Abridged
Drug Formulary
GlobalHealth Medicare (HMO)
PO Box 2328
H0435_2014_Formulary_Abridged_Rev13
oma Cdit 11
GlobalHealth Medicare
2014 Abridged Formulary
List of Covered Drugs
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION
ABOUT THE DRUGS WE COVER IN THIS PLAN
HPMS Approved Formulary File Submission ID 14443, Version 13
This abridged formulary was updated on 11/01/2014 and is not a complete list of drugs covered by our plan.
For a complete listing or other questions, please contact GlobalHealth Medicare Member Services at
(866) 844-0151 or, for TTY users, (800) 899-2114, 24 hours a day, 7 days a week, 365 days a year, or visit
www.globalhealth-medicare.com.
Note to existing members: This formulary has changed since last year. Please review this document to
make sure that it still contains the drugs you take.
When this drug list (formulary) refers to "we," "us", or "our," it means GlobalHealth Medicare. When it
refers to "plan" or "our plan," it means GlobalHealth Medicare.
This document includes a partial list of the drugs (formulary) for our plan which is current as of 11/01/2014.
For a complete updated formulary, please contact us. Our contact information, along with the date we last
updated the formulary, appears on the front and back cover pages.
You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,
pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2014.
What is the GlobalHealth Medicare Abridged Formulary?
A formulary is a list of covered drugs selected by GlobalHealth Medicare in consultation with a team of
health care providers, which represents the prescription therapies believed to be a necessary part of a quality
treatment program. GlobalHealth Medicare will generally cover the drugs listed in our formulary as long as
the drug is medically necessary, the prescription is filled at a GlobalHealth Medicare network pharmacy, and
other plan rules are followed. For more information on how to fill your prescriptions, please review your
Evidence of Coverage.
This document is a partial formulary and includes only some of the drugs covered by GlobalHealth Medicare.
For a complete listing of all prescription drugs covered by GlobalHealth Medicare, please visit our website or
call us. Our contact information, along with the date we last updated the formulary, appears on the front and
back cover pages.
Updated 11/01/2014
Can the Formulary (drug list) change?
Generally, if you are taking a drug on our 2014 formulary that was covered at the beginning of the year, we
will not discontinue or reduce coverage of the drug during the 2014 coverage year except when a new, less
expensive generic drug becomes available or when new adverse information about the safety or effectiveness
of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not
affect members who are currently taking the drug. It will remain available at the same cost-sharing for those
members taking it for the remainder of the coverage year. We feel it is important that you have continued
access for the remainder of the coverage year to the formulary drugs that were available when you chose our
plan, except for cases in which you can save additional money or we can ensure your safety.
If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy
restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the
change at least 60 days before the change becomes effective, or at the time the member requests a refill of the
drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug
Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from
the market, we will immediately remove the drug from our formulary and provide notice to members who
take the drug. The enclosed formulary is current as of 11/01/2014. To get updated information about the
drugs covered by GlobalHealth Medicare, please contact us. Our contact information appears on the front and
back cover pages.
GlobalHealth Medicare will provide at least 60 days' notice to SPAPs, authorized prescribers, and network
pharmacies before removing a Part D drug from the Part D plan's formulary, adding prior authorization,
quantity limits, step therapy or other restrictions on a drug and moving a drug to a higher cost-sharing tier. All
negative formulary changes will be communicated to affected members by providing direct written notice to
affected enrollees at least 60 days prior to the effective date of the negative formulary change.
GlobalHealth Medicare may elect to immediately remove from the formulary covered Part D drugs deemed
unsafe by the Food and Drug Administration or removed from the market by their manufacturer without
meeting these requirements. GlobalHealth Medicare will provide retrospective notice of any such formulary
changes to affected enrollees, CMS, State Pharmaceutical Assistance Programs, entities providing other
prescription drug coverage, authorized prescribers as defined by State law, network pharmacies, and
pharmacists.
The written notice must contain the following information:
1. The name of the affected covered Part D drug; 2. Information on whether the covered Part D drug is being removed from the formulary or changing
its preferred or tiered cost-sharing status or subject to other UM changes (prior authorization, quantity limits, step therapy);
3. The reason why the covered Part D drug is being removed from the formulary or changing its
preferred or cost-sharing status;
4. Alternative drugs in the same therapeutic category, class or cost-sharing tier, and the expected
cost-sharing for those drugs; and
5. The means by which enrollees may obtain an updated coverage determination or an exception to a
coverage determination.
Notice of the change must also be posted on the Part D plan's Web site.
Updated 11/01/2014
How do I use the Formulary?
There are two ways to find your drug within the formulary:
Medical Condition
The formulary begins on page 8. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, "Cardiovascular, Hypertension / Lipids". If you know what your drug is used for, look for the category name in the list that begins on page number 9. Then look under the category name for your drug.
Alphabetical Listing
If you are not sure what category to look under, you should look for your drug in the Index that begins on page 41. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list.
What are generic drugs?
GlobalHealth Medicare covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.
Are there any restrictions on my coverage?
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits
may include:
Prior Authorization: GlobalHealth Medicare requires you [or your physician] to get prior
authorization for certain drugs. This means that you will need to get approval from GlobalHealth Medicare before you fill your prescriptions. If you don't get approval, GlobalHealth Medicare may not cover the drug.
Quantity Limits: For certain drugs, GlobalHealth Medicare limits the amount of the drug that
GlobalHealth Medicare will cover. For example, GlobalHealth Medicare provides thirteen pills for a 90-day supply prescription for alendronate sodium 35 mg. This may be in addition to a standard one-month or three-month supply.
Step Therapy: In some cases, GlobalHealth Medicare requires you to first try certain drugs to treat
your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, GlobalHealth Medicare may not cover Drug B unless you try Drug A first. If Drug A does not work for you, GlobalHealth Medicare will then cover Drug B.
Updated 11/01/2014
You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 8. You can also get more information about the restrictions applied to specific covered drugs by visiting our Web site. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask GlobalHealth Medicare to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, "How do I request an exception to the GlobalHealth Medicare's formulary?" on this page for information about how to request an exception.
What are over-the counter (OTC) drugs?
OTC drugs are non-prescription drugs that are not normally covered by a Medicare Prescription Drug Plan.
GlobalHealth Medicare pays for certain OTC drugs.
What if my drug is not on the Formulary?
If your drug is not included in this formulary (list of covered drugs), you should first contact Member
Services and ask if your drug is covered. This document includes only a partial list of covered drugs, so
GlobalHealth Medicare may cover your drug. For more information, please contact us. Our contact
information, along with the date we last updated the formulary, appears on the front and back cover pages.
If you learn that GlobalHealth Medicare does not cover your drug, you have two options:
You can ask Member Services for a list of similar drugs that are covered by GlobalHealth Medicare.
When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by GlobalHealth Medicare.
You can ask GlobalHealth Medicare to make an exception and cover your drug. See below for
information about how to request an exception.
How do I request an exception to the GlobalHealth Medicare's Formulary?
You can ask GlobalHealth Medicare to make an exception to our coverage rules. There are several types of
exceptions that you can ask us to make.
You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be
covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level.
You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on the
specialty tier. If approved this would lower the amount you must pay for your drug.
Updated 11/01/2014
You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs,
GlobalHealth Medicare limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.
Generally, GlobalHealth Medicare will only approve your request for an exception if the alternative drugs
included on the plan's formulary, the lower cost-sharing drug or additional utilization restrictions would not
be as effective in treating your condition and/or would cause you to have adverse medical effects.
You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization
restriction exception. When you request a formulary, tiering or utilization restriction exception you
should submit a statement from your prescriber or physician supporting your request. Generally, we
must make our decision within 72 hours of getting your prescriber's supporting statement. You can request
an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by
waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no
later than 24 hours after we get a supporting statement from your doctor or other prescriber.
What do I do before I can talk to my doctor about changing my drugs or requesting an
exception?
As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Or, you
may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need
a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if
you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover
the drug you take. While you talk to your doctor to determine the right course of action for you, we may
cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will
cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a
network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a
member of the plan less than 90 days.
If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have
provided you with 91-day transition supply, consistent with dispensing increment, (unless you have a
prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days
you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your
drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day
emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary
exception.
1. All transition medication procedures are managed under the direct oversight of the Quality, Operations
and Compliance Committee (QOC) and are reviewed and updated annually;
2. Level of care setting change medication transition eligible enrollees will receive a temporary 30 day
supply (unless the enrollee presents with a prescription written for less than 30 days) from a network pharmacy;
3. Current enrollees transitioning to a network LTC facility with a new prescription for a drug not on the
Plan formulary or a drug that is subject to prior authorization, step therapy requirements or quantity limit requirements will receive an temporary 31 day supply (unless the enrollee presents with a
Updated 11/01/2014
prescription written for less than 30 days) from the network pharmacy (see policy number RX 1.003 Part D LTC resident medication transition);
4. Medication transition supplies that are subject to point of sale quantity limit edits allowing for less than
the prescribed quantity can be refilled up to the prescribed amount for a 30 day supply or 31 day supply (LTC residents) within the first 90 days while an exception is requested and processed.
5. Enrollees receiving transition supplies for a non-formulary drugs are subject to the same cost sharing
charged for a third tier non preferred brand drug. LIS Enrollees pay LIS copays for transition supplies for non-formulary drugs;
6. Enrollees receiving transition supplies at the point of sale for edits that are associated with prior
authorizations, quantity limits or step therapy are subject to the same cost sharing charged for the drug on the Plan formulary. LIS Enrollees pay LIS copays;
7. Enrollees who do not reside in a LTC and who have not completed the exception request or appeal
process by the end of the minimum transition period (90 days) will be treated on a case-by-case basis until the transition is actually made either through a switch to an appropriate formulary drug, or a decision is made.
8. Enrollees who enroll after the Plan distributes the Annual Notice of Change (ANOC) (Oct. 31st) and
have a level of care change prior to the new contract year will be provided a transition supply consistent with the transition process used for other enrollees with level of care changes. The enrollee is given a full 90 day transition period that extends across contract years;
9. CMS approved medication transition notices are sent by the PBM via US First Class Mail, to affected
enrollees within 3 business days of receipt of a temporary supply;
10. Plan transition process is updated annually or on an as needed basis and is available via Plan web site and
enrollment materials in the Evidence of Coverage, Abridged and Comprehensive formularies.
For more information
For more detailed information about your GlobalHealth Medicare prescription drug coverage, please review
your Evidence of Coverage and other plan materials.
If you have questions about GlobalHealth Medicare, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.
If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. Or, visit www.medicare.gov.
Updated 11/01/2014
GlobalHealth Medicare's Formulary
The abridged formulary that begins on the next page provides coverage information about some of the drugs
covered by GlobalHealth Medicare. If you have trouble finding your drug in the list, turn to the Index that
begins on page 40.
Remember: This is only a partial list of drugs covered by GlobalHealth Medicare. If your prescription is not
in this partial formulary, please contact us. Our contact information, along with the date we last updated the
formulary, appears on the front and back cover pages.
The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., CRESTOR) and
generic drugs are listed in lower-case italics (e.g., pravastatin sodium).
The information in the Requirements/Limits column tells you if GlobalHealth Medicare has any special
requirements for coverage of your drug.
The symbol [B/D] next to a drug name indicates that the drug may be covered under Medicare Part B or D
depending upon the circumstances. Information may need to be submitted describing the use and setting of
the drug to make the determination.
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form.
The symbol [G] next to a drug name indicates that the drug may be available in a generic form.
The symbol [LA] next to a drug name indicates that the drug has been noted as being restricted to certain
pharmacies by the Food and Drug Administration. These drugs can only be obtained at specialty designated
pharmacies able to appropriately handle the drugs.
The symbol [PA] in the Requirements/Limits column indicates that prior authorization may apply.
The symbol [QL] in the Requirements/Limits column indicates that quantities dispensed may be limited.
The symbol [ST] in the Requirements/Limits column indicates that step therapy may apply.
o GlobalHealth Medicare Advantage Option 3 provides additional coverage of generic prescription
drugs in the coverage gap. Please refer to our Evidence of Coverage for more information about this coverage.
Updated 11/01/2014
Require-
Commonly Prescribed Therapeutic
Drug Categories
BARACLUDE ORAL SOLN
ANTI - INFECTIVES
ANTIFUNGAL AGENTS
cidofovir
Require-
didanosine
amphotericin b
EPIVIR ORAL SOLN
clotrimazole troc
fluconazole
famciclovir
fluconazole in dextrose inj
56mg/ml; 400mg/200ml
foscarnet sodium
flucytosine
griseofulvin microsize
ganciclovir
griseofulvin ultramicrosize
itraconazole
INTELENCE TABS 100MG,
ketoconazole
INTELENCE TABS 25MG
MYCAMINE INJ 50MG
MYCAMINE INJ 100MG
ISENTRESS CHEW 100MG
ISENTRESS CHEW 25MG
nystatin susp
nystatin tabs
SPORANOX ORAL SOLN
KALETRA ORAL SOLN
terbinafine hcl tabs
KALETRA TABS 200MG;
50MG KALETRA TABS 100MG;
voriconazole inj
voriconazole susr
lamivudine
voriconazole tabs 200mg
lamivudine/zidovudine
voriconazole tabs 50mg
ANTIVIRALS
abacavir
moderiba 1200 dose pack
moderiba 800 dose pack
sulfate/lamivudine/zidovudine
moderiba tabs
acyclovir
nevirapine
acyclovir sodium inj 50mg/ml
nevirapine er
adefovir dipivoxil
amantadine hcl
Updated 11/01/2014
Require-
Require-
ZIAGEN ORAL SOLN
PREZISTA TABS 600MG,
zidovudine
PREZISTA TABS 150MG,
cefaclor
cefaclor er
RELENZA DISKHALER
cefadroxil
cefazolin sodium inj 10gm, 1gm,
RETROVIR IV INFUSION
1gm; 5%, 500mg cefdinir
REYATAZ CAPS 100MG
cefditoren pivoxil tabs 200mg
REYATAZ CAPS 150MG,
cefepime inj 1gm, 2gm
ribasphere caps
cefotaxime sodium
ribasphere ribapak
cefotetan
ribasphere tabs 600mg
cefoxitin sodium
ribasphere tabs 200mg, 400mg
cefpodoxime proxetil
ribavirin
cefprozil
rimantadine hcl
ceftazidime inj 1gm, 2gm, 6gm
ceftriaxone sodium
cefuroxime axetil tabs
stavudine
cefuroxime sodium inj 1.5gm,
7.5gm, 750mg cephalexin caps 250mg, 500mg
cephalexin susr
SYNAGIS INJ 50MG/0.5ML
cephalexin tabs
TAMIFLU CAPS 45MG, 75MG
TAMIFLU CAPS 30MG
ERYTHROMYCINS / OTHER
MACROLIDES
azithromycin inj 500mg
azithromycin pack
azithromycin susr
azithromycin tabs
clarithromycin
clarithromycin er
valacyclovir hcl
e.e.s. 400
ERY-TAB TBEC 500MG
VIDEX PEDIATRIC ORAL
ery-tab tbec 250mg, 333mg
LACTOBIONATE INJ 500MG
erythrocin stearate
erythromycin base
Updated 11/01/2014
Require-
Require-
erythromycin ethylsuccinate
meropenem inj 500mg
MISCELLANEOUS ANTIINFECTIVES
metronidazole
metronidazole in nacl 0.79%
amikacin sulfate inj 500mg/2ml
atovaquone
atovaquone/proguanil hcl
neomycin sulfate
aztreonam inj 1gm
paromomycin sulfate
bacitracin inj
polymyxin b sulfate
CAPASTAT SULFATE
PRIMAQUINE PHOSPHATE
pyrazinamide
quinine sulfate
chloramphenicol sodium
rifabutin
succinate
rifampin
chloroquine phosphate
clindamycin hcl
clindamycin palmitate hcl
STREPTOMYCIN SULFATE
clindamycin phosphate add-
clindamycin phosphate in d5w
tinidazole
colistimethate sodium
tobramycin
DORIBAX INJ 500MG
ethambutol hcl
tobramycin sulfate inj 10mg/ml,
gentamicin sulfate inj
80mg/2ml tobramycin sulfate/sodium
gentamicin sulfate/0.9% sodium
chloride
chloride inj 0.9mg/ml; 0.9%,
1.4mg/ml; 0.9%, 1.6mg/ml; 0.9%, 1mg/ml; 0.9%
hydroxychloroquine sulfate
XIFAXAN TABS 200MG
imipenem/cilastatin
XIFAXAN TABS 550MG
isoniazid
isotonic gentamicin inj 0.8mg/ml;
0.9%, 1.2mg/ml; 0.9%
PENICILLINS
mefloquine hcl
amoxicillin
amoxicillin/clavulanate potassium 2
Updated 11/01/2014
Require-
Require-
amoxicillin/clavulanate potassium 2
demeclocycline hcl
doxycycline hyclate
ampicillin
doxycycline hyclate dr
ampicillin sodium inj 10gm,
doxycycline monohydrate caps
125mg, 1gm
ampicillin-sulbactam inj 10gm;
doxycycline monohydrate susr
5gm, 2gm; 1gm
doxycycline monohydrate tabs
bactocill in dextrose inj 0;
150mg, 50mg, 75mg
minocycline hcl
bactocill in dextrose inj 0;
minocycline hcl er
2gm/50ml dicloxacillin sodium
URINARY TRACT AGENTS
nafcillin sodium inj 1gm
MACRODANTIN CAPS 25MG
nafcillin sodium inj 10gm
methenamine hippurate
nallpen/dextrose
nitrofurantoin macrocrystals caps 2
oxacillin sodium inj 10gm
50mg nitrofurantoin monohydrate
oxacillin sodium inj 1gm
nitrofurantoin susp
penicillin g potassium inj 5mu
penicillin g procaine
trimethoprim
penicillin g sodium
penicillin v potassium
VANCOMYCIN
pfizerpen-g inj 20mu
vancomycin hcl caps
piperacillin sodium/tazobactam
vancomycin hcl inj 1000mg,
sodium inj 3gm; 0.375gm, 4gm;
10gm, 500mg
ANTINEOPLASTIC /
QUINOLONES
IMMUNOSUPPRESSANT DRUGS
ADJUNCTIVE AGENTS
amifostine
ciprofloxacin er
dexrazoxane inj 250mg
ciprofloxacin hcl
ELITEK INJ 1.5MG
ciprofloxacin i.v.-in d5w inj
200mg/100ml; 5%
ciprofloxacin inj 400mg/40ml
leucovorin calcium inj 100mg,
ciprofloxacin susr
levofloxacin
leucovorin calcium tabs
levofloxacin in d5w inj 5%;
500mg/100ml
moxifloxacin hcl
ofloxacin
ANTINEOPLASTIC /
SULFA'S / RELATED AGENTS
IMMUNOSUPPRESSANT DRUGS
sulfadiazine
sulfamethoxazole/trimethoprim
AFINITOR DISPERZ
sulfamethoxazole/trimethoprim ds 2
AFINITOR TABS 2.5MG, 5MG,
Updated 11/01/2014
Require-
Require-
AFINITOR TABS 10MG
ALIMTA INJ 500MG
anastrozole
epirubicin hcl inj 50mg/25ml
ERBITUX INJ 100MG/50ML
ARZERRA INJ 100MG/5ML
AVASTIN INJ 100MG/4ML
azacitidine
azathioprine
etoposide inj 500mg/25ml
exemestane
bicalutamide
bleomycin sulfate inj 30unit
FIRMAGON INJ 120MG
BOSULIF TABS 100MG
FIRMAGON INJ 80MG
BOSULIF TABS 500MG
fludarabine phosphate inj 50mg
fluorouracil inj 2.5gm/50ml
flutamide
CAPRELSA TABS 100MG
FOLOTYN INJ 40MG/2ML
CAPRELSA TABS 300MG
gemcitabine hcl inj 1gm
carboplatin inj 150mg/15ml
GILOTRIF TABS 40MG
CELLCEPT INTRAVENOUS
GILOTRIF TABS 30MG
cisplatin inj 100mg/100ml
GILOTRIF TABS 20MG
cladribine
GLEEVEC TABS 100MG
GLEEVEC TABS 400MG
CYCLOPHOSPHAMIDE CAPS
cyclophosphamide tabs
cyclosporine
cyclosporine modified
hydroxyurea
cytarabine aqueous
idarubicin hcl inj 10mg/10ml
dacarbazine inj 200mg
ifosfamide inj 1gm
daunorubicin hcl
decitabine
docetaxel inj 80mg/4ml,
irinotecan inj 100mg/5ml
doxorubicin hcl inj 2mg/ml
IXEMPRA KIT INJ 45MG
Updated 11/01/2014
Require-
Require-
JAKAFI TABS 10MG, 15MG,
RAPAMUNE ORAL SOLN
JAKAFI TABS 25MG
RAPAMUNE TABS 0.5MG,
RAPAMUNE TABS 2MG
KADCYLA INJ 100MG
letrozole
SANDIMMUNE ORAL SOLN
leuprolide acetate
SANDOSTATIN LAR DEPOT
LUPRON DEPOT INJ 22.5MG,
SIMULECT INJ 20MG
3.75MG, 30MG, 45MG
sirolimus
LUPRON DEPOT-PED INJ
11.25MG, 15MG, 7.5MG LYSODREN
SPRYCEL TABS 100MG,
20MG, 50MG, 80MG
SPRYCEL TABS 140MG
megestrol acetate
SPRYCEL TABS 70MG
MEKINIST TABS 2MG
MEKINIST TABS 0.5MG
SUTENT CAPS 12.5MG,
melphalan hydrochloride
mercaptopurine
SUTENT CAPS 50MG
methotrexate
methotrexate sodium inj 1gm,
SUTENT CAPS 25MG
mitomycin inj 20mg
SYLVANT INJ 100MG
mitoxantrone hcl
mycophenolate mofetil
tacrolimus caps 0.5mg, 1mg
mycophenolic acid dr
tacrolimus caps 5mg
TAFINLAR CAPS 75MG
TAFINLAR CAPS 50MG
tamoxifen citrate
octreotide acetate inj
TARCEVA TABS 100MG,
1000mcg/ml, 500mcg/ml
octreotide acetate inj 100mcg/ml,
TARCEVA TABS 150MG
200mcg/ml, 50mcg/ml
oxaliplatin inj 100mg/20ml
TASIGNA CAPS 150MG
paclitaxel inj 300mg/50ml
TASIGNA CAPS 200MG
Updated 11/01/2014
Require-
Require-
toposar inj 1gm/50ml
APTIOM TABS 200MG,
topotecan hcl inj 4mg
APTIOM TABS 600MG
TREANDA INJ 100MG
BANZEL TABS 200MG
TRELSTAR DEPOT MIXJECT
BANZEL TABS 400MG
carbamazepine chew
TRELSTAR LA MIXJECT
carbamazepine er
TRELSTAR MIXJECT
carbamazepine susp
tretinoin caps
carbamazepine tabs
clonazepam
clonazepam odt
diazepam gel
VECTIBIX INJ 100MG/5ML
DILANTIN CAPS 30MG
divalproex sodium
divalproex sodium dr
vinblastine sulfate inj 1mg/ml
divalproex sodium er
vincasar pfs
vincristine sulfate
ethosuximide
vinorelbine tartrate inj 50mg/5ml
felbamate
fosphenytoin sodium inj 100mg
XALKORI CAPS 200MG
XALKORI CAPS 250MG
gabapentin caps
gabapentin oral soln
gabapentin tabs
GABITRIL TABS 12MG, 16MG
YERVOY INJ 50MG/10ML
lamotrigine
ZALTRAP INJ 100MG/4ML
lamotrigine er
levetiracetam er
levetiracetam inj 500mg/5ml
levetiracetam oral soln
ZORTRESS TABS 0.5MG,
levetiracetam tabs
ZORTRESS TABS 0.25MG
oxcarbazepine
phenobarbital
AUTONOMIC / CNS DRUGS,
phenytoin
NEUROLOGY / PSYCH
phenytoin sodium
phenytoin sodium extended
Updated 11/01/2014
Require-
Require-
sumatriptan succinate inj
primidone
6mg/0.5ml
sumatriptan succinate tabs
TEGRETOL-XR TB12 100MG
zolmitriptan
tiagabine hydrochloride
topiramate
zolmitriptan odt
valproate sodium
valproic acid
MISCELLANEOUS NEUROLOGICAL
zonisamide
ANTIPARKINSONISM AGENTS
COPAXONE INJ 20MG/ML
donepezil hcl
benztropine mesylate
galantamine hydrobromide
bromocriptine mesylate
carbidopa
carbidopa/levodopa
NAMENDA TITRATION PAK
carbidopa/levodopa er
carbidopa/levodopa odt
NAMENDA XR TITRATION
carbidopa/levodopa/entacapone
entacapone
rivastigmine tartrate
pramipexole dihydrochloride
ropinirole er
TECFIDERA STARTER PACK 4
ropinirole hcl
selegiline hcl
MUSCLE RELAXANTS /
trihexyphenidyl hcl
ANTISPASMODIC THERAPY
MIGRAINE / CLUSTER HEADACHE
baclofen
chlorzoxazone
dihydroergotamine mesylate inj
dantrolene sodium
migergot
naratriptan hcl
40000MCG/20ML, 50MCG/ML
LIORESAL INTRATHECAL INJ 3
rizatriptan benzoate
0.05MG/ML, 10MG/20ML,
rizatriptan benzoate odt
MESTINON TIMESPAN
sumatriptan nasal soln 20mg/act
metaxalone
methocarbamol
sumatriptan nasal soln 5mg/act
orphenadrine citrate
orphenadrine citrate er
Updated 11/01/2014
Require-
Require-
pyridostigmine bromide
tizanidine hcl
NARCOTIC ANALGESICS
levorphanol tartrate
acetaminophen/codeine #3
acetaminophen/codeine oral soln
lorcet hd
acetaminophen/codeine tabs
300mg; 60mg
lorcet plus
acetaminophen/codeine tabs
300mg; 15mg
buprenorphine hcl
codeine sulfate tabs
meperidine hcl inj 100mg/ml,
25mg/ml, 50mg/ml
duramorph
methadone hcl inj
endocet tabs 325mg; 10mg,
methadone hcl oral soln
325mg; 5mg, 325mg; 7.5mg
methadone hcl tabs
fentanyl citrate oral transmucosal 4
morphine sulfate er cp24
lpop 1600mcg
(multiphase) 120mg
fentanyl citrate oral transmucosal 4
morphine sulfate er cp24
lpop 1200mcg
(multiphase) 30mg, 45mg, 60mg,
fentanyl citrate oral transmucosal 4
75mg, 90mg
lpop 800mcg
morphine sulfate er cp24 100mg
fentanyl citrate oral transmucosal 4
lpop 600mcg
morphine sulfate er cp24 80mg
fentanyl citrate oral transmucosal 4
lpop 200mcg, 400mcg
morphine sulfate er cp24 10mg,
fentanyl patches
20mg, 30mg, 50mg, 60mg
morphine sulfate er tbcr 200mg
hydrocodone
bitartrate/acetaminophen oral
morphine sulfate er tbcr 100mg
hydrocodone
morphine sulfate er tbcr 60mg
bitartrate/acetaminophen tabs
hydrocodone/acetaminophen tabs 2
morphine sulfate er tbcr 15mg,
hydrocodone/ibuprofen tabs
morphine sulfate inj 2mg/ml,
7.5mg; 200mg
hydromorphone hcl er t24a 12mg, 2
morphine sulfate oral soln
16mg, 8mg
hydromorphone hcl inj
morphine sulfate oral soln
500mg/50ml
10mg/5ml, 20mg/5ml
hydromorphone hcl liqd
morphine sulfate tabs
hydromorphone hcl tabs
oxycodone hcl caps
Updated 11/01/2014
Require-
Require-
oxycodone hcl conc
flurbiprofen
ibuprofen susp
oxycodone hcl oral soln
ibuprofen tabs 400mg, 600mg,
oxycodone hcl tabs 30mg
indomethacin caps
indomethacin er
oxycodone hcl tabs 10mg, 15mg,
ketoprofen
oxycodone hcl tabs 5mg
ketoprofen er
ketorolac tromethamine inj
oxycodone/acetaminophen
15mg/ml, 30mg/ml
ketorolac tromethamine tabs
oxycodone/aspirin
meclofenamate sodium
mefenamic acid
oxycodone/ibuprofen
meloxicam susp
meloxicam tabs 15mg
oxymorphone hydrochloride er
meloxicam tabs 7.5mg
oxymorphone hydrochloride tabs
nabumetone
oxymorphone hydrochloride tabs
nalbuphine hcl
naloxone hcl inj 1mg/ml
reprexain
naltrexone hcl
naproxen dr
naproxen sodium tabs 275mg,
vicodin es
naproxen susp
naproxen tabs
vicodin hp
oxaprozin
piroxicam
NON-NARCOTIC ANALGESICS
buprenorphine hcl/naloxone hcl
sulindac
tolmetin sodium
butorphanol tartrate
tramadol hcl
diclofenac potassium
tramadol hcl er tb24
diclofenac sodium dr
diclofenac sodium er
hydrochloride/acetaminophen
diclofenac sodium transdermal
PSYCHOTHERAPEUTIC DRUGS
diclofenac sodium/misoprostol
ABILIFY DISCMELT TBDP
diflunisal
etodolac
ABILIFY DISCMELT TBDP
etodolac er
fenoprofen calcium tabs
Updated 11/01/2014
Require-
Require-
ABILIFY MAINTENA INJ
clonidine hcl er
clorazepate dipotassium
ABILIFY ORAL SOLN
clozapine
ABILIFY TABS 15MG
CYMBALTA CPEP 60MG
ABILIFY TABS 10MG
CYMBALTA CPEP 30MG
ABILIFY TABS 5MG
CYMBALTA CPEP 20MG
ABILIFY TABS 2MG
desipramine hcl
dexedrine tabs
ABILIFY TABS 30MG
dexmethylphenidate hcl
ABILIFY TABS 20MG
dexmethylphenidate hcl er
dextroamphetamine sulfate er
amitriptyline hcl
dextroamphetamine sulfate tabs
amoxapine
diazepam intensol
amphetamine/dextroamphetamine 2
diazepam oral soln
BRINTELLIX TABS 20MG
diazepam tabs
doxepin hcl
BRINTELLIX TABS 10MG
duloxetine hcl cpep 60mg
BRINTELLIX TABS 5MG
duloxetine hcl cpep 30mg
budeprion sr
duloxetine hcl cpep 20mg
bupropion hcl
bupropion hcl sr tb12 200mg
ergoloid mesylates
escitalopram oxalate oral soln
bupropion hcl sr tb12 150mg
escitalopram oxalate tabs 20mg
bupropion hcl sr tb12 100mg
escitalopram oxalate tabs 10mg
bupropion hcl xl tb24 300mg
escitalopram oxalate tabs 5mg
bupropion hcl xl tb24 150mg
eszopiclone
buspirone hcl
FANAPT TABS 12MG
chlorpromazine hcl
FANAPT TABS 10MG, 8MG
citalopram hydrobromide oral
citalopram hydrobromide tabs
citalopram hydrobromide tabs
citalopram hydrobromide tabs
clomipramine hcl
Updated 11/01/2014
Require-
Require-
INVEGA SUSTENNA INJ
FANAPT TITRATION PACK
39MG/0.25ML, 78MG/0.5ML
INVEGA SUSTENNA INJ
FAZACLO TBDP 150MG,
117MG/0.75ML, 156MG/ML,
FETZIMA CP24 120MG
FETZIMA CP24 80MG
FETZIMA CP24 40MG
FETZIMA CP24 20MG
INVEGA TB24 1.5MG
FETZIMA TITRATION PACK
LATUDA TABS 60MG, 80MG
fluoxetine dr
LATUDA TABS 40MG
fluoxetine hcl caps 20mg
LATUDA TABS 20MG
fluoxetine hcl caps 40mg
LATUDA TABS 120MG
fluoxetine hcl caps 10mg
fluoxetine hcl oral soln
lithium carbonate
fluoxetine hcl tabs 20mg
lithium carbonate er
fluoxetine hcl tabs 10mg
lorazepam intensol
lorazepam tabs
fluphenazine decanoate
loxapine succinate
fluphenazine hcl
maprotiline hcl
fluvoxamine maleate er cp24
metadate er
fluvoxamine maleate er cp24
methamphetamine hcl
fluvoxamine maleate tabs 100mg
methylphenidate hcl
methylphenidate hcl cd cpcr
fluvoxamine maleate tabs 50mg
10mg, 50mg, 60mg
methylphenidate hcl er cp24
fluvoxamine maleate tabs 25mg
methylphenidate hcl er tbcr 18mg, 2
20mg, 27mg, 36mg, 54mg
methylphenidate hydrochloride
guanidine hcl
mirtazapine
haloperidol conc
mirtazapine odt tbdp 30mg, 45mg
haloperidol decanoate
modafinil
haloperidol lactate
nefazodone hcl
haloperidol tabs
nortriptyline hcl
imipramine hcl
olanzapine inj
imipramine pamoate
Updated 11/01/2014
Require-
Require-
olanzapine odt tbdp 20mg
quetiapine fumarate tabs 400mg
olanzapine odt tbdp 15mg
quetiapine fumarate tabs 300mg
olanzapine odt tbdp 10mg
quetiapine fumarate tabs 200mg
olanzapine odt tbdp 5mg
quetiapine fumarate tabs 100mg
olanzapine tabs 20mg
quetiapine fumarate tabs 50mg
olanzapine tabs 15mg
quetiapine fumarate tabs 25mg
olanzapine tabs 10mg
RISPERDAL CONSTA INJ
olanzapine tabs 7.5mg
RISPERDAL CONSTA INJ
olanzapine tabs 5mg
risperidone odt tbdp 4mg
olanzapine tabs 2.5mg
risperidone odt tbdp 3mg
olanzapine/fluoxetine
risperidone odt tbdp 2mg
oxazepam
risperidone odt tbdp 1mg
paroxetine hcl er tb24 37.5mg
risperidone odt tbdp 0.5mg
paroxetine hcl er tb24 25mg
risperidone odt tbdp 0.25mg
paroxetine hcl er tb24 12.5mg
risperidone oral soln
paroxetine hcl tabs 40mg
risperidone tabs 4mg
paroxetine hcl tabs 30mg
risperidone tabs 3mg
paroxetine hcl tabs 20mg
risperidone tabs 2mg
paroxetine hcl tabs 10mg
risperidone tabs 1mg
risperidone tabs 0.5mg
perphenazine
perphenazine/amitriptyline
risperidone tabs 0.25mg
phenelzine sulfate
PRISTIQ TB24 100MG
PRISTIQ TB24 50MG
SAPHRIS SUBL 10MG
procentra
SAPHRIS SUBL 5MG
protriptyline hcl
Updated 11/01/2014
Require-
Require-
SEROQUEL XR TB24 400MG
VIIBRYD TABS 10MG
SEROQUEL XR TB24 300MG
zaleplon caps 5mg
SEROQUEL XR TB24 200MG
zaleplon caps 10mg
SEROQUEL XR TB24 150MG
zenzedi tabs 10mg, 5mg
SEROQUEL XR TB24 50MG
ziprasidone hcl caps 80mg
sertraline hcl conc
ziprasidone hcl caps 60mg
sertraline hcl tabs 100mg
ziprasidone hcl caps 40mg
sertraline hcl tabs 50mg
ziprasidone hcl caps 20mg
sertraline hcl tabs 25mg
zolpidem tartrate
temazepam
zolpidem tartrate er
thioridazine hcl
thiothixene
tranylcypromine sulfate
HYPERTENSION / LIPIDS
trazodone hcl
ANTIARRHYTHMIC AGENTS
trifluoperazine hcl
amiodarone hcl inj 50mg/ml
trimipramine maleate
amiodarone hcl tabs 200mg,
venlafaxine hcl er cp24 150mg
flecainide acetate
venlafaxine hcl er cp24 75mg
mexiletine hcl
pacerone
venlafaxine hcl er cp24 37.5mg
procainamide hcl
propafenone hcl
venlafaxine hcl tabs 100mg, 75mg 2
propafenone hcl er
venlafaxine hcl tabs 50mg
quinidine gluconate
quinidine gluconate cr
venlafaxine hcl tabs 37.5mg
quinidine sulfate
quinidine sulfate er
venlafaxine hcl tabs 25mg
sotalol hcl (af) tabs 120mg
sotalol hcl tabs 160mg, 240mg,
VIIBRYD TABS 40MG
ANTIHYPERTENSIVE THERAPY
VIIBRYD TABS 20MG
acebutolol hcl
afeditab cr
amiloride hcl
Updated 11/01/2014
Require-
Require-
amiloride/hydrochlorothiazide
doxazosin mesylate tabs 1mg,
amlodipine besylate
amlodipine besylate/benazepril
doxazosin mesylate tabs 8mg
amlodipine besylate/benazepril
hydrochloride
enalapril maleate
atenolol
enalapril
atenolol/chlorthalidone
maleate/hydrochlorothiazide
benazepril hcl
eplerenone
benazepril
eprosartan mesylate
hcl/hydrochlorothiazide
betaxolol hcl
bisoprolol fumarate
felodipine er
bisoprolol
fosinopril sodium
fumarate/hydrochlorothiazide
fosinopril
bumetanide
sodium/hydrochlorothiazide
candesartan cilexetil
furosemide inj
candesartan
furosemide oral soln
cilexetil/hydrochlorothiazide
furosemide tabs
captopril
guanfacine hcl
captopril/hydrochlorothiazide
hydralazine hcl
cartia xt
hydrochlorothiazide
carvedilol
indapamide
chlorothiazide
irbesartan
chlorothiazide sodium
irbesartan/hydrochlorothiazide
chlorthalidone tabs 25mg, 50mg
isradipine
clonidine hcl ptwk
labetalol hcl
lisinopril
clonidine hcl tabs
lisinopril/hydrochlorothiazide
clorpres tabs 15mg; 0.1mg,
losartan potassium
15mg; 0.2mg CLORPRES TABS 15MG;
potassium/hydrochlorothiazide
matzim la
methyclothiazide
methyldopa
methyldopa/hydrochlorothiazide
diltiazem cd cp24 120mg, 240mg,
methyldopate hcl
metolazone
diltiazem hcl er cp12
metoprolol succinate er
diltiazem hcl er cp24 180mg,
metoprolol tartrate inj
360mg, 420mg
metoprolol tartrate tabs
diltiazem hcl inj 100mg,
metoprolol/hydrochlorothiazide
50mg/10ml
minoxidil tabs
diltiazem hcl tabs
moexipril hcl
Updated 11/01/2014
Require-
Require-
moexipril/hydrochlorothiazide
verapamil hcl tabs
CARDIAC GLYCOSIDES
nadolol/bendroflumethiazide
nicardipine hcl
LANOXIN TABS 187.5MCG,
nifedical xl
nifedipine er
COAGULATION THERAPY
nimodipine
nisoldipine
nisoldipine er
cilostazol
perindopril erbumine
clopidogrel
pindolol
dipyridamole tabs
prazosin hcl
propranolol hcl er
propranolol hcl inj
enoxaparin sodium inj
propranolol hcl oral soln
120mg/0.8ml, 150mg/ml
propranolol hcl tabs
enoxaparin sodium inj 100mg/ml,
300mg/3ml, 30mg/0.3ml,
propranolol/hydrochlorothiazide 1
40mg/0.4ml, 60mg/0.6ml,
quinapril hcl
80mg/0.8ml
quinapril/hydrochlorothiazide
fondaparinux sodium inj
ramipril
2.5mg/0.5ml
fondaparinux sodium inj
reserpine
10mg/0.8ml, 5mg/0.4ml,
spironolactone
7.5mg/0.6ml heparin sodium inj 10000unit/ml,
1000unit/ml, 20000unit/ml,
5000unit/ml
taztia xt
heparin sodium/d5w inj 5%;
telmisartan
40unit/ml
telmisartan/amlodipine
heparin sodium/nacl 0.45%
telmisartan/hydrochlorothiazide
heparin sodium/sodium chloride
terazosin hcl caps 1mg, 2mg, 5mg 1
0.9% premix
jantoven
terazosin hcl caps 10mg
pentoxifylline er
timolol maleate
torsemide inj 20mg/2ml
tranexamic acid
torsemide tabs
warfarin sodium
trandolapril
XARELTO TABS 10MG
triamterene/hydrochlorothiazide
XARELTO TABS 15MG, 20MG
valsartan
LIPID/CHOLESTEROL LOWERING
valsartan/hydrochlorothiazide
verapamil hcl er
ADVICOR TB24 20MG; 500MG
verapamil hcl inj
verapamil hcl sr cp24 360mg
Updated 11/01/2014
Require-
Require-
ADVICOR TB24 20MG;
isosorbide dinitrate
1000MG, 20MG; 750MG, 40MG;
isosorbide dinitrate er
isosorbide mononitrate
amlodipine besylate/atorvastatin
isosorbide mononitrate er
nitro-bid
atorvastatin calcium
nitroglycerin inj
cholestyramine light pack
nitroglycerin lingual translingual
colestipol hcl
soln nitroglycerin pt24
nitroglycerin transdermal pt24
fenofibrate caps 130mg, 43mg
0.1mg/hr NITROSTAT
fenofibrate micronized
fenofibrate tabs
fenofibric acid dr
fluvastatin caps 20mg
ANTIPSORIATIC / ANTISEBORRHEIC
acitretin caps 10mg
fluvastatin caps 40mg
acitretin caps 17.5mg, 25mg
calcipotriene
gemfibrozil
dipropionate
lovastatin tabs 10mg
calcitriol
selenium sulfide lotn
lovastatin tabs 20mg, 40mg
BURN THERAPY
niacin er tbcr
silver sulfadiazine
omega-3-acid ethyl esters
MISCELLANEOUS DERMATOLOGICALS
pravastatin sodium
ammonium lactate
prevalite powd
SIMCOR TB24 1000MG; 40MG,
diclofenac sodium gel
500MG; 20MG, 500MG; 40MG
fluorouracil crea 5%
SIMCOR TB24 1000MG; 20MG,
fluorouracil external soln
simvastatin
imiquimod
methoxsalen
MISCELLANEOUS CARDIOVASCULAR
podofilox
prudoxin
NITRATES
Updated 11/01/2014
Require-
Require-
mupirocin
sulfacetamide sodium susp
TOPICAL ANTIFUNGALS
THERAPY FOR ACNE
ciclopirox
adapalene
ciclopirox nail lacquer
amnesteem
ciclopirox olamine
avita crea
clotrimazole external crea
claravis caps 10mg, 20mg, 40mg
clotrimazole external soln
claravis caps 30mg
clindamycin phosphate external
dipropionate
econazole nitrate
clindamycin phosphate foam
ketoconazole
clindamycin phosphate gel
ketodan kit
clindamycin phosphate lotn
clindamycin phosphate swab
nystatin crea
clindamycin/benzoyl peroxide gel
nystatin oint
nystatin powd 100000unit/gm
nystatin/triamcinolone
erythromycin external soln
erythromycin gel
pedi-dri
erythromycin/benzoyl peroxide
TOPICAL ANTIVIRALS
metronidazole
acyclovir
myorisan caps 10mg, 20mg
myorisan caps 40mg
TOPICAL CORTICOSTEROIDS
tretinoin crea
ala cort
tretinoin gel
alclometasone dipropionate
TOPICAL ANESTHETICS
amcinonide
lidocaine hcl external soln
apexicon e
lidocaine hcl inj 0.5%, 1%, 2%
augmented betamethasone
lidocaine hcl jelly
dipropionate
lidocaine oint
betamethasone dipropionate
lidocaine ptch
betamethasone valerate
lidocaine viscous
clobetasol propionate e
lidocaine/prilocaine crea
clobetasol propionate external
TOPICAL ANTIBACTERIALS
clobetasol propionate foam
gentamicin sulfate crea
clobetasol propionate gel
gentamicin sulfate oint 0.1%
clobetasol propionate lotn
mafenide acetate
clobetasol propionate oint
clobetasol propionate sham
Updated 11/01/2014
Require-
Require-
acamprosate calcium dr
desonide
desoximetasone
alendronate sodium tabs 40mg
diflorasone diacetate
fluocinolone acetonide
anagrelide hydrochloride
fluocinolone acetonide body
ARALAST NP INJ 400MG
fluocinonide crea 0.1%
fluocinonide external soln
fluocinonide gel
cevimeline hcl
fluocinonide oint
fluocinonide-e
CLINIMIX 4.25%/DEXTROSE
fluticasone propionate crea
fluticasone propionate lotn
2.75%/DEXTROSE 10%
fluticasone propionate oint
halobetasol propionate
2.75%/DEXTROSE 5%
hydrocortisone butyrate
dextrose 10%/nacl 0.45%
hydrocortisone butyrate
dextrose 10% flex container
(lipophilic)
dextrose 10%/nacl 0.2%
hydrocortisone crea 1%, 2.5%
dextrose 2.5%/sodium chloride
hydrocortisone lotn 2.5%
hydrocortisone oint 1%, 2.5%
dextrose 5%
hydrocortisone valerate
dextrose 5%/lactated ringers
mometasone furoate
dextrose 5%/nacl 0.2%
prednicarbate
dextrose 5%/nacl 0.225%
triamcinolone acetonide crea
dextrose 5%/nacl 0.33%
triamcinolone acetonide lotn
dextrose 5%/nacl 0.45%
triamcinolone acetonide oint
dextrose 5%/nacl 0.9%
disulfiram
TOPICAL ENZYMES
etidronate disodium
EXJADE TBSO 125MG
TOPICAL SCABICIDES / PEDICULICIDES
EXJADE TBSO 250MG, 500MG
malathion
permethrin crea
kionex powd
spinosad
levocarnitine
midodrine hcl
DIAGNOSTICS / MISCELLANEOUS
pilocarpine hcl tabs
IRRIGATING SOLUTIONS
pilocarpine hydrochloride
lactated ringers irrigation
neomycin/polymyxin b sulfates
ringers irrigation
MISCELLANEOUS AGENTS
Updated 11/01/2014
Require-
Require-
riluzole
sodium chloride 0.9%
ADRENAL HORMONES
sodium chloride inj 0.9%
a-hydrocort
sodium phenylbutyrate
cortisone acetate
sodium polystyrene sulfonate susp 2
dexamethasone elix
15gm/60ml
dexamethasone intensol
sterile water irrigation
dexamethasone sodium phosphate 2
inj 10mg/ml, 120mg/30ml
zoledronic acid inj 5mg/100ml
dexamethasone tabs
SMOKING DETERRENTS
fludrocortisone acetate
buproban
hydrocortisone tabs
CHANTIX STARTING MONTH
methylprednisolone
methylprednisolone acetate
NICOTROL INHALER
methylprednisolone dose pack
EAR, NOSE / THROAT
sodiumsuccinate inj 125mg, 40mg
MEDICATIONS
millipred tabs
MISCELLANEOUS AGENTS
prednisolone sodium phosphate
azelastine hcl nasal soln 0.15%
prednisone intensol
azelastine hcl nasal soln
prednisone oral soln
137mcg/spray
prednisone tabs
chlorhexidine gluconate oral
triamcinolone acetonide inj
veripred 20
ipratropium bromide nasal soln
ANTITHYROID AGENTS
ipratropium bromide nasal soln
methimazole
propylthiouracil
periogard
DIABETES THERAPY
triamcinolone in orabase
acarbose tabs 100mg
TYZINE PEDIATRIC NASAL
acarbose tabs 50mg
MISCELLANEOUS OTIC
acarbose tabs 25mg
acetasol hc
ACCU-CHEK ACTIVE
acetic acid
fluocinolone acetonide
hydrocortisone/acetic acid
ACCU-CHEK ACTIVE STRIPS 3
ofloxacin
ACCU-CHEK AVIVA IN
OTIC STEROID / ANTIBIOTIC
ACCU-CHEK AVIVA PLUS
neomycin/polymyxin/hc
ACCU-CHEK COMFORT
CURVE CONTROL SOLUTION
ne otic susp
Updated 11/01/2014
Require-
Require-
ACCU-CHEK COMFORT
glyburide micronized tabs 6mg
glyburide micronized tabs 3mg
ACCU-CHEK COMFORT
CURVE TEST STRIPS
glyburide micronized tabs 1.5mg
ACCU-CHEK COMPACT BLUE 3
CONTROL SOLUTION (2
glyburide tabs 5mg
ACCU-CHEK COMPACT PLUS 3
glyburide tabs 2.5mg
ACCU-CHEK COMPACT PLUS
glyburide tabs 1.25mg
ACCU-CHEK SMARTVIEW
glyburide/metformin hcl tabs
2.5mg; 500mg, 5mg; 500mg
ALCOHOL PREPS PADS
glyburide/metformin hcl tabs
1.25mg; 250mg
BYETTA INJ 5MCG/0.02ML
HUMALOG MIX 50/50
BYETTA INJ 10MCG/0.04ML
HUMALOG MIX 50/50
HUMALOG MIX 75/25
HUMALOG MIX 75/25
GAUZE PADS 2"X2"
glimepiride tabs 4mg
HUMULIN 70/30 KWIKPEN
glimepiride tabs 2mg
HUMULIN 70/30 PEN
glimepiride tabs 1mg
HUMULIN N KWIKPEN
glipizide er tb24 10mg
HUMULIN N U-100 PEN
glipizide er tb24 5mg
glipizide er tb24 2.5mg
INSULIN PEN NEEDLE
INSULIN SYRINGE (DISP) U-
glipizide tabs 10mg
INSULIN SYRINGE (DISP) U-
glipizide tabs 5mg
INSULIN SYRINGE (DISP) U-
glipizide/metformin hcl tabs
2.5mg; 500mg, 5mg; 500mg
INVOKANA TABS 300MG
glipizide/metformin hcl tabs
2.5mg; 250mg
INVOKANA TABS 100MG
GLUCAGEN HYPOKIT
GLUCAGON EMERGENCY
Updated 11/01/2014
Require-
Require-
JANUMET XR TB24 1000MG;
ONETOUCH VERIO IQ
100MG, 500MG; 50MG
JANUMET XR TB24 1000MG;
MONITORING SYSTEM
ONETOUCH VERIO TEST
pioglitazone hcl
pioglitazone hcl-glimepiride
pioglitazone hcl/metformin hcl
PRODIGY INSULIN MINI PEN
NEEDLES/31G X 3/16"
metformin hcl er tb24 1000mg,
PRODIGY INSULIN PEN
NEEDLES/29G X 1/2"
metformin hcl er tb24 500mg
PRODIGY INSULIN SHORT
PENNEEDLES/31G X 5/16"
metformin hcl tabs 1000mg
SYRING/U-100/0.3ML/31G X
metformin hcl tabs 850mg
metformin hcl tabs 500mg
SYRINGE/1/2ML/31G X 5/16"
nateglinide tabs 120mg
SYRINGE/1ML/28G X 1/2"
nateglinide tabs 60mg
repaglinide tabs 2mg
NEEDLES, INSULIN DISP.,
repaglinide tabs 1mg
NOVOFINE 30GX8MM
repaglinide tabs 0.5mg
NOVOFINE 32GX6MM
NOVOFINE AUTOCOVER
tolazamide tabs 500mg
NOVOLOG MIX 70/30
tolazamide tabs 250mg
NOVOLOG MIX 70/30
PREFILLED FLEXPEN
tolbutamide
ONETOUCH ULTRA 2
ONETOUCH ULTRA BLUE
ONETOUCH ULTRA MINI
ONETOUCH ULTRA SYSTEM
Updated 11/01/2014
Require-
Require-
MISCELLANEOUS HORMONES
zoledronic acid inj 4mg/5ml
THYROID HORMONES
levothyroxine sodium tabs
25MG/2.5GM, 50MG/5GM
liothyronine sodium
cabergoline
calcitonin-salmon
calcitriol
CEREZYME INJ 200UNIT
unithroid tabs 100mcg, 112mcg,
chorionic gonadotropin
125mcg, 150mcg, 175mcg,
200mcg, 25mcg, 300mcg, 50mcg,
desmopressin acetate
75mcg, 88mcg
doxercalciferol
ANTIDIARRHEALS / ANTISPASMODICS
atropine sulfate inj 0.05mg/ml,
FABRAZYME INJ 35MG
fortical
diphenoxylate/atropine
glycopyrrolate inj 4mg/20ml
glycopyrrolate tabs
loperamide hcl caps
MISCELLANEOUS GASTROINTESTINAL
oxandrolone tabs 2.5mg
balsalazide disodium
oxandrolone tabs 10mg
budesonide cp24
pamidronate disodium inj
30mg/10ml, 6mg/ml, 90mg/10ml
paricalcitol
colocort
SENSIPAR TABS 60MG, 90MG
constulose
SENSIPAR TABS 30MG
SOMAVERT INJ 10MG, 15MG,
cromolyn sodium conc
testosterone cypionate
testosterone enanthate
dronabinol caps 10mg
dronabinol caps 2.5mg, 5mg
Updated 11/01/2014
Require-
Require-
ZENPEP CPEP 109000UNIT;
20000UNIT; 68000UNIT,
gavilyte-c
136000UNIT; 25000UNIT; 85000UNIT, 16000UNIT;
gavilyte-g
3000UNIT; 10000UNIT,
gavilyte-n/flavor pack
55000UNIT; 10000UNIT;
generlac
34000UNIT, 82000UNIT;
granisetron hcl inj 0.1mg/ml,
15000UNIT; 51000UNIT
ULCER THERAPY
granisetron hcl tabs
carafate susp
hydrocortisone enem
cimetidine
lactulose
cimetidine hcl
esomeprazole sodium
famotidine inj 20mg/2ml
famotidine premixed
meclizine hcl tabs
famotidine susr
mesalamine kit
famotidine tabs 20mg, 40mg
metoclopramide hcl inj
lansoprazole cpdr 30mg
metoclopramide hcl oral soln
lansoprazole cpdr 15mg
metoclopramide hcl tabs
ondansetron hcl inj 4mg/2ml
ondansetron hcl oral soln
ondansetron hcl tabs
misoprostol
ondansetron odt
NEXIUM CPDR 40MG
NEXIUM CPDR 20MG
polyethylene glycol 3350 powd
prochlorperazine
NEXIUM PACK 40MG
prochlorperazine edisylate
NEXIUM PACK 10MG, 2.5MG,
prochlorperazine maleate
procto-pak
nizatidine
proctosol hc
omeprazole cpdr 40mg
proctozone-hc
omeprazole cpdr 10mg, 20mg
omeprazole/sodium bicarbonate
pantoprazole sodium inj
pantoprazole sodium tbec 40mg
sulfasalazine tabs
pantoprazole sodium tbec 20mg
sulfazine ec
rabeprazole sodium
trimethobenzamide hcl
ranitidine hcl caps
ranitidine hcl inj 150mg/6ml
ursodiol
ranitidine hcl syrp
ranitidine hcl tabs
sucralfate
Updated 11/01/2014
Require-
Require-
IMMUNOLOGY, VACCINES /
REBIF REBIDOSE TITRATION
PACK REBIF TITRATION PACK
BIOTECHNOLOGY DRUGS
SAIZEN CLICK.EASY
VACCINES / MISCELLANEOUS
BOTOX INJ 100UNIT
INTRON-A W/DILUENT INJ
CARIMUNE NANOFILTERED
DIPHTHERIA/TETANUS
TOXOIDS ADSORBED
fomepizole
OMNITROPE INJ 5.8MG
GAMUNEX-C INJ 1GM/10ML
OMNITROPE INJ 10MG/1.5ML, 3
PEG-INTRON REDIPEN
IMOVAX RABIES (H.D.C.V.)
IPOL INACTIVATED IPV
PEGASYS PROCLICK
M-M-R II W/DILUENT 10
PROCRIT INJ 20000UNIT/ML,
PROCRIT INJ 10000UNIT/ML,
MENOMUNE-A/C/Y/W-135
2000UNIT/ML, 3000UNIT/ML,
PRIVIGEN INJ 20GM/200ML
Updated 11/01/2014
Require-
Require-
tetanus toxoid adsorbed
HUMIRA PEN-CROHNS
TETANUS/DIPHTHERIA
TOXOIDS-ADSORBED ADULT
leflunomide
SAVELLA TABS 100MG
MUSCULOSKELETAL /
SAVELLA TABS 50MG
SAVELLA TABS 25MG
GOUT THERAPY
allopurinol
SAVELLA TABS 12.5MG
probenecid
SAVELLA TITRATION PACK
probenecid/colchicine
OBSTETRICS / GYNECOLOGY
OSTEOPOROSIS THERAPY
ESTROGENS / PROGESTINS
alendronate sodium oral soln
DEPO-PROVERA 400MG/ML
alendronate sodium tabs 35mg,
alendronate sodium tabs 10mg,
estradiol ptwk
estradiol tabs
estradiol valerate
estradiol/norethindrone acetate
ibandronate sodium inj
estropipate
ibandronate sodium tabs
jolivette
raloxifene hydrochloride
risedronate sodium
medroxyprogesterone acetate
OTHER RHEUMATOLOGICALS
mimvey lo
ACTEMRA INJ 162MG/0.9ML,
BENLYSTA INJ 120MG
norethindrone
norethindrone acetate
norlyroc
ENBREL SURECLICK
Updated 11/01/2014
Require-
Require-
larin 1/20
progesterone caps
larin fe 1.5/30
sharobel
larin fe 1/20
MISCELLANEOUS OB/GYN
clindamycin phosphate crea
levonest
metronidazole vaginal
levonorgestrel/ethinyl estradiol
miconazole 3
tabs 0.03mg; 0.15mg levora 0.15/30-28
terconazole
lomedia 24 fe
tranexamic acid
vandazole
low-ogestrel
zazole crea 0.4%
marlissa
ORAL CONTRACEPTIVES / RELATED
mononessa
necon 0.5/35-28
necon 1/35
amethyst
necon 10/11-28
necon 7/7/7
aranelle
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
briellyn
cryselle-28
ogestrel
cyclafem 1/35
orsythia
cyclafem 7/7/7
pirmella 1/35
drospirenone/ethinyl estradiol
portia-28
emoquette
previfem
enpresse-28
quasense
reclipsen
sprintec 28
gildagia
gildess 1.5/30
tri-legest fe
introvale
tri-previfem
junel 1.5/30
tri-sprintec
junel 1/20
trinessa
junel fe 1.5/30
trivora-28
junel fe 1/20
kelnor 1/35
larin 1.5/30
zenchent
Updated 11/01/2014
Require-
Require-
zenchent fe
DIRECT ACTING MIOTICS
zovia 1/35e
pilocarpine hcl ophthalmic soln
zovia 1/50e
MISCELLANEOUS OPHTHALMOLOGICS
OXYTOCICS
azelastine hcl ophthalmic soln
methylergonovine maleate tabs
cromolyn sodium ophthalmic soln 2
ANTIBIOTICS
epinastine hcl
proparacaine hcl
bacitracin ophthalmic oint
bacitracin/polymyxin b
NON-STEROIDAL ANTI-
INFLAMMATORY AGENTS
ciprofloxacin hcl
bromfenac
erythromycin oint
diclofenac sodium ophthalmic
garamycin
gatifloxacin
flurbiprofen sodium
ketorolac tromethamine
gentamicin sulfate oint 0.3%
ophthalmic soln
gentamicin sulfate ophthalmic
ORAL DRUGS FOR GLAUCOMA
acetazolamide
levofloxacin
acetazolamide er
acetazolamide sodium
neomycin/bacitracin/polymyxin
methazolamide
neomycin/polymyxin/gramicidin
OTHER GLAUCOMA DRUGS
ofloxacin
polymyxin b sulfate/trimethoprim
dorzolamide hcl
tobramycin sulfate ophthalmic
dorzolamide hcl/timolol maleate
latanoprost
ANTIVIRALS
travoprost
trifluridine
STEROID-ANTIBIOTIC COMBINATIONS
ydrocortisone
betaxolol hcl
carteolol hcl
levobunolol hcl ophthalmic soln
ne ophthalmic susp
tobramycin/dexamethasone
metipranolol
timolol maleate
timolol maleate ophthalmic gel
CHOLINESTERASE INHIBITOR
MIOTICS
BLEPHAMIDE S.O.P.
PHOSPHOLINE IODIDE
Updated 11/01/2014
Require-
Require-
sulfacetamide
hydroxyzine pamoate
sodium/prednisolone sodium
levocetirizine dihydrochloride
phosphate
oral soln
STEROIDS
levocetirizine dihydrochloride
dexamethasone sodium phosphate 2
ophthalmic soln
fluorometholone
phenadoz
promethazine hcl inj
promethazine hcl supp
prednisolone acetate
promethazine hcl syrp
prednisolone sodium phosphate
promethazine hcl tabs
promethegan supp 25mg, 50mg
sodium sulfacetamide ophthalmic
PULMONARY AGENTS
acetylcysteine inhalation soln
sulfacetamide sodium oint
ALPHAGAN P OPHTHALMIC
apraclonidine
brimonidine tartrate
albuterol sulfate er
VASOCONSTRICTOR DECONGESTANTS
albuterol sulfate nebu
naphazoline hcl
albuterol sulfate syrp
albuterol sulfate tabs
RESPIRATORY AND ALLERGY
aminophylline
ANTIHISTAMINE / ANTIALLERGENIC
ASMANEX TWISTHALER 120
adrenalin inj 1mg/ml
ASMANEX TWISTHALER 30
arbinoxa
carbinoxamine maleate
ASMANEX TWISTHALER 60
cetirizine hcl syrp 1mg/ml
clemastine fumarate syrp
clemastine fumarate tabs 2.68mg
budesonide susp 32mcg/act
cyproheptadine hcl
budesonide susp 0.25mg/2ml,
desloratadine
0.5mg/2ml
desloratadine odt
COMBIVENT RESPIMAT
diphenhydramine hcl inj
cromolyn sodium nebu
hydroxyzine hcl inj
hydroxyzine hcl oral soln
flunisolide
hydroxyzine hcl tabs
Updated 11/01/2014
Require-
Require-
fluticasone propionate susp
TUDORZA PRESSAIR
FORADIL AEROLIZER
ipratropium bromide inhalation
ipratropium bromide/albuterol
zafirlukast
UROLOGICALS
ANTICHOLINERGICS /
ANTISPASMODICS
levalbuterol
flavoxate hcl
levalbuterol hcl nebu 0.31mg/3ml, 2
0.63mg/3ml
oxybutynin chloride
metaproterenol sulfate
oxybutynin chloride er
montelukast sodium
tolterodine tartrate
tolterodine tartrate er
trospium chloride
trospium chloride er
BENIGN PROSTATIC
PULMICORT SUSP 1MG/2ML
HYPERPLASIA(BPH) THERAPY
alfuzosin hcl er
QVAR AERS 40MCG/ACT
finasteride tabs 5mg
tamsulosin hcl
QVAR AERS 80MCG/ACT
CHOLINERGIC STIMULANTS
bethanechol chloride
MISCELLANEOUS UROLOGICALS
AMMONIUM CHLORIDE
sildenafil
SPIRIVA HANDIHALER
potassium citrate er
VITAMINS, HEMATINICS /
80MCG/ACT; 4.5MCG/ACT
160MCG/ACT; 4.5MCG/ACT
calcium acetate caps
terbutaline sulfate
dextrose 5%/potassium chloride
theophylline
theophylline cr
theophylline er tb12 300mg,
kcl 0.075%/d5w/nacl 0.45%
kcl 0.15%/d5w/lr
theophylline er tb24
kcl 0.15%/d5w/nacl 0.2%
kcl 0.15%/d5w/nacl 0.225%
triamcinolone acetonide aero
kcl 0.15%/d5w/nacl 0.9%
kcl 0.3%/d5w/nacl 0.45%
Updated 11/01/2014
Require-
Require-
kcl 0.3%/d5w/nacl 0.9%
klor-con 8
CLINIMIX 2.75%/DEXTROSE
klor-con m10
klor-con m15
CLINIMIX 4.25%/DEXTROSE
klor-con m20
CLINIMIX 4.25%/DEXTROSE
lactated ringers viaflex
magnesium sulfate inj 50%
CLINIMIX 4.25%/DEXTROSE
NORMOSOL-R IN D5W
potassium chloride 0.15% /nacl
CLINIMIX 5%/DEXTROSE 15% 3
0.45% viaflex
CLINIMIX 5%/DEXTROSE 20% 3
potassium chloride 0.15%
CLINIMIX 5%/DEXTROSE 25% 3
d5w/nacl 0.33%
potassium chloride 0.15%
4.25%/DEXTROSE 25%
d5w/nacl 0.45% viaflex
potassium chloride 0.15% nacl
4.25%/DEXTROSE 5%
CLINIMIX E 5%/DEXTROSE
potassium chloride 0.22%
d5w/nacl 0.45%
CLINIMIX E 5%/DEXTROSE
potassium chloride 0.3%/ nacl
CLINIMIX E 5%/DEXTROSE
potassium chloride 0.3%/d5w
potassium chloride er cpcr
potassium chloride er tbcr 10meq, 1
intralipid inj 2.25%; 20%
potassium chloride inj
IONOSOL-B/DEXTROSE 5%
10meq/100ml, 20meq/100ml, 2meq/ml, 30meq/100ml,
IONOSOL-MB/DEXTROSE 5% 3
40meq/100ml
ISOLYTE-P/DEXTROSE 5%
ringers injection
sodium chloride 0.45% viaflex
liposyn iii inj 2.5%; 10%, 2.5%;
sodium chloride inj 2.5meq/ml,
sodium lactate
NORMOSOL-M IN D5W
MISCELLANEOUS NUTRITION
PRODUCTS
PLASMA-LYTE-56/D5W
8.5%/ELECTROLYTES AMINOSYN II
8.5%/ELECTROLYTES AMINOSYN M
Updated 11/01/2014
Require-
PREMASOL INJ 56MEQ/L;
320MG/100ML; 730MG/100ML; 190MG/100ML; 3MEQ/L; 20MG/100ML; 300MG/100ML; 220MG/100ML; 290MG/100ML; 490MG/100ML; 840MG/100ML; 490MG/100ML; 200MG/100ML; 290MG/100ML; 410MG/100ML; 230MG/100ML; 5MEQ/L; 15MG/100ML; 250MG/100ML; 120MG/100ML; 140MG/100ML; 470MG/100ML premasol inj 52meq/l;
1760mg/100ml; 880mg/100ml; 34meq/l; 1760mg/100ml; 372mg/100ml; 406mg/100ml; 526mg/100ml; 492mg/100ml; 492mg/100ml; 526mg/100ml; 356mg/100ml; 356mg/100ml; 390mg/100ml; 34mg/100ml; 152mg/100ml PROCALAMINE
travasol
VITAMINS / HEMATINICS
prenatal vitamins (generic)
sodium fluoride tabs
Updated 11/01/2014
Index of Drugs
8
acyclovir 9, 26
A
acyclovir sodium 9 ADACEL 33
abacavir 9
abacavir sulfate/lamivudine/zidovudine 9
adapalene 26
adefovir dipivoxil 9
ABILIFY DISCMELT 18
adrenalin 37
ABILIFY MAINTENA 19
ADVAIR DISKUS 37
acamprosate calcium dr 27
acarbose 28
afeditab cr 22
ACCU-CHEK ACTIVE GLUCOSE CONTROL
AFINITOR DISPERZ 12
ACCU-CHEK ACTIVE STRIPS 28
ACCU-CHEK AVIVA 28
a-hydrocort 28
ACCU-CHEK AVIVA PLUS 28
ala cort 26
ACCU-CHEK COMFORT CURVE CONTROL
SOLUTION (2 LEVELS) 28
albuterol sulfate 37
ACCU-CHEK COMFORT CURVE LINEARITY
albuterol sulfate er 37
alclometasone dipropionate 26
ACCU-CHEK COMFORT CURVE TEST
ALCOHOL PREPS 29
ACCU-CHEK COMPACT BLUE CONTROL
alendronate sodium 27, 34
SOLUTION (2 LEVELS) 29
alfuzosin hcl er 38
ACCU-CHEK COMPACT PLUS 29
ACCU-CHEK COMPACT PLUS CARE KIT 29
ACCU-CHEK NANO SMARTVIEW 29
allopurinol 34
ACCU-CHEK SMARTVIEW STRIPS 29
aloprim 34
acebutolol hcl 22
acetaminophen/codeine 17
acetaminophen/codeine #3 17
amantadine hcl 9
acetasol hc 28
acetazolamide 36
amcinonide 26
acetazolamide er 36
amethia 35
acetazolamide sodium 36
amethyst 35
acetic acid 28
amifostine 12
acetylcysteine 37
amikacin sulfate 11
acitretin 25
amiloride hcl 22
amiloride/hydrochlorothiazide 23
aminophylline 37
aranelle 35
AMINOSYN 7%/ELECTROLYTES 39
arbinoxa 37
AMINOSYN 8.5%/ELECTROLYTES 39
AMINOSYN II 8.5%/ELECTROLYTES 39
ASMANEX TWISTHALER 120 METERED
ASMANEX TWISTHALER 30 METERED
AMINOSYN-PF 7% 39
ASMANEX TWISTHALER 60 METERED
amiodarone hcl 22
atenolol 23
amitriptyline hcl 19
atenolol/chlorthalidone 23
amlodipine besylate 23
amlodipine besylate/atorvastatin calcium 25
atorvastatin calcium 25
amlodipine besylate/benazepril hcl 23
atovaquone 11
amlodipine besylate/benazepril hydrochloride 23
atovaquone/proguanil hcl 11
AMMONIUM CHLORIDE 38
ammonium lactate 25
atropine sulfate 31
amnesteem 26
amoxapine 19
amoxicillin 11
augmented betamethasone dipropionate 26
amoxicillin/clavulanate potassium 11
amoxicillin/clavulanate potassium er 12
amphetamine/dextroamphetamine 19
aviane 35
amphotericin b 9
ampicillin 12
ampicillin sodium 12
ampicillin-sulbactam 12
azacitidine 13
anagrelide hydrochloride 27
anastrozole 13
azathioprine 13
azelastine hcl 28, 36
ANDROGEL PUMP 31
androxy 31
azithromycin 10
apexicon e 26
aztreonam 11
B
apraclonidine 37 apri 35
baciim 11
bacitracin 11, 36
bacitracin/polymyxin b 36
baclofen 16
bupropion hcl 19
bactocill in dextrose 12
bupropion hcl sr 19
balsalazide disodium 31
bupropion hcl xl 19
balziva 35
buspirone hcl 19
butorphanol tartrate 18
benazepril hcl 23
C
benazepril hcl/hydrochlorothiazide 23 BENLYSTA 34
cabergoline 31
benztropine mesylate 16
calcipotriene 25
calcipotriene/betamethasone dipropionate 25
betamethasone dipropionate 26
calcitonin-salmon 31
betamethasone valerate 26
calcitriol 25, 31
calcium acetate 38
betaxolol hcl 23, 36
camila 34
bethanechol chloride 38
bicalutamide 13
candesartan cilexetil 23
candesartan cilexetil/hydrochlorothiazide 23
bisoprolol fumarate 23
CAPASTAT SULFATE 11
bisoprolol fumarate/hydrochlorothiazide 23
bleomycin sulfate 13
captopril 23
captopril/hydrochlorothiazide 23
BLEPHAMIDE S.O.P. 36
carafate 32
carbamazepine 15
briellyn 35
carbamazepine er 15
carbidopa 16
brimonidine tartrate 37
carbidopa/levodopa 16
carbidopa/levodopa er 16
bromfenac 36
carbidopa/levodopa odt 16
bromocriptine mesylate 16
carbidopa/levodopa/entacapone 16
budeprion sr 19
carbinoxamine maleate 37
budesonide 31, 37
carboplatin 13
bumetanide 23
CARIMUNE NANOFILTERED 33
carteolol hcl 36
buprenorphine hcl 17
cartia xt 23
buprenorphine hcl/naloxone hcl 18
carvedilol 23
buproban 28
ciclopirox nail lacquer 26
cefaclor 10
ciclopirox olamine 26
cefaclor er 10
cidofovir 9
cefadroxil 10
cilostazol 24
cefazolin sodium 10
cimetidine 32
cefdinir 10
cimetidine hcl 32
cefditoren pivoxil 10
cefepime 10
cefotaxime sodium 10
cefotetan 10
ciprofloxacin 12
cefoxitin sodium 10
ciprofloxacin er 12
cefpodoxime proxetil 10
ciprofloxacin hcl 12, 36
cefprozil 10
ciprofloxacin i.v.-in d5w 12
ceftazidime 10
cisplatin 13
ceftriaxone sodium 10
citalopram hydrobromide 19
cefuroxime axetil 10
cladribine 13
cefuroxime sodium 10
claravis 26
clarithromycin 10
clarithromycin er 10
CELLCEPT INTRAVENOUS 13
clemastine fumarate 37
clindamycin hcl 11
cephalexin 10
clindamycin palmitate hcl 11
clindamycin phosphate 26, 35
clindamycin phosphate add-vantage 11
clindamycin phosphate in d5w 11
cetirizine hcl 37
clindamycin/benzoyl peroxide 26
cevimeline hcl 27
CLINIMIX 2.75%/DEXTROSE 5% 39
CLINIMIX 4.25%/DEXTROSE 10% 39
CHANTIX STARTING MONTH PAK 28
CLINIMIX 4.25%/DEXTROSE 20% 39
CLINIMIX 4.25%/DEXTROSE 25% 39
CLINIMIX 4.25%/DEXTROSE 5% 27
chloramphenicol sodium succinate 11
CLINIMIX 5%/DEXTROSE 15% 39
chlorhexidine gluconate oral rinse 28
CLINIMIX 5%/DEXTROSE 20% 39
chloroquine phosphate 11
CLINIMIX 5%/DEXTROSE 25% 39
chlorothiazide 23
CLINIMIX E 2.75%/DEXTROSE 10% 27
chlorothiazide sodium 23
CLINIMIX E 2.75%/DEXTROSE 5% 27
chlorpromazine hcl 19
CLINIMIX E 4.25%/DEXTROSE 25% 39
chlorthalidone 23
CLINIMIX E 4.25%/DEXTROSE 5% 39
chlorzoxazone 16
CLINIMIX E 5%/DEXTROSE 15% 39
cholestyramine light 25
CLINIMIX E 5%/DEXTROSE 20% 39
chorionic gonadotropin 31
CLINIMIX E 5%/DEXTROSE 25% 39
ciclopirox 26
CLINISOL SF 15% 39
clobetasol propionate 26
cyclosporine modified 13
clobetasol propionate e 26
clodan 27
cyproheptadine hcl 37
clomipramine hcl 19
clonazepam 15
clonazepam odt 15
cytarabine aqueous 13
clonidine hcl 23
D
clonidine hcl er 19 clopidogrel 24
dacarbazine 13
clorazepate dipotassium 19
clorpres 23
clotrimazole 9, 26
danazol 31
clotrimazole/betamethasone dipropionate 26
dantrolene sodium 16
clozapine 19
codeine sulfate 17
daunorubicin hcl 13
colestipol hcl 25
decitabine 13
colistimethate sodium 11
delyla 35
colocort 31
demeclocycline hcl 12
COMBIVENT RESPIMAT 37
DEPO-PROVERA 400MG/ML 34
desipramine hcl 19
compro 31
desloratadine 37
desloratadine odt 37
constulose 31
desmopressin acetate 31
desonide 27
desoximetasone 27
cortisone acetate 28
dexamethasone 28
dexamethasone intensol 28
dexamethasone sodium phosphate 28, 37
dexedrine 19
cromolyn sodium 31, 36, 37
dexmethylphenidate hcl 19
cryselle-28 35
dexmethylphenidate hcl er 19
dexrazoxane 12
cyclafem 1/35 35
dextroamphetamine sulfate 19
cyclafem 7/7/7 35
dextroamphetamine sulfate er 19
CYCLOPHOSPHAMIDE 13
dextrose 10%/nacl 0.45% 27
dextrose 10% flex container 27
cyclosporine 13
dextrose 10%/nacl 0.2% 27
dextrose 2.5%/sodium chloride 0.45% 27
dextrose 5% 27
dorzolamide hcl 36
dextrose 5%/lactated ringers 27
dorzolamide hcl/timolol maleate 36
dextrose 5%/nacl 0.2% 27
doxazosin mesylate 23
dextrose 5%/nacl 0.225% 27
doxepin hcl 19
dextrose 5%/nacl 0.33% 27
doxercalciferol 31
dextrose 5%/nacl 0.45% 27
dextrose 5%/nacl 0.9% 27
doxorubicin hcl 13
dextrose 5%/potassium chloride 0.15% 38
doxycycline hyclate 12
diazepam 15, 19
doxycycline hyclate dr 12
diazepam intensol 19
doxycycline monohydrate 12
dronabinol 31
diclofenac potassium 18
drospirenone/ethinyl estradiol 35
diclofenac sodium 18, 25, 36
diclofenac sodium dr 18
diclofenac sodium er 18
duloxetine hcl 19
diclofenac sodium/misoprostol 18
duramorph 17
dicloxacillin sodium 12
didanosine 9
E
diflorasone diacetate 27 diflunisal 18
e.e.s. 400 10
digoxin 24
E.E.S. GRANULES 10
dihydroergotamine mesylate 16
econazole nitrate 26
dilt-cd 23
diltiazem cd 23
diltiazem hcl 23
diltiazem hcl er 23
dilt-xr 23
eliphos 38
diphenhydramine hcl 37
diphenoxylate/atropine 31
DIPHTHERIA/TETANUS TOXOIDS
ADSORBED PEDIATRIC 33
dipyridamole 24
disulfiram 27
emoquette 35
divalproex sodium 15
divalproex sodium dr 15
divalproex sodium er 15
enalapril maleate 23
enalapril maleate/hydrochlorothiazide 23
docetaxel 13
donepezil hcl 16
ENBREL SURECLICK 34
endocet 17
ethosuximide 15
endodan 17
etidronate disodium 27
etodolac 18
enoxaparin sodium 24
etodolac er 18
enpresse-28 35
entacapone 16
etoposide 13
enulose 32
epinastine hcl 36
exemestane 13
EPIPEN-JR 2-PAK 37
epirubicin hcl 13
epitol 15
F
EPIVIR HBV 9 eplerenone 23
eprosartan mesylate 23
falmina 35
famciclovir 9
famotidine 32
ergoloid mesylates 19
famotidine premixed 32
FANAPT TITRATION PACK 20
felbamate 15
felodipine er 23
fenofibrate 25
ERYTHROCIN LACTOBIONATE 10
fenofibrate micronized 25
erythrocin stearate 10
fenofibric acid dr 25
erythromycin 26, 36
fenoprofen calcium 18
erythromycin base 10
fentanyl citrate oral transmucosal 17
erythromycin ethylsuccinate 11
fentanyl patches 17
erythromycin/benzoyl peroxide 26
escitalopram oxalate 19
esomeprazole sodium 32
FETZIMA TITRATION PACK 20
finasteride 38
estradiol 34
estradiol valerate 34
estradiol/norethindrone acetate 34
flavoxate hcl 38
estropipate 34
flecainide acetate 22
eszopiclone 19
fluconazole 9
ethambutol hcl 11
fluconazole in dextrose 9
flucytosine 9
fludarabine phosphate 13
fludrocortisone acetate 28
ganciclovir 9
flunisolide 37
garamycin 36
fluocinolone acetonide 27, 28
fluocinolone acetonide body 27
gatifloxacin 36
fluocinonide 27
fluocinonide-e 27
gavilyte-c 32
fluorometholone 37
gavilyte-g 32
fluorouracil 13, 25
gavilyte-n/flavor pack 32
fluoxetine dr 20
gemcitabine hcl 13
fluoxetine hcl 20
gemfibrozil 25
fluphenazine decanoate 20
generlac 32
fluphenazine hcl 20
gengraf 13
flurbiprofen 18
gentak 36
flurbiprofen sodium 36
gentamicin sulfate 11, 26, 36
flutamide 13
gentamicin sulfate/0.9% sodium chloride 11
fluticasone propionate 27, 38
fluvastatin 25
gianvi 35
fluvoxamine maleate 20
gildagia 35
fluvoxamine maleate er 20
gildess 1.5/30 35
fomepizole 33
fondaparinux sodium 24
glimepiride 29
FORADIL AEROLIZER 38
glipizide 29
glipizide er 29
fortical 31
glipizide/metformin hcl 29
foscarnet sodium 9
GLUCAGEN HYPOKIT 29
fosinopril sodium 23
GLUCAGON EMERGENCY KIT 29
fosinopril sodium/hydrochlorothiazide 23
glyburide 29
fosphenytoin sodium 15
glyburide micronized 29
furosemide 23
glyburide/metformin hcl 29
glycopyrrolate 31
granisetron hcl 32
GRASTEK 33 griseofulvin microsize 9
G
griseofulvin ultramicrosize 9
gabapentin 15
guanfacine hcl 23
guanidine hcl 20
GABLOFEN 16 galantamine hydrobromide 16
H
hydrocortisone/acetic acid 28 hydromorphone hcl 17
hydromorphone hcl er 17
hydroxychloroquine sulfate 11
halobetasol propionate 27
hydroxyurea 13
haloperidol 20
hydroxyzine hcl 37
haloperidol decanoate 20
hydroxyzine pamoate 37
haloperidol lactate 20 HAVRIX 33
I
heparin sodium 24
ibandronate sodium 34
heparin sodium/d5w 24
ibuprofen 18
heparin sodium/nacl 0.45% 24
idarubicin hcl 13
heparin sodium/sodium chloride 0.9% premix 24
ifosfamide 13
imipenem/cilastatin 11
imipramine hcl 20
imipramine pamoate 20
HUMALOG KWIKPEN 29
imiquimod 25
HUMALOG MIX 50/50 29
IMOVAX RABIES (H.D.C.V.) 33
HUMALOG MIX 50/50 KWIKPEN 29
HUMALOG MIX 75/25 29
HUMALOG MIX 75/25 KWIKPEN 29
indapamide 23
indomethacin 18
HUMIRA PEN-CROHNS DISEASESTARTER
indomethacin er 18
HUMULIN 70/30 29
HUMULIN 70/30 KWIKPEN 29
INSULIN PEN NEEDLE 29
HUMULIN 70/30 PEN 29
INSULIN SYRINGE (DISP) U-100 0.3 ML 29
INSULIN SYRINGE (DISP) U-100 1 ML 29
HUMULIN N KWIKPEN 29
INSULIN SYRINGE (DISP) U-100 1/2 ML 29
HUMULIN N U-100 PEN 29
intralipid 39
HUMULIN R U-500 (CONCENTRATED) 29
hydralazine hcl 23
INTRON-A W/DILUENT 33
hydrochlorothiazide 23
introvale 35
hydrocodone bitartrate/acetaminophen 17
hydrocodone/acetaminophen 17
hydrocodone/ibuprofen 17
hydrocortisone 27, 28, 32
INVEGA SUSTENNA 20
hydrocortisone butyrate 27
hydrocortisone butyrate (lipophilic) 27
hydrocortisone valerate 27
IONOSOL-B/DEXTROSE 5% 39
kariva 35
IONOSOL-MB/DEXTROSE 5% 39
kcl 0.075%/d5w/nacl 0.45% 38
IPOL INACTIVATED IPV 33
kcl 0.15%/d5w/lr 38
ipratropium bromide 28, 38
kcl 0.15%/d5w/nacl 0.2% 38
ipratropium bromide/albuterol sulfate 38
kcl 0.15%/d5w/nacl 0.225% 38
irbesartan 23
kcl 0.15%/d5w/nacl 0.9% 38
irbesartan/hydrochlorothiazide 23
kcl 0.3%/d5w/nacl 0.45% 38
irinotecan 13
kcl 0.3%/d5w/nacl 0.9% 39
kelnor 1/35 35
ISOLYTE-P/DEXTROSE 5% 39
ketoconazole 9, 26
isoniazid 11
ketodan kit 26
isosorbide dinitrate 25
ketoprofen 18
isosorbide dinitrate er 25
ketoprofen er 18
isosorbide mononitrate 25
ketorolac tromethamine 18, 36
isosorbide mononitrate er 25
kionex 27
isotonic gentamicin 11
klor-con 8 39
isradipine 23
klor-con m10 39
klor-con m15 39
itraconazole 9
klor-con m20 39
L
J
labetalol hcl 23
lactated ringers irrigation 27
jantoven 24
lactated ringers viaflex 39
lactulose 32
lamivudine 9
lamivudine/zidovudine 9
lamotrigine 15
jinteli 34
lamotrigine er 15
jolivette 34
junel 1.5/30 35
lansoprazole 32
junel 1/20 35
junel fe 1.5/30 35
junel fe 1/20 35
LANTUS SOLOSTAR 30
larin 1.5/30 35 larin 1/20 35
K
larin fe 1.5/30 35
larin fe 1/20 35
latanoprost 36
lisinopril/hydrochlorothiazide 23
lithium 20
lithium carbonate 20
leflunomide 34
lithium carbonate er 20
lessina 35
lomedia 24 fe 35
letrozole 14
leucovorin calcium 12
loperamide hcl 31
lorazepam 20
lorazepam intensol 20
leuprolide acetate 14
lorcet 17
levalbuterol 38
lorcet hd 17
levalbuterol hcl 38
lorcet plus 17
lortab 17
LEVEMIR FLEXPEN 30
loryna 35
levetiracetam 15
losartan potassium 23
levetiracetam er 15
losartan potassium/hydrochlorothiazide 23
levobunolol hcl 36
levocarnitine 27
lovastatin 25
levocetirizine dihydrochloride 37
levofloxacin 12, 36
low-ogestrel 35
levofloxacin in d5w 12
loxapine succinate 20
levonest 35
levonorgestrel/ethinyl estradiol 35
levora 0.15/30-28 35
LUPRON DEPOT-PED 14
levorphanol tartrate 17
lutera 35
levothyroxine sodium 31
levoxyl 31
M
lidocaine 26 lidocaine hcl 26
lidocaine hcl jelly 26
mafenide acetate 26
lidocaine viscous 26
magnesium sulfate 39
lidocaine/prilocaine 26
malathion 27
maprotiline hcl 20
lindane 27
marlissa 35
LIORESAL INTRATHECAL 16
liothyronine sodium 31
matzim la 23
liposyn iii 39
meclizine hcl 32
lisinopril 23
meclofenamate sodium 18
medroxyprogesterone acetate 34
methylphenidate hcl cd 20
mefenamic acid 18
methylphenidate hcl er 20
mefloquine hcl 11
methylphenidate hydrochloride 20
methylprednisolone 28
megestrol acetate 14
methylprednisolone acetate 28
methylprednisolone dose pack 28
meloxicam 18
methylprednisolone sodiumsuccinate 28
melphalan hydrochloride 14
metipranolol 36
metoclopramide hcl 32
metolazone 23
MENOMUNE-A/C/Y/W-135 33
metoprolol succinate er 23
metoprolol tartrate 23
meperidine hcl 17
metoprolol/hydrochlorothiazide 23
metronidazole 11, 26
mercaptopurine 14
metronidazole in nacl 0.79% 11
meropenem 11
metronidazole vaginal 35
mesalamine 32
mexiletine hcl 22
miconazole 3 35
midodrine hcl 27
MESTINON TIMESPAN 16
migergot 16
metadate er 20
millipred 28
metaproterenol sulfate 38
mimvey lo 34
metaxalone 16
minocycline hcl 12
metformin hcl 30
minocycline hcl er 12
metformin hcl er 30
minoxidil 23
methadone hcl 17
mirtazapine 20
methamphetamine hcl 20
mirtazapine odt 20
methazolamide 36
misoprostol 32
methenamine hippurate 12
mitomycin 14
methimazole 28
mitoxantrone hcl 14
M-M-R II W/DILUENT 10 DOSE 33
methocarbamol 16
modafinil 20
methotrexate 14
moderiba 9
methotrexate sodium 14
moderiba 1200 dose pack 9
methoxsalen 25
moderiba 800 dose pack 9
methyclothiazide 23
moexipril hcl 23
methyldopa 23
moexipril/hydrochlorothiazide 24
methyldopa/hydrochlorothiazide 23
mometasone furoate 27
methyldopate hcl 23
mononessa 35
methylergonovine maleate 36
montelukast sodium 38
methylphenidate hcl 20
morphine sulfate 17
morphine sulfate er 17
neomycin sulfate 11
moxifloxacin hcl 12
neomycin/bacitracin/polymyxin 36
neomycin/polymyxin b sulfates 27
mupirocin 26
neomycin/polymyxin/dexamethasone 36
neomycin/polymyxin/gramicidin 36
neomycin/polymyxin/hc 28
neomycin/polymyxin/hydrocortisone 28, 36
mycophenolate mofetil 14
mycophenolic acid dr 14
myorisan 26
NEUPOGEN 33 nevirapine 9
N
nevirapine er 9
nabumetone 18
nadolol 24
nadolol/bendroflumethiazide 24
nafcillin sodium 12
niacin er 25
nalbuphine hcl 18
nicardipine hcl 24
nallpen/dextrose 12
NICOTROL INHALER 28
naloxone hcl 18
naltrexone hcl 18
nifedical xl 24
nifedipine er 24
NAMENDA TITRATION PAK 16
NAMENDA XR TITRATION PACK 16
nimodipine 24
naphazoline hcl 37
nisoldipine 24
naproxen 18
nisoldipine er 24
naproxen dr 18
nitro-bid 25
naproxen sodium 18
nitrofurantoin macrocrystals 12
naratriptan hcl 16
nitrofurantoin monohydrate 12
nitrofurantoin susp 12
nateglinide 30
nitroglycerin 25
nitroglycerin lingual 25
necon 0.5/35-28 35
nitroglycerin transdermal 25
necon 1/35 35
necon 10/11-28 35
nizatidine 32
necon 7/7/7 35
nora-be 34
NEEDLES, INSULIN DISP., SAFETY 30
norethindrone 34
nefazodone hcl 20
norethindrone acetate 34
norlyroc 34
NORMOSOL-M IN D5W 39
ondansetron hcl 32
NORMOSOL-R IN D5W 39
ondansetron odt 32
nortrel 0.5/35 (28) 35
ONETOUCH ULTRA 2 30
nortrel 1/35 35
ONETOUCH ULTRA BLUE 30
nortrel 7/7/7 35
ONETOUCH ULTRA MINI 30
nortriptyline hcl 20
ONETOUCH ULTRA SYSTEM KIT 30
ONETOUCH VERIO IQ BLOOD GLUCOSE
novarel 31
MONITORING SYSTEM 30
NOVOFINE 30GX8MM 30
ONETOUCH VERIO TEST STRIPS 30
NOVOFINE 32GX6MM 30
NOVOFINE AUTOCOVER 30GX8MM 30
NOVOLIN 70/30 30
orphenadrine citrate 16
NOVOLOG FLEXPEN 30
orphenadrine citrate er 16
NOVOLOG MIX 70/30 30
orsythia 35
NOVOLOG MIX 70/30 PREFILLED FLEXPEN
oxacillin sodium 12
NOVOLOG PENFILL 30
oxaliplatin 14
oxandrolone 31
oxaprozin 18
oxazepam 21
nyamyc 26
oxcarbazepine 15
nystatin 9, 26
nystatin/triamcinolone 26
OXSORALEN ULTRA 25
nystop 26
oxybutynin chloride 38 oxybutynin chloride er 38
O
oxycodone hcl 17, 18
ocella 35
oxycodone/acetaminophen 18
octreotide acetate 14
oxycodone/aspirin 18
ofloxacin 12, 28, 36
oxycodone/ibuprofen 18
ogestrel 35
oxymorphone hydrochloride 18
olanzapine 20, 21
oxymorphone hydrochloride er 18
olanzapine odt 21
P
olanzapine/fluoxetine 21 OLYSIO 9
pacerone 22
omega-3-acid ethyl esters 25
paclitaxel 14
omeprazole 32
palgic 37
omeprazole/sodium bicarbonate 32
pamidronate disodium 31
pioglitazone hcl/metformin hcl 30
pantoprazole sodium 32
pioglitazone hcl-glimepiride 30
paricalcitol 31
piperacillin sodium/tazobactam sodium 12
paromomycin sulfate 11
pirmella 1/35 35
paroxetine hcl 21
piroxicam 18
paroxetine hcl er 21
PLASMA-LYTE A 39
PLASMA-LYTE-148 39
PLASMA-LYTE-56/D5W 39
pedi-dri 26
podofilox 25
polyethylene glycol 3350 32
polymyxin b sulfate 11
polymyxin b sulfate/trimethoprim sulfate 36
PEGASYS PROCLICK 33
portia-28 35
PEG-INTRON REDIPEN 33
potassium chloride 39
penicillin g potassium 12
potassium chloride 0.15% /nacl 0.45% viaflex 39
penicillin g procaine 12
potassium chloride 0.15% d5w/nacl 0.33% 39
penicillin g sodium 12
potassium chloride 0.15% d5w/nacl 0.45% viaflex
penicillin v potassium 12
potassium chloride 0.15% nacl 0.9% 39
potassium chloride 0.22% d5w/nacl 0.45% 39
pentoxifylline er 24
potassium chloride 0.3%/ nacl 0.9% 39
potassium chloride 0.3%/d5w 39
perindopril erbumine 24
potassium chloride er 39
periogard 28
potassium citrate er 38
permethrin 27
perphenazine 21
pramipexole dihydrochloride 16
perphenazine/amitriptyline 21
pravastatin sodium 25
pfizerpen-g 12
prazosin hcl 24
phenadoz 37
phenelzine sulfate 21
prednicarbate 27
phenobarbital 15
prednisolone acetate 37
phenytoin 15
prednisolone sodium phosphate 28, 37
phenytoin sodium 15
prednisone 28
phenytoin sodium extended 15
prednisone intensol 28
PHOSPHOLINE IODIDE 36
pilocarpine hcl 27, 36
pilocarpine hydrochloride 27
pimtrea 35
pindolol 24
prevalite 25
pioglitazone hcl 30
previfem 35
propafenone hcl er 22
proparacaine hcl 36
PRIMAQUINE PHOSPHATE 11
propranolol hcl 24
primidone 16
propranolol hcl er 24
propranolol/hydrochlorothiazide 24
propylthiouracil 28
probenecid 34
protriptyline hcl 21
probenecid/colchicine 34
prudoxin 25
procainamide hcl 22
procentra 21
pyrazinamide 11
prochlorperazine 32
pyridostigmine bromide 17
prochlorperazine edisylate 32
Q
prochlorperazine maleate 32 PROCRIT 33
quasense 35
procto-pak 32
quetiapine fumarate 21
proctosol hc 32
quinapril hcl 24
proctozone-hc 32
quinapril/hydrochlorothiazide 24
PRODIGY INSULIN MINI PEN NEEDLES/31G
quinidine gluconate 22
quinidine gluconate cr 22
PRODIGY INSULIN PEN NEEDLES/29G X 1/2
quinidine sulfate 22
quinidine sulfate er 22
PRODIGY INSULIN SHORT
quinine sulfate 11
PENNEEDLES/31G X 5/16 30
PRODIGY INSULIN SYRING/U-100/0.3ML/31G
R
PRODIGY INSULIN SYRINGE/1/2ML/31G X
rabeprazole sodium 32
PRODIGY INSULIN SYRINGE/1ML/28G X 1/2
raloxifene hydrochloride 34
ramipril 24
progesterone 35
ranitidine hcl 32
REBIF REBIDOSE 33
REBIF REBIDOSE TITRATION PACK 33
promethazine hcl 37
REBIF TITRATION PACK 33
promethegan 37
reclipsen 35
propafenone hcl 22
RECOMBIVAX HB 34
S
RELENZA DISKHALER 10
SAIZEN CLICK.EASY 33
SANDOSTATIN LAR DEPOT 14
repaglinide 30
reprexain 18
reserpine 24
SAVELLA TITRATION PACK 34
selegiline hcl 16
RETROVIR IV INFUSION 10
selenium sulfide 25
SEREVENT DISKUS 38
ribasphere 10
ribasphere ribapak 10
ribavirin 10
sertraline hcl 22
sharobel 35
rifabutin 11
rifampin 11
sildenafil 38
silver sulfadiazine 25
riluzole 28
rimantadine hcl 10
ringers injection 39
simvastatin 25
ringers irrigation 27
sirolimus 14
risedronate sodium 34
sodium chloride 28, 39
RISPERDAL CONSTA 21
sodium chloride 0.45% viaflex 39
risperidone 21
sodium chloride 0.9% 28
risperidone odt 21
sodium fluoride 40
sodium lactate 39
rivastigmine tartrate 16
sodium phenylbutyrate 28
rizatriptan benzoate 16
sodium polystyrene sulfonate 28
rizatriptan benzoate odt 16
sodium sulfacetamide 37
ropinirole er 16
ropinirole hcl 16
SORIATANE 25 sorine 22 sotalol hcl 22
sotalol hcl (af) 22
spinosad 27
SPIRIVA HANDIHALER 38
spironolactone 24
T
spironolactone/hydrochlorothiazide 24 SPORANOX 9
sprintec 28 35
tacrolimus 14
sronyx 35
tamoxifen citrate 14
stavudine 10
tamsulosin hcl 38
sterile water irrigation 28
STREPTOMYCIN SULFATE 11
taztia xt 24
TECFIDERA STARTER PACK 16
sucralfate 32
sulfacetamide sodium 26, 37
telmisartan 24
sulfacetamide sodium/prednisolone sodium
telmisartan/amlodipine 24
phosphate 37
telmisartan/hydrochlorothiazide 24
sulfadiazine 12
temazepam 22
sulfamethoxazole/trimethoprim 12
terazosin hcl 24
sulfamethoxazole/trimethoprim ds 12
terbinafine hcl 9
terbutaline sulfate 38
sulfasalazine 32
terconazole 35
sulfazine ec 32
testosterone cypionate 31
sulindac 18
testosterone enanthate 31
sumatriptan 16
tetanus toxoid adsorbed 34
sumatriptan succinate 16
ADSORBED ADULT 34
theophylline 38
theophylline cr 38
theophylline er 38
thioridazine hcl 22
SYMLINPEN 120 30
thiothixene 22
TRELSTAR MIXJECT 15
tretinoin 15, 26
triamcinolone acetonide 27, 28, 38
tiagabine hydrochloride 16
triamcinolone in orabase 28
triamterene/hydrochlorothiazide 24
timolol maleate 24, 36
triderm 27
timolol maleate ophthalmic gel forming 36
trifluoperazine hcl 22
tinidazole 11
trifluridine 36
trihexyphenidyl hcl 16
tizanidine hcl 17
tri-legest fe 35
trilyte 32
tobramycin 11
trimethobenzamide hcl 32
tobramycin sulfate 11, 36
trimethoprim 12
tobramycin sulfate/sodium chloride 11
trimipramine maleate 22
tobramycin/dexamethasone 36
trinessa 35
tolazamide 30
tri-previfem 35
tolbutamide 30
tolmetin sodium 18
tri-sprintec 35
tolterodine tartrate 38
trivora-28 35
tolterodine tartrate er 38
topiramate 16
toposar 15
trospium chloride 38
topotecan hcl 15
trospium chloride er 38
torsemide 24
TUDORZA PRESSAIR 38
tramadol hcl 18
tramadol hcl er 18
tramadol hydrochloride/acetaminophen 18
trandolapril 24
tranexamic acid 24, 35
tranylcypromine sulfate 22
TYZINE PEDIATRIC NASAL DROPS 28
travasol 40
U
travoprost 36 trazodone hcl 22
unithroid 31
TRELSTAR DEPOT 15
ursodiol 32
TRELSTAR DEPOT MIXJECT 15
V
TRELSTAR LA MIXJECT 15
valacyclovir hcl 10
valproate sodium 16
valproic acid 16
voriconazole 9
valsartan 24
valsartan/hydrochlorothiazide 24
vancomycin hcl 12
vyfemla 35
vandazole 35
W
VAQTA 34 VARIVAX 34
warfarin sodium 24
X
velivet 35
venlafaxine hcl 22
venlafaxine hcl er 22
verapamil hcl 24
verapamil hcl er 24
verapamil hcl sr 24
veripred 20 28
xulane 35
vestura 35
VFEND 9 V-GO 20 30
Y
vicodin 18
Z
vicodin es 18 vicodin hp 18
zafirlukast 38
zaleplon 22
VIDEX PEDIATRIC 10
zamicet 18
vinblastine sulfate 15
zazole 35
vincasar pfs 15
vincristine sulfate 15
vinorelbine tartrate 15
zenchent 35
zenchent fe 36
zenzedi 22
zidovudine 10
zovia 1/35e 36
ziprasidone hcl 22
zovia 1/50e 36
zoledronic acid 28, 31
zolmitriptan 16
zolmitriptan odt 16
zolpidem tartrate 22
zolpidem tartrate er 22
zonisamide 16
This abridged formulary was updated on 11/01/2014 and is not a complete list of drugs covered by our plan. For a complete listing or other questions, please contact GlobalHealth Medicare Member Services, at (866) 844-0151 or, for TTY users, (800) 899-2114, 24 hours a day, 7 days a week, 365 days a year, or visit www.globalhealth-medicare.com.
GlobalHealth is an HMO with a Medicare contract.
Enrollment in GlobalHealth Medicare (HMO) depends on contract renewal.
Mailing address:
GlobalHealth Medicare
Oklahoma City, OK 73101-2328
Customer care:
866 844 0151 (tty/tdd 800 899 2114)
Date last updated: 11/01/2014
Effective date: 1/1/2014
Source: http://generationshealthcare.cc/docs/medicare/H0435_2014_Formulary_Abridged.pdf
FASTING is complete abstinence from food and drink between dawn and dusk. All those who are ill or frail, pregnant or menstruating women, breastfeeding mothers and travellers are exempted. They are required to make up the number of days missed at a later date or give a fixed sum to charity. Page 4 Acknowledgements and useful contacts Page 5 Introduction
Cosmetic Special Topic Textured-Surface Saline-Filled Silicone BreastImplants for Augmentation Mammaplasty Scott L. Spear, M.D., Mohamed Elmaraghy, M.D., and Christopher Hess, M.D. Washington, D.C. The earliest silicone breast implants were smooth-sur- sues include but are not necessarily limited to face, silicone rubber devices filled with either silicone gel