v Department of Human Services IOWA Medicaid Program Preferred / Recommended Only Drug List (Two Drug Columns) Effective January 1, 2020

Highlighted categories denote new changes to the PDL since previous update

Column Header Explanations: B, G or O: P, N, R, or NR: B = Brand P = Preferred G = Generic N = Non-Preferred O = OTC R = Recommended NR = Non-Recommended 3 BUSPIRONE 30mg - Use 2 BUSPIRONE 15mg 94 Preferred product is authorized generic distributed by tablets labeler 61314 6 FLUOXETINE HCL 20mg TABS - Use FLUOXETINE 98 PA required. Preferred for all indicated diagnoses HCL 20mg CAPS instead after step through Humira. 11 PA Required 99 Preferred product is authorized generic of EpiPen PA Required < 6 years of age and > 20 years of age distributed by labeler 49502 PA Required 104 Preferred product is authorized generic distributed by 13 PA Required > 90 days labeler 00406 16 Grandfathered for Existing Users with previous Actos 105 Unit Dose Preferred. No manual PA required if a use or CHF diagnosis preferred artificial tear agent is found in member’s 17 PA Required> 12 Units/30 Days supply pharmacy claims history in past 12 months 19 Preferred < 8yo 106 Preferred for indicated age group (2 to 12 years of 21 PROZAC,FLUOXETINE HCL 40mg CAPS - Use two age) FLUOXETINE HCL 20mg CAPS instead 107 PA required. Preferred for patients with Factor VIII 23 ULTRACET - Use Tramadol & Acetaminophen inhibitors only. Non-preferred for all other diagnoses. separately 110 72-hour emergency supply not available 24 PA Required >= 21 yo. 111 PA required < 6 years of age and > 17 years of age 25 PA Required: > 14 Units/30Days Supply 112 PA Required < 3 years of age and > 20 years of age 27 PA required for quantities exceeding 12-40mg 113 PA Required < 6 years of age and > 20 years of age capsules and 8-80mg capsules 115 PA Required < 6 years of age and > 20 years of age. 28 PA required for quantities exceeding 60-4mg tabs, Preferred product is authorized generic distributed by 60-8mg tabs, 4-20ml vials, and 8-2ml vials. labeler 10147 29 PA required for quantities exceeding 60-4mg tabs, 116 PA Required. Preferred product is authorized generic 60-8mg tabs. distributed by labeler 68682 36 Payable for members who are 12 years of age and 117 PA Required < 12 years of age older. Quantity limitations of 12 packets/4 weeks (28 days) or a total of 48 packets/16 weeks (112 days). 37 Restricted to persons 40 years of age and older. 39 Grandfather Existing Users 43 PA required for concurrent therapy with long acting injectable and oral antispychotics of the same chemical entity after 12 weeks (84 days) of concomitant therapy. 46 Grandfather for seizure disorder. Anticonvulsants Grandfather for seizure disorder. 47 Preferred with Conditions and allow a one time fill. 48 Those 0-18 should be referred to the Vaccines for Children Program. 50 Requires a Selected Brand Name Drug PA 52 Imipramine Pamoate - Use Imipramine HCL 63 Initial fill limited to 15 day supply. 64 Use Multiples of Phenytoin Sodium 100mg Capsules. 69 Payable for members who are 18 years of age and older. Quantity limitations of 30 grams/4 weeks (28 days) or a total of 120 grams/16 weeks (112 days) 70 Payable for members 50 years of age and older without prior authorization 72 Preferred < 2 years of age 74 PA Required < 4 years of age 76 PA Required < 15 years of age 77 PA Required < 6 years of age 78 PA Required < 9 years of age 80 PA Required < 18 years of age 87 No manual PA required if HMG-CoA reductase inhibitor found in member’s pharmacy claims history in past 12 months. 89 PA Required < 7 years of age 90 No manual PA required if a preferred injectable MS agent is found in member’s pharmacy claims history in past 12 months 92 Preferred for ages 19 through 64 93 No PA required for members 6 years of age or older when dosed within established quantity limits Iowa Medicaid Preferred Drug List (PDL) New Drug Process

New Drug Entities

New drug entities (including new generics), and new drug product dosage forms of existing drug entities) will be identified weekly and immediately be coded as "Non-preferred-Prior Authorization required" until presented at the next scheduled P&T Committee meeting. These prior authorization restrictions will continue through the review process, including while committee recommendations are being made, and lasting until DHS makes a final determination.

Exceptions to the Non-preferred default policy for new PDL drugs

There are two major potential exceptions to the non-preferred default policy for new PDL drugs:

A). If a new medication is classified as a priority drug by the FDA, the State may indicate that such a drug is preferred, until the drug is reviewed by the P&T Committee at the nearest scheduled meeting.

B). The State may decide to designate a new drug as "draft preferred" and provide immediate access and increased therapeutic choice to physicians until the drug is reviewed by the P&T Committee at the nearest scheduled meeting if: - a new drug is therapeutically equivalent or superior to existing preferred or non-preferred choices, and - is as safe or safer than existing preferred or non-preferred choices, and - the net cost, adjusted for all rebates, is less expensive than all existing preferred choices.

Existing PDL Drugs

Although the State discourages supplemental rebate offers on existing PDL drugs between annual bidding periods, it may entertain such bids and may accept them if they are determined to represent significant additional savings or if they would replace a delinquent manufacturer's product or a preferred drug pulled from the marketplace or significantly restricted by the FDA. This interim preferred status will remain in effect until the drug is reviewed by the P&T Committee at the next scheduled meeting. Supplemental rebates will only be invoiced for approved drugs under contract. Draft preferred drugs with supplemental rebates will not be invoiced until approved by the Committee and accepted by the State. At that time, the supplemental rebates will be invoiced back to the effective date of the agreement, which is the date the drug began to benefit from preferred status. B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P gentamicin sulfate ACE AND THIAZIDE COMBO'S G P gentamicin in saline

G P benazepril & hydrochlorothiazide G P neomycin sulfate

G P captopril & hydrochlorothiazide G P paromomycin sulfate

G P enalapril maleate & hydrochlorothiazide G P streptomycin sulfate

G P lisinopril & hydrochlorothiazide G P tobramycin neb solution G P tobramycin sulfate

ACE INHIBITORS

G P benazepril hcl ANALGESICS - MISC.

G P captopril O P aspirin

G P enalapril maleate G P diflunisal

G P fosinopril sodium G P salsalate

G P lisinopril O P aspirin buffered

G P quinapril hcl O P acetaminophen

G P ramipril G P butalbital-acetaminophen tab 50-325 mg

G P trandolapril G P butalbital-acetaminophen-caffeine cap 50-325-40 mg G P butalbital-acetaminophen-caffeine tab 50-325-40 mg

ACE INHIBITORS AND CALCIUM CHANNEL BLOCKERS G P butalbital-aspirin-caffeine

G P amlodipine besylate-benazepril hcl

G P trandolapril-verapamil hcl ANAPHYLAXIS THERAPY G 99 P epinephrine auto-injector

ACNE PRODUCTS: ISOTRETINOIN

G 11 P isotretinoin ANDROGENS - ANABOLICS G P danazol

AGENTS FOR FABRYS DISEASE G 11 P testosterone cypionate

B P FABRAZYME G 11 P testosterone enanthate

B 11 P GALAFOLD ANDROGENS -TOPICAL

AGENTS FOR PHEOCHROMOCYTOMA B 11 P ANDRODERM

G P phentolamine mesylate G 11 P testosterone 1% packets

ALCOHOL DETERRENTS ANORECTAL - MISC.

G P acamprosate calcium G P hydrocortisone (rectal)

G P disulfiram G P hydrocortisone (intrarectal)

ALPHA-PROTEINASE INHIBITOR ANTHELMINTICS

B 11 P PROLASTIN C B P ALBENZA G 106 P benznidazole

ALS DRUG G P ivermectin

G 11 P riluzole B P BILTRICIDE

ALZHEIMER - CHOLINOMIMETICS ANTI INFECTIVE COMBO'S - MISC.

G 37 P donepezil hydrochloride G P sulfamethoxazole-trimethoprim

G 37 P galantamine tabs

G 37 P rivastigmine cap ANTIANGINALS

G 37 P memantine G P ranolazine

AMINO GLYCOSIDES

G P amikacin sulfate

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P terbutaline sulfate tab 5 mg ANTIANGINALS--ISOSORBIDE NITRATE ANTIASTHMATIC - LEUKOTRIENE RECEPTOR ANTAGONISTS G P isosorbide dinitrate

G P isosorbide mononitrate G P montelukast sodium chew tab 4 mg (base equiv) G P montelukast sodium chew tab 5 mg (base equiv)

ANTIARRHYTHMICS G P montelukast sodium tab 10 mg (base equiv)

G P disopyramide phosphate G 72 P montelukast granules

G P procainamide hcl ANTIASTHMATIC - MISC. RESPIRATORY INHALANTS G P quinidine gluconate

G P quinidine sulfate G P sodium chloride soln nebu 0.9%

G P mexiletine hcl ANTIASTHMATIC - MIXED ADRENERGICS G P flecainide acetate

G P propafenone hcl G P epinephrine hcl

G P amiodarone hcl tab 200 mg

G P dofetilide ANTIASTHMATIC - MUCOLYTICS

B P MULTAQ G P acetylcysteine

ANTIASTHMATIC - ADRENERGIC COMBOS ANTIASTHMATIC - NASAL MISC.

G P fluticasone/salmeterol G P ipratropium bromide (nasal) soln 0.03%

B P COMBIVENT RESPIMAT

G P ipratropium-albuterol ANTIASTHMATIC - STEROID INHALANTS

B P SYMBICORT G 19 P budesonide (inhalation)

B P BEVESPI AEROSPHERE B P PULMICORT INHALER

B P UTIBRON NEOHALER B P FLOVENT HFA

B P ADVAIR DISKUS B P FLOVENT DISKUS

B P ADVAIR HFA B P ASMANEX

B P DULERA

B P STIOLTO RESPIMAT ANTIASTHMATIC - XANTHINES G P aminophylline

ANTIASTHMATIC - ANTI-CHOLINERGICS B P ELIXOPHYLLIN

G P ipratropium bromide B P THEO-24

B P ATROVENT HFA G P theophylline

B P SPIRIVA HANDIHALER

ANTIASTHMATIC - ANTIINFLAMMATORY AGENTS

G P cromolyn sodium

ANTIASTHMATIC - BETA - ADRENERGICS

G 72 P albuterol sulfate nebu 0.63mg/3

G P albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)

G P albuterol sulfate soln nebu 0.5% (5 mg/ml)

G P albuterol sulfate syrup 2 mg/5ml

G P albuterol sulfate tab sr 12hr 4 mg

G P albuterol sulfate tab sr 12hr 8 mg

B P PROAIR HFA

B P PROVENTIL HFA

B P PROAIR RESPICLICK

B 74 P SEREVENT DISKUS

G P terbutaline sulfate tab 2.5 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B P TEGRETOL SUSP ANTIBIOTICS - MISC. G P gabapentin cap 100 mg G P gabapentin cap 300 mg B P AZACTAM G P gabapentin cap 400 mg B 89 P CAYSTON G P gabapentin oral soln 250 mg/5ml G P colistimethate sodium G P gabapentin tab 600 mg G P metronidazole tab 250 mg G P gabapentin tab 800 mg G P metronidazole tab 500 mg B P VIMPAT B P METRO IV G P lamotrigine G P metronidazole in nacl G P lamotrigine chewable tablet B P NEBUPENT G P levetiracetam B P PENTAM 300 G P oxcarbazepine susp G P trimethoprim G P oxcarbazepine tab 150 mg G P vancomycin hcl G P oxcarbazepine tab 300 mg G P vancomycin hcl caps G P oxcarbazepine tab 600 mg G P vancomycin hcl in dextrose G 11 P pregabalin B P TYGACIL G P primidone G P sulfadiazine G P topiramate

ANTICOAGULANTS G P topiramate sprinkle capsule G P zonisamide G P heparin sodium (porcine)

G P heparin (porcine) in sodium chloride ANTIDEPRESSANTS - MAO INHIBITORS G P enoxaparin sodium syringes G P phenelzine sulfate G P enoxaparin sodium vials G P tranylcypromine sulfate G P warfarin sodium

B P PRADAXA

B P ELIQUIS

B P XARELTO

ANTICONVULSANTS

G P clobazam

G P clonazepam

G P diazepam (anticonvulsant) gel

B P GABITRIL

G P phenytoin susp

G P phenytoin infatab

G P phenytoin sodium

B P DILANTIN CAPS 30MG

G P phenytoin sodium extended cap 100 mg

G P ethosuximide soln 250 mg/5ml

B P ZARONTIN

G P divalproex sodium

G P divalproex sodium cap sprinkle

G P divalproex sodium tablet er 24hr

G P valproate sodium

G P valproic acid

B P FYCOMPA

G P carbamazepine

G P carbamazepine capsule er 12hr

G P carbamazepine tablet er 12hr

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B 27 P EMEND ANTIDEPRESSANTS - SELECTED SSRI'S ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC G P mirtazapine

G P nefazodone hcl G P promethazine hcl suppos 12.5 mg

G P trazodone hcl G P promethazine hcl suppos 25 mg

B P TRINTELLIX G P promethazine hcl syrup 6.25 mg/5ml

G P citalopram hydrobromide G P promethazine hcl tab 25 mg

G P escitalopram oxalate G P promethazine hcl tab 50 mg

G P fluoxetine hcl O P meclizine hcl

G P fluvoxamine maleate G P meclizine hcl

G P paroxetine hcl B P TRANSDERM-SCOP

G P paroxetine hcl er G P trimethobenzamide hcl

B P PAXIL SUSP B P DICLEGIS

G P sertraline hcl ANTIFUNGALS - ASSORTED G P desvenlafaxine

G P duloxetine hcl B 13 P AMBISOME

G P venlafaxine hcl B 13 P ANCOBON

G P venlafaxine hcl cap sr 24hr 150 mg (base equivalent) G 13 P griseofulvin sus

G P venlafaxine hcl cap sr 24hr 37.5 mg (base equivalent) G P nystatin

G P venlafaxine hcl cap sr 24hr 75 mg (base equivalent) G 13 P terbinafine hcl

G P maprotiline hcl G 13 P fluconazole

G P bupropion hcl tab 100 mg G 13 P fluconazole in nacl

G P bupropion hcl tab 75 mg G 13 P fluconazole in dextrose

G P bupropion hcl tab sr 12hr 100 mg B 13 P VFEND IV

G P bupropion hcl tab sr 12hr 150 mg G 13 P voriconazole

G P bupropion hcl tab sr 12hr 200 mg B 13 P CANCIDAS

G P bupropion hcl tab sr 24hr 150 mg B P MYCAMINE

G P bupropion hcl tab sr 24hr 300 mg G 13 P clotrimazole troche

ANTIDEPRESSANTS - TRI-CYCLICS ANTIHEMOPHILIA FACTOR IX AGENTS

G P amitriptyline hcl B P ALPHANINE SD

G P amoxapine B P MONONINE

G 104 P clomipramine hcl B P BENEFIX

G P desipramine hcl B P ALPROLIX

G P doxepin hcl B P PROFILNINE SD

G P imipramine hcl ANTIHEMOPHILIA FACTOR VII AGENTS G P nortriptyline hcl

B P SURMONTIL B P NOVOSEVEN

ANTIDOTES

G P deferoxamine mesylate

ANTIDOTES - CHELATING AGENTS

B 11 P EXJADE

B P CHEMET

ANTIEMETIC - 5-HT3 RECEPTOR ANTAGONISTS/ SUBSTANCE P NEUROKININ

G 29 P ondansetron odt

G 28 P ondansetron hcl

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P clonidine hcl tab 0.2 mg ANTIHEMOPHILIA FACTOR VIII AGENTS G P clonidine hcl tab 0.3 mg

B P HEMOFIL M G P guanfacine hcl

B P KOATE-DVI G P methyldopa

B P MONOCLATE-P G P prazosin hcl

B P KOGENATE FS G P hydralazine hcl

B P RECOMBINATE G P minoxidil

B P NOVOEIGHT ANTI-INFLAMMATORIES, NON-NSAID B P NUWIQ

B P ADVATE B 11 P HUMIRA

B P XYNTHA B 11 P HUMIRA PEN

B P AFSTYLA B 47 P HUMIRA PEN-CROHNS DISEASESTARTER

B 107 P HEMLIBRA B 47 P HUMIRA PEN-PSORIASIS STARTER B 11 P ENBREL

ANTIHEMOPHILIA FACTOR VON WILLEBRAND FACTOR AGENTS B 98 P COSENTYX

B P ALPHANATE ANTILEPROTIC B P HUMATE-P

B P WILATE B P THALOMID

ANTIHISTAMINES - NON-SEDATING ANTIMALARIAL AGENTS

O P cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) G P chloroquine phosphate

O P cetirizine hcl tab 10 mg G P hydroxychloroquine sulfate

O P cetirizine hcl tab 5 mg G P mefloquine hcl

O P loratadine syrup 5 mg/5ml B P KRINTAFEL

O P loratadine tab 10 mg G P atovaquone-proguanil

G P azelastine spr 0.1% ANTIMYCOBACTERIALS / ANTITUBERCULOSIS B P PATANASE G P ethambutol hcl

ANTIHISTAMINES - OTHER B P TRECATOR

O P chlorpheniramine maleate G P isoniazid

O P diphenhydramine hcl G P pyrazinamide

G P diphenhydramine inj G P rifampin

G P cyproheptadine hcl B P PRIFTIN

G P hydroxyzine hcl soln ANTI-PARKINSONIAN DRUGS G P hydroxyzine hcl syrp

G P hydroxyzine hcl tab 25 mg G P amantadine hcl cap 100 mg

G P hydroxyzine hcl tab 50 mg G P amantadine hcl syrup 50 mg/5ml

G P hydroxyzine hcl tabs 10mg B P PARLODEL

G P hydroxyzine pamoate G P bromocriptine mesylate 2.5mg tabs

G P prochlorperazine supp B P INBRIJA

G P prochlorperazine maleate G P carbidopa-levodopa

G P prochlorperazine edisylate G P carbidopa-levodopa-entacapone G P selegiline hcl

ANTIHYPERTENSIVE COMBOS ANTIPROTOZOAL AGENTS G P methyldopa & hydrochlorothiazide G P atovaquone

ANTIHYPERTENSIVES - CENTRAL B P ALINIA

B P CATAPRES-TTS

G P clonidine hcl tab 0.1 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories ANTI-PSORIATICS - NON-BIOLOGICALS ANXIOLYTICS - BENZODIAZEPINES

G P calcipotriene G P alprazolam

B 11 P TAZORAC B P ALPRAZOLAM INTENSOL

B P OXSORALEN ULTRA G P chlordiazepoxide hcl G 78 P clorazepate dipotassium

ANTIPSYCHOTICS - ATYPICALS G P diazepam

B 43 P INVEGA SUSTENNA G P lorazepam

B 43 P INVEGA TRINZA G 77 P oxazepam

G 43 P risperidone

B P PERSERIS ANXIOLYTICS - MISC.

B 43 P RISPERDAL CONSTA G P buspirone hcl tab 10 mg

G P quetiapine fumarate G P buspirone hcl tab 15 mg

G P quetiapine er G P buspirone hcl tab 5 mg

G P olanzapine G P buspirone hcl tab 7.5 mg

G P aripiprazole tablets G P droperidol

B P ARISTADA G P meprobamate

G P ziprasidone hcl ARB COMBINATIONS

ANTIPSYCHOTICS - SPECIAL ATYPICALS B 11 P ENTRESTO

G P clozapine ARB/CCB

ANTIPSYCHOTICS - TYPICAL G P amlodipine-olmesartan

G 43 P haloperidol G P amlodipine besylate-valsartan

G 43 P haloperidol lactate

G 43 P haloperidol decanoate ARB/CCB PLUS DIURETICS

G P loxapine succinate G P amlodipine-valsartan-hydrochlorothiazide

G 43 P fluphenazine hcl

G 43 P fluphenazine decanoate ARB'S

G P perphenazine G P irbesartan

G P thioridazine hcl G P losartan potassium

G P trifluoperazine hcl G P valsartan

G P thiothixene ARB'S AND DIURETICS

ANTISPASMODICS G P irbesartan-hydrochlorothiazide

G P oxybutynin syp 5mg/5ml G P losartan potassium & hydrochlorothiazide

G P oxybutynin tab 5mg G P valsartan-hydrochlorothiazide

G P flavoxate hcl ARTHRITIS - MISC.

ANTISPASMODICS - LONG ACTING B P RIDAURA

G P oxybutynin chloride er

G P solifenacin ARTIFICIAL SALIVA/STIMULANTS G P pilocarpine hcl (oral)

ANTI-THROMBOCYTOPENICS

B 11 P PROMACTA BETA BLOCKERS - ALPHA / BETA G P carvedilol

ANTITHYROID THERAPIES G P labetalol hcl

G P methimazole

G P propylthiouracil

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B P ZOSYN BETA BLOCKERS - CARDIO SELECTIVE BPH G P acebutolol hcl G P doxazosin mesylate G P atenolol G P terazosin hcl G P bisoprolol fumarate G P alfuzosin hcl G P metoprolol succinate G P finasteride G P metoprolol tartrate G P tamsulosin hcl

BETA BLOCKERS - NON SELECTIVE CALCIUM CHANNEL BLOCKERS--AMLODIPINES G P nadolol G P amlodipine besylate G P pindolol

G P propranolol hcl CALCIUM CHANNEL BLOCKERS--DILTIAZEMS G P sotalol hcl

G P sotalol hcl (afib/afl) G P diltiazem hcl

G P timolol maleate G P diltiazem hcl extended release beads

BETA BLOCKERS AND DIURETIC COMBO'S CALCIUM CHANNEL BLOCKERS--NIFEDIPINES

G P atenolol & chlorthalidone G P nifedipine

G P bisoprolol & hydrochlorothiazide G P nifedipine tab sr 24hr 30 mg

G P propranolol & hydrochlorothiazide G P nifedipine tab sr 24hr 60 mg G P nifedipine tab sr 24hr 90 mg

BETA-LACTAMS / CLAVULANATE COMBO'S CALCIUM CHANNEL BLOCKERS--VERAPAMILS G P penicillin g potassium

B P PFIZERPEN-G G P verapamil hcl

G P penicillin g pot in dextrose G P verapamil hcl er tab

B P BICILLIN CARBAPENEMS G P penicillin v potassium

G P amoxicillin (trihydrate) cap 250 mg B P INVANZ

G P amoxicillin (trihydrate) chew tab 125 mg G P meropenem

G P amoxicillin (trihydrate) chew tab 250 mg CARDIAC GLYCOSIDES G P amoxicillin (trihydrate) for susp 125 mg/5ml

G P amoxicillin (trihydrate) for susp 200 mg/5ml G P digoxin

G P amoxicillin (trihydrate) for susp 250 mg/5ml

G P amoxicillin (trihydrate) for susp 400 mg/5ml CARNITINE REPLENISHER - AGENTS

G P amoxicillin (trihydrate) tab 500 mg B P CARNITOR SOL 1GM/10ML

G P amoxicillin (trihydrate) tab 875 mg B P CARNITOR TAB 330MG

G P ampicillin B P CARNITOR SF SOL 1GM/10ML

G P dicloxacillin sodium G P levocarnitine inj 200 mg/ml

G P nafcillin sodium

G P oxacillin sodium CENTRAL PRECOCIOUS PUBERTY AGENTS

B P BACTOCILL IN DEXTROSE B 11 P LUPR DEP-PED INJ 11.25MG

G P amoxicillin & k clavulanate chew tab 400-57 mg B 11 P LUPR DEP-PED INJ 15MG

G P amoxicillin & k clavulanate for susp 200-28.5 mg/5ml B 11 P LUPR DEP-PED INJ 7.5MG

G P amoxicillin & k clavulanate for susp 400-57 mg/5ml

G P amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

G P amoxicillin & k clavulanate tab 500-125 mg

G P amoxicillin & k clavulanate tab 875-125 mg

G P ampicillin & sulbactam sodium

G P piperacillin sodium-tazobactam sodium

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories CEPHALOSPORINS CHOLINERGIC

G P cefadroxil cap 500 mg G P bethanechol chloride

G P cefadroxil for susp 250 mg/5ml COMPOUNDING MATERIALS G P cefadroxil for susp 500 mg/5ml

G P cefazolin sodium B P STERILE DILU SOL FLOLAN

G P cefazolin in d5w G P bacteriostatic water for injection

G P cephalexin G P water for inject, bacteriostatic parabens

G P cephalexin caps 750mg G P saline, bacteriostatic

G P cefprozil

G P cefuroxime axetil tab 250 mg CONTRACEPTIVES - EMERGENCY CONTRACEPTIVE

G P cefuroxime axetil tab 500 mg O P levonorgestrel (emergency oc)

G P cefuroxime sodium B P ELLA

G P cefdinir

B P CLAFORAN CONTRACEPTIVES - INJECTABLE

G P ceftazidime G P medroxyprogesterone acetate (contraceptive)

G P ceftriaxone sodium

G P ceftriaxone sodium in dextrose CONTRACEPTIVES - MONOPHASIC COMBINATION O/C'S

G P cefepime hcl G P desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg G P drospirenone-ethinyl estradiol tab 3-0.03 mg

CHELATING AGENTS G P gianvi

B P SYPRINE G P ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg

B P DEPEN TITRATABS B P ZOVIA 1/50E G P levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg

CHOLESTEROL - BILE SEQUESTRANTS G P levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg

G P cholestyramine G P norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

G P cholestyramine light G P norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

B P WELCHOL TABLETS G P norethindrone & ethinyl estradiol tab 1 mg-35 mcg

G P colestipol hcl G P norethindrone & ethinyl estradiol tab 1 mg-20 mcg G P norethindrone & ethinyl estradiol tab 1.5 mg-30 mcg

CHOLESTEROL - FIBRIC ACID DERIVATIVES B P NECON 1/50-28

G P fenofibrate nanocrystallized 48mg tabs G P norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg

G P fenofibrate nanocrystallized 145mg tabs B P GENERESS FE CHW

G P gemfibrozil G P norethindrone & ethinyl estradiol-fe chew G P norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg

CHOLESTEROL - HMG COA + ABSORB INHIBITORS: HIGH POTENCY DRUGS/COMBINATIONSG P norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg

G P atorvastatin calcium G P desogestrel-ethinyl estradiol (biphasic)

G P rosuvastatin G P levonorgestrel-ethinyl estradiol (91-day) tabs

G P simvastatin tab 10 mg B P SEASONIQUE

G P simvastatin tab 20 mg CONTRACEPTIVES - PATCHES/ VAGINAL PRODUCTS G P simvastatin tab 40 mg

G P simvastatin tab 5 mg G P xulane

B P VYTORIN B P NUVARING

CHOLESTEROL - HMG COA + ABSORB INHIBITORS: LOW POTENCY DRUGS/COMBINATIONSCONTRACEPTIVES - PROGESTIN ONLY

B 87 P ZETIA G P norethindrone (contraceptive)

B P LESCOL XL B P ORTHO MICRONOR

G P lovastatin

G P pravastatin sodium

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories B P LEVEMIR CONTRACEPTIVES - TRI-PHASIC COMBINATIONS B P HUMULIN R U-500 KWIKPEN

G P desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg

G P levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg DIABETIC - MEGLITINIDES

G P norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg G P nateglinide

G P norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg G P repaglinide

G P norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg

B P ORTHO TRI-CYCLEN DIABETIC - NON-INSULIN INJECTABLES

B P ESTROSTEP FE B 11 P BYDUREON B 11 P BYETTA

COUGH/COLD - ANTITUSSIVE-EXPECTORANT B 11 P VICTOZA

O P dextromethorphan-guaifenesin syrup 10-100 mg/5ml B 11 P OZEMPIC

COUGH/COLD - SYSTEMIC DECONGESTANTS DIABETIC - ORAL BIGUANIDES

O P pseudoephedrine hcl tab 30 mg G P metformin hcl

O P pseudoephedrine hcl tab 60 mg G P metformin hcl tab sr

O P pseudoephedrine hcl liq 30 mg/5ml DIABETIC - ORAL SULFONYLUREAS

COX 2 INHIBITORS - SELECTIVE G P chlorpropamide

G P meloxicam G P glimepiride

G P nabumetone G P glipizide G P glyburide

CYSTIC FIBROSIS AGENTS G P glyburide micronized

B 11 P PULMOZYME G P tolazamide

CYTO-MEGALOVIRUS AGENTS DIABETIC - OTHER

G P valganciclovir hcl tablets B P GLUCAGEN

G P valcyte oral solution B P PROGLYCEM B 11 P TRADJENTA

DENTAL PRODUCTS B 11 P JANUVIA

G P sodium fluoride (dental) B 11 P JARDIANCE

G P stannous fluoride B 11 P JENTADUETO B 11 P JANUMET

DIABETIC - ALPHAGLUCOSIDASE B 11 P JANUMET XR

G P acarbose B 11 P SYNJARDY

B P GLYSET DIABETIC - SULFONYLUREA / BIGUANIDE

DIABETIC - INSULIN G P glipizide-metformin hcl

B P LANTUS INJ 100/ML G P glyburide-metformin

B P INSULIN LISPRO

B P LEVEMIR DIABETIC - THIAZOL

B P HUMALOG MIX 50/50 G P pioglitazone hcl

B P HUMALOG MIX 75/25

B P HUMULIN R U-500

DIABETIC - INSULIN PENFILLS

B P NOVOLOG FLEXPEN

B P LANTUS SOLOSTAR

B P INSULIN LISPRO KWIKPEN

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P amino acid electrolyte infusion DIURETICS ENDOMETRIOSIS AGENTS G 11 P eplerenone B P DEPO-SUB Q PROVERA 104 G P acetazolamide B P SYNAREL B P DIAMOX

G P bumetanide ERYTHROPOEISIS STIMULATING AGENTS B P EDECRIN

G P furosemide B 11 P EPOGEN

G P torsemide B 11 P RETACRIT

G P amiloride hcl ESTROGEN COMBOS G P spironolactone

G P chlorothiazide tab B P PREMPHASE

G P chlorthalidone B P PREMPRO

G P hydrochlorothiazide B P COMBIPATCH

G P indapamide B P ANGELIQ

G P methyclothiazide B P CLIMARA PRO

G P metolazone ESTROGENS - PATCHES G P amiloride & hydrochlorothiazide

B P ALDACTAZIDE TABS 50/50 B P ALORA

G P spironolactone & hydrochlorothiazide

G P triamterene & hydrochlorothiazide ESTROGENS - TABS B P PREMARIN

DOPAMINE RECEPTOR AGONISTS G P estradiol

G P cabergoline B P DEPO-ESTRADIOL G P estropipate

EAR FLUOROQUINOLONES G P ofloxacin (otic)

G P acetic acid (otic) G P ciprofloxacin iv soln 200 mg/20ml (1%)

B 19 P CIPRODEX G P ciprofloxacin iv soln 400 mg/40ml (1%)

B P CIPRO HC G P ciprofloxacin-ciprofloxacin hcl

G P neomycin-polymyxin-hc (otic) G P ciprofloxacin hcl tab 100 mg (base equiv)

B P COLY-MYCIN S G P ciprofloxacin hcl tab 250 mg (base equiv)

G P antipyrine-benzocaine G P ciprofloxacin hcl tab 500 mg (base equiv) G P ciprofloxacin hcl tab 750 mg (base equiv)

ELECTROLYTES/ NUTRITIONALS G P levofloxacin

O P oral electrolyte solution

G P lactated ringer's

G P potassium chloride in nacl

G P potassium chloride in dextrose

G P dextrose w/ sodium chloride

G P dextrose in lactated ringers

G P potassium chloride in dextrose & sodium chloride

G P dextrose

B P LIPOSYN

G P amino acid infusion soln 6%

B P AMINOSYN

B P AMINOSYN II

B P PREMASOL

B P TRAVASOL

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories GI - ANTI - FLATULENTS / GI STIMULANTS GI - INFLAMMATORY BOWEL AGENTS

O P sennosides tab 8.6 mg G P balsalazide disodium

G P lactulose B P APRISO CAP 0.375GM

O P polyethylene glycol 3350 B P CANASA

G P polyethylene glycol 3350 pack 3350 nf B P DELZICOL CAP 400MG

B P NULYTELY G P mesalamine rectal

G P peg 3350-potassium chloride-sod bicarbonate-sod chloride G P sulfasalazine

B P COLYTE GI - IRRITABLE BOWEL SYNDROME AGENTS G P peg 3350-kcl-sod bicarb-sod chloride-sod sulfate

B P GOLYTELY B P LOTRONEX

G P cromolyn sodium (mastocytosis) GI - MISC. B P GASTROCROM

G P metoclopramide hcl O P magnesium hydroxide susp 400 mg/5ml

G P lactulose (encephalopathy) O P sennosides syrup 8.8 mg/5ml O P sennosides-docusate sodium tab 8.6-50 mg

GI - ANTIDIARRHEAL / ANTACID - MISC. B P SUPREP

O 11 P sodium bicarbonate (antacid) tabs G P ursodiol

O 11 P magnesium oxide tab 400 mg GI - MISC. ANTI-ULCER G P atropine sulfate

B P ANASPAZ G P sucralfate tab 1 gm

G P hyoscyamine sulfate

G P glycopyrrolate tabs GI - PROSTAGLANDINS

G P methscopolamine bromide G P misoprostol

G P propantheline bromide

G P dicyclomine hcl GI - PROTON PUMP INHIBITOR B P DEXILANT

GI - ANTIPERISTALTIC AGENTS G P omeprazole

G P diphenoxylate w/ atropine G P pantoprazole sodium

G P loperamide hcl cap 2 mg

O P loperamide hcl liq 1 mg/5ml (0.2 mg/ml) GI - ULCER ANTI-INFECTIVE

O P loperamide hcl tab 2 mg B P PYLERA

O P loperamide hcl liq 1mg/7.5ml GI, CONSTIPATION - IBS-OIC

GI - DIGESTIVE ENZYMES B 11 P AMITIZA

B P CREON B 11 P LINZESS 145MCG

G P pancrelipase (lipase-protease-amylase) B 11 P LINZESS 290MCG

B P ZENPEP B 11 P MOVANTIK

GI - H2-ANTAGONISTS

G P cimetidine

G P ranitidine hcl inj 150 mg/6ml (25 mg/ml)

G P ranitidine hcl inj 50 mg/2ml (25 mg/ml)

G P ranitidine hcl syrup 15 mg/ml (75 mg/5ml)

G P ranitidine hcl tab 150 mg

G P ranitidine hcl tab 300 mg

G P famotidine for susp 40 mg/5ml

G P famotidine tab 20 mg

G P famotidine tab 40 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P ribavirin tab 200 mg GLUCOCORTICOIDS - MINERALOCORTICOIDS B 11 P MAVYRET

G P budesonide G 11 P sofosbuvir/velpatasvir

G P cortisone acetate HEREDITARY ANGIOEDEMA AGENTS G P dexamethasone

B P DEXAMETHASONE INTENSOL B 11 P HAEGARDA

G P dexamethasone sodium phosphate B 11 P RUCONEST

B P CORTEF G 11 P icatibant

G P hydrocortisone B 11 P TAKHZYRO

B P A-HYDROCORT

B P SOLU-CORTEF HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS

B P MEDROL PAK 4MG B P ORFADIN

B P MEDROL TAB 4MG

G P methylprednisolone tab 4 mg HERPES AGENTS

G P methylprednisolone acetate G P acyclovir

G P methylprednisolone sod succ G P acyclovir susp

B P SOLU-MEDROL G P acyclovir sodium

G P prednisolone G P valacyclovir hcl

G P prednisolone sodium phosphate

G P prednisone HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS

B P KENALOG G P calcitriol

G P fludrocortisone acetate HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS AND CALCIMIMETICS

GOUT B P ZEMPLAR CAPSULES

G P allopurinol

G P colchicine capsules IMMUNE SERUMS

G P probenecid B P HYPERHEP B S/D SOLN

G P colchicine w/ probenecid B P NABI-HB B P GAMMAGARD

GRANULOCYTE CSF B P HIZENTRA

B 11 P NEUPOGEN B P CUVITRU B P GAMUNEX-C

GROWTH HORMONE B P CUTAQUIG

B 11 P NORDITROPIN B P HYPERRHO S/D

B 11 P NUTROPIN AQ B P MICRHOGAM ULTRA-FILTEREDPLUS B P RHOGAM ULTRA-FILTERED PLUS

HEMOSTATIC B P RHOPHYLAC

G P aminocaproic acid B P WINRHO SDF

B P AMICAR B P HYPERTET S/D B P HYQVIA

HEPATITIS B ONLY

B P HEPSERA

G P entecavir

HEPATITIS C AGENTS

B P PEGASYS

B P PEGASYS PROCLICK

B P PEG-INTRON

G P ribavirin cap 200 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P azithromycin tab 600 mg IMMUNOSUPPRESSANTS G P clarithromycin for susp 125 mg/5ml

G P cyclosporine G P clarithromycin for susp 250 mg/5ml

B P SANDIMMUNE G P clarithromycin tab 250 mg

G P cyclosporine modified (for microemulsion) G P clarithromycin tab 500 mg

G P gengraf MIGRAINE - ERGOT COMBINATIONS B P CELLCEPT SUSR

G P mycophenolate mofetil tabs B P MIGERGOT

G P mycophenolate mofetil caps MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)--INJECTABLES B P MYFORTIC

B P RAPAMUNE G 17 P sumatriptan spray

G P sirolimus G 17 P sumatriptan succinate

G P tacrolimus B 17 P ZOMIG NASAL SPRAY

INFLUENZA AGENTS MIGRAINE - SELECTIVE SEROTONIN AGONISTS (5HT)--TABS

G P rimantadine hydrochloride G 17 P naratriptan hcl

B 25 P TAMIFLU G 17 P rizatriptan benzoate

B P RELENZA DISKHALER G 17 P rizatriptan benzoate tablet disperse

B 48 P FLULAVAL QUAD 2019-20 G 17 P sumatriptan succinate

B 48 P FLUZONE HD INJ PF 2019-20

B 48 P FLUARIX QUAD 2019-20

B 48 P FLUZONE QUAD INJ 2019-20

B 48 P AFLURIA QUAD 2019-20

B 48 P FLUAD INJ 2019-20

K REMOVING RESINS

G P sodium polystyrene sulfonate

LINCOSAMIDES / OXAZOLIDINONES / LEPROSTATICS

G P clindamycin hcl cap 150 mg

G P clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)

B P CLEOCIN IN D5W

G 11 P linezolid

B 11 P ZYVOX INJ

G P dapsone

LITHIUM

G P lithium carbonate cap 150 mg

G P lithium carbonate cap 300 mg

G P lithium carbonate tab 300 mg

G P lithium carbonate tab cr 300 mg

G P lithium carbonate tab cr 450 mg

MACROLIDES / ERYTHROMYCIN'S / KETOLIDES

G P azithromycin for susp 100 mg/5ml

G P azithromycin for susp 200 mg/5ml

G P azithromycin powd pack for susp 1 gm

G P azithromycin tab 250 mg

G P azithromycin tab 500 mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G P triamcinolone acetonide dental paste 0.1% MINERALS MOUTH ANTI-INFECTIVES G P sodium acetate inj 2 meq/ml G P nystatin susp 100000 unit/ml G P sodium bicarbonate inj 4.2%

G P sodium bicarbonate inj 7.5% MOUTH ANTISEPTICS G P sodium bicarbonate inj 8.4% G P chlorhexidine gluconate soln 0.12% O 11 P calcium carbonate

O 11 P calcium citrate MUCOPOLYSACCHARIDOSIS O 11 P calcium carbonate-vitamin d tab

G P sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf) B P ALDURAZYME

G P sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf) MULTIPLE SCLEROSIS AGENTS G P sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

G P sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop naf) B 90 P TECFIDERA

G P sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf) MULTIPLE SCLEROSIS AGENTS – INTERFERONS B P SSKI

G P magnesium sulfate inj 4% B P AVONEX

G P magnesium sulfate inj 50% B P AVONEX PEN

G P magnesium sulfate inj 8% B P REBIF

B 11 P MAGNEBIND 400 B P REBIF REBIDOSE

G P sodium phosphate inj 3 mmole/ml B P REBIF REBIDOSE TITRATIONPACK

G P pot phosphate monobasic w/ sod phosphate dibasic & monobasic B P BETASERON

G P potassium acetate inj 2 meq/ml

G P potassium bicarbonate effer tab 25 meq MULTIPLE SCLEROSIS AGENTS – NON-INTERFERONS

B P MICRO-K B P COPAXONE SOSY 20MG/ML

G P potassium chloride inj 10 meq/100 ml B 90 P AUBAGIO

G P potassium chloride inj 10 meq/50 ml G 11 P dalfampridine er

G P potassium chloride inj 2 meq/ml B 90 P GILENYA

G P potassium chloride tab cr 10 meq

G P potassium chloride tab cr 8 meq (600 mg) MUSCLE RELAXANTS

G P potassium chloride cap er 10 meq G P baclofen

G P potassium chloride cap er 8 meq G P chlorzoxazone

G P potassium chloride tablet er 20meq er G P cyclobenzaprine hcl

G P sodium chloride inj 0.45% G P methocarbamol

G P sodium chloride inj 0.9% G P orphenadrine citrate

G P sodium chloride inj 3% G P tizanidine hcl

G P sodium chloride iv soln 0.9%

G P trace minerals (cr-cu-mn-se-zn) NARCOTIC - ANTAGONISTS

O P ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe) B P NARCAN

O P ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) G P naloxone hcl

O P ferrous sulfate tab 325 mg (65 mg elemental fe) G P naltrexone hcl

O P ferrous gluconate tab 324 mg (38 mg elemental iron)

O P ferrous fumarate tab 325 mg (106 mg elemental fe)

G P iron dextran

G P saline w/ benzyl alcohol

MOUTH - ANESTHETICS TOPICAL ORAL

G P lidocaine hcl viscous soln 2%

MOUTH - STEROIDS

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories O 80 P nicotine polacrilex lozenge 4mg NARCOTICS - MISC. O 80 P nicotine polacrilex gum 4mg

G 80 P codeine sulfate O 80 P nicotine polacrilex lozenge 2mg

G P hydromorphone hcl tab 2 mg NITRO - OINTMENT/CAP/CR G P hydromorphone hcl tab 4 mg

G P hydromorphone hcl tab 8 mg B P NITRO-BID

G P morphine sulfate G P nitroglycerin

G P oxycodone hcl NITRO - PATCHES G P oxycodone capsules

G 11 P buprenorphine hcl tablets B P NITRO-DUR DIS 0.8MG/HR

G 11 P buprenorphine-naloxone sl tabs G P nitroglycerin

G P oxycodone w/ acetaminophen tab 5-325 mg

G P oxycodone w/ acetaminophen tabs 2.5-325 NITRO - SUBLINGUAL/ SPRAY

G P oxycodone-aspirin B P NITROSTAT

G 80 P acetaminophen w/ codeine

G P butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg NSAIDS

G P hydrocodone-acetaminophen G P diclofenac potassium G P diclofenac sodium

NARCOTICS - SELECTED G P etodolac tab 400 mg

G 80 P tramadol hcl G P etodolac tab 500 mg

G 11 P butorphanol tartrate G P flurbiprofen O P ibuprofen susp 100 mg/5ml

NARCOTICS -LONG ACTING O P ibuprofen tab 200 mg

G P fentanyl 25mcg G P ibuprofen tab 400 mg

G P fentanyl 50mcg G P ibuprofen tab 600 mg

G P fentanyl 75mcg G P ibuprofen tab 800 mg

G P fentanyl 100mcg G P indomethacin

G P morphine sul tab er G P ketoprofen

G P morphine sulfate G P naproxen

B P EMBEDA G P naproxen sodium tab 550 mg G P sulindac

NASAL STEROIDS G P diclofenac gel 1%

G P fluticasone propionate (nasal) B P VOLTAREN GEL

NEUROLOGICS - MISC. OP. ANTIALLERGICS - ANTIHISTAMINES

G P ergoloid mesylates G 94 P olopatadine (ophth)

B 11 P AUSTEDO G P azelastine hcl (ophth)

G 11 P tetrabenazine OP. ANTIALLERGICS - MAST CELL STABILIZERS B 11 P INGREZZA

B P MESTINON SYP 60MG/5ML G P cromolyn sodium (ophth)

B P MESTINON TIMESPAN

G P pyridostigmine bromide OP. ANTIBIOTICS

B P REGONOL G P erythromycin (ophth) G P gentamicin sulfate (ophth)

NICOTINE REPLACEMENT THERAPY G P tobramycin (ophth)

O 80 P nicotine td patch 24hr 14 mg/24hr G P trifluridine

O 80 P nicotine td patch 24hr 21 mg/24hr G P bacitracin-polymyxin b (ophth)

O 80 P nicotine td patch 24hr 7 mg/24hr G P polymyxin b-trimethoprim

O 80 P nicotine polacrilex gum 2mg

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories O P sodium chloride hypertonic ophth soln 5% OP. ANTIINFLAMMATORY / STEROIDS OPHTH. OP. NSAID'S B P MAXIDEX

G P dexamethasone sodium phosphate (ophth) G P diclofenac sodium (ophth)

G P fluorometholone (ophth) G P flurbiprofen sodium

B P FML G P ketorolac tromethamine (ophth)

B P FML FORTE B P ILEVRO

B P FLAREX OP. PROSTAGLANDINS B P ALREX

B P PRED MILD G P latanoprost

G P prednisolone acetate (ophth) B P TRAVATAN Z

G P prednisolone sodium phosphate (ophth)

B P PRED-G OP. QUINOLONES

B P ZYLET G P ciprofloxacin hcl (ophth)

G P sulfacetamide sod-prednisolone

B P TOBRADEX OP. QUINOLONES FOURTH GENERATION

G P neomycin-polymy-dexameth G P moxifloxacin ophthalmic solution

G P bacitracin-poly-neomycin-hc OP. RHO KINASE INHIBITORS

OP. BETA - BLOCKERS B P RHOPRESSA

B P BETOPTIC-S B P ROCKLATAN

G P carteolol hcl (ophth)

G P metipranolol OP. SELECTIVE ALPHA ADRENERGIC AGONISTS

G P levobunolol hcl B P ALPHAGAN P SOL 0.1%

G P timolol maleate ophth soln 0.25% B P ALPHAGAN P SOLN 0.15%

G P timolol maleate ophth soln 0.5% G P brimonidine tartrate ophth soln 0.2% B P SIMBRINZA

OP. CARBONIC ANHYDRASE INHIBITORS/COMBO

B P COMBIGAN OSTEOPOROSIS

G P dorzolamide hcl-timolol maleate G P alendronate sodium

G P dorzolamide hcl G P calcitonin (salmon)

OP. CYCLOPLEGICS OXYTOCICS

G P atropine sulfate (ophthalmic) G P methylergonovine maleate

G P cyclopentolate hcl

G P tropicamide PARKINSONS - ANTICHOLINERGICS G P benztropine mesylate tab 0.5 mg

OP. MIOTICS - DIRECT ACTING G P benztropine mesylate tab 1 mg

G P pilocarpine hcl G P benztropine mesylate tab 2 mg

B P PHOSPHOLINE IODIDE G P trihexyphenidyl hcl

OP. MISC PARKINSONS - COMT INHIBITORS

O P artificial tear solution G P entacapone

O P artificial tear ointment

G P phenylephrine hcl (ophth) PARKINSONS - SELECTED DOPAMIN AGONISTS

B 105 P RESTASIS G P pramipexole dihydrochloride

G P proparacaine hcl G P ropinirole hydrochloride

G P tetracaine hcl (ophth)

O P sodium chloride hypertonic ophth oint 5%

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories PURINE ANALOG PERIPHERAL VASODILATORS B P AZASAN

G P papaverine hcl G P azathioprine

PHOSPHATE BINDERS RHEUMATOID ARTHRITIS - NON-BIOLOGICALS

G P calcium acetate tablets (phosphate binder) G P leflunomide

B P ELIPHOS

B P PHOSLYRA RSV AGENTS

G P calcium acetate capsules (phosphate binder) B 11 P SYNAGIS

G P sevelamer carbonate tablets SEDATIVE/HYPNOTICS - BARBITURATE

PLATELET AGGR. INHIBITORS / COMBO'S - MISC. G P phenobarbital

G P cilostazol

G P anagrelide hcl SEDATIVE/HYPNOTICS - BENZODIAZEPINES

B P AGGRENOX G P estazolam

G P pentoxifylline G 76 P flurazepam hcl G P midazolam hcl PLATELET AGGREGATION INHIBITORS G P midazolam hcl syrp

G P dipyridamole G P temazepam cap 15 mg

G P clopidogrel bisulfate G P temazepam cap 30 mg

G P prasugrel

B P BRILINTA SEDATIVE/HYPNOTICS - NON-BENZODIAZEPINES G P eszopiclone POWDERS G P zaleplon

G P progesterone powder G P zolpidem tartrate

G P progesterone micronized powder

G P metronidazole powder SMOKING CESSATION (ORAL) G 80 P bupropion hcl (smoking deterrent) PRESSORS B 80 P CHANTIX

G P midodrine hcl SOMATOSTATIC AGENTS

PROGESTINS G P octreotide acetate

G P medroxyprogesterone acetate B P SANDOSTATIN

G P norethindrone acetate tab 5 mg STIMULANTS - AMPHETAMINES - LONG ACTING

PSYCHOTHERAPEUTIC COMBINATION G 113 P dextroamphetamine sulfate er

G P chlordiazepoxide-amitriptyline B 112 P VYVANSE

G P perphenazine-amitriptyline G 113 P amphetamine-dextroamphetamine er

PULMONARY ANTI-HYPERTENSIVES STIMULANTS - AMPHETAMINES - SHORT ACTING

G 11 P sildenafil citrate (pulmonary hypertension) G 112 P dextroamphetamine sulfate

G 11 P tadalafil G 112 P amphetamine-dextroamphetamine

G 11 P epoprostenol sodium

B 11 P VENTAVIS STIMULANTS - METHYLPHENIDATE G 113 P dexmethylphenidate hcl PULMONARY ANTI-HYPERTENSIVES-ENDOTHELIN RECEPTOR ANTAGONISTG 113 P methylphenidate hcl

G 11 P ambrisentan B 113 P METHYLIN ORAL SOLUTION

B 11 P TRACLEER G 113 P methylphenidate oral solution

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories G 11 P erythromycin (acne aid) STIMULANTS - METHYLPHENIDATE - LONG ACTING B 11 P EPIDUO

G 113 P dexmethylphenidate er B 11 P ACANYA

G 115 P methylphenidate hcl tab sa osm B 11 P METROGEL

G 113 P methylphenidate tab 20mg cr B 11 P METROLOTION

B 113 P QUILLIVANT XR G 11 P metronidazole cream 0.75%

B 113 P QUILLICHEW ER TOPICAL - ANTIBIOTIC

STIMULANTS - OTHER STIMULANTS / LIKE STIMULANTS O P bacitracin (topical)

G 111 P guanfacine er G P gentamicin sulfate (topical)

G 113 P atomoxetine G P mupirocin oint

G 24 P armodafinil O P neomycin-bacitracin-polymyxin

G 24 P modafinil TOPICAL - ANTIFUNGALS

TETRACYCLINES G P ciclopirox solution 8%

G P doxycycline (monohydrate) caps 100mg G P ciclopirox olamine

G P doxycycline (monohydrate) caps 50mg G P nystatin oint 100000 unit/gm

B P VIBRAMYCIN SYRP O P tolnaftate G P clotrimazole (topical)

THYROID HORMONES G P ketoconazole (topical) O P miconazole nitrate cream 2% G P levothyroxine sodium tab 100 mcg G P clotrimazole w/ betamethasone G P levothyroxine sodium tab 112 mcg

G P levothyroxine sodium tab 125 mcg TOPICAL - ANTINEOPLASTICS G P levothyroxine sodium tab 137 mcg

G P levothyroxine sodium tab 150 mcg B P EFUDEX

G P levothyroxine sodium tab 175 mcg G P fluorouracil soln 2%

G P levothyroxine sodium tab 200 mcg G P fluorouracil soln 5%

G P levothyroxine sodium tab 25 mcg TOPICAL - ANTIPRURITICS G P levothyroxine sodium tab 300 mcg

G P levothyroxine sodium tab 50 mcg B P ZONALON

G P levothyroxine sodium tab 75 mcg TOPICAL - ANTISEBORRHEICS G P levothyroxine sodium tab 88 mcg

B P CYTOMEL G P selenium sulfide

B P TRIOSTAT G P sulfacetamide sodium liquid 10%

B P THYROLAR G P selenium sulfide-pyrithione zinc in urea vehicle

TISSUE PLASMINOGEN ACTIVATOR TOPICAL - ASTRINGENTS / PROTECTANTS

B P ACTIVASE B P XERAC AC

B P CATHFLO ACTIVASE TOPICAL - BURN PRODUCTS

TOPICAL - ACNE PREPARATIONS G P silver sulfadiazine

B 11 P DIFFERIN CRE 0.1%

B 11 P DIFFERIN GEL 0.3% TOPICAL - CAUTERIZING AGENTS

B 11 P DIFFERIN LOTN G P silver nitrate

G 11 P adapalene gel 0.1%

G 11 P adapalene gel 0.3%

B 11 P AZELEX

O P benzoyl peroxide

G 11 P clindamycin phosphate (topical)

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories TOPICAL - LOCAL ANESTHETICS TOPICAL - CORTICOSTEROIDS - HIGH POTENCY B P MARCAINE

G P betamethasone dipropionate (topical) oint B P MARCAINE W/O EPI

G P betamethasone dipropionate cream 0.05% G P lidocaine hcl local inj 1%

G P betamethasone dipropionate augmented cream 0.05% G P lidocaine hcl local inj 1.5%

G P clobetasol propionate G P lidocaine hcl local inj 2%

B P CLOBEX G P lidocaine hcl local inj 4%

G P clobetasol propionate emollient base G P lidocaine hcl local preservative free (pf) inj 0.5%

G P clobetasol propionate emulsion foam G P lidocaine hcl local preservative free (pf) inj 1%

G P fluocinonide cream 0.05% G P lidocaine hcl local preservative free (pf) inj 2%

G P fluocinonide gel 0.05% G P lidocaine w/ epinephrine

G P fluocinonide oint 0.05% B P XYLOCAINE/EPINEPHRINE

G P fluocinonide soln 0.05% G P lidocaine oint 5%

G P fluocinonide emulsified base G 11 P lidocaine patch G P lidocaine hcl cream 3% TOPICAL - CORTICOSTEROIDS - LOW POTENCY G P lidocaine hcl lotion 3%

G P hydrocortisone cream 1% G P lidocaine hcl soln 4%

G P hydrocortisone cream 2.5% G P lidocaine-prilocaine

G P hydrocortisone lotion 2.5%

G P hydrocortisone oint 1% TOPICAL - NASAL ANTIBIOTICS

G P hydrocortisone oint 2.5% B P BACTROBAN NASAL

TOPICAL - CORTICOSTEROIDS - MEDIUM POTENCY TOPICAL - SCABICIDES AND PEDICULICIDES

G P betamethasone valerate B P NATROBA

B P CAPEX G P permethrin cream 5%

G P fluticasone propionate O P permethrin lotion 1%

G P mometasone furoate O P pyrethrins-piperonyl butoxide

G P triamcinolone acetonide (topical)

G P triamcinolone acetonide (topical) lotn TOPICAL - STEROID LOCAL ANESTHETICS G P lidocaine-hydrocortisone acetate (rectal) TOPICAL - EMOLLIENTS

O P lactic acid (ammonium lactate) lotion 12% TOPICAL - TRETINOIDS

G P urea lotion 40% B 11 P RETIN-A

TOPICAL - ENZYMES / KERATOLYTICS / UREA UREA CYCLE DISORDER - AGENTS

B P SANTYL B P BUPHENYL

G P salicylic acid cream 6%

G P salicylic acid lotion 6%

G P salicylic acid shampoo 6%

G P salicylic acid soln 26%

TOPICAL - GENITAL WARTS

B 69 P VEREGEN

G 36 P imiquimod

TOPICAL - IMMUNOMODULATORS

G 116 P pimecrolimus

B 11 P PROTOPIC

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

PDL Categories O 11 P cholecalciferol cap 10000 unit UROLOGICAL - MISC. O 11 P cholecalciferol

G P methenamine mandelate B P MEPHYTON

G P nitrofurantoin suspension G P phytonadione

G P nitrofurantoin macrocrystal 50mg G P cyanocobalamin inj 1000 mcg/ml

G P nitrofurantoin macrocrystal 100mg G P folic acid tab 1 mg

G P nitrofurantoin monohyd macro VITAMINS - MISC. B P K-PHOS TAB NO 2

G P potassium citrate (alkalinizer) B 11 P DIALYVITE/ TAB ZINC

B P UROCIT B 11 P NEPHPLEX RX

B P ORACIT O 11 P dekas

G P sodium citrate & citric acid O 11 P aquadeks

G P phenazopyridine hcl O 11 P pediatric multiple vitamin w/ minerals & c

B P RENACIDIN B P PNV FOLIC AC TAB + IRON

G P acetic acid B P PRENATAL VIT TAB PLUS

G P sodium chloride (gu irrigant) B P TRINATAL RX 1

G P neomycin/polymyxin b gu B P VOL-NATE B P VOL-PLUS TAB

VACCINES B P TRINATAL GT

B 70 P ZOSTAVAX INJ B P PNV FERROUS FUMARATE/DOCUSATE/FOLIC ACID

B 92 P PNEUMOVAX B P SE-NATAL 19 CHEW TABLET

B 92 P TENIVAC G P triveen duo G P complete natal dha

VAGINAL - ANTI FUNGALS G P preplus tablet

O P miconazole nitrate vaginal cream 2% G P niva-plus tablet

O P miconazole nitrate vaginal suppos 100 mg G P pretab tablet

G P terconazole vaginal cream 0.4% G P pnv 29-1 tablet

G P terconazole vaginal cream 0.8% G P virt-nate tablet

O P clotrimazole vaginal cream 1% G P vol-tab rx tablet G P thrivite rx tablet

VAGINAL - ANTIBACTERIALS G P completenate tablet G 11 P ferrous fumarate w/ b12-vit c-fa-ifc B P CLEOCIN SUP 100MG

G P clindamycin phosphate vaginal

G P metronidazole vaginal

VAGINAL - ESTROGENS

B P PREMARIN

VASOPRESSINS

G 93 P desmopressin acetate

B 11 P STIMATE

G 11 P desmopressin acetate refrigerated

G 11 P desmopressin acetate spray refrigerated

G 11 P desmopressin acetate spray

VITAMINS

G P thiamine hcl

O 11 P thiamine hcl tab

O 11 P vitamin c

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

RDL Categories B R MATULANE ANTINEOPLASTICS - ALKYLATING AGENTS B 11 R REVLIMID

B R MYLERAN ANTINEOPLASTICS - NITROGEN MUSTARDS

ANTINEOPLASTICS - ANTIADRENALS B R LEUKERAN

B 63 R LYSODREN B R ALKERAN

ANTINEOPLASTICS - ANTIANDROGENS ANTINEOPLASTICS - PROGESTINS

B 11 R ERLEADA B R DEPO-PROVERA

G R bicalutamide G R megestrol acetate

B 11 R XTANDI G 11 R hydroxyprogesterone caproate

B R NILANDRON ANTINEOPLASTICS - PROTEIN-TYROSINE KINASE INHIBITORS

ANTINEOPLASTICS - ANTIESTROGENS B 11 R VERZENIO

G R tamoxifen citrate B 11 R IBRANCE

B P FARESTON B 11 R KISQALI B 11 R AFINITOR

ANTINEOPLASTICS - ANTIMETABOLITES B 11 R SUTENT

B 11 P XELODA B 11 P TARCEVA

G P mercaptopurine B 11 P GLEEVEC

G P methotrexate sodium B 11 R TASIGNA

B R TABLOID B 11 R VOTRIENT B R CAPRELSA

ANTINEOPLASTICS - AROMATASE INHIBITORS B 80 R JAKAFI

G R anastrozole

G P exemestane ANTINEOPLASTICS - RETINOIDS

G 70 P letrozole G 11 R tretinoin (chemotherapy)

ANTINEOPLASTICS - COMBINATIONS ANTINEOPLASTICS - SELECTIVE RETINOID X RECEPTOR AGONISTS

B 11 R KISQALI PAK FEMARA B P TARGRETIN

ANTINEOPLASTICS - ESTROGENS ANTINEOPLASTICS - TOPOISOMERASE I INHIBITORS

B R EMCYT B 11 R HYCAMTIN

ANTINEOPLASTICS - FOLIC ACID ANTAGONISTS RESCUE AGENTS

G R leucovorin calcium

ANTINEOPLASTICS - IMIDAZOTETRAZINES

G 11 P temozolomide

ANTINEOPLASTICS - LHRH ANALOGS

B R ZOLADEX

B 80 R ELIGARD

B 11 R LUPRON DEPOT

B R TRELSTAR

ANTINEOPLASTICS - MISC.

B 11 R TIBSOVO

G P hydroxyurea

RT43025 B, COM P , B, COM P , G, N, Therapeutic Category G, N, Therapeutic Category or R, or or R, or O NR O NR

RDL Categories ANTIRETROVIRALS - COMBINATIONS

G P abacavir-lamivudine

B P EVOTAZ

B P PREZCOBIX

B P DESCOVY

B P TRUVADA

B P CIMDUO

G P lamivudine-zidovudine

B P BIKTARVY

B P DELSTRIGO

B R ATRIPLA

B P SYMFI LO

B P SYMFI

B P ODEFSEY

B P COMPLERA

B P GENVOYA

ANTIRETROVIRALS - INTEGRASE INHIBITORS

B P ISENTRESS CHW 100MG

B P ISENTRESS CHW 25MG

B P ISENTRESS TABS

B P TIVICAY

ANTIRETROVIRALS - PROTEASE INHIBITORS

G P atazanavir

B R PREZISTA

B R NORVIR SOL 80MG/ML

B R NORVIR ORAL POWDER PACKETS

G P ritonavir

ANTIRETROVIRALS - RTI - NON - NUCLEOSIDE ANALOGUES

G P efavirenz

B 117 P EDURANT

ANTIRETROVIRALS - RTI - NUCLEOSIDE/NUCLEOTIDE ANALOGUES

G P abacavir sulfate

B R EMTRIVA

G P lamivudine

G P tenofovir

B P VIREAD

RT43025