Microsoft Word - H4740_2015_Formulary_Chinese_ doc

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1 處方集 這本處方集更新於 2015 年 8 月 1 日 要瞭解更多最新資訊或如有其他疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan( 聯邦醫療保險與醫療補助計劃 ) 投保人服務部 聽障人士請致電 711 通話免費 要瞭解詳情, 請造訪 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 H4740_2015 Formulary_CH_Accepted 1

2 ArchCare Community Advantage FIDA Plan 2015 年承保藥物清單 ( 處方集 ) 此清單列示了投保人可透過 ArchCare Community Advantage FIDA Plan( 聯邦醫療保險與醫療補助計劃 ) 獲取的藥物 ArchCare Community Advantage FIDA Plan 是一項與聯邦醫療保險和紐約州衛生署 ( 醫療補助 ) 簽訂合約的管理式保險計劃, 透過完全整合式雙重福利 (Fully Integrated Duals Advantage, 簡稱 FIDA) 證明為投保人提供兩種計劃的福利 自每年 1 月 1 日起, 具體福利 承保藥物清單和藥房與服務提供者網絡可能隨時變更 您可以隨時造訪 或每週 7 天 每天 24 隨時致電 ( 聽障專線 711) 聯絡 ArchCare Community Advantage FIDA Plan 投保人服務部, 瞭解 ArchCare Community Advantage FIDA Plan 的最新承保藥物清單 通話免費 可能存在限制 要瞭解詳情, 請致電 ArchCare Community Advantage FIDA Plan 投保人服務部, 或閱讀 ArchCare Community Advantage FIDA Plan 投保人手冊 所有承保藥物均無共付額 對於此資訊, 您還可以免費獲取諸如盲文和大字本等其他格式 請致電 聽障專線 711 通話免費 對於此資訊, 您還可以免費獲取其他語言版本 請每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 Usted puede obtener esta información de forma gratuita en otros idiomas. Llame Advantage ArchCare Comunidad al las 24 horas del día, 7 días a la semana. TTY 711. La llamada es gratuita. Вы можете получить эту информацию бесплатно и на других языках. Позвоните ArchCare Community преимущество в часа в сутки, 7 дней в неделю. Телетайп 711. Звонок бесплатный. 你可以在其他语言中这些信息是免费的 呼叫 ArchCare 社区优势在一个星期每天 小时,7 天 TTY711 该电话是免费的 Ou ka jwenn enfòmasyon sa a pou gratis nan lòt lang yo. Rele Advantage ArchCare Kominotè nan èdtan nan yon jou, 7 jou yon semèn. TTY 711. Rele a se gratis. 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 2

3 È possibile ottenere queste informazioni gratuitamente in altre lingue. Chiama Advantage ArchCare Comunità a ore al giorno, 7 giorni alla settimana. TTY 711. La chiamata è gratuita. 당신은다른언어로무료로이정보를얻을수있습니다 하루 24 시간, 주 7 일에 ArchCare 커뮤니티의장점을호출합니다. TTY 711. 통화는무료입니다. 紐約州建立了稱為獨立消費者權益網路 (Independent Consumer Advocacy Network, 簡稱 ICAN) 的投保人申訴專員計劃, 針對 ArchCare Community Advantage FIDA Plan 提供的所有服務向投保人提供免費的保密援助 要與 ICAN 聯絡, 可撥打免費電話 或線上造訪 icannys.org 常見問題 (FAQ) 如果您對此承保藥物清單存有任何疑問, 請在此處尋找答案 您可以閱讀所有常見問題以瞭解詳情, 或尋找問題和答案 承保藥物清單包含哪些處方藥? ( 我們簡稱承保藥物清單為 藥物清單 ) 承保藥物清單從第 11 頁開始列示 ArchCare Community Advantage FIDA Plan 承保的藥物 您可以透過我們的網路內藥房購買這些藥物 如果我們與藥房訂立了合約, 約定雙方合作為您提供服務, 我們的網路中就會包括這些藥房 我們將這些藥房稱為 網路內藥房 ArchCare Community Advantage FIDA Plan 將承保藥物清單中的全部藥物, 前提是 : 您的醫生或其他網路內處方者表示您需要服用該等藥物以幫助及早康復或保持健康, 藥物是醫療上必要的藥物, 並且 您在 ArchCare Community Advantage FIDA Plan 網路內藥房中配藥 ArchCare Community Advantage FIDA Plan 對於購買特定藥物可能規定了其他步驟 ( 請參閱下面的問題 5) 在某些情況下, 您可能必須採取一些行動 ( 例如首先試用其他藥物 ) 才能獲得藥物保險 您還可以造訪我們的網站 ( 或致電 聯絡投保人服務部, 瞭解最新的藥物清單 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 3

4 藥物清單是否會變更? 是 ArchCare Community Advantage FIDA Plan 可能在一年當中新增或移除藥物清單中的藥物 一般來說, 藥物清單僅會在以下情況下變更 : 市面上推出藥效與該藥物清單上現有藥物相同的新藥, 或者我們得知某種藥物不安全 我們可能還會變更關於藥物的規定 例如, 我們可能會 : 決定是否要求購買某種藥物時需獲得事先批准 ( 事先批准是指您需要先從 ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 取得批准, 然後才能購買藥物 ) 增加或變更您可購買的藥物劑量 ( 稱為 藥量限制 ) 增加或變更針對某種藥物的階梯療法限制 ( 階梯療法是指您必須先試用一種藥物, 然後我們才會承保另一種藥物 ) ( 要瞭解藥物規定詳情, 請參閱第 5 頁 ) 當我們將您正在服用的某種藥物從藥物清單中移除時, 我們會通知您 此外, 當我們變更關於藥物承保的規定時, 也會通知您 下面的問題 3 4 和 7 介紹了更多關於藥物清單變更的資訊 您可以隨時線上造訪 以查看 ArchCare Community Advantage FIDA Plan 的最新藥物清單 您還可以致電 聯絡投保人服務部, 瞭解最新的藥物清單 當市面上推出藥效與藥物清單現有藥物相同的更便宜藥物時, 會發生什麼情況? 如果市面上推出藥效與藥物清單現有藥物相同的更便宜藥物 : 您的藥劑師可能會在您下次配藥時提供更便宜的藥物 如果您和您的服務提供者確定更便宜的藥物不適合您, 您的服務提供者可以告訴藥劑師繼續向您提供您當前服用的藥物 ArchCare Community Advantage FIDA Plan 可能會決定將較貴的藥物從藥物清單中移除 如果您正在服用我們因市面上推出藥效相同且更便宜的藥物而從藥物清單中移除的藥物, 我們會在將其從藥物清單中移除前至少 60 天或者您請求加配藥物時通知您 您可以在藥物清單發生變更之前, 獲得 60 天的藥物供應 如果我們將某種藥物從藥物清單中移除, 我們會寄信通知您 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 4

5 如果我們發現某種藥物不安全, 將會發生什麼情況? 如果食品藥物管理局 (FDA) 報告您服用的某種藥物不安全, 我們會立即將其從藥物清單中移除 我們還會給您寄信並打電話, 告知您不安全的藥物已從藥物清單中移除 收到該等信件後, 您應該聯絡開立不安全藥物處方的服務提供者 您還可以每週 7 天 每天 24 小時隨時致電 聯絡我們 聽障專線 711 通話免費 藥物保險是否有任何限制? 或者是否必須採取某些行動才能獲得某些藥物? 是的, 某些藥物存在保險規定或對可購買劑量規定了限制 在某些情況下, 您必須採取一些行動才能獲得藥物 例如 : 事先批准 ( 或事先授權 ): 對於某些藥物, 您 您的醫生或其他處方者必須先從 ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 處獲取批准, 然後才能配藥 如果您沒有獲得批准,ArchCare Community Advantage FIDA Plan 可能不會承保藥物 藥量限制 : 有時,ArchCare Community Advantage FIDA Plan 會限制您可購買的藥物劑量 階梯療法 : 有時,ArchCare Community Advantage FIDA Plan 會要求您進行階梯療法 這意味著您必須按特定順序試用某些藥物治療病症 您可能必須先試用一種藥物, 然後我們才會承保另一種藥物 如果您的醫生認為第一種藥物不起作用, 然後我們才會承保第二種 您可以從第 11 頁開始查閱相關表格, 瞭解您所需的藥物是否有任何額外的條件或限制 您還可以造訪我們的網站 瞭解詳情 我們發佈了線上文件, 說明了我們的事先授權和階梯療法限制 您還可以請求我們寄送一份副本 您可以針對這些限制申請 例外通融 請參閱問題 11, 瞭解關於例外通融的詳情 如果您住在護理機構或其他長期照護機構接受服務, 並且需要使用未列入藥物清單的藥物, 或者您無法輕鬆獲取該等藥物, 我們可以助您一臂之力 無論您是否 ArchCare Community Advantage FIDA Plan 的新投保人, 我們都將為您承保 31 天 ( 除非處方天數少於該時間 ) 的所需藥物應急供應 這樣您就有時間與自己的醫生或其他處方者溝通 他或她可以幫助您確定您是否可改服藥物清單中的類似藥物, 或者是否要請求例外通融 請參閱問題 11, 瞭解關於例外通融的詳情 您如何知道自己需要的藥物是否存在限制或是否需要採取行動才能獲取所需藥物? 第 11 頁上的承保藥物清單包含名為 的欄 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 5

6 如果我們變更關於某些藥物承保方式的規定, 會發生什麼情況? 例如, 當我們對某種藥物增加事先授權 ( 批准 ) 藥量限制和 / 或階梯療法限制時, 會發生什麼情況? 當我們對某種藥物增加事先授權 藥量限制和 / 或階梯療法限制時, 我們將會告知您 我們會在增加限制之前至少提前 60 天或您下次請求加配藥物時告知您 您可以在藥物清單發生變更之前, 獲得 60 天的藥物供應 這樣您就有時間與自己的醫生或其他處方者商討接下來如何治療 如何在藥物清單中尋找藥物? 尋找藥物有兩種方式 : 您可以依字母順序 ( 如果您知道如何拼寫藥物名稱 ) 搜尋, 或者您可以依病症搜尋 要依字母順序搜尋, 請前往第 85 頁上的 依字母順序列示 部分 然後在清單中尋找藥物的名稱即可 要依病症搜尋, 請在第 11 頁上找到名為 藥物清單 - 依病症列示 的部分 然後尋找您所患病症即可 例如, 如果您患有心臟病, 則應在該類別中查詢 您可以從中找到治療心臟病的藥物 如果您所需藥物不在藥物清單中該怎麼做? 如果您未在藥物清單中看到自己要服用的藥物, 請致電 聯絡投保人服務部, 詢問相關事宜 如果知悉 ArchCare Community Advantage FIDA Plan 不承保某種藥物, 您可以採取以下行動 : 向投保人服務部索要與您想服用藥物效果相似的藥物清單 然後將清單交給您的醫生或其他處方者 他或她可以開立藥物清單中與您想服用藥物效果相似的藥物 或者您可以請求該計劃或您的跨學科團隊 (IDT) 例外通融承保您所需的藥物 請參閱問題 11, 瞭解關於例外通融的詳情 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 6

7 如果您是新加入 ArchCare Community Advantage FIDA Plan 的投保人, 並且未能在藥物清單中找到所需的藥物, 或者在獲取所需藥物時遇到問題, 該怎麼做? 我們可以助您一臂之力 在您成為 ArchCare Community Advantage FIDA Plan 投保人的最初 90 天內, 我們必須為您承保最多 90 天的所需藥物臨時供應 這樣您就有時間與自己的醫生或 其他處方者溝通 他或她可以幫助您確定您是否可改服藥物清單中的類似藥物, 或者是否要請求例外通融 我們將為您承保最多 90 天的所需藥物臨時供應, 前提是 : 您正在服用的藥物不在我們的藥物清單中, 或者醫療保健計劃規定不允許您購買處方者所開的劑量, 或者購買藥物需事先取得 ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 的批准, 或者您正在服用的藥物受到階梯療法限制 如果您住在護理機構或其他長期照護機構接受服務, 您可以加配藥物的最長時間為 91 天 您可以在 91 天的時間內多次加配藥物 這樣您的處方者就有時間將您所需的藥物更改為藥物清單中的藥物或者請求例外通融 如果您住在護理機構或其他長期照護機構接受服務, 並且需要使用未列入藥物清單的藥物, 或者您無法輕鬆獲取該等藥物, 我們可以助您一臂之力 無論您是否為 ArchCare Community Advantage FIDA Plan 的新投保人, 我們都將為您承保 31 天 ( 除非處方天數少於該時間 ) 的所需藥物應急供應 這樣您就有時間與自己的醫生或其他處方者溝通 他或她可以幫助您確定您是否可改服藥物清單中的類似藥物, 或者是否要請求例外通融 請參閱問題 11, 瞭解關於例外通融的詳情 您是否可以請求例外通融承保您所需的藥物? 可以 您可以請求 ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 例外通融承保藥物清單中沒有的藥物 您還可以請求 ArchCare Community Advantage FIDA Plan 或您的 IDT 變更針對您所需藥物的規定 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 7

8 例如,ArchCare Community Advantage FIDA Plan 可能會限制我們承保的藥量 如果您所需藥物存在限制, 您可以請求我們或您的 IDT 變更限制, 承保更多藥量 其他範例 : 您可以請求我們或您的 IDT 降低階梯療法限制或實現核准要求 請求例外通融需要多久? 首先,ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 必須收到您的處方者支持您請求例外通融的聲明 收到相關聲明後, 您會在 72 小時內收到關於例外通融的決定 若您或您的處方者認為必須等候 72 小時以獲得決定結果可能會損害您的健康, 您可以請求加速例外通融 這樣可以更快地獲得決定結果 如果您的處方者支持您的請求, 您將會在他們收到處方者支持聲明後 24 小時內獲得決定結果 如何請求例外通融? 要請求例外通融, 請致電您的護理經理 您的護理經理將與您和您的服務提供者一起幫助您請求例外通融 什麼是非品牌藥物? 非品牌藥物是指與品牌藥物的成分相同的藥物 該等藥物通常價格比品牌藥物低, 並且通常不具有知名名稱 非品牌藥物已獲得食品與藥物管理局 (FDA) 的批准 ArchCare Community Advantage FIDA Plan 同時承保品牌藥物和非品牌藥物 什麼是非處方 (OTC) 藥物? OTC 是指 over-the-counter, 意思為非處方藥物 ArchCare Community Advantage FIDA Plan 承保某些非處方藥物, 前提是您的服務提供者為該等藥物開立處方 您可以參閱 ArchCare Community Advantage FIDA Plan 藥物清單, 瞭解承保哪些非處方品牌藥物 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 8

9 ArchCare Community Advantage FIDA Plan 是否承保非處方非藥物產品? ArchCare Community Advantage FIDA Plan 承保某些非處方非藥物產品, 前提是您的服務提供者為該等產品開立處方 例如 : 酒精棉片 消毒紗布片 (2 x2 ) 胰島素注射針頭 胰島素安全針頭和胰島素注射器 您可以參閱 ArchCare Community Advantage FIDA Plan 藥物清單, 瞭解承保哪些非處方非藥物產品 您應支付的共付額是多少? 您無需為藥物清單中的藥物支付共付額 什麼是藥物等級? 為藥物指定一種類別 ( 共三種類別 ) 稱為等級 第一級 : 聯邦醫療保險 D 部分非品牌藥物第二級 : 聯邦醫療保險 D 部分品牌藥物第三級 : 非聯邦醫療保險處方和非處方藥物所有等級均無共付額 承保藥物清單 下方的承保藥物清單介紹了 ArchCare Community Advantage FIDA Plan 承保的藥物 如果您在清單中找不到所需藥物, 請翻到第 85 頁上的 索引 圖表的第一欄列出了藥物名稱 品牌藥物以大寫字母顯示 ( 例如 COUMADIN), 非品牌藥物則以小寫字母列出 ( 例如 warfarin) 欄中的資訊說明了 ArchCare Community Advantage FIDA Plan 對於承保您所需藥物是否有任何規定 備註 : 藥物名稱旁邊的星號 ( * ) 表示相應藥物不是 D 部分藥物 該等藥物有不同的上訴規 上訴是指正式請求審查並變更您認為有誤的承保決定 例如,ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 可能決定不承保您所需的藥物或者聯邦醫療保險或醫療補助不再承保您所需的藥物 如果您 您的醫生或其他的處方者不同意該決定, 您就可以上訴 要查詢關於如何上訴的說明, 請致電 聯絡投保人服務部, 或致電 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 9

10 8800 聯絡獨立消費者權益網路 (ICAN) 您還可以參閱 投保人手冊, 瞭解如何針對決定提出上訴 藥物清單術語指南 PA 需要事先授權 : 對於某些藥物, 您 您的醫生或其他處方者必須先從 ArchCare Community Advantage FIDA Plan 或您的跨學科團隊 (IDT) 處獲取批准, 然後才能配藥 如果您沒有獲得批准, ArchCare Community Advantage FIDA Plan 可能不會承保相應藥物 QL 藥量限制 : 有時,ArchCare Community Advantage FIDA Plan 會限制您可購買的藥物劑量 ST 階梯療法 : 有時,ArchCare Community Advantage FIDA Plan 會要求您進行階梯療法 這意味著您必須按特定順序試用某些藥物治療病症 您可能必須先試用一種藥物, 然後我們才會承保另一種藥物 如果您的醫生認為第一種藥物不起作用, 然後我們才會承保第二種 B/D 該計劃將基於您的醫生處方此藥物的原因確定相應藥物是適用聯邦醫療保險 B 部分還是 D 部分 LA 限制獲取 : 該等藥物只能在少數專門藥房內購買 NM 不可在我們的郵購藥房內購買 並非所有藥物都可以在郵購藥房內買到 ; 如果您有任何問題, 請洽詢客戶服務部 10

11 ArchCare Community Advantage FIDA Plan 生效日期 :2015 年 8 月 1 日 藥物名稱 等級 您需要付費的藥物 鎮痛藥 - 用於治療疼痛和炎症的藥物 痛風藥 - 用於治療痛風的藥物 allopurinol tab 1 $0 colchicine w/ probenecid 1 $0 COLCRYS 2 $0 QL (120 片 /30 天 ) probenecid 1 $0 ULORIC 2 $0 ST 其他 acetaminophen CHEW; ELIX; 3 $0 NM;* LIQD; SOLN; SUSP; TABS; TBCR; TBDP ACETAMINOPHEN SUPP 3 $0 NM;* ACETAMINOPHEN 8 HOUR 3 $0 NM;* ADULT ASPIRIN LOW STRENGT 3 $0 NM;* APAP $0 NM;* ASCRIPTIN 3 $0 NM;* aspirin CHEW 3 $0 NM;* ASPIRIN SUPP 60mg, 120mg, 3 $0 NM;* 200mg aspirin SUPP 300mg, 600mg 3 $0 NM;* aspirin TABS 3 $0 NM;* aspirin TBEC 325mg, 500mg, 3 $0 NM;* 650mg ASPIRIN TBEC 650mg 3 $0 NM;* aspirin buffered (cal carb-mag carb-mag $0 NM;* oxide) aspirin effervescent 3 $0 NM;* BUFFERIN EXTRA STRENGTH 3 $0 NM;* BUFFERIN LOW DOSE 3 $0 NM;* CHILDRENS MOTRIN CHEW 3 $0 NM;* ELIXSURE FEVER/PAIN 3 $0 NM;* FEBROL 3 $0 NM;* FEVERALL INFANTS 3 $0 NM;* ibuprofen CAPS 3 $0 NM;* ibuprofen CHEW 3 $0 NM;* ibuprofen SUSP 50mg/1.25ml, 3 $0 NM;* 100mg/5ml IBUPROFEN TABS 100mg 3 $0 NM;* 11

12 藥物名稱 等級 您需要付費 的藥物 ibuprofen TABS 200mg 3 $0 NM;* magnesium salicylate tetrahydrate 3 $0 NM;* NAPROXEN SODIUM CAPS 3 $0 NM;* naproxen sodium TABS 220mg 3 $0 NM;* NON-ASPIRIN EXTRA STRENGT 3 $0 NM;* TBDP ST JOSEPH ADULT ANALGESIC 3 $0 NM;* STANBACK ASPIRIN FREE 3 $0 NM;* TRIAMINIC FEVER REDUCER P 3 $0 NM;* 非甾體抗炎藥 - 用於治療疼痛和炎症的藥物 celecoxib CAPS 1 $0 QL (60 粒膠囊 /30 天 ) diclofenac potassium 1 $0 diclofenac sodium TB24 1 $0 diclofenac sodium TBEC 1 $0 diflunisal 1 $0 etodolac 1 $0 etodolac er 1 $0 flurbiprofen TABS 1 $0 ibuprofen SUSP 100mg/5ml 1 $0 ibuprofen TABS 400mg, 600mg 1 $0 ibuprofen tab 800 mg 1 $0 ketoprofen CAPS 1 $0 MELOXICAM SUSP 1 $0 meloxicam TABS 1 $0 nabumetone TABS 1 $0 naproxen SUSP;TABS;TBEC 1 $0 naproxen sodium TABS 275mg, 1 $0 550mg piroxicam CAPS 1 $0 sulindac TABS 1 $0 阿片類鎮痛藥 - 用於治療疼痛的藥物 acetaminophen w/ codeine SOLN 1 $0 QL (5000 毫升 /30 天 ) acetaminophen w/ codeine TABS 1 $0 QL (400 片 /30 天 ) butorphanol tartrate SOLN 1 $0 1mg/ml, 2mg/ml hydroco/apap tab 5-325mg 1 $0 QL (360 片 /30 天 ) hydroco/apap tab $0 QL (360 片 /30 天 ) hydroco/apap tab mg 1 $0 QL (360 片 /30 天 ) hydrocodone-acetaminophen mg/15ml 1 $0 QL (5400 毫升 /30 天 ) hydrocodone-ibuprofen tab $0 QL (150 片 /30 天 ) mg 12

13 藥物名稱 等級 您需要付費 的藥物 lorcet hd tab mg 1 $0 QL (360 片 /30 天 ) lorcet plus tab $0 QL (360 片 /30 天 ) lorcet tab 5-325mg 1 $0 QL (360 片 /30 天 ) lortab tab 5-325mg 1 $0 QL (360 片 /30 天 ) lortab tab $0 QL (360 片 /30 天 ) lortab tab mg 1 $0 QL (360 片 /30 天 ) tramadol hcl TABS 1 $0 QL (240 片 /30 天 ) tramadol-acetaminophen 1 $0 QL (240 片 /30 天 ) 阿片類鎮痛藥 (CII) - 用於治療疼痛的藥物 DURAMORPH 1 $0 B/D endocet 1 $0 QL (360 片 /30 天 ) fentanyl 12mcg/hr, 25mcg/hr 1 $0 QL (10 帖 /30 天 ) fentanyl 50mcg/hr, 75mcg/hr, 1 $0 QL (10 帖 /30 天 ),PA 100mcg/hr fentanyl citrate LPOP 2 $0 QL (120 錠 /30 天 ),PA FENTORA 2 $0 QL (120 片 /30 天 ),PA hydromorphon inj 10mg/ml 1 $0 B/D hydromorphone hcl LIQD 1 $0 hydromorphone hcl TABS 1 $0 QL (270 片 /30 天 ) LAZANDA SPR 100MCG 2 $0 QL (30 瓶 /30 天 ),PA LAZANDA SPR 400MCG 2 $0 QL (30 瓶 /30 天 ),PA methadone hcl CONC 1 $0 QL (120 毫升 /30 天 ) methadone hcl SOLN 5mg/5ml, 1 $0 QL (600 毫升 /30 天 ) 10mg/5ml methadone hcl TABS 1 $0 QL (240 片 /30 天 ) morphine ext-rel tab 15mg,30mg 1 $0 QL (90 片 /30 天 ),60mg,100mg morphine ext-rel tab 200mg 1 $0 QL (60 片 /30 天 ) MORPHINE SUL INJ 1mg/ml, 4mg/ml,10mg/ml,15mg/ml 1 $0 B/D morphine sul inj.5mg/ml,1mg/ml 1 $0 B/D morphine sulfate CP24 10mg, 1 $0 QL (60 粒膠囊 /30 天 ) 20mg,30mg,50mg,60mg morphine sulfate CP24 80mg 2 $0 QL (60 粒膠囊 /30 天 ) MORPHINE SULFATE SOLN 2mg/ml 1 $0 B/D,8mg/ml MORPHINE SULFATE TABS 1 $0 QL (180 片 /30 天 ) morphine sulfate beads 1 $0 QL (60 粒膠囊 /30 天 ) morphine sulfate cap 100mg er 2 $0 QL (60 粒膠囊 /30 天 ) MORPHINE SULFATE ORAL SOL 1 $0 oxycodone hcl CAPS 1 $0 QL (180 粒膠囊 /30 天 ) 13

14 藥物名稱 等級 您需要付費 的藥物 OXYCODONE HCL CONC 1 $0 oxycodone hcl SOLN 1 $0 oxycodone hcl TABS 1 $0 QL (180 片 /30 天 ) oxycodone hcl tab 5 mg 1 $0 QL (180 片 /30 天 ) oxycodone w/ acetaminophen $0 QL (360 片 /30 天 ) 325mg oxycodone w/ acetaminophen 5-1 $0 QL (360 片 /30 天 ) 325mg oxycodone w/ acetaminophen $0 QL (360 片 /30 天 ) 325mg oxycodone w/ acetaminophen 10-1 $0 QL (360 片 /30 天 ) 325mg roxicet soln 2 $0 QL (1800 毫升 /30 天, 溶液 ) roxicet tabs 1 $0 QL (360 片 /30 天 ) 麻醉藥 - 用於麻醉的藥物局部麻醉藥 lidocaine hcl (local anesth.) 1 $0 B/D lidocaine inj 0.5% 1 $0 B/D lidocaine inj 1% 1 $0 B/D lidocaine inj 1.5% 1 $0 B/D lidocaine inj 2% 1 $0 B/D 抗感染藥 - 用於治療感染的藥物抗菌藥 - 其他藥物 amikacin sulfate SOLN 1 $0 gentamicin in saline 1 $0 gentamicin sulfate SOLN 1 $0 neomycin sulfate TABS 1 $0 paromomycin sulfate CAPS 1 $0 streptomycin sulfate SOLR 1 $0 sulfadiazine TABS 2 $0 tobramycin NEBU 2 $0 B/D,NM tobramycin sulfate SOLN;SOLR 1 $0 tobramycin sulfate in saline 2 $0 抗感染藥 - 其他藥物 ALBENZA 2 $0 ALINIA 2 $0 atovaquone SUSP 2 $0 AZACTAM 2 $0 AZACTAM/DEX INJ 1GM 2 $0 AZACTAM/DEX INJ 2GM 2 $0 aztreonam 1 $0 BILTRICIDE 2 $0 14

15 藥物名稱 等級 您需要付費 的藥物 CAYSTON 2 $0 NM,LA,PA clindamycin cap 75mg 1 $0 clindamycin cap 300mg 1 $0 clindamycin hcl cap 150 mg 1 $0 clindamycin phosphate inj 1 $0 clindamycin sol 75mg/5ml 1 $0 colistimethate sodium SOLR 1 $0 CUBICIN 2 $0 dapsone TABS 1 $0 DARAPRIM 2 $0 imipenem-cilastatin 1 $0 INVANZ 2 $0 ivermectin TABS 1 $0 linezolid SOLN 2 $0 meropenem 1 $0 methenamine hippurate 1 $0 metronidazole TABS 1 $0 metronidazole in nacl 1 $0 NEBUPENT 2 $0 B/D nitrofurantoin macrocrystal 2 $0 PA;90 天限制, 如果超過 64 歲 nitrofurantoin monohyd macro 2 $0 PA;90 天限制, 如果超過 64 歲 PENTAM $0 SIVEXTRO 2 $0 sulfamethoxazole-trimethoprim 1 $0 sulfamethoxazole-trimethoprim inj 1 $0 SYNERCID 2 $0 trimethoprim TABS 1 $0 TYGACIL 2 $0 vancomycin hcl CAPS 2 $0 vancomycin hcl SOLR 1 $0 ZYVOX SUSR; TABS 2 $0 抗真菌藥 - 用於治療真菌感染的藥物 ABELCET 2 $0 B/D AMBISOME 2 $0 B/D amphotericin b SOLR 1 $0 B/D CANCIDAS 2 $0 ERAXIS 2 $0 fluconazole SUSR;TABS 1 $0 fluconazole in dextrose 1 $0 fluconazole in nacl 1 $0 flucytosine CAPS 2 $0 15

16 藥物名稱 等級 您需要付費 的藥物 griseofulvin microsize 1 $0 griseofulvin ultramicrosize 1 $0 itraconazole CAPS 1 $0 PA ketoconazole TABS 1 $0 PA MYCAMINE 2 $0 NOXAFIL SUSP;TBEC 2 $0 nystatin TABS 1 $0 terbinafine hcl TABS 1 $0 QL (90 片 /365 天 ) voriconazole SOLR 1 $0 voriconazole SUSR;TABS 2 $0 抗瘧藥 - 用於治療瘧疾的藥物 atovaquone-proguanil hcl 1 $0 chloroquine phosphate TABS 1 $0 COARTEM 2 $0 mefloquine hcl 1 $0 PRIMAQUINE PHOSPHATE 2 $0 quinine sulfate CAPS 1 $0 PA 反轉錄病毒藥 - 用於抑制艾滋病病毒 / 艾滋病感染的藥物 abacavir sulfate 1 $0 APTIVUS 2 $0 CRIXIVAN 2 $0 didanosine 1 $0 EDURANT 2 $0 EMTRIVA 2 $0 EPIVIR SOLN 2 $0 FUZEON 2 $0 NM INTELENCE 2 $0 INVIRASE 2 $0 ISENTRESS CHEW;TABS 2 $0 ISENTRESS PACK 1 $0 lamivudine 1 $0 LEXIVA 2 $0 NEVIRAPINE SUSP 1 $0 nevirapine TABS;TB24 1 $0 NORVIR 2 $0 PREZISTA 2 $0 RESCRIPTOR 2 $0 RETROVIR IV INFUSION 2 $0 REYATAZ 2 $0 SELZENTRY 2 $0 stavudine 1 $0 SUSTIVA 2 $0 TIVICAY 2 $0 16

17 藥物名稱 等級 您需要付費 的藥物 TYBOST 2 $0 VIDEX PEDIATRIC 2 $0 VIRACEPT 2 $0 VIRAMUNE XR 100mg 2 $0 VIREAD 2 $0 VITEKTA 2 $0 ZIAGEN SOLN 2 $0 zidovudine 1 $0 反轉錄合胞體病毒藥 - 用於抑制愛滋病病毒 / 愛滋病感染的藥物 abacavir sulfate-lamivudinezidovudine 2 $0 ATRIPLA 2 $0 COMPLERA 2 $0 EPZICOM 2 $0 EVOTAZ 2 $0 KALETRA SOL 2 $0 KALETRA TAB MG 2 $0 KALETRA TAB MG 2 $0 lamivudine-zidovudine 2 $0 PREZCOBIX 2 $0 STRIBILD 2 $0 TRIUMEQ 2 $0 TRUVADA 2 $0 QL (30 片 /30 天 ) 抗結核藥 - 用於治療結核病的藥物 CAPASTAT SULFATE 2 $0 cycloserine CAPS 1 $0 ethambutol hcl TABS 1 $0 isoniazid TABS 1 $0 isoniazid inj 100 mg/ml 1 $0 isoniazid syp 50mg/5ml 1 $0 paser d/r 2 $0 PRIFTIN 2 $0 pyrazinamide 1 $0 rifabutin 1 $0 rifampin CAPS;SOLR 1 $0 RIFATER 2 $0 SIRTURO 2 $0 LA,PA TRECATOR 2 $0 抗病毒藥 - 用於治療病毒感染的藥物 acyclovir CAPS;SUSP;TABS 1 $0 acyclovir sodium 1 $0 B/D adefovir dipivoxil 2 $0 BARACLUDE SOLN 2 $0 17

18 藥物名稱 等級 您需要付費 的藥物 entecavir 2 $0 EPIVIR HBV SOLN 2 $0 famciclovir TABS 1 $0 foscarnet sodium 1 $0 ganciclovir inj 500mg 1 $0 B/D HARVONI 2 $0 NM,PA lamivudine (hbv) 1 $0 moderiba 800 dose pack 2 $0 NM,PA moderiba pak 600/day 2 $0 NM,PA moderiba pak 1000/day 2 $0 NM,PA moderiba pak 1200/day 2 $0 NM,PA moderiba tab 200mg 1 $0 NM,PA OLYSIO 2 $0 NM,PA REBETOL SOLN 2 $0 NM,PA RELENZA DISKHALER 2 $0 ribapak mis 600/day 2 $0 NM,PA ribasphere CAPS 1 $0 NM,PA ribasphere TABS 200mg,400mg 1 $0 NM,PA ribasphere TABS 600mg 2 $0 NM,PA ribasphere ribapak $0 NM,PA ribasphere ribapak $0 NM,PA ribasphere ribapak $0 NM,PA ribavirin 200mg 1 $0 NM,PA rimantadine hydrochloride 1 $0 SOVALDI 2 $0 NM,PA TAMIFLU 2 $0 TYZEKA 2 $0 valacyclovir hcl TABS 1 $0 VALCYTE SOLR 2 $0 valganciclovir hcl 2 $0 VICTRELIS 2 $0 NM,PA 頭孢菌素抗生藥 - 用於治療感染的藥物 cefaclor 1 $0 cefaclor monohydrate er 2 $0 cefadroxil 1 $0 cefazolin in d5w 2 $0 cefazolin inj 1 $0 cefazolin sodium 1gm,20gm 1 $0 cefdinir 1 $0 cefepime hcl 1 $0 cefixime 1 $0 18

19 藥物名稱 等級 您需要付費的藥物 cefotaxime sodium 1gm,2gm, 1 $0 500mg cefoxitin sodium 1 $0 cefpodoxime proxetil 1 $0 cefprozil 1 $0 ceftazidime 1gm,2gm,6gm 1 $0 CEFTAZIDIME/DEXTROSE 2 $0 ceftriaxone sodium SOLR 1gm, 1 $0 2gm, 10gm, 250mg, 500mg ceftriaxone sodium SOLR 1 $0 cefuroxime axetil 1 $0 cefuroxime sodium 1.5gm,7.5gm 1 $0,750mg cephalexin CAPS 250mg,500mg 1 $0 cephalexin SUSR 1 $0 SUPRAX CAPS 2 $0 suprax CHEW 2 $0 suprax SUSR 100mg/5ml, 2 $0 200mg/5ml SUPRAX SUSR 500mg/5ml 2 $0 tazicef SOLR 1 $0 tazicef vial 1 $0 TEFLARO 2 $0 紅黴素 / 大環內酯類藥物 - 用於治療感染的藥物 AZITHROMYCIN PACK 1 $0 azithromycin SOLR 500mg 1 $0 azithromycin SUSR 1 $0 azithromycin TABS 1 $0 clarithromycin TABS 1 $0 clarithromycin er 1 $0 clarithromycin for susp 1 $0 DIFICID 2 $0 e.e.s. 1 $0 e.e.s $0 E.E.S. GRANULES 2 $0 ery-tab 2 $0 ERYPED $0 ERYPED $0 erythrocin lactobionate 500mg 2 $0 erythrocin stearate 1 $0 erythromycin base 1 $0 erythromycin cap 250mg ec 1 $0 ZMAX 2 $0 19

20 藥物名稱 等級 您需要付費的藥物 氟喹諾酮類藥物 - 用於治療感染的藥物 ciprofloxacin SUSR 1 $0 ciprofloxacin er 1 $0 ciprofloxacin hcl tab 1 $0 ciprofloxacin in d5w 1 $0 ciprofloxacin inj 1 $0 levofloxacin TABS 1 $0 levofloxacin in d5w 1 $0 levofloxacin inj 25mg/ml 1 $0 levofloxacin oral soln 25 mg/ml 1 $0 青黴素 - 用於治療感染的藥物 amoxicillin 1 $0 amoxicillin & pot clavulanate 1 $0 ampicillin & sulbactam sodium 1 $0 ampicillin cap 250 mg 1 $0 ampicillin cap 500 mg 1 $0 ampicillin for susp 125 mg/5ml 1 $0 ampicillin for susp 250 mg/5ml 1 $0 ampicillin inj 1 $0 ampicillin sodium 1 $0 BICILLIN L-A 2 $0 dicloxacillin sodium 1 $0 nafcillin sodium 1gm 1 $0 nafcillin sodium 2gm,10gm 2 $0 oxacillin sodium 1gm,2gm 1 $0 oxacillin sodium 10gm 2 $0 PENICILLIN G POT IN DEXTROSE 2 $0 penicillin g potassium 1 $0 penicillin g procaine 2 $0 penicillin g sodium 1 $0 penicillin v potassium 1 $0 penicilln gk inj 5mu 1 $0 piperacillin sodium-tazobactam 1 $0 sodium 四環素類藥物 - 用於治療感染的藥物 doxy inj 1 $0 doxycycline (monohydrate) CAPS 1 $0 50mg,100mg doxycycline (monohydrate) TABS 1 $0 doxycycline hyclate CAPS;SOLR; 1 $0 TABS minocycline hcl CAPS 1 $0 VIBRAMYCIN SYRP 2 $0 20

21 藥物名稱 等級 您需要付費 的藥物 抗腫瘤藥 - 用於治療癌症的藥物烷化劑 BICNU 2 $0 B/D BUSULFEX 2 $0 B/D CYCLOPHOSPHAMIDE CAPS 2 $0 B/D cyclophosphamide SOLR 1 $0 B/D dacarbazine 200mg 1 $0 B/D EMCYT 2 $0 HEXALEN 2 $0 IFEX 3gm 2 $0 B/D ifosfamide inj 1gm 1 $0 B/D ifosfamide inj 1gm/20ml 1 $0 B/D IFOSFAMIDE INJ 3GM 2 $0 B/D ifosfamide inj 3gm/60ml 1 $0 B/D LEUKERAN 2 $0 LOMUSTINE 1 $0 melphalan hcl 2 $0 B/D MUSTARGEN 2 $0 B/D TREANDA 2 $0 B/D,NM 蔥環類藥物 adriamycin 1 $0 B/D daunorubicin hcl 1 $0 B/D doxorubicin hcl for inj 50 mg 1 $0 B/D doxorubicin hcl liposomal inj 2 $0 B/D 2mg/ml doxorubicin inj 50mg 1 $0 B/D epirubicin hcl 1 $0 B/D idarubicin hcl 2 $0 B/D 抗生素 bleomycin sulfate 1 $0 B/D mitomycin SOLR 1 $0 B/D 抗代謝藥 adrucil 1 $0 B/D ALIMTA 2 $0 B/D azacitidine 2 $0 B/D,NM cladribine 2 $0 B/D cytarabine 20mg/ml 1 $0 B/D fludarabine phosphate 1 $0 B/D fluorouracil SOLN 1 $0 B/D GEMCITABINE HCL SOLN 2 $0 B/D gemcitabine hcl SOLR 2 $0 B/D mercaptopurine TABS 1 $0 methotrexate sodium inj 1 $0 B/D 21

22 藥物名稱 等級 您需要付費 的藥物 NIPENT 2 $0 B/D PURIXAN 2 $0 TABLOID 2 $0 抗有絲分裂藥 類紫杉醇類藥物 DOCETAXEL CONC 20mg/ml, 2 $0 B/D 80mg/4ml docetaxel CONC 140mg/7ml 2 $0 B/D DOCETAXEL SOLN 80mg/8ml, 2 $0 B/D 200mg/20ml paclitaxel 1 $0 B/D 抗有絲分裂藥 長春花生物鹼類藥物 vinblastine sulfate 2 $0 B/D vincasar 1 $0 B/D vincristine sulfate 1 $0 B/D vinorelbine tartrate 1 $0 B/D 生物反應調節劑 AVASTIN 2 $0 B/D,NM ERIVEDGE 2 $0 NM,LA,PA FARYDAK 2 $0 NM,LA,PA HERCEPTIN 2 $0 B/D,NM IBRANCE 2 $0 NM, LA, PA ISTODAX 2 $0 B/D,NM KADCYLA 2 $0 B/D,NM LYNPARZA 2 $0 NM, PA PROLEUKIN 2 $0 B/D,NM RITUXAN 2 $0 NM,PA VELCADE 2 $0 B/D,NM ZOLINZA 2 $0 NM,PA 激素類抗腫瘤藥 anastrozole TABS 1 $0 bicalutamide 1 $0 DEPO-PROVERA INJ 400/ML 2 $0 B/D exemestane 1 $0 FARESTON 2 $0 FASLODEX 2 $0 B/D flutamide 1 $0 letrozole TABS 1 $0 leuprolide acetate KIT 1 $0 NM,PA LUPR DEP-PED INJ 30MG (3-2 $0 NM,PA MONTH) LUPRON DEPOT 3.75mg 2 $0 NM,PA LUPRON DEPOT INJ MG 2 $0 NM,PA 22

23 藥物名稱 等級 您需要付費 的藥物 LUPRON DEPOT-PED 2 $0 NM,PA LYSODREN 2 $0 MEGACE ES 2 $0 PA megestrol acetate SUSP;TABS 2 $0 PA NILANDRON 2 $0 SOLTAMOX 2 $0 tamoxifen citrate TABS 1 $0 TRELSTAR DEP INJ 3.75MG 2 $0 NM,PA TRELSTAR LA INJ 11.25MG 2 $0 NM,PA XTANDI 2 $0 NM,LA,PA ZYTIGA 2 $0 NM,PA 激酶抑制劑 AFINITOR 2 $0 NM,PA AFINITOR DISPERZ 2 $0 NM,PA BOSULIF 2 $0 NM,PA CAPRELSA 2 $0 NM,LA,PA COMETRIQ 2 $0 NM,PA GILOTRIF TAB 20MG 2 $0 NM,LA,PA GILOTRIF TAB 30MG 2 $0 NM,LA,PA GILOTRIF TAB 40MG 2 $0 NM,LA,PA GLEEVEC 2 $0 NM,PA ICLUSIG 2 $0 NM,LA,PA IMBRUVICA CAP 140MG 2 $0 NM,LA,PA INLYTA 2 $0 NM,LA,PA JAKAFI 2 $0 NM,LA,PA LENVIMA 10MG DAILY DOSE 2 $0 NM,LA,PA LENVIMA 14MG DAILY DOSE 2 $0 NM,LA,PA LENVIMA 20MG DAILY DOSE 2 $0 NM,LA,PA LENVIMA 24MG DAILY DOSE 2 $0 NM,LA,PA MEKINIST 2 $0 NM,PA NEXAVAR 2 $0 NM,LA,PA SPRYCEL 2 $0 NM,PA STIVARGA 2 $0 NM,LA,PA SUTENT 2 $0 NM,PA TAFINLAR 2 $0 NM,PA TARCEVA 2 $0 NM,PA TASIGNA 2 $0 NM,PA TYKERB 2 $0 NM,LA,PA VOTRIENT 2 $0 NM,PA XALKORI 2 $0 NM,LA,PA ZELBORAF 2 $0 NM,LA,PA 23

24 藥物名稱 等級 您需要付費 的藥物 ZYDELIG 2 $0 NM,LA,PA ZYKADIA 1 $0 NM,LA,PA 其他 DROXIA 2 $0 hydroxyurea CAPS 1 $0 MATULANE 2 $0 mitoxantrone hcl 1 $0 B/D,NM POMALYST CAP 1MG 2 $0 NM,LA,PA POMALYST CAP 2MG 2 $0 NM,LA,PA POMALYST CAP 3MG 2 $0 NM,LA,PA POMALYST CAP 4MG 2 $0 NM,LA,PA SYLATRON KIT 296MCG 2 $0 NM,PA SYLATRON KIT 444MCG 2 $0 NM,PA SYLATRON KIT 888MCG 2 $0 NM,PA TARGRETIN CAPS 2 $0 NM,PA tretinoin (chemotherapy) 2 $0 TRISENOX 2 $0 B/D 含鉑類藥物 carboplatin 1 $0 B/D cisplatin 1 $0 B/D oxaliplatin 2 $0 B/D 保護劑 amifostine crystalline 2 $0 B/D dexrazoxane 250mg 2 $0 B/D ELITEK 2 $0 B/D leucovorin calcium SOLR 1 $0 B/D leucovorin calcium TABS 1 $0 leucovorin calcium for inj 500 mg 1 $0 B/D mesna 1 $0 B/D MESNEX TABS 2 $0 拓撲異構酶抑制劑 etoposide SOLN 500mg/25ml 1 $0 B/D irinotecan hcl 2 $0 B/D toposar 1gm/50ml 1 $0 B/D topotecan hcl SOLR 2 $0 B/D 心血管類藥物 - 用於治療心臟病和循環系統疾病的藥物 血管緊張素轉化酶抑制劑合成藥物 - 用於治療高血壓的藥物 amlodipine--benazepril hcl cap 10-1 $0 QL (30 粒膠囊 /30 天 ) 20 mg amlodipine-benazepril hcl cap mg 1 $0 QL (30 粒膠囊 /30 天 ) 24

25 藥物名稱 等級 您需要付費的藥物 amlodipine-benazepril hcl cap 5-10 mg amlodipine-benazepril hcl cap 5-20 mg amlodipine-benazepril hcl cap 5-40 mg amlodipine-benazepril hcl cap 10-1 $0 40mg benazepril & hydrochlorothiazide 1 $0 captopril & hydrochlorothiazide 1 $0 enalapril maleate & 1 $0 hydrochlorothiazide fosinopril sodium & 1 $0 hydrochlorothiazide lisinopril & hydrochlorothiazide 1 $0 moexipril-hydrochlorothiazide 1 $0 quinapril-hydrochlorothiazide 1 $0 血管緊張素轉化酶抑制劑 - 用於治療高血壓的藥物 benazepril hcl TABS 1 $0 captopril TABS 1 $0 enalapril maleate TABS 1 $0 fosinopril sodium 1 $0 lisinopril TABS 1 $0 moexipril hcl 1 $0 perindopril erbumine 1 $0 quinapril hcl 1 $0 ramipril 1 $0 trandolapril 1 $0 醛固酮受體拮抗劑 - 用於治療高血壓的藥物 eplerenone 1 $0 spironolactone TABS 1 $0 α 阻斷劑 - 用於治療高血壓的藥物 1 $0 QL (30 粒膠囊 /30 天 ) 1 $0 QL (30 粒膠囊 /30 天 ) 1 $0 QL (30 粒膠囊 /30 天 ) doxazosin mesylate 1mg,2mg, 1 $0 QL (30 片 /30 天 ) 4mg doxazosin mesylate 8mg 1 $0 prazosin hcl 1 $0 terazosin hcl 1 $0 血管收縮素 II 受體拮抗劑合成藥物 - 用於治療高血壓的藥物 amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg 1 $0 QL (30 片 /30 天 ) 1 $0 QL (30 片 /30 天 ) 1 $0 QL (30 片 /30 天 ) 25

26 藥物名稱 等級 您需要付費的藥物 amlodipine besylate-valsartan tab 1 $ mg amlodipine-valsartanhydrochlorothiazide mg amlodipine-valsartanhydrochlorothiazide mg amlodipine-valsartanhydrochlorothiazide mg amlodipine-valsartanhydrochlorothiazide mg amlodipine-valsartanhydrochlorothiazide 1 $ mg 1 $0 QL (30 片 /30 天 ) 1 $0 QL (60 片 /30 天 ) 1 $0 QL (30 片 /30 天 ) 1 $0 QL (30 片 /30 天 ) AZOR 10-40MG 2 $0 AZOR TAB 5-20MG 2 $0 QL (30 片 /30 天 ) AZOR TAB 5-40MG 2 $0 QL (30 片 /30 天 ) AZOR TAB 10-20MG 2 $0 QL (30 片 /30 天 ) BENICAR HCT 40-25MG 2 $0 BENICAR HCT TAB MG 2 $0 QL (30 片 /30 天 ) BENICAR HCT TAB MG 2 $0 QL (30 片 /30 天 ) losartan-hctz mg 1 $0 QL (30 片 /30 天 ) losartan-hctz mg 1 $0 QL (30 片 /30 天 ) losartan-hctz mg 1 $0 TRIBENZOR40- TAB 10-25MG 2 $0 TRIBENZOR TAB MG 2 $0 QL (30 片 /30 天 ) TRIBENZOR TAB MG 2 $0 QL (30 片 /30 天 ) TRIBENZOR TAB MG 2 $0 QL (30 片 /30 天 ) TRIBENZOR TAB $0 QL (30 片 /30 天 ) valsartan & hctz tab mg 1 $0 QL (30 片 /30 天 ) valsartan & hctz tab mg 1 $0 QL (30 片 /30 天 ) valsartan & hctz tab mg 1 $0 QL (30 片 /30 天 ) valsartan & hctz tab mg 1 $0 valsartan & hctz tab mg 1 $0 血管收縮素 II 受體拮抗劑 - 用於治療高血壓的藥物 BENICAR 5mg 2 $0 QL (60 片 /30 天 ) BENICAR 20mg 2 $0 QL (30 片 /30 天 ) BENICAR 40mg 2 $0 losartan potassium 25mg,50mg 1 $0 QL (60 片 /30 天 ) losartan potassium 100mg 1 $0 valsartan 40mg,80mg,160mg 1 $0 QL (60 片 /30 天 ) valsartan 320mg 1 $0 抗心律失常藥 - 用於控制心律的藥物 amiodarone hcl 1 $0 26

27 藥物名稱 等級 您需要付費 的藥物 disopyramide phosphate 2 $0 PA flecainide acetate 1 $0 mexiletine hcl 1 $0 MULTAQ 2 $0 NORPACE CR 2 $0 PA pacerone 1 $0 propafenone hcl 1 $0 quinidine gluconate TBCR 1 $0 quinidine sulfate TABS 1 $0 sorine 1 $0 sotalol hcl 1 $0 sotalol hcl (afib/afl) 1 $0 TIKOSYN 2 $0 NM 降血脂藥 還原酶抑製劑 - 用於治療高膽固醇的藥物 atorvastatin calcium TABS 1 $0 QL (30 片 /30 天 ) CRESTOR 2 $0 QL (30 片 /30 天 ) lovastatin 10mg 1 $0 QL (30 片 /30 天 ) lovastatin 20mg 1 $0 QL (120 片 /30 天 ) lovastatin 40mg 1 $0 QL (60 片 /30 天 ) pravastatin sodium 1 $0 QL (30 片 /30 天 ) simvastatin TABS 1 $0 QL (30 片 /30 天 ) 其他降血脂藥 - 用於治療高膽固醇的藥物 cholestyramine 1 $0 cholestyramine light 1 $0 choline fenofibrate 1 $0 colestipol hcl 1 $0 fenofibrate TABS 48mg, 54mg, 1 $0 145mg, 160mg fenofibrate micronized 1 $0 fenofibrate micronized cap 1 $0 gemfibrozil TABS 1 $0 niacin (antihyperlipidemic) 500mg 1 $0 QL (90 片 /30 天 ) niacin (antihyperlipidemic) 750mg 1 $0,1000mg niacor 1 $0 omega-3-acid ethyl esters 1 $0 prevalite 1 $0 VASCEPA 2 $0 WELCHOL 2 $0 ZETIA TAB 10MG 2 $0 β 阻斷劑 / 利尿劑合成藥物 - 用於治療高血壓和心臟病的藥物 atenolol & chlorthalidone 1 $0 27

28 藥物名稱 等級 您需要付費 的藥物 bisoprolol & hydrochlorothiazide 1 $0 metoprolol & hctz tab 50-25mg 1 $0 metoprolol & hctz tab mg 1 $0 metoprolol & hctz tab mg 1 $0 propranolol & hydrochlorothiazide 1 $0 β 阻斷劑 - 用於治療高血壓和心臟病的藥物 acebutolol hcl CAPS 1 $0 atenolol TABS 1 $0 bisoprolol fumarate 1 $0 BYSTOLIC 2 $0 carvedilol 1 $0 labetalol hcl TABS 1 $0 metoprolol succinate 25mg,50mg 1 $0 QL (60 片 /30 天 ) metoprolol succinate 100mg 1 $0 QL (45 片 /30 天 ) metoprolol succinate 200mg 1 $0 metoprolol tartrate SOLN;TABS 1 $0 nadolol TABS 1 $0 pindolol 1 $0 propranolol cap er 1 $0 propranolol hcl SOLN;TABS 1 $0 timolol maleate TABS 1 $0 鈣離子通道阻斷劑 - 用於治療高血壓和心臟病的藥物 afeditab cr 30mg 1 $0 QL (60 片 /30 天 ) afeditab cr 60mg 1 $0 amlodipine besylate TABS 2.5mg, 1 $0 QL (45 片 /30 天 ) 5mg amlodipine besylate TABS 10mg 1 $0 cartia xt cap 120/24hr 1 $0 cartia xt cap 180/24hr 1 $0 cartia xt cap 240/24hr 1 $0 cartia xt cap 300/24hr 1 $0 dilt-cd cap 1 $0 dilt-xr cap 1 $0 diltiazem cap 1 $0 diltiazem cap 120mg/24hr 1 $0 diltiazem cap er/12hr 1 $0 diltiazem hcl SOLN;TABS 1 $0 diltiazem hcl coated beads cp24 1 $0 120mg diltiazem hcl coated beads cp24 1 $0 180mg diltiazem hcl coated beads cp24 240mg 1 $0 28

29 藥物名稱 等級 您需要付費的藥物 diltiazem hcl coated beads cp24 1 $0 300mg diltiazem hcl coated beads cp24 1 $0 360mg diltzac 1 $0 felodipine 2.5mg 1 $0 QL (30 片 /30 天 ) felodipine 5mg 1 $0 QL (60 片 /30 天 ) felodipine 10mg 1 $0 isradipine 1 $0 nicardipine hcl CAPS 1 $0 nifedical 30mg 1 $0 QL (30 片 /30 天 ) nifedical 60mg 1 $0 nifedipine TB24 30mg 1 $0 QL (60 片 /30 天 ) nifedipine TB24 60mg,90mg 1 $0 nifedipine er 30mg 1 $0 QL (30 片 /30 天 ) nifedipine er 60mg,90mg 1 $0 nimodipine CAPS 1 $0 NYMALIZE 2 $0 taztia 1 $0 verapamil cap er 100mg,120mg, 1 $0 180mg,200mg,240mg,300mg VERAPAMIL CAP ER 360mg 1 $0 verapamil hcl SOLN;TABS 1 $0 verapamil tab er 1 $0 毛地黃糖 - 用於治療心臟病的藥物 digitek.25mg 1 $0 PA digitek.125mg 1 $0 QL (30 片 /30 天 ) digoxin SOLN 1 $0 digoxin TABS 125mcg 1 $0 QL (30 片 /30 天 ) digoxin TABS 250mcg 1 $0 PA DIGOXIN SOL 50MCG/ML 1 $0 PA LANOXIN TABS 125mcg 2 $0 QL (30 片 /30 天 ) LANOXIN TABS 250mcg 2 $0 PA 直接腎素抑製劑 / 合成藥物 - 用於治療心臟病的藥物 TEKAMLO MG 2 $0 TEKAMLO TAB 150-5MG 2 $0 QL (30 片 /30 天 ) TEKAMLO TAB MG 2 $0 QL (30 片 /30 天 ) TEKAMLO TAB 300-5MG 2 $0 QL (30 片 /30 天 ) TEKTURNA 150mg 2 $0 QL (30 片 /30 天 ) TEKTURNA 300mg 2 $0 TEKTURNA HCT TAB MG 2 $0 QL (30 片 /30 天 ) TEKTURNA HCT TAB MG 2 $0 QL (60 片 /30 天 ) 29

30 藥物名稱 等級 您需要付費 的藥物 TEKTURNA HCT TAB MG 2 $0 QL (30 片 /30 天 ) TEKTURNA HCT TAB MG 2 $0 利尿劑 - 用於治療心臟病的藥物 acetazolamide CP12;TABS 1 $0 amiloride & hydrochlorothiazide 1 $0 amiloride hcl 1 $0 bumetanide 1 $0 chlorothiazide 1 $0 chlorthalidone 25mg,50mg 1 $0 DIURIL SUS 250/5ML 2 $0 DYRENIUM 2 $0 EDECRIN 2 $0 furosemide SOLN;TABS 1 $0 furosemide inj 1 $0 hydrochlorothiazide CAPS;TABS 1 $0 indapamide 1 $0 methazolamide TABS 1 $0 methyclothiazide 1 $0 metolazone 1 $0 spironolactone & 1 $0 hydrochlorothiazide torsemide inj 20mg/2ml 1 $0 torsemide inj 50mg/5ml 1 $0 torsemide tabs 1 $0 triamterene & hydrochlorothiazide 1 $0 TABS triamterene & hydrochlorothiazide 1 $0 cap mg 其他 clonidine hcl PTWK;TABS 1 $0 DEMSER 2 $0 hydralazine hcl SOLN; TABS 1 $0 midodrine hcl 1 $0 minoxidil TABS 1 $0 RANEXA 2 $0 硝酸鹽 - 用於治療心臟病的藥物 isosorb mononitrate tab 1 $0 isosorbide dinitrate 1 $0 isosorbide mononitrate er tab 1 $0 minitran 1 $0 nitro-bid 2 $0 NITRO-DUR DIS 0.3MG/HR 2 $0 NITRO-DUR DIS 0.8MG/HR 2 $0 30

31 藥物名稱 等級 您需要付費 的藥物 nitroglycerin PT24 1 $0 NITROLINGUAL PUMPSPRAY 2 $0 NITROSTAT 2 $0 肺動脈高壓藥 - 用於治療肺高壓的藥物 ADCIRCA 2 $0 QL (60 片 /30 天 ),NM,PA ADEMPAS 2 $0 QL (90 片 /30 天 ),NM,PA LETAIRIS 2 $0 QL (30 片 /30 天 ),NM,LA,PA REMODULIN 2 $0 B/D,NM,LA REVATIO SUSR 2 $0 QL (2 瓶 /30 天 ),NM, PA sildenafil citrate (pulmonary hypertension) 2 $0 QL (90 片 /30 天 ),NM,PA TRACLEER 62.5mg 2 $0 QL (120 片 /30 天 ),NM,LA,PA TRACLEER 125mg 2 $0 QL (60 片 /30 天 ),NM,LA,PA 用於治療神經系統失常的藥物抗焦慮藥 - 用於治療焦慮的藥物 alprazolam CONC 1 $0 QL (300 毫升 /30 天 ) alprazolam tab 0.5mg 1 $0 QL (240 片 /30 天 ) alprazolam tab 0.25mg 1 $0 QL (480 片 /30 天 ) alprazolam tab 1mg 1 $0 QL (120 片 /30 天 ) alprazolam tab 2mg 1 $0 QL (150 片 /30 天 ) buspirone hcl TABS 1 $0 fluvoxamine maleate TABS 25mg, 1 $0 QL (45 片 /30 天 ) 50mg fluvoxamine maleate TABS 100mg 1 $0 lorazepam CONC 1 $0 QL (150 毫升 /30 天 ) lorazepam SOLN 1 $0 lorazepam TABS 1 $0 QL (150 片 /30 天 ) 抗痙攣藥 - 用於治療痙攣的藥物 APTIOM 200mg 2 $0 QL (180 片 /30 天 ) APTIOM 400mg 2 $0 QL (90 片 /30 天 ) APTIOM 600mg 2 $0 QL (60 片 /30 天 ) APTIOM 800mg 2 $0 QL (30 片 /30 天 ) BANZEL SUS 40MG/ML 2 $0 PA BANZEL TAB 200MG 2 $0 PA BANZEL TAB 400MG 2 $0 PA 31

32 藥物名稱 等級 您需要付費的藥物 carbamazepine CHEW;CP12; 1 $0 SUSP;TABS;TB12 CELONTIN 2 $0 clonazepam TABS 1mg 1 $0 QL (600 片 /30 天 ) clonazepam TABS 2mg 1 $0 QL (300 片 /30 天 ) clonazepam TABS.5mg 1 $0 QL (1200 片 /30 天 ) clonazepam TBDP 1mg 1 $0 QL (600 片 /30 天 ) clonazepam TBDP 2mg 1 $0 QL (300 片 /30 天 ) clonazepam TBDP.5mg 1 $0 QL (1200 片 /30 天 ) clonazepam TBDP.25mg 1 $0 QL (2400 片 /30 天 ) clonazepam TBDP.125mg 1 $0 QL (4800 片 /30 天 ) clorazepate dipotassium 3.75mg, 1 $0 QL (120 片 /30 天 ),PA 7.5mg clorazepate dipotassium 15mg 1 $0 QL (180 片 /30 天 ),PA diazepam CONC 1 $0 QL (240 毫升 /30 天 ), PA diazepam SOLN 1 $0 QL (1200 毫升 /30 天 ), PA diazepam TABS 1 $0 QL (120 片 /30 天 ),PA DIAZEPAM GEL 1 $0 diazepam inj 1 $0 dilantin 2 $0 DILANTIN-125 SUS 125/5ML 2 $0 divalproex sodium 1 $0 epitol 1 $0 ethosuximide CAPS;SOLN 1 $0 felbamate SUSP 2 $0 felbamate TABS 400mg 1 $0 felbamate TABS 600mg 2 $0 FYCOMPA 2mg 2 $0 QL (180 片 /30 天 ),PA FYCOMPA 4mg 2 $0 QL (90 片 /30 天 ),PA FYCOMPA 6mg 2 $0 QL (60 片 /30 天 ),PA FYCOMPA 8mg,10mg,12mg 2 $0 QL (30 片 /30 天 ),PA gabapentin CAPS 100mg 1 $0 QL (1080 粒膠囊 /30 天 ) gabapentin CAPS 300mg 1 $0 QL (360 粒膠囊 /30 天 ) gabapentin CAPS 400mg 1 $0 QL (270 粒膠囊 /30 天 ) gabapentin SOLN 1 $0 QL (2160 毫升 /30 天 ) gabapentin TABS 600mg 1 $0 QL (180 片 /30 天 ) gabapentin TABS 800mg 1 $0 QL (120 片 /30 天 ) GABITRIL 12mg,16mg 2 $0 lamotrigine CHEW;TABS;TB24 1 $0 32

33 藥物名稱 等級 您需要付費的藥物 levetiracetam SOLN;TABS;TB24 1 $0 LEVETIRACETAM IN NACL 2 $0 levetiracetam inj 500/5ml 1 $0 LYRICA CAPS 25mg,50mg,75mg,100mg,150mg 2 $0 QL (120 粒膠囊 /30 天 ) LYRICA CAPS 200mg 2 $0 QL (90 粒膠囊 /30 天 ) LYRICA CAPS 225mg,300mg 2 $0 QL (60 粒膠囊 /30 天 ) LYRICA SOLN 2 $0 QL (946 毫升 /30 天 ) ONFI 2 $0 PA oxcarbazepine 1 $0 PEGANONE 2 $0 phenobarbital ELIX;TABS 2 $0 PA PHENOBARBITAL SODIUM 2 $0 PA 65mg/ml phenobarbital sodium 130mg/ml 2 $0 PA phenytek 2 $0 phenytoin CHEW;SUSP 1 $0 phenytoin sodium SOLN 1 $0 phenytoin sodium extended 1 $0 POTIGA 50mg 2 $0 POTIGA 200mg 2 $0 QL (180 片 /30 天 ) POTIGA 300mg,400mg 2 $0 QL (90 片 /30 天 ) primidone TABS 1 $0 SABRIL PACK 2 $0 QL (180 袋 /30 天 ),NM,LA,PA SABRIL TABS 2 $0 QL (180 片 /30 天 ),NM,LA,PA TEGRETOL 2 $0 TEGRETOL-XR 2 $0 tiagabine hcl 1 $0 topiramate CPSP;TABS 1 $0 valproate sodium SOLN;SYRP 1 $0 valproic acid CAPS 1 $0 VIMPAT SOLN 10mg/ml 2 $0 QL (1200 毫升 /30 天 ) VIMPAT SOLN 200mg/20ml 2 $0 VIMPAT TABS 50mg 2 $0 QL (180 片 /30 天 ) VIMPAT TABS 100mg,150mg, 2 $0 QL (60 片 /30 天 ) 200mg zonisamide CAPS 1 $0 抗失智藥 - 用於治療失智和健忘症的藥物 donepezil hydrochloride TABS 5mg 1 $0 QL (30 片 /30 天 ) 33

34 藥物名稱 等級 您需要付費的藥物 donepezil hydrochloride TABS 1 $0 10mg,23mg donepezil hydrochloride TBDP 5mg 1 $0 QL (30 片 /30 天 ) donepezil hydrochloride TBDP 1 $0 10mg EXELON PATCHES 2 $0 QL (30 帖 /30 天 ) galantamine hydrobromide CP24 1 $0 QL (30 粒膠囊 /30 天 ) 8mg,16mg galantamine hydrobromide CP24 1 $0 24mg galantamine hydrobromide SOLN 1 $0 galantamine hydrobromide TABS 1 $0 QL (180 片 /30 天 ) 4mg galantamine hydrobromide TABS 1 $0 QL (90 片 /30 天 ) 8mg galantamine hydrobromide TABS 1 $0 12mg NAMENDA SOL 10MG/5ML 2 $0 PA;PA, 如果小於 30 歲 NAMENDA TAB 2 $0 PA;PA, 如果小於 30 歲 NAMENDA XR 2 $0 PA;PA, 如果小於 30 歲 NAMENDA XR TITRATION PACK 2 $0 PA;PA, 如果小於 30 歲 rivastigmine tartrate 1 $0 抗憂鬱藥 - 用於治療憂鬱症的藥物 amitriptyline hcl TABS 2 $0 PA amoxapine tab 25mg 1 $0 amoxapine tab 50mg 1 $0 amoxapine tab 100mg 1 $0 amoxapine tab 150mg 1 $0 BRINTELLIX 5mg 2 $0 QL (120 片 /30 天 ) BRINTELLIX 10mg 2 $0 QL (60 片 /30 天 ) BRINTELLIX 20mg 2 $0 QL (30 片 /30 天 ) bupropion hcl TABS 1 $0 bupropion hcl TB12 1 $0 bupropion hcl TB24 150mg 1 $0 QL (90 片 /30 天 ) bupropion hcl TB24 300mg 1 $0 QL (30 片 /30 天 ) citalopram hydrobromide SOLN 1 $0 citalopram hydrobromide TABS 1 $0 QL (45 片 /30 天 ) 10mg,20mg citalopram hydrobromide TABS 1 $0 QL (30 片 /30 天 ) 40mg clomipramine hcl CAPS 2 $0 PA desipramine hcl TABS 1 $0 doxepin hcl CAPS;CONC 2 $0 PA 34

35 藥物名稱 等級 您需要付費的藥物 duloxetine hcl CPEP 20mg, 30mg, 60mg 1 $0 QL (60 粒膠囊 /30 天 ) EMSAM 2 $0 QL (30 帖 /30 天 ),PA escitalopram oxalate SOLN 1 $0 QL (600 毫升 /30 天 ) escitalopram oxalate TABS 5mg, 1 $0 QL (45 片 /30 天 ) 10mg escitalopram oxalate TABS 20mg 1 $0 QL (60 片 /30 天 ) FETZIMA 20mg 2 $0 QL (180 粒膠囊 /30 天 ) FETZIMA 40mg 2 $0 QL (90 粒膠囊 /30 天 ) FETZIMA 80mg,120mg 2 $0 QL (30 粒膠囊 /30 天 ) FETZIMA TITRATION PACK 2 $0 fluoxetine hcl CAPS 10mg 1 $0 QL (30 粒膠囊 /30 天 ) fluoxetine hcl CAPS 20mg 1 $0 QL (120 粒膠囊 /30 天 ) fluoxetine hcl CAPS 40mg 1 $0 fluoxetine hcl SOLN 1 $0 fluoxetine hcl TABS 10mg 1 $0 QL (45 片 /30 天 ) fluoxetine hcl TABS 20mg 1 $0 imipramine hcl TABS 2 $0 PA maprotiline hcl 1 $0 MARPLAN TAB 10MG 2 $0 QL (180 片 /30 天 ) mirtazapine TABS 7.5mg,15mg 1 $0 QL (45 片 /30 天 ) mirtazapine TABS 30mg,45mg 1 $0 mirtazapine TBDP 15mg 1 $0 QL (30 片 /30 天 ) mirtazapine TBDP 30mg,45mg 1 $0 nefazodone hcl 1 $0 nortriptyline hcl CAPS;SOLN 1 $0 paroxetine hcl TABS 10mg,20mg 1 $0 QL (45 片 /30 天 ),40mg paroxetine hcl TABS 30mg 1 $0 QL (60 片 /30 天 ) PAXIL SUSP 2 $0 QL (900 毫升 /30 天 ) phenelzine sulfate TABS 1 $0 PRISTIQ 2 $0 QL (30 片 /30 天 ) protriptyline hcl 1 $0 sertraline hcl CONC 1 $0 sertraline hcl TABS 25mg,50mg 1 $0 QL (45 片 /30 天 ) sertraline hcl TABS 100mg 1 $0 SURMONTIL CAP 25MG 2 $0 QL (240 粒膠囊 /30 天 ),PA SURMONTIL CAP 50MG 2 $0 QL (120 粒膠囊 /30 天 ),PA SURMONTIL CAP 100MG 2 $0 QL (60 粒膠囊 /30 天 ), PA 35

36 藥物名稱 等級 您需要付費的藥物 tranylcypromine sulfate 1 $0 trazodone hcl TABS 50mg,100mg 1 $0,150mg venlafaxine hcl CP mg, 75mg 1 $0 QL (30 粒膠囊 /30 天 ) venlafaxine hcl CP24 150mg 1 $0 QL (60 粒膠囊 /30 天 ) venlafaxine hcl TABS 1 $0 VIIBRYD KIT 2 $0 VIIBRYD TABS 2 $0 QL (30 片 /30 天 ) 抗巴金森症藥物 - 用於治療巴金森氏病的藥物 amantadine hcl CAPS;SYRP; 1 $0 TABS APOKYN 2 $0 NM,LA,PA AZILECT 2 $0 benztropine mesylate SOLN 1 $0 benztropine mesylate TABS 2 $0 PA bromocriptine mesylate CAPS; 1 $0 TABS carbidopa-levodopa 1 $0 CARBIDOPA/LEVODOPA/ENTACAPO 1 $0 NE entacapone 1 $0 NEUPRO 2 $0 pramipexole dihydrochloride TABS 1 $0 ropinirole hydrochloride TABS 1 $0 selegiline hcl CAPS;TABS 1 $0 trihexyphenidyl hcl 2 $0 PA 抗精神病藥 - 用於治療精神病的藥物 ABILIFY DISCMELT 2 $0 QL (60 片 /30 天 ) ABILIFY INJ 9.75MG 2 $0 QL (4 毫升 /1 天 ) ABILIFY MAIN INJ 300MG 2 $0 QL (1 小瓶 /28 天 ) ABILIFY MAIN INJ 400MG 2 $0 QL (1 小瓶 /28 天 ) ABILIFY MAINTENA 2 $0 QL (1 次注射 /28 天 ) ABILIFY TABS 2 $0 QL (30 片 /30 天 ) aripiprazole 2 $0 QL (30 片 /30 天 ) chlorpromazine hcl SOLN 2 $0 chlorpromazine hcl TABS 1 $0 clozapine 25mg, 50mg 1 $0 clozapine 100mg 1 $0 QL (270 片 /30 天 ) clozapine 200mg 1 $0 QL (135 片 /30 天 ) CLOZAPINE ODT 12.5mg, 25mg 1 $0 PA CLOZAPINE ODT 100mg 1 $0 QL (270 片 /30 天 ),PA 36

37 藥物名稱 等級 您需要付費 的藥物 CLOZAPINE ODT 150MG 1 $0 QL (180 片 /30 天 ),PA CLOZAPINE ODT 200MG 1 $0 QL (135 片 /30 天 ),PA FANAPT 2 $0 QL (60 片 /30 天 ),ST FANAPT TITRATION PACK 2 $0 ST FAZACLO TAB 12.5/ODT 2 $0 PA FAZACLO TAB 25MG ODT 2 $0 PA FAZACLO TAB 100/ODT 2 $0 QL (270 片 /30 天 ),PA FAZACLO TAB 150MG 2 $0 QL (180 片 /30 天 ),PA FAZACLO TAB 200MG 2 $0 QL (135 片 /30 天 ),PA fluphenazine decanoate SOLN 1 $0 fluphenazine hcl 1 $0 GEODON SOLR 2 $0 QL (6 毫升 /3 天 ) haloperidol TABS 1 $0 haloperidol decanoate SOLN 1 $0 haloperidol lactate 1 $0 haloperidol lactate oral conc 2 1 $0 mg/ml INVEGA 1.5mg,3mg,9mg 2 $0 QL (30 片 /30 天 ) INVEGA 6mg 2 $0 QL (60 片 /30 天 ) INVEGA SUST INJ 39 MG/0.25 ML 2 $0 QL (1 次注射 /28 天 ) INVEGA SUST INJ 78 MG/0.5 ML 2 $0 QL (1 次注射 /28 天 ) INVEGA SUST INJ 117 MG/0.75 ML 2 $0 QL (1 次注射 /28 天 ) INVEGA SUST INJ 156MG/ML 2 $0 QL (1 次注射 /28 天 ) INVEGA SUST INJ 234 MG/1.5 ML 2 $0 QL (1 次注射 /28 天 ) LATUDA 20mg 2 $0 QL (240 片 /30 天 ) LATUDA 40mg,120mg 2 $0 QL (30 片 /30 天 ) LATUDA 60mg,80mg 2 $0 QL (60 片 /30 天 ) loxapine succinate 1 $0 olanzapine SOLR 1 $0 QL (3 小瓶 /1 天 ) olanzapine TABS 2.5mg,5mg, 1 $0 QL (30 片 /30 天 ) 7.5mg olanzapine TABS 10mg,15mg, 1 $0 QL (60 片 /30 天 ) 20mg olanzapine TBDP 5mg 1 $0 QL (30 片 /30 天 ) olanzapine TBDP 10mg,15mg 1 $0 QL (60 片 /30 天 ) olanzapine TBDP 20mg 2 $0 QL (60 片 /30 天 ) ORAP 2 $0 perphenazine TABS 1 $0 quetiapine fumarate 1 $0 QL (90 片 /30 天 ) RISPERDAL INJ 12.5MG 2 $0 QL (2 次注射 /28 天 ) RISPERDAL INJ 25MG 2 $0 QL (2 次注射 /28 天 ) RISPERDAL INJ 37.5MG 2 $0 QL (2 次注射 /28 天 ) 37

38 藥物名稱 等級 您需要付費 的藥物 RISPERDAL INJ 50MG 2 $0 QL (2 次注射 /28 天 ) risperidone SOLN 1 $0 QL (240 毫升 /30 天 ) risperidone TABS 1mg,2mg,3mg 1 $0 QL (60 片 /30 天 ) risperidone TABS 4mg 1 $0 QL (120 片 /30 天 ) risperidone TABS.25mg,.5mg 1 $0 QL (90 片 /30 天 ) risperidone TBDP 1mg,2mg,3mg 1 $0 QL (60 片 /30 天 ) risperidone TBDP 4mg 1 $0 QL (120 片 /30 天 ) risperidone TBDP.25mg,.5mg 1 $0 QL (90 片 /30 天 ) SAPHRIS 2.5mg 2 $0 QL (240 片 /30 天 ) SAPHRIS 5mg 2 $0 QL (120 片 /30 天 ) SAPHRIS 10mg 2 $0 QL (60 片 /30 天 ) SEROQUEL XR 50mg 2 $0 QL (120 片 /30 天 ) SEROQUEL XR 150mg,200mg 2 $0 QL (30 片 /30 天 ) SEROQUEL XR 300mg,400mg 2 $0 QL (60 片 /30 天 ) thioridazine hcl TABS 2 $0 PA thiothixene 1 $0 trifluoperazine hcl 1 $0 VERSACLOZ 2 $0 QL (600 毫升 /30 天 ), PA ziprasidone hcl 20mg,40mg 1 $0 QL (60 粒膠囊 /30 天 ) ziprasidone hcl 60mg,80mg 1 $0 QL (90 粒膠囊 /30 天 ) ZYPREXA RELPREVV 2 $0 B/D 過動症藥 - 用於治療注意力不足過動症 (ADHD) 的藥物 amphetamine-dextroamphetamine 1 $0 QL (90 粒膠囊 /30 天 ) cap sr 24hr 5 mg amphetamine-dextroamphetamine 1 $0 QL (90 粒膠囊 /30 天 ) cap sr 24hr 10 mg amphetamine-dextroamphetamine 1 $0 QL (30 粒膠囊 /30 天 ) cap sr 24hr 15 mg amphetamine-dextroamphetamine 1 $0 QL (30 粒膠囊 /30 天 ) cap sr 24hr 20 mg amphetamine-dextroamphetamine 1 $0 QL (30 粒膠囊 /30 天 ) cap sr 24hr 25 mg amphetamine-dextroamphetamine 1 $0 QL (30 粒膠囊 /30 天 ) cap sr 24hr 30 mg amphetamine-dextroamphetamine 1 $0 QL (360 片 /30 天 ) tab 5 mg amphetamine-dextroamphetamine 1 $0 QL (240 片 /30 天 ) tab 7.5 mg amphetamine-dextroamphetamine 1 $0 QL (180 片 /30 天 ) tab 10 mg amphetamine-dextroamphetamine tab 12.5 mg 1 $0 QL (144 片 /30 天 ) 38

39 藥物名稱等級您需要付費的藥物 amphetamine-dextroamphetamine tab 15 mg amphetamine-dextroamphetamine tab 20 mg amphetamine-dextroamphetamine tab 30 mg 1 $0 QL (120 片 /30 天 ) 1 $0 QL (90 片 /30 天 ) 1 $0 QL (60 片 /30 天 ) guanfacine hcl (adhd) 2 $0 metadate tab 20mg er 1 $0 QL (90 片 /30 天 ) methylphenidate hcl TABS 5mg, 1 $0 QL (180 片 /30 天 ) 10mg methylphenidate hcl TABS 20mg 1 $0 QL (90 片 /30 天 ) methylphenidate hcl TBCR 10mg, 1 $0 QL (90 片 /30 天 ) 20mg methylphenidate hcl oral soln 1 $0 QL (1800 毫升 /30 天 ) 5mg/5ml methylphenidate hcl oral soln 1 $0 QL (900 毫升 /30 天 ) 10mg/5ml STRATTERA 10mg,18mg,25mg 2 $0 QL (120 粒膠囊 /30 天 ) STRATTERA 40mg 2 $0 QL (60 粒膠囊 /30 天 ) STRATTERA 60mg,80mg,100mg 2 $0 QL (30 粒膠囊 /30 天 ) 催眠藥 - 用於治療失眠的藥物 ROZEREM 2 $0 QL (30 片 /30 天 ) SILENOR 3mg 2 $0 QL (60 片 /30 天 ) SILENOR 6mg 2 $0 QL (30 片 /30 天 ) temazepam 7.5mg 1 $0 QL (30 粒膠囊 /30 天 ), PA; 90 天限制, 如果超過 64 歲 temazepam 15mg 1 $0 QL (60 粒膠囊 /30 天 ), PA; 90 天限制, 如果超過 64 歲 zolpidem tartrate TABS 2 $0 QL (30 片 /30 天 ),PA; 90 天限制, 如果超過 64 歲 頭痛藥 - 用於治療嚴重頭痛的藥物 cafergot 2 $0 dihydroergotamine mesylate 1 $0 1mg/ml naratriptan hcl 1 $0 QL (9 片 /30 天 ) RELPAX 2 $0 QL (12 片 /30 天 ) rizatriptan benzoate 1 $0 QL (18 片 /30 天 ) 39

40 藥物名稱 等級 您需要付費 的藥物 SUMATRIPTAN SOLN 5mg/act 1 $0 QL (24 個吸入器 /30 天 ) SUMATRIPTAN SOLN 20mg/act 1 $0 QL (12 個吸入器 /30 天 ) SUMATRIPTAN SUCCINATE SOCT 1 $0 QL (6 毫升 /30 天 ) sumatriptan succinate SOSY 1 $0 QL (6 毫升 /30 天 ) sumatriptan succinate TABS 1 $0 QL (9 片 /30 天 ) SUMATRIPTAN SUCCINATE INJ 1 $0 QL (6 毫升 /30 天 ) SOAJ 4mg/0.5ml sumatriptan succinate inj SOAJ 1 $0 QL (6 毫升 /30 天 ) 6mg/0.5ml SUMATRIPTAN SUCCINATE INJ 1 $0 QL (6 毫升 /30 天 ) SOCT sumatriptan succinate inj SOLN 1 $0 QL (6 毫升 /30 天 ) zolmitriptan TABS 1 $0 QL (12 片 /30 天 ) zolmitriptan odt 1 $0 QL (12 片 /30 天 ) 其他 LITHIUM 2 $0 lithium carbonate CAPS;TABS 1 $0 lithium carbonate er 1 $0 NUEDEXTA 2 $0 PA pyridostigmine bromide TABS 1 $0 riluzole 1 $0 XENAZINE 12.5mg 2 $0 QL (240 片 /30 天 ),NM,LA,PA XENAZINE 25mg 2 $0 QL (120 片 /30 天 ),NM,LA,PA 多發性硬化症藥物 - 用於治療多發性硬化症的藥物 BETASERON 2 $0 QL (14 個注射器 /28 天 ),NM,PA COPAXONE INJ 40MG/ML 2 $0 QL (12 個注射器 /28 天 ),NM,PA COPAXONE KIT 20MG/ML 2 $0 QL (30 個注射器 /30 天 ),NM,PA GILENYA CAP 0.5MG 2 $0 QL (28 粒膠囊 /28 天 ), NM,PA TYSABRI 2 $0 NM,LA,PA 肌肉骨骼治療藥物 - 用於治療肌肉痙攣的藥物 baclofen TABS 1 $0 cyclobenzaprine hcl TABS 5mg, 1 $0 PA 10mg dantrolene sodium CAPS 1 $0 tizanidine hcl TABS 1 $0 嗜睡症 / 猝倒治療藥物 - 用於治療睡眠障礙的疾病 40

41 藥物名稱 等級 您需要付費 的藥物 NUVIGIL 50mg 2 $0 QL (150 片 /30 天 ),PA NUVIGIL 150mg 2 $0 QL (60 片 /30 天 ),PA NUVIGIL 200mg,250mg 2 $0 QL (30 片 /30 天 ),PA XYREM 2 $0 QL (540 毫升 /30 天 ), LA,PA 心理治療其他藥物 acamprosate calcium 1 $0 buprenorphine hcl SUBL 1 $0 PA buprenorphine hcl-naloxone hcl sl 1 $0 QL (120 片 /30 天 ),PA buproban 1 $0 CHANTIX 2 $0 PA CHANTIX CONTINUING MONTH 2 $0 PA CHANTIX STARTER PACK 2 $0 PA diphenhydramine hcl (sleep) 3 $0 NM;* diphenhydramine-acetaminophen 3 $0 NM;* (sleep) disulfiram TABS 1 $0 doxylamine succinate (sleep) 3 $0 NM;* ibuprofen-diphenhydramine citrate 3 $0 NM;* naloxone hcl SOLN 1 $0 naltrexone hcl TABS 1 $0 nicotine 3 $0 NM;* nicotine polacrilex GUM 3 $0 NM;* nicotine polacrilex LOZG 2mg, 4mg 3 $0 NM;* NICOTINE POLACRILEX LOZG 2mg 3 $0 NM;*,4mg NICOTINE TRANSDERMAL SYST 3 $0 NM;* NICOTROL INHALER 2 $0 NICOTROL NS 2 $0 SUBOXONE MIS 2-0.5MG 2 $0 QL (4 盒 /30 天 ),PA SUBOXONE MIS 4-1MG 2 $0 QL (4 盒 /30 天 ),PA SUBOXONE MIS 8-2MG 2 $0 QL (4 盒 /30 天 ),PA SUBOXONE MIS 12-3MG 2 $0 QL (2 盒 /30 天 ),PA 內分泌和代謝藥物 - 用於治療糖尿病和調節荷爾蒙的藥物 雄激素藥物 - 用於調節男性荷爾蒙的藥物 ANDRODERM 2 $0 QL (30 帖 /30 天 ),PA oxandrolone TABS 1 $0 PA TESTIM 2 $0 QL (300 克 /30 天 ),PA testosterone cypionate SOLN 1 $0 testosterone enanthate SOLN 1 $0 注射類抗糖尿病藥 - 用於治療糖尿病的藥物 41

42 藥物名稱 等級 您需要付費 的藥物 ALCOHOL SWABS 2 $0 * GAUZE PADS 2" X 2" 2 $0 * HUMULIN R INJ U $0 B/D INSULIN PEN NEEDLE 2 $0 * INSULIN SAFETY NEEDLES 2 $0 * INSULIN SYRINGE 2 $0 * LANTUS 2 $0 LANTUS SOLOSTAR 2 $0 LEVEMIR 2 $0 LEVEMIR FLEXTOUCH 2 $0 NOVOLIN 70/30 2 $0 不承保 RELION NOVOLIN N 2 $0 不承保 RELION NOVOLIN R 2 $0 不承保 RELION NOVOLOG 2 $0 NOVOLOG FLEXPEN 2 $0 NOVOLOG MIX 70/30 2 $0 NOVOLOG MIX 70/30 PREFILL 2 $0 NOVOLOG PENFILL 2 $0 SYMLINPEN 60 2 $0 QL (8 支 /30 天 ),PA SYMLINPEN $0 QL (4 支 /30 天 ),PA TOUJEO SOLOSTAR 2 $0 VICTOZA 2 $0 QL (3 支 /30 天 ) 口服抗糖尿病藥 - 用於治療糖尿病的藥物 acarbose 1 $0 glimepiride 1mg 1 $0 QL (240 片 /30 天 ) glimepiride 2mg 1 $0 QL (120 片 /30 天 ) glimepiride 4mg 1 $0 QL (60 片 /30 天 ) glip/metform tab 5-500mg 1 $0 QL (120 片 /30 天 ) glipizide TABS 5mg 1 $0 QL (240 片 /30 天 ) glipizide TABS 10mg 1 $0 QL (120 片 /30 天 ) glipizide TB24 2.5mg 1 $0 QL (240 片 /30 天 ) glipizide TB24 5mg 1 $0 QL (120 片 /30 天 ) glipizide TB24 10mg 1 $0 QL (60 片 /30 天 ) glipizide-metformin hcl tab $0 QL (240 片 /30 天 ) mg glipizide-metformin hcl tab $0 QL (120 片 /30 天 ) mg INVOKAMET TAB MG 2 $0 QL (120 片 /30 天 ) INVOKAMET TAB $0 QL (60 片 /30 天 ) INVOKAMET TAB $0 QL (60 片 /30 天 ) INVOKAMET TAB $0 QL (60 片 /30 天 ) INVOKANA 100mg 2 $0 QL (90 片 /30 天 ) 42

43 藥物名稱 等級 您需要付費 的藥物 INVOKANA 300mg 2 $0 QL (30 片 /30 天 ) JANUMET 2 $0 QL (60 片 /30 天 ) JANUMET XR TAB MG 2 $0 QL (60 片 /30 天 ) JANUMET XR TAB $0 QL (60 片 /30 天 ) JANUMET XR TAB $0 QL (30 片 /30 天 ) JANUVIA 2 $0 QL (30 片 /30 天 ) JENTADUETO 2 $0 QL (60 片 /30 天 ) metformin hcl TABS 500mg 1 $0 QL (150 片 /30 天 ) metformin hcl TABS 850mg 1 $0 QL (90 片 /30 天 ) metformin hcl TABS 1000mg 1 $0 QL (75 片 /30 天 ) metformin hcl TB24 500mg 1 $0 QL (120 片 /30 天 ) metformin hcl TB24 750mg 1 $0 QL (60 片 /30 天 ) nateglinide 1 $0 QL (90 片 /30 天 ) pioglitazone hcl 1 $0 QL (30 片 /30 天 ) repaglinide 2mg 1 $0 QL (240 片 /30 天 ) repaglinide.5mg,1mg 1 $0 QL (120 片 /30 天 ) RIOMET 2 $0 QL (946 毫升 /30 天 ) TRADJENTA 2 $0 QL (30 片 /30 天 ) 雙磷酸鹽 - 用於治療骨質疏鬆的藥物 alendronate sodium TABS 5mg, 1 $0 10mg,40mg alendronate sodium TABS 35mg, 1 $0 QL (4 片 /28 天 ) 70mg ibandronate sodium TABS 1 $0 B/D,QL (1 片 /30 天 ) pamidronate disodium SOLN 1 $0 B/D zoledronic inj 4mg/5ml 2 $0 B/D,NM ZOMETA SOLN 2 $0 B/D,NM 鈣受體致效劑 SENSIPAR 30mg,90mg 2 $0 QL (120 片 /30 天 ),NM SENSIPAR 60mg 2 $0 QL (60 片 /30 天 ),NM 螯合劑 CHEMET 2 $0 DEPEN TITRATABS 2 $0 EXJADE 2 $0 NM,LA,PA kionex 1 $0 sodium polystyrene sulfonate 1 $0 sps susp 15gm/60ml 1 $0 SYPRINE 2 $0 避孕藥 - 用於節育的藥物 altavera 1 $0 apri 28 day 1 $0 43

44 藥物名稱 等級 您需要付費的藥物 aranelle 28 1 $0 aubra 28 day 1 $0 aviane 28 1 $0 balziva 28 day 1 $0 briellyn 28 day 1 $0 camila 28 day 1 $0 cryselle 28 1 $0 cyclafem 1/35 28 day 1 $0 cyclafem 7/7/7 28 day 1 $0 deblitane 28 day 1 $0 delyla 28 day 1 $0 desogestrel-ethinyl estradiol 1 $0 (biphasic) drospirenone-ethinyl estradiol 1 $0 ELLA 2 $0 emoquette 1 $0 enpresse 28 day 1 $0 errin 28 day 1 $0 falmina 28 day 1 $0 GIANVI 1 $0 gildagia 1 $0 gildess 1.5/30 21 day 1 $0 heather 1 $0 introvale 91 day 1 $0 JOLESSA TAB MG 1 $0 JOLIVETTE 1 $0 junel 1.5/30 21 day 1 $0 junel 1/20 21 day 1 $0 junel fe 1.5/30 28 day 1 $0 junel fe 1/20 28 day 1 $0 kariva 28 day 1 $0 kimidess tab 1 $0 larin 1.5/30 1 $0 larin 1/20 1 $0 larin fe 1.5/30 1 $0 larin fe 1/20 1 $0 LEENA 1 $0 lessina 28 day 1 $0 levonest 28 day 1 $0 levonorgestrel & eth estradiol 1 $0 levonorgestrel (emergency oc) 1.5mg levonorgestrel (emergency oc) 1 $0.75mg, 1.5mg 3 $0 NM;* 44

45 藥物名稱 等級 您需要付費的藥物 levonorgestrel-ethinyl estradiol (91-1 $0 day) levora 0.15/30 28 day 1 $0 loryna 28 day 1 $0 low-ogestrel 28 day 1 $0 lutera 28 day 1 $0 lyza 1 $0 marlissa 28 day 1 $0 medroxyprogesterone acetate $0 mg/ml microgestin 1.5/30 21 day 1 $0 microgestin 1/20 21 day 1 $0 microgestin fe 1.5/30 28 day 1 $0 microgestin fe 1/20 28 day 1 $0 MONONESSA 1 $0 my way 1 $0 myzilra 1 $0 necon 0.5/35 28 day 1 $0 necon 1/35 28 day 1 $0 NECON 7/7/7 1 $0 necon 10/11 28 day 2 $0 NECON TAB 1/ $0 next choice one dose 1 $0 nikki 28 day 1 $0 NORA-BE TAB 1 $0 norethindrone (contraceptive) 1 $0 norgestimate-ethinyl estradiol 1 $0 (triphasic) norlyroc 28 day 1 $0 nortrel 0.5/35 28 day 1 $0 nortrel 1/35 21 day 1 $0 nortrel 1/35 28 day 1 $0 nortrel 7/7/7 28 day 1 $0 NUVARING 2 $0 OCELLA TAB MG 1 $0 orsythia 28 day 1 $0 philith 1 $0 pimtrea pack 1 $0 pirmella 1/35 28 day 1 $0 portia 28 day 1 $0 previfem 28 day 1 $0 quasense 91 day 1 $0 reclipsen 28 day 1 $0 sharobel 28 day 1 $0 45

46 藥物名稱 等級 您需要付費的藥物 SOLIA 1 $0 sprintec 28 day 1 $0 sronyx 1 $0 tarina fe tab 1/20 1 $0 tri-legest 28 day 1 $0 tri-previfem 28 day 1 $0 tri-sprintec 28 day 1 $0 TRINESSA 1 $0 trivora 28 day 1 $0 velivet 28 day 1 $0 vestura 1 $0 viorele 1 $0 vyfemia 28 day 1 $0 xulane 1 $0 zarah 1 $0 zenchent 28 day 1 $0 子宮內膜異位症 danazol CAPS 1 $0 SYNAREL 2 $0 酶素替代治療藥物 - 用於治療酶缺乏的藥物 ADAGEN 2 $0 NM,LA,PA ALDURAZYME 2 $0 NM,LA,PA CARBAGLU 2 $0 NM,LA,PA CERDELGA 2 $0 NM,PA CEREZYME 2 $0 NM,PA CYSTADANE 2 $0 NM CYSTAGON 2 $0 NM,PA FABRAZYME 2 $0 NM,PA KUVAN 2 $0 NM,PA levocarnitine (metabolic modifiers) 1 $0 B/D LUMIZYME 2 $0 NM,PA MYOZYME 2 $0 NM,PA NAGLAZYME 2 $0 NM,LA,PA ORFADIN 2 $0 NM,PA sodium phenylbutyrate 2 $0 NM ZAVESCA 2 $0 NM,LA,PA 雌激素藥物 - 用於調節女性荷爾蒙的藥物 COMBIPATCH 2 $0 PA estradiol PTWK 2 $0 PA estradiol TABS 2 $0 PA ESTRADIOL VALERATE OIL 10mg/ml,40mg/ml 1 $0 46

47 藥物名稱 等級 您需要付費的藥物 estradiol valerate OIL 20mg/ml 1 $0 PREMARIN CREAM 2 $0 VAGIFEM 2 $0 糖皮質激素 - 用於治療炎症反應的藥物 a-hydrocort 1 $0 cortisone acetate TABS 1 $0 dexamethasone CONC;ELIX; 1 $0 SOLN;TABS dexamethasone sodium phosphate 1 $0 fludrocortisone acetate TABS 1 $0 hydrocortisone TABS 1 $0 methylpr ace inj 40mg/ml 1 $0 B/D methylpr ace inj 80mg/ml 1 $0 B/D methylpr ss inj 1gm 1 $0 B/D methylpr ss inj 40mg 1 $0 B/D methylpr ss inj 125mg 1 $0 B/D methylpred pak 4mg 1 $0 B/D methylpred tab 4mg 1 $0 B/D methylpred tab 8mg 1 $0 B/D methylpred tab 16mg 1 $0 B/D methylpred tab 32mg 1 $0 B/D pred sod pho sol 5mg/5ml 1 $0 B/D prednisolone sol 15mg/5ml 1 $0 B/D prednisolone sol 25mg/5ml 1 $0 B/D prednisolone syp 15mg/5ml 1 $0 B/D prednisone con 5mg/ml 2 $0 B/D prednisone pak 5mg 1 $0 B/D prednisone pak 10mg 1 $0 B/D prednisone sol 5mg/5ml 1 $0 B/D prednisone tab 1mg 1 $0 B/D prednisone tab 2.5mg 1 $0 B/D prednisone tab 5mg 1 $0 B/D prednisone tab 10mg 1 $0 B/D prednisone tab 20mg 1 $0 B/D prednisone tab 50mg 1 $0 B/D SOLU-CORTEF 250mg 2 $0 血糖提升藥物 - 用於治療低血糖的藥物 GLUCAGEN HYPOKIT 2 $0 GLUCAGON EMERGENCY KIT 2 $0 PROGLYCEM 2 $0 人體生長激素 - 用於調節垂體激素的藥物 NORDITROPIN FLEXPRO 2 $0 NM,PA NORDITROPIN NORDIFLEX PEN 2 $0 NM,PA 47

48 藥物名稱 等級 您需要付費 的藥物 TEV-TROPIN 2 $0 NM,PA 其他 cabergoline 1 $0 calcitonin (salmon) 1 $0 FORTICAL 2 $0 INCRELEX 2 $0 NM,LA,PA methylergonovine maleate TABS 1 $0 MIACALCIN 200unit/ml 2 $0 B/D octreotide acetate 50mcg/ml, 1 $0 NM,PA 100mcg/ml,200mcg/ml octreotide acetate 500mcg/ml, 2 $0 NM,PA 1000mcg/ml PROLIA 2 $0 QL (1 次注射 /180 天 ), NM raloxifene hcl 1 $0 SANDOSTATIN LAR DEPOT 2 $0 NM,PA SOMATULINE DEPOT 2 $0 NM,PA SOMAVERT 2 $0 NM,LA,PA XGEVA 2 $0 NM,PA 副甲狀腺素 - 用於調節副甲狀腺素水平的藥物 FORTEO 2 $0 QL (1 支 /28 天 ),NM, PA 磷酸鹽結合劑 - 用於調節鈣和磷水平的藥物 calcium acetate (phosphate binder) 1 $0 FOSRENOL CHEW 2 $0 PHOSLYRA 2 $0 RENVELA PAK 0.8GM 2 $0 RENVELA PAK 2.4GM 2 $0 RENVELA TAB 800MG 2 $0 黃體素 - 用於調節女性荷爾蒙的藥物 medroxyprogesterone acetate tab 1 $0 norethindrone acetate TABS 1 $0 甲狀腺藥物 - 用於調節甲狀腺激素水平的藥物 levothyroxine sodium TABS 1 $0 LEVOXYL 1 $0 liothyronine sodium TABS 1 $0 methimazole TABS 1 $0 propylthiouracil TABS 1 $0 SYNTHROID 2 $0 UNITHROID 1 $0 抗利尿激素 - 用於調節垂體激素的藥物 desmopressin acetate spray 1 $0 48

49 藥物名稱 等級 您需要付費的藥物 desmopressin acetate spray 1 $0 refrigerated desmopressin acetate tabs 1 $0 desmopressin inj 4mcg/ml 1 $0 DESMOPRESSIN SOL 0.01% 1 $0 胃腸藥物 - 用於治療胃腸道疾病的藥物抗酸藥 alum & mag hydrox-simethicone 3 $0 NM;* ALUMINUM HYDROXIDE 3 $0 NM;* aluminum hydroxide gel 3 $0 NM;* aluminum hydroxide-mag carb 3 $0 NM;* aluminum hydroxide-mag trisil 3 $0 NM;* CALCIUM CARBONATE TABS 3 $0 NM;* 648mg calcium carbonate (antacid) 3 $0 NM;* calcium carbonate-mag hydrox 3 $0 NM;* calcium carbonate-simethicone 3 $0 NM;* GAVISCON CHEW 3 $0 NM;* GAVISCON EXTRA STRENGTH R 3 $0 NM;* MAALOX TC 3 $0 NM;* MAG-AL 3 $0 NM;* MAGNESIUM OXIDE CAPS 3 $0 NM;* magnesium oxide TABS 3 $0 NM;* SODIUM BICARBONATE POWD 3 $0 NM;* sodium bicarbonate (antacid) 3 $0 NM;* URO-MAG 3 $0 NM;* 止瀉劑 bismuth subsalicylate CHEW;SUSP3 $0 NM;* ;TABS FLORASTOR KIDS 3 $0 NM;* lactobacillus 3 $0 NM;* lactobacillus rhamnosus (gg) 3 $0 NM;* loperamide hcl LIQD;SUSP;TABS 3 $0 NM;* PROBIOTIC FORMULA 3 $0 NM;* RISA-BID PROBIOTIC 3 $0 NM;* saccharomyces boulardii 3 $0 NM;* 止吐藥 - 用於治療噁心嘔吐的藥物 compro 1 $0 dimenhydrinate TABS 3 $0 NM;* dronabinol 2.5mg,5mg 1 $0 B/D,QL (60 粒膠囊 /30 天 ) 49

50 藥物名稱 等級 您需要付費 的藥物 dronabinol 10mg 2 $0 B/D,QL (60 粒膠囊 /30 天 ) EMEND CAP 40MG 1 $0 B/D EMEND CAP 80MG 2 $0 B/D EMEND CAP 125MG 2 $0 B/D EMEND PAK 80 & $0 B/D granisetron hcl SOLN 1 $0 granisetron hcl TABS 1 $0 B/D meclizine hcl CHEW 3 $0 NM;* meclizine hcl TABS 12.5mg,25mg 1 $0 meclizine hcl TABS 25mg,32mg 3 $0 NM;* metoclopramide hcl SOLN;TABS 1 $0 metoclopramide inj 1 $0 ondansetron hcl SOLN 1 $0 ondansetron hcl TABS 1 $0 B/D ondansetron hcl inj 1 $0 ondansetron hcl oral soln 1 $0 B/D ondansetron odt 1 $0 B/D prochlorperazine inj 1 $0 prochlorperazine maleate TABS 1 $0 prochlorperazine supp 1 $0 promethazine hcl SOLN 25mg/ml, 2 $0 PA 50mg/ml TRANSDERM-SCOP 2 $0 QL (10 帖 /30 天 ),PA 解痙藥 - 用於治療胃痙攣的藥物 CUVPOSA 2 $0 dicyclomine hcl 1 $0 glycopyrrolate TABS 1 $0 glycopyrrolate inj 1 $0 H2- 受體拮抗藥 - 用於治療潰瘍和胃酸的藥物 AXID AR 3 $0 NM;* cimetidine TABS 200mg 3 $0 NM;* famotidine SOLN 40mg/4ml, 1 $0 200mg/20ml famotidine SUSR 1 $0 famotidine TABS 10mg,20mg 3 $0 NM;* famotidine TABS 20mg,40mg 1 $0 famotidine inj 1 $0 PEPCID AC CHEW 3 $0 NM;* ranitidine hcl SOLN 1 $0 ranitidine hcl TABS 75mg,150mg 3 $0 NM;* ranitidine hcl TABS 150mg,300mg 1 $0 50

51 藥物名稱 等級 您需要付費的藥物 ranitidine hcl inj 1 $0 ranitidine syrup 1 $0 炎症性腸病 APRISO 2 $0 ASACOL HD 2 $0 balsalazide disodium 1 $0 budesonide ec 2 $0 CANASA 2 $0 colocort enema 100mg 1 $0 DELZICOL 2 $0 DIPENTUM 2 $0 HYDROCORTISONE (INTRARECTAL) 1 $0 LIALDA 2 $0 mesalamine enema 1 $0 mesalamine w/ cleanser 1 $0 PENTASA 2 $0 sulfasalazine TABS 1 $0 sulfasalazine ec 1 $0 UCERIS TB24 2 $0 瀉藥 BENEFIBER CHEW;POWD 3 $0 NM;* benzocaine-docusate sodium 3 $0 NM;* bisacodyl SUPP;TBEC 3 $0 NM;* BLACK DRAUGHT 3 $0 NM;* calcium polycarbophil 3 $0 NM;* COATS ALOE VERA JUICE DRI 3 $0 NM;* constulose 1 $0 corn dextrin 3 $0 NM;* docusate calcium 3 $0 NM;* docusate sodium CAPS;ENEM; 3 $0 NM;* LIQD;SYRP;TABS DULCOLAX BOWEL PREP KIT 3 $0 NM;* enulose 1 $0 EQL NATURAL FIBER 3 $0 NM;* EQUALACTIN 3 $0 NM;* fiber CHEW 3 $0 NM;* FIBER CHEW 3 $0 NM;* fiber POWD 3 $0 NM;* FIBER POWD 3 $0 NM;* FLEET BISACODYL 3 $0 NM;* gaviltye-g 1 $0 gavilyte-c 1 $0 51

52 藥物名稱 等級 您需要付費 的藥物 gavilyte-h 1 $0 gavilyte-n 1 $0 generlac 1 $0 GOLYTELY 2 $0 HYDROCIL INSTANT PACK 3 $0 NM;* KONSYL PACK 28.3%,100% 3 $0 NM;* KONSYL POWD 60.3%,71.67% 3 $0 NM;* KONSYL-D 3 $0 NM;* lactulose 1 $0 lactulose (encephalopathy) 1 $0 magnesium citrate SOLN 3 $0 NM;* magnesium hydroxide SUSP 3 $0 NM;* magnesium oxide (laxative) 3 $0 NM;* magnesium sulfate (laxative) 3 $0 NM;* METAMUCIL WAFR 3 $0 NM;* METAMUCIL MULTIHEALTH FIB 3 $0 NM;* POWD 63% METAMUCIL SMOOTH TEXTURE 3 $0 NM;* methylcellulose (laxative) 3 $0 NM;* MILK OF MAGNESIA CONCENTR 3 $0 NM;* mineral oil ENEM 3 $0 NM;* MINERAL OIL OIL 3 $0 NM;* MOVIPREP 2 $0 NULYTELY/FLAVOR PACKS 2 $0 NUTRISOURCE FIBER PACK 3 $0 NM;* PEDIA-LAX LIQD 3 $0 NM;* peg 3350-kcl-sod bicarb-sod 1 $0 chloride-sod sulfate peg 3350-potassium chloride-sod 1 $0 bicarbonate-sod chloride PEG 3350/ELECTROLYTES 1 $0 PHILLIPS MILK OF MAGNESIA 3 $0 NM;* polyethylene glycol 3350 PACK; 1 $0 POWD psyllium CAPS 3 $0 NM;* psyllium POWD 28.3%,30%, 3 $0 NM;* 30.9%,33%,48.57%,58.6%, 68%,95%,100% PSYLLIUM POWD 49% 3 $0 NM;* RELISTOR 2 $0 PA SENNA SYRP 3 $0 NM;* senna TABS 3 $0 NM;* 52

53 藥物名稱 等級 您需要付費 的藥物 SENNA PROMPT 3 $0 NM;* sennosides CAPS 3 $0 NM;* sennosides CHEW 3 $0 NM; * sennosides SYRP 3 $0 NM; * SENNOSIDES TABS 8.6mg 3 $0 NM; * sennosides TABS 8.6mg, 15mg, 3 $0 NM; * 17.2mg, 25mg sennosides-docusate sodium 3 $0 NM;* sodium phosphates 3 $0 NM;* SUPREP BOWEL PREP 2 $0 trilyte 1 $0 wheat dextrin 3 $0 NM;* wheat dextrin-calcium 3 $0 NM;* 其他 alosetron hcl 2 $0 PA AMITIZA CAP 8MCG 2 $0 QL (60 粒膠囊 /30 天 ) AMITIZA CAP 24MCG 2 $0 QL (60 粒膠囊 /30 天 ) cromolyn sodium (mastocytosis) 2 $0 diphenoxylate w/ atropine 1 $0 LINZESS CAP 145MCG 2 $0 QL (60 粒膠囊 /30 天 ) LINZESS CAP 290MCG 2 $0 QL (30 粒膠囊 /30 天 ) loperamide hcl CAPS 1 $0 LOTRONEX 2 $0 PA misoprostol TABS 1 $0 MOVANTIK 12.5mg 2 $0 QL (60 片 / 30 天 ) MOVANTIK 25mg 2 $0 QL (30 片 / 30 天 ) SUCRAID 2 $0 sucralfate TABS 1 $0 ursodiol CAPS;TABS 1 $0 XIFAXAN 550mg 2 $0 PA 胰臟酵素 CREON 2 $0 ZENPEP 2 $0 質子幫浦抑制劑 - 用於治療潰瘍和胃酸的藥物 DEXILANT 2 $0 QL (30 粒膠囊 /30 天 ) esomeprazole sodium inj 1 $0 famotidine-calcium carbonatemagnesium 3 $0 NM;* hydroxide lansoprazole CPDR 15mg 3 $0 NM;* NEXIUM CAP 20MG 2 $0 QL (30 粒膠囊 /30 天 ) NEXIUM CAP 40MG 2 $0 QL (30 粒膠囊 /30 天 ) NEXIUM GRA 2.5MG DR 2 $0 53

54 藥物名稱 等級 您需要付費 的藥物 NEXIUM GRA 5MG DR 2 $0 NEXIUM GRA 10MG DR 2 $0 QL (30 袋 /30 天 ) NEXIUM GRA 20MG DR 2 $0 QL (30 袋 /30 天 ) NEXIUM GRA 40MG DR 2 $0 QL (30 袋 /30 天 ) omeprazole CPDR 10mg,40mg 1 $0 QL (30 粒膠囊 /30 天 ) omeprazole CPDR 20mg 1 $0 QL (60 粒膠囊 /30 天 ) OMEPRAZOLE TBEC 3 $0 NM;* omeprazole magnesium 3 $0 NM;* omeprazole-sodium bicarbonate 3 $0 NM;* pantoprazole sodium tbec 1 $0 QL (30 片 /30 天 ) PRILOSEC OTC 3 $0 NM;* 泌尿生殖用藥 - 用於治療生殖和泌尿系統疾病的藥物 良性前列腺增生治療藥物 - 用於治療良性前列腺增生的藥物 alfuzosin hcl 1 $0 QL (30 片 /30 天 ) AVODART 2 $0 QL (30 粒膠囊 /30 天 ) finasteride TABS 5mg 1 $0 JALYN 2 $0 QL (30 粒膠囊 /30 天 ) tamsulosin hcl 1 $0 QL (60 粒膠囊 /30 天 ) 其他 bethanechol chloride TABS 1 $0 ELMIRON 2 $0 POTASSIUM CITRATE (ALKALINIZER) 540mg,1080mg 1 $0 尿失禁治療藥物 - 用於治療尿失禁的藥物 MYRBETRIQ 25mg 2 $0 QL (60 片 /30 天 ) MYRBETRIQ 50mg 2 $0 QL (30 片 /30 天 ) oxybutynin chloride SYRP 1 $0 oxybutynin chloride TABS 1 $0 oxybutynin chloride TB24 5mg 1 $0 QL (30 片 /30 天 ) oxybutynin chloride TB24 10mg, 1 $0 QL (60 片 /30 天 ) 15mg TOLTERODINE TARTRATE CAP ER 1 $0 QL (30 粒膠囊 /30 天 ) tolterodine tartrate tabs 1 $0 TOVIAZ 2 $0 QL (30 片 /30 天 ) trospium chloride TABS 1 $0 QL (60 片 /30 天 ) VESICARE 2 $0 QL (30 片 /30 天 ) 陰道抗感染藥物 clindamycin phosphate vaginal 1 $0 clotrimazole vaginal 3 $0 NM;* metronidazole vaginal 1 $0 miconazole nitrate vaginal CREA 3 $0 NM;* 54

55 藥物名稱 等級 您需要付費 的藥物 miconazole nitrate vaginal KIT 3 $0 NM;* miconazole nitrate vaginal SUPP 3 $0 NM;* 100mg povidone-iodine vaginal 3 $0 NM;* terconazole vaginal 1 $0 tioconazole vaginal 3 $0 NM;* VANDAZOLE 1 $0 zazole.4% 1 $0 ZAZOLE.8% 1 $0 血液用藥 - 用於治療血液病的藥物抗凝劑 - 抗凝血素 COUMADIN 2 $0 ELIQUIS 2 $0 enoxaparin sodium 30mg/0.3ml, 1 $0 40mg/0.4ml,60mg/0.6ml, 80mg/0.8ml,300mg/3ml enoxaparin sodium 100mg/ml, 120mg/0.8ml,150mg/ml 2 $0 fondaparinux sodium 2.5mg/0.5ml 1 $0 fondaparinux sodium 5mg/0.4ml, 2 $0 7.5mg/0.6ml,10mg/0.8ml heparin sod inj 1000/ml 1 $0 B/D HEPARIN SOD INJ 2000/ML 2 $0 B/D HEPARIN SOD INJ 2500/ML 2 $0 B/D heparin sod inj 5000/ml 1 $0 B/D heparin sod inj 10000/ml 1 $0 B/D heparin sod inj 20000/ml 1 $0 B/D HEPARIN SODIUM/D5W 2 $0 HEPARIN SODIUM/NACL 0.45% 2 $0 jantoven 1 $0 PRADAXA 2 $0 warfarin sodium 1 $0 XARELTO 2 $0 XARELTO STARTER PACK 2 $0 造血生長因子 GRANIX 2 $0 NM,PA LEUKINE 2 $0 NM,PA MOZOBIL 2 $0 NM,PA NEUMEGA 2 $0 NM NEUPOGEN 2 $0 NM,PA PROCRIT 2 $0 NM,PA 補鐵藥 55

56 藥物名稱 等級 您需要付費 的藥物 BIFERA 3 $0 NM;* carbonyl iron 3 $0 NM;* CVS SLOW RELEASE IRON 3 $0 NM;* FEOSOL 45mg 3 $0 NM;* FERRETTS IPS 3 $0 NM;* FERRIMIN $0 NM;* FERROUS FUMARATE TABS 29mg, 3 $0 NM;* 90mg ferrous fumarate TABS 325mg 3 $0 NM;* FERROUS GLUCONATE 225mg, 3 $0 NM;* 324mg ferrous gluconate 240mg,324mg 3 $0 NM;*,325mg ferrous sulfate ELIX 3 $0 NM;* FERROUS SULFATE LIQD 3 $0 NM;* ferrous sulfate SOLN 3 $0 NM;* FERROUS SULFATE SYRP 3 $0 NM;* ferrous sulfate TABS 3 $0 NM;* ferrous sulfate TBCR 45mg, 3 $0 NM;* 47.5mg,50mg FERROUS SULFATE TBCR 140mg 3 $0 NM;* FERROUS SULFATE TBEC 324mg 3 $0 NM;* ferrous sulfate TBEC 325mg 3 $0 NM;* ferrous sulfate dried 3 $0 NM;* FOLGARD 3 $0 NM;* folic acid-vitamin b6-vitamin b12 3 $0 NM;* FOLITAB $0 NM;* INTEGRA 3 $0 NM;* IRON TABS 28mg,90mg 3 $0 NM;* iron TABS 256mg 3 $0 NM;* IRON TBCR 3 $0 NM;* iron chews pediatric 3 $0 NM;* IRON DEXTRAN 3 $0 NM;* IRON UP 3 $0 NM;* iron-vitamin c 3 $0 NM;* iron-vitamin c-vitamin b12-folic acid 3 $0 NM;* MYKIDZ IRON 10 3 $0 NM;* NOVAFERRUM $0 NM;* NOVAFERRUM PEDIATRIC DROP 3 $0 NM;* polysaccharide iron complex 3 $0 NM;* PROFE 3 $0 NM;* 56

57 藥物名稱 等級 您需要付費 的藥物 SLOW RELEASE IRON 3 $0 NM;* SM SLOW RELEASE IRON 3 $0 NM;* VITAMIN B12/FOLIC ACID 3 $0 NM;* 其他 anagrelide hcl 1 $0 cilostazol 1 $0 CINRYZE 2 $0 NM,LA,PA FIRAZYR 2 $0 NM,PA pentoxifylline TBCR 1 $0 PROMACTA 12.5mg 2 $0 QL (360 片 /30 天 ),NM,LA,PA PROMACTA 25mg 2 $0 QL (180 片 /30 天 ),NM,LA,PA PROMACTA 50mg 2 $0 QL (90 片 /30 天 ),NM,LA,PA PROMACTA 75mg 2 $0 QL (60 片 /30 天 ),NM,LA,PA tranexamic acid SOLN;TABS 1 $0 血小板凝集抑制劑 AGGRENOX 2 $0 BRILINTA 2 $0 clopidogrel bisulfate 75mg 1 $0 QL (30 片 /30 天 ) EFFIENT 2 $0 ZONTIVITY 2 $0 免疫製劑 - 用於治療免疫系統疾病的藥物 緩解病情抗風濕藥 (DMARDS) - 用於治療風濕性關節炎的藥物 CIMZIA 2 $0 NM,PA CIMZIA STARTER KIT 2 $0 NM,PA HUMIRA 2 $0 NM,PA HUMIRA KIT 40MG/0.8 1 $0 NM,PA HUMIRA PEN 2 $0 NM,PA HUMIRA PEN-CROHNS DISEASE 2 $0 NM,PA HUMIRA PEN-PSORIASIS STAR 2 $0 NM,PA hydroxychloroquine sulfate 1 $0 leflunomide TABS 1 $0 methotrexate sodium tabs 1 $0 REMICADE 2 $0 NM,PA 免疫球蛋白 BIVIGAM 2 $0 NM,PA CARIMUNE NANOFILTERED 2 $0 NM,PA FLEBOGAMMA 2 $0 NM,PA 57

58 藥物名稱 等級 您需要付費 的藥物 FLEBOGAMMA DIF 2 $0 NM,PA GAMASTAN S/D 2 $0 B/D,NM GAMMAGARD LIQUID 2 $0 NM,PA GAMMAGARD S/D 2 $0 NM,PA GAMMAKED 2 $0 NM,PA GAMMAPLEX 2.5gm/50ml, 2 $0 NM,PA 5gm/100ml,10gm/200ml GAMUNEX-C 2 $0 NM,PA GAMUNEX-C 1GM/10ML 2 $0 NM,PA OCTAGAM 1gm/20ml,2gm/20ml, 2 $0 NM,PA 2.5gm/50ml,5gm/100ml, 10gm/200ml,25gm/500ml PRIVIGEN 2 $0 NM,PA 免疫調節劑 ACTIMMUNE 2 $0 NM,LA,PA ARCALYST 2 $0 NM,PA INTRON-A INJ 10MU 2 $0 B/D,NM INTRON-A INJ 18MU 2 $0 B/D,NM INTRON-A INJ 25MU 2 $0 B/D,NM INTRON-A INJ 50MU 2 $0 B/D,NM PEG-INTRON 2 $0 NM,PA PEG-INTRON REDIPEN 2 $0 NM,PA REVLIMID 2 $0 NM,LA,PA THALOMID 2 $0 NM,PA 免疫抑製劑 azathioprine TABS 1 $0 B/D cyclosporine CAPS;SOLN 1 $0 B/D cyclosporine modified (for 1 $0 B/D microemulsion) gengraf 1 $0 B/D mycophenolate mofetil CAPS; 1 $0 B/D TABS mycophenolate mofetil SUSR 2 $0 B/D mycophenolate sodium 180mg 1 $0 B/D mycophenolate sodium 360mg 2 $0 B/D NEORAL 2 $0 B/D NULOJIX 2 $0 B/D PROGRAF CAPS 2 $0 B/D RAPAMUNE SOLN 2 $0 B/D SANDIMMUNE CAPS 2 $0 B/D SANDIMMUNE SOLN 100mg/ml 2 $0 B/D 58

59 藥物名稱 等級 您需要付費 的藥物 SIROLIMUS TABS 1mg 1 $0 B/D SIROLIMUS TABS 2mg 2 $0 B/D sirolimus TABS.5mg 1 $0 B/D tacrolimus CAPS 5mg 2 $0 B/D tacrolimus CAPS.5mg,1mg 1 $0 B/D ZORTRESS 2 $0 B/D ZORTRESS TAB 0.5MG 2 $0 B/D ZORTRESS TAB 0.75MG 2 $0 B/D 疫苗 ACTHIB 2 $0 ADACEL 2 $0 BCG VACCINE 2 $0 BEXSERO 2 $0 BOOSTRIX 2 $0 CERVARIX 2 $0 COMVAX 2 $0 DAPTACEL 2 $0 DIPHTHERIA/TETANUS TOXOID 2 $0 B/D ENGERIX-B SUSP 2 $0 B/D GARDASIL 2 $0 GARDASIL 9 2 $0 HAVRIX 2 $0 HIBERIX 2 $0 IMOVAX RABIES (H.D.C.V.) 2 $0 INFANRIX 2 $0 IPOL INACTIVATED IPV 2 $0 IXIARO 2 $0 M-M-R II W/DILUENT 10 DOS 2 $0 MENACTRA 2 $0 MENOMUNE-A/C/Y/W $0 MENVEO 2 $0 PEDVAX HIB 2 $0 PROQUAD 2 $0 RABAVERT 2 $0 RECOMBIVAX HB 2 $0 B/D ROTARIX 2 $0 ROTATEQ 2 $0 SYNAGIS 2 $0 NM TENIVAC 2 $0 B/D TETANUS TOXOID ADSORBED 2 $0 B/D TETANUS/DIPHTHERIA TOXOID 2 $0 B/D TRUMENBA 2 $0 TWINRIX INJ 2 $0 59

60 藥物名稱 等級 您需要付費 的藥物 TYPHIM VI 2 $0 VAQTA 2 $0 VARIVAX 2 $0 YF-VAX 2 $0 ZOSTAVAX 2 $0 QL ( 每人終身注射 1 小瓶 ) 營養藥 / 補充劑 - 維他命和補充劑 電解質 KLOR-CON 8 1 $0 KLOR-CON 10 1 $0 klor-con m15 1 $0 klor-con m20 1 $0 klor-con pow 20meq 1 $0 MAGNESIUM SULFATE SOLN 2 $0 40mg/ml,80mg/ml magnesium sulfate SOLN 50% 1 $0 MAGNESIUM SULFATE SOLN 50% 1 $0 MAGNESIUM SULFATE IN D5W 2 $0 oral electrolytes SOLN 3 $0 NM;* potassium chloride CPCR 1 $0 potassium chloride LIQD 1 $0 potassium chloride TBCR 8meq 1 $0 POTASSIUM CHLORIDE TBCR 1 $0 20meq POTASSIUM CHLORIDE ER 1 $0 potassium chloride 1 $0 microencapsulated crystals cr SODIUM CHLORIDE SOLN 1 $0 2.5meq/ml SODIUM FLUORIDE CHEW;TAB; 1 $0 1.1 (0.5 F) MG/ML SOLN TPN ELECTROLYTES 2 $0 B/D 靜脈營養藥 AMINOSYN 2 $0 B/D AMINOSYN 7%/ELECTROLYTES 2 $0 B/D AMINOSYN 8.5%/ELECTROLYTE 2 $0 B/D AMINOSYN II 2 $0 B/D AMINOSYN II 8.5%/ELECTROL 2 $0 B/D AMINOSYN M 2 $0 B/D AMINOSYN-HBC 2 $0 B/D AMINOSYN-PF 2 $0 B/D AMINOSYN-PF 7% 2 $0 B/D AMINOSYN-RF 2 $0 B/D 60

61 藥物名稱 等級 您需要付費 的藥物 CLINIMIX 2.75%/DEXTROSE 5% 2 $0 B/D CLINIMIX 4.25%/DEXTROSE 5% 2 $0 B/D CLINIMIX 4.25%/DEXTROSE 25% 2 $0 B/D CLINIMIX 5%/DEXTROSE 15% 2 $0 B/D CLINIMIX 5%/DEXTROSE 20% 2 $0 B/D CLINIMIX 5%/DEXTROSE 25% 2 $0 B/D CLINIMIX INJ 4.25/D10 2 $0 B/D CLINIMIX INJ 4.25/D20 2 $0 B/D FREAMINE HBC 6.9% 2 $0 B/D FREAMINE III 2 $0 B/D HEPATAMINE 2 $0 B/D INTRALIPID INJ 20% 2 $0 B/D INTRALIPID INJ 30% 2 $0 B/D NEPHRAMINE 2 $0 B/D NUTRILIPID EMU 20% 2 $0 B/D premasol sol 6% 1 $0 B/D premasol sol 10% 2 $0 B/D PROCALAMINE 2 $0 B/D PROSOL 2 $0 B/D travasol 10 2 $0 B/D TROPHAMINE INJ 10% 2 $0 B/D 靜脈替代溶液 DEXTROSE 2.5%/NACL 0.45% 1 $0 DEXTROSE 5% 1 $0 DEXTROSE 5% /ELECTROLYTE 2 $0 DEXTROSE 5%/LACTATED RING 1 $0 DEXTROSE 5%/NACL 0.2% 1 $0 DEXTROSE 5%/NACL 0.3% 1 $0 DEXTROSE 5%/NACL 0.9% 1 $0 DEXTROSE 5%/NACL 0.33% 1 $0 DEXTROSE 5%/NACL 0.45% 1 $0 DEXTROSE 5%/NACL 0.225% 1 $0 DEXTROSE 5%/POTASSIUM CHL 1 $0 DEXTROSE 10% FLEX CONTAIN 1 $0 DEXTROSE 10%/NACL 0.2% 2 $0 DEXTROSE 10%/NACL 0.45% 1 $0 DEXTROSE 50% 1 $0 dextrose inj 70% 1 $0 IONOSOL-B/DEXTROSE 5% 2 $0 IONOSOL-MB/DEXTROSE 5% 2 $0 ISOLYTE P 2 $0 isolyte s 2 $0 KCL0.15%/D5W/NACL0.2% 1 $0 61

62 藥物名稱 等級 您需要付費的藥物 KCL0.15%/D5W/NACL0.225% 2 $0 KCL 0.3%/D5W/NACL 0.9% 1 $0 KCL 0.3%/D5W/NACL 0.45% 1 $0 KCL 0.15%/D5W/NACL 0.9% 1 $0 KCL 0.075%/D5W/NACL 0.45% 1 $0 KCL IN NACL INJ $0 KCL/D5W INJ 0.3% 1 $0 KCL/D5W/NACL INJ.15/.33% 1 $0 KCL/D5W/NACL INJ.15/.45% 1 $0 KCL/NACL INJ $0 LACTATED RINGER'S INJ 1 $0 normosol-m 1 $0 NORMOSOL-R 2 $0 NORMOSOL-R IN D5W 2 $0 PLASMA-LYTE A 2 $0 PLASMA-LYTE-56/D5W 2 $0 PLASMA-LYTE $0 POTASSIUM CHLORIDE SOLN 1 $0 10meq/100ml,20meq/100ml potassium chloride SOLN.4meq/ml 1 $0,2meq/ml,10meq/50ml, 40meq/100ml POTASSIUM CHLORIDE 0.15% 1 $0 POTASSIUM CHLORIDE 0.22% 1 $0 potassium chloride in nacl 1 $0 RINGER'S 1 $0 SODIUM CHLORIDE SOLN 3%,5% 1 $0 SODIUM CHLORIDE 0.45% VIA 1 $0 SODIUM CHLORIDE INJ 0.9% 1 $0 礦物質 ADVANCED CALCIUM FORMULA 3 $0 NM;* BEELITH 3 $0 NM;* BONE DENSITY 3 $0 NM;* bone meal w/ vitamin d 3 $0 NM;* CAL-CITRATE PLUS VITAMIN 3 $0 NM;* CAL-GLU 3 $0 NM;* CAL-QUICK 3 $0 NM;* CAL/MAG 3 $0 NM;* CALCET CREAMY BITES 3 $0 NM;* CALCET PETITES 3 $0 NM;* CALCI-MIX 3 $0 NM;* CALCIONATE 3 $0 NM;* 62

63 藥物名稱 等級 您需要付費 的藥物 calcium TABS 3 $0 NM;* CALCIUM $0 NM;* CALCIUM D 3 $0 NM;* CALCIUM & MAGNESIUM 3 $0 NM;* calcium & phosphorus w/ vitamin d 3 $0 NM;* CALCIUM CARBONATE CHEW 3 $0 NM;* CALCIUM CARBONATE POWD 3 $0 NM;* calcium carbonate SUSP 3 $0 NM;* calcium carbonate TABS 600mg, 3 $0 NM;* 1250mg,1500mg calcium carbonate-cholecalciferol 3 $0 NM;* CAPS calcium carbonate-cholecalciferol 3 $0 NM;* CHEW CALCIUM CARBONATE- 3 $0 NM;* CHOLECALCIFEROL CHEW calcium carbonate-cholecalciferol 3 $0 NM;* TABS calcium carbonate-ergocalciferol 3 $0 NM;* calcium carbonate-vitamin d 3 $0 NM;* calcium carbonate-vitamin d w/ 3 $0 NM;* minerals CALCIUM CITRATE GRAN 3 $0 NM;* CALCIUM CITRATE TABS 250mg 3 $0 NM;* calcium citrate TABS 950mg 3 $0 NM;* CALCIUM CITRATE MALATE/VI 3 $0 NM;* CALCIUM CITRATE W/D 3 $0 NM;* calcium citrate-vitamin d 3 $0 NM;* CALCIUM GLUCONATE TABS 50mg 3 $0 NM;*,500mg calcium gluconate TABS 500mg 3 $0 NM;* CALCIUM GUMMIES 3 $0 NM;* CALCIUM LACTATE 100mg,648mg 3 $0 NM;* calcium lactate 650mg 3 $0 NM;* calcium w/ magnesium 3 $0 NM;* calcium w/ vitamin d 3 $0 NM;* calcium w/ vitamins d & k 3 $0 NM;* calcium-magnesium w/ vitamin d 3 $0 NM;* calcium-magnesium-zinc 3 $0 NM;* CALCIUM/C/D 3 $0 NM;* CALCIUM/MAGNESIUM 3 $0 NM;* CALCIUM/MAGNESIUM/VITAMIN 3 $0 NM;* 63

64 藥物名稱 等級 您需要付費 的藥物 CALCIUM/MAGNESIUM/ZINC 3 $0 NM;* CALMAG THINS 3 $0 NM;* CALTRATE 600+D PLUS MINER 3 $0 NM;* CHEW caltrate 600+d soft chews 3 $0 NM;* CHELATED CALCIUM 3 $0 NM;* CITRACAL CALCIUM GUMMIES 3 $0 NM;* CITRACAL PLUS HEART HEALT 3 $0 NM;* CORAL CALCIUM CAPS 3 $0 NM;* CORAL CALCIUM PLUS 3 $0 NM;* coral calcium-magnesium w/ 3 $0 NM;* vitamin d CVS CALCIUM CITRATE 3 $0 NM;* EQL CALCIUM/VITAMIN D 3 $0 NM;* EQL CHILDRENS CALCIUM GUM 3 $0 NM;* GNP CALCIUM 500 +D3 3 $0 NM;* LIQUID CALCIUM WITH D3 MA 3 $0 NM;* LOCALNESIUM 3 $0 NM;* LOCALNESIUM-C 3 $0 NM;* MAG $0 NM;* MAG-TAB SR 3 $0 NM;* MAGINEX 3 $0 NM;* MAGNEBIND $0 NM;* MAGNEBIND $0 NM;* magnesium CAPS 100mg 3 $0 NM;* MAGNESIUM CAPS 400mg 3 $0 NM;* magnesium TABS 100mg,200mg 3 $0 NM;*,250mg magnesium chloride TBCR 3 $0 NM;* magnesium chloride-calcium 3 $0 NM;* MAGNESIUM CITRATE TABS 3 $0 NM;* MAGNESIUM ELEMENTAL 3 $0 NM;* MAGNESIUM GLUCONATE TABS 250mg,550mg 3 $0 NM;* magnesium oxide (mg supplement) 3 $0 NM;* MAGNESIUM SULFATE CAPS 3 $0 NM;* oral electrolytes TABS 3 $0 NM;* OSTEO-PORETICAL 3 $0 NM;* oyster shell 3 $0 NM;* PARVA-CAL 3 $0 NM;* PARVA-CAL $0 NM;* 64

65 藥物名稱 等級 您需要付費 的藥物 PHOS-NAK POWDER CONCENTRA 3 $0 NM;* RA CALCIUM/BORON 3 $0 NM;* RA OYSTER SHELL CALCIUM/V 3 $0 NM;* selenium TABS 100mcg 3 $0 NM;* SELENIUM TBCR 3 $0 NM;* SLOW-MAG 3 $0 NM;* SM CORAL CALCIUM 3 $0 NM;* UPCAL D 3 $0 NM;* 維他命 A-25 3 $0 NM;* ACEROLA C $0 NM;* ANTIOXIDANT FORMULA SG 3 $0 NM;* APATATE 3 $0 NM;* AQUA-E 3 $0 NM;* ascorbic acid CHEW;CPCR;LOZG 3 $0 NM;* ;SYRP;TABS;TBCR ASCORBIC ACID POWD 3 $0 NM;* b complex w/ c 3 $0 NM;* B-1 3 $0 NM;* B-12 TABS 3 $0 NM;* B-12 DOTS 3 $0 NM;* B-12 QUICK DISSOLVE 3 $0 NM;* b-complex vitamins 3 $0 NM;* b-complex w/ c & calcium 3 $0 NM;* b-complex w/ c & e + zn 3 $0 NM;* b-complex w/ c & folic acid 3 $0 NM;* b-complex w/ folic acid 3 $0 NM;* b-complex w/ minerals 3 $0 NM;* b-complex w/biotin & folic acid 3 $0 NM;* B-NATAL 3 $0 NM;* beta carotene CAPS 15mg, 3 $0 NM;* 25000unit biotin CAPS 5mg 3 $0 NM;* biotin TABS 2.5mg,300mcg 3 $0 NM;* brewers yeast TABS 3 $0 NM;* calcitriol CAPS 1 $0 B/D calcitriol inj 1 $0 B/D calcitriol oral soln 1 mcg/ml 1 $0 B/D calcium ascorbate TABS 3 $0 NM;* calcium pantothenate TABS 500mg 3 $0 NM;* CALNA 3 $0 NM;* 65

66 藥物名稱 等級 您需要付費 的藥物 CENTRUM SILVER CHEW 3 $0 NM;* CHOLECALCIFEROL CAPS 400unit 3 $0 NM; * cholecalciferol CAPS 1000unit, 3 $0 NM; * 2000unit, 5000unit, 10000unit, 50000unit cholecalciferol CHEW 3 $0 NM; * cholecalciferol LIQD 3 $0 NM; * cholecalciferol TABS 3 $0 NM; * CLASSIC PRENATAL 3 $0 NM;* cod liver oil CAPS 3 $0 NM;* COD LIVER OIL OIL 3 $0 NM;* CVS VITAMIN C 3 $0 NM;* cyanocobalamin LIQD;SOLN; 3 $0 NM;* SUBL;TABS;TBCR;TBDP CYTO B2 3 $0 NM;* D3 DOTS 3 $0 NM;* DECARA 25000unit 3 $0 NM;* DIALYVITE 800/ZINC 15 3 $0 NM;* DIALYVITE VITAMIN D3 MAX 3 $0 NM;* ELDERTONIC 3 $0 NM;* EQL CHILDRENS MULTIVITAMI 3 $0 NM;* ergocalciferol CAPS;SOLN 3 $0 NM;* EZFE FORTE 3 $0 NM;* FA-8 3 $0 NM;* FOLIC ACID CAPS 3 $0 NM;* folic acid SOLN 3 $0 NM;* FOLIC ACID TABS 1mg 3 $0 NM;* folic acid TABS 1mg,400mcg, 3 $0 NM;* 800mcg GERIATRIC VITAMIN 3 $0 NM;* GNP DAILY PRENATAL 3 $0 NM;* HONEY BEARS 3 $0 NM;* HONEY BEARS W/IRON AND ZI 3 $0 NM;* hydroxocobalamin SOLN 3 $0 NM;* ICAPS LUTEIN/ZEAXANTHIN F 3 $0 NM;* iron w/ vitamins 3 $0 NM;* KPN PRENATAL 3 $0 NM;* LUMITENE 3 $0 NM;* MEPHYTON 3 $0 NM;* MISSION PRENATAL 3 $0 NM;* MISSION PRENATAL HP 3 $0 NM;* 66

67 藥物名稱 等級 您需要付費 的藥物 MULTI-DELYN/IRON 3 $0 NM;* multiple vitamin 3 $0 NM;* multiple vitamins w/ iron 3 $0 NM;* multiple vitamins w/ minerals 3 $0 NM;* MYKIDZ IRON 3 $0 NM;* NASCOBAL 3 $0 NM;* NEPHRONEX LIQD 3 $0 NM;* niacin CPCR;TABS;TBCR 3 $0 NM;* NIACIN TR 3 $0 NM;* niacinamide TABS 3 $0 NM;* NUTRICION PORVIDA 3 $0 NM;* pantothenic acid 3 $0 NM;* paricalcitol CAPS 1 $0 B/D pediatric multiple vitamin w/ c 3 $0 NM;* pediatric multiple vitamin w/ c & fa 3 $0 NM;* pediatric multiple vitamin w/ extra c 3 $0 NM;* & fa pediatric multiple vitamin w/ 3 $0 NM;* minerals & c pediatric multiple vitamins 3 $0 NM;* pediatric multiple vitamins w/ iron 3 $0 NM;* pediatric vitamins adc 3 $0 NM;* PERRY PRENATAL 3 $0 NM;* phytonadione SOLN;TABS 3 $0 NM;* PRENATAL 3 $0 NM;* PRENATAL VITAMIN/FOLIC ACID > 1 $0 0.8 MG (GENERIC) PROTEXIN 3 $0 NM;* pyridoxine hcl SOLN;TABS;TBCR 3 $0 NM;* riboflavin TABS 25mg,50mg, 3 $0 NM;* 100mg ROCALTROL 2 $0 B/D SCOOBY-DOO ONE A DAY 3 $0 NM;* SM VITAMIN D3 MAXIMUM STR 3 $0 NM;* specialty vitamins products 3 $0 NM;* STUART PRENATAL + DHA 3 $0 NM;* SUPER NU-THERA 3 $0 NM;* TAB-A-VITE WOMENS 3 $0 NM;* THERA-D $0 NM;* THERA/BETA-CAROTENE 3 $0 NM;* THERANATAL CORE NUTRITION 3 $0 NM;* 67

68 藥物名稱 等級 您需要付費 的藥物 thiamine hcl SOLN;TABS 3 $0 NM;* thiamine mononitrate 3 $0 NM;* TRI-VI-SOL 3 $0 NM;* TRI-VI-SOL/IRON 3 $0 NM;* VITA-MAG 3 $0 NM;* VITALETS 3 $0 NM;* vitamin a CAPS 8000unit, 3 $0 NM;* 10000unit VITAMIN A TABS 3 $0 NM;* vitamin a TABS 10000unit 3 $0 NM;* VITAMIN A PALMITATE TABS 3 $0 NM;* VITAMIN C SOLR 3 $0 NM;* VITAMIN D2 3 $0 NM;* VITAMIN D3 LIQD 1200unit/15ml 3 $0 NM;* VITAMIN D3 TABS 3 $0 NM;* vitamin e CAPS 3 $0 NM;* VITAMIN E CHEW 3 $0 NM;* vitamin e LIQD 400unit/15ml 3 $0 NM;* vitamin e OIL 3 $0 NM;* vitamin e SOLN 3 $0 NM;* VITAMIN E TABS 100unit,200unit 3 $0 NM;* vitamin e TABS 400unit 3 $0 NM;* VITAMIN K 3 $0 NM;* vitamin mixture 3 $0 NM;* vitamins a & d CAPS 3 $0 NM;* vitamins c & e 3 $0 NM;* ZOO FRIENDS COMPLETE 3 $0 NM;* 眼藥 - 用於治療眼部疾病的藥物 抗感染藥 / 抗炎藥 - 用於治療感染和炎症的藥物 bacitracin-poly-neomycin-hc 1 $0 blephamide OINT 2 $0 neomycin-polymy-dexameth 1 $0 neomycin-polymyxin-hc (ophth) 1 $0 sulfacetamide sod-prednisolone 1 $0 TOBRADEX OINT 2 $0 TOBRADEX ST 2 $0 tobramycin-dexamethasone 1 $0 ZYLET 2 $0 抗感染藥 - 用於治療感染的藥物 bacitracin (ophthalmic) 1 $0 bacitracin-polymyxin b (ophth) 1 $0 68

69 藥物名稱 等級 您需要付費的藥物 BESIVANCE 2 $0 CILOXAN OINT 2 $0 ciprofloxacin hcl (ophth) 1 $0 erythromycin (ophth) 1 $0 gatifloxacin (ophth) 1 $0 gentak 1 $0 gentamicin sulfate (ophth) 1 $0 ilotycin 1 $0 MOXEZA 2 $0 NATACYN 2 $0 neomycin-bacitracin zn-polymyxin 1 $0 neomycin-polymyxin-gramicidin 1 $0 ofloxacin (ophth) 1 $0 polymyxin b-trimethoprim 1 $0 sulfacetamide sodium (ophth) 1 $0 tobramycin (ophth) 1 $0 TOBREX OINT 2 $0 trifluridine SOLN 1 $0 VIGAMOX 2 $0 抗炎藥 - 用於治療炎症的藥物 ALREX 2 $0 bromfenac sodium (ophth) 1 $0 BROMFENAC SODIUM 1 $0 (OPHTH)(ONCE-DAILY) dexamethasone sodium phosphate 1 $0 (ophth) diclofenac sodium (ophth) 1 $0 DUREZOL 2 $0 FLUOROMETHOLONE 1 $0 flurbiprofen sodium 1 $0 ILEVRO 2 $0 ketorolac tromethamine (ophth) 1 $0 LOTEMAX 2 $0 MAXIDEX 2 $0 NEVANAC 2 $0 PREDNISOLONE ACETATE (OPHTH) 1 $0 prednisolone sodium phosphate 2 $0 (ophth) 抗過敏藥 - 用於治療過敏的藥物 azelastine drop 0.05% 1 $0 BEPREVE 2 $0 cromolyn sodium (ophth) 1 $0 ketotifen fumarate (ophth) 3 $0 NM;* 69

70 藥物名稱 等級 您需要付費 的藥物 LASTACAFT 2 $0 naphazoline w/ pheniramine 3 $0 NM;* NAPHAZOLINE W/ PHENIRAMINE 3 $0 NM;* PATADAY 2 $0 PATANOL 2 $0 PAZEO 2 $0 phenylephrine hcl (ophth) 3 $0 NM;* tetrahydrozoline hcl (ophth) 3 $0 NM;* tetrahydrozoline w/ zinc sulfate 3 $0 NM;* VASOCLEAR A 3 $0 NM;* VISINE-LR 3 $0 NM;* 抗青光眼藥物 - 用於治療青光眼的藥物 ALPHAGAN P SOL 0.1% 2 $0 AZOPT 2 $0 betaxolol hcl (ophth) 1 $0 BETOPTIC-S 2 $0 brimonidine sol 0.2% 1 $0 BRIMONIDINE SOL 0.15% 1 $0 carteolol hcl (ophth) 1 $0 COMBIGAN 2 $0 dorzolamide hcl 1 $0 dorzolamide hcl-timolol maleate 1 $0 ISTALOL 2 $0 latanoprost SOLN 1 $0 levobunolol hcl.5% 1 $0 LEVOBUNOLOL HCL.25% 1 $0 LUMIGAN 2 $0 metipranolol 1 $0 PHOSPHOLINE IODIDE 2 $0 PILOCARPINE HCL SOLN 1 $0 SIMBRINZA 2 $0 timolol maleate (ophth) 1 $0 TIMOLOL MALEATE GEL 1 $0 TRAVATAN Z 2 $0 其他 artificial tear ointment 3 $0 NM;* artificial tear solution 3 $0 NM;* BLINK TEARS LUBRICATING E 3 $0 NM;* carboxymethylcellulose sodium 3 $0 NM;* (ophth) carboxymethylcellulose-glycerin 3 $0 NM;* CLEAR EYES FOR DRY EYES 3 $0 NM;* 70

71 藥物名稱 等級 您需要付費 的藥物 COMPUTER EYE DROPS 3 $0 NM;* ENUCLENE 3 $0 NM;* FRESHKOTE 3 $0 NM;* GENTEAL 3 $0 NM;* GENTEAL MILD 3 $0 NM;* glycerin-hypromellose-polyethylene 3 $0 NM;* glycol 400 GONIOVISC 3 $0 NM;* HYPOTEARS 3 $0 NM;* hypromellose (gonioscopic) 3 $0 NM;* hypromellose (ophth) 3 $0 NM;* ISOPTO TEARS 3 $0 NM;* MURO 128 SOLN 2% 3 $0 NM;* naphazoline 0.1% 1 $0 NUTRATEAR 3 $0 NM;* ophthalmic irrigation solution 3 $0 NM;* polyethylene glycol-propylene glycol 3 $0 NM;* (ophth) polyvinyl alcohol SOLN 3 $0 NM;* polyvinyl alcohol-povidone (ophth) 3 $0 NM;* PROLENSA 2 $0 proparacaine hcl SOLN 1 $0 propylene glycol-glycerin 3 $0 NM;* REFRESH CELLUVISC 3 $0 NM;* REFRESH OPTIVE ADVANCED 3 $0 NM;* RESTASIS 2 $0 QL (64 小瓶 /30 天 ) RETAINE MGD 3 $0 NM;* sodium chloride hypertonic 3 $0 NM;* SOOTHE 3 $0 NM;* STERILE LUBRICANT DROPS 3 $0 NM;* SYSTANE BALANCE RESTORATI 3 $0 NM;* SYSTANE LIQUID GEL 3 $0 NM;* SYSTANE OVERNIGHT THERAPY 3 $0 NM;* TEARS AGAIN NIGHT & DAY 3 $0 NM;* THERATEARS SOLN 3 $0 NM;* VIVA DROPS 3 $0 NM;* white petrolatum-mineral oil 3 $0 NM;* 呼吸道用藥 - 用於治療呼吸系統紊亂的藥物 抗膽鹼能藥物 /β 受體合成藥物 - 用於治療慢性阻塞性肺病 (COPD) 的藥物 ANORO ELLIPTA 2 $0 QL (1 個吸入器 /30 天 ) COMBIVENT RESPIMAT 2 $0 QL (2 個吸入器 /30 天 ) 71

72 藥物名稱 等級 您需要付費 的藥物 ipratropium-albuterol nebu 1 $0 B/D 抗膽鹼能藥物 - 用於治療慢性阻塞性肺病 (COPD) 的藥物 ATROVENT HFA 2 $0 QL (2 個吸入器 /30 天 ) ipratropium bromide SOLN 1 $0 B/D ipratropium bromide (nasal) 1 $0 SPIRIVA HANDIHALER 2 $0 QL (30 粒膠囊 /30 天 ) SPIRIVA RESPIMAT 2 $0 QL (1 個吸入器 /30 天 ) TUDORZA PRESSAIR 2 $0 QL (1 個吸入器 /30 天 ) TUDORZA PRESSAIR 2 $0 QL (2 個吸入器 /30 天 ) (INSTITUTIONAL PACK) 400MCG/ACT 抗組胺藥 - 用於治療過敏的藥物 ALA-HIST IR 3 $0 NM;* ALDEX AN 3 $0 NM;* ALLEGRA ALLERGY CHILDRENS 3 $0 NM;* SUSP;TABS ASTEPRO 2 $0 azelastine hcl SOLN 1 $0 azelastine spr 0.1% 1 $0 cetirizine hcl 3 $0 NM;* cetirizine syrup 1 $0 chlorpheniramine maleate SYRP; 3 $0 NM;* TABS;TBCR CLARITIN CAPS;CHEW 3 $0 NM;* CLARITIN REDITABS 5mg 3 $0 NM;* clemastine fumarate TABS 1.34mg 3 $0 NM;* diphenhydramine hcl CAPS;CHEW 3 $0 NM;* ;ELIX;LIQD;TABS;TBDP diphenhydramine inj 1 $0 ED CHLORPED 3 $0 NM;* fexofenadine hcl TABS 3 $0 NM;* hydroxyzine hcl SOLN;TABS 2 $0 PA hydroxyzine hcl inj 2 $0 PA hydroxyzine pamoate CAPS 2 $0 PA J-TAN PD 3 $0 NM;* levocetirizine dihydrochloride 1 $0 loratadine SYRP;TABS;TBDP 3 $0 NM;* olopatadine hcl (nasal) 1 $0 TRIAMINIC COUGH & RUNNY N STRP 3 $0 NM;* β 致效劑 - 用於治療氣喘和慢性阻塞性肺病 (COPD) 的藥物 albuterol sulfate NEBU 1 $0 B/D 72

73 藥物名稱 等級 您需要付費的藥物 albuterol sulfate SYRP;TABS; 1 $0 TB12 FORADIL AEROLIZER 2 $0 QL (60 粒膠囊 /30 天 ) levalbuterol conc 1.25mg/0.5ml 1 $0 B/D PERFOROMIST 2 $0 B/D PROAIR HFA 2 $0 QL (2 個吸入器 /30 天 ) SEREVENT DISKUS 2 $0 QL (1 個吸入器 /30 天 ) terbutaline sulfate SOLN;TABS 1 $0 XOPENEX HFA 2 $0 QL (2 個吸入器 /30 天 ) 咳嗽和感冒藥 acetaminophen w/ dm 3 $0 NM;* acetaminophen-guaifenesin 3 $0 NM;* ADVIL ALLERGY & CONGESTIO 3 $0 NM;* ADVIL ALLERGY SINUS 3 $0 NM;* ADVIL COLD & SINUS CAPS 3 $0 NM;* AFRIN MENTHOL 3 $0 NM;* ALA-HIST PE 3 $0 NM;* ALDEX GS 3 $0 NM;* ALDEX GS DM 3 $0 NM;* ALDEX-CT 3 $0 NM;* AYR NASAL DROPS 3 $0 NM;* benzonatate 100mg, 200mg 3 $0 NM;* BICLORA 3 $0 NM;* BIOSPEC DMX 3 $0 NM;* BROHIST D 3 $0 NM;* brompheniramine & phenyleph 3 $0 NM;* brompheniramine & pseudoeph 3 $0 NM;* BROVEX PSB 3 $0 NM;* BROVEX PSB DM 3 $0 NM;* CAPCOF 3 $0 NM;* CAPMIST DM 3 $0 NM;* cetirizine-pseudoephedrine 3 $0 NM;* CHLO TUSS EX 3 $0 NM;* chlorpheniramine & phenylephrine 3 $0 NM;* chlorpheniramine & pseudoeph 3 $0 NM;* chlorpheniramine-dm 3 $0 NM;* chlorpheniramine-phenylephrineacetaminophen 3 $0 NM;* chlorpheniramine-pseudoephedrine-acetaminophen $0 NM;* CLOFERA 3 $0 NM;* 73

74 藥物名稱 等級 您需要付費 的藥物 CODAR AR 3 $0 NM;* CODAR D 3 $0 NM;* CODAR GF 3 $0 NM;* CODITUSS DM 3 $0 NM;* COMPLETE SINUS RELIEF 3 $0 NM;* CONEX COLD/ALLERGY 3 $0 NM;* CONTAC COLD/FLU DAY & NIG 3 $0 NM;* CONTAC COLD/FLU MAXIMUM S 3 $0 NM;* COUGH SYRUP D 3 $0 NM;* cromolyn sodium (nasal) 3 $0 NM;* cvs nasal mist.9% 3 $0 NM;* DALLERGY SYRP 3 $0 NM;* DECON-A LIQD 3 $0 NM;* DELTUSS DP 3 $0 NM;* DEX-TUSS 3 $0 NM;* DEXATREX D NASAL 3 $0 NM;* dextromethorphan hbr CAPS;LIQD3 $0 NM;* ;SYRP dextromethorphan polistirex 3 $0 NM;* dextromethorphan-doxylamineacetaminophen 3 $0 NM;* dextromethorphan-guaifenesin 3 $0 NM;* dextromethorphan-phenylephrineacetaminophen 3 $0 NM;* DIABETIC TUSSIN COLD/FLU 3 $0 NM;* DICEL CD 3 $0 NM;* DIMETAPP LONG ACTING COUG 3 $0 NM;* diphenhydramine-acetaminophen 3 $0 NM;* diphenhydramine-phenylephrine 3 $0 NM;* diphenhydramine-phenylephrineacetaminophen 3 $0 NM;* LIQD DIPHENHYDRAMINE- 3 $0 NM;* PHENYLEPHRINE-ACETAMINOPHEN LIQD diphenhydramine-phenylephrineacetaminophen 3 $0 NM;* PACK diphenhydramine-phenylephrineacetaminophen 3 $0 NM;* SUSP diphenhydramine-phenylephrineacetaminophen 3 $0 NM;* TABS DONATUSSIN 3 $0 NM;* doxylamine-dm 3 $0 NM;* 74

75 藥物名稱 等級 您需要付費的藥物 doxylamine-phenylephrineacetaminophen 3 $0 NM;* DRYMAX AF 3 $0 NM;* DURAFLU 3 $0 NM;* ED CHLORPED D 3 $0 NM;* ENTSOL NASAL GEL 3 $0 NM;* ephedrine-guaifenesin 3 $0 NM;* fexofenadine-pseudoephedrine 3 $0 NM;* guaifenesin LIQD;SYRP;TABS; 3 $0 NM;* TB12 guaifenesin-codeine 3 $0 NM;* J-MAX 3 $0 NM;* J-TAN D PD 3 $0 NM;* LITTLE NOSES DECONGESTANT 3 $0 NM;* LODRANE D 3 $0 NM;* LOHIST-D 3 $0 NM;* loratadine & pseudoephedrine 3 $0 NM;* LORTUSS DM 3 $0 NM;* LORTUSS EX 3 $0 NM;* LORTUSS LQ 3 $0 NM;* LUSAIR 3 $0 NM;* M-END DMX 3 $0 NM;* M-END MAX D 3 $0 NM;* M-END PE 3 $0 NM;* MAR-COF BP 3 $0 NM;* MEDI-GRAINE 3 $0 NM;* MUCINEX COUGH FOR KIDS 3 $0 NM;* MUCINEX D 3 $0 NM;* MUCINEX FOR KIDS 3 $0 NM;* MUCINEX MAXIMUM STRENGTH 3 $0 NM;* NASAL DECONGESTANT 3 $0 NM;* NASOHIST DM 3 $0 NM;* NASOPEN PE 3 $0 NM;* NEO-SYNEPHRINE.5% 3 $0 NM;* neutrahist 3 $0 NM; * NOREL AD 3 $0 NM;* NOREL CS 3 $0 NM;* ONSET FORTE 3 $0 NM;* oxymetazoline hcl SOLN 3 $0 NM;* PHENAGIL 3 $0 NM;* phenylephrine hcl SOLN.25%,1% 3 $0 NM;* 75

76 藥物名稱 等級 您需要付費 的藥物 phenylephrine hcl (oral) 3 $0 NM;* phenylephrine w/ acetaminophen 3 $0 NM;* phenylephrine w/ dm-gg 3 $0 NM;* phenylephrine-acetaminophenguaifenesin 3 $0 NM;* phenylephrine-brompheniraminedm 3 $0 NM;* phenylephrine-chlorphen-dm 3 $0 NM;* phenylephrine-chlorpheniraminedm 3 $0 NM;* w/ apap phenylephrine-dm 3 $0 NM;* phenylephrine-dm-gg w/ apap 3 $0 NM;* phenylephrine-doxylaminedextromethorphan-acetaminophen 3 $0 NM;* phenylephrine-guaifenesin 3 $0 NM;* PHENYLHISTINE DH 3 $0 NM;* POLY-TUSSIN 3 $0 NM;* POLY-TUSSIN AC 3 $0 NM;* POLY-TUSSIN D 3 $0 NM;* PRETZ 3 $0 NM;* PRO-CHLO 3 $0 NM;* PRO-CLEAR AC 3 $0 NM;* pseudoephed-bromphen-dm 3 $0 NM;* pseudoephed-doxyl-dm w/apap 3 $0 NM;* pseudoephedrine hcl LIQD;SYRP; 3 $0 NM;* TABA;TABS;TB12 pseudoephedrine w/ codeine-gg 3 $0 NM;* pseudoephedrine w/ dm-gg 3 $0 NM;* pseudoephedrine-acetaminophen 3 $0 NM;* pseudoephedrinebrompheniramine-codeine 3 $0 NM;* pseudoephedrine-chlorphen-dm 3 $0 NM;* pseudoephedrinedexchlorpheniramine-chlophedianol 3 $0 NM;* pseudoephedrine-guaifenesin 3 $0 NM;* PSEUDOEPHEDRINE-IBUPROFEN 3 $0 NM;* SUSP pseudoephedrine-ibuprofen TABS 3 $0 NM;* PYRIL DM 3 $0 NM;* pyrilamine maleate-phenylephrine 3 $0 NM;* hcl tannate RESCON 3 $0 NM;* 76

77 藥物名稱 等級 您需要付費 的藥物 RESCON DM 3 $0 NM;* RESPAIRE-30 3 $0 NM;* RHINARIS 3 $0 NM;* ROBITUSSIN CHILDRENS COUG 3 $0 NM;* RU-HIST-D 3 $0 NM;* RYMED 3 $0 NM;* SALINE GEL 3 $0 NM;* saline SOLN 3 $0 NM;* SCOT-TUSSIN 3 $0 NM;* SCOT-TUSSIN SENIOR 3 $0 NM;* STAHIST AD 3 $0 NM;* STATUSS GREEN 3 $0 NM;* SUDAFED 24 HOUR 3 $0 NM;* THERAFLU FLU & SORE THROA 3 $0 NM;* THERAFLU MAX-D SEVERE COL 3 $0 NM;* THERAFLU SINUS & COLD 3 $0 NM;* TRIAMINIC CHEST & NASAL C 3 $0 NM;* TRIAMINIC COLD & ALLERGY 3 $0 NM;* TRIAMINIC COLD & COUGH DA 3 $0 NM;* SOLN TRIAMINIC COLD/COUGH NIGH 3 $0 NM;* TRIAMINIC MULTI-SYMPTOM F 3 $0 NM;* TRIAMINIC NIGHT TIME COLD 3 $0 NM;* TRICODE AR 3 $0 NM;* TRICODE GF 3 $0 NM;* triprolidine & pseudoephedrine 3 $0 NM;* TUSNEL LIQD 3 $0 NM;* TUSNEL PEDIATRIC 3 $0 NM;* TUSNEL-DM PEDIATRIC 3 $0 NM;* VICKS VAPORUB 3 $0 NM;* Z-TUSS AC 3 $0 NM;* Z-TUSS E 3 $0 NM;* ZODRYL AC 25 3 $0 NM;* ZODRYL AC 30 3 $0 NM;* ZODRYL AC 35 3 $0 NM;* ZODRYL AC 40 3 $0 NM;* ZODRYL DAC 25 3 $0 NM;* ZODRYL DAC 30 3 $0 NM;* ZODRYL DAC 35 3 $0 NM;* ZODRYL DAC 40 3 $0 NM;* 77

78 藥物名稱 等級 您需要付費 的藥物 ZODRYL DEC 25 3 $0 NM;* ZODRYL DEC 30 3 $0 NM;* ZODRYL DEC 35 3 $0 NM;* ZODRYL DEC 40 3 $0 NM;* zonatuss 3 $0 NM;* 白三烯受體拮抗劑 - 用於治療氣喘和過敏的藥物 montelukast sodium CHEW;PACK 1 $0 ;TABS zafirlukast 1 $0 細胞穩定劑 - 用於治療過敏的藥物 cromolyn sodium nebu 1 $0 B/D 其他 acetylcysteine SOLN 10%,20% 1 $0 B/D ARALAST NP 2 $0 NM,LA,PA AUVI-Q 2 $0 DALIRESP 2 $0 EPIPEN 2-PAK 2 $0 EPIPEN-JR 2-PAK 2 $0 PROLASTIN-C 2 $0 NM,LA,PA PULMOZYME 2 $0 B/D,NM SODIUM CHLORIDE NEBU.45% 3 $0 NM;* XOLAIR 2 $0 NM,LA,PA ZEMAIRA 2 $0 NM,LA,PA 鼻用類固醇 - 用於治療過敏的藥物 flunisolide (nasal) 1 $0 QL (2 瓶 /30 天 ) fluticasone propionate (nasal) 1 $0 QL (1 瓶 /30 天 ) NASONEX 2 $0 QL (2 瓶 /30 天 ) 類固醇吸入劑 - 用於治療氣喘的藥物 ASMANEX TWISTHALER 14 MET 2 $0 QL (2 個吸入器 /30 天 ) ASMANEX TWISTHALER 30 MET 2 $0 QL (2 個吸入器 /30 天 ) ASMANEX TWISTHALER 60 MET 2 $0 QL (2 個吸入器 /30 天 ) ASMANEX TWISTHALER 120 ME 2 $0 QL (2 個吸入器 /30 天 ) budesonide (inhalation) 1 $0 B/D FLOVENT DISKUS 50mcg/blist, 2 $0 QL (2 個吸入器 /30 天 ) 100mcg/blist FLOVENT DISKUS 250mcg/blist 2 $0 QL (4 個吸入器 /30 天 ) FLOVENT HFA 2 $0 QL (2 個吸入器 /30 天 ) QVAR 40mcg/act 2 $0 QL (1 個吸入器 /30 天 ) QVAR 80mcg/act 2 $0 QL (2 個吸入器 /30 天 ) 類固醇 /β 致效劑合成藥物 - 用於治療氣喘和慢性阻塞性肺病 (COPD) 的藥物 78

79 藥物名稱 等級 您需要付費 的藥物 ADVAIR DISKUS 2 $0 QL (1 個吸入器 /30 天 ) ADVAIR HFA 2 $0 QL (1 個吸入器 /30 天 ) BREO ELLIPTA 2 $0 QL (1 個吸入器 /30 天 ) DULERA 2 $0 QL (1 個吸入器 /30 天 ) SYMBICORT 2 $0 QL (1 個吸入器 /30 天 ) 黃嘌呤 - 用於治療慢性阻塞性肺病 (COPD) 的藥物 aminophylline inj 1 $0 elixophyllin 2 $0 theo-24 2 $0 theophylline 1 $0 局部用藥 - 用於治療耳部和皮膚疾病的藥物 皮膚科 - 抗痤瘡藥 adapalene CREA 1 $0 adapalene GEL.1% 1 $0 amnesteem 1 $0 AVITA 1 $0 benzoyl peroxide-erythromycin 1 $0 claravis 1 $0 clindamax 1 $0 clindamycin phosphate (topical) 1 $0 GEL;LOTN;SOLN;SWAB ery pad 2% 1 $0 erythromycin (acne aid) 1 $0 myorisan 1 $0 sulfacetamide sodium (acne) 1 $0 tretinoin CREA;GEL 1 $0 zenatane 1 $0 皮膚科 - 抗生素 ACNE MEDICATION 3 $0 NM;* ACNE MEDICATION 5 3 $0 NM;* bacitracin (topical) 3 $0 NM;* bacitracin zinc OINT 3 $0 NM;* bacitracin-polymyxin b 3 $0 NM;* BENZOYL PEROXIDE BAR 3 $0 NM;* benzoyl peroxide CREA 3 $0 NM;* BENZOYL PEROXIDE GEL 2.5% 3 $0 NM;* benzoyl peroxide GEL 5%,10% 3 $0 NM;* benzoyl peroxide LIQD 3 $0 NM;* benzoyl peroxide LOTN 3 $0 NM;* BP CLEANSING LOTION 3 $0 NM;* gentamicin sulfate (topical) 1 $0 79

80 藥物名稱 等級 您需要付費 的藥物 mupirocin OINT 1 $0 neomycin-bacitracin-polymyxin 3 $0 NM;* neomycin-bacitracin-polymyxin w/ 3 $0 NM;* lidocaine neomycin-bacitracin-polymyxinpramoxine 3 $0 NM;* neomycin-polymyxin w/ pramoxine 3 $0 NM;* PANOXYL-4 CREAMY WASH 3 $0 NM;* PANOXYL-8 CREAMY WASH 3 $0 NM;* SILVER SULFADIAZINE CREA 1 $0 SSD 1 $0 SULFAMYLON CREA 2 $0 皮膚科 - 抗真菌藥 castellani paint 3 $0 NM;* ciclopirox CREA;GEL;SUSP 1 $0 ciclopirox shampoo 1% 1 $0 clotrimazole (topical) CREA 1% 1 $0 clotrimazole (topical) CREA 1% 3 $0 NM;* clotrimazole (topical) SOLN 1% 1 $0 clotrimazole (topical) SOLN 1% 3 $0 NM;* econazole nitrate CREA 1 $0 FUNGOID TINCTURE 3 $0 NM;* GENTIAN VIOLET SOLN 3 $0 NM;* ketoconazole cream 1 $0 LAMISIL ADVANCED 3 $0 NM;* LAMISIL AT SPRAY 3 $0 NM;* LOTRIMIN ULTRA 3 $0 NM;* miconazole nitrate (topical) 3 $0 NM;* NIZORAL A-D 3 $0 NM;* nyamyc 1 $0 nystatin (topical) 1 $0 nystop 1 $0 terbinafine hcl (topical) 3 $0 NM;* tolnaftate 3 $0 NM;* 皮膚科 - 止癢劑 procto-pak 1 $0 proctosol hc cre 2.5% 1 $0 proctozone hc 1 $0 PRUDOXIN CRE 5% 1 $0 皮膚科 - 抗銀屑病藥 acitretin 2 $0 PA calcipotriene CREA;OINT;SOLN 1 $0 80

81 藥物名稱 等級 您需要付費 的藥物 calcitrene oin 0.005% 1 $0 8-MOP 2 $0 TAZORAC CREA 2 $0 PA 皮膚科 - 抗皮脂漏藥 ketoconazole shampoo 1 $0 selenium sulfide LOTN 1 $0 皮膚科 - 抗病毒藥 acyclovir topical 1 $0 DENAVIR 2 $0 皮膚科 - 類固醇藥 ala-cort 1 $0 alclometasone dipropionate 1 $0 amcinonide CREA;LOTN 1 $0 amcinonide OINT 2 $0 apexicon 1 $0 betamethasone dipropionate 1 $0 (topical) betamethasone dipropionate 1 $0 augmented betamethasone valerate CREA; 1 $0 LOTN;OINT clobetasol propionate CREA 1 $0 clobetasol propionate GEL 1 $0 clobetasol propionate OINT 1 $0 clobetasol propionate SOLN 1 $0 cormax 1 $0 CVS HDYROCORTISONE ACETAT 3 $0 NM;* DESONIDE CREA 1 $0 desonide LOTN;OINT 1 $0 desoximetasone CREA 1 $0 desoximetasone GEL 1 $0 DESOXIMETASONE OINT.05% 1 $0 desoximetasone OINT.25% 1 $0 diflorasone diacetate 1 $0 fluocinolone acetonide CREA;OIL 1 $0 ;OINT;SOLN fluocinolone acetonide body oil 1 $0 fluocinonide CREA.05% 1 $0 fluocinonide GEL 1 $0 fluocinonide OINT 1 $0 fluocinonide SOLN 1 $0 fluocinonide emulsified base 1 $0 fluticasone propionate CREA 1 $0 81

82 藥物名稱 等級 您需要付費的藥物 fluticasone propionate OINT 1 $0 halobetasol propionate 1 $0 hydrocortisone (topical) CREA 1% 1 $0,2.5% hydrocortisone (topical) CREA.5%,1% 3 $0 NM;* hydrocortisone (topical) GEL 3 $0 NM;* hydrocortisone (topical) LOTN 1% 3 $0 NM;* hydrocortisone (topical) LOTN 1 $0 2.5% hydrocortisone (topical) OINT 1% 1 $0,2.5% hydrocortisone (topical) OINT.5% 3 $0 NM;*,1% hydrocortisone (topical) SOLN 3 $0 NM;* hydrocortisone acetate (topical) 3 $0 NM;* hydrocortisone acetate-aloe vera 3 $0 NM;* hydrocortisone butyrate 1 $0 hydrocortisone valerate 1 $0 hydrocortisone-aloe vera 3 $0 NM;* HYDROCORTISONE/ALOE 3 $0 NM;* LOKARA LOTN 0.05% 1 $0 mometasone furoate CREA;OINT 1 $0 ;SOLN texacort soln 2.5% 2 $0 triamcinolone acetonide (topical) 1 $0 CREA; LOTN; OINT triderm 1 $0 TUCKS ANTI-ITCH 3 $0 NM;* 皮膚科 - 局部麻醉劑 lidocaine PTCH 1 $0 QL (3 帖 /1 天 ),PA lidocaine hcl GEL 1 $0 lidocaine hcl SOLN 4% 1 $0 lidocaine oint 5% 1 $0 lidocaine-prilocaine 1 $0 B/D 皮膚科 - 其他皮膚和粘膜疾病用藥 ABREVA 3 $0 NM;* ammonium lactate CREA;LOTN 1 $0 BOUDREAUXS BUTT PASTE 3 $0 NM;* DESITIN CREA 3 $0 NM;* ELIDEL 2 $0 PA fluorouracil (topical) CREA 5% 1 $0 82

83 藥物名稱 等級 您需要付費的藥物 fluorouracil (topical) SOLN 1 $0 imiquimod CREA 1 $0 laclotion lotn 12% 1 $0 metronidazole (topical) CREA; 1 $0 LOTN metronidazole gel 0.75% 1 $0 MEXSANA 3 $0 NM;* PANRETIN 2 $0 podofilox SOLN 1 $0 RA CALAMINE LOTN 3 $0 NM;* risamine 3 $0 NM;* rosadan cre 0.75% 1 $0 SECURA EXTRA PROTECTIVE 3 $0 NM;* SENSI-CARE PROTECTIVE BAR 3 $0 NM;* TARGRETIN GEL 2 $0 NM,PA TRIPLE PASTE 3 $0 NM;* VALCHLOR 2 $0 NM,LA,PA VOLTAREN 2 $0 ZINC OXIDE PSTE 3 $0 NM;* zinc oxide (topical) 3 $0 NM;* 皮膚科 - 疥瘡藥和抗滅蝨劑 A-200 GEL 3 $0 NM;* BARC 3 $0 NM;* EURAX 2 $0 LICIDE TREATMENT KIT 3 $0 NM;* malathion 1 $0 permethrin AERO;LIQD;LOTN 3 $0 NM;* permethrin CREA 1 $0 permethrin & pyrethrins-piperonyl 3 $0 NM;* butoxide PRONTO 3 $0 NM;* PYRETHINS/PIPERONYL BUTO 3 $0 NM;* pyrethrins-piperonyl butoxide 3 $0 NM;* pyrethrins-piperonyl butoxidepermethrin-nit 3 $0 NM;* remover rid essential lice elimin 3 $0 NM;* SCHOOLTIME SHAMPOO 3 $0 NM;* 皮膚病 傷口護理用藥 acetic acid.25% 1 $0 REGRANEX 2 $0 PA SANTYL 2 $0 SODIUM CHLORIDE 0.9% 1 $0 83

84 藥物名稱 等級 您需要付費的藥物 STERILE WATER IRRIGATION 1 $0 口部 / 喉嚨 / 牙齒用藥 cevimeline hcl 1 $0 chlorhexidine gluconate (mouththroat) 1 $0 clotrimazole TROC 1 $0 lidocaine hcl (mouth-throat) 1 $0 nystatin (mouth-throat) 1 $0 periogard 1 $0 pilocarpine hcl (oral) 1 $0 triamcinolone acetonide (mouth) 1 $0 耳部用藥 - 用於治療耳部疾病的藥物 acetic acid (otic) 1 $0 acetic acid-aluminum acetate 1 $0 CIPRODEX 2 $0 fluocinolone acetonide (otic) 1 $0 neomycin-polymyxin-hc (otic) 1 $0 ofloxacin (otic) 1 $0 84

85 索引 8 8-MOP A A A abacavir sulfate abacavir sulfate-lamivudine-zidovudine ABELCET ABILIFY DISCMELT ABILIFY INJ 9.75MG ABILIFY MAIN INJ 300MG ABILIFY MAIN INJ 400MG ABILIFY MAINTENA ABILIFY TABS ABREVA acamprosate calcium acarbose acebutolol hcl ACEROLA C acetaminophen ACETAMINOPHEN ACETAMINOPHEN 8 HOUR acetaminophen w/ codeine acetaminophen w/ dm acetaminophen-guaifenesin acetazolamide acetic acid acetic acid (otic) acetic acid-aluminum acetate acetylcysteine acitretin ACNE MEDICATION ACNE MEDICATION ACTHIB ACTIMMUNE acyclovir acyclovir sodium acyclovir topical ADACEL ADAGEN adapalene ADCIRCA adefovir dipivoxil ADEMPAS adriamycin adrucil ADULT ASPIRIN LOW STRENGT ADVAIR DISKUS ADVAIR HFA ADVANCED CALCIUM FORMULA ADVIL ALLERGY & CONGESTIO ADVIL ALLERGY SINUS ADVIL COLD & SINUS afeditab cr AFINITOR AFINITOR DISPERZ AFRIN MENTHOL AGGRENOX a-hydrocort ala-cort ALA-HIST IR ALA-HIST PE ALBENZA albuterol sulfate alclometasone dipropionate ALCOHOL SWABS ALDEX AN ALDEX GS ALDEX GS DM ALDEX-CT ALDURAZYME alendronate sodium alfuzosin hcl ALIMTA ALINIA ALLEGRA ALLERGY CHILDRENS allopurinol tab alosetron hcl ALPHAGAN P SOL 0.1% alprazolam alprazolam tab 0.25mg alprazolam tab 0.5mg alprazolam tab 1mg 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 85

86 alprazolam tab 2mg ALREX altavera alum & mag hydrox-simethicone ALUMINUM HYDROXIDE aluminum hydroxide gel aluminum hydroxide-mag carb aluminum hydroxide-mag trisil amantadine hcl AMBISOME amcinonide amifostine crystalline amikacin sulfate amiloride & hydrochlorothiazide amiloride hcl aminophylline inj AMINOSYN AMINOSYN 7%/ELECTROLYTES AMINOSYN 8.5%/ELECTROLYTE AMINOSYN II AMINOSYN II 8.5%/ELECTROL AMINOSYN M AMINOSYN-HBC AMINOSYN-PF AMINOSYN-PF 7% AMINOSYN-RF amiodarone hcl AMITIZA CAP 24MCG AMITIZA CAP 8MCG amitriptyline hcl amlodipine besylate amlodipine besylate-valsartan tab mg.. 25 amlodipine besylate-valsartan tab mg.. 26 amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg amlodipine--benazepril hcl cap mg amlodipine-benazepril hcl cap 10-40mg amlodipine-benazepril hcl cap mg amlodipine-benazepril hcl cap 5-10 mg amlodipine-benazepril hcl cap 5-20 mg amlodipine-benazepril hcl cap 5-40 mg amlodipine-valsartan-hydrochlorothiazide mg amlodipine-valsartan-hydrochlorothiazide mg amlodipine-valsartan-hydrochlorothiazide mg amlodipine-valsartan-hydrochlorothiazide mg amlodipine-valsartan-hydrochlorothiazide mg ammonium lactate amnesteem amoxapine tab 100mg amoxapine tab 150mg amoxapine tab 25mg amoxapine tab 50mg amoxicillin amoxicillin & pot clavulanate amphetamine-dextroamphetamine cap sr 24hr 10 mg amphetamine-dextroamphetamine cap sr 24hr 15 mg amphetamine-dextroamphetamine cap sr 24hr 20 mg amphetamine-dextroamphetamine cap sr 24hr 25 mg amphetamine-dextroamphetamine cap sr 24hr 30 mg amphetamine-dextroamphetamine cap sr 24hr 5 mg amphetamine-dextroamphetamine tab 10 mg amphetamine-dextroamphetamine tab 12.5 mg amphetamine-dextroamphetamine tab 15 mg amphetamine-dextroamphetamine tab 20 mg amphetamine-dextroamphetamine tab 30 mg amphetamine-dextroamphetamine tab 5 mg amphetamine-dextroamphetamine tab 7.5 mg. 38 amphotericin b ampicillin & sulbactam sodium ampicillin cap 250 mg ampicillin cap 500 mg ampicillin for susp 125 mg/5ml ampicillin for susp 250 mg/5ml ampicillin inj ampicillin sodium anagrelide hcl anastrozole ANDRODERM ANORO ELLIPTA ANTIOXIDANT FORMULA SG APAP APATATE 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 86

87 apexicon APOKYN apri 28 day APRISO APTIOM APTIVUS AQUA-E ARALAST NP aranelle ARCALYST aripiprazole artificial tear ointment artificial tear solution ASACOL HD ascorbic acid ASCORBIC ACID ASCRIPTIN ASMANEX TWISTHALER 120 ME ASMANEX TWISTHALER 14 MET ASMANEX TWISTHALER 30 MET ASMANEX TWISTHALER 60 MET aspirin ASPIRIN aspirin buffered (cal carb-mag carb-mag oxide)11 aspirin effervescent ASTEPRO atenolol atenolol & chlorthalidone atorvastatin calcium atovaquone atovaquone-proguanil hcl ATRIPLA ATROVENT HFA aubra 28 day AUVI-Q AVASTIN aviane AVITA AVODART AXID AR AYR NASAL DROPS azacitidine AZACTAM AZACTAM/DEX INJ 1GM AZACTAM/DEX INJ 2GM azathioprine azelastine drop 0.05% azelastine hcl azelastine spr 0.1% AZILECT azithromycin AZITHROMYCIN AZOPT AZOR 10-40MG AZOR TAB 10-20MG AZOR TAB 5-20MG AZOR TAB 5-40MG aztreonam 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 87 B b complex w/ c B B B-12 DOTS B-12 QUICK DISSOLVE bacitracin (ophthalmic) bacitracin (topical) bacitracin zinc bacitracin-polymyxin b bacitracin-polymyxin b (ophth) bacitracin-poly-neomycin-hc baclofen balsalazide disodium balziva 28 day BANZEL SUS 40MG/ML BANZEL TAB 200MG BANZEL TAB 400MG BARACLUDE BARC BCG VACCINE b-complex vitamins b-complex w/ c & calcium b-complex w/ c & e + zn b-complex w/ c & folic acid b-complex w/ folic acid b-complex w/ minerals b-complex w/biotin & folic acid BEELITH benazepril & hydrochlorothiazide benazepril hcl BENEFIBER BENICAR BENICAR HCT 40-25MG BENICAR HCT TAB MG... 26

88 BENICAR HCT TAB MG benzocaine-docusate sodium benzonatate benzoyl peroxide BENZOYL PEROXIDE... 79, 80 benzoyl peroxide-erythromycin benztropine mesylate BEPREVE BESIVANCE beta carotene betamethasone dipropionate (topical) betamethasone dipropionate augmented betamethasone valerate BETASERON betaxolol hcl (ophth) bethanechol chloride BETOPTIC-S BEXSERO bicalutamide BICILLIN L-A BICLORA BICNU BIFERA BILTRICIDE BIOSPEC DMX biotin bisacodyl bismuth subsalicylate bisoprolol & hydrochlorothiazide bisoprolol fumarate BIVIGAM BLACK DRAUGHT bleomycin sulfate blephamide BLINK TEARS LUBRICATING E B-NATAL BONE DENSITY bone meal w/ vitamin d BOOSTRIX BOSULIF BOUDREAUXS BUTT PASTE BP CLEANSING LOTION BREO ELLIPTA brewers yeast briellyn 28 day BRILINTA BRIMONIDINE SOL 0.15% brimonidine sol 0.2% BRINTELLIX BROHIST D bromfenac sodium (ophth) BROMFENAC SODIUM (OPHTH)(ONCE-DAILY) bromocriptine mesylate brompheniramine & phenyleph brompheniramine & pseudoeph BROVEX PSB BROVEX PSB DM budesonide (inhalation) budesonide ec BUFFERIN EXTRA STRENGTH BUFFERIN LOW DOSE bumetanide buprenorphine hcl buprenorphine hcl-naloxone hcl sl buproban bupropion hcl buspirone hcl BUSULFEX butorphanol tartrate BYSTOLIC 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 88 C cabergoline cafergot CAL/MAG CALCET CREAMY BITES CALCET PETITES CALCI-MIX CALCIONATE calcipotriene calcitonin (salmon) CAL-CITRATE PLUS VITAMIN calcitrene oin 0.005% calcitriol calcitriol inj calcitriol oral soln 1 mcg/ml calcium CALCIUM & MAGNESIUM calcium & phosphorus w/ vitamin d CALCIUM D CALCIUM calcium acetate (phosphate binder) calcium ascorbate calcium carbonate... 63

89 CALCIUM CARBONATE... 49, 63 calcium carbonate (antacid) calcium carbonate-cholecalciferol CALCIUM CARBONATE-CHOLECALCIFEROL calcium carbonate-ergocalciferol calcium carbonate-mag hydrox calcium carbonate-simethicone calcium carbonate-vitamin d calcium carbonate-vitamin d w/ minerals calcium citrate CALCIUM CITRATE CALCIUM CITRATE MALATE/VI CALCIUM CITRATE W/D calcium citrate-vitamin d calcium gluconate CALCIUM GLUCONATE CALCIUM GUMMIES calcium lactate CALCIUM LACTATE calcium pantothenate calcium polycarbophil calcium w/ magnesium calcium w/ vitamin d calcium w/ vitamins d & k CALCIUM/C/D CALCIUM/MAGNESIUM CALCIUM/MAGNESIUM/VITAMIN CALCIUM/MAGNESIUM/ZINC calcium-magnesium w/ vitamin d calcium-magnesium-zinc CAL-GLU CALMAG THINS CALNA CAL-QUICK CALTRATE 600+D PLUS MINER caltrate 600+d soft chews camila 28 day CANASA CANCIDAS CAPASTAT SULFATE CAPCOF CAPMIST DM CAPRELSA captopril captopril & hydrochlorothiazide CARBAGLU carbamazepine CARBIDOPA/LEVODOPA/ENTACAPONE carbidopa-levodopa carbonyl iron carboplatin carboxymethylcellulose sodium (ophth) carboxymethylcellulose-glycerin CARIMUNE NANOFILTERED carteolol hcl (ophth) cartia xt cap 120/24hr cartia xt cap 180/24hr cartia xt cap 240/24hr cartia xt cap 300/24hr carvedilol castellani paint CAYSTON cefaclor cefaclor monohydrate er cefadroxil cefazolin in d5w cefazolin inj cefazolin sodium cefdinir cefepime hcl cefixime cefotaxime sodium cefoxitin sodium cefpodoxime proxetil cefprozil ceftazidime CEFTAZIDIME/DEXTROSE ceftriaxone sodium cefuroxime axetil cefuroxime sodium celecoxib CELONTIN CENTRUM SILVER cephalexin CERDELGA CEREZYME CERVARIX cetirizine hcl cetirizine syrup cetirizine-pseudoephedrine cevimeline hcl CHANTIX CHANTIX CONTINUING MONTH CHANTIX STARTER PACK 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 89

90 CHELATED CALCIUM CHEMET CHILDRENS MOTRIN CHLO TUSS EX chlorhexidine gluconate (mouth-throat) chloroquine phosphate chlorothiazide chlorpheniramine & phenylephrine chlorpheniramine & pseudoeph chlorpheniramine maleate chlorpheniramine-dm chlorpheniramine-phenylephrine-acetaminophen chlorpheniramine-pseudoephedrineacetaminophen chlorpromazine hcl chlorthalidone cholecalciferol CHOLECALCIFEROL cholestyramine cholestyramine light choline fenofibrate ciclopirox ciclopirox shampoo 1% cilostazol CILOXAN cimetidine CIMZIA CIMZIA STARTER KIT CINRYZE CIPRODEX ciprofloxacin ciprofloxacin er ciprofloxacin hcl (ophth) ciprofloxacin hcl tab ciprofloxacin in d5w ciprofloxacin inj cisplatin citalopram hydrobromide CITRACAL CALCIUM GUMMIES CITRACAL PLUS HEART HEALT cladribine claravis clarithromycin clarithromycin er clarithromycin for susp CLARITIN CLARITIN REDITABS CLASSIC PRENATAL CLEAR EYES FOR DRY EYES clemastine fumarate clindamax clindamycin cap 300mg clindamycin cap 75mg clindamycin hcl cap 150 mg clindamycin phosphate (topical) clindamycin phosphate inj clindamycin phosphate vaginal clindamycin sol 75mg/5ml CLINIMIX 2.75%/DEXTROSE 5% CLINIMIX 4.25%/DEXTROSE 25% CLINIMIX 4.25%/DEXTROSE 5% CLINIMIX 5%/DEXTROSE 15% CLINIMIX 5%/DEXTROSE 20% CLINIMIX 5%/DEXTROSE 25% CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D clobetasol propionate CLOFERA clomipramine hcl clonazepam clonidine hcl clopidogrel bisulfate clorazepate dipotassium clotrimazole clotrimazole (topical) clotrimazole vaginal clozapine CLOZAPINE ODT CLOZAPINE ODT 150MG CLOZAPINE ODT 200MG COARTEM COATS ALOE VERA JUICE DRI cod liver oil COD LIVER OIL CODAR AR CODAR D CODAR GF CODITUSS DM colchicine w/ probenecid COLCRYS colestipol hcl colistimethate sodium colocort enema 100mg 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 90

91 COMBIGAN COMBIPATCH COMBIVENT RESPIMAT COMETRIQ COMPLERA COMPLETE SINUS RELIEF compro COMPUTER EYE DROPS COMVAX CONEX COLD/ALLERGY constulose CONTAC COLD/FLU DAY & NIG CONTAC COLD/FLU MAXIMUM S COPAXONE INJ 40MG/ML COPAXONE KIT 20MG/ML CORAL CALCIUM CORAL CALCIUM PLUS coral calcium-magnesium w/ vitamin d cormax corn dextrin cortisone acetate COUGH SYRUP D COUMADIN CREON CRESTOR CRIXIVAN cromolyn sodium (mastocytosis) cromolyn sodium (nasal) cromolyn sodium (ophth) cromolyn sodium nebu cryselle CUBICIN CUVPOSA CVS CALCIUM CITRATE CVS HDYROCORTISONE ACETAT cvs nasal mist CVS SLOW RELEASE IRON CVS VITAMIN C cyanocobalamin cyclafem 1/35 28 day cyclafem 7/7/7 28 day cyclobenzaprine hcl cyclophosphamide CYCLOPHOSPHAMIDE cycloserine cyclosporine cyclosporine modified (for microemulsion) CYSTADANE CYSTAGON cytarabine CYTO B 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 91 D D3 DOTS dacarbazine DALIRESP DALLERGY danazol dantrolene sodium dapsone DAPTACEL DARAPRIM daunorubicin hcl deblitane 28 day DECARA DECON-A DELTUSS DP delyla 28 day DELZICOL DEMSER DENAVIR DEPEN TITRATABS DEPO-PROVERA INJ 400/ML desipramine hcl DESITIN desmopressin acetate spray desmopressin acetate spray refrigerated desmopressin acetate tabs desmopressin inj 4mcg/ml DESMOPRESSIN SOL 0.01% desogestrel-ethinyl estradiol (biphasic) desonide DESONIDE desoximetasone DESOXIMETASONE dexamethasone dexamethasone sodium phosphate dexamethasone sodium phosphate (ophth) DEXATREX D NASAL DEXILANT dexrazoxane dextromethorphan hbr dextromethorphan polistirex dextromethorphan-doxylamine-acetaminophen 74

92 dextromethorphan-guaifenesin dextromethorphan-phenylephrineacetaminophen DEXTROSE 10% FLEX CONTAIN DEXTROSE 10%/NACL 0.2% DEXTROSE 10%/NACL 0.45% DEXTROSE 2.5%/NACL 0.45% DEXTROSE 5% DEXTROSE 5% /ELECTROLYTE DEXTROSE 5%/LACTATED RING DEXTROSE 5%/NACL 0.2% DEXTROSE 5%/NACL 0.225% DEXTROSE 5%/NACL 0.3% DEXTROSE 5%/NACL 0.33% DEXTROSE 5%/NACL 0.45% DEXTROSE 5%/NACL 0.9% DEXTROSE 5%/POTASSIUM CHL DEXTROSE 50% dextrose inj 70% DEX-TUSS DIABETIC TUSSIN COLD/FLU DIALYVITE 800/ZINC DIALYVITE VITAMIN D3 MAX diazepam DIAZEPAM GEL diazepam inj DICEL CD diclofenac potassium diclofenac sodium diclofenac sodium (ophth) dicloxacillin sodium dicyclomine hcl didanosine DIFICID diflorasone diacetate diflunisal digitek digoxin DIGOXIN SOL 50MCG/ML dihydroergotamine mesylate dilantin DILANTIN-125 SUS 125/5ML dilt-cd cap diltiazem cap diltiazem cap 120mg/24hr diltiazem cap er/12hr diltiazem hcl diltiazem hcl coated beads cp24 120mg diltiazem hcl coated beads cp24 180mg diltiazem hcl coated beads cp24 240mg diltiazem hcl coated beads cp24 300mg diltiazem hcl coated beads cp24 360mg dilt-xr cap diltzac dimenhydrinate DIMETAPP LONG ACTING COUG DIPENTUM diphenhydramine hcl diphenhydramine hcl (sleep) diphenhydramine inj diphenhydramine-acetaminophen diphenhydramine-acetaminophen (sleep) diphenhydramine-phenylephrine diphenhydramine-phenylephrine-acetaminophen... 74, 75 DIPHENHYDRAMINE-PHENYLEPHRINE- ACETAMINOPHEN diphenoxylate w/ atropine DIPHTHERIA/TETANUS TOXOID disopyramide phosphate disulfiram DIURIL SUS 250/5ML divalproex sodium docetaxel DOCETAXEL docusate calcium docusate sodium DONATUSSIN donepezil hydrochloride dorzolamide hcl dorzolamide hcl-timolol maleate doxazosin mesylate doxepin hcl doxorubicin hcl for inj 50 mg doxorubicin hcl liposomal inj 2mg/ml doxorubicin inj 50mg doxy inj doxycycline (monohydrate) doxycycline hyclate doxylamine succinate (sleep) doxylamine-dm doxylamine-phenylephrine-acetaminophen dronabinol drospirenone-ethinyl estradiol 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 92

93 DROXIA DRYMAX AF DULCOLAX BOWEL PREP KIT DULERA duloxetine hcl DURAFLU DURAMORPH DUREZOL DYRENIUM E e.e.s e.e.s E.E.S. GRANULES econazole nitrate ED CHLORPED ED CHLORPED D EDECRIN EDURANT EFFIENT ELDERTONIC ELIDEL ELIQUIS ELITEK elixophyllin ELIXSURE FEVER/PAIN ELLA ELMIRON EMCYT EMEND CAP 125MG EMEND CAP 40MG EMEND CAP 80MG EMEND PAK 80 & emoquette EMSAM EMTRIVA enalapril maleate enalapril maleate & hydrochlorothiazide endocet ENGERIX-B enoxaparin sodium enpresse 28 day entacapone entecavir ENTSOL NASAL GEL ENUCLENE enulose ephedrine-guaifenesin EPIPEN 2-PAK EPIPEN-JR 2-PAK epirubicin hcl epitol EPIVIR EPIVIR HBV eplerenone EPZICOM EQL CALCIUM/VITAMIN D EQL CHILDRENS CALCIUM GUM EQL CHILDRENS MULTIVITAMI EQL NATURAL FIBER EQUALACTIN ERAXIS ergocalciferol ERIVEDGE errin 28 day ery pad 2% ERYPED ERYPED ery-tab erythrocin lactobionate erythrocin stearate erythromycin (acne aid) erythromycin (ophth) erythromycin base erythromycin cap 250mg ec escitalopram oxalate esomeprazole sodium inj estradiol estradiol valerate ESTRADIOL VALERATE ethambutol hcl ethosuximide etodolac etodolac er etoposide EURAX EVOTAZ EXELON PATCHES exemestane EXJADE EZFE FORTE F FA 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 93

94 FABRAZYME falmina 28 day famciclovir famotidine famotidine inj famotidine-calcium carbonate-magnesium hydroxide FANAPT FANAPT TITRATION PACK FARESTON FARYDAK FASLODEX FAZACLO TAB 100/ODT FAZACLO TAB 12.5/ODT FAZACLO TAB 150MG FAZACLO TAB 200MG FAZACLO TAB 25MG ODT FEBROL felbamate felodipine fenofibrate fenofibrate micronized fenofibrate micronized cap fentanyl fentanyl citrate FENTORA FEOSOL FERRETTS IPS FERRIMIN ferrous fumarate FERROUS FUMARATE ferrous gluconate FERROUS GLUCONATE ferrous sulfate FERROUS SULFATE ferrous sulfate dried FETZIMA FETZIMA TITRATION PACK FEVERALL INFANTS fexofenadine hcl fexofenadine-pseudoephedrine fiber FIBER finasteride FIRAZYR FLEBOGAMMA FLEBOGAMMA DIF flecainide acetate FLEET BISACODYL FLORASTOR KIDS FLOVENT DISKUS FLOVENT HFA fluconazole fluconazole in dextrose fluconazole in nacl flucytosine fludarabine phosphate fludrocortisone acetate flunisolide (nasal) fluocinolone acetonide fluocinolone acetonide (otic) fluocinolone acetonide body oil fluocinonide fluocinonide emulsified base FLUOROMETHOLONE fluorouracil fluorouracil (topical) fluoxetine hcl fluphenazine decanoate fluphenazine hcl flurbiprofen flurbiprofen sodium flutamide fluticasone propionate fluticasone propionate (nasal) fluvoxamine maleate FOLGARD folic acid FOLIC ACID folic acid-vitamin b6-vitamin b FOLITAB fondaparinux sodium FORADIL AEROLIZER FORTEO FORTICAL foscarnet sodium fosinopril sodium fosinopril sodium & hydrochlorothiazide FOSRENOL FREAMINE HBC 6.9% FREAMINE III FRESHKOTE FUNGOID TINCTURE furosemide 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 94

95 furosemide inj FUZEON FYCOMPA G gabapentin GABITRIL galantamine hydrobromide GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S/D GAMMAKED GAMMAPLEX GAMUNEX-C GAMUNEX-C 1GM/10ML ganciclovir inj 500mg GARDASIL GARDASIL gatifloxacin (ophth) GAUZE PADS 2" X 2" gaviltye-g gavilyte-c gavilyte-h gavilyte-n GAVISCON GAVISCON EXTRA STRENGTH R gemcitabine hcl GEMCITABINE HCL gemfibrozil generlac gengraf gentak gentamicin in saline gentamicin sulfate gentamicin sulfate (ophth) gentamicin sulfate (topical) GENTEAL GENTEAL MILD GENTIAN VIOLET GEODON GERIATRIC VITAMIN GIANVI gildagia gildess 1.5/30 21 day GILENYA CAP 0.5MG GILOTRIF TAB 20MG GILOTRIF TAB 30MG GILOTRIF TAB 40MG GLEEVEC glimepiride glip/metform tab 5-500mg glipizide glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT glycerin-hypromellose-polyethylene glycol glycopyrrolate glycopyrrolate inj GNP CALCIUM 500 +D GNP DAILY PRENATAL GOLYTELY GONIOVISC granisetron hcl GRANIX griseofulvin microsize griseofulvin ultramicrosize guaifenesin guaifenesin-codeine guanfacine hcl (adhd) H halobetasol propionate haloperidol haloperidol decanoate haloperidol lactate haloperidol lactate oral conc 2 mg/ml HARVONI HAVRIX heather heparin sod inj 1000/ml heparin sod inj 10000/ml HEPARIN SOD INJ 2000/ML heparin sod inj 20000/ml HEPARIN SOD INJ 2500/ML heparin sod inj 5000/ml HEPARIN SODIUM/D5W HEPARIN SODIUM/NACL 0.45% HEPATAMINE HERCEPTIN HEXALEN HIBERIX HONEY BEARS HONEY BEARS W/IRON AND ZI 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 95

96 HUMIRA HUMIRA KIT 40MG/ HUMIRA PEN HUMIRA PEN-CROHNS DISEASE HUMIRA PEN-PSORIASIS STAR HUMULIN R INJ U hydralazine hcl hydrochlorothiazide HYDROCIL INSTANT hydroco/apap tab mg hydroco/apap tab 5-325mg hydroco/apap tab hydrocodone-acetaminophen mg/15ml 12 hydrocodone-ibuprofen tab mg hydrocortisone HYDROCORTISONE (INTRARECTAL) hydrocortisone (topical) hydrocortisone acetate (topical) hydrocortisone acetate-aloe vera hydrocortisone butyrate hydrocortisone valerate HYDROCORTISONE/ALOE hydrocortisone-aloe vera hydromorphon inj 10mg/ml hydromorphone hcl hydroxocobalamin hydroxychloroquine sulfate hydroxyurea hydroxyzine hcl hydroxyzine hcl inj hydroxyzine pamoate HYPOTEARS hypromellose (gonioscopic) hypromellose (ophth) I ibandronate sodium IBRANCE ibuprofen... 11, 12 IBUPROFEN ibuprofen tab 800 mg ibuprofen-diphenhydramine citrate ICAPS LUTEIN/ZEAXANTHIN F ICLUSIG idarubicin hcl IFEX ifosfamide inj 1gm ifosfamide inj 1gm/20ml IFOSFAMIDE INJ 3GM ifosfamide inj 3gm/60ml ILEVRO ilotycin IMBRUVICA CAP 140MG imipenem-cilastatin imipramine hcl imiquimod IMOVAX RABIES (H.D.C.V.) INCRELEX indapamide INFANRIX INLYTA INSULIN PEN NEEDLE INSULIN SAFETY NEEDLES INSULIN SYRINGE INTEGRA INTELENCE INTRALIPID INJ 20% INTRALIPID INJ 30% INTRON-A INJ 10MU INTRON-A INJ 18MU INTRON-A INJ 25MU INTRON-A INJ 50MU introvale 91 day INVANZ INVEGA INVEGA SUST INJ 117 MG/0.75 ML INVEGA SUST INJ 156MG/ML INVEGA SUST INJ 234 MG/1.5 ML INVEGA SUST INJ 39 MG/0.25 ML INVEGA SUST INJ 78 MG/0.5 ML INVIRASE INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB MG INVOKANA IONOSOL-B/DEXTROSE 5% IONOSOL-MB/DEXTROSE 5% IPOL INACTIVATED IPV ipratropium bromide ipratropium bromide (nasal) ipratropium-albuterol nebu irinotecan hcl iron 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 96

97 IRON iron chews pediatric IRON DEXTRAN IRON UP iron w/ vitamins iron-vitamin c iron-vitamin c-vitamin b12-folic acid ISENTRESS ISOLYTE P isolyte s isoniazid isoniazid inj 100 mg/ml isoniazid syp 50mg/5ml ISOPTO TEARS isosorb mononitrate tab isosorbide dinitrate isosorbide mononitrate er tab isradipine ISTALOL ISTODAX itraconazole ivermectin IXIARO J JAKAFI JALYN jantoven JANUMET JANUMET XR TAB JANUMET XR TAB JANUMET XR TAB MG JANUVIA JENTADUETO J-MAX JOLESSA TAB MG JOLIVETTE J-TAN D PD J-TAN PD junel 1.5/30 21 day junel 1/20 21 day junel fe 1.5/30 28 day junel fe 1/20 28 day K KADCYLA KALETRA SOL KALETRA TAB MG KALETRA TAB MG kariva 28 day KCL 0.075%/D5W/NACL 0.45% KCL 0.15%/D5W/NACL 0.9% KCL 0.3%/D5W/NACL 0.45% KCL 0.3%/D5W/NACL 0.9% KCL IN NACL INJ KCL/D5W INJ 0.3% KCL/D5W/NACL INJ.15/.33% KCL/D5W/NACL INJ.15/.45% KCL/NACL INJ KCL0.15%/D5W/NACL0.2% KCL0.15%/D5W/NACL0.225% ketoconazole ketoconazole cream ketoconazole shampoo ketoprofen ketorolac tromethamine (ophth) ketotifen fumarate (ophth) kimidess tab kionex KLOR-CON KLOR-CON klor-con m klor-con m klor-con pow 20meq KONSYL KONSYL-D KPN PRENATAL KUVAN L labetalol hcl laclotion lotn 12% LACTATED RINGER'S INJ lactobacillus lactobacillus rhamnosus (gg) lactulose lactulose (encephalopathy) LAMISIL ADVANCED LAMISIL AT SPRAY lamivudine lamivudine (hbv) lamivudine-zidovudine lamotrigine LANOXIN 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 97

98 lansoprazole LANTUS LANTUS SOLOSTAR larin 1.5/ larin 1/ larin fe 1.5/ larin fe 1/ LASTACAFT latanoprost LATUDA LAZANDA SPR 100MCG LAZANDA SPR 400MCG LEENA leflunomide LENVIMA 10MG DAILY DOSE LENVIMA 14MG DAILY DOSE LENVIMA 20MG DAILY DOSE LENVIMA 24MG DAILY DOSE lessina 28 day LETAIRIS letrozole leucovorin calcium leucovorin calcium for inj 500 mg LEUKERAN LEUKINE leuprolide acetate levalbuterol conc 1.25mg/0.5ml LEVEMIR LEVEMIR FLEXTOUCH levetiracetam LEVETIRACETAM IN NACL levetiracetam inj 500/5ml levobunolol hcl LEVOBUNOLOL HCL levocarnitine (metabolic modifiers) levocetirizine dihydrochloride levofloxacin levofloxacin in d5w levofloxacin inj 25mg/ml levofloxacin oral soln 25 mg/ml levonest 28 day levonorgestrel & eth estradiol levonorgestrel (emergency oc)... 44, 45 levonorgestrel-ethinyl estradiol (91-day) levora 0.15/30 28 day levothyroxine sodium LEVOXYL LEXIVA LIALDA LICIDE TREATMENT KIT lidocaine lidocaine hcl lidocaine hcl (local anesth.) lidocaine hcl (mouth-throat) lidocaine inj 0.5% lidocaine inj 1% lidocaine inj 1.5% lidocaine inj 2% lidocaine oint 5% lidocaine-prilocaine linezolid LINZESS CAP 145MCG LINZESS CAP 290MCG liothyronine sodium LIQUID CALCIUM WITH D3 MA lisinopril lisinopril & hydrochlorothiazide LITHIUM lithium carbonate lithium carbonate er LITTLE NOSES DECONGESTANT LOCALNESIUM LOCALNESIUM-C LODRANE D LOHIST-D LOKARA LOTN 0.05% LOMUSTINE loperamide hcl... 49, 53 loratadine loratadine & pseudoephedrine lorazepam lorcet hd tab mg lorcet plus tab lorcet tab 5-325mg lortab tab mg lortab tab 5-325mg lortab tab LORTUSS DM LORTUSS EX LORTUSS LQ loryna 28 day losartan potassium losartan-hctz mg losartan-hctz mg 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 98

99 losartan-hctz mg LOTEMAX LOTRIMIN ULTRA LOTRONEX lovastatin low-ogestrel 28 day loxapine succinate LUMIGAN LUMITENE LUMIZYME LUPR DEP-PED INJ 30MG (3-MONTH) LUPRON DEPOT LUPRON DEPOT INJ MG LUPRON DEPOT-PED LUSAIR lutera 28 day LYNPARZA LYRICA LYSODREN lyza M MAALOX TC MAG MAG-AL MAGINEX MAGNEBIND MAGNEBIND magnesium MAGNESIUM magnesium chloride magnesium chloride-calcium magnesium citrate MAGNESIUM CITRATE MAGNESIUM ELEMENTAL MAGNESIUM GLUCONATE magnesium hydroxide magnesium oxide MAGNESIUM OXIDE magnesium oxide (laxative) magnesium oxide (mg supplement) magnesium salicylate tetrahydrate magnesium sulfate MAGNESIUM SULFATE... 60, 64 magnesium sulfate (laxative) MAGNESIUM SULFATE IN D5W MAG-TAB SR malathion maprotiline hcl MAR-COF BP marlissa 28 day MARPLAN TAB 10MG MATULANE MAXIDEX meclizine hcl MEDI-GRAINE medroxyprogesterone acetate 150 mg/ml medroxyprogesterone acetate tab mefloquine hcl MEGACE ES megestrol acetate MEKINIST meloxicam MELOXICAM melphalan hcl MENACTRA M-END DMX M-END MAX D M-END PE MENOMUNE-A/C/Y/W MENVEO MEPHYTON mercaptopurine meropenem mesalamine enema mesalamine w/ cleanser mesna MESNEX metadate tab 20mg er METAMUCIL METAMUCIL MULTIHEALTH FIB METAMUCIL SMOOTH TEXTURE metformin hcl methadone hcl methazolamide methenamine hippurate methimazole methotrexate sodium inj methotrexate sodium tabs methyclothiazide methylcellulose (laxative) methylergonovine maleate methylphenidate hcl methylphenidate hcl oral soln 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 99

100 methylpr ace inj 40mg/ml methylpr ace inj 80mg/ml methylpr ss inj 125mg methylpr ss inj 1gm methylpr ss inj 40mg methylpred pak 4mg methylpred tab 16mg methylpred tab 32mg methylpred tab 4mg methylpred tab 8mg metipranolol metoclopramide hcl metoclopramide inj metolazone metoprolol & hctz tab mg metoprolol & hctz tab mg metoprolol & hctz tab 50-25mg metoprolol succinate metoprolol tartrate metronidazole metronidazole (topical) metronidazole gel 0.75% metronidazole in nacl metronidazole vaginal mexiletine hcl MEXSANA MIACALCIN miconazole nitrate (topical) miconazole nitrate vaginal microgestin 1.5/30 21 day microgestin 1/20 21 day microgestin fe 1.5/30 28 day microgestin fe 1/20 28 day midodrine hcl MILK OF MAGNESIA CONCENTR mineral oil MINERAL OIL minitran minocycline hcl minoxidil mirtazapine misoprostol MISSION PRENATAL MISSION PRENATAL HP mitomycin mitoxantrone hcl M-M-R II W/DILUENT 10 DOS moderiba 800 dose pack moderiba pak 1000/day moderiba pak 1200/day moderiba pak 600/day moderiba tab 200mg moexipril hcl moexipril-hydrochlorothiazide mometasone furoate MONONESSA montelukast sodium morphine ext-rel tab morphine sul inj MORPHINE SUL INJ morphine sulfate MORPHINE SULFATE morphine sulfate beads morphine sulfate cap 100mg er MORPHINE SULFATE ORAL SOL MOVANTIK MOVIPREP MOXEZA MOZOBIL MUCINEX COUGH FOR KIDS MUCINEX D MUCINEX FOR KIDS MUCINEX MAXIMUM STRENGTH MULTAQ MULTI-DELYN/IRON multiple vitamin multiple vitamins w/ iron multiple vitamins w/ minerals mupirocin MURO MUSTARGEN my way MYCAMINE mycophenolate mofetil mycophenolate sodium MYKIDZ IRON MYKIDZ IRON myorisan MYOZYME MYRBETRIQ myzilra 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 N nabumetone... 12

101 nadolol nafcillin sodium NAGLAZYME naloxone hcl naltrexone hcl NAMENDA SOL 10MG/5ML NAMENDA TAB NAMENDA XR NAMENDA XR TITRATION PACK naphazoline 0.1% naphazoline w/ pheniramine NAPHAZOLINE W/ PHENIRAMINE naproxen naproxen sodium NAPROXEN SODIUM naratriptan hcl NASAL DECONGESTANT NASCOBAL NASOHIST DM NASONEX NASOPEN PE NATACYN nateglinide NEBUPENT necon 0.5/35 28 day necon 1/35 28 day necon 10/11 28 day NECON 7/7/ NECON TAB 1/ nefazodone hcl neomycin sulfate neomycin-bacitracin zn-polymyxin neomycin-bacitracin-polymyxin neomycin-bacitracin-polymyxin w/ lidocaine neomycin-bacitracin-polymyxin-pramoxine neomycin-polymy-dexameth neomycin-polymyxin w/ pramoxine neomycin-polymyxin-gramicidin neomycin-polymyxin-hc (ophth) neomycin-polymyxin-hc (otic) NEORAL NEO-SYNEPHRINE NEPHRAMINE NEPHRONEX NEUMEGA NEUPOGEN NEUPRO neutrahist NEVANAC nevirapine NEVIRAPINE NEXAVAR NEXIUM CAP 20MG NEXIUM CAP 40MG NEXIUM GRA 10MG DR NEXIUM GRA 2.5MG DR NEXIUM GRA 20MG DR NEXIUM GRA 40MG DR NEXIUM GRA 5MG DR next choice one dose niacin niacin (antihyperlipidemic) NIACIN TR niacinamide niacor nicardipine hcl nicotine nicotine polacrilex NICOTINE POLACRILEX NICOTINE TRANSDERMAL SYST NICOTROL INHALER NICOTROL NS nifedical nifedipine nifedipine er nikki 28 day NILANDRON nimodipine NIPENT nitro-bid NITRO-DUR DIS 0.3MG/HR NITRO-DUR DIS 0.8MG/HR nitrofurantoin macrocrystal nitrofurantoin monohyd macro nitroglycerin NITROLINGUAL PUMPSPRAY NITROSTAT NIZORAL A-D NON-ASPIRIN EXTRA STRENGT NORA-BE TAB NORDITROPIN FLEXPRO NORDITROPIN NORDIFLEX PEN NOREL AD NOREL CS 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 101

102 norethindrone (contraceptive) norethindrone acetate norgestimate-ethinyl estradiol (triphasic) norlyroc 28 day normosol-m NORMOSOL-R NORMOSOL-R IN D5W NORPACE CR nortrel 0.5/35 28 day nortrel 1/35 21 day nortrel 1/35 28 day nortrel 7/7/7 28 day nortriptyline hcl NORVIR NOVAFERRUM NOVAFERRUM PEDIATRIC DROP NOVOLIN 70/ NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70/ NOVOLOG MIX 70/30 PREFILL NOVOLOG PENFILL NOXAFIL NUEDEXTA NULOJIX NULYTELY/FLAVOR PACKS NUTRATEAR NUTRICION PORVIDA NUTRILIPID EMU 20% NUTRISOURCE FIBER NUVARING NUVIGIL nyamyc NYMALIZE nystatin nystatin (mouth-throat) nystatin (topical) nystop O OCELLA TAB MG OCTAGAM octreotide acetate ofloxacin (ophth) ofloxacin (otic) olanzapine olopatadine hcl (nasal) OLYSIO omega-3-acid ethyl esters omeprazole OMEPRAZOLE omeprazole magnesium omeprazole-sodium bicarbonate ondansetron hcl ondansetron hcl inj ondansetron hcl oral soln ondansetron odt ONFI ONSET FORTE ophthalmic irrigation solution oral electrolytes... 60, 65 ORAP ORFADIN orsythia 28 day OSTEO-PORETICAL oxacillin sodium oxaliplatin oxandrolone oxcarbazepine oxybutynin chloride oxycodone hcl... 13, 14 OXYCODONE HCL oxycodone hcl tab 5 mg oxycodone w/ acetaminophen mg oxycodone w/ acetaminophen mg oxycodone w/ acetaminophen 5-325mg oxycodone w/ acetaminophen mg oxymetazoline hcl oyster shell P pacerone paclitaxel pamidronate disodium PANOXYL-4 CREAMY WASH PANOXYL-8 CREAMY WASH PANRETIN pantoprazole sodium tbec pantothenic acid paricalcitol paromomycin sulfate paroxetine hcl 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 102

103 PARVA-CAL PARVA-CAL paser d/r PATADAY PATANOL PAXIL PAZEO PEDIA-LAX pediatric multiple vitamin w/ c pediatric multiple vitamin w/ c & fa pediatric multiple vitamin w/ extra c & fa pediatric multiple vitamin w/ minerals & c pediatric multiple vitamins pediatric multiple vitamins w/ iron pediatric vitamins adc PEDVAX HIB PEG 3350/ELECTROLYTES peg 3350-kcl-sod bicarb-sod chloride-sod sulfate peg 3350-potassium chloride-sod bicarbonatesod chloride PEGANONE PEG-INTRON PEG-INTRON REDIPEN PENICILLIN G POT IN DEXTROSE penicillin g potassium penicillin g procaine penicillin g sodium penicillin v potassium penicilln gk inj 5mu PENTAM PENTASA pentoxifylline PEPCID AC PERFOROMIST perindopril erbumine periogard permethrin permethrin & pyrethrins-piperonyl butoxide perphenazine PERRY PRENATAL PHENAGIL phenelzine sulfate phenobarbital phenobarbital sodium PHENOBARBITAL SODIUM phenylephrine hcl phenylephrine hcl (ophth) phenylephrine hcl (oral) phenylephrine w/ acetaminophen phenylephrine w/ dm-gg phenylephrine-acetaminophen-guaifenesin phenylephrine-brompheniramine-dm phenylephrine-chlorphen-dm phenylephrine-chlorpheniramine-dm w/ apap phenylephrine-dm phenylephrine-dm-gg w/ apap phenylephrine-doxylamine-dextromethorphanacetaminophen phenylephrine-guaifenesin PHENYLHISTINE DH phenytek phenytoin phenytoin sodium phenytoin sodium extended philith PHILLIPS MILK OF MAGNESIA PHOSLYRA PHOS-NAK POWDER CONCENTRA PHOSPHOLINE IODIDE phytonadione PILOCARPINE HCL pilocarpine hcl (oral) pimtrea pack pindolol pioglitazone hcl piperacillin sodium-tazobactam sodium pirmella 1/35 28 day piroxicam PLASMA-LYTE A PLASMA-LYTE PLASMA-LYTE-56/D5W podofilox polyethylene glycol polyethylene glycol-propylene glycol (ophth) polymyxin b-trimethoprim polysaccharide iron complex POLY-TUSSIN POLY-TUSSIN AC POLY-TUSSIN D polyvinyl alcohol polyvinyl alcohol-povidone (ophth) POMALYST CAP 1MG POMALYST CAP 2MG 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 103

104 POMALYST CAP 3MG POMALYST CAP 4MG portia 28 day potassium chloride... 60, 62 POTASSIUM CHLORIDE... 60, 62 POTASSIUM CHLORIDE 0.15% POTASSIUM CHLORIDE 0.22% POTASSIUM CHLORIDE ER potassium chloride in nacl potassium chloride microencapsulated crystals cr POTASSIUM CITRATE (ALKALINIZER) POTIGA povidone-iodine vaginal PRADAXA pramipexole dihydrochloride pravastatin sodium prazosin hcl pred sod pho sol 5mg/5ml PREDNISOLONE ACETATE (OPHTH) prednisolone sodium phosphate (ophth) prednisolone sol 15mg/5ml prednisolone sol 25mg/5ml prednisolone syp 15mg/5ml prednisone con 5mg/ml prednisone pak 10mg prednisone pak 5mg prednisone sol 5mg/5ml prednisone tab 10mg prednisone tab 1mg prednisone tab 2.5mg prednisone tab 20mg prednisone tab 50mg prednisone tab 5mg PREMARIN CREAM premasol sol 10% premasol sol 6% PRENATAL PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) PRETZ prevalite previfem 28 day PREZCOBIX PREZISTA PRIFTIN PRILOSEC OTC PRIMAQUINE PHOSPHATE primidone PRISTIQ PRIVIGEN PROAIR HFA probenecid PROBIOTIC FORMULA PROCALAMINE PRO-CHLO prochlorperazine inj prochlorperazine maleate prochlorperazine supp PRO-CLEAR AC PROCRIT procto-pak proctosol hc cre 2.5% proctozone hc PROFE PROGLYCEM PROGRAF PROLASTIN-C PROLENSA PROLEUKIN PROLIA PROMACTA promethazine hcl PRONTO propafenone hcl proparacaine hcl propranolol & hydrochlorothiazide propranolol cap er propranolol hcl propylene glycol-glycerin propylthiouracil PROQUAD PROSOL PROTEXIN protriptyline hcl PRUDOXIN CRE 5% pseudoephed-bromphen-dm pseudoephed-doxyl-dm w/apap pseudoephedrine hcl pseudoephedrine w/ codeine-gg pseudoephedrine w/ dm-gg pseudoephedrine-acetaminophen pseudoephedrine-brompheniramine-codeine pseudoephedrine-chlorphen-dm 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 104

105 pseudoephedrine-dexchlorpheniraminechlophedianol pseudoephedrine-guaifenesin pseudoephedrine-ibuprofen PSEUDOEPHEDRINE-IBUPROFEN psyllium PSYLLIUM PULMOZYME PURIXAN pyrazinamide PYRETHINS/PIPERONYL BUTO pyrethrins-piperonyl butoxide pyrethrins-piperonyl butoxide-permethrin-nit remover pyridostigmine bromide pyridoxine hcl PYRIL DM pyrilamine maleate-phenylephrine hcl tannate.. 77 Q quasense 91 day quetiapine fumarate quinapril hcl quinapril-hydrochlorothiazide quinidine gluconate quinidine sulfate quinine sulfate QVAR R RA CALAMINE RA CALCIUM/BORON RA OYSTER SHELL CALCIUM/V RABAVERT raloxifene hcl ramipril RANEXA ranitidine hcl ranitidine hcl inj ranitidine syrup RAPAMUNE REBETOL SOLN reclipsen 28 day RECOMBIVAX HB REFRESH CELLUVISC REFRESH OPTIVE ADVANCED REGRANEX RELENZA DISKHALER RELISTOR RELPAX REMICADE REMODULIN RENVELA PAK 0.8GM RENVELA PAK 2.4GM RENVELA TAB 800MG repaglinide RESCON RESCON DM RESCRIPTOR RESPAIRE RESTASIS RETAINE MGD RETROVIR IV INFUSION REVATIO REVLIMID REYATAZ RHINARIS ribapak mis 600/day ribasphere ribasphere ribapak ribasphere ribapak ribasphere ribapak ribavirin 200mg riboflavin rid essential lice elimin rifabutin rifampin RIFATER riluzole rimantadine hydrochloride RINGER'S RIOMET RISA-BID PROBIOTIC risamine RISPERDAL INJ 12.5MG RISPERDAL INJ 25MG RISPERDAL INJ 37.5MG RISPERDAL INJ 50MG risperidone RITUXAN rivastigmine tartrate rizatriptan benzoate ROBITUSSIN CHILDRENS COUG ROCALTROL 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 105

106 ropinirole hydrochloride rosadan cre 0.75% ROTARIX ROTATEQ roxicet soln roxicet tabs ROZEREM RU-HIST-D RYMED S SABRIL saccharomyces boulardii saline SALINE SANDIMMUNE SANDOSTATIN LAR DEPOT SANTYL SAPHRIS SCHOOLTIME SHAMPOO SCOOBY-DOO ONE A DAY SCOT-TUSSIN SCOT-TUSSIN SENIOR SECURA EXTRA PROTECTIVE selegiline hcl selenium SELENIUM selenium sulfide SELZENTRY senna SENNA SENNA PROMPT sennosides SENNOSIDES sennosides-docusate sodium SENSI-CARE PROTECTIVE BAR SENSIPAR SEREVENT DISKUS SEROQUEL XR sertraline hcl sharobel 28 day sildenafil citrate (pulmonary hypertension) SILENOR SILVER SULFADIAZINE SIMBRINZA simvastatin sirolimus SIROLIMUS SIRTURO SIVEXTRO SLOW RELEASE IRON SLOW-MAG SM CORAL CALCIUM SM SLOW RELEASE IRON SM VITAMIN D3 MAXIMUM STR SODIUM BICARBONATE sodium bicarbonate (antacid) SODIUM CHLORIDE... 60, 62, 78 SODIUM CHLORIDE 0.45% VIA SODIUM CHLORIDE 0.9% sodium chloride hypertonic SODIUM CHLORIDE INJ 0.9% SODIUM FLUORIDE CHEW; TAB; 1.1 (0.5 F) MG/ML SOLN sodium phenylbutyrate sodium phosphates sodium polystyrene sulfonate SOLIA SOLTAMOX SOLU-CORTEF SOMATULINE DEPOT SOMAVERT SOOTHE sorine sotalol hcl sotalol hcl (afib/afl) SOVALDI specialty vitamins products SPIRIVA HANDIHALER SPIRIVA RESPIMAT spironolactone spironolactone & hydrochlorothiazide sprintec 28 day SPRYCEL sps susp 15gm/60ml sronyx SSD ST JOSEPH ADULT ANALGESIC STAHIST AD STANBACK ASPIRIN FREE STATUSS GREEN stavudine STERILE LUBRICANT DROPS STERILE WATER IRRIGATION 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 106

107 STIVARGA STRATTERA streptomycin sulfate STRIBILD STUART PRENATAL + DHA SUBOXONE MIS 12-3MG SUBOXONE MIS 2-0.5MG SUBOXONE MIS 4-1MG SUBOXONE MIS 8-2MG SUCRAID sucralfate SUDAFED 24 HOUR sulfacetamide sodium (acne) sulfacetamide sodium (ophth) sulfacetamide sod-prednisolone sulfadiazine sulfamethoxazole-trimethoprim sulfamethoxazole-trimethoprim inj SULFAMYLON sulfasalazine sulfasalazine ec sulindac SUMATRIPTAN sumatriptan succinate SUMATRIPTAN SUCCINATE sumatriptan succinate inj SUMATRIPTAN SUCCINATE INJ SUPER NU-THERA suprax SUPRAX SUPREP BOWEL PREP SURMONTIL CAP 100MG SURMONTIL CAP 25MG SURMONTIL CAP 50MG SUSTIVA SUTENT SYLATRON KIT 296MCG SYLATRON KIT 444MCG SYLATRON KIT 888MCG SYMBICORT SYMLINPEN SYMLINPEN SYNAGIS SYNAREL SYNERCID SYNTHROID SYPRINE SYSTANE BALANCE RESTORATI SYSTANE LIQUID GEL SYSTANE OVERNIGHT THERAPY 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 T TAB-A-VITE WOMENS TABLOID tacrolimus TAFINLAR TAMIFLU tamoxifen citrate tamsulosin hcl TARCEVA TARGRETIN... 24, 83 tarina fe tab 1/ TASIGNA tazicef tazicef vial TAZORAC taztia TEARS AGAIN NIGHT & DAY TEFLARO TEGRETOL TEGRETOL-XR TEKAMLO MG TEKAMLO TAB MG TEKAMLO TAB 150-5MG TEKAMLO TAB 300-5MG TEKTURNA TEKTURNA HCT TAB MG TEKTURNA HCT TAB MG TEKTURNA HCT TAB MG TEKTURNA HCT TAB MG temazepam TENIVAC terazosin hcl terbinafine hcl terbinafine hcl (topical) terbutaline sulfate terconazole vaginal TESTIM testosterone cypionate testosterone enanthate TETANUS TOXOID ADSORBED TETANUS/DIPHTHERIA TOXOID tetrahydrozoline hcl (ophth) tetrahydrozoline w/ zinc sulfate... 70

108 TEV-TROPIN texacort soln 2.5% THALOMID theo theophylline THERA/BETA-CAROTENE THERA-D THERAFLU FLU & SORE THROA THERAFLU MAX-D SEVERE COL THERAFLU SINUS & COLD THERANATAL CORE NUTRITION THERATEARS thiamine hcl thiamine mononitrate thioridazine hcl thiothixene tiagabine hcl TIKOSYN timolol maleate timolol maleate (ophth) TIMOLOL MALEATE GEL tioconazole vaginal TIVICAY tizanidine hcl TOBRADEX TOBRADEX ST tobramycin tobramycin (ophth) tobramycin sulfate tobramycin sulfate in saline tobramycin-dexamethasone TOBREX tolnaftate TOLTERODINE TARTRATE CAP ER tolterodine tartrate tabs topiramate toposar topotecan hcl torsemide inj 20mg/2ml torsemide inj 50mg/5ml torsemide tabs TOUJEO SOLOSTAR TOVIAZ TPN ELECTROLYTES TRACLEER TRADJENTA tramadol hcl tramadol-acetaminophen trandolapril tranexamic acid TRANSDERM-SCOP tranylcypromine sulfate travasol TRAVATAN Z trazodone hcl TREANDA TRECATOR TRELSTAR DEP INJ 3.75MG TRELSTAR LA INJ 11.25MG tretinoin tretinoin (chemotherapy) triamcinolone acetonide (mouth) triamcinolone acetonide (topical) TRIAMINIC CHEST & NASAL C TRIAMINIC COLD & ALLERGY TRIAMINIC COLD & COUGH DA TRIAMINIC COLD/COUGH NIGH TRIAMINIC COUGH & RUNNY N TRIAMINIC FEVER REDUCER P TRIAMINIC MULTI-SYMPTOM F TRIAMINIC NIGHT TIME COLD triamterene & hydrochlorothiazide triamterene & hydrochlorothiazide cap mg TRIBENZOR TAB MG TRIBENZOR TAB TRIBENZOR TAB MG TRIBENZOR TAB MG TRIBENZOR40- TAB 10-25MG TRICODE AR TRICODE GF triderm trifluoperazine hcl trifluridine trihexyphenidyl hcl tri-legest 28 day trilyte trimethoprim TRINESSA TRIPLE PASTE tri-previfem 28 day triprolidine & pseudoephedrine TRISENOX tri-sprintec 28 day 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 108

109 TRIUMEQ TRI-VI-SOL TRI-VI-SOL/IRON trivora 28 day TROPHAMINE INJ 10% trospium chloride TRUMENBA TRUVADA TUCKS ANTI-ITCH TUDORZA PRESSAIR TUDORZA PRESSAIR (INSTITUTIONAL PACK) 400MCG/ACT TUSNEL TUSNEL PEDIATRIC TUSNEL-DM PEDIATRIC TWINRIX INJ TYBOST TYGACIL TYKERB TYPHIM VI TYSABRI TYZEKA U UCERIS ULORIC UNITHROID UPCAL D URO-MAG ursodiol V VAGIFEM valacyclovir hcl VALCHLOR VALCYTE valganciclovir hcl valproate sodium valproic acid valsartan valsartan & hctz tab mg valsartan & hctz tab mg valsartan & hctz tab mg valsartan & hctz tab mg valsartan & hctz tab mg vancomycin hcl VANDAZOLE VAQTA VARIVAX VASCEPA VASOCLEAR A VELCADE velivet 28 day venlafaxine hcl verapamil cap er VERAPAMIL CAP ER verapamil hcl verapamil tab er VERSACLOZ VESICARE vestura VIBRAMYCIN VICKS VAPORUB VICTOZA VICTRELIS VIDEX PEDIATRIC VIGAMOX VIIBRYD VIMPAT vinblastine sulfate vincasar vincristine sulfate vinorelbine tartrate viorele VIRACEPT VIRAMUNE XR VIREAD VISINE-LR VITALETS VITA-MAG vitamin a VITAMIN A VITAMIN A PALMITATE VITAMIN B12/FOLIC ACID VITAMIN C VITAMIN D VITAMIN D vitamin e VITAMIN E VITAMIN K vitamin mixture vitamins a & d vitamins c & e VITEKTA 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 109

110 VIVA DROPS VOLTAREN voriconazole VOTRIENT vyfemia 28 day W warfarin sodium WELCHOL wheat dextrin wheat dextrin-calcium white petrolatum-mineral oil X XALKORI XARELTO XARELTO STARTER PACK XENAZINE XGEVA XIFAXAN XOLAIR XOPENEX HFA XTANDI xulane XYREM Y YF-VAX Z zafirlukast zarah ZAVESCA zazole ZAZOLE ZELBORAF ZEMAIRA zenatane zenchent 28 day ZENPEP ZETIA TAB 10MG ZIAGEN zidovudine ZINC OXIDE zinc oxide (topical) ziprasidone hcl ZMAX ZODRYL AC ZODRYL AC ZODRYL AC ZODRYL AC ZODRYL DAC ZODRYL DAC ZODRYL DAC ZODRYL DAC ZODRYL DEC ZODRYL DEC ZODRYL DEC ZODRYL DEC zoledronic inj 4mg/5ml ZOLINZA zolmitriptan zolmitriptan odt zolpidem tartrate ZOMETA zonatuss zonisamide ZONTIVITY ZOO FRIENDS COMPLETE ZORTRESS ZORTRESS TAB 0.5MG ZORTRESS TAB 0.75MG ZOSTAVAX Z-TUSS AC Z-TUSS E ZYDELIG ZYKADIA ZYLET ZYPREXA RELPREVV ZYTIGA ZYVOX 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 110

111 這本處方集更新於 2015 年 8 月 1 日 要瞭解更多最新資訊或有其他疑問, 請每週 7 天 每天 24 小時隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 投保人服務部 聽障人士請致電 通話免費 要瞭解詳情, 請造訪 如有疑問, 您可以每週 7 天 每天 24 隨時致電 聯絡 ArchCare Community Advantage FIDA Plan 聽障專線 711 通話免費 要瞭解詳情, 請造訪 111