Drug Prior Authorization List
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- Theodore Potter
- 10 years ago
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1 Drug Prior Authorization List This list is a complete list of drugs which require prior authorization (PA) by Paramount Advantage. Paramount Advantage covers all medically necessary Medicaid-covered prescription medications. Most generic drugs will be covered by your prescription drug benefit without prior authorization. Usually, when a brand name drug is available generically, the generic is covered and the brand requires prior authorization. In addition to the list of PA'd drugs below, Paramount may require prior authorization if your doctor prescribes a quantity of medication that exceeds our quantity limits. Most quantity limits are based on FDA guidelines for maximum dose. Your doctor may request prior authorization and provide evidence of medical necessity for any drug on this list or for a prescription that exceeds our quantity limits by calling Paramount (419) or by obtaining a request form at Members may contact Paramount by calling (800) , TTY (888) Prior authorization requests must be completed by your prescribing physician. Some medications that require a prior authorization are part of what is called "Step Therapy". Paramount wants your doctor to prescribe a step-one medication for you before using a step-two or step-three medication. The drugs below are part of step therapy. Step-two or step-three drugs will require the use of a step-one drug first. Drug_Name For a list of medical services requiring prior authorization, please refer to the listing at the following link: To search this document for a specific medication, follow these steps: 1. With the PDF open, click on the Edit menu, choose Find. 2. In the Find box, type the name of the medication you want to find. 3. Click Find Next button until you find the medications you're looking for. Advantage Step Therapy Alternatives ACIPHEX ELIDEL 1% CREAM generic steroid cream or lotion AXERT escitalopram (generic Lexapro) citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline BYETTA metformin, glymepiride, glyburide, Actos, Novolin, Novolog EDARBI generic ACE inhibitors, losartan CELEBREX ibuprofen, naproxen, etodolac, FROVA meloxicam, nabumetone, COLCRYS allopurinol irbesartan (generic AVAPRO) generic ACE inhibitors, losartan + HCTZ CRESTOR lovastatin, pravastatin, simvastatin irbesartan HCTZ (generic AVALIDE) generic ACE inhibitors, losartan CYMBALTA citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine JANUMET metformin, generic sulfonylureas DEXILANT DR JANUVIA metformin, generic sulfonylureas DIOVAN generic ACE inhibitors, losartan KOMBIGLYZE metformin, generic sulfonylureas DIOVAN HCT generic ACE inhibitors, losartan + HCTZ LANSOPRAZOLE (Rx only)
2 LINDANE Pyretherins (Rid), Permethrin (Nix), RELPAX Malathion (Ovide) LIPITOR lovastatin, pravastatin, simvastatin RENVELA calcium acetate LOTRONEX hyoscyamine, dicyclomine, OTC fiber RHINOCORT AQUA NASAL SPRAY fluticasone, flunisolide supplements LYRICA gabapentin SINGULAIR non sedating antihistamine (loratadine, cetirizine, fexofenadine) and a nasal steroid (fluticasone, flunisolide) MAXALT, MAXALT MLT triamcinolone Nasal Spray (generic fluticasone, flunisolide NASACORT) NASONEX fluticasone, flunisolide ULORIC TABLET allopurinol NEXIUM VICTOZA metformin, glymepiride, glyburide, Actos, Novolin, Novolog ONGLYZA metformin, generic sulfonylureas ZEGERID POWDER PAROXETINE CR TABLET citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline ZETIA lovastatin, pravastatin, simvastatin PRILOSEC SUSPENSION ZOMIG, ZOMIG ZMT PROTONIX SUSPENSION ZYFLO non sedating antihistamine (loratadine, cetirizine, fexofenadine) and a nasal steroid (fluticasone, flunisolide) Advantage Prior Authorization List Drugs requiring a PA for clinical or cost reasons 8 MOP AIRAVITE TABLET AMPYRA ER ARCAPTA NEOHALER CAP ABSTRAL AKNE MYCIN OINTMENT AMRIX ER ARICEPT ACANYA GEL PUMP ALAMAST DROPS AMTURNIDE ARTHROTEC EC ACCOLATE ALBENZA TABLET ANABAR CAPLET ASMANEX TWISTHALER ACID JELLY ALINIA ANADROL ASTELIN ACTIMMUNE 2 MILLION UNIT VIAL ALLEGRA ODT 30MG TABLET ANCOBON ATACAND ACTIQ LOZENGE ALLEGRA D 12 HOUR TABLET ANDRODERM PATCH ATACAND HCT ACTIVELLA TABLET ALLEGRA D 24 HOUR TABLET ANDROGEL ATELVIA DR ACTONEL TABLET ALLFEN CD TABLET ANGELIQ ATRALIN GEL ACTONEL WITH CALCIUM TABLET ALOCRIL EYE DROPS ANTARA AURODEX OTIC SOLUTION ACTOPLUS MET T ALOMIDE EYE DROPS ANTIVERT AVANDAMET ACTOPLUS MET XR ALPHAGAN P ANZEMET AVANDARYL ACUVAIL OPHTH SOLUTION ALPHANATE VIAL APEXICON E AVANDIA ACZONE GEL ALPRAZOLAM ER APIDRA SOLOSTAR AVC CREAM ADCIRCA ALPRAZOLAM ODT APIDRA VIAL AVINZA ADOXA ALREX EYE DROPS APLENZIN ER AVONEX ADRENACLICK AUTO IN ALTABAX OINTMENT APOKYN AXERT ADVATE ALTOPREV TABLET APRISO ER AXIRON ADVICOR ALVESCO INHALER ARANESP AZASAN AFINITOR AMITIZA ARCALYST AZASITE EYE DROPS
3 AZELEX CREAM CLARAVIS DIFICID TABLET FEIBA VH IMMUNO AZILECT CLARIFOAM EF EMOLLIENT FOAM DIFIL G TABLET FEMECAL OB TABLET AZOR CLARINEX DILATRATE SR FEMHRT TABLET BACTROBAN CREAM CLARINEX D DIPENTUM CAPSULE FEMRING VAGINAL RING BEBULIN VH CLARIS CLARIFYING WASH DIPROLENE LOTION FEMTRACE TABLET BECONASE CLENIA EMOLLIENT CREAM DIPROLENE AF CREAM FENTANYL CITRATE BENEFIX CLIMARA PRO PATCH DIVIGEL FENTORA BUCCAL TABL BENICAR CLINDESSE VAG CREAM DONATUSSIN DM SYRUP FEROTRINSIC CAPSULE BENICAR HCT CLOBEX DORAL TABLET FERRALET 90 DUAL IRON BENZACLIN GEL CLODERM CREAM DORYX DR TABLET FERRAPLUS 90 TABLET BENZAMYCINPAK GEL CLONAZEPAM DIS TAB DOXYCYCLINE HYC DR FERREX 28 TABLET BENZEFOAM CLONAZEPAM ODT DOXYCYCLINE MONO 75 MG CAPS FERRIPROX TABLET BENZIQ CLORPRES DRONABINOL CAPSULE FERROCITE PLUS TABLET BEPREVE EYE DROPS COARTEM TABLETS DROXIA FEXMID TABLET BESIVANCE COCET TABLET DUET DHA COMBO PAC FEXOFENADINE HCL TABL BETASERON COLESTID DUETACT TABLET FIBRICOR TABLET BEYAZ COLY MYCIN S EAR DROPS DUEXIS TABLET FINACEA BILTRICIDE COMBIGAN EYE DROPS DULERA INHALE FIRAZYR SYRINGE BONIVA COMPLETE NATAL DHA DURAFLU TABLET FLAGYL ER TABLET B PLEX CONCEPT DHA CAPSULE DUREZOL EYE DROPS FLEBOGAMMA DIF VIAL BPO GEL CONDYLOX GEL DYLIX ELIXIR FLECTOR PATCH BREVOXYL 4 COMPLETE PACK CONZIP DYNACIRC CR TABLET FLO PRED BREVOXYL 8 COMPLETE PACK COPAXONE INJECTION KI ED A HIST TABLET SA FLUOR A DAY BRILINTA CORDRAN CM TAPE ED CHLORPED D PEDIATRIC DROP FLUOXETINE DR 90 MG CAPSULE BROMDAY EYE DROPS COREG CR ED CYTE F TABLET FLUOXETINE HCL TABLET BROMFED DM COUGH SYRUP CORTIFOAM AEROSOL ED A HIST DM LIQUID FML FORTE EYE DROPS BROVANA CORTISPORIN CREAM EDECRIN TABLET FOLAST TABLET BROVEX ADT SUSPENSION CORTISPORIN OINTMENT ED FLEX CAPSULE FOLCAPS TABLET BUPHENYL POWDER CORVITE FREE TABLET EDLUAR TABLET FOLGARD RX TABLET BUTISOL SODIUM COTAB AX TABLET EFFER K TABLET FOLIVANE EC BUTRANS PATCH COVERA HS ER ELESTAT EYE DROPS FOLIVANE OB CAPSULE BYSTOLIC CRINONE GEL ELESTRIN GEL FOLIVANE PRX DHA NF CADUET CUTIVATE LOTION ELITE OB FORTAMET ER TABLET CAMBIA POWDER PACKET CUVPOSA SOLUTION EMADINE EYE DROPS FORTEO PEN CAMPRAL DR CYCLESSA TABLET EMSAM 24 HOURS PATCH FORTESTA GEL PUMP CANASA SUPPOSITORY CYCLIVERT ENABLEX TABLET FOSAMAX ORAL SOLUTION CANTIL CYSTADANE POWDER ENBREL FOSAMAX PLUS D CAPCOF LIQUID CYSTAGON ENJUVIA TABLET FRAGMIN CAPEX SHAMPOO CYTRA K EPIDUO GEL FRESHKOTE EYE DROPS CARBAGLU DISPER TABL DALIRESP TABLET EPLERENONE TABLET FROVA CARDURA XL DALLERGY SYRUP EPOGEN VIAL FUMATINIC ER CAPSULE CARIMUNE NF DAYTRANA PATCH ERTACZO CREAM FURADANTIN SUSPENSION CARISOPRODOL CPD CODEINE DE CHLOR DM LIQUID ESTRACE CREAM FUZEON CONVENIENCE KIT CARMOL HC CREAM DE CHLOR DR LIQUID ESTRADERM PATCH GABLOFEN CAVAN DEMECLOCYCLINE ESTRASORB PACKET GAMMAGARD CAYSTON INHAL SOLUTIO DEMSER CAPSULE ESTRING VAGINAL RING GAMUNEX CEDAX 180 MG/5 ML SUSPENSION DEPEN TITRATAB ESTROSTEP FE 28 TABLET GASTROCROM CENESTIN DERMATOP EVAMIST SPRAY GELNIQUE GEL SACHETS CENTERGY DM PEDIATRIC DROPS DERMOTIC OIL EAR DROP EVOCLIN FOAM GENOTROPIN CEREFOLIN NAC CAPLET DESONATE GEL EXALGO ER TABLET GILENYA CAPSULE CEREFOLIN TABLET DESOWEN LOTION KIT EXELDERM GLEEVEC TABLET CERISA WASH DESOXYN TABLET EXELON GLUMETZA ER TABLET CESAMET CAPSULE DETROL TABLET EXFORGE HCT TAB GLYSET TABLET CETRAXAL EAR SOLUTION DETROL LA CAPSULE EXFORGE TABLET GRALISE CHENODAL TABLET DEXCHLORPHEN SYRUP EXJADE TABLET GRALISE ER CICLOPIROX 8% KIT DEXEDRINE SPANSULE EXTAVIA KIT GUANIDINE HCL TABLET CIMZIA SYRINGE KIT DEXPAK EXTINA FOAM GYNAZOLE 1 CREAM CIPRO HC OTIC SUSPENSION DEXTROMETHORPHAN FACTIVE TABLET HALOG CIPRO SUSPENSION DIALYVITE FAZACLO ODT HELIDAC THERAPY CITRANATAL DIATX ZN TABLET FEIBA NF VIAL HELIXATE FS VIAL
4 HEMATOGEN SOFTGEL LIORESAL IT NATACYN EYE DROPS PACNEX MX CLEANSER HEMOCYTE PLUS CAPSULE LIPOFEN CAPSULE NATAZIA 28 TABLET PAIRE OB PLUS DHA COMBO PAC HEMOCYTE F TABLET LITHOSTAT TABLET NATELLE ONE CAPSULE PALGIC TABLET HEMOFIL M VIAL LIVALO TABLET NATROBA TOPICAL SUSPENSION PANDEL CREAM HEPSERA TABLET LO LOESTRIN FE TABLET NEEVO DHA GELCAP PANRETIN GEL HIPREX TABLET LODOSYN TABLET NEOBENZ MICRO PARCOPA ODT HIZENTRA LOESTRIN 24 FE TABLET NEO FRADIN SOLN PAREGORIC LIQUID HORIZANT ER TABLET LOHIST DM SYRUP NEPHPLEX RX TABLET PASER GRANULES PACKET HUMALOG 100 UNITS/ML CARTRID LORAZEPAM INTENSOL NEPHROCAPS QT TABLET PATADAY EYE DROPS HUMALOG 100 UNITS/ML KWIKPE LORZONE NEPHROCAPS SOFTGEL PATANASE NASAL SPRAY HUMALOG 100 UNITS/ML VIAL LOSEASONIQUE TABLET NEPHRON FA TABLET PATANOL EYE DROPS HUMALOG MIX KWIKPEN LOTEMAX OPHTH OINTMENT NEPHRONEX CAPSULE PEDIADERM AF KIT HUMALOG MIX KWIKPEN LOVAZA CAPSULE NEULASTA SYRINGE PEDIADERM HC KIT HUMALOG MIX VIAL LUMIGAN EYE DROPS NEUMEGA SYRINGE PEDIAPRED SOLN HUMATE P VWF:RCO LUNESTA TABLET NEUPOGEN SYRINGE PEGASYS HUMATROPE LUVOX CR CAPSULE NEVANAC DROPTAINER PEGINTRON HUMIRA LUXIQ FOAM NEXA SELECT CAPSULE PENNSAID SOLUTION HYCAMTIN CAPSULE LYBREL TABLET NEXAVAR TABLET PENTAZOCIN ACETAMINOPHN HYCET MAGNACET TABLET NEXICLON XR PERFOROMIST SOLUTION HYOMAX DT TABLET MARNATAL F CAPSULE NORDITROPIN NORDIFLEX PEXEVA TABLET IBUDONE TABLET MATERNITY VITAMIN NORITATE CREAM PHISOHEX CLEANSER IMIQUIMOD CREAM PACKET MAXAIR AUTOHALER NOROXIN TABLET PHOSLYRA SOLUTION INCIVEK TABLET MAXALT MLT TABLET NOVOSEVEN RT VIAL PHRENILIN FORTE CAPSULE INCRELEX VIAL MAXALT TABLET NOVOSEVEN VIAL PLEXION CLEANSING CLOTHS INFERGEN VIAL MAXARON FORTE CAPSULE NOXAFIL SUSPENSION PLEXION CREAM INNOHEP VIAL MAXIDEX EYE DROPS NUCYNTA ER PNV DHA PLUS SOFTGEL INNOPRAN XL CAPSULE MAXIDONE TABLET NUCYNTA TABLET PNV IRON TABLET INOVA EASY PAD MAXIFED G CD TABLET NUEDEXTA CAPSULE POLY IRON PN FORTE TABLET INTRON A MAXIFLU CD TABLET NUOX GEL POLY TUSSIN DM SYRUP INTUNIV ER TABLET M CLEAR WC LIQUID NUTROPIN AQ POTASSIUM CL 25 MEQ TAB EFF INVEGA ER TABLET MEBARAL TABLET NUTROPIN VIAL PRADAXA CAPSULE IOPIDINE EYE DROPS MEFENAMIC ACID CAPSULE NUVIGIL TABLET PRANDIMET TABLET IQUIX EYE DROPS MEGACE ES SUSPENSION NYDAMAX GEL PRANDIN TABLET IRESSA TABLET M END PE LIQUID OB COMPLETE PRASCION RA CREAM ISOPTO CARBACHOL DROPS M END WC LIQUID OLEPTRO ER TABLET PREFERA OB ISRADIPINE CAPSULE MENTAX CREAM OLUX FOAM PREGNYL ISTALOL EYE DROPS METANX TABLET OLUX E FOAM PRENACARE TABLET JALYN CAPSULE METAXALONE TABLET OMEPRAZOLE BICARB PRENATE ELITE TABLET JUVISYNC METOZOLV ODT TABLET OMNARIS NASAL SPRAY PRENATE ESSENTIAL SOFTGEL KADIAN ER CAPSULE METROGEL OMNITROPE PRENEXA CAPSULE KAPVAY ER TABLET MICARDIS HCT TABLET ONSOLIS SOLUBLE FILM PREQUE 10 TABLET KEFLEX CAPSULE MICARDIS TABLET OPANA ER TABLET PRIFTIN TABLET KENALOG AEROSOL SPRAY MILLIPRED OPANA TABLET PRIMLEV TABLET KEPPRA XR MINOXIDIL TABLET OPIUM TINCTURE PRIMSOL ORAL SOLUTION KEROL AD EMULSION MIRAPEX ER TABLET ORACEA CAPSULE PRISTIQ TABLET KINERET SYRINGE MONOCLATE P KIT ORAPRED ODT TABLET PRIVIGEN VIAL KOGENATE FS VIAL MONONINE VIAL ORAVIG BUCCAL TABLET PROCENTRA SOLUTION K PHOS M.F. TABLET MONUROL SACHET ORENCIA PROCRIT VIAL K PHOS TABLET MOXATAG ER TABLET ORFADIN CAPSULE PROCTOCORT CREAM LACRISERT 5 MG EYE INSERT MOXEZA EYE DROPS ORPHENADRINE COMP FORTE TAB PROFILNINE SD VIAL LAMICTAL ODT MST 600 TABLET ORPHENADRINE COMP TABLET PROMACET TABLET LAMICTAL XR MULTAQ TABLET ORTHO TRI CYCLEN LO TABLET PROMACTA TABLET LAMISIL GRANULES MULTIVIT FLUOR 0.25 MG TAB OXANDROLONE TABLET PROPAFENONE HCL SR LASTACAFT EYE DROPS MULTIVIT FLUORIDE 1 MG TAB OXISTAT PROPARACAINE EYE DROPS LESCOL CAPSULE MULTIVIT IRON FL 0.25 MG/ML OXSORALEN LOTION PROQUIN XR TABLET LESCOL XL TABLET MYKIDZ IRON FL SUSPENSION OXYCODONE IBUPROFEN TAB PROSED DS TABLET LETAIRIS TABLET MYTELASE CAPLET OXYCONTIN TABLET PROTOPIC OINTMENT LEVATOL TABLET NAFTIN OXYTROL PATCH PROVENTIL HFA 90 MCG INHALE LEVORPHANOL TABLET NALFON PACNEX WASH PROVIGIL TABLET LIALDA DR TABLET NAPRELAN CR PACNEX HP CLEANSING PADS PULMICORT FLEXHALER LIDODERM PATCH NASCOBAL 500 MCG NASAL SPRA PACNEX LP CLEANSING PAD PYLERA CAPSULE
5 QUALAQUIN CAPSULE SIMCOR TABLET TRIAZ 3% FOAMING CLOTHS VUSION OINTMENT QUINIDINE SULF ER TAB SIMPONI TRIAZ 3% PAD VYTORIN TABLET QUIXIN EYE DROPS SKELID TABLET TRIAZ 6% FOAMING CLOTHS VYVANSE CAPSULE RANEXA TABLET SOLARAZE GEL TRIAZ 6% PAD WELCHOL RAPAFLO CAPSULE SOLODYN ER TABLET TRIAZ 9% FOAMING CLOTHS WESTCORT OINTMENT REBETOL SOLUTION SOMA TABLET TRIAZ 9% PAD XARELTO REBIF SOMAVERT VIAL TRIBENZOR TABLET XELODA TABLET RECOMBINATE VIAL SORIATANE CAPSULE TRICARE PRENATAL DHA ONE XENAZINE TABLET REGRANEX GEL SPECTRACEF DOSE PACK TRICARE PRENATAL TABLET XERESE CREAM RELPAX TABLET SPORANOX SOLUTION TRICOR TABLET XIBROM EYE DROPS REMICADE VIAL SPRYCEL TABLET TRIGLIDE TABLET XIFAXAN TABLET REMODULIN VIAL STAVZOR DR CAPSULE TRILIPIX DR CAPSULE XODOL TABLET RENAGEL TABLET STIMATE NASAL SPR TRI LUMA CREAM XOLEGEL GEL REPREXAIN TABLET STROMECTOL TABLET TRIMESIS RX TABLET XOLOX TABLET REQUIP XL TABLET STROVITE PLUS CAPLET TRIVEEN ONE CAPSULE XOPENEX RESPAIRE 30 CAPSULE SUBOXONE TUSNEL PEDIATRIC LIQUID XYNTHA UNIT KIT RESPERAL DM DROPS SUCRAID SOLN TUSSI 12D S SUSPENSION XYREM ORAL SOLUTION RETIN A MICRO GEL SULFAMYLON TUSSIONEX PENNKINETIC SUSP XYZAL TABLET REVATIO SUMADAN TWINJECT AUTO INJEC YASMIN 28 TABLET REVLIMID CAPSULE SUMAVEL DOSEPRO TWYNSTA TABLET ZAMICET SOLUTION RIBAPAK DOSEPACK SUMAXIN TYKERB TABLET ZANAFLEX CAPSULE RIBASPHERE TABLET SUPREP BOWEL PREP KIT TYVASO ZATEAN CH CAPSULE RIBAVIRIN SUTENT CAPSULE TYZINE ZATEAN PN DHA CAPSULE RIFAMATE CAPSULE SYLATRON ULESFIA LOTION ZAVESCA CAPSULE RIFATER TABLET SYMBYAX CAPSULE ULTRAM ER TABLET ZENPEP DR CAPSULE RILUTEK TABLET SYMLIN VIAL ULTRAVATE ZEOSA CHEWABLE TABLET RITALIN LA CAPSULE SYMLINPEN INJECTOR UREA 10% LOTION ZIANA GEL RITUXAN VIAL SYNAGIS VIAL UREA 35% LOTION ZIPSOR CAPSULE ROVIN NV DHA CAPSULE SYNALGOS DC CAPSULE UREA 50% EMULSION ZIRGAN OP GEL ROZEREM TABLET SYNAREL NASAL SPRAY UREA 50% NAIL GEL ZOLINZA CAPSULE RYBIX ODT TABLET SYPRINE CAPSULE UREA 50% NAILSTIK ZOLPIDEM TART ER TAB RYNA 12 TABLET TARCEVA TABLET UREA 50% OINTMENT ZOLPIMIST ORAL SPRAY RYNATAN PEDIATRIC TARON DUO EC COMB PACK UREA 50% TOPICAL SUSPENSION ZOLVIT RYZOLT ER TABLET TARON EC UROQID ACID NO.2 TB ZOMIG SAFYRAL TABLET TARON PREX PRENATAL DHA UROXATRAL TABLET ZONALON CREAM SAIZEN TASIGNA CAPSULE VAGIFEM VAGINAL TAB ZORBTIVE VIAL SALICYLIC ACID TAZORAC VALTURNA TABLET ZORTRESS SALKERA FOAM TEKAMLO TABLET VANCOCIN HCL PULVULE ZUPLENZ SOLUBLE FILM SAMSCA TABLET TEKTURNA HCT TABLET VANOS CREAM ZYCLARA CREAM SANCTURA TABLET TEKTURNA TABLET VENTAVIS SOLUTION ZYDONE SANCTURA XR CAPSULE TEMAZEPAM 7.5 MG CAPSULE VERAMYST NASAL SPRAY ZYLET EYE DROPS SANCUSO PATCH TEMAZEPAM 22.5 MG CAPSULE VEREGEN OINTMENT ZYMAXID EYE DROPS SANDOSTATIN TEMODAR CAPSULE VERELAN PM CAP PELLET ZYTIGA TABLET SAPHRIS TABLET SUBLINGUAL TESTIM GEL VERIPRED 20 SOLN ZYVOX SAVELLA TESTRED CAPSULE VFEND SCOPACE TABLET TEVETEN HCT TAB VIBRAMYCIN SUSPENSION SEASONALE TAB TEVETEN TABLET VIBRAMYCIN SYRUP SEASONIQUE TAB TEV TROPIN VIAL VICTRELIS CAPSULE SEB PREV WASH TEXACORT SOLUTION VIIBRYD TABLET SE CARE TABLET THALOMID CAPSULE VIMOVO TABLET SEMPREX D CAPSULE TINDAMAX TABLET VINATE AZ TABLET SENSIPAR TABLET TIROSINT CAPSULE VINATE AZ EXTRA TABLETS SEROMYCIN CAPSULE TOLMETIN SODIUM 600MG TAB VISICOL TABLET SEROQUEL XR TABLET TOVIAZ ER TABLET VITAFOL SYRUP SEROSTIM VIAL TRACLEER TABLET VITAL D RX TABLET SE TAN DHA CAPSULE TRADJENTA TABLET VIVAGLOBIN VIAL SE TAN PLUS CAPSULE TRANSDERM SCOP VIVELLE DOT PATCH SILDEC PE DM SYRUP TRAVATAN Z 0.004% EYE DROP VOL CARE RX TABLET SILDEC PE SYRUP TREXALL TABLET VOLTAREN GEL SILENOR TABLET TREXIMET TABLET VOSOL OTIC
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