2016 Guía de referencia para la lista mejorada de medicamentos

New Mexico Health Connections
Guía de referencia para la lista mejorada
de medicamentos que se cubren conforme
a los beneficios de salud esenciales en 2016
NMHC0338-0715
myNMHC.org
OptumRx.com
2016 Guía de referencia para la lista mejorada de medicamentos que se cubren
conforme a los beneficios de salud esenciales en 2016
Entra en vigor el 1/4/2016
INTRODUCCIÓN
New Mexico Health Connections (NMHC) utiliza los servicios de una compañía que administra los beneficios
farmacéuticos cuyo nombre es OptumRx. OptumRx tiene a su disposición un Comité Farmacéutico y
Terapéutico [Pharmacy and Therapeutics Committee, P & T Committee], constituido por farmacéuticos,
enfermeros(as) y médicos activos quienes ayudan a asegurar que nuestra lista de medicamentos es fuerte
medicamente y apoya la salud de los pacientes. Dicho comité analiza y evalúa los medicamentos de la lista con
respecto a la seguridad y la efectividad a fin de ayudar a mantener la integridad clínica de las categorías
terapéuticas.
El Comité Farmacéutico y Terapéutico se reúne por lo menos cuatro (4) veces al año para determinar si se
necesitan hacer cambios a la lista de medicamentos. A veces se tienen que efectuar cambios por problemas de
abastamiento farmacéutico, por los medicamentos que se retiran del mercado, por los nuevos medicamentos
que se incluyen en el mercado, por los medicamentos genéricos que sustituyen los de marca y por otros
problemas farmacéuticos. Por lo general, los cambios reflejan tanto el mejoramiento en general de la
disponibilidad de nuevos agentes farmacéuticos y mejor acceso a los medicamentos que existen actualmente
como la eliminación de medicamentos que recién se consideran menos efectivos en relación a otras opciones
para los consumidores o la eliminación de medicamentos cuyos precios son inasequibles si están disponibles
otras opciones más económicas pero que son equivalentes clínicamente. La lista de medicamentos se actualiza
cada trimestre del calendario.
DISEÑO DE LA LISTA DE MEDICAMENTOS
NMHC y OptumRx han elegido una estructura cerrada para nuestra lista de medicamentos de beneficios de
salud esenciales. La estructura de la lista de medicamentos incluye medicamentos genéricos, medicamentos
de marca tanto los que favorece el plan como los que no favorece, medicamentos especializados y
medicamentos con fines de prevención conforme a la Ley del Cuidado de Salud a Bajo Precio [Affordable Care
Act, ACA]. Una lista de medicamentos cerrada limita la cobertura de seguro a solo los productos que se
enumeran en esos niveles. Por lo general, el plan no cubre los productos que no se enumeran en la lista de
medicamentos.
 Medicamentos genéricos: La mayoría de los medicamentos genéricos se enumeran bajo el título
“GENERIC” [genérico]. Los medicamentos que se enumeran bajo el título “GENERIC” contienen los
mismos ingredientes activos que las versiones de marca, pero cuestan menos.
 Medicamentos que favorece el plan o medicamentos de marca que favorece el plan: Por lo general,
los medicamentos que se enumeran bajo el título “PREFERRED” [que favorece el plan] incluyen
medicamentos de marca que favorece el plan y que, por lo general, tienen copagos más bajos que los
medicamentos de marca que no favorece el plan.
 Medicamentos de marca que no favorece el plan: Por lo general, los medicamentos que se enumeran
bajo el título “NON PREFERRED” [que no favorece el plan] tienen copagos más altos que los
medicamentos de marca que favorece el plan.


Medicamentos especializados: Por lo general, los medicamentos que se enumeran bajo el título
“SPECIALTY” [especializados] tienen el copago y costo más alto. Los medicamentos especializados son
medicamentos con receta que a veces se utilizan para tratar afecciones médicas complicadas y
crónicas. A lo mejor se necesite manejar o vigilar su uso que manera especial.
Medicamentos con fines de prevención conforme a la Ley del Cuidado de Salud a Bajo Precio
[Affordable Care Act, ACA: Es posible que los medicamentos que se enumeran bajo el título
“PREVENTIVE” [preventivos] estén cubiertos y no tenga que hacer un copago con tal que los requisitos
de la reforma del sistema de salud se cumplan con respecto a la edad, el sexo y/o los factores de
riesgo.
Además de la forma que categorizamos los medicamentos según explicamos más arriba, NMHC tiene un grupo
de medicamentos que se denominan medicamentos genéricos que favorece el plan. Esos medicamentos se
recetan para afecciones médicas crónicas y tienen un copago de $0 conforme a lo que cubren muchos de
nuestros planes. Sírvase consultar el sitio web de
NMHC para conseguir una lista de los medicamentos genéricos que favorece el plan.
ADMINISTRACIÓN MÉDICA RAZONABLE
Además la lista de medicamentos de OptumRx utiliza funciones médicas y de notificación previa y
determinación de tratamiento para comprobar si un medicamento con receta es médicamente necesario. Esas
funciones administrativas que se reconocen y aceptan son, entre otras, los limites que rigen las cantidades, la
terapia escalonada y la autorización previa, y ayudan a OptumRx y a sus clientes determinar si un
medicamento con receta se recetó conforme a las normas de prácticas médicas que se aceptan generalmente,
si es clínicamente apropiado y para confirmar que el medicamento que se recetó no es más caro que otro
producto que pudiera producir resultados terapéuticos equivalentes.
Según recomienda el Departamento de Trabajo de los Estados Unidos, las funciones médicas y de notificación
previa y determinación de tratamiento de OptumRx se aplican a los medicamentos con fines de prevención
conforme a la Ley del Cuidado de Salud a Bajo Precio [Affordable Care Act, ACA].
A continuación presentamos unos términos farmacéuticos importantes referentes a la administración médica
razonable.
Substituciones genéricas
Un medicamento genérico es una versión química y farmacéuticamente equivalente (igual) a un medicamento
de marca cuyo patente ha caducado. Un medicamento genérico cumple las mismas normas de bioequivalencia de la Administración de Medicamentos y Alimentos [FDA por sus siglas en inglés] que tienen que
cumplir los medicamentos de marca. Sin embargo, por lo general, un medicamento genérico cuesta menos. Su
farmacéutico le sustituirá un medicamento genérico automáticamente si está disponible, aún si su proveedor
de servicios médicos escribe la receta para el medicamento de marca. Si el medicamento genérico no es
adecuado para usted, su proveedor de servicios médicos puede iniciar el proceso de solicitar una excepción
farmacéutica. A lo mejor entonces usted podrá conseguir el medicamento de marca dependiendo de los
criterios clínicos del medicamento y con tal que NMHC apruebe la excepción.
Intercambio terapéutico
Muchos medicamentos funcionan de la misma forma y producen los mismos beneficios. El intercambio
terapéutico es la práctica de sustituir un medicamento por otro (una alternativa terapéutica) con tal que
ambos medicamentos tengan el mismo efecto terapéutico. El medicamento que se sustituye se llama una
alternativa terapéutica. Cuando le surtan su medicamento con receta, su farmacéutico le informará si le surtió
una alternativa terapéutica. El farmacéutico solo lo puede hacer si su proveedor de servicios médicos lo
aprueba.
Terapia escalonada
La terapia escalonada es la práctica de tratar a un paciente primero con un medicamento que cueste menos. Si
ese medicamento no funciona bien para el paciente, el proveedor de servicios médicos le recetará terapias o
medicamentos más caros, si es médicamente necesario. La terapia escalonada solo se aplica a algunos
medicamentos. NMHC tiene criterios para la terapia escalonada que ayuda a reducir la práctica de recetar el
medicamento más caro cuando haya un medicamento que cuesta menos y que pudiera funcionar con la
misma efectividad. OptumRx necesitará información de su proveedor de servicios médicos si hay un motivo
médico por el cual no le es posible cumplir con todos los “escalones” del proceso antes de proseguir con otro
medicamento más caro.
Autorización previa
La autorización previa es el proceso de conseguir la aprobación de su plan de seguro médico antes de recibir
servicios. Procuramos reducir al mínimo el número medicamentos que necesitan autorización previa. Sin
embargo, no lo podemos eliminar en su totalidad. Durante el proceso de autorización previa, determinamos
si:
 El asegurado es elegible;
 El plan cubre el medicamento y se encuentra en la lista de medicamentos; y
 El medicamento es médicamente necesario.
Por lo general, se necesita una autorización previa para los medicamentos caros y que se utilizan en exceso.
Eso asegura que la atención médica que se le preste cumpla con las normas de excelencia. Además una
autorización previa asegura que los costos por la atención médica estén bien manejados y que el plan de
seguro médico pueda apoyar sus necesidades especiales en la atención médica.
¿Qué pasa si no se me aprueba mi autorización previa?
Acuérdese: No siempre se aprueba la autorización previa. Tanto usted mismo como su proveedor de servicios
médicos recibirán un aviso escrito sobre nuestra decisión. Cada uno de los avisos incluirá sus opciones y sus
derechos de apelación. Para informarse más afondo, sírvase repasar la sección de autorización previa que se
encuentra en su guía de los asegurados de NMHC.
CÓMO SE UTILIZA ESTA GUÍA DE REFERENCIA PARA LA LISTA DE LOS MEDICAMENTOS A FIN DE AYUDAR A
REDUCIR LOS COSTOS
NMHC es uno de varios planes de seguro médico que utiliza la lista de medicamentos de OptumRx para ayudar
a administrar los costos en general de proporcionar los beneficios de medicamentos con receta. Dicha lista
ofrece una amplia variedad de medicamentos de los cuales uno puede escoger. Nos damos cuenta que esta
guía de referencia para la lista de los medicamentos a lo mejor no incluya todos los medicamentos de todos
los fabricantes. Sin embargo, seleccionar un medicamento genérico o que favorece el plan cuando es
apropiado puede proporcionar acceso a los medicamentos necesarios para mantenerse sano, a un precio más
económico.
CÓMO SE AHORRAN LOS DESEMBOLSOS
NMHC fija los copagos para cada categoría de medicamentos en la lista. Dichas categorías incluyen los
medicamentos genéricos que favorece el plan, los medicamentos genéricos, los medicamentos de marca que
favorece el plan, los medicamentos de marca que no favorece el plan y los medicamentos especializados. Los
copagos y deducibles para los productos con fines de prevención cumplen los reglamentos de la reforma del
sistema de salud. Por lo general, los planes de seguro médico elaboran planes de medicamentos con receta
que fomentan el uso de medicamentos genéricos y medicamentos de marca que favorece el plan. Si uno
seleccionara medicamentos que no favorece el plan (o medicamentos especializados) a lo mejor sus
desembolsos sean más altos (es decir, los montos del coseguro, de los copagos y del deducible) o tal vez no se
cubran en lo absoluto. Además tal vez los pacientes paguen menos por los medicamentos genéricos. Los
términos específicos de la cobertura se enumeran en el Resumen de los Beneficios y la Cobertura de Seguro y
en la Guía de la Evidencia de la Cobertura de Seguro, incluso las limitaciones y exclusiones.
FÍJESE BIEN: Es posible que los medicamentos de marca se quiten de la lista de medicamentos si se hiciera
disponible una versión genérica.
CONSULTAS CON EL PERSONAL DEL CONSULTORIO DEL PROFESIONAL MÉDICO QUE LE ESCRIBIÓ LA RECETA,
SI ES APROPIADO
Cuando los empleadores u otras entidades que ofrecen beneficios elaboran sus propios planes de
medicamentos con receta, tal vez decidan solo proporcionar la cobertura del plan para algunos medicamentos
específicos, durante ciertos plazos de tiempo, para dosis o cantidades específicas o para afecciones médicas
específicas (p. ej., pudieran excluir la cobertura del plan para los medicamentos si se recetan para indicaciones
que no se hayan aprobado o comprobado o para fines cosméticos). Cuando la cobertura del plan para los
medicamentos se proporciona basada en el uso o la cantidad, es posible que OptumRx se comunique con el
personal del consultorio del profesional médico que le escribió la receta para conseguir más información a fin
de determinar si la cobertura está a su disposición bajo su plan. Los pacientes que no estén seguros si estos
reglamentos de cobertura se aplican para un medicamento específico se deben comunicar con el centro de
servicio al cliente de OptumRx para determinar los requisitos específicos de la cobertura del plan.
SABER CÓMO SE ORGANIZA LA INFORMACIÓN DE LA LISTA DE MEDICAMENTOS
La guía de referencia para la lista de medicamentos que se presenta a continuación se ha planteado con el
orden siguiente: medicamentos genéricos, medicamentos genéricos con fines de prevención, medicamentos
de marca que favorece el plan, medicamentos de marca que no favorece el plan, medicamentos de marca con
fines de prevención y medicamentos especializados. Además justo antes del índice hay una sección que
enumera los medicamentos con fines de prevención conforme a la Ley del Cuidado de Salud a Bajo Precio
[Affordable Care Act, ACA] por su categoría.
Fíjese bien: Algunos medicamentos están marcados con las indicaciones siguientes: PA= se exige la
autorización previa; ST= terapia escalonada; QL= limites que rigen las cantidades.
*Descargo de responsabilidad con respecto a la lista de medicamentos: La cobertura de seguro para algunos
medicamentos se puede limitar a potencias y/o formas de dosis específicas. El diseño de los beneficios
determina lo que cubre el plan y el monto del copago que corresponde. Los medicamentos que se enumeran
en esta lista de medicamentos están sujetos a cambiar conforme a las actividades de la administración de la
lista de medicamentos que lleva a cabo OptumRx. El hecho que un medicamento se encuentre en esta lista de
medicamentos no garantiza que se cubra. Si desea consultar la lista de medicamentos más al día, visite el sitio
web de los asegurados. Además usted puede llamar al centro de servicio al cliente al número que se
encuentra al dorso de su tarjeta de identificación para pedir que se le envíe una copia por correo.
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
FIFTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
39
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
ACA PREVENTIVE DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
ASPIRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
FLUORIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44
FOLIC ACID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44
IMMUNIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
IRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
SMOKING CESSATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
VITAMIN D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
BOWEL PREPARATION AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
BREAST CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
NON PREFERRED
Cedax
Claforan
Suprax
July 2016
FOURTH GENERATION
GENERIC
cefepime
NON PREFERRED
Maxipime
ANTI-INFECTIVES
PENICILLINS
GENERIC
amoxicillin
amoxicillin/clavulanate potassium
amoxicillin/clavulanate potassium ER
ampicillin
ampicillin sodium
ampicillin-sulbactam
dicloxacillin sodium
nafcillin sodium
oxacillin sodium
penicillin v potassium
penicillin G potassium
piperacillin sodium/ tazobactam sodium
piperacillin sodium/tazobactam sodium
piperacillin/tazobactam
Amoxicillin/Clavulanate Potassium
Ampicillin-sulbactam
PREFERRED
Augmentin
NON PREFERRED
Bactocill IN Dextrose
Bicillin C-R
Bicillin L-a
Moxatag
Timentin
FIFTH GENERATION
NON PREFERRED
Teflaro
MACROLIDES
GENERIC
azithromycin
clarithromycin
clarithromycin ER
erythromycin
Erythromycin Base
NON PREFERRED
Azithromycin
DificidQL
Ery-TAB
Erythrocin Lactobionate
PCE
Zithromax
TETRACYCLINES
GENERIC
avidoxy
demeclocycline HCL
doxy 100
doxycycline
doxycycline hyclate
doxycycline hyclate DR
doxycycline monohydrate
minocycline HCL
minocycline HCL ER
mondoxyne nl
morgidox 1X100MG
morgidox 2X100MG
tetracycline HCL
Tetracycline HCL
CEPHALOSPORIN
FIRST GENERATION
GENERIC
cefadroxil
cefazolin sodium
cephalexin
SECOND GENERATION
GENERIC
cefaclor
cefotetan
cefoxitin sodium
cefprozil
cefuroxime axetil
cefuroxime sodium
Cefaclor
Cefotetan
Cefotetan/Dextrose
Cefuroxime Sodium
NON PREFERRED
Ceftin
Mefoxin
Zinacef
THIRD GENERATION
GENERIC
cefdinir
cefixime
cefotaxime sodium
cefpodoxime proxetil
ceftazidime
ceftriaxone sodium
tazicef
tazidime
Cefditoren Pivoxil
Ceftriaxone IN Iso-osmotic Dextrose
QUINOLONES
GENERIC
ciprofloxacin
ciprofloxacin ER
ciprofloxacin HCL
ciprofloxacin I.V.-IN D5W
levofloxacin
levofloxacin IN D5W
moxifloxacin HCL
ofloxacin
Ciprofloxacin HCL
Ofloxacin
PREFERRED
Avelox
NON PREFERRED
Factive
Noroxin
AMINOGLYCOSIDES
GENERIC
amikacin sulfate
gentamicin sulfate
gentamicin sulfate pediatric
gentamicin sulfate/0.9% sodium chloride
Effective July 1, 2016 v.1
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners.
© 2016 Optum, Inc. All rights reserved.
TM
1
isotonic gentamicin
neomycin sulfate
paromomycin sulfate
tobramycin sulfate
Streptomycin Sulfate
SPECIALTY
tobramycinPA
tobramycin inhalation solution PAKPA
Tobi PodhalerQL,PA
SULFONAMIDES
GENERIC
Sulfadiazine
ANTIMYCOBACTERIAL AGENTS
GENERIC
ethambutol HCL
isoniazid
pyrazinamide
rifabutin
rifampin
PREFERRED
Isoniazid
Priftin
Sirturo
NON PREFERRED
Capastat Sulfate
Paser
Rifamate
Rifater
Trecator
ANTIFUNGALS
GENERIC
bio-statin
fluconazole
fluconazole IN dextrose
fluconazole IN NACL
flucytosine
griseofulvin microsize
griseofulvin ultramicrosize
itraconazolePA
ketoconazole
nystatin
terbinafine HCLQL
voriconazole
Amphotericin B
PREFERRED
Cancidas
Lamisil
Mycamine
Noxafil
SporanoxPA
NON PREFERRED
Abelcet
Ambisome
Amphotec
Cresemba
Eraxis
ANTIVIRALS
GENERIC
abacavir
abacavir sulfate/lamivudine/zidovudineQL
acyclovir
acyclovir sodium
cidofovir
didanosine
famciclovirQL
ganciclovir
lamivudine
lamivudine/zidovudine
nevirapine
nevirapine ER
rimantadine HCL
stavudine
valacyclovir HCLQL
zidovudine
PREFERRED
Aptivus
AtriplaQL
CompleraQL
Crixivan
Edurant
Emtriva
Epivir HBV
Epzicom
Evotaz
FuzeonQL
Intelence
Invirase
Isentress
Kaletra
Lexiva
Nevirapine
Norvir
Prezcobix
Prezista
Relenza DiskhalerQL
Rescriptor
Retrovir IV Infusion
Reyataz
SelzentryPA
StribildQL
Sustiva
TamifluQL
Tivicay
TriumeqQL
Truvada
Tybost
Videx Pediatric
Viracept
Viramune
Viread
Vitekta
Ziagen
SPECIALTY
adefovir dipivoxilQL,PA
entecavirQL,PA
moderiba
ribasphere
ribavirin
valganciclovir
BaracludeQL,PA
DaklinzaQL,PA
HarvoniPA
Moderiba
Moderiba 1200 Dose Pack
Moderiba 800 Dose Pack
Peg-intronPA
Peg-intron RedipenPA
Peg-intron Redipen PAK 4PA
PegasysPA
Pegasys ProclickPA
PegintronPA
Rebetol
Ribasphere
Ribasphere Ribapak
Ribatab
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
2
SovaldiPA
TyzekaQL,PA
Valcyte
Victrelis
Virazole
ZepatierQL,PA
Ketek
Primsol
Vibativ
Zyvox
SPECIALTY
CaystonPA
ANTIMALARIALS
GENERIC
atovaquone/proguanil HCL
chloroquine phosphate
hydroxychloroquine sulfate
mefloquine HCL
quinine sulfatePA
Primaquine Phosphate
PREFERRED
Coartem
Daraprim
ANTINEOPLASTICS, ETC
ALKYLATING AGENTS
ORAL CHEMO
temozolomidePA
Alkeran
Cyclophosphamide
Gleostine
Hexalen
Leukeran
Lomustine
Myleran
SPECIALTY
carboplatin
cisplatin
cyclophosphamide
ifosfamide
melphalan hydrochloride
oxaliplatin
Bendeka
Bicnu
Busulfex
Cisplatin
Gliadel Wafer
Ifex
Ifosfamide
Mustargen
Temodar
Treanda
ValchlorPA
Yondelis
Zanosar
ANTHELMINTICS
GENERIC
ivermectin
PREFERRED
Albenza
NON PREFERRED
Biltricide
MISC. ANTI-INFECTIVES
GENERIC
atovaquone
aztreonam
baciim
bacitracin
clindamycin
clindamycin palmitate HCL
clindamycin phosphate
clindamycin phosphate add-vantage
clindamycin phosphate pharmacy bulk package
clindamycin phosphate IN D5W
clindamycin HCL
colistimethate sodium
e.s.p.
imipenem/cilastatin
lincomycin HCL
linezolidQL
meropenem
metronidazole
metronidazole IN NACL 0.79%
polymyxin b sulfate
sulfamethoxazole/trimethoprim
sulfamethoxazole/trimethoprim DS
sulfatrim pediatric
tinidazole
trimethoprim
vancomycin HCL
Dapsone
Linezolid
PREFERRED
Alinia
Nebupent
SivextroQL
Tygacil
XifaxanPA
NON PREFERRED
Azactam IN Iso-osmotic Dextrose
Cubicin
Doribax
Flagyl ER
Invanz
ANTIBIOTICS
GENERIC
bleomycin sulfate
SPECIALTY
adriamycin
daunorubicin HCL
doxorubicin HCL
doxorubicin HCL liposome
epirubicin HCL
idarubicin HCL
lipodox
lipodox 50
mitomycin
mitoxantrone HCLQL,PA
Adriamycin
Daunoxome
Doxorubicin HCL
Epirubicin HCL
Mitomycin
Valstar
ANTINEOPLASTIC ENZYMES
SPECIALTY
Erwinaze
Oncaspar
ANTIMETABOLITES
ORAL CHEMO
capecitabinePA
mercaptopurine
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
3
methotrexate
Tabloid
Trexall
GENERIC
methotrexate sodium
Methotrexate Sodium
SPECIALTY
adrucil
azacitidinePA
cladribine
cytarabine
cytarabine aqueous
decitabinePA
floxuridine
fludarabine phosphate
fluorouracil
gemcitabine
gemcitabine HCL
Alimta
Arranon
Clolar
Cytarabine
Depocyt
Floxuridine
Folotyn
ANGIOGENESIS INHIBITORS
SPECIALTY
Avastin
ZaltrapQL,PA
ANTIBODIES
SPECIALTY
AdcetrisPA
ArzerraPA
BlincytoPA
DarzalexPA
EmplicitiPA
Erbitux
GazyvaPA
HerceptinPA
KadcylaPA
OpdivoPA
PerjetaPA
PortrazzaPA
Rituxan
Unituxin
Vectibix
YervoyPA
Zevalin Y-90
HORMONAL AGENTS
ORAL CHEMO
anastrozole
bicalutamide
exemestane
flutamide
letrozole
megestrol acetate
tamoxifen citrate
Emcyt
Fareston
Lysodren
Nilandron
Soltamox
XtandiPA
ZytigaPA
PREFERRED
Depo-provera
SPECIALTY
leuprolide acetatePA
EligardQL,PA
Faslodex
FirmagonQL,PA
Lupron DepotQL,PA
TrelstarQL,PA
Trelstar MixjectQL,PA
VantasQL,PA
ZoladexQL
IMMUNOMODULATORS
ORAL CHEMO
PomalystPA
RevlimidPA
ThalomidPA
GENERIC
azathioprine
cyclosporine
cyclosporine modified
gengraf
hecoria
mycophenolate mofetil
mycophenolic acid DR
sirolimus
tacrolimus
Azathioprine
PREFERRED
Azasan
Rapamune
Sandimmune
NON PREFERRED
Atgam
Cellcept Intravenous
NulojixPA
Prograf
Simulect
Thymoglobulin
ZortressPA
MITOTIC INHIBITORS
ORAL CHEMO
Etoposide
PREFERRED
Teniposide
SPECIALTY
docetaxel
etoposide
paclitaxel
toposar
vincasar PFS
vincristine sulfate
vinorelbine tartrate
Abraxane
Docefrez
Docetaxel
Docetaxel (non- Alcohol Formula)
Docetaxel (non-alcohol Formula)
Etopophos
HalavenPA
Ixempra Kit
JevtanaPA
Marqibo
Paclitaxel
Vinblastine Sulfate
ENZYME INHIBITORS
ORAL CHEMO
imatinib mesylatePA
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
4
AfinitorQL,PA
Afinitor DisperzPA
BosulifPA
CaprelsaQL,PA
CometriqPA
CotellicQL,PA
FarydakQL,PA
GilotrifQL,PA
GleevecPA
IbrancePA
IclusigPA
ImbruvicaPA
InlytaPA
JakafiPA
Lenvima 10MG Daily DosePA
Lenvima 14MG Daily DosePA
Lenvima 20MG Daily DosePA
Lenvima 24MG Daily DosePA
LynparzaPA
MekinistPA
NexavarPA
NinlaroQL,PA
SprycelPA
StivargaPA
SutentPA
TafinlarPA
TagrissoQL,PA
TarcevaQL,PA
TasignaPA
TykerbPA
VotrientPA
XalkoriPA
ZelborafQL,PA
ZolinzaPA
ZydeligPA
ZykadiaPA
SPECIALTY
IstodaxPA
KyprolisPA
Torisel
VelcadePA
TOPOISOMERASE I INHIBITOR
ORAL CHEMO
Hycamtin
SPECIALTY
irinotecan
topotecan HCL
Camptosar
Irinotecan
Onivyde
Topotecan HCL
ANTINEOPLASTICS MISC.
ORAL CHEMO
bexarotenePA
hydroxyurea
tretinoin
ErivedgePA
Matulane
PREFERRED
Photofrin
Uvadex
SPECIALTY
dacarbazine
Actimmune
Alferon N
Dacarbazine
Intron APA
Intron A W/DiluentPA
Nipent
Proleukin
SylatronPA
SynriboPA
Theracys
Tice Bcg
Trisenox
CHEMOTHERAPY RESCUE
ORAL CHEMO
leucovorin calcium
Leucovorin Calcium
Mesnex
SPECIALTY
amifostine
dexrazoxane
levoleucovorin
levoleucovorin calcium
mesna
Fusilev
Levoleucovorin
Totect
Voraxaze
CHEMOTHERAPY ADJUNCTS
SPECIALTY
Elitek
Kepivance
ANTINEOPLASTIC COMBO
ORAL CHEMO
LonsurfQL,PA
CARDIOVASCULAR DRUGS
PHOSPHODIESTERASE INHBTR
GENERIC
milrinone lactate
milrinone IN dextrose
CARDIAC GLYCOSIDES
GENERIC
digitek
digox
digoxin
ANTIANGINAL AGENTS
GENERIC
isosorbide dinitrate
isosorbide mononitrate
isosorbide mononitrate ER
minitran
nitro-time
nitroglycerin lingual
nitroglycerin transdermal
nitroglycerin ER
nitroglycerin IN dextrose 5%
nitroglycerin IN 5% dextrose
Isosorbide Dinitrate
Nitroglycerin Lingual
PREFERRED
Dilatrate SR
Nitro-bid
Nitrostat
Ranexa
NON PREFERRED
Nitromist
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
5
BETA BLOCKERS
GENERIC
acebutolol HCL
atenolol
betaxolol HCL
bisoprolol fumarate
carvedilol
esmolol HCL
labetalol HCL
metoprolol succinate ER
metoprolol tartrate
nadolol
pindolol
propranolol HCL
propranolol HCL ER
sorine
sotalol HCL
sotalol HCL (AF)
Metoprolol Tartrate
Timolol Maleate
PREFERRED
Bystolic
Coreg CR
NON PREFERRED
Inderal XL
Innopran XL
Levatol
CALCIUM CHANNEL BLOCKERS
GENERIC
afeditab CR
amlodipine besylate
cartia XT
dilt-XR
diltiazem CD
diltiazem HCL
diltiazem HCL CD
diltiazem HCL ER
felodipine ER
isradipine
matzim LA
nicardipine HCL
nifedical XL
nifedipine
nifedipine ER
nimodipine
nisoldipine
taztia XT
verapamil HCL
verapamil HCL ER
verapamil HCL SR
NON PREFERRED
Cardene IV
Cardizem LA
ANTIARRHYTHMICS
GENERIC
adenosine
amiodarone HCL
disopyramide phosphate
flecainide acetate
ibutilide fumarate
lidocaine HCL
lidocaine HCL IN D5W
lidocaine HCL/dextrose
mexiletine HCL
pacerone
propafenone HCL
propafenone HCL ER
quinidine gluconate CR
quinidine gluconate ER
quinidine sulfate
Quinidine Sulfate
PREFERRED
Tikosyn
NON PREFERRED
Multaq
Nexterone
Norpace CR
ACE INHIBITORS
GENERIC
benazepril HCL
captopril
enalapril maleate
enalaprilat
fosinopril sodium
lisinopril
moexipril HCL
perindopril erbumine
quinapril HCL
ramipril
trandolapril
ANGIOTENSIN RCPTR BLOCKER
GENERIC
candesartan cilexetilST
irbesartan
losartan potassium
telmisartan
valsartan
Eprosartan Mesylate
PREFERRED
Benicar
NON PREFERRED
EdarbiST
DIRECT RENIN INHIBITORS
PREFERRED
Tekturna
ANTIHYPERTENSIVES MISC.
GENERIC
clonidine HCL
doxazosin
doxazosin mesylate
eplerenone
fenoldopam mesylate
guanfacine HCL
hydralazine HCL
methyldopa
minoxidil
phenoxybenzamine hydrochloride
prazosin HCL
terazosin HCL
Methyldopate HCL
PREFERRED
Demser
ANTIHYPERTENSIVE COMBO
GENERIC
amlodipine besylate/benazepril hydrochloride
amlodipine besylate/benazepril HCL
amlodipine besylate/valsartan
amlodipine/valsartan/hctz
atenolol/chlorthalidone
benazepril HCL/hydrochlorothiazide
bisoprolol fumarate/hydrochlorothiazide
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
6
candesartan cilexetil/hydrochlorothiazide
enalapril maleate/hydrochlorothiazide
fosinopril sodium/hydrochlorothiazide
irbesartan/hydrochlorothiazide
lisinopril/hydrochlorothiazide
losartan potassium/hydrochlorothiazide
metoprolol/hydrochlorothiazide
moexipril/hydrochlorothiazide
nadolol/bendroflumethiazide
quinapril/hydrochlorothiazide
telmisartan/amlodipine
telmisartan/hydrochlorothiazide
trandolapril/verapamil HCL
trandolapril/verapamil HCL ER
valsartan/hydrochlorothiazide
PREFERRED
Amturnide
Azor
Benicar HCT
Tekamlo
Tekturna HCT
Tribenzor
DIURETICS
GENERIC
acetazolamide
acetazolamide sodium
acetazolamide ER
amiloride HCL
amiloride/hydrochlorothiazide
bumetanide
chlorothiazide
chlorothiazide sodium
ethacrynate sodium
furosemide
hydrochlorothiazide
indapamide
mannitol
methazolamide
metolazone
osmitrol viaflex
spironolactone
spironolactone/hydrochlorothiazide
torsemide
triamterene/hydrochlorothiazide
Acetazolamide
Chlorothiazide
Chlorthalidone
Methyclothiazide
Triamterene/Hydrochlorothiazide
NON PREFERRED
Dyrenium
Edecrin
SPECIALTY
KeveyisQL,PA
VASOPRESSORS
GENERIC
dobutamine HCL
dobutamine HCL/D5W
dobutamine/dextrose 5%
dopamine HCL
dopamine HCL-dextrose 5%
dopamine HCL/dextrose 5%
dopamine/D5W
ephedrine sulfate
midodrine HCL
norepinephrine bitartrate
phenylephrine HCL
Dopamine HCL
Epinephrine
PREFERRED
Auvi-q
Epipen 2-PAK
Epipen-JR 2-PAK
ANTIHYPERLIPIDEMICS
GENERIC
atorvastatin calcium
cholestyramine
cholestyramine light
colestipol HCL
fenofibrate
fenofibrate micronized
fenofibric acid DR
fluvastatin
fluvastatin sodium ER
gemfibrozil
lovastatin
micronized colestipol HCL
niacin ER
omega-3-acid ethyl esters
pravastatin sodium
prevalite
rosuvastatin calcium
simvastatin
Fenofibric Acid
PREFERRED
Vascepa
Vytorin
Welchol
Zetia
NON PREFERRED
Fenofibrate
Fenoglide
Fibricor
Livalo
Triglide
SPECIALTY
JuxtapidQL,PA
PraluentQL,PA
RepathaQL,PA
Repatha SureclickQL,PA
CARDIOVASCULAR - MISC.
GENERIC
amlodipine besylate/atorvastatin calcium
cardioplegic
papaverine HCL
PREFERRED
CialisQL
NON PREFERRED
Bidil
SPECIALTY
epoprostenol sodiumPA
sildenafilQL,PA
sildenafil citrateQL,PA
AdcircaQL,PA
AdempasQL,PA
LetairisQL,PA
OpsumitQL,PA
OrenitramPA
RemodulinPA
TracleerQL,PA
TyvasoQL,PA
Tyvaso RefillQL,PA
Tyvaso StarterQL,PA
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
7
UptraviQL,PA
VeletriPA
VentavisQL,PA
DERMATOLOGICALS
ACNE PRODUCTS
GENERIC
amnesteem
avar cleanser
avar-e emollient
avar-e green
benzepro
benzepro creamy wash
benzepro foaming cloths
benzepro SHORT contact
benziq wash
benzoyl peroxide
benzoyl peroxide SHORT contact
bp foam
bp foaming wash
bp wash
bp 10-1
bpo 6% foaming cloths
cerisa wash
claravis
claris clarifying wash
clearplex x
clindacin etz pledgets
clindacin-p
clindamax
clindamycin phosphate
clindamycin/benzoyl peroxide
ery
erythromycin
erythromycin/benzoyl peroxide
myorisan
neuac
oscion cleanser
pr benzoyl peroxide wash
prascion
prascion fc
rosanil cleanser
rosula
se bpo wash
se 10-5 ss
sodium sulfacetamide
sodium sulfacetamide/sulfur
sodium sulfacetamide/sulfur cleanser
sodium sulfacetamide/sulfur cleansing cloths
sodium sulfacetamide/sulfur green
sodium sulfacetamide/sulfur w/sunscreen
sodium sulfacetamide/sulfur wash
ss 10-2
sss 10-5
sss 10%-5%
sulfacetamide sodium
sulfacetamide sodium/sulfur
sulfacetamide sodium/sulfur cleanser
sulfacleanse 8/4
virti-sulf
zenatane
zencia
NON PREFERRED
Azelex
ROSACEA AGENTS
GENERIC
metronidazole
rosadan
Doxycycline
PREFERRED
Finacea
Oracea
ANTIBIOTICS - TOPICAL
GENERIC
mupirocin
mupirocin calcium
NON PREFERRED
Altabax
Cortisporin
Neo-synalar
ANTIFUNGALS - TOPICAL
GENERIC
ciclodan
ciclopirox
ciclopirox nail lacquer
ciclopirox olamine
ciclopirox treatmentPA
clotrimazole
clotrimazole/betamethasone dipropionate
econazole nitrate
ketoconazole
ketodan
naftifine hydrochlorideST
nyamyc
nystatin
nystatin/triamcinolone
nystop
oxiconazole nitrate
pedi-dri
NON PREFERRED
Cnl8 Nail KitPA
ErtaczoST
ExeldermST
MentaxST
Oxistat
Pedipirox-4 NailPA
XolegelST
ANTIVIRALS - TOPICAL
GENERIC
acyclovir
PREFERRED
Denavir
Zovirax
ANTI-INFLAMMATORY AGENTS
GENERIC
diclofenac sodiumQL,PA
diclotral PAK
klofensaid IIQL,PA
sure result dss premium pack
ANTIPRURITICS
GENERIC
Doxepin Hydrochloride
ANTIPSORIATICS
GENERIC
acitretin
calcipotriene
calcitrene
methoxsalen
Calcitriol
PREFERRED
TazoracQL,PA
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
8
8-mop
NON PREFERRED
Vectical
ANTISEBORRHEIC AGENTS
GENERIC
seb-prev wash
selenium sulfide
sodium sulfacetamide
sodium sulfacetamide wash
CORTICOSTEROIDS - TOPICAL
GENERIC
ala cort
alclometasone dipropionate
alphatrex
augmented betamethasone dipropionate
betamethasone dipropionate
betamethasone valerate
calcipotriene/betamethasone dipropionateQL,PA
clobetasol propionate
clobetasol propionate e
clobetasol propionate emollient
clodan
cormax scalp application
desonide
desoximetasone
fluocinolone acetonide
fluocinolone acetonide body
fluocinolone acetonide scalp
fluocinonide
fluocinonide-e
flurandrenolide
fluticasone propionate
halobetasol propionate
halonate PAC
hydrocortisone
hydrocortisone acetate/aloe
hydrocortisone butyrate
hydrocortisone butyrate (lipid)
hydrocortisone butyrate (lipophilic)
hydrocortisone valerate
hydrocortisone IN absorbase
lokara
mometasone furoate
prednicarbate
scalacort
triamcinolone acetonide
triderm
Amcinonide
Apexicon E
Desoximetasone
Diflorasone Diacetate
PREFERRED
TaclonexQL,PA
NON PREFERRED
Capex
Cordran
Cordran Tape
Halog
Locoid
Texacort
IMMUNOMODULATING AGENTS
GENERIC
imiquimod
tacrolimus
PREFERRED
Elidel
DERMATOLOGICALS - MISC.
GENERIC
ammonium lactate
anodynz
avalin-RX
ceramax
cerovel
cidaleaze
diclofenac sodium
elenzapatch
episone CRE
fluorouracil
glydo
grafco silver nitrate applicator
grafco silver nitrate applicator 12"
hypercare
k2k pain relieving patch
lactic acid
lactic acid e
lactic acid w/vitamin e
latrix
lidenza patch
lidocaine
lidocaine HCL
lidocaine HCL jelly
lidocaine-prilocaine-cream base
lidocaine/prilocaine
lidodextrapine
lidopin
lindane
livixil PAK
lorenza
mafenide acetate
malathion
migryl
permethrin
podofilox
pramox gel
premium lidocaine
provenza
rea LO 39
rea LO 40
reciphexamine
relador PAK
relador PAK plus
releevia ML
remeven
salacyn
salicylic acid
salicylic acid cream
salicylic acid lotion
salicylic acid wart remover
silver sulfadiazine
sodium hyaluronate
ssd
synvexia
tetrix
thermazene
tropazone
u-kera e
umecta mousse
ure-k
urea
urea hydrating
urea nail
urea topical
urea IN zinc undecylenate/lactic acid vehicle
urea 40% nail film
urea-c40
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
9
x-viate
xyphex
zeruvia
Cem-urea
CARB-o-philic 40
CARB-o-philic/40
LP lite PAK
Salicylic Acid
PREFERRED
Condylox
Oxsoralen
RegranexPA
Sulfamylon
NON PREFERRED
Eurax
Fluoroplex
Panretin
Picato
Sklice
Ulesfia
Veregen
SPECIALTY
TargretinPA
ValchlorPA
ENDOCRINE AND METABOLIC
CORTICOSTEROIDS
GENERIC
baycadron
betamethasone sodium phosphate/betamethasone
acetate
budesonide
deltasone
dexamethasone
dexamethasone sodium phosphate
fludrocortisone acetate
hydrocortisone
methylprednisolone
methylprednisolone acetate
methylprednisolone dose pack
methylprednisolone sodiumsuccinate
prednisolone
prednisolone sodium phosphate
prednisolone sodium phosphate odt
prednisone
A-hydrocort
Dexamethasone
Dexamethasone Sodium Phosphate
Prednisone
NON PREFERRED
Depo-medrol
Dexamethasone Intensol
Dexpak 10 Day
Dexpak 13 Day
Dexpak 6 Day
Prednisone Intensol
Solu-cortef
ANDROGENS-ANABOLIC
GENERIC
danazol
methyltestosterone
oxandroloneQL,PA
testosterone
testosterone cypionatePA
testosterone enanthatePA
testosterone P.M.
Testosterone
Testosterone P.M.
PREFERRED
Androgel
Androgel P.M.
Androxy
Axiron
Methitest
NON PREFERRED
Anadrol-50PA
StriantST
ESTROGENS
GENERIC
estradiol
estradiol valerate
estradiol/norethindrone acetate
estropipate
fyavolv
jevantique LO
jinteli
lopreeza
mimvey
mimvey LO
norethindrone acetate/ethinyl estradiol
ortho-est
PREFERRED
Cenestin
Combipatch
Enjuvia
Evamist
Premarin
Premphase
Prempro
NON PREFERRED
Menest
CONTRACEPTIVES
PREVENTIVE
aftera
altavera
alyacen 1/35
alyacen 7/7/7
amethiaQL
amethia LOQL
amethyst
apri
aranelle
ashlynaQL
aubra
aviane
azurette
balziva
bekyree
blisovi FE 1.5/30
blisovi FE 1/20
blisovi 24 FE
briellyn
camila
camreseQL
camrese LOQL
caziant
chateal
cryselle-28
cyclafem 1/35
cyclafem 7/7/7
cyred
dasetta 1/35
dasetta 7/7/7
dayseeQL
deblitane
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
10
delyla
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
econtra EZ
elinest
emoquette
enpresse-28
enskyce
errin
estarylla
fallback solo
falmina
gianvi
gildagia
gildess FE 1.5/30
gildess FE 1/20
gildess 1.5/30
gildess 1/20
gildess 24 FE
heather
introvaleQL
jencycla
jolessaQL
jolivette
juleber
junel FE 1.5/30
junel FE 1/20
junel FE 24
junel 1.5/30
junel 1/20
kaitlib FE
kariva
kelnor 1/35
kimidess
kurvelo
larin FE 1.5/30
larin FE 1/20
larin 1.5/30
larin 1/20
larin 24 FE
layolis FE
leena
lessina
levonest
levonorgestrel
levonorgestrel and ethinyl estradiolQL
levonorgestrel/ethinyl estradiol
levora 0.15/30-28
lomedia 24 FE
loryna
low-ogestrel
lutera
lyza
marlissa
medroxyprogesterone acetateQL
microgestin FE
microgestin FE 1.5/30
microgestin 1.5/30
microgestin 1/20
microgestin 24 FE
mono-linyah
mononessa
my way
myzilra
necon 0.5/35-28
necon 1/35
necon 7/7/7
next choice one dose
nikki
nora-be
norethindrone
norethindrone & ethinyl estradiol ferrous fumarate
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
norgestimate/ethinyl estradiol
norlyroc
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
ocella
opcicon one-step
orsythia
philith
pimtrea
pirmella 1/35
pirmella 7/7/7
portia-28
previfem
quasenseQL
reclipsen
setlakinQL
sharobel
sprintec 28
sronyx
syeda
take action
tarina FE 1/20
tilia FE
tri-estarylla
tri-legest FE
tri-linyah
tri-previfem
tri-sprintec
tri-LO-estarylla
tri-LO-marzia
tri-LO-sprintec
trinessa
trinessa LO
trivora-28
velivet
vestura
vienva
viorele
vyfemla
wera
wymzya FE
zarah
zenchent
zenchent FE
zovia 1/35e
Levonorgestrel
Ogestrel
Xulane
PREFERRED
LO Loestrin FE
Minastrin 24 FE
PREVENTIVE
Natazia
NuvaringQL
NON PREFERRED
Depo-subq Provera 104QL
PREVENTIVE
Ella
PREVENTIVE
Implanon
Liletta
Mirena
Nexplanon
Paragard Intrauterine Copper Contraceptive T380a
Skyla
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
11
BIGUANIDES
PROGESTINS
GENERIC
medroxyprogesterone acetate
megestrol acetate
norethindrone acetate
progesterone
SPECIALTY
MakenaPA
ANTIDIABETIC AGENTS
INSULIN
PREFERRED
Lantus
Lantus Solostar
Novolin N
Novolin N Relion
Novolin R
Novolin R Relion
Novolin 70/30
Novolin 70/30 Relion
Novolog
Novolog Flexpen
Novolog Mix 70/30
Novolog Mix 70/30 Prefilled Flexpen
Novolog Penfill
Toujeo Solostar
NON PREFERRED
ApidraST
Apidra SolostarST
HumalogST
Humalog KwikpenST
Humalog Mix 50/50ST
Humalog Mix 50/50 KwikpenST
Humalog Mix 75/25ST
Humalog Mix 75/25 KwikpenST
Humulin NST
Humulin N KwikpenST
Humulin RST
Humulin R U-500 (concentrated)ST
Humulin 70/30ST
Humulin 70/30 KwikpenST
LevemirST
Levemir FlexpenST
Levemir FlextouchST
AMYLIN ANALOGS
PREFERRED
Symlinpen 120PA
Symlinpen 60PA
INCRETIN MIMETIC AGENTS
PREFERRED
Bydureon
Byetta
TrulicityQL,ST
Victoza
SULFONYLUREAS
GENERIC
glimepiride
glipizide
glipizide ER
glipizide XL
glyburide
glyburide micronized
tolazamide
Chlorpropamide
Glyburide
Tolazamide
Tolbutamide
NON PREFERRED
Diabeta
GENERIC
metformin HCL
metformin HCL ER
PREFERRED
Riomet
MEGLITINIDE ANALOGUES
GENERIC
nateglinide
repaglinide
DIABETIC OTHER
PREFERRED
Glucagen Hypokit
Glucagon Emergency Kit
InvokanaPA
Proglycem
NON PREFERRED
Cycloset
JardianceST
ALPHA-GLUCOSIDASE INHIBIT
GENERIC
acarbose
NON PREFERRED
Glyset
DPP-4 INHIBITORS
GENERIC
Alogliptin
PREFERRED
Januvia
Onglyza
NON PREFERRED
Tradjenta
INSULIN SENSITIZING AGENT
GENERIC
pioglitazone HCL
NON PREFERRED
Avandia
ANTIDIABETIC COMBINATIONS
GENERIC
glipizide/metformin HCL
glyburide/metformin HCL
pioglitazone HCL-glimepiride
pioglitazone HCL/metformin HCL
Alogliptin/Metformin HCL
Alogliptin/Pioglitazone
Repaglinide/Metformin Hydrochloride
PREFERRED
Actoplus Met XR
Janumet
Janumet XR
Kombiglyze XR
BISPHOSPHONATES
GENERIC
alendronate sodium
ibandronate sodiumQL
risedronate sodiumQL,ST
risedronate sodium DRQL,ST
Etidronate Disodium
PREFERRED
Alendronate Sodium
Fosamax Plus DQL
SPECIALTY
pamidronate disodium
zoledronic acidPA
Pamidronate Disodium
Zoledronic AcidPA
ZometaPA
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
12
CALCITONINS
GENERIC
calcitonin salmonQL
calcitonin-salmonQL
NON PREFERRED
Miacalcin
vasopressin
SPECIALTY
Stimate
CORTICOTROPIN
SPECIALTY
H.p. ActharPA
PARATHYROID HORMONE
SPECIALTY
ForteoQL
PROLACTIN INHIBITORS
GENERIC
cabergoline
RANK LIGAND INHIBITORS
SPECIALTY
ProliaQL,PA
XgevaPA
HORMONE RECEPTOR MDLTR
GENERIC
raloxifene hydrochloride
FERTILITY REGULATORS
SPECIALTY
chorionic gonadotropinQL
clomiphene citrate
novarelQL
pregnyl w/diluent benzyl alcohol/NACLQL
serophene
LHRH/GNRH AGONIST
SPECIALTY
Lupron Depot-PEDQL,PA
Supprelin LAQL,PA
Synarel
GROWTH HORMONES
SPECIALTY
Norditropin CartridgeQL,PA
Norditropin FlexproQL,PA
Norditropin Nordiflex PenQL,PA
Nutropin AQ Nuspin 10QL,PA
Nutropin AQ Nuspin 20QL,PA
Nutropin AQ Nuspin 5QL,PA
Nutropin AQ PenQL,PA
SerostimQL,PA
ZorbtiveQL,PA
VASOPRESSIN ANTAGONISTS
SPECIALTY
SamscaQL
METABOLIC MODIFIERS
GENERIC
calcitriol
doxercalciferol
levocarnitine
paricalcitol
PREFERRED
SensiparPA
NON PREFERRED
Hectorol
SPECIALTY
sodium phenylbutyrate
AldurazymePA
Buphenyl
Carbaglu
Cystadane
ElaprasePA
FabrazymePA
KanumaPA
KuvanPA
LumizymePA
MyaleptPA
MyozymePA
NaglazymePA
Orfadin
RavictiPA
StrensiqPA
VimizimPA
THYROID AGENTS
GHRH
SPECIALTY
EgriftaQL,PA
SOMATOMEDINS
SPECIALTY
IncrelexPA
SOMATOSTATIC AGENTS
SPECIALTY
octreotide acetatePA
Sandostatin Lar DepotPA
SigniforQL,PA
Somatuline DepotQL,PA
GH RECEPTOR ANTAGONISTS
SPECIALTY
SomavertPA
POSTERIOR PITUITARY
GENERIC
desmopressin acetate
GENERIC
levo-t
levothyroxine sodium
levoxyl
liothyronine sodium
methimazole
propylthiouracil
unithroid
unithroid direct
NP thyroid
NP thyroid 60
NP thyroid 90
PREFERRED
Armour Thyroid
NON PREFERRED
Thyrolar-1
Thyrolar-1/2
Thyrolar-1/4
Thyrolar-2
Thyrolar-3
GASTROINTESTINAL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
13
Gastrinex NF
Nizatidine
PREFERRED
Carafate
NON PREFERRED
Aciphex SprinkleQL
Atropen
Cantil
Cuvposa
DexilantQL
Esomeprazole StrontiumQL
NexiumQL
Omeclamox-PAK
Pylera
LAXATIVES
GENERIC
constulose
gavilyte-h
lactulose
peg-prep
pegylax
polyethylene glycol 3350
PREVENTIVE
gavilyte-c
gavilyte-n/flavor pack
gavilyte-G
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
trilyte
PREFERRED
Moviprep
Suprep Bowel Prep
NON PREFERRED
Osmoprep
Prepopik
ANTIDIARRHEALS
GENERIC
diphenoxylate/atropine
lofene
loperamide HCL
opium
opium tincture
ULCER DRUGS
GENERIC
atropine sulfate
chlordiazepoxide HCL/clidinium bromide
cimetidine
cimetidine HCL
dicyclomine hci
dicyclomine HCL
ed-spaz
esomeprazole magnesiumQL
esomeprazole sodium
famotidine
glycopyrrolate
hyomax-SL
hyoscyamine sulfate
hyoscyamine sulfate odt
hyoscyamine sulfate ER
hyoscyamine sulfate SR
hyosyne
lansoprazoleQL
lansoprazole/amoxicillin/clarithromycin
methscopolamine bromide
misoprostol
nizatidine
nulev
omeprazoleQL
omeprazole/sodium bicarbonateQL
oscimin
oscimin SR
pantoprazole sodiumQL
rabeprazole sodiumQL
ranitidine HCL
sucralfate
symax fastabs
symax-SL
symax-SR
Esomeprazole Sodium
Famotidine
ANTIEMETICS
GENERIC
dronabinolQL,PA
granisetron HCLQL
meclizine HCL
ondansetron odtQL
ondansetron HCLQL
trimethobenzamide HCL
PREFERRED
Aloxi
EmendQL
SancusoQL
Transderm-scop
NON PREFERRED
AkynzeoQL
AnzemetQL
CesametQL,PA
GranisolQL
DIGESTIVE AIDS
PREFERRED
Creon
Pancrelipase
NON PREFERRED
ZenpepST
SPECIALTY
Sucraid
GASTROINTESTINAL - MISC.
GENERIC
alosetron hydrochloride
ana-lex
balsalazide disodium
calcium acetate
colocort
cromolyn sodium
enulose
generlac
hydrocort ene 100MG
hydrocortisone
hydrocortisone acetate/lidocaine HCL
hydrocortisone acetate/pramoxine
lactulose
lidazone HC
lidocaine HCL/hydrocortisone acetate
mesalamine
metoclopramide odt
metoclopramide HCL
pramcort
procto-MED HC
procto-PAK
proctosol HC
proctozone-HC
sulfasalazine
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
14
ursodiol
PREFERRED
AmitizaQL
Asacol HD
Canasa
Chenodal
Cortifoam
Delzicol
Fosrenol
Lialda
LinzessQL
Pentasa
Rectiv
RelistorQL,PA
Renvela
Sevelamer Carbonate
NON PREFERRED
Dipentum
Phoslyra
Renagel
SPECIALTY
CimziaQL,PA
Cimzia Starter KitQL,PA
GattexPA
RemicadeQL,PA
GENITOURINARY
URINARY ANTI-INFECTIVES
GENERIC
azuphen mb
hyolev mb
hyophen
indiomin mb
me/naphos/mb/hyo 1
methenamine hippurate
methenamine mandelate
nitrofurantoin
nitrofurantoin macrocrystals
nitrofurantoin monohydrate
nitrofurantoin monohydrate/macrocrystals
phosphasal
ur n-c
uramit mb
urelle
uretron d/s
uribel
urin d/s
uro-blue
uro-l
uro-mp
uroav-b
uroav-81
urolet mb
urophen mb
uryl
ustell
uta
uticap
utira-c
utrona-c
NON PREFERRED
Monurol
URINARY ANTISPASMODICS
GENERIC
bethanechol chloride
darifenacin hydrobromide ER
darifenacin ER
flavoxate HCL
oxybutynin chloride
oxybutynin chloride ER
tolterodine tartrate
tolterodine tartrate ER
trospium chloride
trospium chloride ER
PREFERRED
Gelnique
Myrbetriq
OxytrolQL
Toviaz
Vesicare
VAGINAL PRODUCTS
GENERIC
clindamycin phosphate
metronidazole vaginal
terconazole
vandazole
zazole
PREVENTIVE
vcf vaginal contraceptivegel
PREFERRED
Estrace
Vagifem
NON PREFERRED
Avc
Gynazole-1
PREVENTIVE
Encare
Options Gynol II Vaginal Contraceptive
Shur-seal
Today Sponge
Vcf Vaginal Contraceptive Film
Vcf Vaginal Contraceptive Foam
SPECIALTY
Crinone
GENITOURINARY - MISC.
GENERIC
acetic acid 0.25%
alfuzosin HCL ER
aminoacetic acid
argyle sterile saline 100ML
citric acid/sodium citrate
curity sterile saline
cytra k crystals
cytra-k
cytra-2
dutasteride
dutasteride/tamsulosin hydrochloride
dutasteride/tamsulosin HCL
finasteride
glycine
neomycin/polymyxin b sulfates
phenazo
phenazopyridine HCL
potassium citrate ER
potassium citrate-citric acid crystals
potassium citrate/citric acid
potassium citrate/sodium citrate/citric acid
sodium chloride
sodium chloride 0.9%
sodium citrate/citric acid
tamsulosin HCL
taron-crystals
tricitrates
virtrate-k
virtrate-2
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
15
virtrate-3
PREFERRED
Elmiron
Rapaflo
NON PREFERRED
Cardura XL
SPECIALTY
Cystagon
ProcysbiPA
HEMATOLOGICAL
HEMATOPOIETIC AGENTS
GENERIC
airavite
corvita 150
cyanocobalamin
dexferrum
fabb
ferocon
ferotrinsic
ferrocite plus
ferrogels forte
folbee
folic acid/vitamin b-6/vitamin b-12
folplex 2.2
foltrin
hematinic plus vitamins/minerals
hematinic/folic acid
hematogen
hematogen forte
hemocyte-f
hemocyte-plus
iferex 150 forte
k-tan plus
myferon 150 forte
nufol
poly-iron 150 forte
polysaccharide iron forte
purevit dualfe plus
se-tan plus
tricon
trigels-f forte
virt-gard
virt-vite
AV-vite fb
Bp Vit 3
FE c plus
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C
Threon/Suc
TL gard RX
TL icon
TL-hem 150
PREVENTIVE
bprotected pedia iron
eq slow-release iron
eql folic acid
eql iron supplement therapy
eql slow release iron
ezfe 200
fa-8
feosol
fer-iron
ferate
fergon
ferosul
ferrex 150
ferric x-150
ferro-bob
ferrocite
ferrotabs
ferrous drops
ferrous fumarate 324
ferrous gluconate
ferrous sulfate
ferrousul
folic acid
gnp folic acid
gnp iron
gnp slow release iron
high potency iron
iferex 150
iron
iron slow release
iron supplement
iron supplement childrens
kp ferrous gluconate
kp ferrous sulfate
kp folic acid
meijer ferrous sulfate
myferon 150
nu-iron 150
poly-iron 150
px folic acid
px iron
qc ferrous sulfate
ra folic acid
ra high potency iron
ra iron
ra slow release iron
slow iron
slow release iron
slow FE
slow-release iron
sm folic acid
sm iron
sm iron slow release
sm slow release iron
th folic acid
th iron
th slow release iron
wee care
yl folic acid
CVS folic acid
CVS iron
Ferretts
FE gluconate
FE TABS
HM folic acid
HM iron
HM iron slow release
HM slow release iron
PREFERRED
Droxia
Nascobal
PREVENTIVE
CVS Slow Release Iron
Elite Iron
Fa-8
Femiron
Feosol
Ferretts Chewable Iron
Ferretts IPS
Ferrimin 150
Ferro-sequels
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
FE Aspartate
High Potency Iron
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
16
Iron
Iron Chews Pediatric
Iron Up
Mykidz Iron 10
Novaferrum Pediatric Drops
Perfect Iron
Profe
Proferrin ES
Slow Release Iron
Sm Slow Release Iron
SPECIALTY
sodium ferric gluconate complex/sucrose
Aranesp Albumin Free
CerezymePA
ElelysoPA
EpogenPA
LeukinePA
MozobilQL,PA
NeulastaPA
Neulasta Onpro KitPA
NeumegaPA
NeupogenPA
NplatePA
ProcritPA
PromactaPA
VprivPA
ZavescaPA
ANTICOAGULANTS
GENERIC
argatroban
bivalirudin
enoxaparin sodiumQL
fondaparinux sodiumQL
hep flush-10
heparin lock
heparin lock flush
heparin lock flush for flushing vascular access devices
heparin lock flush/NACL for flushing vascular access
devices
heparin sodium
heparin sodium dcu
heparin sodium lock flush
heparin sodium/sodium chloride 0.9% premix
heparin sodium/D5W
heparin sodium/NACL 0.9%
jantoven
monoject pharma grade flush syringe/heparin lock
monoject prefill advanced heparin lock flush
sash kit for flushing vascular access devices
warfarin sodium
PREFERRED
EliquisQL
PradaxaQL
XareltoQL
Xarelto Starter PackQL
NON PREFERRED
Argatroban
FragminQL
SavaysaQL
HEMOSTATICS
GENERIC
aminocaproic acid
tranexamic acid
HEMATOLOGICAL - MISC.
GENERIC
albuked 25
albuked 5
albumin human
albumin-zlb
albuminar-25
albuminar-5
alburx
albutein
anagrelide hydrochloride
buminate
cilostazol
clopidogrel
dipyridamole
eptifibatide
flexbumin
hetastarch 6%/NACL
human albumin grifols
kedbumin
pentoxifylline ER
plasbumin-25
plasbumin-5
ticlopidine HCL
Aspirin/Dipyridamole
PREFERRED
Aggrenox
Brilinta
Effient
Zontivity
NON PREFERRED
Aggrastat
SPECIALTY
Advate
Alphanate/Von Willebrand Factor Complex/Human
Alphanine SD
Bebulin
Benefix
Berinert
Ceprotin
Cinryze
Coagadex
Corifact
Eloctate
Feiba
Feiba NF
Firazyr
Helixate FS
Hemofil M
Humate-p
Idelvion
Kalbitor
Koate-dvi
Kogenate FS
Kogenate FS Bio-set
Monoclate-p
Mononine
Novoseven
Novoseven Rt
Obizur
Profilnine
Profilnine SD
Recombinate
Riastap
Rixubis
SolirisPA
Thrombate Iii W/10 ML Sterile Water
Thrombate Iii W/20 ML Sterile Water
Tretten
Wilate
Xyntha
Xyntha Solofuse
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
17
MOUTH/THROAT/DENTAL AGENT
GENERIC
cavarest
cavirinse
cevimeline HCL
chlorhexidine gluconate
chlorhexidine gluconate oral rinse
clinpro 5000
clotrimazole
controlrx
denta 5000 plus
dentagel
easygel
fluoridex daily defense
fluoridex daily defense enhanced whitening
fluoridex daily defense sensitivity relief
karigel
karigel-n
lidocaine viscous
lidocaine HCL viscous
neutragard advanced
neutral sodium fluoride
nystatin
oralone
paroex
periogard
phos-flur
pilocarpine hydrochloride
pilocarpine HCL
stannous fluoride oral rinse
topex topical anesthetic
triamcinolone acetonide
triamcinolone IN orabase
SF
SF 5000 plus
NON PREFERRED
Oravig
NEUROLOGY, CNS, PSYCH
ANTIANXIETY AGENTS
GENERIC
alprazolam
alprazolam odt
alprazolam ER
alprazolam XR
buspirone HCL
chlordiazepoxide HCL
clorazepate dipotassium
diazepam
diazepam intensol
droperidol
gene-xene TAB 15MG
gene-xene TAB 3.75MG
gene-xene TAB 7.5MG
hydroxyzine pamoate
hydroxyzine HCL
lorazepam
lorazepam intensol
meprobamate
oxazepam
Diazepam
Hydroxyzine Pamoate
ANTIDEPRESSANTS
GENERIC
amitriptyline HCL
bupropion HCL
bupropion HCL ERQL
bupropion HCL SRQL
bupropion HCL XLQL
citalopram hydrobromide
clomipramine HCL
desipramine HCL
doxepin HCL
duloxetine HCLQL
escitalopram oxalate
fluoxetine DRQL
fluoxetine HCL
fluvoxamine maleate
fluvoxamine maleate ERQL
imipramine pamoate
imipramine HCL
mirtazapine
mirtazapine odt
nefazodone HCL
nortriptyline HCL
paroxetine HCL
paroxetine HCL ER
phenelzine sulfate
protriptyline HCL
sertraline HCL
tranylcypromine sulfate
trazodone HCL
trimipramine maleate
venlafaxine HCL
venlafaxine HCL ER
Amoxapine
Doxepin HCL
Maprotiline HCL
Nefazodone HCL
Nortriptyline HCL
Venlafaxine HCL ER
PREFERRED
PristiqQL
NON PREFERRED
AplenzinQL
Duloxetine HCLQL
EmsamQL
Marplan
Paxil
ViibrydQL
Viibryd Starter PackQL
ANTIPSYCHOTICS
GENERIC
aripiprazoleQL
chlorpromazine HCL
clozapineQL
clozapine odtQL
compazine
compro
fluphenazine decanoate
fluphenazine HCL
haloperidol
haloperidol decanoate
haloperidol lactate
lithium carbonate
lithium carbonate ER
loxapine
loxapine succinate
olanzapineQL
olanzapine odtQL
paliperidone ERQL,ST
perphenazine
prochlorperazine
prochlorperazine edisylate
prochlorperazine maleate
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
18
quetiapine fumarateQL
risperidoneQL
risperidone odtQL
risperidone M-TABQL
thioridazine HCL
thiothixene
trifluoperazine HCL
ziprasidone HCLQL
Aripiprazole OdtQL
Clozapine OdtQL
PREFERRED
AbilifyQL
Abilify DiscmeltQL
Abilify Maintena
LatudaQL
Molindone Hydrochloride
Risperdal Consta
Seroquel XRQL
NON PREFERRED
FanaptQL,ST
Fanapt Titration PackQL,ST
FazacloQL
Geodon
Invega Sustenna
Invega Trinza
Lithium
RexultiQL,ST
SaphrisQL,ST
Zyprexa Relprevv
HYPNOTICS
GENERIC
dexmedetomidine HCL
estazolam
eszopicloneQL
flurazepam HCL
phenobarbital
temazepam
triazolam
zaleplonQL
zolpidem tartrateQL
zolpidem tartrate ERQL
Flurazepam HCL
Phenobarbital
Phenobarbital Sodium
Quazepam
Triazolam
PREFERRED
RozeremQL
SPECIALTY
HetliozQL,PA
ADHD, NARCOLEPSY, ETC.
GENERIC
amphetamine/dextroamphetamineQL
caffeine citrate
clonidine HCL ER
dexedrineQL
dexmethylphenidate HCLQL
dexmethylphenidate HCL ERQL
dextroamphetamine sulfateQL
dextroamphetamine sulfate ERQL
doxapram HCL
guanfacine ER
metadate ERQL
methamphetamine HCLQL
methylphenidate hydrochloride
methylphenidate HCLQL
methylphenidate HCL CDQL
methylphenidate HCL ERQL
methylphenidate HCL SRQL
modafinilQL,PA
zenzediQL
Methylphenidate HCL ER
ProcentraQL
PREFERRED
DaytranaQL
NuvigilQL,PA
Quillivant XRQL
StratteraQL
VyvanseQL
NON PREFERRED
ConcertaQL
Focalin XRQL
ANTICONVULSANTS
GENERIC
carbamazepine
carbamazepine ER
clonazepam
clonazepam odt
divalproex sodium
divalproex sodium DR
divalproex sodium ER
epitol
ethosuximide
felbamate
fosphenytoin sodium
gabapentin
lamotrigine
lamotrigine odt
lamotrigine titration
lamotrigine ER
levetiracetam
levetiracetam ER
oxcarbazepine
phenytoin
phenytoin infatabs
phenytoin sodium
phenytoin sodium extended
primidone
roweepra
tiagabine hydrochloride
topiragen
topiramate
valproate sodium
valproic acid
zonisamide
PREFERRED
Banzel
Celontin
Dilantin
Fycompa
Gabitril
LyricaQL
Onfi
Peganone
Potiga
Vimpat
NON PREFERRED
Lamictal
Stavzor
SPECIALTY
SabrilPA
ANTIPARKINSON AGENTS
GENERIC
amantadine HCL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
19
benztropine mesylate
bromocriptine mesylate
carbidopa
carbidopa/levodopa
carbidopa/levodopa odt
carbidopa/levodopa ER
entacapone
pramipexole dihydrochloride
pramipexole dihydrochloride ER
ropinirole ER
ropinirole HCL
selegiline HCL
tolcapone
trihexyphenidyl HCL
Carbidopa/Levodopa/Entacapone
PREFERRED
Azilect
Mirapex ER
NON PREFERRED
NeuproST
SPECIALTY
ApokynQL,PA
NEUROLOGY, PSYCH - MISC.
GENERIC
acamprosate calcium DR
disulfiram
donepezil HCL
ergoloid mesylates
galantamine hydrobromide
memantine hydrochloride
memantine HCL
memantine HCL titration PAK
olanzapine/fluoxetineQL
pimozide
rivastigmine tartrate
rivastigmine transdermal system
Ergoloid Mesylates
Galantamine Hydrobromide
Perphenazine/Amitriptyline
PREVENTIVE
buprobanQL
bupropion HCL SRQL
eq nicotineQL
eq nicotine gum refillQL
eq nicotine gum starterQL
eq nicotine polacrilexQL
eq nicotine step 3QL
eql nicotineQL
eql nicotine polacrilexQL
eql nicotine polacrilex refillQL
eql nicotine polacrilex starterQL
gnp nicotine mini lozengeQL
gnp nicotine polacrilexQL
gnp nicotine polacrilex miniQL
goodsense nicotine gumQL
kls quit2QL
kls quit4QL
nicoreliefQL
nicotineQL
nicotine mini lozengeQL
nicotine polacrilexQL
nicotine polacrilex refillQL
nicotine polacrilex starter kitQL
nicotine step 1QL
nicotine step 2QL
nicotine step 3QL
nicotine transdermal systemQL
nicotine transdermal system step 1QL
nicotine transdermal system step 2QL
nicotine transdermal system step 3QL
px stop smoking aidQL
qc nicotine polacrilexQL
ra mini nicotineQL
ra nicotineQL
ra nicotine polacrilexQL
ra nicotine transdermal system step 3QL
sm nicotineQL
sm nicotine polacrilexQL
sm nicotine transdermal systemQL
sw nicotine polacrilexQL
tgt nicotine gumQL
tgt nicotine polacrilexQL
tgt nicotine step oneQL
tgt nicotine step threeQL
tgt nicotine step twoQL
thriveQL
CVS nicotineQL
CVS nicotine lozengeQL
CVS nicotine polacrilexQL
CVS nicotine polacrilex starterQL
CVS nicotine transdermal systemQL
CVS nts step 1QL
HM nicotine polacrilexQL
HM nicotine transdermal systemQL
HM nicotine transdermal system step 3QL
SR nicotine gumQL
PREFERRED
GraliseQL
Gralise StarterQL
Namenda XRQL
Namenda XR Titration PackQL
Nuedexta
SavellaQL
PREVENTIVE
ChantixQL
Chantix Continuing Month PAKQL
Chantix Starting Month PAKQL
Nicotine Transdermal SystemQL
NON PREFERRED
HorizantQL,PA
PREVENTIVE
Nicotrol InhalerQL
Nicotrol NsQL
SPECIALTY
glatopaQL,PA
tetrabenazinePA
AmpyraQL,PA
AubagioQL,PA
AvonexQL,PA
Avonex Pen
BetaseronQL,PA
CopaxoneQL,PA
GilenyaQL,PA
LemtradaPA
Rebif
Rebif Rebidose
Rebif Rebidose Titration Pack
Rebif Titration Pack
TecfideraQL,PA
Tecfidera Starter PackQL,PA
TysabriQL,PA
XyremQL,PA
NEUROMUSCULAR AGENTS
GENERIC
atracurium besylate
cisatracurium besylate
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
20
pancuronium bromide
riluzoleQL,PA
rocuronium bromide
vecuronium bromide
SPECIALTY
BotoxQL,PA
DysportQL,PA
MyoblocQL,PA
XeominQL,PA
MUSCULOSKELETAL AGENTS
GENERIC
baclofen
carisoprodol
carisoprodol/aspirin
carisoprodol/aspirin/codeine
chlorzoxazone
cyclobenzaprine HCL
dantrolene sodium
metaxall
metaxalone
methocarbamol
orphenadrine citrate
orphenadrine citrate ER
revonto
tizanidine HCL
Metaxalone
Orphenadrine/Asa/Caffeine
NON PREFERRED
Lorzone
SPECIALTY
MonoviscPA
OrthoviscPA
SynviscPA
Synvisc OnePA
ANTIMYASTHENIC AGENTS
GENERIC
neostigmine methylsulfate
pyridostigmine bromide
Guanidine HCL
PREFERRED
Mestinon
OPHTHALMOLOGY AND OTIC
ANTI-INFECTIVES
GENERIC
ak-poly-bac
bacitracin/polymyxin b
ciprofloxacin HCL
erythromycin
garamycin
gatifloxacin
gentak
gentamicin sulfate
ilotycin
levofloxacin
neo-polycin
neomycin/bacitracin/polymyxin
neomycin/polymyxin/bacitracin zinc
neomycin/polymyxin/gramicidin
ofloxacin
polycin
polycin b
polymyxin b sulfate/trimethoprim sulfate
romycin
sodium sulfacetamide
sulfacetamide sodium
tobramycin sulfate
trifluridine
trimethoprim sulfate/polymyxin b sulfate
Bacitracin
PREFERRED
Besivance
Moxeza
Natacyn
Vigamox
NON PREFERRED
Ciloxan
Tobrex
Zirgan
ARTIFICIAL TEAR/LUBRICANT
NON PREFERRED
Lacrisert
BETA-BLOCKERS
GENERIC
betaxolol HCL
carteolol HCL
dorzolamide HCL/timolol maleate
levobunolol HCL
timolol maleate
timolol maleate ophthalmic gel forming
Metipranolol
PREFERRED
Combigan
NON PREFERRED
Betimol
OPHTHALMIC STEROIDS
GENERIC
dexamethasone sodium phosphate
fluorometholone
neo-polycin HC
neomycin/polymyxin/bacitracin/hydrocortisone
neomycin/polymyxin/dexamethasone
poly-dex
prednisolone acetate
sulfacetamide sodium/prednisolone sodium phosphate
tobramycin/dexamethasone
PREFERRED
Alrex
FML
Lotemax
Pred Mild
Tobradex
Tobradex ST
NON PREFERRED
Durezol
Flarex
Ozurdex
Vexol
PROSTAGLANDINS
GENERIC
latanoprostQL
BimatoprostQL
PREFERRED
LumiganQL
Travatan ZQL
CYCLOPLEGIC MYDRIATICS
GENERIC
atropine sulfate
atropine-care
cyclopentolate hydrochloride
cyclopentolate HCL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
21
IlevroQL
NevanacQL
Pataday
NON PREFERRED
Acuvail
Alocril
Alomide
Azopt
Emadine
Lastacaft
SPECIALTY
CystaranQL,PA
Eylea
Jetrea
Lucentis
Macugen
Visudyne
homatropaire
homatropine HBR
mydral
tropicamide
DECONGESTANTS
GENERIC
altafrin
neofrin
phenylephrine HCL
MIOTICS
GENERIC
pilocarpine HCL
PREFERRED
Phospholine Iodide
NON PREFERRED
Isopto Carbachol
OTIC AGENTS
ADRENERGIC AGENTS
GENERIC
apraclonidine
brimonidine tartrate
PREFERRED
Alphagan P
NON PREFERRED
Iopidine
IMMUNOMODULATORS
PREFERRED
RestasisQL,PA
LOCAL ANESTHETICS
GENERIC
altacaine
parcaine
proparacaine HCL
tetcaine
tetracaine HCL
tetravisc
tetravisc forte
OPHTHALMICS - MISC.
GENERIC
ak-fluor
altafluor
azelastine HCL
balanced salt
balanced salt solution
bio GLO
bromfenac
bss
cromolyn sodium
diclofenac sodium
dorzolamide HCL
epinastine HCL
flucaine
fluor-i-strips a.t.
fluorescein-benoxinate
fluorescein/proparacaine
flurbiprofen sodium
flurox
ful-GLO
green GLO lissamine greenophthalmic strips
ketorolac tromethamine
lissamine green
olopatadine HCL
PREFERRED
Bepreve
GENERIC
acetasol HC
acetic acid
antipyrine/benzocaine
aurodex
fluocinolone acetonide
fluocinolone acetonide ear drops
hydrocortisone/acetic acid
neomycin/polymyxin/hydrocortisone
neomycin/polymyxin/HC
ofloxacin
otic care
oticin
PREFERRED
Ciprodex
NON PREFERRED
Coly-mycin S
Cortisporin-tc
OXYTOCICS
GENERIC
methergine
methylergonovine maleate
oxytocin
PAIN MANAGEMENT
ANALGESICS - NONNARCOTIC
GENERIC
alagesic LQ
butalbital/acetaminophen
butalbital/acetaminophen/caffeine
butalbital/aspirin/caffeine
capacet
choline magnesium trisalicylate
clonidine HCL
diflunisal
duraxin
ed-flex
esgic
margesic
marten-TAB
salsalate
tencon
zebutal
PREVENTIVE
adult aspirin EC low strength
aspir-low
aspir-81
aspirin
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
22
aspirin adult low dose
aspirin adult low strength
aspirin childrens
aspirin enteric coated adult low strength
aspirin low dose
aspirin low strength
aspirin EC
aspirin EC low dose
aspirin 81
aspirin 81 low dose
aspirtab
bayer advanced aspirin regular strength
bayer aspirin
bayer aspirin regimen
bayer aspirin EC low dose
bayer chewable low dose
bayer low dose
childrens aspirin
childrens aspirin low strength
coated aspirin
ecotrin
ecotrin low strength
ecpirin
enteric coated aspirin
eq adult aspirin low strength
eq aspirin
eq aspirin adult low dose
eq aspirin low dose
eq aspirin EC
eq childrens aspirin
eql adult aspirin low strength
eql aspirin
eql aspirin low dose
eql aspirin EC
eql childrens aspirin
gnp adult aspirin low strength
gnp aspirin
gnp aspirin low dose
goodsense aspirin low dose
kls aspirin low dose
kls aspirin EC
kp aspirin
meijer aspirin EC
miniprin low dose
norwich aspirin
px aspirin
px enteric aspirin
qc aspirin
qc aspirin low dose
qc childrens aspirin
ra aspirin
ra aspirin adult low dose
ra aspirin adult low strength
ra aspirin childrens
ra aspirin EC
ra aspirin EC adult low strength
ra childrens aspirin
sm aspirin
sm aspirin adult low strength
sm aspirin enteric coated
sm aspirin EC low strength
sm childrens aspirin
st joseph aspirin
st joseph low dose aspirin
tgt aspirin
tgt aspirin low dose
tgt childrens aspirin
tgt enteric-coated aspirin
th aspirin
th aspirin low dose
th enteric aspirin
CVS aspirin
CVS aspirin adult low dose
CVS aspirin adult low strength
CVS aspirin child
CVS aspirin low dose
CVS aspirin low strength
CVS aspirin EC
CVS childrens aspirin
CVS enteric aspirin
EC-81 aspirin
HM aspirin
HM aspirin EC
HM aspirin EC low dose
MM aspirin
SB aspirin
SB aspirin EC
SB childrens aspirin
SB low dose asa EC
PREVENTIVE
Aspirin Low Dose
SPECIALTY
Prialt
ANALGESICS - OPIOID
GENERIC
acetaminophen/caffeine/dihydrocodeine
acetaminophen/codeine
acetaminophen/codeine #2
acetaminophen/codeine #3
acetaminophen/codeine #4
acetaminophen/codeine phosphate
alfentanil
ascomp/codeine
buprenorphine HCLQL,PA
buprenorphine HCL/naloxone HCLQL,PA
butalbital/acetaminophen/caffeine/codeine
butalbital/aspirin/caffeine/codeine
butorphanol tartrate
codeine sulfate
duramorph
endocet
endodan
fentanylQL
fentanyl citrate oral transmucosalQL,PA
hydrocodone bitartrate/acetaminophen
hydrocodone/acetaminophen
hydrocodone/ibuprofen
hydromorphone HCL
hydromorphone HCL dosette
hydromorphone HCL ERQL
ibudone
lorcet
lorcet plus
lorcet HD
lortab
meperidine HCL
methadone HCL
methadone HCL intensol
methadose
morphine sulfate
morphine sulfate ERQL
nalbuphine HCL
oxycodone HCL
oxycodone/acetaminophen
oxycodone/aspirin
oxycodone/ibuprofen
oxymorphone hydrochloride
oxymorphone hydrochloride ERQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
23
pentazocine/naloxone HCL
reprexain
roxicet
tramadol hydrochloride/acetaminophen
tramadol HCL
tramadol HCL ERQL
verdrocet
vicodin
vicodin ES
vicodin HP
xylon
zamicet
Aspirin-caffeine-dihydrocodeine
FentanylQL
Hydrocodone/Acetaminophen
Hydromorphone HCL ERQL
Hydromorphone HCL/Sodium Chloride
Levorphanol Tartrate
Morphine Sulfate
Morphine Sulfate ERQL
Oxycodone HCL ERQL
PREFERRED
ButransQL,PA
LazandaQL,PA
Nucynta
Nucynta ERQL
Opana ER (crush Resistant)QL
OxycontinQL
SuboxoneQL,PA
NON PREFERRED
EmbedaQL
ExalgoQL
Oxaydo
Talwin
ANTI-INFLAMMATORY
GENERIC
celecoxibQL
diclofenac potassium
diclofenac sodium DR
diclofenac sodium ER
diclofenac sodium/misoprostol
etodolac
etodolac ER
flurbiprofen
ibuprofen
ibuprofen lysine
indomethacin
indomethacin ER
inflammacin
ketoprofen
ketorolac tromethamineQL
leflunomide
mefenamic acid
meloxicam
nabumetone
naproxen
naproxen kit
naproxen sodium
naproxen sodium CR
naproxen sodium ER
naproxen DR
oxaprozin
piroxicam
sulindac
tolmetin sodium
Fenoprofen Calcium
Meclofenamate Sodium
Naproxen
Tolmetin Sodium
PREFERRED
Ridaura
NON PREFERRED
Nalfon
Naprelan
Rheumatrex
SprixQL
SPECIALTY
ArcalystPA
EnbrelQL,PA
Enbrel SureclickQL,PA
HumiraPA
Humira Pediatric Crohns Disease Starter Pack PA
Humira PenPA
Humira Pen-crohns DiseasestarterPA
Humira Pen-psoriasis StarterPA
IlarisQL,PA
KineretPA
OrenciaQL,PA
SimponiPA
Simponi AriaQL,PA
MIGRAINE PRODUCTS
GENERIC
almotriptan malateQL,ST
dihydroergotamine mesylate
frovatriptan succinateQL,ST
naratriptan HCLQL
rizatriptan benzoateQL
rizatriptan benzoate odtQL
sumatriptan succinateQL
sumatriptan succinate refillQL
zolmitriptanQL
zolmitriptan odtQL
Dihydroergotamine MesylateQL
Sumatriptan SuccinateQL
PREFERRED
RelpaxQL
NON PREFERRED
Cafergot
Ergomar
ZomigQL,ST
Zomig Nasal SprayQL,ST
GOUT AGENTS
GENERIC
allopurinol
probenecid
probenecid/colchicine
PREFERRED
Colchicine
Colcrys
Uloric
SPECIALTY
KrystexxaPA
LOCAL ANESTHETICS-INJ
GENERIC
bupivacaine spinal
bupivacaine HCL
bupivacaine/epinephrine
chloroprocaine HCL
lidocaine HCL
lidocaine/epinephrine
polocaine
polocaine-mpf
ropivacaine
ropivacaine HCL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
24
sensorcaine
sensorcaine-mpf
sensorcaine-mpf spinal
sensorcaine-mpf/epinephrine
sensorcaine/epinephrine
xylocaine dental
Tetracaine HCL
promethazine/dextromethorphan
promethazine/phenylephrine
promethazine/phenylephrine/codeine
pulmosal
sodium chloride
tussigon
ANTIASTHMATIC/COPD AGENTS
RESPIRATORY, ALLERGY, ETC
ANTIHISTAMINES
GENERIC
arbinoxa
bpm
carbinoxamine maleate
cetirizine HCL
clemastine fumarate
cyproheptadine HCL
desloratadine
diphenhydramine HCL
levocetirizine dihydrochloride
pharbedryl
phenadoz
phenergan
promethazine HCL
promethazine HCL plain
promethegan
Clemastine Fumarate
Dexchlorpheniramine Maleate
NON PREFERRED
Clarinex
Desloratadine Odt
NASAL AGENTS
GENERIC
azelastine HCLQL
budesonideQL
flunisolideQL
fluticasone propionateQL
ipratropium bromideQL
mometasone furoateQL
olopatadine HCLQL
triamcinolone acetonideQL
PREFERRED
DymistaQL
NON PREFERRED
Bactroban Nasal
COUGH/COLD/ALLERGY
GENERIC
acetylcysteine
benzonatate
biotuss
biotuss pediatric
bpm pseudo
bromfed DM
bromphen/pseudoephedrine HCL/dextromethorphan HBR
giltuss pediatric
hydrocodone bitartrate/chlorpheniramine maleate/PSE
hydrocodone bitartrate/homatropine methylbromide
hydrocodone polistirex/chlorpheniramine polistirex
hydrocodone/homatropine
hydromet
nebusal
nortuss-DE
phenylephrine/guaifenesin
promethazine VC plain
promethazine VC/codeine
promethazine-DM
promethazine/codeine
GENERIC
albuterol
albuterol sulfate
albuterol sulfate ER
albuterol TAB 4MG
aminophylline
budesonide
difil-G forte
epinephrine HCL
ipratropium bromideQL
ipratropium bromide/albuterol sulfateQL
levalbuterolQL
levalbuterol HCLQL
montelukast sodium
terbutaline sulfate
theochron
theophylline
theophylline CR
theophylline ER
zafirlukast
Cromolyn Sodium
Metaproterenol Sulfate
PREFERRED
Arcapta NeohalerQL
Asmanex HFAQL
Asmanex Twisthaler 120 Metered DosesQL
Asmanex Twisthaler 14 Metered DosesQL
Asmanex Twisthaler 30 Metered DosesQL
Asmanex Twisthaler 60 Metered DosesQL
Asmanex Twisthaler 7 Metered DosesQL
Atrovent HFAQL
Combivent RespimatQL
Daliresp
DuleraQL
Foradil AerolizerQL
PerforomistQL
Proair HFAQL
Proair RespiclickQL
Pulmicort FlexhalerQL
QvarQL
Serevent DiskusQL
Spiriva HandihalerQL
Spiriva RespimatQL
Stiolto RespimatQL
SymbicortQL
Tudorza PressairQL
NON PREFERRED
BrovanaQL
Elixophyllin
Incruse ElliptaQL
Lufyllin
Theo-24
Zyflo CR
SPECIALTY
NucalaQL,PA
XolairPA
RESPIRATORY AGENTS - MISC
SPECIALTY
Aralast NPPA
EsbrietPA
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
25
GlassiaPA
KalydecoPA
OfevPA
Prolastin-cPA
PulmozymePA
ZemairaPA
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluvirin 2015-2016
Fluzone High-dose PF 2013-2014
Fluzone High-dose PF 2014-2015
Fluzone High-dose PF 2015-2016
Fluzone Intradermal
Fluzone Intradermal Quadrivalent 2015-2016
Fluzone Pediatric PF 2013-2014
Fluzone PF 2013-2014
Fluzone PF 2014-2015
Fluzone Quadrivalent 2013-2014
Fluzone Quadrivalent 2014-2015
Fluzone Quadrivalent 2015-2016
Fluzone Split 2013-2014
Fluzone Split 2014-2015
Fluzone Split 2015-2016
Gardasil
Gardasil 9
Havrix
Hiberix
Ipol Inactivated IPV
M-m-r II
Medical Provider EZ Flu Shot PF 2013-2014
Medical Provider EZ Flu Shot PF 2014-2015
Medical Provider EZ Flu Shot 2013-2014
Medical Provider EZ Flu Shot 2014-2015
Medical Provider EZ Flu Shot 2015-2016
Medical Provider Single Use EZ Flu Shot
Menactra
Menhibrix
Menomune-a/C/Y/W-135
Menveo
Pedvax HIB
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Prevnar 13
Proquad
Recombivax HB
Rotarix
Rotateq
Trumenba
Twinrix
Vaqta
Varivax
Zostavax
TOXOIDS
PREFERRED
Tetanus Toxoid Adsorbed
PREVENTIVE
Adacel
Boostrix
Daptacel
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Infanrix
Kinrix
Pediarix
Pentacel
Quadracel
Tenivac
Tetanus/Diphtheria Toxoids-adsorbed
Tetanus/Diphtheria Toxoids-adsorbed Adult
VACCINES
PREFERRED
Bcg Vaccine
Biothrax
Imovax Rabies (h.d.c.v.)
Ixiaro
Rabavert
Typhim VI
Vivotif
Yf-vax
PREVENTIVE
Acthib
Afluria PF 2012-2013
Afluria PF 2013-2014
Afluria PF 2014-2015
Afluria PF 2015-2016
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Afluria 2015-2016
Bexsero
Cervarix
Comvax
Engerix-b
Fluarix Quadrivalent 2013-2014
Fluarix Quadrivalent 2014-2015
Fluarix Quadrivalent 2015-2016
Fluarix 2013-2014
Fluarix 2014-2015
Flublok 2013-2014
Flublok 2014-2015
Flublok 2015-2016
Flucelvax 2013-2014
Flucelvax 2014-2015
Flucelvax 2015-2016
Flulaval Quadrivalent 2013-2014
Flulaval Quadrivalent 2014-2015
Flulaval Quadrivalent 2015-2016
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Quadrivalent
Fluvirin PF 2013-2014
Fluvirin PF 2014-2015
VITAMINS
VITAMINS
GENERIC
ascorbic acid
ergocalciferol
mega-c/a plus
ortho-CS 250
phytonadione
thiamine HCL
vitamin c 222MG
vitamin d
vitamin k1
PREVENTIVE
aqueous vitamin d infants
bio-d-mulsion
bio-d-mulsion forte
bprotected pedia d-vite
calcidol
calciferol
d 1000
d 10000
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
26
d 2000
d 400
d 5000
d-vita
d-1000
d-1000 extra strength
d-2000 maximum strength
d-3-5
d-400
d-5000
d-5000 maximum strength
decara
delta d3
dialyvite vitamin d 5000
dialyvite vitamin d3 max
d2000 ultra strength
d3
d3 adult
d3 adult gummy
d3 high potency
d3 kids
d3 maximum strength
d3 super strength
d3 ultra strength
d3 2000
d3-1000
d3-50
eql childrens vitamin d gummies
eql vitamin d-3
eql vitamin d3
gnp vitamin d
gnp vitamin d maximum strength
gnp vitamin d super strength
gnp vitamin d3 extra strength
healthy kids vitamin d3
just d
kp vitamin d
maximum d3
nat-rul vitamin d
natural vitamin d-3
optimal-d
optimal-d pack
opurity vitamin d
pronutrients vitamin d3
ra vitamin d-3
sm vitamin d
sm vitamin d3
th vitamin d3
thera-d rapid repletion
thera-d sport
thera-d 2000
vitajoy daily d gummies
vitamin d high potency
vitamin d 400
vitamin d-1000
vitamin d-1000 maximum strength
vitamin d-3
vitamin d-400
vitamin d3
vitamin d3 adult gummies
vitamin d3 high potency
vitamin d3 maximum strength
vitamin d3 super strength
vitamin d3 400
CVS d3
CVS vitamin d
CVS vitamin d 5000 high-potency
CVS vitamin d3
HM vitamin d
HM vitamin d3
PA vitamin d-3
PA vitamin d-3 gummy
PREFERRED
Mephyton
PREVENTIVE
Baby Super Daily D3
Ddrops
Decara
D3 Dots
HM Vitamin D3
Optimal D3 M
Replesta
Replesta Childrens
Replesta Nx
Sm Vitamin D3 Maximum Strength
Super Daily D3
Thera-d 4000
Vitamelts Vitamin D
Vitamin D2
Vitamin D3
Wellesse Vitamin D3
MULTIVITAMINS
GENERIC
b-complex 100
b-plex
b-plex plus
biocel
corvita
corvite free
dialyvite
floriva plus
folbee plus
folbee plus cz
infuvite
infuvite adult
infuvite pediatric
lysiplex plus
mult-vitamin/fluoride
multi vitamin/fluoride
multi-vit/fluoride
multi-vit/iron/fluoride
multi-vitamin/fluoride
multi-vitamin/fluoride/iron
multivitamin with fluoride
multivitamin/fluoride
multivitamins/fluoride
mynephrocaps
nephronex
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
nutrifac ZX
rena-vite RX
renal
renalpren
reno CAPS
tri-vit/fluoride
tri-vitamin/fluoride
triphrocaps
triple-vitamin/fluoride
urosex
v-c forte
vic-forte
virt-vite plus
virt-CAPS
vita s forte
vita-min
vitacel
vitamax pediatric
vitamin b-complex 100
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
27
vitamins a/c/d/fluoride
vol-care RX
vp-vite RX
Bp Folinatal Plus B
Bp Multinatal Plus
Cavan-EC Sod DHA
Complete Natal DHA
Completenate
CO-natal Fa
Elite-OB
Escavite LQ
Inatal Advance
Inatal GT
Inatal Ultra
M-vit
Macnatal CN DHA
Mynatal Advance
Mynatal Plus
Mynatal Ultracaplet
Mynatal-z
Mynate 90 Plus
MVC-fluoride
Obstetrix EC
Pr Natal 400
Pr Natal 400 EC
Pr Natal 430
Pr Natal 430 EC
Prenaissance Plus
Prenaplus
Prenatabs Fa
Prenatabs RX
Prenatal Ad
Prenatal Plus
Prenatal 19
Prenatal-u
PNV-select
PNV-DHA
Quflora Pediatric
Se-natal 19
Se-tan DHA
Taron-prex
Triadvance
Tricare
Trinatal RX 1
Trinate
Ultimatecare One
Ultimatecare One NF
Ultra TABS
Vinate C
Vinate Care
Vinate IC
Vinate II
Vinate M
Vinate One
Vitafol-OB
Vp-zel
PREVENTIVE
sm prenatal vitamins
Classic Prenatal
Eql Prenatal Formula
Gnp Prenatal Vitamins
Mission Prenatal HP
Multi Prenatal
Perry Prenatal
Pre-natal Formula
Prenatal
Prenatal And Iron
Prenatal Formula
Prenatal Forte
Prenatal Low Iron
Prenatal Vitamins
Px Prenatal Multivitamins
Ra Prenatal
Sm Prenatal Vitamins
PREVENTIVE
Atabex Prenatal
Brainstrong Prenatal
Cadeau DHA
Centrum Specialist Prenatal
CVS Prenatal
CVS Prenatal Gummy/DHA/Folic Acid
CVS Prenatal Multi+dha
Enfamil Expecta
Gnp Daily Prenatal
Gnp Prenatal
Goodsense Prenatal Vitamins
Healthy Mama Be Well Rounded
HM One Daily Prenatal Combo
HM Prenatal
Kp Prenatal Multivitamins
Mission Prenatal
Nat-rul Prenatal Vitamins
One A Day Womens Prenatal/DHA
One A Day Womens Prenatal1
One-a-day Womens Prenatal
Prenatal Complete
Prenatal Multi + DHA
Prenatal Multi +dha
Prenatal Multivitamin + DHA
Prenatal Multivitamin Plus DHA
Prenatal One Daily
Prenatal Plus DHA
Prenatal Vitamin
Prenatal/Omega-3/Folic Acid/Iron
PA Prenatal Formula
Qc Prenatal
Ra One Daily
Ra Prenatal Formula/Folicacid
Right Step Prenatal
Similac Prenatal Early Shield
Sm One Daily Prenatal
Stuart One
Stuart Prenatal
Th Prenatal Vitamins
Your Life Multi Prenatal
MEDICAL DEVICES
DIABETIC SUPPLIES
PREFERRED
Accu-chek Fastclix LancetsQL
Accu-chek Multiclix LancetsQL
Accu-chek Safe-t-pro LancetsQL
Accu-chek Safe-t-pro PluslancetsQL
Accu-chek Soft Touch LancetsQL
Accu-chek Softclix LancetsQL
Acti-lance Lancets 28GQL
Acti-lance Lite Safety Lancets 28GQL
Acti-lance Special Safety Lancets 17GQL
Acti-lance Special Safetylancets 17GQL
Acti-lance Universal Safety Lancets 23GQL
Active 1ST Blood Lancets 30G/Easy Twist CAPQL
Advocate LancetsQL
Advocate Lancets 30GQL
Advocate Safety LancetsQL
Advocate Safety Lancets 26GQL
Agamatrix Ultra-thin Lancets 33GQL
Assure Comfort Lancets Ultra Thin 28GQL
Assure Comfort Lancets Ultra Thin 30GQL
Assure Haemolance Plus High Flow 18GQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
28
Assure Haemolance Plus Low Flow 25GQL
Assure Haemolance Plus Micro Flow 28GQL
Assure Haemolance Plus Normal Flow 21GQL
Assure Haemolance Plus Pediatric BladeQL
Assure Lance LancetsQL
Assure Lance Lancets 21GQL
Assure Lance Plus Safety Lancets 25GQL
Assure Lance Plus Safety Lancets 30GQL
Assure LancetsQL
Aurora Lancet Super Thin 30GQL
Aurora Lancet Thin 23GQL
AF Lancets Super ThinQL
AT Last LancetsQL
B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16"QL
B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16"QL
B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16"QL
B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL
B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL
B-d Insulin Syringe Ultrafine/1ML/30G X 1/2"QL
Bayer Microlet LancetsQL
Bullseye Mini Safety LancetsQL
Bullseye Safety LancetsQL
BD Autoshield Duo 30G X 3/16"QL
BD Autoshield 29G X 3/16"QL
BD Autoshield 29G X 5/16"QL
BD Insulin Syringe LUER-LOK/U-100/1MLQL
BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"QL
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"QL
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"QL
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"QL
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"QL
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"QL
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"QL
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"QL
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X
5/16"QL
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"QL
BD Insulin Syringe Safetyglide/1ML/29G X 1/2"QL
BD Insulin Syringe Slip Tip/U-100/1MLQL
BD Insulin Syringe U-40/1ML/25G X 5/8"QL
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X
5/16"QL
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/1ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/1ML/31G X 5/16"QL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X
1"QL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X
5/8"QL
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X
1/2"QL
BD Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
BD Insulin Syringe/U-100/1ML/27G X 1/2"QL
BD Insulin Syringe/U-100/1ML/28G X 1/2"QL
BD Insulin Syringe/U-100/2ML/27.5G X 5/8"QL
BD Insulin Syringe/U-100/2ML/29G X 1/2"QL
BD Integra Insulin Syringe/U-100/1ML/29G X 1/2"QL
BD Integra Syringe/Retracting Needle/1ML/25G X 1"QL
BD Lancet Ultrafine 30GQL
BD Lancet Ultrafine 33GQL
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X
1/2"QL
BD Microtainer LancetsQL
BD Pen Needle/Mini/Ultrafine/31G X 3/16"QL
BD Pen Needle/Nano/Ultra Fine/32G X 4MMQL
BD Pen Needle/SHORT/Ultrafine/31G X 5/16"QL
BD Pen Needle/Ultrafine/29G X 12.7MMQL
BD Pen Needle/Ultrafine/29GX1/2" 12.7MMQL
BD Pen Needles SHORT/Ultrafine/31G X 5/16"QL
BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2"QL
BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X
1/2"QL
BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16"QL
BD-insul SYR Mis LO DoseQL
Careone Lancet ThinQL
Careone Lancet Ultra ThinQL
Cleanlet Lancets 28GQL
Clever Chek Lancets UltrathinQL
Clever Chek Lancets Ultrathin 30GQL
Coaguchek LancetsQL
Comfort Assured Lancets Micro Thin 33GQL
Comfort Assured Lancets Super Thin 28GQL
Comfort LancetsQL
CVS Lancets Micro Thin 33GQL
CVS Lancets OriginalQL
CVS Lancets Thin 26GQL
CVS Lancets Ultra Thin 30GQL
CVS Lancets 21GQL
CVS Ultra Thin LancetsQL
Diastar Easy Test II Lancets 30GQL
Diastar Easy Test Lancets30GQL
Droplet Lancets Ultra Thin 30GQL
Drug Mart Lancets ThinQL
Drug Mart Lancets Ultra ThinQL
Drug Mart On-the-go Lancets Gentle 30GQL
Drug Mart Unilet Lancets Super Thin 30GQL
Drug Mart Unilet Lancets Ultra Thin 28GQL
Duane Reade Lancet Alternate Site 26GQL
Duane Reade Lancet Super Thin 30GQL
Duane Reade Lancet Ultra Thin 28GQL
E-z Ject LancetsQL
E-z Ject Lancets ColorQL
E-z Ject Lancets Super ThinQL
E-z Ject Lancets Super Thin 30GQL
E-z Ject Lancets Thin 26GQL
E-z Ject Lancets 21GQL
E-ZJECT Lancets Micro-thin 33GQL
Easy Comfort LancetsQL
Easy Comfort Lancets 30G/Pull TopQL
Easy Comfort Lancets 30G/Thin TopQL
Easy Touch Lancets 21G/Pressure ActivatedQL
Easy Touch Lancets 23G/Pressure ActivatedQL
Easy Touch Lancets 26G/Pressure ActivatedQL
Easy Touch Lancets 26G/Pull-topQL
Easy Touch Lancets 26G/TwistQL
Easy Touch Lancets 28G/Pressure ActivatedQL
Easy Touch Lancets 28G/Pull-topQL
Easy Touch Lancets 28G/TwistQL
Easy Touch Lancets 30G/Button-activatedQL
Easy Touch Lancets 30G/Pressure ActivatedQL
Easy Touch Lancets 30G/Pull-topQL
Easy Touch Lancets 30G/TwistQL
Easy Touch Lancets 32G/Pressure ActivatedQL
Easy Touch Lancets 32G/Pull-topQL
Easy Touch Lancets 32G/TwistQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
29
Easy Touch Lancets 33G/TwistQL
Easy Touch Safety Lancets21G/Pressure ActivatedQL
Easy Touch Safety Lancets23G/Pressure ActivatedQL
Easy Touch Safety Lancets26G/Button ActivatedQL
Easy Touch Safety Lancets26G/Pressure ActivatedQL
Easy Touch Safety Lancets28G/Button ActivatedQL
Easy Touch Safety Lancets28G/Pressure ActivatedQL
Easy Twist & CAP LancetsQL
Easytest II LancetsQL
Easytest LancetsQL
Embrace Lancets Ultra Thin 30GQL
Eql Color Lancets Micro Thin 33GQL
Eql Color Lancets 21GQL
Eql Super Thin Lancets 30GQL
Eql Thin Lancets 26GQL
EZ Smart Blood Glucose LancetsQL
EZ-lets Lancets 21GQL
EZ-lets Lancets 23GQL
EZ-lets Lancets 26G Super-softQL
EZ-lets Lancets 28G Ultra-softQL
EZ-lets Lancets 30GQL
Fifty50 Safety Seal Lancets 30GQL
Fifty50 Safety Seal Lancets 32GQL
Fifty50 Unilet Lancets 33GQL
Fine 30QL
Fingerstix LancetsQL
Fora LancetsQL
Freds Pharmacy Unilet Lancets Super Thin 30GQL
Freds Pharmacy Unilet Lancets Ultra Thin 28GQL
Freestyle LancetsQL
Freestyle Unistick II LancetsQL
Gentle-let GP LancetsQL
Gentle-let Lancets General Purpose Style/Fine PointQL
Gentle-let Lancets General Purpose Style/Medium PointQL
Gentle-let Lancets Safety Style/Fine PointQL
Gentle-let Lancets Safety Style/Medium PointQL
Global Inject Ease Lancets 28GQL
Global Inject Ease Lancets 30GQL
Glucocom Lancets 28GQL
Glucocom Lancets 30GQL
Glucocom Lancets 33GQL
Glucose Control Normal
Glucose Control Solution
Glucosource LancetsQL
Gmate Lancets 30GQL
Gnp LancetsQL
Gnp Lancets Micro Thin 33GQL
Gnp Lancets Super Thin 30GQL
Gnp Lancets ThinQL
Gnp Lancets Thin 26GQL
Gnp Lancets 21GQL
Gnp Micro Thin Lancets 33GQL
Gnp Super Thin Lancets/30GQL
H&h Thinlet Lancets 26GQL
H&h Thinlet Super Thin Lancets 30GQL
H-e-b Incontrol Lancets Micro Thin 33GQL
H-e-b Incontrol Lancets Super Thin 30GQL
H-e-b Incontrol Lancets Ultra Thin 28GQL
HaemolanceQL
Haemolance Low Flow LancetsQL
Haemolance PlusQL
Haemolance Plus High FlowQL
Haemolance Plus Low FlowQL
Haemolance Plus Max FlowQL
Haemolance Plus Pediatric FlowQL
Healthwise Lancets 30GQL
Healthy Accents Unilet Lancets Super Thin 30GQL
Hy-vee LancetsQL
Hy-vee Thin LancetsQL
HM Lancets Micro Thin 33GQL
HM Lancets Ultra Thin 30GQL
IN Touch Diabetes Management Software
IN Touch Sterile Lancets 30GQL
Kinney LancetsQL
Kinney Thin LancetsQL
Kroger LancetsQL
Kroger Lancets Micro Thin33GQL
Kroger Lancets Super ThinQL
Kroger Lancets ThinQL
Kroger Lancets Thin 26GQL
Kroger Lancets Ultrathin 30GQL
Kroger Lancets 21GQL
LancetsQL
Lancets Bullseye SafetyQL
Lancets Micro Thin 33GQL
Lancets Safety Seal 21GQL
Lancets Safety Seal 26GQL
Lancets Safety Seal 28GQL
Lancets Safety Seal 30GQL
Lancets Super Thin 28GQL
Lancets ThinQL
Lancets Twist TopQL
Lancets Ultra FineQL
Lancets Ultra ThinQL
Lancets Ultra Thin 30GQL
Lancets 26G Twist TopQL
Lancets 28GQL
Lancets 30GQL
Lancets 30G Twist TopQL
Lancets 30G/Twist TopQL
Lancets 31G Twist TopQL
Lancets 33G Universal DesignQL
Leader Lancets ColoredQL
Leader Super Thin LancetQL
Leader Thin LancetsQL
Liberty Blood Glucose MeterQL
Liberty Glucose Control Mid
Liberty Glucose Control Normal
Liberty Medical Lancets 30GQL
Liberty Mini Lancing Device
Liberty Test StripsQL
Lifescan Unistik II LancetsQL
Lifescan Unistik 2 Deep PenetrationQL
Lite Touch LancetsQL
Litetouch Lancets Micro Thin 33GQL
Live Better Lancet Super Thin 30GQL
Live Better Lancet Ultra Thin 28GQL
Longs Lancets StandardQL
Longs Lancets ThinQL
Longs Lancets Ultra ThinQL
Medichoice Pre-set Safety Lancet Dual UseQL
Medichoice Pre-set Safety Lancet Low FlowQL
Medichoice Pre-set Safety Lancet Medium FlowQL
Medichoice Pre-set Safety Lancet Moderate FlowQL
Medichoice Safety Lancet ExtraQL
Medichoice Safety Lancet NormalQL
Medicine Shoppe LancetsQL
Medicine Shoppe Lancets ThinQL
Medisense Thin LancetsQL
Medlance Plus Extra Lancets 21GQL
Medlance Plus LancetsQL
Medlance Plus Lancets Lite 25GQL
Medlance Plus Lite Lancets 25GQL
Medlance Plus Special Lancets 0.8MMQL
Medlance Plus Superlite 30GQL
Medlance Plus Superlite 30G/Comfort MaxQL
Medlance Plus Universal Lancets 21GQL
Medlance Plus/Lite 25GQL
Medlance/ExtraQL
Medlance/LiteQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
30
Medlance/UniversalQL
Meijer Color Lancets Universal 33GQL
Meijer LancetsQL
Meijer Lancets ThinQL
Meijer Lancets Universal 33GQL
Meijer Super Thin LancetsQL
Microlet LancetsQL
Microtainer Safety Flow Lancet/Sterile/Single-useQL
Monolet LancetsQL
Monolet Opd LancetsQL
Monolettor Safety LancetsQL
Myglucohealth Mgh Softlance Lancets 30GQL
Netgroup LancetsQL
Nova Safety Lancets 23GQL
Nova Safety Lancets 28GQL
Nova Sureflex LancetsQL
On Call LancetsQL
On Call Plus LancetsQL
Onetouch Club Lancets Fine PointQL
Onetouch Combo PackQL
Onetouch Delica Lancets Extra Fine 33GQL
Onetouch Delica Lancets Fine 30GQL
Onetouch Delica Lancing Device
Onetouch Finepoint LancetsQL
Onetouch LancetsQL
Onetouch Ping Meter Remote
Onetouch Suresoft Lancing Device/18G
Onetouch Suresoft Lancing Device/21G
Onetouch Suresoft Lancing Device/28G
Onetouch Ultra BlueQL
Onetouch Ultra Control
Onetouch Ultra MiniQL
Onetouch Ultra 2QL
Onetouch Ultralink System (hex)QL
Onetouch Ultralink System (DEC)QL
Onetouch Ultrasoft LancetsQL
Onetouch VerioQL
Onetouch Verio Control Solution High
Onetouch Verio Flex Bloodglucose Monitoring SystemQL
Onetouch Verio IQ Blood Glucose Monitoring System QL
Onetouch Verio Mid Control Solution
Onetouch Verio Sync Bloodglucose Monitoring SystemQL
Onetouch Verio Test StripsQL
Penlet II Automatic Bloodsampler
Penlet II Replacement CAPS
Penlet II Replacement CAPS-deep
Penlet II Replacement CAPS-regular
Perfect Lancets 30GQL
Perfect Pressure Activated Safety Lancets 28GQL
Pharmacist Choice Ultra Thin LancetsQL
Pharmacist Choice Ultra Thin Lancets 28GQL
Pharmacist Choice Ultra Thin Lancets 30GQL
Pharmacist Choice Ultra Thin Lancets 31GQL
Pharmacist Choice Ultra Thin Lancets 33GQL
Pharmacy Counter LancetsQL
Precision Thin LancetsQL
Precision Thins GP LancetQL
Precision Ultra LancetQL
Preferred Plus Lancets Colored 21GQL
Preferred Plus Lancets Super Thin 30GQL
Preferred Plus Lancets Thin 26GQL
Pressure Activated Safetylancet 21GQL
Prodigy Pressure Activated Safety LancetsQL
Prodigy Safety LancetsQL
Prodigy Twist Top LancetsQL
Pss Select GP LancetsQL
Pss Select Safety LancetsQL
Push Button Safety Lancets 21GQL
Push Button Safety Lancets 28GQL
Px Lancets Ultra ThinQL
Qc LancetsQL
Qc Lancets Super ThinQL
Qc Lancets ThinQL
Qc Lancets Ultra ThinQL
Qc Unilet Lancets 28G/Ultra ThinQL
Qc Unilet Lancets 33G/Micro ThinQL
Ra E-ZJECT Color Lancets Micro-thin 33GQL
Ra E-ZJECT Lancets Thin 26GQL
Ra E-ZJECT Lancets Thin 28GQL
Ra E-ZJECT Lancets Ultra Thin 30GQL
Ra E-ZJECT Lancets 28GQL
Reality LancetsQL
Reality Trigger LancetsQL
Relion Lancets Micro-thin33GQL
Relion Lancets Standard 21GQL
Relion Lancets Thin 26GQL
Relion Lancets Ultra-thin30GQL
Relion Thin LancetsQL
Relion Ultra Thin LancetsQL
Relion Ultra Thin Lancets30GQL
Relion Ultra Thin Plus Lancets 32GQL
Relion Ultra Thin Plus Lancets 33GQL
Renew Advanced Lancing Cartridge RefillsQL
Rexall Lancets Ultra ThinQL
Rightest Gl300 LancetsQL
Safe-t-lance Low Flow 25GQL
Safe-t-lance Normal Flow 21GQL
Safe-t-lance Plus Safety Lancet High FlowQL
Safe-t-lance Plus Safety Lancet Low FlowQL
Safe-t-lance Plus Safety Lancet Normal FlowQL
Safety Lancet 21G/Pressure ActivatedQL
Safety Lancet 28G/Pressure ActivatedQL
Safety LancetsQL
Safety Lancets 21GQL
Safety Lancets 28GQL
Safety Let LancetsQL
Safety Seal Lancets 28GQL
Safety Seal Lancets 30GQL
Safety-glide Insulin Syringe/0.3ML/29G X 1/2"QL
Sapscare Twist Top Lancets 30GQL
Shopko On-the-go Comfort Lancets 30GQL
Shopko Unilet Lancets Super Thin 30GQL
Shopko Unilet Lancets Ultra Thin 28GQL
Side Button Safety Lancet21GQL
Single-letQL
Sm Lancets 21GQL
Sm Micro Thin Lancets 33GQL
Sm Super Thin LancetsQL
Sm Super Thin Lancets 30GQL
Sm Thin Lancets 26GQL
Smart Diabetes Vantage Universal Lancets 30GQL
Smart Sense Color Lancets Universal 33GQL
Smart Sense Standard Lancets Universal 21GQL
Smart Sense Super Thin Lancets Universal 30GQL
Smart Sense Thin Lancets Universal 26GQL
Smartest Lancets 28GQL
Solus V2 Pressure Activated Safety Lancets 28GQL
Solus V2 Twist Lancets 30GQL
Sterilance TLQL
Super Thin LancetsQL
Sure Comfort Lancets 28GQL
Sure Comfort Lancets 30GQL
Sure-lance Flat LancetsQL
Sure-lance Lancets 26GQL
Sure-lance Thin Lancets 28GQL
Sure-lance Ultra Thin LancetsQL
Sure-touch Lancets UniversalQL
Surelite LancetsQL
Surestep Glucose Control
Surestep Glucose Control Solution
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
31
Surestep Pro High Glucosecontrol
Surestep Pro Linearity Kit
Surestep Pro Low Glucose Control
Surestep Pro Normal Glucose Control
SB Lancets ThinQL
SB Lancets Ultra ThinQL
Techlite AST LancetsQL
Techlite LancetsQL
Techlite Lancets 30GQL
Tgt Lancet Alternate SiteQL
Tgt Lancet Micro Thin 33GQL
Tgt Lancet Super Thin 30GQL
Tgt Lancet Thin 23GQL
Tgt Lancet Thin 26GQL
Tgt Lancet Ultra Thin 28GQL
Tgt Lancet Ultra Thin 30GQL
Thinlets GP LancetsQL
Thinlets LancetQL
Todays Health Super Thin Lancets 30GQL
Todays Health Ultra Thin Lancets 28GQL
Travel Lancets 30GQL
Trueplus Lancets 26GQL
Trueplus Lancets 28GQL
Trueplus Lancets 28G Super ThinQL
Trueplus Lancets 30GQL
Trueplus Lancets 30G Ultra ThinQL
Trueplus Lancets 33GQL
Trueplus Lancets 33G Micro ThinQL
Trueplus Safety Lancets 28GQL
Ulticare Thin Lancets 30GQL
Ultilet Classic LancetsQL
Ultilet LancetsQL
Ultilet Lancets 33GQL
Ultilet Safety Lancets 23GQL
Ultra Thin Lancets 28GQL
Ultra Thin Lancets 30GQL
Ultra-thin II Auto LancetQL
Ultra-thin II Lancets 28GQL
Ultra-thin II Lancets 30GQL
Ultra-thin II Safety Autolancets 26GQL
Unilet Comfortouch LancetQL
Unilet ExceliteQL
Unilet Excelite IIQL
Unilet G.p. LancetQL
Unilet G.p. Superlite LancetQL
Unilet GP 28 Ultra ThinQL
Unilet LancetQL
Unilet Lancets Micro-thin33GQL
Unilet Lancets Super-thin30GQL
Unilet Lancets Ultra-thin 28GQL
Unilet Superlite LancetQL
Unistik Safety Lancets 28GQL
Unistik Safety Lancets 30GQL
Unistik Touch Safety Lancets 21GQL
Unistik Touch Safety Lancets 23GQL
Unistik Touch Safety Lancets 28GQL
Unistik Touch Safety Lancets 30GQL
Unistik 3 GentleQL
Universal 1 Lancets Thin 26GQL
Universal 1 Lancets Ultra Thin 30GQL
V-go 20
V-go 30
V-go 40
Value Plus Lancets Standard 21GQL
Value Plus Lancets Super Thin 30GQL
Value Plus Lancets Thin 26GQL
Valumark Lancet Super Thin 30GQL
Valumark Lancet Ultra Thin 28GQL
Vida Mia Unilet Lancets Super Thin 30GQL
Vida Mia Unilet Lancets Ultra Thin 28GQL
Vitalet Pro LancetsQL
Vitalet Pro Plus LancetsQL
W&f Lancets Colored 21GQL
W&f Lancets 26GQL
Walgreens Advanced Travellancets 28GQL
Walgreens Comfort Assuredlancets Micro Thin/33GQL
Walgreens Comfort Assuredlancets Super Thin/28GQL
Walgreens LancetsQL
Walgreens Thin LancetsQL
Walgreens Ultra Thin LancetsQL
1ST Choice Lancets Super ThinQL
1ST Choice Lancets ThinQL
1ST Choice Lancets Ultra ThinQL
1ST Tier Unilet Comfortouch Lancets 28GQL
1ST Tier Unilet Comfortouch Lancets 30GQL
NON PREFERRED
Accu-chek Active Glucose Control Solution
Accu-chek Active StripsQL
Accu-chek AvivaQL
Accu-chek Aviva PlusQL
Accu-chek Comfort Curve Control Solution (2 Levels)
Accu-chek Comfort Curve Linearity Solution
Accu-chek Comfort Curve Test StripsQL
Accu-chek Compact Blue Control Solution (2 Levels)
Accu-chek Compact PlusQL
Accu-chek Compact Plus Care KitQL
Accu-chek Compact Plus Clear Control Solution (2 Levels)
Accu-chek Compact Test Drum QL
Accu-chek Fastclix Lancetdevice Kit
Accu-chek Instant Glucosecontrol Solution (2 Levels)
Accu-chek Multiclix Lanc Et Device Kit
Accu-chek Nano SmartviewQL
Accu-chek Smartview Control
Accu-chek Smartview StripsQL
Accu-chek Softclix Lancetdevice
Accu-chek Softclix Lancetdevice Kit
Accu-chek VoicemateQL
Adjustable Lancing Device
Advocate Insulin Pen Needles 29GX12.7MMQL
Advocate Insulin Pen Needles 31GX5MMQL
Advocate Insulin Pen Needles 31GX8MMQL
Advocate Insulin Syringe/U-100/0.3ML/29GX1/2"QL
Advocate Insulin Syringe/U-100/0.3ML/30GX5/16"QL
Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"QL
Advocate Insulin Syringe/U-100/0.5ML/29GX1/2"QL
Advocate Insulin Syringe/U-100/0.5ML/30GX5/16"QL
Advocate Insulin Syringe/U-100/0.5ML/31GX5/16"QL
Advocate Insulin Syringe/U-100/1ML/29GX1/2"QL
Advocate Insulin Syringe/U-100/1ML/30GX5/16"QL
Advocate Insulin Syringe/U-100/1ML/31GX5/16"QL
Advocate Lancing Device
Advocate Rapid-safe Lancing Device
Alternate Site Lancing Device
Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2"QL
Aqua Lance Adjustable Lancing Device
Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X
1/2"QL
Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL
Aurora Pen Needles 29GX12MMQL
Aurora Pen Needles 31G X 6MMQL
Aurora Pen Needles 31G X 8MMQL
Aurora Unifine Pentips/Mini/31GX3/16"QL
Aurora Unifine Pentips/32GX5/32"QL
Auto-lancet
Auto-lancet Mini
Autolet Impression
Autolet Impression Lancing Device
Autolet II Clinisafe
Autolet Lite Clinisafe
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
32
Autolet Lite Starter Pack
Autolet Mini
Autolet Platforms
Bayer Microlet 2 Lancing Device
BD Lancet Device
Cardiocom Lancing Device
Carefine Pen Needle 32GX4MMQL
Carefine Pen Needles 29GX1/2"QL
Carefine Pen Needles 30GX5/16"QL
Carefine Pen Needles 31GX6MMQL
Carefine Pen Needles 31GX8MMQL
Carefine Pen Needles 32GX5MMQL
Carefine Pen Needles 32GX6MMQL
Careone Advanced Lancing Device
Careone Insulin Syringes/0.3ML/30G X 1/2"QL
Careone Insulin Syringes/0.3ML/31G X 5/16"QL
Careone Insulin Syringes/0.5ML/30G X 1/2"QL
Careone Insulin Syringes/0.5ML/31G X 5/16"QL
Careone Insulin Syringes/1ML/30G X 1/2"QL
Careone Insulin Syringes/1ML/31GX5/16"QL
Careone Unifine Pentips Pen Needles 32GX4MMQL
Careone Unifine Pentips Plus Pen Needles 29GX12MMQL
Careone Unifine Pentips Plus Pen Needles 31GX5MMQL
Careone Unifine Pentips Plus Pen Needles 31GX6MMQL
Careone Unifine Pentips Plus Pen Needles 31GX8MMQL
Careone Unifine Pentips Plus Pen Needles 32GX4MMQL
Careone Unifine Pentips 29GX12MMQL
Careone Unifine Pentips 31GX5MMQL
Careone Unifine Pentips 31GX6MMQL
Careone Unifine Pentips 31GX8MMQL
Chemstrip Bg Log Book
Clever Choice Comfort EZ Insulin Pen Needles
31GX8MMQL
Clever Choice Comfort EZ Insulin Syringe/U100/1ML/31GX5/16"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X
5/16"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X
5/16"QL
Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X
5/16"QL
Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X
5/16"QL
Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/1ML/28G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/1ML/29G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/1ML/30G X
5/16"QL
Clever Choice Comfort EZ Pen Needles 29GX12MMQL
Clever Choice Comfort EZ Pen Needles 31GX5MMQL
Clever Choice Comfort EZ Pen Needles 31GX6MMQL
Clever Choice Comfort EZ Pen Needles 31GX8MMQL
Clever Choice Comfort EZ Pen Needles 32GX4MMQL
Clever Choice Comfort EZ Pen Needles 32GX5MMQL
Clever Choice Comfort EZ Pen Needles 32GX6MMQL
Clever Choice Comfort EZ Pen Needles 32GX8MMQL
Clever Choice Comfort EZ Pen Needles 33GX4MMQL
Clever Choice Comfort EZ Pen Needles 33GX5MMQL
Clever Choice Comfort EZ Pen Needles 33GX6MMQL
Clever Choice Comfort EZ Pen Needles 33GX8MMQL
Clickfine Pen Needle Universal/31GX1/4"QL
Clickfine Pen Needle Universal/31GX5/16"QL
Clickfine Pen Needle 32GX5/32"QL
Clickfine Pen Needles/31GX1/4"QL
Clickfine Pen Needles/31GX5/16"QL
Clickfine Universal Pen Needles 31GX5/16"QL
Closercare
Comfort Assist Insulin Syringe 0.3ML/29G X 1/2"QL
Comfort Assist Insulin Syringe/0.3ML/30G X 5/16"QL
Comfort Assist Insulin Syringe/0.3ML/31G X 5/16"QL
Comfort Assist Insulin Syringe/0.5ML/29G X 1/2"QL
Comfort Assist Insulin Syringe/0.5ML/30G X 5/16"QL
Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"QL
Comfort Assist Insulin Syringe/1ML/29G X 1/2"QL
Comfort Assist Insulin Syringe/1ML/30G X 5/16"QL
Comfort Assist Insulin Syringe/1ML/31G X 5/16"QL
CVS Insulin Syringe/0.3ML/29G X 1/2"QL
CVS Insulin Syringe/0.3ML/30G X 1/2"QL
CVS Insulin Syringe/0.5ML/29G X 1/2"QL
CVS Insulin Syringe/0.5ML/30G X 1/2"QL
CVS Insulin Syringe/1ML/29G X 1/2"QL
CVS Lancing Device
Diascreen Liquid Urine Controls
Diascreen 1b
Diascreen 1k
Diascreen 1G
Diascreen 10
Diascreen 2GK
Diascreen 2GP
Diascreen 3
Diascreen 4nl
Diascreen 4obl
Diascreen 4PH
Diascreen 5
Diascreen 6
Diascreen 7
Diascreen 8
Diascreen 9
Droplet Lancing Device
Droplet Pen Needles 29GX10MMQL
Droplet Pen Needles 29GX12MMQL
Droplet Pen Needles 31GX5MMQL
Droplet Pen Needles 31GX6MMQL
Droplet Pen Needles 31GX8MMQL
Droplet Pen Needles 32GX4MMQL
Droplet Pen Needles 32GX5MMQL
Droplet Pen Needles 32GX6MMQL
Droplet Pen Needles 32GX8MMQL
Drug Mart Adjustable Lancing Device
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/29G X
1/2"QL
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/30G X
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/31G X
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/0.5ML/30G X
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/0.5ML/31G X
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Drug Mart Ultra Comfort Insulin Syringe/1ML/30G X
5/16"QL
Drug Mart Unifine Pentips 31GX5MMQL
Drug Mart Unifine Pentipsplus 32GX4MMQL
Drug Mart Unifine Pentips29G X 12MMQL
Drug Mart Unifine Pentips31GX6MMQL
Drug Mart Unifine Pentips31GX8MMQL
Drug Mart Unifine Pentips32GX4MMQL
Duane Reade Unifine Pentips 29G X 12MMQL
Duane Reade Unifine Pentips 31G X 6MM Ultra SHORTQL
Duane Reade Unifine Pentips 31G X 8MM SHORTQL
Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
33
Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL
Easy Comfort Insulin Syringe/0.3ML/30G X 5/16"QL
Easy Comfort Insulin Syringe/0.5ML/30G X 5/16"QL
Easy Comfort Insulin Syringe/0.5ML/31G X 5/16"QL
Easy Comfort Insulin Syringe/1ML/30G X 5/16"QL
Easy Comfort Insulin Syringe/1ML/31G X 5/16"QL
Easy Comfort Pen Needles 31GX1/4"QL
Easy Comfort Pen Needles 31GX3/16"QL
Easy Comfort Pen Needles 31GX5/16"QL
Easy Comfort Pen Needles 32GX5/32"QL
Easy Mini Eject Lancing Device
Easy Mini Lancing Device
Easy Touch Fliplock Safety Insulin Syringe
1ML/29GX1/2"QL
Easy Touch Fliplock Safety Insulin Syringe
1ML/30GX1/2"QL
Easy Touch Fliplock Safety Insulin Syringe
1ML/30GX5/16"QL
Easy Touch Fliplock Safety Insulin Syringe
1ML/31GX5/16"QL
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X
1/2"QL
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X
5/16"QL
Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X
1/2"QL
Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X
1/2"QL
Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"QL
Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2"QL
Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2"QL
Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2"QL
Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2"QL
Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16"QL
Easy Touch Insulin Syringe/0.3ML/30G X 5/16"QL
Easy Touch Insulin Syringe/0.3ML/31G X 5/16"QL
Easy Touch Insulin Syringe/0.5ML/29G X 1/2"QL
Easy Touch Insulin Syringe/0.5ML/30G X 5/16"QL
Easy Touch Insulin Syringe/1ML/30G X 5/16"QL
Easy Touch Lancing Device/Ejector
Easy Touch Pen Needles 29GX1/2"QL
Easy Touch Pen Needles 31GX1/4"QL
Easy Touch Pen Needles 31GX5/16"QL
Easy Touch Pen Needles 32GX1/4"QL
Easy Touch Pen Needles 32GX3/16"QL
Easy Touch Pen Needles 32GX5/32"QL
Easy Touch Pen Needles/31G X 3/16"QL
Easy Touch Sheathlock Safety Insulin Syringe
1ML/29GX1/2"QL
Easy Touch Sheathlock Safety Insulin Syringe
1ML/30GX5/16"QL
Easy Touch Sheathlock Safety Insulin Syringe
1ML/31GX5/16"QL
Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2"QL
Easy Touch 32GX5MMQL
Easy Touch 32GX6MMQL
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16"QL
Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16"QL
Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2"QL
Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16"QL
Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2"QL
Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16"QL
Elite-thin Insulin Syringe/0.3ML/31G X 5/16"QL
Elite-thin Insulin Syringe/0.5ML/29G X 1/2"QL
Elite-thin Insulin Syringe/0.5ML/30G X 5/16"QL
Elite-thin Insulin Syringe/1ML/29G X 5/16"QL
Elite-thin Insulin Syringe/1ML/30G X 5/16"QL
Eql Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Eql Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Eql Insulin Syringe/U-100/1ML/29G X 1/2"QL
Eql Insulin Syringe/0.3ML/29G X 1/2"QL
Eql Insulin Syringe/0.3ML/30G X 5/16"QL
Eql Insulin Syringe/0.3ML/31G X 5/16"QL
Eql Insulin Syringe/0.5ML/29G X 1/2"QL
Eql Insulin Syringe/0.5ML/30G X 5/16"QL
Eql Insulin Syringe/0.5ML/31G X 5/16"QL
Eql Insulin Syringe/1ML/29G X 1/2"QL
Eql Insulin Syringe/1ML/30G X 5/16"QL
Eql Insulin Syringe/1ML/31G X 5/16"QL
Eql SHORT Pen Needles 31G X 8MMQL
Eql Ultra Comfort Insulinsyringe/0.3ML/31G X 5/16"QL
Eql Ultra Comfort Insulinsyringe/1ML/30G X 5/16"QL
Eql Ultra SHORT Pen Needles 31G X 6MMQL
Excel Comfort Point Insulin Pen Needles 31G X 4MMQL
Exel Comfort Point Insulin Pen Needles 29G X 12MMQL
Exel Comfort Point Insulin Pen Needles 31G X 6MMQL
Exel Comfort Point Insulin Pen Needles 31G X 8MMQL
Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2"QL
Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"QL
Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2"QL
Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2"QL
Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16"QL
Exel Comfort Point Insulin Syringe/1ML/28G X 1/2"QL
Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"QL
Exel Comfort Point Insulin Syringe/1ML/30G X 5/16"QL
Fifty50 Lancing Device
Fifty50 Pen Needles 31G X3/16" (5MM)QL
Fifty50 Pen Needles 31G X5/16" (8MM)QL
Fifty50 Pen Needles 31GX5MMQL
Fifty50 Pen Needles/31GX8MMQL
Fifty50 Pen Needles/32GX4MMQL
Fifty50 Pen Needles/32GX6MMQL
Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X
5/16"QL
Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X
5/16"QL
Fifty50 Superior Comfort Insulin Syringe/1ML/31G X
5/16"QL
Fora Lancing Device
Fora Lancing Device/Clearcap
Freds Pharmacy Autolet Lancing Device
Freds Pharmacy Unifine Pentips Pen Needles
32GX4MMQL
Freds Pharmacy Unifine Pentips Plus 31GX5MMQL
Freds Pharmacy Unifine Pentips Plus 31GX8MMQL
Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X
5/16"QL
Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X
5/16"QL
Freestyle Precision Insulin Syringe/U-100/1ML/31G X
5/16"QL
Freestyle Precision Insulin Syringes/U-100/1ML/30G X
5/16"QL
Gentle-let Platforms 2.4MM
Gentle-let Platforms 3.0MM
Global Ease Inject Pen Needles 29GX12MMQL
Global Ease Inject Pen Needles 31GX8MMQL
Global Ease Inject Pen Needles 32GX4MMQL
Global Ease Inject Pen Neeedles 31GX5MMQL
Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X
5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X
5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X
1/2"QL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
34
Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X
5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X
5/16"QL
Global Inject Ease Insulin Syringe/U-100/1ML/28G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/29G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/30G X
1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/30G X
5/16"QL
Global Inject Ease Insulin Syringe/U-100/1ML/31G X
5/16"QL
Global Lancing Device
Glucocom Autolink Telemonitoring System
Glucolet 2 Automatic Lancing Device
Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Glucopro Insulin Syringe/U-100/1ML/30G X 1/2"QL
Glucopro Insulin Syringe/U-100/1ML/30G X 5/16"QL
Glucopro Insulin Syringe/U-100/1ML/31G X 5/16"QL
Glucosource Lancet Device
Gmate Lancing Device
Gnp Clickfine Pen Needle Universal/31GX5/16"QL
Gnp Clickfine Universal Pen Needles 31GX1/4"QL
Gnp Clickfine Universal Pen Needles 31GX5/16"QL
Gnp Insulin Syringe/0.3ML/29G X 1/2"QL
Gnp Insulin Syringe/0.3ML/30G X 5/16"QL
Gnp Insulin Syringe/0.3ML/31G X 5/16"QL
Gnp Insulin Syringe/0.5ML/28G X 1/2"QL
Gnp Insulin Syringe/0.5ML/29G X 1/2"QL
Gnp Insulin Syringe/0.5ML/30G X 5/16"QL
Gnp Insulin Syringe/0.5ML/31G X 5/16"QL
Gnp Insulin Syringe/1ML/28G X 1/2"QL
Gnp Insulin Syringe/1ML/29G X 1/2"QL
Gnp Insulin Syringe/1ML/30G X 5/16"QL
Gnp Insulin Syringe/1ML/31G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"
SHORTQL
Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"
SHORTQL
Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"
SHORTQL
Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"
SHORTQL
Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16"
SHORTQL
Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16"
SHORTQL
H-e-b Incontrol Advanced Lancing Device
H-e-b Incontrol Pen Needles 29GX12MMQL
H-e-b IN Control Pen Needles 31GX5MMQL
H-e-b IN Control Pen Needles 31GX6MMQL
H-e-b IN Control Pen Needles 31GX8MMQL
H-e-b IN Control Pen Needles/Nano/32GX4MMQL
H-e-b IN Control Unifine Pentips Plus 31GX5MMQL
H-e-b IN Control Unifine Pentips Plus 32GX4MMQL
Health Care Lancing Device
Healthwise Lancing Pen
Healthwise Mini Pen Needles 31GX6MMQL
Healthwise Pen Needles 29GX12MMQL
Healthwise SHORT Pen Needles 31GX8MMQL
Healthwise Unifine Pentips Pen Needles 32GX4MMQL
Healthy Accents Autolet Impression Lancing Device
Healthy Accents Unifine Pentips Pen Needles
29GX12MMQL
Healthy Accents Unifine Pentips Pen Needles
31GX5MMQL
Healthy Accents Unifine Pentips Pen Needles
31GX6MMQL
Healthy Accents Unifine Pentips Pen Needles
31GX8MMQL
Healthy Accents Unifine Pentips Pen Needles
32GX4MMQL
Hypolance AST Lancing Kit
Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Insulin Syringe/U-100/1ML/28G X 1/2"QL
Insulin Syringe/U-100/1ML/29G X 1/2"QL
Insulin Syringe/U-100/1ML/30G X 5/16"QL
Insulin Syringe/U-100/1ML/31G X 5/16"QL
Insulin Syringe/0.3ML/29G X 1/2"QL
Insulin Syringe/0.3ML/29G X 1"QL
Insulin Syringe/0.3ML/30G X 5/16"QL
Insulin Syringe/0.3ML/31G X 5/16"QL
Insulin Syringe/0.5ML/27G X 1/2"QL
Insulin Syringe/0.5ML/28G X 1/2"QL
Insulin Syringe/0.5ML/29G X 1/2"QL
Insulin Syringe/0.5ML/30G X 1/2"QL
Insulin Syringe/0.5ML/30G X 5/16"QL
Insulin Syringe/0.5ML/31G X 5/16"QL
Insulin Syringe/1ML/28G X 1/2"QL
Insulin Syringe/1ML/29G X 1/2"QL
Insulin Syringe/1ML/30G X 5/16"QL
Insulin Syringe/1ML/31G X 5/16"QL
Insupen Pen Needles 32G X4MMQL
Insupen Sensitive 32GX6MMQL
Insupen Sensitive 32GX8MMQL
Insupen Ultrafin 29GX12MMQL
Insupen Ultrafin 30GX8MMQL
Insupen Ultrafin 31GX6MMQL
Insupen Ultrafin 31GX8MMQL
Insupen 33GX4MMQL
IN Touch Lancing Device
Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16"QL
Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16"QL
Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16"QL
Kinray Insulin Syringe/0.5ML/29G X 1/2"QL
Kmart Valu Plus Insulin Syringe/0.3ML/30GQL
Kmart Valu Plus Insulin Syringe/0.5ML/29GQL
Kmart Valu Plus Insulin Syringe/0.5ML/30GQL
Kmart Valu Plus Insulin Syringe/1ML/29GQL
Kmart Valu Plus Insulin Syringe/1ML/30GQL
Kroger Insulin Syringe/0.3ML/29G X 1/2"QL
Kroger Insulin Syringe/0.3ML/30G X 5/16"QL
Kroger Insulin Syringe/0.3ML/31G X 5/16"QL
Kroger Insulin Syringe/0.5ML/29G X 1/2"QL
Kroger Insulin Syringe/0.5ML/30G X 5/16"QL
Kroger Insulin Syringe/0.5ML/31G X 5/16"QL
Kroger Insulin Syringe/1ML/29G X 1/2"QL
Kroger Insulin Syringe/1ML/30G X 5/16"QL
Kroger Insulin Syringe/1ML/31G X 5/16"QL
Kroger Lancing Device
Kroger Pen Needles 29G X 12MMQL
Kroger Pen Needles 31G X 8MMQL
Kroger Pen Needles 31GX1/4"QL
Lancet Device Adjustable
Lancet Device With Ejector
Lancet Transporter Case
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
35
Lancing Device
Lancing Device Adjustable
Lanzo
Leader Advanced Lancing Device
Leader Insulin Syringe/0.3ML/29G X 1/2"QL
Leader Insulin Syringe/0.3ML/30G X 5/16"QL
Leader Insulin Syringe/0.3ML/31G X 5/16"QL
Leader Insulin Syringe/0.5ML/28G X 1/2"QL
Leader Insulin Syringe/0.5ML/29G X 1/2"QL
Leader Insulin Syringe/0.5ML/30G X 5/16"QL
Leader Insulin Syringe/0.5ML/31G X 5/16"QL
Leader Insulin Syringe/1ML/28G X 1/2"QL
Leader Insulin Syringe/1ML/29G X 1/2"QL
Leader Insulin Syringe/1ML/30G X 5/16"QL
Leader Insulin Syringe/1ML/31G X 5/16"QL
Leader Unifine Pentips Plus/Mini/31GX3/16"QL
Leader Unifine Pentips Plus/SHORT/31GX5/16"QL
Leader Unifine Pentips/Mini/31GX3/16"QL
Leader Unifine Pentips/Nano/32GX5/32"QL
Leader Unifine Pentips/Plus/32GX5/32"QL
Lite Touch Lancing Device
Lite Touch Lancing Pen
Lite Touch Pen Needles/31G X 3/16"QL
Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Litetouch Insulin Syringe/U-100/1ML/28G X 1/2"QL
Litetouch Insulin Syringe/U-100/1ML/29G X 1/2"QL
Litetouch Insulin Syringe/U-100/1ML/31G X 5/16"QL
Litetouch Insulin Syringe/0.3ML/29G X 1/2"QL
Litetouch Insulin Syringe/0.3ML/30G X 5/16"QL
Litetouch Insulin Syringe/0.3ML/31G X 5/16"QL
Litetouch Insulin Syringe/0.5ML/30G X 5/16"QL
Litetouch Insulin Syringe/0.5ML/31G X 5/16"QL
Litetouch Insulin Syringe/1ML/30G X 5/16"QL
Litetouch Pen Needles 29GX12.7MMQL
Litetouch Pen Needles 31G X 6MMQL
Litetouch Pen Needles 31GX8MM SHORTQL
Live Better Advanced Lancing Device
Live Better Pen Needles 29G X 12MMQL
Live Better Pen Needles 31G X 12MMQL
Live Better Pen Needles 31G X 6MMQL
Longs Insulin Syringe/0.5ML/31G X 5/16"QL
Magellan Insulin Safety Syringe/U-100/0.3ML/29G X
1/2"QL
Magellan Insulin Safety Syringe/U-100/0.3ML/30G X
5/16"QL
Magellan Insulin Safety Syringe/U-100/0.5ML/29G X
1/2"QL
Magellan Insulin Safety Syringe/U-100/0.5ML/30G X
5/16"QL
Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL
Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"QL
Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"QL
Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2"QL
Medic Insulin Syringe/0.3ML/30G X 5/16"QL
Medic Insulin Syringe/0.5ML/30G X 5/16"QL
Medicine Shoppe Pen Needles 29G X 12MMQL
Medicine Shoppe Pen Needles 31G X 6MMQL
Medicine Shoppe Pen Needles 31G X 8MMQL
Meijer Pen Needles 29G X 12MMQL
Meijer Pen Needles 31G X 6MMQL
Meijer Pen Needles 31G X 8MMQL
Mini Lancing Device
Monoject Insulin Syringe Regular LUER
Tip/Softpack/1MLQL
Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"QL
Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"QL
Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X
1/2"QL
Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2"QL
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X
1/2"QL
Monoject Insulin Syringe/Safety/Perm
Needle/0.3ML/29GX1/2"QL
Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X
1/2"QL
Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X
1/2"QL
Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X
1/2"QL
Monoject Insulin Syringe/Softpack/1ML/27G X 1/2"QL
Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL
Monoject Insulin Syringe/U-100/1ML/30G X 5/16"QL
Monoject Insulin Syringe/1MLQL
Monoject Insulin Syringe/1ML/31G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X
1/2"QL
Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X
5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X
5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X
1/2"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X
1/2"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X
5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X
5/16"QL
Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL
Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL
Monojector End CAPS
Monojector Opd End CAPS
Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X
1/2"QL
Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X
1/2"QL
Moore MED Monoject Insulin Syringe/U-100/1ML/28G X
1/2"QL
Moore MED Monoject Insulin Syringe/U-100/1ML/29G X
1/2"QL
Multi-lancet Device
Multi-lancet Device 2
MS Insulin Syringe/0.3ML/29G X 1/2"QL
MS Insulin Syringe/0.3ML/30G X 5/16"QL
MS Insulin Syringe/0.3ML/31G X 5/16"QL
MS Insulin Syringe/0.5ML/29G X 1/2"QL
MS Insulin Syringe/0.5ML/30G X 5/16"QL
MS Insulin Syringe/0.5ML/31G X 5/16"QL
MS Insulin Syringe/1ML/29G X 1/2"QL
MS Insulin Syringe/1ML/30G X 5/16"QL
MS Insulin Syringe/1ML/31G X 5/16"QL
Nova Sureflex Lancing Device
Novofine Autocover 30GX8MMQL
Novofine Plus 32GX4MMQL
Novofine 30GX8MMQL
Novofine 32GX6MMQL
Novotwist 30GX8MMQL
Novotwist 32GX5MMQL
On Call Lancing Device
On Call Plus Lancing Device
Pen Needles 29G X 12MMQL
Pen Needles 29GX1/2"QL
Pen Needles 30GX5/16"QL
Pen Needles 31G X 1/4" SHORTQL
Pen Needles 31G X 3/16"QL
Pen Needles 31G X 5MMQL
Pen Needles 31G X 6MMQL
Pen Needles 31GX5/16"QL
Pen Needles 31GX8MMQL
Pen Needles 32GX4MMQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
36
Pentips 31GX5MMQL
Pentips 31GX8MMQL
Pentips 32GX4MMQL
Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16"QL
Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2"QL
Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2"QL
Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8"QL
Precision Sure-dose Insulin Syringe/1ML/28G X 1/2"QL
Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X
1/2"QL
Precision Sure-dose Plus Insulin Syringe/1ML/29G X
1/2"QL
Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16"QL
Preferred Plus Unifine Pentips 29G X 12MMQL
Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORTQL
Preferred Plus Unifine Pentips 31G X 8MM SHORTQL
Preferred Plus Unifine Pentips 32GX4MMQL
Preferred Plus Unifine Pentips/Mini/31GX5MMQL
Prodigy Insulin Mini Pen Needles/31G X 3/16"QL
Prodigy Insulin Pen Needles/29G X 1/2"QL
Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16"QL
Prodigy Insulin Syringe/1/2ML/31G X 5/16"QL
Prodigy Insulin Syringe/1ML/28G X 1/2"QL
Prodigy Insulin SHORT Penneedles/31G X 5/16"QL
Prodigy Lancing Device
Pss Select Platforms
Px Advanced Lancing Device
Px Extra SHORT Pen Needles 31GX6MMQL
Px Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Px Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Px Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Px Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Px Insulin Syringe/U-100/1ML/30G X 1/2"QL
Px Insulin Syringe/U-100/1ML/31G X 5/16"QL
Px Lancet Auto Injector
Px Mini Pen Needles 31GX5MMQL
Px Pen Needle 29GX12MMQL
Px Pen Needle 31GX8MMQL
Px Shortlength Pen Needles/31GX8MMQL
PC Unifine Pentips 29G X 1/2"QL
PC Unifine Pentips 31G X 5MM MiniQL
PC Unifine Pentips 31G X 6MM Ultra SHORTQL
PC Unifine Pentips 31G X 8MM SHORTQL
Qc Advanced Lancing Device
Qc Insulin Syringe 0.5ML/29GQL
Qc Insulin Syringe 0.5ML/30GQL
Qc Insulin Syringe 1ML/29GQL
Qc Insulin Syringe/0.3ML/29GQL
Qc Insulin Syringe/0.3ML/29G X 1/2"QL
Qc Insulin Syringe/0.5ML/29G X 1/2"QL
Qc Insulin Syringe/0.5ML/31G X 5/16"QL
Qc Insulin Syringe/1ML/29G X 1/2"QL
Qc Insulin Syringe/1ML/30GQL
Qc Insulin Syringe/1ML/31G X 5/16"QL
Qc Pen Needles 29G X 12MMQL
Qc Pen Needles 31G X 6MMQL
Qc Pen Needles 31G X 8MMQL
Qc Unifine Pentips 32GX4MMQL
Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ra Insulin Syringe/U-100/1 ML/30G X 5/16"QL
Ra Insulin Syringe/0.5ML/29G X 1/2"QL
Ra Insulin Syringe/1ML/29G X 1/2"QL
Ra Lancing Device
Ra Pen Needles 31G X 5MM 3/16"QL
Ra Pen Needles 31G X 8MM 5/16"QL
Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Reality Insulin Syringe/U-100/1ML/28G X 1/2"QL
Reality Insulin Syringe/U-100/1ML/29G X 1/2"QL
Relion Insulin Syringe/U -100/0.5ML/29GQL
Relion Insulin Syringe/U-00/1ML/29G X 1/2"QL
Relion Insulin Syringe/U-100/0.3ML/29GQL
Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Relion Insulin Syringe/U-100/0.3ML/30GQL
Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Relion Insulin Syringe/U-100/0.5ML/30GQL
Relion Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Relion Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Relion Insulin Syringe/U-100/1ML/30GQL
Relion Insulin Syringe/U-100/1ML/30G X 5/16"QL
Relion Insulin Syringe/U-100/1ML/31G X 5/16"QL
Relion Lancing Device
Relion Mini Pen Needles 31GX6MMQL
Relion Pen Needles 29GX12MMQL
Relion Pen Needles 31GX8MMQL
Relion Pen Needles 32GX4MMQL
Relion SHORT Pen Needles 31GX8MMQL
Relion 2-IN-1 Lancing Device 25G
Relion 2-IN-1 Lancing Device 30G
Renew Advanced Lancing Device
Rightest GD-L500 Alternate Site Adapter
Rightest GD500 Lancing Device
Safesnap Insulin Syringe/0.3ML/30G X 5/16"QL
Safesnap Insulin Syringe/0.5ML/29G X 1/2"QL
Safesnap Insulin Syringe/0.5ML/30G X 5/16"QL
Safesnap Insulin Syringe/1ML/28G X 1/2"QL
Safesnap Insulin Syringe/1ML/29G X 1/2"QL
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X
1/2"QL
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X
5/16"QL
Select-lite Device/Lancets
Select-lite Lancing Device
Shopko Autolet Lancing Device
Shopko Unifine Pentips Pen Needles/Micro/32GX4MMQL
Shopko Unifine Pentips Pen Needles/Mini/31GX5MMQL
Shopko Unifine Pentips Pen
Needles/Original/29GX12MMQL
Shopko Unifine Pentips Pen
Needles/SHORT/31GX8MMQL
Simple Diagnostics Lancing Device
Sm Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Sm Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Sm Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Sm Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Sm Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Sm Insulin Syringe/U-100/1ML/28G X 1/2"QL
Sm Insulin Syringe/U-100/1ML/29G X 1/2"QL
Sm Insulin Syringe/U-100/1ML/30G X 5/16"QL
Sm Insulin Syringe/0.3ML/31G X 5/16"QL
Sm Insulin Syringe/0.5ML/31G X 5/16"QL
Sm Insulin Syringe/1ML/31G X 5/16"QL
Smart Diabetes Vantage Lancing Device
Solus V2 Lancing Device
Sterilance PA
Supreme II Confidence Paddles
Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16QL
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
37
Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16QL
Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL
Sure Comfort Lancing Pen
Sure Comfort Pen Needles 29GX1/2" 12.7MMQL
Sure Comfort Pen Needles 30GX5/16" SHORTQL
Sure Comfort Pen Needles 31GX3/16" (5MM)QL
Sure Comfort Pen Needles 31GX5/16" (8MM)QL
Sure Comfort Pen Needles 32GX5/32"QL
Sure Comfort Pen Needles 32GX6MMQL
Sure-fine Pen Needles 29GX1/2" 12.7MMQL
Sure-fine Pen Needles 31GX3/16" 5MMQL
Sure-fine Pen Needles 31GX5/16" 8MMQL
Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2"QL
Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2"QL
Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16"QL
Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16"QL
Sure-pen
SB Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
SB Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
SB Insulin Syringe/U-100/1ML/29G X 1/2"QL
SB Insulin Syringe/U-100/1ML/30G X 5/16"QL
SB Insulin Syringe/U-100/1ML/31G X 5/16"QL
Techlite Pen Needles/31G X 5MMQL
Techlite Pen Needles/31G X 6 MMQL
Techlite Pen Needles/31G X 8MMQL
Techlite Pen Needles/32G X 4MMQL
Techlite Pen Needles/32G X 6MMQL
Techlite Pen Needles/32G X 8MMQL
Terumo Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Terumo Insulin Syringe/U-100/0.5ML/27G X 1/2"QL
Terumo Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Terumo Insulin Syringe/U-100/1ML/28G X 1/2"QL
Terumo Insulin Syringe/0.3ML/30G X 3/8"QL
Terumo Insulin Syringe/0.5ML/29G X 1/2"QL
Terumo Insulin Syringe/0.5ML/30G X 3/8"QL
Terumo Insulin Syringe/1ML/27G X 1/2"QL
Terumo Insulin Syringe/1ML/29G X 1/2"QL
Terumo Insulin Syringe/1ML/30G X 3/8"QL
Terumo Surguard Insulin Syringe/0.3ML/29G X 1/2"QL
Terumo Surguard Insulin Syringe/0.5ML/28G X 1/2"QL
Terumo Surguard Insulin Syringe/0.5ML/29G X 1/2"QL
Terumo Surguard Insulin Syringe/1ML/28G X 1/2"QL
Terumo Surguard Insulin Syringe/1ML/29G X 1/2"QL
Tgt Advanced Lancing Device
Tgt Lancing Device
Thinpro Insulin Syringe/0.3ML/29G X 1/2"QL
Thinpro Insulin Syringe/0.3ML/30G X 3/8"QL
Thinpro Insulin Syringe/0.3ML/31G X 3/8"QL
Thinpro Insulin Syringe/0.5ML/28G X 1/2"QL
Thinpro Insulin Syringe/0.5ML/29G X 1/2"QL
Thinpro Insulin Syringe/0.5ML/30G X 3/8"QL
Thinpro Insulin Syringe/0.5ML/31G X 3/8"QL
Thinpro Insulin Syringe/1ML/28G X 1/2"QL
Thinpro Insulin Syringe/1ML/29G X 1/2"QL
Thinpro Insulin Syringe/1ML/30G X 3/8"QL
Thinpro Insulin Syringe/1ML/31G X 3/8"QL
Todays Health Advanced Lancing Device
Todays Health Mini Pen Needles 31G X 1/4"QL
Todays Health Original Pen Needles 29G X 1/2"QL
Todays Health SHORT Pen Needles 31G X 5/16"QL
Topcare Clickfine Universal Pen Eedles 31GX1/4"QL
Topcare Clickfine Universal Pen Eedles 31GX5/16"QL
Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X
1/2"QL
Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X
1/2"QL
Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X
1/2"QL
Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X
5/16"QL
Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X
5/16"QL
Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X
5/16"QL
Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X
5/16"QL
Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL
Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16"QL
Topco Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Topco Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Topco Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Topco Insulin Syringe/U-100/1ML/28G X 1/2"QL
Topco Insulin Syringe/U-100/1ML/29G X 1/2"QL
Tracer II 3 Volt Battery
Truedraw Lancing Device
Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Trueplus Insulin Syringe/U-100/1ML/28G X 1/2"QL
Trueplus Insulin Syringe/U-100/1ML/29G X 1/2"QL
Trueplus Insulin Syringe/U-100/1ML/30G X 5/16"QL
Trueplus Insulin Syringe/U-100/1ML/31G X 5/16"QL
Ulti-lance Automatic/ Clear Tip
Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2"QL
Ulticare Insulin Safety Syringe/1ML/29G X 1/2"QL
Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X
5/16"QL
Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X
5/16"QL
Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16"QL
Ulticare Insulin Syringe 1CC/28G U-100 1/2"QL
Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL
Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL
Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL
Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL
Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16"QL
Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16"QL
Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Ulticare Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/1ML/30G X 1/2"QL
Ulticare Insulin Syringe/U-100/1ML/30G X 5/16"QL
Ulticare Insulin Syringe/U-100/1ML/31G X 5/16"QL
Ulticare Insulin Syringe/0.3ML/29G X 1/2"QL
Ulticare Insulin Syringe/0.3ML/30G X 1/2"QL
Ulticare Insulin Syringe/0.3ML/30G X 5/16"QL
Ulticare Insulin Syringe/0.5ML/28G X 1/2"QL
Ulticare Insulin Syringe/0.5ML/29G X 1/2"QL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
38
Ulticare Insulin Syringe/0.5ML/30G X 1/2"QL
Ulticare Insulin Syringe/0.5ML/30G X 5/16"QL
Ulticare Insulin Syringe/1ML/28G X 1/2"QL
Ulticare Insulin Syringe/1ML/29G X 1/2"QL
Ulticare Insulin Syringe/1ML/30G X 1/2"QL
Ulticare Insulin Syringe/1ML/30G X 5/16"QL
Ulticare Micro Pen Needles 31G X 8MMQL
Ulticare Micro Pen Needles 32G X 4MMQL
Ulticare Micro Pen Needles/31G X 8MMQL
Ulticare Micro Pen Needles/32G X 4MMQL
Ulticare Mini Pen Needles Ulti-fine IVQL
Ulticare Mini Pen Needles 31GX6MMQL
Ulticare Mini Pen Needles/31G X 6MMQL
Ulticare Mini Pen Needles31GX6MMQL
Ulticare Original Pen Needles Ulti-fineQL
Ulticare Pen Needles/29G X 12.7MMQL
Ulticare SHORT Pen Needles Ulti-fine IVQL
Ulticare SHORT Pen Needles 31GX8MMQL
Ulticare SHORT Pen Needles/31G X 8MMQL
Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4"QL
Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4"QL
Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4"QL
Ulticare U-100 Insulin Syringes/1ML/31G X 1/4"QL
Ultiguard Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ultiguard Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ultiguard Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ultiguard Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16"QL
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL
Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL
Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL
Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL
Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16"QL
Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16"QL
Ultilet Pen Needle 32GX4MM/SHORTQL
Ultilet SHORT Pen Needles 31GX5/16"QL
Ultilet SHORT Pen Needles31GX3/16"QL
Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ultra Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/30GX5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/31GX5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/30GX5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/31GX5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/1ML/30GX5/16"QL
Ultra-thin II Insulin Syringe SHORT/U100/1ML/31GX5/16"QL
Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2"QL
Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2"QL
Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2"QL
Ultra-thin II Mini Pen Neeedles/31GX3/16"QL
Ultra-thin II Pen Needles 29GX1/2"QL
Ultra-thin II Pen Needles/SHORT/31GX5/16"QL
Ultralance
Unifine Pentips Plus 29GX12MMQL
Unifine Pentips Plus 31GX5MMQL
Unifine Pentips Plus 31GX6MMQL
Unifine Pentips Plus 31GX8MMQL
Unifine Pentips Plus 32GX4MMQL
Unifine Pentips 29GX12MMQL
Unifine Pentips 31G X 3/16"QL
Unifine Pentips 31G X 6MMQL
Unifine Pentips 31G X 8MMQL
Unifine Pentips 31GX5MMQL
Unifine Pentips 31GX6MMQL
Unifine Pentips 31GX8MMQL
Unifine Pentips 32GX4MMQL
Unistik CZT Comfort
Unistik CZT Normal
Unistik 1
Unistik 2
Unistik 2 Comfort
Unistik 2 Extra
Unistik 2 Neonatal
Unistik 2 Normal
Unistik 2 Super
Unistik 3
Unistik 3 Comfort
Unistik 3 Extra
Unistik 3 Neonatal
Unistik 3 Normal
Urin-tek
V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
V-r Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL
V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2"QL
Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Value Health Insulin Syringe/U-100/1ML/29G X 1/2"QL
Value Plus Lancing Device
Valumark Pen Needles 29GX12MMQL
Valumark Pen Needles 31G X 6MMQL
Valumark Pen Needles 31G X 8MMQL
Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"QL
Vanishpoint Insulin Syringe/1ML/29G X 1/2"QL
Vida Mia Autolet Lancing Device
Vida Mia Unifine Pentips Mini 31GX6MMQL
Vida Mia Unifine Pentips Original 29GX12MMQL
Vida Mia Unifine Pentips 32GX4MMQL
Vida Mia Unipfine Pentipsshort 31GX8MMQL
Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Wd Medic Insulin Syringe/0.3ML/29G X 1/2"QL
Wd Medic Insulin Syringe/0.3ML/30G X 5/16"QL
Wd Medic Insulin Syringe/0.5ML/29G X 1/2"QL
Wd Medic Insulin Syringe/0.5ML/30G X 5/16"QL
Wd Medic Insulin Syringe/1ML/29G X 1/2"QL
Wd Medic Insulin Syringe/1ML/30G X 5/16"QL
Wegmans Unifine Pentips Plus 32GX4MMQL
Wegmans Unifine Pentips Plus/Mini/31GX5MMQL
Wegmans Unifine Pentips Plus/SHORT/31GX8MMQL
Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MMQL
1ST Tier Unifine Pentips /Mini/31GX5MMQL
1ST Tier Unifine Pentips Plus 31GX8MMQL
1ST Tier Unifine Pentips Plus 32GX4MMQL
1ST Tier Unifine Pentips Plus/Mini/31GX5MMQL
1ST Tier Unifine Pentips Plus/Original/29GX12MMQL
1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MMQL
1ST Tier Unifine Pentips 29GX12MMQL
1ST Tier Unifine Pentips 31GX6MMQL
1ST Tier Unifine Pentips 31GX8MMQL
1ST Tier Unifine Pentips 32GX4MMQL
MEDICAL DEVICES - MISC
PREFERRED
Aerochamber Mini Aerosol ChamberQL
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
39
Aerochamber MVQL
Aerochamber Plus Flow VUQL
Aerochamber Plus Flow-VUQL
Aerochamber Plus Flow-VU/Large MaskQL
Aerochamber Plus Flow-VU/MaskQL
Aerochamber Plus Flow-VU/Medium MaskQL
Aerochamber Plus Flow-VU/Small MaskQL
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow
VUQL
Aerochamber Z-stat Plus/FlowsignalQL
Aerochamber Z-stat Plus/Large MaskQL
Aerochamber Z-stat Plus/Medium MaskQL
Aerochamber Z-stat Plus/Small MaskQL
Aerochamber/FlowsignalQL
Aerovent Plus Holding Chamber/CollapsibleQL
Alcoh-glove Contoured Wipe
Alcoh-wipe 12" X 12"
Alcohol Pads
Alcohol Prep Pads
Alcohol Preps
Alcohol Swabs
Alcohol Swabstick
Alcohol Wipes
Arial ChamberQL
BreatheriteQL
Breatherite Collapsible Adult Spacer W/MaskQL
Breatherite Collapsible Child Spacer W/MaskQL
Breatherite Collapsible Infant Spacer W/MaskQL
Breatherite Collapsible Small Child Spacer W/MaskQL
Breatherite Collapsible Spacer W/ Neonate MaskQL
Breatherite Rigid Spacer W/MaskQL
Breatherite W/Large MaskQL
Breatherite W/Medium MaskQL
Breatherite W/Small MaskQL
BD Swabs Single Use
BD Swabs Single Use Butterfly
Curity Alcohol Preps/Medium 2 Ply
Curity Alcohol Swabs
CVS Alcohol Prep Swabs
CVS Alcohol Swabs
CVS Prep Pads
E-z SpacerQL
E-z Spacer The Body Guards PackQL
EasiventQL
Easivent/Mask-largeQL
Easivent/Mask-mediumQL
Easivent/Mask-smallQL
Easy Touch Alcohol Prep Pads/Medium
Fifty50 Alcohol Prep Pads
FlexichamberQL
Flexichamber Adult Mask/Small
Flexichamber Child Mask/Large
Flexichamber Child Mask/Small
Global Alcohol Prep Ease Pads
Gnp Alcohol Swabs
Healthwise Alcohol Prep Pads
Inspirachamber/Anti-static Valved/MouthpieceQL
Inspirachamber/LargeQL
Inspirachamber/Soothermask/Inspiramask/MediumQL
Inspirachamber/Soothermask/Inspiramask/SmallQL
Inspirease Bags
Inspirease Drug Delivery SystemQL
Inspirease Mouthpiece
Inspirease Reservoir Bags
LiteaireQL
Mask Vortex/Baby Whirl Duckling
Mask Vortex/Child/Frog
Mask Vortex/Spinner The Duck
Mask Vortex/Toddler/Lady Bug
Meijer Alcohol Swabs Extra-thick
MicrochamberQL
MicrospacerQL
Nessi Spacer/Large MaskQL
Nessi Spacer/MouthpieceQL
Nessi Spacer/Small/MED MaskQL
Optichamber AdvantageQL
Optichamber DiamondQL
Optichamber Diamond/Largeface MaskQL
Optichamber Diamond/Medium Face MaskQL
Optichamber Diamond/Smallface MaskQL
OptihalerQL
Optihaler MDI Drug Delivery SystemQL
Panda Mask Large
Panda Mask Medium
Panda Mask Small
Pediatric Panda Mask
Pharmacist Choice Alcoholprep Pads
Pocket ChamberQL
Pocket SpacerQL
Qc Alcohol Swabs
Ra Alcohol Swabs
Reality Swabs
Relion Alcohol Swabs
RitefloQL
Saps Care Alcohol Prep Pads
Shopko Alcohol Swabs
Sm Alcohol Prep Pads
Sure Comfort Alcohol Prep Pads
Sure-prep Alcohol Prep Pads
SB Alcohol Prep Pads
Tgt Alcohol Swabs
Valved Holding ChamberQL
Vortex Valved Holding ChamberQL
WatchhalerQL
Webcol Alcohol Prep Large 1 Ply
Webcol Alcohol Prep Large 2 Ply
Webcol Alcohol Prep Medium 2 Ply
MISCELLANEOUS
GENERIC
acetylcysteine
adenosine
alprostadil
aminorelief rms
aminosyn II 8.5%/electrolytes
aminosyn 8.5%/electrolytes
argyle sterile water 100ML
calcium chloride
calcium gluconate
chloromag
clinisol SF 15%
cosyntropin
cysteine HCL
deferoxamine mesylate
dehydrated alcohol
delflex-lm/1.5% dextrose
dextrose 10%
dextrose 10% flex container
dextrose 2.5%/sodium chloride 0.45%
dextrose 2.5%/NACL 0.45%
dextrose 30% partial fill
dextrose 5%
dextrose 5% viaflex
dextrose 5%/lactated ringers
dextrose 5%/potassium chloride 0.15%
dextrose 5%/ringers
dextrose 5%/sodium chloride 0.2%
dextrose 5%/sodium chloride 0.33%
dextrose 5%/sodium chloride 0.45%
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
40
dextrose 5%/sodium chloride 0.9%
dextrose 5%/NACL 0.2%
dextrose 5%/NACL 0.33%
dextrose 5%/NACL 0.45%
dextrose 5%/NACL 0.9%
dextrose 50%
dextrose 70%
dipyridamole
effer-k
effervescent pot chloride
effervescent potassium
effervescent potassium/chloride
flumazenil
fomepizole
formadon
formaldehyde
indigo carmine
indocyanine green
intralipid
isolyte-m/dextrose 5%
isosulfan blue
k-effervescent
k-prime
k-sol
k-vescent
kendall sodium chloride flush
kionex
klor-CON
klor-CON m10
klor-CON m20
klor-CON sprinkle
klor-CON 10
klor-CON 8
klor-CON/EF
l-cysteine HCL
lactated ringers
lactated ringers dextrose 5% viaflex
lactated ringers irrigation
lactated ringers viaflex
lanolin
liposyn iii
magnesium chloride
magnesium sulfate
methylene blue
monoject pharma grade flush syringe
monoject sodium chloride flush
morrhuate sodium
multitrace-4 concentrate
multitrace-5 concentrate
n-acetyl-l-cysteine
naloxone HCL
naltrexone HCL
normal saline flush
normal saline flush for flushing vascular access devices
normal saline i.v. flush
nutrilipid
nutrilyte
nutrilyte II
phospha 250 neutral
physiolyte
physiosol irrigation
plenamine
potassium acetate
potassium chloride
potassium chloride CR
potassium chloride ER
potassium chloride SR
potassium chloride 0.15% /NACL 0.45% viaflex
potassium chloride 0.15% w/NACL 0.9% viaflex
potassium chloride 0.15% D5W/NACL 0.33%
potassium chloride 0.15% D5W/NACL 0.45%
potassium chloride 0.15% D5W/NACL 0.45% viaflex
potassium chloride 0.15% NACL 0.9%
potassium chloride 0.15%/D5W
potassium chloride 0.15%/NACL 0.9%
potassium chloride 0.22% D5W/NACL 0.45%
potassium chloride 0.224%/D5W/NACL 0.45%
potassium chloride 0.224%D5W/NACL 0.45% viaflex
potassium chloride 0.3%/ NACL 0.9%
potassium chloride 0.3%/D5W
potassium chloride 0.3%/NACL 0.9%/viaflex
potassium phosphate
potassium phosphates
premasol
ringers injection
ringers irrigation
saline flush
saline flush zr/sterile field
sodium acetate
sodium bicarbonate
sodium bicarbonate partial fill
sodium chloride
sodium chloride bacteriostatic
sodium chloride flush
sodium chloride pab
sodium chloride 0.45%
sodium chloride 0.45% viaflex
sodium phosphate
sodium polystyrene sulfonate
sodium thiosulfate
sps
sterile diluent for epoprostenol sodium
sterile water for injection
sterile water irrigation
sterile water irrigation plastic bottle
sterile water irrigation w/hanger
swabflush saline flush
tis-u-sol
tpn electrolytes
virt-phos 250 neutral
AV-phos 250 neutral
BD posiflush
Delflex-lm/2.5% Dextrose
Delflex-lm/4.25% Dextrose
Delflex-sm/1.5% Dextrose
Delflex-sm/2.5% Dextrose
KCL 0.075%/D5W/NACL 0.45%
KCL 0.15%/D5W/ NACL 0.3%
KCL 0.15%/D5W/NACL 0.2%
KCL 0.15%/D5W/NACL 0.45%
KCL 0.15%/D5W/NACL 0.9%
KCL 0.3%/D5W/NACL 0.45%
MD-gastroview
Naloxone HCL
Potassium Chloride ER
PREVENTIVE
fluor-a-day
fluoride
fluoritab
flura-drops
karidium
ludent
nafrinse
nafrinse drops
sodium fluoride
PREFERRED
Chemet
Chemstrip-k
Cuprimine
Fluor-a-day
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
41
Hyperrab S/D
K-phos
NON PREFERRED
Acetest
Chek-stix Combo PAK Urinalysis Control
Chek-stix Control
Depen Titratabs
Effer-k
Isolyte-s
Ketocare
Ketone Test Strips
Ketostix
Klor-CON M15
Narcan
Plasma-lyte A
Plasma-lyte-148
Plasma-lyte-56/D5W
Relion Ketone
Relion Ketone Test Strips
Veltassa
SPECIALTY
Adagen
BenlystaPA
BivigamPA
Carimune NanofilteredPA
CytogamPA
ExjadePA
FerriproxPA
Flebogamma DifPA
Gamastan S/DPA
Gammagard LiquidPA
Gammagard S/DPA
Gammagard S/D Iga Less Than 1mcg/MLPA
GammakedPA
GammaplexPA
Gamunex-cPA
Hepagam B
HizentraPA
Hyperhep B S/D
Hyperrho S/D
Hyperrho S/D Mini-dose
JadenuPA
Micrhogam Ultra-filtered Plus
Nabi-HB
OctagamPA
PrivigenPA
Rhogam Ultra-filtered Plus
Rhophylac
SynagisPA
Syprine
ThyrogenQL,PA
Vivitrol
Winrho SDF
XiaflexPA
ACA PREVENTIVE DRUGS
ASPIRIN
PREVENTIVE
adult aspirin EC low strength
aspir-low
aspir-81
aspirin
aspirin adult low dose
aspirin adult low strength
aspirin childrens
aspirin enteric coated adult low strength
aspirin low dose
aspirin low strength
aspirin EC
aspirin EC low dose
aspirin 81
aspirin 81 low dose
aspirtab
bayer advanced aspirin regular strength
bayer aspirin
bayer aspirin regimen
bayer aspirin EC low dose
bayer chewable low dose
bayer low dose
childrens aspirin
childrens aspirin low strength
coated aspirin
ecotrin
ecotrin low strength
ecpirin
enteric coated aspirin
eq adult aspirin low strength
eq aspirin
eq aspirin adult low dose
eq aspirin low dose
eq aspirin EC
eq childrens aspirin
eql adult aspirin low strength
eql aspirin
eql aspirin low dose
eql aspirin EC
eql childrens aspirin
gnp adult aspirin low strength
gnp aspirin
gnp aspirin low dose
goodsense aspirin low dose
kls aspirin low dose
kls aspirin EC
kp aspirin
meijer aspirin EC
miniprin low dose
norwich aspirin
px aspirin
px enteric aspirin
qc aspirin
qc aspirin low dose
qc childrens aspirin
ra aspirin
ra aspirin adult low dose
ra aspirin adult low strength
ra aspirin childrens
ra aspirin EC
ra aspirin EC adult low strength
ra childrens aspirin
sm aspirin
sm aspirin adult low strength
sm aspirin enteric coated
sm aspirin EC low strength
sm childrens aspirin
st joseph aspirin
st joseph low dose aspirin
tgt aspirin
tgt aspirin low dose
tgt childrens aspirin
tgt enteric-coated aspirin
th aspirin
th aspirin low dose
th enteric aspirin
CVS aspirin
CVS aspirin adult low dose
CVS aspirin adult low strength
CVS aspirin child
CVS aspirin low dose
CVS aspirin low strength
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
42
CVS aspirin EC
CVS childrens aspirin
CVS enteric aspirin
EC-81 aspirin
HM aspirin
HM aspirin EC
HM aspirin EC low dose
MM aspirin
SB aspirin
SB aspirin EC
SB childrens aspirin
SB low dose asa EC
PREVENTIVE
Aspirin Low Dose
CONTRACEPTIVES
PREVENTIVE
aftera
altavera
alyacen 1/35
alyacen 7/7/7
amethiaQL
amethia LOQL
amethyst
apri
aranelle
ashlynaQL
aubra
aviane
azurette
balziva
bekyree
blisovi FE 1.5/30
blisovi FE 1/20
blisovi 24 FE
briellyn
camila
camreseQL
camrese LOQL
caziant
chateal
cryselle-28
cyclafem 1/35
cyclafem 7/7/7
cyred
dasetta 1/35
dasetta 7/7/7
dayseeQL
deblitane
delyla
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
econtra EZ
elinest
emoquette
enpresse-28
enskyce
errin
estarylla
fallback solo
falmina
gianvi
gildagia
gildess FE 1.5/30
gildess FE 1/20
gildess 1.5/30
gildess 1/20
gildess 24 FE
heather
introvaleQL
jencycla
jolessaQL
jolivette
juleber
junel FE 1.5/30
junel FE 1/20
junel FE 24
junel 1.5/30
junel 1/20
kaitlib FE
kariva
kelnor 1/35
kimidess
kurvelo
larin FE 1.5/30
larin FE 1/20
larin 1.5/30
larin 1/20
larin 24 FE
layolis FE
leena
lessina
levonest
levonorgestrel
levonorgestrel and ethinyl estradiolQL
levonorgestrel/ethinyl estradiol
levora 0.15/30-28
lomedia 24 FE
loryna
low-ogestrel
lutera
lyza
marlissa
medroxyprogesterone acetateQL
microgestin FE
microgestin FE 1.5/30
microgestin 1.5/30
microgestin 1/20
microgestin 24 FE
mono-linyah
mononessa
my way
myzilra
necon 0.5/35-28
necon 1/35
necon 7/7/7
next choice one dose
nikki
nora-be
norethindrone
norethindrone & ethinyl estradiol ferrous fumarate
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
norgestimate/ethinyl estradiol
norlyroc
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
ocella
opcicon one-step
orsythia
philith
pimtrea
pirmella 1/35
pirmella 7/7/7
portia-28
previfem
quasenseQL
reclipsen
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
43
setlakinQL
sharobel
sprintec 28
sronyx
syeda
take action
tarina FE 1/20
tilia FE
tri-estarylla
tri-legest FE
tri-linyah
tri-previfem
tri-sprintec
tri-LO-estarylla
tri-LO-marzia
tri-LO-sprintec
trinessa
trinessa LO
trivora-28
vcf vaginal contraceptivegel
velivet
vestura
vienva
viorele
vyfemla
wera
wymzya FE
zarah
zenchent
zenchent FE
zovia 1/35e
Levonorgestrel
Ogestrel
Xulane
PREFERRED
LO Loestrin FE
Minastrin 24 FE
PREVENTIVE
Natazia
NuvaringQL
NON PREFERRED
Depo-subq Provera 104QL
PREVENTIVE
Caya
Encare
Fc Female Condom
Fc2 Female Condom
Femcap
Omniflex Diaphragm
Options Gynol II Vaginal Contraceptive
Ortho Diaphragm Coil Spring Kit 100
Ortho Diaphragm Coil Spring Kit 105
Ortho Diaphragm Coil Spring Kit 50
Ortho Diaphragm Flat Spring Kit 55
Ortho Diaphragm Flat Spring Kit 60
Ortho Diaphragm Flat Spring Kit 65
Ortho Diaphragm Flat Spring Kit 70
Ortho Diaphragm Flat Spring Kit 75
Ortho Diaphragm Flat Spring Kit 80
Ortho Diaphragm Flat Spring Kit 85
Ortho Diaphragm Flat Spring Kit 90
Ortho Diaphragm Flat Spring Kit 95
Prentif Cavity-rim Cervical CAP
Prentif Fitting Set
Shur-seal
Vcf Vaginal Contraceptive Film
Vcf Vaginal Contraceptive Foam
Wide-seal Silicone Diaphragm Kit 60
Wide-seal Silicone Diaphragm Kit 65
Wide-seal Silicone Diaphragm Kit 70
Wide-seal Silicone Diaphragm Kit 75
Wide-seal Silicone Diaphragm Kit 80
Wide-seal Silicone Diaphragm Kit 85
Wide-seal Silicone Diaphragm Kit 90
Wide-seal Silicone Diaphragm Kit 95
PREVENTIVE
Implanon
Liletta
Mirena
Nexplanon
Skyla
FLUORIDE
PREVENTIVE
fluor-a-day
fluoride
fluoritab
flura-drops
karidium
ludent
nafrinse
nafrinse drops
sodium fluoride
PREFERRED
Fluor-a-day
FOLIC ACID
GENERIC
M-vit
Prenaplus
Prenatal Plus
Tricare
PREVENTIVE
eql folic acid
fa-8
folic acid
gnp folic acid
kp folic acid
px folic acid
ra folic acid
sm folic acid
sm prenatal vitamins
th folic acid
yl folic acid
Classic Prenatal
CVS folic acid
Eql Prenatal Formula
Gnp Prenatal Vitamins
HM folic acid
Mission Prenatal HP
Multi Prenatal
Perry Prenatal
Pre-natal Formula
Prenatal
Prenatal And Iron
Prenatal Formula
Prenatal Forte
Prenatal Low Iron
Prenatal Vitamins
Px Prenatal Multivitamins
Ra Prenatal
Sm Prenatal Vitamins
PREVENTIVE
Atabex Prenatal
CVS Prenatal
Fa-8
Gnp Daily Prenatal
Gnp Prenatal
Goodsense Prenatal Vitamins
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
44
HM One Daily Prenatal Combo
HM Prenatal
Kp Prenatal Multivitamins
Mission Prenatal
Nat-rul Prenatal Vitamins
One-a-day Womens Prenatal
Prenatal Complete
Prenatal Multi +dha
Prenatal One Daily
Prenatal Vitamin
PA Prenatal Formula
Qc Prenatal
Ra One Daily
Ra Prenatal Formula/Folicacid
Right Step Prenatal
Sm One Daily Prenatal
Stuart Prenatal
Th Prenatal Vitamins
Fluzone Quadrivalent 2014-2015
Fluzone Quadrivalent 2015-2016
Fluzone Split 2013-2014
Fluzone Split 2014-2015
Fluzone Split 2015-2016
Gardasil
Gardasil 9
Havrix
Hiberix
Infanrix
Ipol Inactivated IPV
Kinrix
M-m-r II
Medical Provider EZ Flu Shot PF 2013-2014
Medical Provider EZ Flu Shot PF 2014-2015
Medical Provider EZ Flu Shot 2013-2014
Medical Provider EZ Flu Shot 2014-2015
Medical Provider EZ Flu Shot 2015-2016
Medical Provider Single Use EZ Flu Shot
Menactra
Menomune-a/C/Y/W-135
Menveo
Pediarix
Pedvax HIB
Pentacel
Pneumovax 23
Pneumovax 23/1 Dose
Pneumovax 23/5 Dose
Prevnar 13
Proquad
Quadracel
Recombivax HB
Rotarix
Rotateq
Tenivac
Tetanus/Diphtheria Toxoids-adsorbed
Tetanus/Diphtheria Toxoids-adsorbed Adult
Trumenba
Twinrix
Vaqta
Varivax
Zostavax
IMMUNIZATIONS
PREVENTIVE
Acthib
Adacel
Afluria PF 2012-2013
Afluria PF 2013-2014
Afluria PF 2014-2015
Afluria PF 2015-2016
Afluria 2012-2013
Afluria 2013-2014
Afluria 2014-2015
Afluria 2015-2016
Bexsero
Boostrix
Cervarix
Comvax
Daptacel
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Engerix-b
Fluarix Quadrivalent 2013-2014
Fluarix Quadrivalent 2014-2015
Fluarix Quadrivalent 2015-2016
Fluarix 2013-2014
Fluarix 2014-2015
Flublok 2013-2014
Flublok 2014-2015
Flublok 2015-2016
Flucelvax 2013-2014
Flucelvax 2014-2015
Flucelvax 2015-2016
Flulaval Quadrivalent 2013-2014
Flulaval Quadrivalent 2014-2015
Flulaval Quadrivalent 2015-2016
Flulaval 2013-2014
Flulaval 2014-2015
Flumist Quadrivalent
Fluvirin PF 2013-2014
Fluvirin PF 2014-2015
Fluvirin 2013-2014
Fluvirin 2014-2015
Fluvirin 2015-2016
Fluzone High-dose PF 2013-2014
Fluzone High-dose PF 2014-2015
Fluzone High-dose PF 2015-2016
Fluzone Intradermal
Fluzone Intradermal Quadrivalent 2015-2016
Fluzone Pediatric PF 2013-2014
Fluzone PF 2013-2014
Fluzone PF 2014-2015
Fluzone Quadrivalent 2013-2014
IRON
PREVENTIVE
bprotected pedia iron
eq slow-release iron
eql iron supplement therapy
eql slow release iron
ezfe 200
feosol
fer-iron
ferate
fergon
ferosul
ferrex 150
ferric x-150
ferro-bob
ferrotabs
ferrous drops
ferrous gluconate
ferrous sulfate
ferrousul
gnp iron
gnp slow release iron
high potency iron
iferex 150
iron
iron slow release
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
45
iron supplement
iron supplement childrens
kp ferrous gluconate
kp ferrous sulfate
meijer ferrous sulfate
myferon 150
nu-iron 150
poly-iron 150
px iron
qc ferrous sulfate
ra high potency iron
ra iron
ra slow release iron
slow iron
slow release iron
slow FE
slow-release iron
sm iron
sm iron slow release
sm slow release iron
th iron
th slow release iron
wee care
CVS iron
Ferretts
FE gluconate
FE TABS
HM iron
HM iron slow release
HM slow release iron
PREVENTIVE
CVS Slow Release Iron
Elite Iron
Femiron
Feosol
Ferretts IPS
Ferrimin 150
Ferro-sequels
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
FE Aspartate
High Potency Iron
Iron
Iron Chews Pediatric
Iron Up
Mykidz Iron 10
Novaferrum Pediatric Drops
Perfect Iron
Profe
Proferrin ES
Slow Release Iron
Sm Slow Release Iron
SMOKING CESSATION
PREVENTIVE
buprobanQL
bupropion HCL SRQL
eq nicotineQL
eq nicotine gum refillQL
eq nicotine gum starterQL
eq nicotine polacrilexQL
eq nicotine step 3QL
eql nicotineQL
eql nicotine polacrilexQL
eql nicotine polacrilex refillQL
eql nicotine polacrilex starterQL
gnp nicotine mini lozengeQL
gnp nicotine polacrilexQL
gnp nicotine polacrilex miniQL
goodsense nicotine gumQL
kls quit2QL
kls quit4QL
nicoreliefQL
nicotineQL
nicotine mini lozengeQL
nicotine polacrilexQL
nicotine polacrilex refillQL
nicotine polacrilex starter kitQL
nicotine step 1QL
nicotine step 2QL
nicotine step 3QL
nicotine transdermal systemQL
nicotine transdermal system step 1QL
nicotine transdermal system step 2QL
nicotine transdermal system step 3QL
px stop smoking aidQL
qc nicotine polacrilexQL
ra mini nicotineQL
ra nicotineQL
ra nicotine polacrilexQL
ra nicotine transdermal system step 3QL
sm nicotineQL
sm nicotine polacrilexQL
sm nicotine transdermal systemQL
sw nicotine polacrilexQL
tgt nicotine gumQL
tgt nicotine polacrilexQL
tgt nicotine step oneQL
tgt nicotine step threeQL
tgt nicotine step twoQL
thriveQL
CVS nicotineQL
CVS nicotine lozengeQL
CVS nicotine polacrilexQL
CVS nicotine polacrilex starterQL
CVS nicotine transdermal systemQL
CVS nts step 1QL
HM nicotine polacrilexQL
HM nicotine transdermal systemQL
HM nicotine transdermal system step 3QL
SR nicotine gumQL
PREVENTIVE
ChantixQL
Chantix Continuing Month PAKQL
Chantix Starting Month PAKQL
Nicotine Transdermal SystemQL
PREVENTIVE
Nicotrol InhalerQL
Nicotrol NsQL
VITAMIN D
PREVENTIVE
aqueous vitamin d infants
bio-d-mulsion
bio-d-mulsion forte
bprotected pedia d-vite
d 1000
d 10000
d 2000
d 400
d 5000
d-vita
d-1000
d-1000 extra strength
d-2000 maximum strength
d-3-5
d-400
Effective July 1, 2016
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
46
d-5000
d-5000 maximum strength
decara
delta d3
dialyvite vitamin d 5000
dialyvite vitamin d3 max
d2000 ultra strength
d3
d3 adult
d3 adult gummy
d3 high potency
d3 kids
d3 maximum strength
d3 super strength
d3 ultra strength
d3 2000
d3-1000
d3-50
eql childrens vitamin d gummies
eql vitamin d-3
eql vitamin d3
gnp vitamin d
gnp vitamin d maximum strength
gnp vitamin d super strength
gnp vitamin d3 extra strength
healthy kids vitamin d3
just d
kp vitamin d
maximum d3
nat-rul vitamin d
natural vitamin d-3
optimal-d
optimal-d pack
opurity vitamin d
pronutrients vitamin d3
ra vitamin d-3
sm vitamin d
sm vitamin d3
th vitamin d3
thera-d rapid repletion
thera-d sport
thera-d 2000
vitajoy daily d gummies
vitamin d
vitamin d high potency
vitamin d 400
vitamin d-1000
vitamin d-1000 maximum strength
vitamin d-3
vitamin d-400
vitamin d3
vitamin d3 adult gummies
vitamin d3 high potency
vitamin d3 maximum strength
vitamin d3 super strength
vitamin d3 400
CVS d3
CVS vitamin d
CVS vitamin d 5000 high-potency
CVS vitamin d3
HM vitamin d
HM vitamin d3
PA vitamin d-3
PA vitamin d-3 gummy
PREVENTIVE
Baby Super Daily D3
Ddrops
Decara
D3 Dots
HM Vitamin D3
Optimal D3 M
Replesta
Replesta Childrens
Replesta Nx
Sm Vitamin D3 Maximum Strength
Super Daily D3
Thera-d 4000
Vitamelts Vitamin D
Vitamin D3
Wellesse Vitamin D3
BOWEL PREPARATION AGENTS
PREVENTIVE
gavilyte-c
gavilyte-n/flavor pack
gavilyte-G
peg 3350/electrolytes
peg-3350/electrolytes
peg-3350/NACL/NA bicarbonate/KCL
trilyte
BREAST CANCER
ORAL CHEMO
tamoxifen citrate
Effective July 1, 2016 v.1
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;
All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners.
© 2016 Optum, Inc. All rights reserved.
TM
47
Index
A
A-hydrocort, 10
abacavir, 2
abacavir sulfate/lamivudine/zidovudine, 2
Abelcet, 2
Abilify, 19
Abilify Discmelt, 19
Abilify Maintena, 19
Abraxane, 4
acamprosate calcium DR, 20
acarbose, 12
Accu-chek Active Glucose Control
Solution, 32
Accu-chek Active Strips, 32
Accu-chek Aviva, 32
Accu-chek Aviva Plus, 32
Accu-chek Comfort Curve Control
Solution (2 Levels), 32
Accu-chek Comfort Curve Linearity
Solution, 32
Accu-chek Comfort Curve Test Strips, 32
Accu-chek Compact Blue Control
Solution (2 Levels), 32
Accu-chek Compact Plus, 32
Accu-chek Compact Plus Care Kit, 32
Accu-chek Compact Plus Clear Control
Solution (2 Levels), 32
Accu-chek Compact Test Drum, 32
Accu-chek Fastclix Lancetdevice Kit, 32
Accu-chek Fastclix Lancets, 28
Accu-chek Instant Glucosecontrol
Solution (2 Levels), 32
Accu-chek Multiclix Lanc Et Device Kit,
32
Accu-chek Multiclix Lancets, 28
Accu-chek Nano Smartview, 32
Accu-chek Safe-t-pro Lancets, 28
Accu-chek Safe-t-pro Pluslancets, 28
Accu-chek Smartview Control, 32
Accu-chek Smartview Strips, 32
Accu-chek Soft Touch Lancets, 28
Accu-chek Softclix Lancetdevice, 32
Accu-chek Softclix Lancetdevice Kit, 32
Accu-chek Softclix Lancets, 28
Accu-chek Voicemate, 32
acebutolol HCL, 6
acetaminophen/caffeine/dihydrocodeine,
23
acetaminophen/codeine, 23
acetaminophen/codeine #2, 23
acetaminophen/codeine #3, 23
acetaminophen/codeine #4, 23
acetaminophen/codeine phosphate, 23
acetasol HC, 22
acetazolamide, 7
Acetazolamide, 7
acetazolamide ER, 7
acetazolamide sodium, 7
Acetest, 42
acetic acid, 22
acetic acid 0.25%, 15
acetylcysteine, 25, 40
Aciphex Sprinkle, 14
acitretin, 8
Acthib, 26, 45
Acti-lance Lancets 28G, 28
Acti-lance Lite Safety Lancets 28G, 28
Acti-lance Special Safety Lancets 17G,
28
Acti-lance Special Safetylancets 17G, 28
Acti-lance Universal Safety Lancets 23G,
28
Actimmune, 5
Active 1ST Blood Lancets 30G/Easy
Twist CAP, 28
Actoplus Met XR, 12
Acuvail, 22
acyclovir, 2, 8
acyclovir sodium, 2
Adacel, 26, 45
Adagen, 42
Adcetris, 4
Adcirca, 7
adefovir dipivoxil, 2
Adempas, 7
adenosine, 6, 40
Adjustable Lancing Device, 32
adriamycin, 3
Adriamycin, 3
adrucil, 4
adult aspirin EC low strength, 22, 42
Advate, 17
Advocate Insulin Pen Needles
29GX12.7MM, 32
Advocate Insulin Pen Needles
31GX5MM, 32
Advocate Insulin Pen Needles
31GX8MM, 32
Advocate Insulin Syringe/U100/0.3ML/29GX1/2", 32
Advocate Insulin Syringe/U100/0.3ML/30GX5/16", 32
Advocate Insulin Syringe/U100/0.3ML/31GX5/16", 32
Advocate Insulin Syringe/U100/0.5ML/29GX1/2", 32
Advocate Insulin Syringe/U100/0.5ML/30GX5/16", 32
Advocate Insulin Syringe/U100/0.5ML/31GX5/16", 32
Advocate Insulin Syringe/U100/1ML/29GX1/2", 32
Advocate Insulin Syringe/U100/1ML/30GX5/16", 32
Advocate Insulin Syringe/U100/1ML/31GX5/16", 32
Advocate Lancets, 28
Advocate Lancets 30G, 28
Advocate Lancing Device, 32
Advocate Rapid-safe Lancing Device, 32
Advocate Safety Lancets, 28
Advocate Safety Lancets 26G, 28
Aerochamber Mini Aerosol Chamber, 39
Aerochamber MV, 40
Aerochamber Plus Flow VU, 40
Aerochamber Plus Flow-VU, 40
Aerochamber Plus Flow-VU/Large Mask,
40
Aerochamber Plus Flow-VU/Mask, 40
Aerochamber Plus Flow-VU/Medium
Mask, 40
Aerochamber Plus Flow-VU/Small Mask,
40
Aerochamber Z-stat Plus Valved Holding
Chamber W/Flow VU, 40
Aerochamber Z-stat Plus/Flowsignal, 40
Aerochamber Z-stat Plus/Large Mask, 40
Aerochamber Z-stat Plus/Medium Mask,
40
Aerochamber Z-stat Plus/Small Mask, 40
Aerochamber/Flowsignal, 40
Aerovent Plus Holding
Chamber/Collapsible, 40
AF Lancets Super Thin, 29
afeditab CR, 6
Afinitor, 5
Afinitor Disperz, 5
Afluria 2012-2013, 26, 45
Afluria 2013-2014, 26, 45
Afluria 2014-2015, 26, 45
Afluria 2015-2016, 26, 45
Afluria PF 2012-2013, 26, 45
Afluria PF 2013-2014, 26, 45
Afluria PF 2014-2015, 26, 45
Afluria PF 2015-2016, 26, 45
aftera, 10, 43
Agamatrix Ultra-thin Lancets 33G, 28
Aggrastat, 17
Aggrenox, 17
airavite, 16
ak-fluor, 22
ak-poly-bac, 21
Akynzeo, 14
ala cort, 9
alagesic LQ, 22
Albenza, 3
albuked 25, 17
albuked 5, 17
albumin human, 17
albumin-zlb, 17
albuminar-25, 17
albuminar-5, 17
alburx, 17
albutein, 17
albuterol, 25
albuterol sulfate, 25
albuterol sulfate ER, 25
albuterol TAB 4MG, 25
alclometasone dipropionate, 9
Alcoh-glove Contoured Wipe, 40
Alcoh-wipe 12" X 12", 40
Alcohol Pads, 40
Alcohol Prep Pads, 40
Alcohol Preps, 40
Alcohol Swabs, 40
Alcohol Swabstick, 40
Alcohol Wipes, 40
Aldurazyme, 13
alendronate sodium, 12
Alendronate Sodium, 12
alfentanil, 23
Alferon N, 5
alfuzosin HCL ER, 15
Alimta, 4
Alinia, 3
Alkeran, 3
allopurinol, 24
almotriptan malate, 24
Alocril, 22
Alogliptin, 12
Alogliptin/Metformin HCL, 12
Alogliptin/Pioglitazone, 12
Alomide, 22
alosetron hydrochloride, 14
Aloxi, 14
Alphagan P, 22
Alphanate/Von Willebrand Factor
Complex/Human, 17
Alphanine SD, 17
alphatrex, 9
alprazolam, 18
alprazolam ER, 18
alprazolam odt, 18
alprazolam XR, 18
alprostadil, 40
Alrex, 21
Altabax, 8
altacaine, 22
altafluor, 22
altafrin, 22
altavera, 10, 43
Alternate Site Lancing Device, 32
alyacen 1/35, 10, 43
alyacen 7/7/7, 10, 43
amantadine HCL, 19
Ambisome, 2
Amcinonide, 9
amethia, 10, 43
amethia LO, 10, 43
amethyst, 10, 43
amifostine, 5
amikacin sulfate, 1
amiloride HCL, 7
amiloride/hydrochlorothiazide, 7
aminoacetic acid, 15
aminocaproic acid, 17
aminophylline, 25
aminorelief rms, 40
aminosyn 8.5%/electrolytes, 40
aminosyn II 8.5%/electrolytes, 40
amiodarone HCL, 6
Amitiza, 15
amitriptyline HCL, 18
amlodipine besylate, 6
amlodipine besylate/atorvastatin calcium,
7
amlodipine besylate/benazepril HCL, 6
amlodipine besylate/benazepril
hydrochloride, 6
amlodipine besylate/valsartan, 6
amlodipine/valsartan/hctz, 6
ammonium lactate, 9
amnesteem, 8
Amoxapine, 18
amoxicillin, 1
amoxicillin/clavulanate potassium, 1
Amoxicillin/Clavulanate Potassium, 1
amoxicillin/clavulanate potassium ER, 1
amphetamine/dextroamphetamine, 19
Amphotec, 2
Amphotericin B, 2
ampicillin, 1
ampicillin sodium, 1
ampicillin-sulbactam, 1
Ampicillin-sulbactam, 1
Ampyra, 20
Amturnide, 7
ana-lex, 14
Anadrol-50, 10
anagrelide hydrochloride, 17
anastrozole, 4
Androgel, 10
Androgel P.M., 10
Androxy, 10
anodynz, 9
Anti-stick Insulin Syringe/U100/0.5ML/28G X 1/2", 32
Anti-stick Insulin Syringe/U100/0.5ML/29G X 1/2", 32
Anti-stick Insulin Syringe/U-100/1ML/29G
X 1/2", 32
antipyrine/benzocaine, 22
Anzemet, 14
Apexicon E, 9
Apidra, 12
Apidra Solostar, 12
Aplenzin, 18
Apokyn, 20
apraclonidine, 22
apri, 10, 43
Aptivus, 2
Aqua Lance Adjustable Lancing Device,
32
aqueous vitamin d infants, 26, 46
Aralast NP, 25
aranelle, 10, 43
Aranesp Albumin Free, 17
arbinoxa, 25
Arcalyst, 24
Arcapta Neohaler, 25
argatroban, 17
Argatroban, 17
argyle sterile saline 100ML, 15
argyle sterile water 100ML, 40
Arial Chamber, 40
aripiprazole, 18
Aripiprazole Odt, 19
Armour Thyroid, 13
Arranon, 4
Arzerra, 4
Asacol HD, 15
ascomp/codeine, 23
ascorbic acid, 26
ashlyna, 10, 43
Asmanex HFA, 25
Asmanex Twisthaler 120 Metered Doses,
25
Asmanex Twisthaler 14 Metered Doses,
25
Asmanex Twisthaler 30 Metered Doses,
25
Asmanex Twisthaler 60 Metered Doses,
25
Asmanex Twisthaler 7 Metered Doses,
25
aspir-81, 22, 42
aspir-low, 22, 42
aspirin, 22, 42
aspirin 81, 23, 42
aspirin 81 low dose, 23, 42
aspirin adult low dose, 23, 42
aspirin adult low strength, 23, 42
aspirin childrens, 23, 42
aspirin EC, 23, 42
aspirin EC low dose, 23, 42
aspirin enteric coated adult low strength,
23, 42
aspirin low dose, 23, 42
Aspirin Low Dose, 23, 43
aspirin low strength, 23, 42
Aspirin-caffeine-dihydrocodeine, 24
Aspirin/Dipyridamole, 17
aspirtab, 23, 42
Assure Comfort Lancets Ultra Thin 28G,
28
Assure Comfort Lancets Ultra Thin 30G,
28
Assure Haemolance Plus High Flow 18G,
28
Assure Haemolance Plus Low Flow 25G,
29
Assure Haemolance Plus Micro Flow
28G, 29
Assure Haemolance Plus Normal Flow
21G, 29
Assure Haemolance Plus Pediatric Blade,
29
Assure ID Insulin Safety Syringe/U100/0.5ML/29G X 1/2", 32
Assure ID Insulin Safety Syringe/U100/1ML/29G X 1/2", 32
Assure Lance Lancets, 29
Assure Lance Lancets 21G, 29
Assure Lance Plus Safety Lancets 25G,
29
Assure Lance Plus Safety Lancets 30G,
29
Assure Lancets, 29
AT Last Lancets, 29
Atabex Prenatal, 28, 44
atenolol, 6
atenolol/chlorthalidone, 6
Atgam, 4
atorvastatin calcium, 7
atovaquone, 3
atovaquone/proguanil HCL, 3
atracurium besylate, 20
Atripla, 2
Atropen, 14
atropine sulfate, 14, 21
atropine-care, 21
Atrovent HFA, 25
Aubagio, 20
aubra, 10, 43
augmented betamethasone dipropionate,
9
Augmentin, 1
aurodex, 22
Aurora Lancet Super Thin 30G, 29
Aurora Lancet Thin 23G, 29
Aurora Pen Needles 29GX12MM, 32
Aurora Pen Needles 31G X 6MM, 32
Aurora Pen Needles 31G X 8MM, 32
Aurora Unifine Pentips/32GX5/32", 32
Aurora Unifine Pentips/Mini/31GX3/16",
32
Auto-lancet, 32
Auto-lancet Mini, 32
Autolet II Clinisafe, 32
Autolet Impression, 32
Autolet Impression Lancing Device, 32
Autolet Lite Clinisafe, 32
Autolet Lite Starter Pack, 33
Autolet Mini, 33
Autolet Platforms, 33
Auvi-q, 7
AV-phos 250 neutral, 41
AV-vite fb, 16
avalin-RX, 9
Avandia, 12
avar cleanser, 8
avar-e emollient, 8
avar-e green, 8
Avastin, 4
Avc, 15
Avelox, 1
aviane, 10, 43
avidoxy, 1
Avonex, 20
Avonex Pen, 20
Axiron, 10
azacitidine, 4
Azactam IN Iso-osmotic Dextrose, 3
Azasan, 4
azathioprine, 4
Azathioprine, 4
azelastine HCL, 22, 25
Azelex, 8
Azilect, 20
azithromycin, 1
Azithromycin, 1
Azopt, 22
Azor, 7
aztreonam, 3
azuphen mb, 15
azurette, 10, 43
bayer advanced aspirin regular strength,
23, 42
bayer aspirin, 23, 42
bayer aspirin EC low dose, 23, 42
bayer aspirin regimen, 23, 42
bayer chewable low dose, 23, 42
bayer low dose, 23, 42
Bayer Microlet 2 Lancing Device, 33
Bayer Microlet Lancets, 29
Bcg Vaccine, 26
BD Autoshield 29G X 3/16", 29
BD Autoshield 29G X 5/16", 29
BD Autoshield Duo 30G X 3/16", 29
BD Insulin Syringe LUER-LOK/U100/1ML, 29
BD Insulin Syringe Microfine IV/U100/0.3ML/28G X 1/2", 29
BD Insulin Syringe Microfine IV/U100/0.5ML/28G X 1/2", 29
BD Insulin Syringe Microfine IV/U100/1ML/27G X 5/8", 29
BD Insulin Syringe Microfine IV/U100/1ML/28G X 1/2", 29
BD Insulin Syringe Microfine/U100/0.3ML/28G X 1/2", 29
BD Insulin Syringe Microfine/U100/0.5ML/28G X 1/2", 29
BD Insulin Syringe Microfine/U100/1ML/27G X 5/8", 29
BD Insulin Syringe Microfine/U100/1ML/28G X 1/2", 29
BD Insulin Syringe
Safetyglide/0.5ML/29G X 1/2", 29
BD Insulin Syringe Safetyglide/1ML/29G
X 1/2", 29
BD Insulin Syringe Safetyglide/U100/0.3ML/31G X 5/16", 29
BD Insulin Syringe Slip Tip/U-100/1ML,
B
29
b-complex 100, 27
BD Insulin Syringe U-40/1ML/25G X 5/8",
B-d Insulin Syringe Ultrafine II/0.3ML/31G
29
X 5/16", 29
BD Insulin Syringe Ultrafine HalfB-d Insulin Syringe Ultrafine II/0.5ML/31G
unit/0.3ML/31G X 5/16", 29
X 5/16", 29
BD Insulin Syringe Ultrafine
B-d Insulin Syringe Ultrafine II/1ML/31G X
II/SHORT/0.5ML/31G X 5/16", 29
5/16", 29
BD Insulin Syringe Ultrafine
B-d Insulin Syringe Ultrafine/0.3ML/30G X
II/SHORT/1ML/31G X 5/16", 29
1/2", 29
BD Insulin Syringe Ultrafine/0.3ML/30G X
B-d Insulin Syringe Ultrafine/0.5ML/30G X
1/2", 29
1/2", 29
BD Insulin Syringe Ultrafine/0.3ML/31G X
B-d Insulin Syringe Ultrafine/1ML/30G X
5/16", 29
1/2", 29
BD Insulin Syringe Ultrafine/0.5ML/30G X
b-plex, 27
1/2", 29
b-plex plus, 27
BD Insulin Syringe Ultrafine/0.5ML/31G X
Baby Super Daily D3, 27, 47
5/16", 29
baciim, 3
BD Insulin Syringe Ultrafine/1ML/30G X
bacitracin, 3
1/2", 29
Bacitracin, 21
BD Insulin Syringe Ultrafine/1ML/31G X
bacitracin/polymyxin b, 21
5/16", 29
baclofen, 21
BD Insulin Syringe Ultrafine/UBactocill IN Dextrose, 1
100/0.3ML/29G X 1/2", 29
Bactroban Nasal, 25
BD Insulin Syringe Ultrafine/Ubalanced salt, 22
100/0.3ML/30G X 1/2", 29
balanced salt solution, 22
BD Insulin Syringe Ultrafine/Ubalsalazide disodium, 14
100/0.3ML/31G X 15/64", 29
balziva, 10, 43
BD Insulin Syringe Ultrafine/UBanzel, 19
100/0.3ML/31G X 5/16", 29
Baraclude, 2
BD Insulin Syringe Ultrafine/U-100/0.
baycadron, 10
5ML/29G X 1/2", 29
BD Insulin Syringe Ultrafine/U100/0.5ML/30G X 1/2", 29
BD Insulin Syringe Ultrafine/U100/0.5ML/31G X 15/64", 29
BD Insulin Syringe Ultrafine/U100/0.5ML/31G X 5/16", 29
BD Insulin Syringe Ultrafine/U100/1ML/29G X 1/2", 29
BD Insulin Syringe Ultrafine/U100/1ML/30G X 1/2", 29
BD Insulin Syringe Ultrafine/U100/1ML/31G X 15/64", 29
BD Insulin Syringe Ultrafine/U100/1ML/31G X 5/16", 29
BD Insulin Syringe/Detachable Needle/U100/1ML/25G X 1", 29
BD Insulin Syringe/Detachable Needle/U100/1ML/25G X 5/8", 29
BD Insulin Syringe/Detachable Needle/U100/1ML/26G X 1/2", 29
BD Insulin Syringe/U-100/0.5ML/30G X
1/2", 29
BD Insulin Syringe/U-100/1ML/27G X
1/2", 29
BD Insulin Syringe/U-100/1ML/28G X
1/2", 29
BD Insulin Syringe/U-100/2ML/27.5G X
5/8", 29
BD Insulin Syringe/U-100/2ML/29G X
1/2", 29
BD Integra Insulin Syringe/U100/1ML/29G X 1/2", 29
BD Integra Syringe/Retracting
Needle/1ML/25G X 1", 29
BD Lancet Device, 33
BD Lancet Ultrafine 30G, 29
BD Lancet Ultrafine 33G, 29
BD LO-dose Insulin Syringe Microfine
IV/0.5ML/28G X 1/2", 29
BD Microtainer Lancets, 29
BD Pen Needle/Mini/Ultrafine/31G X
3/16", 29
BD Pen Needle/Nano/Ultra Fine/32G X
4MM, 29
BD Pen Needle/SHORT/Ultrafine/31G X
5/16", 29
BD Pen Needle/Ultrafine/29G X 12.7MM,
29
BD Pen Needle/Ultrafine/29GX1/2"
12.7MM, 29
BD Pen Needles SHORT/Ultrafine/31G X
5/16", 29
BD posiflush, 41
BD Safety-glide Insulin
Syringe/0.5ML/29G X 1/2", 29
BD Safety-lok Insulin Syringe/Perm
Needle/UF/1ML/29G X 1/2", 29
BD Safetyglide Insulin
Sysyringe/0.5ML/30G X 5/16", 29
BD Swabs Single Use, 40
BD Swabs Single Use Butterfly, 40
BD-insul SYR Mis LO Dose, 29
Bebulin, 17
bekyree, 10, 43
benazepril HCL, 6
benazepril HCL/hydrochlorothiazide, 6
Bendeka, 3
Benefix, 17
Benicar, 6
Benicar HCT, 7
Benlysta, 42
benzepro, 8
benzepro creamy wash, 8
benzepro foaming cloths, 8
benzepro SHORT contact, 8
benziq wash, 8
benzonatate, 25
benzoyl peroxide, 8
benzoyl peroxide SHORT contact, 8
benztropine mesylate, 20
Bepreve, 22
Berinert, 17
Besivance, 21
betamethasone dipropionate, 9
betamethasone sodium
phosphate/betamethasone acetate, 10
betamethasone valerate, 9
Betaseron, 20
betaxolol HCL, 6, 21
bethanechol chloride, 15
Betimol, 21
bexarotene, 5
Bexsero, 26, 45
bicalutamide, 4
Bicillin C-R, 1
Bicillin L-a, 1
Bicnu, 3
Bidil, 7
Biltricide, 3
Bimatoprost, 21
bio GLO, 22
bio-d-mulsion, 26, 46
bio-d-mulsion forte, 26, 46
bio-statin, 2
biocel, 27
Biothrax, 26
biotuss, 25
biotuss pediatric, 25
bisoprolol fumarate, 6
bisoprolol fumarate/hydrochlorothiazide,
6
bivalirudin, 17
Bivigam, 42
bleomycin sulfate, 3
Blincyto, 4
blisovi 24 FE, 10, 43
blisovi FE 1.5/30, 10, 43
blisovi FE 1/20, 10, 43
Boostrix, 26, 45
Bosulif, 5
Botox, 21
bp 10-1, 8
bp foam, 8
bp foaming wash, 8
Bp Folinatal Plus B, 28
Bp Multinatal Plus, 28
Bp Vit 3, 16
bp wash, 8
bpm, 25
bpm pseudo, 25
bpo 6% foaming cloths, 8
bprotected pedia d-vite, 26, 46
bprotected pedia iron, 16, 45
Brainstrong Prenatal, 28
Breatherite, 40
Breatherite Collapsible Adult Spacer
W/Mask, 40
Breatherite Collapsible Child Spacer
W/Mask, 40
Breatherite Collapsible Infant Spacer
W/Mask, 40
Breatherite Collapsible Small Child
Spacer W/Mask, 40
Breatherite Collapsible Spacer W/
Neonate Mask, 40
Breatherite Rigid Spacer W/Mask, 40
Breatherite W/Large Mask, 40
Breatherite W/Medium Mask, 40
Breatherite W/Small Mask, 40
briellyn, 10, 43
Brilinta, 17
brimonidine tartrate, 22
bromfed DM, 25
bromfenac, 22
bromocriptine mesylate, 20
bromphen/pseudoephedrine
HCL/dextromethorphan HBR, 25
Brovana, 25
bss, 22
budesonide, 10, 25(2)
Bullseye Mini Safety Lancets, 29
Bullseye Safety Lancets, 29
bumetanide, 7
buminate, 17
Buphenyl, 13
bupivacaine HCL, 24
bupivacaine spinal, 24
bupivacaine/epinephrine, 24
buprenorphine HCL, 23
buprenorphine HCL/naloxone HCL, 23
buproban, 20, 46
bupropion HCL, 18
bupropion HCL ER, 18
bupropion HCL SR, 18, 20, 46
bupropion HCL XL, 18
buspirone HCL, 18
Busulfex, 3
butalbital/acetaminophen, 22
butalbital/acetaminophen/caffeine, 22
butalbital/acetaminophen/caffeine/codein
e, 23
butalbital/aspirin/caffeine, 22
butalbital/aspirin/caffeine/codeine, 23
butorphanol tartrate, 23
Butrans, 24
Bydureon, 12
Byetta, 12
Bystolic, 6
C
cabergoline, 13
Cadeau DHA, 28
Cafergot, 24
caffeine citrate, 19
calcidol, 26
calciferol, 26
calcipotriene, 8
calcipotriene/betamethasone
dipropionate, 9
calcitonin salmon, 13
calcitonin-salmon, 13
calcitrene, 8
Calcitriol, 8
calcitriol, 13
calcium acetate, 14
calcium chloride, 40
calcium gluconate, 40
camila, 10, 43
Camptosar, 5
camrese, 10, 43
camrese LO, 10, 43
Canasa, 15
Cancidas, 2
candesartan cilexetil, 6
candesartan cilexetil/hydrochlorothiazide,
7
Cantil, 14
capacet, 22
Capastat Sulfate, 2
capecitabine, 3
Capex, 9
Caprelsa, 5
captopril, 6
Carafate, 14
CARB-o-philic 40, 10
CARB-o-philic/40, 10
Carbaglu, 13
carbamazepine, 19
carbamazepine ER, 19
carbidopa, 20
carbidopa/levodopa, 20
carbidopa/levodopa ER, 20
carbidopa/levodopa odt, 20
Carbidopa/Levodopa/Entacapone, 20
carbinoxamine maleate, 25
carboplatin, 3
Cardene IV, 6
Cardiocom Lancing Device, 33
cardioplegic, 7
Cardizem LA, 6
Cardura XL, 16
Carefine Pen Needle 32GX4MM, 33
Carefine Pen Needles 29GX1/2", 33
Carefine Pen Needles 30GX5/16", 33
Carefine Pen Needles 31GX6MM, 33
Carefine Pen Needles 31GX8MM, 33
Carefine Pen Needles 32GX5MM, 33
Carefine Pen Needles 32GX6MM, 33
Careone Advanced Lancing Device, 33
Careone Insulin Syringes/0.3ML/30G X
1/2", 33
Careone Insulin Syringes/0.3ML/31G X
5/16", 33
Careone Insulin Syringes/0.5ML/30G X
1/2", 33
Careone Insulin Syringes/0.5ML/31G X
5/16", 33
Careone Insulin Syringes/1ML/30G X
1/2", 33
Careone Insulin
Syringes/1ML/31GX5/16", 33
Careone Lancet Thin, 29
Careone Lancet Ultra Thin, 29
Careone Unifine Pentips 29GX12MM, 33
Careone Unifine Pentips 31GX5MM, 33
Careone Unifine Pentips 31GX6MM, 33
Careone Unifine Pentips 31GX8MM, 33
Careone Unifine Pentips Pen Needles
32GX4MM, 33
Careone Unifine Pentips Plus Pen
Needles 29GX12MM, 33
Careone Unifine Pentips Plus Pen
Needles 31GX5MM, 33
Careone Unifine Pentips Plus Pen
Needles 31GX6MM, 33
Careone Unifine Pentips Plus Pen
Needles 31GX8MM, 33
Careone Unifine Pentips Plus Pen
Needles 32GX4MM, 33
Carimune Nanofiltered, 42
carisoprodol, 21
carisoprodol/aspirin, 21
carisoprodol/aspirin/codeine, 21
carteolol HCL, 21
cartia XT, 6
carvedilol, 6
Cavan-EC Sod DHA, 28
cavarest, 18
cavirinse, 18
Caya, 44
Cayston, 3
caziant, 10, 43
Cedax, 1
cefaclor, 1
Cefaclor, 1
cefadroxil, 1
cefazolin sodium, 1
cefdinir, 1
Cefditoren Pivoxil, 1
cefepime, 1
cefixime, 1
cefotaxime sodium, 1
cefotetan, 1
Cefotetan, 1
Cefotetan/Dextrose, 1
cefoxitin sodium, 1
cefpodoxime proxetil, 1
cefprozil, 1
ceftazidime, 1
Ceftin, 1
Ceftriaxone IN Iso-osmotic Dextrose, 1
ceftriaxone sodium, 1
cefuroxime axetil, 1
cefuroxime sodium, 1
Cefuroxime Sodium, 1
celecoxib, 24
Cellcept Intravenous, 4
Celontin, 19
Cem-urea, 10
Cenestin, 10
Centrum Specialist Prenatal, 28
cephalexin, 1
Ceprotin, 17
ceramax, 9
Cerezyme, 17
cerisa wash, 8
cerovel, 9
Cervarix, 26, 45
Cesamet, 14
cetirizine HCL, 25
cevimeline HCL, 18
Chantix, 20, 46
Chantix Continuing Month PAK, 20, 46
Chantix Starting Month PAK, 20, 46
chateal, 10, 43
Chek-stix Combo PAK Urinalysis Control,
42
Chek-stix Control, 42
Chemet, 41
Chemstrip Bg Log Book, 33
Chemstrip-k, 41
Chenodal, 15
childrens aspirin, 23, 42
childrens aspirin low strength, 23, 42
chlordiazepoxide HCL, 18
chlordiazepoxide HCL/clidinium bromide,
14
chlorhexidine gluconate, 18
chlorhexidine gluconate oral rinse, 18
chloromag, 40
chloroprocaine HCL, 24
chloroquine phosphate, 3
chlorothiazide, 7
Chlorothiazide, 7
chlorothiazide sodium, 7
chlorpromazine HCL, 18
Chlorpropamide, 12
Chlorthalidone, 7
chlorzoxazone, 21
cholestyramine, 7
cholestyramine light, 7
choline magnesium trisalicylate, 22
chorionic gonadotropin, 13
Cialis, 7
ciclodan, 8
ciclopirox, 8
ciclopirox nail lacquer, 8
ciclopirox olamine, 8
ciclopirox treatment, 8
cidaleaze, 9
cidofovir, 2
cilostazol, 17
Ciloxan, 21
cimetidine, 14
cimetidine HCL, 14
Cimzia, 15
Cimzia Starter Kit, 15
Cinryze, 17
Ciprodex, 22
ciprofloxacin, 1
ciprofloxacin ER, 1
ciprofloxacin HCL, 1, 21
Ciprofloxacin HCL, 1
ciprofloxacin I.V.-IN D5W, 1
cisatracurium besylate, 20
cisplatin, 3
Cisplatin, 3
citalopram hydrobromide, 18
citric acid/sodium citrate, 15
cladribine, 4
Claforan, 1
claravis, 8
Clarinex, 25
claris clarifying wash, 8
clarithromycin, 1
clarithromycin ER, 1
Classic Prenatal, 28, 44
Cleanlet Lancets 28G, 29
clearplex x, 8
clemastine fumarate, 25
Clemastine Fumarate, 25
Clever Chek Lancets Ultrathin, 29
Clever Chek Lancets Ultrathin 30G, 29
Clever Choice Comfort EZ Insulin Pen
Needles 31GX8MM, 33
Clever Choice Comfort EZ Insulin
Syringe/0.3ML/29G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/0.3ML/30G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/0.3ML/30G X 5/16", 33
Clever Choice Comfort EZ Insulin
Syringe/0.3ML/31G X 5/16", 33
Clever Choice Comfort EZ Insulin
Syringe/0.5ML/28G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/0.5ML/29G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/0.5ML/30G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/0.5ML/30G X 5/16", 33
Clever Choice Comfort EZ Insulin
Syringe/0.5ML/31G X 5/16", 33
Clever Choice Comfort EZ Insulin
Syringe/1.0ML/30G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/1ML/28G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/1ML/29G X 1/2", 33
Clever Choice Comfort EZ Insulin
Syringe/1ML/30G X 5/16", 33
Clever Choice Comfort EZ Insulin
Syringe/U-100/1ML/31GX5/16", 33
Clever Choice Comfort EZ Pen Needles
29GX12MM, 33
Clever Choice Comfort EZ Pen Needles
31GX5MM, 33
Clever Choice Comfort EZ Pen Needles
31GX6MM, 33
Clever Choice Comfort EZ Pen Needles
31GX8MM, 33
Clever Choice Comfort EZ Pen Needles
32GX4MM, 33
Clever Choice Comfort EZ Pen Needles
32GX5MM, 33
Clever Choice Comfort EZ Pen Needles
32GX6MM, 33
Clever Choice Comfort EZ Pen Needles
32GX8MM, 33
Clever Choice Comfort EZ Pen Needles
33GX4MM, 33
Clever Choice Comfort EZ Pen Needles
33GX5MM, 33
Clever Choice Comfort EZ Pen Needles
33GX6MM, 33
Clever Choice Comfort EZ Pen Needles
33GX8MM, 33
Clickfine Pen Needle 32GX5/32", 33
Clickfine Pen Needle Universal/31GX1/4",
33
Clickfine Pen Needle
Universal/31GX5/16", 33
Clickfine Pen Needles/31GX1/4", 33
Clickfine Pen Needles/31GX5/16", 33
Clickfine Universal Pen Needles
31GX5/16", 33
clindacin etz pledgets, 8
clindacin-p, 8
clindamax, 8
clindamycin, 3
clindamycin HCL, 3
clindamycin palmitate HCL, 3
clindamycin phosphate, 3, 8, 15
clindamycin phosphate add-vantage, 3
clindamycin phosphate IN D5W, 3
clindamycin phosphate pharmacy bulk
package, 3
clindamycin/benzoyl peroxide, 8
clinisol SF 15%, 40
clinpro 5000, 18
clobetasol propionate, 9
clobetasol propionate e, 9
clobetasol propionate emollient, 9
clodan, 9
Clolar, 4
clomiphene citrate, 13
clomipramine HCL, 18
clonazepam, 19
clonazepam odt, 19
clonidine HCL, 6, 22
clonidine HCL ER, 19
clopidogrel, 17
clorazepate dipotassium, 18
Closercare, 33
clotrimazole, 8, 18
clotrimazole/betamethasone dipropionate,
8
clozapine, 18
clozapine odt, 18
Clozapine Odt, 19
Cnl8 Nail Kit, 8
CO-natal Fa, 28
Coagadex, 17
Coaguchek Lancets, 29
Coartem, 3
coated aspirin, 23, 42
codeine sulfate, 23
Colchicine, 24
Colcrys, 24
colestipol HCL, 7
colistimethate sodium, 3
colocort, 14
Coly-mycin S, 22
Combigan, 21
Combipatch, 10
Combivent Respimat, 25
Cometriq, 5
Comfort Assist Insulin Syringe 0.3ML/29G
X 1/2", 33
Comfort Assist Insulin Syringe/0.3ML/30G
X 5/16", 33
Comfort Assist Insulin Syringe/0.3ML/31G
X 5/16", 33
Comfort Assist Insulin Syringe/0.5ML/29G
X 1/2", 33
Comfort Assist Insulin Syringe/0.5ML/30G
X 5/16", 33
Comfort Assist Insulin Syringe/0.5ML/31G
X 5/16", 33
Comfort Assist Insulin Syringe/1ML/29G
X 1/2", 33
Comfort Assist Insulin Syringe/1ML/30G
X 5/16", 33
Comfort Assist Insulin Syringe/1ML/31G
X 5/16", 33
Comfort Assured Lancets Micro Thin
33G, 29
Comfort Assured Lancets Super Thin
28G, 29
Comfort Lancets, 29
compazine, 18
Complera, 2
Complete Natal DHA, 28
Completenate, 28
compro, 18
Comvax, 26, 45
Concerta, 19
Condylox, 10
constulose, 14
controlrx, 18
Copaxone, 20
Cordran, 9
Cordran Tape, 9
Coreg CR, 6
Corifact, 17
cormax scalp application, 9
Cortifoam, 15
Cortisporin, 8
Cortisporin-tc, 22
corvita, 27
corvita 150, 16
corvite free, 27
cosyntropin, 40
Cotellic, 5
Creon, 14
Cresemba, 2
Crinone, 15
Crixivan, 2
cromolyn sodium, 14, 22
Cromolyn Sodium, 25
cryselle-28, 10, 43
Cubicin, 3
Cuprimine, 41
Curity Alcohol Preps/Medium 2 Ply, 40
Curity Alcohol Swabs, 40
curity sterile saline, 15
Cuvposa, 14
CVS Alcohol Prep Swabs, 40
CVS Alcohol Swabs, 40
CVS aspirin, 23, 42
CVS aspirin adult low dose, 23, 42
CVS aspirin adult low strength, 23, 42
CVS aspirin child, 23, 42
CVS aspirin EC, 23, 43
CVS aspirin low dose, 23, 42
CVS aspirin low strength, 23, 42
CVS childrens aspirin, 23, 43
CVS d3, 27, 47
CVS enteric aspirin, 23, 43
CVS folic acid, 16, 44
CVS Insulin Syringe/0.3ML/29G X 1/2",
33
CVS Insulin Syringe/0.3ML/30G X 1/2",
33
CVS Insulin Syringe/0.5ML/29G X 1/2",
33
CVS Insulin Syringe/0.5ML/30G X 1/2",
33
CVS Insulin Syringe/1ML/29G X 1/2", 33
CVS iron, 16, 46
CVS Lancets 21G, 29
CVS Lancets Micro Thin 33G, 29
CVS Lancets Original, 29
CVS Lancets Thin 26G, 29
CVS Lancets Ultra Thin 30G, 29
CVS Lancing Device, 33
CVS nicotine, 20, 46
CVS nicotine lozenge, 20, 46
CVS nicotine polacrilex, 20, 46
CVS nicotine polacrilex starter, 20, 46
CVS nicotine transdermal system, 20, 46
CVS nts step 1, 20, 46
CVS Prenatal, 28, 44
CVS Prenatal Gummy/DHA/Folic Acid,
28
CVS Prenatal Multi+dha, 28
CVS Prep Pads, 40
CVS Slow Release Iron, 16, 46
CVS Ultra Thin Lancets, 29
CVS vitamin d, 27, 47
CVS vitamin d 5000 high-potency, 27, 47
CVS vitamin d3, 27, 47
cyanocobalamin, 16
cyclafem 1/35, 10, 43
cyclafem 7/7/7, 10, 43
cyclobenzaprine HCL, 21
cyclopentolate HCL, 21
cyclopentolate hydrochloride, 21
Cyclophosphamide, 3
cyclophosphamide, 3
Cycloset, 12
cyclosporine, 4
cyclosporine modified, 4
cyproheptadine HCL, 25
cyred, 10, 43
Cystadane, 13
Cystagon, 16
Cystaran, 22
cysteine HCL, 40
cytarabine, 4
Cytarabine, 4
cytarabine aqueous, 4
Cytogam, 42
cytra k crystals, 15
cytra-2, 15
cytra-k, 15
D
d 1000, 26, 46
d 10000, 26, 46
d 2000, 27, 46
d 400, 27, 46
d 5000, 27, 46
d-1000, 27, 46
d-1000 extra strength, 27, 46
d-2000 maximum strength, 27, 46
d-3-5, 27, 46
d-400, 27, 46
d-5000, 27, 47
d-5000 maximum strength, 27, 47
d-vita, 27, 46
d2000 ultra strength, 27, 47
d3, 27, 47
d3 2000, 27, 47
d3 adult, 27, 47
d3 adult gummy, 27, 47
D3 Dots, 27, 47
d3 high potency, 27, 47
d3 kids, 27, 47
d3 maximum strength, 27, 47
d3 super strength, 27, 47
d3 ultra strength, 27, 47
d3-1000, 27, 47
d3-50, 27, 47
dacarbazine, 5
Dacarbazine, 5
Daklinza, 2
Daliresp, 25
danazol, 10
dantrolene sodium, 21
Dapsone, 3
Daptacel, 26, 45
Daraprim, 3
darifenacin ER, 15
darifenacin hydrobromide ER, 15
Darzalex, 4
dasetta 1/35, 10, 43
dasetta 7/7/7, 10, 43
daunorubicin HCL, 3
Daunoxome, 3
daysee, 10, 43
Daytrana, 19
Ddrops, 27, 47
deblitane, 10, 43
decara, 27, 47
Decara, 27, 47
decitabine, 4
deferoxamine mesylate, 40
dehydrated alcohol, 40
delflex-lm/1.5% dextrose, 40
Delflex-lm/2.5% Dextrose, 41
Delflex-lm/4.25% Dextrose, 41
Delflex-sm/1.5% Dextrose, 41
Delflex-sm/2.5% Dextrose, 41
delta d3, 27, 47
deltasone, 10
delyla, 11, 43
Delzicol, 15
demeclocycline HCL, 1
Demser, 6
Denavir, 8
denta 5000 plus, 18
dentagel, 18
Depen Titratabs, 42
Depo-medrol, 10
Depo-provera, 4
Depo-subq Provera 104, 11, 44
Depocyt, 4
desipramine HCL, 18
desloratadine, 25
Desloratadine Odt, 25
desmopressin acetate, 13
desogestrel/ethinyl estradiol, 11, 43
desonide, 9
desoximetasone, 9
Desoximetasone, 9
dexamethasone, 10
Dexamethasone, 10
Dexamethasone Intensol, 10
dexamethasone sodium phosphate, 10,
21
Dexamethasone Sodium Phosphate, 10
Dexchlorpheniramine Maleate, 25
dexedrine, 19
dexferrum, 16
Dexilant, 14
dexmedetomidine HCL, 19
dexmethylphenidate HCL, 19
dexmethylphenidate HCL ER, 19
Dexpak 10 Day, 10
Dexpak 13 Day, 10
Dexpak 6 Day, 10
dexrazoxane, 5
dextroamphetamine sulfate, 19
dextroamphetamine sulfate ER, 19
dextrose 10%, 40
dextrose 10% flex container, 40
dextrose 2.5%/NACL 0.45%, 40
dextrose 2.5%/sodium chloride 0.45%,
40
dextrose 30% partial fill, 40
dextrose 5%, 40
dextrose 5% viaflex, 40
dextrose 5%/lactated ringers, 40
dextrose 5%/NACL 0.2%, 41
dextrose 5%/NACL 0.33%, 41
dextrose 5%/NACL 0.45%, 41
dextrose 5%/NACL 0.9%, 41
dextrose 5%/potassium chloride 0.15%,
40
dextrose 5%/ringers, 40
dextrose 5%/sodium chloride 0.2%, 40
dextrose 5%/sodium chloride 0.33%, 40
dextrose 5%/sodium chloride 0.45%, 40
dextrose 5%/sodium chloride 0.9%, 41
dextrose 50%, 41
dextrose 70%, 41
Diabeta, 12
dialyvite, 27
dialyvite vitamin d 5000, 27, 47
dialyvite vitamin d3 max, 27, 47
Diascreen 10, 33
Diascreen 1b, 33
Diascreen 1G, 33
Diascreen 1k, 33
Diascreen 2GK, 33
Diascreen 2GP, 33
Diascreen 3, 33
Diascreen 4nl, 33
Diascreen 4obl, 33
Diascreen 4PH, 33
Diascreen 5, 33
Diascreen 6, 33
Diascreen 7, 33
Diascreen 8, 33
Diascreen 9, 33
Diascreen Liquid Urine Controls, 33
Diastar Easy Test II Lancets 30G, 29
Diastar Easy Test Lancets30G, 29
diazepam, 18
Diazepam, 18
diazepam intensol, 18
diclofenac potassium, 24
diclofenac sodium, 8, 9, 22
diclofenac sodium DR, 24
diclofenac sodium ER, 24
diclofenac sodium/misoprostol, 24
diclotral PAK, 8
dicloxacillin sodium, 1
dicyclomine hci, 14
dicyclomine HCL, 14
didanosine, 2
Dificid, 1
difil-G forte, 25
Diflorasone Diacetate, 9
diflunisal, 22
digitek, 5
digox, 5
digoxin, 5
dihydroergotamine mesylate, 24
Dihydroergotamine Mesylate, 24
Dilantin, 19
Dilatrate SR, 5
dilt-XR, 6
diltiazem CD, 6
diltiazem HCL, 6
diltiazem HCL CD, 6
diltiazem HCL ER, 6
Dipentum, 15
diphenhydramine HCL, 25
diphenoxylate/atropine, 14
Diphtheria/Tetanus Toxoids Adsorbed
Pediatric, 26, 45
dipyridamole, 17, 41
disopyramide phosphate, 6
disulfiram, 20
divalproex sodium, 19
divalproex sodium DR, 19
divalproex sodium ER, 19
dobutamine HCL, 7
dobutamine HCL/D5W, 7
dobutamine/dextrose 5%, 7
Docefrez, 4
docetaxel, 4
Docetaxel, 4
Docetaxel (non- Alcohol Formula), 4
Docetaxel (non-alcohol Formula), 4
donepezil HCL, 20
dopamine HCL, 7
Dopamine HCL, 7
dopamine HCL-dextrose 5%, 7
dopamine HCL/dextrose 5%, 7
dopamine/D5W, 7
Doribax, 3
dorzolamide HCL, 22
dorzolamide HCL/timolol maleate, 21
doxapram HCL, 19
doxazosin, 6
doxazosin mesylate, 6
doxepin HCL, 18
Doxepin HCL, 18
Doxepin Hydrochloride, 8
doxercalciferol, 13
doxorubicin HCL, 3
Doxorubicin HCL, 3
doxorubicin HCL liposome, 3
doxy 100, 1
doxycycline, 1
Doxycycline, 8
doxycycline hyclate, 1
doxycycline hyclate DR, 1
doxycycline monohydrate, 1
dronabinol, 14
droperidol, 18
Droplet Lancets Ultra Thin 30G, 29
Droplet Lancing Device, 33
Droplet Pen Needles 29GX10MM, 33
Droplet Pen Needles 29GX12MM, 33
Droplet Pen Needles 31GX5MM, 33
Droplet Pen Needles 31GX6MM, 33
Droplet Pen Needles 31GX8MM, 33
Droplet Pen Needles 32GX4MM, 33
Droplet Pen Needles 32GX5MM, 33
Droplet Pen Needles 32GX6MM, 33
Droplet Pen Needles 32GX8MM, 33
drospirenone/ethinyl estradiol, 11, 43
Droxia, 16
Drug Mart Adjustable Lancing Device, 33
Drug Mart Lancets Thin, 29
Drug Mart Lancets Ultra Thin, 29
Drug Mart On-the-go Lancets Gentle
30G, 29
Drug Mart Ultra Comfort Insulin
Syringe/0.3ML/29G X 1/2", 33
Drug Mart Ultra Comfort Insulin
Syringe/0.3ML/30G X 5/16", 33
Drug Mart Ultra Comfort Insulin
Syringe/0.3ML/31G X 5/16", 33
Drug Mart Ultra Comfort Insulin
Syringe/0.5ML/30G X 5/16", 33
Drug Mart Ultra Comfort Insulin
Syringe/0.5ML/31G X 5/16", 33
Drug Mart Ultra Comfort Insulin
Syringe/1ML/29G X 1/2", 33
Drug Mart Ultra Comfort Insulin
Syringe/1ML/30G X 5/16", 33
Drug Mart Unifine Pentips 31GX5MM, 33
Drug Mart Unifine Pentips29G X 12MM,
33
Drug Mart Unifine Pentips31GX6MM, 33
Drug Mart Unifine Pentips31GX8MM, 33
Drug Mart Unifine Pentips32GX4MM, 33
Drug Mart Unifine Pentipsplus
32GX4MM, 33
Drug Mart Unilet Lancets Super Thin
30G, 29
Drug Mart Unilet Lancets Ultra Thin 28G,
29
Duane Reade Lancet Alternate Site 26G,
29
Duane Reade Lancet Super Thin 30G,
29
Duane Reade Lancet Ultra Thin 28G, 29
Duane Reade Unifine Pentips 29G X
12MM, 33
Duane Reade Unifine Pentips 31G X
6MM Ultra SHORT, 33
Duane Reade Unifine Pentips 31G X
8MM SHORT, 33
Dulera, 25
duloxetine HCL, 18
Duloxetine HCL, 18
duramorph, 23
duraxin, 22
Durezol, 21
dutasteride, 15
dutasteride/tamsulosin HCL, 15
dutasteride/tamsulosin hydrochloride, 15
Dymista, 25
Dyrenium, 7
Dysport, 21
E
E-z Ject Lancets, 29
E-z Ject Lancets 21G, 29
E-z Ject Lancets Color, 29
E-z Ject Lancets Super Thin, 29
E-z Ject Lancets Super Thin 30G, 29
E-z Ject Lancets Thin 26G, 29
E-z Spacer, 40
E-z Spacer The Body Guards Pack, 40
E-ZJECT Lancets Micro-thin 33G, 29
e.s.p., 3
Easivent, 40
Easivent/Mask-large, 40
Easivent/Mask-medium, 40
Easivent/Mask-small, 40
Easy Comfort Insulin Syringe/0.3ML/30G
X 5/16", 34
Easy Comfort Insulin Syringe/0.5ML/30G
X 5/16", 34
Easy Comfort Insulin Syringe/0.5ML/31G
X 5/16", 34
Easy Comfort Insulin Syringe/1ML/30G X
5/16", 34
Easy Comfort Insulin Syringe/1ML/31G X
5/16", 34
Easy Comfort Insulin Syringe/U100/0.5ML/30G X 1/2", 33
Easy Comfort Insulin Syringe/U100/1ML/30G X 1/2", 34
Easy Comfort Lancets, 29
Easy Comfort Lancets 30G/Pull Top, 29
Easy Comfort Lancets 30G/Thin Top, 29
Easy Comfort Pen Needles 31GX1/4", 34
Easy Comfort Pen Needles 31GX3/16",
34
Easy Comfort Pen Needles 31GX5/16",
34
Easy Comfort Pen Needles 32GX5/32",
34
Easy Mini Eject Lancing Device, 34
Easy Mini Lancing Device, 34
Easy Touch 32GX5MM, 34
Easy Touch 32GX6MM, 34
Easy Touch Alcohol Prep Pads/Medium,
40
Easy Touch Fliplock Safety Insulin
Syringe 1ML/29GX1/2", 34
Easy Touch Fliplock Safety Insulin
Syringe 1ML/30GX1/2", 34
Easy Touch Fliplock Safety Insulin
Syringe 1ML/30GX5/16", 34
Easy Touch Fliplock Safety Insulin
Syringe 1ML/31GX5/16", 34
Easy Touch Insulin Syringe/0.3ML/30G X
5/16", 34
Easy Touch Insulin Syringe/0.3ML/31G X
5/16", 34
Easy Touch Insulin Syringe/0.5ML/29G X
1/2", 34
Easy Touch Insulin Syringe/0.5ML/30G X
5/16", 34
Easy Touch Insulin Syringe/1ML/30G X
5/16", 34
Easy Touch Insulin Syringe/Safety/U100/0.5ML/29G X 1/2", 34
Easy Touch Insulin Syringe/Safety/U100/0.5ML/30G X 5/16", 34
Easy Touch Insulin Syringe/Safety/U100/1ML/29G X 1/2", 34
Easy Touch Insulin Syringe/Safety/U100/1ML/30G X 1/2", 34
Easy Touch Insulin Syringe/U100/0.3ML/30G X 1/2", 34
Easy Touch Insulin Syringe/U100/0.5ML/27G X 1/2", 34
Easy Touch Insulin Syringe/U100/0.5ML/28G X 1/2", 34
Easy Touch Insulin Syringe/U100/0.5ML/30G X 1/2", 34
Easy Touch Insulin Syringe/U100/0.5ML/31G X 5/16", 34
Easy Touch Insulin Syringe/U100/1ML/27G X 1/2", 34
Easy Touch Insulin Syringe/U100/1ML/28G X 1/2", 34
Easy Touch Insulin Syringe/U100/1ML/29G X 1/2", 34
Easy Touch Insulin Syringe/U100/1ML/30G X 1/2", 34
Easy Touch Insulin Syringe/U-
100/1ML/31G X 5/16", 34
Easy Touch Lancets 21G/Pressure
Activated, 29
Easy Touch Lancets 23G/Pressure
Activated, 29
Easy Touch Lancets 26G/Pressure
Activated, 29
Easy Touch Lancets 26G/Pull-top, 29
Easy Touch Lancets 26G/Twist, 29
Easy Touch Lancets 28G/Pressure
Activated, 29
Easy Touch Lancets 28G/Pull-top, 29
Easy Touch Lancets 28G/Twist, 29
Easy Touch Lancets 30G/Buttonactivated, 29
Easy Touch Lancets 30G/Pressure
Activated, 29
Easy Touch Lancets 30G/Pull-top, 29
Easy Touch Lancets 30G/Twist, 29
Easy Touch Lancets 32G/Pressure
Activated, 29
Easy Touch Lancets 32G/Pull-top, 29
Easy Touch Lancets 32G/Twist, 29
Easy Touch Lancets 33G/Twist, 30
Easy Touch Lancing Device/Ejector, 34
Easy Touch Pen Needles 29GX1/2", 34
Easy Touch Pen Needles 31GX1/4", 34
Easy Touch Pen Needles 31GX5/16", 34
Easy Touch Pen Needles 32GX1/4", 34
Easy Touch Pen Needles 32GX3/16", 34
Easy Touch Pen Needles 32GX5/32", 34
Easy Touch Pen Needles/31G X 3/16",
34
Easy Touch Safety Lancets21G/Pressure
Activated, 30
Easy Touch Safety Lancets23G/Pressure
Activated, 30
Easy Touch Safety Lancets26G/Button
Activated, 30
Easy Touch Safety Lancets26G/Pressure
Activated, 30
Easy Touch Safety Lancets28G/Button
Activated, 30
Easy Touch Safety Lancets28G/Pressure
Activated, 30
Easy Touch Sheathlock Safety Insulin
Syringe 1ML/29GX1/2", 34
Easy Touch Sheathlock Safety Insulin
Syringe 1ML/30GX5/16", 34
Easy Touch Sheathlock Safety Insulin
Syringe 1ML/31GX5/16", 34
Easy Touch Sheathlock Safety Syringe
1ML/30GX1/2", 34
Easy Twist & CAP Lancets, 30
easygel, 18
Easytest II Lancets, 30
Easytest Lancets, 30
EC-81 aspirin, 23, 43
econazole nitrate, 8
econtra EZ, 11, 43
ecotrin, 23, 42
ecotrin low strength, 23, 42
ecpirin, 23, 42
ed-flex, 22
ed-spaz, 14
Edarbi, 6
Edecrin, 7
Edurant, 2
effer-k, 41
Effer-k, 42
effervescent pot chloride, 41
effervescent potassium, 41
effervescent potassium/chloride, 41
Effient, 17
Egrifta, 13
Elaprase, 13
Elelyso, 17
elenzapatch, 9
Elidel, 9
Eligard, 4
elinest, 11, 43
Eliquis, 17
Elite Iron, 16, 46
Elite-OB, 28
Elite-thin Insulin Syringe/0.3ML/31G X
5/16", 34
Elite-thin Insulin Syringe/0.5ML/29G X
1/2", 34
Elite-thin Insulin Syringe/0.5ML/30G X
5/16", 34
Elite-thin Insulin Syringe/1ML/29G X
5/16", 34
Elite-thin Insulin Syringe/1ML/30G X
5/16", 34
Elite-thin Insulin Syringe/U100/0.5ML/28G X 1/2", 34
Elite-thin Insulin Syringe/U100/0.5ML/28G X 5/16", 34
Elite-thin Insulin Syringe/U100/0.5ML/29G X 5/16", 34
Elite-thin Insulin Syringe/U100/0.5ML/31G X 5/16", 34
Elite-thin Insulin Syringe/U-100/1ML/28G
X 1/2", 34
Elite-thin Insulin Syringe/U-100/1ML/28G
X 5/16", 34
Elite-thin Insulin Syringe/U-100/1ML/29G
X 1/2", 34
Elite-thin Insulin Syringe/U-100/1ML/31G
X 5/16", 34
Elitek, 5
Elixophyllin, 25
Ella, 11
Elmiron, 16
Eloctate, 17
Emadine, 22
Embeda, 24
Embrace Lancets Ultra Thin 30G, 30
Emcyt, 4
Emend, 14
emoquette, 11, 43
Empliciti, 4
Emsam, 18
Emtriva, 2
enalapril maleate, 6
enalapril maleate/hydrochlorothiazide, 7
enalaprilat, 6
Enbrel, 24
Enbrel Sureclick, 24
Encare, 15, 44
endocet, 23
endodan, 23
Enfamil Expecta, 28
Engerix-b, 26, 45
Enjuvia, 10
enoxaparin sodium, 17
enpresse-28, 11, 43
enskyce, 11, 43
entacapone, 20
entecavir, 2
enteric coated aspirin, 23, 42
enulose, 14
ephedrine sulfate, 7
epinastine HCL, 22
Epinephrine, 7
epinephrine HCL, 25
Epipen 2-PAK, 7
Epipen-JR 2-PAK, 7
epirubicin HCL, 3
Epirubicin HCL, 3
episone CRE, 9
epitol, 19
Epivir HBV, 2
eplerenone, 6
Epogen, 17
epoprostenol sodium, 7
Eprosartan Mesylate, 6
eptifibatide, 17
Epzicom, 2
eq adult aspirin low strength, 23, 42
eq aspirin, 23, 42
eq aspirin adult low dose, 23, 42
eq aspirin EC, 23, 42
eq aspirin low dose, 23, 42
eq childrens aspirin, 23, 42
eq nicotine, 20, 46
eq nicotine gum refill, 20, 46
eq nicotine gum starter, 20, 46
eq nicotine polacrilex, 20, 46
eq nicotine step 3, 20, 46
eq slow-release iron, 16, 45
eql adult aspirin low strength, 23, 42
eql aspirin, 23, 42
eql aspirin EC, 23, 42
eql aspirin low dose, 23, 42
eql childrens aspirin, 23, 42
eql childrens vitamin d gummies, 27, 47
Eql Color Lancets 21G, 30
Eql Color Lancets Micro Thin 33G, 30
eql folic acid, 16, 44
Eql Insulin Syringe/0.3ML/29G X 1/2", 34
Eql Insulin Syringe/0.3ML/30G X 5/16",
34
Eql Insulin Syringe/0.3ML/31G X 5/16",
34
Eql Insulin Syringe/0.5ML/29G X 1/2", 34
Eql Insulin Syringe/0.5ML/30G X 5/16",
34
Eql Insulin Syringe/0.5ML/31G X 5/16",
34
Eql Insulin Syringe/1ML/29G X 1/2", 34
Eql Insulin Syringe/1ML/30G X 5/16", 34
Eql Insulin Syringe/1ML/31G X 5/16", 34
Eql Insulin Syringe/U-100/0.3ML/29G X
1/2", 34
Eql Insulin Syringe/U-100/0.5ML/29G X
1/2", 34
Eql Insulin Syringe/U-100/1ML/29G X
1/2", 34
eql iron supplement therapy, 16, 45
eql nicotine, 20, 46
eql nicotine polacrilex, 20, 46
eql nicotine polacrilex refill, 20, 46
eql nicotine polacrilex starter, 20, 46
Eql Prenatal Formula, 28, 44
Eql SHORT Pen Needles 31G X 8MM,
34
eql slow release iron, 16, 45
Eql Super Thin Lancets 30G, 30
Eql Thin Lancets 26G, 30
Eql Ultra Comfort
Insulinsyringe/0.3ML/31G X 5/16", 34
Eql Ultra Comfort Insulinsyringe/1ML/30G
X 5/16", 34
Eql Ultra SHORT Pen Needles 31G X
6MM, 34
eql vitamin d-3, 27, 47
eql vitamin d3, 27, 47
Eraxis, 2
Erbitux, 4
ergocalciferol, 26
ergoloid mesylates, 20
Ergoloid Mesylates, 20
Ergomar, 24
Erivedge, 5
errin, 11, 43
Ertaczo, 8
Erwinaze, 3
ery, 8
Ery-TAB, 1
Erythrocin Lactobionate, 1
erythromycin, 1, 8, 21
Erythromycin Base, 1
erythromycin/benzoyl peroxide, 8
Esbriet, 25
Escavite LQ, 28
escitalopram oxalate, 18
esgic, 22
esmolol HCL, 6
esomeprazole magnesium, 14
esomeprazole sodium, 14
Esomeprazole Sodium, 14
Esomeprazole Strontium, 14
estarylla, 11, 43
estazolam, 19
Estrace, 15
estradiol, 10
estradiol valerate, 10
estradiol/norethindrone acetate, 10
estropipate, 10
eszopiclone, 19
ethacrynate sodium, 7
ethambutol HCL, 2
ethosuximide, 19
Etidronate Disodium, 12
etodolac, 24
etodolac ER, 24
Etopophos, 4
Etoposide, 4
etoposide, 4
Eurax, 10
Evamist, 10
Evotaz, 2
Exalgo, 24
Excel Comfort Point Insulin Pen Needles
31G X 4MM, 34
Exel Comfort Point Insulin Pen Needles
29G X 12MM, 34
Exel Comfort Point Insulin Pen Needles
31G X 6MM, 34
Exel Comfort Point Insulin Pen Needles
31G X 8MM, 34
Exel Comfort Point Insulin
Syringe/0.3ML/29G X 1/2", 34
Exel Comfort Point Insulin
Syringe/0.3ML/30G X 5/16", 34
Exel Comfort Point Insulin
Syringe/0.5ML/28G X 1/2", 34
Exel Comfort Point Insulin
Syringe/0.5ML/29G X 1/2", 34
Exel Comfort Point Insulin
Syringe/0.5ML/30G X 5/16", 34
Exel Comfort Point Insulin
Syringe/1ML/28G X 1/2", 34
Exel Comfort Point Insulin
Syringe/1ML/29G X 1/2", 34
Exel Comfort Point Insulin
Syringe/1ML/30G X 5/16", 34
Exelderm, 8
exemestane, 4
Exjade, 42
Eylea, 22
EZ Smart Blood Glucose Lancets, 30
EZ-lets Lancets 21G, 30
EZ-lets Lancets 23G, 30
EZ-lets Lancets 26G Super-soft, 30
EZ-lets Lancets 28G Ultra-soft, 30
EZ-lets Lancets 30G, 30
ezfe 200, 16, 45
F
fa-8, 16, 44
Fa-8, 16, 44
fabb, 16
Fabrazyme, 13
Factive, 1
fallback solo, 11, 43
falmina, 11, 43
famciclovir, 2
famotidine, 14
Famotidine, 14
Fanapt, 19
Fanapt Titration Pack, 19
Fareston, 4
Farydak, 5
Faslodex, 4
Fazaclo, 19
Fc Female Condom, 44
Fc2 Female Condom, 44
FE Aspartate, 16, 46
FE c plus, 16
FE gluconate, 16, 46
FE TABS, 16, 46
Feiba, 17
Feiba NF, 17
felbamate, 19
felodipine ER, 6
Femcap, 44
Femiron, 16, 46
fenofibrate, 7
Fenofibrate, 7
fenofibrate micronized, 7
Fenofibric Acid, 7
fenofibric acid DR, 7
Fenoglide, 7
fenoldopam mesylate, 6
Fenoprofen Calcium, 24
fentanyl, 23
Fentanyl, 24
fentanyl citrate oral transmucosal, 23
feosol, 16, 45
Feosol, 16, 46
fer-iron, 16, 45
ferate, 16, 45
fergon, 16, 45
ferocon, 16
ferosul, 16, 45
ferotrinsic, 16
Ferretts, 16, 46
Ferretts Chewable Iron, 16
Ferretts IPS, 16, 46
ferrex 150, 16, 45
ferric x-150, 16, 45
Ferrimin 150, 16, 46
Ferriprox, 42
ferro-bob, 16, 45
Ferro-sequels, 16, 46
ferrocite, 16
ferrocite plus, 16
ferrogels forte, 16
ferrotabs, 16, 45
ferrous drops, 16, 45
Ferrous Fumarate, 16, 46
ferrous fumarate 324, 16
ferrous gluconate, 16, 45
Ferrous Gluconate, 16, 46
ferrous sulfate, 16, 45
Ferrous Sulfate, 16, 46
ferrousul, 16, 45
Fibricor, 7
Fifty50 Alcohol Prep Pads, 40
Fifty50 Lancing Device, 34
Fifty50 Pen Needles 31G X3/16" (5MM),
34
Fifty50 Pen Needles 31G X5/16" (8MM),
34
Fifty50 Pen Needles 31GX5MM, 34
Fifty50 Pen Needles/31GX8MM, 34
Fifty50 Pen Needles/32GX4MM, 34
Fifty50 Pen Needles/32GX6MM, 34
Fifty50 Safety Seal Lancets 30G, 30
Fifty50 Safety Seal Lancets 32G, 30
Fifty50 Superior Comfort Insulin
Syringe/0.3ML/31G X 5/16", 34
Fifty50 Superior Comfort Insulin
Syringe/0.5ML/31G X 5/16", 34
Fifty50 Superior Comfort Insulin
Syringe/1ML/31G X 5/16", 34
Fifty50 Unilet Lancets 33G, 30
Finacea, 8
finasteride, 15
Fine 30, 30
Fingerstix Lancets, 30
Firazyr, 17
Firmagon, 4
Flagyl ER, 3
Flarex, 21
flavoxate HCL, 15
Flebogamma Dif, 42
flecainide acetate, 6
flexbumin, 17
Flexichamber, 40
Flexichamber Adult Mask/Small, 40
Flexichamber Child Mask/Large, 40
Flexichamber Child Mask/Small, 40
floriva plus, 27
floxuridine, 4
Floxuridine, 4
Fluarix 2013-2014, 26, 45
Fluarix 2014-2015, 26, 45
Fluarix Quadrivalent 2013-2014, 26, 45
Fluarix Quadrivalent 2014-2015, 26, 45
Fluarix Quadrivalent 2015-2016, 26, 45
Flublok 2013-2014, 26, 45
Flublok 2014-2015, 26, 45
Flublok 2015-2016, 26, 45
flucaine, 22
Flucelvax 2013-2014, 26, 45
Flucelvax 2014-2015, 26, 45
Flucelvax 2015-2016, 26, 45
fluconazole, 2
fluconazole IN dextrose, 2
fluconazole IN NACL, 2
flucytosine, 2
fludarabine phosphate, 4
fludrocortisone acetate, 10
Flulaval 2013-2014, 26, 45
Flulaval 2014-2015, 26, 45
Flulaval Quadrivalent 2013-2014, 26, 45
Flulaval Quadrivalent 2014-2015, 26, 45
Flulaval Quadrivalent 2015-2016, 26, 45
flumazenil, 41
Flumist Quadrivalent, 26, 45
flunisolide, 25
fluocinolone acetonide, 9, 22
fluocinolone acetonide body, 9
fluocinolone acetonide ear drops, 22
fluocinolone acetonide scalp, 9
fluocinonide, 9
fluocinonide-e, 9
fluor-a-day, 41, 44
Fluor-a-day, 41, 44
fluor-i-strips a.t., 22
fluorescein-benoxinate, 22
fluorescein/proparacaine, 22
fluoride, 41, 44
fluoridex daily defense, 18
fluoridex daily defense enhanced
whitening, 18
fluoridex daily defense sensitivity relief,
18
fluoritab, 41, 44
fluorometholone, 21
Fluoroplex, 10
fluorouracil, 4, 9
fluoxetine DR, 18
fluoxetine HCL, 18
fluphenazine decanoate, 18
fluphenazine HCL, 18
flura-drops, 41, 44
flurandrenolide, 9
flurazepam HCL, 19
Flurazepam HCL, 19
flurbiprofen, 24
flurbiprofen sodium, 22
flurox, 22
flutamide, 4
fluticasone propionate, 9, 25
fluvastatin, 7
fluvastatin sodium ER, 7
Fluvirin 2013-2014, 26, 45
Fluvirin 2014-2015, 26, 45
Fluvirin 2015-2016, 26, 45
Fluvirin PF 2013-2014, 26, 45
Fluvirin PF 2014-2015, 26, 45
fluvoxamine maleate, 18
fluvoxamine maleate ER, 18
Fluzone High-dose PF 2013-2014, 26,
45
Fluzone High-dose PF 2014-2015, 26,
45
Fluzone High-dose PF 2015-2016, 26,
45
Fluzone Intradermal, 26, 45
Fluzone Intradermal Quadrivalent 20152016, 26, 45
Fluzone Pediatric PF 2013-2014, 26, 45
Fluzone PF 2013-2014, 26, 45
Fluzone PF 2014-2015, 26, 45
Fluzone Quadrivalent 2013-2014, 26, 45
Fluzone Quadrivalent 2014-2015, 26, 45
Fluzone Quadrivalent 2015-2016, 26, 45
Fluzone Split 2013-2014, 26, 45
Fluzone Split 2014-2015, 26, 45
Fluzone Split 2015-2016, 26, 45
FML, 21
Focalin XR, 19
folbee, 16
folbee plus, 27
folbee plus cz, 27
folic acid, 16, 44
folic acid/vitamin b-6/vitamin b-12, 16
Folotyn, 4
folplex 2.2, 16
foltrin, 16
fomepizole, 41
fondaparinux sodium, 17
Fora Lancets, 30
Fora Lancing Device, 34
Fora Lancing Device/Clearcap, 34
Foradil Aerolizer, 25
formadon, 41
formaldehyde, 41
Forteo, 13
Fosamax Plus D, 12
fosinopril sodium, 6
fosinopril sodium/hydrochlorothiazide, 7
fosphenytoin sodium, 19
Fosrenol, 15
Fragmin, 17
Freds Pharmacy Autolet Lancing Device,
34
Freds Pharmacy Unifine Pentips Pen
Needles 32GX4MM, 34
Freds Pharmacy Unifine Pentips Plus
31GX5MM, 34
Freds Pharmacy Unifine Pentips Plus
31GX8MM, 34
Freds Pharmacy Unilet Lancets Super
Thin 30G, 30
Freds Pharmacy Unilet Lancets Ultra Thin
28G, 30
Freestyle Lancets, 30
Freestyle Precision Insulin Syringe/U100/0.5ML/30G X 5/16", 34
Freestyle Precision Insulin Syringe/U100/0.5ML/31G X 5/16", 34
Freestyle Precision Insulin Syringe/U100/1ML/31G X 5/16", 34
Freestyle Precision Insulin Syringes/U100/1ML/30G X 5/16", 34
Freestyle Unistick II Lancets, 30
frovatriptan succinate, 24
ful-GLO, 22
furosemide, 7
Fusilev, 5
Fuzeon, 2
fyavolv, 10
Fycompa, 19
G
gabapentin, 19
Gabitril, 19
galantamine hydrobromide, 20
Galantamine Hydrobromide, 20
Gamastan S/D, 42
Gammagard Liquid, 42
Gammagard S/D, 42
Gammagard S/D Iga Less Than
1mcg/ML, 42
Gammaked, 42
Gammaplex, 42
Gamunex-c, 42
ganciclovir, 2
garamycin, 21
Gardasil, 26, 45
Gardasil 9, 26, 45
Gastrinex NF, 14
gatifloxacin, 21
Gattex, 15
gavilyte-c, 14, 47
gavilyte-G, 14, 47
gavilyte-h, 14
gavilyte-n/flavor pack, 14, 47
Gazyva, 4
Gelnique, 15
gemcitabine, 4
gemcitabine HCL, 4
gemfibrozil, 7
gene-xene TAB 15MG, 18
gene-xene TAB 3.75MG, 18
gene-xene TAB 7.5MG, 18
generlac, 14
gengraf, 4
gentak, 21
gentamicin sulfate, 1, 21
gentamicin sulfate pediatric, 1
gentamicin sulfate/0.9% sodium chloride,
1
Gentle-let GP Lancets, 30
Gentle-let Lancets General Purpose
Style/Fine Point, 30
Gentle-let Lancets General Purpose
Style/Medium Point, 30
Gentle-let Lancets Safety Style/Fine
Point, 30
Gentle-let Lancets Safety Style/Medium
Point, 30
Gentle-let Platforms 2.4MM, 34
Gentle-let Platforms 3.0MM, 34
Geodon, 19
gianvi, 11, 43
gildagia, 11, 43
gildess 1.5/30, 11, 43
gildess 1/20, 11, 43
gildess 24 FE, 11, 43
gildess FE 1.5/30, 11, 43
gildess FE 1/20, 11, 43
Gilenya, 20
Gilotrif, 5
giltuss pediatric, 25
Glassia, 26
glatopa, 20
Gleevec, 5
Gleostine, 3
Gliadel Wafer, 3
glimepiride, 12
glipizide, 12
glipizide ER, 12
glipizide XL, 12
glipizide/metformin HCL, 12
Global Alcohol Prep Ease Pads, 40
Global Ease Inject Pen Needles
29GX12MM, 34
Global Ease Inject Pen Needles
31GX8MM, 34
Global Ease Inject Pen Needles
32GX4MM, 34
Global Ease Inject Pen Neeedles
31GX5MM, 34
Global Inject Ease Insulin Syringe/U100/0.3ML/29G X 1/2", 34
Global Inject Ease Insulin Syringe/U100/0.3ML/30G X 1/2", 34
Global Inject Ease Insulin Syringe/U100/0.3ML/30G X 5/16", 34
Global Inject Ease Insulin Syringe/U100/0.3ML/31G X 5/16", 34
Global Inject Ease Insulin Syringe/U100/0.5ML/28G X 1/2", 34
Global Inject Ease Insulin Syringe/U100/0.5ML/29G X 1/2", 34
Global Inject Ease Insulin Syringe/U100/0.5ML/30G X 1/2", 35
Global Inject Ease Insulin Syringe/U100/0.5ML/30G X 5/16", 35
Global Inject Ease Insulin Syringe/U100/0.5ML/31G X 5/16", 35
Global Inject Ease Insulin Syringe/U100/1ML/28G X 1/2", 35
Global Inject Ease Insulin Syringe/U100/1ML/29G X 1/2", 35
Global Inject Ease Insulin Syringe/U100/1ML/30G X 1/2", 35
Global Inject Ease Insulin Syringe/U100/1ML/30G X 5/16", 35
Global Inject Ease Insulin Syringe/U100/1ML/31G X 5/16", 35
Global Inject Ease Lancets 28G, 30
Global Inject Ease Lancets 30G, 30
Global Lancing Device, 35
Glucagen Hypokit, 12
Glucagon Emergency Kit, 12
Glucocom Autolink Telemonitoring
System, 35
Glucocom Lancets 28G, 30
Glucocom Lancets 30G, 30
Glucocom Lancets 33G, 30
Glucolet 2 Automatic Lancing Device, 35
Glucopro Insulin Syringe/U100/0.3ML/30G X 1/2", 35
Glucopro Insulin Syringe/U100/0.3ML/30G X 5/16", 35
Glucopro Insulin Syringe/U100/0.3ML/31G X 5/16", 35
Glucopro Insulin Syringe/U100/0.5ML/30G X 1/2", 35
Glucopro Insulin Syringe/U100/0.5ML/30G X 5/16", 35
Glucopro Insulin Syringe/U100/0.5ML/31G X 5/16", 35
Glucopro Insulin Syringe/U-100/1ML/30G
X 1/2", 35
Glucopro Insulin Syringe/U-100/1ML/30G
X 5/16", 35
Glucopro Insulin Syringe/U-100/1ML/31G
X 5/16", 35
Glucose Control Normal, 30
Glucose Control Solution, 30
Glucosource Lancet Device, 35
Glucosource Lancets, 30
glyburide, 12
Glyburide, 12
glyburide micronized, 12
glyburide/metformin HCL, 12
glycine, 15
glycopyrrolate, 14
glydo, 9
Glyset, 12
Gmate Lancets 30G, 30
Gmate Lancing Device, 35
gnp adult aspirin low strength, 23, 42
Gnp Alcohol Swabs, 40
gnp aspirin, 23, 42
gnp aspirin low dose, 23, 42
Gnp Clickfine Pen Needle
Universal/31GX5/16", 35
Gnp Clickfine Universal Pen Needles
31GX1/4", 35
Gnp Clickfine Universal Pen Needles
31GX5/16", 35
Gnp Daily Prenatal, 28, 44
gnp folic acid, 16, 44
Gnp Insulin Syringe/0.3ML/29G X 1/2",
35
Gnp Insulin Syringe/0.3ML/30G X 5/16",
35
Gnp Insulin Syringe/0.3ML/31G X 5/16",
35
Gnp Insulin Syringe/0.5ML/28G X 1/2",
35
Gnp Insulin Syringe/0.5ML/29G X 1/2",
35
Gnp Insulin Syringe/0.5ML/30G X 5/16",
35
Gnp Insulin Syringe/0.5ML/31G X 5/16",
35
Gnp Insulin Syringe/1ML/28G X 1/2", 35
Gnp Insulin Syringe/1ML/29G X 1/2", 35
Gnp Insulin Syringe/1ML/30G X 5/16", 35
Gnp Insulin Syringe/1ML/31G X 5/16", 35
gnp iron, 16, 45
Gnp Lancets, 30
Gnp Lancets 21G, 30
Gnp Lancets Micro Thin 33G, 30
Gnp Lancets Super Thin 30G, 30
Gnp Lancets Thin, 30
Gnp Lancets Thin 26G, 30
Gnp Micro Thin Lancets 33G, 30
gnp nicotine mini lozenge, 20, 46
gnp nicotine polacrilex, 20, 46
gnp nicotine polacrilex mini, 20, 46
Gnp Prenatal, 28, 44
Gnp Prenatal Vitamins, 28, 44
gnp slow release iron, 16, 45
Gnp Super Thin Lancets/30G, 30
Gnp Ultra Comfort Insulin
Syringe/0.3ML/29G X 1/2", 35
Gnp Ultra Comfort Insulin
Syringe/0.3ML/30G X 5/16" SHORT, 35
Gnp Ultra Comfort Insulin
Syringe/0.3ML/31G X 5/16" SHORT, 35
Gnp Ultra Comfort Insulin
Syringe/0.5ML/28G X 1/2", 35
Gnp Ultra Comfort Insulin
Syringe/0.5ML/29G X 1/2", 35
Gnp Ultra Comfort Insulin
Syringe/0.5ML/30G X 5/16" SHORT, 35
Gnp Ultra Comfort Insulin
Syringe/0.5ML/31G X 5/16" SHORT, 35
Gnp Ultra Comfort Insulin
Syringe/1ML/28G X 1/2", 35
Gnp Ultra Comfort Insulin
Syringe/1ML/29G X 1/2", 35
Gnp Ultra Comfort Insulin
Syringe/1ML/30G X 5/16" SHORT, 35
Gnp Ultra Comfort Insulin
Syringe/1ML/31G X 5/16" SHORT, 35
gnp vitamin d, 27, 47
gnp vitamin d maximum strength, 27, 47
gnp vitamin d super strength, 27, 47
gnp vitamin d3 extra strength, 27, 47
goodsense aspirin low dose, 23, 42
goodsense nicotine gum, 20, 46
Goodsense Prenatal Vitamins, 28, 44
grafco silver nitrate applicator, 9
grafco silver nitrate applicator 12", 9
Gralise, 20
Gralise Starter, 20
granisetron HCL, 14
Granisol, 14
green GLO lissamine greenophthalmic
strips, 22
griseofulvin microsize, 2
griseofulvin ultramicrosize, 2
guanfacine ER, 19
guanfacine HCL, 6
Guanidine HCL, 21
Gynazole-1, 15
H
H&h Thinlet Lancets 26G, 30
H&h Thinlet Super Thin Lancets 30G, 30
H-e-b IN Control Pen Needles
31GX5MM, 35
H-e-b IN Control Pen Needles
31GX6MM, 35
H-e-b IN Control Pen Needles
31GX8MM, 35
H-e-b IN Control Pen
Needles/Nano/32GX4MM, 35
H-e-b IN Control Unifine Pentips Plus
31GX5MM, 35
H-e-b IN Control Unifine Pentips Plus
32GX4MM, 35
H-e-b Incontrol Advanced Lancing
Device, 35
H-e-b Incontrol Lancets Micro Thin 33G,
30
H-e-b Incontrol Lancets Super Thin 30G,
30
H-e-b Incontrol Lancets Ultra Thin 28G,
30
H-e-b Incontrol Pen Needles 29GX12MM,
35
H.p. Acthar, 13
Haemolance, 30
Haemolance Low Flow Lancets, 30
Haemolance Plus, 30
Haemolance Plus High Flow, 30
Haemolance Plus Low Flow, 30
Haemolance Plus Max Flow, 30
Haemolance Plus Pediatric Flow, 30
Halaven, 4
halobetasol propionate, 9
Halog, 9
halonate PAC, 9
haloperidol, 18
haloperidol decanoate, 18
haloperidol lactate, 18
Harvoni, 2
Havrix, 26, 45
Health Care Lancing Device, 35
Healthwise Alcohol Prep Pads, 40
Healthwise Lancets 30G, 30
Healthwise Lancing Pen, 35
Healthwise Mini Pen Needles 31GX6MM,
35
Healthwise Pen Needles 29GX12MM, 35
Healthwise SHORT Pen Needles
31GX8MM, 35
Healthwise Unifine Pentips Pen Needles
32GX4MM, 35
Healthy Accents Autolet Impression
Lancing Device, 35
Healthy Accents Unifine Pentips Pen
Needles 29GX12MM, 35
Healthy Accents Unifine Pentips Pen
Needles 31GX5MM, 35
Healthy Accents Unifine Pentips Pen
Needles 31GX6MM, 35
Healthy Accents Unifine Pentips Pen
Needles 31GX8MM, 35
Healthy Accents Unifine Pentips Pen
Needles 32GX4MM, 35
Healthy Accents Unilet Lancets Super
Thin 30G, 30
healthy kids vitamin d3, 27, 47
Healthy Mama Be Well Rounded, 28
heather, 11, 43
hecoria, 4
Hectorol, 13
Helixate FS, 17
hematinic plus vitamins/minerals, 16
hematinic/folic acid, 16
hematogen, 16
hematogen forte, 16
hemocyte-f, 16
hemocyte-plus, 16
Hemofil M, 17
hep flush-10, 17
Hepagam B, 42
heparin lock, 17
heparin lock flush, 17
heparin lock flush for flushing vascular
access devices, 17
heparin lock flush/NACL for flushing
vascular access devices, 17
heparin sodium, 17
heparin sodium dcu, 17
heparin sodium lock flush, 17
heparin sodium/D5W, 17
heparin sodium/NACL 0.9%, 17
heparin sodium/sodium chloride 0.9%
premix, 17
Herceptin, 4
hetastarch 6%/NACL, 17
Hetlioz, 19
Hexalen, 3
Hiberix, 26, 45
high potency iron, 16, 45
High Potency Iron, 16, 46
Hizentra, 42
HM aspirin, 23, 43
HM aspirin EC, 23, 43
HM aspirin EC low dose, 23, 43
HM folic acid, 16, 44
HM iron, 16, 46
HM iron slow release, 16, 46
HM Lancets Micro Thin 33G, 30
HM Lancets Ultra Thin 30G, 30
HM nicotine polacrilex, 20, 46
HM nicotine transdermal system, 20, 46
HM nicotine transdermal system step 3,
20, 46
HM One Daily Prenatal Combo, 28, 45
HM Prenatal, 28, 45
HM slow release iron, 16, 46
HM vitamin d, 27, 47
HM vitamin d3, 27, 47
HM Vitamin D3, 27, 47
homatropaire, 22
homatropine HBR, 22
Horizant, 20
Humalog, 12
Humalog Kwikpen, 12
Humalog Mix 50/50, 12
Humalog Mix 50/50 Kwikpen, 12
Humalog Mix 75/25, 12
Humalog Mix 75/25 Kwikpen, 12
human albumin grifols, 17
Humate-p, 17
Humira, 24
Humira Pediatric Crohns Disease Starter
Pack, 24
Humira Pen, 24
Humira Pen-crohns Diseasestarter, 24
Humira Pen-psoriasis Starter, 24
Humulin 70/30, 12
Humulin 70/30 Kwikpen, 12
Humulin N, 12
Humulin N Kwikpen, 12
Humulin R, 12
Humulin R U-500 (concentrated), 12
Hy-vee Lancets, 30
Hy-vee Thin Lancets, 30
Hycamtin, 5
hydralazine HCL, 6
hydrochlorothiazide, 7
hydrocodone bitartrate/acetaminophen,
23
hydrocodone bitartrate/chlorpheniramine
maleate/PSE, 25
hydrocodone bitartrate/homatropine
methylbromide, 25
hydrocodone polistirex/chlorpheniramine
polistirex, 25
hydrocodone/acetaminophen, 23
Hydrocodone/Acetaminophen, 24
hydrocodone/homatropine, 25
hydrocodone/ibuprofen, 23
hydrocort ene 100MG, 14
hydrocortisone, 9, 10, 14
hydrocortisone acetate/aloe, 9
hydrocortisone acetate/lidocaine HCL, 14
hydrocortisone acetate/pramoxine, 14
hydrocortisone butyrate, 9
hydrocortisone butyrate (lipid), 9
hydrocortisone butyrate (lipophilic), 9
hydrocortisone IN absorbase, 9
hydrocortisone valerate, 9
hydrocortisone/acetic acid, 22
hydromet, 25
hydromorphone HCL, 23
hydromorphone HCL dosette, 23
hydromorphone HCL ER, 23
Hydromorphone HCL ER, 24
Hydromorphone HCL/Sodium Chloride,
24
hydroxychloroquine sulfate, 3
hydroxyurea, 5
hydroxyzine HCL, 18
hydroxyzine pamoate, 18
Hydroxyzine Pamoate, 18
hyolev mb, 15
hyomax-SL, 14
hyophen, 15
hyoscyamine sulfate, 14
hyoscyamine sulfate ER, 14
hyoscyamine sulfate odt, 14
hyoscyamine sulfate SR, 14
hyosyne, 14
hypercare, 9
Hyperhep B S/D, 42
Hyperrab S/D, 42
Hyperrho S/D, 42
Hyperrho S/D Mini-dose, 42
Hypolance AST Lancing Kit, 35
I
ibandronate sodium, 12
Ibrance, 5
ibudone, 23
ibuprofen, 24
ibuprofen lysine, 24
ibutilide fumarate, 6
Iclusig, 5
idarubicin HCL, 3
Idelvion, 17
iferex 150, 16, 45
iferex 150 forte, 16
Ifex, 3
ifosfamide, 3
Ifosfamide, 3
Ilaris, 24
Ilevro, 22
ilotycin, 21
imatinib mesylate, 4
Imbruvica, 5
imipenem/cilastatin, 3
imipramine HCL, 18
imipramine pamoate, 18
imiquimod, 9
Imovax Rabies (h.d.c.v.), 26
Implanon, 11, 44
IN Touch Diabetes Management
Software, 30
IN Touch Lancing Device, 35
IN Touch Sterile Lancets 30G, 30
Inatal Advance, 28
Inatal GT, 28
Inatal Ultra, 28
Increlex, 13
Incruse Ellipta, 25
indapamide, 7
Inderal XL, 6
indigo carmine, 41
indiomin mb, 15
indocyanine green, 41
indomethacin, 24
indomethacin ER, 24
Infanrix, 26, 45
inflammacin, 24
infuvite, 27
infuvite adult, 27
infuvite pediatric, 27
Inlyta, 5
Innopran XL, 6
Inspirachamber/Anti-static
Valved/Mouthpiece, 40
Inspirachamber/Large, 40
Inspirachamber/Soothermask/Inspiramas
k/Medium, 40
Inspirachamber/Soothermask/Inspiramas
k/Small, 40
Inspirease Bags, 40
Inspirease Drug Delivery System, 40
Inspirease Mouthpiece, 40
Inspirease Reservoir Bags, 40
Insulin Syringe/0.3ML/29G X 1", 35
Insulin Syringe/0.3ML/29G X 1/2", 35
Insulin Syringe/0.3ML/30G X 5/16", 35
Insulin Syringe/0.3ML/31G X 5/16", 35
Insulin Syringe/0.5ML/27G X 1/2", 35
Insulin Syringe/0.5ML/28G X 1/2", 35
Insulin Syringe/0.5ML/29G X 1/2", 35
Insulin Syringe/0.5ML/30G X 1/2", 35
Insulin Syringe/0.5ML/30G X 5/16", 35
Insulin Syringe/0.5ML/31G X 5/16", 35
Insulin Syringe/1ML/28G X 1/2", 35
Insulin Syringe/1ML/29G X 1/2", 35
Insulin Syringe/1ML/30G X 5/16", 35
Insulin Syringe/1ML/31G X 5/16", 35
Insulin Syringe/U-100/0.3ML/29G X 1/2",
35
Insulin Syringe/U-100/0.5ML/28G X 1/2",
35
Insulin Syringe/U-100/0.5ML/29G X 1/2",
35
Insulin Syringe/U-100/1ML/28G X 1/2",
35
Insulin Syringe/U-100/1ML/29G X 1/2",
35
Insulin Syringe/U-100/1ML/30G X 5/16",
35
Insulin Syringe/U-100/1ML/31G X 5/16",
35
Insupen 33GX4MM, 35
Insupen Pen Needles 32G X4MM, 35
Insupen Sensitive 32GX6MM, 35
Insupen Sensitive 32GX8MM, 35
Insupen Ultrafin 29GX12MM, 35
Insupen Ultrafin 30GX8MM, 35
Insupen Ultrafin 31GX6MM, 35
Insupen Ultrafin 31GX8MM, 35
Intelence, 2
intralipid, 41
Intron A, 5
Intron A W/Diluent, 5
introvale, 11, 43
Invanz, 3
Invega Sustenna, 19
Invega Trinza, 19
Invirase, 2
Invokana, 12
Iopidine, 22
Ipol Inactivated IPV, 26, 45
ipratropium bromide, 25(2)
ipratropium bromide/albuterol sulfate, 25
irbesartan, 6
irbesartan/hydrochlorothiazide, 7
irinotecan, 5
Irinotecan, 5
iron, 16, 45
Iron, 17, 46
Iron Asp Gly/ Polysacch Compl/Ascorb
CAL/B12/Fa/C Threon/Suc, 16
Iron Chews Pediatric, 17, 46
iron slow release, 16, 45
iron supplement, 16, 46
iron supplement childrens, 16, 46
Iron Up, 17, 46
Isentress, 2
isolyte-m/dextrose 5%, 41
Isolyte-s, 42
isoniazid, 2
Isoniazid, 2
Isopto Carbachol, 22
isosorbide dinitrate, 5
Isosorbide Dinitrate, 5
isosorbide mononitrate, 5
isosorbide mononitrate ER, 5
isosulfan blue, 41
isotonic gentamicin, 2
isradipine, 6
Istodax, 5
itraconazole, 2
ivermectin, 3
Ixempra Kit, 4
Ixiaro, 26
J
Jadenu, 42
Jakafi, 5
jantoven, 17
Janumet, 12
Janumet XR, 12
Januvia, 12
Jardiance, 12
jencycla, 11, 43
Jetrea, 22
jevantique LO, 10
Jevtana, 4
jinteli, 10
jolessa, 11, 43
jolivette, 11, 43
juleber, 11, 43
junel 1.5/30, 11, 43
junel 1/20, 11, 43
junel FE 1.5/30, 11, 43
junel FE 1/20, 11, 43
junel FE 24, 11, 43
just d, 27, 47
Juxtapid, 7
K
k-effervescent, 41
K-phos, 42
k-prime, 41
k-sol, 41
k-tan plus, 16
k-vescent, 41
k2k pain relieving patch, 9
Kadcyla, 4
kaitlib FE, 11, 43
Kalbitor, 17
Kaletra, 2
Kalydeco, 26
Kanuma, 13
karidium, 41, 44
karigel, 18
karigel-n, 18
kariva, 11, 43
KCL 0.075%/D5W/NACL 0.45%, 41
KCL 0.15%/D5W/ NACL 0.3%, 41
KCL 0.15%/D5W/NACL 0.2%, 41
KCL 0.15%/D5W/NACL 0.45%, 41
KCL 0.15%/D5W/NACL 0.9%, 41
KCL 0.3%/D5W/NACL 0.45%, 41
kedbumin, 17
kelnor 1/35, 11, 43
kendall sodium chloride flush, 41
Kepivance, 5
Ketek, 3
Ketocare, 42
ketoconazole, 2, 8
ketodan, 8
Ketone Test Strips, 42
ketoprofen, 24
ketorolac tromethamine, 22, 24
Ketostix, 42
Keveyis, 7
kimidess, 11, 43
Kineret, 24
Kinney Lancets, 30
Kinney Thin Lancets, 30
Kinray Insulin Syringe Preferred
Plus/0.3ML/31G X 5/16", 35
Kinray Insulin Syringe Preferred
Plus/0.5ML/31G X 5/16", 35
Kinray Insulin Syringe Preferred
Plus/1ML/31G X 5/16", 35
Kinray Insulin Syringe/0.5ML/29G X 1/2",
35
Kinrix, 26, 45
kionex, 41
klofensaid II, 8
klor-CON, 41
klor-CON 10, 41
klor-CON 8, 41
klor-CON m10, 41
Klor-CON M15, 42
klor-CON m20, 41
klor-CON sprinkle, 41
klor-CON/EF, 41
kls aspirin EC, 23, 42
kls aspirin low dose, 23, 42
kls quit2, 20, 46
kls quit4, 20, 46
Kmart Valu Plus Insulin
Syringe/0.3ML/30G, 35
Kmart Valu Plus Insulin
Syringe/0.5ML/29G, 35
Kmart Valu Plus Insulin
Syringe/0.5ML/30G, 35
Kmart Valu Plus Insulin
Syringe/1ML/29G, 35
Kmart Valu Plus Insulin
Syringe/1ML/30G, 35
Koate-dvi, 17
Kogenate FS, 17
Kogenate FS Bio-set, 17
Kombiglyze XR, 12
kp aspirin, 23, 42
kp ferrous gluconate, 16, 46
kp ferrous sulfate, 16, 46
kp folic acid, 16, 44
Kp Prenatal Multivitamins, 28, 45
kp vitamin d, 27, 47
Kroger Insulin Syringe/0.3ML/29G X 1/2",
35
Kroger Insulin Syringe/0.3ML/30G X
5/16", 35
Kroger Insulin Syringe/0.3ML/31G X
5/16", 35
Kroger Insulin Syringe/0.5ML/29G X 1/2",
35
Kroger Insulin Syringe/0.5ML/30G X
5/16", 35
Kroger Insulin Syringe/0.5ML/31G X
5/16", 35
Kroger Insulin Syringe/1ML/29G X 1/2",
35
Kroger Insulin Syringe/1ML/30G X 5/16",
35
Kroger Insulin Syringe/1ML/31G X 5/16",
35
Kroger Lancets, 30
Kroger Lancets 21G, 30
Kroger Lancets Micro Thin33G, 30
Kroger Lancets Super Thin, 30
Kroger Lancets Thin, 30
Kroger Lancets Thin 26G, 30
Kroger Lancets Ultrathin 30G, 30
Kroger Lancing Device, 35
Kroger Pen Needles 29G X 12MM, 35
Kroger Pen Needles 31G X 8MM, 35
Kroger Pen Needles 31GX1/4", 35
Krystexxa, 24
kurvelo, 11, 43
Kuvan, 13
Kyprolis, 5
L
l-cysteine HCL, 41
labetalol HCL, 6
Lacrisert, 21
lactated ringers, 41
lactated ringers dextrose 5% viaflex, 41
lactated ringers irrigation, 41
lactated ringers viaflex, 41
lactic acid, 9
lactic acid e, 9
lactic acid w/vitamin e, 9
lactulose, 14(2)
Lamictal, 19
Lamisil, 2
lamivudine, 2
lamivudine/zidovudine, 2
lamotrigine, 19
lamotrigine ER, 19
lamotrigine odt, 19
lamotrigine titration, 19
Lancet Device Adjustable, 35
Lancet Device With Ejector, 35
Lancet Transporter Case, 35
Lancets, 30
Lancets 26G Twist Top, 30
Lancets 28G, 30
Lancets 30G, 30
Lancets 30G Twist Top, 30
Lancets 30G/Twist Top, 30
Lancets 31G Twist Top, 30
Lancets 33G Universal Design, 30
Lancets Bullseye Safety, 30
Lancets Micro Thin 33G, 30
Lancets Safety Seal 21G, 30
Lancets Safety Seal 26G, 30
Lancets Safety Seal 28G, 30
Lancets Safety Seal 30G, 30
Lancets Super Thin 28G, 30
Lancets Thin, 30
Lancets Twist Top, 30
Lancets Ultra Fine, 30
Lancets Ultra Thin, 30
Lancets Ultra Thin 30G, 30
Lancing Device, 36
Lancing Device Adjustable, 36
lanolin, 41
lansoprazole, 14
lansoprazole/amoxicillin/clarithromycin,
14
Lantus, 12
Lantus Solostar, 12
Lanzo, 36
larin 1.5/30, 11, 43
larin 1/20, 11, 43
larin 24 FE, 11, 43
larin FE 1.5/30, 11, 43
larin FE 1/20, 11, 43
Lastacaft, 22
latanoprost, 21
latrix, 9
Latuda, 19
layolis FE, 11, 43
Lazanda, 24
Leader Advanced Lancing Device, 36
Leader Insulin Syringe/0.3ML/29G X 1/2",
36
Leader Insulin Syringe/0.3ML/30G X
5/16", 36
Leader Insulin Syringe/0.3ML/31G X
5/16", 36
Leader Insulin Syringe/0.5ML/28G X 1/2",
36
Leader Insulin Syringe/0.5ML/29G X 1/2",
36
Leader Insulin Syringe/0.5ML/30G X
5/16", 36
Leader Insulin Syringe/0.5ML/31G X
5/16", 36
Leader Insulin Syringe/1ML/28G X 1/2",
36
Leader Insulin Syringe/1ML/29G X 1/2",
36
Leader Insulin Syringe/1ML/30G X 5/16",
36
Leader Insulin Syringe/1ML/31G X 5/16",
36
Leader Lancets Colored, 30
Leader Super Thin Lancet, 30
Leader Thin Lancets, 30
Leader Unifine Pentips
Plus/Mini/31GX3/16", 36
Leader Unifine Pentips
Plus/SHORT/31GX5/16", 36
Leader Unifine Pentips/Mini/31GX3/16",
36
Leader Unifine Pentips/Nano/32GX5/32",
36
Leader Unifine Pentips/Plus/32GX5/32",
36
leena, 11, 43
leflunomide, 24
Lemtrada, 20
Lenvima 10MG Daily Dose, 5
Lenvima 14MG Daily Dose, 5
Lenvima 20MG Daily Dose, 5
Lenvima 24MG Daily Dose, 5
lessina, 11, 43
Letairis, 7
letrozole, 4
leucovorin calcium, 5
Leucovorin Calcium, 5
Leukeran, 3
Leukine, 17
leuprolide acetate, 4
levalbuterol, 25
levalbuterol HCL, 25
Levatol, 6
Levemir, 12
Levemir Flexpen, 12
Levemir Flextouch, 12
levetiracetam, 19
levetiracetam ER, 19
levo-t, 13
levobunolol HCL, 21
levocarnitine, 13
levocetirizine dihydrochloride, 25
levofloxacin, 1, 21
levofloxacin IN D5W, 1
levoleucovorin, 5
Levoleucovorin, 5
levoleucovorin calcium, 5
levonest, 11, 43
levonorgestrel, 11, 43
Levonorgestrel, 11, 44
levonorgestrel and ethinyl estradiol, 11,
43
levonorgestrel/ethinyl estradiol, 11, 43
levora 0.15/30-28, 11, 43
Levorphanol Tartrate, 24
levothyroxine sodium, 13
levoxyl, 13
Lexiva, 2
Lialda, 15
Liberty Blood Glucose Meter, 30
Liberty Glucose Control Mid, 30
Liberty Glucose Control Normal, 30
Liberty Medical Lancets 30G, 30
Liberty Mini Lancing Device, 30
Liberty Test Strips, 30
lidazone HC, 14
lidenza patch, 9
lidocaine, 9
lidocaine HCL, 6, 9, 24
lidocaine HCL IN D5W, 6
lidocaine HCL jelly, 9
lidocaine HCL viscous, 18
lidocaine HCL/dextrose, 6
lidocaine HCL/hydrocortisone acetate, 14
lidocaine viscous, 18
lidocaine-prilocaine-cream base, 9
lidocaine/epinephrine, 24
lidocaine/prilocaine, 9
lidodextrapine, 9
lidopin, 9
Lifescan Unistik 2 Deep Penetration, 30
Lifescan Unistik II Lancets, 30
Liletta, 11, 44
lincomycin HCL, 3
lindane, 9
linezolid, 3
Linezolid, 3
Linzess, 15
liothyronine sodium, 13
lipodox, 3
lipodox 50, 3
liposyn iii, 41
lisinopril, 6
lisinopril/hydrochlorothiazide, 7
lissamine green, 22
Lite Touch Lancets, 30
Lite Touch Lancing Device, 36
Lite Touch Lancing Pen, 36
Lite Touch Pen Needles/31G X 3/16", 36
Liteaire, 40
Litetouch Insulin Syringe/0.3ML/29G X
1/2", 36
Litetouch Insulin Syringe/0.3ML/30G X
5/16", 36
Litetouch Insulin Syringe/0.3ML/31G X
5/16", 36
Litetouch Insulin Syringe/0.5ML/30G X
5/16", 36
Litetouch Insulin Syringe/0.5ML/31G X
5/16", 36
Litetouch Insulin Syringe/1ML/30G X
5/16", 36
Litetouch Insulin Syringe/U100/0.5ML/28G X 1/2", 36
Litetouch Insulin Syringe/U100/0.5ML/29G X 1/2", 36
Litetouch Insulin Syringe/U-100/1ML/28G
X 1/2", 36
Litetouch Insulin Syringe/U-100/1ML/29G
X 1/2", 36
Litetouch Insulin Syringe/U-100/1ML/31G
X 5/16", 36
Litetouch Lancets Micro Thin 33G, 30
Litetouch Pen Needles 29GX12.7MM, 36
Litetouch Pen Needles 31G X 6MM, 36
Litetouch Pen Needles 31GX8MM
SHORT, 36
Lithium, 19
lithium carbonate, 18
lithium carbonate ER, 18
Livalo, 7
Live Better Advanced Lancing Device, 36
Live Better Lancet Super Thin 30G, 30
Live Better Lancet Ultra Thin 28G, 30
Live Better Pen Needles 29G X 12MM,
36
Live Better Pen Needles 31G X 12MM,
36
Live Better Pen Needles 31G X 6MM, 36
livixil PAK, 9
LO Loestrin FE, 11, 44
Locoid, 9
lofene, 14
lokara, 9
lomedia 24 FE, 11, 43
Lomustine, 3
Longs Insulin Syringe/0.5ML/31G X 5/16",
36
Longs Lancets Standard, 30
Longs Lancets Thin, 30
Longs Lancets Ultra Thin, 30
Lonsurf, 5
loperamide HCL, 14
lopreeza, 10
lorazepam, 18
lorazepam intensol, 18
lorcet, 23
lorcet HD, 23
lorcet plus, 23
lorenza, 9
lortab, 23
loryna, 11, 43
Lorzone, 21
losartan potassium, 6
losartan potassium/hydrochlorothiazide,
7
Lotemax, 21
lovastatin, 7
low-ogestrel, 11, 43
loxapine, 18
loxapine succinate, 18
LP lite PAK, 10
Lucentis, 22
ludent, 41, 44
Lufyllin, 25
Lumigan, 21
Lumizyme, 13
Lupron Depot, 4
Lupron Depot-PED, 13
lutera, 11, 43
Lynparza, 5
Lyrica, 19
lysiplex plus, 27
Lysodren, 4
lyza, 11, 43
M
M-m-r II, 26, 45
M-vit, 28, 44
Macnatal CN DHA, 28
Macugen, 22
mafenide acetate, 9
Magellan Insulin Safety Syringe/U100/0.3ML/29G X 1/2", 36
Magellan Insulin Safety Syringe/U100/0.3ML/30G X 5/16", 36
Magellan Insulin Safety Syringe/U100/0.5ML/29G X 1/2", 36
Magellan Insulin Safety Syringe/U100/0.5ML/30G X 5/16", 36
Magellan Insulin Safety Syringe/U100/1ML/29G X 1/2", 36
Magellan Insulin Safety Syringe/U100/1ML/30G X 5/16", 36
magnesium chloride, 41
magnesium sulfate, 41
Makena, 12
malathion, 9
mannitol, 7
Maprotiline HCL, 18
margesic, 22
marlissa, 11, 43
Marplan, 18
Marqibo, 4
marten-TAB, 22
Mask Vortex/Baby Whirl Duckling, 40
Mask Vortex/Child/Frog, 40
Mask Vortex/Spinner The Duck, 40
Mask Vortex/Toddler/Lady Bug, 40
Matulane, 5
matzim LA, 6
Maxi-comfort Insulin Syringe/U100/0.5ML/28GX1/2", 36
Maxi-comfort Insulin Syringe/U100/1ML/28GX1/2", 36
maximum d3, 27, 47
Maxipime, 1
MD-gastroview, 41
me/naphos/mb/hyo 1, 15
meclizine HCL, 14
Meclofenamate Sodium, 24
Medic Insulin Syringe/0.3ML/30G X 5/16",
36
Medic Insulin Syringe/0.5ML/30G X 5/16",
36
Medical Provider EZ Flu Shot 2013-2014,
26, 45
Medical Provider EZ Flu Shot 2014-2015,
26, 45
Medical Provider EZ Flu Shot 2015-2016,
26, 45
Medical Provider EZ Flu Shot PF 20132014, 26, 45
Medical Provider EZ Flu Shot PF 20142015, 26, 45
Medical Provider Single Use EZ Flu Shot,
26, 45
Medichoice Pre-set Safety Lancet Dual
Use, 30
Medichoice Pre-set Safety Lancet Low
Flow, 30
Medichoice Pre-set Safety Lancet
Medium Flow, 30
Medichoice Pre-set Safety Lancet
Moderate Flow, 30
Medichoice Safety Lancet Extra, 30
Medichoice Safety Lancet Normal, 30
Medicine Shoppe Lancets, 30
Medicine Shoppe Lancets Thin, 30
Medicine Shoppe Pen Needles 29G X
12MM, 36
Medicine Shoppe Pen Needles 31G X
6MM, 36
Medicine Shoppe Pen Needles 31G X
8MM, 36
Medisense Thin Lancets, 30
Medlance Plus Extra Lancets 21G, 30
Medlance Plus Lancets, 30
Medlance Plus Lancets Lite 25G, 30
Medlance Plus Lite Lancets 25G, 30
Medlance Plus Special Lancets 0.8MM,
30
Medlance Plus Superlite 30G, 30
Medlance Plus Superlite 30G/Comfort
Max, 30
Medlance Plus Universal Lancets 21G,
30
Medlance Plus/Lite 25G, 30
Medlance/Extra, 30
Medlance/Lite, 30
Medlance/Universal, 31
medroxyprogesterone acetate, 11, 12, 43
mefenamic acid, 24
mefloquine HCL, 3
Mefoxin, 1
mega-c/a plus, 26
megestrol acetate, 4, 12
Meijer Alcohol Swabs Extra-thick, 40
meijer aspirin EC, 23, 42
Meijer Color Lancets Universal 33G, 31
meijer ferrous sulfate, 16, 46
Meijer Lancets, 31
Meijer Lancets Thin, 31
Meijer Lancets Universal 33G, 31
Meijer Pen Needles 29G X 12MM, 36
Meijer Pen Needles 31G X 6MM, 36
Meijer Pen Needles 31G X 8MM, 36
Meijer Super Thin Lancets, 31
Mekinist, 5
meloxicam, 24
melphalan hydrochloride, 3
memantine HCL, 20
memantine HCL titration PAK, 20
memantine hydrochloride, 20
Menactra, 26, 45
Menest, 10
Menhibrix, 26
Menomune-a/C/Y/W-135, 26, 45
Mentax, 8
Menveo, 26, 45
meperidine HCL, 23
Mephyton, 27
meprobamate, 18
mercaptopurine, 3
meropenem, 3
mesalamine, 14
mesna, 5
Mesnex, 5
Mestinon, 21
metadate ER, 19
Metaproterenol Sulfate, 25
metaxall, 21
metaxalone, 21
Metaxalone, 21
metformin HCL, 12
metformin HCL ER, 12
methadone HCL, 23
methadone HCL intensol, 23
methadose, 23
methamphetamine HCL, 19
methazolamide, 7
methenamine hippurate, 15
methenamine mandelate, 15
methergine, 22
methimazole, 13
Methitest, 10
methocarbamol, 21
methotrexate, 4
methotrexate sodium, 4
Methotrexate Sodium, 4
methoxsalen, 8
methscopolamine bromide, 14
Methyclothiazide, 7
methyldopa, 6
Methyldopate HCL, 6
methylene blue, 41
methylergonovine maleate, 22
methylphenidate HCL, 19
methylphenidate HCL CD, 19
methylphenidate HCL ER, 19
Methylphenidate HCL ER, 19
methylphenidate HCL SR, 19
methylphenidate hydrochloride, 19
methylprednisolone, 10
methylprednisolone acetate, 10
methylprednisolone dose pack, 10
methylprednisolone sodiumsuccinate, 10
methyltestosterone, 10
Metipranolol, 21
metoclopramide HCL, 14
metoclopramide odt, 14
metolazone, 7
metoprolol succinate ER, 6
metoprolol tartrate, 6
Metoprolol Tartrate, 6
metoprolol/hydrochlorothiazide, 7
metronidazole, 3, 8
metronidazole IN NACL 0.79%, 3
metronidazole vaginal, 15
mexiletine HCL, 6
Miacalcin, 13
Micrhogam Ultra-filtered Plus, 42
Microchamber, 40
microgestin 1.5/30, 11, 43
microgestin 1/20, 11, 43
microgestin 24 FE, 11, 43
microgestin FE, 11, 43
microgestin FE 1.5/30, 11, 43
Microlet Lancets, 31
micronized colestipol HCL, 7
Microspacer, 40
Microtainer Safety Flow
Lancet/Sterile/Single-use, 31
midodrine HCL, 7
migryl, 9
milrinone IN dextrose, 5
milrinone lactate, 5
mimvey, 10
mimvey LO, 10
Minastrin 24 FE, 11, 44
Mini Lancing Device, 36
miniprin low dose, 23, 42
minitran, 5
minocycline HCL, 1
minocycline HCL ER, 1
minoxidil, 6
Mirapex ER, 20
Mirena, 11, 44
mirtazapine, 18
mirtazapine odt, 18
misoprostol, 14
Mission Prenatal, 28, 45
Mission Prenatal HP, 28, 44
mitomycin, 3
Mitomycin, 3
mitoxantrone HCL, 3
MM aspirin, 23, 43
modafinil, 19
moderiba, 2
Moderiba, 2
Moderiba 1200 Dose Pack, 2
Moderiba 800 Dose Pack, 2
moexipril HCL, 6
moexipril/hydrochlorothiazide, 7
Molindone Hydrochloride, 19
mometasone furoate, 9, 25
mondoxyne nl, 1
mono-linyah, 11, 43
Monoclate-p, 17
Monoject Insulin Syringe Regular LUER
Tip/Softpack/1ML, 36
Monoject Insulin Syringe/1ML, 36
Monoject Insulin Syringe/1ML/31G X
5/16", 36
Monoject Insulin Syringe/Detach
Needle/1ML/25G X 5/8", 36
Monoject Insulin Syringe/Detach
Needle/1ML/27G X 1/2", 36
Monoject Insulin Syringe/Perm
Needle/1ML/28G X 1/2", 36
Monoject Insulin Syringe/Perm Needle/U100/0.5ML/28G X 1/2", 36
Monoject Insulin Syringe/Safety/Perm
Needle/0.3ML/29G X 1/2", 36
Monoject Insulin Syringe/Safety/Perm
Needle/0.3ML/29GX1/2", 36
Monoject Insulin Syringe/Safety/Perm
Needle/0.5ML/29G X 1/2", 36
Monoject Insulin Syringe/Safety/Perm
Needle/1ML/29G X 1/2", 36
Monoject Insulin
Syringe/Softpack/1ML/27G X 1/2", 36
Monoject Insulin Syringe/Softpack/U100/0.5ML/28G X 1/2", 36
Monoject Insulin Syringe/U100/0.3ML/30G X 5/16", 36
Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 36
Monoject Insulin Syringe/U100/0.5ML/30G X 5/16", 36
Monoject Insulin Syringe/U-100/1ML/28G
X 1/2", 36
Monoject Insulin Syringe/U-100/1ML/30G
X 5/16", 36
monoject pharma grade flush syringe, 41
monoject pharma grade flush
syringe/heparin lock, 17
monoject prefill advanced heparin lock
flush, 17
monoject sodium chloride flush, 41
Monoject Ultra Comfort Insulin
Syringe/0.3ML/29G X 1/2", 36
Monoject Ultra Comfort Insulin
Syringe/0.3ML/30G X 5/16", 36
Monoject Ultra Comfort Insulin
Syringe/0.3ML/31G X 5/16", 36
Monoject Ultra Comfort Insulin
Syringe/0.5ML/28G X 1/2", 36
Monoject Ultra Comfort Insulin
Syringe/0.5ML/29G X 1/2", 36
Monoject Ultra Comfort Insulin
Syringe/0.5ML/30G X 5/16", 36
Monoject Ultra Comfort Insulin
Syringe/0.5ML/31G X 5/16", 36
Monoject Ultra Comfort Insulin
Syringe/1ML/28G X 1/2", 36
Monoject Ultra Comfort Insulin
Syringe/1ML/29G X 1/2", 36
Monoject Ultra Comfort Insulin
Syringe/1ML/30G X 5/16", 36
Monojector End CAPS, 36
Monojector Opd End CAPS, 36
Monolet Lancets, 31
Monolet Opd Lancets, 31
Monolettor Safety Lancets, 31
mononessa, 11, 43
Mononine, 17
Monovisc, 21
montelukast sodium, 25
Monurol, 15
Moore MED Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 36
Moore MED Monoject Insulin Syringe/U100/0.5ML/29G X 1/2", 36
Moore MED Monoject Insulin Syringe/U100/1ML/28G X 1/2", 36
Moore MED Monoject Insulin Syringe/U100/1ML/29G X 1/2", 36
morgidox 1X100MG, 1
morgidox 2X100MG, 1
morphine sulfate, 23
Morphine Sulfate, 24
morphine sulfate ER, 23
Morphine Sulfate ER, 24
morrhuate sodium, 41
Moviprep, 14
Moxatag, 1
Moxeza, 21
moxifloxacin HCL, 1
Mozobil, 17
MS Insulin Syringe/0.3ML/29G X 1/2", 36
MS Insulin Syringe/0.3ML/30G X 5/16",
36
MS Insulin Syringe/0.3ML/31G X 5/16",
36
MS Insulin Syringe/0.5ML/29G X 1/2", 36
MS Insulin Syringe/0.5ML/30G X 5/16",
36
MS Insulin Syringe/0.5ML/31G X 5/16",
36
MS Insulin Syringe/1ML/29G X 1/2", 36
MS Insulin Syringe/1ML/30G X 5/16", 36
MS Insulin Syringe/1ML/31G X 5/16", 36
mult-vitamin/fluoride, 27
Multaq, 6
Multi Prenatal, 28, 44
multi vitamin/fluoride, 27
Multi-lancet Device, 36
Multi-lancet Device 2, 36
multi-vit/fluoride, 27
multi-vit/iron/fluoride, 27
multi-vitamin/fluoride, 27
multi-vitamin/fluoride/iron, 27
multitrace-4 concentrate, 41
multitrace-5 concentrate, 41
multivitamin with fluoride, 27
multivitamin/fluoride, 27
multivitamins/fluoride, 27
mupirocin, 8
mupirocin calcium, 8
Mustargen, 3
MVC-fluoride, 28
my way, 11, 43
Myalept, 13
Mycamine, 2
mycophenolate mofetil, 4
mycophenolic acid DR, 4
mydral, 22
myferon 150, 16, 46
myferon 150 forte, 16
Myglucohealth Mgh Softlance Lancets
30G, 31
Mykidz Iron 10, 17, 46
Myleran, 3
Mynatal Advance, 28
Mynatal Plus, 28
Mynatal Ultracaplet, 28
Mynatal-z, 28
Mynate 90 Plus, 28
mynephrocaps, 27
Myobloc, 21
myorisan, 8
Myozyme, 13
Myrbetriq, 15
myzilra, 11, 43
N
n-acetyl-l-cysteine, 41
Nabi-HB, 42
nabumetone, 24
nadolol, 6
nadolol/bendroflumethiazide, 7
nafcillin sodium, 1
nafrinse, 41, 44
nafrinse drops, 41, 44
naftifine hydrochloride, 8
Naglazyme, 13
nalbuphine HCL, 23
Nalfon, 24
naloxone HCL, 41
Naloxone HCL, 41
naltrexone HCL, 41
Namenda XR, 20
Namenda XR Titration Pack, 20
Naprelan, 24
naproxen, 24
Naproxen, 24
naproxen DR, 24
naproxen kit, 24
naproxen sodium, 24
naproxen sodium CR, 24
naproxen sodium ER, 24
naratriptan HCL, 24
Narcan, 42
Nascobal, 16
Nat-rul Prenatal Vitamins, 28, 45
nat-rul vitamin d, 27, 47
Natacyn, 21
Natazia, 11, 44
nateglinide, 12
natural vitamin d-3, 27, 47
Nebupent, 3
nebusal, 25
necon 0.5/35-28, 11, 43
necon 1/35, 11, 43
necon 7/7/7, 11, 43
nefazodone HCL, 18
Nefazodone HCL, 18
neo-polycin, 21
neo-polycin HC, 21
Neo-synalar, 8
neofrin, 22
neomycin sulfate, 2
neomycin/bacitracin/polymyxin, 21
neomycin/polymyxin b sulfates, 15
neomycin/polymyxin/bacitracin zinc, 21
neomycin/polymyxin/bacitracin/hydrocorti
sone, 21
neomycin/polymyxin/dexamethasone, 21
neomycin/polymyxin/gramicidin, 21
neomycin/polymyxin/HC, 22
neomycin/polymyxin/hydrocortisone, 22
neostigmine methylsulfate, 21
nephronex, 27
Nessi Spacer/Large Mask, 40
Nessi Spacer/Mouthpiece, 40
Nessi Spacer/Small/MED Mask, 40
Netgroup Lancets, 31
neuac, 8
Neulasta, 17
Neulasta Onpro Kit, 17
Neumega, 17
Neupogen, 17
Neupro, 20
neutragard advanced, 18
neutral sodium fluoride, 18
Nevanac, 22
nevirapine, 2
Nevirapine, 2
nevirapine ER, 2
Nexavar, 5
Nexium, 14
Nexplanon, 11, 44
next choice one dose, 11, 43
Nexterone, 6
niacin ER, 7
niacinamide/azelaic ac/ turmer/fa/b6/zinc
ox/copper, 27
nicardipine HCL, 6
nicorelief, 20, 46
nicotine, 20, 46
nicotine mini lozenge, 20, 46
nicotine polacrilex, 20, 46
nicotine polacrilex refill, 20, 46
nicotine polacrilex starter kit, 20, 46
nicotine step 1, 20, 46
nicotine step 2, 20, 46
nicotine step 3, 20, 46
nicotine transdermal system, 20, 46
Nicotine Transdermal System, 20, 46
nicotine transdermal system step 1, 20,
46
nicotine transdermal system step 2, 20,
46
nicotine transdermal system step 3, 20,
46
Nicotrol Inhaler, 20, 46
Nicotrol Ns, 20, 46
nifedical XL, 6
nifedipine, 6
nifedipine ER, 6
nikki, 11, 43
Nilandron, 4
nimodipine, 6
Ninlaro, 5
Nipent, 5
nisoldipine, 6
Nitro-bid, 5
nitro-time, 5
nitrofurantoin, 15
nitrofurantoin macrocrystals, 15
nitrofurantoin monohydrate, 15
nitrofurantoin
monohydrate/macrocrystals, 15
nitroglycerin ER, 5
nitroglycerin IN 5% dextrose, 5
nitroglycerin IN dextrose 5%, 5
nitroglycerin lingual, 5
Nitroglycerin Lingual, 5
nitroglycerin transdermal, 5
Nitromist, 5
Nitrostat, 5
nizatidine, 14
Nizatidine, 14
nora-be, 11, 43
Norditropin Cartridge, 13
Norditropin Flexpro, 13
Norditropin Nordiflex Pen, 13
norepinephrine bitartrate, 7
norethindrone, 11, 43
norethindrone & ethinyl estradiol ferrous
fumarate, 11, 43
norethindrone acetate, 12
norethindrone acetate/ethinyl estradiol,
10, 11, 43
norethindrone acetate/ethinyl
estradiol/ferrous fumarate, 11, 43
norgestimate/ethinyl estradiol, 11, 43
norlyroc, 11, 43
normal saline flush, 41
normal saline flush for flushing vascular
access devices, 41
normal saline i.v. flush, 41
Noroxin, 1
Norpace CR, 6
nortrel 0.5/35 (28), 11, 43
nortrel 1/35, 11, 43
nortrel 7/7/7, 11, 43
nortriptyline HCL, 18
Nortriptyline HCL, 18
nortuss-DE, 25
Norvir, 2
norwich aspirin, 23, 42
Nova Safety Lancets 23G, 31
Nova Safety Lancets 28G, 31
Nova Sureflex Lancets, 31
Nova Sureflex Lancing Device, 36
Novaferrum Pediatric Drops, 17, 46
novarel, 13
Novofine 30GX8MM, 36
Novofine 32GX6MM, 36
Novofine Autocover 30GX8MM, 36
Novofine Plus 32GX4MM, 36
Novolin 70/30, 12
Novolin 70/30 Relion, 12
Novolin N, 12
Novolin N Relion, 12
Novolin R, 12
Novolin R Relion, 12
Novolog, 12
Novolog Flexpen, 12
Novolog Mix 70/30, 12
Novolog Mix 70/30 Prefilled Flexpen, 12
Novolog Penfill, 12
Novoseven, 17
Novoseven Rt, 17
Novotwist 30GX8MM, 36
Novotwist 32GX5MM, 36
Noxafil, 2
NP thyroid, 13
NP thyroid 60, 13
NP thyroid 90, 13
Nplate, 17
nu-iron 150, 16, 46
Nucala, 25
Nucynta, 24
Nucynta ER, 24
Nuedexta, 20
nufol, 16
nulev, 14
Nulojix, 4
nutrifac ZX, 27
nutrilipid, 41
nutrilyte, 41
nutrilyte II, 41
Nutropin AQ Nuspin 10, 13
Nutropin AQ Nuspin 20, 13
Nutropin AQ Nuspin 5, 13
Nutropin AQ Pen, 13
Nuvaring, 11, 44
Nuvigil, 19
nyamyc, 8
nystatin, 2, 8, 18
nystatin/triamcinolone, 8
nystop, 8
O
Obizur, 17
Obstetrix EC, 28
ocella, 11, 43
Octagam, 42
octreotide acetate, 13
Ofev, 26
ofloxacin, 1, 21, 22
Ofloxacin, 1
Ogestrel, 11, 44
olanzapine, 18
olanzapine odt, 18
olanzapine/fluoxetine, 20
olopatadine HCL, 22, 25
Omeclamox-PAK, 14
omega-3-acid ethyl esters, 7
omeprazole, 14
omeprazole/sodium bicarbonate, 14
Omniflex Diaphragm, 44
On Call Lancets, 31
On Call Lancing Device, 36
On Call Plus Lancets, 31
On Call Plus Lancing Device, 36
Oncaspar, 3
ondansetron HCL, 14
ondansetron odt, 14
One A Day Womens Prenatal/DHA, 28
One A Day Womens Prenatal1, 28
One-a-day Womens Prenatal, 28, 45
Onetouch Club Lancets Fine Point, 31
Onetouch Combo Pack, 31
Onetouch Delica Lancets Extra Fine 33G,
31
Onetouch Delica Lancets Fine 30G, 31
Onetouch Delica Lancing Device, 31
Onetouch Finepoint Lancets, 31
Onetouch Lancets, 31
Onetouch Ping Meter Remote, 31
Onetouch Suresoft Lancing Device/18G,
31
Onetouch Suresoft Lancing Device/21G,
31
Onetouch Suresoft Lancing Device/28G,
31
Onetouch Ultra 2, 31
Onetouch Ultra Blue, 31
Onetouch Ultra Control, 31
Onetouch Ultra Mini, 31
Onetouch Ultralink System (DEC), 31
Onetouch Ultralink System (hex), 31
Onetouch Ultrasoft Lancets, 31
Onetouch Verio, 31
Onetouch Verio Control Solution High,
31
Onetouch Verio Flex Bloodglucose
Monitoring System, 31
Onetouch Verio IQ Blood Glucose
Monitoring System, 31
Onetouch Verio Mid Control Solution, 31
Onetouch Verio Sync Bloodglucose
Monitoring System, 31
Onetouch Verio Test Strips, 31
Onfi, 19
Onglyza, 12
Onivyde, 5
Opana ER (crush Resistant), 24
opcicon one-step, 11, 43
Opdivo, 4
opium, 14
opium tincture, 14
Opsumit, 7
Optichamber Advantage, 40
Optichamber Diamond, 40
Optichamber Diamond/Largeface Mask,
40
Optichamber Diamond/Medium Face
Mask, 40
Optichamber Diamond/Smallface Mask,
40
Optihaler, 40
Optihaler MDI Drug Delivery System, 40
Optimal D3 M, 27, 47
optimal-d, 27, 47
optimal-d pack, 27, 47
Options Gynol II Vaginal Contraceptive,
15, 44
opurity vitamin d, 27, 47
Oracea, 8
oralone, 18
Oravig, 18
Orencia, 24
Orenitram, 7
Orfadin, 13
orphenadrine citrate, 21
orphenadrine citrate ER, 21
Orphenadrine/Asa/Caffeine, 21
orsythia, 11, 43
Ortho Diaphragm Coil Spring Kit 100, 44
Ortho Diaphragm Coil Spring Kit 105, 44
Ortho Diaphragm Coil Spring Kit 50, 44
Ortho Diaphragm Flat Spring Kit 55, 44
Ortho Diaphragm Flat Spring Kit 60, 44
Ortho Diaphragm Flat Spring Kit 65, 44
Ortho Diaphragm Flat Spring Kit 70, 44
Ortho Diaphragm Flat Spring Kit 75, 44
Ortho Diaphragm Flat Spring Kit 80, 44
Ortho Diaphragm Flat Spring Kit 85, 44
Ortho Diaphragm Flat Spring Kit 90, 44
Ortho Diaphragm Flat Spring Kit 95, 44
ortho-CS 250, 26
ortho-est, 10
Orthovisc, 21
oscimin, 14
oscimin SR, 14
oscion cleanser, 8
osmitrol viaflex, 7
Osmoprep, 14
otic care, 22
oticin, 22
oxacillin sodium, 1
oxaliplatin, 3
oxandrolone, 10
oxaprozin, 24
Oxaydo, 24
oxazepam, 18
oxcarbazepine, 19
oxiconazole nitrate, 8
Oxistat, 8
Oxsoralen, 10
oxybutynin chloride, 15
oxybutynin chloride ER, 15
oxycodone HCL, 23
Oxycodone HCL ER, 24
oxycodone/acetaminophen, 23
oxycodone/aspirin, 23
oxycodone/ibuprofen, 23
Oxycontin, 24
oxymorphone hydrochloride, 23
oxymorphone hydrochloride ER, 23
oxytocin, 22
Oxytrol, 15
Ozurdex, 21
P
PA Prenatal Formula, 28, 45
PA vitamin d-3, 27, 47
PA vitamin d-3 gummy, 27, 47
pacerone, 6
paclitaxel, 4
Paclitaxel, 4
paliperidone ER, 18
pamidronate disodium, 12
Pamidronate Disodium, 12
Pancrelipase, 14
pancuronium bromide, 21
Panda Mask Large, 40
Panda Mask Medium, 40
Panda Mask Small, 40
Panretin, 10
pantoprazole sodium, 14
papaverine HCL, 7
Paragard Intrauterine Copper
Contraceptive T380a, 11
parcaine, 22
paricalcitol, 13
paroex, 18
paromomycin sulfate, 2
paroxetine HCL, 18
paroxetine HCL ER, 18
Paser, 2
Pataday, 22
Paxil, 18
PC Unifine Pentips 29G X 1/2", 37
PC Unifine Pentips 31G X 5MM Mini, 37
PC Unifine Pentips 31G X 6MM Ultra
SHORT, 37
PC Unifine Pentips 31G X 8MM SHORT,
37
PCE, 1
pedi-dri, 8
Pediarix, 26, 45
Pediatric Panda Mask, 40
Pedipirox-4 Nail, 8
Pedvax HIB, 26, 45
peg 3350/electrolytes, 14, 47
peg-3350/electrolytes, 14, 47
peg-3350/NACL/NA bicarbonate/KCL,
14, 47
Peg-intron, 2
Peg-intron Redipen, 2
Peg-intron Redipen PAK 4, 2
peg-prep, 14
Peganone, 19
Pegasys, 2
Pegasys Proclick, 2
Pegintron, 2
pegylax, 14
Pen Needles 29G X 12MM, 36
Pen Needles 29GX1/2", 36
Pen Needles 30GX5/16", 36
Pen Needles 31G X 1/4" SHORT, 36
Pen Needles 31G X 3/16", 36
Pen Needles 31G X 5MM, 36
Pen Needles 31G X 6MM, 36
Pen Needles 31GX5/16", 36
Pen Needles 31GX8MM, 36
Pen Needles 32GX4MM, 36
penicillin G potassium, 1
penicillin v potassium, 1
Penlet II Automatic Bloodsampler, 31
Penlet II Replacement CAPS, 31
Penlet II Replacement CAPS-deep, 31
Penlet II Replacement CAPS-regular, 31
Pentacel, 26, 45
Pentasa, 15
pentazocine/naloxone HCL, 24
Pentips 31GX5MM, 37
Pentips 31GX8MM, 37
Pentips 32GX4MM, 37
pentoxifylline ER, 17
Perfect Iron, 17, 46
Perfect Lancets 30G, 31
Perfect Pressure Activated Safety
Lancets 28G, 31
Perforomist, 25
perindopril erbumine, 6
periogard, 18
Perjeta, 4
permethrin, 9
perphenazine, 18
Perphenazine/Amitriptyline, 20
Perry Prenatal, 28, 44
pharbedryl, 25
Pharmacist Choice Alcoholprep Pads, 40
Pharmacist Choice Ultra Thin Lancets,
31
Pharmacist Choice Ultra Thin Lancets
28G, 31
Pharmacist Choice Ultra Thin Lancets
30G, 31
Pharmacist Choice Ultra Thin Lancets
31G, 31
Pharmacist Choice Ultra Thin Lancets
33G, 31
Pharmacy Counter Lancets, 31
phenadoz, 25
phenazo, 15
phenazopyridine HCL, 15
phenelzine sulfate, 18
phenergan, 25
phenobarbital, 19
Phenobarbital, 19
Phenobarbital Sodium, 19
phenoxybenzamine hydrochloride, 6
phenylephrine HCL, 7, 22
phenylephrine/guaifenesin, 25
phenytoin, 19
phenytoin infatabs, 19
phenytoin sodium, 19
phenytoin sodium extended, 19
philith, 11, 43
phos-flur, 18
Phoslyra, 15
phospha 250 neutral, 41
phosphasal, 15
Phospholine Iodide, 22
Photofrin, 5
physiolyte, 41
physiosol irrigation, 41
phytonadione, 26
Picato, 10
pilocarpine HCL, 18, 22
pilocarpine hydrochloride, 18
pimozide, 20
pimtrea, 11, 43
pindolol, 6
pioglitazone HCL, 12
pioglitazone HCL-glimepiride, 12
pioglitazone HCL/metformin HCL, 12
piperacillin sodium/ tazobactam sodium,
1
piperacillin sodium/tazobactam sodium, 1
piperacillin/tazobactam, 1
pirmella 1/35, 11, 43
pirmella 7/7/7, 11, 43
piroxicam, 24
plasbumin-25, 17
plasbumin-5, 17
Plasma-lyte A, 42
Plasma-lyte-148, 42
Plasma-lyte-56/D5W, 42
plenamine, 41
Pneumovax 23, 26, 45
Pneumovax 23/1 Dose, 26, 45
Pneumovax 23/5 Dose, 26, 45
PNV-DHA, 28
PNV-select, 28
Pocket Chamber, 40
Pocket Spacer, 40
podofilox, 9
polocaine, 24
polocaine-mpf, 24
poly-dex, 21
poly-iron 150, 16, 46
poly-iron 150 forte, 16
polycin, 21
polycin b, 21
polyethylene glycol 3350, 14
polymyxin b sulfate, 3
polymyxin b sulfate/trimethoprim sulfate,
21
polysaccharide iron forte, 16
Pomalyst, 4
portia-28, 11, 43
Portrazza, 4
potassium acetate, 41
potassium chloride, 41
potassium chloride 0.15% /NACL 0.45%
viaflex, 41
potassium chloride 0.15% D5W/NACL
0.33%, 41
potassium chloride 0.15% D5W/NACL
0.45%, 41
potassium chloride 0.15% D5W/NACL
0.45% viaflex, 41
potassium chloride 0.15% NACL 0.9%,
41
potassium chloride 0.15% w/NACL 0.9%
viaflex, 41
potassium chloride 0.15%/D5W, 41
potassium chloride 0.15%/NACL 0.9%,
41
potassium chloride 0.22% D5W/NACL
0.45%, 41
potassium chloride 0.224%/D5W/NACL
0.45%, 41
potassium chloride 0.224%D5W/NACL
0.45% viaflex, 41
potassium chloride 0.3%/ NACL 0.9%,
41
potassium chloride 0.3%/D5W, 41
potassium chloride 0.3%/NACL
0.9%/viaflex, 41
potassium chloride CR, 41
potassium chloride ER, 41
Potassium Chloride ER, 41
potassium chloride SR, 41
potassium citrate ER, 15
potassium citrate-citric acid crystals, 15
potassium citrate/citric acid, 15
potassium citrate/sodium citrate/citric
acid, 15
potassium phosphate, 41
potassium phosphates, 41
Potiga, 19
pr benzoyl peroxide wash, 8
Pr Natal 400, 28
Pr Natal 400 EC, 28
Pr Natal 430, 28
Pr Natal 430 EC, 28
Pradaxa, 17
Praluent, 7
pramcort, 14
pramipexole dihydrochloride, 20
pramipexole dihydrochloride ER, 20
pramox gel, 9
prascion, 8
prascion fc, 8
pravastatin sodium, 7
prazosin HCL, 6
Pre-natal Formula, 28, 44
Precision Sure-dose Insulin
Syringe/0.3ML/30G X 5/16", 37
Precision Sure-dose Insulin
Syringe/0.5ML/28G X 1/2", 37
Precision Sure-dose Insulin
Syringe/0.5ML/29G X 1/2", 37
Precision Sure-dose Insulin
Syringe/0.5ML/30G X 3/8", 37
Precision Sure-dose Insulin
Syringe/1ML/28G X 1/2", 37
Precision Sure-dose Plus Insulin
Syringe/0.3ML/29G X 1/2", 37
Precision Sure-dose Plus Insulin
Syringe/1ML/29G X 1/2", 37
Precision Thin Lancets, 31
Precision Thins GP Lancet, 31
Precision Ultra Lancet, 31
Pred Mild, 21
prednicarbate, 9
prednisolone, 10
prednisolone acetate, 21
prednisolone sodium phosphate, 10
prednisolone sodium phosphate odt, 10
prednisone, 10
Prednisone, 10
Prednisone Intensol, 10
Preferred Plus Insulin Syringe/U100/0.3ML/29G X 1/2", 37
Preferred Plus Insulin Syringe/U100/0.3ML/30G X 5/16", 37
Preferred Plus Insulin Syringe/U100/0.5ML/28G X 1/2", 37
Preferred Plus Insulin Syringe/U100/0.5ML/29G X 1/2", 37
Preferred Plus Insulin Syringe/U100/0.5ML/30G X 5/16", 37
Preferred Plus Insulin Syringe/U100/1ML/28G X 1/2", 37
Preferred Plus Insulin Syringe/U100/1ML/29G X 1/2", 37
Preferred Plus Insulin Syringe/U100/1ML/30G X 5/16", 37
Preferred Plus Lancets Colored 21G, 31
Preferred Plus Lancets Super Thin 30G,
31
Preferred Plus Lancets Thin 26G, 31
Preferred Plus Unifine Pentips 29G X
12MM, 37
Preferred Plus Unifine Pentips 31G X
6MM Ultra SHORT, 37
Preferred Plus Unifine Pentips 31G X
8MM SHORT, 37
Preferred Plus Unifine Pentips
32GX4MM, 37
Preferred Plus Unifine
Pentips/Mini/31GX5MM, 37
pregnyl w/diluent benzyl alcohol/NACL,
13
Premarin, 10
premasol, 41
premium lidocaine, 9
Premphase, 10
Prempro, 10
Prenaissance Plus, 28
Prenaplus, 28, 44
Prenatabs Fa, 28
Prenatabs RX, 28
Prenatal, 28, 44
Prenatal 19, 28
Prenatal Ad, 28
Prenatal And Iron, 28, 44
Prenatal Complete, 28, 45
Prenatal Formula, 28, 44
Prenatal Forte, 28, 44
Prenatal Low Iron, 28, 44
Prenatal Multi + DHA, 28
Prenatal Multi +dha, 28, 45
Prenatal Multivitamin + DHA, 28
Prenatal Multivitamin Plus DHA, 28
Prenatal One Daily, 28, 45
Prenatal Plus, 28, 44
Prenatal Plus DHA, 28
Prenatal Vitamin, 28, 45
Prenatal Vitamins, 28, 44
Prenatal-u, 28
Prenatal/Omega-3/Folic Acid/Iron, 28
Prentif Cavity-rim Cervical CAP, 44
Prentif Fitting Set, 44
Prepopik, 14
Pressure Activated Safetylancet 21G, 31
prevalite, 7
previfem, 11, 43
Prevnar 13, 26, 45
Prezcobix, 2
Prezista, 2
Prialt, 23
Priftin, 2
Primaquine Phosphate, 3
primidone, 19
Primsol, 3
Pristiq, 18
Privigen, 42
Proair HFA, 25
Proair Respiclick, 25
probenecid, 24
probenecid/colchicine, 24
Procentra, 19
prochlorperazine, 18
prochlorperazine edisylate, 18
prochlorperazine maleate, 18
Procrit, 17
procto-MED HC, 14
procto-PAK, 14
proctosol HC, 14
proctozone-HC, 14
Procysbi, 16
Prodigy Insulin Mini Pen Needles/31G X
3/16", 37
Prodigy Insulin Pen Needles/29G X 1/2",
37
Prodigy Insulin SHORT Penneedles/31G
X 5/16", 37
Prodigy Insulin Syring/U-100/0.3ML/31G
X 5/16", 37
Prodigy Insulin Syringe/1/2ML/31G X
5/16", 37
Prodigy Insulin Syringe/1ML/28G X 1/2",
37
Prodigy Lancing Device, 37
Prodigy Pressure Activated Safety
Lancets, 31
Prodigy Safety Lancets, 31
Prodigy Twist Top Lancets, 31
Profe, 17, 46
Proferrin ES, 17, 46
Profilnine, 17
Profilnine SD, 17
progesterone, 12
Proglycem, 12
Prograf, 4
Prolastin-c, 26
Proleukin, 5
Prolia, 13
Promacta, 17
promethazine HCL, 25
promethazine HCL plain, 25
promethazine VC plain, 25
promethazine VC/codeine, 25
promethazine-DM, 25
promethazine/codeine, 25
promethazine/dextromethorphan, 25
promethazine/phenylephrine, 25
promethazine/phenylephrine/codeine, 25
promethegan, 25
pronutrients vitamin d3, 27, 47
propafenone HCL, 6
propafenone HCL ER, 6
proparacaine HCL, 22
propranolol HCL, 6
propranolol HCL ER, 6
propylthiouracil, 13
Proquad, 26, 45
protriptyline HCL, 18
provenza, 9
Pss Select GP Lancets, 31
Pss Select Platforms, 37
Pss Select Safety Lancets, 31
Pulmicort Flexhaler, 25
pulmosal, 25
Pulmozyme, 26
purevit dualfe plus, 16
Push Button Safety Lancets 21G, 31
Push Button Safety Lancets 28G, 31
Px Advanced Lancing Device, 37
px aspirin, 23, 42
px enteric aspirin, 23, 42
Px Extra SHORT Pen Needles
31GX6MM, 37
px folic acid, 16, 44
Px Insulin Syringe/U-100/0.3ML/30G X
1/2", 37
Px Insulin Syringe/U-100/0.3ML/31G X
5/16", 37
Px Insulin Syringe/U-100/0.5ML/30G X
1/2", 37
Px Insulin Syringe/U-100/0.5ML/31G X
5/16", 37
Px Insulin Syringe/U-100/1ML/30G X
1/2", 37
Px Insulin Syringe/U-100/1ML/31G X
5/16", 37
px iron, 16, 46
Px Lancet Auto Injector, 37
Px Lancets Ultra Thin, 31
Px Mini Pen Needles 31GX5MM, 37
Px Pen Needle 29GX12MM, 37
Px Pen Needle 31GX8MM, 37
Px Prenatal Multivitamins, 28, 44
Px Shortlength Pen Needles/31GX8MM,
37
px stop smoking aid, 20, 46
Pylera, 14
pyrazinamide, 2
pyridostigmine bromide, 21
Q
Qc Advanced Lancing Device, 37
Qc Alcohol Swabs, 40
qc aspirin, 23, 42
qc aspirin low dose, 23, 42
qc childrens aspirin, 23, 42
qc ferrous sulfate, 16, 46
Qc Insulin Syringe 0.5ML/29G, 37
Qc Insulin Syringe 0.5ML/30G, 37
Qc Insulin Syringe 1ML/29G, 37
Qc Insulin Syringe/0.3ML/29G, 37
Qc Insulin Syringe/0.3ML/29G X 1/2", 37
Qc Insulin Syringe/0.5ML/29G X 1/2", 37
Qc Insulin Syringe/0.5ML/31G X 5/16",
37
Qc Insulin Syringe/1ML/29G X 1/2", 37
Qc Insulin Syringe/1ML/30G, 37
Qc Insulin Syringe/1ML/31G X 5/16", 37
Qc Lancets, 31
Qc Lancets Super Thin, 31
Qc Lancets Thin, 31
Qc Lancets Ultra Thin, 31
qc nicotine polacrilex, 20, 46
Qc Pen Needles 29G X 12MM, 37
Qc Pen Needles 31G X 6MM, 37
Qc Pen Needles 31G X 8MM, 37
Qc Prenatal, 28, 45
Qc Unifine Pentips 32GX4MM, 37
Qc Unilet Lancets 28G/Ultra Thin, 31
Qc Unilet Lancets 33G/Micro Thin, 31
Quadracel, 26, 45
quasense, 11, 43
Quazepam, 19
quetiapine fumarate, 19
Quflora Pediatric, 28
Quillivant XR, 19
quinapril HCL, 6
quinapril/hydrochlorothiazide, 7
quinidine gluconate CR, 6
quinidine gluconate ER, 6
quinidine sulfate, 6
Quinidine Sulfate, 6
quinine sulfate, 3
Qvar, 25
R
Ra Alcohol Swabs, 40
ra aspirin, 23, 42
ra aspirin adult low dose, 23, 42
ra aspirin adult low strength, 23, 42
ra aspirin childrens, 23, 42
ra aspirin EC, 23, 42
ra aspirin EC adult low strength, 23, 42
ra childrens aspirin, 23, 42
Ra E-ZJECT Color Lancets Micro-thin
33G, 31
Ra E-ZJECT Lancets 28G, 31
Ra E-ZJECT Lancets Thin 26G, 31
Ra E-ZJECT Lancets Thin 28G, 31
Ra E-ZJECT Lancets Ultra Thin 30G, 31
ra folic acid, 16, 44
ra high potency iron, 16, 46
Ra Insulin Syringe/0.5ML/29G X 1/2", 37
Ra Insulin Syringe/1ML/29G X 1/2", 37
Ra Insulin Syringe/U-100/0.5ML/30G X
5/16", 37
Ra Insulin Syringe/U-100/1 ML/30G X
5/16", 37
ra iron, 16, 46
Ra Lancing Device, 37
ra mini nicotine, 20, 46
ra nicotine, 20, 46
ra nicotine polacrilex, 20, 46
ra nicotine transdermal system step 3,
20, 46
Ra One Daily, 28, 45
Ra Pen Needles 31G X 5MM 3/16", 37
Ra Pen Needles 31G X 8MM 5/16", 37
Ra Prenatal, 28, 44
Ra Prenatal Formula/Folicacid, 28, 45
ra slow release iron, 16, 46
ra vitamin d-3, 27, 47
Rabavert, 26
rabeprazole sodium, 14
raloxifene hydrochloride, 13
ramipril, 6
Ranexa, 5
ranitidine HCL, 14
Rapaflo, 16
Rapamune, 4
Ravicti, 13
rea LO 39, 9
rea LO 40, 9
Reality Insulin Syringe/U-100/0.5ML/28G
X 1/2", 37
Reality Insulin Syringe/U-100/0.5ML/29G
X 1/2", 37
Reality Insulin Syringe/U-100/1ML/28G X
1/2", 37
Reality Insulin Syringe/U-100/1ML/29G X
1/2", 37
Reality Lancets, 31
Reality Swabs, 40
Reality Trigger Lancets, 31
Rebetol, 2
Rebif, 20
Rebif Rebidose, 20
Rebif Rebidose Titration Pack, 20
Rebif Titration Pack, 20
reciphexamine, 9
reclipsen, 11, 43
Recombinate, 17
Recombivax HB, 26, 45
Rectiv, 15
Regranex, 10
relador PAK, 9
relador PAK plus, 9
releevia ML, 9
Relenza Diskhaler, 2
Relion 2-IN-1 Lancing Device 25G, 37
Relion 2-IN-1 Lancing Device 30G, 37
Relion Alcohol Swabs, 40
Relion Insulin Syringe/U -100/0.5ML/29G,
37
Relion Insulin Syringe/U-00/1ML/29G X
1/2", 37
Relion Insulin Syringe/U-100/0.3ML/29G,
37
Relion Insulin Syringe/U-100/0.3ML/29G
X 1/2", 37
Relion Insulin Syringe/U-100/0.3ML/30G,
37
Relion Insulin Syringe/U-100/0.3ML/30G
X 5/16", 37
Relion Insulin Syringe/U-100/0.3ML/31G
X 5/16", 37
Relion Insulin Syringe/U-100/0.5ML/29G
X 1/2", 37
Relion Insulin Syringe/U-100/0.5ML/30G,
37
Relion Insulin Syringe/U-100/0.5ML/30G
X 5/16", 37
Relion Insulin Syringe/U-100/0.5ML/31G
X 5/16", 37
Relion Insulin Syringe/U-100/1ML/30G,
37
Relion Insulin Syringe/U-100/1ML/30G X
5/16", 37
Relion Insulin Syringe/U-100/1ML/31G X
5/16", 37
Relion Ketone, 42
Relion Ketone Test Strips, 42
Relion Lancets Micro-thin33G, 31
Relion Lancets Standard 21G, 31
Relion Lancets Thin 26G, 31
Relion Lancets Ultra-thin30G, 31
Relion Lancing Device, 37
Relion Mini Pen Needles 31GX6MM, 37
Relion Pen Needles 29GX12MM, 37
Relion Pen Needles 31GX8MM, 37
Relion Pen Needles 32GX4MM, 37
Relion SHORT Pen Needles 31GX8MM,
37
Relion Thin Lancets, 31
Relion Ultra Thin Lancets, 31
Relion Ultra Thin Lancets30G, 31
Relion Ultra Thin Plus Lancets 32G, 31
Relion Ultra Thin Plus Lancets 33G, 31
Relistor, 15
Relpax, 24
remeven, 9
Remicade, 15
Remodulin, 7
rena-vite RX, 27
Renagel, 15
renal, 27
renalpren, 27
Renew Advanced Lancing Cartridge
Refills, 31
Renew Advanced Lancing Device, 37
reno CAPS, 27
Renvela, 15
repaglinide, 12
Repaglinide/Metformin Hydrochloride, 12
Repatha, 7
Repatha Sureclick, 7
Replesta, 27, 47
Replesta Childrens, 27, 47
Replesta Nx, 27, 47
reprexain, 24
Rescriptor, 2
Restasis, 22
Retrovir IV Infusion, 2
Revlimid, 4
revonto, 21
Rexall Lancets Ultra Thin, 31
Rexulti, 19
Reyataz, 2
Rheumatrex, 24
Rhogam Ultra-filtered Plus, 42
Rhophylac, 42
Riastap, 17
ribasphere, 2
Ribasphere, 2
Ribasphere Ribapak, 2
Ribatab, 2
ribavirin, 2
Ridaura, 24
rifabutin, 2
Rifamate, 2
rifampin, 2
Rifater, 2
Right Step Prenatal, 28, 45
Rightest GD-L500 Alternate Site Adapter,
37
Rightest GD500 Lancing Device, 37
Rightest Gl300 Lancets, 31
riluzole, 21
rimantadine HCL, 2
ringers injection, 41
ringers irrigation, 41
Riomet, 12
risedronate sodium, 12
risedronate sodium DR, 12
Risperdal Consta, 19
risperidone, 19
risperidone M-TAB, 19
risperidone odt, 19
Riteflo, 40
Rituxan, 4
rivastigmine tartrate, 20
rivastigmine transdermal system, 20
Rixubis, 17
rizatriptan benzoate, 24
rizatriptan benzoate odt, 24
rocuronium bromide, 21
romycin, 21
ropinirole ER, 20
ropinirole HCL, 20
ropivacaine, 24
ropivacaine HCL, 24
rosadan, 8
rosanil cleanser, 8
rosula, 8
rosuvastatin calcium, 7
Rotarix, 26, 45
Rotateq, 26, 45
roweepra, 19
roxicet, 24
Rozerem, 19
S
Sabril, 19
Safe-t-lance Low Flow 25G, 31
Safe-t-lance Normal Flow 21G, 31
Safe-t-lance Plus Safety Lancet High
Flow, 31
Safe-t-lance Plus Safety Lancet Low
Flow, 31
Safe-t-lance Plus Safety Lancet Normal
Flow, 31
Safesnap Insulin Syringe/0.3ML/30G X
5/16", 37
Safesnap Insulin Syringe/0.5ML/29G X
1/2", 37
Safesnap Insulin Syringe/0.5ML/30G X
5/16", 37
Safesnap Insulin Syringe/1ML/28G X
1/2", 37
Safesnap Insulin Syringe/1ML/29G X
1/2", 37
Safety Lancet 21G/Pressure Activated,
31
Safety Lancet 28G/Pressure Activated,
31
Safety Lancets, 31
Safety Lancets 21G, 31
Safety Lancets 28G, 31
Safety Let Lancets, 31
Safety Seal Lancets 28G, 31
Safety Seal Lancets 30G, 31
Safety-glide Insulin Syringe/0.3ML/29G X
1/2", 31
salacyn, 9
salicylic acid, 9
Salicylic Acid, 10
salicylic acid cream, 9
salicylic acid lotion, 9
salicylic acid wart remover, 9
saline flush, 41
saline flush zr/sterile field, 41
salsalate, 22
Samsca, 13
Sancuso, 14
Sandimmune, 4
Sandostatin Lar Depot, 13
Saphris, 19
Saps Care Alcohol Prep Pads, 40
Sapscare Twist Top Lancets 30G, 31
sash kit for flushing vascular access
devices, 17
Savaysa, 17
Savella, 20
SB Alcohol Prep Pads, 40
SB aspirin, 23, 43
SB aspirin EC, 23, 43
SB childrens aspirin, 23, 43
SB Insulin Syringe/U-100/0.5ML/29G X
1/2", 38
SB Insulin Syringe/U-100/0.5ML/30G X
5/16", 38
SB Insulin Syringe/U-100/1ML/29G X
1/2", 38
SB Insulin Syringe/U-100/1ML/30G X
5/16", 38
SB Insulin Syringe/U-100/1ML/31G X
5/16", 38
SB Lancets Thin, 32
SB Lancets Ultra Thin, 32
SB low dose asa EC, 23, 43
scalacort, 9
Schnucks Insulin Syringe Ulti-fine/U100/0.5ML/29G X 1/2", 37
Schnucks Insulin Syringe Ulti-fine/U100/0.5ML/30G X 5/16", 37
se 10-5 ss, 8
se bpo wash, 8
Se-natal 19, 28
Se-tan DHA, 28
se-tan plus, 16
seb-prev wash, 9
Select-lite Device/Lancets, 37
Select-lite Lancing Device, 37
selegiline HCL, 20
selenium sulfide, 9
Selzentry, 2
Sensipar, 13
sensorcaine, 25
sensorcaine-mpf, 25
sensorcaine-mpf spinal, 25
sensorcaine-mpf/epinephrine, 25
sensorcaine/epinephrine, 25
Serevent Diskus, 25
serophene, 13
Seroquel XR, 19
Serostim, 13
sertraline HCL, 18
setlakin, 11, 44
Sevelamer Carbonate, 15
SF, 18
SF 5000 plus, 18
sharobel, 11, 44
Shopko Alcohol Swabs, 40
Shopko Autolet Lancing Device, 37
Shopko On-the-go Comfort Lancets 30G,
31
Shopko Unifine Pentips Pen
Needles/Micro/32GX4MM, 37
Shopko Unifine Pentips Pen
Needles/Mini/31GX5MM, 37
Shopko Unifine Pentips Pen
Needles/Original/29GX12MM, 37
Shopko Unifine Pentips Pen
Needles/SHORT/31GX8MM, 37
Shopko Unilet Lancets Super Thin 30G,
31
Shopko Unilet Lancets Ultra Thin 28G,
31
Shur-seal, 15, 44
Side Button Safety Lancet21G, 31
Signifor, 13
sildenafil, 7
sildenafil citrate, 7
silver sulfadiazine, 9
Similac Prenatal Early Shield, 28
Simple Diagnostics Lancing Device, 37
Simponi, 24
Simponi Aria, 24
Simulect, 4
simvastatin, 7
Single-let, 31
sirolimus, 4
Sirturo, 2
Sivextro, 3
Sklice, 10
Skyla, 11, 44
slow FE, 16, 46
slow iron, 16, 46
slow release iron, 16, 46
Slow Release Iron, 17, 46
slow-release iron, 16, 46
Sm Alcohol Prep Pads, 40
sm aspirin, 23, 42
sm aspirin adult low strength, 23, 42
sm aspirin EC low strength, 23, 42
sm aspirin enteric coated, 23, 42
sm childrens aspirin, 23, 42
sm folic acid, 16, 44
Sm Insulin Syringe/0.3ML/31G X 5/16",
37
Sm Insulin Syringe/0.5ML/31G X 5/16",
37
Sm Insulin Syringe/1ML/31G X 5/16", 37
Sm Insulin Syringe/U-100/0.3ML/29G X
1/2", 37
Sm Insulin Syringe/U-100/0.3ML/30G X
5/16", 37
Sm Insulin Syringe/U-100/0.5ML/28G X
1/2", 37
Sm Insulin Syringe/U-100/0.5ML/29G X
1/2", 37
Sm Insulin Syringe/U-100/0.5ML/30G X
5/16", 37
Sm Insulin Syringe/U-100/1ML/28G X
1/2", 37
Sm Insulin Syringe/U-100/1ML/29G X
1/2", 37
Sm Insulin Syringe/U-100/1ML/30G X
5/16", 37
sm iron, 16, 46
sm iron slow release, 16, 46
Sm Lancets 21G, 31
Sm Micro Thin Lancets 33G, 31
sm nicotine, 20, 46
sm nicotine polacrilex, 20, 46
sm nicotine transdermal system, 20, 46
Sm One Daily Prenatal, 28, 45
sm prenatal vitamins, 28, 44
Sm Prenatal Vitamins, 28, 44
sm slow release iron, 16, 46
Sm Slow Release Iron, 17, 46
Sm Super Thin Lancets, 31
Sm Super Thin Lancets 30G, 31
Sm Thin Lancets 26G, 31
sm vitamin d, 27, 47
sm vitamin d3, 27, 47
Sm Vitamin D3 Maximum Strength, 27,
47
Smart Diabetes Vantage Lancing Device,
37
Smart Diabetes Vantage Universal
Lancets 30G, 31
Smart Sense Color Lancets Universal
33G, 31
Smart Sense Standard Lancets Universal
21G, 31
Smart Sense Super Thin Lancets
Universal 30G, 31
Smart Sense Thin Lancets Universal
26G, 31
Smartest Lancets 28G, 31
sodium acetate, 41
sodium bicarbonate, 41
sodium bicarbonate partial fill, 41
sodium chloride, 15, 25, 41
sodium chloride 0.45%, 41
sodium chloride 0.45% viaflex, 41
sodium chloride 0.9%, 15
sodium chloride bacteriostatic, 41
sodium chloride flush, 41
sodium chloride pab, 41
sodium citrate/citric acid, 15
sodium ferric gluconate complex/sucrose,
17
sodium fluoride, 41, 44
sodium hyaluronate, 9
sodium phenylbutyrate, 13
sodium phosphate, 41
sodium polystyrene sulfonate, 41
sodium sulfacetamide, 8, 9, 21
sodium sulfacetamide wash, 9
sodium sulfacetamide/sulfur, 8
sodium sulfacetamide/sulfur cleanser, 8
sodium sulfacetamide/sulfur cleansing
cloths, 8
sodium sulfacetamide/sulfur green, 8
sodium sulfacetamide/sulfur w/sunscreen,
8
sodium sulfacetamide/sulfur wash, 8
sodium thiosulfate, 41
Soliris, 17
Soltamox, 4
Solu-cortef, 10
Solus V2 Lancing Device, 37
Solus V2 Pressure Activated Safety
Lancets 28G, 31
Solus V2 Twist Lancets 30G, 31
Somatuline Depot, 13
Somavert, 13
sorine, 6
sotalol HCL, 6
sotalol HCL (AF), 6
Sovaldi, 3
Spiriva Handihaler, 25
Spiriva Respimat, 25
spironolactone, 7
spironolactone/hydrochlorothiazide, 7
Sporanox, 2
sprintec 28, 11, 44
Sprix, 24
Sprycel, 5
sps, 41
SR nicotine gum, 20, 46
sronyx, 11, 44
ss 10-2, 8
ssd, 9
sss 10%-5%, 8
sss 10-5, 8
st joseph aspirin, 23, 42
st joseph low dose aspirin, 23, 42
stannous fluoride oral rinse, 18
stavudine, 2
Stavzor, 19
Sterilance PA, 37
Sterilance TL, 31
sterile diluent for epoprostenol sodium,
41
sterile water for injection, 41
sterile water irrigation, 41
sterile water irrigation plastic bottle, 41
sterile water irrigation w/hanger, 41
Stimate, 13
Stiolto Respimat, 25
Stivarga, 5
Strattera, 19
Strensiq, 13
Streptomycin Sulfate, 2
Striant, 10
Stribild, 2
Stuart One, 28
Stuart Prenatal, 28, 45
Suboxone, 24
Sucraid, 14
sucralfate, 14
sulfacetamide sodium, 8, 21
sulfacetamide sodium/prednisolone
sodium phosphate, 21
sulfacetamide sodium/sulfur, 8
sulfacetamide sodium/sulfur cleanser, 8
sulfacleanse 8/4, 8
Sulfadiazine, 2
sulfamethoxazole/trimethoprim, 3
sulfamethoxazole/trimethoprim DS, 3
Sulfamylon, 10
sulfasalazine, 14
sulfatrim pediatric, 3
sulindac, 24
sumatriptan succinate, 24
Sumatriptan Succinate, 24
sumatriptan succinate refill, 24
Super Daily D3, 27, 47
Super Thin Lancets, 31
Supprelin LA, 13
Suprax, 1
Supreme II Confidence Paddles, 37
Suprep Bowel Prep, 14
Sure Comfort Alcohol Prep Pads, 40
Sure Comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 37
Sure Comfort Insulin Syringe/U100/0.3ML/30G X 1/2", 37
Sure Comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 37
Sure Comfort Insulin Syringe/U100/0.3ML/31G X 5/16, 37
Sure Comfort Insulin Syringe/U100/0.3ML/31G X 5/16", 37
Sure Comfort Insulin Syringe/U-100/0.
5ML/28G X 1/2", 37
Sure Comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 38
Sure Comfort Insulin Syringe/U100/0.5ML/30G X 1/2", 38
Sure Comfort Insulin Syringe/U100/0.5ML/30G X 5/16", 38
Sure Comfort Insulin Syringe/U100/0.5ML/31G X 5/16, 38
Sure Comfort Insulin Syringe/U100/1ML/28G X 1/2", 38
Sure Comfort Insulin Syringe/U100/1ML/29G X 1/2", 38
Sure Comfort Insulin Syringe/U100/1ML/30G X 1/2", 38
Sure Comfort Insulin Syringe/U100/1ML/30G X 5/16", 38
Sure Comfort Insulin Syringe/U100/1ML/31G X 5/16", 38
Sure Comfort Lancets 28G, 31
Sure Comfort Lancets 30G, 31
Sure Comfort Lancing Pen, 38
Sure Comfort Pen Needles 29GX1/2"
12.7MM, 38
Sure Comfort Pen Needles 30GX5/16"
SHORT, 38
Sure Comfort Pen Needles 31GX3/16"
(5MM), 38
Sure Comfort Pen Needles 31GX5/16"
(8MM), 38
Sure Comfort Pen Needles 32GX5/32",
38
Sure Comfort Pen Needles 32GX6MM,
38
sure result dss premium pack, 8
Sure-fine Pen Needles 29GX1/2"
12.7MM, 38
Sure-fine Pen Needles 31GX3/16" 5MM,
38
Sure-fine Pen Needles 31GX5/16" 8MM,
38
Sure-ject Insulin Syringe/U100/0.3ML/29G X 1/2", 38
Sure-ject Insulin Syringe/U100/0.3ML/30G X 5/16", 38
Sure-ject Insulin Syringe/U100/0.3ML/31G X 5/16", 38
Sure-ject Insulin Syringe/U100/0.5ML/28G X 1/2", 38
Sure-ject Insulin Syringe/U100/0.5ML/29G X 1/2", 38
Sure-ject Insulin Syringe/U100/0.5ML/30G X 5/16", 38
Sure-ject Insulin Syringe/U100/0.5ML/31G X 5/16", 38
Sure-ject Insulin Syringe/U-100/1ML/28G
X 1/2", 38
Sure-ject Insulin Syringe/U-100/1ML/29G
X 1/2", 38
Sure-ject Insulin Syringe/U-100/1ML/30G
X 5/16", 38
Sure-ject Insulin Syringe/U-100/1ML/31G
X 5/16", 38
Sure-lance Flat Lancets, 31
Sure-lance Lancets 26G, 31
Sure-lance Thin Lancets 28G, 31
Sure-lance Ultra Thin Lancets, 31
Sure-pen, 38
Sure-prep Alcohol Prep Pads, 40
Sure-touch Lancets Universal, 31
Surelite Lancets, 31
Surestep Glucose Control, 31
Surestep Glucose Control Solution, 31
Surestep Pro High Glucosecontrol, 32
Surestep Pro Linearity Kit, 32
Surestep Pro Low Glucose Control, 32
Surestep Pro Normal Glucose Control,
32
Sustiva, 2
Sutent, 5
sw nicotine polacrilex, 20, 46
swabflush saline flush, 41
syeda, 11, 44
Sylatron, 5
symax fastabs, 14
symax-SL, 14
symax-SR, 14
Symbicort, 25
Symlinpen 120, 12
Symlinpen 60, 12
Synagis, 42
Synarel, 13
Synribo, 5
synvexia, 9
Synvisc, 21
Synvisc One, 21
Syprine, 42
T
Tabloid, 4
Taclonex, 9
tacrolimus, 4, 9
Tafinlar, 5
Tagrisso, 5
take action, 11, 44
Talwin, 24
Tamiflu, 2
tamoxifen citrate, 4, 47
tamsulosin HCL, 15
Tarceva, 5
Targretin, 10
tarina FE 1/20, 11, 44
taron-crystals, 15
Taron-prex, 28
Tasigna, 5
tazicef, 1
tazidime, 1
Tazorac, 8
taztia XT, 6
Tecfidera, 20
Tecfidera Starter Pack, 20
Techlite AST Lancets, 32
Techlite Lancets, 32
Techlite Lancets 30G, 32
Techlite Pen Needles/31G X 5MM, 38
Techlite Pen Needles/31G X 6 MM, 38
Techlite Pen Needles/31G X 8MM, 38
Techlite Pen Needles/32G X 4MM, 38
Techlite Pen Needles/32G X 6MM, 38
Techlite Pen Needles/32G X 8MM, 38
Teflaro, 1
Tekamlo, 7
Tekturna, 6
Tekturna HCT, 7
telmisartan, 6
telmisartan/amlodipine, 7
telmisartan/hydrochlorothiazide, 7
temazepam, 19
Temodar, 3
temozolomide, 3
tencon, 22
Teniposide, 4
Tenivac, 26, 45
terazosin HCL, 6
terbinafine HCL, 2
terbutaline sulfate, 25
terconazole, 15
Terumo Insulin Syringe/0.3ML/30G X
3/8", 38
Terumo Insulin Syringe/0.5ML/29G X
1/2", 38
Terumo Insulin Syringe/0.5ML/30G X
3/8", 38
Terumo Insulin Syringe/1ML/27G X 1/2",
38
Terumo Insulin Syringe/1ML/29G X 1/2",
38
Terumo Insulin Syringe/1ML/30G X 3/8",
38
Terumo Insulin Syringe/U-100/0.3ML/29G
X 1/2", 38
Terumo Insulin Syringe/U-100/0.5ML/27G
X 1/2", 38
Terumo Insulin Syringe/U-100/0.5ML/28G
X 1/2", 38
Terumo Insulin Syringe/U-100/1ML/28G
X 1/2", 38
Terumo Surguard Insulin
Syringe/0.3ML/29G X 1/2", 38
Terumo Surguard Insulin
Syringe/0.5ML/28G X 1/2", 38
Terumo Surguard Insulin
Syringe/0.5ML/29G X 1/2", 38
Terumo Surguard Insulin
Syringe/1ML/28G X 1/2", 38
Terumo Surguard Insulin
Syringe/1ML/29G X 1/2", 38
testosterone, 10
Testosterone, 10
testosterone cypionate, 10
testosterone enanthate, 10
testosterone P.M., 10
Testosterone P.M., 10
Tetanus Toxoid Adsorbed, 26
Tetanus/Diphtheria Toxoids-adsorbed,
26, 45
Tetanus/Diphtheria Toxoids-adsorbed
Adult, 26, 45
tetcaine, 22
tetrabenazine, 20
tetracaine HCL, 22
Tetracaine HCL, 25
tetracycline HCL, 1
Tetracycline HCL, 1
tetravisc, 22
tetravisc forte, 22
tetrix, 9
Texacort, 9
Tgt Advanced Lancing Device, 38
Tgt Alcohol Swabs, 40
tgt aspirin, 23, 42
tgt aspirin low dose, 23, 42
tgt childrens aspirin, 23, 42
tgt enteric-coated aspirin, 23, 42
Tgt Lancet Alternate Site, 32
Tgt Lancet Micro Thin 33G, 32
Tgt Lancet Super Thin 30G, 32
Tgt Lancet Thin 23G, 32
Tgt Lancet Thin 26G, 32
Tgt Lancet Ultra Thin 28G, 32
Tgt Lancet Ultra Thin 30G, 32
Tgt Lancing Device, 38
tgt nicotine gum, 20, 46
tgt nicotine polacrilex, 20, 46
tgt nicotine step one, 20, 46
tgt nicotine step three, 20, 46
tgt nicotine step two, 20, 46
th aspirin, 23, 42
th aspirin low dose, 23, 42
th enteric aspirin, 23, 42
th folic acid, 16, 44
th iron, 16, 46
Th Prenatal Vitamins, 28, 45
th slow release iron, 16, 46
th vitamin d3, 27, 47
Thalomid, 4
Theo-24, 25
theochron, 25
theophylline, 25
theophylline CR, 25
theophylline ER, 25
thera-d 2000, 27, 47
Thera-d 4000, 27, 47
thera-d rapid repletion, 27, 47
thera-d sport, 27, 47
Theracys, 5
thermazene, 9
thiamine HCL, 26
Thinlets GP Lancets, 32
Thinlets Lancet, 32
Thinpro Insulin Syringe/0.3ML/29G X
1/2", 38
Thinpro Insulin Syringe/0.3ML/30G X
3/8", 38
Thinpro Insulin Syringe/0.3ML/31G X
3/8", 38
Thinpro Insulin Syringe/0.5ML/28G X
1/2", 38
Thinpro Insulin Syringe/0.5ML/29G X
1/2", 38
Thinpro Insulin Syringe/0.5ML/30G X
3/8", 38
Thinpro Insulin Syringe/0.5ML/31G X
3/8", 38
Thinpro Insulin Syringe/1ML/28G X 1/2",
38
Thinpro Insulin Syringe/1ML/29G X 1/2",
38
Thinpro Insulin Syringe/1ML/30G X 3/8",
38
Thinpro Insulin Syringe/1ML/31G X 3/8",
38
thioridazine HCL, 19
thiothixene, 19
thrive, 20, 46
Thrombate Iii W/10 ML Sterile Water, 17
Thrombate Iii W/20 ML Sterile Water, 17
Thymoglobulin, 4
Thyrogen, 42
Thyrolar-1, 13
Thyrolar-1/2, 13
Thyrolar-1/4, 13
Thyrolar-2, 13
Thyrolar-3, 13
tiagabine hydrochloride, 19
Tice Bcg, 5
ticlopidine HCL, 17
Tikosyn, 6
tilia FE, 11, 44
Timentin, 1
Timolol Maleate, 6
timolol maleate, 21
timolol maleate ophthalmic gel forming,
21
tinidazole, 3
tis-u-sol, 41
Tivicay, 2
tizanidine HCL, 21
TL gard RX, 16
TL icon, 16
TL-hem 150, 16
Tobi Podhaler, 2
Tobradex, 21
Tobradex ST, 21
tobramycin, 2
tobramycin inhalation solution PAK, 2
tobramycin sulfate, 2, 21
tobramycin/dexamethasone, 21
Tobrex, 21
Today Sponge, 15
Todays Health Advanced Lancing Device,
38
Todays Health Mini Pen Needles 31G X
1/4", 38
Todays Health Original Pen Needles 29G
X 1/2", 38
Todays Health SHORT Pen Needles 31G
X 5/16", 38
Todays Health Super Thin Lancets 30G,
32
Todays Health Ultra Thin Lancets 28G,
32
tolazamide, 12
Tolazamide, 12
Tolbutamide, 12
tolcapone, 20
tolmetin sodium, 24
Tolmetin Sodium, 24
tolterodine tartrate, 15
tolterodine tartrate ER, 15
Topcare Clickfine Universal Pen Eedles
31GX1/4", 38
Topcare Clickfine Universal Pen Eedles
31GX5/16", 38
Topcare Ultra Comfort Insulin
Syringe/0.3ML/30G X 5/16", 38
Topcare Ultra Comfort Insulin
Syringe/0.3ML/31G X 5/16", 38
Topcare Ultra Comfort Insulin
Syringe/0.5ML/30G X 5/16", 38
Topcare Ultra Comfort Insulin
Syringe/0.5ML/31G X 5/16", 38
Topcare Ultra Comfort Insulin
Syringe/1ML/30G X 5/16", 38
Topcare Ultra Comfort Insulin
Syringe/1ML/31G X 5/16", 38
Topcare Ultra Comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 38
Topcare Ultra Comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 38
Topcare Ultra Comfort Insulin Syringe/U-
100/1ML/29G X 1/2", 38
Topco Insulin Syringe/U-100/0.3ML/29G
X 1/2", 38
Topco Insulin Syringe/U-100/0.5ML/28G
X 1/2", 38
Topco Insulin Syringe/U-100/0.5ML/29G
X 1/2", 38
Topco Insulin Syringe/U-100/1ML/28G X
1/2", 38
Topco Insulin Syringe/U-100/1ML/29G X
1/2", 38
topex topical anesthetic, 18
topiragen, 19
topiramate, 19
toposar, 4
topotecan HCL, 5
Topotecan HCL, 5
Torisel, 5
torsemide, 7
Totect, 5
Toujeo Solostar, 12
Toviaz, 15
tpn electrolytes, 41
Tracer II 3 Volt Battery, 38
Tracleer, 7
Tradjenta, 12
tramadol HCL, 24
tramadol HCL ER, 24
tramadol hydrochloride/acetaminophen,
24
trandolapril, 6
trandolapril/verapamil HCL, 7
trandolapril/verapamil HCL ER, 7
tranexamic acid, 17
Transderm-scop, 14
tranylcypromine sulfate, 18
Travatan Z, 21
Travel Lancets 30G, 32
trazodone HCL, 18
Treanda, 3
Trecator, 2
Trelstar, 4
Trelstar Mixject, 4
tretinoin, 5
Tretten, 17
Trexall, 4
tri-estarylla, 11, 44
tri-legest FE, 11, 44
tri-linyah, 11, 44
tri-LO-estarylla, 11, 44
tri-LO-marzia, 11, 44
tri-LO-sprintec, 11, 44
tri-previfem, 11, 44
tri-sprintec, 11, 44
tri-vit/fluoride, 27
tri-vitamin/fluoride, 27
Triadvance, 28
triamcinolone acetonide, 9, 18, 25
triamcinolone IN orabase, 18
triamterene/hydrochlorothiazide, 7
Triamterene/Hydrochlorothiazide, 7
triazolam, 19
Triazolam, 19
Tribenzor, 7
Tricare, 28, 44
tricitrates, 15
tricon, 16
triderm, 9
trifluoperazine HCL, 19
trifluridine, 21
trigels-f forte, 16
Triglide, 7
trihexyphenidyl HCL, 20
trilyte, 14, 47
trimethobenzamide HCL, 14
trimethoprim, 3
trimethoprim sulfate/polymyxin b sulfate,
21
trimipramine maleate, 18
Trinatal RX 1, 28
Trinate, 28
trinessa, 11, 44
trinessa LO, 11, 44
triphrocaps, 27
triple-vitamin/fluoride, 27
Trisenox, 5
Triumeq, 2
trivora-28, 11, 44
tropazone, 9
tropicamide, 22
trospium chloride, 15
trospium chloride ER, 15
Truedraw Lancing Device, 38
Trueplus Insulin Syringe/U100/0.3ML/29G X 1/2", 38
Trueplus Insulin Syringe/U100/0.3ML/30G X 5/16", 38
Trueplus Insulin Syringe/U100/0.3ML/31G X 5/16", 38
Trueplus Insulin Syringe/U100/0.5ML/28G X 1/2", 38
Trueplus Insulin Syringe/U100/0.5ML/29G X 1/2", 38
Trueplus Insulin Syringe/U100/0.5ML/30G X 5/16", 38
Trueplus Insulin Syringe/U100/0.5ML/31G X 5/16", 38
Trueplus Insulin Syringe/U-100/1ML/28G
X 1/2", 38
Trueplus Insulin Syringe/U-100/1ML/29G
X 1/2", 38
Trueplus Insulin Syringe/U-100/1ML/30G
X 5/16", 38
Trueplus Insulin Syringe/U-100/1ML/31G
X 5/16", 38
Trueplus Lancets 26G, 32
Trueplus Lancets 28G, 32
Trueplus Lancets 28G Super Thin, 32
Trueplus Lancets 30G, 32
Trueplus Lancets 30G Ultra Thin, 32
Trueplus Lancets 33G, 32
Trueplus Lancets 33G Micro Thin, 32
Trueplus Safety Lancets 28G, 32
Trulicity, 12
Trumenba, 26, 45
Truvada, 2
Tudorza Pressair, 25
tussigon, 25
Twinrix, 26, 45
Tybost, 2
Tygacil, 3
Tykerb, 5
Typhim VI, 26
Tysabri, 20
Tyvaso, 7
Tyvaso Refill, 7
Tyvaso Starter, 7
Tyzeka, 3
X 5/16", 38
Ulticare Insulin Syringe/U-100/1ML/29G X
1/2", 38
U
Ulticare Insulin Syringe/U-100/1ML/30G X
u-kera e, 9
1/2", 38
Ulesfia, 10
Ulticare Insulin Syringe/U-100/1ML/30G X
Uloric, 24
5/16", 38
Ulti-lance Automatic/ Clear Tip, 38
Ulticare Insulin Syringe/U-100/1ML/31G X
Ulticare Insulin Safety Syringe/0.5ML/29G
5/16", 38
X 1/2", 38
Ulticare Micro Pen Needles 31G X 8MM,
Ulticare Insulin Safety Syringe/1ML/29G
39
X 1/2", 38
Ulticare Micro Pen Needles 32G X 4MM,
Ulticare Insulin Syringe 1CC/28G U-100
39
1/2", 38
Ulticare Micro Pen Needles/31G X 8MM,
Ulticare Insulin Syringe Ultrafine U39
100/0.3ML/31G X 5/16", 38
Ulticare Micro Pen Needles/32G X 4MM,
Ulticare Insulin Syringe Ultrafine U39
100/0.5ML/31G X 5/16", 38
Ulticare Mini Pen Needles 31GX6MM, 39
Ulticare Insulin Syringe Ultrafine UUlticare Mini Pen Needles Ulti-fine IV, 39
100/1ML/31G X 5/16", 38
Ulticare Mini Pen Needles/31G X 6MM,
Ulticare Insulin Syringe/0.3ML/29G X
39
1/2", 38
Ulticare Mini Pen Needles31GX6MM, 39
Ulticare Insulin Syringe/0.3ML/30G X
Ulticare Original Pen Needles Ulti-fine,
1/2", 38
39
Ulticare Insulin Syringe/0.3ML/30G X
Ulticare Pen Needles/29G X 12.7MM, 39
5/16", 38
Ulticare SHORT Pen Needles 31GX8MM,
Ulticare Insulin Syringe/0.5ML/28G X
39
1/2", 38
Ulticare SHORT Pen Needles Ulti-fine IV,
Ulticare Insulin Syringe/0.5ML/29G X
39
1/2", 38
Ulticare SHORT Pen Needles/31G X
Ulticare Insulin Syringe/0.5ML/30G X
8MM, 39
1/2", 39
Ulticare Thin Lancets 30G, 32
Ulticare Insulin Syringe/0.5ML/30G X
Ulticare U-100 Insulin
5/16", 39
Syringes/0.3ML/31G X 1/4", 39
Ulticare Insulin Syringe/1ML/28G X 1/2",
Ulticare U-100 Insulin
39
Syringes/0.3ML/31G X1/4", 39
Ulticare Insulin Syringe/1ML/29G X 1/2",
Ulticare U-100 Insulin
39
Syringes/0.5ML/31G X 1/4", 39
Ulticare Insulin Syringe/1ML/30G X 1/2",
Ulticare U-100 Insulin Syringes/1ML/31G
39
X 1/4", 39
Ulticare Insulin Syringe/1ML/30G X 5/16",
Ultiguard Insulin Syringe/U39
100/0.3ML/29G X 1/2", 39
Ulticare Insulin
Ultiguard Insulin Syringe/USyringe/SHORT/0.3ML/30G X 5/16", 38
100/0.3ML/30G X 5/16", 39
Ulticare Insulin
Ultiguard Insulin Syringe/USyringe/SHORT/0.3ML/31G X 5/16", 38
100/0.5ML/29G X 1/2", 39
Ulticare Insulin
Ultiguard Insulin Syringe/USyringe/SHORT/0.5ML/30G X 5/16", 38
100/0.5ML/30G X 5/16", 39
Ulticare Insulin
Ultiguard Insulin Syringe/U-100/1ML/29G
Syringe/SHORT/0.5ML/31G X 5/16", 38
X 1/2", 39
Ulticare Insulin Syringe/SHORT/1ML/30G Ultiguard Insulin Syringe/U-100/1ML/30G
X 5/16", 38
X 5/16", 39
Ulticare Insulin Syringe/SHORT/1ML/31G
Ultilet Classic Lancets, 32
X 5/16", 38
Ultilet Insulin Syringe/SHORT/0.3ML/30G
Ulticare Insulin Syringe/U-100/0.3ML/29G
X 5/16", 39
X 1/2", 38
Ultilet Insulin Syringe/SHORT/0.3ML/31G
Ulticare Insulin Syringe/U-100/0.3ML/30G
X 5/16", 39
X 1/2", 38
Ultilet Insulin Syringe/SHORT/0.5ML/30G
Ulticare Insulin Syringe/U-100/0.3ML/30G
X 5/16", 39
X 5/16", 38
Ultilet Insulin Syringe/SHORT/0.5ML/31G
Ulticare Insulin Syringe/U-100/0.3ML/31G
X 5/16", 39
X 5/16", 38
Ultilet Insulin Syringe/SHORT/1ML/30G X
Ulticare Insulin Syringe/U-100/0.5ML/29G
5/16", 39
X 1/2", 38
Ultilet Insulin Syringe/SHORT/1ML/31G X
Ulticare Insulin Syringe/U-100/0.5ML/30G
5/16", 39
X 1/2", 38
Ultilet Lancets, 32
Ulticare Insulin Syringe/U-100/0.5ML/30G
Ultilet Lancets 33G, 32
X 5/16", 38
Ultilet Pen Needle 32GX4MM/SHORT,
Ulticare Insulin Syringe/U-100/0.5ML/31G
39
Ultilet Safety Lancets 23G, 32
Ultilet SHORT Pen Needles 31GX5/16",
39
Ultilet SHORT Pen Needles31GX3/16",
39
Ultimatecare One, 28
Ultimatecare One NF, 28
Ultra Comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 39
Ultra Comfort Insulin Syringe/U100/0.5ML/28G X 1/2", 39
Ultra TABS, 28
Ultra Thin Lancets 28G, 32
Ultra Thin Lancets 30G, 32
Ultra-comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 39
Ultra-comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 39
Ultra-comfort Insulin Syringe/U100/0.3ML/31G X 5/16", 39
Ultra-comfort Insulin Syringe/U100/0.5ML/28G X 1/2", 39
Ultra-comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 39
Ultra-comfort Insulin Syringe/U100/0.5ML/30G X 5/16", 39
Ultra-comfort Insulin Syringe/U100/0.5ML/31G X 5/16", 39
Ultra-comfort Insulin Syringe/U100/1ML/28G X 1/2", 39
Ultra-comfort Insulin Syringe/U100/1ML/29G X 1/2", 39
Ultra-comfort Insulin Syringe/U100/1ML/30G X 5/16", 39
Ultra-comfort Insulin Syringe/U100/1ML/31G X 5/16", 39
Ultra-thin II Auto Lancet, 32
Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/30GX5/16", 39
Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/31GX5/16", 39
Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/30GX5/16", 39
Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/31GX5/16", 39
Ultra-thin II Insulin Syringe SHORT/U100/1ML/30GX5/16", 39
Ultra-thin II Insulin Syringe SHORT/U100/1ML/31GX5/16", 39
Ultra-thin II Insulin Syringe/U100/0.3ML/29GX1/2", 39
Ultra-thin II Insulin Syringe/U100/0.5ML/29GX1/2", 39
Ultra-thin II Insulin Syringe/U100/1ML/29GX1/2", 39
Ultra-thin II Lancets 28G, 32
Ultra-thin II Lancets 30G, 32
Ultra-thin II Mini Pen
Neeedles/31GX3/16", 39
Ultra-thin II Pen Needles 29GX1/2", 39
Ultra-thin II Pen
Needles/SHORT/31GX5/16", 39
Ultra-thin II Safety Autolancets 26G, 32
Ultralance, 39
umecta mousse, 9
Unifine Pentips 29GX12MM, 39
Unifine Pentips 31G X 3/16", 39
Unifine Pentips 31G X 6MM, 39
Unifine Pentips 31G X 8MM, 39
Unifine Pentips 31GX5MM, 39
Unifine Pentips 31GX6MM, 39
Unifine Pentips 31GX8MM, 39
Unifine Pentips 32GX4MM, 39
Unifine Pentips Plus 29GX12MM, 39
Unifine Pentips Plus 31GX5MM, 39
Unifine Pentips Plus 31GX6MM, 39
Unifine Pentips Plus 31GX8MM, 39
Unifine Pentips Plus 32GX4MM, 39
Unilet Comfortouch Lancet, 32
Unilet Excelite, 32
Unilet Excelite II, 32
Unilet G.p. Lancet, 32
Unilet G.p. Superlite Lancet, 32
Unilet GP 28 Ultra Thin, 32
Unilet Lancet, 32
Unilet Lancets Micro-thin33G, 32
Unilet Lancets Super-thin30G, 32
Unilet Lancets Ultra-thin 28G, 32
Unilet Superlite Lancet, 32
Unistik 1, 39
Unistik 2, 39
Unistik 2 Comfort, 39
Unistik 2 Extra, 39
Unistik 2 Neonatal, 39
Unistik 2 Normal, 39
Unistik 2 Super, 39
Unistik 3, 39
Unistik 3 Comfort, 39
Unistik 3 Extra, 39
Unistik 3 Gentle, 32
Unistik 3 Neonatal, 39
Unistik 3 Normal, 39
Unistik CZT Comfort, 39
Unistik CZT Normal, 39
Unistik Safety Lancets 28G, 32
Unistik Safety Lancets 30G, 32
Unistik Touch Safety Lancets 21G, 32
Unistik Touch Safety Lancets 23G, 32
Unistik Touch Safety Lancets 28G, 32
Unistik Touch Safety Lancets 30G, 32
unithroid, 13
unithroid direct, 13
Unituxin, 4
Universal 1 Lancets Thin 26G, 32
Universal 1 Lancets Ultra Thin 30G, 32
Uptravi, 8
ur n-c, 15
uramit mb, 15
ure-k, 9
urea, 9
urea 40% nail film, 9
urea hydrating, 9
urea IN zinc undecylenate/lactic acid
vehicle, 9
urea nail, 9
urea topical, 9
urea-c40, 9
urelle, 15
uretron d/s, 15
uribel, 15
urin d/s, 15
Urin-tek, 39
uro-blue, 15
uro-l, 15
uro-mp, 15
uroav-81, 15
uroav-b, 15
urolet mb, 15
urophen mb, 15
urosex, 27
ursodiol, 15
uryl, 15
ustell, 15
uta, 15
uticap, 15
utira-c, 15
utrona-c, 15
Uvadex, 5
V
v-c forte, 27
V-go 20, 32
V-go 30, 32
V-go 40, 32
V-r Monoject Insulin Syringe/U100/0.3ML/29G X 1/2", 39
V-r Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 39
V-r Monoject Insulin Syringe/U100/0.5ML/29G X 1/2", 39
V-r Monoject Insulin Syringe/U100/1ML/28G X 1/2", 39
V-r Monoject Insulin Syringe/U100/1ML/29G X 1/2", 39
Vagifem, 15
valacyclovir HCL, 2
Valchlor, 3, 10
Valcyte, 3
valganciclovir, 2
valproate sodium, 19
valproic acid, 19
valsartan, 6
valsartan/hydrochlorothiazide, 7
Valstar, 3
Value Health Insulin Syringe/U100/0.5ML/29G X 1/2", 39
Value Health Insulin Syringe/U100/1ML/29G X 1/2", 39
Value Plus Lancets Standard 21G, 32
Value Plus Lancets Super Thin 30G, 32
Value Plus Lancets Thin 26G, 32
Value Plus Lancing Device, 39
Valumark Lancet Super Thin 30G, 32
Valumark Lancet Ultra Thin 28G, 32
Valumark Pen Needles 29GX12MM, 39
Valumark Pen Needles 31G X 6MM, 39
Valumark Pen Needles 31G X 8MM, 39
Valved Holding Chamber, 40
vancomycin HCL, 3
vandazole, 15
Vanishpoint Insulin Syringe/0.5ML/30G X
1/2", 39
Vanishpoint Insulin Syringe/1ML/29G X
1/2", 39
Vantas, 4
Vaqta, 26, 45
Varivax, 26, 45
Vascepa, 7
vasopressin, 13
Vcf Vaginal Contraceptive Film, 15, 44
Vcf Vaginal Contraceptive Foam, 15, 44
vcf vaginal contraceptivegel, 15, 44
Vectibix, 4
Vectical, 9
vecuronium bromide, 21
Velcade, 5
Veletri, 8
velivet, 11, 44
Veltassa, 42
venlafaxine HCL, 18
venlafaxine HCL ER, 18
Venlafaxine HCL ER, 18
Ventavis, 8
verapamil HCL, 6
verapamil HCL ER, 6
verapamil HCL SR, 6
verdrocet, 24
Veregen, 10
Vesicare, 15
vestura, 11, 44
Vexol, 21
Vibativ, 3
vic-forte, 27
vicodin, 24
vicodin ES, 24
vicodin HP, 24
Victoza, 12
Victrelis, 3
Vida Mia Autolet Lancing Device, 39
Vida Mia Unifine Pentips 32GX4MM, 39
Vida Mia Unifine Pentips Mini 31GX6MM,
39
Vida Mia Unifine Pentips Original
29GX12MM, 39
Vida Mia Unilet Lancets Super Thin 30G,
32
Vida Mia Unilet Lancets Ultra Thin 28G,
32
Vida Mia Unipfine Pentipsshort
31GX8MM, 39
Videx Pediatric, 2
vienva, 11, 44
Vigamox, 21
Viibryd, 18
Viibryd Starter Pack, 18
Vimizim, 13
Vimpat, 19
Vinate C, 28
Vinate Care, 28
Vinate IC, 28
Vinate II, 28
Vinate M, 28
Vinate One, 28
Vinblastine Sulfate, 4
vincasar PFS, 4
vincristine sulfate, 4
vinorelbine tartrate, 4
viorele, 11, 44
Viracept, 2
Viramune, 2
Virazole, 3
Viread, 2
virt-CAPS, 27
virt-gard, 16
virt-phos 250 neutral, 41
virt-vite, 16
virt-vite plus, 27
virti-sulf, 8
virtrate-2, 15
virtrate-3, 16
virtrate-k, 15
Visudyne, 22
vita s forte, 27
vita-min, 27
vitacel, 27
Vitafol-OB, 28
vitajoy daily d gummies, 27, 47
Vitalet Pro Lancets, 32
Vitalet Pro Plus Lancets, 32
vitamax pediatric, 27
Vitamelts Vitamin D, 27, 47
vitamin b-complex 100, 27
vitamin c 222MG, 26
vitamin d, 26, 47
vitamin d 400, 27, 47
vitamin d high potency, 27, 47
vitamin d-1000, 27, 47
vitamin d-1000 maximum strength, 27,
47
vitamin d-3, 27, 47
vitamin d-400, 27, 47
Vitamin D2, 27
vitamin d3, 27, 47
Vitamin D3, 27, 47
vitamin d3 400, 27, 47
vitamin d3 adult gummies, 27, 47
vitamin d3 high potency, 27, 47
vitamin d3 maximum strength, 27, 47
vitamin d3 super strength, 27, 47
vitamin k1, 26
vitamins a/c/d/fluoride, 28
Vitekta, 2
Vivitrol, 42
Vivotif, 26
vol-care RX, 28
Voraxaze, 5
voriconazole, 2
Vortex Valved Holding Chamber, 40
Votrient, 5
Vp Insulin Syringe/U-100/0.3ML/29G X
1/2", 39
vp-vite RX, 28
Vp-zel, 28
Vpriv, 17
vyfemla, 11, 44
Vytorin, 7
Vyvanse, 19
W
W&f Lancets 26G, 32
W&f Lancets Colored 21G, 32
Walgreens Advanced Travellancets 28G,
32
Walgreens Comfort Assuredlancets Micro
Thin/33G, 32
Walgreens Comfort Assuredlancets
Super Thin/28G, 32
Walgreens Lancets, 32
Walgreens Thin Lancets, 32
Walgreens Ultra Thin Lancets, 32
warfarin sodium, 17
Watchhaler, 40
Wd Medic Insulin Syringe/0.3ML/29G X
1/2", 39
Wd Medic Insulin Syringe/0.3ML/30G X
5/16", 39
Wd Medic Insulin Syringe/0.5ML/29G X
1/2", 39
Wd Medic Insulin Syringe/0.5ML/30G X
5/16", 39
Wd Medic Insulin Syringe/1ML/29G X
1/2", 39
Wd Medic Insulin Syringe/1ML/30G X
5/16", 39
Webcol Alcohol Prep Large 1 Ply, 40
Webcol Alcohol Prep Large 2 Ply, 40
Webcol Alcohol Prep Medium 2 Ply, 40
wee care, 16, 46
Wegmans Unifine Pentips Plus
32GX4MM, 39
Wegmans Unifine Pentips
Plus/Mini/31GX5MM, 39
Wegmans Unifine Pentips
Plus/SHORT/31GX8MM, 39
Wegmans Unifine Pentips Plus/Ultra
SHORT/31GX6MM, 39
Welchol, 7
Wellesse Vitamin D3, 27, 47
wera, 11, 44
Wide-seal Silicone Diaphragm Kit 60, 44
Wide-seal Silicone Diaphragm Kit 65, 44
Wide-seal Silicone Diaphragm Kit 70, 44
Wide-seal Silicone Diaphragm Kit 75, 44
Wide-seal Silicone Diaphragm Kit 80, 44
Wide-seal Silicone Diaphragm Kit 85, 44
Wide-seal Silicone Diaphragm Kit 90, 44
Wide-seal Silicone Diaphragm Kit 95, 44
Wilate, 17
Winrho SDF, 42
wymzya FE, 11, 44
X
x-viate, 10
Xalkori, 5
Xarelto, 17
Xarelto Starter Pack, 17
Xeomin, 21
Xgeva, 13
Xiaflex, 42
Xifaxan, 3
Xolair, 25
Xolegel, 8
Xtandi, 4
Xulane, 11, 44
xylocaine dental, 25
xylon, 24
Xyntha, 17
Xyntha Solofuse, 17
xyphex, 10
Xyrem, 20
Y
Yervoy, 4
Yf-vax, 26
yl folic acid, 16, 44
Yondelis, 3
Your Life Multi Prenatal, 28
Z
zafirlukast, 25
zaleplon, 19
Zaltrap, 4
zamicet, 24
Zanosar, 3
zarah, 11, 44
Zavesca, 17
zazole, 15
zebutal, 22
Zelboraf, 5
Zemaira, 26
zenatane, 8
zenchent, 11, 44
zenchent FE, 11, 44
zencia, 8
Zenpep, 14
zenzedi, 19
Zepatier, 3
zeruvia, 10
Zetia, 7
Zevalin Y-90, 4
Ziagen, 2
zidovudine, 2
Zinacef, 1
ziprasidone HCL, 19
Zirgan, 21
Zithromax, 1
Zoladex, 4
zoledronic acid, 12
Zoledronic Acid, 12
Zolinza, 5
zolmitriptan, 24
zolmitriptan odt, 24
zolpidem tartrate, 19
zolpidem tartrate ER, 19
Zometa, 12
Zomig, 24
Zomig Nasal Spray, 24
zonisamide, 19
Zontivity, 17
Zorbtive, 13
Zortress, 4
Zostavax, 26, 45
zovia 1/35e, 11, 44
Zovirax, 8
Zydelig, 5
Zyflo CR, 25
Zykadia, 5
Zyprexa Relprevv, 19
Zytiga, 4
Zyvox, 3
1
1ST Choice Lancets Super Thin, 32
1ST Choice Lancets Thin, 32
1ST Choice Lancets Ultra Thin, 32
1ST Tier Unifine Pentips /Mini/31GX5MM,
39
1ST Tier Unifine Pentips 29GX12MM, 39
1ST Tier Unifine Pentips 31GX6MM, 39
1ST Tier Unifine Pentips 31GX8MM, 39
1ST Tier Unifine Pentips 32GX4MM, 39
1ST Tier Unifine Pentips Plus 31GX8MM,
39
1ST Tier Unifine Pentips Plus 32GX4MM,
39
1ST Tier Unifine Pentips
Plus/Mini/31GX5MM, 39
1ST Tier Unifine Pentips
Plus/Original/29GX12MM, 39
1ST Tier Unifine Pentips Plus/Ultra
SHORT/31GX6MM, 39
1ST Tier Unilet Comfortouch Lancets
28G, 32
1ST Tier Unilet Comfortouch Lancets
30G, 32
8
8-mop, 9
$0 Copay Medications for NMHC Members
New Mexico Health Connections is dedicated to improving our members' health. For that reason, all of our plans offer no copayments for
generic medications for several chronic conditions: Asthma, bipolar disorder, chronic obstructive pulmonary disease, congestive heart failure,
coronary artery disease, depression, diabetes, high cholesterol, and high blood pressure. This makes it easier for members with these chronic
conditions to stay on the medications that help keep them well.
Please contact OptumRx with questions at 1-855-577-6550 or visit www.OptumRx.com.
Drug Name and Strength
ACARBOSE TAB 100 MG
ACARBOSE TAB 25 MG
ACARBOSE TAB 50 MG
ACEBUTOLOL HCL CAP 200 MG
ACEBUTOLOL HCL CAP 400 MG
ACETAZOLAMIDE CAP SR 12HR 500 MG
ACETAZOLAMIDE TAB 250 MG
ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG
ALBUTEROL SULFATE SYRUP 2 MG/5ML
ALBUTEROL SULFATE TAB 2 MG
ALBUTEROL SULFATE TAB 4 MG
ALBUTEROL SULFATE TAB SR 12HR 4 MG
ALBUTEROL SULFATE TAB SR 12HR 8 MG
AMILORIDE & HYDROCHLOROTHIAZIDE TAB 5-50 MG
AMILORIDE HCL TAB 5 MG
AMITRIPTYLINE HCL TAB 10 MG
AMITRIPTYLINE HCL TAB 100 MG
AMITRIPTYLINE HCL TAB 150 MG
AMITRIPTYLINE HCL TAB 25 MG
AMITRIPTYLINE HCL TAB 50 MG
AMITRIPTYLINE HCL TAB 75 MG
AMLODIPINE BESYLATE TAB 10 MG
AMLODIPINE BESYLATE TAB 2.5 MG
AMLODIPINE BESYLATE TAB 5 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 10-20 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 10-40 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 2.5-10 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-10 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-20 MG
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-40 MG
ATENOLOL & CHLORTHALIDONE TAB 100-25 MG
ATENOLOL & CHLORTHALIDONE TAB 50-25 MG
ATENOLOL TAB 100 MG
ATENOLOL TAB 25 MG
ATENOLOL TAB 50 MG
ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)
ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)
BECLOMETHASONE DIPROP INHAL AERO SOLN
BECLOMETHASONE DIPROP INHAL AERO SOLN
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 20-25 MG
BENAZEPRIL & HYDROCHLOROTHIAZIDE TAB 5-6.25 MG
BENAZEPRIL HCL TAB 10 MG
BENAZEPRIL HCL TAB 20 MG
BENAZEPRIL HCL TAB 40 MG
BENAZEPRIL HCL TAB 5 MG
BETAXOLOL HCL TAB 10 MG
BETAXOLOL HCL TAB 20 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 10-6.25 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 2.5-6.25 MG
BISOPROLOL & HYDROCHLOROTHIAZIDE TAB 5-6.25 MG
BISOPROLOL FUMARATE TAB 10 MG
BISOPROLOL FUMARATE TAB 5 MG
BUDESONIDE INHALATION SUSP 0.25 MG/2ML
$0 Copay Medications for NMHC Members
BUDESONIDE INHALATION SUSP 0.5 MG/2ML
BUMETANIDE TAB 0.5 MG
BUMETANIDE TAB 1 MG
BUMETANIDE TAB 2 MG
BUPROPION HCL TAB 100 MG
BUPROPION HCL TAB 75 MG
BUPROPION HCL TAB SR 12HR 100 MG
BUPROPION HCL TAB SR 12HR 150 MG
BUPROPION HCL TAB SR 12HR 200 MG
BUPROPION HCL TAB SR 24HR 150 MG
BUPROPION HCL TAB SR 24HR 300 MG
BUSPIRONE HCL TAB 10 MG
BUSPIRONE HCL TAB 15 MG
BUSPIRONE HCL TAB 30 MG
BUSPIRONE HCL TAB 5 MG
BUSPIRONE HCL TAB 7.5 MG
CANDESARTAN CILEXETIL TAB 16 MG
CANDESARTAN CILEXETIL TAB 32 MG
CANDESARTAN CILEXETIL TAB 4 MG
CANDESARTAN CILEXETIL TAB 8 MG
CANDESARTAN CILEXETIL-HYDROCHLOROTHIAZIDE TAB 16-12.5 MG
CANDESARTAN CILEXETIL-HYDROCHLOROTHIAZIDE TAB 32-12.5 MG
CANDESARTAN CILEXETIL-HYDROCHLOROTHIAZIDE TAB 32-25 MG
CAPTOPRIL TAB 100 MG
CAPTOPRIL TAB 12.5 MG
CAPTOPRIL TAB 25 MG
CAPTOPRIL TAB 50 MG
CARBAMAZEPINE CAP SR 12HR 100 MG
CARBAMAZEPINE CAP SR 12HR 200 MG
CARBAMAZEPINE CAP SR 12HR 300 MG
CARBAMAZEPINE CHEW TAB 100 MG
CARBAMAZEPINE SUSP 100 MG/5ML
CARBAMAZEPINE TAB 200 MG
CARBAMAZEPINE TAB SR 12HR 200 MG
CARBAMAZEPINE TAB SR 12HR 400 MG
CARVEDILOL TAB 12.5 MG
CARVEDILOL TAB 25 MG
CARVEDILOL TAB 3.125 MG
CARVEDILOL TAB 6.25 MG
CHLOROTHIAZIDE TAB 500 MG
CHLORPROMAZINE HCL TAB 10 MG
CHLORPROMAZINE HCL TAB 100 MG
CHLORPROMAZINE HCL TAB 200 MG
CHLORPROMAZINE HCL TAB 25 MG
CHLORPROMAZINE HCL TAB 50 MG
CHOLESTYRAMINE LIGHT POWDER 4 GM/DOSE
CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM
CHOLESTYRAMINE POWDER 4 GM/DOSE
CHOLESTYRAMINE POWDER PACKETS 4 GM
CHOLINE FENOFIBRATE CAP DR 135 MG (FENOFIBRIC ACID EQUIV)
CHOLINE FENOFIBRATE CAP DR 45 MG (FENOFIBRIC ACID EQUIV)
CITALOPRAM HYDROBROMIDE ORAL SOLN 10 MG/5ML
CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV)
CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)
CITALOPRAM HYDROBROMIDE TAB 40 MG (BASE EQUIV)
CLOMIPRAMINE HCL CAP 25 MG
CLOMIPRAMINE HCL CAP 50 MG
CLOMIPRAMINE HCL CAP 75 MG
CLONIDINE HCL TAB 0.1 MG
CLONIDINE HCL TAB 0.2 MG
CLONIDINE HCL TAB 0.3 MG
COLESTIPOL HCL GRANULE PACKETS 5 GM
COLESTIPOL HCL GRANULES 5 GM
COLESTIPOL HCL TAB 1 GM
$0 Copay Medications for NMHC Members
CROMOLYN SODIUM SOLN NEBU 20 MG/2ML
DESIPRAMINE HCL TAB 10 MG
DESIPRAMINE HCL TAB 100 MG
DESIPRAMINE HCL TAB 150 MG
DESIPRAMINE HCL TAB 25 MG
DESIPRAMINE HCL TAB 50 MG
DESIPRAMINE HCL TAB 75 MG
DIGOXIN TAB 125 MCG (0.125 MG)
DIGOXIN TAB 250 MCG (0.25 MG)
DILTIAZEM HCL CAP SR 12HR 120 MG
DILTIAZEM HCL CAP SR 12HR 60 MG
DILTIAZEM HCL CAP SR 12HR 90 MG
DILTIAZEM HCL CAP SR 24HR 120 MG
DILTIAZEM HCL CAP SR 24HR 180 MG
DILTIAZEM HCL CAP SR 24HR 240 MG
DILTIAZEM HCL COATED BEADS CAP SR 24HR 120 MG
DILTIAZEM HCL COATED BEADS CAP SR 24HR 180 MG
DILTIAZEM HCL COATED BEADS CAP SR 24HR 240 MG
DILTIAZEM HCL COATED BEADS CAP SR 24HR 300 MG
DILTIAZEM HCL COATED BEADS CAP SR 24HR 360 MG
DILTIAZEM HCL COATED BEADS TAB SR 24HR 180 MG
DILTIAZEM HCL COATED BEADS TAB SR 24HR 240 MG
DILTIAZEM HCL COATED BEADS TAB SR 24HR 300 MG
DILTIAZEM HCL COATED BEADS TAB SR 24HR 360 MG
DILTIAZEM HCL COATED BEADS TAB SR 24HR 420 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 120 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 180 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 240 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 300 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 360 MG
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 420 MG
DILTIAZEM HCL TAB 120 MG
DILTIAZEM HCL TAB 30 MG
DILTIAZEM HCL TAB 60 MG
DILTIAZEM HCL TAB 90 MG
DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG
DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG
DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG
DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG
DIVALPROEX SODIUM TAB SR 24 HR 250 MG
DIVALPROEX SODIUM TAB SR 24 HR 500 MG
DOXAZOSIN MESYLATE TAB 1 MG
DOXAZOSIN MESYLATE TAB 2 MG
DOXAZOSIN MESYLATE TAB 4 MG
DOXAZOSIN MESYLATE TAB 8 MG
DOXEPIN HCL CAP 10 MG
DOXEPIN HCL CAP 100 MG
DOXEPIN HCL CAP 150 MG
DOXEPIN HCL CAP 25 MG
DOXEPIN HCL CAP 50 MG
DOXEPIN HCL CONC 10 MG/ML
DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG
DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG
DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG
DYPHYLLINE-GUAIFENESIN LIQD 100-100 MG
DYPHYLLINE-GUAIFENESIN TAB 200-200 MG
DYPHYLLINE-GUAIFENESIN TAB 200-400 MG
ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE TAB 10-25 MG
ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE TAB 5-12.5 MG
ENALAPRIL MALEATE TAB 10 MG
ENALAPRIL MALEATE TAB 2.5 MG
ENALAPRIL MALEATE TAB 20 MG
ENALAPRIL MALEATE TAB 5 MG
EPLERENONE TAB 25 MG
$0 Copay Medications for NMHC Members
EPLERENONE TAB 50 MG
EPROSARTAN MESYLATE TAB 600MG
ESCITALOPRAM OXALATE SOLN 5 MG/5ML (BASE EQUIV)
ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)
ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)
ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)
FELODIPINE TAB SR 24HR 10 MG
FELODIPINE TAB SR 24HR 2.5 MG
FELODIPINE TAB SR 24HR 5 MG
FENOFIBRATE MICRONIZED CAP 130 MG
FENOFIBRATE MICRONIZED CAP 134 MG
FENOFIBRATE MICRONIZED CAP 200 MG
FENOFIBRATE MICRONIZED CAP 43 MG
FENOFIBRATE MICRONIZED CAP 67 MG
FENOFIBRATE TAB 145 MG
FENOFIBRATE TAB 160 MG
FENOFIBRATE TAB 48 MG
FENOFIBRATE TAB 54 MG
FLUOXETINE HCL CAP 10 MG
FLUOXETINE HCL CAP 20 MG
FLUOXETINE HCL CAP 40 MG
FLUOXETINE HCL CAP DELAYED RELEASE 90 MG
FLUOXETINE HCL SOLUTION 20 MG/5ML
FLUOXETINE HCL TAB 10 MG
FLUOXETINE HCL TAB 20 MG
FLUPHENAZINE HCL TAB 1 MG
FLUPHENAZINE HCL TAB 10 MG
FLUPHENAZINE HCL TAB 2.5 MG
FLUPHENAZINE HCL TAB 5 MG
FLUVASTATIN SODIUM CAP 20 MG
FLUVASTATIN SODIUM CAP 40 MG
FLUVOXAMINE MALEATE CAP SR 24HR 100 MG
FLUVOXAMINE MALEATE CAP SR 24HR 150 MG
FLUVOXAMINE MALEATE TAB 100 MG
FLUVOXAMINE MALEATE TAB 25 MG
FLUVOXAMINE MALEATE TAB 50 MG
FOSINOPRIL SODIUM & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
FOSINOPRIL SODIUM & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
FOSINOPRIL SODIUM TAB 10 MG
FOSINOPRIL SODIUM TAB 20 MG
FOSINOPRIL SODIUM TAB 40 MG
FUROSEMIDE ORAL SOLN 10 MG/ML
FUROSEMIDE TAB 20 MG
FUROSEMIDE TAB 40 MG
FUROSEMIDE TAB 80 MG
GEMFIBROZIL TAB 600 MG
GLIMEPIRIDE TAB 1 MG
GLIMEPIRIDE TAB 2 MG
GLIMEPIRIDE TAB 4 MG
GLIPIZIDE TAB 10 MG
GLIPIZIDE TAB 5 MG
GLIPIZIDE TAB SR 24HR 10 MG
GLIPIZIDE TAB SR 24HR 2.5 MG
GLIPIZIDE TAB SR 24HR 5 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-250 MG
GLIPIZIDE-METFORMIN HCL TAB 2.5-500 MG
GLIPIZIDE-METFORMIN HCL TAB 5-500 MG
GLUCOSE GEL 40%
GLUCOSE ORAL LIQUID 15 GM/59 ML
GLUCOSE-VITAMIN C CHEW TAB 4-0.006 GM
GLYBURIDE MICRONIZED TAB 1.5 MG
GLYBURIDE MICRONIZED TAB 3 MG
GLYBURIDE MICRONIZED TAB 6 MG
GLYBURIDE TAB 1.25 MG
$0 Copay Medications for NMHC Members
GLYBURIDE TAB 2.5 MG
GLYBURIDE TAB 5 MG
GLYBURIDE-METFORMIN TAB 1.25-250 MG
GLYBURIDE-METFORMIN TAB 2.5-500 MG
GLYBURIDE-METFORMIN TAB 5-500 MG
GUANFACINE HCL TAB 1 MG
GUANFACINE HCL TAB 2 MG
HALOPERIDOL LACTATE ORAL CONC 2 MG/ML
HALOPERIDOL TAB 0.5 MG
HALOPERIDOL TAB 1 MG
HALOPERIDOL TAB 10 MG
HALOPERIDOL TAB 2 MG
HALOPERIDOL TAB 20 MG
HALOPERIDOL TAB 5 MG
HYDRALAZINE HCL TAB 10 MG
HYDRALAZINE HCL TAB 100 MG
HYDRALAZINE HCL TAB 25 MG
HYDRALAZINE HCL TAB 50 MG
HYDROCHLOROTHIAZIDE CAP 12.5 MG
HYDROCHLOROTHIAZIDE TAB 12.5 MG
HYDROCHLOROTHIAZIDE TAB 25 MG
HYDROCHLOROTHIAZIDE TAB 50 MG
HYDROXYZINE HCL SYRUP 10 MG/5ML
HYDROXYZINE HCL TAB 10 MG
HYDROXYZINE HCL TAB 25 MG
HYDROXYZINE HCL TAB 50 MG
HYDROXYZINE PAMOATE CAP 25 MG
HYDROXYZINE PAMOATE CAP 50 MG
IMIPRAMINE HCL TAB 10 MG
IMIPRAMINE HCL TAB 25 MG
IMIPRAMINE HCL TAB 50 MG
IMIPRAMINE PAMOATE CAP 100 MG
IMIPRAMINE PAMOATE CAP 125 MG
IMIPRAMINE PAMOATE CAP 150 MG
IMIPRAMINE PAMOATE CAP 75 MG
INDAPAMIDE TAB 1.25 MG
INDAPAMIDE TAB 2.5 MG
IPRATROPIUM BROMIDE HFA INHAL AEROSOL
IRBESARTAN TAB 150 MG
IRBESARTAN TAB 300 MG
IRBESARTAN TAB 75 MG
IRBESARTAN-HYDROCHLOROTHIAZIDE TAB 150-12.5 MG
IRBESARTAN-HYDROCHLOROTHIAZIDE TAB 300-12.5 MG
ISOSORBIDE DINITRATE TAB 10 MG
ISOSORBIDE DINITRATE TAB 20 MG
ISOSORBIDE DINITRATE TAB 5 MG
ISOSORBIDE DINIRATE TAB CR 40MG
ISOSORBIDE MONONITRATE TAB 10 MG
ISOSORBIDE MONONITRATE TAB 20 MG
ISOSORBIDE MONONITRATE TAB SR 24HR 120 MG
ISOSORBIDE MONONITRATE TAB SR 24HR 30 MG
ISOSORBIDE MONONITRATE TAB SR 24HR 60 MG
LABETALOL HCL TAB 100 MG
LABETALOL HCL TAB 200 MG
LABETALOL HCL TAB 300 MG
LAMOTRIGINE TAB 100 MG
LAMOTRIGINE TAB 150 MG
LAMOTRIGINE TAB 200 MG
LAMOTRIGINE TAB 25 MG
LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 25 MG
LAMOTRIGINE TAB CHEWABLE DISPERSIBLE 5 MG
LAMOTRIGINE TAB SR 24HR 100 MG
LAMOTRIGINE TAB SR 24HR 200 MG
LAMOTRIGINE TAB SR 24HR 25 MG
$0 Copay Medications for NMHC Members
LAMOTRIGINE TAB SR 24HR 250 MG
LAMOTRIGINE TAB SR 24HR 300 MG
LAMOTRIGINE TAB SR 24HR 50 MG
LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML
LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML
LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-25 MG
LISINOPRIL TAB 10 MG
LISINOPRIL TAB 2.5 MG
LISINOPRIL TAB 20 MG
LISINOPRIL TAB 30 MG
LISINOPRIL TAB 40 MG
LISINOPRIL TAB 5 MG
LITHIUM CARBONATE CAP 150 MG
LITHIUM CARBONATE CAP 300 MG
LITHIUM CARBONATE CAP 600 MG
LITHIUM CARBONATE TAB 300 MG
LITHIUM CARBONATE TAB CR 300 MG
LITHIUM CARBONATE TAB CR 450 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-12.5 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 100-25 MG
LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE TAB 50-12.5 MG
LOSARTAN POTASSIUM TAB 100 MG
LOSARTAN POTASSIUM TAB 25 MG
LOSARTAN POTASSIUM TAB 50 MG
LOVASTATIN TAB 10 MG
LOVASTATIN TAB 20 MG
LOVASTATIN TAB 40 MG
LOXAPINE SUCCINATE CAP 10 MG
LOXAPINE SUCCINATE CAP 25 MG
LOXAPINE SUCCINATE CAP 5 MG
LOXAPINE SUCCINATE CAP 50 MG
METFORMIN HCL TAB 1000 MG
METFORMIN HCL TAB 500 MG
METFORMIN HCL TAB 850 MG
METFORMIN HCL TAB SR 24HR 500 MG
METFORMIN HCL TAB SR 24HR 750 MG
METFORMIN HCL TAB SR 24HR OSMOTIC 1000 MG
METFORMIN HCL TAB SR 24HR OSMOTIC 500 MG
METHAZOLAMIDE TAB 25 MG
METHAZOLAMIDE TAB 50 MG
METHYLDOPA TAB 250 MG
METHYLDOPA TAB 500 MG
METOLAZONE TAB 10 MG
METOLAZONE TAB 2.5 MG
METOLAZONE TAB 5 MG
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 100-25 MG
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 100-50 MG
METOPROLOL & HYDROCHLOROTHIAZIDE TAB 50-25 MG
METOPROLOL SUCCINATE TAB SR 24HR 100 MG (TARTRATE EQUIV)
METOPROLOL SUCCINATE TAB SR 24HR 200 MG (TARTRATE EQUIV)
METOPROLOL SUCCINATE TAB SR 24HR 25 MG (TARTRATE EQUIV)
METOPROLOL SUCCINATE TAB SR 24HR 50 MG (TARTRATE EQUIV)
METOPROLOL TARTRATE TAB 100 MG
METOPROLOL TARTRATE TAB 25 MG
METOPROLOL TARTRATE TAB 50 MG
MINOXIDIL TAB 10 MG
MINOXIDIL TAB 2.5 MG
MIRTAZAPINE ORALLY DISINTEGRATING TAB 15 MG
MIRTAZAPINE ORALLY DISINTEGRATING TAB 30 MG
MIRTAZAPINE ORALLY DISINTEGRATING TAB 45 MG
MIRTAZAPINE TAB 15 MG
$0 Copay Medications for NMHC Members
MIRTAZAPINE TAB 30 MG
MIRTAZAPINE TAB 45 MG
MIRTAZAPINE TAB 7.5 MG
MOEXIPRIL HCL TAB 15 MG
MOEXIPRIL HCL TAB 7.5 MG
MOEXIPRIL-HYDROCHLOROTHIAZIDE TAB 15-12.5 MG
MOEXIPRIL-HYDROCHLOROTHIAZIDE TAB 15-25 MG
MOEXIPRIL-HYDROCHLOROTHIAZIDE TAB 7.5-12.5 MG
MOMETASONE FUROATE INHAL POWD 110 MCG/
MOMETASONE FUROATE INHAL POWD 220 MCG/
MONTELUKAST SODIUM CHEW TAB 4 MG (BASE
MONTELUKAST SODIUM CHEW TAB 5 MG (BASE
MONTELUKAST SODIUM TAB 10 MG (BASE EQU
NADOLOL & BENDROFLUMETHIAZIDE TAB 40-5 MG
NADOLOL & BENDROFLUMETHIAZIDE TAB 80-5 MG
NADOLOL TAB 20 MG
NADOLOL TAB 40 MG
NADOLOL TAB 80 MG
NATEGLINIDE TAB 120 MG
NATEGLINIDE TAB 60 MG
NEFAZODONE HCL TAB 250 MG
NIACIN TAB CR 1000 MG (ANTIHYPERLIPIDEMIC)
NIACIN TAB CR 500 MG (ANTIHYPERLIPIDEMIC)
NIACIN TAB CR 750 MG (ANTIHYPERLIPIDEMIC)
NICARDIPINE HCL CAP 20 MG
NICARDIPINE HCL CAP 30 MG
NIFEDIPINE CAP 10 MG
NIFEDIPINE CAP 20 MG
NIFEDIPINE TAB SR 24HR 30 MG
NIFEDIPINE TAB SR 24HR 60 MG
NIFEDIPINE TAB SR 24HR 90 MG
NIFEDIPINE TAB SR 24HR OSMOTIC RELEASE 30 MG
NIFEDIPINE TAB SR 24HR OSMOTIC RELEASE 60 MG
NIFEDIPINE TAB SR 24HR OSMOTIC RELEASE 90 MG
NIMODIPINE CAP 30 MG
NISOLDIPINE TAB SR 24HR 17 MG
NISOLDIPINE TAB SR 24HR 34 MG
NISOLDIPINE TAB SR 24HR 8.5 MG
NITROGLYCERIN CAP CR 2.5 MG
NITROGLYCERIN CAP CR 6.5 MG
NITROGLYCERIN CAP CR 9 MG
NORTRIPTYLINE HCL CAP 10 MG
NORTRIPTYLINE HCL CAP 25 MG
NORTRIPTYLINE HCL CAP 50 MG
NORTRIPTYLINE HCL CAP 75 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 15 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 20 MG
OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG
OLANZAPINE TAB 10 MG
OLANZAPINE TAB 15 MG
OLANZAPINE TAB 2.5 MG
OLANZAPINE TAB 20 MG
OLANZAPINE TAB 5 MG
OLANZAPINE TAB 7.5 MG
OXCARBAZEPINE SUSP 300 MG/5ML (60 MG/ML)
OXCARBAZEPINE TAB 150 MG
OXCARBAZEPINE TAB 300 MG
OXCARBAZEPINE TAB 600 MG
PAROXETINE HCL TAB 10 MG
PAROXETINE HCL TAB 20 MG
PAROXETINE HCL TAB 30 MG
PAROXETINE HCL TAB 40 MG
PAROXETINE HCL TAB SR 24HR 12.5 MG
$0 Copay Medications for NMHC Members
PAROXETINE HCL TAB SR 24HR 25 MG
PAROXETINE HCL TAB SR 24HR 37.5 MG
PERINDOPRIL ERBUMINE TAB 2 MG
PERINDOPRIL ERBUMINE TAB 4 MG
PERINDOPRIL ERBUMINE TAB 8 MG
PERPHENAZINE TAB 16 MG
PERPHENAZINE TAB 2 MG
PERPHENAZINE TAB 4 MG
PERPHENAZINE TAB 8 MG
PHENELZINE SULFATE TAB 15 MG
PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)
PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)
PIOGLITAZONE HCL TAB 45 MG (BASE EQUIV)
PIOGLITAZONE HCL-GLIMEPIRIDE TAB 30-2 MG
PIOGLITAZONE HCL-GLIMEPIRIDE TAB 30-4 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-500 MG
PIOGLITAZONE HCL-METFORMIN HCL TAB 15-850 MG
PRAVASTATIN SODIUM TAB 10 MG
PRAVASTATIN SODIUM TAB 20 MG
PRAVASTATIN SODIUM TAB 40 MG
PRAVASTATIN SODIUM TAB 80 MG
PRAZOSIN HCL CAP 1 MG
PRAZOSIN HCL CAP 2 MG
PRAZOSIN HCL CAP 5 MG
PROPRANOLOL HCL CAP SR 24HR 120 MG
PROPRANOLOL HCL CAP SR 24HR 160 MG
PROPRANOLOL HCL CAP SR 24HR 60 MG
PROPRANOLOL HCL CAP SR 24HR 80 MG
PROPRANOLOL HCL TAB 10 MG
PROPRANOLOL HCL TAB 20 MG
PROPRANOLOL HCL TAB 40 MG
PROPRANOLOL HCL TAB 60 MG
PROPRANOLOL HCL TAB 80 MG
PROTRIPTYLINE HCL TAB 10 MG
PROTRIPTYLINE HCL TAB 5 MG
QUETIAPINE FUMARATE TAB 100 MG
QUETIAPINE FUMARATE TAB 200 MG
QUETIAPINE FUMARATE TAB 25 MG
QUETIAPINE FUMARATE TAB 300 MG
QUETIAPINE FUMARATE TAB 400 MG
QUETIAPINE FUMARATE TAB 50 MG
QUINAPRIL HCL TAB 10 MG
QUINAPRIL HCL TAB 20 MG
QUINAPRIL HCL TAB 40 MG
QUINAPRIL HCL TAB 5 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 10-12.5 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 20-12.5 MG
QUINAPRIL-HYDROCHLOROTHIAZIDE TAB 20-25 MG
RAMIPRIL CAP 1.25 MG
RAMIPRIL CAP 10 MG
RAMIPRIL CAP 2.5 MG
RAMIPRIL CAP 5 MG
REPAGLINIDE TAB 0.5 MG
REPAGLINIDE TAB 1 MG
REPAGLINIDE TAB 2 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 0.25 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 2 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 3 MG
RISPERIDONE ORALLY DISINTEGRATING TAB 4 MG
RISPERIDONE SOLN 1 MG/ML
RISPERIDONE TAB 0.25 MG
RISPERIDONE TAB 0.5 MG
$0 Copay Medications for NMHC Members
RISPERIDONE TAB 1 MG
RISPERIDONE TAB 2 MG
RISPERIDONE TAB 3 MG
RISPERIDONE TAB 4 MG
SERTRALINE HCL ORAL CONC 20 MG/ML
SERTRALINE HCL TAB 100 MG
SERTRALINE HCL TAB 25 MG
SERTRALINE HCL TAB 50 MG
SIMVASTATIN TAB 10 MG
SIMVASTATIN TAB 20 MG
SIMVASTATIN TAB 40 MG
SIMVASTATIN TAB 5 MG
SIMVASTATIN TAB 80 MG
SOTALOL HCL (AFIB/AFL) TAB 120 MG
SOTALOL HCL (AFIB/AFL) TAB 160 MG
SOTALOL HCL (AFIB/AFL) TAB 80 MG
SOTALOL HCL TAB 120 MG
SOTALOL HCL TAB 160 MG
SOTALOL HCL TAB 240 MG
SOTALOL HCL TAB 80 MG
SPIRONOLACTONE & HYDROCHLOROTHIAZIDE TAB 25-25 MG
SPIRONOLACTONE TAB 100 MG
SPIRONOLACTONE TAB 25 MG
SPIRONOLACTONE TAB 50 MG
TELMISARTAN TAB 20 MG
TELMISARTAN TAB 40 MG
TELMISARTAN TAB 80 MG
TELMISARTAN-AMLODIPINE TAB 40-10 MG
TELMISARTAN-AMLODIPINE TAB 40-5 MG
TELMISARTAN-AMLODIPINE TAB 80-10 MG
TELMISARTAN-AMLODIPINE TAB 80-5 MG
TERAZOSIN HCL CAP 1 MG
TERAZOSIN HCL CAP 10 MG
TERAZOSIN HCL CAP 2 MG
TERAZOSIN HCL CAP 5 MG
TERBUTALINE SULFATE TAB 2.5MG
TERBUTALINE SULFATE TAB 5MG
THEOPHYLLINE SOLN 80 MG/15ML
THEOPHYLLINE TAB SR 12HR 100 MG
THEOPHYLLINE TAB SR 12HR 200 MG
THEOPHYLLINE TAB SR 12HR 300 MG
THEOPHYLLINE TAB SR 12HR 450 MG
THEOPHYLLINE TAB SR 24HR 400 MG
THEOPHYLLINE TAB SR 24HR 600 MG
THIORIDAZINE HCL TAB 10 MG
THIORIDAZINE HCL TAB 100 MG
THIORIDAZINE HCL TAB 25 MG
THIORIDAZINE HCL TAB 50 MG
THIOTHIXENE CAP 1 MG
THIOTHIXENE CAP 10 MG
THIOTHIXENE CAP 2 MG
THIOTHIXENE CAP 5 MG
TOLAZAMIDE TAB 250 MG
TORSEMIDE TAB 10 MG
TORSEMIDE TAB 100 MG
TORSEMIDE TAB 20 MG
TORSEMIDE TAB 5 MG
TRANDOLAPRIL TAB 1 MG
TRANDOLAPRIL TAB 2 MG
TRANDOLAPRIL TAB 4 MG
TRANYLCYPROMINE SULFATE TAB 10 MG
TRAZODONE HCL TAB 100 MG
TRAZODONE HCL TAB 150 MG
TRAZODONE HCL TAB 300 MG
$0 Copay Medications for NMHC Members
TRAZODONE HCL TAB 50 MG
TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG
TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG
TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 75-50 MG
TRIFLUOPERAZINE HCL TAB 1 MG
TRIFLUOPERAZINE HCL TAB 10 MG
TRIFLUOPERAZINE HCL TAB 2 MG
TRIFLUOPERAZINE HCL TAB 5 MG
VALPROATE SODIUM SYRUP 250 MG/5ML (BASE EQUIV)
VALPROIC ACID CAP 250 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-12.5 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-25 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-12.5 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-25 MG
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 80-12.5 MG
VENLAFAXINE HCL CAP SR 24HR 150 MG (BASE EQUIVALENT)
VENLAFAXINE HCL CAP SR 24HR 37.5 MG (BASE EQUIVALENT)
VENLAFAXINE HCL CAP SR 24HR 75 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB 100 MG
VENLAFAXINE HCL TAB 25 MG
VENLAFAXINE HCL TAB 37.5 MG
VENLAFAXINE HCL TAB 50 MG
VENLAFAXINE HCL TAB 75 MG
VENLAFAXINE HCL TAB SR 24HR 150 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB SR 24HR 37.5 MG (BASE EQUIVALENT)
VENLAFAXINE HCL TAB SR 24HR 75 MG (BASE EQUIVALENT)
VERAPAMIL HCL CAP SR 24HR 100 MG
VERAPAMIL HCL CAP SR 24HR 120 MG
VERAPAMIL HCL CAP SR 24HR 180 MG
VERAPAMIL HCL CAP SR 24HR 200 MG
VERAPAMIL HCL CAP SR 24HR 240 MG
VERAPAMIL HCL CAP SR 24HR 300 MG
VERAPAMIL HCL CAP SR 24HR 360 MG
VERAPAMIL HCL TAB 120 MG
VERAPAMIL HCL TAB 80 MG
VERAPAMIL HCL TAB CR 120 MG
VERAPAMIL HCL TAB CR 180 MG
VERAPAMIL HCL TAB CR 240 MG
WARFARIN SODIUM TAB 1 MG
WARFARIN SODIUM TAB 10 MG
WARFARIN SODIUM TAB 2 MG
WARFARIN SODIUM TAB 2.5 MG
WARFARIN SODIUM TAB 3 MG
WARFARIN SODIUM TAB 4 MG
WARFARIN SODIUM TAB 5 MG
WARFARIN SODIUM TAB 6 MG
WARFARIN SODIUM TAB 7.5 MG
ZAFIRLUKAST TAB 10 MG
ZAFIRLUKAST TAB 20 MG
ZIPRASIDONE HCL CAP 20 MG
ZIPRASIDONE HCL CAP 40 MG
ZIPRASIDONE HCL CAP 60 MG
ZIPRASIDONE HCL CAP 80 MG