Preferred Drug List (PDL)

Transcription

1 Preferred List (PDL) New York Medicaid Effective Date: 8/1/ United Healthcare Services, Inc. All rights reserved.

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3 Preferred List INTRODUCTION UnitedHealthcare is pleased to provide this Preferred List (PDL) to be used when prescribing for patients covered by the pharmacy benefit plan offered by UnitedHealthcare. The drugs listed in this PDL are intended to provide sufficient options to treat patients who require treatment with a drug from that pharmacologic or therapeutic class. The drugs listed in the UnitedHealthcare PDL have been reviewed and approved by the Pharmacy and Therapeutics Committee. The drugs have been selected to provide the most clinically appropriate and cost-effective medications for patients who have their drug benefit administered through UnitedHealthcare. It is also recognized there may be occasions where an unlisted drug is desired for proper medical management of a specific patient. In those infrequent instances, the unlisted medication may be requested through the prior authorization process. The drugs represented have been reviewed by the Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The PDL is reflective of current medical practice as of the date of review. This edition incorporates drugs added to the PDL since the last edition as well as numerous revisions to the prescribing information based on changes in pharmacotherapy. Comments and suggestions from practicing physicians have also been incorporated to ensure that the UnitedHealthcare PDL is reflective of current medical practice. NOTICE The information contained in this PDL and its appendices is provided by UnitedHealthcare, solely for the convenience of medical providers. UnitedHealthcare does not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This PDL is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in their choice of prescription drugs. UnitedHealthcare assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer s product literature or standard references for more detailed information. National guidelines can be found on the Web sites listed in the Web site section or go to the National Guideline Clearinghouse site at PREFACE The UnitedHealthcare PDL is organized by sections. Each section includes therapeutic groups identified by either a drug class or disease state. Products are listed by name. Brand names are included as a reference to assist in product recognition. Unless exceptions are noted, generally all applicable dosage forms and strengths of the drug cited are included in the PDL. Generics should be considered the first line of prescribing. The UnitedHealthcare PDL covers selected over-thecounter (OTC) products. You are encouraged to prescribe OTC medications when clinically appropriate. PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The P&T Committee includes physicians and pharmacists who are not employees or agents of UnitedHealthcare or its affiliates. They must adhere to the Ethics Policy standards of the P&T Committee. UnitedHealthcare medical directors and pharmacists also participate in the P&T Committee. The P&T Committee meets quarterly to discuss a variety of issues. Those issues pertaining to pharmaceutical selection and pharmacy program management are communicated quarterly. This newsletter is distributed to all participating physicians who have received the PDL. PDL decisions are also communicated quarterly on the UnitedHealthcare internet site. UHC1004a {Released 2/25/11} i

4 OUTPATIENT PRESCRIPTION DRUG BENEFIT-COVERED MEDICATIONS Medically necessary outpatient prescription drugs are covered when prescribed by a provider licensed to prescribe federal legend drugs or medicines. Some items are covered only with prior authorization. Eligibility for Outpatient Prescription Benefits and copays are based on the individual member s benefit plan. PRODUCT SELECTION CRITERIA The P&T Committee considers clinical information on new-to-market drugs that are typically included in an outpatient pharmacy benefit. The evaluation includes all or part of the following: Safety Efficacy Comparison studies Approved indications Adverse effects Contraindications/Warnings/Precautions Pharmacokinetics Patient administration/compliance considerations Medical outcome and pharmacoeconomic studies When a new drug is considered for PDL inclusion, it will be reviewed relative to similar drugs currently included in the UnitedHealthcare PDL. This review process may result in deletion of drug(s) in a particular therapeutic class in an effort to continually promote the most clinically useful and cost-effective agents. All the information in the PDL is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. PDL PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms are covered on the PDL, examples are noted below. The general principles shown in the examples can then usually be extended to other entries in the book. Any exceptions are noted in the drug list. There may also be a statement associated with a drug list that gives additional information about which specific products or dosage forms are covered. Products covered include all strengths associated with the dosage form of the cited name product. carvedilol Coreg All strengths of Coreg would be covered by this listing. Extended-release and delayed-release products require their own entry. diltiazem sustained release CARDIZEM SR Dosage forms covered will be consistent with the category and use where listed. Neomycin/polymixin B/ Cortisporin Hydrocortisone As listed in the OTIC section, this is limited to the otic solution and suspension. From this entry the ophthalmic solution and ointment, and the topical cream cannot be assumed to be on the list unless there are entries for these products in the OPHTHALMIC and DERMATOLOGY sections of the PDL. When a strength or dosage form is specified, only the specified strength and dosage form is on the PDL. Other strengths/dosage forms of the reference product are not citalopram 40 mg tabs Celexa tabs GENERIC SUBSTITUTION The UnitedHealthcare PDL requires substitution on the majority of products when a equivalent is available. Generic substitution is a pharmacy action whereby a equivalent is dispensed rather than the name product. The PDL indicates availability in the column. If a name drug is medically necessary, please submit a prior authorization request. The UnitedHealthcare MAC list sets a ceiling price for the reimbursement of certain multisource prescription drugs. This price will typically cover the acquisition of most s but not ed versions of the same drug. The products selected for inclusion on the MAC list are commonly prescribed and dispensed and have usually gone through the FDA s review and approval process. An important consideration for substitution is the knowledge that all approvals of drugs by the FDA since 1984, and many approvals prior to 1984, have a showing of bioequivalence between the versions and the reference product. To gain FDA approval: 1. The drug must contain the same active ingredient(s), be the same strength and the same dosage form as the name product. 2. The FDA has given the an A rating compared to the ed product indicating bioequivalence, and has determined the is therapeutically equivalent UHC1004a ii

5 to the reference. The ratings of drugs are available by referring to the FDA reference, Approved Products with Therapeutic Equivalence Evaluations (Orange Book). When the above two criteria are met, a can be substituted with the full expectation that the substituted product will produce the same clinical effect and safety profile as the prescribed product. products that have a narrow therapeutic index (NTI) can also be guided by these principles. It is not necessary for the health care provider to approach any one therapeutic class of drug products (e.g., NTI drugs) differently from any other class, when there has been a determination of therapeutic equivalence by the FDA for the drug products under consideration. Also, additional clinical tests or examinations by the physician are not needed when a therapeutically equivalent drug product is substituted for the name product. There are now many name products that are repackaged or distributed under a label. The label version should always be considered therapeutically equivalent and substitutable for the source ed product. DRUG EFFICACY STUDY IMPLEMENTATION (DESI) DRUGS s first marketed between 1938 and 1962 were approved as safe but required no showing of effectiveness for FDA approval. Beginning in 1962, all new drugs were required to be both safe and effective before they could be marketed. This legislation also applied retroactively to all drugs approved as safe from The DESI program was established by the FDA to review the effectiveness of these pre-1962 drugs for their labeled indications, and a determination of fully effective was made for most of these products and they remain in the marketplace. A few DESI products remain classified as less than fully effective while awaiting final administrative disposition. Also, classified as DESI are many products listed as identical, similar, or related to actual DESI products. UnitedHealthcare s PDL does not cover DESI less than fully effective drug products. PLAN EXCLUSIONS The following drug categories are excluded from coverage under the outpatient pharmacy benefit and are not part of the UnitedHealthcare PDL. UHC1004a DESI drugs Antiobesity agents Experimental / research drugs Cosmetic drugs Immunization agents Nutritional / diet supplements Blood and blood plasma products Agents used to promote fertility Agents used for erectile dysfunction Agents used for cosmetic hair growth iii s from manufacturers that do not participate in the FFS Medicaid Rebate Program Diagnostic products Medical supplies and DME except as listed: syringes, needles, lancets, alcohol swabs, spacers, preferred diabetes test strips, peak flow meters (Astech, Assess, Peak Air s, max two per year), vaporizer (limit of 1 per 3 years), humidifier (limit of 1 per 3 years) Mirena DAYS SUPPLY DISPENSING LIMITATIONS UnitedHealthcare members may receive up to a one month supply of a specific medication per prescription order or prescription refill. A medication may be reordered or refilled when eighty-five percent (85%) of the medication has been utilized. If a claim is submitted before 85% of the medication has been used, based on the original day supply submitted on the claim, the claim will reject with a "refill too soon" message. MANDATORY GENERIC SUBSTITUTION The UnitedHealthcare PDL requires mandatory substitution on the vast majority of products when a equivalent is available; however, name drugs may be covered in certain situations by requesting a prior authorization. The UnitedHealthcare PDL prior authorization (PA) list does not include ed items where a equivalent is covered. PRIOR AUTHORIZATION OF NON-PDL MEDICATIONS The drugs in the UnitedHealthcare PDL have been selected to provide the most clinically appropriate and cost-effective medications for patients who have their drug benefit administered through UnitedHealthcare. It is also recognized that there may be occasions where an unlisted drug is desired for the proper medical management of a specific patient. In those infrequent instances, the prior authorization process reviews requests for unlisted medications the physician may consider medically necessary for patient management. Requests for these exceptions should be either made in writing by the physician and faxed or called into: UnitedHealthcare Pharmacy Services Department Fax Phone A prior authorization request form is available in the UnitedHealthcare provider manual and should be used for all prior authorization requests if possible. Appropriate documentation must be provided to support the medical necessity of the non-pdl request. The UnitedHealthcare Pharmacy Department will respond to all requests in accordance with state requirements.

6 Physicians are requested to adhere to this PDL when prescribing for patients covered by their pharmacy benefit plan offered by UnitedHealthcare. If a pharmacist receives a prescription for a non-pdl drug, the pharmacist should contact the prescribing physician and request that the prescription be changed to a medication included in this PDL. If a PDL alternative is not appropriate the physician should then be instructed to contact the Plan for a prior authorization. Please contact the UnitedHealthcare Pharmacy Prior Notification Service at with questions concerning the prior authorization process. NON-PDL DRUGS 5-DAY TEMPORARY SUPPLY OVERRIDES To ensure the use of PDL drugs, all non- PDL drugs should be discussed with the prescribing physician. If you cannot speak to the physician immediately, and there is an immediate need for the medication, the claim processing system will accept an override to permit a one-time dispensing of a 5-day supply of the newly prescribed non-pdl drug. The pharmacy should submit a claim for a 5 day supply, with a PA Type of 8 and Prior Authorization number of Please note that non-preferred drugs are available for a 5-day supply, however availability is subject to the benefit design. For assistance, pharmacies may call The pharmacy should contact the physician to discuss a PDL drug or if a prior authorization request is warranted. If the prescribing physician feels a drug is medically necessary, the physician may fax a request for prior authorization to UnitedHealthcare at QUANTITY LIMITATIONS (QL) Prescriptions for monthly quantities greater than the indicated limit require a prior authorization request. Quantity limits based on Efficient Medication Dosing The Efficient Medication Dosing Program is designed to consolidate medication dosage to the most efficient daily quantity to increase adherence to therapy and also promote the efficient use of health care dollars. The limits for the program are established based on FDA approval for dosing and the availability of the total daily dose in the least amount of tablets or capsules daily. Quantity Limits in the prescription claims processing system will limit the dispensing to consolidate dosing. The pharmacy claims processing system will prompt the pharmacist to request a new prescription order from the physician. Controlled Substances You may fill any FOUR medications from the following classes in a 30-day period: opiate analgesics benzodiazepines sedative hypnotic agents barbiturates UHC1004a iv select muscle relaxants Additional fills will require prior authorization. Medications in these classes may also be subject to individual quantity limits. Additions to the QL program drug list will be made from time to time and providers notified accordingly. As always, we recognize that a number of patient-specific variables must be taken into consideration when drug therapy is prescribed and therefore overrides will be available through the medical exception (prior authorization) process. Please contact the UnitedHealthcare Pharmacy Prior Notification Service at with questions. Specialty Pharmaceutical Management Program UnitedHealthcare is continuously looking for ways to provide high quality cost effective care for Plan members. The Specialty Pharmaceutical Management Program helps UnitedHealthcare to achieve these goals. Injectable medications that are part of this program require plan authorization and are not available through the retail pharmacy network. To obtain authorization, the provider must submit the appropriate Prior Authorization form to the UnitedHealthcare Pharmacy Department via fax at The UnitedHealthcare Pharmacy Department will review and respond to all requests in accordance with state requirements, and if authorized for payment, UnitedHealthcare will coordinate the delivery of the product to the member or provider. s that are part of this program and are on the PDL are identified in this booklet by the designation "SP". Prior Authorization request forms can be requested by calling the UnitedHealthcare Pharmacy Department at MEDICATIONS REQUIRING DIAGNOSIS UnitedHealthcare requires that the diagnosis for prescriptions for ADHD, Antipsychotic, and HIV medications for UnitedHealthcare Community Plan members match the FDA-approved use or a use supported by current published evidence. The diagnosis will be verified at the point-of-sale by the pharmacy claims processing system. If a matching diagnosis is not found in the medical claim file or on the pharmacy drug claim, the prescription will be rejected at the pharmacy. The pharmacist may then contact the prescriber to verify the diagnosis and submit it on the claim. If the diagnosis provided still does not match the approved use, prior authorization may be requested through the standard process by faxing a request to STEP THERAPY (ST) The following PDL drugs are routinely covered only after a sufficient trial of an indicated first-line agent has been

7 adequately tried and failed. These medications may also be requested through the Prior authorization process. While lower cost PDL alternatives may be appropriate in many instances, other non- PDL alternatives are available with prior authorization (PA). fenofibrate Fill of a statin or 90 days of gemfibrozil within the previous 180 days. fentanyl patches 30 day trial of at least 200mg per day of morphine sulfate ER. STEP Advair Amerge Aricept 23mg First-Line Agent(s) 1) 30 day trial of one inhaled corticosteroid (e.g. Flovent, Qvar, Asmanex, Pulmicort, Azmacort) OR 2) 60 day trial of a long-acting beta2- agonist (e.g. Foradil, Serevent) OR 60 day trial of an orally inhaled anticholinergic agent (e.g. Spiriva, Atrovent, Combivent, Tudorza). Trial at a minimum dose of 50mg of sumatriptan tablets. 90 day trial of Aricept 10mg daily Gabitril 30 day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 12 years of age and older. Members less than 12 require prior authorization. GLP-1 Agonists At least a 90 day trial of 1500mg/day of (Tanzeum, metformin Victoza) Intuniv 30 day trial of one of the following: methylphenidate, methylphenidate SR, Concerta, amphetamine salts, Adderall XR, dextroamphetamine, Vyvanse, or dextroamphetamine SA. Banzel 30 day trial of two of the following: lamotrigine, divalproex, or topiramate. levocetirizine midodrine 30 day trial of loratadine and cetirizine. Trial of fludrocortisone Breo Ellipta 1) 30 day trial of one inhaled 100mcg/25mcg corticosteroid (e.g. Flovent, Qvar,, Asmanex, Pulmicort, Azmacort) OR 2) 60 day trial of a long-acting beta2- agonist (e.g. Foradil, Serevent) OR 60 day trial of an orally inhaled anticholinergic agent (e.g. Spiriva, Atrovent, Combivent, Tudorza). Breo Ellipta 30 day trial of one inhaled 200mcg/25mcg corticosteroid (e.g. Flovent, Qvar, Asmanex, Pulmicort, Azmacort) Cymbalta Ditropan XL Minimum 2 month trial of 2 PDL antidepressants in the preceding 6 months 30 day trial of oxybutynin immediate release. DPP4 Inhibitors At least a 90 day trial of 1500mg/day of (Tradjenta, metformin. Jentadueto, Onglyza, Kombiglyze) Dulera Elidel 30 day trial of inhaled corticosteroid Trial of two different topical corticosteroids. Step therapy only applies to members 12 years of age and older. Nucynta ER Onfi Opana ER Optivar 30 day trial of at least 200mg per day of morphine sulfate ER. 30 day trial of two of the following: lamotrigine, divalproex, or topiramate. 30 day trial of at least 200mg per day of morphine sulfate ER. 14 day trial of ketotifen within previous 90 days required first. lansoprazole/ 30 day trial of omeprazole 40mg and Prevacid OTC pantoprazole 40mg within previous 180 days is required first Potiga 30-day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 18 years of age and older. Members less than 18 require prior authorization. Protopic 0.03% Trial of two different topical corticosteroids. Step therapy only applies to members 12 years of age and older. Protopic 0.1% Minimum age of 16. Trial of two different topical corticosteroids. UHC1004a v

8 Ranexa Renvela SGLT-2 Inhibitors (Jardiance, Invokana, Invokamet) Strattera Symbicort tolterodine trospium UHC1004a Trial of one drug from the following classes: beta blockers, calcium channel blockers, long acting nitrates 8 week trial of calcium acetate At least a 90 day trial of 1500mg/day of metformin 30 day trial of one of the following: methylphenidate, methylphenidate SR, Concerta, amphetamine salts, Adderall XR, dextroamphetamine, Vyvanse, or dextroamphetamine SA. 1) 30 day trial of one inhaled corticosteroid (e.g. Flovent, Qvar, Asmanex, Pulmicort, Azmacort) OR 2) 60 day trial of a long-acting beta2- agonist (e.g. Foradil, Serevent) OR 60 day trial of an orally inhaled anticholinergic agent (e.g. Spiriva, Atrovent, Combivent, Tudorza). 30 day trial of oxybutynin immediate release. Step Therapy only applies to members less than 65 years of age. 30 day trial of oxybutynin immediate release. Step Therapy only applies to members less than 65 years of age. TZD s At least a 90 day trial of 1500mg/day of (ActosPlusMet, metformin ActoPlusMet XR Duetact) Uloric Vancocin Vimpat Vytorin 8 week trial of up to 600mg of allopurinol required first. One fill of metronidazole tabs or caps 30 day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 17 years of age and older. Members less than 17 require prior authorization. 90 day trial of simvastatin 40mg, simvastatin 80mg or atorvastatin within previous 180 days is required first. Xopenex Respules 30 day trial of Albuterol.083% or.5% respules. vi PDL SUGGESTIONS Providers who wish to propose PDL suggestions should forward the information to the UnitedHealthcare Director of Pharmacy Services by either mail or fax. Attn: Director of Pharmacy Services UnitedHealthcare Unison Plaza 1001 Brinton Road Pittsburgh, PA Phone: Providers should furnish adequate documentation, such as clinical studies from the medical literature, in order for the request to be considered for PDL addition. This literature should include information documenting clinical necessity as well as therapeutic advantages over current PDL products. Suggestions received by UnitedHealthcare will be reviewed by the Pharmacy and Therapeutics Committee at the subsequent P&T Committee meeting. EDITOR Your comments and suggestions regarding the UnitedHealthcare PDL are encouraged. Your input is vital to this PDL s continued success. All responses will be reviewed and considered. Please send your comments to: UnitedHealthcare by UnitedHealthcare Director of Pharmacy Services Unison Plaza 1001 Brinton Road Pittsburgh, PA Phone: LEGEND # Only the dosage forms/strengths of the name products noted are on the PDL OTC over-the-counter delayed-rel delayed-release (also known as enteric coated) EC enteric-coated ext-rel extended-release (also known as sustainedrelease) PA Prior Authorization required QL Quantity Limits apply ST SP Step Therapy, see pages V-VI for details Specialty Pharmaceuticals, see pages IV-V for details NOTICE The information contained in this document is proprietary information. The information may not be copied in whole or in part without the written permission of UnitedHealthcare. All rights reserved. The drug names listed here are the registered and/or unregistered trademarks of third-party pharmaceutical companies unrelated to and unaffiliated with UnitedHealthcare. These trademarked names are

9 included here for informational purposes only and are not intended to imply or suggest any affiliation between UnitedHealthcare and such third-party pharmaceutical companies. If viewing this PDL via the Internet, please be advised that the PDL is updated periodically and changes may appear prior to their effective date to allow for notification. UHC1004a vii

10 Table of Contents Antineoplastics & Immunosuppressants 4 Hormonal Antineoplastic Agents....4 Oral Agents...4 Immunosuppressants...6 Immunomodulators...6 Miscellaneous...6 Blood Modifiers - Anticoagulants Oral...7 Blood Cell Formation...7 Platelet Synthesis Inhibitor Miscellaneous...7 Platelet Aggregation Inhibitors...7 Cardiovascular Agents...7 Ace Inhibitors...7 Ace Inhibitor/Diuretic Combinations....8 Adrenolytics, Central... 8 Alpha Blockers...8 Angiotensin II Receptor Blockers (Antagonists)...8 Angiotensin II Receptor Blocker Combinations....8 Antiarrhythmics And Cardiac Glycosides....8 Beta Blockers And Beta Blocker/ Diuretic Combinations...9 Calcium Channel Blockers...9 Diuretics Nitrates...10 Lipid Lowering Agents...11 Miscellaneous...11 Central Nervous System Alzheimer s Disease...12 Analgesics...12 Migraine Acute Therapy...14 Migraine Prophylactic Therapy...14 Multiple Sclerosis...15 Myasthenia Gravis...15 Parkinson s Disease Seizures Miscellaneous Dermatology Acne Vulgaris...16 Bacterial Infections Corticosteroids...17 Fungal Infections Psoriasis...18 Rosacea Scabies And Pediculosis...19 Viral Infections Miscellaneous...19 Ear, Nose & Throat Ear...20 Nose Miscellaneous Nasal Throat And Mouth Endocrinology...22 Adrenal Corticosteroids...22 Androgens Diabetes Mellitus...22 Growth Stimulating Agents...24 Osteoporosis Thyroid Disease...24 Miscellaneous...24 Gastrointestinal...25 Diarrhea...25 Emesis...25 Gastroesophageal reflux disease (gerd)/ peptic ulcers Gastrointestinal Spasm...26 Inflammatory Bowel Disease...26 Pancreatic Enzymes...26 Laxatives...26 Probiotic Supplementation...27 Miscellaneous...27 Infectious Diseases Anthelmintics Antibacterials Antifungals Antivirals...29 Miscellaneous...31

11 Musculoskeletal Arthritis Gout Skeletal Muscle Relaxants...33 OB-GYN Contraceptives...33 Endometriosis...35 Hormone Therapy/Menopause...35 Vaginal Infections...35 Miscellaneous...35 Ophthalmic...36 Allergy...36 Anti-Inflammatories Glaucoma...37 Infections...38 Miscellaneous Ophthalmics Psychiatric...38 Alcohol Deterrents...38 Anxiety...38 Miscellaneous...39 Attention Deficit Hyperactivity Disorder (ADHD)...39 Bipolar Disorder...39 Depression...39 Insomnia Narcotic Antagonists...41 Smoking Cessation...41 Psychoses...41 Miscellaneous...42 Respiratory s...42 Antitussives, Decongestants, Expectorants And Combinations Asthma/COPD...47 Potassium...48 Potassium-Removing Agents...49 Vitamins And Minerals...49 Urological...52 Symptomatic Benign Prostatic Hypertrophy..52 Miscellaneous...52 Miscellaneous...53 Anaphylaxis...53 Cystic Fibrosis...53 Hereditary Angioedema...53 Hyperphosphatemia...53 Idiopathic Pulmonary Fibrosis (IPF)...54 Immune Thrombocytopenic Purpura...54 Medical Devices...54 Metabolic Modifiers...54 Vaccine (oral)...54 OTC MEDICATIONS Acne Antifungals Cough/Cold Allergy...55 Atopic Dermatitis...56 Diabetes...56 Earwax Removal Products...56 Family Planning...56 First Aid...56 Gastrointestinal Lice Products...57 Motion Sickness...57 Ophthalmics...57 Pain...57 Smoking Cessation Products...57 Vitamins/Minerals...57 Warts...58 Miscellaneous...58 Index of s

12 Generic Name Brand Name Antineoplastics & Immunosuppressants Hormonal Antineoplastic Agents Androgen Biosynthesis Inhibitors abiraterone ZYTIGA PA, SP Antiandrogens bicalutamide CASODEX flutamide EULEXIN Antiestrogens tamoxifen NOLVADEX toremifene FARESTON Aromatase Inhibitors anastrozole ARIMIDEX exemestane AROMASIN letrozole FEMARA Progestin megestrol acetate MEGACE Oral Agents Alkylating Agents busulfan MYLERAN chlorambucil LUEKERAN cyclophosphamide CYTOXAN estramustine phosphate sodium EMCYT lomustine CEENU melphalan ALKERAN temozolomide TEMODAR PA, SP Antimetabolites capecitabine XELODA PA, SP fludarabine OFORTA PA, SP mercaptopurine PURINETHOL thioguanine THIOGUANINE 4

13 Generic Name Brand Name Tyrosine Kinase Inhibitor afatinib GILOTRIF PA, SP axitinib INLYTA PA, SP bosutinib BOSULIF PA, SP cabozantinib COMETRIQ PA, SP ceritinib ZYKADIA PA, SP crizotinib XALKORI PA, SP dabrafenib TAFINLAR PA, SP dasatanib SPRYCEL PA, SP erlotinib TARCEVA PA, SP ibrutinib IMBRUVICA PA, SP imatinib mesylate GLEEVEC PA, QL, SP lapatinib ditosylate TYKERB PA, SP nilotinib TASIGNA PA, SP pazopanib VOTRIENT PA, SP ponatinib ICLUSIG PA, SP regorafenib STIVARGA PA, SP ruxolitinib JAKAFI PA, SP sorafenib NEXAVAR PA, SP sunitinib SUTENT PA, SP trametinib MEKINIST PA, SP vandetanib CAPRELSA PA, SP vemurafenib ZELBORAF PA, SP Miscellaneous altretamine HEXALEN alitretinoin 1% gel PANRETIN PA bexarotene caps and topical gel TARGRETIN PA etoposide VEPESID everolimus AFINITOR AFINITOR DISPERZ PA, SP hydroxyurea DROXIA HYDREA idelalisib ZYDELIG PA, SP mitotane LYSODREN octreotide SANDOSTATIN pasireotide SIGNIFOR PA, SP 5

14 Generic Name Brand Name procarbazine MATULANE tretinoin VESANOID caps vismodegib ERIVEDGE PA, SP vorinostat ZOLINZA PA, SP Immunosuppressants Antimetabolites azathioprine IMURAN mycophenolate mofetil CELLCEPT mycophenolate sodium MYFORTIC Calcineurin Inhibitors cyclosporine SANDIMMUNE cyclosporine, modified GENGRAF NEORAL tacrolimus HECORIA PROGRAF Other everolimus ZORTRESS Rapamycin Derivative sirolimus RAPAMUNE Immunomodulators Interferons interferon alfa-2a PA, SP interferon alfa-2b INTRON A PA, SP peginterferon alfa-2b SYLATRON PA, SP Other lenalidomide REVLIMID PA, SP Miscellaneous cysteamine bitartrate CYSTAGON leuprolide LUPRON LUPRON DEPOT LUPRON DEPOT PA, SP 6-MONTH LUPRON DEPOT-PED pomalidomide POMALYST PA, SP 6

15 Generic Name Brand Name Blood Modifiers - Anticoagulants Oral warfarin COUMADIN Blood Cell Formation darbepoetin alfa ARANESP PA, SP epoetin alfa EPOGEN PROCRIT PA, SP filgrastim NEUPOGEN PA, SP oprelvekin NEUMEGA SP pegfilgrastim NEULASTA PA, SP sargramostim LEUKINE PA, SP Platelet Synthesis Inhibitor anagrelide AGRYLIN Miscellaneous aminocaproic acid AMICAR 500 mg tabs only apixaban ELIQUIS PA cilostazol PLETAL deferasirox EXJADE PA, SP enoxaparin LOVENOX PA, QL, SP, SP and PA only applies for quantities greater than 14 days heparin HEPARIN pentoxifylline ext-rel TRENTAL plerixafor MOZOBIL PA, SP RIVAROXABAN XARELTO PA Platelet Aggregation Inhibitors aspirin BAYER ECOTRIN clopidogrel PLAVIX dipyridamole PERSANTINE Cardiovascular Agents Ace Inhibitors benazepril LOTENSIN captopril CAPOTEN enalapril VASOTEC OTC Applies to 300 mg tab only, QL 7

16 Generic Name Brand Name enalapril oral soln EPANED Members 8 years of age will require prior authorization. fosinopril MONOPRIL QL lisinopril ZESTRIL QL quinapril ACCUPRIL QL Ace Inhibitor/Diuretic Combinations benazepril/ hydrochlorothiazide LOTENSIN HCT captopril/ hydrochlorothiazide CAPOZIDE enalapril/ hydrochlorothiazide VASERETIC fosinopril/ hydrochlorothiazide MONOPRIL-HCT QL lisinopril/ hydrochlorothiazide ZESTORETIC QL quinapril/ hydrochlorothiazide ACCURETIC QL Adrenolytics, Central clonidine CATAPRES guanfacine TENEX Alpha Blockers doxazosin CARDURA prazosin MINIPRESS terazosin HYTRIN Angiotensin II Receptor Blockers (Antagonists) losartan COZAAR QL Angiotensin II Receptor Blocker Combinations losartan/hctz HYZAAR QL Antiarrhythmics And Cardiac Glycosides amiodarone tabs CORDARONE 200 mg and 400 mg digoxin LANOXIN digoxin LANOXICAPS disopyramide NORPACE disopyramide ext-rel NORPACE CR dofetilide TIKOSYN flecainide TAMBOCOR mexiletine MEXITIL moricizine ETHMOZINE procainamide PRONESTYL 8

17 Generic Name Brand Name procainamide ext-rel PROCANBID procainamide ext-rel PROCAINAMIDE EXT-REL propafenone RYTHMOL IR only QUINIDINE GLUCONATE quinidine gluconate ext-rel EXT-REL quinidine sulfate QUINIDINE SULFATE quinidine sulfate ext-rel QUINIDINE SULFATE EXT-REL sotalol BETAPACE Beta Blockers And Beta Blocker/Diuretic Combinations acebutalol SECTRAL atenolol TENORMIN atenolol/chlorthalidone TENORETIC bisoprolol ZEBETA bisoprolol/ hydrochlorothiazide ZIAC carvedilol COREG QL labetalol TRANDATE metoprolol LOPRESSOR metoprolol succinate TOPROL XL pindolol PINDOLOL propranolol INDERAL IR only propranolol/hctz INDERIDE timolol maleate tablets Calcium Channel Blockers Dihydropyridines amlodipine NORVASC QL felodipine ext-rel PLENDIL QL nicardipine CARDENE nifedipine PROCARDIA nifedipine ext-rel ADALAT CC QL PROCARDIA XL nimodipine NIMOTOP QL nimodipine oral soln NYMALIZE Nondihydropyridines diltiazem CARDIZEM diltiazem ext release CARDIZEM CD QL diltiazem sustained release CARDIZEM SR QL 9

18 Generic Name Brand Name diltiazem ext-rel DILACOR XR TIAZAC QL verapamil CALAN verapamil ext-rel CALAN SR Applies to 120 mg only, QL Diuretics amiloride MIDAMOR amiloride/ hydrochlorothiazide MODURETIC bumetanide BUMEX chlorothiazide DIURIL chlorthalidone CHLORTHALIDONE furosemide LASIX hydrochlorothiazide MICROZIDE 12.5 mg caps hydrochlorothiazide HYDROCHLOROTHIA- ZIDE soln, tabs indapamide LOZOL metolazone ZAROXOLYN spironolactone ALDACTONE spironolactone/ hydrochlorothiazide ALDACTAZIDE torsemide DEMADEX triamterene/ hydrochlorothiazide DYAZIDE 37.5/25 triamterene/ hydrochlorothiazide MAXZIDE /25 triamterene/ hydrochlorothiazide DYAZIDE 50/25 triamterene/ hydrochlorothiazide MAXZIDE 75/50 Nitrates Oral isosorbide dinitrate ext-rel ISOSORBIDE DINITRATE ER isosorbide dinitrate ISORDIL isosorbide mononitrate ISMO isosorbide mononitrate ext-rel IMDUR nitroglycerin ext-rel 10

19 Generic Name Brand Name Sublingual isosorbide dinitrate ISORDIL S.L. nitroglycerin NITROSTAT nitroglycerin NITROLINGUAL Transdermal nitroglycerin NITRO-BID oint nitroglycerin NITREK transdermal, QL NITRO-DUR niacin NIACOR niacin ext-rel NIASPAN Lipid Lowering Agents Bile Acid Resin cholestyramine QUESTRAN QUESTRAN-LIGHT Only the bulk products are covered (cans). Individual packets are not covered. Fibrates fenofibrate LOFIBRA ST gemfibrozil LOPID HMG-CoA Reductase Inhibitors and Combinations atorvastatin LIPITOR ezetimibe/simvastatin VYTORIN ST lovastatin MEVACOR QL simvastatin ZOCOR QL simvastatin/niacin ER SIMCOR Miscellaneous ambrisentan LETAIRIS PA, SP bosentan TRACLEER PA, SP guanabenz WYTENSIN hydralazine APRESOLINE lomitapide JUXTAPID PA, SP methyldopa ALDOMET methyldopa/hctz ALDORIL midodrine PROAMATINE ST minoxidil LONITEN ranolazine RANEXA ST sildenafil REVATIO PA 11

20 Generic Name Brand Name Central Nervous System Alzheimer s Disease donepezil ARICEPT donepezil ARICEPT galantamine RAZADYNE memantine NAMENDA rivastigmine EXELON 5 mg and 10 mg, QL, Members <18 years of age will require prior authorization. 23 mg, ST, Members <18 years of age will require prior authorization. QL, Members <18 years of age will require prior authorization. QL, Members <18 years of age will require prior authorization. QL, Members <18 years of age will require prior authorization. Analgesics Analgesic, Other acetaminophen TYLENOL OTC aspirin/acetaminophen/ EXCEDRIN MIGRAINE mg, OTC caffeine tramadol ULTRAM QL Miscellaneous Non-Narcotic analgesics butalbital/acetaminophen PHRENILIN QL butalbital/acetaminophen SEDAPAP QL butalbital/acetaminophen/ FIORICET QL caffeine butalbital/aspirin/caffeine FIORINAL QL NSAIDS choline magnesium trisalicylate TRILISATE diclofenac sodium delayed release VOLTAREN etodolac LODINE IR Only fenoprofen NALFON 600 mg ibuprofen ADVIL tabs, chew tabs and susp, OTC 12

21 Generic Name Brand Name ibuprofen MOTRIN tabs, chew tabs and susp indomethacin INDOCIN ketoprofen ORUDIS IR only ketorolac tromethamine TORADOL QL meloxicam MOBIC QL nabumetone RELAFEN naproxen NAPROSYN Not EC naproxen sodium ANAPROX oxaprozin DAYPRO piroxicam FELDENE sulindac CLINORIL Opioids Narcotic analgesics butalbital/apap/caff/cod FIORICET W/CODEINE QL, mg butalbital/asa/caff/cod FIORINAL W/CODEINE QL butorphanol STADOL nasal spray, QL codeine sulfate QL codeine/acetaminophen TYLENOL W/CODEINE QL fentanyl transdermal DURAGESIC QL, ST hydrocodone/ acetaminophen NORCO 5/325, 7.5/325, 10/325, QL hydrocodone/ acetaminophen LORTAB ELIXIR QL hydrocodone/ acetaminophen LORTAB 2.5/ /500, QL hydrocodone/ acetaminophen LORTAB 5/500 BANCAP HC, VICODIN 5/500 5/500, QL hydrocodone/ acetaminophen LORTAB 7.5/ /500, QL hydrocodone/ acetaminophen LORCET PLUS 7.5/650, QL hydrocodone/ acetaminophen VICODIN ES 7.5/750, QL hydrocodone/ acetaminophen LORTAB 10/500 10/500, QL hydrocodone/ acetaminophen LORCET 10/650 10/650, QL hydromorphone DILAUDID QL 13

22 Generic Name Brand Name meperidine DEMEROL QL methadone tablets, QL morphine MSIR QL morphine RMS QL morphine ext-rel MS CONTIN QL oxycodone ROXICODONE QL oxycodone ER OXYCONTIN QL, ST oxycodone/ acetaminophen PERCOCET 5/325, QL oxycodone/ acetaminophen TYLOX 5/500, QL oxycodone/aspirin PERCODAN QL oxycodone OXYFAST soln, QL oxymorphone ER OPANA ER QL, ST pentazocine/naloxone TALWIN NX QL tapentadol ER NUCYNTA ER ST Migraine Acute Therapy Ergotamine Derivatives dihydroergotamine D.H.E. 45 inj, QL dihydroergotamine MIGRANAL ergotamine/caffeine CAFERGOT Selective Serotonin Agonists naratriptan AMERGE ST rizatriptan MAXALT/MAXALT MLT QL sumatriptan IMITREX QL sumatriptan IMITREX 4 mg and 6 mg inj 4 MG AND 6 MG INJ Migraine Prophylactic Therapy amitriptyline ELAVIL divalproex sodium cap sprinkle DEPAKOTE SPRINKLE Members 8 years of age will require prior authorization. divalproex sodium delayed-rel DEPAKOTE Minimum age 2 propranolol INDERAL IR only verapamil CALAN 14

23 Generic Name Brand Name Multiple Sclerosis dimethyl fumarate TECFIDERA PA, SP fingolimod GILENYA PA, SP glatiramer acetate COPAXONE PA,QL, SP interferon beta-1a AVONEX/AVONEX PEN PA,QL, SP interferon beta-1a REBIF PA,QL, SP teriflunomide AUBAGIO PA, SP Myasthenia Gravis pyridostigmine MESTINON pyridostigmine ext-rel MESTINON TIMESPAN Parkinson s Disease amantadine SYMMETREL except tabs benztropine COGENTIN biperiden AKINETON bromocriptine PARLODEL carbidopa/levodopa SINEMET carbidopa/levodopa ext-rel SINEMET CR entacapone COMTAN pramipexole MIRAPEX ropinirole REQUIP selegiline ELDEPRYL tabs tolcapone TASMAR trihexyphenidyl ARTANE Seizures carbamazepine TEGRETOL carbamazepine ext-rel CARBATROL TEGRETOL-XR clobazam ONFI ST clonazepam KLONOPIN tabs diazepam DIASTAT ACUDIAL rectal gel, QL divalproex sodium cap sprinkle DEPAKOTE SPRINKLE Members 8 years of age will require prior authorization. divalproex sodium delayed-rel DEPAKOTE Minimum age 2 ethosuximide ZARONTIN exogabine POTIGA Age Limits Apply, ST felbamate FELBATOL 15

24 Generic Name Brand Name felbamate oral susp FELBATOL ORAL SUSP Members 8 years of age will require prior authorization. gabapentin NEURONTIN caps and tabs only lacosamide VIMPAT Age Limits Apply, ST Members 8 years of lamotrigine chew LAMICTAL CD CHEW TAB age will require prior dispersable tab authorization. levetiracetam KEPPRA methsuximide CELONTIN QL, Maximum age of 9 for solution oxcarbazepine TRILEPTAL QL, Maximum age of 9 for suspension phenobarbital PHENOBARBITAL phenytoin DILANTIN INFATABS phenytoin sodium DILANTIN extended PHENYTEK pregabalin LYR ICA PA pregabalin LYRICA SOLUTION oral solution, PA primidone MYSOLINE rufinamide BANZEL tablets only, QL, ST tiagabine GABITRIL Age Limits Apply, ST topiramate TOPAMAX QL topiramate sprinkle caps TOPAMAX SPRINKLE Members 8 years of age will require prior authorization. valproic acid DEPAKENE vigabatrin oral solution SABRIL SOLUTION PA, SP zonisamide ZONEGRAN QL Miscellaneous tetrabenazine XENAZINE PA, SP Dermatology Acne Vulgaris Oral isotretinoin ACCUTANE PA Topical azelaic acid FINACEA benzoyl peroxide BENZAC AC clindamycin CLEOCIN T gel 16

25 Generic Name Brand Name clindamycin CLEOCIN T lotion clindamycin CLEOCIN T soln erythromycin/benzoyl peroxide BENZAMYCIN erythromycin ERYGEL gel 2% erythromycin T-STAT soln sulfacetamide SULFACET-R sulfacetamide/sulfur PLEXION tretinoin AVITA RETIN-A Bacterial Infections bacitracin BACITRACIN OTC gentamicin GENTAK mupirocin BACTROBAN ointment, 22 gram tube only neomycin/polymyxin B/ bacitracin NEOSPORIN OTC silver sulfadiazine SILVADENE Corticosteroids Low Potency alclometasone ACLOVATE 0.05% crm/oint fluocinolone acetonide DERMA-SMOOTHE OIL/FS oil 0.01% fluocinolone acetonide SYNALAR soln/crm 0.01% hydrocortisone HYTONE crm 2.5% hydrocortisone HYTONE 1% lotion hydrocortisone CORTIZONE crm, oint, lot OTC Medium Potency betamethasone val. BETA-VAL crm/oint/lotion 0.1% fluocinolone acetonide SYNALAR crm, oint 0.025% flurandrenolide CORDRAN tape fluticasone propionate CUTIVATE crm 0.05%, oint 0.005% hydrocortisone butyrate LOCOID crm/oint/soln 0.1% mometasone furoate ELOCON crm 0.1% mometasone furoate ELOCON oint 0.1% prednicarbate DERMATOP crm/oint 0.1% triamcinolone acetonide KENALOG crm/lot/oint 0.025% triamcinolone acetonide KENALOG crm/oint/lotion 0.1% 17

26 Generic Name Brand Name High Potency betamethasone augmented dip DIPROLENE AF crm 0.05% betamethasone augmented dip DIPROLENE lotion 0.05% betamethasone dipropionate crm/lotion/oint 0.05% fluocinonide LIDEX crm/oint/gel 0.05% fluocinonide emulsified base LIDEX E crm 0.05% triamcinolone acetonide KENALOG crm 0.5% Very High Potency betamethasone dip augmented DIPROLENE gel 0.05% betamethasone dip augmented DIPROLENE oint 0.05% clobetasol propionate TEMOVATE crm/gel/oint/soln 0.05% Fungal Infections ciclopirox PENLAC SOLUTION 8% clotrimazole MYCELEX clotrimazole LOTRIMIN AF OTC clotrimazole with betamethasone LOTRISONE ketoconazole NIZORAL miconazole MICATIN OTC miconazole MONISTAT-DERM miconazole DESENEX POWDER 2% powder nystatin MYCOSTATIN terbinafine LAMISIL AT OTC tolnaftate TINACTIN OTC Psoriasis acitretin SORIATANE oral caps, PA calcipotriene DOVONEX calcitriol VECTICAL methoxsalen OXSORALEN-ULTRA 18

27 Generic Name Brand Name Rosacea brimonidine MIRVASO PA metronidazole METROCREAM METROGEL METROLOTION Scabies And Pediculosis crotamiton EURAX malathion OVIDE permethrin NIX CREME RINSE 1%, OTC permethrin ELIMITE 5%, QL pyrethrins/piperonyl but. RID SHAMPOO/ BUTOXIDE SHAMPOO 4% OTC Viral Infections podofilox CONDYLOX SOL sol salicylic acid 17%/ collodion DUOFILM OTC Miscellaneous aluminum acetate soln/cream, OTC aluminum chloride hexahydrate HYPERCARE 20% ammonium lactate LAC-HYDRIN 12% calamine lotion/ointment, OTC chloroxine CAPITROL fluorouracil EFUDEX fluorouracil CARAC 0.5% cream fluorouracil FLUOROPLEX 1% cream hexachlorophene PHISOHEX hydrocortisone PROCTOSOL HC CREAM 2.5%, PROCTOZONE CREAM-HC 2.5%, ANUSOL HC 2.5% imiquimod 5% cream ALDARA PA ketoconazole NIZORAL SHAMPOO shampoo 2% lidocaine LIDAMANTEL 3% cream lidocaine XYLOCAINE jelly 2% lidocaine XYLOCAINE oint 5% lidocaine LMX-4 4% cream (15 gm tubes), QL lidocaine/prilocaine EMLA 2.5% cream nitroglycerin RECTIV 0.4% rectal ointment, PA 19

28 Generic Name Brand Name pimecrolimus ELIDEL cream QL, ST, Step therapy is not required for members ages 2-11; not covered for members less than 2 years of age selenium sulfide SELSUN shampoo 2.5% tacrolimus PROTOPIC 0.03% tacrolimus PROTOPIC 0.1% urea 40% UREA 40% CREAM AND LOTION ointment 0.03% ST, Step therapy is not required for members ages 2-11; not covered for members less than 2 years of age ointment 0.1%, ST (minimum age 16) cream and lotion Ear, Nose & Throat Ear acetic acid VOSOL OTIC otic acetic acid/ aluminum acetate DOMEBORO OTIC acetic acid/ hydrocortisone VOSOL HC OTIC benzocaine/antipyrine BENZOTIC carbamide peroxide DEBROX 6.5%, OTC ciprofloxacin/ dexamethasone CIPRODEX PA neomycin/polymyxin B/ hydrocortisone CORTISPORIN OTIC otic ofloxacin FLOXIN OTIC Nose Antihistamines - First Generation, Sedating chlorpheniramine maleate CHLOR-TRIMETON SYRUP 2 mg/5 ml, OTC chlorpheniramine ext-rel CHLOR-TRIMETON ALLERGY 12 mg, OTC clemastine CLEMASTINE cyproheptadine CYPROHEPTADINE diphenhydramine BENADRYL OTC diphenhydramine hydroxyzine HCL ATARAX hydroxyzine pamoate VISTARIL 20

29 Generic Name Brand Name Antihistamines - Second Generation, Nonsedating cetirizine ZYRTEC OTC cetirizine chew tab ZYRTEC CHEWABLE TABLET OTC, Members 8 years of age will require prior authorization. levocetirizine XYZAL tabs, ST loratadine ALAVERT CLARITIN OTC Antihistamines - Others Antihistamine/Decongestant Combinations azelastine ASTELIN spray Antihistamine/Decongestant Combinations - First Generation chlorpheniramine/ phenylephrine/ pyrilamine TRIOTANN chlorpheniramine/pseudoephedrine ext-rel DECONAMINE SR triprolidine/ ACTIFED OTC pseudoephedrine Antihistamine/Decongestant Combinations - Second Generation cetirizine hydrochloride/ pseudoephedrine hydrochloride 12 hours extended-release ZYRTEC-D 5 mg-120 mg tablet ALAVERT-D loratadine/ ALAVERT ALRG pseudoephedrine OTC TAB/SINUS ext-rel ALLERGY/CONG Nasal Steroids fluticasone FLONASE triamcinolone nasal spray NASACORT ALLERGY 24 HOUR OTC Miscellaneous Nasal Decongestants oxymetazoline AFRIN OTC phenylephrine NEO-SYNEPHRINE DIMEATAPP DRO DECONGES OTC 21

30 Generic Name Brand Name Miscellaneous Nasal cromolyn sodium NASALCROM OTC saline nasal spray 0.65% OCEAN NASAL SPRAY OTC Throat And Mouth artificial saliva OTC chlorhexidine gluconate PERIDEX lidocaine viscous XYLOCAINE pilocarpine SALAGEN triamcinolone KENALOG IN ORABASE paste Endocrinology Adrenal Corticosteroids cortisone acetate dexamethasone DECADRON fludrocortisone FLORINEF hydrocortisone CORTEF methylprednisolone MEDROL prednisolone prednisolone sodium ORAPRED phosphate PEDIAPRED prednisolone PRELONE syrup prednisone DELTASONE Androgens testosterone cypionate DEPO-TESTOSTERONE testosterone enanthate DELATESTRYL testosterone gel topical tube, packet, and pump bottle Diabetes Mellitus Glucose Elevating Agents glucagon, human TESTOSTERONE 1% TOPICAL GEL Vials only. Disposable syringes not covered. PA GLUCAGON QL recombinant Insulins insulin aspart NOVOLOG QL insulin aspart protamine 70%/ insulin aspart 30% NOVOLOG MIX 70/30 QL insulin detemir LEVEMIR QL insulin glargine LANTUS QL insulin human NOVOLIN R OTC, QL 22

31 Generic Name Brand Name insulin human RELION R OTC, QL insulin isophane HUMULIN N OTC, QL insulin isophane human NOVOLIN N OTC, QL insulin isophane human RELION N OTC, QL insulin isophane human 70%/regular 30% NOVOLIN 70/30 OTC, QL insulin isophane human 70%/regular 30% RELION 70/30 OTC, QL insulin lisopro pro/lispro HUMALOG MIX 50/50 QL insulin lisopro prot/lispro HUMALOG MIX 75/25 QL insulin isophane/regular HUMULIN 70/30 OTC, QL insulin lispro HUMALOG QL insulin regular HUMULIN R OTC, QL Monitoring- Strips and Kits/Diabetic Supplies ACCU-CHEK TEST STRIPS (AVIVA, AVIVA PLUS, COMPACT, SMARTVIEW) ACCU-CHEK CARE KIT (AVIVA, COMPACT PLUS, NANO SMARTVIEW) ONE TOUCH TEST STRIPS (BASIC/PROFILE, SURESTEP, ULTRA, VERIO) ONE TOUCH SYSTEMS (ULTRA, ULTRASMART, UL- TRA2, ULTRAMINI, VERIO IQ, VERIO SYNC) QL for non-insulin dependent members: allow once daily testing QL for insulin dependent or pregnant members: allow testing up to 6 times per day QL for non-insulin dependent members: allow once daily testing QL for insulin dependent or pregnant members: allow testing up to 6 times per day Oral Agents acarbose PRECOSE canagliflozin INVOKANA ST canagliflozin/metformin INVOKAMET ST chlorpropamide DIABINESE empagliflozin JARDIANCE ST glimepiride AMARYL glipizide GLUCOTROL glipizide ext-rel GLUCOTROL XL glyburide MICRONASE glyburide, micronized GLYNASE linagliptin TRADJENTA ST linagliptin/metformin JENTADUETO ST metformin GLUCOPHAGE metformin ER GLUCOPHAGE ER 23

32 Generic Name Brand Name metformin/glyburide GLUCOVANCE nateglinide STARLIX pioglitazone ACTOS QL pioglitazone/glimepiride DUETACT ST pioglitazone/metformin ACTOPLUSMET QL, ST pioglitazone/metformin ER ACTOPLUS MET XR ST repaglinide PRANDIN saxagliptin ONGLYZA ST saxagliptin/metformin KOMBIGLYZE ST tolazamide TOLINASE tolbutamide TOLBUTAMIDE Miscellaneous Antidiabetic Agents albiglutide TANZEUM ST liraglutide VICTOZA ST pramlintide SYMLIN PA Growth Stimulating Agents mecasermin INCRELEX PA, SP somatropin NORDITROPIN PA, SP Osteoporosis alendronate FOSAMAX QL calcitonin-salmon MIACALCIN inj calcitonin-salmon MIACALCIN FORTICAL nasal spray, QL etidronate DIDRONEL raloxifene EVISTA teriparatide inj FORTEO PA, SP Thyroid Disease levothyroxine LEVOXYL levothyroxine SYNTHROID liothyronine CYTOMEL liotrix THYROLAR methimazole TAPAZOLE propylthiouracil PROPYLTHIOURACIL Miscellaneous bromocriptine PARLODEL desmopressin DDAVP QL methylergonovine METHERGINE mifeprstone KOR LYM PA, SP sapropterin KUVAN PA, SP sapropterin powder KUVAN POWDER FOR SOLUTION PA, SP 24

33 Generic Name Brand Name Gastrointestinal Diarrhea diphenoxylate/atropine LOMOTIL loperamide LOPERAMIDE loperamide IMODIUM A-D OTC Emesis aprepitant EMEND QL applies to 40 mg, 80 mg and mg dronabinol MARINOL PA meclizine ANTIVERT metoclopramide REGLAN ondansetron ZOFRAN ZOFRAN ODT QL prochlorperazine COMPAZINE promethazine PHENERGAN thiethylperazine TORECAN trimethobenzamide TIGAN 300 mg caps Gastroesophageal reflux disease (gerd)/ peptic ulcers alginic acid/sodium bicarbonate OTC alumina/magnesia MAALOX OTC alumina/magnesia/ simethicone MYLANTA OTC cimetidine TAGAMET esomeprazole NEXIUM 24HR OTC PA esomeprazole granules famotidine NEXIUM DELAYED RELEASE PACKET PEPCID PEPCID AC Members 2 years of age will require prior authorization. OTC Pepcid AC 10 mg and 20 mg also covered/ encouraged with written prescription. lansoprazole PREVACID PA lansoprazole del-rel PREVACID SOLUTAB orally disintegrating tabs, Members 2 years of age will require prior authorization. QL omeprazole delayed-rel PRILOSEC Capsules only, QL pantoprazole PROTONIX ranitidine ZANTAC 150 mg tabs 25

34 Generic Name Brand Name ranitidine syrup ZANTAC sucralfate CARAFATE sulcralfate CARAFATE SUSPENSION Gastrointestinal Spasm dicyclomine BENTYL glycopyrrolate ROBINUL hyoscyamine sulfate LEVSIN hyoscyamine sulfate LEVSINEX suspension, Members 10 years of age up to 65 years of age will require prior authorization. ext-rel Inflammatory Bowel Disease balsalazide COLAZAL budesonide ENTOCORT EC PA hydrocortisone COLOCORT enema mesalamine APRISO LIALDA mesalamine ext-rel PENTASA mesalamine ROWASA enema only mesalamine supp CANASA olsalazine sodium DIPENTUM sulfasalazine AZULFIDINE sulfasalazine delayed-rel AZULFIDINE EN-TABS Pancreatic Enzymes pancrelipase Laxatives casanthranol-docusate sodium CREON CREON 3000 UNIT ZENPEP OTC docusate calcium plus OTC docusate potasssium OTC glycerin GLYCERIN SUPPOSITORY suppository, OTC lactulose ENULOSE peg 3350/electrolytes COLYTE peg 3350/sodium bicarbonate/sodium chloride/potassium chloride NULYTELY 26

35 Generic Name Brand Name peg 3350/sodium bicarbonate/sodium TRILYTE chloride polyethylene glycol 3350 MIRALAX sennosides SENOKOT 8.6 mg tab, OTC Probiotic Supplementation acidophilus ACIDOPHILUS caps and tabs, OTC acidophilus ACIDOPHILUS XTRA OTC acidophilus/bifidus ACIDOPHILUS/ BIFIDUS WAFER OTC acidophilus/citrus pectin ACIDOPHILUS/ tabs, OTC CITRUS PECTIN acidophilus/pectin ACIDOPHILUS/PECTIN caps, OTC lactobacillus FLORANEX chewable tablets, OTC probiotic product PROBIOTIC FORMULA caps, OTC Miscellaneous atropine sulfate SAL-TROPINE bismuth subsalicylate + metronidazole + tetracycline HELIDAC methylnaltrexone RELISTOR PA misoprostol CYTOTEC teduglutide GATTEX PA, SP ursodiol Infectious Diseases ACTIGALL URSO URSO FORTE Anthelmintics albendazole ALBENZA PA ivermectin STROMECTOL praziquantel BILTRICIDE PA Antibacterials Cephalosporins - First Generation cefadroxil DURICEF cephalexin KEFLEX tabs are not covered Cephalosporins - Second Generation cefaclor CECLOR cefprozil CEFZIL cefuroxime axetil CEFTIN 27

36 Generic Name Brand Name Cephalosporins - Third Generation cefdinir OMNICEF cefixime SUPRAX 400 mg caps only, QL Fluoroquinolones ciprofloxacin CIPRO levofloxacin LEVAQUIN tablets only ofloxacin FLOXIN tabs Macrolides azithromycin ZITHROMAX QL clarithromycin BIAXIN clarithromycin ER BIAXIN XL erythromycin ethylsuccinate E.E.S. erythromycin delayed-rel ERYC erythromycin delayed-rel ERY-TAB erythromycin stearate ERYTHROCIN erythromycin/sulfisoxazole PEDIAZOLE Penicillins amoxicillin AMOXICILLIN CAPSULES Except 500 mg and 875 mg AND CHEWABLES film-coated tabs. amoxicillin/clavulanate AUGMENTIN amoxicillin AMOXIL SUSP suspension ampicillin PRINCIPEN dicloxacillin DICLOXACILLIN penicillin VK VEETIDS Sulfonamides sulfisoxazole sulfamethoxazole/ BACTRIM trimethoprim, DS BACTRIM DS Tetracyclines doxycycline monohydrate DOXYCYCLINE MONOHYDRATE minocycline MINOCIN capsules, except 75 mg tetracycline SUMYCIN Miscellaneous vancomycin HCl VANCOCIN HCL cap, ST 28

37 Generic Name Brand Name Antifungals clotrimazole MYCELEX troches fluconazole DIFLUCAN QL griseofulvin ultramicrosize GRIS-PEG griseofulvin microsize GRIFULVIN V itraconazole SPORANOX PA, QL ketoconazole NIZORAL nystatin MYCOSTATIN terbinafine LAMISIL QL Antivirals Cytomegalovirus Treatment ganciclovir CYTOVENE valganciclovir VALCYTE tabs only Entry/Fusion Inhibitors enfuvirtide FUZEON KIT SP Hepatitis Treatment adefovir HEPSERA entecavir BARACLUDE interferon alfa-2b INTRON A PA, SP interferon alfacon-1 INFERGEN PA, SP lamivudine EPIVIR HBV ledipasvir/sofosbuvir HARVONI PA peginterferon alfa-2a PEGASYS PA, SP peginterferon alfa-2a PEGASYS PROCLICK PA, SP ribavirin REBETOL/COPEGUS 200 mg caps and tabs only, PA, SP simeprevir OLYSIO PA, SP sofosbuvir SOVALDI PA, SP Herpes Treatment acyclovir ZOVIRAX valacyclovir VALTREX Influenza Treatment amantadine SYMMETREL except tabs oseltamivir TAMIFLU QL rimantadine FLUMADINE zanamivir RELENZA QL 29

38 Generic Name Brand Name Non-Nucleoside Reverse Transcriptase Inhibitors - Diagnosis required delavirdine RESCRIPTOR efavirenz SUSTIVA nevirapine VIRAMUNE nevirapine ER VIRAMUNE XR rilpivirine EDURANT Nucleoside Analogues Nucleoside Reverse-Transcriptase Inhibitors/and Combinations - Diagnosis required abacavir ZIAGEN abacavir/lamivudine EPZICOM abacavir/lamivudine/ zidovudine TRIZIVIR didanosine VIDEX didanosine delayed-rel VIDEX EC emtricitabine EMTRIVA emtricitabine/rilpivirine/ tenofovir COMPLERA lamivudine EPIVIR lamivudine/zidovudine COMBIVIR stavudine ZERIT zalcitabine HIVID zidovudine RETROVIR Nucleoside/Nucleotide Reverse-Transcriptase Inhibitor Combination - Diagnosis required cobicistat/elvitegravir/ STRIBILD emtricitabine/tenofovir PA efavirenz/emtricitabine/ tenofovir ATRIPLA emtricitabine/tenofovir TRUVADA PA Nucleotide Analogues Nucleotide Reverse-Transcriptase Inhibitor - Diagnosis required tenofovir VIREAD Protease Inhibitors - Diagnosis required amprenavir AGENERASE atazanavir REYATAZ darunavir PREZISTA fosamprenavir LEXIVA indinavir CRIXIVAN lopinavir/ritonavir KALETRA nelfinavir VIRACEPT ritonavir NORVIR saquinavir FORTOVASE saquinavir mesylate INVIRASE tipranavir APTIVUS 30

39 Generic Name Brand Name Miscellaneous abacavir/dolutegravir/ lamivudine TRIUMEQ Diagnosis required atovaquone MEPRON PA bedaquiline SIRTURO PA chloroquine phosphate ARALEN clindamycin CLEOCIN 150 mg and 300 mg only dapsone DAPSONE dolutegravir TIVICAY Diagnosis required ethambutol MYAMBUTOL etravirine INTELENCE Diagnosis required hydroxychloroquine PLAQUENIL isoniazid ISONIAZID linezolid ZYVOX PA maraviroc SELZENTRY Diagnosis required mefloquine LARIAM metronidazole FLAGYL tabs only neomycin sulfate nitazoxanide tablet ALINIA PA nitazoxanide suspension ALINIA SUSPENSION nitrofurantoin ext-rel MACROBID nitrofurantoin macrocrystals MACRODANTIN nitrofurantoin macrocrystals MACRODANTIN 25 MG nitrofurantoin susp FURADANTIN SUSP 25 MG/5 ML Members 8 years of age will require prior authorization. Members 8 years of age will require prior authorization. palivizumab SYNAGIS PA paromomycin HUMATIN povidone-iodine OTC primaquine pyrimethamine DARAPRIM pyrazinamide PYRAZINAMIDE raltegravir ISENTRESS Diagnosis required raltegravir ISENTRESS CHEWABLE Chewable tablet; Diagnosis required 31

40 Generic Name Brand Name raltegravir susp ISENTRESS SUSP Members 2 years of age will require prior authorization. Diagnosis required. rifabutin MYCOBUTIN rifampin RIFADIN trimethoprim TRIMETHOPRIM tabs only Musculoskeletal Arthritis Disease Modifying Anti-Rheumatic s adalimumab HUMIRA PA, SP anakinra KINERET PA, SP auranofin RIDAURA azathioprine IMURAN certolizumab pegol CIMZIA PA, SP hydroxychloroquine PLAQUENIL leflunomide ARAVA methotrexate penicillamine CUPRIMINE sulfasalazine AZULFIDINE sulfasalazine delayed-rel AZULFIDINE EN-TABS NSAIDs and Other Analgesics acetaminophen TYLENOL OTC aspirin BAYER OTC ECOTRIN capsaicin OTC celecoxib CELEBREX PA, QL choline magnesium trisalicylate TRILISATE diclofenac 1% gel VOLTAREN 1% TOPICAL GEL PA diclofenac potassium CATAFLAM diclofenac sodium delayed release VOLTAREN diclofenac sodium extended release VOLTAREN XR etodolac LODINE IR only fenoprofen NALFON 600 mg ibuprofen ADVIL tabs, chew tabs and susp, OTC 32

41 Generic Name Brand Name ibuprofen MOTRIN tabs, chew tabs and susp indomethacin INDOCIN ketoprofen ORUDIS IR only meloxicam MOBIC QL naproxen NAPROSYN not EC naproxen sodium ANAPROX oxaprozin DAYPRO piroxicam FELDENE sulindac CLINORIL Gout allopurinol ZYLOPRIM colchicine COLCRYS febuxostat ULORIC ST probenecid PROBENECID Skeletal Muscle Relaxants Muscle Spasm chlorzoxazone PARAFON FORTE DSC cyclobenzaprine FLEXERIL methocarbamol ROBAXIN orphenadrine ext-rel NORFLEX Spasticity baclofen BACLOFEN dantrolene DANTRIUM diazepam VALIUM QL tizanidine ZANAFLEX tabs only, QL OB-GYN Contraceptives Biphasic desogestrel/ee MIRCETTE QL norethindrone/ee ORTHO-NOVUM 10/11 QL Emergency Contraception levonorgestrel PLAN B QL levonorgestrel PLAN B ONE STEP 1.5 mg tab Extended Cycle levonorgestrel/ee SEASONALE QL Injectable medroxyprogesterone acetate DEPO-PROVERA QL Intravaginal etonogestrel/ee NUVARING ring, QL 33

42 Generic Name Brand Name ortho diaphragm ORTHO COIL ORTHO FLAT QL ORTHO FLEX Monophasic - 20 mcg estrogen levonorgestrel/ee ALESSE 0.1/20, QL norethindrone acetate/ee LOESTRIN 1/20 1/20, QL norethindrone acetate/ EE/iron LOESTRIN FE 1/20 1/20, QL Monophasic - 30 mcg estrogen desogestrel/ee ORTHO-CEPT 0.15/30, QL levonorgestrel/ee NORDETTE 0.15/30, QL norethindrone acetate/ EE/iron LOESTRIN FE 1.5/30 1.5/30, QL norethindrone acetate/ee LOESTRIN 1.5/30 1.5/30, QL norgestrel/ee LO/OVRAL 0.3/30, QL Monophasic - 35 mcg estrogen ethynodiol diacetate/ee ZOVIA 1/35 1/35, QL norethindrone/ee BALZIVA 0.4/35, QL norethindrone/ee MODICON 0.5/35, QL norethindrone/ee ORTHO-NOVUM 1/35 1/35, QL norgestimate/ee ORTHO-CYCLEN 0.25/35, QL Monophasic - 50 mcg estrogen ethynodiol diacetate/ee ZOVIA 1/50 1/50, QL norethindrone/ee OVCON 50 1/50, QL norethindrone/me ORTHO-NOVUM 1/50 1/50, QL norgestrel/ee OVRAL 0.5/50, QL Progestin norethindrone ORTHO MICRONOR norgestrel OVRETTE Transdermal norelgestromin/ee ORTHO EVRA Triphasic desogestrel/ee CYCLESSA QL levonorgestrel/ee TRIVORA QL norethindrone acetate/ee/iron ESTROSTEP FE QL norethindrone/ee TRI-NORINYL QL norethindrone/ee ORTHO-NOVUM 7/7/7 QL norgestimate/ee ORTHO TRI-CYCLEN QL norgestimate/ee ORTHO TRI-CYCLEN LO QL 34

43 Generic Name Brand Name Endometriosis danazol DANOCRINE Gender edits apply: for female patients only. Hormone Therapy/Menopause Estrogens - Intravaginal estradiol ESTRACE CRM estrogens, conjugated PREMARIN crm Estrogens - Oral estradiol ESTRACE estrogens, conjugated, synthetic A CENESTIN estrogens, conjugated, ENJUVIA synthetic B estrogens, conjugated PREMARIN estropipate OGEN Estrogens - Transdermal estradiol CLIMARA QL Estrogen/Progestin estrogens, conjugated/ medroxyprogesterone Progestins medroxyprogesterone acetate PREMPHASE PREMPRO PROVERA norethindrone acetate AYGESTIN Vaginal Infections Oral fluconazole DIFLUCAN QL metronidazole FLAGYL tabs Vaginal clotrimazole GYNE-LOTRIMIN OTC clindamycin CLEOCIN crm metronidazole METROGEL-VAGINAL METROGEL 1% miconazole MONISTAT OTC miconazole MONISTAT 3 terconazole TERAZOL 3/7 crm 35

44 Generic Name Brand Name Miscellaneous conjugated estrogen/ bazedoxifene DUAVEE methylergonovine METHERGINE tranexamic acid LYSTEDA PA Ophthalmic Allergy azelastine OPTIVAR ST cromolyn sodium CROLOM QL ketotifen ALAWAY OTC naphazoline HCL VASOCLEAR soln 0.02% naphazoline/antazoline naphazoline/glycerin CLEAR EYES REDNESS RELIEF naphazoline/zinc sulfate VASOCLEAR A tetrahydrozoline /zinc sulfate VISINE-AC Anti-Inflammatories Nonsteroidal diclofenac sodium VOLTAREN flurbiprofen OCUFEN ketorolac ACULAR/ACULAR LS Steroidal dexamethasone sodium phosphate DEXASOL fluorometholone FML FML SOP 0.1% fluorometholone acetate FLAREX fluorometholone FML FORTE susp 0.25% prednisolone acetate PRED MILD 0.12% prednisolone acetate PRED FORTE 1% prednisolone phosphate INFLAMASE FORTE 1% rimexolone VEXOL Anti-Infective/Anti-Inflammatory Combinations gentamicin/prednisolone acetate PRED-G neomycin/polymyxin B/ dexamethasone MAXITROL 36

45 Generic Name Brand Name neomycin/polymyxin B/ hydrocortisone CORTISPORIN sulfacetamide/pred. phos. VASOCIDIN 10%/0.25% tobramycin/ dexamethasone TOBRADEX Glaucoma Oral acetazolamide ACETAZOLAMIDE acetazolamide ext-rel DIAMOX SEQUELS methazolamide NEPTAZANE Topical - Sympathomimetics brimonidine ALPHAGAN P brimonidine BRIMONIDINE 0.2% Topical - Parasympathomimetics pilocarpine PILOPINE HS GEL pilocarpine ISOPTO CARPINE Beta-blockers carteolol levobunolol BETAGAN ophthalmic solution metipranolol OPTIPRANOLOL 0.3% ophthalmic solution timolol TIMOPTIC XE gel forming solution timolol hemihydrate BETIMOL timolol maleate TIMOPTIC Prostaglandins latanoprost XALATAN QL Carbonic Anhydrase Inhibitors dorzolamide TRUSOPT Carbonic Anhydrase Inhibitor/Beta-blocker Combination dorzolamide/ timolol maleate COSOPT Cholinesterase Inhibitor ecothiophate PHOSPHOLINE IODINE Mydriatics atropine ISOPTO ATROPINE cyclopentolate CYCLOGYL homatropine ISOPTO HOMATROPINE scopolamine ISOPTO HYOSCINE 37

46 Generic Name Brand Name Infections Bacterial bacitracin ciprofloxacin CILOXAN erythromycin ERYTHROMYCIN gatifloxin ZYMAR PA gentamicin GENTAK neomycin/polymyxin B/ gramicidin NEOSPORIN ofloxacin OCUFLOX polymyxin B/bacitracin POLYSPORIN polymyxin B/trimethoprim POLYTRIM sulfacetamide/ phenylephrine VASOSULF sulfacetamide BLEPH-10 oint/soln tobramycin TOBREX Viral trifluridine VIROPTIC Miscellaneous Ophthalmics cysteamine 0.44% CYSTARAN PA, SP ophthalmic solution sodium chloride hypertonic Psychiatric MURO 128 soln 5% Alcohol Deterrents acamprosate CAMPRAL disulfiram ANTABUSE naltrexone REVIA Anxiety Benzodiazepines alprazolam XANAX QL, IR only chlordiazepoxide LIBRIUM clonazepam KLONOPIN not wafers clorazepate TRANXENE diazepam VALIUM QL lorazepam ATIVAN QL oxazepam SERAX QL 38

47 Generic Name Brand Name Miscellaneous buspirone BUSPAR fluvoxamine LUVOX Attention Deficit Hyperactivity Disorder (ADHD) - Diagnosis required amphetamine/dextroam- ADDERALL Age Limits Apply, QL phetamine mixed salts amphetamine/ dextroamphetamine mixed salts ext-rel ADDERALL XR (BRAND ADDERALL XR IS PREFERRED) Age Limits Apply, QL atomoxetine STRATTERA Age Limits Apply, QL, ST dextroamphetamine DEXEDRINE Age Limits Apply, QL dextroamphetamine DEXTROSTAT Age Limits Apply, QL dextroamphetamine ext-rel DEXEDRINE SPANSULE Age Limits Apply, QL guanfacine INTUNIV Age Limits Apply, ST lisdexamfetamine VYVANSE Age Limits Apply, QL methylphenidate RITALIN Age Limits Apply, tabs only, QL methylphenidate ext-rel CONCERTA Age Limits Apply, QL methylphenidate ext-rel Bipolar Disorder divalproex sodium cap sprinkle METADATE ER RITALIN-SR RITALIN LA DEPAKOTE SPRINKLE Age Limits Apply, QL Members 8 years of age will require prior authorization. divalproex sodium delayed-rel DEPAKOTE Minimum age 2 lithium carbonate LITHIUM CARBONATE lithium carbonate ext-rel ESKALITH CR LITHOBID Depression Monoamine Oxidase Inhibitor (MAOI) tranylcypromine PARNATE Selective Serotonin Reuptake Inhibitor (SSRIs) citalopram CELEXA QL escitalopram LEXAPRO fluoxetine PROZAC 10 mg and 20 mg caps and 20 mg soln only paroxetine PAXIL tablets sertraline ZOLOFT tablets, QL 39

48 Generic Name Brand Name Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) duloxetine CYMBALTA QL, ST venlafaxine EFFEXOR QL venlafaxine XR EFFEXOR XR QL Tricyclic Antidepressants (TCAs) amitriptyline ELAVIL tablets amoxapine desipramine NORPRAMIN doxepin SINEQUAN imipramine HCL TOFRANIL tablets nortriptyline PAMELOR Tricyclic Antidepressant/Phenothiazine combination amitriptyline/perphenazine TRIAVIL Miscellaneous Agents bupropion WELLBUTRIN bupropion ext-rel WELLBUTRIN SR QL bupropion ext-rel WELLBUTRIN XL 150 mg and 300 mg maprotiline LUDIOMIL mirtazapine REMERON tabs (not soltabs) trazodone DESYREL 150 mg only Insomnia Benzodiazepines flurazepam DALMANE QL temazepam RESTORIL 15 mg and 30 mg only, QL triazolam HALCION QL Non-benzodiazepines chloral hydrate CHLORAL HYDRATE diphenhydramine NYTOL QUICK CAPS OTC zaleplon SONATA QL zolpidem AMBIEN QL 40

49 Generic Name Brand Name Narcotic Antagonists buprenorphine SUBUTEX PA, QL buprenorphine/naloxone SUBOXONE 2 mg and 8 mg film only, PA, QL naloxone NALOXONE INJ naltrexone REVIA Smoking Cessation nicotine NICODERM CQ patches, QL nicotine polacrilex gum NICORETTE OTC QL nicotine polacrilex lozenge COMMITT OTC QL varenicline CHANTIX QL Psychoses - Diagnosis required Atypicals aripiprazole ER injection ABILIFY MAINTENA PA aripiprazole ABILIFY TABLETS clozapine CLOZARIL olanzapine ZYPREXA Age Limit Applies, tablets, PA, QL, Certain daily doses require half tablet dosing: 5 mg once daily must be dosed as 10 mg tablet, ½ tab once daily 10 mg once daily must be dosed as 20 mg tablet, ½ tab once daily 15 mg once daily must be dosed as 30 mg tablet, ½ tab once daily Age Limit Applies, 100 mg only Age Limit Applies, tablets, QL paliperidone INVEGA SUSTENNA Age Limit Applies, PA, QL quetiapine SEROQUEL Age Limit Applies, QL risperidone RISPERDAL CONSTA Age Limit Applies, PA, QL risperidone RISPERDAL Age Limit Applies, QL, (Not M-Tabs) risperidone oral soln RISPERDAL SOLUTION QL, Members 8 years of age will require prior authorization. ziprasidone GEODON Age Limit Applies, QL 41

50 Generic Name Brand Name Miscellaneous chlorpromazine THORAZINE dextromethorphan/ quinidine NUEDEXTA PA fluphenazine PROLIXIN fluphenazine decanoate PROLIXIN DECANOATE haloperidol HALDOL haloperidol decanoate HALDOL DECANOATE loxapine LOXITANE perphenazine TRILAFON pimozide ORAP thioridazine MELLARIL thiothixene NAVANE trifluoperazine STELAZINE Respiratory s Antitussives, Decongestants, Expectorants And Combinations benzonatate TESSALON brompheniramine & DIMETAPP CLD ELX/ phenylephrine ALLERGY BROMFENEX PD CAP brompheniramine/ pseudoephedrine brompheniramine/ pseudoephedrine /dextromethorphan brompheniramine/ pseudoephedrine /dextromethorphan brompheniramine/ pseudoephedrine/ dextromethorphan/ guaifenesin DIMETAPP ELX CLD/ALLE UNI-HIST DRO CARDEC SYP BROMALINE DM elixir BROMFED DM DALLERGY DM CARBOFED NEO DM ANAPLEX DM syrup HISTACOL DM syrup 42

51 Generic Name brompheniramine/ pseudoephedrine brompheniramine/ pseudoephedrine/ dextromethorphan brompheniramine/ pseudoephedrine carbetapentane/ chlorpheniramine/ ephedrine/ phenylephrine carbinoxamine/ pseudoephedrine chlorphen-pemethscopolamine chlorpheniramine/ dextromethorphan chlorpheniramine/ pseudoephedrine chlorpheniramine/ phenylephrine chlorpheniramine/ phenylephrine chlorpheniramine maleate phenylephrine HCL chlorpheniramine tan/ phenylephrine tan chlorphen tan/ pseudoeph tan chlorphen tan/pyrilamine tan/pe tan Brand Name ACCUHIST DROPS RESPERAL-DM liquid ACCUHIST PDX DROPS liquid RONDEC SYRUP syrup RYNATUSS RONDEC DROPS liquid DURADRYL QV-ALLERGY ROBITUSSIN PED LIQ CGH/COLD ROBITUSSIN LIQ CGH/CLD DIMETAPP SYP CGH/CLD CORICIDIN TAB CGH/CLD HISTEX CPM/PSE RONDEC DROPS CARDEC DRO RONDEC SYRUP CARDEC SYP ED A-HIST TABLETS AND LIQUID RYNATAN PEDIATRIC SUSP syrup liquid syrup susp TANAFED susp TRIOTANN PEDIATRIC SUSP R-TANNAMINE susp 43

52 Generic Name chlorphen tan/ carbetapentane tan codeine/ chlorpheniramine/ pseudoephedrine codeine/guaifenesin codeine/guaifenesin/ pseudoephedrine codeine/promethazine codeine/promethazine/ phenylephrine dextromethorphanguaifenesin dextromethorphanguaifenesin dextromethorphan polistirex ext rel dextromethorphan/ guaifenesin dextromethorphan hbr dextromethorphan/ brompheniramine/ pseudoephedrine dextromethorphan/ carbinoxamine/ pseudoephedrine dextromethorphan/ promethazine Brand Name TUSSI-12 S susp DIHISTINE DH PHENYLHIST LIQ DH GUIATUSS AC GG/CODEINE M-CLEAR WC GUIATUSS DAC PROMETHAZINE W/CODEINE PROMETHAZINE VC W/CODEINE ROBITUSSIN LIQ CGH/ CONG QL QL QL liq mg/ 5 ml DURATUSS DM ELX soln mg/5 ml DELSYM OTC GG/DM CR MUCINEX DM ROBITUSSIN DM TUSSIN DM ROBITUSSIN SYP MAX-ST ROBITUSSIN PED SYP BROMETANE DX OTC syrup CARDEC-DM drops PHENERGAN DM PROMETHAZINE SYP DM guaifenesin ROBITUSSIN OTC guaifenesin ext-rel MUCINEX OTC guaifenesin ROBITUSSIN SYP CHST CNG syrup 100 mg/5 ml 44

53 Generic Name guaifenesin/pseudoephedrine ext rel guaifenesin/ pseudoephedrine guaifenesin/ pseudoephedrine ext rel guaifenesin/ pseudoephedrine/ dextromethorphan hydrocodone/chlorpheniramine/phenylephrine Brand Name GUAIFED ROBITUSSIN PE PSE/GG GUAIFEN PSE MUCINEX D GG/PSE CR ROBITUSSIN CF HISTUSSIN HC hydrocodone/guaifenesin VITUSSIN HYDROCODO/GG SYP HYCODAN HYDROMET SYP hydrocodone/homatropine HYDROCODONE/ TAB HOMATROP loratadine & pseudoephedrine SR 24hr RELIEF ALLERGY/CONG TAB phenyleph/bromphen/ dextromethorphan/ ALLANHIST SYP PDX guaifenesin phenylephrine/ brompheniramine/ dextromethorphan phenylephrine/ chlorpheniramine phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ chlorpheniramine/ dextromethorphan QUAL-TUSSIN SYP DC syrup, OTC OTC tab mg OTC ATUSS DR syrup DE-CHLOR DM syrup RONDEC DM DROPS CARDEC DM DRO ROBITUSSIN LIQ CGH/ALRG liquid 45

54 Generic Name phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ephed/ CPM w/ carbetapentane phenylephrine/guaifenesin phenylephrine/chlorpheniramine/dihydrocodeine phenylephrine/dextromethorphan phenylephrine/ dextromethorphan/ guaifenesin phenylephrine/hydrocodone/guaifenesin phenylephrine/pyrilamine/ dextromethorphan phenylephrine/pyrilamine w/hydrocodone phenylephrine tan/pyrilamine tan/ carbeta tan promethazine & phenylephrine pseudoephedrine/ acetaminophen/ dextromethorphan pseudoephedrine/ chlorpheniramine/ dextromethorphan pseudoephedrine/ dextromethorphan/ guaifenesin Brand Name RONDEC DM STATUSS DM SYP CARDEC DM SYP MINUTUSS DR SYP DIHYDRO-PE SYP DIMETAPP DRO DCON/CGH ROBITUSSIN LIQ CGH/CLD RYNATUSS PEDIATRIC SUSP ROBITUSSIN LIQ HD/CHST QUAL-TUSSIN SYP DC CODAL-DM syrup susp CODIMAL DH syrup TUSSI 12D S susp PROMETH VC SYP /5 MAPAP COLD TAB PEDIACARE LIQ MULTI-SY ROBITUSSIN LIQ PED NGHT MULTI SYMPTOM TAB COLD RLF syrup mg/ 5 mg 46

55 Generic Name pseudoephedrine/ iburprofen pseudoephedrine tan/ dexchlorphen tan/ DM tan pyrilamine tan/phenyleph tan tripolidine/ pseudoephedrine Brand Name CHILD IBUPRO SUS COLD IBUOROFEN TAB COLD/SIN TANAFED DMX SUSPENSION TRI-FED X susp RYNA-12 S susp TRIPROL/PSE SYP APHEDRID TAB Asthma/COPD Inhalers - Beta Agonists albuterol sulfate VENTOLIN HFA QL formoterol FORADIL AEROLIZER inhalation caps salmeterol xinafoate SEREVENT DISKUS QL Inhalers - Corticosteroids beclomethasone QVAR QL budesonide PULMICORT FLEXHALER fluticasone HFA FLOVENT HFA QL fluticasone propionate FLOVENT DISKUS QL mometasone ASMANEX TWISTHALER QL mometasone inhalation ASMANEX HFA Inhalers -Corticosteroid/Beta Agonist Combinations budesonide/formoterol SYMBICORT ST fluticasone/salmeterol ADVAIR DISKUS ADVAIR HFA QL, ST ADVAIR INHAL AEROSOL fluticasone/vilanterol BREO ELLIPTA ST mometasone/formoterol DULERA ST Inhalers - Others aclidinium inhalation TUDORZA PRESSAIR cromolyn INTAL QL ipratropium HFA ATROVENT HFA ipratropium/albuterol COMBIVENT QL ipratropium/albuterol COMBIVENT RESPIMAT inhaler nedocromil TILADE omalizumab XOLAIR PA, SP 47

56 Generic Name Brand Name tiotropium SPIRIVA tiotropium respimat SPIRIVA RESPIMAT Inhalers for Nebulization albuterol ACCUNEB 0.63 mg/3 ml and 1.25 mg /3 ml, for members less than 8 years of age. Members 8 years of age will require prior authorization. albuterol PROVENTIL soln 0.083%, 0.5% budesonide PULMICORT RESPULES susp, Members 5 years of age will require prior authorization. QL cromolyn INTAL soln, QL ipratropium ATROVENT soln, QL ipratropium/albuterol DUONEB soln levalbuterol HCl XOPENEX RESPULES QL, ST Oral Agents - Beta Agonists metaproterenol METAPROTERENOL SYRUP terbutaline BRETHINE Oral Agents - Leukotriene Modifiers montelukast SINGULAIR QL Oral Agents - Theophylline theophylline ext-rel THEOPHYLLINE EXT-REL caps (12 hr) theophylline ext-rel THEOCHRON tabs theophylline THEOPHYLLINE liquid theophylline ext-rel THEO-24 caps theophylline ext-rel UNIPHYL tabs Potassium phosphorus K-PHOS NEUTRAL tabs potassium acid phosphate K-PHOS ORIGINAL potassium bicarbonate/ potassium citrate effervescent K-LYTE tabs potassium chloride ext-rel MICRO-K 10 caps K-DUR 10 potassium chloride ext-rel K-DUR 20 KLOR-CON 8 KLOR-CON 10 tabs 48

57 Generic Name Brand Name potassium chloride POTASSIUM CHLORIDE liquid potassium chloride K-LOR powder potassium iodide PIMA Potassium-Removing Agents sodium polysterene KAYEXALATE susp (susp only) sulfonate Vitamins And Minerals calcitriol ROCALTROL calcitriol oral soln ROCALTROL SOLUTION Members 8 years of age will require prior authorization. calcium OS-CAL OTC cholecalciferol VITAMIN D TAB 400 UNIT tab 400 unit, OTC cholecalciferol VITAMIN D TAB 1000 UNIT tab 1000 unit, OTC cholecalciferol VITAMIN D TAB 2000 UNIT tab 2000 unit, OTC cholecalciferol VITAMIN D CAP 400 UNIT cap 400 unit, OTC cholecalciferol VITAMIN D CAP 2000 UNIT cap 2000 unit, OTC cholecalciferol D3-50 CAP cap unit, OTC cholecalciferol BIO-D DRO-MULSION drops 400 unit/0.03 ml, OTC cholecalciferol BIO-D-MULSIO drops 2000 unit/0.03 ml, DRO FORTE OTC cyanocobalamin VITAMIN B-12 inj, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. electrolyte PEDIALYTE soln, oral, OTC ergocalciferol (D2) DRISDOL ferrous bisglycinate/polysaccarides iron Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. NIFEREX caps, OTC 49

58 Generic Name Brand Name ferrous sulfate FEOSOL OTC GEL-KAM Coverage for these medications will be LURIDE determined by the member s fluoride LURIDE LOZI-TABS individual benefits. PHOS-FLUR Please refer to individual plan documents for coverage PREVIDENT information. folic acid FOLIC ACID magnesium oxide MAG-OX OTC, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. Coverage for these medications will be determined by the member s multivitamins/ POLY-VI-FLOR individual benefits. fluoride/±iron Please refer to individual plan documents for coverage information. OTC, Coverage for these medications will be determined by the member s multivitamins/minerals CENTRUM individual benefits. Please refer to individual plan documents for coverage information. phytonadione MEPHYTON polysaccharide iron NIFEREX elixir, OTC complex prenat w/o A w/fecbnfegl-dss-fa & DHA prenatal vit w/ FE bisglyc- VINATE III FE prot succ-fa prenatal vit w/ FE bisglycinate VITAPHIL chelate-fa FOLTABS PAK PLUS DHA RE OB + DHA PAK 50

59 Generic Name prenatal vit w/ FE bisglycinate chelate-fa prenatal vit w/ FE bisglycinate chelate-fa prenatal vit w/ FE polysac cmplx-fa prenatal vit w/ iron carbonyl-fa prenatal vitamins w/folic acid prenatal vit w/o vit a w/ fe bisglycinate-fa tab 32-1 mg prenatal w/o A w/ FE carbonyl-fe gluc-dss-fa prenat-fe Bis-FE prot succ-fa-ca & omega 3 prenat-fe Bis-FE prot succ-fa-ca & omega 3 prenat-fe Bis-FE prot succ-fa-ca & omega 3 prenat-fe bis-fe prot succ-fa-ca & omega DR Brand Name GENTEX ADE 28-1 MG VINATE AZ EX EDGE OB CHW ATABEX PRENATAL PRENATAL VITAMINS W/ FOLIC ACID CENOGEN OB/ULTRA MATERNA NATALCARE NESTABSCBF/FA/RX NIFEREX-PN FORTE NESTABS FOLTABS PRENATAL TRI RX COMPLETE NATALCARE PAK DHA TRUST NATALCARE PAK DHA PRUET DHA PAK SETONET PAK PRUET DHAEC PAK vitamin A OTC QL 51

60 Generic Name vitamin ADC/ fluoride/±iron drops vitamin B complex/ vitamin C/folic acid Brand Name TRI-VI-FLOR NEPHROCAPS Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. vitamin B-1 OTC vitamin C OTC vitamin B-6 OTC vitamins pediatric TRI-VI-SOL members <3 years old, OTC, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. zinc OTC Urological Symptomatic Benign Prostatic Hypertrophy alfuzosin ER UROXATRAL doxazosin CARDURA finasteride PROSCAR tamsulosin FLOMAX terazosin HYTRIN Miscellaneous bethanechol URECHOLINE 52

61 Generic Name Brand Name hyoscyamine, methenamine, phenyl salicylate, sodium phosphate UTIRA C monobasic, methylene blue methenamine hippurate HIPREX UREX oxybutynin IR DITROPAN oxybutynin chloride DITROPAN XL QL, ST potassium citrate UROCIT-K propantheline phenazopyridine PYRIDIUM sodium citrate/citric acid BICITRA tolterodine DETROL ST trospium SANCTURA ST Miscellaneous Anaphylaxis epinephrine EPIPEN EPIPEN JR. QL TWINJECT Cryopyrin Associated Periodic Syndromes (CAPS) canakinumab ILARIS PA, SP rilonacept ARCALYST PA, SP Cystic Fibrosis acetylcysteine MUCOMYST aztreonam CAYSTON PA, SP dornase alfa PULMOZYME PA, SP ivacaftor KALYDECO PA, SP tobramycin neb soln BETHKIS PA, SP Hereditary Angioedema C1 Inhibitor, Human BERINERT PA, SP icatibant FIRAZYR PA, SP Hyperphosphatemia calcium acetate PHOSLO 667 mg tablet only cinacalcet SENSIPAR PA sevelamer RENVELA ST 53

62 Generic Name Brand Name Idiopathic Pulmonary Fibrosis (IPF) nintedanib OFEV PA, SP pirfenidone capsule ESBRIET PA, SP Immune Thrombocytopenic Purpura eltromobpag PROMACTA PA, SP Medical Devices Spacers QL Metabolic Modifiers carglumic acid CARBAGLU PA, SP glycerol phenylbutyrate RAVICTI PA, SP sodium phenylbutyrate BUPHENYL ORAL oral powder POWDER PA Vaccine (oral) typhoid vaccine VIVOTIF BERNA capsules 54

63 Generic Name Brand Name Examples OTC MEDICATIONS The following is a list of OTC products on the PDL. Some OTC products are listed on the drug list. OTC products covered are restricted to s when available. Brand names are provided as reference only. Acne benzoyl peroxide crm, gel, lotion CLEARASIL Antifungals clotrimazole MICATIN miconazole crm, soln LOTRIMIN AF tolnaftate TINACTIN MONISTAT vaginal products GYNE-LOTRIMIN Cough/Cold Allergy CHLOR-TRIMETON BENADRYL antihistamines CLARITIN ALAVERT ZYRTEC antihistamine/decongestant combinations ACTIFED DIMETAPP ALAVERT D cetirizine/pesudoephedrine OTC ZYRTEC D ALAVERT ALRG TAB/SINUS loratadine/pseudoephedrine ALLERGY/CONG ROBITUSSIN cough/cold ROBITUSSIN DM Age edit applied. Not covered for members ROBITUSSIN PE under the age 2. ROBITUSSIN CF DELSYM NEO-SYNEPHRINE nasal sprays AFRIN DIMETAPP DRO DECONGES 55

64 Generic Name Atopic Dermatitis emollients Diabetes alcohol swabs glucose oral tablets insulin (vials only) Earwax Removal Products carbamide peroxide Family Planning condoms contraceptive foam contraceptive gel First Aid Burow s soln, wet dressings dermatological baths hydrocortisone crm, oint topical antibacterials Gastrointestinal antacids liquids, chew tabs antidiarrheals electrolyte rehydrating soln famotidine laxative enemas laxatives psyllium Brand Name Examples BETACARE CREAM AND LOTION CETAPHIL CREAM AND LOTION DERMAPHOR OINTMENT E-OINTMENT GLYCERIN TOPICAL CURITY ALCOHOL PADS HUMULIN NOVOLIN DEBROX TROJAN DELFEN GYNOL II DOMEBORO COLLOIDAL OATMEAL BATHS CORTAID NEOSPORIN MYCITRACIN BACITRACIN MYLANTA LIQUID MAALOX LIQUID TUMS IMODIUM A-D KAOPECTATE PEDIALYTE PEPCID AC FLEET ENEMA DULCOLAX FLEET PHOSPHO-SODA METAMUCIL 56

65 Generic Name rectal crm, suppositories simethicone stool softeners sugar+orthophosphoric acid Lice Products permethrin piperonyl butoxide gel, liquid shampoo Motion Sickness dimenhydrinate meclizine Ophthalmics allergic conjunctivitis artificial tears decongestants Pain acetaminophen tabs, liquid, drops, suppositories aspirin tabs, EC. tabs aspirin with buffers tabs ibuprofen tabs, chew tabs and susp Smoking Cessation Products nicotine Vitamins/Minerals calcium iron ferrous fumarate, ferrous, gluconate, errous sulfate, ferrous bis-glycinate chelate and polysaccharide iron caps iron polysaccharides Brand Name Examples PREPARATION H MYLICON COLACE EMETROL NIX PIPERONYL BUTOXIDE DRAMAMINE BONINE ALAWAY HYPOTEARS VISINE MURINE NAPHCON A TYLENOL BAYER ECOTRIN ADVIL MOTRIN IB COMMIT LOZENGES (QUANTITY LIMIT) NICODERM CQ (QUANTITY LIMIT) NICOTINE GUM (QUANTITY LIMIT) NICOTROL (QUANTITY LIMIT) OS-CAL CALTRATE TUMS FERGON FEOSOL NIFEREX 57

66 Generic Name magnesium oxide vitamin D 400 IU vitamins pediatric members <3 years old vitamins prenatal Warts salicylic acid 17%/collodion Miscellaneous fluoride dental rinse Brand Name Examples MAG-OX VITAMIN D 400 IU VI-DAYLIN POLY-VI-SOL TRI-VI-SOL STUART PRENATAL DUOFILM PHOS-FLUR 58

67 Index of s A abacavir...30, 31 abacavir/dolutegravir/ lamivudine...31 abacavir/lamivudine...30 abacavir/lamivudine/ zidovudine...30 ABILIFY MAINTENA...41 ABILIFY TABLETS...41 abiraterone...4 acamprosate...38 acarbose...23 Accu-Chek Care Kit (Aviva, Compact Plus, Nano Smartview)...23 Accu-Chek Test Strips (Aviva, AVIVA PLUS, Compact, SMARTVIEW)...23 ACCUHIST DROPS...43 ACCUHIST PDX DROPS...43 ACCUNEB...48 ACCUPRIL...8 ACCURETIC...8 ACCUTANE...16 acebutalol...9 acetaminophen , 32, 46, 57 acetaminophen tabs, liquid, drops, suppositories acetazolamide...37 acetazolamide ext-rel...37 acetic acid...20 acetic acid/aluminum acetate...20 acetic acid/hydrocortisone..20 acetylcysteine...53 acidophilus...27 Acidophilus/ Citrus Pectin...27 acidophilus/bifidus...27 ALL CAPS = Brand-name drug lower case = Generic drug Acidophilus/Bifidus Wafer...27 acidophilus/citrus pectin...27 acidophilus/pectin...27 Acidophilus XTRA...27 acitretin...18 aclidinium inhalation...47 ACLOVATE...17 ACTIFED...21, 55 ACTIGALL...27 ACTOPLUS MET XR...24 ACTOPLUSMET...24 ACTOS...24 ACULAR/ACULAR LS...36 acyclovir...29 ADALAT CC...9 adalimumab...32 ADDERALL...39 ADDERALL XR...39 adefovir...29 ADVAIR DISKUS...47 ADVAIR HFA...47 Advair INHAL AEROSOL...47 ADVIL...12, 32, 57 afatinib...5 afinitor...5 AFINITOR DISPERZ...5 AFRIN...21, 55 AGENERASE...30 AGRYLIN...7 AKINETON...15 ALAVERT , 55 ALAVERT-D...21 alavert alrg tab/sinus...21, 55 Alavert D...55 Alaway , 57 ALAWAY OTC...36 albendazole...27 ALBENZA albiglutide albuterol...47, 48 albuterol sulfate...47 alclometasone...17 alcohol swabs...56 ALDACTAZIDE...10 ALDACTONE...10 ALDARA...19 ALDOMET aldoril alendronate...24 ALESSE...34 alfuzosin ER...52 alginic acid/sodium bicarbonate...25 ALINIA...31 ALINIA SUSPENSION...31 alitretinoin 1% gel...5 ALKERAN...4 allanhist syp pdx...45 allergic conjunctivitis...57 allergy/cong...21, 45, 55 allergy/cong tab relief...45 allopurinol ALPHAGAN P...37 alprazolam...38 altretamine...5 alumina/magnesia...25 alumina/magnesia/ simethicone...25 aluminum acetate... 19, 20 aluminum chloride hexahydrate...19 amantadine... 15, 29 AMARYL...23 AMBIEN...40 ambrisentan Amerge...14

68 Index of s AMICAR...7 amiloride...10 amiloride/ hydrochlorothiazide...10 aminocaproic acid...7 amiodarone tabs...8 amitriptyline...14, 40 amitriptyline/perphenazine..40 amlodipine...9 ammonium lactate...19 amoxapine...40 amoxicillin...28 amoxicillin/clavulanate...28 AMOXIcillin capsules and chewables...28 Amoxil Susp...28 amphetamine/ dextroamphetamine mixed salts...39 amphetamine/ dextroamphetamine mixed salts ext-rel...39 ampicillin amprenavir...30 anagrelide...7 anakinra...32 anaplex dm...42 ANAPROX... 13, 33 anastrozole...4 ANTABUSE...38 antacids liquids, chew tabs...56 antidiarrheals...56 antihistamines...20, 21, 55 ANTIVERT...25 ANUSOL HC 2.5%...19 aphedrid tab...47 apixaban...7 aprepitant...25 APRESOLINE ALL CAPS = Brand-name drug lower case = Generic drug APRISO...26 APTIVUS...30 ARALEN...31 ARANESP...7 ARAVA...32 ARCALYST ARICEPT...12 ARIMIDEX...4 aripiprazole...41 aripiprazole ER injection...41 AROMASIN...4 ARTANE...15 artificial saliva...22 artificial tears...57 ASMANEX HFA...47 Asmanex Twisthaler...47 aspirin...7, 12, 14, 32, 57 aspirin/acetaminophen/ caffeine...12 aspirin tabs, EC. tabs...57 aspirin with buffers tabs...57 ASTELIN...21 Atabex Prenatal...51 ATARAX...20 atazanavir...30 atenolol...9 atenolol/chlorthalidone...9 ATIVAN...38 atomoxetine atorvastatin atovaquone...31 ATRIPLA...30 atropine...25, 27, 37 atropine sulfate...27 ATROVENT...47, 48 ATROVENT HFA...47 ATUSS DR...45 AUBAGIO AUGMENTIN...28 auranofin...32 AVITA...17 AVONEX/AVONEX PEN...15 axitinib...5 AYGESTIN...35 azathioprine...6, 32 azelaic acid...16 azelastine...21, 36 azithromycin...28 aztreonam...53 AZULFIDINE...26, 32 AZULFIDINE EN-TABS. 26, 32 B bacitracin...17, 38, 56 baclofen...33 BACTRIM...28 BACTRIM DS...28 BACTROBAN...17 balsalazide...26 BALZIVA...34 BANCAP HC...13 Banzel...16 BARACLUDE...29 BAYER...7, 32, 57 beclomethasone...47 bedaquiline...31 BENADRYL...20, 55 benazepril...7, 8 benazepril/ hydrochlorothiazide...8 BENTYL...26 BENZAC AC BENZAMYCIN benzocaine/antipyrine...20 benzonatate BENZOTIC...20

69 Index of s benzoyl peroxide...16, 17, 55 benzoyl peroxide crm, gel, lotion...55 benztropine...15 BERINERT...53 BETA-VAL...17 Betacare Cream and Lotion. 56 betagan...37 betamethasone augmented dip...18 betamethasone dip augmented...18 betamethasone dipropionate. 18 betamethasone val BETAPACE...9 bethanechol BETHKIS...53 BETIMOL...37 bexarotene caps and topical gel...5 Biaxin...28 BIAXIN XL...28 bicalutamide...4 BICITRA...53 BILTRICIDE...27 BIO-D-MULSIO DRO FORTE...49 BIO-D DRO-MULSION...49 biperiden...15 bismuth subsalicylate + metronidazole + tetracycline...27 bisoprolol...9 bisoprolol/hydrochlorothiazide.9 BLEPH Bonine...57 bosentan BOSULIF...5 bosutinib...5 BREO ELLIPTA...47 BRETHINE...48 brimonidine... 19, 37 bromaline dm...42 BROMETANE DX...44 bromfed dm...42 bromfenex pd cap...42 bromocriptine... 15, 24 brompheniramine/ pseudoephedrine brompheniramine/ pseudoephedrine/ dextromethorphan...42, 43 brompheniramine/ pseudoephedrine/ dextromethorphan/ guaifenesin...42 brompheniramine & phenylephrine...42 budesonide...26, 47, 48 budesonide/formoterol...47 bumetanide...10 BUMEX...10 BUPHENYL ORAL POWDER...54 buprenorphine...41 buprenorphine/naloxone...41 bupropion...40 bupropion ext-rel...40 Burow s soln, wet dressings..56 BUSPAR...39 buspirone...39 busulfan...4 butalbital/acetaminophen...12 butalbital/acetaminophen/ caffeine...12 butalbital/apap/caff/cod...13 butalbital/asa/caff/cod...13 butalbital/aspirin/caffeine...12 butorphanol...13 C C1 Inhibitor, Human...53 cabozantinib...5 CAFERGOT...14 calamine...19 CALAN...10, 14 CALAN SR...10 calcipotriene...18 calcitonin-salmon...24 calcitriol...18, 49 calcitriol oral soln...49 calcium...2, 9, 26, 49, 53, 57 calcium acetate...53 Caltrate...57 campral...38 canagliflozin...23 canagliflozin/metformin...23 canakinumab...53 CANASA...26 capecitabine...4 CAPITROL...19 CAPOTEN...7 CAPOZIDE...8 CAPRELSA...5 capsaicin...32 captopril...7, 8 captopril/hydrochlorothiazide. 8 Carac...19 CARAFATE...26 CARAFATE SUSPENSION..26 CARBAGLU...54 carbamazepine...15 carbamazepine ext-rel...15 carbamide peroxide...20, 56 CARBATROL...15 ALL CAPS = Brand-name drug lower case = Generic drug 61

70 Index of s carbetapentane/ chlorpheniramine/ ephedrine/ phenylephrine...43 carbidopa/levodopa...15 carbidopa/levodopa ext-rel..15 carbinoxamine/ pseudoephedrine...43, 44 carbofed...42 CARDEC-DM...44 cardec dm dro...45 cardec dm syp...46 cardec dro...43 cardec syp...42, 43 CARDENE...9 CARDIZEM...9 CARDIZEM CD...9 CARDIZEM SR...9 CARDURA...8, 52 carglumic acid...54 carteolol...37 carvedilol...9 casanthranol-docusate sodium...26 CASODEX...4 CATAFLAM...32 CATAPRES...8 CAYSTON...53 CECLOR...27 CEENU...4 cefaclor...27 cefadroxil...27 cefdinir...28 cefixime...28 cefprozil...27 CEFTIN...27 cefuroxime axetil...27 CEFZIL...27 Celebrex...32 celecoxib...32 CELEXA...39 CELLCEPT...6 CELONTIN...16 CENESTIN...35 Cenogen OB/Ultra...51 CENTRUM...50 cephalexin...27 ceritinib...5 certolizumab pegol...32 Cetaphil Cream and Lotion..56 cetirizine...21, 55 cetirizine/pesudoephedrine OTC...55 cetirizine chew tab...21 cetirizine hydrochloride/ pseudoephedrine hydrochloride 12 hours extended-release...21 CHANTIX...41 child ibupro sus cold...47 Chlor-Trimeton...20, 55 CHLOR-TRIMETON ALLERGY...20 CHLOR-TRIMETON SYRUP...20 chloral hydrate...40 chlorambucil...4 chlordiazepoxide...38 chlorhexidine gluconate...22 chloroquine phosphate...31 chlorothiazide...10 chloroxine...19 chlorphen-pemethscopolamine 43 chlorphen tan/carbetapentane tan...44 chlorphen tan/pseudoeph tan...43 chlorphen tan/pyrilamine tan/pe tan...43 chlorpheniramine/ dextromethorphan...43, 45, 46 chlorpheniramine/ phenylephrine...21, 43, 45 chlorpheniramine/ phenylephrine/pyrilamine.21 chlorpheniramine/ pseudoephedrine...21, 43, 44 chlorpheniramine/ pseudoephedrine ext-rel. 21 chlorpheniramine ext-rel...20 chlorpheniramine maleate...20, 43 chlorpheniramine maleate phenylephrine HCL...43 chlorpheniramine tan/ phenylephrine tan chlorpromazine...42 chlorpropamide...23 chlorthalidone...9, 10 chlorzoxazone...33 cholecalciferol...49 cholestyramine choline magnesium trisalicylate... 12, 32 ciclopirox...18 cilostazol...7 CILOXAN...38 cimetidine CIMZIA...32 cinacalcet...53 CIPRO CIPRODEX...20 ciprofloxacin...20, 28, 38 ALL CAPS = Brand-name drug lower case = Generic drug 62

71 Index of s ciprofloxacin/ dexamethasone...20 citalopram...39 clarithromycin...28 clarithromycin ER...28 CLARITIN...21, 55 CLEAR EYES REDNESS RELIEF...36 Clearasil...55 clemastine...20 CLEOCIN...16, 17, 31, 35 CLEOCIN T...16, 17 CLIMARA clindamycin...16, 17, 31, 35 CLINORIL... 13, 33 clobazam...15 clobetasol propionate clonazepam...15, 38 clonidine...8 clopidogrel...7 clorazepate...38 clotrimazole...18, 29, 35, 55 clotrimazole with betamethasone...18 clozapine...41 CLOZARIL...41 cobicistat/elvitegravir/ emtricitabine/tenofovir...30 codal-dm...46 codeine/acetaminophen...13 codeine/chlorpheniramine/ pseudoephedrine...44 codeine/guaifenesin...44 codeine/guaifenesin/ pseudoephedrine...44 codeine/promethazine...44 codeine/promethazine/ phenylephrine...44 codeine sulfate...13 CODIMAL DH...46 COGENTIN...15 Colace...57 COLAZAL...26 colchicine...33 COLCRYS...33 Colloidal oatmeal baths...56 COLOCORT...26 COLYTE...26 COMBIVENT...47 COMBIVENT RESPIMAT...47 COMBIVIR...30 COMETRIQ...5 Commit lozenges...57 COMMITT OTC...41 COMPAZINE...25 COMPLERA...30 Complete Natalcare Pak DHA...51 COMTAN...15 CONCERTA...39 condoms...56 CONDYLOX SOL...19 conjugated estrogen/ bazedoxifene...36 contraceptive foam...56 contraceptive gel...56 COPAXONE...15 CORDARONE...8 CORDRAN...17 COREG...9 coricidin tab cgh/cld...43 Cortaid...56 CORTEF...22 cortisone acetate...22 CORTISPORIN...20, 37 CORTISPORIN OTIC...20 CORTIZONE...17 COSOPT...37 cough/cold...3, 55 COUMADIN...7 COZAAR...8 cpm/pse...43 creon...26 CREON 3000 UNIT...26 CRIXIVAN...30 crizotinib...5 CROLOM...36 cromolyn...22, 36, 47, 48 cromolyn sodium...22, 36 crotamiton...19 CUPRIMINE...32 Curity Alcohol Pads...56 CUTIVATE...17 cyanocobalamin...49 CYCLESSA...34 cyclobenzaprine...33 CYCLOGYL...37 cyclopentolate...37 cyclophosphamide...4 cyclosporine...6 cyclosporine, modified...6 CYMBALTA...40 cyproheptadine...20 CYSTAGON...6 CYSTARAN...38 cysteamine 0.44% ophthalmic solution...38 cysteamine bitartrate...6 CYTOMEL...24 CYTOTEC...27 CYTOVENE...29 CYTOXAN...4 D D3-50 CAP...49 ALL CAPS = Brand-name drug lower case = Generic drug 63

72 Index of s D.H.E dabrafenib...5 dallergy dm...42 DALMANE...40 danazol...35 DANOCRINE...35 DANTRIUM...33 dantrolene...33 dapsone...31 Daraprim...31 darbepoetin alfa...7 darunavir...30 dasatanib...5 DAYPRO... 13, 33 DDAVP...24 DE-CHLOR DM...45 DEBROX...20, 56 DECADRON...22 DECONAMINE SR...21 decongestants...3, 21, 42, 57 deferasirox...7 DELATESTRYL...22 delavirdine...30 Delfen...56 DELSYM...44, 55 DELTASONE...22 demadex...10 DEMEROL...14 DEPAKENE...16 DEPAKOTE...14, 15, 39 DEPAKOTE SPRINKLE...14, 15, 39 DEPO-PROVERA...33 DEPO-TESTOSTERONE...22 DERMA-SMOOTHE OIL/FS...17 Dermaphor Ointment...56 dermatological baths...56 DERMATOP...17 DESENEX POWDER 2%...18 desipramine...40 desmopressin...24 desogestrel/ee...33, 34 DESYREL...40 DETROL...53 dexamethasone..20, 22, 36, 37 dexamethasone sodium phosphate...36 DEXASOL...36 DEXEDRINE...39 DEXEDRINE SPANSULE...39 dextroamphetamine...39 dextroamphetamine ext-rel..39 dextromethorphanguaifenesin 44 dextromethorphan/ brompheniramine/ pseudoephedrine...44 dextromethorphan/ carbinoxamine/ pseudoephedrine...44 dextromethorphan/guaifenesin. 42, dextromethorphan/ promethazine...44 dextromethorphan/quinidine. 42 dextromethorphan hbr...44 dextromethorphan polistirex ext rel...44 DEXtrostat...39 DIABINESE...23 DIAMOX SEQUELS...37 DIASTAT ACUDIAL...15 diazepam...15, 33, 38 diclofenac 1% gel...32 diclofenac potassium...32 diclofenac sodium...12, 32, 36 diclofenac sodium delayed release... 12, 32 diclofenac sodium extended release...32 dicloxacillin...28 dicyclomine...26 didanosine...30 didanosine delayed-rel...30 DIDRONEL...24 DIFLUCAN...29, 35 digoxin...8 DIHISTINE DH...44 dihydro-pe syp...46 dihydroergotamine...14 DILACOR XR...10 DILANTIN...16 DILANTIN INFATABS...16 DILAUDID...13 diltiazem...9, 10 diltiazem ext-rel...10 diltiazem ext release...9 diltiazem sustained release...9 dimeatapp dro deconges...21 dimenhydrinate Dimetapp...42, 43, 46, 55 dimetapp cld elx/allergy...42 dimetapp dro dcon/cgh...46 dimetapp dro deconges...55 dimetapp elx cld/alle...42 dimetapp syp cgh/cld...43 dimethyl fumarate...15 DIPENTUM...26 diphenhydramine...20, 40 diphenoxylate/atropine...25 DIPROLENE...18 DIPROLENE AF...18 dipyridamole...7 disopyramide...8 ALL CAPS = Brand-name drug lower case = Generic drug 64

73 Index of s disopyramide ext-rel...8 disulfiram...38 DITROPAN...53 Ditropan Xl...53 DIURIL...10 divalproex sodium cap sprinkle...14, 15, 39 divalproex sodium delayed-rel...14, 15, 39 docusate calcium plus...26 docusate potasssium...26 dofetilide...8 dolutegravir...31 Domeboro...20, 56 DOMEBORO OTIC...20 donepezil...12 dornase alfa...53 dorzolamide...37 dorzolamide/timolol maleate...37 DOVONEX...18 doxazosin...8, 52 doxepin...40 doxycycline monohydrate...28 Dramamine...57 DRISDOL...49 dronabinol...25 droxia...5 DUAVEE...36 DUETACT...24 Dulcolax...56 Dulera...47 duloxetine...40 DUOFILM... 19, 58 DUONEB...48 duradryl...43 DURAGESIC...13 Duratuss dm elx...44 ALL CAPS = Brand-name drug lower case = Generic drug DURICEF...27 DYAZIDE...10 E E-Ointment...56 E.E.S ecothiophate...37 ECOTRIN...7, 32, 57 Ed A-Hist tablets and liquid..43 Edge OB Chw...51 EDURANT...30 efavirenz...30 efavirenz/emtricitabine/ tenofovir...30 EFFEXOR...40 EFFEXOR XR...40 EFUDEX...19 ELAVIL...14, 40 ELDEPRYL...15 electrolyte...49, 56 electrolyte rehydrating soln..56 ELIDEL...20 ELIMITE...19 ELIQUIS...7 ELOCON...17 eltromobpag...54 EMCYT...4 EMEND...25 Emetrol...57 Emla...19 emollients...56 empagliflozin...23 emtricitabine...30 emtricitabine/rilpivirine/ tenofovir...30 emtricitabine/tenofovir...30 EMTRIVA...30 enalapril...7, 8 enalapril/hydrochlorothiazide enalapril oral soln...8 enfuvirtide...29 Enjuvia enoxaparin...7 entacapone...15 entecavir...29 ENTOCORT EC...26 ENULOSE...26 EPANED...8 epinephrine...53 EPIPEN...53 EPIPEN JR EPIVIR...29, 30 Epivir HBV...29 epoetin alfa...7 EPOGEN...7 EPZICOM...30 ergocalciferol (D2)...49 ergotamine/caffeine...14 ERIVEDGE...6 erlotinib...5 errous sulfate...57 ERY-TAB...28 ERYC...28 ERYGEL...17 ERYTHROCIN...28 erythromycin...17, 28, 38 erythromycin/benzoyl peroxide...17 erythromycin/sulfisoxazole..28 erythromycin delayed-rel erythromycin ethylsuccinate. 28 erythromycin stearate...28 ESBRIET...54 escitalopram...39 ESKALITH CR...39 esomeprazole...25 esomeprazole granules...25

74 Index of s ESTRACE...35 ESTRACE CRM...35 estradiol...35 estramustine phosphate sodium...4 estrogens, conjugated...35 estrogens, conjugated/ medroxyprogesterone...35 estrogens, conjugated, synthetic A...35 estrogens, conjugated, synthetic B...35 estropipate...35 ESTROSTEP FE...34 ethambutol...31 ETHMOZINE...8 ethosuximide...15 ethynodiol diacetate/ee...34 etidronate...24 etodolac... 12, 32 etonogestrel/ee...33 etoposide...5 etravirine...31 EULEXIN...4 EURAX...19 everolimus...5, 6 EVISTA...24 EXCEDRIN MIGRAINE...12 EXELON...12 exemestane...4 EXJADE...7 exogabine...15 ezetimibe/simvastatin F famotidine...25, 56 FARESTON...4 febuxostat...33 felbamate...15, 16 ALL CAPS = Brand-name drug lower case = Generic drug felbamate oral susp...16 FELBATOL...15, 16 FELBATOL ORAL SUSP...16 FELDENE... 13, 33 felodipine ext-rel...9 FEMARA...4 fenofibrate fenoprofen... 12, 32 fentanyl transdermal...13 FEOSOL...50, 57 Fergon...57 ferrous, gluconate...57 ferrous bis-glycinate chelate. 57 ferrous bisglycinate/ polysaccarides iron...49 ferrous fumarate...57 ferrous sulfate...50 filgrastim...7 FINACEA...16 finasteride...52 fingolimod...15 FIORICET...12, 13 FIORICET w/codeine...13 FIORINAL...12, 13 FIORINAL w/codeine...13 FIRAZYR...53 FLAGYL...31, 35 FLAREX...36 flecainide...8 Fleet Enema...56 Fleet Phospho-Soda...56 FLEXERIL...33 Flomax...52 FLONASE...21 Floranex...27 FLORINEF...22 FLOVENT Diskus...47 FLOVENT HFA FLOXIN...20, 28 FLOXIN OTIC...20 fluconazole...29, 35 fludarabine...4 fludrocortisone...22 FLUMADINE...29 fluocinolone acetonide...17 fluocinonide...18 fluocinonide emulsified base. 18 fluoride... 50, 52, 58 fluoride dental rinse...58 fluorometholone...36 fluorometholone acetate...36 FLUOROPLEX...19 fluorouracil...19 fluoxetine...39 fluphenazine...42 fluphenazine decanoate...42 flurandrenolide...17 flurazepam...40 flurbiprofen...36 flutamide...4 fluticasone...17, 21, 47 fluticasone/salmeterol...47 fluticasone/vilanterol...47 fluticasone HFA...47 fluticasone propionate...17, 47 fluvoxamine...39 FML...36 FML FORTE...36 FML SOP...36 folic acid Foltabs Pak Plus DHA RE OB + DHA Pak Foltabs Prenatal...51 FORADIL AEROLIZER...47 formoterol...47 FORTEO...24

75 Index of s FORTICAL...24 FORTOVASE...30 FOSAMAX...24 fosamprenavir...30 fosinopril...8 fosinopril/hydrochlorothiazide. 8 FURADANTIN SUSP 25 mg/5 ml...31 furosemide...10 Fuzeon Kit...29 G gabapentin...16 GABITRIL...16 galantamine...12 ganciclovir...29 gatifloxin...38 GATTEX...27 GEL-KAM...50 gemfibrozil GENGRAF...6 GENTAK...17, 38 gentamicin...17, 36, 38 gentamicin/prednisolone acetate...36 Gentex ADE 28-1 mg...51 GEODON...41 gg/codeine...44 gg/dm cr...44 gg/pse cr...45 GILENYA...15 GILOTRIF glatiramer acetate...15 GLEEVEC...5 glimepiride...23, 24 glipizide...23 glipizide ext-rel...23 GLUCAGON...22 glucagon, human recombinant...22 GLUCOPHAGE...23 GLUCOPHAGE ER...23 glucose oral tablets...56 GLUCOTROL...23 GLUCOTROL XL...23 GLUCOVANCE...24 glyburide...23, 24 glyburide, micronized...23 glycerin...26, 36, 56 GLYCERIN SUPPOSITORY...26 Glycerin topical glycerol phenylbutyrate...54 glycopyrrolate...26 GLYNASE...23 GRIFULVIN V...29 GRIS-PEG...29 griseofulvin microsize...29 griseofulvin ultramicrosize...29 GUAIFED...45 GUAIFEN PSE...45 guaifenesin...42, guaifenesin/ pseudoephedrine...44, 45 guaifenesin/pseudoephedrine/ dextromethorphan...45 guaifenesin/pseudoephedrine ext rel...45 guaifenesin ext-rel...44 guanabenz guanfacine...8, 39 GUIATUSS AC...44 GUIATUSS DAC...44 GYNE-LOTRIMIN...35, 55 Gynol II...56 H HALCION HALDOL...42 HALDOL DECANOATE...42 haloperidol...42 haloperidol decanoate...42 HARVONI...29 HECORIA...6 HELIDAC...27 heparin...7 HEPSERA...29 hexachlorophene...19 hexalen...5 Hiprex...53 histacol dm...42 HISTEX...43 HISTUSSIN HC...45 HIVID...30 homatropine...37, 45 HUMALOG...23 HUMALOG MIX 50/ HUMALOG MIX 75/ HUMATIN...31 HUMIRA...32 HUMULIN...23, 56 HUMULIN 70/ HUMULIN N...23 HUMULIN R...23 HYCODAN...45 hydralazine HYDREA...5 hydrochlorothiazide hydrocodo/gg syp...45 hydrocodone/ acetaminophen...13 hydrocodone/ chlorpheniramine/ phenylephrine...45 ALL CAPS = Brand-name drug lower case = Generic drug 67

76 Index of s hydrocodone/ guaifenesin...45, 46 hydrocodone/homatropine..45 hydrocodone/tab homatrop..45 hydrocortisone...17, 19, 20, 22, 26, 37, 56 hydrocortisone butyrate...17 hydrocortisone crm, oint...56 hydromet syp...45 hydromorphone...13 hydroxychloroquine...31, 32 hydroxyurea...5 hydroxyzine HCL...20 hydroxyzine pamoate...20 hyoscyamine...26, 53 hyoscyamine sulfate...26 hyoscyamine sulfate ext-rel..26 HYpercare 20%...19 HypoTears...57 HYTONE...17 HYTRIN...8, 52 HYZAAR...8 I ibrutinib...5 ibuorofen tab cold/sin...47 ibuprofen...12, 13, 32, 33, 57 ibuprofen tabs, chew tabs and susp...57 icatibant...53 ICLUSIG...5 idelalisib...5 Ilaris...53 imatinib mesylate...5 IMBRUVICA...5 IMDUR...10 imipramine HCL imiquimod 5% cream...19 IMITREX...14 IMITREX 4 mg and 6 mg INJ...14 IMODIUM A-D...25, 56 IMURAN...6, 32 INCRELEX...24 indapamide...10 INDERAL , 14 INDERIDE...9 indinavir...30 INDOCIN... 13, 33 indomethacin... 13, 33 INFERGEN...29 INFLAMASE FORTE...36 INLYTA...5 insulin (vials only)...56 insulin aspart...22 insulin aspart protamine 70%/ insulin aspart 30%...22 insulin detemir...22 insulin glargine...22 insulin human...22, 23 insulin isophane...23 insulin isophane/regular...23 insulin isophane human...23 insulin isophane human 70%/ regular 30%...23 insulin lisopro pro/lispro...23 insulin lisopro prot/lispro...23 insulin lispro...23 insulin regular...23 INTAL...47, 48 INTELENCE...31 interferon alfa-2a interferon alfa-2b...6, 29 interferon alfacon interferon beta-1a...15 INTRON A...6, 29 Intuniv...39 Invega Sustenna...41 INVIRASE...30 INVOKAMET...23 INVOKANA...23 ipratropium...47, 48 ipratropium/albuterol...47, 48 ipratropium HFA...47 iron...34, 49-52, 57 iron polysaccharides...57 ISENTRESS...31, 32 ISENTRESS CHEWABLE...31 ISENTRESS SUSP...32 ISMO...10 isoniazid...31 ISOPTO ATROPINE...37 ISOPTO CARPINE...37 ISOPTO HOMATROPINE...37 ISOPTO HYOSCINE...37 ISORDIL...10, 11 ISORDIL S.L isosorbide dinitrate...10, 11 ISOSORBIDE DINITRATE ER...10 isosorbide dinitrate ext-rel...10 isosorbide mononitrate...10 isosorbide mononitrate ext-rel.10 isotretinoin...16 itraconazole...29 ivacaftor...53 ivermectin J JAKAFI...5 JARDIANCE...23 JENTADUETO...23 JUXTAPID ALL CAPS = Brand-name drug lower case = Generic drug 68

77 Index of s K K-DUR K-DUR K-LOR...49 K-LYTE...48 K-PHOS NEUTRAL...48 K-PHOS ORIGINAL...48 KALETRA...30 KALYDECO...53 Kaopectate...56 KAYEXALATE...49 KEFLEX...27 KENALOG...17, 18, 22 KENALOG IN ORABASE...22 Keppra...16 ketoconazole...18, 19, 29 ketoprofen... 13, 33 ketorolac...13, 36 ketorolac tromethamine...13 ketotifen...36 KINERET...32 KLONOPIN...15, 38 KLOR-CON KLOR-CON KOMBIGLYZE...24 KORLYM...24 KUVAN...24 KUVAN POWDER FOR SOLUTION...24 L labetalol...9 LAC-HYDRIN...19 lacosamide...16 lactobacillus lactulose...26 LAMICTAL CD CHEW TAB..16 LAMISIL... 18, 29 LAMISIL AT...18 lamivudine lamivudine/zidovudine...30 lamotrigine chew dispersable tab...16 LANOXICAPS...8 LANOXIN...8 lansoprazole...25 lansoprazole del-rel LANTUS...22 lapatinib ditosylate...5 LARIAM...31 LASIX...10 latanoprost...37 laxative enemas...56 laxatives...2, 26, 56 ledipasvir/sofosbuvir...29 leflunomide...32 lenalidomide...6 LETAIRIS letrozole...4 leukine...7 leuprolide...6 levalbuterol HCl...48 Levaquin...28 LEVEMIR...22 levetiracetam...16 levobunolol...37 levocetirizine...21 levofloxacin...28 levonorgestrel...33, 34 levonorgestrel/ee...33, 34 levothyroxine...24 LEVOXYL...24 LEVSIN...26 LEVSINEX...26 LEXAPRO...39 LEXIVA...30 LIALDA...26 LIBRIUM...38 lidamantel LIDEX...18 LIDEX E...18 lidocaine... 19, 22 lidocaine/prilocaine...19 lidocaine viscous...22 linagliptin...23 linagliptin/metformin...23 linezolid...31 liothyronine...24 liotrix...24 LIPITOR liraglutide...24 lisdexamfetamine...39 lisinopril...8, 82 lisinopril/hydrochlorothiazide..8 lithium carbonate...39 lithium carbonate ext-rel...39 LITHOBID...39 LMX LO/OVRAL...34 LOCOID...17 LODINE... 12, 32 LOESTRIN 1/ LOESTRIN 1.5/ LOESTRIN FE 1/ LOESTRIN FE 1.5/ LOFIBRA lomitapide LOMOTIL...25 lomustine...4 LONITEN loperamide...25 LOPID lopinavir/ritonavir...30 LOPRESSOR...9 ALL CAPS = Brand-name drug lower case = Generic drug 69

78 Index of s loratadine...21, 45, 55 loratadine/ pseudoephedrine. 21, 45, 55 loratadine/pseudoephedrine ext-rel...21 loratadine & pseudoephedrine SR 24hr...45 lorazepam LORCET 10/ LORCET PLUS...13 LORTAB 10/ LORTAB 2.5/ LORTAB 5/ LORTAB 7.5/ LORTAB ELIXIR...13 losartan...8 losartan/hctz...8 LOTENSIN...7, 8 LOTENSIN HCT...8 LOTRIMIN AF... 18, 55 Lotrisone...18 lovastatin LOVENOX...7 loxapine...42 LOXITANE...42 LOZOL...10 LUDIOMIL...40 LUEKERAN...4 Lupron...6 Lupron Depot...6 Lupron Depot-PED...6 LUPRON DEPOT 6-MONTH. 6 LURIDE...50 LURIDE LOZI-TABS...50 LUVOX...39 LYRICA...16 LYRICA SOLUTION...16 LYSODREN...5 ALL CAPS = Brand-name drug lower case = Generic drug Lysteda...36 M m-clear wc...44 MAALOX...25, 56 Maalox liquid...56 MACROBID...31 MACRODANTIN...31 MACRODANTIN 25 mg...31 MAG-OX...50, 58 magnesium oxide...50, 58 malathion...19 mapap cold tab...46 maprotiline...40 maraviroc...31 MARINOL...25 Materna...51 MATULANE...6 MAXALT/MAXALT MLT...14 MAXITROL...36 MAXZIDE...10 MAXZIDE mecasermin...24 meclizine , 57 MEDROL...22 medroxyprogesterone acetate...33, 35 mefloquine...31 MEGACE...4 megestrol acetate...4 MEKINIST...5 MELLARIL...42 meloxicam... 13, 33 melphalan...4 memantine...12 meperidine...14 MEPHYTON...50 MEPRON mercaptopurine...4 mesalamine...26 mesalamine ext-rel...26 mesalamine supp...26 MESTINON...15 MESTINON TIMESPAN...15 MetaDaTe ER...39 Metamucil...56 metaproterenol...48 metaproterenol syrup...48 metformin...23, 24 metformin/glyburide metformin ER...23, 24 methadone...14 methazolamide...37 methenamine...53 methenamine hippurate...53 METHERGINE...24, 36 methimazole...24 methocarbamol...33 methotrexate...32 methoxsalen...18 methsuximide...16 methyldopa methyldopa/hctz methylene blue...53 methylergonovine...24, 36 methylnaltrexone...27 methylphenidate...39 methylphenidate ext-rel...39 methylprednisolone...22 metipranolol metoclopramide...25 metolazone...10 metoprolol...9 metoprolol succinate...9 METROCREAM...19 METROGEL... 19, 35

79 Index of s METROGEL-VAGINAL...35 metrogel 1%...35 METROLOTION...19 metronidazole...19, 27, 31, 35 MEVACOR mexiletine...8 MEXITIL...8 MIACALCIN...24 MICATIN... 18, 55 miconazole...18, 35, 55 miconazole crm, soln...55 MICRO-K MICRONASE...23 Microzide...10 MIDAMOR...10 midodrine mifeprstone...24 MIGRANAL...14 MINIPRESS...8 MINOCIN...28 minocycline...28 minoxidil minutuss dr syp...46 MIRALAX...27 MIRAPEX...15 MIRCETTE...33 mirtazapine...40 Mirvaso...19 misoprostol...27 mitotane...5 MOBIC... 13, 33 MODICON...34 MODURETIC...10 mometasone...17, 47 mometasone/formoterol...47 mometasone furoate...17 mometasone inhalation...47 MONISTAT...35, 55 ALL CAPS = Brand-name drug lower case = Generic drug MONISTAT-DERM...18 MONISTAT MONOPRIL...8 MONOPRIL-HCT...8 montelukast moricizine...8 morphine...14 morphine ext-rel...14 MOTRIN...13, 33, 57 Motrin IB...57 mozobil...7 MS CONTIN...14 MSIR...14 MUCINEX...44, 45 mucinex d...45 MUCINEX DM...44 MUCOMYST...53 multi symptom tab cold rlf...46 multivitamins/fluoride/±iron. 50 multivitamins/minerals mupirocin...17 Murine...57 MURO MYAMBUTOL...31 MYCELEX... 18, 29 Mycitracin...56 MYCOBUTIN...32 mycophenolate mofetil...6 mycophenolate sodium...6 MYCOSTATIN... 18, 29 MYFORTIC...6 MYLANTA...25, 56 Mylanta liquid...56 MYLERAN...4 Mylicon...57 MYSOLINE N nabumetone...13 NALFON... 12, 32 naloxone...14, 41 NALOXONE INJ...41 naltrexone...38, 41 NAMENDA...12 naphazoline/antazoline...36 naphazoline/glycerin...36 naphazoline/zinc sulfate...36 naphazoline HCL...36 Naphcon A NAPROSYN... 13, 33 naproxen... 13, 33 naproxen sodium... 13, 33 naratriptan...14 NASACORT ALLERGY 24 Hour...21 nasal sprays...55 Nasalcrom...22 Natalcare...51 nateglinide...24 NAVANE...42 nedocromil...47 nelfinavir...30 NEO-SYNEPHRINE...21, 55 neo dm...42 neomycin/polymyxin B/ bacitracin...17 neomycin/polymyxin B/ dexamethasone...36 neomycin/polymyxin B/ gramicidin...38 neomycin/polymyxin B/ hydrocortisone...20, 37 neomycin sulfate...31 NEORAL...6 NEOSPORIN...17, 38, 56 NEPHROCAPS...52

80 Index of s NEPTAZANE...37 NESTABS...51 NestabsCBF/FA/RX...51 NEULASTA...7 neumega...7 NEUPOGEN...7 NEURONTIN...16 nevirapine nevirapine ER...30 NEXAVAR...5 NEXIUM 24HR OTC...25 NEXIUM DELAYED RELEASE PACKET...25 niacin niacin ext-rel NIACOR NIASPAN nicardipine...9 Nicoderm CQ...41, 57 NICORETTE OTC...41 nicotine...41, 57 Nicotine Gum...57 nicotine polacrilex gum...41 nicotine polacrilex lozenge...41 Nicotrol...57 nifedipine...9 nifedipine ext-rel...9 NIFEREX...49, 50, 57 Niferex-PN Forte...51 nilotinib...5 nimodipine...9 nimodipine oral soln...9 NIMOTOP...9 nintedanib...54 nitazoxanide suspension...31 nitazoxanide tablet...31 NITREK NITRO-BID NITRO-DUR nitrofurantoin ext-rel...31 nitrofurantoin macrocrystals. 31 nitrofurantoin susp...31 nitroglycerin...10, 11, 19 nitroglycerin ext-rel...10 NITROLINGUAL NITROSTAT Nix 19, 57 NIX CREME RINSE...19 NIZORAL...18, 19, 29 NIZORAL SHAMPOO...19 NOLVADEX...4 NORCO...13 NORDETTE...34 NORDITROPIN...24 norelgestromin/ee...34 norethindrone norethindrone/ee...33, 34 norethindrone/me...34 norethindrone acetate...34, 35 norethindrone acetate/ee...34 norethindrone acetate/ee/ iron...34 NORFLEX...33 norgestimate/ee norgestrel...34 norgestrel/ee...34 NORPACE...8 NORPACE CR...8 NORPRAMIN...40 nortriptyline...40 NORVASC...9 NORVIR...30 Novolin... 22, 23, 56 NOVOLIN 70/ NOVOLIN N...23 NOVOLIN R...22 NOVOLOG...22 NOVOLOG MIX 70/ NUCYNTA ER...14 Nuedexta...42 NULYTELY...26 NUVARING...33 NYMALIZE...9 nystatin... 18, 29 NYTOL QUICK CAPS...40 O OCEAN NASAL SPRAY...22 octreotide...5 OCUFEN...36 OCUFLOX...38 OFEV...54 ofloxacin...20, 28, 38 Oforta...4 OGEN...35 olanzapine...41 olsalazine sodium...26 OLYSIO...29 omalizumab...47 omeprazole delayed-rel...25 OMNICEF...28 ondansetron...25 One Touch Systems (ULTRA, ULTRASMART, ULTRA2, ULTRAMINI, VERIO IQ, VERIO SYNC)...23 One Touch Test Strips (BASIC/ PROFILE, SURESTEP, ULTRA, VERIO)...23 ONFI...15 ONGLYZA...24 OPANA ER...14 oprelvekin OPTIPRANOLOL...37 optivar...36 ALL CAPS = Brand-name drug lower case = Generic drug 72

81 Index of s ORAP...42 ORAPRED...22 orphenadrine ext-rel...33 ORTHO-CEPT...34 ORTHO-CYCLEN...34 ORTHO-NOVUM 1/ ORTHO-NOVUM 1/ ORTHO-NOVUM 10/ ORTHO-NOVUM 7/7/ Ortho Coil...34 ortho diaphragm...34 ORTHO EVRA...34 Ortho Flat...34 Ortho Flex...34 ORTHO MICRONOR...34 ORTHO TRI-CYCLEN...34 ORTHO TRI-CYCLEN LO...34 ORUDIS... 13, 33 OS-CAL...49, 57 oseltamivir...29 OVCON OVIDE...19 OVRAL...34 OVRETTE...34 oxaprozin... 13, 33 oxazepam...38 oxcarbazepine...16 OXSORALEN-ULTRA...18 oxybutynin chloride...53 oxybutynin IR...53 oxycodone...14 oxycodone/acetaminophen..14 oxycodone/aspirin...14 oxycodone ER...14 OXYCONTIN...14 OXYFAST...14 oxymetazoline...21 oxymorphone ER...14 ALL CAPS = Brand-name drug lower case = Generic drug P paliperidone...41 palivizumab...31 PAMELOR...40 pancrelipase...26 PANRETIN...5 pantoprazole...25 PARAFON FORTE DSC...33 PARLODEL... 15, 24 PARNATE...39 paromomycin...31 paroxetine...39 pasireotide...5 PAXIL...39 pazopanib...5 pediacare liq multi-sy...46 PEDIALYTE...49, 56 PEDIAPRED...22 PEDIAZOLE...28 peg 3350/electrolytes...26 peg 3350/sodium bicarbonate/ sodium chloride...26, 27 peg 3350/sodium bicarbonate/ sodium chloride/potassium chloride...26 PEGASYS...29 PEGASYS PROCLICK...29 pegfilgrastim...7 peginterferon alfa-2a...29 peginterferon alfa-2b...6 penicillamine...32 penicillin VK...28 PENLAC SOLUTION 8%...18 PENTASA...26 pentazocine/naloxone...14 pentoxifylline ext-rel...7 PEPCID...25, 56 PEPCID AC...25, PERCOCET...14 PERCODAN...14 PERIDEX permethrin...19, 57 perphenazine...40, 42 PERSANTINE...7 phenazopyridine...53 PHENERGAN...25, 44 PHENERGAN DM...44 phenobarbital...16 phenyl salicylate...53 phenyleph/bromphen/ dextromethorphan/ guaifenesin...45 phenylephrine...21, 38, phenylephrine/ brompheniramine/ dextromethorphan...45 phenylephrine/ chlorpheniramine...45, 46 phenylephrine/ chlorpheniramine/ dextromethorphan...45, 46 phenylephrine/ chlorpheniramine/ dihydrocodeine...46 phenylephrine/ dextromethorphan...46 phenylephrine/ dextromethorphan/ guaifenesin...46 phenylephrine/ephed/cpm w/carbetapentane...46 phenylephrine/guaifenesin..46 phenylephrine/hydrocodone/ guaifenesin...46 phenylephrine/pyrilamine/ dextromethorphan...46 phenylephrine/pyrilamine w/hydrocodone...46

82 Index of s phenylephrine tan/pyrilamine tan/carbeta tan...46 phenylhist liq dh...44 PHENYTEK...16 phenytoin...16 phenytoin sodium extended..16 PHISOHEX...19 PHOS-FLUR...50, 58 PHOSLO...53 PHOSPHOLINE IODINE...37 phosphorus...48 PHRENILIN...12 phytonadione...50 pilocarpine...22, 37 PILOPINE HS GEL...37 PIMA...49 pimecrolimus...20 pimozide...42 pindolol...9 pioglitazone...24 pioglitazone/glimepiride...24 pioglitazone/metformin...24 pioglitazone/metformin ER..24 Piperonyl Butoxide...57 piperonyl butoxide gel, liquid shampoo...57 pirfenidone capsule...54 piroxicam... 13, 33 PLAN B...33 PLAN B ONE STEP...33 PLAQUENIL...31, 32 PLAVIX...7 PLENDIL...9 plerixafor...7 PLETAL...7 PLEXION...17 podofilox...19 POLY-VI-FLOR...50 ALL CAPS = Brand-name drug lower case = Generic drug Poly-Vi-Sol...58 polyethylene glycol polymyxin B/bacitracin...17, 38 polymyxin B/trimethoprim...38 polysaccharide iron caps polysaccharide iron complex. 50 POLYSPORIN...38 POLYTRIM...38 pomalidomide...6 POMALYST...6 ponatinib...5 potassium acid phosphate...48 potassium bicarbonate/ potassium citrate effervescent...48 potassium chloride..26, 48, 49 potassium chloride ext-rel...48 potassium citrate...48, 53 potassium iodide...49 POTIGA...15 povidone-iodine...31 pramipexole...15 pramlintide...24 PRANDIN...24 praziquantel...27 prazosin...8 precose...23 PRED-G...36 PRED FORTE...36 PRED MILD...36 prednicarbate...17 prednisolone...22, 36 prednisolone acetate...36 prednisolone phosphate...36 prednisolone sodium phosphate...22 prednisone...22 pregabalin PRELONE...22 PREMARIN...35 PREMPHASE...35 PREMPRO...35 prenat-fe Bis-FE prot succ- FA-CA & omega prenat-fe bis-fe prot succ- FA-CA & omega DR...51 prenat w/o A w/fecbn-fegl- DSS-FA & DHA...50 prenatal vit w/ FE bisglyc-fe prot succ-fa...50 prenatal vit w/ FE bisglycinate chelate-fa...50, 51 prenatal vit w/ FE polysac cmplx-fa...51 prenatal vit w/ iron carbonyl-fa...51 prenatal vit w/o vit a w/fe bisglycinate-fa tab 32-1 mg...51 PRENATAL VITAMINS w/ FOLIC ACID...51 prenatal vitamins w/folic acid.51 prenatal w/o A w/ FE carbonyl-fe gluc- DSS-FA...51 Preparation H...57 PREVACID...25 PREVACID SOLUTAB...25 PREVIDENT...50 PREZISTA...30 PRILOSEC...25 primaquine...31 primidone...16 PRINCIPEN...28 PROAMATINE probenecid...33 Probiotic Formula...27 probiotic product...27

83 Index of s procainamide...8, 9 procainamide ext-rel...9 PROCANBID...9 procarbazine...6 PROCARDIA...9 PROCARDIA XL...9 prochlorperazine...25 PROCRIT...7 PROCTOSOL HC CREAM 2.5%...19 PROCTOZONE CREAM-HC 2.5%...19 PROGRAF...6 PROLIXIN...42 PROLIXIN DECANOATE...42 PROMACTA...54 prometh vc syp / promethazine...25, 44, 46 promethazine & phenylephrine...44, 46 promethazine syp dm...44 PROMETHAZINE VC w/codeine...44 PROMETHAZINE w/codeine...44 PRONESTYL...8 propafenone...9 propantheline...53 propranolol...9, 14 propranolol/hctz...9 propylthiouracil...24 PROSCAR...52 Protonix...25 Protopic 0.03%...20 Protopic 0.1%...20 PROVENTIL...48 PROVERA...35 PROZAC...39 Pruet DHA Pak Setonet Pak. 51 ALL CAPS = Brand-name drug lower case = Generic drug Pruet DHAEC Pak...51 pse/gg...45 pseudoephedrine/ acetaminophen/ dextromethorphan...46 pseudoephedrine/ chlorpheniramine/ dextromethorphan...46 pseudoephedrine/ dextromethorphan/ guaifenesin...42, 46 pseudoephedrine/ iburprofen...47 pseudoephedrine tan/ dexchlorphen tan/ DM tan...47 psyllium...56 PULMICORT FLEXHALER. 47 PULMICORT RESPULES...48 PULMOZYME...53 PURINETHOL...4 pyrazinamide...31 pyrethrins/piperonyl but PYRIDIUM...53 pyridostigmine...15 pyridostigmine ext-rel...15 pyrilamine tan/phenyleph tan.47 pyrimethamine...31 Q qual-tussin syp dc...45, 46 QUESTRAN QUESTRAN-LIGHT quetiapine...41 quinapril...8 quinapril/hydrochlorothiazide. 8 quinidine gluconate ext-rel...9 quinidine sulfate quinidine sulfate ext-rel...9 qv-allergy QVAR...47 R r-tannamine...43 raloxifene...24 raltegravir...31, 32 raltegravir susp...32 RANEXA ranitidine...25, 26 ranitidine syrup...26 ranolazine RAPAMUNE...6 RAVICTI...54 RAZADYNE...12 REBETOL/COPEGUS...29 REBIF...15 rectal crm, suppositories...57 RECTIV...19 REGLAN...25 regorafenib...5 RELAFEN...13 RELENZA...29 Relion 70/ Relion N...23 Relion R...23 RELISTOR...27 REMERON...40 Renvela...53 repaglinide...24 REQUIP...15 RESCRIPTOR...30 resperal-dm...43 RESTORIL...40 RETIN-A...17 RETROVIR...30 REVATIO REVIA...38, 41 REVLIMID...6

84 Index of s REYATAZ...30 ribavirin...29 RID SHAMPOO/BUTOXIDE SHAMPOO...19 RIDAURA...32 rifabutin...32 RIFADIN...32 rifampin...32 rilonacept...53 rilpivirine...30 rimantadine...29 rimexolone...36 RISPERDAL...41 RISPERDAL CONSTA...41 RISPERDAL SOLUTION...41 risperidone...41 risperidone oral soln...41 RITALIN...39 RITALIN-SR...39 RITALIN LA...39 ritonavir...30 rivaroxaban...7 rivastigmine...12 rizatriptan...14 RMS...14 ROBAXIN...33 ROBINUL...26 ROBITUSSIN , 55 ROBITUSSIN CF...45, 55 ROBITUSSIN DM...44, 55 robitussin liq cgh/alrg...45 robitussin liq cgh/cld...43, 46 robitussin liq cgh/cong...44 robitussin liq hd/chst...46 robitussin liq ped nght...46 ROBITUSSIN PE...45, 55 robitussin ped liq cgh/cold...43 robitussin ped syp...44 ROBITUSSIN syp chst cng..44 ROBITUSSIN syp max-st...44 ROCALTROL...49 ROCALTROL SOLUTION...49 RONDEC DM...45, 46 RONDEC DM DROPS...45 RONDEC DROPS...43 RONDEC SYRUP...43 ropinirole...15 ROWASA...26 ROXICODONE...14 rufinamide...16 ruxolitinib...5 ryna-12 s...47 RYNATAN PEDIATRIC SUSP...43 RYNATUSS...43, 46 RYNATUSS PEDIATRIC SUSP...46 RYTHMOL...9 S SABRIL SOLUTION...16 SAL-TROPINE...27 SALAGEN...22 salicylic acid 17%/ collodion... 19, 58 saline nasal spray 0.65%...22 salmeterol xinafoate...47 SANCTURA...53 SANDIMMUNE...6 Sandostatin...5 sapropterin...24 sapropterin powder...24 saquinavir...30 saquinavir mesylate...30 sargramostim...7 saxagliptin...24 saxagliptin/metformin...24 scopolamine...37 SEASONALE...33 SECTRAL...9 SEDAPAP...12 selegiline...15 selenium sulfide...20 SELSUN...20 Selzentry...31 sennosides...27 SENOKOT...27 Sensipar...53 SERAX...38 SEREVENT DISKUS...47 SEROQUEL...41 sertraline...39 sevelamer...53 SIGNIFOR...5 sildenafil SILVADENE...17 silver sulfadiazine...17 SIMCOR simeprevir simethicone...25, 57 simvastatin simvastatin/niacin ER SINEMET...15 SINEMET CR...15 SINEQUAN...40 SINGULAIR...48 sirolimus...6 SIRTURO...31 sodium chloride hypertonic..38 sodium citrate/citric acid...53 sodium phenylbutyrate oral powder...54 sodium phosphate monobasic...53 ALL CAPS = Brand-name drug lower case = Generic drug 76

85 Index of s sodium polysterene sulfonate...49 sofosbuvir somatropin...24 SONATA...40 sorafenib...5 Soriatane...18 sotalol...9 SOVALDI...29 Spacers...54 SPIRIVA...48 SPIRIVA RESPIMAT...48 spironolactone...10 spironolactone/ hydrochlorothiazide...10 Sporanox...29 SPRYCEL...5 STADOL...13 STARLIX...24 statuss dm syp...46 stavudine...30 STELAZINE...42 STIVARGA...5 stool softeners...57 STRATTERA...39 STRIBILD...30 STROMECTOL...27 Stuart Prenatal...58 SUBOXONE...41 SUBUTEX...41 sucralfate...26 sugar+orthophosphoric acid. 57 sulcralfate...26 SULFACET-R...17 sulfacetamide...17, 37, 38 sulfacetamide/ phenylephrine...38 sulfacetamide/pred. phos ALL CAPS = Brand-name drug lower case = Generic drug sulfacetamide/sulfur...17 sulfamethoxazole/ trimethoprim, DS...28 sulfasalazine...26, 32 sulfasalazine delayed-rel...26, 32 sulfisoxazole...28 sulindac... 13, 33 sumatriptan...14 SUMYCIN...28 sunitinib...5 SUPRAX...28 SUSTIVA...30 SUTENT...5 SYLATRON...6 SYMBICORT...47 SYMLIN...24 SYMMETREL... 15, 29 Synagis...31 SYNALAR...17 SYNTHROID...24 T T-STAT...17 tacrolimus...6, 20 TAFINLAR...5 TAGAMET...25 TALWIN NX...14 tambocor...8 TAMIFLU...29 tamoxifen...4 tamsulosin...52 TANAFED...43, 47 TANAFED DMX SUSPENSION...47 TANZEUM...24 TAPAZOLE...24 tapentadol ER...14 tarceva TARGRETIN...5 TASIGNA...5 TASMAR...15 TECFIDERA...15 teduglutide...27 TEGRETOL...15 TEGRETOL-XR...15 temazepam...40 TEMODAR...4 TEMOVATE...18 temozolomide...4 TENEX...8 tenofovir...30 TENORETIC...9 TENORMIN...9 TERAZOL 3/ terazosin...8, 52 terbinafine... 18, 29 terbutaline...48 terconazole...35 teriflunomide...15 teriparatide inj...24 TESSALON...42 TESTOSTERONE 1% TOPICAL GEL...22 testosterone cypionate...22 testosterone enanthate...22 testosterone gel topical tube, packet, and pump bottle. 22 tetrabenazine...16 tetracycline...27, 28 tetrahydrozoline/ zinc sulfate...36 THEO THEOCHRON...48 theophylline...48 theophylline ext-rel...48 thiethylperazine...25

86 Index of s thioguanine...4 thioridazine...42 thiothixene...42 THORAZINE...42 THYROLAR...24 tiagabine...16 TIAZAC...10 Tigan...25 tikosyn...8 TILADE...47 timolol...9, 37 timolol hemihydrate...37 timolol maleate...9, 37 TIMOPTIC...37 timoptic xe...37 TINACTIN... 18, 55 tiotropium...48 tiotropium respimat...48 tipranavir...30 TIVICAY...31 tizanidine...33 TOBRADEX...37 tobramycin...37, 38, 53 tobramycin/ dexamethasone...37 tobramycin neb soln...53 TOBREX...38 TOFRANIL...40 tolazamide...24 tolbutamide...24 tolcapone...15 TOLINASE...24 tolnaftate... 18, 55 tolterodine...53 TOPAMAX...16 TOPAMAX SPRINKLE...16 topical antibacterials topiramate...16 ALL CAPS = Brand-name drug lower case = Generic drug topiramate sprinkle caps...16 TOPROL XL...9 Toradol...13 TORECAN...25 toremifene...4 torsemide...10 TRACLEER TRADJENTA...23 tramadol...12 trametinib...5 TRANDATE...9 tranexamic acid...36 TRANXENE...38 tranylcypromine...39 trazodone...40 TRENTAL...7 tretinoin...6, 17 tri-fed x...47 TRI-NORINYL...34 TRI-VI-FLOR...52 TRI-VI-SOL...52, 58 Tri RX triamcinolone...17, 18, 21, 22 triamcinolone acetonide..17, 18 triamcinolone nasal spray...21 triamterene/ hydrochlorothiazide...10 TRIAVIL...40 triazolam...40 trifluoperazine...42 trifluridine...38 trihexyphenidyl...15 TRILAFON...42 TRILEPTAL...16 TRILISATE... 12, 32 TRILYTE...27 trimethobenzamide...25 trimethoprim...28, 32, TRIOTANN...21, 43 TRIOTANN PEDIATRIC SUSP...43 tripolidine/pseudoephedrine. 47 triprol/pse syp...47 triprolidine/ pseudoephedrine...21 TRIUMEQ...31 TRIVORA...34 TRIZIVIR...30 Trojan...56 trospium...53 TRUSOPT...37 Trust Natalcare Pak DHA...51 TRUVADA...30 TUDORZA PRESSAIR...47 Tums...56, 57 TUSSI-12 S...44 TUSSI 12D S...46 tussin dm...44 Twinject...53 TYKERB...5 TYLENOL...12, 13, 32, 57 TYLENOL w/codeine...13 TYLOX...14 typhoid vaccine...54 U Uloric...33 Ultram...12 uni-hist dro UNIPHYL...48 urea 40%...20 Urea 40% cream and lotion. 20 URECHOLINE...52 UREX...53 UROCIT-K...53 UROXATRAL...52 URSO...27

87 Index of s URSO FORTE...27 ursodiol...27 Utira C...53 V vaginal products...55 valacyclovir...29 VALCYTE...29 valganciclovir...29 VALIUM...33, 38 valproic acid...16 Valtrex...29 VANCOCIN HCl...28 vancomycin HCl...28 vandetanib...5 varenicline...41 VASERETIC...8 VASOCIDIN...37 VASOCLEAR...36 VASOCLEAR A...36 VASOSULF...38 VASOTEC...7 vectical...18 VEETIDS...28 vemurafenib venlafaxine...40 venlafaxine XR...40 VENTOLIN HFA...47 VEPESID...5 verapamil...10, 14 verapamil ext-rel...10 VESANOID...6 VEXOL...36 Vi-Daylin...58 VICODIN 5/ VICODIN ES...13 Victoza...24 VIDEX...30 VIDEX EC...30 vigabatrin oral solution...16 vimpat...16 Vinate AZ EX...51 Vinate III...50 VIRACEPT...30 VIRAMUNE Viramune XR...30 VIREAD...30 VIROPTIC...38 Visine...57 VISINE-AC...36 vismodegib...6 VISTARIL...20 vitamin A...51 vitamin ADC/fluoride/±iron drops...52 vitamin B VITAMIN B vitamin B vitamin B complex/vitamin C/ folic acid...52 vitamin C...52 vitamin D 400 IU...58 VITAMIN D CAP 2000 UNIT...49 VITAMIN D CAP 400 UNIT..49 VITAMIN D TAB 1000 UNIT. 49 VITAMIN D TAB 2000 UNIT. 49 VITAMIN D TAB 400 UNIT..49 vitamins pediatric...52, 58 vitamins pediatric members <3 years old vitamins prenatal...58 Vitaphil...50 VITUSSIN...45 VIVOTIF BERNA...54 VOLTAREN...12, 32, 36 VOLTAREN 1% TOPICAL GEL...32 VOLTAREN XR...32 vorinostat...6 VOSOL HC OTIC...20 VOSOL OTIC...20 Votrient...5 VYTORIN Vyvanse...39 W warfarin...7 WELLBUTRIN...40 WELLBUTRIN SR...40 WELLBUTRIN XL...40 WYTENSIN X XALATAN...37 XALKORI...5 XANAX...38 XARELTO...7 XELODA...4 XENAZINE...16 XOLAIR...47 XOPENEX Respules...48 XYLOCAINE... 19, 22 XYZAL...21 Z zalcitabine...30 zaleplon...40 ZANAFLEX...33 zanamivir...29 ZANTAC...25, 26 ZARONTIN...15 ZAROXOLYN...10 ZEBETA...9 ZELBORAF ALL CAPS = Brand-name drug lower case = Generic drug 79

88 Index of s zenpep...26 ZERIT...30 ZESTORETIC...8 ZESTRIL...8 ZIAC...9 ZIAGEN...30 zidovudine...30 zinc...36, 52 ziprasidone...41 ZITHROMAX...28 ZOCOR ZOFRAN...25 ZOFRAN ODT...25 ZOLINZA...6 ZOLOFT...39 zolpidem...40 ZONEGRAN...16 zonisamide...16 Zortress...6 ZOVIA 1/ ZOVIA 1/ Zovirax...29 ZYDELIG...5 ZYKADIA...5 ZYLOPRIM...33 ZYMAR...38 ZYPREXA...41 zyrtec...21, 55 ZYRTEC-D...21 ZYRTEC CHEWABLE TABLET...21 zyrtec d...55 ZYTIGA...4 ZYVOX...31 ALL CAPS = Brand-name drug lower case = Generic drug 80

89 Notes 81

90 My Medications worksheet Take this worksheet with you each time you visit a doctor. Each of your doctors should be aware of every drug you take and you should have a list as well. Name of Medicine and Strength Tier I Take This Medicine For Directions Doctor Example: Lisinopril, 20 mg Tier 1 High blood pressure One tablet daily Dr. Johnson 82

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