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PLEASE READ:
THIS DOCUMENT CONTAINS INFORMATION
ABOUT THE DRUGS WE COVER IN THIS PLAN
This formulary is up-to-date through its
publication date, 10/1/2017. Please notify
Blue Cross Community Family Health Plan
at ilmedicaidoperations@bcbsil.com or
1-877-860-2837 TTY/TDD 711 with any
mistakes in the formulary.
IL_FHP_RX 229793.1017
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discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield
of Illinois does not exclude people or treat them differently because of race, color, national origin, age,
disability, or sex.
If you believe that Blue Cross and Blue Shield of Illinois has failed to provide these services or discriminated in
another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois
60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, Civilrightscoordinator@hcsc.net.
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Civil Rights
Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for
Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
i
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Call 1-855-710-6984 (TTY: 711).
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(TTY:711)。
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walang bayad. Tumawag sa 1-855-710-6984 (TTY: 711).
1-855-710-6984 اتصل برقم. فإن خدمات المساعدة اللغوية تتوافر لك بالمجان، إذا كنت تتحدث اذكر اللغة:ملحوظة
.)711:(رقم هاتف الصم والبكم
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1-855-710-6984 (TTY: 711).
تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کريں، اگر آپ اردو بولتے ہیں:خبردار
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CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
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ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti.
Chiamare il numero 1-855-710-6984 (TTY: 711).
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।
1-855-710-6984 (TTY: 711) पर कॉल करें।
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1-855-710-6984 (ATS: 711).
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες
παρέχονται δωρεάν. Καλέστε 1-855-710-6984 (TTY: 711).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: 1-855-710-6984 (TTY: 711).
ii
What is the Blue Cross Community Family –– The information in the “Necessary
Health Plan (the “plan”) drug list? actions, restrictions, or limits on use”
column tells you if Blue Cross
The drug list (sometimes called a formulary) is a list Community Family Health Plan has any
showing the drugs that can be covered by the plan. rules for covering your drug.
The drugs listed will be covered as long as you:
• The drugs are listed in categories, or
• have a medical need for them groups, based on the type of medical
• fill the medication orders at an conditions they treat. (For example, drugs
in-network pharmacy used to treat a heart condition are listed
under Cardiovascular Agents).
• follow the other plan rules
• If you know what your drug is used for,
For more information on how to fill your
look for the group in the drug list.
medication orders, please review your
Member Handbook. • Then, look under that group for your drug.
2. Alphabetical Listing
What will I pay? • Look for your drug in the at the back
You do not pay for covered drugs. of this book.
• Next to your drug, you will see the
Can the drug list change? page number where you can find
Yes, it can change. coverage information.
Coverage may change if: What are generic drugs?
• a new, less expensive generic drug A generic drug is approved by the Food and
becomes available
Drug List
Drug Administration (FDA) as having the same
• new information about a drug shows it to active ingredient as the brand name drug, but
be unsafe or less effective often costs less. The plan covers both brand
name drugs and generic drugs.
You will be told in writing when the drug list
does change.
Are there any limits on my coverage?
How do I use the drug list? Added conditions or limits on some covered
drugs may include:
There are two ways to find your drug in the list
• Prior Authorization: You or your doctor may
beginning on page 1.
need to get approval before you fill your
1. Category medication orders. If you do not get approval,
• The list of covered drugs that begins on the plan may not cover the drug.
page 1 gives you information about the • Quantity Limits: For certain drugs, the plan
drugs covered by Blue Cross Community limits the amount that will be covered.
Family Health Plan. If you have trouble
• Step Therapy: In some cases, the plan
finding your drug in the list, turn to the
requires you to first try certain drugs before
Index that begins at the back of this book. another drug can be covered. For example, if
• The first column of the chart has the name Drug A and Drug B both treat your medical
of the drug. Brand name drugs are condition, the plan may not cover Drug B
capitalized (e.g., CIPRO) and generic drugs unless you try Drug A first. If Drug A does not
are listed in lower-case italics (e.g., ). work for you, the plan will then cover Drug B.
iii
You can find out if your drug has any added Which drug categories are not covered by
conditions or limits by looking at the list that the plan drug list?
begins on page 1. You will find our contact
The following drug categories are not covered by
information below, and the date we last updated
your plan:
the list, on the front and back cover pages.
–– Anorexia, weight loss, or weight
Does the plan pay for over-the-counter gain drugs
(OTC) drugs? –– Bulk chemicals
Yes, the plan pays for certain OTC drugs with –– Cosmetic enhancing drugs
a valid medication order from your doctor, and –– Diagnostic agents
you may get those at no cost. Generic products
–– Drug Efficacy Study Implementation
are to be prescribed and given out when a
(DESI) that are classified as ineffective
vailable. These products are to be filled at a plan
network pharmacy and for quantities up to a –– Experimental and investigational drugs
30-day supply. –– Erectile dysfunction drugs prescribed to
treat impotence
What if my drug is not on the drug list? –– Fertility drugs
Contact Member Services and ask if your drug is –– General anesthetic drugs
covered. If you learn that the plan does not cover
–– Over-the-counter products not
your drug, you have two options:
otherwise included on the plan’s
• Talk to your doctor to decide if you should drug list
first try a different drug on our list before you
–– Surgical supply/medical devices
request an exception.
Drug List
iv
Language Assistance
Interpreter Services
We can arrange for someone to help you speak
with us in any language. These services are free.
If your doctor does not speak your language, we
can arrange for a translator to help you. Please
call Member Services at the number above.
Hearing and Vision Problems
For our members with hearing problems, we offer
TTY/TDD service free of charge. The line is open
24 hours a day/seven day a week at 711.
Other Languages and Formats: You can get this
document in Spanish, or speak with someone
about this information in other languages for
free. Call 1-877-860-2837 (TTY/TDD: 711). The
call is free. You can also call Member Services,
toll-free, to request this information in other
alternative formats such as Braille, large print and
other forms. Call Toll Free: 1-877-860-2837
(TTY/TDD: 711). We are available 24 hours a day,
seven (7) days a week. The call is free.
Drug List
v
2017
78
2017
albuterol sulfate soln nebu 0.63 mg/3ml (base ALPHANINE SD – coagulation factor ix for inj 1500
equiv)............................................................................ unit................................................................................
albuterol sulfate soln nebu 1.25 mg/3ml (base alprazolam tab 0.25 mg (Xanax)..................................
equiv)............................................................................ alprazolam tab 0.5 mg (Xanax)....................................
albuterol sulfate syrup 2 mg/5ml.................................. alprazolam tab 1 mg (Xanax).......................................
alclometasone dipropionate cream 0.05%................... alprazolam tab 2 mg (Xanax).......................................
alclometasone dipropionate oint 0.05%....................... alum & mag hydroxide-simethicone susp 200-200-20
ALCOHOL PREP PADS, SWABS - various................. mg/5ml..........................................................................
ALENDRONATE SODIUM – alendronate sodium tab 40 alum & mag hydroxide-simethicone susp 400-400-40
mg................................................................................ mg/5ml..........................................................................
alendronate sodium tab 5 mg....................................... amantadine hcl cap 100 mg.........................................
alendronate sodium tab 10 mg..................................... amantadine hcl syrup 50 mg/5ml.................................
alendronate sodium tab 35 mg..................................... amiloride & hydrochlorothiazide tab 5-50 mg...............
alendronate sodium tab 70 mg (Fosamax).................. amiloride hcl tab 5 mg..................................................
alfuzosin hcl tab er 24hr 10 mg (Uroxatral).................. amiodarone hcl tab 200 mg..........................................
ALKERAN – melphalan tab 2 mg................................. amitriptyline hcl tab 10 mg............................................
allopurinol tab 100 mg (Zyloprim)................................. amitriptyline hcl tab 50 mg............................................
allopurinol tab 300 mg (Zyloprim)................................. amitriptyline hcl tab 75 mg............................................
ALOGLIPTIN/METFORMIN HCL – alogliptin-metformin amitriptyline hcl tab 100 mg..........................................
hcl tab 12.5-500 mg.................................................... amitriptyline hcl tab 150 mg..........................................
ALOGLIPTIN/METFORMIN HCL – alogliptin-metformin amitriptyline hcl tab 25 mg (Elavil)...............................
hcl tab 12.5-1000 mg.................................................. amlodipine besylate-benazepril hcl cap 2.5-10 mg......
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone amlodipine besylate-benazepril hcl cap 5-40 mg.........
tab 12.5-15 mg............................................................ amlodipine besylate-benazepril hcl cap 5-10 mg
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone (Lotrel)..........................................................................
tab 12.5-30 mg............................................................ amlodipine besylate-benazepril hcl cap 5-20 mg
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone (Lotrel)..........................................................................
tab 12.5-45 mg............................................................ amlodipine besylate-benazepril hcl cap 10-20 mg
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone (Lotrel)..........................................................................
tab 25-15 mg............................................................... amlodipine besylate-benazepril hcl cap 10-40 mg
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone (Lotrel)..........................................................................
tab 25-30 mg............................................................... amlodipine besylate tab 2.5 mg (Norvasc)...................
ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone amlodipine besylate tab 5 mg (Norvasc)......................
tab 25-45 mg............................................................... amlodipine besylate tab 10 mg (Norvasc)....................
ALOGLIPTIN – alogliptin benzoate tab 6.25 mg (base amlodipine besylate-valsartan tab 5-160 mg
equiv)............................................................................ (Exforge)......................................................................
ALOGLIPTIN – alogliptin benzoate tab 12.5 mg (base amlodipine besylate-valsartan tab 5-320 mg
equiv)............................................................................ (Exforge)......................................................................
ALOGLIPTIN – alogliptin benzoate tab 25 mg (base amlodipine besylate-valsartan tab 10-160 mg
equiv)............................................................................ (Exforge)......................................................................
ALPHAGAN P – brimonidine tartrate ophth soln amlodipine besylate-valsartan tab 10-320 mg
0.1%............................................................................. (Exforge)......................................................................
ALPHANATE/VON WILLEBRAND – antihemophilic factor/ amoxicillin & k clavulanate for susp 200-28.5
vwf (human) for inj 250 unit........................................ mg/5ml..........................................................................
ALPHANATE/VON WILLEBRAND – antihemophilic factor/ amoxicillin & k clavulanate for susp 400-57
vwf (human) for inj 500 unit........................................ mg/5ml..........................................................................
ALPHANATE/VON WILLEBRAND – antihemophilic factor/ amoxicillin & k clavulanate for susp 250-62.5 mg/5ml
vwf (human) for inj 1000 unit...................................... (Augmentin).................................................................
ALPHANATE/VON WILLEBRAND – antihemophilic factor/ amoxicillin & k clavulanate for susp 600-42.9 mg/5ml
vwf (human) for inj 1500 unit...................................... (Augmentin es-600).....................................................
ALPHANATE/VON WILLEBRAND – antihemophilic factor/ amoxicillin & k clavulanate tab 250-125 mg.................
vwf (human) for inj 2000 unit...................................... amoxicillin & k clavulanate tab 500-125 mg
ALPHANINE SD – coagulation factor ix for inj 500 (Augmentin).................................................................
unit................................................................................ amoxicillin & k clavulanate tab 875-125 mg
ALPHANINE SD – coagulation factor ix for inj 1000 (Augmentin).................................................................
unit................................................................................
79
2017
AMOXICILLIN – amoxicillin (trihydrate) chew tab 125 ARANESP ALBUMIN FREE – darbepoetin alfa soln inj
mg................................................................................ 300 mcg/ml..................................................................
AMOXICILLIN – amoxicillin (trihydrate) chew tab 250 ARANESP ALBUMIN FREE – darbepoetin alfa soln
mg................................................................................ prefilled syringe 10 mcg/0.4ml....................................
amoxicillin (trihydrate) cap 250 mg............................... ARANESP ALBUMIN FREE – darbepoetin alfa soln
amoxicillin (trihydrate) cap 500 mg............................... prefilled syringe 25 mcg/0.42ml..................................
amoxicillin (trihydrate) for susp 125 mg/5ml................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amoxicillin (trihydrate) for susp 200 mg/5ml................. prefilled syringe 40 mcg/0.4ml....................................
amoxicillin (trihydrate) for susp 250 mg/5ml................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amoxicillin (trihydrate) for susp 400 mg/5ml................. prefilled syringe 60 mcg/0.3ml....................................
amoxicillin (trihydrate) tab 875 mg............................... ARANESP ALBUMIN FREE – darbepoetin alfa soln
amphetamine-dextroamphetamine cap er 24hr 5 mg prefilled syringe 100 mcg/0.5ml..................................
(Adderall xr)................................................................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amphetamine-dextroamphetamine cap er 24hr 10 mg prefilled syringe 150 mcg/0.3ml..................................
(Adderall xr)................................................................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amphetamine-dextroamphetamine cap er 24hr 15 mg prefilled syringe 200 mcg/0.4ml..................................
(Adderall xr)................................................................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amphetamine-dextroamphetamine cap er 24hr 20 mg prefilled syringe 300 mcg/0.6ml..................................
(Adderall xr)................................................................. ARANESP ALBUMIN FREE – darbepoetin alfa soln
amphetamine-dextroamphetamine cap er 24hr 25 mg prefilled syringe 500 mcg/ml.......................................
(Adderall xr)................................................................. aripiprazole oral solution 1 mg/ml.................................
amphetamine-dextroamphetamine cap er 24hr 30 mg aripiprazole tab 2 mg (Abilify).......................................
(Adderall xr)................................................................. aripiprazole tab 5 mg (Abilify).......................................
amphetamine-dextroamphetamine tab 5 mg aripiprazole tab 10 mg (Abilify).....................................
(Adderall)...................................................................... aripiprazole tab 15 mg (Abilify).....................................
amphetamine-dextroamphetamine tab 7.5 mg aripiprazole tab 20 mg (Abilify).....................................
(Adderall)...................................................................... aripiprazole tab 30 mg (Abilify).....................................
amphetamine-dextroamphetamine tab 10 mg ARISTADA – aripiprazole lauroxil im er susp prefilled syr
(Adderall)...................................................................... 441 mg/1.6ml...............................................................
amphetamine-dextroamphetamine tab 12.5 mg ARISTADA – aripiprazole lauroxil im er susp prefilled syr
(Adderall)...................................................................... 662 mg/2.4ml...............................................................
amphetamine-dextroamphetamine tab 15 mg ARISTADA – aripiprazole lauroxil im er susp prefilled syr
(Adderall)...................................................................... 882 mg/3.2ml...............................................................
amphetamine-dextroamphetamine tab 20 mg ARISTADA – aripiprazole lauroxil im er susp prefilled syr
(Adderall)...................................................................... 1064 mg/3.9ml.............................................................
amphetamine-dextroamphetamine tab 30 mg ARNUITY ELLIPTA – fluticasone furoate aerosol powder
(Adderall)...................................................................... breath activ 100 mcg/act.............................................
ampicillin cap 500 mg................................................... ARNUITY ELLIPTA – fluticasone furoate aerosol powder
AMPYRA – dalfampridine tab er 12hr 10 mg............... breath activ 200 mcg/act.............................................
anagrelide hcl cap 1 mg............................................... artificial tear ophth solution...........................................
anagrelide hcl cap 0.5 mg (Agrylin).............................. ascorbic acid tab 500 mg.............................................
anastrozole tab 1 mg (Arimidex).................................. aspirin chew tab 81 mg................................................
apraclonidine hcl ophth soln 0.5% (base equivalent) aspirin-dipyridamole cap er 12hr 25-200 mg
(Iopidine)...................................................................... (Aggrenox)...................................................................
APTIVUS – tipranavir cap 250 mg............................... aspirin tab delayed release 81 mg...............................
APTIVUS – tipranavir oral soln 100 mg/ml................... aspirin tab delayed release 325 mg.............................
ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25 aspirin tab 325 mg........................................................
mcg/ml.......................................................................... atenolol & chlorthalidone tab 50-25 mg (Tenoretic
ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40 50)................................................................................
mcg/ml.......................................................................... atenolol & chlorthalidone tab 100-25 mg (Tenoretic
ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60 100)..............................................................................
mcg/ml.......................................................................... atenolol tab 25 mg (Tenormin).....................................
ARANESP ALBUMIN FREE – darbepoetin alfa soln inj atenolol tab 50 mg (Tenormin).....................................
100 mcg/ml.................................................................. atenolol tab 100 mg (Tenormin)...................................
ARANESP ALBUMIN FREE – darbepoetin alfa soln inj atorvastatin calcium tab 10 mg (base equivalent)
200 mcg/ml.................................................................. (Lipitor).........................................................................
80
2017
atorvastatin calcium tab 20 mg (base equivalent) b-complex w/ c & folic acid tab 5 mg...........................
(Lipitor)......................................................................... b-complex w/ c & folic acid tab 1 mg (Nephro-vite
atorvastatin calcium tab 40 mg (base equivalent) rx).................................................................................
(Lipitor)......................................................................... BEBULIN – factor ix complex for inj 200-1200 unit......
atorvastatin calcium tab 80 mg (base equivalent) benazepril & hydrochlorothiazide tab 5-6.25 mg..........
(Lipitor)......................................................................... benazepril & hydrochlorothiazide tab 10-12.5 mg
atovaquone-proguanil hcl tab 62.5-25 mg (Lotensin hct)...............................................................
(Malarone).................................................................... benazepril & hydrochlorothiazide tab 20-12.5 mg
atovaquone-proguanil hcl tab 250-100 mg (Lotensin hct)...............................................................
(Malarone).................................................................... benazepril & hydrochlorothiazide tab 20-25 mg (Lotensin
atovaquone susp 750 mg/5ml (Mepron)...................... hct)...............................................................................
ATRIPLA – efavirenz-emtricitabine-tenofovir df tab benazepril hcl tab 5 mg................................................
600-200-300 mg.......................................................... benazepril hcl tab 10 mg..............................................
ATROPINE SULFATE – atropine sulfate ophth oint benazepril hcl tab 20 mg (Lotensin).............................
1%................................................................................ benazepril hcl tab 40 mg (Lotensin).............................
ATROPINE SULFATE – atropine sulfate ophth soln BENEFIX – coagulation factor ix (recombinant) for inj kit
1%................................................................................ 250 unit........................................................................
ATROVENT HFA – ipratropium bromide hfa inhal aerosol BENEFIX – coagulation factor ix (recombinant) for inj kit
17 mcg/act................................................................... 500 unit........................................................................
AUBAGIO – teriflunomide tab 7 mg............................. BENEFIX – coagulation factor ix (recombinant) for inj kit
AUBAGIO – teriflunomide tab 14 mg........................... 1000 unit......................................................................
AUGMENTED BETAMETHASONE D – betamethasone BENEFIX – coagulation factor ix (recombinant) for inj kit
dipropionate augmented gel 0.05%............................ 2000 unit......................................................................
AVONEX – interferon beta-1a for im inj kit 30mcg BENEFIX – coagulation factor ix (recombinant) for inj kit
(33mcg(6.6 mu)/vial)................................................... 3000 unit......................................................................
AVONEX – interferon beta-1a im prefilled syringe kit 30 benzoyl peroxide liq 10%..............................................
mcg/0.5ml..................................................................... benzoyl peroxide lotion 6%...........................................
AVONEX PEN – interferon beta-1a im auto-injector kit 30 benztropine mesylate tab 0.5 mg.................................
mcg/0.5ml..................................................................... benztropine mesylate tab 1 mg....................................
azathioprine tab 50 mg (Imuran).................................. benztropine mesylate tab 2 mg....................................
azelastine hcl nasal spray 0.1% (137 mcg/spray)........ betamethasone dipropionate augmented cream 0.05%
azelastine hcl ophth soln 0.05%................................... (Diprolene af)...............................................................
azithromycin for susp 100 mg/5ml (Zithromax)............ betamethasone dipropionate augmented lotion 0.05%
azithromycin for susp 200 mg/5ml (Zithromax)............ (Diprolene)...................................................................
azithromycin tab 250 mg (Zithromax)........................... betamethasone dipropionate augmented oint 0.05%
azithromycin tab 500 mg (Zithromax)........................... (Diprolene)...................................................................
azithromycin tab 600 mg (Zithromax)........................... betamethasone dipropionate cream 0.05%..................
B betamethasone dipropionate lotion 0.05%...................
betamethasone dipropionate oint 0.05%......................
BACITRACIN – bacitracin ophth oint 500 unit/gm....... betamethasone valerate cream 0.1%...........................
bacitracin oint 500 unit/gm............................................ betamethasone valerate lotion 0.1%............................
bacitracin-polymyxin b oint........................................... betamethasone valerate oint 0.1%...............................
bacitracin-polymyxin b ophth oint................................. betaxolol hcl ophth soln 0.5%.......................................
bacitracin-polymyxin-neomycin-hc ophth oint 1%........ betaxolol hcl tab 10 mg................................................
bacitracin zinc oint 500 unit/gm.................................... betaxolol hcl tab 20 mg................................................
baclofen tab 10 mg....................................................... bethanechol chloride tab 5 mg (Urecholine)................
baclofen tab 20 mg....................................................... bethanechol chloride tab 10 mg (Urecholine)..............
balsalazide disodium cap 750 mg (Colazal)................. bethanechol chloride tab 25 mg (Urecholine)..............
BARACLUDE – entecavir oral soln 0.05 mg/ml........... bethanechol chloride tab 50 mg (Urecholine)..............
BASAGLAR KWIKPEN – insulin glargine soln pen-injector bexarotene cap 75 mg (Targretin)................................
100 unit/ml................................................................... bicalutamide tab 50 mg (Casodex)...............................
BAYER CONTOUR BLOOD GLUCO........................... BILTRICIDE – praziquantel tab 600 mg.......................
BAYER MICROLET LANCETS..................................... bisacodyl tab delayed release 5 mg.............................
b-complex w/ c & folic acid cap 1 mg bismuth subsalicylate susp 262 mg/15ml.....................
(Nephrocaps)............................................................... bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg
b-complex w/ c & folic acid tab..................................... (Ziac)............................................................................
81
2017
bisoprolol & hydrochlorothiazide tab 5-6.25 mg butalbital-acetaminophen-caff w/ cod cap 50-325-40-30
(Ziac)............................................................................ mg................................................................................
bisoprolol & hydrochlorothiazide tab 10-6.25 mg butalbital-acetaminophen tab 50-325 mg.....................
(Ziac)............................................................................ butalbital-aspirin-caffeine cap 50-325-40 mg
bisoprolol fumarate tab 5 mg........................................ (Fiorinal).......................................................................
bisoprolol fumarate tab 10 mg...................................... butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg
BRILINTA – ticagrelor tab 60 mg................................. (Fiorinal/codeine #3)....................................................
BRILINTA – ticagrelor tab 90 mg................................. C
brimonidine tartrate ophth soln 0.2%............................
BROHIST D – brompheniramine & phenylephrine tab 4-10 cabergoline tab 0.5 mg.................................................
mg................................................................................ caffeine citrate oral soln 60 mg/3ml (10 mg/ml base
bromocriptine mesylate tab 2.5 mg (base equivalent) equiv)............................................................................
(Parlodel)...................................................................... calcipotriene cream 0.005% (Dovonex).......................
brompheniramine & phenylephrine elixir 1-2.5 calcipotriene oint 0.005%..............................................
mg/5ml.......................................................................... calcipotriene soln 0.005% (50 mcg/ml)........................
budesonide delayed release particles cap 3 mg (Entocort calcitonin (salmon) nasal soln 200 unit/act..................
ec)................................................................................ calcitriol cap 0.25 mcg (Rocaltrol)................................
budesonide inhalation susp 0.25 mg/2ml calcitriol cap 0.5 mcg (Rocaltrol)..................................
(Pulmicort).................................................................... calcitriol oral soln 1 mcg/ml (Rocaltrol)........................
budesonide inhalation susp 0.5 mg/2ml calcium acetate (phosphate binder) cap 667 mg (169 mg
(Pulmicort).................................................................... ca)................................................................................
budesonide inhalation susp 1 mg/2ml (Pulmicort)....... calcium acetate (phosphate binder) tab 667 mg
bumetanide tab 0.5 mg (Bumex).................................. (Eliphos).......................................................................
bumetanide tab 1 mg (Bumex)..................................... calcium carbonate (antacid) chew tab 500 mg.............
bumetanide tab 2 mg (Bumex)..................................... calcium carbonate (antacid) chew tab 750 mg.............
BUNAVAIL – buprenorphine-naloxone buccal film 2.1-0.3 calcium carbonate (antacid) chew tab 1000 mg...........
mg (base equiv).......................................................... calcium carbonate-cholecalciferol tab 500 mg-200
BUNAVAIL – buprenorphine-naloxone buccal film 4.2-0.7 unit................................................................................
mg (base equiv).......................................................... calcium carbonate-cholecalciferol tab 600 mg-400
BUNAVAIL – buprenorphine-naloxone buccal film 6.3-1 unit................................................................................
mg (base equiv).......................................................... calcium carbonate tab 1250 mg (500 mg elemental
buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base ca)................................................................................
equiv)............................................................................ calcium carbonate-vitamin d tab 250 mg-125 unit.......
buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base calcium carbonate-vitamin d tab 500 mg-200 unit.......
equiv)............................................................................ calcium carbonate-vitamin d tab 600 mg-400 unit.......
buprenorphine hcl sl tab 2 mg (base equiv)................. calcium citrate tab 950 mg (200 mg elemental ca)......
buprenorphine hcl sl tab 8 mg (base equiv)................. CANASA – mesalamine suppos 1000 mg...................
bupropion hcl (smoking deterrent) tab er 12hr 150 mg capecitabine tab 150 mg (Xeloda)................................
(Zyban)......................................................................... capecitabine tab 500 mg (Xeloda)................................
bupropion hcl tab er 12hr 100 mg (Wellbutrin sr)......... CAPTOPRIL/HYDROCHLOROTHIA – captopril &
bupropion hcl tab er 12hr 150 mg (Wellbutrin sr)......... hydrochlorothiazide tab 25-15 mg..............................
bupropion hcl tab er 12hr 200 mg (Wellbutrin sr)......... CAPTOPRIL/HYDROCHLOROTHIA – captopril &
bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)......... hydrochlorothiazide tab 25-25 mg..............................
bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)......... CAPTOPRIL/HYDROCHLOROTHIA – captopril &
bupropion hcl tab 75 mg............................................... hydrochlorothiazide tab 50-15 mg..............................
bupropion hcl tab 100 mg............................................. CAPTOPRIL/HYDROCHLOROTHIA – captopril &
buspirone hcl tab 5 mg................................................. hydrochlorothiazide tab 50-25 mg..............................
buspirone hcl tab 10 mg............................................... captopril tab 12.5 mg....................................................
buspirone hcl tab 15 mg............................................... captopril tab 25 mg.......................................................
buspirone hcl tab 30 mg............................................... captopril tab 50 mg.......................................................
butalbital-acetaminophen-caffeine cap 50-325-40 captopril tab 100 mg.....................................................
mg................................................................................ carbamazepine chew tab 100 mg................................
butalbital-acetaminophen-caffeine cap 50-300-40 mg carbamazepine susp 100 mg/5ml (Tegretol)................
(Fioricet)....................................................................... carbamazepine tab er 12hr 100 mg (Tegretol-xr).........
butalbital-acetaminophen-caffeine tab 50-325-40 mg carbamazepine tab er 12hr 200 mg (Tegretol-xr).........
(Esgic).......................................................................... carbamazepine tab er 12hr 400 mg (Tegretol-xr).........
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2017
carbamazepine tab 200 mg (Tegretol)......................... chlordiazepoxide hcl cap 5 mg.....................................
carbamide peroxide 6.5% otic soln.............................. chlordiazepoxide hcl cap 10 mg...................................
carbidopa & levodopa tab er 25-100 mg (Sinemet chlordiazepoxide hcl cap 25 mg...................................
cr)................................................................................. chlorhexidine gluconate soln 0.12% (Peridex).............
carbidopa & levodopa tab er 50-200 mg (Sinemet CHLOROQUINE PHOSPHATE – chloroquine phosphate
cr)................................................................................. tab 250 mg..................................................................
carbidopa & levodopa tab 10-100 mg (Sinemet).......... chloroquine phosphate tab 500 mg..............................
carbidopa & levodopa tab 25-100 mg (Sinemet).......... CHLOROTHIAZIDE – chlorothiazide tab 250 mg........
carbidopa & levodopa tab 25-250 mg (Sinemet).......... chlorothiazide tab 500 mg............................................
carbidopa tab 25 mg (Lodosyn).................................... chlorpheniramine maleate tab 4 mg.............................
carbinoxamine maleate soln 4 mg/5ml......................... chlorthalidone tab 25 mg..............................................
carbinoxamine maleate tab 4 mg................................. chlorthalidone tab 50 mg..............................................
carteolol hcl ophth soln 1%.......................................... chlorzoxazone tab 500 mg (Parafon forte dsc)............
carvedilol tab 3.125 mg (Coreg)................................... cholecalciferol cap 1000 unit........................................
carvedilol tab 6.25 mg (Coreg)..................................... cholecalciferol cap 2000 unit........................................
carvedilol tab 12.5 mg (Coreg)..................................... cholecalciferol cap 5000 unit........................................
carvedilol tab 25 mg (Coreg)........................................ cholecalciferol cap 10000 unit......................................
cefaclor cap 250 mg..................................................... cholecalciferol cap 50000 unit......................................
cefaclor cap 500 mg..................................................... cholecalciferol oral liquid 400 unit/ml............................
cefadroxil cap 500 mg.................................................. cholecalciferol tab 400 unit...........................................
cefadroxil for susp 250 mg/5ml.................................... cholecalciferol tab 1000 unit.........................................
cefadroxil for susp 500 mg/5ml.................................... cholecalciferol tab 2000 unit.........................................
cefadroxil tab 1 gm....................................................... cholecalciferol tab 50000 unit.......................................
cefdinir cap 300 mg...................................................... cholestyramine light powder 4 gm/dose (Questran
cefdinir for susp 125 mg/5ml........................................ light)..............................................................................
cefdinir for susp 250 mg/5ml........................................ cholestyramine light powder packets 4 gm..................
cefprozil for susp 125 mg/5ml...................................... cholestyramine powder 4 gm/dose (Questran)............
cefprozil for susp 250 mg/5ml...................................... cholestyramine powder packets 4 gm (Questran)........
cefprozil tab 250 mg..................................................... choline fenofibrate cap dr 45 mg (fenofibric acid equiv)
cefprozil tab 500 mg..................................................... (Trilipix).........................................................................
ceftriaxone sodium for inj 1 gm.................................... choline fenofibrate cap dr 135 mg (fenofibric acid equiv)
ceftriaxone sodium for inj 2 gm.................................... (Trilipix).........................................................................
ceftriaxone sodium for inj 250 mg................................ ciclopirox olamine cream 0.77% (base equiv)
ceftriaxone sodium for inj 500 mg................................ (Loprox)........................................................................
cefuroxime axetil tab 250 mg....................................... cilostazol tab 50 mg......................................................
cefuroxime axetil tab 500 mg....................................... cilostazol tab 100 mg....................................................
celecoxib cap 50 mg (Celebrex)................................... cimetidine hcl soln 300 mg/5ml....................................
celecoxib cap 100 mg (Celebrex)................................. cimetidine tab 200 mg..................................................
celecoxib cap 200 mg (Celebrex)................................. cimetidine tab 300 mg..................................................
celecoxib cap 400 mg (Celebrex)................................. cimetidine tab 400 mg..................................................
cephalexin cap 250 mg (Keflex)................................... cimetidine tab 800 mg..................................................
cephalexin cap 500 mg (Keflex)................................... ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml)
cephalexin for susp 125 mg/5ml................................... (Cipro)..........................................................................
cephalexin for susp 250 mg/5ml................................... ciprofloxacin for oral susp 500 mg/5ml (10%) (10
cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)................... gm/100ml) (Cipro)........................................................
cetirizine hcl tab 5 mg................................................... ciprofloxacin hcl ophth soln 0.3% (Ciloxan).................
cetirizine hcl tab 10 mg................................................. ciprofloxacin hcl tab 750 mg (base equiv)....................
CHANTIX CONTINUING MONTH – varenicline tartrate ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)........
tab 1 mg (base equiv)................................................. ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)........
CHANTIX STARTING MONTH PA – varenicline tartrate citalopram hydrobromide oral soln 10 mg/5ml.............
tab 0.5 mg x 11 & tab 1 mg x 42 pack....................... citalopram hydrobromide tab 10 mg (base equiv)
CHANTIX – varenicline tartrate tab 0.5 mg (base (Celexa)........................................................................
equiv)............................................................................ citalopram hydrobromide tab 20 mg (base equiv)
CHANTIX – varenicline tartrate tab 1 mg (base (Celexa)........................................................................
equiv)............................................................................ citalopram hydrobromide tab 40 mg (base equiv)
CHEMET – succimer cap 100 mg................................ (Celexa)........................................................................
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2017
clarithromycin for susp 125 mg/5ml.............................. clozapine orally disintegrating tab 100 mg
clarithromycin for susp 250 mg/5ml.............................. (Fazaclo)......................................................................
clarithromycin tab 250 mg............................................ clozapine tab 50 mg.....................................................
clarithromycin tab 500 mg (Biaxin)............................... clozapine tab 200 mg...................................................
clemastine fumarate tab 1.34 mg (1 mg base clozapine tab 25 mg (Clozaril)......................................
equiv)............................................................................ clozapine tab 100 mg (Clozaril)....................................
clindamycin hcl cap 75 mg (Cleocin)............................ COAGADEX – coagulation factor x (human) for inj 250
clindamycin hcl cap 150 mg (Cleocin).......................... unit................................................................................
clindamycin hcl cap 300 mg (Cleocin).......................... COAGADEX – coagulation factor x (human) for inj 500
clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) unit................................................................................
(Cleocin pediatric gr)................................................... codeine sulfate tab 15 mg (Codeine sulfate)................
clindamycin phosphate gel 1% (Cleocin-t)................... codeine sulfate tab 30 mg (Codeine sulfate)................
clindamycin phosphate lotion 1% (Cleocin-t)............... codeine sulfate tab 60 mg (Codeine sulfate)................
clindamycin phosphate soln 1% (Cleocin-t)................. colchicine w/ probenecid tab 0.5-500 mg.....................
clindamycin phosphate swab 1% (Cleocin-t)............... colestipol hcl granule packets 5 gm (Colestid
clindamycin phosphate vaginal cream 2% flavored).......................................................................
(Cleocin)....................................................................... colestipol hcl granules 5 gm (Colestid)........................
clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 colestipol hcl tab 1 gm (Colestid).................................
(1)-5% (Duac).............................................................. COMBIPATCH – estradiol-norethindrone ace td pttw
clobetasol propionate cream 0.05% (Temovate).......... 0.05-0.14 mg/day.........................................................
clobetasol propionate emollient base cream COMBIPATCH – estradiol-norethindrone ace td pttw
0.05%........................................................................... 0.05-0.25 mg/day.........................................................
clobetasol propionate gel 0.05% (Temovate)............... COMBIVENT RESPIMAT – ipratropium-albuterol inhal
clobetasol propionate oint 0.05% (Temovate).............. aerosol soln 20-100 mcg/act.......................................
clobetasol propionate soln 0.05% (Temovate)............. CONDOMS....................................................................
clonazepam orally disintegrating tab 0.125 mg............ CORTISONE ACETATE – cortisone acetate tab 25
clonazepam orally disintegrating tab 0.25 mg.............. mg................................................................................
clonazepam orally disintegrating tab 0.5 mg................ COTELLIC – cobimetinib fumarate tab 20 mg (base
clonazepam orally disintegrating tab 1 mg................... equivalent)....................................................................
clonazepam orally disintegrating tab 2 mg................... CREON – pancrelipase (lip-prot-amyl) dr cap
clonazepam tab 0.5 mg (Klonopin)............................... 3000-9500-15000 unit.................................................
clonazepam tab 1 mg (Klonopin).................................. CREON – pancrelipase (lip-prot-amyl) dr cap
clonazepam tab 2 mg (Klonopin).................................. 6000-19000-30000 unit...............................................
clonidine hcl tab 0.1 mg (Catapres)............................. CREON – pancrelipase (lip-prot-amyl) dr cap
clonidine hcl tab 0.2 mg (Catapres)............................. 12000-38000-60000 unit.............................................
clonidine hcl tab 0.3 mg (Catapres)............................. CREON – pancrelipase (lip-prot-amyl) dr cap
clonidine hcl td patch weekly 0.1 mg/24hr (Catapres- 24000-76000-120000 unit...........................................
tts-1)............................................................................. CREON – pancrelipase (lip-prot-amyl) dr cap
clonidine hcl td patch weekly 0.2 mg/24hr (Catapres- 36000-114000-180000 unit.........................................
tts-2)............................................................................. CRIXIVAN – indinavir sulfate cap 200 mg....................
clonidine hcl td patch weekly 0.3 mg/24hr (Catapres- CRIXIVAN – indinavir sulfate cap 400 mg....................
tts-3)............................................................................. CROMOLYN SODIUM – cromolyn sodium soln nebu 20
clopidogrel bisulfate tab 75 mg (base equiv) mg/2ml..........................................................................
(Plavix)......................................................................... cromolyn sodium ophth soln 4%..................................
clopidogrel bisulfate tab 300 mg (base equiv) cromolyn sodium oral conc 100 mg/5ml
(Plavix)......................................................................... (Gastrocrom)................................................................
clorazepate dipotassium tab 3.75 mg.......................... cyanocobalamin inj 1000 mcg/ml.................................
clorazepate dipotassium tab 15 mg.............................. cyanocobalamin tab er 1000 mcg................................
clorazepate dipotassium tab 7.5 mg (Tranxene t)........ cyanocobalamin tab 100 mcg.......................................
clotrimazole cream 1%.................................................. cyanocobalamin tab 250 mcg.......................................
clotrimazole soln 1%..................................................... cyanocobalamin tab 500 mcg.......................................
clotrimazole troche 10 mg............................................ cyanocobalamin tab 1000 mcg.....................................
clotrimazole vaginal cream 2%..................................... cyclobenzaprine hcl tab 5 mg.......................................
clotrimazole w/ betamethasone cream 1-0.05% cyclobenzaprine hcl tab 10 mg.....................................
(Lotrisone).................................................................... cyclopentolate hcl ophth soln 0.5% (Cyclogyl).............
clozapine orally disintegrating tab 25 mg (Fazaclo)..... cyclopentolate hcl ophth soln 1% (Cyclogyl)................
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2017
cyclopentolate hcl ophth soln 2% (Cyclogyl)................ dexamethasone tab 0.5 mg..........................................
CYCLOPHOSPHAMIDE – cyclophosphamide cap 25 dexamethasone tab 0.75 mg........................................
mg................................................................................ dexamethasone tab 1.5 mg..........................................
CYCLOPHOSPHAMIDE – cyclophosphamide cap 50 dexamethasone tab 4 mg.............................................
mg................................................................................ dexamethasone tab 6 mg.............................................
cyclosporine cap 25 mg (Sandimmune)....................... dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin
cyclosporine cap 100 mg (Sandimmune)..................... xr).................................................................................
cyclosporine modified cap 50 mg (Cyclosporine dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin
modifie)........................................................................ xr).................................................................................
cyclosporine modified cap 25 mg (Neoral)................... dexmethylphenidate hcl cap er 24 hr 15 mg (Focalin
cyclosporine modified cap 100 mg (Neoral)................. xr).................................................................................
CYCLOSPORINE MODIFIED – cyclosporine modified cap dexmethylphenidate hcl cap er 24 hr 20 mg (Focalin
50 mg........................................................................... xr).................................................................................
cyclosporine modified oral soln 100 mg/ml dexmethylphenidate hcl cap er 24 hr 30 mg (Focalin
(Neoral)........................................................................ xr).................................................................................
cyproheptadine hcl syrup 2 mg/5ml.............................. dexmethylphenidate hcl cap er 24 hr 40 mg (Focalin
cyproheptadine hcl tab 4 mg........................................ xr).................................................................................
CYTARABINE – cytarabine inj 20 mg/ml..................... dexmethylphenidate hcl tab 2.5 mg (Focalin)..............
D dexmethylphenidate hcl tab 5 mg (Focalin).................
dexmethylphenidate hcl tab 10 mg (Focalin)...............
danazol cap 50 mg....................................................... dextromethorphan-guaifenesin liquid 10-100
danazol cap 100 mg..................................................... mg/5ml..........................................................................
danazol cap 200 mg..................................................... diazepam conc 5 mg/ml................................................
dantrolene sodium cap 100 mg.................................... DIAZEPAM RECTAL GEL – diazepam rectal gel delivery
dantrolene sodium cap 25 mg (Dantrium).................... system 2.5 mg.............................................................
dantrolene sodium cap 50 mg (Dantrium).................... DIAZEPAM RECTAL GEL – diazepam rectal gel delivery
dapsone tab 25 mg....................................................... system 10 mg..............................................................
dapsone tab 100 mg..................................................... DIAZEPAM RECTAL GEL – diazepam rectal gel delivery
DARAPRIM – pyrimethamine tab 25 mg...................... system 20 mg..............................................................
DECARA – cholecalciferol cap 25000 unit................... diazepam tab 2 mg (Valium)........................................
demeclocycline hcl tab 150 mg.................................... diazepam tab 5 mg (Valium)........................................
DEPEN TITRATABS – penicillamine tab 250 mg......... diazepam tab 10 mg (Valium)......................................
DEPO-PROVERA CONTRACEPTIV – diclofenac potassium tab 50 mg...................................
medroxyprogesterone acetate im susp 150 mg/ diclofenac sodium gel 1% (Voltaren).................. ,
ml.................................................................................. diclofenac sodium ophth soln 0.1%..............................
DESCOVY – emtricitabine-tenofovir alafenamide fumarate diclofenac sodium tab delayed release 50 mg.............
tab 200-25 mg............................................................. diclofenac sodium tab delayed release 75 mg.............
desloratadine tab 5 mg (Clarinex)................................ diclofenac sodium tab er 24hr 100 mg.........................
desmopressin acetate nasal soln 0.01% (refrigerated) dicloxacillin sodium cap 250 mg...................................
(Ddavp)........................................................................ dicloxacillin sodium cap 500 mg...................................
desmopressin acetate nasal spray soln 0.01% dicyclomine hcl cap 10 mg (Bentyl)..............................
(Ddavp)........................................................................ dicyclomine hcl oral soln 10 mg/5ml............................
desmopressin acetate nasal spray soln 0.01% dicyclomine hcl tab 20 mg............................................
(refrigerated)................................................................ didanosine delayed release capsule 125 mg (Videx
desmopressin acetate tab 0.1 mg (Ddavp).................. ec)................................................................................
desmopressin acetate tab 0.2 mg (Ddavp).................. didanosine delayed release capsule 200 mg (Videx
desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 ec)................................................................................
mg(21/5) (Mircette)...................................................... didanosine delayed release capsule 250 mg (Videx
desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ec)................................................................................
(Desogen).................................................................... didanosine delayed release capsule 400 mg (Videx
desoximetasone cream 0.25% (Topicort)..................... ec)................................................................................
DEXAMETHASONE – dexamethasone soln 0.5 DIFFERIN – adapalene gel 0.1%.................................
mg/5ml.......................................................................... DIGOXIN – digoxin oral soln 0.05 mg/ml.....................
dexamethasone elixir 0.5 mg/5ml................................. digoxin tab 125 mcg (0.125 mg) (Lanoxin)..................
DEXAMETHASONE SODIUM PHOS – dexamethasone digoxin tab 250 mcg (0.25 mg) (Lanoxin)....................
sodium phosphate ophth soln 0.1%...........................
85
2017
DILANTIN – phenytoin sodium extended cap 30 docusate sodium cap 100 mg......................................
mg................................................................................ docusate sodium cap 250 mg......................................
diltiazem hcl cap er 12hr 60 mg................................... docusate sodium liquid 150 mg/15ml...........................
diltiazem hcl cap er 24hr 120 mg................................. dofetilide cap 125 mcg (0.125 mg) (Tikosyn)...............
diltiazem hcl cap er 24hr 180 mg................................. dofetilide cap 250 mcg (0.25 mg) (Tikosyn).................
diltiazem hcl cap er 24hr 240 mg................................. dofetilide cap 500 mcg (0.5 mg) (Tikosyn)...................
diltiazem hcl coated beads cap er 24hr 300 mg.......... donepezil hydrochloride orally disintegrating tab 5
diltiazem hcl coated beads cap er 24hr 120 mg (Cardizem mg................................................................................
cd)................................................................................ donepezil hydrochloride orally disintegrating tab 10
diltiazem hcl coated beads cap er 24hr 180 mg (Cardizem mg................................................................................
cd)................................................................................ donepezil hydrochloride tab 5 mg (Aricept)..................
diltiazem hcl coated beads cap er 24hr 240 mg (Cardizem donepezil hydrochloride tab 10 mg (Aricept)................
cd)................................................................................ dorzolamide hcl ophth soln 2% (Trusopt).....................
diltiazem hcl extended release beads cap er 24hr 120 mg dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/
(Tiazac)........................................................................ ml (Cosopt)..................................................................
diltiazem hcl extended release beads cap er 24hr 180 mg doxazosin mesylate tab 1 mg (Cardura)......................
(Tiazac)........................................................................ doxazosin mesylate tab 2 mg (Cardura)......................
diltiazem hcl extended release beads cap er 24hr 240 mg doxazosin mesylate tab 4 mg (Cardura)......................
(Tiazac)........................................................................ doxazosin mesylate tab 8 mg (Cardura)......................
diltiazem hcl extended release beads cap er 24hr 300 mg doxepin hcl cap 10 mg.................................................
(Tiazac)........................................................................ doxepin hcl cap 25 mg.................................................
diltiazem hcl extended release beads cap er 24hr 360 mg doxepin hcl cap 50 mg.................................................
(Tiazac)........................................................................ doxepin hcl cap 100 mg...............................................
diltiazem hcl extended release beads cap er 24hr 420 mg doxepin hcl cap 150 mg...............................................
(Tiazac)........................................................................ doxepin hcl conc 10 mg/ml...........................................
diltiazem hcl tab 90 mg................................................. DOXEPIN HCL – doxepin hcl cap 75 mg.....................
diltiazem hcl tab 30 mg (Cardizem).............................. doxycycline hyclate cap 50 mg.....................................
diltiazem hcl tab 60 mg (Cardizem).............................. doxycycline hyclate cap 100 mg (Vibramycin).............
diltiazem hcl tab 120 mg (Cardizem)............................ doxycycline hyclate tab 20 mg.....................................
diphenhydramine hcl cap 25 mg.................................. doxycycline hyclate tab 100 mg...................................
diphenhydramine hcl cap 50 mg.................................. doxycycline monohydrate cap 50 mg...........................
diphenhydramine hcl liquid 12.5 mg/5ml...................... doxycycline monohydrate cap 100 mg (Monodox).......
diphenhydramine hcl tab 25 mg................................... doxycycline monohydrate for susp 25 mg/5ml
diphenhydramine-phenylephrine liq 6.25-2.5 (Vibramycin).................................................................
mg/5ml.......................................................................... doxycycline monohydrate tab 50 mg............................
diphenoxylate w/ atropine tab 2.5-0.025 mg doxycycline monohydrate tab 75 mg............................
(Lomotil)....................................................................... doxycycline monohydrate tab 100 mg..........................
dipyridamole tab 25 mg................................................ drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin
dipyridamole tab 50 mg................................................ 28)................................................................................
dipyridamole tab 75 mg................................................ duloxetine hcl enteric coated pellets cap 20 mg
disopyramide phosphate cap 100 mg (Norpace)......... (Cymbalta)....................................................................
disopyramide phosphate cap 150 mg (Norpace)......... duloxetine hcl enteric coated pellets cap 30 mg
disulfiram tab 250 mg (Antabuse)................................ (Cymbalta)....................................................................
disulfiram tab 500 mg (Antabuse)................................ duloxetine hcl enteric coated pellets cap 60 mg
divalproex sodium cap delayed release sprinkle 125 mg (Cymbalta)....................................................................
(Depakote sprinkles)...................................................
E
divalproex sodium tab delayed release 125 mg
(Depakote)................................................................... econazole nitrate cream 1%.........................................
divalproex sodium tab delayed release 250 mg EDURANT – rilpivirine hcl tab 25 mg (base
(Depakote)................................................................... equivalent)....................................................................
divalproex sodium tab delayed release 500 mg ELIDEL – pimecrolimus cream 1%...............................
(Depakote)................................................................... ELIQUIS – apixaban tab 2.5 mg..................................
divalproex sodium tab er 24 hr 250 mg (Depakote ELIQUIS – apixaban tab 5 mg.....................................
er)................................................................................. ELLA – ulipristal acetate tab 30 mg.............................
divalproex sodium tab er 24 hr 500 mg (Depakote EMTRIVA – emtricitabine caps 200 mg.......................
er)................................................................................. EMTRIVA – emtricitabine soln 10 mg/ml......................
86
2017
enalapril maleate & hydrochlorothiazide tab 5-12.5 estradiol tab 1 mg (Estrace).........................................
mg................................................................................ estradiol tab 2 mg (Estrace).........................................
enalapril maleate & hydrochlorothiazide tab 10-25 mg estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-
(Vaseretic).................................................................... dot)...............................................................................
enalapril maleate tab 2.5 mg (Vasotec)........................ estradiol td patch twice weekly 0.0375 mg/24hr (Vivelle-
enalapril maleate tab 5 mg (Vasotec)........................... dot)...............................................................................
enalapril maleate tab 10 mg (Vasotec)......................... estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-
enalapril maleate tab 20 mg (Vasotec)......................... dot)...............................................................................
ENBREL – etanercept for subcutaneous inj 25 mg...... estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-
ENBREL – etanercept subcutaneous soln prefilled syringe dot)...............................................................................
25 mg/0.5ml................................................................. estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-
ENBREL – etanercept subcutaneous soln prefilled syringe dot)...............................................................................
50 mg/ml...................................................................... estradiol td patch weekly 0.025 mg/24hr (Climara)......
ENBREL SURECLICK – etanercept subcutaneous estradiol td patch weekly 0.05 mg/24hr (Climara)........
solution auto-injector 50 mg/ml................................... estradiol td patch weekly 0.06 mg/24hr (Climara)........
enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............ estradiol td patch weekly 0.075 mg/24hr (Climara)......
enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............ estradiol td patch weekly 0.1 mg/24hr (Climara)..........
enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............ estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)
enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............ (Climara)......................................................................
enoxaparin sodium inj 100 mg/ml (Lovenox)............... estradiol vaginal tab 10 mcg (Vagifem)........................
enoxaparin sodium inj 120 mg/0.8ml (Lovenox).......... ESTROPIPATE – estropipate tab 0.75 mg...................
enoxaparin sodium inj 150 mg/ml (Lovenox)............... ESTROPIPATE – estropipate tab 1.5 mg.....................
enoxaparin sodium inj 300 mg/3ml (Lovenox)............. ESTROPIPATE – estropipate tab 3 mg........................
entacapone tab 200 mg (Comtan)................................ eszopiclone tab 1 mg (Lunesta)...................................
entecavir tab 0.5 mg (Baraclude)................................. eszopiclone tab 2 mg (Lunesta)...................................
entecavir tab 1 mg (Baraclude).................................... eszopiclone tab 3 mg (Lunesta)...................................
ENTRESTO – sacubitril-valsartan tab 24-26 mg......... ethambutol hcl tab 100 mg (Myambutol)......................
ENTRESTO – sacubitril-valsartan tab 49-51 mg......... ethambutol hcl tab 400 mg (Myambutol)......................
ENTRESTO – sacubitril-valsartan tab 97-103 mg....... ethosuximide cap 250 mg (Zarontin)............................
EPCLUSA – sofosbuvir-velpatasvir tab 400-100 ethosuximide soln 250 mg/5ml (Zarontin)....................
mg................................................................................ ethynodiol diacetate & ethinyl estradiol tab 1 mg-50
EPINEPHRINE – epinephrine solution auto-injector 0.15 mcg...............................................................................
mg/0.3ml (1:2000)....................................................... exemestane tab 25 mg (Aromasin)..............................
EPINEPHRINE – epinephrine solution auto-injector 0.3 EXTAVIA – interferon beta-1b for inj kit 0.3 mg............
mg/0.3ml (1:1000).......................................................
F
EQ MULTIVITAMINS ADULT GU – multiple vitamins w/
minerals chew tab....................................................... FALESSA – levomefolate glucosamine tab 1 mg (folate
ergocalciferol cap 50000 unit........................................ equivalent)....................................................................
erythromycin gel 2% (Erygel)....................................... famotidine for susp 40 mg/5ml (Pepcid).......................
erythromycin ophth oint 5 mg/gm................................. famotidine tab 10 mg....................................................
erythromycin pads 2%.................................................. famotidine tab 20 mg (Pepcid).....................................
erythromycin soln 2%.................................................... famotidine tab 40 mg (Pepcid).....................................
escitalopram oxalate soln 5 mg/5ml (base equiv)........ fe fumarate-vit c-vit b12-fa cap 460 (151 fe)-60-0.01-1
escitalopram oxalate tab 5 mg (base equiv) mg................................................................................
(Lexapro)...................................................................... fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240
escitalopram oxalate tab 10 mg (base equiv) mg................................................................................
(Lexapro)...................................................................... fe fum-iron polysacch complex-fa-b cmplx-c-zn-mn-cu cap
escitalopram oxalate tab 20 mg (base equiv) (Tandem plus)..............................................................
(Lexapro)...................................................................... felodipine tab er 24hr 2.5 mg.......................................
estazolam tab 1 mg...................................................... felodipine tab er 24hr 5 mg..........................................
estazolam tab 2 mg...................................................... felodipine tab er 24hr 10 mg........................................
estradiol & norethindrone acetate tab 0.5-0.1 mg fenofibrate micronized cap 43 mg................................
(Activella)..................................................................... fenofibrate micronized cap 67 mg (Lofibra)..................
estradiol & norethindrone acetate tab 1-0.5 mg fenofibrate micronized cap 134 mg (Lofibra)................
(Activella)..................................................................... fenofibrate micronized cap 200 mg (Lofibra)................
estradiol tab 0.5 mg (Estrace)...................................... fenofibrate tab 160 mg..................................................
87
2017
fenofibrate tab 54 mg (Lofibra)..................................... fluconazole tab 200 mg (Diflucan)................................
fenofibrate tab 48 mg (Tricor)....................................... flucytosine cap 250 mg (Ancobon)...............................
fenofibrate tab 145 mg (Tricor)..................................... flucytosine cap 500 mg (Ancobon)...............................
fentanyl td patch 72hr 12 mcg/hr (Duragesic).............. fludrocortisone acetate tab 0.1 mg...............................
fentanyl td patch 72hr 25 mcg/hr (Duragesic).............. FLULAVAL 2014-2015 – influenza virus vaccine split im
fentanyl td patch 72hr 50 mcg/hr (Duragesic).............. susp..............................................................................
fentanyl td patch 72hr 75 mcg/hr (Duragesic).............. FLULAVAL QUADRIVALENT 201 – influenza virus
fentanyl td patch 72hr 100 mcg/hr (Duragesic)............ vaccine split quadrivalent im inj..................................
ferrous fumarate-fa-b complex-c-zn-mg-mn-cu tab 106-1 FLULAVAL QUADRIVALENT 201 – influenza virus vac
mg................................................................................ split quadrivalent susp pref syr 0.5ml.........................
ferrous fumarate-folic acid tab 324-1 mg..................... FLUNISOLIDE – flunisolide nasal soln 25 mcg/act
ferrous sulfate tab ec 325 mg (65 mg fe (0.025%).......................................................................
equivalent).................................................................... fluocinolone acetonide cream 0.01%...........................
ferrous sulfate tab 325 mg (65 mg elemental fe)......... fluocinolone acetonide cream 0.025% (Synalar)..........
fexofenadine hcl susp 30 mg/5ml (6 mg/ml)................ fluocinolone acetonide oint 0.025% (Synalar)..............
fexofenadine hcl tab 60 mg.......................................... fluocinolone acetonide soln 0.01% (Synalar)...............
fexofenadine hcl tab 180 mg........................................ fluocinonide cream 0.05%............................................
finasteride tab 5 mg (Proscar)...................................... fluocinonide emulsified base cream 0.05%..................
FIRAZYR – icatibant acetate inj 30 mg/3ml (base fluocinonide gel 0.05%..................................................
equivalent).................................................................... fluocinonide oint 0.05%.................................................
FISH OIL ULTRA – omega-3 fatty acids cap 1400 fluocinonide soln 0.05%................................................
mg................................................................................ fluorometholone ophth susp 0.1% (Fml liquifilm).........
flecainide acetate tab 50 mg........................................ fluorouracil cream 5% (Efudex)....................................
flecainide acetate tab 100 mg...................................... fluoxetine hcl cap 10 mg (Prozac)................................
flecainide acetate tab 150 mg...................................... fluoxetine hcl cap 20 mg (Prozac)................................
FLEET LIQUID GLYCERIN SUP – glycerin enema adult fluoxetine hcl solution 20 mg/5ml.................................
5.4 gm/average delivered dose.................................. fluphenazine decanoate inj 25 mg/ml...........................
FLOVENT DISKUS – fluticasone propionate aer pow ba FLUPHENAZINE HCL – fluphenazine hcl elixir 2.5
50 mcg/blister.............................................................. mg/5ml..........................................................................
FLOVENT DISKUS – fluticasone propionate aer pow ba FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/
100 mcg/blister............................................................ ml..................................................................................
FLOVENT DISKUS – fluticasone propionate aer pow ba fluphenazine hcl tab 1 mg............................................
250 mcg/blister............................................................ fluphenazine hcl tab 2.5 mg.........................................
FLOVENT HFA – fluticasone propionate hfa inhal aer 110 fluphenazine hcl tab 5 mg............................................
mcg/act (125/valve)..................................................... fluphenazine hcl tab 10 mg..........................................
FLOVENT HFA – fluticasone propionate hfa inhal aer 220 flurbiprofen sodium ophth soln 0.03% (Ocufen)...........
mcg/act (250/valve)..................................................... flurbiprofen tab 50 mg...................................................
FLOVENT HFA – fluticasone propionate hfa inhal aero 44 flurbiprofen tab 100 mg.................................................
mcg/act (50/valve)....................................................... flutamide cap 125 mg...................................................
FLUAD 2016-2017 – influenza vac type a&b surface ant FLUTICASONE PROPIONATE/SA – fluticasone-
adj susp pref syr 0.5 ml.............................................. salmeterol aer powder ba 55-14 mcg/act...................
FLUARIX QUADRIVALENT 2015 – influenza virus vac FLUTICASONE PROPIONATE/SA – fluticasone-
split quadrivalent susp pref syr 0.5ml......................... salmeterol aer powder ba 113-14 mcg/act.................
FLUARIX QUADRIVALENT 2016 – influenza virus vac FLUTICASONE PROPIONATE/SA – fluticasone-
split quadrivalent susp pref syr 0.5ml......................... salmeterol aer powder ba 232-14 mcg/act.................
FLUARIX QUADRIVALENT 2017 – influenza virus vac fluticasone propionate cream 0.05% (Cutivate)...........
split quadrivalent susp pref syr 0.5ml......................... fluticasone propionate nasal susp 50 mcg/act.............
FLUCELVAX QUADRIVALENT 20 – influenza vac tiss-cult fluticasone propionate oint 0.005%..............................
subunt quad susp pref syr 0.5 ml............................... FLUVIRIN 2015-2016 – influenza vac type a&b surface
FLUCELVAX QUADRIVALENT 20 – influenza vac tissue- antigen susp pref syr 0.5 ml.......................................
cultured subunit quadrivalent im susp........................ FLUVIRIN 2016-2017 – influenza vac type a&b surface
fluconazole for susp 10 mg/ml (Diflucan)..................... antigen susp pref syr 0.5 ml.......................................
fluconazole for susp 40 mg/ml (Diflucan)..................... FLUVIRIN 2017-2018 – influenza vac type a&b surface
fluconazole tab 50 mg (Diflucan).................................. antigen susp pref syr 0.5 ml.......................................
fluconazole tab 100 mg (Diflucan)................................ FLUVIRIN 2015-2016 – influenza virus vaccine types a &
fluconazole tab 150 mg (Diflucan)................................ b surface antigen im susp...........................................
88
2017
FLUVIRIN 2016-2017 – influenza virus vaccine types a & gabapentin oral soln 250 mg/5ml (Neurontin)..............
b surface antigen im susp........................................... gabapentin tab 600 mg (Neurontin)..............................
FLUVIRIN 2017-2018 – influenza virus vaccine types a & gabapentin tab 800 mg (Neurontin)..............................
b surface antigen im susp........................................... gemfibrozil tab 600 mg (Lopid).....................................
fluvoxamine maleate tab 25 mg................................... GENTAK – gentamicin sulfate ophth oint 0.3%............
fluvoxamine maleate tab 50 mg................................... gentamicin sulfate cream 0.1%....................................
fluvoxamine maleate tab 100 mg................................. GENTAMICIN SULFATE – gentamicin sulfate oint
FLUZONE HIGH-DOSE PF 2015 – influenza virus vac 0.1%.............................................................................
split high-dose pf susp pref syr 0.5ml......................... gentamicin sulfate ophth soln 0.3%..............................
FLUZONE HIGH-DOSE PF 2016 – influenza virus vac GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab
split high-dose pf susp pref syr 0.5ml......................... 150-150-200-10 mg.....................................................
FLUZONE HIGH-DOSE PF 2017 – influenza virus vac glatiramer acetate soln prefilled syringe 20 mg/ml
split high-dose pf susp pref syr 0.5ml......................... (Copaxone)..................................................................
FLUZONE QUADRIVALENT 2015 – influenza virus glimepiride tab 1 mg (Amaryl)......................................
vaccine split quadrivalent im inj.................................. glimepiride tab 2 mg (Amaryl)......................................
FLUZONE QUADRIVALENT 2016 – influenza virus glimepiride tab 4 mg (Amaryl)......................................
vaccine split quadrivalent im inj.................................. glipizide tab er 24hr 2.5 mg (Glucotrol xl)....................
FLUZONE QUADRIVALENT 2017 – influenza virus glipizide tab er 24hr 5 mg (Glucotrol xl).......................
vaccine split quadrivalent im inj.................................. glipizide tab er 24hr 10 mg (Glucotrol xl).....................
FLUZONE QUADRIVALENT 2016 – influenza virus glipizide tab 5 mg (Glucotrol)........................................
vaccine split quadrivalent inj 0.5 ml............................ glipizide tab 10 mg (Glucotrol)......................................
FLUZONE QUADRIVALENT 2015 – influenza virus vac GLUCAGON EMERGENCY KIT – glucagon (rdna) for inj
split quadrivalent susp pref syr 0.5ml......................... kit 1 mg........................................................................
FLUZONE QUADRIVALENT 2016 – influenza virus vac glyburide-metformin tab 1.25-250 mg..........................
split quadrivalent susp pref syr 0.5ml......................... glyburide-metformin tab 2.5-500 mg (Glucovance)......
FLUZONE QUADRIVALENT 2017 – influenza virus vac glyburide-metformin tab 5-500 mg (Glucovance).........
split quadrivalent susp pref syr 0.5ml......................... glyburide micronized tab 1.5 mg (Glynase)..................
FLUZONE SPLIT 2015-2016 – influenza virus vaccine glyburide micronized tab 3 mg (Glynase).....................
split im susp................................................................. glyburide micronized tab 6 mg (Glynase).....................
FOLBEE PLUS CZ – b-complex w/ c-biotin-minerals & glyburide tab 1.25 mg...................................................
folic acid tab 5 mg....................................................... glyburide tab 2.5 mg.....................................................
folic acid tab 400 mcg................................................... glyburide tab 5 mg........................................................
folic acid tab 800 mcg................................................... glycerin suppos 1 gm....................................................
folic acid tab 1 mg........................................................ glycerin suppos 2 gm....................................................
folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 glycopyrrolate tab 1 mg (Robinul)................................
mg................................................................................ glycopyrrolate tab 2 mg (Robinul forte)........................
folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg........ griseofulvin microsize susp 125 mg/5ml......................
folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg (Folgard griseofulvin microsize tab 500 mg................................
rx)................................................................................. griseofulvin ultramicrosize tab 125 mg (Gris-peg)........
fosinopril sodium & hydrochlorothiazide tab 10-12.5 griseofulvin ultramicrosize tab 250 mg (Gris-peg)........
mg................................................................................ guaifenesin-codeine soln 100-10 mg/5ml.....................
fosinopril sodium & hydrochlorothiazide tab 20-12.5 guaifenesin liquid 100 mg/5ml......................................
mg................................................................................ guanfacine hcl tab er 24hr 1 mg (base equiv)
fosinopril sodium tab 10 mg......................................... (Intuniv)........................................................................
fosinopril sodium tab 20 mg......................................... guanfacine hcl tab er 24hr 2 mg (base equiv)
fosinopril sodium tab 40 mg......................................... (Intuniv)........................................................................
fructose-dextrose-phosphoric acid oral soln................. guanfacine hcl tab er 24hr 3 mg (base equiv)
furosemide oral soln 10 mg/ml..................................... (Intuniv)........................................................................
furosemide tab 20 mg (Lasix)....................................... guanfacine hcl tab er 24hr 4 mg (base equiv)
furosemide tab 40 mg (Lasix)....................................... (Intuniv)........................................................................
furosemide tab 80 mg (Lasix)....................................... guanfacine hcl tab 1 mg...............................................
G guanfacine hcl tab 2 mg...............................................
89
2017
haloperidol decanoate im soln 50 mg/ml (Haldol HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled
decanoate 50).............................................................. syringe kit 40 mg/0.8ml...............................................
haloperidol decanoate im soln 100 mg/ml (Haldol HUMIRA PEN – adalimumab pen-injector kit 40
decanoate 100)............................................................ mg/0.8ml......................................................................
haloperidol lactate oral conc 2 mg/ml........................... HUMIRA PEN-CROHNS DISEASE – adalimumab pen-
haloperidol tab 0.5 mg.................................................. injector kit 40 mg/0.8ml...............................................
haloperidol tab 1 mg..................................................... HUMIRA PEN-PSORIASIS STAR – adalimumab pen-
haloperidol tab 2 mg..................................................... injector kit 40 mg/0.8ml...............................................
haloperidol tab 5 mg..................................................... HUMULIN 70/30 – insulin nph isophane & regular human
haloperidol tab 10 mg................................................... inj 100 unit/ml (70-30).................................................
haloperidol tab 20 mg................................................... HUMULIN 70/30 KWIKPEN – insulin nph & regular susp
HELIXATE FS – antihemophilic factor (recombinant) for inj pen-inj 100 unit/ml (70-30)..........................................
kit 250 unit................................................................... HUMULIN N – insulin nph (human) (isophane) inj 100
HELIXATE FS – antihemophilic factor (recombinant) for inj unit/ml...........................................................................
kit 500 unit................................................................... HUMULIN N KWIKPEN – insulin nph (human) (isophane)
HELIXATE FS – antihemophilic factor (recombinant) for inj susp pen-injector 100 unit/ml......................................
kit 1000 unit................................................................. HUMULIN R – insulin regular (human) inj 100 unit/
HELIXATE FS – antihemophilic factor (recombinant) for inj ml..................................................................................
kit 2000 unit................................................................. hydralazine hcl tab 10 mg............................................
HELIXATE FS – antihemophilic factor (recombinant) for inj hydralazine hcl tab 25 mg............................................
kit 3000 unit................................................................. hydralazine hcl tab 50 mg............................................
HEMOFIL M – antihemophilic factor (human) for inj 250 hydralazine hcl tab 100 mg..........................................
unit................................................................................ hydrochlorothiazide cap 12.5 mg (Microzide)..............
HEMOFIL M – antihemophilic factor (human) for inj 500 hydrochlorothiazide tab 12.5 mg..................................
unit................................................................................ hydrochlorothiazide tab 25 mg.....................................
HEMOFIL M – antihemophilic factor (human) for inj 1000 hydrochlorothiazide tab 50 mg.....................................
unit................................................................................ hydrocodone-acetaminophen soln 7.5-325 mg/15ml
HEMOFIL M – antihemophilic factor (human) for inj 1700 (Hycet)..........................................................................
unit................................................................................ hydrocodone-acetaminophen tab 2.5-325 mg.............
HUMALOG – insulin lispro inj 100 unit/ml.................... hydrocodone-acetaminophen tab 7.5-325 mg
HUMALOG – insulin lispro soln cartridge 100 unit/ (Norco).........................................................................
ml.................................................................................. hydrocodone-acetaminophen tab 5-325 mg
HUMALOG JUNIOR KWIKPEN – insulin lispro soln pen- (Norco).........................................................................
injector 100 unit/ml...................................................... hydrocodone-acetaminophen tab 10-325 mg
HUMALOG KWIKPEN – insulin lispro soln pen-injector (Norco).........................................................................
100 unit/ml................................................................... hydrocortisone butyrate oint 0.1% (Locoid)..................
HUMALOG KWIKPEN – insulin lispro soln pen-injector hydrocortisone cream 0.5%..........................................
200 unit/ml................................................................... hydrocortisone cream 1%.............................................
HUMALOG MIX 75/25 – insulin lispro prot & lispro inj 100 hydrocortisone cream 2.5%..........................................
unit/ml (75-25)............................................................. hydrocortisone enema 100 mg/60ml (Cortenema).......
HUMALOG MIX 50/50 – insulin lispro protamine & lispro hydrocortisone lotion 2.5%...........................................
inj 100 unit/ml (50-50)................................................. hydrocortisone oint 0.5%..............................................
HUMALOG MIX 50/50 KWIKPEN – insulin lispro prot & hydrocortisone oint 1%.................................................
lispro sus pen-inj 100 unit/ml (50-50)......................... hydrocortisone oint 2.5%..............................................
HUMALOG MIX 75/25 KWIKPEN – insulin lispro prot & hydrocortisone rectal cream 2.5% (Anusol-hc)............
lispro sus pen-inj 100 unit/ml (75-25)......................... hydrocortisone rectal cream 1% (Proctocort)...............
HUMATE-P – antihemophilic factor/vwf (human) for inj hydrocortisone tab 5 mg (Cortef)..................................
500-1200 unit............................................................... hydrocortisone tab 10 mg (Cortef)................................
HUMATE-P – antihemophilic factor/vwf (human) for inj hydrocortisone tab 20 mg (Cortef)................................
1000-2400 unit............................................................. hydrocortisone valerate cream 0.2%............................
HUMIRA – adalimumab prefilled syringe kit 10 hydrocortisone valerate oint 0.2% (Westcort)..............
mg/0.2ml...................................................................... hydrocortisone w/ acetic acid otic soln 1-2%...............
HUMIRA – adalimumab prefilled syringe kit 20 hydromorphone hcl liqd 1 mg/ml (Dilaudid)..................
mg/0.4ml...................................................................... hydromorphone hcl tab 2 mg (Dilaudid).......................
HUMIRA – adalimumab prefilled syringe kit 40 hydromorphone hcl tab 4 mg (Dilaudid).......................
mg/0.8ml...................................................................... hydromorphone hcl tab 8 mg (Dilaudid).......................
90
2017
hydroxychloroquine sulfate tab 200 mg (Plaquenil)..... INVIRASE – saquinavir mesylate cap 200 mg.............
hydroxyurea cap 500 mg (Hydrea)............................... INVIRASE – saquinavir mesylate tab 500 mg..............
HYDROXYZINE HCL – hydroxyzine hcl im soln 25 mg/ ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml......
ml.................................................................................. ipratropium bromide inhal soln 0.02%..........................
hydroxyzine hcl syrup 10 mg/5ml................................. irbesartan-hydrochlorothiazide tab 150-12.5 mg
hydroxyzine hcl tab 10 mg............................................ (Avalide).......................................................................
hydroxyzine hcl tab 25 mg............................................ irbesartan-hydrochlorothiazide tab 300-12.5 mg
hydroxyzine hcl tab 50 mg............................................ (Avalide).......................................................................
hydroxyzine pamoate cap 25 mg (Vistaril)................... irbesartan tab 75 mg (Avapro)......................................
hydroxyzine pamoate cap 50 mg (Vistaril)................... irbesartan tab 150 mg (Avapro)....................................
hyoscyamine sulfate elixir 0.125 mg/5ml..................... irbesartan tab 300 mg (Avapro)....................................
hyoscyamine sulfate soln 0.125 mg/ml........................ iron combination cap.....................................................
hyoscyamine sulfate tab disint 0.125 mg iron-docusate-b12-folic acid-c-e-cu-biotin tab 150-1 mg
(Anaspaz)..................................................................... (Hematron-af)...............................................................
hyoscyamine sulfate tab er 12hr 0.375 mg iron-folic acid-vit c-vit b6-vit b12-zinc tab 150-1.25 mg
(Levbid)........................................................................ (Corvite 150)................................................................
hyoscyamine sulfate tab 0.125 mg (Levsin)................. iron polysacch complex-vit b12-fa cap 150-0.025-1
hyoscyamine sulfate tab sl 0.125 mg (Levsin/sl).......... mg................................................................................
I irrigation solution, physiological....................................
ISENTRESS HD – raltegravir potassium tab 600 mg
IBRANCE – palbociclib cap 75 mg............................... (base equiv).................................................................
IBRANCE – palbociclib cap 100 mg............................. ISENTRESS – raltegravir potassium chew tab 25 mg
IBRANCE – palbociclib cap 125 mg............................. (base equiv).................................................................
ibuprofen cap 200 mg................................................... ISENTRESS – raltegravir potassium chew tab 100 mg
ibuprofen susp 100 mg/5ml.......................................... (base equiv).................................................................
ibuprofen tab 200 mg.................................................... ISENTRESS – raltegravir potassium packet for susp 100
ibuprofen tab 400 mg.................................................... mg (base equiv)..........................................................
ibuprofen tab 600 mg.................................................... ISENTRESS – raltegravir potassium tab 400 mg (base
ibuprofen tab 800 mg.................................................... equiv)............................................................................
imatinib mesylate tab 100 mg (base equivalent) isoniazid tab 100 mg.....................................................
(Gleevec)...................................................................... isoniazid tab 300 mg.....................................................
imatinib mesylate tab 400 mg (base equivalent) ISOSORBIDE DINITRATE ER – isosorbide dinitrate tab er
(Gleevec)...................................................................... 40 mg...........................................................................
imipramine hcl tab 10 mg (Tofranil).............................. isosorbide dinitrate tab 10 mg......................................
imipramine hcl tab 25 mg (Tofranil).............................. isosorbide dinitrate tab 20 mg......................................
imipramine hcl tab 50 mg (Tofranil).............................. isosorbide dinitrate tab 30 mg......................................
imiquimod cream 5% (Aldara)...................................... isosorbide dinitrate tab 5 mg (Isordil titradose)............
indapamide tab 1.25 mg............................................... isosorbide mononitrate tab er 24hr 30 mg...................
indapamide tab 2.5 mg................................................. isosorbide mononitrate tab er 24hr 60 mg...................
indomethacin cap er 75 mg.......................................... isosorbide mononitrate tab er 24hr 120 mg.................
indomethacin cap 25 mg.............................................. isosorbide mononitrate tab 10 mg................................
indomethacin cap 50 mg.............................................. isosorbide mononitrate tab 20 mg................................
INSULIN SYRINGE/0.5ML/30G.................................... isotretinoin cap 10 mg..................................................
INTELENCE – etravirine tab 25 mg............................. isotretinoin cap 20 mg..................................................
INTELENCE – etravirine tab 100 mg........................... itraconazole cap 100 mg (Sporanox)...........................
INTELENCE – etravirine tab 200 mg........................... ivermectin tab 3 mg (Stromectol).................................
INVEGA SUSTENNA – paliperidone palmitate im IXINITY – coagulation factor ix (recombinant) for inj 500
extended-release susp 39 mg/0.25ml........................ unit................................................................................
INVEGA SUSTENNA – paliperidone palmitate im IXINITY – coagulation factor ix (recombinant) for inj 1000
extended-release susp 78 mg/0.5ml.......................... unit................................................................................
INVEGA SUSTENNA – paliperidone palmitate im IXINITY – coagulation factor ix (recombinant) for inj 1500
extended-release susp 156 mg/ml............................. unit................................................................................
INVEGA SUSTENNA – paliperidone palmitate im
extended-release susp 234 mg/1.5ml........................
INVEGA SUSTENNA – paliperidone palmitate im extend-
release susp 117 mg/0.75ml.......................................
91
2017
92
2017
letrozole tab 2.5 mg (Femara)...................................... linezolid for susp 100 mg/5ml (Zyvox)..........................
LEUCOVORIN CALCIUM – leucovorin calcium tab 10 linezolid tab 600 mg (Zyvox)........................................
mg................................................................................ liothyronine sodium tab 5 mcg (Cytomel).....................
LEUCOVORIN CALCIUM – leucovorin calcium tab 15 liothyronine sodium tab 25 mcg (Cytomel)...................
mg................................................................................ liothyronine sodium tab 50 mcg (Cytomel)...................
leucovorin calcium tab 5 mg......................................... lisinopril & hydrochlorothiazide tab 10-12.5 mg
leucovorin calcium tab 25 mg....................................... (Zestoretic)...................................................................
LEUKERAN – chlorambucil tab 2 mg........................... lisinopril & hydrochlorothiazide tab 20-12.5 mg
levetiracetam oral soln 100 mg/ml (Keppra)................ (Zestoretic)...................................................................
levetiracetam tab er 24hr 500 mg (Keppra xr)............. lisinopril & hydrochlorothiazide tab 20-25 mg
levetiracetam tab er 24hr 750 mg (Keppra xr)............. (Zestoretic)...................................................................
levetiracetam tab 250 mg (Keppra).............................. lisinopril tab 5 mg (Prinivil)...........................................
levetiracetam tab 500 mg (Keppra).............................. lisinopril tab 10 mg (Prinivil).........................................
levetiracetam tab 750 mg (Keppra).............................. lisinopril tab 20 mg (Prinivil).........................................
levetiracetam tab 1000 mg (Keppra)............................ lisinopril tab 2.5 mg (Zestril).........................................
levobunolol hcl ophth soln 0.5% (Betagan).................. lisinopril tab 30 mg (Zestril)..........................................
levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... lisinopril tab 40 mg (Zestril)..........................................
levocarnitine tab 330 mg (Carnitor).............................. lithium carbonate cap 300 mg......................................
levocetirizine dihydrochloride tab 5 mg........................ lithium carbonate cap 150 mg (Lithium carbonate)......
LEVOFLOXACIN – levofloxacin oral soln 25 mg/ lithium carbonate cap 600 mg (Lithium carbonate)......
ml.................................................................................. lithium carbonate tab er 450 mg...................................
levofloxacin ophth soln 0.5%........................................ lithium carbonate tab er 300 mg (Lithobid)...................
levofloxacin tab 250 mg (Levaquin).............................. lithium carbonate tab 300 mg.......................................
levofloxacin tab 500 mg (Levaquin).............................. LITHIUM – lithium oral solution 8 meq/5ml..................
levofloxacin tab 750 mg (Levaquin).............................. LMD 10% DEXTROSE 5% – dextran 40 inj 10% in
levonorgestrel & ethinyl estradiol tab 0.1 mg-20 d5w...............................................................................
mcg............................................................................... loperamide hcl cap 2 mg..............................................
levonorgestrel & ethinyl estradiol tab 0.15 mg-30 loperamide hcl liq 1 mg/5ml (0.2 mg/ml)......................
mcg............................................................................... loperamide hcl tab 2 mg...............................................
levonorgestrel-eth estra tab lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)
0.05-30/0.075-40/0.125-30mg-mcg............................ (Kaletra).......................................................................
levonorgestrel tab 1.5 mg............................................. loratadine syrup 5 mg/5ml............................................
levothyroxine sodium tab 25 mcg (Synthroid).............. loratadine tab 10 mg.....................................................
levothyroxine sodium tab 50 mcg (Synthroid).............. lorazepam conc 2 mg/ml..............................................
levothyroxine sodium tab 75 mcg (Synthroid).............. lorazepam tab 0.5 mg (Ativan).....................................
levothyroxine sodium tab 88 mcg (Synthroid).............. lorazepam tab 1 mg (Ativan)........................................
levothyroxine sodium tab 100 mcg (Synthroid)............ lorazepam tab 2 mg (Ativan)........................................
levothyroxine sodium tab 112 mcg (Synthroid)............ losartan potassium & hydrochlorothiazide tab 50-12.5 mg
levothyroxine sodium tab 125 mcg (Synthroid)............ (Hyzaar).......................................................................
levothyroxine sodium tab 137 mcg (Synthroid)............ losartan potassium & hydrochlorothiazide tab 100-12.5
levothyroxine sodium tab 150 mcg (Synthroid)............ mg (Hyzaar).................................................................
levothyroxine sodium tab 175 mcg (Synthroid)............ losartan potassium & hydrochlorothiazide tab 100-25 mg
levothyroxine sodium tab 200 mcg (Synthroid)............ (Hyzaar).......................................................................
levothyroxine sodium tab 300 mcg (Synthroid)............ losartan potassium tab 25 mg (Cozaar).......................
LEXIVA – fosamprenavir calcium susp 50 mg/ml (base losartan potassium tab 50 mg (Cozaar).......................
equiv)............................................................................ losartan potassium tab 100 mg (Cozaar).....................
LEXIVA – fosamprenavir calcium tab 700 mg (base lovastatin tab 10 mg.....................................................
equiv)............................................................................ lovastatin tab 20 mg.....................................................
lidocaine hcl cream 3%................................................. lovastatin tab 40 mg.....................................................
lidocaine hcl gel 2%...................................................... loxapine succinate cap 5 mg........................................
lidocaine hcl soln 4% (Xylocaine)................................. loxapine succinate cap 10 mg......................................
lidocaine hcl viscous soln 2%....................................... loxapine succinate cap 25 mg......................................
lidocaine oint 5%........................................................... loxapine succinate cap 50 mg......................................
lidocaine patch 5% (Lidoderm)..................................... LYNPARZA – olaparib cap 50 mg................................
lidocaine-prilocaine cream 2.5-2.5%............................
lidocaine-prilocaine cream kit 2.5-2.5%........................
93
2017
94
2017
metoprolol succinate tab er 24hr 50 mg (tartrate equiv) mometasone furoate solution 0.1% (lotion)..................
(Toprol xl)..................................................................... MONOCLATE-P – antihemophilic factor (human) for inj kit
metoprolol succinate tab er 24hr 100 mg (tartrate equiv) 1000 unit......................................................................
(Toprol xl)..................................................................... MONOCLATE-P – antihemophilic factor (human) for inj kit
metoprolol succinate tab er 24hr 200 mg (tartrate equiv) 1500 unit......................................................................
(Toprol xl)..................................................................... MONONINE – coagulation factor ix for inj 1000
metoprolol tartrate tab 25 mg....................................... unit................................................................................
metoprolol tartrate tab 50 mg (Lopressor).................... montelukast sodium chew tab 4 mg (base equiv)
metoprolol tartrate tab 100 mg (Lopressor).................. (Singulair).....................................................................
metronidazole cap 375 mg (Flagyl).............................. montelukast sodium chew tab 5 mg (base equiv)
metronidazole cream 0.75% (Metrocream).................. (Singulair).....................................................................
metronidazole gel 0.75%.............................................. montelukast sodium oral granules packet 4 mg (base
metronidazole gel 1% (Metrogel)................................. equiv) (Singulair).........................................................
metronidazole tab 250 mg (Flagyl)............................... montelukast sodium tab 10 mg (base equiv)
metronidazole tab 500 mg (Flagyl)............................... (Singulair).....................................................................
metronidazole vaginal gel 0.75% (Metrogel- MORPHINE SULFATE – morphine sulfate suppos 5
vaginal)......................................................................... mg................................................................................
mexiletine hcl cap 150 mg............................................ MORPHINE SULFATE – morphine sulfate suppos 10
mexiletine hcl cap 200 mg............................................ mg................................................................................
mexiletine hcl cap 250 mg............................................ MORPHINE SULFATE – morphine sulfate suppos 20
miconazole nitrate aerosol pow 2%.............................. mg................................................................................
miconazole nitrate cream 2%....................................... MORPHINE SULFATE – morphine sulfate suppos 30
miconazole nitrate vaginal cream 2%.......................... mg................................................................................
midodrine hcl tab 2.5 mg.............................................. MORPHINE SULFATE – morphine sulfate tab 15
midodrine hcl tab 5 mg................................................. mg................................................................................
midodrine hcl tab 10 mg............................................... MORPHINE SULFATE – morphine sulfate tab 30
minocycline hcl cap 75 mg........................................... mg................................................................................
minocycline hcl cap 50 mg (Minocin)........................... morphine sulfate oral soln 10 mg/5ml..........................
minocycline hcl cap 100 mg (Minocin)......................... morphine sulfate oral soln 20 mg/5ml..........................
minocycline hcl tab 50 mg............................................ morphine sulfate oral soln 100 mg/5ml (20 mg/ml)......
minocycline hcl tab 75 mg............................................ multiple vitamins w/ iron tab.........................................
minocycline hcl tab 100 mg.......................................... multiple vitamins w/ minerals & fa tab 1.25 mg
minoxidil tab 2.5 mg...................................................... (Corvite).......................................................................
minoxidil tab 10 mg....................................................... multiple vitamins w/ minerals cap.................................
MIRENA – levonorgestrel releasing iud 20 mcg/day (52 multiple vitamins w/ minerals tab (Strovite forte)..........
mg total)....................................................................... multiple vitamin tab.......................................................
mirtazapine orally disintegrating tab 15 mg (Remeron mupirocin oint 2%.........................................................
soltab)........................................................................... mycophenolate mofetil cap 250 mg (Cellcept).............
mirtazapine orally disintegrating tab 30 mg (Remeron mycophenolate mofetil for oral susp 200 mg/ml
soltab)........................................................................... (Cellcept)......................................................................
mirtazapine orally disintegrating tab 45 mg (Remeron mycophenolate mofetil tab 500 mg (Cellcept)..............
soltab)........................................................................... mycophenolate sodium tab dr 180 mg (mycophenolic acid
mirtazapine tab 15 mg (Remeron)................................ equiv) (Myfortic)...........................................................
mirtazapine tab 30 mg (Remeron)................................ mycophenolate sodium tab dr 360 mg (mycophenolic acid
mirtazapine tab 45 mg (Remeron)................................ equiv) (Myfortic)...........................................................
misoprostol tab 100 mcg (Cytotec)............................... MYLERAN – busulfan tab 2 mg...................................
misoprostol tab 200 mcg (Cytotec)............................... N
modafinil tab 100 mg (Provigil).....................................
modafinil tab 200 mg (Provigil)..................................... nabumetone tab 500 mg...............................................
moexipril hcl tab 7.5 mg............................................... nabumetone tab 750 mg...............................................
moexipril hcl tab 15 mg................................................ nadolol tab 20 mg (Corgard)........................................
moexipril-hydrochlorothiazide tab 7.5-12.5 mg............ nadolol tab 40 mg (Corgard)........................................
moexipril-hydrochlorothiazide tab 15-12.5 mg............. nadolol tab 80 mg (Corgard)........................................
moexipril-hydrochlorothiazide tab 15-25 mg................ NALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/
mometasone furoate cream 0.1% (Elocon).................. ml..................................................................................
mometasone furoate oint 0.1% (Elocon)......................
95
2017
NALOXONE HCL – naloxone hcl soln prefilled syringe 2 nicotine td patch 24hr 21 mg/24hr................................
mg/2ml.......................................................................... nifedipine cap 10 mg (Procardia).................................
naltrexone hcl tab 50 mg.............................................. nifedipine tab er 24hr 30 mg (Adalat cc)......................
naproxen sodium tab 220 mg....................................... nifedipine tab er 24hr 60 mg (Adalat cc)......................
naproxen sodium tab 275 mg....................................... nifedipine tab er 24hr 90 mg (Adalat cc)......................
naproxen sodium tab 550 mg (Anaprox ds)................. nifedipine tab er 24hr osmotic release 30 mg (Procardia
naproxen tab ec 375 mg (Ec-naprosyn)....................... xl)..................................................................................
naproxen tab ec 500 mg (Ec-naprosyn)....................... nifedipine tab er 24hr osmotic release 60 mg (Procardia
naproxen tab 250 mg.................................................... xl)..................................................................................
naproxen tab 375 mg.................................................... nifedipine tab er 24hr osmotic release 90 mg (Procardia
naproxen tab 500 mg (Naprosyn)................................. xl)..................................................................................
NARCAN – naloxone hcl nasal spray 4 mg/0.1ml........ nitrofurantoin macrocrystalline cap 25 mg
NATACYN – natamycin ophth susp 5%....................... (Macrodantin)...............................................................
nateglinide tab 60 mg (Starlix)...................................... nitrofurantoin macrocrystalline cap 50 mg
nateglinide tab 120 mg (Starlix).................................... (Macrodantin)...............................................................
NECON 10/11-28 – norethindrone-eth estradiol tab nitrofurantoin macrocrystalline cap 100 mg
0.5-35/1-35 mg-mcg (10/11)....................................... (Macrodantin)...............................................................
neomycin-bacitracin-polymyxin oint.............................. nitrofurantoin monohydrate macrocrystalline cap 100 mg
neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt (Macrobid)....................................................................
op oin........................................................................... nitrofurantoin susp 25 mg/5ml (Furadantin).................
neomycin-polymy-gramicid op sol 1.75-10000-0.025mg- nitroglycerin cap er 2.5 mg...........................................
unt-mg/ml (Neosporin)................................................. nitroglycerin cap er 6.5 mg...........................................
neomycin-polymyxin-dexamethasone ophth oint 0.1% nitroglycerin cap er 9 mg..............................................
(Maxitrol)...................................................................... nitroglycerin sl tab 0.3 mg (Nitrostat)...........................
neomycin-polymyxin-dexamethasone ophth susp 0.1% nitroglycerin sl tab 0.4 mg (Nitrostat)...........................
(Maxitrol)...................................................................... nitroglycerin sl tab 0.6 mg (Nitrostat)...........................
neomycin-polymyxin-hc otic soln 1%........................... nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........
neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........
ml-1%........................................................................... nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........
neomycin sulfate tab 500 mg....................................... nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........
NEUPOGEN – filgrastim inj 300 mcg/ml...................... nizatidine cap 150 mg...................................................
NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ nizatidine cap 300 mg...................................................
ml)................................................................................ NIZATIDINE – nizatidine oral soln 15 mg/ml................
NEUPOGEN – filgrastim soln prefilled syringe 300 norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg
mcg/0.5ml..................................................................... (Loestrin fe 1/20).........................................................
NEUPOGEN – filgrastim soln prefilled syringe 480 norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg
mcg/0.8ml (600 mcg/ml)............................................. (Loestrin 1/20-21)........................................................
nevirapine tab er 24hr 100 mg (Viramune xr).............. norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg
nevirapine tab er 24hr 400 mg (Viramune xr).............. (Loestrin 1.5/30-21).....................................................
nevirapine tab 200 mg (Viramune)............................... norethindrone acetate-ethinyl estradiol tab 1 mg-5
NEXAVAR – sorafenib tosylate tab 200 mg (base mcg...............................................................................
equivalent).................................................................... norethindrone acetate tab 5 mg (Aygestin)..................
NEXPLANON – etonogestrel subdermal implant 68 norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg
mg................................................................................ (Ortho-cyclen)..............................................................
niacin cap er 250 mg.................................................... norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35
niacin cap er 500 mg.................................................... mg-mcg (Ortho tri-cyclen)...........................................
niacin tab er 250 mg..................................................... norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25
niacin tab er 500 mg..................................................... mg-mcg (Ortho tri-cyclen lo).......................................
niacin tab er 750 mg..................................................... nortriptyline hcl cap 10 mg (Pamelor)..........................
niacin tab 100 mg......................................................... nortriptyline hcl cap 25 mg (Pamelor)..........................
niacin tab 500 mg......................................................... nortriptyline hcl cap 50 mg (Pamelor)..........................
NIACIN TR – niacin tab er 1000 mg............................ nortriptyline hcl cap 75 mg (Pamelor)..........................
nicotine polacrilex gum 2 mg........................................ NORVIR – ritonavir cap 100 mg...................................
nicotine polacrilex gum 4 mg........................................ NORVIR – ritonavir oral soln 80 mg/ml........................
nicotine td patch 24hr 7 mg/24hr.................................. NORVIR – ritonavir tab 100 mg...................................
nicotine td patch 24hr 14 mg/24hr................................
96
2017
NOVOLIN 70/30 – insulin nph isophane & regular human olanzapine tab 2.5 mg (Zyprexa)..................................
inj 100 unit/ml (70-30)................................................. olanzapine tab 5 mg (Zyprexa).....................................
NOVOLIN 70/30 RELION – insulin nph isophane & olanzapine tab 7.5 mg (Zyprexa)..................................
regular human inj 100 unit/ml (70-30)........................ olanzapine tab 10 mg (Zyprexa)...................................
NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ olanzapine tab 15 mg (Zyprexa)...................................
ml.................................................................................. olanzapine tab 20 mg (Zyprexa)...................................
NOVOLIN N RELION – insulin nph (human) (isophane) inj omega-3 fatty acids cap delayed release 1000 mg......
100 unit/ml................................................................... omega-3 fatty acids cap delayed release 1200 mg......
NOVOLIN R – insulin regular (human) inj 100 unit/ omega-3 fatty acids cap 500 mg..................................
ml.................................................................................. omega-3 fatty acids cap 435 mg..................................
NOVOLIN R RELION – insulin regular (human) inj 100 omega-3 fatty acids cap 1000 mg................................
unit/ml........................................................................... omega-3 fatty acids cap 1200 mg................................
NOVOLOG FLEXPEN – insulin aspart soln pen-injector OMEGA-3 IQ – omega-3 fatty acids chew tab 240
100 unit/ml................................................................... mg................................................................................
NOVOLOG – insulin aspart inj 100 unit/ml................... OMEGA-3 – omega-3 fatty acids cap 1400 mg...........
NOVOLOG MIX 70/30 – insulin aspart prot & aspart OMEGA-3 2100 – omega-3 fatty acids cap 1050
(human) inj 100 unit/ml (70-30).................................. mg................................................................................
NOVOLOG MIX 70/30 PREFILL – insulin aspart prot & OMEGA POWER – omega-3 fatty acids cap 1050
aspart sus pen-inj 100 unit/ml (70-30)........................ mg................................................................................
NOVOLOG PENFILL – insulin aspart soln cartridge 100 omeprazole cap delayed release 20 mg......................
unit/ml........................................................................... omeprazole cap delayed release 40 mg......................
NOXAFIL – posaconazole susp 40 mg/ml................... OMNIFLEX DIAPHRAGM.............................................
NOXAFIL – posaconazole tab delayed release 100 OMNITROPE – somatropin for inj 5.8 mg....................
mg................................................................................ ondansetron hcl oral soln 4 mg/5ml (Zofran)...............
NUVARING – etonogestrel-ethinyl estradiol va ring ondansetron hcl tab 24 mg...........................................
0.120-0.015 mg/24hr................................................... ondansetron hcl tab 4 mg (Zofran)...............................
nystatin cream 100000 unit/gm.................................... ondansetron hcl tab 8 mg (Zofran)...............................
nystatin oint 100000 unit/gm......................................... ondansetron orally disintegrating tab 4 mg (Zofran
nystatin susp 100000 unit/ml........................................ odt)...............................................................................
nystatin tab 500000 unit............................................... ondansetron orally disintegrating tab 8 mg (Zofran
nystatin topical powder 100000 unit/gm....................... odt)...............................................................................
O oral electrolyte solution.................................................
orphenadrine citrate tab er 12hr 100 mg......................
OCEAN BLUE MINICAPS OMEGA – omega-3 fatty acids oseltamivir phosphate cap 30 mg (base equiv)
cap 350 mg.................................................................. (Tamiflu).......................................................................
octreotide acetate inj 50 mcg/ml (0.05 mg/ml) oseltamivir phosphate cap 45 mg (base equiv)
(Sandostatin)................................................................ (Tamiflu).......................................................................
octreotide acetate inj 100 mcg/ml (0.1 mg/ml) oseltamivir phosphate cap 75 mg (base equiv)
(Sandostatin)................................................................ (Tamiflu).......................................................................
octreotide acetate inj 200 mcg/ml (0.2 mg/ml) oxcarbazepine susp 300 mg/5ml (60 mg/ml)
(Sandostatin)................................................................ (Trileptal)......................................................................
octreotide acetate inj 500 mcg/ml (0.5 mg/ml) oxcarbazepine tab 150 mg (Trileptal)...........................
(Sandostatin)................................................................ oxcarbazepine tab 300 mg (Trileptal)...........................
octreotide acetate inj 1000 mcg/ml (1 mg/ml) oxcarbazepine tab 600 mg (Trileptal)...........................
(Sandostatin)................................................................ oxybutynin chloride syrup 5 mg/5ml.............................
ofloxacin ophth soln 0.3% (Ocuflox)............................. oxybutynin chloride tab er 24hr 5 mg (Ditropan xl)......
ofloxacin otic soln 0.3% (Floxin otic)............................ oxybutynin chloride tab er 24hr 10 mg (Ditropan
olanzapine for im inj 10 mg (Zyprexa).......................... xl)..................................................................................
olanzapine orally disintegrating tab 5 mg (Zyprexa oxybutynin chloride tab er 24hr 15 mg (Ditropan
zydis)............................................................................ xl)..................................................................................
olanzapine orally disintegrating tab 10 mg (Zyprexa oxybutynin chloride tab 5 mg........................................
zydis)............................................................................ OXYCODONE/ACETAMINOPHEN – oxycodone w/
olanzapine orally disintegrating tab 15 mg (Zyprexa acetaminophen soln 5-325 mg/5ml............................
zydis)............................................................................ oxycodone-aspirin tab 4.8355-325 mg.........................
olanzapine orally disintegrating tab 20 mg (Zyprexa oxycodone hcl conc 100 mg/5ml (20 mg/ml)................
zydis)............................................................................ oxycodone hcl soln 5 mg/5ml.......................................
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2017
oxycodone hcl tab 10 mg............................................. phenobarbital tab 16.2 mg............................................
oxycodone hcl tab 20 mg............................................. phenobarbital tab 32.4 mg............................................
oxycodone hcl tab 5 mg (Roxicodone)......................... phenobarbital tab 64.8 mg............................................
oxycodone hcl tab 15 mg (Roxicodone)....................... phenobarbital tab 97.2 mg............................................
oxycodone hcl tab 30 mg (Roxicodone)....................... phenoxybenzamine hcl cap 10 mg (Dibenzyline).........
oxycodone w/ acetaminophen tab 5-325 mg PHENYLEPHRINE/GUAIFENESIN – phenylephrine-
(Percocet)..................................................................... guaifenesin liqd 7.5-100 mg/5ml (1.5-20 mg/ml)........
oxycodone w/ acetaminophen tab 7.5-325 mg phenylephrine-guaifenesin tab 10-400 mg...................
(Percocet)..................................................................... phenylephrine hcl tab 10 mg........................................
oxycodone w/ acetaminophen tab 10-325 mg phenylephrine w/ dm-gg liqd 5-10-200 mg/5ml............
(Percocet)..................................................................... phenytoin chew tab 50 mg (Dilantin infatabs)..............
P phenytoin sodium extended cap 100 mg (Dilantin)......
phenytoin sodium extended cap 200 mg
pantoprazole sodium ec tab 20 mg (base equiv) (Phenytek)....................................................................
(Protonix)...................................................................... phenytoin sodium extended cap 300 mg
pantoprazole sodium ec tab 40 mg (base equiv) (Phenytek)....................................................................
(Protonix)...................................................................... phenytoin susp 125 mg/5ml (Dilantin-125)...................
PAPAVERINE HCL – papaverine hcl inj 30 mg/ml....... pilocarpine hcl ophth soln 1% (Isopto carpine)............
PARAGARD INTRAUTERINE COP – copper iud........ pilocarpine hcl ophth soln 2% (Isopto carpine)............
paromomycin sulfate cap 250 mg................................ pilocarpine hcl ophth soln 4% (Isopto carpine)............
paroxetine hcl tab 10 mg (Paxil)................................... pilocarpine hcl tab 5 mg (Salagen)...............................
paroxetine hcl tab 20 mg (Paxil)................................... pilocarpine hcl tab 7.5 mg (Salagen)............................
paroxetine hcl tab 30 mg (Paxil)................................... pimozide tab 1 mg (Orap).............................................
paroxetine hcl tab 40 mg (Paxil)................................... pimozide tab 2 mg (Orap).............................................
PEDIA-LAX – glycerin liquid suppos 2.8 gm (2.7 pioglitazone hcl tab 15 mg (base equiv) (Actos)..........
ml)................................................................................ pioglitazone hcl tab 30 mg (base equiv) (Actos)..........
pediatric multiple vitamin w/ c & fa chew tab............... pioglitazone hcl tab 45 mg (base equiv) (Actos)..........
pediatric multiple vitamin w/ minerals & c drops 45 mg/ piroxicam cap 10 mg (Feldene)....................................
ml.................................................................................. piroxicam cap 20 mg (Feldene)....................................
peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm PLAN B ONE-STEP – levonorgestrel tab 1.5 mg........
(Colyte-flavor packs)................................................... PNV TABS 29-1............................................................
peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm podofilox soln 0.5%.......................................................
(Golytely)...................................................................... polyethylene glycol 3350 oral powder..........................
peg 3350-kcl-sod bicarb-nacl for soln 420 gm (Nulytely/ polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%
flavor pack).................................................................. (Polytrim)......................................................................
penicillin v potassium for soln 125 mg/5ml................... pot & sod citrates w/ cit ac soln 550-500-334
penicillin v potassium for soln 250 mg/5ml................... mg/5ml..........................................................................
penicillin v potassium tab 250 mg................................ potassium bicarbonate effer tab 25 meq......................
penicillin v potassium tab 500 mg................................ potassium chloride cap er 8 meq (Micro-k)..................
pentoxifylline tab er 400 mg......................................... potassium chloride cap er 10 meq (Micro-k)................
perindopril erbumine tab 2 mg...................................... POTASSIUM CHLORIDE ER – potassium chloride tab er
perindopril erbumine tab 4 mg (Aceon)........................ 8 meq (600 mg)...........................................................
perindopril erbumine tab 8 mg (Aceon)........................ potassium chloride microencapsulated crys er tab 10
permethrin cream 5% (Elimite)..................................... meq..............................................................................
permethrin creme rinse 1%.......................................... potassium chloride microencapsulated crys er tab 20
perphenazine tab 2 mg................................................. meq..............................................................................
perphenazine tab 4 mg................................................. potassium chloride oral soln 10% (20 meq/15ml)........
perphenazine tab 8 mg................................................. POTASSIUM CHLORIDE – potassium chloride oral soln
perphenazine tab 16 mg............................................... 20% (40 meq/15ml).....................................................
phenazopyridine hcl tab 100 mg (Pyridium)................. potassium chloride powder packet 20 meq..................
phenazopyridine hcl tab 200 mg (Pyridium)................. potassium chloride tab er 10 meq (K-tab)....................
phenobarbital elixir 20 mg/5ml...................................... potassium chloride tab er 8 meq (600 mg)..................
PHENOBARBITAL – phenobarbital tab 15 mg............ potassium citrate & citric acid powder pack 3300-1002
PHENOBARBITAL – phenobarbital tab 30 mg............ mg................................................................................
PHENOBARBITAL – phenobarbital tab 60 mg............ potassium citrate & citric acid soln 1100-334
PHENOBARBITAL – phenobarbital tab 100 mg.......... mg/5ml..........................................................................
98
2017
potassium citrate tab er 5 meq (540 mg) (Urocit-k PREZISTA – darunavir ethanolate susp 100 mg/ml (base
5).................................................................................. equiv)............................................................................
potassium citrate tab er 10 meq (1080 mg) (Urocit-k PREZISTA – darunavir ethanolate tab 75 mg (base
10)................................................................................ equiv)............................................................................
potassium citrate tab er 15 meq (1620 mg) (Urocit-k PREZISTA – darunavir ethanolate tab 150 mg (base
15)................................................................................ equiv)............................................................................
pot bicarbonate & chloride effer tab 25 meq................ PREZISTA – darunavir ethanolate tab 600 mg (base
pot phos monobasic w/sod phos di & monobas tab equiv)............................................................................
155-852-130mg (K-phos neutral)................................ PREZISTA – darunavir ethanolate tab 800 mg (base
PRALUENT – alirocumab subcutaneous soln pen-injector equiv)............................................................................
75 mg/ml...................................................................... PRIFTIN – rifapentine tab 150 mg...............................
PRALUENT – alirocumab subcutaneous soln pen-injector PRIMAQUINE PHOSPHATE – primaquine phosphate tab
150 mg/ml.................................................................... 26.3 mg (15 mg base)................................................
pramipexole dihydrochloride tab 0.125 mg primidone tab 50 mg (Mysoline)...................................
(Mirapex)...................................................................... primidone tab 250 mg (Mysoline).................................
pramipexole dihydrochloride tab 0.25 mg probenecid tab 500 mg.................................................
(Mirapex)...................................................................... PROBUPHINE IMPLANT KIT – buprenorphine hcl
pramipexole dihydrochloride tab 0.5 mg (Mirapex)...... subdermal implant 74.2 mg (base equiv)...................
pramipexole dihydrochloride tab 0.75 mg prochlorperazine maleate tab 5 mg (base
(Mirapex)...................................................................... equivalent)....................................................................
pramipexole dihydrochloride tab 1 mg (Mirapex)......... prochlorperazine maleate tab 10 mg (base
pramipexole dihydrochloride tab 1.5 mg (Mirapex)...... equivalent)....................................................................
pravastatin sodium tab 10 mg...................................... prochlorperazine suppos 25 mg...................................
pravastatin sodium tab 20 mg (Pravachol)................... PROFILNINE – factor ix complex for inj 500 unit.........
pravastatin sodium tab 40 mg (Pravachol)................... PROFILNINE – factor ix complex for inj 1000 unit.......
pravastatin sodium tab 80 mg (Pravachol)................... PROFILNINE – factor ix complex for inj 1500 unit.......
prazosin hcl cap 1 mg (Minipress)............................... PROFILNINE SD – factor ix complex for inj 500
prazosin hcl cap 2 mg (Minipress)............................... unit................................................................................
prazosin hcl cap 5 mg (Minipress)............................... PROFILNINE SD – factor ix complex for inj 1000
prednicarbate cream 0.1% (Dermatop)........................ unit................................................................................
prednicarbate oint 0.1% (Dermatop)............................ PROFILNINE SD – factor ix complex for inj 1500
prednisolone acetate ophth susp 1% (Pred forte)........ unit................................................................................
PREDNISOLONE SODIUM PHOSP – prednisolone progesterone im in oil 50 mg/ml...................................
sodium phosphate ophth soln 1%.............................. progesterone micronized cap 100 mg
prednisolone sod phosphate oral soln 15 mg/5ml (base (Prometrium)................................................................
equiv)............................................................................ progesterone micronized cap 200 mg
prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml (Prometrium)................................................................
base) (Pediapred)........................................................ promethazine hcl suppos 12.5 mg...............................
prednisolone syrup 15 mg/5ml (usp solution promethazine hcl suppos 25 mg..................................
equivalent).................................................................... promethazine hcl syrup 6.25 mg/5ml...........................
PREDNISONE – prednisone oral soln 5 mg/5ml......... promethazine hcl tab 12.5 mg......................................
PREDNISONE – prednisone tab 50 mg....................... promethazine hcl tab 25 mg.........................................
prednisone tab 1 mg..................................................... promethazine hcl tab 50 mg.........................................
prednisone tab 2.5 mg.................................................. promethazine w/ codeine syrup 6.25-10 mg/5ml.........
prednisone tab 5 mg..................................................... PRO NUTRIENTS OMEGA 3 – omega-3 fatty acids cap
prednisone tab 10 mg................................................... delayed release 332.5 mg..........................................
prednisone tab 20 mg................................................... propafenone hcl tab 150 mg.........................................
PREMPRO – conjugated estrogen-medroxyprogest propafenone hcl tab 225 mg.........................................
acetate tab 0.3-1.5 mg................................................ propafenone hcl tab 300 mg.........................................
PREMPRO – conjugated estrogen-medroxyprogest proparacaine hcl ophth soln 0.5%................................
acetate tab 0.45-1.5 mg.............................................. PROPRANOLOL/HYDROCHLOROTH – propranolol &
PREMPRO – conjugated estrogen-medroxyprogest hydrochlorothiazide tab 40-25 mg..............................
acetate tab 0.625-5 mg............................................... propranolol hcl tab 10 mg.............................................
PRESERVISION AREDS 2 + MU – multiple vitamins w/ propranolol hcl tab 20 mg.............................................
minerals cap................................................................ propranolol hcl tab 40 mg.............................................
propranolol hcl tab 60 mg.............................................
99
2017
propranolol hcl tab 80 mg............................................. RECOMBINATE – antihemophilic factor (recombinant) for
propylthiouracil tab 50 mg............................................ inj 1241-1800 unit........................................................
psyllium powder 28.3%................................................. RECOMBINATE – antihemophilic factor (recombinant) for
psyllium powder 30%.................................................... inj 1801-2400 unit........................................................
psyllium powder 30.9%................................................. RELENZA DISKHALER – zanamivir aero powder breath
psyllium powder 48.57%............................................... activated 5 mg/blister..................................................
psyllium powder 58.6%................................................. RELHIST BP – brompheniramine & phenylephrine tab
psyllium powder 95%.................................................... 4-10 mg........................................................................
PULMOZYME – dornase alfa inhal soln 1 mg/ml......... REPATHA – evolocumab subcutaneous soln prefilled
pyrazinamide tab 500 mg............................................. syringe 140 mg/ml.......................................................
pyridostigmine bromide tab 60 mg (Mestinon)............. REPATHA SURECLICK – evolocumab subcutaneous soln
auto-injector 140 mg/ml...............................................
Q
RESCRIPTOR – delavirdine mesylate tab 100 mg......
QC CALAMINE – calamine lotion................................. RESCRIPTOR – delavirdine mesylate tab 200 mg......
quetiapine fumarate tab 25 mg (Seroquel)................... REVLIMID – lenalidomide cap 5 mg............................
quetiapine fumarate tab 50 mg (Seroquel)................... REVLIMID – lenalidomide cap 10 mg..........................
quetiapine fumarate tab 100 mg (Seroquel)................. REVLIMID – lenalidomide cap 15 mg..........................
quetiapine fumarate tab 200 mg (Seroquel)................. REVLIMID – lenalidomide cap 20 mg..........................
quetiapine fumarate tab 300 mg (Seroquel)................. REVLIMID – lenalidomide cap 25 mg..........................
quetiapine fumarate tab 400 mg (Seroquel)................. REVLIMID – lenalidomide caps 2.5 mg.......................
quinapril hcl tab 5 mg (Accupril)................................... REYATAZ – atazanavir sulfate cap 150 mg (base
quinapril hcl tab 10 mg (Accupril)................................. equiv)............................................................................
quinapril hcl tab 20 mg (Accupril)................................. REYATAZ – atazanavir sulfate cap 200 mg (base
quinapril hcl tab 40 mg (Accupril)................................. equiv)............................................................................
quinapril-hydrochlorothiazide tab 10-12.5 mg REYATAZ – atazanavir sulfate cap 300 mg (base
(Accuretic).................................................................... equiv)............................................................................
quinapril-hydrochlorothiazide tab 20-12.5 mg REYATAZ – atazanavir sulfate oral powder packet 50 mg
(Accuretic).................................................................... (base equiv).................................................................
quinapril-hydrochlorothiazide tab 20-25 mg ribavirin cap 200 mg (Rebetol).....................................
(Accuretic).................................................................... rifabutin cap 150 mg (Mycobutin).................................
quinidine gluconate tab er 324 mg............................... rifampin cap 300 mg.....................................................
QUINIDINE SULFATE – quinidine sulfate tab 200 rifampin cap 150 mg (Rifadin)......................................
mg................................................................................ riluzole tab 50 mg (Rilutek)...........................................
QUINIDINE SULFATE – quinidine sulfate tab 300 ringer's solution for irrigation........................................
mg................................................................................ risperidone orally disintegrating tab 0.25 mg...............
QVAR – beclomethasone diprop inhal aero soln 40 mcg/ risperidone orally disintegrating tab 0.5 mg (Risperdal m-
act (50/valve)............................................................... tab)...............................................................................
QVAR – beclomethasone diprop inhal aero soln 80 mcg/ risperidone orally disintegrating tab 1 mg (Risperdal m-
act (100/valve)............................................................. tab)...............................................................................
R risperidone orally disintegrating tab 2 mg (Risperdal m-
tab)...............................................................................
raloxifene hcl tab 60 mg (Evista).................................. risperidone orally disintegrating tab 3 mg (Risperdal m-
ramipril cap 1.25 mg (Altace)....................................... tab)...............................................................................
ramipril cap 2.5 mg (Altace)......................................... risperidone orally disintegrating tab 4 mg (Risperdal m-
ramipril cap 5 mg (Altace)............................................ tab)...............................................................................
ramipril cap 10 mg (Altace).......................................... risperidone soln 1 mg/ml (Risperdal)............................
ranitidine hcl syrup 15 mg/ml (75 mg/5ml)................... risperidone tab 0.25 mg (Risperdal).............................
ranitidine hcl tab 75 mg................................................ risperidone tab 0.5 mg (Risperdal)...............................
ranitidine hcl tab 150 mg (Zantac)................................ risperidone tab 1 mg (Risperdal)..................................
ranitidine hcl tab 300 mg (Zantac)................................ risperidone tab 2 mg (Risperdal)..................................
RECOMBINATE – antihemophilic factor (recombinant) for risperidone tab 3 mg (Risperdal)..................................
inj 220-400 unit............................................................ risperidone tab 4 mg (Risperdal)..................................
RECOMBINATE – antihemophilic factor (recombinant) for RIXUBIS – coagulation factor ix (recombinant) for inj 250
inj 401-800 unit............................................................ unit................................................................................
RECOMBINATE – antihemophilic factor (recombinant) for RIXUBIS – coagulation factor ix (recombinant) for inj 500
inj 801-1240 unit.......................................................... unit................................................................................
100
2017
RIXUBIS – coagulation factor ix (recombinant) for inj 1000 simvastatin tab 5 mg (Zocor)........................................
unit................................................................................ simvastatin tab 10 mg (Zocor)......................................
RIXUBIS – coagulation factor ix (recombinant) for inj 2000 simvastatin tab 20 mg (Zocor)......................................
unit................................................................................ simvastatin tab 40 mg (Zocor)......................................
RIXUBIS – coagulation factor ix (recombinant) for inj 3000 sirolimus tab 0.5 mg (Rapamune)................................
unit................................................................................ sirolimus tab 1 mg (Rapamune)...................................
rizatriptan benzoate oral disintegrating tab 5 mg (base eq) sirolimus tab 2 mg (Rapamune)...................................
(Maxalt-mlt).................................................................. SKYLA – levonorgestrel releasing iud 14 mcg/day (13.5
rizatriptan benzoate oral disintegrating tab 10 mg (base mg total).......................................................................
eq) (Maxalt-mlt)........................................................... sodium chloride irrigation soln 0.9%.............................
rizatriptan benzoate tab 5 mg (base equivalent) sodium chloride soln nebu 0.9%..................................
(Maxalt)........................................................................ sodium chloride soln nebu 3%.....................................
rizatriptan benzoate tab 10 mg (base equivalent) sodium chloride soln nebu 10%...................................
(Maxalt)........................................................................ sodium chloride soln nebu 7% (Hyper-sal)..................
ropinirole hydrochloride tab 0.25 mg (Requip)............. sodium citrate & citric acid soln 500-334 mg/5ml (Shohls
ropinirole hydrochloride tab 0.5 mg (Requip)............... solution modi)..............................................................
ropinirole hydrochloride tab 1 mg (Requip).................. sodium fluoride chew tab 0.25 mg f (from 0.55 mg
ropinirole hydrochloride tab 2 mg (Requip).................. naf)...............................................................................
ropinirole hydrochloride tab 3 mg (Requip).................. sodium fluoride chew tab 0.5 mg f (from 1.1 mg
ropinirole hydrochloride tab 4 mg (Requip).................. naf)...............................................................................
ropinirole hydrochloride tab 5 mg (Requip).................. sodium fluoride chew tab 1 mg f (from 2.2 mg naf)......
rosuvastatin calcium tab 5 mg (Crestor)...................... sodium fluoride cream 1.1% (Prevident 5000 plus).....
rosuvastatin calcium tab 10 mg (Crestor).................... sodium fluoride gel 1.1% (0.5% f) (Prevident
rosuvastatin calcium tab 20 mg (Crestor).................... fluoride)........................................................................
rosuvastatin calcium tab 40 mg (Crestor).................... sodium fluoride rinse 0.2%...........................................
RUBRACA – rucaparib camsylate tab 200 mg (base SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from
equivalent).................................................................... 2.2 mg naf)..................................................................
RUBRACA – rucaparib camsylate tab 250 mg (base sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop
equivalent).................................................................... naf)...............................................................................
RUBRACA – rucaparib camsylate tab 300 mg (base sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml
equivalent).................................................................... naf)...............................................................................
RU-HIST D – brompheniramine & phenylephrine tab 4-10 sodium polystyrene sulfonate oral susp 15
mg................................................................................ gm/60ml.......................................................................
RYDAPT – midostaurin cap 25 mg.............................. sodium polystyrene sulfonate powder..........................
S sodium polystyrene sulfonate rectal susp 30
gm/120ml.....................................................................
saline nasal spray 0.65%.............................................. sotalol hcl tab 240 mg..................................................
salsalate tab 500 mg.................................................... sotalol hcl tab 80 mg (Betapace)..................................
salsalate tab 750 mg.................................................... sotalol hcl tab 120 mg (Betapace)................................
selegiline hcl cap 5 mg (Eldepryl)................................ sotalol hcl tab 160 mg (Betapace)................................
selegiline hcl tab 5 mg.................................................. SOVALDI – sofosbuvir tab 400 mg..............................
selenium sulfide lotion 2.5%......................................... SPIRIVA HANDIHALER – tiotropium bromide
SELZENTRY – maraviroc tab 25 mg........................... monohydrate inhal cap 18 mcg (base equiv).............
SELZENTRY – maraviroc tab 75 mg........................... spironolactone & hydrochlorothiazide tab 25-25 mg
SELZENTRY – maraviroc tab 300 mg......................... (Aldactazide)................................................................
sennosides tab 8.6 mg................................................. spironolactone tab 25 mg (Aldactone).........................
SEREVENT DISKUS – salmeterol xinafoate aer pow ba spironolactone tab 50 mg (Aldactone).........................
50 mcg/dose (base equiv).......................................... spironolactone tab 100 mg (Aldactone).......................
sertraline hcl oral conc 20 mg/ml (Zoloft)..................... SPRYCEL – dasatinib tab 20 mg.................................
sertraline hcl tab 25 mg (Zoloft)................................... SPRYCEL – dasatinib tab 50 mg.................................
sertraline hcl tab 50 mg (Zoloft)................................... SPRYCEL – dasatinib tab 70 mg.................................
sertraline hcl tab 100 mg (Zoloft)................................. SPRYCEL – dasatinib tab 80 mg.................................
sildenafil citrate tab 20 mg (Revatio)............................ SPRYCEL – dasatinib tab 100 mg...............................
silver sulfadiazine cream 1% (Silvadene).................... SPRYCEL – dasatinib tab 140 mg...............................
simethicone chew tab 80 mg........................................ stavudine cap 15 mg (Zerit)..........................................
simethicone susp 40 mg/0.6ml..................................... stavudine cap 20 mg (Zerit)..........................................
101
2017
stavudine cap 30 mg (Zerit).......................................... T
stavudine cap 40 mg (Zerit)..........................................
STIMATE – desmopressin acetate nasal soln 1.5 mg/ tacrolimus cap 0.5 mg (Prograf)...................................
ml.................................................................................. tacrolimus cap 1 mg (Prograf)......................................
STIVARGA – regorafenib tab 40 mg............................ tacrolimus cap 5 mg (Prograf)......................................
SUBOXONE – buprenorphine hcl-naloxone hcl sl film tacrolimus oint 0.03% (Protopic)...................................
2-0.5 mg (base equiv)................................................. tacrolimus oint 0.1% (Protopic).....................................
SUBOXONE – buprenorphine hcl-naloxone hcl sl film 4-1 TAMIFLU – oseltamivir phosphate for susp 6 mg/ml (base
mg (base equiv).......................................................... equiv)............................................................................
SUBOXONE – buprenorphine hcl-naloxone hcl sl film 8-2 tamoxifen citrate tab 10 mg (base equivalent).............
mg (base equiv).......................................................... tamoxifen citrate tab 20 mg (base equivalent).............
SUBOXONE – buprenorphine hcl-naloxone hcl sl film tamsulosin hcl cap 0.4 mg (Flomax)............................
12-3 mg (base equiv).................................................. TARCEVA – erlotinib hcl tab 25 mg (base
sucralfate tab 1 gm (Carafate)...................................... equivalent)....................................................................
sulfacetamide sodium ophth soln 10% (Bleph-10)....... TARCEVA – erlotinib hcl tab 100 mg (base
sulfacetamide sodium-prednisolone ophth soln equivalent)....................................................................
10-0.23(0.25)%............................................................ TARCEVA – erlotinib hcl tab 150 mg (base
sulfacetamide sodium w/ sulfur emulsion 10-1%......... equivalent)....................................................................
sulfacetamide sodium w/ sulfur emulsion 10-5%......... TASIGNA – nilotinib hcl cap 150 mg (base
SULFADIAZINE – sulfadiazine tab 500 mg.................. equivalent)....................................................................
sulfamethoxazole-trimethoprim susp 200-40 TASIGNA – nilotinib hcl cap 200 mg (base
mg/5ml.......................................................................... equivalent)....................................................................
sulfamethoxazole-trimethoprim tab 400-80 mg tazarotene cream 0.1% (Tazorac)................................
(Bactrim)....................................................................... TAZORAC – tazarotene gel 0.05%..............................
sulfamethoxazole-trimethoprim tab 800-160 mg (Bactrim TAZORAC – tazarotene gel 0.1%................................
ds)................................................................................ TECHLITE PEN NEEDLES 29G..................................
sulfasalazine tab delayed release 500 mg (Azulfidine en- temazepam cap 15 mg (Restoril).................................
tabs)............................................................................. temazepam cap 30 mg (Restoril).................................
sulfasalazine tab 500 mg (Azulfidine).......................... temozolomide cap 5 mg (Temodar)..............................
sulindac tab 150 mg..................................................... temozolomide cap 20 mg (Temodar)............................
sulindac tab 200 mg..................................................... temozolomide cap 100 mg (Temodar)..........................
sumatriptan succinate inj 6 mg/0.5ml (Imitrex)............. temozolomide cap 140 mg (Temodar)..........................
sumatriptan succinate solution cartridge 6 mg/0.5ml temozolomide cap 180 mg (Temodar)..........................
(Imitrex statdose ref)................................................... temozolomide cap 250 mg (Temodar)..........................
sumatriptan succinate tab 25 mg (Imitrex)................... terazosin hcl cap 1 mg.................................................
sumatriptan succinate tab 50 mg (Imitrex)................... terazosin hcl cap 2 mg.................................................
sumatriptan succinate tab 100 mg (Imitrex)................. terazosin hcl cap 5 mg.................................................
SUSTIVA – efavirenz cap 50 mg.................................. terazosin hcl cap 10 mg...............................................
SUSTIVA – efavirenz cap 200 mg................................ terbinafine hcl tab 250 mg (Lamisil).............................
SUSTIVA – efavirenz tab 600 mg................................ terbutaline sulfate tab 2.5 mg.......................................
SUTENT – sunitinib malate cap 12.5 mg (base terbutaline sulfate tab 5 mg..........................................
equivalent).................................................................... terconazole vaginal cream 0.8%..................................
SUTENT – sunitinib malate cap 25 mg (base terconazole vaginal cream 0.4% (Terazol 7)................
equivalent).................................................................... terconazole vaginal suppos 80 mg...............................
SUTENT – sunitinib malate cap 37.5 mg (base testosterone cypionate im inj in oil 100 mg/ml (Depo-
equivalent).................................................................... testosterone)................................................................
SUTENT – sunitinib malate cap 50 mg (base testosterone cypionate im inj in oil 200 mg/ml (Depo-
equivalent).................................................................... testosterone)................................................................
SYMBICORT – budesonide-formoterol fumarate dihyd testosterone enanthate im inj in oil 200 mg/ml.............
aerosol 80-4.5 mcg/act................................................ tetracaine hcl ophth soln 0.5%.....................................
SYMBICORT – budesonide-formoterol fumarate dihyd tetrahydroz-dextran-peg-povidone ophth soln
aerosol 160-4.5 mcg/act............................................. 0.05-0.1-1-1%..............................................................
SYNAGIS – palivizumab im soln 50 mg/0.5ml............. THALOMID – thalidomide cap 50 mg..........................
SYNAGIS – palivizumab im soln 100 mg/ml................ THALOMID – thalidomide cap 100 mg........................
THALOMID – thalidomide cap 150 mg........................
theophylline soln 80 mg/15ml.......................................
102
2017
theophylline tab er 12hr 100 mg................................... trazodone hcl tab 150 mg.............................................
theophylline tab er 12hr 200 mg................................... tretinoin cap 10 mg.......................................................
theophylline tab er 12hr 300 mg................................... tretinoin cream 0.025% (Retin-a).................................
theophylline tab er 12hr 450 mg................................... tretinoin cream 0.05% (Retin-a)....................................
theophylline tab er 24hr 400 mg................................... tretinoin cream 0.1% (Retin-a)......................................
theophylline tab er 24hr 600 mg................................... tretinoin gel 0.01% (Retin-a).........................................
thiamine hcl tab 50 mg................................................. tretinoin gel 0.025% (Retin-a).......................................
thiamine hcl tab 100 mg............................................... triamcinolone acetonide cream 0.025%.......................
thioridazine hcl tab 10 mg............................................ triamcinolone acetonide cream 0.1%...........................
thioridazine hcl tab 25 mg............................................ triamcinolone acetonide cream 0.5%...........................
thioridazine hcl tab 50 mg............................................ triamcinolone acetonide dental paste 0.1%.................
thioridazine hcl tab 100 mg.......................................... triamcinolone acetonide lotion 0.025%.........................
thiothixene cap 1 mg.................................................... triamcinolone acetonide lotion 0.1%.............................
thiothixene cap 2 mg.................................................... triamcinolone acetonide oint 0.025%...........................
thiothixene cap 5 mg.................................................... triamcinolone acetonide oint 0.1%...............................
thiothixene cap 10 mg.................................................. TRIAMINIC NIGHT TIME COLD – diphenhydramine-
thyroid tab 30 mg (1/2 grain) (Armour thyroid)............. phenylephrine syrup 6.25-2.5 mg/5ml........................
thyroid tab 90 mg (1 1/2 grain) (Armour thyroid).......... triamterene & hydrochlorothiazide cap 37.5-25 mg
thyroid tab 60 mg (1 grain) (Armour thyroid)................ (Dyazide)......................................................................
timolol maleate ophth soln 0.25% (Timoptic)............... triamterene & hydrochlorothiazide tab 37.5-25 mg
timolol maleate ophth soln 0.5% (Timoptic)................. (Maxzide-25)................................................................
tioconazole vaginal oint 6.5%....................................... triamterene & hydrochlorothiazide tab 75-50 mg
TIVICAY – dolutegravir sodium tab 10 mg (base (Maxzide).....................................................................
equiv)............................................................................ trifluoperazine hcl tab 1 mg..........................................
TIVICAY – dolutegravir sodium tab 25 mg (base trifluoperazine hcl tab 2 mg..........................................
equiv)............................................................................ trifluoperazine hcl tab 5 mg..........................................
TIVICAY – dolutegravir sodium tab 50 mg (base trifluoperazine hcl tab 10 mg........................................
equiv)............................................................................ trifluridine ophth soln 1% (Viroptic)...............................
tizanidine hcl tab 2 mg (base equivalent)..................... trihexyphenidyl hcl elixir 0.4 mg/ml...............................
tizanidine hcl tab 4 mg (base equivalent) trihexyphenidyl hcl tab 2 mg.........................................
(Zanaflex)..................................................................... trihexyphenidyl hcl tab 5 mg.........................................
tobramycin-dexamethasone ophth susp 0.3-0.1% trimethoprim tab 100 mg...............................................
(Tobradex).................................................................... TRI-VI-SOL – pediatric vitamins adc drops 750 unit-400
tobramycin nebu soln 300 mg/5ml (Tobi)..................... unit-35 mg/ml...............................................................
tobramycin ophth soln 0.3% (Tobrex)........................... TRUVADA – emtricitabine-tenofovir disoproxil fumarate
TOLAZAMIDE – tolazamide tab 250 mg...................... tab 100-150 mg...........................................................
tolnaftate aerosol 1%.................................................... TRUVADA – emtricitabine-tenofovir disoproxil fumarate
topiramate sprinkle cap 15 mg (Topamax sprinkle)...... tab 133-200 mg...........................................................
topiramate sprinkle cap 25 mg (Topamax sprinkle)...... TRUVADA – emtricitabine-tenofovir disoproxil fumarate
topiramate tab 25 mg (Topamax)................................. tab 167-250 mg...........................................................
topiramate tab 50 mg (Topamax)................................. TRUVADA – emtricitabine-tenofovir disoproxil fumarate
topiramate tab 100 mg (Topamax)............................... tab 200-300 mg...........................................................
topiramate tab 200 mg (Topamax)............................... TYMLOS – abaloparatide subcutaneous soln pen-injector
torsemide tab 5 mg....................................................... 3120 mcg/1.56ml.........................................................
torsemide tab 100 mg................................................... U
torsemide tab 10 mg (Demadex)..................................
torsemide tab 20 mg (Demadex).................................. ursodiol cap 300 mg (Actigall)......................................
TRACLEER – bosentan tab 62.5 mg........................... ursodiol tab 250 mg (Urso 250)....................................
TRACLEER – bosentan tab 125 mg............................ ursodiol tab 500 mg (Urso forte)..................................
tramadol hcl tab 50 mg (Ultram)................................... V
trandolapril tab 1 mg.....................................................
trandolapril tab 4 mg..................................................... valacyclovir hcl tab 1 gm (Valtrex)................................
trandolapril tab 2 mg (Mavik)........................................ valacyclovir hcl tab 500 mg (Valtrex)............................
tranexamic acid tab 650 mg (Lysteda)......................... VALCHLOR – mechlorethamine hcl gel 0.016% (base
trazodone hcl tab 50 mg............................................... equivalent)....................................................................
trazodone hcl tab 100 mg.............................................
103
2017
valganciclovir hcl tab 450 mg (base equivalent) VIREAD – tenofovir disoproxil fumarate tab 150
(Valcyte)....................................................................... mg................................................................................
valproate sodium oral soln 250 mg/5ml (base equiv) VIREAD – tenofovir disoproxil fumarate tab 200
(Depakene).................................................................. mg................................................................................
valproic acid cap 250 mg (Depakene).......................... VIREAD – tenofovir disoproxil fumarate tab 250
valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan mg................................................................................
hct)............................................................................... VIREAD – tenofovir disoproxil fumarate tab 300
valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovan mg................................................................................
hct)............................................................................... vitamins a & d oint........................................................
valsartan-hydrochlorothiazide tab 160-25 mg (Diovan VIVITROL – naltrexone for im extended release susp 380
hct)............................................................................... mg................................................................................
valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovan voriconazole for susp 40 mg/ml (Vfend).......................
hct)............................................................................... voriconazole tab 50 mg (Vfend)...................................
valsartan-hydrochlorothiazide tab 320-25 mg (Diovan voriconazole tab 200 mg (Vfend).................................
hct)............................................................................... VOTRIENT – pazopanib hcl tab 200 mg (base
valsartan tab 40 mg (Diovan)....................................... equiv)............................................................................
valsartan tab 80 mg (Diovan)....................................... W
valsartan tab 160 mg (Diovan).....................................
valsartan tab 320 mg (Diovan)..................................... warfarin sodium tab 1 mg (Coumadin).........................
vancomycin hcl cap 125 mg (Vancocin hcl)................. warfarin sodium tab 2 mg (Coumadin).........................
vancomycin hcl cap 250 mg (Vancocin hcl)................. warfarin sodium tab 2.5 mg (Coumadin)......................
venlafaxine hcl cap er 24hr 37.5 mg (base equivalent) warfarin sodium tab 3 mg (Coumadin).........................
(Effexor xr)................................................................... warfarin sodium tab 4 mg (Coumadin).........................
venlafaxine hcl cap er 24hr 75 mg (base equivalent) warfarin sodium tab 5 mg (Coumadin).........................
(Effexor xr)................................................................... warfarin sodium tab 6 mg (Coumadin).........................
venlafaxine hcl cap er 24hr 150 mg (base equivalent) warfarin sodium tab 7.5 mg (Coumadin)......................
(Effexor xr)................................................................... warfarin sodium tab 10 mg (Coumadin).......................
venlafaxine hcl tab 25 mg............................................. water for irrigation, sterile irrigation soln......................
venlafaxine hcl tab 37.5 mg.......................................... X
venlafaxine hcl tab 50 mg.............................................
venlafaxine hcl tab 75 mg............................................. XALKORI – crizotinib cap 200 mg................................
venlafaxine hcl tab 100 mg........................................... XALKORI – crizotinib cap 250 mg................................
VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act XARELTO – rivaroxaban tab 10 mg.............................
(90mcg base equiv)..................................................... XARELTO – rivaroxaban tab 15 mg.............................
verapamil hcl cap er 24hr 120 mg (Verelan)................ XARELTO – rivaroxaban tab 20 mg.............................
verapamil hcl cap er 24hr 180 mg (Verelan)................ XARELTO STARTER PACK – rivaroxaban tab starter
verapamil hcl cap er 24hr 240 mg (Verelan)................ therapy pack 15 mg & 20 mg.....................................
verapamil hcl cap er 24hr 360 mg (Verelan)................ XIFAXAN – rifaximin tab 200 mg..................................
verapamil hcl cap er 24hr 100 mg (Verelan pm).......... XIFAXAN – rifaximin tab 550 mg..................................
verapamil hcl cap er 24hr 200 mg (Verelan pm).......... XTANDI – enzalutamide cap 40 mg.............................
verapamil hcl cap er 24hr 300 mg (Verelan pm).......... XULANE – norelgestromin-ethinyl estradiol td ptwk
verapamil hcl tab er 120 mg (Calan sr)........................ 150-35 mcg/24hr.........................................................
verapamil hcl tab er 180 mg (Calan sr)........................ XYNTHA – antihemophilic factor recombinant paf for inj kit
250 unit........................................................................
verapamil hcl tab er 240 mg (Calan sr)........................
XYNTHA – antihemophilic factor recombinant paf for inj kit
verapamil hcl tab 40 mg...............................................
500 unit........................................................................
verapamil hcl tab 80 mg (Calan)..................................
XYNTHA – antihemophilic factor recombinant paf for inj kit
verapamil hcl tab 120 mg (Calan)................................
1000 unit......................................................................
VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/
XYNTHA – antihemophilic factor recombinant paf for inj kit
ml)................................................................................
2000 unit......................................................................
VIDEX – didanosine for soln 2 gm...............................
XYNTHA SOLOFUSE – antihemophilic factor
VIDEX – didanosine for soln 4 gm...............................
recombinant paf for inj kit 250 unit.............................
VIRACEPT – nelfinavir mesylate tab 250 mg..............
XYNTHA SOLOFUSE – antihemophilic factor
VIRACEPT – nelfinavir mesylate tab 625 mg..............
recombinant paf for inj kit 500 unit.............................
VIRAMUNE – nevirapine susp 50 mg/5ml...................
XYNTHA SOLOFUSE – antihemophilic factor
VIREAD – tenofovir disoproxil fumarate oral powder 40
recombinant paf for inj kit 1000 unit...........................
mg/gm..........................................................................
104
2017
XYNTHA SOLOFUSE – antihemophilic factor ZUBSOLV – buprenorphine hcl-naloxone hcl sl tab 8.6-2.1
recombinant paf for inj kit 2000 unit........................... mg (base eq)...............................................................
XYNTHA SOLOFUSE – antihemophilic factor ZUBSOLV – buprenorphine hcl-naloxone hcl sl tab
recombinant paf for inj kit 3000 unit........................... 11.4-2.9 mg (base eq).................................................
XYREM – sodium oxybate oral solution 500 mg/ml..... ZYCLARA – imiquimod cream 3.75%..........................
Y ZYCLARA PUMP – imiquimod cream 2.5%.................
ZYCLARA PUMP – imiquimod cream 3.75%...............
Z ZYTIGA – abiraterone acetate tab 250 mg..................
ZYTIGA – abiraterone acetate tab 500 mg..................
zaleplon cap 5 mg (Sonata)......................................... ZYVOX – linezolid for susp 100 mg/5ml......................
zaleplon cap 10 mg (Sonata).......................................
ZARXIO – filgrastim-sndz soln prefilled syringe 300
mcg/0.5ml.....................................................................
ZARXIO – filgrastim-sndz soln prefilled syringe 480
mcg/0.8ml.....................................................................
ZELBORAF – vemurafenib tab 240 mg.......................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
3000-10000-16000 unit...............................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
5000-17000-27000 unit...............................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
10000-34000-55000 unit.............................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
15000-51000-82000 unit.............................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
20000-68000-109000 unit...........................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
25000-85000-136000 unit...........................................
ZENPEP – pancrelipase (lip-prot-amyl) dr cap
40000-136000-218000 unit.........................................
ZEPATIER – elbasvir-grazoprevir tab 50-100 mg........
ZIAGEN – abacavir sulfate soln 20 mg/ml (base
equiv)............................................................................
zidovudine cap 100 mg (Retrovir)................................
zidovudine syrup 10 mg/ml (Retrovir)...........................
zidovudine tab 300 mg.................................................
zinc oxide oint 10%.......................................................
zinc oxide oint 20%.......................................................
ziprasidone hcl cap 20 mg (Geodon)...........................
ziprasidone hcl cap 40 mg (Geodon)...........................
ziprasidone hcl cap 60 mg (Geodon)...........................
ziprasidone hcl cap 80 mg (Geodon)...........................
zolpidem tartrate tab 5 mg (Ambien)............................
zolpidem tartrate tab 10 mg (Ambien)..........................
zonisamide cap 50 mg..................................................
zonisamide cap 25 mg (Zonegran)...............................
zonisamide cap 100 mg (Zonegran)............................
ZORTRESS – everolimus tab 0.25 mg........................
ZORTRESS – everolimus tab 0.5 mg..........................
ZORTRESS – everolimus tab 0.75 mg........................
ZUBSOLV – buprenorphine hcl-naloxone hcl sl tab
1.4-0.36 mg (base eq)................................................
ZUBSOLV – buprenorphine hcl-naloxone hcl sl tab
2.9-0.71 mg (base eq)................................................
ZUBSOLV – buprenorphine hcl-naloxone hcl sl tab 5.7-1.4
mg (base eq)...............................................................
105
This formulary was updated on 10/1/2017.