2015 Prescription Drug List
UnitedHealthcare & Affiliated Companies
Table of Contents
2015 Prescription Drug List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Prescription Drug List Medication Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tier Designations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Over-the-Counter and Therapeutically Equivalent Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Keys to Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Generic Medication Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Specialty Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medications Requiring Notification and Other Pharmacy Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
How to Obtain Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Chapters
Anti-Infectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Antineoplastic & Immunosuppressant Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Autonomic & CNS Drugs, Neurology & Psych. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Cardiovascular, Hypertension & Lipids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Dermatologicals/Topical Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Ear, Nose & Throat Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Endocrine/Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Gastroenterology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Immunology, Vaccines & Biotechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Musculoskeletal & Inflammatory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Obstetrics & Gynecology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Ophthalmology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Respiratory, Allergy, Cough & Cold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Urologicals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Vitamins, Hematinics & Electrolytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Diagnostics & Miscellaneous Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Brand Only Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
1
November 2014
2015 Prescription Drug List
Introduction
Tier Designations
The UnitedHealthcare Prescription Drug List (PDL) provides
a list of medications in various therapeutic classes for use in
meeting the prescription medication needs of your patients
who are our members. This list is intended for use with
UnitedHealthcare health plans and affiliated companies’
pharmacy benefit plan designs. The PDL applies only to
prescription medications dispensed to outpatients and does
not include inpatient medications or medications obtained or
administered in a physician’s office. The PDL does not define
benefit coverage. Benefit coverage is determined by the
member’s pharmacy benefit plan.2 This means that there may
be medications listed on the PDL that are not covered under a
particular member’s pharmacy benefit plan.
Prescription medications are categorized within three Tiers on
the PDL.3 Each Tier is assigned a cost,* which is determined
by the member’s pharmacy benefit plan. You may refer to the
PDL as a guide to select the most appropriate medication with
the lowest member cost for your patients.
1
Tier 1
Tier 2
Tier 3
Your patient’s
Your patient’s
Your patient’s
lowest-cost midrange-costhighest-cost
medicationsmedicationsmedications
You may also access PDL information by visiting our website at
UnitedHealthcareOnline.com.
Tier 1
Tier 1 medications are your patient’s lowest-cost option.
Members can maximize their cost savings when you prescribe
Tier 1 medications, if you decide they are appropriate for your
patient’s treatment.
Prescription Drug List Medication Overview
Tier decisions are made by our PDL Management Committee
based on clinical, economic, and other factors. The PDL
Management Committee is comprised of senior UnitedHealth
Group physician and business leaders. The UnitedHealth
Group National Pharmacy & Therapeutics (P&T) Committee,
comprised of physicians and pharmacists, reviews new and
existing medications and provides clinical guidance to the PDL
Management Committee. Guidance is based on similarities
and differences compared with other medications that treat the
same disease or condition.
Tier 2
Tier 2 medications are your patient’s midrange-cost option.
Consider Tier 2 medications if no Tier 1 medication is
appropriate to treat your patient’s condition.
Tier 3
Tier 3 medications are your patient’s highest-cost option. If your
patient is currently taking a medication in Tier 3, you may want
to determine if there is an appropriate alternative in Tier 1 or
Tier 2.
The Tier placement of a medication on the PDL may change.
While medications change Tiers infrequently, such changes
generally occur two times per calendar year. Additionally, when
a brand-name medication becomes available as a generic, the
Tier status of the brand-name medication and its corresponding
generic will be evaluated. When a medication changes Tiers,
your patient may be required to pay more or less for that
medication. These changes may occur without prior notice
to you or your patient. However, you may visit our website
at UnitedHealthcareOnline.com for the most up-to-date
information for a particular medication. And your patient can
find the most up-to-date Tier status and cost* information for a
particular medication by visiting our member website at
myuhc.com® and/or calling the toll-free member phone
number located on his or her health care ID card.
You and your patient make decisions about health care and
medication treatments.
Note: If the member has a “closed” pharmacy benefit (a
two-Tier pharmacy benefit plan that does not cover
medications classified in Tier 3 of this PDL), medications in Tier
3 are generally not covered, except under certain processes
consistent with applicable law. Compounded medications,
those medications containing one or more ingredients that
are prepared onsite by a pharmacist, are classified at the
Tier 3 level, provided that the individual ingredients used in
compounding are covered under the pharmacy benefit.
Note: Some members have a four-Tier prescription plan and
these are noted as T4 throughout the document. Members with
a four-Tier prescription plan should refer to their enrollment
materials, check the Medication Pricing / Coverage information
on our member website or call the toll-free member phone
number provided on their health care ID card for more
information about their benefit plan.
Note: Not all medications are represented in this PDL. Only
the most commonly prescribed medications are included.
*UnitedHealthcare operates a wide number of benefit programs and products, and some benefit programs may have alternative benefit designs. Physicians should always check the member’s specific benefit prior
to prescribing medications.
3
Generic Medication Policy
Over-the-Counter and Therapeutically
Equivalent Medications
While there are exceptions, generic medications are generally
included on the PDL in Tier 1. If a generic medication does
not offer significant financial savings over the brand, it may
be placed in the same Tier as the brand or in a higher Tier.
Generic medications are noted in italics font.
For some conditions, you and your patient may decide that an
over-the-counter (OTC) medication is the most appropriate
treatment. According to UnitedHealthcare benefit design,
OTC medications are defined as medications that do not
require a prescription by federal or state law to be dispensed.
In some instances, OTC medications are listed on the PDL
for reference purposes only. OTC medications may cost less
than the member’s out-of-pocket expense for prescription
medications.
Note that when a brand-name medication becomes available
as a generic, that brand-name product may move to a higher
Tier. Members may be required to pay more for a prescription
when a higher-Tier brand-name product is dispensed. The
member’s payment is determined by the pharmacy benefit
plan. When generic substitution conflicts with state regulations
or restrictions, the pharmacist must obtain approval from the
prescribing physician or other health care professional to
substitute the generic equivalent.
Therapeutically equivalent means that medications can be
expected to produce essentially the same therapeutic outcome
and toxicity or adverse event.
If the patient or physician requests a therapeutically equivalent
product or an OTC product, the patient may be required to
pay the entire cost of the product as they may not be covered
under the member’s pharmacy benefit. Please refer to the
member’s pharmacy benefit plan.
Specialty Medications
Some members may have coverage for self-administered
injectable and oral specialty medications through their
pharmacy benefit plan. You will find these medications
included in the body of this document within the appropriate
therapeutic categories. UnitedHealthcare has developed a
Specialty Pharmacy Program including requiring the majority
of specialty medications be obtained through a designated
specialty pharmacy. These medications are noted by DSP
throughout the document. The specialty pharmacy program
includes specialty pharmacies, each selected based on their
clinical expertise for the targeted therapeutic classes, quality
of services and cost. Their pharmacists are trained to help
educate members and create personalized plans, if needed,
for these specialty medications, which may help improve
treatment adherence.
Keys To Symbols
Symbols
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required**
RS May be eligible for the Refill and Save Program
SDP Select Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
Participating members should be instructed to call the
toll-free member number on the back of their ID card where
a representative will answer questions about our program and
then transfer them to a specialty pharmacy based on their
particular specialty medication prescription.
**Depending on your patients’ benefit and/or medication, notification or medical
necessity criteria will be applied to determine if covered under the pharmacy
benefit.
*UnitedHealthcare operates a wide number of benefit programs and products, and some benefit programs may have alternative benefit designs. Physicians should always check the member’s specific benefit prior
to prescribing medications.
4
Medications Requiring Notification and
Other Pharmacy Programs
The Refill and Save Program (also known as Adherence
Incentive) encourages members to adhere to their treatment
regimen by rewarding them with a discount on their
copayment/coinsurance for refilling their prescription within the
defined time period. Eligible medications have an “RS” notation
(RS for Refill and Save).
Selected medications may require prior authorization and
review to be eligible for coverage under the member’s
pharmacy benefit plan. Such medications have a notation
“N” in this booklet. Depending on your patients’ benefit and/
or medication, notification or medical necessity criteria will be
applied to determine if covered under the pharmacy benefit.
The pharmacy benefit may exclude coverage of medications for
certain uses.
To receive pharmacy benefit coverage on some medications,
a member is required to fill their prescription through a
designated Mail Order Pharmacy or stay at retail with a lowerTier alternative. Such medications have an “SDP” notation in
this booklet.
The medications requiring prior authorization are
noted throughout the document with an “N” notation
and the clinical criteria are available on our website at
UnitedHealthcareOnline.com. The criteria reflect
UnitedHealth Group National Pharmacy and Therapeutics
Committee decisions. For a member to receive benefit
coverage for a medication requiring notification, the physician
or the physician’s designee must provide information to the
prior authorization department.
How to Obtain Authorization?
The Online Prior Authorization tool (available through
UnitedHealthCareOnline.com) is easy to use. The majority of
online prior authorizations are approved in real time, and an
auto-population feature provides 95 percent of a member’s
information. The OptumRx Prior Authorization team is also
available by phone at 800-711-4555. Prior authorizations can
also be submitted online by logging into www.optumrx.com >
Healthcare Professionals > Prior Authorizations.
Some benefit plans may include our Step Therapy program.
Step Therapy offers a “stepwise” approach to therapy for
certain high-cost medications and requires that a member first
try a more cost-effective medication before another high-cost
medication. Such medications have a notation “ST” (for
Step Therapy).
Supply limits define the maximum supply of medication per
copayment or period of time. Supply limits are based on several
factors that may include FDA-approved dosing guidelines
as defined in the product package insert, medical literature,
guidelines or supportive data. Such medications have a
notation “SL” (for supply limit).
1
In certain documents the Prescription Drug List (PDL) was referred to as the “Preferred Drug List (PDL).” This change in descriptive terms does not affect your patient’s benefit coverage.
2
Where differences are noted, the benefit plan documents will govern.
3
In certain documents Tier 1 was referred to as “generics;” Tier 2 was referred to as “preferred brands” or “brand-name” on the PDL; and Tier 3 was referred to as “non-preferred brands,” “not on the PDL,” or
“brand-name not on the PDL.” These changes in descriptive terms do not affect your patient’s benefit coverage.
5
Anti-Infectives
Penicillins
Cephalosporins
Tier 1
Amoxicillin Trihydrate Capsule,
Chewable Tablet, Suspension, Tablet (Amoxil)
Amoxicillin Trihydrate/Potassium
Clavulanate (Augmentin Chewable Tablet, Tablet,
Suspension)
Dicloxacillin Sodium Capsule (Dynapen)
Penicillin V Potassium (Pen-V K)
Tier 3
Amoxicillin Clavulanate ER Tablet,
Sustained-Release 12 Hour (Augmentin XR)*** E T4
FIRST GENERATION CEPHALOSPORINS
Tier 1
Cefadroxil Hydrate (Duricef)
Cephalexin Monohydrate (Keflex)
SECOND GENERATION CEPHALOSPORINS
Tier 1
Cefaclor (Ceclor, Ceclor CD)
Cefpodoxime Tablet (Vantin)
Cefprozil (Cefzil)
Cefuroxime Axetil Suspension, Tablet (Ceftin)
Tier 3
Ceftin Suspension
Tetracyclines
Tier 1
Doxycycline Hyclate Tablet 20 mg (Periostat)
Doxycycline Monohydrate 50, 100 mg Capsule
(Monodox)
Minocycline HCl Capsule (Minocin)
Tier 2
Doxycycline Hyclate 50, 75, 100, 150 mg
(Morgidox, Vibra-Tabs, Vibramycin)**
Tier 3
Adoxa
Doxycycline Hyclate Tablet, Enteric-Coated
(Doryx)***
Doxycycline Monohydrate 75 mg Capsule
(Monodox)***
Doxycycline Monohydrate Capsule
(Adoxa 150 mg)***
Oracea Minocycline HCl Tablet (Dynacin)***
Minocycline HCl Tablet, Extended-Release
24 Hour (Solodyn 45, 90, 135 mg)***
Solodyn Tetracycline HCl (Achromycin V)***
Vibramycin Suspension
THIRD GENERATION CEPHALOSPORINS
Tier 1
Cefditoren Pivoxil (Spectracef)
Tier 2
Cefdinir (Omnicef)**
Tier 3
Cedax
Suprax Tablet, Capsule, Suspension
T4
E T4
Erythromycins & Other Macrolides
E T4
Tier 1
Azithromycin (Zithromax)
Clarithromycin Tablet (Biaxin)
Erythromycin Base Capsule,
Delayed-Release (Eryc)
Erythromycin Base Tablet, Enteric-Coated
250, 333 mg (E-Mycin, Ery-Tab)
Erythromycin Ethylsuccinate (E.E.S.)
Erythromycin Ethylsuccinate/Sulfisoxazole
Acetyl (Pediazole)
Tier 2
Clarithromycin Suspension (Biaxin)**
Clarithromycin Sustained-Release Tablet
(Biaxin XL)**
Tier 3
PCE
Zmax
E T4
E T4
T4
T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
7
Anti-Infectives
Quinolones
Antivirals
Tier 1
Ciprofloxacin Tablet (Cipro)
Levofloxacin (Levaquin Tablet, Solution)
Ofloxacin (Floxin)
Tier 2
Ciprofloxacin Oral Suspension
(Cipro Suspension)**
Tier 3
Ciprofloxacin Tablet, Sustained-Release
24 Hour (Cipro XR)***
Factive
Moxifloxacin Tablet (Avelox)***
Noroxin
MISCELLANEOUS ANTIVIRALS
Tier 1
Acyclovir (Zovirax)
Adefovir (Hepsera)
Amantadine HCl (Symmetrel)
Ganciclovir (Cytovene)
Lamivudine (Epivir HBV)
Ribavirin (Copegus)
Ribavirin (Rebetol Capsules)
Rimantadine HCl Tablet (Flumadine)
Tier 2
Entecavir (Baraclude)**
Famciclovir (Famvir)**
Olysio
Rebetol Solution
Valacyclovir HCl (Valtrex)**
Valcyte
Tier 3
Relenza
Ribapak***
Tamiflu
Tyzeka
Sulfas & Related Agents
Tier 1
Sulfadiazine (Sulfadiazine)
Sulfamethoxazole/Trimethoprim
(Bactrim, Bactrim DS, Septra, Septra DS)
Urinary Tract Agents
DSP
DSP
DSP
DSP
DSP
SL
DSP N SL
DSP
SL
SL
SL
DSP E T4
SL
DSP
Tier 1
Methenamine Mandelate
(Methenamine Mandelate)
Nitrofurantoin Macrocrystal
(Macrodantin 50, 100 mg)
Nitrofurantoin Suspension, Oral (Furadantin)
Nitrofurantoin/Nitrofurantoin Macrocrystal
(Macrobid)
Trimethoprim (Proloprim)
Tier 2
Macrodantin 25 mg
Tier 3
Monurol
Primsol
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
8
Anti-Infectives
Antifungal Agents
HIV/AIDS THERAPY
Tier 1
DSP
Abacavir Sulfate Tablet (Ziagen)
Abacavir/Lamivudine/Zidovudine (Trizivir)
DSP
Didanosine Capsule, Enteric-Coated (Videx EC)DSP
Lamivudine Tablet (Epivir)
DSP
Nevirapine (Viramune)
Stavudine (Zerit)
DSP
Zidovudine (Retrovir)
DSP
Zidovudine/Lamivudine (Combivir)
DSP
Tier 2
DSP
Aptivus
Atripla DSP
Complera
DSP
Crixivan
DSP
Emtriva
DSP
Edurant
DSP
Epivir
DSP
Epzicom
DSP
Fuzeon
DSP
Intelence
DSP
Invirase DSP
Isentress DSP
Kaletra
DSP
Lexiva DSP
Nevirapine Extended-Release (Viramune XR) DSP
DSP
Norvir Prezista
DSP
Rescriptor
DSP
Reyataz
DSP
Selzentry
DSP N
Sustiva
DSP
Truvada
DSP N
Viracept
DSP
Viread
DSP
Ziagen
DSP
Tier 3
DSP N
Stribild
Tier 1
Clotrimazole Troche (Mycelex)
Fluconazole (Diflucan)
Flucytosine (Ancobon)
Griseofulvin Microsize (Grifulvin V)
Griseofulvin Ultramicrosize (Gris-Peg)
Itraconazole Capsule (Sporanox Capsule)
Ketoconazole (Nizoral)
Nystatin (Mycostatin)
Terbinafine HCl Tablet (Lamisil)
Voriconazole (Vfend)
Tier 2
Noxafil Suspension
Sporanox Solution, Oral
Tier 3
Lamisil Granules
Onmel
SL
SL
SL
SL
E SL T4
Vancomycin
Tier 1
Vancomycin HCl (Vancocin HCl) SL
Miscellaneous Anti-infectives
Tier 1
Clindamycin HCl (Cleocin HCl 150, 300 mg)
Neomycin Sulfate (Neomycin Sulfate)
Tier 2
DSP N SL
Bethkis**
Cayston
N SL
Cleocin HCl 75 mg
Clindamycin Palmitate HCl (Cleocin Palmitate)**
Dapsone
SL
Zyvox
Tier 3
SL
Dificid Ketek
DSP N SL
Tobi Podhaler
Tobramycin Nebulized Solution (Tobi)***
DSP E N
SL T4
Xifaxan
N SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
9
Anti-Infectives
ANTIPARASITICS
Tier 1
Atovaquone (Mepron)
Metronidazole (Flagyl)
Paromomycin Sulfate (Humatin)
Tier 2
Albenza
Alinia Biltricide
NebuPent
Stromectol
Tier 3
Flagyl ER Tablet
Tinidazole (Tindamax)***
SL
ANTIMALARIALS
Tier 1
Chloroquine Phosphate (Aralen Phosphate)
Hydroxychloroquine Sulfate (Plaquenil)
Mefloquine HCl (Lariam)
Quinine Sulfate (Qualaquin)
Tier 2
Atovaquone/Proguanil HCl (Malarone)**
Coartem
Daraprim
Primaquine
ANTIMYCOBACTERIALS
Tier 1
Ethambutol HCl (Myambutol)
Isoniazid (Isoniazid)
Pyrazinamide (Pyrazinamide)
Rifampin (Rifadin)
Rifampin/Isoniazid (Rifamate)
Tier 2
Priftin
Rifater
Situro
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SL
N
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
10
Antineoplastic & Immunosuppressant Drugs
Antineoplastic & Immunosuppressant Drugs
ALKYLATING AGENTS
Tier 1
Cyclophosphamide (Cytoxan)
Temozolamide (Temodar) Tier 2
Alkeran
Leukeran
Myleran
ANTIMETABOLITES
Tier 1
Capecitabine (Xeloda)
Mercaptopurine (Purinethol)
Methotrexate Sodium (Methotrexate)
Tier 2
Rheumatrex, Trexall
IMMUNOSUPPRESSANT DRUGS
Tier 1
Azathioprine (Imuran)
Cyclosporine, Modified (Gengraf)
Mycophenolate Mofetil Capsule, Tablet
(CellCept)
Sirolimus (Rapamune)
Tacrolimus Anhydrous (Prograf)
Tier 2
CellCept
Mycophenolic Acid (Myfortic)**
Tier 3
Astagraf XL
Azasan
Neoral
Sandimmune DSP N
DSP SL
DSP
DSP
DSP
DSP
DSP
DSP
DSP E T4
DSP T4
DSP T4
MISCELLANEOUS ANTINEOPLASTIC DRUGS
Tier 1
Etoposide (VePesid)
Hydroxyurea (Hydrea)
N
Leuprolide Acetate (Lupron 1 mg/0.2 ml)
Octreotide Acetate (Sandostatin)
DSP N
Tier 2
DSP N SL
Afinitor
Bosulif DSP N SL ST
Caprelsa
DSP N SL
Cometriq
DSP N SL
Droxia
Emcyt
DSP N SL
Erivedge
Gleevec
DSP N SL
Hexalen
DSP N SL
Hycamtin
Jakafi
DSP N SL
Lysodren
Matulane
DSP N SL
Mekinist
Nexavar
DSP N SL
Revlimid
DSP N SL
Stivarga
DSP N SL
Sutent
DSP N SL
Sylatron
DSP N SL
Tafinlar
DSP N SL
Tarceva
DSP N SL
Tasigna
DSP N SL
Thalomid
DSP N SL
Tretinoin (Vesanoid)**
DSP SL
Tykerb
DSP N SL
Votrient
DSP N SL
Xalkori
DSP N SL
Zelboraf
DSP N SL
Zolinza
DSP SL
Zytiga
DSP N SL
ANDROGENS, ESTROGENS, HORMONES &
RELATED DRUGS
ANDROGENS
Tier 2
Oxandrolone (Oxandrin)**
HORMONES
Tier 1
Megestrol Acetate (Megace)
Tier 3
Megestrol Acetate Suspension (Megace ES)***
ANTIESTROGENS
Tier 1
Anastrozole (Arimidex)
Letrozole (Femara)
Tamoxifen (Nolvadex)
Tier 2
Exemestane (Aromasin)**
Fareston
ANTIANDROGENS
Tier 1
Bicalutamide (Casodex)
Flutamide (Eulexin)
Tier 2
Nilandron
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
11
Antineoplastic & Immunosuppressant Drugs
Tier 3
Pomalyst
Somatuline Depot
Sprycel
Xtandi Zykadia
DSP N SL
DSP N T4
DSP N SL ST
DSP N SL ST
N SL
Adjunctive Agents
Tier 1
Leucovorin Calcium
(Leucovorin Calcium 5, 25 mg)
Tier 2
Leucovorin Calcium 10, 15 mg
(Leucovorin Calcium)
Leukine
Neupogen
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
DSP
DSP
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
12
Autonomic & CNS Drugs, Neurology & Psych
Narcotic Analgesics
NARCOTICS
Tier 1
Codeine Sulfate (Codeine Sulfate)
Hydromorphone HCl (Dilaudid)
Levorphanol Tartrate (Levo-Dromoran)
Methadone HCl (Dolophine HCl)
Meperidine HCl (Demerol)
Morphine Sulfate Solution, Oral
(MSIR 20 mg/ml, Roxanol)
Morphine Sulfate Tablet, Sustained-Action
(MS Contin)
Oxycodone HCl (Roxicodone, OxyIR)
Oxycodone HCl Concentrate, Oral (OxyFAST)
Tier 2
Fentanyl Citrate Lollipop (Actiq)**
Fentanyl Transdermal (Duragesic)**
Opana ER
OxyContin
Oxymorphone Tablet (Opana)**
Tier 3
Abstral
Butrans
Exalgo
Fentora
Hydromorphone Extended-Release Tablet
(Exalgo)***
Lazanda
Morphine Sulfate Capsule, Extended-Release
(Avinza)***
Morphine Sulfate Capsule, Extended-Release
Pellets (Kadian)***
Oxymorphone HCl Tablet,
Sustained-Release 12 Hour (Opana ER)***
Subsys
Zohydro ER
COMBINATION NARCOTIC /ANALGESICS
Tier 1
Acetaminophen/Caffeine/Butalbital
325-50-40 mg (Fioricet)
Acetaminophen/Caffeine/Butalbital/Codeine
325-50-40-30 mg
Aspirin/Caffeine/Butalbital (Fiorinal)
Aspirin/Caffeine/Dihydrocodone
(Synalgos-DC)
Codeine Phosphate/Acetaminophen
(Tylenol w/Codeine)
Codeine Phosphate/Aspirin/Caffeine/
Butalbital (Fiorinal w/Codeine 30 mg)
Hydrocodone Bit/Acetaminophen (Norco)
Ibuprofen/Hydrocodone (Vicoprofen)
Oxycodone HCl/Acetaminophen Tablet
(Percocet)
Oxycodone HCl/Ibuprofen (Combunox)
Oxycodone/Aspirin (Percodan)
Tier 2
Hydrocodone Bit/Acetaminophen
Solution, Oral (Hycet)**
Tier 3
Codeine Phosphate/Acetaminophen/
Caffeine/Butalbital 50-300-40-30 mg
(Fioricet w/Codeine)***
Hydrocodone/Acetaminophen
(Xodol, Vicodin, Vicodin ES, Vicodin HP)***
SL
N SL
SL
N SL
N SL
SL
E N SL T4
SL ST T4
N SL T4
E N SL T4
N SL
N SL
SL
SL
SL
SL
SL
SL
E T4
E SL T4
N SL T4
E N SL T4
N SL
N SL
N SL T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
13
Autonomic & CNS Drugs, Neurology & Psych
Non-Narcotic Analgesics
Migraine & Cluster Headache Therapy
MISCELLANEOUS ANALGESICS
Tier 1
Pentazocine HCl/Naloxone HCl (Talwin NX)
Tramadol HCl (Ultram)
Tramadol HCl/Acetaminophen (Ultracet)
Tier 2
Butorphanol Tartrate Aerosol, Spray (Stadol)**
Tramadol HCl Tablet, Sustained-Release
24 Hour (Ultram ER)**
Tier 3
Conzip
Nucynta
Nucynta ER
Tramadol HCl Tablet, Extended-Release
Multiphase 24 Hour (Ryzolt)***
Tier 1
Dihydroergotamine Mesylate (D.H.E.45)
Dihydroergotamine Mesylate Aerosol,
Spray with Pump (Migranal)
Isometheptene Mucate/Acetaminophen/
Dichloralphenazone (Midrin)
Naratriptan HCl (Amerge)
Sumatriptan Succinate Injection
(Imitrex Injection)
Sumatriptan Succinate Tablet (Imitrex Tablet)
Tier 2
Ergomar
Relpax
Rizatriptan Benzoate Tablet (Maxalt)**
Sumatriptan Succinate Nasal Spray
(Imitrex Nasal Spray)**
Tier 3
Alsuma
Axert
Cafergot
Frova
Rizatriptan Benzoate Tablet, Disintegrating
(Maxalt MLT)***
Sumavel Dosepro
Treximet
Zolmitriptan (Zomig)*** Zolmitriptan Orally Disintegrating Tablet
(Zomig-ZMT)*** Zomig Nasal Spray
SL
SL
SL
E SL T4
SL T4
N SL T4
E SL T4
NARCOTIC ANTAGONISTS/OPIOID DEPENDENCE
Tier 1
N SL
Buphrenorphine Hydrochloride (Subutex)
Naltrexone HCl (ReVia)
Tier 2
N SL
Zubsolv**
Tier 3
Buphrenorphine HCl/Naloxone HCl Tablet,
E N SL T4
Sublingual (Suboxone)**
Suboxone Film
E N SL T4
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
14
SL
SL
SL
SL
SL
E SL T4
SDP SL
SDP SL
SL
SL
E SL T4
SL
SL
SL
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
SL
Autonomic & CNS Drugs, Neurology & Psych
Antiparkinsonism Agents
Anticonvulsants
Tier 1
Amantadine HCl (Symmetrel)
Benztropine Mesylate (Cogentin)
Bromocriptine Mesylate (Parlodel)
Carbidopa/Levodopa (Sinemet)
Carbidopa/Levodopa/Entacapone (Stalevo)
Carbidopa/Levodopa Tablet, Rapid Dissolve (Parcopa)
Carbidopa/Levodopa Tablet, Sustained-Action
(Sinemet CR)
Entacapone (Comtan)
Pramipexole Di-HCl (Mirapex)
Ropinirole HCl (Requip)
Selegiline HCl (Eldepryl)
Trihexyphenidyl HCl (Artane)
Tier 2
DSP
Apokyn
Tasmar
Tier 3
Azilect
E T4
Mirapex ER
Ropinirole HCl Tablet, Extended-Release
E T4
24 Hour (Requip XL)***
Zelapar
Tier 1
Carbamazepine (Tegretol)
Clonazepam (Klonopin)
Diazepam, Rectal (Diastat Acudial)
Divalproex Sodium Tablet (Depakote)
Divalproex Sodium Tablet, Sustained-Release
(Depakote ER)
Ethosuximide (Zarontin)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lamotrigine 5, 25 mg Chewable Tablet
(Lamictal Chewable)
Lamotrigine Tablet (Lamictal)
Levetiracetam (Keppra)
Oxcarbazepine (Trileptal)
Phenobarbital (Phenobarbital)
Phenytoin (Dilantin)
Phenytoin Sodium Extended-Release
(Dilantin, Phenytek)
Primidone (Mysoline)
Tiagabine HCl (Gabitril)
Topiramate Capsule, Sprinkle (Topamax)
Topiramate Tablet (Topamax)
Valproic Acid (Depakene)
Zonisamide (Zonegran)
Tier 2
Carbamazepine Tablet, Sustained-Release
12 Hour (Tegretol XR)**
Celontin
Dilantin
Divalproex Sodium (Depakote Sprinkle)**
Levetiracetam Tablet, Extended-Release
24 Hour (Keppra XR)**
Mysoline
Peganone
Sabril
Tegretol
SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
15
Autonomic & CNS Drugs, Neurology & Psych
Tier 3
Banzel Carbamazepine Capsule, Extended-Release
Multiphase 12 Hour (Carbatrol)***
Depakote
Depakote ER
Equetro
Fycompa
Keppra
Keppra XR
Lamictal
Lamictal Dose Pack
Lamictal ODT
Lamictal XR Lamotrigine Orally Disintegrating Tablet
(Lamictal ODT)*** Lamotrigine Tablet, Extended-Release 24 Hour
(Lamictal XR)***
Lyrica
Neurontin
Onfi
Oxtellar XR
Potiga
Stavzor
Topamax
Trileptal
Trokendi XR
Vimpat
Zonegran
Miscellaneous Neurological Therapy
N
Tier 1
Donepezil HCl Tablet (Aricept)
Galantamine Capsule 24 Hour
Sustained-Release Pellets (Razadyne ER)
Galantamine Tablet, Solution (Razadyne)
Nimodipine (Nimotop)
Rivastigmine Tartrate Capsule (Exelon)
Tier 2
Donepezil HCl Tablet, Rapid Dissolve
(Aricept ODT)**
Mytelase
Nuedexta
Tier 3
Donepezil 23 mg (Aricept 23 mg)***
Exelon Solution
Gralise
Horizant
Namenda XR Savella
N ST T4
N ST T4
N
N ST T4
N ST T4
N ST T4
N ST
N ST T4
N ST T4
ST
ST
SDP SL T4
N ST T4
N
E N ST T4
N
N ST
N ST T4
N ST T4
E N ST T4
N
N ST T4
E T4
E SL T4
E SL T4
T4
SL T4
Muscle Relaxants & Antispasmodic Therapy
MYASTHENIA GRAVIS
Tier 1
Pyridostigmine Bromide Tablet (Mestinon 60 mg)
Tier 2
Mestinon
Prostigmin
Multiple Sclerosis
Tier 2
Ampyra
Avonex Betaseron Copaxone
Tecfidera Tier 3
Aubagio Extavia Gilenya
Rebif DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
DSP N SL
DSP N SL
DSP N SL
DSP N SL
DSP N SL
DSP N SL
ST T4
DSP E N SL
ST T4
DSP N SL ST
DSP N SL
ST T4
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
16
Autonomic & CNS Drugs, Neurology & Psych
Psychotherapeutic Drugs
HYPNOTIC AGENTS
Tier 1
Chloral Hydrate (Chloral Hydrate)
Flurazepam HCl (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Zaleplon (Sonata)
Zolpidem Tartrate (Ambien)
Tier 3
Edluar
Eszopiclone (Lunesta)*** Intermezzo
Rozerem
Sonata
Silenor
Zolpidem Tartrate Tablet, Multiphasic-Release
(Ambien CR)***
Zolpimist
MISCELLANEOUS ANTIDEPRESSANTS
Tier 1
Bupropion HCl (Wellbutrin)
Bupropion HCl Tablet, Sustained-Action
(Wellbutrin SR)
Bupropion HCl Tablet, Sustained-Release
24 Hour (Wellbutrin XL)
Maprotiline HCl (Ludiomil)
Mirtazapine (Remeron)
Mirtazapine Dispersible Tablet
(Remeron SolTab)
Nefazodone HCl (Serzone)
Trazodone HCl (Desyrel)
Venlafaxine HCl Capsule, Sustained-Release
24 Hour (Effexor XR)
Tier 3
Aplenzin
Desvenlafaxine Duloxetine (Cymbalta)*** Forfivo XL Khedezla
Oleptro ER
Pristiq
Venlafaxine HCl Tablet, Extended-Release
24 Hour (Venlafaxine HCl ER)***
Viibryd
SL
SL
E SL ST T4
SL ST
E SL ST T4
SL ST
SL ST
E SL T4
E SL ST T4
SL ST T4
ANTIDEPRESSANT AGENTS
TRICYCLICS
Tier 1
Amitriptyline HCl (Elavil)
Amoxapine (Asendin 50, 100 mg)
Clomipramine HCl (Anafranil)
Desipramine HCl (Norpramin)
Doxepin HCl (Sinequan)
Imipramine Pamoate (Tofranil-PM)
Nortriptyline HCl (Pamelor)
Protriptyline HCl (Vivactil)
E SL T4
E SL T4
SL
E SL T4
E SL T4
E SL T4
RS SL
E SL T4
SL T4
MAO INHIBITORS
Tier 1
Phenelzine Sulfate (Nardil)
Tranylcypromine Sulfate (Parnate)
Tier 3
Emsam
Marplan
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
17
Autonomic & CNS Drugs, Neurology & Psych
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
Tier 1
Citalopram Hydrobromide (Celexa)
Escitalopram Tablet (Lexapro)
Fluoxetine Capsule, Delayed-Release
SL
(Prozac Weekly)
Fluoxetine HCl Capsule (Prozac)
Fluoxetine HCl Tablet (Sarafem)
Fluvoxamine Maleate (Luvox)
Paroxetine HCl Tablet (Paxil)
Sertraline HCl (Zoloft)
Tier 3
Escitalopram Solution, Oral (Lexapro)***
Fluvoxamine Maleate Capsule, Extended-Release
SL
24 Hour (Luvox CR)***
Paroxetine HCl Sustained-Release, 24 Hour
SL
(Paxil CR)***
Pexeva
E SL T4
MISCELLANEOUS ANTIPSYCHOTICS
Tier 1
Clozapine (Clozaril)
Clozapine Orally Disintegrating Tablet
(FazaClo)
Olanzapine Tablet (Zyprexa)
Risperidone Tablet, Rapid Dissolve
(Risperdal M-Tab)
Risperidone Solution (Risperdal)
Risperidone Tablet (Risperdal)
Thiothixene (Navane)
Tier 2
Olanzapine/Fluoxetine (Symbyax)**
Quetiapine Fumarate (Seroquel)**
Ziprasidone (Geodon)**
Tier 3
Abilify
Fanapt
Invega
Latuda
Olanzapine Tablet, Rapid Dissolve
(Zyprexa Zydis)***
Saphris Seroquel XR
ANTIPSYCHOTICS
PHENOTHIAZINES
Tier 1
Chlorpromazine HCl Tablet (Thorazine 200 mg)
Fluphenazine HCl (Prolixin)
Perphenazine (Trilafon)
Thioridazine HCl (Mellaril)
Trifluoperazine HCl (Stelazine)
SL
SL
SL
SL
SL T4
SL T4
SL T4
SL T4
SL
SL T4
SL T4
BUTYROPHENONES
Tier 1
Haloperidol (Haldol)
Haloperidol Lactate Concentrate, Oral (Haldol)
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
18
Autonomic & CNS Drugs, Neurology & Psych
MISCELLANEOUS PSYCHOTHERAPEUTIC AGENTS
Tier 1
Amphetamine Aspartate/Amphetamine
N
Sulfate/Dextroamphetamine (Adderall)
Lithium Carbonate (Eskalith)
Lithium Carbonate, Sustained-Action
(Eskalith CR)
Lithium Carbonate Tablet, Sustained-Action
(Lithobid)
N
Methamphetamine HCl (Desoxyn)
Methylphenidate HCl
N
(Methylin Solution, Oral)
Methylphenidate HCl
N
(Ritalin, Ritalin SR)
Methylphenidate HCl Tablet, Sustained-Action
N
(Metadate ER)
Tier 2
N SL
Adderall XR**
Concerta**
N SL
Metadate CD**
N SL
Vyvanse
N SL
Tier 3
Amphetamine Aspartate/Amphetamine
Sulfate/Dextroamphetamine Capsule,
E N SL T4
Sustained-Release 24 Hour (Adderall XR)
Clonidine Extended-Release (Kapvay)*** E T4
D-Amphetamine Capsule, Extended-Release
N
(Dexedrine)***
D-Amphetamine Sulfate Tablet, Capsule,
N
(Dexedrine)***
Daytrana
E N SL T4
Dexmethylphenidate Extended-Release
E N SL T4
(Focalin XR)***
Intuniv
E SL T4
Methylin Tablet, Chewable
N
Methylphenidate HCl Capsule,
Extended-Release Multiphase
E N SL T4
(Ritalin LA)***
Methylphenidate HCl Capsule,
Extended-Release Multiphase 30-70
E N SL T4
(Metadate CD)
Methylphenidate HCl Tablet,
E N SL T4
Extended-Release 24 Hour (Concerta)
Modafinil (Provigil)***
E N SL T4
Nuvigil
N SL T4
Quillivant XR
E N SL T4
Strattera
SL T4
Xyrem
N SL T4
Zenzedi E N T4
ANXIOLYTICS
Tier 1
Alprazolam (Xanax)
Alprazolam Tablet, Rapid Dissolve (Niravam)
Alprazolam Tablet, Sustained-Release
24 Hour (Xanax XR)
Buspirone HCl (Buspar)
Chlordiazepoxide HCl (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
19
Cardiovascular, Hypertension & Lipids
Antiarrhythmic Agents
LONG ACTING NITRATES
Tier 1
Isosorbide Dinitrate Tablet
(Isordil 5, 10, 20, 30 mg)
Isosorbide Dinitrate Tablet, Sublingual
(Isordil 2.5, 5 mg)
Isosorbide Mononitrate (ISMO)
Isosorbide Mononitrate Tablet,
Sustained-Release 24 Hour (Imdur)
Nitroglycerin Capsule, Sustained-Action
(Nitro-Bid)
Nitroglycerin Patch, Transdermal 24 Hour
(Transderm-Nitro)
Tier 2
Isordil 40 mg
Tier 3
Dilatrate-SR
Nitro-Dur
Tier 1
Amiodarone HCl (Cordarone)2
Disopyramide Phosphate Capsule (Norpace)
Flecainide Acetate (Tambocor)2
Mexiletine HCl (Mexitil)
Propafenone HCl (Rythmol)
Quinidine Gluconate (Quinidine Gluconate)
Quinidine Sulfate (Quinidine Sulfate)
Quinidine Sulfate Tablet, Sustained-Action
(Quinidex)
Sotalol HCl (Betapace, Betapace AF)
Tier 2
Multaq
Norpace CR
Tikosyn1, 2
Tier 3
Propafenone Capsule, Sustained-Release
12 Hour (Rythmol SR)***
This drug is only available to hospitals and prescribers who have received appropriate
education in the initiation and dosing of Tikosyn.
Coagulation Therapy
Cardiologist consultation suggested.
ANTICOAGULANTS
Tier 1
Warfarin Sodium (Coumadin)
Tier 2
Coumadin
Pradaxa
Xarelto
Tier 3
Eliquis
1
2
Cardiac Glycosides
Tier 1
Digoxin (Lanoxin)
Tier 2
Lanoxin (Digoxin)
Nitrates
RAPID ACTING NITRATES
Tier 2
Nitrostat (Nitroglycerin)
Tier 3
Nitroglycerin Spray (Nitromist)*** Nitroglycerin Spray, Non-Aerosol
(Nitrolingual)***
ANTIPLATELET DRUGS
Tier 1
Cilostazol (Pletal)
Clopidogrel Bisulfate (Plavix)
Dipyridamole (Persantine)
Ticlopidine HCl (Ticlid)
Tier 3
Aggrenox
Brilinta
Effient
SL
E SL T4
HEPARIN
Tier 1
Heparin Sodium (Heparin)
Tier 2
Fondaparinux Sodium (Arixtra)**
Enoxaparin (Lovenox)**
Tier 3
Fragmin
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
20
SL T4
N SL T4
SL T4
SL
SL
SL T4
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
SL
SL
Cardiovascular, Hypertension & Lipids
Antihypertensive Therapy
VITAMIN K
Tier 2
Mephyton (Phytonadione)
HEMOSTATICS
Tier 1
Aminocaproic Acid Solution (Amicar)
Aminocaproic Acid Tablet (Amicar 500 mg)
Tier 2
Aminocaproic Acid Tablet 1000 mg
(Aminocaproic Acid)
Tier 3
Promacta DSP N T4
MISCELLANEOUS COAGULATION AGENTS
Tier 2
Advate
Alphanate vonWillebrand
Alphanine SD
Bebulin
BeneFix
Feiba
Helixate FS
Hemofil-M
Humate-P
Koate-DVI
Kogenate FS Monoclate-P Mononine
Novoseven
Profilnine SD Recombinate Xyntha
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
DSP
THIAZIDE & RELATED DIURETICS
Tier 1
Amiloride HCl (Midamor)
Amiloride HCl/Hydrochlorothiazide (Moduretic)
Bumetanide (Bumex)
Chlorothiazide Tablet (Diuril)
Furosemide (Lasix)
Hydrochlorothiazide (HydroDIURIL, Microzide)
Metolazone (Zaroxolyn)
Spironolactone (Aldactone)
Spironolactone/Hydrochlorothiazide
(Aldactazide 25-25 mg)
Triamterene/Hydrochlorothiazide
(Dyazide, Maxzide)
Tier 2
Aldactazide 50-50 mg
Diuril 250 mg/5 ml
Eplerenone (Inspra)**
Tier 3
Dyrenium
Edecrin
BETA BLOCKERS
Tier 1
Acebutolol HCl (Sectral)
Atenolol (Tenormin)
Betaxolol HCl (Kerlone)
Carvedilol (Coreg)
Labetalol HCl (Normodyne)
Metoprolol Succinate Tablet, Sustained-Release
24 Hour (Toprol XL 25 mg)
Metoprolol Tartrate (Lopressor)
Nadolol (Corgard)
Pindolol (Visken)
Propranolol HCl Tablet (Inderal)
Tier 2
Bystolic
Metoprolol Succinate Tablet, Sustained-Release
24 Hour (Toprol XL 50, 100, 200 mg)**
Propranolol HCl Sustained-Action Capsule
(Inderal LA)**
Tier 3
E SL T4
Coreg CR
Innopran XL
Levatol
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
21
Cardiovascular, Hypertension & Lipids
CALCIUM CHANNEL BLOCKERS
ACE INHIBITORS
Tier 1
Benazepril HCl (Lotensin)
Enalapril Maleate (Vasotec)
Lisinopril (Prinivil, Zestril)
Moexipril HCl (Univasc)
Ramipril (Altace)
Trandolapril (Mavik)
Tier 2
Perindopril (Aceon)**
Tier 3
Epaned
CALCIUM CHANNEL BLOCKERS/NON-DIHYDROPYRIDINES
Tier 1
Diltiazem HCl (Cardizem)
Diltiazem HCl Capsule, Controlled-Release
(Dilacor XR)
Diltiazem HCl Capsule, Sustained-Release
12 Hour (Cardizem SR)
Verapamil HCl (Calan)
Verapamil HCl (Verelan)
Verapamil HCl Tablet, Sustained-Action
(Calan SR)
Tier 2
Cardizem LA 120 mg
Diltiazem HCl Capsule, Sustained-Action
(Tiazac)**
Diltiazem HCl Capsule, Sustained-Release
24 Hour (Cardizem CD)**
Diltiazem HCl Tablet, Sustained-Release 24 Hour
(Cardizem LA 180, 240, 300, 360, 420 mg)**
Tier 3
Verapamil HCl Capsule, 24 Hour
Sustained-Release Pellets (Verelan PM)***
ADRENERGIC ANTAGONISTS & RELATED DRUGS
Tier 1
Clonidine HCl (Catapres)
Doxazosin Mesylate (Cardura)
Guanfacine HCl (Tenex)
Prazosin HCl (Minipress)
Terazosin HCl (Hytrin)
Tier 3
Cardura XL
Clonidine Patch, Transdermal Weekly
(Catapres-TTS)***
E T4
Nexiclon XR
CALCIUM CHANNEL BLOCKERS/DIHYDROPYRIDINES
Tier 1
Amlodipine Besylate (Norvasc)
Felodipine (Plendil)
Nicardipine HCl (Cardene)
Nifedipine (Procardia)
Nifedipine Tablet, Osmotic Laser-Drilled Formulation
(Procardia XL)
Tier 2
Nisoldipine (Sular)**
Tier 3
Cardene SR
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
AGENTS FOR PHEOCHROMOCYTOMA
Tier 2
Dibenzyline
VASODILATORS
Tier 1
Hydralazine HCl (Apresoline)
Tier 2
BiDil
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
N
22
Cardiovascular, Hypertension & Lipids
OTHER ANTIHYPERTENSIVE COMBINATIONS
Tier 1
Benazepril/Hydrochlorothiazide (Lotensin HCT)
Bisoprolol Fumarate/Hydrochlorothiazide (Ziac)
Captopril/Hydrochlorothiazide (Capozide)
Enalapril Maleate/Hydrochlorothiazide
(Vaseretic)
Lisinopril/Hydrochlorothiazide
(Prinzide, Zestoretic)
Losartan Potassium/Hydrochlorothiazide
(Hyzaar)
Metoprolol/Hydrochlorothiazide
(Lopressor HCT)
Nadolol/Bendroflumethiazide (Corzide)
Propranolol HCl/Hydrochlorothiazide (Inderide)
Tier 2
SL
Amlodipine/Benazepril (Lotrel)**
Benicar HCT
SL
Clorpres
SL
Dutoprol
Irbesartan/Hydrochlorothiazide (Avalide)**
SL
Quinapril HCl/Hydrochlorothiazide
(Accuretic)**
Telmisartan/Hydrochlorothiazide
SL
(Micardis HCT)** Valsartan/Hydrochlorothiazide (Diovan HCT)** SL
Tier 3
E SL T4
Amlodipine/Telmisartan (Twysta)***
Amlodpine/Valsartan (Exforge)***
E SL T4
Amturnide
E SL T4
Azor
E SL T4
Candesartan/Hydrochlorothiazide
SL
(Atacand HCT)***
Edarbyclor
SL
Exforge HCT
E SL T4
Tekamlo
E SL T4
Tekturna HCT
SDP SL
Teveten HCT
SL
Trandolapril/Verapamil (Tarka)***
E SL T4
Tribenzor
ANGIOTENSIN II RECEPTOR BLOCKERS AND
RENIN INHIBITOR
Tier 1
SL
Eprosartan Hydrochloride (Teveten)
Losartan Potassium (Cozaar)
Tier 2
SL
Benicar
Irbesartan (Avapro)**
SL
Telmisartan (Micardis)**
SL
Tier 3
SL
Candesartan (Atacand) SL
Diovan***
Edarbi
SL
Tekturna
SDP SL
Valsartan (Diovan)***
SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
23
Cardiovascular, Hypertension & Lipids
Lipid/Cholesterol Lowering Agents
Miscellaneous Cardiovascular Agents
Tier 1
Atorvastatin Calcium (Lipitor)
Cholestyramine/Aspartame (Questran Light)
Cholestyramine/Sucrose (Questran)
Colestipol HCl (Colestid)
Fluvastatin Sodium (Lescol)
Gemfibrozil (Lopid)
Lovastatin (Mevacor)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Tier 2
Crestor
Fenofibrate 54, 160 mg (Lofibra)**
Niaspan
Welchol
Tier 3
Advicor
Altoprev
Amlodipine/Atorvastatin (Caduet)***
Antara
Choline Fenofibrate (Trilipix)*** Fenofibrate 50, 150 mg (Lipofen)***
Fenofibrate 67, 134, 200 mg (Lofibra)***
Fenofibrate Micronized 43, 130 mg (Antara)***
Fenofibrate Nanocrystallized 48, 145 mg
(Tricor)***
Fenofibric Acid (Fibricor)***
Fenoglide
Juxtapid
Kynamro
Lescol XL
Liptruzet
Livalo
Niacin Extended-Release (Niaspan)*** Omega-3-Acid Ethyl Esters (Lovaza)*** Simcor
Triglide
Vascepa Vytorin
Zetia
Tier 2
Ranexa
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SL
SL
SL
SL
E SL T4
E SL T4
E T4
E T4
E T4
E T4
E T4
E T4
E T4
E T4
DSP N SL T4
DSP N SL T4
SL
E SL T4
SL T4
T4
N
SL T4
E T4
N T4
SL T4
SL T4
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
24
Dermatologicals/Topical Therapy
Topical Corticosteroids
TOPICAL CORTICOSTEROIDS MEDIUM POTENCY
Tier 1
Betamethasone Valerate Cream, Lotion
(Valisone)
Desoximetasone Cream (Topicort)
SL
Flucinolone Acetonide Ointment Fluticasone Propionate Cream, Ointment
(Cutivate)
Hydrocortisone Butyrate Ointment, Solution,
Non-Oral (Locoid)
Mometasone Furoate Cream, Ointment,
Solution (Elocon)
Prednicarbate Cream (Dermatop)
Triamcinolone Acetonide Cream, Ointment,
Lotion (Aristocort, Kenalog)
Tier 3
E SL T4
Betamethasone Valerate Foam (Luxiq)***
Clocortolone (Cloderm)***
SL ST
Cordran Lotion
SL ST
Cordran Ointment
SL ST
Cordran SP Cream
Fluocinolone Acetonide Cream (Synalar)***
SL
Fluticasone Propionate (Cutivate Lotion)***
MC SL
Hydrocortisone Butyrate Cream
E SL T4
(Locoid Lipocream) Hydrocortisone Valerate Cream, Ointment
SL
(Westcort)***
Locoid Lotion
E SL T4
Pandel Cream
E SL T4
Trianex
TOPICAL CORTICOSTEROIDS VERY HIGH POTENCY
Tier 1
Clobetasol Propionate Cream (Temovate E)
Clobetasol Propionate Cream, Gel, Ointment,
Solution (Temovate)
Tier 3
Betamethasone Dipropionate/Propylene
Glycol Lotion, Ointment (Diprolene)***
E SL T4
Clobetasol Propionate Foam (Olux)***
Clobetasol Propionate Foam (Olux-E)***
E SL T4
Clobetasol Propionate Lotion (Clobex)***
E SL T4
Clobetasol Propionate Shampoo (Clobex)***
E SL T4
Diflorasone Diacetate Ointment
(Psorcon, Apexicon, Florone)***
Halobetasol Propionate Cream, Ointment
SL
(Ultravate)***
TOPICAL CORTICOSTEROIDS HIGH POTENCY
Tier 1
Amcinonide Ointment (Cyclocort)
Betamethasone Dipropionate Lotion
(Diprosone, Maxivate)
Betamethasone Dipropionate/Propylene
Glycol Gel (Diprolene)
Betamethasone DP Augmented Cream
(Diprolene AF Cream)
Betamethasone Valerate Ointment (Valisone)
SL
Desoximetasone Cream (Topicort)
Fluocinonide Cream, Gel, Ointment,
Solution, Non-Oral (Lidex)
Triamcinolone Acetonide Cream
(Aristocort, Kenalog)
Triamcinolone Acetonide Ointment
(Aristocort HP)
Tier 2
Betamethasone Dipropionate Cream, Ointment
(Diprosone, Maxivate)**
Tier 3
Amcinonide Cream, Lotion (Cyclocort)***
Betamethasone Dipropionate Augmented,
Lotion, Ointment (Diprolene)***
SL
Desoximetasone Gel, Ointment (Topicort)***
Diflorasone Diacetate Cream (Apexicon E)*** SL
Flucinonide 0.1% Cream (Vanos)***
E SL T4
Halog Cream, Ointment
SL ST
Topicort Spray
E T4
TOPICAL CORTICOSTEROIDS LOW POTENCY
Tier 1
Alclometasone Dipropionate Cream, Ointment
(Aclovate)
Hydrocortisone 2.5% Cream, Ointment, Lotion
(Hytone)
Tier 3
SL ST
Desonate Desonide Cream, Ointment, Lotion
SL
(DesOwen, Tridesilon)***
Fluocinolone Acetonide Body Oil
SL
(Derma-Smoothe/FS)***
Fluocinolone Acetonide Scalp Oil
SL
(Derma-Smoothe/FS)***
Fluocinolone Acetonide Solution Non-Oral
SL
(Synalar)***
Verdeso
E SL T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
25
Dermatologicals/Topical Therapy
Topical Anesthetics
Tier 3
Absorica Acanya
Aczone
Adapalene (Differin Cream, Gel 0.1%)***
Adapalene (Differin Gel 0.3%)***
Atralin
Avita Gel
Azelex
Benzaclin 1%-5% Clindagel
Clindamycin Phosphate Foam 1% (Evoclin)***
Clindamycin Phosphate Gel (Cleocin T)***
Clindamycin Phosphate Lotion (Cleocin T)***
Clindamycin Phosphate/Benzoyl Peroxide Gel
(Benzaclin 1%-5%)***
Clindamycin Phosphate/Benzoyl Peroxide
Gel 1.2%-5% (Duac)***
Differin Lotion
Epiduo
Fabior
Finacea
Metronidazole Gel 1% (Metrogel 1%)*** Mirvaso
Noritate Retin-A Micro
Tazorac
Tretin-X
Tretinoin Microspheres (Retin-A Micro)***
Veltin
Ziana
Local and Topical Anesthetics
No prescription local or topical anesthetics administered
in hospital or office environments are covered under the
outpatient prescription drug benefit plan.
Tier 1
Lidocaine HCL Gel, Solution (Xylocaine)
SL
Lidocaine HCL Ointment Lidocaine/Prilocaine Cream (Emla)
Tier 2
SL
Lidocaine Adhesive Patch (Lidoderm)** Therapy For Acne
Some prescription non-combination benzoyl peroxide products
are not covered. Numerous benzoyl peroxide products in
various forms and strengths are available over-the-counter.
Tier 1
Clindamycin Phosphate Cream, Solution, Swab
(Cleocin T)
Erythromycin Base/Benzoyl Peroxide
SL
(Benzamycin)
Erythromycin Base/Ethyl Alcohol
(Emgel, Erygel)
Erythromycin Base/Ethyl Alcohol Swab,
Medicated (Erycette)
Metronidazole (Metrolotion)
Metronidazole Cream (Metrocream)
Metronidazole Gel (Metrogel 0.75%)
N SL
Tretinoin Cream (Avita)
Tretinoin Cream, Gel (Retin-A)
N SL
Tier 2
N
Amnesteem (Accutane)** Claravis (Accutane)** N
Differin Cream, Gel 0.1%^^
N SL
Myorisan (Accutane)** N
Sotret (Accutane)** N
Zenatane (Accutane)** N
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
E SL
SL
N SL
SL
E SL T4
T4
E MC T4
SL T4
E MC T4
E N SL T4
N SL T4
E N SL
E N SL T4
E SL T4
E SL T4
Topical Antibacterials
Tier 1
Gentamicin Sulfate (Garamycin)
Mupirocin Ointment (Bactroban)
Sulfacetamide Sodium Suspension, Topical
(Klaron)
Tier 3
Altabax
Centany
Mupirocin Calcium Cream (Bactroban)***
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
26
SL
SL
E T4
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
E N T4
E SL T4
SL T4
N SL
N SL
E MC N SL T4
N SL
SL
E SL T4
E SL T4
SL
SL
Dermatologicals/Topical Therapy
Topical Antifungals
Keratolytics
Tier 1
Ciclopirox Cream, Gel, Lotion (Loprox 0.77%)
Ciclopirox Solution, Non-Oral (Penlac)
Clotrimazole/Betamethasone Dipropionate
(Lotrisone)
Econazole Nitrate (Spectazole 1%)
Ketoconazole Cream, Shampoo (Nizoral 2%)
Nystatin (Mycostatin)
Tier 2
Ciclopirox Shampoo (Loprox 1%)**
Tier 3
Ertaczo
Exelderm
Ketoconazole Foam (Extina)***
Loprox Shampoo
Luzu
Mentax
Naftin
Nystatin/Triamcinolone Acetonide
(Mycolog II)***
Oxistat Cream
Oxistat Lotion
Vusion
Xolegel
Tier 3
Keralyt Scalp
SL
Antipsoriatic/Antiseborrheic
E T4
Tier 1
Acitretin (Soriatane)
Calcipotriene Solution, Topical (Dovonex)
Calcitrol Ointment (Vectical)
Hydrocortisone Acetate/Pramoxine Cream
(Pramosone 2.5%-1%)
Tier 2
Calcipotriene Cream, Ointment (Dovonex)**
Tier 3
Betamethasone/Calcipotriene Ointment
(Taclonex)***
Sorilux Taclonex Suspension
SL
MC
E SL T4
E T4
E T4
N SL ST T4
E SL T4
E MC T4
MC
SL
SL
SL
SL T4
E SL T4
SL T4
Topical Scabicides/Pediculicides
Tier 1
Lindane (Lindane Lotion, Shampoo)
Malathion (Ovide)
Permethrin (Elimite)
Tier 2
Eurax
Tier 3
Sklice Spinosad (Natroba)***
Topical Antivirals
Tier 3
Acyclovir Ointment (Zovirax)***
Denavir
Xerese
Zovirax Cream
E T4
N SL ST T4
E T4
E T4
E SL T4
SL
SL T4
Burn Therapy
Tier 1
Silver Sulfadiazine (Silvadene)
Topical Enzymes
Tier 3
Optase
Santyl
Xenaderm
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
27
Dermatologicals/Topical Therapy
Miscellaneous Dermatologicals
Note: OTC medications are not on the Prescription Drug List,
but are listed for information purposes.
AmLactin (Ammonium Lactate) - OTC
Tier 1
Doxepin Cream (Zonalon)
Fluorouracil (Efudex)
Podofilox Liquid (Condylox Liquid)
Urea 40% Emulsion (Umecta)
Tier 2
Imiquimod (Aldara)**
Oxsoralen-Ultra
Protopic
Regranex
Tier 3
Carmol HC Cream
Condylox Gel
Diclofenac 3% Gel (Solaraze)
Elidel
Panretin Gel
Picato Veregen
Zyclara
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SL
N SL
N
N SL
SL
SL
E SL T4
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
28
Ear, Nose & Throat Medications
Miscellaneous Otic Preparations
Tier 1
Acetic Acid (VoSol)
Acetic Acid/Hydrocortisone (VoSol HC)
Ofloxacin (Floxin Otic)
Tier 3
Cetraxal
Otic Steroid/Antibiotic
Tier 1
Neomycin Sulfate/Polymyxin B Sulfate/
Hydrocortisone (Cortisporin)
Tier 2
Ciprodex
Tier 3
Cipro HC Suspension, Drops
Coly-Mycin S Suspension, Drops
Cortisporin-TC Suspension, Drops
Miscellaneous Agents
Tier 1
Cevimeline HCl (Evoxac)
Chlorhexidine Gluconate (Peridex)
Pilocarpine HCl (Salagen 5 mg)
Sodium Fluoride Gel (Prevident 1.1%)
Triamcinolone Acetonide (Kenalog in Orabase)
Tier 3
E T4
Glycate
Tyzine
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
29
Endocrine/Diabetes
Antithyroid Agents
Miscellaneous Hormones
Tier 1
Methimazole (Tapazole)
Propylthiouracil (Propylthiouracil)
ANDROGENS
Tier 1
Danazol (Danocrine)
Tier 2
Androderm
Android
Oxandrolone (Oxandrin)**
Testim
Tier 3
Androgel
Axiron
Fortesta
Striant
Testosterone Topical Gel (Testim)***
Thyroid Hormones
Tier 1
Levothyroxine (Levothroid)
Tier 2
Levothyroxine Sodium (Levoxyl)**
Liothyronine Sodium (Cytomel)**
Synthroid
Tirosint
Tier 3
Armour Thyroid
Thyrolar
MISCELLANEOUS AGENTS
Tier 1
Calcitriol (Rocaltrol)
Desmopressin Acetate (DDAVP)
Doxercalciferol (Hectorol)
Octreotide Acetate (Octreotide Acetate)
Paricalcitol (Zemplar) Tier 2
Cabergoline (Dostinex)**
Calcitonin Salmon Nasal Spray (Miacalcin)**
Calcitonin, Salmon, Synthetic Nasal Spray
(Fortical)**
Kuvan
Samsca
Synarel
Tier 3
Ravicti
Sensipar
Syprine
Adrenal Hormones
Tier 1
Dexamethasone (Decadron)
Fludrocortisone Acetate (Florinef Acetate)
Hydrocortisone Tablet (Cortef)
Methylprednisolone Tablet, Dose Pack
(Medrol 4, 16, 32 mg)
Orapred
Prednisolone Sodium Phosphate Solution, Oral
(Pediapred)
Prednisolone Syrup (Prelone)
Prednisone (Meticorten)
Tier 2
Medrol 2, 8, 24 mg
Pediapred
Tier 3
Acthar H.P.
Celestone Oral Solution
Orapred ODT
Flo-Pred
Rayos DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N SL
E N SL T4
E N SL T4
E N SL T4
N SL
E N SL T4
DSP N
DSP
DSP N SL
DSP SL
N
T4
DSP T4
N
DSP N SL
ST T4
E T4
E T4
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
N SL
30
Endocrine/Diabetes
GONADOTROPIN & RELATED AGENTS
NON-INSULIN HYPOGLYCEMIC AGENTS
Tier 1
Acarbose (Precose)
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glipizide Tablet, Osmotic Laser-Drilled
Formulation (Glucotrol XL)
Glyburide (DiaBeta)
Glyburide, Micronized (Glynase)
Glyburide/Metformin HCl (Glucovance)
Metformin HCl (Glucophage)
Metformin HCl Sustained-Release
(Glucophage XR)
Pioglitazone HCl/Glimepiride (Duetact)
Tier 2
Byetta
Glipizide/Metformin HCl (Metaglip)**
Invokamet
Invokana
Glyset
Jentadueto
Kazano Kombiglyze XR
Nateglinide (Starlix)**
Nesina Onglyza
Oseni Pioglitazone HCl (Actos)**
Pioglitazone HCl/Metformin HCl
(Actoplus Met)**
Repaglinide (Prandin)** Tanzeum
Tradjenta
Tier 3
Actoplus Met XR
Avandamet
Avandaryl
Avandia
Bydureon
Farxiga
Glumetza
Janumet
Janumet XR
Januvia
Metformin HCl Tablet, Extended-Release
24 Hour (Fortamet)***
Riomet Solution, Oral
SymlinPen
Victoza
Coverage is determined by the consumer’s prescription drug
benefit plan.
Tier 2
DSP N
Cetrotide
Tier 3
DSP N
Ganirelix Acetate
Diabetes Therapy
INSULIN THERAPY
Tier 1
Humalog Mix 50-50 Vial
Humalog Mix 75-25 Vial
Humalog Vial
Humulin 70-30 Vial
Humulin N Vial
Humulin R Vial
Levemir Flexpen
Levemir Vial
Tier 2
Humalog KwikPen
Humalog Mix 50/50 KwikPen
Humalog Mix 75/25 KwikPen
Humulin 70-30 KwikPen
Humulin N KwikPen
Tier 3
Apidra Solostar
Apidra Vial
Lantus Solostar Pen/Cartridge
Lantus Vial
Novolin Vial
NovoLog 70-30 Flexpen
NovoLog 70-30 Vial
NovoLog Flexpen
NovoLog Vial
SDP T4
SDP T4
SDP T4
SDP T4
SDP T4
SDP T4
SDP T4
SL
SL
SL
SL ST
SL
SL
SL
SL
SL
SL
SL
SL
SL
SL
SL
SL
SDP SL
SL
SL
SL
SL
SL ST T4
N T4
SL ST T4
SL ST T4
SL ST T4
N
SL
SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
31
Endocrine/Diabetes
GLUCOSE ELEVATING AGENTS
Tier 2
Glucagen
Glucagon (Glucagon, Human Recombinant)
Glucagon Emergency Kit (Glucagon Kit)
SL
SL
SL
INSULIN SYRINGES/MISCELLANEOUS DURABLE
MEDICAL EQUIPMENT
Tier 1
Accu-Chek Aviva Plus
Accu-Chek Nano SmartView
One Touch Ultra 2 System
One Touch Ultra Mini System
One Touch Verio IQ System
One Touch Verio Sync
BLOOD GLUCOSE MONITORING SUPPLIES
Tier 1
Accu-Chek Aviva Plus Test Strips
Accu-Chek Compact Test Strips
Accu-Chek SmartView
One Touch Ultra Blue Test Strips
One Touch Verio IQ Test Strips
Tier 3
Ascensia Autodisc Test Strips
Ascensia Breeze 2 Test Strips
Contour Next Test Strips
Contour Test Strips
Freestyle Insulinx
Freestyle Lite Test Strips
Freestyle Test Strips
Precision Xtra Test Strips
SL
SL
SL
SL
SL
SDP SL T4
SDP SL T4
SDP SL T4
SDP SL T4
SDP SL T4
SDP SL T4
SDP SL T4
SDP SL T4
Diabetic supplies may not be covered. This is determined by
the consumer’s prescription drug benefit plan.
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
32
Gastroenterology
Ulcer Therapy
Antidiarrheals & Antispasmodics
H2 ANTAGONISTS
Tier 1
Cimetidine Tablet, Liquid (Tagamet)
Famotidine Suspension, Oral (Pepcid)
Ranitidine HCl Syrup (Zantac Syrup)
Tier 2
Nizatidine Solution, Oral (Axid Oral Solution)**
ANTIDIARRHEALS
Tier 1
Diphenoxylate HCl/Atropine Sulfate (Lomotil)
Tier 3
Fulyzaq
Motofen
ANTISPASMODICS
Tier 1
Dicyclomine HCl Tablet (Bentyl)
Glycopyrrolate (Robinul, Robinul Forte)
Hyoscyamine Sulfate (Levsin, Levsin/SL)
Hyoscyamine Sulfate Capsule, Sustained-Release
12 Hour (Levsinex)
Hyoscyamine Sulfate Drops (Spasdel)
Hyoscyamine Sulfate Tablet, Rapid Dissolve
(Nulev)
Hyoscyamine Sulfate Tablet, Sustained-Release
12 Hour (Levbid)
Tier 3
Cantil
Symax Duotab
PROSTAGLANDINS
Tier 1
Misoprostol (Cytotec)
OTHER ULCER THERAPY
Tier 1
Sucralfate Tablet (Carafate)
Tier 2
Lansoprazole/Amoxicillin/Clarithromycin
(Prevpac)
Tier 3
Carafate Oral Suspension
Helidac
Omeclamox Pak
Prevpac
Pylera
PROTON PUMP INHIBITORS
Tier 1
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Tier 3
Aciphex Sprinkle
Dexilant
Lansoprazole Capsule, Delayed-Release
(Prevacid)***
Nexium Capsule
Nexium Suspension
Omeprazole/Sodium Bicarbonate Capsule
(Zegerid)***
Prevacid Solutab
Prilosec Suspension
Protonix Suspension
Rabeprazole (Aciphex)*** Zegerid Capsule
Zegerid Packet
N T4
SL E
E SL T4
SL
E SL T4
SL
COMBINATION ANTICHOLINERGICS
Tier 1
Belladonna Alkaloids/Phenobarbital (Donnatal)
Tier 3
Donnatal Tablet, Sustained-Action
E SL T4
SL
E SL T4
E SL T4
N SL ST
E SL T4
N SL ST
E T4
E T4
SL
E SL T4
SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
33
Gastroenterology
Miscellaneous Gastrointestinal Agents
ANTIVERTIGO & ANTIEMETIC AGENTS
Tier 1
Dronabinol (Marinol)
Ondansetron HCl (Zofran)
Ondansetron HCl Tablet, Rapid Dissolve
(Zofran ODT)
Prochlorperazine Maleate Tablet
(Compazine)
Promethazine HCl (Phenergan)
Trimethobenzamide HCl Capsule
(Tigan 250, 300 mg)
Tier 2
Antivert 50 mg
Emend
Granisetron HCl Tablet (Kytril)**
Tier 3
Anzemet
Cesamet
Sancuso Transderm-Scop
BILE ACIDS
Tier 1
Ursodiol (Actigall, URSO 250, URSO Forte)
DIGESTIVE ENZYMES
Tier 2
Creon
Sucraid
Zenpep
Tier 3
Pancreaze
Pertzye Ultresa Viokace ST
ST T4
ST T4
ST T4
MISCELLANEOUS GASTROINTESTINAL AGENTS
Tier 1
Balsalazide Disodium (Colazal)
Cromolyn Sodium (Gastrocrom)
Hydrocortisone (Cortenema)
Hydrocortisone Acetate Suppository, Rectal
(Anusol-HC)
Hydrocortisone Acetate/Pramoxine HCl
(Analpram-HC)
Hydrocortisone Cream
(ProctoCream-HC 2.5%, Anusol-HC 2.5%)
Lactulose (Cephulac, Chronulac)
SL
Mesalamine Enema (Rowasa)
Metoclopramide HCl (Reglan)
Sulfasalazine Tablet (Azulfidine)
Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
Tier 2
Apriso
Budesonide Capsule, Sustained-Release
(Entocort EC)**
Canasa
Cortifoam
Lialda
N SL
Linzess
Lotronex
N SL
Relistor
Tier 3
N SL ST T4
Amitiza
Asacol HD
E T4
Delzicol E T4
Dipentum
Kristalose
Metoclopramide Orally Disintegrating Tablet
E T4
(Metozolv ODT)*** Pentasa
E T4
Rectiv
N SL
Uceris
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SL
E SL T4
BOWEL EVACUANTS
Tier 1
Bisacodyl Tab & Peg 3350-KCLSod Bicarb-NACL for Solution Kit (Halflytely)
Sod Chloride/NaHCO3/KCl/PEGs
(Nulytely w/Flavor Packs)
Sodium Sulfate/Sodium/Sodium Bicarbonate/
Potassium Chloride/Polyethylene Glycols
(Colyte)
Sodium Sulfate/Sodium/Sodium Bicarbonate/
Potassium Chloride/Polyethylene Glycols
Solution, Reconstituted, Oral (GoLYTELY)
Tier 2
GoLYTELY
Polyethylene Glycol 3350 Powder (Glycolax)**
Tier 3
Moviprep
Osmoprep
Prepopik
Suclear
Suprep
Visicol
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
SL
SL
34
Immunology, Vaccines & Biotechnology
Biotechnology Drugs
ERYTHROID STIMULANTS
Tier 2
Aranesp
Epogen
Procrit
MYELOID STIMULANTS
Tier 2
Leukine
Mozobil
Neupogen
Tier 3
Neulasta
INTERFERONS
Tier 2
Actimmune
Alferon N
Pegasys
Tier 3
Infergen
Intron A
Peg-Intron
GROWTH HORMONES
Tier 2
Increlex Nutropin
Nutropin AQ
Nutropin AQ NuSpin
Saizen
Tev-Tropin
Tier 3
Egrifta
Genotropin
Humatrope
Norditropin
Omnitrope
Serostim
Zorbtive
INTERLEUKINS
Tier 2
Arcalyst
Neumega
DSP SL
DSP SL
DSP SL
DSP
DSP
DSP
DSP
DSP N SL
DSP N SL
DSP N SL T4
DSP N T4
DSP N
SL ST T4
DSP N SL
DSP N SL
DSP N SL
DSP N SL
DSP N SL
DSP N SL
DSP N T4
DSP E N SL T4
DSP E N SL T4
DSP E N SL T4
DSP E N SL T4
DSP N SL T4
DSP N SL
N SL
DSP
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
35
Musculoskeletal & Inflammatory
Nsaid Agents
NSAIDS - SPECIFIC COX-II INHIBITORS
Tier 3
Celebrex
NSAIDS
Tier 1
Diclofenac Potassium (Cataflam)
Diclofenac Sodium (Voltaren)
Diclofenac Sodium Tablet, Sustained-Release
24 Hour (Voltaren-XR)
Etodolac (Lodine)
Etodolac Tablet, Sustained-Release 24 Hour
(Lodine XL)
Flurbiprofen (Ansaid)
Ibuprofen (Motrin)
Indomethacin (Indocin)
Indomethacin Capsule, Sustained-Action
(Indocin SR)
Ketoprofen (Orudis)
Ketoprofen Capsule, 24 Hour Sustained-Release
(Oruvail 200 mg)
Ketorolac Tromethamine (Toradol)
Meclofenamate Sodium (Meclomen)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (EC-Naprosyn)
Naproxen (Naprosyn)
Naproxen Sodium (Anaprox, Anaprox DS)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Sulindac (Clinoril)
Tier 2
Tolmetin Sodium (Tolectin)**
Tolmetin Sodium (Tolectin DS)**
Voltaren Gel
Tier 3
E SL T4
Cambia
Diclofenac Sodium/Misoprostol (Arthrotec)***
Diclofenac Topical Solution (Pennsaid 1.5%)*** E T4
Duexis
E SL T4
Flector
E T4
Mefenamic Acid (Ponstel)***
E T4
Naprelan
Sprix
E SL T4
Vimovo
Zipsor
E T4
Zorvolex
E T4
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SALICYLATES
Tier 1
Salsalate (Salflex)
Gout Therapy
Tier 1
Allopurinol (Zyloprim)
Probenecid (Benemid)
Tier 2
Colcrys
Tier 3
Uloric
SL T4
Other Inflammatory Conditions:
Rheumatoid Arthritis, Crohn’s Disease,
Psoriasis, Ulcerative Colitis
Tier 1
Azathioprine (Imuran)
Hydroxychloroquine Sulfate (Plaquenil)
Leflunomide (Arava)
Methotrexate Sodium (Methotrexate)
Sulfasalazine Tablet (Azulfidine)
Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
Tier 2
DSP N SL
Cimzia
Cuprimine
DSP N SL
Humira Simponi
DSP N SL
Stelara DSP N SL
Tier 3
DSP N SL
Actemra
ST T4
Enbrel
DSP N SL
ST T4
Kineret
DSP N SL
Orencia
DSP N SL
ST T4
Otezla
DSP N SL
ST T4
Xeljanz
DSP N SL
ST T4
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
SL T4
36
Musculoskeletal & Inflammatory
Osteoporosis Therapy
MUSCLE RELAXANTS & ANTISPASMODIC THERAPY
Tier 1
Baclofen (Lioresal)
Carisoprodol (Soma 350 mg)
Chlorzoxazone (Parafon Forte DSC)
Cyclobenzaprine HCl (Flexeril)
Dantrolene Sodium (Dantrium)
Diazepam (Valium)
Methocarbamol (Robaxin)
Tizanidine HCl Tablet (Zanaflex)
Tier 2
Orphenadrine (Norflex)**
Orphenadrine/Aspirin/Caffeine
(Norgesic, Norgesic Forte)**
Tier 3
E T4
Carisoprodol (Soma 250 mg)***
Cyclobenzaprine Capsule, Extended-Release
E T4
24 Hour (Amrix)***
Lorzone
E T4
Metaxalone (Skelaxin 800 mg)***
Tizanidine HCl Capsule (Zanaflex)***
Tier 1
Alendronate Sodium (Fosamax)
Tier 2
Calcitonin Salmon Nasal Spray
(Miacalcin)**
Calcitonin, Salmon, Synthetic Nasal Spray
(Fortical)**
Forteo
Ibandronate Sodium (Boniva)**
Raloxifene (Evista)**
Tier 3
Actonel
Atelvia
Binosto
Fosamax Plus D
Risedronate 150 mg (generic Actonel)***
SL
DSP N
SL
SL T4
E SL T4
E SL T4
SL
SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
37
Obstetrics & Gynecology
Contraceptives & Related Agents
Tier 3
E T4
Beyaz
Ethinyl Estradiol/Drospirenone
(Yasmin)***
Ethinyl Estradiol/Drospirenone (Yaz)***
E T4
Generess Fe
Levonorgestrel-Eth Estr/Ethinyl Estradiol
MC
(Seasonique)***
Levonorgestrel-Ethinyl Estradiol (Lybrel)***
Lo Loestrin Fe
E T4
Lo Minastrin Fe
LoMedia 24 FE (Loestrin 24 FE)***
Norelgestromin/Ethinyl Estradiol Patch
E T4
(Ortho Evra)***
Norethindrone A-E Estradiol/Ferrous
Fumarate (Estrostep Fe)***
Norethindrone-Ethinyl Estradiol
(Ortho-Novum 7/7/7)***
Norethindrone-Ethinyl Estradiol /Iron
Tablet, Chewable (Femcon Fe)***
Norgestimate-Ethinyl Estradiol (Ortho Tri-Cyclen)***
Norgestimate-Ethinyl Estradiol (Ortho-Cyclen)***
Ortho Tri-Cyclen Lo
Ovcon
E T4
Quartette
Safyral
E T4
MONOPHASIC/BIPHASIC/TRIPHASIC AGENTS
Tier 1
Desogestrel-Ethinyl Estradiol (Desogen)
Ethinyl Estradiol/Desogestrel (Cyclessa)
Ethynodiol D-Ethinyl Estradiol (Demulen)
Levonorgestrel-Ethinyl Estradiol (Alesse)
Levonorgestrel-Ethinyl Estradiol (Nordette)
Levonorgestrel-Ethinyl Estradiol (Triphasil)
Natazia
Norethindrone A-E Estradiol/Ferrous Fumarate
(Loestrin Fe)
Norethindrone-Ethinyl Estradiol (Modicon)
Norethindrone-Ethinyl Estradiol
(Ortho-Novum 1-0.035 mg)
Norethindrone-Ethinyl Estradiol
(Ortho-Novum 10-11)
Norethindrone-Ethinyl Estradiol (TriNorinyl)
Norethindrone-Mestranol
(Ortho-Novum 1-0.05 mg)
Norethindrone-Mestranol
(Ortho-Novum 2-0.1 mg)
Norgestrel-Ethinyl Estradiol (Lo/Ovral)
Ortho Tri-Cyclen*
Ortho-Cyclen*
Ortho-Novum 7/7/7*
Plan B
Yasmin*
Tier 2
Desogestrel-Ethinyl Estradiol/Ethinyl
Estradiol (Mircette)**
Levonorgestrel-Eth Estr/Ethinyl Estradiol
MC
(LoSeasonique)**
Levonorgestrel-Ethinyl Estradiol Tablet,
MC
Dosepak, 3 month (Seasonale)**
Norethindrone A-E Estradiol (Loestrin)**
Norethindrone-Ethinyl Estradiol (Ovcon 35)**
Norgestrel-Ethinyl Estradiol (Ovral)**
Nuvaring
Yaz^^
Oxytocics
Tier 1
Methylergonovine Maleate (Methergine)
Estrogens & Progestins
PROGESTINS
Tier 1
Medroxyprogesterone Acet
(Depo-Provera 150 mg/ml)
Medroxyprogesterone Acet (Provera)
Norethindrone Acetate (Aygestin)
Ortho Micronor*
Tier 2
Crinone1
Depo-SubQ Provera Progesterone, Micronized (Prometrium)**
Tier 3
Endometrin
Norethindrone (Ortho Micronor)***
Nor-Q-D
MC
N
MC
N
Benefit determines coverage of treatment of infertility.
1
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
38
Obstetrics & Gynecology
ESTROGENS
Tier 1
Estradiol (Estrace)
Estradiol Patch, Transdermal Weekly (Climara)
Estropipate Tablet (Ogen)
Tier 2
Climara
Divigel
Estring
Evamist
Vagifem
Vivelle-Dot
Tier 3
Alora
Cenestin
Elestrin
Enjuvia
Estrace Cream with Applicator
Estrasorb
Estrogel
Femring
Menest
Menostar Patch, Transdermal Weekly
Minivelle
Premarin
ESTROGEN COMBINATIONS
Tier 2
Estradiol/Norethindrone Acetate (Activella)**
Prefest (Estradiol/Norgestimate)
Tier 3
Angeliq
Climara Pro
Combipatch
Norethindrone Acetate/Ethinyl Estradiol
(Femhrt)***
Premphase
Prempro
Miscellaneous OB/GYN
DRUGS TO TREAT INFERTILITY /IVF AGENTS
Coverage is determined by the consumer’s prescription drug
benefit plan.
Tier 1
N
Clomiphene Citrate (Clomid)
Clomiphene Citrate (Serophene)
N
Leuprolide Acetate (Lupron 1 mg/0.2 ml)
N
Tier 2
DSP
Cetrotide
Gonal-F
DSP N
Gonal-F RFF
DSP N
Tier 3
DSP N ST T4
Bravelle
Follistim AQ
DSP N ST T4
Menopur
DSP N T4
Ovidrel
DSP N
Repronex
DSP N T4
SL
SL
MC SL
SL
SL
E T4
SL
SL
MC SL
VAGINAL CLEANSER/ANTI-INFECTIVES
Tier 1
Clindamycin Phosphate Cream w/Applicator
(Cleocin Phosphate)
Metronidazole Vaginal Gel (Metrogel Vaginal)
Tier 2
AVC
Cleocin Phosphate
Clindesse
SL
SL
VAGINAL ANTIFUNGALS
Tier 1
Fluconazole (Diflucan 150 mg)
Terconazole Cream w/Applicator (Terazol)
Terconazole Suppository, Vaginal (Terazol)
Tier 3
Gynazole-1
SL
SL
SPECIALIZED OB/GYN DRUGS
Tier 1
Terbutaline Sulfate (Brethine)
Tier 2
Synarel
Tranexamic Acid (Lysteda)**
Tier 3
Brisdelle
Diclegis N
SL
E SL T4
N SL T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
39
Ophthalmology
Beta-Blockers
Cycloplegic Mydriatics
Tier 1
Betaxolol HCl (Betoptic)
Carteolol HCl (Ocupress)
Levobunolol HCl (Betagan)
Metipranolol (OptiPranolol)
Timolol Maleate (Timoptic-XE)
Timolol Maleate Drops (Timoptic)
Tier 2
Betimol
Tier 3
Betoptic S
Istalol
Tier 1
Atropine Sulfate (Isopto Atropine)
Cyclopentolate HCl (Cyclogyl 1%, 2%)
Tropicamide (Mydriacyl)
Tier 2
Isopto Homatropine (Homatropine HBr)
Tier 3
Cyclogyl 0.5%
Paremyd
SL
Non-Steroidal Anti-Inflammatory Agents
Tier 1
Diclofenac Sodium (Voltaren)
Flurbiprofen Sodium (Ocufen)
Ketorolac Tromethamine (Acular)
Ketorolac Tromethamine (Acular LS)
Tier 3
Acuvail
Bromfenac Sodium (Bromday)***
Bromfenac Sodium (Xibrom)***
Ilevro
Nevanac
Prolensa
Direct Acting Miotics
Tier 1
Pilocarpine HCl
(Isopto Carpine 0.5%, 1%, 2%, 4%, 6%)
Tier 2
Pilopine HS
Other Glaucoma Drugs
Tier 1
Dorzolamide HCl (Trusopt)
Latanoprost (Xalatan)
Tier 2
Azopt
Combigan
Dorzolamide HCl/Timolol Maleate (Cosopt)**
Lumigan
Travatan Z
Tier 3
Cosopt PF
Rescula
Simbrinza Travoprost (Travatan)***
Zioptan E SL T4
E SL T4
SL
E SL T4
SL T4
E SL T4
Vasoconstrictor Decongestants
Tier 1
Naphazoline HCl (Albalon)
Phenylephrine HCl (Neo-Synephrine)
SL
SL
SL
SL
E SL T4
SL ST
E SL T4
ST
SL ST
Oral Drugs For Glaucoma
Tier 1
Acetazolamide (Diamox)
Acetazolamide Capsule, Sustained-Action
(Diamox Sequel)
Methazolamide (Neptazane)
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
40
Ophthalmology
Antibiotics
Steroid-Antibiotic Combinations
Tier 1
Bacitracin/Polymyxin B Sulfate (Polysporin)
Ciprofloxacin HCl Drops (Ciloxan)
Erythromycin Base (Ilotycin)
Gentamicin Sulfate (Garamycin)
Levofloxacin (Quixin)
Neomycin Sulfate/Bacitracin/Polymyxin B
Ointment (Neosporin)
Neomycin Sulfate/Gramicidin D/Polymyxin B
Drops (Neosporin)
Ofloxacin (Ocuflox)
Polymyxin B Sulfate/Trimethoprim
(Polytrim)
Tobramycin Sulfate Drops (Tobrex)
Tier 3
Azasite
Ciloxan Ointment
Gatifloxacin (generic Zymaxid) Moxeza
Moxifloxacin (Vigamox)***
Natacyn
Tobrex Ointment
Tier 1
Neomycin Sulfate/Bacitracin Zinc/Polymyxin B/
Hydrocortisone Ointment (Cortisporin)
Neomycin Sulfate/Polymyxin B Sulfate/
Hydrocortisone Suspension, Drops
(Cortisporin)
Neomycin/Polymyxin B Sulfate/Dexamethasone
(Maxitrol)
Tier 2
Tobramycin/Dexamethasone Suspension
(Tobradex)**
Tier 3
Pred-G
E SL T4
Tobradex ST
Zylet
SL
Steroid-Sulfonamide Combinations
SL
T4
T4
Tier 1
Sulfacetamide Sodium/Prednisolone Sodium
Phosphate (Vasocidin)
Tier 2
Blephamide S.O.P.
Tier 3
Blephamide Suspension, Drops
Sulfonamides
Tier 1
Sulfacetamide Sodium (Bleph-10, Sodium Sulamyd)
Sympathomimetics
Steroids
Tier 1
Fluorometholone (FML)
Prednisolone Acetate (Pred Forte)
Prednisolone Sodium Phosphate
(Inflamase Forte)
Tier 2
FML Forte
Maxidex
Pred Mild
Vexol
Tier 3
Alrex
Durezol
Lotemax Gel
Lotemax Ointment, Suspension
Tier 1
Apraclonidine HCl Drops (Iopidine 0.5%)
Tier 2
Alphagan P
Brimonidine Tartrate 0.15% (Alphagan P)***
Tier 3
Iopidine 1%
SL
SL
SL T4
T4
E SL T4
SL T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
41
Ophthalmology
Miscellaneous Ophthalmologics
Tier 1
Cromolyn Sodium (Crolom)
Tier 2
Lacrisert
Tier 3
Alocril
Alomide
Azelastine HCl Drops (Optivar)***
Bepreve
Emadine
Epinastine HCl Drops (Elestat)***
Lastacaft
Pataday
Patanol
Restasis
SL
E SL T4
E T4
E SL T4
SL
E SL T4
E SL T4
N SL T4
Antivirals
Tier 1
Trifluridine (Viroptic)
Tier 3
Zirgan
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
SL
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
42
Respiratory, Allergy, Cough & Cold
Antihistamine & Antiallergenic Agents
Cough & Cold Therapy
Note: OTC medications are not on the Prescription Drug
List, but are listed for information purposes. If a prescription
product is identical to an OTC product in strength and dosage
form, the prescription product is not included in the drug list.
Antitussive and Expectorant Drugs
Only prescription antitussive and expectorant drugs are
included in the Prescription Drug List. The use of OTC
antitussive and expectorant products is recommended when
possible. While not all comparable OTC alternatives to
prescription products are provided below, where applicable at
least one is listed for informational purposes.
Claritin (Loratadine Tablet, Syrup) - OTC
ANTIHISTAMINES
Tier 1
Cyproheptadine HCl (Periactin)
Hydroxyzine HCl (Atarax)
Hydroxyzine Pamoate (Vistaril)
Levocetirizine Dihydrochloride Tablet (Xyzal)
Promethazine HCl (Phenergan)
Tier 3
Desloratadine (Clarinex)***
Levocetirizine Dihydrochloride Solution, Oral
(Xyzal)***
SL
ADRENERGICS
Tier 2
Epipen
Epipen Jr
Tier 3
Auvi-Q SL
SL
ANGIOEDEMA
Tier 2
Berinert
Tier 3
Firazyr
INTRANASAL ANTIHISTAMINES
Tier 3
Azelastine (Astepro)*** Azelastine (Astelin)*** Olpatadine (Patanase)*** ANTITUSSIVE COMBINATIONS
Tier 1
Codeine/Promethazine HCl
(Phenergan w/Codeine)
Dextromethorphan HBr/Pseudoephedrine
HCl/Brompheniramine (Bromfed-DM)
Guaifenesin/Codeine Phosphate
(Robitussin A-C)
Guaifenesin/Pseudoephedrine HCl/Codeine
(Robitussin-DAC)
Phenylephrine HCl/Codeine/Promethazine
(Phenergan VC w/Codeine)
Tier 3
Chlorpheniramine/Hydrocodone
Pseudoephedrine (Zutripro)***
Hydrocodone/Chlorpheniramine Suspension,
Sustained-Release 12 Hour (Tussionex)***
E SL
SL
E SL T4
SL
SL
Antihistamine/Decongestant Combinations
Only prescription antihistamine/decongestants are included
in the Prescription Drug List. The use of OTC antihistamine/
decongestant products is recommended when possible. While
not all comparable OTC alternatives to prescription products
are provided below, where applicable at least one is listed for
informational purposes. Strength is listed in mg.
DSP N SL
DSP N SL T4
E SL T4
SL
SL
Claritin-D (Pseudoephedrine Sulfate/Loratadine) - OTC
BIOLOGIC RESPONSE MODIFIERS
Tier 3
Grastek
Oralair
Ragwitek
N SL T4
N SL T4
N SL T4
DECONGESTANT/ANTIHISTAMINES
Tier 1
Phenylephrine HCl/Promethazine HCl
(Phenergan VC)
Tier 3
Clarinex-D
E SL
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
43
Respiratory, Allergy, Cough & Cold
Pulmonary Agents
INTRANASAL STEROIDS
Tier 2
Fluticasone Propionate (Flonase)**
Tier 3
Beconase AQ
Budesonide (Rhinocort Aqua)***
Dymista
Flunisolide
Nasonex
Omnaris
Qnasl Triamcinolone Acetonide (Nasacort AQ)***
Veramyst
Zetonna
XANTHINES
Tier 1
Theophylline Anhydrous Tablet,
Extended-Release 12 Hour (Theochron)
Tier 3
Elixophyllin Elixir
Lufyllin Tablet
Theo-24
BETA AGONISTS ORAL
Tier 1
Albuterol Sulfate (Proventil, Ventolin)
Terbutaline Sulfate (Brethine)
INHALED BETA AGONISTS
Tier 1
Albuterol Sulfate Solution (AccuNeb, Proventil)
Metaproterenol Sulfate Solution, Non-Oral
(Alupent)
Ventolin HFA (Albuterol Sulfate HFA Aerosol)
Tier 2
Foradil
Tier 3
Arcapta Neohaler
Brovana
Perforomist
Proair HFA
Proventil HFA
Serevent Diskus
Xopenex HFA
Levalbuterol HCl (Xopenex Vial, Nebulizer)***
INHALED CORTICOSTEROIDS
Tier 1
Alvesco
Asmanex
QVAR
Tier 2
Budesonide Inhalation Suspension
(Pulmicort Respules 0.25 mg/2 ml,
0.5 mg/2 ml)**
Pulmicort Respules 1 mg/2 ml Tier 3
Aerospan
Flovent Diskus
Flovent HFA
Pulmicort Flexhaler
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
MISCELLANEOUS PULMONARY AGENTS
Tier 1
Acetylcysteine Vial, Nebulizer (Mucomyst)
Cromolyn Sodium Ampul for Nebulization
(Intal)
Ipratropium Bromide Solution, Non-Oral
(Atrovent)
Montelukast Sodium (Singulair)
Sildenafil Citrate (Revatio)
Zafirlukast (Accolate)
Tier 2
Albuterol Sulfate/Ipratropium Solution,
Non-Oral (Duoneb)**
Letairis
Pulmozyme
Spiriva
Tracleer
Tudorza Pressair Tyvaso
Ventavis
Tier 3
Adcirca Advair Diskus
Advair HFA
Atrovent HFA
Atrovent Nasal Spray
Breo Ellipta
Combivent Respimat
Daliresp
Dulera
Symbicort
Zyflo
Zyflo CR
SL
SL
SL
SL
SL
SL
SL
SL
SL
E SL T4
SL
SL
SL
SL
SL
SL
SL
SL
SDP SL T4
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
44
E SL T4
E SL T4
E SL T4
E SL T4
E SL T4
E SL T4
E SL T4
E SL T4
SL
SL
DSP N SL
SL
DSP N SL
DSP N SL
SL
DSP N SL
SL
DSP N
DSP N
DSP N SL T4
RS SL
RS SL
SL
RS SL
SL
N SL
RS SL
E SL T4
SL
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
SL
Urologicals
Cholinergic Stimulants
Erectile Dysfunction
Tier 1
Bethanechol Chloride (Urecholine)
Tier 3
Caverject
Cialis1
Edex
Levitra1
Muse
Staxyn1
Viagra1
Anticholinergics
Tier 1
Oxybutynin Chloride (Ditropan)
Tier 2
Oxybutynin Chloride Tablet, Sustained-Release
(Ditropan XL)**
Tier 3
E T4
Enablex
Gelnique
E T4
Myrbetriq
E T4
Oxytrol
E T4
Tolterodine Extended-Release (Detrol LA)***
E T4
Tolterodine Tartrate (Detrol)***
E T4
Toviaz
E T4
Trospium Chloride (Sanctura)***
Trospium Chloride Capsule, Sustained-Release
E T4
24 Hour (Sanctura XR)***
Vesicare E T4
1
SL
SL T4
SL
SL T4
SL
E SL T4
SL T4
Patient must be an adult male (over 18 years of age) and should not be using concomitant nitrate
products (e.g., nitroglycerin) nor be receiving other drugs for treatment of sexual dysfunction
(e.g., Caverject, Muse).
Benign Prostatic Hyperplasia (BPH) Therapy
Tier 1
Alfuzosin HCl (Uroxatral)
Doxazosin Mesylate (Cardura)
Finasteride (Proscar)
Tamsulosin HCl (Flomax)
Terazosin HCl (Hytrin)
Tier 3
Avodart
Cialis
Jalyn
Rapaflo
Urinary Anesthetics
N SDP T4
SL ST T4
E T4
T4
Tier 1
Phenazopyridine HCl (Pyridium)
Miscellaneous Urologicals
Tier 1
Citric Acid/Sodium Citrate (Bicitra)
Tier 2
Cystagon
Elmiron
K-Phos M.F.
K-Phos Original
Oracit
Renacidin
Tier 3
Procysbi
DSP
DSP N T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
45
Vitamins, Hematinics & Electrolytes
Vitamins & Hematinics
Electrolytes
Injectable vitamins are not included in the Prescription
Drug List.
POTASSIUM
Tier 1
Potassium Chloride (K-Dur)
Potassium Chloride Capsule, Sustained-Action
(Micro-K)
Potassium Chloride Packet (Klor-Con 25mEq)
Potassium Chloride Tablet, Sustained-Action
(K-Tab, Slow-K)
Tier 3
K-Tab
Multivitamins are NOT included in the Prescription Drug List
as various OTC products are available.
Tier 1
Fluoride Ion/Iron/Multivitamins (Poly-Vi-Flor w/Iron)
Fluoride Ion/Iron/Vitamins A,C, and D
(Tri-Vi-Flor w/Iron)
Fluoride Ion/Multivitamins (Poly-Vi-Flor)
Fluoride Ion/Vitamins A,C, and D (Tri-Vi-Flor)
Prenatal Vit/Fe Fumarate/FA (Prenatal)
Sodium Fluoride (Luride)
Tier 3
Brand Prenatal Vitamins
Nascobal
DSP Designated Specialty Program
E
May be excluded from coverage
MC Multiple copay
N
Notification or Prior Authorization required****
RS May be eligible for the Refill and Save Program
SDPSelect Designated Pharmacy
SL Supply limit
ST Step Therapy
T4 May be covered on Tier 4 in selected benefits
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
46
Diagnostics & Miscellaneous Agents
Miscellaneous Agents
Anorexiants
Tier 1
Acamprosate (Campral)
Anagrelide HCl (Agrylin)
Calcium Acetate (PhosLo)
Disulfiram (Antabuse)
Etidronate Disodium (Didronel)
Levocarnitine (Carnitor)
Midodrine HCl (ProAmatine)
Pilocarpine HCl (Salagen)
Riluzole (Rilutek)
Sodium Polystyrene Sulfonate (Kayexalate)
Tier 2
Carbaglu
Chemet
Exjade
Fosrenol
Renagel
Renvela
Sevelamer (Renvela)
Tier 3
Ferriprox
Appetite Suppressants (e.g. Ionamin, Meridia, Xenical, etc.,
and amphetamines when used as appetite suppressants) are
Tier 3. Coverage is determined by the consumer’s prescription
drug benefit plan.
DSP N
DSP N SL T4
Smoking Deterrents
Tier 1
Bupropion HCl Tablet, Sustained-Action
(Zyban)
Nicotine Patch, Transdermal 24 Hour
(Habitrol)
Tier 3
Chantix
Nicotrol Inhaler Nicotrol NS
N
N
N T4
N T4
N T4
Please refer to page 4 for a definition of notations/symbols.
*Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List ***Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List
**Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^^Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
47
Common Brand medications
excluded from coverage
under many benefit plans
Aciphex
Actiq
Actos
Adderall
Adoxa Tablet
Ambien
Arimidex
Astelin
Ativan
Avelox
Avinza
Benzaclin Jar
Celexa
Cipro Suspension
Cloderm
Cymbalta
Diovan HCT
Duac
Duragesic
Effexor XR
Entocort EC
Evista
Femara
Fioricet with Codeine
50-325-40-30 mg
Flomax
Geodon
Imitrex Injection & Tablets
Lexapro
Lidoderm
Lipitor
Lofibra 54, 160 mg
Lovaza
Lunesta
Maxalt
Maxalt-MLT
Mepron
Micardis
Micardis HCT
Monodox
Natroba
Optivar
Ortho Evra
Percocet
Plavix
Prilosec
Protonix
Lower-cost option(s)
Omeprazole (generic Prilosec), Pantoprazole (generic Protonix), Rabeprazole (generic
Aciphex), Dexilant
Fentanyl Lozenge (generic Actiq)
Pioglitazone (generic Actos)
Amphetamine/Dextroamphetamine Immediate-Release
(generic Adderall)
Doxycycline Hyclate (generic Vibra-Tab), Doxycycline Monohydrate Tablet
(generic Adoxa Tablet)
Zolpidem (generic Ambien)
Anastrozole (generic Arimidex)
Azelastine Nasal Spray (generic Astelin)
Lorazepam (generic Ativan)
Moxifloxacin Tablets (generic Avelox)
Morphine Sulfate Extended-Release Tablet (generic MS Contin), Morphine Sulfate
Extended-Release Capsule (generic Avinza)
Clindamycin 1%/Benzoyl Peroxide 5% Gel (generic Benzaclin)
Citalopram (generic Celexa)
Ciprofloxacin Oral Suspension (generic Cipro Suspension)
Clocortolone 0.1% Cream (generic Cloderm), Mometasone Furoate 0.1% Cream
(generic Elocon)
Duloxetine (generic Cymbalta)
Valsartan/Hydrochlorothiazide (generic Diovan HCT)
Clindamycin/Benzoyl Peroxide 1.2-5% Gel (generic Duac)
Fentanyl Transdermal Patch (generic Duragesic)
Venlafaxine Extended-Release Capsule (generic Effexor XR)
Budesonide (generic Entocort EC)
Raloxifene (generic Evista)
Letrozole (generic Femara)
Butalbital/Acetaminophen/Caffeine/Codeine Phosphate 50-325-40-30 mg
(generic Fioricet with Codeine)
Tamsulosin (generic Flomax)
Ziprasidone (generic Geodon)
Sumatriptan Injection, Tablet (generic Imitrex)
Escitalopram (generic Lexapro)
Lidocaine Transdermal Patch (generic Lidoderm)
Atorvastatin (generic Lipitor)
Fenofibrate 54, 160 mg (generic Lofibra)
Omega-3-Acid Ethyl Esters (generic Lovaza), Vascepa
Eszopiclone (generic Lunesta), Zaleplon (generic Sonata), Zolpidem (generic Ambien)
Rizatriptan (generic Maxalt)
Rizatriptan (generic Maxalt), Rizatriptan Orally Disintegrating Tablet (generic Maxalt MLT)
Atovaquone Suspension (generic Mepron)
Losartan (generic Cozaar), Telmisartan (generic Micardis)
Losartan/Hydrochlorothiazide (generic Hyzaar), Telmisartan/Hydrochlorothiazide
(generic Micardis HCT)
Doxycycline Hyclate (generic Vibramycin), Doxycycline Monohydrate (generic Monodox)
Malathion (generic Ovide), Permethrin (generic Elimite), Spinosad (generic Natroba)
Azelastine (generic Optivar), Lastacaft
Norelgestromin/Ethinyl Estradiol Topical Patch, Xulane (generic Ortho Evra)
Acetaminophen/Oxycodone (generic Percocet)
Clopidogrel (generic Plavix)
Omeprazole (generic Prilosec)
Pantoprazole (generic Protonix)
48
Common Brand medications
excluded from coverage
under many benefit plans
Lower-cost option(s)
Prozac
Revatio
Risperdal
Seroquel
Singulair Chewable Tablet
Singulair Tablet
Skelaxin
Taclonex Ointment
Valium
Valtrex
Viramune XR 400 mg
Wellbutrin SR
Wellbutrin XL
Xanax
Xanax XR
Zoloft
Zovirax Ointment
Zutripro
Zyprexa
Zyprexa Zydis
Fluoxetine (generic Prozac)
Sildenafil (generic Revatio)
Risperidone (generic Risperdal)
Quetiapine (generic Seroquel)
Montelukast Chewable Tablet (generic Singulair)
Montelukast (generic Singulair)
Metaxalone (generic Skelaxin)
Betamethasone/Calcipotriene Ointment (generic Taclonex)
Diazepam (generic Valium)
Valacyclovir (generic Valtrex)
Nevirapine Extended-Release (generic Viramune XR)
Bupropion Extended-Release (generic Wellbutrin SR)
Bupropion Extended-Release (generic Wellbutrin XL)
Alprazolam (generic Xanax)
Alprazolam Extended-Release (generic Xanax XR)
Sertraline (generic Zoloft)
Acyclovir Ointment (generic Zovirax)
Chlorpheniramine/Hydrocodone/Pseudoephedrine (generic Zutripro)
Olanzapine (generic Zyprexa)
Olanzapine (generic Zyprexa), Olanzapine Orally Disintegrating Tablet (generic Zyprexa Zydis)
49
2015 Prescription Drug List Medication Index
A
Abacavir/Lamivudine/Zidovudine. . . . . . 9
Abacavir Sulfate Tablet. . . . . . . . . . . . . . 9
Abilify . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Absorica. . . . . . . . . . . . . . . . . . . . . . . . . 26
Abstral. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Acamprosate. . . . . . . . . . . . . . . . . . . . . 47
Acanya. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Acarbose . . . . . . . . . . . . . . . . . . . . . . . . 31
Accolate. . . . . . . . . . . . . . . . . . . . . . . . . 44
Accu-Chek Aviva Plus. . . . . . . . . . . . . . 32
Accu-Chek Aviva Plus Test Strips. . . . 32
Accu-Chek Compact Test Strips. . . . . 32
Accu-Chek Nano SmartView. . . . . . . . 32
Accu-Chek SmartView. . . . . . . . . . . . . 32
AccuNeb, Proventil. . . . . . . . . . . . . . . . 44
Accuretic . . . . . . . . . . . . . . . . . . . . . . . . 23
Accutane . . . . . . . . . . . . . . . . . . . . . . . . 26
Acebutolol HCl . . . . . . . . . . . . . . . . . . . 21
Aceon. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Acetaminophen/Caffeine/Butalbital/
Codeine 325-50-40-30 mg. . . . . . . 13
Acetaminophen/Caffeine/Butalbital
325-50-40 mg. . . . . . . . . . . . . . . . . . 13
Acetaminophen/Oxycodone. . . . . . . . . 48
Acetazolamide. . . . . . . . . . . . . . . . . . . . 40
Acetazolamide Capsule,
Sustained-Action. . . . . . . . . . . . . . . . 40
Acetic Acid. . . . . . . . . . . . . . . . . . . . . . . 29
Acetic Acid/Hydrocortisone. . . . . . . . . 29
Acetylcysteine Vial, Nebulizer. . . . . . . . 44
Achromycin V. . . . . . . . . . . . . . . . . . . . . . 7
Aciphex. . . . . . . . . . . . . . . . . . . . . . 33, 48
Aciphex Sprinkle. . . . . . . . . . . . . . . . . . 33
Acitretin . . . . . . . . . . . . . . . . . . . . . . . . . 27
Aclovate. . . . . . . . . . . . . . . . . . . . . . . . . 25
Actemra . . . . . . . . . . . . . . . . . . . . . . . . . 36
Acthar H.P.. . . . . . . . . . . . . . . . . . . . . . . 30
Actigall. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Actimmune. . . . . . . . . . . . . . . . . . . . . . . 35
Actiq. . . . . . . . . . . . . . . . . . . . . . . . 13, 48
Activella . . . . . . . . . . . . . . . . . . . . . . . . . 39
Actonel. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Actoplus Met. . . . . . . . . . . . . . . . . . . . . 31
Actoplus Met XR. . . . . . . . . . . . . . . . . . 31
Actos. . . . . . . . . . . . . . . . . . . . . . . . 31, 48
Acular. . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Acular LS. . . . . . . . . . . . . . . . . . . . . . . . 40
Acuvail . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Acyclovir. . . . . . . . . . . . . . . . . . . 8, 27, 49
Acyclovir Ointment . . . . . . . . . . . . 27, 49
Aczone. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Adapalene . . . . . . . . . . . . . . . . . . . . . . . 26
Adcirca. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Adderall . . . . . . . . . . . . . . . . . . . . . 19, 48
Adderall XR . . . . . . . . . . . . . . . . . . . . . . 19
Adefovir . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Adoxa. . . . . . . . . . . . . . . . . . . . . . . . . 7, 48
Adoxa 150 mg. . . . . . . . . . . . . . . . . . . . . 7
Adoxa Tablet. . . . . . . . . . . . . . . . . . . . . . 48
Advair Diskus. . . . . . . . . . . . . . . . . . . . . 44
Advair HFA. . . . . . . . . . . . . . . . . . . . . . . 44
Advate. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Advicor. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Aerospan . . . . . . . . . . . . . . . . . . . . . . . . 44
Afinitor . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Aggrenox . . . . . . . . . . . . . . . . . . . . . . . . 20
Agrylin. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Albalon. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Albenza. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Albuterol Sulfate . . . . . . . . . . . . . . . . . . 44
Albuterol Sulfate/Ipratropium
Solution, Non-Oral. . . . . . . . . . . . . . . 44
Albuterol Sulfate HFA Aerosol. . . . . . . 44
Albuterol Sulfate Solution. . . . . . . . . . . 44
Alclometasone Dipropionate Cream,
Ointment. . . . . . . . . . . . . . . . . . . . . . . 25
Aldactazide 25-25 mg . . . . . . . . . . . . . 21
Aldactazide 50-50 mg . . . . . . . . . . . . . 21
Aldactone. . . . . . . . . . . . . . . . . . . . . . . . 21
Aldara. . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Alendronate Sodium. . . . . . . . . . . . . . . 37
Alesse. . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Alferon N . . . . . . . . . . . . . . . . . . . . . . . . 35
Alfuzosin HCl. . . . . . . . . . . . . . . . . . . . . 45
Alinia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Alkeran. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Allopurinol. . . . . . . . . . . . . . . . . . . . . . . . 36
Alocril. . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Alomide. . . . . . . . . . . . . . . . . . . . . . . . . . 42
Alora. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Alphagan P. . . . . . . . . . . . . . . . . . . . . . . 41
Alphanate vonWillebrand. . . . . . . . . . . 21
Alphanine SD. . . . . . . . . . . . . . . . . . . . . 21
Alprazolam. . . . . . . . . . . . . . . . . . . 19, 49
Alprazolam Extended-Release. . . . . . . 49
Alprazolam Tablet, Rapid Dissolve. . . . 19
Alprazolam Tablet,
Sustained-Release 24 Hour. . . . . . . 19
Alrex . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Alsuma. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Altabax. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Altace. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Altoprev . . . . . . . . . . . . . . . . . . . . . . . . . 24
Alupent. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Alvesco. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Amantadine HCl . . . . . . . . . . . . . . . . 8, 15
Amaryl. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
50
Ambien. . . . . . . . . . . . . . . . . . . . . . 17, 48
Ambien CR. . . . . . . . . . . . . . . . . . . . . . . 17
Amcinonide Cream, Lotion. . . . . . . . . . 25
Amcinonide Ointment. . . . . . . . . . . . . . 25
Amerge. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Amicar. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Amicar 500 mg . . . . . . . . . . . . . . . . . . . 21
Amiloride HCl. . . . . . . . . . . . . . . . . . . . . 21
Amiloride HCl/Hydrochlorothiazide. . . 21
Aminocaproic Acid . . . . . . . . . . . . . . . . 21
Aminocaproic Acid Solution. . . . . . . . . 21
Aminocaproic Acid Tablet. . . . . . . . . . . 21
Aminocaproic Acid Tablet 1000 mg . . 21
Amiodarone HCl. . . . . . . . . . . . . . . . . . 20
Amitiza . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Amitriptyline HCl. . . . . . . . . . . . . . . . . . 17
AmLactin. . . . . . . . . . . . . . . . . . . . . . . . . 28
Amlodipine/Atorvastatin . . . . . . . . . . . . 24
Amlodipine/Benazepril . . . . . . . . . . . . . 23
Amlodipine/Telmisartan. . . . . . . . . . . . . 23
Amlodipine Besylate. . . . . . . . . . . . . . . 22
Amlodpine/Valsartan. . . . . . . . . . . . . . . 23
Ammonium Lactate. . . . . . . . . . . . . . . . 28
Amnesteem . . . . . . . . . . . . . . . . . . . . . . 26
Amoxapine. . . . . . . . . . . . . . . . . . . . . . . 17
Amoxicillin Clavulanate ER Tablet,
Sustained-Release 12 Hour. . . . . . . . 7
Amoxicillin Trihydrate/Potassium
Clavulanate. . . . . . . . . . . . . . . . . . . . . . 7
Amoxicillin Trihydrate Capsule,
Chewable Tablet, Suspension,
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Amoxil. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Amphetamine/Dextroamphetamine
Immediate-Release . . . . . . . . . . . . . . 48
Amphetamine Aspartate/
Amphetamine Sulfate/
Dextroamphetamine. . . . . . . . . . . . . . 19
Amphetamine Aspartate/
Amphetamine Sulfate/
Dextroamphetamine Capsule,
Sustained-Release 24 Hour. . . . . . . 19
Ampyra. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Amrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Amturnide. . . . . . . . . . . . . . . . . . . . . . . . 23
Anafranil. . . . . . . . . . . . . . . . . . . . . . . . . 17
Anagrelide HCl . . . . . . . . . . . . . . . . . . . 47
Analpram-HC. . . . . . . . . . . . . . . . . . . . . 34
Anaprox, Anaprox DS . . . . . . . . . . . . . . 36
Anastrozole. . . . . . . . . . . . . . . . . . . 11, 48
Ancobon. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Androderm. . . . . . . . . . . . . . . . . . . . . . . 30
Androgel. . . . . . . . . . . . . . . . . . . . . . . . . 30
Android. . . . . . . . . . . . . . . . . . . . . . . . . . 30
2015 Prescription Drug List Medication Index
Angeliq. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Ansaid. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Antabuse . . . . . . . . . . . . . . . . . . . . . . . . 47
Antara. . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Antivert 50 mg. . . . . . . . . . . . . . . . . . . . 34
Anusol-HC. . . . . . . . . . . . . . . . . . . . . . . 34
Anusol-HC 2.5%. . . . . . . . . . . . . . . . . . 34
Anzemet. . . . . . . . . . . . . . . . . . . . . . . . . 34
Apexicon. . . . . . . . . . . . . . . . . . . . . . . . . 25
Apexicon E. . . . . . . . . . . . . . . . . . . . . . . 25
Apidra Solostar. . . . . . . . . . . . . . . . . . . 31
Apidra Vial . . . . . . . . . . . . . . . . . . . . . . . 31
Aplenzin . . . . . . . . . . . . . . . . . . . . . . . . . 17
Apokyn. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Apraclonidine HCl Drops. . . . . . . . . . . 41
Apresoline . . . . . . . . . . . . . . . . . . . . . . . 22
Apriso. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Aptivus. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Aralen Phosphate . . . . . . . . . . . . . . . . . 10
Aranesp . . . . . . . . . . . . . . . . . . . . . . . . . 35
Arava. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Arcalyst. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Arcapta Neohaler. . . . . . . . . . . . . . . . . . 44
Aricept . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Aricept 23 mg. . . . . . . . . . . . . . . . . . . . 16
Aricept ODT. . . . . . . . . . . . . . . . . . . . . . 16
Arimidex. . . . . . . . . . . . . . . . . . . . . 11, 48
Aristocort. . . . . . . . . . . . . . . . . . . . . . . . 25
Aristocort HP. . . . . . . . . . . . . . . . . . . . . 25
Arixtra. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Armour Thyroid. . . . . . . . . . . . . . . . . . . 30
Aromasin. . . . . . . . . . . . . . . . . . . . . . . . . 11
Artane. . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Arthrotec. . . . . . . . . . . . . . . . . . . . . . . . . 36
Asacol HD. . . . . . . . . . . . . . . . . . . . . . . 34
Ascensia Autodisc Test Strips. . . . . . . 32
Ascensia Breeze 2 Test Strips. . . . . . . 32
Asendin 50, 100 mg. . . . . . . . . . . . . . . 17
Asmanex. . . . . . . . . . . . . . . . . . . . . . . . . 44
Aspirin/Caffeine/Butalbital. . . . . . . . . . 13
Aspirin/Caffeine/Dihydrocodone. . . . . 13
Astagraf XL . . . . . . . . . . . . . . . . . . . . . . 11
Astelin. . . . . . . . . . . . . . . . . . . . . . . 43, 48
Astepro. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Atacand . . . . . . . . . . . . . . . . . . . . . . . . . 23
Atacand HCT. . . . . . . . . . . . . . . . . . . . . 23
Atarax. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Atelvia. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Atenolol. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Ativan . . . . . . . . . . . . . . . . . . . . . . . 19, 48
Atorvastatin . . . . . . . . . . . . . . . . . . 24, 48
Atorvastatin Calcium. . . . . . . . . . . . . . . 24
Atovaquone . . . . . . . . . . . . . . . . . . 10, 48
Atovaquone/Proguanil HCl. . . . . . . . . . 10
Atovaquone Suspension. . . . . . . . . . . . 48
Atralin. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Atripla. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Atropine Sulfate. . . . . . . . . . . . . . . 33, 40
Atrovent . . . . . . . . . . . . . . . . . . . . . . . . . 44
Atrovent HFA. . . . . . . . . . . . . . . . . . . . . 44
Atrovent Nasal Spray . . . . . . . . . . . . . . 44
Aubagio . . . . . . . . . . . . . . . . . . . . . . . . . 16
Augmentin Chewable Tablet, Tablet,
Suspension. . . . . . . . . . . . . . . . . . . . . . 7
Augmentin XR. . . . . . . . . . . . . . . . . . . . . 7
Auvi-Q. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Avalide . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Avandamet. . . . . . . . . . . . . . . . . . . . . . . 31
Avandaryl . . . . . . . . . . . . . . . . . . . . . . . . 31
Avandia. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Avapro. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
AVC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Avelox. . . . . . . . . . . . . . . . . . . . . . . . . 8, 48
Avinza. . . . . . . . . . . . . . . . . . . . . . . 13, 48
Avita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Avita Gel. . . . . . . . . . . . . . . . . . . . . . . . . 26
Avodart. . . . . . . . . . . . . . . . . . . . . . . . . . 45
Avonex . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Axert. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Axid Oral Solution. . . . . . . . . . . . . . . . . 33
Axiron. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Aygestin. . . . . . . . . . . . . . . . . . . . . . . . . 38
Azasan . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Azasite . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Azathioprine. . . . . . . . . . . . . . . . . . 11, 36
Azelastine. . . . . . . . . . . . . . . . . 42, 43, 48
Azelastine HCl Drops. . . . . . . . . . . . . . 42
Azelastine Nasal Spray. . . . . . . . . . . . . 48
Azelex. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Azilect. . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Azithromycin. . . . . . . . . . . . . . . . . . . . . . . 7
Azopt. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Azor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Azulfidine . . . . . . . . . . . . . . . . . . . . 34, 36
B
Bacitracin/Polymyxin B Sulfate . . . . . . 41
Baclofen. . . . . . . . . . . . . . . . . . . . . . . . . 37
Bactrim. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Bactrim DS. . . . . . . . . . . . . . . . . . . . . . . 8
Bactroban. . . . . . . . . . . . . . . . . . . . . . . . 26
Balsalazide Disodium. . . . . . . . . . . . . . 34
Banzel. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Baraclude. . . . . . . . . . . . . . . . . . . . . . . . . 8
Bebulin. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Beconase AQ . . . . . . . . . . . . . . . . . . . . 44
Belladonna Alkaloids/Phenobarbital. . 33
Benazepril/Hydrochlorothiazide. . . . . . 23
Benazepril HCl. . . . . . . . . . . . . . . . . . . . 22
51
BeneFix. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Benemid. . . . . . . . . . . . . . . . . . . . . . . . . 36
Benicar. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Benicar HCT . . . . . . . . . . . . . . . . . . . . . 23
Bentyl. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Benzaclin . . . . . . . . . . . . . . . . . . . . 26, 48
Benzaclin 1%-5%. . . . . . . . . . . . . . . . . 26
Benzaclin Jar . . . . . . . . . . . . . . . . . . . . . 48
Benzamycin . . . . . . . . . . . . . . . . . . . . . . 26
Benztropine Mesylate. . . . . . . . . . . . . . 15
Bepreve . . . . . . . . . . . . . . . . . . . . . . . . . 42
Berinert. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Betagan . . . . . . . . . . . . . . . . . . . . . . . . . 40
Betamethasone/Calcipotriene
Ointment. . . . . . . . . . . . . . . . . . . 27, 49
Betamethasone Dipropionate/
Propylene Glycol Gel. . . . . . . . . . . . . 25
Betamethasone Dipropionate/
Propylene Glycol Lotion, Ointment. . 25
Betamethasone Dipropionate
Augmented, Lotion, Ointment. . . . . . 25
Betamethasone Dipropionate
Cream, Ointment. . . . . . . . . . . . . . . . 25
Betamethasone Dipropionate
Lotion. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Betamethasone DP Augmented
Cream. . . . . . . . . . . . . . . . . . . . . . . . . 25
Betamethasone Valerate Cream,
Lotion. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Betamethasone Valerate Foam . . . . . . 25
Betamethasone Valerate Ointment . . . 25
Betapace, Betapace AF. . . . . . . . . . . . 20
Betaseron. . . . . . . . . . . . . . . . . . . . . . . . 16
Betaxolol HCl. . . . . . . . . . . . . . . . . 21, 40
Bethanechol Chloride. . . . . . . . . . . . . . 45
Bethkis. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Betimol. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Betoptic. . . . . . . . . . . . . . . . . . . . . . . . . 40
Betoptic S . . . . . . . . . . . . . . . . . . . . . . . 40
Beyaz . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Biaxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Biaxin XL. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bicalutamide . . . . . . . . . . . . . . . . . . . . . 11
Bicitra. . . . . . . . . . . . . . . . . . . . . . . . . . . 45
BiDil . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Biltricide. . . . . . . . . . . . . . . . . . . . . . . . . 10
Binosto. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Bisacodyl Tab & Peg 3350-KCL-Sod
Bicarb-NACL for Solution Kit. . . . . . 34
Bisoprolol Fumarate/
Hydrochlorothiazide. . . . . . . . . . . . . . 23
Bleph-10, Sodium Sulamyd. . . . . . . . . 41
Blephamide S.O.P. . . . . . . . . . . . . . . . . 41
Blephamide Suspension, Drops. . . . . 41
2015 Prescription Drug List Medication Index
Boniva. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Bosulif. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Brand Prenatal Vitamins. . . . . . . . . . . . 46
Bravelle. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Breo Ellipta. . . . . . . . . . . . . . . . . . . . . . . 44
Brethine . . . . . . . . . . . . . . . . . . . . . 39, 44
Brilinta. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Brimonidine Tartrate 0.15%. . . . . . . . . 41
Brisdelle. . . . . . . . . . . . . . . . . . . . . . . . . 39
Bromday. . . . . . . . . . . . . . . . . . . . . . . . . 40
Bromfed-DM . . . . . . . . . . . . . . . . . . . . . 43
Bromfenac Sodium. . . . . . . . . . . . . . . . 40
Bromocriptine Mesylate . . . . . . . . . . . . 15
Brovana . . . . . . . . . . . . . . . . . . . . . . . . . 44
Budesonide. . . . . . . . . . . . . . . 34, 44, 48
Budesonide Capsule,
Sustained-Release. . . . . . . . . . . . . . . 34
Budesonide Inhalation Suspension. . . 44
Bumetanide. . . . . . . . . . . . . . . . . . . . . . 21
Bumex. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Buphrenorphine HCl/Naloxone
HCl Tablet, Sublingual. . . . . . . . . . . . 14
Buphrenorphine Hydrochloride . . . . . . 14
Bupropion Extended-Release . . . . . . . 49
Bupropion HCl. . . . . . . . . . . . . . . . 17, 47
Bupropion HCl Tablet,
Sustained-Action. . . . . . . . . . . . 17, 47
Bupropion HCl Tablet,
Sustained-Release 24 Hour. . . . . . . 17
Buspar . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Buspirone HCl. . . . . . . . . . . . . . . . . . . . 19
Butalbital/Acetaminophen/Caffeine/
Codeine Phosphate
50-325-40-30 mg. . . . . . . . . . . . . . . 48
Butorphanol Tartrate Aerosol, Spray. . 14
Butrans. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Bydureon . . . . . . . . . . . . . . . . . . . . . . . . 31
Byetta. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Bystolic. . . . . . . . . . . . . . . . . . . . . . . . . . 21
C
Cabergoline. . . . . . . . . . . . . . . . . . . . . . 30
Caduet. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Cafergot. . . . . . . . . . . . . . . . . . . . . . . . . 14
Calan. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Calan SR. . . . . . . . . . . . . . . . . . . . . . . . 22
Calcipotriene Cream, Ointment. . . . . . 27
Calcipotriene Solution, Topical. . . . . . . 27
Calcitonin, Salmon, Synthetic
Nasal Spray . . . . . . . . . . . . . . . . 30, 37
Calcitonin Salmon Nasal Spray. . 30, 37
Calcitriol. . . . . . . . . . . . . . . . . . . . . . . . . 30
Calcitrol Ointment. . . . . . . . . . . . . . . . . 27
Calcium Acetate . . . . . . . . . . . . . . . . . . 47
Cambia. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Campral. . . . . . . . . . . . . . . . . . . . . . . . . 47
Canasa. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Candesartan . . . . . . . . . . . . . . . . . . . . . 23
Candesartan/Hydrochlorothiazide. . . . 23
Cantil. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Capecitabine. . . . . . . . . . . . . . . . . . . . . 11
Capozide . . . . . . . . . . . . . . . . . . . . . . . . 23
Caprelsa. . . . . . . . . . . . . . . . . . . . . . . . . 11
Captopril/Hydrochlorothiazide. . . . . . . 23
Carafate. . . . . . . . . . . . . . . . . . . . . . . . . 33
Carafate Oral Suspension . . . . . . . . . . 33
Carbaglu. . . . . . . . . . . . . . . . . . . . . . . . . 47
Carbamazepine. . . . . . . . . . . . . . . 15, 16
Carbamazepine Capsule,
Extended-Release Multiphase
12 Hour. . . . . . . . . . . . . . . . . . . . . . . . 16
Carbamazepine Tablet,
Sustained-Release 12 Hour. . . . . . . 15
Carbatrol. . . . . . . . . . . . . . . . . . . . . . . . 16
Carbidopa/Levodopa . . . . . . . . . . . . . . 15
Carbidopa/Levodopa/Entacapone . . . 15
Carbidopa/Levodopa Tablet,
Rapid Dissolve. . . . . . . . . . . . . . . . . . 15
Carbidopa/Levodopa Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 15
Cardene. . . . . . . . . . . . . . . . . . . . . . . . . 22
Cardene SR. . . . . . . . . . . . . . . . . . . . . . 22
Cardizem . . . . . . . . . . . . . . . . . . . . . . . . 22
Cardizem CD. . . . . . . . . . . . . . . . . . . . . 22
Cardizem LA 120 mg. . . . . . . . . . . . . . 22
Cardizem LA 180, 240, 300,
360, 420 mg. . . . . . . . . . . . . . . . . . . . 22
Cardizem SR. . . . . . . . . . . . . . . . . . . . . 22
Cardura. . . . . . . . . . . . . . . . . . . . . . 22, 45
Cardura XL. . . . . . . . . . . . . . . . . . . . . . . 22
Carisoprodol . . . . . . . . . . . . . . . . . . . . . 37
Carmol HC Cream . . . . . . . . . . . . . . . . 28
Carnitor. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Carteolol HCl. . . . . . . . . . . . . . . . . . . . . 40
Carvedilol. . . . . . . . . . . . . . . . . . . . . . . . 21
Casodex. . . . . . . . . . . . . . . . . . . . . . . . . 11
Cataflam. . . . . . . . . . . . . . . . . . . . . . . . . 36
Catapres. . . . . . . . . . . . . . . . . . . . . . . . . 22
Catapres-TTS . . . . . . . . . . . . . . . . . . . . 22
Caverject . . . . . . . . . . . . . . . . . . . . . . . . 45
Cayston . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ceclor, Ceclor CD. . . . . . . . . . . . . . . . . . 7
Cedax. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cefaclor. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cefadroxil Hydrate. . . . . . . . . . . . . . . . . . 7
Cefdinir. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cefditoren Pivoxil. . . . . . . . . . . . . . . . . . . 7
Cefpodoxime Tablet. . . . . . . . . . . . . . . . . 7
Cefprozil. . . . . . . . . . . . . . . . . . . . . . . . . . 7
52
Ceftin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ceftin Suspension. . . . . . . . . . . . . . . . . . 7
Cefuroxime Axetil Suspension,
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cefzil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Celebrex. . . . . . . . . . . . . . . . . . . . . . . . . 36
Celestone Oral Solution. . . . . . . . . . . . 30
Celexa. . . . . . . . . . . . . . . . . . . . . . . 18, 48
CellCept. . . . . . . . . . . . . . . . . . . . . . . . . 11
Celontin . . . . . . . . . . . . . . . . . . . . . . . . . 15
Cenestin. . . . . . . . . . . . . . . . . . . . . . . . . 39
Centany . . . . . . . . . . . . . . . . . . . . . . . . . 26
Cephalexin Monohydrate . . . . . . . . . . . . 7
Cephulac. . . . . . . . . . . . . . . . . . . . . . . . 34
Cesamet. . . . . . . . . . . . . . . . . . . . . . . . . 34
Cetraxal . . . . . . . . . . . . . . . . . . . . . . . . . 29
Cetrotide . . . . . . . . . . . . . . . . . . . . 31, 39
Cevimeline HCl. . . . . . . . . . . . . . . . . . . 29
Chantix. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chemet. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chloral Hydrate. . . . . . . . . . . . . . . . . . . 17
Chlordiazepoxide HCl. . . . . . . . . . . . . . 19
Chlorhexidine Gluconate . . . . . . . . . . . 29
Chloroquine Phosphate . . . . . . . . . . . . 10
Chlorothiazide Tablet. . . . . . . . . . . . . . . 21
Chlorpheniramine/Hydrocodone/
Pseudoephedrine. . . . . . . . . . . . 43, 49
Chlorpheniramine/Hydrocodone
Pseudoephedrine. . . . . . . . . . . . 43, 49
Chlorpromazine HCl Tablet . . . . . . . . . 18
Chlorzoxazone. . . . . . . . . . . . . . . . . . . . 37
Cholestyramine/Aspartame . . . . . . . . . 24
Cholestyramine/Sucrose . . . . . . . . . . . 24
Choline Fenofibrate. . . . . . . . . . . . . . . . 24
Chronulac. . . . . . . . . . . . . . . . . . . . . . . . 34
Cialis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Ciclopirox Cream, Gel, Lotion . . . . . . . 27
Ciclopirox Shampoo. . . . . . . . . . . . . . . 27
Ciclopirox Solution, Non-Oral . . . . . . . 27
Cilostazol. . . . . . . . . . . . . . . . . . . . . . . . 20
Ciloxan. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Ciloxan Ointment. . . . . . . . . . . . . . . . . . 41
Cimetidine Tablet, Liquid. . . . . . . . . . . . 33
Cimzia. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Cipro. . . . . . . . . . . . . . . . . . . . . . 8, 29, 48
Cipro HC Suspension, Drops . . . . . . . 29
Cipro Suspension. . . . . . . . . . . . . . . 8, 48
Cipro XR. . . . . . . . . . . . . . . . . . . . . . . . . . 8
Ciprodex. . . . . . . . . . . . . . . . . . . . . . . . . 29
Ciprofloxacin HCl Drops. . . . . . . . . . . . 41
Ciprofloxacin Oral Suspension. . . . 8, 48
Ciprofloxacin Tablet. . . . . . . . . . . . . . . . . 8
Ciprofloxacin Tablet,
Sustained-Release 24 Hour. . . . . . . . 8
2015 Prescription Drug List Medication Index
Citalopram. . . . . . . . . . . . . . . . . . . 18, 48
Citalopram Hydrobromide . . . . . . . . . . 18
Citric Acid/Sodium Citrate. . . . . . . . . . 45
Claravis. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Clarinex. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Clarinex-D . . . . . . . . . . . . . . . . . . . . . . . 43
Clarithromycin Suspension. . . . . . . . . . . 7
Clarithromycin Sustained-Release
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Clarithromycin Tablet. . . . . . . . . . . . . . . . 7
Claritin . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Claritin-D . . . . . . . . . . . . . . . . . . . . . . . . 43
Cleocin HCl 150, 300 mg. . . . . . . . . . . 9
Cleocin HCl 75 mg. . . . . . . . . . . . . . . . . 9
Cleocin Palmitate . . . . . . . . . . . . . . . . . . 9
Cleocin Phosphate. . . . . . . . . . . . . . . . 39
Cleocin T . . . . . . . . . . . . . . . . . . . . . . . . 26
Climara. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Climara Pro . . . . . . . . . . . . . . . . . . . . . . 39
Clindagel . . . . . . . . . . . . . . . . . . . . . . . . 26
Clindamycin/Benzoyl Peroxide
1.2-5% Gel. . . . . . . . . . . . . . . . . . . . . 48
Clindamycin 1%/Benzoyl Peroxide
5% Gel. . . . . . . . . . . . . . . . . . . . . . . . 48
Clindamycin HCl. . . . . . . . . . . . . . . . . . . 9
Clindamycin Palmitate HCl. . . . . . . . . . . 9
Clindamycin Phosphate/Benzoyl
Peroxide Gel. . . . . . . . . . . . . . . . . . . . 26
Clindamycin Phosphate/Benzoyl
Peroxide Gel 1.2%-5%. . . . . . . . . . . 26
Clindamycin Phosphate Cream,
Solution, Swab. . . . . . . . . . . . . . . . . . 26
Clindamycin Phosphate Cream
w/Applicator. . . . . . . . . . . . . . . . . . . . 39
Clindamycin Phosphate Foam 1%. . . . 26
Clindamycin Phosphate Gel. . . . . . . . . 26
Clindamycin Phosphate Lotion. . . . . . 26
Clindesse. . . . . . . . . . . . . . . . . . . . . . . . 39
Clinoril. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Clobetasol Propionate Cream. . . . . . . 25
Clobetasol Propionate Cream, Gel,
Ointment, Solution. . . . . . . . . . . . . . . 25
Clobetasol Propionate Foam. . . . . . . . 25
Clobetasol Propionate Lotion. . . . . . . . 25
Clobetasol Propionate Shampoo. . . . . 25
Clobex. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Clocortolone . . . . . . . . . . . . . . . . . 25, 48
Clocortolone 0.1% Cream. . . . . . . . . . 48
Cloderm. . . . . . . . . . . . . . . . . . . . . 25, 48
Clomid . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Clomiphene Citrate. . . . . . . . . . . . . . . . 39
Clomipramine HCl. . . . . . . . . . . . . . . . . 17
Clonazepam. . . . . . . . . . . . . . . . . . . . . . 15
Clonidine Extended-Release. . . . . . . . 19
Clonidine HCl . . . . . . . . . . . . . . . . . . . . 22
Clonidine Patch, Transdermal
Weekly. . . . . . . . . . . . . . . . . . . . . . . . . 22
Clopidogrel. . . . . . . . . . . . . . . . . . . 20, 48
Clopidogrel Bisulfate. . . . . . . . . . . . . . . 20
Clorpres. . . . . . . . . . . . . . . . . . . . . . . . . 23
Clotrimazole/Betamethasone
Dipropionate. . . . . . . . . . . . . . . . . . . . 27
Clotrimazole Troche. . . . . . . . . . . . . . . . . 9
Clozapine. . . . . . . . . . . . . . . . . . . . . . . . 18
Clozapine Orally Disintegrating
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 18
Clozaril. . . . . . . . . . . . . . . . . . . . . . . . . . 18
Coartem. . . . . . . . . . . . . . . . . . . . . . . . . 10
Codeine/Promethazine HCl. . . . . . . . . 43
Codeine Phosphate/
Acetaminophen . . . . . . . . . . . . . . . . . 13
Codeine Phosphate/
Acetaminophen/Caffeine/
Butalbital 50-300-40-30 mg. . . . . . 13
Codeine Phosphate/Aspirin/
Caffeine/Butalbital. . . . . . . . . . . . . . . 13
Codeine Sulfate. . . . . . . . . . . . . . . . . . . 13
Cogentin. . . . . . . . . . . . . . . . . . . . . . . . . 15
Colazal. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Colcrys. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Colestid . . . . . . . . . . . . . . . . . . . . . . . . . 24
Colestipol HCl. . . . . . . . . . . . . . . . . . . . 24
Coly-Mycin S Suspension, Drops. . . . 29
Colyte. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Combigan. . . . . . . . . . . . . . . . . . . . . . . . 40
Combipatch. . . . . . . . . . . . . . . . . . . . . . 39
Combivent Respimat. . . . . . . . . . . . . . . 44
Combivir. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Combunox . . . . . . . . . . . . . . . . . . . . . . . 13
Cometriq. . . . . . . . . . . . . . . . . . . . . . . . . 11
Compazine. . . . . . . . . . . . . . . . . . . . . . . 34
Complera. . . . . . . . . . . . . . . . . . . . . . . . . 9
Comtan. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Concerta . . . . . . . . . . . . . . . . . . . . . . . . 19
Condylox Gel. . . . . . . . . . . . . . . . . . . . . 28
Condylox Liquid. . . . . . . . . . . . . . . . . . . 28
Contour Next Test Strips . . . . . . . . . . . 32
Contour Test Strips. . . . . . . . . . . . . . . . 32
Conzip . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Copaxone. . . . . . . . . . . . . . . . . . . . . . . . 16
Copegus. . . . . . . . . . . . . . . . . . . . . . . . . . 8
Cordarone . . . . . . . . . . . . . . . . . . . . . . . 20
Cordran Lotion. . . . . . . . . . . . . . . . . . . . 25
Cordran Ointment. . . . . . . . . . . . . . . . . 25
Cordran SP Cream. . . . . . . . . . . . . . . . 25
Coreg. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Coreg CR. . . . . . . . . . . . . . . . . . . . . . . . 21
Corgard . . . . . . . . . . . . . . . . . . . . . . . . . 21
53
Cortef. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Cortenema. . . . . . . . . . . . . . . . . . . . . . . 34
Cortifoam. . . . . . . . . . . . . . . . . . . . . . . . 34
Cortisporin. . . . . . . . . . . . . . . . . . . 29, 41
Cortisporin-TC Suspension, Drops. . . 29
Corzide. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Cosopt. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Cosopt PF. . . . . . . . . . . . . . . . . . . . . . . 40
Coumadin. . . . . . . . . . . . . . . . . . . . . . . . 20
Cozaar . . . . . . . . . . . . . . . . . . . . . . 23, 48
Creon. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Crestor. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Crinone. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Crixivan. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Crolom. . . . . . . . . . . . . . . . . . . . . . . . . . 42
Cromolyn Sodium. . . . . . . . . . 34, 42, 44
Cromolyn Sodium Ampul for
Nebulization . . . . . . . . . . . . . . . . . . . . 44
Cuprimine. . . . . . . . . . . . . . . . . . . . . . . . 36
Cutivate . . . . . . . . . . . . . . . . . . . . . . . . . 25
Cutivate Lotion. . . . . . . . . . . . . . . . . . . . 25
Cyclessa. . . . . . . . . . . . . . . . . . . . . . . . . 38
Cyclobenzaprine Capsule,
Extended-Release 24 Hour. . . . . . . . 37
Cyclobenzaprine HCl. . . . . . . . . . . . . . 37
Cyclocort. . . . . . . . . . . . . . . . . . . . . . . . 25
Cyclogyl 0.5%. . . . . . . . . . . . . . . . . . . . 40
Cyclogyl 1%, 2%. . . . . . . . . . . . . . . . . . 40
Cyclopentolate HCl. . . . . . . . . . . . . . . . 40
Cyclophosphamide. . . . . . . . . . . . . . . . 11
Cyclosporine, Modified. . . . . . . . . . . . . 11
Cymbalta . . . . . . . . . . . . . . . . . . . . 17, 48
Cyproheptadine HCl. . . . . . . . . . . . . . . 43
Cystagon. . . . . . . . . . . . . . . . . . . . . . . . 45
Cytomel . . . . . . . . . . . . . . . . . . . . . . . . . 30
Cytotec. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Cytovene . . . . . . . . . . . . . . . . . . . . . . . . . 8
Cytoxan. . . . . . . . . . . . . . . . . . . . . . . . . . 11
D
D-Amphetamine Capsule,
Extended-Release. . . . . . . . . . . . . . . 19
D-Amphetamine Sulfate Tablet,
Capsule,. . . . . . . . . . . . . . . . . . . . . . . 19
D.H.E.45. . . . . . . . . . . . . . . . . . . . . . . . . 14
Daliresp . . . . . . . . . . . . . . . . . . . . . . . . . 44
Dalmane. . . . . . . . . . . . . . . . . . . . . . . . . 17
Danazol. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Danocrine. . . . . . . . . . . . . . . . . . . . . . . . 30
Dantrium. . . . . . . . . . . . . . . . . . . . . . . . . 37
Dantrolene Sodium. . . . . . . . . . . . . . . . 37
Dapsone. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Daraprim. . . . . . . . . . . . . . . . . . . . . . . . . 10
Daypro . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Daytrana. . . . . . . . . . . . . . . . . . . . . . . . . 19
2015 Prescription Drug List Medication Index
DDAVP. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Decadron. . . . . . . . . . . . . . . . . . . . . . . . 30
Delzicol. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Demerol . . . . . . . . . . . . . . . . . . . . . . . . . 13
Demulen. . . . . . . . . . . . . . . . . . . . . . . . . 38
Denavir. . . . . . . . . . . . . . . . . . . . . . . . . . 27
Depakene. . . . . . . . . . . . . . . . . . . . . . . . 15
Depakote . . . . . . . . . . . . . . . . . . . . 15, 16
Depakote ER. . . . . . . . . . . . . . . . . 15, 16
Depakote Sprinkle. . . . . . . . . . . . . . . . . 15
Depo-Provera 150 mg/ml. . . . . . . . . . . 38
Depo-SubQ Provera. . . . . . . . . . . . . . . 38
Derma-Smoothe/FS. . . . . . . . . . . . . . . 25
Dermatop. . . . . . . . . . . . . . . . . . . . . . . . 25
Desipramine HCl. . . . . . . . . . . . . . . . . . 17
Desloratadine. . . . . . . . . . . . . . . . . . . . . 43
Desmopressin Acetate. . . . . . . . . . . . . 30
Desogen. . . . . . . . . . . . . . . . . . . . . . . . . 38
Desogestrel-Ethinyl Estradiol. . . . . . . . 38
Desogestrel-Ethinyl Estradiol/
Ethinyl Estradiol. . . . . . . . . . . . . . . . . 38
Desonate . . . . . . . . . . . . . . . . . . . . . . . . 25
Desonide Cream, Ointment, Lotion. . . 25
DesOwen. . . . . . . . . . . . . . . . . . . . . . . . 25
Desoximetasone Cream. . . . . . . . . . . . 25
Desoximetasone Gel, Ointment. . . . . . 25
Desoxyn . . . . . . . . . . . . . . . . . . . . . . . . . 19
Desvenlafaxine. . . . . . . . . . . . . . . . . . . . 17
Desyrel. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Detrol . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Detrol LA . . . . . . . . . . . . . . . . . . . . . . . . 45
Dexamethasone. . . . . . . . . . . . . . . 30, 41
Dexedrine. . . . . . . . . . . . . . . . . . . . . . . . 19
Dexilant. . . . . . . . . . . . . . . . . . . . . . 33, 48
Dexmethylphenidate
Extended-Release. . . . . . . . . . . . . . . 19
Dextromethorphan HBr/
Pseudoephedrine HCl/
Brompheniramine. . . . . . . . . . . . . . . . 43
DiaBeta. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Diamox . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Diamox Sequel. . . . . . . . . . . . . . . . . . . . 40
Diastat Acudial. . . . . . . . . . . . . . . . . . . . 15
Diazepam. . . . . . . . . . . . . . 15, 19, 37, 49
Diazepam, Rectal. . . . . . . . . . . . . . . . . . 15
Dibenzyline. . . . . . . . . . . . . . . . . . . . . . . 22
Diclegis. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Diclofenac 3% Gel . . . . . . . . . . . . . . . . 28
Diclofenac Potassium. . . . . . . . . . . . . . 36
Diclofenac Sodium . . . . . . . . . . . . 36, 40
Diclofenac Sodium/Misoprostol. . . . . . 36
Diclofenac Sodium Tablet,
Sustained-Release 24 Hour. . . . . . . 36
Diclofenac Topical Solution . . . . . . . . . 36
Dicloxacillin Sodium Capsule. . . . . . . . . 7
Dicyclomine HCl Tablet. . . . . . . . . . . . . 33
Didanosine Capsule, Enteric-Coated. . 9
Didronel . . . . . . . . . . . . . . . . . . . . . . . . . 47
Differin Cream, Gel 0.1%. . . . . . . . . . . 26
Differin Gel 0.3%. . . . . . . . . . . . . . . . . . 26
Differin Lotion. . . . . . . . . . . . . . . . . . . . . 26
Dificid. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Diflorasone Diacetate Cream. . . . . . . . 25
Diflorasone Diacetate Ointment. . . . . . 25
Diflucan. . . . . . . . . . . . . . . . . . . . . . . . 9, 39
Diflucan 150 mg . . . . . . . . . . . . . . . . . . 39
Digoxin. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Dihydroergotamine Mesylate. . . . . . . . 14
Dihydroergotamine Mesylate Aerosol,
Spray with Pump. . . . . . . . . . . . . . . . 14
Dilacor XR . . . . . . . . . . . . . . . . . . . . . . . 22
Dilantin. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Dilatrate-SR. . . . . . . . . . . . . . . . . . . . . . 20
Dilaudid. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Diltiazem HCl. . . . . . . . . . . . . . . . . . . . . 22
Diltiazem HCl Capsule,
Controlled-Release. . . . . . . . . . . . . . 22
Diltiazem HCl Capsule,
Sustained-Action. . . . . . . . . . . . . . . . 22
Diltiazem HCl Capsule,
Sustained-Release 12 Hour. . . . . . . 22
Diltiazem HCl Capsule,
Sustained-Release 24 Hour. . . . . . . 22
Diltiazem HCl Tablet,
Sustained-Release 24 Hour. . . . . . . 22
Diovan. . . . . . . . . . . . . . . . . . . . . . . 23, 48
Diovan HCT. . . . . . . . . . . . . . . . . . 23, 48
Dipentum . . . . . . . . . . . . . . . . . . . . . . . . 34
Diphenoxylate HCl/Atropine Sulfate . . 33
Diprolene . . . . . . . . . . . . . . . . . . . . . . . . 25
Diprolene AF Cream. . . . . . . . . . . . . . . 25
Diprosone. . . . . . . . . . . . . . . . . . . . . . . . 25
Diprosone, Maxivate . . . . . . . . . . . . . . . 25
Dipyridamole . . . . . . . . . . . . . . . . . . . . . 20
Disopyramide Phosphate Capsule . . . 20
Disulfiram. . . . . . . . . . . . . . . . . . . . . . . . 47
Ditropan. . . . . . . . . . . . . . . . . . . . . . . . . 45
Ditropan XL . . . . . . . . . . . . . . . . . . . . . . 45
Diuril. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Diuril 250 mg/5 ml. . . . . . . . . . . . . . . . . 21
Divalproex Sodium. . . . . . . . . . . . . . . . . 15
Divalproex Sodium Tablet. . . . . . . . . . . 15
Divalproex Sodium Tablet,
Sustained-Release. . . . . . . . . . . . . . . 15
Divigel. . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Dolophine HCl. . . . . . . . . . . . . . . . . . . . 13
Donepezil 23 mg. . . . . . . . . . . . . . . . . . 16
Donepezil HCl Tablet . . . . . . . . . . . . . . 16
54
Donepezil HCl Tablet,
Rapid Dissolve. . . . . . . . . . . . . . . . . . 16
Donnatal. . . . . . . . . . . . . . . . . . . . . . . . . 33
Donnatal Tablet, Sustained-Action . . . 33
Doryx. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Dorzolamide HCl. . . . . . . . . . . . . . . . . . 40
Dorzolamide HCl/Timolol Maleate. . . . 40
Dostinex. . . . . . . . . . . . . . . . . . . . . . . . . 30
Dovonex. . . . . . . . . . . . . . . . . . . . . . . . . 27
Doxazosin Mesylate. . . . . . . . . . . . 22, 45
Doxepin Cream . . . . . . . . . . . . . . . . . . . 28
Doxepin HCl. . . . . . . . . . . . . . . . . . . . . . 17
Doxercalciferol. . . . . . . . . . . . . . . . . . . . 30
Doxycycline Hyclate. . . . . . . . . . . . . 7, 48
Doxycycline Hyclate
50, 75, 100, 150 mg. . . . . . . . . . . . . . 7
Doxycycline Hyclate Tablet 20 mg. . . . . 7
Doxycycline Hyclate Tablet,
Enteric-Coated. . . . . . . . . . . . . . . . . . . 7
Doxycycline Monohydrate. . . . . . . . . 7, 48
Doxycycline Monohydrate
50, 100 mg Capsule. . . . . . . . . . . . . . 7
Doxycycline Monohydrate
75 mg Capsule. . . . . . . . . . . . . . . . . . . 7
Doxycycline Monohydrate Capsule. . . . 7
Doxycycline Monohydrate Tablet. . . . . 48
Dronabinol. . . . . . . . . . . . . . . . . . . . . . . 34
Droxia. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Duac. . . . . . . . . . . . . . . . . . . . . . . . 26, 48
Duetact. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Duexis. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Dulera. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Duloxetine. . . . . . . . . . . . . . . . . . . . 17, 48
Duoneb. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Duragesic. . . . . . . . . . . . . . . . . . . . 13, 48
Durezol. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Duricef . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Dutoprol. . . . . . . . . . . . . . . . . . . . . . . . . 23
Dyazide. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Dymista. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Dynacin. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Dynapen. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Dyrenium . . . . . . . . . . . . . . . . . . . . . . . . 21
E
E-Mycin. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
E.E.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
EC-Naprosyn. . . . . . . . . . . . . . . . . . . . . 36
Econazole Nitrate. . . . . . . . . . . . . . . . . 27
Edarbi. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Edarbyclor . . . . . . . . . . . . . . . . . . . . . . . 23
Edecrin. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Edex . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Edluar. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Edurant. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2015 Prescription Drug List Medication Index
Effexor XR . . . . . . . . . . . . . . . . . . . 17, 48
Effient. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Efudex. . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Egrifta. . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Elavil. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Eldepryl. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Elestat. . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Elestrin. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Elidel. . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Elimite. . . . . . . . . . . . . . . . . . . . . . . 27, 48
Eliquis. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Elixophyllin Elixir. . . . . . . . . . . . . . . . . . . 44
Elmiron. . . . . . . . . . . . . . . . . . . . . . . . . . 45
Elocon. . . . . . . . . . . . . . . . . . . . . . . 25, 48
Emadine. . . . . . . . . . . . . . . . . . . . . . . . . 42
Emcyt. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Emend. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Emgel. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Emla . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Emsam. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Emtriva. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Enablex. . . . . . . . . . . . . . . . . . . . . . . . . . 45
Enalapril Maleate. . . . . . . . . . . . . . 22, 23
Enalapril Maleate/
Hydrochlorothiazide. . . . . . . . . . . . . . 23
Enbrel. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Endometrin. . . . . . . . . . . . . . . . . . . . . . . 38
Enjuvia. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Enoxaparin. . . . . . . . . . . . . . . . . . . . . . . 20
Entacapone . . . . . . . . . . . . . . . . . . . . . . 15
Entecavir. . . . . . . . . . . . . . . . . . . . . . . . . . 8
Entocort EC. . . . . . . . . . . . . . . . . . 34, 48
Epaned. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Epiduo . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Epinastine HCl Drops. . . . . . . . . . . . . . 42
Epipen. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Epipen Jr. . . . . . . . . . . . . . . . . . . . . . . . . 43
Epivir. . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9
Epivir HBV. . . . . . . . . . . . . . . . . . . . . . . . 8
Eplerenone. . . . . . . . . . . . . . . . . . . . . . . 21
Epogen. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Eprosartan Hydrochloride. . . . . . . . . . . 23
Epzicom. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Equetro. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Ergomar . . . . . . . . . . . . . . . . . . . . . . . . . 14
Erivedge. . . . . . . . . . . . . . . . . . . . . . . . . 11
Ertaczo. . . . . . . . . . . . . . . . . . . . . . . . . . 27
Ery-Tab. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Eryc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Erycette . . . . . . . . . . . . . . . . . . . . . . . . . 26
Erygel. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Erythromycin Base. . . . . . . . . . . 7, 26, 41
Erythromycin Base/Benzoyl
Peroxide. . . . . . . . . . . . . . . . . . . . . . . 26
Erythromycin Base/Ethyl Alcohol. . . . . 26
Erythromycin Base/Ethyl Alcohol
Swab, Medicated. . . . . . . . . . . . . . . . 26
Erythromycin Base Capsule,
Delayed-Release . . . . . . . . . . . . . . . . . 7
Erythromycin Base Tablet,
Enteric-Coated 250, 333 mg. . . . . . . 7
Erythromycin Ethylsuccinate. . . . . . . . . . 7
Erythromycin Ethylsuccinate/
Sulfisoxazole Acetyl. . . . . . . . . . . . . . . 7
Escitalopram . . . . . . . . . . . . . . . . . 18, 48
Escitalopram Solution, Oral. . . . . . . . . 18
Escitalopram Tablet. . . . . . . . . . . . . . . . 18
Eskalith. . . . . . . . . . . . . . . . . . . . . . . . . . 19
Eskalith CR . . . . . . . . . . . . . . . . . . . . . . 19
Estrace. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Estrace Cream with Applicator . . . . . . 39
Estradiol. . . . . . . . . . . . . . . . . . 38, 39, 48
Estradiol/Norethindrone Acetate. . . . . 39
Estradiol/Norgestimate. . . . . . . . . . . . . 39
Estradiol Patch, Transdermal
Weekly. . . . . . . . . . . . . . . . . . . . . . . . . 39
Estrasorb . . . . . . . . . . . . . . . . . . . . . . . . 39
Estring. . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Estrogel . . . . . . . . . . . . . . . . . . . . . . . . . 39
Estropipate Tablet. . . . . . . . . . . . . . . . . 39
Estrostep Fe. . . . . . . . . . . . . . . . . . . . . . 38
Eszopiclone. . . . . . . . . . . . . . . . . . 17, 48
Ethambutol HCl. . . . . . . . . . . . . . . . . . . 10
Ethinyl Estradiol/Desogestrel. . . . . . . . 38
Ethinyl Estradiol/Drospirenone. . . . . . . 38
Ethosuximide. . . . . . . . . . . . . . . . . . . . . 15
Ethynodiol D-Ethinyl Estradiol . . . . . . . 38
Etidronate Disodium. . . . . . . . . . . . . . . 47
Etodolac. . . . . . . . . . . . . . . . . . . . . . . . . 36
Etodolac Tablet, Sustained-Release
24 Hour. . . . . . . . . . . . . . . . . . . . . . . . 36
Etoposide. . . . . . . . . . . . . . . . . . . . . . . . 11
Eulexin. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Eurax. . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Evamist. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Evista . . . . . . . . . . . . . . . . . . . . . . . 37, 48
Evoclin . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Evoxac . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Exalgo. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Exelderm. . . . . . . . . . . . . . . . . . . . . . . . . 27
Exelon. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Exelon Solution . . . . . . . . . . . . . . . . . . . 16
Exemestane. . . . . . . . . . . . . . . . . . . . . . 11
Exforge. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Exforge HCT . . . . . . . . . . . . . . . . . . . . . 23
Exjade. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Extavia. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Extina . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
55
F
Fabior. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Factive . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Famciclovir. . . . . . . . . . . . . . . . . . . . . . . . 8
Famotidine Suspension, Oral. . . . . . . . 33
Famvir. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Fanapt. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Fareston. . . . . . . . . . . . . . . . . . . . . . . . . 11
Farxiga . . . . . . . . . . . . . . . . . . . . . . . . . . 31
FazaClo. . . . . . . . . . . . . . . . . . . . . . . . . . 18
Feiba. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Felbamate. . . . . . . . . . . . . . . . . . . . . . . . 15
Felbatol. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Feldene. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Felodipine. . . . . . . . . . . . . . . . . . . . . . . . 22
Femara. . . . . . . . . . . . . . . . . . . . . . 11, 48
Femcon Fe. . . . . . . . . . . . . . . . . . . . . . . 38
Femhrt. . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Femring. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Fenofibrate 50, 150 mg . . . . . . . . . . . . 24
Fenofibrate 54, 160 mg . . . . . . . . 24, 48
Fenofibrate 67, 134, 200 mg. . . . . . . . 24
Fenofibrate Micronized 43, 130 mg . . 24
Fenofibrate Nanocrystallized
48, 145 mg. . . . . . . . . . . . . . . . . . . . . 24
Fenofibric Acid. . . . . . . . . . . . . . . . . . . . 24
Fenoglide. . . . . . . . . . . . . . . . . . . . . . . . 24
Fentanyl Citrate Lollipop. . . . . . . . . . . . 13
Fentanyl Lozenge. . . . . . . . . . . . . . . . . . 48
Fentanyl Transdermal. . . . . . . . . . . 13, 48
Fentanyl Transdermal Patch. . . . . . . . . 48
Fentora. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Ferriprox. . . . . . . . . . . . . . . . . . . . . . . . . 47
Fibricor. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Finacea. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Finasteride. . . . . . . . . . . . . . . . . . . . . . . 45
Fioricet. . . . . . . . . . . . . . . . . . . . . . 13, 48
Fioricet w/Codeine. . . . . . . . . . . . . . . . 13
Fioricet with Codeine . . . . . . . . . . . . . . 48
Fioricet with Codeine
50-325-40-30 mg. . . . . . . . . . . . . . . 48
Fiorinal . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Fiorinal w/Codeine 30 mg . . . . . . . . . . 13
Firazyr. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Flagyl. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Flagyl ER Tablet. . . . . . . . . . . . . . . . . . . 10
Flecainide Acetate. . . . . . . . . . . . . . . . . 20
Flector. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Flexeril. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Flo-Pred. . . . . . . . . . . . . . . . . . . . . . . . . 30
Flomax. . . . . . . . . . . . . . . . . . . . . . . 45, 48
Flonase. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Florinef Acetate. . . . . . . . . . . . . . . . . . . 30
Florone. . . . . . . . . . . . . . . . . . . . . . . . . . 25
2015 Prescription Drug List Medication Index
Flovent Diskus. . . . . . . . . . . . . . . . . . . . 44
Flovent HFA. . . . . . . . . . . . . . . . . . . . . . 44
Floxin. . . . . . . . . . . . . . . . . . . . . . . . . . 8, 29
Floxin Otic . . . . . . . . . . . . . . . . . . . . . . . 29
Flucinolone Acetonide Ointment. . . . . 25
Flucinonide 0.1% Cream . . . . . . . . . . . 25
Fluconazole . . . . . . . . . . . . . . . . . . . . 9, 39
Flucytosine. . . . . . . . . . . . . . . . . . . . . . . . 9
Fludrocortisone Acetate. . . . . . . . . . . . 30
Flumadine. . . . . . . . . . . . . . . . . . . . . . . . . 8
Flunisolide . . . . . . . . . . . . . . . . . . . . . . . 44
Fluocinolone Acetonide Body Oil . . . . 25
Fluocinolone Acetonide Cream. . . . . . 25
Fluocinolone Acetonide Scalp Oil. . . . 25
Fluocinolone Acetonide Solution
Non-Oral. . . . . . . . . . . . . . . . . . . . . . . 25
Fluocinonide Cream, Gel, Ointment,
Solution, Non-Oral. . . . . . . . . . . . . . . 25
Fluoride Ion/Iron/Multivitamins. . . . . . . 46
Fluoride Ion/Iron/Vitamins
A,C, and D . . . . . . . . . . . . . . . . . . . . . 46
Fluoride Ion/Multivitamins. . . . . . . . . . . 46
Fluoride Ion/Vitamins A,C, and D. . . . . 46
Fluorometholone. . . . . . . . . . . . . . . . . . 41
Fluorouracil. . . . . . . . . . . . . . . . . . . . . . . 28
Fluoxetine. . . . . . . . . . . . . . . . . . . . 18, 49
Fluoxetine Capsule, Delayed-Release.18
Fluoxetine HCl Capsule . . . . . . . . . . . . 18
Fluoxetine HCl Tablet . . . . . . . . . . . . . . 18
Fluphenazine HCl . . . . . . . . . . . . . . . . . 18
Flurazepam HCl. . . . . . . . . . . . . . . . . . . 17
Flurbiprofen . . . . . . . . . . . . . . . . . . 36, 40
Flurbiprofen Sodium. . . . . . . . . . . . . . . 40
Flutamide. . . . . . . . . . . . . . . . . . . . . . . . 11
Fluticasone Propionate. . . . . . . . . 25, 44
Fluticasone Propionate Cream,
Ointment. . . . . . . . . . . . . . . . . . . . . . . 25
Fluvastatin Sodium . . . . . . . . . . . . . . . . 24
Fluvoxamine Maleate. . . . . . . . . . . . . . . 18
Fluvoxamine Maleate Capsule,
Extended-Release 24 Hour. . . . . . . . 18
FML. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
FML Forte. . . . . . . . . . . . . . . . . . . . . . . . 41
Focalin XR . . . . . . . . . . . . . . . . . . . . . . . 19
Follistim AQ. . . . . . . . . . . . . . . . . . . . . . 39
Fondaparinux Sodium. . . . . . . . . . . . . . 20
Foradil. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Forfivo XL. . . . . . . . . . . . . . . . . . . . . . . . 17
Fortamet. . . . . . . . . . . . . . . . . . . . . . . . . 31
Forteo. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Fortesta. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Fortical . . . . . . . . . . . . . . . . . . . . . . 30, 37
Fosamax. . . . . . . . . . . . . . . . . . . . . . . . . 37
Fosamax Plus D. . . . . . . . . . . . . . . . . . . 37
Fosrenol. . . . . . . . . . . . . . . . . . . . . . . . . 47
Fragmin. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Freestyle Insulinx. . . . . . . . . . . . . . . . . . 32
Freestyle Lite Test Strips. . . . . . . . . . . . 32
Freestyle Test Strips. . . . . . . . . . . . . . . 32
Frova. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Fulyzaq. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Furadantin. . . . . . . . . . . . . . . . . . . . . . . . . 8
Furosemide. . . . . . . . . . . . . . . . . . . . . . 21
Fuzeon . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Fycompa. . . . . . . . . . . . . . . . . . . . . . . . . 16
G
Gabapentin . . . . . . . . . . . . . . . . . . . . . . 15
Gabitril . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Galantamine Capsule 24 Hour
Sustained-Release Pellets . . . . . . . . 16
Galantamine Tablet, Solution. . . . . . . . 16
Ganciclovir. . . . . . . . . . . . . . . . . . . . . . . . 8
Ganirelix Acetate. . . . . . . . . . . . . . . . . . 31
Garamycin . . . . . . . . . . . . . . . . . . . 26, 41
Gastrocrom . . . . . . . . . . . . . . . . . . . . . . 34
Gatifloxacin. . . . . . . . . . . . . . . . . . . . . . . 41
Gelnique. . . . . . . . . . . . . . . . . . . . . . . . . 45
Gemfibrozil. . . . . . . . . . . . . . . . . . . . . . . 24
Generess Fe. . . . . . . . . . . . . . . . . . . . . 38
generic Actonel. . . . . . . . . . . . . . . . . . . 37
generic Zymaxid. . . . . . . . . . . . . . . . . . . 41
Gengraf . . . . . . . . . . . . . . . . . . . . . . . . . 11
Genotropin. . . . . . . . . . . . . . . . . . . . . . . 35
Gentamicin Sulfate. . . . . . . . . . . . 26, 41
Geodon . . . . . . . . . . . . . . . . . . . . . 18, 48
Gilenya. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Gleevec . . . . . . . . . . . . . . . . . . . . . . . . . 11
Glimepiride. . . . . . . . . . . . . . . . . . . . . . . 31
Glipizide. . . . . . . . . . . . . . . . . . . . . . . . . 31
Glipizide/Metformin HCl. . . . . . . . . . . . 31
Glipizide Tablet, Osmotic
Laser-Drilled Formulation . . . . . . . . . 31
Glucagen. . . . . . . . . . . . . . . . . . . . . . . . 32
Glucagon. . . . . . . . . . . . . . . . . . . . . . . . 32
Glucagon, Human Recombinant. . . . . 32
Glucagon Emergency Kit. . . . . . . . . . . 32
Glucagon Kit . . . . . . . . . . . . . . . . . . . . . 32
Glucophage. . . . . . . . . . . . . . . . . . . . . . 31
Glucophage XR. . . . . . . . . . . . . . . . . . . 31
Glucotrol. . . . . . . . . . . . . . . . . . . . . . . . . 31
Glucotrol XL. . . . . . . . . . . . . . . . . . . . . . 31
Glucovance . . . . . . . . . . . . . . . . . . . . . . 31
Glumetza . . . . . . . . . . . . . . . . . . . . . . . . 31
Glyburide. . . . . . . . . . . . . . . . . . . . . . . . 31
Glyburide/Metformin HCl. . . . . . . . . . . 31
Glyburide, Micronized. . . . . . . . . . . . . . 31
Glycate. . . . . . . . . . . . . . . . . . . . . . . . . . 29
Glycolax. . . . . . . . . . . . . . . . . . . . . . . . . 34
56
Glycopyrrolate. . . . . . . . . . . . . . . . . . . . 33
Glynase. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Glyset. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
GoLYTELY . . . . . . . . . . . . . . . . . . . . . . . 34
Gonal-F. . . . . . . . . . . . . . . . . . . . . . . . . 39
Gonal-F RFF . . . . . . . . . . . . . . . . . . . . . 39
Gralise . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Granisetron HCl Tablet. . . . . . . . . . . . . 34
Grastek. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Grifulvin V. . . . . . . . . . . . . . . . . . . . . . . . . 9
Gris-Peg. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Griseofulvin Microsize. . . . . . . . . . . . . . . 9
Griseofulvin Ultramicrosize. . . . . . . . . . . 9
Guaifenesin/Codeine Phosphate. . . . . 43
Guaifenesin/Pseudoephedrine
HCl/Codeine . . . . . . . . . . . . . . . . . . . 43
Guanfacine HCl. . . . . . . . . . . . . . . . . . . 22
Gynazole-1. . . . . . . . . . . . . . . . . . . . . . . 39
H
Habitrol. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Halcion. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Haldol. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Halflytely. . . . . . . . . . . . . . . . . . . . . . . . . 34
Halobetasol Propionate Cream,
Ointment. . . . . . . . . . . . . . . . . . . . . . . 25
Halog Cream, Ointment. . . . . . . . . . . . 25
Haloperidol. . . . . . . . . . . . . . . . . . . . . . . 18
Haloperidol Lactate Concentrate,
Oral. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Hectorol. . . . . . . . . . . . . . . . . . . . . . . . . 30
Helidac. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Helixate FS. . . . . . . . . . . . . . . . . . . . . . . 21
Hemofil-M. . . . . . . . . . . . . . . . . . . . . . . . 21
Heparin. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Heparin Sodium. . . . . . . . . . . . . . . . . . . 20
Hepsera. . . . . . . . . . . . . . . . . . . . . . . . . . 8
Hexalen. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Homatropine HBr . . . . . . . . . . . . . . . . . 40
Horizant . . . . . . . . . . . . . . . . . . . . . . . . . 16
Humalog KwikPen. . . . . . . . . . . . . . . . . 31
Humalog Mix 50-50 Vial. . . . . . . . . . . . 31
Humalog Mix 50/50 KwikPen. . . . . . . . 31
Humalog Mix 75-25 Vial. . . . . . . . . . . . 31
Humalog Mix 75/25 KwikPen. . . . . . . . 31
Humalog Vial . . . . . . . . . . . . . . . . . . . . . 31
Humate-P. . . . . . . . . . . . . . . . . . . . . . . . 21
Humatin . . . . . . . . . . . . . . . . . . . . . . . . . 10
Humatrope. . . . . . . . . . . . . . . . . . . . . . . 35
Humira . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Humulin 70-30 KwikPen. . . . . . . . . . . . 31
Humulin 70-30 Vial. . . . . . . . . . . . . . . . 31
Humulin N KwikPen. . . . . . . . . . . . . . . . 31
Humulin N Vial. . . . . . . . . . . . . . . . . . . . 31
Humulin R Vial. . . . . . . . . . . . . . . . . . . . 31
2015 Prescription Drug List Medication Index
Hycamtin. . . . . . . . . . . . . . . . . . . . . . . . . 11
Hycet. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Hydralazine HCl. . . . . . . . . . . . . . . . . . . 22
Hydrea . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Hydrochlorothiazide. . . . . . . . . 21, 23, 48
Hydrocodone/Acetaminophen. . . . . . . 13
Hydrocodone/Chlorpheniramine
Suspension, Sustained-Release
12 Hour. . . . . . . . . . . . . . . . . . . . . . . . 43
Hydrocodone Bit/Acetaminophen. . . . 13
Hydrocodone Bit/Acetaminophen
Solution, Oral. . . . . . . . . . . . . . . . . . . 13
Hydrocortisone . . 25, 27, 29, 30, 34, 41
Hydrocortisone 2.5% Cream,
Ointment, Lotion. . . . . . . . . . . . . . . . . 25
Hydrocortisone Acetate/
Pramoxine Cream. . . . . . . . . . . . . . . . 27
Hydrocortisone Acetate/
Pramoxine HCl. . . . . . . . . . . . . . . . . . 34
Hydrocortisone Acetate Suppository,
Rectal . . . . . . . . . . . . . . . . . . . . . . . . . 34
Hydrocortisone Butyrate Cream . . . . . 25
Hydrocortisone Butyrate Ointment,
Solution, Non-Oral. . . . . . . . . . . . . . . 25
Hydrocortisone Cream. . . . . . . . . . . . . 34
Hydrocortisone Tablet. . . . . . . . . . . . . . 30
Hydrocortisone Valerate Cream,
Ointment. . . . . . . . . . . . . . . . . . . . . . . 25
HydroDIURIL. . . . . . . . . . . . . . . . . . . . . 21
Hydromorphone Extended-Release
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Hydromorphone HCl. . . . . . . . . . . . . . . 13
Hydroxychloroquine Sulfate. . . . . 10, 36
Hydroxyurea. . . . . . . . . . . . . . . . . . . . . . 11
Hydroxyzine HCl . . . . . . . . . . . . . . . . . . 43
Hydroxyzine Pamoate . . . . . . . . . . . . . . 43
Hyoscyamine Sulfate. . . . . . . . . . . . . . . 33
Hyoscyamine Sulfate Capsule,
Sustained-Release 12 Hour. . . . . . . 33
Hyoscyamine Sulfate Drops. . . . . . . . . 33
Hyoscyamine Sulfate Tablet,
Rapid Dissolve. . . . . . . . . . . . . . . . . . 33
Hyoscyamine Sulfate Tablet,
Sustained-Release 12 Hour. . . . . . . 33
Hytone . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Hytrin. . . . . . . . . . . . . . . . . . . . . . . . 22, 45
Hyzaar. . . . . . . . . . . . . . . . . . . . . . . 23, 48
I
Ibandronate Sodium. . . . . . . . . . . . . . . 37
Ibuprofen . . . . . . . . . . . . . . . . . . . . 13, 36
Ibuprofen/Hydrocodone. . . . . . . . . . . . 13
Ilevro. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Ilotycin. . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Imdur. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Imipramine Pamoate. . . . . . . . . . . . . . . 17
Imiquimod. . . . . . . . . . . . . . . . . . . . . . . . 28
Imitrex. . . . . . . . . . . . . . . . . . . . . . . 14, 48
Imitrex Injection . . . . . . . . . . . . . . . 14, 48
Imitrex Injection & Tablets. . . . . . . . . . . 48
Imitrex Nasal Spray. . . . . . . . . . . . . . . . 14
Imitrex Tablet . . . . . . . . . . . . . . . . . . . . . 14
Imuran. . . . . . . . . . . . . . . . . . . . . . . 11, 36
Increlex. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Inderal. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Inderal LA. . . . . . . . . . . . . . . . . . . . . . . . 21
Inderide. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Indocin . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Indocin SR. . . . . . . . . . . . . . . . . . . . . . . 36
Indomethacin. . . . . . . . . . . . . . . . . . . . . 36
Indomethacin Capsule,
Sustained-Action. . . . . . . . . . . . . . . . 36
Infergen. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Inflamase Forte. . . . . . . . . . . . . . . . . . . . 41
Innopran XL. . . . . . . . . . . . . . . . . . . . . . 21
Inspra . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Intal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Intelence. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Intermezzo . . . . . . . . . . . . . . . . . . . . . . . 17
Intron A. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Intuniv. . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Invega. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Invirase. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Invokamet. . . . . . . . . . . . . . . . . . . . . . . . 31
Invokana. . . . . . . . . . . . . . . . . . . . . . . . . 31
Iopidine 0.5%. . . . . . . . . . . . . . . . . . . . . 41
Iopidine 1% . . . . . . . . . . . . . . . . . . . . . . 41
Ipratropium Bromide Solution,
Non-Oral. . . . . . . . . . . . . . . . . . . . . . . 44
Irbesartan. . . . . . . . . . . . . . . . . . . . . . . . 23
Irbesartan/Hydrochlorothiazide. . . . . . 23
Isentress. . . . . . . . . . . . . . . . . . . . . . . . . . 9
ISMO . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Isometheptene Mucate/
Acetaminophen/Dichloralphenazone.14
Isoniazid. . . . . . . . . . . . . . . . . . . . . . . . . 10
Isopto Atropine . . . . . . . . . . . . . . . . . . . 40
Isopto Carpine
0.5%, 1%, 2%, 4%, 6% . . . . . . . . . . 40
Isopto Homatropine. . . . . . . . . . . . . . . . 40
Isordil 2.5, 5 mg. . . . . . . . . . . . . . . . . . . 20
Isordil 40 mg . . . . . . . . . . . . . . . . . . . . . 20
Isordil 5, 10, 20, 30 mg . . . . . . . . . . . . 20
Isosorbide Dinitrate Tablet . . . . . . . . . . 20
Isosorbide Dinitrate Tablet,
Sublingual. . . . . . . . . . . . . . . . . . . . . . 20
Isosorbide Mononitrate. . . . . . . . . . . . . 20
Isosorbide Mononitrate Tablet,
Sustained-Release 24 Hour. . . . . . . 20
57
Istalol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Itraconazole Capsule. . . . . . . . . . . . . . . . 9
J
Jakafi. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Jalyn . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Janumet . . . . . . . . . . . . . . . . . . . . . . . . . 31
Janumet XR . . . . . . . . . . . . . . . . . . . . . . 31
Januvia . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Jentadueto. . . . . . . . . . . . . . . . . . . . . . . 31
Juxtapid. . . . . . . . . . . . . . . . . . . . . . . . . . 24
K
K-Dur. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
K-Phos M.F. . . . . . . . . . . . . . . . . . . . . . . 45
K-Phos Original. . . . . . . . . . . . . . . . . . . 45
K-Tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
K-Tab, Slow-K . . . . . . . . . . . . . . . . . . . . 46
Kadian. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Kaletra. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Kapvay . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Kayexalate . . . . . . . . . . . . . . . . . . . . . . . 47
Kazano . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Keflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Kenalog. . . . . . . . . . . . . . . . . . . . . . 25, 29
Kenalog in Orabase. . . . . . . . . . . . . . . . 29
Keppra . . . . . . . . . . . . . . . . . . . . . . 15, 16
Keppra XR. . . . . . . . . . . . . . . . . . . 15, 16
Keralyt Scalp . . . . . . . . . . . . . . . . . . . . . 27
Kerlone. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Ketek. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ketoconazole. . . . . . . . . . . . . . . . . . . 9, 27
Ketoconazole Cream, Shampoo . . . . . 27
Ketoconazole Foam. . . . . . . . . . . . . . . . 27
Ketoprofen. . . . . . . . . . . . . . . . . . . . . . . 36
Ketoprofen Capsule, 24 Hour
Sustained-Release. . . . . . . . . . . . . . . 36
Ketorolac Tromethamine. . . . . . . . 36, 40
Khedezla. . . . . . . . . . . . . . . . . . . . . . . . . 17
Kineret . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Klaron. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Klonopin. . . . . . . . . . . . . . . . . . . . . . . . . 15
Klor-Con 25mEq. . . . . . . . . . . . . . . . . . 46
Koate-DVI. . . . . . . . . . . . . . . . . . . . . . . . 21
Kogenate FS . . . . . . . . . . . . . . . . . . . . . 21
Kombiglyze XR. . . . . . . . . . . . . . . . . . . . 31
Kristalose. . . . . . . . . . . . . . . . . . . . . . . . 34
Kuvan . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Kynamro. . . . . . . . . . . . . . . . . . . . . . . . . 24
Kytril . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
L
Labetalol HCl. . . . . . . . . . . . . . . . . . . . . 21
Lacrisert. . . . . . . . . . . . . . . . . . . . . . . . . 42
Lactulose . . . . . . . . . . . . . . . . . . . . . . . . 34
Lamictal . . . . . . . . . . . . . . . . . . . . . 15, 16
Lamictal Chewable. . . . . . . . . . . . . . . . 15
2015 Prescription Drug List Medication Index
Lamictal Dose Pack. . . . . . . . . . . . . . . . 16
Lamictal ODT. . . . . . . . . . . . . . . . . . . . . 16
Lamictal XR. . . . . . . . . . . . . . . . . . . . . . 16
Lamisil. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Lamisil Granules . . . . . . . . . . . . . . . . . . . 9
Lamivudine. . . . . . . . . . . . . . . . . . . . . . 8, 9
Lamivudine Tablet . . . . . . . . . . . . . . . . . . 9
Lamotrigine 5, 25 mg
Chewable Tablet. . . . . . . . . . . . . . . . . 15
Lamotrigine Orally Disintegrating
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Lamotrigine Tablet. . . . . . . . . . . . . 15, 16
Lamotrigine Tablet,
Extended-Release 24 Hour. . . . . . . . 16
Lanoxin. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Lansoprazole/Amoxicillin/
Clarithromycin. . . . . . . . . . . . . . . . . . . 33
Lansoprazole Capsule,
Delayed-Release . . . . . . . . . . . . . . . . 33
Lantus Solostar Pen/Cartridge. . . . . . 31
Lantus Vial . . . . . . . . . . . . . . . . . . . . . . . 31
Lariam. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Lastacaft. . . . . . . . . . . . . . . . . . . . . 42, 48
Latanoprost . . . . . . . . . . . . . . . . . . . . . . 40
Latuda. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Lazanda . . . . . . . . . . . . . . . . . . . . . . . . . 13
Leflunomide. . . . . . . . . . . . . . . . . . . . . . 36
Lescol. . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Lescol XL. . . . . . . . . . . . . . . . . . . . . . . . 24
Letairis . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Letrozole. . . . . . . . . . . . . . . . . . . . . 11, 48
Leucovorin Calcium. . . . . . . . . . . . . . . . 12
Leucovorin Calcium 10, 15 mg. . . . . . 12
Leucovorin Calcium 5, 25 mg . . . . . . . 12
Leukeran. . . . . . . . . . . . . . . . . . . . . . . . . 11
Leukine. . . . . . . . . . . . . . . . . . . . . . 12, 35
Leuprolide Acetate . . . . . . . . . . . . 11, 39
Levalbuterol HCl. . . . . . . . . . . . . . . . . . 44
Levaquin Tablet, Solution . . . . . . . . . . . . 8
Levatol . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Levbid. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Levemir Flexpen. . . . . . . . . . . . . . . . . . . 31
Levemir Vial . . . . . . . . . . . . . . . . . . . . . . 31
Levetiracetam. . . . . . . . . . . . . . . . . . . . . 15
Levetiracetam Tablet,
Extended-Release 24 Hour. . . . . . . . 15
Levitra. . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Levo-Dromoran. . . . . . . . . . . . . . . . . . . 13
Levobunolol HCl. . . . . . . . . . . . . . . . . . 40
Levocarnitine. . . . . . . . . . . . . . . . . . . . . 47
Levocetirizine Dihydrochloride
Solution, Oral. . . . . . . . . . . . . . . . . . . 43
Levocetirizine Dihydrochloride
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Levofloxacin. . . . . . . . . . . . . . . . . . . . 8, 41
Levonorgestrel-Eth Estr/
Ethinyl Estradiol. . . . . . . . . . . . . . . . . 38
Levonorgestrel-Ethinyl Estradiol. . . . . . 38
Levonorgestrel-Ethinyl Estradiol
Tablet, Dosepak, 3 month. . . . . . . . . 38
Levorphanol Tartrate. . . . . . . . . . . . . . . 13
Levothroid. . . . . . . . . . . . . . . . . . . . . . . . 30
Levothyroxine. . . . . . . . . . . . . . . . . . . . . 30
Levothyroxine Sodium. . . . . . . . . . . . . . 30
Levoxyl . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Levsin. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Levsin/SL. . . . . . . . . . . . . . . . . . . . . . . . 33
Levsinex . . . . . . . . . . . . . . . . . . . . . . . . . 33
Lexapro. . . . . . . . . . . . . . . . . . . . . . 18, 48
Lexiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Lialda. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Librium . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lidex. . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Lidocaine/Prilocaine Cream. . . . . . . . . 26
Lidocaine Adhesive Patch . . . . . . . . . . 26
Lidocaine HCL Gel, Solution. . . . . . . . 26
Lidocaine HCL Ointment. . . . . . . . . . . 26
Lidocaine Transdermal Patch. . . . . . . . 48
Lidoderm . . . . . . . . . . . . . . . . . . . . 26, 48
Lindane. . . . . . . . . . . . . . . . . . . . . . . . . . 27
Lindane Lotion, Shampoo. . . . . . . . . . . 27
Linzess. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Lioresal. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Liothyronine Sodium. . . . . . . . . . . . . . . 30
Lipitor. . . . . . . . . . . . . . . . . . . . . . . 24, 48
Lipofen. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Liptruzet. . . . . . . . . . . . . . . . . . . . . . . . . 24
Lisinopril. . . . . . . . . . . . . . . . . . . . . 22, 23
Lisinopril/Hydrochlorothiazide . . . . . . . 23
Lithium Carbonate. . . . . . . . . . . . . . . . . 19
Lithium Carbonate,
Sustained-Action. . . . . . . . . . . . . . . . 19
Lithium Carbonate Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 19
Lithobid. . . . . . . . . . . . . . . . . . . . . . . . . . 19
Livalo. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Lo/Ovral. . . . . . . . . . . . . . . . . . . . . . . . . 38
Lo Loestrin Fe . . . . . . . . . . . . . . . . . . . . 38
Lo Minastrin Fe . . . . . . . . . . . . . . . . . . . 38
Locoid. . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Locoid Lipocream. . . . . . . . . . . . . . . . . 25
Locoid Lotion. . . . . . . . . . . . . . . . . . . . . 25
Lodine. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Lodine XL. . . . . . . . . . . . . . . . . . . . . . . . 36
Loestrin. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Loestrin 24 FE. . . . . . . . . . . . . . . . . . . . 38
58
Loestrin Fe. . . . . . . . . . . . . . . . . . . . . . . 38
Lofibra. . . . . . . . . . . . . . . . . . . . . . . 24, 48
Lofibra 54, 160 mg. . . . . . . . . . . . . . . . 48
LoMedia 24 FE . . . . . . . . . . . . . . . . . . . 38
Lomotil . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Lopid. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Lopressor. . . . . . . . . . . . . . . . . . . . 21, 23
Lopressor HCT . . . . . . . . . . . . . . . . . . . 23
Loprox 0.77% . . . . . . . . . . . . . . . . . . . . 27
Loprox 1% . . . . . . . . . . . . . . . . . . . . . . . 27
Loprox Shampoo. . . . . . . . . . . . . . . . . . 27
Loratadine Tablet, Syrup. . . . . . . . . . . . 43
Lorazepam. . . . . . . . . . . . . . . . . . . 19, 48
Lorzone. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Losartan. . . . . . . . . . . . . . . . . . . . . 23, 48
Losartan/Hydrochlorothiazide . . . . . . . 48
Losartan Potassium. . . . . . . . . . . . . . . . 23
Losartan Potassium/
Hydrochlorothiazide. . . . . . . . . . . . . . 23
LoSeasonique. . . . . . . . . . . . . . . . . . . . 38
Lotemax Gel. . . . . . . . . . . . . . . . . . . . . . 41
Lotemax Ointment, Suspension. . . . . . 41
Lotensin . . . . . . . . . . . . . . . . . . . . . 22, 23
Lotensin HCT. . . . . . . . . . . . . . . . . . . . . 23
Lotrel. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Lotrisone. . . . . . . . . . . . . . . . . . . . . . . . . 27
Lotronex. . . . . . . . . . . . . . . . . . . . . . . . . 34
Lovastatin. . . . . . . . . . . . . . . . . . . . . . . . 24
Lovaza. . . . . . . . . . . . . . . . . . . . . . . 24, 48
Lovenox. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Ludiomil . . . . . . . . . . . . . . . . . . . . . . . . . 17
Lufyllin Tablet. . . . . . . . . . . . . . . . . . . . . 44
Lumigan . . . . . . . . . . . . . . . . . . . . . . . . . 40
Lunesta. . . . . . . . . . . . . . . . . . . . . . 17, 48
Lupron 1 mg/0.2 ml. . . . . . . . . . . . 11, 39
Luride. . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Luvox. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Luvox CR. . . . . . . . . . . . . . . . . . . . . . . . 18
Luxiq. . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Luzu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Lybrel. . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Lyrica. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Lysodren. . . . . . . . . . . . . . . . . . . . . . . . . 11
Lysteda. . . . . . . . . . . . . . . . . . . . . . . . . . 39
M
Macrobid . . . . . . . . . . . . . . . . . . . . . . . . . 8
Macrodantin 25 mg. . . . . . . . . . . . . . . . . 8
Macrodantin 50, 100 mg . . . . . . . . . . . . 8
Malarone. . . . . . . . . . . . . . . . . . . . . . . . . 10
Malathion . . . . . . . . . . . . . . . . . . . . 27, 48
Maprotiline HCl. . . . . . . . . . . . . . . . . . . 17
Marinol . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Marplan. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Matulane. . . . . . . . . . . . . . . . . . . . . . . . . 11
2015 Prescription Drug List Medication Index
Mavik. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Maxalt. . . . . . . . . . . . . . . . . . . . . . . 14, 48
Maxalt-MLT. . . . . . . . . . . . . . . . . . . . . . . 48
Maxalt MLT. . . . . . . . . . . . . . . . . . . 14, 48
Maxidex. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Maxitrol. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Maxivate. . . . . . . . . . . . . . . . . . . . . . . . . 25
Maxzide. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Meclofenamate Sodium . . . . . . . . . . . . 36
Meclomen. . . . . . . . . . . . . . . . . . . . . . . . 36
Medrol 2, 8, 24 mg. . . . . . . . . . . . . . . . 30
Medrol 4, 16, 32 mg. . . . . . . . . . . . . . . 30
Medroxyprogesterone Acet . . . . . . . . . 38
Mefenamic Acid. . . . . . . . . . . . . . . . . . . 36
Mefloquine HCl. . . . . . . . . . . . . . . . . . . 10
Megace. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Megace ES . . . . . . . . . . . . . . . . . . . . . . 11
Megestrol Acetate. . . . . . . . . . . . . . . . . 11
Megestrol Acetate Suspension. . . . . . 11
Mekinist . . . . . . . . . . . . . . . . . . . . . . . . . 11
Mellaril. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Meloxicam. . . . . . . . . . . . . . . . . . . . . . . . 36
Menest. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Menopur. . . . . . . . . . . . . . . . . . . . . . . . . 39
Menostar Patch, Transdermal
Weekly. . . . . . . . . . . . . . . . . . . . . . . . . 39
Mentax . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Meperidine HCl. . . . . . . . . . . . . . . . . . . 13
Mephyton. . . . . . . . . . . . . . . . . . . . . . . . 21
Mepron. . . . . . . . . . . . . . . . . . . . . . 10, 48
Mercaptopurine. . . . . . . . . . . . . . . . . . . 11
Mesalamine Enema. . . . . . . . . . . . . . . . 34
Mestinon. . . . . . . . . . . . . . . . . . . . . . . . . 16
Mestinon 60 mg. . . . . . . . . . . . . . . . . . . 16
Metadate CD. . . . . . . . . . . . . . . . . . . . . 19
Metadate ER. . . . . . . . . . . . . . . . . . . . . 19
Metaglip. . . . . . . . . . . . . . . . . . . . . . . . . 31
Metaproterenol Sulfate Solution,
Non-Oral. . . . . . . . . . . . . . . . . . . . . . . 44
Metaxalone. . . . . . . . . . . . . . . . . . . 37, 49
Metformin HCl. . . . . . . . . . . . . . . . . . . . 31
Metformin HCl Sustained-Release. . . 31
Metformin HCl Tablet,
Extended-Release 24 Hour. . . . . . . . 31
Methadone HCl. . . . . . . . . . . . . . . . . . . 13
Methamphetamine HCl. . . . . . . . . . . . . 19
Methazolamide. . . . . . . . . . . . . . . . . . . . 40
Methenamine Mandelate. . . . . . . . . . . . . 8
Methergine. . . . . . . . . . . . . . . . . . . . . . . 38
Methimazole. . . . . . . . . . . . . . . . . . . . . . 30
Methocarbamol. . . . . . . . . . . . . . . . . . . 37
Methotrexate . . . . . . . . . . . . . . . . . 11, 36
Methotrexate Sodium . . . . . . . . . . 11, 36
Methylergonovine Maleate. . . . . . . . . . 38
Methylin Solution, Oral. . . . . . . . . . . . . 19
Methylin Tablet, Chewable. . . . . . . . . . 19
Methylphenidate HCl . . . . . . . . . . . . . . 19
Methylphenidate HCl Capsule,
Extended-Release Multiphase . . . . . 19
Methylphenidate HCl Capsule,
Extended-Release Multiphase
30-70 . . . . . . . . . . . . . . . . . . . . . . . . . 19
Methylphenidate HCl Tablet,
Extended-Release 24 Hour. . . . . . . . 19
Methylphenidate HCl Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 19
Methylprednisolone Tablet,
Dose Pack. . . . . . . . . . . . . . . . . . . . . . 30
Meticorten . . . . . . . . . . . . . . . . . . . . . . . 30
Metipranolol. . . . . . . . . . . . . . . . . . . . . . 40
Metoclopramide HCl. . . . . . . . . . . . . . . 34
Metoclopramide Orally
Disintegrating Tablet . . . . . . . . . . . . . 34
Metolazone. . . . . . . . . . . . . . . . . . . . . . . 21
Metoprolol/Hydrochlorothiazide. . . . . . 23
Metoprolol Succinate Tablet,
Sustained-Release 24 Hour. . . . . . . 21
Metoprolol Tartrate. . . . . . . . . . . . . . . . 21
Metozolv ODT . . . . . . . . . . . . . . . . . . . . 34
Metrocream. . . . . . . . . . . . . . . . . . . . . . 26
Metrogel 0.75%. . . . . . . . . . . . . . . . . . . 26
Metrogel 1% . . . . . . . . . . . . . . . . . . . . . 26
Metrogel Vaginal . . . . . . . . . . . . . . . . . . 39
Metrolotion. . . . . . . . . . . . . . . . . . . . . . . 26
Metronidazole. . . . . . . . . . . . . . 10, 26, 39
Metronidazole Cream. . . . . . . . . . . . . . 26
Metronidazole Gel. . . . . . . . . . . . . . . . . 26
Metronidazole Gel 1% . . . . . . . . . . . . . 26
Metronidazole Vaginal Gel . . . . . . . . . . 39
Mevacor. . . . . . . . . . . . . . . . . . . . . . . . . 24
Mexiletine HCl. . . . . . . . . . . . . . . . . . . . 20
Mexitil. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Miacalcin . . . . . . . . . . . . . . . . . . . . 30, 37
Micardis . . . . . . . . . . . . . . . . . . . . . 23, 48
Micardis HCT. . . . . . . . . . . . . . . . . 23, 48
Micro-K. . . . . . . . . . . . . . . . . . . . . . . . . . 46
Microzide . . . . . . . . . . . . . . . . . . . . . . . . 21
Midamor. . . . . . . . . . . . . . . . . . . . . . . . . 21
Midodrine HCl. . . . . . . . . . . . . . . . . . . . 47
Midrin. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Migranal. . . . . . . . . . . . . . . . . . . . . . . . . 14
Minipress . . . . . . . . . . . . . . . . . . . . . . . . 22
Minivelle. . . . . . . . . . . . . . . . . . . . . . . . . 39
Minocin. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Minocycline HCl Capsule. . . . . . . . . . . . 7
Minocycline HCl Tablet. . . . . . . . . . . . . . 7
Minocycline HCl Tablet,
Extended-Release 24 Hour. . . . . . . . . 7
59
Mirapex. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Mirapex ER. . . . . . . . . . . . . . . . . . . . . . . 15
Mircette. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Mirtazapine. . . . . . . . . . . . . . . . . . . . . . . 17
Mirtazapine Dispersible Tablet. . . . . . . 17
Mirvaso. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Misoprostol. . . . . . . . . . . . . . . . . . . 33, 36
Mobic. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Modafinil. . . . . . . . . . . . . . . . . . . . . . . . . 19
Modicon. . . . . . . . . . . . . . . . . . . . . . . . . 38
Moduretic. . . . . . . . . . . . . . . . . . . . . . . . 21
Moexipril HCl. . . . . . . . . . . . . . . . . . . . . 22
Mometasone Furoate 0.1% Cream. . . 48
Mometasone Furoate Cream,
Ointment, Solution. . . . . . . . . . . . . . . 25
Monoclate-P. . . . . . . . . . . . . . . . . . . . . . 21
Monodox. . . . . . . . . . . . . . . . . . . . . . . 7, 48
Mononine. . . . . . . . . . . . . . . . . . . . . . . . 21
Montelukast. . . . . . . . . . . . . . . . . . 44, 49
Montelukast Chewable Tablet . . . . . . . 49
Montelukast Sodium. . . . . . . . . . . . . . . 44
Monurol. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Morgidox. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Morphine Sulfate Capsule,
Extended-Release. . . . . . . . . . . . . . . 13
Morphine Sulfate Capsule,
Extended-Release Pellets. . . . . . . . . 13
Morphine Sulfate Extended-Release
Capsule. . . . . . . . . . . . . . . . . . . . . . . . 48
Morphine Sulfate Extended-Release
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 48
Morphine Sulfate Solution, Oral. . . . . . 13
Morphine Sulfate Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 13
Motofen . . . . . . . . . . . . . . . . . . . . . . . . . 33
Motrin. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Moviprep. . . . . . . . . . . . . . . . . . . . . . . . . 34
Moxeza. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Moxifloxacin . . . . . . . . . . . . . . . . 8, 41, 48
Moxifloxacin Tablet. . . . . . . . . . . . . . . . . . 8
Moxifloxacin Tablets. . . . . . . . . . . . . . . . 48
Mozobil. . . . . . . . . . . . . . . . . . . . . . . . . . 35
MS Contin. . . . . . . . . . . . . . . . . . . 13, 48
MSIR 20 mg/ml, Roxanol. . . . . . . . . . . 13
Mucomyst. . . . . . . . . . . . . . . . . . . . . . . . 44
Multaq. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Mupirocin Calcium Cream. . . . . . . . . . 26
Mupirocin Ointment. . . . . . . . . . . . . . . . 26
Muse. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Myambutol. . . . . . . . . . . . . . . . . . . . . . . 10
Mycelex. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Mycolog II. . . . . . . . . . . . . . . . . . . . . . . . 27
Mycophenolate Mofetil Capsule,
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 11
2015 Prescription Drug List Medication Index
Mycophenolic Acid. . . . . . . . . . . . . . . . 11
Mycostatin. . . . . . . . . . . . . . . . . . . . . 9, 27
Mydriacyl . . . . . . . . . . . . . . . . . . . . . . . . 40
Myfortic. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Myleran. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Myorisan. . . . . . . . . . . . . . . . . . . . . . . . . 26
Myrbetriq . . . . . . . . . . . . . . . . . . . . . . . . 45
Mysoline. . . . . . . . . . . . . . . . . . . . . . . . . 15
Mytelase. . . . . . . . . . . . . . . . . . . . . . . . . 16
N
Nabumetone. . . . . . . . . . . . . . . . . . . . . . 36
Nadolol. . . . . . . . . . . . . . . . . . . . . . 21, 23
Nadolol/Bendroflumethiazide. . . . . . . . 23
Naftin. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Naltrexone HCl . . . . . . . . . . . . . . . . . . . 14
Namenda XR. . . . . . . . . . . . . . . . . . . . . 16
Naphazoline HCl. . . . . . . . . . . . . . . . . . 40
Naprelan. . . . . . . . . . . . . . . . . . . . . . . . . 36
Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . 36
Naproxen . . . . . . . . . . . . . . . . . . . . . . . . 36
Naproxen Sodium . . . . . . . . . . . . . . . . . 36
Naratriptan HCl. . . . . . . . . . . . . . . . . . . 14
Nardil. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Nasacort AQ . . . . . . . . . . . . . . . . . . . . . 44
Nascobal . . . . . . . . . . . . . . . . . . . . . . . . 46
Nasonex. . . . . . . . . . . . . . . . . . . . . . . . . 44
Natacyn . . . . . . . . . . . . . . . . . . . . . . . . . 41
Natazia. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Nateglinide. . . . . . . . . . . . . . . . . . . . . . . 31
Natroba. . . . . . . . . . . . . . . . . . . . . . 27, 48
Navane. . . . . . . . . . . . . . . . . . . . . . . . . . 18
NebuPent. . . . . . . . . . . . . . . . . . . . . . . . 10
Nefazodone HCl. . . . . . . . . . . . . . . . . . 17
Neo-Synephrine. . . . . . . . . . . . . . . . . . . 40
Neomycin/Polymyxin B Sulfate/
Dexamethasone. . . . . . . . . . . . . . . . . 41
Neomycin Sulfate. . . . . . . . . . . . 9, 29, 41
Neomycin Sulfate/Bacitracin/
Polymyxin B Ointment. . . . . . . . . . . . 41
Neomycin Sulfate/Bacitracin Zinc/
Polymyxin B/Hydrocortisone
Ointment. . . . . . . . . . . . . . . . . . . . . . . 41
Neomycin Sulfate/Gramicidin D/
Polymyxin B Drops. . . . . . . . . . . . . . . 41
Neomycin Sulfate/Polymyxin B
Sulfate/Hydrocortisone. . . . . . . 29, 41
Neomycin Sulfate/Polymyxin B
Sulfate/Hydrocortisone Suspension,
Drops. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Neoral. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Neosporin. . . . . . . . . . . . . . . . . . . . . . . . 41
Neptazane . . . . . . . . . . . . . . . . . . . . . . . 40
Nesina. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Neulasta. . . . . . . . . . . . . . . . . . . . . . . . . 35
Neumega . . . . . . . . . . . . . . . . . . . . . . . . 35
Neupogen. . . . . . . . . . . . . . . . . . . . 12, 35
Neurontin. . . . . . . . . . . . . . . . . . . . 15, 16
Nevanac. . . . . . . . . . . . . . . . . . . . . . . . . 40
Nevirapine . . . . . . . . . . . . . . . . . . . . . 9, 49
Nevirapine Extended-Release . . . . . 9, 49
Nexavar. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Nexiclon XR. . . . . . . . . . . . . . . . . . . . . . 22
Nexium Capsule. . . . . . . . . . . . . . . . . . . 33
Nexium Suspension. . . . . . . . . . . . . . . . 33
Niacin Extended-Release. . . . . . . . . . . 24
Niaspan. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Nicardipine HCl. . . . . . . . . . . . . . . . . . . 22
Nicotine Patch, Transdermal
24 Hour. . . . . . . . . . . . . . . . . . . . . . . . 47
Nicotrol Inhaler. . . . . . . . . . . . . . . . . . . . 47
Nicotrol NS . . . . . . . . . . . . . . . . . . . . . . 47
Nifedipine. . . . . . . . . . . . . . . . . . . . . . . . 22
Nifedipine Tablet, Osmotic
Laser-Drilled Formulation . . . . . . . . . 22
Nilandron . . . . . . . . . . . . . . . . . . . . . . . . 11
Nimodipine. . . . . . . . . . . . . . . . . . . . . . . 16
Nimotop. . . . . . . . . . . . . . . . . . . . . . . . . 16
Niravam. . . . . . . . . . . . . . . . . . . . . . . . . . 19
Nisoldipine. . . . . . . . . . . . . . . . . . . . . . . 22
Nitro-Bid. . . . . . . . . . . . . . . . . . . . . . . . . 20
Nitro-Dur. . . . . . . . . . . . . . . . . . . . . . . . . 20
Nitrofurantoin/Nitrofurantoin
Macrocrystal. . . . . . . . . . . . . . . . . . . . . 8
Nitrofurantoin Macrocrystal . . . . . . . . . . 8
Nitrofurantoin Suspension, Oral. . . . . . . 8
Nitroglycerin. . . . . . . . . . . . . . . . . . 20, 45
Nitroglycerin Capsule,
Sustained-Action. . . . . . . . . . . . . . . . 20
Nitroglycerin Patch, Transdermal
24 Hour. . . . . . . . . . . . . . . . . . . . . . . . 20
Nitroglycerin Spray. . . . . . . . . . . . . . . . 20
Nitroglycerin Spray, Non-Aerosol. . . . 20
Nitrolingual. . . . . . . . . . . . . . . . . . . . . . . 20
Nitromist. . . . . . . . . . . . . . . . . . . . . . . . . 20
Nitrostat. . . . . . . . . . . . . . . . . . . . . . . . . 20
Nizatidine Solution, Oral. . . . . . . . . . . . 33
Nizoral. . . . . . . . . . . . . . . . . . . . . . . . . 9, 27
Nizoral 2%. . . . . . . . . . . . . . . . . . . . . . . 27
Nolvadex. . . . . . . . . . . . . . . . . . . . . . . . . 11
Nor-Q-D. . . . . . . . . . . . . . . . . . . . . . . . . 38
Norco. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Nordette. . . . . . . . . . . . . . . . . . . . . . . . . 38
Norditropin. . . . . . . . . . . . . . . . . . . . . . . 35
Norelgestromin/Ethinyl Estradiol
Patch. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Norelgestromin/Ethinyl Estradiol
Topical Patch . . . . . . . . . . . . . . . . . . . 48
Norethindrone . . . . . . . . . . . . . . . . 38, 39
60
Norethindrone-Ethinyl Estradiol. . . . . . 38
Norethindrone-Ethinyl Estradiol /
Iron Tablet, Chewable . . . . . . . . . . . . 38
Norethindrone-Mestranol. . . . . . . . . . . 38
Norethindrone A-E Estradiol. . . . . . . . . 38
Norethindrone A-E Estradiol/
Ferrous Fumarate. . . . . . . . . . . . . . . . 38
Norethindrone Acetate. . . . . . . . . 38, 39
Norethindrone Acetate/Ethinyl
Estradiol . . . . . . . . . . . . . . . . . . . . . . . 39
Norflex. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Norgesic, Norgesic Forte. . . . . . . . . . . 37
Norgestimate-Ethinyl Estradiol. . . . . . . 38
Norgestrel-Ethinyl Estradiol. . . . . . . . . 38
Noritate. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Normodyne. . . . . . . . . . . . . . . . . . . . . . . 21
Noroxin. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Norpace. . . . . . . . . . . . . . . . . . . . . . . . . 20
Norpace CR. . . . . . . . . . . . . . . . . . . . . . 20
Norpramin. . . . . . . . . . . . . . . . . . . . . . . . 17
Nortriptyline HCl. . . . . . . . . . . . . . . . . . 17
Norvasc . . . . . . . . . . . . . . . . . . . . . . . . . 22
Norvir . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Novolin Vial. . . . . . . . . . . . . . . . . . . . . . . 31
NovoLog 70-30 Flexpen. . . . . . . . . . . . 31
NovoLog 70-30 Vial . . . . . . . . . . . . . . . 31
NovoLog Flexpen. . . . . . . . . . . . . . . . . . 31
NovoLog Vial . . . . . . . . . . . . . . . . . . . . . 31
Novoseven. . . . . . . . . . . . . . . . . . . . . . . 21
Noxafil Suspension. . . . . . . . . . . . . . . . . 9
Nucynta . . . . . . . . . . . . . . . . . . . . . . . . . 14
Nucynta ER . . . . . . . . . . . . . . . . . . . . . . 14
Nuedexta . . . . . . . . . . . . . . . . . . . . . . . . 16
Nulev. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Nulytely w/Flavor Packs . . . . . . . . . . . . 34
Nutropin. . . . . . . . . . . . . . . . . . . . . . . . . 35
Nutropin AQ. . . . . . . . . . . . . . . . . . . . . . 35
Nutropin AQ NuSpin. . . . . . . . . . . . . . . 35
Nuvaring. . . . . . . . . . . . . . . . . . . . . . . . . 38
Nuvigil. . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Nystatin. . . . . . . . . . . . . . . . . . . . . . . . 9, 27
Nystatin/Triamcinolone Acetonide. . . . 27
O
Octreotide Acetate. . . . . . . . . . . . 11, 30
Ocufen. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Ocuflox. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Ocupress. . . . . . . . . . . . . . . . . . . . . . . . 40
Ofloxacin. . . . . . . . . . . . . . . . . . . 8, 29, 41
Ogen. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Olanzapine. . . . . . . . . . . . . . . . . . . 18, 49
Olanzapine/Fluoxetine. . . . . . . . . . . . . . 18
Olanzapine Orally Disintegrating
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 49
Olanzapine Tablet . . . . . . . . . . . . . . . . . 18
2015 Prescription Drug List Medication Index
Olanzapine Tablet, Rapid Dissolve. . . . 18
Oleptro ER. . . . . . . . . . . . . . . . . . . . . . . 17
Olpatadine. . . . . . . . . . . . . . . . . . . . . . . 43
Olux. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Olux-E. . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Olysio. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Omeclamox Pak. . . . . . . . . . . . . . . . . . . 33
Omega-3-Acid Ethyl Esters. . . . . 24, 48
Omeprazole. . . . . . . . . . . . . . . . . . 33, 48
Omeprazole/Sodium Bicarbonate
Capsule. . . . . . . . . . . . . . . . . . . . . . . . 33
Omnaris . . . . . . . . . . . . . . . . . . . . . . . . . 44
Omnicef. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Omnitrope . . . . . . . . . . . . . . . . . . . . . . . 35
Ondansetron HCl . . . . . . . . . . . . . . . . . 34
Ondansetron HCl Tablet,
Rapid Dissolve. . . . . . . . . . . . . . . . . . 34
One Touch Ultra 2 System. . . . . . . . . . 32
One Touch Ultra Blue Test Strips. . . . . 32
One Touch Ultra Mini System. . . . . . . . 32
One Touch Verio IQ System. . . . . . . . . 32
One Touch Verio IQ Test Strips. . . . . . 32
One Touch Verio Sync. . . . . . . . . . . . . . 32
Onfi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Onglyza. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Onmel. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Opana. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Opana ER. . . . . . . . . . . . . . . . . . . . . . . . 13
Optase. . . . . . . . . . . . . . . . . . . . . . . . . . 27
OptiPranolol. . . . . . . . . . . . . . . . . . . . . . 40
Optivar. . . . . . . . . . . . . . . . . . . . . . 42, 48
Oracea. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Oracit. . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Oralair. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Orapred . . . . . . . . . . . . . . . . . . . . . . . . . 30
Orapred ODT. . . . . . . . . . . . . . . . . . . . . 30
Orencia. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Orphenadrine. . . . . . . . . . . . . . . . . . . . . 37
Orphenadrine/Aspirin/Caffeine . . . . . . 37
Ortho-Cyclen. . . . . . . . . . . . . . . . . . . . . 38
Ortho-Novum 1-0.035 mg. . . . . . . . . . 38
Ortho-Novum 1-0.05 mg. . . . . . . . . . . 38
Ortho-Novum 10-11. . . . . . . . . . . . . . . 38
Ortho-Novum 2-0.1 mg . . . . . . . . . . . . 38
Ortho-Novum 7/7/7 . . . . . . . . . . . . . . . 38
Ortho Evra . . . . . . . . . . . . . . . . . . . 38, 48
Ortho Micronor . . . . . . . . . . . . . . . . . . . 38
Ortho Tri-Cyclen . . . . . . . . . . . . . . . . . . 38
Ortho Tri-Cyclen Lo. . . . . . . . . . . . . . . . 38
Orudis. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Oruvail 200 mg. . . . . . . . . . . . . . . . . . . 36
Oseni . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Osmoprep . . . . . . . . . . . . . . . . . . . . . . . 34
Otezla. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Ovcon. . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Ovcon 35. . . . . . . . . . . . . . . . . . . . . . . . 38
Ovide . . . . . . . . . . . . . . . . . . . . . . . 27, 48
Ovidrel . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Ovral. . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Oxandrin. . . . . . . . . . . . . . . . . . . . . 11, 30
Oxandrolone. . . . . . . . . . . . . . . . . . 11, 30
Oxaprozin. . . . . . . . . . . . . . . . . . . . . . . . 36
Oxazepam . . . . . . . . . . . . . . . . . . . . . . . 19
Oxcarbazepine. . . . . . . . . . . . . . . . . . . . 15
Oxistat Cream. . . . . . . . . . . . . . . . . . . . 27
Oxistat Lotion. . . . . . . . . . . . . . . . . . . . . 27
Oxsoralen-Ultra. . . . . . . . . . . . . . . . . . . 28
Oxtellar XR. . . . . . . . . . . . . . . . . . . . . . . 16
Oxybutynin Chloride. . . . . . . . . . . . . . . 45
Oxybutynin Chloride Tablet,
Sustained-Release. . . . . . . . . . . . . . . 45
Oxycodone/Aspirin . . . . . . . . . . . . . . . . 13
Oxycodone HCl. . . . . . . . . . . . . . . . . . . 13
Oxycodone HCl/Acetaminophen
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Oxycodone HCl/Ibuprofen. . . . . . . . . . 13
Oxycodone HCl Concentrate, Oral. . . 13
OxyContin . . . . . . . . . . . . . . . . . . . . . . . 13
OxyFAST. . . . . . . . . . . . . . . . . . . . . . . . . 13
OxyIR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Oxymorphone HCl Tablet,
Sustained-Release 12 Hour. . . . . . . 13
Oxymorphone Tablet. . . . . . . . . . . . . . . 13
Oxytrol. . . . . . . . . . . . . . . . . . . . . . . . . . 45
P
Pamelor. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Pancreaze. . . . . . . . . . . . . . . . . . . . . . . . 34
Pandel Cream . . . . . . . . . . . . . . . . . . . . 25
Panretin Gel. . . . . . . . . . . . . . . . . . . . . . 28
Pantoprazole . . . . . . . . . . . . . . . . . 33, 48
Parafon Forte DSC. . . . . . . . . . . . . . . . 37
Parcopa . . . . . . . . . . . . . . . . . . . . . . . . . 15
Paremyd. . . . . . . . . . . . . . . . . . . . . . . . . 40
Paricalcitol. . . . . . . . . . . . . . . . . . . . . . . 30
Parlodel. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Parnate. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Paromomycin Sulfate . . . . . . . . . . . . . . 10
Paroxetine HCl Sustained-Release,
24 Hour. . . . . . . . . . . . . . . . . . . . . . . . 18
Paroxetine HCl Tablet. . . . . . . . . . . . . . 18
Pataday. . . . . . . . . . . . . . . . . . . . . . . . . . 42
Patanase. . . . . . . . . . . . . . . . . . . . . . . . . 43
Patanol. . . . . . . . . . . . . . . . . . . . . . . . . . 42
Paxil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Paxil CR. . . . . . . . . . . . . . . . . . . . . . . . . 18
PCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pediapred. . . . . . . . . . . . . . . . . . . . . . . . 30
Pediazole . . . . . . . . . . . . . . . . . . . . . . . . . 7
61
Peg-Intron. . . . . . . . . . . . . . . . . . . . . . . . 35
Peganone. . . . . . . . . . . . . . . . . . . . . . . . 15
Pegasys . . . . . . . . . . . . . . . . . . . . . . . . . 35
Pen-V K . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Penicillin V Potassium. . . . . . . . . . . . . . . 7
Penlac. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Pennsaid 1.5% . . . . . . . . . . . . . . . . . . . 36
Pentasa. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Pentazocine HCl/Naloxone HCl . . . . . 14
Pepcid. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Percocet. . . . . . . . . . . . . . . . . . . . . 13, 48
Percodan . . . . . . . . . . . . . . . . . . . . . . . . 13
Perforomist. . . . . . . . . . . . . . . . . . . . . . . 44
Periactin. . . . . . . . . . . . . . . . . . . . . . . . . 43
Peridex. . . . . . . . . . . . . . . . . . . . . . . . . . 29
Perindopril . . . . . . . . . . . . . . . . . . . . . . . 22
Periostat. . . . . . . . . . . . . . . . . . . . . . . . . . 7
Permethrin . . . . . . . . . . . . . . . . . . . 27, 48
Perphenazine. . . . . . . . . . . . . . . . . . . . . 18
Persantine . . . . . . . . . . . . . . . . . . . . . . . 20
Pertzye . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Pexeva. . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Phenazopyridine HCl. . . . . . . . . . . . . . 45
Phenelzine Sulfate. . . . . . . . . . . . . . . . . 17
Phenergan . . . . . . . . . . . . . . . . . . . 34, 43
Phenergan VC. . . . . . . . . . . . . . . . . . . . 43
Phenergan VC w/Codeine. . . . . . . . . . 43
Phenergan w/Codeine . . . . . . . . . . . . . 43
Phenobarbital. . . . . . . . . . . . . . . . . 15, 33
Phenylephrine HCl . . . . . . . . . . . . 40, 43
Phenylephrine HCl/Codeine/
Promethazine . . . . . . . . . . . . . . . . . . . 43
Phenylephrine HCl/Promethazine
HCl . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Phenytek. . . . . . . . . . . . . . . . . . . . . . . . . 15
Phenytoin. . . . . . . . . . . . . . . . . . . . . . . . 15
Phenytoin Sodium
Extended-Release. . . . . . . . . . . . . . . 15
PhosLo. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Phytonadione. . . . . . . . . . . . . . . . . . . . . 21
Picato. . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Pilocarpine HCl. . . . . . . . . . . . 29, 40, 47
Pilopine HS . . . . . . . . . . . . . . . . . . . . . . 40
Pindolol. . . . . . . . . . . . . . . . . . . . . . . . . . 21
Pioglitazone. . . . . . . . . . . . . . . . . . 31, 48
Pioglitazone HCl. . . . . . . . . . . . . . . . . . 31
Pioglitazone HCl/Glimepiride. . . . . . . . 31
Pioglitazone HCl/Metformin HCl. . . . . 31
Piroxicam . . . . . . . . . . . . . . . . . . . . . . . . 36
Plan B. . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Plaquenil. . . . . . . . . . . . . . . . . . . . . 10, 36
Plavix. . . . . . . . . . . . . . . . . . . . . . . . 20, 48
Plendil. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Pletal. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2015 Prescription Drug List Medication Index
Podofilox Liquid. . . . . . . . . . . . . . . . . . . 28
Poly-Vi-Flor. . . . . . . . . . . . . . . . . . . . . . . 46
Poly-Vi-Flor w/Iron. . . . . . . . . . . . . . . . . 46
Polyethylene Glycol 3350 Powder . . . 34
Polymyxin B Sulfate/Trimethoprim. . . . 41
Polysporin. . . . . . . . . . . . . . . . . . . . . . . . 41
Polytrim. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pomalyst. . . . . . . . . . . . . . . . . . . . . . . . . 12
Ponstel. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Potassium Chloride. . . . . . . . . . . . 34, 46
Potassium Chloride Capsule,
Sustained-Action. . . . . . . . . . . . . . . . 46
Potassium Chloride Packet . . . . . . . . . 46
Potassium Chloride Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 46
Potiga. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Pradaxa. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Pramipexole Di-HCl. . . . . . . . . . . . . . . . 15
Pramosone 2.5%-1%. . . . . . . . . . . . . . 27
Prandin. . . . . . . . . . . . . . . . . . . . . . . . . . 31
Pravachol. . . . . . . . . . . . . . . . . . . . . . . . 24
Pravastatin. . . . . . . . . . . . . . . . . . . . . . . 24
Prazosin HCl . . . . . . . . . . . . . . . . . . . . . 22
Precision Xtra Test Strips. . . . . . . . . . . 32
Precose . . . . . . . . . . . . . . . . . . . . . . . . . 31
Pred-G. . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pred Forte. . . . . . . . . . . . . . . . . . . . . . . . 41
Pred Mild . . . . . . . . . . . . . . . . . . . . . . . . 41
Prednicarbate Cream. . . . . . . . . . . . . . 25
Prednisolone Acetate. . . . . . . . . . . . . . 41
Prednisolone Sodium
Phosphate. . . . . . . . . . . . . . . . . . 30, 41
Prednisolone Sodium Phosphate
Solution, Oral. . . . . . . . . . . . . . . . . . . 30
Prednisolone Syrup. . . . . . . . . . . . . . . . 30
Prednisone. . . . . . . . . . . . . . . . . . . . . . . 30
Prefest . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Prelone. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Premarin. . . . . . . . . . . . . . . . . . . . . . . . . 39
Premphase. . . . . . . . . . . . . . . . . . . . . . . 39
Prempro. . . . . . . . . . . . . . . . . . . . . . . . . 39
Prenatal . . . . . . . . . . . . . . . . . . . . . . . . . 46
Prenatal Vit/Fe Fumarate/FA . . . . . . . . 46
Prepopik. . . . . . . . . . . . . . . . . . . . . . . . . 34
Prevacid. . . . . . . . . . . . . . . . . . . . . . . . . 33
Prevacid Solutab. . . . . . . . . . . . . . . . . . 33
Prevident 1.1% . . . . . . . . . . . . . . . . . . . 29
Prevpac. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Prezista. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Priftin. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Prilosec. . . . . . . . . . . . . . . . . . . . . . 33, 48
Prilosec Suspension. . . . . . . . . . . . . . . 33
Primaquine. . . . . . . . . . . . . . . . . . . . . . . 10
Primidone. . . . . . . . . . . . . . . . . . . . . . . . 15
Primsol. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Prinivil. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Prinzide. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Pristiq. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Proair HFA. . . . . . . . . . . . . . . . . . . . . . . 44
ProAmatine. . . . . . . . . . . . . . . . . . . . . . . 47
Probenecid. . . . . . . . . . . . . . . . . . . . . . . 36
Procardia . . . . . . . . . . . . . . . . . . . . . . . . 22
Procardia XL . . . . . . . . . . . . . . . . . . . . . 22
Prochlorperazine Maleate Tablet . . . . . 34
Procrit. . . . . . . . . . . . . . . . . . . . . . . . . . . 35
ProctoCream-HC 2.5%. . . . . . . . . . . . 34
Procysbi. . . . . . . . . . . . . . . . . . . . . . . . . 45
Profilnine SD . . . . . . . . . . . . . . . . . . . . . 21
Progesterone, Micronized. . . . . . . . . . . 38
Prograf. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Prolensa. . . . . . . . . . . . . . . . . . . . . . . . . 40
Prolixin . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Proloprim . . . . . . . . . . . . . . . . . . . . . . . . . 8
Promacta . . . . . . . . . . . . . . . . . . . . . . . . 21
Promethazine HCl. . . . . . . . . . . . . 34, 43
Prometrium. . . . . . . . . . . . . . . . . . . . . . . 38
Propafenone Capsule,
Sustained-Release 12 Hour. . . . . . . 20
Propafenone HCl. . . . . . . . . . . . . . . . . . 20
Propranolol HCl/
Hydrochlorothiazide. . . . . . . . . . . . . . 23
Propranolol HCl Sustained-Action
Capsule. . . . . . . . . . . . . . . . . . . . . . . . 21
Propranolol HCl Tablet. . . . . . . . . . . . . 21
Propylthiouracil . . . . . . . . . . . . . . . . . . . 30
Proscar. . . . . . . . . . . . . . . . . . . . . . . . . . 45
Prostigmin . . . . . . . . . . . . . . . . . . . . . . . 16
Protonix. . . . . . . . . . . . . . . . . . . . . . 33, 48
Protonix Suspension. . . . . . . . . . . . . . . 33
Protopic . . . . . . . . . . . . . . . . . . . . . . . . . 28
Protriptyline HCl . . . . . . . . . . . . . . . . . . 17
Proventil. . . . . . . . . . . . . . . . . . . . . . . . . 44
Proventil HFA. . . . . . . . . . . . . . . . . . . . . 44
Provera. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Provigil . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Prozac. . . . . . . . . . . . . . . . . . . . . . . 18, 49
Prozac Weekly. . . . . . . . . . . . . . . . . . . . 18
Pseudoephedrine Sulfate/
Loratadine. . . . . . . . . . . . . . . . . . . . . . 43
Psorcon . . . . . . . . . . . . . . . . . . . . . . . . . 25
Pulmicort Flexhaler . . . . . . . . . . . . . . . . 44
Pulmicort Respules
0.25 mg/2 ml, 0.5 mg/2 ml. . . . . . . . 44
Pulmicort Respules 1 mg/2 ml. . . . . . . 44
Pulmozyme. . . . . . . . . . . . . . . . . . . . . . . 44
Purinethol. . . . . . . . . . . . . . . . . . . . . . . . 11
Pylera. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Pyrazinamide . . . . . . . . . . . . . . . . . . . . . 10
62
Pyridium. . . . . . . . . . . . . . . . . . . . . . . . . 45
Pyridostigmine Bromide Tablet. . . . . . . 16
Q
Qnasl . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Qualaquin. . . . . . . . . . . . . . . . . . . . . . . . 10
Quartette . . . . . . . . . . . . . . . . . . . . . . . . 38
Questran. . . . . . . . . . . . . . . . . . . . . . . . . 24
Questran Light. . . . . . . . . . . . . . . . . . . . 24
Quetiapine. . . . . . . . . . . . . . . . . . . 18, 49
Quetiapine Fumarate. . . . . . . . . . . . . . . 18
Quillivant XR . . . . . . . . . . . . . . . . . . . . . 19
Quinapril HCl/Hydrochlorothiazide. . . 23
Quinidex. . . . . . . . . . . . . . . . . . . . . . . . . 20
Quinidine Gluconate. . . . . . . . . . . . . . . 20
Quinidine Sulfate. . . . . . . . . . . . . . . . . . 20
Quinidine Sulfate Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 20
Quinine Sulfate . . . . . . . . . . . . . . . . . . . 10
Quixin. . . . . . . . . . . . . . . . . . . . . . . . . . . 41
QVAR. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
R
Rabeprazole. . . . . . . . . . . . . . . . . . 33, 48
Ragwitek. . . . . . . . . . . . . . . . . . . . . . . . . 43
Raloxifene. . . . . . . . . . . . . . . . . . . . 37, 48
Ramipril. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Ranexa. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Ranitidine HCl Syrup. . . . . . . . . . . . . . 33
Rapaflo. . . . . . . . . . . . . . . . . . . . . . . . . . 45
Rapamune . . . . . . . . . . . . . . . . . . . . . . . 11
Ravicti. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Rayos. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Razadyne. . . . . . . . . . . . . . . . . . . . . . . . 16
Razadyne ER. . . . . . . . . . . . . . . . . . . . . 16
Rebetol Capsules. . . . . . . . . . . . . . . . . . 8
Rebetol Solution . . . . . . . . . . . . . . . . . . . 8
Rebif. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Recombinate. . . . . . . . . . . . . . . . . . . . . 21
Rectiv. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Reglan. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Regranex . . . . . . . . . . . . . . . . . . . . . . . . 28
Relafen. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Relenza. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Relistor. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Relpax. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Remeron. . . . . . . . . . . . . . . . . . . . . . . . . 17
Remeron SolTab . . . . . . . . . . . . . . . . . . 17
Renacidin. . . . . . . . . . . . . . . . . . . . . . . . 45
Renagel . . . . . . . . . . . . . . . . . . . . . . . . . 47
Renvela. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Repaglinide . . . . . . . . . . . . . . . . . . . . . . 31
Repronex . . . . . . . . . . . . . . . . . . . . . . . . 39
Requip . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Requip XL. . . . . . . . . . . . . . . . . . . . . . . . 15
Rescriptor. . . . . . . . . . . . . . . . . . . . . . . . . 9
2015 Prescription Drug List Medication Index
Rescula. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Restasis. . . . . . . . . . . . . . . . . . . . . . . . . 42
Restoril. . . . . . . . . . . . . . . . . . . . . . . . . . 17
Retin-A. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Retin-A Micro. . . . . . . . . . . . . . . . . . . . . 26
Retrovir. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Revatio. . . . . . . . . . . . . . . . . . . . . . 44, 49
ReVia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Revlimid . . . . . . . . . . . . . . . . . . . . . . . . . 11
Reyataz. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Rheumatrex . . . . . . . . . . . . . . . . . . . . . . 11
Rhinocort Aqua. . . . . . . . . . . . . . . . . . . 44
Ribapak. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Ribavirin. . . . . . . . . . . . . . . . . . . . . . . . . . 8
Rifadin. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Rifamate. . . . . . . . . . . . . . . . . . . . . . . . . 10
Rifampin. . . . . . . . . . . . . . . . . . . . . . . . . 10
Rifampin/Isoniazid. . . . . . . . . . . . . . . . . 10
Rifater. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Rilutek. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Riluzole. . . . . . . . . . . . . . . . . . . . . . . . . . 47
Rimantadine HCl Tablet . . . . . . . . . . . . . 8
Riomet Solution, Oral. . . . . . . . . . . . . . 31
Risedronate 150 mg. . . . . . . . . . . . . . . 37
Risperdal . . . . . . . . . . . . . . . . . . . . 18, 49
Risperdal M-Tab. . . . . . . . . . . . . . . . . . 18
Risperidone . . . . . . . . . . . . . . . . . . 18, 49
Risperidone Solution. . . . . . . . . . . . . . . 18
Risperidone Tablet. . . . . . . . . . . . . . . . . 18
Risperidone Tablet, Rapid Dissolve. . . 18
Ritalin, Ritalin SR. . . . . . . . . . . . . . . . . . 19
Ritalin LA . . . . . . . . . . . . . . . . . . . . . . . . 19
Rivastigmine Tartrate Capsule. . . . . . . 16
Rizatriptan . . . . . . . . . . . . . . . . . . . 14, 48
Rizatriptan Benzoate Tablet . . . . . . . . . 14
Rizatriptan Benzoate Tablet,
Disintegrating. . . . . . . . . . . . . . . . . . . 14
Rizatriptan Orally Disintegrating
Tablet. . . . . . . . . . . . . . . . . . . . . . . . . . 48
Robaxin. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Robinul. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Robinul Forte. . . . . . . . . . . . . . . . . . . . . 33
Robitussin-DAC. . . . . . . . . . . . . . . . . . . 43
Robitussin A-C . . . . . . . . . . . . . . . . . . . 43
Rocaltrol. . . . . . . . . . . . . . . . . . . . . . . . . 30
Ropinirole HCl. . . . . . . . . . . . . . . . . . . . 15
Ropinirole HCl Tablet,
Extended-Release 24 Hour. . . . . . . . 15
Rowasa. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Roxicodone . . . . . . . . . . . . . . . . . . . . . . 13
Rozerem. . . . . . . . . . . . . . . . . . . . . . . . . 17
Rythmol. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Rythmol SR . . . . . . . . . . . . . . . . . . . . . . 20
Ryzolt . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
S
Sabril. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Safyral. . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Saizen. . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Salagen . . . . . . . . . . . . . . . . . . . . . 29, 47
Salagen 5 mg. . . . . . . . . . . . . . . . . . . . . 29
Salflex. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Salsalate. . . . . . . . . . . . . . . . . . . . . . . . . 36
Samsca. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Sanctura. . . . . . . . . . . . . . . . . . . . . . . . . 45
Sanctura XR. . . . . . . . . . . . . . . . . . . . . . 45
Sancuso. . . . . . . . . . . . . . . . . . . . . . . . . 34
Sandimmune . . . . . . . . . . . . . . . . . . . . . 11
Sandostatin. . . . . . . . . . . . . . . . . . . . . . 11
Santyl. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Saphris. . . . . . . . . . . . . . . . . . . . . . . . . . 18
Sarafem . . . . . . . . . . . . . . . . . . . . . . . . . 18
Savella . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Seasonale. . . . . . . . . . . . . . . . . . . . . . . . 38
Seasonique . . . . . . . . . . . . . . . . . . . . . . 38
Sectral . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Selegiline HCl. . . . . . . . . . . . . . . . . . . . 15
Selzentry. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sensipar. . . . . . . . . . . . . . . . . . . . . . . . . 30
Septra. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Septra DS . . . . . . . . . . . . . . . . . . . . . . . . 8
Serax. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Serevent Diskus. . . . . . . . . . . . . . . . . . . 44
Serophene. . . . . . . . . . . . . . . . . . . . . . . 39
Seroquel. . . . . . . . . . . . . . . . . . . . . 18, 49
Seroquel XR. . . . . . . . . . . . . . . . . . . . . . 18
Serostim. . . . . . . . . . . . . . . . . . . . . . . . . 35
Sertraline . . . . . . . . . . . . . . . . . . . . 18, 49
Sertraline HCl . . . . . . . . . . . . . . . . . . . . 18
Serzone . . . . . . . . . . . . . . . . . . . . . . . . . 17
Sevelamer. . . . . . . . . . . . . . . . . . . . . . . . 47
Sildenafil. . . . . . . . . . . . . . . . . . . . . 44, 49
Sildenafil Citrate . . . . . . . . . . . . . . . . . . 44
Silenor. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Silvadene. . . . . . . . . . . . . . . . . . . . . . . . 27
Silver Sulfadiazine. . . . . . . . . . . . . . . . . 27
Simbrinza. . . . . . . . . . . . . . . . . . . . . . . . 40
Simcor . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Simponi. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Simvastatin. . . . . . . . . . . . . . . . . . . . . . . 24
Sinemet . . . . . . . . . . . . . . . . . . . . . . . . . 15
Sinemet CR. . . . . . . . . . . . . . . . . . . . . . 15
Sinequan . . . . . . . . . . . . . . . . . . . . . . . . 17
Singulair. . . . . . . . . . . . . . . . . . . . . 44, 49
Singulair Chewable Tablet. . . . . . . . . . 49
Singulair Tablet . . . . . . . . . . . . . . . . . . . 49
Sirolimus. . . . . . . . . . . . . . . . . . . . . . . . . 11
Situro . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Skelaxin. . . . . . . . . . . . . . . . . . . . . . 37, 49
63
Skelaxin 800 mg. . . . . . . . . . . . . . . . . . 37
Sklice . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Sod Chloride/NaHCO3/
KCl/PEGs. . . . . . . . . . . . . . . . . . . . . . 34
Sodium Fluoride. . . . . . . . . . . . . . . 29, 46
Sodium Fluoride Gel. . . . . . . . . . . . . . . 29
Sodium Polystyrene Sulfonate. . . . . . . 47
Sodium Sulfate/Sodium/Sodium
Bicarbonate/Potassium Chloride/
Polyethylene Glycols. . . . . . . . . . . . . 34
Sodium Sulfate/Sodium/Sodium
Bicarbonate/Potassium Chloride/
Polyethylene Glycols Solution,
Reconstituted, Oral. . . . . . . . . . . . . . 34
Solaraze. . . . . . . . . . . . . . . . . . . . . . . . . 28
Solodyn. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Solodyn 45, 90, 135 mg. . . . . . . . . . . . . 7
Soma 250 mg. . . . . . . . . . . . . . . . . . . . 37
Soma 350 mg. . . . . . . . . . . . . . . . . . . . 37
Somatuline Depot. . . . . . . . . . . . . . . . . 12
Sonata . . . . . . . . . . . . . . . . . . . . . . 17, 48
Soriatane . . . . . . . . . . . . . . . . . . . . . . . . 27
Sorilux. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Sotalol HCl. . . . . . . . . . . . . . . . . . . . . . . 20
Sotret. . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Spasdel . . . . . . . . . . . . . . . . . . . . . . . . . 33
Spectazole 1% . . . . . . . . . . . . . . . . . . . 27
Spectracef. . . . . . . . . . . . . . . . . . . . . . . . 7
Spinosad . . . . . . . . . . . . . . . . . . . . 27, 48
Spiriva. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Spironolactone. . . . . . . . . . . . . . . . . . . . 21
Spironolactone/Hydrochlorothiazide. . 21
Sporanox Capsule. . . . . . . . . . . . . . . . . . 9
Sporanox Solution, Oral. . . . . . . . . . . . . 9
Sprix. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Sprycel. . . . . . . . . . . . . . . . . . . . . . . . . . 12
Stadol. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Stalevo. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Starlix . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Stavudine. . . . . . . . . . . . . . . . . . . . . . . . . 9
Stavzor. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Staxyn 45
Stelara . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Stelazine. . . . . . . . . . . . . . . . . . . . . . . . . 18
Stivarga. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Strattera. . . . . . . . . . . . . . . . . . . . . . . . . 19
Striant. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Stribild . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Stromectol. . . . . . . . . . . . . . . . . . . . . . . 10
Suboxone. . . . . . . . . . . . . . . . . . . . . . . . 14
Suboxone Film. . . . . . . . . . . . . . . . . . . . 14
Subsys. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Subutex. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Suclear. . . . . . . . . . . . . . . . . . . . . . . . . . 34
2015 Prescription Drug List Medication Index
Sucraid. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Sucralfate Tablet. . . . . . . . . . . . . . . . . . 33
Sular. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Sulfacetamide Sodium. . . . . . . . . 26, 41
Sulfacetamide Sodium/Prednisolone
Sodium Phosphate. . . . . . . . . . . . . . . 41
Sulfacetamide Sodium Suspension,
Topical. . . . . . . . . . . . . . . . . . . . . . . . . 26
Sulfadiazine . . . . . . . . . . . . . . . . . . . . 8, 27
Sulfamethoxazole/Trimethoprim. . . . . . . 8
Sulfasalazine Tablet. . . . . . . . . . . . 34, 36
Sulfasalazine Tablet,
Enteric-Coated. . . . . . . . . . . . . . 34, 36
Sulindac. . . . . . . . . . . . . . . . . . . . . . . . . 36
Sumatriptan Injection, Tablet . . . . . . . . 48
Sumatriptan Succinate Injection . . . . . 14
Sumatriptan Succinate Nasal Spray. . 14
Sumatriptan Succinate Tablet . . . . . . . 14
Sumavel Dosepro . . . . . . . . . . . . . . . . . 14
Suprax Tablet, Capsule, Suspension. . . 7
Suprep. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Sustiva . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sutent. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Sylatron. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Symax Duotab. . . . . . . . . . . . . . . . . . . . 33
Symbicort. . . . . . . . . . . . . . . . . . . . . . . . 44
Symbyax. . . . . . . . . . . . . . . . . . . . . . . . . 18
SymlinPen. . . . . . . . . . . . . . . . . . . . . . . . 31
Symmetrel . . . . . . . . . . . . . . . . . . . . . 8, 15
Synalar. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Synalgos-DC. . . . . . . . . . . . . . . . . . . . . 13
Synarel. . . . . . . . . . . . . . . . . . . . . . 30, 39
Synthroid . . . . . . . . . . . . . . . . . . . . . . . . 30
Syprine. . . . . . . . . . . . . . . . . . . . . . . . . . 30
T
Taclonex. . . . . . . . . . . . . . . . . . . . . 27, 49
Taclonex Ointment. . . . . . . . . . . . . . . . . 49
Taclonex Suspension. . . . . . . . . . . . . . . 27
Tacrolimus Anhydrous. . . . . . . . . . . . . . 11
Tafinlar. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . 33
Talwin NX. . . . . . . . . . . . . . . . . . . . . . . . 14
Tambocor. . . . . . . . . . . . . . . . . . . . . . . . 20
Tamiflu. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Tamoxifen. . . . . . . . . . . . . . . . . . . . . . . . 11
Tamsulosin. . . . . . . . . . . . . . . . . . . 45, 48
Tamsulosin HCl. . . . . . . . . . . . . . . . . . . 45
Tanzeum. . . . . . . . . . . . . . . . . . . . . . . . . 31
Tapazole. . . . . . . . . . . . . . . . . . . . . . . . . 30
Tarceva. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Tarka. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tasigna. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Tasmar . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Tazorac. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Tecfidera. . . . . . . . . . . . . . . . . . . . . . . . . 16
Tegretol. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Tegretol XR. . . . . . . . . . . . . . . . . . . . . . 15
Tekamlo. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tekturna . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tekturna HCT. . . . . . . . . . . . . . . . . . . . . 23
Telmisartan. . . . . . . . . . . . . . . . . . . 23, 48
Telmisartan/Hydrochlorothiazide. 23, 48
Temazepam . . . . . . . . . . . . . . . . . . . . . . 17
Temodar. . . . . . . . . . . . . . . . . . . . . . . . . 11
Temovate . . . . . . . . . . . . . . . . . . . . . . . . 25
Temovate E. . . . . . . . . . . . . . . . . . . . . . . 25
Temozolamide . . . . . . . . . . . . . . . . . . . . 11
Tenex. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Tenormin. . . . . . . . . . . . . . . . . . . . . . . . . 21
Terazol. . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Terazosin HCl. . . . . . . . . . . . . . . . . 22, 45
Terbinafine HCl Tablet. . . . . . . . . . . . . . . 9
Terbutaline Sulfate. . . . . . . . . . . . . 39, 44
Terconazole Cream w/Applicator. . . . . 39
Terconazole Suppository, Vaginal. . . . . 39
Testim. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Testosterone Topical Gel . . . . . . . . . . . 30
Tetracycline HCl . . . . . . . . . . . . . . . . . . . 7
Tev-Tropin. . . . . . . . . . . . . . . . . . . . . . . . 35
Teveten. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Teveten HCT . . . . . . . . . . . . . . . . . . . . . 23
Thalomid. . . . . . . . . . . . . . . . . . . . . . . . . 11
Theo-24. . . . . . . . . . . . . . . . . . . . . . . . . 44
Theochron . . . . . . . . . . . . . . . . . . . . . . . 44
Theophylline Anhydrous Tablet,
Extended-Release 12 Hour. . . . . . . . 44
Thioridazine HCl . . . . . . . . . . . . . . . . . . 18
Thiothixene. . . . . . . . . . . . . . . . . . . . . . . 18
Thorazine 200 mg. . . . . . . . . . . . . . . . . 18
Thyrolar. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Tiagabine HCl . . . . . . . . . . . . . . . . . . . . 15
Tiazac. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Ticlid. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Ticlopidine HCl . . . . . . . . . . . . . . . . . . . 20
Tigan 250, 300 mg. . . . . . . . . . . . . . . . 34
Tikosyn. . . . . . . . . . . . . . . . . . . . . . . . . . 20
Timolol Maleate. . . . . . . . . . . . . . . . . . . 40
Timolol Maleate Drops . . . . . . . . . . . . . 40
Timoptic. . . . . . . . . . . . . . . . . . . . . . . . . 40
Timoptic-XE. . . . . . . . . . . . . . . . . . . . . . 40
Tindamax. . . . . . . . . . . . . . . . . . . . . . . . . 10
Tinidazole. . . . . . . . . . . . . . . . . . . . . . . . 10
Tirosint . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Tizanidine HCl Capsule . . . . . . . . . . . . 37
Tizanidine HCl Tablet. . . . . . . . . . . . . . 37
Tobi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Tobi Podhaler. . . . . . . . . . . . . . . . . . . . . . 9
Tobradex. . . . . . . . . . . . . . . . . . . . . . . . . 41
64
Tobradex ST. . . . . . . . . . . . . . . . . . . . . . 41
Tobramycin/Dexamethasone
Suspension. . . . . . . . . . . . . . . . . . . . . 41
Tobramycin Nebulized Solution. . . . . . . 9
Tobramycin Sulfate Drops. . . . . . . . . . . 41
Tobrex. . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Tobrex Ointment. . . . . . . . . . . . . . . . . . 41
Tofranil-PM. . . . . . . . . . . . . . . . . . . . . . . 17
Tolectin. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Tolectin DS. . . . . . . . . . . . . . . . . . . . . . . 36
Tolmetin Sodium . . . . . . . . . . . . . . . . . . 36
Tolterodine Extended-Release. . . . . . . 45
Tolterodine Tartrate. . . . . . . . . . . . . . . . 45
Topamax. . . . . . . . . . . . . . . . . . . . . 15, 16
Topicort. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Topicort Spray. . . . . . . . . . . . . . . . . . . . 25
Topiramate Capsule, Sprinkle. . . . . . . . 15
Topiramate Tablet. . . . . . . . . . . . . . . . . . 15
Toprol XL 25 mg . . . . . . . . . . . . . . . . . . 21
Toprol XL 50, 100, 200 mg . . . . . . . . . 21
Toradol . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Toviaz . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Tracleer. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Tradjenta. . . . . . . . . . . . . . . . . . . . . . . . . 31
Tramadol HCl. . . . . . . . . . . . . . . . . . . . . 14
Tramadol HCl/Acetaminophen. . . . . . . 14
Tramadol HCl Tablet,
Extended-Release Multiphase
24 Hour. . . . . . . . . . . . . . . . . . . . . . . . 14
Tramadol HCl Tablet,
Sustained-Release 24 Hour. . . . . . . 14
Trandolapril. . . . . . . . . . . . . . . . . . . 22, 23
Trandolapril/Verapamil. . . . . . . . . . . . . . 23
Tranexamic Acid. . . . . . . . . . . . . . . . . . . 39
Transderm-Nitro. . . . . . . . . . . . . . . . . . . 20
Transderm-Scop. . . . . . . . . . . . . . . . . . 34
Tranylcypromine Sulfate . . . . . . . . . . . . 17
Travatan . . . . . . . . . . . . . . . . . . . . . . . . . 40
Travatan Z. . . . . . . . . . . . . . . . . . . . . . . . 40
Travoprost. . . . . . . . . . . . . . . . . . . . . . . . 40
Trazodone HCl. . . . . . . . . . . . . . . . . . . . 17
Tretin-X. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Tretinoin . . . . . . . . . . . . . . . . . . . . . 11, 26
Tretinoin Cream. . . . . . . . . . . . . . . . . . . 26
Tretinoin Cream, Gel. . . . . . . . . . . . . . . 26
Tretinoin Microspheres. . . . . . . . . . . . . 26
Trexall. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Treximet. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Tri-Vi-Flor . . . . . . . . . . . . . . . . . . . . . . . . 46
Tri-Vi-Flor w/Iron . . . . . . . . . . . . . . . . . . 46
Triamcinolone Acetonide. . 25, 27, 29, 44
Triamcinolone Acetonide Cream. . . . . 25
Triamcinolone Acetonide Cream,
Ointment, Lotion. . . . . . . . . . . . . . . . . 25
2015 Prescription Drug List Medication Index
Triamcinolone Acetonide Ointment. . . 25
Triamterene/Hydrochlorothiazide. . . . . 21
Trianex. . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Triazolam. . . . . . . . . . . . . . . . . . . . . . . . . 17
Tribenzor. . . . . . . . . . . . . . . . . . . . . . . . . 23
Tricor. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Tridesilon . . . . . . . . . . . . . . . . . . . . . . . . 25
Trifluoperazine HCl . . . . . . . . . . . . . . . . 18
Trifluridine. . . . . . . . . . . . . . . . . . . . . . . . 42
Triglide . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Trihexyphenidyl HCl. . . . . . . . . . . . . . . . 15
Trilafon . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Trileptal. . . . . . . . . . . . . . . . . . . . . . 15, 16
Trilipix . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Trimethobenzamide HCl Capsule . . . . 34
Trimethoprim. . . . . . . . . . . . . . . . . . . 8, 41
TriNorinyl. . . . . . . . . . . . . . . . . . . . . . . . . 38
Triphasil. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Trizivir . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Trokendi XR. . . . . . . . . . . . . . . . . . . . . . 16
Tropicamide. . . . . . . . . . . . . . . . . . . . . . 40
Trospium Chloride. . . . . . . . . . . . . . . . . 45
Trospium Chloride Capsule,
Sustained-Release 24 Hour. . . . . . . 45
Trusopt. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Truvada. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Tudorza Pressair . . . . . . . . . . . . . . . . . . 44
Tussionex . . . . . . . . . . . . . . . . . . . . . . . . 43
Twysta. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tykerb. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Tylenol w/Codeine. . . . . . . . . . . . . . . . . 13
Tyvaso. . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Tyzeka. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Tyzine . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
U
Uceris. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Uloric. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Ultracet. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ultram. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ultram ER. . . . . . . . . . . . . . . . . . . . . . . . 14
Ultravate. . . . . . . . . . . . . . . . . . . . . . . . . 25
Ultresa . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Umecta. . . . . . . . . . . . . . . . . . . . . . . . . . 28
Univasc. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Urea 40% Emulsion . . . . . . . . . . . . . . . 28
Urecholine . . . . . . . . . . . . . . . . . . . . . . . 45
Uroxatral. . . . . . . . . . . . . . . . . . . . . . . . . 45
URSO 250. . . . . . . . . . . . . . . . . . . . . . . 34
URSO Forte. . . . . . . . . . . . . . . . . . . . . . 34
Ursodiol . . . . . . . . . . . . . . . . . . . . . . . . . 34
V
Vagifem. . . . . . . . . . . . . . . . . . . . . . . . . . 39
Valacyclovir. . . . . . . . . . . . . . . . . . . . . 8, 49
Valacyclovir HCl. . . . . . . . . . . . . . . . . . . . 8
Valcyte . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Valisone . . . . . . . . . . . . . . . . . . . . . . . . . 25
Valium. . . . . . . . . . . . . . . . . . . . 19, 37, 49
Valproic Acid . . . . . . . . . . . . . . . . . . . . . 15
Valsartan. . . . . . . . . . . . . . . . . . . . . 23, 48
Valsartan/Hydrochlorothiazide. . . 23, 48
Valtrex. . . . . . . . . . . . . . . . . . . . . . . . . 8, 49
Vancocin HCl. . . . . . . . . . . . . . . . . . . . . . 9
Vancomycin HCl . . . . . . . . . . . . . . . . . . . 9
Vanos . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Vantin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Vascepa. . . . . . . . . . . . . . . . . . . . . 24, 48
Vaseretic. . . . . . . . . . . . . . . . . . . . . . . . . 23
Vasocidin . . . . . . . . . . . . . . . . . . . . . . . . 41
Vasotec. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Vectical. . . . . . . . . . . . . . . . . . . . . . . . . . 27
Veltin. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Venlafaxine Extended-Release
Capsule. . . . . . . . . . . . . . . . . . . . . . . . 48
Venlafaxine HCl Capsule,
Sustained-Release 24 Hour. . . . . . . 17
Venlafaxine HCl ER. . . . . . . . . . . . . . . . 17
Venlafaxine HCl Tablet,
Extended-Release 24 Hour. . . . . . . . 17
Ventavis . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ventolin. . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ventolin HFA . . . . . . . . . . . . . . . . . . . . . 44
VePesid. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Veramyst. . . . . . . . . . . . . . . . . . . . . . . . . 44
Verapamil HCl. . . . . . . . . . . . . . . . . . . . 22
Verapamil HCl Capsule, 24 Hour
Sustained-Release Pellets . . . . . . . . 22
Verapamil HCl Tablet,
Sustained-Action. . . . . . . . . . . . . . . . 22
Verdeso. . . . . . . . . . . . . . . . . . . . . . . . . . 25
Veregen . . . . . . . . . . . . . . . . . . . . . . . . . 28
Verelan. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Verelan PM. . . . . . . . . . . . . . . . . . . . . . . 22
Vesanoid. . . . . . . . . . . . . . . . . . . . . . . . . 11
Vesicare . . . . . . . . . . . . . . . . . . . . . . . . . 45
Vexol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Vfend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Viagra 45
Vibra-Tab . . . . . . . . . . . . . . . . . . . . . . . . 48
Vibra-Tabs . . . . . . . . . . . . . . . . . . . . . . . . 7
Vibramycin . . . . . . . . . . . . . . . . . . . . . 7, 48
Vibramycin Suspension. . . . . . . . . . . . . . 7
Vicodin, Vicodin ES, Vicodin HP. . . . . 13
Vicoprofen . . . . . . . . . . . . . . . . . . . . . . . 13
Victoza . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Videx EC. . . . . . . . . . . . . . . . . . . . . . . . . . 9
Vigamox . . . . . . . . . . . . . . . . . . . . . . . . . 41
Viibryd. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Vimovo . . . . . . . . . . . . . . . . . . . . . . . . . . 36
65
Vimpat. . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Viokace. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Viracept. . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Viramune. . . . . . . . . . . . . . . . . . . . . . . 9, 49
Viramune XR . . . . . . . . . . . . . . . . . . . 9, 49
Viramune XR 400 mg. . . . . . . . . . . . . . 49
Viread. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Viroptic. . . . . . . . . . . . . . . . . . . . . . . . . . 42
Visicol. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Visken. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Vistaril. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Vivactil. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Vivelle-Dot . . . . . . . . . . . . . . . . . . . . . . . 39
Voltaren. . . . . . . . . . . . . . . . . . . . . . 36, 40
Voltaren-XR. . . . . . . . . . . . . . . . . . . . . . 36
Voltaren Gel. . . . . . . . . . . . . . . . . . . . . . 36
Voriconazole. . . . . . . . . . . . . . . . . . . . . . . 9
VoSol . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
VoSol HC. . . . . . . . . . . . . . . . . . . . . . . . 29
Votrient. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Vusion. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Vytorin. . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Vyvanse. . . . . . . . . . . . . . . . . . . . . . . . . . 19
W
Warfarin Sodium. . . . . . . . . . . . . . . . . . 20
Welchol. . . . . . . . . . . . . . . . . . . . . . . . . . 24
Wellbutrin. . . . . . . . . . . . . . . . . . . . 17, 49
Wellbutrin SR. . . . . . . . . . . . . . . . . 17, 49
Wellbutrin XL. . . . . . . . . . . . . . . . . 17, 49
Westcort. . . . . . . . . . . . . . . . . . . . . . . . . 25
X
Xalatan. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Xalkori. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Xanax . . . . . . . . . . . . . . . . . . . . . . . 19, 49
Xanax XR. . . . . . . . . . . . . . . . . . . . 19, 49
Xarelto . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Xeljanz. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Xeloda. . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Xenaderm. . . . . . . . . . . . . . . . . . . . . . . . 27
Xerese. . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Xibrom . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Xifaxan . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Xodol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Xolegel. . . . . . . . . . . . . . . . . . . . . . . . . . 27
Xopenex HFA. . . . . . . . . . . . . . . . . . . . . 44
Xopenex Vial, Nebulizer. . . . . . . . . . . . . 44
Xtandi. . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Xulane. . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Xylocaine . . . . . . . . . . . . . . . . . . . . . . . . 26
Xyntha. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Xyrem . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Xyzal. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Y
Yasmin . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2015 Prescription Drug List Medication Index
Yaz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Z
Zafirlukast. . . . . . . . . . . . . . . . . . . . . . . . 44
Zaleplon. . . . . . . . . . . . . . . . . . . . . 17, 48
Zanaflex . . . . . . . . . . . . . . . . . . . . . . . . . 37
Zantac Syrup. . . . . . . . . . . . . . . . . . . . . 33
Zarontin . . . . . . . . . . . . . . . . . . . . . . . . . 15
Zaroxolyn . . . . . . . . . . . . . . . . . . . . . . . . 21
Zegerid. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Zegerid Capsule. . . . . . . . . . . . . . . . . . 33
Zegerid Packet. . . . . . . . . . . . . . . . . . . . 33
Zelapar. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Zelboraf . . . . . . . . . . . . . . . . . . . . . . . . . 11
Zemplar. . . . . . . . . . . . . . . . . . . . . . . . . . 30
Zenatane . . . . . . . . . . . . . . . . . . . . . . . . 26
Zenpep. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Zenzedi. . . . . . . . . . . . . . . . . . . . . . . . . . 19
Zerit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Zestoretic. . . . . . . . . . . . . . . . . . . . . . . . 23
Zestril. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Zetia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Zetonna . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ziac. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Ziagen. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ziana. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Zidovudine. . . . . . . . . . . . . . . . . . . . . . . . 9
Zidovudine/Lamivudine. . . . . . . . . . . . . . 9
Zioptan. . . . . . . . . . . . . . . . . . . . . . . . . . 40
Ziprasidone . . . . . . . . . . . . . . . . . . 18, 48
Zipsor. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Zirgan. . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Zithromax. . . . . . . . . . . . . . . . . . . . . . . . . 7
Zmax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Zocor . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Zofran. . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Zofran ODT . . . . . . . . . . . . . . . . . . . . . . 34
Zohydro ER. . . . . . . . . . . . . . . . . . . . . . 13
Zolinza. . . . . . . . . . . . . . . . . . . . . . . . . . 11
Zolmitriptan . . . . . . . . . . . . . . . . . . . . . . 14
Zolmitriptan Orally Disintegrating Tablet. 14
Zoloft. . . . . . . . . . . . . . . . . . . . . . . . 18, 49
Zolpidem. . . . . . . . . . . . . . . . . . . . . 17, 48
Zolpidem Tartrate. . . . . . . . . . . . . . . . . . 17
Zolpidem Tartrate Tablet, MultiphasicRelease. . . . . . . . . . . . . . . . . . . . . . . . 17
Zolpimist. . . . . . . . . . . . . . . . . . . . . . . . . 17
Zomig. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Zomig-ZMT . . . . . . . . . . . . . . . . . . . . . . 14
Zomig Nasal Spray. . . . . . . . . . . . . . . . 14
Zonalon. . . . . . . . . . . . . . . . . . . . . . . . . . 28
Zonegran . . . . . . . . . . . . . . . . . . . . 15, 16
66
Zonisamide. . . . . . . . . . . . . . . . . . . . . . . 15
Zorbtive. . . . . . . . . . . . . . . . . . . . . . . . . . 35
Zorvolex . . . . . . . . . . . . . . . . . . . . . . . . . 36
Zovirax. . . . . . . . . . . . . . . . . . . . . 8, 27, 49
Zovirax Cream. . . . . . . . . . . . . . . . . . . . 27
Zovirax Ointment. . . . . . . . . . . . . . . . . . 49
Zubsolv. . . . . . . . . . . . . . . . . . . . . . . . . . 14
Zutripro. . . . . . . . . . . . . . . . . . . . . . 43, 49
Zyban . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Zyclara . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Zyflo . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Zyflo CR. . . . . . . . . . . . . . . . . . . . . . . . . 44
Zykadia. . . . . . . . . . . . . . . . . . . . . . . . . . 12
Zylet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Zyloprim . . . . . . . . . . . . . . . . . . . . . . . . . 36
Zyprexa. . . . . . . . . . . . . . . . . . . . . . 18, 49
Zyprexa Zydis. . . . . . . . . . . . . . . . . 18, 49
Zytiga . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Zyvox. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
UnitedHealthcare Physician PDL Booklet 1/15 Created November, 2014
© 2014 UnitedHealthCare Services, Inc. All rights reserved.