What is the ONECare Formulary? Can the Formulary change?

Transcription

1 ONECare by Care1st Health Plan Arizona, Inc Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. Formulario para 2009 (Lista de medicamentos cubiertos) LEER: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS CUBIERTOS POR ESTE PLAN Nota para quienes ya son afiliados: Este formulario es diferente del formulario del año pasado. Revise este documento para asegurarse de que todavía incluye los medicamentos que usted toma. Formulary Introduction (English)...1 Introducción al Formulario (Español)...6 ONECare s Formulary (English only)/formulario ONECare (Inglés solamente)...21 H5430 RX Last Updated 9/2008 CMS Approval Date: 09/2008 Última actualización 9/2008

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3 What is the ONECare Formulary? A formulary is a list of covered drugs selected by ONECare in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. ONECare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a ONECare network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary change? Generally, if you are taking a drug on our 2009 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2009 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of September To get updated information about the drugs covered by ONECare please visit our Web site at or call Member Services at , from 8:00 a.m. to 8:00 p.m., seven days a week. TTY/TDD users should call

4 How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page 29. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiac drugs. If you know what your drug is used for, look for the category name in the list that begins on page number 29. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 107. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? ONECare covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: ONECare requires your physician to get prior authorization for certain drugs. This means that you will need to get approval from ONECare before you fill your prescriptions. If you don t get approval, ONECare may not cover the drug. Quantity Limits: For certain drugs, ONECare limits the amount of the drug that ONECare will cover. For example, ONECare provides one inhaler per prescription for QVAR. This may be in addition to a standard one month or three month supply. Step Therapy: In some cases, ONECare requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, ONECare may not cover drug B unless you try Drug A first. If Drug A does not work for you, ONECare will then cover Drug B. 2

5 You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 29. You can ask ONECare to make an exception to these restrictions or limits. See the section, How do I request an exception to the ONECare formulary? on page 3 for information about how to request an exception. What if my drug is not on the Formulary? If your drug is not included in this formulary, you should first contact Member Services and confirm that your drug is not covered. If you learn that ONECare does not cover your drug, you have two options: You can ask Member Services for a list of similar drugs that are covered by ONECare. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by ONECare. You can ask ONECare to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to the ONECare Formulary? You can ask ONECare to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover your drug even if it is not on our formulary. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, ONECare limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more. You can ask us to provide a higher level of coverage for your drug. If your drug is contained in our non-preferred tier, you can ask us to cover it at the cost-sharing amount that applies to drugs in the preferred tier instead. This would lower the amount you must pay for your drug. Please note, if we grant your request to cover a drug that is not on our formulary, you may not ask us to provide a higher level of coverage for the drug. Also, you may not ask us to provide a higher level of coverage for drugs that are in the fourth tier. Generally, ONECare will only approve your request for an exception if the alternative drugs included on the plan s formulary, the lower-tiered drug or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. 3

6 You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician s supporting statement. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will cover a temporary 31- day transition supply (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary, or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. 4

7 In circumstances where a beneficiary is changing from one treatment setting to another, ONECare ensures a fast process for approving non-formulary Part D drugs. This process also applies to formulary Part D drugs that require prior authorization or step-therapy. Examples of level of care changes are: beneficiaries who are discharged from a hospital to a home; beneficiaries who end their skilled nursing facility Medicare Part A stay and who need to revert to their Part D plan formulary; beneficiaries who end a long-term care facility stay and return to the community; and beneficiaries who are discharged from psychiatric hospitals with medication regimens that are highly individualized. ONECare s after hours service provides pharmacies with access to representatives of the plan who are authorized to grant medication exception overrides. This access allows pharmacies to obtain prescription claims overrides at the point-of-sale and ensure that beneficiaries receive reliable access to emergency medication supplies. For more information For more detailed information about your ONECare prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about ONECare, please call Member Services at , from 8:00 a.m. to 8:00 p.m., seven days a week. TTY/TDD users should call Or visit If you have general questions about Medicare prescription drug coverage, please call Medicare at MEDICARE ( ) 24 hours a day/7 days a week. TTY/TDD users should call Or, visit 5

8 Qué es el formulario de ONECare? Un formulario es una lista de los medicamentos cubiertos, los cuales han sido seleccionados por ONECare tras consultar con un equipo de proveedores de atención médica y que corresponden a los tratamientos con medicamentos recetados que se consideran parte necesaria de un programa de tratamiento de calidad. Por lo general, ONECare cubrirá los medicamentos incluidos en nuestro formulario, siempre que sean médicamente necesarios, la receta se surta en una farmacia de la red de ONECare y se cumplan otras reglas del plan. Para obtener más información sobre cómo surtir una receta, consulte su Evidencia de Cobertura. Puede modificarse el formulario? En general, si usted toma medicamentos incluidos en nuestro formulario para 2009 que estaban cubiertos a principio de año, no interrumpiremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2009, a menos que un medicamento genérico de menor costo esté disponible o se divulgue nueva información adversa sobre la inocuidad o eficacia de un medicamento. Otros tipos de modificaciones en el formulario, como la eliminación de algún medicamento de nuestro formulario, no afectarán a aquellos afiliados que ya estén tomando el medicamento. Estará disponible con la misma participación en los gastos para aquellos afiliados que lo tomen por lo que resta del año de cobertura. Creemos que es importante que usted tenga acceso continuo a los medicamentos del formulario que estaban disponibles cuando eligió nuestro plan para lo que resta del año de cobertura, excepto para los casos en los que usted pueda ahorrar más dinero o nosotros podamos garantizar su seguridad. Si eliminamos medicamentos de nuestro formulario o agregamos una autorización previa, límites de cantidad o restricciones en los tratamientos escalonados con algún medicamento o ubicamos el medicamento en un nivel más elevado de participación en los gastos, debemos notificar a todos los afiliados que se verán afectados por la modificación como mínimo 60 días antes de que ésta entre en vigencia o en el momento en que el afiliado solicite una reposición del medicamento, momento en el cual el afiliado recibirá dosis del medicamento suficientes para 60 días. Si la Administración de Drogas y Alimentos (Food and Drug Adminstration, FDA) considera que algún medicamento de nuestro formulario no es seguro o si el fabricante lo quita del mercado, lo eliminaremos inmediatamente de nuestro formulario e informaremos a los afiliados que lo toman. El formulario que se adjunta entra en vigencia el Septiembre,

9 Para obtener información actualizada sobre los medicamentos cubiertos por ONECare, visite nuestro sitio web o llame a Servicios para Afiliados al , de 8:00 a.m. a 8:00 p.m., los siete días de la semana. Los usuarios de TTY/TDD deben llamar al Cómo utilizo el formulario? Hay dos maneras de encontrar su medicamento en el formulario: Problema médico El formulario comienza en la página 29. Los medicamentos en este formulario se agrupan en categorías según el problema médico para el que se los utiliza. Por ejemplo, los medicamentos que se utilizan para tratar una afección cardíaca se incluyen bajo la categoría Medicamentos cardíacos. Si conoce para qué se utiliza su medicamento, busque esa categoría en la lista que comienza en la página 29. Luego busque su medicamento dentro de esa categoría. Listado alfabético Si no está seguro de la categoría, debe buscar el medicamento en el índice que comienza en la página 107. El índice proporciona un listado alfabético de todos los medicamentos que se incluyen en este documento. Tanto los medicamentos de marca como los genéricos se enumeran en el índice. Consulte el índice hasta encontrar su medicamento. Junto al medicamento encontrará el número de la página en la que se incluye la información de la cobertura. Vaya a la página que se indica en el índice y busque el nombre de su medicamento en la primera columna de la lista. Qué son los medicamentos genéricos? ONECare cubre tanto medicamentos de marca como genéricos. Un medicamento genérico está aprobado por la Administración de Drogas y Alimentos (Food and Drug Administration, FDA) porque tiene el mismo principio activo que el de marca. En general, los medicamentos genéricos cuestan menos que los de marca. Existe alguna restricción en mi cobertura? Algunos medicamentos cubiertos pueden tener requisitos adicionales o límites de cobertura. Estos requisitos y límites pueden incluir: Autorización previa: ONECare requiere que su médico obtenga una autorización previa para ciertos medicamentos. Esto significa que usted necesitará la aprobación de ONECare antes de surtir sus recetas. Si no obtiene aprobación, ONECare no podrá cubrir el medicamento. 7

10 Límites de cantidad: Para algunos medicamentos, ONECare limita la cantidad del medicamento que cubrirá. Por ejemplo, ONECare provee un inhalador QVAR por receta. Esto puede ser aparte de un suministro estándar de un mes o tres meses. Tratamientos escalonados: En algunos casos, ONECare requiere que usted pruebe ciertos medicamentos para tratar su afección médica antes de cubrir otro medicamento para ese problema. Por ejemplo, si los medicamentos A y B se utilizan para tratar su afección médica, ONECare no podrá cubrir el medicamento B a menos que usted pruebe antes el medicamento A. Si el medicamento A no le da resultado, ONECare cubrirá entonces el medicamento B. Para saber si su medicamento tiene requisitos o limitaciones adicionales, consulte el formulario que comienza en la página 29. Podrá solicitar a ONECare que realice una excepción a estas restricciones o límites. Consulte la sección Cómo solicito una excepción al formulario de ONECare? en la página 8 para obtener información sobre cómo solicitar una excepción. Qué ocurre si mi medicamento no se encuentra en el formulario? Si su medicamento no está incluido en el formulario, primero debe comunicarse con Servicios para Afiliados y confirmar que su medicamento no está cubierto. Una vez que confirma que ONECare no lo cubre, tiene dos opciones: Puede solicitar en Servicios para Afiliados una lista de medicamentos similares que estén cubiertos por ONECare. Cuando reciba la lista, muéstresela a su médico y pregúntele si puede recetarle algún medicamento similar que esté cubierto por ONECare. Puede solicitar a ONECare que haga una excepción y cubra su medicamento. Consulte la información que se incluye a continuación sobre cómo solicitar una excepción. Cómo solicito una excepción al formulario de ONECare? Puede solicitar a ONECare que realice una excepción a nuestras reglas de cobertura. Existen diferentes clases de excepciones que puede solicitar. Puede solicitar que cubramos su medicamento, aunque no esté en nuestro formulario. Puede solicitar que ignoremos las restricciones de cobertura o límites para su medicamento. Por ejemplo, para algunos medicamentos, ONECare limita la cantidad del medicamento que cubrirá. Si su medicamento tiene un límite de cantidad, puede solicitar que ignoremos el límite y cubramos más. 8

11 Puede solicitarnos que brindemos mayor nivel de cobertura para su medicamento. Si su medicamento figura como no preferido, puede solicitar que lo cubramos al monto de participación en los gastos que se aplica a medicamentos preferidos. Esto hará que el monto que usted deba pagar sea menor. Recuerde que si le concedemos su solicitud de cubrir un medicamento que no se encuentra en nuestro formulario, no podrá solicitar que le brindemos un nivel de cobertura mayor para ese medicamento. Además, tampoco podrá solicitarnos que le brindemos un nivel de cobertura mayor para los medicamentos del cuarto nivel. En general, ONECare sólo aprobará su solicitud de excepción si los medicamentos alternativos que están incluidos en el formulario del plan, los medicamentos de nivel más bajo o las restricciones adicionales de uso no fueran tan efectivos para tratar su afección o le provocaran efectos adversos para la salud. Debe comunicarse con nosotros para solicitar una decisión sobre la cobertura inicial para una excepción al formulario, al nivel de cobertura o a la restricción de utilización. Cuando usted solicita una excepción al formulario, al nivel de cobertura o a una restricción de utilización debe presentar una declaración de su médico que respalde su solicitud. En general, debemos tomar nuestra decisión en un plazo de 72 horas tras haber recibido la declaración de su médico que respalda su solicitud. Se puede solicitar una excepción expeditiva (rápida) si usted o su médico consideran que su salud podría verse seriamente afectada por esperar una decisión durante 72 horas. Si se le concede su solicitud de excepción expeditiva, debemos comunicarle la decisión en no más de 24 horas luego de haber recibido la declaración de respaldo de su médico. Qué debo hacer antes de poder hablar con mi médico sobre el cambio en mis medicamentos o la solicitud de excepción? Como afiliado nuevo o ya existente de nuestro plan, usted puede estar tomando medicamentos que no se encuentran en nuestro formulario. También puede estar tomando un medicamento que esté en nuestro formulario, pero la capacidad para obtenerlo sea limitada. Por ejemplo, quizá necesite nuestra autorización previa antes de poder surtir su receta. Debe hablar con su médico para decidir si debe cambiar el medicamento que toma por otro que sea apropiado y que esté cubierto o solicitar una excepción al formulario para que cubramos el medicamento que usted toma. Mientras decide junto con su médico cuál será el curso de acción correcto para usted, podremos cubrir su medicamento en determinados casos durante los primeros 90 días como afiliado a nuestro plan. 9

12 Para cada uno de sus medicamentos que no se encuentre en el formulario o si su capacidad para obtenerlos es limitada, cubriremos un suministro temporario de 30 días (a menos que su receta indique un período menor) cuando usted vaya a farmacias de la red. Una vez acabado el suministro de 30 días, dejaremos de pagar por estos medicamentos, aún cuando usted haya estado afiliado al plan menos de 90 días. Si usted reside en un centro de atención a largo plazo, cubriremos un período temporario de suministro de transición de 31 días (a menos que su receta indique un período menor). Cubriremos más de una reposición de estos medicamentos durante sus primeros 90 días como afiliado a nuestro plan. Si necesita medicamentos que no se encuentran en nuestro formulario o si su capacidad para obtenerlos es limitada, pero ya han finalizado los primeros 90 días de afiliación a nuestro plan, cubriremos un suministro de emergencia de 31 días (a menos que su receta indique un período menor) mientras usted presenta una excepción al formulario. En caso de que un beneficiario esté cambiándose de un entorno para el tratamiento a otro, ONECare garantizará un proceso rápido para aprobar los medicamentos de la Parte D que no se encuentren en el formulario. Este proceso también se aplicará a los medicamentos de la Parte D del formulario que requieran autorización previa o tratamientos escalonados. Entre los ejemplos de cambios de un entorno de tratamiento a otro podemos mencionar: beneficiarios a los que se les da de alta del hospital y se van a su casa, beneficiarios que terminaron su estadía en un centro de enfermería especializada de la Parte A de Medicare y necesitan regresar al formulario del plan de la Parte D, beneficiarios que terminaron una estadía en un centro de atención a largo plazo y retornan a la comunidad y beneficiarios a quienes se les da el alta de hospitales psiquiátricos con regímenes de medicación muy personalizados. El servicio fuera de horario de ONECare s otorgará a las farmacias acceso a los representantes del plan quienes están autorizados a conceder anulaciones de excepciones de medicamentos. Este acceso permitirá que las farmacias obtengan las anulaciones de los reclamos de medicamentos recetados en el punto de venta, y garantizará que los beneficiarios reciban acceso confiable a los suministros de medicamentos de emergencia. 10

13 Más información Para obtener información más detallada sobre su cobertura de Care 1st de medicamentos recetados, consulte su Evidencia de Cobertura y demás materiales del plan. Si tiene alguna pregunta sobre ONECare, llame a Servicios para Afiliados al , de 8:00 a.m. a 8:00 p.m., los siete días de la semana. Los usuarios de TTY/TDD deben llamar al O bien visite Si tiene preguntas generales sobre la cobertura de medicamentos recetados de Medicare, llame a Medicare al MEDICARE ( ) las 24 horas del día, los 7 días de la semana. Los usuarios de TTY/TDD deben llamar al O bien visite 11

14 ONECare s Formulary The formulary below provides coverage information about some of the drugs covered by ONECare. If you have trouble finding your drug in the list, turn to the Index that begins on page 107. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., IMITREX) and generic drugs are listed in lower-case italics (e.g., simvastatin). The information in the Notes column tells you if ONECare has any special requirements for coverage of your drug. Formulario de ONECare El formulario abajo proporciona información de la cobertura sobre algunos de los medicamentos cubiertos por ONECare. Si tiene dificultades para encontrar su medicamento en la lista, consulte el índice que comienza en la página 107. La primera columna de la tabla menciona el nombre del fármaco. Los medicamentos de marca se escriben con mayúsculas (por ejemplo, IMITREX) y los medicamentos genéricos, con minúscula y en cursiva (por ejemplo, simvastatin). La información en la columna Notas le indica si ONECare tiene algún requisito especial para cubrir su medicamento. Requirements/Limits Legend (Leyenda de Requisitos/Limites) Abbreviation (Abreviatura) Description (Descripción) PA QL ST Prior Authorization Required (Autorización Previa) Quantity Limit (Límites de cantidad) Step Therapy (Tratamientos escalonados) 12

15 Tier Legend (Leyenda de Nivel) Tier (Nivel) Description (Descripción) Co-payment (Copago) 30 day supply (suministro de 30 dias) 0 Excluded Part D Drugs/ Medicamentos excluidos Parte D 1 Formulary Preferred Generic Drugs (Medicamentos genéricos preferidos) 2 Formulary Preferred Brand Drugs (Medicamentos de marca preferidos) 3 Formulary Non-preferred generic and brand drugs (Medicamentos genericos no preferidos y de marca) 4 Formulary High Cost (Specialty Drugs) (Medicamentos especializados y de alto costo.) $0.00 $0 to $2.40 or 15% $0 to $6.00 or 15% $0 to $6.00 or 15% $0 to $6.00 or 15% Traducción de las notas al pie de la página: Símbolo + Δ Nota Loratadine normalmente no está cubierto por un Plan de Medicamentos Recetados de Medicare. No hay copago para Loratadine. El monto para este medicamento no se suma a sus costos totales en medicamentos (es decir que el monto no le ayuda para ser elegible para la cobertura catastrófica). Este medicamento recetado puede estar disponible sólo en algunas farmacias. Para obtener más información, consulte su Directorio de Proveedores o llame a Servicios para Afiliados al , de 8:00 a.m. a 8:00 p.m., los siete días de la semana. Los usuarios de TTY/TDD deben llamar al

16 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS ABILIFY ARIPIPRAZOLE ORAL SOLN 900ml in 30 days ABILIFY ARIPIPRAZOLE TABLET 30 tabs in 30 days ABILIFY DISCMELT ARIPIPRAZOLE TAB RAPDIS 30 tabs of 10mg or 60 tabs of 15mg in 30 days ACCOLATE ZAFIRLUKAST TABLET 60 tabs in 30 days ACETAMINOPHEN-CODEINE ACETAMINOPHEN-CODEINE ADVAIR DISKUS ACETAMINOPHEN WITH CODEINE ORAL ELIXIR 1800ml in 30 days ACETAMINOPHEN WITH CODEINE TABLET 120 tabs in 30 days FLUTICASONE/SALMETEROL INHALATION DISK W/DEV 60 disks in 30 days ADVAIR HFA FLUTICASONE/SALMETEROL AEROSOL 2 Inhalers in 30 days AK-DILATE PHENYLEPHRINE HCL OPHT DROPS 15ml in 30 days ALBUTEROL ALBUTEROL AEROSOL 2 Inhalers in 30 days ALDARA IMIQUIMOD PACKET 12 in 30 days ALENDRONATE SODIUM ALENDRONATE SODIUM TABLET ALENDRONATE SODIUM ALENDRONATE SODIUM TABLET 30 tabs of 5mg, 10mg, 40mg in 30 days 4 tabs of 35mg or 70mg in 28 days ALPHAGAN P BRIMONIDINE TARTRATE OPHT DROPS 15ml in 30 days AMLODIPINE BESYLATE-BENAZEPRIL ASPIRIN WITH CODEINE AMLODIPINE BESYLATE/BENAZEPRIL CAPSULE 30 caps in 30 days ASPIRIN/CODEINE PHOSPHATE TABLET 120 tabs in 30 days ASTELIN AZELASTINE HCL NASAL SPRAY 1 Spray in 30 days ATROPINE SULFATE ATROPINE SULFATE OPHT DROPS 15ml in 30 days AVODART DUTASTERIDE CAPSULE 30 caps in 30 days AZITHROMYCIN AZITHROMYCIN ORAL SUSP AZITHROMYCIN AZITHROMYCIN ORAL SUSP 15ml of 100mg/ 5ml in 30 days 67.5ml of 200mg/ 5ml in 30 days AZITHROMYCIN AZITHROMYCIN PACKET 2 in 30 days AZITHROMYCIN AZITHROMYCIN TABLET 6 tabs of 250mg, 500mg or #8 tabs of 600mg in 30 days AZOPT BRINZOLAMIDE OPHT SUSP 15ml in 30 days BACITRACIN BACITRACIN OPHT OINT 4gm in 30 days BACITRACIN-POLYMYXIN BACITRACIN/POLYMYXIN B SULFATE OPHT OINT 4gm in 30 days 14

17 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS BALSALAZIDE DISODIUM BALSALAZIDE DISODIUM CAPSULE 270 caps in 30 days BELLADONNA & OPIUM OPIUM/BELLADONNA ALKALOIDS SUPP.RECT 120 supp. in 30 days BONIVA IBANDRONATE SODIUM TABLET 1 tab of 150mg in 30 days BONIVA IBANDRONATE SODIUM TABLET 30 tabs in 30 days BRIMONIDINE TARTRATE BRIMONIDINE TARTRATE OPHT DROPS 15ml in 30 days BUDEPRION XL BUPROPION HCL TAB.SR 24H 30 tabs in 30 days BUTALBITAL COMPOUND-CODEINE BUTALBITAL-CAFF-APAP- CODEINE CODEINE/BUTALBITAL /ASA/CAFFEIN CAPSULE 120 caps in 30 days CODEINE/BUTALBIT /ACETAMIN/CAFF CAPSULE 120 caps in 30 days CALCIPOTRIENE CALCIPOTRIENE TOPICAL SOLN 60ml in 30 days CARISOPRODOL CARISOPRODOL TABLET 90 tabs in 30 days CARTEOLOL HCL CARTEOLOL HCL OPHT DROPS 10ml in 30 days CHLORZOXAZONE CHLORZOXAZONE TABLET 90 tabs in 30 days CHLORZOXAZONE W/ACETAMINOPHEN CHLORZOXAZONE /ACETAMINOPHEN TABLET 90 tabs in 30 days CODEINE SULFATE CODEINE SULF TABLET 120 tabs in 30 days COMBIVENT CORTOMYCIN IPRATROPIUM /ALBUTEROL SULFATE AEROSOL 2 Inhalers in 30 days NEOMY SULF/BACITRAC ZN /POLY/HC OPHT OINT 4gm in 30 days CROMOLYN SODIUM CROMOLYN SODIUM OPHT DROPS 15ml in 30 days CYCLOBENZAPRINE HCL CYCLOBENZAPRINE HCL TABLET 90 tabs in 30 days DANTROLENE SODIUM DANTROLENE SODIUM CAPSULE DERMOTIC 90 caps of 25mg, 50mg or 120 caps of 100mg in 30 days FLUOCINOLONE ACETONIDE OIL OTIC DROPS 20ml in 30 days DETROL TOLTERODINE TARTRATE TABLET 60 tabs in 30 days DETROL LA TOLTERODINE TARTRATE CAP.SR 24H 30 caps in 30 days DIFFERIN ADAPALENE MED. SWAB 45gm in 30 days DIFFERIN ADAPALENE TOPICAL CREAM 45gm in 30 days DIFFERIN ADAPALENE TOPICAL GEL 45gm in 30 days DIPENTUM OLSALAZINE SODIUM CAPSULE 120 caps in 30 days 15

18 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS DIPIVEFRIN HCL DIPIVEFRIN HCL OPHT DROPS 15ml in 30 days DOVONEX CALCIPOTRIENE TOPICAL CREAM 60gm in 30 days DOVONEX CALCIPOTRIENE TOPICAL OINT 60gm in 30 days ECONOPRED PLUS PREDNISOLONE ACETATE OPHT SUSP 15ml in 30 days ELIDEL PIMECROLIMUS TOPICAL CREAM 30gm in 30 days ERYTHROMYCIN ERYTHROMYCIN BASE OPHT OINT 4gm in 30 days EVISTA RALOXIFENE HCL TABLET 30 tabs in 30 days FENTANYL FENTANYL PATCH 10 patches in 30 days FEXOFENADINE HCL FEXOFENADINE HCL TABLET 60 of 30mg, 60mg or 30 of 180mg in 30 days FINASTERIDE FINASTERIDE TABLET 30 tabs in 30 days FLOMAX TAMSULOSIN HCL CAP.SR 24H 60 caps in 30 days FLOXIN OFLOXACIN DROPERETTE 20ml in 30 days FLUNISOLIDE FLUNISOLIDE NASAL SPRAY 1 Spray in 30 days FLUOROMETHOLONE FLUOROMETHOLONE OPHT SUSP 15ml in 30 days FLURBIPROFEN SODIUM FLURBIPROFEN SODIUM OPHT DROPS 3ml in 30 days FORTEO TERIPARATIDE PEN INJCTR 3 in 28 days GENTAMICIN SULFATE GENTAMICIN SULFATE OPHT OINT 5gm in 30 days GEODON ZIPRASIDONE HCL CAPSULE GLUCAGEN GLUCAGEN GLUCAGON GLUCAGON EMERGENCY KIT 60 tabs of 20mg, 40mg or 120 tabs of 60mg, 80mg in 30 days GLUCAGON, HUMAN RECOMBINANT INJECTION KIT 2ml in 30 days GLUCAGON, HUMAN RECOMBINANT INJECTION VIAL 2ml in 30 days GLUCAGON, HUMAN RECOMBINANT INJECTION KIT 2ml in 30 days GLUCAGON, HUMAN RECOMBINANT INJECTION KIT 2ml in 30 days GLYCOLAX POLYETHYLENE GLYCOL 3350 POWD PACK 14 in 30 days GLYCOLAX POLYETHYLENE GLYCOL 3350 POWDER 255gm in 30 days HOMATROPAIRE HOMATROPINE HBR OPHT DROPS 5ml in 30 days HYDROCODONE -ACETAMINOPHEN HYDROCODONE BIT /ACETAMINOPHEN CAPSULE 120 caps in 30 days 16

19 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS HYDROCODONE -ACETAMINOPHEN HYDROCODONE -ACETAMINOPHEN HYDROCODONE BIT /ACETAMINOPHEN ORAL SOLN 250ml in 30 days HYDROCODONE BIT /ACETAMINOPHEN TABLET 120 tabs in 30 days HYDROMORPHONE HCL HYDROMORPHONE HCL TABLET 120 tabs in 30 days IBUDONE HYDROCODONE/IBUPROFEN TABLET 120 tabs in 30 days IMITREX SUMATRIPTAN NASAL SPRAY 9 sprays in 30 days IMITREX SUMATRIPTAN SUCCINATE CARTRIDGE 4ml in 30 days IMITREX SUMATRIPTAN SUCCINATE PEN IJ KIT 4ml in 30 days IMITREX SUMATRIPTAN SUCCINATE TABLET 9 tabs in 30 days INFLAMASE FORTE PREDNISOLONE SOD PHOSPHATE OPHT DROPS 15ml in 30 days IRESSA GEFITINIB TABLET 30 tabs in 30 days ISOPTO CARPINE PILOCARPINE HCL OPHT DROPS 15ml in 30 days ISOPTO HOMATROPINE HOMATROPINE HBR OPHT DROPS 15ml in 30 days KETOROLAC TROMETHAMINE KETOROLAC TROMETHAMINE INJECTION VIAL 20ml in 30 days KETOROLAC TROMETHAMINE KETOROLAC TROMETHAMINE TABLET 20 tabs in 30 days LACRISERT HYDROXYPROPYL CELLULOSE INSERT 60 in 30 days LEVOBUNOLOL HCL LEVOBUNOLOL HCL OPHT DROPS 15ml in 30 days LIDOCAINE-PRILOCAINE LIDOCAINE/PRILOCAINE TOPICAL CREAM 5gm in 30 days MAXALT RIZATRIPTAN BENZOATE TABLET 12 tabs in 30 days MAXALT MLT RIZATRIPTAN BENZOATE TAB RAPDIS 12 tabs in 30 days MAXIDEX DEXAMETHASONE OPHT SUSP 15ml in 30 days MEPERIDINE HCL MEPERIDINE HCL ORAL SOLN 600ml in 30 days MEPERIDINE HCL MEPERIDINE HCL TABLET 120 tabs in 30 days METHADONE HCL METHADONE HCL ORAL SOLN 250ml in 30 days METHADONE HCL METHADONE HCL TABLET 120 tabs in 30 days METHADONE INTENSOL METHADONE HCL ORAL CONC 250ml in 30 days METHOCARBAMOL METHOCARBAMOL TABLET 90 tabs in 30 days 17

20 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS METHOCARBAMOL W/ASPIRIN METHOCARBAMOL/ASPIRIN TABLET 90 tabs in 30 days METIPRANOLOL METIPRANOLOL OPHT DROPS 10ml in 30 days METOPROLOL SUCCINATE METOPROLOL SUCCINATE TAB.SR 24H 30 tabs of 25mg, 50mg, 100mg or 60 of 200mg in 30 days MOBAN MOLINDONE HCL TABLET 120 tabs in 30 days MORPHINE SULFATE MORPHINE SULFATE ORAL SOLN 250ml in 30 days MORPHINE SULFATE MORPHINE SULFATE TABLET 120 tabs in 30 days MORPHINE SULFATE MORPHINE SULFATE TABLET SA 90 tabs in 30 days MUPIROCIN MUPIROCIN TOPICAL OINT 22gm in 30 days NAPHAZOLE NAPHAZOLINE HCL OPHT DROPS 15ml in 30 days NAPHAZOLINE HCL W/ANTAZOLINE NAPHAZOLINE HCL W/PHENIRAMINE NEOMYCIN-BACITRACIN -POLYMYXIN NEOMYCIN-POLYMYXIN -DEXAMETH NEOMYCIN-POLYMYXIN -DEXAMETH NAPHAZOLINE HCL /ANTAZOLINE OPHT DROPS 15ml in 30 days NAPHAZOLINE HCL /PHENIR MAL OPHT DROPS 15ml in 30 days NEOMY SULF/BACITRA /POLYMYXIN B OPHT OINT 4gm in 30 days NEO/POLYMYX B SULF /DEXAMETH OPHT OINT 5gm in 30 days NEO/POLYMYX B SULF /DEXAMETH OPHT SUSP 5ml in 30 days OFLOXACIN OFLOXACIN OPHT DROPS 10ml in 30 days OMEPRAZOLE OMEPRAZOLE CAPSULE DR 60 caps in 30 days OMNIPRED PREDNISOLONE ACETATE OPHT SUSP 15ml in 30 days OXYCODONE HCL OXYCODONE HCL CAPSULE 120 caps in 30 days OXYCODONE HCL OXYCODONE HCL ORAL CONC 250ml in 30 days OXYCODONE HCL OXYCODONE HCL ORAL SOLN 250ml in 30 days OXYCODONE HCL OXYCODONE HCL TAB.SR 12H 60 tabs in 30 days OXYCODONE HCL OXYCODONE HCL TABLET 120 tabs in 30 days OXYCODONE HCL -ACETAMINOPHEN OXYCODONE -ACETAMINOPHEN OXYCODONE HCL /ACETAMINOPHEN TABLET 120 tabs in 30 days OXYCODONE HCL /ACETAMINOPHEN CAPSULE 120 caps in 30 days OXYCODONE-ASPIRIN OXYCODONE/ASPIRIN TABLET 120 tabs in 30 days PEG 3350-ELECTROLYTE PEG 3350 /NA SULF,BICARB,CL/KCL ORAL SOLN 4000ml in 30 days 18

21 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS PENTASA MESALAMINE CAPSULE SA 480 caps in 30 days PENTAZOCINE -ACETAMINOPHEN PENTAZOCINE HCL /ACETAMINOPHEN TABLET 120 tabs in 30 days PHENYLEPHRINE HCL PHENYLEPHRINE HCL OPHT DROPS 15ml in 30 days PILOCARPINE HCL PILOCARPINE HCL OPHT DROPS 15ml in 30 days PILOPINE HS PILOCARPINE HCL OPHT GEL 4gm in 30 days PILOPTIC-1 PILOCARPINE HCL OPHT DROPS 15ml in 30 days PILOPTIC-2 PILOCARPINE HCL OPHT DROPS 15ml in 30 days PILOPTIC-3 PILOCARPINE HCL OPHT DROPS 15ml in 30 days PILOPTIC-4 PILOCARPINE HCL OPHT DROPS 15ml in 30 days PILOPTIC-6 PILOCARPINE HCL OPHT DROPS 15ml in 30 days POLYMYXIN B SUL- TRIMETHOPRIM POLYMYXIN B SULFATE/TMP OPHT DROPS 10ml in 30 days PREDNISOLONE ACETATE PREDNISOLONE ACETATE OPHT SUSP 15ml in 30 days PREDNISOLONE SODIUM PHOSPHATE PREDNISOLONE SOD PHOSPHATE OPHT DROPS 15ml in 30 days PROAIR HFA ALBUTEROL SULFATE AEROSOL 2 Inhalers in 30 days PROPARACAINE HCL PROPARACAINE HCL OPHT DROPS 15ml in 30 days PROPOXYPHENE HCL PROPOXYPHENE HCL CAPSULE 120 caps in 30 days PROPOXYPHENE HCL-APAP PROPOXYPHENE HCL /ACETAMINOPHEN TABLET 120 tabs in 30 days PROVENTIL HFA ALBUTEROL SULFATE AEROSOL 2 Inhalers in 30 days REGRANEX BECAPLERMIN TOPICAL GEL 15gm in 30 days RESTASIS CYCLOSPORINE DROPERETTE 64ml in 30 days RISPERDAL RISPERIDONE TAB RAPDIS 60 tabs in 30 days RISPERIDONE RISPERIDONE ORAL SOLN 240ml in 30 days RISPERIDONE RISPERIDONE TABLET 60 tabs in 30 days RMS-SUPPOSITORY MORPHINE SULFATE SUPP.RECT 120 supp. in 30 days SENSIPAR CINACALCET HCL TABLET 30 tabs in 30 days SEROQUEL QUETIAPINE FUMARATE TABLET 90 tabs in 30 days 19

22 BRAND NAME GENERIC NAME DOSAGE FORM QUANTITY LIMITS SKELAXIN METAXALONE TABLET 90 tabs in 30 days SPIRIVA TIOTROPIUM BROMIDE INHALATION CAP W/DEV 30 caps in 30 days SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM OPHT DROPS 15ml in 30 days SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM OPHT OINT 10gm in 30 days SULFACETAMIDE- PREDNISOLONE NA SULFACETM/PREDNIS SP OPHT DROPS 10ml in 30 days TIMOLOL MALEATE TIMOLOL MALEATE OPHT DROPS 15ml in 30 days TIMOLOL MALEATE TIMOLOL MALEATE OPHT GEL 15gm in 30 days TOBRAMYCIN SULFATE TOBRAMYCIN SULFATE OPHT DROPS 5ml in 30 days TRAMADOL HCL TRAMADOL HCL TABLET 120 tabs in 30 days TRAVATAN TRAVOPROST (BENZALKONIUM) OPHT DROPS 5ml in 30 days TRAVATAN Z TRAVOPROST OPHT DROPS 5ml in 30 days TRIFLURIDINE TRIFLURIDINE OPHT DROPS 8ml in 30 days TRIPLE ANTIBIOTIC NEOMY SULF /BACITRA/POLYMYXIN B OPHT OINT 4gm in 30 days TROPICAMIDE TROPICAMIDE OPHT DROPS 15ml in 30 days TRUSOPT DORZOLAMIDE HCL OPHT DROPS 10ml in 30 days XALATAN LATANOPROST OPHT DROPS 2.5ml in 25 days ZMAX AZITHROMYCIN ORAL SUSP 60ml in 30 days ZOLPIDEM TARTRATE ZOLPIDEM TARTRATE TABLET 30 tabs in 30 days ZOVIRAX ACYCLOVIR TOPICAL CREAM 10gm in 30 days ZOVIRAX ACYCLOVIR TOPICAL OINT 15gm in 30 days ZYFLO ZILEUTON TABLET 120 tabs in 30 days ZYPREXA OLANZAPINE TABLET 30 tabs in 30 days ZYPREXA ZYDIS OLANZAPINE TAB RAPDIS 30 tabs in 30 days 20

23 Table of Contents ACIDIFYING AGENTS...29 ACIDIFYING AGENTS...29 ADRENALS...29 ADRENALS...29 ALKALINIZING AGENTS...30 ALKALINIZING AGENTS...30 ALPHA-ADRENERGIC BLOCKING AGENTS...30 ALPHA-ADRENERGIC BLOCKING AGENTS...30 AMMONIA DETOXICANTS...31 AMMONIA DETOXICANTS...31 ANALGESICS AND ANTIPYRETICS...31 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS...31 OPIATE AGONISTS...32 OPIATE PARTIAL AGONISTS...34 ANDROGENS...34 ANDROGENS...34 ANOREXIGENICS,RESPIR.,CEREBRAL STIMULANT...35 AMPHETAMINES...35 ANOREX.,RESPIR.,CEREBRAL STIMULANTS,MISC...35 ANTHELMINTICS...35 ANTHELMINTICS...35 ANTIALLERGIC AGENTS...36 ANTIALLERGIC AGENTS...36 ANTIBACTERIALS...36 AMINOGLYCOSIDES...36 ANTIBACTERIALS, MISCELLANEOUS...36 CEPHALOSPORINS...36 MACROLIDES...37 MISCELLANEOUS B-LACTAM ANTIBIOTICS...38 PENICILLINS...38 QUINOLONES...39 SULFONAMIDES (SYSTEMIC)...40 TETRACYCLINES...40 ANTICHOLINERGIC AGENTS...41 ANTIMUSCARINICS/ANTISPASMODICS...41 ANTICONVULSANTS...41 ANTICONVULSANTS, MISCELLANEOUS...41 BARBITURATES (ANTICONVULSANTS)...42 HYDANTOINS...42 SUCCINIMIDES

24 Table of Contents ANTIDIABETIC AGENTS...43 ALPHA-GLUCOSIDASE INHIBITORS...43 AMYLINOMIMETICS...43 BIGUANIDES...43 DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS...43 INCRETIN MIMETICS...44 INSULINS...44 MEGLITINIDES...44 SULFONYLUREAS...44 THIAZOLIDINEDIONES...45 ANTIDIARRHEA AGENTS...45 ANTIDIARRHEA AGENTS...45 ANTIEMETICS HT3 RECEPTOR ANTAGONISTS...45 ANTIEMETICS, MISCELLANEOUS...46 ANTIHISTAMINES (GI DRUGS)...46 ANTIFUNGAL (SYSTEMIC)...46 ALLYLAMINES...46 ANTIFUNGALS, MISCELLANEOUS...46 AZOLES...46 ECHINOCANDINS...47 POLYENES...47 PYRIMIDINES...47 ANTIGLAUCOMA AGENTS...47 ALPHA-ADRENERGIC AGONISTS (EENT)...47 BETA-ADRENERGIC BLOCKING AGENTS (EENT)...48 CARBONIC ANHYDRASE INHIBITORS (EENT)...48 MIOTICS...48 PROSTAGLANDIN ANALOGS...48 ANTIHEMORRHAGIC AGENTS...48 HEMOSTATICS...48 ANTIHYPOGLYCEMIC AGENTS...49 GLYCOGENOLYTIC AGENTS...49 ANTI-INFECTIVES (EENT)...49 ANTIBACTERIALS (EENT)...49 ANTIVIRALS (EENT)...50 EENT ANTI-INFECTIVES, MISCELLANEOUS...50 ANTI-INFECTIVES (SKIN AND MUCOUS MEMBRANE)...50 ANTIBACTERIALS (SKIN AND MUCOUS MEMBRANE)...50 ANTIFUNGALS (SKIN AND MUCOUS MEMBRANE)...51 ANTIVIRALS (SKIN AND MUCOUS MEMBRANE)...51 LOCAL ANTI-INFECTIVES, MISCELLANEOUS...52 SCABICIDES AND PEDICULICIDES

25 Table of Contents ANTI-INFLAMMATORY AGENTS (EENT)...52 CORTICOSTEROIDS (EENT)...52 EENT ANTI-INFLAMMATORY AGENTS, MISC EENT NONSTEROIDAL ANTI-INFLAM. AGENTS...53 ANTI-INFLAMMATORY AGENTS (GI DRUGS)...53 ANTI-INFLAMMATORY AGENTS (GI DRUGS)...53 ANTI-INFLAMMATORY AGENTS (RESPIRATORY)...53 LEUKOTRIENE MODIFIERS...53 MAST-CELL STABLILIZERS...54 ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS)...54 ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS)...54 ANTILIPEMIC AGENTS...56 ANTILIPEMIC AGENTS, MISCELLANEOUS...56 BILE ACID SEQUESTRANTS...57 CHOLESTEROL ABSORPTION INHIBITORS...57 FIBRIC ACID DERIVATIVES...57 HMG-COA REDUCTASE INHIBITORS...57 ANTIMANIC AGENTS...57 ANTIMANIC AGENTS...57 ANTIMIGRAINE AGENTS...58 SELECTIVE SEROTONIN AGONISTS...58 ANTIMYCOBACTERIALS...58 ANTIMYCOBACTERIALS, MISCELLANEOUS...58 ANTITUBERCULOSIS AGENTS...58 ANTINEOPLASTIC AGENTS...59 ANTINEOPLASTIC AGENTS...59 ANTIPARKINSONIAN AGENTS...61 ADAMANTANES (CNS)...61 ANTICHOLINERGIC AGENTS (CNS)...61 CATECHOL-O-METHYLTRANSFERASE(COMT)INHIB...61 DOPAMINE PRECURSORS...61 DOPAMINE RECEPTOR AGONISTS...62 MONOAMINE OXIDASE B INHIBITORS...62 ANTIPROTOZOALS...62 AMEBICIDES...62 ANTIMALARIALS...62 ANTIPROTOZOALS, MISCELLANEOUS...63 ANTIPRURITICS AND LOCAL ANESTHETICS...63 ANTIPRURITICS AND LOCAL ANESTHETICS

26 Table of Contents ANTITHROMBOTIC AGENTS...63 ANTICOAGULANTS...63 PLATELET-AGGREGATION INHIBITORS...64 ANTIULCER AGENTS AND ACID SUPPRESSANTS...64 HISTAMINE H2-ANTAGONISTS...64 PROSTAGLANDINS...65 PROTECTANTS...65 PROTON-PUMP INHIBITORS...65 ANTIVIRALS (SYSTEMIC)...65 ADAMANTANES...65 ANTIRETROVIRALS...65 INTERFERONS...67 NEURAMINIDASE INHIBITORS...68 NUCLEOSIDES AND NUCLEOTIDES...68 ANXIOLYTICS, SEDATIVES AND HYPNOTICS...68 ANXIOLYTICS, SEDATIVES AND HYPNOTICS,MISC AUTONOMIC DRUGS, MISCELLANEOUS...69 AUTONOMIC DRUGS, MISCELLANEOUS...69 BETA-ADRENERGIC BLOCKING AGENTS...69 BETA-ADRENERGIC BLOCKING AGENTS...69 CALCIUM-CHANNEL BLOCKING AGENTS...70 CALCIUM-CHANNEL BLOCKING AGENTS, MISC DIHYDROPYRIDINES...70 CALORIC AGENTS...71 CALORIC AGENTS...71 CARDIAC DRUGS...71 ANTIARRHYTHMIC AGENTS...71 CARDIAC DRUGS, MISCELLANEOUS...72 CARDIOTONIC AGENTS...72 CATHARTICS AND LAXATIVES...72 CATHARTICS AND LAXATIVES...72 CELL STIMULANTS AND PROLIFERANTS...73 CELL STIMULANTS AND PROLIFERANTS...73 CENTRAL NERVOUS SYSTEM AGENTS, MISC CENTRAL NERVOUS SYSTEM AGENTS, MISC...73 CHOLELITHOLYTIC AGENTS...73 CHOLELITHOLYTIC AGENTS...73 CONTRACEPTIVES...73 CONTRACEPTIVES

27 Table of Contents DEPIGMENTING AND PIGMENTING AGENTS...75 PIGMENTING AGENTS...75 DEVICES...75 DEVICES...75 DIGESTANTS...75 DIGESTANTS...75 DIURETICS...76 LOOP DIURETICS...76 POTASSIUM-SPARING DIURETICS...76 THIAZIDE DIURETICS...76 THIAZIDE-LIKE DIURETICS...77 EENT DRUGS, MISCELLANEOUS...77 EENT DRUGS, MISCELLANEOUS...77 EMOLLIENTS, DEMULCENTS, AND PROTECTANTS...77 BASIC LOTIONS AND LINIMENTS...77 BASIC OINTMENTS AND PROTECTANTS...77 ENZYMES...77 ENZYMES...77 ESTROGENS AND ANTIESTROGENS...78 ESTROGEN AGONIST-ANTAGONISTS...78 ESTROGENS...78 FIRST GENERATION ANTIHISTAMINES...79 ETHANOLAMINE DERIVATIVES...79 FIRST GEN. ANTIHIST. DERIVATIVES, MISC PHENOTHIAZINE DERIVATIVES...79 PROPYLAMINE DERIVATIVES...79 GENITOURINARY SMOOTH MUSCLE RELAXANTS...80 GENITOURINARY SMOOTH MUSCLE RELAXANTS...80 GI DRUGS, MISCELLANEOUS...80 GI DRUGS, MISCELLANEOUS...80 GOLD COMPOUNDS...80 GOLD COMPOUNDS...80 GONADOTROPINS...80 GONADOTROPINS...80 HEAVY METAL ANTAGONISTS...80 HEAVY METAL ANTAGONISTS...80 HEMATOPOIETIC AGENTS...81 HEMATOPOIETIC AGENTS

28 Table of Contents HEMORRHEOLOGIC AGENTS...81 HEMORRHEOLOGIC AGENTS...81 HYPOTENSIVE AGENTS...81 CENTRAL ALPHA-AGONISTS...81 DIRECT VASODILATORS...82 HYPOTENSIVE AGENTS...82 HYPOTENSIVE AGENTS, MISCELLANEOUS...82 ION-REMOVING AGENTS...82 PHOSPHATE-REMOVING AGENTS...82 POTASSIUM-REMOVING AGENTS...82 IRRIGATING SOLUTIONS...83 IRRIGATING SOLUTIONS...83 KERATOLYTIC AGENTS...83 KERATOLYTIC AGENTS...83 LOCAL ANESTHETICS (EENT)...83 LOCAL ANESTHETICS (EENT)...83 LOCAL ANESTHETICS (PARENTERAL)...84 LOCAL ANESTHETICS (PARENTERAL)...84 MISCELLANEOUS THERAPEUTIC AGENTS...84 MISCELLANEOUS THERAPEUTIC AGENTS...84 MULTIVITAMIN PREPARATIONS...86 MULTIVITAMIN PREPARATIONS...86 MYDRIATICS...86 MYDRIATICS...86 OPIATE ANTAGONISTS...87 OPIATE ANTAGONISTS...87 PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)...87 PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)...87 PARATHYROID...87 PARATHYROID...87 PHARMACEUTICAL AIDS...88 PHARMACEUTICAL AIDS...88 PITUITARY...88 PITUITARY...88 PROGESTINS...88 PROGESTINS

29 Table of Contents PROKINETIC AGENTS...89 PROKINETIC AGENTS...89 PSYCHOTHERAPEUTIC AGENTS...89 ANTIDEPRESSANTS...89 ANTIPSYCHOTIC AGENTS...91 RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB...92 ANGIOTENSIN II RECEPTOR ANTAGONISTS...92 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS...92 MINERALOCORTICOID (ALDOSTERONE) ANTAGNTS...93 RENIN INHIBITORS...93 REPLACEMENT PREPARATIONS...93 REPLACEMENT PREPARATIONS...93 RESPIRATORY SMOOTH MUSCLE RELAXANTS...95 RESPIRATORY SMOOTH MUSCLE RELAXANTS...95 RESPIRATORY TRACT AGENTS, MISCELLANEOUS...95 RESPIRATORY TRACT AGENTS, MISCELLANEOUS...95 SECOND GENERATION ANTIHISTAMINES...95 SECOND GENERATION ANTIHISTAMINES...95 SERUMS...96 SERUMS...96 SKELETAL MUSCLE RELAXANTS...97 CENTRALLY ACTING SKELETAL MUSCLE RELAXNT...97 DIRECT-ACTING SKELETAL MUSCLE RELAXANTS...97 GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT...97 SKELETAL MUSCLE RELAXANTS...97 SKIN AND MUCOUS MEMBRANE AGENTS, MISC...98 SKIN AND MUCOUS MEMBRANE AGENTS, MISC...98 SOMATOTROPIN AGONISTS AND ANTAGONISTS...99 SOMATOTROPIN AGONISTS...99 SOMATOTROPIN ANTAGONISTS...99 SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS...99 SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS...99 SYMPATHOMIMETIC (ADRENERGIC) AGENTS...99 ALPHA- AND BETA-ADRENERGIC AGONISTS...99 ALPHA-ADRENERGIC AGONISTS...99 BETA-ADRENERGIC AGONISTS THYROID AND ANTITHYROID AGENTS ANTITHYROID AGENTS THYROID AGENTS

30 Table of Contents TOXOIDS TOXOIDS URICOSURIC AGENTS URICOSURIC AGENTS URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES VACCINES VACCINES VASOCONSTRICTORS VASOCONSTRICTORS VASODILATING AGENTS NITRATES AND NITRITES PHOSPHODIESTERASE INHIBITORS VASODILATING AGENTS, MISCELLANEOUS VITAMIN D VITAMIN D

31 ACIDIFYING AGENTS ACIDIFYING AGENTS K-Phos Neutral Phosphorus #1 tablet 1 Phospha 250 Neutral Phosphorus #1 tablet 1 Vis-Phos N Phosphorus #1 tablet 1 ADRENALS ADRENALS AEROBID Flunisolide aerosol 3 AEROBID-M Flunisolide/Menthol aerosol 3 ARISTOCORT Triamcinolone tablet 2 ACIDIFYING AGENTS AZMACORT Triamcinolone Acetonide aerosol 2 CELESTONE Betamethasone oral soln 2 Cortisone Acetate Cortisone Acetate tablet 1 Dexamethasone Dexamethasone tablet 1 Dexamethasone Dexamethasone oral liq. 1 Dexamethasone Acetate Dexamethasone Acetate injection 1 PA ENTOCORT EC Budesonide cap.sr 24h 2 FLOVENT HFA Fluticasone Propionate aerosol 2 Fludrocortisone Acetate Fludrocortisone Acetate tablet 1 Hydrocortisone Hydrocortisone tablet 1 Hydrocortisone Sod Succinate Hydrocortisone Sod Succinate injection 1 Methylprednisolone Methylprednisolone tab ds pk 1 Methylprednisolone Methylprednisolone tablet 1 Methylprednisolone Sod Succ Methylprednisolone Sod Succ injection 1 PA 29

32 Prednisolone Prednisolone tablet 1 Prednisolone Prednisolone oral soln 1 Prednisolone Sod Phosphate Prednisolone Sod Phosphate oral soln 1 Prednisone Prednisone tablet 1 PULMICORT Budesonide aerosol 2 PULMICORT FLEXHALER Budesonide aerosol 2 QVAR Beclomethasone Dipropionate aerosol 2 ALKALINIZING AGENTS ADRENALS ALKALINIZING AGENTS Citric Acid/Potassium Citrate Citric Acid/Potassium Citrate oral packet 1 Citric Acid/Potassium Citrate Citric Acid/Potassium Citrate oral soln 1 Citric Acid/Sodium Citrate Citric Acid/Sodium Citrate oral soln 1 Cytra-3 Sod/Pot/K Cit/Sod Cit/Cit Acid oral soln 1 Potassium Citrate Potassium Citrate tablet sa 1 Sodium Bicarbonate Sodium Bicarbonate intravenous (iv) 1 Tricitrates Sod/Pot/K & Sod Cit/C Ac/Sucro oral soln 1 ALPHA-ADRENERGIC BLOCKING AGENTS ALPHA-ADRENERGIC BLOCKING AGENTS Doxazosin Mesylate Doxazosin Mesylate tablet 1 Prazosin Hcl Prazosin Hcl capsule 1 Terazosin Hcl Terazosin Hcl capsule 1 30

33 AMMONIA DETOXICANTS AMMONIA DETOXICANTS BUPHENYL Sodium Phenylbutyrate oral powder 2 PA BUPHENYL Sodium Phenylbutyrate tablet 2 PA Lactulose Lactulose syrup 1 Lactulose Lactulose oral soln 1 ANALGESICS AND ANTIPYRETICS NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Chol Sal/Magnesium Salicylate Chol Sal/Magnesium Salicylate oral liq. 1 Chol Sal/Magnesium Salicylate Chol Sal/Magnesium Salicylate tablet 1 Diclofenac Potassium Diclofenac Potassium tablet 1 AMMONIA DETOXICANTS Diclofenac Sodium Diclofenac Sodium tab.sr 24h 1 Diclofenac Sodium Diclofenac Sodium tablet dr 1 Diflunisal Diflunisal tablet 1 Etodolac Etodolac tab.sr 24h 1 Etodolac Etodolac tablet 1 Etodolac Etodolac capsule 1 Fenoprofen Calcium Fenoprofen Calcium tablet 1 Flurbiprofen Flurbiprofen tablet 1 Ibuprofen Ibuprofen tablet 1 Indomethacin Indomethacin capsule 1 Indomethacin Indomethacin capsule sa 1 Indomethacin Indomethacin rectal supp. 1 Ketoprofen Ketoprofen cap.24h pel 1 31

34 Ketoprofen Ketoprofen capsule 1 Ketorolac Tromethamine Ketorolac Tromethamine injection 1 PA,QL Ketorolac Tromethamine Ketorolac Tromethamine tablet 1 QL Meclofenamate Sodium Meclofenamate Sodium capsule 1 Meloxicam Meloxicam tablet 1 MST 600 Magnesium Salicylate tablet 1 ANALGESICS AND ANTIPYRETICS Nabumetone Nabumetone tablet 1 Naproxen Naproxen oral susp 1 Naproxen Naproxen tablet 1 Naproxen Naproxen tablet dr 1 Naproxen Sodium Naproxen Sodium tablet 1 Naproxen Sodium Naproxen Sodium tablet sa 1 Oxaprozin Oxaprozin tablet 1 Piroxicam Piroxicam capsule 1 Salsalate Salsalate tablet 1 Sulindac Sulindac tablet 1 Tolmetin Sodium Tolmetin Sodium capsule 1 Tolmetin Sodium Tolmetin Sodium tablet 1 OPIATE AGONISTS Acetaminophen With Codeine Acetaminophen With Codeine oral liq. 1 QL Aspirin/Codeine Phosphate Aspirin/Codeine Phosphate tablet 1 QL BALACET 325 Propoxyphene/Acetaminophen tablet 2 QL CODEINE PHOSPHATE Codeine Phosphate injection 2 PA Codeine Sulf Codeine Sulf tablet 1 QL Codeine/Butalbit/Acetamin/Caff Codeine/Butalbit/Acetamin/Caff capsule 1 QL 32

35 Fentanyl Fentanyl patch 1 PA,QL Fentanyl Citrate/Pf Fentanyl Citrate/Pf injection 1 PA Hydrocodone Bit/Acetaminophen Hydrocodone Bit/Acetaminophen capsule 1 QL Hydrocodone Bit/Acetaminophen Hydrocodone Bit/Acetaminophen oral soln 1 QL Hydrocodone Bit/Acetaminophen Hydrocodone Bit/Acetaminophen tablet 1 QL Hydrocodone/Ibuprofen Hydrocodone/Ibuprofen tablet 1 QL Hydromorphone Hcl Hydromorphone Hcl injection 1 PA Hydromorphone Hcl Hydromorphone Hcl tablet 1 QL Hydromorphone Hcl/Pf Hydromorphone Hcl/Pf injection 1 PA Meperidine Hcl Meperidine Hcl oral soln 1 QL Meperidine Hcl Meperidine Hcl tablet 1 QL Meperidine Hcl/Pf Meperidine Hcl/Pf injection 1 PA ANALGESICS AND ANTIPYRETICS Methadone Hcl Methadone Hcl injection 1 PA Methadone Hcl Methadone Hcl oral conc. 1 QL Methadone Hcl Methadone Hcl oral soln 1 QL Methadone Hcl Methadone Hcl tablet 1 QL Morphine Sulfate Morphine Sulfate tablet sa 1 QL Morphine Sulfate Morphine Sulfate injection 1 PA Morphine Sulfate Morphine Sulfate rectal supp. 1 QL Morphine Sulfate Morphine Sulfate oral soln 1 QL Morphine Sulfate Morphine Sulfate tablet 1 QL Morphine Sulfate/Pf Morphine Sulfate/Pf injection 1 PA Opium/Belladonna Alkaloids Opium/Belladonna Alkaloids rectal supp. 1 QL Oxycodone Hcl Oxycodone Hcl tab.sr 12h 1 PA,QL Oxycodone Hcl Oxycodone Hcl tablet 1 QL 33

36 Oxycodone Hcl Oxycodone Hcl capsule 1 QL Oxycodone Hcl Oxycodone Hcl oral conc. 1 QL Oxycodone Hcl Oxycodone Hcl oral soln 1 QL Oxycodone Hcl/Acetaminophen Oxycodone Hcl/Acetaminophen tablet 1 QL Oxycodone Hcl/Acetaminophen Oxycodone Hcl/Acetaminophen capsule 1 QL Oxycodone/Aspirin Oxycodone/Aspirin tablet 1 QL ANALGESICS AND ANTIPYRETICS Propoxyphene Hcl Propoxyphene Hcl capsule 1 QL Propoxyphene/Acetaminophen Propoxyphene/Acetaminophen tablet 1 QL Tramadol Hcl Tramadol Hcl tablet 1 QL OPIATE PARTIAL AGONISTS Pentazocine Hcl/Acetaminophen Pentazocine Hcl/Acetaminophen tablet 1 QL SUBOXONE Buprenorphine Hcl/Naloxone Hcl injection 3 PA SUBUTEX Buprenorphine Hcl injection 3 PA ANDROGENS ANDROGENS ANDRODERM Testosterone patch 2 PA Android Methyltestosterone capsule 1 PA Androxy Fluoxymesterone tablet 1 PA Danazol Danazol capsule 1 Nandrolone Decanoate Nandrolone Decanoate injection 1 PA Oxandrolone Oxandrolone tablet 1 PA 34

37 ANOREXIGENICS,RESPIR.,CEREBRAL STIMULANT AMPHETAMINES ADDERALL XR Amphet Asp/Amphet/D-Amphet cap.sr 24h 2 ST Amphetamine Salt Combo Amphet Asp/Amphet/D-Amphet tablet 1 Dextroamphetamine Sulfate D-Amphetamine Sulfate capsule sa 1 Dextrostat D-Amphetamine Sulfate tablet 1 ANOREX.,RESPIR.,CEREBRAL STIMULANTS,MISC CONCERTA Methylphenidate Hcl tab osm 24 2 ST Dexmethylphenidate Hcl Dexmethylphenidate Hcl tablet 1 ST FOCALIN XR Dexmethylphenidate Hcl capsule sa 3 ST Methylphenidate Hcl Methylphenidate Hcl tablet 1 Methylphenidate Hcl Methylphenidate Hcl tablet sa 1 ST PROVIGIL Modafinil tablet 3 PA ANOREXIGENICS,RESPIR.,CEREBRAL STIMULANT ANTHELMINTICS ANTHELMINTICS ALBENZA Albendazole tablet 2 BILTRICIDE Praziquantel tablet 2 Mebendazole Mebendazole tab chew 1 MINTEZOL Thiabendazole oral susp 2 MINTEZOL Thiabendazole tab chew 2 STROMECTOL Ivermectin tablet 2 35

38 ANTIALLERGIC AGENTS ANTIALLERGIC AGENTS ASTELIN Azelastine Hcl nasal spray 2 QL Ketotifen Fumarate Ketotifen Fumarate opht drops 1 ANTIBACTERIALS AMINOGLYCOSIDES ANTIALLERGIC AGENTS Amikacin Sulfate Amikacin Sulfate injection 1 PA Gentamicin Sulfate Gentamicin Sulfate injection 1 PA Neomycin Sulfate Neomycin Sulfate tablet 1 Neomycin Sulfate Neomycin Sulfate oral soln 1 Tobramycin Sulfate Tobramycin Sulfate injection 1 PA ANTIBACTERIALS, MISCELLANEOUS Clindamycin Hcl Clindamycin Hcl capsule 1 Clindamycin Phosphate Clindamycin Phosphate injection 1 PA Colistimethate Sodium Colistimethate Sodium injection 1 VANCOCIN HCL Vancomycin Hcl capsule 3 Vancomycin Hcl Vancomycin Hcl intravenous (iv) 1 PA ZYVOX Linezolid tablet 3 PA CEPHALOSPORINS Cefaclor Cefaclor capsule 1 Cefaclor Cefaclor oral susp 1 Cefaclor ER Cefaclor tab.sr 12h 1 Cefadroxil Hydrate Cefadroxil Hydrate capsule 1 Cefadroxil Hydrate Cefadroxil Hydrate oral susp 1 36

39 Cefadroxil Hydrate Cefadroxil Hydrate tablet 1 Cefazolin Sodium Cefazolin Sodium injection 1 PA Cefazolin Sodium Cefazolin Sodium intravenous (iv) 1 PA Cefepime Hcl Cefepime Hcl injection 1 PA Cefotaxime Sodium Cefotaxime Sodium injection 1 PA Cefpodoxime Proxetil Cefpodoxime Proxetil tablet 1 Cefprozil Cefprozil oral susp 1 Cefprozil Cefprozil tablet 1 Ceftazidime Pentahydrate Ceftazidime Pentahydrate injection 1 PA Ceftriaxone Na/Dextrose,Iso Ceftriaxone Na/Dextrose,Iso intravenous (iv) 1 PA Ceftriaxone Sodium Ceftriaxone Sodium injection 1 PA ANTIBACTERIALS Cefuroxime Axetil Cefuroxime Axetil tablet 1 Cefuroxime Sodium Cefuroxime Sodium injection 1 PA Cephalexin Monohydrate Cephalexin Monohydrate oral susp 1 Cephalexin Monohydrate Cephalexin Monohydrate capsule 1 Cephalexin Monohydrate Cephalexin Monohydrate tablet 1 FORTAZ Ceftazidime Pentahydrate injection 2 PA FORTAZ IN ISO-OSMOTIC DEXTROSECeftazidime Na/Dextrose,Iso intravenous (iv) 2 PA MAXIPIME Cefepime Hcl intravenous (iv) 2 PA MAXIPIME Cefepime Hcl injection 2 PA Tazicef Ceftazidime Pentahydrate intravenous (iv) 1 PA MACROLIDES Azithromycin Azithromycin intravenous (iv) 1 PA Azithromycin Azithromycin oral packet 1 QL Azithromycin Azithromycin tablet 1 QL 37

40 Azithromycin Azithromycin oral susp 1 QL Clarithromycin Clarithromycin oral susp 1 Clarithromycin Clarithromycin tablet 1 Clarithromycin ER Clarithromycin tab.sr 24h 1 Ery E-Succ/Sulfisoxazole Ery E-Succ/Sulfisoxazole oral susp 1 ERYTHROCIN LACTOBIONATE Erythromycin Lactobionate intravenous (iv) 2 PA Erythromycin Base Erythromycin Base capsule dr 1 ANTIBACTERIALS Erythromycin Ethylsuccinate Erythromycin Ethylsuccinate oral susp 1 ERYTHROMYCIN ETHYLSUCCINATE Erythromycin Ethylsuccinate oral susp 2 ERYTHROMYCIN ETHYLSUCCINATE Erythromycin Ethylsuccinate tablet 2 KETEK Telithromycin tablet 3 ST ZMAX Azithromycin oral susp 2 QL MISCELLANEOUS B-LACTAM ANTIBIOTICS AZACTAM Aztreonam injection 2 PA LORABID Loracarbef capsule 2 LORABID Loracarbef oral susp 2 PRIMAXIN Imipenem/Cilastatin Sodium intravenous (iv) 2 PRIMAXIN I.M. Imipenem/Cilastatin Sodium injection 2 PENICILLINS Amox Tr/Potassium Clavulanate Amox Tr/Potassium Clavulanate oral susp 1 Amox Tr/Potassium Clavulanate Amox Tr/Potassium Clavulanate tab chew 1 Amox Tr/Potassium Clavulanate Amox Tr/Potassium Clavulanate tablet 1 Amoxicillin Trihydrate Amoxicillin Trihydrate tab chew 1 Amoxicillin Trihydrate Amoxicillin Trihydrate tablet 1 Amoxicillin Trihydrate Amoxicillin Trihydrate oral susp 1 38

41 Amoxicillin Trihydrate Amoxicillin Trihydrate capsule 1 AMPICILLIN SODIUM Ampicillin Sodium injection 2 PA Ampicillin Sodium/Sulbactam Na Ampicillin Sodium/Sulbactam Na injection 1 PA Ampicillin Trihydrate Ampicillin Trihydrate capsule 1 Ampicillin Trihydrate Ampicillin Trihydrate oral susp 1 BICILLIN C-R Pen G Benz/Pen G Procaine injection 2 PA BICILLIN L-A Penicillin G Benzathine injection 2 PA Dicloxacillin Sodium Dicloxacillin Sodium capsule 1 Nafcillin Sodium Nafcillin Sodium injection 1 PA Penicillin G Potassium Penicillin G Potassium injection 1 PA Penicillin G Sodium Penicillin G Sodium injection 1 PA ANTIBACTERIALS Penicillin V Potassium Penicillin V Potassium oral susp 1 Penicillin V Potassium Penicillin V Potassium tablet 1 Piperacillin Sodium Piperacillin Sodium injection 1 PA TICAR Ticarcillin Disodium intravenous (iv) 2 PA TICAR Ticarcillin Disodium intravenous (iv) 2 PA TICAR IN DEXTROSE Ticarcillin Disodium/D5W intravenous (iv) 2 PA TIMENTIN Ticarcillin/K Clavulanate intravenous (iv) 2 PA QUINOLONES Ciprofloxacin ER Ciprofloxacin Hcl tablet sa 1 Ciprofloxacin Hcl Ciprofloxacin Hcl tablet 1 Ciprofloxacin Hcl Ciprofloxacin Lactate intravenous (iv) 1 FLOXIN I.V. Ofloxacin/Dextrose 5%-Water intravenous (iv) 2 PA LEVAQUIN Levofloxacin tablet 2 LEVAQUIN Levofloxacin/Dextrose 5%-Water intravenous (iv) 2 PA 39

42 LEVAQUIN Levofloxacin oral soln 2 LEVAQUIN Levofloxacin intravenous (iv) 2 PA Nalidixic Acid Nalidixic Acid tablet 1 NEGGRAM Nalidixic Acid tablet 2 Ofloxacin Ofloxacin tablet 1 SULFONAMIDES (SYSTEMIC) BACTRIM Sulfamethoxazole/Trimethoprim mg tablet 2 ANTIBACTERIALS GANTRISIN Sulfisoxazole Acetyl oral susp 2 Sulfadiazine Sulfadiazine tablet 1 Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim intravenous (iv) 1 PA Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim oral susp 1 Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim tablet 1 Sulfasalazine Sulfasalazine tablet 1 Sulfasalazine DR Sulfasalazine tablet dr 1 Sulfisoxazole Sulfisoxazole tablet 1 TETRACYCLINES Demeclocycline Hcl Demeclocycline Hcl tablet 1 Doxycycline Hyclate Doxycycline Hyclate capsule 1 Doxycycline Hyclate Doxycycline Hyclate capsule dr 1 Doxycycline Hyclate Doxycycline Hyclate intravenous (iv) 1 Doxycycline Monohydrate Doxycycline Monohydrate capsule 1 Doxycycline Monohydrate Doxycycline Monohydrate tablet 1 Minocycline Hcl Minocycline Hcl capsule 1 Minocycline Hcl Minocycline Hcl tablet 1 Tetracycline Hcl Tetracycline Hcl capsule 1 40

43 TYGACIL Tigecycline intravenous (iv) 2 PA ANTICHOLINERGIC AGENTS ANTIMUSCARINICS/ANTISPASMODICS Atropine Sulfate Atropine Sulfate injection 1 PA Atropine Sulfate Atropine Sulfate tablet 1 ATROVENT HFA Ipratropium Bromide aerosol 2 Dicyclomine Hcl Dicyclomine Hcl capsule 1 Dicyclomine Hcl Dicyclomine Hcl syrup 1 Dicyclomine Hcl Dicyclomine Hcl tablet 1 Glycopyrrolate Glycopyrrolate tablet 1 ANTIBACTERIALS Hyoscyamine Sulfate Hyoscyamine Sulfate oral liq. 1 Hyoscyamine Sulfate Hyoscyamine Sulfate tab rapdis 1 Hyoscyamine Sulfate Hyoscyamine Sulfate injection 1 PA Hyoscyamine Sulfate Hyoscyamine Sulfate tablet 1 SPIRIVA Tiotropium Bromide inhalation cap 2 QL,ST ANTICONVULSANTS ANTICONVULSANTS, MISCELLANEOUS Carbamazepine Carbamazepine tablet 1 Carbamazepine Carbamazepine oral susp 1 Carbamazepine Carbamazepine tab chew 1 CARBATROL Carbamazepine capsule sa 2 DEPAKOTE Divalproex Sodium tablet dr 2 DEPAKOTE ER Divalproex Sodium tab.sr 24h 2 DEPAKOTE SPRINKLE Divalproex Sodium cap sprink 2 41

44 FELBATOL Felbamate oral susp 3 PA FELBATOL Felbamate tablet 3 PA Gabapentin Gabapentin capsule 1 Gabapentin Gabapentin tablet 1 GABITRIL Tiagabine Hcl tablet 3 PA KEPPRA Levetiracetam tablet 2 PA KEPPRA Levetiracetam oral soln 2 PA ANTICONVULSANTS LAMICTAL Lamotrigine tab ds pk 2 LAMICTAL Lamotrigine tablet 2 Lamotrigine Lamotrigine tab disper 1 LYRICA Pregabalin capsule 3 PA NEURONTIN Gabapentin oral soln 2 Oxcarbazepine Oxcarbazepine tablet 1 PA TEGRETOL XR Carbamazepine tab.sr 12h 2 TOPAMAX Topiramate cap sprink 2 PA TOPAMAX Topiramate tablet 2 PA TRILEPTAL Oxcarbazepine oral susp 2 PA Valproate Sodium Valproate Sodium intravenous (iv) 1 PA Valproic Acid Valproic Acid capsule 1 Valproic Acid Valproate Sodium syrup 1 Zonisamide Zonisamide capsule 1 PA BARBITURATES (ANTICONVULSANTS) Primidone Primidone tablet 1 HYDANTOINS DILANTIN Phenytoin tab chew 2 42

45 DILANTIN Phenytoin Sodium Extended capsule 2 DILANTIN-125 Phenytoin oral susp 2 PEGANONE Ethotoin tablet 2 PHENYTEK Phenytoin Sodium Extended capsule 2 Phenytoin Phenytoin oral susp 1 PHENYTOIN SODIUM Phenytoin Sodium intravenous (iv) 2 PA Phenytoin Sodium Phenytoin Sodium capsule 1 Phenytoin Sodium Extended Phenytoin Sodium Extended capsule 1 SUCCINIMIDES CELONTIN Methsuximide capsule 2 Ethosuximide Ethosuximide capsule 1 ANTICONVULSANTS Ethosuximide Ethosuximide syrup 1 ANTIDIABETIC AGENTS ALPHA-GLUCOSIDASE INHIBITORS Acarbose Acarbose tablet 1 GLYSET Miglitol tablet 2 AMYLINOMIMETICS SYMLIN Pramlintide Acetate injection 3 PA BIGUANIDES Metformin Hcl Metformin Hcl tablet 1 Metformin Hcl ER Metformin Hcl tab.sr 24h 1 DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS JANUVIA Sitagliptin Phosphate tablet 3 PA 43

46 INCRETIN MIMETICS BYETTA Exenatide injection 3 PA INSULINS HUMALOG Insulin Lispro injection (vials) 2 HUMALOG MIX Insulin Npl/Insulin Lispro injection (vials) 2 HUMALOG MIX Insulin Npl/Insulin Lispro injection (vials) 2 HUMULIN Hum Insulin Nph/Reg Insulin Hm injection (vials) 2 ANTIDIABETIC AGENTS HUMULIN Hum Insulin Nph/Reg Insulin Hm injection (vials) 2 HUMULIN N Nph, Human Insulin Isophane injection (vials) 2 HUMULIN R Insulin Regular, Human injection (vials) 2 LANTUS Insulin Glargine,Hum.Rec.Anlog injection (vials) 2 NOVOLIN Hum Insulin Nph/Reg Insulin Hm injection (vials) 2 NOVOLIN N Nph, Human Insulin Isophane injection (vials) 2 NOVOLIN R Insulin Regular, Human injection (vials) 2 NOVOLOG Insulin Aspart injection (vials) 2 NOVOLOG MIX Insuln Asp Prt/Insulin Aspart injection (vials) 2 RELION NOVOLIN Hum Insulin Nph/Reg Insulin Hm injection (vials) 2 RELION NOVOLIN N Nph, Human Insulin Isophane injection (vials) 2 RELION NOVOLIN R Insulin Regular, Human injection (vials) 2 MEGLITINIDES PRANDIN Repaglinide tablet 2 PA STARLIX Nateglinide tablet 2 PA SULFONYLUREAS Glimepiride Glimepiride tablet 1 44

47 Glipizide Glipizide tablet 1 Glipizide ER Glipizide tab osm 24 1 Glipizide/Metformin Hcl Glipizide/Metformin Hcl tablet 1 Glyburide Glyburide tablet 1 Glyburide, Micro/Metformin Hcl Glyburide, Micro/Metformin Hcl tablet 1 Glyburide,Micronized Glyburide,Micronized tablet 1 Tolbutamide Tolbutamide tablet 1 THIAZOLIDINEDIONES ACTOS Pioglitazone Hcl tablet 2 ST AVANDIA Rosiglitazone Maleate tablet 2 ST ANTIDIARRHEA AGENTS ANTIDIABETIC AGENTS ANTIDIARRHEA AGENTS Diphenoxylate Hcl/Atrop Sulf Diphenoxylate Hcl/Atrop Sulf oral liq. 1 Diphenoxylate Hcl/Atrop Sulf Diphenoxylate Hcl/Atrop Sulf tablet 1 Loperamide Hcl Loperamide Hcl capsule 1 ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS GRANISETRON HCL Granisetron Hcl tablet 3 PA GRANISETRON HCL Granisetron Hcl intravenous (iv) 3 PA Ondansetron Hcl Ondansetron Hcl oral soln 1 PA Ondansetron Hcl Ondansetron Hcl tablet 1 PA Ondansetron ODT Ondansetron tab rapdis 1 PA 45

48 ANTIEMETICS, MISCELLANEOUS DRONABINOL Dronabinol capsule 3 PA EMEND Fosaprepitant Dimeglumine intravenous (iv) 2 PA EMEND Aprepitant capsule 2 PA EMEND Aprepitant cap ds pk 2 PA MARINOL Dronabinol capsule 3 PA Scopolamine Hydrobromide Scopolamine Hydrobromide tablet 1 TRANSDERM-SCOP Scopolamine Hydrobromide patch 3 ANTIEMETICS ANTIHISTAMINES (GI DRUGS) Meclizine Hcl Meclizine Hcl tablet 1 Prochlorperazine Edisylate Prochlorperazine Edisylate injection 1 PA Prochlorperazine Maleate Prochlorperazine Maleate rectal supp. 1 Prochlorperazine Maleate Prochlorperazine Maleate tablet 1 Trimethobenzamide Hcl Trimethobenzamide Hcl capsule 1 ANTIFUNGAL (SYSTEMIC) ALLYLAMINES Terbinafine Hcl Terbinafine Hcl tablet 1 PA ANTIFUNGALS, MISCELLANEOUS FULVICIN U/F Griseofulvin,Microsize tablet 2 GRIFULVIN V Griseofulvin,Microsize tablet 2 PA Griseofulvin Griseofulvin,Microsize oral susp 1 PA GRIS-PEG Griseofulvin Ultramicrosize tablet 2 PA AZOLES Fluconazole Fluconazole oral susp 1 46

49 Fluconazole Fluconazole tablet 1 Fluconazole In Dextrose Fluconazole In Dextrose intravenous (iv) 1 PA Fluconazole In Saline Fluconazole In Saline intravenous (iv) 1 PA Itraconazole Itraconazole capsule 1 PA Ketoconazole Ketoconazole tablet 1 ECHINOCANDINS CANCIDAS Caspofungin Acetate intravenous (iv) 4 PA ERAXIS Anidulafungin intravenous (iv) 4 PA POLYENES ABELCET Amphotericin B Lipid Complex intravenous (iv) 2 PA AMBISOME Amphotericin B Liposome intravenous (iv) 2 PA ANTIFUNGAL (SYSTEMIC) AMPHOTEC Amphotericin B Cholesteryl Sul intravenous (iv) 2 PA Amphotericin B Amphotericin B injection 1 PA Nystatin Nystatin oral susp 1 Nystatin Nystatin oral powder 1 Nystatin Nystatin tablet 1 PYRIMIDINES ANCOBON Flucytosine capsule 2 ANTIGLAUCOMA AGENTS ALPHA-ADRENERGIC AGONISTS (EENT) ALPHAGAN P Brimonidine Tartrate opht drops 2 QL Brimonidine Tartrate Brimonidine Tartrate opht drops 1 QL 47

50 BETA-ADRENERGIC BLOCKING AGENTS (EENT) Betaxolol Hcl Betaxolol Hcl opht drops 1 Levobunolol Hcl Levobunolol Hcl opht drops 1 QL Metipranolol Metipranolol opht drops 1 QL Timolol Maleate Timolol Maleate opht gel 1 QL Timolol Maleate Timolol Maleate opht drops 1 QL CARBONIC ANHYDRASE INHIBITORS (EENT) ANTIGLAUCOMA AGENTS Acetazolamide Acetazolamide tablet 1 AZOPT Brinzolamide opht susp 2 QL Methazolamide Methazolamide tablet 1 TRUSOPT Dorzolamide Hcl opht drops 2 QL MIOTICS HUMORSOL Demecarium Bromide opht drops 2 Isopto Carpine Pilocarpine Hcl opht drops 1 QL PHOSPHOLINE IODIDE Echothiophate Iodide opht drops 2 PILOPINE HS Pilocarpine Hcl opht gel 2 QL PROSTAGLANDIN ANALOGS TRAVATAN Travoprost (Benzalkonium) opht drops 2 QL TRAVATAN Z Travoprost opht drops 3 QL XALATAN Latanoprost opht drops 2 QL ANTIHEMORRHAGIC AGENTS HEMOSTATICS Aminocaproic Acid Aminocaproic Acid syrup 1 PA Aminocaproic Acid Aminocaproic Acid tablet 1 PA 48

51 Aminocaproic Acid Aminocaproic Acid intravenous (iv) 1 PA CYKLOKAPRON Tranexamic Acid intravenous (iv) 2 PA TRASYLOL Aprotinin intravenous (iv) 3 PA ANTIHYPOGLYCEMIC AGENTS GLYCOGENOLYTIC AGENTS GLUCAGEN Glucagon,Human Recombinant injection 2 QL GLUCAGON EMERGENCY KIT Glucagon,Human Recombinant injection 2 QL ANTI-INFECTIVES (EENT) ANTIBACTERIALS (EENT) Bacitracin Bacitracin opht oint. 1 QL Bacitracin/Polymyxin B Sulfate Bacitracin/Polymyxin B Sulfate opht oint. 1 QL ANTIHEMORRHAGIC AGENTS Ciprofloxacin Hcl Ciprofloxacin Hcl opht drops 1 Doxycycline Hyclate Doxycycline Hyclate tablet 1 Erythromycin Base Erythromycin Base opht oint. 1 QL FLOXIN Ofloxacin otic drops 2 QL Gentamicin Sulfate Gentamicin Sulfate opht oint. 1 QL Gentamicin Sulfate Gentamicin Sulfate opht drops 1 Neo/Polymyx B Sulf/Dexameth Neo/Polymyx B Sulf/Dexameth opht susp 1 QL Neo/Polymyx B Sulf/Dexameth Neo/Polymyx B Sulf/Dexameth opht oint. 1 QL Neomy Sulf/Bacitrac Zn/Poly/Hc Neomy Sulf/Bacitrac Zn/Poly/Hc opht oint. 1 QL Neomy Sulf/Polymyx B Sulf/Hc Neomy Sulf/Polymyx B Sulf/Hc opht susp 1 Neomy Sulf/Polymyx B Sulf/Hc Neomy Sulf/Polymyx B Sulf/Hc otic drops 1 Neomycin/Polymyxn B/Gramicidin Neomycin/Polymyxn B/Gramicidin opht drops 1 Ofloxacin Ofloxacin otic drops 1 49

52 Polymyxin B Sulfate/Tmp Polymyxin B Sulfate/Tmp opht drops 1 QL POLY-PRED Neomy Sulf/Polymyx B Sulf/Pred opht susp 2 Sulfacetamide Sodium Sulfacetamide Sodium opht drops 1 QL Sulfacetamide Sodium Sulfacetamide Sodium opht oint. 1 QL Sulfacetamide-Prednisolone Na Sulfacetm/Prednis Sp opht drops 1 QL Tobramycin Sulfate Tobramycin Sulfate opht drops 1 QL Triple Antibiotic Neomy Sulf/Bacitra/Polymyxin B opht oint. 1 QL ANTI-INFECTIVES (EENT) ANTIVIRALS (EENT) Trifluridine Trifluridine opht drops 1 QL EENT ANTI-INFECTIVES, MISCELLANEOUS Acetic Acid/Aluminum Acetate Acetic Acid/Aluminum Acetate otic drops 1 Acetic Acid/Hydrocortisone Acetic Acid/Hydrocortisone otic drops 1 Chlorhexidine Gluconate Chlorhexidine Gluconate mouthwash 1 ANTI-INFECTIVES (SKIN AND MUCOUS MEMBRANE) ANTIBACTERIALS (SKIN AND MUCOUS MEMBRANE) Clindamax Clindamycin Phosphate lotion 1 Clindamax Clindamycin Phosphate topical gel 1 Clindamycin Phosphate Clindamycin Phosphate vaginal cream 1 Clindamycin Phosphate Clindamycin Phosphate topical soln 1 Clindamycin Phosphate Clindamycin Phosphate swabs 1 Erythromycin Erythromycin Base/Ethanol topical gel 1 Erythromycin Erythromycin Base/Ethanol swabs 1 Erythromycin Erythromycin Base/Ethanol topical soln 1 Erythromycin Base Erythromycin Base topical soln 1 50

53 Erythromycin Base/Benz Per Erythromycin Base/Benz Per topical gel 1 Metronidazole Metronidazole vaginal gel 1 Mupirocin Mupirocin ointment 1 QL ANTIFUNGALS (SKIN AND MUCOUS MEMBRANE) Ciclopirox Ciclopirox topical gel 1 Ciclopirox Ciclopirox topical soln 1 PA Ciclopirox Olamine Ciclopirox Olamine cream 1 Clotrimazole Clotrimazole topical soln 1 Clotrimazole Clotrimazole troche 1 Clotrimazole Clotrimazole cream 1 Clotrimazole/Betamethasone Clotrimazole/Betamet Diprop cream 1 Clotrimazole/Betamethasone Clotrimazole/Betamet Diprop lotion 1 Econazole Nitrate Econazole Nitrate cream 1 Ketoconazole Ketoconazole cream 1 ANTI-INFECTIVES (SKIN AND MUCOUS MEMBRANE) Ketoconazole Ketoconazole shampoo 1 Miconazole 3 Miconazole Nitrate vaginal supp. 1 Nystatin Nystatin topical powder 1 Nystatin Nystatin ointment 1 Nystatin Nystatin cream 1 Nystatin/Triamcinolone Nystatin/Triamcin ointment 1 Nystatin/Triamcinolone Nystatin/Triamcin cream 1 Terconazole Terconazole vaginal cream 1 Terconazole Terconazole vaginal supp. 1 ANTIVIRALS (SKIN AND MUCOUS MEMBRANE) DENAVIR Penciclovir cream 2 PA 51

54 ZOVIRAX Acyclovir cream 2 QL ZOVIRAX Acyclovir ointment 2 QL LOCAL ANTI-INFECTIVES, MISCELLANEOUS AlcoholSwabs Alcohol Antiseptic Pads swabs 1 ANTI-INFECTIVES (SKIN AND MUCOUS MEMBRANE) Metronidazole Metronidazole cream 1 Metronidazole Metronidazole lotion 1 Selenium Sulfide Selenium Sulfide topical soln 1 Silver Sulfadiazine Silver Sulfadiazine cream 1 SCABICIDES AND PEDICULICIDES Lindane Lindane shampoo 1 Lindane Lindane lotion 1 Permethrin Permethrin cream 1 ANTI-INFLAMMATORY AGENTS (EENT) CORTICOSTEROIDS (EENT) DERMOTIC Fluocinolone Acetonide Oil otic drops 2 QL Dexamethasone Sod Phosphate Dexamethasone Sod Phosphate opht drops 1 Flunisolide Flunisolide nasal spray 1 QL Fluorometholone Fluorometholone opht susp 1 QL Fluticasone Propionate Fluticasone Propionate nasal spray 1 Hc/Pramoxine Hcl/Chloroxylenol Hc/Pramoxine Hcl/Chloroxylenol otic drops 1 LOTEMAX Loteprednol Etabonate opht susp 2 MAXIDEX Dexamethasone opht susp 2 QL Prednisolone Acetate Prednisolone Acetate opht susp 1 QL Prednisolone Sod Phosphate Prednisolone Sod Phosphate opht drops 1 QL 52

55 EENT ANTI-INFLAMMATORY AGENTS, MISC. RESTASIS Cyclosporine droperette 3 PA,QL EENT NONSTEROIDAL ANTI-INFLAM. AGENTS ACULAR Ketorolac Tromethamine opht drops 2 ACULAR LS Ketorolac Tromethamine opht drops 2 ACULAR PF Ketorolac Tromethamine droperette 2 Diclofenac Sodium Diclofenac Sodium opht drops 1 Flurbiprofen Sodium Flurbiprofen Sodium opht drops 1 QL ANTI-INFLAMMATORY AGENTS (GI DRUGS) ANTI-INFLAMMATORY AGENTS (GI DRUGS) ASACOL Mesalamine tablet dr 2 BALSALAZIDE DISODIUM Balsalazide Disodium capsule 3 QL ANTI-INFLAMMATORY AGENTS (EENT) CANASA Mesalamine rectal supp. 2 DIPENTUM Olsalazine Sodium capsule 2 QL Mesalamine Mesalamine enema 1 PENTASA Mesalamine capsule sa 3 PA,QL ANTI-INFLAMMATORY AGENTS (RESPIRATORY) LEUKOTRIENE MODIFIERS ACCOLATE Zafirlukast tablet 2 QL,ST SINGULAIR Montelukast Sodium tab chew 2 ST SINGULAIR Montelukast Sodium tablet 2 ST SINGULAIR Montelukast Sodium granules 2 ST ZYFLO Zileuton tablet 3 PA,QL 53

56 MAST-CELL STABLILIZERS Cromolyn Sodium Cromolyn Sodium opht drops 1 QL GASTROCROM Cromolyn Sodium oral soln 2 INTAL Cromolyn Sodium aerosol 2 TILADE Nedocromil Sodium aerosol 2 ANTI-INFLAMMATORY AGENTS (RESPIRATORY) ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS) ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS) Alclometasone Dipropionate Alclometasone Dipropionate ointment 1 Alclometasone Dipropionate Alclometasone Dipropionate cream 1 Amcinonide Amcinonide ointment 1 Amcinonide Amcinonide cream 1 Amcinonide Amcinonide lotion 1 Betamethasone Dipropionate Betamet Diprop/Prop Gly cream 1 Betamethasone Dipropionate Betamet Diprop/Prop Gly ointment 1 Betamethasone Dipropionate Betamethasone Dipropionate cream 1 Betamethasone Dipropionate Betamethasone Dipropionate topical gel 1 Betamethasone Dipropionate Betamethasone Dipropionate lotion 1 Betamethasone Dipropionate Betamethasone Dipropionate ointment 1 Betamethasone Valerate Betamethasone Valerate ointment 1 Betamethasone Valerate Betamethasone Valerate cream 1 Betamethasone Valerate Betamethasone Valerate lotion 1 Clobetasol Propionate Clobetasol Propionate topical soln 1 Clobetasol Propionate Clobetasol Propionate ointment 1 Clobetasol Propionate Clobetasol Propionate topical gel 1 Clobetasol Propionate Clobetasol Propionate cream 1 54

57 Clobetasol Propionate Clobetasol Propionate topical foam 1 Clobetasol Propionate/Emoll Clobetasol Propionate/Emoll cream 1 DESONATE Desonide topical gel 3 Desonide Desonide cream 1 Desonide Desonide lotion 1 Desonide Desonide ointment 1 Desoximetasone Desoximetasone cream 1 Desoximetasone Desoximetasone topical gel 1 Desoximetasone Desoximetasone ointment 1 Diflorasone Diacetate Diflorasone Diacetate cream 1 Diflorasone Diacetate Diflorasone Diacetate ointment 1 Diflorasone E Diflorasone Diacetate/Emoll cream 1 Fluocinolone Acetonide Fluocinolone Acetonide cream 1 Fluocinolone Acetonide Fluocinolone Acetonide ointment 1 ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS) Fluocinolone Acetonide Fluocinolone Acetonide topical soln 1 Fluocinonide Fluocinonide topical soln 1 Fluocinonide Fluocinonide cream 1 Fluocinonide Fluocinonide topical gel 1 Fluocinonide Fluocinonide ointment 1 Fluocinonide-E Fluocinonide/Emollient cream 1 Fluticasone Propionate Fluticasone Propionate ointment 1 Fluticasone Propionate Fluticasone Propionate cream 1 Halobetasol Propionate Halobetasol Propionate cream 1 Halobetasol Propionate Halobetasol Propionate ointment 1 Hydrocortisone Hc/Mineral Oil/Petrolat,Wht ointment 1 55

58 Hydrocortisone Hydrocortisone rectal cream 1 Hydrocortisone Hydrocortisone cream 1 Hydrocortisone Hydrocortisone enema 1 Hydrocortisone Hydrocortisone lotion 1 Hydrocortisone Hydrocortisone ointment 1 ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS) Hydrocortisone Acetate Hydrocortisone Acetate rectal supp. 1 Hydrocortisone Butyrate Hydrocortisone Butyrate topical soln 1 Hydrocortisone Butyrate Hydrocortisone Butyrate ointment 1 Hydrocortisone Butyrate Hydrocortisone Butyrate cream 1 Hydrocortisone Valerate Hydrocortisone Valerate cream 1 Hydrocortisone Valerate Hydrocortisone Valerate ointment 1 Keratol HC Hydrocortisone Acetate/Urea cream 1 Mometasone Furoate Mometasone Furoate cream 1 Mometasone Furoate Mometasone Furoate ointment 1 Mometasone Furoate Mometasone Furoate topical soln 1 Triamcinolone Acetonide Triamcinolone Acetonide dental paste 1 Triamcinolone Acetonide Triamcinolone Acetonide cream 1 Triamcinolone Acetonide Triamcinolone Acetonide lotion 1 Triamcinolone Acetonide Triamcinolone Acetonide ointment 1 VERDESO Desonide topical foam 3 ANTILIPEMIC AGENTS ANTILIPEMIC AGENTS, MISCELLANEOUS LOVAZA Omega-3 Acid Ethyl Esters capsule 3 NIASPAN Niacin tablet sa 3 PA 56

59 BILE ACID SEQUESTRANTS Cholestyramine Cholestyramine/Sucrose oral packet 1 Cholestyramine Cholestyramine/Sucrose oral powder 1 Cholestyramine Light Cholestyramine/Aspartame oral packet 1 Cholestyramine Light Cholestyramine/Aspartame oral powder 1 COLESTID Colestipol Hcl oral packet 2 Colestipol Hcl Colestipol Hcl granules 1 Colestipol Hcl Colestipol Hcl oral packet 1 Colestipol Hcl Colestipol Hcl tablet 1 CHOLESTEROL ABSORPTION INHIBITORS ZETIA Ezetimibe tablet 2 PA ANTILIPEMIC AGENTS FIBRIC ACID DERIVATIVES Fenofibrate,Micronized Fenofibrate,Micronized capsule 1 Fenofibrate,Micronized Fenofibrate,Micronized tablet 1 Gemfibrozil Gemfibrozil tablet 1 TRICOR Fenofibrate Nanocrystallized tablet 3 HMG-COA REDUCTASE INHIBITORS LIPITOR Atorvastatin Calcium tablet 2 Lovastatin Lovastatin tablet 1 Pravastatin Sodium Pravastatin Sodium tablet 1 Simvastatin Simvastatin tablet 1 ANTIMANIC AGENTS ANTIMANIC AGENTS Lithium Carbonate Lithium Carbonate tablet sa 1 57

60 Lithium Carbonate Lithium Carbonate capsule 1 Lithium Carbonate Lithium Carbonate tablet 1 Lithium Citrate Lithium Citrate oral soln 1 ANTIMIGRAINE AGENTS SELECTIVE SEROTONIN AGONISTS IMITREX Sumatriptan nasal spray 2 QL ANTIMANIC AGENTS IMITREX Sumatriptan Succinate injection 2 QL IMITREX Sumatriptan Succinate tablet 2 QL MAXALT Rizatriptan Benzoate tablet 2 QL MAXALT MLT Rizatriptan Benzoate tab rapdis 2 QL ANTIMYCOBACTERIALS ANTIMYCOBACTERIALS, MISCELLANEOUS DAPSONE Dapsone tablet 2 ANTITUBERCULOSIS AGENTS Ethambutol Hcl Ethambutol Hcl tablet 1 Isoniazid Isoniazid tablet 1 ISONIAZID Isoniazid syrup 2 MYCOBUTIN Rifabutin capsule 2 PRIFTIN Rifapentine tablet 2 Pyrazinamide Pyrazinamide tablet 1 Rifampin Rifampin capsule 1 Rifampin/Isoniazid Rifampin/Isoniazid capsule 1 RIFATER Rifampin/Inh/Pyrazinamide tablet 2 58

61 SEROMYCIN Cycloserine capsule 2 PA TRECATOR Ethionamide tablet 2 ANTINEOPLASTIC AGENTS ANTINEOPLASTIC AGENTS ARIMIDEX Anastrozole tablet 2 PA AROMASIN Exemestane tablet 2 PA Bleomycin Sulfate Bleomycin Sulfate injection 1 PA CAMPATH Alemtuzumab intravenous (iv) 2 PA CASODEX Bicalutamide tablet 2 PA CEENU Lomustine capsule 2 PA Cyclophosphamide Cyclophosphamide tablet 1 ANTIMYCOBACTERIALS DROXIA Hydroxyurea capsule 2 ELIGARD Leuprolide Acetate injection 2 PA EMCYT Estramustine Phosphate Sodium capsule 2 PA FARESTON Toremifene Citrate tablet 2 PA FEMARA Letrozole tablet 2 PA Flutamide Flutamide capsule 1 GLEEVEC Imatinib Mesylate tablet 4 PA HEXALEN Altretamine capsule 3 PA Hydroxyurea Hydroxyurea capsule 1 IRESSA Gefitinib tablet 4 PA,QL LEUKERAN Chlorambucil tablet 2 PA LEUPROLIDE ACETATE Leuprolide Acetate injection 2 PA LUPRON DEPOT Leuprolide Acetate 22.5mg injection 4 PA LUPRON DEPOT Leuprolide Acetate injection 2 PA 59

62 LUPRON DEPOT-PED Leuprolide Acetate injection 2 PA LYSODREN Mitotane tablet 2 PA MATULANE Procarbazine Hcl capsule 4 PA Megestrol Acetate Megestrol Acetate tablet 1 Megestrol Acetate Megestrol Acetate oral susp 1 Mercaptopurine Mercaptopurine tablet 1 Methotrexate Sodium Methotrexate Sodium tablet 1 ANTINEOPLASTIC AGENTS Methotrexate Sodium Methotrexate Sodium tab ds pk 1 Mitoxantrone Hcl Mitoxantrone Hcl intravenous (iv) 1 PA MYLOCEL Hydroxyurea tablet 2 NEXAVAR Sorafenib Tosylate tablet 4 PA NILANDRON Nilutamide tablet 2 PA ONTAK Denileukin Diftitox intravenous (iv) 2 PA PROLEUKIN Aldesleukin intravenous (iv) 2 PA RITUXAN Rituximab intravenous (iv) 2 PA SOLTAMOX Tamoxifen Citrate oral soln 3 SPRYCEL Dasatinib tablet 4 PA SUTENT Sunitinib Malate capsule 4 PA Tamoxifen Citrate Tamoxifen Citrate tablet 1 TARCEVA Erlotinib Hcl tablet 4 PA TARGRETIN Bexarotene capsule 2 TASIGNA Nilotinib Hydrochloride capsule 4 PA TESLAC Testolactone tablet 2 PA THIOGUANINE Thioguanine tablet 2 PA TRELSTAR DEPOT Triptorelin Pamoate injection 2 PA 60

63 TRELSTAR LA Triptorelin Pamoate injection 2 PA Tretinoin Tretinoin capsule 1 PA TREXALL Methotrexate Sodium tablet 2 TRISENOX Arsenic Trioxide intravenous (iv) 2 PA TYKERB Lapatinib Ditosylate tablet 4 PA VELCADE Bortezomib intravenous (iv) 2 PA VIDAZA Azacitidine injection 2 PA ZOLADEX Goserelin Acetate implant 4 PA ZOLINZA Vorinostat capsule 4 PA ANTIPARKINSONIAN AGENTS ADAMANTANES (CNS) ANTINEOPLASTIC AGENTS Amantadine Hcl Amantadine Hcl syrup 1 Amantadine Hcl Amantadine Hcl tablet 1 Amantadine Hcl Amantadine Hcl capsule 1 ANTICHOLINERGIC AGENTS (CNS) Benztropine Mesylate Benztropine Mesylate tablet 1 Trihexyphenidyl Hcl Trihexyphenidyl Hcl oral liq. 1 Trihexyphenidyl Hcl Trihexyphenidyl Hcl tablet 1 CATECHOL-O-METHYLTRANSFERASE(COMT)INHIB. COMTAN Entacapone tablet 2 ST TASMAR Tolcapone tablet 2 ST DOPAMINE PRECURSORS Carbidopa/Levodopa Carbidopa/Levodopa tablet 1 61

64 Carbidopa/Levodopa Carbidopa/Levodopa tablet sa 1 STALEVO 200 Carbidopa/Levodopa/Entacapone tablet 2 DOPAMINE RECEPTOR AGONISTS Bromocriptine Mesylate Bromocriptine Mesylate capsule 1 Bromocriptine Mesylate Bromocriptine Mesylate tablet 1 Cabergoline Cabergoline tablet 1 ANTIPARKINSONIAN AGENTS MIRAPEX Pramipexole Di-Hcl tablet 2 ST Pergolide Mesylate Pergolide Mesylate tablet 1 REQUIP Ropinirole Hcl tab ds pk 2 Ropinirole Hcl Ropinirole Hcl tablet 1 MONOAMINE OXIDASE B INHIBITORS EMSAM Selegiline patch 3 PA Selegiline Hcl Selegiline Hcl capsule 1 Selegiline Hcl Selegiline Hcl tablet 1 ANTIPROTOZOALS AMEBICIDES Iodoquinol Iodoquinol tablet 1 Paromomycin Sulfate Paromomycin Sulfate capsule 1 ANTIMALARIALS Chloroquine Phosphate Chloroquine Phosphate tablet 1 DARAPRIM Pyrimethamine tablet 2 FANSIDAR Pyrimethamine/Sulfadoxine tablet 2 Hydroxychloroquine Sulfate Hydroxychloroquine Sulfate tablet 1 62

65 MALARONE Atovaquone/Proguanil Hcl tablet 2 Mefloquine Hcl Mefloquine Hcl tablet 1 PRIMAQUINE Primaquine Phosphate tablet 2 ANTIPROTOZOALS, MISCELLANEOUS Metronidazole Metronidazole capsule 1 Metronidazole Metronidazole tablet 1 Metronidazole/Sodium Chloride Metronidazole/Sodium Chloride intravenous (iv) 1 PA NEUTREXIN Trimetrexate Glucuronate intravenous (iv) 2 PA ANTIPRURITICS AND LOCAL ANESTHETICS ANTIPRURITICS AND LOCAL ANESTHETICS ANTIPROTOZOALS Americaine Benzocaine topical aerosol 1 Anacaine Benzocaine ointment 1 Lidocaine Hcl Lidocaine Hcl lotion 1 Lidocaine Hcl Lidocaine Hcl cream 1 Lidocaine/Prilocaine Lidocaine/Prilocaine cream 1 PA,QL LIDODERM Lidocaine patch 3 PA Phenazopyridine Hcl Phenazopyridine Hcl tablet 1 PROCTOFOAM Pramoxine Hcl topical foam 3 Xylocaine Lidocaine Hcl ointment 1 ZONALON Doxepin Hcl cream 2 ANTITHROMBOTIC AGENTS ANTICOAGULANTS ARIXTRA Fondaparinux Sodium injection 2 PA 63

66 COUMADIN Warfarin Sodium tablet 2 FRAGMIN Dalteparin Sodium,Porcine injection 3 PA Heparin Sodium,Porcine Heparin Sodium,Porcine injection 1 PA Heparin Sodium,Porcine/Ns/Pf Heparin Sodium,Porcine/Ns/Pf intravenous (iv) 1 PA Jantoven Warfarin Sodium tablet 1 LOVENOX Enoxaparin Sodium injection 2 PA Warfarin Sodium Warfarin Sodium tablet 1 ANTITHROMBOTIC AGENTS PLATELET-AGGREGATION INHIBITORS Cilostazol Cilostazol tablet 1 Clopidogrel Bisulfate Clopidogrel Bisulfate tablet 1 PLAVIX Clopidogrel Bisulfate tablet 2 PA Ticlopidine Hcl Ticlopidine Hcl tablet 1 ANTIULCER AGENTS AND ACID SUPPRESSANTS HISTAMINE H2-ANTAGONISTS Cimetidine Cimetidine tablet 1 Cimetidine Hcl Cimetidine Hcl injection 1 PA Cimetidine Hcl Cimetidine Hcl oral liq. 1 Famotidine Famotidine intravenous (iv) 1 PA Famotidine Famotidine tablet 1 Nizatidine Nizatidine capsule 1 Ranitidine Hcl Ranitidine Hcl capsule 1 Ranitidine Hcl Ranitidine Hcl syrup 1 Ranitidine Hcl Ranitidine Hcl tablet 1 Ranitidine Hcl Ranitidine Hcl injection 1 PA 64

67 PROSTAGLANDINS Misoprostol Misoprostol tablet 1 PROTECTANTS Sucralfate Sucralfate tablet 1 Sucralfate Sucralfate oral susp 1 PROTON-PUMP INHIBITORS Omeprazole Omeprazole capsule dr 1 QL Pantoprazole Sodium Pantoprazole Sodium tablet dr 1 ST PREVACID Lansoprazole capsule dr 2 ST PREVACID Lansoprazole oral susp 2 ST PREVACID Lansoprazole tab rap dr 2 ST PROTONIX IV Pantoprazole Sodium intravenous (iv) 2 PA ANTIVIRALS (SYSTEMIC) ANTIULCER AGENTS AND ACID SUPPRESSANTS ADAMANTANES Rimantadine Hcl Rimantadine Hcl tablet 1 ANTIRETROVIRALS AGENERASE Amprenavir/Vitamin E/Prop Gly oral soln 2 AGENERASE Amprenavir/Vitamin E capsule 2 APTIVUS Tipranavir capsule 2 ATRIPLA Efavirenz/Emtricitab/Tenofovir tablet 4 COMBIVIR Lamivudine/Zidovudine tablet 2 CRIXIVAN Indinavir Sulfate capsule 2 Didanosine Didanosine capsule dr 1 EMTRIVA Emtricitabine oral soln 2 65

68 EMTRIVA Emtricitabine capsule 2 EPIVIR Lamivudine tablet 2 EPIVIR HBV Lamivudine tablet 2 PA EPZICOM Abacavir Sulfate/Lamivudine tablet 4 FUZEON Enfuvirtide injection 4 HIVID Zalcitabine tablet 2 INTELENCE Etravirine tablet 4 ANTIVIRALS (SYSTEMIC) INVIRASE Saquinavir Mesylate tablet 4 INVIRASE Saquinavir Mesylate capsule 4 ISENTRESS Raltegravir Potassium tablet 4 KALETRA Lopinavir/Ritonavir capsule 4 KALETRA Lopinavir/Ritonavir tablet 4 KALETRA Lopinavir/Ritonavir oral soln 4 LEXIVA Fosamprenavir Calcium oral susp 2 LEXIVA Fosamprenavir Calcium tablet 2 NORVIR Ritonavir oral soln 2 NORVIR Ritonavir capsule 2 PREZISTA Darunavir Ethanolate tablet 2 RESCRIPTOR Delavirdine Mesylate tab disper 2 RESCRIPTOR Delavirdine Mesylate tablet 2 RETROVIR Zidovudine intravenous (iv) 2 REYATAZ Atazanavir Sulfate capsule 4 SELZENTRY Maraviroc tablet 4 SUSTIVA Efavirenz capsule 2 SUSTIVA Efavirenz tablet 2 66

69 TRIZIVIR Abacavir/Lamivudine/Zidovudine tablet 4 TRUVADA Emtricitabine/Tenofovir tablet 4 VIDEX Didanosine/Calcium Carb/Mag tab chew 2 VIDEX Didanosine oral soln 2 VIDEX EC Didanosine capsule dr 2 VIRACEPT Nelfinavir Mesylate oral powder 4 VIRACEPT Nelfinavir Mesylate tablet 4 VIRAMUNE Nevirapine oral susp 2 VIRAMUNE Nevirapine tablet 2 VIREAD Tenofovir Disoproxil Fumarate tablet 2 ZERIT Stavudine oral soln 2 ZERIT Stavudine capsule 2 ANTIVIRALS (SYSTEMIC) ZIAGEN Abacavir Sulfate tablet 2 ZIAGEN Abacavir Sulfate oral soln 2 Zidovudine Zidovudine syrup 1 Zidovudine Zidovudine tablet 1 Zidovudine Zidovudine capsule 1 INTERFERONS INFERGEN Interferon Alfacon-1 injection 4 PA INTRON A Interferon Alfa-2B,Recomb. injection 4 PA PEGASYS Peginterferon Alfa-2A injection 4 PA PEGINTRON Peginterferon Alfa-2B injection 4 PA PEGINTRON REDIPEN Peginterferon Alfa-2B injection 4 PA ROFERON-A Interferon Alfa-2A,Recomb. injection 4 PA 67

70 NEURAMINIDASE INHIBITORS RELENZA Zanamivir inhalation disk 3 PA TAMIFLU Oseltamivir Phosphate oral susp 3 PA TAMIFLU Oseltamivir Phosphate capsule 3 PA NUCLEOSIDES AND NUCLEOTIDES Acyclovir Acyclovir capsule 1 Acyclovir Acyclovir oral susp 1 ANTIVIRALS (SYSTEMIC) Acyclovir Acyclovir tablet 1 Acyclovir Sodium Acyclovir Sodium intravenous (iv) 1 PA BARACLUDE Entecavir oral soln 3 PA BARACLUDE Entecavir tablet 3 PA Ganciclovir Ganciclovir capsule 1 HEPSERA Adefovir Dipivoxil tablet 4 PA Ribavirin Ribavirin capsule 1 PA Ribavirin Ribavirin tablet 1 PA TYZEKA Telbivudine tablet 3 PA VALCYTE Valganciclovir Hydrochloride tablet 2 PA VALTREX Valacyclovir Hcl tablet 2 PA ANXIOLYTICS, SEDATIVES AND HYPNOTICS ANXIOLYTICS, SEDATIVES AND HYPNOTICS,MISC. Buspirone Hcl Buspirone Hcl tablet 1 Chloral Hydrate Chloral Hydrate capsule 1 Chloral Hydrate Chloral Hydrate syrup 1 Hydroxyzine Hcl Hydroxyzine Hcl syrup 1 68

71 Hydroxyzine Hcl Hydroxyzine Hcl tablet 1 Hydroxyzine Pamoate Hydroxyzine Pamoate capsule 1 Meprobamate Meprobamate tablet 1 Zaleplon Zaleplon capsule 1 PA Zolpidem Tartrate Zolpidem Tartrate tablet 1 QL AUTONOMIC DRUGS, MISCELLANEOUS AUTONOMIC DRUGS, MISCELLANEOUS NICOTROL Nicotine inhalation 3 PA NICOTROL NS Nicotine nasal spray 3 PA BETA-ADRENERGIC BLOCKING AGENTS BETA-ADRENERGIC BLOCKING AGENTS Acebutolol Hcl Acebutolol Hcl capsule 1 ANXIOLYTICS, SEDATIVES AND HYPNOTICS Atenolol Atenolol tablet 1 Atenolol/Chlorthalidone Atenolol/Chlorthalidone tablet 1 Betaxolol Hcl Betaxolol Hcl tablet 1 Bisoprol/Hydrochlorothiazide Bisoprol/Hydrochlorothiazide tablet 1 Bisoprolol Fumarate Bisoprolol Fumarate tablet 1 BREVIBLOC Esmolol Hcl intravenous (iv) 2 PA Carvedilol Carvedilol tablet 1 ESMOLOL HCL Esmolol Hcl intravenous (iv) 2 PA ESMOLOL HCL/SOD CL Esmolol Hcl/Sod Cl intravenous (iv) 2 PA Labetalol Hcl Labetalol Hcl tablet 1 Metoprol/Hydrochlorothiazide Metoprol/Hydrochlorothiazide tablet 1 Metoprolol Succinate Metoprolol Succinate tab.sr 24h 1 QL 69

72 Metoprolol Tartrate Metoprolol Tartrate tablet 1 Nadolol Nadolol tablet 1 Pindolol Pindolol tablet 1 Propranolol Hcl Propranolol Hcl tablet 1 Propranolol Hcl Propranolol Hcl cap.sa 24h 1 Propranolol/Hydrochlorothiazid Propranolol/Hydrochlorothiazid tablet 1 BETA-ADRENERGIC BLOCKING AGENTS Sotalol Hcl Sotalol Hcl tablet 1 Timolol Maleate Timolol Maleate tablet 1 CALCIUM-CHANNEL BLOCKING AGENTS CALCIUM-CHANNEL BLOCKING AGENTS, MISC. CARDIZEM CD Diltiazem Hcl 360mg cap.sr 24h 2 Diltiazem ER Diltiazem Hcl cap.sr 24h 1 Diltiazem ER Diltiazem Hcl capsule sa 1 Diltiazem Hcl Diltiazem Hcl tablet 1 Verapamil Hcl Verapamil Hcl cap.24h pel 1 Verapamil Hcl Verapamil Hcl tablet 1 Verapamil Hcl Verapamil Hcl tablet sa 1 DIHYDROPYRIDINES Amlodipine Besylate Amlodipine Besylate tablet 1 Amlodipine Besylate/Benazepril Amlodipine Besylate/Benazepril capsule 1 QL Felodipine ER Felodipine tab.sr 24h 1 Isradipine Isradipine capsule 1 Nicardipine Hcl Nicardipine Hcl capsule 1 Nifedipine Nifedipine capsule 1 70

73 Nifedipine CC Nifedipine tablet sa 1 Nifedipine ER Nifedipine tab osm 24 1 CALORIC AGENTS CALORIC AGENTS Amino Acids 8% Amino Acids 8% intravenous (iv) 1 PA AMINOSYN-PF Parent. Amino Acid 7 % #1(Ped) intravenous (iv) 2 PA AMINOSYN-PF Amino Acids 7% intravenous (iv) 2 PA Dextrose 10%-0.25Normal Saline Dextrose 10%-0.25Normal Saline intravenous (iv) 1 PA Dextrose 10%-Normal Saline Dextrose 10%-Normal Saline intravenous (iv) 1 PA Dextrose 10%-Water Dextrose 10%-Water intravenous (iv) 1 PA FREAMINE HBC Amino Acids 6.9% intravenous (iv) 2 PA FRUCTOSE Fructose 10% intravenous (iv) 2 PA CALCIUM-CHANNEL BLOCKING AGENTS IntralipidFat Emulsions Fat Emulsions intravenous (iv) 1 PA NEPHRAMINE Amino Acids 5.4% intravenous (iv) 2 PA RENAMIN Parenter. Amino Acid 6.5% No.1 intravenous (iv) 2 PA Travasol Amino Acids 10% intravenous (iv) 1 PA Travasol Parenter. Amino Acid 8.5% No.4 intravenous (iv) 1 PA CARDIAC DRUGS ANTIARRHYTHMIC AGENTS Amiodarone Hcl Amiodarone Hcl tablet 1 Disopyramide Phosphate Disopyramide Phosphate capsule sa 1 Disopyramide Phosphate Disopyramide Phosphate capsule 1 Flecainide Acetate Flecainide Acetate tablet 1 Lidocaine Hcl/D5W/Pf Lidocaine Hcl/D5W/Pf intravenous (iv) 1 71

74 Lidocaine Hcl/Pf Lidocaine Hcl/Pf intravenous (iv) 1 Mexiletine Hcl Mexiletine Hcl capsule 1 Procainamide Hcl Procainamide Hcl capsule 1 Procainamide Hcl Procainamide Hcl tablet sa 1 PROCANBID Procainamide Hcl tab.sr 12h 2 PRONESTYL Procainamide Hcl capsule 2 PRONESTYL Procainamide Hcl tablet 2 CARDIAC DRUGS Propafenone Hcl Propafenone Hcl tablet 1 Quinidine Sulfate Quinidine Sulfate tablet 1 Quinidine Sulfate Quinidine Sulfate tablet sa 1 TIKOSYN Dofetilide capsule 3 PA CARDIAC DRUGS, MISCELLANEOUS RANEXA Ranolazine tab.sr 12h 2 PA CARDIOTONIC AGENTS Digitek Digoxin tablet 1 Digoxin Digoxin injection 1 PA DIGOXIN Digoxin oral soln 2 INAMRINONE Inamrinone Lactate intravenous (iv) 2 PA LANOXICAPS Digoxin capsule 2 LANOXIN PEDIATRIC Digoxin injection 2 PA Milrinone Lactate Milrinone Lactate intravenous (iv) 1 PA CATHARTICS AND LAXATIVES CATHARTICS AND LAXATIVES Peg 3350/Na Sulf,Bicarb,Cl/Kcl Peg 3350/Na Sulf,Bicarb,Cl/Kcl oral soln 1 QL 72

75 Polyethylene Glycol 3350 Polyethylene Glycol 3350 oral powder 1 QL Trilyte With Flavor Packets Sod Chloride/Nahco3/Kcl/Peg'S oral soln 1 CELL STIMULANTS AND PROLIFERANTS CELL STIMULANTS AND PROLIFERANTS KEPIVANCE Palifermin intravenous (iv) 4 PA Tretinoin Tretinoin cream 1 PA Tretinoin Tretinoin topical gel 1 PA CENTRAL NERVOUS SYSTEM AGENTS, MISC. CENTRAL NERVOUS SYSTEM AGENTS, MISC. CAMPRAL Acamprosate Calcium tablet dr 3 NAMENDA Memantine Hcl oral soln 2 CATHARTICS AND LAXATIVES NAMENDA Memantine Hcl tab ds pk 2 NAMENDA Memantine Hcl tablet 2 RILUTEK Riluzole tablet 2 PA XYREM Sodium Oxybate oral soln 3 PA CHOLELITHOLYTIC AGENTS CHOLELITHOLYTIC AGENTS Ursodiol Ursodiol capsule 1 PA CONTRACEPTIVES CONTRACEPTIVES Apri Desogestrel-Ethinyl Estradiol tablet 1 Aviane Levonorgestrel-Eth Estra tablet 1 This prescription may be available only at certain pharmacies. For more information consult your Provider Directory or call Member Services at , from 8:00 a.m. to 8:00 p.m., seven days a week. TTY/TDD users should call

76 Brevicon Norethindrone-Ethinyl Estrad tablet 1 Cesia Desogestrel-Ethinyl Estradiol tablet 1 Jolessa Levonorgestrel-Eth Estra tab ds pk 1 Jolivette Norethindrone tablet 1 Junel Norethindrone A-E Estradiol tablet 1 Junel Fe Noreth A-Et Estra/Fe Fumarate tablet 1 Kariva Desog-Et Estra/Ethin Estra tablet 1 CONTRACEPTIVES Leena Norethindrone-Ethinyl Estrad tablet 1 Lessina Levonorgestrel-Eth Estra tablet 1 Levlen 28 Levonorgestrel-Eth Estra tablet 1 Levora-28 Levonorgestrel-Eth Estra tablet 1 Low-Ogestrel Norgestrel-Ethinyl Estradiol tablet 1 Microgestin Norethindrone A-E Estradiol tablet 1 Microgestin Fe Noreth A-Et Estra/Fe Fumarate tablet 1 Mononessa Norgestimate-Ethinyl Estradiol tablet 1 Necon Norethindrone-Ethinyl Estrad tablet 1 Necon Norethindrone-Mestranol tablet 1 Nortrel Norethindrone-Ethinyl Estrad tablet 1 Ogestrel Norgestrel-Ethinyl Estradiol tablet 1 PLAN B Levonorgestrel tablet 2 Tri-Legest Fe Noreth A-Et Estra/Fe Fumarate tablet 1 Tri-Levlen 28 Levonorgestrel-Eth Estra tablet 1 Trinessa Norgestimate-Ethinyl Estradiol tablet 1 Trivora-28 Levonorgestrel-Eth Estra tablet 1 Velivet Desogestrel-Ethinyl Estradiol tablet 1 74

77 Zovia 1-35E Ethynodiol D-Ethinyl Estradiol tablet 1 Zovia 1-50E Ethynodiol D-Ethinyl Estradiol tablet 1 DEPIGMENTING AND PIGMENTING AGENTS PIGMENTING AGENTS 8-MOP Methoxsalen capsule 2 PA OXSORALEN Methoxsalen lotion 2 PA OXSORALEN-ULTRA Methoxsalen, Rapid capsule 2 PA DEVICES DEVICES Insulin Needles Needles, Insulin Disposable syringes 1 CONTRACEPTIVES Insulin Needles Syring W-Ndl,Disp,Insul,0.3Ml syringes 1 DIGESTANTS DIGESTANTS CREON 10 Amylase/Lipase/Protease capsule dr 2 CREON 20 Amylase/Lipase/Protease capsule dr 2 CREON 5 Amylase/Lipase/Protease capsule dr 2 Dygase Amylase/Lipase/Protease capsule 1 Enzycap Amylase/Lipase/Protease capsule 1 ENZYMAX Pancreatin tablet 2 Gastrinex Cell/Amy/Lip/Prote/P-Tlox/Hyos capsule 1 KU-ZYME HP Amylase/Lipase/Protease capsule 2 Lipram-PN20 Amylase/Lipase/Protease capsule dr 1 PANCREASE MT 4 Amylase/Lipase/Protease capsule dr 2 75

78 PANCRECARB MS-16 Amylase/Lipase/Protease capsule dr 3 PANCRECARB MS-4 Amylase/Lipase/Protease capsule dr 3 PANCRECARB MS-8 Amylase/Lipase/Protease capsule dr 3 Pancrelipase Amylase/Lipase/Protease capsule dr 1 Pancrelipase EC Amylase/Lipase/Protease capsule dr 1 Pancrelipase MT-16 Amylase/Lipase/Protease capsule dr 1 Pangestyme UL 18 Amylase/Lipase/Protease capsule dr 1 Pangestyme UL 20 Amylase/Lipase/Protease capsule dr 1 DIGESTANTS DIURETICS LOOP DIURETICS Bumetanide Bumetanide tablet 1 Furosemide Furosemide injection 1 PA Furosemide Furosemide oral soln 1 Furosemide Furosemide tablet 1 Torsemide Torsemide tablet 1 POTASSIUM-SPARING DIURETICS Amiloride Hcl Amiloride Hcl tablet 1 Amiloride/Hydrochlorothiazide Amiloride/Hydrochlorothiazide tablet 1 Triamterene/Hydrochlorothiazid Triamterene/Hydrochlorothiazid capsule 1 Triamterene/Hydrochlorothiazid Triamterene/Hydrochlorothiazid tablet 1 THIAZIDE DIURETICS Chlorothiazide Chlorothiazide tablet 1 Hydrochlorothiazide Hydrochlorothiazide capsule 1 Hydrochlorothiazide Hydrochlorothiazide tablet 1 76

79 Methyclothiazide Methyclothiazide tablet 1 THIAZIDE-LIKE DIURETICS Chlorthalidone Chlorthalidone tablet 1 Indapamide Indapamide tablet 1 Metolazone Metolazone tablet 1 EENT DRUGS, MISCELLANEOUS EENT DRUGS, MISCELLANEOUS Carteolol Hcl Carteolol Hcl opht drops 1 QL LACRISERT Hydroxypropyl Cellulose insert 2 QL DIURETICS EMOLLIENTS, DEMULCENTS, AND PROTECTANTS BASIC LOTIONS AND LINIMENTS Ammonium Lactate Ammonium Lactate lotion 1 Lactic Acid Lactic Acid lotion 1 BASIC OINTMENTS AND PROTECTANTS Ammonium Lactate Ammonium Lactate cream 1 ENZYMES ENZYMES ADAGEN Pegademase Bovine injection 4 PA ALDURAZYME Laronidase intravenous (iv) 4 PA CEREDASE Alglucerase intravenous (iv) 4 PA CEREZYME Imiglucerase intravenous (iv) 4 PA ELAPRASE Idursulfase intravenous (iv) 4 PA 77

80 ELITEK Rasburicase intravenous (iv) 2 PA FABRAZYME Agalsidase Beta intravenous (iv) 4 PA NAGLAZYME Galsulfase intravenous (iv) 2 PA PROLASTIN Alpha-1-Proteinase Inhibitor intravenous (iv) 4 PA SUCRAID Sacrosidase oral soln 2 PA ESTROGENS AND ANTIESTROGENS ESTROGEN AGONIST-ANTAGONISTS ENZYMES EVISTA Raloxifene Hcl tablet 2 PA,QL ESTROGENS ALORA Estradiol patch 2 CENESTIN Estrogens,Conj.,Synthetic A tablet 2 COMBIPATCH Estradiol/Noreth Ac patch 2 Estradiol Estradiol patch 1 Estradiol Estradiol tablet 1 Estropipate Estropipate tablet 1 MENEST Estrogens,Esterified tablet 2 PREMARIN Estrogens,Conjugated tablet 2 PREMARIN Estrogens,Conjugated vaginal cream 2 PREMPHASE Estrogen,Con/M-Progest Acet tablet 2 PREMPRO Estrogen,Con/M-Progest Acet tablet 2 Vivelle Estradiol patch 1 78

81 FIRST GENERATION ANTIHISTAMINES ETHANOLAMINE DERIVATIVES Clemastine Fumarate Clemastine Fumarate syrup 1 Clemastine Fumarate Clemastine Fumarate tablet 1 Diphenhydramine Hcl Diphenhydramine Hcl injection 1 PA Diphenhydramine Hcl Diphenhydramine Hcl capsule 1 Diphenhydramine Tannate Diphenhydramine Tannate oral susp 1 Diphenhydramine Tannate Diphenhydramine Tannate tab chew 1 FIRST GEN. ANTIHIST. DERIVATIVES, MISC. Cyproheptadine Hcl Cyproheptadine Hcl syrup 1 Cyproheptadine Hcl Cyproheptadine Hcl tablet 1 PHENOTHIAZINE DERIVATIVES FIRST GENERATION ANTIHISTAMINES Promethazine Hcl Promethazine Hcl rectal supp. 1 Promethazine Hcl Promethazine Hcl syrup 1 Promethazine Hcl Promethazine Hcl tablet 1 Promethazine Hcl Promethazine Hcl injection 1 PA PROPYLAMINE DERIVATIVES Brompheniramine Maleate Brompheniramine Maleate tab.sr 12h 1 Chlorpheniramine Maleate Chlorpheniramine Maleate capsule 1 Chlorpheniramine Maleate Chlorpheniramine Maleate capsule sa 1 Chlorpheniramine Tannate Chlorpheniramine Tannate oral drops 1 Chlorpheniramine Tannate Chlorpheniramine Tannate tablet 1 Dexchlorpheniramine Maleate Dexchlorpheniramine Maleate syrup 1 Dexchlorpheniramine Maleate Dexchlorpheniramine Maleate tablet sa 1 79

82 GENITOURINARY SMOOTH MUSCLE RELAXANTS GENITOURINARY SMOOTH MUSCLE RELAXANTS DETROL Tolterodine Tartrate tablet 2 QL,ST DETROL LA Tolterodine Tartrate cap.sr 24h 2 QL,ST Oxybutynin Chloride Oxybutynin Chloride tablet 1 GENITOURINARY SMOOTH MUSCLE RELAXANTS Oxybutynin Chloride Oxybutynin Chloride syrup 1 GI DRUGS, MISCELLANEOUS GI DRUGS, MISCELLANEOUS LOTRONEX Alosetron Hcl tablet 2 PA GOLD COMPOUNDS GOLD COMPOUNDS GOLD SODIUM THIOMALATE Gold Sodium Thiomalate injection 3 PA RIDAURA Auranofin capsule 2 PA GONADOTROPINS GONADOTROPINS Gonadotropin,Chorionic,Human Gonadotropin,Chorionic,Human injection 1 PA PROFASI Gonadotropin,Chorionic,Human injection 2 PA SYNAREL Nafarelin Acetate nasal spray 4 PA HEAVY METAL ANTAGONISTS HEAVY METAL ANTAGONISTS CUPRIMINE Penicillamine capsule 2 PA Deferoxamine Mesylate Deferoxamine Mesylate injection 1 PA 80

83 DEPEN Penicillamine tablet 2 PA EXJADE Deferasirox tab disper 4 PA HEMATOPOIETIC AGENTS HEMATOPOIETIC AGENTS ARANESP Darbepoetin Alfa In Albumn Sol 25mcg injection 2 PA ARANESP Darbepoetin Alfa In Albumn Sol all other strengths 4 PA EPOGEN Epoetin Alfa 2000u/ml injection 2 PA EPOGEN Epoetin Alfa 3000u/ml injection 2 PA EPOGEN Epoetin Alfa all other strengths 4 PA LEUKINE Sargramostim injection 4 PA NEULASTA Pegfilgrastim injection 4 PA HEAVY METAL ANTAGONISTS NEUPOGEN Filgrastim injection 4 PA PROCRIT Epoetin Alfa 3000u/ml injection 2 PA PROCRIT Epoetin Alfa 2000u/ml injection 2 PA PROCRIT Epoetin Alfa all other strengths 4 PA HEMORRHEOLOGIC AGENTS HEMORRHEOLOGIC AGENTS Pentoxifylline Pentoxifylline tablet sa 1 HYPOTENSIVE AGENTS CENTRAL ALPHA-AGONISTS Clonidine Hcl Clonidine Hcl tablet 1 Guanabenz Acetate Guanabenz Acetate tablet 1 Guanfacine Hcl Guanfacine Hcl tablet 1 81

84 Methyldopa Methyldopa tablet 1 DIRECT VASODILATORS Hydralazine Hcl Hydralazine Hcl tablet 1 Hydralazine/Hydrochlorothiazid Hydralazine/Hydrochlorothiazid capsule 1 Minoxidil Minoxidil tablet 1 PROGLYCEM Diazoxide oral susp 2 PA HYPOTENSIVE AGENTS HYPOTENSIVE AGENTS Hydralazine/Reserpin/Hctz Hydralazine/Reserpin/Hctz tablet 1 Methyldopa/Hydrochlorothiazide Methyldopa/Hydrochlorothiazide tablet 1 Reserpine/Hydrochlorothiazide Reserpine/Hydrochlorothiazide tablet 1 HYPOTENSIVE AGENTS, MISCELLANEOUS Fenoldopam Mesylate Fenoldopam Mesylate intravenous (iv) 1 PA ION-REMOVING AGENTS PHOSPHATE-REMOVING AGENTS PHOSLO Calcium Acetate capsule 2 PHOSLO Calcium Acetate tablet 2 RENAGEL Sevelamer Hcl tablet 3 PA POTASSIUM-REMOVING AGENTS Kionex Sodium Polystyrene Sulfonate oral powder 1 Sodium Polystyrene Sulfonate Sodium Polystyrene Sulfonate enema 1 Sodium Polystyrene Sulfonate Sodium Polystyrene Sulfonate oral susp 1 82

85 IRRIGATING SOLUTIONS IRRIGATING SOLUTIONS Aminoacetic Acid Glycine irrigation 1 PA Sodium Chloride Sodium Chloride Irrig Solution irrigation 1 PA KERATOLYTIC AGENTS KERATOLYTIC AGENTS Urea Urea ointment 1 Urea Urea topical gel 1 Urea Urea lotion 1 Urea-C40 Urea cream 1 Urealac Urea ointment 1 IRRIGATING SOLUTIONS LOCAL ANESTHETICS (EENT) LOCAL ANESTHETICS (EENT) Antipyrine-Benzocaine Antipyrine/Benzocaine/Glycerin otic drops 1 Benzocaine Benzocaine otic drops 1 Lidocaine Hcl Lidocaine Hcl oral jel 1 Lidocaine Viscous Lidocaine Hcl oral solution 1 Phenylephrine/Antipy/B-Caine Phenylephrine/Antipy/B-Caine otic drops 1 Proparacaine Hcl Proparacaine Hcl opht drops 1 QL Tetracaine Hcl Tetracaine Hcl opht drops 1 Uni-Otic Chloroxylenol/Pramoxine Hcl otic drops 1 83

86 LOCAL ANESTHETICS (PARENTERAL) LOCAL ANESTHETICS (PARENTERAL) Lidocaine Hcl Lidocaine Hcl injection 1 PA Lidocaine Hcl/Pf Lidocaine Hcl/Pf injection 1 MISCELLANEOUS THERAPEUTIC AGENTS LOCAL ANESTHETICS (PARENTERAL) MISCELLANEOUS THERAPEUTIC AGENTS ACTIMMUNE Interferon Gamma-1B,Recomb. injection 4 PA Alendronate Sodium Alendronate Sodium tablet 1 QL Allopurinol Allopurinol tablet 1 ANTABUSE Disulfiram tablet 2 ANTIZOL Fomepizole intravenous (iv) 2 PA ATGAM Lymphocyte Immune Globulin intravenous (iv) 2 PA AVODART Dutasteride capsule 3 PA,QL AVONEX Interferon Beta-1A injection 4 PA AVONEX ADMINISTRATION PACK Interferon Beta-1A/Albumin injection 4 PA Azathioprine Azathioprine tablet 1 PA BETASERON Interferon Beta-1B injection 4 PA BONIVA Ibandronate Sodium tablet 3 PA,QL CELLCEPT Mycophenolate Mofetil tablet 2 PA Colchicine Colchicine tablet 1 COPAXONE Glatiramer Acetate injection 4 PA Cyclosporine Cyclosporine capsule 1 PA Cyclosporine Cyclosporine oral soln 1 PA CYCLOSPORINE Cyclosporine, Modified 50mg capsule 2 PA 84

87 Cyclosporine, Modified Cyclosporine, Modified oral soln 1 PA CYSTADANE Betaine oral powder 2 CYSTAGON Cysteamine Bitartrate capsule 2 PA CYTADREN Aminoglutethimide tablet 2 DIDRONEL Etidronate Disodium intravenous (iv) 2 PA ENBREL Etanercept injection 4 PA Etidronate Disodium Etidronate Disodium tablet 1 Finasteride Finasteride tablet 1 QL FLOMAX Tamsulosin Hcl cap.sr 24h 2 QL,ST Fomepizole Fomepizole intravenous (iv) 1 PA GANITE Gallium Nitrate intravenous (iv) 2 PA HUMIRA Adalimumab injection 4 PA KINERET Anakinra injection 4 PA MISCELLANEOUS THERAPEUTIC AGENTS KUVAN Sapropterin Dihydrochloride tablet 4 PA Leflunomide Leflunomide tablet 1 PA Leucovorin Calcium Leucovorin Calcium tablet 1 MESNEX Mesna tablet 2 MIFEPREX Mifepristone tablet 2 MYFORTIC Mycophenolate Sodium tablet dr 2 PA ORENCIA Abatacept/Maltose intravenous (iv) 4 PA ORFADIN Nitisinone capsule 2 PA Pamidronate Disodium Pamidronate Disodium intravenous (iv) 1 PA PROGRAF Tacrolimus Anhydrous intravenous (iv) 2 PA PROGRAF Tacrolimus Anhydrous capsule 2 PA RAPAMUNE Sirolimus tablet 2 PA 85

88 RAPAMUNE Sirolimus oral soln 2 PA REBIF Interferon Beta-1A/Albumin injection 4 PA REMICADE Infliximab intravenous (iv) 4 PA REVLIMID Lenalidomide capsule 4 PA SANDOSTATIN LAR Octreotide Acetate injection 4 PA SENSIPAR Cinacalcet Hcl tablet 4 PA MISCELLANEOUS THERAPEUTIC AGENTS SIMULECT Basiliximab intravenous (iv) 3 PA Sodium Fluoride Sodium Fluoride dental cream 1 Sodium Fluoride Sodium Fluoride dental gel 1 Sodium Fluoride Sodium Fluoride dental soln 1 Stannous Fluoride Stannous Fluoride dental soln 1 THALOMID Thalidomide capsule 4 PA THIOLA Tiopronin tablet 2 PA ZAVESCA Miglustat capsule 2 PA ZENAPAX Daclizumab intravenous (iv) 3 PA MULTIVITAMIN PREPARATIONS MULTIVITAMIN PREPARATIONS Prenatal RX1 Prenatal Vit27&Calcium/Iron/Fa tablet 1 MYDRIATICS MYDRIATICS Atropine Sulfate Atropine Sulfate opht drops 1 QL Atropine Sulfate Atropine Sulfate opht oint. 1 Cyclopentolate Hcl Cyclopentolate Hcl opht drops 1 Dipivefrin Hcl Dipivefrin Hcl opht drops 1 QL 86 This prescription may be available only at certain pharmacies. For more information consult your Provider Directory or call Member Services at , from 8:00 a.m. to 8:00 p.m., seven days a week. TTY/TDD users should call

89 Homatropine Hbr Homatropine Hbr opht drops 1 QL Isopto Homatropine Homatropine Hbr opht drops 1 QL Tropicamide Tropicamide opht drops 1 QL OPIATE ANTAGONISTS OPIATE ANTAGONISTS NALOXONE HCL Naloxone Hcl injection 2 PA Naltrexone Hcl Naltrexone Hcl tablet 1 PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS) PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS) MYDRIATICS ARICEPT Donepezil Hcl tablet 2 ARICEPT ODT Donepezil Hcl tab rapdis 2 Bethanechol Chloride Bethanechol Chloride tablet 1 EXELON Rivastigmine Tartrate capsule 2 EXELON Rivastigmine patch 3 EXELON Rivastigmine Tartrate oral soln 2 Guanidine Hcl Guanidine Hcl tablet 1 MYTELASE Ambenonium Chloride tablet 2 Pilocarpine Hcl Pilocarpine Hcl tablet 1 PROSTIGMIN Neostigmine Bromide tablet 2 Pyridostigmine Bromide Pyridostigmine Bromide tablet 1 PARATHYROID PARATHYROID FORTEO Teriparatide injection 4 PA,QL 87

90 FORTICAL Calcitonin,Salmon,Synthetic nasal spray 3 PA PHARMACEUTICAL AIDS PHARMACEUTICAL AIDS Gauze Bandage Gauze Bandage bandage 1 Water For Inj.,Bacteriostatic Water For Inj.,Bacteriostatic injection 1 PA Water For Injection,Sterile Water For Injection,Sterile intravenous (iv) 1 PA PARATHYROID PITUITARY PITUITARY Desmopressin Desmopressin (Nonrefrigerated) nasal spray 1 Desmopressin Acetate Desmopressin Acetate tablet 1 GENOTROPIN Somatropin injection 4 PA GENOTROPIN Somatropin injection 4 PA HUMATROPE Somatropin injection 4 PA NORDITROPIN Somatropin injection 4 PA NORDITROPIN NORDIFLEX Somatropin injection 4 PA NUTROPIN Somatropin injection 4 PA NUTROPIN AQ Somatropin injection 4 PA SAIZEN Somatropin injection 4 PA SEROSTIM Somatropin injection 4 PA ZORBTIVE Somatropin injection 4 PA PROGESTINS PROGESTINS DEPO-PROVERA Medroxyprogesterone Acet 400mg injection 2 PA 88

91 Medroxyprogesterone Acet Medroxyprogesterone Acet injection 1 PA Medroxyprogesterone Acet Medroxyprogesterone Acet tablet 1 Norethindrone Acetate Norethindrone Acetate tablet 1 PROMETRIUM Progesterone,Micronized capsule 2 PROKINETIC AGENTS PROKINETIC AGENTS Metoclopramide Hcl Metoclopramide Hcl tablet 1 Metoclopramide Hcl Metoclopramide Hcl oral soln 1 PSYCHOTHERAPEUTIC AGENTS ANTIDEPRESSANTS PROGESTINS Amitriptyline Hcl Amitriptyline Hcl tablet 1 Amoxapine Amoxapine tablet 1 Bupropion Hcl Bupropion Hcl tab.sr 24h 1 QL Bupropion Hcl Bupropion Hcl tablet 1 Bupropion Hcl Bupropion Hcl tablet sa 1 Citalopram Hydrobromide Citalopram Hydrobromide oral soln 1 Citalopram Hydrobromide Citalopram Hydrobromide tablet 1 Clomipramine Hcl Clomipramine Hcl capsule 1 CYMBALTA Duloxetine Hcl capsule dr 3 PA Desipramine Hcl Desipramine Hcl tablet 1 Doxepin Hcl Doxepin Hcl oral conc. 1 Doxepin Hcl Doxepin Hcl capsule 1 EFFEXOR XR Venlafaxine Hcl cap.sr 24h 3 ST Fluoxetine Hcl Fluoxetine Hcl capsule 1 89

92 Fluoxetine Hcl Fluoxetine Hcl oral soln 1 Fluoxetine Hcl Fluoxetine Hcl tablet 1 Fluvoxamine Maleate Fluvoxamine Maleate tablet 1 Imipramine Hcl Imipramine Hcl tablet 1 Imipramine Pamoate Imipramine Pamoate capsule 1 LEXAPRO Escitalopram Oxalate tablet 3 PA PSYCHOTHERAPEUTIC AGENTS Maprotiline Hcl Maprotiline Hcl tablet 1 MARPLAN Isocarboxazid tablet 2 Mirtazapine Mirtazapine tab rapdis 1 Mirtazapine Mirtazapine tablet 1 NARDIL Phenelzine Sulfate tablet 2 Nefazodone Hcl Nefazodone Hcl tablet 1 Nortriptyline Hcl Nortriptyline Hcl capsule 1 Nortriptyline Hcl Nortriptyline Hcl oral soln 1 Paroxetine Hcl Paroxetine Hcl oral susp 1 PA Paroxetine Hcl Paroxetine Hcl tablet 1 Perphenazine/Amitriptyline Hcl Perphenazine/Amitriptyline Hcl tablet 1 Sertraline Hcl Sertraline Hcl oral conc. 1 Sertraline Hcl Sertraline Hcl tablet 1 SURMONTIL Trimipramine Maleate capsule 2 Tranylcypromine Sulfate Tranylcypromine Sulfate tablet 1 Trazodone Hcl Trazodone Hcl tablet 1 Trimipramine Maleate Trimipramine Maleate capsule 1 Venlafaxine Hcl Venlafaxine Hcl tablet 1 ST VIVACTIL Protriptyline Hcl tablet 2 90

93 ANTIPSYCHOTIC AGENTS ABILIFY Aripiprazole tablet 2 QL ABILIFY Aripiprazole injection 2 PA ABILIFY Aripiprazole oral soln 2 QL ABILIFY DISCMELT Aripiprazole tab rapdis 2 QL Chlorpromazine Hcl Chlorpromazine Hcl injection 1 PA Chlorpromazine Hcl Chlorpromazine Hcl oral conc. 1 Chlorpromazine Hcl Chlorpromazine Hcl tablet 1 CLOZAPINE Clozapine tablet 2 FAZACLO Clozapine tab rapdis 2 Fluphenazine Decanoate Fluphenazine Decanoate injection 1 PA Fluphenazine Hcl Fluphenazine Hcl tablet 1 PSYCHOTHERAPEUTIC AGENTS Fluphenazine Hcl Fluphenazine Hcl injection 1 PA Fluphenazine Hcl Fluphenazine Hcl oral liq. 1 Fluphenazine Hcl Fluphenazine Hcl oral conc. 1 GEODON Ziprasidone Hcl capsule 3 QL GEODON Ziprasidone Mesylate injection 3 PA Haloperidol Haloperidol tablet 1 Haloperidol Decanoate Haloperidol Decanoate injection 1 PA Haloperidol Lactate Haloperidol Lactate injection 1 PA Haloperidol Lactate Haloperidol Lactate oral conc. 1 INVEGA Paliperidone tab osm 24 2 Loxapine Succinate Loxapine Succinate capsule 1 MOBAN Molindone Hcl tablet 3 QL ORAP Pimozide tablet 3 Perphenazine Perphenazine oral conc. 1 91

94 Perphenazine Perphenazine tablet 1 RISPERDAL Risperidone tab rapdis 2 QL RISPERDAL CONSTA Risperidone Microspheres injection 2 PA Risperidone Risperidone oral soln 1 QL Risperidone Risperidone tablet 1 QL SEROQUEL Quetiapine Fumarate tablet 2 QL PSYCHOTHERAPEUTIC AGENTS Thioridazine Hcl Thioridazine Hcl oral conc. 1 Thioridazine Hcl Thioridazine Hcl tablet 1 Thiothixene Thiothixene capsule 1 Trifluoperazine Hcl Trifluoperazine Hcl tablet 1 ZYPREXA Olanzapine injection 2 PA ZYPREXA Olanzapine tablet 2 QL ZYPREXA ZYDIS Olanzapine tab rapdis 2 PA,QL RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB ANGIOTENSIN II RECEPTOR ANTAGONISTS COZAAR Losartan Potassium tablet 2 PA DIOVAN Valsartan tablet 2 PA DIOVAN HCT Valsartan/Hydrochlorothiazide tablet 2 PA HYZAAR Losartan/Hydrochlorothiazide tablet 2 PA ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Benazepril Hcl Benazepril Hcl tablet 1 Benazepril/Hydrochlorothiazide Benazepril/Hydrochlorothiazide tablet 1 Captopril Captopril tablet 1 Captopril/Hydrochlorothiazide Captopril/Hydrochlorothiazide tablet 1 92

95 Enalapril Maleate Enalapril Maleate tablet 1 Enalapril/Hydrochlorothiazide Enalapril/Hydrochlorothiazide tablet 1 Fosinopril Sodium Fosinopril Sodium tablet 1 Fosinopril/Hydrochlorothiazide Fosinopril/Hydrochlorothiazide tablet 1 Lisinopril Lisinopril tablet 1 Lisinopril/Hydrochlorothiazide Lisinopril/Hydrochlorothiazide tablet 1 Moexipril Hcl Moexipril Hcl tablet 1 Quinapril Hcl Quinapril Hcl tablet 1 Quinapril/Hydrochlorothiazide Quinapril/Hydrochlorothiazide tablet 1 Ramipril Ramipril capsule 3 Trandolapril Trandolapril tablet 1 MINERALOCORTICOID (ALDOSTERONE) ANTAGNTS INSPRA Eplerenone tablet 3 PA RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB Spironolact/Hydrochlorothiazid Spironolact/Hydrochlorothiazid tablet 1 Spironolactone Spironolactone tablet 1 RENIN INHIBITORS TEKTURNA Aliskiren Hemifumarate tablet 2 PA TEKTURNA HCT Aliskiren/Hydrochlorothiazide tablet 2 PA REPLACEMENT PREPARATIONS REPLACEMENT PREPARATIONS Dextrose in Lactated Ringers Dextrose 5%-Lactated Ringers intravenous (iv) 1 PA HYPERLYTE CR Sodium/K+/Mag/Ca/Chlor/Acetate intravenous (iv) 2 HYPERLYTE R Electrolyte Solution,Inj intravenous (iv) 2 K-LYTE DS Pot Bicarb/Potassium Cit/Ca tablet eff. 2 93

96 LYPHOLYTE-II Electrolyte Solution,Inj intravenous (iv) 2 MULTILYTE-20 Electrolyte Solution intravenous (iv) 2 NUTRILYTE II Sodium/K+/Mag/Ca/Chlor/Acetate intravenous (iv) 2 Potassium Bicarbonate/Cit Ac Potassium Bicarbonate/Cit Ac tablet eff. 1 Potassium Chloride Potassium Chloride tablet sa 1 Potassium Chloride Potassium Chloride tab rap dr 1 REPLACEMENT PREPARATIONS Potassium Chloride Potassium Chloride oral packet 1 Potassium Chloride Potassium Chloride oral liq. 1 Potassium Chloride Potassium Chloride capsule sa 1 Potassium Chloride/D5-0.25Ns Potassium Chloride/D5-0.25Ns intravenous (iv) 1 PA Potassium Chloride/D5-0.33Ns Potassium Chloride/D5-0.33Ns intravenous (iv) 1 PA Potassium Chloride/D5-0.5Ns Potassium Chloride/D5-0.5Ns intravenous (iv) 1 PA Potassium Chloride/D5Lr Potassium Chloride/D5Lr intravenous (iv) 1 PA Potassium Chloride/D5-Ns Potassium Chloride/D5-Ns intravenous (iv) 1 PA Potassium Chloride/D5W Potassium Chloride/D5W intravenous (iv) 1 PA Potassium Chloride/Ns Potassium Chloride/Ns intravenous (iv) 1 PA Ringers Solution Ringers Solution intravenous (iv) 1 PA Ringers Solution,Lactated Ringers Solution,Lactated intravenous (iv) 1 PA Sodium Chloride Normal Saline intravenous (iv) 1 PA Sodium Chloride Normal Saline injection 1 Sodium Chloride 1/2 Normal Saline intravenous (iv) 1 PA TPN ELECTROLYTES Sodium/K+/Mag/Ca/Chlor/Acetate intravenous (iv) 2 TPN ELECTROLYTES II Sodium/K+/Mag/Ca/Chlor/Acetate intravenous (iv) 2 94

97 RESPIRATORY SMOOTH MUSCLE RELAXANTS RESPIRATORY SMOOTH MUSCLE RELAXANTS Aminophylline Aminophylline oral liq. 1 Aminophylline Aminophylline tablet 1 Elixophyllin Theophylline Anhydrous oral liq. 1 QUIBRON-T Theophylline Anhydrous tablet 2 THEO-24 Theophylline Anhydrous cap.sr 24h 2 THEOCAP Theophylline Anhydrous cap.sr 12h 2 THEOPHYLLINE Theophylline Anhydrous oral soln 2 Theophylline Anhydrous Theophylline Anhydrous tab.sr 12h 1 Theophylline Anhydrous Theophylline Anhydrous cap.sr 12h 1 Theophylline Anhydrous Theophylline Anhydrous tablet sa 1 Theophylline/Dextrose Theophylline/Dextrose 5%-Water intravenous (iv) 1 PA RESPIRATORY SMOOTH MUSCLE RELAXANTS RESPIRATORY TRACT AGENTS, MISCELLANEOUS RESPIRATORY TRACT AGENTS, MISCELLANEOUS XOLAIR Omalizumab injection 4 PA SECOND GENERATION ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES CLARINEX Desloratadine tablet 2 ST Fexofenadine Hcl Fexofenadine Hcl tablet 1 QL,ST + Loratadine Loratadine oral soln 0 + Loratadine Loratadine tab rapdis 0 + Loratadine Loratadine tablet 0 + Loratadine is not normally covered in a Medicare Prescription Drug Plan. There is no copayment for loratadine. The drug cost for loratadine does not count towards your total drug costs (that is, the drug cost does not help you qualify for catastrophic coverage). 95

98 SERUMS SERUMS ANTIVENIN LATRODECTUS MACTANSAntivenin,Latrodectus Mactans injection 4 PA ANTIVENIN MICRURUS FULVIUS Antivenin,Micrurus Fulvius injection 4 PA ANTIVENIN POLYVALENT Antivenin,Crotalidae (Equine) injection 4 PA CARIMUNE Immu Globulin,Gamma (Igg) intravenous (iv) 4 PA CARIMUNE NF NANOFILTERED Immu Globulin,Gamma (Igg) intravenous (iv) 4 PA CROFAB Antivenin,Crotalidae Fab(Ovin) injection 4 PA SERUMS CYTOGAM Cytomegalovirus Immune Glob intravenous (iv) 4 PA DIGIBIND Digoxin Immune Fab intravenous (iv) 4 PA DIGIFAB Digoxin Immune Fab intravenous (iv) 4 PA GAMMAGARD S-D Immu Globulin,Gamma (Igg) intravenous (iv) 4 PA GAMUNEX Immune Glob,Gam Caprylate(Igg) intravenous (iv) 4 PA HEPAGAM B Hepatitis B Immun Glob/Maltose injection 4 PA HYPERHEP B S-D Hepatitis B Immune Globulin injection 4 PA HYPERRAB S-D Rabies Immune Globulin/Pf injection 4 PA HYPERRHO S/D Rho(D) Immune Globulin injection 4 PA HYPERTET S-D Tetanus Immune Globulin/Pf injection 4 PA IMMUNE GLOBULIN Immu Globulin,Gamma (Igg) injection 4 PA IMOGAM RABIES-HT Rabies Immune Globulin/Pf injection 4 PA MICRHOGAM Rho(D) Immune Globulin injection 3 PA MICRHOGAM PLUS Rho(D) Immune Globulin injection 4 PA NABI-HB Hepatitis B Immune Globulin injection 4 PA PANGLOBULIN NF Immu Globulin,Gamma (Igg) intravenous (iv) 4 PA RESPIGAM Resp Syncytial Vir Immune Glob intravenous (iv) 4 PA 96

99 RHOGAM Rho(D) Immune Globulin injection 4 PA RHOGAM PLUS Rho(D) Immune Globulin injection 4 PA RHOPHYLAC Rho(D) Immune Globulin injection 3 PA VARICELLA-ZOSTER IMM GLOBULIN Varicella-Zoster Immune Glob injection 4 PA VENOGLOBULIN-S Immu Globulin,Gamma (Igg) intravenous (iv) 4 PA WINRHO SDF Rho(D) Immune Globulin/Maltose injection 4 PA SKELETAL MUSCLE RELAXANTS CENTRALLY ACTING SKELETAL MUSCLE RELAXNT Carisoprodol Carisoprodol tablet 1 QL Chlorzoxazone Chlorzoxazone tablet 1 QL SERUMS Cyclobenzaprine Hcl Cyclobenzaprine Hcl tablet 1 QL Methocarbamol Methocarbamol tablet 1 QL SKELAXIN Metaxalone tablet 2 Tizanidine Hcl Tizanidine Hcl tablet 1 DIRECT-ACTING SKELETAL MUSCLE RELAXANTS Dantrolene Sodium Dantrolene Sodium capsule 1 QL GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT Baclofen Baclofen tablet 1 SKELETAL MUSCLE RELAXANTS Chlorzoxazone/Acetaminophen Chlorzoxazone/Acetaminophen tablet 1 QL Methocarbamol/Aspirin Methocarbamol/Aspirin tablet 1 QL 97

100 SKIN AND MUCOUS MEMBRANE AGENTS, MISC. SKIN AND MUCOUS MEMBRANE AGENTS, MISC. ALDARA Imiquimod topical powder 2 PA,QL AMNESTEEM Isotretinoin capsule 3 PA Calcipotriene Calcipotriene topical soln 1 PA,QL SKIN AND MUCOUS MEMBRANE AGENTS, MISC. CAPITROL Chloroxine shampoo 2 CLARAVIS Isotretinoin capsule 3 PA DIFFERIN Adapalene swabs 2 PA,QL DIFFERIN Adapalene topical gel 2 PA,QL DIFFERIN Adapalene cream 2 PA,QL DOVONEX Calcipotriene cream 2 PA,QL DOVONEX Calcipotriene ointment 2 PA,QL EFUDEX Fluorouracil cream 2 ELIDEL Pimecrolimus cream 2 PA,QL Fluorouracil Fluorouracil topical soln 1 LEVULAN Aminolevulinic Acid Hcl topical soln 2 PA PANRETIN Alitretinoin topical gel 2 PA PODOCON-25 Podophyllum Resin topical liquid 2 Podofilox Podofilox topical soln 1 REGRANEX Becaplermin topical gel 3 PA,QL SANTYL Collagenase ointment 2 SOLARAZE Diclofenac Sodium topical gel 2 SOTRET Isotretinoin capsule 3 PA TARGRETIN Bexarotene topical gel 3 98

101 SOMATOTROPIN AGONISTS AND ANTAGONISTS SOMATOTROPIN AGONISTS INCRELEX Mecasermin injection 4 PA IPLEX Mecasermin Rinfabate/Pf injection 4 PA SOMATOTROPIN ANTAGONISTS SOMAVERT Pegvisomant injection 4 PA SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS SYMPATHOLYTIC ADRENERGIC BLOCKING AGENTS Dihydroergotamine Mesylate Dihydroergotamine Mesylate injection 1 PA Ergoloid Mesylates Ergoloid Mesylates injection 1 Ergoloid Mesylates Ergoloid Mesylates tablet 1 ERGOMAR Ergotamine Tartrate injection 2 SOMATOTROPIN AGONISTS AND ANTAGONISTS Ergotamine Tartrate/Caffeine Ergotamine Tartrate/Caffeine tablet 1 Migergot Ergotamine Tartrate/Caffeine rectal supp. 1 SYMPATHOMIMETIC (ADRENERGIC) AGENTS ALPHA- AND BETA-ADRENERGIC AGONISTS Epinephrine Epinephrine injection 1 PA Pseudoephedrine Hcl Pseudoephedrine Hcl capsule sa 1 Pseudoephedrine Hcl Pseudoephedrine Hcl tablet 1 ALPHA-ADRENERGIC AGONISTS Midodrine Hcl Midodrine Hcl tablet 1 Phenylephrine Hcl Phenylephrine Hcl tab chew 1 99

102 BETA-ADRENERGIC AGONISTS ADVAIR DISKUS Fluticasone/Salmeterol inhalation disk 2 QL,ST ADVAIR HFA Fluticasone/Salmeterol aerosol 2 QL,ST Albuterol Albuterol aerosol 1 QL Albuterol Sulfate Albuterol Sulfate syrup 1 SYMPATHOMIMETIC (ADRENERGIC) AGENTS ALBUTEROL SULFATE Albuterol Sulfate inhalation soln 3 PA Albuterol Sulfate Albuterol Sulfate tablet 1 COMBIVENT Ipratropium/Albuterol Sulfate aerosol 2 QL Metaproterenol Sulfate Metaproterenol Sulfate syrup 1 Metaproterenol Sulfate Metaproterenol Sulfate tablet 1 PROAIR HFA Albuterol Sulfate aerosol 2 QL PROVENTIL HFA Albuterol Sulfate aerosol 2 QL SEREVENT DISKUS Salmeterol Xinafoate inhalation disk 2 PA Terbutaline Sulfate Terbutaline Sulfate tablet 1 Terbutaline Sulfate Terbutaline Sulfate injection 1 THYROID AND ANTITHYROID AGENTS ANTITHYROID AGENTS Methimazole Methimazole tablet 1 Propylthiouracil Propylthiouracil tablet 1 THYROID AGENTS ARMOUR THYROID Thyroid tablet 2 CYTOMEL Liothyronine Sodium tablet 2 LEVOTHROID Levothyroxine Sodium tablet 2 Levothyroxine Sodium Levothyroxine Sodium tablet 1 100

103 LEVOXYL Levothyroxine Sodium tablet 2 NATURE-THROID Thyroid,Pork tablet 2 SYNTHROID Levothyroxine Sodium tablet 2 Thyroid Thyroid tablet 1 THYROLAR Liotrix tablet 2 UNITHROID Levothyroxine Sodium tablet 2 Westhroid Thyroid tablet 1 TOXOIDS TOXOIDS ADACEL Diph,Pertuss(Acell),Tet Vac/Pf injection 2 BOOSTRIX Diph,Pertuss(Acell),Tet Ped/Pf injection 2 DAPTACEL Diph,Pertuss(Acell),Tet Ped/Pf injection 2 THYROID AND ANTITHYROID AGENTS DIPHTHERIA-TETANUS TOXOID Tetanus,Diphtheria Toxd Ped/Pf injection 2 INFANRIX Diph,Pertuss(Acell),Tet Ped/Pf injection 2 TETANUS DIPHTHERIA TOXOIDS Tetanus And Diphtheria Toxoid injection 2 TETANUS TOXOID Tetanus Toxoid,Fluid injection 2 PA Tetanus Toxoid,Adsorbed/Pf Tetanus Toxoid,Adsorbed/Pf injection 1 Tetanus Toxoid,Fluid Tetanus Toxoid,Fluid injection 1 TRIHIBIT Dp(A)T Ped/Hib Conj-Tet/Pf injection 2 TRIPEDIA Diph,Pertuss(Acell),Tet Ped/Pf injection 2 URICOSURIC AGENTS URICOSURIC AGENTS Colchicine/Probenecid Colchicine/Probenecid tablet 1 Probenecid Probenecid tablet 1 101

104 URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES Methenamine Hippurate Methenamine Hippurate tablet 1 Methenamine Mandelate Methenamine Mandelate tablet 1 Nitrofurantoin Macrocrystal Nitrofurantoin Macrocrystal capsule 1 Nitrofurantoin/Nitrofuran Mac Nitrofurantoin/Nitrofuran Mac capsule 1 URINARY ANTI-INFECTIVES Trimethoprim Trimethoprim tablet 1 VACCINES VACCINES ACTHIB Haemoph B Poly Conj-Tet Tox/Pf injection 2 ATTENUVAX VACCINE WITH DILUENTMeasles Vaccine,Live,Atten/Pf injection 2 COMVAX Hep B Vaccine/Hib Conj-Meng/Pf injection 2 PA ENGERIX-B Hepatitis B Virus Vaccine,Recb injection 2 PA GARDASIL Human Papilomvirus Vac,Qval/Pf injection 2 HAVRIX Hepatitis A Virus Vaccine injection 2 HIBTITER Haemoph B Oligo Conj-Dipht Crm injection 2 IMOVAX RABIES VACCINE Rabies Vaccine,Human Diploid injection 2 IPOL Poliomyelitis Vac,Killed injection 2 JE-VAX Japanese Encephalitis Vaccine injection 2 MENACTRA Meningoc Vac A,C,Y,W-135 Dip injection 2 MENOMUNE-A-C-Y-W-135 Meningococ Vac A,C,Y,W-135/Pf injection 2 MERUVAX II VACCINE W-DILUENT Rubella Vaccine/Pf injection 2 M-M-R II VACCINE Measles,Mumps&Rubella Vaccine injection 2 M-R-VAX II VACCINE W/DILUENT Measles And Rubella Vaccine injection 2 102

105 MUMPSVAX VACCINE W-DILUENT Mumps Vaccine,Live/Pf injection 2 PEDIARIX Hep B Vaccine/Dp(A)T-Polio injection 2 PA PEDVAXHIB Haemph B Polysac Conj-Menin/Pf injection 2 PROQUAD Measles,Mumps,Rub,Varicella/Pf injection 2 RABAVERT Rabies Vaccine (Pcec)/Pf injection 2 RECOMBIVAX HB Hepatitis B Virus Vaccine,Recb injection 2 PA ROTATEQ Rotavirus Vac,Live Pentav oral susp 2 THERACYS Bcg Live injection 2 TICE BCG Bcg Live injection 2 TWINRIX Hepatitis A & B Vaccines injection 2 PA TYPHIM VI Typhoid Vacc Vi Capsu Polysacc injection 2 VACCINES VAQTA Hepatitis A Virus Vaccine/Pf injection 2 VARIVAX VACCINE Varicella Vacc/Pf injection 2 VIVOTIF BERNA Typhoid Vacc,Live,Attenuated capsule dr 2 YF-VAX Yellow Fever Vaccine/Pf injection 2 ZOSTAVAX Varicella Vacc/Pf injection 2 VASOCONSTRICTORS VASOCONSTRICTORS Naphazoline Hcl Naphazoline Hcl opht drops 1 QL Naphazoline Hcl/Antazoline Naphazoline Hcl/Antazoline opht drops 1 QL Naphazoline Hcl/Phenir Mal Naphazoline Hcl/Phenir Mal opht drops 1 QL Phenylephrine Hcl Phenylephrine Hcl opht drops 1 QL TYZINE Tetrahydrozoline Hcl nasal spray 2 ST 103

106 VASODILATING AGENTS NITRATES AND NITRITES Isosorbide Dinitrate Isosorbide Dinitrate injection 1 Isosorbide Dinitrate Isosorbide Dinitrate tablet 1 Isosorbide Dinitrate Isosorbide Dinitrate tablet sa 1 Isosorbide Mononitrate Isosorbide Mononitrate tab.sr 24h 1 Isosorbide Mononitrate Isosorbide Mononitrate tablet 1 VASODILATING AGENTS Nitroglycerin Nitroglycerin capsule sa 1 Nitroglycerin Nitroglycerin patch 1 Nitroglycerin Nitroglycerin injection 1 NITROSTAT Nitroglycerin injection 2 PHOSPHODIESTERASE INHIBITORS REVATIO Sildenafil Citrate tablet 4 PA VASODILATING AGENTS, MISCELLANEOUS AGGRENOX Aspirin/Dipyridamole capsule sa 3 Dipyridamole Dipyridamole tablet 1 FLOLAN Epoprostenol Na intravenous (iv) 4 PA TRACLEER Bosentan tablet 4 PA VITAMIN D VITAMIN D Calcitriol Calcitriol capsule 1 HECTOROL Doxercalciferol intravenous (iv) 2 PA HECTOROL Doxercalciferol capsule 2 ZEMPLAR Paricalcitol capsule This prescription may be available only at certain pharmacies. For more information consult your Provider Directory or call Member Services at , from 8:00 a.m. to 8:00 p.m., seven days a week. TTY/TDD users should call

107 ZEMPLAR Paricalcitol intravenous (iv) 2 PA VITAMIN D 105

108

109 Index of Drugs 8 8-MOP A ABACAVIR SULFATE ABACAVIR SULFATE/ LAMIVUDINE ABACAVIR/LAMIVUDINE/ ZIDOVUDINE ABATACEPT/MALTOSE ABELCET ABILIFY ABILIFY DISCMELT ACAMPROSATE CALCIUM ACARBOSE ACCOLATE ACEBUTOLOL HCL ACETAMINOPHEN WITH CODEINE ACETAZOLAMIDE ACETIC ACID/ALUMINUM ACETATE ACETIC ACID/ HYDROCORTISONE ACTHIB ACTIMMUNE ACTOS ACULAR ACULAR LS ACULAR PF ACYCLOVIR... 52, 68 ACYCLOVIR SODIUM ADACEL ADAGEN ADALIMUMAB ADAPALENE ADDERALL XR...35 ADEFOVIR DIPIVOXIL...68 ADVAIR DISKUS ADVAIR HFA AEROBID...29 AEROBID-M...29 AGALSIDASE BETA...78 AGENERASE...65 AGGRENOX ALBENDAZOLE...35 ALBENZA...35 ALBUTEROL ALBUTEROL SULFATE ALCLOMETASONE DIPROPIONATE...54 ALCOHOL ANTISEPTIC PADS...52 ALCOHOLSWABS...52 ALDARA...98 ALDESLEUKIN...60 ALDURAZYME...77 ALEMTUZUMAB...59 ALENDRONATE SODIUM...84 ALGLUCERASE...77 ALISKIREN HEMIFUMARATE...93 ALISKIREN/ HYDROCHLOROTHIAZIDE...93 ALITRETINOIN...98 ALLOPURINOL...84 ALORA...78 ALOSETRON HCL...80 ALPHA-1-PROTEINASE INHIBITOR...78 ALPHAGAN P...47 ALTRETAMINE...59 AMANTADINE HCL...61 AMBENONIUM CHLORIDE AMBISOME AMCINONIDE AMERICAINE AMIKACIN SULFATE AMILORIDE HCL AMILORIDE/ HYDROCHLOROTHIAZIDE AMINO ACIDS 10% AMINO ACIDS 5.4% AMINO ACIDS 6.9% AMINO ACIDS 8% AMINOACETIC ACID AMINOCAPROIC ACID AMINOGLUTETHIMIDE AMINOLEVULINIC ACID HCL AMINOPHYLLINE AMINOSYN-PF AMIODARONE HCL AMITRIPTYLINE HCL AMLODIPINE BESYLATE AMLODIPINE BESYLATE/ BENAZEPRIL AMMONIUM LACTATE AMNESTEEM AMOX TR/POTASSIUM CLAVULANATE AMOXAPINE AMOXICILLIN TRIHYDRATE AMPHET ASP/AMPHET/D- AMPHET AMPHETAMINE SALT COMBO AMPHOTEC AMPHOTERICIN B

110 Index of Drugs AMPHOTERICIN B CHOLESTERYL SUL AMPHOTERICIN B LIPID COMPLEX AMPHOTERICIN B LIPOSOME AMPICILLIN SODIUM AMPICILLIN SODIUM/ SULBACTAM NA AMPICILLIN TRIHYDRATE AMPRENAVIR/VITAMIN E/ PROP GLY AMYLASE/LIPASE/ PROTEASE... 75, 76 ANACAINE ANAKINRA ANASTROZOLE ANCOBON ANDRODERM ANDROID ANDROXY ANIDULAFUNGIN ANTABUSE ANTIPYRINE/ BENZOCAINE/GLYCERIN ANTIPYRINE-BENZOCAINE ANTIVENIN LATRODECTUS MACTANS ANTIVENIN MICRURUS FULVIUS ANTIVENIN POLYVALENT ANTIVENIN,CROTALIDAE (EQUINE) ANTIVENIN,CROTALIDAE FAB(OVIN) ANTIVENIN,LATRODECTUS MACTANS ANTIVENIN,MICRURUS FULVIUS ANTIZOL...84 APRI...73 APROTININ...49 APTIVUS...65 ARANESP...81 ARICEPT...87 ARICEPT ODT...87 ARIMIDEX...59 ARIPIPRAZOLE...91 ARISTOCORT...29 ARIXTRA...63 ARMOUR THYROID AROMASIN...59 ARSENIC TRIOXIDE...61 ASACOL...53 ASPIRIN/CODEINE PHOSPHATE...32 ASPIRIN/DIPYRIDAMOLE ASTELIN...36 ATAZANAVIR SULFATE...66 ATENOLOL...69 ATENOLOL/ CHLORTHALIDONE...69 ATGAM...84 ATORVASTATIN CALCIUM...57 ATOVAQUONE/ PROGUANIL HCL...63 ATRIPLA...65 ATROPINE SULFATE...41, 86 ATROVENT HFA...41 ATTENUVAX VACCINE WITH DILUENT AURANOFIN...80 AVANDIA...45 AVIANE...73 AVODART...84 AVONEX AVONEX ADMINISTRATION PACK AZACITIDINE AZACTAM AZATHIOPRINE AZELASTINE HCL AZITHROMYCIN... 37, 38 AZMACORT AZOPT AZTREONAM B BACITRACIN BACITRACIN/POLYMYXIN B SULFATE BACLOFEN BACTRIM BALACET BALSALAZIDE DISODIUM BARACLUDE BASILIXIMAB BCG LIVE BECAPLERMIN BECLOMETHASONE DIPROPIONATE BENAZEPRIL HCL BENAZEPRIL/ HYDROCHLOROTHIAZIDE BENZOCAINE... 63, 83 BENZTROPINE MESYLATE BETAINE BETAMET DIPROP/PROP GLY BETAMETHASONE BETAMETHASONE DIPROPIONATE

111 Index of Drugs BETAMETHASONE VALERATE BETASERON BETAXOLOL HCL... 48, 69 BETHANECHOL CHLORIDE BEXAROTENE... 60, 98 BICALUTAMIDE BICILLIN C-R BICILLIN L-A BILTRICIDE BISOPROL/ HYDROCHLOROTHIAZIDE BISOPROLOL FUMARATE BLEOMYCIN SULFATE BONIVA BOOSTRIX BORTEZOMIB BOSENTAN BREVIBLOC BREVICON BRIMONIDINE TARTRATE BRINZOLAMIDE BROMOCRIPTINE MESYLATE BROMPHENIRAMINE MALEATE BUDESONIDE... 29, 30 BUMETANIDE BUPHENYL BUPRENORPHINE HCL BUPRENORPHINE HCL/ NALOXONE HCL BUPROPION HCL BUSPIRONE HCL BYETTA C CABERGOLINE...62 CALCIPOTRIENE...98 CALCITONIN,SALMON,SY NTHETIC...88 CALCITRIOL CALCIUM ACETATE...82 CAMPATH...59 CAMPRAL...73 CANASA...53 CANCIDAS...47 CAPITROL...98 CAPTOPRIL...92 CAPTOPRIL/ HYDROCHLOROTHIAZIDE...92 CARBAMAZEPINE...41, 42 CARBATROL...41 CARBIDOPA/LEVODOPA...61 CARBIDOPA/LEVODOPA/ ENTACAPONE...62 CARDIZEM CD...70 CARIMUNE...96 CARIMUNE NF NANOFILTERED...96 CARISOPRODOL...97 CARTEOLOL HCL...77 CARVEDILOL...69 CASODEX...59 CASPOFUNGIN ACETATE...47 CEENU...59 CEFACLOR...36 CEFACLOR ER...36 CEFADROXIL HYDRATE...36 CEFAZOLIN SODIUM...37 CEFEPIME HCL...37 CEFOTAXIME SODIUM CEFPODOXIME PROXETIL CEFPROZIL CEFTAZIDIME NA/ DEXTROSE,ISO CEFTAZIDIME PENTAHYDRATE CEFTRIAXONE NA/ DEXTROSE,ISO CEFTRIAXONE SODIUM CEFUROXIME AXETIL CEFUROXIME SODIUM CELESTONE CELL/AMY/LIP/PROTE/P- TLOX/HYOS CELLCEPT CELONTIN CENESTIN CEPHALEXIN MONOHYDRATE CEREDASE CEREZYME CESIA CHLORAL HYDRATE CHLORAMBUCIL CHLORHEXIDINE GLUCONATE CHLOROQUINE PHOSPHATE CHLOROTHIAZIDE CHLOROXINE CHLOROXYLENOL/ PRAMOXINE HCL CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE TANNATE CHLORPROMAZINE HCL

112 Index of Drugs CHLORTHALIDONE CHLORZOXAZONE CHLORZOXAZONE/ ACETAMINOPHEN CHOL SAL/MAGNESIUM SALICYLATE CHOLESTYRAMINE CHOLESTYRAMINE LIGHT CHOLESTYRAMINE/ ASPARTAME CHOLESTYRAMINE/ SUCROSE CICLOPIROX CICLOPIROX OLAMINE CILOSTAZOL CIMETIDINE CIMETIDINE HCL CINACALCET HCL CIPROFLOXACIN ER CIPROFLOXACIN HCL... 39, 49 CITALOPRAM HYDROBROMIDE CITRIC ACID/POTASSIUM CITRATE CITRIC ACID/SODIUM CITRATE CLARAVIS CLARINEX CLARITHROMYCIN CLARITHROMYCIN ER CLEMASTINE FUMARATE CLINDAMAX CLINDAMYCIN HCL CLINDAMYCIN PHOSPHATE... 36, 50 CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE/EMOLL...55 CLOMIPRAMINE HCL...89 CLONIDINE HCL...81 CLOPIDOGREL BISULFATE...64 CLOTRIMAZOLE...51 CLOTRIMAZOLE/BETAMET DIPROP...51 CLOTRIMAZOLE/ BETAMETHASONE...51 CLOZAPINE...91 CODEINE PHOSPHATE...32 CODEINE SULF...32 CODEINE/BUTALBIT/ ACETAMIN/CAFF...32 COLCHICINE...84 COLCHICINE/ PROBENECID COLESTID...57 COLESTIPOL HCL...57 COLISTIMETHATE SODIUM...36 COLLAGENASE...98 COMBIPATCH...78 COMBIVENT COMBIVIR...65 COMTAN...61 COMVAX CONCERTA...35 COPAXONE...84 CORTISONE ACETATE...29 COUMADIN...64 COZAAR...92 CREON CREON CREON CRIXIVAN CROFAB CROMOLYN SODIUM CUPRIMINE CYCLOBENZAPRINE HCL CYCLOPENTOLATE HCL CYCLOPHOSPHAMIDE CYCLOSERINE CYCLOSPORINE CYCLOSPORINE CYCLOSPORINE, MODIFIED... 84, 85 CYKLOKAPRON CYMBALTA CYPROHEPTADINE HCL CYSTADANE CYSTAGON CYSTEAMINE BITARTRATE CYTADREN CYTOGAM CYTOMEGALOVIRUS IMMUNE GLOB CYTOMEL CYTRA D DACLIZUMAB DALTEPARIN SODIUM,PORCINE D-AMPHETAMINE SULFATE DANAZOL DANTROLENE SODIUM DAPSONE DAPTACEL DARAPRIM

113 Index of Drugs DARBEPOETIN ALFA IN ALBUMN SOL DARUNAVIR ETHANOLATE DASATINIB DEFERASIROX DEFEROXAMINE MESYLATE DELAVIRDINE MESYLATE DEMECARIUM BROMIDE DEMECLOCYCLINE HCL DENAVIR DENILEUKIN DIFTITOX DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE DEPEN DEPO-PROVERA DERMOTIC DESIPRAMINE HCL DESLORATADINE DESMOPRESSIN DESMOPRESSIN (NONREFRIGERATED) DESMOPRESSIN ACETATE DESOGESTREL-ETHINYL ESTRADIOL... 73, 74 DESOG-ET ESTRA/ETHIN ESTRA DESONATE DESONIDE... 55, 56 DESOXIMETASONE DETROL DETROL LA DEXAMETHASONE... 29, 52 DEXAMETHASONE ACETATE DEXAMETHASONE SOD PHOSPHATE...52 DEXCHLORPHENIRAMINE MALEATE...79 DEXMETHYLPHENIDATE HCL...35 DEXTROAMPHETAMINE SULFATE...35 DEXTROSE 10%- 0.25NORMAL SALINE...71 DEXTROSE 10%-NORMAL SALINE...71 DEXTROSE 10%-WATER...71 DEXTROSE 5%-LACTATED RINGERS...93 DEXTROSE IN LACTATED RINGERS...93 DEXTROSTAT...35 DIAZOXIDE...82 DICLOFENAC POTASSIUM...31 DICLOFENAC SODIUM..31, 53, 98 DICLOXACILLIN SODIUM...39 DICYCLOMINE HCL...41 DIDANOSINE...65, 67 DIDANOSINE/CALCIUM CARB/MAG...67 DIDRONEL...85 DIFFERIN...98 DIFLORASONE DIACETATE...55 DIFLORASONE DIACETATE/EMOLL...55 DIFLORASONE E...55 DIFLUNISAL...31 DIGIBIND...96 DIGIFAB...96 DIGITEK...72 DIGOXIN...72 DIGOXIN IMMUNE FAB...96 DIHYDROERGOTAMINE MESYLATE DILANTIN DILANTIN DILTIAZEM ER DILTIAZEM HCL DIOVAN DIOVAN HCT DIPENTUM DIPH,PERTUSS(ACELL),TET PED/PF DIPH,PERTUSS(ACELL),TET VAC/PF DIPHENHYDRAMINE HCL DIPHENHYDRAMINE TANNATE DIPHENOXYLATE HCL/ ATROP SULF DIPHTHERIA-TETANUS TOXOID DIPIVEFRIN HCL DIPYRIDAMOLE DISOPYRAMIDE PHOSPHATE DISULFIRAM DIVALPROEX SODIUM DOFETILIDE DONEPEZIL HCL DORZOLAMIDE HCL DOVONEX DOXAZOSIN MESYLATE DOXEPIN HCL... 63, 89 DOXERCALCIFEROL DOXYCYCLINE HYCLATE... 40, 49 DOXYCYCLINE MONOHYDRATE DP(A)T PED/HIB CONJ- TET/PF

114 Index of Drugs DRONABINOL DROXIA DULOXETINE HCL DUTASTERIDE DYGASE E ECHOTHIOPHATE IODIDE ECONAZOLE NITRATE EFAVIRENZ EFAVIRENZ/EMTRICITAB/ TENOFOVIR EFFEXOR XR EFUDEX ELAPRASE ELECTROLYTE SOLUTION ELECTROLYTE SOLUTION,INJ... 93, 94 ELIDEL ELIGARD ELITEK ELIXOPHYLLIN EMCYT EMEND EMSAM EMTRICITABINE EMTRICITABINE/ TENOFOVIR EMTRIVA ENALAPRIL MALEATE ENALAPRIL/ HYDROCHLOROTHIAZIDE ENBREL ENFUVIRTIDE ENGERIX-B ENOXAPARIN SODIUM ENTACAPONE...61 ENTECAVIR...68 ENTOCORT EC...29 ENZYCAP...75 ENZYMAX...75 EPINEPHRINE...99 EPIVIR...66 EPIVIR HBV...66 EPLERENONE...93 EPOETIN ALFA...81 EPOGEN...81 EPOPROSTENOL NA EPZICOM...66 ERAXIS...47 ERGOLOID MESYLATES...99 ERGOMAR...99 ERGOTAMINE TARTRATE...99 ERGOTAMINE TARTRATE/ CAFFEINE...99 ERLOTINIB HCL...60 ERY E-SUCC/ SULFISOXAZOLE...38 ERYTHROCIN LACTOBIONATE...38 ERYTHROMYCIN...50 ERYTHROMYCIN BASE...38, 49, 50 ERYTHROMYCIN BASE/ BENZ PER...51 ERYTHROMYCIN BASE/ ETHANOL...50 ERYTHROMYCIN ETHYLSUCCINATE...38 ERYTHROMYCIN LACTOBIONATE...38 ESCITALOPRAM OXALATE...90 ESMOLOL HCL...69 ESMOLOL HCL/SOD CL...69 ESTRADIOL ESTRADIOL/NORETH AC ESTRAMUSTINE PHOSPHATE SODIUM ESTROGEN,CON/M- PROGEST ACET ESTROGENS,CONJ.,SYNT HETIC A ESTROGENS,CONJUGATE D ESTROGENS,ESTERIFIED ESTROPIPATE ETANERCEPT ETHAMBUTOL HCL ETHIONAMIDE ETHOSUXIMIDE ETHOTOIN ETHYNODIOL D-ETHINYL ESTRADIOL ETIDRONATE DISODIUM ETODOLAC ETRAVIRINE EVISTA EXELON EXEMESTANE EXENATIDE EXJADE EZETIMIBE F FABRAZYME FAMOTIDINE FANSIDAR FARESTON FAT EMULSIONS FAZACLO FELBAMATE

115 Index of Drugs FELBATOL FELODIPINE FELODIPINE ER FEMARA FENOFIBRATE NANOCRYSTALLIZED FENOFIBRATE,MICRONIZE D FENOLDOPAM MESYLATE FENOPROFEN CALCIUM FENTANYL FENTANYL CITRATE/PF FEXOFENADINE HCL FILGRASTIM FINASTERIDE FLECAINIDE ACETATE FLOLAN FLOMAX FLOVENT HFA FLOXIN FLOXIN I.V FLUCONAZOLE FLUCONAZOLE IN DEXTROSE FLUCONAZOLE IN SALINE FLUCYTOSINE FLUDROCORTISONE ACETATE FLUNISOLIDE... 29, 52 FLUNISOLIDE/MENTHOL FLUOCINOLONE ACETONIDE FLUOCINOLONE ACETONIDE OIL FLUOCINONIDE FLUOCINONIDE/ EMOLLIENT FLUOCINONIDE-E...55 FLUOROMETHOLONE...52 FLUOROURACIL...98 FLUOXETINE HCL...89 FLUOXYMESTERONE...34 FLUPHENAZINE DECANOATE...91 FLUPHENAZINE HCL...91 FLURBIPROFEN...31 FLURBIPROFEN SODIUM...53 FLUTAMIDE...59 FLUTICASONE PROPIONATE...29, 52, 55 FLUTICASONE/ SALMETEROL FLUVOXAMINE MALEATE...90 FOCALIN XR...35 FOMEPIZOLE...84, 85 FONDAPARINUX SODIUM...63 FORTAZ...37 FORTAZ IN ISO-OSMOTIC DEXTROSE...37 FORTEO...87 FORTICAL...88 FOSAMPRENAVIR CALCIUM...66 FOSAPREPITANT DIMEGLUMINE...46 FOSINOPRIL SODIUM...93 FOSINOPRIL/ HYDROCHLOROTHIAZIDE...93 FRAGMIN...64 FREAMINE HBC...71 FRUCTOSE...71 FRUCTOSE 10%...71 FULVICIN U/F...46 FUROSEMIDE...76 FUZEON G GABAPENTIN GABITRIL GALLIUM NITRATE GALSULFASE GAMMAGARD S-D GAMUNEX GANCICLOVIR GANITE GANTRISIN GARDASIL GASTRINEX GASTROCROM GAUZE BANDAGE GEFITINIB GEMFIBROZIL GENOTROPIN GENTAMICIN SULFATE... 36, 49 GEODON GLATIRAMER ACETATE GLEEVEC GLIMEPIRIDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE/METFORMIN HCL GLUCAGEN GLUCAGON EMERGENCY KIT GLUCAGON,HUMAN RECOMBINANT GLYBURIDE GLYBURIDE, MICRO/ METFORMIN HCL

116 Index of Drugs GLYBURIDE,MICRONIZED GLYCINE GLYCOPYRROLATE GLYSET GOLD SODIUM THIOMALATE GONADOTROPIN,CHORI ONIC,HUMAN GOSERELIN ACETATE GRANISETRON HCL GRIFULVIN V GRISEOFULVIN GRISEOFULVIN ULTRAMICROSIZE GRISEOFULVIN,MICROSIZ E GRIS-PEG GUANABENZ ACETATE GUANFACINE HCL GUANIDINE HCL H HAEMOPH B OLIGO CONJ-DIPHT CRM HAEMOPH B POLY CONJ- TET TOX/PF HAEMPH B POLYSAC CONJ-MENIN/PF HALOBETASOL PROPIONATE HALOPERIDOL HALOPERIDOL DECANOATE HALOPERIDOL LACTATE HAVRIX HC/MINERAL OIL/ PETROLAT,WHT HC/PRAMOXINE HCL/ CHLOROXYLENOL HECTOROL HEP B VACCINE/DP(A)T- POLIO HEP B VACCINE/HIB CONJ-MENG/PF HEPAGAM B...96 HEPARIN SODIUM,PORCINE...64 HEPARIN SODIUM,PORCINE/NS/PF...64 HEPATITIS A & B VACCINES HEPATITIS A VIRUS VACCINE HEPATITIS A VIRUS VACCINE/PF HEPATITIS B IMMUN GLOB/MALTOSE...96 HEPATITIS B IMMUNE GLOBULIN...96 HEPATITIS B VIRUS VACCINE,RECB...102, 103 HEPSERA...68 HEXALEN...59 HIBTITER HIVID...66 HOMATROPINE HBR...87 HUM INSULIN NPH/REG INSULIN HM...44 HUMALOG...44 HUMALOG MIX HUMALOG MIX HUMAN PAPILOMVIRUS VAC,QVAL/PF HUMATROPE...88 HUMIRA...85 HUMORSOL...48 HUMULIN HUMULIN HUMULIN N HUMULIN R HYDRALAZINE HCL HYDRALAZINE/ HYDROCHLOROTHIAZID HYDRALAZINE/RESERPIN/ HCTZ HYDROCHLOROTHIAZIDE HYDROCODONE BIT/ ACETAMINOPHEN HYDROCODONE/ IBUPROFEN HYDROCORTISONE... 29, 55 HYDROCORTISONE ACETATE HYDROCORTISONE ACETATE/UREA HYDROCORTISONE BUTYRATE HYDROCORTISONE SOD SUCCINATE HYDROCORTISONE VALERATE HYDROMORPHONE HCL HYDROMORPHONE HCL/ PF HYDROXYCHLOROQUINE SULFATE HYDROXYPROPYL CELLULOSE HYDROXYUREA... 59, 60 HYDROXYZINE HCL HYDROXYZINE PAMOATE HYOSCYAMINE SULFATE HYPERHEP B S-D HYPERLYTE CR HYPERLYTE R HYPERRAB S-D HYPERRHO S/D

117 Index of Drugs HYPERTET S-D HYZAAR I IBANDRONATE SODIUM IBUPROFEN IDURSULFASE IMATINIB MESYLATE IMIGLUCERASE IMIPENEM/CILASTATIN SODIUM IMIPRAMINE HCL IMIPRAMINE PAMOATE IMIQUIMOD IMITREX IMMU GLOBULIN,GAMMA (IGG)... 96, 97 IMMUNE GLOB,GAM CAPRYLATE(IGG) IMMUNE GLOBULIN IMOGAM RABIES-HT IMOVAX RABIES VACCINE INAMRINONE INAMRINONE LACTATE INCRELEX INDAPAMIDE INDINAVIR SULFATE INDOMETHACIN INFANRIX INFERGEN INFLIXIMAB INSPRA INSULIN ASPART INSULIN GLARGINE,HUM.REC.ANL OG INSULIN LISPRO INSULIN NEEDLES...75 INSULIN NPL/INSULIN LISPRO...44 INSULIN REGULAR, HUMAN...44 INSULN ASP PRT/INSULIN ASPART...44 INTAL...54 INTELENCE...66 INTERFERON ALFA- 2A,RECOMB INTERFERON ALFA- 2B,RECOMB INTERFERON ALFACON INTERFERON BETA-1A...84 INTERFERON BETA-1A/ ALBUMIN...84, 86 INTERFERON BETA-1B...84 INTERFERON GAMMA- 1B,RECOMB INTRALIPIDFAT EMULSIONS...71 INTRON A...67 INVEGA...91 INVIRASE...66 IODOQUINOL...62 IPLEX...99 IPOL IPRATROPIUM BROMIDE...41 IPRATROPIUM/ALBUTEROL SULFATE IRESSA...59 ISENTRESS...66 ISOCARBOXAZID...90 ISONIAZID...58 ISOPTO CARPINE...48 ISOPTO HOMATROPINE...87 ISOSORBIDE DINITRATE ISOSORBIDE MONONITRATE ISOTRETINOIN ISRADIPINE ITRACONAZOLE IVERMECTIN J JANTOVEN JANUVIA JAPANESE ENCEPHALITIS VACCINE JE-VAX JOLESSA JOLIVETTE JUNEL JUNEL FE K KALETRA KARIVA KEPIVANCE KEPPRA KERATOL HC KETEK KETOCONAZOLE... 47, 51 KETOPROFEN KETOROLAC TROMETHAMINE... 32, 53 KETOTIFEN FUMARATE KINERET KIONEX K-LYTE DS K-PHOS NEUTRAL KUVAN KU-ZYME HP

118 Index of Drugs L LABETALOL HCL LACRISERT LACTIC ACID LACTULOSE LAMICTAL LAMIVUDINE LAMIVUDINE/ ZIDOVUDINE LAMOTRIGINE LANOXICAPS LANOXIN PEDIATRIC LANSOPRAZOLE LANTUS LAPATINIB DITOSYLATE LARONIDASE LATANOPROST LEENA LEFLUNOMIDE LENALIDOMIDE LESSINA LETROZOLE LEUCOVORIN CALCIUM LEUKERAN LEUKINE LEUPROLIDE ACETATE... 59, 60 LEVAQUIN LEVETIRACETAM LEVLEN LEVOBUNOLOL HCL LEVOFLOXACIN LEVONORGESTREL LEVONORGESTREL-ETH ESTRA... 73, 74 LEVORA LEVOTHROID LEVOTHYROXINE SODIUM...100, 101 LEVOXYL LEVULAN...98 LEXAPRO...90 LEXIVA...66 LIDOCAINE...63 LIDOCAINE HCL...63, 83, 84 LIDOCAINE HCL/D5W/PF...71 LIDOCAINE HCL/PF...72, 84 LIDOCAINE VISCOUS...83 LIDOCAINE/PRILOCAINE...63 LIDODERM...63 LINDANE...52 LINEZOLID...36 LIOTHYRONINE SODIUM LIOTRIX LIPITOR...57 LIPRAM-PN LISINOPRIL...93 LISINOPRIL/ HYDROCHLOROTHIAZIDE...93 LITHIUM CARBONATE...57 LITHIUM CITRATE...58 LOMUSTINE...59 LOPERAMIDE HCL...45 LOPINAVIR/RITONAVIR...66 LORABID...38 LORACARBEF...38 LORATADINE...95 LOSARTAN POTASSIUM...92 LOSARTAN/ HYDROCHLOROTHIAZIDE...92 LOTEMAX LOTEPREDNOL ETABONATE LOTRONEX LOVASTATIN LOVAZA LOVENOX LOW-OGESTREL LOXAPINE SUCCINATE LUPRON DEPOT LUPRON DEPOT-PED LYMPHOCYTE IMMUNE GLOBULIN LYPHOLYTE-II LYRICA LYSODREN M MAGNESIUM SALICYLATE MALARONE MAPROTILINE HCL MARAVIROC MARINOL MARPLAN MATULANE MAXALT MAXALT MLT MAXIDEX MAXIPIME MEASLES AND RUBELLA VACCINE MEASLES VACCINE,LIVE,ATTEN/PF MEASLES,MUMPS&RUBELL A VACCINE MEASLES,MUMPS,RUB,VAR ICELLA/PF

119 Index of Drugs MEBENDAZOLE MECASERMIN MECASERMIN RINFABATE/ PF MECLIZINE HCL MECLOFENAMATE SODIUM MEDROXYPROGESTERON E ACET... 88, 89 MEFLOQUINE HCL MEGESTROL ACETATE MELOXICAM MEMANTINE HCL MENACTRA MENEST MENINGOC VAC A,C,Y,W-135 DIP MENINGOCOC VAC A,C,Y,W-135/PF MENOMUNE-A-C-Y-W MEPERIDINE HCL MEPERIDINE HCL/PF MEPROBAMATE MERCAPTOPURINE MERUVAX II VACCINE W- DILUENT MESALAMINE MESNA MESNEX METAPROTERENOL SULFATE METAXALONE METFORMIN HCL METFORMIN HCL ER METHADONE HCL METHAZOLAMIDE METHENAMINE HIPPURATE METHENAMINE MANDELATE METHIMAZOLE METHOCARBAMOL...97 METHOCARBAMOL/ ASPIRIN...97 METHOTREXATE SODIUM...60, 61 METHOXSALEN...75 METHOXSALEN, RAPID...75 METHSUXIMIDE...43 METHYCLOTHIAZIDE...77 METHYLDOPA...82 METHYLDOPA/ HYDROCHLOROTHIAZIDE...82 METHYLPHENIDATE HCL...35 METHYLPREDNISOLONE...29 METHYLPREDNISOLONE SOD SUCC...29 METHYLTESTOSTERONE...34 METIPRANOLOL...48 METOCLOPRAMIDE HCL...89 METOLAZONE...77 METOPROL/ HYDROCHLOROTHIAZIDE...69 METOPROLOL SUCCINATE...69 METOPROLOL TARTRATE...70 METRONIDAZOLE...51, 52, 63 METRONIDAZOLE/ SODIUM CHLORIDE...63 MEXILETINE HCL...72 MICONAZOLE MICONAZOLE NITRATE...51 MICRHOGAM...96 MICRHOGAM PLUS...96 MICROGESTIN MICROGESTIN FE MIDODRINE HCL MIFEPREX MIFEPRISTONE MIGERGOT MIGLITOL MIGLUSTAT MILRINONE LACTATE MINOCYCLINE HCL MINOXIDIL MINTEZOL MIRAPEX MIRTAZAPINE MISOPROSTOL MITOTANE MITOXANTRONE HCL M-M-R II VACCINE MOBAN MODAFINIL MOEXIPRIL HCL MOLINDONE HCL MOMETASONE FUROATE MONONESSA MONTELUKAST SODIUM MORPHINE SULFATE MORPHINE SULFATE/PF M-R-VAX II VACCINE W/ DILUENT MST MULTILYTE MUMPS VACCINE,LIVE/PF MUMPSVAX VACCINE W- DILUENT MUPIROCIN

120 Index of Drugs MYCOBUTIN MYCOPHENOLATE MOFETIL MYCOPHENOLATE SODIUM MYFORTIC MYLOCEL MYTELASE N NA SULFACETM/PREDNIS SP NABI-HB NABUMETONE NADOLOL NAFARELIN ACETATE NAFCILLIN SODIUM NAGLAZYME NALIDIXIC ACID NALOXONE HCL NALTREXONE HCL NAMENDA NANDROLONE DECANOATE NAPHAZOLINE HCL NAPHAZOLINE HCL/ ANTAZOLINE NAPHAZOLINE HCL/ PHENIR MAL NAPROXEN NAPROXEN SODIUM NARDIL NATEGLINIDE NATURE-THROID NECON NEDOCROMIL SODIUM NEEDLES, INSULIN DISPOSABLE...75 NEFAZODONE HCL...90 NEGGRAM...40 NELFINAVIR MESYLATE...67 NEO/POLYMYX B SULF/ DEXAMETH...49 NEOMY SULF/BACITRA/ POLYMYXIN B...50 NEOMY SULF/BACITRAC ZN/POLY/HC...49 NEOMY SULF/POLYMYX B SULF/HC...49 NEOMY SULF/POLYMYX B SULF/PRED...50 NEOMYCIN SULFATE...36 NEOMYCIN/POLYMYXN B/GRAMICIDIN...49 NEOSTIGMINE BROMIDE...87 NEPHRAMINE...71 NEULASTA...81 NEUPOGEN...81 NEURONTIN...42 NEUTREXIN...63 NEVIRAPINE...67 NEXAVAR...60 NIACIN...56 NIASPAN...56 NICARDIPINE HCL...70 NICOTINE...69 NICOTROL...69 NICOTROL NS...69 NIFEDIPINE...70, 71 NIFEDIPINE CC...71 NIFEDIPINE ER...71 NILANDRON...60 NILOTINIB HYDROCHLORIDE NILUTAMIDE NITISINONE NITROFURANTOIN MACROCRYSTAL NITROFURANTOIN/ NITROFURAN MAC NITROGLYCERIN NITROSTAT NIZATIDINE NORDITROPIN NORDITROPIN NORDIFLEX NORETH A-ET ESTRA/FE FUMARATE NORETHINDRONE NORETHINDRONE ACETATE NORETHINDRONE A-E ESTRADIOL NORETHINDRONE- ETHINYL ESTRAD NORGESTIMATE-ETHINYL ESTRADIOL NORGESTREL-ETHINYL ESTRADIOL NORMAL SALINE NORTREL NORTRIPTYLINE HCL NORVIR NOVOLIN NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX NPH, HUMAN INSULIN ISOPHANE

121 Index of Drugs NUTRILYTE II NUTROPIN NUTROPIN AQ NYSTATIN... 47, 51 NYSTATIN/TRIAMCIN NYSTATIN/ TRIAMCINOLONE O OCTREOTIDE ACETATE OFLOXACIN... 40, 49 OFLOXACIN/DEXTROSE 5%-WATER OGESTREL OLANZAPINE OLSALAZINE SODIUM OMALIZUMAB OMEGA-3 ACID ETHYL ESTERS OMEPRAZOLE ONDANSETRON ONDANSETRON HCL ONDANSETRON ODT ONTAK OPIUM/BELLADONNA ALKALOIDS ORAP ORENCIA ORFADIN OSELTAMIVIR PHOSPHATE OXANDROLONE OXAPROZIN OXCARBAZEPINE OXSORALEN OXSORALEN-ULTRA OXYBUTYNIN CHLORIDE OXYCODONE HCL...33 OXYCODONE HCL/ ACETAMINOPHEN...34 OXYCODONE/ASPIRIN...34 P PALIFERMIN...73 PALIPERIDONE...91 PAMIDRONATE DISODIUM...85 PANCREASE MT PANCREATIN...75 PANCRECARB MS PANCRECARB MS PANCRECARB MS PANCRELIPASE...76 PANCRELIPASE EC...76 PANCRELIPASE MT PANGESTYME UL PANGESTYME UL PANGLOBULIN NF...96 PANRETIN...98 PANTOPRAZOLE SODIUM...65 PARENT. AMINO ACID 7 % #1(PED)...71 PARENTER. AMINO ACID 6.5% NO PARICALCITOL PAROMOMYCIN SULFATE...62 PAROXETINE HCL...90 PEDIARIX PEDVAXHIB PEG 3350/NA SULF,BICARB,CL/KCL...72 PEGADEMASE BOVINE...77 PEGANONE...43 PEGASYS...67 PEGFILGRASTIM PEGINTERFERON ALFA-2A PEGINTERFERON ALFA-2B PEGINTRON PEGINTRON REDIPEN PEGVISOMANT PEN G BENZ/PEN G PROCAINE PENCICLOVIR PENICILLAMINE... 80, 81 PENICILLIN G BENZATHINE PENICILLIN G POTASSIUM PENICILLIN G SODIUM PENICILLIN V POTASSIUM PENTASA PENTAZOCINE HCL/ ACETAMINOPHEN PENTOXIFYLLINE PERGOLIDE MESYLATE PERMETHRIN PERPHENAZINE PERPHENAZINE/ AMITRIPTYLINE HCL PHENAZOPYRIDINE HCL PHENELZINE SULFATE PHENYLEPHRINE HCL... 99, 103 PHENYLEPHRINE/ANTIPY/ B-CAINE PHENYTEK PHENYTOIN... 42, 43 PHENYTOIN SODIUM PHENYTOIN SODIUM EXTENDED PHOSLO PHOSPHA 250 NEUTRAL

122 Index of Drugs PHOSPHOLINE IODIDE PHOSPHORUS # PILOCARPINE HCL... 48, 87 PILOPINE HS PIMECROLIMUS PIMOZIDE PINDOLOL PIOGLITAZONE HCL PIPERACILLIN SODIUM PIROXICAM PLAN B PLAVIX PODOCON PODOFILOX PODOPHYLLUM RESIN POLIOMYELITIS VAC,KILLED POLYETHYLENE GLYCOL POLYMYXIN B SULFATE/ TMP POLY-PRED POT BICARB/POTASSIUM CIT/CA POTASSIUM BICARBONATE/CIT AC POTASSIUM CHLORIDE POTASSIUM CHLORIDE/ D5-0.25NS POTASSIUM CHLORIDE/ D5-0.33NS POTASSIUM CHLORIDE/ D5-0.5NS POTASSIUM CHLORIDE/ D5LR POTASSIUM CHLORIDE/ D5-NS POTASSIUM CHLORIDE/ D5W...94 POTASSIUM CHLORIDE/ NS...94 POTASSIUM CITRATE...30 PRAMIPEXOLE DI-HCL...62 PRAMLINTIDE ACETATE...43 PRAMOXINE HCL...63 PRANDIN...44 PRAVASTATIN SODIUM...57 PRAZIQUANTEL...35 PRAZOSIN HCL...30 PREDNISOLONE...30 PREDNISOLONE ACETATE...52 PREDNISOLONE SOD PHOSPHATE...30, 52 PREDNISONE...30 PREGABALIN...42 PREMARIN...78 PREMPHASE...78 PREMPRO...78 PRENATAL RX PRENATAL VIT27&CALCIUM/IRON/FA...86 PREVACID...65 PREZISTA...66 PRIFTIN...58 PRIMAQUINE...63 PRIMAQUINE PHOSPHATE...63 PRIMAXIN...38 PRIMAXIN I.M PRIMIDONE...42 PROAIR HFA PROBENECID PROCAINAMIDE HCL...72 PROCANBID...72 PROCARBAZINE HCL PROCHLORPERAZINE EDISYLATE PROCHLORPERAZINE MALEATE PROCRIT PROCTOFOAM PROFASI PROGESTERONE,MICRON IZED PROGLYCEM PROGRAF PROLASTIN PROLEUKIN PROMETHAZINE HCL PROMETRIUM PRONESTYL PROPAFENONE HCL PROPARACAINE HCL PROPOXYPHENE HCL PROPOXYPHENE/ ACETAMINOPHEN... 32, 34 PROPRANOLOL HCL PROPRANOLOL/ HYDROCHLOROTHIAZID PROPYLTHIOURACIL PROQUAD PROSTIGMIN PROTONIX IV PROTRIPTYLINE HCL PROVENTIL HFA PROVIGIL PSEUDOEPHEDRINE HCL PULMICORT PULMICORT FLEXHALER PYRAZINAMIDE

123 Index of Drugs PYRIDOSTIGMINE BROMIDE PYRIMETHAMINE PYRIMETHAMINE/ SULFADOXINE Q QUETIAPINE FUMARATE QUIBRON-T QUINAPRIL HCL QUINAPRIL/ HYDROCHLOROTHIAZIDE QUINIDINE SULFATE QVAR R RABAVERT RABIES IMMUNE GLOBULIN/PF RABIES VACCINE (PCEC)/ PF RABIES VACCINE,HUMAN DIPLOID RALOXIFENE HCL RALTEGRAVIR POTASSIUM RAMIPRIL RANEXA RANITIDINE HCL RANOLAZINE RAPAMUNE RASBURICASE REBIF RECOMBIVAX HB REGRANEX RELENZA RELION NOVOLIN RELION NOVOLIN N RELION NOVOLIN R...44 REMICADE...86 RENAGEL...82 RENAMIN...71 REPAGLINIDE...44 REQUIP...62 RESCRIPTOR...66 RESERPINE/ HYDROCHLOROTHIAZIDE...82 RESP SYNCYTIAL VIR IMMUNE GLOB...96 RESPIGAM...96 RESTASIS...53 RETROVIR...66 REVATIO REVLIMID...86 REYATAZ...66 RHO(D) IMMUNE GLOBULIN...96, 97 RHO(D) IMMUNE GLOBULIN/MALTOSE...97 RHOGAM...97 RHOGAM PLUS...97 RHOPHYLAC...97 RIBAVIRIN...68 RIDAURA...80 RIFABUTIN...58 RIFAMPIN...58 RIFAMPIN/INH/ PYRAZINAMIDE...58 RIFAMPIN/ISONIAZID...58 RIFAPENTINE...58 RIFATER...58 RILUTEK...73 RILUZOLE...73 RIMANTADINE HCL...65 RINGERS SOLUTION RINGERS SOLUTION,LACTATED RISPERDAL RISPERDAL CONSTA RISPERIDONE RISPERIDONE MICROSPHERES RITONAVIR RITUXAN RITUXIMAB RIVASTIGMINE TARTRATE RIZATRIPTAN BENZOATE ROFERON-A ROPINIROLE HCL ROSIGLITAZONE MALEATE ROTATEQ ROTAVIRUS VAC,LIVE PENTAV RUBELLA VACCINE/PF S SACROSIDASE SAIZEN SALMETEROL XINAFOATE SALSALATE SANDOSTATIN LAR SANTYL SAPROPTERIN DIHYDROCHLORIDE SAQUINAVIR MESYLATE SARGRAMOSTIM SCOPOLAMINE HYDROBROMIDE SELEGILINE SELEGILINE HCL SELENIUM SULFIDE

124 Index of Drugs SELZENTRY SENSIPAR SEREVENT DISKUS SEROMYCIN SEROQUEL SEROSTIM SERTRALINE HCL SEVELAMER HCL SILDENAFIL CITRATE SILVER SULFADIAZINE SIMULECT SIMVASTATIN SINGULAIR SIROLIMUS SITAGLIPTIN PHOSPHATE SKELAXIN SOD CHLORIDE/ NAHCO3/KCL/PEG'S SOD/POT/K & SOD CIT/C AC/SUCRO SOD/POT/K CIT/SOD CIT/ CIT ACID SODIUM BICARBONATE SODIUM CHLORIDE... 83, 94 SODIUM CHLORIDE IRRIG SOLUTION SODIUM FLUORIDE SODIUM OXYBATE SODIUM PHENYLBUTYRATE SODIUM POLYSTYRENE SULFONATE SODIUM/K+/MAG/CA/ CHLOR/ACETATE... 93, 94 SOLARAZE SOLTAMOX SOMATROPIN SOMAVERT...99 SORAFENIB TOSYLATE...60 SOTALOL HCL...70 SOTRET...98 SPIRIVA...41 SPIRONOLACT/ HYDROCHLOROTHIAZID...93 SPIRONOLACTONE...93 SPRYCEL...60 STALEVO STANNOUS FLUORIDE...86 STARLIX...44 STAVUDINE...67 STROMECTOL...35 SUBOXONE...34 SUBUTEX...34 SUCRAID...78 SUCRALFATE...65 SULFACETAMIDE SODIUM...50 SULFACETAMIDE- PREDNISOLONE...50 SULFADIAZINE...40 SULFAMETHOXAZOLE/ TRIMETHOPRIM...40 SULFASALAZINE...40 SULFASALAZINE DR...40 SULFISOXAZOLE...40 SULFISOXAZOLE ACETYL...40 SULINDAC...32 SUMATRIPTAN...58 SUNITINIB MALATE...60 SURMONTIL...90 SUSTIVA...66 SUTENT...60 SYMLIN...43 SYNAREL SYNTHROID T TACROLIMUS ANHYDROUS TAMIFLU TAMOXIFEN CITRATE TAMSULOSIN HCL TARCEVA TARGRETIN... 60, 98 TASIGNA TASMAR TAZICEF TEGRETOL XR TEKTURNA TEKTURNA HCT TELBIVUDINE TELITHROMYCIN TENOFOVIR DISOPROXIL FUMARATE TERAZOSIN HCL TERBINAFINE HCL TERBUTALINE SULFATE TERCONAZOLE TERIPARATIDE TESLAC TESTOLACTONE TESTOSTERONE TETANUS AND DIPHTHERIA TOXOID TETANUS DIPHTHERIA TOXOIDS TETANUS IMMUNE GLOBULIN/PF TETANUS TOXOID

125 Index of Drugs TETANUS TOXOID,ADSORBED/PF TETANUS TOXOID,FLUID TETANUS,DIPHTHERIA TOXD PED/PF TETRACAINE HCL TETRACYCLINE HCL TETRAHYDROZOLINE HCL THALIDOMIDE THALOMID THEO THEOCAP THEOPHYLLINE THEOPHYLLINE ANHYDROUS THEOPHYLLINE/ DEXTROSE THEOPHYLLINE/DEXTROSE 5%-WATER THERACYS THIABENDAZOLE THIOGUANINE THIOLA THIORIDAZINE HCL THIOTHIXENE THYROID , 101 THYROID,PORK THYROLAR TIAGABINE HCL TICAR TICAR IN DEXTROSE TICARCILLIN DISODIUM TICARCILLIN DISODIUM/ D5W TICARCILLIN/K CLAVULANATE TICE BCG TICLOPIDINE HCL...64 TIGECYCLINE...41 TIKOSYN...72 TILADE...54 TIMENTIN...39 TIMOLOL MALEATE...48, 70 TIOPRONIN...86 TIOTROPIUM BROMIDE...41 TIPRANAVIR...65 TIZANIDINE HCL...97 TOBRAMYCIN SULFATE...36, 50 TOLBUTAMIDE...45 TOLCAPONE...61 TOLMETIN SODIUM...32 TOLTERODINE TARTRATE...80 TOPAMAX...42 TOPIRAMATE...42 TOREMIFENE CITRATE...59 TORSEMIDE...76 TPN ELECTROLYTES...94 TPN ELECTROLYTES II...94 TRACLEER TRAMADOL HCL...34 TRANDOLAPRIL...93 TRANEXAMIC ACID...49 TRANSDERM-SCOP...46 TRANYLCYPROMINE SULFATE...90 TRASYLOL...49 TRAVASOL...71 TRAVATAN...48 TRAVATAN Z...48 TRAVOPROST...48 TRAVOPROST (BENZALKONIUM)...48 TRAZODONE HCL TRECATOR TRELSTAR DEPOT TRELSTAR LA TRETINOIN... 61, 73 TREXALL TRIAMCINOLONE TRIAMCINOLONE ACETONIDE... 29, 56 TRIAMTERENE/ HYDROCHLOROTHIAZID TRICITRATES TRICOR TRIFLUOPERAZINE HCL TRIFLURIDINE TRIHEXYPHENIDYL HCL TRIHIBIT TRI-LEGEST FE TRILEPTAL TRI-LEVLEN TRILYTE WITH FLAVOR PACKETS TRIMETHOBENZAMIDE HCL TRIMETHOPRIM TRIMETREXATE GLUCURONATE TRIMIPRAMINE MALEATE TRINESSA TRIPEDIA TRIPLE ANTIBIOTIC TRIPTORELIN PAMOATE... 60, 61 TRISENOX TRIVORA TRIZIVIR TROPICAMIDE

126 Index of Drugs TRUSOPT TRUVADA TWINRIX TYGACIL TYKERB TYPHIM VI TYPHOID VACC VI CAPSU POLYSACC TYPHOID VACC,LIVE,ATTENUATED TYZEKA TYZINE U UNI-OTIC UNITHROID UREA UREA-C UREALAC URSODIOL V VALACYCLOVIR HCL VALCYTE VALGANCICLOVIR HYDROCHLORIDE VALPROATE SODIUM VALPROIC ACID VALSARTAN VALSARTAN/ HYDROCHLOROTHIAZIDE VALTREX VANCOCIN HCL VANCOMYCIN HCL VAQTA VARICELLA VACC/PF VARICELLA-ZOSTER IMM GLOBULIN...97 VARICELLA-ZOSTER IMMUNE GLOB...97 VARIVAX VACCINE VELCADE...61 VELIVET...74 VENLAFAXINE HCL...89, 90 VENOGLOBULIN-S...97 VERAPAMIL HCL...70 VERDESO...56 VIDAZA...61 VIDEX...67 VIDEX EC...67 VIRACEPT...67 VIRAMUNE...67 VIREAD...67 VIS-PHOS N...29 VIVACTIL...90 VIVELLE...78 VIVOTIF BERNA VORINOSTAT...61 W WARFARIN SODIUM...64 WATER FOR INJ.,BACTERIOSTATIC...88 WATER FOR INJECTION,STERILE...88 WESTHROID WINRHO SDF...97 X XALATAN...48 XOLAIR...95 XYLOCAINE...63 XYREM...73 Y YELLOW FEVER VACCINE/ PF YF-VAX Z ZAFIRLUKAST ZALCITABINE ZALEPLON ZANAMIVIR ZAVESCA ZEMPLAR ZENAPAX ZERIT ZETIA ZIAGEN ZIDOVUDINE... 66, 67 ZILEUTON ZIPRASIDONE HCL ZMAX ZOLADEX ZOLINZA ZOLPIDEM TARTRATE ZONALON ZONISAMIDE ZORBTIVE ZOSTAVAX ZOVIA 1-35E ZOVIA 1-50E ZOVIRAX ZYFLO ZYPREXA ZYPREXA ZYDIS ZYVOX