Preferred Drug List Effective December 1, 2016
This Preferred Drug List is a list of medicines that are covered by your pharmacy benefit. The list includes prescription and non-prescription medicines. In addition to this list, you can use our online search tool. You’ll also find the Preferred Drug List Quick Reference on our website at mibluecrosscomplete.com. This is an easy-to-use summary of the medicines we cover. If you have questions, please contact Blue Cross Complete of Michigan Pharmacy Services at 1-888-288-3231. You can call this number from 8:30 a.m. until 6 p.m., Monday through Friday.
Blue Cross Complete participates in the Michigan Common Formulary PH-06/Rev06/16/2016
Drug Alternative Therapy Alternative Therapy - Antiarthritics Glucoten
Status
Notes
F
OTC
50+ Adult Eye Health
F
OTC
Antioxidant
F
OTC
Antioxidant A/C/E/Selenium
F
OTC
Antioxidant Formula (selenium)
F
OTC
Antioxidant Vitamins oral tablet 1,000 unit-200 mg-60 unit-2 mg
F
OTC
E-400 C-500 and Beta Carotene
F
OTC
Healthy Eyes
F
OTC
Healthy Eyes SuperVision
F
OTC
ICaps AREDS
F
OTC
I-Vite
F
OTC
I-Vite Protect
F
OTC
Macuvite With Lutein
F
OTC
Multi-Betic
F
OTC
Ocuvite
F
OTC
Ocuvite Lutein and Zeaxanthin
F
OTC
Ocuvite with Lutein
F
OTC
Opti-Vitamins
F
OTC
PreserVision AREDS
F
OTC
PreserVision AREDS 2
F
OTC
Prosight
F
OTC
SAVision
F
OTC
Super Antioxidant
F
OTC
Vision Formula (with lutein)
F
OTC
Vision-Vite + Zinc
F
OTC
Kelp-Lecithin-B6
F
OTC
Lecithin-Kelp-B6
F
OTC
L-Methyl-MC NAC AL = Age Limit PA = Prior Authorization
F
OTC OTC = Over The Counter ST = Step Therapy
Alternative Therapy - Antioxidant
Alternative Therapy - Unclassified
F = Formulary QL = Quantity Limit
Reviewed and Updated December 2016 1
Drug
Status
Notes
Memory Complex
F
OTC
Men’s Potent Formula
F
OTC
Metafolbic Plus
F
OTC
Mg-Plus-Protein
F
OTC
codeine sulfate oral tablet
F
QL
fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr
F
PA; QL
hydromorphone oral liquid
F
QL
hydromorphone oral tablet 2 mg, 4 mg
F
QL
hydromorphone rectal
F
QL
meperidine oral solution
F
QL; AL
meperidine oral tablet
F
QL; AL
methadone oral concentrate
F
QL
methadone oral solution 10 mg/5 mL, 5 mg/5 mL
F
QL
methadone oral tablet
F
QL
methadone oral tablet, soluble
F
QL
morphine concentrate oral solution
F
QL
morphine oral solution
F
QL
morphine oral tablet
F
QL
morphine oral tablet extended release
F
QL
oxycodone oral solution
F
QL
oxycodone oral tablet 5 mg
F
QL
tramadol oral tablet
F
QL
Analgesic, Anti-Inflammatory or Antipyretic Analgesic Narcotic Agonists
Analgesic Narcotic Codeine Combinations acetaminophen-codeine oral solution 120 mg-12 mg /5 mL (5 mL), 300 mg-30 mg /12.5 mL
F
acetaminophen-codeine oral solution 120-12 mg/5 mL
F
acetaminophen-codeine oral tablet
F
Butalbital Compound W/Codeine
F
butalbital-acetaminop-caf-cod oral capsule 50325-40-30 mg
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
QL
QL
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 2
Drug
Status
codeine-butalbital-ASA-caff
Notes
F
Analgesic Narcotic Hydrocodone and Non-Salicylate Combinations hydrocodone-acetaminophen oral solution 7.5325 mg/15 mL
F
QL
hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg
F
QL
F
QL
hydrocodone-acetaminophen oral solution 7.5325 mg/15 mL
F
QL
hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg
F
QL
hydrocodone-ibuprofen oral tablet 5-200 mg, 7.5200 mg
F
QL
F
QL
F
QL
F
QL
Acephen rectal suppository 325 mg
F
OTC
acetaminophen oral drops, suspension
F
OTC
acetaminophen oral elixir
F
OTC
acetaminophen oral liquid 160 mg/5 mL
F
OTC
acetaminophen oral solution
F
OTC
acetaminophen oral suspension 160 mg/5 mL
F
OTC; QL
Analgesic Narcotic Hydrocodone and NSAID Combinations hydrocodone-ibuprofen oral tablet 5-200 mg, 7.5200 mg
Analgesic Narcotic Hydrocodone Combinations
Analgesic Narcotic Oxycodone and NonSalicylate Combinations oxycodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg
Analgesic Narcotic Oxycodone Combinations oxycodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg
Analgesic Narcotic Partial-Mixed Agonists pentazocine-naloxone
Analgesic or Antipyretic Non-Narcotic
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 3
Drug
Status
Notes
acetaminophen oral tablet
F
OTC
acetaminophen oral tablet extended release
F
OTC
acetaminophen oral tablet, chewable
F
OTC
acetaminophen rectal
F
OTC
Children's Acetaminophen oral suspension 160 mg/5 mL (5 mL)
F
OTC
Feverall rectal suppository 325 mg
F
OTC
Infant's Non-Aspirin oral drops
F
OTC
Mapap (acetaminophen) oral capsule
F
OTC
Pain Reliever oral capsule
F
OTC
Q-PAP oral drops
F
OTC
butalbital-acetaminophen
F
AL
butalbital-acetaminophen-caff oral capsule 50325-40 mg
F
AL
butalbital-acetaminophen-caff oral tablet 50-32540 mg
F
AL
Enbrel subcutaneous recon soln
F
PA; QL
Enbrel subcutaneous syringe 25 mg/0.5mL (0.51), 50 mg/mL (0.98 mL)
F
PA; QL
Enbrel SureClick
F
PA; QL
Humira Pediatric Crohn's Start
F
PA; QL
Humira Pen
F
PA; QL
Humira Pen Crohn's-UC-HS Start
F
PA; QL
Humira Pen Psoriasis-Uveitis
F
PA; QL
Humira subcutaneous syringe kit 10 mg/0.2 mL, 20 mg/0.4 mL, 40 mg/0.8 mL
F
PA; QL
Analgesic or Antipyretic NonNarcotic/Sedative Combinations
Anti-Inflammatory Tumor Necrosis Factor Inhibiting Agents, Non-Selective
Anti-Inflammatory Tumor Necrosis Factor Inhibiting Agents, TNF-Alpha Selective
DMARD - Antimalarials hydroxychloroquine oral
F
DMARD - Antimetabolites AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 4
Drug
Status
methotrexate sodium oral
Notes
F
DMARD - Immunosuppressives azathioprine
F
QL
cyclophosphamide oral capsule
F
PA
cyclosporine modified oral capsule
F
cyclosporine modified oral solution
F
cyclosporine oral capsule
F
mycophenolate mofetil oral capsule
F
mycophenolate mofetil oral suspension for reconstitution
F
mycophenolate mofetil oral tablet
F
AL
AL
DMARD - Other minocycline oral capsule
F
sulfasalazine
F
DMARD - Pyrimidine Synthesis Inhibitors leflunomide
F
QL
F
PA; QL
ketorolac oral
F
AL
nabumetone
F
QL
sulindac oral
F
NSAID Analgesic, Cyclooxygenase-2 (COX-2) Selective Inhibitors celecoxib
NSAID Analgesics (COX Non-Specific) Other
NSAID Analgesics (COX Non-Specific) Oxicam Derivatives meloxicam oral tablet
F
piroxicam
F
QL
NSAID Analgesics (COX Non-Specific) Phenylacetic Acid Derivatives diclofenac sodium oral
F
NSAID Analgesics (COX Non-Specific) Propionic Acid Derivatives fenoprofen oral tablet AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 5
Drug
Status
Notes
flurbiprofen oral tablet 50 mg
F
Ibuprofen IB oral tablet, chewable
F
OTC
Ibuprofen Jr Strength
F
OTC
ibuprofen oral capsule
F
OTC; QL
ibuprofen oral drops, suspension
F
OTC
ibuprofen oral suspension
F
OTC; QL
ibuprofen oral tablet 100 mg, 200 mg
F
OTC
ibuprofen oral tablet 400 mg, 600 mg, 800 mg
F
ketoprofen oral capsule
F
naproxen
F
naproxen sodium oral capsule
F
OTC
naproxen sodium oral tablet 220 mg
F
OTC; QL
F
AL
F
QL; AL
NSAID Analgesics, (Cox Non-Specific) Indole Acetic Acid Derivatives indomethacin oral
Salicylate Analgesic and Sedative Combinations butalbital-aspirin-caffeine oral capsule
Salicylate Analgesic Combinations choline, magnesium salicylate
F
Salicylate Analgesics aspirin oral tablet
F
OTC; QL; AL
aspirin oral tablet, chewable
F
OTC; QL; AL
aspirin oral tablet, delayed release (DR/EC) 325 mg, 81 mg
F
OTC; QL; AL
aspirin rectal
F
OTC
F
OTC; AL
Salicylate Analgesics, Buffered aspirin, buffered
Anorectal Preparations Anorectal - Glucocorticoids hydrocortisone acetate rectal suppository 30 mg
F
Anorectal - Hemorrhoidal Rectal Glucocorticoid-Local Anesthetic Comb hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 % AL = Age Limit PA = Prior Authorization
F
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 6
Drug Antidotes and Other Reversal Agents Antidote - Acetaminophen Poisoning acetylcysteine
Status
Notes
F
Chelating Agents - Lead Poisoning Chemet
F
Opiate/Narcotic Reversal Agents Opiate Antagonists naloxone injection solution
F
QL
naloxone injection syringe 0.4 mg/mL, 1 mg/mL
F
QL
Narcan
F
QL
Anti-Infective Agents Amebicides paromomycin
F
Aminoglycoside Antibiotic neomycin
F
Aminopenicillin Antibiotic amoxicillin oral capsule
F
amoxicillin oral suspension for reconstitution
F
amoxicillin oral tablet
F
amoxicillin oral tablet, chewable 125 mg, 250 mg
F
ampicillin oral capsule
F
ampicillin oral suspension for reconstitution
F
AL
amoxicillin-pot clavulanate oral suspension for reconstitution
F
AL
amoxicillin-pot clavulanate oral tablet
F
amoxicillin-pot clavulanate oral tablet extended release 12 hr
F
amoxicillin-pot clavulanate oral tablet, chewable
F
AL AL
Aminopenicillin Antibiotic - BetaLactamase Inhibitor Combinations
AL
Antibacterial Folate Antagonist - Other Combinations sulfamethoxazole-trimethoprim oral tablet
F
sulfamethoxazole-trimethoprim oral susp
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 7
Drug Antibacterial Folate Antagonist Others trimethoprim
Status
Notes
F
Antifungal - Allylamines terbinafine HCl oral
F
QL
Antifungal - Amphoteric Polyene Macrolides nystatin oral tablet
F
Antifungal - Imidazoles ketoconazole oral
F
QL
fluconazole oral suspension for reconstitution
F
AL
fluconazole oral tablet
F
itraconazole
F
Antifungal - Triazoles
Antifungal Other griseofulvin microsize
F
griseofulvin ultramicrosize
F
Antileprotic - Sulfone Agents dapsone
F
Antimalarials chloroquine phosphate oral Daraprim
F
QL
Specialty
PA
hydroxychloroquine oral
F
mefloquine
F
primaquine
F
PA
Antiprotozoal Agents - Other atovaquone
F
PA
Antiprotozoal-Antibacterial 1st Generation 2-Methyl-5-Nitroimidazole metronidazole oral tablet
F
Antiprotozoal-Antibacterial 2nd Generation 2-Methyl-5-Nitroimidazole tinidazole
F
Antitubercular - D-Alanine Analogs cycloserine AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 8
Drug Antitubercular - Isonicotinic Acid Derivatives
Status
isoniazid oral
Notes
F
Antitubercular - Niacinamide Derivatives pyrazinamide
F
Antitubercular - Rifamycin and Derivatives rifabutin
F
rifampin oral
F
Antitubercular Agents Other ethambutol
F
Trecator
F
Cephalosporin Antibiotics – 1st Generation cefadroxil oral capsule
F
cefadroxil oral suspension for reconstitution 250 mg/5 mL, 500 mg/5 mL
F
cefadroxil oral tablet
F
cephalexin oral capsule 250 mg, 500 mg
F
cephalexin oral suspension for reconstitution
F
AL
AL
Cephalosporin Antibiotics – 2nd Generation cefaclor oral capsule
F
cefaclor oral suspension for reconstitution 125 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL
F
AL
cefprozil oral suspension for reconstitution
F
AL
cefprozil oral tablet
F
cefuroxime axetil oral tablet
F
Cephalosporin Antibiotics – 3rd Generation cefdinir oral capsule
F
cefdinir oral suspension for reconstitution
F
AL
cefixime
F
AL
cefpodoxime oral suspension for reconstitution
F
AL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 9
Drug
Status
Notes
cefpodoxime oral tablet
F
Suprax oral capsule
F
Suprax oral suspension for reconstitution 500 mg/5 mL
F
AL
F
PA; QL
ciprofloxacin
F
AL
ciprofloxacin HCl oral
F
levofloxacin oral solution
F
levofloxacin oral tablet
F
moxifloxacin
F
ofloxacin oral tablet 400 mg
F
CMV Antiviral Agent - Nucleoside Analogs valganciclovir oral tablet
Fluoroquinolone Antibiotics
QL
Glycopeptide Antibiotics vancomycin intravenous
Specialty
vancomycin oral
F
Hepatitis B Treatment- Nucleoside Analogs (Antiviral) entecavir
F
lamivudine oral tablet 100 mg
F
Hepatitis B Treatment- Nucleotide Analogs (Antiviral) adefovir
Specialty
Herpes Antiviral Agent - Purine Analogs acyclovir oral capsule
F
QL
acyclovir oral suspension 200 mg/5 mL
F
AL
acyclovir oral tablet 400 mg, 800 mg
F
QL
valacyclovir oral tablet 1 gram, 500 mg
F
QL
F
QL
Herpes Antiviral Agent - Thymidine Analogs famciclovir
Influenza Antiviral Agents Neuraminidase Inhibitors AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 10
Drug
Status
Notes
Relenza Diskhaler
F
QL; AL
Tamiflu oral capsule
F
QL
Tamiflu oral suspension for reconstitution
F
QL; AL
Influenza-A Antiviral Agents rimantadine
F
Lincosamide Antibiotics clindamycin HCl
F
clindamycin palmitate HCl
F
AL
azithromycin oral packet
F
QL
azithromycin oral suspension for reconstitution
F
AL
azithromycin oral tablet
F
clarithromycin oral suspension for reconstitution
F
clarithromycin oral tablet
F
E.E.S. Granules
F
erythromycin ethylsuccinate oral tablet
F
erythromycin oral capsule, delayed release(DR/EC)
F
erythromycin oral tablet
F
Macrolides
AL QL; AL
Oxazolidinone Antibiotics linezolid oral
F
PA
penicillin V potassium oral recon soln
F
AL
penicillin V potassium oral tablet
F
Penicillin Antibiotic - Natural
Penicillin Antibiotic - PenicillinaseResistant dicloxacillin
F
Rifamycins and Related Derivative Antibiotics rifabutin
F
rifampin oral
F
Tetracycline Antibiotics doxycycline hyclate oral capsule
F
doxycycline hyclate oral tablet 100 mg
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 11
Drug
Status
doxycycline monohydrate oral capsule
F
doxycycline monohydrate oral suspension for reconstitution
F
minocycline oral capsule
F
tetracycline
F
Notes AL
AL
Antineoplastics Antineoplastic - CYP17 (17 AlphaHydroxylase/C17,20-Lyase) Inhibitor Zytiga
Specialty
PA; QL
Antineoplastic - Alkylating Agent Alkyl Sulfonates Myleran
F
PA
F
PA
F
PA
Alkeran oral
F
PA
cyclophosphamide oral capsule
F
PA
Leukeran
F
PA
F
PA
Specialty
PA
F
PA
bicalutamide
F
PA
flutamide
F
PA
nilutamide
Specialty
PA
Antineoplastic - Alkylating Agent Ethylenimines and Methylmelamines Hexalen
Antineoplastic - Alkylating Agent Methylhydrazines Matulane
Antineoplastic - Alkylating Agent Nitrogen Mustards
Antineoplastic - Alkylating Agent Nitrosoureas Lomustine oral capsule 10 mg, 100 mg, 40 mg
Antineoplastic - Alkylating Agent Triazenes temozolomide
Antineoplastic - Antiadrenals Lysodren
Antineoplastic - Antiandrogens
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 12
Drug
Status
Notes
Xtandi
Specialty
PA; QL
Zytiga
Specialty
PA; QL
Antineoplastic - Antimetabolite - Folic Acid Analogs methotrexate sodium
F
methotrexate sodium (PF) injection solution
F
Antineoplastic - Antimetabolite - Purine Analogs mercaptopurine
F
Tabloid
F
PA
F
PA
Antineoplastic - Antimetabolite Pyrimidine Analogs capecitabine
Antineoplastic - Antimetabolite - Urea Derivatives hydroxyurea
F
Antineoplastic - Aromatase Inhibitors anastrozole
F
exemestane
F
letrozole
F
QL; AL
Antineoplastic - Epipodophyllotoxins etoposide oral
Specialty
PA
F
PA
Antineoplastic - Estrogens Emcyt
Antineoplastic - Hedgehog Pathway Inhibitor Erivedge
Specialty
PA; QL
Antineoplastic - Histone Deacetylase (HDAC) Inhibitors Farydak
F
PA
Zolinza
Specialty
PA
Specialty
PA
Antineoplastic - Interferons Intron A injection
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 13
Drug Antineoplastic - Janus Kinase (JAK) Inhibitors Jakafi
Status
Notes
Specialty
PA; QL
Antineoplastic - LHRH (GnRH) Agonist Analog Pituitary Suppressants leuprolide subcutaneous kit
F
PA
Antineoplastic - mTOR Kinase Inhibitors Afinitor Disperz
Specialty
PA; QL
Afinitor oral tablet 10 mg, 2.5 mg, 5 mg
Specialty
PA; QL
Afinitor oral tablet 7.5 mg
Specialty
PA
Antineoplastic - Progestins megestrol oral tablet
F
Antineoplastic - Retinoids tretinoin (chemotherapy)
Specialty
PA
Fareston
F
PA
tamoxifen
F
QL
Specialty
PA
Pomalyst
Specialty
PA
Revlimid oral capsule 10 mg, 15 mg, 25 mg, 5 mg
Specialty
PA; QL
Revlimid oral capsule 2.5 mg, 20 mg
Specialty
PA
Specialty
PA
Antineoplastic - Selective Estrogen Receptor Modulators (SERMs)
Antineoplastic - Selective Retinoid X Receptor Agonists Targretin oral
Antineoplastic - Thalidomide Analogs
Antineoplastic - Topoisomerase I Inhibitors Hycamtin oral
Methotrexate Rescue Agents leucovorin calcium oral
F
Methotrexate Rescue Agents - Folic Acid Antagonist Type leucovorin calcium oral AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 14
Drug Urinary Tract Protective Agents Used In Conjunction with Chemotherapy Mesnex oral
Status
Notes
F
PA
Alcohol Prep Pads
F
OTC
Alcohol Wipes
F
OTC
F
PA
Afluria 2016-2017
F
QL; AL
Afluria 2016-2017 (PF)
F
QL; AL
Flucelvax Quad 2016-2017 (PF)
F
QL; AL
Flulaval Quad 2016-2017
F
QL; AL
Flulaval Quad 2016-2017 (PF)
F
QL; AL
Fluvirin 2016-2017
F
QL; AL
Fluvirin 2016-2017 (PF)
F
QL; AL
Fluzone High-Dose 2016-17 (PF)
F
QL; AL
Fluzone Quad 2016-2017
F
QL; AL
Fluzone Quad 2016-2017 (PF) intramuscular suspension
F
QL; AL
F
QL
Antiseptics and Disinfectants Antiseptic - Alcohols
Biologicals Antiviral Monoclonal Antibodies Synagis
Vaccine Viral - Influenza A and B
Cardiovascular Therapy Agents ACE Inhibitor and Calcium Channel Blocker Combinations amlodipine-benazepril
ACE Inhibitor and Diuretic Combinations benazepril-hydrochlorothiazide
F
captopril-hydrochlorothiazide
F
enalapril-hydrochlorothiazide
F
QL
lisinopril-hydrochlorothiazide
F
QL
quinapril-hydrochlorothiazide
F
ACE Inhibitors AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 15
Drug
Status
Notes
benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg
F
QL
captopril
F
enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg
F
QL
Epaned
F
AL
fosinopril oral tablet 10 mg, 20 mg, 40 mg
F
QL
lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg
F
QL
perindopril erbumine oral tablet 2 mg, 4 mg
F
QL
quinapril
F
QL
ramipril
F
QL
trandolapril
F
QL
Aldosterone Receptor Antagonists spironolactone
F
Alpha-Beta Blockers carvedilol
F
labetalol oral
F
Angiotensin II Receptor Blocker (ARB)Calcium Channel Blocker Comb. amlodipine-valsartan
F
Angiotensin II Receptor Blocker (ARB)Diuretic Combinations irbesartan-hydrochlorothiazide
F
QL
losartan-hydrochlorothiazide
F
QL
valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 80-12.5 mg
F
Angiotensin II Receptor BlockerNeprilysin Inhibitor Comb. (ARNI) Entresto
F
PA; QL; AL
irbesartan
F
QL
losartan
F
QL
valsartan
F
Angiotensin II Receptor Blockers (ARBs)
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 16
Drug Antianginal - Coronary Vasodilators (Nitrates)
Status
isosorbide dinitrate oral
F
isosorbide mononitrate oral tablet
F
isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg
F
Nitro-Bid
F
nitroglycerin sublingual tablet 0.4 mg
F
nitroglycerin transdermal patch 24 hour
F
nitroglycerin translingual spray, on-aerosol
F
Nitrolingual
F
Nitrostat
F
Nitro-Time
F
Notes
QL
QL
Antianginal and Anti-Ischemic Agents, Non-Hemodynamic Ranexa
F
Antiarrhythmic - Class Ia disopyramide phosphate oral capsule
F
quinidine sulfate oral tablet
F
AL
Antiarrhythmic - Class Ib mexiletine
F
Antiarrhythmic - Class Ic flecainide
F
propafenone oral tablet
F
Antiarrhythmic - Class II Sotalol AF
F
sotalol oral
F
QL
Antiarrhythmic - Class III amiodarone oral
F
Antiarrhythmic - Class IV verapamil oral tablet
F
Antihyperlipidemic - Bile Acid Sequestrants cholestyramine (with sugar) oral powder AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
QL OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 17
Drug
Status
cholestyramine (with sugar) oral powder in packet
F
Cholestyramine Light
F
Colestid oral granules
F
colestipol oral packet
F
colestipol oral tablet
F
Notes
Antihyperlipidemic - Fibric Acid Derivatives fenofibrate micronized oral capsule 130 mg, 43 mg
F
fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg
F
QL
fenofibrate nanocrystallized
F
QL
fenofibrate oral capsule
F
fenofibrate oral tablet 160 mg, 54 mg
F
fenofibric acid
F
fenofibric acid (choline)
F
QL
gemfibrozil oral
F
QL
atorvastatin
F
QL
fluvastatin oral capsule 20 mg, 40 mg
F
QL
lovastatin
F
QL
pravastatin
F
QL
simvastatin
F
QL
F
QL
F
PA; QL
F
PA
QL
Antihyperlipidemic - HMG CoA Reductase Inhibitors (Statins)
Antihyperlipidemic - Nicotinic Acid Derivatives niacin oral tablet extended release 24 hr 1,000 mg, 500 mg, 750 mg
Antihyperlipidemic - Selective Cholesterol Absorption Inhibitor Zetia
Antihyperlipidemic Agents - Dietary Source omega-3 acid ethyl esters
Antihyperlipidemic Agents - Dietary Source Combinations AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 18
Drug
Status
vitamin E oral capsule 100 unit, 400 unit
F
Notes OTC
Beta Blockers Cardiac Selective atenolol
F
betaxolol oral
F
bisoprolol fumarate oral tablet 10 mg, 5 mg
F
QL
metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg
F
QL
metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg
F
QL
Beta Blockers Cardiac Selective, Intrinsic Sympathomimetic Activity acebutolol
F
Beta Blockers Non-Cardiac Select., Intrinsic Sympathomimetic Activity pindolol
F
Beta Blockers Non-Cardiac Selective Hemangeol
F
nadolol
F
propranolol oral capsule, extended release 24 hr 120 mg, 160 mg, 60 mg, 80 mg
F
propranolol oral solution
F
propranolol oral tablet
F
Sotalol AF
F
sotalol oral
F
timolol maleate oral
F
AL
QL
QL
Calcium Channel Blockers Benzothiazepines diltiazem HCl oral capsule, extended release
F
QL
diltiazem HCl oral capsule, Ext release degradable
F
QL
diltiazem HCl oral capsule, extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg
F
QL
diltiazem HCl oral tablet 120 mg, 30 mg, 60 mg, 90 mg
F
QL
diltiazem HCl oral tablet extended release 24 hr 180 mg, 300 mg
F
QL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 19
Drug Calcium Channel Blockers Dihydropyridines
Status
Notes
amlodipine
F
QL
felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg
F
QL
isradipine
F
QL
nicardipine oral
F
QL
nifedipine oral capsule
F
QL; AL
nifedipine oral tablet extended release
F
QL
nifedipine oral tablet extended release 24hr
F
QL
F
QL
verapamil oral capsule, 24 hr ER pellet CT
F
QL
verapamil oral capsule, Ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg
F
QL
verapamil oral tablet
F
verapamil oral tablet extended release
F
Calcium Channel Blockers Dihydropyridines - Cerebrovascular Specific nimodipine
Calcium Channel Blockers Phenylakylamines
QL
Cardiac Selective Beta Blocker-Thiazide Diuretic And Related Comb. atenolol-chlorthalidone
F
bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg
F
QL
epinephrine injection auto-injector
F
QL
EpiPen 2-Pak
F
QL
EpiPen Jr 2-Pak
F
QL
F
QL
Cardiovascular Sympathomimetic Anaphylaxis Therapy Single Agents
Cardiovascular Sympathomimetics midodrine
Central Alpha-2 Agonists-Thiazide Diuretic and Related Comb. methyldopa-hydrochlorothiazide AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 20
Drug Central Alpha-2 Receptor Agonists
Status
Notes
clonidine
F
QL
clonidine HCl oral tablet
F
guanfacine oral tablet
F
QL
methyldopa
F
AL
Digitalis Glycosides digoxin oral tablet
F
Direct Acting Vasodilators hydralazine injection
F
hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg
F
minoxidil oral
F
QL
Diuretic - Aldosterone Receptor Antagonist, Non-Selective spironolactone
F
Diuretic - Carbonic Anhydrase Inhibitors acetazolamide
F
methazolamide oral
F
Diuretic - Loop bumetanide oral
F
furosemide oral solution 10 mg/mL, 40 mg/5 mL (8 mg/mL)
F
AL
furosemide oral tablet
F
QL
torsemide oral tablet 10 mg, 100 mg, 20 mg
F
QL
torsemide oral tablet 5 mg
F
Diuretic - Potassium Sparing amiloride
F
QL
amiloride-hydrochlorothiazide
F
QL
spironolactone-hydrochlorothiazide
F
QL
triamterene-hydrochlorothiazide
F
Diuretic - Potassium Sparing-Thiazide and Related Combinations
Diuretic - Thiazides and Related chlorothiazide AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 21
Drug
Status
Notes
chlorthalidone oral tablet 25 mg, 50 mg
F
QL
Diuril
F
AL
hydrochlorothiazide
F
indapamide oral tablet 1.25 mg, 2.5 mg
F
methyclothiazide
F
metolazone
F
QL QL
Dopamine D1 Receptor Agonists, Antihypertensive Corlopam
F
Non-Cardiac Selective Beta BlockerThiazide Diuretic And Related Comb. propranolol-hydrochlorothiazide
F
Peripheral Alpha-1 Receptor Blockers doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg
F
QL
prazosin oral
F
QL
terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg
F
QL
F
PA; QL
Letairis
F
PA; QL
Tracleer
Specialty
PA; QL
Adcirca
F
PA; QL
sildenafil oral
F
PA
F
PA; QL
F
PA; QL
Pulmonary Antihypertensive AgentsSoluble Guanylate Cyclase Stimulator Adempas
Pulmonary Arterial Hypertension Endothelin Receptor Antagonists
Pulmonary Arterial Hypertension Agents-Selective cGMP-PDE5 Inhibitors
Renin Inhibitor, Direct Tekturna
Renin Inhibitor, Direct and Diuretic Combinations Tekturna HCT
Central Nervous System Agents AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 22
Drug Antianxiety Agent - Antihistamine Type
Status
Notes
hydroxyzine HCl oral solution 10 mg/5 mL
F
AL
hydroxyzine HCl oral tablet
F
AL
hydroxyzine pamoate
F
AL
F
QL
Antidepressant-Norepinephrine And Dopamine Reuptake Inhibitors (NDRIs) bupropion HCl oral tablet extended release 150 mg
Antiparkinson - Dopaminerg-Peripheral DOPA-Decarboxylase Inhibit Comb carbidopa-levodopa oral tablet
F
carbidopa-levodopa oral tablet extended release
F
carbidopa-levodopa oral tablet, disintegrating 10100 mg, 25-250 mg
F
carbidopa-levodopa oral tablet, disintegrating 25100 mg
F
QL
Antiparkinson Therapy - Ergot Alkaloids and Derivatives bromocriptine oral capsule
F
bromocriptine oral tablet
F
QL
F
QL
amantadine HCl oral capsule
F
QL
amantadine HCl oral solution
F
QL
amantadine HCl oral tablet
F
pramipexole oral tablet
F
QL
ropinirole oral tablet
F
QL
F
AL
F
QL
Antiparkinson Therapy - Monoamine Oxidase Inhibitor(MAO-B) selegiline HCl oral capsule
Antiparkinson Therapy - Non-Ergot Dopamine Agonist Agents
CNS Stimulant - Analeptics caffeine citrated oral
Migraine Therapy - AnalgesicVasoconstrictor-Sedative Combinations isometh-dichloral-acetaminophn AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 23
Drug Migraine Therapy - Selective Serotonin Agonists 5-HT(1)
Status
Notes
naratriptan
F
QL
rizatriptan
F
QL
sumatriptan succinate oral
F
QL
sumatriptan succinate subcutaneous cartridge
F
PA; QL
sumatriptan succinate subcutaneous pen injector 4 mg/0.5 mL, 6 mg/0.5 mL
F
PA; QL
sumatriptan succinate subcutaneous solution
F
PA; QL
zolmitriptan
F
ST; QL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
F
QL
nicotine (polacrilex)
F
OTC
nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr
F
OTC
nicotine transdermal patch, TD daily, sequential
F
OTC; QL
Nicotrol
F
Nicotrol NS
F
Sedative-Hypnotic - Antihistamines
Chemical Dependency, Agents To Treat Smoking Deterrents - NE and Dopamine Reuptake Inhibitor (NDRI)Type bupropion HCl oral tablet extended release 150 mg
Smoking Deterrents - Nicotine-Type
Smoking Deterrents - Nicotinic Receptor Partial Agonist, Alpha4beta2 Chantix
F
QL
Chantix Continuing Month Box
F
QL
Chantix Starting Month Box
F
QL
Chemicals-Pharmaceutical Adjuvants Pharmaceutical Adjuvant - Inhalation Vehicles AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 24
Drug
Status
sodium chloride inhalation solution for nebulization 0.9 %, 7 %
Notes
F
Cognitive Disorder Therapy Alzheimer's Disease Therapy Cholinesterase Inhibitors donepezil oral tablet 10 mg, 5 mg
F
QL; AL
donepezil oral tablet 23 mg
F
QL
galantamine oral capsule, Ext rel. pellets 24 hr
F
QL
galantamine oral solution
F
galantamine oral tablet
F
QL
rivastigmine tartrate
F
AL
memantine oral tablet
F
PA; QL; AL
memantine oral tablets, dose pack
F
PA; QL; AL
F
QL
Alzheimer's Disease Therapy - NMDA Receptor Antagonists
Contraceptives Contraceptive Injectable - Progestin medroxyprogesterone intramuscular
Contraceptive Oral - Biphasic Azurette (28)
F
desog-e.estradiol/e.estradiol
F
Kariva (28)
F
Lo Loestrin Fe
F
Necon 10/11 (28)
F
Viorele (28)
F
Contraceptive Oral - Monophasic Altavera (28)
F
Alyacen 1/35 (28)
F
Apri
F
Aviane
F
Balziva (28)
F
Brevicon (28)
F
Briellyn
F
Cryselle (28)
F
Cyclafem 1/35 (28) AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 25
Drug
Status
Notes
Dasetta 1/35 (28)
F
desogestrel-ethinyl estradiol
F
drospirenone-ethinyl estradiol oral tablet 3-0.03 mg
F
Elinest
F
Enskyce
F
Estarylla
F
Falmina (28)
F
Femcon Fe
F
PA
Generess Fe
F
PA
Gianvi (28)
F
Gildagia
F
Gildess 1.5/30 (21)
F
Gildess 1/20 (21)
F
Gildess 24 Fe
F
Gildess FE 1.5/30 (28)
F
Gildess FE 1/20 (28)
F
Introvale
F
Jolessa
F
Junel 1.5/30 (21)
F
Junel 1/20 (21)
F
Junel FE 1.5/30 (28)
F
Junel FE 1/20 (28)
F
Kelnor 1/35 (28)
F
Kurvelo
F
Larin 1.5/30 (21)
F
Larin 1/20 (21)
F
Larin Fe 1.5/30 (28)
F
Larin Fe 1/20 (28)
F
Layolis Fe
F
Lessina
F
levonorgestrel-ethinyl estrad
F
Levora-28
F
Loestrin 1/20 (21)
F
Lomedia 24 Fe
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
PA
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 26
Drug
Status
Loryna (28)
F
Low-Ogestrel (28)
F
Lutera (28)
F
Marlissa
F
Microgestin 1.5/30 (21)
F
Microgestin 1/20 (21)
F
Microgestin Fe 1.5/30 (28)
F
Microgestin FE 1/20 (28)
F
Minastrin 24 Fe
F
Modicon (28)
F
Mono-Linyah
F
Mononessa (28)
F
Necon 0.5/35 (28)
F
Necon 1/35 (28)
F
Necon 1/50 (28)
F
Nikki (28)
F
noreth-ethinyl estradiol-iron oral tablet, chewable 0.8mg-25mcg(24) and 75 mg (4)
F
norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg
F
norethindrone-e.estradiol-iron
F
norgestimate-ethinyl estradiol oral tablet 0.25-35 mg-mcg
F
norgestrel-ethinyl estradiol
F
Nortrel 0.5/35 (28)
F
Nortrel 1/35 (21)
F
Ocella
F
Ogestrel (28)
F
Orsythia
F
Ovcon-35 (28)
F
Philith
F
Portia
F
Previfem
F
Quasense
F
Reclipsen (28)
F
Safyral
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
Notes
PA
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 27
Drug
Status
Sprintec (28)
F
Sronyx
F
Syeda
F
Vestura (28)
F
Wera (28)
F
Wymzya Fe
F
Yasmin (28)
F
Zarah
F
ZenChent (28)
F
Zenchent Fe
F
Zovia 1/35E (28)
F
Zovia 1/50E (28)
F
Notes
PA
PA
Contraceptive Oral - Progestin Camila
F
Deblitane
F
Errin
F
Heather
F
Jencycla
F
Jolivette
F
Nora-BE
F
norethindrone (contraceptive)
F
Norlyroc
F
Ortho Micronor
F
Sharobel
F
Contraceptive Oral - Triphasic Alyacen 7/7/7 (28)
F
Aranelle (28)
F
Caziant (28)
F
Cyclafem 7/7/7 (28)
F
Dasetta 7/7/7 (28)
F
Enpresse
F
Leena 28
F
Levonest (28)
F
Myzilra
F
Necon 7/7/7 (28)
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 28
Drug
Status
norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg, 0.18/0.215/0.25 mg35 mcg (28)
F
Nortrel 7/7/7 (28)
F
Ortho Tri-Cyclen (28)
F
Ortho Tri-Cyclen Lo (28)
F
Ortho-Novum 7/7/7 (28)
F
Tilia Fe
F
Tri-Estarylla
F
Tri-Legest Fe
F
Tri-Linyah
F
TriNessa (28)
F
Tri-Previfem (28)
F
Tri-Sprintec (28)
F
Trivora (28)
F
Velivet Triphasic Regimen (28)
F
Notes
Contraceptive Transdermal Combinations Xulane
F
QL
F
QL
Fallback Solo
F
OTC
My Way
F
OTC
Next Choice One Dose
F
OTC
Take Action
F
OTC
Fallback Solo
F
OTC
My Way
F
OTC
Next Choice One Dose
F
OTC
Take Action
F
OTC
Gynol II
F
OTC
Today Contraceptive Sponge
F
OTC
Contraceptives - Intravaginal, Systemic NuvaRing
Emergency Contraceptives
Emergency Contraceptives - Progestin Type
Spermicides
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 29
Drug
Status
Vaginal Contraceptive Foam
Notes
F
OTC
F
PA; QL
Dermatological Acne Therapy Systemic - Retinoids and Derivatives Claravis
Acne Therapy Topical - Anti-Infective clindamycin phosphate topical gel
F
clindamycin phosphate topical lotion
F
clindamycin phosphate topical solution
F
clindamycin phosphate topical swab
F
erythromycin with ethanol topical solution
F
metronidazole topical cream
F
Acne Therapy Topical - Anti-InfectiveKeratolytic Combinations clindamycin-benzoyl peroxide topical gel 1-5 %
F
erythromycin-benzoyl peroxide
F
QL
benzoyl peroxide topical cleanser 5 %
F
OTC
benzoyl peroxide topical gel 10 %
F
OTC; QL
benzoyl peroxide topical gel 5 %
F
OTC
adapalene topical cream
F
ST; QL
adapalene topical gel 0.1 %
F
ST; QL
tretinoin topical cream
F
QL; AL
tretinoin topical gel 0.01 %, 0.025 %
F
QL; AL
Acne Therapy Topical - Keratolytic
Acne Therapy Topical - Retinoids and Derivatives
Dermatological - Antibacterial Aminoglycosides gentamicin topical
F
Dermatological - Antibacterial Mixtures Triple Antibiotic topical ointment
F
OTC
Triple Antibiotic topical ointment in packet
F
OTC
F
QL
Dermatological - Antibacterial Other mupirocin AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 30
Drug Dermatological - Antibacterial Polymyxins and Derivatives
Status
Notes
bacitracin topical
F
OTC
bacitracin zinc
F
OTC
F
OTC
Dermatological - Antifungal Allylamines Jock Itch (terbinafine)
Dermatological - Antifungal Amphoteric Polyene Macrolides nystatin topical cream
F
nystatin topical ointment
F
nystatin topical powder
F
QL
F
QL
Antifungal (clotrimazole)
F
OTC
Antifungal Cream
F
OTC
clotrimazole topical
F
OTC
econazole topical
F
QL
Inzo Antifungal
F
OTC
Jock Itch (clotrimazole)
F
OTC
ketoconazole topical cream
F
QL
ketoconazole topical shampoo
F
QL
miconazole nitrate topical cream
F
OTC
F
OTC
Dermatological - Antifungal Hydroxypyridinone ciclopirox topical solution
Dermatological - Antifungal Imidazole and Related Agents
Dermatological - Antifungal Thiocarbamate tolnaftate topical aerosol powder
Dermatological - AntifungalGlucocorticoid Combinations clotrimazole-betamethasone
F
nystatin-triamcinolone
F
Dermatological - Antineoplastic Antimetabolites AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 31
Drug
Status
fluorouracil topical cream
Notes
F
PA
F
PA
Dermatological - Antineoplastic Or Premalignant Lesions - NSAIDs diclofenac sodium topical gel 3 %
Dermatological - Antiperspirants aluminum chloride
F
Dermatological - Antipsoriatic Agents Systemic, Vitamin A Derivatives acitretin
F
PA
calcipotriene scalp
F
PA; QL
calcipotriene topical cream
F
PA
calcipotriene topical ointment
F
PA; QL
Dermatological - Antipsoriatic Agents Topical
Dermatological - Antiseborrheic selenium sulfide topical lotion
F
selenium sulfide topical shampoo 2.25 %
F
Dermatological - Antiviral, Herpes Abreva
F
OTC
Dermatological - Burn Products AntiInfective silver sulfadiazine
F
Dermatological - Calcineurin Inhibitors Elidel
F
PA; QL
tacrolimus topical
F
PA
ammonium lactate topical cream
F
OTC; QL
ammonium lactate topical lotion
F
OTC; QL
F
QL
Anti-Itch (HC) topical ointment
F
OTC
betamethasone dipropionate topical cream
F
QL
betamethasone valerate topical cream
F
QL
Dermatological - Emollients
Dermatological - Enzymes Santyl
Dermatological - Glucocorticoid
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 32
Drug
Status
Notes
betamethasone valerate topical lotion
F
QL
betamethasone valerate topical ointment
F
QL
betamethasone, augmented topical cream
F
QL
betamethasone, augmented topical gel
F
QL
betamethasone, augmented topical lotion
F
QL
betamethasone, augmented topical ointment
F
QL
clobetasol scalp
F
PA; QL
clobetasol topical cream
F
PA; QL
clobetasol topical ointment
F
PA; QL
Cortizone-10 topical ointment
F
OTC
fluocinonide topical cream 0.05 %
F
QL
fluocinonide topical ointment
F
QL
fluocinonide topical solution
F
QL
Fluocinonide-E
F
QL
halobetasol propionate
F
QL
hydrocortisone acetate topical
F
OTC
hydrocortisone topical cream 0.5 %, 1 %
F
OTC
hydrocortisone topical cream 2.5 %
F
hydrocortisone topical lotion 2.5 %
F
hydrocortisone topical ointment 0.5 %, 1 %
F
hydrocortisone topical ointment 2.5 %
F
hydrocortisone valerate topical cream
F
QL
mometasone topical cream
F
QL
mometasone topical solution
F
QL
Noble Formula HC topical cream
F
OTC
Recort Plus
F
OTC
Soothing Care (hydrocortisone)
F
OTC
triamcinolone acetonide topical cream
F
QL
triamcinolone acetonide topical lotion 0.025 %
F
triamcinolone acetonide topical lotion 0.1 %
F
QL
triamcinolone acetonide topical ointment 0.025 %, 0.1 %
F
QL
triamcinolone acetonide topical ointment 0.5 %
F
OTC
Dermatological - Immunomodulator Imidazoquinolinamines AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 33
Drug imiquimod
Status
Notes
F
PA; QL
Dermatological - KeratolyticAntimitotic Single Agents podofilox
F
Dermatological - Local Anesthetic Combinations lidocaine-prilocaine topical cream
F
QL
Dermatological - Topical Local Anesthetic Amides lidocaine HCl mucous membrane jelly
F
lidocaine HCl mucous membrane jelly in applicator
F
lidocaine HCl topical cream 3 %
F
lidocaine topical adhesive patch, medicated
F
PA
Lidocream topical cream
F
OTC
F
OTC
F
OTC; QL
lindane topical shampoo
F
QL
malathion
F
ST; QL
permethrin topical cream
F
QL
permethrin topical liquid
F
OTC; QL
F
PA
Dermatological Irritants-CounterIrritant Single Agents capsaicin topical cream 0.025 %
Scabicide and Pediculicide Combinations Lice Killing
Scabicide and Pediculicide Single Agents
Eating Disorder Therapy Appetite Stimulants - Cannabinoids dronabinol
Appetite Stimulants - Progestin Hormone Type megestrol oral suspension 400 mg/10 mL (10 mL), 400 mg/10 mL (40 mg/mL)
AL = Age Limit PA = Prior Authorization
F
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 34
Drug Electrolyte Balance-Nutritional Products B-Complex Vitamin Combinations
Status
Notes
Alba-Lybe
F
OTC
Apetex
F
OTC
Apetigen
F
OTC
B Complex Plus Vitamin C
F
OTC
B complex-vitamin C-folic acid
F
OTC
B-100 Complex oral tablet extended release
F
OTC
Balanced B Complex-Vit C
F
OTC
Balanced B-100 Complex oral tablet extended release 100 mg
F
OTC
Balanced B-100 oral tablet 100 mg
F
OTC
B-Complex oral tablet 300 mg-150 mg calcium
F
OTC
B-complex with vitamin C oral tablet
F
OTC
B-complex with vitamin C oral tablet 400-500 mcg-mg
F
OTC
B-complex with vitamin C oral tablet extended release
F
OTC
B-complex with vitamin C oral tablet extended release 400 mcg
F
OTC
Biopetit
F
OTC
Cardiotek-RX (bioperine)
F
Complex B-100 oral tablet extended release 400 mcg
F
OTC
Complex B-50
F
OTC
DIALYVITE 3000
F
DIALYVITE 800
F
OTC
Dialyvite 800 Plus D
F
OTC
Dialyvite 800 with Zinc 15
F
OTC
Dialyvite 800 with Zinc 50
F
OTC
Dialyvite 800-Ultra D
F
OTC
Dialyvite oral tablet 100-1 mg
F
Dialyvite Supreme D
F
Fatigue Relief Complex
F
Folbee AR
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 35
Drug
Status
Notes
Folbee Plus
F
Lysiplex Plus oral tablet
F
Medtycholl-B Complex-Liver
F
OTC
Natural B-100 Complex
F
OTC
Nephrocaps Qt
F
Nephronex
F
OTC
Nephronex-SL
F
OTC
Nutrivit
F
OTC
ProRenal
F
OTC
Quin B Strong
F
OTC
Renal Caps
F
Reno Caps
F
Stress B Plus Zinc
F
OTC
Stress B With Zinc
F
OTC
Stress Formula
F
OTC
Stress Formula 600 C
F
OTC
Stress Formula Energy
F
OTC
Stress Formula plus Iron
F
OTC
Stress Formula With Iron(sulf)
F
OTC
Stress Formula with Zinc
F
OTC
Super B Complex + C
F
OTC
Super B Complex-Vitamin C
F
OTC
Super B/C
F
OTC
Superplex-T
F
OTC
Supervite
F
Support-500
F
OTC
Total B/C
F
OTC
Triphrocaps
F
Virt-Vite Plus
F
vit B complex-folic acid
F
OTC
Vita-Bee with C
F
OTC
Vitamin B Complex With C
F
OTC
Vitamins B Complex oral tablet 500 mg-400 mcg- 18 mg iron
F
OTC
Vitamins for Hair oral tablet
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 36
Drug B-Complex Vitamins
Status
Notes
B Complete
F
OTC
B Complex 1
F
OTC
B Complex 100 injection
F
B Complex sublingual
F
OTC
B Complex-Vitamin B12
F
OTC
B-50 Complex oral tablet extended release
F
OTC
Bal B-100
F
OTC
Bal B-50
F
OTC
Balance B-100
F
OTC
Balance B-50
F
OTC
Balanced B-100 oral tablet
F
OTC
Balanced B-50
F
OTC
Complex B-100 oral tablet extended release
F
OTC
Folgard
F
OTC
Hi-B Complex
F
OTC
Natural B-100
F
OTC
PoDiaPN
F
OTC
Stress B-Biotin
F
OTC
Stress Formula
F
OTC
Super B-50 Complex
F
OTC
Super B-50 Complex Plus
F
OTC
Super Quints B-50
F
OTC
Ultra B-100 Complex
F
OTC
vitamin B complex
F
OTC
Vitamins B Complex oral capsule
F
OTC
Vitamins B Complex oral tablet
F
OTC
Apetigen Plus oral liquid
F
OTC
Dialyvite oral tablet 1-100-300-50 mg-mg-mcgmg
F
Nephplex Rx
F
Rabano Yodado
F
Rena-Vite Rx
F
B-Complex Vitamins And Combinations
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 37
Drug Brewer’s Yeast
Status
Notes
Brewer's Yeast
F
OTC
yeast
F
OTC
Diabetic Support Formula
F
OTC
Hair, Skin and Nails oral tablet 3.3 mg iron-25 mcg
F
OTC
Megavite
F
OTC
Megavite Golden Years 55+
F
OTC
Niacin-Azelaic AC-Turmer-FA-B6-ZN
F
Nicadan
F
Nicazel
F
NicAzel Forte
F
One Daily oral tablet 300-18-400-50 mg-mgmcg-mg
F
OTC
One Daily Women's Metabolism
F
OTC
Prostamen
F
OTC
Vitamin D3 Complete
F
OTC
VP-Zel
F
Dietary Product - Dietary Supplements
Electrolyte Depleters - Ion Exchange Resin sodium polystyrene (sorb free)
F
sodium polystyrene sulfonate oral powder
F
sodium polystyrene sulfonate rectal
F
Geriatric Vitamins A Thru Z Select oral tablet
F
OTC
Central Vite
F
OTC
Central-Vite oral tablet
F
OTC
Central-Vite Select
F
OTC
Centravites 50 Plus
F
OTC
Cerovite Senior
F
OTC
Complete Senior oral tablet
F
OTC
Daily Multivitamin-Minerals
F
OTC
Milltrium Senior
F
OTC
Multivitamin 50 Plus
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 38
Drug
Status
Notes
multivitamin with minerals oral tablet
F
OTC
Multi-Vite 50 and Over
F
OTC
REQ49+
F
Spectravite Senior oral tablet
F
OTC
Theratrum Complete 50 Plus
F
OTC
Theratrum Complete 50 Plus/Lut
F
OTC
Vision Plus Lutein
F
OTC
Vitrum Senior oral tablet
F
OTC
Calci-Chew
F
OTC
Calci-Mix
F
OTC
Calcionate
F
OTC
Calcitrate
F
OTC
Calcium 500 oral tablet, chewable
F
OTC
calcium acetate oral tablet 667 mg
F
calcium amino acid chelate
F
OTC
calcium carbonate oral powder
F
OTC
calcium carbonate oral suspension
F
OTC
calcium carbonate oral tablet 500 mg calcium (1,250 mg), 600 mg (1,500 mg)
F
OTC
calcium carbonate oral tablet, chewable 260 mg (650 mg), 500 mg calcium (1,250 mg)
F
OTC
calcium chloride intravenous
F
calcium citrate
F
calcium gluconate intravenous
F
calcium gluconate oral tablet 45 mg (500 mg), 50 mg calcium, 60 mg (650 mg), 61 mg (648 mg)
F
OTC
calcium lactate
F
OTC
calcium phosphate
F
OTC
Cal-Mint
F
OTC
Coral Calcium oral tablet
F
OTC
Oysco-500
F
OTC
Oyster Shell Calcium
F
OTC
Oyster Shell Calcium 500
F
OTC
Minerals and Electrolytes - Calcium Replacement
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 39
Drug Minerals and Electrolytes - Calcium Replacement Combinations
Status
Notes
ADVANCED Calcium
F
OTC
Biocal
F
OTC
Bone Density Calcium + D
F
OTC
Bone Essentials
F
OTC
Ca-D3-mag ox-zinc-cop-mang-bor oral tablet
F
OTC
Ca-D3-mag ox-zinc-cop-mang-bor oral tablet, chewable 600 mg calcium- 800 unit-40 mg
F
OTC
Ca-D3-mag-zinc-cop-mang-bor
F
OTC
Cal Mag Zinc + D3
F
OTC
Calci-Max
F
OTC
Calcium 600 + Minerals
F
OTC
Calcium 600 Plus Soy
F
OTC
Calcium 600-D3 Plus
F
OTC
calcium carb-D3-mag cmb11-zinc
F
OTC
calcium carbonate-vit D3-min
F
OTC
Calcium Citrate Plus
F
OTC
Calcium for Women
F
OTC
Calcium Magnesium
F
OTC
Calcium Magnesium + D
F
OTC
Calcium Soft Chew
F
OTC
Calcium with Boron
F
OTC
calcium-magnesium
F
OTC
calcium-magnesium-zinc
F
OTC
calcium-vitamin D3-vitamin K oral tablet, chewable 500 mg-1,000 unit-40 mcg, 500-200-40 mg-unit-mcg, 500-500-40 mg-unit-mcg
F
OTC
Cal-Mag
F
OTC
CalMag Thins
F
OTC
Caltrate 600+D Plus Minerals
F
OTC
Citracal + Bone Density
F
OTC
Citracal Chew
F
OTC
Citracal D + Heart Health
F
OTC
Citracal Plus Magnesium
F
OTC
Coral Calcium oral capsule
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 40
Drug
Status
Notes
Fem-Cal Citrate
F
OTC
Folgard OS
F
LoCalnesium
F
OTC
LoCalnesium-C
F
OTC
Oyster Shell Calcium and Mag
F
OTC
Pro-Cal oral tablet
F
OTC
Soy Formula
F
OTC
Super Cal-Mag
F
OTC
TL G-Fol OS
F
Viactiv
F
OTC
Calcet Creamy Bites
F
OTC
Calcet Petites
F
OTC
Cal-Citrate
F
OTC
Calcitrate-Vitamin D
F
OTC
Calcium 500 + D (D3)
F
OTC
Calcium 500 + D oral tablet 500 mg(1,250mg) 200 unit
F
OTC
Calcium 500 + D oral tablet, chewable
F
OTC
Calcium 600 + D(3) oral capsule
F
OTC
Calcium 600 + D(3) oral tablet 600 mg(1,500mg) -200 unit, 600-125 mg-unit
F
OTC
Calcium 600 with Vitamin D3 oral capsule
F
OTC
Calcium 600 with Vitamin D3 oral tablet, chewable
F
OTC
Calcium Adult (calcium phos)
F
OTC
calcium carb and citrate-vitD3
F
OTC
calcium carbonate-vitamin D3 oral capsule 600 mg(1,500mg) -400 unit, 600 mg(1,500mg) -500 unit, 600mg (1,000mg) -1,000 unit
F
OTC
calcium carbonate-vitamin D3 oral tablet 1,000 mg(2,500 mg)-800 unit, 500mg (1,250mg) -600 unit, 600 mg(1,500mg) -400 unit, 600 mg(1,500mg) -800 unit
F
OTC
calcium carbonate-vitamin D3 oral tablet, chewable 500-100 mg-unit
F
OTC
Minerals and Electrolytes - Calcium Replacement/Vitamin D Combinations
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 41
Drug
Status
Notes
Calcium Citrate + D
F
OTC
calcium citrate malate-vit D3
F
OTC
calcium citrate-vitamin D2
F
OTC
calcium citrate-vitamin D3 oral tablet 200 mg calcium -250 unit, 200-125 mg-unit, 250 mg calcium- 200 unit, 315-250 mg-unit
F
OTC
calcium phosphate-vitamin D3
F
OTC
Calcium+D oral tablet 400-133.3 mg-unit
F
OTC
Cal-Quick
F
OTC
Caltrate 600 + D
F
OTC
Caltrate with Vitamin D3
F
OTC
Citracal + D Maximum
F
OTC
Citracal + D Petites
F
OTC
Citracal + D Slow Release
F
OTC
Citracal + D3 (calcium phos) oral tablet, chewable 250 mg calcium- 500 unit
F
OTC
Citracal Regular
F
OTC
Citrus Calcium
F
OTC
Flintstones Bone Support
F
OTC
Hi-Cal Plus Vit D
F
OTC
Liquid Calcium with Vitamin D
F
OTC
Os-Cal 500 + D3
F
OTC
Osteo-Poretical
F
OTC
Oysco 500/D oral tablet
F
OTC
Oyster Shell Calcium-Vit D2 oral tablet 250 (625)-125 mg-unit
F
OTC
Oyster Shell Calcium-Vit D3
F
OTC
Parva-Cal 250
F
OTC
Parva-Cal 500
F
OTC
Prosteon
F
OTC
Risacal-D
F
OTC
TheraCal
F
OTC
TheraCal D2000
F
OTC
TheraCal D4000
F
OTC
Upcal D
F
OTC
Minerals and Electrolytes - Iron AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 42
Drug
Status
Notes
EZFE 200
F
OTC
FE C Plus
F
OTC
Feosol
F
OTC
Feraheme
F
Fer-Iron
F
OTC
FeroSul oral elixir
F
OTC; AL
FeroSul oral tablet
F
OTC
Ferretts
F
OTC
Ferretts Carbonyl Iron
F
OTC
Ferretts IPS
F
OTC
Ferrex 150
F
OTC
Ferrimin 150
F
OTC
Ferrocite
F
OTC
ferrous fumarate
F
OTC
ferrous gluconate oral tablet 236 mg (27 mg iron), 240 mg (27 mg iron), 256 mg (28 mg iron), 324 mg (36 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron)
F
OTC
ferrous sulfate oral drops
F
OTC; AL
ferrous sulfate oral liquid
F
OTC; AL
ferrous sulfate oral solution
F
OTC; AL
ferrous sulfate oral tablet 325 mg (65 mg iron)
F
OTC
ferrous sulfate oral tablet extended release
F
OTC
ferrous sulfate oral tablet, delayed release (DR/EC)
F
OTC
FerrouSul
F
OTC
Hemocyte
F
OTC
High Potency Iron
F
OTC
ICAR oral suspension
F
OTC
iFerex 150
F
OTC
Infed
F
Injectafer
F
Iron (dried)
F
OTC
Iron 100 Plus
F
OTC; AL
Iron Chews
F
OTC
Iron High Potency
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 43
Drug
Status
Notes
iron oral capsule, extended release
F
OTC
iron oral tablet 18 mg
F
OTC
iron oral tablet extended release 159 mg (45 mg iron)
F
OTC
IronUp
F
OTC
Myferon 150
F
OTC
NovaFerrum 125
F
OTC
NovaFerrum 50
F
OTC
NovaFerrum oral drops
F
OTC
Nu-Iron
F
OTC
Perfect Iron
F
OTC
Poly-Iron
F
OTC
Pro Fe
F
OTC
Proferrin ES
F
OTC
Slow Release Iron oral tablet extended release 142 mg (45 mg iron), 143 mg (45 mg iron), 159 mg (45 mg iron), 160 mg (50 mg iron), 168 mg (50 mg iron), 47.5 mg iron
F
OTC
sodium ferric gluconat-sucrose
F
Tandem Dual Action
F
Venofer
F
Wee Care
F
OTC
Abatron
F
OTC
Abatron AF
F
OTC
Active FE
F
Apetigen Plus oral tablet
F
OTC
Central-Vite oral tablet
F
OTC
Centratex
F
Corvita 150
F
Corvite 150 oral tablet 150 mg iron- 1 mg
F
Corvite FE oral tablet 150 mg iron- 1 mg
F
Duofer
F
OTC
FE C
F
OTC
Feosol Bifera
F
OTC
OTC
Minerals and Electrolytes - Iron Combinations
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 44
Drug
Status
FeRiva
F
Feriva 21-7 Tablet
F
FeRiva FA (Sumalate)
F
Ferocon
F
Ferractiv
F
Ferralet 90 Dual-Iron Delivery
F
FerraPlus 90
F
Ferrex 150 Forte
F
Ferrex 150 Forte Plus
F
Ferrex 150 Plus
F
Ferrex 28
F
Ferrocite Plus
F
Ferrogels Forte
F
Focalgin DSS
F
Folitab
F
Folivane-F
F
Folivane-Plus
F
Fusion
F
Fusion Plus
F
Hematinic Plus Vit/Minerals
F
Hematinic/Folic Acid
F
Hematogen
F
Hematogen FA
F
Hematogen Forte
F
Hematron
F
HemeTab
F
Hemocyte-Plus
F
I.L.X. B-12
F
OTC
ICAR-C
F
OTC
iFerex 150 Forte
F
Integra
F
Integra F
F
Integra Plus
F
Iron 21/7
F
OTC
Iron with Stool Softener
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
Notes
OTC
OTC
OTC
OTC
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 45
Drug
Status
Notes
iron-vitamin C
F
OTC
Iro-Plex (iron carbonyl)
F
OTC
Iro-Plex (iron polysaccharide)
F
OTC
Irospan 24/6
F
Liver with Iron
F
OTC
Lydia Pinkham Herbal oral tablet
F
OTC
Maxaron Forte
F
Multigen
F
Multigen Folic
F
Multigen Plus
F
Nephron FA
F
OB Complete oral tablet
F
Parvlex
F
Poly-Iron 150 Forte
F
Proferrin-Forte
F
Siderol oral tablet
F
OTC
Stress Formula
F
OTC
Taron Forte
F
TL Icon
F
Tricon
F
Trigels-F Forte
F
Vitafol
F
Vitron-C
F
OTC
Laxative Dietary Supplement
F
OTC
Mag 64
F
OTC
Mag Glycinate
F
OTC
MagBid ER
F
OTC
Mag-Delay
F
OTC
Mag-G
F
OTC
Maginex
F
OTC
magnesium
F
OTC
Magnesium (oxide/AA chelate)
F
OTC
magnesium amino acid chelate
F
OTC
magnesium chloride injection
F
OTC
OTC
Minerals and Electrolytes - Magnesium
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 46
Drug
Status
Notes
magnesium chloride oral
F
OTC
magnesium citrate oral tablet
F
OTC
magnesium gluconate oral
F
OTC
magnesium oxide
F
OTC
magnesium sulfate in D5W intravenous piggyback 1 gram/100 mL
F
magnesium sulfate in water
F
magnesium sulfate injection
Specialty
Magonate (magnesium carb)
F
OTC
MagOx
F
OTC
Magtab
F
OTC
Phillips
F
OTC
Slow-Mag
F
OTC
Uro-Mag
F
OTC
F
OTC
F
OTC
CeraLyte-70 oral solution
F
OTC
CeraSport oral liquid
F
OTC
Oralyte
F
OTC
Pediatric Electrolyte oral solution
F
OTC
Pediatric Freezer Pops
F
OTC
PediaVance
F
OTC
Minerals and Electrolytes - Magnesium Combinations Beelith
Minerals and Electrolytes - Multiple Minerals calcium-magnesium-copper-zinc
Minerals and Electrolytes - Oral Electrolytes
Minerals and Electrolytes - Phosphate Glycophos
F
Phos-NaK
F
potassium phosphate m-/d-basic
F
sodium phosphate
F
OTC
Minerals and Electrolytes - Potassium Combinations AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 47
Drug
Status
potassium bicarb and chloride
Notes
F
Minerals and Electrolytes - Potassium, Oral potassium bicarb-citric acid
F
potassium chloride oral capsule, extended release
F
potassium chloride oral liquid
F
potassium chloride oral packet
F
potassium chloride oral tablet extended release 10 mEq, 8 mEq
F
potassium chloride oral tablet, ER particles/crystals
F
Multivitamin and Mineral Combinations 50+ Adult Eye Health
F
OTC
A Thru Z
F
OTC
A Thru Z Men's Ultimate
F
OTC
A Thru Z Select 50+ Formula
F
OTC
A Thru Z Select oral tablet 300-600-300 mcg, 500-300-250 mcg
F
OTC
A Thru Z Select Women's
F
OTC
ABC Plus
F
OTC
Actical
F
OTC
Adult Multivitamin Gummies
F
OTC
Adult One Daily Gummies
F
OTC
Advanced AM-PM
F
Antioxidant
F
OTC
Antioxidant A/C/E/Selenium
F
OTC
Antioxidant Formula (selenium)
F
OTC
Antioxidant Vitamins oral tablet 1,000 unit-200 mg-60 unit-2 mg
F
OTC
Apatate Forte
F
OTC
AquADEKs
F
OTC
Bacmin
F
Bee-Zee
F
OTC
Berocca (FA-guarana-caff)
F
OTC
Bio-35
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 48
Drug
Status
Notes
Bio-35, Gluten Free
F
OTC
Biocel (with Lutein)
F
OTC
Biosupp
F
OTC
Biotect Plus
F
OTC
Biotin Plus-Calcium and Vit D3
F
OTC
Biovol
F
OTC
Bladder 2.2
F
OTC
Body, Hair, Skin and Nails
F
OTC
Calcium Citrate + D with Mag
F
OTC
Calcium Citrate Plus (Vit B6)
F
OTC
Cardiamin
F
OTC
Centamin
F
OTC
Central Vite
F
OTC
Central Vite with Lutein
F
OTC
Central-Vite Cardio
F
OTC
Central-Vite Energy
F
OTC
Central-Vite Men's Under 50
F
OTC
Central-Vite oral tablet
F
OTC
Central-Vite Performance oral tablet 18 mg iron400 mcg-50 mg
F
OTC
Central-Vite Select
F
OTC
Central-Vite Senior
F
OTC
Central-Vite Women's Mature
F
OTC
Centram-Care
F
OTC
Centravites
F
OTC
Centrum
F
OTC
Centrum Men
F
OTC
Centrum Silver
F
OTC
Centrum Silver Ultra Men's
F
OTC
Centrum Silver Women
F
OTC
Centrum Specialist Energy
F
OTC
Centrum Specialist Heart
F
OTC
Centrum Ultra Men's
F
OTC
Century Adults 50+
F
OTC
Century Cardio
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 49
Drug
Status
Notes
Century Energy Metabolism
F
OTC
Century Mature oral tablet 0.4-300-250 mg-mcgmcg, 500-300-250 mcg
F
OTC
Century Ultimate Men's
F
OTC
Century Ultimate Women's oral tablet 8 mg iron400 mcg-300 mcg
F
OTC
Cerovite
F
OTC
Certa Plus
F
OTC
CertaVite Senior-Antioxidant
F
OTC
CertaVite-Antioxid (iron gluc) oral liquid 9 mg iron/15 mL
F
OTC
Compete
F
OTC
Complete 50+
F
OTC
Complete Multi
F
OTC
Complete Multi 50+
F
OTC
Complete Multivitamin oral tablet
F
OTC
Complete Multivitamin-Mineral oral liquid
F
OTC
Complete oral tablet 18-500-300-250 mg-mcgmcg-mcg
F
OTC
Complete Premium Vitamin
F
OTC
Complete Senior oral tablet 0.4-300-250 mg-mcgmcg
F
OTC
Corvita
F
Corvite
F
Corvite Free
F
Daily Gummies
F
OTC
Daily Multiple For Women 50+
F
OTC
Daily Multiple oral tablet , 400-120 mcg-mg
F
OTC
Daily Multivitamin
F
OTC
Daily Multivitamin-Minerals
F
OTC
Daily Multi-Vitamins/Iron
F
OTC
DAILY VITAMIN FORMULA-MINERALS
F
OTC
Daily Vitamin with Iron
F
OTC
Daily Vitamin with Iron and CA
F
OTC
Daily Vites/Iron
F
OTC
Daily-Vite
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 50
Drug
Status
Notes
Diabetes Health
F
OTC
Diabetes Health Formula
F
OTC
Diabetes Health Pack
F
OTC
Dialyvite 5000
F
ECee Plus
F
Eldercaps
F
ESSENTIAL Balance with Lutein
F
OTC
ESSENTIAL Daily
F
OTC
ESSENTIAL Man
F
OTC
ESSENTIAL Man 50+
F
OTC
Essential Woman 50+
F
OTC
Fosfree
F
OTC
Freedavite
F
OTC
Hair Vitamins
F
OTC
Hair, Skin and Nails-Argan Oil
F
OTC
Hair, Skin and Nails oral tablet , 1 mg iron-66.7 mcg-1,000 mcg
F
OTC
Hair, Skin and Nails(FA-biotin)
F
OTC
Healthy Eyes
F
OTC
Healthy Eyes SuperVision
F
OTC
Heartburn and Acid Reflux-Aloe
F
OTC
ICaps
F
OTC
I-Caps
F
OTC
ICaps AREDS
F
OTC
ICaps MV
F
OTC
ICaps Plus
F
OTC
I-Vite
F
OTC
I-Vite Protect
F
OTC
K-Pax Immune Support
F
OTC
K-PAX oral capsule
F
OTC
Life-Pack Men's
F
OTC
Life-Pack Women's
F
OTC
Macular Vitamin oral tablet 500-5-1 mcg-mg-mg
F
OTC
Macuvite Eye Care
F
OTC
Maximin Pack
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 51
Drug
Status
Notes
MAXIMUM DAILY GREEN
F
OTC
Maximum Daily Multivitamin
F
OTC
Mega Multi for Women
F
OTC
Mega Multiple/Chelated Mineral
F
OTC
Mega Multivitamin For Men
F
OTC
Mega Multivitamin with Mineral
F
OTC
Men's Biomultiple
F
OTC
Men's Daily
F
OTC
Men's Daily Multivit-Mineral
F
OTC
Men's Multivitamin Gummies
F
OTC
Men's One Daily
F
OTC
Men's Pack
F
OTC
Monocaps
F
OTC
Multi For Her oral tablet
F
OTC
Multi Vitamin
F
OTC
Multi-Betic
F
OTC
Multi-Delyn with Iron
F
OTC
Multilex
F
OTC
Multilex-T and M
F
OTC
Multiple Vitamin, Womens
F
OTC
Multiple Vitamin-Minerals
F
OTC
Multi-Vitamin HP/Minerals
F
OTC
multivitamin with iron
F
OTC
multivitamin with minerals oral liquid
F
OTC
multivitamin with minerals oral tablet
F
OTC
mv-min-folic acid-lutein
F
OTC
My-Vitalife
F
OTC
Nicomide
F
Nicomide (selenium-chromium)
F
Nutricap
F
Ocutabs
F
OTC
Ocuvite
F
OTC
Ocuvite with Lutein
F
OTC
Omnicap
F
OTC
One Daily Calcium/Iron
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 52
Drug
Status
Notes
One Daily Complete
F
OTC
One Daily Energy oral tablet
F
OTC
One Daily Essential oral tablet 0.4 mg
F
OTC
One Daily For Men
F
OTC
One Daily For Women
F
OTC
One Daily Gummy Vites
F
OTC
One Daily Healthy Weight
F
OTC
One Daily Maximum
F
OTC
One Daily Men's 50+ oral tablet 400-120 mcg-mg
F
OTC
One Daily Multi-Vit w-Mineral
F
OTC
One Daily oral tablet 0.4-600 mg-mcg
F
OTC
One Daily Plus Iron oral tablet
F
OTC
One Daily Plus Minerals
F
OTC
One Daily With Iron
F
OTC
One Daily Women 50 Plus
F
OTC
One Daily Womens 50 Plus
F
OTC
One Daily Women's oral tablet 27-0.4 mg
F
OTC
One-A-Day Cholesterol Plus
F
OTC
One-A-Day Maximum Formula
F
OTC
One-A-Day Men VitaCraves
F
OTC
One-A-Day Menopause Formula
F
OTC
One-A-Day Men's 50 Plus
F
OTC
One-A-Day Men's Multivitamin
F
OTC
One-A-Day Teen Advantage oral tablet 9 mg iron-400 mcg
F
OTC
One-A-Day VitaCraves
F
OTC
One-A-Day VitaCraves Energy
F
OTC
One-A-Day Vitacraves Immunity
F
OTC
One-A-Day Vitacraves Omega-3
F
OTC
One-A-Day WeightSmart
F
OTC
One-A-Day Women VitaCraves
F
OTC
One-A-Day Women's Active
F
OTC
One-A-Day Womens Formula oral tablet 18 mg iron-400 mcg-500 mg
F
OTC
One-A-Day Women's Healthy Skin
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 53
Drug
Status
Notes
Optisource
F
OTC
Opti-Vitamins
F
OTC
Opurity Multivitamin
F
OTC
Oxi-Freeda
F
OTC
PreserVision AREDS
F
OTC
PreserVision Lutein
F
OTC
Prevent
F
OTC
ProCerv HP
F
OTC
ProRenal QD
F
OTC
Prosight with Lutein
F
OTC
Protect Cardio AF
F
OTC
Protect Iron
F
Protect Plus SO
F
OTC
Quintabs-M
F
OTC
Quintabs-M Iron Free
F
OTC
REQ49+
F
SAVision
F
OTC
Sentry oral tablet 18-500-300-250 mg-mcg-mcgmcg
F
OTC
Sentry Senior
F
OTC
Softgels Multivit-A,B,D,E,K,Zn
F
Solo
F
OTC
Spectravite Adult
F
OTC
Spectravite Adult 50+
F
OTC
Spectravite Men's
F
OTC
Spectravite Senior oral tablet 500-300-250 mcg
F
OTC
Spectravite Ultra Men 50+
F
OTC
Spectravite Ultra Men's Sr
F
OTC
Spectravite Ultra Women's Sr
F
OTC
Stress B-Complex
F
OTC
Stress Formula Advanced
F
OTC
Strovite Forte
F
Strovite One
F
Sunvite
F
OTC
Super Antioxidant
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 54
Drug
Status
Notes
Super Ginseng Multivitamin
F
OTC
Super Multiple
F
OTC
Super Multiple - Low Iron
F
OTC
Super Thera Vite M
F
OTC
Superior 35
F
OTC
Supervite (EC)
F
Support
F
OTC
Tab-A-Vite/Iron
F
OTC
Tab-A-Vite-Minerals
F
OTC
Thera M Plus (ferrous fumarat)
F
OTC
Theradex M
F
OTC
Theragran-M Premier 50 Plus
F
OTC
Theralogix Companion
F
OTC
Thera-M
F
OTC
Theramill Forte oral capsule 67 mcg-12.5 mg 12.5 mg-17 mg
F
OTC
TheraNatal oral combo pack
F
OTC
Therapeutic M + beta-Carotene
F
OTC
Therapeutic-M oral tablet 9 mg iron-400 mcg
F
OTC
Therapeutic-M Vitamin/Minerals
F
OTC
Thera-Tabs M
F
OTC
Theratrum Complete with Lutein
F
OTC
Therems
F
OTC
Therems-H
F
OTC
Therems-M
F
OTC
Totalday Multiple
F
OTC
TRUEplus Diabetic Multivitamin
F
OTC
TYR Cooler oral liquid
F
OTC
Udamin SP
F
Ultimate Men's Complete 50+
F
OTC
Ultimate Women's Complete 50+
F
OTC
Ultra Freeda
F
OTC
Unicomplex-M
F
OTC
V-C Forte
F
VIC-Forte
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 55
Drug
Status
Notes
Vision
F
OTC
Vision Formula (with lutein)
F
OTC
Vision-Vite + Zinc
F
OTC
Vitacel (with Lutein)
F
OTC
Vital-D Rx
F
Vitalee
F
OTC
Vitamin D-3 with Aloe
F
OTC
Vitamins A-D-E selenium
F
OTC
Vitamins and Minerals
F
OTC
Vitatrum
F
OTC
Vitrum Senior oral tablet 500-300-250 mcg
F
OTC
Whole Source Multi-Vitamins
F
OTC
Women's Active
F
OTC
Women's Biomultiple
F
OTC
Women's Complex
F
OTC
Women's Daily Caplet
F
OTC
Women's Daily Formula oral tablet 27-0.4 mg
F
OTC
Women's Daily Multivitamin
F
OTC
Women's Multivitamin Gummies
F
OTC
A Thru Z Advanced Formula
F
OTC
Animi-3 With Vitamin D
F
Antioxidant
F
OTC
Central Vite
F
OTC
Central-Vite
F
OTC
Central-Vite Women's Under 50
F
OTC
Centrum Complete
F
OTC
Century oral tablet 18-400 mg-mcg
F
OTC
Century Ultimate Women's oral tablet 18-400 mg-mcg
F
OTC
Cerefolin
F
OTC
Cerovite Advanced Formula
F
OTC
Certavite-Antioxidant
F
OTC
Chewable-Vite
F
OTC
Complete Multivitamin-Mineral oral tablet
F
OTC
Multivitamins
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 56
Drug
Status
Notes
Daily Multiple For Men 50+
F
OTC
Daily Multiple For Women
F
OTC
Daily Multiple oral tablet , 18-400 mg-mcg
F
OTC
Daily Multi-Vitamin
F
OTC
Daily Multivitamin with Iron
F
OTC
Daily Value
F
OTC
Daily Vitamin Formula
F
OTC
Daily Vitamin Formula + Iron
F
OTC
Daily-Vite
F
OTC
Decubi Vite
F
OTC
Diabetes Health Support
F
OTC
DIALYVITE 800 with Iron
F
E-400 C-500 and Beta Carotene
F
OTC
Essentia
F
OTC
ESSENTIAL Balance with Lutein
F
OTC
Fortavit
F
Infuvite Adult
F
L-Methyl-MC
F
M.V.I. Adult
F
Men's Multi-Vitamin
F
OTC
Metafolbic
F
OTC
Multi Complete with Iron
F
OTC
Multi-Day with Iron
F
OTC
Multi-Delyn
F
OTC
Multiple Vitamins
F
OTC
multivitamin
F
OTC
Multi-Vite
F
OTC
My Favorite Multiple
F
OTC
Once Daily
F
OTC
Oncovite
F
OTC
One Daily Energy oral tablet 9 mg iron-400 mcg200 mg
F
OTC
One Daily Essential oral tablet , 400 mcg
F
OTC
One Daily For Men 50+ Advanced
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 57
Drug
Status
Notes
One Daily Men's 50+ oral tablet 400-600-120 mcg-mcg-mg
F
OTC
One Daily Multivitamin
F
OTC
One Daily Multivit-Iron(folic)
F
OTC
One Daily oral tablet
F
OTC
One Daily Plus Iron oral tablet 18-400 mg-mcg
F
OTC
One Daily Women's Health
F
OTC
One Daily Women's oral tablet 18 mg iron-400 mcg-450 mg Ca
F
OTC
One-A-Day Energy
F
OTC
One-A-Day Essential
F
OTC
One-A-Day Maximum Formula
F
OTC
One-A-Day Men 50 Plus (ginkgo)
F
OTC
One-A-Day Teen Advantage oral tablet 18-400 mg-mcg
F
OTC
One-A-Day Womens Formula oral tablet 18 mg iron-400 mcg-500 mg Ca
F
OTC
One-A-Day Women's Petites
F
OTC
Pharmacist Favorite Multi-Vit
F
OTC
Quintabs
F
OTC
Sentry oral tablet 18-400 mg-mcg
F
OTC
Se-Tan Plus
F
Spectravite Advanced Formula oral tablet 18-400 mg-mcg
F
OTC
Spectravite Ultra Women
F
OTC
Super Multivitamin
F
OTC
Tab-A-Vite
F
OTC
Thera
F
OTC
Thera Vitamin
F
OTC
Therapeutic Liquid
F
OTC
Thera-Tabs
F
OTC
Therems
F
OTC
Vit 3
F
vitamins A and D
F
OTC
Vitamins for Hair oral tablet
F
OTC
Women's One Daily
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 58
Drug
Status
Notes
Yelets
F
OTC
ANIMAL CHEWS
F
OTC
Animal Shape Vitamins
F
OTC
Chewable Multivit-A,B,D,E,K,Zn
F
Chewable-Vite
F
OTC
Child Multivitamins
F
OTC
Children's Chewable
F
OTC
Children's Chewable Multivitmn
F
OTC
Children's Chewable Vitamin
F
OTC
Children's Chewables
F
OTC
Children's Chewables Extra C
F
OTC
Children's Chewables with Iron
F
OTC
Childs Chew Vite
F
OTC
Complete Formulation D3000 oral capsule
F
Complete Formulation Multivit oral capsule
F
Complete Formulation Pediatric
F
Dino-Life
F
OTC
Dino-Life with Extra C
F
OTC
Flintstones Gummies
F
OTC
Flintstones Gummies Omega-3
F
OTC
Flintstones Multivitamin
F
OTC
Flintstones/Extra C oral tablet, chewable
F
OTC
One-A-Day Teen Him VitaCraves
F
OTC
Ped Multivitamins-A,B,D,E,K,Zn
F
Poly-Vita
F
OTC
Poly-Vitamin
F
OTC
Poly-Vitamins
F
OTC
Tri-Vitamin
F
OTC; QL
Zoo Friends oral tablet, chewable , 15 mg
F
OTC
Zoo Friends Original
F
OTC
F
OTC
Pediatric Vitamins
OTC
Pediatric Vitamins And Mineral Combinations Animal Shapes Complete oral tablet, chewable 18 mg iron AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 59
Drug
Status
Notes
AquADEKs Pediatric
F
OTC
Centrum Kids
F
OTC
Cerovite Jr
F
OTC
Chewable-Vite with Iron
F
OTC
Child Complete Multivitamin
F
OTC
Child Vitamin with Minerals
F
OTC
Children's Chew Multivit-Iron
F
OTC
Children's Complete Vitamin
F
OTC
Child's Chewable Vitamins/Iron oral tablet, chewable
F
OTC
Child's Vitamin with Iron
F
OTC
Childs/Iron
F
OTC
Dino-Life with Iron-Zinc
F
OTC
Flintstones Complete (iron)
F
OTC
Flintstones Plus Calcium
F
OTC
Flintstones with Iron
F
OTC
Honey Bears with Iron-Zinc
F
OTC
NovaFerrum Pediatric
F
OTC
Poly-Vi-Sol
F
OTC
Poly-Vi-Sol with Iron
F
OTC
Poly-Vita (iron)
F
OTC
Poly-Vitamin with Iron
F
OTC
Polyvitamin/Iron
F
OTC
Scooby-Doo One A Day
F
OTC
Pediatric Vitamins With Fluoride Combinations Multi-Vitamin With Fluoride oral tablet, chewable 1 mg
F
Multivitamins With Fluoride oral tablet, chewable 1 mg
F
MVC-Fluoride
F
Quflora Pediatric
F
Tri-Vi-Flor
F
Tri-Vitamin With Fluoride
F
QL
Vitamins A,C,D and Fluoride
F
QL
Prenatal Vitamins And Minerals AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 60
Drug
Status
Notes
CompleteNate
F
QL; AL
Folbecal
F
QL; AL
HemeNatal OB
F
QL; AL
iNatal Advance
F
QL; AL
iNatal Ultra
F
QL; AL
KPN oral tablet
F
OTC
M-Vit
F
QL; AL
Mynatal Advance
F
QL; AL
Mynatal oral tablet
F
QL; AL
Mynatal Plus
F
QL; AL
Mynatal-Z
F
Mynate 90 Plus
F
QL; AL
Nestabs
F
QL; AL
Nestabs DHA
F
AL
NewGen
F
QL; AL
Obstetrix DHA
F
Obstetrix EC
F
QL; AL
Obtrex DHA
F
AL
O-Cal FA
F
AL
P D Natal Vitamins-Folic Acid
F
OTC; QL; AL
PNV 29-1
F
QL; AL
Prefera-OB
F
QL; AL
Prenatabs FA
F
QL; AL
Prenatabs Rx
F
QL; AL
Prenatal 19
F
OTC; QL; AL
Prenatal Formula oral tablet 28 mg iron- 800 mcg
F
OTC; QL; AL
Prenatal Low Iron
F
QL; AL
Prenatal Multi-DHA oral capsule 27 mg iron-800 mcg-228 mg
F
OTC; QL; AL
Prenatal oral tablet 28 mg iron- 800 mcg
F
OTC; QL; AL
Prenatal Plus
F
QL; AL
Prenatal Plus (calcium carb)
F
QL; AL
Prenatal Tablet
F
OTC; QL; AL
Prenatal Vitamin oral tablet , 27-0.8 mg
F
OTC; QL; AL
Prenatal Vitamin Plus Low Iron
F
QL; AL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 61
Drug
Status
Notes
Prenatal Vitamin with Minerals
F
OTC; QL; AL
Prenatal-U
F
QL; AL
Prenate AM
F
QL; AL
PreTAB
F
QL; AL
Right Step Prenatal Vitamins
F
OTC
TheraNatal oral tablet
F
OTC; QL; AL
TriAdvance
F
QL; AL
TriCare
F
QL; AL
Trinatal GT
F
QL; AL
Trinatal Rx 1
F
QL; AL
Trinate
F
QL; AL
Tri-Tabs DHA
F
AL
Vinate GT
F
QL; AL
Vinate II
F
QL; AL
Vinate M
F
QL; AL
Vinate One
F
QL; AL
Vinate Ultra
F
QL; AL
Virt-Advance
F
QL; AL
Virt-Vite GT
F
QL; AL
Vol-Nate
F
QL; AL
Vol-Tab Rx
F
QL; AL
B Complex w-Vit C
F
OTC
B-Complex With B-12
F
OTC
Cerefolin NAC (algal oil)
F
OTC
FaBB
F
Folbee
F
Folbic
F
Folgard RX
F
Folinic-Plus
F
Folplex 2.2
F
Foltabs 800
F
OTC
Foltanx
F
OTC
Homocysteine Formula
F
OTC
lmefol Ca-acetyl-meB12-algal
F
OTC
Vitamins - B Preparation Combinations
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 62
Drug
Status
Notes
L-Methyl-B6-B12
F
OTC
L-Methylfolate Ca P-5-P Me-Cbl
F
OTC
LMTHF-Pyridoxine-Cyanocobalamn
F
OTC
Metafolbic Plus RF
F
OTC
Niva-Fol
F
TL Gard Rx
F
Virt-Vite
F
Virt-Vite Forte
F
Vita-Respa
F
Vitamins - B-1, Thiamine and Derivatives Arkaliox
F
OTC
thiamine HCl (vitamin B1) oral tablet 100 mg
F
OTC
Vitamin B-1 (mononitrate)
F
OTC
Vitamin B-1 oral tablet 100 mg, 50 mg
F
OTC
F
OTC
niacin (inositol niacinate) oral tablet
F
OTC
niacin oral capsule, extended release 250 mg
F
OTC
niacin oral tablet 100 mg, 250 mg, 50 mg
F
OTC
niacin oral tablet extended release 250 mg
F
OTC
niacinamide
F
OTC
Slo-Niacin oral tablet extended release 750 mg
F
OTC
F
OTC
biotin oral capsule 1 mg, 2,500 mcg, 5 mg
F
OTC
biotin oral tablet
F
OTC
Cyto B7
F
OTC
Hard Nail
F
OTC
Mega Biotin
F
OTC
Vitamins - B-2, Riboflavin and Derivatives Vitamin B-2 oral tablet 25 mg
Vitamins - B-3, Niacin and Derivatives
Vitamins - B-6, Pyridoxine and Derivatives pyridoxine (vitamin B6) oral tablet 100 mg, 25 mg, 50 mg
Vitamins - Biotin
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 63
Drug
Status
Meribin
Notes
F
OTC
Calcidol
F
OTC
Calciferol
F
OTC
calcitriol oral capsule
F
QL
calcitriol oral solution
F
AL
cholecalciferol (vitamin D3) oral capsule 1,000 unit, 5,000 unit, 50,000 unit
F
OTC
cholecalciferol (vitamin D3) oral drops 400 unit/mL
F
OTC
cholecalciferol (vitamin D3) oral tablet 1,000 unit, 2,000 unit, 5,000 unit
F
OTC
cholecalciferol (vitamin D3) oral tablet, chewable 400 unit
F
OTC
D3-2000
F
OTC
Delta D3
F
OTC
Dialyvite Vitamin D
F
OTC
Dialyvite Vitamin D3 Max
F
OTC
D-Vita
F
OTC
ergocalciferol (vitamin D2) oral capsule
F
ergocalciferol (vitamin D2) oral drops
F
OTC
Replesta
F
OTC
Thera-D
F
OTC
Vital-D Rx
F
Vitamin D3 oral capsule 1,000 unit, 2,000 unit, 400 unit
F
OTC
Vitamin D3 oral tablet 2,000 unit, 400 unit, 5,000 unit
F
OTC
Aqua-E
F
OTC
Aquasol E
F
OTC
Liqui-E
F
OTC
vitamin E (dl, acetate) oral capsule 1,000 unit, 200 unit, 400 unit
F
OTC
vitamin E (dl, acetate) oral drops
F
OTC
vitamin E acetate
F
OTC
Vitamins - D Derivatives
Vitamins - E
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 64
Drug
Status
Notes
vitamin E mixed
F
OTC
vitamin E oral capsule
F
OTC
vitamin E oral drops 100 unit/0.25 mL, 50 unit/mL
F
OTC
vitamin E oral drops 15 unit/0.3 mL
F
OTC
vitamin E oral liquid
F
OTC
vitamin E succinate
F
OTC
wheat germ oil
F
OTC
F
OTC
Vitamins - Folic Acid And Derivatives folic acid oral tablet
Vitamins - Folic Acid Combinations FaBB
F
Folbee
F
Folbic
F
Folgard RX
F
Folplex 2.2
F
Niva-Fol
F
TL Gard Rx
F
Virt-Vite
F
Virt-Vite Forte
F
Vita-Respa
F
Vitamins - PABA Potaba oral capsule
F
Endocrine Agents To Treat Hypoglycemia (Hyperglycemics) Dex4 Glucose oral tablet, chewable
F
OTC
dextrose oral liquid
F
OTC
GlucaGen HypoKit
F
Glucagon Emergency Kit (human)
F
QL
glucose
F
OTC
Glucose Gel
F
OTC
Proglycem
F
Androgen - Single Agents testosterone cypionate AL = Age Limit PA = Prior Authorization
Specialty F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 65
Drug
Status
testosterone enanthate
Notes
Specialty
testosterone transdermal gel in metered-dose pump 1.25 gram/ actuation (1 %)
F
testosterone transdermal gel in packet
F
Antidiuretic and Vasopressor Hormones desmopressin nasal
F
PA
desmopressin oral tablet 0.1 mg
F
desmopressin oral tablet 0.2 mg
F
QL
Stimate
F
PA
F
QL
alogliptin
F
PA
Januvia
F
PA; QL
Tradjenta
F
PA
nateglinide
F
QL
repaglinide
F
QL
F
PA; QL
Farxiga
F
PA; QL
Invokana
F
PA; QL
Antihyperglycemic - Alpha-Glucosidase Inhibitors acarbose oral tablet 100 mg, 25 mg, 50 mg
Antihyperglycemic - Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
Antihyperglycemic - Meglitinide Analogs
Antihyperglycemic - SGLT-2 Inhibitor And Biguanide Combinations Invokamet
Antihyperglycemic - Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors
Antihyperglycemic - Sulfonylurea and Biguanide Combinations glipizide-metformin
F
glyburide-metformin oral tablet 1.25-250 mg
F
glyburide-metformin oral tablet 2.5-500 mg, 5500 mg
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
QL OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 66
Drug Antihyperglycemic - Sulfonylurea Derivatives
Status
Notes
chlorpropamide oral tablet 100 mg, 250 mg
F
QL; AL
glimepiride
F
QL
glipizide oral tablet 10 mg, 5 mg
F
QL
glipizide oral tablet extended release 24hr
F
QL
glyburide micronized
F
QL
glyburide oral
F
QL
tolazamide
F
tolbutamide
F
Antihyperglycemic, Incretin Mimetic,GLP-1 Receptor Agonist Analog-Type Tanzeum
F
PA; QL
Victoza 2-Pak
F
PA; QL
Victoza 3-Pak
F
PA; QL
F
PA
alogliptin-metformin
F
PA
Janumet
F
PA; QL
Janumet XR
F
PA; QL
Jentadueto
F
PA
Antihyperglycemic-Dipeptidyl Peptidase-4 Inhibit and Thiazolidinedione alogliptin-pioglitazone
Antihyperglycemic-Dipeptidyl Peptidase-4(DPP-4)Inhibitor and Biguanide
Antithyroid Agents, Thionamides Imidazole Derivatives methimazole oral tablet 10 mg, 5 mg
F
Antithyroid Agents, Thionamides Thiouracil Derivatives propylthiouracil
F
Bone Formation Stimulating Agents Parathyroid Hormone-Type AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 67
Drug
Status
Notes
Forteo
F
PA; QL
alendronate oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg
F
QL
etidronate disodium
F
ibandronate oral
F
QL
F
PA; QL
F
QL
Bone Resorption Inhibitors Bisphosphonates
Calcimimetic, Parathyroid Calcium Receptor Sensitivity Enhancer Sensipar oral tablet 30 mg, 60 mg, 90 mg
Calcitonins calcitonin (salmon)
Estrogen-Androgen estrogens-methyltestosterone
F
Estrogen-Progestin estradiol-norethindrone acet
F
femhrt Low Dose
F
QL
norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg
F
QL
PREMPHASE
F
QL
PREMPRO
F
QL
estradiol oral
F
AL
estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr
F
QL
estradiol transdermal patch semiweekly 0.05 mg/24 hr
F
estradiol transdermal patch weekly
F
QL
estropipate
F
AL
Menest
F
Premarin oral
F
Estrogens
QL; AL
Glucocorticoids dexamethasone
F
hydrocortisone oral
F
methylprednisolone
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 68
Drug
Status
prednisolone oral solution 15 mg/5 mL
F
prednisolone sodium phosphate oral solution 15 mg/5 mL (3 mg/mL), 5 mg base/5 mL (6.7 mg/5 mL)
F
prednisone oral
F
Notes
Gonadotropin Inhibitor Pituitary Suppressants danazol oral
F
Growth Hormones Norditropin FlexPro
F
PA
Humulin 70/30
F
OTC; QL
Humulin 70/30 KwikPen
F
OTC; QL; AL
Novolin 70/30
F
OTC; QL
Humulin N
F
OTC; QL
Humulin N KwikPen
F
OTC; QL; AL
Novolin N
F
OTC; QL
Humulin R
F
OTC; QL
Humulin R U-500 (Concentrated)
F
PA
Novolin R
F
OTC; QL
Humalog Mix 50-50
F
QL
Humalog Mix 50-50 KwikPen
F
QL; AL
Humalog Mix 75-25
F
QL
Humalog Mix 75-25 KwikPen
F
QL; AL
Novolog Mix 70-30
F
QL
Novolog Mix 70-30 FlexPen
F
QL; AL
Lantus
F
QL
Lantus SoloStar
F
QL; AL
Apidra
F
QL
Apidra SoloStar AL = Age Limit PA = Prior Authorization
F
QL; AL OTC = Over The Counter ST = Step Therapy
Human Insulins - Fixed Combinations
Human Insulins - Intermediate Acting
Human Insulins - Short Acting
Insulin Analogs - Fixed Combinations
Insulin Analogs - Long Acting
Insulin Analogs - Rapid Acting
F = Formulary QL = Quantity Limit
Reviewed and Updated December 2016 69
Drug
Status
Notes
Humalog KwikPen subcutaneous insulin pen 100 unit/mL
F
QL; AL
Humalog subcutaneous cartridge
F
QL; AL
Humalog subcutaneous solution
F
QL
Novolog
F
QL
Novolog FlexPen
F
QL; AL
Novolog PenFill
F
QL; AL
metformin oral tablet 1,000 mg, 500 mg, 850 mg
F
QL
metformin oral tablet extended release 24 hr
F
Insulin Response Enhancers Biguanides
Insulin Response Enhancers Thiazolidinediones (PPAR-Gamma Agonists) pioglitazone
F
QL
Specialty
PA
Insulin-Like Growth Factor-1 (IGF-1) Increlex
Mineralocorticoids fludrocortisone
F
Oxytocic - Ergot Alkaloids methylergonovine oral
F
AL
Progestins medroxyprogesterone oral
F
norethindrone acetate
F
QL
progesterone micronized oral capsule 100 mg, 200 mg
F
QL
Prolactin Inhibitor - Ergot Derivative Dopamine Receptor Agonists cabergoline
F
Selective Estrogen Receptor Modulators (SERMs) raloxifene
F
QL; AL
Somatostatic Agents octreotide acetate injection solution 1,000 mcg/mL, 100 mcg/mL, 200 mcg/mL, 50 mcg/mL AL = Age Limit PA = Prior Authorization
Specialty
F = Formulary QL = Quantity Limit
PA OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 70
Drug Thyroid Hormones - Animal Source (Porcine)
Status
Armour Thyroid
F
Nature-Throid
F
NP Thyroid oral tablet 30 mg, 60 mg, 90 mg
F
Notes
Thyroid Hormones - Synthetic T3 (Triiodothyronine) liothyronine oral
F
Thyroid Hormones - Synthetic T4 (Thyroxine) levothyroxine oral
F
Gastrointestinal Therapy Agents Antacid - Alginate Combinations Foaming Antacid oral tablet, chewable
F
OTC
Gaviscon oral tablet, chewable
F
OTC
F
OTC
Acid Gone Antacid
F
OTC
Acid Gone Antacid E.Strength
F
OTC
Alka-Seltzer Gold
F
OTC
Alka-Seltzer Heartburn
F
OTC
Antacid (calcium carb-mag hyd)
F
OTC
Antacid ExSt (ca carb-mag hyd)
F
OTC
Antacid ExSt (mag carb-Al hyd)
F
OTC
Antacid Supreme
F
OTC
Foaming Antacid oral suspension
F
OTC
Gaviscon Extra Strength
F
OTC
Heartburn Antacid
F
OTC
Heartburn Relief
F
OTC
MAG-AL
F
OTC
Mi-Acid oral tablet, chewable
F
OTC
Riginic
F
OTC
Rolaids
F
OTC
Antacid - Aluminum aluminum hydroxide gel
Antacid - Antacid Combinations
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 71
Drug Antacid - Bicarbonate
Status
sodium bicarbonate oral
Notes
F
OTC
Alcalak
F
OTC
Antacid (calcium carbonate) oral tablet, chewable 200 mg calcium (500 mg)
F
OTC
Antacid Calcium oral tablet, chewable 215 mg calcium (500 mg)
F
OTC
Antacid Ext Str (calcium carb)
F
OTC
Antacid Extra-Strength oral tablet, chewable 168 mg (420 mg), 300 mg (750 mg)
F
OTC
Antacid Ultra Strength
F
OTC
Calcium Antacid oral tablet, chewable 200 mg calcium (500 mg), 300 mg (750 mg), 320 mg (750 mg), 400 mg (1,000 mg)
F
OTC
Calcium Antacid Ultra Max St
F
OTC
calcium carbonate oral suspension
F
OTC
calcium carbonate oral tablet 260 mg calcium (648 mg)
F
OTC
calcium carbonate oral tablet, chewable 200 mg calcium (500 mg), 400 mg (1,000 mg)
F
OTC
Cal-Gest Antacid
F
OTC
Children's Pepto
F
OTC
Children's Soothe
F
OTC
Smooth Antacid
F
OTC
Tums Freshers
F
OTC
Tums oral tablet, chewable 200 mg calcium (500 mg)
F
OTC
Tums Ultra
F
OTC
Ultra Strength Antacid
F
OTC
Ultra Strength Calcium Antacid
F
OTC
Phillips Milk of Magnesia oral tablet, chewable
F
OTC
Ri-Mag
F
OTC
F
OTC
Antacid - Calcium
Antacid - Magnesium
Antacid - Simethicone Combinations Advanced Antacid-Antigas oral suspension 200200-20 mg/5 mL AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 72
Drug
Status
Notes
Alka-Seltzer Heartburn+Gas
F
OTC
Almacone
F
OTC
Almacone-2
F
OTC
Antacid
F
OTC
Antacid Anti-Gas
F
OTC
Antacid Anti-Gas (ca carb-sim)
F
OTC
Antacid Anti-Gas Double Str
F
OTC
Antacid Extra-Strength oral suspension 200-20020 mg/5 mL
F
OTC
Antacid Liquid
F
OTC
Antacid M
F
OTC
Antacid Maximum Strength
F
OTC
Antacid Multi-Symptom
F
OTC
Antacid Plus Anti-Gas
F
OTC
Antacid Regular Strength
F
OTC
Antacid with Simethicone
F
OTC
Antacid-Antigas II
F
OTC
Antacid-Antigas oral suspension 200-200-20 mg/5 mL
F
OTC
Antacid-Simethicone
F
OTC
Comfort Gel
F
OTC
Comfort Gel Extra Strength
F
OTC
E-Z-Gas II
F
OTC
Flanax Antacid
F
OTC
Gelusil Antacid and Anti-Gas oral tablet, chewable
F
OTC
Geri-Lanta
F
OTC
Geri-Mox Antacid-Antigas
F
OTC
Liquid Antacid
F
OTC
Maalox Advanced
F
OTC
Maalox Maximum Strength
F
OTC
Mag-Al Plus
F
OTC
Mag-Al Plus Extra Strength
F
OTC
Maglox
F
OTC
Masanti Double Strength
F
OTC
Mi-Acid oral suspension
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 73
Drug
Status
Notes
Mintox
F
OTC
Mintox Maximum Strength
F
OTC
Mintox Plus
F
OTC
Ri-Gel
F
OTC
Ri-Gel II
F
OTC
Ri-Mag Plus
F
OTC
Ri-Mox
F
OTC
Ri-Mox Plus
F
OTC
Rulox
F
OTC
F
OTC
Anti-Diarrhea
F
OTC
Anti-Diarrheal (loperamide) oral capsule
F
OTC
Diamode
F
OTC
loperamide oral capsule
F
OTC
loperamide oral liquid 1 mg/7.5 mL
F
OTC
loperamide oral tablet
F
OTC
paregoric
F
Antacid Combinations Other Dewee's Carminative
Antidiarrheal - Antiperistaltic Agents
Antidiarrheal - Bismuth Agents Bismatrol
F
OTC
Bismuth Maximum Strength
F
OTC
Bismuth oral suspension
F
OTC
Bismuth oral tablet
F
OTC
bismuth subsalicylate oral suspension
F
OTC
Diarrhea Relief (bismuth subs)
F
OTC
Diotame
F
OTC
Kaopectate (bismuth subsalicy) oral suspension
F
OTC
Kaopectate Ex Str (bismuth ss)
F
OTC
Kao-Tin (bismuth subsalicylat)
F
OTC
K-Pec Antidiarrheal (bism sub)
F
OTC
Peptic Relief
F
OTC
Pepto-Bismol Max St
F
OTC
Pink Bismuth
F
OTC
Pink Bismuth Maximum Strength AL = Age Limit PA = Prior Authorization
F
OTC OTC = Over The Counter ST = Step Therapy
F = Formulary QL = Quantity Limit
Reviewed and Updated December 2016 74
Drug
Status
Notes
Soothe (bismuth subsalicylate) oral tablet
F
OTC
Soothe Regular Strength
F
OTC
Stomach Relief Max Strength
F
OTC
Stomach Relief oral suspension 525 mg/15 mL
F
OTC
Stomach Relief oral tablet
F
OTC
Stomach Relief oral tablet, chewable
F
OTC
Stomach Relief Original
F
OTC
Antidiarrheal AntiperistalticAnticholinergic Combinations diphenoxylate-atropine
F
Antiemetic - Anticholinergics Transderm-Scop
F
QL
dimenhydrinate oral
F
OTC
meclizine oral tablet 12.5 mg, 25 mg
F
OTC
meclizine oral tablet, chewable
F
OTC
Motion Sickness (meclizine)
F
OTC
Motion Sickness Relief(meclizine)
F
OTC
Travel Sickness (meclizine)
F
OTC
F
PA
Antiemetic - Antihistamines
Antiemetic - Cannabinoids dronabinol
Antiemetic - Dopamine (D2)/5-HT3 Antagonists trimethobenzamide oral
F
Antiemetic - Phenothiazines prochlorperazine
F
QL
prochlorperazine maleate oral tablet 10 mg, 5 mg
F
QL
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
granisetron HCl oral
F
ST; QL
ondansetron HCl oral solution
F
QL; AL
ondansetron HCl oral tablet 24 mg, 4 mg, 8 mg
F
QL
Antiemetic - Selective Serotonin 5-HT3 Antagonists
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 75
Drug
Status
ondansetron oral tablet, disintegrating 4 mg, 8 mg
F
Notes QL
Colonic Acidifier (Ammonia Inhibitor) lactulose oral solution 10 gram/15 mL, 10 gram/15 mL (15 mL)
F
Digestive Enzyme Mixtures Creon oral capsule, delayed release(DR/EC)
F
Zenpep oral capsule, delayed release(DR/EC)
F
QL
Gallstone Solubilizing (Litholysis) Agents ursodiol oral capsule
F
ursodiol oral tablet
F
QL
Gastric Acid Secretion Reducers Histamine H2-Receptor Antagonists Acid Controller
F
OTC
Acid Reducer (famotidine)
F
OTC
cimetidine oral tablet 200 mg
F
OTC
cimetidine oral tablet 300 mg, 400 mg, 800 mg
F
famotidine oral tablet 10 mg, 20 mg
F
famotidine oral tablet 40 mg
F
Heartburn Prevention
F
OTC
Heartburn Relief (cimetidine)
F
OTC
Heartburn Relief (famotidine)
F
OTC
ranitidine HCl oral capsule
F
ranitidine HCl oral syrup
F
QL
ranitidine HCl oral tablet 150 mg, 75 mg
F
OTC
ranitidine HCl oral tablet 300 mg
F
OTC
Gastric Acid Secretion Reducing Agents - Proton Pump Inhibitors (PPIs) lansoprazole oral capsule, delayed release(DR/EC) 15 mg
F
ST; OTC; QL
lansoprazole oral capsule, delayed release(DR/EC) 30 mg
F
ST; QL
Nexium 24HR oral capsule, delayed release(DR/EC)
F
ST; OTC; QL
omeprazole magnesium
F
OTC; QL
omeprazole oral capsule, delayed release(DR/EC)
F
QL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 76
Drug
Status
Notes
omeprazole oral tablet, delayed release (DR/EC)
F
OTC; QL
pantoprazole oral tablet, delayed release (DR/EC) 20 mg, 40 mg
F
QL
Prevacid SoluTab
F
AL
Protonix oral tablet, delayed release (DR/EC) 20 mg
F
Gastric Mucosa - Cytoprotective Prostaglandin Analogs misoprostol
F
QL
Gas Relief 80
F
OTC
Gas Relief Extra Strength oral tablet, chewable
F
OTC
Gas Relief oral drops, suspension
F
OTC
Gas Relief oral tablet, chewable
F
OTC
Gas-X Extra Strength oral tablet, chewable
F
OTC
Gas-X oral tablet, chewable
F
OTC
Infants Gas Relief
F
OTC
Mi-Acid Gas Relief
F
OTC
Mytab Gas
F
OTC
Mytab Gas Maximum Strength
F
OTC
simethicone oral drops, suspension
F
OTC
simethicone oral tablet, chewable
F
OTC
Gastrointestinal Antiflatulents
Gastrointestinal Prokinetic Agents - D2 Antagonist/5-HT4 Agonists metoclopramide HCl oral solution
F
metoclopramide HCl oral tablet
F
GI Antispasmodic - Belladonna Alkaloids hyoscyamine sulfate oral
F
hyoscyamine sulfate sublingual
F
AL
GI Antispasmodic - Quaternary Ammonium Compounds glycopyrrolate oral
F
propantheline
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 77
Drug GI Antispasmodic - Synthetic Tertiary Amines
Status
Notes
dicyclomine oral capsule
F
AL
dicyclomine oral solution
F
AL
dicyclomine oral tablet
F
AL
IBS Agent - Gastrointestinal Chloride Channel Activator Agents Amitiza
F
Inflammatory Bowel Agent Aminosalicylates and Related Agents Apriso
F
ST
Asacol HD
F
ST; QL
balsalazide
F
Canasa
F
Delzicol oral capsule (with del rel tablets)
F
ST
Dipentum
F
QL
mesalamine rectal
F
Pentasa
F
sulfasalazine
F
ST; QL
Inflammatory Bowel Agent Glucocorticoids hydrocortisone rectal
F
Inflammatory Bowel Agent - Tumor Necrosis Factor Alpha Blockers Humira Pediatric Crohn's Start
F
PA; QL
Humira subcutaneous syringe kit 10 mg/0.2 mL, 20 mg/0.4 mL, 40 mg/0.8 mL
F
PA; QL
Benefiber Clear SF (dextrin)
F
OTC
Benefiber Sugar Free (dextrin) oral powder 3 gram/3.8 gram
F
OTC
Best Fiber
F
OTC
Child's Fiber Select Gummies
F
OTC
Citrucel
F
OTC
Citrucel (sucrose)
F
OTC
Laxative - Bulk Forming
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 78
Drug
Status
Notes
Citrucel Sugar Free
F
OTC
Colox
F
OTC
Daily Fiber
F
OTC
Easy Fiber (wheat dextrin)
F
OTC
Easy Fiber oral powder
F
OTC
Equalactin
F
OTC
fiber
F
OTC
Fiber (calcium polycarbophil)
F
OTC
Fiber (dextrin)
F
OTC
Fiber (psyllium husk/sugar) oral powder 3.4 gram/11 gram, 3.4 gram/12 gram
F
OTC
Fiber (with aspartame)
F
OTC
Fiber Choice (inulin)
F
OTC
Fiber Gummies (with chromium)
F
OTC
Fiber Laxative (ca polycarbo)
F
OTC
Fiber Laxative (methylcellulo)
F
OTC
Fiber Select Gummies
F
OTC
Fiber Smooth
F
OTC
Fiber Smooth (sucrose)
F
OTC
Fiber Supplement (inulin)
F
OTC
Fiber Therapy (ca polycarboph)
F
OTC
Fiber Therapy (m-cell/sugar) oral powder 2 gram/19 gram
F
OTC
Fiber Therapy (m-cellulose)
F
OTC
Fiber Therapy (psyllium seed)
F
OTC
Fiber With Probiotic
F
OTC
FiberCon
F
OTC
Fiber-Lax
F
OTC
Fiber-Stat
F
OTC
Fiber-Tabs
F
OTC
Hydrocil
F
OTC
Hydrocil Instant
F
OTC
Konsyl (sugar)
F
OTC
Konsyl Easy Mix
F
OTC
Konsyl Fiber
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 79
Drug
Status
Notes
Konsyl Formula-D
F
OTC
Konsyl Sugar-Free (aspartame)
F
OTC
Konsyl Sugar-Free oral powder
F
OTC
Konsyl Sugar-Free oral powder in packet
F
OTC
LiquaFiber
F
OTC
Metamucil (with sugar) oral powder 3.4 gram/12 gram
F
OTC
Metamucil (with sugar) oral powder in packet
F
OTC
Metamucil Fiber Singles
F
OTC
Metamucil MultiHealth Fiber
F
OTC
Metamucil oral powder
F
OTC
Metamucil oral wafer
F
OTC
Metamucil Plus Calcium
F
OTC
Metamucil Sugar-Free (aspart) oral powder 3.4 gram/5.8 gram
F
OTC
Natural Fiber Laxative
F
OTC
Natural Fiber Laxative (sugar) oral powder 3.4 gram/12 gram, 3.4 gram/7 gram
F
OTC
Natural Fiber Laxative Smooth
F
OTC
Natural Fiber Laxative Therapy
F
OTC
Natural Fiber Laxative(aspart) oral powder
F
OTC
Natural Fiber Supplement oral powder in packet
F
OTC
Natural Vegetable
F
OTC
Natural Vegetable (psyllium)
F
OTC
Natural Vegetable Powder
F
OTC
Nutrisource Fiber
F
OTC
psyllium husk oral capsule 0.52 gram
F
OTC
psyllium husk oral powder
F
OTC
Reguloid (dextrose)
F
OTC
Reguloid oral powder
F
OTC
Reguloid, Sugar Free
F
OTC
Soluble Fiber
F
OTC
Unifiber
F
OTC
Wal-Mucil Natural Fiber Lax
F
OTC
Wal-Mucil with Calcium
F
OTC
Laxative - Lubricant AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 80
Drug
Status
Notes
Kondremul
F
OTC
Mineral Oil Extra Heavy
F
OTC
Mineral Oil Heavy oral
F
OTC
Mineral Oil Laxative
F
OTC
mineral oil oral
F
OTC
mineral oil rectal
F
OTC
Ready-To-Use Enema (min oil)
F
OTC
Citrate of Magnesia
F
OTC
Citroma
F
OTC
Epsom Salt oral
F
OTC
Fleet Glycerin (Adult)
F
OTC
Fleet Glycerin (Child)
F
OTC
Fleet Glycerin Laxative
F
OTC
glycerin (adult)
F
OTC
glycerin (child)
F
OTC
Kristalose
F
lactulose oral solution 10 gram/15 mL, 20 gram/30 mL
F
Laxative (glycerin-pediatric)
F
OTC
magnesium citrate oral solution
F
OTC
Milk of Magnesia
F
OTC
Milk Of Magnesia Concentrated
F
OTC
Pedia-Lax
F
OTC
Phillips Milk of Magnesia oral suspension 400 mg/5 mL
F
OTC
polyethylene glycol 3350 oral powder
F
OTC
polyethylene glycol 3350 oral powder in packet
F
OTC; QL
Sani-Supp (Adult)
F
OTC
Sani-Supp (Infant)
F
OTC
Suppository Adult
F
OTC
Enema Disposable
F
OTC
Enema rectal enema 19-7 gram/118 mL
F
OTC
Fleet Enema
F
OTC
Laxative - Saline And Osmotic
Laxative - Saline/Osmotic Mixtures
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 81
Drug
Status
Notes
Fleet Enema Extra
F
OTC
Fleet Pediatric
F
OTC
Gavilyte-C
F
GaviLyte-G
F
GaviLyte-N
F
Golytely
F
MoviPrep
F
Oral Saline Laxative
F
OsmoPrep
F
peg 3350-electrolytes
F
PEG-3350 with flavor packs
F
peg-electrolyte soln
F
Phosphate Laxative oral liquid
F
OTC
Ready-To-Use Enema
F
OTC
SUPREP Bowel Prep Kit
F
TriLyte With Flavor Packets
F
OTC
Laxative - Stimulant Alophen
F
OTC
Bisac-Evac
F
OTC
bisacodyl oral
F
OTC; QL
bisacodyl rectal
F
OTC; QL
Bisa-Lax
F
OTC
Biscolax
F
OTC; QL
castor oil oral
F
OTC
Chocolate Laxative
F
OTC
Correctol
F
OTC
Ducodyl
F
OTC
Ex-Lax (sennosides)
F
OTC
Ex-Lax Maximum Strength
F
OTC
Fleet Bisacodyl
F
OTC
Fleet Laxative
F
OTC; QL
Gentle Laxative
F
OTC
Geri-kot
F
OTC
Laxative (bisacodyl)
F
OTC
Laxative (sennosides) oral tablet 17.2 mg, 25 mg
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 82
Drug
Status
Notes
Laxative (sennosides) oral tablet, chewable
F
OTC
Laxative Feminine
F
OTC
Laxative Maximum Strength
F
OTC
Laxative Pills
F
OTC
Laxative Pills Regular
F
OTC
Natural Laxative
F
OTC
Natural Senna Laxative
F
OTC
Natural Veg Laxative(sennosid)
F
OTC
Natural Vegetable Laxative
F
OTC
Perdiem Overnight Relief
F
OTC
Senexon
F
OTC
Senna Lax
F
OTC
Senna Laxative
F
OTC
senna leaf
F
OTC
senna oral syrup
F
OTC
senna oral tablet
F
OTC
Senna-Extra
F
OTC
Senno
F
OTC
Senokot
F
OTC
SenokotXTRA
F
OTC
Sen-O-Tab
F
OTC
The Magic Bullet
F
OTC
Vegetable Laxative
F
OTC
Woman's Laxative
F
OTC
Women's Laxative (bisacodyl)
F
OTC
F
OTC
Laxative - Stimulant And Bulk Forming Combinations Senna Prompt
Laxative - Stimulant and Saline/Osmotic Combinations GaviLyte-H and Bisacodyl
F
PEG-Prep
F
Prepopik
F
Laxative - Stimulant and Surfactant Combinations AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 83
Drug
Status
Notes
Doc-Q-Lax
F
OTC
DOK Plus
F
OTC
Lax Stool Softener With Senna
F
OTC
Laxacin
F
OTC
Laxative Plus Stool Softener
F
OTC
Medi-Laxx
F
OTC
P-COL RITE
F
OTC
PERI-COLACE
F
OTC
Senexon-S
F
OTC
Senna Laxative-Stool Softener
F
OTC
Senna Plus
F
OTC
Senna with Docusate Sodium
F
OTC
Sennalax-S
F
OTC
Senna-S
F
OTC
Senna-Time S
F
OTC
sennosides-docusate sodium
F
OTC
Senokot-S
F
OTC
Stimulant Laxative Plus
F
OTC
Stool Softener-Laxative
F
OTC
Stool Softener-Stimulant Laxat
F
OTC
COLACE Clear
F
OTC
Col-Rite oral capsule 100 mg, 50 mg
F
OTC
Diocto
F
OTC
Dioctyl
F
OTC
Docu
F
OTC
Docuprene
F
OTC
docusate calcium
F
OTC
docusate sodium oral
F
OTC
Docusil
F
OTC; QL
Docusol
F
OTC
DocuSol Kids
F
OTC
DocuSol Plus
F
OTC
DOK
F
OTC
Dulcolax Stool Softener (DSS)
F
OTC
Laxative - Surfactant
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 84
Drug
Status
Notes
Enemeez
F
OTC
Enemeez Plus
F
OTC
Pedia-Lax Stool Softener
F
OTC
Phillips Liqui-Gels
F
OTC
Promolaxin
F
OTC
Silace
F
OTC
Stool Softener
F
OTC
Surfak
F
OTC
F
OTC
F
QL
Specialty
PA
Laxative Combinations - Other Ceo-Two
Peptic Ulcer - Gastric Lumen Adherent Cytoprotectives sucralfate oral tablet
Short Bowel Syndrome (SBS) Agents octreotide acetate injection solution 1,000 mcg/mL, 100 mcg/mL, 200 mcg/mL, 50 mcg/mL
Genitourinary Therapy Interstitial Cystitis Agents Elmiron
F
PA; QL
Phosphate Binders Auryxia
F
calcium acetate oral capsule
F
calcium acetate oral tablet 667 mg
F
Calphron
F
Fosrenol oral powder in packet
F
Fosrenol oral tablet, chewable
F
PA
MagneBind 300
F
OTC
MagneBind 400
F
Phoslyra
F
Renagel
F
PA
Renvela oral tablet
F
PA
Velphoro
F
OTC
Phosphate Binders - Calcium-Based calcium acetate oral capsule AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 85
Drug
Status
calcium acetate oral tablet 667 mg
F
Calphron
F
Phoslyra
F
Notes OTC
Phosphate Binders - Iron-Based Auryxia
F
Velphoro
F
Prostatic Hypertrophy Agent - Alpha-1Adrenoceptor Antagonists tamsulosin
F
QL
F
QL
Prostatic Hypertrophy Agent - Type II 5-Alpha Reductase Inhibitors finasteride oral tablet 5 mg
Urinary Acidifier - Phosphates K-Phos No 2
F
K-Phos Original
F
Urinary Alkalinizer - Citrates Cytra K Crystals
F
Cytra-2
F
potassium citrate oral tablet extended release 10 mEq (1,080 mg), 5 mEq (540 mg)
F
potassium citrate-citric acid
F
sodium citrate-citric acid
F
Tricitrates
F
Urocit-K 10
F
Urocit-K 5
F
Virtrate-3
F
Urinary Analgesics phenazopyridine oral tablet 100 mg, 200 mg
F
Urinary Antibacterial - Methenamine And Salts methenamine hippurate
F
methenamine mandelate
F
Urinary Antibacterial - Nitrofuran Derivatives AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 86
Drug
Status
Notes
nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg
F
QL; AL
nitrofurantoin monohyd/m-cryst
F
QL
nitrofurantoin oral
F
AL
Urinary Anti-Infective MethenamineAntispas-Analg Combinations Uretron D-S oral tablet 81.6-10.8-40.8 mg
F
Utira-C
F
Urinary Antispasmodic - Smooth Muscle Relaxants flavoxate
F
oxybutynin chloride oral syrup
F
QL
oxybutynin chloride oral tablet
F
QL
oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg
F
QL
tolterodine oral capsule, extended release 24hr
F
ST; QL
tolterodine oral tablet
F
ST; QL
trospium oral tablet
F
ST; QL
F
QL
F
QL
Urinary Retention Therapy Parasympathomimetic Agents bethanechol chloride
Gout and Hyperuricemia Therapy Gout Acute Therapy - Antimitotics colchicine oral tablet
Gout And Hyperuricemia - AntimitoticUricosuric Combinations probenecid-colchicine
F
Hyperuricemia Therapy - Uricosurics probenecid
F
Hyperuricemia Therapy - Xanthine Oxidase Inhibitors allopurinol oral tablet 100 mg, 300 mg
F
QL
Uloric oral tablet 40 mg
F
PA; QL
Uloric oral tablet 80 mg
F
PA
Hematological Agents AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 87
Drug Anticoagulants - Coumarin
Status
warfarin
Notes
F
Direct Factor Xa Inhibitors Eliquis
F
QL
Xarelto oral tablet 10 mg, 15 mg, 20 mg
F
QL
Xarelto oral tablets, dose pack
F
QL
Aranesp (in polysorbate)
F
PA
Epogen injection solution 10,000 unit/mL, 2,000 unit/mL, 20,000 unit/2 mL, 20,000 unit/mL, 3,000 unit/mL, 4,000 unit/mL
F
PA
Procrit
F
PA
Granix
F
PA
Neupogen
F
PA
Zarxio
F
PA
Erythropoietins
Granulocyte Colony-Stimulating Factor (G-CSF)
Hematorheologic Agents pentoxifylline
F
Heparins heparin (porcine) injection solution 10,000 unit/mL, 5,000 unit/mL
F
Indirect Factor Xa Inhibitors fondaparinux
F
PA
F
PA
F
QL
Low Molecular Weight Heparins enoxaparin subcutaneous syringe
Platelet Aggregation Inhibitors Phosphodiesterase III Inhibitors cilostazol
Platelet Aggregation Inhibitors Quinazoline Agents anagrelide
F
Platelet Aggregation Inhibitors Salicylates aspirin oral tablet AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC; QL; AL OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 88
Drug
Status
Notes
aspirin oral tablet, chewable
F
OTC; QL; AL
aspirin oral tablet, delayed release (DR/EC) 325 mg, 81 mg
F
OTC; QL; AL
F
QL
dipyridamole oral tablet 25 mg, 75 mg
F
QL
dipyridamole oral tablet 50 mg
F
Platelet Aggregation Inhibitors Thienopyridine Agents clopidogrel oral tablet 300 mg, 75 mg
Platelet Aggregation Inhib-PDE and Adenosine Deaminase Inhibitor
Sickle Cell Anemia Agents Droxia
F
Thrombin Inhibitor - Selective Direct And Reversible Pradaxa oral capsule 150 mg, 75 mg
F
QL
Immunosuppressive Agents Immunosuppressive - Calcineurin Inhibitors cyclosporine modified oral capsule
F
cyclosporine modified oral solution
F
cyclosporine oral capsule
F
tacrolimus oral
F
AL
Immunosuppressive - Inosine Monophosphate Dehydrogenase Inhibitors mycophenolate mofetil oral capsule
F
mycophenolate mofetil oral suspension for reconstitution
F
mycophenolate mofetil oral tablet
F
mycophenolate sodium
F
AL
ST
Immunosuppressive - Mammalian Target Of Rapamycin (mTOR) Inhibitors sirolimus
F
Immunosuppressive - Purine Analogs AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 89
Drug
Status
azathioprine
F
Notes QL
Locomotor System ALS Agent - Benzathiazoles riluzole
F
Antimyasthenic Agent - Reversible Cholinesterase Inhibitors pyridostigmine bromide
F
Skeletal Muscle Relaxant - Central Muscle Relaxants baclofen
F
chlorzoxazone
F
AL
cyclobenzaprine oral tablet 10 mg, 5 mg
F
AL
methocarbamol oral
F
AL
orphenadrine citrate oral
F
QL; AL
tizanidine oral tablet
F
Medical Supplies and Durable Medical Equipment (DME) Medical Supplies and DME - Blood Glucose Tests Accu-Chek Aviva Plus test strip
F
OTC; QL
Accu-Chek SmartView Test Strip
F
OTC; QL
Accu-Chek Aviva Control Soln
F
OTC
Accu-Chek Aviva Plus Meter
F
OTC; QL
Accu-Chek FastClix
F
OTC; QL
Accu-Chek FastClix kit
F
OTC
Accu-Chek Multiclix Lancet
F
OTC; QL
Accu-Chek Multiclix Lancet kit
F
OTC
Accu-Chek Nano
F
OTC; QL
Accu-Chek SmartView Control Sol
F
OTC
Accu-Chek Soft Dev Lancets
F
OTC
Accu-Chek Softclix Lancet Dev
F
OTC
Accu-Chek Softclix Lancets
F
OTC; QL
Alternate Site Lancet
F
OTC
Medical Supplies and DME - Glucose Monitoring Test Supplies
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 90
Drug
Status
Notes
Fine 30 Universal Lancets
F
OTC
First Choice Lancets Thin
F
OTC
inControl Super Thin Lancets
F
OTC
inControl Ultra Thin Lancets
F
OTC
Micro Thin Lancets
F
OTC
Nova Safety Lancets 28 gauge
F
OTC
Nova Sureflex Lancets
F
OTC
ReliOn Ultra Thin Plus Lancets
F
OTC
Smart Sense Lancets 26 gauge, 33 gauge
F
OTC
Soft Touch Lancets
F
OTC; QL
Ultra Thin Lancets 28 gauge
F
OTC
Ultra Thin Plus Lancets
F
OTC
UltraLANCE Lancets 26 gauge
F
OTC
Universal 1 Lancets 33 gauge
F
OTC
F
OTC; QL
1st Tier Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Advocate Pen Needles 31 gauge x 5/16"
F
OTC
Advocate Syringes syringe 1 mL 30 gauge x 5/16
F
OTC
BD Insulin Pen Needle UF Mini
F
OTC
BD Insulin Pen Needle UF Orig
F
OTC; QL
BD Insulin Pen Needle UF Short
F
OTC
BD Insulin Syringe Half Unit
F
OTC; QL
BD Insulin Syringe Micro-Fine syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe Ultra-Fine
F
OTC; QL
BD Integra Insulin Syringe
F
OTC; QL
BD Lo-Dose Micro-Fine IV syringe 1/2 mL 28 gauge x 1/2"
F
OTC
BD Lo-Dose Ultra-Fine syringe 0.3 mL 29 gauge x 1/2"
F
OTC
BD Ultra-Fine Nano Pen Needles
F
OTC
Medical Supplies and DME - Hearing Aid Supplies and Batteries Hearing Aid Batteries
Medical Supplies and DME - Insulin Needles-Syringes and Admin Supplies
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 91
Drug
Status
Notes
Easy Comfort Insulin Syringe 1 mL 30 gauge x 5/16
F
OTC
Easy Touch Insulin Syringe 0.5 mL 31 gauge x 5/16, 1 mL 28 gauge x 1/2", 1 mL 31 gauge x 5/16
F
OTC; QL
Easy Touch needle 31 gauge x 3/16"
F
OTC; QL
inControl Pen Needle 29 gauge x 1/2", 32 gauge x 5/32"
F
OTC
insulin syringe-needle U-100 syringe 0.3 mL 30 gauge x 5/16, 0.3 mL 31 gauge x 5/16, 0.5 mL 29 gauge x 1/2", 1 mL 29 gauge x 1/2", 1 mL 30 gauge x 3/8", 1 mL 31 gauge x 5/16, 1/2 mL 28 gauge x 1/2", 1/2 mL 30 gauge x 5/16
F
OTC; QL
insulin syringes (disposable)
F
OTC
NovoFine 30
F
OTC; QL
Novofine 32
F
OTC; QL
Novofine Autocover
F
OTC; QL
Pen Needle 29 gauge x 1/2", 31 gauge x 5/16"
F
OTC
SafeSnap Insulin Syringe 0.3 mL 30 gauge x 5/16"
F
OTC
Sure Comfort Pen Needle 29 gauge x 1/2"
F
OTC; QL
Sure-Fine Pen Needles needle 29 gauge x 1/2"
F
OTC; QL
Sure-Ject Insulin Syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
Ulticare Pen Needle 31 gauge x 5/16"
F
OTC; QL
Ulticare syringe 1 mL 29 x 1/2", 1 mL 30 gauge x 1/2"
F
OTC; QL
Ultilet Pen Needle 29 gauge
F
OTC
Ultra Comfort Insulin Syringe 1 mL 28 gauge, 1/2 mL 28 gauge x 1/2"
F
OTC
Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Unifine Pentips Plus needle 31 gauge x 5/16"
F
OTC
Aimsco
F
OTC; QL
Condoms-Prem Lubricated
F
OTC; QL
F
OTC OTC = Over The Counter ST = Step Therapy
Medical Supplies and DME - Male Condoms
Medical Supplies and DME Miscellaneous Other BD Sharps Collector AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
Reviewed and Updated December 2016 92
Drug
Status
Sharps Container
Notes
F
OTC
F
OTC
Peak Air Peak Flow Meter
F
OTC; QL
Personal Best Full Range
F
OTC
Aerochamber MV
F
QL
OptiChamber Diamond Lg Mask
F
QL
OptiChamber Diamond VHC
F
QL
OptiChamber Diamond-Med Mask
F
QL
OptiChamber Diamond-Sml Mask
F
QL
PrimeAire
F
QL
ProChamber
F
QL
Vortex Holding Chamber
F
QL
1st Tier Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Accu-Chek Aviva Control Soln
F
OTC
Accu-Chek Aviva Plus Meter
F
OTC; QL
Accu-Chek Aviva Plus test strip
F
OTC; QL
Accu-Chek FastClix
F
OTC; QL
Accu-Chek FastClix kit
F
OTC
Accu-Chek Multiclix Lancet
F
OTC; QL
Accu-Chek Multiclix Lancet kit
F
OTC
Accu-Chek Nano
F
OTC; QL
Accu-Chek SmartView Control Sol
F
OTC
Accu-Chek SmartView Test Strip
F
OTC; QL
Accu-Chek Soft Dev Lancets
F
OTC
Accu-Chek Softclix Lancet Dev
F
OTC
Accu-Chek Softclix Lancets
F
OTC; QL
Medical Supplies and DME - Needles and Syringes SafeSnap Syringe 1 mL 25 gauge x 5/8", 1 mL 27 gauge x 1/2", 3 mL
Medical Supplies and DME - Peak Flow Meters
Medical Supplies and DME Respiratory Therapy Supplies
Medical Supply, FDB Superset Medical Supply, FDB Superset
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 93
Drug
Status
Notes
Advocate Pen Needles needle 31 gauge x 5/16"
F
OTC
Advocate Syringes syringe 1 mL 30 gauge x 5/16
F
OTC
Aerochamber MV
F
QL
Aimsco
F
OTC; QL
Alternate Site Lancet
F
OTC
BD Insulin Pen Needle UF Mini
F
OTC
BD Insulin Pen Needle UF Orig
F
OTC; QL
BD Insulin Pen Needle UF Short
F
OTC
BD Insulin Syringe Half Unit
F
OTC; QL
BD Insulin Syringe Micro-Fine syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
BD Insulin Syringe Ultra-Fine
F
OTC; QL
BD Integra Insulin Syringe
F
OTC; QL
BD Lo-Dose Micro-Fine IV syringe 1/2 mL 28 gauge x 1/2"
F
OTC
BD Lo-Dose Ultra-Fine syringe 0.3 mL 29 gauge x 1/2"
F
OTC
BD Sharps Collector
F
OTC
BD Ultra-Fine Nano Pen Needles
F
OTC
Condoms-Prem Lubricated
F
OTC; QL
Easy Comfort Insulin Syringe 1 mL 30 gauge x 5/16
F
OTC
Easy Touch Insulin Syringe 0.5 mL 31 gauge x 5/16, 1 mL 28 gauge x 1/2", 1 mL 31 gauge x 5/16
F
OTC; QL
Easy Touch needle 31 gauge x 3/16"
F
OTC; QL
Fine 30 Universal Lancets
F
OTC
First Choice Lancets Thin
F
OTC
Hearing Aid Batteries
F
OTC; QL
inControl Pen Needle 29 gauge x 1/2", 32 gauge x 5/32"
F
OTC
inControl Super Thin Lancets
F
OTC
inControl Ultra Thin Lancets
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 94
Drug
Status
Notes
insulin syringe-needle U-100 syringe 0.3 mL 30 gauge x 5/16, 0.3 mL 31 gauge x 5/16, 0.5 mL 29 gauge x 1/2", 1 mL 29 gauge x 1/2", 1 mL 30 gauge x 3/8", 1 mL 31 gauge x 5/16, 1/2 mL 28 gauge x 1/2", 1/2 mL 30 gauge x 5/16
F
OTC; QL
insulin syringes (disposable)
F
OTC
Micro Thin Lancets
F
OTC
Nova Safety Lancets 28 gauge
F
OTC
Nova Sureflex Lancets
F
OTC
NovoFine 30
F
OTC; QL
Novofine 32
F
OTC; QL
Novofine Autocover
F
OTC; QL
OptiChamber Diamond Lg Mask
F
QL
OptiChamber Diamond VHC
F
QL
OptiChamber Diamond-Med Mask
F
QL
OptiChamber Diamond-Sml Mask
F
QL
Peak Air Peak Flow Meter
F
OTC; QL
Pen Needle 29 gauge x 1/2", 31 gauge x 5/16"
F
OTC
Personal Best Full Range
F
OTC
PrimeAire
F
QL
ProChamber
F
QL
ReliOn Ultra Thin Plus Lancets
F
OTC
SafeSnap Insulin Syringe 0.3 mL 30 gauge x 5/16"
F
OTC
SafeSnap Syringe 1 mL 25 gauge x 5/8", 1 mL 27 gauge x 1/2", 3 mL
F
OTC
Sharps Container
F
OTC
Smart Sense Lancets 26 gauge, 33 gauge
F
OTC
Soft Touch Lancets
F
OTC; QL
Sure Comfort Pen Needle 29 gauge x 1/2"
F
OTC; QL
Sure-Fine Pen Needles needle 29 gauge x 1/2"
F
OTC; QL
Sure-Ject Insulin Syringe 1 mL 28 gauge x 1/2"
F
OTC; QL
Ulticare Pen Needle 31 gauge x 5/16"
F
OTC; QL
Ulticare syringe 1 mL 29 x 1/2", 1 mL 30 gauge x 1/2"
F
OTC; QL
Ultilet Pen Needle 29 gauge
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 95
Drug
Status
Notes
Ultra Comfort Insulin Syringe 1 mL 28 gauge, 1/2 mL 28 gauge x 1/2"
F
OTC
Ultra Thin Lancets 28 gauge
F
OTC
Ultra Thin Plus Lancets
F
OTC
UltraLANCE Lancets 26 gauge
F
OTC
Unifine Pentips needle 29 gauge x 1/2"
F
OTC
Unifine Pentips Plus needle 31 gauge x 5/16"
F
OTC
Universal 1 Lancets 33 gauge
F
OTC
Vortex Holding Chamber
F
QL
calcitriol oral capsule
F
QL
calcitriol oral solution
F
AL
Metabolic Modifiers Hyperparathyroid Treatment Agents Vitamin D Analog-Type
Mouth-Throat-Dental - Preparations Dental Product - Fluoride Preparations Denta 5000 Plus
F
DentaGel
F
AL
Fluoridex Daily Defense
F
AL
Fluoritab oral tablet, chewable 0.5 mg fluoride (1.1 mg)
F
QL; AL
Fluoritab oral tablet, chewable 1 mg fluoride (2.2 mg)
F
AL
Perio Med
F
OTC; QL
PreviDent 5000 Plus
F
PreviDent dental gel
F
AL
SF
F
AL
SF 5000 Plus
F
sodium fluoride oral drops
F
QL; AL
sodium fluoride oral tablet, chewable 0.25 mg fluoride (0.55 mg)
F
AL
sodium fluoride oral tablet, chewable 0.5 mg fluoride (1.1 mg), 1 mg fluoride (2.2 mg)
F
QL; AL
clotrimazole mucous membrane
F
QL
nystatin oral suspension
F
QL
Mouth And Throat - Antifungals
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 96
Drug Mouth And Throat - Antiseptics
Status
chlorhexidine gluconate mucous membrane
Notes
F
Mouth And Throat - Glucocorticoids triamcinolone acetonide dental
F
QL
Mouth And Throat - Local Anesthetic Amides lidocaine HCl mucous membrane jelly
F
Lidocaine Viscous
F
Mouth And Throat - Saliva Stimulants pilocarpine HCl oral tablet 5 mg
F
Periodontal Product - TetracyclineType, Collagenase Inhibitors doxycycline hyclate oral tablet 20 mg
F
QL
Multiple Sclerosis Agents Multiple Sclerosis Agent - Interferons Avonex (with albumin)
Specialty
PA; QL
Avonex intramuscular pen injector kit
Specialty
PA; QL
Avonex intramuscular syringe
Specialty
PA; QL
Avonex intramuscular syringe kit
Specialty
PA; QL
Glatopa
Specialty
PA; QL
Tecfidera oral capsule, delayed release(DR/EC) 120 mg, 120 mg (14)- 240 mg (46), 240 mg
Specialty
PA; QL
Specialty
PA
Specialty
PA
Multiple Sclerosis Agent - Others
Multiple Sclerosis Agent - Potassium Channel Blocker Ampyra
Multiple Sclerosis Agent - Sphingosine 1-Phosphate Receptor Modulator Gilenya
Ophthalmic Agents Artificial Tears And Lubricant Combinations Artificial Tears (PF)
F
OTC
Artificial Tears(dext70-hypro)
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 97
Drug
Status
Notes
Artificial Tears(glycerin-peg)
F
OTC
Artificial Tears(pvalch-povid)
F
OTC
Bion Tears (PF)
F
OTC
Lubricant Eye Drops (glyc-pg)
F
OTC
Lubricant Eye(dextran70-hypml)
F
OTC
Natural Tears (PF)
F
OTC
Tears Naturale Free (PF)
F
OTC
Tears Pure
F
OTC
Artificial Tears (polyvin alc)
F
OTC
Lubricant Eye Drops ophthalmic dropperette
F
OTC
polyvinyl alcohol
F
OTC
Artificial Tears And Lubricant Single Agents
Miotics - Cholinesterase Inhibitors Phospholine Iodide
F
Miotics - Direct Acting pilocarpine HCl ophthalmic drops 1 %, 2 %, 4 %
F
Ophthalmic - AntibacterialGlucocorticoid Combinations Blephamide
F
Blephamide S.O.P.
F
neomycin-bacitracin-poly-HC
F
neomycin-polymyxin B-dexameth
F
neomycin-polymyxin-HC ophthalmic
F
Neo-Polycin HC
F
sulfacetamide-prednisolone
F
TobraDex ophthalmic ointment
F
tobramycin-dexamethasone
F
Ophthalmic - Anticholinergics atropine ophthalmic
F
cyclopentolate ophthalmic drops 1 %, 2 %
F
homatropine HBr
F
tropicamide ophthalmic
F
Ophthalmic - AntihistamineDecongestant Combinations AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 98
Drug
Status
Eye Allergy Relief
F
Notes OTC
Ophthalmic - Antihistamines azelastine ophthalmic
F
ketotifen fumarate
F
OTC; QL
Ophthalmic - Anti-Inflammatory, Glucocorticoids dexamethasone sodium phosphate ophthalmic
F
Flarex
F
fluorometholone
F
QL
FML Forte
F
QL
FML S.O.P.
F
Pred Mild
F
prednisolone acetate
F
prednisolone sodium phosphate ophthalmic
F
Ophthalmic - Anti-Inflammatory, NSAIDs diclofenac sodium ophthalmic
F
flurbiprofen sodium
F
ketorolac ophthalmic drops 0.5 %
F
QL
F
QL
F
QL
Ophthalmic - Beta Blockers-Carbonic Anhydrase Inhibitor Combinations dorzolamide-timolol
Ophthalmic - Carbonic Anhydrase Inhibitors dorzolamide
Ophthalmic - Decongestants phenylephrine HCl ophthalmic drops 2.5 %
F
Ophthalmic - Hyperosmolar Agents Artificial Tears(dext70-hypro) ophthalmic drops
F
OTC
Ophthalmic - Intraocular Pressure Reducing Agents, Beta-Blockers betaxolol ophthalmic
F
carteolol
F
levobunolol ophthalmic drops 0.5 %
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 99
Drug
Status
metipranolol
F
timolol maleate ophthalmic
F
Notes
Ophthalmic - Local Anesthetic Esters proparacaine
F
Ophthalmic - Mast Cell Stabilizers cromolyn ophthalmic
F
Ophthalmic Antibacterial Mixtures bacitracin-polymyxin B ophthalmic
F
neomycin-bacitracin-polymyxin
F
neomycin-polymyxin-gramicidin
F
polymyxin B sulf-trimethoprim
F
Ophthalmic Antibiotic Aminoglycosides gentamicin ophthalmic
F
tobramycin
F
Ophthalmic Antibiotic Dehydropeptidase Inhibitors bacitracin ophthalmic
F
Ophthalmic Antibiotic Fluoroquinolones ciprofloxacin HCl ophthalmic
F
levofloxacin ophthalmic
F
ofloxacin ophthalmic
F
Vigamox
F
QL
QL
Ophthalmic Antibiotic - Macrolides erythromycin ophthalmic
F
Ophthalmic Antibiotic - Sulfonamides sulfacetamide sodium ophthalmic
F
Ophthalmic Antivirals trifluridine
F
Ophthalmic-Intraocular Press. Reducing, Sel. Alpha Adrenergic Agonists apraclonidine AL = Age Limit PA = Prior Authorization
F F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 100
Drug
Status
brimonidine
Notes
F
Ophthalmic-Intraocular Pressure Reducing Agents, Prostaglandin Analogs latanoprost
F
QL
travoprost (benzalkonium)
F
QL
Otic Otic - Anti-Infective Mixtures acetic acid-aluminum acetate
F
Otic - Anti-Infective-Glucocorticoid Combinations CIPRODEX
F
neomycin-polymyxin-HC otic
F
AL
Otic - Anti-Infectives Other acetic acid otic
F
Otic - Fluoroquinolones ofloxacin otic
F
QL
Otic - Glucocorticoids hydrocortisone-acetic acid
F
Respiratory Therapy Agents 2nd Generation AntihistamineDecongestant Combinations cetirizine-pseudoephedrine
F
OTC
loratadine-pseudoephedrine
F
OTC; QL
chlorpheniramine maleate oral tablet
F
OTC
chlorpheniramine maleate oral tablet extended release
F
OTC
Antihistamine – 1st Generation Alkylamines
Antihistamine - 1st Generation Ethanolamines carbinoxamine maleate
F
clemastine oral tablet 1.34 mg
F
clemastine oral tablet 2.68 mg
F
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC; QL
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 101
Drug
Status
Notes
diphenhydramine HCl injection solution 50 mg/mL
F
AL
diphenhydramine HCl injection syringe
F
AL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral elixir
F
OTC
diphenhydramine HCl oral liquid
F
OTC
diphenhydramine HCl oral syrup
F
OTC
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
F
AL
Antihistamine - 1st Generation Phenothiazines
Antihistamine - 1st Generation Piperidines cyproheptadine
Antihistamines - 1st Generation carbinoxamine maleate
F
chlorpheniramine maleate oral tablet
F
OTC
chlorpheniramine maleate oral tablet extended release
F
OTC
clemastine oral tablet 1.34 mg
F
OTC; QL
clemastine oral tablet 2.68 mg
F
cyproheptadine
F
AL
diphenhydramine HCl injection solution 50 mg/mL
F
AL
diphenhydramine HCl injection syringe
F
AL
diphenhydramine HCl oral capsule
F
OTC; AL
diphenhydramine HCl oral elixir
F
OTC
diphenhydramine HCl oral liquid
F
OTC
diphenhydramine HCl oral syrup
F
OTC
diphenhydramine HCl oral tablet 25 mg
F
OTC; AL
promethazine oral
F
AL
promethazine rectal suppository 12.5 mg, 25 mg
F
AL
F
OTC; QL; AL
Antihistamines - 2nd Generation cetirizine oral solution 1 mg/mL, 5 mg/5 mL AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 102
Drug
Status
Notes
cetirizine oral tablet
F
OTC; QL
cetirizine oral tablet, chewable
F
OTC; QL; AL
fexofenadine oral suspension
F
OTC
fexofenadine oral tablet 180 mg, 60 mg
F
OTC
loratadine oral solution
F
OTC; QL; AL
loratadine oral tablet
F
OTC; QL
loratadine oral tablet, disintegrating
F
OTC
cetirizine oral solution 1 mg/mL, 5 mg/5 mL
F
OTC; QL; AL
cetirizine oral tablet
F
OTC; QL
cetirizine oral tablet, chewable
F
OTC; QL; AL
fexofenadine oral suspension
F
OTC
fexofenadine oral tablet 180 mg, 60 mg
F
OTC
loratadine oral solution
F
OTC; QL; AL
loratadine oral tablet
F
OTC; QL
loratadine oral tablet, disintegrating
F
OTC
F
AL
Aerospan
F
QL
Arnuity Ellipta
F
QL
Asmanex HFA
F
Asmanex Twisthaler
F
QL
budesonide inhalation suspension for nebulization 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL
F
QL; AL
Flovent Diskus inhalation blister with device 100 mcg/actuation, 250 mcg/actuation, 50 mcg/actuation
F
QL
Flovent HFA inhalation HFA aerosol inhaler 110 mcg/actuation, 220 mcg/actuation, 44 mcg/actuation
F
QL
Pulmicort Flexhaler
F
QL
Qvar
F
QL
Antihistamines - 2nd Generation Piperazines
Antihistamines - 2nd Generation Piperidines
Antitussives - Nonnarcotic benzonatate oral capsule 100 mg, 200 mg
Asthma Therapy - Glucocorticoids
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 103
Drug Asthma Therapy - Leukotriene Receptor Antagonists
Status
Notes
montelukast oral granules in packet
F
QL; AL
montelukast oral tablet
F
QL; AL
montelukast oral tablet, chewable 4 mg, 5 mg
F
QL; AL
zafirlukast
F
Asthma Therapy - Mast Cell Stabilizers cromolyn inhalation
F
Asthma Therapy - Xanthines theophylline oral elixir
F
theophylline oral solution
F
theophylline oral tablet extended release 12 hr
F
theophylline oral tablet extended release 24 hr
F
Asthma/COPD - Anticholinergic Agents, Inhaled Long Acting Incruse Ellipta
F
Spiriva Respimat
F
QL
Spiriva with HandiHaler
F
QL
Tudorza Pressair
F
QL
Atrovent HFA
F
QL
ipratropium bromide inhalation
F
Asthma/COPD - Anticholinergic Agents, Inhaled Short Acting
Asthma/COPD Therapy - Beta 2Adrenergic Agents, Inhaled, Long Acting Foradil Aerolizer
F
QL
Serevent Diskus
F
QL
F
QL
Asthma/COPD Therapy - Beta 2Adrenergic Agents, Inhaled, Short Acting albuterol sulfate inhalation solution for nebulization 0.63 mg/3 mL, 1.25 mg/3 mL
albuterol sulfate inhalation solution for nebulization 2.5 mg /3 mL (0.083 %), 2.5 mg/0.5 F mL, 5 mg/mL AL = Age Limit F = Formulary PA = Prior Authorization QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 104
Drug
Status
Notes
levalbuterol tartrate
F
ST; QL
Ventolin HFA
F
QL
Xopenex HFA
F
ST; QL
Asthma/COPD Therapy - Beta Adrenergic Agents albuterol sulfate oral syrup
F
albuterol sulfate oral tablet
F
metaproterenol oral tablet
F
terbutaline oral
F
Asthma/COPD Therapy - Beta Adrenergic-Anticholinergic Combinations Anoro Ellipta
F
QL
Combivent Respimat
F
QL
ipratropium-albuterol
F
QL
Breo Ellipta
F
QL
Dulera
F
QL
Symbicort
F
QL
Tobi Podhaler
Specialty
PA
tobramycin in 0.225 % NaCl
Specialty
PA
Specialty
PA
Asthma/COPD Therapy - Beta Adrenergic-Glucocorticoid Combinations
Cystic Fibrosis - Inhaled Aminoglycosides
Cystic Fibrosis - Inhaled Monobactams Cayston
Mucolytics acetylcysteine Pulmozyme
F Specialty
PA
Narcotic Antitussive-Expectorant Combinations Cheratussin AC
F
OTC; QL
codeine-guaifenesin
F
OTC; QL
Virtussin AC
F
OTC; QL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 105
Drug Nasal Anticholinergics
Status
ipratropium bromide nasal
Notes
F
QL
F
QL
Flonase Allergy Relief
F
OTC
flunisolide nasal spray, on-aerosol 25 mcg (0.025 %)
F
QL
fluticasone nasal
F
OTC; QL
Nasacort
F
OTC; QL
cromolyn nasal
F
OTC
Nasalcrom
F
OTC
Baby Ayr Saline
F
OTC
Deep Sea Nasal
F
OTC
Nasal Spray (sodium chloride)
F
OTC
Ocean for Kids
F
OTC
Ocean Nasal
F
OTC
Saline Mist
F
OTC
Q-Tussin DM
F
OTC
Robafen DM
F
OTC
pseudoephedrine HCl oral liquid
F
OTC; QL
pseudoephedrine HCl oral tablet
F
OTC; QL
Nasal Antihistamines azelastine nasal aerosol, spray
Nasal Corticosteroids
Nasal Mast Cell Stabilizers
Nasal Moisturizers
Non-Narcotic Antitussive-Expectorant Combinations
Systemic Sympathomimetic Decongestants
Vaginal Products Vaginal Antibacterial - Lincosamides clindamycin phosphate vaginal
F
Vaginal Antifungal - Imidazoles Clotrimazole 3 Day
F
OTC
clotrimazole vaginal cream
F
OTC
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 106
Drug
Status
Notes
Miconazole 7 vaginal suppository
F
OTC
miconazole nitrate vaginal comb pack, prefill appl, cream
F
OTC
miconazole nitrate vaginal cream
F
OTC
miconazole nitrate vaginal suppository
F
OTC
Miconazole-3 prefil, cream, wipe
F
OTC
Miconazole-3 vaginal kit
F
OTC
Miconazole-3 vaginal suppository
F
Monistat 7 vaginal comb pack, prefill appl, cream
F
OTC
Vaginal Antifungal - Triazoles terconazole
F
Vaginal Antiprotozoal-Antibacterial Nitroimidazole Derivatives metronidazole vaginal
F
Vaginal Estrogens Estrace vaginal
F
QL
Premarin vaginal
F
QL
AL = Age Limit PA = Prior Authorization
F = Formulary QL = Quantity Limit
OTC = Over The Counter ST = Step Therapy Reviewed and Updated December 2016 107
Index
1 1st Tier Unifine Pentips.... 91, 93 5 50+ Adult Eye Health......... 1, 48 A A Thru Z ................................. 48 A Thru Z Advanced Formula . 56 A Thru Z Men's Ultimate ....... 48 A Thru Z Select ................ 38, 48 A Thru Z Select 50+ Formula 48 A Thru Z Select Women's ...... 48 Abatron ................................... 44 Abatron AF............................. 44 ABC Plus ................................ 48 Abreva .................................... 32 acarbose .................................. 66 Accu-Chek Aviva Control Soln ...................................... 90, 93 Accu-Chek Aviva Plus Meter 90, 93 Accu-Chek Aviva Plus test strp ...................................... 90, 93 Accu-Chek FastClix ......... 90, 93 Accu-Chek Multiclix Lancet . 90, 93 Accu-Chek Nano .............. 90, 93 Accu-Chek SmartView Contrl Sol................................. 90, 93 Accu-Chek SmartView Test Strip .............................. 90, 93 Accu-Chek Soft Dev Lancets 90, 93 Accu-Chek Softclix Lancet Dev ...................................... 90, 93 Accu-Chek Softclix Lancets.. 90, 93 acebutolol ............................... 19 Acephen .................................... 3 acetaminophen ...................... 3, 4 acetaminophen-codeine ............ 2 acetazolamide ......................... 21 acetic acid ............................. 101 acetic acid-aluminum acetate101 acetylcysteine ................... 7, 105 Acid Controller ....................... 76 Acid Gone Antacid ................. 71
Acid Gone Antacid E.Strength ............................................ 71 Acid Reducer (famotidine) ..... 76 acitretin ................................... 32 Actical .................................... 48 Active FE ................................ 44 acyclovir ................................. 10 adapalene ................................ 30 Adcirca ................................... 22 adefovir ................................... 10 Adempas ................................. 22 Adult Multivitamin Gummies 48 Adult One Daily Gummies ..... 48 Advanced AM-PM ................. 48 Advanced Antacid-Antigas .... 72 ADVANCED Calcium ........... 40 Advocate Pen Needles ...... 91, 94 Advocate Syringes ............ 91, 94 Aerochamber MV ............. 93, 94 Aerospan ............................... 103 Afinitor ................................... 14 Afinitor Disperz ...................... 14 Afluria 2016-2017 .................. 15 Afluria 2016-2017 (PF) .......... 15 Aimsco.............................. 92, 94 Alba-Lybe ............................... 35 albuterol sulfate ............ 104, 105 Alcalak.................................... 72 Alcohol Prep Pads .................. 15 Alcohol Wipes ........................ 15 alendronate ............................. 68 Alka-Seltzer Gold ................... 71 Alka-Seltzer Heartburn........... 71 Alka-Seltzer Heartburn+Gas .. 73 Alkeran ................................... 12 allopurinol .............................. 87 Almacone................................ 73 Almacone-2 ............................ 73 alogliptin ................................. 66 alogliptin-metformin .............. 67 alogliptin-pioglitazone............ 67 Alophen .................................. 82 Altavera (28)........................... 25 Alternate Site Lancet ........ 90, 94 aluminum chloride .................. 32 aluminum hydroxide gel ......... 71 Alyacen 1/35 (28) ................... 25
Alyacen 7/7/7 (28) .................. 28 amantadine HCl ...................... 23 amiloride ................................. 21 amiloride-hydrochlorothiazide21 amiodarone ............................. 17 Amitiza ................................... 78 amlodipine .............................. 20 amlodipine-benazepril ............ 15 amlodipine-valsartan .............. 16 ammonium lactate .................. 32 amoxicillin ................................ 7 amoxicillin-pot clavulanate ...... 7 ampicillin .................................. 7 Ampyra ................................... 97 anagrelide ............................... 88 anastrozole .............................. 13 ANIMAL CHEWS ................. 59 Animal Shape Vitamins .......... 59 Animal Shapes Complete ....... 59 Animi-3 With Vitamin D........ 56 Anoro Ellipta ........................ 105 Antacid ................................... 73 Antacid (calcium carb-mag hyd) ............................................ 71 Antacid (calcium carbonate)... 72 Antacid Anti-Gas .................... 73 Antacid Anti-Gas (ca carb-sim) ............................................ 73 Antacid Anti-Gas Double Str . 73 Antacid Calcium ..................... 72 Antacid ExSt (ca carb-mag hyd) ............................................ 71 Antacid ExSt (mag carb-Al hyd) ............................................ 71 Antacid Ext Str (calcium carb) ............................................ 72 Antacid Extra-Strength ..... 72, 73 Antacid Liquid ........................ 73 Antacid M ............................... 73 Antacid Maximum Strength ... 73 Antacid Multi-Symptom ......... 73 Antacid Plus Anti-Gas ............ 73 Antacid Regular Strength ....... 73 Antacid Supreme .................... 71 Antacid Ultra Strength ............ 72 Antacid with Simethicone ...... 73 Antacid-Antigas ...................... 73
108
Antacid-Antigas II .................. 73 Antacid-Simethicone .............. 73 Anti-Diarrhea ......................... 74 Anti-Diarrheal (loperamide) ... 74 Antifungal (clotrimazole) ....... 31 Antifungal Cream ................... 31 Anti-Itch (HC) ........................ 32 Antioxidant ................... 1, 48, 56 Antioxidant A/C/E/Selenium .. 1, 48 Antioxidant Formula (selenium) ........................................ 1, 48 Antioxidant Vitamins ......... 1, 48 Apatate Forte .......................... 48 Apetex .................................... 35 Apetigen ................................. 35 Apetigen Plus ................... 37, 44 Apidra ..................................... 69 Apidra SoloStar ...................... 69 apraclonidine ........................ 100 Apri......................................... 25 Apriso ..................................... 78 AquADEKs ............................ 48 AquADEKs Pediatric ............. 60 Aqua-E ................................... 64 Aquasol E ............................... 64 Aranelle (28) .......................... 28 Aranesp (in polysorbate) ........ 88 Arkaliox .................................. 63 Armour Thyroid ..................... 71 Arnuity Ellipta ...................... 103 Artificial Tears (PF) ............... 97 Artificial Tears (polyvin alc) .. 98 Artificial Tears(dext70-hypro) ...................................... 97, 99 Artificial Tears(glycerin-peg) 98 Artificial Tears(pvalch-povid) 98 Asacol HD .............................. 78 Asmanex HFA ...................... 103 Asmanex Twisthaler............. 103 aspirin ........................... 6, 88, 89 aspirin, buffered ....................... 6 atenolol ................................... 19 atenolol-chlorthalidone........... 20 atorvastatin ............................. 18 atovaquone ............................... 8 atropine ................................... 98 Atrovent HFA ....................... 104 Auryxia ............................. 85, 86 Aviane .................................... 25
Avonex ................................... 97 Avonex (with albumin) .......... 97 azathioprine .................. 5, 89, 90 azelastine ........................ 99, 106 azithromycin ........................... 11 Azurette (28)........................... 25 B B Complete ............................. 37 B Complex .............................. 37 B Complex 1........................... 37 B Complex 100....................... 37 B Complex Plus Vitamin C .... 35 B Complex w-Vit C................ 62 B Complex-Vitamin B12........ 37 B complex-vitamin C-folic acid ............................................ 35 B-100 Complex ...................... 35 B-50 Complex ........................ 37 Baby Ayr Saline ................... 106 bacitracin ........................ 31, 100 bacitracin zinc......................... 31 bacitracin-polymyxin B ........ 100 baclofen .................................. 90 Bacmin.................................... 48 Bal B-100 ............................... 37 Bal B-50 ................................. 37 Balance B-100 ........................ 37 Balance B-50 .......................... 37 Balanced B Complex-Vit C.... 35 Balanced B-100 ................ 35, 37 Balanced B-100 Complex ...... 35 Balanced B-50 ........................ 37 balsalazide .............................. 78 Balziva (28) ............................ 25 B-Complex ............................. 35 B-Complex With B-12 ........... 62 B-complex with vitamin C ..... 35 BD Insulin Pen Needle UF Mini ...................................... 91, 94 BD Insulin Pen Needle UF Orig ...................................... 91, 94 BD Insulin Pen Needle UF Short ...................................... 91, 94 BD Insulin Syringe ........... 91, 94 BD Insulin Syringe Half Unit 91, 94 BD Insulin Syringe Micro-Fine ...................................... 91, 94 BD Insulin Syringe Ultra-Fine ...................................... 91, 94
BD Integra Insulin Syringe .... 91, 94 BD Lo-Dose Micro-Fine IV .. 91, 94 BD Lo-Dose Ultra-Fine .... 91, 94 BD Sharps Collector ......... 92, 94 BD Ultra-Fine Nano Pen Needles ......................... 91, 94 Beelith..................................... 47 Bee-Zee................................... 48 benazepril ......................... 15, 16 benazepril-hydrochlorothiazide ............................................ 15 Benefiber Clear SF (dextrin) .. 78 Benefiber Sugar Free (dextrin) ............................................ 78 benzonatate ........................... 103 benzoyl peroxide .................... 30 Berocca (FA-guarana-caff) ..... 48 Best Fiber................................ 78 betamethasone dipropionate ... 32 betamethasone valerate ..... 32, 33 betamethasone, augmented ..... 33 betaxolol ........................... 19, 99 bethanechol chloride ............... 87 bexarotene............................... 14 bicalutamide ........................... 12 Bio-35 ..................................... 48 Bio-35, Gluten Free ................ 49 Biocal ...................................... 40 Biocel (with Lutein) ............... 49 Bion Tears (PF) ...................... 98 Biopetit ................................... 35 Biosupp ................................... 49 Biotect Plus ............................. 49 biotin ....................................... 63 Biotin Plus-Calcium and Vit D3 ............................................ 49 Biovol ..................................... 49 Bisac-Evac .............................. 82 bisacodyl ................................. 82 Bisa-Lax ................................. 82 Biscolax .................................. 82 Bismatrol ................................ 74 Bismuth................................... 74 Bismuth Maximum Strength .. 74 bismuth subsalicylate.............. 74 bisoprolol fumarate ................. 19 bisoprolol-hydrochlorothiazide ............................................ 20
109
Bladder 2.2 ............................. 49 Blephamide............................. 98 Blephamide S.O.P. ................. 98 Body, Hair, Skin and Nails .... 49 Bone Density Calcium + D .... 40 Bone Essentials ...................... 40 Breo Ellipta .......................... 105 Brevicon (28).......................... 25 Brewer's Yeast ........................ 38 Briellyn ................................... 25 brimonidine .......................... 101 bromocriptine ......................... 23 budesonide............................ 103 bumetanide ............................. 21 bupropion HCl .................. 23, 24 Butalbital Compound W/Codeine............................ 2 butalbital-acetaminop-caf-cod .. 2 butalbital-acetaminophen ......... 4 butalbital-acetaminophen-caff .. 4 butalbital-aspirin-caffeine ........ 6 C cabergoline ............................. 70 Ca-D3-mag ox-zinc-cop-mangbor....................................... 40 Ca-D3-mag-zinc-cop-mang-bor ............................................ 40 caffeine citrated ...................... 23 Cal Mag Zinc + D3 ................ 40 Calcet Creamy Bites ............... 41 Calcet Petites .......................... 41 Calci-Chew ............................. 39 Calcidol .................................. 64 Calciferol ................................ 64 Calci-Max ............................... 40 Calci-Mix ............................... 39 Calcionate ............................... 39 calcipotriene ........................... 32 calcitonin (salmon) ................. 68 Calcitrate ................................ 39 Cal-Citrate .............................. 41 Calcitrate-Vitamin D .............. 41 calcitriol ............................ 64, 96 Calcium 500 ........................... 39 Calcium 500 + D .................... 41 Calcium 500 + D (D3)............ 41 Calcium 600 + D(3) ............... 41 Calcium 600 + Minerals ......... 40 Calcium 600 Plus Soy ............ 40 Calcium 600 with Vitamin D341
Calcium 600-D3 Plus ............. 40 calcium acetate ........... 39, 85, 86 Calcium Adult (calcium phos) 41 calcium amino acid chelate .... 39 Calcium Antacid ..................... 72 Calcium Antacid Ultra Max St ............................................ 72 calcium carb and citrate-vitD341 calcium carb-D3-mag cmb11zinc ..................................... 40 calcium carbonate ............. 39, 72 calcium carbonate-vit D3-min 40 calcium carbonate-vitamin D341 calcium chloride ..................... 39 calcium citrate ........................ 39 Calcium Citrate + D ............... 42 Calcium Citrate + D with Mag ............................................ 49 calcium citrate malate-vit D3 . 42 Calcium Citrate Plus............... 40 Calcium Citrate Plus (Vit B6) 49 calcium citrate-vitamin D2 ..... 42 calcium citrate-vitamin D3 ..... 42 Calcium for Women ............... 40 calcium gluconate ................... 39 calcium lactate ........................ 39 Calcium Magnesium............... 40 Calcium Magnesium + D ....... 40 calcium phosphate .................. 39 calcium phosphate-vitamin D3 ............................................ 42 Calcium Soft Chew ................ 40 Calcium with Boron ............... 40 Calcium+D ............................. 42 calcium-magnesium................ 40 calcium-magnesium-copper-zinc ............................................ 47 calcium-magnesium-zinc........ 40 calcium-vitamin D3-vitamin K ............................................ 40 Cal-Gest Antacid .................... 72 Cal-Mag .................................. 40 CalMag Thins ......................... 40 Cal-Mint ................................. 39 Calphron ........................... 85, 86 Cal-Quick ............................... 42 Caltrate 600 + D ..................... 42 Caltrate 600+D Plus Minerals 40 Caltrate with Vitamin D3 ....... 42 Camila .................................... 28
Canasa..................................... 78 capecitabine ............................ 13 capsaicin ................................. 34 captopril .................................. 16 captopril-hydrochlorothiazide 15 carbidopa-levodopa ................ 23 carbinoxamine maleate . 101, 102 Cardiamin ............................... 49 Cardiotek-RX (bioperine) ....... 35 carteolol .................................. 99 carvedilol ................................ 16 castor oil ................................. 82 Cayston ................................. 105 Caziant (28) ............................ 28 cefaclor ..................................... 9 cefadroxil .................................. 9 cefdinir ...................................... 9 cefixime .................................... 9 cefpodoxime ....................... 9, 10 cefprozil .................................... 9 cefuroxime axetil ...................... 9 celecoxib ................................... 5 Centamin................................. 49 Central Vite ................ 38, 49, 56 Central Vite with Lutein ......... 49 Central-Vite .......... 38, 44, 49, 56 Central-Vite Cardio ................ 49 Central-Vite Energy................ 49 Central-Vite Men's Under 50 . 49 Central-Vite Performance ....... 49 Central-Vite Select ........... 38, 49 Central-Vite Senior ................. 49 Central-Vite Women's Mature 49 Central-Vite Women's Under 50 ............................................ 56 Centram-Care ......................... 49 Centratex................................. 44 Centravites .............................. 49 Centravites 50 Plus ................. 38 Centrum .................................. 49 Centrum Complete.................. 56 Centrum Kids.......................... 60 Centrum Men .......................... 49 Centrum Silver........................ 49 Centrum Silver Ultra Men's .... 49 Centrum Silver Women .......... 49 Centrum Specialist Energy ..... 49 Centrum Specialist Heart ........ 49 Centrum Ultra Men's .............. 49 Century ................................... 56
110
Century Adults 50+ ................ 49 Century Cardio ....................... 49 Century Energy Metabolism .. 50 Century Mature ...................... 50 Century Ultimate Men's ......... 50 Century Ultimate Women's ... 50, 56 Ceo-Two ................................. 85 cephalexin................................. 9 CeraLyte-70 ............................ 47 CeraSport ................................ 47 Cerefolin ................................. 56 Cerefolin NAC (algal oil) ....... 62 Cerovite .................................. 50 Cerovite Advanced Formula .. 56 Cerovite Jr .............................. 60 Cerovite Senior ....................... 38 Certa Plus ............................... 50 CertaVite Senior-Antioxidant 50 CertaVite-Antioxid (iron gluc) ............................................ 50 Certavite-Antioxidant ............. 56 cetirizine ....................... 102, 103 cetirizine-pseudoephedrine... 101 Chantix ................................... 24 Chantix Continuing Month Box ............................................ 24 Chantix Starting Month Box .. 24 Chemet ..................................... 7 Cheratussin AC .................... 105 Chewable MultivitA,B,D,E,K,Zn ..................... 59 Chewable-Vite .................. 56, 59 Chewable-Vite with Iron ........ 60 Child Complete Multivitamin 60 Child Multivitamins ............... 59 Child Vitamin with Minerals.. 60 Children's Acetaminophen ....... 4 Children's Chew Multivit-Iron60 Children's Chewable............... 59 Children's Chewable Multivitmn ............................................ 59 Children's Chewable Vitamin 59 Children's Chewables ............. 59 Children's Chewables Extra C 59 Children's Chewables with Iron ............................................ 59 Children's Complete Vitamin . 60 Children's Pepto ..................... 72 Children's Soothe ................... 72
Childs Chew Vite ................... 59 Child's Chewable Vitamins/Iron ............................................ 60 Child's Fiber Select Gummies 78 Child's Vitamin with Iron ....... 60 Childs/Iron .............................. 60 chlorhexidine gluconate ......... 97 chloroquine phosphate .............. 8 chlorothiazide ......................... 21 chlorpheniramine maleate ... 101, 102 chlorpropamide ....................... 67 chlorthalidone ......................... 22 chlorzoxazone......................... 90 Chocolate Laxative ................. 82 cholecalciferol (vitamin D3) .. 64 cholestyramine (with sugar) .. 17, 18 Cholestyramine Light ............. 18 choline,magnesium salicylate ... 6 ciclopirox ................................ 31 cilostazol................................. 88 cimetidine ............................... 76 Ciprodex ............................... 101 ciprofloxacin ........................... 10 ciprofloxacin HCl ........... 10, 100 Citracal + Bone Density ......... 40 Citracal + D Maximum .......... 42 Citracal + D Petites ................ 42 Citracal + D Slow Release...... 42 Citracal + D3 (calcium phos) . 42 Citracal Chew ......................... 40 Citracal D + Heart Health....... 40 Citracal Plus Magnesium........ 40 Citracal Regular ...................... 42 Citrate of Magnesia ................ 81 Citroma ................................... 81 Citrucel ................................... 78 Citrucel (sucrose) ................... 78 Citrucel Sugar Free ................. 79 Citrus Calcium........................ 42 Claravis ................................... 30 clarithromycin ........................ 11 clemastine ..................... 101, 102 clindamycin HCl..................... 11 clindamycin palmitate HCl ..... 11 clindamycin phosphate ... 30, 106 clindamycin-benzoyl peroxide30 clobetasol ................................ 33 clonidine ................................. 21
clonidine HCl.......................... 21 clopidogrel .............................. 89 clotrimazole .............. 31, 96, 106 Clotrimazole 3 Day............... 106 clotrimazole-betamethasone ... 31 codeine sulfate .......................... 2 codeine-butalbital-ASA-caff .... 3 codeine-guaifenesin .............. 105 COLACE Clear ...................... 84 colchicine ................................ 87 Colestid ................................... 18 colestipol................................. 18 Colox ...................................... 79 Col-Rite .................................. 84 Combivent Respimat ............ 105 Comfort Gel ............................ 73 Comfort Gel Extra Strength.... 73 Compete.................................. 50 Complete................................. 50 Complete 50+ ......................... 50 Complete Formulation D3000 59 Complete Formulation Multivit ............................................ 59 Complete Formulation Pediatric ............................................ 59 Complete Multi....................... 50 Complete Multi 50+ ............... 50 Complete Multivitamin .......... 50 Complete Multivitamin-Mineral ...................................... 50, 56 Complete Premium Vitamin ... 50 Complete Senior ............... 38, 50 CompleteNate ................... 60, 61 Complex B-100 ................ 35, 37 Complex B-50 ........................ 35 Condoms-Prem Lubricated .... 92, 94 Coral Calcium ................... 39, 40 Corlopam ................................ 22 Correctol ................................. 82 Cortizone-10 ........................... 33 Corvita .................................... 50 Corvita 150 ............................. 44 Corvite .................................... 50 Corvite 150 ............................. 44 Corvite FE .............................. 44 Corvite Free ............................ 50 Creon ...................................... 76 cromolyn ............... 100, 104, 106 Cryselle (28) ........................... 25
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Cyclafem 1/35 (28)................. 25 Cyclafem 7/7/7 (28) ............... 28 cyclobenzaprine ...................... 90 cyclopentolate......................... 98 cyclophosphamide .............. 5, 12 cycloserine ................................ 8 cyclosporine ....................... 5, 89 cyclosporine modified ........ 5, 89 cyproheptadine ..................... 102 Cyto B7 .................................. 63 Cytra K Crystals ..................... 86 Cytra-2 .................................... 86 D D3-2000 .................................. 64 Daily Fiber.............................. 79 Daily Gummies ...................... 50 Daily Multiple .................. 50, 57 Daily Multiple For Men 50+ .. 57 Daily Multiple For Women .... 57 Daily Multiple For Women 50+ ............................................ 50 Daily Multivitamin ................. 50 Daily Multi-Vitamin ............... 57 Daily Multivitamin with Iron . 57 Daily Multivitamin-Minerals 38, 50 Daily Multi-Vitamins/Iron ..... 50 Daily Value ............................ 57 Daily Vitamin Formula .......... 57 Daily Vitamin Formula + Iron 57 DAILY VITAMIN FORMULAMINERALS ....................... 50 Daily Vitamin with Iron ......... 50 Daily Vitamin with Iron and CA ............................................ 50 Daily Vites/Iron ...................... 50 Daily-Vite ......................... 50, 57 danazol ................................... 69 dapsone ..................................... 8 Daraprim................................... 8 Dasetta 1/35 (28) .................... 26 Dasetta 7/7/7 (28) ................... 28 Deblitane ................................ 28 Decubi Vite ............................ 57 Deep Sea Nasal..................... 106 Delta D3 ................................. 64 Delzicol .................................. 78 Denta 5000 Plus ..................... 96 DentaGel................................. 96 desmopressin .......................... 66
desog-e.estradiol/e.estradiol ... 25 desogestrel-ethinyl estradiol ... 26 Dewee's Carminative .............. 74 Dex4 Glucose ......................... 65 dexamethasone ....................... 68 dexamethasone sodium phosphate ............................ 99 dextrose .................................. 65 Diabetes Health ...................... 51 Diabetes Health Formula ........ 51 Diabetes Health Pack.............. 51 Diabetes Health Support ......... 57 Diabetic Support Formula ...... 38 Dialyvite ........................... 35, 37 DIALYVITE 3000 ................. 35 Dialyvite 5000 ........................ 51 DIALYVITE 800 ................... 35 Dialyvite 800 Plus D .............. 35 DIALYVITE 800 with Iron .... 57 Dialyvite 800 with Zinc 15 ..... 35 Dialyvite 800 with Zinc 50 ..... 35 Dialyvite 800-Ultra D ............. 35 Dialyvite Supreme D .............. 35 Dialyvite Vitamin D ............... 64 Dialyvite Vitamin D3 Max ..... 64 Diamode ................................. 74 Diarrhea Relief (bismuth subs) ............................................ 74 diclofenac sodium......... 5, 32, 99 dicloxacillin ............................ 11 dicyclomine ............................ 78 digoxin .................................... 21 diltiazem HCl ......................... 19 dimenhydrinate ....................... 75 Dino-Life ................................ 59 Dino-Life with Extra C........... 59 Dino-Life with Iron-Zinc........ 60 Diocto ..................................... 84 Dioctyl .................................... 84 Diotame .................................. 74 Dipentum ................................ 78 diphenhydramine HCl .... 24, 102 diphenoxylate-atropine ........... 75 dipyridamole ........................... 89 disopyramide phosphate ......... 17 Diuril ...................................... 22 Doc-Q-Lax........................ 83, 84 Docu ....................................... 84 Docuprene .............................. 84 docusate calcium .................... 84
docusate sodium ..................... 84 Docusil .................................... 84 Docusol ................................... 84 DocuSol Kids.......................... 84 DocuSol Plus .......................... 84 DOK ....................................... 84 DOK Plus................................ 84 donepezil................................. 25 dorzolamide ............................ 99 dorzolamide-timolol ............... 99 doxazosin ................................ 22 doxycycline hyclate .......... 11, 97 doxycycline monohydrate ...... 12 dronabinol ......................... 34, 75 drospirenone-ethinyl estradiol 26 Droxia ..................................... 89 Ducodyl .................................. 82 Dulcolax Stool Softener (DSS) ............................................ 84 Dulera ................................... 105 Duofer ..................................... 44 D-Vita ..................................... 64 E E.E.S. Granules....................... 11 E-400 C-500 and Beta Carotene ........................................ 1, 57 Easy Comfort Insulin Syringe ...................................... 92, 94 Easy Fiber ............................... 79 Easy Fiber (wheat dextrin) ..... 79 Easy Touch ....................... 92, 94 Easy Touch Insulin Syringe... 92, 94 ECee Plus................................ 51 econazole ................................ 31 Eldercaps ................................ 51 Elidel....................................... 32 Elinest ..................................... 26 Eliquis ..................................... 88 Elmiron ................................... 85 Emcyt ...................................... 13 enalapril maleate ..................... 16 enalapril-hydrochlorothiazide. 15 Enbrel ....................................... 4 Enbrel SureClick ...................... 4 Enema ..................................... 81 Enema Disposable .................. 81 Enemeez ................................. 85 Enemeez Plus.......................... 85 enoxaparin .............................. 88
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Enpresse ................................. 28 Enskyce .................................. 26 entecavir ................................. 10 Entresto................................... 16 Epaned .................................... 16 epinephrine ............................. 20 EpiPen 2-Pak .......................... 20 EpiPen Jr 2-Pak ...................... 20 Epogen .................................... 88 Epsom Salt.............................. 81 Equalactin ............................... 79 ergocalciferol (vitamin D2) .... 64 Erivedge ................................. 13 Errin........................................ 28 erythromycin .................. 11, 100 erythromycin ethylsuccinate .. 11 erythromycin with ethanol ..... 30 erythromycin-benzoyl peroxide ............................................ 30 Essentia................................... 57 ESSENTIAL Balance with Lutein ........................... 51, 57 ESSENTIAL Daily................. 51 ESSENTIAL Man .................. 51 ESSENTIAL Man 50+ ........... 51 Essential Woman 50+ ............ 51 Estarylla .................................. 26 Estrace .................................. 107 estradiol .................................. 68 estradiol-norethindrone acet ... 68 estrogens-methyltestosterone . 68 estropipate .............................. 68 ethambutol ................................ 9 etidronate disodium ................ 68 etoposide................................. 13 exemestane ............................. 13 Ex-Lax (sennosides) ............... 82 Ex-Lax Maximum Strength .... 82 Eye Allergy Relief ............ 98, 99 EZFE 200 ......................... 42, 43 E-Z-Gas II .............................. 73 F FaBB................................. 62, 65 Fallback Solo .......................... 29 Falmina (28) ........................... 26 famciclovir ............................. 10 famotidine............................... 76 Fareston .................................. 14 Farxiga .................................... 66 Farydak ................................... 13
Fatigue Relief Complex.......... 35 FE C ........................................ 44 FE C Plus ................................ 43 felodipine ................................ 20 Fem-Cal Citrate ...................... 41 Femcon Fe .............................. 26 Femhrt Low Dose ................... 68 fenofibrate .............................. 18 fenofibrate micronized ........... 18 fenofibrate nanocrystallized ... 18 fenofibric acid......................... 18 fenofibric acid (choline) ......... 18 fenoprofen ................................ 5 fentanyl ..................................... 2 Feosol ..................................... 43 Feosol Bifera .......................... 44 Feraheme ................................ 43 Fer-Iron ................................... 43 FeRiva .................................... 45 Feriva 21-7 Tablet .................. 45 FeRiva FA (Sumalate) ............ 45 Ferocon ................................... 45 FeroSul ................................... 43 Ferractiv.................................. 45 Ferralet 90 Dual-Iron Delivery ............................................ 45 FerraPlus 90 ............................ 45 Ferretts .................................... 43 Ferretts Carbonyl Iron ............ 43 Ferretts IPS ............................. 43 Ferrex 150............................... 43 Ferrex 150 Forte ..................... 45 Ferrex 150 Forte Plus ............. 45 Ferrex 150 Plus....................... 45 Ferrex 28................................. 45 Ferrimin 150 ........................... 43 Ferrocite.................................. 43 Ferrocite Plus .......................... 45 Ferrogels Forte ....................... 45 ferrous fumarate ..................... 43 ferrous gluconate .................... 43 ferrous sulfate ......................... 43 FerrouSul ................................ 43 Feverall ..................................... 4 fexofenadine ......................... 103 fiber ........................................ 79 Fiber (calcium polycarbophil) 79 Fiber (dextrin)......................... 79 Fiber (psyllium husk/sugar).... 79 Fiber (with aspartame)............ 79
Fiber Choice (inulin) .............. 79 Fiber Gummies (with chromium) .......................... 79 Fiber Laxative (ca polycarbo) 79 Fiber Laxative (methylcellulo) ............................................ 79 Fiber Select Gummies ............ 79 Fiber Smooth .......................... 79 Fiber Smooth (sucrose)........... 79 Fiber Supplement (inulin)....... 79 Fiber Therapy (ca polycarboph) ............................................ 79 Fiber Therapy (m-cell/sugar) .. 79 Fiber Therapy (m-cellulose) ... 79 Fiber Therapy (psyllium seed) 79 Fiber With Probiotic ............... 79 FiberCon ................................. 79 Fiber-Lax ................................ 79 Fiber-Stat ................................ 79 Fiber-Tabs............................... 79 finasteride ............................... 86 Fine 30 Universal Lancets 91, 94 First Choice Lancets Thin 91, 94 Flanax Antacid........................ 73 Flarex ...................................... 99 flavoxate ................................. 87 flecainide ................................ 17 Fleet Bisacodyl ....................... 82 Fleet Enema ............................ 81 Fleet Enema Extra .................. 82 Fleet Glycerin (Adult) ............ 81 Fleet Glycerin (Child)............. 81 Fleet Glycerin Laxative .......... 81 Fleet Laxative ......................... 82 Fleet Pediatric ......................... 82 Flintstones Bone Support ....... 42 Flintstones Complete (iron) .... 60 Flintstones Gummies .............. 59 Flintstones Gummies Omega-3 ............................................ 59 Flintstones Multivitamin ........ 59 Flintstones Plus Calcium ........ 60 Flintstones with Iron ............... 60 Flintstones/Extra C ................. 59 Flonase Allergy Relief .......... 106 Flovent Diskus ...................... 103 Flovent HFA ......................... 103 Flucelvax Quad 2016-2017 (PF) ............................................ 15 fluconazole ............................... 8
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fludrocortisone ....................... 70 Flulaval Quad 2016-2017 ....... 15 Flulaval Quad 2016-2017 (PF) ............................................ 15 flunisolide ............................. 106 fluocinonide............................ 33 Fluocinonide-E ....................... 33 Fluoridex Daily Defense ........ 96 Fluoritab ................................. 96 fluorometholone ..................... 99 fluorouracil ....................... 31, 32 flurbiprofen............................... 6 flurbiprofen sodium ................ 99 flutamide................................. 12 fluticasone ............................ 106 fluvastatin ............................... 18 Fluvirin 2016-2017................. 15 Fluvirin 2016-2017 (PF)......... 15 Fluzone High-Dose 2016-17 (PF) ..................................... 15 Fluzone Quad 2016-2017 ....... 15 Fluzone Quad 2016-2017 (PF) ............................................ 15 FML Forte .............................. 99 FML S.O.P. ............................ 99 Foaming Antacid .................... 71 Focalgin DSS.......................... 45 Folbecal .................................. 61 Folbee ............................... 62, 65 Folbee AR .............................. 35 Folbee Plus ............................. 36 Folbic................................ 62, 65 Folgard ................................... 37 Folgard OS ............................. 41 Folgard RX ....................... 62, 65 folic acid ................................. 65 Folinic-Plus ............................ 62 Folitab..................................... 45 Folivane-F .............................. 45 Folivane-Plus .......................... 45 Folplex 2.2........................ 62, 65 Foltabs 800 ............................. 62 Foltanx .................................... 62 fondaparinux........................... 88 Foradil Aerolizer .................. 104 Fortavit ................................... 57 Forteo ............................... 67, 68 Fosfree .................................... 51 fosinopril ................................ 16 Fosrenol .................................. 85
Freedavite ............................... 51 furosemide .............................. 21 Fusion ..................................... 45 Fusion Plus ............................. 45 G galantamine ............................ 25 Gas Relief ............................... 77 Gas Relief 80 .......................... 77 Gas Relief Extra Strength ....... 77 Gas-X...................................... 77 Gas-X Extra Strength ............. 77 Gavilyte-C .............................. 82 GaviLyte-G ............................. 82 GaviLyte-H and Bisacodyl ..... 83 GaviLyte-N ............................. 82 Gaviscon ................................. 71 Gaviscon Extra Strength ......... 71 Gelusil Antacid and Anti-Gas 73 gemfibrozil ............................. 18 Generess Fe ............................ 26 gentamicin ...................... 30, 100 Gentle Laxative ...................... 82 Geri-kot .................................. 82 Geri-Lanta .............................. 73 Geri-Mox Antacid-Antigas..... 73 Gianvi (28) ............................. 26 Gildagia .................................. 26 Gildess 1.5/30 (21) ................. 26 Gildess 1/20 (21) .................... 26 Gildess 24 Fe .......................... 26 Gildess FE 1.5/30 (28)............ 26 Gildess FE 1/20 (28)............... 26 Gilenya ................................... 97 Glatopa ................................... 97 Gleostine................................. 12 glimepiride.............................. 67 glipizide .................................. 67 glipizide-metformin ................ 66 GlucaGen HypoKit ................. 65 Glucagon Emergency Kit (human) .............................. 65 glucose .................................... 65 Glucose Gel ............................ 65 Glucoten ................................... 1 glyburide ................................. 67 glyburide micronized .............. 67 glyburide-metformin .............. 66 glycerin (adult) ....................... 81 glycerin (child) ....................... 81 Glycophos ............................... 47
glycopyrrolate ......................... 77 Golytely .................................. 82 granisetron HCl ...................... 75 Granix ..................................... 88 griseofulvin microsize .............. 8 griseofulvin ultramicrosize ....... 8 guanfacine............................... 21 Gynol II .................................. 29 H Hair Vitamins ......................... 51 Hair, Skin and Nails-Argan Oil ............................................ 51 Hair,Skin and Nails .......... 38, 51 Hair,Skin and Nails(FA-biotin) ............................................ 51 halobetasol propionate ............ 33 Hard Nail ................................ 63 Healthy Eyes ....................... 1, 51 Healthy Eyes SuperVision .. 1, 51 Hearing Aid Batteries ....... 91, 94 Heartburn and Acid Reflux-Aloe ............................................ 51 Heartburn Antacid .................. 71 Heartburn Prevention.............. 76 Heartburn Relief ..................... 71 Heartburn Relief (cimetidine). 76 Heartburn Relief (famotidine) 76 Heather ................................... 28 Hemangeol .............................. 19 Hematinic Plus Vit/Minerals .. 45 Hematinic/Folic Acid ............. 45 Hematogen .............................. 45 Hematogen FA........................ 45 Hematogen Forte .................... 45 Hematron ................................ 45 HemeNatal OB ....................... 61 HemeTab ................................ 45 Hemocyte ................................ 43 Hemocyte-Plus ....................... 45 heparin (porcine) .................... 88 Hexalen ................................... 12 Hi-B Complex ........................ 37 Hi-Cal Plus Vit D ................... 42 High Potency Iron................... 43 homatropine HBr .................... 98 Homocysteine Formula .......... 62 Honey Bears with Iron-Zinc ... 60 Humalog ................................. 70 Humalog KwikPen ................. 70 Humalog Mix 50-50 ............... 69
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Humalog Mix 50-50 KwikPen69 Humalog Mix 75-25 ............... 69 Humalog Mix 75-25 KwikPen69 Humira................................ 4, 78 Humira Pediatric Crohn's Start 4, 78 Humira Pen ............................... 4 Humira Pen Crohn's-UC-HS Start ...................................... 4 Humira Pen Psoriasis-Uveitis .. 4 Humulin 70/30........................ 69 Humulin 70/30 KwikPen........ 69 Humulin N .............................. 69 Humulin N KwikPen .............. 69 Humulin R .............................. 69 Humulin R U-500 (Concentrated) .................... 69 Hycamtin ................................ 14 hydralazine ............................. 21 hydrochlorothiazide ................ 22 Hydrocil .................................. 79 Hydrocil Instant ...................... 79 hydrocodone-acetaminophen ... 3 hydrocodone-ibuprofen ............ 3 hydrocortisone ............ 33, 68, 78 hydrocortisone acetate ........ 6, 33 hydrocortisone valerate .......... 33 hydrocortisone-acetic acid.... 101 hydrocortisone-pramoxine ....... 6 hydromorphone ........................ 2 hydroxychloroquine ............. 4, 8 hydroxyurea ............................ 13 hydroxyzine HCl .............. 22, 23 hydroxyzine pamoate ............. 23 hyoscyamine sulfate ............... 77 I I.L.X. B-12 ............................. 45 ibandronate ............................. 68 ibuprofen .................................. 6 Ibuprofen IB ............................. 6 Ibuprofen Jr Strength ................ 6 ICaps....................................... 51 I-Caps ..................................... 51 I-Caps ..................................... 51 I-Caps ..................................... 51 ICaps AREDS .................... 1, 51 Icaps MV ................................ 51 Icaps Plus................................ 51 Icar .......................................... 43 Icar-C ...................................... 45
iFerex 150 ............................... 43 iFerex 150 Forte ..................... 45 imiquimod ........................ 33, 34 iNatal Advance ....................... 61 iNatal Ultra ............................. 61 inControl Pen Needle ....... 92, 94 inControl Super Thin Lancets91, 94 inControl Ultra Thin Lancets 91, 94 Increlex ................................... 70 Incruse Ellipta....................... 104 indapamide ............................. 22 indomethacin ............................ 6 Infants Gas Relief ................... 77 Infant's Non-Aspirin ................. 4 Infed........................................ 43 Infuvite Adult ......................... 57 Injectafer ................................. 43 insulin syringe-needle U-100 92, 95 insulin syringes (disposable) . 92, 95 Integra ..................................... 45 Integra F ................................. 45 Integra Plus ............................. 45 Intron A .................................. 13 Introvale.................................. 26 Invokamet ............................... 66 Invokana ................................. 66 Inzo Antifungal....................... 31 ipratropium bromide ..... 104, 106 ipratropium-albuterol............ 105 irbesartan ................................ 16 irbesartan-hydrochlorothiazide ............................................ 16 iron.......................................... 44 Iron (dried) ............................. 43 Iron 100 Plus .......................... 43 Iron 21/7 ................................. 45 Iron Chews ............................. 43 Iron High Potency .................. 43 Iron with Stool Softener ......... 45 IronUp .................................... 44 iron-vitamin C ........................ 46 Iro-Plex (iron carbonyl) .......... 46 Iro-Plex (iron polysaccharide) 46 Irospan 24/6 ............................ 46 isometh-dichloral-acetaminophn ............................................ 23
isoniazid.................................... 9 isosorbide dinitrate ................. 17 isosorbide mononitrate ........... 17 isradipine ................................ 20 itraconazole............................... 8 I-Vite................................... 1, 51 I-Vite Protect ...................... 1, 51 J Jakafi....................................... 14 Janumet ................................... 67 Janumet XR ............................ 67 Januvia .................................... 66 Jencycla .................................. 28 Jentadueto ............................... 67 Jock Itch (clotrimazole) .......... 31 Jock Itch (terbinafine)............. 31 Jolessa ..................................... 26 Jolivette................................... 28 Junel 1.5/30 (21) ..................... 26 Junel 1/20 (21) ........................ 26 Junel FE 1.5/30 (28) ............... 26 Junel FE 1/20 (28) .................. 26 K Kaopectate (bismuth subsalicy) ............................................ 74 Kaopectate Ex Str (bismuth ss) ............................................ 74 Kao-Tin (bismuth subsalicylat) ............................................ 74 Kariva (28).............................. 25 Kelnor 1/35 (28) ..................... 26 Kelp-Lecithin-B6 ...................... 1 ketoconazole ....................... 8, 31 ketoprofen ................................. 6 ketorolac ............................. 5, 99 ketotifen fumarate ................... 99 Kondremul ........................ 80, 81 Konsyl (sugar) ........................ 79 Konsyl Easy Mix .................... 79 Konsyl Fiber ........................... 79 Konsyl Formula-D .................. 80 Konsyl Sugar-Free .................. 80 Konsyl Sugar-Free (aspartame) ............................................ 80 K-PAX .................................... 51 K-Pax Immune Support .......... 51 K-Pec Antidiarrheal (bism sub) ............................................ 74 K-Phos No 2 ........................... 86 K-Phos Original ...................... 86
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KPN ........................................ 61 Kristalose ................................ 81 Kurvelo ................................... 26 L labetalol .................................. 16 lactulose............................ 76, 81 lamivudine .............................. 10 lansoprazole ............................ 76 Lantus ..................................... 69 Lantus Solostar ....................... 69 Larin 1.5/30 (21) .................... 26 Larin 1/20 (21) ....................... 26 Larin Fe 1.5/30 (28) ............... 26 Larin Fe 1/20 (28) .................. 26 latanoprost ............................ 101 Lax Stool Softener With Senna ............................................ 84 Laxacin ................................... 84 Laxative (bisacodyl) ............... 82 Laxative (glycerin-pediatric) .. 81 Laxative (sennosides) ....... 82, 83 Laxative Dietary Supplement . 46 Laxative Feminine .................. 83 Laxative Maximum Strength .. 83 Laxative Pills .......................... 83 Laxative Pills Regular ............ 83 Laxative Plus Stool Softener .. 84 Layolis Fe ............................... 26 Lecithin-Kelp-B6 ..................... 1 Leena 28 ................................. 28 leflunomide............................... 5 Lessina .................................... 26 Letairis .................................... 22 letrozole .................................. 13 leucovorin calcium ................. 14 Leukeran ................................. 12 leuprolide................................ 14 levalbuterol tartrate .............. 105 levobunolol ............................. 99 levofloxacin .................... 10, 100 Levonest (28).......................... 28 levonorgestrel-ethinyl estrad .. 26 Levora-28 ............................... 26 levothyroxine .......................... 71 Lice Killing ............................ 34 lidocaine ................................. 34 lidocaine HCl.................... 34, 97 Lidocaine Viscous .................. 97 lidocaine-prilocaine ................ 34 Lidocream............................... 34
Life-Pack Men's...................... 51 Life-Pack Women's ................ 51 lindane .................................... 34 linezolid .................................. 11 liothyronine ............................ 71 LiquaFiber .............................. 80 Liquid Antacid ........................ 73 Liquid Calcium with Vitamin D ............................................ 42 Liqui-E.................................... 64 lisinopril.................................. 16 lisinopril-hydrochlorothiazide 15 Liver with Iron........................ 46 Lmefol Ca-acetyl-meB12-algal ............................................ 62 L-Methyl-B6-B12 ................... 63 L-Methylfolate Ca P-5-P MeCbl ...................................... 63 L-Methyl-MC ......................... 57 L-Methyl-MC NAC .................. 1 LMTHF-PyridoxineCyanocobalamn .................. 63 Lo Loestrin Fe ........................ 25 LoCalnesium .......................... 41 LoCalnesium-C ...................... 41 Loestrin 1/20 (21) ................... 26 Lomedia 24 Fe ........................ 26 loperamide .............................. 74 loratadine .............................. 103 loratadine-pseudoephedrine.. 101 Loryna (28) ............................. 27 losartan ................................... 16 losartan-hydrochlorothiazide .. 16 lovastatin ................................ 18 Low-Ogestrel (28) .................. 27 Lubricant Eye Drops .............. 98 Lubricant Eye Drops (glyc-pg) ............................................ 98 Lubricant Eye(dextran70hypml) ................................ 98 Lutera (28) .............................. 27 Lydia Pinkham Herbal............ 46 Lysiplex Plus .......................... 36 Lysodren ................................. 12 M M.V.I. Adult ........................... 57 Maalox Advanced................... 73 Maalox Maximum Strength.... 73 Macular Vitamin..................... 51 Macuvite Eye Care ................. 51
Macuvite With Lutein............... 1 Mag 64 .................................... 46 Mag Glycinate ........................ 46 MAG-AL ................................ 71 Mag-Al Plus............................ 73 Mag-Al Plus Extra Strength ... 73 MagBid ER ............................. 46 Mag-Delay .............................. 46 Mag-G..................................... 46 Maginex .................................. 46 Maglox .................................... 73 MagneBind 300 ...................... 85 MagneBind 400 ...................... 85 magnesium .............................. 46 Magnesium (oxide/AA chelate) ............................................ 46 magnesium amino acid chelate ............................................ 46 magnesium chloride.......... 46, 47 magnesium citrate ............. 47, 81 magnesium gluconate ............. 47 magnesium oxide .................... 47 magnesium sulfate .................. 47 magnesium sulfate in D5W .... 47 magnesium sulfate in water .... 47 Magonate (magnesium carb) .. 47 MagOx .................................... 47 Magtab .................................... 47 malathion ................................ 34 Mapap (acetaminophen) ........... 4 Marlissa .................................. 27 Masanti Double Strength ........ 73 Matulane ................................. 12 Maxaron Forte ........................ 46 Maximin Pack ......................... 51 MAXIMUM DAILY GREEN 52 Maximum Daily Multivitamin52 meclizine................................. 75 Medi-Laxx .............................. 84 medroxyprogesterone ....... 25, 70 Medtycholl-B Complex-Liver 36 mefloquine ................................ 8 Mega Biotin ............................ 63 Mega Multi for Women .......... 52 Mega Multiple/Chelated Mineral ............................................ 52 Mega Multivitamin For Men .. 52 Mega Multivitamin with Mineral ............................... 52 Megavite ................................. 38
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Megavite Golden Years 55+ .. 38 megestrol .......................... 14, 34 meloxicam ................................ 5 memantine .............................. 25 Memory Complex .................... 2 Menest .................................... 68 Men's Biomultiple .................. 52 Men's Daily ............................ 52 Men's Daily Multivit-Mineral 52 Men's Multi-Vitamin .............. 57 Men's Multivitamin Gummies 52 Men's One Daily ..................... 52 Men's Pack ............................. 52 Mens Potent Formula ............... 2 meperidine ................................ 2 mercaptopurine ....................... 13 Meribin ................................... 64 mesalamine ............................. 78 Mesnex ................................... 15 Metafolbic .............................. 57 Metafolbic Plus ........................ 2 Metafolbic Plus RF................. 63 Metamucil............................... 80 Metamucil (with sugar) .......... 80 Metamucil Fiber Singles ........ 80 Metamucil MultiHealth Fiber. 80 Metamucil Plus Calcium ........ 80 Metamucil Sugar-Free (aspart) ............................................ 80 metaproterenol ...................... 105 metformin ............................... 70 methadone ................................ 2 methazolamide ....................... 21 methenamine hippurate .......... 86 methenamine mandelate ......... 86 methimazole ........................... 67 methocarbamol ....................... 90 methotrexate sodium ...... 4, 5, 13 methotrexate sodium (PF) ...... 13 methyclothiazide .................... 22 methyldopa ............................. 21 methyldopa-hydrochlorothiazide ............................................ 20 methylergonovine ................... 70 methylprednisolone ................ 68 metipranolol ......................... 100 metoclopramide HCl .............. 77 metolazone ............................. 22 metoprolol succinate .............. 19 metoprolol tartrate .................. 19
metronidazole ............. 8, 30, 107 mexiletine ............................... 17 Mg-Plus-Protein ....................... 2 Mi-Acid ............................ 71, 73 Mi-Acid Gas Relief ................ 77 Miconazole 7 ........................ 107 miconazole nitrate .......... 31, 107 Miconazole-3 ........................ 107 Miconazole-3 prefil,cream,wipe .......................................... 107 Micro Thin Lancets .......... 91, 95 Microgestin 1.5/30 (21) .......... 27 Microgestin 1/20 (21) ............. 27 Microgestin Fe 1.5/30 (28) ..... 27 Microgestin FE 1/20 (28) ....... 27 midodrine................................ 20 Milk of Magnesia ................... 81 Milk Of Magnesia Concentrated ............................................ 81 Milltrium Senior ..................... 38 Minastrin 24 Fe ...................... 27 mineral oil............................... 81 Mineral Oil Extra Heavy ........ 81 Mineral Oil Heavy .................. 81 Mineral Oil Laxative .............. 81 minocycline ........................ 5, 12 minoxidil ................................ 21 Mintox .................................... 74 Mintox Maximum Strength .... 74 Mintox Plus ............................ 74 misoprostol ............................. 77 Modicon (28) .......................... 27 mometasone ............................ 33 Monistat 7 ............................. 107 Monocaps ............................... 52 Mono-Linyah .......................... 27 Mononessa (28) ...................... 27 montelukast .......................... 104 morphine................................... 2 morphine concentrate ............... 2 Motion Sickness (meclizine) .. 75 Motion Sickness Relief(mecliz) ............................................ 75 MoviPrep ................................ 82 moxifloxacin........................... 10 Multi Complete with Iron ....... 57 Multi For Her.......................... 52 Multi Vitamin ......................... 52 Multi-Betic ......................... 1, 52 Multi-Day with Iron ............... 57
Multi-Delyn ............................ 57 Multi-Delyn with Iron ............ 52 Multigen ................................. 46 Multigen Folic ........................ 46 Multigen Plus.......................... 46 Multilex .................................. 52 Multilex-T and M ................... 52 Multiple Vitamin, Womens .... 52 Multiple Vitamin-Minerals ..... 52 Multiple Vitamins................... 57 multivitamin ........................... 57 Multivitamin 50 Plus .............. 38 Multi-Vitamin HP/Minerals ... 52 Multi-Vitamin With Fluoride . 60 multivitamin with iron ............ 52 multivitamin with minerals.... 39, 52 Multivitamins With Fluoride .. 60 Multi-Vite ............................... 57 Multi-Vite 50 and Over .......... 39 mupirocin ................................ 30 Mvc-Fluoride .......................... 60 M-Vit ...................................... 61 mv-min-folic acid-lutein ......... 52 My Favorite Multiple ............. 57 My Way .................................. 29 mycophenolate mofetil ....... 5, 89 mycophenolate sodium ........... 89 Myferon 150 ........................... 44 Myleran................................... 12 Mynatal ................................... 61 Mynatal Advance.................... 61 Mynatal Plus ........................... 61 Mynatal-Z ............................... 61 Mynate 90 Plus ....................... 61 Mytab Gas .............................. 77 Mytab Gas Maximum Strength ............................................ 77 My-Vitalife ............................. 52 Myzilra ................................... 28 N nabumetone............................... 5 nadolol .................................... 19 naloxone ................................... 7 naproxen ................................... 6 naproxen sodium ...................... 6 naratriptan ............................... 24 Narcan....................................... 7 Nasacort ................................ 106
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Nasal Spray (sodium chloride) .......................................... 106 Nasalcrom............................. 106 nateglinide .............................. 66 Natural B-100 ......................... 37 Natural B-100 Complex ......... 36 Natural Fiber Laxative ........... 80 Natural Fiber Laxative (sugar)80 Natural Fiber Laxative Smooth ............................................ 80 Natural Fiber Laxative Therapy ............................................ 80 Natural Fiber Laxative(aspart)80 Natural Fiber Supplement ...... 80 Natural Laxative ..................... 83 Natural Senna Laxative .......... 83 Natural Tears (PF) .................. 98 Natural Veg Laxative(sennosid) ............................................ 83 Natural Vegetable ................... 80 Natural Vegetable (psyllium) . 80 Natural Vegetable Laxative .... 83 Natural Vegetable Powder ..... 80 Nature-Throid ......................... 71 Necon 0.5/35 (28) ................... 27 Necon 1/35 (28) ...................... 27 Necon 1/50 (28) ...................... 27 Necon 10/11 (28) .................... 25 Necon 7/7/7 (28)..................... 28 neomycin .................................. 7 neomycin-bacitracin-poly-HC 98 neomycin-bacitracin-polymyxin .......................................... 100 neomycin-polymyxin Bdexameth ............................ 98 neomycin-polymyxingramicidin......................... 100 neomycin-polymyxin-HC ..... 98, 101 Neo-Polycin HC ..................... 98 Nephplex Rx........................... 37 Nephrocaps Qt ........................ 36 Nephron FA ............................ 46 Nephronex .............................. 36 Nephronex-SL ........................ 36 Nestabs ................................... 61 Nestabs DHA.......................... 61 Neupogen ............................... 88 NewGen .................................. 61 Nexium 24HR ........................ 76
Next Choice One Dose ........... 29 niacin ................................ 18, 63 niacin (inositol niacinate) ....... 63 niacinamide ............................ 63 Niacin-Aze AC-Turmer-FA-B6ZN ....................................... 38 Nicadan ................................... 38 nicardipine .............................. 20 Nicazel .................................... 38 NicAzel Forte ......................... 38 Nicomide ................................ 52 Nicomide (selenium-chromium) ............................................ 52 nicotine ................................... 24 nicotine (polacrilex) ............... 24 Nicotrol ................................... 24 Nicotrol NS............................. 24 nifedipine ................................ 20 Nikki (28) ............................... 27 nilutamide ............................... 12 nimodipine .............................. 20 Nitro-Bid ................................ 17 nitrofurantoin .......................... 87 nitrofurantoin macrocrystal ... 86, 87 nitrofurantoin monohyd/m-cryst ............................................ 87 nitroglycerin ........................... 17 Nitrolingual ............................ 17 Nitrostat .................................. 17 Nitro-Time .............................. 17 Niva-Fol............................ 63, 65 Noble Formula HC ................. 33 Nora-BE.................................. 28 Norditropin FlexPro ............... 69 noreth-ethinyl estradiol-iron ... 27 norethindrone (contraceptive) 28 norethindrone acetate ............. 70 norethindrone ac-eth estradiol ...................................... 27, 68 norethindrone-e.estradiol-iron 27 norgestimate-ethinyl estradiol27, 29 norgestrel-ethinyl estradiol ..... 27 Norlyroc.................................. 28 Nortrel 0.5/35 (28) .................. 27 Nortrel 1/35 (21) ..................... 27 Nortrel 7/7/7 (28).................... 29 Nova Safety Lancets ......... 91, 95 Nova Sureflex Lancets ..... 91, 95
NovaFerrum ............................ 44 NovaFerrum 125 ..................... 44 NovaFerrum 50 ....................... 44 NovaFerrum Pediatric ............ 60 NovoFine 30 ..................... 92, 95 Novofine 32 ...................... 92, 95 Novofine Autocover ......... 92, 95 Novolin 70/30 ......................... 69 Novolin N ............................... 69 Novolin R ............................... 69 Novolog .................................. 70 Novolog Flexpen .................... 70 Novolog Mix 70-30 ................ 69 Novolog Mix 70-30 FlexPen .. 69 Novolog PenFill...................... 70 NP Thyroid ............................. 71 Nu-Iron ................................... 44 Nutricap .................................. 52 Nutrisource Fiber .................... 80 Nutrivit ................................... 36 NuvaRing ................................ 29 nystatin ......................... 8, 31, 96 nystatin-triamcinolone ............ 31 O OB Complete .......................... 46 Obstetrix DHA........................ 61 Obstetrix EC ........................... 61 Obtrex DHA ........................... 61 O-Cal FA ................................ 61 Ocean for Kids ...................... 106 Ocean Nasal .......................... 106 Ocella ...................................... 27 octreotide acetate .............. 70, 85 Ocutabs ................................... 52 Ocuvite ............................... 1, 52 Ocuvite Lutein and Zeaxanthin 1 Ocuvite with Lutein ............ 1, 52 ofloxacin ................. 10, 100, 101 Ogestrel (28) ........................... 27 omega-3 acid ethyl esters ....... 18 omeprazole ....................... 76, 77 omeprazole magnesium .......... 76 Omnicap ................................. 52 Once Daily .............................. 57 Oncovite ................................. 57 ondansetron............................. 76 ondansetron HCl ..................... 75 One Daily.................... 38, 53, 58 One Daily Calcium/Iron ......... 52 One Daily Complete ............... 53
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One Daily Energy ............. 53, 57 One Daily Essential .......... 53, 57 One Daily For Men ................ 53 One Daily For Men 50+ Advanced ............................ 57 One Daily For Women ........... 53 One Daily Gummy Vites ........ 53 One Daily Healthy Weight ..... 53 One Daily Maximum.............. 53 One Daily Men's 50+ ....... 53, 58 One Daily Multi-Vit w-Mineral ............................................ 53 One Daily Multivitamin ......... 58 One Daily Multivit-Iron(folic)58 One Daily Plus Iron .......... 53, 58 One Daily Plus Minerals ........ 53 One Daily With Iron ............... 53 One Daily Women 50 Plus ..... 53 One Daily Women's ......... 53, 58 One Daily Womens 50 Plus ... 53 One Daily Women's Health .... 58 One Daily Women's Metabolism ............................................ 38 One-A-Day Cholesterol Plus.. 53 One-A-Day Energy ................ 58 One-A-Day Essential.............. 58 One-A-Day Maximum Formula ...................................... 53, 58 One-A-Day Men 50 Plus (ginkgo) .............................. 58 One-A-Day Men VitaCraves .. 53 One-A-Day Menopause Formula ............................................ 53 One-A-Day Men's 50 Plus ..... 53 One-A-Day Men's Multivitamin ............................................ 53 One-A-Day Teen Advantage . 53, 58 One-A-Day Teen Him VitaCraves .......................... 59 One-A-Day VitaCraves .......... 53 One-A-Day VitaCraves Energy ............................................ 53 One-A-Day Vitacraves Immunity ............................ 53 One-A-Day Vitacraves Omega-3 ............................................ 53 One-A-Day WeightSmart....... 53 One-A-Day Women VitaCraves ............................................ 53
One-A-Day Women's Active . 53 One-A-Day Womens Formula ...................................... 53, 58 One-A-Day Women's Healthy Skin..................................... 53 One-A-Day Women's Petites . 58 OptiChamber Diamond Lg Mask ............................. 93, 95 OptiChamber Diamond VHC 93, 95 OptiChamber Diamond-Med Msk ............................... 93, 95 OptiChamber Diamond-Sml Mask ............................. 93, 95 Optisource .............................. 54 Opti-Vitamins ..................... 1, 54 Opurity Multivitamin ............. 54 Oral Saline Laxative ............... 82 Oralyte .................................... 47 orphenadrine citrate ................ 90 Orsythia .................................. 27 Ortho Micronor....................... 28 Ortho Tri-Cyclen (28) ............ 29 Ortho Tri-Cyclen Lo (28) ....... 29 Ortho-Novum 7/7/7 (28) ........ 29 Os-Cal 500 + D3 .................... 42 OsmoPrep ............................... 82 Osteo-Poretical ....................... 42 Ovcon-35 (28) ........................ 27 Oxi-Freeda .............................. 54 oxybutynin chloride ................ 87 oxycodone ................................ 2 oxycodone-acetaminophen ....... 3 Oysco 500/D ........................... 42 Oysco-500 .............................. 39 Oyster Shell Calcium.............. 39 Oyster Shell Calcium 500....... 39 Oyster Shell Calcium and Mag ............................................ 41 Oyster Shell Calcium-Vit D2 . 42 Oyster Shell Calcium-Vit D3 . 42 P P D Natal Vitamins-Folic Acid ............................................ 61 Pain Reliever ............................ 4 pantoprazole ........................... 77 paregoric ................................. 74 paromomycin ............................ 7 Parva-Cal 250 ......................... 42 Parva-Cal 500 ......................... 42
Parvlex .................................... 46 P-COL RITE ........................... 84 Peak Air Peak Flow Meter93, 95 Ped MultivitaminsA,B,D,E,K,Zn ..................... 59 Pedia-Lax ................................ 81 Pedia-Lax Stool Softener ........ 85 Pediatric Electrolyte ............... 47 Pediatric Freezer Pops ............ 47 PediaVance ............................. 47 peg 3350-electrolytes.............. 82 PEG-3350 with flavor packs .. 82 peg-electrolyte soln ................ 82 PEG-Prep ................................ 83 Pen Needle ........................ 92, 95 penicillin V potassium ............ 11 Pentasa .................................... 78 pentazocine-naloxone ............... 3 pentoxifylline .......................... 88 Peptic Relief ........................... 74 Pepto-Bismol Max St ............. 74 Perdiem Overnight Relief ....... 83 Perfect Iron ............................. 44 PERI-COLACE ...................... 84 perindopril erbumine .............. 16 Perio Med ............................... 96 permethrin............................... 34 Personal Best Full Range.. 93, 95 Pharmacist Favorite Multi-Vit 58 phenazopyridine ..................... 86 phenylephrine HCl.................. 99 Philith ..................................... 27 Phillips .................................... 47 Phillips Liqui-Gels.................. 85 Phillips Milk of Magnesia 72, 81 Phoslyra ............................ 85, 86 Phos-NaK ............................... 47 Phosphate Laxative ................. 82 Phospholine Iodide ................. 98 pilocarpine HCl ................ 97, 98 pindolol ................................... 19 Pink Bismuth .......................... 74 Pink Bismuth Maximum Strength............................... 74 pioglitazone ............................ 70 piroxicam .................................. 5 PNV 29-1 ................................ 61 PoDiaPN ................................. 37 podofilox................................. 34 polyethylene glycol 3350 ....... 81
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Poly-Iron................................. 44 Poly-Iron 150 Forte ................ 46 polymyxin B sulf-trimethoprim .......................................... 100 polyvinyl alcohol .................... 98 Poly-Vi-Sol............................. 60 Poly-Vi-Sol with Iron ............. 60 Poly-Vita ................................ 59 Poly-Vita (iron) ...................... 60 Poly-Vitamin .......................... 59 Poly-Vitamin with Iron .......... 60 Polyvitamin/Iron..................... 60 Poly-Vitamins......................... 59 Pomalyst ................................. 14 Portia ...................................... 27 Potaba ..................................... 65 potassium bicarb and chloride ...................................... 47, 48 potassium bicarb-citric acid ... 48 potassium chloride.................. 48 potassium citrate ..................... 86 potassium citrate-citric acid ... 86 potassium phosphate m-/d-basic ............................................ 47 Pradaxa ................................... 89 pramipexole ............................ 23 pravastatin .............................. 18 prazosin .................................. 22 Pred Mild ................................ 99 prednisolone ........................... 69 prednisolone acetate ............... 99 prednisolone sodium phosphate ...................................... 69, 99 prednisone .............................. 69 Prefera-OB ............................. 61 Premarin ......................... 68, 107 Premphase .............................. 68 Prempro .................................. 68 Prenatabs FA .......................... 61 Prenatabs Rx ........................... 61 Prenatal ................................... 61 Prenatal 19 .............................. 61 Prenatal Formula .................... 61 Prenatal Low Iron ................... 61 Prenatal Multi-DHA ............... 61 Prenatal Plus ........................... 61 Prenatal Plus (calcium carb)... 61 Prenatal Tablet........................ 61 Prenatal Vitamin ..................... 61
Prenatal Vitamin Plus Low Iron ............................................ 61 Prenatal Vitamin with Minerals ............................................ 62 Prenatal-U ............................... 62 Prenate AM............................. 62 Prepopik.................................. 83 PreserVision AREDS ......... 1, 54 PreserVision AREDS 2 ............ 1 PreserVision Lutein ................ 54 PreTAB ................................... 62 Prevacid SoluTab ................... 77 Prevent .................................... 54 PreviDent ................................ 96 PreviDent 5000 Plus ............... 96 Previfem ................................. 27 primaquine ................................ 8 PrimeAire ......................... 93, 95 Pro Fe ..................................... 44 probenecid .............................. 87 probenecid-colchicine ............ 87 Pro-Cal.................................... 41 ProCerv HP............................. 54 ProChamber ...................... 93, 95 prochlorperazine ..................... 75 prochlorperazine maleate ....... 75 Procrit ..................................... 88 Proferrin ES ............................ 44 Proferrin-Forte ........................ 46 progesterone micronized ........ 70 Proglycem ............................... 65 promethazine .................. 75, 102 Promolaxin ............................. 85 propafenone ............................ 17 propantheline .......................... 77 proparacaine ......................... 100 propranolol ............................. 19 propranolol-hydrochlorothiazid ............................................ 22 propylthiouracil ...................... 67 ProRenal ................................. 36 ProRenal QD .......................... 54 Prosight ..................................... 1 Prosight with Lutein ............... 54 Prostamen ............................... 38 Prosteon .................................. 42 Protect Cardio AF ................... 54 Protect Iron ............................. 54 Protect Plus SO....................... 54 Protonix .................................. 77
pseudoephedrine HCl ........... 106 psyllium husk.......................... 80 Pulmicort Flexhaler .............. 103 Pulmozyme ........................... 105 pyrazinamide ............................ 9 pyridostigmine bromide.......... 90 pyridoxine (vitamin B6) ......... 63 Q Q-PAP....................................... 4 Q-Tussin DM ........................ 106 Quasense ................................. 27 Quflora Pediatric .................... 60 Quin B Strong ......................... 36 quinapril .................................. 16 quinapril-hydrochlorothiazide 15 quinidine sulfate ..................... 17 Quintabs.................................. 58 Quintabs-M ............................. 54 Quintabs-M Iron Free ............. 54 Qvar ...................................... 103 R Rabano Yodado ...................... 37 raloxifene ................................ 70 ramipril ................................... 16 Ranexa .................................... 17 ranitidine HCl ......................... 76 Ready-To-Use Enema ............ 82 Ready-To-Use Enema (min oil) ............................................ 81 Reclipsen (28) ......................... 27 Recort Plus.............................. 33 Reguloid ................................. 80 Reguloid (dextrose) ................ 80 Reguloid, Sugar Free .............. 80 Relenza Diskhaler ............. 10, 11 ReliOn Ultra Thin Plus Lancets ...................................... 91, 95 Renagel ................................... 85 Renal Caps .............................. 36 Rena-Vite Rx .......................... 37 Reno Caps ............................... 36 Renvela ................................... 85 repaglinide .............................. 66 Replesta .................................. 64 REQ49+ ............................ 39, 54 Revlimid ................................. 14 rifabutin .............................. 9, 11 rifampin .............................. 9, 11 Ri-Gel ..................................... 74 Ri-Gel II.................................. 74
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Right Step Prenatal Vitamins . 62 Riginic .................................... 71 riluzole.................................... 90 Ri-Mag ................................... 72 Ri-Mag Plus............................ 74 rimantadine ............................. 11 Ri-Mox ................................... 74 Ri-Mox Plus ........................... 74 Risacal-D ................................ 42 rivastigmine tartrate................ 25 rizatriptan ............................... 24 Robafen DM ......................... 106 Rolaids.................................... 71 ropinirole ................................ 23 Rulox ...................................... 74 S SafeSnap Insulin Syringe . 92, 95 SafeSnap Syringe ............. 93, 95 Safyral .................................... 27 Saline Mist............................ 106 Sani-Supp (Adult) .................. 81 Sani-Supp (Infant) .................. 81 Santyl ...................................... 32 SAVision ............................ 1, 54 Scooby-Doo One A Day ........ 60 selegiline HCl ......................... 23 selenium sulfide...................... 32 Senexon .................................. 83 Senexon-S............................... 84 senna ....................................... 83 Senna Lax ............................... 83 Senna Laxative ....................... 83 Senna Laxative-Stool Softener ............................................ 84 senna leaf ................................ 83 Senna Plus .............................. 84 Senna Prompt ......................... 83 Senna with Docusate Sodium . 84 Senna-Extra ............................ 83 Sennalax-S.............................. 84 Senna-S................................... 84 Senna-Time S ......................... 84 Senno ...................................... 83 sennosides-docusate sodium .. 84 Senokot ................................... 83 Senokot-S ............................... 84 SenokotXTRA ........................ 83 Sen-O-Tab .............................. 83 Sensipar .................................. 68 Sentry ............................... 54, 58
Sentry Senior .......................... 54 Serevent Diskus .................... 104 Se-Tan Plus............................. 58 SF............................................ 96 SF 5000 Plus........................... 96 Sharobel .................................. 28 Sharps Container .............. 93, 95 Siderol .................................... 46 Silace ...................................... 85 sildenafil ................................. 22 silver sulfadiazine ................... 32 simethicone............................. 77 simvastatin .............................. 18 sirolimus ................................. 89 Slo-Niacin ............................... 63 Slow Release Iron ................... 44 Slow-Mag ............................... 47 Smart Sense Lancets ......... 91, 95 Smooth Antacid ...................... 72 sodium bicarbonate................. 72 sodium chloride ................ 24, 25 sodium citrate-citric acid ........ 86 sodium ferric gluconat-sucrose ............................................ 44 sodium fluoride....................... 96 sodium phosphate ................... 47 sodium polystyrene (sorb free) ............................................ 38 sodium polystyrene sulfonate . 38 Soft Touch Lancets ........... 91, 95 Softgels Multivit-A,B,D,E,K,Zn ............................................ 54 Solo......................................... 54 Soluble Fiber .......................... 80 Soothe (bismuth subsalicylate) ............................................ 75 Soothe Regular Strength ......... 75 Soothing Care (hydrocortisone) ............................................ 33 sotalol ............................... 17, 19 Sotalol AF......................... 17, 19 Soy Formula ........................... 41 Spectravite Adult .................... 54 Spectravite Adult 50+ ............. 54 Spectravite Advanced Formula ............................................ 58 Spectravite Men's ................... 54 Spectravite Senior............. 39, 54 Spectravite Ultra Men 50+ ..... 54 Spectravite Ultra Men's Sr...... 54
Spectravite Ultra Women ....... 58 Spectravite Ultra Women's Sr 54 Spiriva Respimat .................. 104 Spiriva with HandiHaler ....... 104 spironolactone................... 16, 21 spironolacton-hydrochlorothiaz ............................................ 21 Sprintec (28) ........................... 28 Sronyx..................................... 28 Stimate .................................... 66 Stimulant Laxative Plus .......... 84 Stomach Relief ....................... 75 Stomach Relief Max Strength 75 Stomach Relief Original ......... 75 Stool Softener ......................... 85 Stool Softener-Laxative .......... 84 Stool Softener-Stimulant Laxat ............................................ 84 Stress B Plus Zinc ................... 36 Stress B With Zinc.................. 36 Stress B-Biotin........................ 37 Stress B-Complex ................... 54 Stress Formula ............ 36, 37, 46 Stress Formula 600 C ............. 36 Stress Formula Advanced ....... 54 Stress Formula Energy ........... 36 Stress Formula plus Iron ......... 36 Stress Formula With Iron(sulf) ............................................ 36 Stress Formula with Zinc........ 36 Strovite Forte .......................... 54 Strovite One ............................ 54 sucralfate................................. 85 sulfacetamide sodium ........... 100 sulfacetamide-prednisolone .... 98 sulfamethoxazole-trimethoprim7 sulfasalazine ....................... 5, 78 Sulfatrim ................................... 7 sulindac ..................................... 5 sumatriptan succinate ............. 24 Sunvite .................................... 54 Super Antioxidant............... 1, 54 Super B Complex + C ............ 36 Super B Complex-Vitamin C . 36 Super B/C ............................... 36 Super B-50 Complex .............. 37 Super B-50 Complex Plus ...... 37 Super Cal-Mag........................ 41 Super Ginseng Multivitamin .. 55 Super Multiple ........................ 55
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Super Multiple - Low Iron ..... 55 Super Multivitamin ................ 58 Super Quints B-50 .................. 37 Super Thera Vite M ................ 55 Superior 35 ............................. 55 Superplex-T ............................ 36 Supervite................................. 36 Supervite (EC) ........................ 55 Support ................................... 55 Support-500 ............................ 36 Suppository Adult .................. 81 Suprax..................................... 10 Suprep Bowel Prep Kit ........... 82 Sure Comfort Pen Needle . 92, 95 Sure-Fine Pen Needles ..... 92, 95 Sure-Ject Insulin Syringe . 92, 95 Surfak ..................................... 85 Syeda ...................................... 28 Symbicort ............................. 105 Synagis ................................... 15 T Tab-A-Vite ............................. 58 Tab-A-Vite/Iron ..................... 55 Tab-A-Vite-Minerals .............. 55 Tabloid ................................... 13 tacrolimus ......................... 32, 89 Take Action ............................ 29 Tamiflu ................................... 11 tamoxifen................................ 14 tamsulosin............................... 86 Tandem Dual Action .............. 44 Tanzeum ................................. 67 Targretin ................................. 14 Taron Forte ............................. 46 Tears Naturale Free (PF) ........ 98 Tears Pure ............................... 98 Tecfidera................................. 97 Tekturna ................................. 22 Tekturna HCT ........................ 22 Temodar ................................. 12 temozolomide ......................... 12 terazosin ................................. 22 terbinafine HCl ......................... 8 terbutaline ............................. 105 terconazole ........................... 107 testosterone ............................. 66 testosterone cypionate ............ 65 testosterone enanthate ............ 66 tetracycline ............................. 12 The Magic Bullet .................... 83
theophylline .......................... 104 Thera ....................................... 58 Thera M Plus (ferrous fumarat) ............................................ 55 Thera Vitamin......................... 58 TheraCal ................................. 42 TheraCal D2000 ..................... 42 TheraCal D4000 ..................... 42 Thera-D .................................. 64 Theradex M ............................ 55 Theragran-M Premier 50 Plus 55 Theralogix Companion ........... 55 Thera-M .................................. 55 Theramill Forte ....................... 55 TheraNatal ........................ 55, 62 Therapeutic Liquid ................. 58 Therapeutic M + beta-Carotene ............................................ 55 Therapeutic-M ........................ 55 Therapeutic-M Vitamin/Minerals................ 55 Thera-Tabs.............................. 58 Thera-Tabs M ......................... 55 Theratrum Complete 50 Plus.. 39 Theratrum Complete 50 Plus/Lut .............................. 39 Theratrum Complete with Lutein.................................. 55 Therems ............................ 55, 58 Therems-H .............................. 55 Therems-M ............................. 55 thiamine HCl (vitamin B1) ..... 63 Tilia Fe ................................... 29 timolol maleate ............... 19, 100 tinidazole .................................. 8 tizanidine ................................ 90 TL Gard Rx ...................... 63, 65 TL G-Fol OS .......................... 41 TL Icon ................................... 46 Tobi Podhaler ....................... 105 TobraDex ................................ 98 tobramycin ............................ 100 tobramycin in 0.225 % NaCl 105 tobramycin-dexamethasone .... 98 Today Contraceptive Sponge . 29 tolazamide .............................. 67 tolbutamide ............................. 67 tolnaftate ................................. 31 tolterodine............................... 87 torsemide ................................ 21
Total B/C ................................ 36 Totalday Multiple ................... 55 Tracleer ................................... 22 Tradjenta ................................. 66 tramadol .................................... 2 trandolapril ............................. 16 Transderm-Scop ..................... 75 Travel Sickness (meclizine) ... 75 travoprost (benzalkonium).... 101 Trecator..................................... 9 tretinoin................................... 30 tretinoin (chemotherapy) ........ 14 TriAdvance ............................. 62 triamcinolone acetonide.... 33, 97 triamterene-hydrochlorothiazid ............................................ 21 TriCare .................................... 62 Tricitrates ................................ 86 Tricon ..................................... 46 Tri-Estarylla ............................ 29 trifluridine ............................. 100 Trigels-F Forte ........................ 46 Tri-Legest Fe .......................... 29 Tri-Linyah............................... 29 TriLyte With Flavor Packets .. 82 trimethobenzamide ................. 75 trimethoprim ............................. 8 Trinatal GT ............................. 62 Trinatal Rx 1 ........................... 62 Trinate..................................... 62 TriNessa (28) .......................... 29 Triphrocaps ............................. 36 Triple Antibiotic ..................... 30 Tri-Previfem (28).................... 29 Tri-Sprintec (28) ..................... 29 Tri-Tabs DHA ........................ 62 Tri-Vi-Flor .............................. 60 Tri-Vitamin ............................. 59 Tri-Vitamin With Fluoride ..... 60 Trivora (28) ............................ 29 tropicamide ............................. 98 trospium .................................. 87 TRUEplus Diabetic Multivitamin ....................... 55 Tudorza Pressair ................... 104 Tums ....................................... 72 Tums Freshers ........................ 72 Tums Ultra .............................. 72 TYR Cooler ............................ 55
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U Udamin SP.............................. 55 Uloric...................................... 87 Ulticare ............................. 92, 95 Ulticare Pen Needle .......... 92, 95 Ultilet Pen Needle ............ 92, 95 Ultimate Men's Complete 50+ 55 Ultimate Women's Complete 50+...................................... 55 Ultra B-100 Complex ............. 37 Ultra Comfort Insulin Syringe ...................................... 92, 96 Ultra Freeda ............................ 55 Ultra Strength Antacid ........... 72 Ultra Strength Calcium Antacid ............................................ 72 Ultra Thin Lancets ............ 91, 96 Ultra Thin Plus Lancets .... 91, 96 UltraLANCE Lancets ....... 91, 96 Unicomplex-M ....................... 55 Unifiber .................................. 80 Unifine Pentips ................. 92, 96 Unifine Pentips Plus ......... 92, 96 Universal 1 Lancets .......... 91, 96 Upcal D .................................. 42 Uretron D-S ............................ 87 Urocit-K 10 ............................ 86 Urocit-K 5 .............................. 86 Uro-Mag ................................. 47 ursodiol ................................... 76 Utira-C .................................... 87 V Vaginal Contraceptive Foam .. 30 valacyclovir ............................ 10 valganciclovir ......................... 10 valsartan ................................. 16 valsartan-hydrochlorothiazide 16 vancomycin ............................ 10 V-C Forte................................ 55 Vegetable Laxative ................. 83 Velivet Triphasic Regimen (28) ............................................ 29 Velphoro ........................... 85, 86 Venofer ................................... 44 Ventolin HFA ....................... 105 verapamil .......................... 17, 20 Vestura (28) ............................ 28 Viactiv .................................... 41 VIC-Forte ............................... 55 Victoza 2-Pak ......................... 67
Victoza 3-Pak ......................... 67 Vigamox ............................... 100 Vinate GT ............................... 62 Vinate II.................................. 62 Vinate M ................................. 62 Vinate One .............................. 62 Vinate Ultra ............................ 62 Viorele (28) ............................ 25 Virt-Advance .......................... 62 Virtrate-3 ................................ 86 Virtussin AC ......................... 105 Virt-Vite ........................... 63, 65 Virt-Vite Forte .................. 63, 65 Virt-Vite GT ........................... 62 Virt-Vite Plus ......................... 36 Vision ..................................... 56 Vision Formula (with lutein) ... 1, 56 Vision Plus Lutein .................. 39 Vision-Vite + Zinc ............. 1, 56 Vit 3 ........................................ 58 vit B complex-folic acid ......... 36 Vita-Bee with C ...................... 36 Vitacel (with Lutein) .............. 56 Vitafol ..................................... 46 Vital-D Rx ........................ 56, 64 Vitalee .................................... 56 vitamin B complex ................. 37 Vitamin B Complex With C ... 36 Vitamin B-1 ............................ 63 Vitamin B-1 (mononitrate) ..... 63 Vitamin B-2 ............................ 63 Vitamin D3 ............................. 64 Vitamin D3 Complete ............ 38 Vitamin D-3 with Aloe ........... 56 vitamin E .................... 18, 19, 65 vitamin E (dl, acetate) ............ 64 vitamin E acetate .................... 64 vitamin E mixed ..................... 65 vitamin E succinate ................ 65 vitamins A and D .................... 58 Vitamins A,C,D and Fluoride. 60 Vitamins A-D-E selenium ...... 56 Vitamins and Minerals ........... 56 Vitamins B Complex ........ 36, 37 Vitamins for Hair.............. 36, 58 Vita-Respa ........................ 63, 65 Vitatrum.................................. 56 Vitron-C.................................. 46 Vitrum Senior ................... 39, 56
Vol-Nate ................................. 62 Vol-Tab Rx ............................. 62 Vortex Holding Chamber . 93, 96 VP-Zel .................................... 38 W Wal-Mucil Natural Fiber Lax . 80 Wal-Mucil with Calcium ........ 80 warfarin............................. 87, 88 Wee Care ................................ 44 Wera (28) ................................ 28 wheat germ oil ........................ 65 Whole Source Multi-Vitamins56 Woman's Laxative .................. 83 Women's Active ..................... 56 Women's Biomultiple ............. 56 Women's Complex ................. 56 Women's Daily Caplet ............ 56 Women's Daily Formula ......... 56 Women's Daily Multivitamin . 56 Women's Laxative (bisacodyl) ............................................ 83 Women's Multivitamin Gummies............................. 56 Women's One Daily................ 58 Wymzya Fe ............................. 28 X Xarelto .................................... 88 Xopenex HFA ....................... 105 Xtandi ..................................... 13 Xulane..................................... 29 Y Yasmin (28) ............................ 28 yeast ........................................ 38 Yelets ...................................... 59 Z zafirlukast ............................. 104 Zarah ....................................... 28 Zarxio ..................................... 88 ZenChent (28) ......................... 28 Zenchent Fe ............................ 28 Zenpep .................................... 76 Zetia ........................................ 18 Zolinza .................................... 13 zolmitriptan............................. 24 Zoo Friends ............................. 59 Zoo Friends Original .............. 59 Zovia 1/35E (28)..................... 28 Zovia 1/50E (28)..................... 28 Zytiga ................................ 12, 13
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