A list of medications that may lower your patients’ costs

INTRODUCTION

Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories.

FORMULARY DESIGN

There are numerous formulary designs that can be used by a pharmacy benefits administrator. Catamaran has chosen a formulary structure which is open and incentive based.

 Open Formulary: features co‐payments for medications that are preferred and non‐ preferred brands, plus lower co‐payments for generic drugs.  Incentive Based: features different co‐payments for medications that are on or off the formulary. In this type of formulary, the patient cost structure may be two‐tier, three‐ tier, or four‐tier design.

USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS

Many benefit sponsors use the Catamaran formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer. However, choosing a preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable.

KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED

The following formulary reference guide is designed so that generic products are listed first in each drug category. The preferred brand name products are listed next, and non‐preferred brand products are listed last. The Generic category is related to Tier 1 medications, Preferred category is related to Tier 2 medications, Non‐Preferred is related to Tier 3 medications, Specialty medications are related to Tier 4 medications, and Tier 00 medications are related to the preventative services covered under the Affordable Care Act.

PLEASE NOTE: If a generic product is listed in the “generics” section and its corresponding brand‐name product is not listed in the “preferred brand‐name” section, then only the generic product is on the formulary. If a brand name product is listed in the “preferred brand‐ name” section and its corresponding generic product is not listed in the “generics” section, then a generic version of the medication is not available.

Formulary Drug Edits Below is a list of the various edits associated with some drugs on the formulary as well as a brief definition.  PA (Prior Authorization)‐ requires review and approval prior to filling  QL (Quantity Limit)‐ limit on the quantity dispensed for that drug  ST (Step Therapy)‐ approval subject to trial of preferred alternatives first  AL (Age Limit)‐ approval of the drug is specific to a certain age range  GL (Gender Limit)‐ approval of the drug is gender specific Mandatory Generic

The Prescription Drug benefit is a “Mandatory Generic” program. Each Prescription will be filled as a Generic when available. If the Physician or the Covered Person requests a Brand Name Medication when there is an FDA “AB” rated Generic available, the Covered Person will be charged the applicable Deductible/ Co‐insurance/ Co‐payments plus the difference in the price of the Brand Name Medication and the available Generic.

CONSIDERING PREFERRED ALTERNATIVES

Catamaran realizes that the medications on the formulary may not always be appropriate for all patients. However, by referring to this formulary reference guide, one can help ensure the full advantage of the coverage provided by the prescription drug plan. Possible preferred alternatives are listed for commonly prescribed non‐preferred medications.

Pharmacies cannot substitute a preferred brand‐name drug without the prescriber’s approval. Therefore, a pharmacist may contact the prescriber to obtain authorization to dispense an alternative preferred product when a non‐preferred product is prescribed.

SAVING ON OUT‐OF‐POCKET COSTS

The prescription drug plan determines the cost for generic, preferred brand‐name, and on‐ preferred brand‐name medications. Benefit providers often design prescription drug plans to encourage the use of generic and preferred brand‐name drugs. Choosing non‐preferred drugs may mean paying higher out‐of‐pocket expenses (such as coinsurance, co‐payments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs, or they may be asked to pay the cost difference between brand‐name drugs and their generic alternatives, which are preferred by the plan.

CONSULTING THE PRESCRIBER’S OFFICE WHEN APPROPRIATE

When employers and other benefit sponsors design their prescription drug plans, they may choose to provide coverage only for certain medications or for particular uses, time periods, doses, or quantities (e.g. they may exclude coverage for medications for unapproved, unproven, or cosmetic indications, as well as over‐the‐counter medications). When coverage for medications is provided based on use or quantity, Catamaran may contact your prescriber’s office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Catamaran Member Services representative to determine specific coverage requirements.

*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co‐payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of catamaran. The presence of a medication on this formulary list does not guarantee coverage. To see the most up‐to‐date formulary, please visit your member website. You may also call Member Services at the number listed on your ID card to request a copy be mailed to you.

Table of Contents

ANTI-INFECTIVES ...... 1

PENICILLINS ...... 1

CEPHALOSPORIN ...... 1

FIRST GENERATION ...... 1

SECOND GENERATION ...... 1

THIRD GENERATION ...... 1

MACROLIDES ...... 1

TETRACYCLINES ...... 1

QUINOLONES ...... 1

AMINOGLYCOSIDES ...... 1

SULFONAMIDES ...... 1

ANTIMYCOBACTERIAL AGENTS ...... 2

ANTIFUNGALS ...... 2

ANTIVIRALS ...... 2

ANTIMALARIALS ...... 3

AMEBICIDES ...... 3

ANTHELMINTICS ...... 3

MISC. ANTI-INFECTIVES ...... 3

ANTINEOPLASTICS, ETC ...... 3

ALKYLATING AGENTS ...... 3

ANTIBIOTICS ...... 3

ANTINEOPLASTIC ENZYMES ...... 3

ANTIMETABOLITES ...... 3

ANGIOGENESIS INHIBITORS ...... 4

ANTIBODIES ...... 4

HORMONAL AGENTS ...... 4

IMMUNOMODULATORS ...... 4

MITOTIC INHIBITORS ...... 4

ENZYME INHIBITORS ...... 4

TOPOISOMERASE I INHIBITOR ...... 5

RADIOPHARMACEUTICALS ...... 5

CELLULAR IMMUNOTHERAPY ...... 5

ANTINEOPLASTICS MISC...... 5

CHEMOTHERAPY RESCUE ...... 5

CHEMOTHERAPY ADJUNCTS ...... 5

CARDIOVASCULAR DRUGS ...... 5

CARDIAC GLYCOSIDES ...... 5

ANTIANGINAL AGENTS ...... 5

BETA BLOCKERS ...... 5

CALCIUM CHANNEL BLOCKERS ...... 6

ANTIARRHYTHMICS ...... 6

ACE INHIBITORS ...... 6

ANGIOTENSIN RCPTR BLOCKER ...... 6

DIRECT RENIN INHIBITORS ...... 6

ANTIHYPERTENSIVES MISC...... 6

ANTIHYPERTENSIVE COMBO ...... 7

DIURETICS ...... 7

VASOPRESSORS ...... 7

ANTIHYPERLIPIDEMICS ...... 7

CARDIOVASCULAR - MISC...... 8

DERMATOLOGICALS ...... 8

ACNE PRODUCTS ...... 8

ROSACEA AGENTS ...... 9

ANTIBIOTICS - TOPICAL ...... 9

ANTIFUNGALS - TOPICAL ...... 9

ANTIVIRALS - TOPICAL ...... 9

ANTI-INFLAMMATORY AGENTS ...... 9

ANTIPRURITICS ...... 9

ANTIPSORIATICS ...... 9

ANTISEBORRHEIC AGENTS ...... 10

CORTICOSTEROIDS - TOPICAL ...... 10

IMMUNOMODULATING AGENTS ...... 11

DERMATOLOGICALS - MISC...... 11

ENDOCRINE AND METABOLIC ...... 11

CORTICOSTEROIDS ...... 12

ANDROGENS-ANABOLIC ...... 12

ESTROGENS ...... 12

CONTRACEPTIVES ...... 12

PROGESTINS ...... 14

ANTIDIABETIC AGENTS ...... 14

INSULIN ...... 14

AMYLIN ANALOGS ...... 14

INCRETIN MIMETIC AGENTS ...... 14

SULFONYLUREAS ...... 14

BIGUANIDES ...... 14

MEGLITINIDE ANALOGUES ...... 14

DIABETIC OTHER ...... 14

ALPHA-GLUCOSIDASE INHIBIT ...... 15

DPP-4 INHIBITORS ...... 15

INSULIN SENSITIZING AGENT ...... 15

ANTIDIABETIC COMBINATIONS ...... 15

BISPHOSPHONATES ...... 15

CALCITONINS ...... 15

PARATHYROID HORMONE ...... 15

RANK LIGAND INHIBITORS ...... 15

HORMONE RECEPTOR MDLTR ...... 15

LHRH/GNRH AGONIST ...... 15

GROWTH HORMONES ...... 15

GHRH ...... 15

SOMATOMEDINS ...... 15

SOMATOSTATIC AGENTS ...... 15

GH RECEPTOR ANTAGONISTS ...... 16

POSTERIOR PITUITARY ...... 16

CORTICOTROPIN ...... 16

PROLACTIN INHIBITORS ...... 16

VASOPRESSIN ANTAGONISTS ...... 16

METABOLIC MODIFIERS ...... 16

THYROID AGENTS ...... 16

GASTROINTESTINAL ...... 16

LAXATIVES ...... 16

ANTIDIARRHEALS ...... 16

ANTACIDS ...... 16

ULCER DRUGS ...... 16

ANTIEMETICS ...... 17

DIGESTIVE AIDS ...... 17

GASTROINTESTINAL - MISC...... 17

GENITOURINARY ...... 18

URINARY ANTI-INFECTIVES ...... 18

URINARY ANTISPASMODICS ...... 18

VAGINAL PRODUCTS ...... 18

GENITOURINARY - MISC...... 18

HEMATOLOGICAL ...... 18

HEMATOPOIETIC AGENTS ...... 18

ANTICOAGULANTS ...... 19

HEMOSTATICS ...... 19

HEMATOLOGICAL - MISC...... 20

MOUTH/THROAT/DENTAL AGENT ...... 20

NEUROLOGY, CNS, PSYCH ...... 20

ANTIANXIETY AGENTS ...... 20

ANTIDEPRESSANTS ...... 21

ANTIPSYCHOTICS ...... 21

HYPNOTICS ...... 22

ADHD, NARCOLEPSY, ETC...... 22

ANTICONVULSANTS ...... 22

ANTIPARKINSON AGENTS ...... 23

NEUROLOGY, PSYCH - MISC...... 23

NEUROMUSCULAR AGENTS ...... 24

MUSCULOSKELETAL AGENTS ...... 24

ANTIMYASTHENIC AGENTS ...... 24

OPHTHALMOLOGY AND OTIC ...... 24

ANTI-INFECTIVES ...... 24

ARTIFICIAL TEAR/LUBRICANT ...... 25

BETA-BLOCKERS ...... 25

OPHTHALMIC STEROIDS ...... 25

PROSTAGLANDINS ...... 25

CYCLOPLEGIC MYDRIATICS ...... 25

DECONGESTANTS ...... 25

MIOTICS ...... 25

ADRENERGIC AGENTS ...... 25

IMMUNOMODULATORS ...... 25

LOCAL ANESTHETICS ...... 25

OPHTHALMICS - MISC...... 26

OTIC AGENTS ...... 26

OXYTOCICS ...... 26

PAIN MANAGEMENT ...... 26

ANALGESICS - NONNARCOTIC ...... 26

ANALGESICS - OPIOID ...... 27

ANTI-INFLAMMATORY ...... 28

MIGRAINE PRODUCTS ...... 28

GOUT AGENTS ...... 29

LOCAL ANESTHETICS-INJ ...... 29

RESPIRATORY, ALLERGY, ETC ...... 29

ANTIHISTAMINES ...... 29

NASAL AGENTS ...... 29

COUGH/COLD/ALLERGY ...... 29

ANTIASTHMATIC/COPD AGENTS ...... 30

RESPIRATORY AGENTS - MISC ...... 30

VACCINES ...... 30

VITAMINS ...... 31

VITAMINS ...... 31

MULTIVITAMINS ...... 31

MEDICAL DEVICES ...... 32

DIABETIC SUPPLIES ...... 32

MEDICAL DEVICES - MISC ...... 36

MISCELLANEOUS ...... 36

Ery-TAB

Eryped 200

Eryped 400

Erythrocin Stearate

October 2014 Erythromycin Base

Erythromycin Ethylsuccinate

PCE

ANTI-INFECTIVES Zithromax PENICILLINS Zithromax Tri-PAK TIER 01 GENERIC Zithromax Z-PAK amoxicillin Zmax amoxicillin/clavulanate potassium

amoxicillin/clavulanate potassium ER TETRACYCLINES ampicillin TIER 01 GENERIC dicloxacillin sodium demeclocycline HCL penicillin v potassium doxycycline TIER 03 NON PREFERRED doxycycline hyclate Amoxicillin doxycycline hyclate DRPA Amoxicillin ER doxycycline monohydrate Ampicillin minocycline HCL Augmentin minocycline HCL ERPA Augmentin ES-600 TIER 03 NON PREFERRED Augmentin XR Acticlate Moxatag Adoxa

Adoxa PAK 1/100 CEPHALOSPORIN Adoxa PAK 1/150 FIRST GENERATION Adoxa PAK 2/100 TIER 01 GENERIC DoryxPA cefadroxil Dynacin cephalexin Minocin TIER 03 NON PREFERRED Monodox Cephalexin Nicazeldoxy 30 Kit Keflex Nicazeldoxy 60 Kit SECOND GENERATION Nutridox TIER 01 GENERIC

Oraxyl cefaclor SolodynPA cefprozil Tetracycline HCL cefuroxime axetil Vibramycin TIER 03 NON PREFERRED

Cefaclor QUINOLONES Cefaclor ER TIER 01 GENERIC Ceftin ciprofloxacin THIRD GENERATION ciprofloxacin ER TIER 01 GENERIC

ciprofloxacin HCL cefdinir levofloxacin cefpodoxime proxetil moxifloxacin HCL TIER 03 NON PREFERRED

ofloxacin Cedax TIER 03 NON PREFERRED Cefditoren Pivoxil Avelox Ceftibuten Avelox Abc Pack Fortaz Cipro Spectracef Cipro XR Suprax Factive

Levaquin MACROLIDES Noroxin TIER 01 GENERIC Ofloxacin azithromycin

clarithromycin AMINOGLYCOSIDES clarithromycin ER TIER 01 GENERIC erythromycin neomycin sulfate TIER 03 NON PREFERRED

paromomycin sulfate Azithromycin TIER 04 SPECIALTY Biaxin tobramycinPA Biaxin XL BethkisPA Biaxin XL PAC TobiPA Dificid Tobi PodhalerQL,PA E.e.s. Granules

E.e.s. 400

SULFONAMIDES

TIER 02

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 1

PREFERRED Crixivan

Sulfisoxizole Edurant

TIER 03 NON PREFERRED Emtriva

Sulfadiazine Epzicom

FuzeonQL,PA

Intelence ANTIMYCOBACTERIAL AGENTS

GENERIC Invirase TIER 01

ethambutol HCL Isentress

isoniazid Kaletra

pyrazinamide Lexiva

rifabutin Nevirapine

rifampin Norvir

PREFERRED Prezista TIER 02

QL Isoniazid Relenza Diskhaler

Priftin Rescriptor

Seromycin Reyataz

PA Sirturo Selzentry

QL NON PREFERRED Stribild TIER 03

Cycloserine Sustiva

QL Myambutol Tamiflu

Mycobutin Tivicay

PA Paser Truvada

Rifadin Videx Pediatric

ST Rifamate Viracept

Rifater Viread

Trecator TIER 03 NON PREFERRED

Combivir

Epivir ANTIFUNGALS Famvir TIER 01 GENERIC Flumadine fluconazole Retrovir flucytosine Rimantalist griseofulvin microsize Sitavig griseofulvin ultramicrosize Triumeq itraconazole TrizivirQL ketoconazole Tybost nystatin Valtrex terbinafine HCL Videx EC voriconazole Viramune TIER 02 PREFERRED

Viramune XR Noxafil Zerit TIER 03 NON PREFERRED Ziagen Ancobon Zovirax Diflucan TIER 04 SPECIALTY Grifulvin V adefovir dipivoxilQL,PA Gris-peg cidofovir Lamisil entecavirQL,PA Onmel ganciclovir Sporanox lamivudine Sporanox Pulsepak ribavirin Vfend BaracludeQL,PA

Copegus ANTIVIRALS Cytovene TIER 01 GENERIC

Epivir HBV abacavir QL,PA QL Hepsera abacavir sulfate/lamivudine/zidovudine IncivekPA acyclovir InfergenPA didanosine Moderiba famciclovir Moderiba 1200 Dose Pack lamivudine/zidovudine Moderiba 800 Dose Pack nevirapine OlysioPA nevirapine ER Peg-intronPA rimantadine HCL Peg-intron RedipenPA stavudine Peg-intron Redipen PAK 4PA valacyclovir HCL PegasysPA zidovudine Pegasys ProclickPA TIER 02 PREFERRED Rebetol Aptivus QL Retrovir IV Infusion Atripla QL Ribasphere Complera

Ribasphere Ribapak

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 2

Ribatab TIER 04 SPECIALTY

SovaldiPA colistimethate sodium

TyzekaQL,PA CaystonPA

Valcyte Coly-mycin M

VictrelisPA Nebupent

Virazole Pentam 300

Vistide

ANTINEOPLASTICS, ETC ANTIMALARIALS ALKYLATING AGENTS TIER 01 GENERIC TIER 02 PREFERRED atovaquone/proguanil HCL Leukeran chloroquine phosphate TIER 03 NON PREFERRED hydroxychloroquine sulfate Cyclophosphamide mefloquine HCL TIER 04 SPECIALTY quinine sulfate carboplatin TIER 02 PREFERRED cisplatin Coartem ifosfamide Daraprim melphalan hydrochloride Primaquine Phosphate oxaliplatin TIER 03 NON PREFERRED PA temozolomide Aralen Alkeran Malarone Bicnu Plaquenil Busulfex Qualaquin Carboplatin

Cisplatin

AMEBICIDES Eloxatin

TIER 03 NON PREFERRED Hexalen

Yodoxin Ifex

Ifosfamide

ANTHELMINTICS Lomustine

TIER 02 PREFERRED Mustargen

Albenza MyleranPA

Stromectol TemodarPA

TIER 03 NON PREFERRED Treanda

Biltricide ValchlorPA

Zanosar

MISC. ANTI-INFECTIVES

TIER 01 GENERIC ANTIBIOTICS

atovaquone TIER 04 SPECIALTY

clindamycin palmitate HCL bleomycin sulfate

clindamycin HCL daunorubicin HCL

metronidazole doxorubicin HCL

sulfamethoxazole/trimethoprim doxorubicin HCL liposome

sulfamethoxazole/trimethoprim DS epirubicin HCL

tinidazole mitoxantrone HCLPA

trimethoprim Adriamycin

vancomycin HCL Daunoxome

TIER 02 PREFERRED Doxil

Alinia Ellence

Dapsone Epirubicin HCL

Xifaxan

Zyvox ANTINEOPLASTIC ENZYMES

TIER 03 NON PREFERRED SPECIALTY TIER 04

Bactrim Elspar

Bactrim DS ErwinazePA

Cleocin Oncaspar

Cleocin Pediatric Granules

Dalvance ANTIMETABOLITES First-vancomycin 25 TIER 01 GENERIC First-vancomycin 50 mercaptopurine Flagyl methotrexate Flagyl ER PA methotrexate sodium Ketek TIER 02 PREFERRED Mepron Trexall Orbactiv TIER 03 NON PREFERRED Primsol Purinethol Sivextro Purixan Tindamax TIER 04 SPECIALTY Vancocin HCL PA azacitidine

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 3

capecitabinePA Lupron DepotQL,PA

cladribine Lysodren

cytarabine Nilandron

cytarabine aqueous Trelstar DepotQL,PA

decitabinePA Trelstar Depot MixjectQL,PA

floxuridine Trelstar LAQL,PA

fludarabine phosphate Trelstar LA MixjectQL,PA

fluorouracil Trelstar MixjectQL,PA

gemcitabine HCL VantasQL,PA

Alimta XtandiPA

Arranon ZoladexQL,PA

Cytarabine ZytigaPA

DacogenPA

Fludara IMMUNOMODULATORS

Fludarabine Phosphate GENERIC TIER 01

Folotyn azathioprine

Gemcitabine cyclosporine

Gemzar cyclosporine modified

Tabloid mycophenolate mofetil

PA Vidaza mycophenolic acid DR

PA Xeloda sirolimus

tacrolimus

ANGIOGENESIS INHIBITORS TIER 02 PREFERRED

TIER 04 SPECIALTY Azasan

Avastin Rapamune

Cyramza Sandimmune

ZaltrapPA TIER 03 NON PREFERRED

Cellcept

Cyclosporine Modified ANTIBODIES

NON PREFERRED Imuran TIER 03

Keytruda Myfortic

SPECIALTY Neoral TIER 04

AdcetrisPA Prograf

Arzerra TIER 04 SPECIALTY

Erbitux Astagraf XL

PA GazyvaPA Nulojix

PA HerceptinPA Pomalyst

PA KadcylaPA Revlimid

PA PerjetaPA Thalomid

PA RituxanPA Zortress

Vectibix

YervoyPA MITOTIC INHIBITORS

Zevalin Y-90 TIER 04 SPECIALTY

etoposide

paclitaxel HORMONAL AGENTS

GENERIC vincristine sulfate TIER 01

anastrozole vinorelbine tartrate

bicalutamide Abraxane

exemestane Docefrez

letrozole Docetaxel

megestrol acetate Etopophos

tamoxifen citrate Etoposide

PA PREFERRED Halaven TIER 02

Fareston Ixempra Kit

PA Megestrol Acetate Jevtana

Soltamox Marqibo

NON PREFERRED Navelbine TIER 03

Arimidex Paclitaxel

Aromasin Taxotere

Casodex Vinblastine Sulfate

Femara

Megace Oral ENZYME INHIBITORS

TIER 04 SPECIALTY TIER 02 PREFERRED

flutamide TarcevaPA

leuprolide acetateQL,PA TasignaPA

EligardQL,PA TIER 04 SPECIALTY

Emcyt AfinitorPA

Faslodex Afinitor DisperzPA

FirmagonQL,PA Beleodaq

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 4

BosulifPA TIER 04 SPECIALTY

CaprelsaQL,PA amifostine

CometriqPA mesna

GilotrifPA Ethyol

GleevecPA Fusilev

IclusigPA Mesnex

ImbruvicaPA

InlytaPA CHEMOTHERAPY ADJUNCTS PA Istodax SPECIALTY TIER 04 PA Jakafi Elitek

KyprolisPA

MekinistPA

CARDIOVASCULAR DRUGS NexavarPA PA CARDIAC GLYCOSIDES Sprycel PA TIER 01 GENERIC Stivarga PA digoxin Sutent PA TIER 03 NON PREFERRED Tafinlar Digoxin Torisel PA Lanoxin Tykerb PA Velcade PA ANTIANGINAL AGENTS Votrient PA TIER 01 GENERIC Xalkori QL,PA isosorbide dinitrate Zelboraf PA isosorbide dinitrate ER Zolinza isosorbide mononitrate Zydelig isosorbide mononitrate ER Zykadia nitroglycerin

nitroglycerin lingual TOPOISOMERASE I INHIBITOR nitroglycerin transdermal TIER 04 SPECIALTY TIER 02 PREFERRED irinotecan Dilatrate SR topotecan HCL Nitro-bid Camptosar Nitrostat Hycamtin Ranexa Irinotecan TIER 03 NON PREFERRED Topotecan HCL Imdur

Isordil Titradose RADIOPHARMACEUTICALS Isosorbide Dinitrate TIER 04 SPECIALTY Nitro-dur Xofigo Nitroglycerin Lingual

Nitrolingual Pumpspray CELLULAR IMMUNOTHERAPY Nitromist TIER 04 SPECIALTY

ProvengePA BETA BLOCKERS

TIER 01 GENERIC ANTINEOPLASTICS MISC. acebutolol HCL TIER 01 GENERIC atenolol hydroxyurea betaxolol HCL TIER 03 NON PREFERRED bisoprolol fumarate Hydrea carvedilol TIER 04 SPECIALTY labetalol HCL dacarbazine metoprolol succinate ER tretinoin metoprolol tartrate Actimmune nadolol Alferon N pindolol Dacarbazine propranolol HCL Intron-aPA propranolol HCL ER Intron-a W/DiluentPA sotalol HCL Matulane sotalol HCL (AF) Nipent TIER 02 PREFERRED Proleukin Bystolic SylatronPA Coreg CR SynriboPA TIER 03 NON PREFERRED TargretinPA Betapace

Betapace AF

CHEMOTHERAPY RESCUE Coreg

TIER 01 GENERIC Corgard

leucovorin calcium Hemangeol

TIER 03 NON PREFERRED Hypertenevide-12.5

Leucovorin Calcium Inderal LA

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 5

Inderal XL Norpace CR

Innopran XL Quinidine Sulfate

Kerlone Quinidine Sulfate ER

Levatol Rythmol

Lopressor Rythmol SR

Propranolol HCL Tambocor

Sectral

Tenormin ACE INHIBITORS

Timolol Maleate GENERIC TIER 01

Toprol XL benazepril HCL

Trandate captopril

Zebeta enalapril maleate

fosinopril sodium

CALCIUM CHANNEL BLOCKERS lisinopril

TIER 01 GENERIC moexipril HCL

amlodipine besylate perindopril erbumine

diltiazem CD quinapril HCL

diltiazem HCL ramipril

diltiazem HCL ER trandolapril

felodipine ER TIER 03 NON PREFERRED

nicardipine HCL Accupril

nifedipine Aceon

nifedipine ER Altace

nimodipine Epaned

nisoldipine Lotensin

verapamil HCL Mavik

verapamil HCL ER Prinivil

verapamil HCL SR Univasc

TIER 03 NON PREFERRED Vasotec

Adalat CC Zestril

Calan

Calan SR ANGIOTENSIN RCPTR BLOCKER

Cardene SR GENERIC TIER 01

Cardizem candesartan cilexetilST

Cardizem CD eprosartan mesylate

Cardizem LA irbesartan

Dilacor XR losartan potassium

Hypertenipine-2.5 telmisartan

Isoptin SR valsartan

Isradipine PREFERRED TIER 02

Nisoldipine Benicar

Nisoldipine ER NON PREFERRED TIER 03

Norvasc AtacandST

Nymalize Avapro

Procardia Cozaar

Procardia XL Diovan

Sular EdarbiQL,ST

Tiazac Micardis

Verapamil HCL TevetenST

Verelan

Verelan PM DIRECT RENIN INHIBITORS

TIER 02 PREFERRED

ANTIARRHYTHMICS Tekturna

TIER 01 GENERIC

amiodarone HCL ANTIHYPERTENSIVES MISC. disopyramide phosphate TIER 01 GENERIC flecainide acetate clonidine HCL mexiletine HCL doxazosin mesylate propafenone HCL eplerenone propafenone HCL ER guanfacine HCL quinidine gluconate CR hydralazine HCL quinidine gluconate ER methyldopa quinidine sulfate minoxidil TIER 02 PREFERRED prazosin HCL Tikosyn terazosin HCL TIER 03 NON PREFERRED TIER 02 PREFERRED Cordarone Demser Multaq Dibenzyline Norpace TIER 03

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 6

NON PREFERRED Uniretic

Cardura Vaseretic

Catapres Zestoretic

Catapres-tts-1 Ziac

Catapres-tts-2

Catapres-tts-3 DIURETICS

Inspra GENERIC TIER 01

Minipress acetazolamide

Reserpine acetazolamide ER

Tenex amiloride HCL

Vecamyl amiloride/hydrochlorothiazide

bumetanide

ANTIHYPERTENSIVE COMBO chlorothiazide

TIER 01 GENERIC furosemide

amlodipine besylate/benazepril hydrochloride hydrochlorothiazide

amlodipine besylate/benazepril HCL indapamide

amlodipine besylate/valsartan methazolamide

atenolol/chlorthalidone metolazone

benazepril HCL/hydrochlorothiazide spironolactone

bisoprolol fumarate/hydrochlorothiazide spironolactone/hydrochlorothiazide

candesartan cilexetil/hydrochlorothiazide torsemide

enalapril maleate/hydrochlorothiazide triamterene/hydrochlorothiazide

fosinopril sodium/hydrochlorothiazide TIER 03 NON PREFERRED

irbesartan/hydrochlorothiazide Acetazolamide

lisinopril/hydrochlorothiazide Aldactazide

losartan potassium/hydrochlorothiazide Aldactone

metoprolol/hydrochlorothiazide Chlorothiazide

moexipril/hydrochlorothiazide Chlorthalidone

nadolol/bendroflumethiazide Demadex

quinapril/hydrochlorothiazide Diamox

telmisartan/amlodipine Diuril

telmisartan/hydrochloroth Dyazide

telmisartan/hydrochlorothiazide Dyrenium

valsartan/hydrochlorothiazide Edecrin

TIER 02 PREFERRED Furosemide

Amturnide Introl

Azor Lasix

Benicar HCT Maxzide

Exforge HCT Maxzide-25

Tarka Methyclothiazide

Tekamlo Microzide

Tekturna HCT Neptazane

Tribenzor Triamterene/Hydrochlorothiazide

TIER 03 NON PREFERRED Zaroxolyn

Accuretic

Atacand HCT VASOPRESSORS

Avalide GENERIC TIER 01

Captopril/Hydrochlorothiazide midodrine HCL

Clorpres PREFERRED TIER 02

Corzide Epipen 2-PAK

Diovan HCT Epipen-JR 2-PAK

Dutoprol NON PREFERRED TIER 03 QL,ST Edarbyclor Adrenaclick

Exforge Auvi-q

Hypertensolol Epinephrine

Hyzaar SPECIALTY TIER 04

Lopressor HCT Northera

Lotensin HCT

Lotrel ANTIHYPERLIPIDEMICS Lytensopril Kit TIER 01 GENERIC Lytensopril-90 QL atorvastatin calcium Lytensopril-90 Kit cholestyramine Methyldopa/Hydrochlorothiazide cholestyramine light Micardis HCT colestipol HCL Propranolol/Hydrochlorothiazide colestipol HCL for oral suspension Tenoretic 100 fenofibrate Tenoretic 50 fenofibrate micronized Teveten HCTQL,ST fenofibric acid DR Twynsta QL fluvastatin

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 7

gemfibrozil FlolanPA

lovastatinQL LetairisQL,PA

niacin ER OpsumitQL,PA

omega-3-acid ethyl esters Orenitram

pravastatin sodiumQL RemodulinPA

simvastatinQL TracleerQL,PA

TIER 02 PREFERRED TyvasoQL,PA

CrestorQL Tyvaso RefillQL,PA

Fenofibrate Tyvaso StarterQL,PA

Lipofen VeletriPA

Liptruzet VentavisQL,PA

Simcor

Vascepa

DERMATOLOGICALS Welchol ACNE PRODUCTS ZetiaQL TIER 01 GENERIC TIER 03 NON PREFERRED adapalene AdvicorQL benzoyl peroxide AltoprevQL,ST benzoyl peroxide SHORT contact AntaraST clindamycin phosphate Colestid clindamycin/benzoyl peroxide Colestid Flavored erythromycin Fenofibric AcidST erythromycin/benzoyl peroxide Fenoglide sodium sulfacetamide FibricorST sodium sulfacetamide/sulfur KynamroQL,PA sodium sulfacetamide/sulfur cleanser LescolQL sodium sulfacetamide/sulfur cleansing cloths Lescol XLQL,ST sodium sulfacetamide/sulfur green LipitorQL sodium sulfacetamide/sulfur w/sunscreen Livalo sodium sulfacetamide/sulfur wash Lofibra sulfacetamide sodium Lopid sulfacetamide sodium/sulfur cleanser Lovaza AL tretinoin QL Mevacor AL tretinoin microsphere Niacor AL tretinoin microsphere P.M. Niaspan TIER 02 PREFERRED PravacholQL Acanya Questran AL Atralin Questran Light Epiduo Tricor AL Veltin ST Triglide AL Ziana Trilipix TIER 03 NON PREFERRED VytorinQL,ST Absorica ZocorQL Aczone TIER 04 SPECIALTY Akne-mycin JuxtapidQL,PA Avar

Avar LS CARDIOVASCULAR - MISC. Avar LS Cleanser TIER 01 GENERIC Avar-e LS amlodipine besylate/atorvastatin calcium AL Azelex TIER 02 PREFERRED Benzac Ac Wash CaverjectQL,PA Benzac W Wash Caverject ImpulseQL,PA Benzaclin CialisQL,PA Benzaclin With P.M. EdexQL,PA Benzamycin MuseQL,PA Benzamycinpak ViagraQL,PA Benzefoam TIER 03 NON PREFERRED Benzefoamultra Bidil Benziq Caduet Benziq LS LevitraQL,PA Claravis RevatioQL,PA Clarifoam EF StaxynQL,PA Cleocin-t StendraQL,PA Clindacin Etz TIER 04 SPECIALTY Clindacin PAC epoprostenol sodiumPA Clindagel sildenafilQL,PA Differin sildenafil citrateQL,PA Duac AdcircaQL,PA Erygel AdempasQL,PA Evoclin

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 8

Fabior nystatin

Inova nystatin/triamcinolone

Inova 4/1 Acne Control Therapy TIER 02 PREFERRED

Inova 8/2 Acne Control Therapy Nystatin

Klaron Nystatin Foreign

Lavoclen-4 Creamy Wash TIER 03 NON PREFERRED

Lavoclen-8 Creamy Wash Ciclodan Cream Kit

Neuac Kit Ciclodan Solution Kit

Nuox Ciclopirox Topical Solution Kit

Plexion Cnl8 Nail Kit

Plexion Cleanser Ecoza

Plexion Cleansing Cloths Ertaczo

Retin-aAL Exelderm

Retin-a MicroAL Extina

Retin-a Micro P.M.AL Halotin

Riax Jublia

Rosanil Kerydin

Sodium Sulfacetamide/Sulfur Ketodan Kit

Sodium Sulfacetamide/Sulfur Cleanser IN Urea Lamisil Spray

Sodium Sulfacetamide/Sulfur IN Urea Loprox

Sulfoam Loprox Shampoo

Sumadan Kit Lotrisone

Sumadan Wash Luzu

Sumadan XLT Mentax

Sumaxin Naftin

Sumaxin CP Kit Nizoral

Sumaxin Ts Oxistat

Sumaxin Wash Pediaderm AF Complete Kit

Tretin-xAL Pedipirox-4 Nail

Vanoxide-HC Vusion

Zacare 4% Kit Xolegel

Zacare 8% Kit Xolegel Corepak

Xolegel Duo/Head & Shoulders

Xolegel Duo/Xolex ROSACEA AGENTS

GENERIC TIER 01

metronidazole ANTIVIRALS - TOPICAL

TIER 02 PREFERRED TIER 01 GENERIC

Finacea acyclovir

Oracea TIER 02 PREFERRED

TIER 03 NON PREFERRED Denavir

Metrocream TIER 03 NON PREFERRED

Metrogel Lidovir

Metrolotion Xerese

Mirvaso Zovirax

Noritate

Rosadan Kit ANTI-INFLAMMATORY AGENTS

GENERIC TIER 01

ANTIBIOTICS - TOPICAL diclofenac sodium

TIER 01 GENERIC TIER 02 PREFERRED

mupirocin Voltaren

mupirocin calcium TIER 03 NON PREFERRED

TIER 03 NON PREFERRED Flector

Altabax K.b.g.l. IN Teroderm Cream

Bactroban Ketorolac 2% Gel

Centany Lidoprofen

Centany AT Pennsaid

Cortisporin Vopac

Gentamicin Sulfate Vopac GB

Neo-synalar Vopac Kt

Neo-synalar Kit

ANTIPRURITICS

ANTIFUNGALS - TOPICAL TIER 03 NON PREFERRED

TIER 01 GENERIC Prudoxin

ciclopirox Zonalon

ciclopirox olamine

clotrimazole ANTIPSORIATICS

clotrimazole/betamethasone dipropionate GENERIC TIER 01

econazole nitrate acitretin

ketoconazole calcipotriene

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 9

TIER 02 PREFERRED Pramosone E

TazoracAL TIER 03 NON PREFERRED

TIER 03 NON PREFERRED Aclovate

Calcitriol Ala Scalp

Dovonex Amcinonide

Dritho-creme HP Apexicon E

Soriatane Capex

Sorilux Carmol-HC

StelaraPA Clobex

Vectical Clocortolone Pivalate

Zithranol Clocortolone Pivalate P.M.

Zithranol-rr Clodan Kit

TIER 04 SPECIALTY Cloderm

methoxsalen Cloderm P.M.

Oxsoralen Ultra Cordran

8-mop Cordran Tape

Cutivate

Derma-smoothe/FS Body ANTISEBORRHEIC AGENTS

GENERIC Derma-smoothe/FS Body Oil TIER 01

selenium sulfide Derma-smoothe/FS Scalp

sodium sulfacetamide Derma-smoothe/FS Scalp Oil

sodium sulfacetamide wash Dermasorb HC

NON PREFERRED Dermasorb Ta TIER 03

Glycolic Acid Dermatop

Glycolic Acid 70% High Purity Desonate

Ovace Plus Desowen

Ovace Plus Wash Desowen Cream/Cetaphil Lotion

Ovace Wash Desowen Lotion/Cetaphil Cream

Promiseb Desowen Ointment/Cetaphil Lotion

Promiseb Complete Desoximetasone

Seb-prev Diflorasone Diacetate

Selenium Sulfide Diprolene

Selrx Diprolene AF

Selsun Shampoo Elocon

Sodium Sulfacetamide/Urea Epifoam

Tersi Foam First-hydrocortisone

TL Triseb Halog

Halonate

Kenalog CORTICOSTEROIDS - TOPICAL Locoid TIER 01 GENERIC Locoid Lipocream alclometasone dipropionate Luxiq amcinonide Nucort augmented betamethasone dipropionate Nuzon betamethasone dipropionate Olux betamethasone valerate Olux-e calcipotriene/betamethasone dipropionate Pandel clobetasol propionate Pediaderm HC clobetasol propionate emollient Pediaderm Ta desonide Scalacort DK desoximetasone Synalar diflorasone diacetate Synalar Cream Kit fluocinolone acetonide Synalar Ointment Kit fluocinonide Synalar Ts fluocinonide emollient base Taclonex fluocinonide-e Temovate fluticasone propionate Temovate E halobetasol propionate Texacort hydrocortisone Topicort hydrocortisone acetate/aloe Triamcinolone Acetonide hydrocortisone butyrate Trianex hydrocortisone butyrate (lipid) U-cort hydrocortisone butyrate (lipophilic) Ultravate hydrocortisone valerate Ultravate PAC hydrocortisone IN absorbase Ultravate X mometasone furoate Vanos prednicarbate Verdeso triamcinolone acetonide Westcort TIER 02 PREFERRED

Pramosone

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 10

Genadur IMMUNOMODULATING AGENTS

GENERIC Gordofilm TIER 01

imiquimod Gordons Urea

PREFERRED Hydro 35 TIER 02

Elidel Hydro 40 Foam

Protopic Hylatopic

Zyclara Hylatopic Plus

Zyclara P.M. Hylira

NON PREFERRED HPR TIER 03

Aldara HPR Plus

HPR Plus/Mb Hydrogel

Kerafoam DERMATOLOGICALS - MISC. Kerafoam 42 TIER 01 GENERIC Keralac ammonium lactate Keralyt episone CRE Keralyt Scalp lactic acid Lac-hydrin lactic acid e Latrix XM lactic acid w/vitamin e Lidocaine HCL lidocaine Lidocaine/Prilocaine lidocaine HCL Lidoderm lidocaine HCL jelly Lycelle lidocaine/prilocaine Mb Hydrogel lindane Medi-derm/L-RX malathion Natroba permethrin Neosalus podofilox Neosalus CP salicylic acid Nivatopic Plus salicylic acid cream Nuvail salicylic acid lotion Ovide sodium hyaluronate Pliaglis urea Pr Cream urea topical Presera urea IN zinc undecylenate/lactic acid vehicle Pruclair urea 40% nail film Prumyx TIER 02 PREFERRED Pyrogallic Acid Condylox Qutenza Eurax Salex Oxsoralen Salex Cream TIER 03 NON PREFERRED

Salex Lotion Aluvea Salicylic Acid Anacaine Salicylic Acid IN Ammonium Lactate Vehicle Arnica Flower Salkera Atopiclair Salvax Aurstat Salvax Duo Plus Aurstat Anti-itch Hydrogel Sklice Aurstat Anti-itch Hydrogel Kit Spinosad Benzoin Compound Tincture Sulfurated Lime Benzoin Tincture Synera Boric Acid Tetrix Cem-urea Tropazone Coal TAR TL-cermide Cocaine HCL Ulesfia Dermasorb XM Ultrasal-ER Drysol Umecta Elenzapatch Umecta Nail Film Eletone Umecta PD Eletone Twinpack Uramaxin Elimite Uramaxin GT Emla Uramaxin GT Kit Emulsion SB Utopic Epiceram Veregen Ethyl Chloride Vexa Ethyl Chloride/Fine Pinpoint Virasal Ethyl Chloride/Fine Stream Xclair Ethyl Chloride/Medium Jet Stream Xerac Ac Ethyl Chloride/Medium Stream Xylocaine Ethyl Chloride/Mist

Gebauers Pain Ease

Gebauers Spray And Stretch ENDOCRINE AND METABOLIC

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 11

FortestaST CORTICOSTEROIDS

GENERIC Oxandrin TIER 01 ST budesonide Striant

ST dexamethasone Testim

dexamethasone sodium phosphate Testosterone

fludrocortisone acetate Testosterone P.M.

hydrocortisone Testred

methylprednisolone Vogelxo

methylprednisolone dose pack Vogelxo P.M.

prednisolone

prednisolone sodium phosphate ESTROGENS

prednisone TIER 01 GENERIC

TIER 02 PREFERRED estradiol

Uceris estradiol/norethindrone acetate

TIER 03 NON PREFERRED estropipate

Betalido TIER 02 PREFERRED

Celestone Alora

Cortef Cenestin

Cortisone Acetate Combipatch

Dexamethasone Enjuvia

Dexamethasone Intensol Evamist

Dexamethasone Sodium Phosphate Minivelle

Dexlido Premarin

Dexlido-m Premphase

Dexpak 10 Day Prempro

Dexpak 13 Day Vivelle-dot

Dexpak 6 Day TIER 03 NON PREFERRED

Doubledex Activella

Dyural-l Angeliq

Dyural-lm Climara

Dyural-40 Climara Pro

Dyural-80 Divigel

Entocort EC Duavee

FLO-pred Elestrin

Marbeta-l Estrace

Marbeta-25 Estrasorb

Mardex-25 Estrogel

Medrol Estropipate

Medrol Dosepak Femhrt Low Dose

Millipred Jinteli

Millipred DP Menest

Mlk F4 Kit Menostar

Orapred Prefest

Orapred Odt TIER 04 SPECIALTY

Pediapred estradiol valerate

Prednisolone Sodium Phosphate Delestrogen

Prednisone

Prednisone Intensol CONTRACEPTIVES

Prelone PREVENTIVE TIER 00

Rayos caziantQL,AL,GL

Veripred 20 fallback soloQL,AL,GL

levonorgestrelQL,AL,GL

ANDROGENS-ANABOLIC low-ogestrelQL,AL,GL

TIER 01 GENERIC luteraQL,AL,GL

danazol medroxyprogesterone acetateQL,AL,GL

oxandrolone mononessaQL,AL,GL

testosterone cypionatePA my wayQL,AL,GL

TIER 02 PREFERRED next choice one doseQL,AL,GL

Androgel sprintec 28QL,AL,GL

Androgel P.M. sronyxQL,AL,GL

Androxy take actionQL,AL,GL

AxironST tri-sprintecQL,AL,GL

TIER 03 NON PREFERRED trinessaQL,AL,GL

Anadrol-50 xulaneQL,AL,GL

AndrodermST NataziaQL,AL,GL

Android NuvaringQL,AL,GL

Depo-testosteronePA TIER 01 GENERIC

First-testosterone altavera

First-testosterone Mc Compounding Kit alyacen 1/35

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 12

alyacen 7/7/7 necon 1/35

amethia necon 7/7/7

amethia LO nikki

apri nora-be

aranelle norethindrone

aubra norethindrone acetate/ethinyl estradiol

aviane norethindrone acetate/ethinyl estradiol/ferrous fumarate

azurette norgestimate/ethinyl estradiol

balziva norlyroc

briellyn nortrel 0.5/35 (28)

camila nortrel 1/35

camrese nortrel 7/7/7

camrese LO ocella

cesia orsythia

chateal philith

cryselle-28 pimtrea

cyclafem 1/35 pirmella 1/35

cyclafem 7/7/7 pirmella 7/7/7

dasetta 1/35 portia-28

dasetta 7/7/7 previfem

daysee quasense

deblitane reclipsen

delyla sharobel

desogestrel/ethinyl estradiol solia

drospirenone/ethinyl estradiol syeda

elinest tilia FE

emoquette tri-estarylla

enpresse-28 tri-legest FE

enskyce tri-linyah

errin tri-previfem

estarylla trivora-28

falmina velivet

gianvi vestura

gildagia viorele

gildess FE 1.5/30 vyfemla

gildess FE 1/20 wera

gildess 1.5/30 wymzya FE

gildess 1/20 zarah

heather zenchent

introvale zenchent FE

jencycla zovia 1/35e

jolessa TIER 02 PREFERRED

jolivette Beyaz

junel FE 1.5/30 Loestrin 24 FE

junel FE 1/20 Lomedia 24 FE

junel 1.5/30 LO Loestrin FE

junel 1/20 Minastrin 24 FE

kariva Safyral

kelnor 1/35 TIER 03 NON PREFERRED

kurvelo Amethyst

larin FE 1.5/30 Brevicon-28

larin FE 1/20 Cyclessa

larin 1.5/30 Depo-provera ContraceptiveQL,AL,GL

larin 1/20 Depo-subq Provera 104QL,AL,GL

leena Desogen

lessina Ella

levonest Estrostep FE

levonorgestrel and ethinyl estradiol Falessa

levonorgestrel/ethinyl estradiol Femcon FE

levora 0.15/30-28 Generess FE

loryna Loestrin FE 1.5/30

lyza Loestrin FE 1/20

marlissa Loestrin 1.5/30-21

microgestin FE Loestrin 1/20-21

microgestin FE 1.5/30 Loseasonique

microgestin 1.5/30 LO Minastrin FE

microgestin 1/20 Mircette

mono-linyah Modicon

myzilra Necon 1/50-28

necon 0.5/35-28 Necon 10/11-28

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 13

Nor-QD Humulin NST

Norinyl 1+35 Humulin N KwikpenST

Norinyl 1+50 Humulin N U-100 PenST

Ogestrel Humulin RST

Ortho EvraQL,AL,GL Humulin R U-500 (concentrated)ST

Ortho Micronor Humulin 70/30ST

Ortho Tri-cyclen Humulin 70/30 KwikpenST

Ortho Tri-cyclen LO Humulin 70/30 PenST

Ortho-cept LevemirST

Ortho-cyclen Levemir FlexpenST

Ortho-novum 1/35 Levemir FlextouchST

Ortho-novum 7/7/7 Relion R

Ovcon-35 AMYLIN ANALOGS

Paragard Intrauterine Copper Contraceptive T380a TIER 02 PREFERRED

Plan BQL,AL,GL Symlinpen 120ST

Plan B One-stepQL,AL,GL Symlinpen 60ST

Quartette INCRETIN MIMETIC AGENTS

Seasonique TIER 02 PREFERRED

Tri-norinyl 28 Bydureon

Yasmin 28 Byetta

Yaz Victoza

Zovia 1/50e TIER 03 NON PREFERRED

Tanzeum

Trulicity PROGESTINS

GENERIC SULFONYLUREAS TIER 01

medroxyprogesterone acetate TIER 01 GENERIC

norethindrone acetate glimepiride

progesterone glipizide

NON PREFERRED glipizide ER TIER 03

Aygestin glyburide

Megace ES glyburide micronized

Prometrium tolazamide

Provera TIER 03 NON PREFERRED

SPECIALTY Amaryl TIER 04

MakenaPA Chlorpropamide

Progesterone Diabeta

Progesterone Micronized Glucotrol

Progesterone Micronized (soy) Glucotrol XL

Progesterone Micronized (yam) Glyburide

Progesterone Micronized Premium Glynase

Progesterone Milled Tolazamide

Progesterone Ultra Micronized Tolbutamide

Progesterone Wettable BIGUANIDES

Progesterone Wettable (yam) TIER 01 GENERIC

metformin HCL

metformin HCL ER ANTIDIABETIC AGENTS TIER 02 PREFERRED INSULIN Riomet TIER 02 PREFERRED

TIER 03 NON PREFERRED Lantus Fortamet Lantus Solostar Glucophage Novolin N Glucophage XR Novolin N Relion Glumetza Novolin R MEGLITINIDE ANALOGUES Novolin R Relion TIER 01 GENERIC Novolin 70/30 nateglinide Novolin 70/30 Relion repaglinide Novolog TIER 03 NON PREFERRED Novolog Flexpen Prandin Novolog Mix 70/30 Starlix Novolog Mix 70/30 Prefilled Flexpen DIABETIC OTHER Novolog Penfill TIER 02 PREFERRED TIER 03 NON PREFERRED ST GlucagenQL Apidra ST Glucagen HypokitQL Apidra Solostar ST Glucagon Emergency KitQL Humalog ST Invokana Humalog Kwikpen ST Proglycem Humalog Mix 50/50 ST TIER 03 NON PREFERRED Humalog Mix 50/50 Kwikpen ST Farxiga Humalog Mix 75/25 ST Jardiance Humalog Mix 75/25 Kwikpen

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 14

TIER 04 SPECIALTY CALCITONINS

Korlym SPECIALTY TIER 04

ALPHA-GLUCOSIDASE INHIBIT calcitonin salmon

TIER 01 GENERIC calcitonin-salmon

acarbose Fortical

TIER 03 NON PREFERRED Miacalcin

Glyset

Precose PARATHYROID HORMONE DPP-4 INHIBITORS TIER 04 SPECIALTY TIER 02 PREFERRED QL Forteo Januvia

Onglyza RANK LIGAND INHIBITORS TIER 03 NON PREFERRED TIER 04 SPECIALTY ST Nesina QL,PA Prolia ST Tradjenta PA Xgeva INSULIN SENSITIZING AGENT

TIER 01 GENERIC HORMONE RECEPTOR MDLTR pioglitazone HCL TIER 01 GENERIC TIER 03 NON PREFERRED raloxifene hydrochloride Actos TIER 03 NON PREFERRED Avandia Evista ANTIDIABETIC COMBINATIONS Osphena TIER 01 GENERIC

glipizide/metformin HCL LHRH/GNRH AGONIST glyburide/metformin HCL TIER 04 SPECIALTY pioglitazone HCL-glimepiride QL,PA Lupaneta Pack pioglitazone HCL/metformin HCL QL,PA Lupron Depot-PED TIER 02 PREFERRED QL,PA Supprelin LA Actoplus Met XR Synarel Janumet

Janumet XR GROWTH HORMONES Juvisync TIER 04 SPECIALTY Kombiglyze XR PA Genotropin Prandimet PA Genotropin Miniquick TIER 03 NON PREFERRED PA

Humatrope Actoplus Met PA Humatrope Combo Pack Appformin PA Norditropin Cartridge Appformin-d PA Norditropin Flexpro Avandamet PA Norditropin Nordiflex Pen Avandaryl PA Nutropin Duetact PA Nutropin AQ Nuspin 10 Glucovance PA Nutropin AQ Nuspin 20 Invokamet PA ST Nutropin AQ Nuspin 5 Jentadueto PA ST Nutropin AQ Pen Kazano PA ST Omnitrope Oseni PA Saizen PA Saizen Click.easy BISPHOSPHONATES PA Serostim TIER 01 GENERIC PA

QL Tev-tropin alendronate sodium PA QL Zorbtive ibandronate sodium QL,ST risedronate sodium GHRH TIER 02 PREFERRED QL TIER 04 SPECIALTY Fosamax Plus D QL,PA Egrifta TIER 03 NON PREFERRED

QL,ST Actonel QL SOMATOMEDINS Alendronate Sodium QL,ST TIER 04 SPECIALTY Atelvia IncrelexPA Binosto QL

Boniva SOMATOSTATIC AGENTS Etidronate Disodium QL TIER 04 SPECIALTY Fosamax octreotide acetatePA TIER 04 SPECIALTY SandostatinPA pamidronate disodium PA Sandostatin Lar DepotPA zoledronic acid SigniforQL,PA Pamidronate Disodium PA Somatuline DepotPA Reclast PA

Zoledronic Acid

ZometaPA

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 15

Thyrolar-1/4 GH RECEPTOR ANTAGONISTS

SPECIALTY Thyrolar-2 TIER 04

SomavertPA Thyrolar-3

Tirosint

Westhroid POSTERIOR PITUITARY Westhroid-p TIER 01 GENERIC

Wp Thyroid desmopressin acetate

TIER 03 NON PREFERRED

Ddavp GASTROINTESTINAL TIER 04 SPECIALTY LAXATIVES

Stimate GENERIC TIER 01

lactulose

CORTICOTROPIN peg 3350/electrolytes

TIER 04 SPECIALTY peg-3350/electrolytes

H.p. ActharPA peg-3350/NACL/NA bicarbonate/KCL

polyethylene glycol 3350

TIER 02 PREFERRED PROLACTIN INHIBITORS

GENERIC Halflytely Bowel Prep/Flavor Packs TIER 01

cabergoline Kristalose

Moviprep

Suclear VASOPRESSIN ANTAGONISTS Suprep Bowel Prep TIER 04 SPECIALTY QL TIER 03 NON PREFERRED Samsca Cascara Sagrada

Colyte-flavor Packs METABOLIC MODIFIERS Golytely TIER 01 GENERIC

Mineral Oil Heavy calcitriol Nulytely/Flavor Packs doxercalciferol Osmoprep levocarnitine Prepopik paricalcitol

TIER 03 NON PREFERRED ANTIDIARRHEALS Carnitor TIER 01 GENERIC Carnitor SF diphenoxylate/atropine Hectorol loperamide HCL Rocaltrol opium Zemplar opium tincture TIER 04 SPECIALTY TIER 03 NON PREFERRED sodium phenylbutyrate PA Diphenoxylate/Atropine Aldurazyme Fulyzaq Buphenyl PA Lomotil Carbaglu Motofen Cystadane PA Opium Tincture (paregoric) Elaprase PA Restora RX Fabrazyme PA Rezyst IM Kuvan PA Rezyst SB Lumizyme PA Vsl#3 DS Myozyme PA

Naglazyme

Orfadin ANTACIDS

RavictiPA TIER 03 NON PREFERRED

Sensipar Sodium Bicarbonate

VimizimPA

ULCER DRUGS

TIER 01 GENERIC THYROID AGENTS

GENERIC cimetidine TIER 01

levothyroxine sodium cimetidine HCL

liothyronine sodium dicyclomine HCL

methimazole famotidine

propylthiouracil glycopyrrolate

PREFERRED hyoscyamine sulfate TIER 02

Armour Thyroid hyoscyamine sulfate odt

NON PREFERRED hyoscyamine sulfate ER TIER 03

Cytomel hyoscyamine sulfate SR

Nature-throid lansoprazole/amoxicillin/clarithromycin

Nature-throid Nt-2.5 methscopolamine bromide

Synthroid misoprostol

Tapazole nizatidine

QL Thyrolar-1 omeprazole

Thyrolar-1/2 ranitidine HCL

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 16

sucralfate DIGESTIVE AIDS

TIER 02 PREFERRED PREFERRED TIER 02 QL,ST lansoprazole Creon

Carafate Pancrelipase

Pylera Viokace

TIER 03 NON PREFERRED NON PREFERRED TIER 03

Anaspaz Pancreaze

Axid Pertzye

Belladonna & Opium Ultresa

Belladonna Alkaloids & Opium Zenpep

Bentyl SPECIALTY TIER 04

Cantil Sucraid

Cuvposa

Cytotec GASTROINTESTINAL - MISC. Deprizine Fusepaq TIER 01 GENERIC Dicyclomine HCL balsalazide disodium Digex NF calcium acetate Esomeprazole Strontium cromolyn sodium First-lansoprazoleQL hydrocort ene 100MG First-omeprazole hydrocortisone Gabitidine hydrocortisone acetate/lidocaine HCL Gastrinex NF hydrocortisone acetate/pramoxine Glycate lactulose Helidac lidocaine HCL/hydrocortisone acetate Levbid mesalamine Levsin metoclopramide HCL Levsin/SL sulfasalazine Omeclamox-PAK ursodiol Omeprazole + Syrspend SF Alka TIER 02 PREFERRED Pamine Amitiza Pamine Forte Asacol HD Pamine FQ Canasa Pepcid Chenodal PrevacidQL,ST Cortifoam Prevacid SolutabQL Delzicol Prevpac Fosrenol PrilosecQL Lialda Propantheline Bromide Linzess Robinul Lotronex Robinul Forte Pentasa Sentradine Proctofoam HC Symax Duotab Rectiv Zantac Renvela

Sevelamer Carbonate

ANTIEMETICS NON PREFERRED TIER 03

TIER 01 GENERIC Actigall

dronabinol Analpram-HC

granisetron HCL Analpram-HC Singles

meclizine HCL Anusol-HC

ondansetron odt Apriso

trimethobenzamide HCL Azulfidine

TIER 02 PREFERRED Azulfidine EN-TABS

Emend Colazal

Sancuso Cortenema

Transderm-scop Dipentum

TIER 03 NON PREFERRED Eliphos

Cesamet Entereg

Diclegis Ferric Citrate

Marinol Gastrocrom

Tigan Giazo

Zofran Odt Lidocaine HCL-hydrocortisone Acetate With Aloe

Zuplenz Metozolv Odt

TIER 04 SPECIALTY Phoslo

ondansetron HCL Phoslyra

Aloxi Procort

Anzemet Proctocort

Granisol Reglan

Zofran Renagel

Rowasa

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 17

Sfrowasa EstringQL

Urso Forte Vagifem

Urso 250 TIER 03 NON PREFERRED

Velphoro Avc

TIER 04 SPECIALTY Cleocin

CimziaPA Fem PH

Cimzia Starter KitPA FemringQL

Entyvio First-progesterone VGS 100 Compounding Kit

GattexPA First-progesterone VGS 200 Compounding Kit

RemicadePA First-progesterone VGS 25 Compounding Kit

First-progesterone VGS 400 Compounding Kit

First-progesterone VGS 50 Compounding Kit

GENITOURINARY Gynazole-1 URINARY ANTI-INFECTIVES Metrogel-vaginal TIER 01 GENERIC

Premarin methenamine hippurate Relagard methenamine mandelate Terazol 3 nitrofurantoin Terazol 7 nitrofurantoin macrocrystals TIER 04 SPECIALTY nitrofurantoin monohydrate Crinone nitrofurantoin monohydrate/macrocrystals

TIER 03 NON PREFERRED GENITOURINARY - MISC. Furadantin TIER 01 GENERIC Hiprex alfuzosin HCL ER Macrobid citric acid/sodium citrate Macrodantin finasteride Methenamine Mandelate phenazopyridine HCL Monurol potassium citrate ER Prosed/DS potassium citrate-citric acid crystals Urelle tamsulosin HCL Uretron D/S TIER 02 PREFERRED Urex Elmiron Uribel Rapaflo Urimar-t Renacidin Urogesic-blue TIER 03 NON PREFERRED Uroqid #2 Avodart Uta Cardura XL

Citrolith URINARY ANTISPASMODICS Cytra-3 TIER 01 GENERIC Flomax bethanechol chloride Jalyn flavoxate HCL K-phos NO 2 oxybutynin chloride Lithostat oxybutynin chloride ER Oracit tolterodine tartrate Proscar tolterodine tartrate ER Pyridium trospium chloride Shohls Solution Modified trospium chloride ER Thiola TIER 02 PREFERRED Tricitrates Gelnique Urocit-k 10 Myrbetriq Urocit-k 15 Toviaz Urocit-k 5 Vesicare Uroxatral TIER 03 NON PREFERRED TIER 04 SPECIALTY Detrol Cystagon Detrol LA ProcysbiPA Ditropan XL

Enablex

Sanctura HEMATOLOGICAL

Sanctura XR HEMATOPOIETIC AGENTS

Urecholine TIER 00 PREVENTIVE

bprotected pedia ironAL

eq slow-release ironAL VAGINAL PRODUCTS AL,GL GENERIC eql folic acid TIER 01

AL clindamycin phosphate eql iron supplement therapy

AL metronidazole vaginal eql slow release iron

AL terconazole ezfe 200

AL,GL PREFERRED fa-8 TIER 02 AL Clindesse feosol

AL Estrace fer-iron

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 18

ferateAL HM ironAL

ferosulAL HM iron slow releaseAL

ferrettsAL IcarAL

ferrex 150AL Icar PediatricAL

ferro-bobAL IronAL

ferrociteAL Iron UpAL

ferrotabsAL Mykidz Iron 10AL

ferrous dropsAL Novaferrum Pediatric DropsAL

ferrous fumarate 324AL Novaferrum 50AL

ferrous gluconateAL Perfect IronAL

ferrous sulfateAL Pic 200AL

ferrousulAL ProfeAL

ferusAL Proferrin ESAL

folic acidAL,GL Slow FEAL

gnp folic acidAL,GL Slow Release IronAL

gnp ironAL Sm Slow Release IronAL

gnp slow release ironAL TIER 02 PREFERRED

high potency ironAL Droxia

iferex 150AL TIER 03 NON PREFERRED

ironAL Cerdelga

iron chews pediatricAL OmontysPA

iron slow releaseAL TIER 04 SPECIALTY

iron supplementAL Aranesp Albumin FreePA

iron supplement childrensAL CerezymePA

kp ferrous gluconateAL ElelysoPA

kp ferrous sulfateAL EpogenPA

kp folic acidAL,GL GranixPA

meijer ferrous sulfateAL LeukineQL,PA

myferon 150AL MozobilQL,PA

nu-iron 150AL NeulastaQL,PA

poly-iron 150AL NeumegaPA

px folic acidAL,GL NeupogenQL,PA

px ironAL NplatePA

qc ferrous sulfateAL ProcritPA

ra folic acidAL,GL PromactaQL,PA

ra high potency ironAL VprivPA

ra ironAL ZavescaPA

ra slow release ironAL

slow ironAL ANTICOAGULANTS AL slow release iron GENERIC TIER 01 AL,GL sm folic acid warfarin sodium

AL sm iron PREFERRED TIER 02 AL sm iron slow release Eliquis

AL,GL th folic acid Pradaxa

AL th iron Xarelto

AL th slow release iron NON PREFERRED TIER 03 AL wee care Coumadin

AL,GL yl folic acid SPECIALTY TIER 04 AL,GL CVS folic acid enoxaparin sodiumQL

AL CVS iron fondaparinux sodiumQL

AL CVS Slow Release Iron ArixtraQL

AL Elite Iron FragminQL

AL,GL Fa-8 Iprivask

AL Femiron LovenoxQL

FeosolAL

Fer-IN-solAL HEMOSTATICS FergonAL TIER 01 GENERIC Ferretts Chewable IronAL aminocaproic acid Ferretts IPSAL tranexamic acid Ferrimin 150AL TIER 03 NON PREFERRED Ferro-sequelsAL Amicar Ferrous FumarateAL Aminocaproic Acid Ferrous GluconateAL Artiss Ferrous SulfateAL Astringyn FE gluconateAL Evicel FE AspartateAL Evithrom FE TABSAL Lysteda HemocyteAL Recothrom High Potency IronAL Recothrom Spray Kit AL,GL

HM folic acid

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 19

Thrombin-jmi Diluent clotrimazole

Thrombin-jmi Epistaxis lidocaine viscous

Thrombin-jmi Syringe Spray Kit lidocaine HCL

Thrombin-jmi W/Dil Spray P.M. Actuator lidocaine HCL viscous

Thrombogen nystatin

Tisseel pilocarpine hydrochloride

pilocarpine HCL

stannous fluoride oral rinse HEMATOLOGICAL - MISC.

GENERIC triamcinolone acetonide TIER 01

anagrelide hydrochloride triamcinolone IN orabase

cilostazol TIER 03 NON PREFERRED

clopidogrel Aquoral

dipyridamole Caphosol

pentoxifylline ER Debacterol

ticlopidine HCL Evoxac

PREFERRED First-bxn Mouthwash TIER 02

Aggrenox First-dukes Mouthwash

Brilinta First-marys Mouthwash

Effient First-mouthwash Blm

NON PREFERRED Gel-kam Oral Care Rinse TIER 03

Agrylin Gelclair

Persantine Lta 360 Kit

Plavix Nafrinse Daily/Acidulated

Pletal Nafrinse Daily/Neutral

Trental Nafrinse Weekly

Zontivity Neutrasal

SPECIALTY Numoisyn TIER 04

AdvatePA Orafate

Alphanate/Von Willebrand Factor Complex/HumanPA Oravig

Alphanine SDPA Peridex

AlprolixPA Prevident

BebulinPA Prothelial

Bebulin VHPA Salagen

BenefixPA TIER 04 SPECIALTY

BerinertPA Arestin

CeprotinPA

CinryzePA

NEUROLOGY, CNS, PSYCH CorifactPA ANTIANXIETY AGENTS EloctatePA TIER 01 GENERIC Feiba NFPA alprazolam FirazyrQL alprazolam odt Helixate FSPA alprazolam ER Hemofil MPA buspirone HCL Humate-pPA chlordiazepoxide HCL Kalbitor clorazepate dipotassium Koate-dviPA diazepam Kogenate FSPA gene-xene TAB 15MG Kogenate FS Bio-setPA gene-xene TAB 3.75MG Monoclate-pPA gene-xene TAB 7.5MG MononinePA hydroxyzine pamoate NovosevenPA hydroxyzine HCL Novoseven RtPA lorazepam Profilnine SDPA meprobamate RecombinatePA oxazepam RiastapPA TIER 03 NON PREFERRED SolirisPA Alprazolam Intensol Thrombate Iii W/10 ML Sterile WaterPA Ativan Thrombate Iii W/20 ML Sterile WaterPA Diazepam TrettenPA Diazepam Intensol WilatePA Gabavale-5 XynthaPA Gabazolamine Xyntha SolofusePA Gabazolamine-0.5

Hydroxyzine Pamoate

Lorazepam Intensol MOUTH/THROAT/DENTAL AGENT Niravam

TIER 01 GENERIC Sentrazolam AM 0.25

cevimeline HCL Tranxene T

chlorhexidine gluconate Valium

chlorhexidine gluconate oral rinse Vistaril

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 20

Xanax PristiqPA

Xanax XR Prozac

Prozac WeeklyQL

Remeron ANTIDEPRESSANTS

GENERIC Remeron Soltab TIER 01

amitriptyline HCL Sentraflox AM-10

bupropion HCL Sentralopram AM-10

bupropion HCL ER Sentravil PM-25

bupropion HCL SR Sentroxatine

bupropion HCL XL Surmontil

citalopram hydrobromideQL Tofranil

clomipramine HCL Tofranil-PM

desipramine HCL Trazamine

doxepin HCL Venlafaxine HCL ER

QL,ST duloxetine HCL Viibryd

escitalopram oxalateQL Vivactil

fluoxetine DRQL Wellbutrin

fluoxetine HCL Wellbutrin SR

fluvoxamine maleate Wellbutrin XL

QL fluvoxamine maleate ERQL,ST Zoloft

imipramine pamoate

imipramine HCL ANTIPSYCHOTICS

mirtazapine TIER 01 GENERIC

mirtazapine odt chlorpromazine HCL

nefazodone HCL clozapine

nortriptyline HCL fluphenazine HCL

paroxetine HCLQL haloperidol

paroxetine HCL ERQL lithium carbonate

phenelzine sulfate lithium carbonate ER

protriptyline HCL loxapine

sertraline HCLQL loxapine succinate

tranylcypromine sulfate olanzapine

trazodone HCL olanzapine odt

trimipramine maleate perphenazine

venlafaxine HCL prochlorperazine

venlafaxine HCL ER prochlorperazine maleate

TIER 03 NON PREFERRED quetiapine fumarate

Amoxapine risperidone

Anafranil risperidone odt

Aplenzin thioridazine HCL

Appbutamone thiothixene

Appbutamone-d trifluoperazine HCL

BrintellixQL,ST ziprasidone HCL

CelexaQL TIER 02 PREFERRED

Cymbalta Latuda

Desvenlafaxine ERQL,ST Seroquel XR

Doxepin HCL TIER 03 NON PREFERRED

Effexor XR AbilifyPA

EmsamPA Abilify DiscmeltPA

FetzimaQL,ST Adasuve

Fetzima Titration PackQL,ST Clozapine Odt

Fluoxetine HCL Clozaril

Forfivo XL Compazine

Gaboxetine Equetro

KhedezlaQL,ST FanaptQL,ST

LexaproQL Fanapt Titration PackQL,ST

Luvox CRQL,ST Fazaclo

Maprotiline HCL Fluphenazine HCL

Marplan Geodon

Nardil InvegaQL,ST

Nefazodone HCL Lithium

Norpramin Lithium Carbonate

Nortriptyline HCL Lithobid

Oleptro Loxitane

Pamelor Risperdal

Parnate Risperdal M-TAB

Paxil SaphrisQL,ST

Paxil CRQL Seroquel

PexevaQL,ST VersaclozQL,ST

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 21

Zyprexa FocalinPA

Zyprexa Zydis Focalin XRPA

Kapvay

Kapvay Dose Pack HYPNOTICS PA GENERIC Metadate CD TIER 01 PA estazolam Methylin

PA eszopicloneQL Methylphenidate HCL ER

PA flurazepam HCL Nuvigil

PA phenobarbital Procentra

PA temazepam Provigil

PA triazolam Ritalin

PA zaleplonQL Ritalin LA

PA zolpidem tartrateQL Ritalin SR

zolpidem tartrate ERQL Sentramodafin AM-100

PA PREFERRED Zenzedi TIER 02

Chloral Hydrate

RozeremQL,ST ANTICONVULSANTS

TIER 03 NON PREFERRED TIER 01 GENERIC

AmbienQL carbamazepine

Ambien CRQL carbamazepine ER

Butisol Sodium clonazepam

Doral clonazepam odt

EdluarQL,ST divalproex sodium

Flurazepam HCL divalproex sodium DR

Gabazolpidem-5 divalproex sodium ER

Halcion ethosuximide

IntermezzoQL,ST felbamate

LunestaQL gabapentin

Phenobarbital lamotrigine

Quazepam lamotrigine ER

Restoril levetiracetam

Seconal levetiracetam ER

Sentrazolpidem PM-5 oxcarbazepine

SilenorQL,ST phenytoin

SonataQL phenytoin sodium extended

Strazepam primidone

ZolpimistQL,ST tiagabine hydrochloride

TIER 04 SPECIALTY topiramate

HetliozQL,PA valproic acid

zonisamide

TIER 02 PREFERRED ADHD, NARCOLEPSY, ETC.

GENERIC Banzel TIER 01

amphetamine/dextroamphetaminePA Celontin

caffeine citrate Diazepam

clonidine HCL ER Fycompa

dexmethylphenidate HCLPA Lamictal Odt

dexmethylphenidate HCL ERPA Lyrica

dextroamphetamine sulfatePA Onfi

dextroamphetamine sulfate ERPA Peganone

methamphetamine HCLPA Potiga

methylphenidate hydrochloridePA Tegretol-XR

methylphenidate HCLPA Vimpat

methylphenidate HCL CDPA TIER 03 NON PREFERRED

methylphenidate HCL ERPA Aptiom

methylphenidate HCL SRPA Carbatrol

modafinilPA Depakene

PREFERRED Depakote TIER 02

Daytrana Depakote ER

Intuniv Depakote Sprinkles

Quillivant XRPA Diastat Acudial

StratteraAL Diastat Pediatric

Vyvanse Dilantin

NON PREFERRED Dilantin Infatabs TIER 03

AdderallPA Felbatol

Adderall XRPA Gabitril

Cafcit Keppra

ConcertaPA Keppra XR

DesoxynPA Klonopin

DexedrinePA Lamictal

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 22

Lamictal Chewable Dispersible NEUROLOGY, PSYCH - MISC.

Lamictal Starter/Not Taking Carbamazepine PREVENTIVE TIER 00

Lamictal Starter/Taking Carbamazepine/Not Taking buprobanQL Valproate QL bupropion HCL SR Lamictal Starter/Taking Valproate QL eq nicotine Lamictal XR QL eq nicotine gum refill Mysoline QL eq nicotine gum starter Neurontin QL eq nicotine polacrilex Oxtellar XR QL eq nicotine step 3 Phenytek QL eql nicotine Qudexy XR QL eql nicotine polacrilex Stavzor QL eql nicotine polacrilex refill Tegretol QL eql nicotine polacrilex starter Therapentin-60 QL gnp nicotine polacrilex Therapentin-90 QL kls quit2 Topamax QL kls quit4 Topamax Sprinkle QL nicorelief Topiramate ER QL nicotine Trileptal QL nicotine polacrilex Trokendi XR QL nicotine polacrilex refill Zarontin QL nicotine polacrilex starter kit Zonegran QL nicotine step 1 TIER 04 SPECIALTY QL nicotine step 2 PA Sabril QL nicotine step 3 QL

nicotine transdermal system ANTIPARKINSON AGENTS QL px stop smoking aid TIER 01 GENERIC QL ra mini nicotine amantadine HCL QL ra nicotine benztropine mesylate QL ra nicotine polacrilex bromocriptine mesylate QL ra nicotine transdermal system step 3 carbidopa QL sm nicotine carbidopa/levodopa QL sm nicotine polacrilex carbidopa/levodopa odt QL sw nicotine polacrilex carbidopa/levodopa ER QL tgt nicotine gum entacapone QL tgt nicotine polacrilex pramipexole dihydrochloride QL tgt nicotine step one ropinirole ER QL tgt nicotine step three ropinirole HCL QL tgt nicotine step two selegiline HCL QL thrive trihexyphenidyl HCL QL Chantix TIER 02 PREFERRED QL Chantix Continuing Month PAK Azilect QL Chantix Starting Month PAK Mirapex ER QL Commit TIER 03 NON PREFERRED QL CVS nicotine Amantadine HCL QL CVS nicotine polacrilex Carbidopa/Levodopa/Entacapone QL CVS nicotine polacrilex starter Comtan QL CVS nicotine transdermal system Eldepryl QL CVS nts step 1 Lodosyn QL HM nicotine polacrilex Mirapex QL HM nicotine transdermal system Neupro QL HM nicotine transdermal system step 3 Parcopa QL Nicoderm CQ Parlodel QL Nicorette Requip QL Nicorette Mini Requip XL QL Nicorette Starter Kit Sinemet QL Nicotine Transdermal System Sinemet CR QL Nicotrol Inhaler Stalevo 100 QL Nicotrol Ns Stalevo 125 QL SR nicotine gum Stalevo 150 QL Zyban Stalevo 200 TIER 01 GENERIC Stalevo 50 acamprosate calcium DR Stalevo 75 disulfiram Tasmar donepezil HCL Zelapar ergoloid mesylates TIER 04 SPECIALTY fluoxetine ApokynPA galantamine

galantamine hydrobromide

olanzapine/fluoxetine

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 23

rivastigmine tartrate orphenadrine citrate ER

TIER 02 PREFERRED orphenadrine/asa/caffeine

Gralise tizanidine HCL

Gralise Starter TIER 02 PREFERRED

Namenda EuflexxaPA

Namenda Titration PAK OrthoviscPA

Namenda XR TIER 03 NON PREFERRED

Namenda XR Titration Pack Amrix

Nuedexta Carisoprodol

Savella Dantrium

TIER 03 NON PREFERRED Dantrium IV

Antabuse Dantrolene Sodium

Aricept Fexmid

Aricept Odt Flexeril

Brisdelle Lorzone

Campral Parafon Forte DSC

Chlordiazepoxide/Amitriptyline Prazolamine

Exelon Robaxin

Horizant Robaxin-750

Orap Ryanodex

Perphenazine/Amitriptyline Skelaxin

Razadyne Soma

Razadyne ER Therabenzaprine-60

Sarafem Therabenzaprine-90

Savella Titration Pack Therabenzaprine-90-5

Symbyax Zanaflex

TIER 04 SPECIALTY TIER 04 SPECIALTY

AmpyraQL,PA HyalganPA

AubagioQL,PA SynviscPA

AvonexQL,PA Synvisc OnePA

Avonex PenQL,PA

BetaseronQL,PA ANTIMYASTHENIC AGENTS QL,PA Copaxone GENERIC TIER 01 QL,PA Extavia pyridostigmine bromide

QL,PA Gilenya PREFERRED TIER 02 QL,PA Rebif Mestinon Timespan

QL,PA Rebif Rebidose Prostigmin

QL,PA Rebif Rebidose Titration Pack NON PREFERRED TIER 03 QL,PA Rebif Titration Pack Guanidine HCL

QL,PA Tecfidera Mestinon

Tecfidera Starter PackQL,PA

TysabriQL,PA

OPHTHALMOLOGY AND OTIC XenazinePA QL,PA ANTI-INFECTIVES Xyrem TIER 01 GENERIC

bacitracin/polymyxin b NEUROMUSCULAR AGENTS ciprofloxacin HCL TIER 01 GENERIC erythromycin riluzole gatifloxacin TIER 03 NON PREFERRED gentamicin sulfate Anectine levofloxacin Quelicin neomycin/bacitracin/polymyxin Rilutek neomycin/polymyxin/bacitracin zinc TIER 04 SPECIALTY neomycin/polymyxin/gramicidin BotoxPA ofloxacin DysportPA polymyxin b sulfate/trimethoprim sulfate MyoblocPA sodium sulfacetamide XeominPA sulfacetamide sodium

tobramycin sulfate MUSCULOSKELETAL AGENTS trifluridine TIER 01 GENERIC trimethoprim sulfate/polymyxin b sulfate baclofen TIER 02 PREFERRED carisoprodol Azasite carisoprodol/aspirin Besivance carisoprodol/aspirin/codeine Moxeza chlorzoxazone Natacyn cyclobenzaprine HCL Vigamox dantrolene sodium TIER 03 NON PREFERRED metaxalone Bacitracin methocarbamol Betadine Ophthalmic Prep

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 24

Bleph-10 Pred-G

Ciloxan Pred-G S.o.p.

Garamycin Prednisolone Sodium Phosphate

Mitosol Tobradex

Neosporin Vexol

Ocuflox

Polytrim PROSTAGLANDINS

Sulfacetamide Sodium GENERIC TIER 01

Tobrex latanoprost

Viroptic PREFERRED TIER 02

Zirgan Travatan Z

Zymaxid Travoprost

NON PREFERRED TIER 03

ARTIFICIAL TEAR/LUBRICANT LumiganQL,ST

TIER 03 NON PREFERRED ResculaQL,ST

Lacrisert Xalatan

ZioptanQL,ST

BETA-BLOCKERS

TIER 01 GENERIC CYCLOPLEGIC MYDRIATICS

betaxolol HCL TIER 01 GENERIC

carteolol HCL atropine sulfate

dorzolamide HCL/timolol maleate cyclopentolate HCL

levobunolol HCL homatropine HBR

timolol maleate TIER 03 NON PREFERRED

timolol maleate ophthalmic gel forming Atropine Sulfate

TIER 02 PREFERRED Cyclogyl

Betoptic-s Cyclomydril

Combigan Isopto Atropine

TIER 03 NON PREFERRED Isopto Homatropine

Betagan Isopto Hyoscine

Betimol

Cosopt DECONGESTANTS

Cosopt PF GENERIC TIER 01

Istalol phenylephrine HCL

Levobunolol HCL NON PREFERRED TIER 03

Metipranolol Mydfrin

Timoptic Naphazoline HCL

Timoptic Ocudose

Timoptic-xe MIOTICS

TIER 01 GENERIC

OPHTHALMIC STEROIDS pilocarpine HCL

TIER 01 GENERIC PREFERRED TIER 02

dexamethasone sodium phosphate Phospholine Iodide

fluorometholone Pilopine HS

neomycin/polymyxin/bacitracin/hydrocortisone NON PREFERRED TIER 03

neomycin/polymyxin/dexamethasone Isopto Carbachol

prednisolone acetate Isopto Carpine

sulfacetamide sodium/prednisolone sodium phosphate

tobramycin/dexamethasone ADRENERGIC AGENTS TIER 02 PREFERRED TIER 01 GENERIC Alrex apraclonidine Durezol brimonidine tartrate FML TIER 03 NON PREFERRED Lotemax Alphagan P Pred Mild Iopidine Retisert Simbrinza Tobradex ST

Zylet IMMUNOMODULATORS TIER 03 NON PREFERRED TIER 02 PREFERRED Blephamide Restasis Blephamide S.o.p.

Flarex LOCAL ANESTHETICS FML Forte TIER 01 GENERIC FML Liquifilm proparacaine HCL Maxidex tetracaine HCL Maxitrol TIER 03 NON PREFERRED Neomycin/Polymyxin/Hydrocortisone Akten Omnipred Alcaine Pred Forte

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 25

OPHTHALMICS - MISC.

PAIN MANAGEMENT TIER 01 GENERIC ANALGESICS - NONNARCOTIC azelastine HCL TIER 00 PREVENTIVE bromfenac AL adult aspirin EC low strength cromolyn sodium AL aspir-low diclofenac sodium AL aspir-81 dorzolamide HCL AL aspirin epinastine HCL AL aspirin adult low strength flurbiprofen sodium AL aspirin childrens ketorolac tromethamine AL aspirin enteric coated adult low strength TIER 02 PREFERRED AL aspirin low dose Bepreve AL aspirin low strength Bromday AL aspirin EC Ilevro AL aspirin EC low dose Nevanac AL aspirin EC LO-dose Pataday AL aspirin 81 Patanol AL aspirtab Prolensa AL bayer advanced aspirin regular strength TIER 03 NON PREFERRED AL bayer aspirin Acular AL bayer aspirin regimen Acular LS AL bayer aspirin EC low dose Acuvail AL bayer chewable low dose Alocril AL bayer low dose Alomide AL childrens aspirin Azopt AL childrens aspirin low strength Elestat AL ecotrin low strength Emadine AL ecpirin Lastacaft AL enteric coated aspirin Ocufen AL eq adult aspirin low strength Optivar AL eq aspirin Trusopt AL eq aspirin adult low dose TIER 04 SPECIALTY AL eq aspirin low dose CystaranQL,PA AL eq aspirin EC Jetrea AL eq childrens aspirin AL

eql adult aspirin low strength

OTIC AGENTS eql aspirinAL

TIER 01 GENERIC eql aspirin low doseAL

acetic acid eql aspirin ECAL

antipyrine/benzocaine eql childrens aspirinAL

fluocinolone acetonide gnp adult aspirin low strengthAL

fluocinolone acetonide ear drops gnp aspirinAL

hydrocortisone/acetic acid gnp aspirin low doseAL

neomycin/polymyxin/hydrocortisone goodsense aspirin low doseAL

neomycin/polymyxin/HC halfprinAL

ofloxacin kls aspirin low doseAL

TIER 02 PREFERRED kls aspirin ECAL

Ciprodex kp aspirinAL

TIER 03 NON PREFERRED meijer aspirin ECAL

Acetic Acid/Aluminum Acetate miniprin low doseAL

Antipyrine/Benzocaine norwich aspirinAL

Auralgan px aspirinAL

Cetraxal px enteric aspirinAL

Cipro HC qc aspirinAL

Ciprofloxacin qc aspirin low doseAL

Coly-mycin S qc childrens aspirinAL

Cortisporin ra aspirinAL

Cortisporin-tc ra aspirin adult low doseAL

Cresylate ra aspirin adult low strengthAL

Dermotic ra aspirin childrensAL

Myoxin ra aspirin ECAL

Otozin ra aspirin EC adult low strengthAL

Pramotic ra childrens aspirinAL

Vosol HC sm aspirinAL

sm aspirin adult low strengthAL

sm aspirin enteric coatedAL

OXYTOCICS sm aspirin low doseAL

AL GENERIC sm aspirin EC low strength TIER 01

AL methylergonovine maleate sm childrens aspirin

st joseph aspirinAL

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 26

tgt aspirinAL acetaminophen/codeine phosphate

tgt aspirin low doseAL buprenorphine HCL

tgt childrens aspirinAL buprenorphine HCL/naloxone HCLPA

tgt enteric-coated aspirinAL butalbital/acetaminophen/caffeine/codeine

th aspirinAL butalbital/aspirin/caffeine/codeine

th aspirin low doseAL butorphanol tartrate

th enteric aspirinAL codeine sulfate

Adult Aspirin Low StrengthAL fentanyl

Aspirin Low DoseAL fentanyl citrate oral transmucosal

CVS aspirinAL hydrocodone bitartrate/acetaminophen

CVS aspirin adult low doseAL hydrocodone/acetaminophen

CVS aspirin adult low strengthAL hydrocodone/ibuprofen

CVS aspirin childAL hydromorphone HCL

CVS aspirin low doseAL hydromorphone HCL ER

CVS aspirin low strengthAL meperidine HCL

CVS aspirin ECAL methadone HCL

CVS childrens aspirinAL morphine sulfate

CVS enteric aspirinAL morphine sulfate ER

Ecotrin Regular StrengthAL oxycodone HCL

EC-81 aspirinAL oxycodone/acetaminophen

HM aspirinAL oxycodone/aspirin

HM aspirin ECAL oxycodone/ibuprofen

HM aspirin EC low doseAL oxymorphone hydrochloride

Medi-seltzerAL oxymorphone hydrochloride ER

MM aspirinAL pentazocine/acetaminophen

St Joseph AdultAL pentazocine/naloxone HCL

St Joseph Adult Analgesiclow Dose Bite SizeAL tramadol hydrochloride/acetaminophen

SB aspirinAL tramadol HCL

SB aspirin ECAL tramadol HCL ER

SB childrens aspirinAL TIER 02 PREFERRED

SB low dose asa ECAL Butrans

1/2halfprinAL Fentora

TIER 01 GENERIC Nucynta

butal/asa/caff Nucynta ER

butalbital/acetaminophen Opana ER (crush Resistant)

butalbital/acetaminophen/caffeine Oxycodone HCL ER

butalbital/apap/caffeine Oxycontin

butalbital/asa/caffeine SuboxonePA

choline magnesium trisalicylate TIER 03 NON PREFERRED

diflunisal Abstral

salsalate Acetaminophen/Caffeine/Dihydrocodeine Bitartrate

TIER 03 NON PREFERRED Actiq

Alagesic LQ Aspirin-caffeine-dihydrocodeine

Bupap Avinza

Butalbital/Aspirin/Caffeine BunavailPA

Disalcid Capital/Codeine

Dolgic Plus Codeine Sulfate

Dologesic Conzip

Equagesic Demerol

Esgic Dilaudid

Esgic-plus Dolophine

Fioricet Dolophine HCL

Fiorinal Duragesic

Levacet Exalgo

Orbivan Fioricet/Codeine

Orbivan CF Fiorinal/Codeine #3

Phrenilin Forte Hycet

Rhinoflex-650 Hydrocodone Bitartrate/Acetaminophen

Staflex Hydrocodone/Acetaminophen

Tencon Hydromorphone HCL

TIER 04 SPECIALTY Hydromorphone HCL ER

Prialt Ibudone

Kadian

Lazanda ANALGESICS - OPIOID

GENERIC Levorphanol Tartrate TIER 01

acetaminophen/codeine Liquicet

acetaminophen/codeine #2 Lorcet Plus

acetaminophen/codeine #3 Lorcet 10/650

acetaminophen/codeine #4 Lortab

Magnacet

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 27

Maxidone Ridaura

Meperidine HCL Vimovo

Methadone HCL TIER 03 NON PREFERRED

Methadose Anaprox

Methadose Sugar-free Anaprox DS

Morphine Sulfate Arava

MS Contin Arthrotec 50

Norco Arthrotec 75

Opana Cataflam

Oxecta Daypro

Oxycodone HCL Duexis

Percocet Enbrel SureclickPA

Percodan EC-naprosyn

Primlev Feldene

Reprexain Fenoprofen Calcium

Roxicet Indocin

Roxicodone IC 400

Rybix Odt IC 800

Subsys Ketoprofen ER

Synalgos-dc Ketorocaine-l

Theracodeine-300 Ketorocaine-lm

Theracodophen-low-90 KineretPA

Theracodophen-325 Meclofenamate Sodium

Theracodophen-650 Meloxicam

Theracodophen-750 Mobic

Theratramadol-60 Nalfon

Theratramadol-90 Naprelan

Tramadol HCL ER Naprosyn

Trezix Ponstel

Tylenol/Codeine #3 Prastera

Tylenol/Codeine #4 Rasuvo

Ultracet Rheumatrex

Ultram SimponiPA

Ultram ER Sprix

Vicoprofen Therafeldamine

Xartemis XR Theraprofen-60

Xodol Theraprofen-800

Xolox Theraprofen-90

Zohydro ER Theraproxen-500

Zolvit Theraproxen-60

ZubsolvPA Theraproxen-90

Zydone Tolmetin Sodium

Trepadiclofen-25

Trepoxen-250 ANTI-INFLAMMATORY

GENERIC Trepoxicam-7.5 TIER 01

diclofenac potassium Voltaren-XR

diclofenac sodium DR Zipsor

diclofenac sodium ER Zorvolex

diclofenac sodium/misoprostol TIER 04 SPECIALTY

PA etodolac Actemra

PA etodolac ER Arcalyst

PA flurbiprofen Enbrel

PA ibuprofen Humira

PA indomethacin Humira Pediatric Crohns Disease Starter Pack

PA indomethacin ER Humira Pen

PA ketoprofen Humira Pen-crohns Diseasestarter

PA ketorolac tromethamine Humira Pen-psoriasis Starter

PA leflunomide Ilaris

PA mefenamic acid Orencia

PA meloxicam Otezla

nabumetone Otrexup

PA naproxen Simponi Aria

PA naproxen sodium Xeljanz

oxaprozin

piroxicam MIGRAINE PRODUCTS

sulindac TIER 01 GENERIC

tolmetin sodium naratriptan HCL

TIER 02 PREFERRED rizatriptan benzoate

CelebrexQL rizatriptan benzoate odt

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 28

sumatriptan succinateQL Palgic

sumatriptan succinate refillQL Respa-BR

zolmitriptanQL

zolmitriptan odtQL NASAL AGENTS

TIER 02 PREFERRED GENERIC TIER 01 QL Relpax azelastine HCL

TIER 03 NON PREFERRED budesonideQL,ST

QL,ST Alsuma flunisolide

Amerge fluticasone propionate

QL,ST Axert ipratropium bromide

Cafergot triamcinolone acetonide

Cambia PREFERRED TIER 02

Dihydroergotamine Mesylate DymistaQL,ST

Ergomar Nasonex

QL,ST Frova Phenylephrine HCL

QL Imitrex NON PREFERRED TIER 03 QL Imitrex Statdose Refill Adrenalin

QL Imitrex Statdose System Astelin

Maxalt Astepro

Maxalt-MLT Atrovent

Migergot Bactroban Nasal

Migral Beconase AQQL,ST

Migranal Flonase

QL Sumatriptan Flunisolide

QL Sumatriptan Succinate Nasacort AQ

QL,ST Sumavel Dosepro OmnarisQL,ST

QL,ST Treximet Patanase

QL Zomig QnaslQL,ST

QL,ST Zomig Nasal Spray Rhinocort AquaQL,ST

QL Zomig ZMT Tyzine

Tyzine Pediatric Nasal Drops

GOUT AGENTS VeramystQL,ST

TIER 01 GENERIC ZetonnaQL,ST

allopurinol

probenecid COUGH/COLD/ALLERGY

probenecid/colchicine GENERIC TIER 01

TIER 02 PREFERRED acetylcysteine

Colcrys benzonatate

Uloric bromphen/pseudoephedrine HCL/dextromethorphan HBR

TIER 03 NON PREFERRED hydrocodone bitartrate/chlorpheniramine maleate/PSE

Zyloprim hydrocodone bitartrate/homatropine methylbromide

TIER 04 SPECIALTY hydrocodone polistirex/chlorpheniramine polistirexQL,AL

PA Krystexxa hydrocodone/homatropine

phenylephrine/guaifenesin

LOCAL ANESTHETICS-INJ promethazine-DM

TIER 03 NON PREFERRED promethazine/codeine

Articadent Dental promethazine/dextromethorphan

Carbocaine sodium chloride

Marlido-25 TIER 02 PREFERRED

Tussicaps

TIER 03 NON PREFERRED

RESPIRATORY, ALLERGY, ETC cetirizine HCL/pseudoephedrine HCL ERQL ANTIHISTAMINES Alahist Ac TIER 01 GENERIC Alahist DHC carbinoxamine maleate Carbaphen 12 clemastine fumarate Carbaphen 12 PED cyproheptadine HCL Cpb Wc diphenhydramine HCL Decon-a loratadine

promethazine HCL Dextromethorphan HBR/Chlorpheniramine/Phenylephrine HCL promethazine HCL plain Donatuss Dc TIER 02 PREFERRED Exactuss cetirizine HCL Gilphex TR TIER 03 NON PREFERRED Giltuss Brompheniramine Tannate Giltuss PED-c Clemastine Fumarate Giltuss TR Dexchlorpheniramine Maleate Hyper-sal Dicopanol Fusepaq Hypersal Doxytex J-cof DHC Karbinal ER

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 29

J-max DHC Breo Ellipta

Nebusal Brondil

Neotuss Plus Brovana

Panatuss Dxp Duoneb

Pediatex TD Elixophyllin

Pediatex TDM Flovent DiskusQL,ST

Poly-tussin DHC Flovent HFAQL,ST

Relhist Lufyllin

Rescon-JR Maxair AutohalerQL

Rescon-MX Metaproterenol Sulfate

Rezira Proventil HFAQL,ST

Semprex-d PulmicortQL

Suttar-SF Pulmophylline

Suttar-2 Senophylline

Tessalon Perles Singulair

Tussionex Pennkinetic Extended ReleaseQL,AL Striverdi Respimat

Vituz Theo-24

Zonatuss Ventolin HFAQL,ST

Zutripro Vospire ER

Xopenex

Xopenex Concentrate ANTIASTHMATIC/COPD AGENTS QL,ST GENERIC Xopenex HFA TIER 01

albuterol sulfate Zyflo

albuterol sulfate ER Zyflo CR

albuterol TAB 4MG TIER 04 SPECIALTY

PA budesonideQL Xolair

cromolyn sodium

epinephrine HCL RESPIRATORY AGENTS - MISC

ipratropium bromide TIER 03 NON PREFERRED

ipratropium bromide/albuterol sulfate Curosurf

levalbuterol Infasurf

levalbuterol HCL Surfaxin

montelukast sodium Survanta Intratracheal

terbutaline sulfate TIER 04 SPECIALTY

theophylline Aralast NPPA

theophylline CR GlassiaPA

theophylline ER KalydecoPA

zafirlukast Prolastin-cPA

TIER 02 PREFERRED PulmozymePA

Advair DiskusQL ZemairaPA

Advair HFAQL

Arcapta Neohaler

VACCINES Asmanex Twisthaler 120 Metered Doses

Asmanex Twisthaler 14 Metered Doses TIER 00 PREVENTIVE Asmanex Twisthaler 30 Me Tered Doses Afluria PF 2012-2013 Asmanex Twisthaler 30 Metered Doses Afluria PF 2013-2014 Asmanex Twisthaler 60 Metered Doses Afluria PF 2014-2015 Asmanex Twisthaler 7 Metered Doses Afluria 2012-2013 Atrovent HFAQL Afluria 2013-2014 CombiventQL Afluria 2014-2015 Combivent Respimat Fluarix Quadrivalent 2013-2014 Daliresp Fluarix Quadrivalent 2014-2015 Dulera Fluarix 2012-2013 Foradil Aerolizer Fluarix 2013-2014 Perforomist Fluarix 2014-2015 Proair HFAQL Flublok 2013-2014 Pulmicort FlexhalerQL Flublok 2014-2015 QvarQL Flucelvax 2012-2013 Serevent DiskusQL Flucelvax 2013-2014 Spiriva Handihaler Flucelvax 2014-2015 Symbicort Flulaval Quadrivalent 2013-2014 Tudorza Pressair Flulaval Quadrivalent 2014-2015 TIER 03 NON PREFERRED Flulaval 2012-2013 Accolate Flulaval 2013-2014 Accuneb Flulaval 2014-2015 Adrenalin Flumist Nasal Vaccine 2012-2013 Aerospan Flumist Quadrivalent Alvesco Fluvirin PF 2012-2013 Anoro Ellipta Fluvirin PF 2013-2014

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 30

Fluvirin PF 2014-2015 Eql Prenatal FormulaAL,GL

Fluvirin 2012-2013 Gnp Daily PrenatalAL,GL

Fluvirin 2013-2014 Gnp PrenatalAL,GL

Fluvirin 2014-2015 Gnp Prenatal VitaminsAL,GL

Fluzone High-dose PF 2012-2013 Goodsense Prenatal VitaminsAL,GL

Fluzone High-dose PF 2013-2014 Healthy Mama Be Well RoundedAL,GL

Fluzone High-dose PF 2014-2015 HM One Daily Prenatal ComboAL,GL

Fluzone Intradermal HM PrenatalAL,GL

Fluzone Pediatric PF 2012-2013 Kp Prenatal MultivitaminsAL,GL

Fluzone Pediatric PF 2013-2014 Mission PrenatalAL,GL

Fluzone PF 2012-2013 Mission Prenatal HPAL,GL

Fluzone PF 2013-2014 Multi PrenatalAL,GL

Fluzone PF 2014-2015 Nat-rul Prenatal VitaminsAL,GL

Fluzone Quadrivalent 2013-2014 One A Day Womens Prenatal/DHAAL,GL

Fluzone Quadrivalent 2014-2015 One-a-day Womens PrenatalAL,GL

Fluzone Split 2012-2013 Perry PrenatalAL,GL

Fluzone Split 2013-2014 Pre-natal FormulaAL,GL

Fluzone Split 2014-2015 PrenatalAL,GL

Influenza A (h1n1) Monovalent 2009 Prenatal And IronAL,GL

Medical Provider EZ Flu Shot PF 2012-2013 Prenatal CompleteAL,GL

Medical Provider EZ Flu Shot PF 2013-2014 Prenatal FormulaAL,GL

Medical Provider EZ Flu Shot PF 2014-2015 Prenatal ForteAL,GL

Medical Provider EZ Flu Shot 2013-2014 Prenatal Low IronAL,GL

Medical Provider EZ Flu Shot 2014-2015 Prenatal Multi +dhaAL,GL

Physicians EZ Use Flu Kit 2012-2013 Prenatal Multivitamin + DHAAL,GL

Pneumovax 23 Prenatal One DailyAL,GL

Pneumovax 23/1 Dose Prenatal Plus DHAAL,GL

Pneumovax 23/5 Dose Prenatal VitaminsAL,GL

Prevnar 13 Prenatal/Omega-3/Folic Acid/IronAL,GL

ZostavaxQL,AL Px Prenatal MultivitaminsAL,GL

PA Prenatal FormulaAL,GL

Qc PrenatalAL,GL

VITAMINS Ra One DailyAL,GL VITAMINS Ra PrenatalAL,GL TIER 01 GENERIC Ra Prenatal Formula/FolicacidAL,GL d3 Right Step PrenatalAL,GL d3 ultra strength Similac Prenatal Early ShieldAL,GL vitamin d Sm One Daily PrenatalAL,GL vitamin d 400 Sm Prenatal VitaminsAL,GL vitamin d-1000 Stuart OneAL,GL vitamin d-3 Stuart PrenatalAL,GL vitamin d3 Stuart Prenatal + DHAAL,GL TIER 03 NON PREFERRED Th Prenatal VitaminsAL,GL Baby Ddrops Your Life Multi PrenatalAL,GL D-VI-sol TIER 03 NON PREFERRED Ddrops Atabex EC Decara Atabex Prenatal Dialyvite Vitamin D3 Max B-nexa D3 Bal-care DHA D3 Dots Bal-care DHA Essential Replesta Cavan-alpha Kit Replesta Childrens Citranatal Assure Replesta Nx Citranatal B-calm Thera-d 4000 Citranatal DHA Vitamelts Vitamin D Citranatal Harmony Vitamin D Citranatal RX Vitamin D3 Citranatal 90 DHA Vitamin D3 400 Concept DHA Wellesse Vitamin D3 Concept OB

Crnatal MULTIVITAMINS CO-natal Fa TIER 00 PREVENTIVE

AL,GL Duet DHA sm prenatal vitamins AL,GL Duet DHA Balanced Brainstrong Prenatal AL,GL Duet DHA EC Centrum Specialist Prenatal AL,GL Duet DHA 400 Classic Prenatal AL,GL Duet DHA 400EC CVS Prenatal AL,GL Duet DHA 430 CVS Prenatal Gummy/DHA/Folic Acid AL,GL Duet DHA 430EC CVS Prenatal Multi+dha AL,GL Elite-OB Enfamil Expecta

Folbecal

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 31

Folcaps Omega 3 Taron-bc

Folet DHA Taron-c DHA

Folet One Taron-duo EC

Folivane-prx DHA NF Taron-prex

Folivane-OB Tricare

Gesticare DHA Tricare Prenatal Compleat

Inatal Advance Tricare Prenatal DHA One

Inatal GT Trinate

Inatal Ultra Triveen-duo DHA

M-vit Triveen-prx RNF

Macnatal CN DHA Triveen-ten

Marnatal-f Triveen-u

Moms Choice RX Vemavite-prx 2

Mynatal Vinacal

Mynatal Advance Vinacal B

Mynatal Ultracaplet Vinate AZ Extra

Natachew Vinate C

Natafort Vinate Calcium

Natalvirt CA Vinate Care

Natalvirt 90 DHA Vinate DHA

Natalvit Vinate DHA RF

Natelle One Vinate GT

Neevo DHA Vinate IC

Nestabs Vinate II

Nestabs Abc Vinate M

Nestabs DHA Vinate One

Newgen Vinate Pn Care

Nexa Plus Vita-pren

Nexa Select Vitafol Ultra

O-CAL Fa Vitafol-nano

O-CAL Prenatal Vitafol-ob+dha

Obstetrix DHA Vitafol-one

Obstetrix EC Vitafol-plus

OB Complete Vitafol-pn

OB Complete One Vitafol-OB

OB Complete Petite Vitamedmd One RX/Quatrefolic

OB Complete Premier Vitamedmd Plus RX/Quatre Folic

OB Complete 400 Vitamedmd Redichew RX

OB Complete/DHA Vitamedmd Redichew RX/Quatrefolic

OB-natal One Vitapearl

Paire OB Viva CT Prenatal

Pr Natal 400 Viva DHA

Pr Natal 400 EC Zatean-pn

Pr Natal 430 Zatean-pn DHA

Pr Natal 430 EC Zatean-pn Plus

Prefera OB Zatean-CH

Prefera OB + DHA

Preferaob One

MEDICAL DEVICES Prefol-DHA DIABETIC SUPPLIES Prenata TIER 02 PREFERRED Prenatabs RX Accu-chek Active Strips Prenatal Ad Accu-chek Aviva Prenatal-u Accu-chek Aviva Plus Prenate Accu-chek Comfort Curve Test Strips Prenate AM Accu-chek Compact Plus Prenate DHA Accu-chek Compact Plus Care Kit Prenate Elite Accu-chek Compact Test Drum Prenate Enhance Accu-chek Fastclix Lancetdevice Kit Prenate Essential Accu-chek Fastclix Lancets Prenate Mini Accu-chek Multiclix Lanc Et Device Kit Prenate Pixie Accu-chek Multiclix Lancets Prenate Restore Accu-chek Nano Smartview Prenate Star Accu-chek Safe-t-pro Lancets Prenexa Accu-chek Safe-t-pro Pluslancets Preque 10 Accu-chek Smartview Strips Protectnatal Accu-chek Soft Touch Lancets Provida OB Accu-chek Softclix Lancetdevice Kit R-natal OB Accu-chek Softclix Lancets Select-ob+dha Accu-chek Voicemate

Select-OB

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 32

Advocate Lancets Comfort Lancets

Advocate Safety Lancets Diastar Easy Test II Lancets 30G

Agamatrix Ultra-thin Lancets 33G Diastar Easy Test Lancets30G

Assure Haemolance Plus High Flow 18G Droplet Lancets Ultra Thin 30G

Assure Haemolance Plus Low Flow 25G Drug Mart On-the-go Lancets Gentle 30G

Assure Haemolance Plus Micro Flow 28G Drug Mart Unilet Lancets Super Thin 30G

Assure Haemolance Plus Normal Flow 21G Drug Mart Unilet Lancets Ultra Thin 28G

Assure Haemolance Plus Pediatric Blade E-z Ject Lancets

Assure Lance Lancets E-z Ject Lancets Color

Assure Lancets E-z Ject Lancets Super Thin

Aurora Lancet Super Thin 30G E-z Ject Lancets Super Thin 30G

Aurora Lancet Thin 23G E-z Ject Lancets Thin 26G

AF Lancets Super Thin E-z Ject Lancets 21G

AT Last Lancets E-ZJECT Lancets Micro-thin 33G

Bayer Microlet Lancets Easy Touch Lancets 21G/Pressure Activated

Bullseye Safety Lancets Easy Touch Lancets 23G/Pressure Activated

BD Insulin Syringe LUER-LOK/U-100/1ML Easy Touch Lancets 26G/Pressure Activated

BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2" Easy Touch Lancets 28G/Pressure Activated

BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2" Easy Touch Lancets 28G/Twist

BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8" Easy Touch Lancets 30G/Pressure Activated

BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2" Easy Touch Lancets 30G/Twist

BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2" Easy Touch Lancets 32G/Pressure Activated

BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2" Easy Touch Lancets 32G/Twist

BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8" Easy Touch Lancets 33G/Twist

BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2" Easy Touch Safety Lancets21G/Pressure Activated

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16" Easy Touch Safety Lancets23G/Pressure Activated

BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2" Easy Touch Safety Lancets26G/Button Activated

BD Insulin Syringe Safetyglide/1ML/29G X 1/2" Easy Touch Safety Lancets26G/Pressure Activated

BD Insulin Syringe Slip Tip/U-100/1ML Easy Touch Safety Lancets28G/Button Activated

BD Insulin Syringe U-40/1ML/25G X 5/8" Easy Touch Safety Lancets28G/Pressure Activated

BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16" Easy Twist & CAP Lancets

BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16" Easytest II Lancets

BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16" Easytest Lancets

BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2" Embrace Lancets Ultra Thin 30G

BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2" EZ Smart Blood Glucose Lancets

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2" EZ-lets Lancets 21G

BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2" EZ-lets Lancets 23G

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2" EZ-lets Lancets 26G Super-soft

BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16" EZ-lets Lancets 28G Ultra-soft

BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2" EZ-lets Lancets 30G

BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16" Fasttake Test Strips

BD Insulin Syringe Ultrafine/1ML/30G X 1/2" Fifty50 Safety Seal Lancets 30G

BD Insulin Syringe Ultrafine/1ML/31G X 5/16" Fifty50 Safety Seal Lancets 32G

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X Fine 30

1" Fingerstix Lancets

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X Fora Lancets 5/8" Freestyle Lancets

BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X Freestyle Unistick II Lancets 1/2"

Gentle-let GP Lancets BD Insulin Syringe/U-100/0.5ML/30G X 1/2" Gentle-let Lancets General Purpose Style/Fine Point BD Insulin Syringe/U-100/1ML/27G X 1/2" Gentle-let Lancets General Purpose Style/Medium Point BD Insulin Syringe/U-100/1ML/28G X 1/2" Gentle-let Lancets Safety Style/Fine Point BD Insulin Syringe/U-100/2ML/27.5G X 5/8" Gentle-let Lancets Safety Style/Medium Point BD Insulin Syringe/U-100/2ML/29G X 1/2" Glucocom Lancets 28G BD Lancet Ultrafine 30G Glucocom Lancets 30G BD Lancet Ultrafine 33G Glucocom Lancets 33G BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X Glucosource Lancets 1/2"

Gmate Lancets 30G BD Microtainer Lancets H&h Thinlet Lancets 26G BD Pen Needle/Mini/Ultrafine/31G X 3/16" H&h Thinlet Super Thin Lancets 30G BD Pen Needle/Nano/Ultra Fine/32G X 4MM Haemolance

BD Pen Needle/SHORT/Ultrafine/31G X 5/16" Haemolance Low Flow Lancets BD Pen Needle/Ultrafine/29G X 12.7MM Haemolance Plus BD Pen Needle/Ultrafine/29GX1/2" 12.7MM Haemolance Plus High Flow BD Pen Needles SHORT/Ultrafine/31G X 5/16" Haemolance Plus Low Flow Careone Lancet Thin Haemolance Plus Max Flow Careone Lancet Ultra Thin Haemolance Plus Pediatric Flow Cleanlet Lancets 28G Hy-vee Lancets Clever Chek Lancets Ultrathin Lancets Clever Chek Lancets Ultrathin 30G Lancets Bullseye Safety Coaguchek Lancets

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 33

Lancets Safety Seal 21G Onetouch Ultralink System (DEC)

Lancets Safety Seal 26G Onetouch Ultrasmart

Lancets Safety Seal 28G Onetouch Ultrasoft Lancets

Lancets Safety Seal 30G Onetouch Verio IQ Blood Glucose Monitoring System

Lancets Thin Onetouch Verio Sync Bloodglucose Monitoring System

Lancets Twist Top Onetouch Verio Test Strips

Lancets Ultra Fine Pen Needles 29G X 12MM

Lancets Ultra Thin Pen Needles 29GX1/2"

Lancets 26G Twist Top Pen Needles 30GX5/16"

Lancets 28G Pen Needles 31G X 1/4" SHORT

Lancets 30G Pen Needles 31G X 3/16"

Lancets 30G Twist Top Pen Needles 31G X 6MM

Lancets 31G Twist Top Pen Needles 31GX5/16"

Liberty Mini Lancing Device Perfect Lancets 30G

Liberty Next Generation Blood Glucose Monitor Perfect Pressure Activated Safety Lancets 28G

Liberty Next Generation Blood Glucose Test Strips Pharmacy Counter Lancets

Lifescan Unistik II Lancets Precision Thin Lancets

Lifescan Unistik 2 Deep Penetration Precision Thins GP Lancet

Litetouch Lancets Micro Thin 33G Precision Ultra Lancet

Live Better Lancet Super Thin 30G Prodigy Pressure Activated Safety Lancets

Live Better Lancet Ultra Thin 28G Prodigy Twist Top Lancets

Medisense Thin Lancets Pss Select GP Lancets

Medlance Plus Extra Lancets 21G Pss Select Safety Lancets

Medlance Plus Lancets Px Lancets Ultra Thin

Medlance Plus Lancets Lite 25G Qc Lancets Super Thin

Medlance Plus Lite Lancets 25G Qc Lancets Ultra Thin

Medlance Plus Special Lancets 0.8MM Relion Lancets

Medlance Plus Superlite 30G Relion Lancets Micro-thin33G

Medlance Plus Superlite 30G/Comfort Max Relion Lancets Standard 21G

Medlance Plus Universal Lancets 21G Relion Lancets Thin 26G

Medlance Plus/Lite 25G Relion Lancets Ultra-thin30G

Medlance/Extra Relion Thin Lancets

Medlance/Lite Relion Ultra Thin Lancets

Medlance/Universal Relion Ultra Thin Lancets30G

Meijer Super Thin Lancets Relion Ultra Thin Plus Lancets 32G

Microlet Lancets Relion Ultra Thin Plus Lancets 33G

Microtainer Safety Flow Lancet/Sterile/Single-use Renew Advanced Lancing Cartridge Refills

Monolet Lancets Rexall Lancets Ultra Thin

Monolet Opd Lancets Rightest Gl300 Lancets

Monolettor Safety Lancets Safe-t-lance Low Flow 25G

Myglucohealth Mgh Softlance Lancets 30G Safe-t-lance Normal Flow 21G

Netgroup Lancets Safe-t-lance Plus Safety Lancet High Flow

Nova Safety Lancets 23G Safe-t-lance Plus Safety Lancet Low Flow

Nova Safety Lancets 28G Safe-t-lance Plus Safety Lancet Normal Flow

Nova Sureflex Lancets Safety Lancet 2MM

Novofine Autocover 30GX8MM Safety Lancet 21G/Pressure Activated

Novofine 30GX8MM Safety Lancet 28G/Pressure Activated

Novofine 32GX6MM Safety Lancets

Novotwist 30GX8MM Safety Lancets 21G

Novotwist 32GX5MM Safety Lancets 28G

On Call Lancets Safety Let Lancets

On Call Plus Lancets Safety Seal Lancets 28G

Onetouch Basic System Safety Seal Lancets 30G

Onetouch Basic/Profile Test Strips Shopko On-the-go Comfort Lancets 30G

Onetouch Club Lancets Fine Point Shopko Unilet Lancets Super Thin 30G

Onetouch Combo Pack Shopko Unilet Lancets Ultra Thin 28G

Onetouch Delica Lancets Extra Fine 33G Single-let

Onetouch Delica Lancets Fine 30G Smart Diabetes Vantage Universal Lancets 30G

Onetouch Delica Lancing Device Smart Sense Color Lancets Universal 33G

Onetouch Finepoint Lancets Smart Sense Standard Lancets Universal 21G

Onetouch Lancets Smart Sense Super Thin Lancets Universal 30G

Onetouch Profile System Smart Sense Thin Lancets Universal 26G

Onetouch Suresoft Lancing Device/18G Smartest Lancets 28G

Onetouch Suresoft Lancing Device/21G Solus V2 Pressure Activated Safety Lancets 28G

Onetouch Suresoft Lancing Device/28G Solus V2 Twist Lancets 30G

Onetouch Ultra Blue Sterilance TL

Onetouch Ultra Mini Sure-lance Flat Lancets

Onetouch Ultra System Kit Sure-lance Lancets 26G

Onetouch Ultra 2 Sure-lance Thin Lancets 28G

Onetouch Ultralink System (hex) Sure-lance Ultra Thin Lancets

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 34

Sure-touch Lancets Universal Assure 3 Test Strips

Surelite Lancets Assure 4 Test Strips

Surestep Pro Test Strips AT Last Test Strips

Surestep Test Strips Bayer Breeze 2 Test DiscQL,ST

Techlite AST Lancets Bayer Contour Blood Glucose Test StripsQL,ST

Techlite Lancets Bayer Contour Next Blood Glucose TestQL,ST

Techlite Lancets 30G Bg Star Blood Glucose Test

Thinlets GP Lancets Bioscanner Glucose Test Strips

Thinlets Lancet Blood Glucose Test Strips

Trueplus Lancets 26G Blood Glucose Test Strips Premium

Trueplus Lancets 28G Careone Blood Glucose Test Strips/Premium

Trueplus Lancets 28G Super Thin Careone Blood Glucose Test Strips/Value

Trueplus Lancets 30G Caresens N Blood Glucose Test Strips

Trueplus Lancets 30G Ultra Thin Choice DM Fora G20 Test Strips

Trueplus Lancets 33G Clever Chek Auto-code Test Strips

Trueplus Lancets 33G Micro Thin Clever Chek Auto-code Voice Test Strips

Trueplus Safety Lancets 28G Clever Chek Test Strips

Ulticare Thin Lancets 30G Clever Choice Auto-code Pro Test Strips

Ultilet Basic Lancets 30G Clever Choice Micro Test Strips

Ultilet Classic Lancets Control AST

Ultilet Lancets Control Test Strips

Ultilet Lancets 33G CVS Advanced Glucose Meter Test Strips

Ultilet Safety Lancets 23G Duo-care Test Strips

Ultra-thin II Auto Lancet Easy Step Test Strips

Ultra-thin II Lancets 28G Easy Touch Glucose Test Strips

Ultra-thin II Lancets 30G Easy Touch Healthpro Glucose Test Strips

Ultra-thin II Safety Autolancets 26G Easygluco

Unilet Comfortouch Lancet Easymax Test Strips

Unilet Excelite Easymax 15 Test Strips

Unilet Excelite II Easypro Blood Glucose Test Strips

Unilet G.p. Lancet Easypro Plus

Unilet G.p. Superlite Lancet Eclipse Test Strips

Unilet GP 28 Ultra Thin Element Plus Test Strips

Unilet Lancet Element Test Strips

Unilet Superlite Lancet Embrace Blood Glucose Test Strips

Unistik 3 Gentle Embrace Evo Blood Glucosetest Strips

Universal 1 Lancets Thin 26G Embrace Pro Blood Glucosetest Strips

Universal 1 Lancets Ultra Thin 30G Envision Autocode Test Strips

Valumark Lancet Super Thin 30G Eql Truetrack Test

Valumark Lancet Ultra Thin 28G Evencare + Blood Glucose Test Strip

Vida Mia Unilet Lancets Super Thin 30G Evencare Blood Glucose Test Strip

Vida Mia Unilet Lancets Ultra Thin 28G Evencare G2 Test Strips

Vitalet Pro Lancets Evencare G3 Test Strips

Vitalet Pro Plus Lancets Evolution Autocode

W&f Lancets Colored 21G Exactech R-s-G Test Strips

W&f Lancets 26G Exactech Test Strips

Walgreens Lancets EZ Smart Blood Glucose Test Strips

Walgreens Thin Lancets EZ Smart Plus Blood Glucose Test Strips

Walgreens Ultra Thin Lancets Fifty50 Glucose Test Strip 2.0

1ST Choice Lancets Super Thin Fora D10 Blood Glucose Test Strips

1ST Choice Lancets Thin Fora D15c Blood Glucose Test Strips

1ST Choice Lancets Ultra Thin Fora D15z Blood Glucose Test Strips

TIER 03 NON PREFERRED Fora D15G Blood Glucose Test Strips

Accutrend Glucose Fora D20 Blood Glucose Test Strips

Acura Blood Glucose Test Strips Fora GD20 Test Strips

Advance Intuition Test Strips Fora GD50 Blood Glucose Test Strips

Advance Micro-draw Test Strips Fora G20 Blood Glucose Test Strips

Advocate Redi-code Fora G30a Blood Glucose Test Strips

Advocate Redi-code+ Test Strips Fora G71a Blood Glucose Test Strips

Advocate Test Strips Fora G90 Blood Glucose Test Strips

Agamatrix Amp NO Code Test Strips Fora Test N' Go Blood Glucose Test Strips

Agamatrix Jazz Test Strips Fora V10 Blood Glucose Test Strips

Agamatrix Keynote Test Strips Fora V12 Blood Glucose Test Strips

Agamatrix Presto Test Strips Fora V20 Blood Glucose Test Strips

Ascensia Autodisc Test StripsQL,ST Fora V22 Blood Glucose Test Strips

Assure II Fora V30a Blood Glucose Test Strips

Assure II Check Strip Foracare GD40

Assure II Test Strips Foracare Premium V10 Teststrips

Assure Platinum Test Strips Foracare Test N Go Test Strips

Assure Pro Test Strips Freestyle Insulinx Blood Glucose TestQL,ST

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 35

Freestyle Insulinx Blood Glucose Test StripsQL,ST Ultima Test Strips

Freestyle Lite Test StripsQL,ST Ultratrak Pro Test Strips

Freestyle Test StripsQL,ST Ultratrak Ultimate Test Strips

Gluco Perfect 3 Test Strips Unistrip1 Generic

Glucocard Expression Blood Glucose Test Strips Victory Agm-4000 Test Strips

Glucocard Vital Test Strips Vocal Point Blood Glucose Test Strips

Glucocard X-sensor Wavesense Presto Test Strips

Glucocard 01 Sensor

Glucocard 01 Test Strips MEDICAL DEVICES - MISC

Glucocom Test Strips PREFERRED TIER 02

Glucolab Test Strips Aerochamber Mini Aerosol ChamberQL

Gluconavii Blood Glucose Test Strips Aerochamber MVQL

Gmate Blood Glucose Test Strips Aerochamber Plus Flow VUQL

Infinity Blood Glucose Test Strips Aerochamber Plus Flow-VUQL

Insulin Syringe/0.5ML/30G X 5/16" Aerochamber Plus Flow-VU/Large MaskQL

Maxima Blood Glucose Teststrips Aerochamber Plus Flow-VU/MaskQL

Microdot Test Strips Aerochamber Plus Flow-VU/Medium MaskQL

Myglucohealth Blood Glucose Test Aerochamber Plus Flow-VU/Small MaskQL

Neutek 2tek Test Strips Aerochamber Z-stat Plus Valved Holding Chamber W/Flow

Nexgen Test Strips VUQL

QL Nova Max Glucose Test Strips Aerochamber Z-stat Plus/Flowsignal

QL On Call Express Blood Glucose Test Strips Aerochamber Z-stat Plus/Large Mask

QL On Call Plus Blood Glucose Test Aerochamber Z-stat Plus/Medium Mask

QL On Call Vivid Blood Glucose Test Aerochamber Z-stat Plus/Small Mask

QL On Call Vivid Blood Glucose Test Strips Aerochamber/Flowsignal

QL Optium Test Strips Breatherite

QL Optiumez Test Strips Breatherite Collapsible Adult Spacer W/Mask

QL Optumrx Blood Glucose Test Breatherite Collapsible Child Spacer W/Mask

QL Pharmacist Choice Autocode Blood Glucose Test Strips Breatherite Collapsible Infant Spacer W/Mask

QL Pocketchem EZ Blood Glucose Test Strips Breatherite Collapsible Small Child Spacer W/Mask

QL Precision Point Of Care Test StripsQL,ST Breatherite Collapsible Spacer W/ Neonate Mask

QL Precision PCXQL,ST Breatherite Rigid Spacer W/Mask

QL Precision PCX Plus Test StripsQL,ST Breatherite W/Large Mask

QL Precision QID Test StripsQL,ST Breatherite W/Medium Mask

QL Precision Sof-tact Test StripsQL,ST Breatherite W/Small Mask

QL Precision XTRA Blood Glucose Test StripsQL,ST E-z Spacer

QL Prestige Test Strips E-z Spacer The Body Guards Pack

QL Prodigy NO Coding Blood Glucose Test Strips Easivent

QL Pts Panels Glucose Test Easivent/Mask-large

QL Quicktek Test Strips Easivent/Mask-medium

QL Quintet Ac Blood Glucose Test Strips Easivent/Mask-small

QL Quintet Blood Glucose Test Strips Inspirease Bags

QL Refuah Plus Blood Glucosetest Strips Inspirease Drug Delivery System

QL Relion Blood Glucose Teststrips Inspirease Mouthpiece

QL Relion Confirm/Micro Test Strips Inspirease Reservoir Bags

QL Relion Insulin Syringe/U-100/0.5ML/29G X 1/2" Liteaire

QL Relion Prime Blood Glucose Test Strips Microchamber

QL Relion Ultima Blood Glucose Test Strips Microspacer

QL Relion Ultima Test Strips Optichamber Advantage

QL Reveal Blood Glucose Test Optichamber Diamond

QL Rexall Blood Glucose Test Strips Optichamber Diamond/Largeface Mask

QL Rightest GS100 Blood Glucose Test Strips Optichamber Diamond/Medium Face Mask

QL Rightest GS300 Blood Glucose Test Strips Optichamber Diamond/Smallface Mask

QL Rightest GS550 Blood Glucose Test Strips Optihaler

QL Smart Diabetes Xpres Blood Glucose Test Strips Optihaler MDI Drug Delivery System

QL Smart Sense Premium Bloodglucose Strips Pocket Chamber

QL Smart Sense Value Blood Glucose Strips Pocket Spacer

QL Smartest Blood Glucose Test Strips Riteflo

QL Solus V2 Audible Test Valved Holding Chamber

QL Supreme Test Strips Vortex Valved Holding Chamber

QL Sure Edge Blood Glucose Test Strips Watchhaler

Sure-test Easyplus Mini Blood Glucose Test Strips

Surechek Blood Glucose Test Strips

MISCELLANEOUS Telcare Blood Glucose Test Strips

True Metrix Blood Glucosetest Strips PREFERRED TIER 02

Truetest Blood Glucose T Est Chemet

Truetest Blood Glucose T Est Strips SPECIALTY TIER 04

Truetest Strips ExjadePA

Truetrack Blood Glucose Test FerriproxPA

Truetrack Test

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 36

Effective October 1, 2014

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; GL=Gender Limits; 37

Index

Acura Blood Glucose Test Strips, 35 Agamatrix Presto Test Strips, 35 A Acuvail, 26 Agamatrix Ultra-thin Lancets 33G, 33 abacavir, 2 acyclovir, 2, 9 Aggrenox, 20 abacavir sulfate/lamivudine/zidovudine, 2 Aczone, 8 Agrylin, 20 Abilify, 21 Adalat CC, 6 Akne-mycin, 8 Abilify Discmelt, 21 adapalene, 8 Akten, 25 Abraxane, 4 Adasuve, 21 Ala Scalp, 10 Absorica, 8 Adcetris, 4 Alagesic LQ, 27 Abstral, 27 Adcirca, 8 Alahist Ac, 29 acamprosate calcium DR, 23 Adderall, 22 Alahist DHC, 29 Acanya, 8 Adderall XR, 22 Albenza, 3 acarbose, 15 adefovir dipivoxil, 2 albuterol sulfate, 30 Accolate, 30 Adempas, 8 albuterol sulfate ER, 30 Accu-chek Active Strips, 32 Adoxa, 1 albuterol TAB 4MG, 30 Accu-chek Aviva, 32 Adoxa PAK 1/100, 1 Alcaine, 25 Accu-chek Aviva Plus, 32 Adoxa PAK 1/150, 1 alclometasone dipropionate, 10 Accu-chek Comfort Curve Test Strips, 32 Adoxa PAK 2/100, 1 Aldactazide, 7 Accu-chek Compact Plus, 32 Adrenaclick, 7 Aldactone, 7 Accu-chek Compact Plus Care Kit, 32 Adrenalin, 29, 30 Aldara, 11 Accu-chek Compact Test Drum, 32 Adriamycin, 3 Aldurazyme, 16 Accu-chek Fastclix Lancetdevice Kit, 32 adult aspirin EC low strength, 26 alendronate sodium, 15 Accu-chek Fastclix Lancets, 32 Adult Aspirin Low Strength, 27 Alendronate Sodium, 15 Accu-chek Multiclix Lanc Et Device Kit, Advair Diskus, 30 Alferon N, 5

32 Advair HFA, 30 alfuzosin HCL ER, 18 Accu-chek Multiclix Lancets, 32 Advance Intuition Test Strips, 35 Alimta, 4 Accu-chek Nano Smartview, 32 Advance Micro-draw Test Strips, 35 Alinia, 3 Accu-chek Safe-t-pro Lancets, 32 Advate, 20 Alkeran, 3 Accu-chek Safe-t-pro Pluslancets, 32 Advicor, 8 allopurinol, 29 Accu-chek Smartview Strips, 32 Advocate Lancets, 33 Alocril, 26 Accu-chek Soft Touch Lancets, 32 Advocate Redi-code, 35 Alomide, 26 Accu-chek Softclix Lancetdevice Kit, 32 Advocate Redi-code+ Test Strips, 35 Alora, 12 Accu-chek Softclix Lancets, 32 Advocate Safety Lancets, 33 Aloxi, 17 Accu-chek Voicemate, 32 Advocate Test Strips, 35 Alphagan P, 25 Accuneb, 30 Aerochamber Mini Aerosol Chamber, 36 Alphanate/Von Willebrand Factor Accupril, 6 Aerochamber MV, 36 Complex/Human, 20 Accuretic, 7 Aerochamber Plus Flow VU, 36 Alphanine SD, 20 Accutrend Glucose, 35 Aerochamber Plus Flow-VU, 36 alprazolam, 20 acebutolol HCL, 5 Aerochamber Plus Flow-VU/Large Mask, alprazolam ER, 20 Aceon, 6 Alprazolam Intensol, 20 36 Acetaminophen/Caffeine/Dihydrocodeine Aerochamber Plus Flow-VU/Mask, 36 alprazolam odt, 20

Bitartrate, 27 Aerochamber Plus Flow-VU/Medium Alprolix, 20 acetaminophen/codeine, 27 Alrex, 25 Mask, 36 acetaminophen/codeine #2, 27 Aerochamber Plus Flow-VU/Small Mask, Alsuma, 29 acetaminophen/codeine #3, 27 Altabax, 9 36 acetaminophen/codeine #4, 27 Aerochamber Z-stat Plus Valved Holding Altace, 6 acetaminophen/codeine phosphate, 27 altavera, 12 Chamber W/Flow VU, 36 acetazolamide, 7 Aerochamber Z-stat Plus/Flowsignal, 36 Altoprev, 8 Acetazolamide, 7 Aerochamber Z-stat Plus/Large Mask, 36 Aluvea, 11 acetazolamide ER, 7 Aerochamber Z-stat Plus/Medium Mask, Alvesco, 30 acetic acid, 26 alyacen 1/35, 12 36 Acetic Acid/Aluminum Acetate, 26 Aerochamber Z-stat Plus/Small Mask, 36 alyacen 7/7/7, 13 acetylcysteine, 29 Aerochamber/Flowsignal, 36 amantadine HCL, 23 acitretin, 9 Aerospan, 30 Amantadine HCL, 23 Aclovate, 10 AF Lancets Super Thin, 33 Amaryl, 14 Actemra, 28 Afinitor, 4 Ambien, 22 Acticlate, 1 Afinitor Disperz, 4 Ambien CR, 22 Actigall, 17 Afluria 2012-2013, 30 amcinonide, 10 Actimmune, 5 Afluria 2013-2014, 30 Amcinonide, 10 Actiq, 27 Afluria 2014-2015, 30 Amerge, 29 Activella, 12 Afluria PF 2012-2013, 30 amethia, 13 Actonel, 15 Afluria PF 2013-2014, 30 amethia LO, 13 Actoplus Met, 15 Afluria PF 2014-2015, 30 Amethyst, 13 Actoplus Met XR, 15 Agamatrix Amp NO Code Test Strips, 35 Amicar, 19 Actos, 15 Agamatrix Jazz Test Strips, 35 amifostine, 5 Acular, 26 Agamatrix Keynote Test Strips, 35 amiloride HCL, 7 Acular LS, 26

amiloride/hydrochlorothiazide, 7 aranelle, 13 Astagraf XL, 4 aminocaproic acid, 19 Aranesp Albumin Free, 19 Astelin, 29

Aminocaproic Acid, 19 Arava, 28 Astepro, 29 amiodarone HCL, 6 Arcalyst, 28 Astringyn, 19

Amitiza, 17 Arcapta Neohaler, 30 AT Last Lancets, 33 amitriptyline HCL, 21 Arestin, 20 AT Last Test Strips, 35 amlodipine besylate, 6 Aricept, 24 Atabex EC, 31 amlodipine besylate/atorvastatin calcium, Aricept Odt, 24 Atabex Prenatal, 31

Arimidex, 4 Atacand, 6 8 amlodipine besylate/benazepril HCL, 7 Arixtra, 19 Atacand HCT, 7 amlodipine besylate/benazepril Armour Thyroid, 16 Atelvia, 15

Arnica Flower, 11 atenolol, 5 hydrochloride, 7 amlodipine besylate/valsartan, 7 Aromasin, 4 atenolol/chlorthalidone, 7 ammonium lactate, 11 Arranon, 4 Ativan, 20

Amoxapine, 21 Arthrotec 50, 28 Atopiclair, 11 amoxicillin, 1 Arthrotec 75, 28 atorvastatin calcium, 7

Amoxicillin, 1 Articadent Dental, 29 atovaquone, 3

Amoxicillin ER, 1 Artiss, 19 atovaquone/proguanil HCL, 3 amoxicillin/clavulanate potassium, 1 Arzerra, 4 Atralin, 8 amoxicillin/clavulanate potassium ER, 1 Asacol HD, 17 Atripla, 2 amphetamine/dextroamphetamine, 22 Ascensia Autodisc Test Strips, 35 atropine sulfate, 25 ampicillin, 1 Asmanex Twisthaler 120 Metered Doses, Atropine Sulfate, 25

Ampicillin, 1 Atrovent, 29 30 Ampyra, 24 Asmanex Twisthaler 14 Metered Doses, Atrovent HFA, 30

Amrix, 24 Aubagio, 24 30 Amturnide, 7 Asmanex Twisthaler 30 Me Tered Doses, aubra, 13

Anacaine, 11 augmented betamethasone dipropionate, 30 Anadrol-50, 12 Asmanex Twisthaler 30 Metered Doses, 10 Anafranil, 21 Augmentin, 1 30 anagrelide hydrochloride, 20 Asmanex Twisthaler 60 Metered Doses, Augmentin ES-600, 1

Analpram-HC, 17 Augmentin XR, 1 30 Analpram-HC Singles, 17 Asmanex Twisthaler 7 Metered Doses, Auralgan, 26

Anaprox, 28 Aurora Lancet Super Thin 30G, 33 30 Anaprox DS, 28 aspir-81, 26 Aurora Lancet Thin 23G, 33

Anaspaz, 17 aspir-low, 26 Aurstat, 11 anastrozole, 4 aspirin, 26 Aurstat Anti-itch Hydrogel, 11

Ancobon, 2 aspirin 81, 26 Aurstat Anti-itch Hydrogel Kit, 11

Androderm, 12 aspirin adult low strength, 26 Auvi-q, 7

Androgel, 12 aspirin childrens, 26 Avalide, 7

Androgel P.M., 12 aspirin EC, 26 Avandamet, 15

Android, 12 aspirin EC LO-dose, 26 Avandaryl, 15

Androxy, 12 aspirin EC low dose, 26 Avandia, 15

Anectine, 24 aspirin enteric coated adult low strength, Avapro, 6

Angeliq, 12 Avar, 8 26 Anoro Ellipta, 30 aspirin low dose, 26 Avar LS, 8

Antabuse, 24 Aspirin Low Dose, 27 Avar LS Cleanser, 8

Antara, 8 aspirin low strength, 26 Avar-e LS, 8 antipyrine/benzocaine, 26 Aspirin-caffeine-dihydrocodeine, 27 Avastin, 4

Antipyrine/Benzocaine, 26 aspirtab, 26 Avc, 18

Anusol-HC, 17 Assure 3 Test Strips, 35 Avelox, 1

Anzemet, 17 Assure 4 Test Strips, 35 Avelox Abc Pack, 1

Apexicon E, 10 Assure Haemolance Plus High Flow 18G, aviane, 13

Apidra, 14 Avinza, 27 33 Apidra Solostar, 14 Assure Haemolance Plus Low Flow 25G, Avodart, 18

Aplenzin, 21 Avonex, 24 33 Apokyn, 23 Assure Haemolance Plus Micro Flow Avonex Pen, 24

Appbutamone, 21 Axert, 29 28G, 33 Appbutamone-d, 21 Assure Haemolance Plus Normal Flow Axid, 17

Appformin, 15 Axiron, 12 21G, 33 Appformin-d, 15 Assure Haemolance Plus Pediatric Blade, Aygestin, 14 apraclonidine, 25 azacitidine, 3 33 apri, 13 Assure II, 35 Azasan, 4

Apriso, 17 Assure II Check Strip, 35 Azasite, 24

Aptiom, 22 Assure II Test Strips, 35 azathioprine, 4

Aptivus, 2 Assure Lance Lancets, 33 azelastine HCL, 26, 29

Aquoral, 20 Assure Lancets, 33 Azelex, 8

Aralast NP, 30 Assure Platinum Test Strips, 35 Azilect, 23

Aralen, 3 Assure Pro Test Strips, 35 azithromycin, 1

Azithromycin, 1 II/SHORT/1ML/31G X 5/16", 33 Benzaclin, 8

Azopt, 26 BD Insulin Syringe Ultrafine/0.3ML/30G X Benzaclin With P.M., 8

Azor, 7 Benzamycin, 8 1/2", 33 Azulfidine, 17 BD Insulin Syringe Ultrafine/0.3ML/31G X Benzamycinpak, 8

Azulfidine EN-TABS, 17 Benzefoam, 8 5/16", 33 azurette, 13 BD Insulin Syringe Ultrafine/0.5ML/30G X Benzefoamultra, 8

Benziq, 8 B 1/2", 33 BD Insulin Syringe Ultrafine/0.5ML/31G X Benziq LS, 8 B-nexa, 31 Benzoin Compound Tincture, 11 5/16", 33 Baby Ddrops, 31 BD Insulin Syringe Ultrafine/1ML/30G X Benzoin Tincture, 11 Bacitracin, 24 benzonatate, 29 1/2", 33 bacitracin/polymyxin b, 24 BD Insulin Syringe Ultrafine/1ML/31G X benzoyl peroxide, 8 baclofen, 24 benzoyl peroxide SHORT contact, 8 5/16", 33 Bactrim, 3 BD Insulin Syringe Ultrafine/U- benztropine mesylate, 23 Bactrim DS, 3 Bepreve, 26 100/0.3ML/29G X 1/2", 33 Bactroban, 9 BD Insulin Syringe Ultrafine/U- Berinert, 20 Bactroban Nasal, 29 Besivance, 24 100/0.5ML/29G X 1/2", 33 Bal-care DHA, 31 BD Insulin Syringe Ultrafine/U- Betadine Ophthalmic Prep, 24 Bal-care DHA Essential, 31 Betagan, 25 100/1ML/29G X 1/2", 33 balsalazide disodium, 17 BD Insulin Syringe Ultrafine/U- Betalido, 12 balziva, 13 betamethasone dipropionate, 10 100/1ML/30G X 1/2", 33 Banzel, 22 BD Insulin Syringe/Detachable Needle/U- betamethasone valerate, 10 Baraclude, 2 Betapace, 5 100/1ML/25G X 1", 33 bayer advanced aspirin regular strength, BD Insulin Syringe/Detachable Needle/U- Betapace AF, 5

26 Betaseron, 24 100/1ML/25G X 5/8", 33 bayer aspirin, 26 BD Insulin Syringe/Detachable Needle/U- betaxolol HCL, 5, 25 bayer aspirin EC low dose, 26 bethanechol chloride, 18 100/1ML/26G X 1/2", 33 bayer aspirin regimen, 26 BD Insulin Syringe/U-100/0.5ML/30G X Bethkis, 1 Bayer Breeze 2 Test Disc, 35 Betimol, 25 1/2", 33 bayer chewable low dose, 26 BD Insulin Syringe/U-100/1ML/27G X Betoptic-s, 25 Bayer Contour Blood Glucose Test Strips, Beyaz, 13 1/2", 33 35 BD Insulin Syringe/U-100/1ML/28G X Bg Star Blood Glucose Test, 35 Bayer Contour Next Blood Glucose Test, Biaxin, 1 1/2", 33 35 BD Insulin Syringe/U-100/2ML/27.5G X Biaxin XL, 1 bayer low dose, 26 Biaxin XL PAC, 1 5/8", 33 Bayer Microlet Lancets, 33 BD Insulin Syringe/U-100/2ML/29G X bicalutamide, 4 BD Insulin Syringe LUER-LOK/U- Bicnu, 3 1/2", 33 100/1ML, 33 BD Lancet Ultrafine 30G, 33 Bidil, 8 BD Insulin Syringe Microfine IV/U- BD Lancet Ultrafine 33G, 33 Biltricide, 3

100/0.3ML/28G X 1/2", 33 BD LO-dose Insulin Syringe Microfine Binosto, 15

BD Insulin Syringe Microfine IV/U- Bioscanner Glucose Test Strips, 35 IV/0.5ML/28G X 1/2", 33 100/0.5ML/28G X 1/2", 33 BD Microtainer Lancets, 33 bisoprolol fumarate, 5

BD Insulin Syringe Microfine IV/U- BD Pen Needle/Mini/Ultrafine/31G X bisoprolol fumarate/hydrochlorothiazide,

100/1ML/27G X 5/8", 33

3/16", 33 7 BD Insulin Syringe Microfine IV/U- BD Pen Needle/Nano/Ultra Fine/32G X bleomycin sulfate, 3

100/1ML/28G X 1/2", 33 Bleph-10, 25 4MM, 33 BD Insulin Syringe Microfine/U- BD Pen Needle/SHORT/Ultrafine/31G X Blephamide, 25

100/0.3ML/28G X 1/2", 33 Blephamide S.o.p., 25 5/16", 33 BD Insulin Syringe Microfine/U- BD Pen Needle/Ultrafine/29G X 12.7MM, Blood Glucose Test Strips, 35

100/0.5ML/28G X 1/2", 33 Blood Glucose Test Strips Premium, 35 33 BD Insulin Syringe Microfine/U- BD Pen Needle/Ultrafine/29GX1/2" Boniva, 15

100/1ML/27G X 5/8", 33 Boric Acid, 11 12.7MM, 33 BD Insulin Syringe Microfine/U- BD Pen Needles SHORT/Ultrafine/31G X Bosulif, 5

100/1ML/28G X 1/2", 33 Botox, 24 5/16", 33 BD Insulin Syringe Bebulin, 20 bprotected pedia iron, 18

Safetyglide/0.5ML/29G X 1/2", 33 Bebulin VH, 20 Brainstrong Prenatal, 31 BD Insulin Syringe Safetyglide/1ML/29G Beconase AQ, 29 Breatherite, 36

X 1/2", 33 Beleodaq, 4 Breatherite Collapsible Adult Spacer

BD Insulin Syringe Safetyglide/U- Belladonna & Opium, 17 W/Mask, 36 100/0.3ML/31G X 5/16", 33 Belladonna Alkaloids & Opium, 17 Breatherite Collapsible Child Spacer

BD Insulin Syringe Slip Tip/U-100/1ML, benazepril HCL, 6 W/Mask, 36 33 benazepril HCL/hydrochlorothiazide, 7 Breatherite Collapsible Infant Spacer BD Insulin Syringe U-40/1ML/25G X 5/8", Benefix, 20 W/Mask, 36 33 Benicar, 6 Breatherite Collapsible Small Child

BD Insulin Syringe Ultrafine Half- Benicar HCT, 7 Spacer W/Mask, 36 unit/0.3ML/31G X 5/16", 33 Bentyl, 17 Breatherite Collapsible Spacer W/

BD Insulin Syringe Ultrafine Benzac Ac Wash, 8 Neonate Mask, 36 II/SHORT/0.5ML/31G X 5/16", 33 Benzac W Wash, 8 Breatherite Rigid Spacer W/Mask, 36 BD Insulin Syringe Ultrafine

Breatherite W/Large Mask, 36 camrese, 13 Cefaclor ER, 1

Breatherite W/Medium Mask, 36 camrese LO, 13 cefadroxil, 1

Breatherite W/Small Mask, 36 Canasa, 17 cefdinir, 1

Breo Ellipta, 30 candesartan cilexetil, 6 Cefditoren Pivoxil, 1

Brevicon-28, 13 candesartan cilexetil/hydrochlorothiazide, cefpodoxime proxetil, 1 briellyn, 13 cefprozil, 1 7 Brilinta, 20 Cantil, 17 Ceftibuten, 1 brimonidine tartrate, 25 capecitabine, 4 Ceftin, 1

Brintellix, 21 Capex, 10 cefuroxime axetil, 1

Brisdelle, 24 Caphosol, 20 Celebrex, 28

Bromday, 26 Capital/Codeine, 27 Celestone, 12 bromfenac, 26 Caprelsa, 5 Celexa, 21 bromocriptine mesylate, 23 captopril, 6 Cellcept, 4 bromphen/pseudoephedrine Captopril/Hydrochlorothiazide, 7 Celontin, 22

Carafate, 17 Cem-urea, 11 HCL/dextromethorphan HBR, 29 Brompheniramine Tannate, 29 Carbaglu, 16 Cenestin, 12

Brondil, 30 carbamazepine, 22 Centany, 9

Brovana, 30 carbamazepine ER, 22 Centany AT, 9 budesonide, 12, 29, 30 Carbaphen 12, 29 Centrum Specialist Prenatal, 31

Bullseye Safety Lancets, 33 Carbaphen 12 PED, 29 cephalexin, 1 bumetanide, 7 Carbatrol, 22 Cephalexin, 1

Bunavail, 27 carbidopa, 23 Ceprotin, 20

Bupap, 27 carbidopa/levodopa, 23 Cerdelga, 19

Buphenyl, 16 carbidopa/levodopa ER, 23 Cerezyme, 19 buprenorphine HCL, 27 carbidopa/levodopa odt, 23 Cesamet, 17 buprenorphine HCL/naloxone HCL, 27 Carbidopa/Levodopa/Entacapone, 23 cesia, 13 buproban, 23 carbinoxamine maleate, 29 cetirizine HCL, 29 bupropion HCL, 21 Carbocaine, 29 cetirizine HCL/pseudoephedrine HCL ER, bupropion HCL ER, 21 carboplatin, 3 29 bupropion HCL SR, 21, 23 Carboplatin, 3 Cetraxal, 26 bupropion HCL XL, 21 Cardene SR, 6 cevimeline HCL, 20 buspirone HCL, 20 Cardizem, 6 Chantix, 23

Busulfex, 3 Cardizem CD, 6 Chantix Continuing Month PAK, 23 butal/asa/caff, 27 Cardizem LA, 6 Chantix Starting Month PAK, 23 butalbital/acetaminophen, 27 Cardura, 7 chateal, 13 butalbital/acetaminophen/caffeine, 27 Cardura XL, 18 Chemet, 36 butalbital/acetaminophen/caffeine/codein Careone Blood Glucose Test Chenodal, 17

childrens aspirin, 26 e, 27 Strips/Premium, 35 butalbital/apap/caffeine, 27 Careone Blood Glucose Test childrens aspirin low strength, 26 butalbital/asa/caffeine, 27 Chloral Hydrate, 22 Strips/Value, 35 Butalbital/Aspirin/Caffeine, 27 Careone Lancet Thin, 33 chlordiazepoxide HCL, 20 butalbital/aspirin/caffeine/codeine, 27 Careone Lancet Ultra Thin, 33 Chlordiazepoxide/Amitriptyline, 24

Butisol Sodium, 22 Caresens N Blood Glucose Test Strips, chlorhexidine gluconate, 20 butorphanol tartrate, 27 chlorhexidine gluconate oral rinse, 20 35 Butrans, 27 carisoprodol, 24 chloroquine phosphate, 3

Bydureon, 14 Carisoprodol, 24 chlorothiazide, 7

Byetta, 14 carisoprodol/aspirin, 24 Chlorothiazide, 7

Bystolic, 5 carisoprodol/aspirin/codeine, 24 chlorpromazine HCL, 21

Carmol-HC, 10 Chlorpropamide, 14 C Carnitor, 16 Chlorthalidone, 7 cabergoline, 16 Carnitor SF, 16 chlorzoxazone, 24 Caduet, 8 carteolol HCL, 25 Choice DM Fora G20 Test Strips, 35 Cafcit, 22 carvedilol, 5 cholestyramine, 7 Cafergot, 29 Cascara Sagrada, 16 cholestyramine light, 7 caffeine citrate, 22 Casodex, 4 choline magnesium trisalicylate, 27 Calan, 6 Cataflam, 28 Cialis, 8 Calan SR, 6 Catapres, 7 Ciclodan Cream Kit, 9 calcipotriene, 9 Catapres-tts-1, 7 Ciclodan Solution Kit, 9 calcipotriene/betamethasone Catapres-tts-2, 7 ciclopirox, 9

dipropionate, 10 Catapres-tts-3, 7 ciclopirox olamine, 9 calcitonin salmon, 15 Cavan-alpha Kit, 31 Ciclopirox Topical Solution Kit, 9 calcitonin-salmon, 15 Caverject, 8 cidofovir, 2 Calcitriol, 10 Caverject Impulse, 8 cilostazol, 20 calcitriol, 16 Cayston, 3 Ciloxan, 25 calcium acetate, 17 caziant, 12 cimetidine, 16 Cambia, 29 Cedax, 1 cimetidine HCL, 16 camila, 13 cefaclor, 1 Cimzia, 18 Campral, 24 Cefaclor, 1 Cimzia Starter Kit, 18 Camptosar, 5

Cinryze, 20 clotrimazole/betamethasone dipropionate, cromolyn sodium, 17, 26, 30

Cipro, 1 cryselle-28, 13 9 Cipro HC, 26 clozapine, 21 Curosurf, 30

Cipro XR, 1 Clozapine Odt, 21 Cutivate, 10

Ciprodex, 26 Clozaril, 21 Cuvposa, 17 ciprofloxacin, 1 Cnl8 Nail Kit, 9 CVS Advanced Glucose Meter Test

Ciprofloxacin, 26 CO-natal Fa, 31 Strips, 35 ciprofloxacin ER, 1 Coaguchek Lancets, 33 CVS aspirin, 27 ciprofloxacin HCL, 1, 24 Coal TAR, 11 CVS aspirin adult low dose, 27 cisplatin, 3 Coartem, 3 CVS aspirin adult low strength, 27

Cisplatin, 3 Cocaine HCL, 11 CVS aspirin child, 27 citalopram hydrobromide, 21 codeine sulfate, 27 CVS aspirin EC, 27

Citranatal 90 DHA, 31 Codeine Sulfate, 27 CVS aspirin low dose, 27

Citranatal Assure, 31 Colazal, 17 CVS aspirin low strength, 27

Citranatal B-calm, 31 Colcrys, 29 CVS childrens aspirin, 27

Citranatal DHA, 31 Colestid, 8 CVS enteric aspirin, 27

Citranatal Harmony, 31 Colestid Flavored, 8 CVS folic acid, 19

Citranatal RX, 31 colestipol HCL, 7 CVS iron, 19 citric acid/sodium citrate, 18 colestipol HCL for oral suspension, 7 CVS nicotine, 23

Citrolith, 18 colistimethate sodium, 3 CVS nicotine polacrilex, 23 cladribine, 4 Coly-mycin M, 3 CVS nicotine polacrilex starter, 23

Claravis, 8 Coly-mycin S, 26 CVS nicotine transdermal system, 23

Clarifoam EF, 8 Colyte-flavor Packs, 16 CVS nts step 1, 23 clarithromycin, 1 Combigan, 25 CVS Prenatal, 31 clarithromycin ER, 1 Combipatch, 12 CVS Prenatal Gummy/DHA/Folic Acid,

Classic Prenatal, 31 Combivent, 30 31 Cleanlet Lancets 28G, 33 Combivent Respimat, 30 CVS Prenatal Multi+dha, 31 clemastine fumarate, 29 Combivir, 2 CVS Slow Release Iron, 19

Clemastine Fumarate, 29 Cometriq, 5 cyclafem 1/35, 13

Cleocin, 3, 18 Comfort Lancets, 33 cyclafem 7/7/7, 13

Cleocin Pediatric Granules, 3 Commit, 23 Cyclessa, 13

Cleocin-t, 8 Compazine, 21 cyclobenzaprine HCL, 24

Clever Chek Auto-code Test Strips, 35 Complera, 2 Cyclogyl, 25

Clever Chek Auto-code Voice Test Strips, Comtan, 23 Cyclomydril, 25

Concept DHA, 31 cyclopentolate HCL, 25 35 Clever Chek Lancets Ultrathin, 33 Concept OB, 31 Cyclophosphamide, 3

Clever Chek Lancets Ultrathin 30G, 33 Concerta, 22 Cycloserine, 2

Clever Chek Test Strips, 35 Condylox, 11 cyclosporine, 4

Clever Choice Auto-code Pro Test Strips, Control AST, 35 cyclosporine modified, 4

Control Test Strips, 35 Cyclosporine Modified, 4 35 Clever Choice Micro Test Strips, 35 Conzip, 27 Cymbalta, 21

Climara, 12 Copaxone, 24 cyproheptadine HCL, 29

Climara Pro, 12 Copegus, 2 Cyramza, 4

Clindacin Etz, 8 Cordarone, 6 Cystadane, 16

Clindacin PAC, 8 Cordran, 10 Cystagon, 18

Clindagel, 8 Cordran Tape, 10 Cystaran, 26 clindamycin HCL, 3 Coreg, 5 cytarabine, 4 clindamycin palmitate HCL, 3 Coreg CR, 5 Cytarabine, 4 clindamycin phosphate, 8, 18 Corgard, 5 cytarabine aqueous, 4 clindamycin/benzoyl peroxide, 8 Corifact, 20 Cytomel, 16

Clindesse, 18 Cortef, 12 Cytotec, 17 clobetasol propionate, 10 Cortenema, 17 Cytovene, 2 clobetasol propionate emollient, 10 Cortifoam, 17 Cytra-3, 18

Clobex, 10 Cortisone Acetate, 12 D Clocortolone Pivalate, 10 Cortisporin, 9, 26 D-VI-sol, 31 Clocortolone Pivalate P.M., 10 Cortisporin-tc, 26 d3, 31 Clodan Kit, 10 Corzide, 7 D3, 31 Cloderm, 10 Cosopt, 25 D3 Dots, 31 Cloderm P.M., 10 Cosopt PF, 25 d3 ultra strength, 31 clomipramine HCL, 21 Coumadin, 19 dacarbazine, 5 clonazepam, 22 Cozaar, 6 Dacarbazine, 5 clonazepam odt, 22 Cpb Wc, 29 Dacogen, 4 clonidine HCL, 6 Creon, 17 Daliresp, 30 clonidine HCL ER, 22 Crestor, 8 Dalvance, 3 clopidogrel, 20 Cresylate, 26 danazol, 12 clorazepate dipotassium, 20 Crinone, 18 Dantrium, 24 Clorpres, 7 Crixivan, 2 Dantrium IV, 24 clotrimazole, 9, 20 Crnatal, 31 dantrolene sodium, 24

Dantrolene Sodium, 24 dexmethylphenidate HCL, 22 Docefrez, 4

Dapsone, 3 dexmethylphenidate HCL ER, 22 Docetaxel, 4

Daraprim, 3 Dexpak 10 Day, 12 Dolgic Plus, 27 dasetta 1/35, 13 Dexpak 13 Day, 12 Dologesic, 27 dasetta 7/7/7, 13 Dexpak 6 Day, 12 Dolophine, 27 daunorubicin HCL, 3 dextroamphetamine sulfate, 22 Dolophine HCL, 27

Daunoxome, 3 dextroamphetamine sulfate ER, 22 Donatuss Dc, 29

Daypro, 28 Dextromethorphan donepezil HCL, 23 daysee, 13 Doral, 22 HBR/Chlorpheniramine/Phenylephrine Daytrana, 22 Doryx, 1 HCL, 29

Ddavp, 16 dorzolamide HCL, 26 Diabeta, 14

Ddrops, 31 dorzolamide HCL/timolol maleate, 25 Dialyvite Vitamin D3 Max, 31

Debacterol, 20 Doubledex, 12 Diamox, 7 deblitane, 13 Dovonex, 10 Diastar Easy Test II Lancets 30G, 33

Decara, 31 doxazosin mesylate, 6 Diastar Easy Test Lancets30G, 33 decitabine, 4 doxepin HCL, 21 Diastat Acudial, 22

Decon-a, 29 Doxepin HCL, 21 Diastat Pediatric, 22

Delestrogen, 12 doxercalciferol, 16 diazepam, 20 delyla, 13 Doxil, 3 Diazepam, 20, 22

Delzicol, 17 doxorubicin HCL, 3 Diazepam Intensol, 20

Demadex, 7 doxorubicin HCL liposome, 3 Dibenzyline, 6 demeclocycline HCL, 1 doxycycline, 1 Diclegis, 17

Demerol, 27 doxycycline hyclate, 1 diclofenac potassium, 28

Demser, 6 doxycycline hyclate DR, 1 diclofenac sodium, 9, 26

Denavir, 9 doxycycline monohydrate, 1 diclofenac sodium DR, 28

Depakene, 22 Doxytex, 29 diclofenac sodium ER, 28

Depakote, 22 Dritho-creme HP, 10 diclofenac sodium/misoprostol, 28

Depakote ER, 22 dronabinol, 17 dicloxacillin sodium, 1

Depakote Sprinkles, 22 Droplet Lancets Ultra Thin 30G, 33 Dicopanol Fusepaq, 29

Depo-provera Contraceptive, 13 drospirenone/ethinyl estradiol, 13 dicyclomine HCL, 16

Depo-subq Provera 104, 13 Droxia, 19 Dicyclomine HCL, 17

Depo-testosterone, 12 Drug Mart On-the-go Lancets Gentle didanosine, 2

Deprizine Fusepaq, 17 Differin, 8 30G, 33

Derma-smoothe/FS Body, 10 Drug Mart Unilet Lancets Super Thin Dificid, 1

Derma-smoothe/FS Body Oil, 10 diflorasone diacetate, 10 30G, 33

Derma-smoothe/FS Scalp, 10 Drug Mart Unilet Lancets Ultra Thin 28G, Diflorasone Diacetate, 10

Derma-smoothe/FS Scalp Oil, 10 Diflucan, 2 33

Dermasorb HC, 10 Drysol, 11 diflunisal, 27

Dermasorb Ta, 10 Duac, 8 Digex NF, 17

Dermasorb XM, 11 Duavee, 12 digoxin, 5

Dermatop, 10 Duet DHA, 31 Digoxin, 5

Dermotic, 26 Duet DHA 400, 31 Dihydroergotamine Mesylate, 29 desipramine HCL, 21 Duet DHA 400EC, 31 Dilacor XR, 6 desmopressin acetate, 16 Duet DHA 430, 31 Dilantin, 22

Desogen, 13 Duet DHA 430EC, 31 Dilantin Infatabs, 22 desogestrel/ethinyl estradiol, 13 Duet DHA Balanced, 31 Dilatrate SR, 5

Desonate, 10 Duet DHA EC, 31 Dilaudid, 27 desonide, 10 Duetact, 15 diltiazem CD, 6

Desowen, 10 Duexis, 28 diltiazem HCL, 6

Desowen Cream/Cetaphil Lotion, 10 Dulera, 30 diltiazem HCL ER, 6

Desowen Lotion/Cetaphil Cream, 10 duloxetine HCL, 21 Diovan, 6

Desowen Ointment/Cetaphil Lotion, 10 Duo-care Test Strips, 35 Diovan HCT, 7 desoximetasone, 10 Duoneb, 30 Dipentum, 17

Desoximetasone, 10 Duragesic, 27 diphenhydramine HCL, 29

Desoxyn, 22 Durezol, 25 diphenoxylate/atropine, 16

Desvenlafaxine ER, 21 Dutoprol, 7 Diphenoxylate/Atropine, 16

Detrol, 18 Dyazide, 7 Diprolene, 10

Detrol LA, 18 Dymista, 29 Diprolene AF, 10 dexamethasone, 12 Dynacin, 1 dipyridamole, 20

Dexamethasone, 12 Dyrenium, 7 Disalcid, 27

Dexamethasone Intensol, 12 Dysport, 24 disopyramide phosphate, 6 dexamethasone sodium phosphate, 12, Dyural-40, 12 disulfiram, 23

Dyural-80, 12 25 Ditropan XL, 18

Dexamethasone Sodium Phosphate, 12 Dyural-l, 12 Diuril, 7

Dexchlorpheniramine Maleate, 29 Dyural-lm, 12 divalproex sodium, 22

Dexedrine, 22 divalproex sodium DR, 22 E Dexlido, 12 divalproex sodium ER, 22 E-z Ject Lancets, 33 Dexlido-m, 12 Divigel, 12 E-z Ject Lancets 21G, 33

E-z Ject Lancets Color, 33 Effient, 20 Epipen-JR 2-PAK, 7

E-z Ject Lancets Super Thin, 33 Egrifta, 15 epirubicin HCL, 3

E-z Ject Lancets Super Thin 30G, 33 Elaprase, 16 Epirubicin HCL, 3

E-z Ject Lancets Thin 26G, 33 Eldepryl, 23 episone CRE, 11

E-z Spacer, 36 Elelyso, 19 Epivir, 2

E-z Spacer The Body Guards Pack, 36 Element Plus Test Strips, 35 Epivir HBV, 2

E-ZJECT Lancets Micro-thin 33G, 33 Element Test Strips, 35 eplerenone, 6

E.e.s. 400, 1 Elenzapatch, 11 Epogen, 19

E.e.s. Granules, 1 Elestat, 26 epoprostenol sodium, 8

Easivent, 36 Elestrin, 12 eprosartan mesylate, 6

Easivent/Mask-large, 36 Eletone, 11 Epzicom, 2

Easivent/Mask-medium, 36 Eletone Twinpack, 11 eq adult aspirin low strength, 26

Easivent/Mask-small, 36 Elidel, 11 eq aspirin, 26

Easy Step Test Strips, 35 Eligard, 4 eq aspirin adult low dose, 26

Easy Touch Glucose Test Strips, 35 Elimite, 11 eq aspirin EC, 26

Easy Touch Healthpro Glucose Test elinest, 13 eq aspirin low dose, 26

Eliphos, 17 eq childrens aspirin, 26 Strips, 35 Easy Touch Lancets 21G/Pressure Eliquis, 19 eq nicotine, 23

Elite Iron, 19 eq nicotine gum refill, 23 Activated, 33 Easy Touch Lancets 23G/Pressure Elite-OB, 31 eq nicotine gum starter, 23

Elitek, 5 eq nicotine polacrilex, 23 Activated, 33 Easy Touch Lancets 26G/Pressure Elixophyllin, 30 eq nicotine step 3, 23

Ella, 13 eq slow-release iron, 18 Activated, 33 Easy Touch Lancets 28G/Pressure Ellence, 3 eql adult aspirin low strength, 26

Elmiron, 18 eql aspirin, 26 Activated, 33 Easy Touch Lancets 28G/Twist, 33 Elocon, 10 eql aspirin EC, 26

Easy Touch Lancets 30G/Pressure Eloctate, 20 eql aspirin low dose, 26

Eloxatin, 3 eql childrens aspirin, 26 Activated, 33 Easy Touch Lancets 30G/Twist, 33 Elspar, 3 eql folic acid, 18

Easy Touch Lancets 32G/Pressure Emadine, 26 eql iron supplement therapy, 18

Embrace Blood Glucose Test Strips, 35 eql nicotine, 23 Activated, 33 Easy Touch Lancets 32G/Twist, 33 Embrace Evo Blood Glucosetest Strips, eql nicotine polacrilex, 23

Easy Touch Lancets 33G/Twist, 33 eql nicotine polacrilex refill, 23 35 Easy Touch Safety Lancets21G/Pressure Embrace Lancets Ultra Thin 30G, 33 eql nicotine polacrilex starter, 23

Embrace Pro Blood Glucosetest Strips, Eql Prenatal Formula, 31 Activated, 33 Easy Touch Safety Lancets23G/Pressure eql slow release iron, 18 35 Emcyt, 4 Eql Truetrack Test, 35 Activated, 33 Easy Touch Safety Lancets26G/Button Emend, 17 Equagesic, 27

Emla, 11 Equetro, 21 Activated, 33 Easy Touch Safety Lancets26G/Pressure emoquette, 13 Erbitux, 4

Emsam, 21 ergoloid mesylates, 23 Activated, 33 Easy Touch Safety Lancets28G/Button Emtriva, 2 Ergomar, 29

Emulsion SB, 11 errin, 13 Activated, 33 Easy Touch Safety Lancets28G/Pressure Enablex, 18 Ertaczo, 9

enalapril maleate, 6 Erwinaze, 3 Activated, 33 Easy Twist & CAP Lancets, 33 enalapril maleate/hydrochlorothiazide, 7 Ery-TAB, 1

Easygluco, 35 Enbrel, 28 Erygel, 8

Easymax 15 Test Strips, 35 Enbrel Sureclick, 28 Eryped 200, 1

Easymax Test Strips, 35 Enfamil Expecta, 31 Eryped 400, 1

Easypro Blood Glucose Test Strips, 35 Enjuvia, 12 Erythrocin Stearate, 1

Easypro Plus, 35 enoxaparin sodium, 19 erythromycin, 1, 8, 24

Easytest II Lancets, 33 enpresse-28, 13 Erythromycin Base, 1

Easytest Lancets, 33 enskyce, 13 Erythromycin Ethylsuccinate, 1

EC-81 aspirin, 27 entacapone, 23 erythromycin/benzoyl peroxide, 8

EC-naprosyn, 28 entecavir, 2 escitalopram oxalate, 21

Eclipse Test Strips, 35 Entereg, 17 Esgic, 27 econazole nitrate, 9 enteric coated aspirin, 26 Esgic-plus, 27 ecotrin low strength, 26 Entocort EC, 12 Esomeprazole Strontium, 17

Ecotrin Regular Strength, 27 Entyvio, 18 estarylla, 13

Ecoza, 9 Envision Autocode Test Strips, 35 estazolam, 22 ecpirin, 26 Epaned, 6 Estrace, 12, 18

Edarbi, 6 Epiceram, 11 estradiol, 12

Edarbyclor, 7 Epiduo, 8 estradiol valerate, 12

Edecrin, 7 Epifoam, 10 estradiol/norethindrone acetate, 12

Edex, 8 epinastine HCL, 26 Estrasorb, 12

Edluar, 22 Epinephrine, 7 Estring, 18

Edurant, 2 epinephrine HCL, 30 Estrogel, 12

Effexor XR, 21 Epipen 2-PAK, 7 estropipate, 12

Estropipate, 12 Farxiga, 14 Fiorinal, 27

Estrostep FE, 13 Faslodex, 4 Fiorinal/Codeine #3, 27 eszopiclone, 22 Fasttake Test Strips, 33 Firazyr, 20 ethambutol HCL, 2 Fazaclo, 21 Firmagon, 4 ethosuximide, 22 FE Aspartate, 19 First-bxn Mouthwash, 20

Ethyl Chloride, 11 FE gluconate, 19 First-dukes Mouthwash, 20

Ethyl Chloride/Fine Pinpoint, 11 FE TABS, 19 First-hydrocortisone, 10

Ethyl Chloride/Fine Stream, 11 Feiba NF, 20 First-lansoprazole, 17

Ethyl Chloride/Medium Jet Stream, 11 felbamate, 22 First-marys Mouthwash, 20

Ethyl Chloride/Medium Stream, 11 Felbatol, 22 First-mouthwash Blm, 20

Ethyl Chloride/Mist, 11 Feldene, 28 First-omeprazole, 17

Ethyol, 5 felodipine ER, 6 First-progesterone VGS 100

Etidronate Disodium, 15 Fem PH, 18 Compounding Kit, 18 etodolac, 28 Femara, 4 First-progesterone VGS 200 etodolac ER, 28 Femcon FE, 13 Compounding Kit, 18 Etopophos, 4 Femhrt Low Dose, 12 First-progesterone VGS 25 Compounding etoposide, 4 Femiron, 19 Kit, 18 Etoposide, 4 Femring, 18 First-progesterone VGS 400

Euflexxa, 24 fenofibrate, 7 Compounding Kit, 18 Eurax, 11 Fenofibrate, 8 First-progesterone VGS 50 Compounding

Evamist, 12 fenofibrate micronized, 7 Kit, 18 Evencare + Blood Glucose Test Strip, 35 Fenofibric Acid, 8 First-testosterone, 12

Evencare Blood Glucose Test Strip, 35 fenofibric acid DR, 7 First-testosterone Mc Compounding Kit,

Evencare G2 Test Strips, 35 Fenoglide, 8 12 Evencare G3 Test Strips, 35 Fenoprofen Calcium, 28 First-vancomycin 25, 3

Evicel, 19 fentanyl, 27 First-vancomycin 50, 3

Evista, 15 fentanyl citrate oral transmucosal, 27 Flagyl, 3

Evithrom, 19 Fentora, 27 Flagyl ER, 3

Evoclin, 8 feosol, 18 Flarex, 25

Evolution Autocode, 35 Feosol, 19 flavoxate HCL, 18

Evoxac, 20 Fer-IN-sol, 19 flecainide acetate, 6

Exactech R-s-G Test Strips, 35 fer-iron, 18 Flector, 9

Exactech Test Strips, 35 ferate, 19 Flexeril, 24

Exactuss, 29 Fergon, 19 FLO-pred, 12

Exalgo, 27 ferosul, 19 Flolan, 8

Exelderm, 9 ferretts, 19 Flomax, 18

Exelon, 24 Ferretts Chewable Iron, 19 Flonase, 29 exemestane, 4 Ferretts IPS, 19 Flovent Diskus, 30

Exforge, 7 ferrex 150, 19 Flovent HFA, 30

Exforge HCT, 7 Ferric Citrate, 17 floxuridine, 4

Exjade, 36 Ferrimin 150, 19 Fluarix 2012-2013, 30

Extavia, 24 Ferriprox, 36 Fluarix 2013-2014, 30

Extina, 9 ferro-bob, 19 Fluarix 2014-2015, 30

EZ Smart Blood Glucose Lancets, 33 Ferro-sequels, 19 Fluarix Quadrivalent 2013-2014, 30

EZ Smart Blood Glucose Test Strips, 35 ferrocite, 19 Fluarix Quadrivalent 2014-2015, 30

EZ Smart Plus Blood Glucose Test Strips, ferrotabs, 19 Flublok 2013-2014, 30

ferrous drops, 19 Flublok 2014-2015, 30 35 EZ-lets Lancets 21G, 33 Ferrous Fumarate, 19 Flucelvax 2012-2013, 30

EZ-lets Lancets 23G, 33 ferrous fumarate 324, 19 Flucelvax 2013-2014, 30

EZ-lets Lancets 26G Super-soft, 33 ferrous gluconate, 19 Flucelvax 2014-2015, 30

EZ-lets Lancets 28G Ultra-soft, 33 Ferrous Gluconate, 19 fluconazole, 2

EZ-lets Lancets 30G, 33 ferrous sulfate, 19 flucytosine, 2 ezfe 200, 18 Ferrous Sulfate, 19 Fludara, 4

ferrousul, 19 fludarabine phosphate, 4 F ferus, 19 Fludarabine Phosphate, 4 fa-8, 18 Fetzima, 21 fludrocortisone acetate, 12 Fa-8, 19 Fetzima Titration Pack, 21 Flulaval 2012-2013, 30 Fabior, 9 Fexmid, 24 Flulaval 2013-2014, 30 Fabrazyme, 16 Fibricor, 8 Flulaval 2014-2015, 30 Factive, 1 Fifty50 Glucose Test Strip 2.0, 35 Flulaval Quadrivalent 2013-2014, 30 Falessa, 13 Fifty50 Safety Seal Lancets 30G, 33 Flulaval Quadrivalent 2014-2015, 30 fallback solo, 12 Fifty50 Safety Seal Lancets 32G, 33 Flumadine, 2 falmina, 13 Finacea, 9 Flumist Nasal Vaccine 2012-2013, 30 famciclovir, 2 finasteride, 18 Flumist Quadrivalent, 30 famotidine, 16 Fine 30, 33 flunisolide, 29 Famvir, 2 Fingerstix Lancets, 33 Flunisolide, 29 Fanapt, 21 Fioricet, 27 fluocinolone acetonide, 10, 26 Fanapt Titration Pack, 21 Fioricet/Codeine, 27 fluocinolone acetonide ear drops, 26 Fareston, 4

fluocinonide, 10 Fora Test N' Go Blood Glucose Test gene-xene TAB 3.75MG, 20 fluocinonide emollient base, 10 gene-xene TAB 7.5MG, 20 Strips, 35 fluocinonide-e, 10 Fora V10 Blood Glucose Test Strips, 35 Generess FE, 13 fluorometholone, 25 Fora V12 Blood Glucose Test Strips, 35 Genotropin, 15 fluorouracil, 4 Fora V20 Blood Glucose Test Strips, 35 Genotropin Miniquick, 15 fluoxetine, 23 Fora V22 Blood Glucose Test Strips, 35 Gentamicin Sulfate, 9 fluoxetine DR, 21 Fora V30a Blood Glucose Test Strips, 35 gentamicin sulfate, 24 fluoxetine HCL, 21 Foracare GD40, 35 Gentle-let GP Lancets, 33

Fluoxetine HCL, 21 Foracare Premium V10 Teststrips, 35 Gentle-let Lancets General Purpose fluphenazine HCL, 21 Foracare Test N Go Test Strips, 35 Style/Fine Point, 33 Fluphenazine HCL, 21 Foradil Aerolizer, 30 Gentle-let Lancets General Purpose flurazepam HCL, 22 Forfivo XL, 21 Style/Medium Point, 33 Flurazepam HCL, 22 Fortamet, 14 Gentle-let Lancets Safety Style/Fine flurbiprofen, 28 Fortaz, 1 Point, 33 flurbiprofen sodium, 26 Forteo, 15 Gentle-let Lancets Safety Style/Medium flutamide, 4 Fortesta, 12 Point, 33 fluticasone propionate, 10, 29 Fortical, 15 Geodon, 21 fluvastatin, 7 Fosamax, 15 Gesticare DHA, 32

Fluvirin 2012-2013, 31 Fosamax Plus D, 15 gianvi, 13

Fluvirin 2013-2014, 31 fosinopril sodium, 6 Giazo, 17

Fluvirin 2014-2015, 31 fosinopril sodium/hydrochlorothiazide, 7 gildagia, 13

Fluvirin PF 2012-2013, 30 Fosrenol, 17 gildess 1.5/30, 13

Fluvirin PF 2013-2014, 30 Fragmin, 19 gildess 1/20, 13

Fluvirin PF 2014-2015, 31 Freestyle Insulinx Blood Glucose Test, gildess FE 1.5/30, 13 fluvoxamine maleate, 21 gildess FE 1/20, 13 35 fluvoxamine maleate ER, 21 Freestyle Insulinx Blood Glucose Test Gilenya, 24

Fluzone High-dose PF 2012-2013, 31 Gilotrif, 5 Strips, 36 Fluzone High-dose PF 2013-2014, 31 Freestyle Lancets, 33 Gilphex TR, 29

Fluzone High-dose PF 2014-2015, 31 Freestyle Lite Test Strips, 36 Giltuss, 29

Fluzone Intradermal, 31 Freestyle Test Strips, 36 Giltuss PED-c, 29

Fluzone Pediatric PF 2012-2013, 31 Freestyle Unistick II Lancets, 33 Giltuss TR, 29

Fluzone Pediatric PF 2013-2014, 31 Frova, 29 Glassia, 30

Fluzone PF 2012-2013, 31 Fulyzaq, 16 Gleevec, 5

Fluzone PF 2013-2014, 31 Furadantin, 18 glimepiride, 14

Fluzone PF 2014-2015, 31 furosemide, 7 glipizide, 14

Fluzone Quadrivalent 2013-2014, 31 Furosemide, 7 glipizide ER, 14

Fluzone Quadrivalent 2014-2015, 31 Fusilev, 5 glipizide/metformin HCL, 15

Fluzone Split 2012-2013, 31 Fuzeon, 2 Glucagen, 14

Fluzone Split 2013-2014, 31 Fycompa, 22 Glucagen Hypokit, 14

Fluzone Split 2014-2015, 31 Glucagon Emergency Kit, 14 G FML, 25 Gluco Perfect 3 Test Strips, 36 gabapentin, 22 FML Forte, 25 Glucocard 01 Sensor, 36 Gabavale-5, 20 FML Liquifilm, 25 Glucocard 01 Test Strips, 36 Gabazolamine, 20 Focalin, 22 Glucocard Expression Blood Glucose Gabazolamine-0.5, 20 Focalin XR, 22 Test Strips, 36 Gabazolpidem-5, 22 Folbecal, 31 Glucocard Vital Test Strips, 36 Gabitidine, 17 Folcaps Omega 3, 32 Glucocard X-sensor, 36 Gabitril, 22 Folet DHA, 32 Glucocom Lancets 28G, 33 Gaboxetine, 21 Folet One, 32 Glucocom Lancets 30G, 33 galantamine, 23 folic acid, 19 Glucocom Lancets 33G, 33 galantamine hydrobromide, 23 Folivane-OB, 32 Glucocom Test Strips, 36 ganciclovir, 2 Folivane-prx DHA NF, 32 Glucolab Test Strips, 36 Garamycin, 25 Folotyn, 4 Gluconavii Blood Glucose Test Strips, 36 Gastrinex NF, 17 fondaparinux sodium, 19 Glucophage, 14 Gastrocrom, 17 Fora D10 Blood Glucose Test Strips, 35 Glucophage XR, 14 gatifloxacin, 24 Fora D15c Blood Glucose Test Strips, 35 Glucosource Lancets, 33 Gattex, 18 Fora D15G Blood Glucose Test Strips, Glucotrol, 14 Gazyva, 4 Glucotrol XL, 14 35 Gebauers Pain Ease, 11 Fora D15z Blood Glucose Test Strips, 35 Glucovance, 15 Gebauers Spray And Stretch, 11 Fora D20 Blood Glucose Test Strips, 35 Glumetza, 14 Gel-kam Oral Care Rinse, 20 Fora G20 Blood Glucose Test Strips, 35 glyburide, 14 Gelclair, 20 Fora G30a Blood Glucose Test Strips, 35 Glyburide, 14 Gelnique, 18 Fora G71a Blood Glucose Test Strips, 35 glyburide micronized, 14 Gemcitabine, 4 Fora G90 Blood Glucose Test Strips, 35 glyburide/metformin HCL, 15 gemcitabine HCL, 4 Fora GD20 Test Strips, 35 Glycate, 17 gemfibrozil, 8 Fora GD50 Blood Glucose Test Strips, Glycolic Acid, 10 Gemzar, 4 Glycolic Acid 70% High Purity, 10 35 Genadur, 11 Fora Lancets, 33 glycopyrrolate, 16 gene-xene TAB 15MG, 20

Glynase, 14 HM aspirin EC low dose, 27 hydrocortisone butyrate (lipophilic), 10

Glyset, 15 HM folic acid, 19 hydrocortisone IN absorbase, 10

Gmate Blood Glucose Test Strips, 36 HM iron, 19 hydrocortisone valerate, 10

Gmate Lancets 30G, 33 HM iron slow release, 19 hydrocortisone/acetic acid, 26 gnp adult aspirin low strength, 26 HM nicotine polacrilex, 23 hydromorphone HCL, 27 gnp aspirin, 26 HM nicotine transdermal system, 23 Hydromorphone HCL, 27 gnp aspirin low dose, 26 HM nicotine transdermal system step 3, hydromorphone HCL ER, 27

Gnp Daily Prenatal, 31 Hydromorphone HCL ER, 27 23 gnp folic acid, 19 HM One Daily Prenatal Combo, 31 hydroxychloroquine sulfate, 3 gnp iron, 19 HM Prenatal, 31 hydroxyurea, 5 gnp nicotine polacrilex, 23 homatropine HBR, 25 hydroxyzine HCL, 20

Gnp Prenatal, 31 Horizant, 24 hydroxyzine pamoate, 20

Gnp Prenatal Vitamins, 31 HPR, 11 Hydroxyzine Pamoate, 20 gnp slow release iron, 19 HPR Plus, 11 Hylatopic, 11

Golytely, 16 HPR Plus/Mb Hydrogel, 11 Hylatopic Plus, 11 goodsense aspirin low dose, 26 Humalog, 14 Hylira, 11

Goodsense Prenatal Vitamins, 31 Humalog Kwikpen, 14 hyoscyamine sulfate, 16

Gordofilm, 11 Humalog Mix 50/50, 14 hyoscyamine sulfate ER, 16

Gordons Urea, 11 Humalog Mix 50/50 Kwikpen, 14 hyoscyamine sulfate odt, 16

Gralise, 24 Humalog Mix 75/25, 14 hyoscyamine sulfate SR, 16

Gralise Starter, 24 Humalog Mix 75/25 Kwikpen, 14 Hyper-sal, 29 granisetron HCL, 17 Humate-p, 20 Hypersal, 29

Granisol, 17 Humatrope, 15 Hypertenevide-12.5, 5

Granix, 19 Humatrope Combo Pack, 15 Hypertenipine-2.5, 6

Grifulvin V, 2 Humira, 28 Hypertensolol, 7

Gris-peg, 2 Humira Pediatric Crohns Disease Starter Hyzaar, 7 griseofulvin microsize, 2 Pack, 28 I griseofulvin ultramicrosize, 2 Humira Pen, 28 ibandronate sodium, 15 guanfacine HCL, 6 Humira Pen-crohns Diseasestarter, 28 Ibudone, 27 Guanidine HCL, 24 Humira Pen-psoriasis Starter, 28 ibuprofen, 28 Gynazole-1, 18 Humulin 70/30, 14 IC 400, 28 Humulin 70/30 Kwikpen, 14 H IC 800, 28 Humulin 70/30 Pen, 14 H&h Thinlet Lancets 26G, 33 Icar, 19 Humulin N, 14 H&h Thinlet Super Thin Lancets 30G, 33 Icar Pediatric, 19 Humulin N Kwikpen, 14 H.p. Acthar, 16 Iclusig, 5 Humulin N U-100 Pen, 14 Haemolance, 33 iferex 150, 19 Humulin R, 14 Haemolance Low Flow Lancets, 33 Ifex, 3 Humulin R U-500 (concentrated), 14 Haemolance Plus, 33 ifosfamide, 3 Hy-vee Lancets, 33 Haemolance Plus High Flow, 33 Ifosfamide, 3 Hyalgan, 24 Haemolance Plus Low Flow, 33 Ilaris, 28 Hycamtin, 5 Haemolance Plus Max Flow, 33 Ilevro, 26 Hycet, 27 Haemolance Plus Pediatric Flow, 33 Imbruvica, 5 hydralazine HCL, 6 Halaven, 4 Imdur, 5 Hydrea, 5 Halcion, 22 imipramine HCL, 21 Hydro 35, 11 Halflytely Bowel Prep/Flavor Packs, 16 imipramine pamoate, 21 Hydro 40 Foam, 11 halfprin, 26 imiquimod, 11 hydrochlorothiazide, 7 halobetasol propionate, 10 Imitrex, 29 hydrocodone bitartrate/acetaminophen, Halog, 10 Imitrex Statdose Refill, 29

27 Halonate, 10 Imitrex Statdose System, 29 Hydrocodone Bitartrate/Acetaminophen, haloperidol, 21 Imuran, 4

27 Halotin, 9 Inatal Advance, 32 hydrocodone bitartrate/chlorpheniramine Healthy Mama Be Well Rounded, 31 Inatal GT, 32

maleate/PSE, 29 heather, 13 Inatal Ultra, 32 hydrocodone bitartrate/homatropine Hectorol, 16 Incivek, 2

methylbromide, 29 Helidac, 17 Increlex, 15 hydrocodone polistirex/chlorpheniramine Helixate FS, 20 indapamide, 7

polistirex, 29 Hemangeol, 5 Inderal LA, 5 hydrocodone/acetaminophen, 27 Hemocyte, 19 Inderal XL, 6 Hydrocodone/Acetaminophen, 27 Hemofil M, 20 Indocin, 28 hydrocodone/homatropine, 29 Hepsera, 2 indomethacin, 28 hydrocodone/ibuprofen, 27 Herceptin, 4 indomethacin ER, 28 hydrocort ene 100MG, 17 Hetlioz, 22 Infasurf, 30 hydrocortisone, 10, 12, 17 Hexalen, 3 Infergen, 2 hydrocortisone acetate/aloe, 10 high potency iron, 19 Infinity Blood Glucose Test Strips, 36 hydrocortisone acetate/lidocaine HCL, 17 High Potency Iron, 19 Influenza A (h1n1) Monovalent 2009, 31 hydrocortisone acetate/pramoxine, 17 Hiprex, 18 Inlyta, 5 hydrocortisone butyrate, 10 HM aspirin, 27 Innopran XL, 6 hydrocortisone butyrate (lipid), 10 HM aspirin EC, 27 Inova, 9

Inova 4/1 Acne Control Therapy, 9 jolessa, 13 L Inova 8/2 Acne Control Therapy, 9 jolivette, 13 labetalol HCL, 5 Inspirease Bags, 36 Jublia, 9 Lac-hydrin, 11 Inspirease Drug Delivery System, 36 junel 1.5/30, 13 Lacrisert, 25 Inspirease Mouthpiece, 36 junel 1/20, 13 lactic acid, 11 Inspirease Reservoir Bags, 36 junel FE 1.5/30, 13 lactic acid e, 11 Inspra, 7 junel FE 1/20, 13 lactic acid w/vitamin e, 11 Insulin Syringe/0.5ML/30G X 5/16", 36 Juvisync, 15 lactulose, 16, 17 Intelence, 2 Juxtapid, 8 Lamictal, 22 Intermezzo, 22 K Lamictal Chewable Dispersible, 23 Introl, 7 K-phos NO 2, 18 Lamictal Odt, 22 Intron-a, 5 K.b.g.l. IN Teroderm Cream, 9 Lamictal Starter/Not Taking Intron-a W/Diluent, 5 Kadcyla, 4 introvale, 13 Carbamazepine, 23 Kadian, 27 Lamictal Starter/Taking Intuniv, 22 Kalbitor, 20 Invega, 21 Carbamazepine/Not Taking Valproate, Kaletra, 2 23 Invirase, 2 Kalydeco, 30 Lamictal Starter/Taking Valproate, 23 Invokamet, 15 Kapvay, 22 Lamictal XR, 23 Invokana, 14 Kapvay Dose Pack, 22 Lamisil, 2 Iopidine, 25 Karbinal ER, 29 Lamisil Spray, 9 ipratropium bromide, 29, 30 kariva, 13 lamivudine, 2 ipratropium bromide/albuterol sulfate, 30 Kazano, 15 lamivudine/zidovudine, 2 Iprivask, 19 Keflex, 1 lamotrigine, 22 irbesartan, 6 kelnor 1/35, 13 lamotrigine ER, 22 irbesartan/hydrochlorothiazide, 7 Kenalog, 10 Lancets, 33 irinotecan, 5 Keppra, 22 Lancets 26G Twist Top, 34 Irinotecan, 5 Keppra XR, 22 Lancets 28G, 34 iron, 19 Kerafoam, 11 Lancets 30G, 34 Iron, 19 Kerafoam 42, 11 Lancets 30G Twist Top, 34 iron chews pediatric, 19 Keralac, 11 Lancets 31G Twist Top, 34 iron slow release, 19 Keralyt, 11 Lancets Bullseye Safety, 33 iron supplement, 19 Keralyt Scalp, 11 Lancets Safety Seal 21G, 34 iron supplement childrens, 19 Kerlone, 6 Lancets Safety Seal 26G, 34 Iron Up, 19 Kerydin, 9 Lancets Safety Seal 28G, 34 Isentress, 2 Ketek, 3 Lancets Safety Seal 30G, 34 isoniazid, 2 ketoconazole, 2, 9 Lancets Thin, 34 Isoniazid, 2 Ketodan Kit, 9 Lancets Twist Top, 34 Isoptin SR, 6 ketoprofen, 28 Lancets Ultra Fine, 34 Isopto Atropine, 25 Ketoprofen ER, 28 Lancets Ultra Thin, 34 Isopto Carbachol, 25 Ketorocaine-l, 28 Lanoxin, 5 Isopto Carpine, 25 Ketorocaine-lm, 28 lansoprazole, 17 Isopto Homatropine, 25 Ketorolac 2% Gel, 9 Isopto Hyoscine, 25 lansoprazole/amoxicillin/clarithromycin, ketorolac tromethamine, 26, 28

Isordil Titradose, 5 16 Keytruda, 4 Lantus, 14 isosorbide dinitrate, 5 Khedezla, 21 Lantus Solostar, 14 Isosorbide Dinitrate, 5 Kineret, 28 larin 1.5/30, 13 isosorbide dinitrate ER, 5 Klaron, 9 larin 1/20, 13 isosorbide mononitrate, 5 Klonopin, 22 larin FE 1.5/30, 13 isosorbide mononitrate ER, 5 kls aspirin EC, 26 larin FE 1/20, 13 Isradipine, 6 kls aspirin low dose, 26 Lasix, 7 Istalol, 25 kls quit2, 23 Lastacaft, 26 Istodax, 5 kls quit4, 23 latanoprost, 25 itraconazole, 2 Koate-dvi, 20 Latrix XM, 11 Ixempra Kit, 4 Kogenate FS, 20 Latuda, 21

J Kogenate FS Bio-set, 20 Lavoclen-4 Creamy Wash, 9

J-cof DHC, 29 Kombiglyze XR, 15 Lavoclen-8 Creamy Wash, 9

J-max DHC, 30 Korlym, 15 Lazanda, 27

Jakafi, 5 kp aspirin, 26 leena, 13

Jalyn, 18 kp ferrous gluconate, 19 leflunomide, 28

Janumet, 15 kp ferrous sulfate, 19 Lescol, 8

Janumet XR, 15 kp folic acid, 19 Lescol XL, 8

Januvia, 15 Kp Prenatal Multivitamins, 31 lessina, 13

Jardiance, 14 Kristalose, 16 Letairis, 8 jencycla, 13 Krystexxa, 29 letrozole, 4

Jentadueto, 15 kurvelo, 13 leucovorin calcium, 5

Jetrea, 26 Kuvan, 16 Leucovorin Calcium, 5

Jevtana, 4 Kynamro, 8 Leukeran, 3

Jinteli, 12 Kyprolis, 5 Leukine, 19

leuprolide acetate, 4 Live Better Lancet Super Thin 30G, 34 M Levacet, 27 Live Better Lancet Ultra Thin 28G, 34 M-vit, 32 levalbuterol, 30 LO Loestrin FE, 13 Macnatal CN DHA, 32 levalbuterol HCL, 30 LO Minastrin FE, 13 Macrobid, 18 Levaquin, 1 Locoid, 10 Macrodantin, 18 Levatol, 6 Locoid Lipocream, 10 Magnacet, 27 Levbid, 17 Lodosyn, 23 Makena, 14 Levemir, 14 Loestrin 1.5/30-21, 13 Malarone, 3 Levemir Flexpen, 14 Loestrin 1/20-21, 13 malathion, 11 Levemir Flextouch, 14 Loestrin 24 FE, 13 Maprotiline HCL, 21 levetiracetam, 22 Loestrin FE 1.5/30, 13 Marbeta-25, 12 levetiracetam ER, 22 Loestrin FE 1/20, 13 Marbeta-l, 12 Levitra, 8 Lofibra, 8 Mardex-25, 12 levobunolol HCL, 25 Lomedia 24 FE, 13 Marinol, 17 Levobunolol HCL, 25 Lomotil, 16 Marlido-25, 29 levocarnitine, 16 Lomustine, 3 marlissa, 13 levofloxacin, 1, 24 loperamide HCL, 16 Marnatal-f, 32 levonest, 13 Lopid, 8 Marplan, 21 levonorgestrel, 12 Lopressor, 6 Marqibo, 4 levonorgestrel and ethinyl estradiol, 13 Lopressor HCT, 7 Matulane, 5 levonorgestrel/ethinyl estradiol, 13 Loprox, 9 Mavik, 6 levora 0.15/30-28, 13 Loprox Shampoo, 9 Maxair Autohaler, 30 Levorphanol Tartrate, 27 loratadine, 29 Maxalt, 29 levothyroxine sodium, 16 lorazepam, 20 Maxalt-MLT, 29 Levsin, 17 Lorazepam Intensol, 20 Maxidex, 25 Levsin/SL, 17 Lorcet 10/650, 27 Maxidone, 28 Lexapro, 21 Lorcet Plus, 27 Maxima Blood Glucose Teststrips, 36 Lexiva, 2 Lortab, 27 Maxitrol, 25 Lialda, 17 loryna, 13 Maxzide, 7 Liberty Mini Lancing Device, 34 Lorzone, 24 Maxzide-25, 7 Liberty Next Generation Blood Glucose losartan potassium, 6 Mb Hydrogel, 11 losartan potassium/hydrochlorothiazide, Monitor, 34 meclizine HCL, 17 Liberty Next Generation Blood Glucose 7 Meclofenamate Sodium, 28 Loseasonique, 13 Test Strips, 34 Medi-derm/L-RX, 11 lidocaine, 11 Lotemax, 25 Medi-seltzer, 27 lidocaine HCL, 11, 20 Lotensin, 6 Medical Provider EZ Flu Shot 2013-2014, Lidocaine HCL, 11 Lotensin HCT, 7

lidocaine HCL jelly, 11 Lotrel, 7 31 Medical Provider EZ Flu Shot 2014-2015, lidocaine HCL viscous, 20 Lotrisone, 9

Lidocaine HCL-hydrocortisone Acetate Lotronex, 17 31

lovastatin, 8 Medical Provider EZ Flu Shot PF 2012- With Aloe, 17 lidocaine HCL/hydrocortisone acetate, 17 Lovaza, 8 2013, 31 Medical Provider EZ Flu Shot PF 2013- lidocaine viscous, 20 Lovenox, 19

lidocaine/prilocaine, 11 low-ogestrel, 12 2014, 31 Medical Provider EZ Flu Shot PF 2014- Lidocaine/Prilocaine, 11 loxapine, 21

Lidoderm, 11 loxapine succinate, 21 2015, 31 Medisense Thin Lancets, 34 Lidoprofen, 9 Loxitane, 21 Medlance Plus Extra Lancets 21G, 34 Lidovir, 9 Lta 360 Kit, 20 Medlance Plus Lancets, 34 Lifescan Unistik 2 Deep Penetration, 34 Lufyllin, 30 Medlance Plus Lancets Lite 25G, 34 Lifescan Unistik II Lancets, 34 Lumigan, 25 Medlance Plus Lite Lancets 25G, 34 lindane, 11 Lumizyme, 16 Medlance Plus Special Lancets 0.8MM, Linzess, 17 Lunesta, 22

liothyronine sodium, 16 Lupaneta Pack, 15 34 Medlance Plus Superlite 30G, 34 Lipitor, 8 Lupron Depot, 4 Medlance Plus Superlite 30G/Comfort Lipofen, 8 Lupron Depot-PED, 15

Liptruzet, 8 lutera, 12 Max, 34 Medlance Plus Universal Lancets 21G, Liquicet, 27 Luvox CR, 21

lisinopril, 6 Luxiq, 10 34 Medlance Plus/Lite 25G, 34 lisinopril/hydrochlorothiazide, 7 Luzu, 9 Medlance/Extra, 34 Liteaire, 36 Lycelle, 11 Medlance/Lite, 34 Litetouch Lancets Micro Thin 33G, 34 Lyrica, 22 Medlance/Universal, 34 Lithium, 21 Lysodren, 4 Medrol, 12 lithium carbonate, 21 Lysteda, 19 Medrol Dosepak, 12 Lithium Carbonate, 21 Lytensopril Kit, 7 medroxyprogesterone acetate, 12, 14 lithium carbonate ER, 21 Lytensopril-90, 7 mefenamic acid, 28 Lithobid, 21 Lytensopril-90 Kit, 7 mefloquine HCL, 3 Lithostat, 18 lyza, 13 Megace ES, 14 Livalo, 8 Megace Oral, 4

megestrol acetate, 4 Mevacor, 8 Moviprep, 16

Megestrol Acetate, 4 mexiletine HCL, 6 Moxatag, 1 meijer aspirin EC, 26 Miacalcin, 15 Moxeza, 24 meijer ferrous sulfate, 19 Micardis, 6 moxifloxacin HCL, 1

Meijer Super Thin Lancets, 34 Micardis HCT, 7 Mozobil, 19

Mekinist, 5 Microchamber, 36 MS Contin, 28 meloxicam, 28 Microdot Test Strips, 36 Multaq, 6

Meloxicam, 28 microgestin 1.5/30, 13 Multi Prenatal, 31 melphalan hydrochloride, 3 microgestin 1/20, 13 mupirocin, 9

Menest, 12 microgestin FE, 13 mupirocin calcium, 9

Menostar, 12 microgestin FE 1.5/30, 13 Muse, 8

Mentax, 9 Microlet Lancets, 34 Mustargen, 3 meperidine HCL, 27 Microspacer, 36 my way, 12

Meperidine HCL, 28 Microtainer Safety Flow Myambutol, 2 meprobamate, 20 Mycobutin, 2 Lancet/Sterile/Single-use, 34 Mepron, 3 Microzide, 7 mycophenolate mofetil, 4 mercaptopurine, 3 midodrine HCL, 7 mycophenolic acid DR, 4 mesalamine, 17 Migergot, 29 Mydfrin, 25 mesna, 5 Migral, 29 myferon 150, 19

Mesnex, 5 Migranal, 29 Myfortic, 4

Mestinon, 24 Millipred, 12 Myglucohealth Blood Glucose Test, 36

Mestinon Timespan, 24 Millipred DP, 12 Myglucohealth Mgh Softlance Lancets

Metadate CD, 22 Minastrin 24 FE, 13 30G, 34 Metaproterenol Sulfate, 30 Mineral Oil Heavy, 16 Mykidz Iron 10, 19 metaxalone, 24 Minipress, 7 Myleran, 3 metformin HCL, 14 miniprin low dose, 26 Mynatal, 32 metformin HCL ER, 14 Minivelle, 12 Mynatal Advance, 32 methadone HCL, 27 Minocin, 1 Mynatal Ultracaplet, 32

Methadone HCL, 28 minocycline HCL, 1 Myobloc, 24

Methadose, 28 minocycline HCL ER, 1 Myoxin, 26

Methadose Sugar-free, 28 minoxidil, 6 Myozyme, 16 methamphetamine HCL, 22 Mirapex, 23 Myrbetriq, 18 methazolamide, 7 Mirapex ER, 23 Mysoline, 23 methenamine hippurate, 18 Mircette, 13 myzilra, 13 methenamine mandelate, 18 mirtazapine, 21 N Methenamine Mandelate, 18 mirtazapine odt, 21 nabumetone, 28 methimazole, 16 Mirvaso, 9 nadolol, 5 methocarbamol, 24 misoprostol, 16 nadolol/bendroflumethiazide, 7 methotrexate, 3 Mission Prenatal, 31 Nafrinse Daily/Acidulated, 20 methotrexate sodium, 3 Mission Prenatal HP, 31 Nafrinse Daily/Neutral, 20 methoxsalen, 10 Mitosol, 25 Nafrinse Weekly, 20 methscopolamine bromide, 16 mitoxantrone HCL, 3 Naftin, 9 Methyclothiazide, 7 Mlk F4 Kit, 12 Naglazyme, 16 methyldopa, 6 MM aspirin, 27 Nalfon, 28 Methyldopa/Hydrochlorothiazide, 7 Mobic, 28 Namenda, 24 methylergonovine maleate, 26 modafinil, 22 Namenda Titration PAK, 24 Methylin, 22 Moderiba, 2 Namenda XR, 24 methylphenidate HCL, 22 Moderiba 1200 Dose Pack, 2 Namenda XR Titration Pack, 24 methylphenidate HCL CD, 22 Moderiba 800 Dose Pack, 2 Naphazoline HCL, 25 methylphenidate HCL ER, 22 Modicon, 13 Naprelan, 28 Methylphenidate HCL ER, 22 moexipril HCL, 6 Naprosyn, 28 methylphenidate HCL SR, 22 moexipril/hydrochlorothiazide, 7 naproxen, 28 methylphenidate hydrochloride, 22 mometasone furoate, 10 naproxen sodium, 28 methylprednisolone, 12 Moms Choice RX, 32 naratriptan HCL, 28 methylprednisolone dose pack, 12 mono-linyah, 13 Nardil, 21 Metipranolol, 25 Monoclate-p, 20 Nasacort AQ, 29 metoclopramide HCL, 17 Monodox, 1 Nasonex, 29 metolazone, 7 Monolet Lancets, 34 Nat-rul Prenatal Vitamins, 31 metoprolol succinate ER, 5 Monolet Opd Lancets, 34 Natachew, 32 metoprolol tartrate, 5 Monolettor Safety Lancets, 34 Natacyn, 24 metoprolol/hydrochlorothiazide, 7 mononessa, 12 Natafort, 32 Metozolv Odt, 17 Mononine, 20 Natalvirt 90 DHA, 32 Metrocream, 9 montelukast sodium, 30 Natalvirt CA, 32 Metrogel, 9 Monurol, 18 Natalvit, 32 Metrogel-vaginal, 18 morphine sulfate, 27 Natazia, 12 Metrolotion, 9 Morphine Sulfate, 28 nateglinide, 14 metronidazole, 3, 9 morphine sulfate ER, 27 Natelle One, 32 metronidazole vaginal, 18 Motofen, 16 Natroba, 11

Nature-throid, 16 nicotine polacrilex starter kit, 23 Nova Sureflex Lancets, 34

Nature-throid Nt-2.5, 16 nicotine step 1, 23 Novaferrum 50, 19

Navelbine, 4 nicotine step 2, 23 Novaferrum Pediatric Drops, 19

Nebupent, 3 nicotine step 3, 23 Novofine 30GX8MM, 34

Nebusal, 30 nicotine transdermal system, 23 Novofine 32GX6MM, 34 necon 0.5/35-28, 13 Nicotine Transdermal System, 23 Novofine Autocover 30GX8MM, 34 necon 1/35, 13 Nicotrol Inhaler, 23 Novolin 70/30, 14

Necon 1/50-28, 13 Nicotrol Ns, 23 Novolin 70/30 Relion, 14

Necon 10/11-28, 13 nifedipine, 6 Novolin N, 14 necon 7/7/7, 13 nifedipine ER, 6 Novolin N Relion, 14

Neevo DHA, 32 nikki, 13 Novolin R, 14 nefazodone HCL, 21 Nilandron, 4 Novolin R Relion, 14

Nefazodone HCL, 21 nimodipine, 6 Novolog, 14

Neo-synalar, 9 Nipent, 5 Novolog Flexpen, 14

Neo-synalar Kit, 9 Niravam, 20 Novolog Mix 70/30, 14 neomycin sulfate, 1 nisoldipine, 6 Novolog Mix 70/30 Prefilled Flexpen, 14 neomycin/bacitracin/polymyxin, 24 Nisoldipine, 6 Novolog Penfill, 14 neomycin/polymyxin/bacitracin zinc, 24 Nisoldipine ER, 6 Novoseven, 20 neomycin/polymyxin/bacitracin/hydrocorti Nitro-bid, 5 Novoseven Rt, 20

Nitro-dur, 5 Novotwist 30GX8MM, 34 sone, 25 neomycin/polymyxin/dexamethasone, 25 nitrofurantoin, 18 Novotwist 32GX5MM, 34 neomycin/polymyxin/gramicidin, 24 nitrofurantoin macrocrystals, 18 Noxafil, 2 neomycin/polymyxin/HC, 26 nitrofurantoin monohydrate, 18 Nplate, 19

Neomycin/Polymyxin/Hydrocortisone, 25 nitrofurantoin nu-iron 150, 19 neomycin/polymyxin/hydrocortisone, 26 Nucort, 10 monohydrate/macrocrystals, 18 Neoral, 4 nitroglycerin, 5 Nucynta, 27

Neosalus, 11 nitroglycerin lingual, 5 Nucynta ER, 27

Neosalus CP, 11 Nitroglycerin Lingual, 5 Nuedexta, 24

Neosporin, 25 nitroglycerin transdermal, 5 Nulojix, 4

Neotuss Plus, 30 Nitrolingual Pumpspray, 5 Nulytely/Flavor Packs, 16

Neptazane, 7 Nitromist, 5 Numoisyn, 20

Nesina, 15 Nitrostat, 5 Nuox, 9

Nestabs, 32 Nivatopic Plus, 11 Nutridox, 1

Nestabs Abc, 32 nizatidine, 16 Nutropin, 15

Nestabs DHA, 32 Nizoral, 9 Nutropin AQ Nuspin 10, 15

Netgroup Lancets, 34 Nor-QD, 14 Nutropin AQ Nuspin 20, 15

Neuac Kit, 9 nora-be, 13 Nutropin AQ Nuspin 5, 15

Neulasta, 19 Norco, 28 Nutropin AQ Pen, 15

Neumega, 19 Norditropin Cartridge, 15 Nuvail, 11

Neupogen, 19 Norditropin Flexpro, 15 Nuvaring, 12

Neupro, 23 Norditropin Nordiflex Pen, 15 Nuvigil, 22

Neurontin, 23 norethindrone, 13 Nuzon, 10

Neutek 2tek Test Strips, 36 norethindrone acetate, 14 Nymalize, 6

Neutrasal, 20 norethindrone acetate/ethinyl estradiol, nystatin, 2, 9, 20

Nevanac, 26 Nystatin, 9 13 nevirapine, 2 norethindrone acetate/ethinyl Nystatin Foreign, 9

Nevirapine, 2 nystatin/triamcinolone, 9 estradiol/ferrous fumarate, 13 nevirapine ER, 2 norgestimate/ethinyl estradiol, 13 O Newgen, 32 Norinyl 1+35, 14 O-CAL Fa, 32 Nexa Plus, 32 Norinyl 1+50, 14 O-CAL Prenatal, 32 Nexa Select, 32 Noritate, 9 OB Complete, 32 Nexavar, 5 norlyroc, 13 OB Complete 400, 32 Nexgen Test Strips, 36 Noroxin, 1 OB Complete One, 32 next choice one dose, 12 Norpace, 6 OB Complete Petite, 32 niacin ER, 8 Norpace CR, 6 OB Complete Premier, 32 Niacor, 8 Norpramin, 21 OB Complete/DHA, 32 Niaspan, 8 Northera, 7 OB-natal One, 32 nicardipine HCL, 6 nortrel 0.5/35 (28), 13 Obstetrix DHA, 32 Nicazeldoxy 30 Kit, 1 nortrel 1/35, 13 Obstetrix EC, 32 Nicazeldoxy 60 Kit, 1 nortrel 7/7/7, 13 ocella, 13 Nicoderm CQ, 23 nortriptyline HCL, 21 octreotide acetate, 15 nicorelief, 23 Nortriptyline HCL, 21 Ocufen, 26 Nicorette, 23 Norvasc, 6 Ocuflox, 25 Nicorette Mini, 23 Norvir, 2 ofloxacin, 1, 24, 26 Nicorette Starter Kit, 23 norwich aspirin, 26 Ofloxacin, 1 nicotine, 23 Nova Max Glucose Test Strips, 36 Ogestrel, 14 nicotine polacrilex, 23 Nova Safety Lancets 23G, 34 olanzapine, 21 nicotine polacrilex refill, 23 Nova Safety Lancets 28G, 34 olanzapine odt, 21

olanzapine/fluoxetine, 23 36 oxymorphone hydrochloride, 27

Oleptro, 21 Optichamber Diamond/Medium Face oxymorphone hydrochloride ER, 27

Olux, 10 Mask, 36 P Olux-e, 10 Optichamber Diamond/Smallface Mask, PA Prenatal Formula, 31 Olysio, 2 36 paclitaxel, 4 Omeclamox-PAK, 17 Optihaler, 36 Paclitaxel, 4 omega-3-acid ethyl esters, 8 Optihaler MDI Drug Delivery System, 36 Paire OB, 32 omeprazole, 16 Optium Test Strips, 36 Palgic, 29 Omeprazole + Syrspend SF Alka, 17 Optiumez Test Strips, 36 Pamelor, 21 Omnaris, 29 Optivar, 26 pamidronate disodium, 15 Omnipred, 25 Optumrx Blood Glucose Test, 36 Pamidronate Disodium, 15 Omnitrope, 15 Oracea, 9 Pamine, 17 Omontys, 19 Oracit, 18 Pamine Forte, 17 On Call Express Blood Glucose Test Orafate, 20 Pamine FQ, 17 Orap, 24 Strips, 36 Panatuss Dxp, 30 On Call Lancets, 34 Orapred, 12 Pancreaze, 17 On Call Plus Blood Glucose Test, 36 Orapred Odt, 12 Pancrelipase, 17 On Call Plus Lancets, 34 Oravig, 20 Pandel, 10 On Call Vivid Blood Glucose Test, 36 Oraxyl, 1 Parafon Forte DSC, 24 On Call Vivid Blood Glucose Test Strips, Orbactiv, 3 Paragard Intrauterine Copper Orbivan, 27 36 Oncaspar, 3 Orbivan CF, 27 Contraceptive T380a, 14 Parcopa, 23 ondansetron HCL, 17 Orencia, 28 paricalcitol, 16 ondansetron odt, 17 Orenitram, 8 Parlodel, 23 One A Day Womens Prenatal/DHA, 31 Orfadin, 16 Parnate, 21 One-a-day Womens Prenatal, 31 orphenadrine citrate ER, 24 paromomycin sulfate, 1 Onetouch Basic System, 34 orphenadrine/asa/caffeine, 24 paroxetine HCL, 21 Onetouch Basic/Profile Test Strips, 34 orsythia, 13 paroxetine HCL ER, 21 Onetouch Club Lancets Fine Point, 34 Ortho Evra, 14 Paser, 2 Onetouch Combo Pack, 34 Ortho Micronor, 14 Pataday, 26 Onetouch Delica Lancets Extra Fine 33G, Ortho Tri-cyclen, 14 Patanase, 29 Ortho Tri-cyclen LO, 14 34 Patanol, 26 Onetouch Delica Lancets Fine 30G, 34 Ortho-cept, 14 Paxil, 21 Onetouch Delica Lancing Device, 34 Ortho-cyclen, 14 Paxil CR, 21 Onetouch Finepoint Lancets, 34 Ortho-novum 1/35, 14 PCE, 1 Onetouch Lancets, 34 Ortho-novum 7/7/7, 14 Pediaderm AF Complete Kit, 9 Onetouch Profile System, 34 Orthovisc, 24 Pediaderm HC, 10 Onetouch Suresoft Lancing Device/18G, Oseni, 15 Pediaderm Ta, 10 Osmoprep, 16 34 Pediapred, 12 Onetouch Suresoft Lancing Device/21G, Osphena, 15 Pediatex TD, 30 Otezla, 28 34 Pediatex TDM, 30 Onetouch Suresoft Lancing Device/28G, Otozin, 26 Pedipirox-4 Nail, 9 Otrexup, 28 34 peg 3350/electrolytes, 16 Onetouch Ultra 2, 34 Ovace Plus, 10 peg-3350/electrolytes, 16 Onetouch Ultra Blue, 34 Ovace Plus Wash, 10 peg-3350/NACL/NA bicarbonate/KCL, 16 Onetouch Ultra Mini, 34 Ovace Wash, 10 Peg-intron, 2 Onetouch Ultra System Kit, 34 Ovcon-35, 14 Peg-intron Redipen, 2 Onetouch Ultralink System (DEC), 34 Ovide, 11 Peg-intron Redipen PAK 4, 2 Onetouch Ultralink System (hex), 34 oxaliplatin, 3 Peganone, 22 Onetouch Ultrasmart, 34 Oxandrin, 12 Pegasys, 2 Onetouch Ultrasoft Lancets, 34 oxandrolone, 12 Pegasys Proclick, 2 Onetouch Verio IQ Blood Glucose oxaprozin, 28 Pen Needles 29G X 12MM, 34 oxazepam, 20 Monitoring System, 34 Pen Needles 29GX1/2", 34 Onetouch Verio Sync Bloodglucose oxcarbazepine, 22 Pen Needles 30GX5/16", 34 Oxecta, 28 Monitoring System, 34 Pen Needles 31G X 1/4" SHORT, 34 Onetouch Verio Test Strips, 34 Oxistat, 9 Pen Needles 31G X 3/16", 34 Onfi, 22 Oxsoralen, 11 Pen Needles 31G X 6MM, 34 Onglyza, 15 Oxsoralen Ultra, 10 Pen Needles 31GX5/16", 34 Onmel, 2 Oxtellar XR, 23 penicillin v potassium, 1 Opana, 28 oxybutynin chloride, 18 Pennsaid, 9 Opana ER (crush Resistant), 27 oxybutynin chloride ER, 18 Pentam 300, 3 opium, 16 oxycodone HCL, 27 Pentasa, 17 opium tincture, 16 Oxycodone HCL, 28 pentazocine/acetaminophen, 27 Opium Tincture (paregoric), 16 Oxycodone HCL ER, 27 pentazocine/naloxone HCL, 27 Opsumit, 8 oxycodone/acetaminophen, 27 pentoxifylline ER, 20 Optichamber Advantage, 36 oxycodone/aspirin, 27 Pepcid, 17 Optichamber Diamond, 36 oxycodone/ibuprofen, 27 Percocet, 28 Optichamber Diamond/Largeface Mask, Oxycontin, 27 Percodan, 28

Perfect Iron, 19 Polytrim, 25 Prenatal One Daily, 31

Perfect Lancets 30G, 34 Pomalyst, 4 Prenatal Plus DHA, 31

Perfect Pressure Activated Safety Ponstel, 28 Prenatal Vitamins, 31

portia-28, 13 Prenatal-u, 32 Lancets 28G, 34 Perforomist, 30 potassium citrate ER, 18 Prenatal/Omega-3/Folic Acid/Iron, 31

Peridex, 20 potassium citrate-citric acid crystals, 18 Prenate, 32 perindopril erbumine, 6 Potiga, 22 Prenate AM, 32

Perjeta, 4 Pr Cream, 11 Prenate DHA, 32 permethrin, 11 Pr Natal 400, 32 Prenate Elite, 32 perphenazine, 21 Pr Natal 400 EC, 32 Prenate Enhance, 32

Perphenazine/Amitriptyline, 24 Pr Natal 430, 32 Prenate Essential, 32

Perry Prenatal, 31 Pr Natal 430 EC, 32 Prenate Mini, 32

Persantine, 20 Pradaxa, 19 Prenate Pixie, 32

Pertzye, 17 pramipexole dihydrochloride, 23 Prenate Restore, 32

Pexeva, 21 Pramosone, 10 Prenate Star, 32

Pharmacist Choice Autocode Blood Pramosone E, 10 Prenexa, 32

Pramotic, 26 Prepopik, 16 Glucose Test Strips, 36 Pharmacy Counter Lancets, 34 Prandimet, 15 Preque 10, 32 phenazopyridine HCL, 18 Prandin, 14 Presera, 11 phenelzine sulfate, 21 Prastera, 28 Prestige Test Strips, 36 phenobarbital, 22 Pravachol, 8 Prevacid, 17

Phenobarbital, 22 pravastatin sodium, 8 Prevacid Solutab, 17 phenylephrine HCL, 25 Prazolamine, 24 Prevident, 20

Phenylephrine HCL, 29 prazosin HCL, 6 previfem, 13 phenylephrine/guaifenesin, 29 Pre-natal Formula, 31 Prevnar 13, 31

Phenytek, 23 Precision PCX, 36 Prevpac, 17 phenytoin, 22 Precision PCX Plus Test Strips, 36 Prezista, 2 phenytoin sodium extended, 22 Precision Point Of Care Test Strips, 36 Prialt, 27 philith, 13 Precision QID Test Strips, 36 Priftin, 2

Phoslo, 17 Precision Sof-tact Test Strips, 36 Prilosec, 17

Phoslyra, 17 Precision Thin Lancets, 34 Primaquine Phosphate, 3

Phospholine Iodide, 25 Precision Thins GP Lancet, 34 primidone, 22

Phrenilin Forte, 27 Precision Ultra Lancet, 34 Primlev, 28

Physicians EZ Use Flu Kit 2012-2013, 31 Precision XTRA Blood Glucose Test Primsol, 3

Pic 200, 19 Prinivil, 6 Strips, 36 pilocarpine HCL, 20, 25 Precose, 15 Pristiq, 21 pilocarpine hydrochloride, 20 Pred Forte, 25 Proair HFA, 30

Pilopine HS, 25 Pred Mild, 25 probenecid, 29 pimtrea, 13 Pred-G, 25 probenecid/colchicine, 29 pindolol, 5 Pred-G S.o.p., 25 Procardia, 6 pioglitazone HCL, 15 prednicarbate, 10 Procardia XL, 6 pioglitazone HCL-glimepiride, 15 prednisolone, 12 Procentra, 22 pioglitazone HCL/metformin HCL, 15 prednisolone acetate, 25 prochlorperazine, 21 pirmella 1/35, 13 prednisolone sodium phosphate, 12 prochlorperazine maleate, 21 pirmella 7/7/7, 13 Prednisolone Sodium Phosphate, 12, 25 Procort, 17 piroxicam, 28 prednisone, 12 Procrit, 19

Plan B, 14 Prednisone, 12 Proctocort, 17

Plan B One-step, 14 Prednisone Intensol, 12 Proctofoam HC, 17

Plaquenil, 3 Prefera OB, 32 Procysbi, 18

Plavix, 20 Prefera OB + DHA, 32 Prodigy NO Coding Blood Glucose Test

Pletal, 20 Preferaob One, 32 Strips, 36 Plexion, 9 Prefest, 12 Prodigy Pressure Activated Safety

Plexion Cleanser, 9 Prefol-DHA, 32 Lancets, 34 Plexion Cleansing Cloths, 9 Prelone, 12 Prodigy Twist Top Lancets, 34

Pliaglis, 11 Premarin, 12, 18 Profe, 19

Pneumovax 23, 31 Premphase, 12 Proferrin ES, 19

Pneumovax 23/1 Dose, 31 Prempro, 12 Profilnine SD, 20

Pneumovax 23/5 Dose, 31 Prenata, 32 progesterone, 14

Pocket Chamber, 36 Prenatabs RX, 32 Progesterone, 14

Pocket Spacer, 36 Prenatal, 31 Progesterone Micronized, 14

Pocketchem EZ Blood Glucose Test Prenatal Ad, 32 Progesterone Micronized (soy), 14

Prenatal And Iron, 31 Progesterone Micronized (yam), 14 Strips, 36 podofilox, 11 Prenatal Complete, 31 Progesterone Micronized Premium, 14 poly-iron 150, 19 Prenatal Formula, 31 Progesterone Milled, 14

Poly-tussin DHC, 30 Prenatal Forte, 31 Progesterone Ultra Micronized, 14 polyethylene glycol 3350, 16 Prenatal Low Iron, 31 Progesterone Wettable, 14 polymyxin b sulfate/trimethoprim sulfate, Prenatal Multi +dha, 31 Progesterone Wettable (yam), 14

Prenatal Multivitamin + DHA, 31 Proglycem, 14 24

Prograf, 4 Qc Prenatal, 31 36

Prolastin-c, 30 Qnasl, 29 Reglan, 17

Prolensa, 26 Qualaquin, 3 Relagard, 18

Proleukin, 5 Quartette, 14 Relenza Diskhaler, 2

Prolia, 15 quasense, 13 Relhist, 30

Promacta, 19 Quazepam, 22 Relion Blood Glucose Teststrips, 36 promethazine HCL, 29 Qudexy XR, 23 Relion Confirm/Micro Test Strips, 36 promethazine HCL plain, 29 Quelicin, 24 Relion Insulin Syringe/U-100/0.5ML/29G promethazine-DM, 29 Questran, 8 X 1/2", 36 promethazine/codeine, 29 Questran Light, 8 Relion Lancets, 34 promethazine/dextromethorphan, 29 quetiapine fumarate, 21 Relion Lancets Micro-thin33G, 34

Prometrium, 14 Quicktek Test Strips, 36 Relion Lancets Standard 21G, 34

Promiseb, 10 Quillivant XR, 22 Relion Lancets Thin 26G, 34

Promiseb Complete, 10 quinapril HCL, 6 Relion Lancets Ultra-thin30G, 34 propafenone HCL, 6 quinapril/hydrochlorothiazide, 7 Relion Prime Blood Glucose Test Strips, propafenone HCL ER, 6 quinidine gluconate CR, 6 36 Propantheline Bromide, 17 quinidine gluconate ER, 6 Relion R, 14 proparacaine HCL, 25 quinidine sulfate, 6 Relion Thin Lancets, 34 propranolol HCL, 5 Quinidine Sulfate, 6 Relion Ultima Blood Glucose Test Strips,

Propranolol HCL, 6 Quinidine Sulfate ER, 6 36 propranolol HCL ER, 5 quinine sulfate, 3 Relion Ultima Test Strips, 36

Propranolol/Hydrochlorothiazide, 7 Quintet Ac Blood Glucose Test Strips, 36 Relion Ultra Thin Lancets, 34 propylthiouracil, 16 Quintet Blood Glucose Test Strips, 36 Relion Ultra Thin Lancets30G, 34

Proscar, 18 Qutenza, 11 Relion Ultra Thin Plus Lancets 32G, 34

Prosed/DS, 18 Qvar, 30 Relion Ultra Thin Plus Lancets 33G, 34

Prostigmin, 24 Relpax, 29 R Protectnatal, 32 Remeron, 21 R-natal OB, 32 Prothelial, 20 Remeron Soltab, 21 ra aspirin, 26 Protopic, 11 Remicade, 18 ra aspirin adult low dose, 26 protriptyline HCL, 21 Remodulin, 8 ra aspirin adult low strength, 26 Provenge, 5 Renacidin, 18 ra aspirin childrens, 26 Proventil HFA, 30 Renagel, 17 ra aspirin EC, 26 Provera, 14 Renew Advanced Lancing Cartridge ra aspirin EC adult low strength, 26 Provida OB, 32 Refills, 34 ra childrens aspirin, 26 Provigil, 22 Renvela, 17 ra folic acid, 19 Prozac, 21 repaglinide, 14 ra high potency iron, 19 Prozac Weekly, 21 Replesta, 31 ra iron, 19 Pruclair, 11 Replesta Childrens, 31 ra mini nicotine, 23 Prudoxin, 9 Replesta Nx, 31 ra nicotine, 23 Prumyx, 11 Reprexain, 28 ra nicotine polacrilex, 23 Pss Select GP Lancets, 34 Requip, 23 ra nicotine transdermal system step 3, 23 Pss Select Safety Lancets, 34 Requip XL, 23 Ra One Daily, 31 Pts Panels Glucose Test, 36 Rescon-JR, 30 Ra Prenatal, 31 Pulmicort, 30 Rescon-MX, 30 Ra Prenatal Formula/Folicacid, 31 Pulmicort Flexhaler, 30 Rescriptor, 2 ra slow release iron, 19 Pulmophylline, 30 Rescula, 25 raloxifene hydrochloride, 15 Pulmozyme, 30 Reserpine, 7 ramipril, 6 Purinethol, 3 Respa-BR, 29 Ranexa, 5 Purixan, 3 Restasis, 25 ranitidine HCL, 16 px aspirin, 26 Restora RX, 16 Rapaflo, 18 px enteric aspirin, 26 Restoril, 22 Rapamune, 4 px folic acid, 19 Retin-a, 9 Rasuvo, 28 px iron, 19 Retin-a Micro, 9 Ravicti, 16 Px Lancets Ultra Thin, 34 Retin-a Micro P.M., 9 Rayos, 12 Px Prenatal Multivitamins, 31 Retisert, 25 Razadyne, 24 px stop smoking aid, 23 Retrovir, 2 Razadyne ER, 24 Pylera, 17 Retrovir IV Infusion, 2 Rebetol, 2 pyrazinamide, 2 Revatio, 8 Rebif, 24 Pyridium, 18 Reveal Blood Glucose Test, 36 Rebif Rebidose, 24 pyridostigmine bromide, 24 Revlimid, 4 Rebif Rebidose Titration Pack, 24 Pyrogallic Acid, 11 Rexall Blood Glucose Test Strips, 36 Rebif Titration Pack, 24 Rexall Lancets Ultra Thin, 34 Q Reclast, 15 Reyataz, 2 qc aspirin, 26 reclipsen, 13 Rezira, 30 qc aspirin low dose, 26 Recombinate, 20 Rezyst IM, 16 qc childrens aspirin, 26 Recothrom, 19 Rezyst SB, 16 qc ferrous sulfate, 19 Recothrom Spray Kit, 19 Rheumatrex, 28 Qc Lancets Super Thin, 34 Rectiv, 17 Rhinocort Aqua, 29 Qc Lancets Ultra Thin, 34 Refuah Plus Blood Glucosetest Strips,

Rhinoflex-650, 27 Safety Lancet 28G/Pressure Activated, Seroquel XR, 21

Riastap, 20 Serostim, 15 34 Riax, 9 Safety Lancet 2MM, 34 sertraline HCL, 21

Ribasphere, 2 Safety Lancets, 34 Sevelamer Carbonate, 17

Ribasphere Ribapak, 2 Safety Lancets 21G, 34 Sfrowasa, 18

Ribatab, 3 Safety Lancets 28G, 34 sharobel, 13 ribavirin, 2 Safety Let Lancets, 34 Shohls Solution Modified, 18

Ridaura, 28 Safety Seal Lancets 28G, 34 Shopko On-the-go Comfort Lancets 30G, rifabutin, 2 Safety Seal Lancets 30G, 34 34 Rifadin, 2 Safyral, 13 Shopko Unilet Lancets Super Thin 30G,

Rifamate, 2 Saizen, 15 34 rifampin, 2 Saizen Click.easy, 15 Shopko Unilet Lancets Ultra Thin 28G,

Rifater, 2 Salagen, 20 34 Right Step Prenatal, 31 Salex, 11 Signifor, 15

Rightest Gl300 Lancets, 34 Salex Cream, 11 sildenafil, 8

Rightest GS100 Blood Glucose Test Salex Lotion, 11 sildenafil citrate, 8

salicylic acid, 11 Silenor, 22 Strips, 36 Rightest GS300 Blood Glucose Test Salicylic Acid, 11 Simbrinza, 25

salicylic acid cream, 11 Simcor, 8 Strips, 36 Rightest GS550 Blood Glucose Test Salicylic Acid IN Ammonium Lactate Similac Prenatal Early Shield, 31

Simponi, 28 Strips, 36 Vehicle, 11 Rilutek, 24 salicylic acid lotion, 11 Simponi Aria, 28 riluzole, 24 Salkera, 11 simvastatin, 8 rimantadine HCL, 2 salsalate, 27 Sinemet, 23

Rimantalist, 2 Salvax, 11 Sinemet CR, 23

Riomet, 14 Salvax Duo Plus, 11 Single-let, 34 risedronate sodium, 15 Samsca, 16 Singulair, 30

Risperdal, 21 Sanctura, 18 sirolimus, 4

Risperdal M-TAB, 21 Sanctura XR, 18 Sirturo, 2 risperidone, 21 Sancuso, 17 Sitavig, 2 risperidone odt, 21 Sandimmune, 4 Sivextro, 3

Ritalin, 22 Sandostatin, 15 Skelaxin, 24

Ritalin LA, 22 Sandostatin Lar Depot, 15 Sklice, 11

Ritalin SR, 22 Saphris, 21 Slow FE, 19

Riteflo, 36 Sarafem, 24 slow iron, 19

Rituxan, 4 Savella, 24 slow release iron, 19 rivastigmine tartrate, 24 Savella Titration Pack, 24 Slow Release Iron, 19 rizatriptan benzoate, 28 SB aspirin, 27 sm aspirin, 26 rizatriptan benzoate odt, 28 SB aspirin EC, 27 sm aspirin adult low strength, 26

Robaxin, 24 SB childrens aspirin, 27 sm aspirin EC low strength, 26

Robaxin-750, 24 SB low dose asa EC, 27 sm aspirin enteric coated, 26

Robinul, 17 Scalacort DK, 10 sm aspirin low dose, 26

Robinul Forte, 17 Seasonique, 14 sm childrens aspirin, 26

Rocaltrol, 16 Seb-prev, 10 sm folic acid, 19 ropinirole ER, 23 Seconal, 22 sm iron, 19 ropinirole HCL, 23 Sectral, 6 sm iron slow release, 19

Rosadan Kit, 9 Select-OB, 32 sm nicotine, 23

Rosanil, 9 Select-ob+dha, 32 sm nicotine polacrilex, 23

Rowasa, 17 selegiline HCL, 23 Sm One Daily Prenatal, 31

Roxicet, 28 selenium sulfide, 10 sm prenatal vitamins, 31

Roxicodone, 28 Selenium Sulfide, 10 Sm Prenatal Vitamins, 31

Rozerem, 22 Selrx, 10 Sm Slow Release Iron, 19

Ryanodex, 24 Selsun Shampoo, 10 Smart Diabetes Vantage Universal

Rybix Odt, 28 Selzentry, 2 Lancets 30G, 34 Rythmol, 6 Semprex-d, 30 Smart Diabetes Xpres Blood Glucose

Rythmol SR, 6 Senophylline, 30 Test Strips, 36 Sensipar, 16 Smart Sense Color Lancets Universal S Sentradine, 17 33G, 34 Sabril, 23 Sentraflox AM-10, 21 Smart Sense Premium Bloodglucose Safe-t-lance Low Flow 25G, 34 Sentralopram AM-10, 21 Strips, 36 Safe-t-lance Normal Flow 21G, 34 Sentramodafin AM-100, 22 Smart Sense Standard Lancets Universal

Safe-t-lance Plus Safety Lancet High Sentravil PM-25, 21 21G, 34 Flow, 34 Sentrazolam AM 0.25, 20 Smart Sense Super Thin Lancets

Safe-t-lance Plus Safety Lancet Low Sentrazolpidem PM-5, 22 Universal 30G, 34 Flow, 34 Sentroxatine, 21 Smart Sense Thin Lancets Universal Safe-t-lance Plus Safety Lancet Normal Serevent Diskus, 30 26G, 34 Flow, 34 Seromycin, 2 Smart Sense Value Blood Glucose Strips,

Safety Lancet 21G/Pressure Activated, Seroquel, 21 36

34

Smartest Blood Glucose Test Strips, 36 Sterilance TL, 34 Sylatron, 5

Smartest Lancets 28G, 34 Stimate, 16 Symax Duotab, 17

Sodium Bicarbonate, 16 Stivarga, 5 Symbicort, 30 sodium chloride, 29 Strattera, 22 Symbyax, 24 sodium hyaluronate, 11 Strazepam, 22 Symlinpen 120, 14 sodium phenylbutyrate, 16 Striant, 12 Symlinpen 60, 14 sodium sulfacetamide, 8, 10, 24 Stribild, 2 Synalar, 10 sodium sulfacetamide wash, 10 Striverdi Respimat, 30 Synalar Cream Kit, 10 sodium sulfacetamide/sulfur, 8 Stromectol, 3 Synalar Ointment Kit, 10

Sodium Sulfacetamide/Sulfur, 9 Stuart One, 31 Synalar Ts, 10 sodium sulfacetamide/sulfur cleanser, 8 Stuart Prenatal, 31 Synalgos-dc, 28

Sodium Sulfacetamide/Sulfur Cleanser IN Stuart Prenatal + DHA, 31 Synarel, 15

Suboxone, 27 Synera, 11 Urea, 9 sodium sulfacetamide/sulfur cleansing Subsys, 28 Synribo, 5

Suclear, 16 Synthroid, 16 cloths, 8 sodium sulfacetamide/sulfur green, 8 Sucraid, 17 Synvisc, 24

Sodium Sulfacetamide/Sulfur IN Urea, 9 sucralfate, 17 Synvisc One, 24 sodium sulfacetamide/sulfur w/sunscreen, Sular, 6 T sulfacetamide sodium, 8, 24 8 Tabloid, 4 sodium sulfacetamide/sulfur wash, 8 Sulfacetamide Sodium, 25 Taclonex, 10 Sodium Sulfacetamide/Urea, 10 sulfacetamide sodium/prednisolone tacrolimus, 4 solia, 13 sodium phosphate, 25 Tafinlar, 5 Soliris, 20 sulfacetamide sodium/sulfur cleanser, 8 take action, 12 Solodyn, 1 Sulfadiazine, 2 Tambocor, 6 Soltamox, 4 sulfamethoxazole/trimethoprim, 3 Tamiflu, 2 Solus V2 Audible Test, 36 sulfamethoxazole/trimethoprim DS, 3 tamoxifen citrate, 4 Solus V2 Pressure Activated Safety sulfasalazine, 17 tamsulosin HCL, 18 Sulfisoxizole, 2 Lancets 28G, 34 Tanzeum, 14 Solus V2 Twist Lancets 30G, 34 Sulfoam, 9 Tapazole, 16 Soma, 24 Sulfurated Lime, 11 Tarceva, 4 Somatuline Depot, 15 sulindac, 28 Targretin, 5 Somavert, 16 Sumadan Kit, 9 Tarka, 7 Sonata, 22 Sumadan Wash, 9 Taron-bc, 32 Soriatane, 10 Sumadan XLT, 9 Taron-c DHA, 32 Sorilux, 10 Sumatriptan, 29 Taron-duo EC, 32 sotalol HCL, 5 sumatriptan succinate, 29 Taron-prex, 32 sotalol HCL (AF), 5 Sumatriptan Succinate, 29 Tasigna, 4 Sovaldi, 3 sumatriptan succinate refill, 29 Tasmar, 23 Spectracef, 1 Sumavel Dosepro, 29 Taxotere, 4 Spinosad, 11 Sumaxin, 9 Tazorac, 10 Spiriva Handihaler, 30 Sumaxin CP Kit, 9 Tecfidera, 24 spironolactone, 7 Sumaxin Ts, 9 Tecfidera Starter Pack, 24 spironolactone/hydrochlorothiazide, 7 Sumaxin Wash, 9 Techlite AST Lancets, 35 Sporanox, 2 Supprelin LA, 15 Techlite Lancets, 35 Sporanox Pulsepak, 2 Suprax, 1 Techlite Lancets 30G, 35 sprintec 28, 12 Supreme Test Strips, 36 Tegretol, 23 Sprix, 28 Suprep Bowel Prep, 16 Tegretol-XR, 22 Sprycel, 5 Sure Edge Blood Glucose Test Strips, 36 Tekamlo, 7 SR nicotine gum, 23 Sure-lance Flat Lancets, 34 Tekturna, 6 sronyx, 12 Sure-lance Lancets 26G, 34 Tekturna HCT, 7 St Joseph Adult, 27 Sure-lance Thin Lancets 28G, 34 Telcare Blood Glucose Test Strips, 36 St Joseph Adult Analgesiclow Dose Bite Sure-lance Ultra Thin Lancets, 34 telmisartan, 6 Sure-test Easyplus Mini Blood Glucose Size, 27 telmisartan/amlodipine, 7 st joseph aspirin, 26 Test Strips, 36 telmisartan/hydrochloroth, 7 Staflex, 27 Sure-touch Lancets Universal, 35 telmisartan/hydrochlorothiazide, 7 Stalevo 100, 23 Surechek Blood Glucose Test Strips, 36 temazepam, 22 Stalevo 125, 23 Surelite Lancets, 35 Temodar, 3 Stalevo 150, 23 Surestep Pro Test Strips, 35 Temovate, 10 Stalevo 200, 23 Surestep Test Strips, 35 Temovate E, 10 Stalevo 50, 23 Surfaxin, 30 temozolomide, 3 Stalevo 75, 23 Surmontil, 21 Tencon, 27 stannous fluoride oral rinse, 20 Survanta Intratracheal, 30 Tenex, 7 Starlix, 14 Sustiva, 2 Tenoretic 100, 7 stavudine, 2 Sutent, 5 Tenoretic 50, 7 Stavzor, 23 Suttar-2, 30 Tenormin, 6 Staxyn, 8 Suttar-SF, 30 Terazol 3, 18 Stelara, 10 sw nicotine polacrilex, 23 Terazol 7, 18 Stendra, 8 syeda, 13 terazosin HCL, 6

terbinafine HCL, 2 Thrombin-jmi Syringe Spray Kit, 20 Transderm-scop, 17 terbutaline sulfate, 30 Thrombin-jmi W/Dil Spray P.M. Actuator, Tranxene T, 20 terconazole, 18 tranylcypromine sulfate, 21 20 Tersi Foam, 10 Thrombogen, 20 Travatan Z, 25

Tessalon Perles, 30 Thyrolar-1, 16 Travoprost, 25

Testim, 12 Thyrolar-1/2, 16 Trazamine, 21

Testosterone, 12 Thyrolar-1/4, 16 trazodone HCL, 21 testosterone cypionate, 12 Thyrolar-2, 16 Treanda, 3

Testosterone P.M., 12 Thyrolar-3, 16 Trecator, 2

Testred, 12 tiagabine hydrochloride, 22 Trelstar Depot, 4 tetracaine HCL, 25 Tiazac, 6 Trelstar Depot Mixject, 4

Tetracycline HCL, 1 ticlopidine HCL, 20 Trelstar LA, 4

Tetrix, 11 Tigan, 17 Trelstar LA Mixject, 4

Tev-tropin, 15 Tikosyn, 6 Trelstar Mixject, 4

Teveten, 6 tilia FE, 13 Trental, 20

Teveten HCT, 7 Timolol Maleate, 6 Trepadiclofen-25, 28

Texacort, 10 timolol maleate, 25 Trepoxen-250, 28 tgt aspirin, 27 timolol maleate ophthalmic gel forming, Trepoxicam-7.5, 28 tgt aspirin low dose, 27 Tretin-x, 9 25 tgt childrens aspirin, 27 Timoptic, 25 tretinoin, 5, 8 tgt enteric-coated aspirin, 27 Timoptic Ocudose, 25 tretinoin microsphere, 8 tgt nicotine gum, 23 Timoptic-xe, 25 tretinoin microsphere P.M., 8 tgt nicotine polacrilex, 23 Tindamax, 3 Tretten, 20 tgt nicotine step one, 23 tinidazole, 3 Trexall, 3 tgt nicotine step three, 23 Tirosint, 16 Treximet, 29 tgt nicotine step two, 23 Tisseel, 20 Trezix, 28 th aspirin, 27 Tivicay, 2 tri-estarylla, 13 th aspirin low dose, 27 tizanidine HCL, 24 tri-legest FE, 13 th enteric aspirin, 27 TL Triseb, 10 tri-linyah, 13 th folic acid, 19 TL-cermide, 11 Tri-norinyl 28, 14 th iron, 19 Tobi, 1 tri-previfem, 13

Th Prenatal Vitamins, 31 Tobi Podhaler, 1 tri-sprintec, 12 th slow release iron, 19 Tobradex, 25 triamcinolone acetonide, 10, 20, 29

Thalomid, 4 Tobradex ST, 25 Triamcinolone Acetonide, 10

Theo-24, 30 tobramycin, 1 triamcinolone IN orabase, 20 theophylline, 30 tobramycin sulfate, 24 triamterene/hydrochlorothiazide, 7 theophylline CR, 30 tobramycin/dexamethasone, 25 Triamterene/Hydrochlorothiazide, 7 theophylline ER, 30 Tobrex, 25 Trianex, 10

Thera-d 4000, 31 Tofranil, 21 triazolam, 22

Therabenzaprine-60, 24 Tofranil-PM, 21 Tribenzor, 7

Therabenzaprine-90, 24 tolazamide, 14 Tricare, 32

Therabenzaprine-90-5, 24 Tolazamide, 14 Tricare Prenatal Compleat, 32

Theracodeine-300, 28 Tolbutamide, 14 Tricare Prenatal DHA One, 32

Theracodophen-325, 28 tolmetin sodium, 28 Tricitrates, 18

Theracodophen-650, 28 Tolmetin Sodium, 28 Tricor, 8

Theracodophen-750, 28 tolterodine tartrate, 18 trifluoperazine HCL, 21

Theracodophen-low-90, 28 tolterodine tartrate ER, 18 trifluridine, 24

Therafeldamine, 28 Topamax, 23 Triglide, 8

Therapentin-60, 23 Topamax Sprinkle, 23 trihexyphenidyl HCL, 23

Therapentin-90, 23 Topicort, 10 Trileptal, 23

Theraprofen-60, 28 topiramate, 22 Trilipix, 8

Theraprofen-800, 28 Topiramate ER, 23 trimethobenzamide HCL, 17

Theraprofen-90, 28 topotecan HCL, 5 trimethoprim, 3

Theraproxen-500, 28 Topotecan HCL, 5 trimethoprim sulfate/polymyxin b sulfate,

Theraproxen-60, 28 Toprol XL, 6 24 Theraproxen-90, 28 Torisel, 5 trimipramine maleate, 21

Theratramadol-60, 28 torsemide, 7 Trinate, 32

Theratramadol-90, 28 Toviaz, 18 trinessa, 12

Thinlets GP Lancets, 35 Tracleer, 8 Triumeq, 2

Thinlets Lancet, 35 Tradjenta, 15 Triveen-duo DHA, 32

Thiola, 18 tramadol HCL, 27 Triveen-prx RNF, 32 thioridazine HCL, 21 tramadol HCL ER, 27 Triveen-ten, 32 thiothixene, 21 Tramadol HCL ER, 28 Triveen-u, 32 thrive, 23 tramadol hydrochloride/acetaminophen, trivora-28, 13

Thrombate Iii W/10 ML Sterile Water, 20 Trizivir, 2 27 Thrombate Iii W/20 ML Sterile Water, 20 Trandate, 6 Trokendi XR, 23

Thrombin-jmi Diluent, 20 trandolapril, 6 Tropazone, 11

Thrombin-jmi Epistaxis, 20 tranexamic acid, 19 trospium chloride, 18

trospium chloride ER, 18 Unilet GP 28 Ultra Thin, 35 Ventolin HFA, 30

True Metrix Blood Glucosetest Strips, 36 Unilet Lancet, 35 Veramyst, 29

Trueplus Lancets 26G, 35 Unilet Superlite Lancet, 35 verapamil HCL, 6

Trueplus Lancets 28G, 35 Uniretic, 7 Verapamil HCL, 6

Trueplus Lancets 28G Super Thin, 35 Unistik 3 Gentle, 35 verapamil HCL ER, 6

Trueplus Lancets 30G, 35 Unistrip1 Generic, 36 verapamil HCL SR, 6

Trueplus Lancets 30G Ultra Thin, 35 Univasc, 6 Verdeso, 10

Trueplus Lancets 33G, 35 Universal 1 Lancets Thin 26G, 35 Veregen, 11

Trueplus Lancets 33G Micro Thin, 35 Universal 1 Lancets Ultra Thin 30G, 35 Verelan, 6

Trueplus Safety Lancets 28G, 35 Uramaxin, 11 Verelan PM, 6

Truetest Blood Glucose T Est, 36 Uramaxin GT, 11 Veripred 20, 12

Truetest Blood Glucose T Est Strips, 36 Uramaxin GT Kit, 11 Versacloz, 21

Truetest Strips, 36 urea, 11 Vesicare, 18

Truetrack Blood Glucose Test, 36 urea 40% nail film, 11 vestura, 13

Truetrack Test, 36 urea IN zinc undecylenate/lactic acid Vexa, 11

Trulicity, 14 Vexol, 25 vehicle, 11 Trusopt, 26 urea topical, 11 Vfend, 2

Truvada, 2 Urecholine, 18 Viagra, 8

Tudorza Pressair, 30 Urelle, 18 Vibramycin, 1

Tussicaps, 29 Uretron D/S, 18 Vicoprofen, 28

Tussionex Pennkinetic Extended Urex, 18 Victory Agm-4000 Test Strips, 36

Uribel, 18 Victoza, 14 Release, 30 Twynsta, 7 Urimar-t, 18 Victrelis, 3

Tybost, 2 Urocit-k 10, 18 Vida Mia Unilet Lancets Super Thin 30G,

Tykerb, 5 Urocit-k 15, 18 35 Tylenol/Codeine #3, 28 Urocit-k 5, 18 Vida Mia Unilet Lancets Ultra Thin 28G,

Tylenol/Codeine #4, 28 Urogesic-blue, 18 35 Tysabri, 24 Uroqid #2, 18 Vidaza, 4

Tyvaso, 8 Uroxatral, 18 Videx EC, 2

Tyvaso Refill, 8 Urso 250, 18 Videx Pediatric, 2

Tyvaso Starter, 8 Urso Forte, 18 Vigamox, 24

Tyzeka, 3 ursodiol, 17 Viibryd, 21

Tyzine, 29 Uta, 18 Vimizim, 16

Tyzine Pediatric Nasal Drops, 29 Utopic, 11 Vimovo, 28

Vimpat, 22 U V Vinacal, 32 U-cort, 10 Vagifem, 18 Vinacal B, 32 Uceris, 12 valacyclovir HCL, 2 Vinate AZ Extra, 32 Ulesfia, 11 Valchlor, 3 Vinate C, 32 Uloric, 29 Valcyte, 3 Vinate Calcium, 32 Ulticare Thin Lancets 30G, 35 Valium, 20 Vinate Care, 32 Ultilet Basic Lancets 30G, 35 valproic acid, 22 Vinate DHA, 32 Ultilet Classic Lancets, 35 valsartan, 6 Vinate DHA RF, 32 Ultilet Lancets, 35 valsartan/hydrochlorothiazide, 7 Vinate GT, 32 Ultilet Lancets 33G, 35 Valtrex, 2 Vinate IC, 32 Ultilet Safety Lancets 23G, 35 Valumark Lancet Super Thin 30G, 35 Vinate II, 32 Ultima Test Strips, 36 Valumark Lancet Ultra Thin 28G, 35 Vinate M, 32 Ultra-thin II Auto Lancet, 35 Valved Holding Chamber, 36 Vinate One, 32 Ultra-thin II Lancets 28G, 35 Vancocin HCL, 3 Vinate Pn Care, 32 Ultra-thin II Lancets 30G, 35 vancomycin HCL, 3 Vinblastine Sulfate, 4 Ultra-thin II Safety Autolancets 26G, 35 Vanos, 10 vincristine sulfate, 4 Ultracet, 28 Vanoxide-HC, 9 vinorelbine tartrate, 4 Ultram, 28 Vantas, 4 Viokace, 17 Ultram ER, 28 Vascepa, 8 viorele, 13 Ultrasal-ER, 11 Vaseretic, 7 Viracept, 2 Ultratrak Pro Test Strips, 36 Vasotec, 6 Viramune, 2 Ultratrak Ultimate Test Strips, 36 Vecamyl, 7 Viramune XR, 2 Ultravate, 10 Vectibix, 4 Virasal, 11 Ultravate PAC, 10 Vectical, 10 Virazole, 3 Ultravate X, 10 Velcade, 5 Viread, 2 Ultresa, 17 Veletri, 8 Viroptic, 25 Umecta, 11 velivet, 13 Vistaril, 20 Umecta Nail Film, 11 Velphoro, 18 Vistide, 3 Umecta PD, 11 Veltin, 8 Vita-pren, 32 Unilet Comfortouch Lancet, 35 Vemavite-prx 2, 32 Vitafol Ultra, 32 Unilet Excelite, 35 venlafaxine HCL, 21 Vitafol-nano, 32 Unilet Excelite II, 35 venlafaxine HCL ER, 21 Vitafol-OB, 32 Unilet G.p. Lancet, 35 Venlafaxine HCL ER, 21 Vitafol-ob+dha, 32 Unilet G.p. Superlite Lancet, 35 Ventavis, 8

Vitafol-one, 32 Zestoretic, 7 X Vitafol-plus, 32 Zestril, 6 Xalatan, 25 Vitafol-pn, 32 Zetia, 8 Xalkori, 5 Vitalet Pro Lancets, 35 Zetonna, 29 Xanax, 21 Vitalet Pro Plus Lancets, 35 Zevalin Y-90, 4 Xanax XR, 21 Vitamedmd One RX/Quatrefolic, 32 Ziac, 7 Xarelto, 19 Vitamedmd Plus RX/Quatre Folic, 32 Ziagen, 2 Xartemis XR, 28 Vitamedmd Redichew RX, 32 Ziana, 8 Xclair, 11 Vitamedmd Redichew RX/Quatrefolic, 32 zidovudine, 2 Xeljanz, 28 Vitamelts Vitamin D, 31 Zioptan, 25 Xeloda, 4 vitamin d, 31 ziprasidone HCL, 21 Xenazine, 24 Vitamin D, 31 Zipsor, 28 Xeomin, 24 vitamin d 400, 31 Zirgan, 25 Xerac Ac, 11 vitamin d-1000, 31 Zithranol, 10 Xerese, 9 vitamin d-3, 31 Zithranol-rr, 10 Xgeva, 15 vitamin d3, 31 Zithromax, 1 Xifaxan, 3 Vitamin D3, 31 Zithromax Tri-PAK, 1 Xodol, 28 Vitamin D3 400, 31 Zithromax Z-PAK, 1 Xofigo, 5 Vitapearl, 32 Zmax, 1 Xolair, 30 Vituz, 30 Zocor, 8 Xolegel, 9 Viva CT Prenatal, 32 Zofran, 17 Xolegel Corepak, 9 Viva DHA, 32 Zofran Odt, 17 Xolegel Duo/Head & Shoulders, 9 Vivactil, 21 Zohydro ER, 28 Xolegel Duo/Xolex, 9 Vivelle-dot, 12 Zoladex, 4 Xolox, 28 Vocal Point Blood Glucose Test Strips, zoledronic acid, 15 Xopenex, 30 Zoledronic Acid, 15 36 Xopenex Concentrate, 30 Vogelxo, 12 Zolinza, 5 Xopenex HFA, 30 Vogelxo P.M., 12 zolmitriptan, 29 Xtandi, 4 Voltaren, 9 zolmitriptan odt, 29 xulane, 12 Voltaren-XR, 28 Zoloft, 21 Xylocaine, 11 Vopac, 9 zolpidem tartrate, 22 Xyntha, 20 Vopac GB, 9 zolpidem tartrate ER, 22 Xyntha Solofuse, 20 Vopac Kt, 9 Zolpimist, 22 Xyrem, 24 voriconazole, 2 Zolvit, 28

Vortex Valved Holding Chamber, 36 Y Zometa, 15

Vosol HC, 26 Zomig, 29 Yasmin 28, 14

Vospire ER, 30 Zomig Nasal Spray, 29 Yaz, 14

Votrient, 5 Zomig ZMT, 29 Yervoy, 4

Vpriv, 19 Zonalon, 9 yl folic acid, 19

Vsl#3 DS, 16 Zonatuss, 30 Yodoxin, 3

Vusion, 9 Zonegran, 23 Your Life Multi Prenatal, 31 vyfemla, 13 zonisamide, 22 Z

Vytorin, 8 Zontivity, 20 Zacare 4% Kit, 9 Vyvanse, 22 Zorbtive, 15 Zacare 8% Kit, 9 Zortress, 4 W

zafirlukast, 30 Zorvolex, 28 W&f Lancets 26G, 35 zaleplon, 22 Zostavax, 31 W&f Lancets Colored 21G, 35 Zaltrap, 4 zovia 1/35e, 13 Walgreens Lancets, 35 Zanaflex, 24 Zovia 1/50e, 14 Walgreens Thin Lancets, 35 Zanosar, 3 Zovirax, 2, 9 Walgreens Ultra Thin Lancets, 35 Zantac, 17 Zubsolv, 28 warfarin sodium, 19 zarah, 13 Zuplenz, 17 Watchhaler, 36 Zarontin, 23 Zutripro, 30 Wavesense Presto Test Strips, 36 Zaroxolyn, 7 Zyban, 23 wee care, 19 Zatean-CH, 32 Zyclara, 11 Welchol, 8 Zatean-pn, 32 Zyclara P.M., 11 Wellbutrin, 21 Zatean-pn DHA, 32 Zydelig, 5 Wellbutrin SR, 21 Zatean-pn Plus, 32 Zydone, 28 Wellbutrin XL, 21 Zavesca, 19 Zyflo, 30 Wellesse Vitamin D3, 31 Zebeta, 6 Zyflo CR, 30 wera, 13 Zelapar, 23 Zykadia, 5 Westcort, 10 Zelboraf, 5 Zylet, 25 Westhroid, 16 Zemaira, 30 Zyloprim, 29 Westhroid-p, 16 Zemplar, 16 Zymaxid, 25 Wilate, 20 zenchent, 13 Zyprexa, 22 Wp Thyroid, 16 zenchent FE, 13 Zyprexa Zydis, 22 wymzya FE, 13 Zenpep, 17 Zytiga, 4 Zenzedi, 22 Zyvox, 3 Zerit, 2

1

1/2halfprin, 27

1ST Choice Lancets Super Thin, 35

1ST Choice Lancets Thin, 35

1ST Choice Lancets Ultra Thin, 35

8

8-mop, 10