Microsoft Word - UHEX18HM _010 MA Ind Formulary Comprehensive V38_CT.docx

Transcription

1 208 ( ) (UnitedHealthcare) Dual Complete (HMO SNP) Y0066_70602_259_FINAL_M38.09CT 208 0

2 (Extra Help) ( ) (QL)

3 ( ) (UnitedHealthcare) (UnitedHealthcare) Dual Complete 3

4 ( ) (FDA) (Humalog) (Simvastatin) () D

5 5 25% (Extra Help) (LIS )

6 6 32 / PA - QL - / ST -

7 7 B/D - B D B ( ) D ( ) LA - FDA MED - (MED) MED ( ) 8

8 () 24

9

10 0 (FDA) / 0-24 D (D EOB)

11 / ( )

12 2 ( ) A Abacavir Abacavir Sulfate/Lamivudine/ Zidovudine Abacavir/Lamivudine Abelcet Abilify Maintena Abraxane Abstral Acamprosate Calcium DR Acarbose... 6 Acebutolol HCl Acetaminophen/Codeine Acetazolamide Acetazolamide ER Acetazolamide Sodium Acetic Acid Acetylcysteine Acitretin Actemra... 9 ActHIB Actimmune... 9 Acyclovir Acyclovir Sodium Adacel Adagen Adapalene Adcirca Adefovir Dipivoxil Adempas Adriamycin Adrucil Advair Diskus Advair HFA Afeditab CR Afinitor Afinitor Disperz Ala-Cort Albenza Albuterol Sulfate Alclometasone Dipropionate Alcohol Prep Pads Aldurazyme Alecensa Alendronate Sodium Alfuzosin HCl ER... 8 Alimta Alinia Aliqopa Allopurinol Alocril Alomide Alosetron HCl Aloxi Alphagan P Alprazolam... 6 Altavera Alunbrig Alyacen / Amantadine HCl AmBisome Amethia Amethia Lo Amikacin Sulfate Amiloride HCl Amiloride/Hydrochlorothiazide Aminophylline Aminosyn 7%/Electrolytes Aminosyn 8.5%/Electrolytes Aminosyn II Aminosyn II 8.5%/Electrolytes Aminosyn-HBC Aminosyn-PF Aminosyn-RF Amiodarone HCl Amitiza Amitriptyline HCl Amlodipine Besylate Amlodipine Besylate/ Atorvastatin Calcium Amlodipine Besylate/ Benazepril HCl Amlodipine Besylate/Valsartan Amlodipine/Olmesartan Medoxomil Amlodipine/Valsartan/ Hydrochlorothiazide Ammonium Lactate Amoxapine Amoxicillin Amoxicillin/Clavulanate Potassium Amoxicillin/Clavulanate Potassium ER Amphetamine/ Dextroamphetamine... 7, 72 Amphotericin B... 47

13 Ampicillin Ampicillin Sodium Ampicillin-Sulbactam Ampyra Anadrol Anagrelide HCl Anastrozole Androderm AndroGel AndroGel Pump Anoro Ellipta Anzemet Apokyn Apraclonidine Aprepitant Apri Apriso Aptiom Aptivus Aralast NP Aranelle Aranesp Albumin Free Arcalyst... 9 Argatroban Aripiprazole Aripiprazole ODT Aristada Arnuity Ellipta Arranon Ashlyna Aspirin/Dipyridamole Atazanavir Sulfate Atenolol Atenolol/Chlorthalidone Atgam... 9 Atomoxetine Atorvastatin Calcium Atovaquone Atovaquone/Proguanil HCl Atripla Atropine Sulfate... 78, 94 Atrovent HFA Aubagio Aubra Augmented Betamethasone Dipropionate Avandia... 6 Avastin Aviane Avonex Avonex Pen Azacitidine Azactam Azasite Azathioprine Azelastine HCl... 95, 97 Azilect Azithromycin Azopt Aztreonam B BACiiM Bacitracin Bacitracin/Polymyxin B Baclofen Bactocill in Dextrose Bactroban Nasal Balsalazide Disodium Balziva Banzel Baraclude Bavencio BCG Vaccine Bekyree Beleodaq Belsomra Benazepril HCl Benazepril HCl/ Hydrochlorothiazide Benlysta... 9 Benznidazole Benztropine Mesylate Bepreve Berinert Besivance Betamethasone Dipropionate Betamethasone Valerate Betaseron Betaxolol HCl... 66, 95 Bethanechol Chloride... 8 Bethkis Betimol Bevespi Aerosphere Bexarotene Bexsero Bicalutamide Bicillin C-R Bicillin L-A BiCNU BiDil Biktarvy... 59

14 4 Biltricide Binosto Bisoprolol Fumarate Bisoprolol Fumarate/ Hydrochlorothiazide BIVIGAM... 9 Bleomycin Sulfate Blephamide Blephamide S.O.P Blisovi 24 Fe Blisovi Fe.5/ Blisovi Fe / Boostrix Bortezomib Bosulif Botox Breo Ellipta Briellyn Brilinta Brimonidine Tartrate Briviact Bromocriptine Mesylate Brovana Budesonide... 93, 97 Budesonide ER Bumetanide Buphenyl Buprenorphine HCl Buprenorphine HCl/Naloxone HCl Bupropion HCl Bupropion HCl SR... 36, 44 Bupropion HCl XL Buspirone HCl Busulfan Busulfex Butalbital/Acetaminophen/ Caffeine Butalbital/Aspirin/Caffeine.. 32 Butorphanol Tartrate Bydureon Bcise... 6 Bydureon Pen... 6 Bydureon Vial... 6 Byetta... 6 Bystolic C Cabergoline Cabometyx Calcipotriene Calcitonin-Salmon Calcitriol... 74, 93 Calcium Acetate Calquence Camila Camrese Lo Canasa Cancidas Candesartan Cilexetil Candesartan Cilexetil/ Hydrochlorothiazide Capastat Sulfate Caprelsa Captopril Captopril/Hydrochlorothiazide Carac Carafate Carbaglu Carbamazepine Carbamazepine ER Carbidopa Carbidopa/Levodopa Carbidopa/Levodopa ER Carbidopa/Levodopa ODT Carbidopa/Levodopa/ Entacapone Carboplatin Cardene IV Carimune Nanofiltered... 9 Carteolol HCl Cartia XT Carvedilol Caspofungin Acetate Cayston Caziant Cefaclor Cefadroxil Cefazolin Sodium Cefdinir Cefepime Cefixime Cefotaxime Sodium Cefotetan Cefoxitin Sodium Cefpodoxime Proxetil Cefprozil Ceftazidime Ceftriaxone Sodium Cefuroxime Axetil Cefuroxime Sodium Celecoxib Cellcept Celontin... 42

15 Cephalexin Cerezyme Cesamet Cetirizine HCl Chantix Chantix Continuing Month Pak Chantix Starting Month Pak.. 36 Chemet Chenodal Chloramphenicol Sodium Succinate Chlordiazepoxide HCl... 6 Chlorhexidine Gluconate Oral Rinse Chloroquine Phosphate Chlorothiazide Chlorothiazide Sodium Chlorpromazine HCl Chlorthalidone Chlorzoxazone Cholbam Cholestyramine Cholestyramine Light Chorionic Gonadotropin Ciclopirox Ciclopirox Nail Lacquer Ciclopirox Olamine Cidofovir Cilostazol Ciloxan Cimduo Cimetidine Cimetidine HCl Cimzia Cinryze Cipro HC Ciprodex Ciprofloxacin Ciprofloxacin ER Ciprofloxacin HCl Ciprofloxacin I.V. in D5W Cisplatin... 5 Citalopram HBr Cladribine Claravis Clarithromycin Clarithromycin ER Climara Pro Clindamycin HCl Clindamycin Palmitate HCl Clindamycin Phosphate... 37, 74 Clindamycin Phosphate in D5W Clindamycin/Benzoyl Peroxide Clobetasol Propionate Clobetasol Propionate E Clofarabine Clomipramine HCl Clonazepam... 6 Clonazepam ODT... 6 Clonidine HCl Clonidine HCl ER Clopidogrel Clorazepate Dipotassium... 6 Clotrimazole Clotrimazole/Betamethasone Dipropionate Clozapine Clozapine ODT Coartem Codeine Sulfate Colchicine Colcrys Colesevelam HCl Colestipol HCl Colistimethate Sodium Colocort Coly-Mycin S Combigan Combivent Respimat Combivir Cometriq Complera Compro Constulose Copaxone Cordran Corlanor Cortisone Acetate Cortisporin Cosentyx Cosentyx Sensoready Pen Cosmegen... 5 Cosopt PF Cotellic Coumadin Creon Crinone Crixivan Cromolyn Sodium... 78, 95, 99 Cryselle Cubicin... 37

16 6 Cuprimine... 8 Cuvposa Cyclafem Cyclobenzaprine HCl Cyclophosphamide Cycloset... 6 Cyclosporine Cyclosporine Modified Cyproheptadine HCl Cyramza Cystadane Cystagon Cystaran Cytarabine Aqueous D Dacarbazine Dacogen... 5 Dactinomycin... 5 Daklinza Daliresp Dalvance Danazol Dantrolene Sodium Dapsone Daptacel Daptomycin DARAPRIM Darzalex Daunorubicin HCl... 5 Deblitane Decitabine... 5 Delyla Demeclocycline HCl... 4 Demser Denavir Depen Titratabs... 8 Depo-Estradiol Depo-Medrol Depo-Provera Descovy Desipramine HCl Desmopressin Acetate Desogestrel/Ethinyl Estradiol Desonide Desoximetasone Desvenlafaxine ER Dexamethasone Dexamethasone Intensol Dexamethasone Sodium Phosphate... 82, 96 Dexilant Dexmethylphenidate HCl Dexmethylphenidate HCl ER Dexrazoxane... 5 Dextroamphetamine Sulfate Dextroamphetamine Sulfate ER Dextrose 0% Dextrose 0%/NaCl 0.2% Dextrose 0%/NaCl 0.45% Dextrose 2.5%/NaCl 0.45%.. 75 Dextrose 5% Dextrose 5%/Lactated Ringers Dextrose 5%/NaCl 0.2% Dextrose 5%/NaCl 0.225% Dextrose 5%/NaCl 0.33% Dextrose 5%/NaCl 0.45% Dextrose 5%/NaCl 0.9% Diastat AcuDial Diastat Pediatric Diazepam... 6 Diazepam Intensol... 6 Diclofenac Potassium Diclofenac Sodium... 32, 74, 96 Diclofenac Sodium DR Diclofenac Sodium ER Dicloxacillin Sodium Dicyclomine HCl Didanosine Dificid Diflunisal Digitek Digox Digoxin Dihydroergotamine Mesylate Dilantin Dilantin INFATABS Dilt-XR Diltiazem HCl Diltiazem HCl ER Dipentum Diphenhydramine HCl Diphenoxylate/Atropine Diphtheria/Tetanus Toxoids Adsorbed Pediatric Disulfiram Diuril Divalproex Sodium... 6

17 Divalproex Sodium DR... 6 Divalproex Sodium ER... 6 Docetaxel... 5 Dofetilide Donepezil HCl Donepezil HCl ODT Doripenem Dorzolamide HCl Dorzolamide HCl/Timolol Maleate Doxazosin Mesylate Doxepin HCl... 46, 74 Doxercalciferol Doxil... 5 Doxorubicin HCl... 5 Doxorubicin HCl Liposome... 5 Doxy Doxycycline... 4 Doxycycline Hyclate... 4 Doxycycline Monohydrate...4 Dronabinol Drospirenone/Ethinyl Estradiol Droxia Duavee Dulera Duloxetine HCl Duramorph Durezol Dutasteride... 8 Dymista Dyrenium Dysport E E.E.S. Granules Econazole Nitrate Edarbi Edarbyclor Edecrin Edurant Efavirenz Egrifta Elaprase Elelyso Elestrin Elidel Eliquis Eliquis Starter Pack Elitek Ellence... 5 Elmiron... 8 Embeda Emcyt Emend Emend Tripack Emoquette Empliciti Emsam Emtriva Enalapril Maleate Enalapril Maleate/ Hydrochlorothiazide Enbrel Enbrel SureClick Endocet Engerix-B Enoxaparin Sodium Enpresse Enskyce Entacapone Entecavir Entocort EC Entresto Enulose Epclusa Epinastine HCl Epinephrine EpiPen Epirubicin HCl... 5 Epitol Epivir HBV Eplerenone Eprosartan Mesylate Epzicom Eraxis Erbitux Ergotamine Tartrate/Caffeine Erivedge Erleada Errin Erwinaze... 5 Ery Ery-Tab EryPed EryPed Erythrocin Lactobionate Erythromycin... 40, 74 Erythromycin Base Erythromycin Ethylsuccinate... 40

18 8 Erythromycin/Benzoyl Peroxide Esbriet Escitalopram Oxalate Esomeprazole Magnesium Esomeprazole Sodium Estarylla Estrace Estradiol Estradiol Valerate Estring Ethacrynic Acid Ethambutol HCl Ethosuximide Ethynodiol Diacetate/Ethinyl Estradiol Etidronate Disodium Etodolac Etodolac ER Etopophos Etoposide Eurax Evotaz Exelderm Exemestane Exjade Exondys Ezetimibe Ezetimibe/Simvastatin F Fabrazyme Falmina Famciclovir Famotidine Famotidine Premixed Fanapt Fanapt Titration Pack Fareston Farydak Faslodex Fazaclo Felbamate Felbatol Felodipine ER Femring Femynor Fenofibrate Fenofibrate Micronized Fenofibric Acid Fenofibric Acid DR Fentanyl Fentanyl Citrate Oral Transmucosal Ferriprox Fetzima Fetzima Titration Pack Finacea Finasteride... 8 Firazyr Firmagon Flarex Flebogamma DIF... 9 Flecainide Acetate Flector Flovent Diskus Flovent HFA Fluconazole Fluconazole in NaCl Flucytosine Fludarabine Phosphate... 5 Fludrocortisone Acetate Flunisolide Fluocinolone Acetonide... 82, 97 Fluocinolone Acetonide Scalp Fluocinonide Fluocinonide Emulsified Base Fluorometholone Fluorouracil... 50, 74 Fluoxetine DR Fluoxetine HCl Fluphenazine Decanoate Fluphenazine HCl Flurbiprofen Flurbiprofen Sodium Flutamide Fluticasone Propionate... 83, 97 Fluticasone Propionate/ Salmeterol Fluvastatin Fluvoxamine Maleate FML FML Forte Folotyn Fomepizole Fondaparinux Sodium Forteo Fosamprenavir Calcium Fosinopril Sodium Fosinopril Sodium/ Hydrochlorothiazide Fosphenytoin Sodium... 43

19 Fosrenol FreAmine HBC 6.9% Furosemide Fusilev... 5 Fuzeon Fyavolv Fycompa G Gabapentin Gabitril Galantamine HBr Galantamine HBr ER Gamastan S/D... 9 Gammagard Liquid... 9 Gammagard S/D IGA Less Than mcg/ml... 9 Gammaked... 9 Gammaplex... 9 Gamunex-C... 9 Ganciclovir Gardasil Gatifloxacin Gattex Gauze GaviLyte-C GaviLyte-G GaviLyte-N/Flavor Pack Gemcitabine HCl Gemfibrozil Gemzar Generlac Gengraf Genotropin Genotropin Miniquick Gentak Gentamicin Sulfate Gentamicin Sulfate/0.9% Sodium Chloride Genvoya Geodon Gianvi Gilenya Gilotrif Glassia Glatiramer Acetate Glatopa Gleostine Glimepiride... 6 Glipizide... 6 Glipizide ER... 6 Glipizide/Metformin HCl... 6 GlucaGen HypoKit Glucagon Emergency Kit Glycopyrrolate Glyxambi... 6 Granisetron HCl Granix Griseofulvin Microsize Griseofulvin Ultramicrosize Guanfacine ER Guanidine HCl H Haegarda Halaven... 5 Halobetasol Propionate Haloperidol Haloperidol Decanoate Haloperidol Lactate Harvoni Havrix Heparin Sodium Heparin Sodium/D5W HepatAmine Hepsera Herceptin Hetlioz Hexalen Hiberix Humalog Cartridge Humalog Junior KwikPen Humalog KwikPen Humalog Mix 50/50 KwikPen Humalog Mix 50/50 Vial Humalog Mix 75/25 KwikPen Humalog Mix 75/25 Vial Humalog Vial Humatrope Humatrope Combo Pack Humira Humira Pediatric Crohns Disease Starter Pack Humira Pen Humira Pen Crohns Disease Starter Pack Humira Pen-Psoriasis Starter Humulin 70/30 KwikPen Humulin 70/30 Vial Humulin N KwikPen Humulin N Vial Humulin R U-500 KwikPen... 63

20 20 Humulin R U-500 Vial Humulin R Vial Hycamtin Hydralazine HCl... 7 Hydrochlorothiazide Hydrocodone/Acetaminophen Hydrocodone/Ibuprofen Hydrocortisone... 83, 93 Hydrocortisone Butyrate Hydrocortisone Valerate Hydrocortisone/Acetic Acid Hydromorphone HCl Hydromorphone HCl ER Hydroxychloroquine Sulfate Hydroxyprogesterone Caproate Hydroxyurea Hydroxyzine HCl Hydroxyzine Pamoate Hysingla ER I Ibandronate Sodium Ibrance Ibu Ibuprofen Iclusig Idamycin PFS... 5 Idarubicin HCl... 5 Idhifa Ifosfamide Ilaris... 9 Ilevro Imatinib Mesylate Imbruvica Imfinzi Imipenem/Cilastatin Imipramine HCl Imipramine Pamoate Imiquimod Imovax Rabies Increlex Incruse Ellipta Indapamide Indomethacin Infanrix Inlyta Insulin Syringes, Needles Intelence Intralipid Intron A Introvale Invanz Invega Sustenna Invega Trinza Invirase Invokamet... 6 Invokamet XR Invokana Ionosol-MB/Dextrose 5% IPOL Inactivated IPV Ipratropium Bromide Ipratropium Bromide/Albuterol Sulfate Irbesartan Irbesartan/Hydrochlorothiazide Iressa Irinotecan... 5 Isentress Isentress HD Isibloom Isolyte-P/Dextrose 5% Isolyte-S Isoniazid Isosorbide Dinitrate... 7 Isosorbide Dinitrate ER... 7 Isosorbide Mononitrate... 7 Isosorbide Mononitrate ER... 7 Isotonic Gentamicin Isotretinoin Istodax... 5 Itraconazole Ivermectin Ixiaro J Jadenu Jadenu Sprinkle Jakafi Jantoven Janumet Janumet XR Januvia Jardiance Jentadueto Jentadueto XR Jevtana Jinteli Jolivette Jublia Juleber... 86

21 Juluca Junel.5/ Junel / Junel Fe.5/ Junel Fe / Junel Fe Juxtapid K Kadcyla Kaitlib Fe Kaletra Kalydeco Kanuma... 8 Kariva KCl 0.075%/D5W/NaCl 0.45% KCl 0.5%/D5W/NaCl 0.2%.. 76 KCl 0.5%/D5W/NaCl 0.45% KCl 0.5%/D5W/NaCl 0.9%.. 76 KCl 0.3%/D5W/NaCl 0.45%.. 76 KCl 0.3%/D5W/NaCl 0.9% Kelnor / Kelnor / Kenalog Kenalog Kepivance Ketoconazole Ketoprofen Ketorolac Tromethamine... 32, 96 Keytruda Kimidess Kineret Kinrix Kionex Kisqali... 5 Kisqali Femara 200 Dose... 5 Kisqali Femara 400 Dose... 5 Kisqali Femara 600 Dose... 5 Klor-Con Klor-Con Klor-Con Klor-Con M Klor-Con M Klor-Con M Klor-Con Sprinkle Kombiglyze XR Korlym Kurvelo Kuvan... 8 Kynamro Kyprolis L Labetalol HCl Lacrisert Lactated Ringers Irrigation Lactated Ringers Viaflex Lactulose Lamivudine... 57, 59 Lamivudine/Zidovudine Lamotrigine Lanoxin Lansoprazole Lanthanum Carbonate Lantus SoloStar Lantus Vial Larin.5/ Larin / Larin Fe.5/ Larin Fe / Larissia Lartruvo Lastacaft Latanoprost Latuda Layolis Fe Leena Leflunomide... 9 Lenvima Lessina Letairis Letrozole Leucovorin Calcium... 5 Leukeran Leukine Leuprolide Acetate Levalbuterol Levemir FlexTouch Levemir Vial Levetiracetam Levetiracetam ER Levobunolol HCl Levocarnitine Levocetirizine Dihydrochloride Levofloxacin Levofloxacin in D5W Levoleucovorin... 5 Levonest Levonorgestrel and Ethinyl Estradiol Levonorgestrel/Ethinyl Estradiol... 86

22 22 Levora 0.5/ Levorphanol Tartrate Levothyroxine Sodium... 88, 89 Levoxyl Lexiva Lialda Lidocaine Lidocaine HCl Lidocaine Viscous Lidocaine/Prilocaine Lincomycin HCl Lindane Linezolid Linzess Lioresal Intrathecal Liothyronine Sodium Lisinopril Lisinopril/Hydrochlorothiazide Lithium... 6 Lithium Carbonate... 6 Lithium Carbonate ER... 6 Lithostat... 8 Livalo Lonsurf... 5 Loperamide HCl Lopinavir/Ritonavir Lorazepam... 6 Lorcet Lorcet HD Lorcet Plus Loryna Losartan Potassium Losartan Potassium/ Hydrochlorothiazide Lotemax Lotronex Lovastatin Low-Ogestrel Loxapine Succinate Lumigan Lumizyme... 8 Lupaneta Pack Lupron Depot Lupron Depot-Ped Lutera Lynparza Lyrica Lysodren Lyza M M-M-R II Magnesium Sulfate Makena Malathion Maprotiline HCl Marlissa Marplan Matulane Matzim LA Mavyret Meclizine HCl Medroxyprogesterone Acetate Mefloquine HCl Megace ES Megestrol Acetate Mekinist Melodetta 24 Fe Meloxicam Melphalan HCl Memantine HCl Memantine HCl ER Memantine HCl Titration Pak Menactra Menest Mentax Menveo Mepron Mercaptopurine Meropenem Mesalamine Mesalamine DR Mesna Mesnex Mestinon Metadate ER Metaproterenol Sulfate Metformin HCl Metformin HCl ER Methadone HCl Methazolamide Methenamine Hippurate Methimazole Methotrexate Methotrexate Sodium Methoxsalen Methscopolamine Bromide.. 78 Methyclothiazide Methyldopa... 65

23 Methyldopa/ Hydrochlorothiazide Methyldopate HCl Methylphenidate HCl Methylphenidate HCl ER Methylprednisolone Methylprednisolone Acetate Methylprednisolone Dose Pack Methylprednisolone Sodium Succinate Metipranolol Metoclopramide HCl Metolazone Metoprolol Succinate ER Metoprolol Tartrate Metoprolol/Hydrochlorothiazide Metronidazole Metronidazole in NaCl 0.79% Metronidazole Vaginal Mexiletine HCl Miacalcin Mibelas 24 Fe Miconazole Microgestin.5/ Microgestin / Microgestin Fe Microgestin Fe.5/ Midodrine HCl Migergot Miglitol Miglustat... 8 Mili Minitran... 7 Minocycline HCl... 4 Minoxidil... 7 Mirtazapine Mirtazapine ODT Mirvaso Misoprostol Mitomycin... 5 Mitoxantrone HCl... 5 Modafinil Moexipril HCl Moexipril/Hydrochlorothiazide Mometasone Furoate... 83, 97 MonoNessa Montelukast Sodium Morphine Sulfate... 34, 35 Morphine Sulfate ER Moxeza Moxifloxacin HCl/Sodium HCl... 4 Moxifloxacin HCl... 4 Mozobil Multaq Mupirocin Mustargen Myalept Mycamine Mycophenolate Mofetil...90 Mycophenolic Acid DR...90 Mylotarg Myrbetriq N Nabumetone Nadolol Nadolol/Bendroflumethiazide Nafcillin Sodium Naftifine HCl Naftin Naglazyme... 8 Nalbuphine HCl Naloxone HCl Naltrexone HCl Namenda XR Namenda XR Titration Pack Namzaric Naproxen Naproxen DR Naratriptan HCl Narcan Natacyn Nateglinide Natpara Nebupent Necon 0.5/ Necon 7/7/ Nefazodone HCl Neomycin Sulfate Neomycin/Bacitracin/ Polymyxin Neomycin/Polymyxin B Sulfates Neomycin/Polymyxin/ Bacitracin/Hydrocortisone... 94

24 24 Neomycin/Polymyxin/ Dexamethasone Neomycin/Polymyxin/ Gramicidin Neomycin/Polymyxin/ Hydrocortisone... 94, 97 Nephramine Nerlynx Neulasta Neupogen Neupro Nevanac Nevirapine Nevirapine ER Nexavar Nexium Niacin ER Niacor Nicardipine HCl Nicotrol Nicotrol NS Nifedipine ER Nikki Nilandron Nilutamide Nimodipine Ninlaro... 5 Nipent Nitro-Bid... 7 Nitrofurantoin Nitrofurantoin Macrocrystals Nitrofurantoin Monohydrate Nitroglycerin... 7 Nitroglycerin Lingual... 7 Nitroglycerin Transdermal... 7 Nitrostat... 7 Nora-BE Norditropin FlexPro Norethindrone Norethindrone Acetate Norethindrone Acetate/Ethinyl Estradiol Norethindrone Acetate/Ethinyl Estradiol/Ferrous Fumarate Norethindrone/Ethinyl Estradiol/Ferrous Fumarate Norgestimate/Ethinyl Estradiol Norlyroc Normosol-M in D5W Normosol-R Normosol-R in D5W Northera Nortrel 0.5/ Nortrel / Nortrel 7/7/ Nortriptyline HCl Norvir Novarel Noxafil Nucala Nucynta ER Nuedexta Nulojix Nuplazid Nutrilipid Nutropin AQ NuvaRing Nyamyc Nymalize Nystatin Nystop O Ocaliva... 8 Ocella Octagam... 9 Octreotide Acetate Odefsey Odomzo Ofev Ofloxacin... 4 Ogestrel Olanzapine Olanzapine ODT Olmesartan Medoxomil Olmesartan Medoxomil/ Amlodipine/ Hydrochlorothiazide Olmesartan Medoxomil/ Hydrochlorothiazide Olopatadine HCl Omega-3-Acid Ethyl Esters Omeprazole Ondansetron HCl Ondansetron ODT Onfi Onglyza Opdivo Opsumit Orencia Orencia Clickject Orenitram... 99

25 Orfadin... 8 Orkambi Orphenadrine Citrate Orsythia Oseltamivir Phosphate Otezla... 9 Oxacillin Sodium Oxaliplatin... 5 Oxandrolone... 84, 85 Oxcarbazepine Oxiconazole Nitrate Oxistat Oxsoralen Ultra Oxybutynin Chloride... 8 Oxybutynin Chloride ER... 8 Oxycodone HCl Oxycodone/Acetaminophen Oxycodone/Aspirin Oxycodone/Ibuprofen P Pacerone Paclitaxel... 5 Paliperidone ER Palonosetron HCl Pamidronate Disodium...93 Panretin Pantoprazole Sodium Paricalcitol Paromomycin Sulfate Paroxetine HCl Paser Paxil Pazeo Pediarix Pedvax HIB PEG 3350/Electrolytes PEG-3350/Electrolytes PEG-3350/NaCl/Na Bicarbonate/KCl Peganone Pegasys Pegasys ProClick Penicillin G Potassium Penicillin G Procaine Penicillin G Sodium Penicillin V Potassium Pentam Pentasa Pentoxifylline ER Perforomist Perindopril Erbumine Periogard Perjeta Permethrin Perphenazine Phenadoz Phenelzine Sulfate Phenobarbital Phenoxybenzamine HCl Phenytek Phenytoin Phenytoin Sodium Phenytoin Sodium Extended Phoslyra Phospholine Iodide Physiolyte Physiosol Irrigation Picato Pilocarpine HCl... 73, 96 Pimozide Pimtrea Pindolol Pioglitazone HCl Pioglitazone HCl/Glimepiride Pioglitazone HCl/Metformin HCl Piperacillin/Tazobactam Pirmella / Piroxicam Plasma-Lyte A Plasma-Lyte Plenamine Podofilox Polyethylene Glycol 3350 Powder Polymyxin B Sulfate Polymyxin B Sulfate/ Trimethoprim Sulfate Pomalyst Portia Potassium Chloride... 76, 77 Potassium Chloride CR Potassium Chloride ER Potassium Chloride/Dextrose Potassium Chloride/Dextrose/ Lactated Ringers Potassium Chloride/Dextrose/ Sodium Chloride Potassium Chloride/Sodium Chloride... 77

26 26 Potassium Citrate ER Pradaxa Praluent Pramipexole Dihydrochloride Prasugrel Pravastatin Sodium Prazosin HCl Pred Mild Pred-G Pred-G S.O.P Prednicarbate Prednisolone Prednisolone Acetate Prednisolone Sodium Phosphate... 83, 96 Prednisone Prednisone Intensol Pregnyl w/diluent Benzyl Alcohol/NaCl Premarin Premasol Premphase Prempro Prevalite Previfem Prezcobix Prezista Priftin Prilosec Primaquine Phosphate...54 Primidone Pristiq Privigen... 9 ProAir HFA ProAir RespiClick Probenecid Probenecid/Colchicine Procainamide HCl Procalamine Prochlorperazine Prochlorperazine Edisylate Prochlorperazine Maleate Procrit Procto-Med HC Procto-Pak Proctosol HC Proctozone-HC Procysbi... 8 Progesterone Proglycem Prograf Prolastin-C... 8 Prolensa Proleukin... 5 Prolia Promacta Promethazine HCl Promethegan Propafenone HCl Propafenone HCl ER Proparacaine HCl Propranolol HCl Propranolol HCl ER Propranolol/ Hydrochlorothiazide Propylthiouracil ProQuad Prosol Protriptyline HCl Prudoxin Pulmozyme Purixan Pyrazinamide Pyridostigmine Bromide Pyridostigmine Bromide ER Q Quadracel Quasense Quetiapine Fumarate Quetiapine Fumarate ER Quinapril HCl Quinapril/Hydrochlorothiazide Quinidine Gluconate Quinidine Gluconate CR Quinidine Sulfate Quinine Sulfate R Rabavert Rabeprazole Sodium Raloxifene HCl Ramipril Ranexa Ranitidine HCl Rapaflo... 8 Rapamune Rasagiline Mesylate Ravicti... 8 Rayaldee Rebif Rebif Rebidose... 73

27 Rebif Rebidose Titration Pack Rebif Titration Pack Reclipsen Recombivax HB Regranex Relenza Diskhaler Relistor Remicade Remodulin Renagel Renvela Repaglinide Repaglinide/Metformin HCl Repatha Repatha Pushtronex System Repatha SureClick Rescriptor Restasis Retrovir IV Infusion Revatio Revlimid Rexulti Reyataz Ribasphere Ribavirin Ridaura... 9 Rifabutin Rifampin Rifater Rilutek Riluzole Rimantadine HCl Ringers Injection Ringers Irrigation Riomet Risedronate Sodium Risperdal Consta Risperidone Risperidone ODT Ritonavir Rituxan Rivastigmine Tartrate Rivastigmine Transdermal System Rizatriptan Benzoate Rizatriptan Benzoate ODT Ropinirole HCl Rosuvastatin Calcium Rotarix RotaTeq Rowasa Roweepra Roweepra XR Rozerem Rubraca Ruconest Rydapt S Sabril Saizen Saizenprep Reconstitution Kit Samsca Sancuso Sandimmune... 9 Sandostatin LAR Depot Santyl Saphris Savella Savella Titration Pack Scopolamine Selegiline HCl Selenium Sulfide Selzentry... 59, 60 Sensipar Serevent Diskus Seroquel XR Serostim Sertraline HCl Setlakin Sevelamer Carbonate Sharobel Shingrix Signifor Sildenafil Silver Sulfadiazine... 4 Simbrinza Simponi... 9 Simponi Aria... 9 Simulect... 9 Simvastatin Sirolimus... 9 Sirturo Sodium Chloride Sodium Chloride 0.9% Sodium Chloride 0.45% Sodium Fluoride Sodium Lactate Sodium Phenylbutyrate... 8

28 28 Sodium Polystyrene Sulfonate Sodium Sulfacetamide... 4 Soliqua 00/ Soltamox Solu-Cortef Solu-Medrol Somatuline Depot Somavert Soriatane Sotalol HCl Sovaldi Spiriva HandiHaler Spiriva Respimat Spironolactone Spironolactone/ Hydrochlorothiazide Sporanox Sprintec Spritam Sprycel SPS Sronyx SSD... 4 Stalevo Stalevo Stalevo Stalevo Stalevo Stalevo Stavudine Stelara Sterile Water Irrigation Stiolto Respimat Stivarga Strensiq... 8 Streptomycin Sulfate Stribild Suboxone Sucraid... 8 Sucralfate Sulfacetamide Sodium... 4 Sulfacetamide Sodium/ Prednisolone Sodium Phosphate Sulfadiazine... 4 Sulfamethoxazole/ Trimethoprim... 4 Sulfamethoxazole/ Trimethoprim DS... 4 Sulfamylon Sulfasalazine Sulindac Sumatriptan Sumatriptan Succinate Sumatriptan Succinate Refill Suprax Suprep Bowel Prep Kit Sustiva Sutent Syeda Sylatron Sylvant Symbicort Symfi Symfi Lo SymlinPen SymlinPen Synagis Synarel Synercid Synjardy Synjardy XR Synribo... 5 Synthroid Syprine T Tabloid Tacrolimus... 75, 9 Tafinlar Tagrisso Tamiflu Tamoxifen Citrate Tamsulosin HCl... 8 Tarceva Targretin Tarina Fe / Tasigna Taxotere... 5 Tazarotene Tazicef Tazorac Taztia XT Tecentriq Tecfidera Tecfidera Starter Pack Telmisartan Telmisartan/Amlodipine Telmisartan/ Hydrochlorothiazide Temazepam Tenivac... 92

29 Tenofovir Disoproxil Fumarate Terazosin HCl... 8 Terbinafine HCl Terbutaline Sulfate Terconazole Testosterone Cypionate Testosterone Enanthate Tetanus/Diphtheria Toxoids- Adsorbed Adult Tetrabenazine Tetracycline HCl... 4 Thalomid Theophylline Theophylline CR Theophylline ER Thioridazine HCl Thiotepa... 5 Thiothixene Thymoglobulin... 9 Tiagabine HCl Tigecycline Timolol Maleate... 66, 96 Timolol Maleate Ophthalmic Gel Forming Tinidazole Tivicay Tizanidine HCl TOBI TOBI Podhaler Tobradex Tobradex ST Tobramycin Tobramycin Sulfate Tobramycin/Dexamethasone Tobrex Tolcapone Topiramate Toposar Topotecan HCl Torisel... 9 Torsemide Toujeo Max Solostar Toujeo SoloStar TPN Electrolytes Tracleer Tradjenta Tramadol HCl Tramadol HCl ER Tramadol HCl/Acetaminophen Trandolapril Tranexamic Acid Transderm-Scop Tranylcypromine Sulfate Travasol Travatan Z Trazodone HCl Treanda Trecator Trelegy Ellipta Trelstar Mixject Tresiba FlexTouch Tretinoin... 53, 75 Tretinoin Microsphere Trexall... 9 Trezix Tri-Legest Fe Tri-Lo-Estarylla Tri-Lo-Sprintec Tri-Mili Tri-Previfem Tri-Sprintec Tri-Vylibra Triamcinolone Acetonide... 83, 84, 97 Triamcinolone Acetonide Dental Paste Triamterene/ Hydrochlorothiazide Triderm Trientine HCl Trifluoperazine HCl Trifluridine Trihexyphenidyl HCl TriLyte Trimethoprim Trimipramine Maleate Trinessa Trintellix Trisenox... 5 Triumeq Trivora Trizivir Trophamine Trulicity Trumenba Truvada Twinrix Tybost Tygacil Tykerb... 53

30 30 Tymlos Typhim Vi Tysabri U Uceris Uloric Unithroid Ursodiol V Valacyclovir HCl Valchlor Valcyte Valganciclovir Valganciclovir Hydrochlorde Valproate Sodium Valproic Acid Valsartan Valsartan/Hydrochlorothiazide Vancocin HCl Vancomycin HCl Vandazole VAQTA Varivax Varizig... 9 Vascepa... 7 Vectibix Velcade... 5 Velivet Velphoro Veltassa Vemlidy Venclexta Venclexta Starting Pack Venlafaxine HCl Venlafaxine HCl ER Ventavis Verapamil HCl Verapamil HCl ER Verapamil HCl SR Versacloz Verzenio Vesicare... 8 Vestura Vfend Vibramycin... 4 Victoza Vidaza Videx EC Videx Pediatric Vienva Vigabatrin Viibryd Viibryd Starter Pack Vimpat Vinblastine Sulfate Vincasar PFS Vincristine Sulfate Vinorelbine Tartrate Viracept Viramune Viread Vivitrol Voriconazole Vosevi Votrient VP-PNV-DHA VPRIV... 8 Vraylar Vyfemla Vylibra Vyvanse Vyxeos W Warfarin Sodium Welchol... 7 Wymzya Fe X Xalkori Xarelto Xarelto Starter Pack Xatmep... 9 Xeljanz... 9 Xeljanz XR... 9 Xenazine Xgeva Xifaxan Xiidra Xolair Xtampza ER Xtandi Xulane Xyrem Y Yervoy YF-Vax Yondelis Yuvafem Z Zafirlukast Zaleplon... 00

31 Zaltrap Zanosar Zarah Zarxio Zavesca... 8 Zejula Zelapar Zelboraf Zemaira... 8 Zenchent Zenpep... 8 Zerbaxa Zerit Ziagen Zidovudine Zileuton ER Zinecard Ziprasidone HCl Zirgan Zoledronic Acid Zolinza Zolpidem Tartrate Zomacton Zometa Zonisamide Zorbtive Zortress... 9 Zostavax Zovia /35E Zyclara Pump Zydelig Zyflo Zyflo CR Zykadia Zyprexa Relprevv Zytiga... 50

32 2-3 ( ) 32 ( Humalog) ( Simvastatin) (QL) 0-24 Butalbital/ Acetaminophen/ Caffeine (50 - QL ) Butalbital/Aspirin/ Caffeine ( QL - 40 ) Celecoxib QL Diclofenac Potassium () Diclofenac Sodium (% ) PA Diclofenac Sodium DR () Diclofenac Sodium ER (24 ) Diflunisal () Etodolac ( ) Etodolac ER (24 ) Flector () PA QL Flurbiprofen () Ibu () Ibuprofen (00 / ) Indomethacin (25 50 ) Ketoprofen () Ketorolac Tromethamine (5 / 30 / 60 / 2 ) 6-7

33 Meloxicam () Nabumetone () Naproxen (25 / ) Naproxen DR ( ) (EC-Naprosyn ) Piroxicam Sulindac () Embeda ( ) QL MED Fentanyl (00 / 72 2 / / 72 QL MED 50 / / 72 ) Hydromorphone HCl ER (2 24 QL MED 8 24 ) Hydromorphone HCl ER (6 24 ) QL MED Hydromorphone HCl ER (32 24 ) Hysingla ER (24 ) Levorphanol Tartrate () Methadone HCl (0 5 0 / 5 5 / 5 ) Methadone HCl (0 / ) Morphine Sulfate ER ( ) (MS Contin ) Nucynta ER (2 ) Tramadol HCl ER ( ) QL MED QL MED QL MED QL MED QL MED QL MED QL MED = =

34 Xtampza ER (2 ) QL MED Abstral ( ) PA QL Acetaminophen/ Codeine (20-2 / QL MED ) Butorphanol Tartrate (0 / QL MED ) Butorphanol Tartrate ( / 2 / ) Codeine Sulfate () QL MED Duramorph Endocet () QL MED Fentanyl Citrate Oral Transmucosal ( PA QL ) Fentanyl Citrate Oral Transmucosal ( ) PA QL Hydrocodone/ Acetaminophen ( QL MED / 5 ) Hydrocodone/ Ibuprofen (7.5 - QL MED 200 ) Hydromorphone HCl (0 / 50 / 5 ) Hydromorphone HCl ( / ) QL MED Hydromorphone HCl (2 4 8 QL MED ) Hydromorphone HCl (2 / ) Lorcet () QL MED Lorcet HD () QL MED Lorcet Plus () QL MED Morphine Sulfate (00 / 5 0 / 5 QL MED 20 / 5 ) Morphine Sulfate (0 / 4 / 8 / ) 6-7

35 Morphine Sulfate (5 QL MED 30 ) Morphine Sulfate (2 / 5 / ) Nalbuphine HCl Oxycodone HCl (00 / 5 ) QL MED Oxycodone HCl ( QL MED 30 5 ) Oxycodone HCl (5 / 5 ) QL MED Oxycodone/ Acetaminophen () QL MED Oxycodone/Aspirin () QL MED Oxycodone/Ibuprofen () QL MED Tramadol HCl ( ) QL MED Tramadol HCl/ Acetaminophen () QL MED Trezix QL MED Lidocaine (5% ) Lidocaine (5% ) PA QL Lidocaine HCl (0.5% % B/D PA 2% ) Lidocaine HCl (4% ) Lidocaine HCl Lidocaine Viscous Lidocaine/Prilocaine / / Acamprosate Calcium DR () Disulfiram () Naltrexone HCl () Vivitrol Buprenorphine HCl (0.3 / ) Buprenorphine HCl (2 8 ) QL = =

36 Buprenorphine HCl/ Naloxone HCl ( ) QL Suboxone () QL Naloxone HCl Narcan () Bupropion HCl SR (50 2 ) Chantix () Chantix Continuing Month Pak () Chantix Starting Month Pak () Nicotrol Nicotrol NS ( ) Amikacin Sulfate Gentak Gentamicin Sulfate (0.% 0.% 0.3% ) Gentamicin Sulfate (40 / ) Gentamicin Sulfate/ 0.9% Sodium Chloride Isotonic Gentamicin Neomycin Sulfate () Paromomycin Sulfate Streptomycin Sulfate Tobramycin Sulfate (0.3% ) Tobramycin Sulfate (0 / 80 / 2 ) Tobrex (0.3% ) BACiiM Bacitracin (50000 ) Bacitracin (500 / ) Bactroban Nasal Chloramphenicol Sodium Succinate Clindamycin HCl () Clindamycin Palmitate HCl ( ) PA 6-7

37 Clindamycin Phosphate (2% ) Clindamycin Phosphate (300 / / / 6 ) Clindamycin Phosphate in D5W Colistimethate Sodium Cubicin Dalvance PA Daptomycin Lincomycin HCl Linezolid (00 / 5 ) PA Linezolid (600 ) PA QL Linezolid (600 / 300 ) PA Methenamine Hippurate () Metronidazole (0.75% 0.75% % 0.75% ) Metronidazole ( ) Metronidazole in NaCl 0.79% Metronidazole Vaginal Mupirocin (2% ) Mupirocin (2% ) Neomycin/Polymyxin B Sulfates ( ) Nitrofurantoin Nitrofurantoin Macrocrystals (00 50 ) (Macrodantin ) Nitrofurantoin Monohydrate (00 ) (Macrobid ) Polymyxin B Sulfate Sulfamylon (85 / ) Synercid Tigecycline Tinidazole () Trimethoprim () Tygacil Vancocin HCl Vancomycin HCl ( ) Vandazole β = =

38 Cefaclor Cefaclor ( ) Cefadroxil (250 / / ) Cefazolin Sodium Cefdinir (25 / / ) Cefepime Cefixime Cefotaxime Sodium Cefotetan Cefoxitin Sodium (0 2 ) Cefpodoxime Proxetil ( / 5 50 / 5 ) Cefprozil (25 / / ) Ceftazidime Ceftriaxone Sodium ( ) Cefuroxime Axetil () Cefuroxime Sodium ( ) Cephalexin (25 / / ) Suprax ( ) Suprax ( / 5 ) Tazicef Zerbaxa PA β Azactam Aztreonam Doripenem Imipenem/Cilastatin Invanz Meropenem β 6-7

39 Amoxicillin ( / / / / ) Amoxicillin/Clavulanate Potassium ( / / / / / 5-57 / / / ) (Augmentin ) Amoxicillin/Clavulanate Potassium ER (2 ) Ampicillin Ampicillin Sodium (0 25 ) Ampicillin-Sulbactam Bactocill in Dextrose Bicillin C-R Bicillin L-A Dicloxacillin Sodium Nafcillin Sodium (0 ) Oxacillin Sodium (0 ) Oxacillin Sodium ( 2 ) Penicillin G Potassium Penicillin G Procaine Penicillin G Sodium Penicillin V Potassium (25 / / ) Piperacillin/ Tazobactam Azasite = =

40 Azithromycin (00 / / ) Azithromycin (500 ) Clarithromycin (25 / / 5 ) Clarithromycin ( ) Clarithromycin ER (24 ) Dificid () E.E.S. Granules Ery-Tab ( ) EryPed 200 EryPed 400 Erythrocin Lactobionate Erythromycin (250 ) Erythromycin (5 / ) Erythromycin Base () Erythromycin Ethylsuccinate (200 / ) Besivance Ciloxan (0.3% ) Ciprofloxacin () Ciprofloxacin ER (24 ) Ciprofloxacin HCl (0.3% ) Ciprofloxacin HCl ( ) Ciprofloxacin I.V. in D5W Gatifloxacin Levofloxacin (0.5% ) Levofloxacin ( ) Levofloxacin (25 / 25 / ) Levofloxacin in D5W Moxeza 6-7

41 Moxifloxacin HCl/ Sodium HCl Moxifloxacin HCl Moxifloxacin HCl () Ofloxacin (0.3% ) Ofloxacin (0.3% ) Silver Sulfadiazine Sodium Sulfacetamide SSD Sulfacetamide Sodium Sulfadiazine () Sulfamethoxazole/ Trimethoprim ( / ) Sulfamethoxazole/ Trimethoprim ( / 5 ) Sulfamethoxazole/ Trimethoprim DS () Demeclocycline HCl () Doxy 00 Doxycycline (25 / 5 ) Doxycycline Hyclate ( ) Doxycycline Monohydrate ( ) Minocycline HCl ( ) Minocycline HCl ( ) Tetracycline HCl Vibramycin (50 / 5 ) = =

42 Briviact ( QL 75 0 / ) Briviact (50 / 5 ) QL Levetiracetam ( / ) Levetiracetam (000 / / / / 5 ) Levetiracetam ER (24 ) Roweepra () Roweepra XR (24 ) Spritam ( ) Celontin Ethosuximide ( / 5 ) Zonisamide γ (GABA) Diastat AcuDial Diastat Pediatric Gabapentin ( ) Gabapentin (250 / 5 ) Gabitril (2 6 ) Onfi (0 20 ) QL Onfi (2.5 / ) Phenobarbital ( / 5 ) Primidone () Sabril ( ) PA QL LA Tiagabine HCl () Valproate Sodium (00 / ) 6-7

43 Valproic Acid ( / 5 ) Vigabatrin () PA QL Felbamate ( ) Felbamate (600 / 5 ) Felbatol (600 / 5 ) Fycompa (0.5 / ) Lamotrigine ( ) Lamotrigine (25 5 ) Topiramate ( ) Aptiom () QL Banzel ( / ) Carbamazepine (00 00 / ) Carbamazepine ER ( ) Dilantin Dilantin INFATABS Epitol () Fosphenytoin Sodium Oxcarbazepine ( ) Oxcarbazepine (300 / 5 ) Peganone () = =

44 Phenytek Phenytoin (25 / 5 50 ) Phenytoin Sodium Phenytoin Sodium Extended Vimpat ( QL 0 / ) Vimpat (200 / 20 ) Donepezil HCl () QL Donepezil HCl ODT ( ) QL Galantamine HBr (2 4 QL 8 4 / ) Galantamine HBr ER (24 QL ) Rivastigmine Tartrate QL Rivastigmine Transdermal System (24 ) QL ST N--D- (NMDA) Memantine HCl (0 5 PA QL 2 / ) Memantine HCI ER (24 PA QL ) Memantine HCl Titration Pak () PA Namenda XR (24 ) PA QL Namenda XR Titration Pack (24 PA QL ) Bupropion HCl ( ) Bupropion HCl SR ( ) Bupropion HCl XL (24 ) Mirtazapine () Mirtazapine ODT ( ) Emsam (24 ) QL 6-7

45 Marplan () Phenelzine Sulfate () Tranylcypromine Sulfate () SSRI / SNRI ( / ) Citalopram HBr ( ) Citalopram HBr (0 / 5 ) Desvenlafaxine ER ( QL ) (Pristiq ) Escitalopram Oxalate ( ) Escitalopram Oxalate (5 / 5 ) Fetzima (24 ) QL ST Fetzima Titration Pack (24 ) ST Fluoxetine DR ( ) Fluoxetine HCl ( / 5 ) Fluvoxamine Maleate () Maprotiline HCl () Nefazodone HCl () Paroxetine HCl ( ) Paxil (0 / 5 ) Pristiq (24 ) PA QL Sertraline HCl ( ) Sertraline HCl (20 / ) Trazodone HCl () Trintellix () QL Venlafaxine HCl ( ) = =

46 Venlafaxine HCl ER ( ) Viibryd () QL Viibryd Starter Pack () QL Amitriptyline HCl () Amoxapine () Clomipramine HCl Desipramine HCl () Doxepin HCl ( / ) Imipramine HCl () Imipramine Pamoate Nortriptyline HCl ( / 5 ) Protriptyline HCl () Trimipramine Maleate Compro () Hydroxyzine Pamoate Meclizine HCl () Metoclopramide HCl (0 5 ) Metoclopramide HCl (5 / 5 ) Metoclopramide HCl (5 / ) Perphenazine () Prochlorperazine () Prochlorperazine Edisylate Prochlorperazine Maleate () Scopolamine (72 ) Transderm-Scop (72 ) Aloxi Anzemet (00 ) B/D PA Anzemet (50 ) B/D PA 6-7

47 Aprepitant ( ) PA Cesamet PA Dronabinol PA Emend ( PA 25 ) Emend (50 ) Emend Tripack PA Granisetron HCl (0. / / 4 / 4 ) Granisetron HCl ( ) B/D PA QL Ondansetron HCl (24 4 B/D PA 8 ) Ondansetron HCl (4 / 2 ) Ondansetron HCl (4 / 5 ) B/D PA Ondansetron ODT ( ) B/D PA Palonosetron HCl (0.25 / 2 ) Palonosetron HCl (0.25 / 5 ) Sancuso () Abelcet B/D PA AmBisome B/D PA Amphotericin B B/D PA Cancidas Caspofungin Acetate Ciclopirox (0.77% 0.77% % ) Ciclopirox Nail Lacquer ( ) Ciclopirox Olamine Clotrimazole (% % 0 ) Econazole Nitrate Eraxis Exelderm (% % ) Fluconazole ( / 40 / ) Fluconazole in NaCl Flucytosine = =

48 Griseofulvin Microsize (25 / ) Griseofulvin Ultramicrosize () Itraconazole PA QL Jublia ( ) Ketoconazole (2% 2% 200 ) Ketoconazole (2% ) Mentax Miconazole 3 () Mycamine Naftifine HCl (% ) Naftifine HCl (2% ) Naftin (% 2% ) Natacyn Noxafil (00 ) PA QL Noxafil (40 / ) QL Nyamyc () Nystatin ( ) Nystop () Oxiconazole Nitrate Oxistat (% ) Sporanox (0 / ) PA Terbinafine HCl () Terconazole (0.4% 0.8% 80 ) Vfend ( / ) Voriconazole ( / ) Voriconazole ( ) Allopurinol () Colchicine ( ) QL Colcrys () PA QL Probenecid () Probenecid/Colchicine () Uloric () ST Dihydroergotamine Mesylate ( / ) 6-7

49 Ergotamine Tartrate/ Caffeine () Migergot () (5-HT) b/d Naratriptan HCl () QL Rizatriptan Benzoate () QL Rizatriptan Benzoate ODT ( ) QL Sumatriptan ( ) QL Sumatriptan Succinate (00 25 QL 50 ) Sumatriptan Succinate (4 / / 0.5 QL ) Sumatriptan Succinate (6 / 0.5 QL ) Sumatriptan Succinate Refill QL Guanidine HCl () Mestinon (60 / 5 ) Pyridostigmine Bromide ( ) Pyridostigmine Bromide ER ( ) Dapsone () Rifabutin Capastat Sulfate Ethambutol HCl () Isoniazid ( ) Isoniazid (00 / 50 / 5 ) Paser () Priftin () Pyrazinamide () Rifampin ( ) Rifampin (600 ) Rifater () Sirturo () PA Trecator () BiCNU Busulfan Busulfex = =

50 Cyclophosphamide B/D PA Dacarbazine Gleostine Hexalen PA Ifosfamide Leukeran () Matulane LA Melphalan HCl Mustargen Treanda PA Valchlor PA LA Yondelis PA Zanosar Bicalutamide () Erleada () PA QL Flutamide Nilandron () Nilutamide () Xtandi PA QL Zytiga () PA QL Pomalyst PA QL Revlimid PA QL LA Thalomid PA QL / Emcyt Fareston () Faslodex Soltamox ( ) Tamoxifen Citrate () Adrucil B/D PA Alimta PA Cladribine B/D PA Clofarabine Cytarabine Aqueous B/D PA Droxia Fluorouracil (5 / 00 ) B/D PA Folotyn Gemcitabine HCl Gemzar Hydroxyurea Mercaptopurine () Nipent Purixan PA Tabloid () PA Abraxane PA Adriamycin B/D PA Arranon Bleomycin Sulfate B/D PA Bortezomib PA Carboplatin 6-7

51 Cisplatin Cosmegen Dacogen Dactinomycin Daunorubicin HCl Decitabine Dexrazoxane PA Docetaxel (60 / 6 ) Docetaxel (80 / 4 ) Doxil Doxorubicin HCl B/D PA Doxorubicin HCl Liposome Ellence Epirubicin HCl Erwinaze Fludarabine Phosphate Fusilev Halaven PA Idamycin PFS Idarubicin HCl Irinotecan Istodax (Overfill) PA Kisqali () PA QL Kisqali Femara 200 Dose () PA QL Kisqali Femara 400 Dose () PA QL Kisqali Femara 600 Dose () PA QL Leucovorin Calcium ( ) Leucovorin Calcium ( ) Levoleucovorin Lonsurf () PA QL Mitomycin Mitoxantrone HCl Ninlaro PA QL Oxaliplatin (00 00 / 20 ) Paclitaxel Proleukin PA Synribo PA Taxotere Thiotepa Trisenox Velcade PA = =

52 Verzenio () PA QL Vinblastine Sulfate B/D PA Vincasar PFS B/D PA Vincristine Sulfate B/D PA Vinorelbine Tartrate Vyxeos PA Zaltrap PA Zinecard PA Zolinza PA 3 Anastrozole () Exemestane () Letrozole () Aliqopa PA Etopophos Etoposide Hycamtin Kyprolis PA Rubraca () PA QL Toposar Topotecan HCl Zejula PA QL Afinitor () PA Afinitor Disperz ( ) PA Alecensa PA QL Alunbrig ( PA QL ) Beleodaq PA Bosulif () PA QL Cabometyx () PA QL Calquence PA QL Caprelsa () PA LA Cometriq () PA Cotellic () PA QL LA Cyramza PA Erivedge PA QL Farydak PA Gilotrif () PA Ibrance PA QL Iclusig () PA QL LA Idhifa () PA QL Imatinib Mesylate () PA QL Imbruvica ( PA QL ) Inlyta () PA QL Iressa () PA QL Jakafi () PA QL LA Jevtana PA 6-7