Hormone Replacement Therapy List

Hormone Replacement Therapy List 800.622.4510 | www.wellsrx.com Hormone Replacement Therapy Medication Form Strength Package Size 0.25mg Per Mi...
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Hormone Replacement Therapy List

800.622.4510 | www.wellsrx.com

Hormone Replacement Therapy Medication

Form

Strength

Package Size

0.25mg

Per Mini-Tab

0.5mg

Per Mini-Tab

1.2mg

Per Mini-Tab

1.5mg

Per Mini-Tab

Oral/Sublingual Preparations

Anastrozole

Rapid Dissolve Mini-Tab

Anastrozole (Commercial Product)

Tablet

1mg

Per Tablet

Clomiphene Citrate (Commercial Product)

Tablet

50mg

Per Tablet

Capsule

200mg

Per Capsule

Sermorelin Acetate

Rapid Dissolve Mini-Tab

400mcg

Per Tablet

Sermorelin Acetate/GHRP(2)/GHRP(6)

Rapid Dissolve Mini-Tab

300mcg/300mcg/300mcg

Per Tablet

10mg

Per Tablet

20mg

Per Tablet

N-Dim (Commercial Product)

Tamoxifen Citrate (Commercial Product)

Tablet

Oral Thyroid Preparations N-Adrenal Complex (Commercial Product)

Capsule

Supplement

Per Capsule

N-Adrenotone (Commercial Product)

Capsule

Supplement

Per Capsule

Tablet

¼ grain - 5 grain

Per Tablet

Biotin/Finasteride

Capsule

5mg/1mg

Per Capsule

Finasteride

Capsule

1.25mg

Per Capsule

1mg

Per Tablet

5mg

Per Tablet

1.5mg

Per Capsule

3.0mg

Per Capsule

4.5mg

Per Capsule

Armour Thyroid® (Commercial Product)

Finasteride (Commercial Product)

Naltrexone

Published 5/17/2016. Prices subject to change

Tablet

Capsule

WPN-4800-05172016

Hormone Replacement Therapy List

800.622.4510 | www.wellsrx.com

Medication

Form

Strength

Package Size

Nature-Throid® (Commercial Product)

Tablet

¼ grain - 4 grain

Per Tablet

up to and including 59mcg*

#30 / #60 / #90

60-90mcg*

#30 / #60 / #90

91mcg-120mcg*

#30 / #60 / #90

121mcg and higher*

#30 / #60 / #90

T3 SR (Slow Release) or T3/T4 SR (Slow Release)

Capsule

*Price is based on the total amount of mcgs of either T3 by iteslf or T3/T4 combined

Thyroid USP, Porcine SR (Slow Release)

WP-Thyroid® (Commercial Product)

Capsule

Tablet

30mg

Per Capsule

60mg

Per Capsule

90mg

Per Capsule

120mg

Per Capsule

¼ grain - 2 grain

Per Tablet

For a complete list of topical & oral preparations, please see (Non-Sterile BHRT Formulary)

Injectable Preparations

Sermorelin Acetate, Lyophilized Vial

Injectable

9mg

Per Kit*

15mg

Per Kit*

28mg

Per Kit*

Sermorelin Acetate/GHRP(6) Lyophilized Vial

Injectable

6mg/3mg

Per Kit*

Sermorelin Acetate/GHRP(2) Lyophilized Vial

Injectable

9mg/3mg

Per Kit*

Sermorelin Acetate/GHRP(2)/GHRP(6) Lyophilized Vial

Injectable

9mg/3.15mg/3.15mg

Per Kit*

9mg/9mg/9mg

Per Kit*

Sermorelin Acetate/GHRP(2)/Theanine Lyophilized Vial

Injectable

15mg/5.4mg/75mg

Per Kit*

*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately)

Published 5/17/2016. Prices subject to change

WPN-4800-05172016

Hormone Replacement Therapy List

800.622.4510 | www.wellsrx.com

Medication

Testosterone Cypionate in Grapeseed Oil

Form

Injectable

Strength

Package Size

20mg/mL

5mL Vial

50mg/mL

1mL Vial

100mg/mL

1mL Vial 5mL Vial 1mL Vial

200mg/mL

5mL Vial 10mL Vial 1mL Vial

Testosterone Cypionate in Sesame Oil

Injectable

200mg/mL

Testosterone Cypionate/Anastrozole

Injectable

200mg/1mg/mL

10mL Vial

Testosterone Enanthate In Grapeseed Oil

Injectable

200mg/mL

10mL Vial

Testosterone Propionate

Injectable

100mg/mL

10mL Vial

Injectable

200mg/mL

10mL Vial

Injectable

250mg/mL

10mL Vial

Tri-Test (50% Cyp/37.5% Enan/12.5% Prop)

Injectable

200mg/mL

10mL Vial

Depo® Testosterone (Commercial Product)

Injectable

200mg/mL

10mL Vial

Ultra-Test (80% Cypionate/20% Propionate)

Published 5/17/2016. Prices subject to change

10mL Vial

WPN-4800-05172016

BHRT Sterile Implantable Pellets List

800.622.4510 | www.wellsrx.com

BHRT Sterile Implantable Pellets Medication

Form

Strength

Pellet Size (mm)

DHEA

Pellet

25mg

(3mm)

3mg

(3mm)

6mg

(3mm)

10mg

(3mm)

12.5mg

(3mm)

15mg

(3mm)

18mg

(3mm)

20mg

(3mm)

22mg

(3mm)

25mg

(3mm)

37.5mg

(3mm)

50mg

(3mm)

10mg

(3mm)

15mg

(3mm)

20mg

(3mm)

50mg

(3mm)

100mg

(3mm)

12.5mg

(3mm)

18mg

(3mm)

25mg

(3mm)

37.5mg

(3mm)

50mg

(3mm)

62.5mg

(3mm)

80mg

(3mm)

87.5mg

(3mm)

100mg

(3mm)

100mg

(4.5mm)

200mg

(4.5mm)

Estradiol

Estradiol/Estriol 50%/50%

Progesterone

Testosterone

Published 05/24/16. Prices subject to change.

Pellet

Pellet

Pellet

Pellet

WPN-4600-05242016

BHRT Sterile Implantable Pellets List

800.622.4510 | www.wellsrx.com

Medication

Testosterone/Anastrozole

Testosterone/Finasteride

Trocar Kit for Pellet Insertion

Published 05/24/16. Prices subject to change.

Form

Pellet

Pellet

Trocar

Strength

Pellet Size (mm)

60mg/4mg

(3mm)

200mg/9mg

(4.5mm)

200mg/20mg

(4.5mm)

60mg/6mg

(3mm)

Disposable Plastic Tip (3mm)

Each

Disposable Plastic Tip (4.5mm)

Each

Disposable Stainless Steel Tip (3mm & 4.5mm)

Each

Reusable - Titanium (3mm & 4.5mm)

Each

WPN-4600-05242016

Non-Sterile BHRT List

800.622.4510 | www.wellsrx.com

Non-Sterile BHRT (Bio-Identical Hormone Replacement Therapy) Medication & Form

Progesterone Capsules Please specify one of the following: - Progesterone in Olive Oil - Progesterone SR (Powder)

Progesterone (Retail Product) 1 Ingredient Capsule: Estriol (E3)/ Estradiol (E2)/DHEA/Testosterone/ Pregnenolone 2 Ingredient Capsule: Estriol (E3)/Estradiol (E2)/DHEA/ Testosterone/Pregnenolone

3 Ingredient Capsule: Estriol (E3)/ Estradiol (E2) / Progesterone/DHEA/ Testosterone/Pregnenolone 4 Ingredient Capsule: Estriol (E3)/Estradiol (E2)/ Estrone (E1)/Progesterone/DHEA/ Testosterone/Pregnenolone Topical / Vaginal Female Cream/Gel (Tier 1) -up to and including: Estriol(E3)/ Estradiol(E2)/Estrone(E1) 1.5mg/mL ea / Progesterone 40mg/mL / Testosterone 5mg/mL / DHEA 5mg/mL / Pregnenolone 20mg/mL (Includes Vaginal Applicator)

Published 5/24/2016. Prices subject to change

Strength

#30 QTY

#60 QTY

#90 QTY

#180 QTY

Min Price

25mg

3

3

3

3

3

50mg

3

3

3

3

3

75mg

3

3

3

3

3

100mg

3

3

3

3

3

125mg

3

3

3

3

3

150mg

3

3

3

3

3

175mg

3

3

3

3

3

200mg

3

3

3

3

3

100mg & 200mg

Call For Pricing

1 Ingredient (≤20mg)

3

3

3

3

3

1 Ingredient (>20mg)

3

3

3

3

3

2 Ingredients (≤20mg)

3

3

3

3

3

2 Ingredients (>20mg)

3

3

3

3

3

3 Ingredients (≤2.5mg/100mg/25mg)

3

3

3

3

3

3 Ingredients (>2.5mg/100mg/25mg)

3

3

3

3

3

4 Ingredients (≤1.25/100/5mg)

3

3

3

3

3

4 Ingredients (>1.25/100/5mg)

3

3

3

3

3

1 Ingredient

3

3

3

3

2 Ingredients

3

3

3

3

3 Ingredients

3

3

3

3

4 Ingredients

3

3

3

3

5 Ingredients

3

3

3

3

WPN-5000-05242016

Non-Sterile BHRT List

800.622.4510 | www.wellsrx.com

Medication & Form Topical/Vaginal Female Cream/Gel (Tier 2) - greater than and including: Estriol(E3)/Estradiol(E2)/Estrone(E1) 1.6mg/mL ea/ Progesterone 41mg/mL/ Testosterone 25mg/mL/ DHEA 6mg/ mL/ Pregnenolone 21mg/mL (Includes Vaginal Applicator)

Mini-Inserts (Vaginal) Estriol/Estradiol ≤1.5mg /Progesterone ≤40mg/ Testosterone ≤20mg / DHEA ≤10mg / Pregnenolone ≤20mg

Mini-Troches (Oral): Estriol/Estradiol ≤1.5mg/Progesterone ≤40mg/Testosterone ≤20mg/ DHEA ≤10mg/Pregnenolone ≤20mg

Testosterone Cream/Gel

Testosterone Troches (Oral)

Strength

#30 QTY

#60 QTY

#90 QTY

#180 QTY

Min Price

1 Ingredient

3

3

3

3

2 Ingredients

3

3

3

3

3 Ingredients

3

3

3

3

4 Ingredients

3

3

3

3

5 Ingredients

3

3

3

3

MINI - 1 Ingredient

3

3

3

3

3

MINI - 2 Ingredients

3

3

3

3

3

MINI - 3 Ingredients

3

3

3

3

3

MINI - 4 Ingredients

3

3

3

3

3

MINI - 1 Ingredient

3

3

3

3

3

MINI - 2 Ingredients

3

3

3

3

3

MINI - 3 Ingredients

3

3

3

3

3

MINI - 4 Ingredients

3

3

3

3

3

26-50mg/mL (2.6%-5%)

3

3

3

3

51-100mg/mL (5.1%-10%)

3

3

3

3

101-200mg/mL (10.1%-20%)

3

3

3

3

20mg-100mg

3

3

3

3

101mg-200mg

3

3

3

3

Troches are scored, Mini-Troches are single dose

BHRT Topical Creams are Dispensed in Topi-Clicks. Pumps or syringes are available upon request

Published 5/24/2016. Prices subject to change

WPN-5000-05242016

Male & Female Sexual Health List

800.622.4510 | www.wellsrx.com

Sexual Health - Male & Female Medication

Form

Strength

Package Size

Troche

6mg

Per Troche

50iu/100mg

Per Tablet

125iu/100mg

Per Tablet

50iu/100mg

Per Troche

125iu/100mg

Per Troche

125iu/25mg

Per Tablet

125iu/20mg

Per Troche

125iu/25mg

Per Troche

100mg/10mg

Per Troche

5mg/10mg

Per Mini-Troche

10mg/10mg

Per Mini-Troche

Male - Oral/Sublingual Preparations Apomorphine *Must Ship Cold* Oxytocin/Sildenafil

Chewable Tablet

Oxytocin/Sildenafil *Must Ship Cold*

Troche

Oxytocin/Tadalafil

Chewable Tablet

Oxytocin/Tadalafil *Must Ship Cold*

Troche

Sildenafil/Testosterone *Must Ship Cold*

Troche

Tadalafil/Testosterone *Must Ship Cold*

Mini-Troche

Male Sexual Wellness Kit

Call for Availability and Pricing Troches are scored, Mini-Troches are single dose

Male - Injectable Preparations Alprostadil (Prostaglandin, PGE1) *Must Ship Cold*

Injectable

Arginine/Carnitine/Citrulline/Lidocaine

Injectable

Bimix (Papaverine/Phentolamine)

Injectable

Published 05/16/16. Prices subject to change.

20mcg/mL

10mL Vial

40mcg/mL

10mL Vial

100mg/100mg/100mg/10mg/mL

10mL Vial

30mg/1mg/mL

5mL Vial

30mg/1mg/mL

10mL Vial

WPN-5200-05162016

Male & Female Sexual Health List

800.622.4510 | www.wellsrx.com

Medication

Form

Strength

Package Size 2mL Vial

Injectable

17.65mg/0.59mg/5.9mcg

5mL Vial 10mL Vial 2mL Vial

Trimix (Papaverine/Phentolamine/Alprostadil) *Must Ship Cold*

Injectable

30mg/1mg/10mcg/mL

5mL Vial 10mL Vial 2mL Vial

Injectable

30mg/3mg/60mcg/mL

5mL Vial 10mL Vial

Phenylephrine (Rescue Vial) (Commercial Product)

Injectable

Male Sexual Wellness Kit

10mg/mL

1mL Vial

Call for Availability and Pricing

Female - Vaginal/Oral/Nasal Spray Preparations Aminophylline/Arginine

Gel

Oxytocin *Must Ship Cold*

Mini-Troche

Oxytocin *Must Ship Cold*

Nasal Spray

3%/6%

15mL

50iu

Per Mini-Troche

250iu

Per Mini-Troche

10iu/Spray 60iu/Spray

15mL Bottle (#180 Sprays)

Sildenafil/Aminophylline/Arginine

Cream

2%/3%/6%

15mL

Sildenafil/Aminophylline/Arginine/Testosterone

Cream

2%/3%/6%/0.1%

15mL

Vitamin E

Cream

200iu/mL

15mL

Female Sexual Wellness Kit

Call for Availability and Pricing

For additional female preparations, please see (Non-Sterile BHRT Formulary)

Published 05/16/16. Prices subject to change.

WPN-5200-05162016

Weight Management, Lipotropics, Vitamin List

800.622.4510 | www.wellsrx.com

Weight Management/Lipotropics/Vitamin Therapies Medication

Form

Strength

Package Size

Capsule

75mg/75mg/75mg/75mg

Per Capsule

200iu

Per Tablet

300iu

Per Tablet

500iu

Per Tablet

Rapid Dissolve Mini-Tablet

500iu/300mcg

Per Tablet

Sublingual Drops

11,562.5iu

Per Vial

MIC + Chromium

Tablet

50mg/100mg/5mg/50mcg

Per Tablet

Methylcobalamin/Pyridoxine/Folic Acid

Tablet

2mg/25mg/2.5mg

Per Tablet

Phendimetrazine (Commercial Product)

Tablet

35mg

Per Tablet

Phentermine HCL (Commercial Product)

Tablet

37.5mg

Per Tablet

Arginine-L

Injectable

100mg/mL

30mL Vial

Carnitine-L

Injectable

250mg/mL

30mL Vial

B-Complex (B2, B3, B6, B12(C)) + Vitamin C

Injectable

2mg/20mg/2mg/ 300mcg + 20mg/mL

30mL Vial

Cyanocobalamin (B12) (Commercial Product)

Injectable

1,000mcg/mL

10mL Vial

Injectable

1,000mcg/mL

30mL Vial

GAC (Glutamine/Arginine/Carnitine)

Injectable

25mg/100mg/200mg/mL

30mL Vial

GOAL (Glutamine/Ornithine/Arginine/Lysine) + Lidocaine

Injectable

75mg/75mg/150mg/ 150mg/mL + 10mg/mL

30mL Vial

Glutathione-L *Must Ship Cold*

Injectable

200mg/mL

30mL Vial

Oral/Sublingual Preparations GOAL (Glutamine/Ornithine/Arginine/Lysine)

hCG

hCG + B12(M) hCG (Diluent/Dropper included)

Rapid Dissolve Mini-Tablet

Injectable Preparations

Published 5/17/2016. Prices subject to change

WPN-4100-05172016

Weight Management, Lipotropics, Vitamin List

800.622.4510 | www.wellsrx.com

Medication

hCG Lyophilized Vial

hCG + B12(C), Lyophilized Vial

Form

Strength

Package Size

Injectable

3,500iu

Per Kit*

Injectable

5,000iu

Per Kit*

Injectable

6,000iu

Per Kit*

Injectable

7,500iu

Per Kit*

Injectable

11,000iu

Per Kit*

Injectable

20,000iu

Per Kit*

Injectable

10,000iu + 40mcg

Per Kit*

*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately) Injectable

1,000mcg/mL

10mL Vial

Injectable

1,000mcg/mL

30mL Vial

Injectable

5,000mcg/mL

10mL Vial

MIC Combo Standard

Injectable

15mg/50mg/100mg/mL

30mL Vial

MIC/B12(M)

Injectable

15mg/50mg/100mg/mL + 1000mcg/mL

30mL Vial

MIC/Chromium/B12(M)

Injectable

25mg/50mg/50mg/ 25mcg/1mg/mL

10mL Vial

MIC/B-Complex (B2, B3, B6, B12(M))

Injectable

15mg/50mg/100mg/2.5mg/ 0.4mg/2.5mg/0.25mg/mL

30mL Vial

MIC/B12(M) + Carnitine

Injectable

12.5mg/50mg/100mg/ 1mg/mL+ 50mg/mL

30mL Vial

MIC/B-Complex (B2, B3, B6, B12(M)) + Carnitine + Lidocaine

Injectable

15mg/30mg/30mg/0.5mg/ 20mg/20mg/0.5mg/mL + 85mg/mL + 20mg/mL

30mL Vial

MIC/B-Complex (B1, B2, B6) + Carnitine + Arginine + Chromium + Lidocaine

Injectable

12.5mg/25mg/25mg/30mg/ 2mg/2mg/25mg/12.5mg/ 0.2mg/20mg/mL

MIC/B-Complex (B2, B3, B5, B12(M)) + Chromium + Carnitine

Injectable

20mg/40mg/50mg/5mg/33mg/ 2mg/1mg/25mcg/25mg/mL

Methylcobalamin (B12)

Published 5/17/2016. Prices subject to change

10mL Vial 30mL Vial 30mL Vial

WPN-4100-05172016

Weight Management, Lipotropics, Vitamin List

800.622.4510 | www.wellsrx.com

Medication IC/B-Complex (B1, B2, B3, B5, B6, B12(C)) + Leucine + Carnitine + Chromium + Lidocaine Vitamin D3 in Sesame Oil

Form

Strength

Package Size

Injectable

25mg/25mg/5mg/2.5mg/ 25mg/5mg/5mg/0.1mg/ 1.5mg/25mg/25mcg/10mg/mL

30mL Vial

Injectable

50,000iu/mL

5mL Vial

Injectable

100,000iu/mL

5mL Vial

B12 Abbreviations - (C)=Cyanocobalamin (M)=Methylcobalamin, (H)=Hydroxocobalamin

Published 5/17/2016. Prices subject to change

WPN-4100-05172016

Syringes, Needles, Misc. List

800.622.4510 | www.wellsrx.com

Syringes/Needles/Miscellaneous Device

Form

Size

Package Size

Syringe w/Needle

28g x 1/2” 0.5mL

Pack of 10

Syringe w/Needle

29g x 1/2” 0.5mL

Pack of 10

Syringe w/Needle

29g x 1/2” 1mL

Pack of 10

Syringe w/Needle

30g x 1/2” 1mL

Pack of 10

Syringe w/Needle

30g x 5/16” 0.5mL

Pack of 10

Syringe w/Needle

30g x 5/16” 0.3mL

Pack of 10

Syringe w/Needle

30g x 5/16” 1mL

Pack of 10

Syringe w/Needle

31g x 5/16” 0.5mL

Pack of 10

Syringe w/Needle

31g x 5/16” 1mL

Pack of 10

Syringe w/Needle

Special Request

Pack of 10

Syringe w/Needle

18g x 1.5” 3mL

Each

Syringe w/Needle

20g x 1” 3mL

Each

Syringe w/Needle

20g x 1.5” 3mL

Each

Syringe w/Needle

21g x 1” 3mL

Each

Syringe w/Needle

22g x 1” 3mL

Each

Syringe w/Needle

22g x 1.5” 3mL

Each

Syringe w/Needle

23g x 1” 3mL

Each

Syringe w/Needle

23g x 1.5” 3mL

Each

Syringe w/Needle

25g x 1” 3mL

Each

Insulin / Subcutaneous Syringes

Insulin Syringe (SureComfort or UltiCare)

BD Brand Insulin Syringes

Intramuscular Syringes

BD IM Syringes

Published 05/13/16. Prices subject to change.

WPN-5400-05132016

Syringes, Needles, Misc. List

800.622.4510 | www.wellsrx.com

Device

Form

Size

Package Size

Needle

16g x 1”

Each

Needle

18g x 1”

Each

Needle

18g x 1.5”

Each

Needle

20g x 1”

Each

Needle

20g x 1.5”

Each

Needle

21g x 1”

Each

Needle

21g x 1.5”

Each

Needle

22g x 1”

Each

Needle

22g x 1.5”

Each

Needle

23g x 1”

Each

Needle

23g x 1.5”

Each

Needle

25g x 5/8”

Each

Needle

25g x 1”

Each

Needle

25g x 1.5”

Each

Needle

27g x 0.5”

Each

Needle

27g x 1.25”

Each

Syringe w/o Needle

1mL

Each

Syringe w/o Needle

3mL

Each

Syringe w/o Needle

5mL

Each

Syringe w/o Needle

10mL

Each

Prep Pads

Prep Pads

#100 Pads

1.4qt

Sharps

Each

Needles

BD Needle

Miscellaneous

BD Luer-Lok™

Alcohol Prep Pads BD - Sharps Container

Published 05/13/16. Prices subject to change.

WPN-5400-05132016