20 14 2015
Smal l Gr oup Empl oy eeBenef i t s
DAKOTACARE Drug Formulary EFFECTIVE 04/01/2015 INTRODUCTION....................................................................................................................................................................................................... 4 PREFACE ................................................................................................................................................................................................................. 4 COPAY DETERMINATION ...................................................................................................................................................................................... 5 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................ 6 GENERIC SUBSTITUTION ...................................................................................................................................................................................... 6 OVER-THE-COUNTER MEDICATIONS .................................................................................................................................................................. 7 PRIOR AUTHORIZATION ........................................................................................................................................................................................ 7 SPECIALTY INJECTABLE COVERAGE DETERMINATION ................................................................................................................................. 8 QUANTITY LIMITATIONS........................................................................................................................................................................................ 8 STEP THERAPY ...................................................................................................................................................................................................... 8 LEGEND ................................................................................................................................................................................................................... 9 NOTICE..................................................................................................................................................................................................................... 9 ANALGESICS......................................................................................................................................................................................................... 10 NSAIDs ......................................................................................................................................................................................................... 10 NSAIDs, TOPICAL ....................................................................................................................................................................................... 10 COX-2 INHIBITORS ..................................................................................................................................................................................... 10 GOUT ........................................................................................................................................................................................................... 10 OPIOID ANALGESICS ................................................................................................................................................................................. 10 NON-OPIOID ANALGESICS........................................................................................................................................................................ 11 ANTI-INFECTIVES ................................................................................................................................................................................................. 11 ANTIBACTERIALS ....................................................................................................................................................................................... 11 ANTIFUNGALS ............................................................................................................................................................................................ 12 ANTIMALARIALS ......................................................................................................................................................................................... 12 ANTIRETROVIRAL AGENTS ...................................................................................................................................................................... 12 ANTITUBERCULAR AGENTS ..................................................................................................................................................................... 13 ANTIVIRALS................................................................................................................................................................................................. 13 MISCELLANEOUS ....................................................................................................................................................................................... 14 ANTINEOPLASTIC AGENTS ................................................................................................................................................................................ 14 ALKYLATING AGENTS ............................................................................................................................................................................... 14 ANTIMETABOLITES .................................................................................................................................................................................... 15 HORMONAL ANTINEOPLASTIC AGENTS ................................................................................................................................................. 15 IMMUNOMODULATORS ............................................................................................................................................................................. 15 KINASE INHIBITORS ................................................................................................................................................................................... 15 TOPOISOMERASE INHIBITORS ................................................................................................................................................................ 16 MISCELLANEOUS ....................................................................................................................................................................................... 16 CARDIOVASCULAR .............................................................................................................................................................................................. 16 ACE INHIBITORS......................................................................................................................................................................................... 16 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ........................................................................................................ 16 ACE INHIBITOR/DIURETIC COMBINATIONS ............................................................................................................................................ 16 ADRENOLYTICS, CENTRAL....................................................................................................................................................................... 16 ALDOSTERONE RECEPTOR ANTAGONISTS .......................................................................................................................................... 17 ALPHA BLOCKERS ..................................................................................................................................................................................... 17 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS........................................................................................... 17 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ......................................................... 17 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ....................................... 17 ANTIARRHYTHMICS ................................................................................................................................................................................... 17 ANTILIPEMICS............................................................................................................................................................................................. 18 BETA-BLOCKERS ....................................................................................................................................................................................... 18 BETA-BLOCKER/DIURETIC COMBINATIONS ........................................................................................................................................... 19 CALCIUM CHANNEL BLOCKERS .............................................................................................................................................................. 19 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS ............................................................................................................ 19 DIGITALIS GLYCOSIDES ............................................................................................................................................................................ 19 DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS ....................................................................................................................... 19 DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...................................................................................... 19 DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS .................................................................... 19 DIURETICS .................................................................................................................................................................................................. 19 1
NITRATES .................................................................................................................................................................................................... 20 NITRATE/VASODILATOR COMBINATIONS .............................................................................................................................................. 20 PULMONARY ARTERIAL HYPERTENSION .............................................................................................................................................. 20 MISCELLANEOUS ....................................................................................................................................................................................... 20 CENTRAL NERVOUS SYSTEM ............................................................................................................................................................................ 21 ANTIANXIETY .............................................................................................................................................................................................. 21 ANTICONVULSANTS .................................................................................................................................................................................. 21 ANTIDEMENTIA ........................................................................................................................................................................................... 21 ANTIDEPRESSANTS .................................................................................................................................................................................. 22 ANTIPARKINSONIAN AGENTS .................................................................................................................................................................. 22 ANTIPSYCHOTICS ...................................................................................................................................................................................... 23 ATTENTION DEFICIT HYPERACTIVITY DISORDER ................................................................................................................................ 23 FIBROMYALGIA........................................................................................................................................................................................... 24 HUNTINGTON'S DISEASE AGENTS .......................................................................................................................................................... 24 HYPNOTICS................................................................................................................................................................................................. 24 MIGRAINE .................................................................................................................................................................................................... 24 MOOD STABILIZERS .................................................................................................................................................................................. 24 MULTIPLE SCLEROSIS AGENTS .............................................................................................................................................................. 24 MUSCULOSKELETAL THERAPY AGENTS ............................................................................................................................................... 25 MYASTHENIA GRAVIS ............................................................................................................................................................................... 25 NARCOLEPSY ............................................................................................................................................................................................. 25 PSYCHOTHERAPEUTIC-MISCELLANEOUS ............................................................................................................................................. 25 ENDOCRINE AND METABOLIC ........................................................................................................................................................................... 25 ANDROGENS .............................................................................................................................................................................................. 25 ANTIDIABETICS .......................................................................................................................................................................................... 25 ANTIOBESITY .............................................................................................................................................................................................. 27 CALCIUM RECEPTOR ANTAGONISTS ..................................................................................................................................................... 27 CALCIUM REGULATORS ........................................................................................................................................................................... 27 CONTRACEPTIVES .................................................................................................................................................................................... 27 ENDOMETRIOSIS ....................................................................................................................................................................................... 28 ESTROGENS ............................................................................................................................................................................................... 28 ESTROGEN/PROGESTINS......................................................................................................................................................................... 29 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ............................................................................. 29 GAUCHER DISEASE ................................................................................................................................................................................... 29 GLUCOCORTICOIDS .................................................................................................................................................................................. 29 GLUCOSE ELEVATING AGENTS ............................................................................................................................................................... 29 HUMAN GROWTH HORMONES................................................................................................................................................................. 29 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ................................................................................................................. 30 PHENYLKETONURIA TREATMENT AGENTS ........................................................................................................................................... 30 PHOSPHATE BINDER AGENTS ................................................................................................................................................................. 30 PROGESTINS .............................................................................................................................................................................................. 30 SELECTIVE ESTROGEN RECEPTOR MODULATORS ............................................................................................................................. 30 THYROID AGENTS ..................................................................................................................................................................................... 30 VASOPRESSINS ......................................................................................................................................................................................... 30 MISCELLANEOUS ....................................................................................................................................................................................... 30 GASTROINTESTINAL ........................................................................................................................................................................................... 31 ANTIDIARRHEALS ...................................................................................................................................................................................... 31 ANTIEMETICS ............................................................................................................................................................................................. 31 ANTISPASMODICS ..................................................................................................................................................................................... 31 CHOLELITHOLYTICS .................................................................................................................................................................................. 31 INFLAMMATORY BOWEL DISEASE .......................................................................................................................................................... 31 IRRITABLE BOWEL SYNDROME ............................................................................................................................................................... 31 LAXATIVES .................................................................................................................................................................................................. 32 PANCREATIC ENZYMES ............................................................................................................................................................................ 32 PROSTAGLANDINS .................................................................................................................................................................................... 32 PROTON PUMP INHIBITORS ..................................................................................................................................................................... 32 SALIVA STIMULANTS ................................................................................................................................................................................. 32 STEROIDS, RECTAL ................................................................................................................................................................................... 32 ULCER THERAPY COMBINATIONS .......................................................................................................................................................... 32 MISCELLANEOUS ....................................................................................................................................................................................... 32 GENITOURINARY .................................................................................................................................................................................................. 32 BENIGN PROSTATIC HYPERPLASIA ........................................................................................................................................................ 32 URINARY ANTISPASMODICS .................................................................................................................................................................... 32 VAGINAL ANTI-INFECTIVES ...................................................................................................................................................................... 33 MISCELLANEOUS ....................................................................................................................................................................................... 33 2
HEMATOLOGIC ..................................................................................................................................................................................................... 33 ANTICOAGULANTS .................................................................................................................................................................................... 33 HEREDITARY ANGIOEDEMA AGENTS ..................................................................................................................................................... 33 IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS ...................................................................................................................... 33 IRON CHELATING AGENTS ....................................................................................................................................................................... 33 PLATELET AGGREGATION INHIBITORS .................................................................................................................................................. 33 PLATELET SYNTHESIS INHIBITORS ........................................................................................................................................................ 33 MISCELLANEOUS ....................................................................................................................................................................................... 34 IMMUNOLOGIC AGENTS...................................................................................................................................................................................... 34 ALLERGEN EXTRACTS .............................................................................................................................................................................. 34 BIOLOGIC DISEASE-MODIFYING AGENTS .............................................................................................................................................. 34 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ................................................................................................................. 34 IMMUNE GLOBULINS ................................................................................................................................................................................. 34 IMMUNOMODULATORS ............................................................................................................................................................................. 34 IMMUNOSUPPRESSANTS ......................................................................................................................................................................... 34 NUTRITIONAL/SUPPLEMENTS............................................................................................................................................................................ 35 ELECTROLYTES ......................................................................................................................................................................................... 35 VITAMINS AND MINERALS ........................................................................................................................................................................ 35 RESPIRATORY ...................................................................................................................................................................................................... 35 ANAPHYLAXIS TREATMENT AGENTS ..................................................................................................................................................... 35 ANTICHOLINERGICS .................................................................................................................................................................................. 35 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS............................................................................................................................ 35 ANTIHISTAMINES, LOW SEDATING.......................................................................................................................................................... 35 ANTIHISTAMINES, SEDATING ................................................................................................................................................................... 35 ANTITUSSIVES............................................................................................................................................................................................ 35 ANTITUSSIVE COMBINATIONS ................................................................................................................................................................. 36 BETA AGONISTS ........................................................................................................................................................................................ 36 CYSTIC FIBROSIS ...................................................................................................................................................................................... 36 LEUKOTRIENE RECEPTOR ANTAGONISTS ............................................................................................................................................ 36 MAST CELL STABILIZERS ......................................................................................................................................................................... 36 NASAL ANTIHISTAMINES .......................................................................................................................................................................... 36 NASAL STEROIDS ...................................................................................................................................................................................... 36 PULMONARY FIBROSIS AGENTS ............................................................................................................................................................. 36 STEROID/BETA AGONIST COMBINATIONS ............................................................................................................................................. 37 STEROID INHALANTS ................................................................................................................................................................................ 37 XANTHINES ................................................................................................................................................................................................. 37 MISCELLANEOUS ....................................................................................................................................................................................... 37 TOPICAL ................................................................................................................................................................................................................ 37 DERMATOLOGY.......................................................................................................................................................................................... 37 MOUTH/THROAT/DENTAL AGENTS ......................................................................................................................................................... 40 OPHTHALMIC .............................................................................................................................................................................................. 40 OTIC ............................................................................................................................................................................................................. 42 WEBSITES ............................................................................................................................................................................................................. 43 INDEX ..................................................................................................................................................................................................................... 45
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INTRODUCTION We are pleased to provide the DAKOTACARE Drug Formulary as a useful reference and informational tool. The Drug Formulary can assist practitioners in selecting clinically-appropriate and cost-effective products for the members that DAKOTACARE serves. The formulary process has been successfully utilized by hospitals and managed care organizations to provide comprehensive, cost-effective pharmacy services. The DAKOTACARE Pharmacy and Therapeutics (P&T) Committee determines what medications will be included on the Drug Formulary. The P&T Committee members come from various clinical specialties that adequately represent the plan’s members. The members of the committee are physicians and pharmacists that practice in the state of South Dakota. The P&T Committee meets on a regular basis and not less frequently than on a quarterly basis. The DAKOTACARE P&T Committee must review the Drug Formulary for clinical appropriateness, as well as the practices and policies for drug formulary management activities (Prior Authorizations, Quantity Limitations and Step Therapy) that affect access to prescription medications. The prescription medications included in the DAKOTACARE Drug Formulary may be amended by DAKOTACARE at any time without notice to members. The information contained in this formulary and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. The information herein is not intended to be a substitute for the knowledge, expertise, skill or judgment of the medical provider in his or her choice of prescription drugs. All the information in the formulary is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. We assume 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 National Guideline Clearinghouse site at http://www.guideline.gov, on the websites listed under each therapeutic class and on the sites listed in the WEBSITES section of this publication.
PREFACE The Drug Formulary is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless otherwise noted, generally all strengths and formulations of a specified drug are included in the formulary. Generics should be considered the first line of prescribing. The Drug Formulary primarily applies to prescription medications dispensed to members by participating pharmacy providers; however, it may apply to medications obtained/administered by a health care provider. The Drug Formulary does not apply to medications given during an inpatient (i.e. hospital) stay. As you use the Drug Formulary, DAKOTACARE welcomes your suggestions to improve the format or content.
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COPAY DETERMINATION Drugs represented in the Drug Formulary may have varying cost to the member. Generic medications typically cost the least; brand-name products selected for Tier 2 will generally cost more; and brand-name medications in Tier 3, or not on the formulary will generally cost the most. The tiered format places drugs into tiers or levels of cost sharing by the plan member in the following manner: Tier 1: Tier 2: Tier 3:
Lowest plan member copayment: Most generic drugs, whether listed or not. Intermediate plan member copayment: Some generic drugs and preferred brand-name products selected for Tier 2. Highest plan member copayment: Brand-name products not selected for Tier 2. In most cases, there will be reasonable alternatives in Tier 1 or Tier 2 for products found in this highest tier.
DAKOTACARE members will pay only the applicable copay for the prescription medication unless one of the following conditions applies: • •
If a prescription is written for a medication that is available as an over-the-counter (OTC) product, the prescription medication will not be covered. Refer to the over-the-counter medication section for further details. If a prescriber indicates “Dispense as Written” (DAW) or if a member requests the brand-name product when a generic is available, the member will pay the applicable copay PLUS the difference between the brand-name medication and the contracted rate. This cost difference is referred to as an ancillary charge.
For medications not listed, please refer to the Drug Formulary look-up tool at www.dakotacare.com to determine whether a specific medication is covered; otherwise, contact CVS/caremark toll-free at 1-866-406-8773. Non-Formulary Medications Health care providers are expected to comply with the Drug Formulary when prescribing medications for plan members. If a pharmacist receives a prescription for a non-formulary medication, the pharmacy may attempt to contact the prescriber to request a change to a Drug Formulary product. If the prescriber is unwilling to change the prescription or is unavailable, the prescription will be dispensed as written. The DAKOTACARE P&T Committee will monitor prescriptions written for non-formulary medications by prescribers. Drug Formulary Addition If a health care provider requests that a new or existing medication be added to the Drug Formulary, a letter indicating the significant clinical advantages of the requested drug product over the current Drug Formulary alternative(s) should be mailed to DAKOTACARE’s Medical Director who will present the request to the DAKOTACARE P&T Committee. Unapproved Use of Drug Formulary Medications The member’s handbook/contract states that medications will be eligible for coverage if the medication has U.S. Food and Drug Administration (FDA) approval and non-experimental indications. Non-experimental indications include the FDA-approved label indication(s) and other indication(s) accepted as effective based on currently available scientific, evidence-based literature and professional opinion.
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DRUG LIST PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms are on the Drug Formulary, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the Drug Formulary. Any exceptions are noted. Products on formulary include all strengths and dosage forms of the cited brand-name product. aripiprazole Abilify Oral tablets, oral disintegrating tablets, solution and all strengths of Abilify would be included in this listing. When a strength or dosage form is specified, only the specified strength and dosage form is on formulary. Other strengths/dosage forms of the reference product are not. acyclovir caps, susp, tabs Zovirax The capsules, suspension and tablets of Zovirax are on formulary. From this entry, the cream and ointment cannot be assumed to be on the list unless there is a specific entry. Extended-release and delayed-release products require their own entry. sitagliptin/metformin Janumet The immediate-release product listing of Janumet alone would not include the extended-release product Janumet XR. sitagliptin/metformin ext-rel Janumet XR A separate entry for Janumet XR confirms that the extended-release product is on formulary. Dosage forms on formulary will be consistent with the category and use where listed. neomycin/polymyxin B/hydrocortisone Cortisporin Since Cortisporin is listed only in the OTIC section, it is limited to the otic solution and suspension. From this entry the topical cream cannot be assumed to be on the list unless there is an entry for this product in the DERMATOLOGY section of the Drug Formulary.
GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In addition, boldface type may indicate that the brand name cited is a generic. Examples of the latter include Levoxyl and Trivora. One way to reduce out-of-pocket cost is by requesting a generic drug. Generic drugs are usually priced lower than their brand-name equivalents. A prescription generic drug is a medication which is: • •
• •
A chemically equivalent copy designed from a brand-name drug whose patent has expired. Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. Requires a prescription and is marketed under its chemical name. Manufactured by more than two (2) generic manufacturers and is offered at a significantly reduced cost as compared to the brand product.
When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug. If a medication has a generic substitute available, the generic drug is the preferred product. Health care providers are reminded of the following: • •
When generic substitution conflicts with state regulations or restrictions, the pharmacist must gain approval from the prescriber to use the generic equivalent. If a prescriber indicates “Dispense as Written” (DAW) or if a member requests the brand-name product, in most cases, the member will pay the applicable copay PLUS the difference between the brand-name medication and the contracted rate. This cost difference is referred to as an ancillary charge.
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OVER-THE-COUNTER MEDICATIONS Over-the-counter (OTC) medications do not require prescriptions, and are generally available at most local pharmacies. If a prescription medication is available with the same active ingredient(s) and dosage form as an OTC product, the prescription medication will not be covered. In these instances, the health care provider should refer members to the OTC equivalent product. If the member or prescriber insists on the prescription equivalent, the member must pay the entire cost of the prescription medication.
PRIOR AUTHORIZATION Certain medications require prior authorization (PA) before they will be approved for coverage. These medications tend to be high-risk or high-cost medications that DAKOTACARE has elected to provide coverage for if the specified criteria is met. The prior authorization criteria are determined by the DAKOTACARE P&T Committee based on current clinical guidelines and medical literature. Please note that medications requiring PA may be added or removed at any time without prior notice to members or providers. Medications that currently require prior authorization are identified within the text of the formulary by the notation PA. The following information is needed when requesting a prior authorized drug: • • • • • •
Patient name and identification number Physician name, address and phone number Drug name and strength Patient diagnosis Documentation of previous medical history pertaining to the requested drug Pharmacy name and phone number
All medications require prior authorization through DAKOTACARE. The current Prior Authorization listing can be found on the provider portal at www.dakotacare.com for guidance. Please contact DAKOTACARE at www.DKC-PA.com or at 1-605-334-4000 or toll-free at 1-800-658-5508 to obtain prior authorization. In order for a member to receive coverage for a medication requiring prior authorization, the prescriber must submit a letter of medical necessity (to DAKOTACARE) with history of past therapies for the specified diagnosis and the member’s identification (name, address and member number). Inquiries can be directed to: DAKOTACARE 2600 W. 49th Street P.O. Box 7406 Sioux Falls, SD 57117-7406 Fax: 1-605-274-3279 Pharmacy Provider Telephone: 1-605-334-4000 1-866-551-8022 Physician Provider Telephone: 1-605-334-4000 1-866-551-8022 Member Telephone: 1-605-334-4000 1-866-551-8022 TDD (for the hearing impaired): Not available
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SPECIALTY INJECTABLE COVERAGE DETERMINATION Medications considered self-administered are covered under the pharmacy benefit. No coverage is available for self-administered medications on the medical benefit unless prior authorization is obtained from DAKOTACARE prior to administration. A member or provider may inquire regarding specific coverage for specialty injectable medications. A listing of medications considered self-administered can be found on the provider portal at www.dakotacare.com.
QUANTITY LIMITATIONS The DAKOTACARE P&T Committee establishes quantity limits (QL) for certain prescription medications based on current clinical guidelines and medical literature. Medications that currently have quantity limitations are identified within the text of the formulary by the notation QL.
STEP THERAPY Certain medications covered under the prescription benefit are required to satisfy specific step therapy criteria. Step therapy criteria simply means that for certain drug products, DAKOTACARE members must first have tried one or more prerequisite medications to treat their condition before other medications are covered through their benefit. Medications that currently require step therapy are identified within the text of the formulary by the notation ST. Step therapy does not apply to the following list of carriers and groups below: Group Numbers for Carrier 4331: 64190 64202 64239 64242
64261 64335 64441 64442
64443 64444
Group Numbers for Carrier 4333: 64178 64241 64315
64445 64446
Group Numbers for Carrier 4349: 64447 64448 64449
64450 64451 64452
64453 64454
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LEGEND # ## EVITI PA OTC PA QL ST lowercase, boldface delayed-rel ext-rel Tier status
Only the dosage forms/strengths of the brand-name product noted are on the Drug Formulary Indicates the generic is at Tier 2 Prior Authorization through EVITI (Oncology PA Process) is required Over-the-counter Prior Authorization is required Quantity Limits Step Therapy criteria applies Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification Extended-release (also known as sustained-release), refer to the reference brand listed for clarification Tier status listed represents the tier of the brand product. If no brand name is listed, tier represents the tier of the generic product
NOTICE The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2015. All rights reserved. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. DAKOTACARE and CVS/caremark do not operate the websites/organizations listed here, nor are they responsible for the availability or reliability of the websites' content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by DAKOTACARE or CVS/caremark. When viewing the Drug Formulary via the internet, please be advised that the formulary is updated periodically and changes may appear prior to their effective date.
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ANALGESICS Practice guidelines of pain management are available at: http://www.asahq.org NSAIDs
diclofenac sodium delayed-rel diflunisal etodolac nabumetone sulindac meloxicam naproxen naproxen sodium oxaprozin
Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3
MOBIC NAPROSYN ANAPROX DAYPRO
NSAIDs, TOPICAL diclofenac sodium soln
Tier 2
COX-2 INHIBITORS ST celecoxib
Tier 3
CELEBREX
Tier 1 Tier 2 Tier 3
COLCRYS ZYLOPRIM
GOUT ##
probenecid colchicine allopurinol
## colchicine is at Tier 2 OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO analgesic ladder) are available at: http://www.asahq.org http://www.nccn.org Opioid guidelines in the management of chronic non-malignant pain are available at: http://www.asipp.org/Guidelines.htm
##
QL
morphine morphine supp oxycodone caps, tabs 5 mg oxycodone concentrate 20 mg/mL hydromorphone ext-rel oxycodone ext-rel tapentadol tapentadol ext-rel buprenorphine transdermal codeine/acetaminophen fentanyl transdermal hydrocodone/acetaminophen hydrocodone/acetaminophen hydromorphone morphine ext-rel morphine ext-rel morphine ext-rel oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL oxycodone/acetaminophen 5/325 tramadol
Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
EXALGO OXYCONTIN NUCYNTA NUCYNTA ER BUTRANS TYLENOL w/CODEINE DURAGESIC NORCO VICODIN ES DILAUDID AVINZA KADIAN MS CONTIN ROXICODONE PERCOCET ULTRAM
## hydromorphone ext-rel is at Tier 2 10
NON-OPIOID ANALGESICS butalbital/acetaminophen/caffeine butalbital/aspirin/caffeine
Tier 1 Tier 3
FIORINAL
ANTI-INFECTIVES Hepatitis: CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of chronic hepatitis by the American Association for the Study of Liver Disease are available at: http://www.aasld.org HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: http://www.aidsinfo.nih.gov Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: http://www.myamericanheart.org Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at: http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm International Travel: CDC recommendations for international travel are available at: http://www.cdc.gov/travel Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: http://www.cdc.gov/std/treatment/default.htm Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: http://www.cdc.gov/flu Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: http://www.idsociety.org ANTIBACTERIALS Cephalosporins First Generation cefadroxil cephalexin
Tier 1 Tier 3
KEFLEX
Second Generation cefaclor cefprozil cefuroxime axetil
Tier 1 Tier 1 Tier 3
CEFTIN
Tier 1 Tier 3 Tier 3
SUPRAX CEDAX
Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
ERY-TAB E.E.S. ERYPED ZITHROMAX BIAXIN BIAXIN XL
Third Generation
cefdinir cefixime ceftibuten
Erythromycins/Macrolides erythromycin delayed-rel erythromycin stearate erythromycin delayed-rel erythromycin ethylsuccinate drops erythromycin ethylsuccinate drops QL azithromycin clarithromycin clarithromycin ext-rel
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erythromycin ethylsuccinate tabs fidaxomicin
Tier 3 Tier 3
E.E.S. tabs DIFICID
ciprofloxacin ext-rel ciprofloxacin susp ciprofloxacin tabs levofloxacin moxifloxacin
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3
CIPRO susp CIPRO tabs LEVAQUIN AVELOX
amoxicillin ampicillin dicloxacillin penicillin VK amoxicillin/clavulanate amoxicillin/clavulanate ext-rel
Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3
AUGMENTIN AUGMENTIN XR
doxycycline hyclate 20 mg tetracycline caps doxycycline hyclate minocycline
Tier 1 Tier 1 Tier 3 Tier 3
VIBRAMYCIN MINOCIN
clotrimazole troches nystatin griseofulvin ultramicrosize fluconazole itraconazole terbinafine tabs voriconazole
Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
GRIS-PEG DIFLUCAN SPORANOX LAMISIL VFEND
mefloquine artemether/lumefantrine atovaquone/proguanil chloroquine
Tier 1 Tier 2 Tier 2 Tier 3
COARTEM MALARONE ARALEN
ANTIRETROVIRAL AGENTS Antiretroviral Adjuvants cobicistat
Tier 2
TYBOST
Antiretroviral Combinations abacavir/dolutegravir/lamivudine abacavir/lamivudine/zidovudine efavirenz/emtricitabine/tenofovir elvitegravir/cobicistat/emtricitabine/tenofovir lamivudine/zidovudine abacavir/lamivudine emtricitabine/rilpivirine/tenofovir emtricitabine/tenofovir
Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
TRIUMEQ TRIZIVIR ATRIPLA STRIBILD COMBIVIR EPZICOM COMPLERA TRUVADA
Chemokine Receptor Antagonists maraviroc
Tier 2
SELZENTRY
Fluoroquinolones ##
## ciprofloxacin susp is at Tier 2 Penicillins
Tetracyclines
ANTIFUNGALS
QL QL QL, # QL ANTIMALARIALS
12
Fusion Inhibitors
enfuvirtide
Tier 2
FUZEON
Integrase Inhibitors QL dolutegravir elvitegravir raltegravir
Tier 3 Tier 3 Tier 3
TIVICAY VITEKTA ISENTRESS
Non-nucleoside Reverse Transcriptase Inhibitors delavirdine efavirenz etravirine nevirapine ## nevirapine ext-rel rilpivirine
Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3
RESCRIPTOR SUSTIVA INTELENCE VIRAMUNE VIRAMUNE XR EDURANT
Nucleoside Reverse Transcriptase Inhibitors abacavir soln abacavir tabs didanosine soln emtricitabine lamivudine stavudine caps stavudine soln didanosine delayed-rel zidovudine
Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3
ZIAGEN soln ZIAGEN tabs VIDEX soln EMTRIVA EPIVIR ZERIT caps ZERIT soln VIDEX EC RETROVIR
Nucleotide Reverse Transcriptase Inhibitors tenofovir
Tier 2
VIREAD
Protease Inhibitors atazanavir darunavir fosamprenavir indinavir lopinavir/ritonavir nelfinavir ritonavir saquinavir mesylate tipranavir
Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2
REYATAZ PREZISTA LEXIVA CRIXIVAN KALETRA VIRACEPT NORVIR INVIRASE APTIVUS
ANTITUBERCULAR AGENTS isoniazid pyrazinamide bedaquiline ethambutol rifampin
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
SIRTURO MYAMBUTOL RIFADIN
ANTIVIRALS Cytomegalovirus Agents ## valganciclovir
Tier 2
VALCYTE
## nevirapine ext-rel is at Tier 2
## valganciclovir is at Tier 2
13
Hepatitis Agents Hepatitis B
entecavir soln entecavir tabs telbivudine adefovir dipivoxil lamivudine
Tier 2 Tier 2 Tier 2 Tier 3 Tier 3
BARACLUDE soln BARACLUDE tabs TYZEKA HEPSERA EPIVIR-HBV
ribavirin oral soln ribavirin tabs boceprevir ledipasvir/sofosbuvir ribavirin caps ribavirin tabs simeprevir sofosbuvir
Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
REBETOL RIBAPAK VICTRELIS HARVONI REBETOL COPEGUS OLYSIO SOVALDI
valacyclovir acyclovir caps, susp, tabs famciclovir
Tier 1 Tier 3 Tier 3
ZOVIRAX FAMVIR
Influenza Agents QL oseltamivir QL zanamivir
Tier 2 Tier 3
TAMIFLU RELENZA
MISCELLANEOUS dapsone sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS trimethoprim clindamycin caps 75 mg clindamycin pediatric soln PA linezolid nitrofurantoin macrocrystals 25 mg nitrofurantoin susp vancomycin clindamycin caps 150 mg, 300 mg metronidazole nitazoxanide nitrofurantoin ext-rel nitrofurantoin macrocrystals 50 mg, 100 mg telavancin tinidazole
Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
CLEOCIN caps 75 mg CLEOCIN PEDIATRIC ZYVOX MACRODANTIN 25 mg FURADANTIN VANCOCIN CLEOCIN caps 150 mg, 300 mg FLAGYL ALINIA MACROBID MACRODANTIN 50 mg, 100 mg VIBATIV TINDAMAX
Tier 1 Tier 2 Tier 2 Tier 2 Tier 2
HEXALEN MYLERAN LEUKERAN ALKERAN
Hepatitis C PA, QL PA, QL PA, QL PA, QL Herpes Agents
ANTINEOPLASTIC AGENTS Clinical practice guidelines in oncology are available at: http://www.asco.org http://www.nccn.org ALKYLATING AGENTS EVITI PA lomustine EVITI PA altretamine EVITI PA busulfan EVITI PA chlorambucil EVITI PA melphalan
14
EVITI PA EVITI PA EVITI PA
temozolomide cyclophosphamide caps mechlorethamine gel
Tier 2 Tier 3 Tier 3
TEMODAR CYCLOPHOSPHAMIDE caps VALCHLOR
ANTIMETABOLITES EVITI PA capecitabine methotrexate EVITI PA mercaptopurine EVITI PA thioguanine
Tier 2 Tier 2 Tier 3 Tier 3
XELODA TREXALL PURINETHOL TABLOID
HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens EVITI PA flutamide EVITI PA abiraterone bicalutamide EVITI PA enzalutamide
Tier 1 Tier 3 Tier 3 Tier 3
ZYTIGA CASODEX XTANDI
Tier 1 Tier 2
FARESTON
Tier 2 Tier 2 Tier 3
ARIMIDEX FEMARA AROMASIN
Tier 3
MEGACE
IMMUNOMODULATORS PA thalidomide EVITI PA lenalidomide EVITI PA pomalidomide
Tier 2 Tier 3 Tier 3
THALOMID REVLIMID POMALYST
KINASE INHIBITORS EVITI PA erlotinib EVITI PA imatinib mesylate EVITI PA lapatinib EVITI PA axitinib EVITI PA, QL bosutinib EVITI PA cabozantinib EVITI PA ceritinib EVITI PA crizotinib EVITI PA, QL dabrafenib EVITI PA dasatinib EVITI PA ibrutinib EVITI PA idelalisib EVITI PA nilotinib EVITI PA pazopanib EVITI PA regorafenib EVITI PA, QL ruxolitinib EVITI PA sorafenib EVITI PA sunitinib EVITI PA, QL trametinib EVITI PA, QL vandetanib EVITI PA vemurafenib
Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TARCEVA GLEEVEC TYKERB INLYTA BOSULIF COMETRIQ ZYKADIA XALKORI TAFINLAR SPRYCEL IMBRUVICA ZYDELIG TASIGNA VOTRIENT STIVARGA JAKAFI NEXAVAR SUTENT MEKINIST CAPRELSA ZELBORAF
Antiestrogens
tamoxifen toremifene
Aromatase Inhibitors anastrozole letrozole exemestane Progestins
megestrol acetate
15
TOPOISOMERASE INHIBITORS EVITI PA topotecan caps
Tier 3
HYCAMTIN caps
MISCELLANEOUS EVITI PA etoposide EVITI PA tretinoin caps EVITI PA bexarotene EVITI PA mitotane EVITI PA vorinostat hydroxyurea PA siltuximab EVITI PA vismodegib
Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
TARGRETIN LYSODREN ZOLINZA HYDREA SYLVANT ERIVEDGE
CARDIOVASCULAR The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: http://www.acc.org http://www.heartfailureguideline.org http://www.myamericanheart.org ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 http://professional.diabetes.org http://www.acc.org http://www.myamericanheart.org captopril fosinopril benazepril enalapril lisinopril perindopril quinapril ramipril trandolapril
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
LOTENSIN VASOTEC ZESTRIL ACEON ACCUPRIL ALTACE MAVIK
Tier 2 Tier 3
LOTREL TARKA
ACE INHIBITOR/DIURETIC COMBINATIONS captopril/hydrochlorothiazide fosinopril/hydrochlorothiazide benazepril/hydrochlorothiazide enalapril/hydrochlorothiazide lisinopril/hydrochlorothiazide quinapril/hydrochlorothiazide
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3
LOTENSIN HCT VASERETIC ZESTORETIC ACCURETIC
ADRENOLYTICS, CENTRAL clonidine QL clonidine transdermal guanfacine
Tier 3 Tier 3 Tier 3
CATAPRES CATAPRES-TTS TENEX
ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/benazepril ## trandolapril/verapamil ext-rel ## trandolapril/verapamil ext-rel is at Tier 2
16
ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone spironolactone
Tier 3 Tier 3
INSPRA ALDACTONE
ALPHA BLOCKERS Guidelines for the use of alpha blockers in various patient populations are available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 terazosin doxazosin
Tier 1 Tier 3
CARDURA
ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 http://professional.diabetes.org candesartan candesartan/hydrochlorothiazide valsartan/hydrochlorothiazide olmesartan olmesartan/hydrochlorothiazide irbesartan irbesartan/hydrochlorothiazide losartan losartan/hydrochlorothiazide telmisartan telmisartan/hydrochlorothiazide valsartan
Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
BENICAR BENICAR HCT AVAPRO AVALIDE COZAAR HYZAAR MICARDIS MICARDIS HCT DIOVAN
ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan Tier 2 AZOR ## amlodipine/telmisartan Tier 2 TWYNSTA ## amlodipine/valsartan Tier 2 EXFORGE ## amlodipine/telmisartan is at Tier 2 ## amlodipine/valsartan is at Tier 2 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ## amlodipine/valsartan/hydrochlorothiazide Tier 2 EXFORGE HCT olmesartan/amlodipine/hydrochlorothiazide Tier 2 TRIBENZOR ## amlodipine/valsartan/hydrochlorothiazide is at Tier 2 ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: http://www.acc.org flecainide disopyramide ext-rel dofetilide amiodarone disopyramide propafenone propafenone ext-rel sotalol sotalol
Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
NORPACE CR TIKOSYN CORDARONE NORPACE RYTHMOL RYTHMOL SR BETAPACE BETAPACE AF
17
ANTILIPEMICS The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk In Adults is available at: http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a Bile Acid Resins
colesevelam cholestyramine colestipol
Tier 2 Tier 3 Tier 3
WELCHOL QUESTRAN/QUESTRAN LIGHT COLESTID
Cholesterol Absorption Inhibitors ST ezetimibe
Tier 2
ZETIA
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
ANTARA LIPOFEN LOFIBRA TRILIPIX LOPID
Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
VYTORIN CRESTOR LIPITOR LIPTRUZET MEVACOR PRAVACHOL ZOCOR
Niacins/Combinations ST niacin ext-rel/simvastatin niacin ext-rel ST niacin ext-rel/lovastatin
Tier 2 Tier 3 Tier 3
SIMCOR NIASPAN ADVICOR
Omega-3 Fatty Acids icosapent ethyl ## omega-3 acid ethyl esters
Tier 3 Tier 3
VASCEPA LOVAZA
Tier 3 Tier 3
JUXTAPID KYNAMRO
Fibrates ##
fenofibrate fenofibrate fenofibrate fenofibric acid delayed-rel gemfibrozil
## fenofibrate (generic for LIPOFEN) is at Tier 2 HMG-CoA Reductase Inhibitors/Combinations ST ezetimibe/simvastatin QL rosuvastatin QL, ST, * atorvastatin ST ezetimibe/atorvastatin ST, * lovastatin ST, * pravastatin ST, * simvastatin * ST applies to brand products only
## omega-3 acid ethyl esters is at Tier 2 Miscellaneous PA PA
lomitapide mipomersen
BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 http://www.acc.org pindolol propranolol atenolol bisoprolol carvedilol
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
TENORMIN ZEBETA COREG 18
carvedilol phosphate ext-rel labetalol metoprolol succinate ext-rel metoprolol tartrate nadolol nebivolol propranolol ext-rel propranolol oral soln
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
COREG CR TRANDATE TOPROL-XL LOPRESSOR CORGARD BYSTOLIC INDERAL LA HEMANGEOL
BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497 http://www.acc.org atenolol/chlorthalidone bisoprolol/hydrochlorothiazide metoprolol/hydrochlorothiazide
Tier 3 Tier 3 Tier 3
TENORETIC ZIAC LOPRESSOR HCT
CALCIUM CHANNEL BLOCKERS Dihydropyridines amlodipine felodipine ext-rel nifedipine ext-rel nifedipine ext-rel
Tier 1 Tier 1 Tier 3 Tier 3
ADALAT CC PROCARDIA XL
Nondihydropyridines diltiazem ext-rel diltiazem ext-rel diltiazem ext-rel verapamil ext-rel
Tier 2 Tier 2 Tier 3 Tier 3
CARDIZEM CD CARDIZEM LA TIAZAC CALAN SR
CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS amlodipine/atorvastatin
Tier 3
CADUET
DIGITALIS GLYCOSIDES digoxin ped elixir digoxin
Tier 1 Tier 3
LANOXIN
DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS aliskiren aliskiren/hydrochlorothiazide
Tier 2 Tier 2
TEKTURNA TEKTURNA HCT
DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS aliskiren/amlodipine Tier 2
TEKAMLO
DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS aliskiren/amlodipine/hydrochlorothiazide Tier 2 AMTURNIDE DIURETICS Carbonic Anhydrase Inhibitors acetazolamide methazolamide acetazolamide ext-rel Loop Diuretics
bumetanide furosemide torsemide
Tier 1 Tier 1 Tier 2
DIAMOX SEQUELS
Tier 1 Tier 3 Tier 3
LASIX DEMADEX 19
Potassium-sparing Diuretics amiloride
Tier 1
Thiazides and Thiazide-like Diuretics chlorthalidone hydrochlorothiazide indapamide metolazone
Tier 1 Tier 1 Tier 1 Tier 3
ZAROXOLYN
Diuretic Combinations amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide triamterene/hydrochlorothiazide triamterene/hydrochlorothiazide
Tier 1 Tier 3 Tier 3 Tier 3
ALDACTAZIDE DYAZIDE MAXZIDE
isosorbide dinitrate ext-rel tabs isosorbide mononitrate isosorbide mononitrate ext-rel isosorbide dinitrate oral
Tier 1 Tier 1 Tier 1 Tier 3
ISORDIL
nitroglycerin sublingual
Tier 3
NITROSTAT
nitroglycerin transdermal nitroglycerin transdermal
Tier 1 Tier 2
NITRO-DUR
NITRATE/VASODILATOR COMBINATIONS isosorbide dinitrate/hydralazine
Tier 3
BIDIL
PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists PA ambrisentan PA bosentan PA, QL macitentan
Tier 2 Tier 2 Tier 3
LETAIRIS TRACLEER OPSUMIT
Phosphodiesterase Inhibitors PA, QL tadalafil PA, QL sildenafil
Tier 2 Tier 3
ADCIRCA REVATIO
Prostaglandin Vasodilators PA iloprost PA, QL treprostinil
Tier 3 Tier 3
VENTAVIS TYVASO
Soluble Guanylate Cyclase Stimulators PA, QL riociguat
Tier 3
ADEMPAS
MISCELLANEOUS hydralazine methyldopa midodrine ranolazine ext-rel
Tier 1 Tier 1 Tier 1 Tier 2
RANEXA
NITRATES Oral
Sublingual Transdermal
20
CENTRAL NERVOUS SYSTEM Practice guidelines for psychiatric disorders are available at: http://www.psych.org ANTIANXIETY Benzodiazepines
Miscellaneous
oxazepam alprazolam clonazepam tabs diazepam lorazepam
Tier 1 Tier 3 Tier 3 Tier 3 Tier 3
XANAX KLONOPIN VALIUM ATIVAN
buspirone fluvoxamine clomipramine
Tier 1 Tier 1 Tier 3
ANAFRANIL
Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TEGRETOL-XR DIASTAT DEPAKOTE ER DEPAKOTE SPRINKLE FELBATOL DILANTIN INFATABS GABITRIL TEGRETOL CARBATROL DEPAKOTE ZARONTIN POTIGA NEURONTIN VIMPAT LAMICTAL LAMICTAL XR KEPPRA KEPPRA XR TRILEPTAL FYCOMPA DILANTIN MYSOLINE BANZEL TOPAMAX DEPAKENE ZONEGRAN
Tier 2 Tier 2 Tier 3
NAMENDA EXELON PATCH ARICEPT, except 23 mg
ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: http://www.aan.com
##
phenobarbital carbamazepine ext-rel diazepam rectal gel divalproex sodium ext-rel divalproex sodium sprinkle felbamate phenytoin tiagabine carbamazepine carbamazepine ext-rel divalproex sodium delayed-rel ethosuximide ezogabine gabapentin lacosamide lamotrigine lamotrigine ext-rel levetiracetam levetiracetam ext-rel oxcarbazepine perampanel phenytoin sodium extended primidone rufinamide topiramate valproic acid zonisamide
## tiagabine is at Tier 2 ANTIDEMENTIA Practice guidelines for the management of dementia are available at: http://www.aan.com memantine rivastigmine transdermal donepezil
21
galantamine galantamine ext-rel memantine ext-rel rivastigmine
Tier 3 Tier 3 Tier 3 Tier 3
RAZADYNE RAZADYNE ER NAMENDA XR EXELON
ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder. Guidelines for the evaluation and management of bipolar and depressive disorders are available at: http://www.psych.org Monoamine Oxidase Inhibitors (MAOIs) phenelzine tranylcypromine
Tier 3 Tier 3
NARDIL PARNATE
Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram escitalopram fluoxetine fluoxetine delayed-rel paroxetine HCl paroxetine HCl ext-rel sertraline QL, ST vortioxetine
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
CELEXA LEXAPRO PROZAC PROZAC WEEKLY PAXIL PAXIL CR ZOLOFT BRINTELLIX
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) venlafaxine QL duloxetine delayed-rel QL, ST desvenlafaxine ext-rel QL, ST levomilnacipran ext-rel venlafaxine ext-rel
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3
CYMBALTA PRISTIQ FETZIMA EFFEXOR XR
Tricyclic Antidepressants (TCAs) amitriptyline doxepin desipramine imipramine HCl nortriptyline
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
NORPRAMIN TOFRANIL PAMELOR
Miscellaneous Agents trazodone ST vilazodone bupropion bupropion ext-rel bupropion ext-rel mirtazapine
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
VIIBRYD WELLBUTRIN WELLBUTRIN SR WELLBUTRIN XL REMERON
ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: http://www.aan.com amantadine benztropine carbidopa/levodopa orally disintegrating tabs trihexyphenidyl apomorphine bromocriptine
Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 3
APOKYN PARLODEL 22
##
carbidopa/levodopa carbidopa/levodopa ext-rel carbidopa/levodopa/entacapone entacapone pramipexole pramipexole ext-rel rasagiline mesylate ropinirole selegiline
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
SINEMET SINEMET CR STALEVO COMTAN MIRAPEX MIRAPEX ER AZILECT REQUIP ELDEPRYL
Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
ABILIFY SAPHRIS CLOZARIL ZYPREXA INVEGA SEROQUEL SEROQUEL XR RISPERDAL GEODON
## pramipexole ext-rel is at Tier 2 ANTIPSYCHOTICS Atypicals QL aripiprazole QL asenapine clozapine olanzapine paliperidone ext-rel quetiapine quetiapine ext-rel risperidone ziprasidone Miscellaneous
chlorpromazine fluphenazine haloperidol perphenazine thioridazine thiothixene trifluoperazine
Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1
ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: http://www.aacap.org http://www.aap.org
QL, ## ##
amphetamine/dextroamphetamine mixed salts amphetamine/dextroamphetamine mixed salts ext-rel dextroamphetamine methylphenidate ext-rel 10 mg atomoxetine guanfacine ext-rel lisdexamfetamine dexmethylphenidate dexmethylphenidate ext-rel dextroamphetamine ext-rel methylphenidate methylphenidate methylphenidate ext-rel methylphenidate ext-rel methylphenidate ext-rel methylphenidate transdermal
Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
STRATTERA INTUNIV VYVANSE FOCALIN FOCALIN XR DEXEDRINE SPANSULE METHYLIN RITALIN CONCERTA METADATE CD RITALIN LA DAYTRANA
## dexmethylphenidate ext-rel 10 mg, 15 mg, 30 mg are at Tier 2 ## guanfacine ext-rel is at Tier 2
23
FIBROMYALGIA QL, ST milnacipran QL, ST pregabalin
Tier 2 Tier 2
SAVELLA LYRICA
HUNTINGTON'S DISEASE AGENTS PA tetrabenazine
Tier 2
XENAZINE
HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia in adults are available at: http://www.aasmnet.org Benzodiazepines
temazepam triazolam
Nonbenzodiazepines QL eszopiclone QL zolpidem QL zolpidem ext-rel Tricyclics
doxepin
Tier 3 Tier 3
RESTORIL HALCION
Tier 3 Tier 3 Tier 3
LUNESTA AMBIEN AMBIEN CR
Tier 3
SILENOR
MIGRAINE Guidelines for prevention and management of migraine headaches are available at: http://www.aan.com Ergotamine Derivatives dihydroergotamine spray ergotamine/caffeine dihydroergotamine inj
Tier 2 Tier 2 Tier 3
MIGRANAL CAFERGOT D.H.E. 45
Selective Serotonin Agonists QL eletriptan QL naratriptan QL rizatriptan QL rizatriptan orally disintegrating tabs QL sumatriptan QL sumatriptan inj QL sumatriptan inj QL sumatriptan nasal spray QL zolmitriptan QL zolmitriptan nasal spray QL zolmitriptan orally disintegrating tabs
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
RELPAX AMERGE MAXALT MAXALT-MLT IMITREX IMITREX inj SUMAVEL DOSEPRO IMITREX nasal spray ZOMIG ZOMIG nasal spray ZOMIG-ZMT
MOOD STABILIZERS lithium carbonate lithium carbonate ext-rel tabs 450 mg lithium carbonate ext-rel tabs 300 mg
Tier 1 Tier 1 Tier 3
LITHOBID
Tier 2 Tier 2 Tier 2
COPAXONE AVONEX EXTAVIA
MULTIPLE SCLEROSIS AGENTS Practice guidelines for multiple sclerosis are available at: http://www.aan.com PA, QL PA, QL PA, QL
glatiramer interferon beta-1a interferon beta-1b
24
PA, QL PA, QL PA, QL PA PA, QL
dimethyl fumarate delayed-rel fingolimod interferon beta-1a peginterferon beta-1a teriflunomide
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TECFIDERA GILENYA REBIF PLEGRIDY AUBAGIO
MUSCULOSKELETAL THERAPY AGENTS baclofen cyclobenzaprine orphenadrine/aspirin/caffeine carisoprodol chlorzoxazone dantrolene metaxalone methocarbamol tabs tizanidine
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
SOMA PARAFON FORTE DSC DANTRIUM SKELAXIN ROBAXIN tabs ZANAFLEX
MYASTHENIA GRAVIS pyridostigmine ext-rel pyridostigmine syrup pyridostigmine tabs
Tier 2 Tier 2 Tier 3
MESTINON TIMESPAN MESTINON syrup MESTINON tabs
NARCOLEPSY PA PA
Tier 3 Tier 3
NUVIGIL PROVIGIL
PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents acamprosate calcium disulfiram
Tier 1 Tier 2
ANTABUSE
Opioid Antagonists naltrexone
Tier 3
REVIA
Partial Opioid Agonist/Opioid Antagonist Combinations QL buprenorphine/naloxone sublingual tabs QL buprenorphine/naloxone sublingual film
Tier 1 Tier 3
SUBOXONE FILM
Pseudobulbar Affect PA dextromethorphan/quinidine
Tier 3
NUEDEXTA
Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
ANDROGEL AXIRON STRIANT TESTIM ANDRODERM
Tier 3
PRECOSE
armodafinil modafinil
ENDOCRINE AND METABOLIC ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: http://www.aace.com testosterone gel testosterone soln testosterone buccal testosterone gel testosterone transdermal ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: http://professional.diabetes.org Alpha-glucosidase Inhibitors acarbose
25
Amylin Analogs PA, QL pramlintide
Tier 2
SYMLINPEN
Tier 3 Tier 3
GLUCOPHAGE GLUCOPHAGE XR
Biguanide/Sulfonylurea Combinations glipizide/metformin
Tier 3
METAGLIP
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors QL saxagliptin QL sitagliptin phosphate
Tier 2 Tier 2
ONGLYZA JANUVIA
Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations QL saxagliptin/metformin ext-rel QL sitagliptin/metformin QL sitagliptin/metformin ext-rel
Tier 2 Tier 2 Tier 2
KOMBIGLYZE XR JANUMET JANUMET XR
Incretin Mimetic Agents PA, QL exenatide ext-rel PA, QL liraglutide PA, QL albiglutide PA, QL dulaglutide
Tier 2 Tier 2 Tier 3 Tier 3
BYDUREON VICTOZA TANZEUM TRULICITY
Insulins QL QL QL QL QL, OTC QL, OTC QL, OTC
Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2
NOVOLOG NOVOLOG MIX 70/30 LEVEMIR LANTUS NOVOLIN R NOVOLIN N NOVOLIN 70/30
Biguanides
metformin metformin ext-rel 750 mg
insulin aspart insulin aspart protamine 70%/insulin aspart 30% insulin detemir insulin glargine insulin human insulin isophane human insulin isophane human 70%/regular 30%
Insulin Sensitizers QL pioglitazone
Tier 1
Insulin Sensitizer/Biguanide Combinations QL pioglitazone/metformin
Tier 3
ACTOPLUS MET
Insulin Sensitizer/Sulfonylurea Combinations QL pioglitazone/glimepiride
Tier 3
DUETACT
Tier 2 Tier 3
PRANDIN STARLIX
Tier 2 Tier 3
INVOKANA JARDIANCE
glimepiride glipizide glipizide ext-rel
Tier 3 Tier 3 Tier 3
AMARYL GLUCOTROL GLUCOTROL XL
blood glucose monitoring kits, test strips
Tier 2
ACCU-CHEK kits and test strips
Meglitinides
repaglinide nateglinide
Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors QL canagliflozin QL empagliflozin Sulfonylureas
Supplies OTC
26
OTC OTC
blood glucose monitoring kits, test strips insulin syringes, needles
Tier 2 Tier 2
CONTOUR kits and test strips BD insulin syringes and needles
ANTIOBESITY Guidelines of treatment and management of obesity are available at: http://www.aace.com http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/obesity-evidence-review Miscellaneous PA
lorcaserin
Tier 2
BELVIQ
Tier 2
SENSIPAR
Tier 2 Tier 3 Tier 3 Tier 3
ACTONEL FOSAMAX BONIVA ACTONEL
Tier 3
MIACALCIN
Parathyroid Hormones PA, QL teriparatide
Tier 3
FORTEO
Miscellaneous PA
Tier 3
PROLIA
norethindrone acetate/EE 1/10 and EE 10 and iron
Tier 2
LO LOESTRIN FE
levonorgestrel/EE 0.1/20 - Lessina norethindrone acetate/EE 1/20 and iron - Lomedia 24 Fe drospirenone/EE 3/20 norethindrone acetate/EE 1/20 norethindrone acetate/EE 1/20 and iron
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
YAZ LOESTRIN 1/20 LOESTRIN FE 1/20
desogestrel/EE 0.15/30 levonorgestrel/EE 0.15/30 - Levora norgestrel/EE 0.3/30 - Low-Ogestrel drospirenone/EE 3/30 norethindrone acetate/EE 1.5/30
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3
YASMIN LOESTRIN 1.5/30
CALCIUM RECEPTOR ANTAGONISTS cinacalcet CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: http://www.aace.com http://www.nof.org Bisphosphonates QL, ST risedronate 5 mg, 30 mg, 35 mg QL, ST, * alendronate QL, ST, * ibandronate QL, ST, * risedronate 150 mg * ST applies to brand products only Calcitonins
calcitonin-salmon
denosumab
CONTRACEPTIVES EE = ethinyl estradiol ME = mestranol Monophasic 10 mcg Estrogen 20 mcg Estrogen
30 mcg Estrogen
27
35 mcg Estrogen
50 mcg Estrogen
Biphasic Triphasic
Four Phase Extended Cycle
Continuous Progestin Only
Transdermal Vaginal ENDOMETRIOSIS
norethindrone acetate/EE 1.5/30 and iron
Tier 3
LOESTRIN FE 1.5/30
ethynodiol diacetate/EE 1/35 - Zovia 1/35 norethindrone/EE 0.5/35 norethindrone/EE 0.5/35 norethindrone/EE 1/35 norethindrone/EE 1/35 norgestimate/EE 0.25/35
Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
BREVICON MODICON NORINYL 1+35 ORTHO-NOVUM 1/35 ORTHO-CYCLEN
ethynodiol diacetate/EE 1/50 - Zovia 1/50 norethindrone/ME 1/50
Tier 1 Tier 3
NORINYL 1+50
desogestrel/EE
Tier 3
MIRCETTE
levonorgestrel/EE - Trivora norgestimate/EE desogestrel/EE norethindrone/EE norethindrone/EE norgestimate/EE
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
ORTHO TRI-CYCLEN LO CYCLESSA ORTHO-NOVUM 7/7/7 TRI-NORINYL ORTHO TRI-CYCLEN
estradiol valerate and dienogest/estradiol valerate
Tier 2
NATAZIA
levonorgestrel/EE 0.15/30 levonorgestrel/EE 0.1/20 and EE 10 levonorgestrel/EE 0.15/30 and EE 10
Tier 1 Tier 3 Tier 3
LOSEASONIQUE SEASONIQUE
levonorgestrel/EE 0.09/20 - Amethyst
Tier 1
norethindrone norethindrone
Tier 3 Tier 3
NOR-QD ORTHO MICRONOR
norelgestromin/EE
Tier 2
ORTHO EVRA
etonogestrel/EE ring
Tier 2
NUVARING
danazol nafarelin
Tier 1 Tier 2
SYNAREL
ESTROGENS Guidelines of treatment and management of hormone therapy and menopause are available at: http://www.menopause.org https://www.aace.com/files/menopause.pdf Oral
estropipate estrogens, conjugated, synthetic B
Tier 1 Tier 2
ENJUVIA 28
estradiol estrogens, conjugated
Tier 3 Tier 3
ESTRACE PREMARIN
estradiol estradiol estradiol
Tier 2 Tier 3 Tier 3
ALORA CLIMARA VIVELLE-DOT
estradiol vaginal crm estradiol vaginal tabs estradiol vaginal ring estradiol vaginal ring estrogens, conjugated crm
Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
ESTRACE VAGIFEM ESTRING FEMRING PREMARIN crm
ESTROGEN/PROGESTINS Oral EE/norethindrone acetate - Jinteli estradiol/norethindrone EE/norethindrone acetate estradiol/norgestimate estrogens, conjugated/medroxyprogesterone estrogens, conjugated/medroxyprogesterone
Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3
FEMHRT PREFEST PREMPHASE PREMPRO
Tier 2 Tier 3
CLIMARA PRO COMBIPATCH
Transdermal QL QL QL Vaginal
Transdermal
estradiol/levonorgestrel estradiol/norethindrone acetate
ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS conjugated estrogens/bazedoxifene Tier 3
DUAVEE
GAUCHER DISEASE PA eliglustat PA miglustat
CERDELGA ZAVESCA
GLUCOCORTICOIDS dexamethasone fludrocortisone prednisolone sodium phosphate 5 mg/5 mL, 15 mg/5 mL prednisone hydrocortisone methylprednisolone ## prednisolone sodium phosphate orally disintegrating tabs prednisolone syrup
Tier 3 Tier 3 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
CORTEF MEDROL ORAPRED ODT
Tier 3
PRELONE
Tier 2 Tier 3
GLUCAGON EMERGENCY KIT GLUCAGEN HYPOKIT
Tier 2
NORDITROPIN
## prednisolone sodium phosphate orally disintegrating tabs are at Tier 2 GLUCOSE ELEVATING AGENTS glucagon, human recombinant glucagon, human recombinant HUMAN GROWTH HORMONES Guidelines for use of growth hormone are available at: http://www.aace.com/publications/guidelines PA
somatropin
29
HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ## doxercalciferol calcitriol (1,25-D3) paricalcitol
Tier 2 Tier 3 Tier 3
HECTOROL ROCALTROL ZEMPLAR
PHENYLKETONURIA TREATMENT AGENTS PA sapropterin
Tier 2
KUVAN
PHOSPHATE BINDER AGENTS lanthanum calcium acetate ferric citrate
Tier 2 Tier 3 Tier 3
FOSRENOL PHOSLO AURYXIA
Tier 2 Tier 3 Tier 3 Tier 3
PROMETRIUM PROVERA MEGACE ES AYGESTIN
Tier 2 Tier 3
EVISTA OSPHENA
THYROID AGENTS Antithyroid Agents propylthiouracil methimazole
Tier 1 Tier 3
TAPAZOLE
Thyroid Supplements levothyroxine levothyroxine - Levoxyl thyroid levothyroxine liothyronine
Tier 1 Tier 1 Tier 2 Tier 3 Tier 3
ARMOUR THYROID SYNTHROID CYTOMEL
VASOPRESSINS # desmopressin spray
Tier 3
DDAVP
MISCELLANEOUS QL cabergoline PA carglumic acid alglucosidase alfa PA glycerol phenylbutyrate PA metreleptin PA mifepristone pasireotide velaglucerase alfa
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
CARBAGLU LUMIZYME RAVICTI MYALEPT KORLYM SIGNIFOR VPRIV
## doxercalciferol is at Tier 2
PROGESTINS Oral
progesterone, micronized medroxyprogesterone acetate megestrol acetate susp norethindrone acetate
SELECTIVE ESTROGEN RECEPTOR MODULATORS ## raloxifene ospemifene ## raloxifene is at Tier 2
30
GASTROINTESTINAL Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: http://www.acg.gi.org http://www.gastro.org ANTIDIARRHEALS crofelemer delayed-rel diphenoxylate/atropine ANTIEMETICS
QL QL QL QL QL
prochlorperazine promethazine metoclopramide orally-disintegrating tabs aprepitant dronabinol granisetron granisetron transdermal metoclopramide netupitant/palonosetron ondansetron scopolamine trimethobenzamide
Tier 3 Tier 3 Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
FULYZAQ LOMOTIL
METOZOLV ODT EMEND MARINOL SANCUSO REGLAN AKYNZEO ZOFRAN TRANSDERM SCOP TIGAN
ANTISPASMODICS chlordiazepoxide/clidinium hyoscyamine sulfate ext-rel caps hyoscyamine sulfate orally disintegrating tabs dicyclomine hyoscyamine sulfate hyoscyamine sulfate ext-rel
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
BENTYL LEVSIN LEVBID
CHOLELITHOLYTICS ursodiol ursodiol
Tier 2 Tier 3
URSO ACTIGALL
INFLAMMATORY BOWEL DISEASE Oral Agents balsalazide mesalamine delayed-rel tabs mesalamine ext-rel caps mesalamine ext-rel caps QL, ## budesonide delayed-rel caps olsalazine sulfasalazine sulfasalazine delayed-rel
Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
LIALDA APRISO PENTASA ENTOCORT EC DIPENTUM AZULFIDINE AZULFIDINE EN-TABS
Tier 1 Tier 2 Tier 2 Tier 2 Tier 3
UCERIS CORTIFOAM CANASA ROWASA
Tier 3
LINZESS
## budesonide delayed-rel caps are at Tier 2 Rectal Agents QL
hydrocortisone enema budesonide rectal foam hydrocortisone acetate foam mesalamine supp mesalamine rectal susp
IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation QL linaclotide
31
LAXATIVES
lactulose lactulose peg 3350/electrolytes peg 3350/electrolytes peg 3350/electrolytes sodium picosulfate/magnesium oxide/citric acid sodium sulfate/potassium sulfate/magnesium sulfate
Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
KRISTALOSE GOLYTELY MOVIPREP NULYTELY PREPOPIK SUPREP
PANCREATIC ENZYMES pancrelipase delayed-rel pancrelipase delayed-rel
Tier 2 Tier 2
CREON ZENPEP
PROSTAGLANDINS misoprostol
Tier 3
CYTOTEC
PROTON PUMP INHIBITORS QL pantoprazole delayed-rel QL dexlansoprazole delayed-rel QL rabeprazole delayed-rel
Tier 1 Tier 2 Tier 3
DEXILANT ACIPHEX
SALIVA STIMULANTS cevimeline pilocarpine tabs
Tier 2 Tier 3
EVOXAC SALAGEN
STEROIDS, RECTAL hydrocortisone acetate/pramoxine foam hydrocortisone crm
Tier 2 Tier 3
PROCTOFOAM-HC ANUSOL-HC
ULCER THERAPY COMBINATIONS QL lansoprazole + amoxicillin + clarithromycin bismuth/metronidazole/tetracycline
Tier 2 Tier 3
PREVPAC PYLERA
MISCELLANEOUS glycopyrrolate sucralfate susp sucralfate tabs PA teduglutide
Tier 2 Tier 2 Tier 3 Tier 3
CUVPOSA CARAFATE susp CARAFATE tabs GATTEX
Tier 2 Tier 3 Tier 3 Tier 3
AVODART JALYN PROSCAR FLOMAX
GENITOURINARY BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: http://www.auanet.org/guidelines dutasteride dutasteride/tamsulosin finasteride tamsulosin URINARY ANTISPASMODICS oxybutynin trospium darifenacin ext-rel solifenacin succinate tolterodine ext-rel oxybutynin ext-rel tolterodine
Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3
ENABLEX VESICARE DITROPAN XL DETROL 32
VAGINAL ANTI-INFECTIVES terconazole supp clindamycin crm clindamycin supp metronidazole QL terconazole QL terconazole crm
Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
CLEOCIN CLEOCIN METROGEL-VAGINAL TERAZOL 7 TERAZOL 3
MISCELLANEOUS pentosan polysulfate sodium bethanechol phenazopyridine potassium citrate ext-rel
Tier 2 Tier 3 Tier 3 Tier 3
ELMIRON URECHOLINE PYRIDIUM UROCIT-K
HEMATOLOGIC Guidelines of treatment and management of hemophilia are available at: http://www.hemophilia.org ANTICOAGULANTS CHEST guidelines are available at: http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/Antithrombotic-Guidelines9th-Ed Injectable
dalteparin enoxaparin
Tier 3 Tier 3
FRAGMIN LOVENOX
apixaban dabigatran etexilate rivaroxaban warfarin
Tier 2 Tier 2 Tier 2 Tier 3
ELIQUIS PRADAXA XARELTO COUMADIN
Tier 3
ARIXTRA
HEREDITARY ANGIOEDEMA AGENTS PA icatibant
Tier 3
FIRAZYR
IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS PA eltrombopag
Tier 3
PROMACTA
IRON CHELATING AGENTS PA deferiprone
Tier 2
FERRIPROX
PLATELET AGGREGATION INHIBITORS clopidogrel dipyridamole ext-rel/aspirin dipyridamole QL prasugrel ticagrelor QL vorapaxar
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
AGGRENOX PERSANTINE EFFIENT BRILINTA ZONTIVITY
PLATELET SYNTHESIS INHIBITORS anagrelide
Tier 3
AGRYLIN
Oral PA, QL PA, QL PA, QL
Synthetic Heparinoid-like Agents ## fondaparinux ## fondaparinux is at Tier 2
33
MISCELLANEOUS tranexamic acid
Tier 2
LYSTEDA
ALLERGEN EXTRACTS grass mixed pollen allergen extract ragweed pollen allergen extract timothy grass pollen allergen extract
Tier 3 Tier 3 Tier 3
ORALAIR RAGWITEK GRASTEK
BIOLOGIC DISEASE-MODIFYING AGENTS PA, QL adalimumab PA, QL etanercept PA, QL anakinra PA, QL certolizumab pegol
Tier 2 Tier 2 Tier 3 Tier 3
HUMIRA ENBREL KINERET CIMZIA
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) methotrexate methotrexate hydroxychloroquine leflunomide PA, QL tofacitinib
Tier 1 Tier 2 Tier 3 Tier 3 Tier 3
RHEUMATREX PLAQUENIL ARAVA XELJANZ
IMMUNE GLOBULINS PA immune globulin/hyaluronidase
Tier 3
HYQVIA
IMMUNOLOGIC AGENTS Guidelines for the management of rheumatic diseases are available at: http://www.rheumatology.org
IMMUNOMODULATORS CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of hepatitis are available at: http://www.aasld.org Interferons PA PA, QL PA, QL EVITI PA
interferon alfa-2b peginterferon alfa-2a peginterferon alfa-2b peginterferon alfa-2b
Tier 2 Tier 2 Tier 2 Tier 3
INTRON A PEGASYS PEGINTRON SYLATRON
Miscellaneous PA, QL
apremilast
Tier 3
OTEZLA
Tier 2 Tier 3 Tier 3 Tier 3
MYFORTIC AZASAN IMURAN CELLCEPT
Tier 2 Tier 3 Tier 3 Tier 3
PROGRAF SANDIMMUNE SANDIMMUNE NEORAL
IMMUNOSUPPRESSANTS Antimetabolites ## mycophenolate sodium delayed-rel azathioprine azathioprine mycophenolate mofetil ## mycophenolate sodium delayed-rel is at Tier 2 Calcineurin Inhibitors tacrolimus cyclosporine caps cyclosporine soln cyclosporine, modified
34
Rapamycin Derivatives everolimus ## sirolimus
Tier 3 Tier 3
ZORTRESS RAPAMUNE
## sirolimus is at Tier 2
NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium
potassium chloride ext-rel potassium chloride liquid
VITAMINS AND MINERALS Miscellaneous phytonadione ergocalciferol (D2)
Tier 1 Tier 1
Tier 2 Tier 3
MEPHYTON DRISDOL
RESPIRATORY Guidelines to the management, prevention, or treatment of COPD and asthma are available at: http://www.aaaai.org http://www.ginasthma.com http://www.goldcopd.com http://www.nhlbi.nih.gov The Allergy Report and guidelines for allergy-related conditions are available at: http://www.aaaai.org ANAPHYLAXIS TREATMENT AGENTS QL epinephrine QL epinephrine QL epinephrine
Tier 1 Tier 2 Tier 2
EPIPEN EPIPEN JR.
ANTICHOLINERGICS ipratropium soln QL ipratropium, CFC-free aerosol QL tiotropium
Tier 1 Tier 2 Tier 2
ATROVENT HFA SPIRIVA
ANTICHOLINERGIC/BETA AGONIST COMBINATIONS QL ipratropium/albuterol soln QL ipratropium/albuterol, CFC-free aerosol QL umeclidinium/vilanterol
Tier 1 Tier 2 Tier 2
COMBIVENT RESPIMAT ANORO ELLIPTA
ANTIHISTAMINES, LOW SEDATING QL levocetirizine
Tier 3
XYZAL
ANTIHISTAMINES, SEDATING cyproheptadine hydroxyzine HCl
Tier 1 Tier 1
ANTITUSSIVES Clinical practice guidelines are available at: http://journal.publications.chestnet.org/article.aspx?articleID=1084267 benzonatate
Tier 3
TESSALON
35
ANTITUSSIVE COMBINATIONS Opioid codeine/chlorpheniramine/pseudoephedrine codeine/guaifenesin liquid codeine/guaifenesin/pseudoephedrine codeine/promethazine codeine/promethazine/phenylephrine hydrocodone/homatropine hydrocodone/chlorpheniramine ext-rel Non-opioid
dextromethorphan/brompheniramine/pseudoephedri ne dextromethorphan/promethazine
BETA AGONISTS Inhalants Short Acting QL albuterol soln QL albuterol sulfate, CFC-free aerosol
Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3
TUSSIONEX
Tier 1 Tier 1
Tier 1 Tier 2
VENTOLIN HFA
indacaterol salmeterol xinafoate formoterol inhalation caps olodaterol, CFC-free aerosol
Tier 2 Tier 2 Tier 3 Tier 3
ARCAPTA NEOHALER SEREVENT DISKUS FORADIL STRIVERDI RESPIMAT
albuterol terbutaline albuterol ext-rel
Tier 1 Tier 1 Tier 3
VOSPIRE ER
Tier 2 Tier 2 Tier 3 Tier 3
PULMOZYME TOBI KALYDECO TOBI PODHALER
LEUKOTRIENE RECEPTOR ANTAGONISTS zafirlukast montelukast
Tier 1 Tier 3
SINGULAIR
MAST CELL STABILIZERS QL cromolyn soln
Tier 1
NASAL ANTIHISTAMINES QL azelastine spray QL azelastine spray
Tier 1 Tier 3
ASTEPRO
NASAL STEROIDS QL flunisolide spray QL mometasone spray
Tier 1 Tier 2
NASONEX
PULMONARY FIBROSIS AGENTS PA nintedanib PA pirfenidone
Tier 3 Tier 3
OFEV ESBRIET
Long Acting QL QL Oral Agents
CYSTIC FIBROSIS dornase alfa QL, ## tobramycin inhalation soln PA, QL ivacaftor tobramycin inhalation powder ## tobramycin inhalation soln is at Tier 2
36
STEROID/BETA AGONIST COMBINATIONS QL fluticasone/salmeterol QL fluticasone/salmeterol, CFC-free aerosol QL mometasone/formoterol QL fluticasone/vilanterol
Tier 2 Tier 2 Tier 2 Tier 3
ADVAIR ADVAIR HFA DULERA BREO ELLIPTA
STEROID INHALANTS QL beclomethasone, CFC-free aerosol QL budesonide QL fluticasone, CFC-free aerosol QL mometasone QL budesonide inh susp QL fluticasone
Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3
QVAR PULMICORT FLEXHALER FLOVENT HFA ASMANEX PULMICORT RESPULES ARNUITY ELLIPTA
Tier 1 Tier 2 Tier 3
ELIXOPHYLLIN THEO-24
Tier 3
ATROVENT spray
XANTHINES
theophylline ext-rel tabs theophylline liquid theophylline ext-rel caps
MISCELLANEOUS QL ipratropium spray
TOPICAL DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: http://www.aad.org/education-and-quality-care/clinical-guidelines Oral
Topical
##
##
isotretinoin - Amnesteem isotretinoin - Claravis
Tier 1 Tier 1
erythromycin gel 2% erythromycin soln sulfacetamide/sulfur crm, gel, lotion, pads adapalene/benzoyl peroxide clindamycin/benzoyl peroxide clindamycin/benzoyl peroxide tazarotene tretinoin adapalene crm, gel 0.1% adapalene gel 0.3% adapalene lotion 0.1% azelaic acid benzoyl peroxide clindamycin gel clindamycin gel, lotion, soln clindamycin/benzoyl peroxide erythromycin/benzoyl peroxide sulfacetamide lotion 10% tretinoin tretinoin tretinoin gel microsphere
Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
EPIDUO ACANYA BENZACLIN TAZORAC ATRALIN DIFFERIN DIFFERIN DIFFERIN AZELEX BENZAC AC CLINDAGEL CLEOCIN T DUAC BENZAMYCIN KLARON AVITA RETIN-A RETIN-A MICRO
## adapalene gel 0.3% is at Tier 2 ## clindamycin/benzoyl peroxide (generic for DUAC) is at Tier 2 37
Actinic Keratosis ## fluorouracil ingenol mebutate
Tier 2 Tier 3
CARAC PICATO
gentamicin mupirocin retapamulin silver sulfadiazine
Tier 1 Tier 3 Tier 3 Tier 3
BACTROBAN ALTABAX SILVADENE
econazole ketoconazole nystatin butenafine ciclopirox oxiconazole
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
MENTAX LOPROX OXISTAT
## fluorouracil is at Tier 2 Antibiotics
Antifungals
Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: http://www.aad.org Injectable PA Oral
Topical
Antiseborrheics
Corticosteroids Low Potency
Medium Potency
QL ## ##
ustekinumab
Tier 3
STELARA
methoxsalen oral acitretin
Tier 2 Tier 3
OXSORALEN-ULTRA SORIATANE
calcipotriene oint calcipotriene crm, soln
Tier 1 Tier 2
DOVONEX
selenium sulfide shampoo 2.5% ketoconazole shampoo 2%
Tier 1 Tier 3
NIZORAL SHAMPOO
fluocinolone acetonide soln 0.01% hydrocortisone crm 2.5% alclometasone crm, oint 0.05% desonide crm, lotion, oint 0.05%
Tier 1 Tier 1 Tier 3 Tier 3
ACLOVATE DESOWEN
betamethasone valerate crm, lotion, oint 0.1% fluocinolone acetonide crm, oint 0.025% triamcinolone acetonide crm, lotion 0.025% triamcinolone acetonide crm, lotion, oint 0.1% desoximetasone crm 0.05% flurandrenolide lotion 0.05% flurandrenolide tape fluticasone propionate crm, lotion 0.05%, oint 0.005% hydrocortisone butyrate crm 0.1% hydrocortisone butyrate crm, oint, soln 0.1% hydrocortisone butyrate lotion 0.1%
Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TOPICORT LP CORDRAN CORDRAN CUTIVATE LOCOID LIPOCREAM LOCOID LOCOID 38
hydrocortisone valerate crm, oint 0.2% mometasone crm, lotion, oint 0.1%
Tier 3 Tier 3
WESTCORT ELOCON
## hydrocortisone butyrate crm 0.1% (generic for LOCOID LIPOCREAM) is at Tier 2 ## hydrocortisone butyrate crm, oint, soln 0.1% (generic for LOCOID) is at Tier 2 High Potency
Very High Potency
betamethasone dipropionate crm, lotion, oint 0.05% diflorasone diacetate crm 0.05% fluocinonide crm, gel, oint, soln 0.05% triamcinolone acetonide crm 0.5% betamethasone dipropionate augmented crm 0.05% betamethasone dipropionate augmented lotion 0.05% desoximetasone crm, oint 0.25%, gel 0.05%
Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
DIPROLENE AF DIPROLENE TOPICORT
diflorasone diacetate oint 0.05% betamethasone dipropionate augmented gel, oint 0.05% clobetasol propionate crm, gel, oint, soln 0.05% clobetasol propionate foam 0.05% clobetasol propionate lotion, shampoo, spray 0.05% fluocinonide crm 0.1% halobetasol propionate crm, oint 0.05%
Tier 1 Tier 3
DIPROLENE
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TEMOVATE OLUX CLOBEX VANOS ULTRAVATE
Tier 2 Tier 2
ELIDEL PROTOPIC
Tier 2
LIDODERM
Immunomodulators Guidelines for the treatment of atopic dermatitis are available at: http://www.aad.org/education/clinical-guidelines ##
pimecrolimus tacrolimus
## tacrolimus is at Tier 2 Local Analgesics ## lidocaine patch ## lidocaine patch is at Tier 2 Local Anesthetics lidocaine/prilocaine Rosacea
metronidazole gel 0.75% sulfacetamide/sulfur azelaic acid gel metronidazole crm 0.75% metronidazole gel 1% metronidazole lotion 0.75%
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3
FINACEA METROCREAM METROGEL METROLOTION
Scabicides and Pediculicides permethrin 5% crotamiton malathion
Tier 1 Tier 2 Tier 3
EURAX OVIDE
Miscellaneous Skin and Mucous Membrane acyclovir oint QL imiquimod
Tier 3 Tier 3
ZOVIRAX oint ALDARA 39
QL
imiquimod podofilox
Tier 3 Tier 3
MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous
Tier 1
Steroids - Mouth/Throat triamcinolone paste
Tier 1
ZYCLARA CONDYLOX
OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: http://one.aao.org Antiallergics
Antifungals Anti-infectives
cromolyn sodium olopatadine olopatadine azelastine bepotastine lodoxamide nedocromil
Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3
PATADAY PATANOL OPTIVAR BEPREVE ALOMIDE ALOCRIL
natamycin
Tier 3
NATACYN
bacitracin erythromycin gentamicin polymyxin B/bacitracin tobramycin oint ciprofloxacin moxifloxacin neomycin/polymyxin B/gramicidin ofloxacin polymyxin B/trimethoprim sulfacetamide soln 10% tobramycin soln
Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
TOBREX oint CILOXAN VIGAMOX NEOSPORIN OCUFLOX POLYTRIM BLEPH-10 TOBREX soln
Anti-infective/Anti-inflammatory Combinations neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25% sulfacetamide/prednisolone acetate oint 10%/0.2% tobramycin/dexamethasone oint 0.3%/0.1% tobramycin/dexamethasone susp 0.3%/0.05% neomycin/polymyxin B/dexamethasone tobramycin/dexamethasone susp 0.3%/0.1% tobramycin/loteprednol Anti-inflammatories Nonsteroidal bromfenac sodium diclofenac sodium ketorolac
Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3
BLEPHAMIDE SOP TOBRADEX OINTMENT TOBRADEX ST MAXITROL TOBRADEX SUSPENSION ZYLET
Tier 1 Tier 1 Tier 3
ACULAR
40
Steroidal
dexamethasone sodium phosphate fluorometholone loteprednol 0.2% loteprednol 0.5% prednisolone phosphate 1%
Tier 1 Tier 2 Tier 2 Tier 2 Tier 2
prednisolone acetate 1%
Tier 3
FML ALREX LOTEMAX PREDNISOLONE PHOSPHATE 1% PRED FORTE
ganciclovir trifluridine
Tier 3 Tier 3
ZIRGAN VIROPTIC
levobunolol metipranolol timolol hemihydrate timolol maleate timolol maleate gel
Tier 3 Tier 3 Tier 3 Tier 3 Tier 3
BETAGAN OPTIPRANOLOL BETIMOL TIMOPTIC TIMOPTIC-XE
betaxolol
Tier 3
BETOPTIC S
Carbonic Anhydrase Inhibitors Topical brinzolamide dorzolamide
Tier 3 Tier 3
AZOPT TRUSOPT
Carbonic Anhydrase Inhibitor/Beta-blocker Combinations dorzolamide/timolol maleate
Tier 3
COSOPT
Carbonic Anhydrase Inhibitor/Sympathomimetic Combinations brinzolamide/brimonidine
Tier 3
SIMBRINZA
Immunomodulators QL cyclosporine, emulsion
Tier 2
RESTASIS
Tier 1 Tier 2 Tier 2 Tier 3 Tier 3
LUMIGAN TRAVATAN Z XALATAN ZIOPTAN
Sympathomimetics brimonidine 0.2% brimonidine 0.1% brimonidine 0.15%
Tier 1 Tier 2 Tier 3
ALPHAGAN P 0.1% ALPHAGAN P 0.15%
Sympathomimetic/Beta-blocker Combinations brimonidine/timolol
Tier 3
COMBIGAN
Antivirals
Beta-blockers Nonselective
Selective
Prostaglandins
ST
travoprost bimatoprost travoprost latanoprost tafluprost
41
OTIC Clinical practice guidelines for the treatment of otitis media are available at: http://www.aap.org Anti-infectives
acetic acid acetic acid/aluminum acetate ofloxacin otic
Anti-infective/Anti-inflammatory Combinations ciprofloxacin/dexamethasone ciprofloxacin/hydrocortisone neomycin/polymyxin B/hydrocortisone
Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3
CIPRODEX CIPRO HC OTIC CORTISPORIN OTIC
42
WEBSITES Agency for Healthcare Research and Quality http://www.ahrq.gov Alzheimer's Association http://www.alz.org American Academy of Allergy, Asthma and Immunology http://www.aaaai.org American Academy of Child & Adolescent Psychiatry http://www.aacap.org American Academy of Dermatology http://www.aad.org American Academy of Neurology http://www.aan.com American Academy of Ophthalmology http://www.aao.org American Academy of Pediatrics http://www.aap.org American Association for the Study of Liver Disease http://www.aasld.org American Association of Clinical Endocrinologists http://www.aace.com American Association of Diabetes Educators http://www.diabeteseducator.org American Cancer Society http://www.cancer.org American College of Allergy, Asthma and Immunology http://www.acaai.org American College of Cardiology http://www.cardiosource.org American College of Chest Physicians http://www.chestnet.org
American Congress of Obstetricians and Gynecologists http://www.acog.org American Diabetes Association http://www.diabetes.org American Gastroenterological Association http://www.gastro.org American Headache Society Committee for Headache Education http://www.achenet.org American Heart Association http://www.myamericanheart.org American Lung Association http://www.lung.org American Medical Association http://www.ama-assn.org American Psychiatric Association http://www.psych.org American Society of Anesthesiologists http://www.asahq.org American Society of Clinical Oncology http://www.asco.org American Society of Interventional Pain Physicians http://www.asipp.org American Urological Association http://www.auanet.org Centers for Disease Control and Prevention http://www.cdc.gov Centers for Disease Control and Prevention Guideline topics: AIDS http://www.cdc.gov/hiv/default.html
American College of Gastroenterology http://gi.org
Centers for Disease Control and Prevention Guideline topics: Sexually Transmitted Diseases http://www.cdc.gov/std/treatment/default.htm
American College of Physicians http://www.acponline.org
CVS/caremark http://www.caremark.com
American College of Rheumatology http://www.rheumatology.org
The Food and Drug Administration http://www.fda.gov
43
Global Initiative for Asthma http://www.ginasthma.com
National Foundation for Infectious Diseases http://www.nfid.org
Infectious Diseases Society of America http://www.idsociety.org
National Guideline Clearinghouse http://www.guideline.gov
Institute for Safe Medication Practices http://www.ismp.org
National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov
Johns Hopkins AIDS Service http://www.thebody.com/content/art12096.html
National Institutes of Health http://www.nih.gov
Juvenile Diabetes Research Foundation International http://jdrf.org
National Kidney Foundation http://www.kidney.org
MedWatch http://www.fda.gov/Safety/MedWatch/default.htm
National Osteoporosis Foundation http://www.nof.org
National Agricultural Library http://www.nal.usda.gov
North American Menopause Society http://www.menopause.org
National Cancer Institute http://www.cancer.gov/cancertopics
United States Department of Health and Human Services http://www.hhs.gov
National Comprehensive Cancer Network http://www.nccn.org
World Health Organization http://www.who.int
44
INDEX A
abacavir soln, 13 abacavir tabs, 13 abacavir/dolutegravir/lamivudine, 12 abacavir/lamivudine, 12 abacavir/lamivudine/zidovudine, 12 ABILIFY, 23 abiraterone, 15 acamprosate calcium, 25 ACANYA, 37 acarbose, 25 ACCU-CHEK kits and test strips, 26 ACCUPRIL, 16 ACCURETIC, 16 ACEON, 16 acetazolamide, 19 acetazolamide ext-rel, 19 acetic acid, 42 acetic acid/aluminum acetate, 42 ACIPHEX, 32 acitretin, 38 ACLOVATE, 38 ACTIGALL, 31 ACTONEL, 27 ACTOPLUS MET, 26 ACULAR, 40 acyclovir caps, susp, tabs, 14 acyclovir oint, 39 ADALAT CC, 19 adalimumab, 34 adapalene crm, gel 0.1%, 37 adapalene gel 0.3%, 37 adapalene lotion 0.1%, 37 adapalene/benzoyl peroxide, 37 ADCIRCA, 20 adefovir dipivoxil, 14 ADEMPAS, 20 ADVAIR, 37 ADVAIR HFA, 37 ADVICOR, 18 AGGRENOX, 33 AGRYLIN, 33 AKYNZEO, 31 albiglutide, 26 albuterol, 36 albuterol ext-rel, 36 albuterol soln, 36 albuterol sulfate, CFC-free aerosol, 36 alclometasone crm, oint 0.05%, 38 ALDACTAZIDE, 20 ALDACTONE, 17 ALDARA, 39 alendronate, 27 alglucosidase alfa, 30 ALINIA, 14 aliskiren, 19 aliskiren/amlodipine, 19 aliskiren/amlodipine/hydrochlorothiazide, 19 aliskiren/hydrochlorothiazide, 19 ALKERAN, 14 allopurinol, 10 ALOCRIL, 40
ALOMIDE, 40 ALORA, 29 ALPHAGAN P 0.1%, 41 ALPHAGAN P 0.15%, 41 alprazolam, 21 ALREX, 41 ALTABAX, 38 ALTACE, 16 altretamine, 14 amantadine, 22 AMARYL, 26 AMBIEN, 24 AMBIEN CR, 24 ambrisentan, 20 AMERGE, 24 amiloride, 20 amiloride/hydrochlorothiazide, 20 amiodarone, 17 amitriptyline, 22 amlodipine, 19 amlodipine/atorvastatin, 19 amlodipine/benazepril, 16 amlodipine/olmesartan, 17 amlodipine/telmisartan, 17 amlodipine/valsartan, 17 amlodipine/valsartan/hydrochlorothiazide, 17 amoxicillin, 12 amoxicillin/clavulanate, 12 amoxicillin/clavulanate ext-rel, 12 amphetamine/dextroamphetamine mixed salts, 23 amphetamine/dextroamphetamine mixed salts ext-rel, 23 ampicillin, 12 AMTURNIDE, 19 ANAFRANIL, 21 anagrelide, 33 anakinra, 34 ANAPROX, 10 anastrozole, 15 ANDRODERM, 25 ANDROGEL, 25 ANORO ELLIPTA, 35 ANTABUSE, 25 ANTARA, 18 ANUSOL-HC, 32 apixaban, 33 APOKYN, 22 apomorphine, 22 apremilast, 34 aprepitant, 31 APRISO, 31 APTIVUS, 13 ARALEN, 12 ARAVA, 34 ARCAPTA NEOHALER, 36 ARICEPT, except 23 mg, 21 ARIMIDEX, 15 aripiprazole, 23 ARIXTRA, 33 armodafinil, 25 ARMOUR THYROID, 30 ARNUITY ELLIPTA, 37 AROMASIN, 15 artemether/lumefantrine, 12 45
asenapine, 23 ASMANEX, 37 ASTEPRO, 36 atazanavir, 13 atenolol, 18 atenolol/chlorthalidone, 19 ATIVAN, 21 atomoxetine, 23 atorvastatin, 18 atovaquone/proguanil, 12 ATRALIN, 37 ATRIPLA, 12 ATROVENT HFA, 35 ATROVENT spray, 37 AUBAGIO, 25 AUGMENTIN, 12 AUGMENTIN XR, 12 AURYXIA, 30 AVALIDE, 17 AVAPRO, 17 AVELOX, 12 AVINZA, 10 AVITA, 37 AVODART, 32 AVONEX, 24 AXIRON, 25 axitinib, 15 AYGESTIN, 30 AZASAN, 34 azathioprine, 34 azelaic acid, 37 azelaic acid gel, 39 azelastine, 40 azelastine spray, 36 AZELEX, 37 AZILECT, 23 azithromycin, 11 AZOPT, 41 AZOR, 17 AZULFIDINE, 31 AZULFIDINE EN-TABS, 31
B
bacitracin, 40 baclofen, 25 BACTROBAN, 38 balsalazide, 31 BANZEL, 21 BARACLUDE soln, 14 BARACLUDE tabs, 14 BD insulin syringes and needles, 27 beclomethasone, CFC-free aerosol, 37 bedaquiline, 13 BELVIQ, 27 benazepril, 16 benazepril/hydrochlorothiazide, 16 BENICAR, 17 BENICAR HCT, 17 BENTYL, 31 BENZAC AC, 37 BENZACLIN, 37 BENZAMYCIN, 37 benzonatate, 35 benzoyl peroxide, 37 benztropine, 22 bepotastine, 40
BEPREVE, 40 BETAGAN, 41 betamethasone dipropionate augmented crm 0.05%, 39 betamethasone dipropionate augmented gel, oint 0.05%, 39 betamethasone dipropionate augmented lotion 0.05%, 39 betamethasone dipropionate crm, lotion, oint 0.05%, 39 betamethasone valerate crm, lotion, oint 0.1%, 38 BETAPACE, 17 BETAPACE AF, 17 betaxolol, 41 bethanechol, 33 BETIMOL, 41 BETOPTIC S, 41 bexarotene, 16 BIAXIN, 11 BIAXIN XL, 11 bicalutamide, 15 BIDIL, 20 bimatoprost, 41 bismuth/metronidazole/tetracycline, 32 bisoprolol, 18 bisoprolol/hydrochlorothiazide, 19 BLEPH-10, 40 BLEPHAMIDE SOP, 40 blood glucose monitoring kits, test strips, 26, 27 boceprevir, 14 BONIVA, 27 bosentan, 20 BOSULIF, 15 bosutinib, 15 BREO ELLIPTA, 37 BREVICON, 28 BRILINTA, 33 brimonidine 0.1%, 41 brimonidine 0.15%, 41 brimonidine 0.2%, 41 brimonidine/timolol, 41 BRINTELLIX, 22 brinzolamide, 41 brinzolamide/brimonidine, 41 bromfenac sodium, 40 bromocriptine, 22 budesonide, 37 budesonide delayed-rel caps, 31 budesonide inh susp, 37 budesonide rectal foam, 31 bumetanide, 19 buprenorphine transdermal, 10 buprenorphine/naloxone sublingual film, 25 buprenorphine/naloxone sublingual tabs, 25 bupropion, 22 bupropion ext-rel, 22 buspirone, 21 busulfan, 14 butalbital/acetaminophen/caffeine, 11 butalbital/aspirin/caffeine, 11 butenafine, 38 BUTRANS, 10 BYDUREON, 26 BYSTOLIC, 19
C
cabergoline, 30 cabozantinib, 15 CADUET, 19 CAFERGOT, 24 46
CALAN SR, 19 calcipotriene crm, soln, 38 calcipotriene oint, 38 calcitonin-salmon, 27 calcitriol (1,25-D3), 30 calcium acetate, 30 canagliflozin, 26 CANASA, 31 candesartan, 17 candesartan/hydrochlorothiazide, 17 capecitabine, 15 CAPRELSA, 15 captopril, 16 captopril/hydrochlorothiazide, 16 CARAC, 38 CARAFATE susp, 32 CARAFATE tabs, 32 CARBAGLU, 30 carbamazepine, 21 carbamazepine ext-rel, 21 CARBATROL, 21 carbidopa/levodopa, 23 carbidopa/levodopa ext-rel, 23 carbidopa/levodopa orally disintegrating tabs, 22 carbidopa/levodopa/entacapone, 23 CARDIZEM CD, 19 CARDIZEM LA, 19 CARDURA, 17 carglumic acid, 30 carisoprodol, 25 carvedilol, 18 carvedilol phosphate ext-rel, 19 CASODEX, 15 CATAPRES, 16 CATAPRES-TTS, 16 CEDAX, 11 cefaclor, 11 cefadroxil, 11 cefdinir, 11 cefixime, 11 cefprozil, 11 ceftibuten, 11 CEFTIN, 11 cefuroxime axetil, 11 CELEBREX, 10 celecoxib, 10 CELEXA, 22 CELLCEPT, 34 cephalexin, 11 CERDELGA, 29 ceritinib, 15 certolizumab pegol, 34 cevimeline, 32 chlorambucil, 14 chlordiazepoxide/clidinium, 31 chloroquine, 12 chlorpromazine, 23 chlorthalidone, 20 chlorzoxazone, 25 cholestyramine, 18 ciclopirox, 38 CILOXAN, 40 CIMZIA, 34 cinacalcet, 27 CIPRO HC OTIC, 42 CIPRO susp, 12
CIPRO tabs, 12 CIPRODEX, 42 ciprofloxacin, 40 ciprofloxacin ext-rel, 12 ciprofloxacin susp, 12 ciprofloxacin tabs, 12 ciprofloxacin/dexamethasone, 42 ciprofloxacin/hydrocortisone, 42 citalopram, 22 clarithromycin, 11 clarithromycin ext-rel, 11 CLEOCIN, 33 CLEOCIN caps 150 mg, 300 mg, 14 CLEOCIN caps 75 mg, 14 CLEOCIN PEDIATRIC, 14 CLEOCIN T, 37 CLIMARA, 29 CLIMARA PRO, 29 CLINDAGEL, 37 clindamycin caps 150 mg, 300 mg, 14 clindamycin caps 75 mg, 14 clindamycin crm, 33 clindamycin gel, 37 clindamycin gel, lotion, soln, 37 clindamycin pediatric soln, 14 clindamycin supp, 33 clindamycin/benzoyl peroxide, 37 clobetasol propionate crm, gel, oint, soln 0.05%, 39 clobetasol propionate foam 0.05%, 39 clobetasol propionate lotion, shampoo, spray 0.05%, 39 CLOBEX, 39 clomipramine, 21 clonazepam tabs, 21 clonidine, 16 clonidine transdermal, 16 clopidogrel, 33 clotrimazole troches, 12 clozapine, 23 CLOZARIL, 23 COARTEM, 12 cobicistat, 12 codeine/acetaminophen, 10 codeine/chlorpheniramine/pseudoephedrine, 36 codeine/guaifenesin liquid, 36 codeine/guaifenesin/pseudoephedrine, 36 codeine/promethazine, 36 codeine/promethazine/phenylephrine, 36 colchicine, 10 COLCRYS, 10 colesevelam, 18 COLESTID, 18 colestipol, 18 COMBIGAN, 41 COMBIPATCH, 29 COMBIVENT RESPIMAT, 35 COMBIVIR, 12 COMETRIQ, 15 COMPLERA, 12 COMTAN, 23 CONCERTA, 23 CONDYLOX, 40 conjugated estrogens/bazedoxifene, 29 CONTOUR kits and test strips, 27 COPAXONE, 24 COPEGUS, 14 CORDARONE, 17 47
CORDRAN, 38 COREG, 18 COREG CR, 19 CORGARD, 19 CORTEF, 29 CORTIFOAM, 31 CORTISPORIN OTIC, 42 COSOPT, 41 COUMADIN, 33 COZAAR, 17 CREON, 32 CRESTOR, 18 CRIXIVAN, 13 crizotinib, 15 crofelemer delayed-rel, 31 cromolyn sodium, 40 cromolyn soln, 36 crotamiton, 39 CUTIVATE, 38 CUVPOSA, 32 CYCLESSA, 28 cyclobenzaprine, 25 cyclophosphamide caps, 15 CYCLOPHOSPHAMIDE caps, 15 cyclosporine caps, 34 cyclosporine soln, 34 cyclosporine, emulsion, 41 cyclosporine, modified, 34 CYMBALTA, 22 cyproheptadine, 35 CYTOMEL, 30 CYTOTEC, 32
D
D.H.E. 45, 24 dabigatran etexilate, 33 dabrafenib, 15 dalteparin, 33 danazol, 28 DANTRIUM, 25 dantrolene, 25 dapsone, 14 darifenacin ext-rel, 32 darunavir, 13 dasatinib, 15 DAYPRO, 10 DAYTRANA, 23 DDAVP, 30 deferiprone, 33 delavirdine, 13 DEMADEX, 19 denosumab, 27 DEPAKENE, 21 DEPAKOTE, 21 DEPAKOTE ER, 21 DEPAKOTE SPRINKLE, 21 desipramine, 22 desmopressin spray, 30 desogestrel/EE, 28 desogestrel/EE 0.15/30, 27 desonide crm, lotion, oint 0.05%, 38 DESOWEN, 38 desoximetasone crm 0.05%, 38 desoximetasone crm, oint 0.25%, gel 0.05%, 39 desvenlafaxine ext-rel, 22 DETROL, 32
dexamethasone, 29 dexamethasone sodium phosphate, 41 DEXEDRINE SPANSULE, 23 DEXILANT, 32 dexlansoprazole delayed-rel, 32 dexmethylphenidate, 23 dexmethylphenidate ext-rel, 23 dextroamphetamine, 23 dextroamphetamine ext-rel, 23 dextromethorphan/brompheniramine/pseudoephedrine, 36 dextromethorphan/promethazine, 36 dextromethorphan/quinidine, 25 DIAMOX SEQUELS, 19 DIASTAT, 21 diazepam, 21 diazepam rectal gel, 21 diclofenac sodium, 40 diclofenac sodium delayed-rel, 10 diclofenac sodium soln, 10 dicloxacillin, 12 dicyclomine, 31 didanosine delayed-rel, 13 didanosine soln, 13 DIFFERIN, 37 DIFICID, 12 diflorasone diacetate crm 0.05%, 39 diflorasone diacetate oint 0.05%, 39 DIFLUCAN, 12 diflunisal, 10 digoxin, 19 digoxin ped elixir, 19 dihydroergotamine inj, 24 dihydroergotamine spray, 24 DILANTIN, 21 DILANTIN INFATABS, 21 DILAUDID, 10 diltiazem ext-rel, 19 dimethyl fumarate delayed-rel, 25 DIOVAN, 17 DIPENTUM, 31 diphenoxylate/atropine, 31 DIPROLENE, 39 DIPROLENE AF, 39 dipyridamole, 33 dipyridamole ext-rel/aspirin, 33 disopyramide, 17 disopyramide ext-rel, 17 disulfiram, 25 DITROPAN XL, 32 divalproex sodium delayed-rel, 21 divalproex sodium ext-rel, 21 divalproex sodium sprinkle, 21 dofetilide, 17 dolutegravir, 13 donepezil, 21 dornase alfa, 36 dorzolamide, 41 dorzolamide/timolol maleate, 41 DOVONEX, 38 doxazosin, 17 doxepin, 22, 24 doxercalciferol, 30 doxycycline hyclate, 12 doxycycline hyclate 20 mg, 12 DRISDOL, 35 dronabinol, 31 48
drospirenone/EE 3/20, 27 drospirenone/EE 3/30, 27 DUAC, 37 DUAVEE, 29 DUETACT, 26 dulaglutide, 26 DULERA, 37 duloxetine delayed-rel, 22 DURAGESIC, 10 dutasteride, 32 dutasteride/tamsulosin, 32 DYAZIDE, 20
E
E.E.S., 11 E.E.S. tabs, 12 econazole, 38 EDURANT, 13 EE/norethindrone acetate, 29 EE/norethindrone acetate - Jinteli, 29 efavirenz, 13 efavirenz/emtricitabine/tenofovir, 12 EFFEXOR XR, 22 EFFIENT, 33 ELDEPRYL, 23 eletriptan, 24 ELIDEL, 39 eliglustat, 29 ELIQUIS, 33 ELIXOPHYLLIN, 37 ELMIRON, 33 ELOCON, 39 eltrombopag, 33 elvitegravir, 13 elvitegravir/cobicistat/emtricitabine/tenofovir, 12 EMEND, 31 empagliflozin, 26 emtricitabine, 13 emtricitabine/rilpivirine/tenofovir, 12 emtricitabine/tenofovir, 12 EMTRIVA, 13 ENABLEX, 32 enalapril, 16 enalapril/hydrochlorothiazide, 16 ENBREL, 34 enfuvirtide, 13 ENJUVIA, 28 enoxaparin, 33 entacapone, 23 entecavir soln, 14 entecavir tabs, 14 ENTOCORT EC, 31 enzalutamide, 15 EPIDUO, 37 epinephrine, 35 EPIPEN, 35 EPIPEN JR., 35 EPIVIR, 13 EPIVIR-HBV, 14 eplerenone, 17 EPZICOM, 12 ergocalciferol (D2), 35 ergotamine/caffeine, 24 ERIVEDGE, 16 erlotinib, 15 ERYPED, 11
ERY-TAB, 11 erythromycin, 40 erythromycin delayed-rel, 11 erythromycin ethylsuccinate drops, 11 erythromycin ethylsuccinate tabs, 12 erythromycin gel 2%, 37 erythromycin soln, 37 erythromycin stearate, 11 erythromycin/benzoyl peroxide, 37 ESBRIET, 36 escitalopram, 22 ESTRACE, 29 estradiol, 29 estradiol vaginal crm, 29 estradiol vaginal ring, 29 estradiol vaginal tabs, 29 estradiol valerate and dienogest/estradiol valerate, 28 estradiol/levonorgestrel, 29 estradiol/norethindrone, 29 estradiol/norethindrone acetate, 29 estradiol/norgestimate, 29 ESTRING, 29 estrogens, conjugated, 29 estrogens, conjugated crm, 29 estrogens, conjugated, synthetic B, 28 estrogens, conjugated/medroxyprogesterone, 29 estropipate, 28 eszopiclone, 24 etanercept, 34 ethambutol, 13 ethosuximide, 21 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 28 ethynodiol diacetate/EE 1/50 - Zovia 1/50, 28 etodolac, 10 etonogestrel/EE ring, 28 etoposide, 16 etravirine, 13 EURAX, 39 everolimus, 35 EVISTA, 30 EVOXAC, 32 EXALGO, 10 EXELON, 22 EXELON PATCH, 21 exemestane, 15 exenatide ext-rel, 26 EXFORGE, 17 EXFORGE HCT, 17 EXTAVIA, 24 ezetimibe, 18 ezetimibe/atorvastatin, 18 ezetimibe/simvastatin, 18 ezogabine, 21
F
famciclovir, 14 FAMVIR, 14 FARESTON, 15 felbamate, 21 FELBATOL, 21 felodipine ext-rel, 19 FEMARA, 15 FEMHRT, 29 FEMRING, 29 fenofibrate, 18 fenofibric acid delayed-rel, 18 49
fentanyl transdermal, 10 ferric citrate, 30 FERRIPROX, 33 FETZIMA, 22 fidaxomicin, 12 FINACEA, 39 finasteride, 32 fingolimod, 25 FIORINAL, 11 FIRAZYR, 33 FLAGYL, 14 flecainide, 17 FLOMAX, 32 FLOVENT HFA, 37 fluconazole, 12 fludrocortisone, 29 flunisolide spray, 36 fluocinolone acetonide crm, oint 0.025%, 38 fluocinolone acetonide soln 0.01%, 38 fluocinonide crm 0.1%, 39 fluocinonide crm, gel, oint, soln 0.05%, 39 fluorometholone, 41 fluorouracil, 38 fluoxetine, 22 fluoxetine delayed-rel, 22 fluphenazine, 23 flurandrenolide lotion 0.05%, 38 flurandrenolide tape, 38 flutamide, 15 fluticasone, 37 fluticasone propionate crm, lotion 0.05%, oint 0.005%, 38 fluticasone, CFC-free aerosol, 37 fluticasone/salmeterol, 37 fluticasone/salmeterol, CFC-free aerosol, 37 fluticasone/vilanterol, 37 fluvoxamine, 21 FML, 41 FOCALIN, 23 FOCALIN XR, 23 fondaparinux, 33 FORADIL, 36 formoterol inhalation caps, 36 FORTEO, 27 FOSAMAX, 27 fosamprenavir, 13 fosinopril, 16 fosinopril/hydrochlorothiazide, 16 FOSRENOL, 30 FRAGMIN, 33 FULYZAQ, 31 FURADANTIN, 14 furosemide, 19 FUZEON, 13 FYCOMPA, 21
G
gabapentin, 21 GABITRIL, 21 galantamine, 22 galantamine ext-rel, 22 ganciclovir, 41 GATTEX, 32 gemfibrozil, 18 gentamicin, 38, 40 GEODON, 23 GILENYA, 25
glatiramer, 24 GLEEVEC, 15 glimepiride, 26 glipizide, 26 glipizide ext-rel, 26 glipizide/metformin, 26 GLUCAGEN HYPOKIT, 29 GLUCAGON EMERGENCY KIT, 29 glucagon, human recombinant, 29 GLUCOPHAGE, 26 GLUCOPHAGE XR, 26 GLUCOTROL, 26 GLUCOTROL XL, 26 glycerol phenylbutyrate, 30 glycopyrrolate, 32 GOLYTELY, 32 granisetron, 31 granisetron transdermal, 31 grass mixed pollen allergen extract, 34 GRASTEK, 34 griseofulvin ultramicrosize, 12 GRIS-PEG, 12 guanfacine, 16 guanfacine ext-rel, 23
H
HALCION, 24 halobetasol propionate crm, oint 0.05%, 39 haloperidol, 23 HARVONI, 14 HECTOROL, 30 HEMANGEOL, 19 HEPSERA, 14 HEXALEN, 14 HUMIRA, 34 HYCAMTIN caps, 16 hydralazine, 20 HYDREA, 16 hydrochlorothiazide, 20 hydrocodone/acetaminophen, 10 hydrocodone/chlorpheniramine ext-rel, 36 hydrocodone/homatropine, 36 hydrocortisone, 29 hydrocortisone acetate foam, 31 hydrocortisone acetate/pramoxine foam, 32 hydrocortisone butyrate crm 0.1%, 38 hydrocortisone butyrate crm, oint, soln 0.1%, 38 hydrocortisone butyrate lotion 0.1%, 38 hydrocortisone crm, 32 hydrocortisone crm 2.5%, 38 hydrocortisone enema, 31 hydrocortisone valerate crm, oint 0.2%, 39 hydromorphone, 10 hydromorphone ext-rel, 10 hydroxychloroquine, 34 hydroxyurea, 16 hydroxyzine HCl, 35 hyoscyamine sulfate, 31 hyoscyamine sulfate ext-rel, 31 hyoscyamine sulfate ext-rel caps, 31 hyoscyamine sulfate orally disintegrating tabs, 31 HYQVIA, 34 HYZAAR, 17
I
ibandronate, 27 ibrutinib, 15 50
icatibant, 33 icosapent ethyl, 18 idelalisib, 15 iloprost, 20 imatinib mesylate, 15 IMBRUVICA, 15 imipramine HCl, 22 imiquimod, 39, 40 IMITREX, 24 IMITREX inj, 24 IMITREX nasal spray, 24 immune globulin/hyaluronidase, 34 IMURAN, 34 indacaterol, 36 indapamide, 20 INDERAL LA, 19 indinavir, 13 ingenol mebutate, 38 INLYTA, 15 INSPRA, 17 insulin aspart, 26 insulin aspart protamine 70%/insulin aspart 30%, 26 insulin detemir, 26 insulin glargine, 26 insulin human, 26 insulin isophane human, 26 insulin isophane human 70%/regular 30%, 26 insulin syringes, needles, 27 INTELENCE, 13 interferon alfa-2b, 34 interferon beta-1a, 24, 25 interferon beta-1b, 24 INTRON A, 34 INTUNIV, 23 INVEGA, 23 INVIRASE, 13 INVOKANA, 26 ipratropium soln, 35 ipratropium spray, 37 ipratropium, CFC-free aerosol, 35 ipratropium/albuterol soln, 35 ipratropium/albuterol, CFC-free aerosol, 35 irbesartan, 17 irbesartan/hydrochlorothiazide, 17 ISENTRESS, 13 isoniazid, 13 ISORDIL, 20 isosorbide dinitrate ext-rel tabs, 20 isosorbide dinitrate oral, 20 isosorbide dinitrate/hydralazine, 20 isosorbide mononitrate, 20 isosorbide mononitrate ext-rel, 20 isotretinoin - Amnesteem, 37 isotretinoin - Claravis, 37 itraconazole, 12 ivacaftor, 36
J
JAKAFI, 15 JALYN, 32 JANUMET, 26 JANUMET XR, 26 JANUVIA, 26 JARDIANCE, 26 JUXTAPID, 18
K
KADIAN, 10 KALETRA, 13 KALYDECO, 36 KEFLEX, 11 KEPPRA, 21 KEPPRA XR, 21 ketoconazole, 38 ketoconazole shampoo 2%, 38 ketorolac, 40 KINERET, 34 KLARON, 37 KLONOPIN, 21 KOMBIGLYZE XR, 26 KORLYM, 30 KRISTALOSE, 32 KUVAN, 30 KYNAMRO, 18
L
labetalol, 19 lacosamide, 21 lactulose, 32 LAMICTAL, 21 LAMICTAL XR, 21 LAMISIL, 12 lamivudine, 13, 14 lamivudine/zidovudine, 12 lamotrigine, 21 lamotrigine ext-rel, 21 LANOXIN, 19 lansoprazole + amoxicillin + clarithromycin, 32 lanthanum, 30 LANTUS, 26 lapatinib, 15 LASIX, 19 latanoprost, 41 ledipasvir/sofosbuvir, 14 leflunomide, 34 lenalidomide, 15 LETAIRIS, 20 letrozole, 15 LEUKERAN, 14 LEVAQUIN, 12 LEVBID, 31 LEVEMIR, 26 levetiracetam, 21 levetiracetam ext-rel, 21 levobunolol, 41 levocetirizine, 35 levofloxacin, 12 levomilnacipran ext-rel, 22 levonorgestrel/EE - Trivora, 28 levonorgestrel/EE 0.09/20 - Amethyst, 28 levonorgestrel/EE 0.1/20 - Lessina, 27 levonorgestrel/EE 0.1/20 and EE 10, 28 levonorgestrel/EE 0.15/30, 28 levonorgestrel/EE 0.15/30 - Levora, 27 levonorgestrel/EE 0.15/30 and EE 10, 28 levothyroxine, 30 levothyroxine - Levoxyl, 30 LEVSIN, 31 LEXAPRO, 22 LEXIVA, 13 LIALDA, 31 lidocaine patch, 39 51
lidocaine viscous, 40 lidocaine/prilocaine, 39 LIDODERM, 39 linaclotide, 31 linezolid, 14 LINZESS, 31 liothyronine, 30 LIPITOR, 18 LIPOFEN, 18 LIPTRUZET, 18 liraglutide, 26 lisdexamfetamine, 23 lisinopril, 16 lisinopril/hydrochlorothiazide, 16 lithium carbonate, 24 lithium carbonate ext-rel tabs 300 mg, 24 lithium carbonate ext-rel tabs 450 mg, 24 LITHOBID, 24 LO LOESTRIN FE, 27 LOCOID, 38 LOCOID LIPOCREAM, 38 lodoxamide, 40 LOESTRIN 1.5/30, 27 LOESTRIN 1/20, 27 LOESTRIN FE 1.5/30, 28 LOESTRIN FE 1/20, 27 LOFIBRA, 18 lomitapide, 18 LOMOTIL, 31 lomustine, 14 LOPID, 18 lopinavir/ritonavir, 13 LOPRESSOR, 19 LOPRESSOR HCT, 19 LOPROX, 38 lorazepam, 21 lorcaserin, 27 losartan, 17 losartan/hydrochlorothiazide, 17 LOSEASONIQUE, 28 LOTEMAX, 41 LOTENSIN, 16 LOTENSIN HCT, 16 loteprednol 0.2%, 41 loteprednol 0.5%, 41 LOTREL, 16 lovastatin, 18 LOVAZA, 18 LOVENOX, 33 LUMIGAN, 41 LUMIZYME, 30 LUNESTA, 24 LYRICA, 24 LYSODREN, 16 LYSTEDA, 34
M
macitentan, 20 MACROBID, 14 MACRODANTIN 25 mg, 14 MACRODANTIN 50 mg, 100 mg, 14 MALARONE, 12 malathion, 39 maraviroc, 12 MARINOL, 31 MAVIK, 16
MAXALT, 24 MAXALT-MLT, 24 MAXITROL, 40 MAXZIDE, 20 mechlorethamine gel, 15 MEDROL, 29 medroxyprogesterone acetate, 30 mefloquine, 12 MEGACE, 15 MEGACE ES, 30 megestrol acetate, 15 megestrol acetate susp, 30 MEKINIST, 15 meloxicam, 10 melphalan, 14 memantine, 21 memantine ext-rel, 22 MENTAX, 38 MEPHYTON, 35 mercaptopurine, 15 mesalamine delayed-rel tabs, 31 mesalamine ext-rel caps, 31 mesalamine rectal susp, 31 mesalamine supp, 31 MESTINON syrup, 25 MESTINON tabs, 25 MESTINON TIMESPAN, 25 METADATE CD, 23 METAGLIP, 26 metaxalone, 25 metformin, 26 metformin ext-rel 750 mg, 26 methazolamide, 19 methimazole, 30 methocarbamol tabs, 25 methotrexate, 15, 34 methoxsalen oral, 38 methyldopa, 20 METHYLIN, 23 methylphenidate, 23 methylphenidate ext-rel, 23 methylphenidate ext-rel 10 mg, 23 methylphenidate transdermal, 23 methylprednisolone, 29 metipranolol, 41 metoclopramide, 31 metoclopramide orally-disintegrating tabs, 31 metolazone, 20 metoprolol succinate ext-rel, 19 metoprolol tartrate, 19 metoprolol/hydrochlorothiazide, 19 METOZOLV ODT, 31 metreleptin, 30 METROCREAM, 39 METROGEL, 39 METROGEL-VAGINAL, 33 METROLOTION, 39 metronidazole, 14, 33 metronidazole crm 0.75%, 39 metronidazole gel 0.75%, 39 metronidazole gel 1%, 39 metronidazole lotion 0.75%, 39 MEVACOR, 18 MIACALCIN, 27 MICARDIS, 17 MICARDIS HCT, 17 52
midodrine, 20 mifepristone, 30 miglustat, 29 MIGRANAL, 24 milnacipran, 24 MINOCIN, 12 minocycline, 12 mipomersen, 18 MIRAPEX, 23 MIRAPEX ER, 23 MIRCETTE, 28 mirtazapine, 22 misoprostol, 32 mitotane, 16 MOBIC, 10 modafinil, 25 MODICON, 28 mometasone, 37 mometasone crm, lotion, oint 0.1%, 39 mometasone spray, 36 mometasone/formoterol, 37 montelukast, 36 morphine, 10 morphine ext-rel, 10 morphine supp, 10 MOVIPREP, 32 moxifloxacin, 12, 40 MS CONTIN, 10 mupirocin, 38 MYALEPT, 30 MYAMBUTOL, 13 mycophenolate mofetil, 34 mycophenolate sodium delayed-rel, 34 MYFORTIC, 34 MYLERAN, 14 MYSOLINE, 21
N
nabumetone, 10 nadolol, 19 nafarelin, 28 naltrexone, 25 NAMENDA, 21 NAMENDA XR, 22 NAPROSYN, 10 naproxen, 10 naproxen sodium, 10 naratriptan, 24 NARDIL, 22 NASONEX, 36 NATACYN, 40 natamycin, 40 NATAZIA, 28 nateglinide, 26 nebivolol, 19 nedocromil, 40 nelfinavir, 13 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 40 neomycin/polymyxin B/dexamethasone, 40 neomycin/polymyxin B/gramicidin, 40 neomycin/polymyxin B/hydrocortisone, 42 neomycin/polymyxin B/hydrocortisone susp, 40 NEORAL, 34 NEOSPORIN, 40 netupitant/palonosetron, 31 NEURONTIN, 21
nevirapine, 13 nevirapine ext-rel, 13 NEXAVAR, 15 niacin ext-rel, 18 niacin ext-rel/lovastatin, 18 niacin ext-rel/simvastatin, 18 NIASPAN, 18 nifedipine ext-rel, 19 nilotinib, 15 nintedanib, 36 nitazoxanide, 14 NITRO-DUR, 20 nitrofurantoin ext-rel, 14 nitrofurantoin macrocrystals 25 mg, 14 nitrofurantoin macrocrystals 50 mg, 100 mg, 14 nitrofurantoin susp, 14 nitroglycerin sublingual, 20 nitroglycerin transdermal, 20 NITROSTAT, 20 NIZORAL SHAMPOO, 38 NORCO, 10 NORDITROPIN, 29 norelgestromin/EE, 28 norethindrone, 28 norethindrone acetate, 30 norethindrone acetate/EE 1.5/30, 27 norethindrone acetate/EE 1.5/30 and iron, 28 norethindrone acetate/EE 1/10 and EE 10 and iron, 27 norethindrone acetate/EE 1/20, 27 norethindrone acetate/EE 1/20 and iron, 27 norethindrone acetate/EE 1/20 and iron - Lomedia 24 Fe, 27 norethindrone/EE, 28 norethindrone/EE 0.5/35, 28 norethindrone/EE 1/35, 28 norethindrone/ME 1/50, 28 norgestimate/EE, 28 norgestimate/EE 0.25/35, 28 norgestrel/EE 0.3/30 - Low-Ogestrel, 27 NORINYL 1+35, 28 NORINYL 1+50, 28 NORPACE, 17 NORPACE CR, 17 NORPRAMIN, 22 NOR-QD, 28 nortriptyline, 22 NORVIR, 13 NOVOLIN 70/30, 26 NOVOLIN N, 26 NOVOLIN R, 26 NOVOLOG, 26 NOVOLOG MIX 70/30, 26 NUCYNTA, 10 NUCYNTA ER, 10 NUEDEXTA, 25 NULYTELY, 32 NUVARING, 28 NUVIGIL, 25 nystatin, 12, 38
O
OCUFLOX, 40 OFEV, 36 ofloxacin, 40 ofloxacin otic, 42 olanzapine, 23 olmesartan, 17 53
olmesartan/amlodipine/hydrochlorothiazide, 17 olmesartan/hydrochlorothiazide, 17 olodaterol, CFC-free aerosol, 36 olopatadine, 40 olsalazine, 31 OLUX, 39 OLYSIO, 14 omega-3 acid ethyl esters, 18 ondansetron, 31 ONGLYZA, 26 OPSUMIT, 20 OPTIPRANOLOL, 41 OPTIVAR, 40 ORALAIR, 34 ORAPRED ODT, 29 orphenadrine/aspirin/caffeine, 25 ORTHO EVRA, 28 ORTHO MICRONOR, 28 ORTHO TRI-CYCLEN, 28 ORTHO TRI-CYCLEN LO, 28 ORTHO-CYCLEN, 28 ORTHO-NOVUM 1/35, 28 ORTHO-NOVUM 7/7/7, 28 oseltamivir, 14 ospemifene, 30 OSPHENA, 30 OTEZLA, 34 OVIDE, 39 oxaprozin, 10 oxazepam, 21 oxcarbazepine, 21 oxiconazole, 38 OXISTAT, 38 OXSORALEN-ULTRA, 38 oxybutynin, 32 oxybutynin ext-rel, 32 oxycodone caps, tabs 5 mg, 10 oxycodone concentrate 20 mg/mL, 10 oxycodone ext-rel, 10 oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL, 10 oxycodone/acetaminophen 5/325, 10 OXYCONTIN, 10
P
paliperidone ext-rel, 23 PAMELOR, 22 pancrelipase delayed-rel, 32 pantoprazole delayed-rel, 32 PARAFON FORTE DSC, 25 paricalcitol, 30 PARLODEL, 22 PARNATE, 22 paroxetine HCl, 22 paroxetine HCl ext-rel, 22 pasireotide, 30 PATADAY, 40 PATANOL, 40 PAXIL, 22 PAXIL CR, 22 pazopanib, 15 peg 3350/electrolytes, 32 PEGASYS, 34 peginterferon alfa-2a, 34 peginterferon alfa-2b, 34 peginterferon beta-1a, 25 PEGINTRON, 34
penicillin VK, 12 PENTASA, 31 pentosan polysulfate sodium, 33 perampanel, 21 PERCOCET, 10 perindopril, 16 permethrin 5%, 39 perphenazine, 23 PERSANTINE, 33 phenazopyridine, 33 phenelzine, 22 phenobarbital, 21 phenytoin, 21 phenytoin sodium extended, 21 PHOSLO, 30 phytonadione, 35 PICATO, 38 pilocarpine tabs, 32 pimecrolimus, 39 pindolol, 18 pioglitazone, 26 pioglitazone/glimepiride, 26 pioglitazone/metformin, 26 pirfenidone, 36 PLAQUENIL, 34 PLEGRIDY, 25 podofilox, 40 polymyxin B/bacitracin, 40 polymyxin B/trimethoprim, 40 POLYTRIM, 40 pomalidomide, 15 POMALYST, 15 potassium chloride ext-rel, 35 potassium chloride liquid, 35 potassium citrate ext-rel, 33 POTIGA, 21 PRADAXA, 33 pramipexole, 23 pramipexole ext-rel, 23 pramlintide, 26 PRANDIN, 26 prasugrel, 33 PRAVACHOL, 18 pravastatin, 18 PRECOSE, 25 PRED FORTE, 41 prednisolone acetate 1%, 41 prednisolone phosphate 1%, 41 PREDNISOLONE PHOSPHATE 1%, 41 prednisolone sodium phosphate 5 mg/5 mL, 15 mg/5 mL, 29 prednisolone sodium phosphate orally disintegrating tabs, 29 prednisolone syrup, 29 prednisone, 29 PREFEST, 29 pregabalin, 24 PRELONE, 29 PREMARIN, 29 PREMARIN crm, 29 PREMPHASE, 29 PREMPRO, 29 PREPOPIK, 32 PREVPAC, 32 PREZISTA, 13 primidone, 21 54
PRISTIQ, 22 probenecid, 10 PROCARDIA XL, 19 prochlorperazine, 31 PROCTOFOAM-HC, 32 progesterone, micronized, 30 PROGRAF, 34 PROLIA, 27 PROMACTA, 33 promethazine, 31 PROMETRIUM, 30 propafenone, 17 propafenone ext-rel, 17 propranolol, 18 propranolol ext-rel, 19 propranolol oral soln, 19 propylthiouracil, 30 PROSCAR, 32 PROTOPIC, 39 PROVERA, 30 PROVIGIL, 25 PROZAC, 22 PROZAC WEEKLY, 22 PULMICORT FLEXHALER, 37 PULMICORT RESPULES, 37 PULMOZYME, 36 PURINETHOL, 15 PYLERA, 32 pyrazinamide, 13 PYRIDIUM, 33 pyridostigmine ext-rel, 25 pyridostigmine syrup, 25 pyridostigmine tabs, 25
Q
QUESTRAN/QUESTRAN LIGHT, 18 quetiapine, 23 quetiapine ext-rel, 23 quinapril, 16 quinapril/hydrochlorothiazide, 16 QVAR, 37
R
rabeprazole delayed-rel, 32 ragweed pollen allergen extract, 34 RAGWITEK, 34 raloxifene, 30 raltegravir, 13 ramipril, 16 RANEXA, 20 ranolazine ext-rel, 20 RAPAMUNE, 35 rasagiline mesylate, 23 RAVICTI, 30 RAZADYNE, 22 RAZADYNE ER, 22 REBETOL, 14 REBIF, 25 REGLAN, 31 regorafenib, 15 RELENZA, 14 RELPAX, 24 REMERON, 22 repaglinide, 26 REQUIP, 23 RESCRIPTOR, 13 RESTASIS, 41
RESTORIL, 24 retapamulin, 38 RETIN-A, 37 RETIN-A MICRO, 37 RETROVIR, 13 REVATIO, 20 REVIA, 25 REVLIMID, 15 REYATAZ, 13 RHEUMATREX, 34 RIBAPAK, 14 ribavirin caps, 14 ribavirin oral soln, 14 ribavirin tabs, 14 RIFADIN, 13 rifampin, 13 rilpivirine, 13 riociguat, 20 risedronate 150 mg, 27 risedronate 5 mg, 30 mg, 35 mg, 27 RISPERDAL, 23 risperidone, 23 RITALIN, 23 RITALIN LA, 23 ritonavir, 13 rivaroxaban, 33 rivastigmine, 22 rivastigmine transdermal, 21 rizatriptan, 24 rizatriptan orally disintegrating tabs, 24 ROBAXIN tabs, 25 ROCALTROL, 30 ropinirole, 23 rosuvastatin, 18 ROWASA, 31 ROXICODONE, 10 rufinamide, 21 ruxolitinib, 15 RYTHMOL, 17 RYTHMOL SR, 17
S
SALAGEN, 32 salmeterol xinafoate, 36 SANCUSO, 31 SANDIMMUNE, 34 SAPHRIS, 23 sapropterin, 30 saquinavir mesylate, 13 SAVELLA, 24 saxagliptin, 26 saxagliptin/metformin ext-rel, 26 scopolamine, 31 SEASONIQUE, 28 selegiline, 23 selenium sulfide shampoo 2.5%, 38 SELZENTRY, 12 SENSIPAR, 27 SEREVENT DISKUS, 36 SEROQUEL, 23 SEROQUEL XR, 23 sertraline, 22 SIGNIFOR, 30 sildenafil, 20 SILENOR, 24 siltuximab, 16 55
SILVADENE, 38 silver sulfadiazine, 38 SIMBRINZA, 41 SIMCOR, 18 simeprevir, 14 simvastatin, 18 SINEMET, 23 SINEMET CR, 23 SINGULAIR, 36 sirolimus, 35 SIRTURO, 13 sitagliptin phosphate, 26 sitagliptin/metformin, 26 sitagliptin/metformin ext-rel, 26 SKELAXIN, 25 sodium picosulfate/magnesium oxide/citric acid, 32 sodium sulfate/potassium sulfate/magnesium sulfate, 32 sofosbuvir, 14 solifenacin succinate, 32 SOMA, 25 somatropin, 29 sorafenib, 15 SORIATANE, 38 sotalol, 17 SOVALDI, 14 SPIRIVA, 35 spironolactone, 17 spironolactone/hydrochlorothiazide, 20 SPORANOX, 12 SPRYCEL, 15 STALEVO, 23 STARLIX, 26 stavudine caps, 13 stavudine soln, 13 STELARA, 38 STIVARGA, 15 STRATTERA, 23 STRIANT, 25 STRIBILD, 12 STRIVERDI RESPIMAT, 36 SUBOXONE FILM, 25 sucralfate susp, 32 sucralfate tabs, 32 sulfacetamide lotion 10%, 37 sulfacetamide soln 10%, 40 sulfacetamide/prednisolone acetate oint 10%/0.2%, 40 sulfacetamide/prednisolone phosphate 10%/0.25%, 40 sulfacetamide/sulfur, 39 sulfacetamide/sulfur crm, gel, lotion, pads, 37 sulfamethoxazole/trimethoprim, 14 sulfamethoxazole/trimethoprim DS, 14 sulfasalazine, 31 sulfasalazine delayed-rel, 31 sulindac, 10 sumatriptan, 24 sumatriptan inj, 24 sumatriptan nasal spray, 24 SUMAVEL DOSEPRO, 24 sunitinib, 15 SUPRAX, 11 SUPREP, 32 SUSTIVA, 13 SUTENT, 15 SYLATRON, 34 SYLVANT, 16 SYMLINPEN, 26
SYNAREL, 28 SYNTHROID, 30
T
TABLOID, 15 tacrolimus, 34, 39 tadalafil, 20 TAFINLAR, 15 tafluprost, 41 TAMIFLU, 14 tamoxifen, 15 tamsulosin, 32 TANZEUM, 26 TAPAZOLE, 30 tapentadol, 10 tapentadol ext-rel, 10 TARCEVA, 15 TARGRETIN, 16 TARKA, 16 TASIGNA, 15 tazarotene, 37 TAZORAC, 37 TECFIDERA, 25 teduglutide, 32 TEGRETOL, 21 TEGRETOL-XR, 21 TEKAMLO, 19 TEKTURNA, 19 TEKTURNA HCT, 19 telavancin, 14 telbivudine, 14 telmisartan, 17 telmisartan/hydrochlorothiazide, 17 temazepam, 24 TEMODAR, 15 TEMOVATE, 39 temozolomide, 15 TENEX, 16 tenofovir, 13 TENORETIC, 19 TENORMIN, 18 TERAZOL 3, 33 TERAZOL 7, 33 terazosin, 17 terbinafine tabs, 12 terbutaline, 36 terconazole, 33 terconazole crm, 33 terconazole supp, 33 teriflunomide, 25 teriparatide, 27 TESSALON, 35 TESTIM, 25 testosterone buccal, 25 testosterone gel, 25 testosterone soln, 25 testosterone transdermal, 25 tetrabenazine, 24 tetracycline caps, 12 thalidomide, 15 THALOMID, 15 THEO-24, 37 theophylline ext-rel caps, 37 theophylline ext-rel tabs, 37 theophylline liquid, 37 thioguanine, 15 56
thioridazine, 23 thiothixene, 23 thyroid, 30 tiagabine, 21 TIAZAC, 19 ticagrelor, 33 TIGAN, 31 TIKOSYN, 17 timolol hemihydrate, 41 timolol maleate, 41 timolol maleate gel, 41 TIMOPTIC, 41 TIMOPTIC-XE, 41 timothy grass pollen allergen extract, 34 TINDAMAX, 14 tinidazole, 14 tiotropium, 35 tipranavir, 13 TIVICAY, 13 tizanidine, 25 TOBI, 36 TOBI PODHALER, 36 TOBRADEX OINTMENT, 40 TOBRADEX ST, 40 TOBRADEX SUSPENSION, 40 tobramycin inhalation powder, 36 tobramycin inhalation soln, 36 tobramycin oint, 40 tobramycin soln, 40 tobramycin/dexamethasone oint 0.3%/0.1%, 40 tobramycin/dexamethasone susp 0.3%/0.05%, 40 tobramycin/dexamethasone susp 0.3%/0.1%, 40 tobramycin/loteprednol, 40 TOBREX oint, 40 TOBREX soln, 40 tofacitinib, 34 TOFRANIL, 22 tolterodine, 32 tolterodine ext-rel, 32 TOPAMAX, 21 TOPICORT, 39 TOPICORT LP, 38 topiramate, 21 topotecan caps, 16 TOPROL-XL, 19 toremifene, 15 torsemide, 19 TRACLEER, 20 tramadol, 10 trametinib, 15 TRANDATE, 19 trandolapril, 16 trandolapril/verapamil ext-rel, 16 tranexamic acid, 34 TRANSDERM SCOP, 31 tranylcypromine, 22 TRAVATAN Z, 41 travoprost, 41 trazodone, 22 treprostinil, 20 tretinoin, 37 tretinoin caps, 16 tretinoin gel microsphere, 37 TREXALL, 15 triamcinolone acetonide crm 0.5%, 39 triamcinolone acetonide crm, lotion 0.025%, 38
triamcinolone acetonide crm, lotion, oint 0.1%, 38 triamcinolone paste, 40 triamterene/hydrochlorothiazide, 20 triazolam, 24 TRIBENZOR, 17 trifluoperazine, 23 trifluridine, 41 trihexyphenidyl, 22 TRILEPTAL, 21 TRILIPIX, 18 trimethobenzamide, 31 trimethoprim, 14 TRI-NORINYL, 28 TRIUMEQ, 12 TRIZIVIR, 12 trospium, 32 TRULICITY, 26 TRUSOPT, 41 TRUVADA, 12 TUSSIONEX, 36 TWYNSTA, 17 TYBOST, 12 TYKERB, 15 TYLENOL w/CODEINE, 10 TYVASO, 20 TYZEKA, 14
U
UCERIS, 31 ULTRAM, 10 ULTRAVATE, 39 umeclidinium/vilanterol, 35 URECHOLINE, 33 UROCIT-K, 33 URSO, 31 ursodiol, 31 ustekinumab, 38
V
VAGIFEM, 29 valacyclovir, 14 VALCHLOR, 15 VALCYTE, 13 valganciclovir, 13 VALIUM, 21 valproic acid, 21 valsartan, 17 valsartan/hydrochlorothiazide, 17 VANCOCIN, 14 vancomycin, 14 vandetanib, 15 VANOS, 39 VASCEPA, 18 VASERETIC, 16 VASOTEC, 16 velaglucerase alfa, 30 vemurafenib, 15 venlafaxine, 22 venlafaxine ext-rel, 22 VENTAVIS, 20 VENTOLIN HFA, 36 verapamil ext-rel, 19 VESICARE, 32 VFEND, 12 VIBATIV, 14 VIBRAMYCIN, 12 VICODIN ES, 10 57
VICTOZA, 26 VICTRELIS, 14 VIDEX EC, 13 VIDEX soln, 13 VIGAMOX, 40 VIIBRYD, 22 vilazodone, 22 VIMPAT, 21 VIRACEPT, 13 VIRAMUNE, 13 VIRAMUNE XR, 13 VIREAD, 13 VIROPTIC, 41 vismodegib, 16 VITEKTA, 13 VIVELLE-DOT, 29 vorapaxar, 33 voriconazole, 12 vorinostat, 16 vortioxetine, 22 VOSPIRE ER, 36 VOTRIENT, 15 VPRIV, 30 VYTORIN, 18 VYVANSE, 23
W
warfarin, 33 WELCHOL, 18 WELLBUTRIN, 22 WELLBUTRIN SR, 22 WELLBUTRIN XL, 22 WESTCORT, 39
X
XALATAN, 41 XALKORI, 15 XANAX, 21 XARELTO, 33 XELJANZ, 34 XELODA, 15 XENAZINE, 24 XTANDI, 15 XYZAL, 35
Y
YASMIN, 27 YAZ, 27
Z
zafirlukast, 36
ZANAFLEX, 25 zanamivir, 14 ZARONTIN, 21 ZAROXOLYN, 20 ZAVESCA, 29 ZEBETA, 18 ZELBORAF, 15 ZEMPLAR, 30 ZENPEP, 32 ZERIT caps, 13 ZERIT soln, 13 ZESTORETIC, 16 ZESTRIL, 16 ZETIA, 18 ZIAC, 19 ZIAGEN soln, 13 ZIAGEN tabs, 13 zidovudine, 13 ZIOPTAN, 41 ziprasidone, 23 ZIRGAN, 41 ZITHROMAX, 11 ZOCOR, 18 ZOFRAN, 31 ZOLINZA, 16 zolmitriptan, 24 zolmitriptan nasal spray, 24 zolmitriptan orally disintegrating tabs, 24 ZOLOFT, 22 zolpidem, 24 zolpidem ext-rel, 24 ZOMIG, 24 ZOMIG nasal spray, 24 ZOMIG-ZMT, 24 ZONEGRAN, 21 zonisamide, 21 ZONTIVITY, 33 ZORTRESS, 35 ZOVIRAX, 14 ZOVIRAX oint, 39 ZYCLARA, 40 ZYDELIG, 15 ZYKADIA, 15 ZYLET, 40 ZYLOPRIM, 10 ZYPREXA, 23 ZYTIGA, 15 ZYVOX, 14
58
