H2751_NY030536_MMP_FOR_CHI_FINAL_08_NY_06_15_PREFACE.indd

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1 2016 年 承 保 藥 物 清 單 ( 處 方 藥 目 錄 ) wellcare advocate complete fida (Medicare-Medicaid 計 劃 ) 09/01/ (TTY: ) WellCare Advocate Complete FIDA 8 8 https// H2751_NY030536_MMP_FOR_CHI CMS Approved WellCare 2015 NY_06_15 NY6MMPFOR67979C_0615

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3 WellCare Advocate Complete FIDA v WellCare Medicare New York (Medicaid) (FIDA) v v 1 v WellCare Advocate Complete FIDA (TTY: ) WellCare Advocate Complete FIDA 8 8 v WellCare WellCare Advocate Complete FIDA v v (TTY: ) 8 8 v You can get this information for free in other languages. Call and TTY/TDD 711 during 8 a.m. to 8 p.m. Eastern, Monday Sunday. The call is free. v Puede obtener esta información gratis en otros idiomas. Llame al y TTY/TDD al 711 de 8 a.m. a 8 p.m., hora del este, de lunes a domingo. La llamada es gratis. v TTY/TDD 711 v Ou kapab jwenn enfòmasyon sa yo gratis nan lòt lang yo. Rele nimewo ak TTY/TDD 711 depi 8 a.m. jiska 8 p.m. Lè Zòn Lès, Lendi Dimanch. Koutfil la gratis. v Queste informazioni possono essere ottenute gratuitamente in altre lingue. Chiamare e TTY/TDD 711 dalle ore 8 alle 20, ora della costa orientale degli USA, dal lunedì alla domenica. La chiamata è gratuita. v 이 정보는 다른 언어로 무료로 제공됩니다. 월요일 - 일요일, 동부 표준시, 오전 8 시 ~ 오후 8시에 및 TTY/TDD 711으로 연락 주십시오. 이 전화 통화도 무료입니다. v Вы можете получить эту информацию на других языках бесплатно. Звоните по номеру и TTY/TDD 711 с 8 утра до 8 вечера по восточному поясному времени с понедельника по воскресенье. Звонок бесплатный. v New York (ICAN) WellCare Advocate Complete FIDA ICAN icannys.org (TTY: ) WellCare Advocate Complete FIDA

4 常 見 問 題 (FAQ) FAQ 1. 承 保 藥 物 清 單 上 有 哪 些 處 方 藥 物 ( 我 們 將 承 保 藥 物 清 單 簡 稱 為 藥 物 清 單 ) 9 WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA # (TTY: ) 藥 物 清 單 是 否 會 發 生 變 化 WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA (IDT) (TTY: ) WellCare Advocate Complete FIDA

5 WellCare Advocate Complete FIDA (TTY: ) 有 與 藥 物 清 單 上 現 有 藥 物 作 用 相 同 價 格 更 便 宜 的 藥 物 時 會 怎 麼 樣 WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA 4. 當 我 們 發 現 某 種 藥 物 不 安 全 時 會 怎 麼 樣 (FDA) 5. 藥 物 承 保 是 否 有 任 何 限 制 或 限 額 或 者 是 否 需 要 採 取 任 何 必 要 措 施 才 能 獲 得 某 些 藥 物 WellCare Advocate Complete FIDA (IDT) WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA (TTY: ) WellCare Advocate Complete FIDA

6 WellCare Advocate Complete FIDA 您 如 何 知 道 您 想 要 的 藥 物 是 否 有 限 制 或 是 否 需 要 采 取 措 施 才 能 獲 得 該 藥 物 9 7. 當 我 們 變 更 對 一 些 藥 物 的 承 保 規 定 時 會 怎 麼 樣 例 如 如 果 我 們 新 增 某 種 藥 物 的 事 先 授 權 ( 核 準 ) 數 量 限 制 和 / 或 階 段 性 療 法 限 制 您 如 何 在 藥 物 清 單 上 找 到 一 種 藥 物 如 果 您 想 服 用 的 藥 物 不 在 藥 物 清 單 上 該 怎 麼 辦 (TTY: ) (TTY: ) WellCare Advocate Complete FIDA

7 WellCare Advocate Complete FIDA (IDT) 如 果 您 是 一 位 WellCare Advocate Complete FIDA 新 參 保 者 而 且 不 能 在 藥 物 清 單 上 找 到 您 的 藥 物 或 難 以 獲 得 所 需 藥 物 該 怎 麼 辦 WellCare Advocate Complete FIDA WellCare Advocate Complete FIDA (IDT) 您 是 否 能 夠 申 請 例 外 處 理 以 承 保 您 所 需 藥 物 WellCare Advocate Complete FIDA (IDT) WellCare Advocate Complete FIDA IDT WellCare Advocate Complete FIDA IDT IDT (TTY: ) WellCare Advocate Complete FIDA

8 12. 獲 得 例 外 處 理 需 要 多 長 時 間 WellCare Advocate Complete FIDA (IDT) 您 如 何 要 求 例 外 處 理 14. 甚 麼 是 副 廠 藥 (FDA) WellCare Advocate Complete FIDA 15. 甚 麼 是 OTC 藥 物 OTC WellCare Advocate Complete FIDA OTC WellCare Advocate Complete FIDA OTC 16. WellCare Advocate Complete FIDA 是 否 承 保 OTC 非 藥 物 產 品 WellCare Advocate Complete FIDA OTC WellCare Advocate Complete FIDA OTC 17. 什 麼 是 共 付 款 18. 甚 麼 是 藥 物 層 級 1 Medicare Part D 2 Medicare Part D 3 Medicare /OTC Medicaid (TTY: ) WellCare Advocate Complete FIDA

9 承 保 藥 物 清 單 WellCare Advocate Complete FIDA 177 COUMADIN simvastatin WellCare Advocate Complete FIDA NM PA 3 B/D Part B Part D Medicare Part B Part D WellCare Advocate Complete FIDA Medicare Part D WellCare Advocate Complete FIDA QL 3 LA Exactus (TTY: ) 8 8 ST (TTY: ) WellCare Advocate Complete FIDA

10 ^ Part D WellCare Advocate Complete FIDA (IDT) Medicare Medicaid (TTY: ) (ICAN) (TTY: ) WellCare Advocate Complete FIDA

11 allopurinol 100 mg, 300 mg colchicine-probenecid mg COLCRYS 0.6 MG QL probenecid 500 mg ULORIC 40 MG, 80 MG ST celecoxib 100 mg, 200 mg, 400 mg, 50 mg QL diclofenac potassium 50 mg diclofenac sodium er 24 * 100 mg diclofenac sodium 25 mg, 50 mg, 75 mg diflunisal 500 mg etodolac er 24 * 400 mg, 500 mg, 600 mg WellCare Advocate Complete FIDA (TTY: )

12 etodolac 200 mg, 300 mg etodolac 400 mg, 500 mg flurbiprofen 100 mg, 50 mg ibuprofen 100 mg/5ml ibuprofen 400 mg, 600 mg, 800 mg ketoprofen 50 mg, 75 mg meloxicam 7.5 mg/5ml meloxicam 15 mg, 7.5 mg nabumetone 500 mg, 750 mg naproxen dr 375 mg, 500 mg naproxen 125 mg/5ml naproxen 250 mg, 375 mg, 500 mg naproxen sodium 275 mg, 550 mg piroxicam 10 mg, 20 mg sulindac 150 mg, 200 mg CII duramorph 0.5 mg/ml, 1 mg/ml B/D WellCare Advocate Complete FIDA (TTY: )

13 endocet mg, mg, mg QL fentanyl citrate 1200 mcg, 1600 mcg, 200 mcg, PA; QL mcg, 600 mcg, 800 mcg fentanyl mcg50 mcg PA; QL mcg fentanyl mcg25 mcg QL FENTORA 100 MCG, 200 MCG, 400 MCG, 600 MCG, PA; QL MCG hydrocodone-acetaminophen mg/15ml QL ML hydrocodone-acetaminophen mg, mg, QL mg hydrocodone-ibuprofen mg QL hydromorphone hcl 1 mg/ml hydromorphone hcl 2 mg, 4 mg, 8 mg QL hydromorphone hcl pf 500 mg/50ml B/D lorcet hd mg QL lorcet mg QL lorcet plus mg QL lortab mg, mg, mg QL methadone hcl intensol 10 mg/ml QL ML WellCare Advocate Complete FIDA (TTY: )

14 methadone hcl 10 mg/5ml, 5 mg/5ml QL ML methadone hcl 10 mg, 5 mg QL morphine sulfate 20 mg/ml morphine sulfate (pf) 0.5 mg/ml, 1 mg/ml B/D morphine sulfate (pf) * 10 mg/ml, 15 mg/ml, 2 mg/ml, B/D 4 mg/ml, 8 mg/ml morphine sulfate er mg, 30 mg, 45 mg, 60 mg, QL mg, 90 mg morphine sulfate er mg, 20 mg, QL mg, 50 mg, 60 mg morphine sulfate er mg, 80 mg QL morphine sulfate er * 100 mg, 15 mg, 30 mg, QL mg morphine sulfate er * 200 mg QL morphine sulfate * 1 mg/ml B/D morphine sulfate 10 mg/5ml, 20 mg/5ml morphine sulfate 15 mg, 30 mg QL oxycodone hcl 5 mg QL WellCare Advocate Complete FIDA (TTY: )

15 oxycodone hcl 100 mg/5ml oxycodone hcl 5 mg/5ml oxycodone hcl 10 mg, 15 mg, 20 mg, 30 mg, 5 mg QL oxycodone-acetaminophen mg, mg, QL mg, mg roxicet mg/5ml QL ML acetaminophen-codeine # mg QL acetaminophen-codeine # mg QL acetaminophen-codeine # mg QL acetaminophen-codeine mg/5ml QL ML butorphanol tartrate 1 mg/ml, 2 mg/ml nalbuphine hcl 10 mg/ml, 20 mg/ml tramadol hcl 50 mg QL tramadol-acetaminophen mg QL lidocaine hcl (pf) 0.5 %, 1 % B/D lidocaine hcl 0.5 %, 1 %, 1.5 %, 2 % B/D WellCare Advocate Complete FIDA (TTY: )

16 - amikacin sulfate 1 gm/4ml, 500 mg/2ml gentamicin saline * mg/ml-%, mg/ml-%, mg/ml-%, mg/ml-%, mg/ml-%, mg/ml-%, mg/ml-% gentamicin sulfate 10 mg/ml, 40 mg/ml gentamicin sulfate * 10 mg/ml neomycin sulfate 500 mg paromomycin sulfate 250 mg streptomycin sulfate * 1 gm sulfadiazine 500 mg tobramycin 300 mg/5ml B/D tobramycin sulfate saline * mg/ml-% tobramycin sulfate 1.2 gm/30ml, 10 mg/ml, 2 gm/50ml, 80 mg/2ml tobramycin sulfate 1.2 gm WellCare Advocate Complete FIDA (TTY: )

17 ABELCET * 5 MG/ML B/D AMBISOME * 50 MG B/D amphotericin b 50 mg B/D CANCIDAS * 50 MG, 70 MG fluconazole dextrose * 200 mg/100ml, 400 mg/200ml fluconazole sodium chloride * mg/100ml-%, mg/200ml-% fluconazole 10 mg/ml, 40 mg/ml fluconazole 100 mg, 150 mg, 200 mg, 50 mg flucytosine 250 mg, 500 mg griseofulvin microsize 125 mg/5ml griseofulvin microsize 500 mg griseofulvin ultramicrosize 125 mg, 250 mg itraconazole 100 mg PA ketoconazole 200 mg PA WellCare Advocate Complete FIDA (TTY: )

18 MYCAMINE * 100 MG, 50 MG NOXAFIL 40 MG/ML NOXAFIL 100 MG nystatin terbinafine hcl 250 mg voriconazole * 200 mg voriconazole 40 mg/ml voriconazole 200 mg, 50 mg - QL ALBENZA 200 MG ALINIA 100 MG/5ML ALINIA 500 MG atovaquone 750 mg/5ml AZACTAM DEXTROSE * 1 GM, 2 GM aztreonam 1 gm, 2 gm BILTRICIDE 600 MG CAYSTON 75 MG PA; LA WellCare Advocate Complete FIDA (TTY: )

19 clindamycin hcl 150 mg, 300 mg, 75 mg clindamycin palmitate hcl 75 mg/5ml clindamycin phosphate d5w * 300 mg/50ml, 600 mg/50ml, 900 mg/50ml clindamycin phosphate 300 mg/2ml, 600 mg/4ml, 9 gm/60ml, 900 mg/6ml, 9000 mg/60ml clindamycin phosphate * 300 mg/2ml, 600 mg/4ml, 900 mg/6ml colistimethate sodium 150 mg CUBICIN * 500 MG dapsone 100 mg, 25 mg DARAPRIM 25 MG imipenem-cilastatin * 250 mg, 500 mg INVANZ 1 GM INVANZ * 1 GM ivermectin 3 mg linezolid * 2 mg/ml LINEZOLID 600 MG WellCare Advocate Complete FIDA (TTY: )

20 meropenem * 1 gm, 500 mg methenamine hippurate 1 gm metronidazole nacl * mg/100ml-% metronidazole 250 mg, 500 mg NEBUPENT 300 MG B/D nitrofurantoin macrocrystal 100 mg, 50 mg PA nitrofurantoin monohyd macro 100 mg PA PENTAM 300 MG SIVEXTRO * 200 MG SIVEXTRO 200 MG sulfamethoxazole-tmp ds mg sulfamethoxazole-trimethoprim * mg/5ml sulfamethoxazole-trimethoprim mg/5ml sulfamethoxazole-trimethoprim mg SYNERCID * MG trimethoprim 100 mg WellCare Advocate Complete FIDA (TTY: )

21 TYGACIL * 50 MG vancomycin hcl * 10 gm, 1000 mg, 500 mg, 5000 mg, 750 mg vancomycin hcl 125 mg, 250 mg ZYVOX 100 MG/5ML ZYVOX 600 MG atovaquone-proguanil hcl mg, mg chloroquine phosphate 250 mg, 500 mg COARTEM MG mefloquine hcl 250 mg PRIMAQUINE PHOSPHATE 26.3 MG quinine sulfate 324 mg PA abacavir sulfate 300 mg APTIVUS 250 MG APTIVUS 100 MG/ML CRIXIVAN 200 MG, 400 MG didanosine 125 mg, 200 mg, 250 mg, 400 mg EDURANT 25 MG WellCare Advocate Complete FIDA (TTY: )

22 EMTRIVA 200 MG EMTRIVA 10 MG/ML FUZEON * 90 MG INTELENCE 100 MG, 200 MG, 25 MG INVIRASE 200 MG INVIRASE 500 MG ISENTRESS 100 MG ISENTRESS 400 MG ISENTRESS 100 MG, 25 MG lamivudine 10 mg/ml lamivudine 150 mg, 300 mg LEXIVA 50 MG/ML LEXIVA 700 MG nevirapine er 24 * 400 mg nevirapine 50 mg/5ml nevirapine 200 mg NORVIR 100 MG NORVIR 80 MG/ML NORVIR 100 MG PREZISTA 100 MG/ML PREZISTA 150 MG, 600 MG, 75 MG, 800 MG WellCare Advocate Complete FIDA (TTY: )

23 RESCRIPTOR 100 MG, 200 MG RETROVIR * 10 MG/ML REYATAZ 150 MG, 200 MG, 300 MG REYATAZ 50 MG SELZENTRY 150 MG, 300 MG stavudine 15 mg, 20 mg, 30 mg, 40 mg stavudine 1 mg/ml SUSTIVA 200 MG, 50 MG SUSTIVA 600 MG TIVICAY 50 MG TYBOST 150 MG VIDEX 2 GM, 4 GM VIRACEPT 250 MG, 625 MG VIRAMUNE XR 24 * 100 MG VIREAD 40 MG/GM VIREAD 150 MG, 200 MG, 250 MG, 300 MG VITEKTA 150 MG, 85 MG ZIAGEN 20 MG/ML zidovudine 100 mg WellCare Advocate Complete FIDA (TTY: )

24 zidovudine 50 mg/5ml zidovudine 300 mg abacavir-lamivudine-zidovudine mg ATRIPLA MG COMPLERA MG EPZICOM MG EVOTAZ MG KALETRA MG/5ML KALETRA MG, MG lamivudine-zidovudine mg PREZCOBIX MG STRIBILD MG TRIUMEQ MG TRUVADA MG QL CAPASTAT SULFATE 1 GM cycloserine 250 mg WellCare Advocate Complete FIDA (TTY: )

25 ethambutol hcl 100 mg, 400 mg isoniazid 100 mg/ml isoniazid 50 mg/5ml isoniazid 100 mg, 300 mg paser 4 gm PRIFTIN 150 MG pyrazinamide 500 mg rifabutin 150 mg rifampin * 600 mg rifampin 150 mg, 300 mg RIFATER MG SIRTURO 100 MG PA; LA TRECATOR 250 MG acyclovir 200 mg acyclovir 200 mg/5ml acyclovir 400 mg, 800 mg acyclovir sodium * 50 mg/ml B/D acyclovir sodium * 500 mg B/D adefovir dipivoxil 10 mg WellCare Advocate Complete FIDA (TTY: )

26 BARACLUDE 0.05 MG/ML entecavir 0.5 mg, 1 mg EPIVIR HBV 5 MG/ML famciclovir 125 mg, 250 mg, 500 mg foscarnet sodium * 24 mg/ml ganciclovir sodium * 500 mg B/D HARVONI MG PA lamivudine 100 mg MODERIBA MG moderiba mg moderiba 200 & 400 mg, 400 & 600 mg moderiba 200 mg PEG-INTRON REDIPEN * 120 MCG/0.5ML, 150 MCG/0.5ML, PA 50 MCG/0.5ML, 80 MCG/0.5ML PEGINTRON * 120 MCG/0.5ML, 150 MCG/0.5ML, PA 80 MCG/0.5ML PEG-INTRON * 50 MCG/0.5ML PA REBETOL 40 MG/ML WellCare Advocate Complete FIDA (TTY: )

27 RELENZA DISKHALER 5 MG ribasphere 200 mg ribasphere 200 mg, 400 mg ribasphere 600 mg ribasphere ribapak 200 & 400 mg, 400 & 600 mg, 400 mg, 600 mg ribavirin 200 mg ribavirin 200 mg rimantadine hcl 100 mg SOVALDI 400 MG PA TAMIFLU 30 MG, 45 MG, 75 MG TAMIFLU 6 MG/ML TYZEKA 600 MG valacyclovir hcl 1 gm, 500 mg VALCYTE 50 MG/ML valganciclovir hcl 450 mg cefaclor er 12 * 500 mg cefaclor 250 mg, 500 mg cefaclor 125 mg/5ml, 250 mg/5ml, 375 mg/5ml WellCare Advocate Complete FIDA (TTY: )

28 cefadroxil 500 mg cefadroxil 250 mg/5ml, 500 mg/5ml cefadroxil 1 gm cefazolin sodium 1 gm, 10 gm, 20 gm, 500 mg cefazolin sodium * 1-5 gm-% cefazolin sodium * 1 gm cefdinir 300 mg cefdinir 125 mg/5ml, 250 mg/5ml cefepime hcl 1 gm, 2 gm cefixime 100 mg/5ml, 200 mg/5ml cefotaxime sodium 1 gm, 2 gm, 500 mg cefoxitin sodium 10 gm cefoxitin sodium * 1 gm, 2 gm cefpodoxime proxetil 100 mg/5ml, 50 mg/5ml cefpodoxime proxetil 100 mg, 200 mg WellCare Advocate Complete FIDA (TTY: )

29 cefprozil 125 mg/5ml, 250 mg/5ml cefprozil 250 mg, 500 mg CEFTAZIDIME AND DEXTROSE * 1 GM/50ML, 2 GM/50ML ceftazidime 1 gm, 2 gm, 6 gm ceftriaxone sodium 1 gm, 2 gm, 250 mg, 500 mg ceftriaxone sodium * 1 gm, 10 gm, 2 gm cefuroxime axetil 250 mg, 500 mg cefuroxime sodium 1.5 gm, 7.5 gm, 750 mg cefuroxime sodium * 1.5 gm, 7.5 gm cephalexin 250 mg, 500 mg cephalexin 125 mg/5ml, 250 mg/5ml SUPRAX 400 MG SUPRAX 500 MG/5ML WellCare Advocate Complete FIDA (TTY: )

30 suprax 100 mg, 200 mg tazicef 1 gm, 2 gm, 6 gm tazicef * 1 gm, 2 gm TEFLARO * 400 MG, 600 MG azithromycin * 500 mg azithromycin 1 gm azithromycin 100 mg/5ml, 200 mg/5ml azithromycin 250 mg, 500 mg, 600 mg clarithromycin er 24 * 500 mg clarithromycin 125 mg/5ml, 250 mg/5ml clarithromycin 250 mg, 500 mg DIFICID 200 MG e.e.s mg ery-tab 250 mg, 333 mg, 500 mg erythrocin lactobionate * 500 mg erythrocin stearate 250 mg WellCare Advocate Complete FIDA (TTY: )

31 erythromycin base 250 mg erythromycin base 250 mg, 500 mg erythromycin ethylsuccinate 400 mg 喹 ciprofloxacin hcl 100 mg, 250 mg, 500 mg, 750 mg ciprofloxacin d5w * 200 mg/100ml, 400 mg/200ml ciprofloxacin * 200 mg/20ml, 400 mg/40ml ciprofloxacin 250 mg/5ml (5%), 500 mg/5ml (10%) ciprofloxacin-ciproflox hcl er 24 * 1000 mg, 500 mg levofloxacin d5w * 250 mg/50ml, 500 mg/100ml, 750 mg/150ml levofloxacin * 25 mg/ml levofloxacin 25 mg/ml levofloxacin 250 mg, 500 mg, 750 mg amoxicillin 250 mg, 500 mg WellCare Advocate Complete FIDA (TTY: )

32 amoxicillin 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml amoxicillin 500 mg, 875 mg amoxicillin 125 mg, 250 mg amoxicillin-pot clavulanate er 12 * mg amoxicillin-pot clavulanate mg/5ml, mg/5ml, mg/5ml, mg/5ml amoxicillin-pot clavulanate mg, mg, mg amoxicillin-pot clavulanate mg, mg ampicillin 250 mg, 500 mg ampicillin 125 mg/5ml, 250 mg/5ml ampicillin sodium 1 gm, 125 mg, 2 gm, 250 mg, 500 mg ampicillin sodium * 1 gm, 10 gm, 2 gm WellCare Advocate Complete FIDA (TTY: )

33 ampicillin-sulbactam sodium 1.5 (1-0.5) gm, 15 (10-5) gm, 3 (2-1) gm ampicillin-sulbactam sodium * 1.5 (1-0.5) gm, 15 (10-5) gm, 3 (2-1) gm BICILLIN L-A * ML, ML, ML dicloxacillin sodium 250 mg, 500 mg nafcillin sodium 1 gm nafcillin sodium 10 gm, 2 gm nafcillin sodium * 1 gm nafcillin sodium * 2 gm oxacillin sodium 1 gm, 2 gm oxacillin sodium 10 gm PENICILLIN G POT DEXTROSE * ML, ML penicillin g potassium , WellCare Advocate Complete FIDA (TTY: )

34 penicillin g procaine * ml penicillin g sodium penicillin v potassium 125 mg/5ml, 250 mg/5ml penicillin v potassium 250 mg, 500 mg piperacillin sod-tazobactam so * gm, gm, gm, gm doxy 100 * 100 mg doxycycline hyclate * 100 mg doxycycline hyclate 100 mg, 50 mg doxycycline hyclate 100 mg, 20 mg doxycycline monohydrate 100 mg, 50 mg doxycycline monohydrate 100 mg, 150 mg, 50 mg, 75 mg minocycline hcl 100 mg, 50 mg, 75 mg BICNU * 100 MG B/D WellCare Advocate Complete FIDA (TTY: )

35 BUSULFEX * 6 MG/ML B/D cyclophosphamide 1 gm, 500 mg B/D cyclophosphamide 2 gm B/D CYCLOPHOSPHAMIDE 25 MG, 50 MG B/D dacarbazine * 200 mg B/D EMCYT 140 MG HEXALEN 50 MG IFEX * 3 GM B/D ifosfamide * 1 gm/20ml, 3 gm/60ml B/D ifosfamide * 1 gm B/D IFOSFAMIDE * 3 GM B/D LEUKERAN 2 MG lomustine 10 mg, 100 mg, 40 mg melphalan hcl * 50 mg B/D MUSTARGEN 10 MG B/D TREANDA * 180 MG/2ML, 45 MG/0.5ML B/D TREANDA * 100 MG, 25 MG B/D WellCare Advocate Complete FIDA (TTY: )

36 adriamycin * 50 mg B/D daunorubicin hcl * 5 mg/ml B/D doxorubicin hcl * 2 mg/ml B/D doxorubicin hcl * 50 mg B/D doxorubicin hcl liposomal * 2 mg/ml B/D epirubicin hcl * 200 mg/100ml, 50 mg/25ml B/D idarubicin hcl * 10 mg/10ml, 20 mg/20ml, B/D 5 mg/5ml bleomycin sulfate B/D mitomycin * 20 mg, 40 mg, 5 mg B/D adrucil * 2.5 gm/50ml, 5 gm/100ml, 500 mg/10ml B/D ALIMTA * 100 MG, 500 MG B/D azacitidine 100 mg B/D cladribine * 1 mg/ml B/D WellCare Advocate Complete FIDA (TTY: )

37 cytarabine 20 mg/ml B/D fludarabine phosphate * 50 mg/2ml B/D fludarabine phosphate * 50 mg B/D fluorouracil * 1 gm/20ml, 2.5 gm/50ml, 500 mg/10ml B/D GEMCITABINE HCL * 1 GM/26.3ML, 2 GM/52.6ML, B/D 200 MG/5.26ML gemcitabine hcl * 1 gm, 2 gm, 200 mg B/D mercaptopurine 50 mg methotrexate sodium (pf) 1 gm/40ml B/D methotrexate sodium 25 mg/ml B/D methotrexate sodium 1 gm B/D NIPENT * 10 MG B/D PURIXAN 2000 MG/100ML TABLOID 40 MG ABRAXANE * 100 MG B/D WellCare Advocate Complete FIDA (TTY: )

38 docetaxel * 140 mg/7ml B/D DOCETAXEL * 20 MG/ML, 80 MG/4ML B/D DOCETAXEL * 200 MG/20ML, 80 MG/8ML B/D paclitaxel * 100 mg/16.7ml, 150 mg/25ml, B/D 30 mg/5ml, 300 mg/50ml vinblastine sulfate * 1 mg/ml B/D vincasar pfs * 1 mg/ml B/D vincristine sulfate * 1 mg/ml B/D vinorelbine tartrate * 10 mg/ml, 50 mg/5ml B/D AVASTIN * 100 MG/4ML, 400 MG/16ML B/D; LA BELEODAQ * 500 MG PA ERIVEDGE 150 MG PA; LA FARYDAK 10 MG, 15 MG, 20 MG PA; LA HERCEPTIN * 440 MG B/D IBRANCE 100 MG, 125 MG, 75 MG PA; LA WellCare Advocate Complete FIDA (TTY: )

39 ISTODAX * 10 MG B/D KADCYLA * 100 MG, 160 MG B/D KEYTRUDA * 50 MG PA LYNPARZA 50 MG PA; LA PROLEUKIN * B/D RITUXAN * 10 MG/ML PA; LA VELCADE 3.5 MG B/D YERVOY * 50 MG/10ML PA ZOLINZA 100 MG PA anastrozole 1 mg bicalutamide 50 mg DEPO-PROVERA * 400 MG/ML B/D exemestane 25 mg FARESTON 60 MG FASLODEX * 250 MG/5ML B/D flutamide 125 mg letrozole 2.5 mg leuprolide acetate 1 mg/0.2ml PA WellCare Advocate Complete FIDA (TTY: )

40 LUPRON DEPOT * MG, 3.75 MG PA LUPRON DEPOT-PED * MG, MG (PED), PA 15 MG, 30 MG (PED), 7.5 MG LYSODREN 500 MG MEGACE ES 625 MG/5ML PA megestrol acetate 40 mg/ml PA megestrol acetate 20 mg, 40 mg PA NILANDRON 150 MG SOLTAMOX 10 MG/5ML tamoxifen citrate 10 mg, 20 mg TRELSTAR MIXJECT * MG, 3.75 MG PA XTANDI 40 MG PA; LA ZYTIGA 250 MG PA; LA AFINITOR DISPERZ 2 MG, 3 MG, 5 MG PA AFINITOR 10 MG, 2.5 MG, 5 MG, 7.5 MG PA BOSULIF 100 MG, 500 MG PA WellCare Advocate Complete FIDA (TTY: )

41 CAPRELSA 100 MG, 300 MG PA; LA COMETRIQ 100 MG 1 X 80 & 1 X 20 MG PA; LA COMETRIQ 140 MG 1 X 80 & 3 X 20 MG PA; LA COMETRIQ 60 MG 20 MG PA; LA GILOTRIF 20 MG, 30 MG, 40 MG PA; LA GLEEVEC 100 MG, 400 MG PA ICLUSIG 15 MG, 45 MG PA; LA IMBRUVICA 140 MG PA; LA INLYTA 1 MG, 5 MG PA; LA JAKAFI 10 MG, 15 MG, 20 MG, 25 MG, 5 MG PA; LA LENVIMA 10 MG 10 MG PA; LA LENVIMA 14 MG 10 & 4 MG PA; LA LENVIMA 20 MG 10 (2) MG PA; LA LENVIMA 24 MG 10 (2) & 4 MG PA; LA MEKINIST 0.5 MG, 2 MG PA; LA NEXAVAR 200 MG PA; LA SPRYCEL 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG PA WellCare Advocate Complete FIDA (TTY: )

42 STIVARGA 40 MG PA; LA SUTENT 12.5 MG, 25 MG, 37.5 MG, 50 MG PA TAFINLAR 50 MG, 75 MG PA; LA TARCEVA 100 MG, 150 MG, 25 MG PA; LA TASIGNA 150 MG, 200 MG PA TYKERB 250 MG PA; LA VOTRIENT 200 MG PA; LA XALKORI 200 MG, 250 MG PA; LA ZELBORAF 240 MG PA; LA ZYDELIG 100 MG, 150 MG PA; LA ZYKADIA 150 MG PA; LA DROXIA 200 MG, 300 MG, 400 MG hydroxyurea 500 mg MATULANE 50 MG LA mitoxantrone hcl * 20 mg/10ml, 25 mg/12.5ml, B/D 30 mg/15ml POMALYST 1 MG, 2 MG, 3 MG, 4 MG PA; LA SYLATRON * 200 MCG, 300 MCG, 4 X 200 MCG, 4 X 300 MCG, PA 600 MCG SYNRIBO * 3.5 MG PA WellCare Advocate Complete FIDA (TTY: )

43 TARGRETIN 75 MG PA tretinoin 10 mg TRISENOX * 10 MG/10ML B/D carboplatin * 150 mg/15ml, 450 mg/45ml, B/D 50 mg/5ml, 600 mg/60ml cisplatin * 100 mg/100ml, 200 mg/200ml, B/D 50 mg/50ml oxaliplatin * 100 mg/20ml, 50 mg/10ml B/D oxaliplatin * 100 mg, 50 mg B/D amifostine * 500 mg B/D dexrazoxane * 250 mg B/D ELITEK * 1.5 MG, 7.5 MG B/D FUSILEV * 50 MG B/D leucovorin calcium 100 mg, 200 mg, 350 mg, 50 mg, B/D 500 mg leucovorin calcium 10 mg, 15 mg, 25 mg, 5 mg levoleucovorin calcium * 175 mg/17.5ml B/D WellCare Advocate Complete FIDA (TTY: )

44 mesna * 100 mg/ml B/D MESNEX 400 MG etoposide * 500 mg/25ml B/D irinotecan hcl * 100 mg/5ml, 40 mg/2ml, B/D 500 mg/25ml toposar * 1 gm/50ml B/D topotecan hcl * 4 mg B/D amlodipine besy-benazepril hcl mg, mg, QL mg, 5-20 mg, 5-40 mg amlodipine besy-benazepril hcl mg benazepril-hydrochlorothiazide mg, mg, mg, mg captopril-hydrochlorothiazide mg, mg, mg, mg enalapril-hydrochlorothiazide mg, mg fosinopril sodium-hctz mg, mg WellCare Advocate Complete FIDA (TTY: )

45 lisinopril-hydrochlorothiazide mg, mg, mg moexipril-hydrochlorothiazide mg, mg, mg quinapril-hydrochlorothiazide mg, mg, mg benazepril hcl 10 mg, 20 mg, 40 mg, 5 mg captopril 100 mg, 12.5 mg, 25 mg, 50 mg enalapril maleate 10 mg, 2.5 mg, 20 mg, 5 mg fosinopril sodium 10 mg, 20 mg, 40 mg lisinopril 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg moexipril hcl 15 mg, 7.5 mg perindopril erbumine 2 mg, 4 mg, 8 mg quinapril hcl 10 mg, 20 mg, 40 mg, 5 mg ramipril 1.25 mg, 10 mg, 2.5 mg, 5 mg trandolapril 1 mg, 2 mg, 4 mg WellCare Advocate Complete FIDA (TTY: )

46 eplerenone 25 mg, 50 mg spironolactone 100 mg, 25 mg, 50 mg - doxazosin mesylate 1 mg, 2 mg, 4 mg QL doxazosin mesylate 8 mg prazosin hcl 1 mg, 2 mg, 5 mg terazosin hcl 1 mg, 10 mg, 2 mg, 5 mg II amlodipine besylate-valsartan mg, mg, QL mg amlodipine besylate-valsartan mg amlodipine-valsartan-hctz mg, QL mg, mg amlodipine-valsartan-hctz mg amlodipine-valsartan-hctz mg QL AZOR MG, 5-20 MG, 5-40 MG QL AZOR MG WellCare Advocate Complete FIDA (TTY: )

47 BENICAR HCT MG, MG, MG irbesartan-hydrochlorothiazide mg, mg losartan potassium-hctz mg, mg, mg TRIBENZOR MG, MG, MG, MG TRIBENZOR MG valsartan-hydrochlorothiazide mg, mg, mg, mg, mg II BENICAR 20 MG, 40 MG, 5 MG irbesartan 150 mg, 300 mg, 75 mg losartan potassium 100 mg, 25 mg, 50 mg valsartan 160 mg, 320 mg, 40 mg, 80 mg amiodarone hcl * 150 mg/3ml, 450 mg/9ml, 900 mg/18ml QL WellCare Advocate Complete FIDA (TTY: )

48 amiodamne hcl 100 mg, 200 mg, 400 mg disopyramide phosphate 100 mg, 150 mg PA flecainide acetate 100 mg, 150 mg, 50 mg mexiletine hcl 150 mg, 200 mg, 250 mg MULTAQ 400 MG NORPACE CR MG, 150 MG PA pacerone 100 mg, 200 mg, 400 mg propafenone hcl er mg, 325 mg, 425 mg propafenone hcl 150 mg, 225 mg, 300 mg quinidine gluconate er * 324 mg quinidine sulfate 200 mg, 300 mg sorine 120 mg, 160 mg, 240 mg, 80 mg sotalol hcl (af) 120 mg, 160 mg, 80 mg sotalol hcl 120 mg, 160 mg, 240 mg, 80 mg TIKOSYN 125 MCG, 250 MCG, 500 MCG WellCare Advocate Complete FIDA (TTY: )

49 HMG-COA atorvastatin calcium 10 mg, 20 mg, 40 mg, 80 mg QL CRESTOR 10 MG, 20 MG, 40 MG, 5 MG QL lovastatin 10 mg QL lovastatin 20 mg QL lovastatin 40 mg QL pravastatin sodium 10 mg, 20 mg, 40 mg, 80 mg QL simvastatin 10 mg, 20 mg, 40 mg, 5 mg, 80 mg QL cholestyramine light 4 gm cholestyramine 4 gm cholestyramine 4 gm/dose colestipol hcl 5 gm colestipol hcl 5 gm colestipol hcl 1 gm fenofibrate micronized 134 mg, 200 mg, 67 mg fenofibrate 145 mg, 160 mg, 48 mg, 54 mg fenofibric acid 135 mg, 45 mg gemfibrozil 600 mg WellCare Advocate Complete FIDA (TTY: )

50 JUXTAPID 10 MG, 20 MG, 30 MG, 40 MG, 5 MG, PA; LA 60 MG KYNAMRO * 200 MG/ML PA niacin er* 1000 mg, 750 mg niacin er* 500 mg QL niacor 500 mg omega-3-acid ethyl esters 1 gm prevalite 4 gm/dose VASCEPA 1 GM WELCHOL 3.75 GM WELCHOL 625 MG ZETIA 10 MG - atenolol-chlorthalidone mg, mg bisoprolol-hydrochlorothiazide mg, mg, mg metoprolol-hydrochlorothiazide mg, mg, mg propranolol-hctz mg, mg WellCare Advocate Complete FIDA (TTY: )

51 - acebutolol hcl 200 mg, 400 mg atenolol 100 mg, 25 mg, 50 mg bisoprolol fumarate 10 mg, 5 mg BYSTOLIC 10 MG, 2.5 MG, 20 MG, 5 MG carvedilol 12.5 mg, 25 mg, mg, 6.25 mg labetalol hcl 100 mg, 200 mg, 300 mg metoprolol succinate er 24 * 100 mg QL metoprolol succinate er 24 * 200 mg metoprolol succinate er 24 * 25 mg, 50 mg QL metoprolol tartrate * 1 mg/ml metoprolol tartrate 100 mg, 25 mg, 50 mg nadolol 20 mg, 40 mg, 80 mg pindolol 10 mg, 5 mg propranolol hcl er mg, 160 mg, 60 mg, 80 mg WellCare Advocate Complete FIDA (TTY: )

52 propranolol hcl * 1 mg/ml propranolol hcl 20 mg/5ml, 40 mg/5ml propranolol hcl 10 mg, 20 mg, 40 mg, 60 mg, 80 mg timolol maleate 10 mg, 20 mg, 5 mg afeditab cr 24 * 30 mg afeditab cr 24 * 60 mg amlodipine besylate 10 mg amlodipine besylate 2.5 mg, 5 mg cartia xt mg, 180 mg, 240 mg, 300 mg diltiazem hcl er mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg diltiazem hcl er mg, 180 mg, 240 mg, 300 mg, 360 mg diltiazem hcl er mg, 60 mg, 90 mg diltiazem hcl er mg QL QL WellCare Advocate Complete FIDA (TTY: )

53 diltiazem hcl * 125 mg/25ml, 25 mg/5ml, 50 mg/10ml diltiazem hcl 120 mg, 30 mg, 60 mg, 90 mg dilt-xr mg, 180 mg, 240 mg diltzac mg, 180 mg, 240 mg, 300 mg felodipine er 24 * 10 mg felodipine er 24 * 2.5 mg QL felodipine er 24 * 5 mg QL isradipine 2.5 mg, 5 mg nicardipine hcl 20 mg, 30 mg nifedical xl 24 * 30 mg QL nifedical xl 24 * 60 mg nifedipine er 24 * 30 mg QL nifedipine er 24 * 60 mg, 90 mg nifedipine er osmotic 24 * 30 mg QL nifedipine er osmotic 24 * 60 mg, 90 mg WellCare Advocate Complete FIDA (TTY: )

54 nimodipine 30 mg NYMALIZE 60 MG/20ML taztia xt mg, 180 mg, 240 mg, 300 mg, 360 mg verapamil hcl er mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg verapamil hcl er mg verapamil hcl er * 120 mg, 180 mg, 240 mg verapamil hcl * 2.5 mg/ml verapamil hcl 120 mg, 40 mg, 80 mg digitek 125 mcg QL digitek 250 mcg PA digoxin 0.25 mg/ml digoxin 0.05 mg/ml PA digoxin mg QL digoxin 250 mcg PA TEKTURNA HCT MG, MG QL WellCare Advocate Complete FIDA (TTY: )

55 TEKTURNA HCT MG QL TEKTURNA HCT MG TEKTURNA 150 MG QL TEKTURNA 300 MG acetazolamide er mg acetazolamide 125 mg, 250 mg amiloride hcl 5 mg amiloride-hydrochlorothiazide 5-50 mg bumetanide 0.25 mg/ml bumetanide 0.5 mg, 1 mg, 2 mg chlorothiazide 250 mg, 500 mg chlorthalidone 25 mg, 50 mg furosemide 10 mg/ml furosemide 10 mg/ml, 8 mg/ml furosemide 20 mg, 40 mg, 80 mg hydrochlorothiazide 12.5 mg hydrochlorothiazide 12.5 mg, 25 mg, 50 mg WellCare Advocate Complete FIDA (TTY: )

56 indapamide 1.25 mg, 2.5 mg methazolamide 25 mg, 50 mg methyclothiazide 5 mg metolazone 10 mg, 2.5 mg, 5 mg spironolactone-hctz mg torsemide * 50 mg/5ml torsemide 10 mg, 100 mg, 20 mg, 5 mg triamterene-hctz mg triamterene-hctz mg, mg clonidine hcl 0.1 mg, 0.2 mg, 0.3 mg clonidine hcl 0.1 mg mg mg 24 DEMSER 250 MG hydralazine hcl 20 mg/ml hydralazine hcl 10 mg, 100 mg, 25 mg, 50 mg midodrine hcl 10 mg, 2.5 mg, 5 mg minoxidil 10 mg, 2.5 mg WellCare Advocate Complete FIDA (TTY: )

57 RANEXA 12 * 1000 MG, 500 MG isosorbide dinitrate er * 40 mg isosorbide dinitrate 10 mg, 20 mg, 30 mg, 5 mg isosorbide mononitrate er 24 * 120 mg, 30 mg, 60 mg isosorbide mononitrate 10 mg, 20 mg minitran mg0.2 mg 0.4 mg0.6 mg nitro-bid 2 % NITRO-DUR MG0.8 MG nitroglycerin mg0.2 mg 0.4 mg0.6 mg NITROSTAT SUBLINGUAL 0.3 MG, 0.4 MG, 0.6 MG ADEMPAS 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG PA; LA ; QL LETAIRIS 10 MG, 5 MG PA; LA ; QL OPSUMIT 10 MG PA; LA ; QL WellCare Advocate Complete FIDA (TTY: )

58 REMODULIN 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML B/D; LA REVATIO 10 MG/ML PA; QL ML sildenafil citrate 20 mg PA; QL TRACLEER 125 MG PA; LA ; QL TRACLEER 62.5 MG PA; LA ; QL alprazolam 0.25 mg QL alprazolam 0.5 mg QL alprazolam 1 mg QL alprazolam 2 mg QL buspirone hcl 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg fluvoxamine maleate 100 mg fluvoxamine maleate 25 mg, 50 mg QL lorazepam 2 mg/ml, 4 mg/ml lorazepam intensol 2 mg/ml QL ML lorazepam 0.5 mg, 1 mg, 2 mg QL APTIOM 200 MG QL APTIOM 400 MG QL APTIOM 600 MG QL APTIOM 800 MG QL WellCare Advocate Complete FIDA (TTY: )

59 BANZEL 40 MG/ML PA BANZEL 200 MG, 400 MG PA carbamazepine er mg, 200 mg, 300 mg carbamazepine er 12 * 200 mg, 400 mg carbamazepine 100 mg/5ml carbamazepine 200 mg carbamazepine 100 mg CELONTIN 300 MG clonazepam 0.5 mg QL clonazepam 1 mg QL clonazepam 2 mg QL clonazepam mg QL clonazepam 0.25 mg QL clonazepam 0.5 mg QL clonazepam 1 mg QL clonazepam 2 mg QL clorazepate dipotassium 15 mg PA; QL WellCare Advocate Complete FIDA (TTY: )

60 clorazepate dipotassium 3.75 mg, 7.5 mg PA; QL diazepam 10 mg, 2.5 mg, 20 mg diazepam 5 mg/ml diazepam intensol 5 mg/ml PA; QL ML diazepam 1 mg/ml PA; QL ML diazepam 10 mg, 2 mg, 5 mg PA; QL dilantin infatabs 50 mg dilantin 100 mg, 30 mg DILANTIN 125 MG/5ML divalproex sodium er 24 * 250 mg, 500 mg divalproex sodium 125 mg divalproex sodium 125 mg, 250 mg, 500 mg epitol 200 mg ethosuximide 250 mg ethosuximide 250 mg/5ml felbamate 600 mg/5ml felbamate 400 mg felbamate 600 mg FYCOMPA 10 MG, 12 MG, 8 MG PA; QL WellCare Advocate Complete FIDA (TTY: )

61 FYCOMPA 2 MG PA; QL FYCOMPA 4 MG PA; QL FYCOMPA 6 MG PA; QL gabapentin 100 mg QL gabapentin 300 mg QL gabapentin 400 mg QL gabapentin 250 mg/5ml QL ML gabapentin 600 mg QL gabapentin 800 mg QL GABITRIL 12 MG, 16 MG lamotrigine er 24 * 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg lamotrigine 100 mg, 150 mg, 200 mg, 25 mg lamotrigine 25 mg, 5 mg levetiracetam er 24 * 500 mg, 750 mg LEVETIRACETAM IN NACL * 1000 MG/100ML, 1500 MG/100ML, 500 MG/100ML levetiracetam * 500 mg/5ml levetiracetam 100 mg/ml levetiracetam 1000 mg, 250 mg, 500 mg, 750 mg WellCare Advocate Complete FIDA (TTY: )

62 LYRICA 100 MG, 150 MG, 25 MG, 50 MG, 75 MG QL LYRICA 200 MG QL LYRICA 225 MG, 300 MG QL LYRICA 20 MG/ML QL ML ONFI 2.5 MG/ML PA ONFI 10 MG, 20 MG PA oxcarbazepine 300 mg/5ml oxcarbazepine 150 mg, 300 mg, 600 mg PEGANONE 250 MG phenobarbital 20 mg/5ml PA phenobarbital 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, PA 60 mg, 64.8 mg, 97.2 mg phenobarbital sodium 130 mg/ml PA PHENOBARBITAL SODIUM 65 MG/ML PA phenytek 200 mg, 300 mg phenytoin 125 mg/5ml phenytoin 50 mg phenytoin sodium extended 100 mg, 200 mg, 300 mg phenytoin sodium 50 mg/ml POTIGA 200 MG QL WellCare Advocate Complete FIDA (TTY: )

63 POTIGA 300 MG, 400 MG QL POTIGA 50 MG primidone 250 mg, 50 mg SABRIL 500 MG PA; LA ; QL SABRIL 500 MG PA; LA ; QL TEGRETOL 100 MG/5ML TEGRETOL 200 MG TEGRETOL-XR 12 * 100 MG, 200 MG, 400 MG tiagabine hcl 2 mg, 4 mg topiramate 15 mg, 25 mg topiramate 100 mg, 200 mg, 25 mg, 50 mg valproate sodium * 500 mg/5ml valproic acid 250 mg valproic acid 250 mg/5ml VIMPAT * 200 MG/20ML VIMPAT 10 MG/ML QL ML VIMPAT 100 MG, 150 MG, 200 MG QL VIMPAT 50 MG QL zonisamide 100 mg, 25 mg, 50 mg WellCare Advocate Complete FIDA (TTY: )

64 donepezil hcl 10 mg, 23 mg donepezil hcl 5 mg QL donepezil hcl 10 mg donepezil hcl 5 mg QL EXELON MG MG 24 QL MG 24 galantamine hydrobromide er mg, QL mg galantamine hydrobromide er mg galantamine hydrobromide 4 mg/ml galantamine hydrobromide 12 mg galantamine hydrobromide 4 mg QL galantamine hydrobromide 8 mg QL NAMENDA 10 MG/5ML PA NAMENDA 10 MG, 5 MG PA NAMENDA XR MG, 21 MG, 28 MG, 7 MG PA WellCare Advocate Complete FIDA (TTY: )

65 NAMENDA XR 24 7 & 14 & 21 PA rivastigmine tartrate 1.5 mg, 3 mg, 4.5 mg, 6 mg amitriptyline hcl 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, PA 75 mg amoxapine 100 mg, 150 mg, 25 mg, 50 mg BRINTELLIX 10 MG QL BRINTELLIX 20 MG QL BRINTELLIX 5 MG QL bupropion hcl er (sr) 12 * 100 mg, 150 mg, 200 mg bupropion hcl er (xl) 24 * 150 mg QL bupropion hcl er (xl) 24 * 300 mg QL bupropion hcl 100 mg, 75 mg citalopram hydrobromide 10 mg/5ml citalopram hydrobromide 10 mg, 20 mg QL citalopram hydrobromide 40 mg QL clomipramine hcl 25 mg, 50 mg, 75 mg PA WellCare Advocate Complete FIDA (TTY: )

66 desipramine hcl 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg doxepin hcl 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, PA 75 mg doxepin hcl 10 mg/ml PA duloxetine hcl 20 mg, 30 mg, 60 mg QL EMSAM MG 24 6 MG 24 PA; QL MG 24 escitalopram oxalate 5 mg/5ml QL ML escitalopram oxalate 10 mg, 5 mg QL escitalopram oxalate 20 mg QL FETZIMA MG, 80 MG QL FETZIMA MG QL FETZIMA MG QL FETZIMA TITRATION ORAL 20 & 40 MG fluoxetine hcl 10 mg QL fluoxetine hcl 20 mg QL fluoxetine hcl 40 mg fluoxetine hcl 20 mg/5ml WellCare Advocate Complete FIDA (TTY: )

67 fluoxetine hcl 10 mg QL fluoxetine hcl 20 mg imipramine hcl 10 mg, 25 mg, 50 mg PA maprotiline hcl 25 mg, 50 mg, 75 mg MARPLAN 10 MG QL mirtazapine 15 mg, 7.5 mg QL mirtazapine 30 mg, 45 mg mirtazapine 15 mg QL mirtazapine 30 mg, 45 mg nefazodone hcl 100 mg, 150 mg, 200 mg, 250 mg, 50 mg nortriptyline hcl 10 mg, 25 mg, 50 mg, 75 mg nortriptyline hcl 10 mg/5ml paroxetine hcl 10 mg, 20 mg, 40 mg QL paroxetine hcl 30 mg QL PAXIL 10 MG/5ML QL ML phenelzine sulfate 15 mg PRISTIQ 24 * 100 MG, 25 MG, 50 MG QL protriptyline hcl 10 mg, 5 mg WellCare Advocate Complete FIDA (TTY: )

68 sertraline hcl 20 mg/ml sertraline hcl 100 mg sertraline hcl 25 mg, 50 mg QL SURMONTIL 100 MG PA; QL SURMONTIL 25 MG PA; QL SURMONTIL 50 MG PA; QL tranylcypromine sulfate 10 mg trazodone hcl 100 mg, 150 mg, 50 mg venlafaxine hcl er mg QL venlafaxine hcl er mg, 75 mg QL venlafaxine hcl 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg VIIBRYD 10 & 20 & 40 MG VIIBRYD 10 MG, 20 MG, 40 MG QL amantadine hcl 100 mg amantadine hcl 50 mg/5ml amantadine hcl 100 mg APOKYN * 10 MG/ML PA; LA AZILECT 0.5 MG, 1 MG WellCare Advocate Complete FIDA (TTY: )

69 benztrnpine mesylate 1 mg/ml benztrnpine mesylate 0.5 mg, 1 mg, 2 mg PA bromocriptine mesylate 5 mg bromocriptine mesylate 2.5 mg carbidopa-levodopa er * mg, mg carbidopa-levodopa mg, mg, mg carbidopa-levodopa mg, mg, mg carbidopa-levodopa-entacapone mg, mg, mg, mg, mg, mg entacapone 200 mg NEUPRO 24 1 MG 24 2 MG 24 3 MG 24 4 MG 24 6 MG 24 8 MG 24 pramipexole dihydrochloride mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg ropinirole hcl 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg selegiline hcl 5 mg WellCare Advocate Complete FIDA (TTY: )

70 selegiline hcl 5 mg trihexyphenidyl hcl 0.4 mg/ml PA trihexyphenidyl hcl 2 mg, 5 mg PA ABILIFY DISCMELT 10 MG QL ABILIFY MAINTENA * 300 MG, 400 MG QL 28 1 aripiprazole 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg QL chlorpromazine hcl 25 mg/ml chlorpromazine hcl 10 mg, 100 mg, 200 mg, 25 mg, 50 mg clozapine 100 mg QL clozapine 200 mg QL clozapine 25 mg, 50 mg clozapine 100 mg PA; QL clozapine 12.5 mg, 25 mg PA CLOZAPINE 150 MG PA; QL CLOZAPINE 200 MG PA; QL FANAPT 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG ST; QL WellCare Advocate Complete FIDA (TTY: )

71 FANAPT 1 & 2 & 4 & 6 MG ST FAZACLO 150 MG PA; QL FAZACLO 200 MG PA; QL fluphenazine decanoate 25 mg/ml fluphenazine hcl 2.5 mg/ml fluphenazine hcl 5 mg/ml fluphenazine hcl 2.5 mg/5ml fluphenazine hcl 1 mg, 10 mg, 2.5 mg, 5 mg GEODON * 20 MG QL 3 6 haloperidol decanoate * 100 mg/ml, 50 mg/ml haloperidol lactate 5 mg/ml haloperidol lactate 2 mg/ml haloperidol 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg INVEGA 24 * 1.5 MG, 3 MG, 9 MG QL INVEGA 24 * 6 MG QL WellCare Advocate Complete FIDA (TTY: )

72 INVEGA SUSTENNA * 117 MG/0.75ML QL ML INVEGA SUSTENNA * 156 MG/ML QL 28 1 ML INVEGA SUSTENNA * 234 MG/1.5ML QL ML INVEGA SUSTENNA * 39 MG/0.25ML QL ML INVEGA SUSTENNA * 78 MG/0.5ML QL ML LATUDA 120 MG, 40 MG QL LATUDA 20 MG QL LATUDA 60 MG, 80 MG QL loxapine succinate 10 mg, 25 mg, 5 mg, 50 mg olanzapine * 10 mg QL 1 3 olanzapine 10 mg, 15 mg, 20 mg QL olanzapine 2.5 mg, 5 mg, 7.5 mg QL olanzapine 10 mg, 15 mg, 20 mg QL olanzapine 5 mg QL WellCare Advocate Complete FIDA (TTY: )

73 ORAP 1 MG, 2 MG perphenazine 16 mg, 2 mg, 4 mg, 8 mg quetiapine fumarate 100 mg, 200 mg, 25 mg, 300 mg, QL mg, 50 mg RISPERDAL CONSTA * 12.5 MG, 25 MG, QL MG, 50 MG risperidone 1 mg/ml QL ML risperidone 0.25 mg, 0.5 mg QL risperidone 1 mg, 2 mg, 3 mg QL risperidone 4 mg QL risperidone 0.25 mg, 0.5 mg QL risperidone 1 mg, 2 mg, 3 mg QL risperidone 4 mg QL SAPHRIS SUBLINGUAL 10 MG QL SAPHRIS SUBLINGUAL 2.5 MG QL SAPHRIS SUBLINGUAL 5 MG QL SEROQUEL XR 24 * 150 MG, 200 MG QL WellCare Advocate Complete FIDA (TTY: )

74 SEROQUEL XR 24 * 300 MG, 400 MG SEROQUEL XR 24 * 50 MG thioridazine hcl 10 mg, 100 mg, 25 mg, 50 mg thiothixene 1 mg, 10 mg, 2 mg, 5 mg trifluoperazine hcl 1 mg, 10 mg, 2 mg, 5 mg VERSACLOZ 50 MG/ML ziprasidone hcl 20 mg, 40 mg ziprasidone hcl 60 mg, 80 mg ZYPREXA RELPREVV * 210 MG, 300 MG ZYPREXA RELPREVV * 405 MG amphetamine-dextroamphet er mg, 5 mg amphetamine-dextroamphet er mg, 20 mg, 25 mg, 30 mg QL QL PA PA; QL ML QL QL PA; QL 28 2 PA; QL 28 1 QL QL WellCare Advocate Complete FIDA (TTY: )

75 amphetamine-dextroamphetamine 10 mg amphetamine-dextroamphetamine 12.5 mg amphetamine-dextroamphetamine 15 mg amphetamine-dextroamphetamine 20 mg amphetamine-dextroamphetamine 30 mg amphetamine-dextroamphetamine 5 mg amphetamine-dextroamphetamine 7.5 mg guanfacine hcl er 24 * 1 mg, 2 mg, 3 mg, 4 mg metadate er * 20 mg methylphenidate hcl er * 10 mg, 20 mg methylphenidate hcl 10 mg/5ml methylphenidate hcl 5 mg/5ml methylphenidate hcl 10 mg, 5 mg methylphenidate hcl 20 mg STRATTERA 10 MG, 18 MG, 25 MG QL QL QL QL QL QL QL PA QL QL QL ML QL ML QL QL QL WellCare Advocate Complete FIDA (TTY: )

76 STRATTERA 100 MG, 60 MG, 80 MG QL STRATTERA 40 MG QL HETLIOZ 20 MG PA; LA ROZEREM 8 MG QL SILENOR 3 MG QL SILENOR 6 MG QL temazepam 15 mg PA; QL temazepam 7.5 mg PA; QL zolpidem tartrate 10 mg, 5 mg PA; QL dihydroergotamine mesylate 1 mg/ml naratriptan hcl 1 mg, 2.5 mg QL 30 9 RELPAX 20 MG, 40 MG QL rizatriptan benzoate 10 mg, 5 mg QL rizatriptan benzoate 10 mg, 5 mg QL sumatriptan 20 mg/act QL sumatriptan 5 mg/act QL sumatriptan succinate 100 mg, 25 mg, 50 mg QL 30 9 sumatriptan succinate refill * 4 mg/0.5ml, 6 mg/0.5ml QL 30 6 ML WellCare Advocate Complete FIDA (TTY: )

77 sumatriptan succinate * 4 mg/0.5ml QL 30 6 ML sumatriptan succinate * 6 mg/0.5ml QL 30 6 ML sumatriptan succinate * 6 mg/0.5ml QL 30 6 ML zolmitriptan 2.5 mg, 5 mg QL zolmitriptan 2.5 mg, 5 mg QL lithium carbonate er * 300 mg, 450 mg lithium carbonate 150 mg, 300 mg, 600 mg lithium carbonate 300 mg LITHIUM 8 MEQ/5ML NUEDEXTA MG PA pyridostigmine bromide 60 mg riluzole 50 mg XENAZINE 12.5 MG PA; LA ; QL XENAZINE 25 MG PA; LA ; QL AMPYRA 12 * 10 MG PA; LA BETASERON * 0.3 MG PA; QL COPAXONE * 40 MG/ML PA; QL ML WellCare Advocate Complete FIDA (TTY: )

78 GILENYA 0.5 MG PA; QL glatopa * 20 mg/ml PA; QL ML TYSABRI * 300 MG/15ML PA; LA baclofen 10 mg, 20 mg dantrolene sodium 100 mg, 25 mg, 50 mg tizanidine hcl 2 mg, 4 mg NUVIGIL 150 MG PA; QL NUVIGIL 200 MG, 250 MG PA; QL NUVIGIL 50 MG PA; QL XYREM 500 MG/ML PA; LA ; QL ML - acamprosate calcium 333 mg buprenorphine hcl sublingual 2 mg, 8 mg PA buprenorphine hcl-naloxone hcl sublingual mg, PA; QL mg buproban 12 * 150 mg CHANTIX 1 MG PA CHANTIX 0.5 MG, 1 MG PA WellCare Advocate Complete FIDA (TTY: )

79 CHANTIX 0.5 MG X 11 & 1 MG X 42 PA disulfiram 250 mg, 500 mg naloxone hcl 0.4 mg/ml, 1 mg/ml naltrexone hcl 50 mg NICOTROL INHALATION 10 MG NICOTROL NS 10 MG/ML SUBOXONE 12-3 MG PA; QL SUBOXONE MG, 4-1 MG, 8-2 MG PA; QL ANDRODERM 24 2 MG 24 4 MG 24 PA; QL AXIRON 30 MG/ACT PA; QL ML oxandrolone 10 mg PA oxandrolone 2.5 mg PA testosterone cypionate * 100 mg/ml, 200 mg/ml PA testosterone enanthate * 200 mg/ml PA WellCare Advocate Complete FIDA (TTY: )

80 ASSURE ID 29G X 1/2 1 ML BYDUREON * 2 MG QL 28 4 BYDUREON * 2 MG QL 28 4 BYETTA 10 MCG * 10 MCG/0.04ML QL ML BYETTA 5 MCG * 5 MCG/0.02ML QL ML EXCEL COMFORT 29G X 12MM GLOBAL 70 % HUMULIN R U-500 * 500 ML B/D 29G X 1/2 0.3 ML, 29G X 1/2 1 ML LANTUS SOLOSTAR * 100 ML LANTUS * 100 ML LEVEMIR FLEXTOUCH * 100 ML LEVEMIR * 100 ML NOVOLIN 70/30 * (70-30) 100 ML NOVOLIN N * 100 ML WellCare Advocate Complete FIDA (TTY: )

81 NOVOLIN R 100 ML NOVOLOG FLEX * 100 ML NOVOLOG MIX 70/30 FLEX * (70-30) 100 ML NOVOLOG MIX 70/30 * (70-30) 100 ML NOVOLOG PENFILL * 100 ML NOVOLOG * 100 ML PREFERRED PLUS 28G X 1/2 0.5 ML RA 2 X2 SYMLINPEN 120 * 2700 MCG/2.7ML PA; QL ML SYMLINPEN 60 * 1500 MCG/1.5ML PA; QL ML VICTOZA * 18 MG/3ML QL 30 9 ML acarbose 100 mg, 25 mg, 50 mg FARXIGA 10 MG QL FARXIGA 5 MG QL glimepiride 1 mg QL glimepiride 2 mg QL glimepiride 4 mg QL WellCare Advocate Complete FIDA (TTY: )

82 glipizide er 24 * 10 mg QL glipizide er 24 * 2.5 mg QL glipizide er 24 * 5 mg QL glipizide 10 mg QL glipizide 5 mg QL glipizide-metformin hcl mg QL glipizide-metformin hcl mg, mg QL INVOKAMET MG, MG, QL MG INVOKAMET MG QL INVOKANA 100 MG QL INVOKANA 300 MG QL JANUMET MG, MG QL JANUMET XR 24 * MG QL JANUMET XR 24 * MG, QL MG JANUVIA 100 MG, 25 MG, 50 MG QL JENTADUETO MG, MG, MG QL WellCare Advocate Complete FIDA (TTY: )

83 metformin hcl er 24 * 500 mg QL metformin hcl er 24 * 750 mg QL metformin hcl 1000 mg QL metformin hcl 500 mg QL metformin hcl 850 mg QL nateglinide 120 mg, 60 mg QL pioglitazone hcl 15 mg, 30 mg, 45 mg QL repaglinide 0.5 mg, 1 mg QL repaglinide 2 mg QL TRADJENTA 5 MG QL ONETOUCH ULTRA 2 ONETOUCH ULTRA BLUE ONETOUCH ULTRA MINI ONETOUCH ULTRA SYSTEM ONETOUCH ULTRASMART Part B $0 Part B $0 Part B $0 Part B $0 Part B $0 NDC ( ); QL NDC ( , , ); QL NDC ( , , , , , ); QL NDC ( ); QL NDC ( ); QL WellCare Advocate Complete FIDA (TTY: )

84 ONETOUCH VERIO Part B $0 ONETOUCH VERIO IQ SYSTEM Part B $0 ONETOUCH VERIO Part B $0 ONETOUCH VERIO SYNC SYSTEM alendronate sodium 10 mg, 40 mg, 5 mg alendronate sodium 35 mg, 70 mg ibandronate sodium 150 mg pamidronate disodium * 30 mg/10ml, 6 mg/ml, 90 mg/10ml zoledronic acid * 4 mg/5ml zoledronic acid * 5 mg/100ml SENSIPAR 30 MG, 90 MG Part B $0 NDC ( , , ); QL NDC ( ); QL NDC ( ); QL NDC ( ); QL QL 28 4 B/D; QL 30 1 B/D B/D B/D QL SENSIPAR 60 MG QL CHEMET 100 MG DEPEN TITRATABS 250 MG WellCare Advocate Complete FIDA (TTY: )

85 EXJADE 125 MG, 250 MG, 500 MG PA; LA FERRIPROX 500 MG PA; LA kionex kionex 15 gm/60ml sodium polystyrene sulfonate 15 gm/60ml sps 15 gm/60ml SYPRINE 250 MG altavera mg-mcg apri mg-mcg aranelle 0.5/1/ mg-mcg aubra mg-mcg aviane mg-mcg balziva mg-mcg briellyn mg-mcg camila 0.35 mg cryselle mg-mcg cyclafem 1/ mg-mcg cyclafem 7/7/7 0.5/0.75/1-35 mg-mcg deblitane 0.35 mg delyla mg-mcg desogestrel-ethinyl estradiol /0.01 mg (21/5) drospirenone-ethinyl estradiol mg WellCare Advocate Complete FIDA (TTY: )

86 emoquette mg-mcg enpresse-28 errin 0.35 mg falmina mg-mcg gianvi mg gildagia mg-mcg gildess 1.5/ mg-mcg heather 0.35 mg introvale mg jolessa mg jolivette 0.35 mg junel 1.5/ mg-mcg junel 1/ mg-mcg junel fe 1.5/ mg-mcg junel fe 1/ mg-mcg kariva /0.01 mg (21/5) kelnor 1/ mg-mcg larin 1.5/ mg-mcg larin 1/ mg-mcg larin fe 1.5/ mg-mcg larin fe 1/ mg-mcg WellCare Advocate Complete FIDA (TTY: )

87 leena 0.5/1/ mg-mcg lessina mg-mcg levonest levonorgest-eth estrad mg levonorgestrel 0.75 mg, 1.5 mg levonorgestrel-ethinyl estrad mg-mcg levora 0.15/30 (28) mg-mcg loryna mg low-ogestrel mg-mcg lutera mg-mcg lyza 0.35 mg marlissa mg-mcg medroxyprogesterone acetate * 150 mg/ml microgestin 1.5/ mg-mcg microgestin 1/ mg-mcg microgestin fe 1.5/ mg-mcg microgestin fe 1/ mg-mcg mononessa mg-mcg WellCare Advocate Complete FIDA (TTY: )

88 myzilra necon 0.5/35 (28) mg-mcg necon 1/35 (28) 1-35 mg-mcg necon 1/50 (28) 1-50 mg-mcg necon 10/11 (28) 35 mcg necon 7/7/7 0.5/0.75/1-35 mg-mcg next choice one dose 1.5 mg nikki mg nora-be 0.35 mg norethindrone 0.35 mg norgestim-eth estrad triphasic 0.18/0.215/0.25 mg-35 mcg norlyroc 0.35 mg nortrel 0.5/35 (28) mg-mcg nortrel 1/35 (21) 1-35 mg-mcg nortrel 1/35 (28) 1-35 mg-mcg nortrel 7/7/7 0.5/0.75/1-35 mg-mcg NUVARING MG 24 ocella mg orsythia mg-mcg philith mg-mcg WellCare Advocate Complete FIDA (TTY: )

89 pimtrea /0.01 mg (21/5) pirmella 1/ mg-mcg portia mg-mcg previfem mg-mcg quasense mg reclipsen mg-mcg sharobel 0.35 mg solia mg-mcg sprintec mg-mcg sronyx mg-mcg syeda mg tarina fe 1/ mg-mcg tri-legest fe 1-20/1-30/1-35 mg-mcg trinessa (28) 0.18/0.215/0.25 mg-35 mcg tri-previfem 0.18/0.215/0.25 mg-35 mcg tri-sprintec 0.18/0.215/0.25 mg-35 mcg trivora (28) velivet 0.1/0.125/ mg vestura mg WellCare Advocate Complete FIDA (TTY: )

90 viorele /0.01 mg (21/5) vyfemla mg-mcg xulane mcg 24 zarah mg zenchent mg-mcg zovia 1/35e (28) 1-35 mg-mcg zovia 1/50e (28) 1-50 mg-mcg danazol 100 mg, 200 mg, 50 mg SYNAREL 2 MG/ML ADAGEN * 250 ML PA; LA ALDURAZYME * 2.9 MG/5ML PA; LA CARBAGLU 200 MG PA; LA CERDELGA 84 MG PA CEREZYME * 200, 400 PA; LA CYSTADANE LA CYSTAGON 150 MG, 50 MG PA; LA FABRAZYME * 35 MG, 5 MG PA; LA WellCare Advocate Complete FIDA (TTY: )

91 KUVAN 100 MG, 500 MG PA; LA KUVAN 100 MG PA; LA levocarnitine * 200 mg/ml B/D levocarnitine 1 gm/10ml B/D levocarnitine 330 mg B/D LUMIZYME * 50 MG PA; LA MYOZYME * 50 MG PA; LA NAGLAZYME * 1 MG/ML PA; LA ORFADIN 10 MG, 2 MG, 5 MG PA; LA RAVICTI 1.1 GM/ML PA sodium phenylbutyrate 3 gm/tsp ZAVESCA 100 MG PA; LA DELESTROGEN * 10 MG/ML estrace 0.1 mg/gm estradiol 0.5 mg, 1 mg, 2 mg PA estradiol mg mg mg mg mg mg 24 PA WellCare Advocate Complete FIDA (TTY: )

92 estradiol valerate * 20 mg/ml, 40 mg/ml jinteli 1-5 mg-mcg PA norethindrone-eth estradiol 1-5 mg-mcg PA VAGIFEM 10 MCG a-hydrocort 100 mg cortisone acetate 25 mg dexamethasone intensol 1 mg/ml dexamethasone 0.5 mg/5ml dexamethasone 0.5 mg/5ml dexamethasone 0.5 mg, 0.75mg, 1 mg, 1.5mg, 2 mg, 4 mg, 6 mg dexamethasone sod phosphate pf 10 mg/ml dexamethasone sodium phosphate 10 mg/ml, 100 mg/10ml, 120 mg/30ml, 20 mg/5ml fludrocortisone acetate 0.1 mg hydrocortisone 10 mg, 20 mg, 5 mg methylprednisolone (pak) 4 mg B/D methylprednisolone acetate 40 mg/ml, 80 mg/ml B/D WellCare Advocate Complete FIDA (TTY: )

93 methylprednisolone 16 mg, 32 mg, 4 mg, 8 mg B/D methylprednisolone sodium succ 1 gm, 125 mg, B/D 40 mg prednisolone 15 mg/5ml B/D prednisolone sodium phosphate 15 mg/5ml, 25 mg/5ml, B/D 6.7 (5 base) mg/5ml prednisone (pak) 10 mg, 5 mg B/D prednisone intensol 5 mg/ml B/D prednisone 5 mg/5ml B/D prednisone 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg B/D SOLU-CORTEF 250 MG GLUCAGEN HYPOKIT 1 MG GLUCAGON 1 MG KORLYM 300 MG PA; LA PROGLYCEM 50 MG/ML NORDITROPIN FLEXPRO * 10 MG/1.5ML, 15 MG/1.5ML, 5 MG/1.5ML PA WellCare Advocate Complete FIDA (TTY: )

94 NORDITROPIN NORDIFLEX * 30 MG/3ML PA cabergoline 0.5 mg calcitonin (salmon) 200 act FORTICAL 200 ACT INCRELEX * 40 MG/4ML PA; LA methylergonovine maleate 0.2 mg MIACALCIN 200 ML B/D octreotide acetate 100 mcg/ml, 50 mcg/ml PA octreotide acetate 1000 mcg/ml, 200 mcg/ml, PA 500 mcg/ml PROLIA * 60 MG/ML QL ML raloxifene hcl 60 mg SANDOSTATIN LAR DEPOT * 10 MG, 20 MG, 30 MG PA SIGNIFOR * 0.3 MG/ML, 0.6 MG/ML, 0.9 MG/ML PA; LA WellCare Advocate Complete FIDA (TTY: )

95 SOMATULINE DEPOT * 120 MG/0.5ML, 60 MG/0.2ML, PA 90 MG/0.3ML SOMAVERT * 10 MG, 15 MG, 20 MG, 25 MG, 30 MG PA; LA XGEVA * 120 MG/1.7ML PA FORTEO * 600 MCG/2.4ML PA; QL ML NATPARA * 100 MCG, 25 MCG, 50 MCG, 75 MCG PA calcium acetate 667 mg RENVELA 0.8 GM, 2.4 GM RENVELA 800 MG medroxyprogesterone acetate 10 mg, 2.5 mg, 5 mg norethindrone acetate 5 mg levothyroxine sodium 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg WellCare Advocate Complete FIDA (TTY: )

96 levoxyl 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg liothyronine sodium 25 mcg, 5 mcg, 50 mcg methimazole 10 mg, 5 mg propylthiouracil 50 mg SYNTHROID 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG unithroid 100 mcg, 112 mcg, 125 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg desmopressin ace 0.01 % desmopressin ace 0.01 % desmopressin acetate 4 mcg/ml desmopressin acetate 0.1 mg, 0.2 mg desmopressin acetate spray 0.01 % compro 25 mg WellCare Advocate Complete FIDA (TTY: )

97 dronabinol 10 mg B/D; QL dronabinol 2.5 mg, 5 mg B/D; QL EMEND 125 MG, 40 MG, 80 & 125 MG, 80 MG B/D granisetron hcl * 0.1 mg/ml, 1 mg/ml, 4 mg/4ml granisetron hcl 1 mg B/D meclizine hcl 12.5 mg, 25 mg metoclopramide hcl 5 mg/ml metoclopramide hcl 5 mg/5ml metoclopramide hcl 10 mg, 5 mg ondansetron hcl 4 mg/2ml, 40 mg/20ml ondansetron hcl 4 mg/5ml B/D ondansetron hcl 24 mg, 4 mg, 8 mg B/D ondansetron 4 mg, 8 mg B/D phenadoz 12.5 mg PA phenergan 12.5 mg, 25 mg, 50 mg PA prochlorperazine edisylate 5 mg/ml prochlorperazine maleate 10 mg, 5 mg prochlorperazine 25 mg WellCare Advocate Complete FIDA (TTY: )

98 promethazine hcl 25 mg/ml, 50 mg/ml PA promethazine hcl 6.25 mg/5ml PA promethazine hcl 12.5 mg, 25 mg, 50 mg PA promethazine hcl 12.5 mg, 25 mg, 50 mg PA promethegan 25 mg, 50 mg PA TRANSDERM-SCOP 72 1 MG/3 PA; QL CUVPOSA 1 MG/5ML dicyclomine hcl 10 mg dicyclomine hcl 10 mg/5ml dicyclomine hcl 20 mg glycopyrrolate 4 mg/20ml glycopyrrolate 1 mg, 2 mg H2 famotidine * 20 mg/2ml, 200 mg/20ml, 40 mg/4ml famotidine 40 mg/5ml famotidine 20 mg, 40 mg famotidine premixed * mg/50ml-% WellCare Advocate Complete FIDA (TTY: )

99 ranitidine hcl 150 mg/6ml, 50 mg/2ml ranitidine hcl 15 mg/ml ranitidine hcl 150 mg, 300 mg APRISO GM ASACOL HD 800 MG balsalazide disodium 750 mg budesonide er 24 3 mg CANASA 1000 MG colocort 100 mg/60ml DELZICOL 400 MG DIPENTUM 250 MG hydrocortisone 100 mg/60ml mesalamine 4 gm mesalamine 4 gm sulfasalazine 500 mg sulfazine ec 500 mg UCERIS 24 * 9 MG constulose 10 gm/15ml enulose 10 gm/15ml WellCare Advocate Complete FIDA (TTY: )

100 gavilyte-c 240 gm gavilyte-g 236 gm gavilyte-h mg-gm gavilyte-n 420 gm generlac 10 gm/15ml GOLYTELY GM, 236 GM lactulose encephalopathy 10 gm/15ml lactulose 10 gm/15ml MOVIPREP 100 GM NULYTELY 420 GM peg 3350/electrolytes 240 gm peg 3350-kcl-na bicarb-nacl 420 gm peg-3350/electrolytes 236 gm polyethylene glycol 3350 polyethylene glycol 3350 RELISTOR * 12 MG/0.6ML, 8 MG/0.4ML PA WellCare Advocate Complete FIDA (TTY: )

101 SUPREP trilyte 420 gm alosetron hcl 0.5 mg, 1 mg PA AMITIZA 24 MCG, 8 MCG QL cromolyn sodium 100 mg/5ml diphenoxylate-atropine mg/5ml diphenoxylate-atropine mg GATTEX * 5 MG PA; LA LINZESS 145 MCG QL LINZESS 290 MCG QL loperamide hcl 2 mg misoprostol 100 mcg, 200 mcg MOVANTIK 12.5 MG QL MOVANTIK 25 MG QL SUCRAID 8500 ML LA sucralfate 1 gm ursodiol 300 mg ursodiol 250 mg, 500 mg XIFAXAN 550 MG PA WellCare Advocate Complete FIDA (TTY: )

102 CREON 12000, 24000, , 36000, 6000 ZENPEP 10000, 15000, 20000, 25000, , 40000, 5000 DEXILANT 30 MG, 60 MG QL esomeprazole sodium * 20 mg, 40 mg NEXIUM 20 MG, 40 MG QL NEXIUM 10 MG, 20 MG, 40 MG QL NEXIUM 2.5 MG, 5 MG omeprazole 10 mg, 40 mg QL omeprazole 20 mg QL pantoprazole sodium 20 mg, 40 mg QL alfuzosin hcl er 24 * 10 mg QL AVODART 0.5 MG QL WellCare Advocate Complete FIDA (TTY: )

103 finasteride 5 mg JALYN MG QL tamsulosin hcl 0.4 mg bethanechol chloride 10 mg, 25 mg, 5 mg, 50 mg ELMIRON 100 MG potassium citrate er * 10 meq (1080 mg), 5 meq (540 mg) MYRBETRIQ 24 * 25 MG QL MYRBETRIQ 24 * 50 MG QL oxybutynin chloride er 24 * 10 mg, 15 mg QL oxybutynin chloride er 24 * 5 mg QL oxybutynin chloride 5 mg/5ml oxybutynin chloride 5 mg tolterodine tartrate er 24 2 mg, 4 mg QL tolterodine tartrate 1 mg, 2 mg TOVIAZ 24 * 4 MG, 8 MG QL trospium chloride 20 mg QL WellCare Advocate Complete FIDA (TTY: )

104 VESICARE 10 MG, 5 MG QL clindamycin phosphate 2 % metronidazole 0.75 % terconazole 0.4 %, 0.8 % terconazole 80 mg vandazole 0.75 % zazole 0.4 % zazole 0.8 % COUMADIN 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG ELIQUIS 2.5 MG, 5 MG enoxaparin sodium 300 mg/3ml enoxaparin sodium * 100 mg/ml, 120 mg/0.8ml, 150 mg/ml enoxaparin sodium * 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml fondaparinux sodium * 10 mg/0.8ml, 5 mg/0.4ml, 7.5 mg/0.6ml WellCare Advocate Complete FIDA (TTY: )

105 fondaparinux sodium * 2.5 mg/0.5ml HEPARIN (PORCINE) D5W * 40-5 ML-%, 50-5 ML-% HEPARIN (PORCINE) NACL ML-%, ML-% HEPARIN SOD (PORCINE) D5W * 100 ML heparin sodium (porcine) 1000 ml, ml, B/D ml, 5000 ml HEPARIN SODIUM (PORCINE) 2500 ML B/D HEPARIN SODIUM (PORCINE) * 2000 ML B/D jantoven 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg PRADAXA 150 MG, 75 MG warfarin sodium 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg XARELTO 10 MG, 15 MG, 20 MG XARELTO 15 & 20 MG WellCare Advocate Complete FIDA (TTY: )

106 GRANIX * 300 MCG/0.5ML, 480 MCG/0.8ML PA LEUKINE * 250 MCG PA MOZOBIL * 24 MG/1.2ML PA NEUMEGA * 5 MG NEUPOGEN 300 MCG/0.5ML, 300 MCG/ML, PA 480 MCG/0.8ML, 480 MCG/1.6ML PROCRIT ML, 2000 ML, ML, PA 3000 ML, 4000 ML, ML anagrelide hcl 0.5 mg, 1 mg cilostazol 100 mg, 50 mg CINRYZE * 500 PA; LA FIRAZYR * 30 MG/3ML PA pentoxifylline er * 400 mg PROMACTA 12.5 MG PA; LA ; QL PROMACTA 25 MG PA; LA ; QL PROMACTA 50 MG PA; LA ; QL PROMACTA 75 MG PA; LA ; QL WellCare Advocate Complete FIDA (TTY: )

107 tranexamic acid * 100 mg/ml tranexamic acid 650 mg AGGRENOX MG BRILINTA 90 MG clopidogrel bisulfate 75 mg EFFIENT 10 MG, 5 MG ZONTIVITY 2.08 MG (DMARDS) CIMZIA PREFILLED * 2 X 200 MG/ML PA CIMZIA STARTER KIT * 6 X 200 MG/ML PA CIMZIA * 2 X 200 MG PA HUMIRA * 40 MG/0.8ML PA HUMIRA PEN-CROHNS * 40 MG/0.8ML PA HUMIRA PEN-PSORIASIS * 40 MG/0.8ML PA WellCare Advocate Complete FIDA (TTY: )

108 HUMIRA * 10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML PA hydroxychloroquine sulfate 200 mg leflunomide 10 mg, 20 mg methotrexate 2.5 mg REMICADE * 100 MG PA BIVIGAM * 10 GM/100ML, 5 GM/50ML PA CARIMUNE NF * 12 GM PA FLEBOGAMMA DIF * 0.5 GM/10ML, 10 GM/100ML, 10 GM/200ML, 2.5 GM/50ML, PA 20 GM/200ML, 20 GM/400ML, 5 GM/100ML, 5 GM/50ML FLEBOGAMMA * 0.5 GM/10ML PA GAMASTAN S/D * B/D GAMMAGARD 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, PA 30 GM/300ML, 5 GM/50ML GAMMAGARD S/D * 2.5 GM PA WellCare Advocate Complete FIDA (TTY: )

109 GAMMAGARD S/D LESS IGA * 10 GM, 5 GM PA GAMMAKED 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, PA 20 GM/200ML, 5 GM/50ML GAMMAPLEX * 10 GM/200ML, 5 GM/100ML PA GAMUNEX-C 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 40 GM/400ML, PA 5 GM/50ML OCTAGAM * 1 GM/20ML, 10 GM/200ML, 2 GM/20ML, 2.5 GM/50ML, 25 GM/500ML, PA 5 GM/100ML PRIVIGEN * 10 GM/100ML, 20 GM/200ML, 40 GM/400ML, PA 5 GM/50ML ACTIMMUNE * ML PA; LA ARCALYST * 220 MG PA INTRON A ML, B/D ML INTRON A , , B/D WellCare Advocate Complete FIDA (TTY: )

110 REVLIMID 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, PA; LA 5 MG THALOMID 100 MG, 150 MG, 200 MG, 50 MG PA azathioprine 50 mg B/D BENLYSTA * 120 MG PA cyclosporine * 50 mg/ml B/D cyclosporine modified 100 mg, 25 mg, 50 mg B/D cyclosporine modified 100 mg/ml B/D cyclosporine 100 mg, 25 mg B/D gengraf 100 mg, 25 mg B/D gengraf 100 mg/ml B/D mycophenolate mofetil 250 mg B/D mycophenolate mofetil 200 mg/ml B/D mycophenolate mofetil 500 mg B/D mycophenolic acid 180 mg B/D mycophenolic acid 360 mg B/D NEORAL 100 MG, 25 MG B/D WellCare Advocate Complete FIDA (TTY: )

111 NEORAL 100 MG/ML B/D NULOJIX * 250 MG B/D PROGRAF 0.5 MG, 1 MG, 5 MG B/D RAPAMUNE 1 MG/ML B/D SANDIMMUNE 100 MG/ML B/D sirolimus 0.5 mg, 1 mg B/D SIROLIMUS 2 MG B/D tacrolimus 0.5 mg, 1 mg B/D tacrolimus 5 mg B/D ZORTRESS 0.25 MG, 0.5 MG, 0.75 MG B/D ACTHIB * NM ADACEL * LF-MCG/0.5 NM BCG VACCINE NM BEXSERO * NM BOOSTRIX * NM CERVARIX * NM COMVAX * MCG/0.5ML NM WellCare Advocate Complete FIDA (TTY: )

112 DAPTACEL * NM DIPHTHERIA-TETANUS TOXOIDS DT * 25-5 LFU/0.5ML B/D; NM ENGERIX-B 10 MCG/0.5ML, 20 MCG/ML B/D; NM GARDASIL 9 * NM GARDASIL 9 * NM GARDASIL * NM HAVRIX * 1440 EL U/ML, 720 EL U/0.5ML NM HIBERIX 10 MCG NM IMOVAX RABIES * 2.5 ML NM INFANRIX * NM IPOL NM IXIARO * NM MENACTRA * NM MENOMUNE * NM MENVEO * NM M-M-R II * NM WellCare Advocate Complete FIDA (TTY: )

113 PEDVAX HIB * 7.5 MCG/0.5ML NM PROQUAD * NM RABAVERT * NM RECOMBIVAX HB 10 MCG/ML, 40 MCG/ML, B/D; NM 5 MCG/0.5ML ROTARIX NM ROTATEQ NM SYNAGIS * 100 MG/ML, 50 MG/0.5ML NM TENIVAC * 5-2 LFU B/D; NM TETANUS-DIPHTHERIA TOXOIDS TD * 2-2 LF/0.5ML B/D; NM TRUMENBA * NM TWINRIX * NM TYPHIM VI * 25 MCG/0.5ML NM VAQTA * ML, 50 ML NM VARIVAX * 1350 PFU/0.5ML NM YF-VAX * NM WellCare Advocate Complete FIDA (TTY: )

114 ZOSTAVAX * UNT/0.65ML NM; QL * mg ABREVA 10 % ACEPHEN 120 MG, 325 MG, 650 MG ACEROLA C MG acetaminophen mg acetaminophen junior strength 160 mg acetaminophen 160 mg/5ml ACID GONE MG/15ML ACID GONE MG acid reducer 10 mg acidophilus/l-sporogenes 5 5 % 10 % advanced calcium formula 200 mg ADVIL MG WellCare Advocate Complete FIDA (TTY: )

115 ADVIL MG ADVIL MG ADVIL JUNIOR STRENGTH 100 MG AFRIN 0.25 % ALA-HIST IR 2 MG ALA-HIST PE 2-10 MG all day allergy-d 12 * mg all day pain relief 220 mg ALLEGRA 30 MG aller-ease 60 mg 25 mg 10 mg, 25 mg aluminum hydroxide gel 320 mg/5ml ambi 12.5cpd/1dcpm/30pse mg/5ml ambi 40pse/400gfn/20dm mg antacid mg/5ml anti-diarrheal 1 mg/5ml anti-diarrheal 2 mg antifungal 2 % antioxidant formula sg * WellCare Advocate Complete FIDA (TTY: )

116 apap mg/5ml ap-hist dm mg/5ml AQUADEKS AQUA-E 30-2 MG/ML AQUANIL HC 1 % artificial tears 1.4 % ascorbic acid aspirin ec 325 mg aspirin 325 mg, 81 mg aspirin 300 mg, 600 mg athletes 1 % AXID AR 75 MG AYR SALINE 0.65 % AYR SALINE NASAL b complex b complex B-12 DOTS 500 MCG b mcg b mcg b-12 sublingual 2500 mcg bacitracin 500 gm WellCare Advocate Complete FIDA (TTY: )

117 bacitracin zinc 500 gm b-complex/vitamin c bee zee benzonatate 100 mg, 200 mg benzoyl peroxide 6 % benzoyl peroxide 2.5 % benzoyl peroxide 5 % beta carotene biospec dmx mg/5ml biotin 300 mcg B-NATAL 25 MG B-NATAL 25 MG BONE DENSITY MG- bone meal BOUDREAUXS BUTT PASTE 16 % brohist d 4-10 mg c mg cal/mag mg CALCET CREAMY BITES MG WellCare Advocate Complete FIDA (TTY: )

118 CALCET PETITES MG- CALCI-MIX 1250 MG calcionate 1.8 gm/5ml cal-citrate plus vitamin d mg- calcium + d mg-unt-mcg calcium + d mg- calcium d mg- calcium mg-mg- calcium 500/d mg- calcium 500+d high potency mg- calcium mg calcium 600/vitamin d mg- calcium 600+d plus minerals mg- calcium 600+d plus minerals mg- calcium antacid 750 mg calcium antacid 500 mg calcium antacid ultra 1000 mg WellCare Advocate Complete FIDA (TTY: )

119 calcium ascorbate 500 mg calcium carbonate 800 mg/2gm calcium carbonate 1250 mg/5ml calcium carbonate 1250 mg calcium carbonate 260 mg calcium carbonate-vitamin d mg- calcium citrate + d mg-, mg- calcium citrate malate-vit d mg- calcium citrate 760 mg/3.5gm calcium citrate 250 mg calcium citrate-vitamin d mg- calcium for women calcium gluconate 50 mg, 500 mg calcium gummies mg- calcium lactate 100 mg, 648 mg, 650 mg calcium 500 mg calcium pantothenate 500 mg WellCare Advocate Complete FIDA (TTY: )

120 calcium soft chews mg-unt-mcg calcium/c/d mg-mg- calcium+d3 gradual release 24 * mg-mg- calcium-magnesium mg, mg calcium-magnesium-vitamin d mg-mg- calcium-magnesium-zinc mg calcium-vitamin d mg-, mg- calmag thins mg CAL-QUICK MG-UNT/5ML CALTRATE 600+D SOFT MG- castellani paint modified 1.5 % CENTRUM KIDS COMPLETE 60 MG CENTRUM SILVER CEROVITE cetirizine hcl 5 mg cetirizine hcl 10 mg, 5 mg WellCare Advocate Complete FIDA (TTY: )

121 chelated calcium 200 mg chewable calcium mg-unt-mcg chewable vite chewable vite/iron 15 mg childrens acetaminophen 80 mg childrens cold & allergy mg/5ml childrens complete allergy 12.5 mg childrens non-aspirin 80 mg childrens plus & mg/5ml childrens plus cold mg/5ml chlo tuss ex mg/5ml chlorpheniramine maleate er * 12 mg CITRACAL CALCIUM GUMMIES MG-MG- CITRACAL PLUS HEART HEALTH MG--MG citrus calcium +d mg WellCare Advocate Complete FIDA (TTY: )

122 citrus calcium/vitamin d mg- CLARITIN 5 MG CLARITIN REDITABS 5 MG classic prenatal mg clotrimazole 3 2 % clotrimazole 1 % cod liver oil codituss dm mg/5ml cold head congestion severe mg mg/5ml mg/10ml complete mg COMTREX & MG CONEX 1-30 MG/5ML CONEX 2-60 MG CONTAC MG WellCare Advocate Complete FIDA (TTY: )

123 coral calcium mg-mg-, mg-mg-, mg- coral calcium plus mg-mg- CORICIDIN HBP MG CORTIZONE-10 1 % 4-30 mg mg/15ml cough dm extendedrelease* 30 mg/5ml cromolyn sodium 5.2 mg/act cvs calcium citrate 200 mg cvs easy fiber/calcium cvs hydrocortisone acetate 0.5 % cvs 500 mg cvs 1 % cvs % cvs nasal mist 0.9 % cvs 500 mg/15ml WellCare Advocate Complete FIDA (TTY: )

124 cvs probiotic (lactobacillus) cvs senna-extra 17.2 mg cvs 50 mg cvs vitamin b mg cvs vitamin c 1000 mg cyanocobalamin 1000 mcg/ml CYTO B2 343 MG/GM d d d D d daily-vite/iron/beta-carotene day-time sinus mg DELTUSS DP 1-30 MG/5ML DESENEX 2 % DESENEX 2 % DESITIN 13 % DIALYVITE MG DIALYVITE 800-ZINC WellCare Advocate Complete FIDA (TTY: )

125 DIALYVITE VITAMIN D3 MAX DIMETAPP MG/5ML DIMETAPP MG/5ML diphenhydramine hcl 50 mg docusate sodium 50 mg/5ml DOK 100 MG double antibiotic gm DRAMAMINE 25 MG dual action complete mg DURAFLU MG ecee plus ECOTRIN 500 MG ed bron gp mg/5ml ED CHLORPED D 2-5 MG/ML ed chlorped jr 2 mg/5ml ED CHLORPED 2 MG/ML WellCare Advocate Complete FIDA (TTY: )

126 ed-a-hist dm mg/5ml ed-apap 160 mg/5ml ELDERTONIC enema 7-19 gm/118ml enema mineral oil ENEMEEZ MINI 283 MG ENEMEEZ PLUS MG entre-cough mg/5ml entre-hist pse mg/ml ENUCLENE 0.25 % e-oil 100 unt/0.25ml epsom salt eq 12.5 mg eql 1 % eql calcium/vitamin d mg- eql childrens calcium gummies mg-mg- eql eql iron 200 (65 fe) mg eql lice solution % WellCare Advocate Complete FIDA (TTY: )

127 eql oyster shell calcium/d mg- EQUALACTIN 625 MG exefen-ir mg EX-LAX ULTRA 5 MG eye drops % eye drops 0.05 % eye wash EZFE (200 FE) MG ezfe forte mg FEBROL 325 MG/5ML fer-iron 75 (15 fe) mg/ml ferretts ips 40 mg/15ml ferretts 325 (106 fe) mg FERRIMIN MG ferrous fumarate 29 mg, 90 mg ferrous gluconate 225 (27 fe) mg, 240 (27 fe) mg, 324 (38 fe) mg ferrous sulfate er * 140 (45 fe) mg ferrous sulfate 220 (44 fe) mg/5ml WellCare Advocate Complete FIDA (TTY: )

128 ferrous sulfate 220 (44 fe) mg/5ml ferrous sulfate 300 (60 fe) mg/5ml ferrous sulfate 324 (65 fe) mg, 325 (65 fe) mg FEVERALL 80 MG fexofenadine hcl childrens 30 mg/5ml fexofenadine hcl 180 mg fiber fiber fiber laxative 625 mg fiber FLEET BISACODYL 10 MG/30ML FLORANEX FLORASTOR KIDS 250 MG FOLGARD folic acid 5 mg/ml folic acid 20 mg folic acid 1 mg, 400 mcg, 800 mcg FOLITAB 500 * MG FOLTABS MCG-MG-MCG WellCare Advocate Complete FIDA (TTY: )

129 FRESHKOTE % FUNGICURE INTENSIVE/NAILGUARD 1 % FUNGOID TINCTURE 2 % FUNGOID TINCTURE 2 % GAVISCON EXTRA RELIEF FORMULA MG/10ML GAVISCON MG gentian violet 1 %, 2 % gentle laxative 10 mg geravim gnp antacid & anti-gas mg gnp artificial tears 5-6 mg/ml gnp calcium mg- gnp childrens chewables/ex c gnp childrens mg/5ml gnp mg gnp mg WellCare Advocate Complete FIDA (TTY: )

130 gnp foaming antacid mg gnp iron * 142 (45 fe) mg gnp mg/15ml gnp 60 mg/15ml GONIOTAIRE 2.5 % goodsense all day allergy 10 mg goodsense pain relief pm mg guaifenesin dm mg guaifenesin-codeine mg/5ml GUMMI BEAR MULTIVITAMIN/MIN headache pm mg hm 12.5 mg/5ml hm famotidine 20 mg hm rapid melts junior 160 mg HONEY BEARS HONEY BEARS W/IRON-ZINC HYDROCIL 95 % WellCare Advocate Complete FIDA (TTY: )

131 hydrocortisone 0.5 % hydrocortisone 0.5 % hydrocortisone-aloe 0.5 %, 1 % hydroxocobalamin * 1000 mcg/ml HYPOTEARS 1-1 % ibuprofen junior strength 100 mg ibuprofen 200 mg ibuprofen pm mg ICAPS LUTEIN-ZEAXANTHIN * ICAPS MV ICAPS infants ibuprofen 50 mg/1.25ml infants pain relief 80 mg/0.8ml INTEGRA MG intense mg intense mg/5ml IROMIN-G iron (ferrous gluconate) 256 (28 fe) mg WellCare Advocate Complete FIDA (TTY: )

132 iron 100 plus mg iron 100/c mg iron chews pediatric 15 mg iron 90 (18 fe) mg IRON UP 15 MG/0.5ML ISOPTO TEARS 0.5 % J-MAX MG/5ML J-TAN D PD MG/ML J-TAN PD 1 MG/ML k mcg KAOPECTATE 262 MG/15ML kidkare mg/5ml kls acid reducer 150 mg KONSYL 520 MG KONSYL 100 %, 28.3 % KONSYL 28.3 %, 30.9 %, 60.3 %, % KONSYL-D 52.3 % kp b complex-c kp benzoyl peroxide 10 %, 5 % kp calcium 600+d mg WellCare Advocate Complete FIDA (TTY: )

133 kp calcium 600+d mg- kp calcium-magnesium-zinc mg kp ferrous gluconate 324 (37.5 fe) mg kp ferrous sulfate 325 (65 fe) mg kp hydrocortisone 1 % kp ketotifen fumarate % kp pseudoephedrine hcl 60 mg kp terbinafine hydrochloride 1 % kp vitamin d 1000 kp vitamin e 100 kpn prenatal 0.1 mg LAMISIL ADVANCED 1 % LAMISIL AF DEFENSE 1 % laxative pills 25 mg lice killing % lice killing % lice treatment 1 % liquid calcium with d mg- liquid calcium/vitamin d mg WellCare Advocate Complete FIDA (TTY: )

134 liquituss gg 200 mg/5ml localnesium mg localnesium-c mg LODRANE D 4-60 MG LOHIST-D 2-30 MG/5ML lohist-dm mg/5ml lohist-peb 4-10 mg/5ml loperamide hcl 1 mg/7.5ml loratadine 10 mg loratadine-pseudoephedrine er 24 * mg LOTRIMIN ULTRA 1 % lubricating plus 0.5 % LUMITENE 30 MG MAALOX 400 MG MAALOX MG/5ML mag-al mg/5ml mag-delay * 535 (64 mg) mg MAGINEX 615 MG WellCare Advocate Complete FIDA (TTY: )

135 MAGNEBIND MG magnesium citrate gm/30ml magnesium citrate 100 mg magnesium 300 mg, 400 mg magnesium 200 mg, 30 mg magnesium oxide 400 mg magnesium oxide 250 mg, 400 (240 mg) mg, 400 mg, 420 mg, 500 mg MAG-TAB SR * 84 MG (7MEQ) MAPAP COLD FORMULA MULTI-SYMPT MG m-end dmx mg/5ml MEPHYTON 5 MG MERIBIN 5 MG METAMUCIL MULTIHEALTH FIBER 63 % METAMUCIL METAMUCIL 28 % MEXSANA 10.8 % WellCare Advocate Complete FIDA (TTY: )

136 MI-ACID MG miconazole mg-% miconazole 3 combo pack mg-% (9gm) miconazole 3 4 % miconazole 3 miconazole 7 2 % miconazole mg milk of magnesia concentrate 2400 mg/10ml milk of magnesia 1200 mg/15ml mineral oil MINTOX PLUS MG MISSION PRENATAL HP MISSION PRENATAL motion 25 mg MOTRIN IB 200 MG mucaphed mg MUCINEX MG MUCINEX D 12 * MG, MG MUCINEX FAST-MAX MG WellCare Advocate Complete FIDA (TTY: )

137 MUCINEX 100 MG MUCINEX 12 * 1200 MG mucus mg/20ml mucus mg/5ml mucus relief er 12 * 600 mg mucus relief 400 mg mucus-dm max 12 * mg mucus-dm 12 * mg multi-delyn multi-delyn/iron multi-symptom mg/10ml MURO % my way 1.5 mg MYKIDZ IRON MG/1.5ML MYKIDZ IRON 10 MG/2ML naproxen sodium 220 mg nasal decongestant 30 mg/5ml WellCare Advocate Complete FIDA (TTY: )

138 nasal decongestant 30 mg/5ml nasal decongestant pe 10 mg 0.05 % NASCOBAL 500 MCG/0.1ML NASOPEN PE MG/15ML natural fiber laxative 68 % natural fiber therapy % natures tears 0.4 % neotuss mg/5ml NEPHRONEX NEXAFED 30 MG NEXAFED SINUS PRESSURE + PAIN MG niacin er * 250 mg, 500 mg niacin er * 1000 mg, 500 mg, 750 mg niacin 100 mg, 50 mg, 500 mg niacinamide 100 mg, 500 mg nicotine polacrilex 2 mg, 4 mg WellCare Advocate Complete FIDA (TTY: )

139 nicotine polacrilex 2 mg, 4 mg nicotine mg 24 nicotine mg mg 24 7 mg 24 night-time sinus mg nohist-lq 4-10 mg/5ml NOREL AD MG NOVAFERRUM MG-UNT/5ML NOVAFERRUM 15 MG/ML NU-IRON 150 MG NUTRISOURCE FIBER NUTRISOURCE FIBER omeprazole 20 mg organ-i nr 200 mg OS-CAL EXTRA D MG- OSTEO-PORETICAL MG- OYSCO MG oyster shell calcium 250+d mg- oyster shell calcium/d mg- pain relief 8 * 650 mg WellCare Advocate Complete FIDA (TTY: )

140 160 mg/5ml 500 mg pain reliever 325 mg PANOXYL 10 % PANOXYL 10 % PANOXYL-4 CREAMY 4 % parva-cal mg- PEDIACARE 7.5 MG/5ML PEDIA-LAX 50 MG/15ML PEPCID AC 10 MG peptic 262 mg PERDIEM 15 MG permethrin 1 % PERRY PRENATAL MG PHENAGIL MG phos-nak mg polyvitamin 35 mg/ml polyvitamin/iron 10 mg/ml prenatal mg WellCare Advocate Complete FIDA (TTY: )

141 PRETZ PRILOSEC OTC 20 MG pro-chlo mg/5ml PROFE (180 FE) MG PRONUTRIENTS CALCIUM+D MG- pseudoeph-bromphen-dm mg/5ml psyldex 30 % PURE & GENTLE LUBRICANT 0.3 % pyrethins-piperonyl butoxide % pyridoxine hcl 100 mg/ml pyrilamine-phenylephrine 5-16 mg/5ml pyrilamine-phenylephrine mg qc 3 day 4 % qc natural vegetable 95 % q-pap infants 80 mg/0.8ml Q-TAPP DM MG/5ML ra anti-itch 1 % WellCare Advocate Complete FIDA (TTY: )

142 ra b-complex/vitamin c cr * ra beta carotene 15 mg ra calamine % ra calcium 600/vit d/minerals mg- ra calcium-boron mg ra central-vite performance ra col-rite 50 mg ra coral calcium mg- ra high potency iron 27 mg ra hydrocortisone plus 0.5 % ra ibuprofen 100 mg/5ml ra lubricant eye % ra magnesium 500 mg ra mg ra omeprazole-sodium bicarb mg ra ophthalmic 5 % ra oyster shell calcium/d mg-, mg- ra probiotic complex WellCare Advocate Complete FIDA (TTY: )

143 ra severe cold/sinus relief pe mg ra slow release iron * 45 mg, 47.5 mg ra soluble fiber 500 mg ra vitamin c drops 60 mg ra vitamin c/rose hips cr * 1000 mg ranitidine hcl 75 mg REFRESH CELLUVISC 1 % REFRESH OPTIVE ADVANCED % REFRESH P.M. REGULOID %, 58.6 % REHYDRALYTE RESCON DM MG/5ML RESCON 2-60 MG RESPAIRE MG RETAINE MGD % RHINARIS 0.2 % RHINARIS 0.2 % RID ESSENTIAL % RISA-BID PROBIOTIC WellCare Advocate Complete FIDA (TTY: )

144 RISAMINE % robafen cf mg/5ml robafen 15 mg ROBITUSSIN CF MG/5ML ROBITUSSIN LA MG/5ML ROBITUSSIN LA 7.5 MG/5ML ROBITUSSIN MG ROBITUSSIN LINGERING LA 15 MG/5ML ROBITUSSIN 100 MG/5ML ROBITUSSIN MAX MG/5ML ROBITUSSIN PEAK COLD MG/5ML rymed 2-10 mg rynex dm mg/5ml rynex pse 1-15 mg/5ml saline gm/5ml sb fib lax orange 33 % sb lice treatment % WellCare Advocate Complete FIDA (TTY: )

145 sb natural fiber laxative 49 % SCOOBY-DOO ONE A DAY SCOT-TUSSIN DM 2-15 MG/5ML SCOT-TUSSIN SENIOR MG/5ML SECURA EXTRA PROTECTIVE 30.6 % SECURA PROTECTIVE 10 % selenium er * 200 mcg selenium 100 mcg senna laxative 8.6 mg senna 8.6 mg senna 176 mg/5ml, 8.8 mg/5ml SENNA PROMPT MG senna s mg SENSI-CARE PROTECTIVE BARRIER % sleep aid 25 mg SLO-NIACIN * 250 MG slow magnesium/calcium mg slow release iron * 140 (45 fe) mg, 50 mg WellCare Advocate Complete FIDA (TTY: )

146 SLOW-MAG MG sm adult nasal decongestant 15 mg/5ml sm calcium/vitamin d mg- sm calcium-magnesium-zinc mg SM CORAL CALCIUM 1000 (390 CA) MG sm iron slow release * 160 (50 fe) mg sm lansoprazole 15 mg sm magnesium oxide 250 mg sm motion 50 mg sm redness relief % sm slow release iron * 143 (45 fe) mg sm vitamin b12 tr * 2000 mcg sm vitamin c cr * 500 mg sm vitamin d sodium bicarbonate sodium chloride 5 % WellCare Advocate Complete FIDA (TTY: )

147 SOLUBLE FIBER THERAPY SOOTHE % SOOTHE 262 MG sorbulax 100 % stahist ad mg/5ml stahist ad mg STERILE 0.7 % stomach relief 525 mg/15ml laxative dc 240 mg 100 mg SUMMERS EVE DISP MEDICATED 0.3 % SYSTANE BALANCE 0.6 % SYSTANE SYSTANE 0.3 % TEARS AGAIN % tg 10peh/380gfn mg tg 10peh/380gfn/15dm mg tgt cough formula dm max adult mg/5ml WellCare Advocate Complete FIDA (TTY: )

148 tgt % tgt mg tgt % tgt pain reliever pm mg th calcium-magnesium-zinc mg th eye drop tears % THERA/BETA-CAROTENE THERA-D THERANATAL CORE NUTRITION 27-1 MG THERATEARS 0.25 % thiamine hcl 100 mg/ml tioconazole % TITRALAC 420 MG tolnaftate 1 % tolnaftate 1 % tolnaftate 1 % total b/c triacting mg/5ml WellCare Advocate Complete FIDA (TTY: )

149 TRIAMINIC 12.5 MG TRIAMINIC 160 MG/5ML TRIAMINIC MG/5ML tri-buffered aspirin 325 mg triple antibiotic triple paste af 2 % TRIPLE PASTE 12.8 % TRI-VI-SOL MG/ML TRI-VITA MG/ML tri-vitamin TUSNEL MG/5ML TUSNEL MG/5ML, MG/ML TUSNEL-DM PEDIATRIC MG/ML tussin cf mg/5ml tussin dm mg/5ml tussi-pres b mg/5ml WellCare Advocate Complete FIDA (TTY: )

150 UPCAL D MG- UPCAL D MG-UNT/5GM VAGISTAT MG-% (9GM) VICKS DAYQUIL MUCUS CONTROL DM MG/15ML VICKS NYQUIL D MG/30ML VICKS VAPORUB % VISINE-LR % VITALETS 40 MG VITAMELTS ENERGY VITAMIN B MCG vitamin a & d vitamin a palmitate vitamin b mg, 50 mg vitamin b mcg/15ml vitamin b mcg, 500 mcg WellCare Advocate Complete FIDA (TTY: )

151 vitamin b-12 sublingual 1000 mcg vitamin b12-folic acid mcg vitamin b-2 25 mg, 50 mg vitamin b-6 er * 200 mg vitamin b mg, 25 mg, 50 mg vitamin c (calcium ascorbate) vitamin c 500 mg/5ml vitamin c 100 mg, 250 mg, 500 mg vitamin c 100 mg, 250 mg vitamin d (ergocalciferol) vitamin d 1000, 2000 vitamin d2 2000, 400 vitamin d3 2000, 400, 5000 vitamin d ml, 400 ml, 5000 ml vitamin d3 3000, 400 vitamin e 1000, 200 vitamin e ml WellCare Advocate Complete FIDA (TTY: )

152 vitamin e 100 vitamin e-selenium mcg vitamin k (phytonadione) 100 mcg vitamin k1 1 mg/0.5ml, 10 mg/ml vitatrum WAL-ACT MG WAL-DRYL MG WAL-DRYL-D MG WAL-FEX D 12 * MG WAL-FLU MG WAL-ITIN D 12 * MG WAL-ITIN 5 MG/5ML WAL-PHED PE 4-10 MG WAL-PHED 4-60 MG wal-som 50 mg wee care 15 mg/1.25ml WellCare Advocate Complete FIDA (TTY: )

153 zinc oxide 20 %, 40 % zinc oxide 25 % ZONATUSS 150 MG zoo friends complete 30 mg klor-con 10 * 10 meq klor-con m15 * 15 meq klor-con m20 * 20 meq klor-con 20 meq klor-con * 8 meq MAGNESIUM SULFATE D5W * 10-5 MG/ML-%, 20-5 MG/ML-% MAGNESIUM SULFATE 40 MG/ML, 80 MG/ML magnesium sulfate 50 % potassium chloride crys er * 10 meq, 20 meq potassium chloride er * 10 meq, 8 meq potassium chloride er * 10 meq, 20 meq WellCare Advocate Complete FIDA (TTY: )

154 potassium chloride er * 8 meq potassium chloride 20 meq/15ml (10%), 40 meq/15ml (20%) sodium chloride 2.5 meq/ml sodium fluoride 2.2 (1 f) mg TPN ELECTROLYTES * B/D AMINOSYN II * 10 %, 7 %, 8.5 % B/D AMINOSYN II/ELECTROLYTES * 8.5 % B/D AMINOSYN * 10 %, 8.5 % B/D AMINOSYN M * 3.5 % B/D AMINOSYN/ELECTROLYTES * 7 %, 8.5% B/D AMINOSYN-HBC * 7 % B/D AMINOSYN-PF * 10 %, 7 % B/D AMINOSYN-RF * 5.2 % B/D CLINIMIX/DEXTROSE (2.75/5) * 2.75 % B/D WellCare Advocate Complete FIDA (TTY: )

155 CLINIMIX/DEXTROSE (4.25/10) * 4.25 % B/D CLINIMIX/DEXTROSE (4.25/20) * 4.25 % B/D CLINIMIX/DEXTROSE (4.25/25) * 4.25 % B/D CLINIMIX/DEXTROSE (4.25/5) * 4.25 % B/D CLINIMIX/DEXTROSE (5/15) * 5 % B/D CLINIMIX/DEXTROSE (5/20) * 5 % B/D CLINIMIX/DEXTROSE (5/25) * 5 % B/D FREAMINE HBC * 6.9 % B/D FREAMINE III * 10 % B/D HEPATAMINE * 8 % B/D INTRALIPID * 20 %, 30 % B/D NEPHRAMINE * 5.4 % B/D NUTRILIPID * 20 % B/D premasol * 10 % B/D premasol * 6 % B/D PROCALAMINE * 3 % B/D WellCare Advocate Complete FIDA (TTY: )

156 PROSOL * 20 % B/D TRAVASOL * 10 % B/D TROPHAMINE * 10 % B/D DEXTROSE 5%/ELECTROLYTE #48 * dextrose lactated ringers * 5 % dextrose * 10 %, 5 %, 50 %, 70 % DEXTROSE-NACL * % dextrose-nacl * %, %, %, %, %, %, %, % IONOSOL-B D5W * IONOSOL-MB D5W * ISOLYTE-P D5W * ISOLYTE-S * WellCare Advocate Complete FIDA (TTY: )

157 kcl dextmse-nacl * meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-%, meq/l-%-% KCL DEXTROSE-NACL * MEQ/L-%-% lactated ringers * normosol-m d5w * NORMOSOL-R D5W * NORMOSOL-R PH 7.4 * PLASMA-LYTE 148 * PLASMA-LYTE A * PLASMA-LYTE-56 D5W * potassium chloride dextrose * 20-5 meq/l-%, 40-5 meq/l-% potassium chloride nacl * meq/l-%, meq/l-%, meq/l-% WellCare Advocate Complete FIDA (TTY: )

158 potassium chloride * 0.4 meq/ml, 10 meq/100ml, 10 meq/50ml, 20 meq/100ml, 40 meq/100ml potassium chloride * 2 meq/ml ringers * sodium chloride * 0.45 %, 0.9 %, 3 %, 5 % calcitriol * 1 mcg/ml B/D calcitriol 0.25 mcg, 0.5 mcg B/D calcitriol 1 mcg/ml B/D paricalcitol 1 mcg, 2 mcg, 4 mcg B/D prenatal 27-1 mg azelastine hcl 0.05 % BEPREVE 1.5 % cromolyn sodium 4 % LASTACAFT 0.25 % PATADAY 0.2% PAZEO 0.7% WellCare Advocate Complete FIDA (TTY: )

159 ALPHAGAN P 0.1 % AZOPT 1% betaxolol hcl 0.5 % BETOPTIC-S 0.25 % brimonidine tartrate 0.15 % brimonidine tartrate 0.2 % carteolol hcl 1 % COMBIGAN % dorzolamide hcl 2 % dorzolamide hcl-timolol mal mg/ml ISTALOL 0.5 % latanoprost % levobunolol hcl 0.25 % levobunolol hcl 0.5 % LUMIGAN 0.01 % WellCare Advocate Complete FIDA (TTY: )

160 metipranolol 0.3% PHOSPHOLINE IODIDE % pilocarpine hcl 1 %, 2 %, 4 % SIMBRINZA % timolol maleate 0.25 %, 0.5 % timolol maleate 0.25 %, 0.5 % TRAVATAN Z % bacitra-neomycin-polymyxin-hc 1 % blephamide s.o.p % neomycin-polymyxin-dexameth neomycin-polymyxin-dexameth neomycin-polymyxin-hc sulfacetamide-prednisolone % TOBRADEX % WellCare Advocate Complete FIDA (TTY: )

161 TOBRADEX ST % tobramycin-dexamethasone % ZYLET % bacitracin 500 gm bacitracin-polymyxin b gm BESIVANCE 0.6 % CILOXAN 0.3 % ciprofloxacin hcl 0.3 % erythromycin 5 mg/gm gatifloxacin 0.5 % gentak 0.3 % gentamicin sulfate 0.3 % gentamicin sulfate 0.3 % ilotycin 5 mg/gm MOXEZA 0.5 % NATACYN 5 % WellCare Advocate Complete FIDA (TTY: )

162 neomycin-bacitracin zn-polymyx neomycin-polymyxin-gramicidin ofloxacin 0.3 % polymyxin b-trimethoprim ml-% sulfacetamide sodium 10 % sulfacetamide sodium 10 % tobramycin 0.3 % TOBREX 0.3 % trifluridine 1 % VIGAMOX 0.5 % ZIRGAN OPHTHALMIC 0.15 % ALREX 0.2 % bromfenac sodium 0.09 % bromfenac sodium 0.09 % dexamethasone sodium phosphate 0.1 % diclofenac sodium 0.1 % WellCare Advocate Complete FIDA (TTY: )

163 DUREZOL 0.05 % fluorometholone 0.1 % flurbiprofen sodium 0.03 % ILEVRO 0.3 % ketorolac tromethamine 0.4 %, 0.5 % LOTEMAX 0.5 % LOTEMAX 0.5 % LOTEMAX 0.5 % MAXIDEX 0.1 % prednisolone acetate 1 % prednisolone sodium phosphate 1 % naphazoline hcl 0.1 % PROLENSA 0.07 % proparacaine hcl 0.5 % RESTASIS 0.05 % QL WellCare Advocate Complete FIDA (TTY: )

164 ANORO ELLIPTA MCG/INH QL COMBIVENT RESPIMAT MCG/ACT QL 30 8 GM ipratropium-albuterol (3) mg/3ml B/D ANTICHOLINERGICS ATROVENT HFA 17 MCG/ACT QL GM INCRUSE ELLIPTA 62.5 MCG/INH QL ipratropium bromide 0.02 % B/D ipratropium bromide 0.03 %, 0.06 % ASTEPRO 0.15 % azelastine hcl 0.1 %, 0.15 % cetirizine hcl 1 mg/ml diphenhydramine hcl 50 mg/ml hydroxyzine hcl * 25 mg/ml, 50 mg/ml PA hydroxyzine hcl 10 mg/5ml PA WellCare Advocate Complete FIDA (TTY: )

165 hydroxyzine hcl 10 mg, 25 mg, 50 mg PA hydroxyzine pamoate 100 mg, 25 mg, 50 mg PA levocetirizine dihydrochloride 2.5 mg/5ml levocetirizine dihydrochloride 5 mg olopatadine hcl 0.6 % - albuterol sulfate er 12 * 4 mg, 8 mg albuterol sulfate (2.5 mg/3ml) 0.083%, (5 mg/ml) B/D 0.5%, 0.63 mg/3ml, 1.25 mg/3ml albuterol sulfate 2 mg/5ml albuterol sulfate 2 mg, 4 mg levalbuterol hcl 1.25 mg/0.5ml B/D PERFOROMIST 20 MCG/2ML B/D SEREVENT DISKUS 50 MCG/DOSE QL terbutaline sulfate 1 mg/ml terbutaline sulfate 2.5 mg, 5 mg WellCare Advocate Complete FIDA (TTY: )

166 VENTOLIN HFA 108 (90 BASE) MCG/ACT QL GM XOPENEX HFA 45 MCG/ACT QL GM montelukast sodium 4 mg montelukast sodium 10 mg montelukast sodium 4 mg, 5 mg zafirlukast 10 mg, 20 mg cromolyn sodium 20 mg/2ml B/D acetylcysteine 10 %, 20 % B/D ARALAST NP * 1000 MG, 400 MG, 500 MG, PA; LA 800 MG AUVI-Q 0.15 MG/0.15ML, 0.3 MG/0.3ML DALIRESP 500 MCG EPIPEN 2-PAK 0.3 MG/0.3ML EPIPEN JR 2-PAK 0.15 MG/0.3ML ESBRIET 267 MG PA WellCare Advocate Complete FIDA (TTY: )

167 KALYDECO 50 MG, 75 MG PA KALYDECO 150 MG PA OFEV 100 MG, 150 MG PA PROLASTIN-C * 1000 MG PA; LA PULMOZYME 1 MG/ML B/D XOLAIR * 150 MG PA; LA ZEMAIRA * 1000 MG PA; LA flunisolide 25 mcg/act (0.025%) fluticasone propionate 50 mcg/act ARNUITY ELLIPTA 100 MCG/ACT, 200 MCG/ACT budesonide 0.25 mg/2ml, 0.5 mg/2ml FLOVENT DISKUS 100 MCG/BLIST, 50 MCG/BLIST QL ML QL GM QL B/D QL WellCare Advocate Complete FIDA (TTY: )

168 FLOVENT DISKUS 250 MCG/BLIST QL FLOVENT HFA 110 MCG/ACT, 220 MCG/ACT QL GM FLOVENT HFA 44 MCG/ACT QL GM PULMICORT FLEXHALER 180 MCG/ACT, QL MCG/ACT - ADVAIR DISKUS MCG/DOSE, MCG/DOSE, QL MCG/DOSE ADVAIR HFA MCG/ACT, QL GM MCG/ACT, MCG/ACT BREO ELLIPTA MCG/INH, QL MCG/INH SYMBICORT MCG/ACT, MCG/ACT QL GM aminophylline * 25 mg/ml elixophyllin 80 mg/15ml WellCare Advocate Complete FIDA (TTY: )

169 theo mg, 200 mg, 300 mg, 400 mg theophylline er 12 * 100 mg, 200 mg, 300 mg, 450 mg theophylline er 24 * 400 mg, 600 mg theophylline 80 mg/15ml adapalene 0.1 % adapalene 0.1 % amnesteem 10 mg, 20 mg, 40 mg avita % avita % benzoyl peroxide-erythromycin 5-3 % claravis 10 mg, 20 mg, 30 mg, 40 mg clindamax 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % ery 2 % WellCare Advocate Complete FIDA (TTY: )

170 erythromycin 2 % erythromycin 2 % myorisan 10 mg, 20 mg, 40 mg sulfacetamide sodium 10 % tretinoin 0.01 %, % tretinoin %, 0.05 %, 0.1 % zenatane 10 mg, 20 mg, 30 mg, 40 mg gentamicin sulfate 0.1 % gentamicin sulfate 0.1 % mupirocin 2 % silver sulfadiazine 1 % ssd 1 % SULFAMYLON 85 MG/GM SULFAMYLON 5% ciclopirox 0.77 % ciclopirox 1 % ciclopirox olamine 0.77 % ciclopirox olamine 0.77 % WellCare Advocate Complete FIDA (TTY: )

171 clotrimazole 1 % clotrimazole 1 % econazole nitrate 1 % ketoconazole 2 % nyamyc gm nystatin gm nystatin gm nystatin gm nystop gm procto-pak 1 % proctosol hc 2.5 % proctozone-hc 2.5 % prudoxin 5 % 8-MOP 10 MG acitretin 10 mg, 17.5 mg, 25 mg PA calcipotriene % calcipotriene % calcipotriene % WellCare Advocate Complete FIDA (TTY: )

172 calcitrene % TAZORAC 0.05 %, 0.1 % PA ketoconazole 2 % selenium sulfide 2.5% ala cort 1 % alclometasone dipropionate 0.05 % alclometasone dipropionate 0.05 % apexicon 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate 0.05 % betamethasone dipropionate 0.05 % betamethasone dipropionate 0.05 % WellCare Advocate Complete FIDA (TTY: )

173 betamethasone valerate 0.1 % betamethasone valerate 0.1 % betamethasone valerate 0.1 % clobetasol propionate e 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % cormax scalp application 0.05 % desonide 0.05 % desonide 0.05 % desonide 0.05 % desoximetasone 0.05 % desoximetasone 0.05 %, 0.25 % desoximetasone 0.05 % desoximetasone 0.25 % diflorasone diacetate 0.05 % diflorasone diacetate 0.05 % WellCare Advocate Complete FIDA (TTY: )

174 fluocinolone acetonide body 0.01 % fluocinolone acetonide 0.01 %, % fluocinolone acetonide % fluocinolone acetonide 0.01 % fluocinolone acetonide 0.01 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide-e 0.05 % fluticasone propionate 0.05 % fluticasone propionate % halobetasol propionate 0.05 % halobetasol propionate 0.05 % hydrocortisone butyrate 0.1 % hydrocortisone butyrate 0.1 % hydrocortisone butyrate 0.1 % WellCare Advocate Complete FIDA (TTY: )

175 hydrocortisone 1 %, 2.5 % hydrocortisone 2.5 % hydrocortisone 1 %, 2.5 % hydrocortisone valerate 0.2 % hydrocortisone valerate 0.2 % lokara 0.05 % mometasone furoate 0.1 % mometasone furoate 0.1 % mometasone furoate 0.1 % texacort 2.5 % triamcinolone acetonide %, 0.1 %, 0.5 % triamcinolone acetonide %, 0.1 % triamcinolone acetonide %, 0.1 %, 0.5 % triderm 0.1 % lidocaine 5 % lidocaine 5 % PA; QL 1 3 lidocaine hcl 2 % lidocaine hcl 4 % lidocaine-prilocaine % B/D WellCare Advocate Complete FIDA (TTY: )

176 acyclovir 5 % ammonium lactate 12 % ammonium lactate 12 % ELIDEL 1 % PA fluorouracil 5 % fluorouracil 2 %, 5 % imiquimod 5 % laclotion 12 % metronidazole 0.75 % metronidazole 0.75 % metronidazole 0.75 % PANRETIN 0.1 % podofilox 0.5 % rosadan 0.75 % tacrolimus 0.03 %, 0.1 % PA TARGRETIN 1 % PA VALCHLOR % PA; LA VOLTAREN 1 % EURAX 10 % EURAX 10 % malathion 0.5 % WellCare Advocate Complete FIDA (TTY: )

177 permethrin 5 % acetic acid 0.25 % REGRANEX 0.01 % PA SANTYL 250 GM sodium chloride 0.9 % cevimeline hcl 30 mg chlorhexidine gluconate 0.12 % clotrimazole 10 mg lidocaine viscous 2 % nystatin ml periogard 0.12 % pilocarpine hcl 5 mg pilocarpine hcl 7.5 mg triamcinolone acetonide 0.1 % acetic acid 2 % acetic acid-aluminum acetate 2 % WellCare Advocate Complete FIDA (TTY: )

178 CIPRODEX % fluocinolone acetonide 0.01 % neomycin-polymyxin-hc 1 % neomycin-polymyxin-hc ofloxacin 0.3 % WellCare Advocate Complete FIDA (TTY: )

179 MOP abacavir sulfate...19 abacavir-lamivudine-zidovudine...22 ABELCET...15 ABILIFY DISCMELT...68 ABILIFY MAINTENA...68 ABRAXANE...35 ABREVA acamprosate calcium...76 acarbose...79 acebutolol hcl...49 ACEPHEN ACEROLA C acetaminophen acetaminophen acetaminophen junior strength acetaminophen-codeine...13 acetaminophen-codeine # acetaminophen-codeine # acetaminophen-codeine # acetazolamide...53 acetazolamide er...53 acetic acid acetic acid-aluminum acetate acetylcysteine ACID GONE acid reducer acidophilus/l-sporogenes acitretin ACTHIB ACTIMMUNE acyclovir...23, 174 acyclovir sodium...23 ADACEL ADAGEN...88 adapalene adefovir dipivoxil...23 ADEMPAS...55 adriamycin...34 adrucil...34 ADVAIR DISKUS ADVAIR HFA advanced calcium formula ADVIL ADVIL ADVIL LIQUI-GELS ADVIL JUNIOR STRENGTH afeditab cr...50 AFINITOR...38 AFINITOR DISPERZ...38 AFRIN AGGRENOX a-hydrocort...90 ala cort ALA-HIST IR ALA-HIST PE ALBENZA...16 albuterol sulfate albuterol sulfate er alclometasone dipropionate ALDURAZYME...88 alendronate sodium...82 alfuzosin hcl er ALIMTA...34 ALINIA...16 all day allergy-d all day pain relief ALLEGRA aller-ease allopurinol...9 alosetron hcl...99 ALPHAGAN P alprazolam...56 ALREX altavera...83 aluminum hydroxide gel amantadine hcl...66 ambi 12.5cpd/1dcpm/30pse ambi 40pse/400gfn/20dm AMBISOME...15 amifostine...41 amikacin sulfate...14 amiloride hcl...53 amiloride-hydrochlorothiazide...53 aminophylline AMINOSYN AMINOSYN II AMINOSYN II/ELECTROLYTES AMINOSYN M AMINOSYN/ELECTROLYTES AMINOSYN-HBC AMINOSYN-PF AMINOSYN-RF amiodarone hcl...45, 46 AMITIZA...99 amitriptyline hcl...63 amlodipine besy-benazepril hcl...42 amlodipine besylate...50 amlodipine besylate-valsartan...44 amlodipine-valsartan-hctz...44 ammonium lactate amnesteem amoxapine...63 amoxicillin...29, 30 amoxicillin-pot clavulanate...30 amoxicillin-pot clavulanate er WellCare Advocate Complete FIDA (TTY: )

180 amphetamine-dextroamphet er...72 amphetamine-dextroamphetami ne...73 amphotericin b...15 ampicillin...30 ampicillin sodium...30 ampicillin-sulbactam sodium...31 AMPYRA...75 anagrelide hcl anastrozole...37 ANDRODERM...77 ANORO ELLIPTA antacid anti-diarrheal antifungal antioxidant formula sg apap apexicon ap-hist dm APOKYN...66 apri...83 APRISO...97 APTIOM...56 APTIVUS...19 AQUADEKS AQUA-E AQUANIL HC ARALAST NP aranelle...83 ARCALYST aripiprazole...68 ARNUITY ELLIPTA artificial tears ASACOL HD...97 ascorbic acid aspirin aspirin ec ASSURE ID...78 ASTEPRO atenolol...49 atenolol-chlorthalidone...48 athletes atorvastatin calcium...47 atovaquone...16 atovaquone-proguanil hcl...19 ATRIPLA...22 ATROVENT HFA aubra...83 AUVI-Q AVASTIN...36 aviane...83 avita AVODART AXID AR AXIRON...77 AYR SALINE AYR SALINE azacitidine...34 AZACTAM DEXTROSE...16 azathioprine azelastine hcl...156, 162 AZILECT...66 azithromycin...28 AZOPT AZOR...44 aztreonam...16 b complex b B-12 DOTS bacitracin...114, 159 bacitracin zinc bacitracin-polymyxin b bacitra-neomycin-polymyxin-hc baclofen...76 balsalazide disodium...97 balziva...83 BANZEL...57 BARACLUDE...24 BCG VACCINE b-complex/vitamin c bee zee BELEODAQ...36 benazepril hcl...43 benazepril-hydrochlorothiazide...42 BENICAR...45 BENICAR HCT...45 BENLYSTA benzonatate benzoyl peroxide benzoyl peroxide benzoyl peroxide benzoyl peroxide-erythromycin benztropine mesylate...67 BEPREVE BESIVANCE beta carotene betamethasone dipropionate betamethasone dipropionate aug betamethasone valerate BETASERON...75 betaxolol hcl bethanechol chloride BETOPTIC-S BEXSERO bicalutamide...37 BICILLIN L-A...31 BICNU...32 BILTRICIDE...16 biospec dmx biotin bisoprolol fumarate...49 bisoprolol-hydrochlorothiazide...48 BIVIGAM bleomycin sulfate...34 blephamide s.o.p B-NATAL BONE DENSITY WellCare Advocate Complete FIDA (TTY: )

181 bone meal BOOSTRIX BOSULIF...38 BOUDREAUXS BUTT PASTE BREO ELLIPTA briellyn...83 BRILINTA brimonidine tartrate BRINTELLIX...63 brohist d bromfenac sodium bromfenac sodium bromocriptine mesylate...67 budesonide budesonide er...97 bumetanide...53 buprenorphine hcl...76 buprenorphine hcl-naloxone hcl...76 buproban...76 bupropion hcl...63 bupropion hcl er (sr)...63 bupropion hcl er (xl)...63 buspirone hcl...56 BUSULFEX...33 butorphanol tartrate...13 BYDUREON...78 BYETTA 10 MCG...78 BYETTA 5 MCG...78 BYSTOLIC...49 c cabergoline...92 cal/mag CALCET CREAMY BITES CALCET PETITES CALCI-MIX calcionate calcipotriene calcitonin (salmon)...92 cal-citrate plus vitamin d calcitrene calcitriol calcium calcium + d calcium + d calcium d calcium calcium 500/d calcium 500+d high potency calcium calcium 600/vitamin d calcium 600+d plus minerals calcium acetate...93 calcium antacid calcium antacid calcium antacid calcium ascorbate calcium carbonate calcium carbonate-vitamin d calcium citrate calcium citrate + d calcium citrate malate-vit d calcium citrate-vitamin d calcium for women calcium gluconate calcium gummies calcium lactate calcium pantothenate calcium soft chews calcium/c/d calcium+d3 gradual release calcium-magnesium calcium-magnesium-vitamin d calcium-magnesium-zinc calcium-vitamin d calmag thins CAL-QUICK CALTRATE 600+D SOFT camila...83 CANASA...97 CANCIDAS...15 CAPASTAT SULFATE...22 CAPRELSA...39 captopril...43 captopril-hydrochlorothiazide...42 CARBAGLU...88 carbamazepine...57 carbamazepine er...57 carbidopa-levodopa...67 carbidopa-levodopa er...67 carbidopa-levodopa-entacapone...67 carboplatin...41 CARIMUNE NF carteolol hcl cartia xt...50 carvedilol...49 castellani paint modified CAYSTON...16 cefaclor...25 cefaclor er...25 cefadroxil...26 cefazolin sodium...26 cefdinir...26 cefepime hcl...26 cefixime...26 cefotaxime sodium...26 cefoxitin sodium...26 cefpodoxime proxetil...26 cefprozil...27 ceftazidime...27 CEFTAZIDIME AND DEXTROSE...27 ceftriaxone sodium...27 cefuroxime axetil...27 cefuroxime sodium WellCare Advocate Complete FIDA (TTY: )

182 celecoxib...9 CELONTIN...57 CENTRUM KIDS COMPLETE CENTRUM SILVER cephalexin...27 CERDELGA...88 CEREZYME...88 CEROVITE CERVARIX cetirizine hcl...118, 162 cevimeline hcl CHANTIX...76 CHANTIX...76 CHANTIX...77 chelated calcium CHEMET...82 chewable calcium chewable vite chewable vite/iron childrens acetaminophen childrens childrens childrens non-aspirin childrens plus childrens plus chlo tuss ex chlorhexidine gluconate chloroquine phosphate...19 chlorothiazide...53 chlorpheniramine maleate er chlorpromazine hcl...68 chlorthalidone...53 cholestyramine...47 cholestyramine light...47 ciclopirox ciclopirox olamine cilostazol CILOXAN CIMZIA CIMZIA PREFILLED CIMZIA STARTER KIT CINRYZE CIPRODEX ciprofloxacin...29 ciprofloxacin hcl...29, 159 ciprofloxacin d5w...29 ciprofloxacin-ciproflox hcl er...29 cisplatin...41 citalopram hydrobromide...63 CITRACAL CALCIUM GUMMIES CITRACAL PLUS HEART HEALTH citrus calcium +d citrus calcium/vitamin d cladribine...34 claravis clarithromycin...28 clarithromycin er...28 CLARITIN CLARITIN REDITABS classic prenatal clindamax clindamycin hcl...17 clindamycin palmitate hcl...17 clindamycin phosphate...17, 102, 167 clindamycin phosphate d5w...17 CLINIMIX/DEXTROSE (2.75/5) CLINIMIX/DEXTROSE (4.25/10) CLINIMIX/DEXTROSE (4.25/20) CLINIMIX/DEXTROSE (4.25/25) CLINIMIX/DEXTROSE (4.25/5) CLINIMIX/DEXTROSE (5/15) CLINIMIX/DEXTROSE (5/20) CLINIMIX/DEXTROSE (5/25) clobetasol propionate clobetasol propionate e clomipramine hcl...63 clonazepam...57 clonidine hcl...54 clopidogrel bisulfate clorazepate dipotassium...57, 58 clotrimazole...120, 169, 175 clotrimazole clozapine...68 CLOZAPINE...68 COARTEM...19 cod liver oil codituss dm colchicine-probenecid...9 COLCRYS...9 cold head congestion severe colestipol hcl...47 colistimethate sodium...17 colocort...97 COMBIGAN COMBIVENT RESPIMAT COMETRIQ 100 MG...39 COMETRIQ 140 MG...39 COMETRIQ 60 MG...39 COMPLERA...22 complete compro...94 COMTREX WellCare Advocate Complete FIDA (TTY: )

183 COMVAX CONEX constulose...97 CONTAC COPAXONE...75 coral calcium coral calcium plus CORICIDIN HBP cormax scalp application cortisone acetate...90 CORTIZONE cough dm COUMADIN CREON CRESTOR...47 CRIXIVAN...19 cromolyn sodium...99, 121, 156, 164 cryselle CUBICIN...17 CUVPOSA...96 cvs calcium citrate cvs easy fiber/calcium cvs hydrocortisone acetate cvs cvs cvs cvs cvs cvs probiotic (lactobacillus) cvs senna-extra cvs cvs vitamin b cvs vitamin c cyanocobalamin cyclafem 1/ cyclafem 7/7/ cyclophosphamide...33 CYCLOPHOSPHAMIDE...33 cycloserine...22 cyclosporine cyclosporine modified CYSTADANE...88 CYSTAGON...88 cytarabine...35 CYTO B d d d D d dacarbazine...33 daily-vite/iron/beta-carotene DALIRESP danazol...88 dantrolene sodium...76 dapsone...17 DAPTACEL DARAPRIM...17 daunorubicin hcl...34 day-time sinus deblitane...83 DELESTROGEN...89 DELTUSS DP delyla...83 DELZICOL...97 DEMSER...54 DEPEN TITRATABS...82 DEPO-PROVERA...37 DESENEX DESENEX desipramine hcl...64 DESITIN desmopressin ace...94 desmopressin ace...94 desmopressin acetate...94 desmopressin acetate spray...94 desogestrel-ethinyl estradiol...83 desonide desoximetasone dexamethasone...90 dexamethasone intensol...90 dexamethasone sod phosphate pf...90 dexamethasone sodium phosphate...90, 160 DEXILANT dexrazoxane...41 dextrose DEXTROSE 5%/ELECTROLYTE # dextrose lactated ringers DEXTROSE-NACL dextrose-nacl DIALYVITE DIALYVITE 800-ZINC DIALYVITE VITAMIN D3 MAX diazepam...58 diazepam intensol...58 diclofenac potassium...9 diclofenac sodium...9, 160 diclofenac sodium er...9 dicloxacillin sodium...31 dicyclomine hcl...96 didanosine...19 DIFICID...28 diflorasone diacetate diflunisal...9 digitek...52 digoxin...52 dihydroergotamine mesylate...74 dilantin...58 DILANTIN...58 dilantin infatabs...58 diltiazem hcl...51 diltiazem hcl er...50 diltiazem hcl er WellCare Advocate Complete FIDA (TTY: )

184 diltiazem hcl er...50 dilt-xr...51 diltzac...51 DIMETAPP DIMETAPP DIPENTUM...97 diphenhydramine hcl...123, 162 diphenoxylate-atropine...99 DIPHTHERIA-TETANUS TOXOIDS DT disopyramide phosphate...46 disulfiram...77 divalproex sodium...58 divalproex sodium er...58 docetaxel...36 DOCETAXEL...36 docusate sodium DOK donepezil hcl...62 dorzolamide hcl dorzolamide hcl-timolol mal double antibiotic doxazosin mesylate...44 doxepin hcl...64 doxorubicin hcl...34 doxorubicin hcl liposomal...34 doxy doxycycline hyclate...32 doxycycline monohydrate...32 DRAMAMINE dronabinol...95 drospirenone-ethinyl estradiol...83 DROXIA...40 dual action complete duloxetine hcl...64 DURAFLU duramorph...10 DUREZOL e.e.s ecee plus econazole nitrate ECOTRIN MAXIMUM STRENGTH ed bron gp ED CHLORPED ED CHLORPED D ed chlorped jr ed-a-hist dm ed-apap EDURANT...19 EFFIENT ELDERTONIC ELIDEL ELIQUIS ELITEK...41 elixophyllin ELMIRON EMCYT...33 EMEND...95 emoquette...84 EMSAM...64 EMTRIVA...20 enalapril maleate...43 enalapril-hydrochlorothiazide...42 endocet...11 enema enema mineral oil ENEMEEZ MINI ENEMEEZ PLUS ENGERIX-B enoxaparin sodium enpresse entacapone...67 entecavir...24 entre-cough entre-hist pse ENUCLENE enulose...97 e-oil EPIPEN 2-PAK EPIPEN JR 2-PAK epirubicin hcl...34 epitol...58 EPIVIR HBV...24 eplerenone...44 epsom salt EPZICOM...22 eq eql eql calcium/vitamin d eql childrens calcium gummies eql eql iron eql lice solution eql oyster shell calcium/d EQUALACTIN ERIVEDGE...36 errin...84 ery ery-tab...28 erythrocin lactobionate...28 erythrocin stearate...28 erythromycin...159, 168 erythromycin base...29 erythromycin ethylsuccinate...29 ESBRIET escitalopram oxalate...64 esomeprazole sodium estrace...89 estradiol...89 estradiol valerate...90 ethambutol hcl...23 ethosuximide...58 etodolac...10 etodolac er...9 etoposide...42 EURAX WellCare Advocate Complete FIDA (TTY: )

185 EVOTAZ...22 EXCEL COMFORT NEEDLE...78 exefen-ir EXELON...62 exemestane...37 EXJADE...83 EX-LAX ULTRA eye drops eye drops eye wash EZFE ezfe forte FABRAZYME...88 falmina...84 famciclovir...24 famotidine...96 famotidine premixed...96 FANAPT...68 FANAPT...69 FARESTON...37 FARXIGA...79 FARYDAK...36 FASLODEX...37 FAZACLO...69 FEBROL felbamate...58 felodipine er...51 fenofibrate...47 fenofibrate micronized...47 fenofibric acid...47 fentanyl...11 fentanyl citrate...11 FENTORA...11 fer-iron ferretts ferretts ips FERRIMIN FERRIPROX...83 ferrous fumarate ferrous gluconate ferrous sulfate...125, 126 ferrous sulfate er FETZIMA...64 FETZIMA...64 FEVERALL fexofenadine hcl fexofenadine hcl childrens fiber fiber fiber fiber laxative finasteride FIRAZYR FLEBOGAMMA FLEBOGAMMA DIF flecainide acetate...46 FLEET BISACODYL FLORANEX FLORASTOR KIDS FLOVENT DISKUS...165, 166 FLOVENT HFA fluconazole...15 fluconazole dextrose...15 fluconazole sodium chloride...15 flucytosine...15 fludarabine phosphate...35 fludrocortisone acetate...90 flunisolide fluocinolone acetonide...172, 176 fluocinolone acetonide body fluocinolone acetonide fluocinonide fluocinonide-e fluorometholone fluorouracil...35, 174 fluoxetine hcl...64, 65 fluphenazine decanoate...69 fluphenazine hcl...69 flurbiprofen...10 flurbiprofen sodium flutamide...37 fluticasone propionate...165, 172 fluvoxamine maleate...56 FOLGARD folic acid FOLITAB FOLTABS fondaparinux sodium...102, 103 FORTEO...93 FORTICAL...92 foscarnet sodium...24 fosinopril sodium...43 fosinopril sodium-hctz...42 FREAMINE HBC FREAMINE III FRESHKOTE FUNGICURE INTENSIVE/NAILGUARD FUNGOID TINCTURE furosemide...53 FUSILEV...41 FUZEON...20 FYCOMPA...58, 59 gabapentin...59 GABITRIL...59 galantamine hydrobromide...62 galantamine hydrobromide er...62 GAMASTAN S/D GAMMAGARD GAMMAGARD S/D GAMMAGARD S/D LESS IGA GAMMAKED GAMMAPLEX GAMUNEX-C ganciclovir sodium...24 GARDASIL GARDASIL gatifloxacin WellCare Advocate Complete FIDA (TTY: )

186 GATTEX...99 gavilyte-c...98 gavilyte-g...98 gavilyte-h...98 gavilyte-n...98 GAVISCON GAVISCON EXTRA RELIEF FORMULA GEMCITABINE HCL...35 gemcitabine hcl...35 gemfibrozil...47 generlac...98 gengraf gentak gentamicin saline...14 gentamicin sulfate...14, 159, 168 gentian violet gentle laxative GEODON...69 geravim gianvi...84 gildagia...84 gildess 1.5/ GILENYA...76 GILOTRIF...39 glatopa...76 GLEEVEC...39 glimepiride...79 glipizide...80 glipizide er...80 glipizide-metformin hcl...80 GLOBAL...78 GLUCAGEN HYPOKIT...91 GLUCAGON...91 glycopyrrolate...96 gnp antacid & anti-gas gnp artificial tears gnp calcium gnp childrens chewables/ex c gnp childrens gnp gnp gnp foaming antacid gnp iron gnp gnp GOLYTELY...98 GONIOTAIRE goodsense all day allergy goodsense pain relief pm granisetron hcl...95 GRANIX griseofulvin microsize...15 griseofulvin ultramicrosize...15 guaifenesin dm guaifenesin-codeine guanfacine hcl er...73 GUMMI BEAR MULTIVITAMIN/MIN halobetasol propionate haloperidol...69 haloperidol decanoate...69 haloperidol lactate...69 HARVONI...24 HAVRIX headache pm heather...84 HEPARIN (PORCINE) D5W HEPARIN (PORCINE) NACL HEPARIN SOD (PORCINE) D5W heparin sodium (porcine) HEPARIN SODIUM (PORCINE) HEPATAMINE HERCEPTIN...36 HETLIOZ...74 HEXALEN...33 HIBERIX hm hm famotidine hm rapid melts junior HONEY BEARS HONEY BEARS W/IRON-ZINC HUMIRA HUMIRA HUMIRA PEN-CROHNS HUMIRA PEN-PSORIASIS HUMULIN R U hydralazine hcl...54 hydrochlorothiazide...53 HYDROCIL hydrocodone-acetaminophen...11 hydrocodone-ibuprofen...11 hydrocortisone...90, 97, 129, 173 hydrocortisone butyrate hydrocortisone valerate hydrocortisone-aloe hydromorphone hcl...11 hydromorphone hcl pf...11 hydroxocobalamin hydroxychloroquine sulfate hydroxyurea...40 hydroxyzine hcl...162, 163 hydroxyzine pamoate HYPOTEARS ibandronate sodium...82 IBRANCE...36 ibuprofen...10, 129 ibuprofen junior strength WellCare Advocate Complete FIDA (TTY: )

187 ibuprofen pm ICAPS ICAPS LUTEIN-ZEAXANTHIN ICAPS MV ICLUSIG...39 idarubicin hcl...34 IFEX...33 ifosfamide...33 IFOSFAMIDE...33 ILEVRO ilotycin IMBRUVICA...39 imipenem-cilastatin...17 imipramine hcl...65 imiquimod IMOVAX RABIES INCRELEX...92 INCRUSE ELLIPTA indapamide...54 INFANRIX infants ibuprofen infants pain relief INLYTA INTEGRA INTELENCE...20 intense intense INTRALIPID INTRON A introvale...84 INVANZ...17 INVEGA...69 INVEGA SUSTENNA...70 INVIRASE...20 INVOKAMET...80 INVOKANA...80 IONOSOL-B D5W IONOSOL-MB D5W IPOL ipratropium bromide ipratropium-albuterol irbesartan...45 irbesartan-hydrochlorothiazide...45 irinotecan hcl...42 IROMIN-G iron iron (ferrous gluconate) iron 100 plus iron 100/c iron chews pediatric IRON UP ISENTRESS...20 ISOLYTE-P D5W ISOLYTE-S isoniazid...23 ISOPTO TEARS isosorbide dinitrate...55 isosorbide dinitrate er...55 isosorbide mononitrate...55 isosorbide mononitrate er...55 isradipine...51 ISTALOL ISTODAX...37 itraconazole...15 ivermectin...17 IXIARO JAKAFI...39 JALYN jantoven JANUMET...80 JANUMET XR...80 JANUVIA...80 JENTADUETO...80 jinteli...90 J-MAX jolessa...84 jolivette...84 J-TAN D PD J-TAN PD junel 1.5/ junel 1/ junel fe 1.5/ junel fe 1/ JUXTAPID...48 k KADCYLA...37 KALETRA...22 KALYDECO KAOPECTATE kariva...84 kcl dextrose-nacl KCL DEXTROSE-NACL kelnor 1/ ketoconazole...15, 169, 170 ketoprofen...10 ketorolac tromethamine KEYTRUDA...37 kidkare kionex...83 klor-con klor-con klor-con m klor-con m kls acid reducer KONSYL KONSYL-D KORLYM...91 kp b complex-c kp benzoyl peroxide kp calcium 600+d...130, 131 kp calcium-magnesium-zinc kp ferrous gluconate kp ferrous sulfate kp hydrocortisone kp ketotifen fumarate kp pseudoephedrine hcl kp terbinafine hydrochloride kp vitamin d kp vitamin e kpn prenatal WellCare Advocate Complete FIDA (TTY: )

188 KUVAN...89 KYNAMRO...48 labetalol hcl...49 laclotion lactated ringers lactulose...98 lactulose encephalopathy...98 LAMISIL ADVANCED LAMISIL AF DEFENSE lamivudine...20, 24 lamivudine-zidovudine...22 lamotrigine...59 lamotrigine er...59 LANTUS...78 LANTUS SOLOSTAR...78 larin 1.5/ larin 1/ larin fe 1.5/ larin fe 1/ LASTACAFT latanoprost LATUDA...70 laxative pills leena...85 leflunomide LENVIMA 10 MG...39 LENVIMA 14 MG...39 LENVIMA 20 MG...39 LENVIMA 24 MG...39 lessina...85 LETAIRIS...55 letrozole...37 leucovorin calcium...41 LEUKERAN...33 LEUKINE leuprolide acetate...37 levalbuterol hcl LEVEMIR...78 LEVEMIR FLEXTOUCH...78 levetiracetam...59 levetiracetam er...59 LEVETIRACETAM NACL...59 levobunolol hcl levocarnitine...89 levocetirizine dihydrochloride levofloxacin...29 levofloxacin d5w...29 levoleucovorin calcium...41 levonest...85 levonorgest-eth estrad levonorgestrel...85 levonorgestrel-ethinyl estrad...85 levora 0.15/30 (28)...85 levothyroxine sodium...93 levoxyl...94 LEXIVA...20 lice killing lice treatment lidocaine lidocaine hcl...13, 173 lidocaine hcl (pf)...13 lidocaine viscous lidocaine-prilocaine linezolid...17 LINEZOLID...17 LINZESS...99 liothyronine sodium...94 liquid calcium with d liquid calcium/vitamin d liquituss gg lisinopril...43 lisinopril-hydrochlorothiazide...43 LITHIUM...75 lithium carbonate...75 lithium carbonate er...75 localnesium localnesium-c LODRANE D LOHIST-D lohist-dm lohist-peb lokara lomustine...33 loperamide hcl...99, 132 loratadine loratadine-pseudoephedrine er lorazepam...56 lorazepam intensol...56 lorcet...11 lorcet hd...11 lorcet plus...11 lortab...11 loryna...85 losartan potassium...45 losartan potassium-hctz...45 LOTEMAX LOTRIMIN ULTRA lovastatin...47 low-ogestrel...85 loxapine succinate...70 lubricating plus LUMIGAN LUMITENE LUMIZYME...89 LUPRON DEPOT...38 LUPRON DEPOT-PED...38 lutera...85 LYNPARZA...37 LYRICA...60 LYSODREN...38 lyza...85 MAALOX MAALOX mag-al mag-delay MAGINEX WellCare Advocate Complete FIDA (TTY: )

189 MAGNEBIND magnesium magnesium citrate magnesium oxide MAGNESIUM SULFATE magnesium sulfate MAGNESIUM SULFATE D5W MAG-TAB SR malathion MAPAP COLD FORMULA MULTI-SYMPT maprotiline hcl...65 marlissa...85 MARPLAN...65 MATULANE...40 MAXIDEX meclizine hcl...95 medroxyprogesterone acetate...85, 93 mefloquine hcl...19 MEGACE ES...38 megestrol acetate...38 MEKINIST...39 meloxicam...10 melphalan hcl...33 MENACTRA m-end dmx MENOMUNE MENVEO MEPHYTON mercaptopurine...35 MERIBIN meropenem...18 mesalamine...97 mesalamine mesna...42 MESNEX...42 metadate er...73 METAMUCIL METAMUCIL MULTIHEALTH FIBER METAMUCIL metformin hcl...81 metformin hcl er...81 methadone hcl...12 methadone hcl intensol...11 methazolamide...54 methenamine hippurate...18 methimazole...94 methotrexate methotrexate sodium...35 methotrexate sodium (pf)...35 methyclothiazide...54 methylergonovine maleate...92 methylphenidate hcl...73 methylphenidate hcl er...73 methylprednisolone...91 methylprednisolone (pak)...90 methylprednisolone acetate...90 methylprednisolone sodium succ...91 metipranolol metoclopramide hcl...95 metolazone...54 metoprolol succinate er...49 metoprolol tartrate...49 metoprolol-hydrochlorothiazide...48 metronidazole...18, 102, 174 metronidazole nacl...18 mexiletine hcl...46 MEXSANA MIACALCIN...92 MI-ACID miconazole miconazole miconazole 3 combo pack miconazole microgestin 1.5/ microgestin 1/ microgestin fe 1.5/ microgestin fe 1/ midodrine hcl...54 milk of magnesia milk of magnesia concentrate mineral oil minitran...55 minocycline hcl...32 minoxidil...54 MINTOX PLUS mirtazapine...65 misoprostol...99 MISSION PRENATAL MISSION PRENATAL HP mitomycin...34 mitoxantrone hcl...40 M-M-R II moderiba...24 MODERIBA moderiba moexipril hcl...43 moexipril-hydrochlorothiazide...43 mometasone furoate mononessa...85 montelukast sodium morphine sulfate...12 morphine sulfate...12 morphine sulfate (pf)...12 morphine sulfate er...12 morphine sulfate er...12 motion MOTRIN IB MOVANTIK...99 MOVIPREP...98 MOXEZA MOZOBIL mucaphed MUCINEX MUCINEX D WellCare Advocate Complete FIDA (TTY: )

190 MUCINEX FAST-MAX MUCINEX MUCINEX mucus mucus mucus mucus relief er mucus-dm mucus-dm max MULTAQ...46 multi-delyn multi-delyn/iron multi-symptom mupirocin MURO MUSTARGEN...33 my way MYCAMINE...16 mycophenolate mofetil mycophenolic acid MYKIDZ IRON MYKIDZ IRON myorisan MYOZYME...89 MYRBETRIQ myzilra...86 nabumetone...10 nadolol...49 nafcillin sodium...31 NAGLAZYME...89 nalbuphine hcl...13 naloxone hcl...77 naltrexone hcl...77 NAMENDA...62 NAMENDA XR...62 NAMENDA XR...63 naphazoline hcl naproxen...10 naproxen dr...10 naproxen sodium...10, 135 naratriptan hcl...74 nasal decongestant...135, 136 nasal decongestant pe NASCOBAL NASOPEN PE NATACYN nateglinide...81 NATPARA...93 natural fiber laxative natural fiber therapy natures tears NEBUPENT...18 necon 0.5/35 (28)...86 necon 1/35 (28)...86 necon 1/50 (28)...86 necon 10/11 (28)...86 necon 7/7/ nefazodone hcl...65 neomycin sulfate...14 neomycin-bacitracin zn-polymyx neomycin-polymyxin-dexameth neomycin-polymyxin-gramicidin neomycin-polymyxin-hc...158, 176 NEORAL...108, 109 neotuss NEPHRAMINE NEPHRONEX NEUMEGA NEUPOGEN NEUPRO...67 nevirapine...20 nevirapine er...20 NEXAFED NEXAFED SINUS PRESSURE + PAIN NEXAVAR...39 NEXIUM next choice one dose...86 niacin niacin er niacin er...48 niacinamide niacor...48 nicardipine hcl...51 nicotine nicotine polacrilex...136, 137 NICOTROL...77 NICOTROL NS...77 nifedical xl...51 nifedipine er...51 nifedipine er osmotic...51 night-time sinus nikki...86 NILANDRON...38 nimodipine...52 NIPENT...35 nitro-bid...55 NITRO-DUR...55 nitrofurantoin macrocrystal...18 nitrofurantoin monohyd macro...18 nitroglycerin...55 NITROSTAT...55 nohist-lq nora-be...86 NORDITROPIN FLEXPRO...91 NORDITROPIN NORDIFLEX...92 NOREL AD norethindrone...86 norethindrone acetate...93 norethindrone-eth estradiol WellCare Advocate Complete FIDA (TTY: )

191 norgestim-eth estrad triphasic...86 norlyroc...86 normosol-m d5w NORMOSOL-R D5W NORMOSOL-R PH NORPACE CR...46 nortrel 0.5/35 (28)...86 nortrel 1/35 (21)...86 nortrel 1/35 (28)...86 nortrel 7/7/ nortriptyline hcl...65 NORVIR...20 NOVAFERRUM NOVAFERRUM NOVOLIN 70/ NOVOLIN N...78 NOVOLIN R...79 NOVOLOG...79 NOVOLOG FLEX...79 NOVOLOG MIX 70/ NOVOLOG MIX 70/30 FLEX...79 NOVOLOG PENFILL...79 NOXAFIL...16 NUEDEXTA...75 NU-IRON NULOJIX NULYTELY...98 NUTRILIPID NUTRISOURCE FIBER NUVARING...86 NUVIGIL...76 nyamyc NYMALIZE...52 nystatin...16, 169, 175 nystop ocella...86 OCTAGAM octreotide acetate...92 OFEV ofloxacin...160, 176 olanzapine...70 olopatadine hcl omega-3-acid ethyl esters...48 omeprazole...100, 137 ondansetron...95 ondansetron hcl...95 ONETOUCH ULTRA ONETOUCH ULTRA BLUE...81 ONETOUCH ULTRA MINI...81 ONETOUCH ULTRA SYSTEM...81 ONETOUCH ULTRASMART...81 ONETOUCH VERIO...82 ONETOUCH VERIO IQ SYSTEM...82 ONETOUCH VERIO SYNC SYSTEM...82 ONFI...60 OPSUMIT...55 ORAP...71 ORFADIN...89 organ-i nr orsythia...86 OS-CAL EXTRA D OSTEO-PORETICAL oxacillin sodium...31 oxaliplatin...41 oxandrolone...77 oxcarbazepine...60 oxybutynin chloride oxybutynin chloride er oxycodone hcl...12, 13 oxycodone-acetaminophen...13 OYSCO oyster shell calcium 250+d oyster shell calcium/d pacerone...46 paclitaxel...36 pain relief pain reliever pamidronate disodium...82 PANOXYL PANOXYL PANOXYL-4 CREAMY PANRETIN pantoprazole sodium paricalcitol paromomycin sulfate...14 paroxetine hcl...65 parva-cal paser...23 PATADAY PAXIL...65 PAZEO PEDIACARE PEDIA-LAX PEDVAX HIB peg 3350/electrolytes...98 peg 3350-kcl-na bicarb-nacl...98 peg-3350/electrolytes...98 PEGANONE...60 PEGINTRON...24 PEG-INTRON...24 PEG-INTRON REDIPEN...24 PENICILLIN G POT DEXTROSE...31 penicillin g potassium...31 penicillin g procaine...32 penicillin g sodium...32 penicillin v potassium...32 PENTAM...18 pentoxifylline er PEPCID AC peptic PERDIEM PERFOROMIST perindopril erbumine WellCare Advocate Complete FIDA (TTY: )

192 periogard permethrin...138, 175 perphenazine...71 PERRY PRENATAL phenadoz...95 PHENAGIL phenelzine sulfate...65 phenergan...95 phenobarbital...60 phenobarbital sodium...60 PHENOBARBITAL SODIUM...60 phenytek...60 phenytoin...60 phenytoin sodium...60 phenytoin sodium extended...60 philith...86 phos-nak PHOSPHOLINE IODIDE pilocarpine hcl...158, 175 pimtrea...87 pindolol...49 pioglitazone hcl...81 piperacillin sod-tazobactam so...32 pirmella 1/ piroxicam...10 PLASMA-LYTE PLASMA-LYTE A PLASMA-LYTE-56 D5W podofilox polyethylene glycol polymyxin b-trimethoprim polyvitamin polyvitamin/iron POMALYST...40 portia potassium chloride...152, 156 potassium chloride crys er potassium chloride er...151,152 potassium chloride dextrose potassium chloride nacl potassium citrate er POTIGA...60, 61 PRADAXA pramipexole dihydrochloride...67 pravastatin sodium...47 prazosin hcl...44 prednisolone...91 prednisolone acetate prednisolone sodium phosphate...91,161 prednisone...91 prednisone (pak)...91 prednisone intensol...91 PREFERRED PLUS...79 premasol prenatal...138, 156 PRETZ prevalite...48 previfem...87 PREZCOBIX...22 PREZISTA...20 PRIFTIN...23 PRILOSEC OTC PRIMAQUINE PHOSPHATE...19 primidone...61 PRISTIQ...65 PRIVIGEN probenecid...9 PROCALAMINE pro-chlo prochlorperazine...95 prochlorperazine edisylate...95 prochlorperazine maleate...95 PROCRIT procto-pak proctosol hc proctozone-hc PROFE PROGLYCEM...91 PROGRAF PROLASTIN-C PROLENSA PROLEUKIN...37 PROLIA...92 PROMACTA promethazine hcl...96 promethegan...96 PRONUTRIENTS CALCIUM+D propafenone hcl...46 propafenone hcl er...46 proparacaine hcl propranolol hcl...49, 50 propranolol hcl er...49 propranolol-hctz...48 propylthiouracil...94 PROQUAD PROSOL protriptyline hcl...65 prudoxin pseudoeph-bromphen-dm psyldex PULMICORT FLEXHALER PULMOZYME PURE & GENTLE LUBRICANT PURIXAN...35 pyrazinamide...23 pyrethins-piperonyl butoxide pyridostigmine bromide...75 pyridoxine hcl pyrilamine-phenylephrine qc 3 day qc natural vegetable q-pap infants Q-TAPP DM quasense...87 quetiapine fumarate...71 quinapril hcl...43 quinapril-hydrochlorothiazide...43 quinidine gluconate er WellCare Advocate Complete FIDA (TTY: )

193 quinidine sulfate...46 quinine sulfate...19 ra anti-itch ra b-complex/vitamin c cr ra beta carotene ra calamine ra calcium 600/vit d/minerals ra calcium-boron ra central-vite performance ra col-rite ra coral calcium ra high potency iron ra hydrocortisone plus ra ibuprofen ra lubricant eye ra magnesium ra ra omeprazole-sodium bicarb ra ophthalmic ra oyster shell calcium/d ra probiotic complex ra severe cold/sinus relief pe ra slow release iron ra soluble fiber RA STERILE...79 ra vitamin c drops ra vitamin c/rose hips cr RABAVERT raloxifene hcl...92 ramipril...43 RANEXA...55 ranitidine hcl...97, 141 RAPAMUNE RAVICTI...89 REBETOL...24 reclipsen...87 RECOMBIVAX HB REFRESH CELLUVISC REFRESH OPTIVE ADVANCED REFRESH P.M REGRANEX REGULOID REHYDRALYTE RELENZA DISKHALER...25 RELISTOR...98 RELPAX...74 REMICADE REMODULIN...56 RENVELA...93 repaglinide...81 RESCON RESCON DM RESCRIPTOR...21 RESPAIRE RESTASIS RETAINE MGD RETROVIR...21 REVATIO...56 REVLIMID REYATAZ...21 RHINARIS ribasphere...25 ribasphere ribapak...25 ribavirin...25 RID ESSENTIAL rifabutin...23 rifampin...23 RIFATER...23 riluzole...75 rimantadine hcl...25 ringers RISA-BID PROBIOTIC RISAMINE RISPERDAL CONSTA...71 risperidone...71 RITUXAN...37 rivastigmine tartrate...63 rizatriptan benzoate...74 robafen cf robafen ROBITUSSIN CF ROBITUSSIN LA ROBITUSSIN LA ROBITUSSIN ROBITUSSIN LINGERING LA ROBITUSSIN ROBITUSSIN MAX ROBITUSSIN PEAK COLD ropinirole hcl...67 rosadan ROTARIX ROTATEQ roxicet...13 ROZEREM...74 rymed rynex dm rynex pse SABRIL...61 saline laxative SANDIMMUNE SANDOSTATIN LAR DEPOT...92 SANTYL SAPHRIS...71 sb fib lax orange sb lice treatment sb natural fiber laxative SCOOBY-DOO ONE A DAY SCOT-TUSSIN DM SCOT-TUSSIN SENIOR WellCare Advocate Complete FIDA (TTY: )

194 SECURA EXTRA PROTECTIVE SECURA PROTECTIVE selegiline hcl...67, 68 selenium selenium er selenium sulfide SELZENTRY...21 senna senna laxative SENNA PROMPT senna s SENSI-CARE PROTECTIVE BARRIER SENSIPAR...82 SEREVENT DISKUS SEROQUEL XR...71,72 sertraline hcl...66 sharobel...87 SIGNIFOR...92 sildenafil citrate...56 SILENOR...74 silver sulfadiazine SIMBRINZA simvastatin...47 sirolimus SIROLIMUS SIRTURO...23 SIVEXTRO...18 sleep aid SLO-NIACIN slow magnesium/calcium slow release iron SLOW-MAG sm adult nasal decongestant sm calcium/vitamin d sm calcium-magnesium-zinc SM CORAL CALCIUM sm iron slow release sm lansoprazole sm magnesium oxide sm motion sm redness relief sm slow release iron sm vitamin b12 tr sm vitamin c cr sm vitamin d sodium bicarbonate sodium chloride...152, 156, 175 sodium chloride sodium fluoride sodium phenylbutyrate...89 sodium polystyrene sulfonate...83 solia...87 SOLTAMOX...38 SOLUBLE FIBER THERAPY SOLU-CORTEF...91 SOMATULINE DEPOT...93 SOMAVERT...93 SOOTHE sorbulax sorine...46 sotalol hcl...46 sotalol hcl (af)...46 SOVALDI...25 spironolactone...44 spironolactone-hctz...54 sprintec SPRYCEL...39 sps...83 sronyx...87 ssd stahist ad stavudine STIVARGA...40 stomach relief stool softener stool softener laxative dc STRATTERA...73, 74 streptomycin sulfate...14 STRIBILD...22 SUBOXONE...77 SUCRAID...99 sucralfate...99 sulfacetamide sodium...160, 168 sulfacetamide-prednisolone sulfadiazine...14 sulfamethoxazole-tmp ds...18 sulfamethoxazole-trimethoprim...18 SULFAMYLON sulfasalazine...97 sulfazine ec...97 sulindac...10 sumatriptan...74 sumatriptan succinate...74, 75 sumatriptan succinate refill...74 SUMMERS EVE DISP MEDICATED SUPRAX...27 suprax...28 SUPREP...99 SURMONTIL...66 SUSTIVA...21 SUTENT...40 syeda...87 SYLATRON...40 SYMBICORT SYMLINPEN SYMLINPEN SYNAGIS SYNAREL...88 SYNERCID...18 SYNRIBO...40 SYNTHROID...94 SYPRINE...83 SYSTANE BALANCE SYSTANE WellCare Advocate Complete FIDA (TTY: )

195 SYSTANE TABLOID...35 tacrolimus...109, 174 TAFINLAR...40 TAMIFLU...25 tamoxifen citrate...38 tamsulosin hcl TARCEVA...40 TARGRETIN...41,174 tarina fe 1/ TASIGNA...40 tazicef...28 TAZORAC taztia xt...52 TEARS AGAIN TEFLARO...28 TEGRETOL...61 TEGRETOL-XR...61 TEKTURNA...53 TEKTURNA HCT...52, 53 temazepam...74 TENIVAC terazosin hcl...44 terbinafine hcl...16 terbutaline sulfate terconazole testosterone cypionate...77 testosterone enanthate...77 TETANUS-DIPHTHERIA TOXOIDS TD texacort tg 10peh/380gfn tg 10peh/380gfn/15dm tgt cough formula dm max adult tgt tgt tgt tgt pain reliever pm th calcium-magnesium-zinc th eye drop tears THALOMID theo theophylline theophylline er THERA/BETA-CAROTENE THERA-D THERANATAL CORE NUTRITION THERATEARS thiamine hcl thioridazine hcl...72 thiothixene...72 tiagabine hcl...61 TIKOSYN...46 timolol maleate...50, 158 tioconazole TITRALAC TIVICAY...21 tizanidine hcl...76 TOBRADEX TOBRADEX ST tobramycin...14, 160 tobramycin sulfate...14 tobramycin sulfate saline...14 tobramycin-dexamethasone TOBREX tolnaftate tolterodine tartrate tolterodine tartrate er topiramate...61 toposar...42 topotecan hcl...42 torsemide...54 total b/c TOVIAZ TPN ELECTROLYTES TRACLEER...56 TRADJENTA...81 tramadol hcl...13 tramadol-acetaminophen...13 trandolapril...43 tranexamic acid TRANSDERM-SCOP...96 tranylcypromine sulfate...66 TRAVASOL TRAVATAN Z trazodone hcl...66 TREANDA...33 TRECATOR...23 TRELSTAR MIXJECT...38 tretinoin...41,168 triacting triamcinolone acetonide...173, 175 TRIAMINIC TRIAMINIC TRIAMINIC triamterene-hctz...54 TRIBENZOR...45 tri-buffered aspirin triderm trifluoperazine hcl...72 trifluridine trihexyphenidyl hcl...68 tri-legest fe...87 trilyte...99 trimethoprim...18 trinessa (28)...87 triple antibiotic TRIPLE PASTE triple paste af tri-previfem...87 TRISENOX...41 tri-sprintec...87 TRIUMEQ...22 TRI-VI-SOL WellCare Advocate Complete FIDA (TTY: )

196 TRI-VITA tri-vitamin trivora (28)...87 TROPHAMINE trospium chloride TRUMENBA TRUVADA...22 TUSNEL TUSNEL TUSNEL-DM tussin cf tussin dm tussi-pres b TWINRIX TYBOST...21 TYGACIL...19 TYKERB...40 TYPHIM VI TYSABRI...76 TYZEKA...25 UCERIS...97 ULORIC...9 unithroid...94 UPCAL D ursodiol...99 VAGIFEM...90 VAGISTAT valacyclovir hcl...25 VALCHLOR VALCYTE...25 valganciclovir hcl...25 valproate sodium...61 valproic acid...61 valsartan...45 valsartan-hydrochlorothiazide...45 vancomycin hcl...19 vandazole VAQTA VARIVAX VASCEPA...48 VELCADE...37 velivet...87 venlafaxine hcl...66 venlafaxine hcl er...66 VENTOLIN HFA verapamil hcl...52 verapamil hcl er...52 VERSACLOZ...72 VESICARE vestura...87 VICKS DAYQUIL MUCUS CONTROL DM VICKS NYQUIL D VICKS VAPORUB VICTOZA...79 VIDEX...21 VIGAMOX VIIBRYD...66 VIMPAT...61 vinblastine sulfate...36 vincasar pfs...36 vincristine sulfate...36 vinorelbine tartrate...36 viorele...88 VIRACEPT...21 VIRAMUNE XR...21 VIREAD...21 VISINE-LR VITALETS VITAMELTS ENERGY VITAMIN B vitamin a & d vitamin a palmitate vitamin b vitamin b , 149 vitamin b12-folic acid vitamin b vitamin b vitamin b-6 er vitamin c vitamin c (calcium ascorbate) vitamin d vitamin d (ergocalciferol) vitamin d vitamin d vitamin e...149, 150 vitamin e-selenium vitamin k (phytonadione) vitamin k vitatrum VITEKTA...21 VOLTAREN voriconazole...16 VOTRIENT...40 vyfemla...88 WAL-ACT WAL-DRYL WAL-DRYL-D WAL-FEX D WAL-FLU SEVERE COLD DAYTIME WAL-ITIN WAL-ITIN D WAL-PHED PE WAL-PHED wal-som warfarin sodium wee care WELCHOL...48 XALKORI...40 XARELTO XARELTO XENAZINE...75 XGEVA...93 XIFAXAN...99 XOLAIR XOPENEX HFA WellCare Advocate Complete FIDA (TTY: )

197 XTANDI...38 xulane...88 XYREM...76 YERVOY...37 YF-VAX zafirlukast zarah...88 ZAVESCA...89 zazole ZELBORAF...40 ZEMAIRA zenatane zenchent...88 ZENPEP ZETIA...48 ZIAGEN...21 zidovudine...21,22 zinc oxide ziprasidone hcl...72 ZIRGAN zoledronic acid...82 ZOLINZA...37 zolmitriptan...75 zolpidem tartrate...74 ZONATUSS zonisamide...61 ZONTIVITY zoo friends complete ZORTRESS ZOSTAVAX zovia 1/35e (28)...88 zovia 1/50e (28)...88 ZYDELIG...40 ZYKADIA...40 ZYLET ZYPREXA RELPREVV...72 ZYTIGA...38 ZYVOX WellCare Advocate Complete FIDA (TTY: )

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204 09/01/ (TTY: ) WellCare Advocate Complete FIDA