If you are on a Tier 3 drug there may be alternatives in Tier 1 and 2 which can be discussed with your clinician.
Drug |
Tier |
Restrictions |
| 50% UREA NAIL STK |
2 |
PA, QL |
| A/B OTIC |
1 |
|
| ABILIFY |
2 |
|
| ACARBOSE |
1 |
|
| ACCOLATE |
2 |
|
| ACCU-CHEK COMFORT CURVE TES COMFORT |
3 |
PA, QL |
| ACCU-CHEK COMPACT |
3 |
PA, QL |
| ACCUZYME |
2 |
QL |
| ACETAMINOPHEN/CODEINE #3 |
1 |
|
| ACETASOL HC |
1 |
|
| ACETAZOLAMIDE |
1 |
T |
| ACETIC ACID |
1 |
|
| ACETIC ACID/ALUMINUM |
1 |
|
| ACETYLCYSTEINE |
1 |
|
| ACIPHEX |
3 |
ST |
| ACLARO EMU |
3 |
QL |
| ACTIQ LOZ |
3 |
PA, ST |
| ACTONEL |
3 |
|
| ACTOPLUS MET |
2 |
|
| ACTOS |
2 |
|
| ACULAR |
3 |
|
| ACULAR LS |
3 |
|
| ACYCLOVIR |
1 |
|
| ACZONE |
2 |
PA, ST, QL |
| ADDERALL |
3 |
|
| ADDERALL XR |
3 |
|
| ADOXA |
3 |
PA, ST |
| ADVAIR DISKUS |
2 |
QL |
| ADVICOR |
2 |
QL |
| AEROBID AER |
2 |
|
| AEROCHAMBER MIS |
NC |
PA |
| AGGRENOX |
2 |
|
| AK-PENTOLATE |
1 |
|
| AK-POLY-BAC |
1 |
|
| ALAMAG |
NC |
OTC |
| ALAMAST |
3 |
|
| ALBENZA |
1 |
|
| ALBUTEROL SULFATE |
1 |
|
| ALCLOMETASONE DIPROPIONATE |
1 |
QL |
| ALDACTONE |
3 |
|
| ALDARA |
2 |
PA, QL |
| ALENDRONATE |
1 |
|
| ALINIA |
2 |
|
| ALINIA |
2 |
|
| ALKERAN |
3 |
|
| ALLANFILLENZYME |
2 |
QL |
| ALLOPURINOL |
1 |
|
| ALOCRIL |
3 |
|
| ALOMIDE |
3 |
|
| ALORA DIS |
3 |
|
| ALPHAGAN P |
3 |
|
| ALPHAQUIN HP |
2 |
QL |
| ALPRAZOLAM |
1 |
|
| ALPRAZOLAM ER |
1 |
|
| ALREX |
3 |
|
| ALTABAX |
2 |
PA, QL |
| ALTACE |
3 |
|
| AMANTADINE HCL |
1 |
|
| AMARYL |
3 |
|
| AMBIEN |
3 |
PA, ST, QL, T |
| AMBIEN CR |
3 |
ST, QL, T |
| AMCINONIDE |
1 |
QL |
| AMERGE |
3 |
ST, QL |
| AMILORIDE |
1 |
|
| AMILORIDE/HYDROCHLOROTHIAZI |
1 |
|
| AMIODARONE HCL |
1 |
|
| AMITIZA |
2 |
|
| AMITRIPTYLINE |
1 |
|
| AMLACTIN |
NC |
QL |
| AMLODIPINE |
1 |
|
| AMLODIPINE BESYLATE/BENAZEP |
1 |
|
| AMMONIUM LACTATE |
NC |
QL |
| AMNESTEEM |
1 |
QL |
| AMOX/POT CLAV |
1 |
|
| AMOXICILLIN |
1 |
T |
| AMOXICILLIN /CLAVU |
1 |
|
| AMOXICILLIN/CLAV |
1 |
|
| AMPHETAMINE SALT COMBO |
1 |
|
| AMPHETAMINE/DEXTROAMPHETAMI |
1 |
|
| AMRIX CAP |
3 |
PA, ST |
| ANAGRELIDE HYDROCHLORIDE |
1 |
|
| ANALPRAM-HC |
1 |
QL |
| ANASTROZOLE |
|
|
| ANDRODERM DIS |
2 |
|
| ANDROGEL |
2 |
|
| ANDROXY |
2 |
|
| ANGELIQ |
3 |
|
| ANTABUSE |
1 |
|
| ANTARA |
3 |
|
| ANTIPYRINE/BENZOCAINE |
1 |
|
| ANUCORT-HC |
1 |
QL |
| ANZEMET |
3 |
PA |
| APEXICON E |
3 |
PA, ST, QL |
| APHTHASOL PST |
1 |
QL |
| APIDRA |
3 |
|
| ARANELLE |
1 |
|
| ARANESP |
2 |
PA, QL |
| ARAVA |
2 |
|
| ARICEPT |
2 |
|
| ARIMIDEX |
3 |
|
| ARIXTRA |
3 |
PA |
| ARMOUR THYROID |
1 |
|
| AROMASIN |
2 |
|
| ARTHROTEC |
2 |
|
| ARTHROTEC-50 |
2 |
|
| ASACOL |
2 |
|
| ASMANEX |
2 |
|
| ASTELIN |
3 |
PA, QL |
| ATACAND |
3 |
|
| ATACAND HCT |
3 |
|
| ATENOLOL |
1 |
|
| ATENOLOL/CHLORTHALIDONE |
1 |
|
| ATOVAQUONE |
1 |
T |
| ATRIPLA |
2 |
|
| ATROPINE |
1 |
|
| ATROVENT HFA AER |
2 |
|
| AUGMENTED BETAMETHASONE DIP |
1 |
ST, QL |
| AUGMENTIN |
1 |
|
| AUGMENTIN XR |
3 |
PA |
| AVALIDE |
2 |
|
| AVANDAMET |
2 |
|
| AVANDARYL |
2 |
|
| AVANDIA |
2 |
|
| AVAPRO |
2 |
|
| AVC |
1 |
|
| AVELOX |
2 |
|
| AVINZA |
3 |
|
| AVODART |
2 |
|
| AVONEX |
2 |
|
| AXERT |
3 |
ST, QL |
| AXID |
2 |
|
| AZASITE |
3 |
|
| AZATHIOPRINE |
2 |
|
| AZELEX |
3 |
QL |
| AZILECT |
2 |
|
| AZITHROMYCIN |
1 |
T |
| AZMACORT AER |
3 |
|
| AZOPT |
2 |
|
| AZURETTE |
1 |
|
| BACITRACIN |
1 |
|
| BACLOFEN |
1 |
|
| BACTROBAN |
2 |
QL |
| BACTROBAN NASAL |
2 |
QL |
| BALSALAZIDE DIS |
1 |
|
| BALZIVA |
1 |
|
| BANZEL |
3 |
|
| BARACLUDE |
2 |
|
| B-D 3CC LUER-LOK SYRINGE/25 MIS 25GX1" |
1 |
|
| B-D GLUCOSE |
NC |
|
| B-D INSULIN SYRINGE ULTRAFI MIS 1CC/31G |
1 |
|
| BD NEEDLE/27G X 1/2" MIS 27GX1/2" |
1 |
|
| B-D ULTRAFINE ORIGINAL PEN MIS PENNEEDL |
1 |
|
| BECONASE-AQ |
3 |
ST, QL |
| BELLADONNA ALK/PHENOB |
1 |
|
| BENAZEPRIL HCL |
1 |
|
| BENAZEPRIL HCL/HYDROCHLOROT TAB |
1 |
|
| BENICAR |
3 |
|
| BENICAR HCT |
3 |
|
| BENPROX |
3 |
QL |
| BENZACLIN |
3 |
PA, ST, QL |
| BENZAMYCIN GEL |
3 |
ST, QL |
| BENZASHAVE |
NC |
QL |
| BENZONATATE |
1 |
|
| BENZOYL PEROXIDE CREAMY WAS KIT WASH |
1 |
ST, QL |
| BENZOYL PEROXIDE GEL |
1 |
ST, QL |
| BENZOYL PEROXIDE PAD |
3 |
ST, QL |
| BENZOYL PEROXIDE WASH |
1 |
QL |
| BENZTROPINE MESYLATE |
1 |
|
| BETAMETHASONE DIPROPIONATE |
1 |
QL |
| BETAMETHASONE VALERATE |
1 |
QL |
| BETAXOLOL L |
1 |
|
| BETAXOLOL HCL |
1 |
|
| BETHANECHOL |
1 |
|
| BETIMOL |
3 |
|
| BETOPTIC-S |
3 |
|
| BIAFINE EMU |
2 |
QL |
| BILTRICIDE |
2 |
|
| BISOPROLOL FUMARATE |
1 |
|
| BISOPROLOL FUMARATE/HYDROCH |
1 |
|
| BLEPHAMIDE LIQUIFILM |
3 |
|
| BLEPHAMIDE-S.O.P. |
3 |
|
| BONIVA |
3 |
|
| BONIVA KIT |
$0 |
PA |
| BOTOX INJ |
$0 |
PA |
| BREVOXYL |
3 |
ST, QL |
| BRIMONIDINE |
1 |
|
| BROMOCRIPTINE MESYLATE |
1 |
|
| BUDEPRIONSR |
1 |
|
| BUMETANIDE |
1 |
|
| BUPROPION HCL SR |
1 |
|
| BUPROPION HCL |
1 |
|
| BUPROPION HCL ER |
1 |
|
| BUPROPION HCL XL |
1 |
|
| BUTAL/ASA/CAFF |
1 |
|
| BUTALBITAL/APAP/CAFFEINE |
1 |
|
| BUTRANS PATCH |
3 |
PA |
| BYETTA INJ |
3 |
|
| BYSTOLIC |
3 |
PA |
| CADUET |
2 |
|
| CALAN |
3 |
|
| CALCIPOTRIENE |
1 |
PA, QL |
| CALCITRIOL |
1 |
|
| CAL-NATE |
1 |
|
| CAMILA |
1 |
|
| CAMPRAL |
2 |
|
| CANASA |
2 |
|
| CAPHOSOL |
1 |
QL |
| CAPTOPRIL |
1 |
|
| CAPTOPRIL/HYDROCHLOROTHIAZI |
1 |
|
| CARAC |
2 |
PA, QL |
| CARAFATE |
3 |
|
| CARBAMAZEPINE |
1 |
|
| CARBAMIDE PEROXIDE |
1 |
|
| CARBATROL |
2 |
|
| CARBIDOPA/LEVODOPA |
1 |
|
| CARBIDOPA/LEVODOPA ER |
1 |
|
| CARDIZEM CD |
3 |
|
| CARISOPRODOL |
1 |
|
| CARISOPRODOL/ASPIRIN |
1 |
|
| CARMOL 40 |
3 |
PA, QL |
| CARMOL-HC |
3 |
QL |
| CARTEOLOL HCL |
1 |
|
| CARTIA XT |
1 |
|
| CARVEDIOL |
1 |
|
| CASAMET |
3 |
|
| CASODEX |
2 |
|
| CATAPRES-TTS-3 DIS |
3 |
|
| CAVERJECT IMPULSE KIT |
$0 |
PA, QL |
| CAZIANT |
1 |
|
| CEFACLOR |
1 |
|
| CEFADROXIL |
1 |
|
| CEFDINIR |
1 |
|
| CEFPODOXIME |
1 |
|
| CEFPROZIL |
1 |
|
| CEFTIN |
3 |
|
| CEFUROXIME |
1 |
|
| CELEBREX |
2 |
|
| CELESTONE-SOLUSPAN INJ |
$0 |
|
| CELEXA |
3 |
PA, ST |
| CELLECEPT |
$0 |
|
| CENESTIN |
3 |
|
| CEPHALEXIN |
1 |
|
| CEREFOLIN |
3 |
|
| CERUMENEX |
3 |
|
| CETROTIDE KIT |
3 |
|
| CHANTIX |
2 |
QL |
| CHLORAL HYDRATE |
1 |
|
| CHLORDIAZEPOXIDE |
1 |
|
| CHLORDIAZEPOXIDE/CLID |
1 |
|
| CHLORHEXIDINE GLUC |
1 |
QL |
| CHLOROQUINE |
3 |
T |
| CHLORPROMAZINE |
1 |
|
| CHLORPROPAMIDE |
1 |
|
| CHLORTHALIDONE |
1 |
|
| CHLORZOXAZONE |
1 |
|
| CHOLESTYRAMINE |
1 |
|
| CHOLINE MAGNESIUM TRISALICY |
1 |
|
| CHORI GONADO INJ |
1 |
|
| CHROMAGEN |
2 |
|
| CHROMAGEN FA |
2 |
|
| CHROMAGEN FORTE |
2 |
|
| CIALIS |
2 |
QL |
| CICLOPIROX |
1 |
PA, ST, QL |
| CILOSTAZOL |
1 |
|
| CILOXAN |
3 |
PA |
| CIMETIDINE |
1 |
|
| CIPRO |
1 |
T |
| CIPRO HC |
3 |
|
| CIPRO XR |
3 |
T |
| CIPRODEX |
3 |
|
| CIPROFLOXACIN |
1 |
T |
| CIPROFLOXACIN HCL |
1 |
|
| CITALOPRAM |
1 |
|
| CLARINEX- |
3 |
PA, ST |
| CLARITHROMYCIN |
1 |
|
| CLENIA |
3 |
ST, QL |
| CLENIA FOAMING WASH EMU |
3 |
ST, QL |
| CLEOCIN PED GRAN |
2 |
|
| CLEOCIN SUP |
2 |
|
| CLEOCIN-T |
3 |
PA, ST, QL |
| CLIMARA DIS |
3 |
|
| CLINDAGEL |
3 |
PA, ST, QL |
| CLINDAMYCIN HCL |
1 |
|
| CLINDAMYCIN PHOSPHATE |
1 |
QL |
| CLOBETASOL PROPIONATE |
1 |
QL |
| CLOBETASOL PROPIONATE AER |
3 |
PA, ST, QL |
| CLOMIPHENE |
1 |
|
| CLOMIPRAMINE |
1 |
|
| CLONAZEPAM |
1 |
|
| CLONAZEPAM ORALLY DISINTEGR |
1 |
|
| CLONIDINE HCL |
1 |
|
| CLORAZEPATE DIPOTASSIUM |
1 |
|
| CLOTRIMAZOLE CRE 1% |
NC |
QL |
| CLOTRIMAZOLE/BET |
1 |
QL |
| CLOZAPINE |
1 |
|
| CODEINE SULFATE |
1 |
|
| COLCRYS |
2 |
|
| COLESTIPOL HCL |
1 |
|
| COLOCORT ENE |
1 |
QL |
| COMBIGAN |
3 |
|
| COMBIPATCH DIS |
2 |
|
| COMBIVENT AER |
2 |
|
| COMBIVIR |
2 |
|
| COMMIT LOZ |
NC |
OTC |
| COMPOUNDS |
3 |
|
| COMTAN |
3 |
|
| CONCERTA |
3 |
QL |
| CONDYLOX |
3 |
PA, QL |
| COPAXONE |
2 |
|
| CORDRAN TAPE |
3 |
QL |
| COREG CR |
3 |
|
| CORTEF |
3 |
|
| CORTISPORIN |
3 |
QL |
| COUMADIN |
3 |
|
| COZAAR |
3 |
PA |
| CREON |
2 |
|
| CRESTOR |
3 |
QL |
| CRINONE |
3 |
|
| CROMOLYN SODIUM |
1 |
|
| CRYSELLE-28 |
1 |
|
| CUTIVATE |
3 |
QL |
| CYANOCOBALAMIN INJ |
$0 |
|
| CYCLOBENZAPRINE HCL |
1 |
|
| CYCLOCORT |
1 |
QL |
| CYCLOGYL |
1 |
|
| CYCLOPHOSPHAMIDE |
1 |
|
| CYMBALTA |
2 |
|
| CYPROHEPTADINE |
1 |
|
| CYTOMEL |
3 |
|
| CYTRA-2 |
1 |
|
| DANAZOL |
2 |
|
| DAPSONE |
1 |
|
| DDAVP |
3 |
|
| DELESTROGEN INJ |
$0 |
|
| DEMECLOCYCLINE |
1 |
|
| DENAVIR |
2 |
QL |
| DENTA 5000 PLUS |
1 |
QL |
| DENTAGEL |
1 |
QL |
| DEPAKOTE |
3 |
|
| DEPAKOTE ER |
3 |
|
| DEPLIN |
2 |
|
| DEPO-MEDROL |
$0 |
|
| DEPO-TESTOSTERONE INJ 200MG/ML |
$0 |
|
| DERMA-SMOOTHE/FS |
3 |
PA, ST, QL |
| DERMAZENE |
1 |
QL |
| DERMOTIC OIL |
2 |
|
| DESIPRAMINE HCL |
1 |
|
| DESMOPRESSIN ACETATE |
1 |
|
| DESONIDE |
1 |
QL |
| DESOXIMETASONE |
1 |
QL |
| DETROL |
3 |
|
| DETROL LA |
2 |
|
| DEXAMETHASONE |
1 |
|
| DEXAMETHASONE SODIUM PHOSPH |
1 |
|
| DEXAMETHASONE SODIUM PHOSPH INJ 4MG/ML UD |
$0 |
|
| DEXEDRINE |
3 |
|
| DEXMETHYLPHENIDATE HCL |
1 |
|
| DEXTROAMPHETAMINE CR |
1 |
|
| DEXTROAMPHETAMINE SULFATE |
1 |
|
| DEXTROSTAT |
1 |
|
| DIALYVITE |
1 |
|
| DIALYVITE 3000 |
2 |
|
| DIAMOX |
3 |
T |
| DIASTAT |
3 |
PA |
| DIATX ZN |
3 |
|
| DIAZEPAM |
1 |
|
| DICLOFENAC SODIUM |
1 |
|
| DICLOFENAC SODIUM ER |
1 |
|
| DICLOXACILLIN |
1 |
|
| DICYCLOMINE HCL |
1 |
|
| DIDRONEL |
1 |
|
| DIETHYLPROPION HCL |
1 |
|
| DIETHYLPROPION HCL ER |
1 |
|
| DIFFERIN |
2 |
PA, QL |
| DIFLORASONE DIACETATE |
1 |
QL |
| DIFLUNISAL |
1 |
|
| DILANTIN |
1 |
|
| DILTIAZEM |
1 |
|
| DILTIAZEM HCL |
1 |
|
| DILT-XR |
1 |
|
| DILTZAC |
1 |
|
| DIOVAN |
2 |
|
| DIOVAN HCT |
2 |
|
| DIPENTUM |
2 |
|
| DIPHENOXY/ATROP |
1 |
|
| DIPIVEFRIN HCL |
1 |
|
| DIPROLENE |
3 |
QL |
| DIPYRIDAMOLE |
1 |
|
| DISOPYRAMIDE PHOSPHATE |
1 |
|
| DITROPAN |
3 |
|
| DITROPAN XL |
3 |
|
| DIURIL |
2 |
|
| DIVALPROEX SODIUM |
1 |
|
| DOMEBORO |
1 |
|
| DORYX |
3 |
PA, ST |
| DORZOLAMIDE |
1 |
|
| DORZOLAMIDE HCL/TIMOLOL MAL |
1 |
|
| DOSTINEX |
2 |
PA |
| DOVONEX |
2 |
PA, QL |
| DOXAZOSIN MESYLATE |
1 |
|
| DOXYCYCLINE HYC |
1 |
T |
| DRITHO-SCALP |
3 |
PA, QL |
| DRONABINOL |
1 |
|
| DUAC CS KIT |
3 |
PA, ST, QL |
| DUET |
3 |
|
| DUET DHA PAK |
3 |
|
| DUETACT |
2 |
|
| DULERA |
2 |
|
| DURAGESIC DIS |
3 |
QL |
| DYAZIDE |
3 |
|
| DYNACIRC |
3 |
|
| DYNACIRC-CR |
3 |
|
| DYRENIUM |
3 |
|
| E.E.S.-200 |
1 |
|
| ECONAZOLE NITRATE |
1 |
QL |
| EDECRIN |
3 |
|
| EDEX KIT |
$0 |
PA, QL |
| EFFEXOR |
3 |
|
| EFFEXOR XR |
3 |
|
| EFFEXOR XL |
3 |
|
| EFFIENT |
2 |
|
| EFUDEX |
3 |
PA, QL |
| ELDEPRYL |
3 |
|
| ELESTAT |
3 |
|
| ELIDEL |
2 |
PA, QL |
| ELOCON |
3 |
QL |
| EMADINE |
3 |
|
| EMCYT |
2 |
|
| EMEND |
2 |
PA |
| EMSAM DIS |
3 |
PA, ST |
| ENABLEX |
3 |
|
| ENALAPRIL MALEATE |
1 |
|
| ENALAPRIL MALEATE/HYDROCHLO |
1 |
|
| ENBREL INJ 25MG UD |
2 |
|
| ENBREL INJ 50MG/ML UD |
2 |
|
| ENBREL SURECLICK INJ 50MG/ML UD |
2 |
|
| ENDOCET |
1 |
|
| ENDOMETRIN SUPP. |
3 |
|
| ENJUVIA |
2 |
|
| ENPRESSE |
1 |
|
| ENTOCORT EC |
2 |
|
| EPIFOAM AER |
3 |
QL |
| EPIPENS |
2 |
|
| EPIQUIN MICRO |
2 |
QL |
| EPIVIR |
2 |
|
| EPIVIR HBV |
2 |
|
| EPLERENONE |
3 |
|
| EPZICOM |
3 |
PA |
| ERTACZO |
3 |
PA, ST, QL |
| ERY PAD |
3 |
QL |
| ERYPED-200 |
1 |
|
| ERY-TAB |
2 |
|
| ERYTHRO /SULFISOX |
1 |
|
| ERYTHROCIN STE FILMTAB |
1 |
|
| ERYTHROMYCIN |
1 |
|
| ERYTHROMYCIN GEL 2% |
1 |
QL |
| ERYTHROMYCIN OIN OP |
1 |
|
| ERYTHROMYCIN/BENZOYL PEROXI GEL |
1 |
ST, QL |
| ESTRACE CRE |
2 |
|
| ESTRACE TAB |
3 |
|
| ESTRADERM DIS |
3 |
|
| ESTRADIOL |
1 |
|
| ESTRADIOL DIS |
1 |
|
| ESTRADIOL/NORET |
1 |
|
| ESTRATEST-H.S. |
3 |
|
| ESTRING MIS |
2 |
|
| ESTROGEL |
3 |
|
| ESTROSTEP FE |
3 |
|
| ETHAMBUTOL HCL |
$0 |
|
| ETHOSUXIMIDE |
1 |
|
| ETODOLAC |
1 |
|
| ETODOLAC ER |
1 |
|
| EUFLEXXA INJ 10MG/ML UD |
3 |
QL |
| EURAX |
1 |
QL |
| EVISTA |
2 |
|
| EVOCLIN |
3 |
PA, ST, QL |
| EVOXAC |
2 |
QL |
| EXELON |
2 |
|
| EXELON DIS |
2 |
|
| EXFORGE |
2 |
|
| EXFORGE HTC |
2 |
|
| EXTINA AE |
3 |
PA, ST, QL |
| FABRAZYME INJ 35MG UD |
$0 |
PA |
| FAMCICLOVIR |
1 |
|
| FAMOTIDINE |
1 |
|
| FAMVIR |
3 |
|
| FANAPT |
3 |
PA |
| FELODIPINE |
1 |
|
| FEMARA |
2 |
|
| FEMCON FE |
3 |
|
| FEMHRT |
2 |
|
| FEMHRT low |
2 |
|
| FENTANYL DIS |
1 |
QL |
| FEROTRINSIC |
1 |
|
| FINACEA |
3 |
QL |
| FINASTERIDE |
1 |
|
| FIRST-HYDROCORTISONE |
2 |
QL |
| FIRST-TESTOSTERONE MC COMPO |
2 |
|
| FIRTST PROGESTONE VAG |
3 |
|
| FLAREX |
3 |
|
| FLECAINIDE ACETATE |
1 |
|
| FLECTOR PAD |
2 |
PA, QL |
| FLOMAX |
3 |
|
| FLONASE SPR |
3 |
PA, ST, QL |
| FLOVENT |
2 |
QL |
| FLOXIN OTIC |
3 |
|
| FLUCONAZOLE |
1 |
|
| FLUDROCORTISONE ACETATE |
1 |
|
| FLUOCINOLONE ACETONIDE S |
1 |
QL |
| FLUOCINONIDE |
1 |
QL |
| FLUOCINONIDE-E |
1 |
QL |
| FLUOR-A-DAY |
3 |
|
| FLUOROMETHOLONE |
1 |
|
| FLUOROPLEX |
2 |
PA, QL |
| FLUOXETINE |
1 |
|
| FLUPHENAZINE |
1 |
|
| FLURAZEPAM HCL |
1 |
|
| FLURBIPROFEN |
1 |
|
| FLUTAMIDE |
1 |
|
| FLUTICASONE PROPIONATE |
1 |
QL |
| FLUVOXAMINE MALEATE |
1 |
|
| FML FORTE |
3 |
|
| FML-S.O.P. |
3 |
|
| FOCALIN |
3 |
|
| FOCALIN XR |
3 |
|
| FOLBIC |
1 |
|
| FOLGARD OS |
2 |
|
| FOLGARD RX |
3 |
|
| FOLIC ACID |
1 |
|
| FOLLISTIM AQ INJ 900UNIT |
3 |
|
| FOLLISTIM INJ 75IU UD |
3 |
|
| FOLPLEX |
1 |
|
| FORADIL AEROLIZER |
2 |
QL |
| FOSAMAX |
3 |
PA |
| FOSAMAX PLUS D |
2 |
|
| FOSINOPRIL SODIUM |
1 |
|
| FOSINOPRIL SODIUM/HYDROCHLO |
1 |
|
| FOSRENOL |
2 |
|
| FRAGMIN |
3 |
PA, QL |
| FREESTYLE TEST STRIP AND LANCETS |
1 |
|
| FREESTYLE LITE TEST STRIP AND LANCETS |
1 |
|
| FROVA |
3 |
ST, QL |
| FURADANTIN |
2 |
|
| FUROSEMIDE |
1 |
|
| GABAPENTIN |
1 |
|
| GABITRIL |
3 |
|
| GALANTAMINE ER |
1 |
|
| GARDASIL INJ UD |
$0 |
|
| GASTROCROM CON |
1 |
|
| GELCLAIR |
1 |
QL |
| GEMFIBROZIL |
1 |
|
| GENOTROPIN |
3 |
|
| GENTAK |
1 |
|
| GENTAMICIN |
1 |
QL |
| GENTAMICIN SULFATE |
1 |
|
| GEODON |
2 |
|
| GIANVI |
1 |
|
| GILENYA |
3 |
PA |
| GLIMEPIRIDE |
1 |
|
| GLIPIZIDE |
1 |
|
| GLIPIZIDE ER |
1 |
|
| GLIPIZIDE XL |
1 |
|
| GLUCAGON EMERGENCY KIT KIT 1MG UD |
2 |
|
| GLUCOPHAGE XR |
3 |
|
| GLUCOTROL XL |
3 |
|
| GLUCOVANCE |
3 |
|
| GLUMETZA |
2 |
PA |
| GLUTOSE |
NC |
OTC |
| GLYBURIDE |
1 |
|
| GLYBURIDE MICRONIZED |
3 |
|
| GLYBURIDE/METFORMIN HCL |
1 |
|
| GLYCOLAX |
NC |
|
| GLYCOPYRROLATE |
1 |
|
| GOLYTELY |
1 |
|
| GONAL-F INJ 1200IU |
3 |
|
| GONAL-F RFF PEN INJ 900 |
3 |
|
| GRANISETRON HCL |
1 |
|
| GRIFULVIN-V |
3 |
|
| GUANFACINE HCL |
1 |
|
| GYNAZOLE-1 |
1 |
|
| HALFLYTELY BOWEL PREP |
2 |
|
| HALOBETASOL PROP. |
1 |
QL |
| HALOPERIDOL |
1 |
|
| HALOPERIDOL DECANOATE INJ |
$0 |
|
| HELIDAC MIS |
NC |
PA, ST |
| HEMATOGEN |
3 |
|
| HEPARIN SODIUM INJ 5000U/ML |
1 |
|
| HEPSERA |
2 |
|
| HIBICLENS |
NC |
QL |
| HIPREX; |
3 |
|
| HUMALOG Vial |
2 |
|
| HUMALOG MIX PEN |
3 |
|
| HUMALOG MIX Vial |
2 |
|
| HUMALOG PEN |
3 |
|
| HUMATROPE |
3 |
|
| HUMIRA |
2 |
|
| HUMULIN 70/30 Vial |
1 |
|
| HUMULIN R U-500 |
1 |
|
| HUMULIN-N U-100 INJ |
1 |
|
| HUMULIN-N U-100 PEN |
3 |
|
| HYALGAN |
$0 |
QL |
| HYDRALAZINE HC |
1 |
|
| HYDRO 40 FOAM |
3 |
PA, QL |
| HYDROCHLOROTHIAZIDE |
1 |
|
| HYDROCODONE/ACETAMINOPHEN |
1 |
|
| HYDROCODONE/HOMATROPINE |
1 |
|
| HYDROCODONE/IBUPROFEN |
1 |
|
| HYDROCORTISONE |
1 |
QL |
| HYDROCORTISONE 1% CREAM |
NC |
QL, OTC |
| HYDROCORTISONE BUTYRATE |
1 |
QL |
| HYDROCORTISONE |
1 |
|
| HYDROCORTISONE VALERATE |
1 |
QL |
| HYDROCORTISONE/IODO CRM |
1 |
QL |
| HYDROMET SYP 5-1.5/5 |
1 |
|
| HYDROMORPHONE HCL |
1 |
|
| HYDROQUINONE |
NC |
|
| HYDROQUINONE/SUNSCREENS |
NC |
|
| HYDROXYCHLOROQUINE |
1 |
|
| HYDROXYUREA |
1 |
QL |
| HYDROXYZINE HCL |
1 |
|
| HYDROXYZINE PAMOATE |
1 |
|
| HYOMAX-SR |
3 |
|
| HYOSCYAMINE SULFATE IR/HYOS |
1 |
|
| HYPERCARE |
1 |
QL |
| HYPER-SAL NEB UD |
1 |
|
| HYTRIN |
3 |
|
| HYZAAR |
3 |
PA |
| IBUPROFEN |
1 |
|
| IMDUR |
3 |
|
| IMITREX |
3 |
PA, ST, QL |
| IMURAN |
$0 |
|
| INCIVEK |
2 |
PA |
| INDAPAMIDE |
1 |
|
| INDERAL LA |
3 |
|
| INDOMETHACIN |
1 |
|
| INDOMETHACIN ER |
1 |
|
| INNOHEP INJ 20000/ML |
3 |
|
| INOVA PAD |
3 |
ST, QL |
| INSPRA TAB |
3 |
|
| INTAL INHALER |
2 |
QL |
| INTRON-A INJ |
2 |
PA, QL |
| INVEGA |
3 |
PA, ST |
| IPRATROPIUM |
1 |
QL |
| IPRATROPIUM /ALBUTER |
1 |
QL |
| IPRATROPIUM BROMIDE SPR |
1 |
QL |
| IRESSA |
2 |
PA, QL |
| ISENTRESS |
2 |
|
| ISOMETHEPTENE/DICHLORALPHEN |
1 |
|
| ISONIAZID |
$0 |
|
| ISOPTIN SR |
3 |
|
| ISOPTO HOMATROPINE |
1 |
|
| ISOPTO HYOSCINE |
1 |
|
| ISORDIL TITRADOSE |
3 |
PA |
| ISOSORBIDE DINITRATE TA |
1 |
|
| ISOSORBIDE MONONITRATE ER |
1 |
|
| ISRADIPINE |
1 |
|
| ISTALOL |
3 |
|
| ITRACONAZOLE |
1 |
|
| JANUMET |
2 |
|
| JANUVIA |
2 |
|
| JOLESSA |
1 |
|
| JUNEL FE |
1 |
|
| KADIAN |
3 |
|
| KALETRA |
2 |
|
| KAON-CL-10 |
1 |
|
| KAPIDEX |
3 |
ST |
| KARIVA 28 DAY |
1 |
|
| K-EFFERVESCENT |
1 |
|
| KENALOG-10 INJ |
$0 |
|
| KEPPRA |
3 |
|
| KERAFOAM |
3 |
PA, QL |
| KERALAC |
3 |
PA, QL |
| KERALYT |
2 |
QL |
| KEROL EMU |
3 |
PA, QL |
| KETEK PAK |
2 |
|
| KETOCONAZOLE CREAM |
1 |
QL |
| KETOCONAZOLE TAB |
1 |
|
| KETOPROFEN |
1 |
|
| KETOROLAC TROMETHAMINE |
1 |
QL |
| KINERASE |
2 |
PA, QL |
| KLARON |
3 |
PA, ST, QL |
| KLONOPIN |
3 |
|
| KLONOPIN WAFERS |
3 |
PA, ST |
| KLOR-CON |
1 |
|
| KLOR-CON /EF |
1 |
|
| KLOR-CON-8 |
1 |
|
| KRISTALOSE PAK |
3 |
|
| K-TABS |
1 |
|
| LABETALOL HCL |
1 |
|
| LAC-HYDRIN |
NC |
OTC |
| LACTIC ACID |
1 |
QL |
| LACTIC ACID E |
1 |
QL |
| LACTINOL |
3 |
QL |
| LACTINOL-E |
3 |
QL |
| LACTULOSE |
1 |
|
| LAMICTAL |
3 |
|
| LAMICTAL ODT |
2 |
|
| LAMICTAL STARTER/NOT TAKING KIT |
3 |
PA |
| LAMICTAL XR |
2 |
|
| LAMOTRIGINE |
1 |
|
| LANOXIN |
1 |
|
| LANSOPRAZOLE 15 MG |
1 |
|
| LANSOPRAZOLE 30 MG |
1 |
|
| LANTANOPROST |
1 |
|
| LANTUS INJ 100U/ML |
2 |
|
| LANTUS SOLOSTAR INJ SOLOSTAR |
3 |
|
| LASIX |
3 |
|
| LAVOCLEN-4 CREAMY WASH LIQ CREM WSH |
3 |
QL |
| LAVOCLEN-8 CREAMY WASH LIQ CREM WSH |
3 |
QL |
| LAZERFORMALYDE |
2 |
QL |
| LEFLUNOMIDE |
1 |
|
| LESCOL |
3 |
QL |
| LESCOL XL |
3 |
ST, QL |
| LESSINA |
1 |
ST, QL |
| LEUCOVORIN |
1 |
QL |
| LEUKERAN |
1 |
|
| LEUKINE INJ |
2 |
PA, QL |
| LEUPROLIDE |
1 |
|
| LEVAQUIN |
2 |
|
| LEVBID |
2 |
|
| LEVEMIR INJ |
2 |
|
| LEVEMIR INJ FLEXPEN |
3 |
|
| LEVETIRACETAM |
1 |
|
| LEVITRA |
3 |
QL |
| LEVLITE-28 |
1 |
|
| LEVOBUNOLOL HCL |
1 |
|
| LEVORA |
1 |
|
| LEVOTHROID |
3 |
|
| LEVOTHYROXINE SODIUM INJ |
$0 |
|
| LEVOTHYROXINE SODIUM TAB |
1 |
|
| LEVSIN |
2 |
|
| LEXAPRO |
2 |
PA, ST |
| LIALDA |
3 |
|
| LIDAMANTLE |
2 |
QL |
| LIDAZONE HC |
1 |
QL |
| LIDEX |
3 |
PA, QL |
| LIDOCAINE HCL |
1 |
QL |
| LIDOCAINE VISCOUS |
1 |
QL |
| LIDOCAINE/PRILOCAINE |
1 |
QL |
| LIDODERM DIS |
2 |
QL |
| LIMBREL |
3 |
PA |
| LINDANE |
3 |
QL |
| LIPITOR |
2 |
|
| LISINOPRIL |
1 |
|
| LISINOPRIL/HYDROCHLOROTHIAZ |
1 |
|
| LITHIUM CARBONATE |
1 |
|
| LITHIUM CARBONATE ER |
1 |
|
| LITHOBID |
3 |
|
| LOCOID |
3 |
QL |
| LOCOID LIPOCREAM |
3 |
PA, ST, QL |
| LOESTRIN 24 FE |
3 |
|
| LOESTRIN FE 1/20 |
3 |
|
| LOFIBRA |
3 |
|
| LOPERAMIDE HCL |
NC |
|
| LOPROX GEL |
3 |
PA, ST, QL |
| LOPROX SHAMPOO |
3 |
PA, ST, QL |
| LORATADINE |
NC |
|
| LORAZEPAM |
1 |
T |
| LOSARTAN |
1 |
|
| LOSARTAN/ HCTZ |
1 |
|
| LOTEMAX |
3 |
|
| LOTENSIN |
3 |
|
| LOTENSIN HCT |
3 |
|
| LOTREL |
3 |
|
| LOVASTATIN |
1 |
QL |
| LOVAZA |
3 |
QL |
| LOVENOX INJ |
2 |
QL |
| LOW OGESTREL |
1 |
|
| LUGOL'S SOL |
1 |
|
| LUGOL'S SOL BP |
1 |
|
| LUMIGAN SOL 0.03% |
2 |
|
| LUNESTA |
3 |
ST, QL |
| LUPRON DEPOT |
3 |
|
| LUSTRA |
NC |
QL |
| LUSTRA-ULTRA |
NC |
QL |
| LUVERIS INJ 75UNIT UD |
3 |
|
| LUVOX CR |
3 |
|
| LUXIQ |
3 |
PA, QL |
| LYRICA |
2 |
|
| MACRODANTIN |
3 |
|
| MAG-OX 400 |
NC |
OTC |
| MALARONE |
3 |
T |
| MARPLAN TAB |
3 |
|
| MAXAIR AUTOHALER |
3 |
PA, QL |
| MAXALT |
2 |
QL |
| MAXZIDE-25 |
3 |
|
| MEBENDAZOLE |
2 |
|
| MEDERMA GEL |
2 |
QL |
| MEDROXYPROG INJ |
1 |
|
| MEFENAMIC ACID |
1 |
|
| MEFLOQUINE HCL |
3 |
T |
| MEGACE |
3 |
|
| MEGESTROL ACETATE |
1 |
|
| MELOXICAM |
1 |
|
| MENEST |
2 |
|
| MENOPUR INJ 75UNIT UD |
3 |
|
| MENOSTAR DIS |
3 |
|
| MENTAX |
3 |
PA, ST, QL |
| MEPERIDINE HCL |
1 |
|
| MEPHYTON |
1 |
|
| MEPRON |
2 |
|
| MERCAPTOPURINE |
1 |
|
| MESALAMINE ENE |
1 |
|
| MESTINON |
2 |
|
| METADATE CD |
3 |
PA |
| METADATE ER |
3 |
|
| METANX |
3 |
|
| METFORMIN HCL |
1 |
|
| METHADONE HCL |
1 |
|
| METHADOSE |
1 |
|
| METHAZOLAMIDE |
1 |
|
| METHENAMINE HIP |
1 |
|
| METHENAMINE MAN E |
1 |
|
| METHERGINE |
1 |
|
| METHIMAZOLE |
1 |
|
| METHOCARBAMOL |
1 |
|
| METHOTREXATE |
1 |
|
| METHYLDOPA |
1 |
|
| METHYLIN ER |
1 |
|
| METHYLIN SOL |
2 |
|
| METHYLIN TAB |
1 |
|
| METHYLPREDNISOLONE PAK |
1 |
|
| METHYLPREDNISOLONE SODIUMSU INJ |
$0 |
|
| METHYLPREDNISOLONE TAB |
1 |
|
| METHYLTESTOSTERONE/ESTE |
1 |
|
| METOCLOPRAMIDE |
1 |
|
| METOCLOPRAMIDE HCL |
1 |
|
| METOLAZONE |
1 |
|
| METOPROLOL |
1 |
|
| METOPROLOL/HYDROCHLOROTHIAZ |
1 |
|
| METROGEL GEL |
3 |
QL |
| METRONIDAZOLE TABLETS |
1 |
QL |
| MEXILETINE HCL |
1 |
|
| MIACALCIN |
2 |
|
| MICARDIS |
3 |
|
| MICARDIS HCT |
3 |
|
| MICROGESTIN FE |
1 |
|
| MIDODRINE HCL |
1 |
|
| MIDRIN |
3 |
|
| MIMYX |
2 |
PA, QL |
| MINITRAN DIS |
1 |
|
| MINOCIN |
3 |
PA |
| MINOCYCLINE HCL |
1 |
|
| MINOXIDIL |
1 |
|
| MIRAPEX |
3 |
|
| MIRCETTE 28 |
3 |
|
| MIRENA IUD SYSTEM |
2 |
|
| MIRTAZAPINE |
1 |
|
| MISOPROSTOL |
1 |
|
| MOBIC |
3 |
|
| MODICON 28 |
3 |
|
| MOEXIPRIL HCL |
1 |
|
| MOEXIPRIL/HYDROCHLOROTHIAZI |
1 |
|
| MOMETASONE FUROATE |
1 |
QL |
| MONOPRIL |
3 |
|
| MORPHINE SULFATE |
1 |
|
| MOTRIN TAB |
3 |
PA |
| MOVIPREP |
2 |
|
| M-OXY |
1 |
|
| MULTAQ |
3 |
|
| MULTI VITA-BETS/FLUORIDE |
1 |
|
| MULTIGEN |
2 |
|
| MUPIROCIN |
1 |
QL |
| MUSE |
3 |
PA, QL |
| MYAMBUTOL |
1 |
|
| MYCOPHENOLATE |
$0 |
|
| MYDRIACYL |
3 |
|
| MYFORTIC |
$0 |
|
| NA BICARBONATE |
1 |
|
| NABUMETONE |
1 |
|
| NADOLOL |
1 |
|
| NAFTIN |
3 |
ST, QL |
| NALTREXONE HCL |
1 |
|
| NAMENDA |
2 |
|
| NAMENDA TITRATION PAK |
3 |
|
| NAPROXEN EC |
1 |
|
| NARDIL |
2 |
|
| NASACORT-AQ |
3 |
ST, QL |
| NASCOBAL |
3 |
PA, ST |
| NASONEX |
2 |
QL |
| NECON 1/35 |
1 |
|
| NECON 7/7/7 |
1 |
|
| NEFAZODONE HCL |
1 |
|
| NEO/POLY/CORT |
1 |
|
| NEOBENZ MICRO |
3 |
PA, ST |
| NEOCATE |
2 |
|
| NEOMYCIN SULFATE |
1 |
|
| NEOMYCIN/POLYMIXIN/DEXAMETH |
1 |
|
| NEOMYCIN/POLYMYXIN/GRAMICID |
1 |
|
| NEOMYCIN/POLYMYXIN/HC |
1 |
|
| NEOMYCIN/POLYMYXIN/HYDROCOR |
1 |
|
| NEORAL |
$0 |
|
| NEULASTA INJ 6MG/0.6M |
2 |
PA, QL |
| NEUPOGEN PFS |
2 |
PA, QL |
| NEUPRO DIS |
2 |
PA |
| NEURONTIN |
3 |
|
| NEUTRA-PHOS |
3 |
|
| NEUTRA-PHOS-K |
3 |
|
| NEVANAC |
3 |
|
| NEXIUM |
3 |
ST |
| NIASPAN |
2 |
QL |
| NICOTINAMIDE W/ZINC OXIDE/C |
3 |
PA |
| NICOTINE POLACRILEX GUM |
NC |
OTC |
| NICOTINE TRANSDERMAL SYSTEM |
NC |
OTC |
| NICOTROL INHALER |
3 |
PA |
| NIFEDICAL XL |
1 |
|
| NIFEDIPINE |
1 |
|
| NIFEDIPINE ER |
1 |
|
| NIFEREX GOLD |
2 |
|
| NIFEREX-150 |
2 |
|
| NIFEREX-150 FORTE |
2 |
|
| NILANDRON |
2 |
|
| NITROBID |
2 |
|
| NITRO-DUR DIS |
3 |
|
| NITROFURAN MACROCRYSTAL |
1 |
|
| NITROFURANN MONOHY |
1 |
|
| NITROFURIN MACROCRYSTAL |
1 |
|
| NITROGLYCERIN TRANSDERMAL |
1 |
|
| NITROLINGUAL PUMPSPRAY |
3 |
ST |
| NITROSTAT SUB |
1 |
|
| NIZATIDINE CAP |
1 |
|
| NORITATE |
3 |
QL |
| NORPACE CR |
3 |
|
| NORPRAMIN |
3 |
PA, ST |
| NOR-BE |
1 |
|
| NORTREL 0.5/35 |
1 |
|
| NORTREL 1/35 |
1 |
|
| NORTREL 7/7/7 |
1 |
|
| NORTRIPTYLINE HCL |
1 |
|
| NORVASC |
3 |
|
| NORVIR |
2 |
|
| NOVAREL INJ 10000U |
3 |
|
| NOVOLIN-70/30 VIALS |
1 |
|
| NOVOLIN-70/30 PEN |
3 |
|
| NOVOLIN-N U-100 VIALS |
1 |
|
| NOVOLIN-N U-100 PEN |
3 |
|
| NOVOLIN-R U-100 VIALS |
1 |
|
| NOVOLIN-R U-100 PEN |
3 |
|
| NOVOLOG INJ 100U/ML |
2 |
|
| NOVOLOG INJ FLEXPEN |
3 |
|
| NOVOLOG MIX 70/30 |
2 |
|
| NOVOLOG MIX 70/30 PREFILLED INJ SYRINGE |
3 |
|
| NULYTELY |
3 |
|
| NUQUIN HP |
1 |
QL |
| NUTRINATE |
3 |
|
| NUTROPIN |
3 |
|
| NUVARING MIS |
2 |
|
| NUVIGIL |
2 |
|
| NYSTATIN CREAM |
1 |
QL |
| NYSTATIN SUSPENSION |
1 |
QL |
| NYSTATIN TABLETS |
1 |
|
| NYSTATIN/TRIAMCINOLONE |
1 |
QL |
| NYSTOP |
1 |
QL |
| OCELLA |
1 |
|
| OFLOXACIN |
1 |
|
| OGESTREL |
1 |
|
| OLANZIPINE |
1 |
|
| OLUX AER |
3 |
PA, ST, QL |
| OMEPRAZOLE |
1 |
|
| OMNARIS SPR |
3 |
ST, QL |
| OMNICEF |
3 |
|
| OMNITROPE |
3 |
|
| ONDANSETRON |
1 |
|
| ONE TOUCH TEST STRIPS |
3 |
PA, QL |
| ONETOUCH |
3 |
PA, QL |
| OPANA |
3 |
|
| OPANA ER |
3 |
|
| OPTIHALER MIS |
3 |
PA |
| OPTIVAR DRO |
3 |
|
| ORACEA |
3 |
QL |
| ORAPRED ODT TAB |
2 |
|
| ORAPRED SOL 15MG/5ML |
3 |
|
| ORPHENADRINE CITRATE ER |
1 |
|
| ORTHO DIAPHRAGM ALL-FLEX DPR KIT |
3 |
|
| ORTHO EVRA DIS 24HR |
3 |
|
| ORTHO TRI-CYCLEN |
3 |
|
| ORTHO TRI-CYCLEN LO |
2 |
|
| ORTHO-CEPT 28 |
3 |
|
| ORTHO-CYCLEN |
3 |
|
| ORTHO-NOVUM |
3 |
|
| ORTHOVISC INJ 15MG/ML UD |
3 |
QL |
| OSCION CLEANSER |
2 |
ST, QL |
| OSMOPREP |
2 |
|
| OVCON-35 |
3 |
|
| OVIDE |
2 |
QL |
| OVIDREL INJ UD |
3 |
|
| OXAPROZIN |
1 |
|
| OXAZEPAM |
1 |
|
| OXCARBAZEPINE |
1 |
|
| OXISTAT |
2 |
PA, QL |
| OXSORALEN LOT 1% |
2 |
PA, QL |
| OXSORALEN ULTRA CAP 10MG |
3 |
PA, QL |
| OXYBUTYNIN |
1 |
|
| OXYBUTYNIN ER |
1 |
|
| OXYCODONE HCL |
1 |
|
| OXYCODONE/ACETAMINOPHEN |
1 |
|
| OXYCONTIN |
2 |
|
| OXYTROL |
3 |
|
| PAMELOR |
3 |
PA, ST |
| PANCREAZE |
2 |
|
| PANDEL |
3 |
QL |
| PANTOPRAZOLE SODIUM |
1 |
ST |
| PARAGARD INTRAUTERINE COPPE IUD |
2 |
|
| PARI TREK COMBO PAK |
NC |
|
| PARI TREK S COMPACT COMPRESS |
NC |
PA |
| PARI TREK S PORTABLE POWER KIT POWER |
NC |
PA |
| PARLODEL |
3 |
|
| PAROMOMYCIN SULFATE |
1 |
|
| PAROXETINE ER |
1 |
|
| PAROXETINE HCL |
1 |
|
| PATADAY SOL |
3 |
PA |
| PATANASE |
3 |
PA, QL |
| PATANOL |
3 |
PA |
| PAXIL |
3 |
|
| PEGASYS INJ 180MCG/M UD |
2 |
|
| PEGASYS KIT |
2 |
|
| PEG-INTRON KIT |
2 |
|
| PEG-INTRON REDIPEN PAK 4 KIT 80MCG RP UD |
2 |
|
| PENICILLIN V POTASSIUM |
1 |
|
| PENTASA |
2 |
|
| PENTAZOCINE/ACETAMINOPHEN |
1 |
|
| PENTOXIFYLLINE ER |
1 |
|
| PEPCID SUS 40MG/5ML |
3 |
|
| PEPCID TAB 40MG |
3 |
PA |
| PERCOCET |
3 |
|
| PERIDEX RINSE |
3 |
QL |
| PERMAX |
2 |
|
| PERMETHRIN |
1 |
QL |
| PERPHENAZINE |
1 |
|
| PHENOBARBITAL |
1 |
|
| PHENTERMINE HCL |
1 |
|
| PHENYLEPHRINE |
1 |
|
| PHENYTEK |
1 |
|
| PHENYTOIN |
1 |
|
| PHOS FLUR |
1 |
QL |
| PHOSLO |
2 |
|
| PHOS-NAK |
1 |
|
| PILOCARPINE HCL |
1 |
|
| PILOPINE HS |
3 |
|
| PINDOLOL |
1 |
|
| PIROXICAM |
1 |
|
| PLAVIX |
2 |
|
| PLENDIL |
3 |
|
| PLEXION |
3 |
QL |
| POLYETHYLENE GLYCOL |
NC |
|
| POLY-VI-FLOR DROPS |
3 |
|
| POLY-VITAMIN/FLUORIDE |
1 |
|
| POLY-VITAMIN/IRON/FLUORIDE DRO |
1 |
|
| PONSTEL |
3 |
|
| PORTIA-28 |
1 |
|
| POTASSIUM CHLORIDE |
1 |
|
| POTASSIUM CHLORIDE ER |
1 |
|
| PRADAXA |
3 |
PA |
| PRAMOSONE |
1 |
QL |
| PRANDIN |
2 |
|
| PRASCION EMU |
1 |
QL |
| PRAVACHOL |
3 |
QL |
| PRAVASTATIN SODIUM |
1 |
QL |
| PRAZOSIN HCL |
1 |
|
| PRECARE CHW |
3 |
|
| PRECARE PREMIER |
3 |
|
| PRED FORTE |
3 |
|
| PRED MILD |
3 |
|
| PRED-G |
3 |
|
| PRED-G-S.O.P. |
3 |
|
| PREDNICARBATE |
1 |
QL |
| PREDNISOLONE |
1 |
|
| PREDNISOLONE ACETATE |
1 |
|
| PREDNISOLONE SODIUM PHOSPHA |
1 |
|
| PREDNISONE |
1 |
|
| PREMARIN |
3 |
|
| PREMARIN W/APP CREAM |
2 |
|
| PREMPHASE |
3 |
|
| PREMPRO |
3 |
|
| PRENATAL 19 |
1 |
|
| PRENATAL PLUS |
1 |
|
| PRENATAL S |
1 |
|
| PRENATE DHA |
3 |
|
| PRENATE ELITE |
3 |
PA |
| PRESISTA |
2 |
|
| PREVACID |
3 |
ST |
| PREVACID SOLUTAB |
3 |
ST |
| PREVACID-DR |
3 |
ST |
| PREVALITE |
1 |
|
| PREVIDENT |
3 |
PA, QL |
| PREVIFEM |
1 |
|
| PREVPAC |
NC |
PA, ST |
| PRILOSEC |
NC |
ST |
| PRIMACARE ONE |
3 |
|
| PRIMAQUINE PHOSPHATE |
3 |
|
| PRIMIDONE |
1 |
|
| PRINIVIL |
3 |
|
| PRINZIDE |
3 |
|
| PRISTIQ |
3 |
|
| PROAMATINE |
3 |
|
| PROBENECID |
1 |
|
| PROCAINAMIDE HCL |
1 |
|
| PROCARDIA |
3 |
|
| PROCARDIA XL |
3 |
|
| PROCHLORPERAZINE |
1 |
|
| PROCRIT INJ 2000U/ML UD |
2 |
PA, QL |
| PROCTOFOAM-HC AER |
3 |
QL |
| PROCTOFOAM-NS AER |
3 |
QL |
| PROCTOZONE-HC |
1 |
QL |
| PROGESTERONE IN OIL |
3 |
|
| PROGRAF |
$0 |
|
| PROGUANIL |
1 |
T |
| PROMETHAZINE/CODEINE |
1 |
|
| PROMETRIUM |
2 |
|
| PRONEB ULTRA II ADULT |
$0 |
|
| PRONEB ULTRA II PEDI |
$0 |
|
| PROPAFENONE HCL |
1 |
|
| PROPANTHELINE |
1 |
|
| PROPARACAINE HCL |
1 |
|
| PROPECIA |
NC |
QL |
| PROPIMEX-2 |
2 |
|
| PROPRANOLOL |
1 |
|
| PROSCAR |
3 |
|
| PROSED EC |
3 |
|
| PROTOPIC |
2 |
PA, QL |
| PROVENTIL AER HFA |
3 |
QL |
| PROVIGIL |
2 |
|
| PROZAC |
3 |
|
| PROZAC WEEKLY |
3 |
PA, ST |
| PRUDOXIN |
2 |
PA, ST, QL |
| PSORCON E |
3 |
PA, ST, QL |
| PULMICORT FLEXHALER |
2 |
QL |
| PULMOZYME |
2 |
|
| PURALUBE TEARS |
1 |
|
| PYRAZINAMIDE |
$0 |
|
| PYRIDOSTIGMINE |
1 |
|
| PYRIDOXINE |
$0 |
|
| QUASENSE |
1 |
|
| QUALAQUIN |
2 |
|
| QUESTRAN LIGHT |
3 |
|
| QUINAPRIL HCL |
1 |
|
| QUINAPRIL/HYDROCHLOROTHIAZI |
1 |
|
| QUINIDINE SULFATE |
1 |
|
| QUIXIN |
3 |
|
| QVAR AER |
2 |
QL |
| RABAVERT INJ UD |
$0 |
|
| RAMIPRIL |
1 |
|
| RANEXA |
3 |
PA |
| RANITIDINE HCL |
1 |
|
| RAPAMUNE |
$0 |
|
| RAZADYNE |
3 |
|
| RE-SA |
2 |
QL |
| REBIF |
2 |
|
| RECLAST |
$0 |
|
| RECLIPSEN |
1 |
|
| RELENZA DISKHALER |
2 |
|
| RELPAX |
3 |
ST, QL |
| REMERON |
3 |
|
| REMINYL |
2 |
|
| RENAGEL |
2 |
|
| RENAL CAP SOFTGEL |
3 |
PA |
| RENA-VITE |
1 |
|
| RENAX |
2 |
|
| RENOVA |
NC |
QL |
| RENVELA |
2 |
|
| REPRONEX INJ 75IU UD |
3 |
|
| REQUIP XL |
2 |
|
| RESERPINE |
1 |
|
| RESTASIS EMU |
3 |
|
| RESTORIL |
3 |
|
| RETIN-A |
3 |
QL |
| RETIN-A MICRO |
3 |
PA, ST, QL |
| RETROVIR |
3 |
|
| REVATIO |
3 |
QL |
| REVLIMID CAP |
3 |
PA |
| REYATAZ |
2 |
|
| RHINOCORT AQUA |
2 |
PA, ST, QL |
| RIBAPAK TAB 800/DAY |
2 |
|
| RIBAVIRIN TAB 200MG |
1 |
|
| RIFADIN CAP |
2 |
|
| RIFAMPIN CAP 150MG |
1 |
|
| RILUTEK |
2 |
|
| RIMANTADINE HCL |
1 |
|
| RIMSO-50 |
3 |
|
| RISPERDAL |
3 |
|
| RISPERDAL CONSTA INJ |
$0 |
PA |
| RISPERDAL M-TAB |
3 |
|
| RISPERIDONE |
1 |
|
| RITALIN |
3 |
|
| RITALIN LA |
3 |
ST |
| ROPINIROLE HCL |
1 |
|
| ROSAC |
3 |
QL |
| ROSADERM EMU CLEANSER |
1 |
QL |
| ROSANIL CLEANSER EMU |
3 |
ST, QL |
| ROSULA |
3 |
PA, ST, QL |
| ROXICET |
1 |
|
| ROXICODONE |
1 |
|
| ROZEREM |
3 |
PA, ST, QL |
| RYTHMOL SR |
3 |
|
| SALAGEN |
2 |
PA, QL |
| SALEX |
3 |
QL |
| SALSALATE |
1 |
|
| SANCTURA |
3 |
|
| SANCTURA XR |
3 |
|
| SANDOSTATIN INJ 0.1MG/ML |
$0 |
|
| SANDOSTATIN LAR DEPOT KIT LAR 30MG UD |
$0 |
|
| SANTYL |
2 |
QL |
| SAPHRIS |
3 |
|
| SARNA LOT |
NC |
QL |
| SEASONALE |
3 |
QL |
| SEASONIQUE |
3 |
QL |
| SELEGILINE HCL |
1 |
|
| SELENIUM SULFIDE LOTION |
1 |
QL |
| SELENIUM SULFIDE SHA |
3 |
PA, ST, QL |
| SENSIPAR |
2 |
PA |
| SEREVENT MIS |
2 |
QL |
| SEROQUEL |
2 |
|
| SEROQUEL XR |
2 |
|
| SERTRALINE HCL |
1 |
|
| SF 5000 PLUS |
1 |
QL |
| SILVER NITRATE |
1 |
QL |
| SIMCOR |
2 |
|
| SIMVASTATIN |
1 |
QL |
| SINGULAIR |
2 |
|
| SKELAXIN |
3 |
ST |
| SODIUM CHLORIDE INJ 0.9% UD |
$0 |
|
| SODIUM FLUORIDE |
1 |
|
| SODIUM SULFACETAMIDE |
1 |
QL |
| SODIUM SULFACETAMIDE AND SU EMU SULFUR |
1 |
QL |
| SODIUM SULFACETAMIDE/SULFUR |
1 |
QL |
| SOLODYN |
3 |
PA, ST |
| SOLU-CORTEF INJ 100MG UD |
$0 |
|
| SOLU-MEDROL INJ 1000MG UD |
$0 |
|
| SOLU-MEDROL INJ 40MG UD |
$0 |
|
| SOLU-MEDROL-ACT-O-VIAL INJ 1000MG |
$0 |
|
| SOMA |
3 |
|
| SONATA CAP |
3 |
ST, QL |
| SORBITOL |
1 |
|
| SORIATANE CK KIT |
3 |
PA, QL |
| SOTALOL HCL |
1 |
|
| SPIRIVA |
2 |
QL |
| SPIRONOLACTONE |
1 |
|
| SPIRONOLACTONE/HYDROCHLOROT |
1 |
|
| SPRINTEC |
1 |
|
| SRONYX |
1 |
|
| SSKI |
1 |
|
| STALEVO |
2 |
|
| STARLIX |
2 |
|
| STAVUDINE |
1 |
|
| STRATTERA |
2 |
|
| STROMECTOL |
2 |
|
| STRONGSTART CHW |
3 |
|
| SUBOXONE SUB |
2 |
|
| SUBUTEX SUB |
2 |
|
| SUCRALFATE |
1 |
|
| SULFACETAMIDE SODIUM OIN |
1 |
|
| SULFACETAMIDE SODIUM |
1 |
|
| SULFACETAMIDE SODIUM/SULFUR |
1 |
QL |
| SULFACET-R LOT TINT-FRE |
3 |
QL |
| SULFADIAZINE |
1 |
|
| SULFAMETHOXAZOLE/TRIMETHOPR |
1 |
|
| SULFASALAZINE |
1 |
|
| SULFATOL |
3 |
QL |
| SULFAZINE EC |
1 |
|
| SULFUR SUBLIMED |
1 |
QL |
| SULINDAC |
1 |
|
| SUMATRIPTAN |
1 |
QL |
| SUPARTZ INJ 25MG UD |
$0 |
QL |
| SUPRAX |
2 |
|
| SUSTIVA |
2 |
|
| SUTENT |
2 |
PA, QL |
| SYMAX FASTABS |
3 |
PA |
| SYMBICORT |
2 |
QL |
| SYMLIN INJ 0.6MG/ML |
2 |
|
| SYNALAR |
3 |
QL |
| SYNTHROID |
1 |
|
| SYNVISC INJ 8MG/ML UD |
$0 |
PA, QL |
| SYPRINE |
2 |
PA |
| TACLONEX OIN |
2 |
PA, QL |
| TAMIFLU |
2 |
|
| TAMOXIFEN CITRATE |
1 |
|
| TAMSOLUSIN |
1 |
|
| TARCEVA |
3 |
PA |
| TAZORAC |
2 |
PA, QL |
| TEGRETOL |
3 |
|
| TEGRETOL-XR |
2 |
|
| TEKTURNA |
2 |
|
| TEKTURNA HTC |
2 |
|
| TEMAZEPAM |
1 |
|
| TEMODAR |
2 |
|
| TENORMIN |
3 |
PA |
| TERAZOSIN HCL |
1 |
|
| TERBINAFINE HCL |
1 |
|
| TERBUTALINE SULFATE |
1 |
|
| TERCONAZOLE |
1 |
|
| THALOMID |
2 |
PA, QL |
| THEOPHYLLINE ER |
1 |
|
| THERMAZENE |
1 |
QL |
| THEROBEC TAB PLUS |
1 |
|
| THIOTHIXENE |
1 |
|
| THYROID |
1 |
|
| TIAZAC |
3 |
|
| TICLOPIDINE HCL |
1 |
|
| TILIA FE |
1 |
|
| TIMOLOL MALEATE OP |
1 |
|
| TIMOLOL OP |
1 |
|
| TIMOPTIC |
3 |
|
| TIMOPTIC-XE OP |
2 |
|
| TINDAMAX |
2 |
|
| TIZANIDINE HCL |
1 |
|
| TOBI NEB 300/5ML |
2 |
|
| TOBRADEX |
3 |
|
| TOBRAMYCIN SULFATE |
1 |
|
| TOBREX |
3 |
PA |
| TOLBUTAMIDE |
1 |
|
| TOLMETIN SODIUM |
1 |
|
| TOPAMAX |
3 |
|
| TOPROL XL |
3 |
|
| TORSEMIDE |
1 |
|
| TOVIAZ |
2 |
|
| TRAMADOL HCL |
1 |
|
| TRAMADOL HYDROCHLORIDE/ACET |
1 |
|
| TRANSDERM-SCOP DIS |
2 |
T |
| TRANYLCYPROMINE SULFATE |
1 |
|
| TRAVATAN |
2 |
|
| TRAVATAN Z |
2 |
|
| TRAZODONE HC |
1 |
|
| TRENTAL |
3 |
|
| TRETINOIN CRE |
1 |
QL |
| TRETINOIN EMOLLIENT |
NC |
QL |
| TRETINOIN GEL |
1 |
QL |
| TREXIMET |
3 |
PA, QL |
| TRIAMCINOLONE IN ORABASE |
1 |
QL |
| TRIAMTERENE/HYDROCHLOROTHIA |
1 |
|
| TRIAZ |
3 |
QL |
| TRIAZOLAM |
1 |
QL |
| TRICOR |
3 |
ST |
| TRIFLUOPERAZINE |
1 |
|
| TRIFLURIDINE |
1 |
|
| TRIGLIDE |
3 |
|
| TRIHEXYPHENIDYL HCL |
1 |
|
| TRI-LEGEST FE |
1 |
|
| TRILEPTAL |
3 |
|
| TRI-LO-SPRINTEC |
1 |
|
| TRI-LUMA |
NC |
QL |
| TRILYTE |
3 |
|
| TRIMETHOBENZAMIDE HCL |
1 |
|
| TRIMETHOPRIM |
1 |
|
| TRIMETHOPRIM SULFATE |
1 |
|
| TRI-PREVIFEM |
1 |
|
| TRI-SPRINTEC |
1 |
|
| TRI-VITAMIN/FLUORIDE |
1 |
|
| TRIVORA |
1 |
|
| TRIZIVIR |
2 |
|
| TROPICAMIDE |
1 |
|
| TRUVADA |
2 |
|
| TYKOSIN |
3 |
PA |
| TYLENOL/CODEINE #3 |
3 |
|
| ULORIC |
3 |
PA |
| ULTRA NATALCARE |
3 |
|
| ULTRACET |
3 |
|
| ULTRAM |
3 |
|
| ULTRAVATE |
3 |
QL |
| UMECTA EMU |
3 |
PA, ST, QL |
| UMECTA MOUSSE AER |
3 |
PA, QL |
| UMECTA NAIL FILM |
3 |
PA, ST, QL |
| UNIRETIC |
3 |
|
| UNIVASC |
3 |
|
| UREA |
1 |
QL |
| UREALAC LOTION |
1 |
QL |
| UREALAC NAIL GEL |
3 |
PA, QL |
| URIMAX |
3 |
|
| URISED |
1 |
|
| UROQID |
1 |
|
| URSO |
2 |
|
| URSO FORTE |
2 |
|
| URSODIOL |
1 |
|
| USEPT |
1 |
|
| VAGIFEM |
2 |
|
| VALACYCLOVIR |
1 |
|
| VALCYTE |
3 |
PA, ST, QL |
| VALPROIC |
1 |
|
| VALTREX |
3 |
|
| VALTURNA |
2 |
|
| VANCOCIN HCL |
2 |
|
| VANDAZOLE |
2 |
|
| VANIQA |
NC |
|
| VANOS |
3 |
PA, ST, QL |
| VASOTEC |
3 |
|
| VELIVET PAK |
3 |
|
| VENLAFAXINE ER CAP |
1 |
|
| VENLAFAXINE HCL |
1 |
|
| VENLAFAXINE ER TAB |
1 |
|
| VENTOLIN HFA AER |
1 |
QL |
| VEPESID |
3 |
PA, QL |
| VERAMYST |
2 |
ST, QL |
| VERAPAMIL HCL |
1 |
|
| VERELAN PM |
3 |
PA |
| VERELAN SR |
3 |
PA |
| VESICARE |
2 |
|
| VFEND |
2 |
|
| VIAGRA |
2 |
QL |
| VIBRAMYCIN |
3 |
|
| VICODIN ES |
3 |
|
| VICTOZA |
3 |
|
| VICTRELIS |
2 |
PA |
| VIGAMOX |
3 |
|
| VINATAL FORTE |
3 |
|
| VIRACEPT |
2 |
|
| VIRAMUNE |
2 |
|
| VIREAD |
2 |
|
| VISICOL |
2 |
|
| VISTARIL |
3 |
PA |
| VITAFOL-OB |
3 |
|
| VITAMIN D |
1 |
|
| VIVACTIL |
2 |
|
| VIVAGLOBIN |
|
|
| VIVELLE-DOT |
3 |
|
| VIVOTIF BERNA |
3 |
T |
| VOLTAREN GEL |
2 |
PA, QL |
| VOLTAREN SOL 0.1% OP |
3 |
PA |
| VOLTAREN TAB 75MG EC |
3 |
|
| VORTEX CHAMBER |
1 |
|
| VOSPIRE ER TAB 4MG |
2 |
QL |
| VYTORIN |
2 |
PA, QL |
| VYVANSE |
3 |
|
| WARFARIN SODIUM |
1 |
|
| WELCHOL |
3 |
|
| WELLBUTRIN |
3 |
|
| WELLBUTRIN XL |
3 |
|
| WELLBUTRIN-SR |
3 |
|
| XALATAN |
3 |
|
| XANAX |
3 |
PA, ST |
| XELODA |
2 |
QL |
| XENADERM |
2 |
QL |
| XENICAL |
NC |
OTC |
| XERAC AC |
1 |
QL |
| XIBROM |
3 |
PA |
| XIFAXAN |
3 |
T |
| XOLAIR |
2 |
PA |
| XOLEGEL |
3 |
PA, ST, QL |
| XOPENEX |
2 |
PA, QL |
| XYREM |
2 |
|
| XYZAL |
3 |
|
| YASMIN |
3 |
PA |
| YAZ |
3 |
|
| YODOXIN |
1 |
|
| YOHIMBINE HCL |
1 |
|
| Yale Health H.PYLORI |
1 |
|
| ZACLIR CLEANSING |
2 |
ST, QL |
| ZADITOR |
NC |
|
| ZALEPLON CAP 5MG |
1 |
|
| ZANAFLEX CAP 6MG |
3 |
|
| ZANTAC |
3 |
PA |
| ZAROXOLYN |
3 |
|
| ZEGERID |
3 |
PA, ST |
| ZELAPAR |
2 |
|
| ZEMPLAR CAP |
2 |
|
| ZENPEP |
2 |
|
| ZESTORETIC |
3 |
|
| ZESTRIL |
3 |
|
| ZETIA |
2 |
QL |
| ZIAGEN |
2 |
|
| ZIANA |
3 |
ST, QL |
| ZIDOVUDINE |
1 |
|
| ZINC OXIDE |
NC |
QL |
| ZITHROMAX |
2 |
T |
| ZODERM |
3 |
ST, QL |
| ZOFRAN |
3 |
PA, ST |
| ZOLADEX IMP |
3 |
|
| ZOLENE HC |
3 |
|
| ZOLINZA TAB |
3 |
PA, QL |
| ZOLOFT |
3 |
|
| ZOLPIDEM TARTRATE |
1 |
T |
| ZOMIG |
3 |
QL |
| ZONALON |
3 |
PA, ST, QL |
| ZONISAMIDE |
1 |
|
| ZOVIA |
1 |
|
| ZOVIRAX |
2 |
QL |
| ZYFLO CR |
2 |
|
| ZYLET |
3 |
|
| ZYMAXID |
3 |
|
| ZYPREXA |
3 |
|
| ZYVOX |
3 |
PA |
