E&I CA I000043063 BPLD0161 Access 3 Tier

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2019 California Access Large Group 3-Tier PPO Prescription Drug List Please note: This Prescription Drug List (PDL) is accurate as of May 1, 2019 and is subject to change after this date. All previous versions of this PDL are no longer in effect. Your estimated coverage and copay/coinsurance may vary based on the benefit plan you choose and the effective date of the plan. This PDL can also be accessed online at myuhc.com > Pharmacy Information > California Prescription Drug Lists (PDL) and Formulary (For Pre-Members/ Members). Plan-specific coverage documents may be accessed online at uhc.com/statedruglists > Large Group Plans > California. If you are a UnitedHealthcare member, please register or log on to myuhc.com or call the toll-free number on your health plan ID card to find pharmacy information specific to your benefit plan. This PDL is applicable to the following health insurance products offered by UnitedHealthcare: • Navigate • Core • Navigate Plus • Core Essential • Choice • Options PPO • Choice Plus • Non-Differential PPO • Select • Select Plus

At UnitedHealthcare, we want to help you better understand your medication options...... 3

How do I use my PDL? ...... 4

What are tiers? ...... 5

When does the PDL change?...... 5

Utilization Management Programs ...... 6

Your Right to Request Access to a Non-formulary Drug ...... 6

Requesting a Prior Authorization or Step Therapy Exception...... 7

How do I locate and fill a prescription through a retail network pharmacy?...... 7

How do I locate and fill a prescription through the mail order pharmacy? ...... 7

How do I locate and fill a prescription at a specialty pharmacy? ...... 8

How do I get updated information about my pharmacy benefit?...... 8

Nondiscrimination notice and access to communication services...... 9

Prescription Drug List...... 12

2 At UnitedHealthcare, we want to help you better understand your medication options. Your pharmacy benefit offers flexibility and choice in determining the right medication for you. To help you get the most out of your pharmacy benefit, we’ve included some of the most commonly used terms and their definitions as well as frequently asked questions: Brand-name drug means a Prescription Drug Product (1) which is manufactured and marketed under a trademark or name by a specific drug manufacturer; or (2) that we identify as a brand-name product, based on available data resources. This includes data sources such as Medi-Span, that classify drugs as either brand or generic based on a number of factors. Not all products identified as a “brand-name” by the manufacturer, pharmacy, or your Physician will be classified as brand-name by us. A brand- name drug is listed in this PDL in all CAPITAL letters. Coinsurance means a percentage of the cost of a covered health care benefit that you pay after you have paid the deductible, if a deductible applies to the health care benefit. Copayment means a fixed dollar amount that you pay for a covered health care benefit after you have paid the deductible, if a deductible applies to the health care benefit. Deductible means the amount you pay for covered health care benefits that are subject to the deductible before your health insurer begins to pay. If your health insurance policy has a deductible, it may have either one deductible or separate deductibles for medical benefits and prescription drug benefits. After you pay your deductible, you usually pay only a copayment or coinsurance for covered health care benefits. Your insurance company pays the rest. Drug Tier means a group of Prescription Drug Products that correspond to a specified cost sharing tier in your health insurance policy. The drug tier in which a Prescription Drug Product is placed determines your portion of the cost for the drug. Exception request means a request for coverage of a non-formulary drug. If you, your designee, or your prescribing health care provider submits a request for coverage of a non-formulary drug, your insurer must cover the non-formulary drug when it is medically necessary for you to take the drug. Exigent circumstances means when you are suffering from a medical condition that may seriously jeopardize your life, health, or ability to regain maximum function, or when you are undergoing a current course of treatment using a non-formulary drug. Formulary or Prescription Drug List (PDL) means a list that categorizes into tiers medications or products that have been approved by the U.S. Food and Drug Administration (FDA). This list is subject to our periodic review and modification (generally quarterly, but no more than six times per calendar year). Generic drug means a Prescription Drug Product: (1) that is Chemically Equivalent to a Brand-name drug; or (2) that we identify as a Generic product based on available data resources. This includes, data sources such as Medi-Span, that classify drugs as either brand or generic based on a number of factors. Not all products identified as a “generic” by the manufacturer, pharmacy or your Physician will be classified as a Generic by us. A generic drug is listed in this PDL in italicized lowercase letters. Medically Necessary means health care benefits needed to diagnose, treat, or prevent a medical condition or its symptoms and that meet accepted standards of medicine. Health insurance usually does not cover health care benefits that are not medically necessary. Non-formulary drug means a Prescription Drug Product that is not listed on this PDL. Out-of-pocket costs means your expenses for health care benefits that aren’t reimbursed by your health insurance. Out-of- pocket costs include deductibles, copayments, and coinsurance for covered health care benefits, plus all costs for health care benefits that are not covered. Prescribing provider means a health care provider who can write a prescription for a drug to diagnose, treat, or prevent a medical condition. Prescription means an oral, written, or electronic order from a prescribing provider authorizing a Prescription Drug Product to be provided to a specific individual. Prescription Drug Product means a medication or product that has been approved by the U.S. Food and Drug Administration (FDA) and that can, under federal or state law, be dispensed only according to a Prescription Order or Refill. A Prescription Drug

3 Product includes a medication that, due to its characteristics, is appropriate for self-administration or administration by a non- skilled caregiver. We will provide coverage for a Prescription Drug Product which includes a medication that, due to its characteristics, is appropriate for self-administration or administration by a non-skilled caregiver. This definition includes: Inhalers (with spacers); Insulin; the following diabetic supplies: standard insulin syringes with needles; blood-testing strips - glucose; urine-testing strips - glucose; ketone-testing strips and tablets; lancets and lancet devices; and glucose meters (does not include continuous glucose monitors which are covered under the Evidence of Coverage); disposable devices which are Medically Necessary for the administration of a covered outpatient Prescription Drug Product. Benefits also include FDA-approved contraceptive drugs, devices, and products available over-the-counter when prescribed by a Network provider. Prior Authorization means a process by your health insurer to determine that a health care benefit is medically necessary for you. If a Prescription Drug Product is subject to prior authorization in this PDL, your prescribing provider must request approval from your health insurer to cover the drug before you fill your prescription. Your health insurer must grant a prior authorization request when it is medically necessary for you to take the drug. Step therapy means a specific sequence in which Prescription Drug Products for a particular medical condition must be tried. If a drug is subject to step therapy in this PDL, you may have to try one or more other drugs before your health insurance policy will cover that drug for your medical condition. If your prescribing provider submits a request for an exception to the step therapy requirement, your health insurer must grant the request when it is medically necessary for you to take the drug. How do I use my PDL? When choosing a medication, you and your doctor should consult the PDL. It will help you and your doctor choose the most cost-effective prescription drugs. This guide tells you if special programs apply. Bring this list with you when you see your doctor. It is organized by therapeutic category and class. The therapeutic category and class are based on the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification and the U.S. Pharmacopeial Convention (USP) Medicare Model Guidelines. You may also find a drug by its brand or generic name in the alphabetical index. If a generic equivalent for a brand- name drug is not available on the market or is not covered, the drug will not be separately listed by its generic name. This is the way Prescription Drug Products appear in the PDL: 1. A drug is listed alphabetically by its brand and generic names in the therapeutic category and class to which it belongs; 2. The generic name for a brand- name drug is included after the brand- name in parentheses and all lowercase italicized letters; 3. If a generic equivalent for a brand- name drug is both available and covered, the generic drug will be listed separately from the brand name drug in all lowercase italicized letters; and

4. If a generic drug is marketed under a proprietary, trademark-protected brand- name, the brand- name will be listed after the generic name in parentheses and regular typeface with the first letter of each word capitalized. Example:

If your medication is not listed in this document, please visit myuhc.com or call the toll-free member phone number on your health plan ID card.

4 Below is a list of drug tier numbers, abbreviations, and designations used in the PDL as well as an explanation for each.

Drug Tier 1 Lower-cost medications covered under the outpatient prescription drug benefit. Drug Tier 2 Mid-range cost medications covered under the outpatient prescription drug benefit. Drug Tier 3 Highest-cost medications, such as specialty, covered under the outpatient prescription drug benefit. PA Prior authorization required SL Supply Limit ST Step Therapy H May be part of health care reform preventive H-PA May be part of health care reform preventive with prior authorization SP Specialty medication CM Orally administered anticancer medication What are tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3, look to see if there is a Tier 1 option available. Discuss these options with your doctor. For orally administered anti-cancer medications on any Tier, the total amount of copayments and/or coinsurance shall not exceed $250 for an individual prescription of up to a 30-day supply. For high deductible health plans, the $250 maximum only applies once the deductible has been met. Check your benefit plan documents to find out your specific pharmacy plan costs, including any maximum dollar amount of cost sharing that may apply to a drug. Preferred medications are found in tier 1 or tier 2 and may vary depending on the medication and the condition it treats.

$ Drug tier Includes Helpful tips

Tier 1 Medications that provide the highest overall Use Tier 1 drugs for the lowest Your lowest value. Mostly generic drugs. Some brand-name out‑of-pocket costs. drugs may also be included. cost

Tier 2 Medications that provide good overall value. Use Tier 2 drugs instead of Your mid-range A mix of brand-name and generic drugs. Tier 3 to help reduce your out-of-pocket costs. cost

Tier 3 Medications that provide the lowest overall Many Tier 3 drugs have Your highest value. Mostly brand-name drugs, as well as lower‑cost options in Tier 1 or some generics. 2. Ask your doctor if they could cost work for you.

Please note: If you have a high deductible plan, the tier cost levels may apply once you reach your deductible. Refer to your enrollment and plan materials on myuhc.com, or call the toll-free number on your health plan ID card for more information about your benefit plan. When does the PDL change? This PDL is required to be updated on a monthly basis. • Medications may move to a lower tier at any time. • Medications may move to a higher tier when a generic becomes available. • Medications may move to a higher tier or become non-formulary most often on January 1 or July 1. • Medications may become subject to new or revised utilization management procedures, such as prior authorization, step therapy or supply limits, at any time but most often upon FDA approval of the medication or its generic, January 1, or July 1.

5 When a medication changes tiers, you may have to pay a different amount for that medication. The presence of a Prescription Drug Product on the PDL does not guarantee that you will be prescribed that Prescription Drug Product by your provider for a particular medical condition. Utilization Management Programs Prior authorization required — Your doctor is required to provide additional information to us to determine coverage. For specific prior authorization requirements, please refer to your Evidence of Coverage.

Supply limit — Amount of medication covered per copayment or in a specific time period.

Step therapy — Requires you to try one or more other medications before the medication you are requesting may be covered. For specific step therapy requirements, please refer to your Evidence of Coverage.

Health Care Reform Preventive with Prior Authorization — This medication is part of a health care reform preventive benefit and may be available at no cost to you if prior authorization criteria is met. For more information, please refer to the California Traditional, Access, and Enhanced PPO Prescription Drug List (PDL) PPACA $0 Cost-Share Preventive Care Medications list.

Designated specialty program — For certain Specialty Prescription Drug Products, we may direct you to a Designated Pharmacy with whom we have an arrangement to provide those Prescription Drug Products, which are identified in the Coverage Requirements and Limits column of the Prescription Drug List (PDL). If you choose not to obtain your Prescription Drug Product from the Designated Pharmacy, you may opt-out of the Designated Pharmacy program by contacting us at myuhc.com or the telephone number on your ID card.

To learn more about a pharmacy program or to find out if it applies to you, please visitmyuhc.com or call the toll-free member phone number on your health plan ID card. If you are a pre-enrollee and you would like to learn more about your specific pharmacy benefit, please contact your employer. Drugs administered by a healthcare professional are generally covered under the medical benefit while drugs that are self- administered are covered under the pharmacy benefit. In order to obtain medical benefits for drugs that are administered by a healthcare professional, your provider may also be required to obtain a prior authorization. The provider may contact UnitedHealthcare for more information or uhcprovider.com. Your Right to Request Access to a Non-formulary Drug This plan must cover all Medically Necessary Prescription Drug Products. When a Prescription Drug Product is not on our PDL, you or your representative may request an exception to gain access to that Prescription Drug Product. To make a request, contact us in writing or call the toll-free number on your ID card. We will notify you of our determination within 72 hours. If approved, we will cover the Prescription Drug Product for the duration of the prescription, including refills. Urgent Requests If your request requires immediate action and a delay could significantly increase the risk to your health, or the ability to regain maximum function, call us as soon as possible. We will provide a written or electronic determination within 24 hours. If approved, we will cover the Prescription Drug Product for the duration of the exigency. External Review If you are not satisfied with our determination of your exception request, you may be entitled to request an external review. You or your representative may request an external review by sending a written request to us to the address set out in the determination letter or by calling the toll-free number on your ID card. The Independent Review Organization (IRO) will notify you of its determination within 72 hours. Expedited External Review If you are not satisfied with our determination of your exception request and it involves an urgent situation, you or your representative may request an expedited external review by calling the toll-free number on your ID card or by sending a written request to the address set out in the determination letter. The IRO will notify you of our determination within 24 hours.

6 If we deny your exception request, you may appeal. Please refer to your Evidence of coverage for details. The complaint and appeals process, including independent review, is described under Section 6: Questions, Complaints and Appeals. You may also call the telephone number listed on your identification (ID) card. Requesting a Prior Authorization or Step Therapy Exception Before certain Prescription Drug Products are dispensed to you, your prescribing provider or your pharmacist is required to obtain prior authorization or step therapy exception from us. Your prescribing provider can submit a request by contacting us at uhcprovider.com. You may determine whether a particular Prescription Drug Product is subject to prior authorization or step therapy requirements through the Internet at myuhc.com or by calling at the toll-free phone number on the back of your health plan ID card. If you are changing policies, we will not require you to repeat step therapy when you are already being treated for a medical condition by a Prescription Drug Product provided the Prescription Drug Product is appropriately prescribed and considered safe and effective for your medical condition. However, we may impose a prior authorization requirement for the continued coverage of a Prescription Drug Product prescribed pursuant to step therapy requirements imposed by the former policy. Your prescribing provider may also prescribe another Prescription Drug Product covered under your policy that is medically appropriate for your medical condition. If you are currently taking a Prescription Drug Product which was approved by UnitedHealthcare for a specific medical condition and that drug is removed from the Prescription Drug List (PDL) and the prescribing provider continues to prescribe the Prescription Drug Product for your medical condition, we will continue to cover the Prescription Drug Product provided that the drug is appropriately prescribed and is considered safe and effective for treating your medical condition. In the case of a standard prior authorization or step therapy exception request, we will notify you, your designee, or your prescribing provider of the Benefit determination no later than 72 hours following receipt of the request. In the case of an expedited prior authorization or step therapy exception request based on exigent circumstances, we will notify you, your designee, or your prescribing provider of the Benefit determination no later than 24 hours following receipt of the request. If we fail to respond to you, your designee, or your prescribing provider within the prescribed time limits, the request is deemed approved and we may not deny the request thereafter. If you disagree with a determination, you can request an appeal. The complaint and appeals process, including independent medical review, is described in the Evidence of Coverage under Section 6: Questions, Complaints and Appeals. You may also call at the telephone number on your ID card. How do I locate and fill a prescription through a retail network pharmacy? UnitedHealthcare has a well-established Network of pharmacies including most major pharmacy and supermarket chains as well as many independent pharmacies. For a listing of Network Pharmacies, call the toll-free phone number on your health plan ID card to help locate a Network Pharmacy near you or visit our web site at myuhc.com for an up-to-date list. How do I locate and fill a prescription through the mail order pharmacy? UnitedHealthcare offers a Mail Order Pharmacy Program through OptumRx®. Here’s how to fill prescriptions through the Mail Order Pharmacy Program. 1. Call your prescribing provider to obtain a new prescription for each medication. When you call, ask the Physician to write the prescription for a 90-day supply which represents three Prescription Units with up to three additional refills. The doctor will tell you when to pick up the written prescription. (Note: OptumRx must have a new prescription to process any new Mail Order request.) 2. After picking up the prescription, complete the Mail Order Form included in your enrollment materials. (To obtain additional forms or for assistance in completing the form, contact UnitedHealthcare’s Customer Service Department by calling the telephone number on the back of your ID card. You can also find the form at the web site addressoptumrx.com .) 3. Enclose the prescription and appropriate copayment via check, money order, or credit card. Your Pharmacy Schedule of Benefits will have the applicable copayment for the Mail Order Pharmacy Program. Make the check or money order payable to OptumRx. No cash please.

7 Note: Prescription Drug Products such as Schedule II substances (e.g., Morphine, Ritalin and Dexedrine), antibiotics, drugs used for short-term or acute illnesses, and drugs that require special packaging (including refrigeration), are not available through our Mail Order Pharmacy Program. Prescription medications prescribed for the treatment of sexual dysfunction are not available through the Mail Order Pharmacy Program. Important Tip: If you are starting a new Prescription Drug Product, please request two prescriptions from your licensed physician. Have one filled immediately at a Network Pharmacy while mailing the second prescription to UnitedHealthcare’s Mail Order Pharmacy. Once you receive your medication through the Mail Order Pharmacy Program, you should stop filling the prescription at the Network Pharmacy. How do I locate and fill a prescription at a specialty pharmacy? Call the phone number on the back of your health plan ID card or visit BriovaRx.com to locate a designated specialty pharmacy for your medication.

Designated Pharmacies If you require certain Specialty Prescription Drug Products, we may direct you to a Designated Pharmacy with whom we have an arrangement to provide those Specialty Prescription Drug Products. There are both retail and mail pharmacies in the Designated Pharmacy network. Note that not all contracted retail pharmacies are in the Designated Pharmacy network. Only retail pharmacies that are in the Designated Pharmacy network will provide access to these Specialty Prescription Drug Products. If you choose not to obtain your Specialty Prescription Drug Product from the Designated Pharmacy, you may opt-out of the Designated Pharmacy program through the Internet at [myuhc.com] or by calling the telephone number on your ID card. If you want to opt-out of the program and fill your Specialty Prescription Drug Product at a non-Designated Pharmacy but do not inform us, you will be responsible for the entire cost of the Specialty Prescription Drug Product and no Benefits will be paid. In urgent or emergent circumstances, you may contact Customer Service by calling the telephone number on the back of your ID card. This will allow you access to the retail network override process and allow the urgent or emergent prescription claim to pay at your local pharmacy for same day access if they have the Prescription Drug Product available. How do I get updated information about my pharmacy benefit? Since the PDL may change during your plan year, we encourage you to visit myuhc.com or call the toll-free member phone number on your health plan ID card for more current information.

Log in to myuhc.com for the following pharmacy information and tools: • Pharmacy benefit and coverage information • Possible lower-cost medication options • Medication interactions and side effects • Participating retail pharmacies by ZIP code • Your prescription history

And, if home delivery services are included in your pharmacy benefit, you can also: • Refill prescriptions • Check the status of your order • Set up reminders for refills • Manage your account

Call the toll-free member phone number on your health plan ID card, or visit myuhc.com® for more information.

8 Nondiscrimination notice and access to communication services

UnitedHealthcare Services, Inc. on behalf of itself and its affiliates does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. If you think you were treated unfairly for any of these reasons, you can send a complaint to: Online: [email protected] Mail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UTAH 84130

You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your ID card. If you think you were treated unfairly because of your race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability, you can also send a complaint to the California Department of Insurance: California Department of Insurance Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013 1-800-927-HELP (1-800-927-4357) 1-800-482-4833 (TTY) Internet Web site: www.insurance.ca.gov

If you think you were treated unfairly because of your sex, age, race, color, national origin, or disability, you can also file a complaint with the U.S. Dept. of Health and Human services: Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201

9 English IMPORTANT: You can get an interpreter at no cost to talk to your doctor or health insurance company. To get an interpreter or to ask about written information in your language, first call your insurance company’s phone number at 1-800-842-2656. Someone who speaks your language can help you. If you need more help, call the Department of Insurance Hotline at 1-800-927-4357.

Español IMPORTANTE: Puede obtener la ayuda de un intérprete sin costo alguno para hablar con su médico o con su compañía de seguros. Para obtener la ayuda de un intérprete o preguntar sobre información escrita en español, primero llame al número de teléfono de su compañía de seguros al 1-800-842-2656. Alguien que habla español puede ayudarle. Si necesita ayuda adicional, llame a la línea directa del Departamento de seguros al 1-800-927-4357. (Spanish)

中文

重要事項﹕您與您的醫生或醫療保險公司交談時，可獲得免費口譯服務。如欲請翻譯員提供口譯，或欲查詢中文書面資料，請先致電您的保險公司，電話號碼1-800-842-2656

說中文人士將為您提供協助。如需更多協助，請致電保險部熱線 1-800-927-4357 (Chinese)

10 ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 1-866-260-2723.

請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請致電：1-866-260-2723.

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PAUNAWA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll-free na numero ng telepono na nasa iyong identification card.

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ﺗﻨﺒﯿﮫ: إذا ﻛﻨﺖ ﺗﺘﺤﺪث اﻟﻌﺮﺑﯿﺔ (Arabic)، ﻓﺈن ﺧﺪﻣﺎت اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ اﻟﻤﺠﺎﻧﯿﺔ ﻣﺘﺎﺣﺔ ﻟﻚ. اﻟﺮﺟﺎء اﻻﺗﺼﺎل ﻋﻠﻰ رﻗﻢ اﻟﮭﺎﺗﻒ اﻟﻤﻮﺟﻮد ﻋﻠﻰ ّﻣﻌﺮف اﻟﻌﻀﻮﯾﺔ. اﻟﻤﺠﺎﻧﻲ

注意事項：日本語(Japanese)を話される場合、無料の言語支援サービスをご利用いただけます。健康保険証に記載されているフリーダイヤルにお電話ください。

ﺗﻮﺟﮫ: اﮔﺮ زﺑﺎن ﺷﻤﺎ ﻓﺎرﺳﯽ (Farsi) اﺳﺖ، ﺧﺪﻣﺎت اﻣﺪاد زﺑﺎﻧﯽ ﺑﮫ طﻮر راﯾﮕﺎن در اﺧﺘﯿﺎر ﺷﻤﺎ ﻣﯽ ﺑﺎﺷﺪ. ﻟﻄﻔﺎ ﺑﺎ ﺷﻤﺎره ﺗﻠﻔﻦ راﯾﮕﺎﻧﯽ ﮐﮫ روی ﮐﺎرت ﺷﻨﺎﺳﺎﯾﯽ ﺷﻤﺎ ﻗﯿﺪ ﺷﺪه ﺗﻤﺎس ﺑﮕﯿﺮﯾﺪ.

�यान ��: य�� आप हंद (Hindi) भाषी ह� तो आपके लए भाषा सहायता सेवाएं �न:शुक उपल�� ह�� कृ पया अपने पहचान प पर ��ए टोल- फ़ोन नंबर पर काल कर� �

CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.

��ខមែ��ស��ខែ (Khmer, Cambodian) �ស��ស�� សូមទូខស��ស��ខ�ស��

ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե հայերեն (Armenian) եք խոսում, անվճար լեզվական օգնության ծառայություններ են հասնում Ձեզ: Խնդրվում է զանգահարել անվճար հեռախոսահամարով, որը նշվել է Ձեր ճանաչողական քարտի վրա:

ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ� ਪੰ ਜ ਾ ਬ ੀ (Punjabi) ਬੋਲਦੇ ਹੋ, ਤ� ਤੁਹਾਡੇ ਲਈ ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਸੇਵਾਵ� ਿਬਲਕੁਲ ਮੁਫ਼ਤ ਉਪਲਬਧ ਹਨ। ਿਕਰਪਾ ਕਰਕੇ ਆਪਣੇ ਪਛਾਣ-ਪੱ ਤ ਰ 'ਤੇ ਿਦੱ ਤ ੇ ਗਏ ਟੋਲ ਫ਼ੀ ਨੰ ਬ ਰ 'ਤੇ ਕਾੱਲ ਕਰੋ।

โปรดทราบ: หากคุณพูดภาษาไทย (Thai) มีบริการความชวยเห่ ลือด ้านภาษาให ้แก่คุณโดยที คุณไม่ต ้องเสยค่าใชี จ่ายแต่อย่างใด้ โปรดโทรศพท์ถึงหั มายเลขโทรฟรีทีอยู่บนบัตรประจําตัวของคุณ 11 Table of Contents of Prescription Drug List

Informational Section...... 1 Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions...... 12 Anesthetics - Drugs for Numbing...... 19 Anti-Addiction/Substance Abuse Treatment Agents - Drugs for Overdose or Deterrence...... 20 Antibacterials - Drugs to Treat Bacterial Infections...... 21 Anticonvulsants - Drugs to Treat Seizures...... 29 Antidementia Agents - Drugs to Treat Alzheimer's Disease and Dementia...... 33 Antidepressants - Drugs to Treat Depression...... 34 Antiemetics - Drugs to Treat Nausea and Vomiting...... 37 Antifungals - Drugs to Treat Fungal Infections...... 38 Antigout Agents - Drugs to Treat Gout...... 41 Anti-inflammatory Agents - Drugs to Treat Inflammation...... 41 Antimigraine Agents - Drugs to Treat Migraines...... 41 Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis...... 43 Antimycobacterials - Drugs to Treat Infections...... 43 Antineoplastics - Drugs to Treat Cancer...... 44 Antiparasitics - Drugs to Treat Parasitic Infections...... 51 Antiparkinson Agents - Drugs to Treat Parkinson's Disease...... 52 Antipsychotics - Drugs to Treat Mood Disorders...... 54 Antispasticity Agents...... 56 Antivirals - Drugs to Treat Viral Infections...... 56 Anxiolytics - Drugs to Treat Anxiety...... 62 Bipolar Agents - Drugs to Treat Mood Disorders...... 64 Blood Glucose Regulators - Drugs to Regulate Blood Sugar...... 64 Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders...... 69 Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions...... 75 Central Nervous System Agents - Drugs to Treat Nerve Conditions...... 88 Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions...... 93 Dermatological Agents - Drugs to Treat Skin Conditions...... 94 Electrolytes/Minerals/Metals/Vitamins...... 103 Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions...... 108 Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment...... 113 Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions...... 115 Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) - Drugs to Regulate Hormones...... 118 Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Drugs to Regulate Hormones...... 124 Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) - Drugs to Regulate Hormones...... 124 Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones...... 124 Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Drugs to Replace Thyroid Hormones...... 135 Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones...... 136 Hormonal Agents, Suppressant (Pituitary) - Drugs to Regulate Hormones...... 136 Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones...... 137 Immunological Agents - Drugs that Stimulate or Suppress the Immune System...... 138 Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease...... 142 Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions...... 144 Miscellaneous Therapeutic Agents...... 145 Ophthalmic Agents - Drugs to Treat Eye Conditions...... 149 Otic Agents - Drugs to Treat Ear Conditions...... 155 Respiratory Tract Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions...... 156 Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions...... 156 Skeletal Muscle Relaxants - Drugs to Treat Muscle Tension and Spasm...... 165 TOC-1 Sleep Disorder Agents - Drugs for Sedation and Sleep...... 166

TOC-2 Coverage Requirements & Prescription Drug Name Drug Tier Limits Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions Analgesics - Miscellaneous Analgesics ALLZITAL ORAL TABLET 25-325 MG (butalbital- 3 acetaminophen) butalbital-acetaminophen (Bupap Oral Tablet 50-300 Mg) 3 butalbital-acetaminophen oral tablet 50-300 mg, 50-325 mg 1 butalbital-apap oral tablet 50-325 mg 1 butalbital-apap-caffeine oral capsule 50-300-40 mg, 50-325-40 1 SL (6 capsules per day) mg butalbital-apap-caffeine oral tablet 50-325-40 mg 1 SL (6 tablets per day) butalbital-aspirin-caffeine oral capsule 50-325-40 mg 1 butalbital-aspirin-caffeine oral tablet 50-325-40 mg 1 duraxin oral capsule 300-200-20 mg 1 ESGIC ORAL CAPSULE 50-325-40 MG (butalbital-apap- 3 SL (6 capsules per day) caffeine) ESGIC ORAL TABLET 50-325-40 MG (butalbital-apap-caffeine) 3 SL (6 tablets per day) FIORICET ORAL CAPSULE 50-300-40 MG (butalbital-apap- 3 SL (6 capsules per day) caffeine) FIORINAL ORAL CAPSULE 50-325-40 MG (butalbital-aspirin- 3 caffeine) MEDI-DERM-RX EXTERNAL CREAM 0.035-5-20 % (capsaicin- 3 menthol-methyl sal) MEDROX-RX EXTERNAL OINTMENT 0.05-7-20 % (capsaicin- 3 menthol-methyl sal) butalbital-apap-caffeine (Phrenilin Forte Oral Capsule 50-300- 1 SL (6 capsules per day) 40 Mg) tencon oral tablet 50-325 mg 1 TURPENTINE EXTERNAL SPIRIT 3 VANATOL LQ ORAL SOLUTION 50-325-40 MG/15ML 2 (butalbital-apap-caffeine) VANATOL S ORAL SOLUTION 50-325-40 MG/15ML 2 (butalbital-apap-caffeine) butalbital-apap-caffeine (Zebutal Oral Capsule 50-325-40 Mg) 1 SL (6 capsules per day)

Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 105 Coverage Requirements & Prescription Drug Name Drug Tier Limits JADENU ORAL TABLET 180 MG, 360 MG, 90 MG 2 PA; SP (deferasirox) JADENU SPRINKLE ORAL PACKET 180 MG, 360 MG, 90 MG 2 SP (deferasirox) JYNARQUE ORAL TABLET THERAPY PACK 45 & 15 MG, 60 PA; SL (2 tablets per day); 2 & 30 MG, 90 & 30 MG (tolvaptan) SP sodium polystyrene sulfonate (Kionex Oral Suspension 15 1 Gm/60Ml) SL (31 tablets per 31 days); SAMSCA ORAL TABLET 15 MG (tolvaptan) 2 SP SAMSCA ORAL TABLET 30 MG (tolvaptan) 2 SL (2 tablets per day); SP sodium polystyrene sulfonate oral powder 1 sodium polystyrene sulfonate oral suspension 15 gm/60ml 1 sodium polystyrene sulfonate rectal suspension 30 gm/120ml, 1 50 gm/200ml sps oral suspension 15 gm/60ml 1 SYPRINE ORAL CAPSULE 250 MG (trientine hcl) 1 PA VELTASSA ORAL PACKET 16.8 GM, 25.2 GM, 8.4 GM 3 SL (1 Packet per day) (patiromer sorbitex calcium) Phosphate Binders - Phosphate-Removing Agents AURYXIA ORAL TABLET 1 GM 210 MG(FE) (ferric citrate) 3 calcium acetate (phos binder) oral capsule 667 mg 1 calcium acetate (phos binder) oral tablet 667 mg 1 FOSRENOL ORAL PACKET 1000 MG, 750 MG (lanthanum 3 carbonate) lanthanum carbonate oral tablet chewable 1000 mg, 500 mg, 1 750 mg PHOSLYRA ORAL SOLUTION 667 MG/5ML (calcium acetate 3 (phos binder)) RENAGEL ORAL TABLET 800 MG (sevelamer hcl) 3 RENVELA ORAL PACKET 0.8 GM, 2.4 GM (sevelamer 3 carbonate) sevelamer carbonate oral packet 0.8 gm, 2.4 gm 1 sevelamer carbonate oral tablet 800 mg 1 sevelamer hcl oral tablet 400 mg, 800 mg 1 VELPHORO ORAL TABLET CHEWABLE 500 MG (sucroferric 2 oxyhydroxide) Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 106 Coverage Requirements & Prescription Drug Name Drug Tier Limits Vitamins adc/f (0.5mg/ml) oral solution 0.5 mg/ml 1 aminobenzoate potassium oral packet 2 gm 1 AZESCO ORAL TABLET 13-1 MG 3 CALCIFOL ORAL WAFER 1342-1.6 MG (ca carb-fa-d-b6-b12- 3 boron-mg) calcium-folic acid plus d oral wafer 1342-1 mg 1 CITRANATAL MEDLEY ORAL CAPSULE 27-1-200 MG 3 (prenat-fecb-fefum-fa-dha w/o a) DRISDOL ORAL CAPSULE 50000 UNIT (ergocalciferol) 3 ERGOCAL ORAL CAPSULE 2500 UNIT 3 ergocalciferol oral capsule 50000 unit 1 ESCAVITE ORAL TABLET CHEWABLE 0.25-7.5 MG (ped 3 multivitamins-fl-iron) FLORIVA PLUS ORAL SOLUTION 0.25 MG/ML (pediatric 3 multivitamins-fl) MAGNEBIND 400 ORAL TABLET 400-200-1 MG (magnesium- 2 calcium-folic acid) MEPHYTON ORAL TABLET 5 MG (phytonadione) 3 M-NATAL PLUS ORAL TABLET 27-1 MG 3 multi-vit/iron/fluoride oral solution 0.25-10 mg/ml 1 multivitamin/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml 1 multi-vitamin/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml 1 multivitamin/fluoride oral tablet chewable 0.5 mg, 1 mg 1 MULTIVITAMIN/FLUORIDE TABLET CHEWABLE 0.25 MG 3 ORAL 0.25 MG multivitamin/fluoride tablet chewable 0.25 mg oral 0.25 mg 1 multivitamin/fluoride/iron oral solution 0.25-10 mg/ml 1 multi-vitamin/fluoride/iron oral solution 0.25-10 mg/ml 1 multivitamins/fluoride oral tablet chewable 0.5 mg 1 mvc-fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg 1 n-acetyl-l-cysteine oral capsule 600 mg 1 NASCOBAL NASAL SOLUTION 500 MCG/0.1ML 3 (cyanocobalamin) NICOMIDE ORAL TABLET 750-27-2-0.5 MG (niacinamide-zn- 3 cu-methfo-se-cr) Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 107 Coverage Requirements & Prescription Drug Name Drug Tier Limits phytonadione oral tablet 5 mg 1 pnv prenatal plus multivit+dha oral 27-1 & 312 mg 1 POLY-VI-FLOR ORAL SUSPENSION 0.25 MG/ML (pediatric 3 multivitamins-fl) POLY-VI-FLOR ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG, 3 1 MG (pediatric multivitamins-fl) POLY-VI-FLOR/IRON ORAL SUSPENSION 0.25-7 MG/ML 3 (ped multivitamins-fl-iron) POLY-VI-FLOR/IRON ORAL TABLET CHEWABLE 0.5-10 MG 3 (ped multivitamins-fl-iron) POTABA ORAL CAPSULE 500 MG (potassium 3 aminobenzoate) PREMESISRX ORAL TABLET 1 MG (prenatal ca-b6-b12-fa- 3 ginger) prenatal oral tablet 27-1 mg 1 prenatal plus iron oral tablet 29-1 mg 1 QUFLORA PEDIATRIC ORAL SOLUTION 0.25 MG/ML, 0.5 3 MG/ML (pediatric multivitamins-fl) QUFLORA PEDIATRIC ORAL TABLET CHEWABLE 0.25 MG, 3 0.5 MG, 1 MG (pediatric multivitamins-fl) RELNATE DHA ORAL CAPSULE 28-1-200 MG 3 TL-FLUORIVITE ORAL TABLET CHEWABLE 0.25-7.5 MG 3 TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 3 MG (prenatal-fefum-fa-dss-fish oil) TRI-VI-FLOR ORAL SUSPENSION 0.25 MG/ML, 0.5 MG/ML 3 (ped vit a-c-d-methylfolate-fl) TRI-VI-FLORO ORAL SUSPENSION 0.25 MG/ML, 0.5 MG/ML 3 tri-vitamin/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml 1 tri-vite/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml 1 vitamin d (ergocalciferol) oral capsule 50000 unit 1 vitamins acd-fluoride oral solution 0.25 mg/ml 1 WHEAT GERM OIL ORAL OIL 3 Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions Antispasmodics, Gastrointestinal - Bowel Treatment Drugs ANASPAZ ORAL TABLET DISPERSIBLE 0.125 MG 2 (hyoscyamine sulfate) Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 108 Coverage Requirements & Prescription Drug Name Drug Tier Limits ed-spaz oral tablet dispersible 0.125 mg 1 hyoscyamine sulfate er oral tablet extended release 12 hour 1 0.375 mg hyoscyamine sulfate oral elixir 0.125 mg/5ml 1 hyoscyamine sulfate oral solution 0.125 mg/ml 1 hyoscyamine sulfate oral tablet dispersible 0.125 mg 1 hyoscyamine sulfate sl sublingual tablet sublingual 0.125 mg 1 hyoscyamine sulfate sublingual tablet sublingual 0.125 mg 1 hyosyne oral elixir 0.125 mg/5ml 1 hyosyne oral solution 0.125 mg/ml 1 LEVBID ORAL TABLET EXTENDED RELEASE 12 HOUR 3 0.375 MG (hyoscyamine sulfate) LEVSIN/SL SUBLINGUAL TABLET SUBLINGUAL 0.125 MG 3 (hyoscyamine sulfate) hyoscyamine sulfate (Nulev Oral Tablet Dispersible 0.125 Mg) 3 oscimin oral tablet dispersible 0.125 mg 1 oscimin sr oral tablet extended release 12 hour 0.375 mg 1 oscimin sublingual tablet sublingual 0.125 mg 1 SYMAX DUOTAB ORAL TABLET EXTENDED RELEASE 0.375 3 MG (hyoscyamine sulfate) hyoscyamine sulfate (Symax-Sl Sublingual Tablet Sublingual 1 0.125 Mg) hyoscyamine sulfate er (Symax-Sr Oral Tablet Extended 1 Release 12 Hour 0.375 Mg) Antispasmodics, Gastrointestinal - Stomach and Intestine Drugs BELLADONNA ALKALOIDS-OPIUM RECTAL SUPPOSITORY 2 16.2-60 MG belladonna-opium rectal suppository 16.2-30 mg 1 chlordiazepoxide-clidinium oral capsule 5-2.5 mg 1 CUVPOSA ORAL SOLUTION 1 MG/5ML (glycopyrrolate) 3 dicyclomine hcl oral capsule 10 mg 1 dicyclomine hcl oral solution 10 mg/5ml 1 dicyclomine hcl oral tablet 20 mg 1 GLYCATE ORAL TABLET 1.5 MG (glycopyrrolate) 3 glycopyrrolate oral tablet 1 mg, 2 mg 1 Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 109 Coverage Requirements & Prescription Drug Name Drug Tier Limits GLYCOPYRROLATE ORAL TABLET 1.5 MG 3 hyoscyamine sulfate oral tablet 0.125 mg 1 LEVSIN ORAL TABLET 0.125 MG (hyoscyamine sulfate) 3 methscopolamine bromide oral tablet 2.5 mg, 5 mg 1 oscimin oral tablet 0.125 mg 1 propantheline bromide oral tablet 15 mg 1 Gastrointestinal Agents, Other - Miscellaneous Gastrointestinal Drugs ACTIGALL ORAL CAPSULE 300 MG (ursodiol) 3 SL (112 capsules and tablets amoxicill-clarithro-lansopraz oral 1 (1 Package) per 180 days) CHENODAL ORAL TABLET 250 MG (chenodiol) 3 SP cromolyn sodium oral concentrate 100 mg/5ml 1 diphenoxylate-atropine oral liquid 2.5-0.025 mg/5ml 1 diphenoxylate-atropine oral tablet 2.5-0.025 mg 1 ENTEREG ORAL CAPSULE 12 MG (alvimopan) 3 GASTROCROM ORAL CONCENTRATE 100 MG/5ML 3 (cromolyn sodium) GATTEX SUBCUTANEOUS KIT 5 MG (teduglutide (rdna)) 2 PA; SL (1 vial per day); SP LOMOTIL ORAL TABLET 2.5-0.025 MG (diphenoxylate- 3 atropine) metoclopramide hcl oral tablet 10 mg, 5 mg 1 metoclopramide hcl oral tablet dispersible 5 mg 1 MOTOFEN ORAL TABLET 1-0.025 MG (difenoxin-atropine) 3 MYALEPT SUBCUTANEOUS SOLUTION RECONSTITUTED 3 PA; SL (1 vial per day); SP 11.3 MG (metreleptin) MYTESI ORAL TABLET DELAYED RELEASE 125 MG 3 PA; SL (2 tablets per day) (crofelemer) PA; ST; SL (1 tablet per day); OCALIVA ORAL TABLET 10 MG, 5 MG (obeticholic acid) 3 SP SL (1 carton (10 OMECLAMOX-PAK ORAL 500-500-20 MG (amoxicill-clarithro- 3 administrative cards, 80 omeprazole) tablets) per 6 months) opium oral tincture 10 mg/ml (1%) 1 paregoric oral tincture 2 mg/5ml 1

Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 132 Coverage Requirements & Prescription Drug Name Drug Tier Limits norgestim-eth estrad triphasic (Tri-Lo-Marzia Oral Tablet 1 H 0.18/0.215/0.25 Mg-25 Mcg) tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg 1 H tri-mili oral tablet 0.18/0.215/0.25 mg-35 mcg 1 H TRI-NORINYL (28) ORAL TABLET 0.5/1/0.5-35 MG-MCG 3 (norethin-eth estrad triphasic) tri-previfem oral tablet 0.18/0.215/0.25 mg-35 mcg 1 H norgestim-eth estrad triphasic (Tri-Sprintec Oral Tablet 1 H 0.18/0.215/0.25 Mg-35 Mcg) trivora (28) oral tablet 1 H tri-vylibra lo oral tablet 0.18/0.215/0.25 mg-25 mcg 1 H tri-vylibra oral tablet 0.18/0.215/0.25 mg-35 mcg 1 H drospiren-eth estrad-levomefol (Tydemy Oral Tablet 3-0.03- 1 H 0.451 Mg) velivet oral tablet 0.1/0.125/0.15 -0.025 mg 1 H vienva oral tablet 0.1-20 mg-mcg 1 H viorele oral tablet 0.15-0.02/0.01 mg (21/5) 1 H VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY SL (8 patches (1 box) per 28 0.025 MG/24HR, 0.0375 MG/24HR, 0.05 MG/24HR, 0.075 1 days) MG/24HR, 0.1 MG/24HR (estradiol) vyfemla oral tablet 0.4-35 mg-mcg 1 H norgestimate-eth estradiol (Vylibra Oral Tablet 0.25-35 Mg-Mcg) 1 H wera oral tablet 0.5-35 mg-mcg 1 H norethin-eth estradiol-fe (Wymzya Fe Oral Tablet Chewable 0.4- 1 H 35 Mg-Mcg) xulane transdermal patch weekly 150-35 mcg/24hr 1 H YASMIN 28 ORAL TABLET 3-0.03 MG (drospirenone-ethinyl 3 H estradiol) YAZ ORAL TABLET 3-0.02 MG (drospirenone-ethinyl estradiol) 3 estradiol (Yuvafem Vaginal Tablet 10 Mcg) 1 drospirenone-ethinyl estradiol (Zarah Oral Tablet 3-0.03 Mg) 1 H zovia 1/35e (28) oral tablet 1-35 mg-mcg 1 H Progestins - Hormone Replacement/Modifying Drugs AYGESTIN ORAL TABLET 5 MG (norethindrone acetate) 3 camila oral tablet 0.35 mg 1 H CRINONE VAGINAL GEL 4 % (progesterone) 3 ST Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 133 Coverage Requirements & Prescription Drug Name Drug Tier Limits CRINONE VAGINAL GEL 8 % (progesterone) 3 PA; ST deblitane oral tablet 0.35 mg 1 H DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 3 MG/ML (medroxyprogesterone acetate) DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 150 MG/ML (medroxyprogesterone 3 acetate) DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE 104 MG/0.65ML 2 H (medroxyprogesterone acetate) ELLA ORAL TABLET 30 MG (ulipristal acetate) 1 SL (1 tablet per 21 days); H ENDOMETRIN VAGINAL INSERT 100 MG (progesterone) 2 PA errin oral tablet 0.35 mg 1 H heather oral tablet 0.35 mg 1 H incassia oral tablet 0.35 mg 1 H jencycla oral tablet 0.35 mg 1 H jolivette oral tablet 0.35 mg 1 H levonorgestrel oral tablet 1.5 mg 1 H norethindrone (Lyza Oral Tablet 0.35 Mg) 1 H medroxyprogesterone acetate intramuscular suspension 150 1 H mg/ml medroxyprogesterone acetate intramuscular suspension 1 H prefilled syringe 150 mg/ml medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg 1 MEGACE ES ORAL SUSPENSION 625 MG/5ML (megestrol 3 acetate) megestrol acetate oral suspension 40 mg/ml, 625 mg/5ml 1 megestrol acetate oral tablet 20 mg, 40 mg 1 nora-be oral tablet 0.35 mg 1 H norethindrone acetate oral tablet 5 mg 1 norethindrone oral tablet 0.35 mg 1 H norlyda oral tablet 0.35 mg 1 H norlyroc oral tablet 0.35 mg 1 H ORTHO MICRONOR ORAL TABLET 0.35 MG (norethindrone) 3 PLAN B ONE-STEP ORAL TABLET 1.5 MG (levonorgestrel) 1 H progesterone intramuscular oil 50 mg/ml 1 Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 134 Coverage Requirements & Prescription Drug Name Drug Tier Limits progesterone micronized oral capsule 100 mg, 200 mg 1 PROMETRIUM ORAL CAPSULE 100 MG, 200 MG 3 (progesterone micronized) PROVERA ORAL TABLET 10 MG, 2.5 MG, 5 MG 3 (medroxyprogesterone acetate) sharobel oral tablet 0.35 mg 1 H tulana oral tablet 0.35 mg 1 H Selective Estrogen Receptor Modifying Agents - Hormone Replacement/Modifying Drugs OSPHENA ORAL TABLET 60 MG (ospemifene) 2 SL (1 tablet per day) raloxifene hcl oral tablet 60 mg 1 H-PA Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Drugs to Replace Thyroid Hormones Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Thyroid Replacement Drugs CYTOMEL ORAL TABLET 25 MCG, 5 MCG, 50 MCG 3 (liothyronine sodium) euthyrox oral tablet 100 mcg, 125 mcg, 137 mcg, 150 mcg, 200 1 mcg, 25 mcg, 50 mcg, 75 mcg levothyroxine sodium (Euthyrox Oral Tablet 112 Mcg, 175 Mcg, 1 88 Mcg) levo-t oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 1 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 88 mcg levothyroxine sodium (Levo-T Oral Tablet 300 Mcg, 75 Mcg) 1 levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 1 mcg, 75 mcg, 88 mcg levoxyl oral tablet 100 mcg, 112 mcg, 175 mcg, 75 mcg, 88 mcg 1 levothyroxine sodium (Levoxyl Oral Tablet 125 Mcg, 137 Mcg, 1 150 Mcg, 200 Mcg, 25 Mcg, 50 Mcg) liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg 1 SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 2 50 MCG, 75 MCG, 88 MCG (levothyroxine sodium) THYROLAR-1 ORAL TABLET 60 (12.5-50) MG (MCG) (liotrix 3 (t3-t4)) THYROLAR-1/2 ORAL TABLET 30 (6.25-25) MG (MCG) (liotrix 3 (t3-t4)) Drug Tier 1: Lower-cost medications covered under the outpatient prescription drug benefit; Drug Tier 2: Mid- range cost medications covered under the outpatient prescription drug benefit; Drug Tier 3: Highest-cost medications covered under the outpatient prescription drug benefit.; PA: Prior authorization required; SL: Supply Limit; ST: Step Therapy; H: May be part of health care reform preventive; H-PA: May be part of health care reform preventive with prior authorization; SP: Specialty medication; CM: Orally administered anticancer medication. 135 Coverage Requirements & Prescription Drug Name Drug Tier Limits THYROLAR-1/4 ORAL TABLET 15 (3.1-12.5) MG (MCG) (liotrix 3 (t3-t4)) THYROLAR-2 ORAL TABLET 120 (25-100) MG (MCG) (liotrix 3 (t3-t4)) THYROLAR-3 ORAL TABLET 180 (37.5-150) MG (MCG) (liotrix 3 (t3-t4)) TIROSINT ORAL CAPSULE 100 MCG, 112 MCG, 125 MCG, 13 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 3 50 MCG, 75 MCG, 88 MCG (levothyroxine sodium) levothyroxine sodium (Unithroid Oral Tablet 100 Mcg) 1 unithroid oral tablet 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 1 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones Hormonal Agents, Suppressant (Adrenal) - Hormone Suppressants LYSODREN ORAL TABLET 500 MG (mitotane) 2 CM Hormonal Agents, Suppressant (Pituitary) - Drugs to Regulate Hormones Hormonal Agents, Suppressant (Pituitary) - Hormone Suppressants cabergoline oral tablet 0.5 mg 1 EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED 1 3 PA; SP MG (tesamorelin acetate) ELIGARD SUBCUTANEOUS KIT 22.5 MG (leuprolide acetate 3 PA (3 month)) ELIGARD SUBCUTANEOUS KIT 30 MG (leuprolide acetate (4 3 PA month)) ELIGARD SUBCUTANEOUS KIT 45 MG (leuprolide acetate (6 3 PA month)) ELIGARD SUBCUTANEOUS KIT 7.5 MG (leuprolide acetate) 3 PA FIRMAGON SUBCUTANEOUS SOLUTION RECONSTITUTED 3 SP 120 MG, 80 MG (degarelix acetate) leuprolide acetate injection kit 1 mg/0.2ml 1 PA LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG 3 INTRAMUSCULAR KIT 30 MG (leuprolide acetate (4 month)) LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG 3 INTRAMUSCULAR KIT 45 MG (leuprolide acetate (6 month))

168 amlodipine besylate...... 79 ARANESP (ALBUMIN FREE) AVAR...... 94 amlodipine besylate-benazepril ...... 70, 71 Avar Cleanser...... 94 hcl...... 80 ARAVA...... 141 AVAR LS...... 95 amlodipine besylate-valsartan.. 81 ARCALYST...... 141 AVAR LS CLEANSER...... 94 amlodipine-atorvastatin...... 81 ARICEPT...... 33 Avar-E Emollient...... 95 amlodipine-olmesartan...... 81 ARIKAYCE...... 21 AVAR-E GREEN...... 95 amlodipine-valsartan-hctz...... 81 aripiprazole...... 54 AVAR-E LS...... 95 Amnesteem...... 94 ARIXTRA...... 69 AVC VAGINAL...... 38 amnesteem...... 94 armodafinil...... 167 aviane...... 126 amoxapine...... 37 ARMOUR THYROID...... 137 avidoxy...... 28 amoxicill-clarithro-lansopraz... 110 ARNUITY ELLIPTA...... 157 AVIDOXY DK...... 28 amoxicillin...... 25 AROMASIN...... 46 Avita...... 95 amoxicillin-potassium ARTHROTEC...... 13 AVONEX PEN...... 92 clavulanate...... 25 ARTISS...... 72 AVONEX PREFILLED...... 92 amoxicillin-potassium ARZOL SILVER NIT AVONEX VIAL clavulanate er...... 25 APPLICATORS...... 22 INTRAMUSCULAR KIT...... 92 amphetamine sulfate...... 88 Ascomp-Codeine...... 16 AYGESTIN...... 133 amphetamine- ashlyna...... 125 AZASAN...... 138 dextroamphetamine...... 88 ASMANEX 120 METERED AZASITE...... 152 ampicillin...... 25 DOSES...... 157 azathioprine...... 138 ANADROL-50...... 124 ASMANEX 14 METERED azelaic acid...... 95 anagrelide hcl...... 70 DOSES...... 157 azelastine hcl...... 152, 156 ANALPRAM HC...... 143 ASMANEX 30 METERED AZELEX...... 95 ANALPRAM HC SINGLES..... 143 DOSES...... 157 AZESCO...... 107 ANALPRAM-HC...... 143 ASMANEX 60 METERED AZILECT...... 54 ANASPAZ...... 108 DOSES...... 157 azithromycin...... 26 anastrozole...... 46 ASMANEX 7 METERED AZOPT...... 153 ANCOBON...... 38 DOSES...... 158 AZULFIDINE...... 144 ANDRODERM...... 125 ASMANEX HFA...... 158 AZULFIDINE EN-TABS...... 144 ANGELIQ...... 125 aspirin-dipyridamole er...... 75 azurette...... 126 ANORO ELLIPTA...... 163 ASTRINGYN...... 72 bacitracin...... 152 ANTABUSE...... 20 ATACAND...... 76 bacitracin-polymyxin b...... 150 ANTARA...... 84 ATACAND HCT...... 81 bacitra-neomycin-polymyxin-hc anticoagulant cit dext soln a...... 69 atazanavir sulfate...... 61 ...... 150 ANTICOAGULANT SODIUM atenolol...... 78 baclofen...... 165 CITRATE...... 69 atenolol-chlorthalidone...... 81 BACTRIM...... 27 anucort-hc...... 41 atomoxetine hcl...... 89 BACTRIM DS...... 27 ANUSOL-HC...... 143 atorvastatin calcium...... 85 balsalazide disodium...... 142 ANZEMET...... 38 atovaquone...... 51 balsam peru-castor oil...... 95 apap-caff-dihydrocodeine...... 16 atovaquone-proguanil hcl...... 51 balziva...... 126 APEXICON E...... 118 ATRIPLA...... 59 BANZEL...... 32 APLENZIN...... 34 atropine sulfate...... 150 BARACLUDE...... 57 APOKYN...... 52 ATROVENT HFA...... 159 BASAGLAR KWIKPEN...... 68 apraclonidine hcl...... 153 AUBAGIO...... 92 BAXDELA...... 27 aprepitant...... 38 aubra...... 126 BAYER BREEZE 2 CONTROL apri...... 125 aubra eq...... 125 ...... 146 APRISO...... 142 AUGMENTIN...... 26 BAYER CONTOUR...... 146 APTENSIO XR...... 89 AURYXIA...... 106 BAYER CONTOUR NEXT APTIOM...... 32 AUSTEDO...... 90 CONTROL...... 146 APTIVUS...... 61 AUTOLET II CLINISAFE...... 145 BAYER CONTOUR NEXT aranelle...... 125 AVALIDE...... 81 MONITOR...... 146 AVANDIA...... 64 BAYER CONTOUR NEXT AVAPRO...... 76 TEST...... 146

169 BAYER MICROLET 2 BIO-STATIN...... 38 BYDUREON BCISE LANCING DEVIC...... 146 bio-statin...... 38 AUTOINJECTOR...... 64 BECONASE AQ...... 158 bisoprolol fumarate...... 78 BYETTA 10 MCG PEN...... 65 bekyree...... 126 bisoprolol-hydrochlorothiazide.. 81 BYETTA 5 MCG PEN...... 65 BELBUCA...... 14 BLEPH-10...... 27 BYSTOLIC...... 78 BELLADONNA ALKALOIDS- BLEPHAMIDE...... 150 BYVALSON...... 81 OPIUM...... 109 BLEPHAMIDE S.O.P...... 150 cabergoline...... 136 belladonna-opium...... 109 blisovi 24 fe...... 126 CABOMETYX...... 47 BELSOMRA...... 167 blisovi fe 1.5/30...... 126 CAFERGOT...... 41 BELVIQ...... 90 blisovi fe 1/20...... 126 caffeine citrate...... 90 BELVIQ XR...... 90 BONIVA...... 144 CALAN...... 79 benazepril hcl...... 76 BORIC ACID...... 95 CALAN SR...... 79 benazepril-hydrochlorothiazide. 81 BOSULIF...... 47 CALCIFOL...... 107 BENEFIX...... 72 bp 10-1...... 95 calcipotriene...... 95 BENLYSTA...... 141 bp cleansing wash...... 95 calcipotriene-betameth diprop...95 BENZALKONIUM CHLORIDE.. 22 BRAFTOVI...... 47 calcitonin (salmon)...... 144 benzalkonium chloride...... 22 BREO ELLIPTA...... 163 Calcitrene...... 95 BENZAMYCIN...... 95 briellyn...... 126 calcitriol...... 95, 144 BENZIQ WASH...... 95 BRILINTA...... 75 calcium acetate (phos binder).106 BENZNIDAZOLE...... 51 brimonidine tartrate...... 153 calcium-folic acid plus d...... 107 BENZOIN...... 95 BRIVIACT...... 29 CALQUENCE...... 47 benzoin compound...... 95 Bromfed Dm...... 163 CAMBIA...... 13 benzonatate...... 163 bromfenac sodium (once-daily) camila...... 133 benzoyl peroxide-erythromycin. 95 ...... 154 camrese...... 126 benzphetamine hcl...... 90 bromocriptine mesylate...... 52 camrese lo...... 126 benztropine mesylate...... 52 brompheniramine tannate...... 156 CANASA...... 143 BEPREVE...... 152 BROMSITE...... 154 candesartan cilexetil...... 76 BERINERT...... 138 BROVANA...... 160 candesartan cilexetil-hctz...... 81 BESIVANCE...... 152 budesonide...... 143, 158 CAPEX...... 118 BETADINE OPHTHALMIC bumetanide...... 83 CAPRELSA...... 47 PREP...... 22 BUMEX...... 83 captopril...... 76 betamethasone dipropionate.. 118 BUNAVAIL...... 20 captopril-hydrochlorothiazide.... 81 betamethasone dipropionate Bupap...... 12 CARAC...... 95 aug...... 118 BUPHENYL...... 113 CARAFATE...... 113 betamethasone valerate...... 118 buprenorphine hcl...... 20 CARBAGLU...... 103 BETAPACE AF...... 77 buprenorphine hcl-naloxone carbamazepine...... 32 BETASERON...... 92 hcl...... 20 carbamazepine er...... 32 betaxolol hcl...... 78, 153 bupropion hcl...... 34 CARBATROL...... 32 bethanechol chloride...... 117 bupropion hcl er (smoking det). 21 carbidopa...... 53 BETHKIS...... 161 bupropion hcl er (sr)...... 34 carbidopa-levodopa...... 53 BETIMOL...... 153 bupropion hcl er (xl)...... 34 carbidopa-levodopa er...... 53 BETOPTIC-S...... 153 BUPROPION HCL ER (XL)...... 34 carbidopa-levodopa- BEVESPI AEROSPHERE...... 163 buspirone hcl...... 62 entacapone...... 53 BEVYXXA...... 69 butalbital-acetaminophen...... 12 carbinoxamine maleate...... 156 bicalutamide...... 44 butalbital-apap...... 12 CARDIOVID PLUS...... 146 BIDIL...... 81 butalbital-apap-caff-cod...... 16 CARDURA...... 76 BI-EST 80:20 butalbital-apap-caffeine...... 12 CARDURA XL...... 116 PROGESTERONE...... 126 butalbital-asa-caff-codeine...... 16 CARETOUCH BIEST/PROGESTERONE...... 126 butalbital-aspirin-caffeine...... 12 LANCING/EJECTOR...... 146 BIKTARVY...... 60 BUTISOL SODIUM...... 167 carisoprodol...... 166 BILTRICIDE...... 51 butorphanol tartrate...... 16 carisoprodol-aspirin...... 166 bimatoprost...... 155 BYDUREON...... 64 carisoprodol-aspirin-codeine.....16 BINOSTO...... 144 CARNITOR...... 103

170 CARNITOR SF...... 103 chloroquine phosphate...... 51 clindamycin phosphate- CAROSPIR...... 84 chlorothiazide...... 84 benzoyl peroxide...... 96 carteolol hcl...... 153 chlorpromazine hcl...... 54 clindamycin-tretinoin...... 96 Cartia Xt...... 79 chlorpropamide...... 65 CLINDESSE...... 22 carvedilol...... 78 chlorthalidone...... 84 clinpro 5000...... 93 carvedilol phosphate er...... 78 chlorzoxazone...... 166 clobazam...... 30 cascara sagrada...... 112 CHOLBAM...... 114 clobetasol prop emollient base118 CASODEX...... 44 cholestyramine...... 85 clobetasol propionate...... 118, 119 CATAPRES...... 75 cholestyramine light...... 85 clobetasol propionate e...... 118 CATAPRES-TTS-1...... 75 choline fenofibrate...... 84 clobetasol propionate emulsion CATAPRES-TTS-2...... 75 choline-mag trisalicylate...... 13 ...... 118 CATAPRES-TTS-3...... 75 CIALIS...... 116, 117 CLOBEX SPRAY...... 119 cavarest...... 93 Ciclodan...... 38 clocortolone pivalate...... 119 CAVERJECT...... 117 CICLODAN SOLUTION...... 38 clocortolone pivalate pump..... 119 CAVERJECT IMPULSE...... 117 ciclopirox...... 38 CLODAN...... 96 CAYA...... 146 ciclopirox olamine...... 38, 39 Clodan...... 119 CAYSTON...... 161 ciclopirox treatment...... 39 clomipramine hcl...... 37 caziant...... 126 cilostazol...... 75 clonazepam...... 63 cefaclor...... 24 CILOXAN...... 152 clonidine...... 75 CEFACLOR...... 24 CIMDUO...... 60 clonidine hcl...... 75 cefaclor er...... 24 cimetidine...... 111 clonidine hcl er...... 89 cefadroxil...... 24 cimetidine hcl...... 111 clopidogrel bisulfate...... 75 cefdinir...... 24 CIMZIA PREFILLED KIT...... 138 clorazepate dipotassium...... 63 cefditoren pivoxil...... 24 CIMZIA STARTER KIT...... 138 clotrimazole...... 39 cefixime...... 25 cinacalcet hcl...... 144 clotrimazole-betamethasone.....96 cefpodoxime proxetil...... 25 CIPRO...... 27 clozapine...... 56 cefprozil...... 25 CIPRO HC...... 155 CLOZARIL...... 56 cefuroxime axetil...... 25 CIPRODEX...... 156 COAGADEX...... 72 celecoxib...... 13 ciprofloxacin...... 27 COAL TAR...... 96 CELONTIN...... 29 ciprofloxacin hcl...... 27, 152, 155 COARTEM...... 51 CENTANY...... 22 ciprofloxacin-ciproflox hcl er...... 27 codeine sulfate...... 16 CENTANY AT...... 22 citalopram hydrobromide...... 35 colchicine-probenecid...... 41 cephalexin...... 25 CITRANATAL MEDLEY...... 107 COLCIGEL...... 146 CERDELGA...... 114 claravis...... 95 COLESTID...... 85 Cerovel...... 95 CLARINEX...... 156 COLESTID FLAVORED...... 85 CERVIDIL...... 117 CLARINEX-D 12 HOUR...... 163 colestipol hcl...... 85, 86 CESAMET...... 38 clarithromycin...... 26 colistimethate sodium (cba)...... 22 CETRAXAL...... 155 clarithromycin er...... 26 Colocort...... 143 cevimeline hcl...... 93 clemastine fumarate...... 156 COLY-MYCIN M...... 22 CHANTIX...... 21 CLENPIQ...... 112 COLY-MYCIN S...... 156 CHANTIX CONTINUING CLEOCIN...... 22 COLYTE WITH FLAVOR MONTH PAK...... 21 CLEOCIN-T...... 95, 96 PACKS...... 112 CHANTIX STARTING MONTH CLIMARA PRO...... 126 COMBIGAN...... 153 PAK...... 21 CLINDACIN ETZ...... 96 COMBIPATCH...... 126 chateal...... 126 Clindacin Etz...... 96 COMBIVENT RESPIMAT...... 163 chateal eq...... 126 CLINDACIN PAC...... 96 COMBIVIR...... 60 CHEMET...... 105 clindacin-p...... 96 COMETRIQ (100 MG DAILY CHEMSTRIP UGK...... 146 CLINDAGEL...... 96 DOSE)...... 47 CHENODAL...... 110 clindamycin hcl...... 22 COMETRIQ (140 MG DAILY chlordiazepoxide hcl...... 63 clindamycin palmitate hcl...... 22 DOSE)...... 47 chlordiazepoxide-amitriptyline...34 clindamycin phosphate...... 22, 96 COMETRIQ (60 MG DAILY chlordiazepoxide-clidinium...... 109 CLINDAMYCIN PHOSPHATE.. 96 DOSE)...... 47 chlorhexidine gluconate...... 93 COMPLERA...... 59

171 Compro...... 37 CYCLOSET...... 65 DERMACINRX NEUROTRAL COMTAN...... 52 cyclosporine...... 138 PHARMAPAK...... 19 CONCERTA...... 89 cyclosporine modified...... 138 DERMA-SMOOTHE/FS BODY CONDYLOX...... 96 cyproheptadine hcl...... 156 ...... 119 constulose...... 112 cyred...... 126 DERMA-SMOOTHE/FS CONTRAVE...... 90 Cyred Eq...... 126 SCALP...... 119 CONZIP...... 14 CYSTADANE...... 114 DERMASORB HC...... 119 COPIKTRA...... 45 CYSTAGON...... 114 DERMASORB TA...... 119 CORDRAN...... 119 CYSTARAN...... 150 DERMASORB XM...... 97 COREG...... 78 CYTOMEL...... 135 Dermazene...... 39 CORGARD...... 78 CYTOTEC...... 113 DERMOTIC...... 156 CORIFACT...... 72 cytra k crystals...... 103 DESCOVY...... 60 CORLANOR...... 81 DAKLINZA...... 57 desipramine hcl...... 37 CORTANE-B...... 96 dalfampridine er...... 92 desloratadine...... 156 CORTEF...... 119 DALIRESP...... 161 desmopressin ace spray refrig 124 CORTENEMA...... 143 danazol...... 125 desmopressin acetate...... 124 cortic-nd...... 156 DANTRIUM...... 166 desmopressin acetate spray... 124 CORTIFOAM...... 143 dantrolene sodium...... 166 desogestrel-ethinyl estradiol... 127 cortisone acetate...... 119 dapsone...... 43 DESONATE...... 119 CORTISPORIN...... 96 DARAPRIM...... 51 desonide...... 119 CORTROSYN...... 146 darifenacin hydrobromide er... 115 DESOWEN...... 119 COSENTYX 150 MG/ML...... 96 dasetta 1/35...... 126 desoximetasone...... 119, 120 COSENTYX 300 DOSE...... 96 dasetta 7/7/7...... 126 DESOXYN...... 88 COSENTYX SENSOREADY DAURISMO...... 47 DESVENLAFAXINE ER...... 35 300 DOSE...... 96 DAYPRO...... 13 desvenlafaxine succinate er...... 35 COSENTYX SENSOREADY Daysee...... 126 dexamethasone...... 120 PEN...... 97 DAYTRANA...... 89 dexamethasone intensol...... 120 COSOPT...... 153 DDAVP...... 124 dexamethasone sodium cosyntropin...... 146 DDAVP RHINAL TUBE...... 124 phosphate...... 154 COTELLIC...... 47 DEBACTEROL...... 93 dexchlorpheniramine maleate.156 COTEMPLA XR-ODT...... 89 deblitane...... 134 DEXEDRINE...... 88 COUMADIN...... 69 deferasirox...... 105 DEXILANT...... 113 Covaryx...... 126 DELESTROGEN...... 127 dexmethylphenidate hcl...... 89 covaryx hs...... 126 DELSTRIGO...... 59 dexmethylphenidate hcl er...... 89 COZAAR...... 76 Deltasone...... 119 Dexpak 10 Day...... 120 CREON...... 114 delyla...... 127 Dexpak 13 Day...... 120 CRESEMBA...... 39 DEMADEX...... 83 DEXPAK 6 DAY...... 120 CRINONE...... 133, 134 demeclocycline hcl...... 28 dextroamphetamine sulfate...... 88 CRIXIVAN...... 61 DEMSER...... 81 dextroamphetamine sulfate er.. 88 cromolyn sodium.....110, 152, 161 DENAVIR...... 58 DIASTAT ACUDIAL...... 30 crotan...... 52 denta 5000 plus...... 93 DIASTAT PEDIATRIC...... 30 cryselle-28...... 126 Dentagel...... 93 diazepam...... 30, 63 CUPRIMINE...... 105 DEPAKENE...... 30 Diazepam Intensol...... 63 CUTIVATE...... 119 DEPAKOTE...... 64 DICLOFENAC EPOLAMINE.....13 CUVPOSA...... 109 DEPAKOTE ER...... 64 diclofenac potassium...... 13 cyclafem 1/35...... 126 DEPAKOTE SPRINKLES...... 64 diclofenac sodium...... 13, 97, 154 cyclafem 7/7/7...... 126 DEPEN TITRATABS...... 105 diclofenac sodium er...... 13 cyclobenzaprine hcl...... 166 DEPO-ESTRADIOL...... 127 diclofenac-misoprostol...... 13 CYCLOGYL...... 150 DEPO-PROVERA...... 134 dicloxacillin sodium...... 26 CYCLOMYDRIL...... 152 DEPO-SUBQ PROVERA 104.134 dicyclomine hcl...... 109 cyclopentolate hcl...... 150 DEPO-TESTOSTERONE...... 125 didanosine...... 60 cyclophosphamide...... 44 DERMACINRX DUOPATCH diethylpropion hcl...... 90 cycloserine...... 43 PHARMAPAK...... 19 diethylpropion hcl er...... 90

172 DIFICID...... 26 drospirenone-ethinyl estradiol.127 ELOCTATE...... 72 difil-g forte...... 161 DROXIA...... 45 EMADINE...... 152 diflorasone diacetate...... 120 DRYSOL...... 97 EMCYT...... 45 DIFLUCAN...... 39 DUAVEE...... 127 EMEND...... 38 diflunisal...... 13 DUETACT...... 65 EMEND TRI-PACK...... 38 digitek...... 81 DULERA...... 163 EMGALITY...... 19, 42 Digitek...... 81 duloxetine hcl...... 91 emoquette...... 127 Digox...... 81 DUOPA...... 53 EMSAM...... 35 digox...... 81 DUPIXENT...... 97 EMTRIVA...... 60 digoxin...... 81 duraxin...... 12 EMVERM...... 51 dihydroergotamine mesylate.....42 DUREZOL...... 154 enalapril maleate...... 76 DILANTIN...... 32 dutasteride...... 116 enalapril-hydrochlorothiazide.... 81 DILANTIN INFATABS...... 32 dutasteride-tamsulosin hcl...... 117 ENBREL...... 138 DILATRATE-SR...... 87 DVORAH...... 17 ENBREL MINI...... 138 DILAUDID...... 16, 17 DYANAVEL XR...... 88 ENBREL SURECLICK...... 138 diltiazem hcl...... 79 DYAZIDE...... 81 ENDARI...... 103 diltiazem hcl er...... 79 DYMISTA...... 164 Endocet...... 17 diltiazem hcl er beads...... 79 DYRENIUM...... 84 ENDOMETRIN...... 134 diltiazem hcl er coated beads... 79 E.E.S. GRANULES...... 26 enoxaparin sodium...... 69 dilt-xr...... 79 EASIVENT...... 146 Enpresse-28...... 127 DIPENTUM...... 143 EASYMAX CONTROL...... 146 enskyce...... 127 diphenhydramine hcl...... 156 EASYPLUS BLOOD ENSTILAR...... 97 diphenoxylate-atropine...... 110 GLUCOSE TEST...... 146 entacapone...... 52 DIPROLENE...... 120 EC-NAPROXEN...... 13 entecavir...... 57 DIPROLENE AF...... 120 econazole nitrate...... 39 ENTEREG...... 110 dipyridamole...... 75 ECOZA...... 39 ENTRESTO...... 82 disopyramide phosphate...... 77 EC-RX DHEA...... 146 enulose...... 112 disulfiram...... 20 EDARBI...... 76 EPANED...... 76 DITROPAN XL...... 115 EDARBYCLOR...... 81 EPCLUSA...... 57 DIURIL...... 84 EDECRIN...... 83 EPIDIOLEX...... 29 divalproex sodium...... 64 EDEX...... 117 EPIDUO...... 97 divalproex sodium er...... 64 EDLUAR...... 166 EPIDUO FORTE...... 97 DIVIGEL...... 127 ed-spaz...... 109 EPIFOAM...... 97 dofetilide...... 77 EDURANT...... 59 epinastine hcl...... 152 DOLOPHINE...... 14 eemt...... 127 EPINEPHRINE...... 160 donepezil hcl...... 33 eemt hs...... 127 epinephrine...... 160 DOPTELET...... 71 efavirenz...... 59 Epitol...... 32 DORAL...... 63 EFFER-K...... 103 EPIVIR...... 60 DORYX MPC...... 28 effer-k...... 103 EPIVIR HBV...... 57 dorzolamide hcl...... 153 EFUDEX...... 97 eplerenone...... 84 dorzolamide hcl-timolol mal.... 153 EGRIFTA...... 136 EPOGEN...... 71 dorzolamide hcl-timolol mal pf 153 ELESTRIN...... 127 eprosartan mesylate...... 76 DOVONEX...... 97 eletriptan hydrobromide...... 42 EQUETRO...... 32, 64 doxazosin mesylate...... 76 ELIDEL...... 97 ERGOCAL...... 107 doxepin hcl...... 37, 97 ELIGARD...... 136 ergocalciferol...... 107 doxercalciferol...... 144 ELIMITE...... 52 ergoloid mesylates...... 146 doxycycline...... 28 elinest...... 127 ERGOMAR...... 42 doxycycline hyclate...... 28 ELIQUIS...... 69 ergotamine-caffeine...... 42 doxycycline monohydrate...... 28 ELIQUIS STARTER PACK...... 69 ERIVEDGE...... 48 D-PENAMINE...... 117 ELIXOPHYLLIN...... 161 ERLEADA...... 44 DRISDOL...... 107 ELLA...... 134 errin...... 134 dronabinol...... 38 ELMIRON...... 117 ery...... 97 drospiren-eth estrad-levomefol127 ELOCON...... 120 ERYGEL...... 97

173 ERYPED 200...... 26 FALESSA...... 128 FLORIVA PLUS...... 107 ERYPED 400...... 26 falmina...... 128 FLOVENT DISKUS...... 158 ERY-TAB...... 26 famciclovir...... 58 FLOVENT HFA...... 158 ERYTHROCIN STEARATE...... 26 famotidine...... 111 FLUAD...... 142 erythromycin...... 97, 152 FANAPT...... 54, 55 FLUARIX QUADRIVALENT....142 erythromycin base...... 26 FANAPT TITRATION PACK..... 55 FLUCELVAX erythromycin ethylsuccinate...... 26 FARESTON...... 45 QUADRIVALENT...... 142 ESBRIET...... 163 FARYDAK...... 48 fluconazole...... 39 ESCAVITE...... 107 Fayosim...... 128 flucytosine...... 39 escitalopram oxalate...... 35 FAZACLO...... 56 fludrocortisone acetate...... 120 ESGIC...... 12 FEIBA...... 72 FLULAVAL QUADRIVALENT. 142 est estrogens-methyltest...... 127 felbamate...... 31 FLUMADINE...... 62 est estrogens-methyltest ds.... 127 FELBATOL...... 31 FLUMIST QUADRIVALENT....142 est estrogens-methyltest hs.... 127 FELDENE...... 13 flunisolide...... 158 estarylla...... 127 felodipine er...... 79 fluocinolone acetonide.... 120, 156 estazolam...... 63 FEM PH...... 22 fluocinolone acetonide body... 120 ESTRACE...... 127 FEMHRT LOW DOSE...... 128 fluocinolone acetonide scalp...120 estradiol...... 127 FEMRING...... 128 fluocinonide...... 120 estradiol valerate...... 127 femynor...... 128 fluocinonide emulsified base...120 estradiol-norethindrone acet... 128 fenofibrate...... 84 FLUORABON...... 103 ESTRING...... 128 fenofibrate micronized...... 84 fluoridex...... 93 ESTROGEL...... 128 fenofibric acid...... 84 fluoridex daily renewal...... 93 ESTROSTEP FE...... 128 fentanyl...... 15 fluoridex enhanced whitening... 93 eszopiclone...... 166 fentanyl citrate...... 17 fluoridex sensitivity relief...... 93 ethacrynic acid...... 83 FENTORA...... 17 fluorometholone...... 154 ethambutol hcl...... 43 FERRIPROX...... 105 FLUOROPLEX...... 97 ethosuximide...... 29 FETZIMA...... 35 FLUOROURACIL...... 97 ethynodiol diac-eth estradiol... 128 FETZIMA TITRATION...... 35 fluorouracil...... 97 etidronate disodium...... 144 FEXMID...... 166 fluoxetine hcl...... 35 etodolac...... 13 FINACEA...... 97 fluoxetine hcl (pmdd)...... 35 etodolac er...... 13 finasteride...... 117 fluphenazine hcl...... 54 etoposide...... 46 FIORICET...... 12 FLURA-DROPS...... 103 EUCRISA...... 97 FIORINAL...... 12 flurandrenolide...... 120, 121 EURAX...... 52 FIORINAL/CODEINE #3...... 17 flurazepam hcl...... 166 euthyrox...... 135 FIRAZYR...... 138 flurbiprofen...... 13 Euthyrox...... 135 FIRMAGON...... 136 flurbiprofen sodium...... 154 EVAMIST...... 128 FIRST-VANCOMYCIN 25...... 21 flutamide...... 44 EVEKEO...... 88 FIRST-VANCOMYCIN 50...... 28 fluticasone propionate.....121, 158 EVOCLIN...... 97 FIRVANQ...... 22 FLUTICASONE- EVOTAZ...... 61 Flac...... 156 SALMETEROL...... 164 EVOXAC...... 93 FLAGYL...... 22 fluvastatin sodium...... 85 EVZIO...... 21 FLAREX...... 154 fluvastatin sodium er...... 85 EXELDERM...... 39 flavoxate hcl...... 115 fluvoxamine maleate...... 35 exemestane...... 46 flecainide acetate...... 77 fluvoxamine maleate er...... 35 EXJADE...... 105 FLECTOR...... 13 FLUZONE HIGH-DOSE...... 142 exoderm...... 39 FLEXICHAMBER ADULT FLUZONE QUADRIVALENT.. 142 exotic-hc...... 156 MASK/SMALL...... 146 FML...... 154 EXTINA...... 39 FLEXICHAMBER CHILD FML FORTE...... 154 EZ FLU SHOT-FLUCELVAX MASK/LARGE...... 146 FML LIQUIFILM...... 154 QUAD...... 142 FLEXICHAMBER CHILD FOCALIN...... 89 ezetimibe...... 86 MASK/SMALL...... 147 folic acid...... 103 ezetimibe-simvastatin...... 86 FLOLIPID...... 85 fondaparinux sodium...... 69 FABIOR...... 97 FLORIVA...... 103 FORANE...... 147

174 FORFIVO XL...... 34 GLEOSTINE...... 44 heparin sodium (porcine)...... 70 Formadon...... 97 glimepiride...... 65 heparin sodium (porcine) pf...... 70 formaldehyde...... 97 glipizide er...... 65 heparin sodium lock flush...... 147 FORMALDEHYDE...... 97 glipizide ir...... 65 HEPSERA...... 57 FORMA-RAY...... 98 glipizide xl...... 65 HETLIOZ...... 167 FORTEO...... 144 glipizide-metformin hcl...... 65 Hidex 6-Day...... 121 FORTISCARE CONTROL...... 147 GLUCAGEN HYPOKIT...... 67 HIPREX...... 23 FOSAMAX...... 144 GLUCAGON EMERGENCY..... 67 Homatropaire...... 150 FOSAMAX PLUS D...... 144 GLUCOPHAGE...... 65 homatropine hbr...... 150 fosamprenavir calcium...... 61 GLUCOPHAGE XR...... 65 HORIZANT...... 90 fosinopril sodium...... 76 GLUCOTROL...... 65 HP ACTHAR...... 121 fosinopril sodium-hctz...... 82 GLUCOTROL XL...... 65 HUMALOG KWIKPEN...... 68 FOSRENOL...... 106 GLUTARALDEHYDE...... 23 HUMALOG MIX 50/50 FRAGMIN...... 69 glyburide...... 65 KWIKPEN...... 68 FROVA...... 42 glyburide micronized...... 65 HUMALOG MIX 50/50 VIAL...... 68 frovatriptan succinate...... 42 glyburide-metformin...... 65 HUMALOG MIX 75/25 FULPHILA...... 71 GLYCATE...... 109 KWIKPEN...... 68 FURADANTIN...... 23 glycopyrrolate...... 109 HUMALOG MIX 75/25 VIAL...... 68 furosemide...... 83 GLYCOPYRROLATE...... 110 HUMALOG U-100 JUNIOR FUZEON...... 61 GLYNASE...... 65 KWIKPEN...... 68 Fyavolv...... 128 GLYSET...... 65 HUMALOG U-100 VIAL AND fyavolv...... 128 GLYXAMBI...... 65 CARTRIDGE...... 68 FYCOMPA...... 31 GOLYTELY...... 112 HUMATE-P...... 73 gabapentin...... 30 GONITRO...... 87 HUMIRA...... 139 GABITRIL...... 30 GORDOFILM...... 98 HUMIRA PEDIATRIC GALAFOLD...... 114 GORDONS UREA...... 98 CROHNS START...... 139 galantamine hydrobromide...... 33 grafco silver nit applicator...... 23 HUMIRA PEN...... 139 galantamine hydrobromide er... 33 granisetron hcl...... 38 HUMIRA PEN-CD/UC/HS GALZIN...... 103 GRASTEK...... 164 STARTER...... 139 GASTROCROM...... 110 griseofulvin microsize...... 39 HUMIRA PEN-PS/UV/ADOL gatifloxacin...... 152 griseofulvin ultramicrosize...... 39 HS START...... 139 GATTEX...... 110 guaiatussin ac...... 164 HUMULIN 70/30 KWIKPEN...... 68 Gavilyte-C...... 112 guaifenesin ac...... 164 HUMULIN 70/30 VIAL...... 68 Gavilyte-G...... 112 guanfacine hcl...... 75 HUMULIN N KWIKPEN...... 68 gavilyte-h...... 112 guanfacine hcl er...... 89 HUMULIN N VIAL...... 68 gavilyte-n with flavor pack...... 112 GUANIDINE HCL...... 43 HUMULIN R U-500 KWIKPEN..68 GELCLAIR...... 93 GYNAZOLE-1...... 39 HUMULIN R U-500 VIAL GELFILM...... 150 HAEGARDA...... 138 (CONCENTRATED)...... 68 GELNIQUE...... 115 Hailey 24 Fe...... 128 HUMULIN R VIAL...... 69 GELNIQUE PUMP...... 115 HALCION...... 63 HYCAMTIN...... 46 gemfibrozil...... 84 halobetasol propionate...... 121 hydralazine hcl...... 87 GENADUR...... 147 HALOG...... 121 HYDREA...... 45 generlac...... 112 haloperidol...... 54 HYDRO 40...... 98 Gengraf...... 138 haloperidol lactate...... 54 hydrochlorothiazide...... 84 gentak...... 152 HARVONI...... 57 hydrocodone polst-cpm polst gentamicin sulfate...... 21, 152 heather...... 134 er...... 164 GENVOYA...... 59 hematinic/folic acid...... 103 hydrocodone-acetaminophen... 17 gianvi...... 128 HEMLIBRA...... 73 hydrocodone-homatropine...... 164 GILENYA...... 92 Hemmorex-Hc...... 41 hydrocodone-ibuprofen...... 17 GILOTRIF...... 48 hemocyte-f...... 103 hydrocortisone...... 121, 143 GILPHEX TR...... 164 HEMOFIL M...... 73 hydrocortisone ace-pramoxine GILTUSS TR...... 164 hemorrhoidal-hc...... 41 ...... 98, 143 glatiramer acetate...... 92 heparin lock flush...... 147 hydrocortisone acetate...... 41

175 hydrocortisone butyr lipo base 121 INOVA...... 98 jencycla...... 134 hydrocortisone butyrate...... 121 INOVA 4/1 ACNE CONTROL JENTADUETO...... 66 hydrocortisone valerate...... 121 THERAPY...... 98 JENTADUETO XR...... 66 hydrocortisone-acetic acid...... 156 INOVA 8/2 ACNE CONTROL Jinteli...... 128 hydrocortisone-iodoquinol...... 39 THERAPY...... 98 JIVI...... 147 hydromet...... 164 INSPIREASE RESERVOIR Jolessa...... 128 hydromorphone hcl...... 17 BAGS...... 147 jolivette...... 134 hydromorphone hcl er...... 15 INSPRA...... 84 JUBLIA...... 39 hydroxychloroquine sulfate...... 51 INSULIN PEN NEEDLES...... 147 juleber...... 128 hydroxyurea...... 45 INSULIN SYRINGES...... 147 JULUCA...... 59 hydroxyzine hcl...... 62 INTELENCE...... 59 junel 1.5/30...... 129 hydroxyzine pamoate...... 156 INTRAROSA...... 125 junel 1/20...... 129 HYLIRA...... 98 INTRON A...... 58 junel fe 1.5/30...... 129 hyophen...... 115 introvale...... 128 junel fe 1/20...... 129 hyoscyamine sulfate...... 109, 110 INVIRASE...... 61 junel fe 24...... 129 hyoscyamine sulfate er...... 109 INVOKAMET...... 65 JUXTAPID...... 86 hyoscyamine sulfate sl...... 109 INVOKAMET XR...... 65 JYNARQUE...... 106 hyosyne...... 109 INVOKANA...... 66 KADIAN...... 17 HYPERSAL...... 164 IODINE STRONG...... 147 Kaitlib Fe...... 129 HYPOCYN...... 150 iodine tincture...... 23 KALETRA...... 62 HYZAAR...... 82 IOPIDINE...... 153 KALYDECO...... 161 ibandronate sodium...... 144 ipratropium bromide...... 159 KAPSPARGO SPRINKLE...... 78 IBRANCE...... 48 ipratropium-albuterol...... 164 KARBINAL ER...... 157 Ibu...... 13 irbesartan...... 76 Kariva...... 129 ibudone...... 17 irbesartan-hydrochlorothiazide..82 KAZANO...... 66 ibuprofen...... 13 IRESSA...... 48 KEFLEX...... 25 ICLUSIG...... 48 ISENTRESS...... 59 Kelnor 1/35...... 129 IDELVION...... 73 ISENTRESS HD...... 59 Kelnor 1/50...... 129 IDHIFA...... 48 isibloom...... 128 KEPPRA...... 29 ILEVRO...... 154 isoflurane...... 147 KEPPRA XR...... 29 imatinib mesylate...... 48 isoniazid...... 43 KERALYT SCALP...... 98 IMBRUVICA...... 48 ISOPTO ATROPINE...... 150 KERYDIN...... 39 imipramine hcl...... 37 ISOPTO CARPINE...... 153 KETOCARE...... 147 imipramine pamoate...... 37 ISORDIL TITRADOSE...... 87 ketoconazole...... 39 imiquimod...... 98 isosorbide dinitrate...... 87 ketoprofen...... 13 IMITREX...... 42 isosorbide dinitrate er...... 87 ketoprofen er...... 13 IMPAVIDO...... 51 isosorbide mononitrate...... 87 ketorolac tromethamine.... 14, 155 IMVEXXY MAINTENANCE isosorbide mononitrate er...... 87 KETOSTIX...... 147 PACK...... 128 isotretinoin...... 98 KEVEYIS...... 83 IMVEXXY STARTER PACK... 128 isoxsuprine hcl...... 82 KEVZARA...... 141 INBRIJA...... 147 isradipine...... 79 KHEDEZLA...... 36 incassia...... 134 ISTALOL...... 153 KINERET...... 139 INCRELEX...... 124 itraconazole...... 39 Kionex...... 106 INCRUSE ELLIPTA...... 159 ivermectin...... 51 KISQALI 200 DOSE...... 45 indapamide...... 84 JADENU...... 106 KISQALI 400 DOSE...... 45 INDERAL LA...... 78 JADENU SPRINKLE...... 106 KISQALI 600 DOSE...... 45, 46 INDERAL XL...... 78 JAKAFI...... 48 KISQALI FEMARA 200 DOSE..46 INDOCIN...... 13 Jantoven...... 70 KISQALI FEMARA 400 DOSE..46 indomethacin...... 13 JANUMET...... 66 KISQALI FEMARA 600 DOSE..46 indomethacin er...... 13 JANUMET XR...... 66 KLARON...... 98 INGREZZA...... 90 JANUVIA...... 66 KLONOPIN...... 63 INLYTA...... 48 JARDIANCE...... 66 Klor-Con...... 104 INNOPRAN XL...... 78 jasmiel...... 128 Klor-Con 10...... 104

176 Klor-Con M10...... 104 lecithin...... 147 LEVULAN KERASTICK...... 98 KLOR-CON M15...... 104 LEDIPASVIR-SOFOSBUVIR.... 57 LEXIVA...... 62 Klor-Con M20...... 104 leena...... 129 LIALDA...... 143 Klor-Con Sprinkle...... 104 leflunomide...... 141 lidocaine...... 19 Klor-Con/Ef...... 104 LENVIMA 10 MG DAILY lidocaine hcl...... 19 KOATE...... 73 DOSE...... 48 lidocaine viscous...... 19 KOATE-DVI...... 73 LENVIMA 12 MG DAILY lidocaine-hydrocortisone ace.... 41 KOGENATE FS...... 73 DOSE...... 48 lidocaine-prilocaine...... 19 KOMBIGLYZE XR...... 66 LENVIMA 14 MG DAILY LIDOPIN...... 19 KORLYM...... 124 DOSE...... 48 lillow...... 129 KOVALTRY...... 73 LENVIMA 18 MG DAILY lindane...... 52 K-PHOS...... 104 DOSE...... 48 linezolid...... 23 K-PHOS NO 2...... 104 LENVIMA 20 MG DAILY LINZESS...... 111 K-PHOS-NEUTRAL...... 104 DOSE...... 49 liothyronine sodium...... 135 k-prime...... 104 LENVIMA 24 MG DAILY LIPOFEN...... 84 KRISTALOSE...... 112 DOSE...... 49 lisinopril...... 76 K-TAB...... 104 LENVIMA 4 MG DAILY DOSE..49 lisinopril-hydrochlorothiazide.....82 Kurvelo...... 129 LENVIMA 8 MG DAILY DOSE..49 lithium...... 64 KUVAN...... 114 lessina...... 129 lithium carbonate...... 64 KYNAMRO...... 86 LETAIRIS...... 162 lithium carbonate er...... 64 labetalol hcl...... 78 letrozole...... 46 LITHOBID...... 64 LACRISERT...... 150 leucovorin calcium...... 46 LITHOSTAT...... 117 lactulose...... 112 LEUKERAN...... 44 LIVALO...... 85 lactulose encephalopathy...... 112 LEUKINE...... 71 LO LOESTRIN FE...... 129 LAMICTAL...... 31 leuprolide acetate...... 136 LOCOID...... 121 LAMICTAL ODT...... 31 levalbuterol hcl...... 160 LOESTRIN 1.5/30 (21)...... 130 LAMICTAL STARTER...... 31 LEVALBUTEROL HFA...... 160 LOESTRIN 1/20 (21)...... 130 LAMICTAL XR...... 31 LEVAQUIN...... 27 LOESTRIN FE 1.5/30...... 130 lamivudine...... 57, 60 LEVBID...... 109 LOESTRIN FE 1/20...... 130 lamivudine-zidovudine...... 60 LEVEMIR U-100 FLEXTOUCH.69 LOMAIRA...... 91 lamotrigine...... 31 LEVEMIR U-100 VIAL...... 69 LOMOTIL...... 110 lamotrigine er...... 31 levetiracetam...... 29 LONHALA MAGNAIR REFILL lamotrigine starter kit-blue...... 31 levetiracetam er...... 29 KIT...... 159 lamotrigine starter kit-green...... 31 levobunolol hcl...... 153 LONHALA MAGNAIR lamotrigine starter kit-orange.... 31 levocarnitine...... 104 STARTER KIT...... 159 LANCETS...... 147 levocetirizine dihydrochloride..157 LONSURF...... 46 LANOXIN...... 82 levofloxacin...... 27, 152 LOPID...... 84 lansoprazole...... 113 levonest...... 129 lopinavir-ritonavir...... 62 lanthanum carbonate...... 106 levonorgest-eth est & eth est.. 129 lopreeza...... 130 larin 1.5/30...... 129 levonorgest-eth estrad 91-day 129 LOPRESSOR...... 78 Larin 1/20...... 129 levonorgestrel...... 134 LOPRESSOR HCT...... 82 larin 24 fe...... 129 levonorgestrel-ethinyl estrad...129 LOPROX...... 40 larin fe 1.5/30...... 129 levonorg-eth estrad triphasic...129 lorazepam...... 63 larin fe 1/20...... 129 levora 0.15/30 (28)...... 129 Lorazepam Intensol...... 63 larissia...... 129 levorphanol tartrate...... 15 Lorcet...... 17 LASIX...... 83 levo-t...... 135 Lorcet Hd...... 17 LASTACAFT...... 150 Levo-T...... 135 Lorcet Plus...... 17 latanoprost...... 155 levothyroxine sodium...... 135 LORTAB...... 17 LATRIX XM...... 98 levothyroxine-liothyronine...... 137 loryna...... 130 LATUDA...... 55 levoxyl...... 135 LORZONE...... 166 layolis fe...... 129 Levoxyl...... 135 losartan potassium...... 76 LAZANDA...... 17 LEVSIN...... 110 losartan potassium-hctz...... 82 L-CYSTINE...... 147 LEVSIN/SL...... 109 LOSEASONIQUE...... 130

177 LOTEMAX...... 155 mefloquine hcl...... 51 methylphenidate hcl...... 90 LOTENSIN...... 77 MEGACE ES...... 134 methylphenidate hcl er...... 90 LOTENSIN HCT...... 82 megestrol acetate...... 134 methylphenidate hcl er (cd)...... 89 LOTREL...... 82 MEKINIST...... 49 methylphenidate hcl er (la)...... 89 LOTRISONE...... 98 MEKTOVI...... 49 methylprednisolone...... 121 LOUTREX...... 98 melodetta 24 fe...... 130 methyltestosterone...... 125 lovastatin...... 85 meloxicam...... 14 metoclopramide hcl...... 37, 110 LOVENOX...... 70 melphalan...... 44 metolazone...... 84 low-ogestrel...... 130 memantine hcl...... 34 Metopic...... 98 loxapine succinate...... 54 memantine hcl er...... 34 metoprolol succinate er...... 78 LUCEMYRA...... 20 MENEST...... 130 metoprolol tartrate...... 78 lugols...... 23 MENOSTAR...... 130 metoprolol-hydrochlorothiazide.82 LULICONAZOLE...... 40 MENTAX...... 40 METROCREAM...... 23 LUMIGAN...... 155 meperidine hcl...... 17 METROLOTION...... 23 LUPRON DEPOT (4-MONTH) MEPHYTON...... 107 metronidazole...... 23 INTRAMUSCULAR KIT 30MG 136 meprobamate...... 62 mexiletine hcl...... 77 LUPRON DEPOT (6-MONTH) mercaptopurine...... 45 MIACALCIN...... 144 INTRAMUSCULAR KIT 45MG 136 mesalamine...... 143 Mibelas 24 Fe...... 130 lutera...... 130 mesalamine-cleanser...... 143 miconazole 3...... 40 LUZU...... 40 MESNEX...... 51 MICONAZOLE-ZINC OXIDE- LYNPARZA...... 49 MESTINON...... 43 PETROLAT...... 40 LYRICA...... 91 Metadate Er...... 89 MICORT-HC...... 121 LYRICA CR...... 91 metaproterenol sulfate...... 160 microgestin 1.5/30...... 130 LYSODREN...... 136 Metaxall...... 166 microgestin 1/20...... 130 LYSTEDA...... 73 metaxalone...... 166 microgestin fe 1.5/30...... 130 Lyza...... 134 metformin hcl er...... 66 microgestin fe 1/20...... 130 MACROBID...... 23 METFORMIN HCL IR...... 66 MICROLET NEXT LANCING MACRODANTIN...... 23 metformin hcl ir...... 66 DEVICE...... 147 mafenide acetate...... 23 methadone hcl...... 15 midazolam hcl...... 63 MAGNEBIND 400...... 107 Methadone Hcl Intensol...... 15 midodrine hcl...... 75 MALARONE...... 51 methadose...... 15 MIGERGOT...... 42 malathion...... 52 Methadose...... 15 miglitol...... 66 maprotiline hcl...... 36 methadose sugar-free...... 15 miglustat...... 114 MARINOL...... 38 methamphetamine hcl...... 88 mili...... 130 marlissa...... 130 methazolamide...... 83 MILLIPRED...... 122 MARPLAN...... 35 methenamine hippurate...... 23 MILLIPRED DP...... 122 MASK VORTEX...... 147 methenamine mandelate...... 23 MILLIPRED DP 12-DAY...... 122 MATULANE...... 44 Methergine...... 147 mimvey...... 130 Matzim La...... 79 methimazole...... 137 Mimvey Lo...... 130 MAVYRET...... 57 METHITEST...... 125 mineral oil heavy...... 112 MAXI-COMFORT SAFETY methocarbamol...... 166 MINIPRESS...... 76 PEN NEEDLE...... 147 methotrexate...... 139 Minitran...... 87 MAXIDEX...... 155 methotrexate (anti-rheumatic).141 MINIVELLE...... 130 MAXITROL...... 150 methotrexate sodium...... 139 minocycline hcl...... 28 MAXZIDE...... 82 methoxsalen...... 98 minoxidil...... 87 MAXZIDE-25...... 82 methoxsalen rapid...... 98 MIRAPEX...... 53 me/naphos/mb/hyo1...... 115 methscopolamine bromide...... 110 MIRCETTE...... 130 meclofenamate sodium...... 14 methyclothiazide...... 84 mirtazapine...... 34 MEDI-DERM-RX...... 12 methyl salicylate...... 98 MIRVASO...... 98 MEDROL...... 121 methyldopa...... 75 misoprostol...... 113 MEDROX-RX...... 12 methyldopa- MITIGARE...... 41 medroxyprogesterone acetate 134 hydrochlorothiazide...... 82 MITOSOL...... 155 mefenamic acid...... 14 METHYLIN...... 89 M-NATAL PLUS...... 107

178 MOBIC...... 14 myzilra...... 131 NEULASTA...... 71 modafinil...... 167 nabumetone...... 14 NEUPRO...... 53 moderiba...... 58 n-acetyl-l-cysteine...... 107 NEURONTIN...... 30 moderiba 1200 dose pack...... 58 nadolol...... 78 neutral sodium fluoride...... 104 moexipril hcl...... 77 nadolol-bendroflumethiazide.....82 NEVANAC...... 155 molindone hcl...... 54 NAFRINSE DAILY nevirapine...... 60 mometasone furoate...... 122, 158 ACIDULATED...... 93 nevirapine er...... 60 Mondoxyne Nl...... 28 NAFRINSE DAILY/NEUTRAL...93 NEXAVAR...... 49 MONOCLATE-P...... 73 NAFRINSE WEEKLY...... 93 NEXIUM...... 113 mono-linyah...... 130 naftifine hcl...... 40 niacin er (antihyperlipidemic).... 86 mononessa...... 130 NAFTIN...... 40 niacor...... 86 MONONINE...... 73 naloxone hcl...... 21 NIASPAN...... 86 monsels ferric subsulfate...... 73 naltrexone hcl...... 20 nicardipine hcl...... 79 montelukast sodium...... 159 NAMENDA...... 34 NICOMIDE...... 107 MONUROL...... 23 NAMENDA TITRATION PAK....34 NICORETTE...... 21 MORGIDOX...... 28 NAMENDA XR TITRATION nicotine polacrilex...... 21 Morgidox...... 28 PACK...... 34 nicotine step 1...... 21 morphine sulfate...... 18 NAMZARIC...... 91 nicotine step 2...... 21 MORPHINE SULFATE...... 18 NAPROSYN...... 14 nicotine step 3...... 21 morphine sulfate (concentrate). 18 naproxen...... 14 NICOTROL...... 21 morphine sulfate er...... 15, 18 naproxen dr...... 14 NICOTROL NS...... 21 morphine sulfate er beads...... 15 naproxen sodium...... 14 nifedipine...... 80 MOTOFEN...... 110 naproxen sodium er...... 14 nifedipine er...... 79 MOVIPREP...... 112 naratriptan hcl...... 42 nifedipine er osmotic release.... 79 MOXEZA...... 27 NARCAN...... 21 Nikki...... 131 moxifloxacin hcl...... 27 NARDIL...... 35 nilutamide...... 44 MOZOBIL...... 71 NASCOBAL...... 107 nimodipine...... 80 MS CONTIN...... 15 NATACYN...... 40 NINLARO...... 46 MULPLETA...... 71 NATAZIA...... 131 nisoldipine er...... 80 MULTAQ...... 77 nateglinide...... 66 NITRO-BID...... 87 multi-vit/iron/fluoride...... 107 NATPARA...... 145 NITRO-DUR...... 87 multivitamin/fluoride...... 107 NATURE-THROID...... 137 nitrofurantoin...... 23 MULTIVITAMIN/FLUORIDE... 107 NEBUPENT...... 51 nitrofurantoin macrocrystal...... 23 multi-vitamin/fluoride...... 107 Nebusal...... 164 nitrofurantoin monohydrate multivitamin/fluoride/iron...... 107 NEBUSAL...... 164 macrocrystals...... 23 multi-vitamin/fluoride/iron...... 107 necon 0.5/35 (28)...... 131 nitroglycerin...... 87 multivitamins/fluoride...... 107 nefazodone hcl...... 36 nitroglycerin er...... 87 mupirocin...... 23 neomycin sulfate...... 21 NITROMIST...... 87 mupirocin calcium...... 23 neomycin-bacitracin zn- NITROSTAT...... 87 MUSE...... 117 polymyx...... 150 Nitro-Time...... 87 mvc-fluoride...... 107 neomycin-polymyxin-dexameth NITYR...... 114 MYALEPT...... 110 ...... 150 nizatidine...... 111 MYAMBUTOL...... 43 neomycin-polymyxin- NIZORAL...... 40 MYCOBUTIN...... 43 gramicidin...... 150 NOCDURNA...... 124 mycophenolate mofetil...... 139 neomycin-polymyxin-hc.. 151, 156 Nolix...... 122 mycophenolate sodium...... 139 Neo-Polycin...... 151 nora-be...... 134 MYDAYIS...... 88 Neo-Polycin Hc...... 151 NORCO...... 18 MYLERAN...... 44 NEO-SYNALAR...... 23, 99 norethin ace-eth estrad-fe...... 131 myorisan...... 98 NEOTUSS PLUS...... 164 norethindrone...... 134 Myorisan...... 98 NERLYNX...... 49 norethindrone acetate...... 134 MYRBETRIQ...... 115 NESINA...... 66 norethindrone acet-ethinyl est.131 MYSOLINE...... 30 Neuac...... 99 norethindrone-eth estradiol..... 131 MYTESI...... 110 NEUAC...... 99 norethin-eth estradiol-fe...... 131

179 norgestimate-eth estradiol...... 131 ODEFSEY...... 60 ORENCIA...... 140 norgestimate-ethinyl estradiol ODOMZO...... 49 ORENCIA CLICKJECT...... 140 triphasic...... 131 OFEV...... 163 ORENITRAM...... 162 norlyda...... 134 ofloxacin...... 27, 152, 155 ORILISSA...... 137 norlyroc...... 134 ogestrel...... 131 ORKAMBI...... 161 NORPACE...... 77 okebo...... 28 orphenadrine citrate er...... 166 NORPACE CR...... 77 olanzapine...... 55 orsythia...... 131 NORPRAMIN...... 37 olanzapine-fluoxetine hcl...... 34 ORTHO MICRONOR...... 134 NORTHERA...... 75 olmesartan medoxomil...... 76 ORTHO TRI-CYCLEN (28)..... 131 nortrel 0.5/35 (28)...... 131 olmesartan medoxomil-hctz...... 82 ORTHO-CYCLEN (28)...... 131 nortrel 1/35 (21)...... 131 olmesartan-amlodipine-hctz...... 82 ORTHO-NOVUM 1/35 (28)..... 131 nortrel 1/35 (28)...... 131 olopatadine hcl...... 152, 157 ORTHO-NOVUM 7/7/7 (28).... 131 nortrel 7/7/7...... 131 OMECLAMOX-PAK...... 110 oscimin...... 109, 110 nortriptyline hcl...... 37 omega-3-acid ethyl esters...... 86 oscimin sr...... 109 NORVASC...... 80 omeprazole...... 113 oseltamivir phosphate...... 62 NORVIR...... 62 OMNARIS...... 158 OSENI...... 66 NOVOEIGHT...... 73 ondansetron hcl...... 38 OSMOPREP...... 112 NOVOFINE AUTOCOVER ondansetron odt...... 38 OSPHENA...... 135 PEN NEEDLE...... 147 ONE TOUCH VERIO KIT OTEZLA...... 141 NOVOFINE PEN NEEDLE..... 147 W/DEVICE...... 148 OTICIN HC NR...... 156 NOVOFINE PLUS PEN ONETOUCH DELICA OTOVEL...... 155 NEEDLE...... 148 LANCING DEV...... 148 OVACE PLUS...... 99 NOVOPEN ECHO...... 148 ONETOUCH ULTRA 2...... 148 OVACE PLUS WASH...... 99 NOVOSEVEN RT...... 73 ONETOUCH ULTRA BLUE OVACE WASH...... 99 NOVOTWIST PEN NEEDLE.. 148 TEST STRIPS...... 148 OVIDE...... 52 NOXAFIL...... 40 ONETOUCH ULTRA MINI...... 148 oxandrolone...... 125 np thyroid...... 137 ONETOUCH VERIO FLEX oxaprozin...... 14 NUCORT...... 122 SYSTEM KIT W/DEVICE...... 148 oxazepam...... 63 NUCYNTA...... 18 ONETOUCH VERIO IQ oxcarbazepine...... 32, 33 NUCYNTA ER...... 15, 16 SYSTEM...... 148 oxiconazole nitrate...... 40 NUEDEXTA...... 91 ONETOUCH VERIO SYNC OXISTAT...... 40 Nulev...... 109 SYSTEM KIT W/DEVICE...... 148 OXSORALEN ULTRA...... 99 NULYTELY WITH FLAVOR ONEXTON...... 99 oxybutynin chloride...... 115 PACKS...... 112 ONFI...... 30 oxybutynin chloride er...... 115 NUPLAZID...... 55 ONGLYZA...... 66 oxycodone hcl...... 18 NUTRIDOX...... 28 ONZETRA XSAIL...... 42 oxycodone-acetaminophen...... 18 NUTROPIN AQ NUSPIN 10... 124 OPANA...... 18 oxycodone-aspirin...... 18 NUTROPIN AQ NUSPIN 20... 124 opium...... 110 oxycodone-ibuprofen...... 18 NUTROPIN AQ NUSPIN 5..... 124 OPSUMIT...... 162 oxymorphone hcl...... 18 NUVAIL...... 99 ORACEA...... 28 oxymorphone hcl er...... 16 NUVARING...... 131 ORACIT...... 104 OZEMPIC...... 66 NUVESSA...... 23 ORALAIR...... 164 Pacerone...... 77 NUWIQ...... 73, 74 ORALAIR ADULT SAMPLE paliperidone er...... 55 nyamyc...... 40 KIT...... 164 PALYNZIQ...... 114 NYMALIZE...... 80 ORALAIR ADULT STARTER PAMELOR...... 37 nystatin...... 40 PACK...... 164 PANCREAZE...... 114 nystatin-triamcinolone...... 40 ORALAIR CHILDRENS PANDEL...... 122 Nystop...... 40 SAMPLE KIT...... 164 PANRETIN...... 50 OCALIVA...... 110 ORALAIR CHILDRENS pantoprazole sodium...... 113 ocella...... 131 STARTER PACK...... 164 paregoric...... 110 octreotide acetate...... 137 Oralone...... 93 paricalcitol...... 145 OCUFLOX...... 152 ORAPRED ODT...... 122 PARNATE...... 35 ODACTRA...... 164 ORAVIG...... 40 Paroex...... 93

180 paromomycin sulfate...... 22 phosphorous...... 104 PRANDIN...... 67 paroxetine hcl...... 36 phospho-trin 250 neutral...... 104 prasugrel hcl...... 75 paroxetine hcl er...... 36 PHOTREXA-PHOTREXA PRAVACHOL...... 85 paroxetine mesylate...... 36 VISCOUS KIT...... 151 pravastatin sodium...... 85 PASER...... 43 Phrenilin Forte...... 12 praziquantel...... 51 PATANASE...... 157 phytonadione...... 108 prazosin hcl...... 76 PAXIL...... 36 PICATO...... 99 PRECISION XTRA KETONE..148 PAXIL CR...... 36 pilocarpine hcl...... 93, 153 PRECOSE...... 67 PAZEO...... 152 pimecrolimus...... 99 PRED FORTE...... 155 PCP 100...... 112 pimozide...... 54 PRED MILD...... 155 PEDIAPRED...... 122 pimtrea...... 132 PRED-G...... 151 peg 3350/electrolytes...... 112 pindolol...... 78 PRED-G S.O.P...... 151 peg 3350-kcl-na bicarb-nacl....112 pioglitazone hcl...... 66 prednicarbate...... 122 peg-3350/electrolytes...... 112 pioglitazone hcl-glimepiride...... 67 prednisolone...... 122 PEGANONE...... 33 pioglitazone hcl-metformin hcl.. 67 prednisolone acetate...... 155 PEGASYS...... 58 pirmella 1/35...... 132 prednisolone sodium PEGASYS PROCLICK...... 58 pirmella 7/7/7...... 132 phosphate...... 122, 155 PEGINTRON...... 58 piroxicam...... 14 prednisone...... 122 peg-prep...... 112 PLAN B ONE-STEP...... 134 prednisone intensol...... 122 penicillin v potassium...... 26 PLAQUENIL...... 52 PREFEST...... 132 pentazocine-naloxone hcl...... 18 PLEGRIDY...... 92 PREMARIN...... 132 pentoxifylline er...... 82 PLEGRIDY STARTER PACK... 92 PREMESISRX...... 108 PERFOROMIST...... 160 PLENVU...... 113 premium lidocaine...... 19 PERIDEX...... 93 PLEXION...... 99 PREMPHASE...... 132 perindopril erbumine...... 77 PLEXION CLEANSER...... 99 PREMPRO...... 132 periogard...... 93 PLEXION CLEANSING prenatal...... 108 permethrin...... 52 CLOTH...... 99 prenatal plus iron...... 108 perphenazine...... 37 pnv prenatal plus multivit+dha 108 PREPIDIL...... 117 perphenazine-amitriptyline...... 34 podocon...... 99 PREPOPIK...... 113 PERTZYE...... 114 podofilox...... 99 PREVACID SOLUTAB...... 113 PEXEVA...... 36 Polycin...... 151 Prevalite...... 86 phenadoz...... 157 polymyxin b-trimethoprim...... 151 PREVIDENT...... 94, 105 Phenazo...... 117 POLYTRIM...... 151 PREVIDENT 5000 BOOSTER phenazopyridine hcl...... 117 POLY-VI-FLOR...... 108 PLUS...... 94 phendimetrazine tartrate...... 91 POLY-VI-FLOR/IRON...... 108 PREVIDENT 5000 DRY PHENDIMETRAZINE POMALYST...... 45 MOUTH...... 94 TARTRATE ER...... 91 portia-28...... 132 PREVIDENT 5000 ENAMEL phenelzine sulfate...... 35 pot bicarb-pot chloride...... 104 PROTECT...... 94 phenobarbital...... 29, 30 POTABA...... 108 PREVIDENT 5000 PLUS...... 94 PHENOL...... 23, 24 potassium bicarbonate...... 104 PREVIDENT 5000 SENSITIVE.94 phenoxybenzamine hcl...... 76 potassium chloride...... 105 previfem...... 132 phentermine hcl...... 91 potassium chloride crys er...... 104 PREVYMIS...... 56 phenylephrine hcl...... 151 potassium chloride er...... 105 PREZCOBIX...... 62 phenylephrine-guaifenesin...... 165 potassium citrate er...... 105 PREZISTA...... 62 PHENYTEK...... 33 potassium citrate-citric acid.....105 PRIFTIN...... 43 phenytoin...... 33 PRADAXA...... 70 PRILOSEC...... 113 Phenytoin Infatabs...... 33 PRALUENT...... 86 primaquine phosphate...... 52 phenytoin sodium extended...... 33 pramcort...... 143 primidone...... 30 philith...... 131 pramipexole dihydrochloride..... 53 PRIMSOL...... 24 PHOSLYRA...... 106 pramosone...... 99 PRINIVIL...... 77 Phospha 250 Neutral...... 104 PRAMOSONE...... 99, 100 PRISTIQ...... 36 phosphasal...... 116 PRAMOTIC...... 156 PROAIR HFA...... 160 PHOSPHOLINE IODIDE...... 153 pramox...... 19 PROAIR RESPICLICK...... 160

181 probenecid...... 41 PULMICORT SUSPENSION.. 158 RECOMBINATE...... 74 PROCARDIA...... 80 Pulmosal...... 165 RECOTHROM...... 74 PROCARDIA XL...... 80 PULMOZYME...... 165 RECOTHROM SPRAY KIT...... 74 PROCENTRA...... 88 PURIXAN...... 45 RECTIV...... 87 prochlorperazine...... 37 PYLERA...... 111 REGLAN...... 111 prochlorperazine maleate...... 54 pyrazinamide...... 43 REGRANEX...... 100 PROCORT...... 143 PYRIDIUM...... 117 RELENZA DISKHALER...... 62 PROCRIT...... 71 pyridostigmine bromide...... 43 RELION ULTIMA TEST...... 148 PROCTOCORT...... 41 pyridostigmine bromide er...... 43 RELISTOR...... 111 PROCTOFOAM HC...... 143 PYROGALLIC ACID...... 100 RELNATE DHA...... 108 procto-med hc...... 143 QBRELIS...... 77 REMERON...... 34 Procto-Pak...... 143 QNASL...... 158 REMERON SOLTAB...... 34 proctosol hc...... 143 QNASL CHILDRENS...... 158 REMIGEN...... 100 Proctozone-Hc...... 143 QSYMIA...... 91 RENAGEL...... 106 PROCYSBI...... 114 QUALAQUIN...... 52 RENVELA...... 106 PROFILNINE...... 74 quazepam...... 63 repaglinide...... 67 PROFILNINE SD...... 74 QUDEXY XR...... 31 repaglinide-metformin hcl...... 67 progesterone...... 134 QUESTRAN...... 86 REPATHA...... 86 progesterone micronized...... 135 QUESTRAN LIGHT...... 86 REPATHA PUSHTRONEX PROGLYCEM...... 68 quetiapine fumarate...... 55 SYSTEM...... 86 PROLENSA...... 155 quetiapine fumarate er...... 55 REPATHA SURECLICK...... 86 PROMACTA...... 71 QUFLORA PEDIATRIC...... 108 RESCRIPTOR...... 60 promethazine hcl...... 157 QUILLICHEW ER...... 90 RESTASIS...... 151 promethazine-codeine...... 165 QUILLIVANT XR...... 90 RESTASIS MULTIDOSE...... 151 promethazine-dm...... 165 quinapril hcl...... 77 RESTORA RX...... 111 promethazine-phenyleph- quinapril-hydrochlorothiazide.... 82 RESTORIL...... 63, 166 codeine...... 165 quinidine gluconate er...... 77 RETIN-A MICRO PUMP...... 100 promethazine-phenylephrine.. 165 quinidine sulfate...... 77 RETROVIR...... 61 Promethegan...... 157 quinine sulfate...... 52 REVATIO...... 162 PROMETRIUM...... 135 QVAR REDIHALER...... 158, 159 REVLIMID...... 45 PROMISEB...... 100 rabeprazole sodium...... 113 REXULTI...... 55 PROMISEB COMPLETE...... 100 RADIOGARDASE...... 148 REYATAZ...... 62 propafenone hcl...... 77 RAGWITEK...... 165 RHOFADE...... 100 propafenone hcl er...... 77 raloxifene hcl...... 135 Ribasphere...... 58 propantheline bromide...... 110 ramipril...... 77 ribasphere...... 58 proparacaine hcl...... 151 RANEXA...... 82 ribasphere ribapak...... 58 propranolol hcl...... 78 ranitidine hcl...... 111 ribavirin...... 56, 58 propranolol hcl er...... 78 ranolazine er...... 83 RIDAURA...... 141 propranolol-hctz...... 82 RAPAFLO...... 117 rifabutin...... 43 propylthiouracil...... 137 RAPAMUNE...... 140 RIFADIN...... 43 PROSCAR...... 117 RAPID GEL RX...... 148 RIFAMATE...... 44 PROSTIN E2...... 117 rasagiline mesylate...... 54 rifampin...... 44 PROTONIX...... 113 RASUVO...... 140 RIFATER...... 44 protriptyline hcl...... 37 RAVICTI...... 114 RILUTEK...... 91 PROVENTIL HFA...... 160 RAZADYNE...... 33 riluzole...... 91 PROVERA...... 135 RAZADYNE ER...... 33 rimantadine hcl...... 62 PRUDOXIN...... 100 REBETOL...... 58 RIOMET...... 67 pseudoeph-chlorphen- REBIF...... 92 risedronate sodium...... 145 hydrocod...... 165 REBIF REBIDOSE...... 92 risperidone...... 55 pseudoephedrine-bromphen- REBIF REBIDOSE Risperidone M-Tab...... 55 dm...... 165 TITRATION PACK...... 92 RITALIN...... 90 PSORCON...... 122 REBIF TITRATION PACK...... 92 ritonavir...... 62 PULMICORT FLEXHALER.....158 reclipsen...... 132 rivastigmine...... 34

182 rivastigmine tartrate...... 33 sevelamer carbonate...... 106 SPIRIVA HANDIHALER...... 159 rivelsa...... 132 sevelamer hcl...... 106 SPIRIVA RESPIMAT...... 159 RIXUBIS...... 74 sevoflurane...... 148 spironolactone...... 84 rizatriptan benzoate...... 42 sf...... 94 spironolactone-hctz...... 83 ROBAXIN...... 166 sf 5000 plus...... 94 SPORANOX...... 40 ROBAXIN-750...... 166 SFROWASA...... 143 SPORANOX PULSEPAK...... 40 ROCALTROL...... 145 sharobel...... 135 sprintec 28...... 132 ropinirole hcl...... 53 SHARPS CONTAINER...... 148 SPRIX...... 14 ropinirole hcl er...... 53 SIGNIFOR...... 137 SPRYCEL...... 49 Rosadan...... 24 sildenafil citrate...... 117, 162 sps...... 106 ROSADAN...... 100 SILENOR...... 167 Sronyx...... 132 rosuvastatin calcium...... 85 SILIQ...... 100 Ssd...... 27 ROWASA...... 143 silodosin...... 117 SSKI...... 148 Roweepra...... 29 SILVADENE...... 27 sss 10-5...... 101 Roweepra Xr...... 29 silver nitrate...... 24 STALEVO 100...... 53 ROXICODONE...... 18 silver sulfadiazine...... 27 STALEVO 125...... 53 ROZEREM...... 167 SIMBRINZA...... 154 STALEVO 150...... 53 RUBRACA...... 46 SIMPONI...... 140 STALEVO 200...... 53 RUCONEST...... 138 simvastatin...... 85 STALEVO 50...... 53 RYDAPT...... 49 SINEMET...... 53 STALEVO 75...... 54 RYTHMOL SR...... 77 SINEMET CR...... 53 STARLIX...... 67 SABRIL...... 30 SINGULAIR...... 159 stavudine...... 61 SALAGEN...... 94 sirolimus...... 140 STAXYN...... 117 salicylic acid...... 100 SIRTURO...... 44 STELARA...... 101 salimez...... 100 SIVEXTRO...... 24 STENDRA...... 117 salsalate...... 14 SKLICE...... 51 STIMATE...... 124 SALVAX DUO PLUS...... 100 sod citrate-citric acid...... 105 STIVARGA...... 49 SAMSCA...... 106 SODIUM BICARBONATE...... 111 STRATTERA...... 90 SANDIMMUNE...... 140 sodium chloride...... 165 STRENSIQ...... 115 SANDOSTATIN...... 137 sodium fluoride...... 105 STRIANT...... 125 SANTYL...... 100 sodium hyaluronate...... 100 STRIBILD...... 59 SAPHRIS...... 56 sodium phenylbutyrate...... 114 STRIVERDI RESPIMAT...... 161 SAVAYSA...... 70 sodium polystyrene sulfonate. 106 STROMECTOL...... 51 SAVELLA...... 91 sodium sulfacetamide...... 100 SUBOXONE...... 20 SAVELLA TITRATION PACK... 92 sodium sulfacetamide wash....101 Subvenite...... 31 SAXENDA...... 91 SOFOSBUVIR-VELPATASVIR.57 Subvenite Starter Kit-Blue...... 32 SCALACORT DK...... 100 SOLIQUA...... 67 Subvenite Starter Kit-Green...... 32 SCARZEN SKIN REPAIR...... 100 SOLOSEC...... 24 Subvenite Starter Kit-Orange....32 SEASONIQUE...... 132 Soloxide...... 28 SUCRAID...... 115 SECONAL...... 167 SOLTAMOX...... 45 sucralfate...... 113 SEEBRI NEOHALER...... 159 SOMA...... 166 SULAR...... 80 selegiline hcl...... 54 SOMATULINE DEPOT...... 137 sulfacetamide sodium...... 27, 101 selenium sulfide...... 100 SOMAVERT...... 137 sulfacetamide sodium (acne).. 101 selenium sulf-pyrithione-urea..100 SOOLANTRA...... 101 sulfacetamide sodium-sulfur... 101 SELZENTRY...... 61 SORIATANE...... 101 sulfacetamide sod-sulfur wash 101 SEMPREX-D...... 165 SORILUX...... 101 sulfacetamide-prednisolone.... 151 SENSIPAR...... 145 sotalol hcl...... 77 sulfacetamide-sulfur in urea....101 SEREVENT DISKUS...... 160 sotalol hcl (af)...... 77 sulfacetamide-sulfur- SERNIVO...... 122 SOTYLIZE...... 77 sunscreen...... 101 SEROQUEL XR...... 56 SOVALDI...... 57 Sulfacleanse 8/4...... 101 SEROSTIM...... 111 SPECTRACEF...... 25 sulfadiazine...... 27 sertraline hcl...... 36 SPEEDGEL RX...... 148 sulfamethoxazole-trimethoprim.27 setlakin...... 132 spinosad...... 52 sulfamez wash...... 101

183 SULFAMYLON...... 24 tadalafil (pah)...... 162 TEXACORT...... 123 sulfasalazine...... 144 TAFINLAR...... 49 THALOMID...... 45 Sulfatrim Pediatric...... 28 TAGRISSO...... 49 THEO-24...... 161 SULFURATED LIME...... 52 TAKHZYRO...... 138 Theochron...... 162 sulindac...... 14 TALTZ...... 102 theophylline...... 162 SUMADAN XLT...... 101 tamoxifen citrate...... 45 theophylline er...... 162 sumatriptan...... 42 tamsulosin hcl...... 117 THIOLA...... 117 sumatriptan succinate...... 42 TAPAZOLE...... 137 thioridazine hcl...... 54 sumatriptan succinate refill...... 42 TAPERDEX 12-DAY...... 123 thiothixene...... 54 SUMAXIN...... 101 TAPERDEX 6-DAY...... 123 THROMBIN-JMI...... 74 SUMAXIN CP...... 101 TAPERDEX 7-DAY...... 123 THROMBIN-JMI EPISTAXIS.... 74 SUMAXIN WASH...... 102 TARCEVA...... 49 THROMBOGEN...... 74 SUPRAX...... 25 TARGRETIN...... 50 THYROLAR-1...... 135 SUPREP BOWEL PREP KIT..113 tarina 24 fe...... 132 THYROLAR-1/2...... 135 SURESTEP PRO HIGH Tarina Fe 1/20...... 132 THYROLAR-1/4...... 136 GLUCOSE...... 149 tarina fe 1/20 eq...... 132 THYROLAR-2...... 136 SURESTEP PRO LOW TARKA...... 83 THYROLAR-3...... 136 GLUCOSE...... 149 taron-crystals...... 105 tiagabine hcl...... 30 SURESTEP PRO NORMAL TASIGNA...... 50 TIAZAC...... 80 GLUCOSE...... 149 TAVALISSE...... 74 TIBSOVO...... 50 SURMONTIL...... 37 TAYTULLA...... 132 TIGAN...... 37 SUSTIVA...... 60 TAZORAC...... 102 TIKOSYN...... 78 SUTENT...... 49 Taztia Xt...... 80 tilia fe...... 132 syeda...... 132 TECFIDERA...... 93 timolol maleate...... 79, 154 SYLATRON...... 58 TEGRETOL...... 33 TIMOPTIC...... 154 SYMAX DUOTAB...... 109 TEGRETOL-XR...... 33 TIMOPTIC OCUDOSE...... 154 Symax-Sl...... 109 TEGSEDI...... 115 TIMOPTIC-XE...... 154 Symax-Sr...... 109 TEKTURNA...... 83 tinidazole...... 24 SYMBICORT...... 165 TEKTURNA HCT...... 83 TIROSINT...... 136 SYMBYAX...... 35 telmisartan...... 76 TISSEEL...... 74 SYMDEKO...... 161 telmisartan-amlodipine...... 83 TISSEEL VHSD...... 74 SYMFI...... 60 telmisartan-hctz...... 83 TIVICAY...... 59 SYMFI LO...... 60 temazepam...... 63, 166 TIVORBEX...... 14 SYMJEPI...... 161 TEMODAR...... 44 TIZANIDINE COMFORT PAC.. 56 SYMLINPEN 120...... 67 TEMOVATE...... 123 tizanidine hcl...... 166 SYMLINPEN 60...... 67 temozolomide...... 44 TL-FLUORIVITE...... 108 SYMPROIC...... 111 tencon...... 12 TOBI PODHALER...... 161 SYMTUZA...... 62 tenofovir disoproxil fumarate.....61 TOBRADEX...... 151 SYNALAR...... 122, 123 terazosin hcl...... 117 TOBRADEX ST...... 151 SYNALAR (CREAM)...... 102 terbinafine hcl...... 40 tobramycin...... 152 SYNALAR (OINTMENT)...... 102 terbutaline sulfate...... 161 tobramycin-dexamethasone....151 SYNALAR TS...... 102 terconazole...... 40 TOBREX...... 152, 153 SYNAREL...... 137 Terrell...... 149 TOFRANIL...... 37 SYNDROS...... 38 TESSALON PERLES...... 165 TOLAK...... 102 SYNJARDY...... 67 TESTIM...... 125 tolazamide...... 67 SYNJARDY XR...... 67 testosterone cypionate...... 125 tolbutamide...... 67 SYNRIBO...... 46 testosterone enanthate...... 125 tolcapone...... 52 SYNTHROID...... 135 tetcaine...... 151 tolmetin sodium...... 14 SYNVEXIA TC...... 19 tetrabenazine...... 91 tolterodine tartrate...... 116 SYPRINE...... 106 tetracaine hcl...... 151 tolterodine tartrate er...... 116 TABLOID...... 45 tetracycline hcl...... 28 TOPAMAX...... 32 TACLONEX...... 102 tetravisc...... 151 TOPAMAX SPRINKLE...... 32 tacrolimus...... 102, 140 tetravisc forte...... 151

184 TOPEX TOPICAL tri-linyah...... 132 TYVASO STARTER...... 162 ANESTHETIC...... 94 tri-lo-estarylla...... 132 UCERIS...... 144 TOPICORT...... 123 Tri-Lo-Marzia...... 133 ULESFIA...... 52 topiramate...... 32 tri-lo-sprintec...... 133 ULORIC...... 41 topiramate er...... 32 Trilyte...... 113 ULTANE...... 149 TOPROL XL...... 79 trimethobenzamide hcl...... 38 ULTRACET...... 19 toremifene citrate...... 45 trimethoprim...... 24 ULTRAM...... 19 torsemide...... 83 tri-mili...... 133 ULTRAVATE...... 123 TOVIAZ...... 116 trimipramine maleate...... 37 UMECTA MOUSSE...... 102 TRACLEER...... 162 TRI-NORINYL (28)...... 133 UNISTIK 2 EXTRA...... 149 TRADJENTA...... 67 TRINTELLIX...... 36 UNISTIK 2 SUPER...... 149 TRAMADOL HCL ER...... 16 tri-previfem...... 133 UNISTRIP CONTROL...... 149 tramadol hcl er...... 16, 18 Tri-Sprintec...... 133 Unithroid...... 136 tramadol hcl er (biphasic)...... 18 TRIUMEQ...... 59 unithroid...... 136 tramadol hcl ir...... 18 TRI-VI-FLOR...... 108 UPTRAVI...... 162 tramadol-acetaminophen...... 19 TRI-VI-FLORO...... 108 URAMAXIN...... 102 trandolapril...... 77 tri-vitamin/fluoride...... 108 urea...... 102 trandolapril-verapamil hcl er...... 83 tri-vite/fluoride...... 108 urea in zn undecyl-lactic acid..102 tranexamic acid...... 74 trivora (28)...... 133 urea nail...... 102 TRANSDERM-SCOP (1.5 MG).37 tri-vylibra...... 133 urea-c40...... 102 TRANXENE-T...... 63 tri-vylibra lo...... 133 URECHOLINE...... 118 tranylcypromine sulfate...... 35 TRIZIVIR...... 61 urelle...... 116 TRANZGEL...... 149 trospium chloride...... 116 uremez-40...... 103 TRAVATAN Z...... 155 trospium chloride er...... 116 uretron d/s...... 116 trazodone hcl...... 36 TRUE METRIX BLOOD URIBEL...... 116 TRECATOR...... 44 GLUCOSE TEST...... 149 URIMAR-T...... 116 TRELEGY ELLIPTA...... 165 TRUE METRIX LEVEL 1...... 149 urin ds...... 116 TREMFYA...... 102 TRUE METRIX LEVEL 2...... 149 uro-458...... 116 TRESIBA...... 69 TRUE METRIX LEVEL 3...... 149 UROCIT-K 10...... 105 TRESIBA FLEXTOUCH...... 69 TRUEPLUS 5-BEVEL PEN UROCIT-K 15...... 105 tretinoin...... 51, 102 NEEDLES...... 149 UROCIT-K 5...... 105 tretinoin microsphere...... 102 TRUETRACK TEST...... 149 UROGESIC-BLUE...... 116 tretinoin microsphere pump.... 102 TRULANCE...... 111 uro-mp...... 116 TRETTEN...... 74 TRULICITY...... 67 UROXATRAL...... 117 TREXALL...... 141 TRUSOPT...... 154 URSO 250...... 111 trezix...... 19 TRUVADA...... 61 URSO FORTE...... 111 tri femynor...... 132 TRYPTOPHAN...... 149 ursodiol...... 111 triamcinolone acetonide.... 94, 123 TUDORZA PRESSAIR...... 159 URYL...... 116 triamterene-hctz...... 83 tulana...... 135 ustell...... 116 triazolam...... 63 TURPENTINE...... 12 uticap...... 116 TRICARE PRENATAL DHA TUSSICAPS...... 165 utira-c...... 116 ONE...... 108 TUSSIONEX PENNKINETIC UTOPIC...... 103 TRI-CHLOR...... 102 ER...... 165 utrona-c...... 116 TRICITRASOL...... 70 TUXARIN ER...... 165 valacyclovir hcl...... 59 tricitrates...... 105 TUZISTRA XR...... 165 VALCHLOR...... 44 Triderm...... 123 TYBOST...... 59 VALCYTE...... 56 tridesilon...... 123 Tydemy...... 133 valganciclovir hcl...... 56, 57 tri-estarylla...... 132 TYKERB...... 50 valproate sodium...... 30 trifluoperazine hcl...... 54 TYLENOL WITH CODEINE #3. 19 valproic acid...... 30 trifluridine...... 58 TYLENOL WITH CODEINE #4. 19 valsartan...... 76 trihexyphenidyl hcl...... 52 TYMLOS...... 145 valsartan-hydrochlorothiazide... 83 tri-legest fe...... 132 TYVASO...... 162 VANATOL LQ...... 12 TRILEPTAL...... 33 TYVASO REFILL...... 162 VANATOL S...... 12

185 VANCOCIN HCL...... 24 VIMPAT...... 33 XOLEGEL DUO/XOLEX...... 41 vancomycin hcl...... 24 VIOKACE...... 115 XOPENEX HFA...... 161 Vandazole...... 24 viorele...... 133 XOSPATA...... 50 vardenafil hcl...... 118 VIRACEPT...... 62 XTAMPZA ER...... 16 VARUBI...... 38 VIRAMUNE...... 60 XTANDI...... 44 VASCEPA...... 86 VIRAZOLE...... 56 xulane...... 133 VECAMYL...... 83 VIREAD...... 61 XURIDEN...... 115 VECTICAL...... 103 VIROPTIC...... 59 XYNTHA...... 75 velivet...... 133 virt-phos 250 neutral...... 105 XYNTHA SOLOFUSE...... 75 VELPHORO...... 106 VISTARIL...... 157 XYREM...... 167 VELTASSA...... 106 VISTOGARD...... 149 YASMIN 28...... 133 VELTIN...... 103 vitamin d (ergocalciferol)...... 108 YAZ...... 133 VEMLIDY...... 57 vitamins acd-fluoride...... 108 Yuvafem...... 133 VENCLEXTA...... 50 VITRAKVI...... 50 ZACARE...... 103 VENCLEXTA STARTING VIVELLE-DOT...... 133 zaclir cleansing...... 103 PACK...... 50 VIZIMPRO...... 50 zafirlukast...... 159 VENELEX...... 103 VOLTAREN...... 14 zaleplon...... 166 venlafaxine hcl...... 36 VONVENDI...... 74 ZANAFLEX...... 166 venlafaxine hcl er...... 36 voriconazole...... 41 Zarah...... 133 VENTAVIS...... 162 VOSEVI...... 57 ZARONTIN...... 29 VENTOLIN HFA...... 161 VOTRIENT...... 50 ZARXIO...... 72 verapamil hcl...... 80 VRAYLAR...... 56 Zebutal...... 12 verapamil hcl er...... 80 VUSION...... 41 ZEJULA...... 46 VERDESO...... 123 vyfemla...... 133 ZELAPAR...... 54 verdrocet...... 19 Vylibra...... 133 ZELBORAF...... 50 VEREGEN...... 103 VYTORIN...... 86 ZEMBRACE SYMTOUCH...... 43 VERELAN...... 80 VYVANSE...... 88 ZEMPLAR...... 145 VERELAN PM...... 80 warfarin sodium...... 70 zenatane...... 103 VERIPRED 20...... 123 WELCHOL...... 86 Zenatane...... 103 VERSACLOZ...... 56 wera...... 133 ZENPEP...... 115 VERZENIO...... 46 WESTHROID...... 137 ZEPATIER...... 57 VESICARE...... 116 WHEAT GERM OIL...... 108 ZETONNA...... 159 VFEND...... 41 WIDE-SEAL DIAPHRAGM 60 149 ZIAC...... 83 V-GO 20...... 149 WILATE...... 74 ZIAGEN...... 61 V-GO 30...... 149 WP THYROID...... 137 zidovudine...... 61 V-GO 40...... 149 Wymzya Fe...... 133 zileuton er...... 159 VIBERZI...... 111 XALATAN...... 155 ZIOPTAN...... 155 VIBRAMYCIN...... 29 XALKORI...... 50 ziprasidone hcl...... 56 Vicodin...... 19 XARELTO...... 70 ZIPSOR...... 14 Vicodin Es...... 19 XARELTO STARTER PACK.....70 ZIRGAN...... 57 Vicodin Hp...... 19 XATMEP...... 141 ZITHROMAX...... 26 VICTOZA...... 67 XELJANZ...... 141 ZITHROMAX TRI-PAK...... 27 VIDEX...... 61 XELJANZ XR...... 141 ZITHROMAX Z-PAK...... 27 VIDEX EC...... 61 XELODA...... 45 ZOCOR...... 85 VIEKIRA PAK...... 57 XENICAL...... 91 ZOFRAN...... 38 vienva...... 133 XERMELO...... 111 ZOHYDRO ER...... 16 vigabatrin...... 30 XIFAXAN...... 112 ZOLINZA...... 46 Vigadrone...... 30 XIIDRA...... 151 zolmitriptan...... 43 VIGAMOX...... 27 XIMINO...... 29 zolpidem tartrate...... 166, 167 VIIBRYD...... 36 XOLEGEL...... 41 zolpidem tartrate er...... 166 VIIBRYD STARTER PACK...... 37 XOLEGEL COREPAK...... 41 ZOLPIMIST...... 167 vilamit mb...... 116 XOLEGEL DUO/HEAD & ZOMIG...... 43 vilevev mb...... 116 SHOULDERS...... 41 ZOMIG ZMT...... 43

186 ZONALON...... 103 ZONEGRAN...... 29 zonisamide...... 29 ZONTIVITY...... 70 ZORBTIVE...... 111 ZORTRESS...... 141 ZORVOLEX...... 14 zovia 1/35e (28)...... 133 ZOVIRAX...... 59 ZUBSOLV...... 20, 21 ZUPLENZ...... 38 ZYDELIG...... 50 ZYFLO...... 159 ZYFLO CR...... 159 ZYKADIA...... 50 ZYLET...... 152 ZYLOPRIM...... 41 ZYMAXID...... 153 ZYTIGA...... 44 ZYVOX...... 24

187