2021 Essential Complete Formulary

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Arkansas Blue Cross and Blue Shield Essential Complete Formulary

Effective 07/01/2021

INTRODUCTION ...... 4 PREFACE ...... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...... 4 DRUG LIST PRODUCT DESCRIPTIONS...... 4 GENERIC SUBSTITUTION ...... 5 PLAN DESIGN ...... 6 LEGEND ...... 6 ANALGESICS ...... 7 ANALGESICS, OTHER ...... 7 NSAIDs ...... 7 GOUT ...... 7 OPIOID ANALGESICS ...... 7 ANTI-INFECTIVES ...... 8 ANTIBACTERIALS ...... 9 ANTIFUNGALS ...... 10 ANTITUBERCULAR AGENTS ...... 10 ANTIVIRALS ...... 10 MISCELLANEOUS ...... 10 ANTINEOPLASTIC AGENTS ...... 11 ALKYLATING AGENTS ...... 11 ANTIMETABOLITES ...... 11 HORMONAL ANTINEOPLASTIC AGENTS...... 11 MISCELLANEOUS ...... 12 CARDIOVASCULAR ...... 12 ACE INHIBITORS ...... 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 12 ACE INHIBITOR/DIURETIC COMBINATIONS ...... 12 ADRENOLYTICS, CENTRAL ...... 12 ALDOSTERONE RECEPTOR ANTAGONISTS ...... 13 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ...... 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ...... 13 ANTIARRHYTHMICS ...... 13 ANTILIPEMICS ...... 13 BETA-BLOCKERS ...... 14 BETA-BLOCKER/DIURETIC COMBINATIONS...... 14 CALCIUM CHANNEL BLOCKERS ...... 15 DIGITALIS GLYCOSIDES ...... 15 DIURETICS ...... 15 HEART FAILURE ...... 16 NITRATES ...... 16 MISCELLANEOUS ...... 16 CENTRAL NERVOUS SYSTEM ...... 16 ANTIANXIETY ...... 16 ANTICONVULSANTS ...... 16 ANTIDEMENTIA...... 17 ANTIDEPRESSANTS ...... 17 ANTIPARKINSONIAN AGENTS ...... 18 ANTIPSYCHOTICS ...... 19 ATTENTION DEFICIT HYPERACTIVITY DISORDER ...... 19 FIBROMYALGIA ...... 19 HYPNOTICS ...... 20 MIGRAINE ...... 20

MOOD STABILIZERS ...... 20 MUSCULOSKELETAL THERAPY AGENTS ...... 20 MYASTHENIA GRAVIS ...... 20 NARCOLEPSY ...... 21 PSYCHOTHERAPEUTIC-MISCELLANEOUS ...... 21 MISCELLANEOUS ...... 21 ENDOCRINE AND METABOLIC ...... 21 ANDROGENS ...... 21 ANTIDIABETICS ...... 21 CALCIUM REGULATORS ...... 23 CONTRACEPTIVES ...... 24 ENDOMETRIOSIS ...... 25 GLUCOCORTICOIDS ...... 25 GLUCOSE ELEVATING AGENTS ...... 25 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ...... 25 MENOPAUSAL SYMPTOM AGENTS ...... 26 PHOSPHATE BINDER AGENTS ...... 26 PROGESTINS ...... 26 SELECTIVE ESTROGEN RECEPTOR MODULATORS ...... 26 THYROID AGENTS ...... 26 VASOPRESSINS ...... 27 MISCELLANEOUS ...... 27 GASTROINTESTINAL ...... 27 ANTIDIARRHEALS ...... 27 ANTIEMETICS ...... 27 ANTISPASMODICS ...... 27 CHOLELITHOLYTICS ...... 27 H2 RECEPTOR ANTAGONISTS ...... 27 INFLAMMATORY BOWEL DISEASE ...... 28 IRRITABLE BOWEL SYNDROME ...... 28 LAXATIVES ...... 28 OPIOID-INDUCED CONSTIPATION ...... 28 PANCREATIC ENZYMES ...... 28 PROSTAGLANDINS ...... 28 PROTON PUMP INHIBITORS ...... 28 SALIVA STIMULANTS ...... 28 STEROIDS, RECTAL ...... 29 MISCELLANEOUS ...... 29 GENITOURINARY ...... 29 BENIGN PROSTATIC HYPERPLASIA ...... 29 URINARY ANTISPASMODICS ...... 29 VAGINAL ANTI-INFECTIVES ...... 29 MISCELLANEOUS ...... 29 HEMATOLOGIC ...... 29 ANTICOAGULANTS ...... 29 PLATELET AGGREGATION INHIBITORS ...... 30 PLATELET SYNTHESIS INHIBITORS ...... 30 MISCELLANEOUS ...... 30 IMMUNOLOGIC AGENTS ...... 30 ALLERGENIC EXTRACTS ...... 30 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ...... 30 IMMUNOSUPPRESSANTS ...... 30 NUTRITIONAL/SUPPLEMENTS ...... 31 ELECTROLYTES ...... 31 VITAMINS AND MINERALS ...... 31 RESPIRATORY ...... 31 ANAPHYLAXIS TREATMENT AGENTS ...... 31 ANTICHOLINERGICS ...... 31 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ...... 32

ANTIHISTAMINES, LOW SEDATING ...... 32 ANTIHISTAMINES, NONSEDATING ...... 32 ANTIHISTAMINES, SEDATING ...... 32 ANTIHISTAMINE/DECONGESTANT COMBINATIONS ...... 32 ANTITUSSIVES ...... 32 ANTITUSSIVE COMBINATIONS ...... 32 BETA AGONISTS ...... 32 LEUKOTRIENE MODULATORS ...... 33 NASAL ANTIHISTAMINES ...... 33 NASAL STEROIDS ...... 33 STEROID/BETA AGONIST COMBINATIONS ...... 33 STEROID INHALANTS ...... 33 XANTHINES ...... 33 MISCELLANEOUS ...... 33 TOPICAL ...... 33 DERMATOLOGY ...... 33 MOUTH/THROAT/DENTAL AGENTS ...... 36 OPHTHALMIC ...... 36 OTIC ...... 38 WEBSITES ...... 39 INDEX ...... 41

INTRODUCTION We are pleased to provide the 2021 Arkansas Blue Cross and Blue Shield Essential Complete Formulary as a useful reference and informational tool. This document can assist practitioners in selecting clinically appropriate and cost-effective products for their patients.

The drugs represented have been reviewed by a National Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The document is reflective of current medical practice as of the date of review.

The information contained in this document and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This document is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in the document is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber.

The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable.

We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.

National guidelines can be found on the National Guideline Clearinghouse site at https://www.ahrq.gov/gam/, on the websites listed under each therapeutic class and on the sites listed in the Websites section of this publication.

PREFACE The document is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless the cited drug is available as an injectable or an exception is specifically noted, generally, all applicable dosage forms and strengths of the drug cited are included in the document.

Drugs represented in this document may have varying cost to the plan member based on the plan's benefit structure. Some prescription benefit plan designs may alter coverage of certain products or vary copay amounts based on the condition being treated. Generic medications typically are available at the lower cost, brand-name medications on the document will generally cost more than generics. Generics should be considered the first line of prescribing subject to applicable rules. PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The services of an independent National Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of clinical professionals from across the United States. The P&T Committee's voting members include physicians, pharmacists, a pharmacoeconomist and a medical ethicist, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Employees with significant clinical expertise are invited to meet with the P&T Committee, but no employee may vote on issues before the P&T Committee. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.

Arkansas Blue Cross will utilize the services of the independent National P&T Committee as well as internal pharmacy and medical advisory committees to direct formulary decisions as it relates to our benefit certificates and policies. DRUG LIST PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms on the document are covered, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the document. Any exceptions are noted.

Listed products on the document generally include all strengths and all oral dosage forms of the cited product. escitalopram Lexapro Oral tablets, oral solution and all strengths of Lexapro would be included in this listing.

Nasal sprays require a separate entry. sumatriptan nasal spray Imitrex

Oral disintegrating tablets require a separate entry. prednisolone sodium phosphate orally disintegrating tabs Orapred ODT

Injectable dosage forms require a separate entry. sumatriptan inj Imitrex

When a strength or dosage form is specified, only the specified strength and dosage form is on the document. Other strengths/dosage forms, including injectable dosage forms of the reference product are not. gabapentin caps, tabs Neurontin The capsule and tablet formulations are listed on the document, but the oral solution is not.

Extended-release and delayed-release products require their own entry. lamotrigine Lamictal The immediate-release product listing of Lamictal alone would not include the extended-release product Lamictal XR.

lamotrigine ext-rel Lamictal XR A separate entry for Lamictal XR confirms that the extended-release product is on the document.

Dosage forms on the document will be consistent with the category and use where listed.

nystatin The above nystatin entry listed in the TOPICAL/DERMATOLOGY section is limited to the topical dosage forms. From this entry the oral formulations cannot be assumed to be on the list unless there is an entry for this product in the ANTI- INFECTIVES section of the document.

GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product to the market. However, the document is subject to state specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate.

Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:

• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs. • Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. • Manufactured in the same strength and dosage form as the brand-name drugs.

When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence).

Prescription Drug Tiers Tier Drug Type* Tier 1 Preferred generics (drugs listed in lowercase on formulary) Tier 2 Non-preferred generics (generic drugs not listed on the formulary)

Tier 3 Brand (brand drugs listed in all CAPS on the formulary)

* Brand name drugs not listed on the formulary are not covered.

PLAN DESIGN The document represents a closed formulary plan design. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity. If a medication is not listed on the document, a formulary exception may be requested for coverage. Medical necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria.

Individual pharmacy benefit plans may impose restrictions or not reimburse some products. In addition, over-the- counter (OTC) products, with the exception of insulin and diabetic monitoring products, are usually not included in the pharmacy benefit. If covered in the pharmacy benefit, OTC products require a valid prescription. OTC products are listed for informational purposes.

Log in to www.arkansasbluecross.com to check coverage. LEGEND † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

ANALGESICS Practice guidelines of pain management are available at: https://www.asahq.org

ANALGESICS, OTHER Treatment recommendations for osteoarthritis are available at: https://www.rheumatology.org

OTC acetaminophen TYLENOL

NSAIDs diclofenac potassium diclofenac sodium delayed-rel diclofenac sodium ext-rel diflunisal etodolac flurbiprofen ibuprofen OTC ibuprofen ADVIL ketoprofen 50 mg, 75 mg ketorolac ketorolac inj meloxicam MOBIC nabumetone naproxen delayed-rel EC-NAPROSYN OTC naproxen sodium ALEVE naproxen sodium tabs naproxen tabs oxaprozin DAYPRO piroxicam FELDENE sulindac tolmetin

GOUT allopurinol ZYLOPRIM colchicine COLCRYS probenecid

OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO analgesic ladder) are available at: https://www.asahq.org https://www.nccn.org

Opioid guidelines in the management of chronic non-malignant pain are available at: https://www.asipp.org/ASIPP-Guidelines.html

LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 7

The quantity of opioid products prescribed (including those that are combined with acetaminophen, aspirin or ibuprofen) will be limited to up to 90 morphine milligram equivalents (MME) per day based on a 30-day supply. Members who are opioid-naïve will be required to use an immediate-release (IR) formulation before moving to an extended-release (ER) formulation and will be subject to quantity limit restrictions.

QL, PA, * buprenorphine BELBUCA QL, PA, * buprenorphine transdermal BUTRANS QL, PA codeine sulfate QL codeine/acetaminophen PA, QL fentanyl lozenge ACTIQ QL, PA, * fentanyl transdermal DURAGESIC QL hydrocodone/acetaminophen QL, PA hydromorphone DILAUDID QL, PA methadone DOLOPHINE QL, PA morphine QL, PA, * morphine ext-rel QL, PA, * morphine ext-rel MS CONTIN QL, PA morphine supp QL, PA oxycodone ROXICODONE QL, PA, * oxycodone ext-rel XTAMPZA ER QL oxycodone/acetaminophen PERCOCET QL, PA tramadol 50 mg ULTRAM QL, PA, * tramadol ext-rel tabs

* Initial PA may apply to higher strengths

ANTI-INFECTIVES Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: https://www.idsociety.org

Hepatitis: CDC recommendations on the treatment of hepatitis are available at: https://www.cdc.gov/hepatitis/Resources/

Guidelines for the management of chronic hepatitis by the American Association for the Study of Liver Disease are available at: https://www.aasld.org

HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: https://www.aidsinfo.nih.gov

Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: https://professional.heart.org

Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 8

International Travel: CDC recommendations for international travel are available at: https://wwwnc.cdc.gov/travel

Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: https://www.cdc.gov/pneumonia/management-prevention-guidelines.html

Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: https://www.cdc.gov/std/treatment/default.htm

ANTIBACTERIALS Cephalosporins First Generation cefadroxil cephalexin KEFLEX

Second Generation cefprozil cefuroxime axetil

Third Generation cefdinir cefpodoxime VANTIN

Erythromycins/Macrolides azithromycin ZITHROMAX clarithromycin clarithromycin ext-rel erythromycin delayed-rel erythromycin ethylsuccinate E.E.S. erythromycin stearate ERYTHROCIN PA fidaxomicin DIFICID

Fluoroquinolones ciprofloxacin CIPRO levofloxacin moxifloxacin

Penicillins amoxicillin amoxicillin/clavulanate AUGMENTIN amoxicillin/clavulanate ext-rel ampicillin dicloxacillin penicillin VK LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 9

Tetracyclines doxycycline hyclate VIBRAMYCIN doxycycline hyclate tabs 20 mg, 100 mg doxycycline monohydrate susp VIBRAMYCIN minocycline MINOCIN tetracycline

ANTIFUNGALS clotrimazole troches fluconazole DIFLUCAN griseofulvin microsize itraconazole SPORANOX nystatin terbinafine tabs PA voriconazole VFEND

ANTITUBERCULAR AGENTS capreomycin CAPASTAT SULFATE cycloserine ethambutol MYAMBUTOL ethionamide TRECATOR isoniazid pyrazinamide rifampin RIFADIN rifapentine PRIFTIN † streptomycin sulfate inj

ANTIVIRALS Herpes Agents acyclovir ZOVIRAX famciclovir valacyclovir VALTREX

Influenza Agents QL, PA oseltamivir TAMIFLU

MISCELLANEOUS atovaquone MEPRON clindamycin CLEOCIN dapsone ivermectin STROMECTOL PA linezolid ZYVOX † linezolid inj ZYVOX mebendazole EMVERM metronidazole FLAGYL LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 10

nitrofurantoin ext-rel MACROBID nitrofurantoin macrocrystals MACRODANTIN praziquantel BILTRICIDE rifabutin MYCOBUTIN PA rifaximin 550 mg XIFAXAN sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS tinidazole trimethoprim QL vancomycin VANCOCIN

ANTINEOPLASTIC AGENTS Clinical practice guidelines in oncology are available at: https://www.asco.org https://www.nccn.org

Most oncology medications are eligible for coverage and some may require prior authorization. Please call the Customer Care phone number located on the member ID card for coverage determination.

ALKYLATING AGENTS busulfan MYLERAN chlorambucil LEUKERAN cyclophosphamide caps estramustine EMCYT lomustine GLEOSTINE melphalan ALKERAN

ANTIMETABOLITES mercaptopurine thioguanine TABLOID

HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens bicalutamide flutamide nilutamide NILANDRON

Antiestrogens/Selective Estrogen Receptor Modifiers tamoxifen toremifene FARESTON

Aromatase Inhibitors anastrozole ARIMIDEX exemestane AROMASIN letrozole FEMARA

Progestins megestrol acetate

MISCELLANEOUS etoposide caps hydroxyurea HYDREA mitotane LYSODREN procarbazine MATULANE tretinoin caps

CARDIOVASCULAR The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is available at: https://jamanetwork.com/journals/jama/fullarticle/1791497

Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: https://www.acc.org https://professional.heart.org

ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org https://www.acc.org https://professional.heart.org

captopril enalapril VASOTEC lisinopril ZESTRIL perindopril ramipril ALTACE trandolapril

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/benazepril LOTREL

ACE INHIBITOR/DIURETIC COMBINATIONS captopril/hydrochlorothiazide enalapril/hydrochlorothiazide VASERETIC lisinopril/hydrochlorothiazide ZESTORETIC

ADRENOLYTICS, CENTRAL clonidine CATAPRES clonidine transdermal CATAPRES-TTS

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone INSPRA spironolactone ALDACTONE

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org

irbesartan AVAPRO irbesartan/hydrochlorothiazide AVALIDE losartan COZAAR losartan/hydrochlorothiazide HYZAAR olmesartan BENICAR olmesartan/hydrochlorothiazide BENICAR HCT valsartan DIOVAN valsartan/hydrochlorothiazide DIOVAN HCT

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan AZOR olmesartan/amlodipine/hydrochlorothiazide TRIBENZOR

ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: https://www.acc.org

acebutolol amiodarone amiodarone - Pacerone disopyramide NORPACE disopyramide ext-rel NORPACE CR flecainide ibutilide CORVERT propafenone propafenone ext-rel RYTHMOL SR sotalol BETAPACE sotalol BETAPACE AF

ANTILIPEMICS The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol is available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

Bile Acid Resins cholestyramine QUESTRAN/QUESTRAN LIGHT colestipol COLESTID LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 13

Cholesterol Absorption Inhibitors ezetimibe ZETIA

Fibrates fenofibrate TRICOR fenofibrate caps 67 mg, 134 mg, 200 mg gemfibrozil LOPID

HMG-CoA Reductase Inhibitors atorvastatin LIPITOR pravastatin PRAVACHOL rosuvastatin CRESTOR simvastatin ZOCOR

Niacins niacin ext-rel NIASPAN

Omega-3 Fatty Acids icosapent ethyl VASCEPA

BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

atenolol TENORMIN bisoprolol carvedilol COREG labetalol TRANDATE metoprolol 25 mg, 50 mg, 100 mg LOPRESSOR metoprolol ext-rel TOPROL-XL nadolol CORGARD pindolol propranolol propranolol ext-rel INDERAL LA

BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

atenolol/chlorthalidone TENORETIC bisoprolol/hydrochlorothiazide ZIAC metoprolol/hydrochlorothiazide propranolol/hydrochlorothiazide LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 14

CALCIUM CHANNEL BLOCKERS Guidelines for the use of calcium channel blockers in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

Dihydropyridines amlodipine NORVASC felodipine ext-rel isradipine nicardipine nifedipine ext-rel nifedipine ext-rel PROCARDIA XL

Nondihydropyridines diltiazem ext-rel CARDIZEM CD diltiazem ext-rel CARDIZEM LA diltiazem ext-rel TIAZAC verapamil ext-rel CALAN SR verapamil ext-rel VERELAN verapamil ext-rel VERELAN PM

DIGITALIS GLYCOSIDES digoxin LANOXIN digoxin ped elixir

DIURETICS Loop Diuretics bumetanide furosemide LASIX torsemide

Potassium-sparing Diuretics amiloride

Thiazides and Thiazide-like Diuretics chlorthalidone hydrochlorothiazide indapamide metolazone

Diuretic Combinations amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide ALDACTAZIDE triamterene/hydrochlorothiazide MAXZIDE triamterene/hydrochlorothiazide caps LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 15

HEART FAILURE ivabradine CORLANOR sacubitril/valsartan ENTRESTO

NITRATES Oral isosorbide dinitrate 5 mg, 10 mg, 20 mg, 30 mg ISORDIL isosorbide mononitrate isosorbide mononitrate ext-rel

Sublingual nitroglycerin sublingual NITROSTAT

Transdermal nitroglycerin transdermal NITRO-DUR

MISCELLANEOUS hydralazine methyldopa midodrine ranolazine ext-rel RANEXA

CENTRAL NERVOUS SYSTEM Practice guidelines for psychiatric disorders are available at: https://www.psychiatry.org

ANTIANXIETY Benzodiazepines QL alprazolam XANAX QL alprazolam orally disintegrating tabs QL clorazepate TRANXENE T-TAB QL diazepam VALIUM QL lorazepam ATIVAN QL oxazepam

Miscellaneous buspirone fluvoxamine

ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: https://www.aan.com

carbamazepine TEGRETOL

carbamazepine ext-rel TEGRETOL-XR PA clobazam ONFI QL clonazepam tabs KLONOPIN divalproex sodium delayed-rel DEPAKOTE divalproex sodium ext-rel DEPAKOTE ER divalproex sodium sprinkle caps DEPAKOTE SPRINKLE ethosuximide ZARONTIN felbamate FELBATOL gabapentin caps, tabs NEURONTIN lamotrigine LAMICTAL lamotrigine ext-rel LAMICTAL XR levetiracetam KEPPRA levetiracetam ext-rel KEPPRA XR oxcarbazepine TRILEPTAL phenobarbital phenytoin chewable tabs DILANTIN INFATABS phenytoin sodium extended DILANTIN phenytoin susp DILANTIN primidone MYSOLINE tiagabine GABITRIL topiramate TOPAMAX topiramate sprinkle caps TOPAMAX SPRINKLE CAPS valproic acid zonisamide ZONEGRAN

ANTIDEMENTIA Practice guidelines for the management of dementia are available at: https://www.aan.com

donepezil ARICEPT donepezil orally disintegrating tabs galantamine galantamine ext-rel RAZADYNE ER memantine NAMENDA rivastigmine rivastigmine transdermal EXELON PATCH

ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder.

Guidelines for the evaluation and management of bipolar and depressive disorders are available at: https://www.psychiatry.org

Monoamine Oxidase Inhibitors (MAOIs) phenelzine NARDIL LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 17

tranylcypromine PARNATE

Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram CELEXA escitalopram LEXAPRO fluoxetine PROZAC paroxetine HCl ext-rel PAXIL CR paroxetine HCl tabs PAXIL sertraline ZOLOFT

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) desvenlafaxine succinate ext-rel PRISTIQ duloxetine delayed-rel CYMBALTA venlafaxine venlafaxine ext-rel EFFEXOR XR

Tricyclic Antidepressants (TCAs) amitriptyline desipramine NORPRAMIN doxepin imipramine HCl nortriptyline PAMELOR

Miscellaneous Agents bupropion bupropion ext-rel WELLBUTRIN SR bupropion ext-rel WELLBUTRIN XL mirtazapine REMERON mirtazapine orally disintegrating tabs REMERON SOLTAB trazodone

ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: https://www.aan.com

amantadine benztropine bromocriptine PARLODEL carbidopa/levodopa SINEMET carbidopa/levodopa ext-rel carbidopa/levodopa orally disintegrating tabs carbidopa/levodopa/entacapone STALEVO entacapone COMTAN pramipexole MIRAPEX rasagiline mesylate AZILECT ropinirole LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 18

selegiline trihexyphenidyl

ANTIPSYCHOTICS Atypicals aripiprazole ABILIFY † aripiprazole lauroxil ext-rel inj ARISTADA † aripiprazole lauroxil ext-rel inj ARISTADA INITIO asenapine SAPHRIS clozapine CLOZARIL clozapine orally disintegrating tabs olanzapine ZYPREXA paliperidone ext-rel INVEGA quetiapine SEROQUEL risperidone RISPERDAL risperidone orally disintegrating tabs ziprasidone GEODON

Miscellaneous chlorpromazine fluphenazine haloperidol trifluoperazine

ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: https://www.aacap.org https://www.aap.org

QL, PA amphetamine/dextroamphetamine mixed salts ADDERALL QL, PA amphetamine/dextroamphetamine mixed salts ext-rel ADDERALL XR QL atomoxetine STRATTERA QL, PA dexmethylphenidate FOCALIN QL, PA dextroamphetamine QL, PA dextroamphetamine ext-rel DEXEDRINE SPANSULE QL, PA methylphenidate QL, PA methylphenidate ext-rel QL, PA methylphenidate ext-rel CONCERTA QL, PA methylphenidate ext-rel RITALIN LA

FIBROMYALGIA PA milnacipran SAVELLA

HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia are available at: https://aasm.org

Benzodiazepines QL temazepam RESTORIL

Nonbenzodiazepines QL, PA ramelteon ROZEREM QL, PA zaleplon QL, PA zolpidem AMBIEN QL, PA zolpidem ext-rel AMBIEN CR

Tricyclics doxepin SILENOR

MIGRAINE Guidelines for prevention and management of migraine headaches are available at: https://www.aan.com

Selective Serotonin Agonists QL, PA naratriptan AMERGE QL, PA rizatriptan MAXALT QL, PA rizatriptan orally disintegrating tabs MAXALT-MLT QL, PA sumatriptan IMITREX QL, PA sumatriptan inj IMITREX QL, PA sumatriptan nasal spray IMITREX QL, PA zolmitriptan orally disintegrating tabs ZOMIG-ZMT QL, PA zolmitriptan tabs ZOMIG

MOOD STABILIZERS lithium carbonate lithium carbonate ext-rel tabs 300 mg LITHOBID lithium carbonate ext-rel tabs 450 mg

MUSCULOSKELETAL THERAPY AGENTS baclofen cyclobenzaprine 5 mg, 10 mg dantrolene DANTRIUM methocarbamol ROBAXIN tizanidine tabs ZANAFLEX

MYASTHENIA GRAVIS pyridostigmine MESTINON

NARCOLEPSY PA, QL armodafinil NUVIGIL PA, QL modafinil PROVIGIL

PSYCHOTHERAPEUTIC-MISCELLANEOUS Opioid Antagonists naloxone inj QL, PA naloxone nasal spray NARCAN naltrexone

Partial Opioid Agonists PA, QL buprenorphine

Partial Opioid Agonist/Opioid Antagonist Combinations QL buprenorphine/naloxone sublingual film SUBOXONE FILM QL buprenorphine/naloxone sublingual tabs

Smoking Deterrents Treating Tobacco Use and Dependence: 2008 Update-Clinical Practice Guideline is available at: https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html

bupropion ext-rel OTC nicotine polacrilex gum NICORETTE OTC nicotine transdermal NICODERM CQ varenicline CHANTIX

MISCELLANEOUS riluzole RILUTEK

ENDOCRINE AND METABOLIC ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: https://www.aace.com

PA testosterone cypionate inj DEPO-TESTOSTERONE PA testosterone enanthate inj DELATESTRYL PA testosterone gel FORTESTA PA testosterone gel 25 mg/2.5 g ANDROGEL

ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: https://professional.diabetes.org

Amylin Analogs ST, PA pramlintide SYMLINPEN

Biguanides metformin ^ metformin ext-rel

^ Listing does not include generics for FORTAMET and GLUMETZA

Biguanide/Sulfonylurea Combinations glipizide/metformin METAGLIP

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors ST, PA sitagliptin JANUVIA

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations ST, PA sitagliptin/metformin JANUMET ST, PA sitagliptin/metformin ext-rel JANUMET XR

Incretin Mimetic Agents ST, PA dulaglutide TRULICITY ST, PA liraglutide VICTOZA ST, PA semaglutide OZEMPIC ST, PA semaglutide RYBELSUS

Incretin Mimetic Agent/Insulin Combinations ST, PA lixisenatide/insulin glargine SOLIQUA

Insulins insulin aspart FIASP insulin aspart NOVOLOG insulin aspart protamine 70%/insulin aspart 30% NOVOLOG MIX 70/30 insulin detemir LEVEMIR insulin glargine BASAGLAR OTC insulin human NOVOLIN R insulin human, concentrated HUMULIN R U-500 OTC insulin isophane human NOVOLIN N OTC insulin isophane human 70%/regular 30% NOVOLIN 70/30

Insulin Sensitizers pioglitazone ACTOS

Insulin Sensitizer/Biguanide Combinations pioglitazone/metformin ACTOPLUS MET

Insulin Sensitizer/Sulfonylurea Combinations pioglitazone/glimepiride DUETACT

Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors ST, PA dapagliflozin FARXIGA ST, PA empagliflozin JARDIANCE

Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations ST, PA dapagliflozin/metformin ext-rel XIGDUO XR ST, PA empagliflozin/metformin SYNJARDY ST, PA empagliflozin/metformin ext-rel SYNJARDY XR

Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 (DPP-4) Inhibitor Combinations ST, PA empagliflozin/linagliptin GLYXAMBI

Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitor/Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations ST, PA empagliflozin/linagliptin/metformin ext-rel TRIJARDY XR

Sulfonylureas glimepiride AMARYL glipizide GLUCOTROL glipizide ext-rel GLUCOTROL XL

Supplies* *An ACCU-CHEK or ONETOUCH blood glucose meter may be provided at no charge by the manufacturer to those individuals currently using a meter other than ACCU-CHEK or ONETOUCH. For more information on how to obtain a blood glucose meter, call: 1-877-418- 4746.

OTC blood glucose monitoring kits, test strips ACCU-CHEK AVIVA PLUS STRIPS AND KITS OTC blood glucose monitoring kits, test strips ACCU-CHEK COMPACT PLUS STRIPS AND KITS OTC blood glucose monitoring kits, test strips ACCU-CHEK GUIDE STRIPS AND KITS OTC blood glucose monitoring kits, test strips ACCU-CHEK SMARTVIEW STRIPS AND KITS OTC blood glucose monitoring kits, test strips ONETOUCH ULTRA STRIPS AND KITS OTC blood glucose monitoring kits, test strips ONETOUCH VERIO STRIPS AND KITS OTC insulin syringes, needles BD insulin syringes and needles OTC lancets LANCETS

CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: https://www.aace.com https://www.nof.org

Bisphosphonates alendronate FOSAMAX ibandronate BONIVA risedronate ACTONEL

CONTRACEPTIVES EE = ethinyl estradiol

Monophasic 20 mcg Estrogen drospirenone/EE 3/20 YAZ levonorgestrel/EE 0.1/20 - Lessina norethindrone acetate/EE 1/20 norethindrone acetate/EE 1/20 and iron

25 mcg Estrogen norethindrone acetate/EE 0.8/25 and iron GENERESS FE

30 mcg Estrogen desogestrel/EE 0.15/30 - Apri drospirenone/EE 3/30 YASMIN levonorgestrel/EE 0.15/30 - Levora norethindrone acetate/EE 1.5/30 norethindrone acetate/EE 1.5/30 and iron norgestrel/EE 0.3/30 - Low-Ogestrel

35 mcg Estrogen ethynodiol diacetate/EE 1/35 - Zovia 1/35 norethindrone/EE 0.5/35 norethindrone/EE 1/35 norgestimate/EE 0.25/35

50 mcg Estrogen ethynodiol diacetate/EE 1/50

Biphasic desogestrel/EE MIRCETTE

Triphasic desogestrel/EE levonorgestrel/EE - Trivora norethindrone/EE norgestimate/EE

Extended Cycle levonorgestrel/EE 0.15/30 - Jolessa LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 24

Progestin Only norethindrone ORTHO MICRONOR

Emergency Contraception ulipristal ELLA

Injectable medroxyprogesterone acetate 150 mg/mL DEPO-PROVERA

Progestin Intrauterine Devices levonorgestrel-releasing IUD KYLEENA levonorgestrel-releasing IUD MIRENA levonorgestrel-releasing IUD SKYLA

Transdermal norelgestromin/EE - Xulane

Vaginal etonogestrel/EE ring NUVARING segesterone acetate/EE ring ANNOVERA

ENDOMETRIOSIS danazol nafarelin SYNAREL

GLUCOCORTICOIDS dexamethasone fludrocortisone hydrocortisone CORTEF methylprednisolone MEDROL prednisolone sodium phosphate prednisolone sodium phosphate orally disintegrating ORAPRED ODT tabs prednisolone syrup PRELONE prednisone

GLUCOSE ELEVATING AGENTS glucagon, human recombinant GLUCAGON EMERGENCY KIT glucagon intranasal powder BAQSIMI glucagon subcutaneous soln GVOKE

HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol (1,25-D3) ROCALTROL doxercalciferol HECTOROL paricalcitol ZEMPLAR LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 25

MENOPAUSAL SYMPTOM AGENTS Guidelines of treatment and management of hormone therapy and menopause are available at: https://www.menopause.org https://www.aace.com/files/menopause.pdf

Oral EE/norethindrone acetate FEMHRT EE/norethindrone acetate - Jinteli estradiol ESTRACE estradiol/norethindrone

Transdermal estradiol CLIMARA estradiol/levonorgestrel CLIMARA PRO

Vaginal estradiol vaginal crm ESTRACE estradiol vaginal inserts IMVEXXY

PHOSPHATE BINDER AGENTS calcium acetate caps sevelamer carbonate RENVELA

PROGESTINS Oral medroxyprogesterone acetate PROVERA norethindrone acetate AYGESTIN progesterone, micronized PROMETRIUM

Vaginal progesterone vaginal inserts ENDOMETRIN

SELECTIVE ESTROGEN RECEPTOR MODULATORS raloxifene EVISTA

THYROID AGENTS Antithyroid Agents methimazole TAPAZOLE propylthiouracil

Thyroid Supplements levothyroxine levothyroxine SYNTHROID levothyroxine - Levoxyl liothyronine CYTOMEL LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 26

VASOPRESSINS desmopressin nasal spray DDAVP desmopressin tabs DDAVP

MISCELLANEOUS cabergoline

GASTROINTESTINAL Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: https://gi.org https://www.gastro.org

ANTIDIARRHEALS diphenoxylate/atropine LOMOTIL loperamide

ANTIEMETICS QL, PA aprepitant caps EMEND dronabinol MARINOL granisetron meclizine metoclopramide REGLAN ondansetron ZOFRAN ondansetron orally disintegrating tabs prochlorperazine promethazine trimethobenzamide TIGAN

ANTISPASMODICS dicyclomine hyoscyamine sulfate LEVSIN hyoscyamine sulfate ext-rel caps hyoscyamine sulfate orally disintegrating tabs

CHOLELITHOLYTICS ursodiol ACTIGALL ursodiol URSO

H2 RECEPTOR ANTAGONISTS cimetidine OTC cimetidine TAGAMET HB famotidine PEPCID OTC famotidine PEPCID AC

INFLAMMATORY BOWEL DISEASE Oral Agents balsalazide budesonide delayed-rel caps ENTOCORT EC mesalamine delayed-rel LIALDA mesalamine ext-rel caps APRISO sulfasalazine AZULFIDINE sulfasalazine delayed-rel AZULFIDINE EN-TABS

Rectal Agents hydrocortisone enema mesalamine rectal susp ROWASA

IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation/Chronic Idiopathic Constipation linaclotide LINZESS

Irritable Bowel Syndrome with Diarrhea alosetron LOTRONEX

LAXATIVES lactulose soln peg 3350/electrolytes sodium picosulfate/magnesium oxide/citric acid CLENPIQ

OPIOID-INDUCED CONSTIPATION naloxegol MOVANTIK

PANCREATIC ENZYMES pancrelipase VIOKACE pancrelipase delayed-rel CREON

PROSTAGLANDINS misoprostol CYTOTEC

PROTON PUMP INHIBITORS lansoprazole delayed-rel PREVACID lansoprazole delayed-rel orally-disintegrating tabs PREVACID SOLUTAB omeprazole delayed-rel PRILOSEC OTC omeprazole magnesium delayed-rel PRILOSEC OTC OTC omeprazole/sodium bicarbonate ZEGERID OTC pantoprazole delayed-rel tabs PROTONIX

SALIVA STIMULANTS pilocarpine tabs SALAGEN

STEROIDS, RECTAL hydrocortisone crm ANUSOL-HC

MISCELLANEOUS AL glycopyrrolate CUVPOSA

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: https://www.auanet.org/guidelines

alfuzosin ext-rel UROXATRAL doxazosin CARDURA finasteride PROSCAR tamsulosin FLOMAX terazosin

URINARY ANTISPASMODICS oxybutynin oxybutynin ext-rel DITROPAN XL tolterodine DETROL trospium

VAGINAL ANTI-INFECTIVES clindamycin crm CLEOCIN metronidazole terconazole

MISCELLANEOUS bethanechol potassium citrate ext-rel UROCIT-K

HEMATOLOGIC ANTICOAGULANTS CHEST guidelines are available at: https://www.chestnet.org/Guidelines-and-Resources/CHEST-Guideline-Topic-Areas/Pulmonary-Vascular

Injectable enoxaparin LOVENOX

Oral rivaroxaban XARELTO warfarin

Synthetic Heparinoid-like Agents fondaparinux ARIXTRA

PLATELET AGGREGATION INHIBITORS clopidogrel PLAVIX dipyridamole dipyridamole ext-rel/aspirin prasugrel EFFIENT ticagrelor BRILINTA

PLATELET SYNTHESIS INHIBITORS anagrelide AGRYLIN

MISCELLANEOUS OTC aspirin cilostazol

IMMUNOLOGIC AGENTS ALLERGENIC EXTRACTS PA grass mixed pollen allergen extract ORALAIR

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) Guidelines for the management of rheumatic diseases are available at: https://www.rheumatology.org

hydroxychloroquine PLAQUENIL leflunomide ARAVA methotrexate penicillamine DEPEN TITRA

IMMUNOSUPPRESSANTS Antimetabolites azathioprine IMURAN mycophenolate mofetil CELLCEPT

Calcineurin Inhibitors cyclosporine SANDIMMUNE cyclosporine, modified NEORAL tacrolimus PROGRAF

Rapamycin Derivatives sirolimus RAPAMUNE

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium potassium chloride ext-rel potassium chloride ext-rel K-TAB potassium chloride liquid

VITAMINS AND MINERALS Folic Acid folic acid

Prenatal Vitamins prenatal vitamin/minerals

Miscellaneous cyanocobalamin inj ergocalciferol (D2) OTC ferrous sulfate fluoride drops, tabs multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs phytonadione MEPHYTON vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops

RESPIRATORY Guidelines to the management, prevention, or treatment of COPD and asthma are available at: https://www.aaaai.org https://ginasthma.org https://goldcopd.org https://www.nhlbi.nih.gov

The Allergy Report and guidelines for allergy-related conditions are available at: https://www.aaaai.org

ANAPHYLAXIS TREATMENT AGENTS QL, PA epinephrine EPIPEN QL, PA epinephrine EPIPEN JR. QL, PA epinephrine SYMJEPI QL, PA epinephrine auto-injector

ANTICHOLINERGICS QL ipratropium inhalation solution QL revefenacin inhalation solution YUPELRI QL tiotropium SPIRIVA LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 31

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting QL ipratropium/albuterol soln

Long Acting QL glycopyrrolate/formoterol BEVESPI AEROSPHERE QL umeclidinium/vilanterol ANORO ELLIPTA

ANTIHISTAMINES, LOW SEDATING OTC cetirizine ZYRTEC

ANTIHISTAMINES, NONSEDATING OTC fexofenadine ALLEGRA OTC loratadine CLARITIN OTC loratadine orally disintegrating tabs CLARITIN REDITABS

ANTIHISTAMINES, SEDATING cyproheptadine hydroxyzine HCl

ANTIHISTAMINE/DECONGESTANT COMBINATIONS OTC cetirizine/pseudoephedrine ext-rel ZYRTEC-D 12 HOUR OTC fexofenadine/pseudoephedrine ext-rel ALLEGRA-D OTC loratadine/pseudoephedrine ext-rel CLARITIN-D

ANTITUSSIVES Clinical practice guidelines are available at: https://journal.chestnet.org/article/S0012-3692(15)52856-0/pdf

benzonatate TESSALON

ANTITUSSIVE COMBINATIONS Opioid codeine/promethazine codeine/promethazine/phenylephrine hydrocodone/homatropine

Non-opioid dextromethorphan/promethazine

BETA AGONISTS Inhalants Short Acting QL albuterol inhalation soln QL albuterol sulfate, CFC-free aerosol LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 32

QL levalbuterol nebulizer soln concentrate XOPENEX SOLUTION

Long Acting Hand-held Active Inhalation QL olodaterol, CFC-free aerosol STRIVERDI RESPIMAT

Nebulized Passive Inhalation QL formoterol inhalation soln PERFOROMIST

LEUKOTRIENE MODULATORS montelukast SINGULAIR

NASAL ANTIHISTAMINES azelastine spray

NASAL STEROIDS flunisolide spray fluticasone spray

STEROID/BETA AGONIST COMBINATIONS QL budesonide/formoterol SYMBICORT QL fluticasone/salmeterol ADVAIR ^, QL fluticasone/salmeterol, CFC-free aerosol ADVAIR HFA ^, QL fluticasone/vilanterol BREO ELLIPTA

^ Listing does not include certain NDCs.

STEROID INHALANTS QL beclomethasone breath-activated aerosol QVAR REDIHALER QL, PA budesonide inh susp PULMICORT RESPULES QL fluticasone furoate ARNUITY ELLIPTA QL fluticasone propionate FLOVENT DISKUS QL fluticasone propionate, CFC-free aerosol FLOVENT HFA

XANTHINES theophylline ext-rel tabs

MISCELLANEOUS ipratropium spray

TOPICAL DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines

Oral isotretinoin - Claravis

Topical benzoyl peroxide crm, lotion QL, PA clindamycin gel, lotion, soln CLEOCIN T QL, PA erythromycin gel 2% QL, PA erythromycin soln erythromycin/benzoyl peroxide BENZAMYCIN sulfacetamide lotion 10% KLARON tretinoin RETIN-A tretinoin - Avita

Actinic Keratosis fluorouracil crm 4% TOLAK fluorouracil crm 5% fluorouracil soln 2%, 5% imiquimod crm ALDARA

Antibiotics QL gentamicin QL mupirocin oint silver sulfadiazine SILVADENE

Antifungals QL, PA ciclopirox LOPROX QL, PA clotrimazole QL, PA econazole QL, PA ketoconazole crm 2% QL, PA nystatin

Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: https://www.aad.org

Topical QL calcipotriene oint, soln 0.005% calcipotriene/betamethasone dipropionate ENSTILAR calcipotriene/betamethasone dipropionate TACLONEX halobetasol propionate/tazarotene DUOBRII

Antiseborrheics QL, PA ketoconazole shampoo 2% selenium sulfide lotion 2.5%

Atopic Dermatitis Guidelines for the treatment of atopic dermatitis are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines

Topical pimecrolimus ELIDEL tacrolimus PROTOPIC

Corticosteroids Low Potency QL, PA alclometasone crm, oint 0.05% QL, PA desonide crm, lotion, oint 0.05% DESOWEN QL, PA fluocinolone acetonide soln 0.01% QL, PA hydrocortisone crm 2.5% OTC hydrocortisone lotion 1%

Medium Potency QL, PA betamethasone valerate crm, lotion, oint 0.1% QL, PA desoximetasone crm 0.05% QL, PA fluocinolone acetonide crm, oint 0.025% QL, PA fluticasone propionate crm 0.05%, oint 0.005% QL, PA hydrocortisone butyrate crm, oint, soln 0.1% QL, PA hydrocortisone valerate crm, oint 0.2% QL, PA mometasone crm, lotion, oint 0.1% QL, PA triamcinolone acetonide crm, lotion 0.025% QL, PA triamcinolone acetonide crm, lotion, oint 0.1%

High Potency QL, PA amcinonide crm, lotion, oint 0.1% QL, PA betamethasone dipropionate augmented crm 0.05% DIPROLENE AF QL, PA betamethasone dipropionate augmented lotion 0.05% QL, PA betamethasone dipropionate crm, lotion, oint 0.05% QL, PA desoximetasone crm, oint 0.25%, gel 0.05% TOPICORT QL, PA fluocinonide crm, gel, oint 0.05% QL, PA fluocinonide soln 0.05% QL, PA triamcinolone acetonide crm 0.5%

Very High Potency QL, PA betamethasone dipropionate augmented gel, oint 0.05% DIPROLENE QL, PA clobetasol propionate crm, gel, oint 0.05% TEMOVATE QL, PA clobetasol propionate foam 0.05% OLUX QL, PA clobetasol propionate lotion 0.05% CLOBEX QL, PA halobetasol propionate crm, oint 0.05%

Emollients ammonium lactate 12% LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 35

Local Anesthetics PA, QL lidocaine patch LIDODERM lidocaine/prilocaine crm

Rosacea doxycycline monohydrate delayed-rel ORACEA metronidazole crm 0.75% METROCREAM metronidazole gel 0.75% metronidazole lotion 0.75% METROLOTION

Scabicides and Pediculicides malathion OVIDE OTC permethrin NIX permethrin 5% OTC pyrethrins/piperonyl butoxide GOOD SENSE COMPLETE OTC pyrethrins/piperonyl butoxide RID

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous

Steroids - Mouth/Throat triamcinolone paste

OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: https://one.aao.org

Antiallergics azelastine cromolyn sodium OTC ketotifen ZADITOR

Antifungals natamycin NATACYN

Anti-infectives bacitracin ciprofloxacin soln erythromycin QL gentamicin moxifloxacin VIGAMOX neomycin/polymyxin B/gramicidin ofloxacin OCUFLOX polymyxin B/bacitracin LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 36

polymyxin B/trimethoprim POLYTRIM sulfacetamide soln 10% BLEPH-10 tobramycin TOBREX

Anti-infective/Anti-inflammatory Combinations neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/dexamethasone MAXITROL neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate tobramycin/dexamethasone susp 0.3%/0.1% TOBRADEX SUSPENSION

Anti-inflammatories Nonsteroidal diclofenac sodium ketorolac 0.5% ACULAR

Steroidal dexamethasone sodium phosphate fluorometholone 0.1% susp FML LIQUIFILM loteprednol susp 0.5% prednisolone acetate 1% PRED FORTE prednisolone phosphate 1%

Antivirals trifluridine

Beta-blockers Nonselective timolol maleate TIMOPTIC timolol maleate gel TIMOPTIC-XE

Selective betaxolol solution

Carbonic Anhydrase Inhibitors Topical dorzolamide TRUSOPT

Carbonic Anhydrase Inhibitor/Beta-blocker Combinations dorzolamide/timolol maleate COSOPT

Dry Eye Disease lifitegrast XIIDRA

Prostaglandins latanoprost XALATAN LEGEND boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name. Brand name is for reference and may not be covered. † Coverage determined under the Medical Benefit AL Age Limit OTC Over the Counter; with the exception of insulin and diabetic monitoring products, OTC products are usually not included in the pharmacy benefit. OTC products are listed for informational purposes. PA Prior Authorization PA, QL Quantity Limit is applied after Prior Authorization approval QL Quantity Limit QL, PA If Quantity Limit is exceeded, Prior Authorization may apply ST Step Therapy ST, PA If Step Therapy requirements are not met, Prior Authorization may apply 37

Sympathomimetics brimonidine 0.15% ALPHAGAN P 0.15% brimonidine 0.2%

OTIC Clinical practice guidelines for the treatment of otitis media are available at: https://www.aap.org

Anti-infectives acetic acid ofloxacin otic

Anti-infective/Anti-inflammatory Combinations ciprofloxacin/dexamethasone CIPRODEX neomycin/polymyxin B/hydrocortisone

WEBSITES Agency for Healthcare Research and Quality American Congress of Obstetricians and https://www.ahrq.gov Gynecologists https://www.acog.org Alzheimer's Association https://www.alz.org American Diabetes Association http://www.diabetes.org American Academy of Allergy, Asthma and Immunology American Gastroenterological Association https://www.aaaai.org https://www.gastro.org

American Academy of Child & Adolescent Psychiatry American Headache Society Committee for Headache https://www.aacap.org Education https://americanheadachesociety.org American Academy of Dermatology https://www.aad.org American Heart Association https://professional.heart.org American Academy of Neurology https://www.aan.com American Lung Association https://www.lung.org American Academy of Ophthalmology https://www.aao.org American Medical Association https://www.ama-assn.org American Academy of Pediatrics https://www.aap.org American Psychiatric Association https://www.psychiatry.org American Association for the Study of Liver Disease https://www.aasld.org American Society of Anesthesiologists https://www.asahq.org American Association of Clinical Endocrinologists https://www.aace.com American Society of Clinical Oncology https://www.asco.org American Association of Diabetes Educators https://www.diabeteseducator.org American Society of Interventional Pain Physicians https://www.asipp.org American Cancer Society https://www.cancer.org American Urological Association https://www.auanet.org American College of Allergy, Asthma and Immunology https://www.acaai.org Centers for Disease Control and Prevention https://www.cdc.gov American College of Cardiology https://www.acc.org Centers for Disease Control and Prevention Guideline topics: AIDS American College of Chest Physicians https://www.cdc.gov/hiv/default.html https://www.chestnet.org Centers for Disease Control and Prevention American College of Gastroenterology Guideline topics: Sexually Transmitted Diseases https://gi.org https://www.cdc.gov/std/treatment/default.htm

American College of Physicians CVS Caremark® https://www.acponline.org https://www.caremark.com

American College of Rheumatology The Food and Drug Administration https://www.rheumatology.org https://www.fda.gov

Global Initiative for Asthma National Foundation for Infectious Diseases https://ginasthma.org http://www.nfid.org

Infectious Diseases Society of America National Guideline Clearinghouse https://www.idsociety.org https://www.ahrq.gov

Institute for Safe Medication Practices National Heart, Lung and Blood Institute https://www.ismp.org https://www.nhlbi.nih.gov

Johns Hopkins AIDS Service National Institutes of Health https://www.thebody.com/content/art12096.html https://www.nih.gov

Juvenile Diabetes Research Foundation International National Kidney Foundation https://www.jdrf.org https://www.kidney.org

MedWatch National Osteoporosis Foundation https://www.fda.gov/Safety/MedWatch/default.htm https://www.nof.org

National Agricultural Library North American Menopause Society https://www.nal.usda.gov https://www.menopause.org

National Cancer Institute United States Department of Health and Human https://www.cancer.gov/about-cancer Services https://www.hhs.gov National Comprehensive Cancer Network https://www.nccn.org World Health Organization https://www.who.int

INDEX

A ampicillin, 9 anagrelide, 30 ABILIFY, 19 anastrozole, 11 ACCU-CHEK AVIVA PLUS STRIPS AND KITS, 23 ANDROGEL, 21 ACCU-CHEK COMPACT PLUS STRIPS AND KITS, 23 ANNOVERA, 25 ACCU-CHEK GUIDE STRIPS AND KITS, 23 ANORO ELLIPTA, 32 ACCU-CHEK SMARTVIEW STRIPS AND KITS, 23 ANUSOL-HC, 29 acebutolol, 13 aprepitant caps, 27 acetaminophen, 7 APRISO, 28 acetic acid, 38 ARAVA, 30 ACTIGALL, 27 ARICEPT, 17 ACTIQ, 8 ARIMIDEX, 11 ACTONEL, 24 aripiprazole, 19 ACTOPLUS MET, 22 aripiprazole lauroxil ext-rel inj, 19 ACTOS, 22 ARISTADA, 19 ACULAR, 37 ARISTADA INITIO, 19 acyclovir, 10 ARIXTRA, 30 ADDERALL, 19 armodafinil, 21 ADDERALL XR, 19 ARNUITY ELLIPTA, 33 ADVAIR, 33 AROMASIN, 11 ADVAIR HFA, 33 asenapine, 19 ADVIL, 7 aspirin, 30 AGRYLIN, 30 atenolol, 14 albuterol inhalation soln, 32 atenolol/chlorthalidone, 14 albuterol sulfate, CFC-free aerosol, 32 ATIVAN, 16 alclometasone crm, oint 0.05%, 35 atomoxetine, 19 ALDACTAZIDE, 15 atorvastatin, 14 ALDACTONE, 13 atovaquone, 10 ALDARA, 34 AUGMENTIN, 9 alendronate, 24 AVALIDE, 13 ALEVE, 7 AVAPRO, 13 alfuzosin ext-rel, 29 AYGESTIN, 26 ALKERAN, 11 azathioprine, 30 ALLEGRA, 32 azelastine, 36 ALLEGRA-D, 32 azelastine spray, 33 allopurinol, 7 AZILECT, 18 alosetron, 28 azithromycin, 9 ALPHAGAN P 0.15%, 38 AZOR, 13 alprazolam, 16 AZULFIDINE, 28 alprazolam orally disintegrating tabs, 16 AZULFIDINE EN-TABS, 28 ALTACE, 12 amantadine, 18 B AMARYL, 23 bacitracin, 36 AMBIEN, 20 baclofen, 20 AMBIEN CR, 20 balsalazide, 28 amcinonide crm, lotion, oint 0.1%, 35 BAQSIMI, 25 AMERGE, 20 BASAGLAR, 22 amiloride, 15 BD insulin syringes and needles, 23 amiloride/hydrochlorothiazide, 15 beclomethasone breath-activated aerosol, 33 amiodarone, 13 BELBUCA, 8 amiodarone - Pacerone, 13 BENICAR, 13 amitriptyline, 18 BENICAR HCT, 13 amlodipine, 15 BENZAMYCIN, 34 amlodipine/benazepril, 12 benzonatate, 32 amlodipine/olmesartan, 13 benzoyl peroxide crm, lotion, 34 ammonium lactate 12%, 35 benztropine, 18 amoxicillin, 9 betamethasone dipropionate augmented crm 0.05%, 35 amoxicillin/clavulanate, 9 betamethasone dipropionate augmented gel, oint 0.05%, 35 amoxicillin/clavulanate ext-rel, 9 betamethasone dipropionate augmented lotion 0.05%, 35 amphetamine/dextroamphetamine mixed salts, 19 betamethasone dipropionate crm, lotion, oint 0.05%, 35 amphetamine/dextroamphetamine mixed salts ext-rel, 19 betamethasone valerate crm, lotion, oint 0.1%, 35

BETAPACE, 13 CHANTIX, 21 BETAPACE AF, 13 chlorambucil, 11 betaxolol solution, 37 chlorpromazine, 19 bethanechol, 29 chlorthalidone, 15 BEVESPI AEROSPHERE, 32 cholestyramine, 13 bicalutamide, 11 ciclopirox, 34 BILTRICIDE, 11 cilostazol, 30 bisoprolol, 14 cimetidine, 27 bisoprolol/hydrochlorothiazide, 14 CIPRO, 9 BLEPH-10, 37 CIPRODEX, 38 blood glucose monitoring kits, test strips, 23 ciprofloxacin, 9 BONIVA, 24 ciprofloxacin soln, 36 BREO ELLIPTA, 33 ciprofloxacin/dexamethasone, 38 BRILINTA, 30 citalopram, 18 brimonidine 0.15%, 38 clarithromycin, 9 brimonidine 0.2%, 38 clarithromycin ext-rel, 9 bromocriptine, 18 CLARITIN, 32 budesonide delayed-rel caps, 28 CLARITIN REDITABS, 32 budesonide inh susp, 33 CLARITIN-D, 32 budesonide/formoterol, 33 CLENPIQ, 28 bumetanide, 15 CLEOCIN, 10, 29 buprenorphine, 8, 21 CLEOCIN T, 34 buprenorphine transdermal, 8 CLIMARA, 26 buprenorphine/naloxone sublingual film, 21 CLIMARA PRO, 26 buprenorphine/naloxone sublingual tabs, 21 clindamycin, 10 bupropion, 18 clindamycin crm, 29 bupropion ext-rel, 18, 21 clindamycin gel, lotion, soln, 34 buspirone, 16 clobazam, 17 busulfan, 11 clobetasol propionate crm, gel, oint 0.05%, 35 BUTRANS, 8 clobetasol propionate foam 0.05%, 35 C clobetasol propionate lotion 0.05%, 35 CLOBEX, 35 cabergoline, 27 clonazepam tabs, 17 CALAN SR, 15 clonidine, 12 calcipotriene oint, soln 0.005%, 34 clonidine transdermal, 12 calcipotriene/betamethasone dipropionate, 34 clopidogrel, 30 calcitriol (1,25-D3), 25 clorazepate, 16 calcium acetate caps, 26 clotrimazole, 34 CAPASTAT SULFATE, 10 clotrimazole troches, 10 capreomycin, 10 clozapine, 19 captopril, 12 clozapine orally disintegrating tabs, 19 captopril/hydrochlorothiazide, 12 CLOZARIL, 19 carbamazepine, 16 codeine sulfate, 8 carbamazepine ext-rel, 17 codeine/acetaminophen, 8 carbidopa/levodopa, 18 codeine/promethazine, 32 carbidopa/levodopa ext-rel, 18 codeine/promethazine/phenylephrine, 32 carbidopa/levodopa orally disintegrating tabs, 18 colchicine, 7 carbidopa/levodopa/entacapone, 18 COLCRYS, 7 CARDIZEM CD, 15 COLESTID, 13 CARDIZEM LA, 15 colestipol, 13 CARDURA, 29 COMTAN, 18 carvedilol, 14 CONCERTA, 19 CATAPRES, 12 COREG, 14 CATAPRES-TTS, 12 CORGARD, 14 cefadroxil, 9 CORLANOR, 16 cefdinir, 9 CORTEF, 25 cefpodoxime, 9 CORVERT, 13 cefprozil, 9 COSOPT, 37 cefuroxime axetil, 9 COZAAR, 13 CELEXA, 18 CREON, 28 CELLCEPT, 30 CRESTOR, 14 cephalexin, 9 cromolyn sodium, 36 cetirizine, 32 CUVPOSA, 29 cetirizine/pseudoephedrine ext-rel, 32 cyanocobalamin inj, 31

cyclobenzaprine 5 mg, 10 mg, 20 DIPROLENE AF, 35 cyclophosphamide caps, 11 dipyridamole, 30 cycloserine, 10 dipyridamole ext-rel/aspirin, 30 cyclosporine, 30 disopyramide, 13 cyclosporine, modified, 30 disopyramide ext-rel, 13 CYMBALTA, 18 DITROPAN XL, 29 cyproheptadine, 32 divalproex sodium delayed-rel, 17 CYTOMEL, 26 divalproex sodium ext-rel, 17 CYTOTEC, 28 divalproex sodium sprinkle caps, 17 D DOLOPHINE, 8 donepezil, 17 danazol, 25 donepezil orally disintegrating tabs, 17 DANTRIUM, 20 dorzolamide, 37 dantrolene, 20 dorzolamide/timolol maleate, 37 dapagliflozin, 23 doxazosin, 29 dapagliflozin/metformin ext-rel, 23 doxepin, 18, 20 dapsone, 10 doxercalciferol, 25 DAYPRO, 7 doxycycline hyclate, 10 DDAVP, 27 doxycycline hyclate tabs 20 mg, 100 mg, 10 DELATESTRYL, 21 doxycycline monohydrate delayed-rel, 36 DEPAKOTE, 17 doxycycline monohydrate susp, 10 DEPAKOTE ER, 17 dronabinol, 27 DEPAKOTE SPRINKLE, 17 drospirenone/EE 3/20, 24 DEPEN TITRA, 30 drospirenone/EE 3/30, 24 DEPO-PROVERA, 25 DUETACT, 22 DEPO-TESTOSTERONE, 21 dulaglutide, 22 desipramine, 18 duloxetine delayed-rel, 18 desmopressin nasal spray, 27 DUOBRII, 34 desmopressin tabs, 27 DURAGESIC, 8 desogestrel/EE, 24 desogestrel/EE 0.15/30 - Apri, 24 E desonide crm, lotion, oint 0.05%, 35 E.E.S., 9 DESOWEN, 35 EC-NAPROSYN, 7 desoximetasone crm 0.05%, 35 econazole, 34 desoximetasone crm, oint 0.25%, gel 0.05%, 35 EE/norethindrone acetate, 26 desvenlafaxine succinate ext-rel, 18 EE/norethindrone acetate - Jinteli, 26 DETROL, 29 EFFEXOR XR, 18 dexamethasone, 25 EFFIENT, 30 dexamethasone sodium phosphate, 37 ELIDEL, 35 DEXEDRINE SPANSULE, 19 ELLA, 25 dexmethylphenidate, 19 EMCYT, 11 dextroamphetamine, 19 EMEND, 27 dextroamphetamine ext-rel, 19 empagliflozin, 23 dextromethorphan/promethazine, 32 empagliflozin/linagliptin, 23 diazepam, 16 empagliflozin/linagliptin/metformin ext-rel, 23 diclofenac potassium, 7 empagliflozin/metformin, 23 diclofenac sodium, 37 empagliflozin/metformin ext-rel, 23 diclofenac sodium delayed-rel, 7 EMVERM, 10 diclofenac sodium ext-rel, 7 enalapril, 12 dicloxacillin, 9 enalapril/hydrochlorothiazide, 12 dicyclomine, 27 ENDOMETRIN, 26 DIFICID, 9 enoxaparin, 29 DIFLUCAN, 10 ENSTILAR, 34 diflunisal, 7 entacapone, 18 digoxin, 15 ENTOCORT EC, 28 digoxin ped elixir, 15 ENTRESTO, 16 DILANTIN, 17 epinephrine, 31 DILANTIN INFATABS, 17 epinephrine auto-injector, 31 DILAUDID, 8 EPIPEN, 31 diltiazem ext-rel, 15 EPIPEN JR., 31 DIOVAN, 13 eplerenone, 13 DIOVAN HCT, 13 ergocalciferol (D2), 31 diphenoxylate/atropine, 27 ERYTHROCIN, 9 DIPROLENE, 35 erythromycin, 36

erythromycin delayed-rel, 9 fluorouracil soln 2%, 5%, 34 erythromycin ethylsuccinate, 9 fluoxetine, 18 erythromycin gel 2%, 34 fluphenazine, 19 erythromycin soln, 34 flurbiprofen, 7 erythromycin stearate, 9 flutamide, 11 erythromycin/benzoyl peroxide, 34 fluticasone furoate, 33 escitalopram, 18 fluticasone propionate, 33 ESTRACE, 26 fluticasone propionate crm 0.05%, oint 0.005%, 35 estradiol, 26 fluticasone propionate, CFC-free aerosol, 33 estradiol vaginal crm, 26 fluticasone spray, 33 estradiol vaginal inserts, 26 fluticasone/salmeterol, 33 estradiol/levonorgestrel, 26 fluticasone/salmeterol, CFC-free aerosol, 33 estradiol/norethindrone, 26 fluticasone/vilanterol, 33 estramustine, 11 fluvoxamine, 16 ethambutol, 10 FML LIQUIFILM, 37 ethionamide, 10 FOCALIN, 19 ethosuximide, 17 folic acid, 31 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 24 fondaparinux, 30 ethynodiol diacetate/EE 1/50, 24 formoterol inhalation soln, 33 etodolac, 7 FORTESTA, 21 etonogestrel/EE ring, 25 FOSAMAX, 24 etoposide caps, 12 furosemide, 15 EVISTA, 26 G EXELON PATCH, 17 gabapentin caps, tabs, 17 exemestane, 11 GABITRIL, 17 ezetimibe, 14 galantamine, 17 F galantamine ext-rel, 17 famciclovir, 10 gemfibrozil, 14 famotidine, 27 GENERESS FE, 24 FARESTON, 11 gentamicin, 34, 36 FARXIGA, 23 GEODON, 19 felbamate, 17 GLEOSTINE, 11 FELBATOL, 17 glimepiride, 23 FELDENE, 7 glipizide, 23 felodipine ext-rel, 15 glipizide ext-rel, 23 FEMARA, 11 glipizide/metformin, 22 FEMHRT, 26 GLUCAGON EMERGENCY KIT, 25 fenofibrate, 14 glucagon intranasal powder, 25 fenofibrate caps 67 mg, 134 mg, 200 mg, 14 glucagon subcutaneous soln, 25 fentanyl lozenge, 8 glucagon, human recombinant, 25 fentanyl transdermal, 8 GLUCOTROL, 23 ferrous sulfate, 31 GLUCOTROL XL, 23 fexofenadine, 32 glycopyrrolate, 29 fexofenadine/pseudoephedrine ext-rel, 32 glycopyrrolate/formoterol, 32 FIASP, 22 GLYXAMBI, 23 fidaxomicin, 9 GOOD SENSE COMPLETE, 36 finasteride, 29 granisetron, 27 FLAGYL, 10 grass mixed pollen allergen extract, 30 flecainide, 13 griseofulvin microsize, 10 FLOMAX, 29 GVOKE, 25 FLOVENT DISKUS, 33 H FLOVENT HFA, 33 halobetasol propionate crm, oint 0.05%, 35 fluconazole, 10 halobetasol propionate/tazarotene, 34 fludrocortisone, 25 haloperidol, 19 flunisolide spray, 33 HECTOROL, 25 fluocinolone acetonide crm, oint 0.025%, 35 HUMULIN R U-500, 22 fluocinolone acetonide soln 0.01%, 35 hydralazine, 16 fluocinonide crm, gel, oint 0.05%, 35 HYDREA, 12 fluocinonide soln 0.05%, 35 hydrochlorothiazide, 15 fluoride drops, tabs, 31 hydrocodone/acetaminophen, 8 fluorometholone 0.1% susp, 37 hydrocodone/homatropine, 32 fluorouracil crm 4%, 34 hydrocortisone, 25 fluorouracil crm 5%, 34

hydrocortisone butyrate crm, oint, soln 0.1%, 35 ketoconazole shampoo 2%, 34 hydrocortisone crm, 29 ketoprofen 50 mg, 75 mg, 7 hydrocortisone crm 2.5%, 35 ketorolac, 7 hydrocortisone enema, 28 ketorolac 0.5%, 37 hydrocortisone lotion 1%, 35 ketorolac inj, 7 hydrocortisone valerate crm, oint 0.2%, 35 ketotifen, 36 hydromorphone, 8 KLARON, 34 hydroxychloroquine, 30 KLONOPIN, 17 hydroxyurea, 12 K-TAB, 31 hydroxyzine HCl, 32 KYLEENA, 25 hyoscyamine sulfate, 27 L hyoscyamine sulfate ext-rel caps, 27 labetalol, 14 hyoscyamine sulfate orally disintegrating tabs, 27 lactulose soln, 28 HYZAAR, 13 LAMICTAL, 17 I LAMICTAL XR, 17 ibandronate, 24 lamotrigine, 17 ibuprofen, 7 lamotrigine ext-rel, 17 ibutilide, 13 lancets, 23 icosapent ethyl, 14 LANCETS, 23 imipramine HCl, 18 LANOXIN, 15 imiquimod crm, 34 lansoprazole delayed-rel, 28 IMITREX, 20 lansoprazole delayed-rel orally-disintegrating tabs, 28 IMURAN, 30 LASIX, 15 IMVEXXY, 26 latanoprost, 37 indapamide, 15 leflunomide, 30 INDERAL LA, 14 letrozole, 11 INSPRA, 13 LEUKERAN, 11 insulin aspart, 22 levalbuterol nebulizer soln concentrate, 33 insulin aspart protamine 70%/insulin aspart 30%, 22 LEVEMIR, 22 insulin detemir, 22 levetiracetam, 17 insulin glargine, 22 levetiracetam ext-rel, 17 insulin human, 22 levofloxacin, 9 insulin human, concentrated, 22 levonorgestrel/EE - Trivora, 24 insulin isophane human, 22 levonorgestrel/EE 0.1/20 - Lessina, 24 insulin isophane human 70%/regular 30%, 22 levonorgestrel/EE 0.15/30 - Jolessa, 24 insulin syringes, needles, 23 levonorgestrel/EE 0.15/30 - Levora, 24 INVEGA, 19 levonorgestrel-releasing IUD, 25 ipratropium inhalation solution, 31 levothyroxine, 26 ipratropium spray, 33 levothyroxine - Levoxyl, 26 ipratropium/albuterol soln, 32 LEVSIN, 27 irbesartan, 13 LEXAPRO, 18 irbesartan/hydrochlorothiazide, 13 LIALDA, 28 isoniazid, 10 lidocaine patch, 36 ISORDIL, 16 lidocaine viscous, 36 isosorbide dinitrate 5 mg, 10 mg, 20 mg, 30 mg, 16 lidocaine/prilocaine crm, 36 isosorbide mononitrate, 16 LIDODERM, 36 isosorbide mononitrate ext-rel, 16 lifitegrast, 37 isotretinoin - Claravis, 34 linaclotide, 28 isradipine, 15 linezolid, 10 itraconazole, 10 linezolid inj, 10 ivabradine, 16 LINZESS, 28 ivermectin, 10 liothyronine, 26 J LIPITOR, 14 liraglutide, 22 JANUMET, 22 lisinopril, 12 JANUMET XR, 22 lisinopril/hydrochlorothiazide, 12 JANUVIA, 22 lithium carbonate, 20 JARDIANCE, 23 lithium carbonate ext-rel tabs 300 mg, 20 K lithium carbonate ext-rel tabs 450 mg, 20 KEFLEX, 9 LITHOBID, 20 KEPPRA, 17 lixisenatide/insulin glargine, 22 KEPPRA XR, 17 LOMOTIL, 27 ketoconazole crm 2%, 34 lomustine, 11

loperamide, 27 midodrine, 16 LOPID, 14 milnacipran, 19 LOPRESSOR, 14 MINOCIN, 10 LOPROX, 34 minocycline, 10 loratadine, 32 MIRAPEX, 18 loratadine orally disintegrating tabs, 32 MIRCETTE, 24 loratadine/pseudoephedrine ext-rel, 32 MIRENA, 25 lorazepam, 16 mirtazapine, 18 losartan, 13 mirtazapine orally disintegrating tabs, 18 losartan/hydrochlorothiazide, 13 misoprostol, 28 loteprednol susp 0.5%, 37 mitotane, 12 LOTREL, 12 MOBIC, 7 LOTRONEX, 28 modafinil, 21 LOVENOX, 29 mometasone crm, lotion, oint 0.1%, 35 LYSODREN, 12 montelukast, 33 M morphine, 8 morphine ext-rel, 8 MACROBID, 11 morphine supp, 8 MACRODANTIN, 11 MOVANTIK, 28 malathion, 36 moxifloxacin, 9, 36 MARINOL, 27 MS CONTIN, 8 MATULANE, 12 multivitamins/fluoride drops, tabs, 31 MAXALT, 20 multivitamins/fluoride/iron drops, tabs, 31 MAXALT-MLT, 20 mupirocin oint, 34 MAXITROL, 37 MYAMBUTOL, 10 MAXZIDE, 15 MYCOBUTIN, 11 mebendazole, 10 mycophenolate mofetil, 30 meclizine, 27 MYLERAN, 11 MEDROL, 25 MYSOLINE, 17 medroxyprogesterone acetate, 26 medroxyprogesterone acetate 150 mg/mL, 25 N megestrol acetate, 12 nabumetone, 7 meloxicam, 7 nadolol, 14 melphalan, 11 nafarelin, 25 memantine, 17 naloxegol, 28 MEPHYTON, 31 naloxone inj, 21 MEPRON, 10 naloxone nasal spray, 21 mercaptopurine, 11 naltrexone, 21 mesalamine delayed-rel, 28 NAMENDA, 17 mesalamine ext-rel caps, 28 naproxen delayed-rel, 7 mesalamine rectal susp, 28 naproxen sodium, 7 MESTINON, 20 naproxen sodium tabs, 7 METAGLIP, 22 naproxen tabs, 7 metformin, 22 naratriptan, 20 metformin ext-rel, 22 NARCAN, 21 methadone, 8 NARDIL, 17 methimazole, 26 NATACYN, 36 methocarbamol, 20 natamycin, 36 methotrexate, 30 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 37 methyldopa, 16 neomycin/polymyxin B/dexamethasone, 37 methylphenidate, 19 neomycin/polymyxin B/gramicidin, 36 methylphenidate ext-rel, 19 neomycin/polymyxin B/hydrocortisone, 38 methylprednisolone, 25 neomycin/polymyxin B/hydrocortisone susp, 37 metoclopramide, 27 NEORAL, 30 metolazone, 15 NEURONTIN, 17 metoprolol 25 mg, 50 mg, 100 mg, 14 niacin ext-rel, 14 metoprolol ext-rel, 14 NIASPAN, 14 metoprolol/hydrochlorothiazide, 14 nicardipine, 15 METROCREAM, 36 NICODERM CQ, 21 METROLOTION, 36 NICORETTE, 21 metronidazole, 10, 29 nicotine polacrilex gum, 21 metronidazole crm 0.75%, 36 nicotine transdermal, 21 metronidazole gel 0.75%, 36 nifedipine ext-rel, 15 metronidazole lotion 0.75%, 36 NILANDRON, 11

nilutamide, 11 oxybutynin ext-rel, 29 NITRO-DUR, 16 oxycodone, 8 nitrofurantoin ext-rel, 11 oxycodone ext-rel, 8 nitrofurantoin macrocrystals, 11 oxycodone/acetaminophen, 8 nitroglycerin sublingual, 16 OZEMPIC, 22 nitroglycerin transdermal, 16 P NITROSTAT, 16 paliperidone ext-rel, 19 NIX, 36 PAMELOR, 18 norelgestromin/EE - Xulane, 25 pancrelipase, 28 norethindrone, 25 pancrelipase delayed-rel, 28 norethindrone acetate, 26 pantoprazole delayed-rel tabs, 28 norethindrone acetate/EE 0.8/25 and iron, 24 paricalcitol, 25 norethindrone acetate/EE 1.5/30, 24 PARLODEL, 18 norethindrone acetate/EE 1.5/30 and iron, 24 PARNATE, 18 norethindrone acetate/EE 1/20, 24 paroxetine HCl ext-rel, 18 norethindrone acetate/EE 1/20 and iron, 24 paroxetine HCl tabs, 18 norethindrone/EE, 24 PAXIL, 18 norethindrone/EE 0.5/35, 24 PAXIL CR, 18 norethindrone/EE 1/35, 24 peg 3350/electrolytes, 28 norgestimate/EE, 24 penicillamine, 30 norgestimate/EE 0.25/35, 24 penicillin VK, 9 norgestrel/EE 0.3/30 - Low-Ogestrel, 24 PEPCID, 27 NORPACE, 13 PEPCID AC, 27 NORPACE CR, 13 PERCOCET, 8 NORPRAMIN, 18 PERFOROMIST, 33 nortriptyline, 18 perindopril, 12 NORVASC, 15 permethrin, 36 NOVOLIN 70/30, 22 permethrin 5%, 36 NOVOLIN N, 22 phenelzine, 17 NOVOLIN R, 22 phenobarbital, 17 NOVOLOG, 22 phenytoin chewable tabs, 17 NOVOLOG MIX 70/30, 22 phenytoin sodium extended, 17 NUVARING, 25 phenytoin susp, 17 NUVIGIL, 21 phytonadione, 31 nystatin, 10, 34 pilocarpine tabs, 28 O pimecrolimus, 35 OCUFLOX, 36 pindolol, 14 ofloxacin, 36 pioglitazone, 22 ofloxacin otic, 38 pioglitazone/glimepiride, 22 olanzapine, 19 pioglitazone/metformin, 22 olmesartan, 13 piroxicam, 7 olmesartan/amlodipine/hydrochlorothiazide, 13 PLAQUENIL, 30 olmesartan/hydrochlorothiazide, 13 PLAVIX, 30 olodaterol, CFC-free aerosol, 33 polymyxin B/bacitracin, 36 OLUX, 35 polymyxin B/trimethoprim, 37 omeprazole delayed-rel, 28 POLYTRIM, 37 omeprazole magnesium delayed-rel, 28 potassium chloride ext-rel, 31 omeprazole/sodium bicarbonate, 28 potassium chloride liquid, 31 ondansetron, 27 potassium citrate ext-rel, 29 ondansetron orally disintegrating tabs, 27 pramipexole, 18 ONETOUCH ULTRA STRIPS AND KITS, 23 pramlintide, 21 ONETOUCH VERIO STRIPS AND KITS, 23 prasugrel, 30 ONFI, 17 PRAVACHOL, 14 ORACEA, 36 pravastatin, 14 ORALAIR, 30 praziquantel, 11 ORAPRED ODT, 25 PRED FORTE, 37 ORTHO MICRONOR, 25 prednisolone acetate 1%, 37 oseltamivir, 10 prednisolone phosphate 1%, 37 OVIDE, 36 prednisolone sodium phosphate, 25 oxaprozin, 7 prednisolone sodium phosphate orally disintegrating tabs, 25 oxazepam, 16 prednisolone syrup, 25 oxcarbazepine, 17 prednisone, 25 oxybutynin, 29 PRELONE, 25

prenatal vitamin/minerals, 31 RISPERDAL, 19 PREVACID, 28 risperidone, 19 PREVACID SOLUTAB, 28 risperidone orally disintegrating tabs, 19 PRIFTIN, 10 RITALIN LA, 19 PRILOSEC, 28 rivaroxaban, 29 PRILOSEC OTC, 28 rivastigmine, 17 primidone, 17 rivastigmine transdermal, 17 PRISTIQ, 18 rizatriptan, 20 probenecid, 7 rizatriptan orally disintegrating tabs, 20 procarbazine, 12 ROBAXIN, 20 PROCARDIA XL, 15 ROCALTROL, 25 prochlorperazine, 27 ropinirole, 18 progesterone vaginal inserts, 26 rosuvastatin, 14 progesterone, micronized, 26 ROWASA, 28 PROGRAF, 30 ROXICODONE, 8 promethazine, 27 ROZEREM, 20 PROMETRIUM, 26 RYBELSUS, 22 propafenone, 13 RYTHMOL SR, 13 propafenone ext-rel, 13 S propranolol, 14 sacubitril/valsartan, 16 propranolol ext-rel, 14 SALAGEN, 28 propranolol/hydrochlorothiazide, 14 SANDIMMUNE, 30 propylthiouracil, 26 SAPHRIS, 19 PROSCAR, 29 SAVELLA, 19 PROTONIX, 28 segesterone acetate/EE ring, 25 PROTOPIC, 35 selegiline, 19 PROVERA, 26 selenium sulfide lotion 2.5%, 34 PROVIGIL, 21 semaglutide, 22 PROZAC, 18 SEROQUEL, 19 PULMICORT RESPULES, 33 sertraline, 18 pyrazinamide, 10 sevelamer carbonate, 26 pyrethrins/piperonyl butoxide, 36 SILENOR, 20 pyridostigmine, 20 SILVADENE, 34 Q silver sulfadiazine, 34 QUESTRAN/QUESTRAN LIGHT, 13 simvastatin, 14 quetiapine, 19 SINEMET, 18 QVAR REDIHALER, 33 SINGULAIR, 33 R sirolimus, 30 sitagliptin, 22 raloxifene, 26 sitagliptin/metformin, 22 ramelteon, 20 sitagliptin/metformin ext-rel, 22 ramipril, 12 SKYLA, 25 RANEXA, 16 sodium picosulfate/magnesium oxide/citric acid, 28 ranolazine ext-rel, 16 SOLIQUA, 22 RAPAMUNE, 30 sotalol, 13 rasagiline mesylate, 18 SPIRIVA, 31 RAZADYNE ER, 17 spironolactone, 13 REGLAN, 27 spironolactone/hydrochlorothiazide, 15 REMERON, 18 SPORANOX, 10 REMERON SOLTAB, 18 STALEVO, 18 RENVELA, 26 STRATTERA, 19 RESTORIL, 20 streptomycin sulfate inj, 10 RETIN-A, 34 STRIVERDI RESPIMAT, 33 revefenacin inhalation solution, 31 STROMECTOL, 10 RID, 36 SUBOXONE FILM, 21 rifabutin, 11 sulfacetamide lotion 10%, 34 RIFADIN, 10 sulfacetamide soln 10%, 37 rifampin, 10 sulfacetamide/prednisolone phosphate, 37 rifapentine, 10 sulfamethoxazole/trimethoprim, 11 rifaximin 550 mg, 11 sulfamethoxazole/trimethoprim DS, 11 RILUTEK, 21 sulfasalazine, 28 riluzole, 21 sulfasalazine delayed-rel, 28 risedronate, 24 sulindac, 7

sumatriptan, 20 tramadol ext-rel tabs, 8 sumatriptan inj, 20 TRANDATE, 14 sumatriptan nasal spray, 20 trandolapril, 12 SYMBICORT, 33 TRANXENE T-TAB, 16 SYMJEPI, 31 tranylcypromine, 18 SYMLINPEN, 21 trazodone, 18 SYNAREL, 25 TRECATOR, 10 SYNJARDY, 23 tretinoin, 34 SYNJARDY XR, 23 tretinoin - Avita, 34 SYNTHROID, 26 tretinoin caps, 12 T triamcinolone acetonide crm 0.5%, 35 triamcinolone acetonide crm, lotion 0.025%, 35 TABLOID, 11 triamcinolone acetonide crm, lotion, oint 0.1%, 35 TACLONEX, 34 triamcinolone paste, 36 tacrolimus, 30, 35 triamterene/hydrochlorothiazide, 15 TAGAMET HB, 27 triamterene/hydrochlorothiazide caps, 15 TAMIFLU, 10 TRIBENZOR, 13 tamoxifen, 11 TRICOR, 14 tamsulosin, 29 trifluoperazine, 19 TAPAZOLE, 26 trifluridine, 37 TEGRETOL, 16 trihexyphenidyl, 19 TEGRETOL-XR, 17 TRIJARDY XR, 23 temazepam, 20 TRILEPTAL, 17 TEMOVATE, 35 trimethobenzamide, 27 TENORETIC, 14 trimethoprim, 11 TENORMIN, 14 trospium, 29 terazosin, 29 TRULICITY, 22 terbinafine tabs, 10 TRUSOPT, 37 terconazole, 29 TYLENOL, 7 TESSALON, 32 testosterone cypionate inj, 21 U testosterone enanthate inj, 21 ulipristal, 25 testosterone gel, 21 ULTRAM, 8 testosterone gel 25 mg/2.5 g, 21 umeclidinium/vilanterol, 32 tetracycline, 10 UROCIT-K, 29 theophylline ext-rel tabs, 33 UROXATRAL, 29 thioguanine, 11 URSO, 27 tiagabine, 17 ursodiol, 27 TIAZAC, 15 V ticagrelor, 30 valacyclovir, 10 TIGAN, 27 VALIUM, 16 timolol maleate, 37 valproic acid, 17 timolol maleate gel, 37 valsartan, 13 TIMOPTIC, 37 valsartan/hydrochlorothiazide, 13 TIMOPTIC-XE, 37 VALTREX, 10 tinidazole, 11 VANCOCIN, 11 tiotropium, 31 vancomycin, 11 tizanidine tabs, 20 VANTIN, 9 TOBRADEX SUSPENSION, 37 varenicline, 21 tobramycin, 37 VASCEPA, 14 tobramycin/dexamethasone susp 0.3%/0.1%, 37 VASERETIC, 12 TOBREX, 37 VASOTEC, 12 TOLAK, 34 venlafaxine, 18 tolmetin, 7 venlafaxine ext-rel, 18 tolterodine, 29 verapamil ext-rel, 15 TOPAMAX, 17 VERELAN, 15 TOPAMAX SPRINKLE CAPS, 17 VERELAN PM, 15 TOPICORT, 35 VFEND, 10 topiramate, 17 VIBRAMYCIN, 10 topiramate sprinkle caps, 17 VICTOZA, 22 TOPROL-XL, 14 VIGAMOX, 36 toremifene, 11 VIOKACE, 28 torsemide, 15 vitamin ADC/fluoride drops, 31 tramadol 50 mg, 8

vitamin ADC/fluoride/iron drops, 31 ZEGERID OTC, 28 voriconazole, 10 ZEMPLAR, 25 W ZESTORETIC, 12 ZESTRIL, 12 warfarin, 29 ZETIA, 14 WELLBUTRIN SR, 18 ZIAC, 14 WELLBUTRIN XL, 18 ziprasidone, 19 X ZITHROMAX, 9 XALATAN, 37 ZOCOR, 14 XANAX, 16 ZOFRAN, 27 XARELTO, 29 zolmitriptan orally disintegrating tabs, 20 XIFAXAN, 11 zolmitriptan tabs, 20 XIGDUO XR, 23 ZOLOFT, 18 XIIDRA, 37 zolpidem, 20 XOPENEX SOLUTION, 33 zolpidem ext-rel, 20 XTAMPZA ER, 8 ZOMIG, 20 Y ZOMIG-ZMT, 20 ZONEGRAN, 17 YASMIN, 24 zonisamide, 17 YAZ, 24 ZOVIRAX, 10 YUPELRI, 31 ZYLOPRIM, 7 Z ZYPREXA, 19 ZADITOR, 36 ZYRTEC, 32 zaleplon, 20 ZYRTEC-D 12 HOUR, 32 ZANAFLEX, 20 ZYVOX, 10 ZARONTIN, 17