Indiana Medicaid Formulary

Healthy Indiana Plan PLUS

Medicaid-Approved

Preferred Drug List

Effective July 1, 2023

Legend

In each class, drugs are listed alphabetically by either brand name or generic name.

Brand name drug: Uppercase in bold type

Generic drug: Lowercase in plain type

AL: Age Limit Restrictions

DO: Dose Optimization Program

GR: Gender Restriction

OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the

prescription)

PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before

certain prescriptions are filled.

QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month.

SP: Specialty Pharmacy

ST: Step therapy is required. You may need to use one medication before benefits for the use of another

medication can be authorized.

Drug Name Reference Notes

*ADHD/ANTI-NARCOLEPSY/ANTI-

OBESITY/ANOREXIANTS*

*ADHD AGENT - SELECTIVE ALPHA

ADRENERGIC AGONISTS***

clonidine hcl er oral tablet extended release

12 hour

Kapvay QL

guanfacine hcl er oral tablet extended

release 24 hour

Intuniv QL

*ADHD AGENT - SELECTIVE

NOREPINEPHRINE REUPTAKE

INHIBITOR***

atomoxetine hcl oral capsule Strattera QL

QELBREE ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

AL; QL

*AMPHETAMINE MIXTURES***

amphetamine-dextroamphet er oral capsule

extended release 24 hour

Adderall XR AL; QL

amphetamine-dextroamphetamine oral

tablet

Adderall AL; QL

MYDAYIS ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

AL; QL

*AMPHETAMINES***

ADZENYS XR-ODT ORAL TABLET

EXTENDED RELEASE DISPERSIBLE

AL; QL

amphetamine sulfate oral tablet Evekeo AL; QL

dextroamphetamine sulfate er oral capsule

extended release 24 hour

Dexedrine AL; QL

dextroamphetamine sulfate oral solution ProCentra AL; QL

dextroamphetamine sulfate oral tablet Zenzedi AL; QL

DYANAVEL XR ORAL SUSPENSION

EXTENDED RELEASE

AL; QL

DYANAVEL XR ORAL TABLET

CHEWABLE EXTENDED RELEASE

AL; QL

EVEKEO ODT ORAL TABLET

DISPERSIBLE

AL; QL

methamphetamine hcl oral tablet Desoxyn AL

PROCENTRA ORAL SOLUTION AL; QL

VYVANSE ORAL CAPSULE AL; QL

VYVANSE ORAL TABLET CHEWABLE AL; QL

XELSTRYM TRANSDERMAL PATCH QL

Drug Name Reference Notes

ZENZEDI ORAL TABLET AL; QL

*ANALEPTICS***

caffeine citrate oral solution

*DOPAMINE AND NOREPINEPHRINE

REUPTAKE INHIBITORS (DNRIS)***

SUNOSI ORAL TABLET QL

*HISTAMINE H3-RECEPTOR

ANTAGONIST/INVERSE AGONISTS***

WAKIX ORAL TABLET 17.8 MG PA; SP; QL

WAKIX ORAL TABLET 4.45 MG PA; SP; DO; QL

*STIMULANT COMBINATIONS***

AZSTARYS ORAL CAPSULE AL; QL

*STIMULANTS - MISC.***

armodafinil oral tablet Nuvigil PA; QL

COTEMPLA XR-ODT ORAL TABLET

EXTENDED RELEASE DISPERSIBLE

AL; QL

dexmethylphenidate hcl er oral capsule

extended release 24 hour

Focalin XR AL; QL

dexmethylphenidate hcl oral tablet Focalin AL; QL

JORNAY PM ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

AL; QL

methylphenidate hcl er (cd) oral capsule

extended release

AL; QL

methylphenidate hcl er (la) oral capsule

extended release 24 hour

Ritalin LA AL; QL

methylphenidate hcl er (osm) oral tablet

extended release

Concerta AL; QL

methylphenidate hcl er (xr) oral capsule

extended release 24 hour

Aptensio XR AL; QL

methylphenidate hcl er oral tablet extended

release

AL; QL

methylphenidate hcl er oral tablet extended

release 24 hour

AL; QL

methylphenidate hcl oral solution Methylin AL; QL

methylphenidate hcl oral tablet Ritalin AL; QL

methylphenidate hcl oral tablet chewable AL; QL

methylphenidate transdermal patch Daytrana AL; QL

modafinil oral tablet 100 mg Provigil PA; DO; QL

modafinil oral tablet 200 mg Provigil PA; QL

Drug Name Reference Notes

QUILLICHEW ER ORAL TABLET

CHEWABLE EXTENDED RELEASE

AL; QL

QUILLIVANT XR ORAL SUSPENSION

RECONSTITUTED ER

AL; QL

RELEXXII ORAL TABLET EXTENDED

RELEASE

AL; QL

RITALIN LA ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

AL; QL

*ALTERNATIVE MEDICINES*

*ALTERNATIVE MEDICINE - ME'S***

melatonin extra strength oral liquid AL; OTC; QL

melatonin extra strength oral tablet OTC; QL

melatonin extra strength oral tablet

chewable

YumVs Melatonin OTC; QL

melatonin gummies oral tablet chewable VitaJoy Gummies OTC; QL

melatonin maximum strength oral tablet OTC; QL

melatonin oral capsule OTC; QL

melatonin oral liquid 1 mg/4ml, 2.5 mg/10ml AL; OTC; QL

melatonin oral liquid 1 mg/ml

Zarbees Sleep

Child/Melatonin

AL; OTC; QL

melatonin oral liquid 5 mg/ml OTC; QL

melatonin oral tablet OTC; QL

melatonin oral tablet chewable VitaJoy Gummies OTC; QL

SLEEP SOUNDLY ORAL LIQUID OTC; QL

ZARBEES SLEEP CHILD/MELATONIN

ORAL LIQUID

AL; OTC; QL

*AMINOGLYCOSIDES*

*AMINOGLYCOSIDES***

neomycin sulfate oral tablet

paromomycin sulfate oral capsule Humatin

tobramycin inhalation nebulization solution Bethkis SP; QL

*ANALGESICS - ANTI-

INFLAMMATORY*

*ANTI-TNF-ALPHA - MONOCLONAL

ANTIBODIES***

AMJEVITA SUBCUTANEOUS SOLUTION

AUTO-INJECTOR

PA; SP; QL

AMJEVITA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP; QL

Drug Name Reference Notes

HUMIRA PEDIATRIC CROHNS START

SUBCUTANEOUS PREFILLED SYRINGE

KIT

PA; SP; QL

HUMIRA PEN SUBCUTANEOUS PEN-

INJECTOR KIT

PA; SP; QL

HUMIRA PEN-CD/UC/HS STARTER

SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA PEN-PEDIATRIC UC START

SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA PEN-PS/UV/ADOL HS START

SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA PEN-PSOR/UVEIT STARTER

SUBCUTANEOUS PEN-INJECTOR KIT

PA; SP; QL

HUMIRA SUBCUTANEOUS PREFILLED

SYRINGE KIT

PA; SP; QL

*CYCLOOXYGENASE 2 (COX-2)

INHIBITORS***

celecoxib oral capsule CeleBREX PA; QL

*GOLD COMPOUNDS***

RIDAURA ORAL CAPSULE

*NONSTEROIDAL ANTI-

INFLAMMATORY AGENTS

(NSAIDS)***

ADVIL JUNIOR STRENGTH ORAL

TABLET CHEWABLE

OTC

all day pain relief oral tablet Mediproxen OTC; QL

all day relief oral tablet Mediproxen OTC; QL

CHILDRENS ADVIL ORAL SUSPENSION PA; OTC; QL

childrens ibuprofen oral suspension Childrens Advil OTC; QL

CHILDRENS MOTRIN ORAL

SUSPENSION

PA; OTC; QL

cvs ibuprofen childrens oral tablet chewable Advil Junior Strength OTC

diclofenac potassium oral tablet

diclofenac sodium er oral tablet extended

release 24 hour

diclofenac sodium oral tablet delayed

release

etodolac er oral tablet extended release 24

hour

etodolac oral capsule QL

Drug Name Reference Notes

etodolac oral tablet Lodine QL

fenoprofen calcium oral capsule Nalfon QL

flurbiprofen oral tablet QL

IBU ORAL TABLET QL

ibu-200 oral tablet Medi-First Ibuprofen OTC; QL

ibuprofen 100 junior strength oral tablet

chewable

Advil Junior Strength OTC

ibuprofen infants oral suspension Infants Advil OTC; QL

ibuprofen junior strength oral tablet

chewable

Advil Junior Strength OTC

ibuprofen oral suspension Childrens Advil OTC; QL

ibuprofen oral tablet 200 mg Medi-First Ibuprofen OTC; QL

ibuprofen oral tablet 400 mg, 600 mg, 800

IBU QL

indomethacin er oral capsule extended

release

indomethacin oral capsule QL

INFANTS ADVIL ORAL SUSPENSION PA; OTC; QL

infants ibuprofen oral suspension Infants Advil OTC; QL

ketoprofen er oral capsule extended release

24 hour

ketoprofen oral capsule QL

ketorolac tromethamine oral tablet QL

meclofenamate sodium oral capsule QL

MEDI-FIRST IBUPROFEN ORAL TABLET OTC; QL

MEDI-PROFEN ORAL SUSPENSION OTC; QL

MEDI-PROFEN ORAL TABLET OTC; QL

MEDIPROXEN ORAL TABLET OTC; QL

meloxicam oral tablet QL

MOTRIN CHILDRENS ORAL TABLET

CHEWABLE

OTC

MOTRIN IB ORAL TABLET OTC; QL

MOTRIN INFANTS DROPS ORAL

SUSPENSION

PA; OTC; QL

nabumetone oral tablet QL

naproxen oral tablet Naprosyn

naproxen sodium oral tablet 220 mg Mediproxen OTC; QL

naproxen sodium oral tablet 275 mg QL

naproxen sodium oral tablet 550 mg Anaprox DS QL

Drug Name Reference Notes

oxaprozin oral tablet Daypro QL

PAMPRIN ALL DAY RELIEF MAX ST

ORAL TABLET

OTC; QL

piroxicam oral capsule Feldene QL

sulindac oral tablet QL

tolmetin sodium oral tablet QL

*PHOSPHODIESTERASE 4 (PDE4)

INHIBITORS***

OTEZLA ORAL TABLET PA; SP; QL

OTEZLA ORAL TABLET THERAPY PACK PA; SP; QL

*PYRIMIDINE SYNTHESIS

INHIBITORS***

leflunomide oral tablet Arava QL

*SOLUBLE TUMOR NECROSIS

FACTOR RECEPTOR AGENTS***

ENBREL MINI SUBCUTANEOUS

SOLUTION CARTRIDGE

PA; SP; QL

ENBREL SUBCUTANEOUS SOLUTION PA; SP; QL

ENBREL SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP; QL

ENBREL SURECLICK SUBCUTANEOUS

SOLUTION AUTO-INJECTOR

PA; SP; QL

*ANALGESICS - NONNARCOTIC*

*ANALGESIC COMBINATIONS***

added strength headache relief oral tablet Bayer Migraine OTC

BAYER MIGRAINE ORAL TABLET OTC

extraprin oral tablet Bayer Migraine OTC

headache formula oral tablet Bayer Migraine OTC

headache relief oral tablet Bayer Migraine OTC

migraine formula oral tablet Bayer Migraine OTC

migraine relief oral tablet Bayer Migraine OTC

pain reliever extra strength oral tablet Bayer Migraine OTC

pain reliever plus oral tablet Bayer Migraine OTC

pain-off oral tablet Bayer Migraine OTC

PAMPRIN MAX ORAL TABLET OTC

*ANALGESICS OTHER***

acetaminophen childrens oral solution AL; OTC; QL

acetaminophen childrens oral suspension Panadol Infants AL; OTC; QL

Drug Name Reference Notes

acetaminophen extra strength oral tablet

Healthy Mama Shake

That Ache

OTC; QL

acetaminophen infants oral suspension Panadol Infants AL; OTC; QL

acetaminophen oral liquid Little Remedies for Fever AL; OTC; QL

acetaminophen oral solution AL; OTC; QL

acetaminophen oral suspension Panadol Infants AL; OTC; QL

acetaminophen oral tablet 325 mg Aphen OTC

acetaminophen oral tablet 500 mg

Healthy Mama Shake

That Ache

OTC; QL

acetaminophen rectal suppository 120 mg FeverAll Childrens AL; OTC

acetaminophen rectal suppository 650 mg FeverAll Adults OTC

APHEN ORAL TABLET OTC

childrens acetaminophen oral suspension Panadol Infants AL; OTC; QL

childrens non-aspirin oral tablet chewable Childrens Medi-Tabs AL; OTC

childrens silapap oral liquid Little Remedies for Fever AL; OTC; QL

ed-apap oral liquid Little Remedies for Fever AL; OTC; QL

FEVERALL ADULTS RECTAL

SUPPOSITORY

OTC

FEVERALL INFANTS RECTAL

SUPPOSITORY

AL; OTC

FEVERALL JUNIOR STRENGTH RECTAL

SUPPOSITORY

OTC

HEALTHY MAMA SHAKE THAT ACHE

ORAL TABLET

OTC; QL

infants pain & fever oral suspension Panadol Infants AL; OTC; QL

liquid acetaminophen oral liquid Little Remedies for Fever AL; OTC; QL

liquid pain relief oral liquid Little Remedies for Fever AL; OTC; QL

MAPAP ACETAMINOPHEN EXTRA STR

ORAL LIQUID

OTC

mapap oral capsule OTC; QL

MEDI-TABS EXTRA STRENGTH ORAL

TABLET

OTC; QL

MM ACETAMINOPHEN EX STR ORAL

TABLET

OTC; QL

m-pap oral liquid Little Remedies for Fever AL; OTC; QL

non-aspirin extra strength oral tablet

Healthy Mama Shake

That Ache

OTC; QL

non-aspirin oral tablet 325 mg Aphen OTC

non-aspirin oral tablet 500 mg

Healthy Mama Shake

That Ache

OTC; QL

Drug Name Reference Notes

non-aspirin pain relief oral tablet Aphen OTC

pain & fever infants oral suspension Panadol Infants AL; OTC; QL

pain & fever kids oral suspension Panadol Infants AL; OTC; QL

pain relief extra strength oral capsule OTC; QL

pain relief extra strength oral tablet

Healthy Mama Shake

That Ache

OTC; QL

pain relief oral liquid

Mapap Acetaminophen

Extra Str

OTC

pain relief regular strength oral tablet Aphen OTC

pain reliever extra strength oral tablet

Healthy Mama Shake

That Ache

OTC; QL

pain reliever for adults oral tablet

Healthy Mama Shake

That Ache

OTC; QL

pain reliever oral liquid

Mapap Acetaminophen

Extra Str

OTC

pain reliever oral tablet Aphen OTC

pain reliever/fever reducer rectal suppository FeverAll Childrens AL; OTC

PANADOL EXTRA STRENGTH ORAL

TABLET

OTC; QL

PANADOL INFANTS ORAL SUSPENSION AL; OTC; QL

PEDIACARE CHILDREN ORAL

SUSPENSION

AL; OTC; QL

PEDIACARE INFANT FEVER/PAIN ORAL

SUSPENSION

AL; OTC; QL

PEDIACARE INFANTS ORAL

SUSPENSION

AL; OTC; QL

PHARBETOL EXTRA STRENGTH ORAL

TABLET

OTC; QL

PHARBETOL ORAL TABLET OTC

TYLENOL CHILDRENS ORAL

SUSPENSION

AL; OTC; QL

TYLENOL CHILDRENS PAIN + FEVER

ORAL SUSPENSION

AL; OTC; QL

TYLENOL FOR CHILDREN + ADULTS

ORAL SUSPENSION

AL; OTC; QL

TYLENOL INFANTS PAIN+FEVER ORAL

SUSPENSION

AL; OTC; QL

*ANALGESICS-SEDATIVES***

BAC ORAL TABLET QL

butalbital-acetaminophen oral tablet Tencon QL

Drug Name Reference Notes

butalbital-apap-caffeine oral tablet Bac QL

butalbital-aspirin-caffeine oral capsule QL

TENCON ORAL TABLET QL

*SALICYLATE COMBINATIONS***

tri-buffered aspirin oral tablet Bufferin AL; OTC

*SALICYLATES***

adult aspirin regimen oral tablet delayed

release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin 81 oral tablet chewable Bayer Low Dose OTC

aspirin 81 oral tablet delayed release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin adult low dose oral tablet delayed

release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin adult low strength oral tablet delayed

release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin childrens oral tablet chewable Bayer Low Dose OTC

aspirin ec low dose oral tablet delayed

release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin ec low strength oral tablet delayed

release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin low dose oral tablet chewable Bayer Low Dose OTC

aspirin low dose oral tablet delayed release

Bayer Aspirin EC Low

Dose

OTC; QL

aspirin low strength oral tablet chewable Bayer Low Dose OTC

aspirin oral tablet

Bayer Advanced Aspirin

Reg St

OTC

aspirin oral tablet chewable Bayer Low Dose OTC

aspirin oral tablet delayed release Bayer Aspirin OTC; QL

aspirin regimen oral tablet delayed release

Bayer Aspirin EC Low

Dose

OTC; QL

BAYER ADVANCED ASPIRIN REG ST

ORAL TABLET

OTC

BAYER ASPIRIN EC LOW DOSE ORAL

TABLET DELAYED RELEASE

OTC; QL

BAYER ASPIRIN ORAL TABLET OTC

BAYER ASPIRIN ORAL TABLET

DELAYED RELEASE

OTC; QL

BAYER LOW DOSE ORAL TABLET

CHEWABLE

OTC

Drug Name Reference Notes

BAYER LOW DOSE ORAL TABLET

DELAYED RELEASE

OTC; QL

diflunisal oral tablet

ECOTRIN LOW STRENGTH ORAL

TABLET DELAYED RELEASE

OTC; QL

genuine aspirin oral tablet

Bayer Advanced Aspirin

Reg St

OTC

goodsense aspirin adults oral tablet

Bayer Advanced Aspirin

Reg St

OTC

MEDI-FIRST ASPIRIN ORAL TABLET OTC

MEDIQUE ASPIRIN ORAL TABLET OTC

mm aspirin oral tablet delayed release

Bayer Aspirin EC Low

Dose

OTC; QL

ST JOSEPH ASPIRIN ORAL TABLET

DELAYED RELEASE

OTC; QL

ST JOSEPH LOW DOSE ORAL TABLET

CHEWABLE

OTC

ST JOSEPH LOW DOSE ORAL TABLET

DELAYED RELEASE

OTC; QL

*ANALGESICS - OPIOID*

*CODEINE COMBINATIONS***

acetaminophen-codeine oral solution PA; AL; QL

acetaminophen-codeine oral tablet 300-15

AL; QL

acetaminophen-codeine oral tablet 300-30

mg, 300-60 mg

PA; AL; QL

ASCOMP-CODEINE ORAL CAPSULE PA; AL; QL

butalbital-apap-caff-cod oral capsule Fioricet/Codeine PA; AL; QL

butalbital-asa-caff-codeine oral capsule Ascomp-Codeine PA; AL; QL

*HYDROCODONE COMBINATIONS***

hydrocodone-acetaminophen oral solution PA; QL

hydrocodone-acetaminophen oral tablet Xodol PA; QL

hydrocodone-ibuprofen oral tablet PA; QL

*OPIOID AGONISTS***

codeine sulfate oral tablet PA; AL; QL

fentanyl citrate buccal lozenge on a handle Actiq PA; QL

fentanyl transdermal patch 72 hour PA; QL

hydromorphone hcl oral liquid Dilaudid PA; QL

hydromorphone hcl oral tablet Dilaudid PA; QL

Drug Name Reference Notes

meperidine hcl oral solution PA; QL

meperidine hcl oral tablet PA; QL

METHADONE HCL INTENSOL ORAL

CONCENTRATE

PA; QL

methadone hcl oral concentrate Methadone HCl Intensol PA; QL

methadone hcl oral solution PA; QL

methadone hcl oral tablet PA; QL

methadone hcl oral tablet soluble Methadose PA; QL

METHADOSE ORAL TABLET SOLUBLE PA; QL

morphine sulfate (concentrate) oral solution PA; QL

morphine sulfate er oral tablet extended

release

MS Contin PA; QL

morphine sulfate oral solution PA; QL

morphine sulfate oral tablet QL

oxycodone hcl oral capsule PA; QL

oxycodone hcl oral concentrate PA; QL

oxycodone hcl oral solution PA; QL

oxycodone hcl oral tablet Oxaydo PA; QL

tramadol hcl oral tablet PA; AL; QL

*OPIOID COMBINATIONS***

ENDOCET ORAL TABLET PA; QL

oxycodone-acetaminophen oral tablet Endocet PA; QL

*OPIOID PARTIAL AGONISTS***

buprenorphine hcl sublingual tablet

sublingual

buprenorphine hcl-naloxone hcl sublingual

tablet sublingual

butorphanol tartrate nasal solution QL

pentazocine-naloxone hcl oral tablet PA; QL

*TRAMADOL COMBINATIONS***

tramadol-acetaminophen oral tablet PA; AL; QL

*ANDROGENS-ANABOLIC*

*ANDROGENS***

DEPO-TESTOSTERONE

INTRAMUSCULAR SOLUTION

testosterone cypionate intramuscular

solution

Depo-Testosterone PA

Drug Name Reference Notes

testosterone enanthate intramuscular

solution

testosterone transdermal gel Testim PA; QL

*ANORECTAL AND RELATED

PRODUCTS*

*INTRARECTAL STEROIDS***

hydrocortisone rectal enema Cortenema

*RECTAL COMBINATIONS - MISC.***

AVEDANA HEMORRHOID PAIN RELIEF

RECTAL OINTMENT

OTC

hemorrhoidal rectal ointment

Avedana Hemorrhoid

Pain Relief

OTC

hemorrhoidal rectal suppository OTC

*RECTAL LOCAL ANESTHETICS***

dibucaine (perianal) external ointment Nupercainal OTC

qc dibucaine (perianal) external ointment Nupercainal OTC

*RECTAL STEROIDS***

hydrocortisone (perianal) external cream Procto-Med HC QL

PROCTO-MED HC EXTERNAL CREAM QL

PROCTOSOL HC EXTERNAL CREAM QL

PROCTOZONE-HC EXTERNAL CREAM QL

*ANTACIDS*

*ANTACID & SIMETHICONE***

antacid & antigas oral suspension Mintox OTC

antacid anti-gas oral suspension Mintox OTC

antacid fast relief oral suspension Mintox OTC

antacid i oral suspension Mintox OTC

antacid liquid oral suspension Mintox OTC

antacid m oral suspension Mintox OTC

antacid maximum strength oral suspension

Almacone Double

Strength

AL; OTC

antacid oral suspension Mintox OTC

antacid regular strength oral suspension Mintox OTC

antacid/antigas oral suspension Mintox OTC

comfort gel antacid & anti-gas oral

suspension

Mintox OTC

comfort gel antacid anti-gas oral suspension Mintox OTC

comfort gel oral suspension Mintox OTC

Drug Name Reference Notes

goodsense advanced antacid oral

suspension

Mintox OTC

goodsense antacid & gas relief oral

suspension

Almacone Double

Strength

AL; OTC

mag-al plus oral liquid Mintox OTC

MINTOX PLUS ORAL TABLET

CHEWABLE

OTC

*ANTACID COMBINATIONS***

ACID GONE ORAL SUSPENSION AL; OTC

ACID GONE ORAL TABLET CHEWABLE OTC

antacid extra strength oral tablet chewable Acid Gone OTC

cvs heartburn relief ex st oral suspension

Gaviscon Extra Relief

Formula

OTC

heartburn antacid ex st oral tablet chewable Acid Gone OTC

heartburn relief ex st oral suspension

Gaviscon Extra Relief

Formula

OTC

*ANTACIDS - ALUMINUM SALTS***

aluminum hydroxide gel oral suspension AL; OTC

*ANTACIDS - BICARBONATE***

sodium bicarbonate oral tablet OTC

*ANTACIDS - CALCIUM SALTS***

ALKA-SELTZER HEARTBURN ORAL

TABLET CHEWABLE

AL; OTC

antacid calcium oral tablet chewable Cal-Gest Antacid OTC; QL

antacid calcium rich oral tablet chewable Cal-Gest Antacid OTC; QL

antacid extra strength oral tablet chewable Alka-Seltzer Heartburn AL; OTC

ANTACID FLAVOR CHEWS ORAL

TABLET CHEWABLE

AL; OTC

antacid maximum oral tablet chewable Tums Ultra 1000 AL; OTC

antacid oral tablet chewable 500 mg Cal-Gest Antacid OTC; QL

antacid oral tablet chewable 750 mg Alka-Seltzer Heartburn AL; OTC

antacid regular strength oral tablet chewable Cal-Gest Antacid OTC; QL

antacid ultra strength oral tablet chewable Tums Ultra 1000 AL; OTC

calcium antacid extra strength oral tablet

chewable

Alka-Seltzer Heartburn AL; OTC

calcium antacid oral tablet chewable Cal-Gest Antacid OTC; QL

calcium carbonate antacid oral suspension OTC

calcium carbonate antacid oral tablet

chewable

Cal-Gest Antacid OTC; QL

Drug Name Reference Notes

CAL-GEST ANTACID ORAL TABLET

CHEWABLE

OTC; QL

HEALTHY MAMA TAME THE FLAME

ORAL TABLET CHEWABLE

OTC; QL

hm antacid oral tablet chewable Cal-Gest Antacid OTC; QL

long lasting antacid oral tablet chewable Cal-Gest Antacid OTC; QL

TUMS SMOOTHIES ORAL TABLET

CHEWABLE

AL; OTC

*ANTACIDS - MAGNESIUM SALTS***

magnesium oxide (antacid) oral tablet OTC; QL

magnesium oxide oral tablet OTC; QL

*ANTHELMINTICS*

*ANTHELMINTICS***

ivermectin oral tablet Stromectol QL

praziquantel oral tablet Biltricide

*ANTIANGINAL AGENTS*

*NITRATES***

isosorbide dinitrate oral tablet Isordil Titradose

isosorbide mononitrate er oral tablet

extended release 24 hour

isosorbide mononitrate oral tablet

NITRO-BID TRANSDERMAL OINTMENT

nitroglycerin sublingual tablet sublingual Nitrostat

nitroglycerin transdermal patch 24 hour Nitro-Dur

*ANTIANXIETY AGENTS*

*ANTIANXIETY AGENTS - MISC.***

buspirone hcl oral tablet QL

droperidol injection solution

hydroxyzine hcl intramuscular solution

hydroxyzine hcl oral syrup QL

hydroxyzine hcl oral tablet QL

hydroxyzine pamoate oral capsule Vistaril QL

meprobamate oral tablet QL

*BENZODIAZEPINES***

alprazolam er oral tablet extended release

24 hour

Xanax XR PA; QL

ALPRAZOLAM INTENSOL ORAL

CONCENTRATE

PA; QL

Drug Name Reference Notes

alprazolam oral tablet 0.25 mg, 1 mg, 2 mg Xanax PA; QL

alprazolam oral tablet 0.5 mg Xanax QL

alprazolam oral tablet dispersible 0.25 mg,

0.5 mg

alprazolam oral tablet dispersible 1 mg, 2

PA; QL

alprazolam xr oral tablet extended release

24 hour

Xanax XR PA; QL

chlordiazepoxide hcl oral capsule 10 mg, 5

chlordiazepoxide hcl oral capsule 25 mg PA; QL

clorazepate dipotassium oral tablet QL

diazepam injection solution

DIAZEPAM INTENSOL ORAL

CONCENTRATE

PA; QL

diazepam oral concentrate diazePAM Intensol PA; QL

diazepam oral solution PA

diazepam oral tablet 10 mg Valium PA; QL

diazepam oral tablet 2 mg, 5 mg Valium QL

LORAZEPAM INTENSOL ORAL

CONCENTRATE

lorazepam oral concentrate LORazepam Intensol PA

lorazepam oral tablet 0.5 mg, 1 mg Ativan QL

lorazepam oral tablet 2 mg Ativan PA; QL

LOREEV XR ORAL CAPSULE ER 24

HOUR SPRINKLE 1 MG, 2 MG, 3 MG

PA; AL; QL

LOREEV XR ORAL CAPSULE ER 24

HOUR SPRINKLE 1.5 MG

oxazepam oral capsule 10 mg, 15 mg QL

oxazepam oral capsule 30 mg PA; QL

*ANTIARRHYTHMICS*

*ANTIARRHYTHMICS TYPE I-A***

disopyramide phosphate oral capsule Norpace

quinidine gluconate er oral tablet extended

release

quinidine sulfate oral tablet

*ANTIARRHYTHMICS TYPE I-B***

mexiletine hcl oral capsule

Drug Name Reference Notes

*ANTIARRHYTHMICS TYPE I-C***

flecainide acetate oral tablet QL

propafenone hcl er oral capsule extended

release 12 hour

Rythmol SR

propafenone hcl oral tablet

*ANTIARRHYTHMICS TYPE III***

amiodarone hcl oral tablet Pacerone

PACERONE ORAL TABLET

*ANTIASTHMATIC AND

BRONCHODILATOR AGENTS*

*ADRENERGIC COMBINATIONS***

ANORO ELLIPTA INHALATION AEROSOL

POWDER BREATH ACTIVATED

budesonide-formoterol fumarate inhalation

aerosol

Symbicort QL

COMBIVENT RESPIMAT INHALATION

AEROSOL SOLUTION

fluticasone-salmeterol inhalation aerosol

powder breath activated

AirDuo RespiClick 113/14 QL

ipratropium-albuterol inhalation solution QL

STIOLTO RESPIMAT INHALATION

AEROSOL SOLUTION

WIXELA INHUB INHALATION AEROSOL

POWDER BREATH ACTIVATED

*ANTI-IGE MONOCLONAL

ANTIBODIES***

XOLAIR SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP

XOLAIR SUBCUTANEOUS SOLUTION

RECONSTITUTED

PA; SP

*ANTI-INFLAMMATORY AGENTS***

cromolyn sodium inhalation nebulization

solution

*BETA ADRENERGICS***

albuterol sulfate hfa inhalation aerosol

solution

Proventil HFA QL

albuterol sulfate inhalation nebulization

solution

albuterol sulfate oral syrup

albuterol sulfate oral tablet

Drug Name Reference Notes

SEREVENT DISKUS INHALATION

AEROSOL POWDER BREATH

ACTIVATED

terbutaline sulfate oral tablet

*BRONCHODILATORS -

ANTICHOLINERGICS***

ATROVENT HFA INHALATION AEROSOL

SOLUTION

ipratropium bromide inhalation solution QL

SPIRIVA RESPIMAT INHALATION

AEROSOL SOLUTION

*LEUKOTRIENE RECEPTOR

ANTAGONISTS***

montelukast sodium oral packet Singulair QL

montelukast sodium oral tablet Singulair QL

montelukast sodium oral tablet chewable Singulair QL

zafirlukast oral tablet Accolate QL

*STEROID INHALANTS***

ARNUITY ELLIPTA INHALATION

AEROSOL POWDER BREATH

ACTIVATED

budesonide inhalation suspension Pulmicort QL

FLOVENT DISKUS INHALATION

AEROSOL POWDER BREATH

ACTIVATED

fluticasone propionate hfa inhalation aerosol Flovent HFA QL

*XANTHINES***

theophylline er oral tablet extended release

12 hour

theophylline er oral tablet extended release

24 hour

theophylline oral elixir Elixophyllin QL

theophylline oral solution QL

*ANTICOAGULANTS*

*COUMARIN ANTICOAGULANTS***

JANTOVEN ORAL TABLET

warfarin sodium oral tablet Jantoven

*DIRECT FACTOR XA INHIBITORS***

ELIQUIS DVT/PE STARTER PACK ORAL

TABLET THERAPY PACK

Drug Name Reference Notes

ELIQUIS ORAL TABLET

*HEPARINS AND HEPARINOID-LIKE

AGENTS***

heparin sodium (porcine) injection solution

heparin sodium (porcine) pf injection solution

*LOW MOLECULAR WEIGHT

HEPARINS***

enoxaparin sodium injection solution Lovenox QL

enoxaparin sodium injection solution

prefilled syringe

Lovenox QL

*ANTICONVULSANTS*

*ANTICONVULSANTS -

BENZODIAZEPINES***

clobazam oral suspension Onfi QL

clobazam oral tablet Onfi QL

clonazepam oral tablet 0.5 mg KlonoPIN QL

clonazepam oral tablet 1 mg, 2 mg KlonoPIN PA; QL

clonazepam oral tablet dispersible 0.125 mg,

0.25 mg, 0.5 mg

clonazepam oral tablet dispersible 1 mg, 2

PA; QL

diazepam rectal gel Diastat AcuDial QL

SYMPAZAN ORAL FILM PA; QL

*ANTICONVULSANTS - MISC.***

carbamazepine er oral capsule extended

release 12 hour

Carbatrol

carbamazepine er oral tablet extended

release 12 hour

TEGretol-XR

carbamazepine oral suspension TEGretol

carbamazepine oral tablet Epitol

carbamazepine oral tablet chewable

EPIDIOLEX ORAL SOLUTION PA; SP

EPITOL ORAL TABLET

EPRONTIA ORAL SOLUTION PA; AL; QL

gabapentin oral capsule Neurontin QL

gabapentin oral solution Neurontin QL

gabapentin oral tablet Neurontin QL

LAMICTAL XR ORAL KIT

Drug Name Reference Notes

lamotrigine er oral tablet extended release

24 hour

LaMICtal XR

lamotrigine oral kit LaMICtal ODT

lamotrigine oral tablet Subvenite

lamotrigine oral tablet chewable LaMICtal

lamotrigine oral tablet dispersible LaMICtal ODT

lamotrigine starter kit-blue oral kit Subvenite Starter Kit-Blue

lamotrigine starter kit-green oral kit

Subvenite Starter Kit-

Green

lamotrigine starter kit-orange oral kit

Subvenite Starter Kit-

Orange

levetiracetam er oral tablet extended release

24 hour

Keppra XR QL

levetiracetam oral solution Keppra QL

levetiracetam oral tablet Keppra QL

oxcarbazepine oral suspension Trileptal

oxcarbazepine oral tablet Trileptal

OXTELLAR XR ORAL TABLET

EXTENDED RELEASE 24 HOUR

pregabalin oral capsule Lyrica QL

pregabalin oral solution Lyrica QL

primidone oral tablet 125 mg

primidone oral tablet 250 mg, 50 mg Mysoline QL

ROWEEPRA ORAL TABLET QL

SUBVENITE ORAL TABLET

SUBVENITE STARTER KIT-BLUE ORAL

KIT

SUBVENITE STARTER KIT-GREEN ORAL

KIT

SUBVENITE STARTER KIT-ORANGE

ORAL KIT

topiramate er oral capsule er 24 hour

sprinkle

Qudexy XR QL

topiramate er oral capsule extended release

24 hour

Trokendi XR QL

topiramate oral capsule sprinkle Topamax Sprinkle

topiramate oral tablet Topamax

zonisamide oral capsule Zonegran QL

Drug Name Reference Notes

*CARBAMATES***

felbamate oral suspension Felbatol QL

felbamate oral tablet Felbatol QL

*GABA MODULATORS***

tiagabine hcl oral tablet Gabitril QL

*HYDANTOINS***

DILANTIN ORAL CAPSULE

PHENYTOIN INFATABS ORAL TABLET

CHEWABLE

phenytoin oral suspension Dilantin

phenytoin oral tablet chewable Phenytoin Infatabs

phenytoin sodium extended oral capsule Dilantin

*SUCCINIMIDES***

ethosuximide oral capsule Zarontin QL

ethosuximide oral solution Zarontin QL

*VALPROIC ACID***

divalproex sodium er oral tablet extended

release 24 hour

Depakote ER

divalproex sodium oral capsule delayed

release sprinkle

Depakote Sprinkles

divalproex sodium oral tablet delayed

release 125 mg

Depakote

divalproex sodium oral tablet delayed

release 250 mg, 500 mg

Depakote QL

valproic acid oral capsule

valproic acid oral solution

*ANTIDEPRESSANTS*

*ALPHA-2 RECEPTOR ANTAGONISTS

(TETRACYCLICS)***

mirtazapine oral tablet Remeron QL

mirtazapine oral tablet dispersible Remeron SolTab QL

*ANTIDEPRESSANT -

MISCELLANEOUS COMBINATIONS***

AUVELITY ORAL TABLET EXTENDED

RELEASE

*ANTIDEPRESSANTS - MISC.***

APLENZIN ORAL TABLET EXTENDED

RELEASE 24 HOUR

Drug Name Reference Notes

bupropion hcl er (sr) oral tablet extended

release 12 hour

Wellbutrin SR QL

bupropion hcl er (xl) oral tablet extended

release 24 hour

Forfivo XL QL

bupropion hcl oral tablet QL

FORFIVO XL ORAL TABLET EXTENDED

RELEASE 24 HOUR

*MONOAMINE OXIDASE INHIBITORS

(MAOIS)***

EMSAM TRANSDERMAL PATCH 24

HOUR

PA; QL

MARPLAN ORAL TABLET QL

phenelzine sulfate oral tablet Nardil QL

tranylcypromine sulfate oral tablet Parnate QL

*N-METHYL-D-ASPARTIC ACID

(NMDA) RECEPTOR ANTAGONISTS***

SPRAVATO (56 MG DOSE) NASAL

SOLUTION THERAPY PACK

SP; AL; QL

SPRAVATO (84 MG DOSE) NASAL

SOLUTION THERAPY PACK

SP; AL; QL

*SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIS)***

citalopram hydrobromide oral capsule QL

citalopram hydrobromide oral solution QL

citalopram hydrobromide oral tablet CeleXA QL

escitalopram oxalate oral solution QL

escitalopram oxalate oral tablet Lexapro QL

fluoxetine hcl oral capsule 10 mg PROzac DO; QL

fluoxetine hcl oral capsule 20 mg, 40 mg PROzac QL

fluoxetine hcl oral capsule delayed release QL

fluoxetine hcl oral solution QL

fluoxetine hcl oral tablet QL

fluvoxamine maleate er oral capsule

extended release 24 hour

fluvoxamine maleate oral tablet QL

paroxetine hcl er oral tablet extended

release 24 hour

Paxil CR AL; QL

paroxetine hcl oral suspension Paxil AL; QL

paroxetine hcl oral tablet Paxil AL; QL

Drug Name Reference Notes

sertraline hcl oral capsule QL

sertraline hcl oral concentrate Zoloft QL

sertraline hcl oral tablet Zoloft QL

*SEROTONIN MODULATORS***

nefazodone hcl oral tablet QL

trazodone hcl oral tablet QL

TRINTELLIX ORAL TABLET QL

VIIBRYD STARTER PACK ORAL KIT

vilazodone hcl oral tablet Viibryd QL

*SEROTONIN-NOREPINEPHRINE

REUPTAKE INHIBITORS (SNRIS)***

desvenlafaxine er oral tablet extended

release 24 hour

desvenlafaxine succinate er oral tablet

extended release 24 hour

Pristiq QL

duloxetine hcl oral capsule delayed release

particles

Cymbalta QL

FETZIMA ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

FETZIMA TITRATION ORAL CAPSULE ER

24 HOUR THERAPY PACK

AL; QL

venlafaxine besylate er oral tablet extended

release 24 hour

venlafaxine hcl er oral capsule extended

release 24 hour

Effexor XR QL

venlafaxine hcl er oral tablet extended

release 24 hour

venlafaxine hcl oral tablet QL

*TRICYCLIC AGENTS***

amitriptyline hcl oral tablet QL

amoxapine oral tablet QL

clomipramine hcl oral capsule Anafranil QL

desipramine hcl oral tablet Norpramin QL

doxepin hcl oral capsule QL

doxepin hcl oral concentrate QL

imipramine hcl oral tablet QL

imipramine pamoate oral capsule QL

nortriptyline hcl oral capsule Pamelor QL

nortriptyline hcl oral solution QL

Drug Name Reference Notes

protriptyline hcl oral tablet QL

trimipramine maleate oral capsule QL

*ANTIDIABETICS*

*ALPHA-GLUCOSIDASE

INHIBITORS***

acarbose oral tablet QL

*ANTIDIABETIC - AMYLIN

ANALOGS***

SYMLINPEN 120 SUBCUTANEOUS

SOLUTION PEN-INJECTOR

SYMLINPEN 60 SUBCUTANEOUS

SOLUTION PEN-INJECTOR

PA; QL

*BIGUANIDES***

metformin hcl er oral tablet extended release

24 hour

metformin hcl oral tablet QL

*DIABETIC OTHER -

COMBINATIONS***

DEX4 GLUCOSE ORAL TABLET

CHEWABLE

OTC

DEX4 NATURALS ORAL TABLET

CHEWABLE

OTC

DEX4 ORAL TABLET CHEWABLE OTC

DEX4 POUCH PACK ORAL TABLET

CHEWABLE

OTC

glucose instant energy oral tablet chewable Dex4 OTC

glucose oral tablet chewable Dex4 OTC

*DIABETIC OTHER***

BD GLUCOSE ORAL TABLET

CHEWABLE

OTC

DEX4 QUICK DISSOLVE GLUCOSE ORAL

TABLET CHEWABLE

OTC

GLUCAGEN HYPOKIT INJECTION

SOLUTION RECONSTITUTED

GLUCO TO GO 15 ORAL GEL OTC

glucose oral gel Gluco to Go 15 OTC

glucose oral tablet chewable

Dex4 Quick Dissolve

Glucose

OTC

GLUTOSE 15 ORAL GEL OTC

GLUTOSE 45 ORAL GEL OTC

Drug Name Reference Notes

GLUTOSE 5 ORAL GEL OTC

RELION GLUCOSE ORAL GEL OTC

TRUEPLUS GLUCOSE ON THE GO ORAL

TABLET CHEWABLE

OTC

TRUEPLUS GLUCOSE ORAL TABLET

CHEWABLE

OTC

*DIPEPTIDYL PEPTIDASE-4 (DPP-4)

INHIBITORS***

JANUVIA ORAL TABLET PA; QL

*DIPEPTIDYL PEPTIDASE-4

INHIBITOR-BIGUANIDE

COMBINATIONS***

JANUMET ORAL TABLET PA; QL

JANUMET XR ORAL TABLET EXTENDED

RELEASE 24 HOUR

PA; QL

*HUMAN INSULIN***

ADMELOG INJECTION SOLUTION QL

ADMELOG SOLOSTAR SUBCUTANEOUS

SOLUTION PEN-INJECTOR

BASAGLAR KWIKPEN SUBCUTANEOUS

SOLUTION PEN-INJECTOR

HUMALOG MIX 50/50 KWIKPEN

SUBCUTANEOUS SUSPENSION PEN-

INJECTOR

HUMALOG MIX 50/50 SUBCUTANEOUS

SUSPENSION

HUMALOG MIX 75/25 SUBCUTANEOUS

SUSPENSION

PA; QL

HUMULIN 70/30 KWIKPEN

SUBCUTANEOUS SUSPENSION PEN-

INJECTOR

OTC; QL

HUMULIN 70/30 SUBCUTANEOUS

SUSPENSION

OTC; QL

HUMULIN N KWIKPEN SUBCUTANEOUS

SUSPENSION PEN-INJECTOR

OTC; QL

HUMULIN N SUBCUTANEOUS

SUSPENSION

OTC; QL

HUMULIN R INJECTION SOLUTION OTC; QL

HUMULIN R U-500 (CONCENTRATED)

SUBCUTANEOUS SOLUTION

PA; QL

Drug Name Reference Notes

HUMULIN R U-500 KWIKPEN

SUBCUTANEOUS SOLUTION PEN-

INJECTOR

PA; QL

insulin asp prot & asp flexpen subcutaneous

suspension pen-injector

NovoLOG 70/30 FlexPen

ReliOn

insulin aspart prot & aspart subcutaneous

suspension

NovoLOG Mix 70/30 QL

insulin glargine-yfgn subcutaneous solution Semglee (yfgn) QL

insulin glargine-yfgn subcutaneous solution

pen-injector

Semglee (yfgn) QL

insulin lispro (1 unit dial) subcutaneous

solution pen-injector

Admelog SoloStar QL

insulin lispro injection solution Admelog QL

insulin lispro junior kwikpen subcutaneous

solution pen-injector

HumaLOG Junior

KwikPen

insulin lispro prot & lispro subcutaneous

suspension pen-injector

HumaLOG Mix 75/25

KwikPen

NOVOLIN 70/30 FLEXPEN RELION

SUBCUTANEOUS SUSPENSION PEN-

INJECTOR

OTC; QL

NOVOLIN 70/30 FLEXPEN

SUBCUTANEOUS SUSPENSION PEN-

INJECTOR

OTC; QL

NOVOLIN 70/30 RELION

SUBCUTANEOUS SUSPENSION

OTC; QL

NOVOLIN 70/30 SUBCUTANEOUS

SUSPENSION

OTC; QL

NOVOLIN N FLEXPEN RELION

SUBCUTANEOUS SUSPENSION PEN-

INJECTOR

OTC; QL

NOVOLIN N FLEXPEN SUBCUTANEOUS

SUSPENSION PEN-INJECTOR

OTC; QL

NOVOLIN N RELION SUBCUTANEOUS

SUSPENSION

OTC; QL

NOVOLIN N SUBCUTANEOUS

SUSPENSION

OTC; QL

NOVOLIN R FLEXPEN INJECTION

SOLUTION PEN-INJECTOR

OTC; QL

NOVOLIN R FLEXPEN RELION

INJECTION SOLUTION PEN-INJECTOR

OTC; QL

NOVOLIN R INJECTION SOLUTION OTC; QL

Drug Name Reference Notes

NOVOLIN R RELION INJECTION

SOLUTION

OTC; QL

*INCRETIN MIMETIC AGENTS (GLP-1

RECEPTOR AGONISTS)***

OZEMPIC (0.25 OR 0.5 MG/DOSE)

SUBCUTANEOUS SOLUTION PEN-

INJECTOR

OZEMPIC (1 MG/DOSE) SUBCUTANEOUS

SOLUTION PEN-INJECTOR

PA; QL

OZEMPIC (2 MG/DOSE) SUBCUTANEOUS

SOLUTION PEN-INJECTOR

PA; QL

TRULICITY SUBCUTANEOUS SOLUTION

PEN-INJECTOR

PA; QL

*MEGLITINIDE ANALOGUES***

nateglinide oral tablet PA; QL

repaglinide oral tablet PA; QL

*SODIUM-GLUCOSE CO-

TRANSPORTER 2 (SGLT2)

INHIBITORS***

JARDIANCE ORAL TABLET PA; QL

*SODIUM-GLUCOSE CO-

TRANSPORTER 2 INHIBITOR-

BIGUANIDE COMB***

SYNJARDY ORAL TABLET PA; QL

SYNJARDY XR ORAL TABLET

EXTENDED RELEASE 24 HOUR

PA; QL

*SULFONYLUREA-BIGUANIDE

COMBINATIONS***

glipizide-metformin hcl oral tablet QL

glyburide-metformin oral tablet QL

*SULFONYLUREAS***

glimepiride oral tablet Amaryl QL

glipizide er oral tablet extended release 24

hour

Glucotrol XL QL

glipizide oral tablet QL

glipizide xl oral tablet extended release 24

hour

Glucotrol XL QL

glyburide micronized oral tablet Glynase QL

glyburide oral tablet QL

Drug Name Reference Notes

*SULFONYLUREA-

THIAZOLIDINEDIONE

COMBINATIONS***

pioglitazone hcl-glimepiride oral tablet Duetact PA; QL

*THIAZOLIDINEDIONE-BIGUANIDE

COMBINATIONS***

pioglitazone hcl-metformin hcl oral tablet Actoplus Met PA; QL

*THIAZOLIDINEDIONES***

pioglitazone hcl oral tablet Actos PA; QL

*ANTIDIARRHEAL/PROBIOTIC

AGENTS*

*ANTIDIARRHEAL/PROBIOTIC

AGENTS - MISC.***

bismatrol oral tablet chewable Soothe AL; OTC

bismuth oral tablet chewable Soothe AL; OTC

bismuth subsalicylate oral tablet chewable Soothe AL; OTC

diarrhea oral suspension Kaopectate AL; OTC; QL

diotame instydose oral suspension Kaopectate AL; OTC; QL

KAOPECTATE EXTRA STRENGTH ORAL

SUSPENSION

OTC

KAOPECTATE ORAL SUSPENSION AL; OTC; QL

KAOPECTATE ORAL TABLET AL; OTC

pink bismuth maximum strength oral

suspension

Kaopectate Extra

Strength

OTC

pink bismuth oral suspension Kaopectate AL; OTC; QL

SOOTHE MAXIMUM STRENGTH ORAL

SUSPENSION

OTC

SOOTHE ORAL SUSPENSION AL; OTC; QL

SOOTHE ORAL TABLET CHEWABLE AL; OTC

stomach relief extra strength oral

suspension

Kaopectate Extra

Strength

OTC

stomach relief oral suspension 525 mg/15ml

Kaopectate Extra

Strength

OTC

stomach relief oral suspension 525 mg/30ml,

527 mg/30ml

Kaopectate AL; OTC; QL

stomach relief oral tablet Kaopectate AL; OTC

stomach relief oral tablet chewable Soothe AL; OTC

stomach relief plus oral suspension

Kaopectate Extra

Strength

OTC

Drug Name Reference Notes

stomach relief ultra oral suspension

Kaopectate Extra

Strength

OTC

*ANTIPERISTALTIC AGENTS***

anti-diarrheal oral capsule Imodium A-D OTC; QL

anti-diarrheal oral tablet Imodium A-D OTC; QL

diamode oral tablet Imodium A-D OTC; QL

diphenoxylate-atropine oral liquid

diphenoxylate-atropine oral tablet Lomotil

loperamide hcl oral capsule Imodium A-D QL

loperamide hcl oral tablet Imodium A-D OTC; QL

*ANTIDOTES AND SPECIFIC

ANTAGONISTS*

*BENZODIAZEPINE ANTAGONISTS***

flumazenil intravenous solution

*OPIOID ANTAGONISTS***

KLOXXADO NASAL LIQUID QL

naloxone hcl injection solution QL

naloxone hcl injection solution cartridge QL

naloxone hcl injection solution prefilled

syringe

naloxone hcl nasal liquid Narcan QL

naltrexone hcl oral tablet

ZIMHI INJECTION SOLUTION PREFILLED

SYRINGE

*ANTIEMETICS*

*5-HT3 RECEPTOR ANTAGONISTS***

ondansetron hcl oral solution PA; QL

ondansetron hcl oral tablet QL

ondansetron oral tablet dispersible QL

*ANTIEMETICS -

ANTICHOLINERGIC***

BONINE ORAL TABLET CHEWABLE OTC

DRAMAMINE LESS DROWSY ORAL

TABLET

OTC

DRAMAMINE MOTION SICKNESS ORAL

TABLET CHEWABLE

OTC

DRAMAMINE ORAL TABLET OTC

meclizine hcl oral tablet 25 mg Dramamine OTC

Drug Name Reference Notes

meclizine hcl oral tablet chewable Bonine OTC

meclizine hcl tablet 12.5 mg oral (rx)

motion sickness relief oral tablet Dramamine OTC

motion sickness relief oral tablet chewable Bonine OTC

motion-time oral tablet chewable Bonine OTC

trimethobenzamide hcl oral capsule

*ANTIFUNGALS*

*ANTIFUNGALS***

flucytosine oral capsule Ancobon PA

griseofulvin microsize oral suspension

griseofulvin ultramicrosize oral tablet

nystatin oral tablet

terbinafine hcl oral tablet QL

*IMIDAZOLES***

ketoconazole oral tablet

*TRIAZOLES***

fluconazole oral suspension reconstituted Diflucan

fluconazole oral tablet Diflucan

itraconazole oral capsule Sporanox PA; QL

voriconazole oral suspension reconstituted Vfend PA

voriconazole oral tablet Vfend PA

*ANTIHISTAMINES*

*ANTIHISTAMINES - ALKYLAMINES***

chlorpheniramine maleate oral tablet Chlor-Trimeton AL; OTC

DIABETIC TUSSIN ALLERGY ORAL

SYRUP

AL; OTC

*ANTIHISTAMINES -

ETHANOLAMINES***

carbinoxamine maleate oral solution AL

carbinoxamine maleate oral tablet AL

diphenhydramine hcl childrens oral liquid Banophen OTC; QL

diphenhydramine hcl oral capsule 25 mg Banophen AL; OTC; QL

diphenhydramine hcl oral capsule 50 mg Banophen AL; OTC

diphenhydramine hcl oral liquid Banophen OTC; QL

diphenhydramine hcl oral tablet Alka-Seltzer Plus Allergy AL; OTC; QL

kls allergy medicine oral tablet Alka-Seltzer Plus Allergy AL; OTC; QL

Drug Name Reference Notes

*ANTIHISTAMINES - NON-

SEDATING***

all day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

all-day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

ALLEGRA HIVES 24HR ORAL TABLET PA; OTC; QL

allergy (cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

allergy 24hour indoor/outdoor oral tablet KLS Aller-Tec PA; OTC; QL

allergy childrens oral suspension Allegra Allergy Childrens AL; OTC; QL

allergy relief (cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

allergy relief cetirizine oral tablet 10 mg KLS Aller-Tec PA; OTC; QL

allergy relief cetirizine oral tablet 5 mg PA; AL; OTC; QL

allergy relief childrens 24-hr oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

allergy relief childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

allergy relief/indoor/outdoor oral tablet KLS Aller-Tec PA; OTC; QL

cetirizine hcl allergy child oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

cetirizine hcl childrens alrgy oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

cetirizine hcl oral tablet 10 mg KLS Aller-Tec PA; OTC; QL

cetirizine hcl oral tablet 5 mg PA; AL; OTC; QL

childrens 24 hour allergy oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

cvs allergy relief childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

cvs allergy relief(cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

cvs indoor/outdoor allergy rlf oral tablet KLS Aller-Tec PA; OTC; QL

eq allerg relief child (cetir) oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

eq allergy relief (cetirizine) oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

eq allergy relief (cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

eql all day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

eql all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

fexofenadine hcl oral tablet Allegra Allergy PA; OTC; QL

gnp all day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

gnp all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

goodsense all day allergy oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

goodsense all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

hm all day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

hm allergy relief (cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

hm cetirizine hcl oral tablet KLS Aller-Tec PA; OTC; QL

Drug Name Reference Notes

KLS ALLER-TEC CHILDRENS ORAL

SOLUTION

PA; AL; OTC; QL

KLS ALLER-TEC ORAL TABLET PA; OTC; QL

loratadine oral solution Claritin AL; OTC; QL

loratadine oral tablet dispersible Alavert OTC; QL

px allergy relief cetirizine oral tablet KLS Aller-Tec PA; OTC; QL

px childrens allergy oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

qc all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

qc allergy relief childrens oral syrup KLS Aller-Tec Childrens PA; AL; OTC; QL

qc cetirizine allergy relief oral tablet KLS Aller-Tec PA; OTC; QL

qc childrens allergy oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

ra allergy relief (cetirizine) oral tablet KLS Aller-Tec PA; OTC; QL

ra allergy relief childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

ra allergy relief childrens oral syrup KLS Aller-Tec Childrens PA; AL; OTC; QL

sb allergy oral tablet KLS Aller-Tec PA; OTC; QL

sb cetirizine hcl childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

sm all day allergy childrens oral solution KLS Aller-Tec Childrens PA; AL; OTC; QL

sm all day allergy oral tablet KLS Aller-Tec PA; OTC; QL

WAL-ZYR ALL DAY ALLERGY CHILD

ORAL SOLUTION

PA; AL; OTC; QL

WAL-ZYR ALLERGY CHILDRENS ORAL

SOLUTION

PA; AL; OTC; QL

WAL-ZYR CHILDRENS ORAL SOLUTION PA; AL; OTC; QL

WAL-ZYR ORAL SOLUTION PA; AL; OTC; QL

WAL-ZYR ORAL TABLET PA; OTC; QL

*ANTIHISTAMINES -

PHENOTHIAZINES***

promethazine hcl oral solution AL; QL

promethazine hcl oral syrup AL; QL

promethazine hcl oral tablet AL; QL

promethazine hcl rectal suppository Promethegan AL; QL

PROMETHEGAN RECTAL SUPPOSITORY AL; QL

*ANTIHISTAMINES - PIPERIDINES***

cyproheptadine hcl oral syrup

cyproheptadine hcl oral tablet

*ANTIHYPERLIPIDEMICS*

*BILE ACID SEQUESTRANTS***

cholestyramine light oral packet Prevalite QL

Drug Name Reference Notes

cholestyramine light oral powder Prevalite QL

cholestyramine oral packet Questran QL

cholestyramine oral powder Questran QL

colestipol hcl oral granules Colestid QL

colestipol hcl oral packet Colestid QL

colestipol hcl oral tablet Colestid QL

PREVALITE ORAL PACKET QL

PREVALITE ORAL POWDER QL

*FIBRIC ACID DERIVATIVES***

fenofibrate micronized oral capsule QL

fenofibrate oral capsule QL

fenofibrate oral tablet Tricor QL

fenofibric acid oral capsule delayed release Trilipix QL

gemfibrozil oral tablet Lopid QL

*HMG COA REDUCTASE

INHIBITORS***

atorvastatin calcium oral tablet 10 mg, 20

mg, 40 mg

Lipitor DO; QL

atorvastatin calcium oral tablet 80 mg Lipitor QL

lovastatin oral tablet 10 mg, 20 mg DO; QL

lovastatin oral tablet 40 mg QL

pravastatin sodium oral tablet 10 mg, 20 mg,

40 mg

DO; QL

pravastatin sodium oral tablet 80 mg QL

rosuvastatin calcium oral tablet 10 mg, 20

mg, 5 mg

Crestor DO; QL

rosuvastatin calcium oral tablet 40 mg Crestor QL

simvastatin oral tablet 10 mg, 20 mg Zocor DO; QL

simvastatin oral tablet 40 mg Zocor QL

simvastatin oral tablet 5 mg DO; QL

simvastatin oral tablet 80 mg PA; QL

*INTESTINAL CHOLESTEROL

ABSORPTION INHIBITORS***

ezetimibe oral tablet Zetia QL

*NICOTINIC ACID DERIVATIVES***

niacin (antihyperlipidemic) oral tablet Niacor PA; OTC; QL

NIACOR ORAL TABLET PA; QL

Drug Name Reference Notes

*PCSK9 INHIBITORS***

REPATHA PUSHTRONEX SYSTEM

SUBCUTANEOUS SOLUTION

CARTRIDGE

PA; QL

REPATHA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; QL

REPATHA SURECLICK SUBCUTANEOUS

SOLUTION AUTO-INJECTOR

PA; QL

*ANTIHYPERTENSIVES*

*ACE INHIBITOR & CALCIUM

CHANNEL BLOCKER

COMBINATIONS***

amlodipine besy-benazepril hcl oral capsule

10-20 mg, 10-40 mg

Lotrel QL

amlodipine besy-benazepril hcl oral capsule

2.5-10 mg

DO; QL

amlodipine besy-benazepril hcl oral capsule

5-10 mg, 5-20 mg

Lotrel DO; QL

amlodipine besy-benazepril hcl oral capsule

5-40 mg

*ACE INHIBITORS &

THIAZIDE/THIAZIDE-LIKE***

benazepril-hydrochlorothiazide oral tablet

10-12.5 mg

Lotensin HCT DO; QL

benazepril-hydrochlorothiazide oral tablet

20-12.5 mg, 20-25 mg

Lotensin HCT QL

benazepril-hydrochlorothiazide oral tablet 5-

6.25 mg

DO; QL

captopril-hydrochlorothiazide oral tablet QL

enalapril-hydrochlorothiazide oral tablet 10-

25 mg

Vaseretic QL

enalapril-hydrochlorothiazide oral tablet 5-

12.5 mg

DO; QL

fosinopril sodium-hctz oral tablet 10-12.5 mg DO; QL

fosinopril sodium-hctz oral tablet 20-12.5 mg QL

lisinopril-hydrochlorothiazide oral tablet 10-

12.5 mg

Zestoretic DO; QL

lisinopril-hydrochlorothiazide oral tablet 20-

12.5 mg, 20-25 mg

Zestoretic QL

quinapril-hydrochlorothiazide oral tablet Accuretic QL

Drug Name Reference Notes

*ACE INHIBITORS***

benazepril hcl oral tablet 10 mg, 20 mg Lotensin DO; QL

benazepril hcl oral tablet 40 mg Lotensin QL

benazepril hcl oral tablet 5 mg DO; QL

captopril oral tablet 100 mg QL

captopril oral tablet 12.5 mg, 25 mg, 50 mg DO; QL

enalapril maleate oral tablet 10 mg, 2.5 mg,

5 mg

Vasotec DO; QL

enalapril maleate oral tablet 20 mg Vasotec QL

fosinopril sodium oral tablet 10 mg, 20 mg DO; QL

fosinopril sodium oral tablet 40 mg QL

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 5

Zestril DO; QL

lisinopril oral tablet 30 mg, 40 mg Zestril QL

moexipril hcl oral tablet 15 mg QL

moexipril hcl oral tablet 7.5 mg DO; QL

perindopril erbumine oral tablet 2 mg, 4 mg DO; QL

perindopril erbumine oral tablet 8 mg QL

quinapril hcl oral tablet 10 mg, 20 mg, 5 mg Accupril DO; QL

quinapril hcl oral tablet 40 mg Accupril QL

ramipril oral capsule 1.25 mg, 2.5 mg, 5 mg Altace DO; QL

ramipril oral capsule 10 mg Altace QL

trandolapril oral tablet 1 mg, 2 mg DO; QL

trandolapril oral tablet 4 mg QL

*ANGIOTENSIN II RECEPTOR ANTAG

& THIAZIDE/THIAZIDE-LIKE***

candesartan cilexetil-hctz oral tablet Atacand HCT QL

irbesartan-hydrochlorothiazide oral tablet Avalide QL

losartan potassium-hctz oral tablet 100-12.5

mg, 100-25 mg

Hyzaar QL

losartan potassium-hctz oral tablet 50-12.5

Hyzaar DO; QL

valsartan-hydrochlorothiazide oral tablet

160-12.5 mg, 80-12.5 mg

Diovan HCT DO; QL

valsartan-hydrochlorothiazide oral tablet

160-25 mg, 320-12.5 mg, 320-25 mg

Diovan HCT QL

Drug Name Reference Notes

*ANGIOTENSIN II RECEPTOR

ANTAGONISTS***

candesartan cilexetil oral tablet 16 mg, 32

Atacand QL

candesartan cilexetil oral tablet 4 mg, 8 mg Atacand DO; QL

irbesartan oral tablet 150 mg, 75 mg Avapro DO; QL

irbesartan oral tablet 300 mg Avapro QL

losartan potassium oral tablet 100 mg, 50

Cozaar QL

losartan potassium oral tablet 25 mg Cozaar DO; QL

valsartan oral tablet 160 mg, 320 mg Diovan QL

valsartan oral tablet 40 mg, 80 mg Diovan DO; QL

*ANTIADRENERGICS - CENTRALLY

ACTING***

clonidine hcl oral tablet 0.1 mg, 0.2 mg DO; QL

clonidine hcl oral tablet 0.3 mg QL

clonidine transdermal patch weekly Catapres-TTS-1 QL

guanfacine hcl oral tablet QL

methyldopa oral tablet 250 mg DO; QL

methyldopa oral tablet 500 mg QL

*ANTIADRENERGICS -

PERIPHERALLY ACTING***

doxazosin mesylate oral tablet Cardura QL

prazosin hcl oral capsule Minipress

terazosin hcl oral capsule QL

*BETA BLOCKER & DIURETIC

COMBINATIONS***

atenolol-chlorthalidone oral tablet Tenoretic 100 QL

bisoprolol-hydrochlorothiazide oral tablet Ziac QL

metoprolol-hydrochlorothiazide oral tablet QL

*VASODILATORS***

hydralazine hcl oral tablet

minoxidil oral tablet

*ANTI-INFECTIVE AGENTS - MISC.*

*ANTI-INFECTIVE AGENTS - MISC.***

metronidazole oral capsule Flagyl

metronidazole oral tablet

tinidazole oral tablet QL

Drug Name Reference Notes

trimethoprim oral tablet

*ANTI-INFECTIVE MISC. -

COMBINATIONS***

sulfamethoxazole-trimethoprim oral

suspension

Sulfatrim Pediatric

sulfamethoxazole-trimethoprim oral tablet Bactrim

SULFATRIM PEDIATRIC ORAL

SUSPENSION

*GLYCOPEPTIDES***

vancomycin hcl oral capsule Vancocin PA; QL

*LEPROSTATICS***

dapsone oral tablet

*LINCOSAMIDES***

clindamycin hcl oral capsule Cleocin

clindamycin palmitate hcl oral solution

reconstituted

Cleocin

*OXAZOLIDINONES***

linezolid oral suspension reconstituted Zyvox QL

linezolid oral tablet Zyvox QL

*URINARY ANTI-INFECTIVES***

methenamine hippurate oral tablet Hiprex

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd macro oral capsule Macrobid

*ANTIMALARIALS*

*ANTIMALARIAL COMBINATIONS***

atovaquone-proguanil hcl oral tablet Malarone

*ANTIMALARIALS***

chloroquine phosphate oral tablet

hydroxychloroquine sulfate oral tablet Plaquenil QL

mefloquine hcl oral tablet QL

primaquine phosphate oral tablet

*ANTIMYASTHENIC/CHOLINERGIC

AGENTS*

*ANTIMYASTHENIC/CHOLINERGIC

AGENTS***

pyridostigmine bromide er oral tablet

extended release

Mestinon

pyridostigmine bromide oral solution Mestinon

Drug Name Reference Notes

pyridostigmine bromide oral tablet Mestinon

*ANTIMYCOBACTERIAL AGENTS*

*ANTIMYCOBACTERIAL AGENTS***

ethambutol hcl oral tablet Myambutol

isoniazid oral syrup

isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule

*ANTINEOPLASTICS AND

ADJUNCTIVE THERAPIES*

*ALKYLATING AGENTS***

MYLERAN ORAL TABLET SP

*ANTIANDROGENS***

bicalutamide oral tablet Casodex QL

*ANTIESTROGENS***

tamoxifen citrate oral tablet

*ANTIMETABOLITES***

mercaptopurine oral tablet

methotrexate oral tablet

methotrexate sodium (pf) injection solution

methotrexate sodium injection solution

reconstituted

methotrexate sodium oral tablet

TABLOID ORAL TABLET

*ANTINEOPLASTIC - BCR-ABL

KINASE INHIBITORS***

imatinib mesylate oral tablet Gleevec PA; SP; QL

*ANTINEOPLASTIC - EGFR

INHIBITORS***

gefitinib oral tablet Iressa PA; SP; QL

*ANTINEOPLASTICS MISC.***

hydroxyurea oral capsule Hydrea

*AROMATASE INHIBITORS***

anastrozole oral tablet Arimidex QL

Drug Name Reference Notes

exemestane oral tablet Aromasin QL

letrozole oral tablet Femara QL

*ESTROGENS-ANTINEOPLASTIC***

EMCYT ORAL CAPSULE PA; SP

*FOLIC ACID ANTAGONISTS RESCUE

AGENTS***

leucovorin calcium oral tablet

*MITOTIC INHIBITORS***

etoposide oral capsule SP

*NITROGEN MUSTARDS AND

RELATED ANALOGUES***

cyclophosphamide oral capsule SP

LEUKERAN ORAL TABLET

melphalan oral tablet Alkeran SP

*PROGESTINS-ANTINEOPLASTIC***

hydroxyprogesterone caproate intramuscular

solution

PA; SP

megestrol acetate oral suspension

megestrol acetate oral tablet PA

*RETINOIDS***

tretinoin oral capsule

*URINARY TRACT PROTECTIVE

AGENTS***

MESNEX ORAL TABLET PA

*ANTIPARKINSON AND RELATED

THERAPY AGENTS*

*ANTIPARKINSON

ANTICHOLINERGICS***

benztropine mesylate oral tablet

trihexyphenidyl hcl oral solution

trihexyphenidyl hcl oral tablet

*ANTIPARKINSON

DOPAMINERGICS***

amantadine hcl oral capsule QL

amantadine hcl oral solution QL

amantadine hcl oral tablet QL

bromocriptine mesylate oral capsule Parlodel

bromocriptine mesylate oral tablet Parlodel

Drug Name Reference Notes

*ANTIPARKINSON MONOAMINE

OXIDASE INHIBITORS***

selegiline hcl oral capsule

selegiline hcl oral tablet

*LEVODOPA COMBINATIONS***

carbidopa-levodopa er oral tablet extended

release

carbidopa-levodopa oral tablet Dhivy

carbidopa-levodopa oral tablet dispersible

carbidopa-levodopa-entacapone oral tablet Stalevo 100

*NONERGOLINE DOPAMINE

RECEPTOR AGONISTS***

pramipexole dihydrochloride oral tablet QL

ropinirole hcl oral tablet

*PERIPHERAL COMT INHIBITORS***

entacapone oral tablet Comtan QL

*ANTIPSYCHOTICS/ANTIMANIC

AGENTS*

*ANTIMANIC AGENTS***

lithium carbonate er oral tablet extended

release

Lithobid

lithium carbonate oral capsule

lithium carbonate oral tablet

*ANTIPSYCHOTICS - MISC.***

CAPLYTA ORAL CAPSULE 10.5 MG, 21

CAPLYTA ORAL CAPSULE 42 MG AL; QL

EQUETRO ORAL CAPSULE EXTENDED

RELEASE 12 HOUR

PA; QL

lurasidone hcl oral tablet Latuda AL; QL

NUPLAZID ORAL CAPSULE SP; QL

NUPLAZID ORAL TABLET SP; QL

VRAYLAR ORAL CAPSULE AL; QL

VRAYLAR ORAL CAPSULE THERAPY

PACK

ziprasidone hcl oral capsule Geodon AL; QL

ziprasidone mesylate intramuscular solution

reconstituted

Geodon AL

Drug Name Reference Notes

*BENZISOXAZOLES***

FANAPT ORAL TABLET AL; QL

FANAPT TITRATION PACK ORAL

TABLET

AL; QL

INVEGA HAFYERA INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

INVEGA SUSTENNA INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

INVEGA TRINZA INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

paliperidone er oral tablet extended release

24 hour

Invega AL; QL

PERSERIS SUBCUTANEOUS PREFILLED

SYRINGE

AL; QL

RISPERDAL CONSTA INTRAMUSCULAR

SUSPENSION RECONSTITUTED ER

AL; QL

risperidone oral solution RisperDAL AL; QL

risperidone oral tablet RisperDAL AL; QL

risperidone oral tablet dispersible AL; QL

*BUTYROPHENONES***

HALDOL DECANOATE INTRAMUSCULAR

SOLUTION

haloperidol decanoate intramuscular solution Haldol Decanoate AL

haloperidol lactate injection solution AL

haloperidol lactate oral concentrate AL

haloperidol oral tablet AL; QL

*DIBENZODIAZEPINES***

clozapine oral tablet Clozaril AL; QL

clozapine oral tablet dispersible AL; QL

VERSACLOZ ORAL SUSPENSION AL; QL

*DIBENZO-OXEPINO PYRROLES***

asenapine maleate sublingual tablet

sublingual

Saphris AL; QL

*DIBENZOTHIAZEPINES***

quetiapine fumarate er oral tablet extended

release 24 hour

SEROquel XR AL; QL

quetiapine fumarate oral tablet SEROquel AL; QL

Drug Name Reference Notes

*DIBENZOXAZEPINES***

ADASUVE INHALATION AEROSOL

POWDER BREATH ACTIVATED

loxapine succinate oral capsule AL; QL

*DIHYDROINDOLONES***

molindone hcl oral tablet AL; QL

*PHENOTHIAZINES***

chlorpromazine hcl injection solution

chlorpromazine hcl oral concentrate QL

chlorpromazine hcl oral tablet QL

COMPRO RECTAL SUPPOSITORY

fluphenazine decanoate injection solution AL

fluphenazine hcl injection solution AL

fluphenazine hcl oral concentrate AL

fluphenazine hcl oral elixir AL

fluphenazine hcl oral tablet AL; QL

perphenazine oral tablet AL; QL

prochlorperazine maleate oral tablet

prochlorperazine rectal suppository Compro

thioridazine hcl oral tablet AL; QL

trifluoperazine hcl oral tablet AL; QL

*QUINOLINONE DERIVATIVES***

ABILIFY MAINTENA INTRAMUSCULAR

PREFILLED SYRINGE

AL; QL

ABILIFY MAINTENA INTRAMUSCULAR

SUSPENSION RECONSTITUTED ER

AL; QL

ABILIFY MYCITE MAINTENANCE KIT

ORAL TABLET THERAPY PACK

AL; QL

ABILIFY MYCITE STARTER KIT ORAL

TABLET THERAPY PACK

AL; QL

aripiprazole oral solution AL; QL

aripiprazole oral tablet Abilify AL; QL

aripiprazole oral tablet dispersible AL; QL

ARISTADA INITIO INTRAMUSCULAR

PREFILLED SYRINGE

AL; QL

ARISTADA INTRAMUSCULAR

PREFILLED SYRINGE

AL; QL

REXULTI ORAL TABLET AL; QL

Drug Name Reference Notes

*THIENBENZODIAZEPINES***

olanzapine intramuscular solution

reconstituted

ZyPREXA AL; QL

olanzapine oral tablet ZyPREXA AL; QL

olanzapine oral tablet dispersible ZyPREXA Zydis AL; QL

ZYPREXA RELPREVV INTRAMUSCULAR

SUSPENSION RECONSTITUTED

AL; QL

*THIOXANTHENES***

thiothixene oral capsule AL; QL

*ANTIVIRALS*

*ANTIRETROVIRAL

COMBINATIONS***

abacavir sulfate-lamivudine oral tablet Epzicom SP; QL

BIKTARVY ORAL TABLET SP; QL

CIMDUO ORAL TABLET SP; QL

DOVATO ORAL TABLET SP; QL

emtricitabine-tenofovir df oral tablet Truvada SP; QL

EVOTAZ ORAL TABLET SP; QL

GENVOYA ORAL TABLET SP; QL

JULUCA ORAL TABLET PA; SP; QL

lamivudine-zidovudine oral tablet Combivir SP; QL

lopinavir-ritonavir oral solution Kaletra SP; QL

PREZCOBIX ORAL TABLET SP; QL

STRIBILD ORAL TABLET SP; QL

TRIUMEQ ORAL TABLET SP; QL

*ANTIRETROVIRALS - CCR5

ANTAGONISTS (ENTRY INHIBITOR)***

maraviroc oral tablet Selzentry SP; QL

SELZENTRY ORAL SOLUTION SP; QL

SELZENTRY ORAL TABLET SP; QL

*ANTIRETROVIRALS - FUSION

INHIBITORS***

FUZEON SUBCUTANEOUS SOLUTION

RECONSTITUTED

PA; SP; QL

Drug Name Reference Notes

*ANTIRETROVIRALS - GP120-

DIRECTED ATTACHMENT

INHIBITOR***

RUKOBIA ORAL TABLET EXTENDED

RELEASE 12 HOUR

PA; SP; QL

*ANTIRETROVIRALS - INTEGRASE

INHIBITORS***

ISENTRESS HD ORAL TABLET SP; QL

ISENTRESS ORAL PACKET SP; QL

ISENTRESS ORAL TABLET SP; QL

ISENTRESS ORAL TABLET CHEWABLE SP; QL

TIVICAY ORAL TABLET SP; QL

TIVICAY PD ORAL TABLET SOLUBLE SP; QL

*ANTIRETROVIRALS - PROTEASE

INHIBITORS***

APTIVUS ORAL CAPSULE PA; SP; QL

atazanavir sulfate oral capsule Reyataz SP; QL

PREZISTA ORAL SUSPENSION SP; QL

PREZISTA ORAL TABLET SP; QL

REYATAZ ORAL PACKET SP; QL

ritonavir oral tablet Norvir SP; QL

*ANTIRETROVIRALS - RTI-NON-

NUCLEOSIDE ANALOGUES***

EDURANT ORAL TABLET PA; SP; QL

etravirine oral tablet Intelence PA; SP; QL

INTELENCE ORAL TABLET PA; SP; QL

nevirapine er oral tablet extended release 24

hour

SP; QL

nevirapine oral suspension SP; QL

nevirapine oral tablet SP; QL

PIFELTRO ORAL TABLET SP; QL

*ANTIRETROVIRALS - RTI-

NUCLEOSIDE ANALOGUES-

PURINES***

abacavir sulfate oral solution Ziagen SP; QL

abacavir sulfate oral tablet Ziagen SP; QL

Drug Name Reference Notes

*ANTIRETROVIRALS - RTI-

NUCLEOSIDE ANALOGUES-

PYRIMIDINES***

emtricitabine oral capsule Emtriva SP; QL

EMTRIVA ORAL SOLUTION SP; QL

lamivudine oral solution Epivir SP; QL

lamivudine oral tablet Epivir SP; QL

*ANTIRETROVIRALS - RTI-

NUCLEOSIDE ANALOGUES-

THYMIDINES***

stavudine oral capsule SP; QL

zidovudine oral capsule Retrovir SP; QL

zidovudine oral syrup Retrovir SP; QL

zidovudine oral tablet SP; QL

*ANTIRETROVIRALS - RTI-

NUCLEOTIDE ANALOGUES***

tenofovir disoproxil fumarate oral tablet Viread PA; SP; QL

VIREAD ORAL POWDER PA; SP; QL

VIREAD ORAL TABLET PA; SP; QL

*ANTIRETROVIRALS ADJUVANTS***

TYBOST ORAL TABLET SP; QL

*CMV AGENTS***

valganciclovir hcl oral solution reconstituted Valcyte SP

valganciclovir hcl oral tablet Valcyte SP

*HEPATITIS B AGENTS***

adefovir dipivoxil oral tablet PA; SP; QL

BARACLUDE ORAL SOLUTION PA; SP; QL

entecavir oral tablet Baraclude PA; SP; QL

lamivudine oral tablet PA; SP; QL

*HERPES AGENTS - PURINE

ANALOGUES***

acyclovir oral capsule

acyclovir oral suspension

acyclovir oral tablet

valacyclovir hcl oral tablet Valtrex QL

*HERPES AGENTS - THYMIDINE

ANALOGUES***

famciclovir oral tablet QL

Drug Name Reference Notes

*INFLUENZA AGENTS***

rimantadine hcl oral tablet

*NEURAMINIDASE INHIBITORS***

oseltamivir phosphate oral capsule Tamiflu QL

oseltamivir phosphate oral suspension

reconstituted

Tamiflu QL

RELENZA DISKHALER INHALATION

AEROSOL POWDER BREATH

ACTIVATED

*PA ENDONUCLEASE INHIBITORS***

XOFLUZA (40 MG DOSE) ORAL TABLET

THERAPY PACK

XOFLUZA (80 MG DOSE) ORAL TABLET

THERAPY PACK

*BETA BLOCKERS*

*ALPHA-BETA BLOCKERS***

carvedilol oral tablet 12.5 mg, 3.125 mg,

6.25 mg

Coreg DO; QL

carvedilol oral tablet 25 mg Coreg QL

labetalol hcl oral tablet 100 mg, 200 mg DO; QL

labetalol hcl oral tablet 300 mg QL

*BETA BLOCKERS CARDIO-

SELECTIVE***

acebutolol hcl oral capsule QL

atenolol oral tablet 100 mg Tenormin QL

atenolol oral tablet 25 mg, 50 mg Tenormin DO; QL

betaxolol hcl oral tablet 10 mg DO; QL

betaxolol hcl oral tablet 20 mg QL

bisoprolol fumarate oral tablet 10 mg QL

bisoprolol fumarate oral tablet 5 mg DO; QL

metoprolol succinate er oral tablet extended

release 24 hour 100 mg, 200 mg, 50 mg

Toprol XL QL

metoprolol succinate er oral tablet extended

release 24 hour 25 mg

Toprol XL DO; QL

metoprolol tartrate oral tablet Lopressor QL

*BETA BLOCKERS NON-

SELECTIVE***

HEMANGEOL ORAL SOLUTION

Drug Name Reference Notes

INDERAL XL ORAL CAPSULE

EXTENDED RELEASE 24 HOUR

PA; QL

INNOPRAN XL ORAL CAPSULE

EXTENDED RELEASE 24 HOUR

PA; QL

nadolol oral tablet 20 mg, 40 mg Corgard DO; QL

nadolol oral tablet 80 mg QL

pindolol oral tablet 10 mg QL

pindolol oral tablet 5 mg DO; QL

propranolol hcl er oral capsule extended

release 24 hour 120 mg, 60 mg, 80 mg

Inderal LA DO; QL

propranolol hcl er oral capsule extended

release 24 hour 160 mg

Inderal LA QL

propranolol hcl intravenous solution

propranolol hcl oral solution QL

propranolol hcl oral tablet 10 mg, 20 mg, 40

mg, 60 mg

DO; QL

propranolol hcl oral tablet 80 mg QL

SORINE ORAL TABLET QL

sotalol hcl (af) oral tablet Betapace AF

sotalol hcl oral tablet Sorine QL

timolol maleate oral tablet 10 mg, 20 mg QL

timolol maleate oral tablet 5 mg DO; QL

*CALCIUM CHANNEL BLOCKERS*

*CALCIUM CHANNEL BLOCKERS***

amlodipine besylate oral tablet 10 mg Norvasc QL

amlodipine besylate oral tablet 2.5 mg, 5 mg Norvasc DO; QL

CARTIA XT ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 120 MG

DO; QL

CARTIA XT ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 180 MG, 240 MG, 300

diltiazem hcl er beads oral capsule extended

release 24 hour 120 mg, 240 mg

Taztia XT DO; QL

diltiazem hcl er beads oral capsule extended

release 24 hour 180 mg, 300 mg, 360 mg

Taztia XT QL

diltiazem hcl er beads oral capsule extended

release 24 hour 420 mg

Tiadylt ER QL

diltiazem hcl er coated beads oral capsule

extended release 24 hour 120 mg

Cartia XT DO; QL

Drug Name Reference Notes

diltiazem hcl er coated beads oral capsule

extended release 24 hour 180 mg, 240 mg,

300 mg

Cartia XT QL

diltiazem hcl er coated beads oral capsule

extended release 24 hour 360 mg

Cardizem CD QL

diltiazem hcl er oral capsule extended

release 24 hour 120 mg

DO; QL

diltiazem hcl er oral capsule extended

release 24 hour 180 mg, 240 mg

diltiazem hcl oral tablet 120 mg Cardizem QL

diltiazem hcl oral tablet 30 mg, 60 mg Cardizem DO; QL

diltiazem hcl oral tablet 90 mg QL

dilt-xr oral capsule extended release 24 hour

120 mg

DO; QL

dilt-xr oral capsule extended release 24 hour

180 mg, 240 mg

felodipine er oral tablet extended release 24

hour 10 mg

felodipine er oral tablet extended release 24

hour 2.5 mg, 5 mg

DO; QL

isradipine oral capsule 2.5 mg DO; QL

isradipine oral capsule 5 mg QL

nicardipine hcl oral capsule QL

nifedipine er oral tablet extended release 24

hour

nifedipine er osmotic release oral tablet

extended release 24 hour 30 mg

Procardia XL DO; QL

nifedipine er osmotic release oral tablet

extended release 24 hour 60 mg, 90 mg

Procardia XL QL

nifedipine oral capsule 10 mg DO; QL

nifedipine oral capsule 20 mg QL

TAZTIA XT ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 120 MG, 240 MG

DO; QL

TAZTIA XT ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 180 MG, 300 MG, 360

TIADYLT ER ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 120 MG, 240 MG

DO; QL

TIADYLT ER ORAL CAPSULE EXTENDED

RELEASE 24 HOUR 180 MG, 300 MG, 360

MG, 420 MG

Drug Name Reference Notes

verapamil hcl er oral capsule extended

release 24 hour 100 mg

Verelan PM DO; QL

verapamil hcl er oral capsule extended

release 24 hour 120 mg, 180 mg

Verelan DO; QL

verapamil hcl er oral capsule extended

release 24 hour 200 mg, 300 mg

Verelan PM QL

verapamil hcl er oral capsule extended

release 24 hour 240 mg, 360 mg

Verelan QL

verapamil hcl er oral tablet extended release

120 mg

DO; QL

verapamil hcl er oral tablet extended release

180 mg, 240 mg

verapamil hcl oral tablet 120 mg QL

verapamil hcl oral tablet 40 mg, 80 mg DO; QL

*CARDIOTONICS*

*CARDIAC GLYCOSIDES***

DIGOX ORAL TABLET 125 MCG DO; QL

DIGOX ORAL TABLET 250 MCG QL

digoxin oral solution

digoxin oral tablet 125 mcg Digox DO; QL

digoxin oral tablet 250 mcg Digox QL

digoxin oral tablet 62.5 mcg Lanoxin DO; QL

LANOXIN ORAL TABLET 125 MCG, 62.5

MCG

DO; QL

LANOXIN ORAL TABLET 250 MCG QL

*CARDIOVASCULAR AGENTS -

MISC.*

*PULMONARY HYPERTENSION -

ENDOTHELIN RECEPTOR

ANTAGONISTS***

ambrisentan oral tablet Letairis PA; SP; QL

*PULMONARY HYPERTENSION -

PHOSPHODIESTERASE

INHIBITORS***

ALYQ ORAL TABLET PA; SP; QL

sildenafil citrate oral tablet Revatio PA; SP; QL

tadalafil (pah) oral tablet Alyq PA; SP; QL

Drug Name Reference Notes

*CEPHALOSPORINS*

*CEPHALOSPORINS - 1ST

GENERATION***

cefadroxil oral capsule

cefadroxil oral suspension reconstituted

cefadroxil oral tablet

cephalexin oral capsule

cephalexin oral suspension reconstituted

cephalexin oral tablet

*CEPHALOSPORINS - 2ND

GENERATION***

cefaclor er oral tablet extended release 12

hour

cefaclor oral capsule

cefaclor oral suspension reconstituted

cefprozil oral suspension reconstituted

cefprozil oral tablet

cefuroxime axetil oral tablet 250 mg

cefuroxime axetil oral tablet 500 mg QL

*CEPHALOSPORINS - 3RD

GENERATION***

cefdinir oral capsule

cefdinir oral suspension reconstituted

cefpodoxime proxetil oral suspension

reconstituted

cefpodoxime proxetil oral tablet

*CONTRACEPTIVES*

*BIPHASIC CONTRACEPTIVES -

ORAL***

AZURETTE ORAL TABLET AL; QL

desogestrel-ethinyl estradiol oral tablet Azurette AL; QL

KARIVA ORAL TABLET AL; QL

PIMTREA ORAL TABLET AL; QL

SIMLIYA ORAL TABLET AL; QL

viorele oral tablet Azurette AL; QL

VOLNEA ORAL TABLET AL; QL

Drug Name Reference Notes

*COMBINATION CONTRACEPTIVES -

ORAL***

AFIRMELLE ORAL TABLET AL; QL

ALTAVERA ORAL TABLET AL; QL

alyacen 1/35 oral tablet Dasetta 1/35 AL; QL

APRI ORAL TABLET AL; QL

AUBRA EQ ORAL TABLET AL; QL

AUROVELA 1.5/30 ORAL TABLET AL; QL

AUROVELA 1/20 ORAL TABLET AL; QL

AUROVELA 24 FE ORAL TABLET AL; QL

AUROVELA FE 1.5/30 ORAL TABLET AL; QL

AUROVELA FE 1/20 ORAL TABLET AL; QL

AVIANE ORAL TABLET AL; QL

AYUNA ORAL TABLET AL; QL

BALZIVA ORAL TABLET AL; QL

BLISOVI 24 FE ORAL TABLET AL; QL

BLISOVI FE 1.5/30 ORAL TABLET AL; QL

BLISOVI FE 1/20 ORAL TABLET AL; QL

briellyn oral tablet Balziva AL; QL

CHARLOTTE 24 FE ORAL TABLET

CHEWABLE

AL; QL

CHATEAL EQ ORAL TABLET AL; QL

CRYSELLE-28 ORAL TABLET AL; QL

CYRED EQ ORAL TABLET AL; QL

DASETTA 1/35 ORAL TABLET AL; QL

DELYLA ORAL TABLET AL; QL

desogestrel-ethinyl estradiol oral tablet Apri AL; QL

drospiren-eth estrad-levomefol oral tablet Beyaz AL; QL

drospirenone-ethinyl estradiol oral tablet Jasmiel AL; QL

ELINEST ORAL TABLET AL; QL

ENSKYCE ORAL TABLET AL; QL

ESTARYLLA ORAL TABLET AL; QL

ethynodiol diac-eth estradiol oral tablet Kelnor 1/35 AL; QL

FALMINA ORAL TABLET AL; QL

FINZALA ORAL TABLET CHEWABLE AL; QL

GEMMILY ORAL CAPSULE AL; QL

HAILEY 1.5/30 ORAL TABLET AL; QL

Drug Name Reference Notes

HAILEY 24 FE ORAL TABLET AL; QL

HAILEY FE 1.5/30 ORAL TABLET AL; QL

HAILEY FE 1/20 ORAL TABLET AL; QL

ISIBLOOM ORAL TABLET AL; QL

JASMIEL ORAL TABLET AL; QL

JULEBER ORAL TABLET AL; QL

JUNEL 1.5/30 ORAL TABLET AL; QL

JUNEL 1/20 ORAL TABLET AL; QL

JUNEL FE 1.5/30 ORAL TABLET AL; QL

JUNEL FE 1/20 ORAL TABLET AL; QL

JUNEL FE 24 ORAL TABLET AL; QL

KAITLIB FE ORAL TABLET CHEWABLE AL; QL

KALLIGA ORAL TABLET AL; QL

KELNOR 1/35 ORAL TABLET AL; QL

KELNOR 1/50 ORAL TABLET AL; QL

KURVELO ORAL TABLET AL; QL

LARIN 1.5/30 ORAL TABLET AL; QL

LARIN 1/20 ORAL TABLET AL; QL

LARIN 24 FE ORAL TABLET AL; QL

LARIN FE 1.5/30 ORAL TABLET AL; QL

LARIN FE 1/20 ORAL TABLET AL; QL

LAYOLIS FE ORAL TABLET CHEWABLE AL; QL

LESSINA ORAL TABLET AL; QL

levonorgestrel-ethinyl estrad oral tablet Afirmelle AL; QL

LEVORA 0.15/30 (28) ORAL TABLET AL; QL

LOESTRIN 1.5/30 (21) ORAL TABLET AL; QL

LOESTRIN 1/20 (21) ORAL TABLET AL; QL

LOESTRIN FE 1.5/30 ORAL TABLET AL; QL

LOESTRIN FE 1/20 ORAL TABLET AL; QL

LORYNA ORAL TABLET AL; QL

LOW-OGESTREL ORAL TABLET AL; QL

LO-ZUMANDIMINE ORAL TABLET AL; QL

LUTERA ORAL TABLET AL; QL

marlissa oral tablet Altavera AL; QL

MERZEE ORAL CAPSULE AL; QL

MICROGESTIN 1.5/30 ORAL TABLET AL; QL

MICROGESTIN 1/20 ORAL TABLET AL; QL

Drug Name Reference Notes

MICROGESTIN 24 FE ORAL TABLET AL; QL

MICROGESTIN FE 1.5/30 ORAL TABLET AL; QL

MICROGESTIN FE 1/20 ORAL TABLET AL; QL

MILI ORAL TABLET AL; QL

MONO-LINYAH ORAL TABLET AL; QL

NECON 0.5/35 (28) ORAL TABLET AL; QL

NIKKI ORAL TABLET AL; QL

norethin ace-eth estrad-fe oral capsule Gemmily AL; QL

norethin ace-eth estrad-fe oral tablet Aurovela Fe 1.5/30 AL; QL

norethin ace-eth estrad-fe oral tablet

chewable

Charlotte 24 Fe AL; QL

norethindrone acet-ethinyl est oral tablet Aurovela 1.5/30 AL; QL

norethin-eth estradiol-fe oral tablet chewable Kaitlib Fe AL; QL

norgestimate-eth estradiol oral tablet Estarylla AL; QL

NORTREL 0.5/35 (28) ORAL TABLET AL; QL

NORTREL 1/35 (21) ORAL TABLET AL; QL

NORTREL 1/35 (28) ORAL TABLET AL; QL

NYLIA 1/35 ORAL TABLET AL; QL

NYMYO ORAL TABLET AL; QL

OCELLA ORAL TABLET AL; QL

ORSYTHIA ORAL TABLET AL; QL

PHILITH ORAL TABLET AL; QL

PIRMELLA 1/35 ORAL TABLET AL; QL

PORTIA-28 ORAL TABLET AL; QL

RECLIPSEN ORAL TABLET AL; QL

SPRINTEC 28 ORAL TABLET AL; QL

SRONYX ORAL TABLET AL; QL

SYEDA ORAL TABLET AL; QL

TARINA 24 FE ORAL TABLET AL; QL

TARINA FE 1/20 EQ ORAL TABLET AL; QL

TAYSOFY ORAL CAPSULE AL; QL

TYDEMY ORAL TABLET AL; QL

VESTURA ORAL TABLET AL; QL

VIENVA ORAL TABLET AL; QL

VYFEMLA ORAL TABLET AL; QL

VYLIBRA ORAL TABLET AL; QL

WERA ORAL TABLET AL; QL

Drug Name Reference Notes

WYMZYA FE ORAL TABLET CHEWABLE AL; QL

ZOVIA 1/35 (28) ORAL TABLET AL; QL

ZUMANDIMINE ORAL TABLET AL; QL

*COMBINATION CONTRACEPTIVES -

TRANSDERMAL***

XULANE TRANSDERMAL PATCH

WEEKLY

AL; QL

ZAFEMY TRANSDERMAL PATCH

WEEKLY

AL; QL

*COMBINATION CONTRACEPTIVES -

VAGINAL***

ELURYNG VAGINAL RING AL; QL

etonogestrel-ethinyl estradiol vaginal ring EluRyng AL; QL

HALOETTE VAGINAL RING AL; QL

*CONTINUOUS CONTRACEPTIVES -

ORAL***

AMETHYST ORAL TABLET AL; QL

DOLISHALE ORAL TABLET AL; QL

levonorgestrel-ethinyl estrad oral tablet Amethyst AL; QL

*COPPER CONTRACEPTIVES - IUD***

PARAGARD INTRAUTERINE COPPER

INTRAUTERINE INTRAUTERINE DEVICE

*EMERGENCY CONTRACEPTIVES***

AFTERA ORAL TABLET OTC; QL

AFTERPILL ORAL TABLET OTC; QL

CURAE ORAL TABLET OTC; QL

ECONTRA ONE-STEP ORAL TABLET OTC; QL

ELLA ORAL TABLET QL

HER STYLE ORAL TABLET OTC; QL

levonorgestrel oral tablet Aftera OTC; QL

MY CHOICE ORAL TABLET OTC; QL

MY WAY ORAL TABLET OTC; QL

NEW DAY ORAL TABLET OTC; QL

OPCICON ONE-STEP ORAL TABLET OTC; QL

OPTION 2 ORAL TABLET OTC; QL

REACT ORAL TABLET OTC; QL

TAKE ACTION ORAL TABLET OTC; QL

Drug Name Reference Notes

*EXTENDED-CYCLE

CONTRACEPTIVES - ORAL***

AMETHIA ORAL TABLET AL; QL

ASHLYNA ORAL TABLET AL; QL

CAMRESE LO ORAL TABLET AL; QL

CAMRESE ORAL TABLET AL; QL

DAYSEE ORAL TABLET AL; QL

FAYOSIM ORAL TABLET AL; QL

ICLEVIA ORAL TABLET AL; QL

INTROVALE ORAL TABLET AL; QL

JAIMIESS ORAL TABLET AL; QL

JOLESSA ORAL TABLET AL; QL

levonorgest-eth est & eth est oral tablet Fayosim AL; QL

levonorgest-eth estrad 91-day oral tablet Amethia AL; QL

LOJAIMIESS ORAL TABLET AL; QL

RIVELSA ORAL TABLET AL; QL

SETLAKIN ORAL TABLET AL; QL

SIMPESSE ORAL TABLET AL; QL

*PROGESTIN CONTRACEPTIVES -

INJECTABLE***

medroxyprogesterone acetate intramuscular

suspension

Depo-Provera AL; QL

medroxyprogesterone acetate intramuscular

suspension prefilled syringe

Depo-Provera AL; QL

*PROGESTIN CONTRACEPTIVES -

IUD***

KYLEENA INTRAUTERINE

INTRAUTERINE DEVICE

LILETTA (52 MG) INTRAUTERINE

INTRAUTERINE DEVICE

MIRENA (52 MG) INTRAUTERINE

INTRAUTERINE DEVICE

SKYLA INTRAUTERINE INTRAUTERINE

DEVICE

*PROGESTIN CONTRACEPTIVES -

ORAL***

CAMILA ORAL TABLET AL; QL

DEBLITANE ORAL TABLET AL; QL

ERRIN ORAL TABLET AL; QL

Drug Name Reference Notes

HEATHER ORAL TABLET AL; QL

INCASSIA ORAL TABLET AL; QL

JENCYCLA ORAL TABLET AL; QL

LYLEQ ORAL TABLET AL; QL

LYZA ORAL TABLET AL; QL

NORA-BE ORAL TABLET AL; QL

norethindrone oral tablet Camila AL; QL

NORLYDA ORAL TABLET AL; QL

NORLYROC ORAL TABLET AL; QL

SHAROBEL ORAL TABLET AL; QL

*TRIPHASIC CONTRACEPTIVES -

ORAL***

alyacen 7/7/7 oral tablet Dasetta 7/7/7 AL; QL

ARANELLE ORAL TABLET AL; QL

DASETTA 7/7/7 ORAL TABLET AL; QL

ENPRESSE-28 ORAL TABLET AL; QL

LEENA ORAL TABLET AL; QL

LEVONEST ORAL TABLET AL; QL

levonorg-eth estrad triphasic oral tablet Enpresse-28 AL; QL

norethindron-ethinyl estrad-fe oral tablet Tilia Fe AL; QL

norgestim-eth estrad triphasic oral tablet Tri Femynor AL; QL

NORTREL 7/7/7 ORAL TABLET AL; QL

NYLIA 7/7/7 ORAL TABLET AL; QL

PIRMELLA 7/7/7 ORAL TABLET AL; QL

TILIA FE ORAL TABLET AL; QL

TRI FEMYNOR ORAL TABLET AL; QL

TRI-ESTARYLLA ORAL TABLET AL; QL

TRI-LEGEST FE ORAL TABLET AL; QL

TRI-LINYAH ORAL TABLET AL; QL

TRI-LO-ESTARYLLA ORAL TABLET AL; QL

TRI-LO-MARZIA ORAL TABLET AL; QL

TRI-LO-MILI ORAL TABLET AL; QL

TRI-LO-SPRINTEC ORAL TABLET AL; QL

TRI-MILI ORAL TABLET AL; QL

TRI-NYMYO ORAL TABLET AL; QL

TRI-SPRINTEC ORAL TABLET AL; QL

TRIVORA (28) ORAL TABLET AL; QL

Drug Name Reference Notes

TRI-VYLIBRA LO ORAL TABLET AL; QL

TRI-VYLIBRA ORAL TABLET AL; QL

VELIVET ORAL TABLET AL; QL

*CORTICOSTEROIDS*

*GLUCOCORTICOSTEROIDS***

budesonide oral capsule delayed release

particles

DEXAMETHASONE INTENSOL ORAL

CONCENTRATE

dexamethasone oral elixir

dexamethasone oral solution

dexamethasone oral tablet

dexamethasone oral tablet therapy pack HiDex 6-Day

HIDEX 6-DAY ORAL TABLET THERAPY

PACK

hydrocortisone oral tablet Cortef

methylprednisolone oral tablet Medrol

methylprednisolone oral tablet therapy pack Medrol

MILLIPRED ORAL TABLET

prednisolone oral solution

prednisolone oral tablet Millipred

prednisolone sodium phosphate oral solution Pediapred

prednisolone sodium phosphate oral tablet

dispersible 10 mg, 30 mg

Orapred ODT QL

prednisolone sodium phosphate oral tablet

dispersible 15 mg

Orapred ODT DO; QL

PREDNISONE INTENSOL ORAL

CONCENTRATE

prednisone oral solution

prednisone oral tablet

prednisone oral tablet therapy pack

TAPERDEX 6-DAY ORAL TABLET

THERAPY PACK

*MINERALOCORTICOIDS***

fludrocortisone acetate oral tablet

*COUGH/COLD/ALLERGY*

*ANTITUSSIVE - NONNARCOTIC***

benzonatate oral capsule

Drug Name Reference Notes

dextromethorphan polistirex er oral

suspension extended release

Delsym OTC; QL

*ANTITUSSIVE - OPIOID***

hydrocodone bit-homatrop mbr oral solution Hycodan AL

hydrocodone bit-homatrop mbr oral tablet Hycodan AL

hydromet oral solution Hycodan AL

*ANTITUSSIVE-EXPECTORANT***

biocotron oral liquid Diabetic Tussin DM AL; OTC; QL

chest congestion relief dm oral tablet Fenesin DM IR AL; OTC

chest congestion/cough relief oral tablet Fenesin DM IR AL; OTC

cvs chest congestion relief dm oral tablet Fenesin DM IR AL; OTC

dextromethorphan-guaifenesin oral liquid Diabetic Tussin DM AL; OTC; QL

dextromethorphan-guaifenesin oral syrup Robafen DM Cough Clear AL; OTC; QL

dextromethorphan-guaifenesin oral tablet Fenesin DM IR AL; OTC

DIABETIC TUSSIN DM MAX ST ORAL

LIQUID

AL; OTC

DIABETIC TUSSIN DM ORAL LIQUID AL; OTC; QL

eql tussin cough/chest dm max oral liquid

Delsym Cgh/Chest Cong

DM Child

AL; OTC; QL

FENESIN DM IR ORAL TABLET AL; OTC

gnp mucus relief dm oral tablet Fenesin DM IR AL; OTC

gnp tab tussin dm oral tablet Fenesin DM IR AL; OTC

guaiatussin ac oral syrup AL; QL

guaifenesin ac oral syrup AL; OTC; QL

guaifenesin-codeine oral solution AL; OTC; QL

G-ZYNCOF ORAL SYRUP AL; OTC

hm chest congestion relief dm oral tablet Fenesin DM IR AL; OTC

maxi-tuss gmx oral liquid

Diabetic Tussin DM Max

AL; OTC

medi-tussin dm double strength oral liquid AL; OTC; QL

mucus relief dm cough oral tablet Fenesin DM IR AL; OTC

mucus relief dm oral tablet Fenesin DM IR AL; OTC

PECGEN DMX ORAL LIQUID AL; OTC

pharbinex-dm oral tablet Fenesin DM IR AL; OTC

qc medifin dm oral tablet Fenesin DM IR AL; OTC

ra tussin cough/chest dm max oral liquid

Diabetic Tussin DM Max

AL; OTC

refenesen dm oral tablet Fenesin DM IR AL; OTC

Drug Name Reference Notes

sb mucus relief dm oral tablet Fenesin DM IR AL; OTC

SB TAB TUSSIN DM ORAL TABLET AL; OTC

sm chest congestion relief dm oral tablet Fenesin DM IR AL; OTC

supress dm pediatric oral liquid AL; OTC

ZYNCOF ORAL SYRUP AL; OTC

*DECONGESTANT &

ANTIHISTAMINE***

loratadine-d 12hr oral tablet extended

release 12 hour

Alavert Allergy/Sinus AL; OTC

loratadine-d 24hr oral tablet extended

release 24 hour

Claritin-D 24 Hour AL; OTC

promethazine vc oral syrup AL; QL

*EXPECTORANTS***

cvs mucus extended release oral tablet

extended release 12 hour

EQ Mucus ER OTC; QL

eq 12 hour mucus relief oral tablet extended

release 12 hour

EQ Mucus ER OTC; QL

EQ MUCUS ER ORAL TABLET

EXTENDED RELEASE 12 HOUR

OTC; QL

gnp mucus er oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

goodsense mucus er oral tablet extended

release 12 hour

EQ Mucus ER OTC; QL

guaifenesin er oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

mucus relief er oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

mucus relief oral tablet extended release 12

hour

EQ Mucus ER OTC; QL

qc mucus relief oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

ra mucus relief oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

sm mucus relief oral tablet extended release

12 hour

EQ Mucus ER OTC; QL

*MISC. RESPIRATORY INHALANTS***

NEBUSAL INHALATION NEBULIZATION

SOLUTION

PULMOSAL INHALATION NEBULIZATION

SOLUTION

Drug Name Reference Notes

sodium chloride inhalation nebulization

solution

Nebusal

*MUCOLYTICS***

acetylcysteine inhalation solution

*NON-NARC ANTITUSSIVE-

ANTIHISTAMINE***

promethazine-dm oral syrup AL; QL

*OPIOID ANTITUSSIVE-

ANTIHISTAMINE***

promethazine-codeine oral solution AL; QL

promethazine-codeine oral syrup AL; QL

*OPIOID ANTITUSSIVE-

DECONGESTANT-ANTIHISTAMINE***

promethazine vc/codeine oral syrup AL; QL

*DERMATOLOGICALS*

*ACNE ANTIBIOTICS***

CLINDACIN ETZ EXTERNAL SWAB QL

CLINDACIN-P EXTERNAL SWAB QL

clindamycin phosphate external gel Clindagel QL

clindamycin phosphate external solution QL

clindamycin phosphate external swab Clindacin ETZ QL

ery external pad QL

erythromycin external solution QL

*ACNE COMBINATIONS***

clindamycin phos-benzoyl perox external gel Neuac QL

*ACNE PRODUCTS***

ACCUTANE ORAL CAPSULE PA; QL

acne foaming wash external liquid

Medpura Benzoyl

Peroxide

AL; OTC

acne maximum strength external cream Clearasil Daily Clear Acne AL; OTC

acne medication 10 external gel

Clean & Clear Persa-Gel

Max St

OTC; QL

acne medication 2.5 external gel OTC; QL

acne medication 5 external gel

Medpura Benzoyl

Peroxide

OTC; QL

acne treatment external gel

Clean & Clear Persa-Gel

Max St

OTC; QL

Drug Name Reference Notes

acne-clear external gel

Clean & Clear Persa-Gel

Max St

OTC; QL

adapalene external gel Differin QL

adapalene treatment external gel Differin OTC; QL

AMNESTEEM ORAL CAPSULE PA; QL

benzoyl peroxide external gel

Clean & Clear Persa-Gel

Max St

OTC; QL

benzoyl peroxide wash external liquid

Medpura Benzoyl

Peroxide

AL; OTC

bp wash external liquid 10 %, 5 %

Medpura Benzoyl

Peroxide

AL; OTC

bp wash external liquid 2.5 % PanOxyl

CERAVE ACNE FOAMING CREAM

EXTERNAL LIQUID

AL; OTC

CLARAVIS ORAL CAPSULE PA; QL

CLEAN & CLEAR PERSA-GEL MAX ST

EXTERNAL GEL

OTC; QL

CLEARASIL DAILY CLEAR ACNE

EXTERNAL CREAM

AL; OTC

CLEARASIL RAPID RESCUE SPOT

EXTERNAL CREAM

AL; OTC

CLEARSKIN EXTERNAL CREAM AL; OTC

cvs acne treatment external cream Clearasil Daily Clear Acne AL; OTC

cvs adapalene external gel Differin OTC; QL

isotretinoin oral capsule Accutane PA; QL

MEDPURA BENZOYL PEROXIDE

EXTERNAL GEL

OTC; QL

MEDPURA BENZOYL PEROXIDE

EXTERNAL LIQUID

AL; OTC

NEUTROGENA CLEAR PORE EXTERNAL

LIQUID

OTC

PANOXYL CREAMY WASH EXTERNAL

LIQUID

AL; OTC

PANOXYL EXTERNAL LIQUID OTC

PANOXYL FOAMING WASH EXTERNAL

LIQUID

AL; OTC

tretinoin external cream Avita PA; QL

tretinoin external gel Retin-A PA; QL

tretinoin microsphere external gel Retin-A Micro QL

ZENATANE ORAL CAPSULE PA; QL

Drug Name Reference Notes

*ANTIBIOTIC MIXTURES TOPICAL***

poly bacitracin external ointment Neosporin OTC

triple antibiotic external ointment Lanabiotic OTC; QL

*ANTIBIOTICS - TOPICAL***

antibiotic external ointment Bacitraycin Plus OTC; QL

bacitracin external ointment Bacitraycin Plus OTC; QL

bacitracin zinc external ointment OTC; QL

bacitracin zinc-aloe external ointment OTC; QL

BACITRAYCIN PLUS EXTERNAL

OINTMENT

OTC; QL

gentamicin sulfate external cream QL

gentamicin sulfate external ointment QL

mupirocin external ointment QL

*ANTIFUNGALS - TOPICAL

COMBINATIONS***

clotrimazole-betamethasone external cream QL

clotrimazole-betamethasone external lotion QL

*ANTIFUNGALS - TOPICAL***

CICLODAN EXTERNAL SOLUTION PA; QL

ciclopirox external solution Ciclodan PA; QL

ciclopirox olamine external cream QL

ciclopirox olamine external suspension Loprox QL

LOTRIMIN AF EXTERNAL POWDER OTC; QL

NYAMYC EXTERNAL POWDER QL

nystatin external cream QL

nystatin external ointment QL

nystatin external powder Nyamyc QL

NYSTOP EXTERNAL POWDER QL

terbinafine hcl external cream LamISIL AT OTC; QL

tolnaftate antifungal external cream Tinactin OTC; QL

tolnaftate external aerosol powder

Odor Eaters

Foot/Sneaker Spray

OTC; QL

tolnaftate external cream Tinactin OTC; QL

tolnaftate external powder Lotrimin AF OTC; QL

*ANTI-INFLAMMATORY AGENTS -

TOPICAL***

diclofenac sodium external gel Aspercreme Arthritis Pain QL

Drug Name Reference Notes

diclofenac sodium external solution QL

*ANTINEOPLASTIC

ANTIMETABOLITES - TOPICAL***

fluorouracil external cream Efudex QL

fluorouracil external solution PA; QL

*ANTIPSORIATICS - SYSTEMIC***

COSENTYX (300 MG DOSE)

SUBCUTANEOUS SOLUTION PREFILLED

SYRINGE

PA; SP; QL

COSENTYX SENSOREADY (300 MG)

SUBCUTANEOUS SOLUTION AUTO-

INJECTOR

PA; SP; QL

COSENTYX SENSOREADY PEN

SUBCUTANEOUS SOLUTION AUTO-

INJECTOR

PA; SP; QL

COSENTYX SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP; QL

*ANTIPSORIATICS***

calcipotriene external cream QL

calcipotriene external ointment Calcitrene QL

calcipotriene external solution QL

*ANTISEBORRHEIC PRODUCTS***

selenium sulfide external lotion QL

*ANTIVIRALS - TOPICAL***

acyclovir external cream Zovirax PA; QL

acyclovir external ointment Zovirax PA; QL

docosanol external cream Abreva OTC

*BURN PRODUCTS***

silver sulfadiazine external cream

SSD (silver

sulfADIAZINE)

SSD (SILVER SULFADIAZINE)

EXTERNAL CREAM

*CORTICOSTEROIDS - TOPICAL***

ala-cort external cream

Cortizone-10 Intensve

Moisture

anti-itch maximum strength external cream

Cortizone-10 Intensve

Moisture

OTC; QL

AQUAPHOR ITCH RELIEF MAX STR

EXTERNAL OINTMENT

OTC; QL

Drug Name Reference Notes

betamethasone dipropionate aug external

cream

betamethasone dipropionate external lotion QL

betamethasone valerate external cream QL

betamethasone valerate external ointment QL

clobetasol prop emollient base external

cream

clobetasol propionate e external cream QL

clobetasol propionate external cream QL

clobetasol propionate external gel QL

clobetasol propionate external ointment QL

clobetasol propionate external solution QL

CORTIZONE-10 EXTERNAL OINTMENT OTC; QL

CORTIZONE-10 INTENSVE MOISTURE

EXTERNAL CREAM

OTC; QL

CORTIZONE-10 SENSITIVE SKIN

EXTERNAL CREAM

OTC; QL

CORTIZONE-10 SOOTHING ALOE

EXTERNAL CREAM

OTC; QL

DESRX EXTERNAL GEL QL

fluocinonide emulsified base external cream QL

fluocinonide external cream QL

fluocinonide external gel QL

fluocinonide external ointment QL

fluocinonide external solution QL

fluticasone propionate external cream QL

fluticasone propionate external ointment QL

halobetasol propionate external cream QL

halobetasol propionate external ointment QL

hydrocortisone anti-itch external cream

Cortizone-10 Intensve

Moisture

OTC; QL

hydrocortisone external cream 0.5 % OTC; QL

hydrocortisone external cream 1 %

Cortizone-10 Intensve

Moisture

OTC; QL

hydrocortisone external cream 2.5 % QL

hydrocortisone external lotion PA; QL

hydrocortisone external ointment 0.5 % OTC; QL

hydrocortisone external ointment 1 %

Aquaphor Itch Relief Max

Str

OTC; QL

Drug Name Reference Notes

hydrocortisone external ointment 2.5 % QL

hydrocortisone max st external cream

Cortizone-10 Intensve

Moisture

OTC; QL

hydrocortisone max st external ointment

Aquaphor Itch Relief Max

Str

OTC; QL

hydrocortisone max st/12 moist external

cream

Cortizone-10 Intensve

Moisture

OTC; QL

hydrocortisone plus external cream

Cortizone-10 Intensve

Moisture

OTC; QL

hydrocortisone/aloe max str external cream

Cortizone-10 Intensve

Moisture

OTC; QL

instacort 5 external cream OTC; QL

KERICORT 10 EXTERNAL CREAM OTC; QL

MEDPURA HYDROCORTISONE

EXTERNAL CREAM

OTC; QL

mometasone furoate external cream QL

mometasone furoate external ointment QL

mometasone furoate external solution QL

PREPARATION H EXTERNAL CREAM OTC; QL

triamcinolone acetonide external cream Triderm QL

triamcinolone acetonide external lotion QL

triamcinolone acetonide external ointment QL

*EMOLLIENTS***

AMLACTIN DAILY EXTERNAL LOTION OTC

ammonium lactate external cream QL

ammonium lactate external lotion Amlactin Daily OTC

*IMIDAZOLE-RELATED

ANTIFUNGALS - TOPICAL***

antifungal (clotrimazole) external cream Micotrin AC OTC; QL

antifungal external powder Micotrin AP OTC; QL

baza antifungal external cream Micatin OTC; QL

clotrimazole anti-fungal external cream Micotrin AC OTC; QL

clotrimazole external cream Micotrin AC OTC; QL

clotrimazole external solution QL

ketoconazole external cream QL

ketoconazole external shampoo QL

LOTRIMIN AF DEODORANT POWDER

EXTERNAL AEROSOL POWDER

OTC; QL

miconazole antifungal external cream Micatin OTC; QL

Drug Name Reference Notes

miconazole nitrate external cream Micatin OTC; QL

MICOTRIN AC EXTERNAL CREAM OTC; QL

MICOTRIN AP EXTERNAL POWDER OTC; QL

MYCOZYL AC EXTERNAL CREAM OTC; QL

tm-clotrimazole external cream Micotrin AC OTC; QL

*IMMUNOMODULATORS

IMIDAZOQUINOLINAMINES -

TOPICAL***

imiquimod external cream PA; QL

*KERATOLYTIC/ANTIMITOTIC

AGENTS***

podofilox external solution PA; QL

*LOCAL ANESTHETICS - TOPICAL***

afterburn external gel OTC

ALOCANE EMERGENCY BURN MAX STR

EXTERNAL AEROSOL

OTC

ALOCANE EMERGENCY BURN MAX STR

EXTERNAL GEL

OTC

ALOCANE EMERGENCY BURN MAX STR

EXTERNAL PAD

OTC

aloe vera burn relief external aerosol Solarcaine Cool Aloe OTC

aloe/lidocaine pain reliever external gel OTC

ANECREAM EXTERNAL CREAM OTC

arthritis pain relieving external cream OTC

ASPERCREME LIDOCAINE ESSENTIAL

EXTERNAL LIQUID

OTC

ASPERCREME LIDOCAINE EXTERNAL

CREAM

OTC

ASPERCREME LIDOCAINE EXTERNAL

LIQUID

OTC

ASPERCREME LIDOCAINE EXTERNAL

PATCH

OTC

ASPERCREME MAX STRENGTH

EXTERNAL AEROSOL

OTC

ASPERCREME W/LIDOCAINE EXTERNAL

CREAM

OTC

asperflex max st external patch Aspercreme Lidocaine OTC

ASPERFLEX PAIN RELIEVING

EXTERNAL PATCH

OTC

BENGAY LIDOCAINE EXTERNAL CREAM OTC

Drug Name Reference Notes

burn relief external aerosol Solarcaine Cool Aloe OTC

burn relief external gel OTC

capsaicin external cream DermacinRx Penetral OTC

cooling external gel OTC

cvs hemorrhoidal & analgesic external

ointment

OTC; QL

DERMACINRX PENETRAL EXTERNAL

CREAM

OTC

dibucaine external ointment OTC; QL

DOLOGESIC PAIN RELIEF ROLL-ON

EXTERNAL LIQUID

OTC

FIRST CARE PAIN RELIEF EXTERNAL

PATCH

OTC

GOLD BOND MULTI-SYMPTOM

EXTERNAL CREAM

OTC

HEALTHWISE PAIN RELIEF EXTERNAL

PATCH

OTC

LANSINOH PAIN RELIEF SPRAY

EXTERNAL SOLUTION

OTC

lidocaine external cream AneCream OTC

lidocaine external patch 4 % Aspercreme Lidocaine OTC

lidocaine external patch 5 % Lidoderm PA; QL

lidocaine hcl external cream Aspercreme Lidocaine OTC

lidocaine hcl external solution PA; QL

lidocaine max st 24 hours external patch Aspercreme Lidocaine OTC

lidocaine pain relief external patch Aspercreme Lidocaine OTC

lidocaine pain relief max st external cream Aspercreme Lidocaine OTC

lidocaine pain relief max st external patch Aspercreme Lidocaine OTC

lidocaine pain relieving external patch Aspercreme Lidocaine OTC

lidocaine plus external cream Aspercreme Lidocaine OTC

LIDODOSE EXTERNAL GEL OTC

LIDODOSE PEDIATRIC BULK PACK

EXTERNAL GEL

OTC

numbcream external cream OTC

pain relief maximum strength external patch Aspercreme Lidocaine OTC

pain relief roll-on external liquid Aspercreme Lidocaine OTC

pain relieving + lidocaine external cream Aspercreme Lidocaine OTC

pain relieving lidocaine external patch Aspercreme Lidocaine OTC

REGENECARE HA EXTERNAL GEL OTC

Drug Name Reference Notes

REGENECARE HA EXTERNAL LIQUID OTC

RE-LIEVED MAXIMUM STRENGTH

EXTERNAL PATCH

OTC

SALONPAS PAIN RELIEVING EXTERNAL

PATCH

OTC

SOLARCAINE COOL ALOE EXTERNAL

AEROSOL

OTC

SUN BURNT PLUS EXTERNAL GEL OTC

sure result sr relief external cream DermacinRx Penetral OTC

theracare pain relief external patch Aspercreme Lidocaine OTC

WELMATE LIDOCAINE PAIN RELIEV

EXTERNAL PATCH

OTC

xolido external cream OTC

xolido xp external cream Aspercreme Lidocaine OTC

*MACROLIDE

IMMUNOSUPPRESSANTS -

TOPICAL***

pimecrolimus external cream Elidel PA; AL; QL

tacrolimus external ointment PA; AL; QL

*ROSACEA AGENTS***

metronidazole external cream MetroCream QL

metronidazole external gel Metrogel QL

metronidazole external lotion MetroLotion QL

*SCABICIDE COMBINATIONS***

lice killing external shampoo Rid Lice Killing Shampoo OTC

lice killing maximum strength external

shampoo

Rid Lice Killing Shampoo OTC

RID LICE KILLING SHAMPOO EXTERNAL

SHAMPOO

OTC

VANALICE EXTERNAL GEL OTC

*SCABICIDES & PEDICULICIDES***

lice treatment creme rinse external liquid Nix Creme Rinse OTC; QL

lice treatment external liquid Nix Creme Rinse OTC; QL

lice treatment external lotion OTC; QL

permethrin external cream QL

spinosad external suspension Natroba QL

*TOPICAL ANESTHETIC

COMBINATIONS***

lidocaine-prilocaine external cream QL

Drug Name Reference Notes

*DIAGNOSTIC PRODUCTS*

*DIAGNOSTIC DRUGS***

GLUCAGEN DIAGNOSTIC INJECTION

SOLUTION RECONSTITUTED

*DIAGNOSTIC TESTS***

ACCU-CHEK GUIDE IN VITRO STRIP OTC; QL

RELION TRUE METRIX TEST STRIPS IN

VITRO STRIP

OTC; QL

TRUE METRIX BLOOD GLUCOSE TEST

IN VITRO STRIP

OTC; QL

*INFECTION TESTS***

BINAXNOW COVID-19 AG HOME TEST IN

VITRO KIT

OTC; QL

ellume covid-19 home test in vitro kit

BinaxNOW COVID-19 Ag

Home Test

OTC; QL

FLOWFLEX COVID-19 AG HOME TEST IN

VITRO KIT

OTC; QL

INTELISWAB COVID-19 RAPID TEST IN

VITRO KIT

OTC; QL

QUICKVUE AT-HOME COVID-19 TEST IN

VITRO KIT

OTC; QL

*MULTIPLE URINE TESTS***

CHEMSTRIP UGK IN VITRO STRIP OTC; QL

KETO-DIASTIX IN VITRO STRIP OTC; QL

*DIGESTIVE AIDS*

*DIGESTIVE ENZYMES***

CREON ORAL CAPSULE DELAYED

RELEASE PARTICLES

PERTZYE ORAL CAPSULE DELAYED

RELEASE PARTICLES

PA; QL

*DIURETICS*

*CARBONIC ANHYDRASE

INHIBITORS***

acetazolamide er oral capsule extended

release 12 hour

acetazolamide oral tablet

methazolamide oral tablet

*DIURETIC COMBINATIONS***

amiloride-hydrochlorothiazide oral tablet

Drug Name Reference Notes

spironolactone-hctz oral tablet Aldactazide DO; QL

triamterene-hctz oral capsule

triamterene-hctz oral tablet Maxzide

*LOOP DIURETICS***

bumetanide oral tablet Bumex

furosemide oral solution

furosemide oral tablet Lasix

torsemide oral tablet Soaanz

*POTASSIUM SPARING DIURETICS***

amiloride hcl oral tablet

spironolactone oral tablet 100 mg Aldactone QL

spironolactone oral tablet 25 mg, 50 mg Aldactone DO; QL

*THIAZIDES AND THIAZIDE-LIKE

DIURETICS***

chlorthalidone oral tablet

hydrochlorothiazide oral capsule

hydrochlorothiazide oral tablet

indapamide oral tablet

metolazone oral tablet

*ENDOCRINE AND METABOLIC

AGENTS - MISC.*

*BISPHOSPHONATES***

alendronate sodium oral solution QL

alendronate sodium oral tablet Fosamax QL

*CALCITONINS***

calcitonin (salmon) nasal solution QL

*CARNITINE REPLENISHER -

AGENTS***

levocarnitine oral solution Carnitor

levocarnitine oral tablet Carnitor

levocarnitine sf oral solution Carnitor

*DOPAMINE RECEPTOR AGONISTS***

cabergoline oral tablet QL

*GROWTH HORMONES***

HUMATROPE INJECTION CARTRIDGE PA; SP; QL

ZOMACTON SUBCUTANEOUS

SOLUTION RECONSTITUTED

PA; SP; QL

Drug Name Reference Notes

*HYPERPARATHYROID TREATMENT -

VITAMIN D ANALOGS***

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

*SELECTIVE ESTROGEN RECEPTOR

MODULATORS (SERMS)***

raloxifene hcl oral tablet Evista

*SOMATOSTATIC AGENTS***

octreotide acetate injection solution SandoSTATIN PA; SP

octreotide acetate subcutaneous solution

prefilled syringe

PA; SP

*UREA CYCLE DISORDER -

AGENTS***

sodium phenylbutyrate oral powder Buphenyl PA; SP; QL

sodium phenylbutyrate oral tablet Buphenyl PA; SP; QL

*VASOPRESSIN***

desmopressin ace spray refrig nasal solution

desmopressin acetate oral tablet 0.1 mg DDAVP DO; QL

desmopressin acetate oral tablet 0.2 mg DDAVP QL

desmopressin acetate spray nasal solution

*ESTROGENS*

*ESTROGEN & PROGESTIN***

AMABELZ ORAL TABLET

estradiol-norethindrone acet oral tablet Amabelz

FYAVOLV ORAL TABLET

JINTELI ORAL TABLET

MIMVEY ORAL TABLET

norethindrone-eth estradiol oral tablet Fyavolv

*ESTROGENS***

estradiol oral tablet Estrace

estradiol transdermal patch weekly Climara QL

*FLUOROQUINOLONES*

*FLUOROQUINOLONES***

ciprofloxacin hcl oral tablet Cipro

levofloxacin oral solution

levofloxacin oral tablet Levaquin

ofloxacin oral tablet

Drug Name Reference Notes

*GASTROINTESTINAL AGENTS -

MISC.*

*ANTIFLATULENTS***

gas relief infants oral liquid Gas-X Infant Drops AL; OTC

gas relief infants oral suspension

PediaCare Infants Gas

Relief

AL; OTC

gas relief oral liquid Gas-X Infant Drops AL; OTC

GAS-X INFANT DROPS ORAL LIQUID AL; OTC

infants gas relief oral suspension

PediaCare Infants Gas

Relief

AL; OTC

PEDIACARE INFANTS GAS RELIEF

ORAL SUSPENSION

AL; OTC

qc gas relief infants oral suspension

PediaCare Infants Gas

Relief

AL; OTC

simeped oral suspension

PediaCare Infants Gas

Relief

AL; OTC

simethicone drops infants oral suspension

PediaCare Infants Gas

Relief

AL; OTC

simethicone oral suspension

PediaCare Infants Gas

Relief

AL; OTC

*GALLSTONE SOLUBILIZING

AGENTS***

ursodiol oral capsule

ursodiol oral tablet Urso 250

*GASTROINTESTINAL CHLORIDE

CHANNEL ACTIVATORS***

lubiprostone oral capsule Amitiza PA; QL

*GASTROINTESTINAL

STIMULANTS***

metoclopramide hcl oral solution QL

metoclopramide hcl oral tablet Reglan QL

*INFLAMMATORY BOWEL AGENTS***

balsalazide disodium oral capsule Colazal QL

mesalamine er oral capsule extended

release 24 hour

Apriso QL

mesalamine rectal enema QL

mesalamine-cleanser rectal kit Rowasa

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet delayed release Azulfidine EN-tabs QL

Drug Name Reference Notes

*INTESTINAL ACIDIFIERS***

enulose oral solution QL

generlac oral solution QL

lactulose encephalopathy oral solution QL

*PHOSPHATE BINDER AGENTS***

calcium acetate (phos binder) oral capsule QL

calcium acetate (phos binder) oral tablet Calphron QL

calcium acetate oral tablet Calphron QL

lanthanum carbonate oral tablet chewable Fosrenol QL

sevelamer carbonate oral packet Renvela QL

sevelamer carbonate oral tablet Renvela QL

*GENITOURINARY AGENTS -

MISCELLANEOUS*

*5-ALPHA REDUCTASE

INHIBITORS***

finasteride oral tablet Proscar QL

*ALPHA 1-ADRENOCEPTOR

ANTAGONISTS***

alfuzosin hcl er oral tablet extended release

24 hour

Uroxatral QL

tamsulosin hcl oral capsule Flomax QL

*CITRATES***

potassium citrate er oral tablet extended

release

Urocit-K 10

*GENITOURINARY IRRIGANTS***

ARGYLE STERILE SALINE IRRIGATION

SOLUTION

CURITY STERILE SALINE IRRIGATION

SOLUTION

sodium chloride irrigation solution Argyle Sterile Saline

*GOUT AGENTS*

*GOUT AGENT COMBINATIONS***

colchicine-probenecid oral tablet

*GOUT AGENTS***

allopurinol oral tablet Zyloprim QL

*URICOSURICS***

probenecid oral tablet

Drug Name Reference Notes

*HEMATOLOGICAL AGENTS - MISC.*

*C1 ESTERASE INHIBITORS***

HAEGARDA SUBCUTANEOUS

SOLUTION RECONSTITUTED

PA; SP; QL

*HEMATORHEOLOGIC AGENTS***

pentoxifylline er oral tablet extended release

*PHOSPHODIESTERASE III

INHIBITORS***

cilostazol oral tablet

*PLASMA KALLIKREIN INHIBITORS -

MONOCLONAL ANTIBODIES***

TAKHZYRO SUBCUTANEOUS SOLUTION PA; SP; QL

*PLATELET AGGREGATION

INHIBITORS***

dipyridamole oral tablet

*QUINAZOLINE AGENTS***

anagrelide hcl oral capsule Agrylin QL

*THIENOPYRIDINE DERIVATIVES***

clopidogrel bisulfate oral tablet Plavix QL

*HEMATOPOIETIC AGENTS*

*COBALAMINS***

b-12 oral capsule OTC

b-12 oral tablet OTC

b-12 sublingual tablet sublingual OTC

b-12-sl sublingual tablet sublingual OTC

cyanocobalamin injection solution Dodex

DODEX INJECTION SOLUTION

vitamin b-12 oral liquid OTC

vitamin b-12 oral tablet OTC

vitamin b-12 sublingual tablet sublingual OTC

*CYTOTOXIC AGENTS***

DROXIA ORAL CAPSULE

*ERYTHROPOIESIS-STIMULATING

AGENTS (ESAS)***

ARANESP (ALBUMIN FREE) INJECTION

SOLUTION

SP; QL

ARANESP (ALBUMIN FREE) INJECTION

SOLUTION PREFILLED SYRINGE

SP; QL

Drug Name Reference Notes

EPOGEN INJECTION SOLUTION SP; QL

RETACRIT INJECTION SOLUTION SP; QL

*FOLIC ACID/FOLATES***

folate oral tablet OTC

folic acid oral tablet OTC

yl folic acid oral tablet OTC

*GRANULOCYTE COLONY-

STIMULATING FACTORS (G-CSF)***

NEULASTA ONPRO SUBCUTANEOUS

PREFILLED SYRINGE KIT

SP; QL

NEULASTA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

SP; QL

UDENYCA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

SP; QL

ZARXIO INJECTION SOLUTION

PREFILLED SYRINGE

PA; SP

*IRON***

BPROTECTED PEDIA IRON ORAL

SOLUTION

AL; OTC

fe tabs oral tablet delayed release OTC

FEROSUL ORAL TABLET OTC

FERREX 150 ORAL CAPSULE OTC

ferric x-150 oral capsule Ferrex 150 OTC

ferrous sulfate oral elixir OTC

ferrous sulfate oral liquid OTC

ferrous sulfate oral solution BProtected Pedia Iron AL; OTC

ferrous sulfate oral tablet FeroSul OTC

ferrous sulfate oral tablet delayed release OTC

fe-vite iron oral solution BProtected Pedia Iron AL; OTC

IFEREX 150 ORAL CAPSULE OTC

iron (ferrous sulfate) oral solution BProtected Pedia Iron AL; OTC

iron (ferrous sulfate) oral tablet FeroSul OTC

iron high-potency oral tablet FeroSul OTC

iron infant & toddler oral solution BProtected Pedia Iron AL; OTC

iron infant/toddler oral solution BProtected Pedia Iron AL; OTC

iron oral tablet FeroSul OTC

iron supplement childrens oral solution BProtected Pedia Iron AL; OTC

iron supplement oral elixir OTC

Drug Name Reference Notes

iron supplement oral solution BProtected Pedia Iron AL; OTC

nat-rul iron oral tablet FeroSul OTC

NOVAFERRUM PEDIATRIC DROPS ORAL

LIQUID

AL; OTC

NU-IRON ORAL CAPSULE OTC

POLY-IRON 150 ORAL CAPSULE OTC

polysaccharide iron complex oral capsule Ferrex 150 OTC

polysaccharide-iron complex oral capsule Ferrex 150 OTC

sv iron oral tablet FeroSul OTC

*HEMOSTATICS*

*HEMOSTATICS - SYSTEMIC***

aminocaproic acid oral tablet Amicar QL

tranexamic acid oral tablet QL

*HYPNOTICS/SEDATIVES/SLEEP

DISORDER AGENTS*

*ANTIHISTAMINE HYPNOTICS***

night time sleep aid oral tablet Nytol QuickCaps OTC

nighttime sleep aid oral tablet Nytol QuickCaps OTC

NYTOL QUICKCAPS ORAL TABLET OTC

SIMPLY SLEEP ORAL TABLET OTC

sleep aid (diphenhydramine) oral tablet Nytol QuickCaps OTC

sleep aid oral tablet Unisom SleepTabs OTC

sleep tabs oral tablet Nytol QuickCaps OTC

sleep-aid oral capsule Unisom Sleepgels OTC

sleep-aid oral tablet Unisom SleepTabs OTC

sleep-tabs oral tablet Nytol QuickCaps OTC

*BARBITURATE HYPNOTICS***

pentobarbital sodium injection solution

phenobarbital oral elixir

phenobarbital oral tablet

*BENZODIAZEPINE HYPNOTICS***

estazolam oral tablet 1 mg QL

estazolam oral tablet 2 mg PA; QL

midazolam hcl (pf) injection solution

midazolam hcl injection solution

midazolam hcl oral syrup PA

quazepam oral tablet Doral QL

Drug Name Reference Notes

temazepam oral capsule 15 mg, 7.5 mg Restoril QL

temazepam oral capsule 22.5 mg, 30 mg Restoril PA; QL

triazolam oral tablet Halcion PA; QL

*HYPNOTICS - TRICYCLIC AGENTS***

doxepin hcl oral tablet Silenor PA; QL

*NON-BENZODIAZEPINE - GABA-

RECEPTOR MODULATORS***

EDLUAR SUBLINGUAL TABLET

SUBLINGUAL

PA; QL

eszopiclone oral tablet Lunesta PA; QL

zaleplon oral capsule QL

zolpidem tartrate er oral tablet extended

release

Ambien CR PA; QL

zolpidem tartrate oral tablet Ambien QL

zolpidem tartrate sublingual tablet sublingual PA; QL

*OREXIN RECEPTOR

ANTAGONISTS***

BELSOMRA ORAL TABLET AL; QL

DAYVIGO ORAL TABLET AL; QL

QUVIVIQ ORAL TABLET AL; QL

*SELECTIVE ALPHA2-

ADRENORECEPTOR AGONIST

SEDATIVES***

IGALMI SUBLINGUAL FILM

*SELECTIVE MELATONIN RECEPTOR

AGONISTS***

HETLIOZ LQ ORAL SUSPENSION PA; QL

ramelteon oral tablet Rozerem PA; QL

tasimelteon oral capsule Hetlioz PA; SP; QL

*LAXATIVES*

*BOWEL EVACUANT

COMBINATIONS***

GAVILYTE-C ORAL SOLUTION

RECONSTITUTED

GAVILYTE-G ORAL SOLUTION

RECONSTITUTED

peg 3350-kcl-na bicarb-nacl oral solution

reconstituted

Drug Name Reference Notes

peg-3350/electrolytes oral solution

reconstituted

GaviLyte-G QL

*BULK LAXATIVES***

cvs natural fiber supplement oral powder Wal-Mucil AL; OTC

eq daily fiber oral powder

Metamucil MultiHealth

Fiber

OTC

fiber oral powder

Metamucil Smooth

Texture

AL; OTC

konsyl daily fiber oral packet AL; OTC

konsyl daily fiber oral powder 28.3 %

Metamucil Smooth

Texture

AL; OTC

konsyl daily fiber oral powder 60.3 % OTC

konsyl original daily fiber oral packet AL; OTC

METAMUCIL MULTIHEALTH FIBER ORAL

PACKET

AL; OTC

METAMUCIL ORAL PACKET OTC

METAMUCIL SMOOTH TEXTURE ORAL

POWDER

AL; OTC

natural fiber laxative oral powder

Metamucil Smooth

Texture

AL; OTC

natural fiber oral powder

Metamucil Smooth

Texture

AL; OTC

natural psyllium seed oral powder Wal-Mucil AL; OTC

natural vegetable fiber oral powder Reguloid AL; OTC

psyldex oral powder AL; OTC

REGULOID ORAL POWDER AL; OTC

sb fib lax orange oral powder AL; OTC

WAL-MUCIL ORAL POWDER AL; OTC

*LAXATIVES - MISCELLANEOUS***

CLEARLAX ORAL POWDER OTC; QL

constulose oral solution QL

gavilax oral powder ClearLax OTC; QL

gentlelax oral powder ClearLax OTC; QL

glycerin (adult) rectal suppository AL; OTC

glycerin (infants & children) rectal

suppository

AL; OTC

glycerin (pediatric) rectal suppository AL; OTC

glycerin adult rectal suppository Avedana Glycerin (Adult) AL; OTC

glycerin childrens rectal suppository AL; OTC

Drug Name Reference Notes

GLYCOLAX ORAL POWDER OTC; QL

lactulose oral solution QL

PEDIA-LAX RECTAL SUPPOSITORY AL; OTC

peg 3350 oral powder ClearLax OTC; QL

polyethylene glycol 3350 oral powder ClearLax OTC; QL

sorbitol oral solution OTC

*SALINE LAXATIVE MIXTURES***

enema disposable rectal enema Fleet Enema AL; OTC

enema pediatric rectal enema Fleet Pediatric OTC

enema rectal enema Fleet Enema AL; OTC

*SALINE LAXATIVES***

citrate of magnesia oral solution Citroma OTC

CITROMA ORAL SOLUTION OTC

magnesium citrate oral solution Citroma OTC

milk of magnesia oral suspension Dulcolax OTC

*STIMULANT LAXATIVES***

bisacodyl ec oral tablet delayed release Alophen OTC; QL

bisacodyl laxative rectal suppository Dulcolax OTC

bisacodyl oral tablet delayed release Alophen OTC; QL

senna oral liquid OneLAX Senna AL; OTC

senna oral syrup AL; OTC

senna oral tablet Evac-U-Gen OTC

SENNA SMOOTH ORAL TABLET OTC

SENOKOT EXTRA STRENGTH ORAL

TABLET

OTC

*SURFACTANT LAXATIVES***

docusate calcium oral capsule Surfak AL; OTC

docusate sodium oral capsule DOK OTC; QL

docusate sodium oral liquid OTC

DOK ORAL CAPSULE OTC; QL

DOK ORAL TABLET OTC

DULCOLAX PINK STOOL SOFTENER

ORAL CAPSULE

OTC; QL

DULCOLAX STOOL SOFTENER ORAL

CAPSULE

OTC; QL

goodsense stool softener oral capsule DOK OTC; QL

PROMOLAXIN ORAL TABLET OTC

Drug Name Reference Notes

stool softener oral capsule Surfak AL; OTC

*MACROLIDES*

*AZITHROMYCIN***

azithromycin oral packet Zithromax

azithromycin oral suspension reconstituted Zithromax

azithromycin oral tablet Zithromax

*CLARITHROMYCIN***

clarithromycin er oral tablet extended

release 24 hour

clarithromycin oral suspension reconstituted

clarithromycin oral tablet

*ERYTHROMYCINS***

E.E.S. 400 ORAL TABLET

ERY-TAB ORAL TABLET DELAYED

RELEASE

ERYTHROCIN STEARATE ORAL TABLET

erythromycin base oral capsule delayed

release particles

erythromycin base oral tablet

erythromycin base oral tablet delayed

release

Ery-Tab

erythromycin ethylsuccinate oral tablet E.E.S. 400

erythromycin oral tablet delayed release Ery-Tab

*MEDICAL DEVICES AND SUPPLIES*

*APPLICATORS,COTTON

BALLS,ETC***

alcohol prep pad Curity Alcohol Preps OTC

alcohol swabs pad Curity Alcohol Preps OTC

CURITY ALCOHOL PREPS PAD OTC

EASY TOUCH ALCOHOL PREP MEDIUM

PAD

OTC

RELION ALCOHOL SWABS PAD OTC

ULTICARE ALCOHOL SWABS PAD OTC

WEBCOL ALCOHOL PREP LARGE PAD OTC

WEBCOL ALCOHOL PREP MEDIUM PAD OTC

*CERVICAL CAPS***

FEMCAP VAGINAL DEVICE QL

Drug Name Reference Notes

*DIAPHRAGMS***

CAYA VAGINAL DIAPHRAGM QL

OMNIFLEX DIAPHRAGM VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 60 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 65 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 70 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 75 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 80 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 85 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 90 VAGINAL

DIAPHRAGM

WIDE-SEAL DIAPHRAGM 95 VAGINAL

DIAPHRAGM

*GLUCOSE MONITORING TEST

SUPPLIES***

ACCU-CHEK AVIVA IN VITRO SOLUTION OTC

ACCU-CHEK GUIDE KIT OTC

ACCU-CHEK GUIDE ME KIT OTC

ACCU-CHEK SMARTVIEW CONTROL IN

VITRO LIQUID

OTC

ACCUTREND GLUCOSE CONTROL IN

VITRO SOLUTION

OTC

acti-lance lite lancets 28g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

acti-lance special lancets 17g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

adjustable lancing device Advocate Lancing Device OTC; QL

advanced mobile lancet

AgaMatrix Ultra-Thin

Lancets

OTC; QL

ADVOCATE LANCING DEVICE OTC; QL

AGAMATRIX ULTRA-THIN LANCETS OTC; QL

aimsco twist lancets 32g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

AIMSCO TWIST LANCETS 33G OTC; QL

Drug Name Reference Notes

ASSURE HAEMOLANCE PLUS HIGH OTC; QL

ASSURE HAEMOLANCE PLUS LOW OTC; QL

ASSURE HAEMOLANCE PLUS MICRO OTC; QL

ASSURE HAEMOLANCE PLUS NORMAL OTC; QL

ASSURE HAEMOLANCE PLUS PED OTC; QL

ASSURE LANCE LANCETS OTC; QL

aurora lancet super thin 30g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

aurora lancet thin 23g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

AUTO-LANCET OTC; QL

AUTO-LANCET MINI OTC; QL

AUTOLET II CLINISAFE KIT OTC

AUTOLET LANCING DEVICE OTC; QL

AUTOLET LITE CLINISAFE KIT OTC

AUTOLET LITE STARTER PACK KIT OTC

AUTOLET MINI OTC; QL

AUTOLET PLATFORMS OTC; QL

AUTOLET PLUS OTC; QL

CARDIOCOM LANCING DEVICE OTC; QL

careone advanced lancing dev Advocate Lancing Device OTC; QL

CAREONE LANCET SUPER THIN 30G OTC; QL

careone lancet thin 23g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

CARESENS LANCETS OTC; QL

CLEANLET LANCETS 28G OTC; QL

comfort assured lancets 28g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

comfort assured lancets 33g

AgaMatrix Ultra-Thin

Lancets

OTC; QL

comfort lancets

AgaMatrix Ultra-Thin

Lancets

OTC; QL

DIATHRIVE LANCETS OTC; QL

DIATHRIVE LANCING DEVICE OTC; QL

DROPLET LANCETS ULTRA THIN 30G OTC; QL

DROPLET LANCING DEVICE OTC; QL

DROPLET PERSONAL LANCETS 30G OTC; QL

DRUG MART LANCING DEVICE OTC; QL

Drug Name Reference Notes

EASY TOUCH LANCETS 21G OTC; QL

EASY TOUCH LANCETS 23G OTC; QL

EASY TOUCH LANCETS 26G OTC; QL

EASY TOUCH LANCETS 28G OTC; QL

EASY TOUCH LANCETS 28G/TWIST OTC; QL

EASY TOUCH LANCETS 30G OTC; QL

EASY TOUCH LANCETS 30G/TWIST OTC; QL

EASY TOUCH LANCETS 32G OTC; QL

EASY TOUCH LANCETS 32G/TWIST OTC; QL

EASY TOUCH LANCETS 33G/TWIST OTC; QL

EASY TOUCH LANCING DEVICE OTC; QL

EASY TOUCH SAFETY LANCETS 21G OTC; QL

EASY TOUCH SAFETY LANCETS 23G OTC; QL

EASY TOUCH SAFETY LANCETS 26G OTC; QL

EASY TOUCH SAFETY LANCETS 28G OTC; QL

E-Z JECT LANCET MICRO-THIN 33G OTC; QL

E-Z JECT LANCET SUPER THIN 30G OTC; QL

E-Z JECT LANCETS OTC; QL

E-Z JECT LANCETS 21G OTC; QL

E-Z JECT LANCETS THIN 26G OTC; QL

EZ-LETS LANCETS 21G OTC; QL

EZ-LETS LANCETS 26G OTC; QL

EZ-LETS LANCETS 28G OTC; QL

EZ-LETS LANCETS 30G OTC; QL

FORA LANCETS OTC; QL

FORA LANCING DEVICE OTC; QL

FREESTYLE CONTROL SOLUTION IN

VITRO LIQUID

OTC

FREESTYLE LITE DEVICE OTC

GENTEEL CONTACT TIPS (BLUE) OTC; QL

GENTEEL CONTACT TIPS (CLEAR) OTC; QL

GENTEEL CONTACT TIPS (GREEN) OTC; QL

GENTEEL CONTACT TIPS (ORANGE) OTC; QL

GENTEEL CONTACT TIPS (RAINBOW) OTC; QL

GENTEEL CONTACT TIPS (VIOLET) OTC; QL

GENTEEL CONTACT TIPS (YELLOW) OTC; QL

GENTEEL LANCING KIT (BLUE) KIT OTC

Drug Name Reference Notes

GENTEEL NOZZLES OTC; QL

GENTEEL PLUS LANCING (BLACK) OTC

GENTEEL PLUS LANCING (PURPLE) OTC

GENTEEL PLUS LANCING (WHITE) OTC

GENTEEL PLUS LANCING DEV(BLUE) OTC

GENTEEL PLUS LANCING DEV(PINK) OTC

GENTLE-LET PLATFORMS OTC; QL

GLUCOCOM LANCETS 28G OTC; QL

GLUCOCOM LANCETS 30G OTC; QL

GLUCOCOM LANCETS 33G OTC; QL

HAEMOLANCE OTC; QL

HAEMOLANCE PLUS OTC; QL

HEALTH CARE LANCING DEVICE OTC; QL

HYPOLANCE AST LANCING KIT OTC

IN TOUCH LANCING DEVICE OTC; QL

IN TOUCH STERILE LANCETS 30G OTC; QL

KROGER HEALTHPRO CONTROL HI/LO

IN VITRO LIQUID

OTC

kroger lancets

AgaMatrix Ultra-Thin

Lancets

OTC; QL

LANCETS ULTRA THIN OTC; QL

LANZO OTC; QL

LIBERTY MINI LANCING DEVICE OTC; QL

lite touch lancets

AgaMatrix Ultra-Thin

Lancets

OTC; QL

LITE TOUCH LANCING PEN OTC; QL

LITETOUCH LANCETS OTC; QL

MEDISENSE GLUCOSE KETONE CONTR

IN VITRO LIQUID

OTC

MEDISENSE HI/MID/LOW CONTROL IN

VITRO LIQUID

OTC

MEDLANCE EXTRA 21G OTC; QL

MEDLANCE LITE 25G OTC; QL

MEDLANCE PLUS EXTRA 21G OTC; QL

MEDLANCE PLUS LANCETS OTC; QL

MEDLANCE PLUS LITE 25G OTC; QL

MEDLANCE PLUS SPECIAL 0.8MM OTC; QL

MEDLANCE PLUS SUPERLITE 30G OTC; QL

Drug Name Reference Notes

MEDLANCE PLUS UNIVERSAL 21G OTC; QL

MEDLANCE UNIVERSAL 21G OTC; QL

MEIJER LANCETS OTC; QL

MEIJER LANCETS THIN OTC; QL

MEIJER LANCETS UNIVERSAL 21G OTC; QL

MEIJER LANCETS UNIVERSAL 30G OTC; QL

MEIJER LANCETS UNIVERSAL 33G OTC; QL

MEIJER SUPER THIN LANCETS OTC; QL

MM TWIST LANCETS OTC; QL

MONOLET LANCETS OTC; QL

MONOLET OPD LANCETS OTC; QL

MONOLETTOR SAFETY LANCETS OTC; QL

MYGLUCOHEALTH LANCETS 30G OTC; QL

NOVA SAFETY LANCETS 23G OTC; QL

NOVA SAFETY LANCETS 28G OTC; QL

NOVA SUREFLEX LANCETS OTC; QL

NOVA SUREFLEX LANCING DEVICE OTC; QL

PERFECT LANCETS 28G OTC; QL

PERFECT LANCETS 30G OTC; QL

PHARMACY COUNTER LANCETS OTC; QL

PRECISION GLUCOSE KETONE CONTR

IN VITRO LIQUID

OTC

PRECISION THINS GP LANCETS OTC; QL

PSS SELECT GP LANCETS OTC; QL

PSS SELECT SAFETY LANCETS OTC; QL

READYLANCE SAFETY LANCETS OTC; QL

RELION LANCET DEVICES 30G OTC; QL

RELION LANCETS MICRO-THIN 33G OTC; QL

RELION LANCETS THIN 26G OTC; QL

RELION LANCETS ULTRA-THIN 30G OTC; QL

RELION LANCING DEVICE OTC; QL

RELION LANCING DEVICE KIT OTC; QL

RELION TRUE MET AIR GLUC METER

KIT

OTC

RELION ULTRA THIN LANCETS 30G OTC; QL

RELION ULTRA THIN PLUS LANCETS OTC; QL

REXALL LANCETS ULTRA THIN 30G OTC; QL

Drug Name Reference Notes

RIGHTEST ALTERNATE SITE ADAPT OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC; QL

RIGHTEST GL300 LANCETS OTC; QL

SAFE-T-LANCE OTC; QL

SAFE-T-LANCE PLUS OTC; QL

SAFETY LANCETS 21G OTC; QL

STERILANCE PA OTC; QL

STERILANCE TL OTC; QL

super thin lancets

AgaMatrix Ultra-Thin

Lancets

OTC; QL

SURELITE LANCETS OTC; QL

TECHLITE AST LANCETS OTC; QL

TECHLITE LANCETS OTC; QL

TECHLITE LANCETS 30G OTC; QL

THINLETS GP LANCETS OTC; QL

TRAVEL LANCETS ADVANCED 28G OTC; QL

TRUE METRIX AIR GLUCOSE METER

DEVICE

OTC

TRUE METRIX AIR GLUCOSE METER KIT OTC

TRUE METRIX GO GLUCOSE METER KIT OTC

TRUE METRIX LEVEL 1 IN VITRO

SOLUTION

OTC

TRUE METRIX LEVEL 2 IN VITRO

SOLUTION

OTC

TRUE METRIX LEVEL 3 IN VITRO

SOLUTION

OTC

TRUE METRIX METER DEVICE OTC

TRUE METRIX METER KIT OTC

TRUEDRAW LANCING DEVICE OTC; QL

TRUEPLUS LANCETS 26G OTC; QL

TRUEPLUS LANCETS 28G OTC; QL

TRUEPLUS LANCETS 30G OTC; QL

TRUEPLUS LANCETS 33G OTC; QL

TRUEPLUS SAFETY LANCETS 28G OTC; QL

ULTRA-THIN II AUTO LANCET OTC; QL

ULTRA-THIN II LANCETS OTC; QL

UNILET COMFORTOUCH LANCET OTC; QL

UNILET EXCELITE OTC; QL

Drug Name Reference Notes

UNILET EXCELITE II OTC; QL

UNILET G.P. LANCET OTC; QL

UNILET G.P. SUPERLITE LANCET OTC; QL

UNILET GP 28 ULTRA THIN OTC; QL

UNILET LANCET OTC; QL

UNILET MICRO-THIN 33G OTC; QL

UNILET SUPERLITE LANCET OTC; QL

UNILET SUPER-THIN 30G OTC; QL

UNILET ULTRA-THIN 28G OTC; QL

UNISTIK 1 OTC; QL

UNISTIK 2 OTC; QL

UNISTIK 2 COMFORT OTC; QL

UNISTIK 2 EXTRA OTC; QL

UNISTIK 2 NEONATAL OTC; QL

UNISTIK 2 NORMAL OTC; QL

UNISTIK 2 SUPER OTC; QL

UNISTIK 3 OTC; QL

UNISTIK 3 COMFORT OTC; QL

UNISTIK 3 EXTRA OTC; QL

UNISTIK 3 GENTLE OTC; QL

UNISTIK 3 NEONATAL OTC; QL

UNISTIK 3 NORMAL OTC; QL

UNISTIK CZT COMFORT OTC; QL

UNISTIK CZT NORMAL OTC; QL

UNISTIK NORMAL OTC; QL

UNISTIK PRO SAFETY LANCET OTC; QL

UNISTIK SAFETY LANCETS 28G OTC; QL

UNISTIK SAFETY LANCETS 30G OTC; QL

UNISTIK TOUCH SAFETY LANC 21G OTC; QL

UNISTIK TOUCH SAFETY LANC 23G OTC; QL

UNISTIK TOUCH SAFETY LANC 28G OTC; QL

UNISTIK TOUCH SAFETY LANC 30G OTC; QL

UNIVERSAL 1 LANCETS THIN 26G OTC; QL

UNIVERSAL 1 LANCETS THIN 33G OTC; QL

UNIVERSAL 1 LANCETS ULTRA THIN OTC; QL

VIDA MIA AUTOLET LANCING DEV OTC; QL

VIDA MIA UNILET LANCETS 28G OTC; QL

Drug Name Reference Notes

VIDA MIA UNILET LANCETS 30G OTC; QL

VIVAGUARD LANCETS OTC; QL

VIVAGUARD LANCING DEVICE OTC; QL

WALGREENS LANCETS OTC; QL

WALGREENS THIN LANCETS OTC; QL

WALGREENS ULTRA THIN LANCETS OTC; QL

*INSULIN ADMINISTRATION

SUPPLIES***

OMNIPOD 5 G6 INTRO (GEN 5) KIT PA; QL

OMNIPOD 5 G6 POD (GEN 5) PA; QL

OMNIPOD CLASSIC PODS (GEN 3) PA; QL

OMNIPOD DASH INTRO (GEN 4) KIT PA; QL

OMNIPOD DASH PDM (GEN 4) KIT PA; QL

OMNIPOD DASH PODS (GEN 4) PA; QL

OMNIPOD POD PALS PA; QL

*NEEDLES & SYRINGES***

BD AUTOSHIELD OTC; QL

BD AUTOSHIELD DUO OTC; QL

BD INSULIN SYR ULTRAFINE II QL

BD INSULIN SYRINGE QL

BD INSULIN SYRINGE HALF-UNIT QL

BD INSULIN SYRINGE MICROFINE QL

BD INSULIN SYRINGE U/F QL

BD INSULIN SYRINGE U/F 1/2UNIT QL

BD INSULIN SYRINGE U-500 QL

BD INSULIN SYRINGE ULTRAFINE QL

BD PEN NEEDLE MICRO U/F OTC; QL

BD PEN NEEDLE MINI U/F OTC; QL

BD PEN NEEDLE NANO 2ND GEN OTC; QL

BD PEN NEEDLE NANO U/F OTC; QL

BD PEN NEEDLE ORIGINAL U/F OTC; QL

BD PEN NEEDLE SHORT U/F OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE QL

BD SAFETY-LOK INSULIN SYRINGE QL

BD VEO INSULIN SYR U/F 1/2UNIT QL

BD VEO INSULIN SYRINGE U/F QL

Drug Name Reference Notes

*PEAK FLOW METERS***

AIRZONE PEAK FLOW METER DEVICE OTC

lung perform peak flow meter device Airzone Peak Flow Meter OTC

MINI WRIGHT PEAK FLOW METER

DEVICE

OTC

peak a-i-r flow meter device Airzone Peak Flow Meter OTC

PEAK AIR PEAK FLOW METER DEVICE OTC

PIKO 1 DEVICE OTC

POCKET PEAK FLOW METER DEVICE OTC

*SPACER/AEROSOL-HOLDING

CHAMBERS & SUPPLIES***

AEROVENT PLUS DEVICE QL

COMPACT SPACE CHAMBER DEVICE QL

COMPACT SPACE CHAMBER/LG MASK

DEVICE

COMPACT SPACE CHAMBER/MED

MASK DEVICE

MICROCHAMBER DEVICE QL

MICROSPACER QL

OPTICHAMBER DIAMOND QL

OPTICHAMBER DIAMOND DEVICE QL

OPTICHAMBER DIAMOND-LG MASK

DEVICE

OPTICHAMBER DIAMOND-MD MASK QL

OPTICHAMBER DIAMOND-SM MASK QL

PANDA MASK LARGE OTC; QL

PANDA MASK MEDIUM OTC; QL

PANDA MASK SMALL OTC; QL

PEDIATRIC PANDA MASK OTC; QL

POCKET CHAMBER DEVICE QL

RITEFLO DEVICE QL

VORTEX VALVED HOLDING CHAMBER

DEVICE

*MIGRAINE PRODUCTS*

*CALCITONIN GENE-RELATED

PEPTIDE RECEPTOR ANTAG

(CGRP)***

NURTEC ORAL TABLET DISPERSIBLE PA; QL

Drug Name Reference Notes

*CGRP RECEPTOR ANTAGONISTS -

MONOCOLONAL ANTIBODIES***

AIMOVIG SUBCUTANEOUS SOLUTION

AUTO-INJECTOR

PA; QL

EMGALITY (300 MG DOSE)

SUBCUTANEOUS SOLUTION PREFILLED

SYRINGE

PA; QL

EMGALITY SUBCUTANEOUS SOLUTION

AUTO-INJECTOR

PA; QL

EMGALITY SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; QL

*ERGOT COMBINATIONS***

ergotamine-caffeine oral tablet Cafergot

MIGERGOT RECTAL SUPPOSITORY

*SELECTIVE SEROTONIN AGONISTS

5-HT(1)***

naratriptan hcl oral tablet QL

sumatriptan nasal solution Imitrex PA; QL

sumatriptan succinate oral tablet Imitrex QL

sumatriptan succinate refill subcutaneous

solution cartridge

Imitrex STATdose Refill PA; QL

sumatriptan succinate subcutaneous

solution

PA; QL

sumatriptan succinate subcutaneous

solution auto-injector

Imitrex STATdose System PA; QL

*MINERALS & ELECTROLYTES*

*CALCIUM COMBINATIONS***

600+d3 oral tablet Pronutrients Calcium+D3 OTC

CALCET CREAMY BITES ORAL TABLET

CHEWABLE

OTC

calcitrate plus d oral tablet OTC

cal-citrate plus vitamin d oral tablet OTC

calcium + vitamin d3 oral tablet OTC

calcium 1000 + d oral tablet OTC

calcium 500 + d oral tablet Os-Cal Calcium + D3 OTC

calcium 500 + d3 oral tablet Os-Cal Calcium + D3 OTC

calcium 500/d oral tablet Os-Cal Calcium + D3 OTC

calcium 500/vitamin d oral tablet OTC

calcium 500+d high potency oral tablet OTC

Drug Name Reference Notes

calcium 500+d oral tablet Os-Cal Calcium + D3 OTC

calcium 500+d3 oral tablet Os-Cal Calcium + D3 OTC

calcium 600 + d oral tablet OTC

calcium 600/vitamin d oral tablet OTC

calcium 600/vitamin d oral tablet chewable OTC

calcium 600/vitamin d3 oral tablet Pronutrients Calcium+D3 OTC

calcium 600+d high potency oral tablet OTC

calcium 600+d oral tablet OTC

calcium 600+d3 oral tablet Pronutrients Calcium+D3 OTC

calcium carb-cholecalciferol oral tablet Pronutrients Calcium+D3 OTC

calcium carbonate-vitamin d oral capsule OTC

calcium carbonate-vitamin d oral tablet OTC

calcium citrate + d oral tablet OTC

calcium citrate + d3 maximum oral tablet Calcitrate OTC

calcium citrate + d3 oral tablet Calcitrate OTC

calcium citrate + oral tablet OTC

calcium citrate chewy bite oral tablet

chewable

Celebrate Calcium Citrate OTC

calcium citrate+d3 oral tablet Calcitrate OTC

calcium citrate+d3 petites oral tablet Citracal Petites/Vitamin D OTC

calcium citrate-vitamin d oral tablet OTC

calcium citrate-vitamin d3 oral liquid OTC

calcium citrate-vitamin d3 oral tablet Calcitrate OTC

calcium creamies oral tablet chewable OTC

calcium high potency/vitamin d oral tablet OTC

calcium oral tablet chewable OTC

calcium plus d3 absorbable oral capsule OTC

calcium plus vitamin d oral tablet Os-Cal Calcium + D3 OTC

calcium plus vitamin d3 oral capsule OTC

calcium plus vitamin d3 oral tablet Pronutrients Calcium+D3 OTC

calcium+d3 oral tablet Os-Cal Extra D3 OTC

calcium-vitamin d3 oral capsule OTC

calcium-vitamin d3 oral tablet OTC

CAL-QUICK ORAL LIQUID OTC

CALTRATE 600+D3 SOFT ORAL TABLET

CHEWABLE

OTC

CELEBRATE CALCIUM CITRATE ORAL

TABLET CHEWABLE

OTC

Drug Name Reference Notes

citrus calcium/vitamin d oral tablet Citracal Petites/Vitamin D OTC

eql calcium/vitamin d oral capsule OTC

finest nutrition calcium/vit d oral capsule OTC

liquid calcium with d3 oral capsule OTC

liquid calcium/vitamin d oral capsule OTC

MAGNEBIND 300 ORAL TABLET OTC

nat-rul oyster calcium+vit d oral tablet OTC

OS-CAL CALCIUM + D3 ORAL TABLET OTC

OS-CAL EXTRA D3 ORAL TABLET OTC

OS-CAL ORAL TABLET CHEWABLE OTC

OYSCO 500+D ORAL TABLET OTC

oyster calcium/d3 oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium + d oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium + d3 oral tablet OTC

oyster shell calcium oral tablet OTC

oyster shell calcium plus d oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium w/d oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium/d oral tablet OTC

oyster shell calcium/d3 oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium/vit d oral tablet Os-Cal Calcium + D3 OTC

oyster shell calcium/vit d3 oral tablet OTC

oyster shell calcium/vitamin d oral tablet Os-Cal Calcium + D3 OTC

PRONUTRIENTS CALCIUM+D3 ORAL

TABLET

OTC

super calcium 600 + d 400 oral tablet OTC

super calcium 600 + d3 oral tablet OTC

UPCAL D ORAL PACKET OTC

UPCAL D ORAL POWDER OTC

*CALCIUM***

calcium carbonate oral tablet OTC

calcium carbonate oral tablet chewable OTC

calcium oyster shell oral tablet OTC

oyster shell calcium oral tablet OTC

ra calcium oral tablet OTC

*FLUORIDE***

NAFRINSE ORAL TABLET CHEWABLE

sodium fluoride oral solution

Drug Name Reference Notes

sodium fluoride oral tablet chewable NaFrinse

*MAGNESIUM***

magnesium oxide -mg supplement oral

tablet

MAGnesium-Oxide OTC; QL

MAGNESIUM-OXIDE ORAL TABLET OTC; QL

mgo oral tablet MAGnesium-Oxide OTC; QL

*PHOSPHATE***

PHOSPHA 250 NEUTRAL ORAL TABLET

phosphorous oral tablet Phospha 250 Neutral

PHOSPHO-TRIN 250 NEUTRAL ORAL

TABLET

*POTASSIUM***

KLOR-CON 10 ORAL TABLET EXTENDED

RELEASE

KLOR-CON M10 ORAL TABLET

EXTENDED RELEASE

KLOR-CON M15 ORAL TABLET

EXTENDED RELEASE

KLOR-CON M20 ORAL TABLET

EXTENDED RELEASE

KLOR-CON ORAL PACKET

KLOR-CON ORAL TABLET EXTENDED

RELEASE

potassium chloride crys er oral tablet

extended release

Klor-Con M10

potassium chloride er oral capsule extended

release

potassium chloride er oral tablet extended

release

K-Tab

potassium chloride oral packet Klor-Con

potassium chloride oral solution

*ZINC***

ORAZINC ORAL CAPSULE AL; OTC

zinc oral capsule Orazinc AL; OTC

zinc sulfate oral capsule Orazinc AL; OTC

*MISCELLANEOUS THERAPEUTIC

CLASSES*

*CHELATING AGENTS***

penicillamine oral tablet Depen Titratabs PA; SP; QL

Drug Name Reference Notes

trientine hcl oral capsule Syprine PA; SP; QL

*CYCLOSPORINE ANALOGS***

cyclosporine modified oral capsule Gengraf SP

cyclosporine modified oral solution Gengraf SP

cyclosporine oral capsule SandIMMUNE SP

GENGRAF ORAL CAPSULE SP

GENGRAF ORAL SOLUTION SP

SANDIMMUNE ORAL SOLUTION SP

*HOMEOPATHIC PRODUCTS***

COLD-EEZE MOUTH/THROAT LOZENGE OTC

COLD-EEZE PLUS DEFENSE

MOUTH/THROAT LOZENGE

OTC

eql zinc cold relief mouth/throat lozenge Cold-Eeze OTC

zinc mouth/throat lozenge Cold-Eeze OTC

*INOSINE MONOPHOSPHATE

DEHYDROGENASE INHIBITORS***

mycophenolate mofetil oral capsule CellCept SP

mycophenolate mofetil oral suspension

reconstituted

CellCept SP

mycophenolate mofetil oral tablet CellCept SP

mycophenolate sodium oral tablet delayed

release

Myfortic SP

*MACROLIDE

IMMUNOSUPPRESSANTS***

sirolimus oral solution Rapamune SP

sirolimus oral tablet Rapamune SP

tacrolimus oral capsule Prograf SP

*MONOCLONAL ANTIBODIES***

ENSPRYNG SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP; QL

*POTASSIUM REMOVING AGENTS***

SPS ORAL SUSPENSION

*PURINE ANALOGS***

AZASAN ORAL TABLET SP

azathioprine oral tablet Azasan SP

*MOUTH/THROAT/DENTAL AGENTS*

*ANESTHETICS TOPICAL ORAL***

lidocaine hcl mouth/throat solution QL

Drug Name Reference Notes

lidocaine viscous hcl mouth/throat solution QL

*ANTI-INFECTIVES - THROAT***

clotrimazole mouth/throat troche QL

nystatin mouth/throat suspension QL

*ANTISEPTICS - MOUTH/THROAT***

chlorhexidine gluconate mouth/throat

solution

Periogard QL

PERIOGARD MOUTH/THROAT

SOLUTION

*FLUORIDE DENTAL PRODUCTS***

DENTA 5000 PLUS DENTAL CREAM QL

DENTAGEL DENTAL GEL QL

sf 5000 plus dental cream Denta 5000 Plus QL

sf dental gel DentaGel QL

sodium fluoride 5000 plus dental cream Denta 5000 Plus QL

sodium fluoride 5000 ppm dental cream Denta 5000 Plus QL

sodium fluoride dental cream Denta 5000 Plus QL

sodium fluoride dental gel DentaGel QL

*SALIVA STIMULANTS***

pilocarpine hcl oral tablet Salagen QL

*STEROIDS -

MOUTH/THROAT/DENTAL***

ORALONE MOUTH/THROAT PASTE

triamcinolone acetonide mouth/throat paste Oralone

*MULTIVITAMINS*

*B-COMPLEX W/ C & E + ZN***

bec/zinc oral tablet OTC

stress b/zinc oral tablet OTC

stress b-complex/vit c/zinc oral tablet OTC

stress formula/zinc (b-compl) oral tablet OTC

stress plus zinc oral tablet OTC

zinc-vites oral tablet OTC

*B-COMPLEX W/ MINERALS***

ELDERTONIC ORAL LIQUID OTC

*MULTIPLE VITAMINS W/ IRON***

daily vite multivitamin/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

Drug Name Reference Notes

daily-vitamin/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

multiple vitamins/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

multivitamin plus iron adult oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

multi-vitamin/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

nat-rul daily-vite+iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

one daily multivitamin/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

one-daily multi-vitamin/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

one-daily/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

stress b complex/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

stress formula/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

tab-a-vite/iron oral tablet

Tab-A-Vite/Iron/Beta

Carotene

AL; OTC

*MULTIPLE VITAMINS W/

MINERALS***

a thru z advanced adult oral tablet Cerovite Senior AL; OTC

a thru z advanced oral tablet Cerovite Senior AL; OTC

a thru z high potency oral tablet Cerovite Senior AL; OTC

a thru z select 50+ advanced oral tablet Cerovite Senior AL; OTC

a thru z select 50+ mens oral tablet Cerovite Senior AL; OTC

a thru z select advanced oral tablet Cerovite Senior AL; OTC

a thru z select oral tablet Cerovite Senior AL; OTC

a thru z select oral tablet chewable Advanced Multi EA AL; OTC

a thru z select ultimate women oral tablet Cerovite Senior AL; OTC

a thru z ultimate mens oral tablet Cerovite Senior AL; OTC

ACTIVESSENTIALS ORAL PACKET AL; OTC

ACTIVNUTRIENTS W/O COPPER/IRON

ORAL POWDER

OTC

advanced eye health oral capsule Amoryn Mood Booster AL; OTC

ADVANCED MULTI EA ORAL TABLET

CHEWABLE

AL; OTC

Drug Name Reference Notes

AIRBORNE GUMMIES ORAL TABLET

CHEWABLE

AL; OTC

AIRBORNE KIDS ORAL TABLET

CHEWABLE

AL; OTC

AIRBORNE ORAL PACKET AL; OTC

AIRBORNE ORAL TABLET CHEWABLE AL; OTC

AIRBORNE ORAL TABLET

EFFERVESCENT

OTC

AIRBORNE+EVERYDAY STRESS AWAY

ORAL PACKET

AL; OTC

AIRBORNE+NATURAL ENERGY ORAL

LIQUID

AL; OTC

ALIVE MULTI-VITAMIN ORAL LIQUID AL; OTC

AMORYN MOOD BOOSTER ORAL

CAPSULE

AL; OTC

antioxidant a/c/e/selenium oral tablet Cerovite Senior AL; OTC

antioxidant formula/minerals oral capsule Amoryn Mood Booster AL; OTC

antioxidant oral capsule Amoryn Mood Booster AL; OTC

antioxidant protection formula oral tablet Cerovite Senior AL; OTC

antioxidant vitamins oral tablet Cerovite Senior AL; OTC

ATP IGNITE ORAL PACKET AL; OTC

BEROCCA ORAL TABLET

EFFERVESCENT

OTC

BURIED TREASURE ACTIVE 55 PLUS

ORAL LIQUID

AL; OTC

c-buff oral powder

ActivNutrients w/o

Copper/Iron

OTC

centavite a-z complete-mineral oral tablet Cerovite Senior AL; OTC

centravites 50 plus oral tablet Cerovite Senior AL; OTC

centravites oral tablet Cerovite Senior AL; OTC

CENTRUM FLAVOR BURST DRINK ORAL

PACKET

AL; OTC

century mature oral tablet Cerovite Senior AL; OTC

century oral tablet Cerovite Senior AL; OTC

CEROVITE SENIOR ORAL TABLET AL; OTC

CERTAVITE/ANTIOXIDANTS ORAL

TABLET

AL; OTC

companion oral tablet Cerovite Senior AL; OTC

COMPETE ORAL TABLET AL; OTC

complete multivitamin/mineral oral liquid Airborne+Natural Energy AL; OTC

Drug Name Reference Notes

coral calcium plus oral capsule Amoryn Mood Booster AL; OTC

CVS AIRSHIELD FORMULA ORAL

TABLET EFFERVESCENT

OTC

CVS AIRSHIELD ORAL TABLET

CHEWABLE

AL; OTC

cvs daily gummies adult oral tablet chewable Advanced Multi EA AL; OTC

cvs daily gummies oral tablet chewable Advanced Multi EA AL; OTC

cvs immune support vitamin c oral packet ActivEssentials AL; OTC

cvs mens daily gummies oral tablet

chewable

Advanced Multi EA AL; OTC

cvs spectravite ultra mens oral tablet Cerovite Senior AL; OTC

cvs womens daily gummies oral tablet

chewable

Advanced Multi EA AL; OTC

daily betic oral tablet Cerovite Senior AL; OTC

daily combo multi vitamins oral tablet Cerovite Senior AL; OTC

daily mens health formula oral tablet Cerovite Senior AL; OTC

daily multiple vitamins/min oral tablet Cerovite Senior AL; OTC

daily multivitamin oral capsule Amoryn Mood Booster AL; OTC

daily vitamin plus oral capsule Amoryn Mood Booster AL; OTC

daily womens health formula oral tablet Cerovite Senior AL; OTC

daily-vitamin maximum formula oral tablet Cerovite Senior AL; OTC

diabetes health formula oral tablet Cerovite Senior AL; OTC

dialyvite 800/ultra d oral tablet Cerovite Senior AL; OTC

DRY EYE FORMULA ORAL CAPSULE AL; OTC

EMERGEN-C BLUE ORAL PACKET AL; OTC

EMERGEN-C FIVE ORAL PACKET AL; OTC

EMERGEN-C HEART HEALTH ORAL

PACKET

AL; OTC

EMERGEN-C IMMUNE ORAL PACKET AL; OTC

EMERGEN-C IMMUNE PLUS ORAL

PACKET

AL; OTC

EMERGEN-C IMMUNE+WARMERS ORAL

PACKET

AL; OTC

EMERGEN-C JOINT HEALTH ORAL

PACKET

AL; OTC

EMERGEN-C KIDZ ORAL PACKET AL; OTC

EMERGEN-C MSM LITE ORAL PACKET AL; OTC

EMERGEN-C PINK ORAL PACKET AL; OTC

Drug Name Reference Notes

EMERGEN-C SUPER FRUIT ORAL

PACKET

AL; OTC

EMERGEN-C VITAMIN C LITE ORAL

PACKET

AL; OTC

EMERGEN-C VITAMIN C ORAL PACKET AL; OTC

EMERGEN-C VITAMIN D/CALCIUM ORAL

PACKET

AL; OTC

ENERGY BOOSTER ORAL PACKET AL; OTC

eql air protector oral tablet effervescent Airborne OTC

ESSENTIA ORAL TABLET AL; OTC

essential balance oral tablet Cerovite Senior AL; OTC

EVOLUTION60 ORAL PACKET AL; OTC

EYE VITAMINS ORAL CAPSULE AL; OTC

EYE-VITES ORAL TABLET AL; OTC

glucoten oral capsule Amoryn Mood Booster AL; OTC

gnp immune support oral packet ActivEssentials OTC

gnp immune support oral tablet effervescent Airborne OTC

hair skin and nails formula oral tablet Cerovite Senior AL; OTC

hair skin nails oral capsule Amoryn Mood Booster AL; OTC

hair/skin/nails oral tablet Cerovite Senior AL; OTC

healthy eyes oral tablet Cerovite Senior AL; OTC

healthy eyes/lutein-zeaxanthin oral capsule Amoryn Mood Booster AL; OTC

hi-kovite 2-part formula oral tablet Cerovite Senior AL; OTC

hi-potency multi-vitamin oral tablet Cerovite Senior AL; OTC

ICAPS LUTEIN & OMEGA-3 ORAL

CAPSULE

AL; OTC

ICAPS MV ORAL TABLET AL; OTC

ICAPS ORAL CAPSULE AL; OTC

IMMUBLAST-C ORAL PACKET AL; OTC

i-vite oral tablet Cerovite Senior AL; OTC

LYSIPLEX PLUS ORAL LIQUID AL; OTC

MACULAR HEALTH FORMULA ORAL

CAPSULE

AL; OTC

MACUVITE EYE CARE ORAL TABLET AL; OTC

MACUVITE ORAL TABLET AL; OTC

MACUVITE/LUTEIN ORAL TABLET AL; OTC

MAXIMIN PACK ORAL PACKET AL; OTC

maximum daily green oral tablet Cerovite Senior AL; OTC

Drug Name Reference Notes

mens daily formula/lycopene oral capsule Amoryn Mood Booster AL; OTC

mens daily pack oral packet ActivEssentials AL; OTC

MENS LIFE PACK ORAL TABLET AL; OTC

MILLTRIUM ADVANCED FORMULA ORAL

TABLET

AL; OTC

MILLTRIUM CARDIO ORAL TABLET AL; OTC

MILLTRIUM SENIOR ORAL TABLET AL; OTC

multi + omega-3 adult gummies oral tablet

chewable

Advanced Multi EA AL; OTC

multi adult gummies oral tablet chewable Advanced Multi EA AL; OTC

MULTI COMPLETE ORAL CAPSULE AL; OTC

multi complete/iron oral tablet Cerovite Senior AL; OTC

multi for her 50+ oral capsule Amoryn Mood Booster AL; OTC

multi for her 50+ oral tablet Cerovite Senior AL; OTC

multi for her oral capsule Amoryn Mood Booster AL; OTC

multi for her oral packet ActivEssentials AL; OTC

multi for her oral tablet Cerovite Senior AL; OTC

multi for him 50+ oral tablet Cerovite Senior AL; OTC

MULTI FOR HIM ORAL CAPSULE AL; OTC

MULTI FOR HIM ORAL PACKET AL; OTC

MULTI FOR HIM ORAL TABLET AL; OTC

multi vitamin/minerals oral tablet Cerovite Senior AL; OTC

MULTI-LEAN ORAL TABLET AL; OTC

multiple vit/minerals/no iron oral tablet Cerovite Senior AL; OTC

multiple vitamins/womens oral tablet Cerovite Senior AL; OTC

multivit/multimineral adult oral liquid Airborne+Natural Energy AL; OTC

multivitamin & mineral oral liquid Airborne+Natural Energy AL; OTC

multivitamin adults 50+ oral tablet Cerovite Senior AL; OTC

multivitamin adults oral tablet Cerovite Senior AL; OTC

multivitamin gummies adult oral tablet

chewable

Advanced Multi EA AL; OTC

multivitamin gummies mens oral tablet

chewable

Advanced Multi EA AL; OTC

multi-vitamin gummies oral tablet chewable Advanced Multi EA AL; OTC

multivitamin gummies womens oral tablet

chewable

Advanced Multi EA AL; OTC

multivitamin men 50+ oral tablet Cerovite Senior AL; OTC

multi-vitamin menopausal oral tablet Cerovite Senior AL; OTC

100

Drug Name Reference Notes

multivitamin oral liquid Airborne+Natural Energy AL; OTC

multivitamin women 50+ oral tablet Cerovite Senior AL; OTC

multivitamin women oral tablet Cerovite Senior AL; OTC

multivitamin womens 50+ adv oral tablet Cerovite Senior AL; OTC

multi-vitamin/minerals oral tablet Cerovite Senior AL; OTC

multi-vite oral liquid Airborne+Natural Energy AL; OTC

myamulti oral tablet Cerovite Senior AL; OTC

NANOVM ADULT ORAL POWDER OTC

NANOVM SENIOR + ORAL POWDER OTC

ocutabs oral tablet Cerovite Senior AL; OTC

ocutabs-lutein oral tablet Cerovite Senior AL; OTC

OCUVITE EXTRA ORAL TABLET AL; OTC

OCUVITE EYE + MULTI ORAL TABLET AL; OTC

OCUVITE EYE HEALTH FORMULA ORAL

CAPSULE

AL; OTC

OCUVITE EYE HEATLH GUMMIES ORAL

TABLET CHEWABLE

AL; OTC

OCUVITE-LUTEIN ORAL TABLET AL; OTC

one daily 50 plus oral tablet Cerovite Senior AL; OTC

one daily calcium/iron oral tablet Cerovite Senior AL; OTC

one daily complete for men oral tablet Cerovite Senior AL; OTC

one daily complete oral tablet Cerovite Senior AL; OTC

one daily for men 50+ advanced oral tablet Cerovite Senior AL; OTC

one daily for men/lycopene oral tablet Cerovite Senior AL; OTC

one daily for women 50+ adv oral tablet Cerovite Senior AL; OTC

one daily for women oral tablet Cerovite Senior AL; OTC

one daily healthy weight adv oral tablet Cerovite Senior AL; OTC

one daily healthy weight oral tablet Cerovite Senior AL; OTC

one daily maximum oral tablet Cerovite Senior AL; OTC

one daily mens 50+ multivit oral tablet Cerovite Senior AL; OTC

one daily mens 50+/lycopene oral tablet Cerovite Senior AL; OTC

one daily mens health oral tablet Cerovite Senior AL; OTC

one daily mens oral tablet Cerovite Senior AL; OTC

one daily multivit/iron-free oral tablet Cerovite Senior AL; OTC

one daily multivitamin men oral tablet Cerovite Senior AL; OTC

one daily multivitamin women oral tablet Cerovite Senior AL; OTC

one daily womens 50 plus oral tablet Cerovite Senior AL; OTC

101

Drug Name Reference Notes

one daily womens 50+ oral tablet Cerovite Senior AL; OTC

one daily womens oral tablet Cerovite Senior AL; OTC

one daily/minerals oral tablet Cerovite Senior AL; OTC

ONE-A-DAY TEEN ADVANTAGE/HER

ORAL TABLET

AL; OTC

one-daily multi-vit/mineral oral tablet Cerovite Senior AL; OTC

optic-vites oral tablet Cerovite Senior AL; OTC

optic-vites with lutein oral tablet Cerovite Senior AL; OTC

optimum pms oral tablet Cerovite Senior AL; OTC

OSTEOPRIME ULTRA ORAL TABLET AL; OTC

PHLEXY-VITS ORAL POWDER OTC

PROSIGHT ORAL TABLET AL; OTC

PROXEED PLUS ORAL PACKET AL; OTC

qc multi-vite oral tablet Cerovite Senior AL; OTC

quintabs-m oral tablet Cerovite Senior AL; OTC

RA ESSENCE-C ORAL PACKET AL; OTC

RENAPLEX ORAL TABLET AL; OTC

senior tabs oral tablet Cerovite Senior AL; OTC

skin beauty & wellness oral packet ActivEssentials AL; OTC

stress b complex/antioxid/zinc oral tablet Cerovite Senior AL; OTC

stress formula/zinc oral tablet Cerovite Senior AL; OTC

STRESSTABS ADVANCED ORAL

TABLET

AL; OTC

super antioxidants protector oral capsule Amoryn Mood Booster AL; OTC

SYSTANE ICAPS AREDS2 ORAL

CAPSULE

AL; OTC

thera vital m oral tablet Cerovite Senior AL; OTC

thera vital-m oral tablet Cerovite Senior AL; OTC

therabasic-m oral tablet Cerovite Senior AL; OTC

THERADEX M ORAL TABLET AL; OTC

THERADEX M/BETA CAROTENE ORAL

TABLET

AL; OTC

THERA-MILL M ORAL TABLET AL; OTC

therapeutic formula/hematinics oral tablet Cerovite Senior AL; OTC

therapeutic-m oral tablet Cerovite Senior AL; OTC

therapeutic-m/lutein oral tablet Cerovite Senior AL; OTC

THERATRUM COMPLETE 50 PLUS ORAL

TABLET

AL; OTC

102

Drug Name Reference Notes

THERATRUM COMPLETE ORAL TABLET AL; OTC

THRIVE FOR LIFE WOMENS ORAL

TABLET

AL; OTC

tropical liquid nutrition oral liquid Airborne+Natural Energy AL; OTC

ultra freeda oral tablet Cerovite Senior AL; OTC

ultra freeda/iron oral tablet Cerovite Senior AL; OTC

ultra multi formula/iron oral capsule Amoryn Mood Booster AL; OTC

ULTRACHOICE ADV FORMULA MATURE

ORAL TABLET

AL; OTC

ULTRACHOICE ADVANCED FORMULA

ORAL TABLET

AL; OTC

vision formula 2 oral capsule Amoryn Mood Booster AL; OTC

vision formula/lutein oral tablet Cerovite Senior AL; OTC

vision plus oral capsule Amoryn Mood Booster AL; OTC

vision vitamins oral tablet Cerovite Senior AL; OTC

visivites oral tablet Cerovite Senior AL; OTC

visivites/lutein oral tablet Cerovite Senior AL; OTC

vita hair oral tablet Cerovite Senior AL; OTC

vitabasic complete oral tablet Cerovite Senior AL; OTC

vitabasic senior oral tablet Cerovite Senior AL; OTC

vitamin c effervescent blend oral packet ActivEssentials AL; OTC

vita-min oral capsule Amoryn Mood Booster AL; OTC

vitamins a-d-e/selenium oral tablet Cerovite Senior AL; OTC

VITATRUM COMPLETE ORAL TABLET AL; OTC

vitatrum oral tablet chewable Advanced Multi EA AL; OTC

VITEYES CLASSIC+MULTI ORAL

POWDER

OTC

VITEYES COMPLETE ORAL CAPSULE AL; OTC

VITRUM SENIOR ORAL TABLET AL; OTC

womens 50+ advanced oral capsule Amoryn Mood Booster AL; OTC

womens daily form/fa/ca/fe oral tablet Cerovite Senior AL; OTC

womens daily formula oral tablet Cerovite Senior AL; OTC

womens daily pack oral packet ActivEssentials AL; OTC

WOMENS LIFE PACK ORAL TABLET AL; OTC

womens multi oral capsule Amoryn Mood Booster AL; OTC

womens multivitamin oral tablet Cerovite Senior AL; OTC

zinc oral lozenge AL; OTC

103

Drug Name Reference Notes

*MULTIVITAMINS***

anti-oxidant oral tablet One Daily Essential AL; OTC

daily multiple vitamins oral tablet One Daily Essential AL; OTC

daily value multivitamin oral tablet One Daily Essential AL; OTC

daily vitamins oral tablet One Daily Essential AL; OTC

daily vite oral tablet One Daily Essential AL; OTC

daily vites oral tablet One Daily Essential AL; OTC

daily-vitamin oral tablet One Daily Essential AL; OTC

daily-vite multivitamin oral tablet One Daily Essential AL; OTC

daily-vite oral tablet One Daily Essential AL; OTC

healthy hair/skin/nails oral tablet One Daily Essential AL; OTC

multi vitamin oral tablet One Daily Essential AL; OTC

multiple vitamin-folic acid oral tablet One Daily Essential AL; OTC

multiple vitamins essential oral tablet One Daily Essential AL; OTC

multiple vitamins oral tablet One Daily Essential AL; OTC

multivitamin adult oral tablet One Daily Essential AL; OTC

multivitamin iron-free oral tablet One Daily Essential AL; OTC

multi-vitamin oral tablet One Daily Essential AL; OTC

once daily oral tablet One Daily Essential AL; OTC

ONE DAILY ESSENTIAL ORAL TABLET AL; OTC

one daily multivitamin adult oral tablet One Daily Essential AL; OTC

one daily oral tablet One Daily Essential AL; OTC

one-daily multi vitamins oral tablet One Daily Essential AL; OTC

one-daily multi-vitamin oral tablet One Daily Essential AL; OTC

stress formula oral tablet One Daily Essential OTC

STRESSTABS ENERGY ORAL TABLET AL; OTC

TAB-A-VITE ORAL TABLET AL; OTC

TAB-A-VITE/BETA CAROTENE ORAL

TABLET

AL; OTC

thera-mill oral tablet One Daily Essential AL; OTC

thera-tabs oral tablet One Daily Essential AL; OTC

vit e-vit c-beta carotene oral tablet One Daily Essential AL; OTC

vitalee oral tablet One Daily Essential AL; OTC

*PED MULTI VITAMINS W/FL & FE***

multi-vitamin/fluoride/iron oral solution OTC

*PED MV W/ FLUORIDE***

multi-vitamin/fluoride oral solution Floriva Plus OTC

104

Drug Name Reference Notes

multivitamin/fluoride oral tablet chewable Multi-Vit-Flor OTC

*PED MV W/ IRON***

BPROTECTED PEDIA POLY-VITE/FE

ORAL SOLUTION

AL; OTC; QL

HONEY BEARS W/IRON-ZINC ORAL

TABLET CHEWABLE

OTC

multivitamins plus iron child oral tablet

chewable

Cerovite Jr AL; OTC

pc pediatric poly-vita/fe drop oral solution

BProtected Pedia Poly-

Vite/Fe

AL; OTC; QL

poly-vita/iron oral solution

BProtected Pedia Poly-

Vite/Fe

AL; OTC; QL

*PED VITAMINS ACD W/ FLUORIDE***

adc/f (0.5mg/ml) oral solution OTC

tri-vite/fluoride oral solution OTC

vitamins acd-fluoride oral solution OTC

*PEDIATRIC MULTIPLE VITAMINS***

childrens chew multivitamin oral tablet

chewable

Culturelle Kids Complete OTC

NOVAMV PEDIATRIC MULTI-VITAMIN

ORAL LIQUID

AL; OTC

*PRENATAL MV & MIN W/FE-FA &

COENZYME Q10***

THERANATAL OVAVITE ORAL THERAPY

PACK

AL; OTC; QL

*PRENATAL MV & MIN W/FE-FA***

ATABEX ORAL TABLET CHEWABLE AL; OTC; QL

classic prenatal oral tablet AL; OTC; QL

HEALTHY MAMA BE WELL ROUNDED

ORAL THERAPY PACK

AL; OTC; QL

kp prenatal multivitamins oral tablet AL; OTC; QL

kpn prenatal oral tablet AL; OTC; QL

masonatal oral tablet AL; OTC; QL

multi prenatal oral tablet NeoNatal Vitamin AL; OTC; QL

neonatal prenatal oral tablet NeoNatal Vitamin AL; OTC; QL

NEONATAL VITAMIN ORAL TABLET AL; OTC; QL

NESTABS ORAL TABLET QL

one vite womens oral tablet NeoNatal Vitamin AL; OTC; QL

105

Drug Name Reference Notes

ONE-A-DAY WOMENS PRENATAL 1

ORAL CAPSULE

AL; OTC; QL

ONE-A-DAY WOMENS PRENATAL ORAL AL; OTC; QL

prenatabs fa oral tablet Co-Natal FA OTC; QL

prenatal (w/iron & fa) oral tablet AL; OTC; QL

prenatal complete oral tablet AL; OTC; QL

prenatal formula a-free oral tablet AL; OTC; QL

prenatal formula oral capsule AL; OTC; QL

prenatal forte oral tablet AL; OTC; QL

prenatal multi +dha oral capsule AL; OTC; QL

prenatal one daily oral tablet NeoNatal Vitamin AL; OTC; QL

prenatal oral tablet NeoNatal Vitamin AL; OTC; QL

prenatal vitamin and mineral oral tablet AL; OTC; QL

prenatal vitamins oral tablet AL; OTC; QL

prenatal/iron oral tablet AL; OTC; QL

THERANATAL CORE NUTRITION ORAL

TABLET

AL; OTC; QL

*PRENATAL MV & MIN W/FE-FA-

DHA***

cadeau dha oral capsule OTC; QL

CENTRUM SPECIALIST PRENATAL

ORAL

AL; OTC; QL

ENFAMIL EXPECTA ORAL AL; OTC; QL

prenatal multi +dha oral capsule AL; OTC; QL

PRENATAL MULTIVITAMIN + DHA ORAL AL; OTC; QL

prenatal multivitamin plus dha oral capsule AL; OTC; QL

prenatal vitamin/min +dha oral capsule OTC; QL

prenatal+dha oral AL; OTC; QL

SIMILAC PRENATAL EARLY SHIELD

ORAL

AL; OTC; QL

STUART ONE ORAL CAPSULE AL; OTC; QL

THERANATAL COMPLETE ORAL AL; OTC; QL

THERANATAL ONE ORAL CAPSULE AL; OTC; QL

ultra prenatal + dha oral capsule OTC; QL

*MUSCULOSKELETAL THERAPY

AGENTS*

*CENTRAL MUSCLE RELAXANTS***

baclofen oral tablet QL

106

Drug Name Reference Notes

carisoprodol oral tablet Soma QL

chlorzoxazone oral tablet QL

cyclobenzaprine hcl oral tablet QL

methocarbamol oral tablet QL

orphenadrine citrate er oral tablet extended

release 12 hour

tizanidine hcl oral tablet Zanaflex QL

VANADOM ORAL TABLET QL

*DIRECT MUSCLE RELAXANTS***

dantrolene sodium oral capsule Dantrium

*NASAL AGENTS - SYSTEMIC AND

TOPICAL*

*NASAL AGENTS - MISC.***

AFRIN SALINE NASAL MIST NASAL

SOLUTION

OTC; QL

NASAL MOIST NASAL SOLUTION OTC; QL

saline nasal spray nasal solution Afrin Saline Nasal Mist OTC; QL

*NASAL ANTICHOLINERGICS***

ipratropium bromide nasal solution QL

*NASAL ANTIHISTAMINES***

azelastine hcl nasal solution Astepro QL

*NASAL MAST CELL STABILIZERS***

cromolyn sodium nasal aerosol solution NasalCrom AL; OTC

*NASAL STEROIDS***

budesonide nasal suspension OTC; QL

CLARISPRAY NASAL SUSPENSION OTC; QL

fluticasone propionate nasal suspension ClariSpray OTC; QL

goodsense 24-hr allergy nasal nasal

suspension

ClariSpray OTC; QL

triamcinolone acetonide nasal aerosol KLS Aller-Cort QL

*SYSTEMIC DECONGESTANTS***

pseudoephedrine hcl er oral tablet extended

release 12 hour

Sudafed Sinus

Congestion 12HR

AL; OTC; QL

pseudoephedrine hcl oral tablet 30 mg Sudafed AL; OTC

pseudoephedrine hcl oral tablet 60 mg SudoGest AL; OTC; QL

SUDAFED CHILDRENS ORAL LIQUID AL; OTC

107

Drug Name Reference Notes

*NEUROMUSCULAR AGENTS*

*BENZATHIAZOLES***

riluzole oral tablet Rilutek PA; SP; QL

*NUTRIENTS*

*AMINO ACIDS-SINGLE***

arginine oral tablet OTC

CYTO ARG ORAL POWDER OTC

l-arginine double strength oral tablet OTC

l-arginine maximum strength oral tablet OTC

l-arginine oral capsule OTC

l-arginine oral tablet OTC

pure l-arginine hcl oral capsule OTC

ra l-arginine oral tablet OTC

*LIPOTROPICS***

inositol oral tablet OTC

*OPHTHALMIC AGENTS*

*ARTIFICIAL TEAR AND LUBRICANT

COMBINATIONS***

ALTALUBE OPHTHALMIC OINTMENT OTC

artificial tears ophthalmic solution Clear Eyes Natural Tears OTC

CLEAR EYES NATURAL TEARS

OPHTHALMIC SOLUTION

OTC

eye lubricant ophthalmic ointment Altalube OTC

for sty relief ophthalmic ointment Altalube OTC

FRESHKOTE OPHTHALMIC SOLUTION OTC

GENTEAL TEARS NIGHT-TIME

OPHTHALMIC OINTMENT

OTC

HYPOTEARS OPHTHALMIC OINTMENT OTC

lubricant drops/dual-action ophthalmic

solution

Refresh Optive OTC

lubricant eye drops ophthalmic solution Systane OTC

lubricant eye fast acting ophthalmic ointment Altalube OTC

lubricant eye nighttime ophthalmic ointment Altalube OTC

lubricant eye ophthalmic ointment Altalube OTC

lubricant pm ophthalmic ointment Altalube OTC

lubricating eye drops ophthalmic solution Systane OTC

lubrifresh p.m. ophthalmic ointment Altalube OTC

108

Drug Name Reference Notes

REFRESH DIGITAL OPHTHALMIC

SOLUTION

OTC

REFRESH LACRI-LUBE OPHTHALMIC

OINTMENT

OTC

REFRESH OPTIVE ADVANCED

OPHTHALMIC SOLUTION

OTC

RETAINE PM OPHTHALMIC OINTMENT OTC

SOOTHE NIGHTTIME OPHTHALMIC

OINTMENT

OTC

STYE OPHTHALMIC OINTMENT OTC

STYE OPHTHALMIC SOLUTION OTC

SYSTANE NIGHTTIME OPHTHALMIC

OINTMENT

OTC

ULTRA FRESH PM OPHTHALMIC

OINTMENT

OTC

ultra lubricating eye drops ophthalmic

solution

Systane OTC

*ARTIFICIAL TEAR SOLUTIONS***

artificial tears ophthalmic solution GenTeal Tears OTC

GENTEAL TEARS OPHTHALMIC

SOLUTION

OTC

just tears eye drops ophthalmic solution GenTeal Tears OTC

SOOTHE HYDRATION OPHTHALMIC

SOLUTION

OTC

SOOTHE XP OPHTHALMIC SOLUTION OTC

SOOTHE XP XTRA PROTECTION

OPHTHALMIC SOLUTION

OTC

SYSTANE CONTACTS OPHTHALMIC

SOLUTION

OTC

*ARTIFICIAL TEARS AND

LUBRICANTS***

ALCON TEARS OPHTHALMIC SOLUTION OTC

artificial tears ophthalmic solution OTC

BIOLLE TEARS OPHTHALMIC SOLUTION OTC

carboxymethylcellulose sodium ophthalmic

solution

Ultra Fresh OTC

cvs lubricant drops ophthalmic gel Refresh Liquigel OTC

dry eye relief ophthalmic gel Refresh Liquigel OTC

lubricant eye drops ophthalmic solution Systane Balance OTC

lubricant eye drops pf ophthalmic solution Biolle Tears OTC

109

Drug Name Reference Notes

lubricating plus eye drops ophthalmic

solution

Biolle Tears OTC

polyvinyl alcohol ophthalmic solution OTC

PURE & GENTLE LUBRICANT

OPHTHALMIC SOLUTION

OTC

ULTRA FRESH OPHTHALMIC SOLUTION OTC

*BETA-BLOCKERS - OPHTHALMIC

COMBINATIONS***

dorzolamide hcl-timolol mal ophthalmic

solution

Cosopt QL

*BETA-BLOCKERS - OPHTHALMIC***

betaxolol hcl ophthalmic solution QL

carteolol hcl ophthalmic solution

levobunolol hcl ophthalmic solution

timolol maleate ophthalmic gel forming

solution

Timoptic-XE QL

timolol maleate ophthalmic solution Timoptic QL

*CYCLOPLEGIC MYDRIATICS***

atropine sulfate ophthalmic solution Isopto Atropine QL

phenylephrine hcl ophthalmic solution Altafrin

*MIOTICS - DIRECT ACTING***

pilocarpine hcl ophthalmic solution

*OPHTHALMIC ANTIALLERGIC***

ALAWAY CHILDRENS ALLERGY

OPHTHALMIC SOLUTION

OTC; QL

ALAWAY OPHTHALMIC SOLUTION OTC; QL

azelastine hcl ophthalmic solution QL

CLARITIN EYE OPHTHALMIC SOLUTION OTC; QL

cromolyn sodium ophthalmic solution QL

epinastine hcl ophthalmic solution QL

eye allergy itch relief ophthalmic solution Pataday OTC; QL

eye allergy itch/redness rel ophthalmic

solution

Pataday OTC; QL

eye itch relief ophthalmic solution Alaway OTC; QL

ketotifen fumarate ophthalmic solution Alaway OTC; QL

olopatadine hcl ophthalmic solution 0.1 % Pataday QL

olopatadine hcl ophthalmic solution 0.2 % Pataday OTC; QL

PATADAY OPHTHALMIC SOLUTION OTC; QL

110

Drug Name Reference Notes

*OPHTHALMIC ANTIBIOTICS***

bacitracin ophthalmic ointment QL

ciprofloxacin hcl ophthalmic solution

erythromycin ophthalmic ointment QL

gatifloxacin ophthalmic solution Zymaxid

gentamicin sulfate ophthalmic solution QL

levofloxacin ophthalmic solution

moxifloxacin hcl ophthalmic solution Vigamox QL

ofloxacin ophthalmic solution Ocuflox QL

tobramycin ophthalmic solution QL

*OPHTHALMIC ANTI-INFECTIVE

COMBINATIONS***

bacitracin-polymyxin b ophthalmic ointment Polycin

neomycin-bacitracin zn-polymyx ophthalmic

ointment

Neo-Polycin OTC; QL

neomycin-polymyxin-gramicidin ophthalmic

solution

NEO-POLYCIN OPHTHALMIC OINTMENT OTC; QL

POLYCIN OPHTHALMIC OINTMENT

polymyxin b-trimethoprim ophthalmic

solution

Polytrim QL

*OPHTHALMIC ANTIVIRALS***

trifluridine ophthalmic solution QL

*OPHTHALMIC CARBONIC

ANHYDRASE INHIBITORS***

dorzolamide hcl ophthalmic solution QL

*OPHTHALMIC DECONGESTANT

COMBINATIONS***

allergy eye ophthalmic solution Visine AL; OTC; QL

eye allergy relief ophthalmic solution Visine AL; OTC; QL

VISINE OPHTHALMIC SOLUTION AL; OTC; QL

*OPHTHALMIC

IMMUNOMODULATORS***

cyclosporine ophthalmic emulsion Restasis PA; QL

*OPHTHALMIC NONSTEROIDAL ANTI-

INFLAMMATORY AGENTS***

diclofenac sodium ophthalmic solution QL

flurbiprofen sodium ophthalmic solution QL

111

Drug Name Reference Notes

*OPHTHALMIC SELECTIVE ALPHA

ADRENERGIC AGONISTS***

apraclonidine hcl ophthalmic solution

brimonidine tartrate ophthalmic solution Alphagan P QL

*OPHTHALMIC STEROID

COMBINATIONS***

bacitra-neomycin-polymyxin-hc ophthalmic

ointment

Neo-Polycin HC

neomycin-polymyxin-dexameth ophthalmic

ointment

Maxitrol

neomycin-polymyxin-dexameth ophthalmic

suspension

Maxitrol

neomycin-polymyxin-hc ophthalmic

suspension

NEO-POLYCIN HC OPHTHALMIC

OINTMENT

sulfacetamide-prednisolone ophthalmic

solution

tobramycin-dexamethasone ophthalmic

suspension

TobraDex QL

*OPHTHALMIC STEROIDS***

dexamethasone sodium phosphate

ophthalmic solution

fluorometholone ophthalmic suspension FML Liquifilm

prednisolone acetate ophthalmic suspension Pred Forte QL

prednisolone sodium phosphate ophthalmic

solution

*OPHTHALMIC SULFONAMIDES***

sulfacetamide sodium ophthalmic ointment QL

sulfacetamide sodium ophthalmic solution QL

*PROSTAGLANDINS -

OPHTHALMIC***

latanoprost ophthalmic solution Xalatan QL

*OTIC AGENTS*

*OTIC AGENTS - MISCELLANEOUS***

acetic acid otic solution

CLEARCANAL EARWAX SOFTENER

OTIC SOLUTION

AL; OTC

CLINERE EARWAX REMOVAL KIT OTIC

SOLUTION

AL; OTC

112

Drug Name Reference Notes

ear drops earwax aid otic solution

Clearcanal Earwax

Softener

AL; OTC

ear drops otic solution

Clearcanal Earwax

Softener

AL; OTC

ear wax removal drops otic solution

Clearcanal Earwax

Softener

AL; OTC

ear wax removal kit otic solution

Clearcanal Earwax

Softener

AL; OTC

ear wax removal system otic solution

Clearcanal Earwax

Softener

AL; OTC

earwax removal kit otic solution

Clearcanal Earwax

Softener

AL; OTC

earwax removal otic solution

Clearcanal Earwax

Softener

AL; OTC

MURINE EAR OTIC SOLUTION AL; OTC

MURINE EAR WAX REMOVAL SYSTEM

OTIC SOLUTION

AL; OTC

*OTIC ANTI-INFECTIVES***

ciprofloxacin hcl otic solution Cetraxal QL

ofloxacin otic solution QL

*OTIC STEROID-ANTI-INFECTIVE

COMBINATIONS***

neomycin-polymyxin-hc otic solution

neomycin-polymyxin-hc otic suspension

*OXYTOCICS*

*OXYTOCICS***

METHERGINE ORAL TABLET

methylergonovine maleate oral tablet Methergine

*PASSIVE IMMUNIZING AND

TREATMENT AGENTS*

*ANTIVIRAL MONOCLONAL

ANTIBODIES***

SYNAGIS INTRAMUSCULAR SOLUTION PA; SP

*IMMUNE SERUMS***

GAMUNEX-C INJECTION SOLUTION PA; SP

*PENICILLINS*

*AMINOPENICILLINS***

amoxicillin oral capsule

amoxicillin oral suspension reconstituted

113

Drug Name Reference Notes

amoxicillin oral tablet

amoxicillin oral tablet chewable

ampicillin oral capsule

*NATURAL PENICILLINS***

penicillin v potassium oral solution

reconstituted

penicillin v potassium oral tablet

*PENICILLIN COMBINATIONS***

amoxicillin-pot clavulanate er oral tablet

extended release 12 hour

amoxicillin-pot clavulanate oral suspension

reconstituted

Augmentin ES-600

amoxicillin-pot clavulanate oral tablet 250-

125 mg

amoxicillin-pot clavulanate oral tablet 500-

125 mg

Augmentin

amoxicillin-pot clavulanate oral tablet 875-

125 mg

amoxicillin-pot clavulanate oral tablet

chewable

*PENICILLINASE-RESISTANT

PENICILLINS***

dicloxacillin sodium oral capsule

*PROGESTINS*

*PROGESTINS***

medroxyprogesterone acetate oral tablet Provera QL

megestrol acetate oral suspension PA

norethindrone acetate oral tablet Aygestin

progesterone oral capsule Prometrium QL

*PSYCHOTHERAPEUTIC AND

NEUROLOGICAL AGENTS - MISC.*

*ALCOHOL DETERRENTS***

acamprosate calcium oral tablet delayed

release

disulfiram oral tablet

*ANTI-CATAPLECTIC AGENTS***

sodium oxybate oral solution Xyrem SP; QL

XYREM ORAL SOLUTION SP; QL

114

Drug Name Reference Notes

*ANTI-CATAPLECTIC

COMBINATIONS***

XYWAV ORAL SOLUTION SP; QL

*ANTIDEMENTIA AGENT

COMBINATIONS***

NAMZARIC ORAL CAPSULE ER 24 HOUR

THERAPY PACK

NAMZARIC ORAL CAPSULE EXTENDED

RELEASE 24 HOUR

*BENZODIAZEPINES & TRICYCLIC

AGENTS***

chlordiazepoxide-amitriptyline oral tablet

*CHOLINOMIMETICS - ACHE

INHIBITORS***

ADLARITY TRANSDERMAL PATCH

WEEKLY

donepezil hcl oral tablet Aricept QL

donepezil hcl oral tablet dispersible QL

galantamine hydrobromide er oral capsule

extended release 24 hour

galantamine hydrobromide oral solution QL

galantamine hydrobromide oral tablet QL

rivastigmine tartrate oral capsule QL

rivastigmine transdermal patch 24 hour Exelon QL

*FIBROMYALGIA AGENT - SNRIS***

SAVELLA ORAL TABLET PA

SAVELLA TITRATION PACK ORAL PA; QL

*MS AGENTS - PYRIMIDINE

SYNTHESIS INHIBITORS***

teriflunomide oral tablet Aubagio PA; SP; QL

*MULTIPLE SCLEROSIS AGENTS -

INTERFERONS***

AVONEX PEN INTRAMUSCULAR AUTO-

INJECTOR KIT

PA; SP; QL

AVONEX PREFILLED INTRAMUSCULAR

PREFILLED SYRINGE KIT

PA; SP; QL

REBIF REBIDOSE SUBCUTANEOUS

SOLUTION AUTO-INJECTOR

PA; SP; QL

115

Drug Name Reference Notes

REBIF REBIDOSE TITRATION PACK

SUBCUTANEOUS SOLUTION AUTO-

INJECTOR

PA; SP; QL

REBIF SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE

PA; SP; QL

REBIF TITRATION PACK

SUBCUTANEOUS SOLUTION PREFILLED

SYRINGE

PA; SP; QL

*MULTIPLE SCLEROSIS AGENTS -

NRF2 PATHWAY ACTIVATORS***

dimethyl fumarate oral capsule delayed

release

Tecfidera PA; SP; QL

dimethyl fumarate starter pack oral Tecfidera PA; SP; QL

*MULTIPLE SCLEROSIS AGENTS***

glatiramer acetate subcutaneous solution

prefilled syringe 20 mg/ml

Glatopa PA; SP

glatiramer acetate subcutaneous solution

prefilled syringe 40 mg/ml

Glatopa PA; SP; QL

GLATOPA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE 20 MG/ML

PA; SP

GLATOPA SUBCUTANEOUS SOLUTION

PREFILLED SYRINGE 40 MG/ML

PA; SP; QL

*N-METHYL-D-ASPARTATE (NMDA)

RECEPTOR ANTAGONISTS***

memantine hcl er oral capsule extended

release 24 hour

Namenda XR QL

memantine hcl oral solution QL

memantine hcl oral tablet Namenda QL

*PHENOTHIAZINES & TRICYCLIC

AGENTS***

perphenazine-amitriptyline oral tablet AL

*POSTHERPETIC NEURALGIA

(PHN)/NEUROPATHIC PAIN

AGENTS***

GRALISE ORAL TABLET 300 MG PA; DO; QL

GRALISE ORAL TABLET 450 MG, 750

MG, 900 MG

GRALISE ORAL TABLET 600 MG PA; QL

116

Drug Name Reference Notes

*PREMENSTRUAL DYSPHORIC

DISORDER (PMDD) AGENTS -

SSRIS***

fluoxetine hcl (pmdd) oral tablet QL

*PSEUDOBULBAR AFFECT AGENT

COMBINATIONS***

NUEDEXTA ORAL CAPSULE PA; QL

*PSYCHOTHERAPEUTIC AND

NEUROLOGICAL AGENTS - MISC.***

ergoloid mesylates oral tablet QL

pimozide oral tablet AL; QL

*RESTLESS LEG SYNDROME (RLS)

AGENTS***

HORIZANT ORAL TABLET EXTENDED

RELEASE

PA; QL

*SMOKING DETERRENTS***

bupropion hcl er (smoking det) oral tablet

extended release 12 hour

HABITROL TRANSDERMAL PATCH 24

HOUR

AL; OTC; QL

nicotine mini mouth/throat lozenge KLS Quit2 AL; OTC; QL

nicotine polacrilex mini mouth/throat lozenge KLS Quit2 AL; OTC; QL

nicotine polacrilex mouth/throat gum KLS Quit4 AL; OTC; QL

nicotine polacrilex mouth/throat lozenge KLS Quit2 AL; OTC; QL

nicotine step 1 transdermal patch 24 hour Habitrol AL; OTC; QL

nicotine step 2 transdermal patch 24 hour Nicoderm CQ AL; OTC; QL

nicotine step 3 transdermal patch 24 hour Nicoderm CQ AL; OTC; QL

nicotine transdermal kit AL; OTC

nicotine transdermal patch 24 hour Habitrol AL; OTC; QL

THRIVE MOUTH/THROAT GUM AL; OTC; QL

varenicline tartrate oral tablet QL

varenicline tartrate oral tablet therapy pack QL

*THIENBENZODIAZEPINES & OPIOID

ANTAGONISTS***

LYBALVI ORAL TABLET AL; QL

*THIENBENZODIAZEPINES & SSRIS***

olanzapine-fluoxetine hcl oral capsule Symbyax AL; QL

117

Drug Name Reference Notes

*RESPIRATORY AGENTS - MISC.*

*HYDROLYTIC ENZYMES***

PULMOZYME INHALATION SOLUTION PA; SP; QL

*SULFONAMIDES*

*SULFONAMIDES***

sulfadiazine oral tablet

*TETRACYCLINES*

*TETRACYCLINES***

demeclocycline hcl oral tablet

doxycycline hyclate oral capsule Vibramycin QL

doxycycline hyclate oral tablet TargaDOX QL

doxycycline hyclate oral tablet delayed

release

Doryx QL

doxycycline monohydrate oral capsule Mondoxyne NL QL

doxycycline monohydrate oral suspension

reconstituted

Vibramycin QL

doxycycline monohydrate oral tablet QL

minocycline hcl oral capsule

minocycline hcl oral tablet

MONDOXYNE NL ORAL CAPSULE QL

TARGADOX ORAL TABLET QL

*THYROID AGENTS*

*ANTITHYROID AGENTS***

methimazole oral tablet

propylthiouracil oral tablet

*THYROID HORMONES***

EUTHYROX ORAL TABLET

LEVO-T ORAL TABLET

levothyroxine sodium oral tablet Euthyrox

LEVOXYL ORAL TABLET

liothyronine sodium oral tablet Cytomel

SYNTHROID ORAL TABLET

UNITHROID ORAL TABLET

*TOXOIDS*

*TOXOID COMBINATIONS***

ADACEL INTRAMUSCULAR

SUSPENSION

118

Drug Name Reference Notes

BOOSTRIX INTRAMUSCULAR

SUSPENSION

BOOSTRIX INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

DAPTACEL INTRAMUSCULAR

SUSPENSION

INFANRIX INTRAMUSCULAR

SUSPENSION

KINRIX INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

PEDIARIX INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

PENTACEL INTRAMUSCULAR

SUSPENSION RECONSTITUTED

QUADRACEL INTRAMUSCULAR

SUSPENSION

QUADRACEL INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

TDVAX INTRAMUSCULAR SUSPENSION AL

TENIVAC INTRAMUSCULAR

INJECTABLE

tetanus-diphtheria toxoids td intramuscular

suspension

TDVAX AL

VAXELIS INTRAMUSCULAR

SUSPENSION

VAXELIS INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

*ULCER

DRUGS/ANTISPASMODICS/ANTICHO

LINERGICS*

*ANTISPASMODICS***

dicyclomine hcl oral capsule

dicyclomine hcl oral solution

dicyclomine hcl oral tablet

*H-2 ANTAGONISTS***

acid control maximum strength oral tablet

MM Acid-Pep Maximum

Strength

OTC; QL

acid controller max st oral tablet

MM Acid-Pep Maximum

Strength

OTC; QL

acid controller oral tablet Zantac 360 DO; OTC; QL

119

Drug Name Reference Notes

acid reducer maximum strength oral tablet

MM Acid-Pep Maximum

Strength

OTC; QL

acid reducer oral tablet Zantac 360 DO; OTC; QL

cimetidine 200 oral tablet Tagamet HB OTC; QL

cimetidine acid reducer oral tablet Tagamet HB OTC; QL

cimetidine oral tablet Tagamet HB QL

cvs heartburn relief oral tablet Tagamet HB OTC; QL

eq acid reducer oral tablet Tagamet HB OTC; QL

eq cimetidine oral tablet Tagamet HB OTC; QL

famotidine maximum strength oral tablet

MM Acid-Pep Maximum

Strength

OTC; QL

famotidine oral suspension reconstituted PA; QL

famotidine oral tablet 10 mg Zantac 360 DO; OTC; QL

famotidine oral tablet 20 mg

MM Acid-Pep Maximum

Strength

famotidine oral tablet 40 mg Pepcid QL

famotidine orig st oral tablet Zantac 360 DO; OTC; QL

heartburn relief max st oral tablet

MM Acid-Pep Maximum

Strength

OTC; QL

heartburn relief oral tablet Zantac 360 DO; OTC; QL

MM ACID-PEP MAXIMUM STRENGTH

ORAL TABLET

OTC; QL

nizatidine oral capsule QL

px acid reducer oral tablet Tagamet HB OTC; QL

sb cimetidine oral tablet Tagamet HB OTC; QL

sm acid reducer oral tablet Tagamet HB OTC; QL

ZANTAC 360 MAX ST ORAL TABLET OTC; QL

ZANTAC 360 ORAL TABLET DO; OTC; QL

*MISC. ANTI-ULCER***

sucralfate oral tablet Carafate

*PROTON PUMP INHIBITOR-ANTACID

COMBINATIONS***

omeprazole-sodium bicarbonate oral

capsule

Zegerid OTC; QL

*PROTON PUMP INHIBITORS***

acid reducer oral capsule delayed release OTC

acid reducer oral tablet delayed release PriLOSEC OTC OTC

esomeprazole magnesium oral capsule

delayed release

NexIUM 24HR PA; QL

120

Drug Name Reference Notes

esomeprazole magnesium oral tablet

delayed release

NexIUM 24HR OTC; QL

lansoprazole oral capsule delayed release Prevacid 24HR OTC; QL

NEXIUM 24HR CLEAR MINIS ORAL

CAPSULE DELAYED RELEASE

OTC; QL

NEXIUM 24HR ORAL CAPSULE

DELAYED RELEASE

OTC; QL

NEXIUM 24HR ORAL TABLET DELAYED

RELEASE

OTC; QL

omeprazole magnesium oral capsule

delayed release

OTC

omeprazole magnesium oral tablet delayed

release

PriLOSEC OTC OTC

omeprazole oral capsule delayed release 10

mg, 40 mg

omeprazole oral capsule delayed release 20

PA; Preferred for Members

less than 6 years of age. PA

required for members greater

than 6.

omeprazole oral tablet delayed release OTC

omeprazole oral tablet delayed release

dispersible

OTC

pantoprazole sodium oral packet Protonix

pantoprazole sodium oral tablet delayed

release

Protonix

PREVACID 24HR ORAL CAPSULE

DELAYED RELEASE

OTC; QL

PRILOSEC OTC ORAL TABLET

DELAYED RELEASE

OTC; QL

*QUATERNARY

ANTICHOLINERGICS***

glycopyrrolate oral tablet Robinul

*ULCER DRUGS -

PROSTAGLANDINS***

misoprostol oral tablet Cytotec

*URINARY ANTISPASMODICS*

*URINARY ANTISPASMODIC -

ANTIMUSCARINIC

(ANTICHOLINERGIC)***

darifenacin hydrobromide er oral tablet

extended release 24 hour

121

Drug Name Reference Notes

oxybutynin chloride er oral tablet extended

release 24 hour 10 mg, 15 mg

oxybutynin chloride er oral tablet extended

release 24 hour 5 mg

Ditropan XL

oxybutynin chloride oral syrup QL

oxybutynin chloride oral tablet QL

OXYTROL FOR WOMEN TRANSDERMAL

PATCH TWICE WEEKLY

OTC; QL

tolterodine tartrate er oral capsule extended

release 24 hour

Detrol LA QL

tolterodine tartrate oral tablet Detrol QL

trospium chloride er oral capsule extended

release 24 hour

trospium chloride oral tablet QL

*URINARY ANTISPASMODICS -

CHOLINERGIC AGONISTS***

bethanechol chloride oral tablet

*URINARY ANTISPASMODICS -

DIRECT MUSCLE RELAXANTS***

flavoxate hcl oral tablet

*VACCINES*

*BACTERIAL VACCINES***

ACTHIB INTRAMUSCULAR SOLUTION

RECONSTITUTED

BEXSERO INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

BIOTHRAX INTRAMUSCULAR

SUSPENSION

HIBERIX INJECTION SOLUTION

RECONSTITUTED

MENACTRA INTRAMUSCULAR

SOLUTION

AL; QL

MENQUADFI INTRAMUSCULAR

SOLUTION

AL; QL

MENVEO INTRAMUSCULAR SOLUTION

RECONSTITUTED

AL; QL

PEDVAX HIB INTRAMUSCULAR

SUSPENSION

PNEUMOVAX 23 INJECTION

INJECTABLE

122

Drug Name Reference Notes

PREVNAR 13 INTRAMUSCULAR

SUSPENSION

AL; QL

PREVNAR 20 INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

TRUMENBA INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

TYPHIM VI INTRAMUSCULAR SOLUTION

PREFILLED SYRINGE

VAXNEUVANCE INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

VIVOTIF ORAL CAPSULE DELAYED

RELEASE

*VIRAL VACCINE COMBINATIONS***

M-M-R II INJECTION SOLUTION

RECONSTITUTED

PRIORIX SUBCUTANEOUS SUSPENSION

RECONSTITUTED

PROQUAD SUBCUTANEOUS

SUSPENSION RECONSTITUTED

TWINRIX INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

*VIRAL VACCINES***

AFLURIA QUADRIVALENT

INTRAMUSCULAR SUSPENSION

AL; QL

AFLURIA QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

ENGERIX-B INJECTION SUSPENSION AL

ENGERIX-B INJECTION SUSPENSION

PREFILLED SYRINGE

FLUAD QUADRIVALENT

INTRAMUSCULAR PREFILLED SYRINGE

AL; QL

FLUARIX QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

FLUBLOK QUADRIVALENT

INTRAMUSCULAR SOLUTION

PREFILLED SYRINGE

AL; QL

FLUCELVAX QUADRIVALENT

INTRAMUSCULAR SUSPENSION

AL; QL

123

Drug Name Reference Notes

FLUCELVAX QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

FLULAVAL QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

FLUZONE HIGH-DOSE QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

FLUZONE QUADRIVALENT

INTRAMUSCULAR SUSPENSION

AL; QL

FLUZONE QUADRIVALENT

INTRAMUSCULAR SUSPENSION

PREFILLED SYRINGE

AL; QL

GARDASIL 9 INTRAMUSCULAR

SUSPENSION

AL; QL

GARDASIL 9 INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

AL; QL

HAVRIX INTRAMUSCULAR SUSPENSION AL

HEPLISAV-B INTRAMUSCULAR

SOLUTION PREFILLED SYRINGE

IMOVAX RABIES INTRAMUSCULAR

SUSPENSION RECONSTITUTED

IPOL INJECTION INJECTABLE

prehevbrio intramuscular suspension AL

RABAVERT INTRAMUSCULAR

SUSPENSION RECONSTITUTED

RECOMBIVAX HB INJECTION

SUSPENSION

RECOMBIVAX HB INJECTION

SUSPENSION PREFILLED SYRINGE

SHINGRIX INTRAMUSCULAR

SUSPENSION RECONSTITUTED

AL; QL

TICOVAC INTRAMUSCULAR

SUSPENSION PREFILLED SYRINGE

VAQTA INTRAMUSCULAR SUSPENSION AL

VARIVAX SUBCUTANEOUS INJECTABLE AL

124

Drug Name Reference Notes

*VAGINAL AND RELATED

PRODUCTS*

*IMIDAZOLE-RELATED

ANTIFUNGALS***

clotrimazole 3 vaginal cream Gyne-Lotrimin 3 OTC

clotrimazole vaginal cream Gyne-Lotrimin OTC; QL

clotrimazole-7 vaginal cream Gyne-Lotrimin OTC; QL

miconazole 1 vaginal kit Monistat 1 Combo Pack OTC

miconazole 3 combo pack app vaginal kit

Monistat 3 Combo Pack

App

OTC; QL

miconazole 3 combo pack vaginal kit

Monistat 3 Combo Pack

App

OTC; QL

miconazole 3 vaginal suppository

miconazole 7 vaginal cream Monistat 7 Simply Cure OTC

miconazole 7 vaginal suppository OTC

miconazole nitrate vaginal cream Monistat 7 Simply Cure OTC

MONISTAT 1-DAY VAGINAL OINTMENT OTC

terconazole vaginal cream QL

terconazole vaginal suppository QL

tioconazole-1 vaginal ointment Monistat 1-Day OTC

*VAGINAL ANTI-INFECTIVES***

CLEOCIN VAGINAL SUPPOSITORY

clindamycin phosphate vaginal cream Cleocin

metronidazole vaginal gel Vandazole

VANDAZOLE VAGINAL GEL

*VAGINAL ESTROGENS***

estradiol vaginal tablet Yuvafem

YUVAFEM VAGINAL TABLET

*VASOPRESSORS*

*ANAPHYLAXIS THERAPY AGENTS***

epinephrine injection solution auto-injector Auvi-Q QL

SYMJEPI INJECTION SOLUTION

PREFILLED SYRINGE

*VASOPRESSORS***

epinephrine injection solution

midodrine hcl oral tablet

125

Drug Name Reference Notes

*VITAMINS*

*BIOTIN***

biotin maximum strength oral capsule Meribin AL; OTC

biotin oral capsule Meribin AL; OTC

MERIBIN ORAL CAPSULE AL; OTC

super biotin oral capsule Meribin AL; OTC

*VITAMIN A***

natural vitamin a oral capsule AL; OTC

vitamin a oral capsule 2400 mcg (8000 ut) OTC

vitamin a oral capsule 3 mg (10000 ut) AL; OTC

vitamin a oral tablet OTC

vitamin a palmitate oral tablet OTC

*VITAMIN B-1***

b1 oral tablet OTC

b-1 oral tablet AL; OTC

thiamine hcl oral tablet AL; OTC

thiamine mononitrate oral tablet OTC

vitamin b1 oral tablet AL; OTC

vitamin b-1 oral tablet 100 mg OTC

vitamin b-1 oral tablet 250 mg, 50 mg AL; OTC

*VITAMIN B-2***

b-2 oral tablet AL; OTC

vitamin b-2 oral tablet AL; OTC

*VITAMIN B-3***

niacin oral tablet OTC

plain niacin oral tablet OTC

*VITAMIN B-6***

b6 natural oral tablet AL; OTC

b-6 oral tablet AL; OTC

pyridoxine hcl oral tablet 25 mg OTC

pyridoxine hcl oral tablet 50 mg AL; OTC

vitamin b6 oral tablet AL; OTC

vitamin b-6 oral tablet 100 mg, 50 mg AL; OTC

vitamin b-6 oral tablet 25 mg OTC

yl vitamin b-6 oral tablet AL; OTC

126

Drug Name Reference Notes

*VITAMIN C***

acerola c-500 oral tablet chewable Sunkist Vitamin C OTC

ascorbic acid oral tablet PureWay-C AL; OTC

BPROTECTED VITAMIN C ORAL LIQUID OTC

ENDUR-C ORAL TABLET EXTENDED

RELEASE

OTC

liquid c oral liquid BProtected Vitamin C OTC

natural c/rose hips oral tablet PureWay-C AL; OTC

PUREWAY-C ORAL TABLET AL; OTC

vitamin c er oral tablet extended release

1500 mg

AL; OTC

vitamin c er oral tablet extended release 500

Endur-C OTC

vitamin c immune health oral tablet

chewable

Sunkist Vitamin C OTC

vitamin c oral liquid BProtected Vitamin C OTC

vitamin c oral tablet PureWay-C AL; OTC

vitamin c oral tablet chewable Sunkist Vitamin C OTC

vitamin c plus wild rose hips oral tablet

chewable

Sunkist Vitamin C OTC

vitamin c/bioflavonoids/rosehp oral tablet PureWay-C AL; OTC

vitamin c/natural rose hips oral tablet AL; OTC

vitamin c/rose hips oral tablet PureWay-C AL; OTC

vitamin c/rose hips tr oral tablet extended

release

Endur-C OTC

vitamin c-acerola oral tablet chewable Sunkist Vitamin C OTC

vitamin c-rose hips er oral tablet extended

release

Endur-C OTC

vitamin c-rose hips oral tablet PureWay-C AL; OTC

vitamin c-rose hips oral tablet chewable Sunkist Vitamin C OTC

vitamin c-rose hips tr oral tablet extended

release

Endur-C OTC

yl vitamin c oral tablet PureWay-C AL; OTC

yl vitamin c-rose hips oral tablet PureWay-C AL; OTC

*VITAMIN D***

aqueous vitamin d oral liquid BProtected Pedia D-Vite AL; OTC; QL

BPROTECTED PEDIA D-VITE ORAL

LIQUID

AL; OTC; QL

CALCIDOL ORAL SOLUTION AL; OTC

127

Drug Name Reference Notes

d 1000 oral capsule Pronutrients Vitamin D3 OTC

d 1000 oral tablet chewable

Kids First Vitamin D3

Gummies

AL; OTC

d 400 oral tablet OTC

d 5000 oral capsule Dialyvite Vitamin D 5000 OTC

d-1000 extra strength oral tablet Vitamin D-1000 Max St OTC

d-1000 oral tablet Vitamin D-1000 Max St OTC

d2000 ultra strength oral capsule OTC

d3 2000 oral capsule OTC

d3 5000 oral capsule Dialyvite Vitamin D 5000 OTC

d3 adult oral tablet chewable

Kids First Vitamin D3

Gummies

AL; OTC

d3 high potency oral capsule Dialyvite Vitamin D 5000 OTC

d3 high potency oral tablet OTC

d3 kids oral tablet chewable Healthy Kids Vitamin D3 OTC

d3 maximum strength oral capsule Dialyvite Vitamin D 5000 OTC

d3 oral tablet Thera-D 2000 OTC

d3 oral tablet chewable Healthy Kids Vitamin D3 OTC

d3 super strength oral capsule OTC

d3-1000 oral capsule Pronutrients Vitamin D3 OTC

d3-1000 oral tablet Vitamin D-1000 Max St OTC

d-3-5 oral capsule Dialyvite Vitamin D 5000 OTC

d-400 oral tablet OTC

d-5000 oral tablet

Radiance Platinum

Vitamin D3

OTC

delta d3 oral tablet OTC

DIALYVITE VITAMIN D 5000 ORAL

CAPSULE

OTC

d-vite pediatric oral liquid BProtected Pedia D-Vite AL; OTC; QL

ergocalciferol oral capsule Drisdol

ergocalciferol oral solution Calcidol AL; OTC

finest nutrition vitamin d3 oral capsule Pronutrients Vitamin D3 OTC

HEALTHY KIDS VITAMIN D3 ORAL

TABLET CHEWABLE

OTC

KIDS FIRST VITAMIN D3 GUMMIES ORAL

TABLET CHEWABLE

AL; OTC

nat-rul vitamin d oral tablet

Radiance Platinum

Vitamin D3

OTC

128

Drug Name Reference Notes

natural vitamin d-3 oral tablet

Radiance Platinum

Vitamin D3

OTC

pharmacist choice d-vitamin oral liquid BProtected Pedia D-Vite AL; OTC; QL

PRONUTRIENTS VITAMIN D3 ORAL

CAPSULE

OTC

sm vitamin d3 oral tablet

Radiance Platinum

Vitamin D3

OTC

THERA-D 2000 ORAL TABLET OTC

THERA-D RAPID REPLETION ORAL

TABLET

OTC

VITAJOY DAILY D GUMMIES ORAL

TABLET CHEWABLE

AL; OTC

vitamin d (cholecalciferol) oral capsule Pronutrients Vitamin D3 OTC

vitamin d (cholecalciferol) oral tablet Vitamin D-1000 Max St OTC

vitamin d (cholecalciferol) oral tablet

chewable

Healthy Kids Vitamin D3 OTC

vitamin d (ergocalciferol) oral capsule Drisdol

vitamin d high potency oral capsule Pronutrients Vitamin D3 OTC

vitamin d infant oral liquid BProtected Pedia D-Vite AL; OTC; QL

vitamin d oral capsule OTC

vitamin d oral liquid BProtected Pedia D-Vite AL; OTC; QL

vitamin d oral tablet Thera-D 2000 OTC

VITAMIN D-1000 MAX ST ORAL TABLET OTC

vitamin d3 adult gummies oral tablet

chewable

Kids First Vitamin D3

Gummies

AL; OTC

vitamin d3 gummies adult oral tablet

chewable

Kids First Vitamin D3

Gummies

AL; OTC

vitamin d3 gummies oral tablet chewable

Kids First Vitamin D3

Gummies

AL; OTC

vitamin d3 maximum strength oral capsule Dialyvite Vitamin D 5000 OTC

vitamin d3 oral capsule Dialyvite Vitamin D 5000 OTC

vitamin d-3 oral capsule Pronutrients Vitamin D3 OTC

vitamin d3 oral liquid BProtected Pedia D-Vite AL; OTC; QL

vitamin d3 oral tablet

Radiance Platinum

Vitamin D3

OTC

vitamin d-3 oral tablet

Radiance Platinum

Vitamin D3

OTC

vitamin d3 oral tablet chewable 10 mcg (400

unit)

Healthy Kids Vitamin D3 OTC

129

Drug Name Reference Notes

vitamin d3 oral tablet chewable 25 mcg

(1000 ut)

Kids First Vitamin D3

Gummies

AL; OTC

YUMVS VITAMIN D3 ORAL TABLET

CHEWABLE

AL; OTC

*VITAMIN E***

AQUA-E ORAL LIQUID 20 UNIT AL; OTC

AQUA-E ORAL LIQUID 50.25 MG/ML (75

UT/ML)

OTC

aqueous vitamin e oral solution SoluVita E OTC

e 1000 oral capsule OTC

e-1000 oral capsule OTC

e200 oral capsule OTC

e-200 oral capsule 200 unit AL; OTC

e-200 oral capsule 90 mg (200 unit) OTC

e400 oral capsule OTC

e-400 oral capsule OTC

e-400-clear oral capsule OTC

natural vitamin e oral capsule 100 unit AL; OTC

natural vitamin e oral capsule 400 unit, 670

mg (1000 ut)

OTC

SOLUVITA E ORAL SOLUTION OTC

vitamin e blend oral capsule OTC

vitamin e high potency oral capsule OTC

vitamin e oral capsule 100 unit, 180 mg (400

unit), 200 unit

AL; OTC

vitamin e oral capsule 1000 unit, 134 mg

(200 unit), 268 mg (400 unit), 400 unit, 45

mg (100 unit), 450 mg (1000 ut), 670 mg

(1000 ut), 90 mg (200 unit)

OTC

vitamin e oral solution SoluVita E OTC

vitamin e water soluble oral capsule OTC

vitamin e/d-alpha natural oral capsule OTC

vitamin e/d-alpha oral capsule OTC

*VITAMIN K***

phytonadione oral tablet

130

131