CommuniCare Advantage - Community Health Group

Transcription

CommuniCare Advantage
2009 Formulary
(List of Covered Drugs)
!"#$"%
' ( &)*
+
&
% !
!
"
#
!
$
$
%
!
&
!
'
$
&
(
)
*
*
&
+
,
!
!
-
/
1
'
! 2
0 111 22 223 4
.
--5)-++
0
436
!
-
7
"
$
+
-0 8
9&
!
-0 -
!
!
1
#
&
&
&
$
$
&0 :
$; !
&
!
$
&
!
$
< $
-
&
+
#
/
7
•
%
(
&
,
•
&
$
$
3
•
3
=
$> -
# &
' #
$
+
+
:
:
+
!
&+
+
5
:
!
-0
5
/
!
!
8?
@9
&
$
$
,
3
$
2
$
&
.
/
&
7
•
5
!.
/
'
•
5
/
!
!
$
$
!
(
5
!
) #
*
!
!
$
•
5
!
•
5
!
$
!
!
$
&
!
#
$
,
(
)
5
!
(
$
(
) #
,#
(
+
%
##
#
!
,
4
5
$
A
B
$
4
&
$
2
,
-
(
) #
!
%
!
3
$
5
(
!
$
! '
!
A
B
!
&
A
B'
&
A
B
$
$
!
,
.
C
+
D
(
"
&
111 22 223 4
%
&
.
01
.
! 2
--5)-++
.
. "+& E" A0 1 *33 2
0 144 21* 21 %
4B 2
4
)4
/
01
0
436
! --5)-++
*
-
-0
&
&
$
&0
CF;. & %E-B
-
:
(
A
<
5
A
B
.& /
F
G
H
H
C
I
G
C
H
"
.
C
I
J
J
J
$
G
H
%
I
G
"
I
G
J
/
G
I
J
H
$
$
I
/
K
(
J
H
L
)
K
*
L
H
I
I
*
L
/
H
I
D
7
L
436
L
I
(
/
;
C
C
G
H
0 111 22 223
--5)-++
6
I
L
"
2
01
.0
"$
0
/
"
(
I
I
L
(
H
C
G
(
A
(H B
I
(
0
/
H
D
L
L
1
-M0 ;
8.
-0 +
9/
G
D
/
I
D
L
I
&0
N
G
GL
"
G
N
H
I
K
I
O
.& /
N
I
:
I
J
N
/
G
F
G
;
G
I
H
I
.1)
L
"
•
7
%
0
C
G
(
H
H "
H
•
"
$2
30
IC
L
7
D
3
L
H "
A+ B
H =
$> C
•
"
H
G
H
G
H C
D
:
:
/
I
:
F
L
(
I
-0
F
$
L
H 8P H
@9
$
H
H
.& /
/
/
I
C
I
/
7
•
C
/
C
G
G
G
L
•
L
G
C
$
O
<%- 7+
.
A
A"+
H
.0
I
H
.
L
$
C
H
O
/
;
D
C
$
H
$
C
I
8
H
.
) # 0
"$
H
H
B
GB
C
•
H
C
G
•
C
L
D
/
L
I
L
C
H
(
H
H
H
(
$
$
H
H
H
$
H
H
G
4
(
G
G
H
J
AI
B
G
4
H /
H
H
(
H
.& /
)
D
H
C
H
H
+
(
$
H
G
H
C
I
2
G
G
#
) # 0
/
I
I
G
G
G
L
D
(
H C
H
H +
G
$
H
.
G
H
L
C
L
G
H
L
A
H
+
L B
G
L
L
/
H
H
L A
(
H
/
(
/
G
9
L B
L
I
L
L
A
G
H
$
L B
H
C
D
H
(
I
H
H
I
I
C
+
I
D
(
H
0
C
H
H
"
?4 1*Q"%
/
C
/
0 111 22 223
--5)-++
/
.
L
"
2
01
01
L
4 L
436
. "+& E" A0 1 *33 2
--5)-++
;
-0
(
I
"
G
H
4B
2
0 144 21*
H
L
21
H
/
N
;
;
D
I
I
K
K
E
);L
10
A
A
D
D
&0
;
7CF;. & %E-B
7
B
4
+
+
#
#
#
+
+
#
11
12
ZYFLO CR ........................................... T-18
ZYLET.................................................. T-16
Zyloprim ............................................... T-42
ZYMAR ................................................ T-16
ZYPREXA ............................................ T-48
ZYPREXA ZYDIS ............................... T-48
Zyrtec Allergy....................................... T-51
Zyrtec-D................................................ T-51
Zyrtec-d Allergy/congesti ..................... T-51
ZYVOX................................................... T-6
I-25
Drug Name
Drug
Tier
Notes
Acidifying Agents
Acidifying Agents
(Ammonium Chloride)
ammonium chloride
1
soln
(Cortisone Acetate)
DEPO-MEDROL
(Decadron)
(Dexamethasone Sodium
Phosphate)
ENTOCORT EC
FLOVENT DISKUS
FLOVENT HFA
(Florinef)
(Cortef)
(A-hydrocort)
1
2
1
1
tabs
susp; 20mg/ml
elix, soln, tabs
soln
2
2
2
1
1
1
cp24
aepb
aero
tabs
tabs
solr
(Medrol)
(Depo-medrol)
1
1
(Solu-medrol)
1
(Millipred)
(Pediapred)
1
1
tabs
susp; 40mg/ml,
80mg/ml
solr; 40mg,
125mg, 500mg,
1000mg
syrp, tabs
liqd, soln
(Prednisone)
PREDNISONE INTENSOL
PULMICORT FLEXHALER
QVAR
SOLU-MEDROL
SOLU-MEDROL ACT-OVIAL
SYMBICORT
1
2
2
2
2
2
soln, tabs
conc
inha
aers
solr; 2gm
solr; 500mg
Adrenals
Adrenals
cortisone acetate
dexamethasone
dexamethasone sodium
phosphate
fludrocortisone acetate
hydrocortisone
hydrocortisone sodium
succinate
methylprednisolone
methylprednisolone
acetate
methylprednisolone
sodium succinate
prednisolone anhydrous
prednisolone sodium
phosphate
prednisone
2
QL, ST
QL
aero
Alkalinizing Agents
Alkalinizing Agents
(Urocit-K)
potassium citrate
(Sodium Bicarbonate)
sodium bicarbonate
(Sodium Lactate)
sodium lactate
1
1
1
tbcr
soln
soln
1
1
1
tabs
caps
caps
Alpha-Adrenergic Blocking Agents
Alpha-Adrenergic Blocking Agents
(Cardura)
doxazosin mesylate
prazosin hydrochloride (Minipress)
(Hytrin)
terazosin hcl
T-1
Drug Name
Drug
Tier
Notes
Ammonia Detoxicants
Ammonia Detoxicants
BUPHENYL
(Enulose)
lactulose
LITHOSTAT
2
1
2
powd, tabs
soln
tabs
Analgesics and Antipyretics
Non-Steroidal Anti-inflammatory Agents
CELEBREX
(Cataflam)
diclofenac potassium
(Voltaren)
diclofenac sodium
(Dolobid)
diflunisal
(Lodine)
etodolac
(Nalfon)
fenoprofen calcium
(Ansaid)
flurbiprofen
(Motrin)
ibuprofen
(Indocin)
indomethacin
(Orudis)
ketoprofen
ketorolac tromethamine (Toradol)
(Meclomen)
meclofenamate sodium
(Mobic)
meloxicam
(Relafen)
nabumetone
(Naprosyn)
naproxen
(Anaprox)
naproxen sodium
(Daypro)
oxaprozin
(Feldene)
piroxicam
PREVACID NAPRAPAC
(Clinoril)
sulindac
(Tolectin)
tolmetin sodium
VOLTAREN
Opiate Agonists
(Fioricet/codeine)
acetaminophen and
butalbital and caffeine
and codeine phosphate
(Panlor SS)
acetaminophen and
caffeine and
dihydrocodeine
bitartrate
(Tylenol/codeine #3)
acetaminophen and
codeine phosphate
(Vicodin ES)
acetaminophen and
hydrocodone bitartrate
(Percocet)
acetaminophen and
oxycodone hydrochloride
T-2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
2
QL, ST
QL
QL, ST
ST
caps
tabs
tb24, tbec
tabs
caps, tabs, tb24
tabs
tabs
susp, tabs
caps, cpcr
caps, cp24
soln, tabs
caps
susp, tabs
tabs
susp, tabs, tbec
tabs, tb24
tabs
caps
kit
tabs
caps, tabs
gel
1
caps
1
caps, tabs
1
soln, tabs
1
caps, soln, tabs
1
caps, soln, tabs
Drug Name
acetaminophen and
propoxyphene
hydrochloride
acetaminophen and
propoxyphene napsylate
acetaminophen and
tramadol hcl
aspirin and butalbital
and caffeine and codeine
phosphate
aspirin and oxycodone
hydrochloride and
oxycodone terephthalate
codeine sulfate
fentanyl
fentanyl citrate
fentanyl citrate
Drug
Tier
Notes
(Acetaminophen and
Propoxyphene Hydrochloride)
1
tabs
(Darvocet-n 100)
1
tabs
(Ultracet)
1
tabs
(Fiorinal/codeine #3)
1
caps
(Percodan)
1
tabs
(Codeine Sulfate)
DOLOPHINE HCL
(Duragesic)
(Actiq)
(Actiq)
FENTORA
(Vicoprofen)
1
1
1
1
1
2
1
tabs
tabs
pt72
soln
lpop
tabs
tabs
hydrocodone bitartrate
and ibuprofen
(Dilaudid)
hydromorphone
hydrochloride
ibuprofen and oxycodone (Combunox)
hydrochloride
KADIAN
LEVO-DROMORAN
(Levo-dromoran)
levorphanol tartrate
LORTAB 2.5
PA, QL
PA, QL
PA, QL
1
soln, tabs
1
tabs
(Demerol)
1
cp24
tabs
tabs
tabs; 500mg,
2.5mg
soln, tabs
(Dolophine)
1
conc, soln, tabs
(MS Contin)
NARVOX
ORAMORPH SR
oxycodone hydrochloride (Oxycodone Hydrochloride)
1
1
1
1
QL
oxycodone hydrochloride (Roxicodone)
OXYCONTIN
1
2
QL
soln, tabs, tb12
tabs; 500mg, 10mg
tb12
tb12; 10mg, 20mg,
40mg, 80mg
tabs
tb12; 10mg, 15mg,
20mg, 30mg,
40mg, 60mg,
80mg
meperidine
hydrochloride
methadone
hydrochloride
morphine sulfate
T-3
2
1
1
1
ST
Drug Name
propoxyphene
hydrochloride
tramadol hcl
Drug
Tier
Notes
PERLOXX
1
(Darvon)
1
tabs; 300mg,
2.5mg
caps
1
1
tabs
tabs; 500mg, 5mg
2
1
soln
soln
1
1
soln
soln
2
2
subl
subl
(Ultram)
VANACET
Opiate Partial Agonists
BUPRENEX
(Buprenorphine
buprenorphine
Hydrochloride)
hydrochloride
(Stadol)
butorphanol tartrate
(Nubain)
nalbuphine
hydrochloride
SUBOXONE
SUBUTEX
Androgens
Androgens
danazol
fluoxymesterone
oxandrolone
testosterone cypionate
testosterone enanthate
ANDRODERM
ANDROGEL
2
2
PA, QL
PA, QL
ANDROGEL PUMP
ANDROID
(Danocrine)
(Halotestin)
METHITEST
(Oxandrin)
(Depo-testosterone)
(Delatestryl)
TESTRED
2
1
1
1
2
1
1
1
1
PA, QL
2
1
QL, ST
PA
PA
pt24
gel; 25mg/2.5gm,
50mg/5gm
gel; 1%
caps
caps
tabs
tabs
tabs
oil
oil
caps
Anorexigenics, Respiratory, Cerebral Stimulants
Amphetamines
ADDERALL XR
(Adderall)
amphetamine aspartate
and amphetamine sulfate
and dextroamphetamine
saccharate and
dextroamphetamine
(Dexedrine)
1
dextroamphetamine
sulfate
Anorexigenics, Respiratory, Cerebral Stimulants, Miscellaneous
CONCERTA
2
QL, ST
dexmethylphenidate
hydrochloride
(Dexmethylphenidate
Hydrochloride)
T-4
1
cp24
tabs
cp24, tabs
tbcr; 18mg, 27mg,
36mg, 54mg
tabs
Drug Name
methylphenidate
hydrochloride
Drug
Tier
METADATE ER
(Ritalin)
1
1
PROVIGIL
2
ALBENZA
BILTRICIDE
(Vermox)
STROMECTOL
2
2
1
2
Notes
tbcr; 20mg
tabs, tbcr
PA, QL
tabs
Anthelmintics
Anthelmintics
mebendazole
tabs
tabs
chew
tabs
Antiallergic Agents
Antiallergic Agents
ALAMAST
ASTELIN
ASTEPRO
(Zaditor)
ketotifen fumarate
PATADAY
PATANOL
2
2
2
ST
2
2
ST
ST
soln
soln
soln
drops, soln, OTC
soln; 0.2%
soln; 0.1%
Antibacterials
Aminoglycosides
(Amikin)
amikacin sulfate
(Garamycin)
gentamicin sulfate
(Gentamicin Sulfate and
gentamicin sulfate and
Sodium Chloride)
sodium chloride
(Kanamycin Sulfate)
kanamycin sulfate
(Neomycin Sulfate)
neomycin sulfate
(Sodium Chloride and
sodium chloride and
Tobramycin Sulfate)
tobramycin sulfate
(Streptomycin Sulfate)
streptomycin sulfate
(Nebcin)
tobramycin sulfate
Antibacterials, Miscellaneous
(Bacitracin)
bacitracin
(Cleocin)
clindamycin
hydrochloride
(Cleocin Phosphate)
clindamycin phosphate
(Coly-mycin-m)
colistimethate sodium
CUBICIN
(Dextrose (anhydrous) and
dextrose (anhydrous)
Vancomycin Hydrochloride)
and vancomycin
hydrochloride
(Polymyxin B Sulfate)
polymyxin b sulfate
PYLERA
SYNERCID
VANCOCIN HCL
T-5
1
1
1
soln
soln
soln
1
1
1
soln
soln, tabs
soln
1
1
solr
soln, solr
1
1
solr
caps
1
2
2
1
soln
solr
solr
soln
1
2
2
2
solr
caps
solr
caps
Drug Name
vancomycin
hydrochloride
Cephalosporins
cefaclor
cefaclor monohydrate
cefadroxil hemihydrate
cefadroxil monohydrate
cefazolin sodium
cefazolin sodium and
cefdinir
cefepime hydrochloride
cefotaxime sodium
cefpodoxime proxetil
cefprozil
ceftazidime
Drug
Tier
(Vancomycin Hydrochloride)
1
solr
ZYVOX
2
soln, susr, tabs
(Ceclor)
(Ceclor)
(Cefadroxil Hemihydrate)
(Duricef)
(Ancef)
(Cefazolin Sodium and
Dextrose (anhydrous))
(Omnicef)
(Maxipime)
CEFIZOX IN DEXTROSE 5%
(Claforan)
(Vantin)
(Cefzil)
(Fortaz)
1
1
1
1
1
1
caps, susr
tb12
caps
susr, tabs
solr
soln
1
1
2
1
1
1
1
1
1
caps, susr
solr; 1gm, 2gm
soln
solr
susr, tabs
susr, tabs
solr; 1gm, 2gm,
6gm
solr
soln
2
1
1
1
solr
susr, tabs
solr
solr
1
1
2
2
2
2
caps
susr, tabs
solr; 500mg
soln
solr; 1gm, 2gm,
500mg
soln
2
tabs
1
solr
1
pack, solr, susr,
tabs
susr, tabs, tb24
solr; 1000mg
(Rocephin)
(Ceftriaxone Sodium and
Dextrose (anhydrous))
CEFTRIAXONE/DEXTROSE
(Ceftin)
cefuroxime axetil
(Zinacef)
cefuroxime sodium
cefuroxime sodium and (Cefuroxime Sodium and
Dextrose Monohydrate)
dextrose monohydrate
(Keflex)
cephalexin
cephalexin monohydrate (Keflex)
FORTAZ
FORTAZ
MAXIPIME
ceftriaxone sodium
ceftriaxone sodium and
ROCEPHIN IN ISOOSMOTIC DEXTROSE
SUPRAX
Chloramphenicol
chloramphenicol sodium (Chloromycetin)
succinate
Macrolides
(Zithromax Z-pak)
azithromycin
clarithromycin
Notes
(Biaxin)
ERYTHROCIN
1
2
T-6
Drug Name
erythromycin
erythromycin and
sulfisoxazole
erythromycin
ethylsuccinate
Drug
Tier
ERYTHROCIN
LACTOBIONATE
(Eryc)
(Pediazole)
2
solr; 500mg
1
1
cpep, tabs
susr
(Erythromycin Ethylsuccinate)
1
susp, tabs
2
solr; 500mg
ERYTHROMYCIN
LACTOBIONATE
(Erythromycin Stearate)
erythromycin stearate
KETEK
ZMAX
Miscellaneous B-Lactam Antibiotics
(Cefotetan)
cefotetan disodium
(Mefoxin)
cefoxitin sodium
Penicillins
amoxicillin
amoxicillin and
clavulanic acid
amoxicillin and
potassium clavulanate
ampicillin
ampicillin sodium
ampicillin sodium and
sulbactam sodium
and nafcillin sodium
Notes
1
2
2
1
1
ST
tabs
tabs
susr
solr
solr; 1gm, 2gm,
10gm
solr
solr
solr; 10gm
solr; 1gm, 2gm
solr
solr; 500mg,
500mg
solr; 250mg,
250mg, 500mg,
500mg
solr; 250mg,
250mg, 500mg,
500mg
DORIBAX
INVANZ
MEFOXIN
MEFOXIN ADD-VANTAGE
MERREM
PRIMAXIN I.M.
2
2
1
1
2
2
PRIMAXIN IV
2
PRIMAXIN IV ADDVANTAGE
2
(Amoxil)
1
(Augmentin)
1
caps, chew, susr,
tabs
chew, susr, tabs
(Augmentin ES-600)
1
susr, tabs
(Ampicillin)
(Ampicillin Sodium)
(Unasyn)
1
1
1
caps, susr
solr
solr
BICILLIN C-R
BICILLIN L-A
Nafcillin Sodium)
2
2
1
susp
susp
soln
T-7
Drug Name
and oxacillin sodium
and penicillin g
potassium
dicloxacillin sodium
nafcillin sodium
oxacillin sodium
penicillin g potassium
penicillin g procaine
penicillin g sodium
penicillin v potassium
piperacillin sodium
Drug
Tier
Notes
Oxacillin Sodium)
Penicillin G Potassium)
1
soln
1
soln
(Dynapen)
(Unipen)
(Oxacillin Sodium)
(Penicillin G Potassium)
(Penicillin G Procaine)
(Penicillin G Sodium)
(Veetids)
(Piperacillin Sodium)
TRIMOX
VEETIDS
ZOSYN
ZOSYN
1
1
1
1
1
1
1
1
1
1
2
2
caps
solr
solr
solr
susp
solr
solr, tabs
solr
caps
tabs
solr
soln
AVELOX
AVELOX
AVELOX ABC PACK
(Cipro I.V.)
(Cipro XR)
2
2
2
1
1
soln
tabs
tabs
soln
tb24
(Cipro I.V. in D5W)
1
soln
(Cipro)
LEVAQUIN
LEVAQUIN
1
2
2
LEVAQUIN LEVA-PAK
LEVAQUIN PREMIX
2
2
1
tabs
soln, tabs
soln; 5%, 750mg/
150ml
tabs
soln; 5%, 250mg/
50ml
tabs
2
1
1
susp
tabs
soln, susp, tabs
1
tabs, tbec
1
tabs
Quinolones
ciprofloxacin
ciprofloxacin and
ciprofloxacin hcl
ciprofloxacin and
ciprofloxacin hcl
(Floxin)
ofloxacin
Sulfonamides (Systemic)
GANTRISIN PEDIATRIC
(Sulfadiazine)
sulfadiazine
(Bactrim)
sulfamethoxazole and
trimethoprim
(Azulfidine)
sulfasalazine
Tetracyclines
(Declomycin)
demeclocycline
hydrochloride
T-8
Drug Name
Drug
Tier
Notes
doxycycline hyclate
(Vibramycin)
1
doxycycline
monohydrate
minocycline
hydrochloride
tetracycline
hydrochloride
(Adoxa)
1
caps, cpep, solr,
tabs
caps, susr, tabs
(Minocin)
1
caps, tabs
(Tetracycline Hydrochloride)
1
caps
TYGACIL
VIBRAMYCIN
VIBRAMYCIN
2
2
2
solr
susr
syrp
1
2
2
1
1
soln
aers
tabs
soln, tabs
tabs
Anticholinergic Agents
Antimuscarinics/Antispasmodics
(Atropine Sulfate)
atropine sulfate
ATROVENT HFA
CANTIL
(Robinul)
glycopyrrolate
(Pamine)
methscopolamine
bromide
SPIRIVA HANDIHALER
2
ST
caps
2
1
ST
tabs
chew, susp, tabs,
tb12
cp12
tbec
soln
Anticonvulsants
Anticonvulsants, Miscellaneous
BANZEL
(Tegretol)
carbamazepine
and magnesium sulfate,
heptahydrate
divalproex sodium
gabapentin
lamotrigine
CARBATROL
DEPAKOTE
Magnesium Sulfate,
Heptahydrate)
(Depakote)
FELBATOL
(Neurontin)
GABITRIL
KEPPRA
LAMICTAL STARTER/NOT
TAKING CARBAMAZEPINE
LAMICTAL STARTER/
TAKING
CARBAMAZEPINE/NOT
TAKING VALPROATE
LAMICTAL STARTER/
TAKING VALPROATE
(Lamictal)
T-9
2
2
1
ST
1
2
1
2
2
2
cpsp, tb24, tbec
susp, tabs
caps, tabs
tabs
soln
kit; 25mg-100mg
2
kit; 25mg-100mg
2
kit; 25mg
1
tabs, tbdp
Drug Name
(Keppra)
LYRICA
(Magnesium Sulfate,
magnesium sulfate,
Heptahydrate)
heptahydrate
NEURONTIN
(Trileptal)
oxcarbazepine
TEGRETOL-XR
(Topamax)
topiramate
TRILEPTAL
(Depacon)
valproate sodium
(Depakene)
valproic acid
VIMPAT
(Zonegran)
zonisamide
Barbiturates (Anticonvulsants)
(Mysoline)
primidone
Hydantoins
DILANTIN
DILANTIN INFATABS
(Cerebyx)
fosphenytoin sodium
PEGANONE
PHENYTEK
levetiracetam
phenytoin
phenytoin sodium
Succinimides
ethosuximide
Drug
Tier
Notes
1
2
1
soln, tabs
caps
soln
2
1
2
1
2
1
1
2
1
soln
tabs
tb12
cpsp, tabs
susp, tabs
soln, syrp
caps
soln, tabs
caps
QL, ST
1
tabs
2
2
1
2
2
(Dilantin)
(Dilantin)
1
1
caps; 30mg
chew
soln
tabs
caps; 200mg,
300mg
susp
caps, soln
CELONTIN
(Zarontin)
2
1
caps
caps, soln
1
2
tabs
tabs
Antidiabetic Agents
Alpha-Glucosidase Inhibitors
(Precose)
acarbose
GLYSET
Amylinomimetics
SYMLIN
SYMLINPEN 120
SYMLINPEN 60
Biguanides
metformin hydrochloride (Glucophage)
Dipeptidyl Peptidase-4 (dpp-4) Inhibitors
JANUMET
JANUVIA
Incretin Mimetics
BYETTA
Insulins
HUMALOG
T-10
2
2
2
PA
PA
PA
1
soln; 600mcg/ml
soln; 1000mcg/ml
soln; 1000mcg/ml
tabs, tb24
2
2
ST
ST
tabs
tabs
2
PA
soln
2
soln
Drug Name
Drug
Tier
HUMALOG KWIKPEN
HUMALOG MIX 50/50
HUMALOG MIX 50/50
KWIKPEN
HUMALOG MIX 50/50 PEN
HUMALOG MIX 75/25
HUMALOG MIX 75/25
KWIKPEN
HUMALOG MIX 75/25 PEN
HUMALOG PEN
HUMULIN 50/50
HUMULIN 70/30
HUMULIN 70/30 PEN
HUMULIN N
HUMULIN N U-100 PEN
HUMULIN R
HUMULIN R U-500
(CONCENTRATED)
LANTUS
LANTUS FOR OPTICLIK
LANTUS SOLOSTAR
LEVEMIR
LEVEMIR FLEXPEN
NOVOLIN 70/30
NOVOLIN 70/30 INNOLET
NOVOLIN 70/30 PENFILL
NOVOLIN N
NOVOLIN N INNOLET
NOVOLIN N U-100 PENFILL
NOVOLIN R
NOVOLIN R INNOLET
NOVOLIN R U-100 PENFILL
NOVOLOG
NOVOLOG FLEXPEN
NOVOLOG MIX 70/30
NOVOLOG MIX 70/30
PENFILL
NOVOLOG MIX 70/30
PREFILLED FLEXPEN
NOVOLOG PENFILL
RELION 70/30
RELION 70/30 INNOLET
RELION N
RELION N INNOLET
T-11
Notes
2
2
2
soln
susp; 50%, 50%
susp; 50%, 50%
2
2
2
susp; 50%, 50%
susp; 25%, 75%
susp; 25%, 75%
2
2
2
2
2
2
2
2
2
susp; 25%, 75%
soln
susp; 50%, 50%
susp; 30%, 70%
susp; 30%, 70%
susp
susp
soln; 100 unit/ml
soln; 500 unit/ml
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
soln
soln
soln
soln
soln
susp; 30%, 70%
susp; 30%, 70%
susp; 30%, 70%
susp
susp
susp
soln; 100 unit/ml
soln; 100 unit/ml
soln; 100 unit/ml
soln
soln
susp
susp
2
susp
2
2
2
2
2
soln
susp; 30%, 70%
susp; 30%, 70%
susp
susp
Drug Name
Drug
Tier
RELION R
2
PRANDIMET
PRANDIN
STARLIX
2
2
2
Notes
soln; 100 unit/ml
Meglitinides
Sulfonylureas
(Amaryl)
glimepiride
(Glucotrol)
glipizide
glipizide and metformin (Metaglip)
hydrochloride
(Micronase)
glyburide
glyburide and metformin (Glucovance)
hydrochloride
(Tolinase)
tolazamide
(Orinase)
tolbutamide
Thiazolidinediones
ACTOPLUS MET
ACTOS
AVANDAMET
AVANDARYL
AVANDIA
DUETACT
ST
ST
ST
tabs
tabs
tabs
1
1
1
tabs
tabs, tb24
tabs
1
1
tabs
tabs
1
1
tabs
tabs
2
2
2
2
2
2
ST
ST
ST
ST
ST
ST
tabs
tabs
tabs
tabs
tabs
tabs
Antidiarrhea Agents
Antidiarrhea Agents
(Lomotil)
atropine sulfate and
diphenoxylate
hydrochloride
(Imodium)
loperamide
hydrochloride
MOTOFEN
1
liqd, tabs
1
caps
2
tabs
Antiemetics
5-HT3 Receptor Antagonists
(Kytril)
granisetron hcl
(Kytril)
granisetron hcl
(Zofran)
ondansetron
(Zofran)
ondansetron hcl
(Zofran)
ondansetron hcl
SANCUSO
Antiemetics, Miscellaneous
CESAMET
(Marinol)
dronabinol
EMEND
TRANSDERM-SCOP
T-12
1
1
1
1
1
2
2
1
2
2
PA
PA
PA
PA
PA, QL
tabs
soln, vial
tbdp
soln, vial
soln, tabs
ptch
caps
caps
caps, misc
pt72
Drug Name
Drug
Tier
Notes
Antihistamines (GI Drugs)
ANTIVERT
meclizine hydrochloride (Antivert)
2
1
(Compazine)
(Compazine)
1
1
tabs; 50mg
tabs; 12.5mg,
25mg
supp
soln
(Compazine)
1
tabs
(Tigan)
1
caps, soln
1
tabs
1
2
susp
tabs
1
soln
1
1
susr, tabs
soln
1
1
2
2
2
2
caps
tabs
susp
soln
susr, tabs
solr
2
2
solr
solr
prochlorperazine
prochlorperazine
edisylate
prochlorperazine
maleate
trimethobenzamide
hydrochloride
Antifungals (Systemic)
Allylamines
(Lamisil)
terbinafine
hydrochloride
Antifungals, Miscellaneous
(Grifulvin V)
griseofulvin
GRIS-PEG
Azoles
(Diflucan in Iso-osmotic
Dextrose)
and fluconazole
(Diflucan)
fluconazole
fluconazole and sodium (Diflucan in NaCl)
chloride
(Sporanox)
itraconazole
(Nizoral)
ketoconazole
NOXAFIL
SPORANOX
VFEND
VFEND IV
Echinocandins
CANCIDAS
ERAXIS
Polyenes
ABELCET
AMBISOME
AMPHOTEC
(Amphocin)
amphotericin b
(Mycostatin)
nystatin
Pyrimidines
ANCOBON
2
2
2
1
1
PA
PA
PA
PA
susp
susr; 50mg
susr; 50mg, 100mg
solr
susp, tabs
2
caps
2
soln; 0.1%, 0.15%
Antiglaucoma Agents
Alpha-Adrenergic Agonists (EENT)
ALPHAGAN P
T-13
Drug Name
Drug
Tier
(Brimonidine Tartrate)
COMBIGAN
Beta-Adrenergic Blocking Agents (EENT)
betaxolol hydrochloride (Betaxolol Hydrochloride)
BETIMOL
ISTALOL
(Betagan)
levobunolol
hydrochloride
(Optipranolol)
metipranolol
(Timoptic)
timolol maleate
TIMOPTIC OCUDOSE
Carbonic Anhydrase Inhibitors (EENT)
(Diamox)
acetazolamide
(Acetazolamide Sodium)
acetazolamide sodium
AZOPT
(Trusopt)
dorzolamide
hydrochloride
(Cosopt)
dorzolamide
hydrochloride and
timolol maleate
(Neptazane)
methazolamide
Miotics
PHOSPHOLINE IODIDE
PILOPINE HS
Prostaglandin Analogs
TRAVATAN
TRAVATAN Z
XALATAN
brimonidine tartrate
Notes
1
2
1
2
2
1
1
1
2
soln; 0.2%
soln
ST
ST
soln
soln
soln; 0.5%
soln
soln
solg, soln
soln; 0.25%, 0.5%
1
1
2
1
cp12, tabs
solr
susp
soln
1
soln
1
tabs
2
2
solr
gel
2
2
2
ST
ST
soln
soln
soln
Antihemorrhagic Agents
Hemostatics
CYKLOKAPRON
2
soln
2
2
solr
kit
1
1
oint
oint
Antihypoglycemic Agents
Glycogenolytic Agents
GLUCAGEN HYPOKIT
GLUCAGON EMERGENCY
KIT
Anti-infectives (EENT)
Antibacterials (EENT)
(Bacitracin)
bacitracin
(Bacitracin Zinc and
bacitracin zinc and
Hydrocortisone Acetate and
hydrocortisone acetate
Neomycin Sulfate and
and neomycin sulfate
and polymyxin b sulfate Polymyxin B Sulfate)
T-14
Drug Name
bacitracin zinc and
neomycin sulfate and
polymyxin b sulfate
bacitracin zinc and
polymyxin b sulfate
ciprofloxacin hcl
dexamethasone and
polymyxin b sulfate
dexamethasone and
tobramycin sulfate
Drug
Tier
Notes
(Neosporin)
1
oint
(Polycin B)
1
oint
BACTROBAN NASAL
BLEPHAMIDE
BLEPHAMIDE S.O.P.
CIPRO HC
CIPRODEX
(Ciloxan)
COLY-MYCIN-S
2
2
2
2
2
1
2
CORTISPORIN-TC
2
(Maxitrol)
1
oint
susp
oint
susp
susp
soln
susp; 3mg/ml, 1%,
5mg/ml, 0.05%
susp; 3mg/ml,
10mg/ml, 3.3mg/
ml, 0.5mg/ml
oint, susp
(Tobradex)
1
susp
1
1
1
1
1
susp
tabs
oint
oint, soln
soln
1
soln, susp
1
1
1
2
1
1
soln
soln
susp
susp
oint
soln
2
1
susp
soln
1
1
2
oint, soln
soln
soln
DEXASPORIN
(Periostat)
doxycycline hyclate
(Erythromycin)
erythromycin
(Garamycin)
gentamicin sulfate
gramicidin and neomycin (Neosporin)
sulfate and polymyxin b
sulfate
(Cortisporin)
hydrocortisone and
polymyxin b sulfate
OCUSULF-10
(Ocuflox)
ofloxacin
OTICIN HC
PEDIOTIC
POLYCIN B
polymyxin b sulfate and (Polytrim)
trimethoprim sulfate
POLY-PRED
(Prednisolone Sodium
prednisolone sodium
Phosphate and Sulfacetamide
phosphate and
Sodium)
sulfacetamide sodium
(Sulfac)
(Tobrex)
tobramycin sulfate
VIGAMOX
T-15
Drug Name
Drug
Tier
ZYLET
ZYMAR
Antifungals (EENT)
NATACYN
Antivirals (EENT)
(Viroptic)
trifluridine
EENT Anti-infectives, Miscellaneous
ACETASOL HC
(Vosol)
acetic acid
(Domeboro)
acetic acid and
aluminum acetate
(Vosol HC)
acetic acid and
hydrocortisone
chlorhexidine gluconate (Peridex)
Notes
2
2
susp
soln
2
susp
1
soln
1
1
1
soln
soln
soln
1
soln
1
soln
2
2
1
gel; 2.5%, 1.2%
gel; 5%, 1%
gel
1
1
1
1
1
1
1
crea, gel, lotn,
soln, swab
soln
gel, pads, soln
crea, oint
gel
oint
soln
1
gel
1
crea, lotn
1
1
1
gel, soln
crea, susp
crea, lozg, soln,
troc
crea
crea, soln
crea
crea, sham
crea
soln
Anti-infectives (Skin and Mucous Membrane)
Antibacterials (Skin and Mucous Membrane)
ACANYA
BENZACLIN
(Benzamycin)
benzoyl peroxide and
erythromycin
(Cleocin)
clindamycin phosphate
erythromycin
gentamicin sulfate
metronidazole
mupirocin
polymyxin b sulfate
ERYDERM
(Erygel)
(Gentamicin Sulfate)
(Vandazole)
(Centany)
(Neosporin Gu Irrigant)
VANDAZOLE
Antifungals (Skin and Mucous Membrane)
(Lotrisone)
betamethasone
dipropionate and
clotrimazole
(Ciclopirox)
ciclopirox
(Loprox)
ciclopirox olamine
(Mycelex)
clotrimazole
econazole nitrate
ketoconazole
(Spectazole)
EXELDERM
GYNAZOLE-1
(Kuric)
KURIC
LAMISIL
1
2
2
1
1
2
T-16
Drug Name
miconazole nitrate
Drug
Tier
LOPROX SHAMPOO
(Monistat 3)
NAFTIN
NAFTIN-MP
(Mycostatin)
(Mycolog-II)
nystatin
nystatin and
triamcinolone acetonide
(Terazol 3)
terconazole
Antivirals (Skin and Mucous Membrane)
DENAVIR
ZOVIRAX
Local Anti-infectives, Miscellaneous
ALCOHOL SWABS
(Metrogel)
metronidazole
(Selsun Shampoo)
selenium sulfide
(Silvadene)
silver sulfadiazine
(Klaron)
THERMAZENE
Scabicides and Pediculicides
EURAX
(Lindane)
lindane
OVIDE
(Elimite)
permethrin
Notes
2
1
2
2
1
1
sham
supp
crea, gel
crea
crea, oint, powd
crea, oint
1
crea, supp
2
2
crea
crea, oint
QL
2
1
1
1
1
1
pads
crea, gel, lotn
lotn
crea
lotn
crea
2
1
2
1
crea, lotn
lotn, sham
lotn
crea
2
2
1
susp; 0.2%
oil
soln
1
1
1
1
2
2
1
1
susp
soln
susp
susp
susp; 0.5%
susp
susp
soln
Anti-inflammatory Agents (EENT)
Corticosteroids (EENT)
ALREX
DERMOTIC
dexamethasone sodium (Dexasol)
phosphate
ECONOPRED PLUS
(Nasarel)
flunisolide
(FML Liquifilm)
fluorometholone
(Flonase)
fluticasone propionate
LOTEMAX
NASONEX
(Pred Forte)
prednisolone acetate
(Prednisol)
prednisolone sodium
phosphate
EENT Anti-inflammatory Agents, Miscellaneous
RESTASIS
EENT Non-Steroidal Anti-inflammatory Agents
ACULAR
ACULAR LS
ACULAR PF
T-17
2
2
2
2
QL, ST
PA, QL
emul
soln; 0.5%
soln; 0.4%
soln; 0.5%
Drug Name
diclofenac sodium
flurbiprofen sodium
Drug
Tier
(Voltaren)
(Ocufen)
NEVANAC
Notes
1
1
2
soln
soln
susp
2
2
2
1
2
2
1
2
cp24
tbec; 400mg
tbec; 800mg
caps
supp
caps
enem
cpcr
Anti-inflammatory Agents (GI Drugs)
Anti-inflammatory Agents (GI Drugs)
APRISO
ASACOL
ASACOL HD
(Colazal)
balsalazide disodium
CANASA
DIPENTUM
(Rowasa)
mesalamine (5-asa)
PENTASA
Anti-inflammatory Agents (Respiratory)
Leukotriene Modifiers
ACCOLATE
SINGULAIR
ZYFLO CR
Mast Cell Stablilizers
(Cromolyn Sodium)
cromolyn sodium
GASTROCROM
INTAL INHALER
2
2
2
ST
ST
tabs
chew, pack, tabs
tb12
1
2
2
soln
conc
aers
1
crea, oint
1
1
crea, lotn, oint
crea, gel, lotn, oint
1
crea, lotn, oint
1
1
crea, lotn, oint
crea, foam, gel,
oint, soln
crea
lotn
crea
tape
lotn
lotn
crea, lotn, oint
crea, gel, oint
crea, oint
Anti-inflammatory Agents (Skin and Mucous)
Anti-inflammatory Agents (Skin and Mucous)
(Aclovate)
alclometasone
dipropionate
(Cyclocort)
amcinonide
(Alphatrex)
augmented
betamethasone
dipropionate
(Del-beta)
betamethasone
dipropionate
betamethasone valerate (Betamethasone Valerate)
(Olux)
clobetasol propionate
desonide
desoximetasone
diflorasone diacetate
CLODERM
CORDRAN
CORDRAN SP
CORDRAN TAPE
CUTIVATE
DEL-BETA
(Desowen)
(Topicort)
(Apexicon)
2
2
2
2
2
1
1
1
1
T-18
Drug Name
Drug
Tier
Notes
fluocinolone acetonide
fluocinonide
fluticasone propionate
halobetasol propionate
hydrocortisone
(Synalar)
(Lidex)
(Cutivate)
(Ultravate)
(Hytone)
1
1
1
1
1
crea, oint, soln
crea, gel, oint, soln
crea, oint
crea, oint
crea, enem, lotn,
oint
crea
hydrocortisone acetate
and urea (carbamide)
hydrocortisone butyrate
hydrocortisone valerate
mometasone furoate
prednicarbate
triamcinolone acetonide
(Carmol-HC)
1
(Locoid)
(Westcort)
(Elocon)
(Dermatop)
(Kenalog)
1
1
1
1
1
TRIDERM
1
crea, oint, soln
crea, oint
crea, oint, soln
crea, oint
crea, lotn, oint,
pste
oint
2
1
2
caps
tabs
tbcr
1
1
2
pack, powd
gran, pack, tabs
tabs
2
tabs
1
1
2
caps, tabs
tabs
tabs
2
2
1
1
1
tabs
tabs
tabs
tabs
tabs
1
1
caps, tabs, tbcr
syrp
Antilipemic Agents
Antilipemic Agents, Miscellaneous
LOVAZA
(Niacin)
niacin
NIASPAN
Bile Acid Sequestrants
(Questran)
cholestyramine
colestipol hydrochloride (Colestid)
WELCHOL
Cholesterol Absorption Inhibitors
ZETIA
Fibric Acid Derivatives
(Lofibra)
fenofibrate
(Lopid)
gemfibrozil
TRICOR
HMG-CoA Reductase Inhibitors
CRESTOR
LIPITOR
(Mevacor)
lovastatin
(Pravachol)
pravastatin sodium
(Zocor)
simvastatin
Antimanic Agents
Antimanic Agents
(Lithobid)
lithium carbonate
(Lithium Citrate)
lithium citrate
Antimigraine Agents
Selective Serotonin Agonists
IMITREX
2
T-19
QL
soln
Drug Name
sumatriptan succinate
Drug
Tier
IMITREX STATDOSE
REFILL
IMITREX STATDOSE
SYSTEM
MAXALT
MAXALT-MLT
(Imitrex)
TREXIMET
Notes
2
QL
kit
2
QL
kit
2
2
1
2
QL
QL
QL
QL
tabs
tbdp
soln, tabs
tabs
Antimycobacterials
Antimycobacterials, Miscellaneous
(Dapsone)
dapsone
Antituberculosis Agents
CAPASTAT SULFATE
(Myambutol)
ethambutol
hydrochloride
(Nydrazid)
isoniazid
(Rifamate)
isoniazid and rifampin
MYCOBUTIN
PASER
PRIFTIN
(Pyrazinamide)
pyrazinamide
(Rifadin)
rifampin
RIFATER
SEROMYCIN
TRECATOR
1
tabs
2
1
solr
tabs
1
1
2
2
2
1
1
2
2
2
soln, syrp, tabs
caps
caps
pack
tabs
tabs
caps, solr
tabs
caps
tabs
2
2
2
2
2
2
2
2
1
2
susr
tabs
solr
solr
tabs
tabs
soln
soln
tabs
solr
Antineoplastic Agents
Antineoplastic Agents
ABRAXANE
AFINITOR
ALIMTA
ALKERAN
ARIMIDEX
AROMASIN
ARRANON
AVASTIN
(Casodex)
bicalutamide
BICNU W/DILUENT
ABSOLUTEETHANOL
(Blenoxane)
bleomycin sulfate
BUSULFEX
CAMPATH
(Paraplatin)
carboplatin
CASODEX
CEENU
T-20
1
2
2
1
2
2
PA
solr
soln
soln
soln
tabs
caps
Drug Name
cisplatin
cladribine
cyclophosphamide
cyclophosphamide
cytarabine
cytarabine
dacarbazine
daunorubicin
hydrochloride
doxorubicin
hydrochloride
epirubicin hcl
etoposide
fludarabine phosphate
fluorouracil
flutamide
hydroxyurea
idarubicin hcl
ifosfamide
ifosfamide and mesna
Drug
Tier
Notes
(Platinol AQ)
(Leustatin)
CLOLAR
COSMEGEN
(Cytoxan)
(Cytoxan)
(Cytosar-U)
(Cytosar-U)
(DTIC-Dome)
DACOGEN
(Cerubidine)
1
1
2
2
1
1
1
1
1
2
1
soln
soln
soln
solr
solr
tabs
solr
soln, solr
solr
solr
inj, solr
DAUNOXOME
DEGARELIX
DOXIL
(Adriamycin)
2
2
2
1
DROXIA
2
ELIGARD
2
ELOXATIN
ELSPAR
EMCYT
(Ellence)
ERBITUX
ETOPOPHOS
(Vepesid)
FARESTON
FASLODEX
FEMARA
(Fludara)
(Adrucil)
(Eulexin)
GEMZAR
GLEEVEC
HERCEPTIN
HEXALEN
HYCAMTIN
(Hydrea)
(Idamycin)
(Ifex)
(Ifex/mesnex Combo Pack)
2
2
2
1
2
2
1
2
2
2
1
1
1
2
2
2
2
2
1
1
1
1
T-21
PA
ST
PA
PA
PA
PA
inj
solr
inj
soln, solr
caps; 200mg,
300mg, 400mg
kit; 7.5mg,
22.5mg, 30mg,
45mg
soln
solr
caps
soln
soln
solr
soln
tabs
soln
tabs
soln, solr
soln
caps
solr
tabs
solr
caps
solr
caps; 500mg
soln
soln, solr
kit
Drug Name
Drug
Tier
IRESSA
irinotecan hydrochloride (Camptosar)
IXEMPRA KIT
LEUKERAN
(Lupron)
leuprolide acetate
LUPRON DEPOT
megestrol acetate
mercaptopurine
methotrexate
methotrexate sodium
mitomycin c
mitoxantrone
hydrochloride
oxaliplatin
paclitaxel
pentostatin
tamoxifen citrate
thiotepa
Notes
2
1
2
2
1
2
LUPRON DEPOT-PED
2
LYSODREN
MATULANE
MEGACE ES
(Megace)
(Purinethol)
(Rheumatrex)
(Methotrexate)
(Mutamycin)
(Novantrone)
2
2
2
1
1
1
1
1
1
MUSTARGEN
MYLOTARG
NEXAVAR
NILANDRON
ONCASPAR
ONTAK
(Eloxatin)
(Taxol)
(Nipent)
PHOTOFRIN
PROLEUKIN
RHEUMATREX
RITUXAN
SOLTAMOX
SPRYCEL
SUTENT
TABLOID
(Nolvadex)
TARCEVA
TARGRETIN
TASIGNA
TAXOTERE
(Thioplex)
TORISEL
2
2
2
2
2
2
1
1
1
2
2
2
2
2
2
2
2
1
2
2
2
2
1
2
T-22
ST
ST
tabs
soln
solr
tabs
kit, soln
kit; 3.75mg,
7.5mg, 11.25mg,
22.5mg, 30mg
kit; 7.5mg,
11.25mg, 15mg
tabs
caps
susp
susp, tabs
tabs
tabs
soln, solr
solr
conc
solr
solr
tabs
tabs
soln
soln
soln
conc
solr
solr
solr
tabs
conc
soln
tabs
caps
tabs
tabs
tabs
caps
caps
conc
solr
soln
Drug Name
tretinoin
vinblastine sulfate
vinblastine sulfate
vincristine sulfate
vinorelbine tartrate
Drug
Tier
TREANDA
TRELSTAR DEPOT
TRELSTAR LA
(Vesanoid)
TREXALL
TRISENOX
TYKERB
VANTAS
VECTIBIX
VELCADE
VIDAZA
(Vinblastine Sulfate)
(Vinblastine Sulfate)
(Oncovin)
(Navelbine)
ZANOSAR
ZOLINZA
2
2
2
1
2
2
2
2
2
2
2
1
1
1
1
2
2
Notes
ST
PA
PA
solr
susr; 3.75mg
susr; 11.25mg
caps
tabs
soln
tabs
kit
soln
solr
susr
soln
solr
soln
soln
solr
caps
Antiparkinsonian Agents
Adamantanes (CNS)
(Symmetrel)
amantadine
hydrochloride
Anticholinergic Agents (CNS)
(Cogentin)
benztropine mesylate
COGENTIN
KEMADRIN
(Artane)
trihexyphenidyl
hydrochloride
Catechol-O-Methyltransferase (COMT) Inhibitors
COMTAN
TASMAR
Dopamine Precursors
(Sinemet)
carbidopa anhydrous
and levodopa
carbidopa monohydrate (Parcopa)
and levodopa
LODOSYN
STALEVO 100
1
caps, tabs
1
2
2
1
soln, tabs
soln
tabs
elix, tabs
2
2
tabs
tabs
1
tabs, tbcr, tbdp
1
tbdp
2
2
tabs
tabs; 25mg,
200mg, 100mg
tabs; 31.25mg,
200mg, 125mg
tabs; 37.5mg,
200mg, 150mg
tabs; 50mg,
200mg, 200mg
STALEVO 125
2
STALEVO 150
2
STALEVO 200
2
T-23
Drug Name
Drug
Tier
STALEVO 50
2
STALEVO 75
2
Dopamine Receptor Agonists
APOKYN
bromocriptine mesylate (Parlodel)
(Dostinex)
cabergoline
MIRAPEX
ropinirole hydrochloride (Requip)
Monoamine Oxidase B Inhibitors
AZILECT
EMSAM
(Eldepryl)
selegiline hcl
ZELAPAR
Notes
tabs; 12.5mg,
200mg, 50mg
tabs; 18.75mg,
200mg, 75mg
2
1
1
2
1
soln
caps, tabs
tabs
tabs
tabs
2
2
1
2
tabs
pt24
caps, tabs
tbdp
(Humatin)
1
caps
(Aralen)
DARAPRIM
FANSIDAR
(Plaquenil)
1
2
2
1
tabs
tabs
tabs
tabs
2
1
2
2
tabs
tabs
tabs
caps
Antiprotozoals
Amebicides
paromomycin sulfate
Antimalarials
chloroquine phosphate
hydroxychloroquine
sulfate
MALARONE
(Lariam)
mefloquine hcl
PRIMAQUINE PHOSPHATE
QUALAQUIN
Antiprotozoals, Miscellaneous
MEPRON
METRO IV
metronidazole
metronidazole and
sodium chloride
PA
2
1
(Flagyl)
(Flagyl IV)
1
1
NEUTREXIN
2
susp
soln; 500mg/
100ml, 0.74%
caps, tabs
soln; 5mg/ml,
0.79%
solr
1
1
2
crea
oint
ptch
Antipruritics and Local Anesthetics
Antipruritics and Local Anesthetics
lidocaine and prilocaine (EMLA)
lidocaine hydrochloride (Xylocaine)
LIDODERM
Antithrombotic Agents
Anticoagulants
ARIXTRA
2
T-24
PA, QL
soln
Drug Name
and heparin sodium
(porcine)
Drug
Tier
COUMADIN
Heparin Sodium (porcine))
FRAGMIN
heparin sodium (porcine) (Heparin Sodium (porcine))
heparin sodium (porcine) (Heparin Sodium (porcine) and
Sodium Chloride)
and sodium chloride
INNOHEP
LOVENOX
(Coumadin)
warfarin sodium
Platelet Aggregation Inhibitors
(Pletal)
cilostazol
PLAVIX
ticlopidine hydrochloride (Ticlid)
Notes
2
1
solr
soln
2
1
1
PA, QL
inj
soln
soln
2
2
1
PA, QL
PA, QL
soln
soln
tabs
1
2
1
tabs
tabs
tabs
1
1
1
1
tabs
soln
soln, tabs
soln
1
1
caps
caps, soln, syrp,
tabs
1
tabs
2
1
susp
tabs
1
1
tbec, OTC
cpdr
tbec
Antiulcer Agents and Acid Suppressants
Histamine H2-Antagonists
(Tagamet)
cimetidine
cimetidine hydrochloride (Tagamet)
(Pepcid)
famotidine
(Pepcid IV)
famotidine and sodium
chloride
(Axid)
nizatidine
ranitidine hydrochloride (Zantac)
Prostaglandins
misoprostol
Protectants
(Cytotec)
CARAFATE
(Carafate)
sucralfate
Proton Pump Inhibitors
(Prilosec)
omeprazole
(Prilosec)
omeprazole
(Protonix)
pantoprazole sodium
sesquihydrate
PREVACID
PREVACID SOLUTAB
PREVPAC
PROTONIX
2
2
2
2
QL, ST
QL, ST
cpdr
tbdp
misc
solr
Antivirals (Systemic)
Adamantanes
rimantadine
hydrochloride
FLUMADINE
(Flumadine)
2
1
T-25
tabs
tabs
Drug Name
Drug
Tier
Notes
Antiretrovirals
didanosine
APTIVUS
ATRIPLA
COMBIVIR
CRIXIVAN
(Videx EC)
EMTRIVA
EPIVIR
2
2
2
2
1
2
2
EPIVIR HBV
2
EPZICOM
FUZEON
INTELENCE
INVIRASE
ISENTRESS
KALETRA
LEXIVA
NORVIR
PREZISTA
RESCRIPTOR
RETROVIR IV INFUSION
REYATAZ
SELZENTRY
(Zerit)
stavudine
SUSTIVA
TRIZIVIR
TRUVADA
VIDEX
VIRACEPT
VIRAMUNE
VIREAD
ZIAGEN
(Retrovir)
zidovudine
Antivirals, Miscellaneous
(Foscavir)
foscarnet sodium
Interferons
ALFERON N
INFERGEN
INTRON-A
INTRON-A W/DILUENT
PEGASYS
PEG-INTRON
PEG-INTRON REDIPEN
T-26
caps, soln
tabs
tabs
caps
cpdr
caps, soln
soln, tabs; 10mg/
ml, 150mg, 300mg
soln, tabs; 5mg/ml,
100mg
tabs
kit
tabs
caps, tabs
tabs
caps, soln, tabs
susp, tabs
caps, soln
tabs
tabs
soln
caps
tabs
caps, solr
caps, tabs
tabs
tabs
solr
powd, tabs
susp, tabs
tabs
soln, tabs
caps, syrp, tabs
2
2
2
2
2
2
2
2
2
2
2
2
2
1
2
2
2
2
2
2
2
2
1
1
2
2
2
2
2
2
2
PA
soln
PA
PA
PA
PA
PA
PA
soln
inj
kit, soln
solr
kit
kit
kit
Drug Name
Drug
Tier
PEG-INTRON REDIPEN
PAK 4
Monoclonal Antibodies
SYNAGIS
Neuraminidase Inhibitors
RELENZA DISKHALER
TAMIFLU
Nucleosides and Nucleotides
(Zovirax)
acyclovir
(Zovirax)
acyclovir sodium
BARACLUDE
CYTOVENE
(Famvir)
famciclovir
(Cytovene)
ganciclovir
HEPSERA
REBETOL
RIBATAB
(Copegus)
ribavirin
TYZEKA
VALCYTE
VALTREX
VISTIDE
2
Notes
PA
2
2
2
1
1
2
2
1
1
2
2
1
1
2
2
2
2
kit
soln
QL
PA
PA
aepb
caps, susr
caps, susp, tabs
soln, solr
soln, tabs
solr
tabs
caps
tabs
soln
misc, tabs
caps, misc, tabs
tabs
tabs
tabs
soln
Anxiolytics, Sedatives and Hypnotics
Anxiolytics, Sedatives and Hypnotics, Miscellaneous
1
buspirone hydrochloride (Buspar)
(Atarax)
1
hydroxyzine
hydrochloride
(Vistaril)
1
hydroxyzine pamoate
LUNESTA
2
(Miltown)
1
meprobamate
(Sonata)
1
zaleplon
(Ambien)
1
zolpidem tartrate
tabs
soln, syrp, tabs
ST
caps
tabs
tabs
caps
tabs
Autonomic Drugs, Miscellaneous
Autonomic Drugs, Miscellaneous
CHANTIX
NICOTROL INHALER
NICOTROL NS
2
2
2
PA
misc, tabs
inha
soln
Beta-Adrenergic Blocking Agents
Beta-Adrenergic Blocking Agents
acebutolol hydrochloride (Sectral)
(Tenormin)
atenolol
(Tenoretic)
atenolol and
chlorthalidone
1
1
1
T-27
caps
tabs
tabs
Drug Name
Drug
Tier
Notes
(Corzide)
1
tabs
(Kerlone)
(Zebeta)
(Ziac)
1
1
1
tabs
tabs
tabs
1
2
1
tabs
cp24
tabs
1
tabs
1
1
1
1
1
1
soln, tabs
tb24
soln, tabs
tabs
tabs
cp24, soln, tabs
1
1
2
tabs
tabs
tb24
Calcium Channel Blocking Agents, Miscellaneous
CARDIZEM CD
diltiazem hydrochloride (Cardizem CD)
2
1
verapamil hydrochloride (Calan SR)
1
cp24
cp12, cp24, soln,
solr, tabs
cp24, soln, tabs,
tbcr
Dihydropyridines
(Norvasc)
amlodipine besylate
amlodipine besylate and (Lotrel)
benazepril hcl
1
1
bendroflumethiazide and
nadolol
betaxolol hydrochloride
bisoprolol fumarate
bisoprolol fumarate and
hydrochlorothiazide
carvedilol
(Coreg)
COREG CR
hydrochlorothiazide and (Lopressor HCT)
metoprolol tartrate
hydrochlorothiazide and (Inderide)
propranolol
hydrochloride
labetalol hydrochloride (Trandate)
(Toprol XL)
metoprolol succinate
(Lopressor)
metoprolol tartrate
(Corgard)
nadolol
(Visken)
pindolol
(Inderal LA)
propranolol
hydrochloride
(Betapace)
sotalol hydrochloride
(Blocadren)
timolol maleate
TOPROL XL
Calcium Channel Blocking Agents
felodipine
isradipine
nicardipine hcl
nifedipine
nimodipine
CARDENE I.V.
EXFORGE
(Plendil)
(Dynacirc)
LOTREL
2
2
1
1
2
(Cardene)
(Procardia XL)
(Nimotop)
1
1
1
T-28
ST
tabs
caps; various
strengths are
available
soln
tabs
tb24
caps
caps; 5mg, 40mg,
10mg, 40mg
caps
caps, tb24
caps
Drug Name
nisoldipine
Drug
Tier
Notes
(Sular)
1
tb24
(Alcohol, USP and Dextrose
(anhydrous))
AMINOSYN 7%/
ELECTROLYTES
1
soln
2
PA
AMINOSYN 8.5%/
ELECTROLYTES
2
PA
AMINOSYN
2
PA
AMINOSYN
AMINOSYN II 3.5%/
DEXTROSE 25%
2
2
PA
PA
AMINOSYN II 3.5%/
DEXTROSE 25%
AMINOSYN II 3.5%/
DEXTROSE 5%
2
PA
2
PA
AMINOSYN II 4.25%/
DEXTROSE 20%
1
PA
AMINOSYN II 5%/
DEXTROSE 25%
2
PA
AMINOSYN II 8.5%/
ELECTROLYTES
2
PA
AMINOSYN II
2
PA
AMINOSYN II
1
PA
AMINOSYN II M 3.5%/
DEXTROSE 5%
2
PA
AMINOSYN M
2
PA
Caloric Agents
Caloric Agents
alcohol, usp and
T-29
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln
soln; various
strengths are
available
soln
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
Drug Name
Drug
Tier
Notes
AMINOSYN-HBC
2
PA
AMINOSYN-HF
AMINOSYN-PF 7%
CLIMIMIX E 4.25%/
DEXTROSE 5%
1
2
2
PA
PA
PA
CLINIMIX 2.75%/
DEXTROSE 5%
2
PA
CLINIMIX 4.25%/
DEXTROSE 5%
2
PA
CLINIMIX 5%/DEXTROSE
15%
2
PA
20%
2
PA
25%
2
PA
CLINIMIX E 2.75%/
DEXTROSE 10%
2
PA
CLINIMIX E 2.75%/
DEXTROSE 5%
2
PA
CLINIMIX E 5%/DEXTROSE
15%
2
PA
20%
2
PA
25%
2
PA
35%
2
PA
1
PA
(Dextrose (anhydrous) 10%)
10%
dextrose (anhydrous) 5% (Dextrose (anhydrous) 5%)
T-30
1
soln; various
strengths are
available
soln
soln
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln
soln
Drug Name
and sodium chloride
and sodium chloride
glycerin and
phospholipids and
soybean oil
Drug
Tier
Notes
(Dextrose 5%/Sodium
Chloride)
(Dextrose 5%/Sodium
Chloride)
1
FREAMINE HBC 6.9%
2
PA
FREAMINE III 3%
2
PA
(Intralipid)
1
PA
HEPATASOL
INTRALIPID
1
1
PA
PA
NEPHRAMINE
PREMASOL
2
1
PA
PA
PROCALAMINE
PROSOL
RENAMIN
TRAVASOL 2.75%/
DEXTROSE 10%
2
2
2
2
PA
PA
PA
PA
TRAVASOL 2.75%/
DEXTROSE 5%
2
PA
TRAVASOL 3.5%/
ELECTROLYTES
TRAVASOL 4.25%/
DEXTROSE 10%
2
PA
1
PA
TRAVASOL 4.25%/
DEXTROSE 25%
2
PA
TRAVASOL 5.5%/
DEXTROSE 10%
2
PA
T-31
PA
1
soln; 10%, 0.45%
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
emul; 2.25%,
1.2%, 20%
soln
emul; various
strengths are
available
soln
soln; various
strengths are
available
soln
soln
soln
soln; various
strengths are
available
soln; various
strengths are
available
soln
soln; various
strengths are
available
soln; various
strengths are
available
soln; 44 meq/l, 0 -,
10%, 250mg/
100ml, 560mg/
100ml
Drug Name
Drug
Tier
Notes
TRAVASOL 5.5%/
DEXTROSE 20%
2
PA
TRAVASOL 5.5%/
ELECTROLYTES
2
PA
TRAVASOL 8.5%/
DEXTROSE 10%
2
PA
TRAVASOL 8.5%/
DEXTROSE 20%
2
PA
TRAVASOL 8.5%/
DEXTROSE 50%
2
PA
TRAVASOL 8.5%/
ELECTROLYTES
2
PA
TRAVASOL
2
PA
TRAVASOL
1
PA
TROPHAMINE
1
PA
soln; 44 meq/l, 0 -,
20%, 250mg/
100ml, 560mg/
100ml
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
soln; various
strengths are
available
Cardiac Drugs
Antiarrhythmic Agents
(Cordarone)
amiodarone hcl
disopyramide phosphate (Norpace)
(Tambocor)
flecainide acetate
lidocaine hydrochloride (Lidocaine Hydrochloride)
mexiletine hydrochloride (Mexitil)
(Procainamide Hydrochloride)
procainamide
hydrochloride
PROCANBID
PRONESTYL
PRONESTYL
PRONESTYL SR
(Rythmol)
propafenone hcl
(Quinidine Gluconate)
quinidine gluconate
(Quinidine Sulfate)
quinidine sulfate
RYTHMOL SR
T-32
1
1
1
1
1
1
soln, tabs
caps, cp12
tabs
soln
caps
soln
2
2
1
1
1
1
1
2
tb12
caps; 375mg
caps; 250mg
tbcr
tabs
soln, tbcr
tabs, tbcr
cp12
Drug Name
Drug
Tier
TIKOSYN
Cardiac Drugs, Miscellaneous
RANEXA
Cardiotonic Agents
DIGOXIN
(Lanoxin)
digoxin
LANOXIN
Notes
2
2
caps
PA
tb12
2
1
2
soln; 0.05mg/ml
soln, tabs
soln; 0.1mg/ml
2
1
1
caps
powd
solr
1
solr
1
2
1
crea
solr
crea, gel
2
2
2
PA, QL
PA, QL
tbec
soln, tabs
tabs
2
2
2
PA
LA
tabs
caps
soln
Cathartics and Laxatives
Cathartics and Laxatives
AMITIZA
(Miralax)
polyethylene glycol
polyethylene glycol and (Nulytely)
potassium chloride and
sodium bicarbonate and
sodium chloride
polyethylene glycol and (Colyte)
sodium bicarbonate and
sodium chloride and
sodium sul
Cell Stimulants and Proliferants
Cell Stimulants and Proliferants
AVITA
KEPIVANCE
(Retin-A)
tretinoin
Central Nervous System Agents, Miscellaneous
Central Nervous System Agents, Miscellaneous
CAMPRAL
NAMENDA
NAMENDA TITRATION
PAK
RILUTEK
STRATTERA
XYREM
Cholelitholytic Agents
Cholelitholytic Agents
(Actigall)
ursodiol
1
caps, tabs
BREVICON-28
1
(Ortho-cept-28)
1
tabs; 35mcg,
0.5mg
tabs
Contraceptives
Contraceptives
desogestrel and ethinyl
estradiol
T-33
Drug Name
Drug
Tier
Notes
drospirenone and ethinyl
estradiol
ethinyl estradiol and
ethynodiol diacetate
ferrous fumarate and
norethindrone acetate
levonorgestrel
norethindrone
(Yasmin 28)
1
tabs; 3mg, 0.03mg
(Demulen 1/35-28)
1
tabs
(Loestrin Fe 1/20)
1
tabs
(Seasonale)
1
tabs
(Ovcon-35/28)
1
norgestimate
norgestrel
levonorgestrel
mestranol and
norethindrone
norethindrone
(Loestrin 1/20-21)
1
tabs; various
strengths are
available
tabs
(Ortho Tri-cyclen)
1
tabs
(Ovral)
1
tabs
(Plan B)
(Norinyl 1+50)
1
1
tabs
tabs
(Nor-qd)
NOR-QD
NUVARING
ORTHO EVRA
PLAN B
YAZ
1
1
2
2
2
2
tabs
tabs
ring
ptwk
tabs
tabs; 3mg, 0.02mg
ST
ST
Depigmenting and Pigmenting Agents
Depigmenting Agents
BENOQUIN
Pigmenting Agents
8-MOP
OXSORALEN ULTRA
UVADEX
2
crea
2
2
2
caps
caps
soln
DIABETIC SUPPLIES, MISC
2
2
2
misc, insulin
syringe (disp) u100 0.3 ml
misc, insulin
syringe (disp) u100 1 ml
misc, insulin pen
needle
Devices
Devices
T-34
Drug Name
Drug
Tier
2
2
CREON 5
2
CREON 10
2
CREON 20
2
CREON
2
DYGASE
1
ENZYMAX
2
KU-ZYME HP
2
LAPASE
1
LIPRAM 4500
1
LIPRAM-PN10
1
LIPRAM-PN16
1
LIPRAM-PN20
1
Notes
, insulin safety
syringe
misc, insulin
syringe (disp) u100 1/2 ml
Digestants
Digestants
T-35
cpep; 16600 unit,
5000 unit, 18750
unit
cpep; 33200 unit,
10000 unit, 37500
unit
cpep; 66400 unit,
20000 unit, 75000
unit
cpep; various
strengths are
available
caps; 30000 unit,
2400 unit, 30000
unit
tabs; 12500 unit,
1000 unit, 12500
unit
caps; 30000 unit,
8000 unit, 30000
unit
caps; 15000 unit,
1200 unit, 15000
unit
cpep; 20000 unit,
4500 unit, 25000
unit
cpep; 30000 unit,
10000 unit, 30000
unit
cpep; 48000 unit,
16000 unit, 48000
unit
cpep; 56000 unit,
20000 unit, 44000
unit
Drug Name
Drug
Tier
LIPRAM-UL12
1
LIPRAM-UL18
1
LIPRAM-UL20
1
PALCAPS 10
1
PALCAPS 20
1
PANCREASE MT 4
2
PANCRECARB MS-16
2
PANCRECARB MS-4
2
PANCRECARB MS-8
2
PANCRELIPASE
PANCRELIPASE MST-16
1
1
PANCRON 10
1
PANCRON 20
1
PANGESTYME CN 10
1
PANGESTYME CN 20
1
T-36
Notes
cpep; 39000 unit,
12000 unit, 39000
unit
cpep; 58500 unit,
18000 unit, 58500
unit
cpep; 65000 unit,
20000 unit, 65000
unit
cpep; 33200 unit,
10000 unit, 37500
unit
cpep; 66400 unit,
20000 unit, 75000
unit
cpep; 12000 unit,
4000 unit, 12000
unit
cpep; 52000 unit,
16000 unit, 52000
unit
cpep; 25000 unit,
4000 unit, 25000
unit
cpep; 40000 unit,
8000 unit, 45000
unit
cpep, tabs
cpep; 48000 unit,
16000 unit, 48000
unit
cpep; 33200 unit,
10000 unit, 37500
unit
cpep; 66400 unit,
20000 unit, 75000
unit
cpep; 33200 unit,
10000 unit, 37500
unit
cpep; 66400 unit,
20000 unit, 75000
unit
Drug Name
Drug
Tier
Notes
PANGESTYME EC
1
PANGESTYME MT 16
1
PANGESTYME UL 12
1
PANGESTYME UL 18
1
PANGESTYME UL 20
1
PANOCAPS
1
PANOCAPS MT 16
1
PANOCAPS MT 20
1
PANOKASE
1
PANOKASE-16
1
PLARETASE 8000
1
ULTRACAPS MT 20
1
ULTRASE
2
VIOKASE
2
cpep; 20000 unit,
4500 unit, 25000
unit
cpep; 48000 unit,
16000 unit, 48000
unit
cpep; 39000 unit,
12000 unit, 39000
unit
cpep; 58500 unit,
18000 unit, 58500
unit
cpep; 65000 unit,
20000 unit, 65000
unit
cpep; 20000 unit,
4500 unit, 25000
unit
cpep; 48000 unit,
16000 unit, 48000
unit
cpep; 56000 unit,
20000 unit, 44000
unit
tabs; 30000 unit,
8000 unit, 30000
unit
tabs; 60000 unit,
16000 unit, 60000
unit
tabs; 30000 unit,
8000 unit, 30000
unit
cpep; 65000 unit,
20000 unit, 65000
unit
cpep; 20000 unit,
4500 unit, 25000
unit
powd
(Bumex)
(Lasix)
(Demadex)
1
1
1
soln, tabs
soln, tabs
tabs
Diuretics
Loop Diuretics
bumetanide
furosemide
torsemide
T-37
Drug Name
Drug
Tier
Potassium-Sparing Diuretics
amiloride hydrochloride (Midamor)
(anhydrous)
amiloride hydrochloride (Moduretic 5-50)
(anhydrous) and
hydrochlorothiazide
DYRENIUM
hydrochlorothiazide and (Dyazide)
triamterene
Thiazide Diuretics
(Diuril)
chlorothiazide
(Microzide)
hydrochlorothiazide
(Enduron)
methyclothiazide
Thiazide-Like Diuretics
(Hygroton)
chlorthalidone
(Lozol)
indapamide
(Zaroxolyn)
metolazone
Notes
1
tabs
1
tabs
2
1
caps
caps, tabs
1
1
1
tabs
caps, tabs
tabs
1
1
1
tabs
tabs
tabs
1
soln
1
1
2
soln
soln
inst
1
1
lotn
lotn
ADAGEN
ALDURAZYME
ARALAST
2
2
2
CEREDASE
CEREZYME
ELAPRASE
ELITEK
FABRAZYME
MYOZYME
NAGLAZYME
PROLASTIN
SUCRAID
ZEMAIRA
2
2
2
2
2
2
2
2
2
2
soln
soln
solr; 400mg,
800mg
soln
solr
soln
solr
solr
solr
soln
solr, susr
soln
solr; 1000mg
EENT Drugs, Miscellaneous
EENT Drugs, Miscellaneous
(Iopidine)
apraclonidine
hydrochloride
(Ocupress)
carteolol hcl
(Atrovent)
ipratropium bromide
LACRISERT
Emollients, Demulcents, and Protectants
Basic Lotions and Liniments
(Ammonium Lactate)
ammonium lactate
(Lac-hydrin)
lactic acid
Enzymes
Enzymes
T-38
Drug Name
Drug
Tier
Notes
Estrogens and Antiestrogens
Estrogen Agonist-Antagonists
EVISTA
Estrogens
ALORA
estradiol
estradiol and
estradiol valerate
estropipate
2
tabs
2
pttw; various
strengths are
available
ptwk
pttw
crea
pttw; 0.05mg/24hr,
0.1mg/24hr
ptwk, tabs
tabs
CLIMARA
COMBIPATCH
ESTRACE
ESTRADERM
2
2
2
2
(Climara)
(Activella)
1
1
(Delestrogen)
(Ogen)
1
1
GYNODIOL
ORTHO-EST
1
1
PREMARIN
PREMARIN W/
APPLICATOR
PREMPHASE
2
2
PREMPRO
2
VIVELLE-DOT
2
2
oil
tabs; 0.75mg,
1.5mg, 3mg
tabs
tabs; 0.75mg,
1.5mg
solr, tabs
crea
tabs; 0.625mg,
5mg
tabs; various
strengths are
available
pttw; various
strengths are
available
First Generation Antihistamines
Ethanolamine Derivatives
1
carbinoxamine maleate (Pediox)
(Tavist Allergy)
1
clemastine fumarate
(Benadryl)
1
diphenhydramine
hydrochloride
First Generation Antihistamine Derivatives, Miscellaneous
(Periactin)
1
cyproheptadine
hydrochloride
T-39
liqd
syrp, tabs
caps, elix, soln
syrp, tabs
Drug Name
Drug
Tier
Phenothiazine Derivatives
(Phenylephrine Hydrochloride
phenylephrine
and Promethazine
hydrochloride and
Hydrochloride)
promethazine
hydrochloride
(Phenergan)
promethazine
hydrochloride
Propylamine Derivatives
(Dexchlorpheniramine
dexchlorpheniramine
Maleate)
maleate
Notes
1
syrp
1
soln, supp, syrp,
tabs
1
syrp
2
2
1
1
2
2
tabs
cp24
tabs
syrp, tabs, tb24
tb24
tabs
2
2
tabs
kit, soln
Genitourinary Smooth Muscle Relaxants
Genitourinary Smooth Muscle Relaxants
DETROL
DETROL LA
flavoxate hydrochloride (Urispas)
(Ditropan)
oxybutynin chloride
TOVIAZ
VESICARE
GI Drugs, Miscellaneous
GI Drugs, Miscellaneous
LOTRONEX
RELISTOR
PA, QL
Gold Compounds
Gold Compounds
RIDAURA
2
caps
(Novarel)
SYNAREL
1
2
solr
soln
2
2
2
2
2
caps
caps
tabs
tbso
caps
Gonadotropins
Gonadotropins
gonadotropin, chorionic
Heavy Metal Antagonists
Heavy Metal Antagonists
CHEMET
CUPRIMINE
DEPEN TITRATABS
EXJADE
SYPRINE
T-40
Drug Name
Drug
Tier
Notes
Hematopoietic Agents
Hematopoietic Agents
ARANESP ALBUMIN FREE
2
PA, QL
ARANESP ALBUMIN FREE
SURE
2
PA, QL
EPOGEN
LEUKINE
NEULASTA
NEUPOGEN
PROCRIT
2
2
2
2
2
PA, QL
PA, QL
soln; 25mcg/
0.42ml, 25mcg/ml,
40mcg/0.4ml,
40mcg/ml, 60mcg/
ml, 100mcg/ml,
150mcg/0.3ml,
150mcg/0.75ml,
200mcg/0.4ml,
200mcg/ml,
300mcg/ml,
500mcg/ml
soln; 60mcg/0.3ml,
100mcg/0.5ml,
300mcg/0.6ml
soln
soln, solr
soln
soln
soln
Hemorrheologic Agents
Hemorrheologic Agents
(Trental)
pentoxifylline
1
tbcr
1
1
1
tabs
tabs
tabs
1
soln, tabs
1
2
tabs
susp
2
tabs
1
tabs
Hypotensive Agents
Central Alpha-Agonists
clonidine hydrochloride (Catapres)
(Wytensin)
guanabenz acetate
(Tenex)
guanfacine hcl
Direct Vasodilators
(Apresoline)
hydralazine
hydrochloride
(Loniten)
minoxidil
PROGLYCEM
Hypotensive Agents, Miscellaneous
INVERSINE
Peripheral Adrenergic Inhibitors
(Serpasil)
reserpine
Ion-Removing Agents
Phosphate-Removing Agents
(Phoslo)
calcium acetate
RENAGEL
RENVELA
1
2
2
T-41
ST
ST
caps, tabs
tabs
tabs
Drug Name
Drug
Tier
Potassium-Removing Agents
(Kayexalate)
sodium polystyrene
sulfonate
Notes
1
powd, susp
1
soln
2
soln
1
1
1
1
1
soln
soln
soln
soln
soln
Irrigating Solutions
Irrigating Solutions
(Tis-u-sol)
calcium (+2) and
chloride ion and
potassium (+1) and
sodium (+1)
LACTATED RINGER'S
IRRIGATION
PHYSIOLYTE
(Sodium Chloride 0.9%)
sodium chloride
TIS-U-SOL
TIS-U-SOL VIAFLEX
(Water, Sterile)
water, sterile
Keratoplastic Agents
Keratoplastic Agents
VECTICAL
2
ST
oint
Local Anesthetics (EENT)
Local Anesthetics (EENT)
lidocaine hydrochloride (Xylocaine Jelly)
(Ophthetic)
proparacaine
hydrochloride
1
1
gel, soln
soln
1
soln
Local Anesthetics (Parenteral)
Local Anesthetics (Parenteral)
lidocaine hydrochloride (Xylocaine)
Miscellaneous Therapeutic Agents
Miscellaneous Therapeutic Agents
ACTIMMUNE
ACTONEL
ACTONEL WITH CALCIUM
(Fosamax)
alendronate sodium
(Zyloprim)
allopurinol
(Aloprim)
allopurinol sodium
(Ethyol)
amifostine
(Agrylin)
anagrelide
hydrochloride
ANTABUSE
ARCALYST
ATGAM
AVODART
AVONEX
T-42
2
2
2
1
1
1
1
1
2
2
2
2
2
QL, ST
QL, ST
soln
tabs
tabs
tabs
tabs
solr
solr
caps
tabs
solr
inj
caps
kit
Drug Name
azathioprine
azathioprine sodium
cyclosporine
dexrazoxane
etidronate disodium
finasteride
fluoride prepartion
fomepizole (4methylpyrazole)
leflunomide
leucovorin calcium
levocarnitine
mesna
mycophenolate mofetil
octreotide acetate
Drug
Tier
Notes
(Imuran)
(Imuran)
BETASERON
BONIVA
BOTOX
CELLCEPT
CELLCEPT INTRAVENOUS
CIMZIA
COPAXONE
(Neoral)
CYSTADANE
CYSTAGON
(Totect)
ELMIRON
ENBREL
ENBREL SURECLICK
ETHYOL
(Didronel)
(Proscar)
FLOMAX
(Fluoride Prepartion)
(Antizol)
1
1
2
2
2
2
2
2
2
1
2
2
1
2
2
2
2
1
1
2
2
2
PA
PA
FOSAMAX
FOSAMAX PLUS D
HUMIRA
HUMIRA PEN
HUMIRA PEN-CROHNS
DISEASE
KINERET
KUVAN
(Arava)
(Leucovorin Calcium)
(Carnitor)
(Mesnex)
MESNEX
(Cellcept)
MYFORTIC
MYOBLOC
NEUMEGA
(Sandostatin)
ORENCIA
ORFADIN
ORTHOCLONE OKT3
2
2
2
2
2
QL
QL
PA
PA
PA
T-43
2
2
1
1
1
1
2
1
2
2
2
2
2
2
2
ST
PA
PA
PA, QL
PA
PA
PA
ST
tabs
solr
solr
kit, tabs
solr
susr
solr
kit
kit
caps, soln
powd
caps
solr
caps
kit, soln
soln
solr
tabs
tabs
cp24
soln
PA
PA
PA
PA
soln
tabs
kit
kit
kit
soln
tbso
tabs
soln, solr, tabs
soln, tabs
soln
tabs
caps, tabs
tbec
soln
solr
soln
solr
caps
inj
Drug Name
pamidronate disodium
tacrolimus
Drug
Tier
(Aredia)
PROGRAF
PROMACTA
RAPAFLO
RAPAMUNE
REBIF
1
2
2
2
2
2
REBIF TITRATION PACK
2
REMICADE
REVLIMID
SANDOSTATIN LAR
DEPOT
SENSIPAR
SIMPONI
SIMULECT
SOMATULINE DEPOT
(Prograf)
THALOMID
THIOLA
THYMOGLOBULIN
TYSABRI
ULORIC
ZAVESCA
ZENAPAX
ZOMETA
2
2
2
2
2
2
2
1
2
2
2
2
2
2
2
2
Notes
PA
PA
ST
PA
PA
LA
PA
PA
PA
LA
ST
PA
soln, solr
caps, soln
tabs
caps
soln, tabs
soln; 22mcg/0.5ml,
44mcg/0.5ml
soln; 8.8mcg/
0.2ml-22mcg/
0.5ml
solr
caps
kit
tabs
soln
solr
soln
caps
caps
tabs
solr
conc
tabs
caps
conc
conc
Mucolytic Agents
Mucolytic Agents
(Mucomyst)
acetylcysteine
1
soln
Multivitamin Preparations
Multivitamin Preparations
prenatal with folic acid (Prenatal With Folic Acid
(Greater than .8mg))
(greater than .8mg)
2
Mydriatics
Mydriatics
dipivefrin hydrochloride
tropicamide
(Propine)
MYDRAL
(Mydriacyl)
1
1
1
soln
soln
soln
1
1
soln
tabs
Opiate Antagonists
Opiate Antagonists
naloxone hydrochloride (Narcan)
naltrexone hydrochloride (Revia)
T-44
Drug Name
Drug
Tier
Notes
Oxytocics
Oxytocics
METHERGINE
2
tabs
Parasympathomimetics (Cholinergic Agents)
Parasympathomimetics (Cholinergic Agents)
ARICEPT
ARICEPT ODT
(Urecholine)
bethanechol chloride
EVOXAC
EXELON
EXELON
(Razadyne)
galantamine
hydrobromide
guanidine hydrochloride (Guanidine Hydrochloride)
MESTINON
MESTINON TIMESPAN
MYTELASE
(Salagen)
pilocarpine
hydrochloride
pyridostigmine bromide (Mestinon)
REGONOL
2
2
1
2
2
2
1
PA, QL
PA, QL
PA, QL
PA, QL
tabs
tbdp
tabs
caps
pt24
caps, soln
cp24, tabs
1
2
2
2
1
tabs
syrp
tbcr
tabs
tabs
1
2
tabs
soln
Parathyroid
Parathyroid
calcitonin,salmon
(Miacalcin)
FORTEO
FORTICAL
MIACALCIN
1
2
2
2
PA, QL
soln; 200 unit/act
soln
soln
soln; 200 unit/ml
Pharmaceutical Aids
Pharmaceutical Aids
2
pads
(DDAVP)
GENOTROPIN
1
2
PA
GENOTROPIN MINIQUICK
2
PA
HUMATROPE
HUMATROPE
HUMATROPE COMBO
PACK
2
2
2
PA
PA
PA
soln, tabs
solr; 5.8mg,
13.8mg
solr; various
strengths are
available
solr; 6mg
solr; 12mg, 24mg
solr; 5mg
Pituitary
Pituitary
desmopressin acetate
T-45
Drug Name
Drug
Tier
Notes
NORDITROPIN
CARTRIDGE
NORDITROPIN
NORDIFLEX PEN
2
PA
soln; 5mg/1.5ml,
15mg/1.5ml
soln; 5mg/1.5ml,
10mg/1.5ml,
15mg/1.5ml
solr; 5mg, 10mg
soln; 10mg/2ml
soln; 10mg/2ml,
20mg/2ml
soln, solr
solr; 5mg, 8.8mg
solr; 8.8mg
solr; 4mg, 5mg,
6mg
soln
solr; 5mg
solr; 8.8mg
2
PA
NUTROPIN
NUTROPIN AQ
NUTROPIN AQ PEN
2
2
2
PA
PA
PA
OMNITROPE
SAIZEN
SAIZEN CLICK.EASY
SEROSTIM
2
2
2
2
PA
PA
PA
PA
STIMATE
TEV-TROPIN
ZORBTIVE
2
2
2
PA
PA
DEPO-PROVERA
DEPO-SUBQ PROVERA 104
2
2
(Provera)
1
susp; 400mg/ml
susp; 104mg/
0.65ml
susp, tabs
(Aygestin)
PROCHIEVE
PROMETRIUM
1
2
2
tabs
gel
caps
1
soln, tabs
(Elavil)
1
tabs
(Limbitrol)
1
tabs
(Triavil)
1
tabs
(Asendin)
(Wellbutrin)
1
1
tabs
tabs, tb12, tb24
Progestins
Progestins
medroxyprogesterone
acetate
Prokinetic Agents
Prokinetic Agents
(Reglan)
metoclopramide
hydrochloride
Psychotherapeutic Agents
Antidepressants
amitriptyline
hydrochloride
amitriptyline
hydrochloride and
chlordiazepoxide
amitriptyline
hydrochloride and
perphenazine
amoxapine
bupropion hcl
T-46
Drug Name
citalopram
hydrobromide
clomipramine hcl
desipramine
hydrochloride
doxepin hydrochloride
fluoxetine hcl
fluvoxamine maleate
imipramine
hydrochloride
imipramine pamoate
maprotiline
hydrochloride
mirtazapine
Drug
Tier
Notes
(Celexa)
1
soln, tabs
(Anafranil)
CYMBALTA
(Norpramin)
1
2
1
caps
cpep
tabs
(Sinequan)
EFFEXOR XR
(Prozac)
(Luvox)
(Tofranil)
1
2
1
1
1
(Tofranil-PM)
LEXAPRO
LUVOX CR
(Ludiomil)
1
2
2
1
MARPLAN
(Remeron)
NARDIL
(Serzone)
2
1
2
1
tabs
tabs, tbdp
tabs
tabs
1
caps, soln
1
2
1
susp, tabs, tb24
tb24
tabs
nefazodone
hydrochloride
(Pamelor)
nortriptyline
hydrochloride
paroxetine hydrochloride (Paxil)
PRISTIQ
(Vivactil)
protriptyline
hydrochloride
RAPIFLUX
SAVELLA
SAVELLA TITRATION
PACK
sertraline hydrochloride (Zoloft)
SURMONTIL
tranylcypromine sulfate (Parnate)
trazodone hydrochloride (Desyrel)
(Surmontil)
trimipramine maleate
(Effexor)
venlafaxine hcl
Antipsychotic Agents
ABILIFY
ABILIFY DISCMELT
(Thorazine)
chlorpromazine
hydrochloride
(Clozaril)
clozapine
T-47
ST
caps, conc
cp24
caps, soln, tabs
tabs
tabs
QL, ST
QL, ST
QL, ST
caps
soln, tabs
cp24
tabs
1
2
2
tabs
tabs
misc
1
2
1
1
1
1
conc, tabs
caps; 100mg
tabs
tabs
caps; 25mg, 50mg
tabs
2
2
1
QL
QL
soln, tabs
tbdp
soln, tabs
1
QL
tabs
Drug Name
fluphenazine decanoate
fluphenazine
hydrochloride
haloperidol
haloperidol decanoate
haloperidol lactate
loxapine succinate
perphenazine
risperidone
thioridazine
hydrochloride
thiothixene
trifluoperazine
hydrochloride
Drug
Tier
Notes
FAZACLO
(Prolixin Decanoate)
(Prolixin)
2
1
1
QL
GEODON
GEODON
HALDOL
HALDOL DECANOATE-100
HALDOL DECANOATE-50
(Haldol)
(Haldol Decanoate)
2
2
2
2
2
1
1
QL
QL
(Haloperidol Lactate)
INVEGA
(Loxitane)
MOBAN
NAVANE
ORAP
(Trilafon)
RISPERDAL CONSTA
RISPERDAL M-TAB
(Risperdal)
SEROQUEL
SEROQUEL XR
(Mellaril)
1
2
1
2
2
2
1
2
2
1
2
2
1
(Navane)
1
(Stelazine)
1
ZYPREXA
ZYPREXA ZYDIS
2
2
QL
QL
solr, tabs
tbdp
2
2
2
2
2
ST
ST
ST
ST
ST
tabs
tabs
tabs
tabs
tabs
QL, ST
QL
QL
QL
QL
tbdp
soln
conc, elix, soln,
tabs
caps
solr
soln
soln; 100mg/ml
soln; 50mg/ml
tabs
soln; 50mg/ml,
100mg/ml
conc, soln
tb24
caps
tabs
caps; 20mg
tabs
tabs
susr
tbdp
soln, tabs, tbdp
tabs
tb24
tabs
caps; 1mg, 2mg,
5mg, 10mg
tabs
Renin-Angiotensin-Aldosterone System Inhibitors
Angiotensin II Receptor Antagonists
COZAAR
DIOVAN
DIOVAN HCT
EXFORGE HCT
HYZAAR
Angiotensin-Converting Enzyme Inhibitors
(Lotensin)
benazepril hcl
(Lotensin HCT)
benazepril hcl and
hydrochlorothiazide
(Capoten)
captopril
T-48
1
1
tabs
tabs
1
tabs
Drug Name
Drug
Tier
(Capozide)
captopril and
hydrochlorothiazide
(Vasotec)
enalapril maleate
(Vaseretic)
enalapril maleate and
hydrochlorothiazide
(Monopril)
fosinopril sodium
(Monopril HCT)
fosinopril sodium and
hydrochlorothiazide
hydrochlorothiazide and (Zestoretic)
lisinopril
hydrochlorothiazide and (Uniretic)
moexipril hydrochloride
hydrochlorothiazide and (Accuretic)
quinapril hcl
(Zestril)
lisinopril
moexipril hydrochloride (Univasc)
(Accupril)
quinapril hcl
(Altace)
ramipril
(Mavik)
trandolapril
Mineralocorticoid (Aldosterone) Antagonists
(Inspra)
eplerenone
hydrochlorothiazide and (Aldactazide)
spironolactone
(Aldactone)
spironolactone
Renin Inhibitors
TEKTURNA
TEKTURNA HCT
Notes
1
tabs
1
1
tabs
tabs
1
1
tabs
tabs
1
tabs
1
tabs
1
tabs
1
1
1
1
1
tabs
tabs
tabs
caps
tabs
1
1
tabs
tabs
1
tabs
2
2
ST
ST
tabs
tabs
Replacement Preparations
Replacement Preparations
(Calcium (+2) and Chloride
calcium (+2) and
Ion and Dextrose (anhydrous)
chloride ion and
and Lactate Anion and
Potassium (+1))
and lactate anion and
potassium (+1)
(Calcium (+2) and Chloride
calcium (+2) and
Ion and Potassium (+1) and
chloride ion and
Sodium (+1))
potassium (+1) and
sodium (+1)
(Chloride Ion and Dextrose
chloride ion and
(anhydrous) and Lactate Anion
and Magnesium (+2) and
Phosphate)
magnesium (+2) and
phosphate
T-49
1
soln
1
soln
1
soln; 24 meq/l, 5%,
23 meq/l, 3 meq/l,
3 meq/l
Drug Name
chloride ion and
phosphate and potassium
(+1)
and potassium chloride
and potassium chloride
and sodium chloride
potassium chloride
Drug
Tier
Notes
(Chloride Ion and Dextrose
(anhydrous) and Lactate Anion
and Phosphate and Potassium
(+1))
1
soln; 48 meq/l, 5%,
20 meq/l, 15 meq/l,
35 meq/l
Potassium Chloride)
(KCl 0.075%/D5W/NaCl
0.45%)
1
soln
1
soln
IONOSOL-B/DEXTROSE 5%
2
IONOSOL-MB/DEXTROSE
5%
2
IONOSOL-T/DEXTROSE 5%
2
ISOLYTE-H/DEXTROSE 5%
2
ISOLYTE-P/DEXTROSE 5%
ISOLYTE-S
ISOLYTE-S PH 7.4
ISOLYTE-S/DEXTROSE 5%
2
2
2
2
KLOTRIX
K-TABS
NORMOSOL -R
NORMOSOL-M IN D5W
1
1
1
1
NORMOSOL-R
PLASMA-LYTE 56
PLASMA-LYTE A
PLASMA-LYTE-148
PLASMA-LYTE-148/D5W
2
2
2
2
2
PLASMA-LYTE-56/D5W
2
(K-Dur)
1
soln; 49 meq/l, 5%,
25 meq/l, 5 meq/l,
13 meq/l
soln; 22 meq/l, 5%,
23 meq/l, 3 meq/l,
3 meq/l
soln; 40 meq/l, 5%,
20 meq/l, 15 meq/l,
35 meq/l
soln; 17 meq/l, 39
meq/l, 5%, 3 meq/
l, 13 meq/l
soln
soln
soln
soln; 30 meq/l, 98
meq/l, 5%, 23
meq/l, 3 meq/l
tbcr
tbcr
soln
soln; 16 meq/l, 40
meq/l, 5%, 3 meq/
l, 13 meq/l
soln
soln
soln
soln
soln; 27 meq/l, 98
meq/l, 5%, 23
meq/l, 3 meq/l
soln; 16 meq/l, 40
meq/l, 5%, 3 meq/
l, 13 meq/l
cpcr, soln, tbcr
T-50
Drug Name
sodium chloride
sodium chloride
Drug
Tier
(Potassium Chloride and
Sodium Chloride)
(Sodium Chloride)
Notes
1
soln
1
soln
1
1
1
soln, tabs
tb12
elix, tb12, tb24
Respiratory Smooth Muscle Relaxants
Respiratory Smooth Muscle Relaxants
(Aminophylline)
aminophylline
THEOCHRON
(Uniphyl)
theophylline
Respiratory Tract Agents, Miscellaneous
Respiratory Tract Agents, Miscellaneous
XOLAIR
2
PA, QL
solr
Second Generation Antihistamines
Second Generation Antihistamines
ALLEGRA-D 12 HOUR
ALLEGRA-D 24 HOUR
(Zyrtec Allergy)
cetirizine hcl
2
2
tb12
tb24
chew, soln,
solution, syrp, tab
chew, tablet, tabs,
OTC
tb12, OTC
1
tabs
cetirizine hcl and
pseudoephedrine
hydrochloride
fexofenadine
hydrochloride
loratadine
(Zyrtec-d Allergy/congesti)
loratadine and
pseudoephedrine
hydrochloride
loratadine and
pseudoephedrine sulfate
p-ephed hcl/cetirizine hcl
p-ephed sul/loratadine
(Claritin-D)
soln, solution,
syrp, tablet, tabs,
tbdp, OTC
tb24, OTC
(Claritin-D)
tb12, tb24, OTC
(Zyrtec-D)
(Claritin-D)
XYZAL
tab.sr 12h, OTC
tab.sr 24h, OTC
soln, tabs
(Allegra)
(Claritin)
2
Serums
Serums
CARIMUNE
NANOFILTERED
CARIMUNE
NANOFILTERED
FLEBOGAMMA
GAMASTAN S/D
GAMMAGARD LIQUID
T-51
2
PA
solr
2
PA
2
2
2
PA
PA
PA
solr; 1gm, 3gm,
6gm
soln
inj
soln
Drug Name
Drug
Tier
GAMUNEX
IVEEGAM EN
OCTAGAM
PANGLOBULIN NF
PANGLOBULIN NF
POLYGAM S/D
VIVAGLOBIN
2
2
2
2
2
2
2
Notes
PA
PA
PA
PA
PA
PA
PA
soln
solr; 5gm
soln
solr
solr; 6gm
solr
soln
Skeletal Muscle Relaxants
Centrally-Acting Skeletal Muscle Relaxants
aspirin and carisoprodol (Soma Compound)
aspirin and carisoprodol (Soma Compound/codeine)
and codeine phosphate
(Soma)
carisoprodol
(Parafon Forte DSC)
chlorzoxazone
(Flexeril)
cyclobenzaprine
hydrochloride
(Robaxin)
methocarbamol
SKELAXIN
tizanidine hydrochloride (Zanaflex)
Direct-Acting Skeletal Muscle Relaxants
(Dantrium)
dantrolene sodium
Gaba-Derivative Skeletal Muscle Relaxants
(Lioresal)
baclofen
1
1
tabs
tabs
1
1
1
tabs
tabs
tabs
1
2
1
tabs
tabs
tabs
1
caps
1
tabs
Skin and Mucous Membrane Agents, Miscellaneous
Skin and Mucous Membrane Agents, Miscellaneous
ALDARA
2
AMEVIVE
2
(Dovonex)
1
calcipotriene
CARAC
2
CONDYLOX
2
DOVONEX
2
EFUDEX OCCLUSION
2
PACK
ELIDEL
2
FLUOROPLEX
2
(Efudex)
1
fluorouracil
(Accutane)
1
isotretinoin
PANRETIN
2
(Condylox)
1
podofilox
PROTOPIC
2
REGRANEX
2
SANTYL
2
SOLARAZE
2
TARGRETIN
2
T-52
PA, QL
PA
PA
crea
solr
soln
crea; 0.5%
gel
crea
kit
crea
crea; 1%
crea, soln
caps
gel
soln
oint
gel
oint
gel
gel
Drug Name
TAZORAC
Drug
Tier
Notes
2
crea, gel
2
2
soln
soln
2
solr
1
supp, tabs
2
1
caps
soln; 1mg/ml
2
1
subl
tabs
2
soln; 4mg/ml
1
soln
2
2
2
devi; 1 :1000
devi; 1 :2000
devi
1
tabs
Somatotropin Agonists and Antagonists
Somatotropin Agonists
INCRELEX
IPLEX
Somatotropin Antagonists
SOMAVERT
Sympatholytic Adrenergic Blocking Agents
Sympatholytic Adrenergic Blocking Agents
caffeine and ergotamine (Cafergot)
tartrate
DIBENZYLINE
(D.H.E. 45)
dihydroergotamine
mesylate
ERGOMAR
(Ergot Alkaloids,
ergot alkaloids,
hydrogenated (mesylate) Hydrogenated (mesylate))
MIGRANAL
Sympathomimetic (Adrenergic) Agents
Alpha- and Beta-Adrenergic Agonists
(Adrenalin)
epinephrine
hydrochloride
EPIPEN 2-PAK
EPIPEN-JR 2-PAK
TWINJECT
Alpha-Adrenergic Agonists
(Proamatine)
midodrine hcl
Beta-Adrenergic Agonists
ADVAIR DISKUS
ADVAIR HFA
(Proventil)
albuterol sulfate
metaproterenol sulfate
terbutaline sulfate
BRETHINE
COMBIVENT
FORADIL AEROLIZER
(Alupent)
PROAIR HFA
PROVENTIL HFA
SEREVENT DISKUS
(Brethine)
VENTOLIN HFA
2
2
1
2
2
2
1
2
2
2
1
2
QL
QL
QL
QL
misc
aero
nebu, syrp, tabs,
tb12
soln
aero
caps
nebu, syrp, tabs
aers
aers
aepb
soln, tabs
aers
Thyroid and Antithyroid Agents
Antithyroid Agents
(Tapazole)
methimazole
1
T-53
tabs
Drug Name
Drug
Tier
Notes
propylthiouracil
Thyroid Agents
levothyroxine sodium
(Propylthiouracil)
1
tabs
(Synthroid)
1
liothyronine sodium
(Cytomel)
UNITHROID
1
1
tabs; various
strengths are
available
soln, tabs
tabs; 137mcg
ADACEL
2
BOOSTRIX
2
DAPTACEL
2
DECAVAC
DIPTHERIA/TETANUS
TOXOIDPEDIATRIC
INFANRIX
2
2
TETANUS TOXOID
ADSORBED
TETANUS/DIPHTHERIA
TOXOIDS-ADSORBED
ADULT
TRIHIBIT
TRIPEDIA
1
Toxoids
Toxoids
2
PA
susp; 15.5mcg/
0.5ml, 2 lf/0.5ml, 5
lf/0.5ml
susp; 18.5mcg/
0.5ml, 2.5 lf/0.5ml,
5 lf/0.5ml
susp; 10mcg/
0.5ml, 15 lf/0.5ml,
5 lf/0.5ml
inj; 2 lfu, 5 lfu
inj; 6.7 lfu/0.5ml, 5
lfu/0.5ml
susp; 58mcg/
0.5ml, 25 lfu/
0.5ml, 10 lfu/0.5ml
soln
2
susp
2
2
kit
susp; 46.8mcg/
0.5ml, 6.7 lfu/
0.5ml, 5 lfu/0.5ml
1
tabs
1
tabs
2
1
2
susp
tabs
pack
Uricosuric Agents
Uricosuric Agents
(Col-Benemid)
colchicine and
probenecid
(Benemid)
probenecid
Urinary Anti-infectives
Urinary Anti-infectives
FURADANTIN
methenamine hippurate (Hiprex)
MONUROL
T-54
Drug Name
nitrofurantoin
macrocrystalline
nitrofurantoin
monohydrate
macrocrystals
trimethoprim
Drug
Tier
Notes
(Macrodantin)
1
caps
(Macrobid)
1
caps
PRIMSOL
(Proloprim)
UREX
2
1
1
soln
tabs
tabs
ACTHIB
ATTENUVAX
COMVAX
ENGERIX-B
2
2
2
2
GARDASIL
HAVRIX
HIBTITER
IMOVAX RABIES
(H.D.C.V.)
IPOL INACTIVATED IPV
JE-VAX
MENACTRA
MENOMUNE-A/C/Y/W-135
MERUVAX II W/DILUENT
10 DOSE
M-M-R II W/DILUENT 10
DOS
PEDIARIX
PEDVAX HIB
PROQUAD
RABAVERT
RECOMBIVAX HB
2
2
2
2
solr
inj
susp
inj, susp; 10mcg/
0.5ml, 20mcg/ml
susp
susp
soln
inj
ROTATEQ
TWINRIX
TYPHIM VI
VAQTA
VARIVAX
VIVOTIF BERNA
YF-VAX
ZOSTAVAX
2
2
2
2
2
2
1
2
Vaccines
Vaccines
T-55
PA
PA
PA
PA
2
2
2
2
2
inj
solr
inj; 4mcg/0.5ml
inj; 50mcg/0.5ml
inj
2
inj
2
2
2
2
2
susp
soln
inj
susr
inj, susp; 5mcg/
0.5ml, 10mcg/ml,
40mcg/ml
susp
susp
soln
inj
inj
cpdr
inj
solr
PA
PA
PA
Drug Name
Drug
Tier
Notes
Vasoconstrictors
Vasoconstrictors
(Albalon)
naphazoline
hydrochloride
TYZINE
TYZINE PEDIATRIC
NASAL DROPS
1
soln
2
2
soln; 0.1%
soln; 0.05%
1
1
1
1
1
2
tabs
tbcr
subl, tabs, tbcr
tabs, tb24
pt24, soln
soln
2
subl
Vasodilating Agents
Nitrates and Nitrites
ISMO
ISOCHRON
(Isordil)
isosorbide dinitrate
(Imdur)
isosorbide mononitrate
(Nitro-dur)
nitroglycerin
NITROLINGUAL
PUMPSPRAY
NITROSTAT
Phosphodiesterase Inhibitors
ADCIRCA
REVATIO
Vasodilating Agents, Miscellaneous
AGGRENOX
(Persantine)
dipyridamole
LETAIRIS
REMODULIN
TRACLEER
2
2
2
1
2
2
2
PA
PA
tabs
tabs
PA
LA
cp12
tabs
tabs
soln
tabs
Vitamin D
Vitamin D
calcitriol
(Rocaltrol)
HECTOROL
1
2
T-56
caps, soln
caps, soln
INDEX
ACTONEL WITH CALCIUM ............. T-42
ACTOPLUS MET ................................ T-12
ACTOS ................................................. T-12
ACULAR .............................................. T-17
ACULAR LS ........................................ T-17
ACULAR PF......................................... T-17
acyclovir................................................ T-27
acyclovir sodium ................................... T-27
ADACEL .............................................. T-54
ADAGEN.............................................. T-38
ADCIRCA............................................. T-56
Adderall................................................... T-4
ADDERALL XR .................................... T-4
Adoxa...................................................... T-9
Adrenalin............................................... T-53
Adriamycin ........................................... T-21
Adrucil .................................................. T-21
ADVAIR DISKUS................................ T-53
ADVAIR HFA ...................................... T-53
AFINITOR............................................ T-20
AGGRENOX ........................................ T-56
Agrylin .................................................. T-42
A-hydrocort............................................. T-1
ALAMAST ............................................. T-5
Albalon.................................................. T-56
ALBENZA.............................................. T-5
albuterol sulfate .................................... T-53
alclometasone dipropionate.................. T-18
ALCOHOL SWABS............................. T-17
alcohol, usp and dextrose (anhydrous). T-29
Alcohol, USP and Dextrose anhydrous T-29
Aldactazide ........................................... T-49
Aldactone .............................................. T-49
ALDARA.............................................. T-52
ALDURAZYME................................... T-38
alendronate sodium............................... T-42
ALFERON N ........................................ T-26
ALIMTA ............................................... T-20
ALKERAN ........................................... T-20
Allegra................................................... T-51
ALLEGRA-D 12 HOUR ...................... T-51
ALLEGRA-D 24 HOUR ...................... T-51
allopurinol............................................. T-42
8-MOP................................................... T-34
ABELCET............................................. T-13
ABILIFY............................................... T-47
ABILIFY DISCMELT.......................... T-47
ABRAXANE ........................................ T-20
ACANYA ............................................. T-16
acarbose................................................ T-10
ACCOLATE ......................................... T-18
Accupril................................................. T-49
Accuretic ............................................... T-49
Accutane ............................................... T-52
acebutolol hydrochloride ...................... T-27
acetaminophen and butalbital and caffeine
and codeine phosphate........................ T-2
acetaminophen and caffeine and
dihydrocodeine bitartrate ................... T-2
acetaminophen and codeine phosphate .. T-2
acetaminophen and hydrocodone bitartrate.
T-2
acetaminophen and oxycodone
hydrochloride...................................... T-2
acetaminophen and propoxyphene
hydrochloride...................................... T-3
Acetaminophen and Propoxyphene
Hydrochloride ..................................... T-3
acetaminophen and propoxyphene napsylate
T-3
acetaminophen and tramadol hcl............ T-3
ACETASOL HC ................................... T-16
acetazolamide ....................................... T-14
acetazolamide sodium........................... T-14
Acetazolamide Sodium ......................... T-14
acetic acid ............................................. T-16
acetic acid and aluminum acetate......... T-16
acetic acid and hydrocortisone............. T-16
acetylcysteine ........................................ T-44
Aclovate ................................................ T-18
ACTHIB................................................ T-55
Actigall.................................................. T-33
ACTIMMUNE...................................... T-42
Actiq........................................................ T-3
Activella................................................ T-39
ACTONEL............................................ T-42
I-1
allopurinol sodium ................................ T-42
Aloprim ................................................. T-42
ALORA................................................. T-39
ALPHAGAN P ..................................... T-13
Alphatrex............................................... T-18
ALREX ................................................. T-17
Altace .................................................... T-49
Alupent.................................................. T-53
amantadine hydrochloride .................... T-23
Amaryl .................................................. T-12
Ambien.................................................. T-27
AMBISOME ......................................... T-13
amcinonide............................................ T-18
AMEVIVE ............................................ T-52
amifostine.............................................. T-42
amikacin sulfate ...................................... T-5
Amikin .................................................... T-5
amiloride hydrochloride (anhydrous)... T-38
amiloride hydrochloride (anhydrous) and
hydrochlorothiazide .......................... T-38
aminophylline........................................ T-51
Aminophylline ...................................... T-51
AMINOSYN ......................................... T-29
AMINOSYN 7%/ELECTROLYTES ... T-29
AMINOSYN 8.5%/ELECTROLYTES T-29
AMINOSYN II ..................................... T-29
AMINOSYN II 3.5%/DEXTROSE 25%......
T-29
AMINOSYN II 3.5%/DEXTROSE 5% T-29
AMINOSYN II 4.25%/DEXTROSE 20%....
T-29
AMINOSYN II 5%/DEXTROSE 25%. T-29
AMINOSYN II 8.5%/ELECTROLYTES ....
T-29
AMINOSYN II M 3.5%/DEXTROSE 5% ...
T-29
AMINOSYN M .................................... T-29
AMINOSYN-HBC ............................... T-30
AMINOSYN-HF................................... T-30
AMINOSYN-PF 7%............................. T-30
amiodarone hcl ..................................... T-32
AMITIZA.............................................. T-33
amitriptyline hydrochloride .................. T-46
amitriptyline hydrochloride and
chlordiazepoxide ............................... T-46
amitriptyline hydrochloride and
perphenazine ..................................... T-46
amlodipine besylate .............................. T-28
amlodipine besylate and benazepril hcl T-28
ammonium chloride ................................ T-1
Ammonium Chloride .............................. T-1
ammonium lactate................................. T-38
Ammonium Lactate .............................. T-38
amoxapine ............................................. T-46
amoxicillin............................................... T-7
amoxicillin and clavulanic acid .............. T-7
amoxicillin and potassium clavulanate... T-7
Amoxil .................................................... T-7
amphetamine aspartate and amphetamine
sulfate and dextroamphetamine
saccharate and dextroamphetamine ... T-4
Amphocin.............................................. T-13
AMPHOTEC......................................... T-13
amphotericin b ...................................... T-13
ampicillin ................................................ T-7
Ampicillin ............................................... T-7
ampicillin sodium.................................... T-7
Ampicillin Sodium.................................. T-7
ampicillin sodium and sulbactam sodium.....
T-7
Anafranil ............................................... T-47
anagrelide hydrochloride...................... T-42
Anaprox................................................... T-2
Ancef....................................................... T-6
ANCOBON........................................... T-13
ANDRODERM....................................... T-4
ANDROGEL........................................... T-4
ANDROGEL PUMP............................... T-4
ANDROID .............................................. T-4
Ansaid ..................................................... T-2
ANTABUSE ......................................... T-42
Antivert ................................................. T-13
ANTIVERT........................................... T-13
Antizol................................................... T-43
Apexicon ............................................... T-18
APOKYN.............................................. T-24
apraclonidine hydrochloride ................ T-38
Apresoline ............................................. T-41
APRISO ................................................ T-18
APTIVUS.............................................. T-26
ARALAST ............................................ T-38
I-2
AVELOX ABC PACK ........................... T-8
AVITA .................................................. T-33
AVODART ........................................... T-42
AVONEX.............................................. T-42
Axid....................................................... T-25
Aygestin ................................................ T-46
azathioprine .......................................... T-43
azathioprine sodium.............................. T-43
AZILECT.............................................. T-24
azithromycin............................................ T-6
AZOPT.................................................. T-14
Azulfidine ............................................... T-8
bacitracin ...................................... T-5, T-14
Bacitracin ...................................... T-5, T-14
bacitracin zinc and hydrocortisone acetate
and neomycin sulfate and polymyxin b
sulfate................................................ T-14
Bacitracin Zinc and Hydrocortisone Acetate
and Neomycin Sulfate and Polymyxin B
Sulfate ............................................... T-14
bacitracin zinc and neomycin sulfate and
polymyxin b sulfate ........................... T-15
bacitracin zinc and polymyxin b sulfate T-15
baclofen................................................. T-52
Bactrim.................................................... T-8
BACTROBAN NASAL ....................... T-15
balsalazide disodium............................. T-18
BANZEL................................................. T-9
BARACLUDE ...................................... T-27
Benadryl................................................ T-39
benazepril hcl........................................ T-48
benazepril hcl and hydrochlorothiazide T-48
bendroflumethiazide and nadolol ......... T-28
Benemid ................................................ T-54
BENOQUIN.......................................... T-34
BENZACLIN........................................ T-16
Benzamycin........................................... T-16
benzoyl peroxide and erythromycin ...... T-16
benztropine mesylate............................. T-23
Betagan ................................................. T-14
betamethasone dipropionate................. T-18
betamethasone dipropionate and
clotrimazole....................................... T-16
betamethasone valerate ........................ T-18
Betamethasone Valerate........................ T-18
Betapace................................................ T-28
Aralen.................................................... T-24
ARANESP ALBUMIN FREE.............. T-41
ARANESP ALBUMIN FREE SURE... T-41
Arava..................................................... T-43
ARCALYST ......................................... T-42
Aredia.................................................... T-44
ARICEPT.............................................. T-45
ARICEPT ODT..................................... T-45
ARIMIDEX........................................... T-20
ARIXTRA............................................. T-24
AROMASIN ......................................... T-20
ARRANON........................................... T-20
Artane.................................................... T-23
ASACOL............................................... T-18
ASACOL HD........................................ T-18
Asendin ................................................. T-46
aspirin and butalbital and caffeine and
codeine phosphate............................... T-3
aspirin and carisoprodol ...................... T-52
aspirin and carisoprodol and codeine
phosphate .......................................... T-52
aspirin and oxycodone hydrochloride and
oxycodone terephthalate ..................... T-3
ASTELIN................................................ T-5
ASTEPRO............................................... T-5
Atarax.................................................... T-27
atenolol ................................................. T-27
atenolol and chlorthalidone.................. T-27
ATGAM................................................ T-42
ATRIPLA.............................................. T-26
atropine sulfate ....................................... T-9
Atropine Sulfate ...................................... T-9
atropine sulfate and diphenoxylate
hydrochloride.................................... T-12
Atrovent ................................................ T-38
ATROVENT HFA .................................. T-9
ATTENUVAX...................................... T-55
augmented betamethasone dipropionate ......
T-18
Augmentin............................................... T-7
Augmentin ES-600.................................. T-7
AVANDAMET..................................... T-12
AVANDARYL ..................................... T-12
AVANDIA............................................ T-12
AVASTIN ............................................. T-20
AVELOX ................................................ T-8
I-3
calcitonin,salmon .................................. T-45
calcitriol................................................ T-56
calcium (+2) and chloride ion and dextrose
(anhydrous) and lactate anion and
potassium (+1).................................. T-49
calcium (+2) and chloride ion and
potassium (+1) and sodium (+1) ..... T-42,
T-49
Calcium +2 and Chloride Ion and Dextrose
anhydrous and Lactate Anion and
Potassium +1..................................... T-49
Calcium +2 and Chloride Ion and Potassium
+1 and Sodium +1............................. T-49
calcium acetate ..................................... T-41
CAMPATH ........................................... T-20
CAMPRAL ........................................... T-33
Camptosar ............................................. T-22
CANASA .............................................. T-18
CANCIDAS .......................................... T-13
CANTIL.................................................. T-9
CAPASTAT SULFATE ....................... T-20
Capoten ................................................. T-48
Capozide ............................................... T-49
captopril................................................ T-48
captopril and hydrochlorothiazide ....... T-49
CARAC................................................. T-52
Carafate ................................................. T-25
CARAFATE ......................................... T-25
carbamazepine ........................................ T-9
CARBATROL ........................................ T-9
carbidopa anhydrous and levodopa...... T-23
carbidopa monohydrate and levodopa . T-23
carbinoxamine maleate......................... T-39
carboplatin............................................ T-20
Cardene ................................................. T-28
CARDENE I.V. .................................... T-28
Cardizem CD ........................................ T-28
CARDIZEM CD ................................... T-28
Cardura.................................................... T-1
CARIMUNE NANOFILTERED.......... T-51
carisoprodol.......................................... T-52
Carmol-HC............................................ T-19
Carnitor ................................................. T-43
carteolol hcl .......................................... T-38
carvedilol .............................................. T-28
Casodex................................................. T-20
BETASERON ....................................... T-43
betaxolol hydrochloride .............. T-14, T-28
Betaxolol Hydrochloride....................... T-14
bethanechol chloride............................. T-45
BETIMOL............................................. T-14
Biaxin...................................................... T-6
bicalutamide.......................................... T-20
BICILLIN C-R........................................ T-7
BICILLIN L-A........................................ T-7
BICNU W/DILUENT
ABSOLUTEETHANOL................... T-20
BILTRICIDE .......................................... T-5
bisoprolol fumarate............................... T-28
bisoprolol fumarate and
hydrochlorothiazide .......................... T-28
Blenoxane ............................................. T-20
bleomycin sulfate .................................. T-20
BLEPHAMIDE..................................... T-15
BLEPHAMIDE S.O.P. ......................... T-15
Blocadren .............................................. T-28
BONIVA ............................................... T-43
BOOSTRIX........................................... T-54
BOTOX................................................. T-43
Brethine................................................. T-53
BRETHINE........................................... T-53
BREVICON-28..................................... T-33
brimonidine tartrate.............................. T-14
Brimonidine Tartrate............................. T-14
bromocriptine mesylate......................... T-24
bumetanide............................................ T-37
Bumex ................................................... T-37
BUPHENYL ........................................... T-2
BUPRENEX ........................................... T-4
buprenorphine hydrochloride ................. T-4
Buprenorphine Hydrochloride ................ T-4
bupropion hcl ........................................ T-46
Buspar ................................................... T-27
buspirone hydrochloride....................... T-27
BUSULFEX.......................................... T-20
butorphanol tartrate................................ T-4
BYETTA............................................... T-10
cabergoline ........................................... T-24
Cafergot................................................. T-53
caffeine and ergotamine tartrate .......... T-53
Calan SR ............................................... T-28
calcipotriene ......................................... T-52
I-4
cephalexin ............................................... T-6
cephalexin monohydrate ......................... T-6
Cerebyx ................................................. T-10
CEREDASE.......................................... T-38
CEREZYME ......................................... T-38
Cerubidine............................................. T-21
CESAMET............................................ T-12
cetirizine hcl.......................................... T-51
cetirizine hcl and pseudoephedrine
hydrochloride.................................... T-51
CHANTIX............................................. T-27
CHEMET .............................................. T-40
chloramphenicol sodium succinate......... T-6
chlorhexidine gluconate........................ T-16
chloride ion and dextrose (anhydrous) and
lactate anion and magnesium (+2) and
phosphate .......................................... T-49
chloride ion and dextrose (anhydrous) and
lactate anion and phosphate and
potassium (+1).................................. T-50
Chloride Ion and Dextrose anhydrous and
Lactate Anion and Magnesium +2 and
Phosphate .......................................... T-49
Chloride Ion and Dextrose anhydrous and
Lactate Anion and Phosphate and
Potassium +1..................................... T-50
Chloromycetin......................................... T-6
chloroquine phosphate.......................... T-24
chlorothiazide ....................................... T-38
chlorpromazine hydrochloride.............. T-47
chlorthalidone ....................................... T-38
chlorzoxazone ....................................... T-52
cholestyramine ...................................... T-19
ciclopirox .............................................. T-16
Ciclopirox ............................................. T-16
ciclopirox olamine ................................ T-16
cilostazol ............................................... T-25
Ciloxan.................................................. T-15
cimetidine.............................................. T-25
cimetidine hydrochloride ...................... T-25
CIMZIA ................................................ T-43
Cipro ....................................................... T-8
CIPRO HC ............................................ T-15
Cipro I.V. ................................................ T-8
Cipro I.V. in D5W .................................. T-8
Cipro XR................................................. T-8
CASODEX............................................ T-20
Cataflam.................................................. T-2
Catapres................................................. T-41
Ceclor...................................................... T-6
CEENU ................................................. T-20
cefaclor ................................................... T-6
cefaclor monohydrate ............................. T-6
cefadroxil hemihydrate ........................... T-6
Cefadroxil Hemihydrate.......................... T-6
cefadroxil monohydrate .......................... T-6
cefazolin sodium...................................... T-6
cefazolin sodium and dextrose (anhydrous) .
T-6
Cefazolin Sodium and Dextrose anhydrous..
T-6
cefdinir .................................................... T-6
cefepime hydrochloride........................... T-6
CEFIZOX IN DEXTROSE 5% .............. T-6
cefotaxime sodium................................... T-6
Cefotetan ................................................. T-7
cefotetan disodium .................................. T-7
cefoxitin sodium ...................................... T-7
cefpodoxime proxetil............................... T-6
cefprozil................................................... T-6
ceftazidime .............................................. T-6
Ceftin....................................................... T-6
ceftriaxone sodium .................................. T-6
ceftriaxone sodium and dextrose
(anhydrous) ......................................... T-6
Ceftriaxone Sodium and Dextrose
anhydrous............................................ T-6
CEFTRIAXONE/DEXTROSE............... T-6
cefuroxime axetil..................................... T-6
cefuroxime sodium .................................. T-6
cefuroxime sodium and dextrose
monohydrate ....................................... T-6
Cefuroxime Sodium and Dextrose
Monohydrate ....................................... T-6
Cefzil....................................................... T-6
CELEBREX............................................ T-2
Celexa ................................................... T-47
Cellcept ................................................. T-43
CELLCEPT........................................... T-43
CELLCEPT INTRAVENOUS ............. T-43
CELONTIN........................................... T-10
Centany ................................................. T-16
I-5
Col-Benemid ......................................... T-54
colchicine and probenecid .................... T-54
Colestid ................................................. T-19
colestipol hydrochloride ....................... T-19
colistimethate sodium.............................. T-5
Coly-mycin-m ......................................... T-5
COLY-MYCIN-S ................................. T-15
Colyte.................................................... T-33
COMBIGAN......................................... T-14
COMBIPATCH .................................... T-39
COMBIVENT....................................... T-53
COMBIVIR........................................... T-26
Combunox............................................... T-3
Compazine ............................................ T-13
COMTAN ............................................. T-23
COMVAX............................................. T-55
CONCERTA ........................................... T-4
Condylox............................................... T-52
CONDYLOX ........................................ T-52
COPAXONE......................................... T-43
Copegus................................................. T-27
Cordarone.............................................. T-32
CORDRAN ........................................... T-18
CORDRAN SP...................................... T-18
CORDRAN TAPE ................................ T-18
Coreg..................................................... T-28
COREG CR........................................... T-28
Corgard ................................................. T-28
Cortef ...................................................... T-1
cortisone acetate ..................................... T-1
Cortisone Acetate.................................... T-1
Cortisporin ............................................ T-15
CORTISPORIN-TC.............................. T-15
Corzide.................................................. T-28
COSMEGEN......................................... T-21
Cosopt ................................................... T-14
Coumadin.............................................. T-25
COUMADIN......................................... T-25
COZAAR .............................................. T-48
CREON ................................................. T-35
CREON 5 ............................................. T-35
CREON 10 ............................................ T-35
CREON 20 ............................................ T-35
CRESTOR............................................. T-19
CRIXIVAN ........................................... T-26
cromolyn sodium................................... T-18
CIPRODEX........................................... T-15
ciprofloxacin ........................................... T-8
ciprofloxacin and ciprofloxacin hcl ........ T-8
ciprofloxacin and dextrose (anhydrous) . T-8
ciprofloxacin hcl ........................... T-8, T-15
cisplatin................................................. T-21
citalopram hydrobromide ..................... T-47
cladribine .............................................. T-21
Claforan................................................... T-6
clarithromycin......................................... T-6
Claritin .................................................. T-51
Claritin-D .............................................. T-51
clemastine fumarate .............................. T-39
Cleocin .......................................... T-5, T-16
Cleocin Phosphate................................... T-5
Climara.................................................. T-39
CLIMARA ............................................ T-39
CLIMIMIX E 4.25%/DEXTROSE 5% T-30
clindamycin hydrochloride ..................... T-5
clindamycin phosphate.................. T-5, T-16
CLINIMIX 2.75%/DEXTROSE 5% .... T-30
CLINIMIX 4.25%/DEXTROSE 5% .... T-30
CLINIMIX 5%/DEXTROSE 15% ....... T-30
CLINIMIX E 2.75%/DEXTROSE 10% .......
T-30
CLINIMIX E 2.75%/DEXTROSE 5% . T-30
CLINIMIX E 5%/DEXTROSE 15% .... T-30
Clinoril .................................................... T-2
clobetasol propionate............................ T-18
CLODERM ........................................... T-18
CLOLAR............................................... T-21
clomipramine hcl .................................. T-47
clonidine hydrochloride ........................ T-41
clotrimazole........................................... T-16
clozapine ............................................... T-47
Clozaril.................................................. T-47
codeine sulfate ........................................ T-3
Codeine Sulfate....................................... T-3
Cogentin................................................ T-23
COGENTIN .......................................... T-23
Colazal .................................................. T-18
I-6
Demadex ............................................... T-37
demeclocycline hydrochloride ................ T-8
Demerol................................................... T-3
Demulen 1/35-28 .................................. T-34
DENAVIR............................................. T-17
Depacon ................................................ T-10
Depakene............................................... T-10
Depakote ................................................. T-9
DEPAKOTE ........................................... T-9
DEPEN TITRATABS........................... T-40
Depo-medrol ........................................... T-1
DEPO-MEDROL.................................... T-1
DEPO-PROVERA ................................ T-46
DEPO-SUBQ PROVERA 104 ............. T-46
Depo-testosterone ................................... T-4
Dermatop............................................... T-19
DERMOTIC.......................................... T-17
desipramine hydrochloride ................... T-47
desmopressin acetate ............................ T-45
desogestrel and ethinyl estradiol .......... T-33
desonide ................................................ T-18
Desowen................................................ T-18
desoximetasone ..................................... T-18
Desyrel .................................................. T-47
DETROL............................................... T-40
DETROL LA ........................................ T-40
dexamethasone........................................ T-1
dexamethasone and neomycin sulfate and
dexamethasone and tobramycin sulfate T-15
dexamethasone sodium phosphate T-1, T-17
Dexamethasone Sodium Phosphate ........ T-1
Dexasol ................................................. T-17
DEXASPORIN ..................................... T-15
dexchlorpheniramine maleate............... T-40
Dexchlorpheniramine Maleate.............. T-40
Dexedrine................................................ T-4
dexmethylphenidate hydrochloride......... T-4
Dexmethylphenidate Hydrochloride....... T-4
dexrazoxane .......................................... T-43
dextroamphetamine sulfate ..................... T-4
dextrose (anhydrous) 10% .................... T-30
dextrose (anhydrous) 5% ...................... T-30
dextrose (anhydrous) and fluconazole .. T-13
dextrose (anhydrous) and heparin sodium
(porcine)............................................ T-25
Cromolyn Sodium................................. T-18
CUBICIN ................................................ T-5
CUPRIMINE......................................... T-40
Cutivate ................................................. T-19
CUTIVATE........................................... T-18
cyclobenzaprine hydrochloride............. T-52
Cyclocort............................................... T-18
cyclophosphamide................................. T-21
cyclosporine .......................................... T-43
CYKLOKAPRON ................................ T-14
CYMBALTA ........................................ T-47
cyproheptadine hydrochloride .............. T-39
CYSTADANE ...................................... T-43
CYSTAGON......................................... T-43
cytarabine ............................................. T-21
Cytomel................................................. T-54
Cytosar-U.............................................. T-21
Cytotec .................................................. T-25
Cytovene ............................................... T-27
CYTOVENE ......................................... T-27
Cytoxan ................................................. T-21
D.H.E. 45 .............................................. T-53
dacarbazine........................................... T-21
DACOGEN ........................................... T-21
danazol.................................................... T-4
Danocrine................................................ T-4
Dantrium ............................................... T-52
dantrolene sodium................................. T-52
dapsone ................................................. T-20
Dapsone................................................. T-20
DAPTACEL.......................................... T-54
DARAPRIM ......................................... T-24
Darvocet-n 100........................................ T-3
Darvon..................................................... T-4
daunorubicin hydrochloride ................. T-21
DAUNOXOME .................................... T-21
Daypro..................................................... T-2
DDAVP................................................. T-45
Decadron ................................................. T-1
DECAVAC ........................................... T-54
Declomycin ............................................. T-8
DEGARELIX........................................ T-21
Delatestryl ............................................... T-4
Del-beta................................................. T-18
DEL-BETA ........................................... T-18
Delestrogen ........................................... T-39
I-7
diflunisal ................................................. T-2
digoxin................................................... T-33
DIGOXIN ............................................. T-33
dihydroergotamine mesylate................. T-53
Dilantin ................................................. T-10
DILANTIN ........................................... T-10
DILANTIN INFATABS....................... T-10
Dilaudid................................................... T-3
diltiazem hydrochloride ........................ T-28
DIOVAN............................................... T-48
DIOVAN HCT...................................... T-48
DIPENTUM.......................................... T-18
diphenhydramine hydrochloride........... T-39
dipivefrin hydrochloride ....................... T-44
DIPTHERIA/TETANUS
TOXOIDPEDIATRIC ...................... T-54
dipyridamole ......................................... T-56
disopyramide phosphate ....................... T-32
Ditropan ................................................ T-40
Diuril ..................................................... T-38
divalproex sodium................................... T-9
Dolobid ................................................... T-2
Dolophine................................................ T-3
DOLOPHINE HCL................................. T-3
Domeboro ............................................. T-16
DORIBAX .............................................. T-7
dorzolamide hydrochloride................... T-14
dorzolamide hydrochloride and timolol
maleate.............................................. T-14
Dostinex ................................................ T-24
Dovonex................................................ T-52
DOVONEX........................................... T-52
doxazosin mesylate.................................. T-1
doxepin hydrochloride .......................... T-47
DOXIL .................................................. T-21
doxorubicin hydrochloride.................... T-21
doxycycline hyclate ....................... T-9, T-15
doxycycline monohydrate........................ T-9
dronabinol............................................. T-12
drospirenone and ethinyl estradiol ....... T-34
DROXIA ............................................... T-21
DTIC-Dome .......................................... T-21
DUETACT............................................ T-12
Duragesic ................................................ T-3
Duricef .................................................... T-6
Dyazide ................................................. T-38
dextrose (anhydrous) and magnesium
sulfate, heptahydrate........................... T-9
dextrose (anhydrous) and nafcillin sodium...
T-7
dextrose (anhydrous) and oxacillin sodium..
T-8
dextrose (anhydrous) and penicillin g
potassium ............................................ T-8
dextrose (anhydrous) and potassium
chloride ............................................. T-50
dextrose (anhydrous) and potassium
chloride and sodium chloride ........... T-50
dextrose (anhydrous) and sodium chloride...
T-31
dextrose (anhydrous) and vancomycin
hydrochloride...................................... T-5
Dextrose 5%/Sodium Chloride ............. T-31
Dextrose anhydrous 10% ...................... T-30
Dextrose anhydrous 5% ........................ T-30
Dextrose anhydrous and Heparin Sodium
porcine............................................... T-25
Dextrose anhydrous and Magnesium
Sulfate, Heptahydrate.......................... T-9
Dextrose anhydrous and Nafcillin Sodium ...
T-7
Dextrose anhydrous and Oxacillin Sodium ..
T-8
Dextrose anhydrous and Penicillin G
Potassium ............................................ T-8
Dextrose anhydrous and Potassium Chloride
T-50
Dextrose anhydrous and Vancomycin
Hydrochloride ..................................... T-5
DIABETIC SUPPLIES, MISC . T-34, T-35,
T-45
Diamox.................................................. T-14
DIBENZYLINE.................................... T-53
diclofenac potassium............................... T-2
diclofenac sodium ......................... T-2, T-18
dicloxacillin sodium ................................ T-8
didanosine ............................................. T-26
Didronel ................................................ T-43
diflorasone diacetate............................. T-18
Diflucan................................................. T-13
Diflucan in Iso-osmotic Dextrose ......... T-13
Diflucan in NaCl ................................... T-13
I-8
EPZICOM ............................................. T-26
ERAXIS ................................................ T-13
ERBITUX ............................................. T-21
ERGOMAR........................................... T-53
ergot alkaloids, hydrogenated (mesylate).....
T-53
Ergot Alkaloids, Hydrogenated mesylate .....
T-53
Eryc ......................................................... T-7
ERYDERM ........................................... T-16
Erygel.................................................... T-16
ERYTHROCIN....................................... T-6
ERYTHROCIN LACTOBIONATE....... T-7
erythromycin ...................... T-7, T-15, T-16
Erythromycin ........................................ T-15
erythromycin and sulfisoxazole............... T-7
erythromycin ethylsuccinate ................... T-7
Erythromycin Ethylsuccinate.................. T-7
ERYTHROMYCIN LACTOBIONATE T-7
erythromycin stearate ............................. T-7
Erythromycin Stearate ............................ T-7
ESTRACE............................................. T-39
ESTRADERM ...................................... T-39
estradiol ................................................ T-39
estradiol and norethindrone acetate..... T-39
estradiol valerate .................................. T-39
estropipate............................................. T-39
ethambutol hydrochloride..................... T-20
ethinyl estradiol and ethynodiol diacetate....
T-34
ethinyl estradiol and ferrous fumarate and
norethindrone acetate ....................... T-34
ethinyl estradiol and levonorgestrel ..... T-34
ethinyl estradiol and norethindrone...... T-34
ethinyl estradiol and norethindrone acetate .
T-34
ethinyl estradiol and norgestimate........ T-34
ethinyl estradiol and norgestrel ............ T-34
ethosuximide ......................................... T-10
Ethyol.................................................... T-42
ETHYOL............................................... T-43
etidronate disodium .............................. T-43
etodolac................................................... T-2
ETOPOPHOS ....................................... T-21
etoposide ............................................... T-21
Eulexin .................................................. T-21
DYGASE .............................................. T-35
Dynacirc................................................ T-28
Dynapen .................................................. T-8
DYRENIUM ......................................... T-38
econazole nitrate................................... T-16
ECONOPRED PLUS............................ T-17
Effexor .................................................. T-47
EFFEXOR XR ...................................... T-47
Efudex ................................................... T-52
EFUDEX OCCLUSION PACK ........... T-52
ELAPRASE .......................................... T-38
Elavil ..................................................... T-46
Eldepryl................................................. T-24
ELIDEL................................................. T-52
ELIGARD ............................................. T-21
Elimite................................................... T-17
ELITEK................................................. T-38
Ellence................................................... T-21
ELMIRON ............................................ T-43
Elocon ................................................... T-19
Eloxatin ................................................. T-22
ELOXATIN .......................................... T-21
ELSPAR................................................ T-21
EMCYT................................................. T-21
EMEND ................................................ T-12
EMLA ................................................... T-24
EMSAM................................................ T-24
EMTRIVA ............................................ T-26
enalapril maleate .................................. T-49
enalapril maleate and hydrochlorothiazide..
T-49
ENBREL ............................................... T-43
ENBREL SURECLICK........................ T-43
Enduron................................................. T-38
ENGERIX-B ......................................... T-55
ENTOCORT EC ..................................... T-1
Enulose.................................................... T-2
ENZYMAX........................................... T-35
epinephrine hydrochloride.................... T-53
EPIPEN 2-PAK..................................... T-53
EPIPEN-JR 2-PAK ............................... T-53
epirubicin hcl ........................................ T-21
EPIVIR.................................................. T-26
EPIVIR HBV ........................................ T-26
eplerenone............................................. T-49
EPOGEN............................................... T-41
I-9
fludrocortisone acetate ........................... T-1
Flumadine ............................................. T-25
FLUMADINE ....................................... T-25
flunisolide.............................................. T-17
fluocinolone acetonide .......................... T-19
fluocinonide........................................... T-19
fluoride prepartion................................ T-43
Fluoride Prepartion ............................... T-43
fluorometholone .................................... T-17
FLUOROPLEX..................................... T-52
fluorouracil ................................. T-21, T-52
fluoxetine hcl......................................... T-47
fluoxymesterone ...................................... T-4
fluphenazine decanoate......................... T-48
fluphenazine hydrochloride .................. T-48
flurbiprofen ............................................. T-2
flurbiprofen sodium............................... T-18
flutamide ............................................... T-21
fluticasone propionate ................ T-17, T-19
fluvoxamine maleate ............................. T-47
FML Liquifilm ...................................... T-17
fomepizole (4-methylpyrazole).............. T-43
FORADIL AEROLIZER ...................... T-53
Fortaz ...................................................... T-6
FORTAZ ................................................. T-6
FORTEO ............................................... T-45
FORTICAL ........................................... T-45
Fosamax ................................................ T-42
FOSAMAX ........................................... T-43
FOSAMAX PLUS D ............................ T-43
foscarnet sodium ................................... T-26
Foscavir................................................. T-26
fosinopril sodium .................................. T-49
fosinopril sodium and hydrochlorothiazide ..
T-49
fosphenytoin sodium.............................. T-10
FRAGMIN ............................................ T-25
FREAMINE HBC 6.9%........................ T-31
FREAMINE III 3%............................... T-31
FURADANTIN..................................... T-54
furosemide............................................. T-37
FUZEON............................................... T-26
gabapentin............................................... T-9
GABITRIL.............................................. T-9
galantamine hydrobromide................... T-45
GAMASTAN S/D................................. T-51
EURAX................................................. T-17
EVISTA ................................................ T-39
EVOXAC.............................................. T-45
EXELDERM......................................... T-16
EXELON............................................... T-45
EXFORGE ............................................ T-28
EXFORGE HCT ................................... T-48
EXJADE ............................................... T-40
FABRAZYME...................................... T-38
famciclovir ............................................ T-27
famotidine ............................................. T-25
famotidine and sodium chloride............ T-25
Famvir ................................................... T-27
FANSIDAR........................................... T-24
FARESTON.......................................... T-21
FASLODEX.......................................... T-21
FAZACLO ............................................ T-48
FELBATOL ............................................ T-9
Feldene.................................................... T-2
felodipine............................................... T-28
FEMARA.............................................. T-21
fenofibrate ............................................. T-19
fenoprofen calcium.................................. T-2
fentanyl.................................................... T-3
fentanyl citrate ........................................ T-3
FENTORA .............................................. T-3
fexofenadine hydrochloride .................. T-51
finasteride ............................................. T-43
Fioricet/codeine....................................... T-2
Fiorinal/codeine #3 ................................. T-3
Flagyl .................................................... T-24
Flagyl IV ............................................... T-24
flavoxate hydrochloride ........................ T-40
FLEBOGAMMA .................................. T-51
flecainide acetate .................................. T-32
Flexeril .................................................. T-52
FLOMAX.............................................. T-43
Flonase .................................................. T-17
Florinef.................................................... T-1
FLOVENT DISKUS............................... T-1
FLOVENT HFA ..................................... T-1
Floxin ...................................................... T-8
fluconazole ............................................ T-13
fluconazole and sodium chloride .......... T-13
Fludara .................................................. T-21
fludarabine phosphate .......................... T-21
I-10
Haldol.................................................... T-48
HALDOL .............................................. T-48
Haldol Decanoate.................................. T-48
HALDOL DECANOATE-100 ............. T-48
HALDOL DECANOATE-50 ............... T-48
halobetasol propionate ......................... T-19
haloperidol............................................ T-48
haloperidol decanoate .......................... T-48
haloperidol lactate ................................ T-48
Haloperidol Lactate............................... T-48
Halotestin ................................................ T-4
HAVRIX ............................................... T-55
HECTOROL ......................................... T-56
heparin sodium (porcine)...................... T-25
heparin sodium (porcine) and sodium
chloride ............................................. T-25
Heparin Sodium porcine ....................... T-25
Heparin Sodium porcine and Sodium
Chloride............................................. T-25
HEPATASOL ....................................... T-31
HEPSERA............................................. T-27
HERCEPTIN......................................... T-21
HEXALEN............................................ T-21
HIBTITER ............................................ T-55
Hiprex ................................................... T-54
HUMALOG .......................................... T-10
HUMALOG KWIKPEN....................... T-11
HUMALOG MIX 50/50 ....................... T-11
HUMALOG MIX 50/50 KWIKPEN.... T-11
HUMALOG MIX 50/50 PEN............... T-11
HUMALOG MIX 75/25 ....................... T-11
HUMALOG MIX 75/25 KWIKPEN.... T-11
HUMALOG MIX 75/25 PEN............... T-11
HUMALOG PEN.................................. T-11
Humatin................................................. T-24
HUMATROPE...................................... T-45
HUMATROPE COMBO PACK .......... T-45
HUMIRA .............................................. T-43
HUMIRA PEN...................................... T-43
HUMIRA PEN-CROHNS DISEASE... T-43
HUMULIN 50/50.................................. T-11
HUMULIN 70/30.................................. T-11
HUMULIN 70/30 PEN ......................... T-11
HUMULIN N........................................ T-11
HUMULIN N U-100 PEN .................... T-11
HUMULIN R ........................................ T-11
GAMMAGARD LIQUID..................... T-51
GAMUNEX .......................................... T-52
ganciclovir ............................................ T-27
GANTRISIN PEDIATRIC ..................... T-8
Garamycin..................................... T-5, T-15
GARDASIL .......................................... T-55
GASTROCROM................................... T-18
gemfibrozil ............................................ T-19
GEMZAR.............................................. T-21
GENOTROPIN ..................................... T-45
GENOTROPIN MINIQUICK .............. T-45
gentamicin sulfate .............. T-5, T-15, T-16
Gentamicin Sulfate................................ T-16
gentamicin sulfate and sodium chloride . T-5
Gentamicin Sulfate and Sodium Chloride ....
T-5
GEODON.............................................. T-48
GLEEVEC ............................................ T-21
glimepiride ............................................ T-12
glipizide................................................. T-12
glipizide and metformin hydrochloride. T-12
GLUCAGEN HYPOKIT ...................... T-14
GLUCAGON EMERGENCY KIT....... T-14
Glucophage ........................................... T-10
Glucotrol ............................................... T-12
Glucovance ........................................... T-12
glyburide ............................................... T-12
glyburide and metformin hydrochloride .......
T-12
glycerin and phospholipids and soybean oil.
T-31
glycopyrrolate ......................................... T-9
GLYSET ............................................... T-10
gonadotropin, chorionic ....................... T-40
gramicidin and neomycin sulfate and
granisetron hcl ...................................... T-12
Grifulvin V............................................ T-13
griseofulvin ........................................... T-13
GRIS-PEG............................................. T-13
guanabenz acetate................................. T-41
guanfacine hcl....................................... T-41
guanidine hydrochloride....................... T-45
Guanidine Hydrochloride...................... T-45
GYNAZOLE-1 ..................................... T-16
GYNODIOL ......................................... T-39
I-11
Imitrex................................................... T-20
IMITREX.............................................. T-19
IMITREX STATDOSE REFILL.......... T-20
IMITREX STATDOSE SYSTEM........ T-20
Imodium................................................ T-12
IMOVAX RABIES H.D.C.V. .............. T-55
Imuran ................................................... T-43
INCRELEX........................................... T-53
indapamide............................................ T-38
Inderal LA............................................. T-28
Inderide ................................................. T-28
Indocin .................................................... T-2
indomethacin........................................... T-2
INFANRIX ........................................... T-54
INFERGEN........................................... T-26
INNOHEP ............................................. T-25
Inspra..................................................... T-49
INTAL INHALER ................................ T-18
INTELENCE......................................... T-26
Intralipid................................................ T-31
INTRALIPID ........................................ T-31
INTRON-A ........................................... T-26
INTRON-A W/DILUENT .................... T-26
INVANZ ................................................. T-7
INVEGA ............................................... T-48
INVERSINE ......................................... T-41
INVIRASE............................................ T-26
IONOSOL-B/DEXTROSE 5%............. T-50
IONOSOL-MB/DEXTROSE 5% ......... T-50
IONOSOL-T/DEXTROSE 5%............. T-50
Iopidine ................................................. T-38
IPLEX ................................................... T-53
IPOL INACTIVATED IPV .................. T-55
ipratropium bromide............................. T-38
IRESSA................................................. T-22
irinotecan hydrochloride ...................... T-22
ISENTRESS.......................................... T-26
ISMO..................................................... T-56
ISOCHRON .......................................... T-56
ISOLYTE-H/DEXTROSE 5% ............. T-50
ISOLYTE-P/DEXTROSE 5% .............. T-50
ISOLYTE-S .......................................... T-50
ISOLYTE-S PH 7.4 .............................. T-50
ISOLYTE-S/DEXTROSE 5% .............. T-50
isoniazid ................................................ T-20
isoniazid and rifampin .......................... T-20
HUMULIN R U-500 CONCENTRATED....
T-11
HYCAMTIN ......................................... T-21
hydralazine hydrochloride .................... T-41
Hydrea................................................... T-21
hydrochlorothiazide .............................. T-38
hydrochlorothiazide and lisinopril ....... T-49
hydrochlorothiazide and metoprolol tartrate
T-28
hydrochlorothiazide and moexipril
hydrochloride.................................... T-49
hydrochlorothiazide and propranolol
hydrochloride.................................... T-28
hydrochlorothiazide and quinapril hcl . T-49
hydrochlorothiazide and spironolactone ......
T-49
hydrochlorothiazide and triamterene ... T-38
hydrocodone bitartrate and ibuprofen.... T-3
hydrocortisone .............................. T-1, T-19
hydrocortisone acetate and urea
(carbamide)....................................... T-19
hydrocortisone and neomycin sulfate and
hydrocortisone butyrate ........................ T-19
hydrocortisone sodium succinate............ T-1
hydrocortisone valerate ........................ T-19
hydromorphone hydrochloride ............... T-3
hydroxychloroquine sulfate................... T-24
hydroxyurea .......................................... T-21
hydroxyzine hydrochloride.................... T-27
hydroxyzine pamoate ............................ T-27
Hygroton ............................................... T-38
Hytone................................................... T-19
Hytrin ...................................................... T-1
HYZAAR.............................................. T-48
ibuprofen ................................................. T-2
ibuprofen and oxycodone hydrochloride T-3
Idamycin ............................................... T-21
idarubicin hcl ........................................ T-21
Ifex ........................................................ T-21
Ifex/mesnex Combo Pack ..................... T-21
ifosfamide.............................................. T-21
ifosfamide and mesna............................ T-21
Imdur..................................................... T-56
imipramine hydrochloride .................... T-47
imipramine pamoate ............................. T-47
I-12
lactulose .................................................. T-2
Lamictal .................................................. T-9
LAMICTAL STARTER/NOT TAKING
CARBAMAZEPINE........................... T-9
LAMICTAL STARTER/TAKING
CARBAMAZEPINE/NOT TAKING
VALPROATE..................................... T-9
LAMICTAL STARTER/TAKING
VALPROATE..................................... T-9
Lamisil .................................................. T-13
LAMISIL .............................................. T-16
lamotrigine.............................................. T-9
Lanoxin ................................................. T-33
LANOXIN ............................................ T-33
LANTUS............................................... T-11
LANTUS FOR OPTICLIK................... T-11
LANTUS SOLOSTAR ......................... T-11
LAPASE ............................................... T-35
Lariam ................................................... T-24
Lasix...................................................... T-37
leflunomide............................................ T-43
LETAIRIS............................................. T-56
leucovorin calcium................................ T-43
Leucovorin Calcium.............................. T-43
LEUKERAN ......................................... T-22
LEUKINE ............................................. T-41
leuprolide acetate.................................. T-22
Leustatin................................................ T-21
LEVAQUIN............................................ T-8
LEVAQUIN LEVA-PAK....................... T-8
LEVAQUIN PREMIX............................ T-8
LEVEMIR............................................. T-11
LEVEMIR FLEXPEN .......................... T-11
levetiracetam......................................... T-10
levobunolol hydrochloride .................... T-14
levocarnitine ......................................... T-43
Levo-dromoran ....................................... T-3
LEVO-DROMORAN ............................. T-3
levonorgestrel ....................................... T-34
levorphanol tartrate ................................ T-3
levothyroxine sodium ............................ T-54
LEXAPRO ............................................ T-47
LEXIVA................................................ T-26
Lidex ..................................................... T-19
lidocaine and prilocaine ....................... T-24
lidocaine hydrochloride ... T-24, T-32, T-42
Isordil .................................................... T-56
isosorbide dinitrate ............................... T-56
isosorbide mononitrate ......................... T-56
isotretinoin ............................................ T-52
isradipine .............................................. T-28
ISTALOL.............................................. T-14
itraconazole........................................... T-13
IVEEGAM EN...................................... T-52
IXEMPRA KIT..................................... T-22
JANUMET............................................ T-10
JANUVIA ............................................. T-10
JE-VAX................................................. T-55
KADIAN................................................. T-3
KALETRA............................................ T-26
kanamycin sulfate.................................... T-5
Kanamycin Sulfate.................................. T-5
Kayexalate............................................. T-42
KCl 0.075%/D5W/NaCl 0.45%............ T-50
K-Dur .................................................... T-50
Keflex...................................................... T-6
KEMADRIN ......................................... T-23
Kenalog ................................................. T-19
KEPIVANCE........................................ T-33
Keppra................................................... T-10
KEPPRA ................................................. T-9
Kerlone.................................................. T-28
KETEK ................................................... T-7
ketoconazole................................ T-13, T-16
ketoprofen ............................................... T-2
ketorolac tromethamine .......................... T-2
ketotifen fumarate ................................... T-5
KINERET ............................................. T-43
Klaron ................................................... T-17
KLOTRIX ............................................. T-50
K-TABS ................................................ T-50
Kuric ..................................................... T-16
KURIC .................................................. T-16
KUVAN ................................................ T-43
KU-ZYME HP ...................................... T-35
Kytril ..................................................... T-12
labetalol hydrochloride......................... T-28
Lac-hydrin............................................. T-38
LACRISERT......................................... T-38
LACTATED RINGER'S IRRIGATION ......
T-42
lactic acid.............................................. T-38
I-13
Lotrisone ............................................... T-16
LOTRONEX ......................................... T-40
lovastatin............................................... T-19
LOVAZA .............................................. T-19
LOVENOX ........................................... T-25
loxapine succinate................................. T-48
Loxitane ................................................ T-48
Lozol ..................................................... T-38
Ludiomil................................................ T-47
LUNESTA ............................................ T-27
Lupron................................................... T-22
LUPRON DEPOT................................. T-22
LUPRON DEPOT-PED........................ T-22
Luvox .................................................... T-47
LUVOX CR .......................................... T-47
LYRICA................................................ T-10
LYSODREN ......................................... T-22
Macrobid ............................................... T-55
Macrodantin .......................................... T-55
magnesium sulfate, heptahydrate.......... T-10
Magnesium Sulfate, Heptahydrate........ T-10
MALARONE........................................ T-24
maprotiline hydrochloride .................... T-47
Marinol.................................................. T-12
MARPLAN ........................................... T-47
MATULANE ........................................ T-22
Mavik .................................................... T-49
MAXALT ............................................. T-20
MAXALT-MLT.................................... T-20
Maxipime ................................................ T-6
MAXIPIME ............................................ T-6
Maxitrol................................................. T-15
mebendazole............................................ T-5
meclizine hydrochloride........................ T-13
meclofenamate sodium............................ T-2
Meclomen ............................................... T-2
Medrol..................................................... T-1
medroxyprogesterone acetate ............... T-46
mefloquine hcl....................................... T-24
Mefoxin................................................... T-7
MEFOXIN .............................................. T-7
MEFOXIN ADD-VANTAGE ................ T-7
Megace.................................................. T-22
MEGACE ES ........................................ T-22
megestrol acetate .................................. T-22
Mellaril.................................................. T-48
Lidocaine Hydrochloride ...................... T-32
LIDODERM ......................................... T-24
Limbitrol ............................................... T-46
lindane................................................... T-17
Lindane ................................................. T-17
Lioresal ................................................. T-52
liothyronine sodium .............................. T-54
LIPITOR ............................................... T-19
LIPRAM 4500 ...................................... T-35
LIPRAM-PN10 ..................................... T-35
LIPRAM-PN16 ..................................... T-35
LIPRAM-PN20 ..................................... T-35
LIPRAM-UL12..................................... T-36
LIPRAM-UL18..................................... T-36
LIPRAM-UL20..................................... T-36
lisinopril................................................ T-49
lithium carbonate .................................. T-19
lithium citrate........................................ T-19
Lithium Citrate...................................... T-19
Lithobid................................................. T-19
LITHOSTAT........................................... T-2
Locoid ................................................... T-19
Lodine ..................................................... T-2
LODOSYN ........................................... T-23
Loestrin 1/20-21.................................... T-34
Loestrin Fe 1/20 .................................... T-34
Lofibra................................................... T-19
Lomotil.................................................. T-12
Loniten .................................................. T-41
loperamide hydrochloride..................... T-12
Lopid ..................................................... T-19
Lopressor............................................... T-28
Lopressor HCT...................................... T-28
Loprox................................................... T-16
LOPROX SHAMPOO .......................... T-17
loratadine.............................................. T-51
loratadine and pseudoephedrine
hydrochloride.................................... T-51
loratadine and pseudoephedrine sulfate.......
T-51
LORTAB 2.5........................................... T-3
LOTEMAX ........................................... T-17
Lotensin................................................. T-48
Lotensin HCT........................................ T-48
Lotrel..................................................... T-28
LOTREL ............................................... T-28
I-14
metronidazole and sodium chloride...... T-24
Mevacor ................................................ T-19
mexiletine hydrochloride ...................... T-32
Mexitil................................................... T-32
Miacalcin............................................... T-45
MIACALCIN........................................ T-45
miconazole nitrate................................. T-17
Micronase.............................................. T-12
Microzide .............................................. T-38
Midamor................................................ T-38
midodrine hcl ........................................ T-53
MIGRANAL ......................................... T-53
Millipred ................................................. T-1
Miltown................................................. T-27
Minipress................................................. T-1
Minocin ................................................... T-9
minocycline hydrochloride...................... T-9
minoxidil ............................................... T-41
Miralax.................................................. T-33
MIRAPEX............................................. T-24
mirtazapine ........................................... T-47
misoprostol............................................ T-25
mitomycin c ........................................... T-22
mitoxantrone hydrochloride.................. T-22
M-M-R II W/DILUENT 10 DOS ......... T-55
MOBAN................................................ T-48
Mobic ...................................................... T-2
Moduretic 5-50...................................... T-38
moexipril hydrochloride........................ T-49
mometasone furoate .............................. T-19
Monistat 3 ............................................. T-17
Monopril ............................................... T-49
Monopril HCT ...................................... T-49
MONUROL .......................................... T-54
morphine sulfate...................................... T-3
MOTOFEN ........................................... T-12
Motrin ..................................................... T-2
MS Contin............................................... T-3
Mucomyst ............................................. T-44
mupirocin .............................................. T-16
MUSTARGEN...................................... T-22
Mutamycin ............................................ T-22
Myambutol............................................ T-20
Mycelex................................................. T-16
MYCOBUTIN ...................................... T-20
Mycolog-II ............................................ T-17
meloxicam ............................................... T-2
MENACTRA ........................................ T-55
MENOMUNE-A/C/Y/W-135............... T-55
meperidine hydrochloride....................... T-3
meprobamate......................................... T-27
MEPRON.............................................. T-24
mercaptopurine ..................................... T-22
MERREM ............................................... T-7
MERUVAX II W/DILUENT 10 DOSE .......
T-55
mesalamine (5-asa)............................... T-18
mesna .................................................... T-43
Mesnex.................................................. T-43
MESNEX .............................................. T-43
Mestinon ............................................... T-45
MESTINON.......................................... T-45
MESTINON TIMESPAN..................... T-45
mestranol and norethindrone................ T-34
METADATE ER .................................... T-5
Metaglip ................................................ T-12
metaproterenol sulfate .......................... T-53
metformin hydrochloride ...................... T-10
methadone hydrochloride ....................... T-3
methazolamide ...................................... T-14
methenamine hippurate......................... T-54
METHERGINE..................................... T-45
methimazole .......................................... T-53
METHITEST .......................................... T-4
methocarbamol ..................................... T-52
methotrexate.......................................... T-22
Methotrexate ......................................... T-22
methotrexate sodium ............................. T-22
methscopolamine bromide ...................... T-9
methyclothiazide ................................... T-38
methylphenidate hydrochloride .............. T-5
methylprednisolone ................................. T-1
methylprednisolone acetate .................... T-1
methylprednisolone sodium succinate .... T-1
metipranolol.......................................... T-14
metoclopramide hydrochloride............. T-46
metolazone ............................................ T-38
metoprolol succinate............................. T-28
metoprolol tartrate................................ T-28
METRO IV ........................................... T-24
Metrogel................................................ T-17
metronidazole................... T-16, T-17, T-24
I-15
NEULASTA ......................................... T-41
NEUMEGA........................................... T-43
NEUPOGEN ......................................... T-41
Neurontin ................................................ T-9
NEURONTIN ....................................... T-10
NEUTREXIN........................................ T-24
NEVANAC ........................................... T-18
NEXAVAR ........................................... T-22
niacin..................................................... T-19
Niacin.................................................... T-19
NIASPAN ............................................. T-19
nicardipine hcl ...................................... T-28
NICOTROL INHALER........................ T-27
NICOTROL NS .................................... T-27
nifedipine............................................... T-28
NILANDRON....................................... T-22
nimodipine............................................. T-28
Nimotop ................................................ T-28
Nipent.................................................... T-22
nisoldipine............................................. T-29
Nitro-dur ............................................... T-56
nitrofurantoin macrocrystalline............ T-55
nitrofurantoin monohydrate macrocrystals ..
T-55
nitroglycerin.......................................... T-56
NITROLINGUAL PUMPSPRAY........ T-56
NITROSTAT ........................................ T-56
nizatidine............................................... T-25
Nizoral................................................... T-13
Nolvadex ............................................... T-22
NORDITROPIN CARTRIDGE............ T-46
NORDITROPIN NORDIFLEX PEN ... T-46
norethindrone........................................ T-34
norethindrone acetate ........................... T-46
Norinyl 1+50......................................... T-34
NORMOSOL -R ................................... T-50
NORMOSOL-M IN D5W .................... T-50
NORMOSOL-R .................................... T-50
Norpace ................................................. T-32
Norpramin ............................................. T-47
Nor-qd ................................................... T-34
NOR-QD ............................................... T-34
nortriptyline hydrochloride................... T-47
Norvasc ................................................. T-28
NORVIR ............................................... T-26
Novantrone............................................ T-22
mycophenolate mofetil .......................... T-43
Mycostatin................................... T-13, T-17
MYDRAL ............................................. T-44
Mydriacyl.............................................. T-44
MYFORTIC.......................................... T-43
MYLOTARG........................................ T-22
MYOBLOC........................................... T-43
MYOZYME.......................................... T-38
Mysoline ............................................... T-10
MYTELASE ......................................... T-45
nabumetone ............................................. T-2
nadolol .................................................. T-28
nafcillin sodium....................................... T-8
NAFTIN................................................ T-17
NAFTIN-MP......................................... T-17
NAGLAZYME ..................................... T-38
nalbuphine hydrochloride....................... T-4
Nalfon ..................................................... T-2
naloxone hydrochloride ........................ T-44
naltrexone hydrochloride...................... T-44
NAMENDA .......................................... T-33
NAMENDA TITRATION PAK........... T-33
naphazoline hydrochloride ................... T-56
Naprosyn ................................................. T-2
naproxen ................................................. T-2
naproxen sodium..................................... T-2
Narcan ................................................... T-44
NARDIL ............................................... T-47
NARVOX ............................................... T-3
Nasarel .................................................. T-17
NASONEX ........................................... T-17
NATACYN ........................................... T-16
Navane .................................................. T-48
NAVANE.............................................. T-48
Navelbine .............................................. T-23
Nebcin ..................................................... T-5
nefazodone hydrochloride..................... T-47
neomycin sulfate...................................... T-5
Neomycin Sulfate.................................... T-5
neomycin sulfate and polymyxin b sulfate ....
T-16
Neoral.................................................... T-43
Neosporin.............................................. T-15
Neosporin Gu Irrigant ........................... T-16
NEPHRAMINE .................................... T-31
Neptazane.............................................. T-14
I-16
ORAMORPH SR .................................... T-3
ORAP.................................................... T-48
ORENCIA............................................. T-43
ORFADIN............................................. T-43
Orinase .................................................. T-12
ORTHO EVRA..................................... T-34
Ortho Tri-cyclen.................................... T-34
Ortho-cept-28........................................ T-33
ORTHOCLONE OKT3 ........................ T-43
ORTHO-EST ........................................ T-39
Orudis...................................................... T-2
OTICIN HC .......................................... T-15
Ovcon-35/28 ......................................... T-34
OVIDE .................................................. T-17
Ovral ..................................................... T-34
oxacillin sodium ...................................... T-8
Oxacillin Sodium .................................... T-8
oxaliplatin ............................................. T-22
Oxandrin ................................................. T-4
oxandrolone ............................................ T-4
oxaprozin................................................. T-2
oxcarbazepine ....................................... T-10
OXSORALEN ULTRA ........................ T-34
oxybutynin chloride............................... T-40
oxycodone hydrochloride........................ T-3
Oxycodone Hydrochloride...................... T-3
OXYCONTIN......................................... T-3
paclitaxel............................................... T-22
PALCAPS 10 ........................................ T-36
PALCAPS 20 ........................................ T-36
Pamelor ................................................. T-47
pamidronate disodium .......................... T-44
Pamine..................................................... T-9
PANCREASE MT 4 ............................. T-36
PANCRECARB MS-16........................ T-36
PANCRECARB MS-4.......................... T-36
PANCRECARB MS-8.......................... T-36
PANCRELIPASE ................................. T-36
PANCRELIPASE MST-16................... T-36
PANCRON 10 ...................................... T-36
PANCRON 20 ...................................... T-36
PANGESTYME CN 10 ........................ T-36
PANGESTYME CN 20 ........................ T-36
PANGESTYME EC.............................. T-37
PANGESTYME MT 16........................ T-37
PANGESTYME UL 12 ........................ T-37
Novarel.................................................. T-40
NOVOLIN 70/30 .................................. T-11
NOVOLIN 70/30 INNOLET................ T-11
NOVOLIN 70/30 PENFILL ................. T-11
NOVOLIN N ........................................ T-11
NOVOLIN N INNOLET ...................... T-11
NOVOLIN N U-100 PENFILL ............ T-11
NOVOLIN R......................................... T-11
NOVOLIN R INNOLET ...................... T-11
NOVOLIN R U-100 PENFILL ............ T-11
NOVOLOG........................................... T-11
NOVOLOG FLEXPEN ........................ T-11
NOVOLOG MIX 70/30........................ T-11
NOVOLOG MIX 70/30 PENFILL....... T-11
NOVOLOG MIX 70/30 PREFILLED
FLEXPEN ......................................... T-11
NOVOLOG PENFILL.......................... T-11
NOXAFIL ............................................. T-13
Nubain..................................................... T-4
Nulytely................................................. T-33
NUTROPIN .......................................... T-46
NUTROPIN AQ.................................... T-46
NUTROPIN AQ PEN ........................... T-46
NUVARING ......................................... T-34
Nydrazid................................................ T-20
nystatin........................................ T-13, T-17
nystatin and triamcinolone acetonide... T-17
OCTAGAM .......................................... T-52
octreotide acetate.................................. T-43
Ocufen................................................... T-18
Ocuflox ................................................. T-15
Ocupress................................................ T-38
OCUSULF-10 ....................................... T-15
ofloxacin........................................ T-8, T-15
Ogen...................................................... T-39
Olux....................................................... T-18
omeprazole............................................ T-25
Omnicef................................................... T-6
OMNITROPE ....................................... T-46
ONCASPAR ......................................... T-22
Oncovin................................................. T-23
ondansetron........................................... T-12
ondansetron hcl..................................... T-12
ONTAK................................................. T-22
Ophthetic............................................... T-42
Optipranolol .......................................... T-14
I-17
p-ephed sul/loratadine .......................... T-51
Percocet................................................... T-2
Percodan.................................................. T-3
Periactin ................................................ T-39
Peridex .................................................. T-16
Periostat................................................. T-15
PERLOXX .............................................. T-4
permethrin............................................. T-17
perphenazine ......................................... T-48
Persantine.............................................. T-56
Phenergan.............................................. T-40
phenylephrine hydrochloride and
promethazine hydrochloride ............. T-40
Phenylephrine Hydrochloride and
Promethazine Hydrochloride ............ T-40
PHENYTEK ......................................... T-10
phenytoin............................................... T-10
phenytoin sodium .................................. T-10
Phoslo.................................................... T-41
PHOSPHOLINE IODIDE .................... T-14
PHOTOFRIN ........................................ T-22
PHYSIOLYTE...................................... T-42
pilocarpine hydrochloride .................... T-45
PILOPINE HS....................................... T-14
pindolol ................................................. T-28
piperacillin sodium ................................. T-8
Piperacillin Sodium................................. T-8
piroxicam ................................................ T-2
Plan B.................................................... T-34
PLAN B ................................................ T-34
Plaquenil ............................................... T-24
PLARETASE 8000............................... T-37
PLASMA-LYTE 56.............................. T-50
PLASMA-LYTE A............................... T-50
PLASMA-LYTE-148 ........................... T-50
PLASMA-LYTE-148/D5W.................. T-50
PLASMA-LYTE-56/D5W.................... T-50
Platinol AQ ........................................... T-21
PLAVIX................................................ T-25
Plendil ................................................... T-28
Pletal ..................................................... T-25
podofilox ............................................... T-52
Polycin B............................................... T-15
POLYCIN B.......................................... T-15
polyethylene glycol................................ T-33
PANGESTYME UL 18 ........................ T-37
PANGESTYME UL 20 ........................ T-37
PANGLOBULIN NF ............................ T-52
Panlor SS................................................. T-2
PANOCAPS.......................................... T-37
PANOCAPS MT 16.............................. T-37
PANOCAPS MT 20.............................. T-37
PANOKASE ......................................... T-37
PANOKASE-16.................................... T-37
PANRETIN........................................... T-52
pantoprazole sodium sesquihydrate...... T-25
Parafon Forte DSC................................ T-52
Paraplatin .............................................. T-20
Parcopa.................................................. T-23
Parlodel ................................................. T-24
Parnate................................................... T-47
paromomycin sulfate............................. T-24
paroxetine hydrochloride...................... T-47
PASER .................................................. T-20
PATADAY ............................................. T-5
PATANOL.............................................. T-5
Paxil ...................................................... T-47
Pediapred................................................. T-1
PEDIARIX............................................ T-55
Pediazole ................................................. T-7
PEDIOTIC ............................................ T-15
Pediox ................................................... T-39
PEDVAX HIB ...................................... T-55
PEGANONE ......................................... T-10
PEGASYS............................................. T-26
PEG-INTRON....................................... T-26
PEG-INTRON REDIPEN..................... T-26
PEG-INTRON REDIPEN PAK 4......... T-27
penicillin g potassium ............................. T-8
Penicillin G Potassium............................ T-8
penicillin g procaine ............................... T-8
Penicillin G Procaine .............................. T-8
penicillin g sodium.................................. T-8
Penicillin G Sodium................................ T-8
penicillin v potassium ............................. T-8
PENTASA............................................. T-18
pentostatin............................................. T-22
pentoxifylline......................................... T-41
Pepcid.................................................... T-25
Pepcid IV .............................................. T-25
p-ephed hcl/cetirizine hcl...................... T-51
I-18
Prenatal With Folic Acid Greater than .8mg
T-44
PREVACID........................................... T-25
PREVACID NAPRAPAC ...................... T-2
PREVACID SOLUTAB ....................... T-25
PREVPAC............................................. T-25
PREZISTA............................................ T-26
PRIFTIN ............................................... T-20
Prilosec.................................................. T-25
PRIMAQUINE PHOSPHATE ............. T-24
PRIMAXIN I.M...................................... T-7
PRIMAXIN IV........................................ T-7
PRIMAXIN IV ADD-VANTAGE ......... T-7
primidone .............................................. T-10
PRIMSOL ............................................. T-55
PRISTIQ ............................................... T-47
PROAIR HFA....................................... T-53
Proamatine ............................................ T-53
probenecid............................................. T-54
procainamide hydrochloride................. T-32
Procainamide Hydrochloride ................ T-32
PROCALAMINE.................................. T-31
PROCANBID ....................................... T-32
Procardia XL......................................... T-28
PROCHIEVE ........................................ T-46
prochlorperazine................................... T-13
prochlorperazine edisylate.................... T-13
prochlorperazine maleate ..................... T-13
PROCRIT.............................................. T-41
PROGLYCEM...................................... T-41
Prograf................................................... T-44
PROGRAF ............................................ T-44
PROLASTIN......................................... T-38
PROLEUKIN........................................ T-22
Prolixin.................................................. T-48
Prolixin Decanoate................................ T-48
Proloprim .............................................. T-55
PROMACTA ........................................ T-44
promethazine hydrochloride ................. T-40
PROMETRIUM.................................... T-46
PRONESTYL ....................................... T-32
PRONESTYL SR.................................. T-32
propafenone hcl .................................... T-32
proparacaine hydrochloride ................. T-42
Propine .................................................. T-44
propoxyphene hydrochloride .................. T-4
polyethylene glycol and potassium chloride
and sodium bicarbonate and sodium
chloride ............................................. T-33
polyethylene glycol and potassium chloride
and sodium bicarbonate and sodium
chloride and sodium sul .................... T-33
POLYGAM S/D.................................... T-52
polymyxin b sulfate ................................. T-5
Polymyxin B Sulfate ............................... T-5
polymyxin b sulfate and trimethoprim sulfate
T-15
POLY-PRED......................................... T-15
Polytrim................................................. T-15
potassium chloride ................................ T-50
potassium chloride and sodium chloride ......
T-51
Potassium Chloride and Sodium Chloride....
T-51
potassium citrate..................................... T-1
PRANDIMET ....................................... T-12
PRANDIN............................................. T-12
Pravachol............................................... T-19
pravastatin sodium................................ T-19
prazosin hydrochloride ........................... T-1
Precose .................................................. T-10
Pred Forte.............................................. T-17
prednicarbate........................................ T-19
Prednisol ............................................... T-17
prednisolone acetate ............................. T-17
prednisolone anhydrous.......................... T-1
prednisolone sodium phosphate.... T-1, T-17
prednisolone sodium phosphate and
sulfacetamide sodium........................ T-15
Prednisolone Sodium Phosphate and
Sulfacetamide Sodium ...................... T-15
prednisone............................................... T-1
Prednisone............................................... T-1
PREDNISONE INTENSOL ................... T-1
PREMARIN.......................................... T-39
PREMARIN W/APPLICATOR ........... T-39
PREMASOL ......................................... T-31
PREMPHASE ....................................... T-39
PREMPRO............................................ T-39
prenatal with folic acid (greater than .8mg).
T-44
I-19
RELION 70/30...................................... T-11
RELION 70/30 INNOLET ................... T-11
RELION N ............................................ T-11
RELION N INNOLET.......................... T-11
RELION R ............................................ T-12
RELISTOR ........................................... T-40
Remeron................................................ T-47
REMICADE.......................................... T-44
REMODULIN....................................... T-56
RENAGEL............................................ T-41
RENAMIN............................................ T-31
RENVELA............................................ T-41
Requip ................................................... T-24
RESCRIPTOR ...................................... T-26
reserpine ............................................... T-41
RESTASIS ............................................ T-17
Retin-A.................................................. T-33
Retrovir ................................................. T-26
RETROVIR IV INFUSION.................. T-26
REVATIO ............................................. T-56
Revia ..................................................... T-44
REVLIMID ........................................... T-44
REYATAZ............................................ T-26
Rheumatrex ........................................... T-22
RHEUMATREX................................... T-22
RIBATAB ............................................. T-27
ribavirin ................................................ T-27
RIDAURA ............................................ T-40
Rifadin................................................... T-20
Rifamate................................................ T-20
rifampin................................................. T-20
RIFATER.............................................. T-20
RILUTEK ............................................. T-33
rimantadine hydrochloride ................... T-25
Risperdal ............................................... T-48
RISPERDAL CONSTA........................ T-48
RISPERDAL M-TAB........................... T-48
risperidone ............................................ T-48
Ritalin...................................................... T-5
RITUXAN............................................. T-22
Robaxin ................................................. T-52
Robinul.................................................... T-9
Rocaltrol................................................ T-56
Rocephin ................................................. T-6
ROCEPHIN IN ISO-OSMOTIC
DEXTROSE........................................ T-6
propranolol hydrochloride.................... T-28
propylthiouracil .................................... T-54
Propylthiouracil..................................... T-54
PROQUAD ........................................... T-55
Proscar................................................... T-43
PROSOL ............................................... T-31
Protonix................................................. T-25
PROTONIX .......................................... T-25
PROTOPIC ........................................... T-52
protriptyline hydrochloride................... T-47
Proventil................................................ T-53
PROVENTIL HFA ............................... T-53
Provera .................................................. T-46
PROVIGIL.............................................. T-5
Prozac.................................................... T-47
PULMICORT FLEXHALER ................. T-1
Purinethol.............................................. T-22
PYLERA ................................................. T-5
pyrazinamide......................................... T-20
Pyrazinamide......................................... T-20
pyridostigmine bromide ........................ T-45
QUALAQUIN....................................... T-24
Questran ................................................ T-19
quinapril hcl.......................................... T-49
quinidine gluconate............................... T-32
Quinidine Gluconate ............................. T-32
quinidine sulfate.................................... T-32
Quinidine Sulfate .................................. T-32
QVAR ..................................................... T-1
RABAVERT ......................................... T-55
ramipril ................................................. T-49
RANEXA.............................................. T-33
ranitidine hydrochloride ....................... T-25
RAPAFLO ............................................ T-44
RAPAMUNE ........................................ T-44
RAPIFLUX ........................................... T-47
Razadyne............................................... T-45
REBETOL............................................. T-27
REBIF ................................................... T-44
REBIF TITRATION PACK ................. T-44
RECOMBIVAX HB ............................. T-55
Reglan ................................................... T-46
REGONOL ........................................... T-45
REGRANEX......................................... T-52
Relafen .................................................... T-2
RELENZA DISKHALER..................... T-27
I-20
Sodium Chloride and Tobramycin Sulfate ...
T-5
sodium lactate ......................................... T-1
Sodium Lactate ....................................... T-1
sodium polystyrene sulfonate................ T-42
SOLARAZE.......................................... T-52
SOLTAMOX ........................................ T-22
Solu-medrol............................................. T-1
SOLU-MEDROL.................................... T-1
SOLU-MEDROL ACT-O-VIAL............ T-1
Soma ..................................................... T-52
Soma Compound................................... T-52
Soma Compound/codeine ..................... T-52
SOMATULINE DEPOT....................... T-44
SOMAVERT......................................... T-53
Sonata.................................................... T-27
sotalol hydrochloride ............................ T-28
Spectazole ............................................. T-16
SPIRIVA HANDIHALER...................... T-9
spironolactone....................................... T-49
Sporanox ............................................... T-13
SPORANOX ......................................... T-13
SPRYCEL ............................................. T-22
Stadol ...................................................... T-4
STALEVO 100 ..................................... T-23
STALEVO 125 ..................................... T-23
STALEVO 150 ..................................... T-23
STALEVO 200 ..................................... T-23
STALEVO 50 ....................................... T-24
STALEVO 75 ....................................... T-24
STARLIX.............................................. T-12
stavudine ............................................... T-26
Stelazine................................................ T-48
STIMATE ............................................. T-46
STRATTERA ....................................... T-33
streptomycin sulfate ................................ T-5
Streptomycin Sulfate............................... T-5
STROMECTOL...................................... T-5
SUBOXONE........................................... T-4
SUBUTEX .............................................. T-4
SUCRAID ............................................. T-38
sucralfate............................................... T-25
Sular ...................................................... T-29
Sulfac .................................................... T-15
sulfacetamide sodium.................. T-15, T-17
sulfadiazine ............................................. T-8
ropinirole hydrochloride....................... T-24
ROTATEQ............................................ T-55
Rowasa.................................................. T-18
Roxicodone ............................................. T-3
Rythmol................................................. T-32
RYTHMOL SR..................................... T-32
SAIZEN ................................................ T-46
SAIZEN CLICK.EASY........................ T-46
Salagen.................................................. T-45
SANCUSO............................................ T-12
Sandostatin............................................ T-43
SANDOSTATIN LAR DEPOT............ T-44
SANTYL............................................... T-52
SAVELLA ............................................ T-47
SAVELLA TITRATION PACK .......... T-47
Seasonale............................................... T-34
Sectral ................................................... T-27
selegiline hcl ......................................... T-24
selenium sulfide..................................... T-17
Selsun Shampoo.................................... T-17
SELZENTRY........................................ T-26
SENSIPAR............................................ T-44
SEREVENT DISKUS........................... T-53
SEROMYCIN ....................................... T-20
SEROQUEL.......................................... T-48
SEROQUEL XR ................................... T-48
SEROSTIM........................................... T-46
Serpasil.................................................. T-41
sertraline hydrochloride ....................... T-47
Serzone.................................................. T-47
Silvadene............................................... T-17
silver sulfadiazine ................................. T-17
SIMPONI .............................................. T-44
SIMULECT........................................... T-44
simvastatin ............................................ T-19
Sinemet ................................................. T-23
Sinequan................................................ T-47
SINGULAIR ......................................... T-18
SKELAXIN........................................... T-52
sodium bicarbonate................................. T-1
Sodium Bicarbonate................................ T-1
sodium chloride........................... T-42, T-51
Sodium Chloride ................................... T-51
Sodium Chloride 0.9%.......................... T-42
sodium chloride and tobramycin sulfate. T-5
I-21
terbutaline sulfate ................................. T-53
terconazole............................................ T-17
testosterone cypionate............................. T-4
testosterone enanthate ............................ T-4
TESTRED ............................................... T-4
TETANUS TOXOID ADSORBED ..... T-54
TETANUS/DIPHTHERIA TOXOIDSADSORBED ADULT ...................... T-54
tetracycline hydrochloride ...................... T-9
Tetracycline Hydrochloride .................... T-9
TEV-TROPIN ....................................... T-46
THALOMID ......................................... T-44
THEOCHRON...................................... T-51
theophylline........................................... T-51
THERMAZENE ................................... T-17
THIOLA................................................ T-44
Thioplex ................................................ T-22
thioridazine hydrochloride.................... T-48
thiotepa ................................................. T-22
thiothixene............................................. T-48
Thorazine .............................................. T-47
THYMOGLOBULIN ........................... T-44
Ticlid ..................................................... T-25
ticlopidine hydrochloride...................... T-25
Tigan ..................................................... T-13
TIKOSYN ............................................. T-33
timolol maleate............................ T-14, T-28
Timoptic................................................ T-14
TIMOPTIC OCUDOSE........................ T-14
Tis-u-sol ................................................ T-42
TIS-U-SOL ........................................... T-42
TIS-U-SOL VIAFLEX ......................... T-42
tizanidine hydrochloride ....................... T-52
Tobradex ............................................... T-15
tobramycin sulfate......................... T-5, T-15
Tobrex ................................................... T-15
Tofranil ................................................. T-47
Tofranil-PM .......................................... T-47
tolazamide ............................................. T-12
tolbutamide ........................................... T-12
Tolectin ................................................... T-2
Tolinase................................................. T-12
tolmetin sodium....................................... T-2
Topamax ............................................... T-10
Topicort................................................. T-18
topiramate ............................................. T-10
Sulfadiazine............................................. T-8
sulfamethoxazole and trimethoprim........ T-8
sulfasalazine............................................ T-8
sulindac ................................................... T-2
sumatriptan succinate ........................... T-20
SUPRAX................................................. T-6
Surmontil............................................... T-47
SURMONTIL ....................................... T-47
SUSTIVA.............................................. T-26
SUTENT ............................................... T-22
SYMBICORT ......................................... T-1
SYMLIN ............................................... T-10
SYMLINPEN 120................................. T-10
SYMLINPEN 60................................... T-10
Symmetrel ............................................. T-23
SYNAGIS ............................................. T-27
Synalar .................................................. T-19
SYNAREL ............................................ T-40
SYNERCID............................................. T-5
Synthroid............................................... T-54
SYPRINE.............................................. T-40
TABLOID ............................................. T-22
tacrolimus ............................................. T-44
Tagamet................................................. T-25
Tambocor .............................................. T-32
TAMIFLU............................................. T-27
tamoxifen citrate ................................... T-22
Tapazole................................................ T-53
TARCEVA............................................ T-22
TARGRETIN.............................. T-22, T-52
TASIGNA ............................................. T-22
TASMAR.............................................. T-23
Tavist Allergy ....................................... T-39
Taxol ..................................................... T-22
TAXOTERE ......................................... T-22
TAZORAC............................................ T-53
Tegretol ................................................... T-9
TEGRETOL-XR ................................... T-10
TEKTURNA ......................................... T-49
TEKTURNA HCT ................................ T-49
Tenex..................................................... T-41
Tenoretic ............................................... T-27
Tenormin............................................... T-27
Terazol 3 ............................................... T-17
terazosin hcl ............................................ T-1
terbinafine hydrochloride ..................... T-13
I-22
Trileptal................................................. T-10
TRILEPTAL ......................................... T-10
trimethobenzamide hydrochloride ........ T-13
trimethoprim ......................................... T-55
trimipramine maleate............................ T-47
TRIMOX................................................. T-8
TRIPEDIA ............................................ T-54
TRISENOX........................................... T-23
TRIZIVIR ............................................. T-26
TROPHAMINE .................................... T-32
tropicamide ........................................... T-44
Trusopt .................................................. T-14
TRUVADA ........................................... T-26
TWINJECT ........................................... T-53
TWINRIX ............................................. T-55
TYGACIL ............................................... T-9
TYKERB............................................... T-23
Tylenol/codeine #3.................................. T-2
TYPHIM VI .......................................... T-55
TYSABRI ............................................. T-44
TYZEKA............................................... T-27
TYZINE ................................................ T-56
TYZINE PEDIATRIC NASAL DROPS ......
T-56
ULORIC................................................ T-44
ULTRACAPS MT 20 ........................... T-37
Ultracet.................................................... T-3
Ultram ..................................................... T-4
ULTRASE............................................. T-37
Ultravate................................................ T-19
Unasyn .................................................... T-7
Unipen..................................................... T-8
Uniphyl ................................................. T-51
Uniretic ................................................. T-49
UNITHROID ........................................ T-54
Univasc ................................................. T-49
Urecholine............................................. T-45
UREX.................................................... T-55
Urispas .................................................. T-40
Urocit-K .................................................. T-1
ursodiol ................................................. T-33
UVADEX.............................................. T-34
VALCYTE............................................ T-27
valproate sodium................................... T-10
valproic acid ......................................... T-10
VALTREX............................................ T-27
Toprol XL ............................................. T-28
TOPROL XL......................................... T-28
Toradol.................................................... T-2
TORISEL .............................................. T-22
torsemide............................................... T-37
Totect .................................................... T-43
TOVIAZ................................................ T-40
TRACLEER.......................................... T-56
tramadol hcl ............................................ T-4
Trandate ................................................ T-28
trandolapril ........................................... T-49
TRANSDERM-SCOP........................... T-12
tranylcypromine sulfate ........................ T-47
TRAVASOL ......................................... T-32
TRAVASOL 2.75%/DEXTROSE 10% T-31
TRAVASOL 2.75%/DEXTROSE 5%.. T-31
TRAVASOL 3.5%/ELECTROLYTES T-31
TRAVATAN......................................... T-14
TRAVATAN Z ..................................... T-14
trazodone hydrochloride....................... T-47
TREANDA ........................................... T-23
TRECATOR ......................................... T-20
TRELSTAR DEPOT ............................ T-23
TRELSTAR LA .................................... T-23
Trental ................................................... T-41
tretinoin....................................... T-23, T-33
TREXALL ............................................ T-23
TREXIMET .......................................... T-20
triamcinolone acetonide........................ T-19
Triavil.................................................... T-46
TRICOR................................................ T-19
TRIDERM............................................. T-19
trifluoperazine hydrochloride ............... T-48
trifluridine ............................................. T-16
trihexyphenidyl hydrochloride .............. T-23
TRIHIBIT ............................................. T-54
Trilafon ................................................. T-48
I-23
VISTIDE ............................................... T-27
Vivactil.................................................. T-47
VIVAGLOBIN ..................................... T-52
VIVELLE-DOT .................................... T-39
VIVOTIF BERNA ................................ T-55
Voltaren......................................... T-2, T-18
VOLTAREN ........................................... T-2
Vosol ..................................................... T-16
Vosol HC .............................................. T-16
warfarin sodium .................................... T-25
water, sterile ......................................... T-42
Water, Sterile ........................................ T-42
WELCHOL ........................................... T-19
Wellbutrin ............................................. T-46
Westcort ................................................ T-19
Wytensin ............................................... T-41
XALATAN ........................................... T-14
XOLAIR ............................................... T-51
Xylocaine .................................... T-24, T-42
Xylocaine Jelly...................................... T-42
XYREM ................................................ T-33
XYZAL ................................................. T-51
Yasmin 28 ............................................. T-34
YAZ ...................................................... T-34
YF-VAX ............................................... T-55
Zaditor..................................................... T-5
zaleplon ................................................. T-27
Zanaflex ................................................ T-52
ZANOSAR............................................ T-23
Zantac.................................................... T-25
Zarontin................................................. T-10
Zaroxolyn.............................................. T-38
ZAVESCA ............................................ T-44
Zebeta.................................................... T-28
ZELAPAR............................................. T-24
ZEMAIRA ............................................ T-38
ZENAPAX............................................ T-44
Zerit....................................................... T-26
Zestoretic............................................... T-49
Zestril .................................................... T-49
ZETIA ................................................... T-19
Ziac ....................................................... T-28
ZIAGEN................................................ T-26
zidovudine ............................................. T-26
Zinacef .................................................... T-6
Zithromax Z-pak ..................................... T-6
VANACET ............................................. T-4
VANCOCIN HCL .................................. T-5
vancomycin hydrochloride...................... T-6
Vancomycin Hydrochloride.................... T-6
Vandazole ............................................. T-16
VANDAZOLE...................................... T-16
VANTAS .............................................. T-23
Vantin...................................................... T-6
VAQTA................................................. T-55
VARIVAX ............................................ T-55
Vaseretic ............................................... T-49
Vasotec.................................................. T-49
VECTIBIX............................................ T-23
VECTICAL........................................... T-42
Veetids .................................................... T-8
VEETIDS................................................ T-8
VELCADE............................................ T-23
venlafaxine hcl ...................................... T-47
VENTOLIN HFA ................................. T-53
Vepesid ................................................. T-21
verapamil hydrochloride....................... T-28
Vermox ................................................... T-5
Vesanoid ............................................... T-23
VESICARE ........................................... T-40
VFEND ................................................. T-13
VFEND IV ............................................ T-13
Vibramycin ............................................. T-9
VIBRAMYCIN....................................... T-9
Vicodin ES .............................................. T-2
Vicoprofen .............................................. T-3
VIDAZA ............................................... T-23
VIDEX .................................................. T-26
Videx EC............................................... T-26
VIGAMOX ........................................... T-15
VIMPAT ............................................... T-10
vinblastine sulfate ................................. T-23
Vinblastine Sulfate................................ T-23
vincristine sulfate .................................. T-23
vinorelbine tartrate ............................... T-23
VIOKASE ............................................. T-37
VIRACEPT ........................................... T-26
VIRAMUNE ......................................... T-26
VIREAD ............................................... T-26
Viroptic ................................................. T-16
Visken ................................................... T-28
Vistaril................................................... T-27
I-24
ZMAX..................................................... T-7
Zocor ..................................................... T-19
Zofran.................................................... T-12
ZOLINZA ............................................. T-23
Zoloft..................................................... T-47
zolpidem tartrate................................... T-27
ZOMETA.............................................. T-44
Zonegran ............................................... T-10
zonisamide............................................. T-10
ZORBTIVE........................................... T-46
ZOSTAVAX ......................................... T-55
ZOSYN ................................................... T-8
Zovirax.................................................. T-27
ZOVIRAX............................................. T-17
ZYFLO CR ........................................... T-18
ZYLET.................................................. T-16
Zyloprim ............................................... T-42
ZYMAR ................................................ T-16
ZYPREXA ............................................ T-48
ZYPREXA ZYDIS ............................... T-48
Zyrtec Allergy....................................... T-51
Zyrtec-D................................................ T-51
Zyrtec-d Allergy/congesti ..................... T-51
ZYVOX................................................... T-6
I-25

CommuniCare Advantage - Community Health Group

Transcription

Documents pareils

CEDIA Opiate Cross Reactivity Guide, 300ng/mL

Entry List - IndyCar.com

WellCare Health Plan Kentucky Medicaid

NF-641: Preventive Medication List for Health Savings Account