DRUG FORMULARY QUALIFIED HEALTH PLANS EFFECTIVE JANUARY 1, 2017 LAST UPDATED DECEMBER 1, 2017 INTRODUCTION As a general rule, generic drugs have the lowest This is the Health Alliance Drug Formulary for member copayment. Typically, when a generic Qualified Health Plans (also known as the health enters the market the brand drug moves to Tier 3. insurance “exchange” plans). In order to assist Members who choose the brand name after the members and providers in choosing prescription release of a generic version may pay the copayment drugs for treatment, we encourage members to show plus the difference in cost between the brand and this list to their physicians and pharmacists. In generic drug. Generic drugs can help members save addition, we encourage prescribers to use this list on out-of-pocket medication costs. when considering treatment options. Final decisions regarding treatment options are made between the Generic Equivalent vs. Generic Alternative physician and patient. Generic equivalents are medications that contain the same active ingredient, with the same strength The formulary is subject to change at any time. and dosage form as the brand medication. Generic Members can access the most up-to-date version of equivalents are as safe and effective and produce this list by visiting HealthAlliance.org. Members the same results as the brand counterpart. can also log in to YourHealthAlliance.org to check specific drug coverage and pricing information. The Generic alternatives can produce the same formulary does not provide information about an intended effect on the body as the comparable individual’s specific coverage. Please refer to your brand. Generic alternatives are medications that plan documents for complete coverage details. work like a particular brand drug and are used to treat the same condition. However, the active HOW TO USE THIS LIST ingredient in a generic alternative is different from This drug list is organized in sections by drug the brand medication. class or medical condition. Within each section are subsections to help locate medications. Talk to Your Doctor Most drugs listed, whether generic or brand, are If your doctor writes a prescription for a brand formulary drugs. drug that does not have a generic equivalent, consider asking if an appropriate generic alternative To search within the PDF, choose the search is available. function, enter a drug name and click “search” or “find.” You can also search using the index, which As a patient, you can tell your pharmacist you lists drugs alphabetically. are interested in generics. In most situations, your pharmacist can substitute a generic equivalent for Generics its brand counterpart without a new prescription Like brand drugs, generic drugs go through an from your doctor. approval process by the Food and Drug Administration (FDA) and must meet similar For more information on generics, visit standards of effectiveness and chemical make-up as AskForGenerics.org. branded drugs. Drugs to Treat Multiple Conditions The main difference between the reference brand Doctors use some drugs to treat more than one drug and its generic equivalent is that the generic medical condition. Within this document, each drug often costs much less. is listed according to its first FDA-approved use. Please check the index if you do not find your medication in the therapeutic class that corresponds to your condition.

ph-formularyintroQHP-1217 COVERAGE AND LIMITATIONS B. Documented allergy to a formulary drug, with no other formulary choices Tier Information C. Successfully maintained condition on a specific A drug’s copayment tier indicates what you will drug where switching to an alternative drug may pay for the medication with each fill. cause a health risk: o Antiarrhythmics • The majority of generics are Tier 1. These are o Theophylline products your least expensive prescription drugs. o Seizure medications • Preferred brand-name drugs are Tier 2, the o Antipsychotics lowest brand tier. o Antidepressants • Non-preferred brand-name drugs are Tier 3. • Specialty drugs are in Tiers 4, 5, and 6. o Preferred Specialty drugs are Tier 4 Physicians—Requesting a Medical o Non-Preferred Specialty drugs are Tier 5 Exception o Non-Formulary Specialty drugs are Tier 6 To request a Medical Exception for a medication • Preventive drugs are Tier 7. These are covered on behalf of a member, or to request further at no charge as defined in the plan policy. information, please call the Health Alliance Pharmacy department at 1-800-851-3379, option 4, Your pharmacy benefit includes coverage for or log in to YourHealthAlliance.org. the majority of prescription drugs, though some exclusions may apply. Contraceptive Coverage Under Preventive Health Wellness Benefit Utilization Management A female member age 10–50 years old has coverage Some drugs on this list require utilization of some FDA-approved contraceptives for no out- management (UM), i.e. preauthorization, managed of-pocket cost. dose limitations and step-therapy. If UM applies to a drug, it is indicated with one of the following Free contraceptives are listed below: symbols in the column next to the drug name. • Tier 1 oral contraceptives • Limit of three units on condoms (male or • MDL- Managed Dose Limitations female) • PA- Preauthorization • Limit of 2.7 units of spermicidal product • ST- Step-Therapy Only one Tier 1 prescription drug (like a generic NOTE: Effective 8/1/17, most specialty oral contraceptive) or one over-the-counter (OTC) medications used during cancer treatment will product (like male and female condoms or require your doctor to submit for preauthorization spermicides) is covered per 30-day period for no through eviCore. Please click on the link below for cost to the member. a list of these medications: Brand-name contraceptives that are Tier 2 or eviCore Preauthorization List higher are covered with the appropriate member cost share/quantity restrictions according to the These medications are also indicated in our member’s plan. Specialty Drug List. Emergency contraception is covered at Tier 1 Medical Exception using generic levonorgestrel/ethinyl estradiol- Medical exception is a process for reviewing containing products. Brand-name emergency coverage for drugs not on our formulary. Members contraception is covered according to the may qualify for a medical exception if they meet member’s plan. one of these: Quantities above a 30-day supply, including A. Documented failure of all formulary drugs vacation overrides and commercially available within the same therapeutic class extended-cycle contraceptives (like Seasonale), are subject to appropriate member cost-sharing according to the member’s plan. General Exclusions Blood Glucose Monitors FREE By Mail A. Over-the-counter (OTC) medications and their Members with diabetes are eligible to receive a equivalents are not covered, unless otherwise FREE blood glucose meter if they choose one of the specified within the Formulary. Nicotine preferred meters listed below and obtain the meter smoking-cessation products (e.g., transdermal by mail. If a member picks up a blood glucose nicotine, nicotine gum, nicotine inhaler) meter at their local pharmacy, the member’s Tier 2 coverage is based on specific member benefits. copayment will apply when obtained with a B. Any drugs used for cosmetic purposes are not prescription. Free meters are limited to one meter covered. per member per year. The FreeStyle InsuLinx C. Experimental drugs, or any drug product used in System is limited to one meter every three years. an experimental manner, are not covered. D. Replacement of lost or stolen medication is not Freestyle Lite® and Freestyle InsuLinx® covered. ® E. Non-self-administered injectable drugs, unless FreeStyle Lite System FreeStyle Freedom Lite® System otherwise noted, are not covered through the ® pharmacy benefit. Refer to your description of FreeStyle InsuLinx System coverage materials for details. To get an Abbott product, call 1-866-224-8892 F. Foreign drugs and drugs not approved by the and use Offer Code ZD218BKX. FDA are not covered. Or visit www.choosefreestyle.com and enter G. Drugs used to treat erectile dysfunction. Offer Code ZD218BKX. InsuLinx systems are limited to one free PHARMACY SAVINGS PROGRAMS product per member every three years. Health Alliance offers members several programs to lower the drug costs and to help members take their Not all benefit plans include each of the programs medications safely and correctly. listed above. Please refer to your description of coverage documents for more detail or contact the Rxtra Pharmacy department at 1-800-851-3379, option 4. Health Alliance members with prescription coverage can save money based on where they have their 30-day-supply of prescriptions filled. CONTACT US Health Alliance Pharmacy Department 301 S. Vine St. The Rxtra program is simple. Urbana, IL 61801-3347 1-800-851-3379, option 4 • Preferred—At Preferred pharmacies, members can get hundreds of common prescriptions FREE. • Preferred Plus—At Preferred Plus pharmacies, members have the same benefits as the Preferred pharmacies mentioned above. In addition, simvastatin, pravastatin, ProAir and Ventolin HFA are FREE.

For a list of participating pharmacies and available drugs in the Rxtra program, visit the pharmacy section of HealthAlliance.org.

Retail 90 The Retail 90 program allows members to purchase a 90-day supply of maintenance medication at a discounted copayment from participating retail pharmacies. Because this is a voluntary program designed to increase flexibility, members who prefer may continue purchasing the traditional 30-day supply from their pharmacy with their regular copayment.

Table of Contents

ANTI-INFECTIVES ...... 1

PENICILLINS ...... 1

CEPHALOSPORIN ...... 1

FIRST GENERATION ...... 1

SECOND GENERATION ...... 1

THIRD GENERATION ...... 1

FOURTH GENERATION ...... 1

MACROLIDES ...... 1

TETRACYCLINES ...... 2

QUINOLONES ...... 2

AMINOGLYCOSIDES ...... 2

SULFONAMIDES ...... 2

ANTIMYCOBACTERIAL AGENTS ...... 2

ANTIFUNGALS ...... 2

ANTIVIRALS ...... 3

ANTIMALARIALS ...... 4

ANTHELMINTICS ...... 4

MISC. ANTI-INFECTIVES ...... 4

ANTINEOPLASTICS, ETC ...... 5

ALKYLATING AGENTS ...... 5

ANTIBIOTICS ...... 5

ANTINEOPLASTIC ENZYMES ...... 5

ANTIMETABOLITES ...... 5

ANGIOGENESIS INHIBITORS ...... 5

ANTIBODIES ...... 5

HORMONAL AGENTS ...... 6

IMMUNOMODULATORS ...... 6

MITOTIC INHIBITORS ...... 6

ENZYME INHIBITORS ...... 6

TOPOISOMERASE I INHIBITOR ...... 7

RADIOPHARMACEUTICALS ...... 7

CELLULAR IMMUNOTHERAPY ...... 7

ANTINEOPLASTICS MISC...... 7

CHEMOTHERAPY RESCUE ...... 7

CHEMOTHERAPY ADJUNCTS ...... 7

ANTINEOPLASTIC COMBO ...... 7

CARDIOVASCULAR DRUGS ...... 7

PHOSPHODIESTERASE INHBTR ...... 7

CARDIAC GLYCOSIDES ...... 7

ANTIANGINAL AGENTS ...... 8

BETA BLOCKERS ...... 8

CALCIUM CHANNEL BLOCKERS ...... 8

ANTIARRHYTHMICS ...... 8

ACE INHIBITORS ...... 9

ANGIOTENSIN RCPTR BLOCKER ...... 9

DIRECT RENIN INHIBITORS ...... 9

ANTIHYPERTENSIVES MISC...... 9

ANTIHYPERTENSIVE COMBO ...... 9

DIURETICS ...... 10

VASOPRESSORS ...... 10

ANTIHYPERLIPIDEMICS ...... 10

CARDIOVASCULAR - MISC...... 11

DERMATOLOGICALS ...... 11

ACNE PRODUCTS ...... 11

ROSACEA AGENTS ...... 12

ANTIBIOTICS - TOPICAL ...... 12

ANTIFUNGALS - TOPICAL ...... 12

ANTIVIRALS - TOPICAL ...... 12

ANTI-INFLAMMATORY AGENTS ...... 12

ANTIPRURITICS ...... 12

ANTIPSORIATICS ...... 12

ANTISEBORRHEIC AGENTS ...... 13

ANTINEOPLASTIC-TOPICAL ...... 13

CORTICOSTEROIDS - TOPICAL ...... 13

IMMUNOMODULATING AGENTS ...... 13

DERMATOLOGICALS - MISC...... 13

ENDOCRINE AND METABOLIC ...... 15

CORTICOSTEROIDS ...... 15

ANDROGENS-ANABOLIC ...... 15

ESTROGENS ...... 16

CONTRACEPTIVES ...... 16

PROGESTINS ...... 18

ANTIDIABETIC AGENTS ...... 18

INSULIN ...... 18

AMYLIN ANALOGS ...... 18

INCRETIN MIMETIC AGENTS ...... 18

SULFONYLUREAS ...... 18

BIGUANIDES ...... 18

MEGLITINIDE ANALOGUES ...... 18

DIABETIC OTHER ...... 18

ALPHA-GLUCOSIDASE INHIBIT ...... 19

DPP-4 INHIBITORS ...... 19

INSULIN SENSITIZING AGENT ...... 19

ANTIDIABETIC COMBINATIONS ...... 19

BISPHOSPHONATES ...... 19

CALCITONINS ...... 19

PARATHYROID HORMONE ...... 19

RANK LIGAND INHIBITORS ...... 19

HORMONE RECEPTOR MDLTR ...... 19

FERTILITY REGULATORS ...... 19

LHRH/GNRH AGONIST ...... 19

GNRH/LHRH ANTAGONISTS ...... 19

GROWTH HORMONES ...... 20

GHRH ...... 20

SOMATOMEDINS ...... 20

SOMATOSTATIC AGENTS ...... 20

GH RECEPTOR ANTAGONISTS ...... 20

POSTERIOR PITUITARY ...... 20

CORTICOTROPIN ...... 20

PROLACTIN INHIBITORS ...... 20

VASOPRESSIN ANTAGONISTS ...... 20

PROGESTERONE ANTAGONISTS ...... 20

METABOLIC MODIFIERS ...... 20

THYROID AGENTS ...... 20

GASTROINTESTINAL ...... 21

LAXATIVES ...... 21

ANTIDIARRHEALS ...... 21

ANTACIDS ...... 21

ULCER DRUGS ...... 22

ANTIEMETICS ...... 22

DIGESTIVE AIDS ...... 22

GASTROINTESTINAL - MISC...... 22

GENITOURINARY ...... 23

URINARY ANTI-INFECTIVES ...... 23

URINARY ANTISPASMODICS ...... 23

VAGINAL PRODUCTS ...... 24

GENITOURINARY - MISC...... 24

HEMATOLOGICAL ...... 24

HEMATOPOIETIC AGENTS ...... 24

ANTICOAGULANTS ...... 25

HEMOSTATICS ...... 26

HEMATOLOGICAL - MISC...... 26

MOUTH/THROAT/DENTAL AGENT ...... 27

NEUROLOGY, CNS, PSYCH ...... 27

ANTIANXIETY AGENTS ...... 27

ANTIDEPRESSANTS ...... 28

ANTIPSYCHOTICS ...... 28

HYPNOTICS ...... 29

ADHD, NARCOLEPSY, ETC...... 29

ANTICONVULSANTS ...... 29

ANTIPARKINSON AGENTS ...... 30

NEUROLOGY, PSYCH - MISC...... 30

NEUROMUSCULAR AGENTS ...... 31

MUSCULOSKELETAL AGENTS ...... 32

ANTIMYASTHENIC AGENTS ...... 32

OPHTHALMOLOGY AND OTIC ...... 32

ANTI-INFECTIVES ...... 32

ARTIFICIAL TEAR/LUBRICANT ...... 32

BETA-BLOCKERS ...... 32

OPHTHALMIC STEROIDS ...... 33

PROSTAGLANDINS ...... 33

CYCLOPLEGIC MYDRIATICS ...... 33

DECONGESTANTS ...... 33

MIOTICS ...... 33

ADRENERGIC AGENTS ...... 33

IMMUNOMODULATORS ...... 33

LOCAL ANESTHETICS ...... 33

OPHTHALMICS - MISC...... 33

OTIC AGENTS ...... 34

OXYTOCICS ...... 34

PAIN MANAGEMENT ...... 34

ANALGESICS - NONNARCOTIC ...... 34

ANALGESICS - OPIOID ...... 35

ANTI-INFLAMMATORY ...... 36

MIGRAINE PRODUCTS ...... 37

GOUT AGENTS ...... 37

LOCAL ANESTHETICS-INJ ...... 37

GENERAL ANESTHETICS ...... 38

RESPIRATORY, ALLERGY, ETC ...... 38

ANTIHISTAMINES ...... 38

NASAL AGENTS ...... 38

COUGH/COLD/ALLERGY ...... 38

ANTIASTHMATIC/COPD AGENTS ...... 39

RESPIRATORY AGENTS - MISC ...... 39

TOXOIDS ...... 39

VACCINES ...... 39

VITAMINS ...... 40

VITAMINS ...... 40

MULTIVITAMINS ...... 41

MEDICAL DEVICES ...... 43

DIABETIC SUPPLIES ...... 43

MISCELLANEOUS ...... 50

GENERIC

cefaclor

cefprozil

cefuroxime axetil

December 2017 Cefaclor ER

TIER 03 NON PREFERRED

Cefaclor ANTI-INFECTIVES Ceftin PENICILLINS MEDICAL GENERAL MEDICAL TIER 01 GENERIC

cefotetan amoxicillin cefoxitin sodium amoxicillin/clavulanate potassium cefuroxime sodium amoxicillin/clavulanate potassium ER Cefotan ampicillin Cefotetan dicloxacillin sodium Cefotetan/Dextrose penicillin v potassium Cefoxitin Sodium Amoxicillin Cefuroxime Sodium Amoxicillin/Clavulanate Potassium Zinacef Ampicillin THIRD GENERATION Penicillin V Potassium TIER 01 GENERIC TIER 03 NON PREFERRED

cefdinir Amoxicillin ER cefixime Augmentin cefpodoxime proxetil Augmentin ES-600 Ceftibuten Augmentin XR TIER 03 NON PREFERRED Moxatag Cedax MEDICAL GENERAL MEDICAL

Cefditoren Pivoxil ampicillin sodium Spectracef ampicillin-sulbactam Suprax nafcillin sodium MEDICAL GENERAL MEDICAL oxacillin sodium ceftazidime penicillin G potassium ceftriaxone sodium piperacillin sodium/ tazobactam sodium tazicef piperacillin sodium/tazobactam sodium Cefotaxime Sodium piperacillin/tazobactam Ceftazidime/Dextrose Ampicillin Sodium Ceftriaxone IN Iso-osmotic Dextrose Bactocill IN Dextrose Ceftriaxone Sodium Bicillin C-R Ceftriaxone/Dextrose Bicillin L-a Claforan Nafcillin Claforan/D5W Nafcillin Sodium Fortaz Penicillin G Potassium IN Iso-osmotic Dextrose Tazicef Penicillin G Procaine FOURTH GENERATION Penicillin G Sodium MEDICAL GENERAL MEDICAL Pfizerpen-G cefepime Piperacillin/Tazobactam Cefepime Unasyn Cefepime/Dextrose Unasyn Bulk Pack Maxipime Zosyn

MACROLIDES CEPHALOSPORIN TIER 01 GENERIC FIRST GENERATION

azithromycin TIER 01 GENERIC

clarithromycin cefadroxil clarithromycin ER cephalexin erythromycin Cephalexin erythromycin ethylsuccinate TIER 03 NON PREFERRED

Azithromycin Keflex Clarithromycin MEDICAL GENERAL MEDICAL

E.e.s. 400 cefazolin sodium Erythromycin Base Cefazolin Erythromycin Ethylsuccinate Cefazolin Sodium TIER 02 PREFERRED BRAND Cefazolin Sodium/Dextrose E.e.s. Granules Cefazolin Sodium/Sodium Chloride Eryped 200 Cefazolin/Dextrose Eryped 400 Cefazolin/D5W TIER 03 NON PREFERRED Cefazolin/Sodium Chloride Biaxin SECOND GENERATION DificidST TIER 01

Ery-TAB

Effective December 1, 2017

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

Erythrocin Stearate Moxifloxacin HCL

PCE

Zithromax Tri-PAK AMINOGLYCOSIDES

Zithromax Z-PAK GENERIC TIER 01

Zmax amikacin sulfate

MEDICAL GENERAL MEDICAL neomycin sulfate

Erythrocin Lactobionate paromomycin sulfate

Zithromax PREFERRED SPECIALTY TIER 04

tobramycinPA

TETRACYCLINES tobramycin inhalation solution PAKPA

TIER 01 GENERIC TIER 05 NON PREFERRED SPECIALTY

avidoxy BethkisPA

demeclocycline hydrochloride Tobi PodhalerPA

demeclocycline HCL TIER 06 NON FORMULARY SPECIALTY

doxycycline Kitabis PAKPA

doxycycline hyclate TobiPA

doxycycline hyclate DR TobramycinPA

doxycycline monohydrate MEDICAL GENERAL MEDICAL

minocycline hydrochloride gentamicin sulfate

minocycline HCL gentamicin sulfate pediatric

mondoxyne nl gentamicin sulfate/0.9% sodium chloride

morgidox 1X100MG tobramycin sulfate

morgidox 1X50MG Gentamicin Sulfate/0.9% Sodium Chloride

morgidox 2X100MG Isotonic Gentamicin

okebo Streptomycin Sulfate

tetracycline hydrochloride Tobramycin Sulfate

tetracycline HCL

Tetracycline HCL SULFONAMIDES

TIER 03 NON PREFERRED GENERIC TIER 01

Adoxa Sulfadiazine

Adoxa PAK 1/100

Adoxa PAK 1/150 ANTIMYCOBACTERIAL AGENTS Adoxa PAK 2/100 TIER 01 GENERIC

Minocin ethambutol HCL Monodox isoniazid Nutridox pyrazinamide Targadox rifabutin Vibramycin TIER 02 PREFERRED BRAND

Ximino Mycobutin MEDICAL GENERAL MEDICAL TIER 03 NON PREFERRED

doxy 100 Cycloserine

Myambutol

QUINOLONES Paser

TIER 01 GENERIC Priftin

ciprofloxacin Rifadin

ciprofloxacin ER Rifamate

ciprofloxacin HCL Rifater

levofloxacin Trecator

moxifloxacin HCL NON PREFERRED SPECIALTY TIER 05

ofloxacin SirturoPA

Ciprofloxacin HCL GENERAL MEDICAL MEDICAL

Levofloxacin rifampin

Ofloxacin Capastat Sulfate

TIER 03 NON PREFERRED Isoniazid

Avelox

Avelox Abc Pack ANTIFUNGALS Cipro TIER 01 GENERIC

Cipro XR bio-statin Factive fluconazole Levaquin flucytosine TIER 04 PREFERRED SPECIALTY griseofulvin microsize BaxdelaPA griseofulvin ultramicrosize MEDICAL GENERAL MEDICAL itraconazole ciprofloxacin I.V.-IN D5W ketoconazole levofloxacin IN D5W nystatin levofloxacin IN 5% dextrose terbinafine HCL moxifloxacin hydrochloride/sodium hydrochloride TIER 02 PREFERRED BRAND

Cipro I.V.-IN D5W Grifulvin V Ciprofloxacin Gris-peg

Effective December 1, 2017

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

TIER 03 NON PREFERRED NON PREFERRED

Ancobon BaracludePA

Bio-statin Combivir

Diflucan Edurant

Lamisil Epivir

OnmelPA Epivir HBV

Sporanox Epzicom

Sporanox Pulsepak Famvir

TIER 04 PREFERRED SPECIALTY Flumadine

voriconazolePA HepseraPA

SPECIALTY MEDICAL Intelence

Vfend IVPA Juluca

TIER 05 NON PREFERRED SPECIALTY Lexiva

CresembaPA Prezista

NoxafilPA Relenza DiskhalerQL

VfendPA Retrovir

MEDICAL GENERAL MEDICAL Sitavig

caspofungin acetate TamifluQL

fluconazole IN dextrose Trizivir

fluconazole IN NACL TybostST

Abelcet TyzekaPA

Ambisome Valcyte

Amphotec Valtrex

Amphotericin B Videx EC

Cancidas Viracept

Caspofungin Acetate Viramune

Eraxis Viramune XR

Fluconazole IN NACL Zerit

Mycamine Ziagen

Zovirax

TIER 04 PREFERRED SPECIALTY ANTIVIRALS

GENERIC moderiba TIER 01

abacavir ribasphere

abacavir sulfate/lamivudine/zidovudine ribavirin

abacavir/lamivudine Copegus

PA acyclovir Epclusa

PA adefovir dipivoxilPA Harvoni

PA didanosine Mavyret

PA entecavirPA Peg-intron

PA famciclovir Peg-intron Redipen

PA fosamprenavir calcium Peg-intron Redipen PAK 4

PA lamivudine Pegasys

PA lamivudine/zidovudine Pegasys Proclick

PA lopinavir/ritonavir Pegintron

nevirapine Rebetol

PA nevirapine ER Vemlidy

oseltamivir phosphateQL TIER 05 NON PREFERRED SPECIALTY

rimantadine HCL Atripla

stavudine Complera

valacyclovir HCL Descovy

valganciclovir Evotaz

valganciclovir hydrochlorde Fuzeon

zidovudine Genvoya

Nevirapine Moderiba

PREFERRED BRAND Moderiba 1200 Dose Pack TIER 02

Aptivus Moderiba 800 Dose Pack

Crixivan Odefsey

Emtriva Prezcobix

Invirase Ribasphere

Isentress Ribasphere Ribapak

Isentress HD Ribatab

PA Kaletra Selzentry

Norvir Stribild

PA Rescriptor Technivie

Reyataz Tivicay

Sustiva Triumeq

Videx Pediatric Truvada

PA Viread Viekira PAK

Viekira XRPA TIER 03

Vitekta

Effective December 1, 2017

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

ZepatierPA First-vancomycin 25

SPECIALTY MEDICAL First-vancomycin 50

VirazolePA Flagyl

TIER 06 NON FORMULARY SPECIALTY Impavido

DaklinzaPA Invanz

OlysioPA Ketek

SovaldiPA Nebupent

VictrelisQL,PA Primsol

VoseviPA Trimpex

MEDICAL GENERAL MEDICAL Vancocin HCL

acyclovir sodium TIER 04 PREFERRED SPECIALTY

cidofovir linezolidQL

ganciclovir XifaxanPA

Acyclovir Sodium SPECIALTY MEDICAL

Cytovene Linezolid

Foscavir Orbactiv

Ganciclovir Zyvox

Rapivab TIER 05 NON PREFERRED SPECIALTY

Retrovir IV Infusion CaystonPA

SPECIALTY MEDICAL

Dalvance ANTIMALARIALS

GENERIC Sivextro TIER 01

atovaquone/proguanil HCL MEDICAL GENERAL MEDICAL

chloroquine phosphate aztreonam

hydroxychloroquine sulfate baciim

mefloquine HCL bacitracin

quinine sulfate clindamycin

Chloroquine Phosphate clindamycin phosphate

Mefloquine HCL clindamycin phosphate add-vantage

Primaquine Phosphate clindamycin phosphate IN D5W

PREFERRED BRAND colistimethate sodium TIER 02

Coartem daptomycin

NON PREFERRED imipenem/cilastatin TIER 03

Daraprim lincomycin HCL

Malarone meropenem

Plaquenil metronidazole

Qualaquin metronidazole IN NACL 0.79%

polymyxin b sulfate

vancomycin HCL ANTHELMINTICS Avycaz TIER 01 GENERIC

Azactam ivermectin Azactam IN Iso-osmotic Dextrose TIER 03 NON PREFERRED

Chloramphenicol Sodium Succinate Albenza Cleocin IN D5W Benznidazole Cleocin Phosphate Biltricide Coly-mycin M Emverm Cubicin Mebendazole Cubicin RF Stromectol Doribax

Doripenem MISC. ANTI-INFECTIVES Lincocin TIER 01 GENERIC

Meropenem/Sodium Chloride atovaquone Merrem clindamycin palmitate HCL Metro IV clindamycin HCL Pentam 300 dapsone Primaxin IV sulfamethoxazole/trimethoprim Primaxin IV Add-vantage sulfamethoxazole/trimethoprim DS Synercid sulfatrim pediatric Tigecycline tinidazole Tygacil trimethoprim Vabomere TIER 02 PREFERRED BRAND

Vancomycin Mepron Vancomycin Hydrochloride/Dextrose Tindamax Vancomycin Hydrochloride/Sodium Chloride TIER 03 NON PREFERRED

Vancomycin HCL Alinia Vancomycin HCL IN Dextrose Bactrim Vancomycin HCL/Sodium Chloride Bactrim DS Vibativ Cleocin Zerbaxa Cleocin Pediatric Granules

Effective December 1, 2017

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

SPECIALTY MEDICAL ANTINEOPLASTICS, ETC ErwinazePA ALKYLATING AGENTS OncasparPA TIER 01 GENERIC

PA

melphalan ANTIMETABOLITES TIER 02 PREFERRED BRAND

PA TIER 01 GENERIC Alkeran PA mercaptopurine Hexalen PA methotrexate Leukeran Methotrexate Sodium Myleran TIER 02 PREFERRED BRAND TIER 03 NON PREFERRED

PA Tabloid Cyclophosphamide Trexall TIER 04 PREFERRED SPECIALTY

PA TIER 03 NON PREFERRED temozolomide capecitabinePA TIER 05 NON PREFERRED SPECIALTY

PA Purixan Gleostine PA TIER 05 SPECIALTY MEDICAL Lomustine PA azacitidinePA Temodar cladribinePA SPECIALTY MEDICAL PA clofarabinePA busulfan PA cytarabinePA cyclophosphamide PA cytarabine aqueousPA ifosfamide PA decitabinePA melphalan hydrochloride PA fludarabine phosphatePA thiotepa PA methotrexate sodium Bendeka PA AlimtaPA Bicnu PA ArranonPA Busulfex PA ClolarPA Ifex PA Cytarabine AqueousPA Ifosfamide PA DacogenPA Mustargen PA DepocytPA Tepadina PA FloxuridinePA Treanda PA FolotynPA Yondelis PA VidazaPA Zanosar TIER 06 NON FORMULARY SPECIALTY TIER 06 NON FORMULARY SPECIALTY

PA XelodaPA Valchlor MEDICAL GENERAL MEDICAL MEDICAL GENERAL MEDICAL

PA adrucilPA carboplatin PA fluorouracilPA cisplatin PA gemcitabinePA oxaliplatin PA gemcitabine HCLPA Cisplatin GemzarPA Evomela

Gliadel Wafer ANGIOGENESIS INHIBITORS

TIER 05 SPECIALTY MEDICAL ANTIBIOTICS AvastinPA TIER 05 SPECIALTY MEDICAL

PA CyramzaPA bleomycin sulfate PA ZaltrapPA daunorubicin HCL PA

doxorubicin HCL liposome

epirubicin HCLPA ANTIBODIES

idarubicin HCLPA TIER 05 SPECIALTY MEDICAL

PA lipodoxPA Adcetris

PA lipodox 50PA Arzerra

PA mitoxantrone HCL Besponsa

PA Bleo 15kPA Blincyto

PA CosmegenPA Campath

PA DaunoxomePA Darzalex

PA DoxilPA Empliciti

PA EllencePA Erbitux

PA Idamycin PFSPA Gazyva

PA ValstarPA Herceptin

PA GENERAL MEDICAL Kadcyla MEDICAL

PA adriamycinPA Keytruda

PA doxorubicin HCLPA Lartruvo

PA mitomycinPA Mylotarg

PA Doxorubicin HCLPA Opdivo

PA MitomycinPA Perjeta

PortrazzaPA

RituxanPA ANTINEOPLASTIC ENZYMES TecentriqPA TIER 05

Effective December 1, 2017

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

UnituxinPA Imuran

VectibixPA Myfortic

YervoyPA TIER 05 NON PREFERRED SPECIALTY

Zevalin Y-90 PomalystPA

MEDICAL GENERAL MEDICAL RevlimidPA

Bavencio ThalomidPA

Zortress

SPECIALTY MEDICAL HORMONAL AGENTS PA GENERIC Atgam TIER 01

anastrozole MEDICAL GENERAL MEDICAL

bicalutamide cyclosporine

exemestane Azathioprine

flutamidePA Cellcept Intravenous

letrozole Nulojix

megestrol acetate Sandimmune

nilutamide Simulect

tamoxifen citrate Thymoglobulin

PREFERRED BRAND TIER 02

EmcytPA MITOTIC INHIBITORS

FarestonPA TIER 03 NON PREFERRED

LysodrenPA EtoposidePA

Nilandron TIER 05 SPECIALTY MEDICAL

TIER 03 NON PREFERRED docetaxelPA

Arimidex paclitaxelPA

Aromasin vinorelbine tartratePA

Casodex AbraxanePA

Femara DocetaxelPA

Megace Oral Docetaxel (non-alcohol Formula)PA

Soltamox EtopophosPA

TIER 04 PREFERRED SPECIALTY HalavenPA

Hydroxyprogesterone CaproatePA Ixempra KitPA

TIER 05 NON PREFERRED SPECIALTY JevtanaPA

leuprolide acetatePA MarqiboPA

XtandiPA NavelbinePA

ZytigaPA PaclitaxelPA

SPECIALTY MEDICAL TaxoterePA

EligardPA TeniposidePA

FaslodexPA Vinblastine SulfatePA

FirmagonPA MEDICAL GENERAL MEDICAL

Lupron Depot (1-month)PA etoposidePA

Lupron Depot (3-month)PA toposarPA

Lupron Depot (4-month)PA vincasar PFSPA

Lupron Depot (6-month)PA vincristine sulfatePA

TrelstarPA Docefrez

Trelstar MixjectPA

VantasPA ENZYME INHIBITORS PA Zoladex NON PREFERRED TIER 03

MEDICAL GENERAL MEDICAL Calquence

Depo-provera Verzenio

PREFERRED SPECIALTY TIER 04

IMMUNOMODULATORS imatinib mesylateQL,PA

TIER 01 GENERIC TasignaPA

azathioprine TIER 05 NON PREFERRED SPECIALTY

cyclosporine modified AfinitorPA

gengraf Afinitor DisperzPA

mycophenolate mofetil AlecensaPA

mycophenolic acid DR AlunbrigPA

sirolimus BosulifQL,PA

tacrolimus CabometyxPA

Cyclosporine Modified CaprelsaPA

TIER 02 PREFERRED BRAND CometriqPA

Neoral CotellicPA

Prograf GilotrifPA

Rapamune IbrancePA

TIER 03 NON PREFERRED IclusigQL,PA

Astagraf XL IdhifaPA

Azasan ImbruvicaPA

Cellcept InlytaPA

Envarsus XR IressaPA

Effective December 1, 2017

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

JakafiPA tretinoinPA

KisqaliPA TIER 03 NON PREFERRED

Lenvima 10 MG Daily DosePA Hydrea

Lenvima 14 MG Daily DosePA TIER 05 NON PREFERRED SPECIALTY

Lenvima 18 MG Daily DosePA bexarotenePA

Lenvima 20 MG Daily DosePA ActimmunePA

Lenvima 24 MG Daily DosePA MatulanePA

Lenvima 8 MG Daily DosePA SynriboPA

LynparzaPA TargretinPA

MekinistPA SPECIALTY MEDICAL

NerlynxPA dacarbazinePA

NexavarPA Alferon NPA

NinlaroPA DacarbazinePA

RubracaPA Intron APA

RydaptPA Intron A W/DiluentPA

SprycelPA NipentPA

StivargaPA PhotofrinPA

SutentPA ProleukinPA

TafinlarPA SylatronPA

TagrissoPA TrisenoxPA

TarcevaPA MEDICAL GENERAL MEDICAL

TykerbPA TheracysPA

VotrientPA Tice BcgPA

XalkoriPA Uvadex

ZejulaPA

ZelborafPA CHEMOTHERAPY RESCUE PA Zolinza GENERIC TIER 01

PA Zykadia leucovorin calcium

SPECIALTY MEDICAL Leucovorin Calcium

PA Aliqopa SPECIALTY MEDICAL TIER 05

PA Beleodaq levoleucovorinPA

PA Istodax levoleucovorin calciumPA

PA Istodax (overfill) mesna

PA Kyprolis FusilevPA

PA Torisel LevoleucovorinPA

PA Velcade Mesnex

TIER 06 NON FORMULARY SPECIALTY GENERAL MEDICAL MEDICAL

PA Farydak dexrazoxane

QL,PA Gleevec Totect

PA Zydelig Voraxaze

Zinecard

TOPOISOMERASE I INHIBITOR

TIER 05 SPECIALTY MEDICAL CHEMOTHERAPY ADJUNCTS PA Onivyde SPECIALTY MEDICAL TIER 05

MEDICAL GENERAL MEDICAL Elitek

PA irinotecan KepivancePA

irinotecan hydrochloridePA

irinotecan HCLPA ANTINEOPLASTIC COMBO topotecan HCLPA TIER 05 NON PREFERRED SPECIALTY

CamptosarPA PA Lonsurf HycamtinPA SPECIALTY MEDICAL IrinotecanPA PA Rituxan Hycela Topotecan HCLPA PA Vyxeos

RADIOPHARMACEUTICALS CARDIOVASCULAR DRUGS TIER 05 SPECIALTY MEDICAL PHOSPHODIESTERASE INHBTR Quadramet PA MEDICAL GENERAL MEDICAL

Xofigo milrinone lactate MEDICAL GENERAL MEDICAL milrinone IN dextrose Metastron

CARDIAC GLYCOSIDES CELLULAR IMMUNOTHERAPY TIER 01 GENERIC

TIER 06 SPECIALTY MEDICAL digitek Kymriah PA digox Provenge digoxin

Digoxin ANTINEOPLASTICS MISC. TIER 03 NON PREFERRED

TIER 01 GENERIC Lanoxin hydroxyurea MEDICAL

Effective December 1, 2017

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

GENERAL MEDICAL Sotylize

Lanoxin Pediatric Tenormin

Toprol XL

Zebeta ANTIANGINAL AGENTS

GENERIC MEDICAL GENERAL MEDICAL TIER 01

isosorbide dinitrate esmolol HCL

isosorbide mononitrate labetalol HCL

isosorbide mononitrate ER Brevibloc

minitran Sotalol Hydrochloride

nitro-time

nitroglycerin CALCIUM CHANNEL BLOCKERS

nitroglycerin lingual TIER 01 GENERIC

nitroglycerin transdermal afeditab CR

nitroglycerin ER amlodipine besylate

Isosorbide Dinitrate ER cartia XT

Nitroglycerin Lingual dilt-XR

TIER 02 PREFERRED BRAND diltiazem CD

Dilatrate SR diltiazem HCL

Nitro-bid diltiazem HCL CD

Nitro-dur diltiazem HCL ER

Nitromist felodipine ER

Nitrostat isradipine

TIER 03 NON PREFERRED matzim LA

Isordil Titradose nifedical XL

Nitrolingual Pumpspray nifedipine

Ranexa nifedipine ER

MEDICAL GENERAL MEDICAL nimodipine

nitroglycerin IN dextrose 5% nisoldipine ER

nitroglycerin IN 5% dextrose taztia XT

Nitroglycerin verapamil HCL

Nitroglycerin IN Dextrose 5% verapamil HCL ER

verapamil HCL SR

Nisoldipine ER BETA BLOCKERS

GENERIC TIER 03 NON PREFERRED TIER 01

acebutolol hydrochloride Adalat CC

acebutolol HCL Calan

atenolol Calan SR

betaxolol HCL Cardizem

bisoprolol fumarate Cardizem CD

carvedilol Cardizem LA

carvedilol phosphate Norvasc

labetalol hydrochloride Nymalize

metoprolol succinate ER Procardia

metoprolol tartrate Procardia XL

nadolol Sular

pindolol Tiazac

propranolol hydrochloride Verelan

propranolol HCL Verelan PM

propranolol HCL ER MEDICAL GENERAL MEDICAL

sorine nicardipine HCL

sotalol hydrochloride (AF) Cardene IV

sotalol HCL Cleviprex

sotalol HCL (AF) Diltiazem Hydrochloride/Dextrose

Metoprolol Tartrate Diltiazem Hydrochloride/Sodium Chloride

Propranolol HCL Diltiazem HCL

Timolol Maleate Nicardipine Hydrochloride/Sodium Chloride

PREFERRED BRAND TIER 02

Bystolic ANTIARRHYTHMICS

TIER 03 NON PREFERRED TIER 01 GENERIC

Betapace amiodarone HCL

Betapace AF disopyramide phosphate

Coreg dofetilide

Coreg CR flecainide acetate

Corgard mexiletine HCL

Inderal LA pacerone

Inderal XL propafenone hydrochloride ER

Innopran XL propafenone hydrochlorideer

Lopressor propafenone HCL

Sectral propafenone HCL ER

Effective December 1, 2017

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

quinidine gluconate CR NON PREFERRED

quinidine gluconate ER Atacand

Quinidine Sulfate Avapro

Quinidine Sulfate ER Cozaar

TIER 02 PREFERRED BRAND Diovan

Multaq Edarbi

Norpace CR Micardis

TIER 03 NON PREFERRED

Cordarone DIRECT RENIN INHIBITORS

Norpace PREFERRED BRAND TIER 02

Rythmol Tekturna

Rythmol SR

Tikosyn ANTIHYPERTENSIVES MISC. MEDICAL GENERAL MEDICAL TIER 01 GENERIC

adenosine clonidine HCL ibutilide fumarate doxazosin lidocaine HCL doxazosin mesylate lidocaine HCL IN D5W eplerenone lidocaine HCL/dextrose guanfacine HCL procainamide hydrochloride hydralazine HCL procainamide HCL methyldopa Adenocard minoxidil Adenosine QL,PA phenoxybenzamine hydrochloride Amiodarone Hydrochloride/Dextrose prazosin HCL Amiodarone HCL terazosin HCL Corvert Reserpine Lidocaine HCL TIER 03 NON PREFERRED

Nexterone Cardura Quinidine Gluconate Catapres Xylocaine Catapres-tts-1

Catapres-tts-2

ACE INHIBITORS Catapres-tts-3

TIER 01 GENERIC Demser

benazepril HCL DibenzylineQL,PA

captopril Inspra

enalapril maleate Minipress

fosinopril sodium Tenex

lisinopril Vecamyl

moexipril HCL GENERAL MEDICAL MEDICAL

perindopril erbumine sodium nitroprusside

quinapril HCL Corlopam

ramipril Methyldopate HCL

trandolapril Nipride RTU

TIER 03 NON PREFERRED Nitropress

Accupril Phentolamine Mesylate

Aceon

Altace ANTIHYPERTENSIVE COMBO Epaned TIER 01 GENERIC

Lotensin amlodipine besylate/benazepril hydrochloride Mavik amlodipine besylate/benazepril HCL Prinivil amlodipine besylate/valsartan Qbrelis amlodipine/olmesartan medoxomil Vasotec amlodipine/valsartan/hctz Zestril atenolol/chlorthalidone MEDICAL GENERAL MEDICAL benazepril HCL/hydrochlorothiazide enalaprilat bisoprolol fumarate/hydrochlorothiazide

candesartan cilexetil/hydrochlorothiazide

ANGIOTENSIN RCPTR BLOCKER enalapril maleate/hydrochlorothiazide

TIER 01 GENERIC fosinopril sodium/hydrochlorothiazide

candesartan cilexetil irbesartan/hydrochlorothiazide

irbesartan lisinopril/hydrochlorothiazide

losartan potassium losartan potassium/hydrochlorothiazide

olmesartan medoxomil metoprolol/hydrochlorothiazide

telmisartan moexipril/hydrochlorothiazide

valsartan nadolol/bendroflumethiazide

Eprosartan Mesylate olmesartan medoxomil/amlodipine/hydrochlorothiazide

TIER 02 PREFERRED BRAND olmesartan medoxomil/hydrochlorothiazide

Benicar quinapril/hydrochlorothiazide

TIER 03 telmisartan/amlodipine

Effective December 1, 2017

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

telmisartan/hydrochlorothiazide Diuril

trandolapril/verapamil HCL ER Dyazide

valsartan/hydrochlorothiazide Dyrenium

Captopril/Hydrochlorothiazide Edecrin

Methyldopa/Hydrochlorothiazide Lasix

Metoprolol/Hydrochlorothiazide Maxzide

Propranolol/Hydrochlorothiazide Maxzide-25

TIER 02 PREFERRED BRAND Microzide

Azor Neptazane

Benicar HCT TIER 06 NON FORMULARY SPECIALTY

Tekturna HCT KeveyisPA

Tribenzor MEDICAL GENERAL MEDICAL

TIER 03 NON PREFERRED acetazolamide sodium

Accuretic chlorothiazide sodium

Atacand HCT ethacrynate sodium

Avalide mannitol

Byvalson osmitrol viaflex

Clorpres Osmitrol Viaflex

Corzide Sodium Diuril

Diovan HCT Sodium Edecrin

Dutoprol

Edarbyclor VASOPRESSORS

Exforge GENERIC TIER 01

Exforge HCT midodrine HCL

Hyzaar EpinephrineQL

Lopressor HCT PREFERRED BRAND TIER 02

Lotensin HCT AdrenaclickQL

Lotrel NON PREFERRED TIER 03

Metoprolol Succinate ER/Hydrochlorothiazide Epipen 2-PAKQL

Micardis HCT Epipen-JR 2-PAKQL

Prestalia NON PREFERRED SPECIALTY TIER 05

Tarka NortheraPA

Tenoretic 100 GENERAL MEDICAL MEDICAL

Tenoretic 50 dobutamine hydrochloride/dextrose

Twynsta dobutamine HCL

Vaseretic dobutamine HCL/D5W

Zestoretic dobutamine/dextrose 5%

Ziac dopamine hydrochloride/dextrose

dopamine HCL

DIURETICS dopamine/D5W

TIER 01 GENERIC ephedrine sulfate

acetazolamide epinephrine HCL

acetazolamide ER norepinephrine bitartrate

amiloride HCL phenylephrine HCL

amiloride/hydrochlorothiazide AdrenalinQL

bumetanide Akovaz

chlorothiazide Dopamine HCL

chlorthalidone Ephedrine Sulfate/Sodium Chloride

ethacrynic acid Epinephrine Hydrochloride/Sodium Chloride

furosemide Epinephrine HCL

hydrochlorothiazide Levophed

indapamide Norepinephrine Bitartrate/Sodium Chloride

methazolamide Norepinephrine/Dextrose

metolazone Phenylephrine Hydrochloride/Dextrose

spironolactone Phenylephrine Hydrochloride/Sodium Chloride

spironolactone/hydrochlorothiazide Phenylephrine HCL

torsemide Phenylephrine/Sodium Chloride

triamterene/hydrochlorothiazide Vazculep

Chlorothiazide

Furosemide ANTIHYPERLIPIDEMICS

Methyclothiazide PREVENTIVE TIER 07

Triamterene/Hydrochlorothiazide lovastatin

TIER 03 NON PREFERRED GENERIC TIER 01

Aldactazide atorvastatin calcium

Aldactone cholestyramine

Bumex cholestyramine light

Carospir colestipol HCL

Demadex ezetimibe

Diamox ezetimibe/simvastatin

Effective December 1, 2017

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

fenofibrate SPECIALTY MEDICAL

fenofibrate micronized epoprostenol sodiumPA

fenofibric acid DR TIER 05 NON PREFERRED SPECIALTY

fluvastatin AdcircaPA

fluvastatin sodium ERPA AdempasPA

gemfibrozil LetairisPA

niacin ER OpsumitPA

omega-3-acid ethyl estersPA OrenitramPA

pravastatin sodium RevatioPA

prevalite TracleerPA

rosuvastatin calcium TyvasoPA

simvastatin Tyvaso RefillPA

trikloPA Tyvaso StarterPA

Fenofibrate UptraviPA

Fenofibric Acid VentavisPA

TIER 02 PREFERRED BRAND SPECIALTY MEDICAL

Welchol FlolanPA

TIER 03 NON PREFERRED RemodulinPA

Advicor VeletriPA

AltoprevPA MEDICAL GENERAL MEDICAL

Antara cardioplegic

Colestid Natrecor

Colestid Flavored Plegisol

Crestor

Equapax/Atorvastatin Calcium/Coq10 DERMATOLOGICALS Fibricor ACNE PRODUCTS Lescol XLPA TIER 01 GENERIC

Lipitor adapalene Lipofen adapalene P.M. PA Livalo QL amnesteem Lofibra avar cleanser Lopid avar-e emollient LovazaPA avar-e green MevacorST avita Niacor bp 10-1 Niaspan cerisa wash ST Pravachol QL claravis Questran clindacin etz pledgets Questran Light clindacin-p Simcor clindamycin phosphate Tricor PA dapsone Triglide ery Trilipix erythromycin PA Vascepa QL myorisan Vytorin rosanil cleanser Zetia sodium sulfacetamide ZocorST sodium sulfacetamide/sulfur TIER 05 NON PREFERRED SPECIALTY sodium sulfacetamide/sulfur cleanser PraluentPA sodium sulfacetamide/sulfur green RepathaPA sodium sulfacetamide/sulfur wash Repatha Pushtronex SystemPA sss 10%-5% Repatha SureclickPA sulfacetamide sodium TIER 06 NON FORMULARY SPECIALTY sulfacetamide sodium/sulfur JuxtapidPA sulfacetamide sodium/sulfur cleanser KynamroPA sulfacleanse 8/4

tretinoin CARDIOVASCULAR - MISC. tretinoin microsphere TIER 01 GENERIC tretinoin microsphere P.M. amlodipine besylate/atorvastatin calcium QL zenatane TIER 03 NON PREFERRED zencia Bidil Sodium Sulfacetamide/Sulfur IN Urea Caduet TIER 03 NON PREFERRED

CialisQL,ST benzoyl peroxide- HC CorlanorST vanoxide-HC EntrestoPA QL,PA Absorica TIER 04 PREFERRED SPECIALTY PA Aczone sildenafilPA PA Azelex sildenafil citratePA Benzolyl Peroxide Forte- HC

Bp Cleansing Wash

Effective December 1, 2017

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

Clindacin Etz Loprox Shampoo

Clindacin PAC Lotrisone

Clinoin LuzuST

Inova MentaxST

Inova 4/1 Acne Control Therapy NaftinST

Inova 8/2 Acne Control Therapy Nizoral

Retin-a Micro OxistatST

Sodium Sulfacetamide/Sulfur Cleanser IN Urea Pediaderm AF Complete Kit

Sumadan Kit Penlac Nail LacquerQL

Sumaxin CP Kit Recura

Zacare 4% Kit Vusion

Zacare 8% Kit Xolegel

Xolegel Corepak

Xolegel Duo/Head & Shoulders ROSACEA AGENTS

GENERIC Xolegel Duo/Xolex TIER 01

metronidazole

rosadan ANTIVIRALS - TOPICAL

TIER 03 NON PREFERRED TIER 01 GENERIC

FinaceaPA acyclovirQL

MirvasoPA TIER 02 PREFERRED BRAND

RhofadePA ZoviraxQL

Rosadan Kit TIER 03 NON PREFERRED

SoolantraPA DenavirST

ANTIBIOTICS - TOPICAL ANTI-INFLAMMATORY AGENTS

TIER 01 GENERIC TIER 01 GENERIC

gentamicin sulfate diclofenac sodium

mupirocin TIER 03 NON PREFERRED

Gentamicin Sulfate Active-ketoprofen Kit

TIER 02 PREFERRED BRAND Diclofenac Sodium

Altabax Enovarx-ibuprofen

Centany AT Fbl Kit

TIER 03 NON PREFERRED FlectorST

Cortisporin Lidoprofen

Neo-synalar Triple Complex Formula 3 Kit

Voltaren

Vopac Kt ANTIFUNGALS - TOPICAL

GENERIC Vopac Mds TIER 01

ciclodanQL Vp Gkl Kit

ciclopirox

ciclopirox nail lacquerQL ANTIPRURITICS

ciclopirox olamine TIER 01 GENERIC

ciclopirox treatment Doxepin Hydrochloride

clotrimazole TIER 03 NON PREFERRED

clotrimazole/betamethasone dipropionate Prudoxin

econazole nitrate Zonalon

ketoconazole

ketodan ANTIPSORIATICS ST naftifine hydrochloride GENERIC TIER 01

ST naftifine HCL acitretin

nyata calcipotriene

nystatin calcitrene

nystatin/triamcinolone methoxsalen

nystatin/triamcinolone acetonide tazarotene

nystop CalcitriolST

ST oxiconazole nitrate PREFERRED BRAND TIER 02

TIER 03 NON PREFERRED Dritho-creme HP

PA Ciclodan Cream Kit Oxsoralen Ultra

Ciclodan Solution Kit Soriatane

PA Cnl8 Nail Kit 8-mop

ST Ertaczo NON PREFERRED TIER 03

Exelderm TazoracPA

Exoderm VecticalST

Extina Zithranol

Fungimez Zithranol-rr

Halotin NON PREFERRED SPECIALTY TIER 05

PA Jublia CosentyxPA

PA Kerydin Cosentyx Sensoready PenPA

Loprox SiliqPA

Effective December 1, 2017

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

StelaraPA prednicarbate

TaltzPA scalacort

TremfyaPA triamcinolone acetonide

triderm

Amcinonide ANTISEBORRHEIC AGENTS

GENERIC Apexicon E TIER 01

seb-prev wash Augmented Betamethasone Dipropionate

selenium sulfide Clocortolone Pivalate

selenium sulfide shampoo Clocortolone Pivalate P.M.

sodium sulfacetamide Diflorasone Diacetate

sodium sulfacetamide wash TIER 03 NON PREFERRED

NON PREFERRED Cloderm TIER 03

Glycolic Acid Cloderm P.M.

Glycolic Acid 70% High Purity Cordran

Ovace Plus Cordran Tape

Ovace Plus Wash Epifoam

Ovace Wash Halog

Selrx Pramosone

Sodium Sulfacetamide Wash Psorcon

Tersi Foam Scalacort DK

Ultravate X

Xilapak ANTINEOPLASTIC-TOPICAL

TIER 01 GENERIC

diclofenac sodiumPA IMMUNOMODULATING AGENTS

fluorouracil TIER 01 GENERIC

Fluorouracil imiquimod

NON PREFERRED tacrolimus TIER 03

Levulan Kerastick TIER 03 NON PREFERRED

Panretin Elidel

PicatoPA

SolarazePA DERMATOLOGICALS - MISC.

TIER 05 NON PREFERRED SPECIALTY TIER 01 GENERIC

TargretinPA agoneaze

TIER 06 NON FORMULARY SPECIALTY ammonium lactate

ValchlorPA anodyne lpt

anodynz

benzoin compound tincture CORTICOSTEROIDS - TOPICAL

GENERIC ceramax TIER 01

ala-cort cerovel

alclometasone dipropionate cidaleaze

alphatrex dermacinrx empricaine

augmented betamethasone dipropionate dermacinrx prizopak

betamethasone dipropionate glydo

betamethasone valerate lactic acid

clobetasol propionate lactic acid e

clobetasol propionate e lactic acid w/vitamin e

clobetasol propionate emollient latrix

clodan leva set

cormax scalp application leva set/occlusive dressing

desonide lidenza patch

desoximetasone lido bdk

fluocinolone acetonide lido-prilo caine pack

QL fluocinolone acetonide body lidocaine

fluocinolone acetonide scalp lidocaine HCL

fluocinonide lidocaine HCL jelly

QL fluocinonide emulsified base lidocaine PAK

flurandrenolide lidocaine-prilocaine-cream base

fluticasone propionate lidocaine/prilocaine

halobetasol propionate lidopin

hydrocortisone lidopril

hydrocortisone butyrate lidopril XR

hydrocortisone butyrate (lipid) lindane

hydrocortisone butyrate (lipophilic) liprozonepak

hydrocortisone valerate livixil PAK

hydrocortisone IN absorbase lorenza

hydrocortisone 1% IN absobase malathion

lokara medolor PAK

mometasone furoate migryl

nolix permethrin

Effective December 1, 2017

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

podofilox Curity Hypertonic Sodium Chloride Packing Strip 1/2"X15'

pramox gel Curity Sodium Chloride Dressing 6"X6-3/4"

premium lidocaineQL Elimite

prilolid Emla

priloxx LP Essentra Wipes 9X9" Cleanroom Supplies/Presaturated

rea LO 39 Ethyl Chloride

rea LO 40 Ethyl Chloride/Fine Pinpoint

relador PAK Ethyl Chloride/Fine Stream

relador PAK plus Ethyl Chloride/Medium Jet Stream

releevia ML Ethyl Chloride/Medium Stream

remeven Ethyl Chloride/Mist

salacyn Flexin

salicylic acid Gordofilm

salicylic acid cream Hydro 35

salicylic acid lotion Hydrofera Blue Foam Dressing

salicylic acid wart remover Hydrofera Blue Foam Dressing 2"X2"

salimez Hydrofera Blue Foam Dressing 4"X4"

salisol forte Hydrofera Blue Foam Dressing 6"X6"

salitech forte Hydrofera Blue Foam Dressing/Moisture Retentive Film

synvexia Hydrofera Blue Foam Dressing/Moisture Retentive Film/Island umecta mousse

ure-k Hydrofera Blue Foam Dressing/Moisture Retentive Film/2- 1/4X8 ure-39 Hydrofera Blue Foam Dressing/Moisture Retentive urea Film/4"X4"

urea hydrating Hydrofera Blue Foam Dressing/Moisture urea nail Retentive/Ostomy/2.5"

urea nail gel Hydrofera Blue Foam Dressing/Tunneling/9MM urea 40% nail film Hydrofera Blue Heavy Drainage 4"X4" urea-c40 Hydrofera Blue Heavy Drainage 6"X6" uremez-40 Hydrofera Blue Ready Foamdressing 2.5"X2.5" xyphex Hydrofera Blue Ready Foamdressing 4"X5" zeruvia Hydrofera Blue Ready Foamdressing 8"X8" Cem-urea Hydrofera Blue 4"X4" Lidocaine HCL Hylatopic Plus Lindane Hylira LP lite PAK Kendall Hydrogel Impregnated Gauze 2"X2" Podocon 25 IN Benzoin Tincture Kendall Hydrogel Impregnated Gauze 4"X4" Spinosad Kendall Hydrogel Impregnated Gauze 4"X8" Urea IN Zinc Undecylenate/Lactic Acid Vehicle Kendall Hydrogel Wound Dressing 3" Disk Urea Topical Kendall Hydrogel Wound Dressing 4-3/4" Disk TIER 02 PREFERRED BRAND Kendall Zinc Calcium Alginate Dressing Rope 12" Condylox Kendall Zinc Calcium Alginate Dressing 2"X2" Drysol Kendall Zinc Calcium Alginate Dressing 4"X4" EuraxST Kendall Zinc Calcium Alginate Dressing 4"X8" TIER 03 NON PREFERRED Keralyt Acticoat Absorbent Antimicrobial Dressing 4"X5" Keralyt Scalp Acticoat Antimicrobial Dressing 2"X2" Keramatrix Replicine 10CMX10CM Acticoat Antimicrobial Dressing 4"X4" Keramatrix Replicine 5CMX5CM Acticoat Flex 3 Barrier Dressing 4"'X4" Lac-hydrin Acticoat 7 2"X2" Latrix XM Acticoat 7 4"X5" Levatio Patch Acuicyn Daily Eyelid & Eyelash Cleanser Lido-k Alevicyn Dermal Spray Lidocaine And Tetracaine Cream Allevyn AG Adhesive Lidoderm Allevyn AG Gentle Border Loyon Allevyn AG Non-adhesive Lycelle Allevyn AG Sacrum Medi-derm/L-RX Allevyn Gentle Medi-patch RX Anacaine Medihoney Calcium Alginate Dressing 4"X5" Arnica Flower Medihoney Calcium Alginate Dressing/2"X2" Aurstat Anti-itch Hydrogel Medihoney Wound & Burn Dressing 3/4"X12" Avenova Medihoney Wound/Burn Dressing 4"X5" Avenova/Neutrox Mentho-caine Kit Bensal HP Menthocin Patch/Lidocaine Benzoin Tincture Mentholix Boric Acid Microcyn Celacyn Post-procedure Pack Natroba Coal TAR Neuvaxin Cocaine HCL Nuvail Copasil Ovide

Effective December 1, 2017

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

Oxsoralen

Pico Single Use Negative Pressure Wound Therapy TIER 05 SPECIALTY MEDICAL

System Qutenza Pliaglis MEDICAL GENERAL MEDICAL

Pyrogallic Acid Amniofix Sports MED RegranexPA Amphenol-40 Releevia Epifix 4CM X 6CM Releevia Mc Paingo Kft Renovo Sculptra Restore Silver Dressing 2"X2"

Restore Silver Dressing 4"X4.75" ENDOCRINE AND METABOLIC Restore Silver Dressing 4"X4" Non-adhesive CORTICOSTEROIDS Restore Silver Dressing 4"X5" Contact Layer TIER 01 GENERIC Restore Silver Dressing 6"X8" Contact Layer deltasone Restore Silver Dressing 6"X8" Non-adhesive dexamethasone Rtd Wound Care Dressing 2" X 2" fludrocortisone acetate Rtd Wound Care Dressing 4" X 4" hydrocortisone Rtd Wound Care Dressing 4" X 5" methylprednisolone Salex methylprednisolone dose pack Salex Cream prednisolone Salex Lotion prednisolone sodium phosphate Salimez Forte prednisolone sodium phosphate odt Salvax prednisone Salvax Duo Plus Dexamethasone Scarlet Red Dressing Prednisolone Sodium Phosphate Sebuderm Prednisone Sil-k Pad/Large TIER 02 PREFERRED BRAND Sil-k Pad/Medium Dexamethasone Intensol Sil-k Pad/Small Medrol Sklice Millipred Sulfurated Lime Prednisone Intensol Synera TIER 03 NON PREFERRED Synvexia Tc Cortef Tegaderm AG Mesh Dressing With Silver 2"X2" Cortisone Acetate Tegaderm AG Mesh Dressing With Silver 4"X5" Dexpak 10 Day Tegaderm AG Mesh Dressing With Silver 4"X8" Dexpak 13 Day Tegaderm AG Mesh Dressing With Silver 8"X8" Dexpak 6 Day Ulesfia Medrol Dosepak Umecta PD Millipred DP Uramaxin Orapred Odt Urea Nail Pediapred Urea Nail Kit Veripred 20 Vacustim Black Zodex 6-day Vacustim Silver TIER 04 PREFERRED SPECIALTY

Vascuderm Stasis Kit PA budesonide Veltrix TIER 05 NON PREFERRED SPECIALTY

Venelex PA Uceris Veregen TIER 06 NON FORMULARY SPECIALTY

Virasal PA Emflaza Wound Debridement PA Entocort EC Xalix MEDICAL GENERAL MEDICAL Xerac Ac betamethasone sodium phosphate/betamethasone Xeroform Non-occlusive Oil Emulsion Gauze Strip 5"X9" acetate

Xeroform Non-occlusive Oil Emulsion Patch 2"X2" dexamethasone sodium phosphate Xeroform Non-occlusive Oil Emulsion Roll 4"X9" methylprednisolone acetate

Xeroform Non-occlusive Oil Emulsion Strip/Overwrap methylprednisolone sodiumsuccinate 1"X8" Celestone-soluspan Xeroform Occlusive Petrolatum Gauze Roll 4"X9' Depo-medrol Xeroform Occlusive Petrolatum Gauze Strip 1"X8" Dexamethasone Sodium Phosphate Xeroform Occlusive Petrolatum Gauze Strip 5"X9" Dexamethasone Sodium Phosphate/Sodium Chloride Xeroform Occlusive Petrolatum Gauze Strip/Overwrap Kenalog-10 1"X8"

Kenalog-40 Xeroform Occlusive Petrolatum Gauze Strip/Overwrap Lidocidex I 5"X9"

Xeroform Occlusive Petroltum Gauze Patch 2"X2" Lidocilone I

Xeroform Occlusive Petroltum Gauze Patch 4"X4" Solu-cortef

Xeroform Petrolatum Dressing Solu-medrol

Xeroform Petrolatum Dressing Overwrap 1"X8"

Xeroform Petrolatum Dressing Overwrap 5"X9" ANDROGENS-ANABOLIC

Xeroform Petrolatum Dressing Roll 4"X3YD TIER 01

Xylocaine

Effective December 1, 2017

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

GENERIC Evamist

danazol Prefest

methyltestosterone Premphase

oxandrolone Prempro

testosteronePA Vivelle-dot

testosterone cypionate MEDICAL GENERAL MEDICAL

testosterone enanthate Depo-estradiol

testosterone topical solution Premarin

testosterone P.M.PA

TestosteronePA CONTRACEPTIVES

TIER 02 PREFERRED BRAND PREVENTIVE TIER 07

PA Androgel aftera

PA Androgel P.M. altavera

TIER 03 NON PREFERRED alyacen 1/35

Anadrol-50 alyacen 7/7/7

Androderm amethia

Android amethia LO

Androxy amethyst

Aveed apri

Axiron aranelle

Depo-testosterone ashlyna

First-testosterone aubra

First-testosterone Mc Compounding Kit aviane

PA Fortesta azurette

Methitest balziva

Oxandrin bekyree

Striant blisovi FE 1.5/30

PA Testim blisovi FE 1/20

Testone Cik blisovi 24 FE

PA Testosterone P.M. briellyn

Testred camila

PA Vogelxo camrese

PA Vogelxo P.M. camrese LO

MEDICAL GENERAL MEDICAL caziant

PA Testopel chateal

cryselle-28

ESTROGENS cyclafem 1/35

TIER 01 GENERIC cyclafem 7/7/7

amabelz cyred

estradiol dasetta 1/35

estradiol valeratePA dasetta 7/7/7

estradiol/norethindrone acetate daysee

fyavolv deblitane

jevantique LO delyla

jinteli desogestrel/ethinyl estradiol

lopreeza drospirenone/ethinyl estradiol

mimvey drospirenone/ethinyl estradiol/levomefolate calcium

mimvey LO econtra EZ

norethindrone acetate/ethinyl estradiol elinest

Estropipate emoquette

TIER 02 PREFERRED BRAND enpresse-28

Alora enskyce

Femhrt Low Dose errin

Menest estarylla

Menostar ethynodiol diacetate/ethinyl estradiol

Minivelle fallback solo

TIER 03 NON PREFERRED falmina

Activella fayosim

Angeliq femynor

Climara gianvi

Climara Pro gildagia

Combipatch gildess FE 1.5/30

DelestrogenPA gildess FE 1/20

Divigel gildess 1.5/30

Duavee gildess 1/20

Elestrin gildess 24 FE

Enjuvia heather

Estrace introvale

Estrogel isibloom

Effective December 1, 2017

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

jencycla pirmella 1/35

jolessa pirmella 7/7/7

jolivette portia-28

juleber previfem

junel FE 1.5/30 quasense

junel FE 1/20 rajani

junel FE 24 react

junel 1.5/30 reclipsen

junel 1/20 rivelsa

kaitlib FE setlakin

kariva sharobel

kelnor 1/35 sprintec 28

kimidess sronyx

kurvelo syeda

larin FE 1.5/30 take action

larin FE 1/20 tarina FE 1/20

larin 1.5/30 tilia FE

larin 1/20 tri femynor

larin 24 FE tri-estarylla

larissia tri-legest FE

layolis FE tri-linyah

leena tri-previfem

lessina tri-sprintec

levonest tri-LO-estarylla

levonorgestrel tri-LO-marzia

levonorgestrel and ethinyl estradiol tri-LO-sprintec

levonorgestrel/ethinyl estradiol trinessa

levora 0.15/30-28 trinessa LO

lillow trivora-28

lomedia 24 FE velivet

loryna vestura

low-ogestrel vienva

lutera viorele

lyza vyfemla

marlissa wera

medroxyprogesterone acetate wymzya FE

melodetta 24 FE zarah

mibelas 24 FE zenchent

microgestin FE zenchent FE

microgestin FE 1.5/30 zovia 1/35e

microgestin 1.5/30 zovia 1/50e

microgestin 1/20 Ella

microgestin 24 FE Kyleena

mono-linyah Levonorgestrel And Ethinyl Estradiol

mononessa Liletta

my way Mirena

myzilra Natazia

necon 0.5/35-28 Necon 1/50-28

necon 1/35 Nexplanon

necon 7/7/7 Nuvaring

next choice one dose Ogestrel

nikki Paragard Intrauterine Copper Contraceptive T380a

nora-be Skyla

norethindrone Xulane

norethindrone & ethinyl estradiol ferrous fumarate TIER 03 NON PREFERRED

norethindrone acetate/ethinyl estradiol Beyaz

norethindrone acetate/ethinyl estradiol/ferrous fumarate Brevicon-28

norethindrone/ethinyl estradiol/ferrous fumarate Cyclessa

norgestimate/ethinyl estradiol Desogen

norlyda Estrostep FE

norlyroc Falessa

nortrel 0.5/35 (28) Femcon FE

nortrel 1/35 Generess FE

nortrel 7/7/7 Loestrin FE 1.5/30

ocella Loestrin FE 1/20

opcicon one-step Loestrin 1.5/30-21

option 2 Loestrin 1/20-21

orsythia Loseasonique

philith LO Loestrin FE

pimtrea Minastrin 24 FE

Effective December 1, 2017

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

Mircette Novolin 70/30QL,ST

Modicon Novolin 70/30 RelionQL,ST

Necon 10/11-28 NovologQL,ST

Nor-QD Novolog FlexpenQL,ST

Norinyl 1+35 Novolog Mix 70/30QL,ST

Norinyl 1+50 Novolog Mix 70/30 Prefilled FlexpenQL,ST

Ortho Micronor Novolog PenfillQL,ST

Ortho Tri-cyclen Relion RQL

Ortho Tri-cyclen LO Tresiba FlextouchQL

Ortho-cyclen AMYLIN ANALOGS

Ortho-novum 1/35 TIER 03 NON PREFERRED

Ortho-novum 7/7/7 Symlinpen 120ST

Ovcon-35 Symlinpen 60ST

Quartette INCRETIN MIMETIC AGENTS

Safyral TIER 03 NON PREFERRED

Seasonique AdlyxinQL,PA

Taytulla Adlyxin Starter PackQL,PA

Tri-norinyl 28 BydureonQL,PA

Yasmin 28 Bydureon BcisePA

Yaz Bydureon PenQL,PA

ByettaQL,PA

TanzeumQL,PA PROGESTINS QL,PA GENERIC Trulicity TIER 01

QL,PA medroxyprogesterone acetate Victoza

megestrol acetate SULFONYLUREAS

norethindrone acetate TIER 01 GENERIC

progesterone glimepiride

NON PREFERRED glipizide TIER 03

Aygestin glipizide ER

EC-RX Progesterone 10% glipizide XL

Megace ES glyburide

Progesterone 10% Kit glyburide micronized

Prometrium Chlorpropamide

Provera Tolazamide

SPECIALTY MEDICAL Tolbutamide TIER 05

MakenaPA TIER 02 PREFERRED BRAND

Diabeta

TIER 03 NON PREFERRED ANTIDIABETIC AGENTS Amaryl INSULIN Glucotrol TIER 02 PREFERRED BRAND

QL Glucotrol XL Humalog QL Glynase Humalog Kwikpen QL BIGUANIDES Humalog Mix 50/50 QL TIER 01 GENERIC Humalog Mix 50/50 Kwikpen QL metformin hydrochloride Humalog Mix 75/25 QL metformin HCL Humalog Mix 75/25 Kwikpen QL metformin HCL ER Humulin N QL TIER 03 NON PREFERRED Humulin N Kwikpen QL Glucophage Humulin R QL Glucophage XR Humulin R U-500 (concentrated) QL Riomet Humulin R U-500 Kwikpen QL MEGLITINIDE ANALOGUES Humulin 70/30 QL TIER 01 GENERIC Humulin 70/30 Kwikpen QL nateglinide Lantus QL repaglinide Lantus Solostar QL TIER 03 NON PREFERRED Levemir QL Prandin Levemir Flextouch QL Starlix Toujeo Solostar DIABETIC OTHER TIER 03 NON PREFERRED

QL TIER 02 PREFERRED BRAND Afrezza QL Glucagen Hypokit Apidra QL Glucagon Emergency Kit Apidra Solostar InvokanaQL,ST Basaglar Kwikpen QL,ST JardianceQL,ST Fiasp QL,ST TIER 03 NON PREFERRED Fiasp Flextouch QL Cycloset Humalog Junior Kwikpen QL,ST FarxigaQL,PA Novolin N QL,ST Proglycem Novolin N Relion QL,ST TIER 05 NON PREFERRED SPECIALTY Novolin R QL,ST KorlymPA Novolin R Relion

Effective December 1, 2017

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

ALPHA-GLUCOSIDASE INHIBIT TIER 04 SPECIALTY MEDICAL

TIER 01 GENERIC pamidronate disodium

acarbose zoledronic acid

miglitol Pamidronate Disodium

TIER 03 NON PREFERRED Zoledronic Acid

Glyset TIER 05 SPECIALTY MEDICAL

Precose Zometa

DPP-4 INHIBITORS TIER 06 SPECIALTY MEDICAL

TIER 02 PREFERRED BRAND Reclast

JanuviaQL,ST

TradjentaQL,ST CALCITONINS

TIER 03 NON PREFERRED GENERIC TIER 01

QL,PA Alogliptin calcitonin salmon

QL,PA Nesina calcitonin-salmon

QL,PA Onglyza NON PREFERRED TIER 03

INSULIN SENSITIZING AGENT Fortical

TIER 01 GENERIC Miacalcin

pioglitazone HCL

TIER 03 NON PREFERRED PARATHYROID HORMONE Actos TIER 05 NON PREFERRED SPECIALTY

AvandiaST PA Forteo ANTIDIABETIC COMBINATIONS PA Tymlos TIER 01 GENERIC TIER 06 SPECIALTY MEDICAL

glipizide/metformin HCL PA Natpara glyburide/metformin HCL

pioglitazone HCL-glimepiride RANK LIGAND INHIBITORS pioglitazone HCL/metformin HCL TIER 05 SPECIALTY MEDICAL

Repaglinide/Metformin Hydrochloride Prolia TIER 02 PREFERRED BRAND Xgeva Duetact

InvokametQL,ST QL,ST HORMONE RECEPTOR MDLTR Invokamet XR QL,ST TIER 01 GENERIC

Janumet QL,ST raloxifene hydrochloride Janumet XR QL,ST TIER 03 NON PREFERRED

Jentadueto QL,ST Evista Jentadueto XR QL,ST Osphena Synjardy QL,ST Synjardy XR FERTILITY REGULATORS TIER 03 NON PREFERRED

TIER 01 GENERIC

Actoplus Met PA clomiphene citrate Actoplus Met XR PA QL,PA Clomiphene Citrate Alogliptin/Metformin HCL QL,PA TIER 04 PREFERRED SPECIALTY

Alogliptin/Pioglitazone PA Chorionic Gonadotropin Glucovance PA PA Follistim AQ Glyxambi PA QL,PA Novarel Kazano PA QL,PA Pregnyl W/Diluent Benzyl Alcohol/NACL Kombiglyze XR QL,PA TIER 05 NON PREFERRED SPECIALTY

Oseni PA Bravelle Prandimet PA Gonal-f Qtern PA PA Gonal-f RFF Soliqua 100/33 PA QL,PA Gonal-f RFF Rediject Xigduo XR PA QL,PA Menopur Xultophy 100/3.6 PA Ovidrel

BISPHOSPHONATES LHRH/GNRH AGONIST TIER 01 GENERIC

TIER 02 PREFERRED BRAND alendronate sodium Synarel ibandronate sodium ST TIER 05 SPECIALTY MEDICAL

risedronate sodium PA ST Lupaneta Pack risedronate sodium DR PA Lupron Depot-PED (1-month) Alendronate Sodium PA Lupron Depot-PED (3-month) Etidronate Disodium PA Triptodur TIER 03 NON PREFERRED

ST TIER 06 SPECIALTY MEDICAL

Actonel PA ST Supprelin LA Atelvia ST Binosto ST GNRH/LHRH ANTAGONISTS Boniva QL TIER 05 NON PREFERRED SPECIALTY

Fosamax PA Cetrotide Fosamax Plus D PA Ganirelix Acetate

Effective December 1, 2017

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

GROWTH HORMONES METABOLIC MODIFIERS

TIER 04 PREFERRED SPECIALTY TIER 01 GENERIC

OmnitropePA calcitriol

TIER 05 NON PREFERRED SPECIALTY doxercalciferolPA

GenotropinPA levocarnitine

Genotropin MiniquickPA paricalcitolST

HumatropePA sodium phenylbutyrate

Humatrope Combo PackPA TIER 03 NON PREFERRED

Norditropin CartridgePA Buphenyl

Norditropin FlexproPA Carnitor

Nutropin AQ Nuspin 10PA Carnitor SF

Nutropin AQ Nuspin 20PA Cystadane

Nutropin AQ Nuspin 5PA HectorolPA

Nutropin AQ PenPA Rocaltrol

SaizenPA TIER 05 NON PREFERRED SPECIALTY

Saizen Click.easyPA RayaldeePA

Saizenprep ReconstitutionkitPA SensiparPA

SerostimPA SPECIALTY MEDICAL

ZorbtivePA AldurazymePA

TIER 06 NON FORMULARY SPECIALTY

CarbagluPA GHRH PA NON FORMULARY SPECIALTY Kuvan TIER 06

PA EgriftaPA Myalept

NityrPA

OrfadinPA SOMATOMEDINS RavictiPA TIER 05 NON PREFERRED SPECIALTY

PA XuridenPA Increlex SPECIALTY MEDICAL

BrineuraPA SOMATOSTATIC AGENTS ElaprasePA TIER 05 NON PREFERRED SPECIALTY PA PA Fabrazyme octreotide acetate PA PA Kanuma Sandostatin LumizymePA SPECIALTY MEDICAL PA PA Naglazyme Sandostatin Lar Depot PA PA Strensiq Somatuline Depot VimizimPA TIER 06 NON FORMULARY SPECIALTY

PA MEDICAL GENERAL MEDICAL Signifor sodium phenylacetate/sodium benzoate

Ammonul GH RECEPTOR ANTAGONISTS Calcitriol TIER 06 NON FORMULARY SPECIALTY ST

PA Zemplar Somavert

THYROID AGENTS POSTERIOR PITUITARY TIER 01 GENERIC TIER 01 GENERIC

levo-t desmopressin acetate levothyroxine sodium TIER 02 PREFERRED BRAND

levoxyl Stimate liothyronine sodium MEDICAL GENERAL MEDICAL

methimazole Ddavp propylthiouracil Vasostrict unithroid

unithroid direct CORTICOTROPIN NP thyroid 120 TIER 06 NON FORMULARY SPECIALTY

PA NP thyroid 15 H.p. Acthar NP thyroid 60

NP thyroid 90 PROLACTIN INHIBITORS TIER 02 PREFERRED BRAND

TIER 01 GENERIC levothyroxine/liothyronine cabergoline Armour Thyroid

NP thyroid 30 VASOPRESSIN ANTAGONISTS Synthroid TIER 05 NON PREFERRED SPECIALTY Thyrolar-1 SamscaPA Thyrolar-1/2 MEDICAL GENERAL MEDICAL Thyrolar-1/4 Vaprisol Thyrolar-2

Thyrolar-3 PROGESTERONE ANTAGONISTS TIER 03 NON PREFERRED

TIER 03 NON PREFERRED Cytomel Mifeprex Nature-throid

Effective December 1, 2017

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

Nature-throid Nt-2.5 ra laxativeQL

Tapazole ra magnesium citrateQL

Tirosint ra womens laxativeQL

Westhroid sm clearlaxQL

Wp Thyroid sm gentle laxativeQL

MEDICAL GENERAL MEDICAL sm magnesium citrateQL

Levothyroxine Sodium sm womans laxativeQL

Triostat smooth LAXQL

stimulant laxativeQL

sw clearlaxQL GASTROINTESTINAL tgt gentle laxativeQL LAXATIVES tgt powderlaxQL TIER 07 PREVENTIVE QL QL tgt womens laxative alophen QL QL trilyte bisacodyl laxative QL QL veracolate bisacodyl EC QL QL womans laxative carters little pills QL QL women's gentle laxative citrate of magnesia QL QL womens laxative citrate of megnesia QL QL CVS bisacodyl citroma QL QL CVS c-LAX laxative clearlax QL QL CVS citrate of magnesia correct QL QL CVS gentle laxative correctol QL QL CVS gentle laxative womens ducodyl QL QL CVS magnesium citrate dulcolax balance QL QL CVS purelax eq clearlax QL QL EX-LAX ultra eq gentle laxative QL QL HM clearlax eq magnesium citrate QL QL HM laxative eq womans laxative QL QL HM magnesium citrate eq womens laxative QL QL SB bisacodyl laxative EC eql clearlax QL QL SB gentle laxative womens eql gentle laxative QL QL SB gentle LAX-women eql laxative QL QL SB magnesium citrate eql magnesium citrate QL QL SB polyethylene glycol 3 350 eql womans laxative QL TIER 01 GENERIC feenamint QL constulose fleet laxative QL gavilyte-h gavilax QL lactulose gavilyte-c QL mineral oil heavy gavilyte-n/flavor pack QL peg-prep gavilyte-G QL TIER 03 NON PREFERRED gentle laxative QL Colyte-flavor Packs gentle laxative for women QL Golytely gentle laxative overnightrelief QL Kristalose gentlelax QL Moviprep glycolax QL Nulytely/Flavor Packs gnp bisa-LAX QL Osmoprep gnp clearlax QL Prepopik gnp laxative QL Suprep Bowel Prep Kit gnp magnesium citrate QL

gnp womens laxative QL ANTIDIARRHEALS goodsense magnesium citrate QL TIER 01 GENERIC kls laxaclear QL diphenoxylate/atropine kp bisacodyl QL loperamide HCL laxative QL opium laxative feminine QL opium tincture laxative polyethlyene glycol 3350 QL Diphenoxylate/Atropine magnesium citrate QL TIER 03 NON PREFERRED peg 3350 QL FulyzaqPA peg 3350/electrolytes QL Lomotil peg-3350/electrolytes QL Motofen peg-3350/NACL/NA bicarbonate/KCL QL MytesiPA pegylax QL Paregoric peg3350 QL

polyethylene glycol 3350

polyethylene glycol 3350-grxQL ANTACIDS

px laxativeQL TIER 03 NON PREFERRED

qc gentle laxativeQL Sodium Bicarbonate

qc magnesium citrateQL

qc natura-LAXQL

Effective December 1, 2017

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

Glycopyrrolate ULCER DRUGS

GENERIC Nexium I.v. TIER 01

chlordiazepoxide HCL/clidinium bromide Robinul

cimetidine

cimetidine HCL ANTIEMETICS

dicyclomine HCL TIER 01 GENERIC

ed-spaz aprepitantQL

famotidine dronabinol

hyoscyamine sulfate granisetron HCL

hyoscyamine sulfate odt meclizine HCL

hyoscyamine sulfate ER ondansetron odt

hyoscyamine sulfate SR ondansetron HCL

lansoprazole scopolamine

lansoprazole/amoxicillin/clarithromycin trimethobenzamide HCL

methscopolamine bromide TIER 02 PREFERRED BRAND

misoprostol Anzemet

nizatidine SancusoQL

nulev TIER 03 NON PREFERRED

omeprazole AkynzeoQL

oscimin Cesamet

oscimin SR EmendQL

pantoprazole sodium Emend TripackQL

rabeprazole sodium Marinol

ranitidine HCL Syndros

sucralfate Transderm-scop

symax-SR VarubiQL

Belladonna Alkaloids & Opium Zofran

Cimetidine HCL Zofran Odt

First-lansoprazolePA Zuplenz

First-omeprazole TIER 05 NON PREFERRED SPECIALTY

Nizatidine SustolQL

Omeprazole + Syrspend SF Alka MEDICAL GENERAL MEDICAL

Propantheline Bromide AloxiPA

TIER 02 PREFERRED BRAND Dimenhydrinate

Carafate Granisetron HCL

TIER 03 NON PREFERRED Tigan

Aciphex

Aciphex Sprinkle DIGESTIVE AIDS

Anaspaz PREFERRED BRAND TIER 02

Belladonna & Opium Creon

Bentyl NON PREFERRED TIER 03

Cantil Pancreaze

Cuvposa Pertzye

Cytotec Ultresa

PA Dexilant Viokace

Levbid Zenpep

Levsin NON PREFERRED SPECIALTY TIER 05

Levsin/SL SucraidPA

Librax

Omeclamox-PAK GASTROINTESTINAL - MISC. Pamine TIER 01 GENERIC

Pamine Forte alosetron hydrochloride Pamine FQ ana-lex Pepcid balsalazide disodium Prevacid calcium acetate Prevacid Solutab colocort Prevpac cromolyn sodium Prilosec enulose Protonix generlac Pylera hydrocort ene 100MG Robinul Forte hydrocortisone Symax Duotab hydrocortisone acetate/pramoxine Zantac lactulose MEDICAL GENERAL MEDICAL lanthanum carbonate esomeprazole sodium lidocaine HCL/hydrocortisone acetate glycopyrrolate mesalamine Atropine Sulfate mesalamine DR Esomeprazole Sodium metoclopramide HCL Famotidine Premixed pramcort

Effective December 1, 2017

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

procto-MED HC GattexPA

procto-PAK OcalivaPA

proctosol HC

proctozone-HC GENITOURINARY sevelamer carbonate URINARY ANTI-INFECTIVES sulfasalazine TIER 01 GENERIC

ursodiol azuphen mb Mesalamine DR hyolev mb Metoclopramide Odt hyophen TIER 02 PREFERRED BRAND indiomin mb AmitizaQL me/naphos/mb/hyo 1 Analpram-HC methenamine hippurate Apriso methenamine mandelate Asacol HD nitrofurantoin Canasa nitrofurantoin macrocrystals Cortifoam nitrofurantoin monohydrate Delzicol nitrofurantoin monohydrate/macrocrystals Dipentum phosphasal LinzessQL ur n-c RelistorPA uramit mb TIER 03 NON PREFERRED uretron d/s Actigall uribel Anusol-HC urin d/s Auryxia uro-blue Azulfidine uro-l Azulfidine EN-TABS uro-mp Chenodal uro-458 Colazal uroav-b Cortenema uroav-81 Eliphos urolet mb Entereg urophen mb Fosrenol uryl Gastrocrom ustell GiazoPA uta Lialda uticap Lidocaine HCL-hydrocortisone Acetate With Aloe utira-c Lotronex utrona-c Metozolv Odt vilamit mb Movantik vilevev mb Pentasa Methenamine Mandelate Phoslyra TIER 02 PREFERRED BRAND

Procort Macrodantin Proctocort TIER 03 NON PREFERRED

Proctofoam HC Furadantin Rectiv Hiprex Reglan Macrobid Renagel Monurol Renvela Urimar-t Rowasa Urogesic-blue Sfrowasa

Symproic QL URINARY ANTISPASMODICS Trulance TIER 01 GENERIC

Uceris bethanechol chloride Urso Forte darifenacin hydrobromide ER Urso 250 flavoxate HCL TIER 04 PREFERRED SPECIALTY

PA oxybutynin chloride Viberzi oxybutynin chloride ER TIER 05 NON PREFERRED SPECIALTY

PA tolterodine tartrate Cimzia PA tolterodine tartrate ER Cimzia Starter Kit trospium chloride Velphoro PA trospium chloride ER Xermelo TIER 02 PREFERRED BRAND

SPECIALTY MEDICAL PA Myrbetriq Entyvio Vesicare Inflectra TIER 03 NON PREFERRED

Remicade PA Detrol Renflexis PA Detrol LA Stelara Ditropan XL TIER 06 NON FORMULARY SPECIALTY

PA Enablex

Cholbam

Effective December 1, 2017

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

Gelnique potassium citrate/sodium citrate/citric acid

Gelnique P.M. sodium chloride

Toviaz sodium chloride 0.9%

Urecholine sodium citrate/citric acid

tamsulosin HCL

taron-crystals VAGINAL PRODUCTS

PREVENTIVE tricitrates TIER 07

vcf vaginal contraceptivegelQL virtrate-k

EncareQL virtrate-2

Options Conceptrol Vaginal ContraceptiveQL virtrate-3

Options Gynol II Vaginal ContraceptiveQL TIER 02 PREFERRED BRAND

Shur-sealQL Cardura XL

Today SpongeQL Oracit

Vcf Vaginal Contraceptive FilmQL Shohls Solution Modified

Vcf Vaginal Contraceptive FoamQL Urocit-k 10

GENERIC Urocit-k 15 TIER 01

clindamycin phosphate Urocit-k 5

estradiol TIER 03 NON PREFERRED

metronidazole vaginal Avodart

terconazole Cystagon

vandazole Elmiron

yuvafem Flomax

zazole Jalyn

Miconazole 3 K-phos NO 2

PREFERRED BRAND Lithostat TIER 02

Endometrin Neosporin GU Irrigant

Estrace Proscar

Estring Pyridium

NON PREFERRED Rapaflo TIER 03

Avc Renacidin

Cleocin Sorbitol

Clindesse Sorbitol-mannitol

PA Crinone Thiola

Fem PH Uroxatral

Femring TIER 06 NON FORMULARY SPECIALTY

PA First-progesterone VGS 100 Compounding Kit Procysbi

First-progesterone VGS 200 Compounding Kit MEDICAL GENERAL MEDICAL

First-progesterone VGS 25 Compounding Kit Deflux

First-progesterone VGS 400 Compounding Kit Rimso-50

First-progesterone VGS 50 Compounding Kit

Gynazole-1 HEMATOLOGICAL Intrarosa HEMATOPOIETIC AGENTS Metrogel-vaginal TIER 07 PREVENTIVE

Premarin eql folic acid Relagard fa-8 Terazol 3 folic acid Terazol 7 gnp folic acid Vagifem kp folic acid

px folic acid

GENITOURINARY - MISC. ra folic acid

TIER 01 GENERIC sm folic acid

acetic acid 0.25% yl folic acid

alfuzosin HCL ER CVS folic acid

aminoacetic acid HM folic acid

argyle sterile saline 100ML GENERIC TIER 01

curity sterile saline airavite

dutasteride chromagen

dutasteride/tamsulosin hydrochloride corvita 150

dutasteride/tamsulosin HCL cyanocobalamin

finasteride fabb

glycine ferocon

neomycin/polymyxin b sulfates ferotrinsic

phenazo ferrocite plus

phenazopyridine hydrochloride folbee

phenazopyridine hydrocholride folic acid/vitamin b-6/vitamin b-12

phenazopyridine HCL folplex 2.2

potassium citrate ER foltrin

potassium citrate-citric acid crystals hematinic plus vitamins/minerals

potassium citrate/citric acid hematinic/folic acid

Effective December 1, 2017

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

hematogen Niferex

hematogen forte Nufera

hemocyte-f Ortho D

hemocyte-plus Ortho DF

iferex 150 forte Pre-folic

k-tan plus Proferrin-forte

myferon 150 forte Protectiron

nufol Purefe Plus

poly-iron 150 forte Tandem F

polysaccharide iron forte Tandem Plus

purevit dualfe plus Taron Forte

se-tan plus Zolate

tricon TIER 04 PREFERRED SPECIALTY

trigels-f forte Granix

virt-gard PromactaPA

virt-vite Zarxio

vitamez TIER 05 NON PREFERRED SPECIALTY

AV-vite fb Aranesp Albumin Free

Bp Vit 3 Epogen

TL gard RX Neulasta

TL icon Neulasta Onpro Kit

TL-hem 150 Neupogen

TIER 02 PREFERRED BRAND Procrit

Droxia SPECIALTY MEDICAL

TIER 03 NON PREFERRED Leukine

Abaneu-SL MozobilPA

Active FE NplatePA

Animi-3 TIER 06 NON FORMULARY SPECIALTY

Animi-3/Vitamin D CerdelgaPA

B-6 Folic Acid ZavescaPA

Biferarx SPECIALTY MEDICAL

Bp Vit 3 Plus CerezymePA

Cenfol ElelysoPA

Centratex VprivPA

Ciferex MEDICAL GENERAL MEDICAL

Cifrazol sodium ferric gluconate complex/sucrose

Corvite FE Feraheme

Corvite 150 Ferrlecit

Divista Folic Acid

Durachol Hydroxocobalamin

Feriva Infed

Ferivafa Injectafer

Ferralet 90 Triferic

Ferraplus 90 Venofer

Ferro-plex Hematinic

Ferrotrin ANTICOAGULANTS

Focalgin Dss GENERIC TIER 01

Folgard RX enoxaparin sodium

Folivane-f fondaparinux sodium

Folivane-plus heparin lock flush

Foltrate heparin lock flush for flushing vascular access devices

Fusion Plus heparin lock flush/NACL for flushing vascular access

Hematogen Fa devices

Hematron-AF heparin sodium

Hemetab heparin sodium dcu

Hemocyte Plus heparin sodium lock flush

Hemocyte-f heparin sodium/sodium chloride 0.9% premix

Icar-c Plus heparin sodium/D5W

Integra F heparin sodium/NACL 0.9%

Integra Plus jantoven

Irospan 24/6 monoject pharma grade flush syringe/heparin lock

Is 24/6 monoject prefill advanced heparin lock flush

Maxfe sash kit for flushing vascular access devices

Mircera warfarin sodium

Multigen Heparin Lock Flush

Multigen Folic Heparin Sodium

Multigen Plus Heparin Sodium/D5W

Nascobal Heparin Sodium/Sodium Chloride

Nephron Fa Heparin Sodium/Sodium CH Loride

Neurin-SL

Effective December 1, 2017

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

Sash Kit For Flushing Vascular Access Devices EffientPA

TIER 02 PREFERRED BRAND Persantine

Coumadin Plavix

Eliquis Pletal

Fragmin ZontivityST

Pradaxa TIER 05 SPECIALTY MEDICAL

Xarelto Advate

Xarelto Starter Pack Adynovate

TIER 03 NON PREFERRED Afstyla

Acd Formula A Alphanate/Von Willebrand Factor Complex/Human

Acd Formula B Alphanine SD

Acd-a Noclot-50 Alprolix

Anticoagulant Citrate Dextrose Solution A Bebulin

Anticoagulant Citrate Phosphate Dextrose Solution Benefix

Anticoagulant Sodium Citrate Coagadex

Arixtra Corifact

Heparin Sodium/NACL 0.45% Eloctate

Heparin Sodium/Sodium Chloride 0.9% Feiba

Lovenox Feiba NF

SavaysaST Helixate FS

Tricitrasol Hemofil M

MEDICAL GENERAL MEDICAL Humate-p

argatroban Idelvion

bivalirudin Ixinity

Angiomax Koate

Argatroban Koate-dvi

Defitelio Kogenate FS

Heparin Sodium/Sodium Chloride PF Kogenate FS Bio-set

Iprivask Kovaltry

Monoclate-p

Mononine HEMOSTATICS

PREFERRED BRAND Novoeight TIER 02

Lysteda Novoseven

NON PREFERRED Novoseven Rt TIER 03

Amicar Nuwiq

Artiss Profilnine

Astringyn Profilnine SD

Evicel Recombinate

Evithrom Rixubis

PA Gelfoam-jmi Sponge Kit Ruconest

PA Monsels Ferric Subsulfate Soliris

Recothrom Tretten

Recothrom Spray Kit Vonvendi

Thrombin-jmi Diluent Wilate

Thrombin-jmi Epistaxis Xyntha

Thrombin-jmi Syringe Spray Kit Xyntha Solofuse

Thrombin-jmi W/Dil Spray P.M. Actuator TIER 06 NON FORMULARY SPECIALTY

QL,PA Thrombogen Firazyr

PA Tisseel Haegarda

Tisseel VH SPECIALTY MEDICAL

PA GENERAL MEDICAL Berinert MEDICAL

PA tranexamic acid Cinryze

PA Aminocaproic Acid Kalbitor

Cyklokapron MEDICAL GENERAL MEDICAL

albuked 25

albuked 5 HEMATOLOGICAL - MISC. albumin human TIER 01 GENERIC

albumin-zlb anagrelide hydrochloride albuminar-25 aspirin/dipyridamole albuminar-5 cilostazol alburx clopidogrel albutein dipyridamole buminate pentoxifylline ER PA eptifibatide prasugrel flexbumin TIER 02 PREFERRED BRAND

hetastarch 6%/NACL Brilinta human albumin grifols TIER 03 NON PREFERRED

kedbumin Aggrenox plasbumin-25 Agrylin

plasbumin-5

Effective December 1, 2017

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

Activase Arestin

Aggrastat Bocasal

Cathflo Activase Caphosol

Ceprotin Debacterol

Hespan Evoxac

Hextend First-bxn Mouthwash

Integrilin First-dukes Mouthwash

Kcentra First-marys Mouthwash

Kengreal First-mouthwash Blm

LMD 10% Dextrose 5% Fluoridex Daily Defense Sensitivity Relief

LMD 10% Sodium Chloride 0.9% Gel-kam Oral Care Rinse

Obizur Gelclair

Octaplas Blood Group A Nafrinse Daily/Acidulated

Octaplas Blood Group Ab Nafrinse Daily/Neutral

Octaplas Blood Group B Nafrinse Weekly

Octaplas Blood Group O Neutrasal

Panhematin Numoisyn

Plasmanate Orafate

Protamine Sulfate Oravig

Reopro Peridex

Riastap Prevident

Thrombate IiiPA Prevident Fluoride

Thrombate Iii W/10 ML Sterile WaterPA Prevident 5000 Booster

Thrombate Iii W/20 ML Sterile WaterPA Prevident 5000 Booster Plus

Tnkase Prevident 5000 Dry Mouth

Voluven Prevident 5000 Enamel Protect

Prevident 5000 Plus

Prevident 5000 Sensitive MOUTH/THROAT/DENTAL AGENT Prothelial

Salagen TIER 01 GENERIC

Salivamax cavarest Salivate RX cavirinse Thera-flur-n cevimeline HCL

chlorhexidine gluconate

chlorhexidine gluconate oral rinse NEUROLOGY, CNS, PSYCH

clinpro 5000 ANTIANXIETY AGENTS

clotrimazole GENERIC TIER 01

controlrx alprazolam

denta 5000 plus alprazolam odtST

dentagel alprazolam ER

easygel alprazolam XR

fluoridex buspirone HCL

fluoridex daily defense chlordiazepoxide HCL

fluoridex daily defense enhanced whitening clorazepate dipotassium

fluoridex daily defense sensitivity relief diazepam

fluoridex daily renewal diazepam intensol

fluoridex enhanced whitening gene-xene TAB 15MG

fluoridex sensitivity relief gene-xene TAB 3.75MG

fluoridex sensitivity relief/sls free gene-xene TAB 7.5MG

karigel hydroxyzine pamoate

karigel-n hydroxyzine HCL

lidocaine viscous lorazepam

lidocaine HCL viscous lorazepam intensol

neutragard advanced meprobamate

neutral sodium fluoride oxazepam

nystatin Diazepam

oralone dental paste Hydroxyzine Pamoate

paroex NON PREFERRED TIER 03

periogard Alprazolam Intensol

phos-flur Ativan

pilocarpine hydrochloride Tranxene T

pilocarpine HCL Valium

prevident rinse Vistaril

topex topical anesthetic Xanax

triamcinolone acetonide dental paste Xanax XR

SF GENERAL MEDICAL MEDICAL

SF 5000 plus droperidol

TIER 03 NON PREFERRED Hydroxyzine HCL

Aquoral Lorazepam/Dextrose

Effective December 1, 2017

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

Lorazepam/Sodium Chloride Tofranil-PM

TrintellixPA

ViibrydPA ANTIDEPRESSANTS PA GENERIC Viibryd Starter Pack TIER 01

amitriptyline HCL Wellbutrin

bupropion HCL Wellbutrin SR

bupropion HCL ER Wellbutrin XL

bupropion HCL SR Zoloft

bupropion HCL XL

citalopram hydrobromide ANTIPSYCHOTICS

clomipramine HCL TIER 01 GENERIC

desipramine HCL aripiprazolePA

desvenlafaxine ERPA aripiprazole odtPA

doxepin HCL chlorpromazine HCL

duloxetine HCLQL clozapine

escitalopram oxalate clozapine odt

fluoxetine HCL compro

fluvoxamine maleate fluphenazine HCL

fluvoxamine maleate ER haloperidol

imipramine pamoate lithium carbonate

imipramine HCL lithium carbonate ER

mirtazapine loxapine

mirtazapine odt loxapine succinate

nefazodone HCL olanzapine

nortriptyline HCL olanzapine odt

paroxetine HCL paliperidone ERPA

paroxetine HCL ER perphenazine

phenelzine sulfate prochlorperazine

protriptyline HCL prochlorperazine maleate

sertraline HCL quetiapine fumarate

tranylcypromine sulfate quetiapine fumarate ERPA

trazodone HCL risperidone

trimipramine maleate risperidone odt

venlafaxine HCL risperidone M-TAB

venlafaxine HCL ER thioridazine HCL

Amoxapine thiothixene

Fluoxetine DR trifluoperazine HCL

Maprotiline HCL ziprasidone HCL

Nefazodone HCL Clozapine Odt

Nortriptyline HCL Lithium

TIER 02 PREFERRED BRAND Lithium Carbonate

Emsam Molindone Hydrochloride

Paxil TIER 03 NON PREFERRED

TIER 03 NON PREFERRED AbilifyPA

Anafranil Adasuve

AplenzinQL,ST Clozaril

BrintellixPA Equetro

Celexa FanaptPA

CymbaltaQL Fanapt Titration PackPA

Desvenlafaxine ER Fazaclo

Effexor XR Fluphenazine HCL

Elavil InvegaPA

FetzimaPA LatudaPA

Fetzima Titration Pack Lithobid

Khedezla NuplazidPA

Lexapro RexultiPA

Marplan Risperdal

Nardil Risperdal M-TAB

Norpramin SaphrisPA

Pamelor Seroquel

Parnate Seroquel XRPA

Paxil CR Versacloz

PristiqPA VraylarPA

Prozac Zyprexa

Prozac Weekly Zyprexa Zydis

Remeron TIER 04 PREFERRED SPECIALTY

Remeron Soltab Abilify Maintena

Surmontil Aristada

Tofranil Invega Sustenna

Effective December 1, 2017

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

Invega Trinza metadate ERQL

Risperdal Consta methamphetamine HCL

Zyprexa Relprevv methylphenidate hydrochlorideQL

MEDICAL GENERAL MEDICAL methylphenidate hydrochloride ER

fluphenazine decanoate methylphenidate HCLQL

haloperidol decanoate methylphenidate HCL CDQL

haloperidol lactate methylphenidate HCL ERQL

prochlorperazine edisylate modafinil

Chlorpromazine HCL Methylphenidate HCLQL

Geodon Methylphenidate HCL ER

Haldol Methylphenidate HCL ER (LA)QL

Haldol Decanoate 100 TIER 03 NON PREFERRED

Haldol Decanoate 50 zenzediQL

AdderallQL

Adderall XRQL HYPNOTICS

GENERIC Aptensio XR TIER 01

QL estazolam Concerta

QL eszopiclone Daytrana

phenobarbital Desoxyn

QL temazepam Dexedrine

PA triazolam Dyanavel XR

QL zaleplon Focalin

QL zolpidem tartrate Focalin XR

zolpidem tartrate ER Intuniv

Flurazepam HCL Kapvay

QL Phenobarbital Metadate CD

QL Quazepam Methylin

Triazolam Nuvigil

NON PREFERRED Procentra TIER 03

Ambien Provigil

PA Ambien CR Quillichew ER

QL,PA BelsomraST Quillivant XR

QL Butisol Sodium Ritalin

QL Doral Ritalin LA

QL Halcion Strattera

QL Lunesta Vyvanse

Restoril Zenzedi

Rozerem MEDICAL GENERAL MEDICAL

Seconal caffeine citrate

Seconal Sodium Cafcit

SilenorST Dopram

Sonata

ZolpimistST ANTICONVULSANTS

TIER 06 NON FORMULARY SPECIALTY TIER 01 GENERIC

HetliozPA carbamazepine

MEDICAL GENERAL MEDICAL carbamazepine ER

dexmedetomidine HCL clonazepam

midazolam HCL clonazepam odt

pentobarbital sodium divalproex sodium

Dexmedetomidine HCL divalproex sodium DR

Midazolam Hydrochloride/Sodium Chloride divalproex sodium ER

Nembutal Sodium epitol

Phenobarbital Sodium ethosuximide

Precedex felbamate

gabapentin

lamotrigine ADHD, NARCOLEPSY, ETC.

GENERIC lamotrigine odt TIER 01

amphetamine/dextroamphetamineQL lamotrigine starter kit/blue

armodafinil lamotrigine starter kit/green

atomoxetineQL lamotrigine starter kit/orange

clonidine hydrochloride ER lamotrigine titration

clonidine HCL ER lamotrigine ER

dexedrineQL levetiracetam

dexmethylphenidate hydrochlorideQL levetiracetam ER

dexmethylphenidate HCLQL oxcarbazepine

dexmethylphenidate HCL ERQL phenytoin

dextroamphetamine sulfateQL phenytoin infatabs

dextroamphetamine sulfate ERQL phenytoin sodium extended

guanfacine ER primidone

Effective December 1, 2017

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

roweepra TIER 01 GENERIC

tiagabine hydrochloride amantadine HCL

topiramate bromocriptine mesylate

valproic acid carbidopa

zonisamide carbidopa/levodopa

Diazepam carbidopa/levodopa odt

Diazepam Rectal Gel carbidopa/levodopa ER

Topiramate ERPA entacapone

TIER 02 PREFERRED BRAND pramipexole dihydrochloride

Banzel pramipexole dihydrochloride ER

Felbatol rasagiline mesylate

TIER 03 NON PREFERRED ropinirole ER

AptiomST ropinirole HCL

BriviactST selegiline HCL

Carbatrol tolcapone

Celontin trihexyphenidyl HCL

Depakene Carbidopa/Levodopa/Entacapone

Depakote TIER 03 NON PREFERRED

Depakote ER Azilect

Depakote Sprinkles Comtan

Diastat Acudial Eldepryl

Diastat Pediatric Lodosyn

Dilantin Mirapex

Dilantin Infatabs Mirapex ER

Dilantin-125 Neupro

Fycompa Parlodel

Gabitril Requip

Keppra Requip XL

Keppra XR Rytary

Klonopin Sinemet

Lamictal Sinemet CR

Lamictal Chewable Dispersible Stalevo 100

Lamictal Odt Stalevo 125

Lamictal Starter/Not Taking Carbamazepine Stalevo 150

Lamictal Starter/Taking Carbamazepine/Not Taking Stalevo 200 Valproate Stalevo 50 Lamictal Starter/Taking Valproate Stalevo 75 Lamictal XR Tasmar LyricaPA PA Xadago Mysoline Zelapar Neurontin TIER 05 NON PREFERRED SPECIALTY

Onfi PA Apokyn Oxtellar XR MEDICAL GENERAL MEDICAL

Peganone benztropine mesylate Phenytek Cogentin PotigaPA

Qudexy XRPA NEUROLOGY, PSYCH - MISC. SpritamST TIER 07 PREVENTIVE

Tegretol buproban Tegretol-XR bupropion HCL SR Topamax eq nicotine Topamax Sprinkle eq nicotine gum refill Trileptal eq nicotine gum starter Trokendi XRPA eq nicotine lozenges Vimpat eq nicotine polacrilex Zarontin eq nicotine step 3 Zonegran eql nicotine TIER 05 NON PREFERRED SPECIALTY eql nicotine polacrilex vigabatrinPA eql nicotine polacrilex refill SabrilPA eql nicotine polacrilex starter MEDICAL GENERAL MEDICAL gnp nicotine gum fosphenytoin sodium gnp nicotine mini lozenge phenytoin sodium gnp nicotine polacrilex valproate sodium gnp nicotine polacrilex mini Cerebyx gnp nicotine transdermal system Depacon goodsense nicotine Levetiracetam goodsense nicotine gum

kls quit2 ANTIPARKINSON AGENTS kls quit4

Effective December 1, 2017

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

nicorelief rivastigmine tartrate

nicotine rivastigmine transdermal system

nicotine mini lozenge Chlordiazepoxide/Amitriptyline

nicotine polacrilex Ergoloid Mesylates

nicotine polacrilex refill Fluoxetine

nicotine polacrilex starter kit Galantamine Hydrobromide

nicotine step 1 TIER 03 NON PREFERRED

nicotine step 2 Antabuse

nicotine step 3 Aricept

nicotine transdermal system Exelon

nicotine transdermal system step 1 GraliseST

nicotine transdermal system step 2 Gralise StarterST

nicotine transdermal system step 3 HorizantST

px stop smoking aid Namenda

qc nicotine polacrilex Namenda Titration PAK

ra mini nicotine Namenda XR

ra nicotine Namenda XR Titration Pack

ra nicotine gum Namzaric

ra nicotine polacrilex Nuedexta

ra nicotine transdermal system Orap

ra nicotine transdermal system step 3 Perphenazine/Amitriptyline

sm nicotine Razadyne

sm nicotine polacrilex Razadyne ER

sm nicotine transdermal system SavellaPA

sm nicotine transdermal system/step 1/clear Savella Titration PackPA

sm nicotine transdermal system/step 2/clear SymbyaxPA

sm nicotine transdermal system/step 3/clear TIER 04 PREFERRED SPECIALTY

sw nicotine polacrilex glatiramer acetate

tgt nicotine gum glatopa

tgt nicotine polacrilex Aubagio

tgt nicotine step one Avonex

tgt nicotine step three Betaseron

tgt nicotine step two Copaxone

thrive Plegridy

Chantix Plegridy Starter Pack

Chantix Continuing Month PAK Rebif

Chantix Starting Month PAK Rebif Rebidose

Commit Rebif Rebidose Titration Pack

CVS nicotine Rebif Titration Pack

CVS nicotine lozenge Tecfidera

CVS nicotine polacrilex Tecfidera Starter Pack

CVS nicotine polacrilex starter TIER 05 NON PREFERRED SPECIALTY

CVS nicotine transdermal system Avonex PenPA

CVS nts step 1 Extavia

HM nicotine polacrilex Gilenya

HM nicotine transdermal system IngrezzaPA

HM nicotine transdermal system step 1 SPECIALTY MEDICAL

HM nicotine transdermal system step 2 LemtradaPA

HM nicotine transdermal system step 3 TysabriPA

Nicoderm CQ TIER 06 NON FORMULARY SPECIALTY

Nicorette tetrabenazinePA

Nicorette Mini AmpyraPA

Nicorette Starter Kit AustedoPA

Nicotine Transdermal System XenazinePA

Nicotrol Inhaler XyremST

Nicotrol Ns SPECIALTY MEDICAL

SR nicotine gum OcrevusPA

Zyban ZinbrytaPA

TIER 01 GENERIC

acamprosate calcium DR NEUROMUSCULAR AGENTS

disulfiram NON PREFERRED SPECIALTY TIER 05

donepezil hydrochloride riluzole

donepezil HCL Rilutek

galantamine hydrobromide SPECIALTY MEDICAL TIER 06

galantamine hydrobromide ER Radicava

memantine hydrochloride SpinrazaPA

memantine HCL GENERAL MEDICAL MEDICAL

memantine HCL titration PAK atracurium besylate

PA olanzapine/fluoxetine cisatracurium besylate

pimozide

Effective December 1, 2017

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

pancuronium bromide PREFERRED BRAND

rocuronium bromide Mestinon Timespan

vecuronium bromide TIER 03 NON PREFERRED

Anectine Mestinon

BotoxPA MEDICAL GENERAL MEDICAL

Cisatracurium Besylate neostigmine methylsulfate

DysportPA Bloxiverz

MyoblocPA Enlon

Nimbex Neostigmine Methylsulfate

Pancuronium Bromide Regonol

Quelicin

XeominPA OPHTHALMOLOGY AND OTIC Zemuron ANTI-INFECTIVES

TIER 01 GENERIC

MUSCULOSKELETAL AGENTS ak-poly-bac TIER 01 GENERIC bacitracin/polymyxin b baclofen ciprofloxacin HCL carisoprodol erythromycin carisoprodol/aspirin gatifloxacin carisoprodol/aspirin/codeine gentak chlorzoxazone gentamicin sulfate cyclobenzaprine HCL ilotycin dantrolene sodium levofloxacin metaxall moxifloxacin hydrochloride metaxalone moxifloxacin HCL methocarbamol neo-polycin orphenadrine citrate ER neomycin/bacitracin/polymyxin tizanidine hydrochloride neomycin/polymyxin/bacitracin zinc tizanidine HCL neomycin/polymyxin/gramicidin Metaxalone ofloxacin TIER 03 NON PREFERRED polycin Chlorzoxazone polymyxin b sulfate/trimethoprim sulfate Cyclo/Gaba10/300 Pack sodium sulfacetamide Dantrium sulfacetamide sodium FexmidST tobramycin Lorzone tobramycin sulfate Parafon Forte DSC trifluridine Robaxin-750 trimethoprim sulfate/polymyxin b sulfate Skelaxin Bacitracin Soma Cefuroxime Sodium/Sodium Chloride Zanaflex Gentak MEDICAL GENERAL MEDICAL TIER 03 NON PREFERRED

orphenadrine citrate Azasite revonto Besivance Dantrium IV Betadine Ophthalmic Prep Euflexxa Bleph-10 Gablofen Ciloxan Gel-one Moxeza Gelsyn-3 Natacyn Genvisc 850 Neosporin Hyalgan Ocuflox Hymovis Polytrim Lioresal Intrathecal Sulfacetamide Sodium Maci Tobrex Monovisc Vigamox Orthovisc Viroptic Robaxin Zirgan Ryanodex Zymaxid Supartz MEDICAL GENERAL MEDICAL

Supartz Fx Mitosol Synvisc Moxifloxacin Hydrochlordie/Sodium Chloride Synvisc One

ARTIFICIAL TEAR/LUBRICANT ANTIMYASTHENIC AGENTS TIER 03 NON PREFERRED

TIER 01 GENERIC Lacrisert pyridostigmine bromide

pyridostigmine bromide ER BETA-BLOCKERS Guanidine HCL TIER 01 GENERIC

TIER 02 betaxolol HCL

Effective December 1, 2017

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

carteolol HCL Travatan Z

dorzolamide HCL/timolol maleate TIER 03 NON PREFERRED

levobunolol HCL Rescula

timolol maleate Vyzulta

timolol maleate ophthalmic gel forming Xalatan

Metipranolol Zioptan

TIER 02 PREFERRED BRAND

Betoptic-s CYCLOPLEGIC MYDRIATICS

Timoptic GENERIC TIER 01

TIER 03 NON PREFERRED cyclopentolate hydrochloride

Betagan cyclopentolate HCL

Betimol homatropaire

Combigan homatropine HBR

Cosopt Atropine Sulfate

Cosopt PF PREFERRED BRAND TIER 02

Istalol Cyclogyl

Timoptic Ocudose Cyclomydril

Timoptic-xe GENERAL MEDICAL MEDICAL

tropicamide

OPHTHALMIC STEROIDS Mydriacyl

TIER 01 GENERIC

fluorometholone DECONGESTANTS

neo-polycin HC GENERIC TIER 01

neomycin/polymyxin/bacitracin/hydrocortisone altafrin

neomycin/polymyxin/dexamethasone phenylephrine HCL

prednisolone acetate Naphazoline HCL

sulfacetamide sodium/prednisolone sodium phosphate

tobramycin/dexamethasone MIOTICS Dexamethasone Sodium Phosphate TIER 01 GENERIC

Neomycin/Polymyxin/Hydrocortisone pilocarpine HCL Prednisolone Sodium Phosphate TIER 02 PREFERRED BRAND

TIER 02 PREFERRED BRAND Phospholine Iodide Blephamide TIER 03 NON PREFERRED

Blephamide S.o.p. Isopto Carpine Flarex Miochol-e FML Miostat FML Forte

Pred Mild ADRENERGIC AGENTS Pred-G TIER 01 GENERIC

Pred-G S.o.p. apraclonidine Tobradex brimonidine tartrate Tobradex ST TIER 02 PREFERRED BRAND

Vexol Alphagan P TIER 03 NON PREFERRED TIER 03 NON PREFERRED

Alrex Iopidine Durezol Simbrinza FML Liquifilm

Iluvien IMMUNOMODULATORS Lotemax TIER 02 PREFERRED BRAND

Maxidex Restasis Maxitrol Restasis Multidose Omnipred

Pred Forte LOCAL ANESTHETICS Prednisolone/Moxifloxacin TIER 01 GENERIC Prednisolone/Moxifloxacin/Bromfenac altacaine Prednisolone/Moxifloxacin/Ketorolac proparacaine HCL Retisert tetcaine Triesence tetracaine HCL Triple Pmb tetravisc Triple Pmk tetravisc forte Zylet TIER 03 NON PREFERRED

Akten PROSTAGLANDINS Alcaine TIER 01 GENERIC

latanoprost OPHTHALMICS - MISC. Bimatoprost TIER 01 GENERIC Travoprost azelastine HCL TIER 02 PREFERRED BRAND balanced salt Lumigan balanced salt solution

Effective December 1, 2017

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

bromfenac

bss TIER 01 GENERIC

bss plus Methergine

cromolyn sodium TIER 03 NON PREFERRED

diclofenac sodium Cervidil

dorzolamide HCL Prepidil

epinastine HCL Prostin E2

flurbiprofen sodium MEDICAL GENERAL MEDICAL

ketorolac tromethamine methylergonovine maleate

olopatadine hydrochloride oxytocin

olopatadine HCL Hemabate

Bromfenac Oxytocin/Dextrose

Flurbiprofen Sodium Oxytocin/Dextrose/Lactated Ringers

TIER 02 PREFERRED BRAND Oxytocin/Dextrose/Lactateringers

Alomide Oxytocin/Lactated Ringers

TIER 03 NON PREFERRED Oxytocin/Sodium Chlordie

Acular Oxytocin/Sodium Chloride

Acular LS Pitocin

Acuvail

Alocril PAIN MANAGEMENT Azopt ANALGESICS - NONNARCOTIC Bepreve TIER 07 PREVENTIVE

Bromsite adult aspirin regimen Bss Plus adult aspirin EC low strength Elestat aspir-low Emadine aspir-81 Ilevro aspirin Lastacaft aspirin adult low dose Nevanac aspirin adult low strength Ocufen aspirin childrens Pataday aspirin enteric coated adult low strength Patanol aspirin low dose Pazeo aspirin low strength Prolensa aspirin regimen low dose/adult Trusopt aspirin EC Xiidra aspirin EC low dose TIER 05 SPECIALTY MEDICAL aspirin 81 JetreaPA aspirin 81 low dose MEDICAL GENERAL MEDICAL aspirtab ak-fluor bayer advanced aspirin regular strength Ak-fluor bayer aspirin Fluorescite bayer aspirin regimen Paremyd bayer aspirin EC low dose

bayer chewable low dose OTIC AGENTS bayer low dose TIER 01 GENERIC childrens aspirin acetasol HC childrens aspirin low strength acetic acid ecotrin fluocinolone acetonide ecotrin low strength fluocinolone acetonide ear drops ecpirin hydrocortisone/acetic acid enteric coated aspirin neomycin/polymyxin/hydrocortisone eq adult aspirin low strength neomycin/polymyxin/HC eq aspirin ofloxacin eq aspirin adult low dose Acetic Acid/Aluminum Acetate eq aspirin low dose Ciprofloxacin eq aspirin EC TIER 03 NON PREFERRED eq childrens aspirin Cetraxal eql adult aspirin low strength Cipro HC eql aspirin Ciprodex eql aspirin low dose Coly-mycin S eql aspirin EC Cortisporin-tc eql childrens aspirin Dermotic gnp adult aspirin low strength Floxin Otic gnp aspirin Otiprio gnp aspirin low dose Otovel goodsense aspirin Pramotic goodsense aspirin adult low strength

goodsense aspirin low dose

OXYTOCICS h-e-b aspirin

Effective December 1, 2017

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

kls aspirin low dose TIER 03 NON PREFERRED

kls aspirin EC bupap

kp aspirin Disalcid

meijer aspirin EC Esgic

miniprin low dose Fioricet

norwich aspirin Fiorinal

px aspirin Levacet

px enteric aspirin TIER 05 SPECIALTY MEDICAL

qc aspirin clonidine HCL

qc aspirin low dose Duraclon

qc chewable aspirin low dose MEDICAL GENERAL MEDICAL

qc childrens aspirin Ofirmev

qc enteric aspirin Prialt

ra aspirin

ra aspirin adult low dose ANALGESICS - OPIOID

ra aspirin adult low strength GENERIC TIER 01

ra aspirin childrens acetaminophen/codeine

ra aspirin EC acetaminophen/codeine phosphate

ra aspirin EC adult low strength ascomp/codeine

ra childrens aspirin buprenorphine HCL

sm aspirin buprenorphine HCL/naloxone HCL

sm aspirin adult low strength butalbital/acetaminophen/caffeine/codeine

sm aspirin enteric coated butalbital/aspirin/caffeine/codeine

sm aspirin EC low strength butorphanol tartrate

sm childrens aspirin codeine sulfate

st joseph aspirin endocet

st joseph low dose aspirin fentanylQL

tgt aspirin fentanyl citrate oral transmucosalPA

tgt aspirin low dose hydrocodone bitartrate/acetaminophen

tgt childrens aspirin hydrocodone/acetaminophen

tgt enteric-coated aspirin hydrocodone/ibuprofen

Aspirin Low Dose hydromorphone hydrochlorideQL,ST

CVS aspirin hydromorphone hydrochloride ERQL,ST

CVS aspirin adult low dose hydromorphone HCL

CVS aspirin adult low strength hydromorphone HCL ERQL,ST

CVS aspirin child ibudone

CVS aspirin low dose lorcet

CVS aspirin low strength lorcet plus

CVS aspirin EC lorcet HD

CVS childrens aspirin lortab

CVS enteric aspirin meperidine HCL

Ecotrin Regular Strength methadone HCL

EC-81 aspirin methadone HCL intensol

HM aspirin methadose

HM aspirin EC morphine sulfate

HM aspirin EC low dose morphine sulfate ERQL,ST

MM aspirin oxycodone HCL

SB aspirin oxycodone/acetaminophen

SB aspirin adult low strength oxycodone/aspirin

SB aspirin EC oxymorphone hydrochloride

SB childrens aspirin oxymorphone hydrochloride ER

SB low dose asa EC pentazocine/naloxone HCL

TIER 01 GENERIC reprexain

butalbital/acetaminophen tramadol hydrochloride/acetaminophen

butalbital/acetaminophen/caffeine tramadol HCL

butalbital/aspirin/caffeine tramadol HCL ERQL,ST

capacet verdrocet

choline magnesium trisalicylate vicodin

diflunisal vicodin ES

esgic vicodin HP

margesic xylon

marten-TAB Acetaminophen/Caffeine/Dihydrocodeine

phrenilin forte Aspirin-caffeine-dihydrocodeine

salsalate Codeine Sulfate

zebutal FentanylQL

Butalbital/Aspirin/Caffeine Hydromorphone HCL

Duraxin Meperidine HCL

Tencon Methadone HCL

Vanatol LQ Morphine Sulfate

Vanatol S

Effective December 1, 2017

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

Morphine Sulfate ERQL,ST Butorphanol Tartrate

Oxycodone HCL ERQL Dilaudid-HP

Oxycodone/Ibuprofen Fentanyl Citrate

Oxymorphone Hydrochloride ER Fentanyl Citrate/Bupivacaine Hydrochloride

TIER 02 PREFERRED BRAND Fentanyl Citrate/Bupivacaine Hydrochloride/Sodium

Chloride Capital/Codeine

TIER 03 NON PREFERRED Fentanyl Citrate/Bupivicaine Hydrochloride/Sodium

PA Chloride Abstral PA Fentanyl Citrate/Bupivicaine HCL/Sodium Chloride Actiq ST Fentanyl Citrate/Ropivacaine Hydrochloride Arymo ER

BelbucaQL Fentanyl Citrate/Ropivacaine Hydrochloride/Sodium ST Chloride

Bunavail Fentanyl Citrate/Sodium Chloride Buprenorphine Hydromorphone Hydrochlor Ide/Sodium Chloride Butrans Hydromorphone Hydrochloride/ Sodium Chloride Demerol Hydromorphone Hydrochloride/Bupivacaine Hydrochloride Dilaudid Hydromorphone Hydrochloride/Bupivacaine Dolophine Hydrochloride/Sodium

DuragesicQL Hydromorphone Hydrochloride/Sodium Chloride EmbedaQL,ST Hydromorphone HCL/Sodium Chloride ExalgoQL,ST Infumorph 200 FentoraPA Infumorph 500 Fioricet/Codeine Meperidine Hydrochloride/Sodium Chloride Fiorinal/Codeine #3 Morphine Sulfate/Dextrose Hycet Morphine Sulfate/Sodium Chloride Hysingla ERST Probuphine Implant Kit Ibudone Sublimaze KadianQL,ST Sufentanil Citrate LazandaPA Talwin Levorphanol Tartrate Ultiva Lortab

Methadose ANTI-INFLAMMATORY Methadose Sugar-free TIER 01 GENERIC

MS ContinQL celecoxib Norco diclofenac potassium NucyntaQL,ST diclofenac sodium DR Nucynta ERQL,ST diclofenac sodium ER Opana diclofenac sodium/misoprostol Opana ER (crush Resistant)QL,ST etodolac OxaydoPA etodolac ER Oxycodone/Acetaminophen fenoprofen calcium OxycontinQL,ST flurbiprofen Percocet ibuprofen Primlev indomethacin Reprexain indomethacin ER Roxicodone ketoprofen ST Suboxone QL ketorolac tromethamine SubsysPA leflunomide Synalgos-dc mefenamic acid Trezix meloxicam Tylenol/Codeine #3 nabumetone Tylenol/Codeine #4 naproxen Ultracet naproxen kit Ultram naproxen sodium Ultram ERQL,ST naproxen sodium CR Vicoprofen naproxen sodium ER Xartemis XRST naproxen DR Xodol oxaprozin Xtampza ERQL,PA piroxicam Zamicet profeno Zohydro ERQL,ST sulindac ZubsolvST tolmetin sodium MEDICAL GENERAL MEDICAL Fenoprofen Calcium alfentanil Ketoprofen ER duramorph Ketorolac Tromethamine fentanyl citrate Meclofenamate Sodium hydromorphone HCL dosette Meloxicam nalbuphine HCL Naproxen sufentanil citrate Tolmetin Sodium Alfentanil HCL TIER 02

Buprenex

Effective December 1, 2017

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

PREFERRED BRAND Sumatriptan SuccinateQL

Fenortho TIER 02 PREFERRED BRAND

Nalfon MigranalQL,PA

Ridaura TIER 03 NON PREFERRED

TIER 03 NON PREFERRED AmergeQL

Anaprox DS AxertQL

Arava Cafergot

Arthrotec 50 Cambia

Arthrotec 75 Ergomar

Celebrex FrovaQL

Daypro ImitrexQL

Equapax/Ibuprofen/Minrex Imitrex Statdose RefillQL

EC-naprosyn Imitrex Statdose SystemQL

Feldene MaxaltQL

Indocin Maxalt-MLTQL

IC 400 Migergot

IC 800 RelpaxQL

Lodine ZomigQL

Mobic Zomig ZMTQL

Naprelan MEDICAL GENERAL MEDICAL

Naprosyn dihydroergotamine mesylate

Ponstel D.h.e. 45

Rheumatrex

SprixQL GOUT AGENTS

TIER 04 PREFERRED SPECIALTY GENERIC TIER 01

PA Enbrel allopurinol

PA Enbrel Mini probenecid

PA Enbrel Sureclick probenecid/colchicine

PA Humira PREFERRED BRAND TIER 02

PA Humira Pediatric Crohns Disease Starter Pack Colcrys

PA Humira Pen NON PREFERRED TIER 03

PA Humira Pen-crohns Diseasestarter Colchicine

PA Humira Pen-psoriasis Starter DuzalloPA

TIER 05 NON PREFERRED SPECIALTY Mitigare

PA Arcalyst Uloric

PA Kevzara ZurampicPA

PA Kineret Zyloprim

PA Orencia Clickject SPECIALTY MEDICAL TIER 05

PA Otezla KrystexxaPA

PA Simponi GENERAL MEDICAL MEDICAL

PA Xeljanz allopurinol sodium

PA Xeljanz XR Aloprim

SPECIALTY MEDICAL

ActemraPA LOCAL ANESTHETICS-INJ IlarisPA TIER 03 NON PREFERRED

OrenciaPA Lets Kit Simponi AriaPA Zingo MEDICAL GENERAL MEDICAL MEDICAL GENERAL MEDICAL

ibuprofen lysine bupivacaine spinal Caldolor bupivacaine HCL Dyloject bupivacaine/dextrose spinal Neoprofen bupivacaine/epinephrine

chloroprocaine hydrochloride

MIGRAINE PRODUCTS lidocaine HCL

TIER 01 GENERIC lidocaine/epinephrine

QL almotriptan polocaine

QL almotriptan malate polocaine-mpf

QL eletriptan hydrobromide ropivacaine

ergotamine tartrate/caffeine ropivacaine HCL

QL frovatriptan succinate sensorcaine

QL naratriptan HCL sensorcaine-mpf

QL rizatriptan benzoate sensorcaine-mpf spinal

QL rizatriptan benzoate odt sensorcaine-mpf/epinephrine

QL sumatriptan sensorcaine/epinephrine

QL sumatriptan succinate xylocaine dental

QL sumatriptan succinate refill Articadent Dental

QL zolmitriptan Bupivacaine Hydrochloride/Sodium Chloride

QL zolmitriptan odt Carbocaine

QL,PA Dihydroergotamine Mesylate Citanest Forte Dental

Effective December 1, 2017

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

Citanest Plain Dental ra budesonide nasal spray

Exparel rhinocort allergy

Lidocaine Hydrochloride triamcinolone acetonide

Lidocaine HCL/Dextrose Flunisolide

Marcaine TIER 03 NON PREFERRED

Marcaine Spinal Adrenalin

Marcaine/Epinephrine Astepro

Naropin Atrovent

Nesacaine Bactroban Nasal

Nesacaine-mpf Beconase AQ

Ropivacaine Hydrochloride Nasonex

Ropivacaine Hydrochloride/Sodium Chloride Omnaris

Sensorcaine-mpf/Epinephrine Patanase

Xylocaine Qnasl

Xylocaine-mpf Qnasl Childrens

Xylocaine-mpf/Epinephrine Rhinocort Aqua

Xylocaine/Epinephrine Tyzine Pediatric Nasal Drops

Veramyst

Xhance GENERAL ANESTHETICS

GENERAL MEDICAL Zetonna MEDICAL

etomidate

fresenius propoven COUGH/COLD/ALLERGY

ketamine HCL TIER 01 GENERIC

propofol acetylcysteine

Amidate benzonatate

Anesthesia S/I-40 biotuss

Anesthesia S/I-40a biotuss pediatric

Anesthesia S/I-40h bpm pseudo

Anesthesia S/I-40s bromfed DM

Anesthesia S/I-60 bromphen/pseudoephedrine HCL/dextromethorphan HBR

Brevital Sodium giltuss pediatric

Diprivan hydrocodone bitartrate/chlorpheniramine maleate/PSE

Ketalar hydrocodone bitartrate/homatropine methylbromide

Ketamine Hydrochloride/Sodium Chloride hydrocodone polistirex/chlorpheniramine polistirex

hydrocodone/homatropine

hydromet RESPIRATORY, ALLERGY, ETC nebusal ANTIHISTAMINES nortuss-DE TIER 01 GENERIC

promethazine VC plain arbinoxa promethazine VC/codeine bpm promethazine-DM carbinoxamine maleate promethazine/codeine clemastine fumarate promethazine/dextromethorphan cyproheptadine HCL promethazine/phenylephrine desloratadine promethazine/phenylephrine/codeine diphenhydramine HCL pulmosal levocetirizine dihydrochloride sodium chloride pharbedryl tussigon phenadoz TIER 02 PREFERRED BRAND phenergan Histex-ac promethazine HCL TIER 03 NON PREFERRED promethazine HCL plain Carbaphen 12 promethegan Carbaphen 12 PED Desloratadine Odt Clarinex-d 12 HOUR TIER 03 NON PREFERRED

Codar AR Brompheniramine Tannate Decon-a Clemastine Fumarate Exactuss Karbinal ER Gilphex TR Phenergan Giltuss Respa-BR Giltuss TR

Hyper-sal NASAL AGENTS Hypersal TIER 01 GENERIC

Lexuss 210 azelastine hydrochloride Nebusal azelastine HCL Neotuss Plus budesonide nasal spray Nortuss-EX fluticasone propionate Panatuss Dxp ipratropium bromide Phenylephrine/Guaifenesin mometasone furoate Relhist olopatadine HCL

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 38

Rezira Elixophyllin

Semprex-d Flovent DiskusPA

Tessalon Perles Flovent HFAQL,PA

Tgq 15DM/5PEH/2CPM Incruse Ellipta

Tgq 30PSE/150GFN/15DM Perforomist

Tgq 30PSE/3BRM/15DM Pulmicort

Tussicaps Singulair

Tussionex Pennkinetic Extended Release Stiolto Respimat

Tuzistra XR Theo-24

Zonatuss Trelegy Ellipta

Zutripro Utibron Neohaler

Vospire ER

Xopenex ANTIASTHMATIC/COPD AGENTS

GENERIC Xopenex Concentrate TIER 01

albuterol sulfate Xopenex HFA

albuterol sulfate ER TIER 04 PREFERRED SPECIALTY

albuterol TAB 4MG zileuton ER

aminophylline Zyflo

budesonide Zyflo CR

cromolyn sodium TIER 05 SPECIALTY MEDICAL

PA difil-G forte Nucala

PA ipratropium bromide Xolair

ipratropium bromide/albuterol sulfate MEDICAL GENERAL MEDICAL

levalbuterol isoproterenol hydrochloride

levalbuterol HCL terbutaline sulfate

montelukast sodium Cinqair

theochron Isuprel

theophylline Theophylline/D5W

theophylline CR

theophylline ER RESPIRATORY AGENTS - MISC

zafirlukast TIER 03 NON PREFERRED

Fluticasone Propionate/SalmeterolPA Curosurf

Levalbuterol Tartrate HFA Infasurf

Metaproterenol Sulfate Sclerosol Intrapleural

Proair HFAQL Sterile Talc Powder

Proair RespiclickQL Survanta Intratracheal

Ventolin HFAQL TIER 05 NON PREFERRED SPECIALTY

TIER 02 PREFERRED BRAND KalydecoPA

Aerospan OrkambiPA

Asmanex HFA PulmozymePA

Asmanex Twisthaler 120 Metered DosesQL TIER 06 NON FORMULARY SPECIALTY

Asmanex Twisthaler 14 Metered DosesQL EsbrietPA

Asmanex Twisthaler 30 Metered DosesQL OfevPA

Asmanex Twisthaler 60 Metered DosesQL SPECIALTY MEDICAL

Asmanex Twisthaler 7 Metered DosesQL Aralast NPPA

Atrovent HFA GlassiaPA

Combivent Respimat Prolastin-cPA

Dulera ZemairaPA

Foradil Aerolizer

Pulmicort Flexhaler TOXOIDS QvarQL

Serevent Diskus TIER 07 PREVENTIVE

Spiriva Handihaler Adacel Spiriva Respimat Boostrix Striverdi Respimat Daptacel Symbicort Diphtheria/Tetanus Toxoids Adsorbed Pediatric Tudorza Pressair Infanrix TIER 03 NON PREFERRED Kinrix Accolate Pediarix Advair DiskusPA Pentacel Advair HFAPA Quadracel Alvesco Tenivac Anoro Ellipta Tetanus/Diphtheria Toxoids-adsorbed Arcapta NeohalerQL

Arnuity ElliptaPA VACCINES Bevespi Aerosphere PA Breo Ellipta TIER 07 PREVENTIVE

Brovana AL ST Acthib Daliresp Afluria PF 2016-2017

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 39

Afluria PF 2017-2018 VITAMINS Afluria Quadrivalent 2016-2017 VITAMINS Afluria Quadrivalent 2017-2018 TIER 07 PREVENTIVE

Afluria 2016-2017 aqueous vitamin d infants Afluria 2017-2018 bio-d-mulsion Bexsero bio-d-mulsion forte CervarixAL bprotected pedia d-vite Comvax calcidol Engerix-b calciferol Fluad 2016-2017 d 1000 Fluad 2017-2018 d 10000 Fluarix Quadrivalent 2016-2017 d 2000 Fluarix Quadrivalent 2017-2018 d 400 Flublok Quadrivalent 2017-2018 d 5000 Flublok 2016-2017 d-vita Flublok 2017-2018 d-1000 Flucelvax Quadrivalent 2016-2017 d-1000 extra strength Flucelvax Quadrivalent 2017-2018 d-2000 maximum strength Flulaval Quadrivalent 2016-2017 d-3-5 Flulaval Quadrivalent 2017-2018 d-400 Fluvirin 2016-2017 d-5000 Fluvirin 2017-2018 decara Fluzone High-dose PF 2016-2017 delta d3 Fluzone High-dose PF 2017-2018 dialyvite vitamin d 5000 Fluzone Intradermal Quadrivalent 2016-2017 dialyvite vitamin d3 max Fluzone Intradermal Quadrivalent 2017-2018 d2000 ultra strength Fluzone Quadrivalent 2016-2017 d3 Fluzone Quadrivalent 2017-2018 d3 adult GardasilAL d3 adult gummy Gardasil 9PA,AL d3 high potency Havrix d3 kids HiberixAL d3 maximum strength Ipol Inactivated IPVAL d3 super strength M-m-r II d3 ultra strength Medical Provider Single Use EZ Flu Shot d3 2000 Medical Provider Single Use EZ Flu Shot 2016-2017 d3-1000 Menactra d3-50 MenhibrixAL eql childrens vitamin d gummies Menomune-a/C/Y/W-135 eql vitamin d-3 Menveo eql vitamin d3 Pedvax HIBAL eql vitamin d3 gummies Pneumovax 23 ergocalciferol Pneumovax 23/1 Dose gnp d 1000 Prevnar 13 gnp d 2000 Proquad gnp vitamin d Recombivax HB gnp vitamin d maximum strength RotarixAL gnp vitamin d super strength RotateqAL gnp vitamin d3 extra strength ShingrixAL healthy kids vitamin d3 Trumenba just d Twinrix kp vitamin d Vaqta kp vitamin d3 Varivax maximum d3 ZostavaxAL nat-rul vitamin d TIER 02 PREFERRED BRAND natural vitamin d-3 Flumist Quadrivalent optimal-d TIER 03 NON PREFERRED optimal-d pack Vaxchora opurity vitamin d VivotifQL pronutrients vitamin d3 MEDICAL GENERAL MEDICAL ra vitamin d-3 Bcg Vaccine sm vitamin d Biothrax sm vitamin d3 Imovax Rabies (h.d.c.v.) thera-d rapid repletion Ixiaro thera-d sport Rabavert thera-d 2000 Stamaril vitajoy daily d gummies Typhim VI vitamin d Yf-vax vitamin d high potency

vitamin d 400

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 40

vitamin d-1000 Gnp Prenatal

vitamin d-1000 maximum strength Goodsense Prenatal Vitamins

vitamin d-3 Healthy Mama Be Well Rounded

vitamin d-400 HM One Daily Prenatal Combo

vitamin d3 HM Prenatal

vitamin d3 adult gummies Kp Prenatal Multivitamins

vitamin d3 gummies Multi Prenatal

vitamin d3 high potency Nat-rul Prenatal Vitamins

vitamin d3 maximum strength One A Day Womens Prenatal/DHA

vitamin d3 super strength One A Day Womens Prenatal1

vitamin d3 ultra potency One-a-day Womens Prenatal

vitamin d3 400 Perry Prenatal

Baby Ddrops Pre-natal Formula

Baby Super Daily D3 Prenatal

Baby Vitamin D3 Drops Prenatal And Iron

CVS d3 Prenatal Complete

CVS vitamin d childrens gummies Prenatal Formula

CVS vitamin d3 Prenatal Forte

CVS Vitamin D3 Drops/Infants Prenatal Gummies/DHA & Folic Acid

D-VI-sol Prenatal Low Iron

Ddrops Prenatal Multi + DHA

Ddrops Booster Prenatal Multi +dha

Decara Prenatal Multivitamin

Drisdol Prenatal Multivitamin + DHA

D3 Dots Prenatal Multivitamin Plus DHA

HM vitamin d Prenatal One Daily

HM vitamin d3 Prenatal Plus DHA

HM Vitamin D3 Prenatal Vitamin

Optimal D3 M Prenatal Vitamin & Mineral

PA vitamin d-3 Prenatal Vitamin/Iron

PA vitamin d-3 gummy Prenatal Vitamins

Replesta Prenatal/Omega-3/Folic Acid/Iron

Replesta Childrens Px Prenatal Multivitamins

Replesta Nx PA Prenatal Formula

Sm Vitamin D3 Maximum Strength Qc Prenatal

Super Daily D3 Ra One Daily

Thera-d 4000 Ra Prenatal

Upspringbaby Vitamin D3 Ra Prenatal Formula/Folicacid

Vitamelts Vitamin D Right Step Prenatal

Vitamin D2 Similac Prenatal Early Shield

Vitamin D3 Sm One Daily Prenatal

Wellesse Vitamin D3 Sm Prenatal Vitamins

TIER 02 PREFERRED BRAND Stuart One

Mephyton Your Life Multi Prenatal

TIER 03 NON PREFERRED TIER 01 GENERIC

Niacin b-plex

Wheat Germ b-plex plus

MEDICAL GENERAL MEDICAL biocel

phytonadione corvita

pyridoxine HCL corvite free

thiamine HCL dialyvite

vitamin k1 folbee plus

Aquasol A Parenteral lysiplex plus

Vitamin K1 mult-vitamin/fluoride

multi vitamin/fluoride

multi-vit/fluoride MULTIVITAMINS

PREVENTIVE multi-vit/iron/fluoride TIER 07

sm prenatal vitamins multi-vitamin/fluoride

Atabex Prenatal multi-vitamin/fluoride drops

Brainstrong Prenatal multi-vitamin/fluoride/iron

Cadeau DHA multivitamin with fluoride

Centrum Specialist Prenatal multivitamin/fluoride

Classic Prenatal multivitamin/fluoride/iron

CVS Prenatal multivitamins/fluoride

CVS Prenatal Gummy/DHA/Folic Acid mynephrocaps

CVS Prenatal Multi+dha mynephron

Enfamil Expecta nephronex

Eql Prenatal Formula niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper

Gnp Daily Prenatal nutrifac ZX

rena-vite RX

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 41

renal CAPS Citranatal DHA

reno CAPS Citranatal Harmony

tri-vit/fluoride Citranatal RX

tri-vitamin/fluoride Citranatal 90 DHA

triphrocaps Cod Liver Oil

triple-vitamin/fluoride Concept DHA

urosex Concept OB

v-c forte Corvite

vic-forte Dialyvite Supreme D

virt-vite plus Dialyvite 3000

virt-CAPS Dialyvite 5000

vita s forte Dialyvite/Zinc

vita-min Dothelle DHA

vitacel Duet DHA Balanced

vitamax pediatric Duet DHA 400

vitamins a/c/d/fluoride Enbrace HR

vol-care RX Escavite

vp-vite RX Escavite D

Bp Folinatal Plus B Extra-virt Plus DHA

Bp Multinatal Plus Floriva Plus

Complete Natal DHA Focalgin CA

Completenate Focalgin 90 DHA

CO-natal Fa Folbee Plus Cz

Elite-OB Folcal DHA

Escavite LQ Folcaps Omega 3

Inatal Advance Folet One

Inatal GT Folgard OS

Inatal Ultra Folivane-OB

M-vitQL Fortavit

Macnatal CN DHA Hemenatal OB

Mynatal Advance Hemenatal OB + DHA

Mynatal Plus Infanate Balance

Mynatal Ultracaplet Levomefolate DHA

Mynatal-z Marnatal-f

Mynate 90 Plus Multivitamin/Fluoride

MVC-fluoride Mykidz Iron Fl

Obstetrix EC Mynatal

Pr Natal 400 Natachew

Pr Natal 400 EC Natalvit

Pr Natal 430 Natelle One

Pr Natal 430 EC Neevo DHA

Prenaissance Plus Nephplex RX

Prenatabs RX Nephro-vite RX

Prenatal-u Nestabs

Quflora Pediatric Nestabs Abc

Se-natal 19 Nestabs DHA

Se-tan DHA Newgen

Taron-prex Nexa Plus

Triadvance Nicadan

TricareQL Nicadan ZX

Trinatal RX 1 Nicazel

Trinate Nicazel Forte

Ultimatecare One Nicomide

Ultimatecare One NF Niva-plusQL

Vinate II Nutricap

Vinate M Nutrivit

Vinate One O-CAL FaQL

Vitafol-OB O-CAL Prenatal

TIER 03 NON PREFERRED Obstetrix DHA

Active OB Obstetrix One

Adrenal C Formula OB Complete

Advanced AM/PM OB Complete One

Atabex EC OB Complete Petite

AP-zel OB Complete Premier

Bacmin OB Complete/DHA

Bal-care DHA Poly-VI-flor

C-nate DHA Poly-VI-flor FS

Calcium PNV Poly-VI-flor/Iron

Citranatal Assure Prefera OB

Citranatal B-calm Preferaob +dha

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 42

Preferaob One Tristart DHA

Prenaissance Tristart One

Prenaissance Balance Triveen-duo DHA

Prenaissance Harmony DHA Triveen-prx RNF

Prenaissance Next TL Folate

Prenaissance Next-b TL G-FOL OS

Prenata TL-care DHA

Prenatabs Fa TL-fluorivite

Prenatal PlusQL TL-select

Prenatal Plus Iron Udamin SP

Prenatal Vitamins Plus Low IronQL Vemavite-prx 2

Prenatal 19 Vena-bal DHA

Prenate Vinate DHA RF

Prenate AM Virt Nate

Prenate DHA Virt-advance

Prenate Elite Virt-c DHA

Prenate Enhance Virt-nate DHA

Prenate Essential Virt-pn

Prenate Mini Virt-pn DHA

Prenate Pixie Virt-pn Plus

Prenate Restore Virt-select

Prenate Star Virt-vite GT

Prena1 Chew Virtprex

Prena1 Pearl Vita-pren

PreplusQL Vita-RX Diabetic Vitamin

Preque 10 Vitafol

Pretab Vitafol Ultra

Protect Plus Vitafol-nano

Provida DHA Vitafol-ob+dha

Provida OB Vitafol-one

Purefe OB Plus Vital-d RX

PNV Ferrous Fumarate/Docusate/Folic Acid Vitamedmd One RX/Quatrefolic

PNV Folic Acid + Iron MultivitaminQL Vitamedmd Plus RX/Quatre Folic

PNV Ob+dha Vitamedmd Redichew RX

PNV Prenatal Plus MultivitaminQL Vitapearl

PNV Prenatal Plus Multivitamin + DHA Vitaroca Plus

PNV TABS 29-1 Viva DHA

PNV-dha+docusate Vol-nate

PNV-omega Vol-plusQL

PNV-total Vol-TAB RX

PNV-vp-u Vp-ggr-b6 Prenatal

Quflora FE Vp-heme One

R-natal OB Vp-heme OB

Relnate DHA Vp-heme OB + DHA

Renatabs Vp-zel

Renatabs With Iron Vp-CH Plus

Req 49+ Vp-CH-PNV

Rulavite DHA Vp-PNV-DHA

Select-ob+dha Zatean-pn DHA

Select-OB Zatean-pn Plus

Siderol Zatean-CH

Strovite Forte MEDICAL GENERAL MEDICAL

Strovite One Infuvite

Supervite Infuvite Adult

Supervite EC Infuvite Pediatric

Support M.v.i. Adult

Support-500 M.v.i. Pediatric

Synagex M.v.i.-12 Without Vitamin K

Synatek

Taron-bc MEDICAL DEVICES Taron-c DHA DIABETIC SUPPLIES Thrivite RX TIER 02 PREFERRED BRAND

Thrivite 19 Advocate Insulin Pen Needles Tri-vit/Fluoride/Iron Advocate Insulin Pen Needles 29GX12.7MM Tri-TABS DHA Advocate Insulin Pen Needles 31GX5MM Tri-VI-flor Advocate Insulin Pen Needles 31GX8MM Tri-VI-floro Advocate Insulin Syringe/U-100/0.3ML/29GX1/2" Tricare Prenatal Compleat Advocate Insulin Syringe/U-100/0.3ML/30GX5/16" Tricare Prenatal DHA One Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"

Trinatal GT

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 43

Advocate Insulin Syringe/U-100/0.5ML/29GX1/2" BD Insulin Syringe/U-500/0.5ML/31G X 15/64"

Advocate Insulin Syringe/U-100/0.5ML/30GX5/16" BD Integra Insulin Syringe/U-100/1ML/29G X 1/2"

Advocate Insulin Syringe/U-100/0.5ML/31GX5/16" BD Integra Syringe/Retracting Needle/1ML/25G X 1"

Advocate Insulin Syringe/U-100/1ML/29GX1/2" BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X

1/2" Advocate Insulin Syringe/U-100/1ML/30GX5/16" BD Pen Needle/Mini/Ultrafine/31G X 3/16" Advocate Insulin Syringe/U-100/1ML/31GX5/16" BD Pen Needle/Nano/Ultra Fine/32G X 4MM Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2" BD Pen Needle/SHORT/Ultrafine/31G X 5/16" Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2" BD Pen Needle/Ultrafine/29G X 12.7MM Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2" BD Pen Needle/Ultrafine/29GX1/2" 12.7MM Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2" BD Pen Needles SHORT/Ultrafine/31G X 5/16" Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2" BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2" Aurora Pen Needles 29GX12MM

Aurora Pen Needles 31G X 6MM BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2" Aurora Pen Needles 31G X 8MM BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16" Aurora Unifine Pentips/Mini/31GX3/16" BD Ultra-fine Micro Pen Needles 6MM X 32G Aurora Unifine Pentips/32GX5/32" BD-insul SYR Mis LO Dose B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16" BD-insul SYR Mis U-100 B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16" Carefine Pen Needle 32GX4MM B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16" Carefine Pen Needles 29GX1/2" B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2" Carefine Pen Needles 30GX5/16" B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2" Carefine Pen Needles 31GX6MM BD Autoshield Duo 30G X 3/16" Carefine Pen Needles 31GX8MM BD Autoshield 29G X 3/16" Carefine Pen Needles 32GX5MM BD Autoshield 29G X 5/16" Carefine Pen Needles 32GX6MM BD Insulin Syringe LUER-LOK/U-100/1ML Careone Insulin Syringes/0.3ML/30G X 1/2" BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2" Careone Insulin Syringes/0.3ML/31G X 5/16" BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2" Careone Insulin Syringes/0.5ML/30G X 1/2" BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8" Careone Insulin Syringes/0.5ML/31G X 5/16" BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2" Careone Insulin Syringes/1ML/30G X 1/2" BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2" Careone Insulin Syringes/1ML/31GX5/16" BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2" Careone Unifine Pentips Pen Needles 32GX4MM BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8" Careone Unifine Pentips Plus Pen Needles 29GX12MM BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2" Careone Unifine Pentips Plus Pen Needles 31GX5MM BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 15/64" Careone Unifine Pentips Plus Pen Needles 31GX6MM BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16" Careone Unifine Pentips Plus Pen Needles 31GX8MM BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2" Careone Unifine Pentips Plus Pen Needles 32GX4MM BD Insulin Syringe Safetyglide/1ML/29G X 1/2" Careone Unifine Pentips 29GX12MM BD Insulin Syringe Slip Tip/U-100/1ML Careone Unifine Pentips 31GX5MM BD Insulin Syringe U-40/1ML/25G X 5/8" Careone Unifine Pentips 31GX6MM BD Insulin Syringe Ultra Fine/1ML/30G X 1/2" Careone Unifine Pentips 31GX8MM BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16" Caretouch Pen Needles 31 G X 6 MM BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16" Caretouch Pen Needles 31GX 5MM BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16" Caretouch Pen Needles 31GX 8MM BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2" Caretouch Pen Needles 32GX 4MM BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2" Caretouch Pen Needles 32GX 5MM BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64" Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16" Clever Choice Comfort EZ Insulin Pen Needles 33GX4MM BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"

BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2" Clever Choice Comfort EZ Insulin Syringe/U- 100/1ML/31GX5/16"

BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64" Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16" 1/2"

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2" Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2" 1/2"

BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64" Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16" BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16"

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2" Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16" BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"

BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2" Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2"

BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16" Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X BD Insulin Syringe Ultrafine/1ML/30G X 1/2" 1/2"

BD Insulin Syringe Ultrafine/1ML/31G X 5/16" Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1/2"

1" Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/16"

5/8" Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 5/16"

1/2" Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X BD Insulin Syringe/U-100/0.5ML/30G X 1/2" 1/2"

BD Insulin Syringe/U-100/1ML/27G X 1/2" Clever Choice Comfort EZ Insulin Syringe/1ML/28G X 1/2"

BD Insulin Syringe/U-100/1ML/28G X 1/2" Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2"

BD Insulin Syringe/U-100/2ML/27.5G X 5/8"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 44

Clever Choice Comfort EZ Insulin Syringe/1ML/30G X Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"

5/16" Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2" Clever Choice Comfort EZ Pen Needles 29GX12MM Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2" Clever Choice Comfort EZ Pen Needles 31GX5MM Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16" Clever Choice Comfort EZ Pen Needles 31GX6MM Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2" Clever Choice Comfort EZ Pen Needles 31GX8MM Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2" Clever Choice Comfort EZ Pen Needles 32GX4MM Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2" Clever Choice Comfort EZ Pen Needles 32GX5MM Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2" Clever Choice Comfort EZ Pen Needles 32GX6MM Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16" Clever Choice Comfort EZ Pen Needles 32GX8MM Easy Touch Insulin Syringe/0.3ML/30G X 5/16" Clever Choice Comfort EZ Pen Needles 33GX4MM Easy Touch Insulin Syringe/0.3ML/31G X 5/16" Clever Choice Comfort EZ Pen Needles 33GX5MM Easy Touch Insulin Syringe/0.5ML/29G X 1/2" Clever Choice Comfort EZ Pen Needles 33GX6MM Easy Touch Insulin Syringe/0.5ML/30G X 5/16" Clever Choice Comfort EZ Pen Needles 33GX8MM Easy Touch Insulin Syringe/1ML/30G X 5/16" Clickfine Pen Needle Universal/31GX1/4" Easy Touch Pen Needle 30 G X 5/16" Clickfine Pen Needle Universal/31GX5/16" Easy Touch Pen Needles 29GX1/2" Clickfine Pen Needle 32GX5/32" Easy Touch Pen Needles 31GX1/4" Clickfine Pen Needles/31GX1/4" Easy Touch Pen Needles 31GX5/16" Clickfine Pen Needles/31GX5/16" Easy Touch Pen Needles 32GX1/4" Clickfine Universal Pen Needles 31GX5/16" Easy Touch Pen Needles 32GX3/16" Comfort Assist Insulin Syringe 0.3ML/29G X 1/2" Easy Touch Pen Needles 32GX5/32" Comfort Assist Insulin Syringe/0.3ML/30G X 5/16" Easy Touch Pen Needles/31G X 3/16" Comfort Assist Insulin Syringe/0.3ML/31G X 5/16" Easy Touch Sheathlock Safety Insulin Syringe Comfort Assist Insulin Syringe/0.5ML/29G X 1/2" 1ML/29GX1/2"

Comfort Assist Insulin Syringe/0.5ML/30G X 5/16" Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16" Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"

Comfort Assist Insulin Syringe/1ML/29G X 1/2" Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16" Comfort Assist Insulin Syringe/1ML/30G X 5/16" Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2" Comfort Assist Insulin Syringe/1ML/31G X 5/16" Easy Touch 32GX5MM Droplet Pen Needles 29GX10MM Easy Touch 32GX6MM Droplet Pen Needles 29GX12MM Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2" Droplet Pen Needles 31GX5MM Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16" Droplet Pen Needles 31GX6MM Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16" Droplet Pen Needles 31GX8MM Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16" Droplet Pen Needles 32GX4MM Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2" Droplet Pen Needles 32GX5MM Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16" Droplet Pen Needles 32GX6MM Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2" Droplet Pen Needles 32GX8MM Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16" Drug Mart Unifine Pentips 31GX5MM Elite-thin Insulin Syringe/0.3ML/31G X 5/16" Drug Mart Unifine Pentipsplus 32GX4MM Elite-thin Insulin Syringe/0.5ML/29G X 1/2" Drug Mart Unifine Pentips29G X 12MM Elite-thin Insulin Syringe/0.5ML/30G X 5/16" Drug Mart Unifine Pentips31GX6MM Elite-thin Insulin Syringe/1ML/29G X 5/16" Drug Mart Unifine Pentips31GX8MM Elite-thin Insulin Syringe/1ML/30G X 5/16" Drug Mart Unifine Pentips32GX4MM Eql Insulin Syringe/U-100/0.3ML/29G X 1/2" Duane Reade Unifine Pentips 29G X 12MM Eql Insulin Syringe/U-100/0.5ML/29G X 1/2" Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT Eql Insulin Syringe/U-100/1ML/29G X 1/2" Duane Reade Unifine Pentips 31G X 8MM SHORT Eql Insulin Syringe/0.3ML/29G X 1/2" Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2" Eql Insulin Syringe/0.3ML/30G X 5/16" Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2" Eql Insulin Syringe/0.3ML/31G X 5/16" Easy Comfort Insulin Syringe/0.3ML/30G X 5/16" Eql Insulin Syringe/0.5ML/29G X 1/2" Easy Comfort Insulin Syringe/0.5ML/30G X 5/16" Eql Insulin Syringe/0.5ML/30G X 5/16" Easy Comfort Insulin Syringe/0.5ML/31G X 5/16" Eql Insulin Syringe/0.5ML/31G X 5/16" Easy Comfort Insulin Syringe/1ML/30G X 5/16" Eql Insulin Syringe/1ML/29G X 1/2" Easy Comfort Insulin Syringe/1ML/31G X 5/16" Eql Insulin Syringe/1ML/30G X 5/16" Easy Comfort Pen Needles 31GX1/4" Eql Insulin Syringe/1ML/31G X 5/16" Easy Comfort Pen Needles 31GX3/16" Eql SHORT Pen Needles 31G X 8MM Easy Comfort Pen Needles 31GX5/16" Eql Ultra Comfort Insulinsyringe/0.3ML/31G X 5/16" Easy Comfort Pen Needles 32GX5/32" Eql Ultra Comfort Insulinsyringe/1ML/30G X 5/16" Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2" Eql Ultra SHORT Pen Needles 31G X 6MM Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2" Excel Comfort Point Insulin Pen Needles 31G X 4MM Easy Touch Fliplock Safety Insulin Syringe Exel Comfort Point Insulin Pen Needles 29G X 12MM 1ML/30GX5/16"

Exel Comfort Point Insulin Pen Needles 31G X 6MM Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16" Exel Comfort Point Insulin Pen Needles 31G X 8MM

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2" 1/2" Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2" 5/16" Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2" Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2" Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16" Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2" Exel Comfort Point Insulin Syringe/1ML/28G X 1/2" Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2" Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 45

Exel Comfort Point Insulin Syringe/1ML/30G X 5/16" Gnp Insulin Syringe/0.3ML/29G X 1/2"

Fifty50 Pen Needles 31G X3/16" (5MM) Gnp Insulin Syringe/0.3ML/30G X 5/16"

Fifty50 Pen Needles 31G X5/16" (8MM) Gnp Insulin Syringe/0.3ML/31G X 5/16"

Fifty50 Pen Needles 31GX5MM Gnp Insulin Syringe/0.5ML/28G X 1/2"

Fifty50 Pen Needles/31GX8MM Gnp Insulin Syringe/0.5ML/29G X 1/2"

Fifty50 Pen Needles/32GX4MM Gnp Insulin Syringe/0.5ML/30G X 5/16"

Fifty50 Pen Needles/32GX6MM Gnp Insulin Syringe/0.5ML/31G X 5/16"

Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X Gnp Insulin Syringe/1ML/28G X 1/2" 5/16" Gnp Insulin Syringe/1ML/29G X 1/2"

Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X Gnp Insulin Syringe/1ML/30G X 5/16" 5/16" Gnp Insulin Syringe/1ML/31G X 5/16" Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16" Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2" Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" Freds Pharmacy Unifine Pentips Plus 31GX5MM SHORT

Freds Pharmacy Unifine Pentips Plus 31GX8MM Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" Freestyle Freedom Lite SHORT

Freestyle Insulinx Blood Glucose Monitoring System Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"

Freestyle Insulinx Blood Glucose TestQL Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"

Freestyle Insulinx Blood Glucose Test StripsQL Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT Freestyle Lite Blood Glucose Monitoring System

Freestyle Lite Test StripsQL Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2" 5/16"

Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2" Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16" Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16"

SHORT Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16" Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16"

SHORT Freestyle Precision Insulin Syringes/U-100/1ML/30G X 5/16" H-e-b Incontrol Pen Needles 29GX12MM

Freestyle Test StripsQL H-e-b IN Control Pen Needles 31GX5MM

Global Ease Inject Pen Needles 29GX12MM H-e-b IN Control Pen Needles 31GX6MM

Global Ease Inject Pen Needles 31GX8MM H-e-b IN Control Pen Needles 31GX8MM

Global Ease Inject Pen Needles 32GX4MM H-e-b IN Control Pen Needles/Nano/32GX4MM

Global Ease Inject Pen Neeedles 31GX5MM H-e-b IN Control Unifine Pentips Plus 31GX5MM

Global Easy Glide Insulinsyringe/U-100/0.3ML/31G X H-e-b IN Control Unifine Pentips Plus 32GX4MM 5/16" Healthwise Mini Pen Needles 31GX6MM Global Easy Glide Pen Needles 32GX4MM Healthwise Pen Needles 29GX12MM

Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X Healthwise SHORT Pen Needles 31GX8MM 1/2" Healthwise Unifine Pentips Pen Needles 32GX4MM

Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X Healthy Accents Unifine Pentips Pen Needles 29GX12MM 1/2"

Healthy Accents Unifine Pentips Pen Needles 31GX5MM Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X Healthy Accents Unifine Pentips Pen Needles 31GX6MM 5/16"

Healthy Accents Unifine Pentips Pen Needles 31GX8MM Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16" Healthy Accents Unifine Pentips Pen Needles 32GX4MM

Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X Insulin Syringe/U-100/0.3ML/29G X 1/2" 1/2" Insulin Syringe/U-100/0.5ML/28G X 1/2"

Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X Insulin Syringe/U-100/0.5ML/29G X 1/2" 1/2" Insulin Syringe/U-100/1ML/28G X 1/2"

Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X Insulin Syringe/U-100/1ML/29G X 1/2" 1/2"

Insulin Syringe/U-100/1ML/30G X 5/16" Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X Insulin Syringe/U-100/1ML/31G X 5/16" 5/16"

Insulin Syringe/0.3ML/29G X 1/2" Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16" Insulin Syringe/0.3ML/29G X 1"

Global Inject Ease Insulin Syringe/U-100/1ML/28G X 1/2" Insulin Syringe/0.3ML/30G X 5/16"

Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2" Insulin Syringe/0.3ML/31G X 5/16"

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2" Insulin Syringe/0.5ML/27G X 1/2"

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16" Insulin Syringe/0.5ML/28G X 1/2"

Global Inject Ease Insulin Syringe/U-100/1ML/31G X 5/16" Insulin Syringe/0.5ML/29G X 1/2"

Global Insulin Syringe/U-100/0.3ML/30G X 1/2" Insulin Syringe/0.5ML/30G X 1/2"

Global Insulin Syringes/U-100/0.3ML/30GX5/16" Insulin Syringe/0.5ML/30G X 5/16"

Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2" Insulin Syringe/0.5ML/31G X 5/16"

Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16" Insulin Syringe/1ML/28G X 1/2"

Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16" Insulin Syringe/1ML/29G X 1/2"

Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2" Insulin Syringe/1ML/30G X 5/16"

Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16" Insulin Syringe/1ML/31G X 5/16"

Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16" Insulin Syringes/0.5ML/27GX1/2"

Glucopro Insulin Syringe/U-100/1ML/30G X 1/2" Insulin Syringes/0.5ML/28GX1/2"

Glucopro Insulin Syringe/U-100/1ML/30G X 5/16" Insulin Syringes/0.5ML/29GX1/2"

Glucopro Insulin Syringe/U-100/1ML/31G X 5/16" Insulin Syringes/0.5ML/30GX5/16"

Gnp Clickfine Pen Needle Universal/31GX5/16" Insulin Syringes/0.5ML/31GX 5/16"

Gnp Clickfine Universal Pen Needles 31GX1/4" Insulin Syringes/0.5ML/31GX5/16"

Gnp Clickfine Universal Pen Needles 31GX5/16" Insulin Syringes/1ML/27GX/1/2"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 46

Insulin Syringes/1ML/27GX1/2" Live Better Pen Needles 31G X 12MM

Insulin Syringes/1ML/28GX1/2" Live Better Pen Needles 31G X 6MM

Insulin Syringes/1ML/29GX1/2" Longs Insulin Syringe/0.5ML/31G X 5/16"

Insulin Syringes/1ML/30GX1/2" Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2"

Insulin Syringes/1ML/31GX5/16" Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16"

Insupen Pen Needles 32G X4MM Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"

Insupen Sensitive 32GX6MM Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16"

Insupen Sensitive 32GX8MM Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"

Insupen Ultrafin 29GX12MM Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"

Insupen Ultrafin 30GX8MM Marathon Medical Pentips 29GX12MM

Insupen Ultrafin 31GX6MM Marathon Medical Pentips 31GX5MM

Insupen Ultrafin 31GX8MM Marathon Medical Pentips 31GX8MM

Insupen 29G X 12MM Marathon Medical Pentips 32GX4MM

Insupen 31G X 5MM Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"

Insupen 31G X 8MM Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2"

Insupen 32G X 4MM Medic Insulin Syringe/0.3ML/30G X 5/16"

Insupen 33GX4MM Medic Insulin Syringe/0.5ML/30G X 5/16"

Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16" Medicine Shoppe Pen Needles 29G X 12MM

Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16" Medicine Shoppe Pen Needles 31G X 6MM

Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16" Medicine Shoppe Pen Needles 31G X 8MM

Kinray Insulin Syringe/0.5ML/29G X 1/2" Meijer Pen Needles 29G X 12MM

Kmart Valu Plus Insulin Syringe/0.3ML/30G Meijer Pen Needles 31G X 6MM

Kmart Valu Plus Insulin Syringe/0.5ML/29G Meijer Pen Needles 31G X 8MM

Kmart Valu Plus Insulin Syringe/0.5ML/30G Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML

Kmart Valu Plus Insulin Syringe/1ML/29G Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"

Kmart Valu Plus Insulin Syringe/1ML/30G Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"

Kroger Insulin Syringe/0.3ML/29G X 1/2" Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2" Kroger Insulin Syringe/0.3ML/30G X 5/16" Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2" Kroger Insulin Syringe/0.3ML/31G X 5/16"

Kroger Insulin Syringe/0.5ML/29G X 1/2" Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2" Kroger Insulin Syringe/0.5ML/30G X 5/16"

Kroger Insulin Syringe/0.5ML/31G X 5/16" Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2"

Kroger Insulin Syringe/1ML/29G X 1/2" Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X Kroger Insulin Syringe/1ML/30G X 5/16" 1/2"

Kroger Insulin Syringe/1ML/31G X 5/16" Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X Kroger Pen Needles 29G X 12MM 1/2"

Kroger Pen Needles 31G X 8MM Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X

1/2" Kroger Pen Needles 31GX1/4" Monoject Insulin Syringe/Softpack/1ML/27G X 1/2" Leader Insulin Syringe/0.3ML/29G X 1/2" Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16" Leader Insulin Syringe/0.3ML/30G X 5/16" Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2" Leader Insulin Syringe/0.3ML/31G X 5/16" Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16" Leader Insulin Syringe/0.5ML/28G X 1/2" Monoject Insulin Syringe/U-100/1ML/28G X 1/2" Leader Insulin Syringe/0.5ML/29G X 1/2" Monoject Insulin Syringe/U-100/1ML/30G X 5/16" Leader Insulin Syringe/0.5ML/30G X 5/16" Monoject Insulin Syringe/1ML Leader Insulin Syringe/0.5ML/31G X 5/16" Monoject Insulin Syringe/1ML/31G X 5/16" Leader Insulin Syringe/1ML/28G X 1/2" Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2" Leader Insulin Syringe/1ML/29G X 1/2" Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" Leader Insulin Syringe/1ML/30G X 5/16" Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" Leader Insulin Syringe/1ML/31G X 5/16" Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2" Leader Unifine Pentips Plus/Mini/31GX3/16" Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2" Leader Unifine Pentips Plus/SHORT/31GX5/16" Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" Leader Unifine Pentips/Mini/31GX3/16" Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" Leader Unifine Pentips/Nano/32GX5/32" Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2" Leader Unifine Pentips/Plus/32GX5/32" Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2" Lite Touch Pen Needles/31G X 3/16" Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16" Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"

Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2" Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2" Litetouch Insulin Syringe/U-100/1ML/28G X 1/2"

Litetouch Insulin Syringe/U-100/1ML/29G X 1/2" Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"

Litetouch Insulin Syringe/U-100/1ML/31G X 5/16" Moore MED Monoject Insulin Syringe/U-100/1ML/28G X Litetouch Insulin Syringe/0.3ML/29G X 1/2" 1/2"

Litetouch Insulin Syringe/0.3ML/30G X 5/16" Moore MED Monoject Insulin Syringe/U-100/1ML/29G X Litetouch Insulin Syringe/0.3ML/31G X 5/16" 1/2"

Litetouch Insulin Syringe/0.5ML/30G X 5/16" MM Pen Needles 31G X 1/4"

Litetouch Insulin Syringe/0.5ML/31G X 5/16" MM Pen Needles 31G X 3/16"

Litetouch Insulin Syringe/1ML/30G X 5/16" MM Pen Needles 31G X 5/16"

Litetouch Pen Needles 29GX12.7MM MM Pen Needles 32G X 5/32"

Litetouch Pen Needles 31G X 6MM MS Insulin Syringe/0.3ML/29G X 1/2"

Litetouch Pen Needles 31GX8MM SHORT MS Insulin Syringe/0.3ML/30G X 5/16"

Live Better Pen Needles 29G X 12MM MS Insulin Syringe/0.3ML/31G X 5/16"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 47

MS Insulin Syringe/0.5ML/29G X 1/2" Px Insulin Syringe/U-100/1ML/31G X 5/16"

MS Insulin Syringe/0.5ML/30G X 5/16" Px Mini Pen Needles 31GX5MM

MS Insulin Syringe/0.5ML/31G X 5/16" Px Pen Needle 29GX12MM

MS Insulin Syringe/1ML/29G X 1/2" Px Pen Needle 31GX8MM

MS Insulin Syringe/1ML/30G X 5/16" Px Shortlength Pen Needles/31GX8MM

MS Insulin Syringe/1ML/31G X 5/16" PC Unifine Pentips 29G X 1/2"

Novofine Autocover 30GX8MM PC Unifine Pentips 31G X 5MM Mini

Novofine Plus 32GX4MM PC Unifine Pentips 31G X 6MM Ultra SHORT

Novofine 30GX8MM PC Unifine Pentips 31G X 8MM SHORT

Novofine 32GX6MM Qc Insulin Syringe/0.3ML/29G X 1/2"

Novotwist 30GX8MM Qc Insulin Syringe/0.5ML/29G X 1/2"

Novotwist 32GX5MM Qc Insulin Syringe/0.5ML/31G X 5/16"

Pen Needles 29G X 12MM Qc Insulin Syringe/1ML/29G X 1/2"

Pen Needles 29GX1/2" Qc Insulin Syringe/1ML/31G X 5/16"

Pen Needles 30GX5/16" Qc Pen Needles 29G X 12MM

Pen Needles 30GX5MM Qc Pen Needles 31G X 6MM

Pen Needles 30GX8MM Qc Pen Needles 31G X 8MM

Pen Needles 31G X 1/4" SHORT Qc Unifine Pentips 32GX4MM

Pen Needles 31G X 3/16" Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"

Pen Needles 31G X 5MM Ra Insulin Syringe/U-100/1 ML/30G X 5/16"

Pen Needles 31G X 6MM Ra Insulin Syringe/0.5ML/29G X 1/2"

Pen Needles 31GX5/16" Ra Insulin Syringe/1ML/29G X 1/2"

Pen Needles 31GX6MM (1/4") Ra Pen Needles 31G X 5MM 3/16"

Pen Needles 31GX8MM Ra Pen Needles 31G X 8MM 5/16"

Pen Needles 31GX8MM (5/16") Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"

Pen Needles 32GX4MM Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"

Pentips 29G X 12MM Reality Insulin Syringe/U-100/1ML/28G X 1/2"

Pentips 29GX12MM Reality Insulin Syringe/U-100/1ML/29G X 1/2"

Pentips 31G X 5MM Relion Insulin Syringe 0.5ML/31G X 15/64"

Pentips 31G X 8MM Relion Insulin Syringe 1ML/31GX15/64"

Pentips 31GX5MM Relion Insulin Syringe/U -100/0.5ML/29G

Pentips 31GX6MM Relion Insulin Syringe/U-00/1ML/29G X 1/2"

Pentips 31GX8MM Relion Insulin Syringe/U-100/0.3ML/29G

Pentips 32G X 4MM Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"

Pentips 32GX4MM Relion Insulin Syringe/U-100/0.3ML/30G

Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16" Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"

Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2" Relion Insulin Syringe/U-100/0.3ML/31G X 15/64"

Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2" Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"

Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8" Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"

Precision Sure-dose Insulin Syringe/1ML/28G X 1/2" Relion Insulin Syringe/U-100/0.5ML/30G

Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X Relion Insulin Syringe/U-100/0.5ML/30G X 5/16" 1/2" Relion Insulin Syringe/U-100/0.5ML/31G X 5/16" Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2" Relion Insulin Syringe/U-100/1ML/30G Precision XTRA Relion Insulin Syringe/U-100/1ML/30G X 5/16" Precision XTRA Blood Glucose Test StripsQL Relion Insulin Syringe/U-100/1ML/31G X 15/64" Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2" Relion Insulin Syringe/U-100/1ML/31G X 5/16" Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16" Relion Mini Pen Needles 31GX6MM Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2" Relion Pen Needles 29GX12MM Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2" Relion Pen Needles 31GX6MM Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16" Relion Pen Needles 31GX8MM Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2" Relion Pen Needles 32GX4MM Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2" Relion SHORT Pen Needles 31GX8MM Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16" Safesnap Insulin Syringe/0.3ML/30G X 5/16" Preferred Plus Unifine Pentips 29G X 12MM Safesnap Insulin Syringe/0.5ML/29G X 1/2" Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT Safesnap Insulin Syringe/0.5ML/30G X 5/16" Preferred Plus Unifine Pentips 31G X 8MM SHORT Safesnap Insulin Syringe/1ML/28G X 1/2" Preferred Plus Unifine Pentips 32GX4MM Safesnap Insulin Syringe/1ML/29G X 1/2" Preferred Plus Unifine Pentips/Mini/31GX5MM Safety Insulin Syringes 0.5ML/29GX1/2" Pro Comfort Pen Needles/ 31G X 8MM Safety Insulin Syringes 0.5ML/30GX5/16" Pro Comfort Pen Needles/ 32G X 4MM Safety Insulin Syringes 1ML/27GX1/2" Pro Comfort Pen Needles/ 32G X 5MM Safety Insulin Syringes 1ML/29GX1/2" Pro Comfort Pen Needles/ 32G X 6MM Safety Insulin Syringes 1ML/30GX1/2" Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16" Safety-glide Insulin Syringe/0.3ML/29G X 1/2" Prodigy Insulin Syringe/1/2ML/31G X 5/16" Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2" Prodigy Insulin Syringe/1ML/28G X 1/2" Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X Px Extra SHORT Pen Needles 31GX6MM 5/16"

Px Insulin Syringe/U-100/0.3ML/30G X 1/2" Shopko Unifine Pentips Pen Needles/Micro/32GX4MM

Px Insulin Syringe/U-100/0.3ML/31G X 5/16" Shopko Unifine Pentips Pen Needles/Mini/31GX5MM

Px Insulin Syringe/U-100/0.5ML/30G X 1/2" Shopko Unifine Pentips Pen Needles/Original/29GX12MM

Px Insulin Syringe/U-100/0.5ML/31G X 5/16" Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM

Px Insulin Syringe/U-100/1ML/30G X 1/2"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 48

Shopko Unifine Pentips Plus Pen Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"

Needles/Micro/Removr/32GX4MM Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"

Shopko Unifine Pentips Plus Pen Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" Needles/Mini/Remover/31GX5MM Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"

Shopko Unifine Pentips Plus Pen Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16" Needles/Remover/29GX12MM

Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16" Shopko Unifine Pentips Plus Pen Topco Insulin Syringe/U-100/0.3ML/29G X 1/2" Needles/SHORT/Removr/31GX8MM

Topco Insulin Syringe/U-100/0.5ML/28G X 1/2" Sm Insulin Syringe/1ML/31G X 5/16" Topco Insulin Syringe/U-100/0.5ML/29G X 1/2" Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2" Topco Insulin Syringe/U-100/1ML/28G X 1/2" Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2" Topco Insulin Syringe/U-100/1ML/29G X 1/2" Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16" Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2" Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16 Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16" Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16" Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16" Sure Comfort Insulin Syringe/U-100/0.3ML/31GX1/4" Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2" Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2" Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2" Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2" Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16" Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2" Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16" Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16" Trueplus Insulin Syringe/U-100/1ML/28G X 1/2" Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16 Trueplus Insulin Syringe/U-100/1ML/29G X 1/2" Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2" Trueplus Insulin Syringe/U-100/1ML/30G X 5/16" Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2" Trueplus Insulin Syringe/U-100/1ML/31G X 5/16" Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2" Trueplus Pen Needles 29GX12MM Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16" Trueplus Pen Needles 31GX5MM Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16" Trueplus Pen Needles 31GX6MM Sure Comfort Insulin Syringes/U-100/1ML/31GX6MM Trueplus Pen Needles 31GX8MM Sure Comfort Insulin Syringes/0.5ML/31G X 6MM Trueplus Pen Needles 32GX4MM Sure Comfort Pen Needles 29GX1/2" 12.7MM Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2" Sure Comfort Pen Needles 30GX5/16" SHORT Ulticare Insulin Safety Syringe/1ML/29G X 1/2" Sure Comfort Pen Needles 31GX3/16" (5MM) Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16" Sure Comfort Pen Needles 31GX5/16" (8MM) Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16" Sure Comfort Pen Needles 32GX5/32" Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16" Sure Comfort Pen Needles 32GX6MM Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16" Sure-fine Pen Needles 29GX1/2" 12.7MM Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16" Sure-fine Pen Needles 31GX3/16" 5MM Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16" Sure-fine Pen Needles 31GX5/16" 8MM Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16" Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2" Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16" Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16" Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16" Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16" Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2" Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2" Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2" Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2" Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16" Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16" Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16" Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16" Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2" Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2" Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2" Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2" Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16" Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16" Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16" Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16" Ulticare Insulin Syringe/U-100/1ML/29G X 1/2" SB Insulin Syringe/U-100/0.5ML/29G X 1/2" Ulticare Insulin Syringe/U-100/1ML/30G X 1/2" SB Insulin Syringe/U-100/0.5ML/30G X 5/16" Ulticare Insulin Syringe/U-100/1ML/30G X 5/16" SB Insulin Syringe/U-100/1ML/29G X 1/2" Ulticare Insulin Syringe/U-100/1ML/31G X 5/16" SB Insulin Syringe/U-100/1ML/30G X 5/16" Ulticare Insulin Syringe/0.3ML/29G X 1/2" SB Insulin Syringe/U-100/1ML/31G X 5/16" Ulticare Insulin Syringe/0.3ML/30G X 1/2" Techlite Pen Needles 29G X 10MM Ulticare Insulin Syringe/0.3ML/30G X 5/16" Techlite Pen Needles 29G X 12 MM Ulticare Insulin Syringe/0.5ML/28G X 1/2" Techlite Pen Needles 31G X 5MM Ulticare Insulin Syringe/0.5ML/29G X 1/2" Techlite Pen Needles/31G X 5MM Ulticare Insulin Syringe/0.5ML/30G X 1/2" Techlite Pen Needles/31G X 6 MM Ulticare Insulin Syringe/0.5ML/30G X 5/16" Techlite Pen Needles/31G X 8MM Ulticare Insulin Syringe/1ML/28G X 1/2" Techlite Pen Needles/32G X 4MM Ulticare Insulin Syringe/1ML/29G X 1/2" Techlite Pen Needles/32G X 6MM Ulticare Insulin Syringe/1ML/30G X 1/2" Techlite Pen Needles/32G X 8MM Ulticare Insulin Syringe/1ML/30G X 5/16" Todays Health Mini Pen Needles 31G X 1/4" Ulticare Micro Pen Needles 31G X 8MM Todays Health Original Pen Needles 29G X 1/2" Ulticare Micro Pen Needles 32G X 4MM Todays Health SHORT Pen Needles 31G X 5/16" Ulticare Micro Pen Needles/32G X 4MM Topcare Clickfine Universal Pen Eedles 31GX1/4" Ulticare Mini Pen Needles Ulti-fine IV Topcare Clickfine Universal Pen Eedles 31GX5/16" Ulticare Mini Pen Needles 31GX6MM Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2" Ulticare Mini Pen Needles/31G X 6MM

Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X Ulticare Mini Pen Needles31GX6MM 1/2" Ulticare Original Pen Needles Ulti-fine

Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X Ulticare Pen Needles 31G X 5MM/Mini 1/2"

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 49

Ulticare Pen Needles/29G X 12.7MM Unifine Pentips 31GX5MM

Ulticare SHORT Pen Needles Ulti-fine IV Unifine Pentips 31GX6MM

Ulticare SHORT Pen Needles 31GX8MM Unifine Pentips 31GX8MM

Ulticare SHORT Pen Needles/31G X 8MM Unifine Pentips 32GX4MM

Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4" V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4" V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"

Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4" V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ulticare U-100 Insulin Syringes/1ML/31G X 1/4" V-r Monoject Insulin Syringe/U-100/1ML/28G X 1/2"

Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16" V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2"

Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16" Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ultilet Insulin Syringe 31X6MM Value Health Insulin Syringe/U-100/1ML/29G X 1/2"

Ultilet Insulin Syringe/SHORT/0.3ML/30G X 12.7MM Valumark Pen Needles 29GX12MM

Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16" Valumark Pen Needles 31G X 6MM

Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16" Valumark Pen Needles 31G X 8MM

Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16" Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"

Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16" Vanishpoint Insulin Syringe/0.5ML/30G X 3/16"

Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16" Vanishpoint Insulin Syringe/0.5ML/30G X 5/16"

Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16" Vanishpoint Insulin Syringe/1ML/29G X 1/2"

Ultilet Insulin Syringe/U-100/0.5ML/30G X 1/2" Vanishpoint Insulin Syringe/1ML/29G X 5/16"

Ultilet Insulin Syringe/U-100/0.5ML/31GX6MM Vanishpoint Insulin Syringe/1ML/30G X 3/16"

Ultilet Insulin Syringe/U-100/1ML/30G X 1/2" Vanishpoint Insulin Syringe/1ML/30G X 5/16"

Ultilet Insulin Syringe/0.3ML/30G X 8MM Vida Mia Unifine Pentips Mini 31GX6MM

Ultilet Insulin Syringe/0.3ML/31G X 8MM Vida Mia Unifine Pentips Original 29GX12MM

Ultilet Insulin Syringe/0.5ML/30G X 8MM Vida Mia Unifine Pentips 32GX4MM

Ultilet Insulin Syringe/1ML/30G X 8MM Vida Mia Unipfine Pentipsshort 31GX8MM

Ultilet Insulin Syringe/1ML/31G X 8MM Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ultilet Pen Needle 29GX12.7MM Wegmans Unifine Pentips Plus 32GX4MM

Ultilet Pen Needle 31GX5MM Wegmans Unifine Pentips Plus/Mini/31GX5MM

Ultilet Pen Needle 31GX8MM Wegmans Unifine Pentips Plus/SHORT/31GX8MM

Ultilet Pen Needle 32GX4MM Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM

Ultilet Pen Needle 32GX4MM/SHORT 1ST Tier Unifine Pentips /Mini/31GX5MM

Ultilet SHORT Pen Needles 31GX5/16" 1ST Tier Unifine Pentips Plus 31GX8MM

Ultilet SHORT Pen Needles31GX3/16" 1ST Tier Unifine Pentips Plus 32GX4MM

Ultilet U-100 Insulin Syringes/1ML/31G X 6MM 1ST Tier Unifine Pentips Plus/Mini/31GX5MM

Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16" 1ST Tier Unifine Pentips Plus/Original/29GX12MM

Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2" 1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM

Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16" 1ST Tier Unifine Pentips 29GX12MM

Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16" 1ST Tier Unifine Pentips 31GX6MM

Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2" 1ST Tier Unifine Pentips 31GX8MM

Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2" 1ST Tier Unifine Pentips 32GX4MM

Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"

Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16" MISCELLANEOUS Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2"

Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2" TIER 07 PREVENTIVE

Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16" fluor-a-day Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16" fluoride

Ultra-thin II Insulin Syringe SHORT/U- fluoritab 100/0.3ML/30GX5/16" flura-drops Ultra-thin II Insulin Syringe SHORT/U- karidium 100/0.3ML/31GX5/16"

ludent Ultra-thin II Insulin Syringe SHORT/U- nafrinse 100/0.5ML/30GX5/16"

nafrinse drops Ultra-thin II Insulin Syringe SHORT/U- 100/0.5ML/31GX5/16" sodium fluoride

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/30GX5/16" TIER 01 GENERIC

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/31GX5/16" effer-k

Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2" effervescent pot chloride

Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2" effervescent potassium

Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2" effervescent potassium/chloride

Ultra-thin II Mini Pen Neeedles/31GX3/16" k-effervescent

Ultra-thin II Pen Needles 29GX1/2" k-prime

Ultra-thin II Pen Needles/SHORT/31GX5/16" k-sol

Unifine Pentips Plus 29GX12MM k-vescent

Unifine Pentips Plus 31GX5MM kionex

Unifine Pentips Plus 31GX6MM klor-CON

Unifine Pentips Plus 31GX8MM klor-CON m10

Unifine Pentips Plus 32GX4MM klor-CON m20

Unifine Pentips 29GX12MM klor-CON sprinkle

Unifine Pentips 31G X 3/16" klor-CON 10

Unifine Pentips 31G X 6MM klor-CON 8

Unifine Pentips 31G X 8MM

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 50

klor-CON/EF flumazenil

naloxone HCL fomepizole

naltrexone HCL potassium acetate

potassium chloride Acetadote

potassium chloride CR Anascorp

potassium chloride ER Antivenin Micrurus Fulvius

potassium chloride SR Antivenin North American Coral Snake

sodium polystyrene sulfonate Antizol

sps Bal IN Oil

Naloxone HCL Bridion

Potassium Chloride ER Calcium Disodium Versenate

TIER 02 PREFERRED BRAND Crofab

Varizig Cyanokit

TIER 03 NON PREFERRED Desferal

Chemet Digifab

Effer-k Duodote

Fluor-a-day Hepagam B

Fluorabon Hyperrab S/D

Flura-drops Hypertet S/D

K-TAB Imogam Rabies-ht

Kayexalate Nithiodote

Klor-CON M15 Potassium Acetate

Klor-CON/25 Potassium Chloride

Lozi-flur Pralidoxime Chloride

Luride Praxbind

Micro-k Protopam Chloride

Narcan Provayblue

Sodium Fluoride Sodium Nitrite

VeltassaPA Sodium Thiosulfate

TIER 04 PREFERRED SPECIALTY Vivitrol

Depen Titratabs

TIER 05 NON PREFERRED SPECIALTY

CuvitruPA

ExjadePA

FerriproxPA

HizentraPA

HyqviaPA

JadenuPA

Jadenu SprinklePA

Radiogardase

SyprinePA

SPECIALTY MEDICAL

BivigamPA

Carimune Nanofiltered

Cytogam

Flebogamma DifPA

Gamastan S/DPA

Gammagard LiquidPA

Gammagard S/D Iga Less Than 1mcg/MLPA

GammakedPA

GammaplexPA

Gamunex-cPA

Hyperhep B S/DPA

Hyperrho S/D

Hyperrho S/D Mini-dose

Micrhogam Ultra-filtered Plus

Nabi-HBPA

OctagamPA

PrivigenPA

Rhogam Ultra-filtered Plus

Rhophylac

SynagisPA

Winrho SDF

TIER 06 NON FORMULARY SPECIALTY

VistogardPA

SPECIALTY MEDICAL

ZinplavaPA

MEDICAL GENERAL MEDICAL

acetylcysteine

deferoxamine mesylate

Effective December 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 51

Index

acyclovir, 3, 12 Afinitor Disperz, 6 A acyclovir sodium, 4 Afluria 2016-2017, 40 abacavir, 3 Acyclovir Sodium, 4 Afluria 2017-2018, 40 abacavir sulfate/lamivudine/zidovudine, 3 Aczone, 11 Afluria PF 2016-2017, 39 abacavir/lamivudine, 3 Adacel, 39 Afluria PF 2017-2018, 40

Abaneu-SL, 25 Adalat CC, 8 Afluria Quadrivalent 2016-2017, 40 Abelcet, 3 adapalene, 11 Afluria Quadrivalent 2017-2018, 40 Abilify, 28 adapalene P.M., 11 Afrezza, 18

Abilify Maintena, 28 Adasuve, 28 Afstyla, 26 Abraxane, 6 Adcetris, 5 aftera, 16 Absorica, 11 Adcirca, 11 Aggrastat, 27

Abstral, 36 Adderall, 29 Aggrenox, 26 acamprosate calcium DR, 31 Adderall XR, 29 agoneaze, 13 acarbose, 19 adefovir dipivoxil, 3 Agrylin, 26

Accolate, 39 Adempas, 11 airavite, 24 Accupril, 9 Adenocard, 9 ak-fluor, 34 Accuretic, 10 adenosine, 9 Ak-fluor, 34

Acd Formula A, 26 Adenosine, 9 ak-poly-bac, 32 Acd Formula B, 26 Adlyxin, 18 Akovaz, 10 Acd-a Noclot-50, 26 Adlyxin Starter Pack, 18 Akten, 33 acebutolol HCL, 8 Adoxa, 2 Akynzeo, 22 acebutolol hydrochloride, 8 Adoxa PAK 1/100, 2 ala-cort, 13 Aceon, 9 Adoxa PAK 1/150, 2 Albenza, 4

Acetadote, 51 Adoxa PAK 2/100, 2 albuked 25, 26 Acetaminophen/Caffeine/Dihydrocodeine, Adrenaclick, 10 albuked 5, 26

35 Adrenal C Formula, 42 albumin human, 26 acetaminophen/codeine, 35 Adrenalin, 10, 38 albumin-zlb, 26 acetaminophen/codeine phosphate, 35 adriamycin, 5 albuminar-25, 26 acetasol HC, 34 adrucil, 5 albuminar-5, 26 acetazolamide, 10 adult aspirin EC low strength, 34 alburx, 26 acetazolamide ER, 10 adult aspirin regimen, 34 albutein, 26 acetazolamide sodium, 10 Advair Diskus, 39 albuterol sulfate, 39 acetic acid, 34 Advair HFA, 39 albuterol sulfate ER, 39 acetic acid 0.25%, 24 Advanced AM/PM, 42 albuterol TAB 4MG, 39 Acetic Acid/Aluminum Acetate, 34 Advate, 26 Alcaine, 33 acetylcysteine, 38, 51 Advicor, 11 alclometasone dipropionate, 13 Aciphex, 22 Advocate Insulin Pen Needles, 43 Aldactazide, 10 Aciphex Sprinkle, 22 Advocate Insulin Pen Needles Aldactone, 10 acitretin, 12 Aldurazyme, 20 29GX12.7MM, 43 Actemra, 37 Advocate Insulin Pen Needles Alecensa, 6 Acthib, 39 alendronate sodium, 19 31GX5MM, 43 Acticoat 7 2"X2", 14 Advocate Insulin Pen Needles Alendronate Sodium, 19 Acticoat 7 4"X5", 14 Alevicyn Dermal Spray, 14 31GX8MM, 43 Acticoat Absorbent Antimicrobial Advocate Insulin Syringe/U- alfentanil, 36

Dressing 4"X5", 14 Alfentanil HCL, 36 100/0.3ML/29GX1/2", 43 Acticoat Antimicrobial Dressing 2"X2", 14 Advocate Insulin Syringe/U- Alferon N, 7 Acticoat Antimicrobial Dressing 4"X4", 14 alfuzosin HCL ER, 24 100/0.3ML/30GX5/16", 43 Acticoat Flex 3 Barrier Dressing 4"'X4", Advocate Insulin Syringe/U- Alimta, 5

14 Alinia, 4 100/0.3ML/31GX5/16", 43 Actigall, 23 Advocate Insulin Syringe/U- Aliqopa, 7

Actimmune, 7 Alkeran, 5 100/0.5ML/29GX1/2", 44 Actiq, 36 Advocate Insulin Syringe/U- Allevyn AG Adhesive, 14 Activase, 27 Allevyn AG Gentle Border, 14 100/0.5ML/30GX5/16", 44 Active FE, 25 Advocate Insulin Syringe/U- Allevyn AG Non-adhesive, 14 Active OB, 42 Allevyn AG Sacrum, 14 100/0.5ML/31GX5/16", 44 Active-ketoprofen Kit, 12 Advocate Insulin Syringe/U- Allevyn Gentle, 14

Activella, 16 allopurinol, 37 100/1ML/29GX1/2", 44 Actonel, 19 Advocate Insulin Syringe/U- allopurinol sodium, 37 Actoplus Met, 19 almotriptan, 37 100/1ML/30GX5/16", 44 Actoplus Met XR, 19 Advocate Insulin Syringe/U- almotriptan malate, 37 Actos, 19 Alocril, 34 100/1ML/31GX5/16", 44 Acuicyn Daily Eyelid & Eyelash Cleanser, Adynovate, 26 Alogliptin, 19

14 Aerospan, 39 Alogliptin/Metformin HCL, 19 Acular, 34 afeditab CR, 8 Alogliptin/Pioglitazone, 19 Acular LS, 34 Afinitor, 6 Alomide, 34

Acuvail, 34

alophen, 21 amoxicillin/clavulanate potassium, 1 aprepitant, 22

Aloprim, 37 Amoxicillin/Clavulanate Potassium, 1 apri, 16

Alora, 16 amoxicillin/clavulanate potassium ER, 1 Apriso, 23 alosetron hydrochloride, 22 Amphenol-40, 15 Aptensio XR, 29

Aloxi, 22 amphetamine/dextroamphetamine, 29 Aptiom, 30

Alphagan P, 33 Amphotec, 3 Aptivus, 3

Alphanate/Von Willebrand Factor Amphotericin B, 3 Aquasol A Parenteral, 41

ampicillin, 1 aqueous vitamin d infants, 40 Complex/Human, 26 Alphanine SD, 26 Ampicillin, 1 Aquoral, 27 alphatrex, 13 ampicillin sodium, 1 Aralast NP, 39 alprazolam, 27 Ampicillin Sodium, 1 aranelle, 16 alprazolam ER, 27 ampicillin-sulbactam, 1 Aranesp Albumin Free, 25

Alprazolam Intensol, 27 Ampyra, 31 Arava, 37 alprazolam odt, 27 ana-lex, 22 arbinoxa, 38 alprazolam XR, 27 Anacaine, 14 Arcalyst, 37

Alprolix, 26 Anadrol-50, 16 Arcapta Neohaler, 39

Alrex, 33 Anafranil, 28 Arestin, 27

Altabax, 12 anagrelide hydrochloride, 26 argatroban, 26 altacaine, 33 Analpram-HC, 23 Argatroban, 26

Altace, 9 Anaprox DS, 37 argyle sterile saline 100ML, 24 altafrin, 33 Anascorp, 51 Aricept, 31 altavera, 16 Anaspaz, 22 Arimidex, 6

Altoprev, 11 anastrozole, 6 aripiprazole, 28

Alunbrig, 6 Ancobon, 3 aripiprazole odt, 28

Alvesco, 39 Androderm, 16 Aristada, 28 alyacen 1/35, 16 Androgel, 16 Arixtra, 26 alyacen 7/7/7, 16 Androgel P.M., 16 armodafinil, 29 amabelz, 16 Android, 16 Armour Thyroid, 20 amantadine HCL, 30 Androxy, 16 Arnica Flower, 14

Amaryl, 18 Anectine, 32 Arnuity Ellipta, 39

Ambien, 29 Anesthesia S/I-40, 38 Aromasin, 6

Ambien CR, 29 Anesthesia S/I-40a, 38 Arranon, 5

Ambisome, 3 Anesthesia S/I-40h, 38 Arthrotec 50, 37

Amcinonide, 13 Anesthesia S/I-40s, 38 Arthrotec 75, 37

Amerge, 37 Anesthesia S/I-60, 38 Articadent Dental, 37 amethia, 16 Angeliq, 16 Artiss, 26 amethia LO, 16 Angiomax, 26 Arymo ER, 36 amethyst, 16 Animi-3, 25 Arzerra, 5

Amicar, 26 Animi-3/Vitamin D, 25 Asacol HD, 23

Amidate, 38 anodyne lpt, 13 ascomp/codeine, 35 amikacin sulfate, 2 anodynz, 13 ashlyna, 16 amiloride HCL, 10 Anoro Ellipta, 39 Asmanex HFA, 39 amiloride/hydrochlorothiazide, 10 Antabuse, 31 Asmanex Twisthaler 120 Metered Doses, aminoacetic acid, 24 Antara, 11 39 Aminocaproic Acid, 26 Anti-stick Insulin Syringe/U- Asmanex Twisthaler 14 Metered Doses, aminophylline, 39 100/0.5ML/28G X 1/2", 44 39 amiodarone HCL, 8 Anti-stick Insulin Syringe/U- Asmanex Twisthaler 30 Metered Doses,

Amiodarone HCL, 9 100/0.5ML/29G X 1/2", 44 39 Amiodarone Hydrochloride/Dextrose, 9 Anti-stick Insulin Syringe/U-100/1ML/29G Asmanex Twisthaler 60 Metered Doses,

Amitiza, 23 X 1/2", 44 39 amitriptyline HCL, 28 Anticoagulant Citrate Dextrose Solution Asmanex Twisthaler 7 Metered Doses, amlodipine besylate, 8 A, 26 39 amlodipine besylate/atorvastatin calcium, Anticoagulant Citrate Phosphate aspir-81, 34

aspir-low, 34 11 Dextrose Solution, 26 amlodipine besylate/benazepril HCL, 9 Anticoagulant Sodium Citrate, 26 aspirin, 34 amlodipine besylate/benazepril Antivenin Micrurus Fulvius, 51 aspirin 81, 34

Antivenin North American Coral Snake, aspirin 81 low dose, 34 hydrochloride, 9 amlodipine besylate/valsartan, 9 aspirin adult low dose, 34 51 amlodipine/olmesartan medoxomil, 9 Antizol, 51 aspirin adult low strength, 34 amlodipine/valsartan/hctz, 9 Anusol-HC, 23 aspirin childrens, 34 ammonium lactate, 13 Anzemet, 22 aspirin EC, 34

Ammonul, 20 AP-zel, 42 aspirin EC low dose, 34 amnesteem, 11 Apexicon E, 13 aspirin enteric coated adult low strength,

Amniofix Sports MED, 15 Apidra, 18 34 Amoxapine, 28 Apidra Solostar, 18 aspirin low dose, 34 amoxicillin, 1 Aplenzin, 28 Aspirin Low Dose, 35

Amoxicillin, 1 Apokyn, 30 aspirin low strength, 34

Amoxicillin ER, 1 apraclonidine, 33 aspirin regimen low dose/adult, 34

Aspirin-caffeine-dihydrocodeine, 35 Axiron, 16 BD Autoshield 29G X 3/16", 44 aspirin/dipyridamole, 26 Aygestin, 18 BD Autoshield 29G X 5/16", 44 aspirtab, 34 azacitidine, 5 BD Autoshield Duo 30G X 3/16", 44

Assure ID Insulin Safety Syringe/U- Azactam, 4 BD Insulin Syringe LUER-LOK/U-

Azactam IN Iso-osmotic Dextrose, 4 100/0.5ML/29G X 1/2", 44 100/1ML, 44 Assure ID Insulin Safety Syringe/U- Azasan, 6 BD Insulin Syringe Microfine IV/U-

Azasite, 32 100/1ML/29G X 1/2", 44 100/0.3ML/28G X 1/2", 44 Astagraf XL, 6 azathioprine, 6 BD Insulin Syringe Microfine IV/U-

Astepro, 38 Azathioprine, 6 100/0.5ML/28G X 1/2", 44 Astringyn, 26 azelastine HCL, 33, 38 BD Insulin Syringe Microfine IV/U-

Atabex EC, 42 azelastine hydrochloride, 38 100/1ML/27G X 5/8", 44 Atabex Prenatal, 41 Azelex, 11 BD Insulin Syringe Microfine IV/U-

Atacand, 9 Azilect, 30 100/1ML/28G X 1/2", 44 Atacand HCT, 10 azithromycin, 1 BD Insulin Syringe Microfine/U-

Atelvia, 19 Azithromycin, 1 100/0.3ML/28G X 1/2", 44 atenolol, 8 Azopt, 34 BD Insulin Syringe Microfine/U- atenolol/chlorthalidone, 9 Azor, 10 100/0.5ML/28G X 1/2", 44 Atgam, 6 aztreonam, 4 BD Insulin Syringe Microfine/U-

Ativan, 27 Azulfidine, 23 100/1ML/27G X 5/8", 44 atomoxetine, 29 Azulfidine EN-TABS, 23 BD Insulin Syringe Microfine/U- atorvastatin calcium, 10 azuphen mb, 23 100/1ML/28G X 1/2", 44 atovaquone, 4 azurette, 16 BD Insulin Syringe atovaquone/proguanil HCL, 4 B Safetyglide/0.5ML/29G X 1/2", 44 atracurium besylate, 31 BD Insulin Syringe Safetyglide/1ML/29G B-6 Folic Acid, 25 Atripla, 3 X 1/2", 44 B-d Insulin Syringe Ultrafine II/0.3ML/31G Atropine Sulfate, 22, 33 BD Insulin Syringe Safetyglide/U-

Atrovent, 38 X 5/16", 44 100/0.3ML/31G X 15/64", 44 B-d Insulin Syringe Ultrafine II/0.5ML/31G Atrovent HFA, 39 BD Insulin Syringe Safetyglide/U-

Aubagio, 31 X 5/16", 44 100/0.3ML/31G X 5/16", 44 B-d Insulin Syringe Ultrafine II/1ML/31G X aubra, 16 BD Insulin Syringe Slip Tip/U-100/1ML,

augmented betamethasone dipropionate, 5/16", 44 44 B-d Insulin Syringe Ultrafine/0.3ML/30G X BD Insulin Syringe U-40/1ML/25G X 5/8", 13 Augmented Betamethasone 1/2", 44 44 B-d Insulin Syringe Ultrafine/0.5ML/30G X BD Insulin Syringe Ultra Fine/1ML/30G X Dipropionate, 13 Augmentin, 1 1/2", 44 1/2", 44 b-plex, 41 Augmentin ES-600, 1 BD Insulin Syringe Ultrafine Half- b-plex plus, 41 Augmentin XR, 1 unit/0.3ML/31G X 5/16", 44 Baby Ddrops, 41 Aurora Pen Needles 29GX12MM, 44 BD Insulin Syringe Ultrafine

Baby Super Daily D3, 41 Aurora Pen Needles 31G X 6MM, 44 II/SHORT/0.5ML/31G X 5/16", 44 Baby Vitamin D3 Drops, 41 Aurora Pen Needles 31G X 8MM, 44 BD Insulin Syringe Ultrafine baciim, 4 Aurora Unifine Pentips/32GX5/32", 44 II/SHORT/1ML/31G X 5/16", 44 bacitracin, 4 Aurora Unifine Pentips/Mini/31GX3/16", BD Insulin Syringe Ultrafine/0.3ML/30G X Bacitracin, 32

44 1/2", 44 bacitracin/polymyxin b, 32 Aurstat Anti-itch Hydrogel, 14 BD Insulin Syringe Ultrafine/0.3ML/31G X

baclofen, 32 Auryxia, 23 5/16", 44 Bacmin, 42 Austedo, 31 BD Insulin Syringe Ultrafine/0.5ML/30G X Bactocill IN Dextrose, 1 AV-vite fb, 25 1/2", 44 Bactrim, 4 Avalide, 10 BD Insulin Syringe Ultrafine/0.5ML/31G X Bactrim DS, 4 Avandia, 19 5/16", 44 Bactroban Nasal, 38 Avapro, 9 BD Insulin Syringe Ultrafine/1ML/30G X

Bal IN Oil, 51 avar cleanser, 11 1/2", 44 Bal-care DHA, 42 avar-e emollient, 11 BD Insulin Syringe Ultrafine/1ML/31G X balanced salt, 33 avar-e green, 11 5/16", 44 balanced salt solution, 33 Avastin, 5 BD Insulin Syringe Ultrafine/U- balsalazide disodium, 22 Avc, 24 100/0.3ML/29G X 1/2", 44 balziva, 16 Aveed, 16 BD Insulin Syringe Ultrafine/U-

Banzel, 30 Avelox, 2 100/0.3ML/30G X 1/2", 44 Baraclude, 3 Avelox Abc Pack, 2 BD Insulin Syringe Ultrafine/U- Basaglar Kwikpen, 18 Avenova, 14 100/0.3ML/31G X 15/64", 44 Bavencio, 6 Avenova/Neutrox, 14 BD Insulin Syringe Ultrafine/U- Baxdela, 2 aviane, 16 100/0.3ML/31G X 5/16", 44 bayer advanced aspirin regular strength, avidoxy, 2 BD Insulin Syringe Ultrafine/U-

avita, 11 34 100/0.5ML/29G X 1/2", 44 bayer aspirin, 34 Avodart, 24 BD Insulin Syringe Ultrafine/U- bayer aspirin EC low dose, 34 Avonex, 31 100/0.5ML/30G X 1/2", 44 bayer aspirin regimen, 34 Avonex Pen, 31 BD Insulin Syringe Ultrafine/U- bayer chewable low dose, 34 Avycaz, 4 100/0.5ML/31G X 15/64", 44 bayer low dose, 34 Axert, 37 BD Insulin Syringe Ultrafine/U-100/0.

Bcg Vaccine, 40

5ML/31G X 5/16", 44 Bentyl, 22 Boric Acid, 14

BD Insulin Syringe Ultrafine/U- Benznidazole, 4 Bosulif, 6

benzoin compound tincture, 13 Botox, 32 100/1ML/29G X 1/2", 44 BD Insulin Syringe Ultrafine/U- Benzoin Tincture, 14 bp 10-1, 11

Benzolyl Peroxide Forte- HC, 11 Bp Cleansing Wash, 11 100/1ML/30G X 1/2", 44 BD Insulin Syringe Ultrafine/U- benzonatate, 38 Bp Folinatal Plus B, 42

benzoyl peroxide- HC, 11 Bp Multinatal Plus, 42 100/1ML/31G X 15/64", 44 BD Insulin Syringe Ultrafine/U- benztropine mesylate, 30 Bp Vit 3, 25

Bepreve, 34 Bp Vit 3 Plus, 25 100/1ML/31G X 5/16", 44 BD Insulin Syringe/Detachable Needle/U- Berinert, 26 bpm, 38

Besivance, 32 bpm pseudo, 38 100/1ML/25G X 1", 44 BD Insulin Syringe/Detachable Needle/U- Besponsa, 5 bprotected pedia d-vite, 40

Betadine Ophthalmic Prep, 32 Brainstrong Prenatal, 41 100/1ML/25G X 5/8", 44 BD Insulin Syringe/Detachable Needle/U- Betagan, 33 Bravelle, 19

betamethasone dipropionate, 13 Breo Ellipta, 39 100/1ML/26G X 1/2", 44 BD Insulin Syringe/U-100/0.5ML/30G X betamethasone sodium Brevibloc, 8

Brevicon-28, 17 1/2", 44 phosphate/betamethasone acetate, 15 BD Insulin Syringe/U-100/1ML/27G X betamethasone valerate, 13 Brevital Sodium, 38

Betapace, 8 Bridion, 51 1/2", 44 BD Insulin Syringe/U-100/1ML/28G X Betapace AF, 8 briellyn, 16

Betaseron, 31 Brilinta, 26 1/2", 44 BD Insulin Syringe/U-100/2ML/27.5G X betaxolol HCL, 8, 32 brimonidine tartrate, 33

bethanechol chloride, 23 Brineura, 20 5/8", 44 BD Insulin Syringe/U-500/0.5ML/31G X Bethkis, 2 Brintellix, 28

Betimol, 33 Briviact, 30 15/64", 44 BD Integra Insulin Syringe/U- Betoptic-s, 33 bromfed DM, 38

Bevespi Aerosphere, 39 bromfenac, 34 100/1ML/29G X 1/2", 44 BD Integra Syringe/Retracting bexarotene, 7 Bromfenac, 34

Bexsero, 40 bromocriptine mesylate, 30 Needle/1ML/25G X 1", 44 BD LO-dose Insulin Syringe Microfine Beyaz, 17 bromphen/pseudoephedrine

Biaxin, 1 IV/0.5ML/28G X 1/2", 44 HCL/dextromethorphan HBR, 38 BD Pen Needle/Mini/Ultrafine/31G X bicalutamide, 6 Brompheniramine Tannate, 38

Bicillin C-R, 1 Bromsite, 34 3/16", 44 BD Pen Needle/Nano/Ultra Fine/32G X Bicillin L-a, 1 Brovana, 39

Bicnu, 5 bss, 34 4MM, 44 BD Pen Needle/SHORT/Ultrafine/31G X Bidil, 11 bss plus, 34

Biferarx, 25 Bss Plus, 34 5/16", 44 BD Pen Needle/Ultrafine/29G X 12.7MM, Biltricide, 4 budesonide, 15, 39

Bimatoprost, 33 budesonide nasal spray, 38 44 BD Pen Needle/Ultrafine/29GX1/2" Binosto, 19 bumetanide, 10

bio-d-mulsion, 40 Bumex, 10 12.7MM, 44 BD Pen Needles SHORT/Ultrafine/31G X bio-d-mulsion forte, 40 buminate, 26

bio-statin, 2 Bunavail, 36 5/16", 44 BD Safety-glide Insulin Bio-statin, 3 bupap, 35

biocel, 41 Buphenyl, 20 Syringe/0.5ML/29G X 1/2", 44 BD Safety-lok Insulin Syringe/Perm Biothrax, 40 bupivacaine HCL, 37

biotuss, 38 Bupivacaine Hydrochloride/Sodium Needle/UF/1ML/29G X 1/2", 44 BD Safetyglide Insulin biotuss pediatric, 38 Chloride, 37 bisacodyl EC, 21 bupivacaine spinal, 37 Sysyringe/0.5ML/30G X 5/16", 44 BD Ultra-fine Micro Pen Needles 6MM X bisacodyl laxative, 21 bupivacaine/dextrose spinal, 37

bisoprolol fumarate, 8 bupivacaine/epinephrine, 37 32G, 44 BD-insul SYR Mis LO Dose, 44 bisoprolol fumarate/hydrochlorothiazide, Buprenex, 36

BD-insul SYR Mis U-100, 44 Buprenorphine, 36 9 Bebulin, 26 bivalirudin, 26 buprenorphine HCL, 35

Beconase AQ, 38 Bivigam, 51 buprenorphine HCL/naloxone HCL, 35 bekyree, 16 Bleo 15k, 5 buproban, 30

Belbuca, 36 bleomycin sulfate, 5 bupropion HCL, 28

Beleodaq, 7 Bleph-10, 32 bupropion HCL ER, 28

Belladonna & Opium, 22 Blephamide, 33 bupropion HCL SR, 28, 30

Belladonna Alkaloids & Opium, 22 Blephamide S.o.p., 33 bupropion HCL XL, 28

Belsomra, 29 Blincyto, 5 buspirone HCL, 27 benazepril HCL, 9 blisovi 24 FE, 16 busulfan, 5 benazepril HCL/hydrochlorothiazide, 9 blisovi FE 1.5/30, 16 Busulfex, 5

Bendeka, 5 blisovi FE 1/20, 16 butalbital/acetaminophen, 35

Benefix, 26 Bloxiverz, 32 butalbital/acetaminophen/caffeine, 35

Benicar, 9 Bocasal, 27 butalbital/acetaminophen/caffeine/codein

Benicar HCT, 10 Boniva, 19 e, 35 Bensal HP, 14 Boostrix, 39 butalbital/aspirin/caffeine, 35

Butalbital/Aspirin/Caffeine, 35 carbinoxamine maleate, 38 Catapres-tts-2, 9 butalbital/aspirin/caffeine/codeine, 35 Carbocaine, 37 Catapres-tts-3, 9

Butisol Sodium, 29 carboplatin, 5 Cathflo Activase, 27 butorphanol tartrate, 35 Cardene IV, 8 cavarest, 27

Butorphanol Tartrate, 36 cardioplegic, 11 cavirinse, 27

Butrans, 36 Cardizem, 8 Cayston, 4

Bydureon, 18 Cardizem CD, 8 caziant, 16

Bydureon Bcise, 18 Cardizem LA, 8 Cedax, 1

Bydureon Pen, 18 Cardura, 9 cefaclor, 1

Byetta, 18 Cardura XL, 24 Cefaclor, 1

Bystolic, 8 Carefine Pen Needle 32GX4MM, 44 Cefaclor ER, 1

Byvalson, 10 Carefine Pen Needles 29GX1/2", 44 cefadroxil, 1

Carefine Pen Needles 30GX5/16", 44 Cefazolin, 1 C Carefine Pen Needles 31GX6MM, 44 cefazolin sodium, 1

C-nate DHA, 42 Carefine Pen Needles 31GX8MM, 44 Cefazolin Sodium, 1 cabergoline, 20 Carefine Pen Needles 32GX5MM, 44 Cefazolin Sodium/Dextrose, 1 Cabometyx, 6 Carefine Pen Needles 32GX6MM, 44 Cefazolin Sodium/Sodium Chloride, 1

Cadeau DHA, 41 Careone Insulin Syringes/0.3ML/30G X Cefazolin/D5W, 1 Caduet, 11 Cefazolin/Dextrose, 1 1/2", 44 Cafcit, 29 Careone Insulin Syringes/0.3ML/31G X Cefazolin/Sodium Chloride, 1

Cafergot, 37 cefdinir, 1 5/16", 44 caffeine citrate, 29 Careone Insulin Syringes/0.5ML/30G X Cefditoren Pivoxil, 1 Calan, 8 cefepime, 1 1/2", 44 Calan SR, 8 Careone Insulin Syringes/0.5ML/31G X Cefepime, 1 calcidol, 40 Cefepime/Dextrose, 1 5/16", 44 calciferol, 40 Careone Insulin Syringes/1ML/30G X cefixime, 1 calcipotriene, 12 Cefotan, 1 1/2", 44 calcitonin salmon, 19 Careone Insulin Cefotaxime Sodium, 1 calcitonin-salmon, 19 cefotetan, 1 Syringes/1ML/31GX5/16", 44 calcitrene, 12 Careone Unifine Pentips 29GX12MM, 44 Cefotetan, 1 Calcitriol, 12, 20 Careone Unifine Pentips 31GX5MM, 44 Cefotetan/Dextrose, 1 calcitriol, 20 Careone Unifine Pentips 31GX6MM, 44 cefoxitin sodium, 1 calcium acetate, 22 Careone Unifine Pentips 31GX8MM, 44 Cefoxitin Sodium, 1 Calcium Disodium Versenate, 51 Careone Unifine Pentips Pen Needles cefpodoxime proxetil, 1 Calcium PNV, 42 cefprozil, 1 32GX4MM, 44 Caldolor, 37 Careone Unifine Pentips Plus Pen ceftazidime, 1 Calquence, 6 Ceftazidime/Dextrose, 1 Needles 29GX12MM, 44 Cambia, 37 Careone Unifine Pentips Plus Pen Ceftibuten, 1 camila, 16 Ceftin, 1 Needles 31GX5MM, 44 Campath, 5 Careone Unifine Pentips Plus Pen Ceftriaxone IN Iso-osmotic Dextrose, 1 Camptosar, 7 ceftriaxone sodium, 1 Needles 31GX6MM, 44 camrese, 16 Careone Unifine Pentips Plus Pen Ceftriaxone Sodium, 1 camrese LO, 16 Ceftriaxone/Dextrose, 1 Needles 31GX8MM, 44 Canasa, 23 Careone Unifine Pentips Plus Pen cefuroxime axetil, 1

Cancidas, 3 cefuroxime sodium, 1 Needles 32GX4MM, 44 candesartan cilexetil, 9 Caretouch Pen Needles 31 G X 6 MM, Cefuroxime Sodium, 1 candesartan cilexetil/hydrochlorothiazide, Cefuroxime Sodium/Sodium Chloride, 32 44 9 Caretouch Pen Needles 31GX 5MM, 44 Celacyn Post-procedure Pack, 14 Cantil, 22 Caretouch Pen Needles 31GX 8MM, 44 Celebrex, 37 capacet, 35 Caretouch Pen Needles 32GX 4MM, 44 celecoxib, 36

Capastat Sulfate, 2 Caretouch Pen Needles 32GX 5MM, 44 Celestone-soluspan, 15 capecitabine, 5 Carimune Nanofiltered, 51 Celexa, 28 Caphosol, 27 carisoprodol, 32 Cellcept, 6

Capital/Codeine, 36 carisoprodol/aspirin, 32 Cellcept Intravenous, 6 Caprelsa, 6 carisoprodol/aspirin/codeine, 32 Celontin, 30 captopril, 9 Carnitor, 20 Cem-urea, 14

Captopril/Hydrochlorothiazide, 10 Carnitor SF, 20 Cenfol, 25 Carafate, 22 Carospir, 10 Centany AT, 12 Carbaglu, 20 carteolol HCL, 33 Centratex, 25 carbamazepine, 29 carters little pills, 21 Centrum Specialist Prenatal, 41 carbamazepine ER, 29 cartia XT, 8 cephalexin, 1 Carbaphen 12, 38 carvedilol, 8 Cephalexin, 1

Carbaphen 12 PED, 38 carvedilol phosphate, 8 Ceprotin, 27 Carbatrol, 30 Casodex, 6 ceramax, 13 carbidopa, 30 caspofungin acetate, 3 Cerdelga, 25 carbidopa/levodopa, 30 Caspofungin Acetate, 3 Cerebyx, 30 carbidopa/levodopa ER, 30 Catapres, 9 Cerezyme, 25 carbidopa/levodopa odt, 30 Catapres-tts-1, 9 cerisa wash, 11

Carbidopa/Levodopa/Entacapone, 30

cerovel, 13 ciprofloxacin ER, 2 Clever Choice Comfort EZ Pen Needles

Cervarix, 40 ciprofloxacin HCL, 2, 32 29GX12MM, 45 Cervidil, 34 Ciprofloxacin HCL, 2 Clever Choice Comfort EZ Pen Needles

Cesamet, 22 ciprofloxacin I.V.-IN D5W, 2 31GX5MM, 45 Cetraxal, 34 cisatracurium besylate, 31 Clever Choice Comfort EZ Pen Needles

Cetrotide, 19 Cisatracurium Besylate, 32 31GX6MM, 45 cevimeline HCL, 27 cisplatin, 5 Clever Choice Comfort EZ Pen Needles

Chantix, 31 Cisplatin, 5 31GX8MM, 45 Chantix Continuing Month PAK, 31 citalopram hydrobromide, 28 Clever Choice Comfort EZ Pen Needles

Chantix Starting Month PAK, 31 Citanest Forte Dental, 37 32GX4MM, 45 chateal, 16 Citanest Plain Dental, 38 Clever Choice Comfort EZ Pen Needles

Chemet, 51 Citranatal 90 DHA, 42 32GX5MM, 45 Chenodal, 23 Citranatal Assure, 42 Clever Choice Comfort EZ Pen Needles childrens aspirin, 34 Citranatal B-calm, 42 32GX6MM, 45 childrens aspirin low strength, 34 Citranatal DHA, 42 Clever Choice Comfort EZ Pen Needles

Chloramphenicol Sodium Succinate, 4 Citranatal Harmony, 42 32GX8MM, 45 chlordiazepoxide HCL, 27 Citranatal RX, 42 Clever Choice Comfort EZ Pen Needles chlordiazepoxide HCL/clidinium bromide, citrate of magnesia, 21 33GX4MM, 45 citrate of megnesia, 21 Clever Choice Comfort EZ Pen Needles 22 Chlordiazepoxide/Amitriptyline, 31 citroma, 21 33GX5MM, 45 chlorhexidine gluconate, 27 cladribine, 5 Clever Choice Comfort EZ Pen Needles chlorhexidine gluconate oral rinse, 27 Claforan, 1 33GX6MM, 45 chloroprocaine hydrochloride, 37 Claforan/D5W, 1 Clever Choice Comfort EZ Pen Needles chloroquine phosphate, 4 claravis, 11 33GX8MM, 45 Chloroquine Phosphate, 4 Clarinex-d 12 HOUR, 38 Cleviprex, 8 chlorothiazide, 10 clarithromycin, 1 Clickfine Pen Needle 32GX5/32", 45

Chlorothiazide, 10 Clarithromycin, 1 Clickfine Pen Needle Universal/31GX1/4", chlorothiazide sodium, 10 clarithromycin ER, 1 45 chlorpromazine HCL, 28 Classic Prenatal, 41 Clickfine Pen Needle

Chlorpromazine HCL, 29 clearlax, 21 Universal/31GX5/16", 45 Chlorpropamide, 18 clemastine fumarate, 38 Clickfine Pen Needles/31GX1/4", 45 chlorthalidone, 10 Clemastine Fumarate, 38 Clickfine Pen Needles/31GX5/16", 45 chlorzoxazone, 32 Cleocin, 4, 24 Clickfine Universal Pen Needles

Chlorzoxazone, 32 Cleocin IN D5W, 4 31GX5/16", 45 Cholbam, 23 Cleocin Pediatric Granules, 4 Climara, 16 cholestyramine, 10 Cleocin Phosphate, 4 Climara Pro, 16 cholestyramine light, 10 Clever Choice Comfort EZ Insulin Pen Clindacin Etz, 12 choline magnesium trisalicylate, 35 clindacin etz pledgets, 11 Needles 31GX8MM, 44 Chorionic Gonadotropin, 19 Clever Choice Comfort EZ Insulin Pen Clindacin PAC, 12 chromagen, 24 clindacin-p, 11 Needles 33GX4MM, 44 Cialis, 11 Clever Choice Comfort EZ Insulin clindamycin, 4 ciclodan, 12 clindamycin HCL, 4 Syringe/0.3ML/29G X 1/2", 44 Ciclodan Cream Kit, 12 Clever Choice Comfort EZ Insulin clindamycin palmitate HCL, 4

Ciclodan Solution Kit, 12 clindamycin phosphate, 4, 11, 24 Syringe/0.3ML/30G X 1/2", 44 ciclopirox, 12 Clever Choice Comfort EZ Insulin clindamycin phosphate add-vantage, 4 ciclopirox nail lacquer, 12 clindamycin phosphate IN D5W, 4 Syringe/0.3ML/30G X 5/16", 44 ciclopirox olamine, 12 Clever Choice Comfort EZ Insulin Clindesse, 24 ciclopirox treatment, 12 Clinoin, 12 Syringe/0.3ML/31G X 5/16", 44 cidaleaze, 13 Clever Choice Comfort EZ Insulin clinpro 5000, 27 cidofovir, 4 clobetasol propionate, 13 Syringe/0.5ML/28G X 1/2", 44 Ciferex, 25 Clever Choice Comfort EZ Insulin clobetasol propionate e, 13

Cifrazol, 25 clobetasol propionate emollient, 13 Syringe/0.5ML/29G X 1/2", 44 cilostazol, 26 Clever Choice Comfort EZ Insulin Clocortolone Pivalate, 13

Ciloxan, 32 Clocortolone Pivalate P.M., 13 Syringe/0.5ML/30G X 1/2", 44 cimetidine, 22 Clever Choice Comfort EZ Insulin clodan, 13 cimetidine HCL, 22 Cloderm, 13 Syringe/0.5ML/30G X 5/16", 44 Cimetidine HCL, 22 Clever Choice Comfort EZ Insulin Cloderm P.M., 13

Cimzia, 23 clofarabine, 5 Syringe/0.5ML/31G X 5/16", 44 Cimzia Starter Kit, 23 Clever Choice Comfort EZ Insulin Clolar, 5

Cinqair, 39 clomiphene citrate, 19 Syringe/1.0ML/30G X 1/2", 44 Cinryze, 26 Clever Choice Comfort EZ Insulin Clomiphene Citrate, 19

Cipro, 2 clomipramine HCL, 28 Syringe/1ML/28G X 1/2", 44 Cipro HC, 34 Clever Choice Comfort EZ Insulin clonazepam, 29

Cipro I.V.-IN D5W, 2 clonazepam odt, 29 Syringe/1ML/29G X 1/2", 44 Cipro XR, 2 Clever Choice Comfort EZ Insulin clonidine HCL, 9, 35

Ciprodex, 34 clonidine HCL ER, 29 Syringe/1ML/30G X 5/16", 44 ciprofloxacin, 2 Clever Choice Comfort EZ Insulin clonidine hydrochloride ER, 29

Ciprofloxacin, 2, 34 clopidogrel, 26 Syringe/U -100/1ML/31GX5/16", 44 clorazepate dipotassium, 27 Copaxone, 31 CVS gentle laxative, 21

Clorpres, 10 Copegus, 3 CVS gentle laxative womens, 21 clotrimazole, 12, 27 Cordarone, 9 CVS magnesium citrate, 21 clotrimazole/betamethasone dipropionate, Cordran, 13 CVS nicotine, 31

Cordran Tape, 13 CVS nicotine lozenge, 31 12 clozapine, 28 Coreg, 8 CVS nicotine polacrilex, 31 clozapine odt, 28 Coreg CR, 8 CVS nicotine polacrilex starter, 31

Clozapine Odt, 28 Corgard, 8 CVS nicotine transdermal system, 31

Clozaril, 28 Corifact, 26 CVS nts step 1, 31

Cnl8 Nail Kit, 12 Corlanor, 11 CVS Prenatal, 41

CO-natal Fa, 42 Corlopam, 9 CVS Prenatal Gummy/DHA/Folic Acid,

Coagadex, 26 cormax scalp application, 13 41 Coal TAR, 14 correct, 21 CVS Prenatal Multi+dha, 41

Coartem, 4 correctol, 21 CVS purelax, 21

Cocaine HCL, 14 Cortef, 15 CVS vitamin d childrens gummies, 41

Cod Liver Oil, 42 Cortenema, 23 CVS vitamin d3, 41

Codar AR, 38 Cortifoam, 23 CVS Vitamin D3 Drops/Infants, 41 codeine sulfate, 35 Cortisone Acetate, 15 cyanocobalamin, 24

Codeine Sulfate, 35 Cortisporin, 12 Cyanokit, 51

Cogentin, 30 Cortisporin-tc, 34 cyclafem 1/35, 16

Colazal, 23 Corvert, 9 cyclafem 7/7/7, 16

Colchicine, 37 corvita, 41 Cyclessa, 17

Colcrys, 37 corvita 150, 24 Cyclo/Gaba10/300 Pack, 32

Colestid, 11 Corvite, 42 cyclobenzaprine HCL, 32

Colestid Flavored, 11 Corvite 150, 25 Cyclogyl, 33 colestipol HCL, 10 Corvite FE, 25 Cyclomydril, 33 colistimethate sodium, 4 corvite free, 41 cyclopentolate HCL, 33 colocort, 22 Corzide, 10 cyclopentolate hydrochloride, 33

Coly-mycin M, 4 Cosentyx, 12 Cyclophosphamide, 5

Coly-mycin S, 34 Cosentyx Sensoready Pen, 12 cyclophosphamide, 5

Colyte-flavor Packs, 21 Cosmegen, 5 Cycloserine, 2

Combigan, 33 Cosopt, 33 Cycloset, 18

Combipatch, 16 Cosopt PF, 33 cyclosporine, 6

Combivent Respimat, 39 Cotellic, 6 cyclosporine modified, 6

Combivir, 3 Coumadin, 26 Cyclosporine Modified, 6

Cometriq, 6 Cozaar, 9 Cyklokapron, 26

Comfort Assist Insulin Syringe 0.3ML/29G Creon, 22 Cymbalta, 28

Cresemba, 3 cyproheptadine HCL, 38 X 1/2", 45 Comfort Assist Insulin Syringe/0.3ML/30G Crestor, 11 Cyramza, 5

Crinone, 24 cyred, 16 X 5/16", 45 Comfort Assist Insulin Syringe/0.3ML/31G Crixivan, 3 Cystadane, 20

Crofab, 51 Cystagon, 24 X 5/16", 45 Comfort Assist Insulin Syringe/0.5ML/29G cromolyn sodium, 22, 34, 39 cytarabine, 5

cryselle-28, 16 cytarabine aqueous, 5 X 1/2", 45 Comfort Assist Insulin Syringe/0.5ML/30G Cubicin, 4 Cytarabine Aqueous, 5

Cubicin RF, 4 Cytogam, 51 X 5/16", 45 Comfort Assist Insulin Syringe/0.5ML/31G Curity Hypertonic Sodium Chloride Cytomel, 20

Cytotec, 22 X 5/16", 45 Packing Strip 1/2"X15', 14 Comfort Assist Insulin Syringe/1ML/29G Curity Sodium Chloride Dressing 6"X6- Cytovene, 4

X 1/2", 45 3/4", 14 D Comfort Assist Insulin Syringe/1ML/30G curity sterile saline, 24 d 1000, 40 Curosurf, 39 X 5/16", 45 d 10000, 40 Comfort Assist Insulin Syringe/1ML/31G Cuvitru, 51

d 2000, 40 Cuvposa, 22 X 5/16", 45 d 400, 40 Commit, 31 CVS aspirin, 35 d 5000, 40 Complera, 3 CVS aspirin adult low dose, 35

d-1000, 40 Complete Natal DHA, 42 CVS aspirin adult low strength, 35 d-1000 extra strength, 40 Completenate, 42 CVS aspirin child, 35 d-2000 maximum strength, 40 compro, 28 CVS aspirin EC, 35

d-3-5, 40 Comtan, 30 CVS aspirin low dose, 35 d-400, 40 Comvax, 40 CVS aspirin low strength, 35 d-5000, 40 Concept DHA, 42 CVS bisacodyl, 21

D-VI-sol, 41 Concept OB, 42 CVS c-LAX laxative, 21 d-vita, 40 Concerta, 29 CVS childrens aspirin, 35 D.h.e. 45, 37 Condylox, 14 CVS citrate of magnesia, 21

d2000 ultra strength, 40 constulose, 21 CVS d3, 41 d3, 40 controlrx, 27 CVS enteric aspirin, 35 d3 2000, 40 Copasil, 14 CVS folic acid, 24

d3 adult, 40

d3 adult gummy, 40 dermacinrx empricaine, 13 Diflucan, 3

D3 Dots, 41 dermacinrx prizopak, 13 diflunisal, 35 d3 high potency, 40 Dermotic, 34 Digifab, 51 d3 kids, 40 Descovy, 3 digitek, 7 d3 maximum strength, 40 Desferal, 51 digox, 7 d3 super strength, 40 desipramine HCL, 28 digoxin, 7 d3 ultra strength, 40 desloratadine, 38 Digoxin, 7 d3-1000, 40 Desloratadine Odt, 38 Dihydroergotamine Mesylate, 37 d3-50, 40 desmopressin acetate, 20 dihydroergotamine mesylate, 37 dacarbazine, 7 Desogen, 17 Dilantin, 30

Dacarbazine, 7 desogestrel/ethinyl estradiol, 16 Dilantin Infatabs, 30

Dacogen, 5 desonide, 13 Dilantin-125, 30

Daklinza, 4 desoximetasone, 13 Dilatrate SR, 8

Daliresp, 39 Desoxyn, 29 Dilaudid, 36

Dalvance, 4 desvenlafaxine ER, 28 Dilaudid-HP, 36 danazol, 16 Desvenlafaxine ER, 28 dilt-XR, 8

Dantrium, 32 Detrol, 23 diltiazem CD, 8

Dantrium IV, 32 Detrol LA, 23 diltiazem HCL, 8 dantrolene sodium, 32 dexamethasone, 15 Diltiazem HCL, 8 dapsone, 4, 11 Dexamethasone, 15 diltiazem HCL CD, 8

Daptacel, 39 Dexamethasone Intensol, 15 diltiazem HCL ER, 8 daptomycin, 4 dexamethasone sodium phosphate, 15 Diltiazem Hydrochloride/Dextrose, 8

Daraprim, 4 Dexamethasone Sodium Phosphate, 15, Diltiazem Hydrochloride/Sodium Chloride, darifenacin hydrobromide ER, 23 33 8 Darzalex, 5 Dexamethasone Sodium Dimenhydrinate, 22 dasetta 1/35, 16 Diovan, 9 Phosphate/Sodium Chloride, 15 dasetta 7/7/7, 16 dexedrine, 29 Diovan HCT, 10 daunorubicin HCL, 5 Dexedrine, 29 Dipentum, 23

Daunoxome, 5 Dexilant, 22 diphenhydramine HCL, 38

Daypro, 37 dexmedetomidine HCL, 29 diphenoxylate/atropine, 21 daysee, 16 Dexmedetomidine HCL, 29 Diphenoxylate/Atropine, 21

Daytrana, 29 dexmethylphenidate HCL, 29 Diphtheria/Tetanus Toxoids Adsorbed

Ddavp, 20 dexmethylphenidate HCL ER, 29 Pediatric, 39 Ddrops, 41 dexmethylphenidate hydrochloride, 29 Diprivan, 38

Ddrops Booster, 41 Dexpak 10 Day, 15 dipyridamole, 26

Debacterol, 27 Dexpak 13 Day, 15 Disalcid, 35 deblitane, 16 Dexpak 6 Day, 15 disopyramide phosphate, 8 decara, 40 dexrazoxane, 7 disulfiram, 31

Decara, 41 dextroamphetamine sulfate, 29 Ditropan XL, 23 decitabine, 5 dextroamphetamine sulfate ER, 29 Diuril, 10

Decon-a, 38 Diabeta, 18 divalproex sodium, 29 deferoxamine mesylate, 51 dialyvite, 41 divalproex sodium DR, 29

Defitelio, 26 Dialyvite 3000, 42 divalproex sodium ER, 29

Deflux, 24 Dialyvite 5000, 42 Divigel, 16

Delestrogen, 16 Dialyvite Supreme D, 42 Divista, 25 delta d3, 40 dialyvite vitamin d 5000, 40 dobutamine HCL, 10 deltasone, 15 dialyvite vitamin d3 max, 40 dobutamine HCL/D5W, 10 delyla, 16 Dialyvite/Zinc, 42 dobutamine hydrochloride/dextrose, 10

Delzicol, 23 Diamox, 10 dobutamine/dextrose 5%, 10

Demadex, 10 Diastat Acudial, 30 Docefrez, 6 demeclocycline HCL, 2 Diastat Pediatric, 30 docetaxel, 6 demeclocycline hydrochloride, 2 diazepam, 27 Docetaxel, 6

Demerol, 36 Diazepam, 27, 30 Docetaxel (non-alcohol Formula), 6

Demser, 9 diazepam intensol, 27 dofetilide, 8

Denavir, 12 Diazepam Rectal Gel, 30 Dolophine, 36 denta 5000 plus, 27 Dibenzyline, 9 donepezil HCL, 31 dentagel, 27 diclofenac potassium, 36 donepezil hydrochloride, 31

Depacon, 30 diclofenac sodium, 12, 13, 34 dopamine HCL, 10

Depakene, 30 Diclofenac Sodium, 12 Dopamine HCL, 10

Depakote, 30 diclofenac sodium DR, 36 dopamine hydrochloride/dextrose, 10

Depakote ER, 30 diclofenac sodium ER, 36 dopamine/D5W, 10

Depakote Sprinkles, 30 diclofenac sodium/misoprostol, 36 Dopram, 29

Depen Titratabs, 51 dicloxacillin sodium, 1 Doral, 29

Depo-estradiol, 16 dicyclomine HCL, 22 Doribax, 4

Depo-medrol, 15 didanosine, 3 Doripenem, 4

Depo-provera, 6 Dificid, 1 dorzolamide HCL, 34

Depo-testosterone, 16 difil-G forte, 39 dorzolamide HCL/timolol maleate, 33

Depocyt, 5 Diflorasone Diacetate, 13 Dothelle DHA, 42

doxazosin, 9 Dyloject, 37 100/1ML/28G X 1/2", 45 doxazosin mesylate, 9 Dyrenium, 10 Easy Touch Insulin Syringe/U- doxepin HCL, 28 Dysport, 32 100/1ML/29G X 1/2", 45 Doxepin Hydrochloride, 12 Easy Touch Insulin Syringe/U- E doxercalciferol, 20 100/1ML/30G X 1/2", 45 E.e.s. 400, 1 Doxil, 5 Easy Touch Insulin Syringe/U- E.e.s. Granules, 1 doxorubicin HCL, 5 100/1ML/31G X 5/16", 45 Easy Comfort Insulin Syringe/0.3ML/30G Doxorubicin HCL, 5 Easy Touch Pen Needle 30 G X 5/16",

doxorubicin HCL liposome, 5 X 5/16", 45 45 Easy Comfort Insulin Syringe/0.5ML/30G doxy 100, 2 Easy Touch Pen Needles 29GX1/2", 45

doxycycline, 2 X 5/16", 45 Easy Touch Pen Needles 31GX1/4", 45

Easy Comfort Insulin Syringe/0.5ML/31G doxycycline hyclate, 2 Easy Touch Pen Needles 31GX5/16", 45

doxycycline hyclate DR, 2 X 5/16", 45 Easy Touch Pen Needles 32GX1/4", 45 Easy Comfort Insulin Syringe/1ML/30G X doxycycline monohydrate, 2 Easy Touch Pen Needles 32GX3/16", 45

Drisdol, 41 5/16", 45 Easy Touch Pen Needles 32GX5/32", 45 Easy Comfort Insulin Syringe/1ML/31G X Dritho-creme HP, 12 Easy Touch Pen Needles/31G X 3/16",

dronabinol, 22 5/16", 45 45 Easy Comfort Insulin Syringe/U- droperidol, 27 Easy Touch Sheathlock Safety Insulin

Droplet Pen Needles 29GX10MM, 45 100/0.5ML/30G X 1/2", 45 Syringe 1ML/29GX1/2", 45 Easy Comfort Insulin Syringe/U- Droplet Pen Needles 29GX12MM, 45 Easy Touch Sheathlock Safety Insulin

Droplet Pen Needles 31GX5MM, 45 100/1ML/30G X 1/2", 45 Syringe 1ML/30GX5/16", 45 Easy Comfort Pen Needles 31GX1/4", 45 Droplet Pen Needles 31GX6MM, 45 Easy Touch Sheathlock Safety Insulin Easy Comfort Pen Needles 31GX3/16", Droplet Pen Needles 31GX8MM, 45 Syringe 1ML/31GX5/16", 45 Droplet Pen Needles 32GX4MM, 45 45 Easy Touch Sheathlock Safety Syringe Easy Comfort Pen Needles 31GX5/16", Droplet Pen Needles 32GX5MM, 45 1ML/30GX1/2", 45 Droplet Pen Needles 32GX6MM, 45 45 easygel, 27

Easy Comfort Pen Needles 32GX5/32", Droplet Pen Needles 32GX8MM, 45 EC-81 aspirin, 35

drospirenone/ethinyl estradiol, 16 45 EC-naprosyn, 37 Easy Touch 32GX5MM, 45 drospirenone/ethinyl EC-RX Progesterone 10%, 18

Easy Touch 32GX6MM, 45 econazole nitrate, 12 estradiol/levomefolate calcium, 16 Easy Touch Fliplock Safety Insulin Droxia, 25 econtra EZ, 16

Drug Mart Unifine Pentips 31GX5MM, 45 Syringe 1ML/29GX1/2", 45 ecotrin, 34

Easy Touch Fliplock Safety Insulin Drug Mart Unifine Pentips29G X 12MM, ecotrin low strength, 34

Syringe 1ML/30GX1/2", 45 Ecotrin Regular Strength, 35 45 Easy Touch Fliplock Safety Insulin Drug Mart Unifine Pentips31GX6MM, 45 ecpirin, 34

Drug Mart Unifine Pentips31GX8MM, 45 Syringe 1ML/30GX5/16", 45 ed-spaz, 22 Easy Touch Fliplock Safety Insulin Drug Mart Unifine Pentips32GX4MM, 45 Edarbi, 9

Drug Mart Unifine Pentipsplus Syringe 1ML/31GX5/16", 45 Edarbyclor, 10

Easy Touch Insulin Syringe/0.3ML/30G X Edecrin, 10 32GX4MM, 45 Drysol, 14 5/16", 45 Edurant, 3 Easy Touch Insulin Syringe/0.3ML/31G X Duane Reade Unifine Pentips 29G X effer-k, 50

5/16", 45 Effer-k, 51 12MM, 45 Easy Touch Insulin Syringe/0.5ML/29G X Duane Reade Unifine Pentips 31G X effervescent pot chloride, 50

1/2", 45 effervescent potassium, 50 6MM Ultra SHORT, 45 Easy Touch Insulin Syringe/0.5ML/30G X Duane Reade Unifine Pentips 31G X effervescent potassium/chloride, 50

5/16", 45 Effexor XR, 28 8MM SHORT, 45 Easy Touch Insulin Syringe/1ML/30G X Duavee, 16 Effient, 26

ducodyl, 21 5/16", 45 Egrifta, 20 Easy Touch Insulin Syringe/Safety/U- Duet DHA 400, 42 Elaprase, 20

Duet DHA Balanced, 42 100/0.5ML/29G X 1/2", 45 Elavil, 28

Easy Touch Insulin Syringe/Safety/U- Duetact, 19 Eldepryl, 30

dulcolax balance, 21 100/0.5ML/30G X 5/16", 45 Elelyso, 25 Easy Touch Insulin Syringe/Safety/U- Dulera, 39 Elestat, 34

duloxetine HCL, 28 100/1ML/29G X 1/2", 45 Elestrin, 16 Easy Touch Insulin Syringe/Safety/U- Duodote, 51 eletriptan hydrobromide, 37

Durachol, 25 100/1ML/30G X 1/2", 45 Elidel, 13

Easy Touch Insulin Syringe/U- Duraclon, 35 Eligard, 6

Duragesic, 36 100/0.3ML/30G X 1/2", 45 Elimite, 14 Easy Touch Insulin Syringe/U- duramorph, 36 elinest, 16

Duraxin, 35 100/0.5ML/27G X 1/2", 45 Eliphos, 23 Easy Touch Insulin Syringe/U- Durezol, 33 Eliquis, 26

dutasteride, 24 100/0.5ML/28G X 1/2", 45 Elite-OB, 42

Easy Touch Insulin Syringe/U- dutasteride/tamsulosin HCL, 24 Elite-thin Insulin Syringe/0.3ML/31G X

dutasteride/tamsulosin hydrochloride, 24 100/0.5ML/30G X 1/2", 45 5/16", 45 Easy Touch Insulin Syringe/U- Dutoprol, 10 Elite-thin Insulin Syringe/0.5ML/29G X

Duzallo, 37 100/0.5ML/31G X 5/16", 45 1/2", 45 Easy Touch Insulin Syringe/U- Dyanavel XR, 29 Elite-thin Insulin Syringe/0.5ML/30G X

Dyazide, 10 100/1ML/27G X 1/2", 45 5/16", 45 Easy Touch Insulin Syringe/U-

Elite-thin Insulin Syringe/1ML/29G X ephedrine sulfate, 10 eql magnesium citrate, 21

Ephedrine Sulfate/Sodium Chloride, 10 eql nicotine, 30 5/16", 45 Elite-thin Insulin Syringe/1ML/30G X Epifix 4CM X 6CM, 15 eql nicotine polacrilex, 30

Epifoam, 13 eql nicotine polacrilex refill, 30 5/16", 45 Elite-thin Insulin Syringe/U- epinastine HCL, 34 eql nicotine polacrilex starter, 30

Epinephrine, 10 Eql Prenatal Formula, 41 100/0.5ML/28G X 1/2", 45 Elite-thin Insulin Syringe/U- epinephrine HCL, 10 Eql SHORT Pen Needles 31G X 8MM,

Epinephrine HCL, 10 100/0.5ML/28G X 5/16", 45 45 Elite-thin Insulin Syringe/U- Epinephrine Hydrochloride/Sodium Eql Ultra Comfort

100/0.5ML/29G X 5/16", 45 Chloride, 10 Insulinsyringe/0.3ML/31G X 5/16", 45 Elite-thin Insulin Syringe/U- Epipen 2-PAK, 10 Eql Ultra Comfort Insulinsyringe/1ML/30G

Epipen-JR 2-PAK, 10 100/0.5ML/31G X 5/16", 45 X 5/16", 45 Elite-thin Insulin Syringe/U-100/1ML/28G epirubicin HCL, 5 Eql Ultra SHORT Pen Needles 31G X

epitol, 29 X 1/2", 45 6MM, 45 Elite-thin Insulin Syringe/U-100/1ML/28G Epivir, 3 eql vitamin d-3, 40

Epivir HBV, 3 eql vitamin d3, 40 X 5/16", 45 Elite-thin Insulin Syringe/U-100/1ML/29G eplerenone, 9 eql vitamin d3 gummies, 40

Epogen, 25 eql womans laxative, 21 X 1/2", 45 Elite-thin Insulin Syringe/U-100/1ML/31G epoprostenol sodium, 11 Equapax/Atorvastatin Calcium/Coq10, 11

Eprosartan Mesylate, 9 Equapax/Ibuprofen/Minrex, 37 X 5/16", 45 Elitek, 7 eptifibatide, 26 Equetro, 28

Elixophyllin, 39 Epzicom, 3 Eraxis, 3

Ella, 17 eq adult aspirin low strength, 34 Erbitux, 5

Ellence, 5 eq aspirin, 34 ergocalciferol, 40

Elmiron, 24 eq aspirin adult low dose, 34 Ergoloid Mesylates, 31

Eloctate, 26 eq aspirin EC, 34 Ergomar, 37

Emadine, 34 eq aspirin low dose, 34 ergotamine tartrate/caffeine, 37

Embeda, 36 eq childrens aspirin, 34 errin, 16

Emcyt, 6 eq clearlax, 21 Ertaczo, 12

Emend, 22 eq gentle laxative, 21 Erwinaze, 5

Emend Tripack, 22 eq magnesium citrate, 21 ery, 11

Emflaza, 15 eq nicotine, 30 Ery-TAB, 1

Emla, 14 eq nicotine gum refill, 30 Eryped 200, 1 emoquette, 16 eq nicotine gum starter, 30 Eryped 400, 1

Empliciti, 5 eq nicotine lozenges, 30 Erythrocin Lactobionate, 2

Emsam, 28 eq nicotine polacrilex, 30 Erythrocin Stearate, 2

Emtriva, 3 eq nicotine step 3, 30 erythromycin, 1, 11, 32

Emverm, 4 eq womans laxative, 21 Erythromycin Base, 1

Enablex, 23 eq womens laxative, 21 erythromycin ethylsuccinate, 1 enalapril maleate, 9 eql adult aspirin low strength, 34 Erythromycin Ethylsuccinate, 1 enalapril maleate/hydrochlorothiazide, 9 eql aspirin, 34 Esbriet, 39 enalaprilat, 9 eql aspirin EC, 34 Escavite, 42

Enbrace HR, 42 eql aspirin low dose, 34 Escavite D, 42

Enbrel, 37 eql childrens aspirin, 34 Escavite LQ, 42

Enbrel Mini, 37 eql childrens vitamin d gummies, 40 escitalopram oxalate, 28

Enbrel Sureclick, 37 eql clearlax, 21 esgic, 35

Encare, 24 eql folic acid, 24 Esgic, 35 endocet, 35 eql gentle laxative, 21 esmolol HCL, 8

Endometrin, 24 Eql Insulin Syringe/0.3ML/29G X 1/2", 45 esomeprazole sodium, 22

Enfamil Expecta, 41 Eql Insulin Syringe/0.3ML/30G X 5/16", Esomeprazole Sodium, 22

Engerix-b, 40 Essentra Wipes 9X9" Cleanroom 45 Enjuvia, 16 Eql Insulin Syringe/0.3ML/31G X 5/16", Supplies/Presaturated, 14 Enlon, 32 estarylla, 16 45 Enovarx-ibuprofen, 12 Eql Insulin Syringe/0.5ML/29G X 1/2", 45 estazolam, 29 enoxaparin sodium, 25 Eql Insulin Syringe/0.5ML/30G X 5/16", Estrace, 16, 24 enpresse-28, 16 estradiol, 16, 24 45 enskyce, 16 Eql Insulin Syringe/0.5ML/31G X 5/16", estradiol valerate, 16 entacapone, 30 estradiol/norethindrone acetate, 16 45 entecavir, 3 Eql Insulin Syringe/1ML/29G X 1/2", 45 Estring, 24

Entereg, 23 Eql Insulin Syringe/1ML/30G X 5/16", 45 Estrogel, 16 enteric coated aspirin, 34 Eql Insulin Syringe/1ML/31G X 5/16", 45 Estropipate, 16

Entocort EC, 15 Eql Insulin Syringe/U-100/0.3ML/29G X Estrostep FE, 17

Entresto, 11 eszopiclone, 29 1/2", 45 Entyvio, 23 Eql Insulin Syringe/U-100/0.5ML/29G X ethacrynate sodium, 10 enulose, 22 ethacrynic acid, 10 1/2", 45 Envarsus XR, 6 Eql Insulin Syringe/U-100/1ML/29G X ethambutol HCL, 2

Epaned, 9 ethosuximide, 29 1/2", 45 Epclusa, 3 eql laxative, 21 Ethyl Chloride, 14

Ethyl Chloride/Fine Pinpoint, 14 fallback solo, 16 Fetzima Titration Pack, 28

Ethyl Chloride/Fine Stream, 14 falmina, 16 Fexmid, 32

Ethyl Chloride/Medium Jet Stream, 14 famciclovir, 3 Fiasp, 18

Ethyl Chloride/Medium Stream, 14 famotidine, 22 Fiasp Flextouch, 18

Ethyl Chloride/Mist, 14 Famotidine Premixed, 22 Fibricor, 11 ethynodiol diacetate/ethinyl estradiol, 16 Famvir, 3 Fifty50 Pen Needles 31G X3/16" (5MM),

Etidronate Disodium, 19 Fanapt, 28 46 etodolac, 36 Fanapt Titration Pack, 28 Fifty50 Pen Needles 31G X5/16" (8MM), etodolac ER, 36 Fareston, 6 46 etomidate, 38 Farxiga, 18 Fifty50 Pen Needles 31GX5MM, 46

Etopophos, 6 Farydak, 7 Fifty50 Pen Needles/31GX8MM, 46

Etoposide, 6 Faslodex, 6 Fifty50 Pen Needles/32GX4MM, 46 etoposide, 6 fayosim, 16 Fifty50 Pen Needles/32GX6MM, 46

Euflexxa, 32 Fazaclo, 28 Fifty50 Superior Comfort Insulin

Eurax, 14 Fbl Kit, 12 Syringe/0.3ML/31G X 5/16", 46 Evamist, 16 feenamint, 21 Fifty50 Superior Comfort Insulin

Evicel, 26 Feiba, 26 Syringe/0.5ML/31G X 5/16", 46 Evista, 19 Feiba NF, 26 Fifty50 Superior Comfort Insulin

Evithrom, 26 felbamate, 29 Syringe/1ML/31G X 5/16", 46 Evomela, 5 Felbatol, 30 Finacea, 12

Evotaz, 3 Feldene, 37 finasteride, 24

Evoxac, 27 felodipine ER, 8 Fioricet, 35

EX-LAX ultra, 21 Fem PH, 24 Fioricet/Codeine, 36

Exactuss, 38 Femara, 6 Fiorinal, 35

Exalgo, 36 Femcon FE, 17 Fiorinal/Codeine #3, 36

Excel Comfort Point Insulin Pen Needles Femhrt Low Dose, 16 Firazyr, 26

Femring, 24 Firmagon, 6 31G X 4MM, 45 Exel Comfort Point Insulin Pen Needles femynor, 16 First-bxn Mouthwash, 27

fenofibrate, 11 First-dukes Mouthwash, 27 29G X 12MM, 45 Exel Comfort Point Insulin Pen Needles Fenofibrate, 11 First-lansoprazole, 22

fenofibrate micronized, 11 First-marys Mouthwash, 27 31G X 6MM, 45 Exel Comfort Point Insulin Pen Needles Fenofibric Acid, 11 First-mouthwash Blm, 27

fenofibric acid DR, 11 First-omeprazole, 22 31G X 8MM, 45 Exel Comfort Point Insulin fenoprofen calcium, 36 First-progesterone VGS 100

Fenoprofen Calcium, 36 Syringe/0.3ML/29G X 1/2", 45 Compounding Kit, 24 Exel Comfort Point Insulin Fenortho, 37 First-progesterone VGS 200

fentanyl, 35 Syringe/0.3ML/30G X 5/16", 45 Compounding Kit, 24 Exel Comfort Point Insulin Fentanyl, 35 First-progesterone VGS 25 Compounding

fentanyl citrate, 36 Syringe/0.5ML/28G X 1/2", 45 Kit, 24 Exel Comfort Point Insulin Fentanyl Citrate, 36 First-progesterone VGS 400

fentanyl citrate oral transmucosal, 35 Syringe/0.5ML/29G X 1/2", 45 Compounding Kit, 24 Exel Comfort Point Insulin Fentanyl Citrate/Bupivacaine First-progesterone VGS 50 Compounding

Syringe/0.5ML/30G X 5/16", 45 Hydrochloride, 36 Kit, 24 Exel Comfort Point Insulin Fentanyl Citrate/Bupivacaine First-testosterone, 16

First-testosterone Mc Compounding Kit, Syringe/1ML/28G X 1/2", 45 Hydrochloride/Sodium Chloride, 36 Exel Comfort Point Insulin Fentanyl Citrate/Bupivicaine HCL/Sodium 16 First-vancomycin 25, 4 Syringe/1ML/29G X 1/2", 45 Chloride, 36 Exel Comfort Point Insulin Fentanyl Citrate/Bupivicaine First-vancomycin 50, 4

Flagyl, 4 Syringe/1ML/30G X 5/16", 46 Hydrochloride/Sodium Chloride, 36 Exelderm, 12 Fentanyl Citrate/Ropivacaine Flarex, 33

Exelon, 31 flavoxate HCL, 23 Hydrochloride, 36 exemestane, 6 Fentanyl Citrate/Ropivacaine Flebogamma Dif, 51

Exforge, 10 flecainide acetate, 8 Hydrochloride/Sodium Chloride, 36 Exforge HCT, 10 Fentanyl Citrate/Sodium Chloride, 36 Flector, 12

Exjade, 51 Fentora, 36 fleet laxative, 21

Exoderm, 12 Feraheme, 25 flexbumin, 26

Exparel, 38 Feriva, 25 Flexin, 14

Extavia, 31 Ferivafa, 25 Flolan, 11

Extina, 12 ferocon, 24 Flomax, 24

Extra-virt Plus DHA, 42 ferotrinsic, 24 Floriva Plus, 42 ezetimibe, 10 Ferralet 90, 25 Flovent Diskus, 39 ezetimibe/simvastatin, 10 Ferraplus 90, 25 Flovent HFA, 39

Ferriprox, 51 Floxin Otic, 34 F Ferrlecit, 25 Floxuridine, 5 fa-8, 24 Ferro-plex Hematinic, 25 Fluad 2016-2017, 40 fabb, 24 ferrocite plus, 24 Fluad 2017-2018, 40 Fabrazyme, 20 Ferrotrin, 25 Fluarix Quadrivalent 2016-2017, 40 Factive, 2 Fetzima, 28 Fluarix Quadrivalent 2017-2018, 40

Falessa, 17

Flublok 2016-2017, 40 Fluzone High-dose PF 2017-2018, 40 100/0.5ML/30G X 5/16", 46

Flublok 2017-2018, 40 Fluzone Intradermal Quadrivalent 2016- Freestyle Precision Insulin Syringe/U-

Flublok Quadrivalent 2017-2018, 40 2017, 40 100/0.5ML/31G X 5/16", 46 Flucelvax Quadrivalent 2016-2017, 40 Fluzone Intradermal Quadrivalent 2017- Freestyle Precision Insulin Syringe/U-

Flucelvax Quadrivalent 2017-2018, 40 2018, 40 100/1ML/31G X 5/16", 46 fluconazole, 2 Fluzone Quadrivalent 2016-2017, 40 Freestyle Precision Insulin Syringes/U- fluconazole IN dextrose, 3 Fluzone Quadrivalent 2017-2018, 40 100/1ML/30G X 5/16", 46 fluconazole IN NACL, 3 FML, 33 Freestyle Test Strips, 46

Fluconazole IN NACL, 3 FML Forte, 33 fresenius propoven, 38 flucytosine, 2 FML Liquifilm, 33 Frova, 37 fludarabine phosphate, 5 Focalgin 90 DHA, 42 frovatriptan succinate, 37 fludrocortisone acetate, 15 Focalgin CA, 42 Fulyzaq, 21

Flulaval Quadrivalent 2016-2017, 40 Focalgin Dss, 25 Fungimez, 12

Flulaval Quadrivalent 2017-2018, 40 Focalin, 29 Furadantin, 23

Flumadine, 3 Focalin XR, 29 furosemide, 10 flumazenil, 51 folbee, 24 Furosemide, 10

Flumist Quadrivalent, 40 folbee plus, 41 Fusilev, 7

Flunisolide, 38 Folbee Plus Cz, 42 Fusion Plus, 25 fluocinolone acetonide, 13, 34 Folcal DHA, 42 Fuzeon, 3 fluocinolone acetonide body, 13 Folcaps Omega 3, 42 fyavolv, 16 fluocinolone acetonide ear drops, 34 Folet One, 42 Fycompa, 30 fluocinolone acetonide scalp, 13 Folgard OS, 42 G fluocinonide, 13 Folgard RX, 25

gabapentin, 29 fluocinonide emulsified base, 13 folic acid, 24 Gabitril, 30 fluor-a-day, 50 Folic Acid, 25 Gablofen, 32 Fluor-a-day, 51 folic acid/vitamin b-6/vitamin b-12, 24

galantamine hydrobromide, 31 Fluorabon, 51 Folivane-f, 25 Galantamine Hydrobromide, 31 Fluorescite, 34 Folivane-OB, 42 galantamine hydrobromide ER, 31 fluoride, 50 Folivane-plus, 25

Gamastan S/D, 51 fluoridex, 27 Follistim AQ, 19 Gammagard Liquid, 51 fluoridex daily defense, 27 Folotyn, 5 Gammagard S/D Iga Less Than fluoridex daily defense enhanced folplex 2.2, 24

Foltrate, 25 1mcg/ML, 51 whitening, 27 Gammaked, 51 fluoridex daily defense sensitivity relief, foltrin, 24 Gammaplex, 51 fomepizole, 51 27 Gamunex-c, 51 Fluoridex Daily Defense Sensitivity Relief, fondaparinux sodium, 25 ganciclovir, 4 Foradil Aerolizer, 39 27 Ganciclovir, 4 fluoridex daily renewal, 27 Fortavit, 42

Ganirelix Acetate, 19 fluoridex enhanced whitening, 27 Fortaz, 1 Gardasil, 40 fluoridex sensitivity relief, 27 Forteo, 19 Gardasil 9, 40 fluoridex sensitivity relief/sls free, 27 Fortesta, 16

Gastrocrom, 23 fluoritab, 50 Fortical, 19 gatifloxacin, 32 fluorometholone, 33 Fosamax, 19 Gattex, 23 fluorouracil, 5, 13 Fosamax Plus D, 19

gavilax, 21 Fluorouracil, 13 fosamprenavir calcium, 3 gavilyte-c, 21 Fluoxetine, 31 Foscavir, 4 gavilyte-G, 21 Fluoxetine DR, 28 fosinopril sodium, 9

gavilyte-h, 21 fluoxetine HCL, 28 fosinopril sodium/hydrochlorothiazide, 9 gavilyte-n/flavor pack, 21 fluphenazine decanoate, 29 fosphenytoin sodium, 30 Gazyva, 5 fluphenazine HCL, 28 Fosrenol, 23

Gel-kam Oral Care Rinse, 27 Fluphenazine HCL, 28 Fragmin, 26 Gel-one, 32 flura-drops, 50 Freds Pharmacy Unifine Pentips Pen Gelclair, 27 Flura-drops, 51 Needles 32GX4MM, 46 Gelfoam-jmi Sponge Kit, 26 flurandrenolide, 13 Freds Pharmacy Unifine Pentips Plus Gelnique, 24 Flurazepam HCL, 29 31GX5MM, 46 Gelnique P.M., 24 flurbiprofen, 36 Freds Pharmacy Unifine Pentips Plus

Gelsyn-3, 32 flurbiprofen sodium, 34 31GX8MM, 46 gemcitabine, 5 Flurbiprofen Sodium, 34 Freestyle Freedom Lite, 46 gemcitabine HCL, 5 flutamide, 6 Freestyle Insulinx Blood Glucose

gemfibrozil, 11 fluticasone propionate, 13, 38 Monitoring System, 46 Gemzar, 5 Fluticasone Propionate/Salmeterol, 39 Freestyle Insulinx Blood Glucose Test, gene-xene TAB 15MG, 27 fluvastatin, 11 46 gene-xene TAB 3.75MG, 27 fluvastatin sodium ER, 11 Freestyle Insulinx Blood Glucose Test gene-xene TAB 7.5MG, 27 Fluvirin 2016-2017, 40 Strips, 46 Generess FE, 17 Fluvirin 2017-2018, 40 Freestyle Lite Blood Glucose Monitoring

generlac, 22 fluvoxamine maleate, 28 System, 46 gengraf, 6 fluvoxamine maleate ER, 28 Freestyle Lite Test Strips, 46 Genotropin, 20 Fluzone High-dose PF 2016-2017, 40 Freestyle Precision Insulin Syringe/U-

Genotropin Miniquick, 20

gentak, 32 100/0.5ML/30G X 5/16", 46 Gnp Daily Prenatal, 41

Gentak, 32 Global Inject Ease Insulin Syringe/U- gnp folic acid, 24 gentamicin sulfate, 2, 12, 32 Gnp Insulin Syringe/0.3ML/29G X 1/2", 100/0.5ML/31G X 5/16", 46 Gentamicin Sulfate, 12 Global Inject Ease Insulin Syringe/U- 46 gentamicin sulfate pediatric, 2 Gnp Insulin Syringe/0.3ML/30G X 5/16", 100/1ML/28G X 1/2", 46 gentamicin sulfate/0.9% sodium chloride, Global Inject Ease Insulin Syringe/U- 46 Gnp Insulin Syringe/0.3ML/31G X 5/16", 2 100/1ML/29G X 1/2", 46 Gentamicin Sulfate/0.9% Sodium Global Inject Ease Insulin Syringe/U- 46 Gnp Insulin Syringe/0.5ML/28G X 1/2", Chloride, 2 100/1ML/30G X 1/2", 46 gentle laxative, 21 Global Inject Ease Insulin Syringe/U- 46 gentle laxative for women, 21 Gnp Insulin Syringe/0.5ML/29G X 1/2", 100/1ML/30G X 5/16", 46 gentle laxative overnightrelief, 21 Global Inject Ease Insulin Syringe/U- 46 gentlelax, 21 Gnp Insulin Syringe/0.5ML/30G X 5/16", 100/1ML/31G X 5/16", 46 Genvisc 850, 32 Global Insulin Syringe/U-100/0.3ML/30G 46 Genvoya, 3 Gnp Insulin Syringe/0.5ML/31G X 5/16", X 1/2", 46 Geodon, 29 Global Insulin Syringes/U- 46 gianvi, 16 Gnp Insulin Syringe/1ML/28G X 1/2", 46 100/0.3ML/30GX5/16", 46 Giazo, 23 Glucagen Hypokit, 18 Gnp Insulin Syringe/1ML/29G X 1/2", 46 gildagia, 16 Glucagon Emergency Kit, 18 Gnp Insulin Syringe/1ML/30G X 5/16", 46 gildess 1.5/30, 16 Glucophage, 18 Gnp Insulin Syringe/1ML/31G X 5/16", 46 gildess 1/20, 16 Glucophage XR, 18 gnp laxative, 21 gildess 24 FE, 16 Glucopro Insulin Syringe/U- gnp magnesium citrate, 21 gildess FE 1.5/30, 16 gnp nicotine gum, 30 100/0.3ML/30G X 1/2", 46 gildess FE 1/20, 16 Glucopro Insulin Syringe/U- gnp nicotine mini lozenge, 30

Gilenya, 31 gnp nicotine polacrilex, 30 100/0.3ML/30G X 5/16", 46 Gilotrif, 6 Glucopro Insulin Syringe/U- gnp nicotine polacrilex mini, 30

Gilphex TR, 38 gnp nicotine transdermal system, 30 100/0.3ML/31G X 5/16", 46 Giltuss, 38 Glucopro Insulin Syringe/U- Gnp Prenatal, 41 giltuss pediatric, 38 Gnp Ultra Comfort Insulin 100/0.5ML/30G X 1/2", 46 Giltuss TR, 38 Glucopro Insulin Syringe/U- Syringe/0.3ML/29G X 1/2", 46 Glassia, 39 Gnp Ultra Comfort Insulin 100/0.5ML/30G X 5/16", 46 glatiramer acetate, 31 Glucopro Insulin Syringe/U- Syringe/0.3ML/30G X 5/16" SHORT, 46 glatopa, 31 Gnp Ultra Comfort Insulin 100/0.5ML/31G X 5/16", 46 Gleevec, 7 Glucopro Insulin Syringe/U-100/1ML/30G Syringe/0.3ML/31G X 5/16" SHORT, 46 Gleostine, 5 Gnp Ultra Comfort Insulin X 1/2", 46 Gliadel Wafer, 5 Glucopro Insulin Syringe/U-100/1ML/30G Syringe/0.5ML/28G X 1/2", 46 glimepiride, 18 Gnp Ultra Comfort Insulin X 5/16", 46 glipizide, 18 Glucopro Insulin Syringe/U-100/1ML/31G Syringe/0.5ML/29G X 1/2", 46 glipizide ER, 18 Gnp Ultra Comfort Insulin X 5/16", 46 glipizide XL, 18 Glucotrol, 18 Syringe/0.5ML/30G X 5/16" SHORT, 46 glipizide/metformin HCL, 19 Glucotrol XL, 18 Gnp Ultra Comfort Insulin

Global Ease Inject Pen Needles Glucovance, 19 Syringe/0.5ML/31G X 5/16" SHORT, 46 glyburide, 18 Gnp Ultra Comfort Insulin 29GX12MM, 46 Global Ease Inject Pen Needles glyburide micronized, 18 Syringe/1ML/28G X 1/2", 46 glyburide/metformin HCL, 19 Gnp Ultra Comfort Insulin 31GX8MM, 46 Global Ease Inject Pen Needles glycine, 24 Syringe/1ML/29G X 1/2", 46 glycolax, 21 Gnp Ultra Comfort Insulin 32GX4MM, 46 Global Ease Inject Pen Neeedles Glycolic Acid, 13 Syringe/1ML/30G X 5/16" SHORT, 46 Glycolic Acid 70% High Purity, 13 Gnp Ultra Comfort Insulin 31GX5MM, 46 Global Easy Glide Insulinsyringe/U- glycopyrrolate, 22 Syringe/1ML/31G X 5/16" SHORT, 46 Glycopyrrolate, 22 gnp vitamin d, 40 100/0.3ML/31G X 5/16", 46 Global Easy Glide Pen Needles glydo, 13 gnp vitamin d maximum strength, 40

Glynase, 18 gnp vitamin d super strength, 40 32GX4MM, 46 Global Inject Ease Insulin Syringe/U- Glyset, 19 gnp vitamin d3 extra strength, 40

Glyxambi, 19 gnp womens laxative, 21 100/0.3ML/29G X 1/2", 46 Global Inject Ease Insulin Syringe/U- gnp adult aspirin low strength, 34 Golytely, 21

gnp aspirin, 34 Gonal-f, 19 100/0.3ML/30G X 1/2", 46 Global Inject Ease Insulin Syringe/U- gnp aspirin low dose, 34 Gonal-f RFF, 19

gnp bisa-LAX, 21 Gonal-f RFF Rediject, 19 100/0.3ML/30G X 5/16", 46 Global Inject Ease Insulin Syringe/U- gnp clearlax, 21 goodsense aspirin, 34

Gnp Clickfine Pen Needle goodsense aspirin adult low strength, 34 100/0.3ML/31G X 5/16", 46 Global Inject Ease Insulin Syringe/U- goodsense aspirin low dose, 34 Universal/31GX5/16", 46 Gnp Clickfine Universal Pen Needles goodsense magnesium citrate, 21 100/0.5ML/28G X 1/2", 46 Global Inject Ease Insulin Syringe/U- goodsense nicotine, 30 31GX1/4", 46 Gnp Clickfine Universal Pen Needles goodsense nicotine gum, 30 100/0.5ML/29G X 1/2", 46 Global Inject Ease Insulin Syringe/U- Goodsense Prenatal Vitamins, 41 31GX5/16", 46 gnp d 1000, 40 Gordofilm, 14 100/0.5ML/30G X 1/2", 46 Global Inject Ease Insulin Syringe/U- gnp d 2000, 40 Gralise, 31

Gralise Starter, 31 hematogen, 25 Humalog, 18 granisetron HCL, 22 Hematogen Fa, 25 Humalog Junior Kwikpen, 18

Granisetron HCL, 22 hematogen forte, 25 Humalog Kwikpen, 18

Granix, 25 Hematron-AF, 25 Humalog Mix 50/50, 18

Grifulvin V, 2 Hemenatal OB, 42 Humalog Mix 50/50 Kwikpen, 18

Gris-peg, 2 Hemenatal OB + DHA, 42 Humalog Mix 75/25, 18 griseofulvin microsize, 2 Hemetab, 25 Humalog Mix 75/25 Kwikpen, 18 griseofulvin ultramicrosize, 2 Hemocyte Plus, 25 human albumin grifols, 26 guanfacine ER, 29 hemocyte-f, 25 Humate-p, 26 guanfacine HCL, 9 Hemocyte-f, 25 Humatrope, 20

Guanidine HCL, 32 hemocyte-plus, 25 Humatrope Combo Pack, 20

Gynazole-1, 24 Hemofil M, 26 Humira, 37

Hepagam B, 51 Humira Pediatric Crohns Disease Starter H heparin lock flush, 25 Pack, 37 h-e-b aspirin, 34 Heparin Lock Flush, 25 Humira Pen, 37 H-e-b IN Control Pen Needles heparin lock flush for flushing vascular Humira Pen-crohns Diseasestarter, 37

31GX5MM, 46 Humira Pen-psoriasis Starter, 37 access devices, 25 H-e-b IN Control Pen Needles heparin lock flush/NACL for flushing Humulin 70/30, 18

31GX6MM, 46 Humulin 70/30 Kwikpen, 18 vascular access devices, 25 H-e-b IN Control Pen Needles heparin sodium, 25 Humulin N, 18

31GX8MM, 46 Heparin Sodium, 25 Humulin N Kwikpen, 18 H-e-b IN Control Pen heparin sodium dcu, 25 Humulin R, 18

Needles/Nano/32GX4MM, 46 heparin sodium lock flush, 25 Humulin R U-500 (concentrated), 18

H-e-b IN Control Unifine Pentips Plus heparin sodium/D5W, 25 Humulin R U-500 Kwikpen, 18

31GX5MM, 46 Heparin Sodium/D5W, 25 Hyalgan, 32 H-e-b IN Control Unifine Pentips Plus Heparin Sodium/NACL 0.45%, 26 Hycamtin, 7

32GX4MM, 46 heparin sodium/NACL 0.9%, 25 Hycet, 36 H-e-b Incontrol Pen Needles 29GX12MM, Heparin Sodium/Sodium CH Loride, 25 hydralazine HCL, 9

46 Heparin Sodium/Sodium Chloride, 25 Hydrea, 7

H.p. Acthar, 20 Heparin Sodium/Sodium Chloride 0.9%, Hydro 35, 14 Haegarda, 26 hydrochlorothiazide, 10 26 Halaven, 6 heparin sodium/sodium chloride 0.9% hydrocodone bitartrate/acetaminophen, Halcion, 29

premix, 25 35 Haldol, 29 Heparin Sodium/Sodium Chloride PF, 26 hydrocodone bitartrate/chlorpheniramine Haldol Decanoate 100, 29 Hepsera, 3 maleate/PSE, 38 Haldol Decanoate 50, 29 Herceptin, 5 hydrocodone bitartrate/homatropine halobetasol propionate, 13 Hespan, 27 methylbromide, 38 Halog, 13 hetastarch 6%/NACL, 26 hydrocodone polistirex/chlorpheniramine haloperidol, 28 Hetlioz, 29 polistirex, 38 haloperidol decanoate, 29 Hexalen, 5 hydrocodone/acetaminophen, 35 haloperidol lactate, 29 Hextend, 27 hydrocodone/homatropine, 38

Halotin, 12 Hiberix, 40 hydrocodone/ibuprofen, 35 Harvoni, 3 Hiprex, 23 hydrocort ene 100MG, 22 Havrix, 40 Histex-ac, 38 hydrocortisone, 13, 15, 22

Healthwise Mini Pen Needles 31GX6MM, Hizentra, 51 hydrocortisone 1% IN absobase, 13

46 HM aspirin, 35 hydrocortisone acetate/pramoxine, 22 Healthwise Pen Needles 29GX12MM, 46 HM aspirin EC, 35 hydrocortisone butyrate, 13

Healthwise SHORT Pen Needles HM aspirin EC low dose, 35 hydrocortisone butyrate (lipid), 13

31GX8MM, 46 HM clearlax, 21 hydrocortisone butyrate (lipophilic), 13 Healthwise Unifine Pentips Pen Needles HM folic acid, 24 hydrocortisone IN absorbase, 13

32GX4MM, 46 HM laxative, 21 hydrocortisone valerate, 13 Healthy Accents Unifine Pentips Pen HM magnesium citrate, 21 hydrocortisone/acetic acid, 34

Needles 29GX12MM, 46 HM nicotine polacrilex, 31 Hydrofera Blue 4"X4", 14

Healthy Accents Unifine Pentips Pen HM nicotine transdermal system, 31 Hydrofera Blue Foam Dressing, 14

Needles 31GX5MM, 46 HM nicotine transdermal system step 1, Hydrofera Blue Foam Dressing 2"X2", 14 Healthy Accents Unifine Pentips Pen Hydrofera Blue Foam Dressing 4"X4", 14 31 Needles 31GX6MM, 46 HM nicotine transdermal system step 2, Hydrofera Blue Foam Dressing 6"X6", 14 Healthy Accents Unifine Pentips Pen Hydrofera Blue Foam Dressing/Moisture 31 Needles 31GX8MM, 46 HM nicotine transdermal system step 3, Retentive Film, 14 Healthy Accents Unifine Pentips Pen Hydrofera Blue Foam Dressing/Moisture 31 Needles 32GX4MM, 46 HM One Daily Prenatal Combo, 41 Retentive Film/2-1/4X8, 14 healthy kids vitamin d3, 40 HM Prenatal, 41 Hydrofera Blue Foam Dressing/Moisture

Healthy Mama Be Well Rounded, 41 HM vitamin d, 41 Retentive Film/4"X4", 14 heather, 16 HM vitamin d3, 41 Hydrofera Blue Foam Dressing/Moisture Hectorol, 20 HM Vitamin D3, 41 Retentive Film/Island, 14 Helixate FS, 26 homatropaire, 33 Hydrofera Blue Foam Dressing/Moisture Hemabate, 34 homatropine HBR, 33 Retentive/Ostomy/2.5", 14 hematinic plus vitamins/minerals, 24 Horizant, 31 Hydrofera Blue Foam hematinic/folic acid, 24

Dressing/Tunneling/9MM, 14 IC 400, 37 Insulin Syringe/0.5ML/31G X 5/16", 46

Hydrofera Blue Heavy Drainage 4"X4", IC 800, 37 Insulin Syringe/1ML/28G X 1/2", 46

Icar-c Plus, 25 Insulin Syringe/1ML/29G X 1/2", 46 14 Hydrofera Blue Heavy Drainage 6"X6", Iclusig, 6 Insulin Syringe/1ML/30G X 5/16", 46

Idamycin PFS, 5 Insulin Syringe/1ML/31G X 5/16", 46 14 Hydrofera Blue Ready Foamdressing idarubicin HCL, 5 Insulin Syringe/U-100/0.3ML/29G X 1/2",

Idelvion, 26 2.5"X2.5", 14 46 Hydrofera Blue Ready Foamdressing Idhifa, 6 Insulin Syringe/U-100/0.5ML/28G X 1/2",

iferex 150 forte, 25 4"X5", 14 46 Hydrofera Blue Ready Foamdressing Ifex, 5 Insulin Syringe/U-100/0.5ML/29G X 1/2",

ifosfamide, 5 8"X8", 14 46 hydromet, 38 Ifosfamide, 5 Insulin Syringe/U-100/1ML/28G X 1/2", hydromorphone HCL, 35 Ilaris, 37 46 Hydromorphone HCL, 35 Ilevro, 34 Insulin Syringe/U-100/1ML/29G X 1/2", hydromorphone HCL dosette, 36 ilotycin, 32 46 hydromorphone HCL ER, 35 Iluvien, 33 Insulin Syringe/U-100/1ML/30G X 5/16",

Hydromorphone HCL/Sodium Chloride, imatinib mesylate, 6 46 Imbruvica, 6 Insulin Syringe/U-100/1ML/31G X 5/16", 36 Hydromorphone Hydrochlor Ide/Sodium imipenem/cilastatin, 4 46 imipramine HCL, 28 Insulin Syringes/0.5ML/27GX1/2", 46 Chloride, 36 hydromorphone hydrochloride, 35 imipramine pamoate, 28 Insulin Syringes/0.5ML/28GX1/2", 46 hydromorphone hydrochloride ER, 35 imiquimod, 13 Insulin Syringes/0.5ML/29GX1/2", 46

Hydromorphone Hydrochloride/ Sodium Imitrex, 37 Insulin Syringes/0.5ML/30GX5/16", 46

Imitrex Statdose Refill, 37 Insulin Syringes/0.5ML/31GX 5/16", 46 Chloride, 36 Hydromorphone Imitrex Statdose System, 37 Insulin Syringes/0.5ML/31GX5/16", 46

Imogam Rabies-ht, 51 Insulin Syringes/1ML/27GX/1/2", 46 Hydrochloride/Bupivacaine Imovax Rabies (h.d.c.v.), 40 Insulin Syringes/1ML/27GX1/2", 47 Hydrochloride, 36

Impavido, 4 Insulin Syringes/1ML/28GX1/2", 47 Hydromorphone Imuran, 6 Insulin Syringes/1ML/29GX1/2", 47 Hydrochloride/Bupivacaine Inatal Advance, 42 Insulin Syringes/1ML/30GX1/2", 47 Hydrochloride/Sodium, 36 Inatal GT, 42 Insulin Syringes/1ML/31GX5/16", 47 Hydromorphone Hydrochloride/Sodium Inatal Ultra, 42 Insupen 29G X 12MM, 47

Chloride, 36 Increlex, 20 Insupen 31G X 5MM, 47 Hydroxocobalamin, 25 Incruse Ellipta, 39 Insupen 31G X 8MM, 47 hydroxychloroquine sulfate, 4

indapamide, 10 Insupen 32G X 4MM, 47 Hydroxyprogesterone Caproate, 6 Inderal LA, 8 Insupen 33GX4MM, 47 hydroxyurea, 7 Inderal XL, 8 Insupen Pen Needles 32G X4MM, 47 hydroxyzine HCL, 27

indiomin mb, 23 Insupen Sensitive 32GX6MM, 47 Hydroxyzine HCL, 27 Indocin, 37 Insupen Sensitive 32GX8MM, 47 hydroxyzine pamoate, 27 indomethacin, 36 Insupen Ultrafin 29GX12MM, 47 Hydroxyzine Pamoate, 27

indomethacin ER, 36 Insupen Ultrafin 30GX8MM, 47 Hylatopic Plus, 14 Infanate Balance, 42 Insupen Ultrafin 31GX6MM, 47 Hylira, 14 Infanrix, 39 Insupen Ultrafin 31GX8MM, 47 Hymovis, 32

Infasurf, 39 Integra F, 25 hyolev mb, 23 Infed, 25 Integra Plus, 25 hyophen, 23 Inflectra, 23 Integrilin, 27 hyoscyamine sulfate, 22

Infumorph 200, 36 Intelence, 3 hyoscyamine sulfate ER, 22 Infumorph 500, 36 Intrarosa, 24 hyoscyamine sulfate odt, 22 Infuvite, 43 Intron A, 7 hyoscyamine sulfate SR, 22

Infuvite Adult, 43 Intron A W/Diluent, 7 Hyper-sal, 38 Infuvite Pediatric, 43 introvale, 16 Hyperhep B S/D, 51 Ingrezza, 31 Intuniv, 29 Hyperrab S/D, 51

Injectafer, 25 Invanz, 4 Hyperrho S/D, 51 Inlyta, 6 Invega, 28 Hyperrho S/D Mini-dose, 51 Innopran XL, 8 Invega Sustenna, 28 Hypersal, 38

Inova, 12 Invega Trinza, 29 Hypertet S/D, 51 Inova 4/1 Acne Control Therapy, 12 Invirase, 3 Hyqvia, 51 Inova 8/2 Acne Control Therapy, 12 Invokamet, 19 Hysingla ER, 36

Inspra, 9 Invokamet XR, 19 Hyzaar, 10 Insulin Syringe/0.3ML/29G X 1", 46 Invokana, 18 I

Insulin Syringe/0.3ML/29G X 1/2", 46 Iopidine, 33 ibandronate sodium, 19 Insulin Syringe/0.3ML/30G X 5/16", 46 Ipol Inactivated IPV, 40

Ibrance, 6 Insulin Syringe/0.3ML/31G X 5/16", 46 ipratropium bromide, 38, 39 ibudone, 35 Insulin Syringe/0.5ML/27G X 1/2", 46 ipratropium bromide/albuterol sulfate, 39 Ibudone, 36 Insulin Syringe/0.5ML/28G X 1/2", 46 Iprivask, 26 ibuprofen, 36 Insulin Syringe/0.5ML/29G X 1/2", 46 irbesartan, 9 ibuprofen lysine, 37 Insulin Syringe/0.5ML/30G X 1/2", 46 irbesartan/hydrochlorothiazide, 9 ibutilide fumarate, 9 Insulin Syringe/0.5ML/30G X 5/16", 46 Iressa, 6

irinotecan, 7 Kadian, 36 Kinray Insulin Syringe Preferred

Irinotecan, 7 kaitlib FE, 17 Plus/1ML/31G X 5/16", 47 irinotecan HCL, 7 Kalbitor, 26 Kinray Insulin Syringe/0.5ML/29G X 1/2", irinotecan hydrochloride, 7 Kaletra, 3 47 Irospan 24/6, 25 Kalydeco, 39 Kinrix, 39

Is 24/6, 25 Kanuma, 20 kionex, 50

Isentress, 3 Kapvay, 29 Kisqali, 7

Isentress HD, 3 Karbinal ER, 38 Kitabis PAK, 2 isibloom, 16 karidium, 50 Klonopin, 30 isoniazid, 2 karigel, 27 klor-CON, 50

Isoniazid, 2 karigel-n, 27 klor-CON 10, 50 isoproterenol hydrochloride, 39 kariva, 17 klor-CON 8, 50

Isopto Carpine, 33 Kayexalate, 51 klor-CON m10, 50

Isordil Titradose, 8 Kazano, 19 Klor-CON M15, 51 isosorbide dinitrate, 8 Kcentra, 27 klor-CON m20, 50

Isosorbide Dinitrate ER, 8 kedbumin, 26 klor-CON sprinkle, 50 isosorbide mononitrate, 8 Keflex, 1 Klor-CON/25, 51 isosorbide mononitrate ER, 8 kelnor 1/35, 17 klor-CON/EF, 51

Isotonic Gentamicin, 2 Kenalog-10, 15 kls aspirin EC, 35 isradipine, 8 Kenalog-40, 15 kls aspirin low dose, 35

Istalol, 33 Kendall Hydrogel Impregnated Gauze kls laxaclear, 21

Istodax, 7 kls quit2, 30 2"X2", 14 Istodax (overfill), 7 Kendall Hydrogel Impregnated Gauze kls quit4, 30

Isuprel, 39 Kmart Valu Plus Insulin 4"X4", 14 itraconazole, 2 Kendall Hydrogel Impregnated Gauze Syringe/0.3ML/30G, 47 ivermectin, 4 Kmart Valu Plus Insulin 4"X8", 14 Ixempra Kit, 6 Kendall Hydrogel Wound Dressing 3" Syringe/0.5ML/29G, 47 Ixiaro, 40 Kmart Valu Plus Insulin Disk, 14 Ixinity, 26 Kendall Hydrogel Wound Dressing 4-3/4" Syringe/0.5ML/30G, 47 Kmart Valu Plus Insulin J Disk, 14 Kendall Zinc Calcium Alginate Dressing Syringe/1ML/29G, 47 Jadenu, 51 Kmart Valu Plus Insulin 2"X2", 14 Jadenu Sprinkle, 51 Kendall Zinc Calcium Alginate Dressing Syringe/1ML/30G, 47 Jakafi, 7 Koate, 26 4"X4", 14 Jalyn, 24 Kendall Zinc Calcium Alginate Dressing Koate-dvi, 26 jantoven, 25 Kogenate FS, 26 4"X8", 14 Janumet, 19 Kendall Zinc Calcium Alginate Dressing Kogenate FS Bio-set, 26 Janumet XR, 19 Kombiglyze XR, 19 Rope 12", 14 Januvia, 19 Kengreal, 27 Korlym, 18 Jardiance, 18 Kepivance, 7 Kovaltry, 26 jencycla, 17 Keppra, 30 kp aspirin, 35

Jentadueto, 19 Keppra XR, 30 kp bisacodyl, 21 Jentadueto XR, 19 Keralyt, 14 kp folic acid, 24 Jetrea, 34 Keralyt Scalp, 14 Kp Prenatal Multivitamins, 41 jevantique LO, 16 Keramatrix Replicine 10CMX10CM, 14 kp vitamin d, 40 Jevtana, 6 Keramatrix Replicine 5CMX5CM, 14 kp vitamin d3, 40 jinteli, 16 Kerydin, 12 Kristalose, 21 jolessa, 17 Ketalar, 38 Kroger Insulin Syringe/0.3ML/29G X 1/2", jolivette, 17 ketamine HCL, 38 47 Jublia, 12 Ketamine Hydrochloride/Sodium Kroger Insulin Syringe/0.3ML/30G X juleber, 17

Chloride, 38 5/16", 47 Juluca, 3 Ketek, 4 Kroger Insulin Syringe/0.3ML/31G X junel 1.5/30, 17 ketoconazole, 2, 12 5/16", 47 junel 1/20, 17 ketodan, 12 Kroger Insulin Syringe/0.5ML/29G X 1/2", junel FE 1.5/30, 17 ketoprofen, 36 47 junel FE 1/20, 17 Ketoprofen ER, 36 Kroger Insulin Syringe/0.5ML/30G X junel FE 24, 17 ketorolac tromethamine, 34, 36 5/16", 47 just d, 40 Ketorolac Tromethamine, 36 Kroger Insulin Syringe/0.5ML/31G X Juxtapid, 11 Keveyis, 10 5/16", 47 K Kevzara, 37 Kroger Insulin Syringe/1ML/29G X 1/2",

Keytruda, 5 k-effervescent, 50 47

Khedezla, 28 Kroger Insulin Syringe/1ML/30G X 5/16", K-phos NO 2, 24

kimidess, 17 k-prime, 50 47

Kineret, 37 Kroger Insulin Syringe/1ML/31G X 5/16", k-sol, 50

Kinray Insulin Syringe Preferred K-TAB, 51 47

Kroger Pen Needles 29G X 12MM, 47 k-tan plus, 25 Plus/0.3ML/31G X 5/16", 47

Kinray Insulin Syringe Preferred Kroger Pen Needles 31G X 8MM, 47 k-vescent, 50

Kroger Pen Needles 31GX1/4", 47 Kadcyla, 5 Plus/0.5ML/31G X 5/16", 47

Krystexxa, 37 Leader Insulin Syringe/0.5ML/28G X 1/2", Levoleucovorin, 7 kurvelo, 17 levoleucovorin calcium, 7 47 Kuvan, 20 Leader Insulin Syringe/0.5ML/29G X 1/2", Levomefolate DHA, 42

Kyleena, 17 levonest, 17 47 Kymriah, 7 Leader Insulin Syringe/0.5ML/30G X levonorgestrel, 17

Kynamro, 11 levonorgestrel and ethinyl estradiol, 17 5/16", 47 Kyprolis, 7 Leader Insulin Syringe/0.5ML/31G X Levonorgestrel And Ethinyl Estradiol, 17

levonorgestrel/ethinyl estradiol, 17 L 5/16", 47 Leader Insulin Syringe/1ML/28G X 1/2", Levophed, 10 labetalol HCL, 8 levora 0.15/30-28, 17 47 labetalol hydrochloride, 8 Leader Insulin Syringe/1ML/29G X 1/2", Levorphanol Tartrate, 36

Lac-hydrin, 14 levothyroxine sodium, 20 47 Lacrisert, 32 Leader Insulin Syringe/1ML/30G X 5/16", Levothyroxine Sodium, 21 lactic acid, 13 levothyroxine/liothyronine, 20 47 lactic acid e, 13 Leader Insulin Syringe/1ML/31G X 5/16", levoxyl, 20 lactic acid w/vitamin e, 13 Levsin, 22 47 lactulose, 21, 22 Leader Unifine Pentips Levsin/SL, 22

Lamictal, 30 Levulan Kerastick, 13 Plus/Mini/31GX3/16", 47 Lamictal Chewable Dispersible, 30 Leader Unifine Pentips Lexapro, 28 Lamictal Odt, 30 Lexiva, 3 Plus/SHORT/31GX5/16", 47 Lamictal Starter/Not Taking Leader Unifine Pentips/Mini/31GX3/16", Lexuss 210, 38

Carbamazepine, 30 Lialda, 23 47 Lamictal Starter/Taking Leader Unifine Pentips/Nano/32GX5/32", Librax, 22

Carbamazepine/Not Taking Valproate, lidenza patch, 13 47 30 Leader Unifine Pentips/Plus/32GX5/32", lido bdk, 13 Lamictal Starter/Taking Valproate, 30 Lido-k, 14 47 Lamictal XR, 30 leena, 17 lido-prilo caine pack, 13 Lamisil, 3 leflunomide, 36 lidocaine, 13 lamivudine, 3 Lemtrada, 31 Lidocaine And Tetracaine Cream, 14 lamivudine/zidovudine, 3 Lenvima 10 MG Daily Dose, 7 lidocaine HCL, 9, 13, 37 lamotrigine, 29 Lenvima 14 MG Daily Dose, 7 Lidocaine HCL, 9, 14 lamotrigine ER, 29 Lenvima 18 MG Daily Dose, 7 lidocaine HCL IN D5W, 9 lamotrigine odt, 29 Lenvima 20 MG Daily Dose, 7 lidocaine HCL jelly, 13 lamotrigine starter kit/blue, 29 Lenvima 24 MG Daily Dose, 7 lidocaine HCL viscous, 27 lamotrigine starter kit/green, 29 Lenvima 8 MG Daily Dose, 7 Lidocaine HCL-hydrocortisone Acetate lamotrigine starter kit/orange, 29 Lescol XL, 11 With Aloe, 23 lamotrigine titration, 29 lessina, 17 lidocaine HCL/dextrose, 9 Lanoxin, 7 Letairis, 11 Lidocaine HCL/Dextrose, 38

Lanoxin Pediatric, 8 letrozole, 6 lidocaine HCL/hydrocortisone acetate, 22 lansoprazole, 22 Lets Kit, 37 Lidocaine Hydrochloride, 38 lansoprazole/amoxicillin/clarithromycin, leucovorin calcium, 7 lidocaine PAK, 13

22 Leucovorin Calcium, 7 lidocaine viscous, 27 lanthanum carbonate, 22 Leukeran, 5 lidocaine-prilocaine-cream base, 13 Lantus, 18 Leukine, 25 lidocaine/epinephrine, 37

Lantus Solostar, 18 leuprolide acetate, 6 lidocaine/prilocaine, 13 larin 1.5/30, 17 leva set, 13 Lidocidex I, 15 larin 1/20, 17 leva set/occlusive dressing, 13 Lidocilone I, 15 larin 24 FE, 17 Levacet, 35 Lidoderm, 14 larin FE 1.5/30, 17 levalbuterol, 39 lidopin, 13 larin FE 1/20, 17 levalbuterol HCL, 39 lidopril, 13 larissia, 17 Levalbuterol Tartrate HFA, 39 lidopril XR, 13 Lartruvo, 5 Levaquin, 2 Lidoprofen, 12 Lasix, 10 Levatio Patch, 14 Liletta, 17

Lastacaft, 34 Levbid, 22 lillow, 17 latanoprost, 33 Levemir, 18 Lincocin, 4 latrix, 13 Levemir Flextouch, 18 lincomycin HCL, 4

Latrix XM, 14 levetiracetam, 29 lindane, 13 Latuda, 28 Levetiracetam, 30 Lindane, 14 laxative, 21 levetiracetam ER, 29 linezolid, 4 laxative feminine, 21 levo-t, 20 Linezolid, 4 laxative polyethlyene glycol 3350, 21 levobunolol HCL, 33 Linzess, 23 layolis FE, 17 levocarnitine, 20 Lioresal Intrathecal, 32

Lazanda, 36 levocetirizine dihydrochloride, 38 liothyronine sodium, 20

Leader Insulin Syringe/0.3ML/29G X 1/2", levofloxacin, 2, 32 Lipitor, 11

47 Levofloxacin, 2 lipodox, 5

Leader Insulin Syringe/0.3ML/30G X levofloxacin IN 5% dextrose, 2 lipodox 50, 5

5/16", 47 levofloxacin IN D5W, 2 Lipofen, 11

Leader Insulin Syringe/0.3ML/31G X levoleucovorin, 7 liprozonepak, 13

5/16", 47 lisinopril, 9 lorazepam intensol, 27 5ML/30G X 5/16", 47 lisinopril/hydrochlorothiazide, 9 Lorazepam/Dextrose, 27 Magellan Insulin Safety Syringe/U-

Lite Touch Pen Needles/31G X 3/16", 47 Lorazepam/Sodium Chloride, 28 100/1ML/29G X 1/2", 47 Litetouch Insulin Syringe/0.3ML/29G X lorcet, 35 Magellan Insulin Safety Syringe/U-

lorcet HD, 35 1/2", 47 100/1ML/30G X 5/16", 47 Litetouch Insulin Syringe/0.3ML/30G X lorcet plus, 35 magnesium citrate, 21

lorenza, 13 Makena, 18 5/16", 47 Litetouch Insulin Syringe/0.3ML/31G X lortab, 35 Malarone, 4

Lortab, 36 malathion, 13 5/16", 47 Litetouch Insulin Syringe/0.5ML/30G X loryna, 17 mannitol, 10

Lorzone, 32 Maprotiline HCL, 28 5/16", 47 Litetouch Insulin Syringe/0.5ML/31G X losartan potassium, 9 Marathon Medical Pentips 29GX12MM,

losartan potassium/hydrochlorothiazide, 5/16", 47 47 Litetouch Insulin Syringe/1ML/30G X Marathon Medical Pentips 31GX5MM, 47 9 Loseasonique, 17 Marathon Medical Pentips 31GX8MM, 47 5/16", 47 Litetouch Insulin Syringe/U- Lotemax, 33 Marathon Medical Pentips 32GX4MM, 47

Lotensin, 9 Marcaine, 38 100/0.5ML/28G X 1/2", 47 Litetouch Insulin Syringe/U- Lotensin HCT, 10 Marcaine Spinal, 38

Lotrel, 10 Marcaine/Epinephrine, 38 100/0.5ML/29G X 1/2", 47 Litetouch Insulin Syringe/U-100/1ML/28G Lotrisone, 12 margesic, 35

Lotronex, 23 Marinol, 22 X 1/2", 47 Litetouch Insulin Syringe/U-100/1ML/29G lovastatin, 10 marlissa, 17

Lovaza, 11 Marnatal-f, 42 X 1/2", 47 Litetouch Insulin Syringe/U-100/1ML/31G Lovenox, 26 Marplan, 28

low-ogestrel, 17 Marqibo, 6 X 5/16", 47 Litetouch Pen Needles 29GX12.7MM, 47 loxapine, 28 marten-TAB, 35

Litetouch Pen Needles 31G X 6MM, 47 loxapine succinate, 28 Matulane, 7

Litetouch Pen Needles 31GX8MM Loyon, 14 matzim LA, 8

Lozi-flur, 51 Mavik, 9 SHORT, 47 Lithium, 28 LP lite PAK, 14 Mavyret, 3 lithium carbonate, 28 ludent, 50 Maxalt, 37

Lithium Carbonate, 28 Lumigan, 33 Maxalt-MLT, 37 lithium carbonate ER, 28 Lumizyme, 20 Maxfe, 25

Lithobid, 28 Lunesta, 29 Maxi-comfort Insulin Syringe/U-

Lithostat, 24 Lupaneta Pack, 19 100/0.5ML/28GX1/2", 47 Livalo, 11 Lupron Depot (1-month), 6 Maxi-comfort Insulin Syringe/U-

Live Better Pen Needles 29G X 12MM, Lupron Depot (3-month), 6 100/1ML/28GX1/2", 47 Lupron Depot (4-month), 6 Maxidex, 33 47 Live Better Pen Needles 31G X 12MM, Lupron Depot (6-month), 6 maximum d3, 40

Lupron Depot-PED (1-month), 19 Maxipime, 1 47 Live Better Pen Needles 31G X 6MM, 47 Lupron Depot-PED (3-month), 19 Maxitrol, 33 livixil PAK, 13 Luride, 51 Maxzide, 10

LMD 10% Dextrose 5%, 27 lutera, 17 Maxzide-25, 10

LMD 10% Sodium Chloride 0.9%, 27 Luzu, 12 me/naphos/mb/hyo 1, 23

LO Loestrin FE, 17 Lycelle, 14 Mebendazole, 4

Lodine, 37 Lynparza, 7 meclizine HCL, 22

Lodosyn, 30 Lyrica, 30 Meclofenamate Sodium, 36

Loestrin 1.5/30-21, 17 lysiplex plus, 41 Medi-derm/L-RX, 14

Loestrin 1/20-21, 17 Lysodren, 6 Medi-patch RX, 14

Loestrin FE 1.5/30, 17 Lysteda, 26 Medic Insulin Syringe/0.3ML/30G X 5/16",

Loestrin FE 1/20, 17 lyza, 17 47 Lofibra, 11 Medic Insulin Syringe/0.5ML/30G X 5/16", M lokara, 13 47 M-m-r II, 40 lomedia 24 FE, 17 Medical Provider Single Use EZ Flu Shot, M-vit, 42 Lomotil, 21 40 M.v.i. Adult, 43 Lomustine, 5 Medical Provider Single Use EZ Flu Shot

M.v.i. Pediatric, 43 Longs Insulin Syringe/0.5ML/31G X 5/16", 2016-2017, 40 M.v.i.-12 Without Vitamin K, 43 Medicine Shoppe Pen Needles 29G X 47 Maci, 32 Lonsurf, 7 12MM, 47 Macnatal CN DHA, 42 loperamide HCL, 21 Medicine Shoppe Pen Needles 31G X Macrobid, 23 Lopid, 11 6MM, 47 Macrodantin, 23 lopinavir/ritonavir, 3 Medicine Shoppe Pen Needles 31G X

Magellan Insulin Safety Syringe/U- lopreeza, 16 8MM, 47 Lopressor, 8 100/0.3ML/29G X 1/2", 47 Medihoney Calcium Alginate Dressing Magellan Insulin Safety Syringe/U- Lopressor HCT, 10 4"X5", 14 Loprox, 12 100/0.3ML/30G X 5/16", 47 Medihoney Calcium Alginate Magellan Insulin Safety Syringe/U- Loprox Shampoo, 12 Dressing/2"X2", 14 lorazepam, 27 100/0.5ML/29G X 1/2", 47 Medihoney Wound & Burn Dressing 3/4"

Magellan Insulin Safety Syringe/U-100/0.

X12", 14 methadose, 35 Microzide, 10

Medihoney Wound/Burn Dressing 4"X5", Methadose, 36 midazolam HCL, 29

Methadose Sugar-free, 36 Midazolam Hydrochloride/Sodium 14 medolor PAK, 13 methamphetamine HCL, 29 Chloride, 29 Medrol, 15 methazolamide, 10 midodrine HCL, 10

Medrol Dosepak, 15 methenamine hippurate, 23 Mifeprex, 20 medroxyprogesterone acetate, 17, 18 methenamine mandelate, 23 Migergot, 37 mefenamic acid, 36 Methenamine Mandelate, 23 miglitol, 19 mefloquine HCL, 4 Methergine, 34 Migranal, 37

Mefloquine HCL, 4 methimazole, 20 migryl, 13

Megace ES, 18 Methitest, 16 Millipred, 15

Megace Oral, 6 methocarbamol, 32 Millipred DP, 15 megestrol acetate, 6, 18 methotrexate, 5 milrinone IN dextrose, 7 meijer aspirin EC, 35 Methotrexate Sodium, 5 milrinone lactate, 7

Meijer Pen Needles 29G X 12MM, 47 methotrexate sodium, 5 mimvey, 16

Meijer Pen Needles 31G X 6MM, 47 methoxsalen, 12 mimvey LO, 16

Meijer Pen Needles 31G X 8MM, 47 methscopolamine bromide, 22 Minastrin 24 FE, 17

Mekinist, 7 Methyclothiazide, 10 mineral oil heavy, 21 melodetta 24 FE, 17 methyldopa, 9 Minipress, 9 meloxicam, 36 Methyldopa/Hydrochlorothiazide, 10 miniprin low dose, 35

Meloxicam, 36 Methyldopate HCL, 9 minitran, 8 melphalan, 5 methylergonovine maleate, 34 Minivelle, 16 melphalan hydrochloride, 5 Methylin, 29 Minocin, 2 memantine HCL, 31 methylphenidate HCL, 29 minocycline HCL, 2 memantine HCL titration PAK, 31 Methylphenidate HCL, 29 minocycline hydrochloride, 2 memantine hydrochloride, 31 methylphenidate HCL CD, 29 minoxidil, 9

Menactra, 40 methylphenidate HCL ER, 29 Miochol-e, 33

Menest, 16 Methylphenidate HCL ER, 29 Miostat, 33

Menhibrix, 40 Methylphenidate HCL ER (LA), 29 Mirapex, 30

Menomune-a/C/Y/W-135, 40 methylphenidate hydrochloride, 29 Mirapex ER, 30

Menopur, 19 methylphenidate hydrochloride ER, 29 Mircera, 25

Menostar, 16 methylprednisolone, 15 Mircette, 18

Mentax, 12 methylprednisolone acetate, 15 Mirena, 17

Mentho-caine Kit, 14 methylprednisolone dose pack, 15 mirtazapine, 28

Menthocin Patch/Lidocaine, 14 methylprednisolone sodiumsuccinate, 15 mirtazapine odt, 28

Mentholix, 14 methyltestosterone, 16 Mirvaso, 12

Menveo, 40 Metipranolol, 33 misoprostol, 22 meperidine HCL, 35 metoclopramide HCL, 22 Mitigare, 37

Meperidine HCL, 35 Metoclopramide Odt, 23 mitomycin, 5

Meperidine Hydrochloride/Sodium metolazone, 10 Mitomycin, 5

metoprolol succinate ER, 8 Mitosol, 32 Chloride, 36 Mephyton, 41 Metoprolol Succinate mitoxantrone HCL, 5 meprobamate, 27 MM aspirin, 35 ER/Hydrochlorothiazide, 10 Mepron, 4 metoprolol tartrate, 8 MM Pen Needles 31G X 1/4", 47 mercaptopurine, 5 Metoprolol Tartrate, 8 MM Pen Needles 31G X 3/16", 47 meropenem, 4 metoprolol/hydrochlorothiazide, 9 MM Pen Needles 31G X 5/16", 47

Meropenem/Sodium Chloride, 4 Metoprolol/Hydrochlorothiazide, 10 MM Pen Needles 32G X 5/32", 47

Merrem, 4 Metozolv Odt, 23 Mobic, 37 mesalamine, 22 Metro IV, 4 modafinil, 29 mesalamine DR, 22 Metrogel-vaginal, 24 moderiba, 3

Mesalamine DR, 23 metronidazole, 4, 12 Moderiba, 3 mesna, 7 metronidazole IN NACL 0.79%, 4 Moderiba 1200 Dose Pack, 3

Mesnex, 7 metronidazole vaginal, 24 Moderiba 800 Dose Pack, 3

Mestinon, 32 Mevacor, 11 Modicon, 18

Mestinon Timespan, 32 mexiletine HCL, 8 moexipril HCL, 9

Metadate CD, 29 Miacalcin, 19 moexipril/hydrochlorothiazide, 9 metadate ER, 29 mibelas 24 FE, 17 Molindone Hydrochloride, 28

Metaproterenol Sulfate, 39 Micardis, 9 mometasone furoate, 13, 38

Metastron, 7 Micardis HCT, 10 mondoxyne nl, 2 metaxall, 32 Miconazole 3, 24 mono-linyah, 17 metaxalone, 32 Micrhogam Ultra-filtered Plus, 51 Monoclate-p, 26

Metaxalone, 32 Micro-k, 51 Monodox, 2 metformin HCL, 18 Microcyn, 14 Monoject Insulin Syringe Regular LUER metformin HCL ER, 18 microgestin 1.5/30, 17 Tip/Softpack/1ML, 47 metformin hydrochloride, 18 microgestin 1/20, 17 Monoject Insulin Syringe/1ML, 47 methadone HCL, 35 microgestin 24 FE, 17 Monoject Insulin Syringe/1ML/31G X

Methadone HCL, 35 microgestin FE, 17 5/16", 47 methadone HCL intensol, 35 microgestin FE 1.5/30, 17 Monoject Insulin Syringe/Detach

Needle/1ML/25G X 5/8", 47 morgidox 1X50MG, 2 Mynatal, 42

Monoject Insulin Syringe/Detach morgidox 2X100MG, 2 Mynatal Advance, 42

morphine sulfate, 35 Mynatal Plus, 42 Needle/1ML/27G X 1/2", 47 Monoject Insulin Syringe/Perm Morphine Sulfate, 35 Mynatal Ultracaplet, 42

morphine sulfate ER, 35 Mynatal-z, 42 Needle/1ML/28G X 1/2", 47 Monoject Insulin Syringe/Perm Needle/U- Morphine Sulfate ER, 36 Mynate 90 Plus, 42

Morphine Sulfate/Dextrose, 36 mynephrocaps, 41 100/0.5ML/28G X 1/2", 47 Monoject Insulin Syringe/Safety/Perm Morphine Sulfate/Sodium Chloride, 36 mynephron, 41

Motofen, 21 Myobloc, 32 Needle/0.3ML/29G X 1/2", 47 Monoject Insulin Syringe/Safety/Perm Movantik, 23 myorisan, 11

Moviprep, 21 Myrbetriq, 23 Needle/0.3ML/29GX1/2", 47 Monoject Insulin Syringe/Safety/Perm Moxatag, 1 Mysoline, 30

Moxeza, 32 Mytesi, 21 Needle/0.5ML/29G X 1/2", 47 Monoject Insulin Syringe/Safety/Perm moxifloxacin HCL, 2, 32 myzilra, 17

Moxifloxacin HCL, 2 Needle/1ML/29G X 1/2", 47 N Monoject Insulin Moxifloxacin Hydrochlordie/Sodium Nabi-HB, 51

Syringe/Softpack/1ML/27G X 1/2", 47 Chloride, 32 nabumetone, 36 Monoject Insulin Syringe/Softpack/U- moxifloxacin hydrochloride, 32 nadolol, 8 moxifloxacin hydrochloride/sodium 100/0.5ML/28G X 1/2", 47 nadolol/bendroflumethiazide, 9 Monoject Insulin Syringe/U- hydrochloride, 2 Nafcillin, 1 Mozobil, 25 100/0.3ML/30G X 5/16", 47 nafcillin sodium, 1 Monoject Insulin Syringe/U- MS Contin, 36 Nafcillin Sodium, 1 MS Insulin Syringe/0.3ML/29G X 1/2", 47 100/0.5ML/28G X 1/2", 47 nafrinse, 50 Monoject Insulin Syringe/U- MS Insulin Syringe/0.3ML/30G X 5/16", Nafrinse Daily/Acidulated, 27

100/0.5ML/30G X 5/16", 47 47 Nafrinse Daily/Neutral, 27 Monoject Insulin Syringe/U-100/1ML/28G MS Insulin Syringe/0.3ML/31G X 5/16", nafrinse drops, 50

X 1/2", 47 47 Nafrinse Weekly, 27 Monoject Insulin Syringe/U-100/1ML/30G MS Insulin Syringe/0.5ML/29G X 1/2", 48 naftifine HCL, 12 MS Insulin Syringe/0.5ML/30G X 5/16", X 5/16", 47 naftifine hydrochloride, 12 monoject pharma grade flush 48 Naftin, 12 MS Insulin Syringe/0.5ML/31G X 5/16", syringe/heparin lock, 25 Naglazyme, 20 monoject prefill advanced heparin lock 48 nalbuphine HCL, 36 MS Insulin Syringe/1ML/29G X 1/2", 48 flush, 25 Nalfon, 37 Monoject Ultra Comfort Insulin MS Insulin Syringe/1ML/30G X 5/16", 48 naloxone HCL, 51 MS Insulin Syringe/1ML/31G X 5/16", 48 Syringe/0.3ML/29G X 1/2", 47 Naloxone HCL, 51 Monoject Ultra Comfort Insulin mult-vitamin/fluoride, 41 naltrexone HCL, 51 Multaq, 9 Syringe/0.3ML/30G X 5/16", 47 Namenda, 31 Monoject Ultra Comfort Insulin Multi Prenatal, 41

Namenda Titration PAK, 31 multi vitamin/fluoride, 41 Syringe/0.3ML/31G X 5/16", 47 Namenda XR, 31 Monoject Ultra Comfort Insulin multi-vit/fluoride, 41 Namenda XR Titration Pack, 31 multi-vit/iron/fluoride, 41 Syringe/0.5ML/28G X 1/2", 47 Namzaric, 31 Monoject Ultra Comfort Insulin multi-vitamin/fluoride, 41 Naphazoline HCL, 33 multi-vitamin/fluoride drops, 41 Syringe/0.5ML/29G X 1/2", 47 Naprelan, 37 Monoject Ultra Comfort Insulin multi-vitamin/fluoride/iron, 41

Naprosyn, 37 Multigen, 25 Syringe/0.5ML/30G X 5/16", 47 naproxen, 36 Monoject Ultra Comfort Insulin Multigen Folic, 25 Naproxen, 36 Multigen Plus, 25 Syringe/0.5ML/31G X 5/16", 47 naproxen DR, 36 Monoject Ultra Comfort Insulin multivitamin with fluoride, 41 naproxen kit, 36 multivitamin/fluoride, 41 Syringe/1ML/28G X 1/2", 47 naproxen sodium, 36 Monoject Ultra Comfort Insulin Multivitamin/Fluoride, 42

naproxen sodium CR, 36 multivitamin/fluoride/iron, 41 Syringe/1ML/29G X 1/2", 47 naproxen sodium ER, 36 Monoject Ultra Comfort Insulin multivitamins/fluoride, 41 naratriptan HCL, 37 mupirocin, 12 Syringe/1ML/30G X 5/16", 47 Narcan, 51 mononessa, 17 Mustargen, 5 Nardil, 28 Mononine, 26 MVC-fluoride, 42 Naropin, 38 Monovisc, 32 my way, 17

Nascobal, 25 Monsels Ferric Subsulfate, 26 Myalept, 20 Nasonex, 38 montelukast sodium, 39 Myambutol, 2 Nat-rul Prenatal Vitamins, 41 Monurol, 23 Mycamine, 3

nat-rul vitamin d, 40 Moore MED Monoject Insulin Syringe/U- Mycobutin, 2 Natachew, 42 mycophenolate mofetil, 6 100/0.5ML/28G X 1/2", 47 Natacyn, 32 Moore MED Monoject Insulin Syringe/U- mycophenolic acid DR, 6

Natalvit, 42 Mydriacyl, 33 100/0.5ML/29G X 1/2", 47 Natazia, 17 Moore MED Monoject Insulin Syringe/U- myferon 150 forte, 25 nateglinide, 18 Myfortic, 6 100/1ML/28G X 1/2", 47 Natelle One, 42 Moore MED Monoject Insulin Syringe/U- Mykidz Iron Fl, 42 Natpara, 19 Myleran, 5 100/1ML/29G X 1/2", 47 Natrecor, 11 morgidox 1X100MG, 2 Mylotarg, 5

Natroba, 14

natural vitamin d-3, 40 next choice one dose, 17 Nitrolingual Pumpspray, 8

Nature-throid, 20 Nexterone, 9 Nitromist, 8

Nature-throid Nt-2.5, 21 Niacin, 41 Nitropress, 9

Navelbine, 6 niacin ER, 11 Nitrostat, 8

Nebupent, 4 niacinamide/azelaic ac/ turmer/fa/b6/zinc Nityr, 20 nebusal, 38 Niva-plus, 42 ox/copper, 41 Nebusal, 38 Niacor, 11 nizatidine, 22 necon 0.5/35-28, 17 Niaspan, 11 Nizatidine, 22 necon 1/35, 17 Nicadan, 42 Nizoral, 12

Necon 1/50-28, 17 Nicadan ZX, 42 nolix, 13

Necon 10/11-28, 18 nicardipine HCL, 8 Nor-QD, 18 necon 7/7/7, 17 Nicardipine Hydrochloride/Sodium nora-be, 17

Neevo DHA, 42 Norco, 36 Chloride, 8 nefazodone HCL, 28 Nicazel, 42 Norditropin Cartridge, 20

Nefazodone HCL, 28 Nicazel Forte, 42 Norditropin Flexpro, 20

Nembutal Sodium, 29 Nicoderm CQ, 31 norepinephrine bitartrate, 10 neo-polycin, 32 Nicomide, 42 Norepinephrine Bitartrate/Sodium neo-polycin HC, 33 nicorelief, 31 Chloride, 10 Neo-synalar, 12 Nicorette, 31 Norepinephrine/Dextrose, 10 neomycin sulfate, 2 Nicorette Mini, 31 norethindrone, 17 neomycin/bacitracin/polymyxin, 32 Nicorette Starter Kit, 31 norethindrone & ethinyl estradiol ferrous neomycin/polymyxin b sulfates, 24 nicotine, 31 fumarate, 17 neomycin/polymyxin/bacitracin zinc, 32 nicotine mini lozenge, 31 norethindrone acetate, 18 neomycin/polymyxin/bacitracin/hydrocorti nicotine polacrilex, 31 norethindrone acetate/ethinyl estradiol,

nicotine polacrilex refill, 31 sone, 33 16, 17 neomycin/polymyxin/dexamethasone, 33 nicotine polacrilex starter kit, 31 norethindrone acetate/ethinyl neomycin/polymyxin/gramicidin, 32 nicotine step 1, 31 estradiol/ferrous fumarate, 17 neomycin/polymyxin/HC, 34 nicotine step 2, 31 norethindrone/ethinyl estradiol/ferrous

Neomycin/Polymyxin/Hydrocortisone, 33 nicotine step 3, 31 fumarate, 17 neomycin/polymyxin/hydrocortisone, 34 nicotine transdermal system, 31 norgestimate/ethinyl estradiol, 17

Neoprofen, 37 Nicotine Transdermal System, 31 Norinyl 1+35, 18

Neoral, 6 nicotine transdermal system step 1, 31 Norinyl 1+50, 18

Neosporin, 32 nicotine transdermal system step 2, 31 norlyda, 17

Neosporin GU Irrigant, 24 nicotine transdermal system step 3, 31 norlyroc, 17 neostigmine methylsulfate, 32 Nicotrol Inhaler, 31 Norpace, 9

Neostigmine Methylsulfate, 32 Nicotrol Ns, 31 Norpace CR, 9

Neotuss Plus, 38 nifedical XL, 8 Norpramin, 28

Nephplex RX, 42 nifedipine, 8 Northera, 10

Nephro-vite RX, 42 nifedipine ER, 8 nortrel 0.5/35 (28), 17

Nephron Fa, 25 Niferex, 25 nortrel 1/35, 17 nephronex, 41 nikki, 17 nortrel 7/7/7, 17

Neptazane, 10 Nilandron, 6 nortriptyline HCL, 28

Nerlynx, 7 nilutamide, 6 Nortriptyline HCL, 28

Nesacaine, 38 Nimbex, 32 nortuss-DE, 38

Nesacaine-mpf, 38 nimodipine, 8 Nortuss-EX, 38

Nesina, 19 Ninlaro, 7 Norvasc, 8

Nestabs, 42 Nipent, 7 Norvir, 3

Nestabs Abc, 42 Nipride RTU, 9 norwich aspirin, 35

Nestabs DHA, 42 nisoldipine ER, 8 Novarel, 19

Neulasta, 25 Nisoldipine ER, 8 Novoeight, 26

Neulasta Onpro Kit, 25 Nithiodote, 51 Novofine 30GX8MM, 48

Neupogen, 25 Nitro-bid, 8 Novofine 32GX6MM, 48

Neupro, 30 Nitro-dur, 8 Novofine Autocover 30GX8MM, 48

Neurin-SL, 25 nitro-time, 8 Novofine Plus 32GX4MM, 48

Neurontin, 30 nitrofurantoin, 23 Novolin 70/30, 18 neutragard advanced, 27 nitrofurantoin macrocrystals, 23 Novolin 70/30 Relion, 18 neutral sodium fluoride, 27 nitrofurantoin monohydrate, 23 Novolin N, 18

Neutrasal, 27 nitrofurantoin Novolin N Relion, 18

Neuvaxin, 14 Novolin R, 18 monohydrate/macrocrystals, 23 Nevanac, 34 nitroglycerin, 8 Novolin R Relion, 18 nevirapine, 3 Nitroglycerin, 8 Novolog, 18

Nevirapine, 3 nitroglycerin ER, 8 Novolog Flexpen, 18 nevirapine ER, 3 nitroglycerin IN 5% dextrose, 8 Novolog Mix 70/30, 18

Newgen, 42 nitroglycerin IN dextrose 5%, 8 Novolog Mix 70/30 Prefilled Flexpen, 18

Nexa Plus, 42 Nitroglycerin IN Dextrose 5%, 8 Novolog Penfill, 18

Nexavar, 7 nitroglycerin lingual, 8 Novoseven, 26

Nexium I.v., 22 Nitroglycerin Lingual, 8 Novoseven Rt, 26

Nexplanon, 17 nitroglycerin transdermal, 8 Novotwist 30GX8MM, 48

Novotwist 32GX5MM, 48 olanzapine odt, 28 oscimin, 22

Noxafil, 3 olanzapine/fluoxetine, 31 oscimin SR, 22

NP thyroid 120, 20 olmesartan medoxomil, 9 oseltamivir phosphate, 3

NP thyroid 15, 20 olmesartan Oseni, 19

NP thyroid 30, 20 osmitrol viaflex, 10 medoxomil/amlodipine/hydrochlorothiazid NP thyroid 60, 20 Osmitrol Viaflex, 10 e, 9

NP thyroid 90, 20 Osmoprep, 21 olmesartan Nplate, 25 Osphena, 19

medoxomil/hydrochlorothiazide, 9 Nucala, 39 Otezla, 37 olopatadine HCL, 34, 38

Nucynta, 36 Otiprio, 34 olopatadine hydrochloride, 34

Nucynta ER, 36 Otovel, 34 Olysio, 4

Nuedexta, 31 Ovace Plus, 13 Omeclamox-PAK, 22

Nufera, 25 Ovace Plus Wash, 13 omega-3-acid ethyl esters, 11 nufol, 25 Ovace Wash, 13 omeprazole, 22 nulev, 22 Ovcon-35, 18 Omeprazole + Syrspend SF Alka, 22

Nulojix, 6 Ovide, 14 Omnaris, 38

Nulytely/Flavor Packs, 21 Ovidrel, 19 Omnipred, 33

Numoisyn, 27 oxacillin sodium, 1 Omnitrope, 20

Nuplazid, 28 oxaliplatin, 5 Oncaspar, 5

Nutricap, 42 Oxandrin, 16 ondansetron HCL, 22

Nutridox, 2 oxandrolone, 16 ondansetron odt, 22 nutrifac ZX, 41 oxaprozin, 36 One A Day Womens Prenatal/DHA, 41

Nutrivit, 42 Oxaydo, 36 One A Day Womens Prenatal1, 41

Nutropin AQ Nuspin 10, 20 oxazepam, 27 One-a-day Womens Prenatal, 41

Nutropin AQ Nuspin 20, 20 oxcarbazepine, 29 Onfi, 30

Nutropin AQ Nuspin 5, 20 oxiconazole nitrate, 12 Onglyza, 19

Nutropin AQ Pen, 20 Oxistat, 12 Onivyde, 7

Nuvail, 14 Oxsoralen, 15 Onmel, 3

Nuvaring, 17 Oxsoralen Ultra, 12 Opana, 36

Nuvigil, 29 Oxtellar XR, 30 Opana ER (crush Resistant), 36

Nuwiq, 26 oxybutynin chloride, 23 opcicon one-step, 17 nyata, 12 oxybutynin chloride ER, 23 Opdivo, 5

Nymalize, 8 oxycodone HCL, 35 opium, 21 nystatin, 2, 12, 27 Oxycodone HCL ER, 36 opium tincture, 21 nystatin/triamcinolone, 12 oxycodone/acetaminophen, 35 Opsumit, 11 nystatin/triamcinolone acetonide, 12 Oxycodone/Acetaminophen, 36 Optimal D3 M, 41 nystop, 12 oxycodone/aspirin, 35 optimal-d, 40

Oxycodone/Ibuprofen, 36 optimal-d pack, 40 O Oxycontin, 36 option 2, 17 O-CAL Fa, 42 oxymorphone hydrochloride, 35 Options Conceptrol Vaginal O-CAL Prenatal, 42 oxymorphone hydrochloride ER, 35

OB Complete, 42 Contraceptive, 24 Oxymorphone Hydrochloride ER, 36 Options Gynol II Vaginal Contraceptive, OB Complete One, 42 oxytocin, 34

OB Complete Petite, 42 24 Oxytocin/Dextrose, 34 opurity vitamin d, 40 OB Complete Premier, 42 Oxytocin/Dextrose/Lactated Ringers, 34 Oracit, 24 OB Complete/DHA, 42 Oxytocin/Dextrose/Lactateringers, 34 Orafate, 27 Obizur, 27 Oxytocin/Lactated Ringers, 34 oralone dental paste, 27 Obstetrix DHA, 42 Oxytocin/Sodium Chlordie, 34 Orap, 31 Obstetrix EC, 42 Oxytocin/Sodium Chloride, 34 Orapred Odt, 15 Obstetrix One, 42 Oravig, 27 Ocaliva, 23 P

Orbactiv, 4 ocella, 17 PA Prenatal Formula, 41 Orencia, 37 Ocrevus, 31 PA vitamin d-3, 41 Orencia Clickject, 37 Octagam, 51 PA vitamin d-3 gummy, 41

Orenitram, 11 Octaplas Blood Group A, 27 pacerone, 8 Orfadin, 20 Octaplas Blood Group Ab, 27 paclitaxel, 6 Orkambi, 39 Octaplas Blood Group B, 27 Paclitaxel, 6

orphenadrine citrate, 32 Octaplas Blood Group O, 27 Paingo Kft, 15 orphenadrine citrate ER, 32 octreotide acetate, 20 paliperidone ER, 28 orsythia, 17 Ocufen, 34 Pamelor, 28

Ortho D, 25 Ocuflox, 32 pamidronate disodium, 19 Ortho DF, 25 Odefsey, 3 Pamidronate Disodium, 19 Ortho Micronor, 18 Ofev, 39 Pamine, 22

Ortho Tri-cyclen, 18 Ofirmev, 35 Pamine Forte, 22 Ortho Tri-cyclen LO, 18 ofloxacin, 2, 32, 34 Pamine FQ, 22 Ortho-cyclen, 18 Ofloxacin, 2 Panatuss Dxp, 38

Ortho-novum 1/35, 18 Ogestrel, 17 Pancreaze, 22 Ortho-novum 7/7/7, 18 okebo, 2 pancuronium bromide, 32 Orthovisc, 32 olanzapine, 28 Pancuronium Bromide, 32

Panhematin, 27 Penlac Nail Lacquer, 12 pilocarpine HCL, 27, 33

Panretin, 13 Pentacel, 39 pilocarpine hydrochloride, 27 pantoprazole sodium, 22 Pentam 300, 4 pimozide, 31

Parafon Forte DSC, 32 Pentasa, 23 pimtrea, 17

Paragard Intrauterine Copper pentazocine/naloxone HCL, 35 pindolol, 8

Pentips 29G X 12MM, 48 pioglitazone HCL, 19 Contraceptive T380a, 17 Paregoric, 21 Pentips 29GX12MM, 48 pioglitazone HCL-glimepiride, 19

Paremyd, 34 Pentips 31G X 5MM, 48 pioglitazone HCL/metformin HCL, 19 paricalcitol, 20 Pentips 31G X 8MM, 48 piperacillin sodium/ tazobactam sodium,

Parlodel, 30 Pentips 31GX5MM, 48 1 Parnate, 28 Pentips 31GX6MM, 48 piperacillin sodium/tazobactam sodium, 1 paroex, 27 Pentips 31GX8MM, 48 piperacillin/tazobactam, 1 paromomycin sulfate, 2 Pentips 32G X 4MM, 48 Piperacillin/Tazobactam, 1 paroxetine HCL, 28 Pentips 32GX4MM, 48 pirmella 1/35, 17 paroxetine HCL ER, 28 pentobarbital sodium, 29 pirmella 7/7/7, 17

Paser, 2 pentoxifylline ER, 26 piroxicam, 36

Pataday, 34 Pepcid, 22 Pitocin, 34

Patanase, 38 Percocet, 36 Plaquenil, 4

Patanol, 34 Perforomist, 39 plasbumin-25, 26

Paxil, 28 Peridex, 27 plasbumin-5, 26

Paxil CR, 28 perindopril erbumine, 9 Plasmanate, 27

Pazeo, 34 periogard, 27 Plavix, 26

PC Unifine Pentips 29G X 1/2", 48 Perjeta, 5 Plegisol, 11

PC Unifine Pentips 31G X 5MM Mini, 48 permethrin, 13 Plegridy, 31

PC Unifine Pentips 31G X 6MM Ultra perphenazine, 28 Plegridy Starter Pack, 31

Perphenazine/Amitriptyline, 31 Pletal, 26 SHORT, 48 PC Unifine Pentips 31G X 8MM SHORT, Perry Prenatal, 41 Pliaglis, 15

Persantine, 26 Pneumovax 23, 40 48 PCE, 2 Pertzye, 22 Pneumovax 23/1 Dose, 40

Pediaderm AF Complete Kit, 12 Pfizerpen-G, 1 PNV Ferrous Fumarate/Docusate/Folic

Pediapred, 15 pharbedryl, 38 Acid, 43 Pediarix, 39 phenadoz, 38 PNV Folic Acid + Iron Multivitamin, 43

Pedvax HIB, 40 phenazo, 24 PNV Ob+dha, 43 peg 3350, 21 phenazopyridine HCL, 24 PNV Prenatal Plus Multivitamin, 43 peg 3350/electrolytes, 21 phenazopyridine hydrochloride, 24 PNV Prenatal Plus Multivitamin + DHA, peg-3350/electrolytes, 21 phenazopyridine hydrocholride, 24 43 peg-3350/NACL/NA bicarbonate/KCL, 21 phenelzine sulfate, 28 PNV TABS 29-1, 43

Peg-intron, 3 phenergan, 38 PNV-dha+docusate, 43

Peg-intron Redipen, 3 Phenergan, 38 PNV-omega, 43

Peg-intron Redipen PAK 4, 3 phenobarbital, 29 PNV-total, 43 peg-prep, 21 Phenobarbital, 29 PNV-vp-u, 43 peg3350, 21 Phenobarbital Sodium, 29 Podocon 25 IN Benzoin Tincture, 14

Peganone, 30 phenoxybenzamine hydrochloride, 9 podofilox, 14

Pegasys, 3 Phentolamine Mesylate, 9 polocaine, 37

Pegasys Proclick, 3 phenylephrine HCL, 10, 33 polocaine-mpf, 37

Pegintron, 3 Phenylephrine HCL, 10 poly-iron 150 forte, 25 pegylax, 21 Phenylephrine Hydrochloride/Dextrose, Poly-VI-flor, 42

Pen Needles 29G X 12MM, 48 Poly-VI-flor FS, 42 10 Pen Needles 29GX1/2", 48 Phenylephrine Hydrochloride/Sodium Poly-VI-flor/Iron, 42

Pen Needles 30GX5/16", 48 polycin, 32 Chloride, 10 Pen Needles 30GX5MM, 48 Phenylephrine/Guaifenesin, 38 polyethylene glycol 3350, 21

Pen Needles 30GX8MM, 48 Phenylephrine/Sodium Chloride, 10 polyethylene glycol 3350-grx, 21

Pen Needles 31G X 1/4" SHORT, 48 Phenytek, 30 polymyxin b sulfate, 4

Pen Needles 31G X 3/16", 48 phenytoin, 29 polymyxin b sulfate/trimethoprim sulfate,

Pen Needles 31G X 5MM, 48 phenytoin infatabs, 29 32 Pen Needles 31G X 6MM, 48 phenytoin sodium, 30 polysaccharide iron forte, 25

Pen Needles 31GX5/16", 48 phenytoin sodium extended, 29 Polytrim, 32

Pen Needles 31GX6MM (1/4"), 48 philith, 17 Pomalyst, 6

Pen Needles 31GX8MM, 48 phos-flur, 27 Ponstel, 37

Pen Needles 31GX8MM (5/16"), 48 Phoslyra, 23 portia-28, 17

Pen Needles 32GX4MM, 48 phosphasal, 23 Portrazza, 5 penicillin G potassium, 1 Phospholine Iodide, 33 potassium acetate, 51

Penicillin G Potassium IN Iso-osmotic Photofrin, 7 Potassium Acetate, 51

phrenilin forte, 35 potassium chloride, 51 Dextrose, 1 Penicillin G Procaine, 1 phytonadione, 41 Potassium Chloride, 51

Penicillin G Sodium, 1 Picato, 13 potassium chloride CR, 51 penicillin v potassium, 1 Pico Single Use Negative Pressure potassium chloride ER, 51

Penicillin V Potassium, 1 Potassium Chloride ER, 51 Wound Therapy System, 15 potassium chloride SR, 51 Preferred Plus Insulin Syringe/U- Prenate, 43 potassium citrate ER, 24 Prenate AM, 43 100/0.3ML/29G X 1/2", 48 potassium citrate-citric acid crystals, 24 Preferred Plus Insulin Syringe/U- Prenate DHA, 43 potassium citrate/citric acid, 24 Prenate Elite, 43 100/0.3ML/30G X 5/16", 48 potassium citrate/sodium citrate/citric Preferred Plus Insulin Syringe/U- Prenate Enhance, 43

Prenate Essential, 43 acid, 24 100/0.5ML/28G X 1/2", 48 Potiga, 30 Preferred Plus Insulin Syringe/U- Prenate Mini, 43

Pr Natal 400, 42 Prenate Pixie, 43 100/0.5ML/29G X 1/2", 48 Pr Natal 400 EC, 42 Preferred Plus Insulin Syringe/U- Prenate Restore, 43

Pr Natal 430, 42 Prenate Star, 43 100/0.5ML/30G X 5/16", 48 Pr Natal 430 EC, 42 Preferred Plus Insulin Syringe/U- Prepidil, 34

Pradaxa, 26 Preplus, 43 100/1ML/28G X 1/2", 48 Pralidoxime Chloride, 51 Preferred Plus Insulin Syringe/U- Prepopik, 21

Praluent, 11 Preque 10, 43 100/1ML/29G X 1/2", 48 pramcort, 22 Preferred Plus Insulin Syringe/U- Prestalia, 10 pramipexole dihydrochloride, 30 Pretab, 43 100/1ML/30G X 5/16", 48 pramipexole dihydrochloride ER, 30 Preferred Plus Unifine Pentips 29G X Prevacid, 22

Pramosone, 13 Prevacid Solutab, 22 12MM, 48 Pramotic, 34 Preferred Plus Unifine Pentips 31G X prevalite, 11 pramox gel, 14 Prevident, 27 6MM Ultra SHORT, 48 Prandimet, 19 Preferred Plus Unifine Pentips 31G X Prevident 5000 Booster, 27

Prandin, 18 Prevident 5000 Booster Plus, 27 8MM SHORT, 48 prasugrel, 26 Preferred Plus Unifine Pentips Prevident 5000 Dry Mouth, 27

Pravachol, 11 Prevident 5000 Enamel Protect, 27 32GX4MM, 48 pravastatin sodium, 11 Preferred Plus Unifine Prevident 5000 Plus, 27

Praxbind, 51 Prevident 5000 Sensitive, 27 Pentips/Mini/31GX5MM, 48 prazosin HCL, 9 Prefest, 16 Prevident Fluoride, 27

Pre-folic, 25 Pregnyl W/Diluent Benzyl Alcohol/NACL, prevident rinse, 27

Pre-natal Formula, 41 previfem, 17 19 Precedex, 29 Premarin, 16, 24 Prevnar 13, 40

Precision Sure-dose Insulin premium lidocaine, 14 Prevpac, 22

Premphase, 16 Prezcobix, 3 Syringe/0.3ML/30G X 5/16", 48 Precision Sure-dose Insulin Prempro, 16 Prezista, 3

Prena1 Chew, 43 Prialt, 35 Syringe/0.5ML/28G X 1/2", 48 Precision Sure-dose Insulin Prena1 Pearl, 43 Priftin, 2

Prenaissance, 43 prilolid, 14 Syringe/0.5ML/29G X 1/2", 48 Precision Sure-dose Insulin Prenaissance Balance, 43 Prilosec, 22

Prenaissance Harmony DHA, 43 priloxx LP, 14 Syringe/0.5ML/30G X 3/8", 48 Precision Sure-dose Insulin Prenaissance Next, 43 Primaquine Phosphate, 4

Prenaissance Next-b, 43 Primaxin IV, 4 Syringe/1ML/28G X 1/2", 48 Precision Sure-dose Plus Insulin Prenaissance Plus, 42 Primaxin IV Add-vantage, 4

Prenata, 43 primidone, 29 Syringe/0.3ML/29G X 1/2", 48 Precision Sure-dose Plus Insulin Prenatabs Fa, 43 Primlev, 36

Prenatabs RX, 42 Primsol, 4 Syringe/1ML/29G X 1/2", 48 Precision XTRA, 48 Prenatal, 41 Prinivil, 9

Precision XTRA Blood Glucose Test Prenatal 19, 43 Pristiq, 28

Prenatal And Iron, 41 Privigen, 51 Strips, 48 Precose, 19 Prenatal Complete, 41 Pro Comfort Pen Needles/ 31G X 8MM,

Pred Forte, 33 Prenatal Formula, 41 48 Pred Mild, 33 Prenatal Forte, 41 Pro Comfort Pen Needles/ 32G X 4MM,

Pred-G, 33 Prenatal Gummies/DHA & Folic Acid, 41 48 Pred-G S.o.p., 33 Prenatal Low Iron, 41 Pro Comfort Pen Needles/ 32G X 5MM, prednicarbate, 13 Prenatal Multi + DHA, 41 48 prednisolone, 15 Prenatal Multi +dha, 41 Pro Comfort Pen Needles/ 32G X 6MM, prednisolone acetate, 33 Prenatal Multivitamin, 41 48 prednisolone sodium phosphate, 15 Prenatal Multivitamin + DHA, 41 Proair HFA, 39

Prednisolone Sodium Phosphate, 15, 33 Prenatal Multivitamin Plus DHA, 41 Proair Respiclick, 39 prednisolone sodium phosphate odt, 15 Prenatal One Daily, 41 probenecid, 37

Prednisolone/Moxifloxacin, 33 Prenatal Plus, 43 probenecid/colchicine, 37

Prednisolone/Moxifloxacin/Bromfenac, Prenatal Plus DHA, 41 Probuphine Implant Kit, 36

Prenatal Plus Iron, 43 procainamide HCL, 9 33 Prednisolone/Moxifloxacin/Ketorolac, 33 Prenatal Vitamin, 41 procainamide hydrochloride, 9 prednisone, 15 Prenatal Vitamin & Mineral, 41 Procardia, 8

Prednisone, 15 Prenatal Vitamin/Iron, 41 Procardia XL, 8

Prednisone Intensol, 15 Prenatal Vitamins, 41 Procentra, 29

Prefera OB, 42 Prenatal Vitamins Plus Low Iron, 43 prochlorperazine, 28

Preferaob +dha, 42 Prenatal-u, 42 prochlorperazine edisylate, 29

Preferaob One, 43 Prenatal/Omega-3/Folic Acid/Iron, 41 prochlorperazine maleate, 28

Procort, 23 Provigil, 29 Qnasl Childrens, 38

Procrit, 25 Prozac, 28 Qtern, 19 procto-MED HC, 23 Prozac Weekly, 28 Quadracel, 39 procto-PAK, 23 Prudoxin, 12 Quadramet, 7

Proctocort, 23 Psorcon, 13 Qualaquin, 4

Proctofoam HC, 23 Pulmicort, 39 Quartette, 18 proctosol HC, 23 Pulmicort Flexhaler, 39 quasense, 17 proctozone-HC, 23 pulmosal, 38 Quazepam, 29

Procysbi, 24 Pulmozyme, 39 Qudexy XR, 30

Prodigy Insulin Syring/U-100/0.3ML/31G Purefe OB Plus, 43 Quelicin, 32

Purefe Plus, 25 Questran, 11 X 5/16", 48 Prodigy Insulin Syringe/1/2ML/31G X purevit dualfe plus, 25 Questran Light, 11

Purixan, 5 quetiapine fumarate, 28 5/16", 48 Prodigy Insulin Syringe/1ML/28G X 1/2", px aspirin, 35 quetiapine fumarate ER, 28

px enteric aspirin, 35 Quflora FE, 43 48 profeno, 36 Px Extra SHORT Pen Needles Quflora Pediatric, 42

Proferrin-forte, 25 Quillichew ER, 29 31GX6MM, 48 Profilnine, 26 px folic acid, 24 Quillivant XR, 29

Profilnine SD, 26 Px Insulin Syringe/U-100/0.3ML/30G X quinapril HCL, 9 progesterone, 18 quinapril/hydrochlorothiazide, 9 1/2", 48 Progesterone 10% Kit, 18 Px Insulin Syringe/U-100/0.3ML/31G X Quinidine Gluconate, 9

Proglycem, 18 quinidine gluconate CR, 9 5/16", 48 Prograf, 6 Px Insulin Syringe/U-100/0.5ML/30G X quinidine gluconate ER, 9

Prolastin-c, 39 Quinidine Sulfate, 9 1/2", 48 Prolensa, 34 Px Insulin Syringe/U-100/0.5ML/31G X Quinidine Sulfate ER, 9

Proleukin, 7 quinine sulfate, 4 5/16", 48 Prolia, 19 Px Insulin Syringe/U-100/1ML/30G X Qutenza, 15

Promacta, 25 Qvar, 39 1/2", 48 promethazine HCL, 38 Px Insulin Syringe/U-100/1ML/31G X R promethazine HCL plain, 38 5/16", 48 R-natal OB, 43 promethazine VC plain, 38 px laxative, 21 ra aspirin, 35 promethazine VC/codeine, 38 Px Mini Pen Needles 31GX5MM, 48

ra aspirin adult low dose, 35 promethazine-DM, 38 Px Pen Needle 29GX12MM, 48 ra aspirin adult low strength, 35 promethazine/codeine, 38 Px Pen Needle 31GX8MM, 48 ra aspirin childrens, 35 promethazine/dextromethorphan, 38 Px Prenatal Multivitamins, 41

ra aspirin EC, 35 promethazine/phenylephrine, 38 Px Shortlength Pen Needles/31GX8MM, ra aspirin EC adult low strength, 35 promethazine/phenylephrine/codeine, 38 48 ra budesonide nasal spray, 38 promethegan, 38 px stop smoking aid, 31

ra childrens aspirin, 35 Prometrium, 18 Pylera, 22 ra folic acid, 24 pronutrients vitamin d3, 40 pyrazinamide, 2 Ra Insulin Syringe/0.5ML/29G X 1/2", 48 propafenone HCL, 8 Pyridium, 24

Ra Insulin Syringe/1ML/29G X 1/2", 48 propafenone HCL ER, 8 pyridostigmine bromide, 32 Ra Insulin Syringe/U-100/0.5ML/30G X propafenone hydrochloride ER, 8 pyridostigmine bromide ER, 32

propafenone hydrochlorideer, 8 pyridoxine HCL, 41 5/16", 48

Ra Insulin Syringe/U-100/1 ML/30G X Propantheline Bromide, 22 Pyrogallic Acid, 15

proparacaine HCL, 33 5/16", 48

Q ra laxative, 21 propofol, 38

Qbrelis, 9 ra magnesium citrate, 21 propranolol HCL, 8 qc aspirin, 35 ra mini nicotine, 31 Propranolol HCL, 8 qc aspirin low dose, 35 ra nicotine, 31 propranolol HCL ER, 8

qc chewable aspirin low dose, 35 ra nicotine gum, 31 propranolol hydrochloride, 8 qc childrens aspirin, 35 ra nicotine polacrilex, 31 Propranolol/Hydrochlorothiazide, 10 qc enteric aspirin, 35 ra nicotine transdermal system, 31 propylthiouracil, 20

qc gentle laxative, 21 ra nicotine transdermal system step 3, 31 Proquad, 40 Qc Insulin Syringe/0.3ML/29G X 1/2", 48 Ra One Daily, 41 Proscar, 24 Qc Insulin Syringe/0.5ML/29G X 1/2", 48 Ra Pen Needles 31G X 5MM 3/16", 48 Prostin E2, 34

Qc Insulin Syringe/0.5ML/31G X 5/16", Ra Pen Needles 31G X 8MM 5/16", 48 Protamine Sulfate, 27 Ra Prenatal, 41 Protect Plus, 43 48 Qc Insulin Syringe/1ML/29G X 1/2", 48 Ra Prenatal Formula/Folicacid, 41 Protectiron, 25

Qc Insulin Syringe/1ML/31G X 5/16", 48 ra vitamin d-3, 40 Prothelial, 27 qc magnesium citrate, 21 ra womens laxative, 21 Protonix, 22 qc natura-LAX, 21 Rabavert, 40 Protopam Chloride, 51

qc nicotine polacrilex, 31 rabeprazole sodium, 22 protriptyline HCL, 28 Qc Pen Needles 29G X 12MM, 48 Radicava, 31 Provayblue, 51 Qc Pen Needles 31G X 6MM, 48 Radiogardase, 51 Provenge, 7

Qc Pen Needles 31G X 8MM, 48 rajani, 17 Provera, 18 Qc Prenatal, 41 raloxifene hydrochloride, 19 Provida DHA, 43 Qc Unifine Pentips 32GX4MM, 48 ramipril, 9 Provida OB, 43

Qnasl, 38 Ranexa, 8

ranitidine HCL, 22 Relion Insulin Syringe/U-100/0.5ML/30G Restoril, 29

Rapaflo, 24 Retin-a Micro, 12 X 5/16", 48 Rapamune, 6 Relion Insulin Syringe/U-100/0.5ML/31G Retisert, 33

Rapivab, 4 Retrovir, 3 X 5/16", 48 rasagiline mesylate, 30 Relion Insulin Syringe/U-100/1ML/30G, Retrovir IV Infusion, 4

Ravicti, 20 Revatio, 11 48 Rayaldee, 20 Relion Insulin Syringe/U-100/1ML/30G X Revlimid, 6

Razadyne, 31 revonto, 32 5/16", 48 Razadyne ER, 31 Relion Insulin Syringe/U-100/1ML/31G X Rexulti, 28 rea LO 39, 14 Reyataz, 3 15/64", 48 rea LO 40, 14 Relion Insulin Syringe/U-100/1ML/31G X Rezira, 39 react, 17 Rheumatrex, 37 5/16", 48 Reality Insulin Syringe/U-100/0.5ML/28G Relion Mini Pen Needles 31GX6MM, 48 rhinocort allergy, 38

Relion Pen Needles 29GX12MM, 48 Rhinocort Aqua, 38 X 1/2", 48 Reality Insulin Syringe/U-100/0.5ML/29G Relion Pen Needles 31GX6MM, 48 Rhofade, 12

Relion Pen Needles 31GX8MM, 48 Rhogam Ultra-filtered Plus, 51 X 1/2", 48 Reality Insulin Syringe/U-100/1ML/28G X Relion Pen Needles 32GX4MM, 48 Rhophylac, 51

Relion R, 18 Riastap, 27 1/2", 48 Reality Insulin Syringe/U-100/1ML/29G X Relion SHORT Pen Needles 31GX8MM, ribasphere, 3

Ribasphere, 3 1/2", 48 48 Rebetol, 3 Relistor, 23 Ribasphere Ribapak, 3

Rebif, 31 Relnate DHA, 43 Ribatab, 3

Rebif Rebidose, 31 Relpax, 37 ribavirin, 3

Rebif Rebidose Titration Pack, 31 Remeron, 28 Ridaura, 37

Rebif Titration Pack, 31 Remeron Soltab, 28 rifabutin, 2

Reclast, 19 remeven, 14 Rifadin, 2 reclipsen, 17 Remicade, 23 Rifamate, 2

Recombinate, 26 Remodulin, 11 rifampin, 2

Recombivax HB, 40 rena-vite RX, 41 Rifater, 2

Recothrom, 26 Renacidin, 24 Right Step Prenatal, 41

Recothrom Spray Kit, 26 Renagel, 23 Rilutek, 31

Rectiv, 23 renal CAPS, 42 riluzole, 31

Recura, 12 Renatabs, 43 rimantadine HCL, 3

Reglan, 23 Renatabs With Iron, 43 Rimso-50, 24

Regonol, 32 Renflexis, 23 Riomet, 18

Regranex, 15 reno CAPS, 42 risedronate sodium, 19 relador PAK, 14 Renovo, 15 risedronate sodium DR, 19 relador PAK plus, 14 Renvela, 23 Risperdal, 28

Relagard, 24 Reopro, 27 Risperdal Consta, 29

Releevia, 15 repaglinide, 18 Risperdal M-TAB, 28

Releevia Mc, 15 Repaglinide/Metformin Hydrochloride, 19 risperidone, 28 releevia ML, 14 Repatha, 11 risperidone M-TAB, 28

Relenza Diskhaler, 3 Repatha Pushtronex System, 11 risperidone odt, 28

Relhist, 38 Repatha Sureclick, 11 Ritalin, 29

Relion Insulin Syringe 0.5ML/31G X Replesta, 41 Ritalin LA, 29

Replesta Childrens, 41 Rituxan, 5 15/64", 48 Relion Insulin Syringe 1ML/31GX15/64", Replesta Nx, 41 Rituxan Hycela, 7

reprexain, 35 rivastigmine tartrate, 31 48 Relion Insulin Syringe/U -100/0.5ML/29G, Reprexain, 36 rivastigmine transdermal system, 31

Req 49+, 43 rivelsa, 17 48 Relion Insulin Syringe/U-00/1ML/29G X Requip, 30 Rixubis, 26

Requip XL, 30 rizatriptan benzoate, 37 1/2", 48 Relion Insulin Syringe/U-100/0.3ML/29G, Rescriptor, 3 rizatriptan benzoate odt, 37

Rescula, 33 Robaxin, 32 48 Relion Insulin Syringe/U-100/0.3ML/29G Reserpine, 9 Robaxin-750, 32

Respa-BR, 38 Robinul, 22 X 1/2", 48 Relion Insulin Syringe/U-100/0.3ML/30G, Restasis, 33 Robinul Forte, 22

Restasis Multidose, 33 Rocaltrol, 20 48 Relion Insulin Syringe/U-100/0.3ML/30G Restore Silver Dressing 2"X2", 15 rocuronium bromide, 32

Restore Silver Dressing 4"X4" Non- ropinirole ER, 30 X 5/16", 48 Relion Insulin Syringe/U-100/0.3ML/31G ropinirole HCL, 30 adhesive, 15 Restore Silver Dressing 4"X4.75", 15 ropivacaine, 37 X 15/64", 48 Relion Insulin Syringe/U-100/0.3ML/31G Restore Silver Dressing 4"X5" Contact ropivacaine HCL, 37

Ropivacaine Hydrochloride, 38 X 5/16", 48 Layer, 15 Relion Insulin Syringe/U-100/0.5ML/29G Restore Silver Dressing 6"X8" Contact Ropivacaine Hydrochloride/Sodium

X 1/2", 48 Layer, 15 Chloride, 38 Relion Insulin Syringe/U-100/0.5ML/30G, Restore Silver Dressing 6"X8" Non- rosadan, 12

Rosadan Kit, 12 48 adhesive, 15 rosanil cleanser, 11 Sandostatin, 20 sertraline HCL, 28 rosuvastatin calcium, 11 Sandostatin Lar Depot, 20 setlakin, 17

Rotarix, 40 Saphris, 28 sevelamer carbonate, 23

Rotateq, 40 sash kit for flushing vascular access SF, 27

Rowasa, 23 SF 5000 plus, 27 devices, 25 roweepra, 30 Sash Kit For Flushing Vascular Access Sfrowasa, 23

Roxicodone, 36 sharobel, 17 Devices, 26 Rozerem, 29 Savaysa, 26 Shingrix, 40

Rtd Wound Care Dressing 2" X 2", 15 Savella, 31 Shohls Solution Modified, 24

Rtd Wound Care Dressing 4" X 4", 15 Savella Titration Pack, 31 Shopko Unifine Pentips Pen

Rtd Wound Care Dressing 4" X 5", 15 SB aspirin, 35 Needles/Micro/32GX4MM, 48 Rubraca, 7 SB aspirin adult low strength, 35 Shopko Unifine Pentips Pen

Ruconest, 26 SB aspirin EC, 35 Needles/Mini/31GX5MM, 48 Rulavite DHA, 43 SB bisacodyl laxative EC, 21 Shopko Unifine Pentips Pen

Ryanodex, 32 SB childrens aspirin, 35 Needles/Original/29GX12MM, 48 Rydapt, 7 SB gentle LAX-women, 21 Shopko Unifine Pentips Pen

Rytary, 30 SB gentle laxative womens, 21 Needles/SHORT/31GX8MM, 48 Rythmol, 9 SB Insulin Syringe/U-100/0.5ML/29G X Shopko Unifine Pentips Plus Pen

Rythmol SR, 9 1/2", 49 Needles/Micro/Removr/32GX4MM, 48 S SB Insulin Syringe/U-100/0.5ML/30G X Shopko Unifine Pentips Plus Pen

5/16", 49 Needles/Mini/Remover/31GX5MM, 49 Sabril, 30 SB Insulin Syringe/U-100/1ML/29G X Shopko Unifine Pentips Plus Pen Safesnap Insulin Syringe/0.3ML/30G X

1/2", 49 Needles/Remover/29GX12MM, 49 5/16", 48 SB Insulin Syringe/U-100/1ML/30G X Shopko Unifine Pentips Plus Pen Safesnap Insulin Syringe/0.5ML/29G X

5/16", 49 Needles/SHORT/Removr/31GX8MM, 49 1/2", 48 SB Insulin Syringe/U-100/1ML/31G X Shur-seal, 24

Safesnap Insulin Syringe/0.5ML/30G X Siderol, 43 5/16", 49 5/16", 48 SB low dose asa EC, 35 Signifor, 20 Safesnap Insulin Syringe/1ML/28G X SB magnesium citrate, 21 Sil-k Pad/Large, 15

1/2", 48 SB polyethylene glycol 3 350, 21 Sil-k Pad/Medium, 15 Safesnap Insulin Syringe/1ML/29G X scalacort, 13 Sil-k Pad/Small, 15

1/2", 48 Scalacort DK, 13 sildenafil, 11

Safety Insulin Syringes 0.5ML/29GX1/2", Scarlet Red Dressing, 15 sildenafil citrate, 11

48 Schnucks Insulin Syringe Ulti-fine/U- Silenor, 29 Safety Insulin Syringes Siliq, 12 100/0.5ML/29G X 1/2", 48 0.5ML/30GX5/16", 48 Schnucks Insulin Syringe Ulti-fine/U- Simbrinza, 33 Safety Insulin Syringes 1ML/27GX1/2", Simcor, 11 100/0.5ML/30G X 5/16", 48 48 Sclerosol Intrapleural, 39 Similac Prenatal Early Shield, 41

Safety Insulin Syringes 1ML/29GX1/2", scopolamine, 22 Simponi, 37

48 Sculptra, 15 Simponi Aria, 37 Safety Insulin Syringes 1ML/30GX1/2", Se-natal 19, 42 Simulect, 6

48 Se-tan DHA, 42 simvastatin, 11 Safety-glide Insulin Syringe/0.3ML/29G X se-tan plus, 25 Sinemet, 30

1/2", 48 Seasonique, 18 Sinemet CR, 30

Safyral, 18 seb-prev wash, 13 Singulair, 39 Saizen, 20 Sebuderm, 15 sirolimus, 6 Saizen Click.easy, 20 Seconal, 29 Sirturo, 2

Saizenprep Reconstitutionkit, 20 Seconal Sodium, 29 Sitavig, 3 salacyn, 14 Sectral, 8 Sivextro, 4 Salagen, 27 Select-OB, 43 Skelaxin, 32

Salex, 15 Select-ob+dha, 43 Sklice, 15 Salex Cream, 15 selegiline HCL, 30 Skyla, 17 Salex Lotion, 15 selenium sulfide, 13 sm aspirin, 35 salicylic acid, 14 selenium sulfide shampoo, 13 sm aspirin adult low strength, 35 salicylic acid cream, 14 Selrx, 13 sm aspirin EC low strength, 35 salicylic acid lotion, 14 Selzentry, 3 sm aspirin enteric coated, 35 salicylic acid wart remover, 14 Semprex-d, 39 sm childrens aspirin, 35 salimez, 14 Sensipar, 20 sm clearlax, 21 Salimez Forte, 15 sensorcaine, 37 sm folic acid, 24 salisol forte, 14 sensorcaine-mpf, 37 sm gentle laxative, 21 salitech forte, 14 sensorcaine-mpf spinal, 37 Sm Insulin Syringe/1ML/31G X 5/16", 49 Salivamax, 27 sensorcaine-mpf/epinephrine, 37 sm magnesium citrate, 21

Salivate RX, 27 Sensorcaine-mpf/Epinephrine, 38 sm nicotine, 31 salsalate, 35 sensorcaine/epinephrine, 37 sm nicotine polacrilex, 31 Salvax, 15 Serevent Diskus, 39 sm nicotine transdermal system, 31

Salvax Duo Plus, 15 Seroquel, 28 sm nicotine transdermal system/step Samsca, 20 Seroquel XR, 28 1/clear, 31 Sancuso, 22 Serostim, 20 sm nicotine transdermal system/step

Sandimmune, 6

2/clear, 31 sprintec 28, 17 Support, 43 sm nicotine transdermal system/step Spritam, 30 Support-500, 43

Sprix, 37 Supprelin LA, 19 3/clear, 31 Sm One Daily Prenatal, 41 Sprycel, 7 Suprax, 1 sm prenatal vitamins, 41 sps, 51 Suprep Bowel Prep Kit, 21

Sm Prenatal Vitamins, 41 SR nicotine gum, 31 Sure Comfort Insulin Syringe/U- sm vitamin d, 40 sronyx, 17 100/0.3ML/29G X 1/2", 49 sm vitamin d3, 40 sss 10%-5%, 11 Sure Comfort Insulin Syringe/U-

Sm Vitamin D3 Maximum Strength, 41 st joseph aspirin, 35 100/0.3ML/30G X 1/2", 49 sm womans laxative, 21 st joseph low dose aspirin, 35 Sure Comfort Insulin Syringe/U- smooth LAX, 21 Stalevo 100, 30 100/0.3ML/30G X 5/16", 49 Sodium Bicarbonate, 21 Stalevo 125, 30 Sure Comfort Insulin Syringe/U- sodium chloride, 24, 38 Stalevo 150, 30 100/0.3ML/31G X 5/16, 49 sodium chloride 0.9%, 24 Stalevo 200, 30 Sure Comfort Insulin Syringe/U- sodium citrate/citric acid, 24 Stalevo 50, 30 100/0.3ML/31G X 5/16", 49 Sodium Diuril, 10 Stalevo 75, 30 Sure Comfort Insulin Syringe/U-

Sodium Edecrin, 10 Stamaril, 40 100/0.3ML/31GX1/4", 49 sodium ferric gluconate complex/sucrose, Starlix, 18 Sure Comfort Insulin Syringe/U-

stavudine, 3 25 100/0.5ML/28G X 1/2", 49 sodium fluoride, 50 Stelara, 13, 23 Sure Comfort Insulin Syringe/U-

Sodium Fluoride, 51 Sterile Talc Powder, 39 100/0.5ML/29G X 1/2", 49 Sodium Nitrite, 51 Stimate, 20 Sure Comfort Insulin Syringe/U- sodium nitroprusside, 9 stimulant laxative, 21 100/0.5ML/30G X 1/2", 49 sodium phenylacetate/sodium benzoate, Stiolto Respimat, 39 Sure Comfort Insulin Syringe/U-

Stivarga, 7 20 100/0.5ML/30G X 5/16", 49 sodium phenylbutyrate, 20 Strattera, 29 Sure Comfort Insulin Syringe/U- sodium polystyrene sulfonate, 51 Strensiq, 20 100/0.5ML/31G X 5/16, 49 sodium sulfacetamide, 11, 13, 32 Streptomycin Sulfate, 2 Sure Comfort Insulin Syringe/U- sodium sulfacetamide wash, 13 Striant, 16 100/1ML/28G X 1/2", 49 Sodium Sulfacetamide Wash, 13 Stribild, 3 Sure Comfort Insulin Syringe/U- sodium sulfacetamide/sulfur, 11 Striverdi Respimat, 39 100/1ML/29G X 1/2", 49 sodium sulfacetamide/sulfur cleanser, 11 Stromectol, 4 Sure Comfort Insulin Syringe/U-

Sodium Sulfacetamide/Sulfur Cleanser IN Strovite Forte, 43 100/1ML/30G X 1/2", 49 Strovite One, 43 Sure Comfort Insulin Syringe/U- Urea, 12 sodium sulfacetamide/sulfur green, 11 Stuart One, 41 100/1ML/30G X 5/16", 49 Sodium Sulfacetamide/Sulfur IN Urea, 11 Sublimaze, 36 Sure Comfort Insulin Syringe/U- sodium sulfacetamide/sulfur wash, 11 Suboxone, 36 100/1ML/31G X 5/16", 49 Sodium Thiosulfate, 51 Subsys, 36 Sure Comfort Insulin Syringes/0.5ML/31G

Solaraze, 13 Sucraid, 22 X 6MM, 49 Soliqua 100/33, 19 sucralfate, 22 Sure Comfort Insulin Syringes/U-

Soliris, 26 sufentanil citrate, 36 100/1ML/31GX6MM, 49 Soltamox, 6 Sufentanil Citrate, 36 Sure Comfort Pen Needles 29GX1/2"

Solu-cortef, 15 Sular, 8 12.7MM, 49 Solu-medrol, 15 sulfacetamide sodium, 11, 32 Sure Comfort Pen Needles 30GX5/16"

Soma, 32 Sulfacetamide Sodium, 32 SHORT, 49 Somatuline Depot, 20 sulfacetamide sodium/prednisolone Sure Comfort Pen Needles 31GX3/16"

Somavert, 20 sodium phosphate, 33 (5MM), 49 Sonata, 29 sulfacetamide sodium/sulfur, 11 Sure Comfort Pen Needles 31GX5/16"

Soolantra, 12 sulfacetamide sodium/sulfur cleanser, 11 (8MM), 49 Sorbitol, 24 sulfacleanse 8/4, 11 Sure Comfort Pen Needles 32GX5/32",

Sorbitol-mannitol, 24 Sulfadiazine, 2 49 Soriatane, 12 sulfamethoxazole/trimethoprim, 4 Sure Comfort Pen Needles 32GX6MM, sorine, 8 sulfamethoxazole/trimethoprim DS, 4 49 sotalol HCL, 8 sulfasalazine, 23 Sure-fine Pen Needles 29GX1/2" sotalol HCL (AF), 8 sulfatrim pediatric, 4 12.7MM, 49 Sotalol Hydrochloride, 8 Sulfurated Lime, 15 Sure-fine Pen Needles 31GX3/16" 5MM, sotalol hydrochloride (AF), 8 sulindac, 36 49 Sotylize, 8 Sumadan Kit, 12 Sure-fine Pen Needles 31GX5/16" 8MM,

Sovaldi, 4 sumatriptan, 37 49 Spectracef, 1 sumatriptan succinate, 37 Sure-ject Insulin Syringe/U-

Spinosad, 14 Sumatriptan Succinate, 37 100/0.3ML/29G X 1/2", 49 Spinraza, 31 sumatriptan succinate refill, 37 Sure-ject Insulin Syringe/U-

Spiriva Handihaler, 39 Sumaxin CP Kit, 12 100/0.3ML/30G X 5/16", 49 Spiriva Respimat, 39 Supartz, 32 Sure-ject Insulin Syringe/U- spironolactone, 10 Supartz Fx, 32 100/0.3ML/31G X 5/16", 49 spironolactone/hydrochlorothiazide, 10 Super Daily D3, 41 Sure-ject Insulin Syringe/U-

Sporanox, 3 Supervite, 43 100/0.5ML/28G X 1/2", 49 Sporanox Pulsepak, 3 Supervite EC, 43 Sure-ject Insulin Syringe/U-100/0.

5ML/29G X 1/2", 49 Taron-c DHA, 43 testosterone topical solution, 16

Sure-ject Insulin Syringe/U- taron-crystals, 24 Testred, 16

Taron-prex, 42 Tetanus/Diphtheria Toxoids-adsorbed, 100/0.5ML/30G X 5/16", 49 Sure-ject Insulin Syringe/U- Tasigna, 6 39 Tasmar, 30 tetcaine, 33 100/0.5ML/31G X 5/16", 49 Sure-ject Insulin Syringe/U-100/1ML/28G Taxotere, 6 tetrabenazine, 31

Taytulla, 18 tetracaine HCL, 33 X 1/2", 49 Sure-ject Insulin Syringe/U-100/1ML/29G tazarotene, 12 tetracycline HCL, 2

tazicef, 1 Tetracycline HCL, 2 X 1/2", 49 Sure-ject Insulin Syringe/U-100/1ML/30G Tazicef, 1 tetracycline hydrochloride, 2

Tazorac, 12 tetravisc, 33 X 5/16", 49 Sure-ject Insulin Syringe/U-100/1ML/31G taztia XT, 8 tetravisc forte, 33

Tecentriq, 5 Tgq 15DM/5PEH/2CPM, 39 X 5/16", 49 Surmontil, 28 Tecfidera, 31 Tgq 30PSE/150GFN/15DM, 39

Survanta Intratracheal, 39 Tecfidera Starter Pack, 31 Tgq 30PSE/3BRM/15DM, 39

Sustiva, 3 Techlite Pen Needles 29G X 10MM, 49 tgt aspirin, 35

Sustol, 22 Techlite Pen Needles 29G X 12 MM, 49 tgt aspirin low dose, 35

Sutent, 7 Techlite Pen Needles 31G X 5MM, 49 tgt childrens aspirin, 35 sw clearlax, 21 Techlite Pen Needles/31G X 5MM, 49 tgt enteric-coated aspirin, 35 sw nicotine polacrilex, 31 Techlite Pen Needles/31G X 6 MM, 49 tgt gentle laxative, 21 syeda, 17 Techlite Pen Needles/31G X 8MM, 49 tgt nicotine gum, 31

Sylatron, 7 Techlite Pen Needles/32G X 4MM, 49 tgt nicotine polacrilex, 31

Symax Duotab, 22 Techlite Pen Needles/32G X 6MM, 49 tgt nicotine step one, 31 symax-SR, 22 Techlite Pen Needles/32G X 8MM, 49 tgt nicotine step three, 31

Symbicort, 39 Technivie, 3 tgt nicotine step two, 31

Symbyax, 31 Tegaderm AG Mesh Dressing With Silver tgt powderlax, 21

Symlinpen 120, 18 tgt womens laxative, 21 2"X2", 15 Symlinpen 60, 18 Tegaderm AG Mesh Dressing With Silver Thalomid, 6

Symproic, 23 Theo-24, 39 4"X5", 15 Synagex, 43 Tegaderm AG Mesh Dressing With Silver theochron, 39

Synagis, 51 theophylline, 39 4"X8", 15 Synalgos-dc, 36 Tegaderm AG Mesh Dressing With Silver theophylline CR, 39

Synarel, 19 theophylline ER, 39 8"X8", 15 Synatek, 43 Tegretol, 30 Theophylline/D5W, 39

Syndros, 22 Tegretol-XR, 30 thera-d 2000, 40

Synera, 15 Tekturna, 9 Thera-d 4000, 41

Synercid, 4 Tekturna HCT, 10 thera-d rapid repletion, 40

Synjardy, 19 telmisartan, 9 thera-d sport, 40

Synjardy XR, 19 telmisartan/amlodipine, 9 Thera-flur-n, 27

Synribo, 7 telmisartan/hydrochlorothiazide, 10 Theracys, 7

Synthroid, 20 temazepam, 29 thiamine HCL, 41 synvexia, 14 Temodar, 5 Thiola, 24

Synvexia Tc, 15 temozolomide, 5 thioridazine HCL, 28

Synvisc, 32 Tencon, 35 thiotepa, 5

Synvisc One, 32 Tenex, 9 thiothixene, 28

Syprine, 51 Teniposide, 6 thrive, 31

Tenivac, 39 Thrivite 19, 43 T Tenoretic 100, 10 Thrivite RX, 43 Tabloid, 5 Tenoretic 50, 10 Thrombate Iii, 27 tacrolimus, 6, 13 Tenormin, 8 Thrombate Iii W/10 ML Sterile Water, 27

Tafinlar, 7 Tepadina, 5 Thrombate Iii W/20 ML Sterile Water, 27 Tagrisso, 7 Terazol 3, 24 Thrombin-jmi Diluent, 26 take action, 17 Terazol 7, 24 Thrombin-jmi Epistaxis, 26

Taltz, 13 terazosin HCL, 9 Thrombin-jmi Syringe Spray Kit, 26 Talwin, 36 terbinafine HCL, 2 Thrombin-jmi W/Dil Spray P.M. Actuator, Tamiflu, 3 terbutaline sulfate, 39 26 tamoxifen citrate, 6 terconazole, 24 Thrombogen, 26 tamsulosin HCL, 24 Tersi Foam, 13 Thymoglobulin, 6 Tandem F, 25 Tessalon Perles, 39 Thyrolar-1, 20

Tandem Plus, 25 Testim, 16 Thyrolar-1/2, 20 Tanzeum, 18 Testone Cik, 16 Thyrolar-1/4, 20 Tapazole, 21 Testopel, 16 Thyrolar-2, 20

Tarceva, 7 testosterone, 16 Thyrolar-3, 20 Targadox, 2 Testosterone, 16 tiagabine hydrochloride, 30 Targretin, 7, 13 testosterone cypionate, 16 Tiazac, 8 tarina FE 1/20, 17 testosterone enanthate, 16 Tice Bcg, 7 Tarka, 10 testosterone P.M., 16 Tigan, 22 Taron Forte, 25 Testosterone P.M., 16 Tigecycline, 4

Taron-bc, 43

Tikosyn, 9 Syringe/1ML/30G X 5/16", 49 tri-sprintec, 17 tilia FE, 17 Topcare Ultra Comfort Insulin Tri-TABS DHA, 43

Timolol Maleate, 8 Tri-VI-flor, 43 Syringe/1ML/31G X 5/16", 49 timolol maleate, 33 Topcare Ultra Comfort Insulin Syringe/U- Tri-VI-floro, 43 timolol maleate ophthalmic gel forming, tri-vit/fluoride, 42 100/0.3ML/29G X 1/2", 49 Topcare Ultra Comfort Insulin Syringe/U- Tri-vit/Fluoride/Iron, 43 33 Timoptic, 33 tri-vitamin/fluoride, 42 100/0.5ML/29G X 1/2", 49 Timoptic Ocudose, 33 Topcare Ultra Comfort Insulin Syringe/U- Triadvance, 42

Timoptic-xe, 33 triamcinolone acetonide, 13, 38 100/1ML/29G X 1/2", 49 Tindamax, 4 Topco Insulin Syringe/U-100/0.3ML/29G triamcinolone acetonide dental paste, 27 tinidazole, 4 triamterene/hydrochlorothiazide, 10 X 1/2", 49 Tirosint, 21 Topco Insulin Syringe/U-100/0.5ML/28G Triamterene/Hydrochlorothiazide, 10

Tisseel, 26 triazolam, 29 X 1/2", 49 Tisseel VH, 26 Topco Insulin Syringe/U-100/0.5ML/29G Triazolam, 29

Tivicay, 3 Tribenzor, 10 X 1/2", 49 tizanidine HCL, 32 Topco Insulin Syringe/U-100/1ML/28G X Tricare, 42 tizanidine hydrochloride, 32 Tricare Prenatal Compleat, 43 1/2", 49 TL Folate, 43 Topco Insulin Syringe/U-100/1ML/29G X Tricare Prenatal DHA One, 43

TL G-FOL OS, 43 Tricitrasol, 26 1/2", 49 TL gard RX, 25 topex topical anesthetic, 27 tricitrates, 24

TL icon, 25 topiramate, 30 tricon, 25

TL-care DHA, 43 Topiramate ER, 30 Tricor, 11

TL-fluorivite, 43 toposar, 6 triderm, 13

TL-hem 150, 25 topotecan HCL, 7 Triesence, 33

TL-select, 43 Topotecan HCL, 7 Triferic, 25

Tnkase, 27 Toprol XL, 8 trifluoperazine HCL, 28

Tobi, 2 Torisel, 7 trifluridine, 32

Tobi Podhaler, 2 torsemide, 10 trigels-f forte, 25

Tobradex, 33 Totect, 7 Triglide, 11

Tobradex ST, 33 Toujeo Solostar, 18 trihexyphenidyl HCL, 30 tobramycin, 2, 32 Toviaz, 24 triklo, 11

Tobramycin, 2 Tracleer, 11 Trileptal, 30 tobramycin inhalation solution PAK, 2 Tradjenta, 19 Trilipix, 11 tobramycin sulfate, 2, 32 tramadol HCL, 35 trilyte, 21

Tobramycin Sulfate, 2 tramadol HCL ER, 35 trimethobenzamide HCL, 22 tobramycin/dexamethasone, 33 tramadol hydrochloride/acetaminophen, trimethoprim, 4

Tobrex, 32 trimethoprim sulfate/polymyxin b sulfate, 35 Today Sponge, 24 trandolapril, 9 32 Todays Health Mini Pen Needles 31G X trandolapril/verapamil HCL ER, 10 trimipramine maleate, 28

tranexamic acid, 26 Trimpex, 4 1/4", 49 Todays Health Original Pen Needles 29G Transderm-scop, 22 Trinatal GT, 43

Tranxene T, 27 Trinatal RX 1, 42 X 1/2", 49 Todays Health SHORT Pen Needles 31G tranylcypromine sulfate, 28 Trinate, 42

Travatan Z, 33 trinessa, 17 X 5/16", 49 Tofranil, 28 Travoprost, 33 trinessa LO, 17

Tofranil-PM, 28 trazodone HCL, 28 Trintellix, 28

Tolazamide, 18 Treanda, 5 Triostat, 21

Tolbutamide, 18 Trecator, 2 triphrocaps, 42 tolcapone, 30 Trelegy Ellipta, 39 Triple Complex Formula 3 Kit, 12 tolmetin sodium, 36 Trelstar, 6 Triple Pmb, 33

Tolmetin Sodium, 36 Trelstar Mixject, 6 Triple Pmk, 33 tolterodine tartrate, 23 Tremfya, 13 triple-vitamin/fluoride, 42 tolterodine tartrate ER, 23 Tresiba Flextouch, 18 Triptodur, 19

Topamax, 30 tretinoin, 7, 11 Trisenox, 7

Topamax Sprinkle, 30 tretinoin microsphere, 11 Tristart DHA, 43

Topcare Clickfine Universal Pen Eedles tretinoin microsphere P.M., 11 Tristart One, 43

Tretten, 26 Triumeq, 3 31GX1/4", 49 Topcare Clickfine Universal Pen Eedles Trexall, 5 Triveen-duo DHA, 43

Trezix, 36 Triveen-prx RNF, 43 31GX5/16", 49 Topcare Ultra Comfort Insulin tri femynor, 17 trivora-28, 17

tri-estarylla, 17 Trizivir, 3 Syringe/0.3ML/30G X 5/16", 49 Topcare Ultra Comfort Insulin tri-legest FE, 17 Trokendi XR, 30

tri-linyah, 17 tropicamide, 33 Syringe/0.3ML/31G X 5/16", 49 Topcare Ultra Comfort Insulin tri-LO-estarylla, 17 trospium chloride, 23

tri-LO-marzia, 17 trospium chloride ER, 23 Syringe/0.5ML/30G X 5/16", 49 Topcare Ultra Comfort Insulin tri-LO-sprintec, 17 Trueplus Insulin Syringe/U-

Tri-norinyl 28, 18 Syringe/0.5ML/31G X 5/16", 49 100/0.3ML/29G X 1/2", 49 Topcare Ultra Comfort Insulin tri-previfem, 17 Trueplus Insulin Syringe/U-100/0.

3ML/30G X 5/16", 49 1/2", 49 Ulticare Pen Needles 31G X 5MM/Mini,

Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.3ML/30G X 49 Ulticare Pen Needles/29G X 12.7MM, 50 100/0.3ML/31G X 5/16", 49 5/16", 49 Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/28G X Ulticare SHORT Pen Needles 31GX8MM,

100/0.5ML/28G X 1/2", 49 1/2", 49 50 Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/29G X Ulticare SHORT Pen Needles Ulti-fine IV,

100/0.5ML/29G X 1/2", 49 1/2", 49 50 Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/30G X Ulticare SHORT Pen Needles/31G X

100/0.5ML/30G X 5/16", 49 1/2", 49 8MM, 50 Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/30G X Ulticare U-100 Insulin

100/0.5ML/31G X 5/16", 49 5/16", 49 Syringes/0.3ML/31G X 1/4", 50 Trueplus Insulin Syringe/U-100/1ML/28G Ulticare Insulin Syringe/1ML/28G X 1/2", Ulticare U-100 Insulin

X 1/2", 49 49 Syringes/0.3ML/31G X1/4", 50 Trueplus Insulin Syringe/U-100/1ML/29G Ulticare Insulin Syringe/1ML/29G X 1/2", Ulticare U-100 Insulin

X 1/2", 49 49 Syringes/0.5ML/31G X 1/4", 50 Trueplus Insulin Syringe/U-100/1ML/30G Ulticare Insulin Syringe/1ML/30G X 1/2", Ulticare U-100 Insulin Syringes/1ML/31G

X 5/16", 49 49 X 1/4", 50 Trueplus Insulin Syringe/U-100/1ML/31G Ulticare Insulin Syringe/1ML/30G X 5/16", Ultiguard Insulin Syringe/U-

X 5/16", 49 49 100/0.5ML/30G X 5/16", 50 Trueplus Pen Needles 29GX12MM, 49 Ulticare Insulin Ultiguard Insulin Syringe/U-100/1ML/30G

Trueplus Pen Needles 31GX5MM, 49 Syringe/SHORT/0.3ML/30G X 5/16", 49 X 5/16", 50 Trueplus Pen Needles 31GX6MM, 49 Ulticare Insulin Ultilet Insulin Syringe 31X6MM, 50

Trueplus Pen Needles 31GX8MM, 49 Ultilet Insulin Syringe/0.3ML/30G X 8MM, Syringe/SHORT/0.3ML/31G X 5/16", 49 Trueplus Pen Needles 32GX4MM, 49 Ulticare Insulin 50 Trulance, 23 Ultilet Insulin Syringe/0.3ML/31G X 8MM, Syringe/SHORT/0.5ML/30G X 5/16", 49 Trulicity, 18 Ulticare Insulin 50 Trumenba, 40 Ultilet Insulin Syringe/0.5ML/30G X 8MM, Syringe/SHORT/0.5ML/31G X 5/16", 49 Trusopt, 34 Ulticare Insulin Syringe/SHORT/1ML/30G 50 Truvada, 3 Ultilet Insulin Syringe/1ML/30G X 8MM, X 5/16", 49 Tudorza Pressair, 39 Ulticare Insulin Syringe/SHORT/1ML/31G 50 Tussicaps, 39 Ultilet Insulin Syringe/1ML/31G X 8MM, X 5/16", 49 tussigon, 38 Ulticare Insulin Syringe/U-100/0.3ML/29G 50 Tussionex Pennkinetic Extended Ultilet Insulin Syringe/SHORT/0.3ML/30G X 1/2", 49 Ulticare Insulin Syringe/U-100/0.3ML/30G Release, 39 X 12.7MM, 50 Tuzistra XR, 39 Ultilet Insulin Syringe/SHORT/0.3ML/30G X 1/2", 49 Twinrix, 40 Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16", 50 Twynsta, 10 Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16", 49 Tybost, 3 Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16", 50 Tygacil, 4 Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16", 49 Tykerb, 7 Ulticare Insulin Syringe/U-100/0.5ML/29G X 5/16", 50 Tylenol/Codeine #3, 36 Ultilet Insulin Syringe/SHORT/0.5ML/31G X 1/2", 49 Tylenol/Codeine #4, 36 Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16", 50 Tymlos, 19 Ultilet Insulin Syringe/SHORT/1ML/30G X X 1/2", 49 Typhim VI, 40 Ulticare Insulin Syringe/U-100/0.5ML/30G 5/16", 50 Tysabri, 31 Ultilet Insulin Syringe/SHORT/1ML/31G X X 5/16", 49 Tyvaso, 11 Ulticare Insulin Syringe/U-100/0.5ML/31G 5/16", 50 Tyvaso Refill, 11 Ultilet Insulin Syringe/U-100/0.5ML/30G X X 5/16", 49 Tyvaso Starter, 11 Ulticare Insulin Syringe/U-100/1ML/29G X 1/2", 50 Tyzeka, 3 Ultilet Insulin Syringe/U- 1/2", 49 Tyzine Pediatric Nasal Drops, 38 Ulticare Insulin Syringe/U-100/1ML/30G X 100/0.5ML/31GX6MM, 50 Ultilet Insulin Syringe/U-100/1ML/30G X U 1/2", 49 Ulticare Insulin Syringe/U-100/1ML/30G X 1/2", 50 Uceris, 15, 23 Ultilet Pen Needle 29GX12.7MM, 50 5/16", 49 Udamin SP, 43 Ulticare Insulin Syringe/U-100/1ML/31G X Ultilet Pen Needle 31GX5MM, 50 Ulesfia, 15 Ultilet Pen Needle 31GX8MM, 50 5/16", 49 Uloric, 37 Ulticare Micro Pen Needles 31G X 8MM, Ultilet Pen Needle 32GX4MM, 50

Ulticare Insulin Safety Syringe/0.5ML/29G Ultilet Pen Needle 32GX4MM/SHORT, 49 X 1/2", 49 Ulticare Micro Pen Needles 32G X 4MM, 50 Ulticare Insulin Safety Syringe/1ML/29G Ultilet SHORT Pen Needles 31GX5/16", 49 X 1/2", 49 Ulticare Micro Pen Needles/32G X 4MM, 50 Ulticare Insulin Syringe Ultrafine U- Ultilet SHORT Pen Needles31GX3/16", 49 100/0.3ML/31G X 5/16", 49 Ulticare Mini Pen Needles 31GX6MM, 49 50 Ulticare Insulin Syringe Ultrafine U- Ulticare Mini Pen Needles Ulti-fine IV, 49 Ultilet U-100 Insulin Syringes/1ML/31G X

100/0.5ML/31G X 5/16", 49 Ulticare Mini Pen Needles/31G X 6MM, 6MM, 50 Ulticare Insulin Syringe Ultrafine U- Ultimatecare One, 42 49 100/1ML/31G X 5/16", 49 Ulticare Mini Pen Needles31GX6MM, 49 Ultimatecare One NF, 42 Ulticare Insulin Syringe/0.3ML/29G X Ulticare Original Pen Needles Ulti-fine, Ultiva, 36

1/2", 49 Ultra Comfort Insulin Syringe/U-100/0. 49 Ulticare Insulin Syringe/0.3ML/30G X

3ML/30G X 5/16", 50 unithroid, 20 valacyclovir HCL, 3

Ultra-comfort Insulin Syringe/U- unithroid direct, 20 Valchlor, 5, 13

Unituxin, 6 Valcyte, 3 100/0.3ML/29G X 1/2", 50 Ultra-comfort Insulin Syringe/U- Upspringbaby Vitamin D3, 41 valganciclovir, 3

Uptravi, 11 valganciclovir hydrochlorde, 3 100/0.3ML/30G X 5/16", 50 Ultra-comfort Insulin Syringe/U- ur n-c, 23 Valium, 27

Uramaxin, 15 valproate sodium, 30 100/0.3ML/31G X 5/16", 50 Ultra-comfort Insulin Syringe/U- uramit mb, 23 valproic acid, 30

ure-39, 14 valsartan, 9 100/0.5ML/28G X 1/2", 50 Ultra-comfort Insulin Syringe/U- ure-k, 14 valsartan/hydrochlorothiazide, 10

urea, 14 Valstar, 5 100/0.5ML/29G X 1/2", 50 Ultra-comfort Insulin Syringe/U- urea 40% nail film, 14 Valtrex, 3

urea hydrating, 14 Value Health Insulin Syringe/U- 100/0.5ML/30G X 5/16", 50 Ultra-comfort Insulin Syringe/U- Urea IN Zinc Undecylenate/Lactic Acid 100/0.5ML/29G X 1/2", 50 Value Health Insulin Syringe/U- 100/0.5ML/31G X 5/16", 50 Vehicle, 14 Ultra-comfort Insulin Syringe/U- urea nail, 14 100/1ML/29G X 1/2", 50 Urea Nail, 15 Valumark Pen Needles 29GX12MM, 50 100/1ML/28G X 1/2", 50 Ultra-comfort Insulin Syringe/U- urea nail gel, 14 Valumark Pen Needles 31G X 6MM, 50

Urea Nail Kit, 15 Valumark Pen Needles 31G X 8MM, 50 100/1ML/29G X 1/2", 50 Ultra-comfort Insulin Syringe/U- Urea Topical, 14 Vanatol LQ, 35

urea-c40, 14 Vanatol S, 35 100/1ML/30G X 5/16", 50 Ultra-comfort Insulin Syringe/U- Urecholine, 24 Vancocin HCL, 4

uremez-40, 14 Vancomycin, 4 100/1ML/31G X 5/16", 50 Ultra-thin II Insulin Syringe SHORT/U- uretron d/s, 23 vancomycin HCL, 4

uribel, 23 Vancomycin HCL, 4 100/0.3ML/30GX5/16", 50 Ultra-thin II Insulin Syringe SHORT/U- Urimar-t, 23 Vancomycin HCL IN Dextrose, 4

urin d/s, 23 Vancomycin HCL/Sodium Chloride, 4 100/0.3ML/31GX5/16", 50 Ultra-thin II Insulin Syringe SHORT/U- uro-458, 23 Vancomycin Hydrochloride/Dextrose, 4

uro-blue, 23 Vancomycin Hydrochloride/Sodium 100/0.5ML/30GX5/16", 50 Ultra-thin II Insulin Syringe SHORT/U- uro-l, 23 Chloride, 4 uro-mp, 23 vandazole, 24 100/0.5ML/31GX5/16", 50 Ultra-thin II Insulin Syringe SHORT/U- uroav-81, 23 Vanishpoint Insulin Syringe/0.5ML/30G X

uroav-b, 23 100/1ML/30GX5/16", 50 1/2", 50 Ultra-thin II Insulin Syringe SHORT/U- Urocit-k 10, 24 Vanishpoint Insulin Syringe/0.5ML/30G X

Urocit-k 15, 24 100/1ML/31GX5/16", 50 3/16", 50 Ultra-thin II Insulin Syringe/U- Urocit-k 5, 24 Vanishpoint Insulin Syringe/0.5ML/30G X

Urogesic-blue, 23 100/0.3ML/29GX1/2", 50 5/16", 50 Ultra-thin II Insulin Syringe/U- urolet mb, 23 Vanishpoint Insulin Syringe/1ML/29G X

urophen mb, 23 100/0.5ML/29GX1/2", 50 1/2", 50 Ultra-thin II Insulin Syringe/U- urosex, 42 Vanishpoint Insulin Syringe/1ML/29G X

Uroxatral, 24 100/1ML/29GX1/2", 50 5/16", 50 Ultra-thin II Mini Pen Urso 250, 23 Vanishpoint Insulin Syringe/1ML/30G X

Urso Forte, 23 Neeedles/31GX3/16", 50 3/16", 50 Ultra-thin II Pen Needles 29GX1/2", 50 ursodiol, 23 Vanishpoint Insulin Syringe/1ML/30G X

Ultra-thin II Pen uryl, 23 5/16", 50 ustell, 23 vanoxide-HC, 11 Needles/SHORT/31GX5/16", 50 Ultracet, 36 uta, 23 Vantas, 6

Ultram, 36 Utibron Neohaler, 39 Vaprisol, 20

Ultram ER, 36 uticap, 23 Vaqta, 40

Ultravate X, 13 utira-c, 23 Varivax, 40

Ultresa, 22 utrona-c, 23 Varizig, 51 umecta mousse, 14 Uvadex, 7 Varubi, 22

Umecta PD, 15 Vascepa, 11 V Unasyn, 1 Vascuderm Stasis Kit, 15 v-c forte, 42 Unasyn Bulk Pack, 1 Vaseretic, 10 V-r Monoject Insulin Syringe/U- Unifine Pentips 29GX12MM, 50 Vasostrict, 20

Unifine Pentips 31G X 3/16", 50 100/0.3ML/29G X 1/2", 50 Vasotec, 9 V-r Monoject Insulin Syringe/U- Unifine Pentips 31G X 6MM, 50 Vaxchora, 40

Unifine Pentips 31G X 8MM, 50 100/0.5ML/28G X 1/2", 50 Vazculep, 10

V-r Monoject Insulin Syringe/U- Unifine Pentips 31GX5MM, 50 Vcf Vaginal Contraceptive Film, 24

Unifine Pentips 31GX6MM, 50 100/0.5ML/29G X 1/2", 50 Vcf Vaginal Contraceptive Foam, 24 V-r Monoject Insulin Syringe/U- Unifine Pentips 31GX8MM, 50 vcf vaginal contraceptivegel, 24

Unifine Pentips 32GX4MM, 50 100/1ML/28G X 1/2", 50 Vecamyl, 9 V-r Monoject Insulin Syringe/U- Unifine Pentips Plus 29GX12MM, 50 Vectibix, 6

Unifine Pentips Plus 31GX5MM, 50 100/1ML/29G X 1/2", 50 Vectical, 12

Vabomere, 4 Unifine Pentips Plus 31GX6MM, 50 vecuronium bromide, 32 Vacustim Black, 15 Unifine Pentips Plus 31GX8MM, 50 Velcade, 7 Vacustim Silver, 15 Unifine Pentips Plus 32GX4MM, 50 Veletri, 11

Vagifem, 24

velivet, 17 vinorelbine tartrate, 6 Vitapearl, 43

Velphoro, 23 Viokace, 22 Vitaroca Plus, 43

Veltassa, 51 viorele, 17 Vitekta, 3

Veltrix, 15 Viracept, 3 Viva DHA, 43

Vemavite-prx 2, 43 Viramune, 3 Vivelle-dot, 16

Vemlidy, 3 Viramune XR, 3 Vivitrol, 51

Vena-bal DHA, 43 Virasal, 15 Vivotif, 40

Venelex, 15 Virazole, 4 Vogelxo, 16 venlafaxine HCL, 28 Viread, 3 Vogelxo P.M., 16 venlafaxine HCL ER, 28 Viroptic, 32 vol-care RX, 42

Venofer, 25 Virt Nate, 43 Vol-nate, 43

Ventavis, 11 Virt-advance, 43 Vol-plus, 43

Ventolin HFA, 39 Virt-c DHA, 43 Vol-TAB RX, 43 veracolate, 21 virt-CAPS, 42 Voltaren, 12

Veramyst, 38 virt-gard, 25 Voluven, 27 verapamil HCL, 8 Virt-nate DHA, 43 Vonvendi, 26 verapamil HCL ER, 8 Virt-pn, 43 Vopac Kt, 12 verapamil HCL SR, 8 Virt-pn DHA, 43 Vopac Mds, 12 verdrocet, 35 Virt-pn Plus, 43 Voraxaze, 7

Veregen, 15 Virt-select, 43 voriconazole, 3

Verelan, 8 virt-vite, 25 Vosevi, 4

Verelan PM, 8 Virt-vite GT, 43 Vospire ER, 39

Veripred 20, 15 virt-vite plus, 42 Votrient, 7

Versacloz, 28 Virtprex, 43 Vp Gkl Kit, 12

Verzenio, 6 virtrate-2, 24 Vp Insulin Syringe/U-100/0.3ML/29G X

Vesicare, 23 virtrate-3, 24 1/2", 50 vestura, 17 virtrate-k, 24 Vp-CH Plus, 43

Vexol, 33 Vistaril, 27 Vp-CH-PNV, 43

Vfend, 3 Vistogard, 51 Vp-ggr-b6 Prenatal, 43

Vfend IV, 3 vita s forte, 42 Vp-heme OB, 43

Vibativ, 4 vita-min, 42 Vp-heme OB + DHA, 43

Viberzi, 23 Vita-pren, 43 Vp-heme One, 43

Vibramycin, 2 Vita-RX Diabetic Vitamin, 43 Vp-PNV-DHA, 43 vic-forte, 42 vitacel, 42 vp-vite RX, 42 vicodin, 35 Vitafol, 43 Vp-zel, 43 vicodin ES, 35 Vitafol Ultra, 43 Vpriv, 25 vicodin HP, 35 Vitafol-nano, 43 Vraylar, 28

Vicoprofen, 36 Vitafol-OB, 42 Vusion, 12

Victoza, 18 Vitafol-ob+dha, 43 vyfemla, 17

Victrelis, 4 Vitafol-one, 43 Vytorin, 11

Vida Mia Unifine Pentips 32GX4MM, 50 vitajoy daily d gummies, 40 Vyvanse, 29

Vida Mia Unifine Pentips Mini 31GX6MM, Vital-d RX, 43 Vyxeos, 7

vitamax pediatric, 42 Vyzulta, 33 50 Vida Mia Unifine Pentips Original Vitamedmd One RX/Quatrefolic, 43 W Vitamedmd Plus RX/Quatre Folic, 43 29GX12MM, 50 warfarin sodium, 25 Vida Mia Unipfine Pentipsshort Vitamedmd Redichew RX, 43 Wegmans Unifine Pentips Plus Vitamelts Vitamin D, 41 31GX8MM, 50 Vidaza, 5 vitamez, 25 32GX4MM, 50 Wegmans Unifine Pentips Videx EC, 3 vitamin d, 40

Videx Pediatric, 3 vitamin d 400, 40 Plus/Mini/31GX5MM, 50

Wegmans Unifine Pentips Viekira PAK, 3 vitamin d high potency, 40

Viekira XR, 3 vitamin d-1000, 41 Plus/SHORT/31GX8MM, 50 Wegmans Unifine Pentips Plus/Ultra vienva, 17 vitamin d-1000 maximum strength, 41

vigabatrin, 30 vitamin d-3, 41 SHORT/31GX6MM, 50 Welchol, 11 Vigamox, 32 vitamin d-400, 41 Wellbutrin, 28 Viibryd, 28 Vitamin D2, 41

Wellbutrin SR, 28 Viibryd Starter Pack, 28 vitamin d3, 41 Wellbutrin XL, 28 vilamit mb, 23 Vitamin D3, 41 Wellesse Vitamin D3, 41 vilevev mb, 23 vitamin d3 400, 41

wera, 17 Vimizim, 20 vitamin d3 adult gummies, 41 Westhroid, 21 Vimpat, 30 vitamin d3 gummies, 41 Wheat Germ, 41 Vinate DHA RF, 43 vitamin d3 high potency, 41

Wilate, 26 Vinate II, 42 vitamin d3 maximum strength, 41 Winrho SDF, 51 Vinate M, 42 vitamin d3 super strength, 41 womans laxative, 21 Vinate One, 42 vitamin d3 ultra potency, 41

women's gentle laxative, 21 Vinblastine Sulfate, 6 vitamin k1, 41 womens laxative, 21 vincasar PFS, 6 Vitamin K1, 41 Wound Debridement, 15 vincristine sulfate, 6 vitamins a/c/d/fluoride, 42

Wp Thyroid, 21

wymzya FE, 17 Xultophy 100/3.6, 19 Zinacef, 1

Xuriden, 20 Zinbryta, 31 X

Xylocaine, 9, 15, 38 Zinecard, 7

Xadago, 30 xylocaine dental, 37 Zingo, 37

Xalatan, 33 Xylocaine-mpf, 38 Zinplava, 51

Xalix, 15 Xylocaine-mpf/Epinephrine, 38 Zioptan, 33

Xalkori, 7 Xylocaine/Epinephrine, 38 ziprasidone HCL, 28

Xanax, 27 xylon, 35 Zirgan, 32

Xanax XR, 27 Xyntha, 26 Zithranol, 12

Xarelto, 26 Xyntha Solofuse, 26 Zithranol-rr, 12

Xarelto Starter Pack, 26 xyphex, 14 Zithromax, 2

Xartemis XR, 36 Xyrem, 31 Zithromax Tri-PAK, 2

Xeljanz, 37 Zithromax Z-PAK, 2 Y

Xeljanz XR, 37 Zmax, 2

Yasmin 28, 18 Xeloda, 5 Zocor, 11 Yaz, 18 Xenazine, 31 Zodex 6-day, 15 Yervoy, 6 Xeomin, 32 Zofran, 22

Yf-vax, 40 Xerac Ac, 15 Zofran Odt, 22 yl folic acid, 24 Xermelo, 23 Zohydro ER, 36 Yondelis, 5 Xeroform Non-occlusive Oil Emulsion Zoladex, 6

Your Life Multi Prenatal, 41

Gauze Strip 5"X9", 15 Zolate, 25 yuvafem, 24 Xeroform Non-occlusive Oil Emulsion zoledronic acid, 19 Z

Patch 2"X2", 15 Zoledronic Acid, 19

Xeroform Non-occlusive Oil Emulsion Roll Zolinza, 7 Zacare 4% Kit, 12

4"X9", 15 zolmitriptan, 37 Zacare 8% Kit, 12

Xeroform Non-occlusive Oil Emulsion zolmitriptan odt, 37 zafirlukast, 39

Strip/Overwrap 1"X8", 15 Zoloft, 28 zaleplon, 29

Xeroform Occlusive Petrolatum Gauze zolpidem tartrate, 29 Zaltrap, 5

Roll 4"X9', 15 zolpidem tartrate ER, 29 Zamicet, 36

Xeroform Occlusive Petrolatum Gauze Zolpimist, 29 Zanaflex, 32

Strip 1"X8", 15 Zometa, 19 Zanosar, 5

Xeroform Occlusive Petrolatum Gauze Zomig, 37 Zantac, 22

Strip 5"X9", 15 Zomig ZMT, 37 zarah, 17

Xeroform Occlusive Petrolatum Gauze Zonalon, 12 Zarontin, 30

Strip/Overwrap 1"X8", 15 Zonatuss, 39 Zarxio, 25

Xeroform Occlusive Petrolatum Gauze Zonegran, 30 Zatean-CH, 43

Strip/Overwrap 5"X9", 15 zonisamide, 30 Zatean-pn DHA, 43

Xeroform Occlusive Petroltum Gauze Zontivity, 26 Zatean-pn Plus, 43

Patch 2"X2", 15 Zorbtive, 20 Zavesca, 25

Xeroform Occlusive Petroltum Gauze Zortress, 6 zazole, 24

Patch 4"X4", 15 Zostavax, 40 Zebeta, 8 Xeroform Petrolatum Dressing, 15 Zosyn, 1 zebutal, 35

Xeroform Petrolatum Dressing Overwrap zovia 1/35e, 17 Zejula, 7

1"X8", 15 zovia 1/50e, 17 Zelapar, 30

Xeroform Petrolatum Dressing Overwrap Zovirax, 3, 12 Zelboraf, 7

5"X9", 15 Zubsolv, 36 Zemaira, 39

Xeroform Petrolatum Dressing Roll Zuplenz, 22 Zemplar, 20

4"X3YD, 15 Zurampic, 37 Zemuron, 32

Xgeva, 19 Zutripro, 39 zenatane, 11 Xhance, 38 Zyban, 31 zenchent, 17 Xifaxan, 4 Zydelig, 7 zenchent FE, 17

Xigduo XR, 19 Zyflo, 39 zencia, 11 Xiidra, 34 Zyflo CR, 39 Zenpep, 22 Xilapak, 13 Zykadia, 7 zenzedi, 29

Ximino, 2 Zylet, 33 Zenzedi, 29 Xodol, 36 Zyloprim, 37 Zepatier, 4 Xofigo, 7 Zymaxid, 32 Zerbaxa, 4

Xolair, 39 Zyprexa, 28 Zerit, 3 Xolegel, 12 Zyprexa Relprevv, 29 zeruvia, 14 Xolegel Corepak, 12 Zyprexa Zydis, 28 Zestoretic, 10

Xolegel Duo/Head & Shoulders, 12 Zytiga, 6 Zestril, 9 Xolegel Duo/Xolex, 12 Zyvox, 4 Zetia, 11 Xopenex, 39 Zetonna, 38 1

Xopenex Concentrate, 39 Zevalin Y-90, 6 Xopenex HFA, 39 1ST Tier Unifine Pentips /Mini/31GX5MM, Ziac, 10

Xtampza ER, 36 50 Ziagen, 3 1ST Tier Unifine Pentips 29GX12MM, 50 Xtandi, 6 zidovudine, 3 1ST Tier Unifine Pentips 31GX6MM, 50 Xulane, 17 zileuton ER, 39 1ST Tier Unifine Pentips 31GX8MM, 50

1ST Tier Unifine Pentips 32GX4MM, 50

1ST Tier Unifine Pentips Plus 31GX8MM,

50 1ST Tier Unifine Pentips Plus 32GX4MM,

50 1ST Tier Unifine Pentips

Plus/Mini/31GX5MM, 50 1ST Tier Unifine Pentips

Plus/Original/29GX12MM, 50 1ST Tier Unifine Pentips Plus/Ultra

SHORT/31GX6MM, 50 8

8-mop, 12