-LET (lancets) 2 DD Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 174 Coverage Prescription Drug Name Drug Tier Requirements and Limits SMART SENSE LANCETS 21 GAUGE, 26 GAUGE, 33 2 DD GAUGE (lancets) SMARTDIABETES VANTAGE (lancing device) 2 DD SMARTEST LANCET (lancets) 2 DD SOF-SERTER INSERTION DEVICE (diabetic 2 DD supplies,miscell) SOFT TOUCH LANCETS (lancets) 2 DD SOLUS V2 LANCETS 28 GAUGE, 30 GAUGE (lancets) 2 DD SOLUS V2 LANCING DEVICE KIT (lancing 2 DD device/lancets) STERILANCE TL 30 GAUGE, 32 GAUGE (lancets) 2 DD SUPER THIN LANCETS 28 GAUGE, 30 GAUGE (lancets) 2 DD SURE COMFORT LANCETS 18 GAUGE, 21 GAUGE, 23 2 DD GAUGE, 28 GAUGE, 30 GAUGE (lancets) SURE COMFORT LANCING PEN (lancing device) 2 DD SUREFLEX DEVICE WITH LANCETS KIT (lancing 2 DD device/lancets) SUREFLEX LANCING DEVICE (lancing device) 2 DD SURE-LANCE , 26 GAUGE, 28 GAUGE (lancets) 2 DD SURE-LANCE ULTRA THIN 30 GAUGE (lancets) 2 DD SURE-PEN LANCING DEVICE (lancing device) 2 DD SURE-TOUCH LANCET (lancets) 2 DD TECHLITE LANCETS 25 GAUGE, 28 GAUGE, 30 GAUGE 2 DD (lancets) TELCARE LANCETS 30 GAUGE (lancets) 2 DD THIN LANCETS 26 GAUGE (lancets) 2 DD TOPCARE UNIVERSAL1 LANCET , 33 GAUGE (lancets) 2 DD TRUE COMFORT LANCET 30 GAUGE (lancets) 2 DD TRUEDRAW LANCING DEVICE (lancing device) 2 DD TRUEPLUS LANCETS 26 GAUGE, 28 GAUGE, 30 2 DD GAUGE, 33 GAUGE (lancets) TWIST LANCETS 30 GAUGE, 32 GAUGE (lancets) 2 DD ULTI-LANCE (lancing device) 2 DD ULTI-LANCE KIT (lancing device/lancets) 2 DD Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 175 Coverage Prescription Drug Name Drug Tier Requirements and Limits ULTILET BASIC LANCETS 30 GAUGE (lancets) 2 DD ULTILET CLASSIC LANCETS , 28 GAUGE, 30 GAUGE, 2 DD 33 GAUGE (lancets) ULTILET LANCETS 28 GAUGE, 30 GAUGE, 33 GAUGE 2 DD (lancets) ULTILET SAFETY LANCETS 23 GAUGE (lancets) 2 DD ULTRA FINE LANCETS 30 GAUGE (lancets) 1 OTC ULTRA THIN II LANCETS 30 GAUGE (lancets) 2 DD ULTRA THIN LANCETS 28 GAUGE, 30 GAUGE, 33 2 DD GAUGE (lancets) ULTRA THIN LANCETS 31 GAUGE (lancets) 1 OTC Medical ULTRA THIN PLUS LANCETS 33 GAUGE (lancets) 2 DD ULTRA TLC LANCETS (lancets) 2 DD ULTRA-CARE LANCETS 30 GAUGE (lancets) 2 DD ULTRALANCE LANCETS 26 GAUGE, 28 GAUGE 2 DD (lancets) ULTRA-THIN II LANCETS 26 GAUGE, 28 GAUGE 2 DD (lancets) UNILET COMFORTOUCH LANCET , 26 GAUGE (lancets) 2 DD UNILET EXCELITE II LANCET (lancets) 2 DD UNILET EXCELITE LANCET (lancets) 2 DD UNILET GP LANCET (lancets) 2 DD UNILET LANCET 28 GAUGE, 33 GAUGE (lancets) 2 DD UNILET SUPER THIN LANCETS 30 GAUGE (lancets) 2 DD UNISTIK 2 DEVICE KIT (lancing device/lancets) 2 DD UNISTIK 2 EXTRA KIT (lancing device/lancets) 2 DD UNISTIK 2 NORMAL LANCET,DEVICE KIT (lancing 2 DD device/lancets) UNISTIK 3 COMFORT DEVICE KIT (lancing 2 DD device/lancets) UNISTIK 3 COMFORT LANCET (lancets) 2 DD UNISTIK 3 EXTRA LANCET 21 GAUGE (lancets) 2 DD UNISTIK 3 GENTLE 30 GAUGE (lancets) 2 DD UNISTIK 3 KIT (lancing device/lancets) 2 DD Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 176 Coverage Prescription Drug Name Drug Tier Requirements and Limits UNISTIK 3 LANCETS 21 GAUGE (lancets) 2 DD UNISTIK 3 NEONATAL DEVICE KIT (lancing 2 DD device/lancets) UNISTIK 3 NORMAL LANCET 23 GAUGE (lancets) 2 DD UNISTIK CZT LANCET 23 GAUGE, 28 GAUGE (lancets) 2 DD UNISTIK PRO LANCET 21 GAUGE, 25 GAUGE, 28 2 DD GAUGE (lancets) UNISTIK SAFETY 28 GAUGE, 30 GAUGE (lancets) 2 DD UNISTIK TOUCH LANCETS 21 GAUGE, 23 GAUGE, 28 2 DD GAUGE, 30 GAUGE (lancets) UNIVERSAL 1 LANCETS 21 GAUGE, 26 GAUGE, 30 2 DD GAUGE, 33 GAUGE (lancets) VIVAGUARD LANCET 30 GAUGE (lancets) 1 OTC VIVAGUARD LANCING DEVICE (lancing device) 2 DD Medical Supplies And Dme - Incontinence Supplies - Medical Supplies And Durable Medical Equipment PREVAIL BLADDER CONTROL PAD PAD (incontinence 1 OTC Medical pad,liner,disp) Medical Supplies And Dme - Insulin Needles-Syringes And Admin Supplies - Medical Supplies And Durable Medical Equipment BD ULTRA-FINE NANO PEN NEEDLE NEEDLE 32 2 DD GAUGE X 5/32" (pen needle, diabetic) BD VEO INSULIN SYR (HALF UNIT) SYRINGE 0.3 ML 31 GAUGE X 15/64" (syringe with needle,insulin 0.3 ml (half 2 DD unit mark)) BD VEO INSULIN SYRINGE UF SYRINGE 1 ML 31 GAUGE X 15/64" (syringe with needle,disposable,insulin 2 DD 1 ml) BD VEO INSULIN SYRINGE UF SYRINGE 1/2 ML 31 2 DD GAUGE X 15/64" (syringe with needle,insulin,0.5 ml) SURE COMFORT INS. SYR. U-100 SYRINGE 0.5 ML 29 2 DD GAUGE X 1/2" (syringe with needle,insulin,0.5 ml) Medical Supplies And Dme - Male Condoms - Medical Supplies And Durable Medical Equipment

Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 189 Coverage Prescription Drug Name Drug Tier Requirements and Limits RELIAMED LANCET 23 GAUGE, 28 GAUGE, 30 GAUGE 2 DD (lancets) RELIAMED MINI LANCING DEVICE (lancing device) 2 DD RELIAMED SAFETY SEAL LANCETS 28 GAUGE, 30 2 DD GAUGE (lancets) RELION THIN LANCETS 26 GAUGE (lancets) 2 DD RELION ULTRA THIN PLUS LANCETS (lancets) 2 DD RIGHTEST GD500 LANCING DEVICE (lancing device) 2 DD RIGHTEST GL300 LANCETS 30 GAUGE (lancets) 2 DD SAFETY LANCETS 21 GAUGE, 26 GAUGE, 28 GAUGE 2 DD (lancets) SAFETY SEAL LANCETS 28 GAUGE, 30 GAUGE 2 DD (lancets) SAFETY-LET LANCETS 30 GAUGE (lancets) 2 DD SIDESTREAM PEDIATRIC FACE MASK DEVICE (inhaler, 2 OTC Medical assist devices, accessories) SILICONE MASK - PEDIATRIC DEVICE (inhaler, assist 2 OTC Medical devices, accessories) SINGLE-LET (lancets) 2 DD SMART SENSE LANCETS 21 GAUGE, 26 GAUGE, 33 2 DD GAUGE (lancets) SMARTDIABETES VANTAGE (lancing device) 2 DD SMARTEST LANCET (lancets) 2 DD SOF-SERTER INSERTION DEVICE (diabetic 2 DD supplies,miscell) SOFT TOUCH LANCETS (lancets) 2 DD SOLUS V2 LANCETS 28 GAUGE, 30 GAUGE (lancets) 2 DD SOLUS V2 LANCING DEVICE KIT (lancing 2 DD device/lancets) STERILANCE TL 30 GAUGE, 32 GAUGE (lancets) 2 DD SUPER THIN LANCETS 28 GAUGE, 30 GAUGE (lancets) 2 DD SURE COMFORT INS. SYR. U-100 SYRINGE 0.5 ML 29 2 DD GAUGE X 1/2" (syringe with needle,insulin,0.5 ml) SURE COMFORT LANCETS 18 GAUGE, 21 GAUGE, 23 2 DD GAUGE, 28 GAUGE, 30 GAUGE (lancets) Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 190 Coverage Prescription Drug Name Drug Tier Requirements and Limits SURE COMFORT LANCING PEN (lancing device) 2 DD SUREFLEX DEVICE WITH LANCETS KIT (lancing 2 DD device/lancets) SUREFLEX LANCING DEVICE (lancing device) 2 DD SURE-LANCE , 26 GAUGE, 28 GAUGE (lancets) 2 DD SURE-LANCE ULTRA THIN 30 GAUGE (lancets) 2 DD SURE-PEN LANCING DEVICE (lancing device) 2 DD SURE-TOUCH LANCET (lancets) 2 DD SURGUARD2 SAFETY NEEDLE 18 GAUGE X 1 1/2", 18 GAUGE X 1", 25 GAUGE X 1 1/2", 25 GAUGE X 1", 25 X 1 5/8 " (needles, safety) TECHLITE LANCETS 25 GAUGE, 28 GAUGE, 30 GAUGE 2 DD (lancets) TELCARE LANCETS 30 GAUGE (lancets) 2 DD THIN LANCETS 26 GAUGE (lancets) 2 DD TOPCARE UNIVERSAL1 LANCET , 33 GAUGE (lancets) 2 DD TRUE COMFORT LANCET 30 GAUGE (lancets) 2 DD TRUEDRAW LANCING DEVICE (lancing device) 2 DD TRUEPLUS KETONE STRIP (urine acetone test,strips) 1 DD TRUEPLUS LANCETS 26 GAUGE, 30 GAUGE, 33 GAUGE 2 DD (lancets) TRUZONE PEAK FLOW METER DEVICE (peak flow 2 meter) TWIST LANCETS 30 GAUGE, 32 GAUGE (lancets) 2 DD ULTI-LANCE (lancing device) 2 DD ULTI-LANCE KIT (lancing device/lancets) 2 DD ULTILET BASIC LANCETS 30 GAUGE (lancets) 2 DD ULTILET CLASSIC LANCETS , 28 GAUGE, 30 GAUGE, 2 DD 33 GAUGE (lancets) ULTILET LANCETS 28 GAUGE, 30 GAUGE, 33 GAUGE 2 DD (lancets) ULTILET SAFETY LANCETS 23 GAUGE (lancets) 2 DD ULTRA FINE LANCETS 30 GAUGE (lancets) 1 OTC ULTRA THIN II LANCETS 30 GAUGE (lancets) 2 DD Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 191 Coverage Prescription Drug Name Drug Tier Requirements and Limits ULTRA THIN LANCETS 28 GAUGE, 33 GAUGE (lancets) 2 DD ULTRA THIN PLUS LANCETS 33 GAUGE (lancets) 2 DD ULTRA TLC LANCETS (lancets) 2 DD ULTRA-CARE LANCETS 30 GAUGE (lancets) 2 DD ULTRALANCE LANCETS 26 GAUGE, 28 GAUGE 2 DD (lancets) ULTRA-THIN II LANCETS 26 GAUGE, 28 GAUGE 2 DD (lancets) UNILET COMFORTOUCH LANCET , 26 GAUGE (lancets) 2 DD UNILET EXCELITE II LANCET (lancets) 2 DD UNILET EXCELITE LANCET (lancets) 2 DD UNILET GP LANCET (lancets) 2 DD UNILET LANCET 28 GAUGE (lancets) 2 DD UNILET SUPER THIN LANCETS 30 GAUGE (lancets) 2 DD UNISTIK 2 DEVICE KIT (lancing device/lancets) 2 DD UNISTIK 2 EXTRA KIT (lancing device/lancets) 2 DD UNISTIK 3 COMFORT DEVICE KIT (lancing 2 DD device/lancets) UNISTIK 3 COMFORT LANCET (lancets) 2 DD UNISTIK 3 EXTRA LANCET 21 GAUGE (lancets) 2 DD UNISTIK 3 GENTLE 30 GAUGE (lancets) 2 DD UNISTIK 3 KIT (lancing device/lancets) 2 DD UNISTIK 3 LANCETS 21 GAUGE (lancets) 2 DD UNISTIK 3 NEONATAL DEVICE KIT (lancing 2 DD device/lancets) UNISTIK 3 NORMAL LANCET 23 GAUGE (lancets) 2 DD UNISTIK CZT LANCET 23 GAUGE, 28 GAUGE (lancets) 2 DD UNISTIK PRO LANCET 21 GAUGE, 25 GAUGE, 28 2 DD GAUGE (lancets) UNISTIK SAFETY 28 GAUGE, 30 GAUGE (lancets) 2 DD UNISTIK TOUCH LANCETS 21 GAUGE, 23 GAUGE, 28 2 DD GAUGE, 30 GAUGE (lancets) UNIVERSAL 1 LANCETS 21 GAUGE, 26 GAUGE, 30 2 DD GAUGE, 33 GAUGE (lancets) Age = Age Edit | PA = Prior Authorization Required | PA NSO = PA Required New Starts Only | QL = Quantity Limit | ST = Step Therapy | SP = Specialty | IHSS = IHSS Only | OTC MediCal = Over The Counter, MediCal Only | OTC = Over The Counter | DD = Diabetes Drug or Device | CT = Contraceptives | OCH = Orally Administered Anti-Cancer Drug 192 Coverage Prescription Drug Name Drug Tier Requirements and Limits VIVAGUARD LANCET 30 GAUGE (lancets) 1 OTC VIVAGUARD LANCING DEVICE (lancing device) 2 DD VORTEX ADULT MASK DEVICE (inhaler, assist devices, 2 OTC Medical accessories) VORTEX FROG MASK-CHILD DEVICE (inhaler, assist 2 devices, accessories) VORTEX HOLDING CHAMBER SPACER (inhaler, assist 2 devices) VORTEX LADYBUG MASK-TODDLER DEVICE (inhaler, 2 assist devices, accessories) VORTEX VHC LADYBUG MASK-TODDLR SPACER 2 (inhaler,assist device with small mask) Metabolic Modifiers - Drugs That Alter Metabolism Hyperparathyroid Treatment Agents - Vitamin D Analog-Type - Drugs That Alter Metabolism calcitriol oral capsule 0.25 mcg, 0.5 mcg 1 calcitriol oral solution 1 mcg/ml 1 AGE (Max 11 Years) doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg 1 PA Metabolic Modifier - Carnitine Replenisher Agents - Drugs That Alter Metabolism levocarnitine (with sugar) oral solution 100 mg/ml 1 QL (1000 per 1 day) levocarnitine oral tablet 330 mg 1 QL (290 per 1 day) Mouth-Throat-Dental - Preparations - Drugs For The Mouth And Throat Dental Product - Fluoride Preparations - Drugs For The Mouth And Throat fluoride (sodium) oral drops 0.5 mg (1.1 mg 1 sod.fluorid)/ml Mouth And Throat - Antifungals - Drugs For The Mouth And Throat clotrimazole mucous membrane troche 10 mg 1 nystatin oral suspension 100,000 unit/ml 1 QL (500 per 1 day) Mouth And Throat - Anti-Infective-Local Anesthetic Combinations - Drugs For The Mouth And Throat ORASEP MUCOUS MEMBRANE SPRAY,NON-AEROSOL 2-0.5-0.1 % (benzocaine/menthol/cetylpyridinium 2 QL (500 per 1 day) chloride)

1 ACCU-CHEK SAFE-T-PRO acne medication ...... 99 ...... 169, 182 12 hour decongestant ..... 223 ACNE MEDICATION ...... 99 ACCU-CHEK SAFE-T-PRO 12 hour nasal decongest PLUS ...... 169, 182 acne treatment (benzoyl (pse) ...... 223 perox) ...... 100 ACCU-CHEK SOFT DEV 1-day ...... 224 LANCETS ...... 169, 182 acne vanishing ...... 100

1ST TIER UNILET ACCU-CHEK SOFTCLIX acne-clear ...... 100 COMFORTOUCH 169, 181 LANCETS ...... 169, 182 ACTHIB (PF) ...... 57 2 acebutolol ...... 66 ACTI-LANCE LANCETS 170, 24 hour allergy relief ...... 220 acephen ...... 26 182

2-IN-1 LANCET DEVICE 169, acetaminophen ...... 26 acyclovir ...... 40 181 acetaminophen-codeine .... 24 ADACEL(TDAP 3 ADOLESN/ADULT)(PF) 55, Acetasol Hc ...... 204 56 3 day vaginal ...... 224 acetazolamide ...... 69 adapalene ...... 100 3-day vaginal ...... 224 acetic acid ...... 161, 203 addaprin ...... 30 8 acetic acid-aluminum acetate added strength pain reliever 8 hour pain reliever ...... 26 ...... 203 ...... 31

A acetylcysteine ...... 34, 219 ADJUSTABLE LANCING DEVICE ...... 170, 182 a and d (lan, pet) ...... 105 acid control (ranitidine) .... 150 ADLYXIN ...... 137 abiraterone ...... 43, 45 acid controller ...... 150 ABREVA ...... 105 ADMELOG SOLOSTAR U- acid gone antacid ...... 144 100 INSULIN...... 142 acarbose ...... 136 acid gone antacid e.strength ADMELOG U-100 INSULIN ACCU-CHEK FASTCLIX ...... 144 LISPRO ...... 142 LANCET DRUM ... 169, 181 acid reducer (famotidine) . 150 ADRENALIN ...... 221 ACCU-CHEK FASTCLIX acid reducer (ranitidine) ... 150 LANCING DEV .... 169, 182 adriamycin ...... 50 acid-pep ...... 150 ACCU-CHEK MULTICLIX Adriamycin ...... 50 LANCET ...... 169, 182 acne control cleanser ...... 99 Adrucil ...... 45

acne foaming wash ...... 99 adult aspirin regimen . 32, 167

227 adult nasal decongestant 223 AEROCHAMBER WITH alendronate ...... 138 FLOWSIGNAL ..... 179, 182 ADVAIR HFA ...... 217 aler-cap ...... 206, 208 AEROCHAMBER Z-STAT advanced exfoliating cleanser PLUS-FLW SG .... 179, 182 alfuzosin ...... 161 ...... 100 AEROSPAN ...... 214 ALIQOPA ...... 48 ADVANCED EYE RELIEF ...... 195 AEROTRACH PLUS 180, 182 alka-seltzer plus allergy .... 81, 206, 208 ADVANCED LANCING Afeditab Cr ...... 67 DEVICE ...... 170, 182 ALKERAN ...... 44 Afirmelle ...... 87 ADVANCED TRAVEL all day allergy (cetirizine) 211, LANCETS ...... 170, 182 AFLURIA QD 2020-21(3YR 212 UP)(PF) ...... 59 ADVIL ...... 30 ALLEGRA ALLERGY ..... 211, AFLURIA QD 2020-21(6- 213 ADVIL JUNIOR STRENGTH 35MO)(PF) ...... 59 ...... 30 aller-chlor ...... 206, 208 AFLURIA QUAD 2020- ADVOCATE LANCET .... 170, 2021(6MO UP) ...... 59 allerclear d-12hr ...... 205 182 aftera ...... 98 aller-cort ...... 220 ADVOCATE LANCING aller-ease ...... 211, 213 DEVICE ...... 170, 182 AIRZONE PEAK FLOW METER ...... 178, 182 aller-flo ...... 220 advocate pain relief ...... 110 AKTEN (PF) ...... 201 allergy (chlorpheniramine) AEROCHAMBER MINI .. 179, ...... 206, 208 182 Ala-Cort ...... 105 alavert ...... 211, 213 allergy (diphenhydramine) AEROCHAMBER MV ..... 179, ...... 206, 208 182 alavert d-12 allergy-sinus 205 allergy eye (naphazoline- AEROCHAMBER PLUS alaway ...... 198 phen) ...... 198 FLOW-VU ...... 179, 182 albendazole ...... 35 allergy medication ... 206, 209 AEROCHAMBER PLUS FLOW-VU,S MSK ...... 179 albuterol sulfate ...... 216, 217 allergy medicine ...... 206, 209

AEROCHAMBER PLUS Z Alcaine ...... 201 allergy relief (cetirizine) .. 211, STAT LG MSK ..... 179, 182 212 alcalak ...... 145 AEROCHAMBER PLUS Z allergy relief (fluticasone) 220 alclometasone ...... 105 STAT MD MSK .... 179, 182 allergy relief d12 ...... 205 ALCOHOL PREP PADS.... 52 AEROCHAMBER PLUS Z allergy relief(diphenhydramin) STAT SM MSK .... 179, 182 ALECENSA ...... 44 ...... 206, 209

228 allergy relief-d (cetirizine) 205 Amethyst (28) ...... 88 amphotericin b ...... 35 allergy relief-d(fexofenadine) amiloride ...... 69 ampicillin ...... 34 ...... 205 AMINOSYN 10 % ...... 125 anagrelide ...... 167 aller-tec ...... 211, 212 AMINOSYN 7 % WITH anastrozole ...... 46 aller-tec d ...... 206 ELECTROLYTES ...... 124 anbesol (benzocaine) ...... 194 ALLI ...... 112 AMINOSYN 8.5 % ...... 125 androxy ...... 136 allopurinol ...... 164 AMINOSYN 8.5 %- ELECTROLYTES ...... 124 ANORO ELLIPTA ...... 217 almacone ...... 146 AMINOSYN II 10 % ...... 125 antacid (calcium carb-mag almacone-2 ...... 146 hyd) ...... 144 AMINOSYN II 15 % ...... 125 aloe vesta antifungal (micon) antacid anti-gas ...... 146 ...... 102 AMINOSYN II 8.5 % ...... 125 antacid exst (ca carb-mag alogliptin ...... 136 AMINOSYN II 8.5 %- hyd) ...... 144 ELECTROLYTES ...... 124 alogliptin-metformin ...... 138 antacid extra-strength ...... 145 AMINOSYN M 3.5 % 124, 125 alogliptin-pioglitazone ...... 138 antacid ii plus simethicone AMINOSYN-HBC 7% ...... 125 ...... 146 alophen (bisacodyl) ...... 158 AMINOSYN-PF 10 % ...... 125 antacid supreme ...... 144 altamist ...... 220 AMINOSYN-PF 7 % antacid ultra strength ...... 145 Altavera (28)...... 87 (SULFITE-FREE) ...... 125 antacid with simethicone . 146 ALTERNATE SITE LANCET AMINOSYN-RF 5.2 % ..... 125 ...... 170, 183 antacid-antigas ...... 146 amiodarone ...... 64 ALTERNATE SITE LANCING antacid-antigas ii ...... 146 DEVICE ...... 170, 183 amitriptyline ...... 75 antibiotic plus (pramoxine) aluminum hydroxide gel .. 144 amitriptyline-chlordiazepoxide ...... 101 ...... 75, 77 ALUMINUM HYDROXIDE anticoag citrate phos GEL (BULK) ...... 83, 144 amlodipine ...... 67 dextrose ...... 164

ALUNBRIG ...... 44 amlodipine-benazepril ...... 62 anti-dandruff ...... 104

Alyacen 1/35 (28) ...... 87 amlodipine-valsartan ...... 63 anti-dandruff with menthol 105

Alyacen 7/7/7 (28) ...... 95 amoxapine ...... 75 anti-diarrheal ...... 147

Amethia ...... 86 amoxicillin ...... 34 anti-diarrheal (loperamide) ...... 147 Amethia Lo ...... 86 amoxicillin-pot clavulanate 34

229 anti-fungal ...... 102 ARCAPTA NEOHALER ... 216 aspir-low ...... 32, 167 antifungal (clotrimazole) .. 102 armodafinil ...... 80 aspir-trin ...... 32, 167 antifungal (terbinafine) .... 102 ARMONAIR RESPICLICK ASSURE HAEMOLANCE ...... 214 PLUS ...... 170, 183 antifungal cream (miconazole) ...... 102 ARNUITY ELLIPTA ...... 214 ASSURE LANCE..... 170, 183 antifungal ringworm ...... 102 ARRANON ...... 45 ASSURE LANCE PLUS . 170, 183 anti-gas maximum strength arthritis pain relief(capsaic) ...... 152 ...... 111 ASTHMA CHECK METER ...... 178, 183 anti-gas ultra strength ..... 152 ARTIFICIAL TEARS (CMC) ...... 196 atenolol ...... 66 antihistamine ...... 206, 209 artificial tears (petro/min) . 195 atenolol-chlorthalidone ...... 67 anti-itch (hc) ...... 105 artificial tears (pf) ...... 195 athenol ...... 26 anti-itch (hc) with aloe-vit e ...... 108 artificial tears (polyvin alc) 196 athlete's foot ...... 102 anti-itch plus ...... 108 artificial tears(dext70-hypro) athlete's foot (clotrimazole) ...... 195, 200 ...... 102 antiseptic mouth cleanser 194 artificial tears(glycerin-peg) athletic foot cream ...... 102 antitussive dm ...... 222 ...... 195 atomoxetine ...... 77 anucort-hc ...... 33 artificial tears(pg-hypm-glyc) atorvastatin ...... 65 ANZEMET ...... 149 ...... 195 atovaquone ...... 36 aprepitant ...... 149, 150 artificial tears(pvalch-povid) ...... 195 atropine ...... 198 Apri ...... 88 ARZERRA ...... 46 ATROVENT HFA ...... 216 APRISO ...... 153 Ashlyna ...... 86 Aubra ...... 88 aprodine ...... 204 ASMANEX HFA ...... 214 AUGMENTIN ...... 35 AQUA LANCE LANCING DEVICE ...... 170, 183 ASMANEX TWISTHALER auro eardrops ...... 204 ...... 214 AQUADEKS PEDIATRIC 129 Aurovela 1.5/30 (21) ...... 88 aspirin...... 32, 167 aquanil hc ...... 105 Aurovela 1/20 (21) ...... 88 aspirin low dose ...... 32 aquaphor itch relief ...... 106 Aurovela 24 Fe ...... 88 aspirin,buffd-calcium carb- Aranelle (28)...... 96 mag...... 33 Aurovela Fe 1.5/30 (28) ..... 88

230 Aurovela Fe 1-20 (28) ...... 88 bacitracin ...... 101, 202 BD REGULAR BEVEL NEEDLES ...... 178, 183 AUTO-LANCET MINI ..... 170, bacitracin zinc ...... 101 183 BD SAFETYGLIDE NEEDLE bacitracin-polymyxin b ..... 201 ...... 178, 183 AUTOLET IMPRESSION LANC DEV ...... 170, 183 bacitraycin plus ...... 101 BD ULTRA FINE LANCETS ...... 170, 183 AUTOLET LANCING baclofen ...... 168, 169 DEVICE ...... 170, 183 balsalazide ...... 153 BD ULTRA-FINE II LANCETS ...... 170, 183 AUTOLET PLUS LANCING Balziva (28) ...... 88 DEVICE ...... 170, 183 BD ULTRA-FINE NANO PEN banophen ...... 206, 209 NEEDLE ...... 177, 183 AVASTIN ...... 42 banophen allergy ..... 206, 209 BD VEO INSULIN SYR AVC VAGINAL ...... 224 (HALF UNIT) ...... 177, 184 BAQSIMI ...... 135 Aviane ...... 88 BD VEO INSULIN SYRINGE BASAGLAR KWIKPEN U- UF ...... 177, 184 avita ...... 100 100 INSULIN ...... 141 Bekyree (28) ...... 86 ayr saline ...... 220 bayer advanced ...... 32, 167 BENADRYL ALLERGY .. 206, Ayuna ...... 88 BAYER CHEWABLE 209 azathioprine...... 29, 168 ASPIRIN ...... 32, 167 benazepril ...... 62 azelastine ...... 198, 219 bayer plus extra strength ... 33 benazepril- baza antifungal ...... 103 azithromycin ...... 40 hydrochlorothiazide ...... 62 BCG VACCINE, LIVE (PF) azolen tincture ...... 103 BENGAY COLD THERAPY ...... 55, 58 ...... 111 AZULFIDINE ...... 29, 153 b-complex with vitamin c . 113 BENGAY VANISHING Azurette (28) ...... 86 BD LUER-LOK SYRINGE SCENT ...... 111 B ...... 178, 183 benzonatate ...... 214 b complex-vitamin c-folic acid BD MICROTAINER LANCET benzoyl peroxide ...... 100 ...... 113 ...... 170, 183 beta-hc ...... 106 b-12 dots ...... 131 bd posiflush normal saline 0.9...... 130 betamethasone dipropionate baby ddrops ...... 132 ...... 106 BD PRECISIONGLIDE NON- baby iron-multivitamin ..... 129 STERILE ...... 178, 183 betamethasone valerate .. 106 baby vitamin d3 ...... 132 bd pre-filled normal saline 130 betamethasone, augmented baby's super daily d3 ...... 132 ...... 106

231 betasept surgical scrub ..... 52 bisoprolol fumarate ...... 66 brompheniramine- pseudoeph-dm ...... 221 betatemp ...... 26 bisoprolol- hydrochlorothiazide...... 67 brotapp dm ...... 221 bethanechol chloride ...... 164 bleomycin ...... 51 budesonide ...... 215, 220 BEVESPI AEROSPHERE217 Bleph-10 ...... 202 budesonide-formoterol .... 218 BEXSERO ...... 58 Blephamide S.O.P...... 197 bufferin ...... 33 bicalutamide ...... 45 Blisovi 24 Fe ...... 88 BULLSEYE MINI SAFETY BICARSIM ...... 152 LANCETS ...... 170, 184 Blisovi Fe 1.5/30 (28) ...... 88 bicarsim forte ...... 152 bumetanide ...... 69 Blisovi Fe 1/20 (28) ...... 88 BICILLIN C-R ...... 42 bupropion hcl ...... 75, 82 blis-to-sol (tolnaftate) ...... 103 BICILLIN L-A ...... 41 bupropion hcl (smoking BOOSTRIX TDAP ...... 56 BICNU ...... 44 deter) ...... 82 boro-packs ...... 105 BIDIL ...... 70 buspirone ...... 71 BOSULIF ...... 49 bio-d-mulsion ...... 132 busulfan ...... 43 boudreauxs butt paste ..... 109 bio-d-mulsion forte ...... 132 BUSULFEX ...... 43 BOUDREAUXS BUTT butalbital-acetaminophen .. 28 bio-dtuss dmx ...... 221 PASTE ...... 109 BIOTHRAX ...... 58 butalbital-acetaminophen-caff bp wash ...... 100 ...... 28 bisac-evac ...... 158 BP WASH ...... 100 BUTTERFLY TOUCH bisacodyl ...... 158 bpo ...... 100 LANCET ...... 170, 184 biscolax ...... 158 BREATHERITE VALVED BYDUREON ...... 137 bismatrol ...... 147 MDI CHAMBER ... 180, 184 BYDUREON BCISE ...... 137 bismuth maximum strength BREO ELLIPTA ...... 218 BYETTA ...... 137 ...... 148 Briellyn ...... 88 C BISMUTH SUBCARBONATE BRILINTA ...... 167 (BULK) ...... 83 cabergoline ...... 143 brimonidine ...... 203 BISMUTH SUBNITRATE CABOMETYX ...... 48 (BULK) ...... 83 bromfenac ...... 199 CALAMINE (BULK) ...... 83

BISMUTH SUBSALICYLATE bromi-lotion ...... 104 calamine-zinc oxide ...... 109 (BULK) ...... 83, 148 calci-chew ...... 115

232 calcidol ...... 133 calcium lactate ...... 116 CAREONE ULTRA THIN LANCET ...... 171, 184 calci-mix ...... 116 calcium+d ...... 117 CARESENS LANCETS .. 171, calcipotriene ...... 104 cal-gest antacid ...... 145 184 calcitonin (salmon) ...... 138 CALQUENCE ...... 46, 49 CARESENS PREM calcitriol ...... 133, 193 CALTRATE 600 PLUS D . 117 LANCING DEVICE ..... 171, 184 calcium 500 + d ...... 116 CALTRATE WITH VITAMIN D3 ...... 117 CARETOUCH LANCING calcium 500 + d (d3)...... 116 DEVICE ...... 171, 184 Camila ...... 95 calcium 600 ...... 116 CARETOUCH SAFETY camrese ...... 86 LANCETS ...... 171, 184 calcium 600 + d(3)... 116, 117 camrese lo ...... 86 CARETOUCH TWIST calcium 600 with vitamin d3 LANCET ...... 171, 184 ...... 117 cank-oxide ...... 194 CAROSPIR ...... 63, 69 CALCIUM 600 WITH capecitabine ...... 45 VITAMIN D3 ...... 117 Cartia Xt ...... 66 CAPRELSA ...... 49 CALCIUM ACETATE ...... 116 carvedilol ...... 63 capsaicin ...... 111 calcium acetate(phosphat castor oil ...... 158 bind) ...... 116, 161 CAPSAICIN (BULK) ...... 83 CASTOR OIL ...... 84 calcium antacid ...... 145 capsicum ...... 111 CATHFLO ACTIVASE ..... 168 calcium carbonate ... 116, 145 captopril ...... 62 Caziant (28) ...... 96 calcium carbonate-vit d3-min carbamazepine ...... 72, 78 cefaclor ...... 38 ...... 116 CARBAMIDE PEROXIDE calcium carbonate-vitamin d3 (BULK) ...... 52, 83 cefadroxil ...... 38 ...... 117 carbidopa-levodopa ...... 76 cefdinir ...... 38

CALCIUM CARBONATE- carbidopa-levodopa- cefixime ...... 38 VITAMIN D3 ...... 117 entacapone ...... 76 cefpodoxime ...... 38 calcium citrate ...... 116 carboplatin ...... 48 cefprozil ...... 38 CALCIUM CITRATE ...... 116 CARELANCE ULT LANCING cefuroxime axetil ...... 38 calcium citrate-vitamin d2 117 DEVICE ...... 170, 184 celecoxib ...... 30 calcium citrate-vitamin d3 117 CAREONE LANCING DEVICE ...... 171, 184 CELONTIN ...... 73 calcium gluconate ...... 116

233 cephalexin ...... 38 CHILDREN'S ADVIL ...... 30 children's q-pap ...... 27

CERALYTE 90 ...... 121 children's allegra allergy . 211, children's soothe ...... 145 213 ceralyte-70 ...... 121 CHILDREN'S SUDAFED . 223 children's allergy (diphenhyd) CERALYTE-70 ...... 121 ...... 207, 209 children's tactinal ...... 27 certain dri ...... 104 children's allergy complete children's tylenol ...... 27 cetiri-d ...... 206 ...... 211, 212 children's wal-fex ..... 212, 213 cetirizine ...... 211, 212 children's allergy relief(fex) children's wal-zyr ..... 212, 213 ...... 211, 213 cevimeline ...... 194 CHILDREN'S ZYRTEC children's allergy relief(lor) ALLERGY ...... 212, 213 CHANTIX ...... 83 ...... 211, 213 child's all day allergy(cetir) CHANTIX CONTINUING children's allergy(cetirizine) ...... 212, 213 MONTH BOX ...... 83 ...... 211, 212 chloramphenicol sod CHANTIX STARTING children's aller-tec ... 211, 213 succinate ...... 38 MONTH BOX ...... 83 children's antacid ...... 145 chlordiazepoxide hcl .... 70, 77 Charlotte 24 Fe ...... 89 children's aurodryl allergy chlorhexidine gluconate .... 52, Chateal (28) ...... 89 ...... 207, 209 194

CHEMET ...... 34 children's cetirizine .. 211, 213 chlorhist ...... 206, 209 cheratussin ac ...... 223 children's chest congestion chloroquine phosphate ...... 36 ...... 218 chest congestion relief .... 218 chlorthalidone ...... 69 children's dibromm cold- chest congestion relief dm allerg ...... 204 chocolate laxative ...... 158 ...... 222 children's ibu-drops ...... 30 CHOLECALCIFEROL (VIT child allergy relf(cetirizine) D3)(BULK) ...... 83, 133 ...... 211, 212 children's ibuprofen ...... 30 cholecalciferol (vitamin d3) child aspirin ...... 32, 167 children's mapap ...... 26 ...... 133 child dometuss-da ...... 204 children's pain relief ...... 26 CHOLECALCIFEROL child ibuprofen ...... 30 children's pain reliever ...... 26 (VITAMIN D3) ...... 133 child mucinex chest children's pain-fever relief . 26 cholestyramine (with sugar) congestion ...... 218 ...... 65 children's pepto ...... 145 childrens 24 hr allergy relief Cholestyramine Light ...... 65 children's profen ib ...... 31 ...... 220 ciclopirox ...... 102

234 cilostazol ...... 167 clemastine ...... 207, 209 CLINIMIX 8%- D14W(SULFITE-FREE) CILOXAN ...... 202 CLEOCIN ...... 224 ...... 124 cimetidine ...... 151 CLEVER CHEK LANCETS CLINIMIX E 2.75%/D10W ...... 171, 184 cimetidine hcl ...... 151 SUL FREE ...... 125, 127 CLEVER CHOICE PEAK cinacalcet ...... 138 CLINIMIX E 2.75%/D5W FLOW METER ..... 178, 184 SULF FREE ...... 125, 127 CIPRO ...... 38 clindamycin hcl ...... 40 CLINIMIX E 4.25%/D10W CIPRO HC...... 203 Clindamycin Pediatric ...... 40 SUL FREE ...... 126, 127 ciprofloxacin ...... 39 clindamycin phosphate ..... 99, CLINIMIX E 4.25%/D25W SUL FREE ...... 126, 128 ciprofloxacin hcl . 38, 202, 203 224 CLINIMIX E 4.25%/D5W ciprofloxacin-dexamethasone CLINIMIX 5%/D15W SULF FREE ...... 126, 128 ...... 203 SULFITE FREE ...... 123 CLINIMIX E 5%/D15W cisplatin ...... 48 CLINIMIX 5%/D25W SULFITE-FREE ...... 123 SULFIT FREE ...... 126, 128 citalopram...... 74 CLINIMIX 2.75%/D5W CLINIMIX E 5%/D20W CITRACAL-D3 SLOW SULFIT FREE ...... 123 SULFIT FREE ...... 126, 128 RELEASE ...... 117 CLINIMIX 4.25%/D10W CLINIMIX E 5%/D25W citrate of magnesia ...... 156 SULF FREE ...... 124 SULFIT FREE ...... 126, 128 citroma ...... 156 CLINIMIX 4.25%/D5W CLINIMIX E 8%-D10W SULFIT FREE ...... 124 SULFITEFREE ...... 128 citrus calcium-vitamin d3 . 118 CLINIMIX 4.25%-D20W CLINIMIX E 8%-D14W cladribine ...... 45 SULF-FREE ...... 124 SULFITEFREE ...... 128 clarispray ...... 220 CLINIMIX 4.25%-D25W CLINISOL SF 15 % ...... 126 clarithromycin ...... 41 SULF-FREE ...... 124 clobetasol ...... 106

CLARITIN REDITABS .... 212, CLINIMIX 5%- clobetasol-emollient ...... 106 213 D20W(SULFITE-FREE) ...... 124 clonazepam ...... 70, 71, 78 clean-clear continuous control ...... 100 CLINIMIX 6%-D5W clonidine ...... 68 (SULFITE-FREE) ...... 124 clearasil daily clear(benzoyl) clonidine hcl ...... 68 ...... 100 CLINIMIX 8%- D10W(SULFITE-FREE) clopidogrel ...... 167 clearasil ultra ...... 100 ...... 124 clotrimazole ..... 103, 193, 224 clearlax ...... 156

235 clotrimazole af ...... 103 COMFORT EZ LANCETS CORTISPORIN-TC ...... 203 ...... 171, 184 clotrimazole-7 ...... 225 cortizone-10 ...... 106 comfort gel ...... 146 clotrimazole-betamethasone cough control dm ...... 222 ...... 104 comfort gel extra strength 146 COUGH FORMULA DM .. 222 COAGUCHEK LANCETS COMFORT LANCETS.... 171, ...... 171, 184 184 cough syrup dm ...... 222 codeine-guaifenesin ...... 223 COMFORT TOUCH PLUS cough-sore throat night ... 221 SAFETY LANC .... 171, 184 coditussin ac ...... 223 COUMADIN ...... 164 COMFORT TOUCH ULT creamy acne face ...... 100 COLACE ...... 160 THIN LANCETS ... 171, 184 CREON ...... 150 COLACE 2-IN-1 ...... 159 complete lice treatment ... 111 COLACE CLEAR ...... 160 critic-aid clear af(miconazol) compoz ...... 81, 207, 209 ...... 103 colchicine ...... 164 Compro ...... 149 cromolyn .... 47, 201, 215, 220 cold and allergy (bromphen- CONCEPTROL ...... 99 pe) ...... 204 Crotan ...... 112 CONDOMS-PREM Cryselle (28) ...... 89 cold and allergy(triprolidine) LUBRICATED ...... 178, 185 ...... 204 CUPRIMINE ...... 29, 34 congest-eze ...... 218 cold multi-symptom nighttime cyanocobalamin (vitamin b- ...... 221 Constulose ...... 156 12) ...... 131 cold-allergy-sinus ...... 204 cool and heat ...... 111 CYANOCOBALAMIN cold-flu relief ...... 221 cool heat (m-salicylate- (VITAMIN B-12) ...... 131 menth) ...... 110 colestipol ...... 65 Cyclafem 1/35 (28) ...... 89 cool 'n heat extra strength 110 collyrium ...... 200 Cyclafem 7/7/7 (28) ...... 96 coral calcium ...... 116 Colocort ...... 153 cyclobenzaprine ...... 169 Cormax ...... 106 COLOR LANCETS .. 171, 184 cyclopentolate ...... 198 cortaid ...... 106 colox ...... 154 cyclophosphamide ...... 29, 44 cortisone ...... 139 col-rite ...... 160 CYCLOPHOSPHAMIDE .. 29, cortisone (hydrocortisone) 44 COMBIVENT RESPIMAT 217 ...... 106 cycloserine ...... 37 COMETRIQ ...... 48 cortisone with aloe ...... 108 cyclosporine modified 29, 168

236 cyproheptadine ...... 208, 209 Dasetta 1/35 (28) ...... 89 desmopressin ...... 136

Cyred ...... 89 Dasetta 7/7/7 (28) ...... 96 desog-e.estradiol/e.estradiol ...... 87 cytra k crystals ...... 162 daunorubicin ...... 50, 51 desogestrel-ethinyl estradiol cytra-k ...... 162 dayhist allergy ...... 207, 209 ...... 89

D daylogic acne treatment .. 100 desonide ...... 106 d10 %-0.45 % sodium Daysee ...... 86 desoximetasone ...... 106 chloride ...... 114 day-time cough ...... 214 despec-dm (phenyleph-dm- d2.5 %-0.45 % sodium guaif) ...... 222 chloride ...... 114 ddrops ...... 133 desvenlafaxine succinate .. 74 d3 dots ...... 133 Deblitane ...... 95 dexamethasone ...... 139 d5 % and 0.9 % sodium debrox ...... 204 chloride ...... 114 decara ...... 133 DEXAMETHASONE INTENSOL ...... 139 d5 %-0.45 % sodium chloride DECARA ...... 134 ...... 114 dexamethasone sodium phos deep sea nasal ...... 220 (pf) ...... 139 dacarbazine...... 44 delta d3 ...... 134 dexamethasone sodium daily fiber ...... 154 phosphate ...... 139, 199 Deltasone ...... 139 daily fiber (psyllium-aspart) dexmethylphenidate ...... 76 ...... 154 DELTUSS DMX (DEXCHLORPHEN) .... 221 dextroamphetamine .... 77, 79, daily fiber (psyllium-sucrose) 80 ...... 154 Delyla (28) ...... 89 dextroamphetamine- DEPEN TITRATABS ... 29, 34 dailyhist-1 ...... 207, 209 amphetamine ..... 77, 79, 81 DEPO-SUBQ PROVERA 104 DALIRESP ...... 216 dextromethorphan polistirex ...... 86 dallergy (chlorpheniramine- ...... 214 dermafungal ...... 103 pe) ...... 204 dextromethorphan- dandruff shampoo DERMA-SMOOTHE/FS guaifenesin ...... 222 BODY OIL ...... 106 (pyrithione) ...... 104 dextrose 10 % and 0.2 % dantrolene ...... 169 DESCOVY ...... 37 nacl ...... 114 dapsone ...... 36 desenex ...... 103 dextrose 10 % in water (d10w) ...... 114 DAPTACEL (DTAP desipramine ...... 75 PEDIATRIC) (PF) ...... 56 dextrose 20 % in water DESITIN RAPID RELIEF . 109 (d20w) ...... 114, 115

237 dextrose 25 % in water diclofenac potassium ...... 30 divalproex ...... 71, 78, 79, 80 (d25w) ...... 114, 115 diclofenac sodium .... 30, 109, docosanol ...... 105 dextrose 30 % in water 199 (d30w) ...... 114, 115 doc-q-lace ...... 160 dicloxacillin ...... 42 dextrose 40 % in water doc-q-lax ...... 159 dicyclomine ...... 153 (d40w) ...... 114, 115 docu ...... 160 didanosine ...... 37 dextrose 5 % in water (d5w) docusate sodium ...... 160 ...... 114 Digitek ...... 68 DOCUSATE SODIUM dextrose 5 %-lactated ringers Digox ...... 68 (BULK) ...... 83, 160 ...... 114 digoxin ...... 68 docusol ...... 160 dextrose 5%-0.2 % sod chloride ...... 114 DIGOXIN ...... 68 dok ...... 160 dextrose 5%-0.3 % Dilantin Extended ...... 72 Dolishale ...... 89 sod.chloride ...... 114 Dilantin Infatabs ...... 72 DOMEBORO ...... 105 dextrose 50 % in water DILANTIN-125 ...... 72 donepezil ...... 85 (d50w) ...... 115 DILATRATE-SR ...... 63 dorzolamide ...... 199 dextrose 70 % in water (d70w) ...... 115 diltiazem hcl ...... 64, 66 dorzolamide-timolol ...... 199 diabetic tussin ex ...... 219 diltiazem in dextrose 5 % .. 67 double antibiotic ...... 101 dialyvite ...... 113 dilt-xr ...... 67 double antibiotic (b.tracn zn) ...... 101 DIALYVITE 800 WITH ZINC dimaphen dm ...... 221 15 ...... 113 doxazosin ...... 70 diotame instydose ...... 148 DIALYVITE 800 WITH ZINC doxepin ...... 75 50 ...... 113 diphedryl ...... 207 doxercalciferol ...... 193 dialyvite vitamin d ...... 134 diphenhist ...... 207, 209 doxorubicin ...... 51 DIALYVITE VITAMIN D3 diphenhydramine hcl 81, 207, MAX ...... 134 209, 210 doxycycline hyclate ... 42, 195 diamode ...... 147 diphenoxylate-atropine .... 148 doxycycline monohydrate .. 42 diaper rash ...... 109 dipyridamole ...... 167 d-penamine ...... 29, 34 diazepam ...... 70, 71, 78 disopyramide phosphate ... 64 dr. smith's diaper ...... 109

Diazepam Intensol ...... 70, 78 disposable enema ...... 157 dramamine less drowsy ... 148 DIURIL ...... 69 dronabinol ...... 79, 112, 149

238 DROPLET GENTEEL EASIVENT HOLDING effervescent pain relief ...... 32 LANCING DEVICE ..... 171, CHAMBER ...... 180, 185 185 electrolyte-48 in d5w ...... 118 EASIVENT MASK LARGE DROPLET LANCETS ..... 171, ...... 180, 185 Elinest ...... 89 185 EASIVENT MASK MEDIUM Eliphos ...... 161 DROPLET LANCING ...... 180, 185 ELIQUIS ...... 164 DEVICE ...... 171, 185 EASIVENT MASK SMALL ELIQUIS DVT-PE TREAT drospirenone-ethinyl estradiol ...... 180, 185 30D START ...... 164 ...... 89 EASY CLICK LANCING Elixophyllin ...... 215 DRYSOL DAB-O-MATIC . 104 DEVICE ...... 171, 185 ELLA ...... 98 dulcoease ...... 160 EASY COMFORT LANCETS ...... 171, 185 ELMIRON ...... 161 dulcolax (magnesium hydroxide) ...... 156 EASY MINI EJECT Eluryng ...... 98 LANCING DEVICE ..... 171, EMBRACE LANCING dulcolax stool softener (dss) 185 ...... 160 DEVICE ...... 171, 185 EASY TOUCH LANCING EMCYT ...... 47 duloxetine ...... 74, 79 DEVICE ...... 171, 185 Emoquette ...... 89 DUREX AVANTI BARE EASY TOUCH SAFETY REAL FEEL ...... 178, 185 LANCETS ...... 171, 185 enalapril maleate ...... 62 dutasteride ...... 162 EASY TOUCH TWIST enalapril-hydrochlorothiazide d-vi-sol ...... 134 LANCETS ...... 171, 185 ...... 62 d-vita ...... 134 EASY TWIST AND CAP Endocet ...... 25, 26 LANCETS ...... 171, 185 dyna-hex ...... 52 endur-acin ...... 132 econazole ...... 103 E enema ...... 157 econtra ez ...... 98 e.c. prin ...... 32, 167 enema disposable ...... 157 ecotrin ...... 32, 167 E.E.S. 400 ...... 41 enemeez ...... 160 ed a-hist ...... 204 ear drops (carbamide ENFAMIL WATER ...... 84 peroxide)...... 204 ED CHLORPED D ...... 204 ENGERIX-B (PF) ...... 53 ear drops otc ...... 204 EDECRIN ...... 69 ENGERIX-B PEDIATRIC ear health formula ...... 114 ed-spaz ...... 152, 163 (PF) ...... 53 ear wax removal system . 204 effer-k ...... 122 enoxaparin ...... 166

239 Enpresse ...... 96 Estarylla ...... 89 eye wash (boric acid) ...... 201

Enskyce ...... 89 estazolam ...... 78, 82 eye wash sterile...... 201 entacapone ...... 76 estradiol ...... 138, 139, 225 E-Z JECT LANCETS 171, 185 entecavir ...... 39 eszopiclone ...... 82 E-Z JECT THIN LANCETS ...... 171, 185 Enulose ...... 150 ethambutol ...... 37 EZ SMART LANCETS .... 172, EPANED ...... 62 ethosuximide ...... 73 185 epinephrine ...... 68, 214 ethynodiol diac-eth estradiol ezetimibe ...... 65 ...... 89 epinephrine hcl (pf) ...... 68 EZ-LETS ...... 172, 185 etodolac ...... 31 EPIPEN 2-PAK ...... 68 F etonogestrel-ethinyl estradiol EPIPEN JR 2-PAK ...... 68 ...... 98 fa-8 ...... 135 epirubicin ...... 51 etoposide ...... 47 fallback solo ...... 98

Epitol ...... 72, 79 EURAX ...... 112 Falmina (28) ...... 89 eq gentle ...... 196 euthyrox ...... 143 famotidine ...... 151

ERBITUX...... 51 EVAC ...... 154 famotidine (pf) ...... 151 ergocalciferol (vitamin d2) 134 evac-u-gen (sennosides) . 158 Fayosim ...... 95

Ergocalciferol (Vitamin D2) EXAPHEN ...... 205 FC2 FEMALE CONDOM 169, ...... 134 185 EXCEDRIN MIGRAINE ..... 32 ergoloid ...... 85 felodipine ...... 67 exemestane ...... 46 erlotinib ...... 43 Femynor ...... 89 ex-lax (sennosides) ...... 158 Errin ...... 95 fenofibrate ...... 65 EX-LAX (SENNOSIDES) . 158 ertapenem ...... 37 fenofibrate micronized ...... 65 EX-LAX MAXIMUM Ery-Tab ...... 41 STRENGTH ...... 158 fenofibrate nanocrystallized ...... 65 Erythrocin (As Stearate) .... 41 expectorant ...... 219 feosol ...... 119 erythromycin ...... 41, 202 expectorant dm ...... 222 FEOSOL ...... 119 erythromycin ethylsuccinate eye allergy relief ...... 198 ...... 41 ferate ...... 119 EYE IRRIGATING erythromycin with ethanol.. 99 SOLUTION ...... 201 fer-iron ...... 119 escitalopram oxalate ...... 74

240 ferocon ...... 120 FINGERSTIX LANCETS 172, FLUCELVAX QUAD 2020- 186 2021 (PF) ...... 59 ferosul ...... 119 first aid antibiotic ...... 101 fluconazole ...... 36 ferrocite ...... 119 FIRVANQ ...... 39 flucytosine ...... 36 ferrous fumarate ...... 119 flanax antacid ...... 146 fludrocortisone ...... 142 ferrous gluconate ...... 119 FLAREX ...... 199 FLULAVAL QUAD 2020- ferrous sulfate ...... 119 2021 (PF) ...... 60 flavor chews antacid ...... 145 FERROUS SULFATE, FLUMIST QUAD 2020-2021 DRIED (BULK) ...... 83, 119 flecainide ...... 64 ...... 55, 60 feverall ...... 27 FLEET BISACODYL...... 158 flunisolide ...... 220

FEVERALL ...... 27 FLEET ENEMA EXTRA .. 157 fluocinolone ...... 106, 107 fexofenadine...... 212, 213 fleet glycerin (child) ...... 156 fluocinonide ...... 107 fexofenadine- FLEET MINERAL OIL ..... 156 Fluocinonide-E ...... 107 pseudoephedrine ...... 206 FLONASE ALLERGY fluorescein-proparacaine . 200 fiber (psyllium husk) ...... 154 RELIEF ...... 220 fluoride (sodium)...... 193 fiber (psyllium husk-sugar) FLONASE SENSIMIST ... 220 ...... 154 fluorometholone...... 199 FLOVENT DISKUS ...... 215 fiber laxative (psyllium husk) fluorouracil ...... 45, 104 ...... 154 FLOVENT HFA ...... 215 fluoxetine ...... 74 fiber smooth ...... 154 floxuridine ...... 45 flurazepam ...... 78, 82 fiber therapy (m-cell/sugar) FLUAD 2020-2021 (65 YR ...... 154 UP)(PF) ...... 59 flurbiprofen sodium ...... 199 fiber therapy (psyllium-sucro) FLUAD QUAD 2020-21(65Y flutamide ...... 45 UP)(PF) ...... 59 ...... 154 fluticasone propionate .... 107, fiber therapy(psyl seed- FLUARIX QUAD 2020-2021 220 (PF) ...... 59 sugar) ...... 154 fluticasone propion- FIFTY50 SAFETY SEAL FLUBLOK QUAD 2020-2021 salmeterol ...... 218 (PF) ...... 59 LANCETS ...... 172, 185 fluvoxamine ...... 74 flucaine ...... 200 finasteride...... 161 FLUZONE HIGHDOSE FINE 30 UNIVERSAL FLUCELVAX QUAD 2020- QUAD 20-21 PF ...... 60 LANCETS ...... 172, 185 2021 ...... 60

241 FLUZONE QUAD 2020-2021 Fyavolv ...... 138 GEMZAR ...... 46 ...... 60 G Generlac ...... 150 FLUZONE QUAD 2020-2021 (PF) ...... 60 gabapentin ...... 72 Gentak ...... 202

FML S.O.P...... 199 GAMIFANT ...... 168 gentamicin ...... 101, 202 foaming acne face wash . 100 GARDASIL (PF) ...... 59 genteal tears mild ...... 195 foaming antacid ...... 144 GARDASIL 9 (PF) ...... 59 GENTEAL TEARS MODERATE ...... 195 folic acid ...... 135 gas relief (simethicone) ... 152 GENTEAL TEARS SEVERE FOLIC ACID ...... 135 gas relief 80 (simethicone) GEL ...... 196 ...... 152 FOLIC ACID (BULK) ...... 135 gentlelax ...... 156 gas relief extra strength ... 152 FORA LANCING DEVICE GERBER GOOD START ...... 172, 186 gas-x extra strength ...... 152 WATER ...... 85

FORACARE LANCETS .. 172, GAS-X EXTRA STRENGTH geri-dryl ...... 207, 210 186 ...... 152 geri-lanta ...... 146 formula 3 ...... 103 gas-x ultra-strength ...... 152 gianvi (28) ...... 90 fosinopril ...... 62 GAVILAX ...... 156 Gildagia ...... 90 fosinopril-hydrochlorothiazide gavilyte-c ...... 157 GILOTRIF ...... 43 ...... 62 Gavilyte-G ...... 157 GLEEVEC ...... 49 FREAMINE HBC 6.9 % ... 126 Gavilyte-H And Bisacodyl 159 glenmax peb ...... 205 FREAMINE III 10 % ...... 126 Gavilyte-N ...... 157 glimepiride ...... 136 FREESTYLE LANCETS . 172, GAVISCON ...... 144 186 glipizide ...... 137 GAVISCON EXTRA FREESTYLE UNISTIK 2 172, STRENGTH ...... 144 GLUCAGEN HYPOKIT ... 135 186 GAZYVA ...... 46 Glucagon Emergency Kit full spectrum b-vitamin c . 113 (Human) ...... 135 gelusil antacid and anti-gas fungi cure ...... 103 ...... 146 GLUCOCOM LANCETS . 172, 186 FUNGOID TINCTURE .... 103 gemcitabine ...... 46 glucose ...... 135 fungoid-d ...... 103 gemfibrozil ...... 65 glyburide ...... 137 furosemide ...... 69 Gemmily ...... 90 glyburide micronized ...... 137

242 glyburide-metformin ...... 136 H heparin lock ...... 165, 166 glycerin ...... 105 Hailey ...... 90 heparin lock flush ...... 166 glycerin (adult) ...... 156 Hailey 24 Fe ...... 90 heparin lock flush (porcine) ...... 165, 166 GLYCERIN (BULK) ...... 84 Hailey Fe 1.5/30 (28) ...... 90 heparin lockflush(porcine)(pf) glycerin (child) ...... 156 Hailey Fe 1/20 (28) ...... 90 ...... 166 glycerin and rose water ... 105 halobetasol propionate .... 107 heparin, porcine (pf) 165, 166 glycolax ...... 156 HAVRIX (PF) ...... 53 HEPATAMINE 8% ...... 126 glycopyrrolate ...... 153 HEALTHY ACCENTS HEPLISAV-B (PF) ...... 53 AUTOLET ...... 172, 186 GOJJI LANCETS .... 172, 186 HERCEPTIN ...... 52 HEALTHY ACCENTS GOJJI LANCING DEVICE UNILET LANCET . 172, 186 HERCEPTIN HYLECTA .... 52 ...... 172, 186 healthylax ...... 156 HEXALEN ...... 43 GOLYTELY ...... 157 heartburn antacid ...... 144 HIBERIX (PF) ...... 57 gonak ...... 196, 200 heartburn prevention ...... 151 HIBICLENS ...... 52 goniosoft ...... 196, 200 heartburn relief ...... 144 hi-cal plus vit d...... 118 goniotaire ...... 196, 200 heartburn relief (famotidine) high potency capsaicin .... 111 goniovisc ...... 196, 200 ...... 151 high potency iron ...... 119 goody's migraine relief ...... 32 heartburn relief (ranitidine) homatropaire ...... 198 granisetron hcl ...... 149 ...... 151 homatropine hbr ...... 198 griseofulvin microsize ...... 36 heartburn treatment 24 hour ...... 151 home lice-bedbug-dust mite griseofulvin ultramicrosize . 36 Heather ...... 95 spr ...... 112 g-tron ...... 222 hemorrhoidal ...... 33 hot and cold pain relief .... 109 guaifenesin ...... 219 hemorrhoidal suppository .. 33 HUMALOG MIX 50-50 guanfacine...... 68, 76 INSULN U-100 ...... 141 hep flush-10 (pf) ...... 165 GVOKE HYPOPEN 1-PACK HUMALOG MIX 75-25(U- ...... 135 HEPAGAM B ...... 54 100)INSULN ...... 141

GVOKE PFS 1-PACK heparin (porcine) ...... 166 HUMALOG U-100 INSULIN ...... 142 SYRINGE ...... 135 heparin (porcine) in 0.9% GYNOL II...... 99 nacl ...... 165, 166

243 HUMULIN 70/30 U-100 hydroskin with aloe ...... 108 IBRANCE ...... 47 INSULIN ...... 140 hydroxychloroquine ..... 28, 36 Ibu ...... 31 HUMULIN N NPH U-100 INSULIN ...... 140 hydroxyprogest(pf)(preg ibu-drops ...... 31 presv) ...... 139, 142 HUMULIN R REGULAR U- ibuprofen ...... 31 100 INSULN ...... 141 hydroxyprogesterone cap(ppres) ...... 139, 142 ibuprofen jr strength ...... 31 HUMULIN R U-500 (CONC) Iclevia ...... 90 INSULIN ...... 141 hydroxyurea ...... 46 ICLUSIG ...... 48 HUMULIN R U-500 (CONC) hydroxyzine hcl ...... 70 KWIKPEN ...... 141 hydroxyzine pamoate ...... 70 icy hot ...... 110

HYCAMTIN ...... 50 hyoscyamine sulfate ...... 152, ICY HOT (MENTHOL) ..... 111 hydralazine ...... 69 153, 163 ICY HOT ADVANCED RELIEF PATCH ...... 111 hydrochlorothiazide ...... 70 hyosyne ...... 153, 163 ICY HOT NO MESS ...... 111 HYDROCHLOROTHIAZIDE hypercare ...... 104 (BULK) ...... 70, 83 HYPERHEP B ...... 54 ICY HOT PAIN RELIEVING ...... 111 HYDROCIL INSTANT ..... 154 HYPERHEP B NEONATAL ifosfamide ...... 44 hydrocodone-acetaminophen ...... 54 ...... 24, 25 HYPERLYTE CR ...... 121 ifosfamide-mesna ...... 44 hydrocodone-ibuprofen ..... 25 HYPERRAB (PF) ...... 54 imatinib ...... 49 hydrocortisone . 107, 140, 153 HYPERRAB S/D (PF)...... 54 IMBRUVICA ...... 46, 49 hydrocortisone acetate ..... 33, HYPER-SAL ...... 84 imipramine hcl ...... 75 107 HYPERTET S/D (PF) ...... 55 imiquimod ...... 108 hydrocortisone plus . 107, 108 HYPOLANCE AST LANCING IMOGAM RABIES-HT (PF) 54 hydrocortisone-acetic acid ...... 172, 186 IMOVAX RABIES VACCINE ...... 204 HYPROMELLOSE ...... 85 (PF) ...... 61 hydrocortisone-aloe vera . 108 HYPROMELLOSE (BULK) Incassia ...... 95 hydrocortisone-pramoxine 33, ...... 83, 85 IN-CHECK NASAL WITH 107, 108 HYQVIA IG COMPONENT 54 MASK ...... 179, 186 hydrocream ...... 107 IN-CHECK ORAL FLOW I hydromorphone ...... 24 METER ...... 179, 186 ibandronate ...... 138 hydroskin ...... 107

244 INCONTROL LANCING IONOSOL-MB IN D5W .... 118 Jasmiel (28) ...... 90 DEVICE ...... 172, 186 IPOL ...... 61 Jencycla ...... 95 INCONTROL SUPER THIN LANCETS ...... 172, 186 ipratropium bromide 216, 219 Jinteli ...... 138

INCONTROL ULTRA THIN ipratropium-albuterol ...... 217 jock itch (clotrimazole) ..... 103 LANCETS ...... 172, 186 irbesartan ...... 63 jolessa ...... 90

INCRUSE ELLIPTA ...... 216 irbesartan- jolivette ...... 95 hydrochlorothiazide...... 63 indapamide...... 70 jr. acetaminophen ...... 27 IRESSA ...... 43 indomethacin ...... 31 Juleber ...... 90 irinotecan ...... 50 INFANRIX (DTAP) (PF) .... 56 Junel 1.5/30 (21) ...... 90 iron ...... 119 infant's advil ...... 31 Junel 1/20 (21) ...... 90 iron (dried) ...... 119 infants gas relief ...... 152 Junel Fe 1.5/30 (28) ...... 90 ISENTRESS ...... 37 infant's ibuprofen ...... 31 Junel Fe 1/20 (28) ...... 91 Isibloom ...... 90 INFANT'S MOTRIN ...... 31 Junel Fe 24 ...... 91 infant's pain reliever ...... 27 ISOLYTE-P IN 5 % DEXTROSE ...... 118 junior mapap ...... 27 INFED ...... 119 ISOLYTE-S ...... 121 K INJECT EASE LANCETS K1-1000 ...... 135 ...... 172, 186 isoniazid ...... 37 KABIVEN ...... 127 INLYTA ...... 49 isopto tears ...... 196 Kalliga ...... 91 insulin asp prt-insulin aspart ISORDIL ...... 63 ...... 141 isosorbide dinitrate ...... 63, 64 kaopectate (bismuth subsalicy) ...... 148 insulin lispro ...... 142 isosorbide mononitrate ...... 64 kaopectate ex str (bismuth INTRALIPID ...... 127 isradipine ...... 67 ss) ...... 148

INTRAROSA ...... 142 itraconazole ...... 36 Kariva (28) ...... 87

Introvale ...... 90 ivermectin ...... 35 KATERZIA ...... 67

INVACARE LANCETS ... 172, IXIARO (PF) ...... 60 KEDRAB (PF)...... 54 186 J k-effervescent ...... 122 inzo antifungal ...... 103 Jaimiess ...... 87 Kelnor 1/35 (28)...... 91 IONOSOL-B IN D5W ...... 118 Jantoven ...... 164 Kelnor 1-50 (28) ...... 91

245 ketoconazole ...... 36, 103 K-PHOS NO 2 ...... 162 lapatinib ...... 42

KETONE CARE ...... 181, 186 K-PHOS ORIGINAL ...... 162 Larin 1.5/30 (21) ...... 91

KETONE URINE TEST .. 181, Kurvelo (28) ...... 91 Larin 1/20 (21) ...... 91 186 L Larin 24 Fe ...... 91 ketoprofen ...... 31 l norgest/e.estradiol-e.estrad Larin Fe 1.5/30 (28) ...... 91 ketorolac ...... 199 ...... 87 Larin Fe 1/20 (28) ...... 91 KETOSTIX ...... 181, 186 labetalol ...... 63 Larissia ...... 91 ketotifen fumarate ...... 198 LACTATED RINGERS ... 115, 130 latanoprost ...... 203 KEYTRUDA...... 51 lactulose ...... 150, 156 laxacin ...... 159 kids first vitamin d3 ...... 134 LAMISIL AT ...... 102 laxaclear ...... 156 kids mini enema ...... 160 lamotrigine ...... 73 laxative (bisacodyl) ...... 158 KIDS VITAMIN D3 ...... 134 LANCETS ...... 172, 186 laxative (sennosides) ...... 158 Kimidess (28) ...... 87 LANCETS, SUPER THIN 172, laxative dietary supplement KINRIX (PF) ...... 56 186 ...... 120

Kionex ...... 115 LANCETS,THIN ...... 172, 186 laxative maximum strength ...... 158 kionex (with sorbitol) ...... 115 LANCETS,ULTRA THIN . 172, laxative peg 3350 ...... 156 KISQALI ...... 47 186 laxative pills regular ...... 158 Klor-Con M10 ...... 122 LANCING DEVICE .. 172, 186 ledipasvir-sofosbuvir ...... 40 Klor-Con M15 ...... 123 LANCING DEVICE WITH LANCETS ...... 172, 186 leena 28 ...... 96 Klor-Con M20 ...... 123 LANCING SYSTEM 172, 187 leflunomide ...... 30 Klor-Con Sprinkle ...... 123 LANOXIN ...... 68 lemon glycerin ...... 194 konsyl (sugar) ...... 154 lansoprazole ...... 151 LENVIMA ...... 49 KONSYL DAILY FIBER (STEVIA) ...... 154 LANTUS SOLOSTAR U-100 Lessina ...... 91 INSULIN ...... 141 KONSYL EASY MIX ...... 154 letrozole ...... 46 LANTUS U-100 INSULIN 141 KONSYL SUGAR-FREE . 155 leucovorin calcium ...... 52 LANZO LANCING DEVICE KONSYL SUGAR-FREE ...... 172, 187 LEUKERAN ...... 44 (ASPARTAME) ...... 154 levalbuterol tartrate ...... 217

246 levetiracetam ...... 73 lidocaine-prilocaine ...... 109 Lomedia 24 Fe ...... 92 levobunolol ...... 200 Lillow (28) ...... 92 loperamide ...... 147 levocarnitine ...... 193 liothyronine ...... 143 lopreeza ...... 138 levocarnitine (with sugar) 193 liquid antacid ...... 146 loradamed ...... 212, 213 levofloxacin ...... 39, 202 liquid calcium with vitamin d loratadine ...... 212, 213 ...... 118 Levonest (28) ...... 96 lorazepam ...... 70, 71, 78, 82 lisinopril ...... 62 levonorgestrel ...... 98 Lorcet (Hydrocodone) .. 24, 25 lisinopril-hydrochlorothiazide levonorgestrel-ethinyl estrad ...... 62 Lorcet Hd ...... 24, 25 ...... 91 LITE TOUCH LANCETS 173, Lorcet Plus ...... 25 levonorg-eth estrad triphasic 187 ...... 96 Loryna (28) ...... 92 LITE TOUCH LANCING losartan ...... 63 Levora-28 ...... 91 DEVICE ...... 173, 187 levothyroxine ...... 144 losartan-hydrochlorothiazide LITE TOUCH-MEDIUM ...... 63 lice bedding spray ...... 112 MASK ...... 180, 187 lotrimin af ...... 103 lice complete kit 1-2-3 ..... 111 LITEAIRE MDI CHAMBER ...... 180, 187 lovastatin ...... 65 lice cream rinse ...... 112 little noses ...... 221 Low-Ogestrel (28) ...... 92 lice killing ...... 111 little remedies ...... 220 Lo-Zumandimine (28) ...... 92 lice pyrinyl shampoo ...... 111 little remedies fever and pain lubricant dry eye relief ..... 196 lice solution ...... 111 ...... 27 lubricant eye ...... 195 lice treatment ...... 112 little remedies saline mist 221 lubricant eye (cmc-glycerin) lice treatment (permethrin) little tummys gas relief ..... 152 ...... 195 ...... 112 LO LOESTRIN FE ...... 87 lubricant eye (pg-peg 400) LIDO BDK ...... 181 ...... 195 lo-dose aspirin ...... 32, 167 lido king ...... 110 lubricant eye drops ...... 196 LODRANE D ...... 205 lidocaine ...... 33, 110 lubricating jelly (chlorhexid) lohist - d ...... 205 ...... 109 lidocaine hcl ...... 110, 194 Lojaimiess ...... 87 lubricating plus ...... 196 lidocaine pain relief ...... 110 lomaira ...... 112 lugols ...... 52 Lidocaine Viscous ...... 194

247 LUPRON DEPOT ...... 47, 142 magnesium sulfate in d5w MEDLANCE PLUS ...... 120 LANCETS ...... 173, 187 LUPRON DEPOT (3 MONTH) ...... 47, 142 magnesium sulfate in lr ... 120 medroxyprogesterone 86, 143

LUPRON DEPOT (4 MAGOX ...... 120 megestrol ...... 49, 113 MONTH) ...... 47 MAKENA ...... 139, 143 MEKINIST ...... 48 LUPRON DEPOT (6 MONTH) ...... 47 MAKENA (PF) ...... 139, 143 Melodetta 24 Fe ...... 92

Lutera (28)...... 92 mapap (acetaminophen) ... 27 meloxicam ...... 30

Lyleq ...... 95 mapap arthritis pain ...... 27 melphalan ...... 44

LYNPARZA ...... 49 mapap extra strength ...... 27 memantine ...... 85

LYSODREN ...... 45 maprotiline ...... 75 MENACTRA (PF) ...... 57

Lyza ...... 95 Marlissa (28) ...... 92 MENOMUNE - A/C/Y/W-135 ...... 57 Marten-Tab ...... 28 M MENOMUNE - A/C/Y/W-135 maalox advanced ...... 146 masophen ...... 27 (PF) ...... 57

MAALOX ADVANCED .... 147 MATULANE ...... 43 MENQUADFI (PF) ...... 57

MAALOX MAXIMUM MAVYRET ...... 39 MENVEO A-C-Y-W-135-DIP STRENGTH ...... 147 MAXIDEX ...... 199 (PF) ...... 58

MAG-AL ...... 145 MAXIFED TR ...... 205 MENVEO MENA COMPONENT (PF) ...... 58 mag-g ...... 120 maxilube ...... 109 MENVEO MENCYW-135 magnesium...... 120 maxi-tuss pe ...... 205 COMPNT (PF) ...... 58 magnesium citrate ...... 156 maxi-tuss tr ...... 205 MEPHYTON ...... 135

MAGNESIUM CITRATE m-dryl ...... 207, 210 mercaptopurine ...... 45 (BULK) ...... 156 meclizine ...... 148 mesalamine ...... 153 MAGNESIUM HYDROXIDE (BULK) ...... 84 medicated heat patch ...... 111 META APPETITE CTRL (ASPARTAME) ...... 155 magnesium oxide .... 120, 146 medi-first anti-fungal ...... 103 METAMUCIL ...... 155 MAGNESIUM OXIDE ...... 120 medi-laxx ...... 159 METAMUCIL (WITH medi-meclizine ...... 148 magnesium sulfate in 0.9 SUGAR) ...... 155 %nacl ...... 120 MEDISENSE THIN LANCETS ...... 173, 187

248 METAMUCIL FIBER metoprolol ta- MICROLET 2 LANCING SINGLES ...... 155 hydrochlorothiaz ...... 68 DEVICE ...... 173, 187

METAMUCIL FIBER THIN metoprolol tartrate ...... 66 MICROLET LANCET ...... 173 ...... 155 metronidazole ..... 37, 99, 110, MICROLIFE PEAK FLOW METAMUCIL FREE ...... 155 225 METER ...... 179, 187 metamucil plus calcium ... 155 mexiletine ...... 64 MICROSPACER...... 180, 187 metaproterenol ...... 217 MEZPAROX-HC ...... 108 midazolam ...... 33, 78 metformin ...... 142 mgo ...... 121 midazolam (pf)...... 33, 78 methadone ...... 24 mi-acid ...... 147 midodrine ...... 68 methenamine hippurate ... 41, mi-acid gas relief(simethicon) migraine formula...... 32 162 ...... 152 Mili ...... 92 methenamine mandelate .. 41, mi-acid(calcium carb-mag 162 hydr) ...... 145 milk of magnesia ...... 156 methimazole ...... 138 Mibelas 24 Fe ...... 92 milk of magnesia concentrated ...... 156 methocarbamol ...... 169 micatin ...... 103 MILLIPRED ...... 140 METHOCEL E 4 M ...... 85 miconazole nitrate ... 103, 225 MINI LANCING DEVICE 173, METHOCEL K 100 M .. 84, 85 miconazole-3 ...... 225 187 methotrexate sodium ... 29, 45 miconazole-3 MINI WRIGHT PEAK FLOW prefil,cream,wipe ...... 225 METER ...... 179, 187 methotrexate sodium (pf) .. 45 miconazole-7 ...... 225 Minitran ...... 64 methyldopa...... 68 miconazole-skin clnsr17 .. 225 minocycline ...... 29, 42 methylergonovine ...... 142 MICRO THIN LANCETS . 173 minoxidil ...... 69 methylphenidate hcl .... 77, 80 MICROCHAMBER .. 180, 187 mintox ...... 147 methylprednisolone ...... 140 Microgestin 1.5/30 (21)...... 92 mintox maximum strength 147 methylprednisolone acetate ...... 140 Microgestin 1/20 (21)...... 92 mintox plus ...... 147 metipranolol...... 200 Microgestin Fe 1.5/30 (28) 92 MIRALAX ...... 157 metoclopramide hcl ...... 152 Microgestin Fe 1/20 (28) ... 92 MIRENA ...... 86 metolazone...... 70 micro-guard ...... 103 mirtazapine ...... 73 metoprolol succinate ...... 66 misoprostol ...... 151

249 mitomycin ...... 51 motion sickness ii ...... 148 MYLERAN ...... 43

M-M-R II (PF) .. 55, 60, 61, 62 motion sickness relief(mecliz) mynephrocaps ...... 113 ...... 148, 149 modafinil ...... 80 mytab gas (simethicone) . 152 MOUTHPIECE ...... 180, 187 MOISTURE DROPS ...... 195 mytab gas maximum strength moxifloxacin ...... 202 ...... 152 mometasone ...... 107 mucilin sf ...... 155 Myzilra ...... 96 MONISTAT 1 COMBO PACK ...... 225 mucinex fast-max chest- N congest ...... 219 MONISTAT 3 ...... 225 NABI-HB ...... 54 mucus relief cough ...... 222 monistat 7...... 225 nabumetone ...... 30 mucus relief d MONISTAT 7 ...... 225 (pseudoephed) ...... 218 nadolol ...... 66

MONOJECT 0.9% SODIUM mucus relief dm ...... 222 NAPHCON-A ...... 198 CHLORIDE ...... 130 mucus relief er ...... 219 naproxen ...... 31 MONOJECT HYPODERMIC NEEDLES ...... 178, 187 multi antibiotic plus ...... 102 naproxen sodium ...... 31

MONOJECT HYPODERMIC MULTI-LANCET DEVICE 2 naramin ...... 207, 210 POLYPROPYL .... 178, 187 ...... 173, 187 NASACORT ...... 220

MONOJECT PREFILL multi-vit with fluoride-iron . 129 nasal allergy ...... 220 ADVANCED NS ...... 130 multivit-fluor (vit e acetate) nasal and sinus MONOLET LANCETS .... 173, ...... 129 decongestant ...... 223 187 mupirocin ...... 101 nasal decongestant (pe) .. 223 MONOLET THIN LANCETS ...... 173, 187 murine ear wax removal nasal decongestant system ...... 204 (pseudoeph) ...... 224 Mono-Linyah ...... 92 muro 128 ...... 200 nasal decongest- mononessa (28) ...... 92 Mutamycin ...... 51 antihistamine...... 205 montelukast ...... 215 my choice ...... 98 nasal mist ...... 221 morphine ...... 24 my way ...... 98 NASALCROM...... 220 MORPHINE ...... 24 mycophenolate mofetil ..... 29, NATACYN ...... 202 motion relief (meclizine) .. 148 168 natural calcium ...... 116 motion sickness (meclizine) MYGLUCOHEALTH natural daily fiber ...... 155 ...... 148 LANCETS ...... 173, 187

250 natural fiber laxative ...... 155 Neo-Polycin ...... 201 NICOTINE ...... 83 natural fiber supplement .. 155 Neo-Polycin Hc ...... 198 nicotine (polacrilex) ...... 82

NATURAL FIBER neosporin (neo-bac-polym) nifedipine ...... 67 SUPPLEMNT(ASPRT) 155 ...... 101 nightime sleep ...... 81, 210 natural senna laxative ..... 158 neosporin plus pain relief 102 nighttime sleep aid (diphen) natural tears (pf) ...... 195 neo-tuss ...... 222 ...... 81, 210 natural vegetable ...... 155 nephplex rx ...... 113 nighttime sleep-aid (doxylamn) ...... 81 nature-throid ...... 143 NEPHRAMINE 5.4 % ...... 126 Nikki (28) ...... 93 NAVELBINE ...... 50 nephro-vite ...... 113 ninjacof-xg ...... 223 NAYZILAM ...... 71, 78 nephro-vite rx ...... 113 NINLARO ...... 49 NEBUPENT...... 41 NEUTROGENA ON THE SPOT ...... 100 NIPENT ...... 45 nebusal ...... 84 new day ...... 98, 99 Nitro-Bid ...... 64 NEBUSAL ...... 84 NEXAVAR ...... 48 nitrofurantoin ...... 35, 163 Necon 0.5/35 (28) ...... 93 NEXPLANON ...... 86 nitrofurantoin macrocrystal35, necon 1/50 (28) ...... 93 162 next choice one dose .. 98, 99 necon 10/11 (28) ...... 87 nitrofurantoin monohyd/m- niacin ...... 65, 132 necon 7/7/7 (28) ...... 96 cryst ...... 35, 162 niacin (inositol niacinate) . 132 nefazodone ...... 74 nitroglycerin ...... 64 NIACIN (INOSITOL NIVESTYM ...... 165 neomycin ...... 34 NIACINATE) ...... 132 NIX CREME RINSE ...... 112 neomycin-bacitracin-poly-hc niacin (niacinamide) ...... 132 ...... 197 NIZORAL A-D...... 103 Niacor ...... 65 neomycin-bacitracin- non-aspirin ...... 27 polymyxin...... 201 NIAVASC ...... 132 non-aspirin child ...... 27 neomycin-polymyxin b- NIAVASC 750 ...... 132 dexameth ...... 197 non-aspirin childrens ...... 27 NICODERM CQ ...... 82 neomycin-polymyxin- non-aspirin extra strength .. 27 gramicidin ...... 201 nicorelief ...... 82 non-aspirin jr strength ...... 27 neomycin-polymyxin-hc .. 197, NICORETTE ...... 82 non-aspirin pain relief ...... 27 203 nicotine ...... 82

251 nora-be ...... 95 NOVOLIN N NPH U-100 omeprazole ...... 151 INSULIN ...... 140 norethindrone (contraceptive) ON CALL LANCET .. 173, 188 ...... 95 NOVOLIN R REGULAR U- 100 INSULN ...... 141 ON CALL LANCING DEVICE norethindrone acetate ..... 143 ...... 173, 188 NOVOLOG MIX 70-30 U-100 norethindrone ac-eth INSULN ...... 141 ON CALL PLUS LANCET estradiol ...... 93, 138 ...... 173, 188 np thyroid ...... 143 norethindrone-e.estradiol-iron ON CALL PLUS LANCING ...... 93 NUTRILIPID ...... 127 DEVICE ...... 173, 188 norgestimate-ethinyl estradiol Nyamyc ...... 102 ondansetron ...... 149 ...... 93, 96 Nylia 7/7/7 (28) ...... 96 ondansetron hcl ...... 149 Norlyda ...... 95 Nymyo ...... 93 ONE WAY VALVED Norlyroc ...... 95 MOUTHPIECE ..... 180, 188 nystatin ...... 36, 102, 193 normal saline flush ...... 130 ONETOUCH DELICA LANC NYSTATIN (BULK) ...... 36, 84 DEVICE ...... 173, 188 NORMOSOL-M IN 5 % DEXTROSE ...... 118 nystatin-triamcinolone ..... 104 ONETOUCH DELICA LANCETS ...... 173, 188 NORMOSOL-R IN 5 % Nystop ...... 102 DEXTROSE ...... 118 nytol...... 81, 207, 210 ONETOUCH DELICA PLUS LANC DEV ...... 173, 188 NORMOSOL-R PH 7.4 ... 121 O ONETOUCH DELICA PLUS nortemp ...... 27 obagi nu-derm tolereen ... 107 LANCET ...... 173, 188

Nortrel 0.5/35 (28) ...... 93 ocean nasal ...... 221 ONETOUCH SURESOFT LANCING DEV .... 173, 188 nortrel 1/35 (21) ...... 93 ocella ...... 93 ONETOUCH ULTRASOFT Nortrel 1/35 (28) ...... 93 OCUSOFT IRRIGATING LANCETS ...... 173, 188 Nortrel 7/7/7 (28) ...... 96 OPHTH SOLN ...... 201 ONETOUCH VERIO FLEX ofloxacin ...... 39, 202, 203 nortriptyline...... 75 START ...... 173, 188 ogestrel (28) ...... 93 NOVA SAFETY LANCETS ONETOUCH VERIO HIGH ...... 173, 187 Okebo...... 42 CONTROL ...... 174, 188

NOVA SUREFLEX olopatadine ...... 198 ONETOUCH VERIO MID LANCETS ...... 173, 187 CONTROL ...... 174, 188 OLUMIANT ...... 29 NOVOLIN 70/30 U-100 ONETOUCH VERIO TEST INSULIN ...... 140 omega-3 acid ethyl esters . 65 STRIPS ...... 169, 188

252 ON-THE-GO LANCETS . 174, oxycodone-acetaminophen Paroex Oral Rinse ...... 194 188 ...... 25, 26 paromomycin ...... 34 onxol ...... 50 OXYTROL ...... 163 paroxetine hcl ...... 74 opcicon one-step ...... 98, 99 OXYTROL FOR WOMEN 163 PARVA-CAL 500 ...... 118 OPCON-A ...... 198 oysco 500/d ...... 118 p-col rite ...... 159 OPDIVO ...... 51 oysco-500 ...... 116 PEAK AIR PEAK FLOW OPTICHAMBER ADULT oyster shell calcium-vit d2 118 METER ...... 179, 189 MASK-LARGE ..... 180, 188 oyster shell calcium-vit d3 118 pedi multivit no.194-iron sulf OPTICHAMBER DIAMOND ...... 129 LG MASK...... 180, 188 oystercal-d ...... 118 pedia tri-vite ...... 128 OPTICHAMBER DIAMOND OZEMPIC ...... 137 pediacare fever reducer .... 28 VHC ...... 180, 188 P PEDIA-LAX ...... 157 OPTICHAMBER DIAMOND- Pacerone ...... 64 MED MSK ...... 180, 188 pedia-lax stool softener ... 160 paclitaxel ...... 50 OPTICHAMBER DIAMOND- PEDIARIX (PF)...... 53, 56 SML MASK ...... 180, 188 pain relief 8hr ...... 28 pediatric cough and cold . 219 option-2 ...... 98, 99 pain relief cream ...... 110 pediatric d-vite ...... 134 Oralone ...... 194 pain reliever (acetaminophen) ...... 28 pediatric electrolyte ...... 121 oralyte ...... 121 pain reliever jr strength ...... 28 pediatric fe-vite ...... 119 ORASEP ...... 193 pain reliever plus ...... 32 pediatric freezer pops ...... 121 Orsythia ...... 93 pain relieving rub (camphor) pediatric multivitamin no.171 oscimin ...... 153, 163 ...... 110 ...... 128 oscimin sl ...... 153, 163 pamprin max ...... 32 PEDIATRIC PANDA MASK ...... 180, 189 oseltamivir ...... 40 PANCREAZE ...... 150 pediatric poly-vite ...... 128 oxaliplatin ...... 48 PANDA MASK ...... 180, 189 oxcarbazepine ...... 73 pediatric poly-vite with iron panoxyl ...... 100 ...... 129 oxybutynin chloride ...... 163 panoxyl-4 ...... 100 PEDIATRIC SMALL MASK oxycodone ...... 24 pantoprazole ...... 151 ...... 181, 189

PARAGARD T 380A...... 86 pediatric tri-vite ...... 128

253 pedi-boro soak ...... 105 pharbetol ...... 28 pilocarpine hcl ...... 194, 197

PEDVAX HIB (PF) ...... 57 pharmabase barrier ...... 109 Pimtrea (28) ...... 87 peg 3350-electrolytes ...... 158 PHAZYME ...... 152 pink bismuth ...... 148

PEGANONE ...... 72 Phenadoz ...... 149, 208, 210 pinworm treatment ...... 35

PEGASYS ...... 39 PHENAGIL ...... 205 pin-x ...... 35

PEGASYS PROCLICK ...... 39 phenazopyridine ...... 162 PIN-X ...... 35 peg-electrolyte soln ...... 158 phenobarbital ...... 71, 81, 82 pioglitazone ...... 142

PEGINTRON ...... 39 phentermine ...... 112 PIP LANCET ...... 174, 189 penicillamine ...... 29, 34 phenylephrine hcl ...... 200 Pirmella ...... 93, 96 penicillin v potassium ...... 41 Phenytek ...... 72 piroxicam ...... 30

PENTACEL (PF) ...... 56, 59 phenytoin ...... 72 PLASMA-LYTE 148 ...... 121

PENTACEL DTAP-IPV phenytoin sodium extended PLASMA-LYTE A ...... 121 COMPNT (PF) ...... 56 ...... 72 PLENAMINE ...... 126 pentobarbital sodium ...... 81 Philith ...... 93 PNEUMOVAX-23 ...... 58 pentoxifylline ...... 165 phillips ...... 121 POCKET CHAMBER ...... 181, peptic relief ...... 148 phillips' liqui-gels ...... 160 189 perdiem overnight relief ... 158 PHILLIPS MILK OF POCKET PEAK FLOW MAGNESIA ...... 146, 157 METER ...... 179, 189 periguard ...... 109 PHOSLYRA ...... 161 podofilox ...... 108 PERIKABIVEN ...... 127 phospha 250 neutral 122, 162 Polycin ...... 201 perindopril erbumine ...... 62 PHOSPHOLINE IODIDE . 197 polyethylene glycol 3350 . 157 Periogard ...... 194 phospho-trin 250 neutral 122, POLYETHYLENE GLYCOL PERISHIELD ...... 109 162 3350(BULK) ...... 84

PERJETA ...... 51 PHYSICIANS EZ USE B-12 polymyxin b sulf-trimethoprim permethrin ...... 112 ...... 131 ...... 201 persa-gel ...... 100 phytonadione (vitamin k1) 135 POLYSPORIN ...... 101

PERSONAL BEST FULL PHYTONADIONE (VITAMIN polysporin (bacitracin zinc) RANGE ...... 179, 189 K1) ...... 135 ...... 101 personal lubricating jelly .. 109 PIKO 1 ...... 179, 189

254 POLYVINYL ALCOHOL potassium chloride-d5- prenatal vits96-iron fum-folic (BULK) ...... 84, 85 0.3%nacl ...... 122 ...... 130

POLY-VI-SOL ...... 128 potassium chloride-d5- preparation h hydrocortisone 0.9%nacl ...... 122 ...... 107 POLY-VI-SOL WITH IRON ...... 129 potassium citrate ...... 162 PRESSURE ACTIVATED LANCETS ...... 174, 189 poly-vita ...... 128 potassium citrate-citric acid ...... 162 PREVAIL BLADDER poly-vita (iron) ...... 129 CONTROL PAD ... 177, 189 potassium hydroxide ...... 100 poly-vitamin ...... 128 Prevalite ...... 65 powderlax ...... 157 poly-vitamin with iron ...... 129 Previfem ...... 93 pramipexole ...... 76 Portia 28 ...... 93 PREVNAR 13 (PF) ...... 58 prasugrel ...... 167 PORTRAZZA ...... 51 PREZISTA ...... 42 pravastatin ...... 65 potassium bicarb and PRIFTIN ...... 37, 42 chloride ...... 122 prazosin ...... 70 PRIMAQUINE...... 36 potassium bicarb-citric acid PRED MILD ...... 199 ...... 123 PRIMEAIRE ...... 181, 189 prednicarbate ...... 107 potassium chlorid-d5- primidone ...... 71 0.45%nacl ...... 122 prednisolone acetate ...... 199 PRO COMFORT LANCET potassium chloride .. 122, 123 prednisolone acetate (pf). 199 ...... 174, 189 potassium chloride in prednisolone sodium PROAIR RESPICLICK .... 217 0.9%nacl ...... 122 phosphate ...... 140, 199 probenecid ...... 164 potassium chloride in 5 % prednisone ...... 140 probenecid-colchicine ...... 164 dex ...... 122 PREDNISONE INTENSOL potassium chloride in lr-d5 ...... 140 PROCHAMBER...... 181, 189 ...... 122 pregabalin ...... 72, 79 prochlorperazine...... 149 potassium chloride in water PREMARIN ...... 226 prochlorperazine maleate . 76, ...... 122 149 PREMASOL 10 % ...... 126 potassium chloride-0.45 % Procto-Med Hc ...... 33, 107 nacl ...... 122 PREMASOL 6 % ...... 126 Proctosol Hc ...... 33, 108 potassium chloride-d5- prenatal ...... 130 0.2%nacl ...... 122 Proctozone-Hc...... 33 prenatal vitamin ...... 130

255 PRODIGY LANCETS ..... 174, PSYLLIUM HUSK (BULK) 84, quinidine sulfate ...... 64 189 155 quinine sulfate ...... 36 PRODIGY LANCING PULMICORT FLEXHALER DEVICE ...... 174, 189 ...... 215 QVAR ...... 215

PRODIGY TWIST TOP PULMOSAL ...... 84 QVAR REDIHALER ...... 215 LANCET ...... 174, 189 pure and gentle eye ...... 196 R progesterone micronized . 143 PURE COMFORT LANCETS RABAVERT (PF) ...... 61 promethazine .. 149, 208, 210 ...... 174, 189 raloxifene ...... 143 promethazine-dm ...... 222 PURE COMFORT SAFETY ramipril ...... 63 LANCETS ...... 174, 189 promethazine-phenylephrine ranitidine hcl ...... 151 ...... 205 PURECOMFORT PEAK FLOW METER ..... 179, 189 READYLANCE SAFETY Promethegan ... 149, 208, 210 LANCETS ...... 174, 189 purelax ...... 157 promolaxin...... 160 Reclipsen (28) ...... 94 PURIXAN ...... 45 propafenone ...... 64 RECOMBIVAX HB (PF) .... 54 PUSH BUTTON SAFETY propantheline ...... 153 LANCETS ...... 174, 189 recort plus ...... 108 proparacaine ...... 201 pyrazinamide ...... 37 reese's pinworm medicine . 35 propranolol ...... 66 pyridostigmine bromide ... 168 refenesen ...... 219 propylthiouracil ...... 138 pyridoxine (vitamin b6) .... 132 REFRESH CELLUVISC .. 196

PROQUAD (PF) ... 55, 60, 61, pyrimethamine ...... 36 REFRESH CONTACTS .. 197 62 Q REFRESH OPTIVE ...... 196 PROSOL 20 % ...... 127 QBRELIS ...... 62 reguloid (aspartame) ...... 155 protriptyline...... 75 q-dryl ...... 207, 210 reguloid (psyllium husk) ... 155 pseudoephedrine hcl ...... 224 QINLOCK ...... 49 relcof c ...... 223 pseudoephedrine-guaifenesin ...... 218 q-pap ...... 28 RELENZA DISKHALER .... 40 psoriasis medicated ...... 109 q-pap extra strength ...... 28 RELIAMED LANCET ...... 174, 190 psyllium husk ...... 155 QUADRACEL (PF) ...... 57 RELIAMED MINI LANCING PSYLLIUM HUSK ...... 155 Quasense ...... 94 DEVICE ...... 174, 190 quinapril ...... 63

256 RELIAMED SAFETY SEAL RIDAURA ...... 29 RYBELSUS ...... 137 LANCETS ...... 174, 190 rifampin ...... 37, 42 RYDAPT ...... 49 RELION THIN LANCETS174, 190 ri-gel ...... 147 rynex pse ...... 205

RELION ULTRA THIN PLUS RIGHTEST GD500 S LANCETS ...... 174, 190 LANCING DEVICE ..... 174, 190 SAFETY LANCETS . 174, 190 remedy phytoplex antifungal SAFETY SEAL LANCETS ...... 103 RIGHTEST GL300 LANCETS ...... 174, 190 ...... 174, 190 renal caps...... 113 riluzole ...... 168 SAFETY-LET LANCETS 174, renal vitamin ...... 113 190 ri-mag ...... 146 renal-vite ...... 113 saline mist ...... 221 ri-mag plus ...... 147 rena-vite ...... 113 saline nasal ...... 221 ri-mox ...... 147 rena-vite rx ...... 113 saline nose ...... 221 ri-mox plus ...... 147 RENFLEXIS ...... 28, 154 sal-plant ...... 109 ringer's ...... 115, 130 reno caps ...... 113 SANTYL ...... 105 ritonavir ...... 42 repaglinide...... 136 scalp relief ...... 108, 109 RITUXAN ...... 46 REPLESTA ...... 134 scalpicin anti-itch ...... 108 RITUXAN HYCELA ...... 46 RESPAIRE-30 ...... 218 scopolamine base ...... 148 rivastigmine tartrate ...... 85 restfully sleep .... 81, 208, 210 scot-tussin expectorant ... 219 rivelsa ...... 95 restore tears ...... 197 SCOT-TUSSIN SENIOR . 222 rizatriptan ...... 80 RETACRIT ...... 165 SCRUB CARE EXIDINE ... 52 robafen ...... 219 retaine nacl...... 200 SEGLUROMET ...... 136 robafen ac ...... 223 revive plus ...... 197 selegiline hcl ...... 76 robitussin pediatric ...... 214 RHOPRESSA ...... 203 selenium ...... 123 roll-on deodorant ...... 104 Ribasphere ...... 40 selenium sulfide...... 104 ropinirole ...... 76 ribavirin ...... 40 selenomax ...... 123 rosuvastatin ...... 65 rid complete lice elim kit .. 112 SELENOMETHIONINE ... 123 ROTARIX ...... 55, 61 rid lice killing ...... 112 selsun blue ...... 104 ROTATEQ VACCINE .. 55, 61

257 SEMGLEE PEN U-100 SILICONE MASK - smoflipid ...... 127 INSULIN ...... 141 PEDIATRIC ...... 181, 190 smoothlax ...... 157 SEMGLEE U-100 INSULIN silphen cough ...... 208, 210 ...... 141 sochlor ...... 200 siltussin sa ...... 219 senexon ...... 158 sodium bicarbonate ...... 145 SILVASORB ...... 112 senexon-s...... 159 sodium chloride . 84, 115, 200 silver sulfadiazine ...... 105 senna ...... 158, 159 sodium chloride 0.45 % ... 130 SIMETHICONE (BULK) .... 84, SENNA ...... 159 152 sodium chloride 0.9 % .... 115, 131 senna-extra ...... 159 SIMILAC STERILIZED WATER ...... 85 sodium chloride 0.9 % (flush) sennalax-s ...... 159 ...... 131 Simliya (28) ...... 87 sennosides-docusate sodium sodium chloride 3 % 130, 131 ...... 159 Simpesse ...... 87 sodium chloride 5 % 130, 131 SENOKOT...... 159 simply sleep ...... 81, 208, 210 sodium citrate-citric acid .. 162 SENOKOT EXTRA simvastatin ...... 65 STRENGTH ...... 159 sodium polystyrene (sorb SINGLE-LET ...... 174, 190 free) ...... 115 senokot-s ...... 159 sinus pressure-cong relief pe sodium polystyrene sulfonate SEREVENT DISKUS ...... 216 ...... 224 ...... 115 sertraline ...... 74 sleep aid (diphenhydramine) sofosbuvir-velpatasvir ...... 40 ...... 81, 210 Setlakin ...... 94 SOF-SERTER INSERTION sleep tablet DEVICE ...... 175, 190 sevelamer carbonate ...... 161 (diphenhydramine) 81, 208, 210 SOFT TOUCH LANCETS Sharobel ...... 95 ...... 175, 190 SLO-NIACIN ...... 132 SHARPS CONTAINER ... 178 solifenacin ...... 163 slow release iron ...... 120 SHINGRIX (PF) ...... 61 SOLU-CORTEF ACT-O-VIAL SIDESTREAM PEDIATRIC SLOW RELEASE IRON .. 120 (PF) ...... 140 FACE MASK ...... 181, 190 SMART SENSE LANCETS SOLUS V2 LANCETS .... 175, silace ...... 160 ...... 175, 190 190 siladryl sa ...... 208, 210 SMARTDIABETES SOLUS V2 LANCING VANTAGE ...... 175, 190 DEVICE ...... 175, 190 silapap ...... 28 SMARTEST LANCET..... 175, sominex ...... 81, 208, 210 190

258 soothing care stool softener ...... 160 super calcium ...... 116 (hydrocortisone) ...... 108 stool softener-laxative ..... 160 super daily d3 ...... 134 sore throat ...... 194 stool softener-stimulant laxat SUPER DAILY D3 ...... 134 sore throat (phenol) ...... 194 ...... 160 SUPER THIN LANCETS 175, Sorine ...... 64, 66 stop lice ...... 112 190 sotalol ...... 64, 66 stop smoking aid ...... 83 superplex-t ...... 113

Sotalol Af ...... 64, 66 STRIVERDI RESPIMAT .. 216 suphedrin ...... 224 spironolactone ...... 63, 69 strong iodine ...... 118 suphedrine 12 hour ...... 224 spironolacton- sucralfate ...... 161 suphedrine pe cold and hydrochlorothiaz ...... 69 allergy ...... 205 SUDAFED ...... 224 Sprintec (28)...... 94 SURE COMFORT INS. SYR. sudafed 12 hour ...... 224 U-100 ...... 177, 190 SPRITAM ...... 73 SUDAFED 24 HOUR...... 224 SURE COMFORT LANCETS SPRYCEL ...... 49 sudogest ...... 224 ...... 175, 190 Sps (With Sorbitol) ...... 115 sudogest 12-hour ...... 224 SURE COMFORT LANCING Sronyx ...... 94 PEN ...... 175, 191 sulfacetamide sodium..... 104, ssd ...... 105 202 SUREFLEX DEVICE WITH LANCETS ...... 175, 191 sski ...... 118 sulfacetamide sodium (acne) ...... 99 SUREFLEX LANCING st joseph aspirin ...... 32, 167 DEVICE ...... 175, 191 sulfacetamide-prednisolone st. joseph aspirin ...... 32, 167 ...... 198 SURE-LANCE ...... 175, 191

STEGLATRO ...... 136 sulfamethoxazole- SURE-LANCE ULTRA THIN ...... 175, 191 STEGLUJAN ...... 136 trimethoprim ...... 35 SURE-PEN LANCING STERILANCE TL .... 175, 190 sulfasalazine ...... 29, 153 DEVICE ...... 175, 191 sterile eye wash ...... 201 sulfatrim ...... 35 SURE-TOUCH LANCET 175, STERILE LUBRICANT .... 197 sulindac ...... 30 191 sterile saline ...... 221 sumatriptan ...... 80 surgilube ...... 109

STIOLTO RESPIMAT ..... 217 sumatriptan succinate ...... 80 SURGUARD2 SAFETY .. 178, 191 STIVARGA ...... 48 super b complex-vitamin c ...... 113 SUTENT ...... 49 stomach relief ...... 148

259 Syeda ...... 94 Taztia Xt ...... 67 THIN LANCETS ...... 175, 191

SYLATRON ...... 47 TDVAX ...... 57 thiotepa ...... 43

SYMJEPI ...... 68 tears again (pva) ...... 197 Tiadylt Er ...... 67

SYMLINPEN 120 ...... 137 tears naturale free (pf) ..... 196 tiagabine ...... 72

SYMLINPEN 60 ...... 137 TECHLITE LANCETS .... 175, TICE BCG ...... 48, 55 191 SYSTANE GEL ...... 197 tiger balm ...... 111 TELCARE LANCETS ..... 175, SYSTANE ULTRA ...... 196 191 TIGER BALM ...... 110, 111

T telmisartan ...... 63 TIGER BALM (WITH CAPSICUM)...... 110 tab tussin ...... 219 temazepam ...... 78, 82 Tilia Fe ...... 96 TABLOID ...... 45 TEMODAR ...... 44 timolol maleate ...... 66, 200 tacrolimus ...... 168 temozolomide ...... 44 TINACTIN ...... 103 tactinal ...... 28 Tencon ...... 28 tioconazole-1 ...... 225 tactinal extra strength ...... 28 teniposide ...... 47 TIVICAY ...... 37 TAFINLAR ...... 46 TENIVAC (PF) ...... 57 tizanidine ...... 169 TAGRISSO...... 43 terazosin ...... 70 tl icon ...... 120 take action ...... 98, 99 terbinafine hcl ...... 35, 102 TOBRADEX ...... 198 TALTZ AUTOINJECTOR 101 terconazole ...... 225 tobramycin ...... 202 TALTZ SYRINGE ...... 101 TETANUS,DIPHTHERIA TOX PED(PF) ...... 57 tobramycin-dexamethasone tamoxifen ...... 50 ...... 198 tetracycline ...... 42 tamsulosin ...... 161 TOBREX ...... 202 the magic bullet ...... 159 TANZEUM ...... 137 TODAY CONTRACEPTIVE TARCEVA ...... 43 Theochron ...... 215 SPONGE ...... 99 targeted acne spot treatment theophylline ...... 215, 216 tolcylen ...... 104 ...... 100 thera-d ...... 134 tolnaftate ...... 104

Tarina 24 Fe ...... 94 THERA-D 4000 ...... 134 tolterodine ...... 163

Tarina Fe 1/20 (28) ...... 94 THERATEARS ...... 197 TOPCARE UNIVERSAL1 LANCET ...... 175, 191 TASIGNA ...... 50 thiamine hcl (vitamin b1) . 131

260 topiramate ...... 73 tricon ...... 120 TRI-VI-SOL ...... 129

Toposar ...... 47 Triderm ...... 108 tri-vita ...... 129 topotecan ...... 50 Tri-Estarylla ...... 96 tri-vitamin ...... 129 torsemide ...... 69 trifluridine ...... 203 tri-vite with fluoride ...... 129 total allergy medicine ..... 208, Tri-Legest Fe ...... 96 Trivora (28) ...... 97 210 Tri-Linyah ...... 97 Tri-Vylibra ...... 97 TOVIAZ ...... 163 Tri-Lo-Estarylla ...... 97 Tri-Vylibra Lo ...... 97 TPN ELECTROLYTES II . 121 Tri-Lo-Marzia ...... 97 TROPHAMINE 10 % ...... 127 tramadol ...... 24 Tri-Lo-Mili ...... 97 TROPHAMINE 6% ...... 127 tramadol-acetaminophen .. 26 Tri-Lo-Sprintec ...... 97 tropicamide ...... 198 trandolapril ...... 63 Trilyte With Flavor Packets trospium ...... 163 TRANSDERM-SCOP ...... 148 ...... 158 TRUE COMFORT LANCET TRAVASOL 10 % ...... 127 trimethoprim ...... 35 ...... 175, 191 travel-ease (meclizine) .... 149 Tri-Mili ...... 97 TRUEDRAW LANCING DEVICE ...... 175, 191 trazodone ...... 74 trimipramine ...... 75 trueplus glucose ...... 135 TRECATOR ...... 37 trinessa (28) ...... 97 TRUEPLUS KETONE ..... 191 TRELEGY ELLIPTA ...... 218 trinessa lo ...... 97 TRUEPLUS LANCETS ... 175, tretinoin ...... 100 TRINTELLIX ...... 75 191 tretinoin (antineoplastic) .... 50 Tri-Nymyo ...... 97 TRULICITY ...... 137 tretinoin (emollient) ...... 110 triphrocaps ...... 113 TRUMENBA ...... 58

Tri Femynor ...... 96 triple antibiotic ...... 101 TRUVADA ...... 37 triacting expectorant ...... 218 TRIPLE PASTE ...... 109 TRUZONE PEAK FLOW triamcinolone acetonide . 108, triple paste af ...... 103 METER ...... 179, 191 194, 220 Tri-Previfem (28) ...... 97 TUDORZA PRESSAIR .... 216 triamterene- Tulana ...... 95 hydrochlorothiazid ...... 69 TRISPEC DMX ...... 222 TUMS ...... 145 tri-biozene ...... 102 Tri-Sprintec (28) ...... 97 TRITON X-100 ...... 85 TUMS EXTRA STRENGTH tri-buffered aspirin ...... 33 SMOOTHIES ...... 145

261 tums ultra ...... 145 ULTRA THIN LANCETS . 176, UNISTIK 3 ...... 176, 192 192 tussin chest congestion ... 219 UNISTIK 3 COMFORT ULTRA THIN PLUS DEVICE ...... 176, 192 tussin cough (dm only) .... 214 LANCETS ...... 176, 192 UNISTIK 3 COMFORT tussin cough-chest ULTRA TLC LANCETS .. 176, LANCET ...... 176, 192 congestion ...... 223 192 UNISTIK 3 EXTRA LANCET tussin dm ...... 223 ULTRA-CARE LANCETS ...... 176, 192 ...... 176, 192 tussin dm max ...... 223 UNISTIK 3 GENTLE 176, 192 ultracin m ...... 111 tussin pe ...... 218 UNISTIK 3 LANCETS ..... 177, TWINRIX (PF) ...... 52, 53 ULTRALANCE LANCETS 192 ...... 176, 192 TWIST LANCETS ... 175, 191 UNISTIK 3 NEONATAL ULTRA-THIN II LANCETS DEVICE ...... 177, 192 tyblume ...... 94 ...... 176, 192 UNISTIK 3 NORMAL TYKERB ...... 42 UNILET COMFORTOUCH LANCET ...... 177, 192 LANCET ...... 176, 192 tylophen ...... 28 UNISTIK CZT LANCET .. 177, UNILET EXCELITE II 192 U LANCET ...... 176, 192 UNISTIK PRO LANCET . 177, ULTI-LANCE ...... 175, 191 UNILET EXCELITE LANCET 192 ULTILET BASIC LANCETS ...... 176, 192 UNISTIK SAFETY ... 177, 192 ...... 176, 191 UNILET GP LANCET ..... 176, UNISTIK TOUCH LANCETS ULTILET CLASSIC 192 ...... 177, 192 LANCETS ...... 176, 191 UNILET LANCET .... 176, 192 UNITHROID ...... 144 ULTILET LANCETS 176, 191 UNILET SUPER THIN UNIVERSAL 1 LANCETS ULTILET SAFETY LANCETS LANCETS ...... 176, 192 ...... 177, 192 ...... 176, 191 unisom (diphenhydramine) URO-MAG ...... 121 ULTRA FINE LANCETS . 176, ...... 81, 210 191 UNISOM (DOXYLAMINE) . 81 UROQID-ACID NO.2 . 41, 162 ultra sleep (doxylamine succ) unisom sleepgels ...... 81, 210 ursodiol ...... 150 ...... 81 UNISTIK 2 DEVICE . 176, 192 UTIBRON NEOHALER ... 217 ultra strength antacid ...... 146 UNISTIK 2 EXTRA .. 176, 192 V ULTRA THIN II LANCETS ...... 176, 191 UNISTIK 2 NORMAL VAGINAL CONTRACEPTIVE LANCET,DEVICE ...... 176 FILM ...... 99

262 vaginal contraceptive foam 99 VERZENIO ...... 47 vits a and d-white pet-lanolin ...... 105 vagistat-3 ...... 225 Vestura (28) ...... 94 VIVAGUARD LANCET ... 177, valacyclovir...... 40 vicks dayquil cough ...... 214 193 valproic acid ...... 71, 79 VICKS DAYQUIL MUCUS VIVAGUARD LANCING CONTROL DM ...... 223 valproic acid (as sodium salt) DEVICE ...... 177, 193 ...... 71, 79 VICTOZA ...... 137 vol-care rx ...... 114 valsartan ...... 63 Vienva ...... 94 Volnea (28) ...... 87 valsartan-hydrochlorothiazide vinblastine ...... 50 VORTEX ADULT MASK . 181, ...... 63 Vincasar Pfs ...... 50 193 VALTOCO ...... 71, 78 vinorelbine ...... 50 VORTEX FROG MASK- valu-dryl ...... 208, 210 CHILD ...... 181, 193 Viorele (28) ...... 87 valu-dryl allergy ...... 208, 210 VORTEX HOLDING virt-caps ...... 113 CHAMBER ...... 181, 193 valu-tapp decongestant ... 224 virt-phos 250 neutral 122, 162 VORTEX LADYBUG MASK- vancomycin ...... 39 TODDLER ...... 181, 193 vista gel ...... 197 VANCOMYCIN ...... 39 VORTEX VHC LADYBUG vit a palmitate-vit c-vit d3 . 129 MASK-TODDLR ... 181, 193 vancomycin in 0.9 % sodium vitamin a and d ...... 105 chl ...... 39 VOTRIENT ...... 50 vitamin a and d diaper rash vanicream hc ...... 108 vp-vite rx ...... 114 ...... 109 vanquish ...... 32 Vyfemla (28) ...... 94 vitamin b complex ...... 113 VAQTA (PF) ...... 53 Vylibra ...... 94 vitamin b-1 ...... 131 VARIVAX (PF) ...... 55, 61 W vitamin b-1 (mononitrate) 131 vcf contraceptive gel ...... 99 wal-act d cold and allergy 205 vitamin b-6 ...... 132 VELCADE ...... 49 wal-dram 2 ...... 149 vitamin d3 ...... 134 Velivet Triphasic Regimen wal-dryl allergy ...... 208, 211 (28) ...... 97 VITAMIN D3 ...... 134 wal-fex allergy ...... 212, 213 venlafaxine ...... 74 vitamin e ...... 135 wal-finate ...... 206, 211 verapamil ...... 64, 67 vitamin e (dl, acetate) ...... 135 wal-itin ...... 212, 213, 214 verticalm ...... 149 vitamin e mixed ...... 135 wal-itin d 12 hour ...... 206 vitamins b complex ...... 113

263 wal-mucil fiber ...... 156 westhroid ...... 143 ZANTAC MAXIMUM STRENGTH ...... 151 WAL-MUCIL FIBER west-vite with folic acid .... 113 (ASPARTAME) ...... 156 Zarah ...... 94 Wixela Inhub ...... 218 wal-mucil with calcium ..... 156 ZARXIO ...... 165 wp thyroid ...... 143 wal-phed ...... 224 zeasorb af ...... 103 Wymzya Fe ...... 94 wal-phed d...... 224 ZEJULA ...... 49 X wal-profen ...... 31 Zenchent (28) ...... 94 XALKORI ...... 44 wal-sleep z ...... 81, 211 Zenchent Fe ...... 95 XARELTO ...... 164, 165 wal-som (diphenhydramine) ZENPEP ...... 150 ...... 81 XARELTO DVT-PE TREAT 30D START ...... 164 Zenzedi ...... 77, 79, 81 wal-som (doxylamine) ...... 81 XATMEP ...... 29, 45 zephrex-d ...... 224 wal-sporin ...... 101 XERAC AC ...... 104 zidovudine ...... 37 wal-tap ...... 205 XOFLUZA ...... 40 zinc oxide ...... 110 wal-tussin ...... 219 XOLAIR ...... 215 zolpidem ...... 82 wal-tussin cough and cold cf ...... 222 XTANDI ...... 45 zonisamide ...... 73 wal-tussin dm clear ...... 223 xulane...... 97 ZOSTAVAX (PF) ...... 55, 62 wal-zan 150 ...... 151 Y zostrix ...... 111 wal-zan 75 ...... 151 YF-VAX (PF) ...... 55 zostrix-hp ...... 111 wal-zyr (cetirizine) ... 212, 213 Yuvafem ...... 226 Zovia 1/35E (28) ...... 95 wal-zyr (ketotifen) ...... 198 Z Zovia 1/50E (28) ...... 95 warfarin ...... 164 ZADITOR ...... 199 z-sleep ...... 81, 211 wart remover ...... 109 Zafemy ...... 97 Zumandimine (28) ...... 95

WATER (BULK) ...... 84 zaleplon ...... 82 ZYDELIG ...... 48 weekly-d ...... 135 ZANOSAR ...... 51 ZYKADIA ...... 44

Wera (28) ...... 94 ZANTAC ...... 151 zyncof ...... 223 zantac 360 ...... 151 ZYTIGA ...... 43, 45

264