Preferred Drug List (PDL)

Preferred List (PDL) New York Essential Plan Effective Date: 6/1/16 2016 United Healthcare Services, Inc. All rights reserved.

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

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

to the reference brand. The ratings of generic drugs are available by referring to the FDA reference, Approved Products with Therapeutic Equivalence Evaluations (Orange Book). When the above two criteria are met, a generic can be substituted with the full expectation that the substituted product will produce the same clinical effect and safety profile as the prescribed product. products that have a narrow therapeutic index (NTI) can also be guided by these principles. It is not necessary for the health care provider to approach any one therapeutic class of drug products (e.g., NTI drugs) differently from any other class, when there has been a determination of therapeutic equivalence by the FDA for the drug products under consideration. Also, additional clinical tests or examinations by the physician are not needed when a therapeutically equivalent generic drug product is substituted for the brand name product. There are now many brand name products that are repackaged or distributed under a generic label. The generic label version should always be considered therapeutically equivalent and substitutable for the source branded product. DRUG EFFICACY STUDY IMPLEMENTATION (DESI) DRUGS s first marketed between 1938 and 1962 were approved as safe but required no showing of effectiveness for FDA approval. Beginning in 1962, all new drugs were required to be both safe and effective before they could be marketed. This legislation also applied retroactively to all drugs approved as safe from 1938-1962. The DESI program was established by the FDA to review the effectiveness of these pre-1962 drugs for their labeled indications, and a determination of fully effective was made for most of these products and they remain in the marketplace. A few DESI products remain classified as less than fully effective while awaiting final administrative disposition. Also, classified as DESI are many products listed as identical, similar, or related to actual DESI products. UnitedHealthcare s PDL does not cover DESI less than fully effective drug products. PLAN EXCLUSIONS The following drug categories are excluded from coverage under the outpatient pharmacy benefit and are not part of the UnitedHealthcare PDL. DESI drugs Antiobesity agents Experimental / research drugs Cosmetic drugs Immunization agents Nutritional / diet supplements Blood and blood plasma products Agents used for erectile dysfunction Agents used for cosmetic hair growth s from manufacturers that do not participate in the FFS Medicaid Rebate Program Diagnostic products Medical supplies and DME except as listed: syringes, needles, lancets, alcohol swabs, spacers, preferred diabetes test strips, peak flow meters (Astech, Assess, Peak Air brands, max two per year), vaporizer (limit of 1 per 3 years), humidifier (limit of 1 per 3 years) Mirena DAYS SUPPLY DISPENSING LIMITATIONS UnitedHealthcare members may receive up to a one month supply of a specific medication per prescription order or prescription refill. A medication may be reordered or refilled when eighty-five percent (85%) of the medication has been utilized. If a claim is submitted before 85% of the medication has been used, based on the original day supply submitted on the claim, the claim will reject with a "refill too soon" message. MANDATORY GENERIC SUBSTITUTION The UnitedHealthcare PDL requires mandatory generic substitution on the vast majority of products when a generic equivalent is available; however, brand name drugs may be covered in certain situations by requesting a prior authorization. The UnitedHealthcare PDL prior authorization (PA) list does not include branded items where a generic equivalent is covered. PRIOR AUTHORIZATION OF NON-PDL MEDICATIONS The drugs in the UnitedHealthcare PDL have been selected to provide the most clinically appropriate and cost-effective medications for patients who have their drug benefit administered through UnitedHealthcare. It is also recognized that there may be occasions where an unlisted drug is desired for the proper medical management of a specific patient. In those infrequent instances, the prior authorization process reviews requests for unlisted medications the physician may consider medically necessary for patient management. Requests for these exceptions should be either made in writing by the physician and faxed or called into: UnitedHealthcare Pharmacy Services Department Fax 866-940-7328 Phone 800-310-6826 A prior authorization request form is available in the UnitedHealthcare provider manual and should be used for all prior authorization requests if possible. Appropriate documentation must be provided to support the medical necessity of the non-pdl request. The UnitedHealthcare Pharmacy Department will respond to all requests in accordance with state requirements. UHC1004a iii

Physicians are requested to adhere to this PDL when prescribing for patients covered by their pharmacy benefit plan offered by UnitedHealthcare. If a pharmacist receives a prescription for a non-pdl drug, the pharmacist should contact the prescribing physician and request that the prescription be changed to a medication included in this PDL. If a PDL alternative is not appropriate the physician should then be instructed to contact the Plan for a prior authorization. Please contact the UnitedHealthcare Pharmacy Prior Notification Service at 800-310-6826 with questions concerning the prior authorization process. NON-PDL DRUGS 5-DAY TEMPORARY SUPPLY OVERRIDES To ensure the use of PDL drugs, all non- PDL drugs should be discussed with the prescribing physician. If you cannot speak to the physician immediately, and there is an immediate need for the medication, the claim processing system will accept an override to permit a one-time dispensing of a 5-day supply of the newly prescribed non-pdl drug. The pharmacy should submit a claim for a 5 day supply, with a PA Type of 8 and Prior Authorization number of 00000000120. Please note that non-preferred drugs are available for a 5-day supply, however availability is subject to the benefit design. For assistance, pharmacies may call 800-310-6826. The pharmacy should contact the physician to discuss a PDL drug or if a prior authorization request is warranted. If the prescribing physician feels a drug is medically necessary, the physician may fax a request for prior authorization to UnitedHealthcare at 800-310-6826. QUANTITY LIMITATIONS (QL) Prescriptions for monthly quantities greater than the indicated limit require a prior authorization request. Quantity limits based on Efficient Medication Dosing The Efficient Medication Dosing Program is designed to consolidate medication dosage to the most efficient daily quantity to increase adherence to therapy and also promote the efficient use of health care dollars. The limits for the program are established based on FDA approval for dosing and the availability of the total daily dose in the least amount of tablets or capsules daily. Quantity Limits in the prescription claims processing system will limit the dispensing to consolidate dosing. The pharmacy claims processing system will prompt the pharmacist to request a new prescription order from the physician. Controlled Substances You may fill any FOUR medications from the following classes in a 30-day period: opiate analgesics benzodiazepines sedative hypnotic agents barbiturates UHC1004a iv select muscle relaxants Additional fills will require prior authorization. Medications in these classes may also be subject to individual quantity limits. Additions to the QL program drug list will be made from time to time and providers notified accordingly. As always, we recognize that a number of patient-specific variables must be taken into consideration when drug therapy is prescribed and therefore overrides will be available through the medical exception (prior authorization) process. Please contact the UnitedHealthcare Pharmacy Prior Notification Service at 800-310-6826 with questions. Specialty Pharmaceutical Management Program UnitedHealthcare is continuously looking for ways to provide high quality cost effective care for Plan members. The Specialty Pharmaceutical Management Program helps UnitedHealthcare to achieve these goals. Injectable medications that are part of this program require plan authorization and are not available through the retail pharmacy network. To obtain authorization, the provider must submit the appropriate Prior Authorization form to the UnitedHealthcare Pharmacy Department via fax at 866-940-7328. The UnitedHealthcare Pharmacy Department will review and respond to all requests in accordance with state requirements, and if authorized for payment, UnitedHealthcare will coordinate the delivery of the product to the member or provider. s that are part of this program and are on the PDL are identified in this booklet by the designation "SP". Prior Authorization request forms can be requested by calling the UnitedHealthcare Pharmacy Department at 800-310-6826. STEP THERAPY (ST) The following PDL drugs are routinely covered only after a sufficient trial of an indicated first-line agent has been adequately tried and failed. These medications may also be requested through the Prior authorization process. While lower cost PDL alternatives may be appropriate in many instances, other non- PDL alternatives are available with prior authorization (PA). STEP Amerge Aricept 23mg Banzel First-Line Agent(s) Trial at a minimum dose of 50mg of sumatriptan tablets. 90 day trial of Aricept 10mg daily 30 day trial of two of the following: lamotrigine, divalproex, or topiramate.

Breo Ellipta Ditropan XL 1) 30 day trial of one inhaled corticosteroid (e.g. Arnuity Ellipta, Asmanex) OR 2) 60 day trial of a longacting beta2- agonist (e.g. Arcapta, Striverdi) OR 60 day trial of an orally inhaled anticholinergic agent (e.g. Incruse Ellipta, Atrovent, Combivent, Anoro Ellipta). 30 day trial of oxybutynin immediate release. DPP4 Inhibitors At least a 90 day trial of 1500mg/day of (Tradjenta, metformin. Jentadueto, Onglyza, Kombiglyze) Dulera Elidel fenofibrate Gabitril 1) 30 day trial of one inhaled corticosteroid (e.g. Arnuity Ellipta, Asmanex) OR 2) 60 day trial of a longacting beta2- agonist (e.g. Arcapta, Striverdi) OR 60 day trial of an orally inhaled anticholinergic agent (e.g. Incruse Ellipta, Atrovent, Combivent, Anoro Ellipta). Trial of two different topical corticosteroids. Step therapy only applies to members 12 years of age and older. Fill of a statin or 90 days of gemfibrozil within the previous 180 days. 30 day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 12 years of age and older. Members less than 12 require prior authorization. GLP-1 Agonists At least a 90 day trial of 1500mg/day of (Tanzeum, metformin Victoza) lansoprazole/ 30 day trial of omeprazole 40mg and Prevacid OTC pantoprazole 40mg within previous 180 days is required first Lantus vials trial of Toujeo Solostar Optivar 14 day trial of ketotifen within previous 90 days required first. oxymorphone ER 30-day trial of both Fentanyl patch and morphine sulfate ER at least 200mg per day Potiga 30-day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 18 years of age and older. Members less than 18 require prior authorization. Protopic 0.03% Trial of two different topical corticosteroids. Step therapy only applies to members 12 years of age and older. Protopic 0.1% Ranexa Renvela Minimum age of 16. Trial of two different topical corticosteroids. Trial of one drug from the following classes: beta blockers, calcium channel blockers, long acting nitrates 8 week trial of calcium acetate SGLT-2 At least a 90 day trial of 1500mg/day of Inhibitors metformin (Jardiance, Invokana, Invokamet, Synjardy) tolterodine trospium 30 day trial of oxybutynin immediate release. Step Therapy only applies to members less than 65 years of age. 30 day trial of oxybutynin immediate release. Step Therapy only applies to members less than 65 years of age. TZD s At least a 90 day trial of 1500mg/day of (ActosPlusMet, metformin ActoPlusMet XR Duetact) Uloric Vancocin 8 week trial of up to 600mg of allopurinol required first. One fill of metronidazole tabs or caps levocetirizine midodrine Onfi 30 day trial of loratadine and cetirizine. Trial of fludrocortisone 30 day trial of two of the following: lamotrigine, divalproex, or topiramate. Vimpat 30 day trial of two of the following: lamotrigine, topiramate, carbamazepine, divalproex, or phenytoin. Step therapy only applies to members 17 years of age and older. Members less than 17 require prior authorization. UHC1004a v

Xopenex Respules 30 day trial of Albuterol.083% or.5% respules. Zohydro ER 30-day trial of both Fentanyl patch and morphine sulfate ER at least 200mg per day PDL SUGGESTIONS Providers who wish to propose PDL suggestions should forward the information to the UnitedHealthcare Director of Pharmacy Services by either mail or fax. Attn: Director of Pharmacy Services UnitedHealthcare Unison Plaza 1001 Brinton Road Pittsburgh, PA 15221 Phone: 800-310-6826 Providers should furnish adequate documentation, such as clinical studies from the medical literature, in order for the request to be considered for PDL addition. This literature should include information documenting clinical necessity as well as therapeutic advantages over current PDL products. Suggestions received by UnitedHealthcare will be reviewed by the Pharmacy and Therapeutics Committee at the subsequent P&T Committee meeting. EDITOR Your comments and suggestions regarding the UnitedHealthcare PDL are encouraged. Your input is vital to this PDL s continued success. All responses will be reviewed and considered. Please send your comments to: UnitedHealthcare by UnitedHealthcare Director of Pharmacy Services Unison Plaza 1001 Brinton Road Pittsburgh, PA 15221 Phone: 800-310-6826 LEGEND # Only the dosage forms/strengths of the brand name products noted are on the PDL OTC over-the-counter delayed-rel delayed-release (also known as enteric coated) EC enteric-coated ext-rel extended-release (also known as sustainedrelease) PA Prior Authorization required QL Quantity Limits apply ST SP Step Therapy, see pages V-VI for details Specialty Pharmaceuticals, see pages IV-V for details NOTICE The information contained in this document is proprietary information. The information may not be copied in whole or in part without the written permission of UnitedHealthcare. All rights reserved. The drug names listed here are the registered and/or unregistered trademarks of third-party pharmaceutical companies unrelated to and unaffiliated with UnitedHealthcare. These trademarked brand names are included here for informational purposes only and are not intended to imply or suggest any affiliation between UnitedHealthcare and such third-party pharmaceutical companies. If viewing this PDL via the Internet, please be advised that the PDL is updated periodically and changes may appear prior to their effective date to allow for notification. UHC1004a vi

Table of copays for Essential Plans How Displayed in PDL booklet Essential Plan 1 1 (Generics) 1 in column $6 for 30 days $15 for 90 days 2 (Brands) 2 in column $15 for 30 days $37.50 for 90 days Over the Counter (OTCs) DME Supplies Oral Chemotherapy Preventative s Non-Preferred s (not listed in PDL) Compounds (not listed in PDL) OTC listed in OR listed in OTC Medications section DME Supply listed in & Limits oral chemo listed in preventative drug listed in NOT LISTED IN PDL NOT LISTED IN PDL Essential Plan 2 $1 for 30 days $2.50 for 90 days $3 for 30 days $7.50 for 90 Essential Plan 3 $1 for 30 days $2.50 for 90 days $3 for 30 days $7.50 for 90 days days Plan Exclusion Plan Exclusion $1 for 30 days $2.50 for 90 days 5% coinsurance for both 30 & 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $30 for 30 days $75 for 90 days $30 for 30 days $75 for 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $3 for 30 days $7.50 for 90 days $3 for 30 days $7.50 for 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $3 for 30 days $7.50 for 90 days $3 for 30 days $7.50 for 90 days Essential Plan 4 $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days $0 for both 30 and 90 days UHC1004a vii

Table of Contents Antineoplastics & Immunosuppressants...4 Antineoplastic Agents...4 Hormonal Antineoplastic Agents....5 Immunomodulators...5 Immunosuppressants...5 Miscellaneous...6 Blood Modifiers - Anticoagulants...6 Anticoagulants...6 Blood Cell Formation...7 Platelet Inhibitors...7 Miscellaneous...7 Cardiovascular Agents...7 Ace Inhibitors...7 Ace Inhibitor/Diuretic Combinations....8 Adrenolytics, Central...8 Alpha Blockers....8 Angiotensin II Receptor Blockers (Antagonists) 8 Angiotensin II Receptor Blocker Combinations. 8 Antiarrhythmics and Cardiac Glycosides...8 Beta Blockers and Beta Blocker/Diuretic Combinations....9 Calcium Channel Blockers....9 Diuretics...10 Lipid Lowering Agents...10 Nitrates...11 Potassium-Removing Agents...11 Miscellaneous...11 Central Nervous System....11 Alzheimer s Disease...11 Analgesics...12 Migraine Acute Therapy...13 Migraine Prophylactic Therapy...14 Multiple Sclerosis....14 Myasthenia Gravis...14 Parkinson s Disease...14 Seizures....15 Miscellaneous...16 Dermatology...16 Acne Vulgaris...16 Bacterial Infections...16 Corticosteroids....17 Fungal Infections...18 Psoriasis...18 Rosacea...18 Scabies and Pediculosis....18 Viral Infections...18 Miscellaneous...19 Ear, Nose & Throat...20 Ear...20 Nose...20 Antihistamine/Decongestant Combinations - First Generation...21 Throat and Mouth...21 Endocrinology....22 Adrenal Corticosteroids...22 Androgens...22 Diabetes Mellitus...22 Growth Stimulating Agents....24 Hormones and Hormone Modifiers...24 Osteoporosis...24 Thyroid Disease...24 Miscellaneous...24 Gastrointestinal....25 Diarrhea....25 Emesis....25 Gastroesophageal Reflux Disease (Gerd)/ Peptic Ulcers...25 Gastrointestinal Spasm...26 Inflammatory Bowel Disease...26 Laxatives...27 Pancreatic Enzymes...27 Probiotic Supplementation....27 Miscellaneous...27 2

Infectious Diseases...28 Anthelmintics...28 Antibacterials...28 Miscellaneous...29 Antifungals...29 Antivirals...29 Miscellaneous...31 Musculoskeletal...32 Arthritis...32 Gout....33 Skeletal Muscle Relaxants...33 OB-GYN...34 Contraceptives...34 Endometriosis...35 Hormone Therapy/Menopause....35 Vaginal Infections....36 Miscellaneous...36 Ophthalmic...36 Allergy...36 Anti-Inflammatories...37 Glaucoma...37 Infections....38 Miscellaneous...38 Psychiatric....39 Alcohol Deterrents...39 Anxiety....39 Attention Deficit Hyperactivity Disorder (ADHD)....39 Bipolar Disorder....40 Depression...40 Insomnia...40 Narcotic Antagonists...41 Psychoses....41 Smoking Cessation...42 Miscellaneous...42 Urological...48 Symptomatic Benign Prostatic Hypertrophy..48 Miscellaneous...49 Vitamins and Minerals....49 Potassium...53 Miscellaneous...53 Anaphylaxis...53 Cystic Fibrosis...53 Hereditary Angioedema...54 Hyperphosphatemia...54 Immune Thrombocytopenic Purpura........ 54 Medical Devices....54 Metabolic Modifiers....54 Vaccine...55 OTC MEDICATIONS...56 Acne....56 Antifungals...56 Atopic Dermatitis...56 Cough/Cold Allergy....56 Diabetes...57 Earwax Removal Products...57 Family Planning...57 First Aid...57 Gastrointestinal...57 Lice Products...58 Motion Sickness....58 Ophthalmics...58 Pain...58 Smoking Cessation Products...58 Vitamins/Minerals...59 Warts...59 Miscellaneous....59 Index of covered drugs....60 Respiratory s....42 Antitussives, Decongestants, Expectorants and Combinations....42 Asthma/COPD...47 3

Generic Name Brand Name Antineoplastics & Immunosuppressants Antineoplastic Agents Alkylating Agents altretamine HEXALEN brand 2 oral chemo busulfan MYLERAN brand 2 oral chemo chlorambucil LEUKERAN brand 2 oral chemo cyclophosphamide CYTOXAN generic 1 oral chemo estramustine phosphate sodium EMCYT brand 2 oral chemo lomustine CEENU generic 1 oral chemo melphalan ALKERAN brand 2 oral chemo temozolomide TEMODAR generic 1 PA, SP, oral chemo Antimetabolites capecitabine XELODA generic 1 PA, SP, oral chemo mercaptopurine PURINETHOL generic 1 oral chemo thioguanine TABLOID brand 2 oral chemo Histone Deacetylase Inhibitors panobinostat FARYDAK brand 2 PA, SP, oral chemo vorinostat ZOLINZA brand 2 PA, SP, oral chemo Kinase Inhibitor afatinib GILOTRIF brand 2 PA, SP, oral chemo axitinib INLYTA brand 2 PA, SP, oral chemo bosutinib BOSULIF brand 2 PA, SP, oral chemo cabozantinib COMETRIQ brand 2 PA, SP, oral chemo ceritinib ZYKADIA brand 2 PA, SP, oral chemo crizotinib XALKORI brand 2 PA, SP, oral chemo dabrafenib TAFINLAR brand 2 PA, SP, oral chemo dasatinib SPRYCEL brand 2 PA, SP, oral chemo erlotinib TARCEVA brand 2 PA, SP, oral chemo everolimus AFINITOR AFINITOR DISPERZ brand 2 PA, SP, oral chemo ibrutinib IMBRUVICA brand 2 PA, SP, oral chemo idelalisib ZYDELIG brand 2 PA, SP, oral chemo imatinib mesylate GLEEVEC generic 1 PA, QL, SP, oral chemo lapatinib ditosylate TYKERB brand 2 PA, SP, oral chemo lenvatinib LENVIMA brand 2 PA, SP, oral chemo nilotinib TASIGNA brand 2 PA, SP, oral chemo palbociclib IBRANCE brand 2 PA, SP, oral chemo pazopanib VOTRIENT brand 2 PA, SP, oral chemo ponatinib ICLUSIG brand 2 PA, SP, oral chemo 4

Generic Name Brand Name regorafenib STIVARGA brand 2 PA, SP, oral chemo ruxolitinib JAKAFI brand 2 PA, SP, oral chemo sorafenib NEXAVAR brand 2 PA, SP, oral chemo sunitinib SUTENT brand 2 PA, SP, oral chemo trametinib MEKINIST brand 2 PA, SP, oral chemo vandetanib CAPRELSA brand 2 PA, SP, oral chemo vemurafenib ZELBORAF brand 2 PA, SP, oral chemo Hormonal Antineoplastic Agents Androgen Biosynthesis Inhibitors abiraterone ZYTIGA brand 2 PA, SP, oral chemo Antiandrogens bicalutamide CASODEX generic 1 oral chemo flutamide EULEXIN generic 1 oral chemo Antiestrogens tamoxifen NOLVADEX generic 1 oral chemo toremifene FARESTON brand 2 oral chemo Aromatase Inhibitors anastrozole ARIMIDEX generic 1 oral chemo exemestane AROMASIN generic 1 oral chemo letrozole FEMARA generic 1 oral chemo Gonadotropin Releasing Hormone Analog leuprolide LUPRON generic 1 PA, SP LUPRON DEPOT leuprolide LUPRON DEPOT 6-MONTH brand 2 PA, SP LUPRON DEPOT-PED Progestin megestrol acetate MEGACE generic 1 oral chemo Immunomodulators Interferons interferon alfa-2b INTRON A brand 2 PA, SP peginterferon alfa-2b SYLATRON brand 2 PA, SP Miscellaneous lenalidomide REVLIMID brand 2 PA, SP pomalidomide POMALYST brand 2 PA, SP, oral chemo thalidomide THALOMID brand 2 PA, SP Immunosuppressants Antimetabolites azathioprine IMURAN generic 1 mycophenolate mofetil CELLCEPT generic 1 5

Generic Name Brand Name mycophenolate sodium MYFORTIC generic 1 Calcineurin Inhibitors cyclosporine SANDIMMUNE generic 1 cyclosporine, modified NEORAL GENGRAF generic 1 tacrolimus HECORIA PROGRAF generic 1 Other everolimus ZORTRESS brand 2 Rapamycin Derivative sirolimus RAPAMUNE generic 1 tabs sirolimus RAPAMUNE brand 2 solution Miscellaneous alitretinoin 1% gel PANRETIN brand 2 PA bexarotene caps TARGRETIN generic 1 PA, SP, oral chemo bexarotene topical gel TARGRETIN brand 2 PA, SP cysteamine bitartrate CYSTAGON brand 2 SP etoposide VEPESID generic 1 oral chemo hydroxyurea DROXIA brand 2 hydroxyurea HYDREA generic 1 oral chemo mesna MESNEX brand 2 oral chemo mitotane LYSODREN brand 2 oral chemo octreotide SANDOSTATIN generic 1 SP olaparib LYNPARZA brand 2 PA, SP, oral chemo pasireotide SIGNIFOR brand 2 PA, SP procarbazine MATULANE brand 2 SP, oral chemo topotecan HYCAMTIN brand 2 PA, SP tretinoin VESANOID generic 1 SP, caps, oral chemo vismodegib ERIVEDGE brand 2 PA, SP, oral chemo Blood Modifiers - Anticoagulants Anticoagulants apixaban ELIQUIS brand 2 edoxaban SAVAYSA brand 2 enoxaparin LOVENOX generic 1 heparin HEPARIN generic 1 rivaroxaban XARELTO brand 2 PA, QL, PA only applies for quantities greater than 14 days 6

Generic Name Brand Name warfarin COUMADIN generic 1 Blood Cell Formation darbepoetin alfa ARANESP brand 2 PA, SP epoetin alfa EPOGEN PROCRIT brand 2 PA, SP filgrastim ZARXIO brand 2 PA, SP oprelvekin NEUMEGA brand 2 PA, SP pegfilgrastim NEULASTA brand 2 PA, SP plerixafor MOZOBIL brand 2 PA, SP sargramostim LEUKINE brand 2 PA, SP TBO-filgrastim GRANIX brand 2 PA, SP Platelet Inhibitors anagrelide AGRYLIN generic 1 aspirin BAYER OTC, preventative generic 1 ECOTRIN drug cilostazol PLETAL generic 1 clopidogrel PLAVIX generic 1 QL dipyridamole PERSANTINE generic 1 Miscellaneous aminocaproic acid AMICAR brand 2 500 mg tabs & syrup only deferasirox pentoxifylline extended-release Cardiovascular Agents EXJADE JADENU TRENTAL generic 1 Ace Inhibitors benazepril LOTENSIN generic 1 captopril CAPOTEN generic 1 enalapril VASOTEC generic 1 enalapril oral soln EPANED brand 2 brand 2 PA, SP Members 8 years of age will require prior authorization. fosinopril MONOPRIL generic 1 QL lisinopril ZESTRIL generic 1 QL quinapril ACCUPRIL generic 1 QL 7

Generic Name Brand Name Ace Inhibitor/Diuretic Combinations benazepril/ hydrochlorothiazide LOTENSIN HCT generic 1 captopril/ hydrochlorothiazide CAPOZIDE generic 1 enalapril/ hydrochlorothiazide VASERETIC generic 1 fosinopril/ hydrochlorothiazide MONOPRIL-HCT generic 1 QL lisinopril/ hydrochlorothiazide ZESTORETIC generic 1 QL quinapril/ hydrochlorothiazide ACCURETIC generic 1 QL Adrenolytics, Central clonidine CATAPRES generic 1 tablets guanfacine TENEX generic 1 Alpha Blockers doxazosin CARDURA generic 1 prazosin MINIPRESS generic 1 terazosin HYTRIN generic 1 Angiotensin II Receptor Blockers (Antagonists) losartan COZAAR generic 1 QL Angiotensin II Receptor Blocker Combinations losartan/hctz HYZAAR generic 1 QL Antiarrhythmics and Cardiac Glycosides amiodarone tabs CORDARONE generic 1 200 mg and 400 mg digoxin LANOXIN generic 1 disopyramide NORPACE generic 1 disopyramide extended-release NORPACE CR brand 2 dofetilide TIKOSYN brand 2 flecainide TAMBOCOR generic 1 mexiletine MEXITIL generic 1 propafenone RYTHMOL generic 1 IR only quinidine gluconate extended-release EXT-REL QUINIDINE GLUCONATE generic 1 quinidine sulfate QUINIDINE SULFATE generic 1 quinidine sulfate QUINIDINE SULFATE extended-release EXT-REL generic 1 8

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Generic Name Brand Name mifepristone KORLYM brand 2 PA, SP pegvisomant SOMAVERT brand 2 PA, SP sapropterin KUVAN brand 2 PA, SP sapropterin powder KUVAN POWDER FOR SO- LUTION brand 2 PA, SP Gastrointestinal Diarrhea diphenoxylate/atropine LOMOTIL generic 1 loperamide IMODIUM A-D generic 1 OTC loperamide LOPERAMIDE generic 1 Emesis aprepitant EMEND brand 2 QL applies to 40 mg, 80 mg and 80-125 mg dronabinol MARINOL generic 1 PA meclizine ANTIVERT generic 1 metoclopramide REGLAN generic 1 ondansetron ZOFRAN ZOFRAN ODT generic 1 QL prochlorperazine COMPAZINE generic 1 promethazine PHENERGAN generic 1 trimethobenzamide TIGAN generic 1 300 mg caps Gastroesophageal Reflux Disease (Gerd)/Peptic Ulcers alginic acid/sodium bicarbonate brand 2 OTC alumina/magnesia MAALOX generic 1 OTC alumina/magnesia/ simethicone MYLANTA generic 1 OTC cimetidine TAGAMET generic 1 esomeprazole NEXIUM 24HR OTC brand 2 PA Members 2 years esomeprazole granules NEXIUM DELAYED of age will require brand 2 RELEASE PACKET prior authorization. famotidine PEPCID PEPCID AC generic 1 OTC Pepcid AC 10 mg and 20 mg also covered/encouraged with written prescription. lansoprazole PREVACID generic 1 PA 25

Generic Name lansoprazole delayed-release Brand Name PREVACID SOLUTAB generic 1 orally disintegrating tabs, Members 2 years of age will require prior authorization. QL omeprazole delayed-release PRILOSEC generic 1 Capsules only, QL pantoprazole PROTONIX generic 1 ranitidine ZANTAC generic 1 150 mg tabs ranitidine syrup ZANTAC generic 1 sucralfate CARAFATE generic 1 sulcralfate CARAFATE SUSPENSION generic 1 Gastrointestinal Spasm dicyclomine BENTYL generic 1 glycopyrrolate ROBINUL generic 1 hyoscyamine sulfate LEVSIN generic 1 hyoscyamine sulfate LEVSINEX generic 1 suspension, Members 10 years of age up to 65 years of age will require prior authorization. extended-release Inflammatory Bowel Disease balsalazide COLAZAL generic 1 budesonide ENTOCORT EC generic 1 PA hydrocortisone COLOCORT generic 1 enema mesalamine ROWASA generic 1 enema only mesalamine extended-release ASACOL HD APRISO DELZICOL LIALDA brand 2 PENTASA mesalamine supp CANASA brand 2 olsalazine sodium DIPENTUM brand 2 sulfasalazine AZULFIDINE generic 1 sulfasalazine delayed-release AZULFIDINE EN-TABS generic 1 26

Generic Name Laxatives casanthranol-docusate sodium Brand Name generic 1 OTC docusate calcium plus generic 1 OTC docusate potasssium generic 1 OTC docusate sodium COLACE generic 1 OTC lactulose ENULOSE generic 1 glycerin GLYCERIN SUPPOSITORY generic 1 suppository, OTC peg 3350/electrolytes COLYTE generic 1 peg 3350/sodium bicarbonate/sodium chloride peg 3350/sodium bicarbonate/sodium chloride/potassium chloride TRILYTE generic 1 NULYTELY generic 1 polyethylene glycol 3350 MIRALAX generic 1 sennosides SENOKOT generic 1 8.6 mg tab, OTC Pancreatic Enzymes pancrelipase CREON CREON 3000 UNIT brand 2 ZENPEP Probiotic Supplementation acidophilus ACIDOPHILUS brand 2 caps and tabs, OTC acidophilus ACIDOPHILUS XTRA brand 2 OTC acidophilus/bifidus ACIDOPHILUS/ BIFIDUS WAFER brand 2 OTC acidophilus/citrus pectin ACIDOPHILUS/ CITRUS PECTIN brand 2 tabs, OTC acidophilus/pectin ACIDOPHILUS/PECTIN brand 2 caps, OTC lactobacillus FLORANEX brand 2 chewable tablets, OTC probiotic product PROBIOTIC FORMULA brand 2 caps, OTC Miscellaneous atropine sulfate SAL-TROPINE brand 2 bismuth subsalicylate + metronidazole + HELIDAC brand 2 tetracycline misoprostol CYTOTEC generic 1 naloxegol MOVANTIK brand 2 PA teduglutide GATTEX brand 2 PA, SP 27

Generic Name ursodiol Infectious Diseases Brand Name ACTIGALL URSO URSO FORTE generic 1 Anthelmintics albendazole ALBENZA brand 2 ivermectin STROMECTOL brand 2 praziquantel BILTRICIDE brand 2 PA Antibacterials Antituberculosis Agents ethambutol MYAMBUTOL generic 1 isoniazid ISONIAZID generic 1 pyrazinamide PYRAZINAMIDE generic 1 rifabutin MYCOBUTIN generic 1 rifampin RIFADIN generic 1 Cephalosporins - First Generation cefadroxil DURICEF generic 1 cephalexin KEFLEX generic 1 tabs are not covered Cephalosporins - Second Generation cefaclor CECLOR generic 1 cefprozil CEFZIL generic 1 cefuroxime axetil CEFTIN generic 1 tabs cefuroxime axetil CEFTIN brand 2 suspension Cephalosporins - Third Generation cefdinir OMNICEF generic 1 cefixime SUPRAX brand 2 400 mg caps only, QL Fluoroquinolones ciprofloxacin CIPRO generic 1 levofloxacin LEVAQUIN generic 1 tablets only ofloxacin FLOXIN generic 1 tabs Macrolides azithromycin ZITHROMAX generic 1 QL clarithromycin BIAXIN generic 1 clarithromycin ER BIAXIN XL generic 1 erythromycin delayed-release ERYC generic 1 erythromycin delayed-release ERY-TAB brand 2 28

Generic Name Brand Name erythromycin ethylsuccinate E.E.S. generic 1 erythromycin stearate ERYTHROCIN generic 1 erythromycin/sulfisoxazole PEDIAZOLE generic 1 Penicillins amoxicillin AMOXICILLIN CAPSULES AND CHEWABLES generic 1 Except 500 mg and 875 mg film-coated tabs. amoxicillin AMOXIL SUSP generic 1 suspension amoxicillin/clavulanate AUGMENTIN generic 1 ampicillin PRINCIPEN generic 1 dicloxacillin DICLOXACILLIN generic 1 penicillin VK VEETIDS generic 1 Sulfonamides sulfamethoxazole/ trimethoprim, DS Tetracyclines doxycycline monohydrate BACTRIM BACTRIM DS DOXYCYCLINE MONOHYDRATE generic 1 generic 1 minocycline MINOCIN generic 1 capsules, except 75 mg tetracycline SUMYCIN generic 1 Miscellaneous vancomycin HCl VANCOCIN HCL generic 1 cap, ST Antifungals clotrimazole MYCELEX generic 1 troches fluconazole DIFLUCAN generic 1 QL griseofulvin microsize GRIFULVIN V generic 1 griseofulvin ultramicrosize GRIS-PEG generic 1 itraconazole SPORANOX generic 1 caps, PA, QL itraconazole SPORANOX brand 2 soln, PA, QL ketoconazole NIZORAL generic 1 nystatin MYCOSTATIN generic 1 terbinafine LAMISIL generic 1 QL voriconazole VFEND generic 1 PA Antivirals Cytomegalovirus Treatment ganciclovir CYTOVENE generic 1 valganciclovir VALCYTE generic 1 tabs only 29

Generic Name Brand Name Entry/Fusion Inhibitors enfuvirtide FUZEON KIT brand 2 Hepatitis Treatment adefovir HEPSERA generic 1 SP daclatasvir DAKLINZA brand 2 PA, SP entecavir BARACLUDE brand 2 SP interferon alfa-2b INTRON A brand 2 PA, SP interferon alfacon-1 INFERGEN brand 2 PA, SP lamivudine EPIVIR HBV brand 2 SP, solution lamivudine EPIVIR HBV generic 1 SP, tablets ledipasvir/sofosbuvir HARVONI brand 2 PA, SP peginterferon alfa-2a PEGASYS brand 2 PA, SP peginterferon alfa-2a PEGASYS PROCLICK brand 2 PA, SP ribavirin REBETOL/COPEGUS generic 1 200 mg caps and tabs only, PA, SP sofosbuvir SOVALDI brand 2 PA, SP Herpes Treatment acyclovir ZOVIRAX generic 1 caps, tabs, suspension valacyclovir VALTREX generic 1 Influenza Treatment amantadine SYMMETREL generic 1 except tabs oseltamivir TAMIFLU brand 2 QL rimantadine FLUMADINE generic 1 zanamivir RELENZA brand 2 QL Non-Nucleoside Reverse Transcriptase Inhibitors delavirdine RESCRIPTOR brand 2 efavirenz SUSTIVA brand 2 nevirapine VIRAMUNE generic 1 nevirapine ER VIRAMUNE XR brand 2 rilpivirine EDURANT brand 2 Nucleoside Analogues Nucleoside Reverse - Transcriptase Inhibitors/and Combinations abacavir ZIAGEN generic 1 abacavir/lamivudine EPZICOM brand 2 abacavir/lamivudine/ zidovudine TRIZIVIR generic 1 didanosine VIDEX brand 2 didanosine delayed-release VIDEX EC generic 1 emtricitabine EMTRIVA brand 2 emtricitabine/rilpivirine/ tenofovir COMPLERA brand 2 lamivudine EPIVIR generic 1 lamivudine/zidovudine COMBIVIR generic 1 30

Generic Name Brand Name stavudine ZERIT generic 1 zidovudine RETROVIR generic 1 Nucleoside/Nucleotide Reverse - Transcriptase Inhibitor Combination cobicistat/elvitegravir/ emtricitabine/tenofovir STRIBILD brand 2 PA efavirenz/emtricitabine/ tenofovir ATRIPLA brand 2 emtricitabine/tenofovir TRUVADA brand 2 PA Nucleotide Analogues Nucleotide Reverse - Transcriptase Inhibitor tenofovir VIREAD brand 2 Protease Inhibitors atazanavir REYATAZ brand atazanavir Members 8 years of REYATAZ POWDER brand 2 age will require prior PACKET authorization darunavir PREZISTA brand 2 fosamprenavir LEXIVA brand 2 indinavir CRIXIVAN brand 2 lopinavir/ritonavir KALETRA brand 2 nelfinavir VIRACEPT brand 2 ritonavir NORVIR brand 2 saquinavir mesylate INVIRASE brand 2 tipranavir APTIVUS brand 2 Miscellaneous abacavir/dolutegravir/ lamivudine TRIUMEQ brand 2 atovaquone MEPRON generic 1 PA bedaquiline SIRTURO brand 2 PA chloroquine phosphate ARALEN generic 1 clindamycin CLEOCIN generic 1 150 mg and 300 mg only cobicistat TYBOST brand 2 dapsone DAPSONE brand 2 darunavir/cobicistat PREZCOBIX brand 2 dolutegravir TIVICAY brand 2 etravirine INTELENCE brand 2 hydroxychloroquine PLAQUENIL generic 1 interferon gamma-1b ACTIMMUNE brand 2 PA, SP linezolid ZYVOX generic 1 PA maraviroc SELZENTRY brand 2 mefloquine LARIAM generic 1 metronidazole FLAGYL generic 1 tabs only neomycin sulfate brand 2 31

Generic Name Brand Name Members 8 years of nitazoxanide suspension ALINIA SUSPENSION brand 2 age will require prior authorization. nitazoxanide tablet ALINIA brand 2 PA nitrofurantoin extended-release MACROBID generic 1 nitrofurantoin macrocrystals MACRODANTIN generic 1 nitrofurantoin susp FURADANTIN SUSP 25 MG/5 ML generic 1 Members 8 years of age will require prior authorization. palivizumab SYNAGIS brand 2 PA, SP paromomycin HUMATIN generic 1 povidone-iodine generic 1 OTC primaquine generic 1 pyrimethamine DARAPRIM brand 2 PA, SP raltegravir ISENTRESS brand 2 raltegravir ISENTRESS CHEWABLE brand 2 chewable tablet raltegravir susp ISENTRESS SUSP brand 2 Members 2 years of age will require prior authorization. trimethoprim TRIMETHOPRIM generic 1 tabs only Musculoskeletal Arthritis Disease Modifying Anti-Rheumatic s adalimumab HUMIRA brand 2 PA, SP anakinra KINERET brand 2 PA, SP auranofin RIDAURA brand 2 azathioprine IMURAN generic 1 certolizumab pegol CIMZIA brand 2 PA, SP hydroxychloroquine PLAQUENIL generic 1 leflunomide ARAVA generic 1 methotrexate generic 1 oral chemo penicillamine CUPRIMINE brand 2 SP sulfasalazine AZULFIDINE generic 1 sulfasalazine delayed-release AZULFIDINE EN-TABS generic 1 NSAIDs and Other Analgesics acetaminophen TYLENOL generic 1 OTC aspirin BAYER OTC, preventative generic 1 ECOTRIN drug capsaicin brand 2 OTC 32

Generic Name Brand Name celecoxib CELEBREX generic 1 PA, QL choline magnesium trisalicylate TRILISATE generic 1 diclofenac 1% gel VOLTAREN 1% TOPICAL GEL brand 2 PA diclofenac potassium CATAFLAM generic 1 diclofenac sodium delayed-release VOLTAREN generic 1 diclofenac sodium extended-release VOLTAREN XR generic 1 etodolac LODINE generic 1 IR only fenoprofen NALFON generic 1 600 mg ibuprofen ADVIL generic 1 tabs, chew tabs ibuprofen MOTRIN generic 1 and susp, OTC tabs, chew tabs and susp indomethacin INDOCIN generic 1 ketoprofen ORUDIS generic 1 IR only meloxicam MOBIC generic 1 QL naproxen NAPROSYN generic 1 not EC naproxen sodium ANAPROX generic 1 oxaprozin DAYPRO generic 1 piroxicam FELDENE generic 1 sulindac CLINORIL generic 1 Gout allopurinol ZYLOPRIM generic 1 colchicine MITIGARE brand 2 febuxostat ULORIC brand 2 ST probenecid PROBENECID generic 1 Skeletal Muscle Relaxants Muscle Spasm chlorzoxazone PARAFON FORTE DSC generic 1 cyclobenzaprine FLEXERIL generic 1 methocarbamol ROBAXIN generic 1 orphenadrine NORFLEX generic 1 extended-release Spasticity baclofen BACLOFEN generic 1 dantrolene DANTRIUM generic 1 diazepam VALIUM generic 1 QL tizanidine ZANAFLEX generic 1 tabs only, QL 33

Generic Name Brand Name OB-GYN Contraceptives Biphasic desogestrel/ee MIRCETTE generic 1 QL, preventative drug norethindrone/ee ORTHO-NOVUM 10/11 generic 1 QL, preventative drug Emergency Contraception levonorgestrel PLAN B generic 1 QL, preventative drug levonorgestrel PLAN B ONE STEP generic 1 1.5 mg tab, preventative drug Extended Cycle levonorgestrel/ee SEASONALE generic 1 QL, preventative drug Injectable medroxyprogesterone acetate Intravaginal DEPO-PROVERA generic 1 QL, preventative drug etonogestrel/ee NUVARING brand 2 ortho diaphragm ORTHO COIL ORTHO FLAT ORTHO FLEX Monophasic - 20 mcg Estrogen levonorgestrel/ee ALESSE generic 1 norethindrone acetate/ee LOESTRIN 1/20 generic 1 norethindrone acetate/ee/ LOESTRIN FE 1/20 iron generic 1 Monophasic - 30 mcg Estrogen desogestrel/ee ORTHO-CEPT generic 1 levonorgestrel/ee NORDETTE generic 1 norethindrone acetate/ee LOESTRIN 1.5/30 generic 1 norethindrone acetate/ee/ iron LOESTRIN FE 1.5/30 generic 1 norgestrel/ee LO/OVRAL generic 1 ring, QL, preventative drug brand 2 QL, preventative drug 0.1/20, QL, preventative drug 1/20, QL, preventative drug 1/20, QL, preventative drug 0.15/30, QL, preventative drug 0.15/30, QL, preventative drug 1.5/30, QL, preventative drug 1.5/30, QL, preventative drug 0.3/30, QL, preventative drug 34

Generic Name Monophasic - 35 mcg Estrogen Brand Name ethynodiol diacetate/ee ZOVIA 1/35 generic 1 norethindrone/ee BALZIVA generic 1 norethindrone/ee MODICON generic 1 norethindrone/ee ORTHO-NOVUM 1/35 generic 1 norgestimate/ee ORTHO-CYCLEN generic 1 Monophasic - 50 mcg Estrogen 1/35, QL, preventative drug 0.4/35, QL, preventative drug 0.5/35, QL, preventative drug 1/35, QL, preventative drug 0.25/35, QL, preventative drug ethynodiol diacetate/ee ZOVIA 1/50 generic 1 1/50, QL, preventative drug norethindrone/ee OVCON 50 generic 1 1/50, QL, preventative drug norethindrone/me ORTHO-NOVUM 1/50 generic 1 1/50, QL, preventative drug norgestrel/ee OVRAL generic 1 0.5/50, QL, preventative drug Progestin norethindrone ORTHO MICRONOR generic 1 preventative drug norgestrel OVRETTE generic 1 preventative drug Transdermal norelgestromin/ee ORTHO EVRA generic 1 preventative drug Triphasic desogestrel/ee CYCLESSA generic 1 QL, preventative drug levonorgestrel/ee TRIVORA generic 1 QL, preventative drug norethindrone acetate/ee/iron ESTROSTEP FE generic 1 QL, preventative drug norethindrone/ee TRI-NORINYL generic 1 QL, preventative drug norethindrone/ee ORTHO-NOVUM 7/7/7 generic 1 QL, preventative drug norgestimate/ee ORTHO TRI-CYCLEN generic 1 QL, preventative drug Endometriosis danazol DANOCRINE generic 1 Gender edits apply: for female patients only. Hormone Therapy/Menopause Estrogens - Intravaginal estradiol ESTRACE CRM brand 2 estrogens, conjugated PREMARIN brand 2 crm Estrogens - Oral estradiol ESTRACE generic 1 estrogens, conjugated PREMARIN brand 2 35

Generic Name Brand Name estrogens, conjugated, synthetic A CENESTIN brand 2 estrogens, conjugated, synthetic B ENJUVIA brand 2 estropipate OGEN generic 1 Estrogens - Transdermal estradiol CLIMARA generic 1 QL Estrogen/Progestin estrogens, conjugated/medroxyprogesterone PREMPRO PREMPHASE brand 2 Progestins medroxyprogesterone acetate PROVERA generic 1 norethindrone acetate AYGESTIN generic 1 Vaginal Infections Oral fluconazole DIFLUCAN generic 1 QL metronidazole FLAGYL generic 1 tabs Vaginal clotrimazole GYNE-LOTRIMIN generic 1 OTC clindamycin CLEOCIN generic 1 crm metronidazole METROGEL-VAGINAL METROGEL 1% generic 1 miconazole MONISTAT generic 1 OTC miconazole MONISTAT 3 generic 1 terconazole TERAZOL 3/7 generic 1 crm Miscellaneous conjugated estrogen/ bazedoxifene DUAVEE brand 2 methylergonovine METHERGINE generic 1 tranexamic acid LYSTEDA generic 1 PA Ophthalmic Allergy azelastine OPTIVAR generic 1 ST cromolyn sodium CROLOM generic 1 QL ketotifen ALAWAY OTC brand 2 naphazoline/antazoline brand 2 naphazoline/glycerin CLEAR EYES REDNESS RELIEF generic 1 naphazoline HCL VASOCLEAR generic 1 soln 0.02% naphazoline/zinc sulfate VASOCLEAR A generic 1 36

Generic Name Brand Name tetrahydrozoline/ zinc sulfate VISINE-AC generic 1 Anti-Inflammatories Nonsteroidal diclofenac sodium VOLTAREN generic 1 flurbiprofen OCUFEN generic 1 ketorolac ACULAR/ACULAR LS generic 1 Steroidal dexamethasone sodium phosphate DEXASOL generic 1 fluorometholone FML brand 2 oint 0.1% fluorometholone FML FORTE brand 2 susp 0.25% fluorometholone FML LIQUIFILM generic 1 susp 0.1% prednisolone acetate PRED FORTE generic 1 1% prednisolone acetate PRED MILD brand 2 0.12% prednisolone phosphate INFLAMASE FORTE generic 1 1% rimexolone VEXOL brand 2 Anti-Infective/Anti-Inflammatory Combinations gentamicin/prednisolone acetate PRED-G brand 2 neomycin/polymyxin B/ hydrocortisone CORTISPORIN generic 1 neomycin/polymyxin B/ dexamethasone MAXITROL generic 1 sulfacetamide/pred phos VASOCIDIN generic 1 10%/0.25% tobramycin/ dexamethasone TOBRADEX generic 1 Glaucoma Beta-Blockers carteolol generic 1 levobunolol BETAGAN generic 1 ophthalmic solution metipranolol OPTIPRANOLOL generic 1 0.3% ophthalmic solution timolol TIMOPTIC XE generic 1 gel forming solution timolol hemihydrate BETIMOL brand 2 timolol maleate TIMOPTIC generic 1 Carbonic Anhydrase Inhibitors dorzolamide TRUSOPT generic 1 Carbonic Anhydrase Inhibitor/Beta-Blocker Combination dorzolamide/ COSOPT generic 1 timolol maleate Cholinesterase Inhibitor ecothiophate PHOSPHOLINE IODINE brand 2 37

Generic Name Brand Name Mydriatics atropine ISOPTO ATROPINE generic 1 cyclopentolate CYCLOGYL generic 1 homatropine ISOPTO HOMATROPINE generic 1 scopolamine ISOPTO HYOSCINE brand 2 Oral acetazolamide ACETAZOLAMIDE generic 1 acetazolamide DIAMOX SEQUELS generic 1 extended-release methazolamide NEPTAZANE generic 1 Prostaglandins latanoprost XALATAN generic 1 QL Topical - Parasympathomimetics pilocarpine ISOPTO CARPINE generic 1 pilocarpine PILOPINE HS GEL brand 2 Topical - Sympathomimetics brimonidine ALPHAGAN P brand 2 brimonidine BRIMONIDINE generic 1 0.2% Infections Bacterial bacitracin generic 1 ciprofloxacin CILOXAN generic 1 erythromycin ERYTHROMYCIN generic 1 gatifloxin ZYMAR brand 2 PA gentamicin GENTAK generic 1 neomycin/polymyxin B/ NEOSPORIN generic 1 gramicidin ofloxacin OCUFLOX generic 1 polymyxin B/bacitracin POLYSPORIN generic 1 polymyxin B/trimethoprim POLYTRIM generic 1 sulfacetamide BLEPH-10 generic 1 oint/soln sulfacetamide/ VASOSULF brand 2 phenylephrine tobramycin TOBREX generic 1 Viral trifluridine VIROPTIC generic 1 Miscellaneous cysteamine 0.44% ophthalmic solution sodium chloride hypertonic CYSTARAN brand 2 PA, SP MURO 128 generic 1 soln 5% 38

Generic Name Brand Name Psychiatric Alcohol Deterrents acamprosate CAMPRAL brand 2 disulfiram ANTABUSE generic 1 naltrexone REVIA generic 1 Anxiety Benzodiazepines alprazolam XANAX generic 1 QL, IR only chlordiazepoxide LIBRIUM generic 1 clonazepam KLONOPIN generic 1 not wafers clorazepate TRANXENE generic 1 diazepam VALIUM generic 1 QL lorazepam ATIVAN generic 1 QL oxazepam SERAX generic 1 QL Miscellaneous buspirone BUSPAR generic 1 fluvoxamine LUVOX generic 1 Attention Deficit Hyperactivity Disorder (ADHD) amphetamine/ dextroamphetamine ADDERALL generic 1 Age Limits Apply, QL mixed salts amphetamine/ dextroamphetamine mixed salts extended-release ADDERALL XR (BRAND ADDERALL XR IS PREFERRED) brand 2 Age Limits Apply, QL dextroamphetamine DEXEDRINE generic 1 Age Limits Apply, QL dextroamphetamine DEXTROSTAT brand 2 Age Limits Apply, QL dextroamphetamine extended-release DEXEDRINE SPANSULE generic 1 Age Limits Apply, QL guanfacine ER INTUNIV generic 1 lisdexamfetamine VYVANSE brand 2 Age Limits Apply, QL methylphenidate RITALIN generic 1 Age Limits Apply, tabs only, QL methylphenidate extended-release methylphenidate extended-release CONCERTA generic 1 Age Limits Apply, QL METADATE ER RITALIN-SR RITALIN LA generic 1 Age Limits Apply, QL 39

Generic Name Bipolar Disorder divalproex sodium cap sprinkle Brand Name DEPAKOTE SPRINKLE generic 1 Members 8 years of age will require prior authorization. divalproex sodium delayed-release DEPAKOTE generic 1 Minimum age 2 lithium carbonate LITHIUM CARBONATE generic 1 lithium carbonate ESKALITH CR extended-release LITHOBID generic 1 Depression Monoamine Oxidase Inhibitor (MAOI) tranylcypromine PARNATE generic 1 Selective Serotonin Reuptake Inhibitor (SSRIs) citalopram CELEXA generic 1 QL escitalopram LEXAPRO generic 1 fluoxetine PROZAC generic 1 10 mg and 20 mg caps and 20 mg soln only paroxetine PAXIL generic 1 tablets sertraline ZOLOFT generic 1 tablets, QL Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) duloxetine CYMBALTA generic 1 QL venlafaxine EFFEXOR generic 1 QL venlafaxine XR EFFEXOR XR generic 1 QL Tricyclic Antidepressants (TCAs) amitriptyline ELAVIL generic 1 tablets amoxapine generic 1 desipramine NORPRAMIN generic 1 doxepin SINEQUAN generic 1 imipramine HCL TOFRANIL generic 1 tablets nortriptyline PAMELOR generic 1 Tricyclic Antidepressant/Phenothiazine Combination amitriptyline/perphenazine TRIAVIL generic 1 Miscellaneous Agents bupropion WELLBUTRIN generic 1 bupropion WELLBUTRIN SR generic 1 QL, preventative drug extended-release bupropion extended-release WELLBUTRIN XL generic 1 150 mg and 300 mg maprotiline LUDIOMIL generic 1 mirtazapine REMERON generic 1 tabs (not soltabs) trazodone DESYREL generic 1 150 mg only Insomnia 40

Generic Name Brand Name Benzodiazepines flurazepam DALMANE generic 1 QL temazepam RESTORIL generic 1 15 mg and 30 mg only, QL triazolam HALCION generic 1 QL Non-Benzodiazepines chloral hydrate CHLORAL HYDRATE generic 1 diphenhydramine NYTOL QUICK CAPS generic 1 OTC zaleplon SONATA generic 1 QL zolpidem AMBIEN generic 1 QL Narcotic Antagonists buprenorphine SUBUTEX generic 1 PA, QL buprenorphine/naloxone SUBOXONE brand 2 2 mg and 8 mg film only, PA, QL naloxone NALOXONE INJ generic 1 QL naltrexone REVIA generic 1 Psychoses Atypicals aripiprazole ABILIFY TABLETS generic 1 Age Limit Applies, tablets, PA, QL aripiprazole ER injection ABILIFY MAINTENA brand 2 Age Limit Applies, PA, QL clozapine CLOZARIL generic 1 Age Limit Applies, 100 mg only olanzapine ZYPREXA generic 1 Age Limit Applies, tablets, QL paliperidone INVEGA SUSTENNA brand 2 Age Limit Applies, PA, QL paliperidone INVEGA TRINZA brand 2 Age Limit Applies, PA quetiapine SEROQUEL generic 1 Age Limit Applies, QL risperidone RISPERDAL generic 1 Age Limit Applies, QL, (Not M-Tabs) risperidone RISPERDAL CONSTA brand 2 Age Limit Applies, PA, QL risperidone oral soln RISPERDAL SOLUTION generic 1 QL, Members 8 years of age will require prior authorization. ziprasidone GEODON generic 1 Age Limit Applies, QL 41

Generic Name Brand Name Smoking Cessation nicotine NICODERM CQ generic 1 patches, QL, preventative drug nicotine polacrilex gum NICORETTE OTC generic 1 QL, preventative drug nicotine polacrilex lozenge COMMITT OTC generic 1 QL, preventative drug varenicline CHANTIX brand 2 QL, preventative drug Miscellaneous chlorpromazine THORAZINE generic 1 dextromethorphan/ quinidine NUEDEXTA brand 2 PA fluphenazine PROLIXIN generic 1 fluphenazine decanoate PROLIXIN DECANOATE generic 1 haloperidol HALDOL generic 1 haloperidol decanoate HALDOL DECANOATE generic 1 loxapine LOXITANE generic 1 perphenazine TRILAFON generic 1 pimozide ORAP generic 1 thioridazine MELLARIL generic 1 thiothixene NAVANE generic 1 trifluoperazine STELAZINE generic 1 Respiratory s Antitussives, Decongestants, Expectorants and Combinations benzonatate TESSALON generic 1 brompheniramine & DIMETAPP CLD ELX/ phenylephrine ALLERGY generic 1 brompheniramine/ ACCUHIST DROPS pseudoephedrine RESPERAL-DM generic 1 liquid BROMFENEX PD CAP brompheniramine/ pseudoephedrine brompheniramine/ pseudoephedrine brompheniramine/ pseudoephedrine/ dextromethorphan brompheniramine/ pseudoephedrine/ dextromethorphan DIMETAPP ELX CLD/ALLE UNI-HIST DRO CARDEC SYP generic 1 RONDEC SYRUP generic 1 syrup ACCUHIST PDX DROPS generic 1 liquid BROMALINE DM generic 1 elixir 42

Generic Name brompheniramine/ pseudoephedrine/ dextromethorphan brompheniramine/ pseudoephedrine/ dextromethorphan/ guaifenesin carbetapentane/ chlorpheniramine/ ephedrine/ phenylephrine carbinoxamine/ pseudoephedrine chlorphen-pemethscopolamine chlorphen tan/ carbetapentane tan chlorphen tan/ pseudoeph tan chlorphen tan/pyrilamine tan/pe tan chlorpheniramine/ dextromethorphan chlorpheniramine maleate phenylephrine HCL chlorpheniramine/ phenylephrine chlorpheniramine/ phenylephrine Brand Name BROMFED DM DALLERGY DM CARBOFED NEO DM ANAPLEX DM generic 1 syrup HISTACOL DM generic 1 syrup RYNATUSS generic 1 RONDEC DROPS generic 1 liquid DURADRYL QV-ALLERGY generic 1 syrup TUSSI-12 S generic 1 susp TANAFED generic 1 susp TRIOTANN PEDIATRIC SUSP R-TANNAMINE ROBITUSSIN PED LIQ CGH/COLD ROBITUSSIN LIQ CGH/CLD DIMETAPP SYP CGH/CLD CORICIDIN TAB CGH/CLD ED A-HIST TABLETS AND LIQUID RONDEC DROPS CARDEC DRO RONDEC SYRUP CARDEC SYP generic 1 susp generic 1 generic 1 generic 1 liquid generic 1 syrup 43

Generic Name chlorpheniramine/ pseudoephedrine chlorpheniramine tan/ phenylephrine tan codeine/ chlorpheniramine/ pseudoephedrine codeine/guaifenesin codeine/guaifenesin/pseudoephedrine codeine/promethazine codeine/promethazine/ phenylephrine dextromethorphan/ brompheniramine/ pseudoephedrine dextromethorphan/ carbinoxamine/ pseudoephedrine dextromethorphanguaifenesin dextromethorphan/ guaifenesin dextromethorphanguaifenesin dextromethorphan hbr Brand Name HISTEX CPM/PSE generic 1 RYNATAN PEDIATRIC SUSP generic 1 susp DIHISTINE DH PHENYLHIST LIQ DH GUIATUSS AC GG/CODEINE M-CLEAR WC generic 1 GUIATUSS DAC generic 1 PROMETHAZINE W/CODEINE PROMETHAZINE VC W/CODEINE BROMETANE DX generic 1 generic 1 QL generic 1 QL generic 1 QL CARDEC-DM generic 1 drops DURATUSS DM ELX generic 1 soln 25-225 mg/5 ml GG/DM CR MUCINEX DM ROBITUSSIN DM TUSSIN DM ROBITUSSIN LIQ CGH/ CONG ROBITUSSIN SYP MAX-ST generic 1 OTC generic 1 liq 10-200 mg/ 5 ml generic 1 syrup ROBITUSSIN PED SYP dextromethorphan polistirex DELSYM brand 2 OTC extended-release dextromethorphan/ PHENERGAN DM promethazine PROMETHAZINE SYP DM generic 1 guaifenesin ROBITUSSIN generic 1 OTC guaifenesin ROBITUSSIN SYP CHST CNG generic 1 syrup 100 mg/5 ml 44

Generic Name guaifenesin extended-release guaifenesin/ pseudoephedrine guaifenesin/ pseudoephedrine/ dextromethorphan guaifenesin/ pseudoephedrine extended-release guaifenesin/ pseudoephedrine extended-release hydrocodone/ chlorpheniramine/ phenylephrine hydrocodone/ guaifenesin hydrocodone/ homatropine loratadine & pseudoephedrine SR 24hr phenyleph/bromphen/ dextromethorphan/ guaifenesin phenylephrine/ brompheniramine/ dextromethorphan phenylephrine/ chlorpheniramine phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ chlorpheniramine/ dextromethorphan Brand Name MUCINEX generic 1 OTC ROBITUSSIN PE PSE/GG ROBITUSSIN CF generic 1 GUAIFED generic 1 GUAIFEN PSE MUCINEX D GG/PSE CR HISTUSSIN HC generic 1 VITUSSIN HYDROCODO/GG SYP HYCODAN HYDROMET SYP HYDROCODONE/ TAB HOMATROP ALLERGY/CONG TAB RE- LIEF generic 1 syrup, OTC generic 1 OTC generic 1 generic 1 ALLANHIST SYP PDX generic 1 QUAL-TUSSIN SYP DC generic 1 generic 1 tab 10-240 mg generic 1 OTC ATUSS DR generic 1 syrup DE-CHLOR DM generic 1 syrup 45

Generic Name phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ chlorpheniramine/ dextromethorphan phenylephrine/ chlorpheniramine/ dihydrocodeine phenylephrine/ dextromethorphan phenylephrine/ dextromethorphan/ guaifenesin phenylephrine/ephed/ CPM w/ carbetapentane phenylephrine/guaifenesin phenylephrine/ hydrocodone/ guaifenesin phenylephrine/pyrilamine/ dextromethorphan phenylephrine/pyrilamine w/hydrocodone phenylephrine tan/ pyrilamine tan/ carbeta tan promethazine & phenylephrine pseudoephedrine/ acetaminophen/ dextromethorphan pseudoephedrine/ chlorpheniramine/ dextromethorphan Brand Name RONDEC DM STATUSS DM SYP CARDEC DM SYP MINUTUSS DR SYP RONDEC DM DROPS CARDEC DM DRO ROBITUSSIN LIQ CGH/ALRG DIHYDRO-PE SYP generic 1 DIMETAPP DRO DCON/CGH ROBITUSSIN LIQ CGH/CLD RYNATUSS PEDIATRIC SUSP ROBITUSSIN LIQ HD/CHST generic 1 syrup generic 1 liquid generic 1 generic 1 generic 1 susp generic 1 QUAL-TUSSIN SYP DC generic 1 CODAL-DM generic 1 CODIMAL DH generic 1 syrup TUSSI 12D S generic 1 susp PROMETH VC SYP 6.25-5/5 generic 1 MAPAP COLD TAB generic 1 PEDIACARE LIQ MULTI-SY ROBITUSSIN LIQ PED NGHT generic 1 syrup 6.25-5 mg/ 5 mg 46

Generic Name pseudoephedrine/ dextromethorphan/ guaifenesin pseudoephedrine/ iburprofen pseudoephedrine tan/ dexchlorphen tan/ DM tan pyrilamine tan/phenyleph tan tripolidine/ Brand Name MULTI SYMPTOM TAB COLD RLF CHILD IBUPRO SUS COLD IBUOROFEN TAB COLD/SIN TANAFED DMX SUSPENSION TRI-FED X generic 1 generic 1 generic 1 susp RYNA-12 S generic 1 susp TRIPROL/PSE SYP pseudoephedrine APHEDRID TAB generic 1 Asthma/COPD Inhalers - Beta Agonists albuterol sulfate VENTOLIN HFA brand 2 QL indacaterol ARCAPTA NEOHALER brand 2 olodaterol STRIVERDI RESPIMAT brand 2 Inhalers - Corticosteroids fluticasone furoate ARNUITY ELLIPTA brand 2 QL mometasone ASMANEX TWISTHALER brand 2 QL mometasone inhalation ASMANEX HFA brand 2 QL Inhalers - Corticosteroid/Beta Agonist Combinations fluticasone/vilanterol BREO ELLIPTA brand 2 ST mometasone/formoterol DULERA brand 2 ST Inhalers - Others cromolyn INTAL brand 2 QL ipratropium/albuterol COMBIVENT brand 2 QL ipratropium/albuterol COMBIVENT RESPIMAT brand 2 inhaler ipratropium HFA ATROVENT HFA brand 2 nedocromil TILADE brand 2 omalizumab XOLAIR brand 2 PA, SP umeclidinium inhalation INCRUSE ELLIPTA brand 2 umeclidinium/vilanterol ANORO ELLIPTA brand 2 47

Generic Name Inhalers for Nebulization Brand Name albuterol ACCUNEB generic 1 0.63 mg/3 ml and 1.25 mg /3 ml, for members less than 8 years of age. Members 8 years of age will require prior authorization. albuterol PROVENTIL generic 1 soln 0.083%, 0.5% budesonide PULMICORT RESPULES generic 1 susp, Members 5 years of age will require prior authorization. QL cromolyn INTAL generic 1 soln, QL ipratropium ATROVENT generic 1 soln, QL ipratropium/albuterol DUONEB generic 1 soln levalbuterol HCl XOPENEX RESPULES generic 1 QL, ST Oral Agents - Beta Agonists metaproterenol METAPROTERENOL SYRUP generic 1 terbutaline BRETHINE generic 1 Oral Agents - Leukotriene Modifiers montelukast SINGULAIR generic 1 QL Oral Agents - Theophylline theophylline THEOPHYLLINE generic 1 liquid theophylline extended-release theophylline extended-release theophylline extended-release theophylline extended-release Urological THEO-24 brand 2 caps THEOCHRON generic 1 tabs THEOPHYLLINE EXT-REL generic 1 caps (12 hr) UNIPHYL generic 1 tabs Symptomatic Benign Prostatic Hypertrophy alfuzosin ER UROXATRAL generic 1 doxazosin CARDURA generic 1 finasteride PROSCAR generic 1 tamsulosin FLOMAX generic 1 terazosin HYTRIN generic 1 48

Generic Name Brand Name Miscellaneous bethanechol URECHOLINE generic 1 hyoscyamine, methenamine, phenyl salicylate, sodium phosphate UTIRA C brand 2 monobasic, methylene blue methenamine hippurate HIPREX generic 1 UREX oxybutynin chloride DITROPAN XL generic 1 QL, ST oxybutynin IR DITROPAN generic 1 phenazopyridine PYRIDIUM generic 1 potassium citrate UROCIT-K generic 1 propantheline generic 1 sodium citrate/citric acid BICITRA generic 1 tolterodine DETROL generic 1 ST trospium SANCTURA generic 1 ST Vitamins and Minerals calcitriol ROCALTROL generic 1 calcitriol oral soln ROCALTROL SOLUTION generic 1 Members 8 years of age will require prior authorization. calcium OS-CAL generic 1 OTC cholecalciferol BIO-D DRO-MULSION brand 2 drops 400 unit/0.03 ml, OTC drops 2000 unit/0.03 ml, OTC cholecalciferol BIO-D-MULSIO DRO FORTE brand 2 cholecalciferol D3-50 CAP brand 2 cap 50000 unit, OTC cholecalciferol VITAMIN D CAP 400 UNIT brand 2 cap 400 unit, OTC cholecalciferol VITAMIN D CAP 2000 UNIT brand 2 cap 2000 unit, OTC cholecalciferol VITAMIN D TAB 400 UNIT brand 2 tab 400 unit, OTC cholecalciferol VITAMIN D TAB 1000 UNIT brand 2 tab 1000 unit, OTC cholecalciferol VITAMIN D TAB 2000 UNIT brand 2 tab 2000 unit, OTC 49

Generic Name Brand Name inj, Coverage for these medications will be determined by the member s individual cyanocobalamin VITAMIN B-12 generic 1 benefits. Please refer to individual plan documents for coverage information. electrolyte PEDIALYTE generic 1 soln, oral, OTC ergocalciferol (D2) DRISDOL generic 1 Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. ferrous bisglycinate/ caps, OTC, NIFEREX generic 1 polysaccarides iron preventative drug ferrous sulfate FEOSOL generic 1 OTC, preventative drug Coverage for these GEL-KAM medications will be determined by the LURIDE member s individual fluoride LURIDE LOZI-TABS generic 1 benefits. PREVIDENT Please refer to individual plan PHOS-FLUR documents for coverage information. folic acid FOLIC ACID generic 1 preventative drug magnesium oxide MAG-OX generic 1 OTC, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. 50

Generic Name multivitamins/ fluoride/±iron Brand Name POLY-VI-FLOR generic 1 multivitamins/minerals CENTRUM generic 1 phytonadione MEPHYTON brand 2 polysaccharide iron complex NIFEREX generic 1 prenat-fe Bis-FE COMPLETE NATALCARE prot succ-fa-ca PAK DHA & omega 3 brand 2 prenat-fe Bis-FE prot succ-fa-ca & omega 3 prenat-fe Bis-FE prot succ-fa-ca & omega 3 prenat-fe bis-fe prot succ-fa-ca & omega DR prenat w/o A w/fecbn-fegl- DSS-FA & DHA prenatal vit w/fe bisglyc-fe prot succ-fa prenatal vit w/fe bisglycinate chelate-fa TRUST NATALCARE PAK DHA PRUET DHA PAK SETONET PAK brand 2 brand 2 PRUET DHAEC PAK brand 2 FOLTABS PAK PLUS DHA RE OB + DHA PAK brand 2 VINATE III brand 2 VITAPHIL brand 2 Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. OTC, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. elixir, OTC, preventative drug 51

Generic Name prenatal vit w/fe bisglycinate chelate-fa prenatal vit w/fe bisglycinate chelate-fa prenatal vit w/fe polysac cmplx-fa prenatal vit w/iron carbonyl-fa prenatal vitamins w/folic acid prenatal w/o A w/fe carbonyl-fe gluc-dss-fa Brand Name GENTEX ADE 28-1 MG brand 2 VINATE AZ EX brand 2 EDGE OB CHW brand 2 ATABEX PRENATAL brand 2 PRENATAL VITAMINS W/ FOLIC ACID CENOGEN OB/ULTRA MATERNA NATALCARE NESTABSCBF/FA/RX NIFEREX-PN FORTE FOLTABS PRENATAL TRI RX generic 1 QL brand 2 vitamin A generic 1 OTC vitamin ADC/fluoride/±iron drops vitamin B complex/ vitamin C/folic acid TRI-VI-FLOR generic 1 NEPHROCAPS generic 1 Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. vitamin B-1 generic 1 OTC vitamin B-6 generic 1 OTC vitamin C generic 1 OTC 52

Generic Name Brand Name vitamins pediatric TRI-VI-SOL generic 1 members <3 years old, OTC, Coverage for these medications will be determined by the member s individual benefits. Please refer to individual plan documents for coverage information. zinc generic 1 OTC Potassium phosphorus K-PHOS NEUTRAL generic 1 tabs potassium acid phosphate K-PHOS ORIGINAL brand 2 potassium bicarbonate/ potassium citrate effervescent potassium chloride extended-release K-LYTE generic 1 tabs K-DUR 10 K-DUR 20 KLOR-CON 8 generic 1 tabs KLOR-CON 10 potassium chloride extended-release MICRO-K 10 generic 1 caps potassium chloride K-LOR generic 1 powder potassium chloride POTASSIUM CHLORIDE generic 1 liquid potassium iodide PIMA brand 2 Miscellaneous Anaphylaxis epinephrine EPIPEN EPIPEN JR. brand 2 QL TWINJECT Cryopyrin - Associated Periodic Syndromes (CAPS) canakinumab ILARIS brand 2 PA, SP rilonacept ARCALYST brand 2 PA, SP Cystic Fibrosis acetylcysteine MUCOMYST generic 1 aztreonam CAYSTON brand 2 PA, SP dornase alfa PULMOZYME brand 2 PA, SP ivacaftor KALYDECO KALYDECO GRANULES brand 2 PA, SP 53

Generic Name Brand Name lumacaftor/ivacaftor ORKAMBI brand 2 PA, SP tobramycin neb soln BETHKIS brand 2 PA, SP Hereditary Angioedema C1 Inhibitor, Human BERINERT brand 2 PA, SP icatibant FIRAZYR brand 2 PA, SP Hyperphosphatemia calcium acetate generic 1 667 mg tablet only cinacalcet SENSIPAR brand 2 PA sevelamer RENVELA generic 1 ST Idiopathic Pulmonary Fibrosis (IPF) nintedanib OFEV brand 2 PA, SP pirfenidone capsule ESBRIET brand 2 PA, SP Immune Thrombocytopenic Purpura eltrombopag PROMACTA brand 2 PA, SP Medical Devices spacers QL, DME Supply Metabolic Modifiers carglumic acid CARBAGLU brand 2 PA, SP glycerol phenylbutyrate RAVICTI brand 2 PA, SP sodium phenylbutyrate oral powder BUPHENYL ORAL POWDER generic 1 PA, SP 54

Generic Name Vaccine influenza virus vaccine live quadrivalent intranasal nfluenza virus vaccine recombinant hemagglutinin (ha) influenza virus vaccine split influenza virus vaccine split high-dose pf influenza virus vaccine split pf influenza virus vaccine split quadrivalent nfluenza virus vaccine tisscult subunit influenza virus vaccine types a&b surface antigen pneumococcal 13-valent conjugate pneumococcal vaccine polyvalent Brand Name FLUMIST QUAD brand 2 QL FLUBLOK brand 2 QL AFLURIA, FLUZONE SPLT brand 2 QL FLUZONE HD PF brand 2 QL AFLURIA PF brand 2 QL FLUZONE QUAD brand 2 QL FLUCELVAX brand 2 QL FLUVIRIN brand 2 QL PREVNAR 13 brand 2 QL PNEUMOVAX, PNEU- MOVAX 23 brand 2 QL typhoid vaccine VIVOTIF BERNA brand 2 capsules, preventative drug zoster vaccine live ZOSTAVAX brand 2 QL, Age Limits Apply 55

Generic Name Brand Name Examples OTC MEDICATIONS The following is a list of OTC products on the PDL. Some OTC products are listed on the drug list. OTC products covered are restricted to generics when available. Brand names are provided as reference only. Over-the-counter drugs are coverable for Essential Plan 3 and 4 only. Acne benzoyl peroxide crm, gel, lotion Antifungals clotrimazole miconazole crm, soln tolnaftate vaginal products Atopic Dermatitis emollients Cough/Cold Allergy antihistamines Antihistamine/Decongestant Combinations brompheniramine/pseudoephedrine cetirizine/pseudoephedrine OTC chlorpheniramine/pseudoephedrine loratadine/pseudoephedrine CLEARASIL MICATIN LOTRIMIN AF TINACTIN MONISTAT GYNE-LOTRIMIN BETACARE CREAM AND LOTION CETAPHIL CREAM AND LOTION DERMAPHOR OINTMENT E-OINTMENT GLYCERIN TOPICAL CHLOR-TRIMETON BENADRYL CLARITIN ALAVERT ZYRTEC DIMETAPP ZYRTEC D ACTIFED ALAVERT ALRG TAB/SINUS ALAVERT D ALLERGY/CONG 56

Generic Name Brand Name Examples Cough/Cold antitussives Age edit applied. Not covered for members under the age 2. nasal sprays Diabetes alcohol swabs (DME Supply) glucose oral tablets insulin (vials only) Earwax Removal Products carbamide peroxide Family Planning condoms (preventative drug) contraceptive foam (preventative drug) contraceptive gel (preventative drug) First Aid Burow s soln, wet dressings dermatological baths hydrocortisone crm, oint topical antibacterials Gastrointestinal antacids liquids, chew tabs antidiarrheals electrolyte rehydrating soln famotidine laxative enemas ROBITUSSIN ROBITUSSIN DM ROBITUSSIN PE ROBITUSSIN CF DELSYM NEO-SYNEPHRINE AFRIN DIMETAPP DRO DECONGES CURITY ALCOHOL PADS HUMULIN NOVOLIN DEBROX TROJAN DELFEN GYNOL II DOMEBORO COLLOIDAL OATMEAL BATHS CORTAID NEOSPORIN MYCITRACIN BACITRACIN MYLANTA LIQUID MAALOX LIQUID TUMS IMODIUM A-D KAOPECTATE PEDIALYTE PEPCID AC FLEET ENEMA 57

Generic Name laxatives psyllium rectal hydrocortisone crm, suppositories simethicone stool softeners sugar+orthophosphoric acid Lice Products permethrin piperonyl butoxide gel, liquid shampoo Motion Sickness dimenhydrinate meclizine Ophthalmics allergic conjunctivitis artificial tears decongestants Pain acetaminophen tabs, liquid, drops, suppositories aspirin tabs, EC tabs (preventative drug) aspirin with buffers tabs ibuprofen tabs, chew tabs and susp Smoking Cessation Products nicotine (preventative drug) Brand Name Examples DULCOLAX FLEET PHOSPHO-SODA METAMUCIL PREPARATION H MYLICON COLACE EMETROL NIX PIPERONYL BUTOXIDE DRAMAMINE BONINE ALAWAY HYPOTEARS VISINE MURINE NAPHCON A TYLENOL BAYER ECOTRIN ADVIL MOTRIN IB COMMIT LOZENGES (QUANTITY LIMIT) NICODERM CQ (QUANTITY LIMIT) NICOTINE GUM (QUANTITY LIMIT) NICOTROL (QUANTITY LIMIT) 58

Generic Name Vitamins/Minerals calcium iron (preventative drug) ferrous fumarate, ferrous, gluconate, errous sulfate, ferrous bis-glycinate chelate and polysaccharide iron caps iron polysaccharides (preventative drug) magnesium oxide vitamin D 400 IU vitamins pediatric members <3 years old vitamins prenatal Warts salicylic acid 17%/collodion Miscellaneous fluoride dental rinse Brand Name Examples OS-CAL CALTRATE TUMS FERGON FEOSOL NIFEREX MAG-OX VITAMIN D 400 IU VI-DAYLIN POLY-VI-SOL TRI-VI-SOL STUART PRENATAL DUOFILM PHOS-FLUR 59

Index of covered s drugs A abacavir............ 30 abacavir/dolutegravir/ lamivudine........ 31 abacavir/lamivudine..... 30 abacavir/lamivudine/ zidovudine.........30 ABILIFY MAINTENA..... 41 ABILIFY TABLETS...... 41 abiraterone...........5 acamprosate......... 39 acarbose............23 ACCUHIST DROPS..... 42 ACCUHIST PDX DROPS.. 42 ACCUNEB.......... 48 ACCUPRIL........... 7 ACCURETIC.......... 8 ACCUTANE.......... 16 acebutalol............9 acetaminophen......12, 32 acetaminophen tabs, liquid, drops, suppositories... 58 acetazolamide.........38 ACETAZOLAMIDE...... 38 acetazolamide extended-release..... 38 acetic acid...........20 acetic acid/aluminum acetate 20 acetic acid/hydrocortisone..20 acetylcysteine.........53 acidophilus.......... 27 ACIDOPHILUS........ 27 acidophilus/bifidus...... 27 ACIDOPHILUS/ BIFIDUS WAFER..... 27 acidophilus/citrus pectin...27 ACIDOPHILUS/ CITRUS PECTIN..... 27 acidophilus/pectin...... 27 ACIDOPHILUS/PECTIN... 27 ACIDOPHILUS XTRA.... 27 acitretin............ 18 ACLOVATE.......... 17 ACTIFED.......... 21, 56 ALL CAPS = Brand-name drug Lower case = Generic drug ACTIGALL.......... 28 ACTIMMUNE......... 31 ACTOPLUSMET....... 23 ACTOPLUS MET XR..... 23 ACTOS............. 23 ACULAR/ACULAR LS.... 37 acyclovir............ 30 ADALAT CC........... 9 adalimumab..........32 ADDERALL.......... 39 ADDERALL XR........ 39 adefovir............ 30 ADVIL......... 12, 33, 58 afatinib............. 4 AFINITOR............ 4 AFINITOR DISPERZ...... 4 AFLURIA, FLUZONE SPLT.. 55 AFLURIA PF.......... 55 AFRIN........... 21, 57 AGRYLIN............ 7 ALAVERT......... 20, 56 ALAVERT ALRG TAB/SINUS...... 21, 56 ALAVERT D....... 21, 56 ALAWAY............ 58 ALAWAY OTC......... 36 albendazole.......... 28 ALBENZA........... 28 albiglutide........... 24 albuterol............ 48 albuterol sulfate........47 alclometasone........ 17 alcohol swabs.........57 ALDACTAZIDE........ 10 ALDACTONE......... 10 ALDARA............ 19 ALDOMET........... 11 ALDORIL........... 11 alendronate.......... 24 ALESSE............ 34 alfuzosin ER..........48 alginic acid/sodium bicarbonate........ 25 ALINIA............. 32 60 ALINIA SUSPENSION.... 32 alirocumab.......... 10 alitretinoin 1% gel....... 6 ALKERAN............ 4 ALLANHIST SYP PDX.... 45 allergic conjunctivitis..... 58 ALLERGY/CONG...... 56 ALLERGY/CONG TAB RELIEF........ 45 ALLERY/CONG....... 21 allopurinol........... 33 ALPHAGAN P......... 38 alprazolam...........39 altretamine........... 4 alumina/magnesia...... 25 alumina/magnesia/ simethicone........25 aluminum acetate.......19 aluminum chloride hexahydrate........19 amantadine........14, 30 AMARYL............ 23 AMBIEN............ 41 ambrisentan..........11 AMERGE........... 14 AMICAR............. 7 amiloride............10 amiloride/hydrochlorothiazide10 aminocaproic acid.......7 amiodarone tabs........8 amitriptyline........14, 40 amitriptyline/perphenazine. 40 amlodipine...........9 ammonium lactate...... 19 amoxapine...........40 amoxicillin........... 29 AMOXICILLIN CAPSULES AND CHEWABLES... 29 amoxicillin/clavulanate.... 29 AMOXIL SUSP........ 29 amphetamine/dextroamphetamine mixed salts.... 39 amphetamine/dextroamphetamine mixed salts extended-release..... 39

Index of s ampicillin........... 29 anagrelide........... 7 anakinra............ 32 ANAPLEX DM........ 43 ANAPROX......... 13, 33 anastrozole...........5 ANORO ELLIPTA....... 47 ANTABUSE.......... 39 antacids liquids, chew tabs. 57 antidiarrheals......... 57 antihistamines.........56 antitussives........... 57 ANTIVERT........... 25 ANUSOL HC 2.5%...... 19 APHEDRID TAB........ 47 apixaban............ 6 aprepitant........... 25 APRESOLINE......... 11 APRISO............ 26 APTIVUS........... 31 ARALEN............ 31 ARANESP............ 7 ARAVA............. 32 ARCALYST.......... 53 ARCAPTA NEOHALER... 47 ARICEPT........... 11 ARIMIDEX............ 5 aripiprazole.......... 41 aripiprazole ER injection... 41 ARNUITY ELLIPTA...... 47 AROMASIN........... 5 ARTANE............ 14 artificial tears......... 58 ASACOL HD......... 26 ASMANEX HFA........ 47 ASMANEX TWISTHALER.. 47 aspirin........... 7, 32 aspirin/acetaminophen/ caffeine.......... 12 aspirin tabs, EC tabs..... 58 aspirin with buffers tabs... 58 ASTELIN............ 21 ATABEX PRENATAL..... 52 ATARAX............ 20 atazanavir........... 31 ALL CAPS = Brand-name drug Lower case = Generic drug atenolol.............9 atenolol/chlorthalidone.... 9 ATIVAN............ 39 atorvastatin.......... 10 atovaquone.......... 31 ATRALIN........... 16 ATRIPLA............ 31 atropine............ 38 atropine sulfate........ 27 ATROVENT.......... 48 ATROVENT HFA....... 47 ATROVENT NASAL SPRAY. 21 ATUSS DR.......... 45 AUBAGIO........... 14 AUGMENTIN......... 29 auranofin........... 32 AVITA............. 16 AVONEX/AVONEX PEN... 14 axitinib............. 4 AYGESTIN........... 36 azathioprine........ 5, 32 azelaic acid.......... 16 azelastine.........21, 36 azithromycin..........28 aztreonam...........53 AZULFIDINE....... 26, 32 AZULFIDINE EN-TABS.. 26, 32 B bacitracin.........16, 38 BACITRACIN....... 16, 57 baclofen............ 33 BACLOFEN.......... 33 BACTRIM........... 29 BACTRIM DS......... 29 BACTROBAN......... 16 balsalazide.......... 26 BALZIVA............ 35 BANZEL............ 15 BARACLUDE......... 30 BAYER......... 7, 32, 58 becaplermin gel........19 bedaquiline.......... 31 BENADRYL........ 20, 56 benazepril............7 61 benazepril/hydrochlorothiazide8 BENTYL............ 26 BENZAC AC......... 16 BENZAMYCIN........ 16 benzocaine/antipyrine.... 20 benzonatate..........42 BENZOTIC.......... 20 benzoyl peroxide.....16, 56 benztropine.......... 14 BERINERT.......... 54 BETACARE CREAM AND LOTION.......... 56 BETAGAN........... 37 betamethasone augmented dip....17, 18 betamethasone dipropionate 17 betamethasone val...... 17 BETAPACE........... 9 BETA-VAL........... 17 bethanechol..........49 BETHKIS........... 54 BETIMOL........... 37 bexarotene caps........6 bexarotene topical gel.....6 BIAXIN............. 28 BIAXIN XL........... 28 bicalutamide..........5 BICITRA............ 49 BILTRICIDE.......... 28 BIO-D DRO-MULSION.... 49 BIO-D-MULSIO DRO FORTE....... 49 bismuth subsalicylate + metronidazole + tetracycline... 27 bisoprolol............9 bisoprolol/hydrochlorothiazide 9 BLEPH-10........... 38 BONINE............ 58 bosentan........... 11 BOSULIF............ 4 bosutinib............ 4 BRAVELLE.......... 24 BREO ELLIPTA........ 47 BRETHINE.......... 48 brimonidine........18, 38

Index of s BRIMONIDINE........ 38 BROMALINE DM....... 42 BROMETANE DX....... 44 BROMFED DM........ 43 BROMFENEX PD CAP.... 42 brompheniramine & phenylephrine.......42 brompheniramine/ pseudoephedrine.. 42, 56 brompheniramine/ pseudoephedrine/ dextromethorphan..42, 43 brompheniramine/ pseudoephedrine/dextromethorphan/guaifenesin 43 budesonide........26, 48 bumetanide.......... 10 BUMEX............ 10 BUPHENYL ORAL POWDER 54 buprenorphine........ 41 buprenorphine/naloxone...41 bupropion........... 40 bupropion extended-release 40 Burow s soln, wet dressings. 57 BUSPAR............ 39 buspirone........... 39 busulfan.............4 butalbital/acetaminophen.. 12 butalbital/acetaminophen/ caffeine.......... 12 butalbital/apap/caff/cod...13 butalbital/asa/caff/cod....13 butalbital/aspirin/caffeine.. 12 butorphanol.......... 13 C C1 Inhibitor, Human..... 54 cabergoline.......... 24 cabozantinib.......... 4 CAFERGOT.......... 13 calamine............19 CALAN........... 9, 14 CALAN SR........... 9 calcipotriene......... 18 calcitonin-salmon.......24 ALL CAPS = Brand-name drug Lower case = Generic drug calcitriol..........18, 49 calcium..........49, 59 calcium acetate........54 CALTRATE.......... 59 CAMPRAL........... 39 canagliflozin..........23 canagliflozin/metformin... 23 canakinumab......... 53 CANASA............ 26 capecitabine..........4 CAPOTEN............ 7 CAPOZIDE........... 8 CAPRELSA........... 5 capsaicin........... 32 captopril.............7 captopril/hydrochlorothiazide.8 CARAC............ 19 CARAFATE.......... 26 CARAFATE SUSPENSION. 26 CARBAGLU.......... 54 carbamazepine........ 15 carbamazepine extended-release..... 15 carbamide peroxide...20, 57 CARBATROL......... 15 carbetapentane/ chlorpheniramine/ ephedrine/ phenylephrine.......43 carbidopa/levodopa..... 14 carbidopa/levodopa extended-release..... 14 carbinoxamine/ pseudoephedrine.....43 CARBOFED.......... 43 CARDEC-DM......... 44 CARDEC DM DRO...... 46 CARDEC DM SYP...... 46 CARDEC DRO........ 43 CARDEC SYP....... 42, 43 CARDENE............ 9 CARDIZEM........... 9 CARDIZEM CD......... 9 CARDIZEM SR......... 9 CARDURA......... 8, 48 62 carglumic acid........ 54 carteolol............ 37 carvedilol............9 casanthranol-docusate sodium.......... 27 CASODEX............ 5 CATAFLAM.......... 33 CATAPRES........... 8 CAYSTON........... 53 CECLOR........... 28 CEENU............. 4 cefaclor............ 28 cefadroxil........... 28 cefdinir.............28 cefixime............ 28 cefprozil............ 28 CEFTIN............ 28 cefuroxime axetil....... 28 CEFZIL............. 28 CELEBREX.......... 33 celecoxib........... 33 CELEXA............ 40 CELLCEPT........... 5 CELONTIN.......... 15 CENESTIN.......... 36 CENOGEN OB/ULTRA... 52 CENTRUM.......... 51 cephalexin...........28 ceritinib.............4 certolizumab pegol......32 CETAPHIL CREAM AND LOTION.......... 56 cetirizine............20 cetirizine chew tab...... 20 cetirizine hydrochloride/pseudoephedrine hydrochloride extended-release..... 21 cetirizine/ pseudoephedrine OTC..56 cetrorelix acetate for inj kit.. 24 CETROTIDE.......... 24 CHANTIX........... 42 CHILD IBUPRO SUS COLD. 47 chloral hydrate........ 41 CHLORAL HYDRATE.... 41

Index of s chlorambucil..........4 chlordiazepoxide....... 39 chlorhexidine gluconate... 21 chloroquine phosphate....31 chlorothiazide.........10 chlorothiazide.........10 chlorpheniramine/ dextromethorphan.... 43 chlorpheniramine extended-release..... 20 chlorpheniramine maleate.. 20 chlorpheniramine maleate phenylephrine HCL....43 chlorpheniramine/ phenylephrine.......43 chlorpheniramine/ phenylephrine/ pyrilamine......... 21 chlorpheniramine/ pseudoephedrine 21, 44, 56 chlorpheniramine tan/ phenylephrine tan.... 44 chlorphen-pemethscopolamine.... 43 chlorphen tan/ carbetapentane tan....43 chlorphen tan/ pseudoeph tan...... 43 chlorphen tan/pyrilamine tan/ PE tan........... 43 chlorpromazine........ 42 chlorpropamide........23 chlorthalidone.........10 CHLORTHALIDONE..... 10 CHLOR-TRIMETON..... 56 CHLOR-TRIMETON ALLERGY......... 20 CHLOR-TRIMETON SYRUP. 20 chlorzoxazone.........33 CHOLBAM.......... 24 cholecalciferol.........49 cholestyramine........ 10 cholic acid...........24 choline magnesium trisalicylate...... 12, 33 ALL CAPS = Brand-name drug Lower case = Generic drug choriogonadotropin alfa inj. 24 ciclopirox........... 18 cilostazol............ 7 CILOXAN........... 38 cimetidine........... 25 CIMZIA............. 32 cinacalcet........... 54 CIPRO............. 28 CIPRODEX.......... 20 ciprofloxacin....... 28, 38 ciprofloxacin/dexamethasone20 citalopram...........40 clarithromycin.........28 clarithromycin ER.......28 CLARITIN......... 20, 56 CLEARASIL.......... 56 CLEAR EYES REDNESS RELIEF.......... 36 clemastine...........20 CLEMASTINE......... 20 CLEOCIN......... 31, 36 CLEOCIN T.......... 16 CLIMARA........... 36 clindamycin..... 16, 31, 36 CLINORIL......... 13, 33 clobazam........... 15 clobetasol propionate.... 18 clonazepam....... 15, 39 clonidine............ 8 clopidogrel...........7 clorazepate.......... 39 clotrimazole... 18, 29, 36, 56 clotrimazole with betamethasone......18 clozapine........... 41 CLOZARIL........... 41 cobicistat........... 31 cobicistat/elvitegravir/emtricitabine/tenofovir......31 CODAL-DM.......... 46 codeine/acetaminophen...13 codeine/chlorpheniramine/ pseudoephedrine.....44 codeine/guaifenesin..... 44 63 codeine/guaifenesin/ pseudoephedrine.....44 codeine/promethazine....44 codeine/promethazine/ phenylephrine.......44 codeine sulfate........ 13 CODIMAL DH......... 46 COGENTIN.......... 14 COLACE......... 27, 58 COLAZAL........... 26 colchicine........... 33 collagenase oint....... 19 COLLOIDAL OATMEAL BATHS........... 57 COLOCORT......... 26 COLYTE............ 27 COMBIVENT......... 47 COMBIVENT RESPIMAT.. 47 COMBIVIR.......... 30 COMETRIQ........... 4 COMMIT LOZENGES.... 58 COMMITT OTC........ 42 COMPAZINE......... 25 COMPLERA.......... 30 COMPLETE NATALCARE PAK DHA......... 51 COMTAN........... 14 CONCERTA.......... 39 condoms........... 57 CONDYLOX SOL....... 18 conjugated estrogen/ bazedoxifene....... 36 contraceptive foam...... 57 contraceptive gel....... 57 COPAXONE.......... 14 CORDARONE......... 8 CORDRAN.......... 17 COREG............. 9 CORICIDIN TAB CGH/CLD. 43 CORTAID........... 57 CORTEF............ 22 cortisone acetate....... 22 CORTISPORIN........ 37 CORTISPORIN OTIC..... 20 CORTIZONE......... 17

Index of s CORTIZONE-10 INTENSIVE HEALING......... 17 COSOPT........... 37 COUMADIN........... 7 COZAAR............ 8 CPM/PSE........... 44 CREAM 2.5%......... 19 CREON............ 27 CRIXIVAN........... 31 crizotinib............ 4 CROLOM........... 36 cromolyn......... 47, 48 cromolyn sodium.....21, 36 crotamiton...........18 CUPRIMINE.......... 32 CURITY ALCOHOL PADS.. 57 CUTIVATE........... 17 cyanocobalamin....... 50 CYCLESSA.......... 35 cyclobenzaprine....... 33 CYCLOGYL.......... 38 cyclopentolate.........38 cyclophosphamide.......4 cyclosporine.......... 6 cyclosporine, modified.....6 CYMBALTA.......... 40 cyproheptadine........ 20 CYPROHEPTADINE..... 20 CYSTAGON........... 6 CYSTARAN.......... 38 cysteamine 0.44% ophthalmic solution....38 cysteamine bitartrate......6 CYTOMEL........... 24 CYTOTEC........... 27 CYTOVENE.......... 29 CYTOXAN............ 4 D D3-50 CAP.......... 49 dabrafenib........... 4 daclatasvir...........30 DAKLINZA........... 30 DALLERGY DM........ 43 DALMANE........... 41 ALL CAPS = Brand-name drug Lower case = Generic drug danazol............ 35 DANOCRINE......... 35 DANTRIUM.......... 33 dantrolene...........33 dapsone............31 DAPSONE........... 31 DARAPRIM.......... 32 darbepoetin alfa........ 7 darunavir........... 31 darunavir/cobicistat..... 31 dasatinib............ 4 DAYPRO.......... 13, 33 DDAVP............. 24 DEBROX......... 20, 57 DECADRON......... 22 DE-CHLOR DM........ 45 decongestants........ 58 deferasirox........... 7 DELATESTRYL........ 22 delavirdine...........30 DELFEN............ 57 DELSYM.......... 44, 57 DELTASONE......... 22 DELZICOL.......... 26 DEMADEX.......... 10 DEMEROL.......... 13 DEPAKENE.......... 16 DEPAKOTE...... 14, 15, 40 DEPAKOTE SPRINKLE.... 14, 15, 40 DEPO-PROVERA....... 34 DEPO-TESTOSTERONE... 22 DERMAPHOR OINTMENT. 56 DERMA-SMOOTHE OIL/FS. 17 dermatological baths.....57 DERMATOP.......... 17 DESENEX........... 18 desipramine..........40 desmopressin.........24 desogestrel/ee......34, 35 DESYREL........... 40 DETROL............ 49 dexamethasone........22 dexamethasone sodium phosphate.........37 64 DEXASOL........... 37 DEXEDRINE......... 39 DEXEDRINE SPANSULE.. 39 dextroamphetamine..... 39 dextroamphetamine extended-release..... 39 dextromethorphan/brompheniramine/pseudoephedrine. 44 dextromethorphan/carbinoxamine/pseudoephedrine 44 dextromethorphanguaifenesin........ 44 dextromethorphan/ guaifenesin........ 44 dextromethorphan hbr.... 44 dextromethorphan polistirex extended-release44 dextromethorphan/ promethazine....... 44 dextromethorphan/ quinidine......... 42 DEXTROSTAT......... 39 D.H.E. 45........... 13 DIABINESE.......... 23 DIAMOX SEQUELS..... 38 DIASTAT ACUDIAL...... 15 diazepam...... 15, 33, 39 diclofenac 1% gel.......33 diclofenac potassium.....33 diclofenac sodium...... 37 diclofenac sodium delayed-release....12, 33 dicloxacillin.......... 29 DICLOXACILLIN....... 29 dicyclomine.......... 26 didanosine.......... 30 didanosine delayed-release. 30 DIDRONEL.......... 24 DIFLUCAN........ 29, 36 digoxin............. 8 DIHISTINE DH........ 44 dihydroergotamine...... 13 DIHYDRO-PE SYP...... 46 DILACOR XR.......... 9 DILANTIN........... 15

Index of s DILAUDID........... 13 diltiazem............ 9 diltiazem extended-release.. 9 diltiazem sustained-release..9 DIMEATAPP DRO DECONGES....... 21 dimenhydrinate........ 58 DIMETAPP.......... 56 DIMETAPP CLD ELX/ ALLERGY......... 42 DIMETAPP DRO DCON/CGH 46 DIMETAPP DRO DECONGES 57 DIMETAPP ELX CLD/ALLE. 42 DIMETAPP SYP CGH/CLD. 43 dimethyl fumarate.......14 DIPENTUM.......... 26 diphenhydramine.... 20, 41 diphenoxylate/atropine....25 DIPROLENE....... 17, 18 DIPROLENE AF........ 17 dipyridamole..........7 disopyramide..........8 disopyramide extended-release8 disulfiram........... 39 DITROPAN.......... 49 DITROPAN XL........ 49 DIURIL............. 10 DIURIL ORAL SUSPENSION 10 divalproex sodium cap sprinkle... 14, 15, 40 divalproex sodium delayed-release. 14, 15, 40 docusate calcium plus.... 27 docusate potasssium.....27 docusate sodium....... 27 dofetilide............ 8 DOLOPHINE......... 13 dolutegravir.......... 31 DOMEBORO......... 57 DOMEBORO OTIC...... 20 donepezil........... 11 dornase alfa..........53 dorzolamide..........37 dorzolamide/timolol maleate 37 DOSTINEX.......... 24 ALL CAPS = Brand-name drug Lower case = Generic drug DOVONEX.......... 18 doxazosin......... 8, 48 doxepin............ 40 doxycycline monohydrate.. 29 DOXYCYCLINE MONOHYDRATE..... 29 DRAMAMINE......... 58 DRISDOL........... 50 dronabinol...........25 DROXIA............. 6 DUAVEE............ 36 DUETACT........... 23 DULCOLAX.......... 58 DULERA............ 47 duloxetine........... 40 DUOFILM......... 18, 59 DUONEB........... 48 DURADRYL......... 43 DURAGESIC......... 13 DURATUSS DM ELX..... 44 DURICEF........... 28 DYAZIDE............ 10 E ecothiophate......... 37 ECOTRIN........ 7, 32, 58 ED A-HIST TABLETS AND LIQUID.......... 43 EDGE OB CHW....... 52 edoxaban............6 EDURANT........... 30 E.E.S.............. 29 efavirenz............30 efavirenz/emtricitabine/ tenofovir.......... 31 EFFEXOR........... 40 EFFEXOR XR......... 40 EFUDEX............ 19 ELAVIL........... 14, 40 ELDEPRYL.......... 14 electrolyte........... 50 electrolyte rehydrating soln..57 ELIDEL............ 19 ELIMITE............ 18 ELIQUIS............. 6 65 ELOCON........... 17 eltrombopag..........54 EMCYT............. 4 EMEND............ 25 EMETROL........... 58 EMLA............. 19 emollients........... 56 empagliflozin......... 23 empagliflozin/metformin... 23 emtricitabine......... 30 emtricitabine/rilpivirine/ tenofovir.......... 30 emtricitabine/tenofovir.... 31 EMTRIVA........... 30 enalapril.............7 enalapril/hydrochlorothiazide.8 enfuvirtide...........30 ENJUVIA........... 36 enoxaparin...........6 entacapone.......... 14 entecavir............30 ENTOCORT EC........ 26 ENULOSE........... 27 E-OINTMENT......... 56 EPANED............. 7 epinephrine.......... 53 EPIPEN............ 53 EPIPEN JR........... 53 EPIVIR............. 30 EPIVIR HBV.......... 30 epoetin alfa...........7 EPOGEN............ 7 EPZICOM........... 30 ergocalciferol (D2)...... 50 ergotamine/caffeine..... 13 ergotamine tartrate/caffeine. 13 ERIVEDGE........... 6 erlotinib.............4 ERYC............. 28 ERYGEL............ 16 ERY-TAB............ 28 ERYTHROCIN........ 29 erythromycin.......16, 38 ERYTHROMYCIN...... 38

Index of s erythromycin/ benzoyl peroxide..... 16 erythromycin delayed-release 28 erythromycin ethylsuccinate. 29 erythromycin stearate.....29 erythromycin/sulfisoxazole..29 ESBRIET............ 54 escitalopram......... 40 ESGIC............. 12 ESKALITH CR........ 40 esomeprazole.........25 ESTRACE........... 35 estradiol..........35, 36 estramustine phosphate sodium.....4 estrogens, conjugated.... 35 estrogens, conjugated/ medroxyprogesterone.. 36 estrogens, conjugated, synthetic A.........36 estrogens, conjugated, synthetic B...........36 estropipate.......... 36 ESTROSTEP FE....... 35 ethambutol.......... 28 ethosuximide......... 15 ethynodiol diacetate/ee... 35 etidronate........... 24 etodolac..........12, 33 etonogestrel/ee........34 etoposide............6 etravirine............31 EULEXIN............ 5 EURAX............ 18 everolimus.......... 4, 6 EVISTA............. 24 EXCEDRIN MIGRAINE.... 12 EXELON............ 12 exemestane...........5 EXJADE............. 7 exogabine........... 15 ezetimibe........... 10 ALL CAPS = Brand-name drug Lower case = Generic drug F famotidine........ 25, 57 FARESTON........... 5 FARYDAK............ 4 febuxostat........... 33 felbamate........... 15 FELBATOL.......... 15 FELDENE......... 13, 33 felodipine extended-release..9 FEMARA............ 5 fenofibrate...........10 fenoprofen........ 12, 33 fentanyl transdermal..... 13 FEOSOL.......... 50, 59 FERGON........... 59 ferrous bisglycinate/ polysaccarides iron....50 ferrous sulfate.........50 filgrastim............ 7 FINACEA........... 16 finasteride........... 48 fingolimod...........14 FIORICET........... 12 FIORICET W/CODEINE... 13 FIORINAL........... 12 FIORINAL W/CODEINE... 13 FIRAZYR........... 54 FLAGYL.......... 31, 36 flecainide............8 FLEET ENEMA........ 57 FLEET PHOSPHO-SODA.. 58 FLEXERIL........... 33 FLOMAX............ 48 FLONASE........... 21 FLORANEX.......... 27 FLORINEF........... 22 FLOXIN............ 28 FLOXIN OTIC......... 20 FLUBLOK........... 55 FLUCELVAX.......... 55 fluconazole........29, 36 fludrocortisone........ 22 FLUMADINE......... 30 FLUMIST QUAD....... 55 fluocinolone acetonide....17 fluocinonide..........17 fluocinonide emulsified base 17 66 fluoride.............50 fluoride dental rinse..... 59 fluorometholone....... 37 FLUOROPLEX........ 19 fluorouracil.......... 19 fluoxetine........... 40 fluphenazine......... 42 fluphenazine decanoate... 42 flurandrenolide........ 17 flurazepam.......... 41 flurbiprofen.......... 37 flutamide............ 5 fluticasone...........21 fluticasone furoate...... 47 fluticasone propionate.... 17 fluticasone/vilanterol..... 47 FLUVIRIN........... 55 fluvoxamine.......... 39 FLUZONE HD PF....... 55 FLUZONE QUAD....... 55 FML.............. 37 FML FORTE.......... 37 FML LIQUIFILM........ 37 folic acid............50 FOLIC ACID.......... 50 FOLLISTIM AQ........ 24 follitropin alfa for inj......24 follitropin beta inj....... 24 FOLTABS PAK PLUS DHA RE OB + DHA PAK...... 51 FOLTABS PRENATAL.... 52 FORTEO............ 24 FORTICAL........... 24 FOSAMAX........... 24 fosamprenavir.........31 fosinopril............ 7 fosinopril/hydrochlorothiazide 8 FURADANTIN SUSP..... 32 furosemide.......... 10 FUZEON KIT......... 30 G gabapentin.......... 15 GABITRIL......... 15, 16 galantamine..........12

Index of s ganciclovir...........29 GANIRELIX ACETATE.... 24 ganirelix acetate inj......24 gatifloxin............38 GATTEX............ 27 GEL-KAM........... 50 gemfibrozil...........10 GENGRAF........... 6 GENTAK.......... 16, 38 gentamicin........16, 38 gentamicin/prednisolone acetate...........37 GENTEX ADE......... 52 GEODON........... 41 GG/CODEINE........ 44 GG/DM CR.......... 44 GG/PSE CR......... 45 GILENYA........... 14 GILOTRIF............ 4 glatiramer acetate.......14 GLEEVEC............ 4 glimepiride.......... 23 glipizide............ 23 glipizide ext-rel........ 23 GLUCAGON......... 22 glucagon, human recombinant........22 GLUCOPHAGE........ 23 GLUCOPHAGE ER...... 23 glucose oral tablets......57 GLUCOTROL......... 23 GLUCOTROL XL....... 23 GLUCOVANCE........ 23 glyburide............23 glyburide, micronized.....23 glycerin............ 27 GLYCERIN SUPPOSITORY. 27 GLYCERIN TOPICAL..... 56 glycerol phenylbutyrate....54 glycopyrrolate......... 26 GLYNASE........... 23 GONAL-F........... 24 GONAL-F RFF PEN...... 24 GRANIX............. 7 GRIFULVIN V......... 29 ALL CAPS = Brand-name drug Lower case = Generic drug griseofulvin microsize.....29 griseofulvin ultramicrosize.. 29 GRIS-PEG........... 29 GUAIFED........... 45 guaifenesin.......... 44 guaifenesin extended-release 45 guaifenesin/pseudoephedrine45 guaifenesin/pseudoephedrine/ dextromethorphan.... 45 guaifenesin/pseudoephedrine extended-release..... 45 GUAIFEN PSE........ 45 guanabenz.......... 11 guanfacine...........8 guanfacine ER........ 39 GUIATUSS AC........ 44 GUIATUSS DAC....... 44 GYNE-LOTRIMIN..... 36, 56 GYNOL II........... 57 H HALCION........... 41 HALDOL............ 42 HALDOL DECANOATE... 42 haloperidol.......... 42 haloperidol decanoate.... 42 HARVONI........... 30 HECORIA............ 6 HELIDAC........... 27 heparin.............6 HEPARIN............ 6 HEPSERA........... 30 hexachlorophene.......19 HEXALEN............ 4 HIPREX............ 49 HISTACOL DM........ 43 HISTEX............ 44 HISTUSSIN HC........ 45 homatropine..........38 HUMALOG.......... 23 HUMALOG MIX 50/50... 23 HUMALOG MIX 75/25... 23 HUMATIN........... 32 HUMIRA............ 32 HUMULIN........... 57 67 HUMULIN 70/30....... 23 HUMULIN N......... 22 HUMULIN R.......... 23 HYCAMTIN........... 6 HYCODAN.......... 45 hydralazine.......... 11 HYDREA............. 6 hydrochlorothiazide......10 HYDROCHLOROTHIAZIDE. 10 HYDROCODO/GG SYP... 45 hydrocodone/ acetaminophen......13 hydrocodone/chlorpheniramine/phenylephrine... 45 hydrocodone ER....... 13 hydrocodone/guaifenesin.. 45 hydrocodone/homatropine. 45 HYDROCODONE/ TAB HOMATROP.... 45 hydrocortisone. 17, 19, 22, 26 hydrocortisone/aloe..... 17 hydrocortisone butyrate... 17 hydrocortisone crm, oint... 57 hydrocortisone valerate... 17 HYDROMET SYP....... 45 hydromorphone........13 hydroxychloroquine... 31, 32 hydroxyurea.......... 6 hydroxyzine HCL....... 20 hydroxyzine pamoate.....20 hyoscyamine, methenamine, phenyl salicylate, sodium phosphate monobasic, methylene blue...... 49 hyoscyamine sulfate..... 26 hyoscyamine sulfate extended-release..... 26 HYPERCARE 20%...... 19 HYPOTEARS......... 58 HYTONE........... 17 HYTRIN........... 8, 48 HYZAAR............. 8

Index of s I IBRANCE............ 4 ibrutinib.............4 IBUOROFEN TAB COLD/SIN 47 ibuprofen...... 12, 33, 58 icatibant............ 54 ICLUSIG............. 4 idelalisib.............4 ILARIS............. 53 imatinib mesylate........4 IMBRUVICA........... 4 IMDUR............. 11 imipramine HCL....... 40 imiquimod 5% cream.....19 IMITREX............ 14 IMODIUM A-D....... 25, 57 IMURAN...........5, 32 INCRELEX.......... 24 INCRUSE ELLIPTA...... 47 indacaterol...........47 indapamide.......... 10 INDERAL.......... 9, 14 INDERIDE............ 9 indinavir............ 31 INDOCIN......... 12, 33 indomethacin.......12, 33 INFERGEN.......... 30 INFLAMASE FORTE..... 37 influenza virus vaccine live quadrivalent intranasal..55 influenza virus vaccine split. 55 influenza virus vaccine split high-dose pf........55 influenza virus vaccine split pf55 influenza virus vaccine split quadrivalent........55 influenza virus vaccine types a&b surface antigen... 55 INLYTA.............. 4 insulin aspart......... 22 insulin aspart protamine 70%/ insulin aspart 30%.... 22 insulin glargine........ 22 insulin human.........22 insulin isophane........22 ALL CAPS = Brand-name drug Lower case = Generic drug insulin isophane human... 22 insulin isophane human 70%/ regular 30%........22 insulin isophane/regular... 23 insulin lisopro pro/lispro... 23 insulin lisopro prot/lispro...23 insulin lispro..........23 insulin regular.........23 insulin.............57 INTAL........... 47, 48 INTELENCE.......... 31 interferon alfa-2b..... 5, 30 interferon alfacon-1......30 interferon beta-1a.......14 interferon gamma-1b.....31 INTRON A..........5, 30 INTUNIV............ 39 INVEGA SUSTENNA..... 41 INVEGA TRINZA....... 41 INVIRASE........... 31 INVOKAMET......... 23 INVOKANA.......... 23 ipratropium.......... 48 ipratropium/albuterol.. 47, 48 ipratropium HFA....... 47 ipratropium nasal....... 21 iron polysaccharides..... 59 iron...............59 ISENTRESS.......... 32 ISENTRESS CHEWABLE.. 32 ISENTRESS SUSP...... 32 ISMO.............. 11 isoniazid............28 ISONIAZID.......... 28 ISOPTO ATROPINE..... 38 ISOPTO CARPINE...... 38 ISOPTO HOMATROPINE.. 38 ISOPTO HYOSCINE..... 38 ISORDIL............ 11 ISORDIL S.L.......... 11 isosorbide dinitrate...... 11 ISOSORBIDE DINITRATE ER 11 isosorbide dinitrate extended-release..... 11 isosorbide mononitrate....11 68 isosorbide mononitrate extended-release..... 11 isotretinoin...........16 itraconazole.......... 29 ivacaftor............ 53 ivermectin........... 28 J JADENU............. 7 JAKAFI.............. 5 JARDIANCE.......... 23 JENTADUETO........ 23 JUXTAPID........... 11 K KALETRA........... 31 KALYDECO.......... 53 KAOPECTATE......... 57 KAYEXALATE......... 11 K-DUR 10........... 53 K-DUR 20........... 53 KEFLEX............ 28 KENALOG........... 17 KENALOG IN ORABASE.. 21 KEPPRA............ 15 ketoconazole.... 18, 19, 29 ketoprofen........ 12, 33 ketorolac............37 ketorolac tromethamine... 12 ketotifen............ 36 KINERET........... 32 KLONOPIN........ 15, 39 K-LOR............. 53 KLOR-CON 8........ 53 KLOR-CON 10........ 53 K-LYTE............. 53 KOMBIGLYZE......... 23 KORLYM............ 25 K-PHOS NEUTRAL...... 53 K-PHOS ORIGINAL...... 53 KUVAN............ 25 L labetalol.............9 LAC-HYDRIN......... 19

Index of s lacosamide.......... 15 LACTINOL.......... 19 lactobacillus..........27 lactulose............27 LAMICTAL........... 15 LAMICTAL CD CHEW TAB. 15 LAMICTAL STARTER KIT.. 15 LAMISIL............ 29 LAMISIL AT.......... 18 lamivudine...........30 lamivudine/zidovudine....30 lamotrigine.......... 15 lamotrigine chew dispersable tab...... 15 lamotrigine starter kit.....15 LANOXIN............ 8 lansoprazole..........25 lansoprazole delayed-release 26 LANTUS............ 22 lapatinib ditosylate.......4 LARIAM............ 31 LASIX............. 10 latanoprost.......... 38 laxative enemas........57 laxatives............ 58 ledipasvir/sofosbuvir..... 30 leflunomide.......... 32 lenalidomide..........5 lenvatinib............4 LENVIMA............ 4 LETAIRIS........... 11 letrozole.............5 LEUKERAN........... 4 LEUKINE............ 7 leuprolide............5 levalbuterol HCl........48 LEVAQUIN.......... 28 levetiracetam......... 15 levobunolol.......... 37 levocetirizine......... 20 levofloxacin.......... 28 levonorgestrel.........34 levonorgestrel/ee.... 34, 35 levothyroxine......... 24 LEVOXYL........... 24 ALL CAPS = Brand-name drug Lower case = Generic drug LEVSIN............ 26 LEVSINEX........... 26 LEXAPRO........... 40 LEXIVA............. 31 LIALDA............ 26 LIBRIUM............ 39 LIDAMANTEL......... 19 LIDEX............. 17 LIDEX E............ 17 lidocaine............19 lidocaine/prilocaine..... 19 lidocaine viscous....... 21 linagliptin........... 23 linagliptin/metformin..... 23 linezolid............ 31 liothyronine.......... 24 liotrix.............. 24 LIPITOR............ 10 liraglutide........... 24 lisdexamfetamine.......39 lisinopril.............7 lisinopril/hydrochlorothiazide.8 lithium carbonate....... 40 LITHIUM CARBONATE... 40 lithium carbonate extended-release..... 40 LITHOBID........... 40 LMX-4............. 19 LOCOID............ 17 LODINE.......... 12, 33 LOESTRIN 1.5/30...... 34 LOESTRIN 1/20....... 34 LOESTRIN FE 1.5/30.... 34 LOESTRIN FE 1/20..... 34 LOFIBRA........... 10 lomitapide...........11 LOMOTIL........... 25 lomustine............4 LONITEN........... 11 LO/OVRAL.......... 34 loperamide.......... 25 loperamide.......... 25 LOPERAMIDE........ 25 LOPID............. 10 lopinavir/ritonavir....... 31 69 LOPRESSOR.......... 9 loratadine........... 20 loratadine/pseudoephedrine 56 loratadine/pseudoephedrine extended-release..... 21 loratadine & pseudoephedrine SR............. 45 lorazepam...........39 LORCET............ 13 LORTAB............ 13 LORTAB ELIXIR........ 13 losartan.............8 losartan/hctz.........8 LOTENSIN............ 7 LOTENSIN HCT......... 8 LOTRIMIN AF....... 18, 56 LOTRISONE.......... 18 lovastatin............10 LOVENOX............ 6 loxapine............ 42 LOXITANE........... 42 LOZOL............. 10 LUDIOMIL........... 40 lumacaftor/ivacaftor..... 54 LUPRON............ 5 LUPRON DEPOT........ 5 LUPRON DEPOT-PED..... 5 LURIDE............ 50 LUVOX............. 39 LYNPARZA........... 6 LYRICA............ 15 LYSODREN........... 6 LYSTEDA........... 36 M MAALOX......... 25, 57 MACROBID.......... 32 MACRODANTIN....... 32 magnesium oxide.... 50, 59 MAG-OX.......... 50, 59 malathion........... 18 MAPAP COLD TAB...... 46 maprotiline.......... 40 maraviroc........... 31 MARINOL........... 25

Index of s MATERNA........... 52 MATULANE........... 6 MAXALT/MAXALT MLT... 14 MAXITROL.......... 37 MAXZIDE........... 10 M-CLEAR WC........ 44 mecasermin..........24 meclizine.........25, 58 MEDROL........... 22 medroxyprogesterone acetate........ 34, 36 mefloquine.......... 31 MEGACE............ 5 megestrol acetate....... 5 MEKINIST............ 5 MELLARIL........... 42 meloxicam........ 12, 33 melphalan........... 4 memantine.......... 12 MENOPUR.......... 24 menotropins for inj...... 24 meperidine.......... 13 MEPHYTON......... 51 MEPRON........... 31 mercaptopurine........ 4 mesalamine.......... 26 mesalamine extended-release26 mesalamine supp.......26 mesna..............6 MESNEX............ 6 MESTINON.......... 14 MESTINON TIMESPAN... 14 METADATE ER........ 39 METAMUCIL......... 58 metaproterenol........ 48 METAPROTERENOL SYRUP 48 metformin........... 23 metformin ER......... 23 metformin/glyburide..... 23 methadone.......... 13 methazolamide........ 38 methenamine hippurate... 49 METHERGINE...... 24, 36 methimazole..........24 methocarbamol........33 ALL CAPS = Brand-name drug Lower case = Generic drug methotrexate......... 32 methoxsalen..........18 methsuximide.........15 methyldopa.......... 11 methyldopa/hctz...... 11 methylergonovine.... 24, 36 methylphenidate....... 39 methylphenidate extended-release..... 39 methylprednisolone......22 metipranolol..........37 metoclopramide....... 25 metolazone.......... 10 metoprolol........... 9 metoprolol succinate......9 METROCREAM....... 18 METROGEL.......... 18 METROGEL 1%....... 36 METROGEL-VAGINAL.... 36 METROLOTION....... 18 metronidazole.... 18, 31, 36 MEVACOR.......... 10 mexiletine............8 MEXITIL............. 8 MIACALCIN.......... 24 MICATIN.......... 18, 56 miconazole..... 18, 36, 56 MICRO-K 10......... 53 MICRONASE......... 23 MICROZIDE.......... 10 MIDAMOR........... 10 midodrine........... 11 mifepristone..........25 MIGERGOT SUPPOSITORIES13 MIGRANAL.......... 13 MINIPRESS........... 8 MINOCIN........... 29 minocycline.......... 29 minoxidil............11 MINUTUSS DR SYP..... 46 MIRALAX........... 27 MIRAPEX........... 14 MIRCETTE.......... 34 mirtazapine.......... 40 MIRVASO........... 18 70 misoprostol.......... 27 MITIGARE........... 33 mitotane.............6 MOBIC.......... 12, 33 MODICON.......... 35 MODURETIC......... 10 mometasone......... 47 mometasone/formoterol... 47 mometasone furoate..... 17 mometasone inhalation... 47 MONISTAT........ 36, 56 MONISTAT 3......... 36 MONISTAT-DERM...... 18 MONOPRIL........... 7 MONOPRIL-HCT........ 8 montelukast..........48 morphine........... 13 morphine extended-release. 13 MOTRIN.......... 12, 33 MOTRIN IB.......... 58 MOVANTIK.......... 27 MOZOBIL............ 7 MS CONTIN......... 13 MSIR.............. 13 MUCINEX........... 45 MUCINEX D.......... 45 MUCINEX DM........ 44 MUCOMYST......... 53 MULTI SYMPTOM TAB COLD RLF........ 47 multivitamins/fluoride/±iron. 51 multivitamins/minerals.... 51 mupirocin........... 16 MURINE............ 58 MURO 128.......... 38 MYAMBUTOL......... 28 MYCELEX......... 18, 29 MYCITRACIN......... 57 MYCOBUTIN......... 28 mycophenolate mofetil.....5 mycophenolate sodium....6 MYCOSTATIN....... 18, 29 MYFORTIC........... 6 MYLANTA......... 25, 57 MYLERAN............ 4

Index of s MYLICON........... 58 MYSOLINE.......... 15 N nabumetone..........12 NALFON.......... 12, 33 naloxegol........... 27 naloxone............41 NALOXONE INJ....... 41 naltrexone.........39, 41 NAMENDA.......... 12 naphazoline/antazoline... 36 naphazoline/glycerin..... 36 naphazoline HCL....... 36 naphazoline/zinc sulfate... 36 NAPHCON A......... 58 NAPROSYN........ 12, 33 naproxen.........12, 33 naproxen sodium.... 13, 33 naratriptan...........14 NASACORT ALLERGY... 21 NASALCROM......... 21 nasal sprays..........57 NATALCARE......... 52 nateglinide...........23 NAVANE............ 42 nedocromil.......... 47 nelfinavir............31 NEO DM............ 43 neomycin/polymyxin B/ bacitracin......... 16 neomycin/polymyxin B/ dexamethasone......37 neomycin/polymyxin B/ gramicidin.........38 neomycin/polymyxin B/ hydrocortisone....20, 37 neomycin sulfate....... 31 NEORAL............. 6 NEOSPORIN..... 16, 38, 57 NEO-SYNEPHRINE... 21, 57 NEPHROCAPS........ 52 NEPTAZANE......... 38 NESTABSCBF/FA/RX.... 52 NEULASTA........... 7 ALL CAPS = Brand-name drug Lower case = Generic drug NEUMEGA........... 7 NEURONTIN......... 15 NEUTROGENA OIL FREE ACNE WASH....... 16 nevirapine........... 30 nevirapine ER......... 30 NEXAVAR............ 5 NEXIUM 24HR OTC..... 25 NEXIUM DELAYED RELEASE PACKET... 25 nfluenza virus vaccine recombinant hemagglutinin....55 nfluenza virus vaccine tiss-cult subunit...........55 niacin............. 10 niacin extended-release... 10 NIACOR............ 10 NIASPAN........... 10 nicardipine...........9 NICODERM CQ..... 42, 58 NICORETTE OTC...... 42 nicotine............ 42 NICOTINE GUM....... 58 nicotine polacrilex gum....42 nicotine polacrilex lozenge..42 nicotine............ 58 NICOTROL.......... 58 nifedipine............9 nifedipine extended-release..9 NIFEREX....... 50, 51, 59 NIFEREX-PN FORTE..... 52 nilotinib.............4 nimodipine...........9 NIMOTOP............ 9 nintedanib...........54 nitazoxanide suspension...32 nitazoxanide tablet...... 32 NITREK............ 11 NITRO-BID.......... 11 NITRO-DUR.......... 11 nitrofurantoin extended-release..... 32 nitrofurantoin macrocrystals. 32 nitrofurantoin susp...... 32 nitroglycerin........11, 19 71 NITROLINGUAL....... 11 NITROSTAT.......... 11 NIX............. 19, 58 NIZORAL......... 18, 29 NIZORAL SHAMPOO.... 19 NOLVADEX........... 5 NORCO............ 13 NORDETTE.......... 34 norelgestromin/ee...... 35 norethindrone.........35 norethindrone acetate.... 36 norethindrone acetate/ee.. 34 norethindrone acetate/ee/iron... 34, 35 norethindrone/ee.... 34, 35 norethindrone/me...... 35 NORFLEX........... 33 norgestimate/ee....... 35 norgestrel........... 35 norgestrel/ee.......34, 35 NORPACE............ 8 NORPACE CR......... 8 NORPRAMIN......... 40 nortriptyline.......... 40 NORVASC............ 9 NORVIR............ 31 NOVOLIN........... 57 NOVOLIN 70/30....... 22 NOVOLIN N.......... 22 NOVOLIN R.......... 22 NOVOLOG.......... 22 NOVOLOG MIX 70/30.... 22 NUEDEXTA.......... 42 NULYTELY.......... 27 NUTROPIN AQ NUSPIN... 24 NUVARING.......... 34 NYMALIZE........... 9 nystatin..........18, 29 NYTOL QUICK CAPS.... 41 O OCEAN NASAL SPRAY... 21 octreotide............6 OCUFEN........... 37 OCUFLOX........... 38

Index of s OFEV............. 54 ofloxacin....... 20, 28, 38 OGEN............. 36 olanzapine...........41 olaparib.............6 olodaterol........... 47 olsalazine sodium.......26 omalizumab..........47 omeprazole delayed-release...... 26 OMNICEF........... 28 ondansetron..........25 ONE TOUCH SYSTEMS (ULTRA 2, ULTRAMINI, VERIO, VE- RIO FLEX, VERIO IQ, VERIO SYNC)....... 23 ONE TOUCH TEST STRIPS (ULTRA, VERIO)..... 23 ONFI.............. 15 ONGLYZA........... 23 oprelvekin............7 OPTIPRANOLOL....... 37 OPTIVAR........... 36 ORAP............. 42 ORAPRED........... 22 ORKAMBI........... 54 orphenadrine extended-release..... 33 ORTHO-CEPT........ 34 ORTHO COIL......... 34 ORTHO-CYCLEN...... 35 ortho diaphragm....... 34 ORTHO EVRA........ 35 ORTHO FLAT......... 34 ORTHO FLEX......... 34 ORTHO MICRONOR..... 35 ORTHO-NOVUM 1/35.... 35 ORTHO-NOVUM 1/50.... 35 ORTHO-NOVUM 7/7/7... 35 ORTHO-NOVUM 10/11... 34 ORTHO TRI-CYCLEN.... 35 ORUDIS.......... 12, 33 OS-CAL.......... 49, 59 oseltamivir...........30 OVCON 50.......... 35 ALL CAPS = Brand-name drug Lower case = Generic drug OVIDE............. 18 OVIDREL........... 24 OVRAL............. 35 OVRETTE........... 35 oxaprozin.........13, 33 oxazepam........... 39 oxcarbazepine........ 15 OXSORALEN-ULTRA.... 18 oxybutynin chloride......49 oxybutynin IR......... 49 oxycodone.......... 13 oxycodone/acetaminophen. 13 oxycodone/aspirin...... 13 OXYFAST........... 13 oxymetazoline.........21 oxymorphone ER.......13 OXYMORPHONE ER.... 13 P palbociclib........... 4 paliperidone..........41 palivizumab.......... 32 PAMELOR........... 40 pancrelipase......... 27 panobinostat..........4 PANRETIN........... 6 pantoprazole......... 26 PARAFON FORTE DSC... 33 PARNATE........... 40 paromomycin......... 32 paroxetine........... 40 pasireotide........... 6 PAXIL............. 40 pazopanib........... 4 PEDIACARE LIQ MULTI-SY. 46 PEDIALYTE........ 50, 57 PEDIAPRED.......... 22 PEDIAZOLE.......... 29 peg 3350/electrolytes.... 27 peg 3350/sodium bicarbonate/ sodium chloride..... 27 peg 3350/sodium bicarbonate/ sodium chloride/potassium chloride.......... 27 PEGASYS........... 30 72 PEGASYS PROCLICK.... 30 pegfilgrastim..........7 peginterferon alfa-2a..... 30 peginterferon alfa-2b......5 pegvisomant......... 25 penicillamine......... 32 penicillin VK..........29 PENLAC SOLUTION 8%.. 18 PENTASA........... 26 pentazocine/naloxone.... 13 pentoxifylline extended-release......7 PEPCID............ 25 PEPCID AC........ 25, 57 PERCOCET.......... 13 PERCODAN.......... 13 PERIDEX........... 21 permethrin........ 18, 58 perphenazine......... 42 PERSANTINE.......... 7 phenazopyridine....... 49 PHENERGAN......... 25 PHENERGAN DM...... 44 phenobarbital......... 15 PHENOBARBITAL...... 15 phenyleph/bromphen/dextromethorphan/guaifenesin 45 phenylephrine.........21 phenylephrine/ brompheniramine/ dextromethorphan.... 45 phenylephrine/ chlorpheniramine.....45 phenylephrine/ chlorpheniramine/ dextromethorphan..45, 46 phenylephrine/ chlorpheniramine/ dihydrocodeine......46 phenylephrine/ dextromethorphan.... 46 phenylephrine/ dextromethorphan/ guaifenesin........ 46

Index of s phenylephrine/ephed/cpm w/ carbetapentane......46 phenylephrine/guaifenesin..46 phenylephrine/hydrocodone/ guaifenesin........ 46 phenylephrine/pyrilamine/ dextromethorphan.... 46 phenylephrine/pyrilamine w/hydrocodone......46 phenylephrine tan/ pyrilamine tan/ carbeta tan........ 46 PHENYLHIST LIQ DH.... 44 PHENYTEK.......... 15 phenytoin........... 15 phenytoin sodium extended. 15 PHISOHEX.......... 19 PHOS-FLUR........ 50, 59 PHOSPHOLINE IODINE... 37 phosphorus.......... 53 PHRENILIN.......... 12 phytonadione......... 51 pilocarpine........21, 38 PILOPINE HS GEL...... 38 PIMA.............. 53 pimecrolimus......... 19 pimozide............42 pindolol.............9 PINDOLOL........... 9 pioglitazone.......... 23 pioglitazone/glimepiride... 23 pioglitazone/metformin... 23 pioglitazone/metformin ER. 23 PIPERONYL BUTOXIDE... 58 piperonyl butoxide gel, liquid shampoo......... 58 pirfenidone capsule..... 54 piroxicam.........13, 33 PLAN B............ 34 PLAQUENIL........ 31, 32 PLAVIX.............. 7 PLENDIL............. 9 plerixafor............ 7 PLETAL............. 7 PLEXION........... 16 ALL CAPS = Brand-name drug Lower case = Generic drug pneumococcal 13-valent conjugate......... 55 pneumococcal vaccine polyvalent......... 55 PNEUMOVAX, PNEUMOVAX 23..... 55 podofilox............18 polyethylene glycol 3350...27 polymyxin B/bacitracin....38 polymyxin B/trimethoprim.. 38 polysaccharide iron complex.......... 51 POLYSPORIN......... 38 POLYTRIM.......... 38 POLY-VI-FLOR......... 51 POLY-VI-SOL......... 59 pomalidomide......... 5 POMALYST........... 5 ponatinib............4 potassium acid phosphate..53 potassium bicarbonate/ potassium citrate effervescent........53 potassium chloride...... 53 POTASSIUM CHLORIDE.. 53 potassium chloride extended-release..... 53 potassium citrate....... 49 potassium iodide....... 53 POTIGA............ 15 povidone-iodine........32 PRALUENT.......... 10 pramipexole..........14 pramlintide.......... 24 PRANDIN........... 23 praziquantel..........28 prazosin.............8 PRECOSE........... 23 PRED FORTE......... 37 PRED-G............ 37 PRED MILD.......... 37 prednicarbate.........17 prednisolone......... 22 prednisolone acetate.....37 prednisolone phosphate... 37 73 prednisolone sodium phosphate.........22 prednisone.......... 22 pregabalin...........15 PRELONE........... 22 PREMARIN.......... 35 PREMPHASE......... 36 PREMPRO.......... 36 prenatal vitamins w/folic acid 52 PRENATAL VITAMINS W/ FOLIC ACID....... 52 prenatal vit w/fe bisglyc-fe prot succ-fa.......... 51 prenatal vit w/fe bisglycinate chelate-fa...... 51, 52 prenatal vit w/fe polysac cmplx-fa.....52 prenatal vit w/iron carbonyl-fa........ 52 prenatal w/o A w/fe carbonyl- FE gluc-dss-fa......52 prenat-fe Bis-FE prot succ-fa-ca & omega 3........ 51 prenat-fe bis-fe prot succ-fa-ca & omega DR....... 51 prenat w/o A w/fecbn-fegl- DSS-FA & DHA...... 51 PREPARATION H....... 58 PREVACID......... 25, 26 PREVIDENT.......... 50 PREVNAR 13......... 55 PREZCOBIX......... 31 PREZISTA........... 31 PRILOSEC.......... 26 primaquine.......... 32 primidone........... 15 PRINCIPEN.......... 29 PROAMATINE......... 11 probenecid.......... 33 PROBENECID........ 33 PROBIOTIC FORMULA... 27 probiotic product....... 27

Index of s procarbazine..........6 PROCARDIA.......... 9 PROCARDIA XL........ 9 prochlorperazine....... 25 PROCRIT............ 7 PROCTOSOL HC...... 19 PROCTOZONE CREAM-HC 2.5%.... 19 PROGRAF............ 6 PROLIXIN........... 42 PROLIXIN DECANOATE... 42 PROMACTA.......... 54 promethazine......... 25 promethazine & phenylephrine.......46 PROMETHAZINE SYP DM. 44 PROMETHAZINE VC W/CODEINE....... 44 PROMETHAZINE W/CODEINE....... 44 PROMETH VC SYP..... 46 propafenone..........8 propantheline......... 49 propranolol........ 9, 14 propranolol/hctz.......9 propylthiouracil........ 24 PROPYLTHIOURACIL.... 24 PROSCAR........... 48 PROTONIX.......... 26 PROTOPIC 0.1%....... 20 PROTOPIC 0.03%...... 19 PROVENTIL.......... 48 PROVERA........... 36 PROZAC............ 40 PRUET DHAEC PAK..... 51 PRUET DHA PAK SETONET PAK...... 51 PSE/GG............ 45 pseudoephedrine/ acetaminophen/ dextromethorphan.... 46 pseudoephedrine/ chlorpheniramine/ dextromethorphan.... 46 ALL CAPS = Brand-name drug Lower case = Generic drug pseudoephedrine/dextromethorphan/guaifenesin.... 47 pseudoephedrine/iburprofen 47 pseudoephedrine tan/dexchlorphen tan/dm tan..... 47 psyllium............ 58 PULMICORT RESPULES.. 48 PULMOZYME......... 53 PURINETHOL.......... 4 pyrazinamide......... 28 PYRAZINAMIDE....... 28 pyrethrins/piperonyl but... 18 PYRIDIUM........... 49 pyridostigmine........ 14 pyridostigmine extended-release..... 14 pyrilamine tan/phenyleph tan 47 pyrimethamine........ 32 Q QUAL-TUSSIN SYP DC. 45, 46 QUESTRAN.......... 10 QUESTRAN-LIGHT...... 10 quetiapine...........41 quinapril.............7 quinapril/hydrochlorothiazide.8 quinidine gluconate extended-release......8 QUINIDINE GLUCONATE EXT-REL........... 8 quinidine sulfate........8 QUINIDINE SULFATE..... 8 quinidine sulfate extended-release......8 QUINIDINE SULFATE EXT-REL........... 8 QV-ALLERGY......... 43 R raloxifene........... 24 raltegravir........... 32 RANEXA............ 11 ranitidine............26 ranolazine........... 11 RAPAMUNE........... 6 74 RAVICTI............ 54 RAZADYNE.......... 12 REBETOL/COPEGUS.... 30 REBIF............. 14 rectal hydrocortisone crm, suppositories....... 58 RECTIV............ 19 REGLAN........... 25 regorafenib...........5 REGRANEX.......... 19 RELAFEN........... 12 RELENZA........... 30 RELION 70/30........ 22 RELION N........... 22 RELION R........... 22 REMERON.......... 40 RENVELA........... 54 repaglinide.......... 23 REPRONEX.......... 24 REQUIP............ 14 RESCRIPTOR......... 30 RESPERAL-DM........ 42 RESTORIL........... 41 RETIN-A............ 16 RETROVIR.......... 31 REVATIO............ 11 REVIA........... 39, 41 REVLIMID............ 5 REYATAZ........... 31 REYATAZ POWDER PACKET 31 ribavirin............ 30 RIDAURA........... 32 RID SHAMPOO/ BUTOXIDE SHAMPOO. 18 rifabutin............ 28 RIFADIN............ 28 rifampin............ 28 rilonacept........... 53 rilpivirine............30 rimantadine.......... 30 rimexolone...........37 RISPERDAL.......... 41 RISPERDAL CONSTA.... 41 RISPERDAL SOLUTION... 41 risperidone.......... 41

Index of s RITALIN............ 39 RITALIN LA.......... 39 RITALIN-SR.......... 39 ritonavir............ 31 rivaroxaban...........6 rivastigmine.......... 12 rizatriptan........... 14 RMS.............. 13 ROBAXIN........... 33 ROBINUL........... 26 ROBITUSSIN....... 44, 57 ROBITUSSIN CF..... 45, 57 ROBITUSSIN DM..... 44, 57 ROBITUSSIN LIQ CGH/ALRG........ 46 ROBITUSSIN LIQ CGH/CLD....... 43, 46 ROBITUSSIN LIQ CGH/CONG....... 44 ROBITUSSIN LIQ HD/CHST 46 ROBITUSSIN LIQ PED NGHT 46 ROBITUSSIN PE..... 45, 57 ROBITUSSIN PED LIQ CGH/COLD....... 43 ROBITUSSIN PED SYP... 44 ROBITUSSIN SYP CHST CNG........ 44 ROBITUSSIN SYP MAX-ST. 44 ROCALTROL......... 49 ROCALTROL SOLUTION.. 49 RONDEC DM......... 46 RONDEC DROPS...... 43 RONDEC SYRUP..... 42, 43 ropinirole........... 14 ROWASA........... 26 ROXICODONE........ 13 R-TANNAMINE........ 43 rufinamide...........15 ruxolitinib............5 RYNA-12 S.......... 47 RYNATAN PEDIATRIC SUSP 44 RYNATUSS.......... 43 RYNATUSS PEDIATRIC SUSP46 RYTHMOL........... 8 ALL CAPS = Brand-name drug Lower case = Generic drug S SABRIL SOLUTION..... 16 SALAGEN........... 21 salicylic acid....... 16, 18 salicylic acid 17%/ collodion.......18, 59 saline nasal spray 0.65%...21 SAL-TROPINE......... 27 SANCTURA.......... 49 SANDIMMUNE......... 6 SANDOSTATIN......... 6 SANTYL............ 19 sapropterin.......... 25 sapropterin powder......25 saquinavir mesylate......31 sargramostim..........7 SAVAYSA............ 6 saxagliptin...........23 saxagliptin/metformin.... 23 SCALPICIN.......... 18 scopolamine......... 38 SEASONALE......... 34 SECTRAL............ 9 SEDAPAP........... 12 selegiline........... 14 selenium sulfide........19 SELSUN............ 19 SELZENTRY......... 31 sennosides.......... 27 SENOKOT........... 27 SENSIPAR........... 54 SERAX............. 39 SEROQUEL.......... 41 sertraline............40 sevelamer........... 54 SIGNIFOR............ 6 sildenafil............11 SILVADENE.......... 16 silver sulfadiazine.......16 simethicone.......... 58 simvastatin...........10 SINEMET........... 14 SINEMET CR......... 14 SINEQUAN.......... 40 75 SINGULAIR.......... 48 sirolimus............ 6 sirolimus............ 6 SIRTURO........... 31 sodium chloride hypertonic. 38 sodium citrate/citric acid...49 sodium phenylbutyrate oral powder.......... 54 sodium polysterene sulfonate..........11 sofosbuvir........... 30 somatropin.......... 24 SOMAVERT.......... 25 SONATA............ 41 sorafenib............ 5 SORIATANE.......... 18 sotalol..............9 SOVALDI........... 30 spacers............ 54 spironolactone........ 10 spironolactone/ hydrochlorothiazide... 10 SPORANOX.......... 29 SPRYCEL............ 4 STADOL............ 13 STARLIX............ 23 STATUSS DM SYP...... 46 stavudine........... 31 STELAZINE.......... 42 STIVARGA............ 5 stool softeners........ 58 STRIBILD........... 31 STRIVERDI RESPIMAT.... 47 STROMECTOL........ 28 STUART PRENATAL..... 59 SUBOXONE.......... 41 SUBUTEX........... 41 sucralfate........... 26 sugar+orthophosphoric acid 58 sulcralfate........... 26 sulfacetamide......... 38 sulfacetamide/phenylephrine 38 sulfacetamide/pred phos.. 37 sulfacetamide/sulfur..... 16 SULFACET-R......... 16

Index of s sulfamethoxazole/ trimethoprim, DS..... 29 sulfasalazine....... 26, 32 sulfasalazine delayed-release....26, 32 sulindac..........13, 33 sumatriptan.......... 14 SUMYCIN........... 29 sunitinib.............5 SUPRAX............ 28 SUSTIVA............ 30 SUTENT............. 5 SYLATRON........... 5 SYMLIN............ 24 SYMMETREL....... 14, 30 SYNAGIS........... 32 SYNALAR........... 17 SYNJARDY.......... 23 SYNTHROID......... 24 T TABLOID............. 4 tacrolimus....... 6, 19, 20 TAFINLAR............ 4 TAGAMET........... 25 TALWIN NX.......... 13 TAMBOCOR.......... 8 TAMIFLU............ 30 tamoxifen............5 tamsulosin...........48 TANAFED........... 43 TANAFED DMX SUSPENSION...... 47 TANZEUM........... 24 TAPAZOLE.......... 24 TARCEVA............ 4 TARGRETIN........... 6 TASIGNA............ 4 TASMAR............ 14 TBO-filgrastim......... 7 TECFIDERA.......... 14 teduglutide.......... 27 TEGRETOL.......... 15 TEGRETOL-XR........ 15 temazepam.......... 41 ALL CAPS = Brand-name drug Lower case = Generic drug TEMODAR........... 4 TEMOVATE.......... 18 temozolomide......... 4 TENEX.............. 8 tenofovir............ 31 TENORETIC.......... 9 TENORMIN........... 9 TERAZOL 3/7........ 36 terazosin.......... 8, 48 terbinafine........ 18, 29 terbutaline...........48 terconazole.......... 36 teriflunomide......... 14 teriparatide inj.........24 TESSALON.......... 42 TESTOSTERONE 1% TOPICAL GEL...... 22 testosterone cypionate.... 22 testosterone enanthate....22 testosterone gel topical tube, packet, and pump bottle 22 tetrabenazine......... 16 tetracycline.......... 29 tetrahydrozoline/zinc sulfate. 37 thalidomide...........5 THALOMID........... 5 THEO-24........... 48 THEOCHRON........ 48 theophylline.......... 48 THEOPHYLLINE....... 48 theophylline extended-release..... 48 THEOPHYLLINE EXT-REL.. 48 thioguanine...........4 thioridazine.......... 42 thiothixene...........42 THORAZINE......... 42 THYROLAR.......... 24 tiagabine......... 15, 16 TIAZAC............. 9 TIGAN............. 25 TIKOSYN............ 8 TILADE............ 47 timolol............. 37 timolol hemihydrate......37 76 timolol maleate...... 9, 37 TIMOPTIC........... 37 TIMOPTIC XE......... 37 TINACTIN......... 18, 56 tipranavir............31 TIVICAY............ 31 tizanidine........... 33 TOBRADEX.......... 37 tobramycin.......... 38 tobramycin/ dexamethasone......37 tobramycin neb soln..... 54 TOBREX............ 38 TOFRANIL........... 40 tolazamide...........24 tolbutamide.......... 24 TOLBUTAMIDE........ 24 tolcapone........... 14 TOLINASE........... 24 tolnaftate......... 18, 56 tolterodine...........49 TOPAMAX........... 16 TOPAMAX SPRINKLE.... 16 topical antibacterials..... 57 topiramate...........16 topiramate sprinkle caps...16 topotecan............6 TOPROL XL........... 9 TORADOL........... 12 toremifene........... 5 torsemide........... 10 TOUJEO SOLOSTAR.... 22 TRACLEER.......... 11 TRADJENTA......... 23 tramadol............12 trametinib............5 TRANDATE........... 9 tranexamic acid........36 TRANXENE.......... 39 tranylcypromine........40 trazodone........... 40 TRENTAL............ 7 tretinoin.......... 6, 16 triamcinolone......... 21 triamcinolone acetonide... 17

Index of s triamcinolone nasal spray.. 21 triamterene/ hydrochlorothiazide... 10 TRIAVIL............ 40 triazolam............41 TRI-FED X........... 47 trifluoperazine.........42 trifluridine........... 38 trihexyphenidyl........ 14 TRILAFON.......... 42 TRILEPTAL.......... 15 TRILISATE......... 12, 33 TRILYTE............ 27 trimethobenzamide......25 trimethoprim..........32 TRIMETHOPRIM....... 32 TRI-NORINYL......... 35 TRIOTANN.......... 21 TRIOTANN PEDIATRIC SUSP 43 tripolidine/pseudoephedrine 47 TRIPROL/PSE SYP..... 47 TRI RX............. 52 TRIUMEQ........... 31 TRI-VI-FLOR.......... 52 TRI-VI-SOL........ 53, 59 TRIVORA........... 35 TRIZIVIR............ 30 TROJAN............ 57 trospium............49 TRUSOPT........... 37 TRUST NATALCARE PAK DHA......... 51 TRUVADA........... 31 T-STAT............. 16 TUMS........... 57, 59 TUSSI 12D S......... 46 TUSSI-12 S.......... 43 TUSSIN DM.......... 44 TWINJECT.......... 53 TYBOST............ 31 TYKERB............. 4 TYLENOL....... 12, 32, 58 TYLENOL W/CODEINE... 13 typhoid vaccine........55 ALL CAPS = Brand-name drug Lower case = Generic drug U ULORIC............ 33 ULTRAM............ 12 umeclidinium inhalation... 47 umeclidinium/vilanterol... 47 UNI-HIST DRO........ 42 UNIPHYL........... 48 urea 40%........... 20 UREA 40% CREAM AND LOTION....... 20 URECHOLINE........ 49 UREX............. 49 UROCIT-K........... 49 urofollitropin purified for inj............24 UROXATRAL......... 48 URSO............. 28 ursodiol............ 28 URSO FORTE......... 28 UTIRA C............ 49 V vaginal products....... 56 valacyclovir.......... 30 VALCYTE........... 29 valganciclovir......... 29 VALIUM.......... 33, 39 valproic acid..........16 VALTREX........... 30 VANCOCIN HCL....... 29 vancomycin HCl....... 29 vandetanib........... 5 varenicline...........42 VASERETIC........... 8 VASOCIDIN.......... 37 VASOCLEAR......... 36 VASOCLEAR A........ 36 VASOSULF.......... 38 VASOTEC............ 7 VECTICAL........... 18 VEETIDS............ 29 vemurafenib.......... 5 venlafaxine.......... 40 venlafaxine XR........ 40 VENTOLIN HFA........ 47 77 VEPESID............. 6 verapamil......... 9, 14 verapamil extended-release..9 VESANOID........... 6 VEXOL............. 37 VFEND............. 29 VICODIN............ 13 VICODIN ES.......... 13 VICTOZA........... 24 VI-DAYLIN........... 59 VIDEX............. 30 VIDEX EC........... 30 vigabatrin oral solution.... 16 VIMPAT............ 15 VINATE AZ EX........ 52 VINATE III........... 51 VIRACEPT........... 31 VIRAMUNE.......... 30 VIRAMUNE XR........ 30 VIREAD............ 31 VIROPTIC........... 38 VISINE............. 58 VISINE-AC........... 37 vismodegib...........6 VISTARIL............ 20 vitamin A............52 vitamin ADC/fluoride/±iron drops........... 52 vitamin B-1.......... 52 vitamin B-6.......... 52 VITAMIN B-12......... 50 vitamin B complex/ vitamin C/folic acid....52 vitamin C........... 52 vitamin D............59 VITAMIN D......... 49, 59 vitamins pediatric.... 53, 59 vitamins prenatal....... 59 VITAPHIL........... 51 VITUSSIN........... 45 VIVOTIF BERNA....... 55 VOLTAREN...... 12, 33, 37 VOLTAREN 1% TOPICAL GEL33 VOLTAREN XR........ 33 voriconazole..........29

Index of s vorinostat............4 VOSOL HC OTIC....... 20 VOSOL OTIC......... 20 VOTRIENT............ 4 VYVANSE........... 39 W warfarin.............7 WELLBUTRIN......... 40 WELLBUTRIN SR...... 40 WELLBUTRIN XL....... 40 WESTCORT.......... 17 WYTENSIN.......... 11 X XALATAN........... 38 XALKORI............ 4 XANAX............ 39 XARELTO............ 6 XELODA............. 4 XENAZINE.......... 16 XOLAIR............ 47 XOPENEX RESPULES.... 48 XYLOCAINE........ 19, 21 XYZAL............. 20 Z zaleplon............ 41 ZANAFLEX.......... 33 zanamivir........... 30 ZANTAC............ 26 ZARONTIN.......... 15 ZAROXOLYN......... 10 ZARXIO............. 7 ZEBETA............. 9 ZEBUTAL........... 12 ZELBORAF........... 5 ZENPEP............ 27 ZERIT............. 31 ZESTORETIC.......... 8 ZESTRIL............. 7 ZETIA............. 10 ZIAC............... 9 ZIAGEN............ 30 zidovudine...........31 ALL CAPS = Brand-name drug Lower case = Generic drug zinc...............53 ziprasidone.......... 41 ZITHROMAX......... 28 ZOCOR............ 10 ZOFRAN............ 25 ZOFRAN ODT......... 25 ZOHYDRO ER........ 13 ZOLINZA............ 4 ZOLOFT............ 40 zolpidem............41 ZONEGRAN.......... 16 zonisamide.......... 16 ZORTRESS........... 6 ZOSTAVAX.......... 55 zoster vaccine live.......55 ZOVIA 1/35.......... 35 ZOVIA 1/50.......... 35 ZOVIRAX........... 30 ZYDELIG............ 4 ZYKADIA............ 4 ZYLOPRIM.......... 33 ZYMAR............ 38 ZYPREXA........... 41 ZYRTEC.......... 20, 56 ZYRTEC D........ 21, 56 ZYTIGA............. 5 ZYVOX............. 31 78

Notes 79

My Medications worksheet Take this worksheet with you each time you visit a doctor. Each of your doctors should be aware of every drug you take and you should have a list as well. Name of Medicine and Strength I Take This Medicine For Directions Doctor Example: Lisinopril, 20mg 1 High blood pressure One tablet daily Dr. Johnson 80

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