florida’s blue cross and blue shield plan 2018 · bluemedicare complete rx (pdp) s5904-002...

2018FormularioCompletoBlueMedicareSM

BlueMedicare Complete Rx (PDP) S5904-002BlueMedicare Group PPO (Employer PPO)BlueMedicare Group Rx (Employer PDP)

Este formulario fue actualizado el 01/01/2018. Si tiene preguntas o desea información más actualizada, comuníquese con Florida Blue a 1-800-926-6565 o, los usuarios de equipo teleescritor (TTY), llamen 1-877-955-8773. Nuestro horario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, desde el 1 de octubre hasta el 14 de febrero, excepto el día de Acción de Gracias y el día de Navidad. Desde el 15 de febrero hasta el 30 de septiembre, el horario es de 8:00 a.m. a 8:00 p.m. hora local, excepto los días feriados. O visite www.BlueMedicareFL.com. Florida Blue es un Licenciatario Independiente de Blue Cross and Blue Shield Association.

Florida’s Blue Cross and Blue Shield Plan

BlueMedicare es mucho más que salud

i

BlueMedicare Complete Rx (PDP) BlueMedicare PPO para Grupos (PPO ofrecido por el empleador) BlueMedicare Rx para Grupos (PDP ofrecido por el empleador)

Formulario 2018 (Lista de medicinas cubiertas)

POR FAVOR LEA: ESTE DOCUMENTO CONTIENE INFORMACION SOBRE LAS MEDICINAS QUE ESTAN CUBIERTAS EN ESTE PLAN

Formulary ID 00018434, Version 5

Este formulario fue actualizado el 01/01/2018. Para obtener información más reciente o si tiene otras preguntas, comuníquese con Servicio al cliente de BlueMedicare Complete Rx al 1-800-926-6565 o, para los usuarios de TTY, 1-877-955-8773. Nuestro horario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, desde el 1 de octubre hasta el 14 de febrero, excepto el día de Acción de Gracias y el día de Navidad. Desde el 15 de febrero hasta el 30 de septiembre, el horario es de 8:00 a.m. a 8:00 p.m. hora local, excepto los días feriados. O visite www.BlueMedicareFL.com.

Florida Blue es un plan Rx (PDP) que tiene un contrato con Medicare. La inscripción en Florida Blue depende de la renovación del contrato.

If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-800-926-6565 (TTY: 1-800-955-8770).

Si habla español, hay servicios de traducción, libre de cargos, disponibles para usted. Llame al 1-800-926-6565 (TTY: 1-877-955-8773). Este formulario puede cambiar en cualquier momento. Recibirá un aviso en caso de ser necesario.

Este documento es una traducción de su original escrito en inglés. Los términos en inglésprevalecerán en caso de alguna disputa con respecto al significado de este documento o sus términos.

ii

Nota para los asegurados actuales: Este formulario ha cambiado desde el año pasado. Revise este documento para asegurarse que aún contiene las medicinas que toma. Cuando esta lista de medicinas (formulario) dice “nosotros”, "nos" o “nuestro”, se refiere a Florida Blue. Cuando se hace referencia a "plan" o "nuestro plan", se refiere a BlueMedicare Complete Rx y BlueMedicare Rx para Grupos. Este documento contiene una lista de las medicinas (formulario) para nuestro plan, la cual está actualizada al 1 de enero de 2018. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, así como las fechas de actualización del formulario, aparece en las portadas delantera y trasera. Usted por lo general debe utilizar farmacias en la red para poder utilizar sus beneficios de medicinas recetadas. Los beneficios, la lista de medicinas cubiertas, la red de farmacias y/o copagos/coaseguro pueden cambiar el 1 de enero de 2019, y periódicamente durante el año. ¿Qué es el Formulario de BlueMedicare Complete Rx and BlueMedicare Rx para Grupos? El formulario es una lista de las medicinas cubiertas seleccionadas por nuestro plan en conjunto con un equipo de proveedores de salud, los cuales representan las medicinas recetadas que se consideran como una parte necesaria de cualquier programa de tratamiento de calidad. Nuestro plan generalmente cubrirá las medicinas mencionadas en nuestro formulario siempre y cuando la medicina sea médicamente necesaria, sea surtida en una farmacia de la red BlueMedicare Complete Rx y BlueMedicare Rx para Grupos y se sigan las otras reglas del plan. Para más información sobre cómo surtir sus medicinas recetadas, consulte su Constancia de cobertura.

¿Puede cambiar al Formulario (lista de medicinas)? Generalmente, si está tomando una medicina que se encuentra en nuestro formulario del 2018 que estaba cubierta al principio del año, no descontinuaremos o reduciremos la cobertura de la medicina durante el año de cobertura 2018, excepto cuando una medicina nueva, genérica, más económica esté disponible o cuando surja nueva información adversa acerca de la seguridad o la efectividad de la medicina. Otros tipos de cambios al formulario, tales como remover una medicina del formulario, no afectarán a los miembros que ya estén tomando la medicina. Estará aun disponible al mismo costo compartido para los miembros que ya la están tomando por el resto del año de la cobertura. Entendemos que es importante que tenga acceso continuo por el resto del año a las medicinas del formulario que ya estaban disponibles cuando usted eligió su plan, excepto en casos en los cuales usted pueda ahorrar dinero adicional o cuando no podamos asegurar su seguridad. Si eliminamos medicinas del formulario, o añadimos el requerimiento de una autorización previa, límite de cantidad y/o restricciones de terapia escalonada en una medicina, o movemos la medicina a un nivel de costo más alto, debemos notificarle a los miembros del cambio con al menos 60 días antes de que el cambio entre en vigencia, o en el momento en el que el miembro solicite un abastecimiento de la medicina, para el cual el miembro recibirá un suministro de 60 días de la medicina. Si la Administración de Alimentos y Medicinas (Food and Drug Administration) considera que una medicina en nuestro formulario no es segura o el fabricante de la medicina lo retira del mercado, nosotros eliminaremos inmediatamente la medicina de nuestro formulario y enviaremos una notificación a los miembros que toman esa medicina. Esta lista está actualizada al 1 de enero de 2018. Para obtener información actualizada sobre las medicinas cubiertas por nuestro plan, comuníquese con nosotros. Nuestra información de contacto aparece en las portadas delantera y trasera.

BlueMedicare Complete Rx and BlueMedicare Rx para Grupos proporciona actualizaciones mensuales del formulario en (www.BlueMedicareFL.com) y en papel como sea necesario. El siguiente párrafo explicará cómo será notificado en el caso de ciertos cambios.

BlueMedicare Complete Rx y BlueMedicare Rx para Grupos solo eliminará medicinas de la Parte D del formulario, moverá medicinas cubiertas por la Parte D a un nivel preferido menor o añadirá requisitos de manejo de utilización 60 días después del inicio del año del contrato asociado con el periodo de elección

iii

anual, y solamente si estos cambios son aprobados por CMS. Si BlueMedicare Complete Rx y BlueMedicare Rx para Grupos debe hacer tales cambios al formulario, los miembros actuales que están tomando la medicina están exentos del cambio del formulario por el resto del año del contrato. Antes de eliminar una medicina cubierta por la Parte D de este formulario, o hacer algún cambio en el nivel de costo compartido o nivel de preferencia de una medicina cubierta por la Parte D, BlueMedicare Complete Rx y BlueMedicare Rx para Grupos: • Proporcionará una notificación escrita a los miembros afectados con al menos 60 días antes de la fecha

en que el cambio sea efectivo; o

• En el momento en que los miembros afectados soliciten un reabastecimiento de la medicina de la ParteD, le proporcionaremos al miembro un suministro de 60 días de la medicina de la Parte D bajo losmismos términos que estaban permitidos anteriormente y una notificación escrita sobre el cambio alformulario.

¿Cómo utilizo el Formulario? Hay dos maneras en las que puede encontrar su medicina en el formulario:

Condición médica El formulario comienza en la página 1. Las medicinas en este formulario están agrupadas en categorías dependiendo del tipo de condición médica que estas medicinas tratan. Por ejemplo, las medicinas utilizadas para tratar una condición médica están listados bajo la categoría de "Agentes cardiovasculares". Si usted sabe para qué se utiliza la medicina, busque el nombre de la categoría en la lista que comienza en la página 1. Después busque bajo el nombre de la categoría de su medicina.

Lista alfabética Si no está seguro bajo qué categoría buscar, puede buscar la medicina en el índice que comienza en la página 125. El índice proporciona una lista alfabética de todas las medicinas que se incluyen en este documento. Tanto el nombre de marca como el genérico aparecen en el índice. Busque en el índice hasta encontrar su medicina. Al lado del nombre de la medicina, encontrará el número de la página donde puede encontrar la información de la cobertura. Vaya a la página indicada en el índice y encuentre el nombre de la medicina en la primera columna de la lista.

¿Qué son las medicinas genéricas? Nuestro plan cubre tanto las medicinas de marca como las genéricas. Una medicina genérica que es aprobada por la Administración de medicinas y alimentos de los Estados Unidos (U.S. Food and Drug Administration, FDA) e indica que contiene el mismo ingrediente activo que la medicina de marca. Por lo general, las medicinas genéricas son menos costosas que las de marca.

¿Existen restricciones en mi cobertura? Algunas medicinas cubiertas pueden tener requisitos adicionales o límites en la cobertura. Estos requisitos y límites pueden incluir:

• Autorización previa: Nuestro plan requiere que usted o su médico obtenga autorización previapara ciertas medicinas. Esto significa que deberá obtener aprobación por parte de nuestro planantes de poder surtir sus medicinas recetadas. Si no obtiene aprobación, nuestro plan puede queno cubra la medicina.

• Límites de cantidad: Por ejemplo, para ciertas medicinas, nuestro plan limita la cantidad de lamedicina que nuestro plan puede cubrir. Por ejemplo, nuestro plan proporciona 30 tabletas porreceta médica para Januvia. Esto puede ser adicional a un suministro normal para uno o tresmeses.

• Terapia Escalonada: En algunos casos, nuestro plan le pedirá que primero pruebe ciertasmedicinas para tratar su condición médica, antes de que cubramos otra medicina para esa

iv

condición. Por ejemplo, si la Medicina A y la Medicina B tratan su condición médica, nuestro plan puede que no cubra la medicina B hasta que usted pruebe la medicina A primero. Si la Medicina A no le funciona, entonces el plan puede cubrir la Medicina B.

Usted puede averiguar si la medicina tiene algún requisito adicional o límite buscándolo en el formulario que comienza en la página 1. También puede obtener más información acerca de las restricciones que aplican a medicinas específicas cubiertas al visitar nuestra página de Internet. Tenemos un documento en la página de Internet que explica nuestras restricciones de autorización previa y de terapia escalonada. También nos puede pedir que le enviemos una copia. Nuestra información de contacto, así como las fechas de actualización del formulario, aparece en las portadas delantera y trasera. Usted puede preguntarle al plan que haga una excepción a estas restricciones o límites, o para obtener una lista de otras medicinas similares que pueden tratar su condición de salud. Vea la sección, "¿Cómo puedo solicitar una excepción al formulario de BlueMedicare Complete Rx y BlueMedicare Rx para Grupos?" en la página iv para obtener información acerca de cómo solicitar una excepción.

¿Qué sucede si mi medicina no está en el Formulario? Si su medicina no está incluida en el Formulario (lista de medicinas cubiertas), debe primero comunicarse con Servicio al cliente y preguntar si su medicina está cubierta. Si se entera de que nuestro plan no cubre su medicina, usted tendrá dos opciones:

• Puede solicitar a Servicios para miembros un listado de las medicinas similares que están cubiertaspor BlueMedicare Complete Rx y BlueMedicare Rx para Grupos. Cuando reciba la lista,muéstresela a su médico y pídale que le recete una medicina similar que esté cubierta por nuestroplan.

• Puede solicitarle a nuestro plan que haga una excepción y cubra su medicina. Lea a continuaciónpara obtener más información acerca de cómo solicitar una excepción.

¿Cómo puedo solicitar una excepción al formulario de BlueMedicare Complete Rx y BlueMedicare Rx para Grupos? Puede solicitarle a nuestro plan que haga una excepción a las normas de cobertura. Existen muchos tipos de excepciones que usted puede solicitar.

• Nos puede solicitar que cubramos su medicina aun si no está en el formulario. Si es aprobada, estamedicina será cubierta el nivel de costo compartido pre determinado y usted no podrá solicitarnos que proporcionemos la medicina a un nivel de costo compartido más bajo.

• Nos puede solicitar que cubramos una medicina del formulario a un nivel de costo compartido másbajo (si esta medicina no se encuentra en el nivel de medicinas especializadas). Si es aprobada,esto reducirá la cantidad que debe pagar por la medicina.

• Nos puede solicitar ser eximido de esta restricción o límite en su medicina. Por ejemplo, paraciertas medicinas, nuestro plan limita la cantidad de la medicina que nuestro plan puede cubrir. Sisu medicina tiene un límite de cantidad, puede solicitarnos que se le exima de este límite y que secubra una cantidad mayor.

Generalmente, nuestros planes solamente aprueban su solicitud para una excepción si las medicinas alternativas incluidas en el formulario del plan, la medicina del nivel de costo compartido más bajo o las restricciones de utilización adicional no son un tratamiento efectivo para su condición y/o le puede causar efectos médicos adversos. Debe comunicarse con nosotros para solicitar una decisión inicial sobre la cobertura, en el caso de una excepción a las restricciones de un formulario, de uso o de nivel. Cuando solicite una excepción a las restricciones de un formulario, de uso o de nivel, debe adjuntar una declaración de su médico o persona autorizada que apoye su solicitud. Generalmente, después de recibir la declaración de su médico que apoye su solicitud, debemos tomar nuestra decisión dentro de 72 horas. Usted puede solicitar una excepción acelerada (rápida) si usted o su médico entienden que su salud puede estar en serio peligro

v

si espera las 72 horas para tomar una una decisión. Si se le aprueba la excepción acelerada, debemos tomar una decisión no más tardar de 24 horas después de recibir las declaraciones de apoyo de su médico.

¿Qué debo hacer antes de hablar con mi médico acerca de cambiar mi medicina o solicitar una excepción? Como un nuevo o actual asegurado de nuestro plan, usted puede que esté tomando medicinas que no están en nuestro formulario. O, puede ser que esté tomando una medicina que está en nuestro formulario pero sólo puede recibir una cantidad limitada. Por ejemplo, puede que necesite una autorización previa de nuestra parte para surtir su medicina recetada. Debe hablar con su médico para decidir si debe cambiar a una medicina apropiada que esté cubierta o solicitar una excepción al formulario para que podamos cubrir la medicina que necesita. Mientras habla con su médico para determinar el curso de acción correcto para usted, puede ser que cubramos su medicina en ciertos casos durante los primeros 90 días que usted es miembro de nuestro plan.

Por cada una de sus medicinas que no esté en nuestro formulario o si la cantidad que puede recibir es limitada, le cubriremos un suministro temporal de 30 días (a menos que su receta indique menos días) cuando vaya a una farmacia de la red. Después de su primer suministro de 30 días, no pagaremos por esta medicina, aún si usted ha sido un miembro del plan por menos de 90 días. Si usted es un residente de un establecimiento de cuidados a largo plazo, le permitiremos abastecer su medicina recetada hasta que le proporcionemos con un suministro de 98 días de transición, de acuerdo con el incremento del abastecimiento (a menos que su receta indique menos días). Cubriremos más de un abastecimiento de esta medicina por los primeros 90 días que usted sea asegurado de nuestro plan. Si necesita una medicina que no está en nuestro formulario o si la cantidad que puede recibir es limitada, pero ya pasaron los primeros 90 días de la afiliación a nuestro plan, le cubriremos un suministro de emergencia de 30 días de esa medicina (a menos que su receta indique menos días) mientras usted consigue una excepción al formulario. Existen circunstancias en las cuales pueden ocurrir transiciones no planificadas para los asegurados actuales y en los cuales el régimen de la medicina recetada puede que no aparezcan en el formulario. Estas circunstancias usualmente envuelven un cambio en el nivel de cuidado en el cual cambian a un asegurado de un tratamiento a otro. Para estas transiciones inesperadas, usted debe utilizar nuestro proceso de excepción y apelación. Las determinaciones y re determinaciones de cobertura serán procesadas tan rápido como lo requiera su condición.

Cuando un asegurado es admitido o dado de alta de un establecimiento de cuidados a largo plazo (Long Term Care, LTC), no tendrá acceso al remanente de la medicina recetada abastecida anteriormente. Nos aseguraremos de que tenga un reabastecimiento al momento de la admisión o de alta. Se proporcionará una anulación única para el "abastecimiento temprano" para cada medicina que se vea afectada debido a que el asegurado fue admitido o dado de alta de un establecimiento de cuidados a largo plazo. No se utilizan los cambios a los abastecimientos tempranos para limitar el acceso apropiado o necesario a los beneficios de la Parte D del asegurado, y estos asegurados pueden obtener un abastecimiento al momento de la admisión o de alta.

Para más información Para obtener información más detallada acerca de su cobertura de medicinas recetadas con BlueMedicare Complete Rx y BlueMedicare Rx para Grupos, consulte su Constancia de cobertura y los demás materiales del plan. Si tiene preguntas acerca de su plan, comuníquese con nosotros. Nuestra información de contacto, así como las fechas de actualización del formulario, aparece en las portadas delantera y trasera. Si tiene preguntas generales acerca de la cobertura de medicinas recetadas de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227) las 24 horas del día, los 7 días de la semana. Los usuarios de equipo teleescritor (TTY) deben llamar al 1-877-486-2048. O visite http://www.medicare.gov.

vi

El Formulario de Nuestro Plan El formulario que comienza en la página 1 proporciona información de cobertura de las medicinas cubiertas por nuestro plan. Si tiene problemas para encontrar su medicina en el formulario, vaya al índice que comienza en la página 125. La primera columna de la tabla lista el nombre de la medicina. Los nombres de las medicinas de marca están en mayúsculas (por ejemplo, LANTUS) y las medicinas genéricas están en letras minúsculas en cursiva (por ejemplo, metformin).

La información en la columna Requisitos/Límites indica si su plan tiene algún requisito especial para cubrir su medicina. La información en la segunda columna de la tabla indica a qué nivel de cobertura se encuentra la medicina. La tercera columna de la tabla indica si se solicitan requisitos especiales para la cobertura de una medicina como por ejemplo, Autorización previa", "Límite de cantidad" y "Terapia escalonada". Si un Límite de cantidad aplica para una medicina, la cantidad de la restricción se muestra en el listado que comienza en la página 1.

vii

CLAVE DE ABREVIACIONES DE LAS DOSIS

act Activación liqd Líquidas ad Absorbido mcg Microgramo aer, aero Aerosol meq Mili equivalente ba Respiración activada mg Miligramo bau Unidades bioequivalentes de

l í ml Mililitro

cap Cápsulas mu Millones de unidades chew tab Tabletas masticables nebu Nébula conc Concentración NF No pertenece al formulario

conj Conjugar odt Tabletas de disolución oral

cr Liberación controlada oin, oint Ungüento crys Cristales op, ophth Oftálmico

deter Disuasivo pf Libre de preservativos

dr Liberación retrasada pfu Unidades formadoras de l ec Envoltura entérica pow, powd Polvo

el Ensayo por inmunoabsorción ligado a enzimas

pref Precargada

er, extended, extended rel, xl, xr Liberación prolongada recmb, recomb Recombinante

g, gm Gramo sl Sublingual gu genitourinario soln Solución hr Hora sr Liberación sostenida im Intramuscular suppos Supositorios inh, inhal Inhalación susp Suspensión inj Inyección syr Jeringuilla IR Liberación inmediata tab Tableta iv Intravenoso td Transdermal l Litro tl Translingual LF Unidades de floculación unt Unidad la Larga duración vac Vacunas

viii

Etapa de brecha en la cobertura La siguiente información le explicará lo que cubre cada plan cuando está en la brecha en la cobertura. Para obtener información, consulte su Constancia de cobertura.

Plan(es) Cobertura adicional cuando se encuentra en la brecha en la cobertura

• BlueMedicare Complete Rx Este plan proporciona cobertura para el Nivel 1: Genéricas preferidas y el Nivel 2: Genéricas cuando se encuentra en la Brecha en la cobertura. Paga el mismo costo compartido que pagó durante la Etapa inicial de cobertura para las medicinas del Nivel 1 y Nivel 2.

• BlueMedicare Rx para Grupos – Opción 1 y 2 Este plan proporciona cobertura para todos los niveles. Su costo compartido sigue siendo el mismo que en la Etapa de cobertura inicial cuando se encuentra en la etapa de Brecha en la cobertura.

• BlueMedicare Rx para Grupos – Opción 3 Este plan proporciona cobertura para el Nivel 1: Genéricas preferidas y el Nivel 2: Genéricas cuando se encuentra en la Brecha en la cobertura. Paga el mismo costo compartido que pagó durante la Etapa inicial de cobertura para las medicinas del Nivel 1 y Nivel 2.

Etapa de cobertura inicial La cantidad de copago/coaseguro que usted paga por un suministro de un mes (31 días) de la medicina en cada Nivel de medicina se muestra a continuación.

Para BlueMedicare Complete Rx

Tipo de farmacia

Nivel 1: Genéricas preferidas

Nivel 2 Genéricas

Nivel 3 De marca

preferidas

Nivel 4 De marca

no preferidas

Nivel 5 Especializadas

Blue Medicare Complete Rx

De venta al público preferidas

$3 de copago

$10 de copago

$40 de copago

$93 de copago

33% De venta al público estándar

$13 de copago

$20 de copago

$47 de copago

$100 de copago

Pedido por correo

$3 de copago

$10 de copago

$40 de copago

$93 de copago

ix

Para BlueMedicare Rx para Grupos

Tipo de farmacia

Nivel 1: Genéricas preferidas

Nivel 2 Genéricas

Nivel 3 De marca

preferidas

Nivel 4 De marca

no preferidas

Nivel 5 Especiali-

zadas

BlueMedicare Rx para Grupos – Opción 1


No corresponde

No corresponde

No corresponde

No corresponde


$10 de copago

$10 de copago

$40 de copago

$70 de copago

Pedido por correo

$0 de copago

$0 de copago

$40 de copago

$70 de copago



No corresponde

No corresponde

No corresponde

No corresponde


$15 de copago

$15 de copago

$45 de copago

$85 de copago

Pedido por correo

$8 de copago

$8 de copago

$45 de copago

$85 de copago



No corresponde

No corresponde

No corresponde

No corresponde


$10 de copago

$10 de copago

$45 de copago

$95 de copago

Pedido por correo

$10 de copago

$10 de copago

$45 de copago

$95 de copago

Aplica un deducible de $75 para las medicinas en el Nivel 3, el Nivel 4 y el Nivel 5.

x

Clave de abreviaturas

1 = Medicinas genéricas preferidas

2= Medicinas genéricas

3= Medicinas de marca preferidas

4= Medicinas de marca no preferidas

5= Medicinas especializadas

BD= Medicinas que pueden estar cubiertas por Medicare Parte B o Medicare Parte D dependiendo en las circunstancias Estas medicinas pueden requerir autorización para determinar la cobertura bajo la Parte B o la Parte D. Puede requerirse que se proporcione información que describa el uso o el lugar donde la medicina se recibe para determinar la cobertura.

PA= Autorización previa (Prior Authorization)

QL= Límites de cantidad (Quantity Limits)

ST= Terapia escalonada (Step Therapy)

*= Las medicinas con distribución limitada están indicadas con un asterisco (*) en la lista de medicinas. Puede que estas medicinas estén disponibles sólo en algunas farmacias. Para más información, consulte nuestro Directorio de farmacia o llame al Departamento de Servicio al cliente al 1-800-926-6565. Los usuarios de equipo teleescritor (TTY) deben llamar al 1-800-955-8770. El horario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, del 1 de octubre al 14 de febrero, excepto el Día de Acción de Gracias (Thanksgiving) y el Día de Navidad. Desde el 15 de febrero hasta el 30 de septiembre, el horario es de lunes a viernes de 8:00 a.m. a 8:00 p.m., hora local, excepto los días feriados. O visite www.BlueMedicareFL.com.

#= Medicinas de alto riesgo (HRM). Medicinas que no son seguras para pacientes mayors de 65 años de edad. Nuestro formulario no incluye cobertura para algunas de estas medicinas, pero se pueden buscar otras alternativas en los niveles con copagos más bajos. Converse con su médico si hay alternativas a estas medicinas que podrían ser apropiadas para su uso.

^ = Se proporciona cobertura adicional de estas medicinas recetadas para ciertos planes durante la la brecha en la cobertura. Consulte la tabla en la Sección "Etapa de la brecha en la cobertura" en la página viii para determinar si su plan proporciona cobertura adicionalen la brecha. También puede consultar su Constancia de cobertura.

2018

Usted puede encontrar información acerca del significado de los símbolos y abreviaturas que aparecen en estatabla al inicio de este documento.

1

Nombre del medicamentoNivel delmedicamento Requisitos/Límites

Medicamentos analgésicosABSTRAL - fentanyl citrate sl tab 100 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 200 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 300 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 400 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 600 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 800 mcg 5 PA, QL (120 tablets/30 days)acetaminophen w/ codeine soln 120-12 mg/5ml^ 1 QL (2700 mls/30 days)acetaminophen w/ codeine tab 300-15 mg^ 2 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-30 mg^ 2 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-60 mg^ 2 QL (180 tablets/30 days)ANAPROX DS - naproxen sodium tab 550 mg 4 QL (90 tablets/30 days)ARTHROTEC 50 - diclofenac w/ misoprostol tab delayed release

50-0.2 mg4 QL (120 tablets/30 days)

ARTHROTEC 75 - diclofenac w/ misoprostol tab delayed release75-0.2 mg

4 QL (90 tablets/30 days)

butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)butalbital-acetaminophen-caffeine cap 50-300-40 mg# 4 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine cap 50-325-40 mg# 4 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine tab 50-325-40 mg# 4 PA, QL (180 tablets/30 days)butalbital-aspirin-caffeine cap 50-325-40 mg# 4 PA, QL (180 capsules/30 days)BUTORPHANOL TARTRATE - butorphanol tartrate inj 1 mg/ml 3butorphanol tartrate inj 2 mg/ml^ 2butorphanol tartrate nasal soln 10 mg/ml^ 2 QL (87.5 mls/30 days)BUTRANS - buprenorphine td patch weekly 5 mcg/hr 4 PA, QL (4 patches/28 days)BUTRANS - buprenorphine td patch weekly 7.5 mcg/hr 4 PA, QL (4 patches/28 days)BUTRANS - buprenorphine td patch weekly 10 mcg/hr 4 PA, QL (4 patches/28 days)BUTRANS - buprenorphine td patch weekly 15 mcg/hr 4 PA, QL (4 patches/28 days)BUTRANS - buprenorphine td patch weekly 20 mcg/hr 4 PA, QL (4 patches/28 days)CELEBREX - celecoxib cap 50 mg 4 QL (60 capsules/30 days)CELEBREX - celecoxib cap 100 mg 4 QL (60 capsules/30 days)CELEBREX - celecoxib cap 200 mg 4 QL (60 capsules/30 days)CELEBREX - celecoxib cap 400 mg 4 QL (30 capsules/30 days)celecoxib cap 50 mg^ 2 QL (60 capsules/30 days)celecoxib cap 100 mg^ 2 QL (60 capsules/30 days)celecoxib cap 200 mg^ 2 QL (60 capsules/30 days)celecoxib cap 400 mg^ 2 QL (30 capsules/30 days)codeine sulfate tab 15 mg^ 2 QL (180 tablets/30 days)

2018

Usted puede encontrar información acerca del significado de los símbolos y abreviaturas que aparecen en estatabla al inicio de este documento.2


codeine sulfate tab 30 mg^ 2 QL (180 tablets/30 days)codeine sulfate tab 60 mg^ 2 QL (180 tablets/30 days)DAYPRO - oxaprozin tab 600 mg 4 QL (90 tablets/30 days)diclofenac potassium tab 50 mg^ 2 QL (120 tablets/30 days)diclofenac sodium gel 1%^ 2 STdiclofenac sodium tab delayed release 25 mg^ 2 QL (240 tablets/30 days)diclofenac sodium tab delayed release 50 mg^ 2 QL (120 tablets/30 days)diclofenac sodium tab delayed release 75 mg^ 2 QL (60 tablets/30 days)diclofenac sodium tab er 24hr 100 mg^ 2 QL (60 tablets/30 days)diclofenac w/ misoprostol tab delayed release 50-0.2 mg^ 2 QL (120 tablets/30 days)diclofenac w/ misoprostol tab delayed release 75-0.2 mg^ 2 QL (90 tablets/30 days)DOLOPHINE - methadone hcl tab 5 mg 4 QL (180 tablets/30 days)DOLOPHINE - methadone hcl tab 10 mg 4 QL (360 tablets/30 days)EC-NAPROSYN - naproxen tab ec 375 mg 4 QL (120 tablets/30 days)EC-NAPROSYN - naproxen tab ec 500 mg 4 QL (90 tablets/30 days)etodolac cap 200 mg^ 2 QL (150 capsules/30 days)etodolac cap 300 mg^ 2 QL (90 capsules/30 days)etodolac tab er 24hr 400 mg^ 2 QL (60 tablets/30 days)etodolac tab er 24hr 500 mg^ 2 QL (60 tablets/30 days)etodolac tab er 24hr 600 mg^ 2 QL (30 tablets/30 days)etodolac tab 400 mg^ 2 QL (60 tablets/30 days)etodolac tab 500 mg^ 2 QL (60 tablets/30 days)FELDENE - piroxicam cap 10 mg 4 QL (60 capsules/30 days)FELDENE - piroxicam cap 20 mg 4 QL (30 capsules/30 days)fentanyl citrate lozenge on a handle 200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 400 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 800 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl td patch 72hr 12 mcg/hr^ 2 PA, QL (15 patches/30 days)fentanyl td patch 72hr 25 mcg/hr^ 2 PA, QL (15 patches/30 days)fentanyl td patch 72hr 50 mcg/hr^ 2 PA, QL (15 patches/30 days)fentanyl td patch 72hr 75 mcg/hr^ 2 PA, QL (15 patches/30 days)fentanyl td patch 72hr 100 mcg/hr^ 2 PA, QL (15 patches/30 days)flurbiprofen tab 50 mg^ 2 QL (180 tablets/30 days)flurbiprofen tab 100 mg^ 2 QL (90 tablets/30 days)hydrocodone-acetaminophen soln 7.5-325 mg/15ml^ 2 QL (3600 mls/30 days)

2018


3


hydrocodone-acetaminophen tab 10-325 mg^ 2 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-300 mg^ 2 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg^ 2 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-325 mg^ 2 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-325 mg^ 2 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 10-300 mg^ 2 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg^ 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg^ 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg^ 2 QL (150 tablets/30 days)hydromorphone hcl liqd 1 mg/ml^ 2 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 10 mg/ml^ 2 BDhydromorphone hcl tab 2 mg^ 2 QL (180 tablets/30 days)hydromorphone hcl tab 4 mg^ 2 QL (180 tablets/30 days)hydromorphone hcl tab 8 mg^ 2 QL (180 tablets/30 days)ibuprofen susp 100 mg/5ml^ 1 QL (4800 mls/30 days)ibuprofen tab 400 mg^ 1 QL (240 tablets/30 days)ibuprofen tab 600 mg^ 1 QL (150 tablets/30 days)ibuprofen tab 800 mg^ 1 QL (120 tablets/30 days)ketoprofen cap 50 mg^ 2 QL (180 capsules/30 days)ketoprofen cap 75 mg^ 2 QL (120 capsules/30 days)LAZANDA - fentanyl citrate nasal spray 100 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 300 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 400 mcg/act 5 PA, QL (30 bottles/30 days)LEVORPHANOL TARTRATE - levorphanol tartrate tab 2 mg 4 QL (120 tablets/30 days)meloxicam tab 7.5 mg^ 1 QL (60 tablets/30 days)meloxicam tab 15 mg^ 1 QL (30 tablets/30 days)methadone hcl tab 5 mg^ 2 QL (180 tablets/30 days)methadone hcl tab 10 mg^ 2 QL (360 tablets/30 days)MOBIC - meloxicam tab 7.5 mg 4 QL (60 tablets/30 days)MOBIC - meloxicam tab 15 mg 4 QL (30 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 15 mg 4 QL (240 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 30 mg 4 QL (180 tablets/30 days)morphine sulfate inj pf 0.5 mg/ml^ 2 BDmorphine sulfate inj pf 1 mg/ml^ 2 BDmorphine sulfate oral soln 10 mg/5ml^ 2 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml^ 2 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml)^ 2 QL (270 mls/30 days)morphine sulfate tab er 15 mg^ 2 PA, QL (90 tablets/30 days)

2018



morphine sulfate tab er 30 mg^ 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg^ 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg^ 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg^ 2 PA, QL (90 tablets/30 days)nabumetone tab 500 mg^ 2 QL (120 tablets/30 days)nabumetone tab 750 mg^ 2 QL (60 tablets/30 days)NAPROSYN - naproxen tab 500 mg 4 QL (90 tablets/30 days)naproxen sodium tab 275 mg^ 1 QL (150 tablets/30 days)naproxen sodium tab 550 mg^ 1 QL (90 tablets/30 days)naproxen susp 125 mg/5ml^ 2 QL (1800 mls/30 days)naproxen tab ec 375 mg^ 2 QL (120 tablets/30 days)naproxen tab ec 500 mg^ 2 QL (90 tablets/30 days)naproxen tab 250 mg^ 1 QL (180 tablets/30 days)naproxen tab 375 mg^ 1 QL (120 tablets/30 days)naproxen tab 500 mg^ 1 QL (90 tablets/30 days)NUCYNTA - tapentadol hcl tab 50 mg 4 QL (180 tablets/30 days)NUCYNTA - tapentadol hcl tab 75 mg 4 QL (180 tablets/30 days)NUCYNTA - tapentadol hcl tab 100 mg 4 QL (180 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 50 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 100 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 150 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 200 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 250 mg 3 PA, QL (60 tablets/30 days)oxaprozin tab 600 mg^ 2 QL (90 tablets/30 days)oxycodone hcl tab 5 mg^ 2 QL (360 tablets/30 days)oxycodone hcl tab 10 mg^ 2 QL (180 tablets/30 days)oxycodone hcl tab 15 mg^ 2 QL (180 tablets/30 days)oxycodone hcl tab 20 mg^ 2 QL (180 tablets/30 days)oxycodone hcl tab 30 mg^ 2 QL (180 tablets/30 days)oxycodone w/ acetaminophen tab 2.5-325 mg^ 2 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 5-325 mg^ 2 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 7.5-325 mg^ 2 QL (240 tablets/30 days)oxycodone w/ acetaminophen tab 10-325 mg^ 2 QL (180 tablets/30 days)oxycodone-aspirin tab 4.8355-325 mg^ 2 QL (360 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 10 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 15 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 20 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 30 mg 3 PA, QL (60 tablets/30 days)

2018


5


OXYCONTIN - oxycodone hcl tab er 12hr deter 40 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 60 mg 3 PA, QL (120 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 80 mg 3 PA, QL (120 tablets/30 days)piroxicam cap 10 mg^ 2 QL (60 capsules/30 days)piroxicam cap 20 mg^ 2 QL (30 capsules/30 days)ROXICODONE - oxycodone hcl tab 5 mg 4 QL (360 tablets/30 days)ROXICODONE - oxycodone hcl tab 15 mg 4 QL (180 tablets/30 days)ROXICODONE - oxycodone hcl tab 30 mg 4 QL (180 tablets/30 days)sulindac tab 150 mg^ 2 QL (60 tablets/30 days)sulindac tab 200 mg^ 2 QL (60 tablets/30 days)TENCON - butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)TOLMETIN SODIUM - tolmetin sodium cap 400 mg 3 QL (120 capsules/30 days)tramadol hcl tab er 24hr 100 mg^ 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 200 mg^ 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 300 mg^ 2 PA, QL (30 tablets/30 days)tramadol hcl tab 50 mg^ 1 QL (240 tablets/30 days)tramadol-acetaminophen tab 37.5-325 mg^ 2 QL (240 tablets/30 days)ULTRACET - tramadol-acetaminophen tab 37.5-325 mg 4 QL (240 tablets/30 days)ULTRAM - tramadol hcl tab 50 mg 4 QL (240 tablets/30 days)VOLTAREN - diclofenac sodium gel 1% 4 STZOHYDRO ER - hydrocodone bitartrate cap er 12hr abuse-

deterrent 10 mg4 PA, QL (60 capsules/30 days)

ZOHYDRO ER - hydrocodone bitartrate cap er 12hr abuse-deterrent 15 mg

4 PA, QL (60 capsules/30 days)









Medicamentos anestésicoslidocaine hcl gel 2%^ 1 PA, QL (150 mls/30 days)lidocaine hcl local inj 1%^ 1lidocaine hcl local preservative free inj 1%^ 1lidocaine hcl soln 4%^ 2 PAlidocaine hcl viscous soln 2%^ 1lidocaine oint 5%^ 2 PA, QL (100 grams/30 days)lidocaine patch 5%^ 2 PA, QL (90 patches/30 days)

2018



lidocaine-prilocaine cream 2.5-2.5%^ 2 PA, QL (60 grams/30 days)LIDODERM - lidocaine patch 5% 4 PA, QL (90 patches/30 days)XYLOCAINE - lidocaine hcl local inj 1% 4XYLOCAINE - lidocaine hcl soln 4% 4 PAXYLOCAINE-MPF - lidocaine hcl local preservative free inj 1% 4Agentes contra las adicciones y para tratar el abuso deacamprosate calcium tab delayed release 333 mg^ 2ANTABUSE - disulfiram tab 250 mg 4ANTABUSE - disulfiram tab 500 mg 4buprenorphine hcl sl tab 2 mg^ 2 PA, QL (90 tablets/30 days)buprenorphine hcl sl tab 8 mg^ 2 PA, QL (90 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg^ 2 PA, QL (120 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 8-2 mg^ 2 PA, QL (90 tablets/30 days)bupropion hcl (smoking deterrent) tab er 12hr 150 mg^ 2CHANTIX - varenicline tartrate tab 0.5 mg 3CHANTIX - varenicline tartrate tab 1 mg 3CHANTIX CONTINUING MONTH PACK - varenicline tartrate tab

1 mg3

CHANTIX STARTING MONTH PACK - varenicline tartrate tab0.5 mg x 11 & tab 1 mg x 42 pack

3

disulfiram tab 250 mg^ 2disulfiram tab 500 mg^ 2NALOXONE HCL - naloxone hcl soln cartridge 0.4 mg/ml 3NALOXONE HCL - naloxone hcl soln prefilled syringe 2 mg/2ml 3naloxone hcl inj 0.4 mg/ml^ 2naloxone hcl inj 4 mg/10ml^ 2naltrexone hcl tab 50 mg^ 2NARCAN - naloxone hcl nasal spray 4 mg/0.1ml 4NICOTROL INHALER - nicotine inhaler system 10 mg (4 mg

delivered)4

NICOTROL NS - nicotine nasal spray 10 mg/ml (0.5 mg/spray) 4SUBOXONE - buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 4 PA, QL (120 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1 mg 4 PA, QL (30 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 8-2 mg 4 PA, QL (60 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 12-3 mg 4 PA, QL (60 films/30 days)VIVITROL - naltrexone for im extended release susp 380 mg 5ZYBAN - bupropion hcl (smoking deterrent) tab er 12hr 150 mg 4Medicamentos antibacterialesamikacin sulfate inj 500 mg/2ml (250 mg/ml)^ 2

2018


7


amikacin sulfate inj 1 gm/4ml (250 mg/ml)^ 2amoxicillin (trihydrate) cap 250 mg^ 1amoxicillin (trihydrate) cap 500 mg^ 1amoxicillin (trihydrate) for susp 125 mg/5ml^ 1amoxicillin (trihydrate) for susp 200 mg/5ml^ 1amoxicillin (trihydrate) for susp 250 mg/5ml^ 1amoxicillin (trihydrate) for susp 400 mg/5ml^ 1amoxicillin (trihydrate) tab 500 mg^ 1amoxicillin (trihydrate) tab 875 mg^ 1amoxicillin & k clavulanate for susp 200-28.5 mg/5ml^ 2amoxicillin & k clavulanate for susp 400-57 mg/5ml^ 2amoxicillin & k clavulanate for susp 600-42.9 mg/5ml^ 2amoxicillin & k clavulanate tab 250-125 mg^ 2amoxicillin & k clavulanate tab 500-125 mg^ 2amoxicillin & k clavulanate tab 875-125 mg^ 2AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & k

clavulanate chew tab 200-28.5 mg4

AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & kclavulanate chew tab 400-57 mg

4

AMPICILLIN - ampicillin for susp 125 mg/5ml 4AMPICILLIN - ampicillin for susp 250 mg/5ml 4ampicillin & sulbactam sodium for inj 3 (2-1) gm^ 2ampicillin cap 250 mg^ 1ampicillin cap 500 mg^ 1AMPICILLIN SODIUM - ampicillin sodium for iv soln 1 gm 4ampicillin sodium for inj 250 mg^ 2ampicillin sodium for inj 500 mg^ 2ampicillin sodium for inj 1 gm^ 2ampicillin sodium for inj 2 gm^ 2ampicillin sodium for iv soln 2 gm^ 2ampicillin sodium for iv soln 10 gm^ 2AUGMENTIN - amoxicillin & k clavulanate tab 500-125 mg 4AUGMENTIN - amoxicillin & k clavulanate tab 875-125 mg 4AVELOX - moxifloxacin hcl tab 400 mg 4AVELOX - moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8%

inj3

AZACTAM - aztreonam for inj 1 gm 4AZACTAM - aztreonam for inj 2 gm 4

2018



AZACTAM IN ISO-OSMOTIC DEXTROSE - aztreonam indextrose inj 1 gm/50 ml

4

AZACTAM IN ISO-OSMOTIC DEXTROSE - aztreonam indextrose inj 2 gm/50 ml

4

AZITHROMYCIN - azithromycin powd pack for susp 1 gm 4azithromycin for susp 100 mg/5ml^ 2azithromycin for susp 200 mg/5ml^ 2azithromycin iv for soln 500 mg^ 2azithromycin tab 250 mg^ 1azithromycin tab 500 mg^ 1azithromycin tab 600 mg^ 1aztreonam for inj 1 gm^ 2aztreonam for inj 2 gm^ 2BACTRIM - sulfamethoxazole-trimethoprim tab 400-80 mg 4BACTRIM DS - sulfamethoxazole-trimethoprim tab 800-160 mg 4BICILLIN L-A - penicillin g benzathine intramuscular susp 600000

unit/ml4

BICILLIN L-A - penicillin g benzathine intramuscular susp 1200000unit/2ml

4

BICILLIN L-A - penicillin g benzathine intramuscular susp 2400000unit/4ml

4

cefaclor cap 250 mg^ 2cefaclor cap 500 mg^ 2cefadroxil cap 500 mg^ 1cefadroxil for susp 250 mg/5ml^ 2cefadroxil for susp 500 mg/5ml^ 2cefadroxil tab 1 gm^ 2CEFAZOLIN SODIUM - cefazolin sodium for inj 20 gm 3cefazolin sodium for inj 500 mg^ 2cefazolin sodium for inj 1 gm^ 2cefazolin sodium for inj 10 gm^ 2cefdinir cap 300 mg^ 2cefdinir for susp 125 mg/5ml^ 2cefdinir for susp 250 mg/5ml^ 2cefepime hcl for inj 1 gm^ 2cefepime hcl for inj 2 gm^ 2CEFOTAXIME SODIUM - cefotaxime sodium for inj 500 mg 3CEFOTAXIME SODIUM - cefotaxime sodium for inj 1 gm 3CEFOTAXIME SODIUM - cefotaxime sodium for inj 2 gm 3

2018


9


CEFOTAXIME SODIUM - cefotaxime sodium for inj 10 gm 3cefoxitin sodium for inj 10 gm^ 2cefoxitin sodium for iv soln 1 gm^ 2cefoxitin sodium for iv soln 2 gm^ 2cefpodoxime proxetil for susp 50 mg/5ml^ 2cefpodoxime proxetil for susp 100 mg/5ml^ 2cefpodoxime proxetil tab 100 mg^ 2cefpodoxime proxetil tab 200 mg^ 2cefprozil for susp 125 mg/5ml^ 2cefprozil for susp 250 mg/5ml^ 2cefprozil tab 250 mg^ 2cefprozil tab 500 mg^ 2ceftazidime for inj 1 gm^ 2ceftazidime for inj 2 gm^ 2ceftazidime for inj 6 gm^ 2ceftazidime for iv soln 1 gm^ 2ceftazidime for iv soln 2 gm^ 2CEFTIN - cefuroxime axetil for susp 125 mg/5ml 4CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxone

sodium in dextrose inj 20 mg/ml4

CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxonesodium in dextrose inj 40 mg/ml

4

ceftriaxone sodium for inj 250 mg^ 2ceftriaxone sodium for inj 500 mg^ 2ceftriaxone sodium for inj 1 gm^ 2ceftriaxone sodium for inj 2 gm^ 2ceftriaxone sodium for inj 10 gm^ 2ceftriaxone sodium for iv soln 1 gm^ 2ceftriaxone sodium for iv soln 2 gm^ 2CEFTRIAXONE/DEXTROSE - ceftriaxone sodium for iv soln 1 gm

and dextrose 3.74%4

CEFTRIAXONE/DEXTROSE - ceftriaxone sodium for iv soln 2 gmand dextrose 2.22%

4

cefuroxime axetil tab 250 mg^ 2cefuroxime axetil tab 500 mg^ 2cefuroxime sodium for inj 750 mg^ 2cefuroxime sodium for inj 1.5 gm^ 2cefuroxime sodium for inj 7.5 gm^ 2cefuroxime sodium for iv soln 1.5 gm^ 2

2018



cephalexin cap 250 mg^ 1cephalexin cap 500 mg^ 1cephalexin cap 750 mg^ 1cephalexin for susp 125 mg/5ml^ 2cephalexin for susp 250 mg/5ml^ 2CHLORAMPHENICOL SODIUM SUCCINATE - chloramphenicol

sodium succinate for iv inj 1 gm4

CIPRO - ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) 4CIPRO - ciprofloxacin for oral susp 500 mg/5ml (10%)

(10 gm/100ml)4

CIPRO - ciprofloxacin hcl tab 250 mg 4CIPRO - ciprofloxacin hcl tab 500 mg 4CIPRO I.V.-IN D5W - ciprofloxacin 400 mg/200ml in d5w 4CIPROFLOXACIN - ciprofloxacin iv soln 200 mg/20ml (1%) 3CIPROFLOXACIN - ciprofloxacin iv soln 400 mg/40ml (1%) 3ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml)^ 2ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml)^ 2CIPROFLOXACIN HCL - ciprofloxacin hcl tab 100 mg 4ciprofloxacin hcl tab er 24hr 500 mg^ 2ciprofloxacin hcl tab er 24hr 1000 mg^ 2ciprofloxacin hcl tab 250 mg^ 1ciprofloxacin hcl tab 500 mg^ 1ciprofloxacin hcl tab 750 mg^ 1ciprofloxacin 200 mg/100ml in d5w^ 2ciprofloxacin 400 mg/200ml in d5w^ 2clarithromycin for susp 125 mg/5ml^ 2clarithromycin for susp 250 mg/5ml^ 2clarithromycin tab er 24hr 500 mg^ 2clarithromycin tab 250 mg^ 2clarithromycin tab 500 mg^ 2CLEOCIN - clindamycin hcl cap 75 mg 4CLEOCIN - clindamycin hcl cap 150 mg 4CLEOCIN - clindamycin hcl cap 300 mg 4CLEOCIN - clindamycin phosphate vaginal cream 2% 4CLEOCIN IN D5W - clindamycin phosphate in d5w iv soln

300 mg/50ml4

CLEOCIN IN D5W - clindamycin phosphate in d5w iv soln600 mg/50ml

4

2018


11


CLEOCIN IN D5W - clindamycin phosphate in d5w iv soln900 mg/50ml

4

CLEOCIN PHOSPHATE - clindamycin phosphate in d5w iv soln300 mg/50ml

4


4


4

CLEOCIN PHOSPHATE - clindamycin phosphate inj 300 mg/2ml 4CLEOCIN PHOSPHATE - clindamycin phosphate inj 600 mg/4ml 4CLEOCIN PHOSPHATE - clindamycin phosphate inj 900 mg/6ml 4CLEOCIN PHOSPHATE - clindamycin phosphate inj 9 gm/60ml 4CLEOCIN PHOSPHATE - clindamycin phosphate iv soln

300 mg/2ml4

CLEOCIN PHOSPHATE - clindamycin phosphate iv soln600 mg/4ml

4

CLEOCIN PHOSPHATE - clindamycin phosphate iv soln900 mg/6ml

4

CLEOCIN-T - clindamycin phosphate gel 1% 4CLEOCIN-T - clindamycin phosphate lotion 1% 4CLEOCIN-T - clindamycin phosphate soln 1% 4CLEOCIN-T - clindamycin phosphate swab 1% 4clindamycin hcl cap 75 mg^ 1clindamycin hcl cap 150 mg^ 1clindamycin hcl cap 300 mg^ 1clindamycin phosphate gel 1%^ 2clindamycin phosphate in d5w iv soln 300 mg/50ml^ 2clindamycin phosphate in d5w iv soln 600 mg/50ml^ 2clindamycin phosphate in d5w iv soln 900 mg/50ml^ 2clindamycin phosphate inj 300 mg/2ml^ 1clindamycin phosphate inj 600 mg/4ml^ 1clindamycin phosphate inj 900 mg/6ml^ 1clindamycin phosphate inj 9 gm/60ml^ 1clindamycin phosphate iv soln 300 mg/2ml^ 1clindamycin phosphate iv soln 600 mg/4ml^ 1clindamycin phosphate iv soln 900 mg/6ml^ 1clindamycin phosphate lotion 1%^ 2clindamycin phosphate soln 1%^ 2clindamycin phosphate swab 1%^ 2clindamycin phosphate vaginal cream 2%^ 2

2018



colistimethate sodium for inj 150 mg 5CUBICIN - daptomycin for iv soln 500 mg 5CUBICIN RF - daptomycin for iv soln 500 mg 5DALVANCE - dalbavancin hcl for iv soln 500 mg 5daptomycin for iv soln 500 mg 5demeclocycline hcl tab 150 mg^ 2demeclocycline hcl tab 300 mg^ 2dicloxacillin sodium cap 250 mg^ 2dicloxacillin sodium cap 500 mg^ 2DIFICID - fidaxomicin tab 200 mg 5doxycycline hyclate cap 50 mg^ 2doxycycline hyclate cap 100 mg^ 2doxycycline hyclate for inj 100 mg^ 2doxycycline hyclate tab 20 mg^ 2doxycycline hyclate tab 100 mg^ 2doxycycline monohydrate cap 50 mg^ 2doxycycline monohydrate cap 75 mg^ 2doxycycline monohydrate cap 100 mg^ 2doxycycline monohydrate cap 150 mg^ 2doxycycline monohydrate tab 50 mg^ 2doxycycline monohydrate tab 75 mg^ 2doxycycline monohydrate tab 100 mg^ 2doxycycline monohydrate tab 150 mg^ 2E.E.S. GRANULES - erythromycin ethylsuccinate for susp

200 mg/5ml4

ERY-TAB - erythromycin tab delayed release 250 mg 4ERY-TAB - erythromycin tab delayed release 333 mg 4ERY-TAB - erythromycin tab delayed release 500 mg 4ERYPED 200 - erythromycin ethylsuccinate for susp 200 mg/5ml 4ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 4ERYTHROCIN LACTOBIONATE - erythromycin lactobionate for

inj 500 mg4

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 4ERYTHROMYCIN BASE - erythromycin tab 250 mg 4ERYTHROMYCIN BASE - erythromycin tab 500 mg 4erythromycin ethylsuccinate for susp 200 mg/5ml^ 2erythromycin pads 2%^ 2erythromycin soln 2%^ 2

2018


13


FLAGYL - metronidazole cap 375 mg 4FLAGYL - metronidazole tab 250 mg 4FLAGYL - metronidazole tab 500 mg 4FORTAZ - ceftazidime for inj 1 gm 4FORTAZ - ceftazidime for inj 2 gm 4FORTAZ - ceftazidime for inj 6 gm 4FORTAZ - ceftazidime for iv soln 1 gm 4FORTAZ - ceftazidime for iv soln 2 gm 4FORTAZ - ceftazidime sodium in d5w inj 1 gm/50ml 4FORTAZ - ceftazidime sodium in d5w inj 2 gm/50ml 4gentamicin in saline inj 0.8 mg/ml^ 2gentamicin in saline inj 1 mg/ml^ 2gentamicin in saline inj 1.2 mg/ml^ 2gentamicin in saline inj 1.6 mg/ml^ 2gentamicin sulfate inj 10 mg/ml^ 2gentamicin sulfate inj 40 mg/ml^ 2gentamicin sulfate iv soln 10 mg/ml^ 2HIPREX - methenamine hippurate tab 1 gm 4imipenem-cilastatin intravenous for soln 250 mg^ 2imipenem-cilastatin intravenous for soln 500 mg^ 2INVANZ - ertapenem sodium for inj 1 gm 4INVANZ - ertapenem sodium for iv inj 1 gm 4KLARON - sulfacetamide sodium lotion 10% 4LEVOFLOXACIN - levofloxacin oral soln 25 mg/ml 3levofloxacin in d5w iv soln 250 mg/50ml^ 2levofloxacin in d5w iv soln 500 mg/100ml^ 2levofloxacin in d5w iv soln 750 mg/150ml^ 2levofloxacin iv soln 25 mg/ml^ 2levofloxacin tab 250 mg^ 1levofloxacin tab 500 mg^ 1levofloxacin tab 750 mg^ 1LINEZOLID - linezolid in sodium chloride iv soln

600 mg/300ml-0.9%5

linezolid for susp 100 mg/5ml 5 PAlinezolid iv soln 600 mg/300ml (2 mg/ml)^ 2linezolid tab 600 mg^ 2 PAmeropenem iv for soln 500 mg^ 2meropenem iv for soln 1 gm^ 2

2018



MERREM - meropenem iv for soln 500 mg 4MERREM - meropenem iv for soln 1 gm 4methenamine hippurate tab 1 gm^ 2METRO IV - metronidazole in nacl 0.74% iv soln 500 mg/100ml 4METROGEL-VAGINAL - metronidazole vaginal gel 0.75% 4metronidazole cap 375 mg^ 2metronidazole in nacl 0.79% iv soln 500 mg/100ml^ 2metronidazole tab 250 mg^ 2metronidazole tab 500 mg^ 2metronidazole vaginal gel 0.75%^ 2MINOCIN - minocycline hcl cap 50 mg 4MINOCIN - minocycline hcl cap 100 mg 4minocycline hcl cap 50 mg^ 2minocycline hcl cap 75 mg^ 2minocycline hcl cap 100 mg^ 2minocycline hcl tab 50 mg^ 2minocycline hcl tab 75 mg^ 2minocycline hcl tab 100 mg^ 2moxifloxacin hcl tab 400 mg^ 2moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj^ 2NAFCILLIN SODIUM - nafcillin sodium for iv soln 1 gm 4NAFCILLIN SODIUM - nafcillin sodium for iv soln 2 gm 4nafcillin sodium for inj 1 gm^ 2nafcillin sodium for inj 2 gm^ 2nafcillin sodium for inj 10 gm 5neomycin sulfate tab 500 mg^ 2neomycin-polymyxin b gu irrigation soln^ 2nitrofurantoin macrocrystalline cap 50 mg# 4 PAnitrofurantoin macrocrystalline cap 100 mg# 4 PAnitrofurantoin monohydrate macrocrystalline cap 100 mg# 4 PAnitrofurantoin susp 25 mg/5ml# 4 PAofloxacin tab 400 mg^ 2paromomycin sulfate cap 250 mg^ 2penicillin g potassium for inj 5000000 unit^ 2penicillin g potassium for inj 20000000 unit^ 2PENICILLIN G POTASSIUM IN DEXTROSE - penicillin g

potassium inj 20000 unit/ml in dextrose4

2018


15


PENICILLIN G POTASSIUM IN DEXTROSE - penicillin gpotassium inj 40000 unit/ml in dextrose

4

PENICILLIN G POTASSIUM IN DEXTROSE - penicillin gpotassium inj 60000 unit/ml in dextrose

4

PENICILLIN G SODIUM - penicillin g sodium for inj 5000000 unit 4penicillin v potassium for soln 125 mg/5ml^ 2penicillin v potassium for soln 250 mg/5ml^ 2penicillin v potassium tab 250 mg^ 1penicillin v potassium tab 500 mg^ 1PFIZERPEN-G - penicillin g potassium for inj 20000000 unit 4piperacillin sod-tazobactam na for inj 3.375 gm (3-0.375 gm)^ 2piperacillin sod-tazobactam sod for inj 2.25 gm (2-0.25 gm)^ 2piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm)^ 2SIVEXTRO - tedizolid phosphate for iv soln 200 mg 5SIVEXTRO - tedizolid phosphate tab 200 mg 5 PASTREPTOMYCIN SULFATE - streptomycin sulfate for inj 1 gm 4sulfacetamide sodium lotion 10%^ 2SULFADIAZINE - sulfadiazine tab 500 mg 4sulfamethoxazole-trimethoprim iv soln 400-80 mg/5ml^ 2sulfamethoxazole-trimethoprim susp 200-40 mg/5ml^ 2sulfamethoxazole-trimethoprim tab 400-80 mg^ 1sulfamethoxazole-trimethoprim tab 800-160 mg^ 1SUPRAX - cefixime cap 400 mg 4SUPRAX - cefixime chew tab 100 mg 4SUPRAX - cefixime chew tab 200 mg 4SYNERCID - quinupristin-dalfopristin for inj 500 mg (150-350 mg) 5TEFLARO - ceftaroline fosamil for iv soln 400 mg 5TEFLARO - ceftaroline fosamil for iv soln 600 mg 5tetracycline hcl cap 250 mg^ 2tetracycline hcl cap 500 mg^ 2TOBRAMYCIN SULFATE - tobramycin sulfate inj 2 gm/50ml

(40 mg/ml)4

tobramycin sulfate for inj 1.2 gm^ 2tobramycin sulfate inj 10 mg/ml^ 2tobramycin sulfate inj 80 mg/2ml (40 mg/ml)^ 2tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml)^ 2trimethoprim tab 100 mg^ 2TYGACIL - tigecycline for iv soln 50 mg 5vancomycin hcl cap 125 mg^ 2

2018



vancomycin hcl cap 250 mg^ 2vancomycin hcl for inj 100 gm^ 2vancomycin hcl for inj 500 mg^ 2vancomycin hcl for inj 750 mg^ 2vancomycin hcl for inj 1000 mg^ 2vancomycin hcl for inj 5000 mg^ 2vancomycin hcl for inj 10 gm^ 2VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose

5% inj 500 mg/100ml4

VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose5% inj 750 mg/150ml

4

VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose5% inj 1 gm/200ml

4

VIBRAMYCIN - doxycycline hyclate cap 100 mg 4ZINACEF - cefuroxime in sterile water inj 1.5 gm/50ml 4ZITHROMAX - azithromycin for susp 100 mg/5ml 4ZITHROMAX - azithromycin for susp 200 mg/5ml 4ZITHROMAX - azithromycin iv for soln 500 mg 4ZITHROMAX - azithromycin tab 250 mg 4ZITHROMAX - azithromycin tab 500 mg 4ZITHROMAX - azithromycin tab 600 mg 4ZITHROMAX TRI-PAK - azithromycin tab 500 mg 4ZITHROMAX Z-PAK - azithromycin tab 250 mg 4ZOSYN - piperacillin sod-tazobactam na for inj 3.375 gm

(3-0.375 gm)4

ZOSYN - piperacillin sod-tazobactam sod for inj 2.25 gm(2-0.25 gm)

4

ZOSYN - piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) 4ZOSYN - piperacillin sod-tazobactam sod in dex iv soln

2-0.25gm/50ml4

ZOSYN - piperacillin sod-tazobactam sod in dex iv soln4-0.5gm/100ml

4

ZOSYN - piperacillin sod-tazobactam sod in dex iv sol3-0.375gm/50ml

4

ZYVOX - linezolid for susp 100 mg/5ml 5 PAZYVOX - linezolid iv soln 200 mg/100ml (2 mg/ml) 5ZYVOX - linezolid iv soln 600 mg/300ml (2 mg/ml) 5ZYVOX - linezolid tab 600 mg 5 PAMedicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 5

2018


17


APTIOM - eslicarbazepine acetate tab 400 mg 5APTIOM - eslicarbazepine acetate tab 600 mg 5APTIOM - eslicarbazepine acetate tab 800 mg 5BANZEL - rufinamide susp 40 mg/ml 5BANZEL - rufinamide tab 200 mg 4BANZEL - rufinamide tab 400 mg 5BRIVIACT - brivaracetam iv soln 50 mg/5ml 4BRIVIACT - brivaracetam oral soln 10 mg/ml 5BRIVIACT - brivaracetam tab 10 mg 5BRIVIACT - brivaracetam tab 25 mg 5BRIVIACT - brivaracetam tab 50 mg 5BRIVIACT - brivaracetam tab 75 mg 5BRIVIACT - brivaracetam tab 100 mg 5carbamazepine cap er 12hr 100 mg^ 2carbamazepine cap er 12hr 200 mg^ 2carbamazepine cap er 12hr 300 mg^ 2carbamazepine chew tab 100 mg^ 2carbamazepine susp 100 mg/5ml^ 2carbamazepine tab er 12hr 100 mg^ 2carbamazepine tab er 12hr 200 mg^ 2carbamazepine tab er 12hr 400 mg^ 2carbamazepine tab 200 mg^ 2CARBATROL - carbamazepine cap er 12hr 100 mg 4CARBATROL - carbamazepine cap er 12hr 200 mg 4CARBATROL - carbamazepine cap er 12hr 300 mg 4CELONTIN - methsuximide cap 300 mg 4DEPACON - valproate sodium inj 100 mg/ml 4DEPAKENE - valproic acid cap 250 mg 4DEPAKOTE - divalproex sodium tab delayed release 125 mg 4DEPAKOTE - divalproex sodium tab delayed release 250 mg 4DEPAKOTE - divalproex sodium tab delayed release 500 mg 4DEPAKOTE ER - divalproex sodium tab er 24 hr 250 mg 4DEPAKOTE ER - divalproex sodium tab er 24 hr 500 mg 4DEPAKOTE SPRINKLES - divalproex sodium cap delayed release

sprinkle 125 mg4

DIASTAT ACUDIAL - diazepam rectal gel delivery system 10 mg 4 QL (5 twin pack(s)/30 days)DIASTAT ACUDIAL - diazepam rectal gel delivery system 20 mg 4 QL (5 twin pack(s)/30 days)

2018



DIASTAT PEDIATRIC - diazepam rectal gel delivery system2.5 mg

4 QL (5 twin pack(s)/30 days)

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system2.5 mg


DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system10 mg


DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system20 mg


DILANTIN - phenytoin sodium extended cap 30 mg 4DILANTIN - phenytoin sodium extended cap 100 mg 4DILANTIN INFATABS - phenytoin chew tab 50 mg 4DILANTIN-125 - phenytoin susp 125 mg/5ml 4divalproex sodium cap delayed release sprinkle 125 mg^ 2divalproex sodium tab delayed release 125 mg^ 2divalproex sodium tab delayed release 250 mg^ 2divalproex sodium tab delayed release 500 mg^ 2divalproex sodium tab er 24 hr 250 mg^ 2divalproex sodium tab er 24 hr 500 mg^ 2ethosuximide cap 250 mg^ 2ethosuximide soln 250 mg/5ml^ 2felbamate susp 600 mg/5ml 5felbamate tab 400 mg^ 2felbamate tab 600 mg^ 2fosphenytoin sodium inj 100 mg/2ml^ 2fosphenytoin sodium inj 500 mg/10ml^ 2FYCOMPA - perampanel susp 0.5 mg/ml 5FYCOMPA - perampanel tab 2 mg 4FYCOMPA - perampanel tab 4 mg 5FYCOMPA - perampanel tab 6 mg 5FYCOMPA - perampanel tab 8 mg 5FYCOMPA - perampanel tab 10 mg 5FYCOMPA - perampanel tab 12 mg 5gabapentin cap 100 mg^ 1 QL (1080 capsules/30 days)gabapentin cap 300 mg^ 1 QL (360 capsules/30 days)gabapentin cap 400 mg^ 1 QL (270 capsules/30 days)gabapentin oral soln 250 mg/5ml^ 2 QL (2160 mls/30 days)gabapentin tab 600 mg^ 2 QL (180 tablets/30 days)gabapentin tab 800 mg^ 2 QL (135 tablets/30 days)GABITRIL - tiagabine hcl tab 2 mg 4

2018


19


GABITRIL - tiagabine hcl tab 4 mg 4GABITRIL - tiagabine hcl tab 12 mg 4GABITRIL - tiagabine hcl tab 16 mg 4KEPPRA - levetiracetam inj 500 mg/5ml (100 mg/ml) 4KEPPRA - levetiracetam oral soln 100 mg/ml 4KEPPRA - levetiracetam tab 250 mg 4KEPPRA - levetiracetam tab 500 mg 4KEPPRA - levetiracetam tab 750 mg 4KEPPRA - levetiracetam tab 1000 mg 4LAMICTAL - lamotrigine tab 25 mg 5LAMICTAL - lamotrigine tab 100 mg 5LAMICTAL - lamotrigine tab 150 mg 5LAMICTAL - lamotrigine tab 200 mg 5LAMICTAL CHEWABLE DISPERSIBLE - lamotrigine tab chewable

dispersible 5 mg4

LAMICTAL CHEWABLE DISPERSIBLE - lamotrigine tab chewabledispersible 25 mg

5

lamotrigine tab chewable dispersible 5 mg^ 2lamotrigine tab chewable dispersible 25 mg^ 2lamotrigine tab 25 mg^ 1lamotrigine tab 100 mg^ 1lamotrigine tab 150 mg^ 1lamotrigine tab 200 mg^ 1levetiracetam in sodium chloride iv soln 500 mg/100ml^ 2levetiracetam in sodium chloride iv soln 1000 mg/100ml^ 2levetiracetam in sodium chloride iv soln 1500 mg/100ml^ 2levetiracetam inj 500 mg/5ml (100 mg/ml)^ 2levetiracetam oral soln 100 mg/ml^ 2levetiracetam tab 250 mg^ 2levetiracetam tab 500 mg^ 2levetiracetam tab 750 mg^ 2levetiracetam tab 1000 mg^ 2LYRICA - pregabalin cap 25 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 50 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 75 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 100 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 150 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 200 mg 3 QL (90 capsules/30 days)

2018



LYRICA - pregabalin cap 225 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin cap 300 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin soln 20 mg/ml 3 QL (900 mls/30 days)MYSOLINE - primidone tab 50 mg 5MYSOLINE - primidone tab 250 mg 5NEURONTIN - gabapentin cap 100 mg 4 QL (1080 capsules/30 days)NEURONTIN - gabapentin cap 300 mg 4 QL (360 capsules/30 days)NEURONTIN - gabapentin cap 400 mg 4 QL (270 capsules/30 days)NEURONTIN - gabapentin oral soln 250 mg/5ml 4 QL (2160 mls/30 days)NEURONTIN - gabapentin tab 600 mg 4 QL (180 tablets/30 days)NEURONTIN - gabapentin tab 800 mg 4 QL (135 tablets/30 days)ONFI - clobazam suspension 2.5 mg/ml 5 PA, QL (480 mls/30 days)ONFI - clobazam tab 10 mg 5 PA, QL (60 tablets/30 days)ONFI - clobazam tab 20 mg 5 PA, QL (60 tablets/30 days)oxcarbazepine susp 300 mg/5ml (60 mg/ml)^ 2oxcarbazepine tab 150 mg^ 2oxcarbazepine tab 300 mg^ 2oxcarbazepine tab 600 mg^ 2PEGANONE - ethotoin tab 250 mg 4PHENOBARBITAL - phenobarbital tab 15 mg# 4 PAPHENOBARBITAL - phenobarbital tab 30 mg# 4 PAPHENOBARBITAL - phenobarbital tab 60 mg# 4 PAPHENOBARBITAL - phenobarbital tab 100 mg# 4 PAphenobarbital elixir 20 mg/5ml# 4 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 65 mg/ml# 4 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 130 mg/

ml#4 PA

phenobarbital tab 16.2 mg# 4 PAphenobarbital tab 32.4 mg# 4 PAphenobarbital tab 64.8 mg# 4 PAphenobarbital tab 97.2 mg# 4 PAPHENYTEK - phenytoin sodium extended cap 200 mg 4PHENYTEK - phenytoin sodium extended cap 300 mg 4phenytoin chew tab 50 mg^ 2phenytoin sodium extended cap 100 mg^ 2phenytoin sodium extended cap 200 mg^ 2phenytoin sodium extended cap 300 mg^ 2phenytoin susp 125 mg/5ml^ 2

2018


21


primidone tab 50 mg^ 2primidone tab 250 mg^ 2SABRIL - vigabatrin powd pack 500 mg* 4SABRIL - vigabatrin tab 500 mg* 5SPRITAM - levetiracetam tab disintegrating soluble 250 mg 4SPRITAM - levetiracetam tab disintegrating soluble 500 mg 4SPRITAM - levetiracetam tab disintegrating soluble 750 mg 5SPRITAM - levetiracetam tab disintegrating soluble 1000 mg 4TEGRETOL - carbamazepine susp 100 mg/5ml 4TEGRETOL - carbamazepine tab 200 mg 4TEGRETOL-XR - carbamazepine tab er 12hr 100 mg 4TEGRETOL-XR - carbamazepine tab er 12hr 200 mg 4TEGRETOL-XR - carbamazepine tab er 12hr 400 mg 4tiagabine hcl tab 2 mg^ 2tiagabine hcl tab 4 mg^ 2topiramate sprinkle cap 15 mg^ 2topiramate sprinkle cap 25 mg^ 2topiramate tab 25 mg^ 1topiramate tab 50 mg^ 1topiramate tab 100 mg^ 1topiramate tab 200 mg^ 1TRILEPTAL - oxcarbazepine susp 300 mg/5ml (60 mg/ml) 4TRILEPTAL - oxcarbazepine tab 150 mg 4TRILEPTAL - oxcarbazepine tab 300 mg 4TRILEPTAL - oxcarbazepine tab 600 mg 4valproate sodium inj 100 mg/ml^ 2valproate sodium oral soln 250 mg/5ml^ 2valproic acid cap 250 mg^ 2vigabatrin powd pack 500 mg^* 2VIMPAT - lacosamide iv inj 200 mg/20ml (10 mg/ml) 3VIMPAT - lacosamide oral solution 10 mg/ml 3VIMPAT - lacosamide tab 50 mg 3VIMPAT - lacosamide tab 100 mg 3VIMPAT - lacosamide tab 150 mg 3VIMPAT - lacosamide tab 200 mg 3ZARONTIN - ethosuximide cap 250 mg 4ZONEGRAN - zonisamide cap 25 mg 5ZONEGRAN - zonisamide cap 100 mg 5

2018



zonisamide cap 25 mg^ 2zonisamide cap 50 mg^ 2zonisamide cap 100 mg^ 2Agentes contra la demenciaARICEPT - donepezil hydrochloride tab 5 mg 4ARICEPT - donepezil hydrochloride tab 10 mg 4donepezil hydrochloride orally disintegrating tab 5 mg^ 2donepezil hydrochloride orally disintegrating tab 10 mg^ 2donepezil hydrochloride tab 5 mg^ 1donepezil hydrochloride tab 10 mg^ 1donepezil hydrochloride tab 23 mg^ 2ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 3 PAEXELON - rivastigmine td patch 24hr 4.6 mg/24hr 4EXELON - rivastigmine td patch 24hr 9.5 mg/24hr 4EXELON - rivastigmine td patch 24hr 13.3 mg/24hr 4GALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml4

galantamine hydrobromide cap er 24hr 8 mg^ 2galantamine hydrobromide cap er 24hr 16 mg^ 2galantamine hydrobromide cap er 24hr 24 mg^ 2galantamine hydrobromide tab 4 mg^ 2galantamine hydrobromide tab 8 mg^ 2galantamine hydrobromide tab 12 mg^ 2memantine hcl oral solution 2 mg/ml^ 2 PAmemantine hcl tab 5 mg^ 2 PAmemantine hcl tab 10 mg^ 2 PAmemantine hcl tab 5 mg (28) & 10 mg (21) titration pak^ 2 PANAMENDA - memantine hcl oral solution 2 mg/ml 4 PANAMENDA - memantine hcl tab 5 mg 4 PANAMENDA - memantine hcl tab 10 mg 4 PANAMENDA TITRATION PAK - memantine hcl tab 5 mg (28) &

10 mg (21) titration pak4 PA

RAZADYNE - galantamine hydrobromide tab 4 mg 4RAZADYNE - galantamine hydrobromide tab 8 mg 4RAZADYNE - galantamine hydrobromide tab 12 mg 4RAZADYNE ER - galantamine hydrobromide cap er 24hr 8 mg 4RAZADYNE ER - galantamine hydrobromide cap er 24hr 16 mg 4RAZADYNE ER - galantamine hydrobromide cap er 24hr 24 mg 4

2018


23


rivastigmine tartrate cap 1.5 mg^ 2rivastigmine tartrate cap 3 mg^ 2rivastigmine tartrate cap 4.5 mg^ 2rivastigmine tartrate cap 6 mg^ 2rivastigmine td patch 24hr 4.6 mg/24hr^ 2rivastigmine td patch 24hr 9.5 mg/24hr^ 2rivastigmine td patch 24hr 13.3 mg/24hr^ 2Medicamentos antidepresivosamitriptyline hcl tab 10 mg# 4 PAamitriptyline hcl tab 25 mg# 4 PAamitriptyline hcl tab 50 mg# 4 PAamitriptyline hcl tab 75 mg# 4 PAamitriptyline hcl tab 100 mg# 4 PAamitriptyline hcl tab 150 mg# 4 PAAMOXAPINE - amoxapine tab 25 mg# 4 PAAMOXAPINE - amoxapine tab 50 mg# 4 PAAMOXAPINE - amoxapine tab 100 mg# 4 PAAMOXAPINE - amoxapine tab 150 mg# 4 PAbupropion hcl tab er 12hr 100 mg^ 2 QL (90 tablets/30 days)bupropion hcl tab er 12hr 150 mg^ 2 QL (60 tablets/30 days)bupropion hcl tab er 12hr 200 mg^ 2 QL (60 tablets/30 days)bupropion hcl tab er 24hr 150 mg^ 2 QL (90 tablets/30 days)bupropion hcl tab er 24hr 300 mg^ 2 QL (30 tablets/30 days)bupropion hcl tab 75 mg^ 2 QL (60 tablets/30 days)bupropion hcl tab 100 mg^ 2 QL (120 tablets/30 days)CELEXA - citalopram hydrobromide tab 10 mg 4 QL (45 tablets/30 days)CELEXA - citalopram hydrobromide tab 20 mg 4 QL (45 tablets/30 days)CELEXA - citalopram hydrobromide tab 40 mg 4 QL (30 tablets/30 days)citalopram hydrobromide oral soln 10 mg/5ml^ 2 QL (600 mls/30 days)citalopram hydrobromide tab 10 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 20 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 40 mg^ 1 QL (30 tablets/30 days)clomipramine hcl cap 25 mg# 4 PAclomipramine hcl cap 50 mg# 4 PAclomipramine hcl cap 75 mg# 4 PACYMBALTA - duloxetine hcl enteric coated pellets cap 20 mg 4 QL (60 capsules/30 days)CYMBALTA - duloxetine hcl enteric coated pellets cap 30 mg 4 QL (90 capsules/30 days)CYMBALTA - duloxetine hcl enteric coated pellets cap 60 mg 4 QL (60 capsules/30 days)

2018



desipramine hcl tab 10 mg# 3 PAdesipramine hcl tab 25 mg# 3 PAdesipramine hcl tab 50 mg# 3 PAdesipramine hcl tab 75 mg# 3 PAdesipramine hcl tab 100 mg# 3 PAdesipramine hcl tab 150 mg# 3 PAdesvenlafaxine succinate tab er 24hr 25 mg^ 2 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 50 mg^ 2 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 100 mg^ 2 QL (30 tablets/30 days)doxepin hcl cap 10 mg# 4 PAdoxepin hcl cap 25 mg# 4 PAdoxepin hcl cap 50 mg# 4 PAdoxepin hcl cap 75 mg# 4 PAdoxepin hcl cap 100 mg# 4 PAdoxepin hcl cap 150 mg# 4 PAdoxepin hcl conc 10 mg/ml# 3 PAduloxetine hcl enteric coated pellets cap 20 mg^ 2 QL (60 capsules/30 days)duloxetine hcl enteric coated pellets cap 30 mg^ 2 QL (90 capsules/30 days)duloxetine hcl enteric coated pellets cap 60 mg^ 2 QL (60 capsules/30 days)EFFEXOR XR - venlafaxine hcl cap er 24hr 37.5 mg 4 QL (60 capsules/30 days)EFFEXOR XR - venlafaxine hcl cap er 24hr 75 mg 4 QL (90 capsules/30 days)EFFEXOR XR - venlafaxine hcl cap er 24hr 150 mg 4 QL (30 capsules/30 days)EMSAM - selegiline td patch 24hr 6 mg/24hr 5EMSAM - selegiline td patch 24hr 9 mg/24hr 5EMSAM - selegiline td patch 24hr 12 mg/24hr 5escitalopram oxalate soln 5 mg/5ml^ 2 QL (600 mls/30 days)escitalopram oxalate tab 5 mg^ 1 QL (45 tablets/30 days)escitalopram oxalate tab 10 mg^ 1 QL (45 tablets/30 days)escitalopram oxalate tab 20 mg^ 1 QL (30 tablets/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 20 mg 4 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 40 mg 4 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 80 mg 4 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 120 mg 4 QL (30 capsules/30 days)FETZIMA TITRATION PACK - levomilnacipran hcl cap er 24hr 20

& 40 mg therapy pack4 QL (28 capsules/28 days)

FLUOXETINE DR - fluoxetine hcl cap delayed release 90 mg^ 2 QL (4 capsules/28 days)fluoxetine hcl cap 10 mg^ 1 QL (90 capsules/30 days)fluoxetine hcl cap 20 mg^ 1 QL (120 capsules/30 days)

2018


25


fluoxetine hcl cap 40 mg^ 1 QL (60 capsules/30 days)fluoxetine hcl solution 20 mg/5ml^ 2 QL (600 mls/30 days)fluoxetine hcl tab 10 mg^ 2 QL (90 tablets/30 days)fluoxetine hcl tab 20 mg^ 2 QL (120 tablets/30 days)fluvoxamine maleate tab 25 mg^ 2 QL (30 tablets/30 days)fluvoxamine maleate tab 50 mg^ 2 QL (30 tablets/30 days)fluvoxamine maleate tab 100 mg^ 2 QL (90 tablets/30 days)imipramine hcl tab 10 mg# 4 PAimipramine hcl tab 25 mg# 4 PAimipramine hcl tab 50 mg# 4 PALEXAPRO - escitalopram oxalate tab 5 mg 4 QL (45 tablets/30 days)LEXAPRO - escitalopram oxalate tab 10 mg 4 QL (45 tablets/30 days)LEXAPRO - escitalopram oxalate tab 20 mg 4 QL (30 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 25 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 4 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 4mirtazapine orally disintegrating tab 15 mg^ 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 30 mg^ 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 45 mg^ 2 QL (30 tablets/30 days)mirtazapine tab 7.5 mg^ 2 QL (30 tablets/30 days)mirtazapine tab 15 mg^ 2 QL (45 tablets/30 days)mirtazapine tab 30 mg^ 2 QL (30 tablets/30 days)mirtazapine tab 45 mg^ 2 QL (30 tablets/30 days)NARDIL - phenelzine sulfate tab 15 mg 4NEFAZODONE HCL - nefazodone hcl tab 100 mg 4NEFAZODONE HCL - nefazodone hcl tab 150 mg 4NEFAZODONE HCL - nefazodone hcl tab 200 mg 4nefazodone hcl tab 50 mg^ 2nefazodone hcl tab 250 mg^ 2NORPRAMIN - desipramine hcl tab 10 mg# 4 PANORPRAMIN - desipramine hcl tab 25 mg# 4 PANORTRIPTYLINE HCL - nortriptyline hcl soln 10 mg/5ml# 4 PAnortriptyline hcl cap 10 mg# 4 PAnortriptyline hcl cap 25 mg# 4 PAnortriptyline hcl cap 50 mg# 4 PAnortriptyline hcl cap 75 mg# 4 PAPARNATE - tranylcypromine sulfate tab 10 mg 5

2018



paroxetine hcl tab 10 mg# 4 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 4 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 4 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 4 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl oral susp 10 mg/5ml# 4 PA, QL (900 mls/30 days)PAXIL - paroxetine hcl tab 10 mg# 4 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl tab 20 mg# 4 PA, QL (30 tablets/30 days)PAXIL - paroxetine hcl tab 30 mg# 4 PA, QL (60 tablets/30 days)PAXIL - paroxetine hcl tab 40 mg# 4 PA, QL (45 tablets/30 days)phenelzine sulfate tab 15 mg^ 2PRISTIQ - desvenlafaxine succinate tab er 24hr 25 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 50 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 100 mg 4 QL (30 tablets/30 days)protriptyline hcl tab 5 mg# 4 PAprotriptyline hcl tab 10 mg# 4 PAPROZAC - fluoxetine hcl cap 10 mg 4 QL (90 capsules/30 days)PROZAC - fluoxetine hcl cap 20 mg 4 QL (120 capsules/30 days)PROZAC - fluoxetine hcl cap 40 mg 4 QL (60 capsules/30 days)REMERON - mirtazapine tab 15 mg 4 QL (45 tablets/30 days)REMERON - mirtazapine tab 30 mg 4 QL (30 tablets/30 days)REMERON - mirtazapine tab 45 mg 4 QL (30 tablets/30 days)REMERON SOLTAB - mirtazapine orally disintegrating tab 15 mg 4 QL (30 tablets/30 days)REMERON SOLTAB - mirtazapine orally disintegrating tab 30 mg 4 QL (30 tablets/30 days)REMERON SOLTAB - mirtazapine orally disintegrating tab 45 mg 4 QL (30 tablets/30 days)sertraline hcl oral conc 20 mg/ml^ 2 QL (300 mls/30 days)sertraline hcl tab 25 mg^ 1 QL (45 tablets/30 days)sertraline hcl tab 50 mg^ 1 QL (45 tablets/30 days)sertraline hcl tab 100 mg^ 1 QL (60 tablets/30 days)SURMONTIL - trimipramine maleate cap 25 mg# 4 PASURMONTIL - trimipramine maleate cap 50 mg# 4 PASURMONTIL - trimipramine maleate cap 100 mg# 4 PAtranylcypromine sulfate tab 10 mg^ 2trazodone hcl tab 50 mg^ 1trazodone hcl tab 100 mg^ 1trazodone hcl tab 150 mg^ 1trazodone hcl tab 300 mg^ 1trimipramine maleate cap 25 mg# 4 PAtrimipramine maleate cap 50 mg# 4 PA

2018


27


trimipramine maleate cap 100 mg# 4 PATRINTELLIX - vortioxetine hbr tab 5 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 10 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 20 mg 4 QL (30 tablets/30 days)venlafaxine hcl cap er 24hr 37.5 mg^ 2 QL (60 capsules/30 days)venlafaxine hcl cap er 24hr 75 mg^ 2 QL (90 capsules/30 days)venlafaxine hcl cap er 24hr 150 mg^ 2 QL (30 capsules/30 days)venlafaxine hcl tab er 24hr 37.5 mg^ 2 QL (60 tablets/30 days)venlafaxine hcl tab er 24hr 75 mg^ 2 QL (90 tablets/30 days)venlafaxine hcl tab er 24hr 150 mg^ 2 QL (30 tablets/30 days)venlafaxine hcl tab 25 mg^ 2 QL (90 tablets/30 days)venlafaxine hcl tab 37.5 mg^ 2 QL (90 tablets/30 days)venlafaxine hcl tab 50 mg^ 2 QL (90 tablets/30 days)venlafaxine hcl tab 75 mg^ 2 QL (90 tablets/30 days)venlafaxine hcl tab 100 mg^ 2 QL (90 tablets/30 days)VIIBRYD - vilazodone hcl tab 10 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 20 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 40 mg 4 QL (30 tablets/30 days)VIIBRYD STARTER PACK - vilazodone hcl tab starter kit 10 (7) &

20 (23) mg4 QL (1 kit/30 days)

WELLBUTRIN SR - bupropion hcl tab er 12hr 100 mg 4 QL (90 tablets/30 days)WELLBUTRIN SR - bupropion hcl tab er 12hr 150 mg 4 QL (60 tablets/30 days)WELLBUTRIN SR - bupropion hcl tab er 12hr 200 mg 4 QL (60 tablets/30 days)WELLBUTRIN XL - bupropion hcl tab er 24hr 150 mg 5 QL (90 tablets/30 days)WELLBUTRIN XL - bupropion hcl tab er 24hr 300 mg 5 QL (30 tablets/30 days)ZOLOFT - sertraline hcl oral conc 20 mg/ml 4 QL (300 mls/30 days)ZOLOFT - sertraline hcl tab 25 mg 4 QL (45 tablets/30 days)ZOLOFT - sertraline hcl tab 50 mg 4 QL (45 tablets/30 days)ZOLOFT - sertraline hcl tab 100 mg 4 QL (60 tablets/30 days)Medicamentos antieméticosALOXI - palonosetron hcl iv soln 0.25 mg/5ml 4aprepitant capsule therapy pack 80 & 125 mg^ 2 BDaprepitant capsule 40 mg^ 2 BDaprepitant capsule 80 mg^ 2 BDaprepitant capsule 125 mg^ 2 BDCHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 4 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 4 PAchlorpromazine hcl tab 10 mg^ 2 PA

2018



chlorpromazine hcl tab 25 mg^ 2 PAchlorpromazine hcl tab 50 mg^ 2 PAchlorpromazine hcl tab 100 mg^ 2 PAchlorpromazine hcl tab 200 mg^ 2 PAdronabinol cap 2.5 mg^ 2 BDdronabinol cap 5 mg^ 2 BDdronabinol cap 10 mg^ 2 BDEMEND - aprepitant capsule 40 mg 4 BDEMEND - aprepitant capsule 80 mg 4 BDEMEND - aprepitant capsule 125 mg 4 BDEMEND - fosaprepitant dimeglumine for iv infusion 150 mg 4EMEND TRIPACK - aprepitant capsule therapy pack 80 & 125 mg 4 BDgranisetron hcl inj 1 mg/ml^ 2granisetron hcl inj 4 mg/4ml (1 mg/ml)^ 2granisetron hcl tab 1 mg^ 2 BDmeclizine hcl tab 12.5 mg# 4 PAmeclizine hcl tab 25 mg# 4 PAondansetron hcl inj 4 mg/2ml (2 mg/ml)^ 2ondansetron hcl inj 40 mg/20ml (2 mg/ml)^ 2ondansetron hcl oral soln 4 mg/5ml^ 2 BDondansetron hcl tab 4 mg^ 2 BDondansetron hcl tab 8 mg^ 2 BDondansetron hcl tab 24 mg^ 2 BDondansetron orally disintegrating tab 4 mg^ 2 BDondansetron orally disintegrating tab 8 mg^ 2 BDperphenazine tab 2 mg^ 2 PAperphenazine tab 4 mg^ 2 PAperphenazine tab 8 mg^ 2 PAperphenazine tab 16 mg^ 2 PAprochlorperazine edisylate inj 5 mg/ml^ 2prochlorperazine maleate tab 5 mg^ 1prochlorperazine maleate tab 10 mg^ 1prochlorperazine suppos 25 mg^ 2promethazine hcl suppos 12.5 mg# 4 PApromethazine hcl suppos 25 mg# 4 PApromethazine hcl syrup 6.25 mg/5ml# 4 PApromethazine hcl tab 12.5 mg# 4 PApromethazine hcl tab 25 mg# 4 PA

2018


29


promethazine hcl tab 50 mg# 4 PAZOFRAN - ondansetron hcl oral soln 4 mg/5ml 4 BDZOFRAN - ondansetron hcl tab 4 mg 4 BDZOFRAN - ondansetron hcl tab 8 mg 4 BDZOFRAN ODT - ondansetron orally disintegrating tab 4 mg 4 BDZOFRAN ODT - ondansetron orally disintegrating tab 8 mg 4 BDMedicamentos antimicóticosAMBISOME - amphotericin b liposome iv for susp 50 mg 5 BDAMPHOTERICIN B - amphotericin b for inj 50 mg 4 BDCANCIDAS - caspofungin acetate for iv soln 50 mg 5CANCIDAS - caspofungin acetate for iv soln 70 mg 5caspofungin acetate for iv soln 50 mg 5caspofungin acetate for iv soln 70 mg 5ciclopirox gel 0.77%^ 2ciclopirox olamine cream 0.77%^ 2ciclopirox olamine susp 0.77%^ 2ciclopirox shampoo 1%^ 2ciclopirox solution 8%^ 2clotrimazole cream 1%^ 1clotrimazole troche 10 mg^ 2CRESEMBA - isavuconazonium sulfate cap 186 mg 5 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 5 PADIFLUCAN - fluconazole for susp 10 mg/ml 4DIFLUCAN - fluconazole for susp 40 mg/ml 4DIFLUCAN - fluconazole tab 50 mg 4DIFLUCAN - fluconazole tab 100 mg 4DIFLUCAN - fluconazole tab 150 mg 4DIFLUCAN - fluconazole tab 200 mg 4econazole nitrate cream 1%^ 2fluconazole for susp 10 mg/ml^ 2fluconazole for susp 40 mg/ml^ 2fluconazole in dextrose inj 200 mg/100ml^ 2fluconazole in dextrose inj 400 mg/200ml^ 2fluconazole in nacl 0.9% inj 200 mg/100ml^ 2fluconazole in nacl 0.9% inj 400 mg/200ml^ 2fluconazole tab 50 mg^ 2fluconazole tab 100 mg^ 2fluconazole tab 150 mg^ 2

2018



fluconazole tab 200 mg^ 2flucytosine cap 250 mg 5flucytosine cap 500 mg 5GRIS-PEG - griseofulvin ultramicrosize tab 125 mg 4GRIS-PEG - griseofulvin ultramicrosize tab 250 mg 4griseofulvin microsize susp 125 mg/5ml^ 2griseofulvin ultramicrosize tab 125 mg^ 2griseofulvin ultramicrosize tab 250 mg^ 2itraconazole cap 100 mg^ 2ketoconazole cream 2%^ 2ketoconazole shampoo 2%^ 2ketoconazole tab 200 mg^ 2LAMISIL - terbinafine hcl tab 250 mg 4LOPROX SHAMPOO - ciclopirox shampoo 1% 4MYCAMINE - micafungin sodium for iv soln 50 mg 5MYCAMINE - micafungin sodium for iv soln 100 mg 5NIZORAL - ketoconazole shampoo 2% 4NOXAFIL - posaconazole iv soln 300 mg/16.7ml (18 mg/ml) 4 PANOXAFIL - posaconazole susp 40 mg/ml 5 PANOXAFIL - posaconazole tab delayed release 100 mg 5 PAnystatin cream 100000 unit/gm^ 2nystatin oint 100000 unit/gm^ 2nystatin susp 100000 unit/ml^ 2nystatin tab 500000 unit^ 2nystatin topical powder 100000 unit/gm^ 2SPORANOX - itraconazole cap 100 mg 5SPORANOX PULSEPAK - itraconazole cap 100 mg 5TERAZOL 7 - terconazole vaginal cream 0.4% 4terbinafine hcl tab 250 mg^ 1terconazole vaginal cream 0.4%^ 2terconazole vaginal cream 0.8%^ 2terconazole vaginal suppos 80 mg^ 2VFEND IV - voriconazole for inj 200 mg 4 PAvoriconazole for inj 200 mg^ 2 PAvoriconazole for susp 40 mg/ml 5 PAvoriconazole tab 50 mg 5 PAvoriconazole tab 200 mg 5 PA

2018


31


Agentes contra la gotaallopurinol sodium for inj 500 mg^ 2allopurinol tab 100 mg^ 1allopurinol tab 300 mg^ 1ALOPRIM - allopurinol sodium for inj 500 mg 4colchicine w/ probenecid tab 0.5-500 mg^ 2COLCRYS - colchicine tab 0.6 mg 3probenecid tab 500 mg^ 2ULORIC - febuxostat tab 40 mg 3 STULORIC - febuxostat tab 80 mg 3 STZYLOPRIM - allopurinol tab 100 mg 4ZYLOPRIM - allopurinol tab 300 mg 4Agentes contra las migrañasAMERGE - naratriptan hcl tab 1 mg 4 QL (18 tablets/30 days)AMERGE - naratriptan hcl tab 2.5 mg 4 QL (18 tablets/30 days)IMITREX - sumatriptan nasal spray 5 mg/act 4 QL (12 units (2

packages)/30 days)IMITREX - sumatriptan nasal spray 20 mg/act 4 QL (12 units (2

packages)/30 days)IMITREX - sumatriptan succinate inj 6 mg/0.5ml 4IMITREX - sumatriptan succinate tab 25 mg 4 QL (18 tablets/30 days)IMITREX - sumatriptan succinate tab 50 mg 4 QL (18 tablets/30 days)IMITREX - sumatriptan succinate tab 100 mg 4 QL (18 tablets/30 days)IMITREX STATDOSE REFILL - sumatriptan succinate solution

cartridge 4 mg/0.5ml4

IMITREX STATDOSE REFILL - sumatriptan succinate solutioncartridge 6 mg/0.5ml

4

IMITREX STATDOSE SYSTEM - sumatriptan succinate solutionauto-injector 4 mg/0.5ml

4

IMITREX STATDOSE SYSTEM - sumatriptan succinate solutionauto-injector 6 mg/0.5ml

4

MAXALT - rizatriptan benzoate tab 5 mg 4 QL (18 tablets/30 days)MAXALT - rizatriptan benzoate tab 10 mg 4 QL (18 tablets/30 days)MAXALT-MLT - rizatriptan benzoate oral disintegrating tab 5 mg 4 QL (18 tablets/30 days)MAXALT-MLT - rizatriptan benzoate oral disintegrating tab 10 mg 4 QL (18 tablets/30 days)MIGERGOT - ergotamine w/ caffeine suppos 2-100 mg 5MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml 3 QL (8 mls/28 days)naratriptan hcl tab 1 mg^ 2 QL (18 tablets/30 days)naratriptan hcl tab 2.5 mg^ 2 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 5 mg^ 2 QL (18 tablets/30 days)

2018



rizatriptan benzoate oral disintegrating tab 10 mg^ 2 QL (18 tablets/30 days)rizatriptan benzoate tab 5 mg^ 2 QL (18 tablets/30 days)rizatriptan benzoate tab 10 mg^ 2 QL (18 tablets/30 days)sumatriptan nasal spray 5 mg/act^ 2 QL (12 units (2

packages)/30 days)sumatriptan nasal spray 20 mg/act^ 2 QL (12 units (2

packages)/30 days)SUMATRIPTAN SUCCINATE - sumatriptan succinate solution

prefilled syringe 6 mg/0.5ml^2

sumatriptan succinate inj 6 mg/0.5ml^ 2sumatriptan succinate solution auto-injector 4 mg/0.5ml^ 2sumatriptan succinate solution auto-injector 6 mg/0.5ml^ 2sumatriptan succinate solution cartridge 4 mg/0.5ml^ 2sumatriptan succinate solution cartridge 6 mg/0.5ml^ 2sumatriptan succinate tab 25 mg^ 2 QL (18 tablets/30 days)sumatriptan succinate tab 50 mg^ 2 QL (18 tablets/30 days)sumatriptan succinate tab 100 mg^ 2 QL (18 tablets/30 days)zolmitriptan orally disintegrating tab 2.5 mg^ 2 QL (12 tablets/30 days)zolmitriptan orally disintegrating tab 5 mg^ 2 QL (12 tablets/30 days)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 4MESTINON - pyridostigmine bromide syrup 60 mg/5ml 5MESTINON - pyridostigmine bromide tab 60 mg 5MESTINON TIMESPAN - pyridostigmine bromide tab er 180 mg 5pyridostigmine bromide tab er 180 mg^ 2pyridostigmine bromide tab 60 mg^ 2Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 4CYCLOSERINE - cycloserine cap 250 mg 5dapsone tab 25 mg^ 2dapsone tab 100 mg^ 2ethambutol hcl tab 100 mg^ 2ethambutol hcl tab 400 mg^ 2ISONIAZID - isoniazid inj 100 mg/ml 3isoniazid tab 100 mg^ 1isoniazid tab 300 mg^ 1MYCOBUTIN - rifabutin cap 150 mg 5PASER - aminosalicylic acid er granules packet 4 gm 4PRIFTIN - rifapentine tab 150 mg 4

2018


33


pyrazinamide tab 500 mg^ 2rifabutin cap 150 mg^ 2RIFADIN - rifampin cap 150 mg 4RIFADIN - rifampin for inj 600 mg 5rifampin cap 150 mg^ 2rifampin cap 300 mg^ 2rifampin for inj 600 mg 5SIRTURO - bedaquiline fumarate tab 100 mg 5TRECATOR - ethionamide tab 250 mg 4Medicamentos antineoplásicosABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 5AFINITOR - everolimus tab 2.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 7.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 10 mg 5 PA, QL (30 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 2 mg 5 PA, QL (60 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 3 mg 5 PA, QL (90 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 5 mg 5 PA, QL (60 tablets/30 days)ALECENSA - alectinib hcl cap 150 mg* 5 PA, QL (240 capsules/30 days)ALIMTA - pemetrexed disodium for iv soln 100 mg 5ALIMTA - pemetrexed disodium for iv soln 500 mg 5ALIQOPA - copanlisib hcl for iv soln 60 mg 5ALUNBRIG - brigatinib tab 30 mg 5 PA, QL (180 tablets/30 days)anastrozole tab 1 mg^ 1ARIMIDEX - anastrozole tab 1 mg 4AROMASIN - exemestane tab 25 mg 5ARRANON - nelarabine iv soln 5 mg/ml 5ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 5ARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 5AVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 5AVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 5BAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/

ml)5

BELEODAQ - belinostat for iv inj 500 mg* 5BENDEKA - bendamustine hcl iv soln 100 mg/4ml (25 mg/ml) 5BESPONSA - inotuzumab ozogamicin for iv soln 0.9 mg 5bexarotene cap 75 mg 5 PAbicalutamide tab 50 mg^ 2

2018



BICNU - carmustine for inj 100 mg 4bleomycin sulfate for inj 15 unit^ 2 BDbleomycin sulfate for inj 30 unit^ 2 BDBLINCYTO - blinatumomab for iv infusion 35 mcg* 5 BDBOSULIF - bosutinib tab 100 mg 5 PA, QL (120 tablets/30 days)BOSULIF - bosutinib tab 500 mg 5 PA, QL (30 tablets/30 days)busulfan inj 6 mg/ml 5CABOMETYX - cabozantinib s-malate tab 20 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 40 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 60 mg* 5 PA, QL (30 tablets/30 days)CAPRELSA - vandetanib tab 100 mg* 5 PA, QL (60 tablets/30 days)CAPRELSA - vandetanib tab 300 mg* 5 PA, QL (30 tablets/30 days)carboplatin iv soln 50 mg/5ml^ 2carboplatin iv soln 150 mg/15ml^ 2carboplatin iv soln 450 mg/45ml^ 2carboplatin iv soln 600 mg/60ml^ 2CASODEX - bicalutamide tab 50 mg 4CISPLATIN - cisplatin inj 200 mg/200ml (1 mg/ml)^ 2cisplatin inj 50 mg/50ml (1 mg/ml)^ 2cisplatin inj 100 mg/100ml (1 mg/ml)^ 2cladribine iv soln 10 mg/10ml (1 mg/ml) 5 BDclofarabine iv soln 1 mg/ml 5CLOLAR - clofarabine iv soln 1 mg/ml 5COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20 mg (100

dose) kit*5 PA, QL (56 capsules/28 days)

COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 3 x 20 mg (140dose) kit*


COMETRIQ - cabozantinib s-malate cap 3 x 20 mg (60 mg dose)kit*


COSMEGEN - dactinomycin for inj 0.5 mg 5COTELLIC - cobimetinib fumarate tab 20 mg* 5 PA, QL (63 tablets/28 days)CYCLOPHOSPHAMIDE - cyclophosphamide cap 25 mg 4 BDCYCLOPHOSPHAMIDE - cyclophosphamide cap 50 mg 4 BDcyclophosphamide for inj 500 mg 5cyclophosphamide for inj 1 gm 5cyclophosphamide for inj 2 gm 5CYRAMZA - ramucirumab iv soln 100 mg/10ml (for infusion)* 5CYRAMZA - ramucirumab iv soln 500 mg/50ml (for infusion)* 5CYTARABINE - cytarabine inj 20 mg/ml^ 2 BD

2018


35


cytarabine inj pf 20 mg/ml^ 2 BDcytarabine inj pf 100 mg/ml^ 2 BDDACARBAZINE - dacarbazine for inj 100 mg 4dacarbazine for inj 200 mg^ 2DARZALEX - daratumumab iv soln 100 mg/5ml* 5DARZALEX - daratumumab iv soln 400 mg/20ml* 5daunorubicin hcl inj 5 mg/ml^ 2decitabine for inj 50 mg 5dexrazoxane for inj 250 mg 5dexrazoxane for inj 500 mg 5DOCETAXEL - docetaxel for inj conc 20 mg/ml 5DOCETAXEL - docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5DOCETAXEL - docetaxel for inj conc 160 mg/8ml (20 mg/ml) 5DOCETAXEL - docetaxel for inj conc 200 mg/10ml (20 mg/ml) 5DOCETAXEL - docetaxel soln for iv infusion 20 mg/2ml 5DOCETAXEL - docetaxel soln for iv infusion 80 mg/8ml 5DOCETAXEL - docetaxel soln for iv infusion 160 mg/16ml 5DOCETAXEL - docetaxel soln for iv infusion 200 mg/20ml 5docetaxel for inj conc 20 mg/ml 5docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5DOXORUBICIN HCL - doxorubicin hcl for inj 10 mg 4 BDDOXORUBICIN HCL - doxorubicin hcl for inj 50 mg 4 BDdoxorubicin hcl inj 2 mg/ml^ 2 BDdoxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml 5 BDELITEK - rasburicase for iv soln 1.5 mg 5ELITEK - rasburicase for iv soln 7.5 mg 5EMCYT - estramustine phosphate sodium cap 140 mg 4EMPLICITI - elotuzumab for iv soln 300 mg 5EMPLICITI - elotuzumab for iv soln 400 mg 5epirubicin hcl iv soln 50 mg/25ml (2 mg/ml)^ 2epirubicin hcl iv soln 200 mg/100ml (2 mg/ml)^ 2ERBITUX - cetuximab iv soln 100 mg/50ml (2 mg/ml) 5ERBITUX - cetuximab iv soln 200 mg/100ml (2 mg/ml) 5ERIVEDGE - vismodegib cap 150 mg* 5 PA, QL (30 capsules/30 days)ERWINAZE - asparaginase erwinia chrysanthemi for inj 10000

unit5

ETHYOL - amifostine for inj 500 mg 5ETOPOPHOS - etoposide phosphate iv for inj 100 mg 4

2018



etoposide inj 100 mg/5ml (20 mg/ml)^ 2etoposide inj 500 mg/25ml (20 mg/ml)^ 2etoposide inj 1 gm/50ml (20 mg/ml)^ 2EVOMELA - melphalan hcl for inj 50 mg* 5exemestane tab 25 mg^ 2FARESTON - toremifene citrate tab 60 mg 5FARYDAK - panobinostat lactate cap 10 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 15 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 20 mg* 5 PA, QL (6 capsules/21 days)FASLODEX - fulvestrant inj 250 mg/5ml 5FEMARA - letrozole tab 2.5 mg 5fludarabine phosphate for inj 50 mg^ 2fludarabine phosphate inj 25 mg/ml^ 2fluorouracil inj 500 mg/10ml (50 mg/ml)^ 1 BDfluorouracil inj 1 gm/20ml (50 mg/ml)^ 1 BDfluorouracil inj 2.5 gm/50ml (50 mg/ml)^ 1 BDfluorouracil inj 5 gm/100ml (50 mg/ml)^ 1 BDflutamide cap 125 mg^ 2FOLOTYN - pralatrexate iv inj 20 mg/ml 5FOLOTYN - pralatrexate iv inj 40 mg/2ml 5GAZYVA - obinutuzumab soln for iv infusion 1000 mg/40ml

(25 mg/ml)5

gemcitabine hcl for inj 200 mg^ 2gemcitabine hcl for inj 1 gm^ 2gemcitabine hcl for inj 2 gm^ 2gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml)^ 2gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml)^ 2gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml)^ 2GILOTRIF - afatinib dimaleate tab 20 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 30 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 40 mg 5 PA, QL (30 tablets/30 days)GLEEVEC - imatinib mesylate tab 100 mg 5 PA, QL (90 tablets/30 days)GLEEVEC - imatinib mesylate tab 400 mg 5 PA, QL (60 tablets/30 days)GLEOSTINE - lomustine cap 5 mg 4GLEOSTINE - lomustine cap 10 mg 4GLEOSTINE - lomustine cap 40 mg 4GLEOSTINE - lomustine cap 100 mg 4HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 5

2018


37


HERCEPTIN - trastuzumab for iv soln 150 mg* 5HERCEPTIN - trastuzumab for iv soln 440 mg* 5HEXALEN - altretamine cap 50 mg 5 PAHYDREA - hydroxyurea cap 500 mg 4hydroxyurea cap 500 mg^ 2IBRANCE - palbociclib cap 75 mg* 5 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 100 mg* 5 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 125 mg* 5 PA, QL (21 capsules/28 days)ICLUSIG - ponatinib hcl tab 15 mg 5 PA, QL (60 tablets/30 days)ICLUSIG - ponatinib hcl tab 45 mg 5 PA, QL (30 tablets/30 days)idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 5idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) 5idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) 5IDHIFA - enasidenib mesylate tab 50 mg 5 PA, QL (30 tablets/30 days)IDHIFA - enasidenib mesylate tab 100 mg 5 PA, QL (30 tablets/30 days)IFEX - ifosfamide for inj 3 gm 4IFOSFAMIDE - ifosfamide for inj 3 gm 4ifosfamide for inj 1 gm^ 2ifosfamide iv inj 1 gm/20ml (50 mg/ml)^ 2ifosfamide iv inj 3 gm/60ml (50 mg/ml)^ 2imatinib mesylate tab 100 mg 5 PA, QL (90 tablets/30 days)imatinib mesylate tab 400 mg 5 PA, QL (60 tablets/30 days)IMBRUVICA - ibrutinib cap 140 mg 5 PA, QL (120 capsules/30 days)IMFINZI - durvalumab soln for iv infusion 120 mg/2.4ml (50 mg/ml) 5IMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 5IMLYGIC - talimogene laherparepvec intralesional inj 1000000

unit/ml*4

IMLYGIC - talimogene laherparepvec intralesional inj 100000000unit/ml*

5

INLYTA - axitinib tab 1 mg* 5 PA, QL (180 tablets/30 days)INLYTA - axitinib tab 5 mg* 5 PA, QL (120 tablets/30 days)IRESSA - gefitinib tab 250 mg* 5 PA, QL (30 tablets/30 days)IRINOTECAN - irinotecan hcl inj 500 mg/25ml (20 mg/ml)^ 2irinotecan hcl inj 40 mg/2ml (20 mg/ml)^ 2irinotecan hcl inj 100 mg/5ml (20 mg/ml)^ 2ISTODAX - romidepsin for iv inj 10 mg 5ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 5IXEMPRA KIT - ixabepilone for iv infusion 15 mg 5

2018



IXEMPRA KIT - ixabepilone for iv infusion 45 mg 5JAKAFI - ruxolitinib phosphate tab 5 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 10 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 15 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 20 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 25 mg* 5 PA, QL (60 tablets/30 days)JEVTANA - cabazitaxel inj 60 mg/1.5ml (for iv infusion) 5KADCYLA - ado-trastuzumab emtansine for iv soln 100 mg 5KADCYLA - ado-trastuzumab emtansine for iv soln 160 mg 5KEYTRUDA - pembrolizumab for iv soln 50 mg* 5KEYTRUDA - pembrolizumab iv soln 100 mg/4ml (25 mg/ml)* 5KISQALI - ribociclib succinate tab 200 mg 5 PA, QL (63 tablets/28 days)KISQALI FEMARA 200 DOSE - ribociclib tab 200 mg & letrozole

tab 2.5 mg therapy pack5 PA, QL (91 tablets/28 days)

KISQALI FEMARA 400 DOSE - ribociclib tab 200 mg & letrozoletab 2.5 mg therapy pack

5 PA, QL (91 tablets/28 days)

KISQALI FEMARA 600 DOSE - ribociclib tab 200 mg & letrozoletab 2.5 mg therapy pack


KYPROLIS - carfilzomib for inj 30 mg 5KYPROLIS - carfilzomib for inj 60 mg 5LARTRUVO - olaratumab soln for iv infusion 190 mg/19ml (10 mg/

ml)5

LARTRUVO - olaratumab soln for iv infusion 500 mg/50ml (10 mg/ml)

5

LENVIMA 10 MG DAILY DOSE - lenvatinib cap therapy pack10 mg*


LENVIMA 14 MG DAILY DOSE - lenvatinib cap therapy pack 10 &4 mg*


LENVIMA 18 MG DAILY DOSE - lenvatinib cap therapy pack 10 &4 (2) mg*


LENVIMA 20 MG DAILY DOSE - lenvatinib cap therapy pack 10(2) mg*


LENVIMA 24 MG DAILY DOSE - lenvatinib cap therapy pack 10(2) & 4 mg*


LENVIMA 8 MG DAILY DOSE - lenvatinib cap therapy pack 4(2) mg*


letrozole tab 2.5 mg^ 1LEUCOVORIN CALCIUM - leucovorin calcium for inj 500 mg^ 2LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 3LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 4leucovorin calcium for inj 50 mg^ 2

2018


39


leucovorin calcium for inj 100 mg^ 2leucovorin calcium for inj 200 mg^ 2leucovorin calcium for inj 350 mg^ 2leucovorin calcium tab 5 mg^ 2leucovorin calcium tab 25 mg^ 2LEUKERAN - chlorambucil tab 2 mg 3LONSURF - trifluridine-tipiracil tab 15-6.14 mg 5 PA, QL (100 tablets/28 days)LONSURF - trifluridine-tipiracil tab 20-8.19 mg 5 PA, QL (80 tablets/28 days)LYNPARZA - olaparib cap 50 mg* 5 PA, QL (480 capsules/30 days)LYNPARZA - olaparib tab 100 mg* 5 PA, QL (120 tablets/30 days)LYNPARZA - olaparib tab 150 mg* 5 PA, QL (120 tablets/30 days)MARQIBO - vincristine sulfate liposome iv susp 5 mg/31ml

(0.16 mg/ml)5

MATULANE - procarbazine hcl cap 50 mg* 5 PAMEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg* 5 PA, QL (90 tablets/30 days)MEKINIST - trametinib dimethyl sulfoxide tab 2 mg* 5 PA, QL (30 tablets/30 days)melphalan hcl for inj 50 mg 5mercaptopurine tab 50 mg^ 2mesna inj 100 mg/ml^ 2MESNEX - mesna tab 400 mg 4MITOMYCIN - mitomycin for iv soln 5 mg 4mitomycin for iv soln 20 mg^ 2mitomycin for iv soln 40 mg 5mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml)^ 2mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml)^ 2mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml)^ 2MUSTARGEN - mechlorethamine hcl for inj 10 mg 4MYLOTARG - gemtuzumab ozogamicin for iv soln 4.5 mg 5NERLYNX - neratinib maleate tab 40 mg 5 PA, QL (180 tablets/30 days)NEXAVAR - sorafenib tosylate tab 200 mg* 5 PA, QL (120 tablets/30 days)NILANDRON - nilutamide tab 150 mg 5nilutamide tab 150 mg 5NINLARO - ixazomib citrate cap 2.3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 4 mg 5 PA, QL (3 capsules/28 days)NIPENT - pentostatin for inj 10 mg 5ODOMZO - sonidegib phosphate cap 200 mg* 5 PA, QL (30 capsules/30 days)ONCASPAR - pegaspargase inj 750 unit/ml 5

2018



ONIVYDE - irinotecan hcl liposome iv inj 43 mg/10ml (4.3 mg/ml) 5OPDIVO - nivolumab iv soln 40 mg/4ml* 5OPDIVO - nivolumab iv soln 100 mg/10ml* 5oxaliplatin for iv inj 50 mg 5oxaliplatin for iv inj 100 mg 5oxaliplatin iv soln 50 mg/10ml^ 2oxaliplatin iv soln 100 mg/20ml^ 2paclitaxel iv conc 30 mg/5ml (6 mg/ml)^ 2paclitaxel iv conc 100 mg/16.7ml (6 mg/ml)^ 2paclitaxel iv conc 300 mg/50ml (6 mg/ml)^ 2PANRETIN - alitretinoin gel 0.1% 5PERJETA - pertuzumab soln for iv infusion 420 mg/14ml (30 mg/

ml)*5

POMALYST - pomalidomide cap 1 mg* 5 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 2 mg* 5 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 3 mg* 5 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 4 mg* 5 PA, QL (21 capsules/28 days)PORTRAZZA - necitumumab iv soln 800 mg/50ml (16 mg/ml)* 5PROLEUKIN - aldesleukin for iv soln 22000000 unit 5PURIXAN - mercaptopurine susp 2000 mg/100ml (20 mg/ml)* 5REVLIMID - lenalidomide caps 2.5 mg* 5 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 5 mg* 5 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 10 mg* 5 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 15 mg* 5 PA, QL (21 capsules/28 days)REVLIMID - lenalidomide cap 20 mg* 5 PA, QL (21 capsules/28 days)REVLIMID - lenalidomide cap 25 mg* 5 PA, QL (21 capsules/28 days)RITUXAN - rituximab iv soln 100 mg/10ml* 5 PARITUXAN - rituximab iv soln 500 mg/50ml* 5 PARITUXAN HYCELA - rituximab-hyaluronidase human inj

1400-23400 mg-unit/11.7ml5 PA

RITUXAN HYCELA - rituximab-hyaluronidase human inj1600-26800 mg-unit/13.4ml

5 PA

RUBRACA - rucaparib camsylate tab 200 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 250 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 300 mg 5 PA, QL (120 tablets/30 days)RYDAPT - midostaurin cap 25 mg 5 PA, QL (240 capsules/30 days)SOLTAMOX - tamoxifen citrate oral soln 10 mg/5ml 4SPRYCEL - dasatinib tab 20 mg 5 PA, QL (90 tablets/30 days)SPRYCEL - dasatinib tab 50 mg 5 PA, QL (30 tablets/30 days)

2018


41


SPRYCEL - dasatinib tab 70 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 80 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 100 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 140 mg 5 PA, QL (30 tablets/30 days)STIVARGA - regorafenib tab 40 mg* 5 PA, QL (84 tablets/28 days)SUTENT - sunitinib malate cap 12.5 mg 5 PA, QL (90 capsules/30 days)SUTENT - sunitinib malate cap 25 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 37.5 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 50 mg 5 PA, QL (30 capsules/30 days)SYNRIBO - omacetaxine mepesuccinate for inj 3.5 mg 5TABLOID - thioguanine tab 40 mg 4TAFINLAR - dabrafenib mesylate cap 50 mg* 5 PA, QL (120 capsules/30 days)TAFINLAR - dabrafenib mesylate cap 75 mg* 5 PA, QL (120 capsules/30 days)TAGRISSO - osimertinib mesylate tab 40 mg* 5 PA, QL (30 tablets/30 days)TAGRISSO - osimertinib mesylate tab 80 mg* 5 PA, QL (30 tablets/30 days)tamoxifen citrate tab 10 mg^ 2tamoxifen citrate tab 20 mg^ 2TARCEVA - erlotinib hcl tab 25 mg 5 PA, QL (60 tablets/30 days)TARCEVA - erlotinib hcl tab 100 mg 5 PA, QL (30 tablets/30 days)TARCEVA - erlotinib hcl tab 150 mg 5 PA, QL (30 tablets/30 days)TARGRETIN - bexarotene cap 75 mg 5 PATARGRETIN - bexarotene gel 1% 5TASIGNA - nilotinib hcl cap 150 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 200 mg 5 PA, QL (120 capsules/30 days)TAXOTERE - docetaxel for inj conc 20 mg/ml 5TAXOTERE - docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5TECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 5TEMODAR - temozolomide for iv soln 100 mg 5THALOMID - thalidomide cap 50 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 100 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 150 mg 5 PA, QL (60 capsules/30 days)THALOMID - thalidomide cap 200 mg 5 PA, QL (60 capsules/30 days)thiotepa for inj 15 mg 5TOPOTECAN HCL - topotecan hcl inj 4 mg/4ml (for infusion) 5topotecan hcl for inj 4 mg 5TORISEL - temsirolimus soln for iv infusion 25 mg/ml 5TREANDA - bendamustine hcl for iv soln 25 mg 5TREANDA - bendamustine hcl for iv soln 100 mg 5

2018



tretinoin cap 10 mg 5 PATRISENOX - arsenic trioxide inj 10 mg/10ml (1 mg/ml) 4TYKERB - lapatinib ditosylate tab 250 mg* 5 PA, QL (180 tablets/30 days)UNITUXIN - dinutuximab iv soln 17.5 mg/5ml (3.5 mg/ml)* 5VALCHLOR - mechlorethamine hcl gel 0.016%* 5VECTIBIX - panitumumab iv soln 100 mg/5ml 5VECTIBIX - panitumumab iv soln 400 mg/20ml 5VELCADE - bortezomib for inj 3.5 mg 5VENCLEXTA - venetoclax tab 10 mg* 3 PA, QL (60 tablets/30 days)VENCLEXTA - venetoclax tab 50 mg* 4 PA, QL (30 tablets/30 days)VENCLEXTA - venetoclax tab 100 mg* 5 PA, QL (120 tablets/30 days)VENCLEXTA STARTING PACK - venetoclax tab therapy starter

pack 10 & 50 & 100 mg*5 PA, QL (1 pack (42

tablets)/28 days)VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 4 BDvincristine sulfate iv soln 1 mg/ml^ 2 BDvinorelbine tartrate inj 10 mg/ml^ 2vinorelbine tartrate inj 50 mg/5ml (10 mg/ml)^ 2VOTRIENT - pazopanib hcl tab 200 mg* 5 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 5XALKORI - crizotinib cap 200 mg* 5 PA, QL (60 capsules/30 days)XALKORI - crizotinib cap 250 mg* 5 PA, QL (60 capsules/30 days)XTANDI - enzalutamide cap 40 mg* 5 PA, QL (120 capsules/30 days)YERVOY - ipilimumab soln for iv infusion 50 mg/10ml (5 mg/ml)* 5YERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 5YONDELIS - trabectedin for inj 1 mg 5ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 5ZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 5ZANOSAR - streptozocin for inj 1 gm 4ZEJULA - niraparib tosylate cap 100 mg 5 PA, QL (90 capsules/30 days)ZELBORAF - vemurafenib tab 240 mg* 5 PA, QL (240 tablets/30 days)ZOLINZA - vorinostat cap 100 mg 5 PA, QL (120 capsules/30 days)ZYDELIG - idelalisib tab 100 mg* 5 PA, QL (60 tablets/30 days)ZYDELIG - idelalisib tab 150 mg* 5 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 5 PA, QL (150 capsules/30 days)ZYTIGA - abiraterone acetate tab 250 mg* 5 PA, QL (120 tablets/30 days)ZYTIGA - abiraterone acetate tab 500 mg* 5 PA, QL (60 tablets/30 days)Medicamentos antiparasitariosALBENZA - albendazole tab 200 mg 5

2018


43


ALINIA - nitazoxanide for susp 100 mg/5ml 5ALINIA - nitazoxanide tab 500 mg 5atovaquone susp 750 mg/5ml 5atovaquone-proguanil hcl tab 62.5-25 mg^ 2atovaquone-proguanil hcl tab 250-100 mg^ 2BILTRICIDE - praziquantel tab 600 mg 4CHLOROQUINE PHOSPHATE - chloroquine phosphate tab

250 mg3

chloroquine phosphate tab 500 mg^ 2COARTEM - artemether-lumefantrine tab 20-120 mg 4DARAPRIM - pyrimethamine tab 25 mg 5hydroxychloroquine sulfate tab 200 mg^ 2ivermectin tab 3 mg^ 2LINDANE - lindane shampoo 1% 3MALARONE - atovaquone-proguanil hcl tab 62.5-25 mg 4MALARONE - atovaquone-proguanil hcl tab 250-100 mg 4malathion lotion 0.5%^ 2mefloquine hcl tab 250 mg^ 2NEBUPENT - pentamidine isethionate for nebulization soln

300 mg4 BD

OVIDE - malathion lotion 0.5% 4PENTAM 300 - pentamidine isethionate for soln 300 mg 4 BDpermethrin cream 5%^ 2PLAQUENIL - hydroxychloroquine sulfate tab 200 mg 4PRIMAQUINE PHOSPHATE - primaquine phosphate tab 26.3 mg 4STROMECTOL - ivermectin tab 3 mg 4Agentes contra la enfermedad de Parkinsonamantadine hcl cap 100 mg^ 2amantadine hcl syrup 50 mg/5ml^ 2amantadine hcl tab 100 mg^ 2APOKYN - apomorphine hcl soln cartridge 30 mg/3ml* 5 PA, QL (60 mls/30 days)AZILECT - rasagiline mesylate tab 0.5 mg 4AZILECT - rasagiline mesylate tab 1 mg 4benztropine mesylate tab 0.5 mg# 3 PAbenztropine mesylate tab 1 mg# 3 PAbenztropine mesylate tab 2 mg# 3 PAbromocriptine mesylate cap 5 mg^ 2bromocriptine mesylate tab 2.5 mg^ 2

2018



carbidopa & levodopa orally disintegrating tab 10-100 mg^ 2carbidopa & levodopa orally disintegrating tab 25-100 mg^ 2carbidopa & levodopa orally disintegrating tab 25-250 mg^ 2carbidopa & levodopa tab er 25-100 mg^ 2carbidopa & levodopa tab er 50-200 mg^ 2carbidopa & levodopa tab 10-100 mg^ 2carbidopa & levodopa tab 25-100 mg^ 2carbidopa & levodopa tab 25-250 mg^ 2carbidopa tab 25 mg 5CARBIDOPA/LEVODOPA/ENTACAPONE - carbidopa-levodopa-

entacapone tabs 12.5-50-200 mg3

CARBIDOPA/LEVODOPA/ENTACAPONE - carbidopa-levodopa-entacapone tabs 18.75-75-200 mg

3

CARBIDOPA/LEVODOPA/ENTACAPONE - carbidopa-levodopa-entacapone tabs 25-100-200 mg

3


3


3

CARBIDOPA/LEVODOPA/ENTACAPONE - carbidopa-levodopa-entacapone tabs 50-200-200 mg

3

COMTAN - entacapone tab 200 mg 5ELDEPRYL - selegiline hcl cap 5 mg 4entacapone tab 200 mg^ 2MIRAPEX - pramipexole dihydrochloride tab 0.125 mg 4MIRAPEX - pramipexole dihydrochloride tab 0.25 mg 4MIRAPEX - pramipexole dihydrochloride tab 0.5 mg 4MIRAPEX - pramipexole dihydrochloride tab 0.75 mg 4MIRAPEX - pramipexole dihydrochloride tab 1 mg 4MIRAPEX - pramipexole dihydrochloride tab 1.5 mg 4NEUPRO - rotigotine td patch 24hr 1 mg/24hr 3NEUPRO - rotigotine td patch 24hr 2 mg/24hr 3NEUPRO - rotigotine td patch 24hr 3 mg/24hr 3NEUPRO - rotigotine td patch 24hr 4 mg/24hr 3NEUPRO - rotigotine td patch 24hr 6 mg/24hr 3NEUPRO - rotigotine td patch 24hr 8 mg/24hr 3pramipexole dihydrochloride tab 0.125 mg^ 1pramipexole dihydrochloride tab 0.25 mg^ 1pramipexole dihydrochloride tab 0.5 mg^ 1

2018


45


pramipexole dihydrochloride tab 0.75 mg^ 1pramipexole dihydrochloride tab 1 mg^ 1pramipexole dihydrochloride tab 1.5 mg^ 1rasagiline mesylate tab 0.5 mg^ 2rasagiline mesylate tab 1 mg^ 2REQUIP - ropinirole hydrochloride tab 0.25 mg 4REQUIP - ropinirole hydrochloride tab 0.5 mg 4REQUIP - ropinirole hydrochloride tab 1 mg 4REQUIP - ropinirole hydrochloride tab 2 mg 4REQUIP - ropinirole hydrochloride tab 3 mg 4REQUIP - ropinirole hydrochloride tab 4 mg 4REQUIP - ropinirole hydrochloride tab 5 mg 4ropinirole hydrochloride tab er 24hr 2 mg^ 2ropinirole hydrochloride tab er 24hr 4 mg^ 2ropinirole hydrochloride tab er 24hr 6 mg^ 2ropinirole hydrochloride tab er 24hr 8 mg^ 2ropinirole hydrochloride tab er 24hr 12 mg^ 2ropinirole hydrochloride tab 0.25 mg^ 2ropinirole hydrochloride tab 0.5 mg^ 2ropinirole hydrochloride tab 1 mg^ 2ropinirole hydrochloride tab 2 mg^ 2ropinirole hydrochloride tab 3 mg^ 2ropinirole hydrochloride tab 4 mg^ 2ropinirole hydrochloride tab 5 mg^ 2selegiline hcl cap 5 mg^ 2selegiline hcl tab 5 mg^ 2SINEMET - carbidopa & levodopa tab 10-100 mg 4SINEMET - carbidopa & levodopa tab 25-100 mg 4SINEMET - carbidopa & levodopa tab 25-250 mg 4SINEMET CR - carbidopa & levodopa tab er 25-100 mg 4SINEMET CR - carbidopa & levodopa tab er 50-200 mg 4TASMAR - tolcapone tab 100 mg 5tolcapone tab 100 mg 5Medicamentos antipsicóticosABILIFY - aripiprazole tab 2 mg 5 PA, QL (45 tablets/30 days)ABILIFY - aripiprazole tab 5 mg 5 PA, QL (45 tablets/30 days)ABILIFY - aripiprazole tab 10 mg 5 PA, QL (30 tablets/30 days)ABILIFY - aripiprazole tab 15 mg 5 PA, QL (30 tablets/30 days)

2018



ABILIFY - aripiprazole tab 20 mg 5 PA, QL (30 tablets/30 days)ABILIFY - aripiprazole tab 30 mg 5 PA, QL (30 tablets/30 days)ADASUVE - loxapine aerosol powder breath activated 10 mg 4 PAaripiprazole oral solution 1 mg/ml^ 2 PA, QL (750 mls/30 days)aripiprazole orally disintegrating tab 10 mg 5 PA, QL (60 tablets/30 days)aripiprazole orally disintegrating tab 15 mg 5 PA, QL (60 tablets/30 days)aripiprazole tab 2 mg^ 2 PA, QL (45 tablets/30 days)aripiprazole tab 5 mg^ 2 PA, QL (45 tablets/30 days)aripiprazole tab 10 mg^ 2 PA, QL (30 tablets/30 days)aripiprazole tab 15 mg^ 2 PA, QL (30 tablets/30 days)aripiprazole tab 20 mg^ 2 PA, QL (30 tablets/30 days)aripiprazole tab 30 mg^ 2 PA, QL (30 tablets/30 days)ARISTADA - aripiprazole lauroxil im er susp prefilled syr

441 mg/1.6ml5 PA, QL (1 syringe/28 days)

ARISTADA - aripiprazole lauroxil im er susp prefilled syr662 mg/2.4ml

5 PA, QL (1 syringe/28 days)





clozapine orally disintegrating tab 25 mg^ 2 PA, QL (270 tablets/30 days)clozapine orally disintegrating tab 100 mg^ 2 PA, QL (270 tablets/30 days)clozapine tab 25 mg^ 2 PA, QL (90 tablets/30 days)clozapine tab 50 mg^ 2 PA, QL (90 tablets/30 days)clozapine tab 100 mg^ 2 PA, QL (270 tablets/30 days)clozapine tab 200 mg^ 2 PA, QL (120 tablets/30 days)CLOZARIL - clozapine tab 25 mg 4 PA, QL (90 tablets/30 days)CLOZARIL - clozapine tab 100 mg 4 PA, QL (270 tablets/30 days)FANAPT - iloperidone tab 1 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 2 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 4 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 6 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 8 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 10 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 12 mg 5 PA, QL (60 tablets/30 days)FANAPT TITRATION PACK - iloperidone tab 1 mg & 2 mg & 4 mg

& 6 mg titration pak4 PA, QL (7 packs (56

tablets)/28 days)FAZACLO - clozapine orally disintegrating tab 25 mg 4 PA, QL (270 tablets/30 days)FAZACLO - clozapine orally disintegrating tab 100 mg 4 PA, QL (270 tablets/30 days)

2018


47


fluphenazine decanoate inj 25 mg/ml^ 2 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 4 PAfluphenazine hcl tab 1 mg^ 2 PAfluphenazine hcl tab 2.5 mg^ 2 PAfluphenazine hcl tab 5 mg^ 2 PAfluphenazine hcl tab 10 mg^ 2 PAGEODON - ziprasidone hcl cap 20 mg 5 PA, QL (90 capsules/30 days)GEODON - ziprasidone hcl cap 40 mg 5 PA, QL (90 capsules/30 days)GEODON - ziprasidone hcl cap 60 mg 5 PA, QL (60 capsules/30 days)GEODON - ziprasidone hcl cap 80 mg 5 PA, QL (60 capsules/30 days)GEODON - ziprasidone mesylate for inj 20 mg 4 PA, QL (60 vials/30 days)HALDOL - haloperidol lactate inj 5 mg/ml 4 PAHALDOL DECANOATE 100 - haloperidol decanoate im soln

100 mg/ml4 PA

HALDOL DECANOATE 50 - haloperidol decanoate im soln 50 mg/ml

4 PA

haloperidol decanoate im soln 50 mg/ml^ 2 PAhaloperidol decanoate im soln 100 mg/ml^ 2 PAhaloperidol lactate inj 5 mg/ml^ 2 PAhaloperidol lactate oral conc 2 mg/ml^ 2 PAhaloperidol tab 0.5 mg^ 2 PAhaloperidol tab 1 mg^ 2 PAhaloperidol tab 2 mg^ 2 PAhaloperidol tab 5 mg^ 2 PAhaloperidol tab 10 mg^ 2 PAhaloperidol tab 20 mg^ 2 PAINVEGA - paliperidone tab er 24hr 1.5 mg 5 PA, QL (30 tablets/30 days)INVEGA - paliperidone tab er 24hr 3 mg 5 PA, QL (30 tablets/30 days)INVEGA - paliperidone tab er 24hr 6 mg 5 PA, QL (60 tablets/30 days)INVEGA - paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)INVEGA SUSTENNA - paliperidone palmitate im extend-release

susp 117 mg/0.75ml5 PA, QL (1 kit/28 days)

INVEGA SUSTENNA - paliperidone palmitate im extended-release susp 39 mg/0.25ml

4 PA, QL (1 kit/28 days)



2018



INVEGA SUSTENNA - paliperidone palmitate im extended-release susp 156 mg/ml




INVEGA TRINZA - paliperidone palmitate im extend-release susp273 mg/0.875ml








LATUDA - lurasidone hcl tab 20 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 40 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 60 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 80 mg 5 PA, QL (60 tablets/30 days)LATUDA - lurasidone hcl tab 120 mg 5 PA, QL (30 tablets/30 days)loxapine succinate cap 5 mg^ 2 PAloxapine succinate cap 10 mg^ 2 PAloxapine succinate cap 25 mg^ 2 PAloxapine succinate cap 50 mg^ 2 PANUPLAZID - pimavanserin tartrate tab 17 mg* 5 PA, QL (60 tablets/30 days)olanzapine for im inj 10 mg^ 2 PA, QL (90 vials/30 days)olanzapine orally disintegrating tab 5 mg^ 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 10 mg^ 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 15 mg^ 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 20 mg^ 2 PA, QL (30 tablets/30 days)olanzapine tab 2.5 mg^ 2 PA, QL (45 tablets/30 days)olanzapine tab 5 mg^ 2 PA, QL (45 tablets/30 days)olanzapine tab 7.5 mg^ 2 PA, QL (45 tablets/30 days)olanzapine tab 10 mg^ 2 PA, QL (45 tablets/30 days)olanzapine tab 15 mg^ 2 PA, QL (30 tablets/30 days)olanzapine tab 20 mg^ 2 PA, QL (30 tablets/30 days)ORAP - pimozide tab 1 mg 4ORAP - pimozide tab 2 mg 4paliperidone tab er 24hr 1.5 mg^ 2 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg^ 2 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg^ 2 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)

2018


49


pimozide tab 1 mg^ 2pimozide tab 2 mg^ 2quetiapine fumarate tab er 24hr 50 mg^ 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 150 mg^ 2 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 200 mg^ 2 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 300 mg^ 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 400 mg^ 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab 25 mg^ 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 50 mg^ 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 100 mg^ 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 200 mg^ 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 300 mg^ 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab 400 mg^ 2 PA, QL (60 tablets/30 days)REXULTI - brexpiprazole tab 0.25 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 0.5 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 1 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 2 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 3 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 4 mg 5 PA, QL (30 tablets/30 days)RISPERDAL - risperidone soln 1 mg/ml 4 PA, QL (480 mls/30 days)RISPERDAL - risperidone tab 0.25 mg 4 PA, QL (60 tablets/30 days)RISPERDAL - risperidone tab 0.5 mg 4 PA, QL (60 tablets/30 days)RISPERDAL - risperidone tab 1 mg 4 PA, QL (60 tablets/30 days)RISPERDAL - risperidone tab 2 mg 4 PA, QL (60 tablets/30 days)RISPERDAL - risperidone tab 3 mg 5 PA, QL (60 tablets/30 days)RISPERDAL - risperidone tab 4 mg 5 PA, QL (120 tablets/30 days)RISPERDAL CONSTA - risperidone microspheres for inj 12.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 5 PA, QL (2 vials/28 days)RISPERDAL M-TAB - risperidone orally disintegrating tab 0.5 mg 4 PA, QL (60 tablets/30 days)RISPERDAL M-TAB - risperidone orally disintegrating tab 1 mg 4 PA, QL (60 tablets/30 days)RISPERDAL M-TAB - risperidone orally disintegrating tab 2 mg 4 PA, QL (60 tablets/30 days)RISPERDAL M-TAB - risperidone orally disintegrating tab 3 mg 4 PA, QL (60 tablets/30 days)RISPERDAL M-TAB - risperidone orally disintegrating tab 4 mg 4 PA, QL (120 tablets/30 days)risperidone orally disintegrating tab 0.25 mg^ 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 0.5 mg^ 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 1 mg^ 2 PA, QL (60 tablets/30 days)

2018



risperidone orally disintegrating tab 2 mg^ 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 3 mg^ 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 4 mg^ 2 PA, QL (120 tablets/30 days)risperidone soln 1 mg/ml^ 2 PA, QL (480 mls/30 days)risperidone tab 0.25 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 0.5 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 1 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 2 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 3 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 4 mg^ 1 PA, QL (120 tablets/30 days)SAPHRIS - asenapine maleate sl tab 2.5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 10 mg 4 PA, QL (60 tablets/30 days)SEROQUEL - quetiapine fumarate tab 25 mg 4 PA, QL (120 tablets/30 days)SEROQUEL - quetiapine fumarate tab 50 mg 4 PA, QL (120 tablets/30 days)SEROQUEL - quetiapine fumarate tab 100 mg 4 PA, QL (120 tablets/30 days)SEROQUEL - quetiapine fumarate tab 200 mg 4 PA, QL (120 tablets/30 days)SEROQUEL - quetiapine fumarate tab 300 mg 4 PA, QL (60 tablets/30 days)SEROQUEL - quetiapine fumarate tab 400 mg 4 PA, QL (60 tablets/30 days)SEROQUEL XR - quetiapine fumarate tab er 24hr 50 mg 4 PA, QL (60 tablets/30 days)SEROQUEL XR - quetiapine fumarate tab er 24hr 150 mg 4 PA, QL (30 tablets/30 days)SEROQUEL XR - quetiapine fumarate tab er 24hr 200 mg 4 PA, QL (30 tablets/30 days)SEROQUEL XR - quetiapine fumarate tab er 24hr 300 mg 4 PA, QL (60 tablets/30 days)SEROQUEL XR - quetiapine fumarate tab er 24hr 400 mg 4 PA, QL (60 tablets/30 days)thioridazine hcl tab 10 mg 4 PAthioridazine hcl tab 25 mg 4 PAthioridazine hcl tab 50 mg 4 PAthioridazine hcl tab 100 mg 4 PAthiothixene cap 1 mg^ 2 PAthiothixene cap 2 mg^ 2 PAthiothixene cap 5 mg^ 2 PAthiothixene cap 10 mg^ 2 PAtrifluoperazine hcl tab 1 mg^ 2 PAtrifluoperazine hcl tab 2 mg^ 2 PAtrifluoperazine hcl tab 5 mg^ 2 PAtrifluoperazine hcl tab 10 mg^ 2 PAVERSACLOZ - clozapine susp 50 mg/ml 5 PA, QL (540 mls/30 days)VRAYLAR - cariprazine hcl cap 1.5 mg 5 PA, QL (30 capsules/30 days)

2018


51


VRAYLAR - cariprazine hcl cap 3 mg 5 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 4.5 mg 5 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 6 mg 5 PA, QL (30 capsules/30 days)ziprasidone hcl cap 20 mg^ 2 PA, QL (90 capsules/30 days)ziprasidone hcl cap 40 mg^ 2 PA, QL (90 capsules/30 days)ziprasidone hcl cap 60 mg^ 2 PA, QL (60 capsules/30 days)ziprasidone hcl cap 80 mg^ 2 PA, QL (60 capsules/30 days)ZYPREXA - olanzapine for im inj 10 mg 4 PA, QL (90 vials/30 days)ZYPREXA - olanzapine tab 2.5 mg 4 PA, QL (45 tablets/30 days)ZYPREXA - olanzapine tab 5 mg 4 PA, QL (45 tablets/30 days)ZYPREXA - olanzapine tab 7.5 mg 4 PA, QL (45 tablets/30 days)ZYPREXA - olanzapine tab 10 mg 4 PA, QL (45 tablets/30 days)ZYPREXA - olanzapine tab 15 mg 4 PA, QL (30 tablets/30 days)ZYPREXA - olanzapine tab 20 mg 4 PA, QL (30 tablets/30 days)ZYPREXA RELPREVV - olanzapine pamoate for extended rel im

susp 210 mg5 PA, QL (2 vials/28 days)

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 300 mg

5 PA, QL (2 vials/28 days)

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 405 mg

5 PA, QL (1 vial/28 days)

ZYPREXA ZYDIS - olanzapine orally disintegrating tab 5 mg 4 PA, QL (30 tablets/30 days)ZYPREXA ZYDIS - olanzapine orally disintegrating tab 10 mg 4 PA, QL (30 tablets/30 days)ZYPREXA ZYDIS - olanzapine orally disintegrating tab 15 mg 4 PA, QL (30 tablets/30 days)ZYPREXA ZYDIS - olanzapine orally disintegrating tab 20 mg 4 PA, QL (30 tablets/30 days)Agentes antiespasmódicosbaclofen tab 10 mg^ 2baclofen tab 20 mg^ 2DANTRIUM - dantrolene sodium cap 25 mg 4DANTRIUM - dantrolene sodium cap 50 mg 4dantrolene sodium cap 25 mg^ 2dantrolene sodium cap 50 mg^ 2dantrolene sodium cap 100 mg^ 2tizanidine hcl cap 2 mg^ 2tizanidine hcl cap 4 mg^ 2tizanidine hcl cap 6 mg^ 2tizanidine hcl tab 2 mg^ 2tizanidine hcl tab 4 mg^ 2ZANAFLEX - tizanidine hcl tab 4 mg 4

2018



Medicamentos antiviralesabacavir sulfate soln 20 mg/ml^ 2 QL (960 mls/30 days)abacavir sulfate tab 300 mg^ 2 QL (60 tablets/30 days)abacavir sulfate-lamivudine tab 600-300 mg 5 QL (30 tablets/30 days)abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 5 QL (60 tablets/30 days)acyclovir cap 200 mg^ 1acyclovir oint 5%^ 2ACYCLOVIR SODIUM - acyclovir sodium for inj 500 mg 3 BDacyclovir sodium iv soln 50 mg/ml^ 2 BDacyclovir susp 200 mg/5ml^ 2acyclovir tab 400 mg^ 2acyclovir tab 800 mg^ 2adefovir dipivoxil tab 10 mg 5APTIVUS - tipranavir cap 250 mg 5 QL (120 capsules/30 days)APTIVUS - tipranavir oral soln 100 mg/ml 5 QL (380 mls/30 days)ATRIPLA - efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg5 QL (30 tablets/30 days)

BARACLUDE - entecavir oral soln 0.05 mg/ml 4BARACLUDE - entecavir tab 0.5 mg 5BARACLUDE - entecavir tab 1 mg 5cidofovir iv inj 75 mg/ml 5COMPLERA - emtricitabine-rilpivirine-tenofovir df tab

200-25-300 mg5 QL (30 tablets/30 days)

CRIXIVAN - indinavir sulfate cap 200 mg 3 QL (270 capsules/30 days)CRIXIVAN - indinavir sulfate cap 400 mg 3 QL (180 capsules/30 days)CYTOVENE - ganciclovir sodium for inj 500 mg 4 BDDAKLINZA - daclatasvir dihydrochloride tab 30 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 60 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 90 mg 5 PADENAVIR - penciclovir cream 1% 5DESCOVY - emtricitabine-tenofovir alafenamide fumarate tab

200-25 mg5 QL (30 tablets/30 days)

didanosine delayed release capsule 125 mg^ 2 QL (30 capsules/30 days)didanosine delayed release capsule 200 mg^ 2 QL (30 capsules/30 days)didanosine delayed release capsule 250 mg^ 2 QL (30 capsules/30 days)didanosine delayed release capsule 400 mg^ 2 QL (30 capsules/30 days)EDURANT - rilpivirine hcl tab 25 mg 5 QL (30 tablets/30 days)EMTRIVA - emtricitabine caps 200 mg 4 QL (30 capsules/30 days)EMTRIVA - emtricitabine soln 10 mg/ml 4 QL (850 mls/30 days)

2018


53


entecavir tab 0.5 mg^ 2entecavir tab 1 mg^ 2EPCLUSA - sofosbuvir-velpatasvir tab 400-100 mg 5 PAEPIVIR - lamivudine oral soln 10 mg/ml 4 QL (960 mls/30 days)EPIVIR - lamivudine tab 150 mg 4 QL (60 tablets/30 days)EPIVIR - lamivudine tab 300 mg 4 QL (30 tablets/30 days)EPIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) 3EPIVIR HBV - lamivudine tab 100 mg (hbv) 4EPZICOM - abacavir sulfate-lamivudine tab 600-300 mg 5 QL (30 tablets/30 days)EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg 5 QL (30 tablets/30 days)famciclovir tab 125 mg^ 2famciclovir tab 250 mg^ 2famciclovir tab 500 mg^ 2fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)FUZEON - enfuvirtide for inj 90 mg 5 QL (60 vials/30 days)ganciclovir sodium for inj 500 mg^ 2 BDGENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mg5 QL (30 tablets/30 days)

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg 5 PAINTELENCE - etravirine tab 25 mg 4 QL (120 tablets/30 days)INTELENCE - etravirine tab 100 mg 4 QL (60 tablets/30 days)INTELENCE - etravirine tab 200 mg 5 QL (60 tablets/30 days)INTRON A - interferon alfa-2b inj 6000000 unit/ml 5INTRON A - interferon alfa-2b inj 10000000 unit/ml 5INTRON A - interferon alfa-2b for inj 10000000 unit 5INTRON A - interferon alfa-2b for inj 18000000 unit 5INTRON A - interferon alfa-2b for inj 50000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 10000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 18000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 50000000 unit 5INVIRASE - saquinavir mesylate cap 200 mg 5 QL (300 capsules/30 days)INVIRASE - saquinavir mesylate tab 500 mg 5 QL (120 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 25 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 100 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium packet for susp 100 mg 4 QL (60 packets/30 days)ISENTRESS - raltegravir potassium tab 400 mg 5 QL (60 tablets/30 days)ISENTRESS HD - raltegravir potassium tab 600 mg 5 QL (60 tablets/30 days)KALETRA - lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 5 QL (480 mls/30 days)

2018



KALETRA - lopinavir-ritonavir tab 100-25 mg 5 QL (300 tablets/30 days)KALETRA - lopinavir-ritonavir tab 200-50 mg 5 QL (120 tablets/30 days)lamivudine oral soln 10 mg/ml^ 2 QL (960 mls/30 days)lamivudine tab 100 mg (hbv)^ 2lamivudine tab 150 mg^ 2 QL (60 tablets/30 days)lamivudine tab 300 mg^ 2 QL (30 tablets/30 days)lamivudine-zidovudine tab 150-300 mg^ 2 QL (60 tablets/30 days)LEXIVA - fosamprenavir calcium susp 50 mg/ml 4 QL (1800 mls/30 days)LEXIVA - fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 5 QL (480 mls/30 days)MAVYRET - glecaprevir-pibrentasvir tab 100-40 mg 5 PANEVIRAPINE - nevirapine susp 50 mg/5ml 4 QL (1200 mls/30 days)nevirapine tab er 24hr 100 mg^ 2 QL (90 tablets/30 days)nevirapine tab er 24hr 400 mg^ 2 QL (30 tablets/30 days)nevirapine tab 200 mg^ 2 QL (60 tablets/30 days)NORVIR - ritonavir cap 100 mg 4 QL (360 capsules/30 days)NORVIR - ritonavir oral soln 80 mg/ml 4 QL (480 mls/30 days)NORVIR - ritonavir tab 100 mg 4 QL (360 tablets/30 days)ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg 5 QL (30 tablets/30 days)OLYSIO - simeprevir sodium cap 150 mg 5 PAoseltamivir phosphate cap 30 mg^ 2oseltamivir phosphate cap 45 mg^ 2oseltamivir phosphate cap 75 mg^ 2oseltamivir phosphate for susp 6 mg/ml^ 2PEGASYS - peginterferon alfa-2a inj 180 mcg/ml 5 PAPEGASYS - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 135 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPREZCOBIX - darunavir-cobicistat tab 800-150 mg 5 QL (30 tablets/30 days)PREZISTA - darunavir ethanolate susp 100 mg/ml 5 QL (400 mls/30 days)PREZISTA - darunavir ethanolate tab 75 mg 4 QL (300 tablets/30 days)PREZISTA - darunavir ethanolate tab 150 mg 4 QL (180 tablets/30 days)PREZISTA - darunavir ethanolate tab 600 mg 5 QL (60 tablets/30 days)PREZISTA - darunavir ethanolate tab 800 mg 5 QL (30 tablets/30 days)REBETOL - ribavirin soln 40 mg/ml 4RESCRIPTOR - delavirdine mesylate tab 100 mg 4 QL (360 tablets/30 days)RESCRIPTOR - delavirdine mesylate tab 200 mg 4 QL (180 tablets/30 days)RETROVIR - zidovudine cap 100 mg 4 QL (180 capsules/30 days)

2018


55


RETROVIR - zidovudine syrup 10 mg/ml 4 QL (1920 mls/30 days)RETROVIR IV INFUSION - zidovudine iv soln 10 mg/ml 4REYATAZ - atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)REYATAZ - atazanavir sulfate cap 300 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate oral powder packet 50 mg 5 QL (240 packets/30 days)RIBASPHERE - ribavirin tab 400 mg 5RIBASPHERE - ribavirin tab 600 mg 5RIBASPHERE RIBAPAK - ribavirin tab 400 mg 5RIBASPHERE RIBAPAK - ribavirin tab 600 mg 5ribavirin cap 200 mg^ 2ribavirin tab 200 mg^ 2rimantadine hydrochloride tab 100 mg^ 2SELZENTRY - maraviroc oral soln 20 mg/ml 5 QL (1840 mls/30 days)SELZENTRY - maraviroc tab 25 mg 4 QL (240 tablets/30 days)SELZENTRY - maraviroc tab 75 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 150 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 300 mg 5 QL (120 tablets/30 days)SOVALDI - sofosbuvir tab 400 mg 5 PAstavudine cap 15 mg^ 2 QL (60 capsules/30 days)stavudine cap 20 mg^ 2 QL (60 capsules/30 days)stavudine cap 30 mg^ 2 QL (60 capsules/30 days)stavudine cap 40 mg^ 2 QL (60 capsules/30 days)STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab

150-150-200-300 mg5 QL (30 tablets/30 days)

SUSTIVA - efavirenz cap 50 mg 4 QL (90 capsules/30 days)SUSTIVA - efavirenz cap 200 mg 5 QL (60 capsules/30 days)SUSTIVA - efavirenz tab 600 mg 5 QL (30 tablets/30 days)SYLATRON - peginterferon alfa-2b for inj kit 200 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 300 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 600 mcg 5 PATAMIFLU - oseltamivir phosphate cap 30 mg 4TAMIFLU - oseltamivir phosphate cap 45 mg 4TAMIFLU - oseltamivir phosphate cap 75 mg 4TAMIFLU - oseltamivir phosphate for susp 6 mg/ml 4TECHNIVIE - ombitasvir-paritaprevir-ritonavir tab 12.5-75-50 mg 5 PATIVICAY - dolutegravir sodium tab 10 mg 4 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 25 mg 5 QL (60 tablets/30 days)

2018



TIVICAY - dolutegravir sodium tab 50 mg 5 QL (60 tablets/30 days)TRIUMEQ - abacavir-dolutegravir-lamivudine tab 600-50-300 mg 5 QL (30 tablets/30 days)TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab


TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab133-200 mg






TYBOST - cobicistat tab 150 mg 3 QL (30 tablets/30 days)valacyclovir hcl tab 500 mg^ 2valacyclovir hcl tab 1 gm^ 2VALCYTE - valganciclovir hcl for soln 50 mg/ml 5VALCYTE - valganciclovir hcl tab 450 mg 5valganciclovir hcl for soln 50 mg/ml 5valganciclovir hcl tab 450 mg 5VALTREX - valacyclovir hcl tab 500 mg 4VALTREX - valacyclovir hcl tab 1 gm 4VIDEX - didanosine for soln 2 gm 4 QL (1200 mls/30 days)VIDEX - didanosine for soln 4 gm 4 QL (1200 mls/30 days)VIDEX EC - didanosine delayed release capsule 125 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 200 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 250 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 400 mg 4 QL (30 capsules/30 days)VIEKIRA PAK - ombitas-paritapre-riton & dasab tab pak

12.5-75-50 & 250 mg5 PA

VIEKIRA XR - dasab-ombit-paritap-riton tab er 24hr200-8.33-50-33.33 mg

5 PA

VIRACEPT - nelfinavir mesylate tab 250 mg 5 QL (270 tablets/30 days)VIRACEPT - nelfinavir mesylate tab 625 mg 5 QL (120 tablets/30 days)VIRAMUNE - nevirapine susp 50 mg/5ml 4 QL (1200 mls/30 days)VIRAMUNE XR - nevirapine tab er 24hr 100 mg 4 QL (90 tablets/30 days)VIRAMUNE XR - nevirapine tab er 24hr 400 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate oral powder 40 mg/gm 5 QL (240 grams/30 days)VIREAD - tenofovir disoproxil fumarate tab 150 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 200 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 250 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 300 mg 5 QL (30 tablets/30 days)

2018


57


VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 5 PAZEPATIER - elbasvir-grazoprevir tab 50-100 mg 5 PAZERIT - stavudine cap 15 mg 4 QL (60 capsules/30 days)ZERIT - stavudine cap 20 mg 4 QL (60 capsules/30 days)ZERIT - stavudine cap 30 mg 4 QL (60 capsules/30 days)ZERIT - stavudine cap 40 mg 4 QL (60 capsules/30 days)ZERIT - stavudine for oral soln 1 mg/ml 4 QL (2400 mls/30 days)ZIAGEN - abacavir sulfate soln 20 mg/ml 4 QL (960 mls/30 days)ZIAGEN - abacavir sulfate tab 300 mg 4 QL (60 tablets/30 days)zidovudine cap 100 mg^ 2 QL (180 capsules/30 days)zidovudine syrup 10 mg/ml^ 2 QL (1920 mls/30 days)zidovudine tab 300 mg^ 2 QL (60 tablets/30 days)ZOVIRAX - acyclovir cap 200 mg 4ZOVIRAX - acyclovir oint 5% 4ZOVIRAX - acyclovir susp 200 mg/5ml 4ZOVIRAX - acyclovir tab 400 mg 4Medicamentos ansiolíticosalprazolam tab 0.25 mg^ 1 QL (120 tablets/30 days)alprazolam tab 0.5 mg^ 1 QL (120 tablets/30 days)alprazolam tab 1 mg^ 1 QL (120 tablets/30 days)alprazolam tab 2 mg^ 1 QL (150 tablets/30 days)buspirone hcl tab 5 mg^ 2buspirone hcl tab 7.5 mg^ 2buspirone hcl tab 10 mg^ 2buspirone hcl tab 15 mg^ 2buspirone hcl tab 30 mg^ 2clonazepam orally disintegrating tab 0.125 mg^ 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.25 mg^ 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.5 mg^ 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 1 mg^ 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 2 mg^ 2 PA, QL (300 tablets/30 days)clonazepam tab 0.5 mg^ 1 PA, QL (120 tablets/30 days)clonazepam tab 1 mg^ 1 PA, QL (120 tablets/30 days)clonazepam tab 2 mg^ 1 PA, QL (300 tablets/30 days)clorazepate dipotassium tab 3.75 mg^ 2 PA, QL (120 tablets/30 days)clorazepate dipotassium tab 7.5 mg^ 2 PA, QL (90 tablets/30 days)clorazepate dipotassium tab 15 mg^ 2 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 4 PA, QL (1200 mls/30 days)

2018



diazepam conc 5 mg/ml^ 2 PA, QL (240 mls/30 days)diazepam tab 2 mg^ 1 PA, QL (120 tablets/30 days)diazepam tab 5 mg^ 1 PA, QL (120 tablets/30 days)diazepam tab 10 mg^ 1 PA, QL (120 tablets/30 days)hydroxyzine hcl syrup 10 mg/5ml# 4 PAhydroxyzine hcl tab 10 mg# 4 PAhydroxyzine hcl tab 25 mg# 4 PAhydroxyzine hcl tab 50 mg# 4 PAlorazepam tab 0.5 mg^ 1 PA, QL (120 tablets/30 days)lorazepam tab 1 mg^ 1 PA, QL (120 tablets/30 days)lorazepam tab 2 mg^ 1 PA, QL (150 tablets/30 days)Agentes bipolaresLITHIUM - lithium oral solution 8 meq/5ml 4lithium carbonate cap 150 mg^ 2lithium carbonate cap 300 mg^ 1lithium carbonate cap 600 mg^ 2lithium carbonate tab er 300 mg^ 2lithium carbonate tab er 450 mg^ 2lithium carbonate tab 300 mg^ 2LITHOBID - lithium carbonate tab er 300 mg 4Reguladores de la glucosa en sangreacarbose tab 25 mg^ 2 QL (360 tablets/30 days)acarbose tab 50 mg^ 2 QL (180 tablets/30 days)acarbose tab 100 mg^ 2 QL (90 tablets/30 days)ACTOS - pioglitazone hcl tab 15 mg 4 QL (90 tablets/30 days)ACTOS - pioglitazone hcl tab 30 mg 4 QL (30 tablets/30 days)ACTOS - pioglitazone hcl tab 45 mg 4 QL (30 tablets/30 days)ALCOHOL SWABS 3AMARYL - glimepiride tab 1 mg 4 QL (240 tablets/30 days)AMARYL - glimepiride tab 2 mg 4 QL (120 tablets/30 days)AMARYL - glimepiride tab 4 mg 4 QL (60 tablets/30 days)BYDUREON - exenatide for inj extended release susp 2 mg 3 QL (4 vials/28 days)BYDUREON BCISE - exenatide extended release susp auto-

injector 2 mg/0.85ml3 QL (4 pens/28 days)

BYDUREON PEN - exenatide extended release for susp pen-injector 2 mg

3 QL (4 pens/28 days)

CYCLOSET - bromocriptine mesylate tab 0.8 mg 4 QL (180 tablets/30 days)GAUZE PADS 2" X 2" 3glimepiride tab 1 mg^ 1 QL (240 tablets/30 days)

2018


59


glimepiride tab 2 mg^ 1 QL (120 tablets/30 days)glimepiride tab 4 mg^ 1 QL (60 tablets/30 days)glipizide tab er 24hr 2.5 mg^ 2 QL (240 tablets/30 days)glipizide tab er 24hr 5 mg^ 2 QL (120 tablets/30 days)glipizide tab er 24hr 10 mg^ 2 QL (60 tablets/30 days)glipizide tab 5 mg^ 1 QL (240 tablets/30 days)glipizide tab 10 mg^ 1 QL (120 tablets/30 days)glipizide-metformin hcl tab 2.5-250 mg^ 2 QL (240 tablets/30 days)glipizide-metformin hcl tab 2.5-500 mg^ 2 QL (120 tablets/30 days)glipizide-metformin hcl tab 5-500 mg^ 2 QL (120 tablets/30 days)GLUCAGEN HYPOKIT - glucagon hcl (rdna) for inj 1 mg 3GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit 1 mg 3GLUCOPHAGE - metformin hcl tab 500 mg 4 QL (150 tablets/30 days)GLUCOPHAGE - metformin hcl tab 850 mg 4 QL (90 tablets/30 days)GLUCOPHAGE - metformin hcl tab 1000 mg 4 QL (75 tablets/30 days)GLUCOPHAGE XR - metformin hcl tab er 24hr 500 mg 4 QL (120 tablets/30 days)GLUCOPHAGE XR - metformin hcl tab er 24hr 750 mg 4 QL (60 tablets/30 days)GLUCOTROL - glipizide tab 5 mg 4 QL (240 tablets/30 days)GLUCOTROL - glipizide tab 10 mg 4 QL (120 tablets/30 days)GLUCOTROL XL - glipizide tab er 24hr 2.5 mg 4 QL (240 tablets/30 days)GLUCOTROL XL - glipizide tab er 24hr 5 mg 4 QL (120 tablets/30 days)GLUCOTROL XL - glipizide tab er 24hr 10 mg 4 QL (60 tablets/30 days)HUMALOG - insulin lispro inj 100 unit/ml 3 QL (60 mls/30 days)HUMALOG - insulin lispro soln cartridge 100 unit/ml 3 QL (20 cartridges/30 days)HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector

100 unit/ml3 QL (20 pens/30 days)

HUMALOG KWIKPEN - insulin lispro soln pen-injector 100 unit/ml 3 QL (20 pens/30 days)HUMALOG KWIKPEN - insulin lispro soln pen-injector 200 unit/ml 3 QL (20 pens/30 days)HUMALOG MIX 50/50 - insulin lispro protamine & lispro inj 100

unit/ml (50-50)3 QL (6 vials/30 days)

HUMALOG MIX 50/50 KWIKPEN - insulin lispro prot & lispro suspen-inj 100 unit/ml (50-50)


HUMALOG MIX 75/25 - insulin lispro prot & lispro inj 100 unit/ml(75-25)

3 QL (6 vials/30 days)

HUMALOG MIX 75/25 KWIKPEN - insulin lispro prot & lispro suspen-inj 100 unit/ml (75-25)


HUMULIN N - insulin nph (human) (isophane) inj 100 unit/ml 3 QL (60 mls/30 days)HUMULIN N KWIKPEN - insulin nph (human) (isophane) susp

pen-injector 100 unit/ml3 QL (20 pens/30 days)

2018



HUMULIN R - insulin regular (human) inj 100 unit/ml 3 QL (60 mls/30 days)HUMULIN R U-500 (CONCENTRATE) - insulin regular (human) inj

500 unit/ml3 BD, QL (3 vials/30 days)

HUMULIN R U-500 KWIKPEN - insulin regular (human) soln pen-injector 500 unit/ml


HUMULIN 70/30 - insulin nph isophane & regular human inj 100unit/ml (70-30)

3 QL (60 mls/30 days)

HUMULIN 70/30 KWIKPEN - insulin nph & regular susp pen-inj100 unit/ml (70-30)


INSULIN INJECTION DEVICE 3INSULIN SYRINGE/NEEDLE 3INVOKAMET - canagliflozin-metformin hcl tab 50-500 mg 3 QL (120 tablets/30 days)INVOKAMET - canagliflozin-metformin hcl tab 50-1000 mg 3 QL (60 tablets/30 days)INVOKAMET - canagliflozin-metformin hcl tab 150-500 mg 3 QL (60 tablets/30 days)INVOKAMET - canagliflozin-metformin hcl tab 150-1000 mg 3 QL (60 tablets/30 days)INVOKAMET XR - canagliflozin-metformin hcl tab er 24hr


INVOKAMET XR - canagliflozin-metformin hcl tab er 24hr50-1000 mg






INVOKANA - canagliflozin tab 100 mg 3 QL (90 tablets/30 days)INVOKANA - canagliflozin tab 300 mg 3 QL (30 tablets/30 days)JANUMET - sitagliptin-metformin hcl tab 50-500 mg 3 QL (60 tablets/30 days)JANUMET - sitagliptin-metformin hcl tab 50-1000 mg 3 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 50-500 mg 3 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 50-1000 mg 3 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 100-1000 mg 3 QL (30 tablets/30 days)JANUVIA - sitagliptin phosphate tab 25 mg 3 QL (120 tablets/30 days)JANUVIA - sitagliptin phosphate tab 50 mg 3 QL (60 tablets/30 days)JANUVIA - sitagliptin phosphate tab 100 mg 3 QL (30 tablets/30 days)JARDIANCE - empagliflozin tab 10 mg 3 QL (60 tablets/30 days)JARDIANCE - empagliflozin tab 25 mg 3 QL (30 tablets/30 days)JENTADUETO - linagliptin-metformin hcl tab 2.5-500 mg 4 QL (60 tablets/30 days)JENTADUETO - linagliptin-metformin hcl tab 2.5-850 mg 4 QL (60 tablets/30 days)JENTADUETO - linagliptin-metformin hcl tab 2.5-1000 mg 4 QL (60 tablets/30 days)JENTADUETO XR - linagliptin-metformin hcl tab er 24hr

2.5-1000 mg4 QL (60 tablets/30 days)

2018


61


JENTADUETO XR - linagliptin-metformin hcl tab er 24hr5-1000 mg


KOMBIGLYZE XR - saxagliptin-metformin hcl tab er 24hr2.5-1000 mg


KOMBIGLYZE XR - saxagliptin-metformin hcl tab er 24hr5-500 mg


KOMBIGLYZE XR - saxagliptin-metformin hcl tab er 24hr5-1000 mg


LANTUS - insulin glargine inj 100 unit/ml 3 QL (6 vials/30 days)LANTUS SOLOSTAR - insulin glargine soln pen-injector 100 unit/

ml3 QL (20 pens/30 days)

LEVEMIR - insulin detemir inj 100 unit/ml 3 QL (6 vials/30 days)LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 100

unit/ml3 QL (20 pens/30 days)

metformin hcl tab er 24hr 500 mg^ 2 QL (120 tablets/30 days)metformin hcl tab er 24hr 750 mg^ 2 QL (60 tablets/30 days)metformin hcl tab 500 mg^ 1 QL (150 tablets/30 days)metformin hcl tab 850 mg^ 1 QL (90 tablets/30 days)metformin hcl tab 1000 mg^ 1 QL (75 tablets/30 days)nateglinide tab 60 mg^ 2 QL (180 tablets/30 days)nateglinide tab 120 mg^ 2 QL (90 tablets/30 days)ONGLYZA - saxagliptin hcl tab 2.5 mg 3 QL (60 tablets/30 days)ONGLYZA - saxagliptin hcl tab 5 mg 3 QL (30 tablets/30 days)pioglitazone hcl tab 15 mg^ 1 QL (90 tablets/30 days)pioglitazone hcl tab 30 mg^ 1 QL (30 tablets/30 days)pioglitazone hcl tab 45 mg^ 1 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-2 mg^ 2 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-4 mg^ 2 QL (30 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-500 mg^ 2 QL (90 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-850 mg^ 2 QL (90 tablets/30 days)PRECOSE - acarbose tab 25 mg 4 QL (360 tablets/30 days)PRECOSE - acarbose tab 50 mg 4 QL (180 tablets/30 days)PRECOSE - acarbose tab 100 mg 4 QL (90 tablets/30 days)PROGLYCEM - diazoxide susp 50 mg/ml 4repaglinide tab 0.5 mg^ 2 QL (960 tablets/30 days)repaglinide tab 1 mg^ 2 QL (480 tablets/30 days)repaglinide tab 2 mg^ 2 QL (240 tablets/30 days)STARLIX - nateglinide tab 60 mg 4 QL (180 tablets/30 days)STARLIX - nateglinide tab 120 mg 4 QL (90 tablets/30 days)

2018



SYMLINPEN 120 - pramlintide acetate pen-inj 2700 mcg/2.7ml(1000 mcg/ml)

3

SYMLINPEN 60 - pramlintide acetate pen-inj 1500 mcg/1.5ml(1000 mcg/ml)

3

SYNJARDY - empagliflozin-metformin hcl tab 5-500 mg 3 QL (120 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 5-1000 mg 3 QL (60 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 12.5-500 mg 3 QL (60 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 12.5-1000 mg 3 QL (60 tablets/30 days)SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr


SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr10-1000 mg


SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr12.5-1000 mg


SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr25-1000 mg


TOUJEO SOLOSTAR - insulin glargine soln pen-injector 300 unit/ml


TRADJENTA - linagliptin tab 5 mg 4 QL (30 tablets/30 days)TRESIBA FLEXTOUCH - insulin degludec soln pen-injector 100

unit/ml3 QL (20 pens/30 days)

TRESIBA FLEXTOUCH - insulin degludec soln pen-injector 200unit/ml


VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) 3 QL (1 package/30 days)Hemoderivados/Modificadores de la sangre/ Expansores delAGGRENOX - aspirin-dipyridamole cap er 12hr 25-200 mg 4AGRYLIN - anagrelide hcl cap 0.5 mg 4anagrelide hcl cap 0.5 mg^ 2anagrelide hcl cap 1 mg^ 2ARANESP ALBUMIN FREE - darbepoetin alfa soln inj 25 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 40 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 60 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 100 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 200 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 300 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln prefilled

syringe 10 mcg/0.4ml4 PA

ARANESP ALBUMIN FREE - darbepoetin alfa soln prefilledsyringe 25 mcg/0.42ml

4 PA


4 PA

2018


63



4 PA


5 PA


5 PA


5 PA


5 PA

ARANESP ALBUMIN FREE - darbepoetin alfa soln prefilledsyringe 500 mcg/ml

5 PA

aspirin-dipyridamole cap er 12hr 25-200 mg^ 2azacitidine for inj 100 mg 5BRILINTA - ticagrelor tab 60 mg 3BRILINTA - ticagrelor tab 90 mg 3cilostazol tab 50 mg^ 2cilostazol tab 100 mg^ 2clopidogrel bisulfate tab 75 mg^ 1COUMADIN - warfarin sodium tab 1 mg 4COUMADIN - warfarin sodium tab 2 mg 4COUMADIN - warfarin sodium tab 2.5 mg 4COUMADIN - warfarin sodium tab 3 mg 4COUMADIN - warfarin sodium tab 4 mg 4COUMADIN - warfarin sodium tab 5 mg 4COUMADIN - warfarin sodium tab 6 mg 4COUMADIN - warfarin sodium tab 7.5 mg 4COUMADIN - warfarin sodium tab 10 mg 4CYKLOKAPRON - tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)4

dipyridamole tab 25 mg# 4dipyridamole tab 50 mg# 4dipyridamole tab 75 mg# 4EFFIENT - prasugrel hcl tab 5 mg 3EFFIENT - prasugrel hcl tab 10 mg 3ELIQUIS - apixaban tab 2.5 mg 3 QL (60 tablets/30 days)ELIQUIS - apixaban tab 5 mg 3 QL (120 tablets/30 days)enoxaparin sodium inj 30 mg/0.3ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 40 mg/0.4ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 60 mg/0.6ml^ 2 QL (30 syringes/90 days)

2018



enoxaparin sodium inj 80 mg/0.8ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 100 mg/ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 120 mg/0.8ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 150 mg/ml^ 2 QL (30 syringes/90 days)enoxaparin sodium inj 300 mg/3ml^ 2 QL (10 vials/90 days)EPOGEN - epoetin alfa inj 2000 unit/ml 4 PAEPOGEN - epoetin alfa inj 3000 unit/ml 4 PAEPOGEN - epoetin alfa inj 4000 unit/ml 4 PAEPOGEN - epoetin alfa inj 10000 unit/ml 4 PAEPOGEN - epoetin alfa inj 20000 unit/ml 4 PAfondaparinux sodium subcutaneous inj 2.5 mg/0.5ml^ 2 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 5 mg/0.4ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 10 mg/0.8ml 5 QL (30 syringes/90 days)GRANIX - tbo-filgrastim soln prefilled syringe 300 mcg/0.5ml 5GRANIX - tbo-filgrastim soln prefilled syringe 480 mcg/0.8ml 5heparin sodium (porcine) inj 1000 unit/ml^ 2heparin sodium (porcine) inj 5000 unit/ml^ 2heparin sodium (porcine) inj 10000 unit/ml^ 2heparin sodium (porcine) inj 20000 unit/ml^ 2heparin sodium (porcine) pf inj 5000 unit/0.5ml^ 2heparin sodium (porcine) 40 unit/ml in d5w^ 2LEUKINE - sargramostim lyophilized for inj 250 mcg 5LOVENOX - enoxaparin sodium inj 30 mg/0.3ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 40 mg/0.4ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 60 mg/0.6ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 80 mg/0.8ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 100 mg/ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 120 mg/0.8ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 150 mg/ml 4 QL (30 syringes/90 days)LOVENOX - enoxaparin sodium inj 300 mg/3ml 4 QL (10 vials/90 days)MOZOBIL - plerixafor subcutaneous inj 24 mg/1.2ml (20 mg/ml) 5NEULASTA - pegfilgrastim soln prefilled syringe 6 mg/0.6ml 5NEULASTA ONPRO KIT - pegfilgrastim soln prefilled syringe kit

6 mg/0.6ml5

PLAVIX - clopidogrel bisulfate tab 75 mg 4PRADAXA - dabigatran etexilate mesylate cap 75 mg 4 QL (60 capsules/30 days)PRADAXA - dabigatran etexilate mesylate cap 110 mg 4 QL (71 capsules/90 days)

2018


65


PRADAXA - dabigatran etexilate mesylate cap 150 mg 4 QL (60 capsules/30 days)prasugrel hcl tab 5 mg^ 2prasugrel hcl tab 10 mg^ 2PROCRIT - epoetin alfa inj 2000 unit/ml 4 PAPROCRIT - epoetin alfa inj 3000 unit/ml 4 PAPROCRIT - epoetin alfa inj 4000 unit/ml 4 PAPROCRIT - epoetin alfa inj 10000 unit/ml 4 PAPROCRIT - epoetin alfa inj 20000 unit/ml 5 PAPROCRIT - epoetin alfa inj 40000 unit/ml 5 PAPROMACTA - eltrombopag olamine tab 12.5 mg* 5 PAPROMACTA - eltrombopag olamine tab 25 mg* 5 PAPROMACTA - eltrombopag olamine tab 50 mg* 5 PAPROMACTA - eltrombopag olamine tab 75 mg* 5 PAtranexamic acid iv soln 1000 mg/10ml (100 mg/ml)^ 2tranexamic acid tab 650 mg^ 2warfarin sodium tab 1 mg^ 1warfarin sodium tab 2 mg^ 1warfarin sodium tab 2.5 mg^ 1warfarin sodium tab 3 mg^ 1warfarin sodium tab 4 mg^ 1warfarin sodium tab 5 mg^ 1warfarin sodium tab 6 mg^ 1warfarin sodium tab 7.5 mg^ 1warfarin sodium tab 10 mg^ 1XARELTO - rivaroxaban tab 10 mg 3 QL (35 tablets/90 days)XARELTO - rivaroxaban tab 15 mg 3 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 20 mg 3 QL (30 tablets/30 days)XARELTO STARTER PACK - rivaroxaban tab starter therapy pack

15 mg & 20 mg3 QL (51 tablets/30 days)

ZONTIVITY - vorapaxar sulfate tab 2.08 mg 4Agentes cardiovascularesACCUPRIL - quinapril hcl tab 5 mg 4ACCUPRIL - quinapril hcl tab 10 mg 4ACCUPRIL - quinapril hcl tab 20 mg 4ACCUPRIL - quinapril hcl tab 40 mg 4ACCURETIC - quinapril-hydrochlorothiazide tab 10-12.5 mg 4ACCURETIC - quinapril-hydrochlorothiazide tab 20-12.5 mg 4ACCURETIC - quinapril-hydrochlorothiazide tab 20-25 mg 4

2018



acebutolol hcl cap 200 mg^ 2acebutolol hcl cap 400 mg^ 2acetazolamide cap er 12hr 500 mg^ 2acetazolamide tab 125 mg^ 2acetazolamide tab 250 mg^ 2ADALAT CC - nifedipine tab er 24hr 30 mg 4ADALAT CC - nifedipine tab er 24hr 60 mg 4ADALAT CC - nifedipine tab er 24hr 90 mg 4ALDACTAZIDE - spironolactone & hydrochlorothiazide tab

25-25 mg4

ALDACTONE - spironolactone tab 25 mg 4ALDACTONE - spironolactone tab 50 mg 4ALDACTONE - spironolactone tab 100 mg 4ALTACE - ramipril cap 1.25 mg 4ALTACE - ramipril cap 2.5 mg 4ALTACE - ramipril cap 5 mg 4ALTACE - ramipril cap 10 mg 4amiloride & hydrochlorothiazide tab 5-50 mg^ 2amiloride hcl tab 5 mg^ 2amiodarone hcl tab 200 mg^ 2amiodarone hcl tab 400 mg^ 2amlodipine besylate tab 2.5 mg^ 1amlodipine besylate tab 5 mg^ 1amlodipine besylate tab 10 mg^ 1amlodipine besylate-atorvastatin calcium tab 2.5-10 mg^ 2amlodipine besylate-atorvastatin calcium tab 2.5-20 mg^ 2amlodipine besylate-atorvastatin calcium tab 2.5-40 mg^ 2amlodipine besylate-atorvastatin calcium tab 5-10 mg^ 2amlodipine besylate-atorvastatin calcium tab 5-20 mg^ 2amlodipine besylate-atorvastatin calcium tab 5-40 mg^ 2amlodipine besylate-atorvastatin calcium tab 5-80 mg^ 2amlodipine besylate-atorvastatin calcium tab 10-10 mg^ 2amlodipine besylate-atorvastatin calcium tab 10-20 mg^ 2amlodipine besylate-atorvastatin calcium tab 10-40 mg^ 2amlodipine besylate-atorvastatin calcium tab 10-80 mg^ 2amlodipine besylate-benazepril hcl cap 2.5-10 mg^ 2amlodipine besylate-benazepril hcl cap 5-10 mg^ 2amlodipine besylate-benazepril hcl cap 5-20 mg^ 2

2018


67


amlodipine besylate-benazepril hcl cap 5-40 mg^ 2amlodipine besylate-benazepril hcl cap 10-20 mg^ 2amlodipine besylate-benazepril hcl cap 10-40 mg^ 2amlodipine besylate-olmesartan medoxomil tab 5-20 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 5-40 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 10-20 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-olmesartan medoxomil tab 10-40 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-160 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-320 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-160 mg^ 2 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-320 mg^ 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg^ 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-25 mg^ 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg^ 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg^ 2 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-320-25 mg^ 2 QL (30 tablets/30 days)ATACAND - candesartan cilexetil tab 4 mg 4 QL (60 tablets/30 days)ATACAND - candesartan cilexetil tab 8 mg 4 QL (60 tablets/30 days)ATACAND - candesartan cilexetil tab 16 mg 4 QL (60 tablets/30 days)ATACAND - candesartan cilexetil tab 32 mg 4 QL (30 tablets/30 days)ATACAND HCT - candesartan cilexetil-hydrochlorothiazide tab


ATACAND HCT - candesartan cilexetil-hydrochlorothiazide tab32-12.5 mg


ATACAND HCT - candesartan cilexetil-hydrochlorothiazide tab32-25 mg


atenolol & chlorthalidone tab 50-25 mg^ 2atenolol & chlorthalidone tab 100-25 mg^ 2atenolol tab 25 mg^ 1atenolol tab 50 mg^ 1atenolol tab 100 mg^ 1atorvastatin calcium tab 10 mg^ 1 QL (45 tablets/30 days)atorvastatin calcium tab 20 mg^ 1 QL (45 tablets/30 days)atorvastatin calcium tab 40 mg^ 1 QL (45 tablets/30 days)atorvastatin calcium tab 80 mg^ 1 QL (30 tablets/30 days)AVALIDE - irbesartan-hydrochlorothiazide tab 150-12.5 mg 4 QL (30 tablets/30 days)AVALIDE - irbesartan-hydrochlorothiazide tab 300-12.5 mg 4 QL (30 tablets/30 days)AVAPRO - irbesartan tab 75 mg 4 QL (30 tablets/30 days)AVAPRO - irbesartan tab 150 mg 4 QL (30 tablets/30 days)

2018



AVAPRO - irbesartan tab 300 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 5-20 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 5-40 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 10-20 mg 4 QL (30 tablets/30 days)AZOR - amlodipine besylate-olmesartan medoxomil tab 10-40 mg 4 QL (30 tablets/30 days)benazepril & hydrochlorothiazide tab 5-6.25 mg^ 2benazepril & hydrochlorothiazide tab 10-12.5 mg^ 2benazepril & hydrochlorothiazide tab 20-12.5 mg^ 2benazepril & hydrochlorothiazide tab 20-25 mg^ 2benazepril hcl tab 5 mg^ 1benazepril hcl tab 10 mg^ 1benazepril hcl tab 20 mg^ 1benazepril hcl tab 40 mg^ 1BENICAR - olmesartan medoxomil tab 5 mg 4 QL (60 tablets/30 days)BENICAR - olmesartan medoxomil tab 20 mg 4 QL (30 tablets/30 days)BENICAR - olmesartan medoxomil tab 40 mg 4 QL (30 tablets/30 days)BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab


BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg


BENICAR HCT - olmesartan medoxomil-hydrochlorothiazide tab40-25 mg


betaxolol hcl tab 10 mg^ 2betaxolol hcl tab 20 mg^ 2bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg^ 1bisoprolol & hydrochlorothiazide tab 5-6.25 mg^ 1bisoprolol & hydrochlorothiazide tab 10-6.25 mg^ 1bisoprolol fumarate tab 5 mg^ 2bisoprolol fumarate tab 10 mg^ 2bumetanide inj 0.25 mg/ml^ 2bumetanide tab 0.5 mg^ 2bumetanide tab 1 mg^ 2bumetanide tab 2 mg^ 2CALAN - verapamil hcl tab 80 mg 4CALAN - verapamil hcl tab 120 mg 4CALAN SR - verapamil hcl tab er 120 mg 4CALAN SR - verapamil hcl tab er 240 mg 4candesartan cilexetil tab 4 mg^ 2 QL (60 tablets/30 days)candesartan cilexetil tab 8 mg^ 2 QL (60 tablets/30 days)

2018


69


candesartan cilexetil tab 16 mg^ 2 QL (60 tablets/30 days)candesartan cilexetil tab 32 mg^ 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg^ 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg^ 2 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-25 mg^ 2 QL (30 tablets/30 days)captopril tab 12.5 mg^ 2captopril tab 25 mg^ 2captopril tab 50 mg^ 2captopril tab 100 mg^ 2CAPTOPRIL/HYDROCHLOROTHIAZIDE - captopril &

hydrochlorothiazide tab 25-15 mg4

CAPTOPRIL/HYDROCHLOROTHIAZIDE - captopril &hydrochlorothiazide tab 25-25 mg

4


4


4

CARDIZEM - diltiazem hcl tab 30 mg 4CARDIZEM - diltiazem hcl tab 60 mg 4CARDIZEM - diltiazem hcl tab 120 mg 4CARDIZEM CD - diltiazem hcl coated beads cap er 24hr 120 mg 4CARDIZEM CD - diltiazem hcl coated beads cap er 24hr 180 mg 4CARDIZEM CD - diltiazem hcl coated beads cap er 24hr 240 mg 4CARDIZEM CD - diltiazem hcl coated beads cap er 24hr 360 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 120 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 180 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 240 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 300 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 360 mg 4CARDIZEM LA - diltiazem hcl coated beads tab er 24hr 420 mg 4CARDURA - doxazosin mesylate tab 1 mg 4 QL (60 tablets/30 days)CARDURA - doxazosin mesylate tab 2 mg 4 QL (60 tablets/30 days)CARDURA - doxazosin mesylate tab 4 mg 4 QL (60 tablets/30 days)CARDURA - doxazosin mesylate tab 8 mg 4 QL (60 tablets/30 days)carvedilol phosphate cap er 24hr 10 mg^ 2carvedilol phosphate cap er 24hr 20 mg^ 2carvedilol phosphate cap er 24hr 40 mg^ 2carvedilol phosphate cap er 24hr 80 mg^ 2carvedilol tab 3.125 mg^ 1

2018



carvedilol tab 6.25 mg^ 1carvedilol tab 12.5 mg^ 1carvedilol tab 25 mg^ 1CATAPRES - clonidine hcl tab 0.1 mg 4CATAPRES - clonidine hcl tab 0.2 mg 4CATAPRES - clonidine hcl tab 0.3 mg 4CATAPRES-TTS-1 - clonidine hcl td patch weekly 0.1 mg/24hr 4CATAPRES-TTS-2 - clonidine hcl td patch weekly 0.2 mg/24hr 4CATAPRES-TTS-3 - clonidine hcl td patch weekly 0.3 mg/24hr 4CHLOROTHIAZIDE - chlorothiazide tab 250 mg 4chlorothiazide tab 500 mg^ 2chlorthalidone tab 25 mg^ 2chlorthalidone tab 50 mg^ 2cholestyramine light powder packets 4 gm^ 2cholestyramine light powder 4 gm/dose^ 2cholestyramine powder packets 4 gm^ 2cholestyramine powder 4 gm/dose^ 2choline fenofibrate cap dr 45 mg^ 2 QL (60 capsules/30 days)choline fenofibrate cap dr 135 mg^ 2 QL (30 capsules/30 days)clonidine hcl tab 0.1 mg^ 1clonidine hcl tab 0.2 mg^ 1clonidine hcl tab 0.3 mg^ 1clonidine hcl td patch weekly 0.1 mg/24hr^ 2clonidine hcl td patch weekly 0.2 mg/24hr^ 2clonidine hcl td patch weekly 0.3 mg/24hr^ 2COLESTID - colestipol hcl granule packets 5 gm 4COLESTID - colestipol hcl granules 5 gm 4COLESTID - colestipol hcl tab 1 gm 4COLESTID FLAVORED - colestipol hcl granule packets 5 gm 4COLESTID FLAVORED - colestipol hcl granules 5 gm 4colestipol hcl granule packets 5 gm^ 2colestipol hcl granules 5 gm^ 2colestipol hcl tab 1 gm^ 2COREG - carvedilol tab 3.125 mg 4COREG - carvedilol tab 6.25 mg 4COREG - carvedilol tab 12.5 mg 4COREG - carvedilol tab 25 mg 4COREG CR - carvedilol phosphate cap er 24hr 10 mg 4

2018


71


COREG CR - carvedilol phosphate cap er 24hr 20 mg 4COREG CR - carvedilol phosphate cap er 24hr 40 mg 4COREG CR - carvedilol phosphate cap er 24hr 80 mg 4CORGARD - nadolol tab 20 mg 4CORGARD - nadolol tab 40 mg 4CORGARD - nadolol tab 80 mg 4CORLANOR - ivabradine hcl tab 5 mg 3 PA, QL (60 tablets/30 days)CORLANOR - ivabradine hcl tab 7.5 mg 3 PA, QL (60 tablets/30 days)COZAAR - losartan potassium tab 25 mg 4 QL (60 tablets/30 days)COZAAR - losartan potassium tab 50 mg 4 QL (60 tablets/30 days)COZAAR - losartan potassium tab 100 mg 4 QL (30 tablets/30 days)CRESTOR - rosuvastatin calcium tab 5 mg 4 QL (45 tablets/30 days)CRESTOR - rosuvastatin calcium tab 10 mg 4 QL (45 tablets/30 days)CRESTOR - rosuvastatin calcium tab 20 mg 4 QL (45 tablets/30 days)CRESTOR - rosuvastatin calcium tab 40 mg 4 QL (30 tablets/30 days)DEMADEX - torsemide tab 10 mg 4DEMSER - metyrosine cap 250 mg 5DIAMOX - acetazolamide cap er 12hr 500 mg 4DIGOXIN - digoxin oral soln 0.05 mg/ml# 4 QL (150 mls/30 days)digoxin tab 125 mcg (0.125 mg)#^ 2 QL (30 tablets/30 days)digoxin tab 250 mcg (0.25 mg)# 4 PA, QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg^ 2diltiazem hcl cap er 12hr 90 mg^ 2diltiazem hcl cap er 12hr 120 mg^ 2diltiazem hcl cap er 24hr 120 mg^ 2diltiazem hcl cap er 24hr 180 mg^ 2diltiazem hcl cap er 24hr 240 mg^ 2diltiazem hcl coated beads cap er 24hr 120 mg^ 2diltiazem hcl coated beads cap er 24hr 180 mg^ 2diltiazem hcl coated beads cap er 24hr 240 mg^ 2diltiazem hcl coated beads cap er 24hr 300 mg^ 2diltiazem hcl coated beads cap er 24hr 360 mg^ 2diltiazem hcl coated beads tab er 24hr 180 mg^ 2diltiazem hcl coated beads tab er 24hr 240 mg^ 2diltiazem hcl coated beads tab er 24hr 300 mg^ 2diltiazem hcl coated beads tab er 24hr 360 mg^ 2diltiazem hcl coated beads tab er 24hr 420 mg^ 2diltiazem hcl extended release beads cap er 24hr 120 mg^ 2

2018



diltiazem hcl extended release beads cap er 24hr 180 mg^ 2diltiazem hcl extended release beads cap er 24hr 240 mg^ 2diltiazem hcl extended release beads cap er 24hr 300 mg^ 2diltiazem hcl extended release beads cap er 24hr 360 mg^ 2diltiazem hcl extended release beads cap er 24hr 420 mg^ 2diltiazem hcl tab 30 mg^ 2diltiazem hcl tab 60 mg^ 2diltiazem hcl tab 90 mg^ 2diltiazem hcl tab 120 mg^ 2DIOVAN - valsartan tab 40 mg 4 QL (60 tablets/30 days)DIOVAN - valsartan tab 80 mg 4 QL (60 tablets/30 days)DIOVAN - valsartan tab 160 mg 4 QL (60 tablets/30 days)DIOVAN - valsartan tab 320 mg 4 QL (30 tablets/30 days)DIOVAN HCT - valsartan-hydrochlorothiazide tab 80-12.5 mg 4 QL (30 tablets/30 days)DIOVAN HCT - valsartan-hydrochlorothiazide tab 160-12.5 mg 4 QL (30 tablets/30 days)DIOVAN HCT - valsartan-hydrochlorothiazide tab 160-25 mg 4 QL (30 tablets/30 days)DIOVAN HCT - valsartan-hydrochlorothiazide tab 320-12.5 mg 4 QL (30 tablets/30 days)DIOVAN HCT - valsartan-hydrochlorothiazide tab 320-25 mg 4 QL (30 tablets/30 days)dofetilide cap 125 mcg (0.125 mg)^ 2dofetilide cap 250 mcg (0.25 mg)^ 2dofetilide cap 500 mcg (0.5 mg)^ 2doxazosin mesylate tab 1 mg^ 2 QL (60 tablets/30 days)doxazosin mesylate tab 2 mg^ 2 QL (60 tablets/30 days)doxazosin mesylate tab 4 mg^ 2 QL (60 tablets/30 days)doxazosin mesylate tab 8 mg^ 2 QL (60 tablets/30 days)DYAZIDE - triamterene & hydrochlorothiazide cap 37.5-25 mg 4enalapril maleate & hydrochlorothiazide tab 5-12.5 mg^ 1enalapril maleate & hydrochlorothiazide tab 10-25 mg^ 1enalapril maleate tab 2.5 mg^ 2enalapril maleate tab 5 mg^ 2enalapril maleate tab 10 mg^ 2enalapril maleate tab 20 mg^ 2ENTRESTO - sacubitril-valsartan tab 24-26 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 3 PA, QL (60 tablets/30 days)eplerenone tab 25 mg^ 2eplerenone tab 50 mg^ 2EXFORGE - amlodipine besylate-valsartan tab 5-160 mg 4 QL (30 tablets/30 days)

2018


73


EXFORGE - amlodipine besylate-valsartan tab 5-320 mg 4 QL (30 tablets/30 days)EXFORGE - amlodipine besylate-valsartan tab 10-160 mg 4 QL (30 tablets/30 days)EXFORGE - amlodipine besylate-valsartan tab 10-320 mg 4 QL (30 tablets/30 days)EXFORGE HCT - amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg4 QL (30 tablets/30 days)

EXFORGE HCT - amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg


EXFORGE HCT - amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg






ezetimibe tab 10 mg^ 2 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-10 mg^ 2 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-20 mg^ 2 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-40 mg^ 2 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-80 mg^ 2 QL (30 tablets/30 days)felodipine tab er 24hr 2.5 mg^ 2felodipine tab er 24hr 5 mg^ 2felodipine tab er 24hr 10 mg^ 2fenofibrate micronized cap 43 mg^ 2 QL (60 capsules/30 days)fenofibrate micronized cap 67 mg^ 2 QL (30 capsules/30 days)fenofibrate micronized cap 130 mg^ 2 QL (30 capsules/30 days)fenofibrate micronized cap 134 mg^ 2 QL (30 capsules/30 days)fenofibrate micronized cap 200 mg^ 2 QL (30 capsules/30 days)fenofibrate tab 48 mg^ 2 QL (60 tablets/30 days)fenofibrate tab 54 mg^ 2 QL (60 tablets/30 days)fenofibrate tab 145 mg^ 2 QL (30 tablets/30 days)fenofibrate tab 160 mg^ 2 QL (30 tablets/30 days)flecainide acetate tab 50 mg^ 2flecainide acetate tab 100 mg^ 2flecainide acetate tab 150 mg^ 2fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg^ 2fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg^ 2fosinopril sodium tab 10 mg^ 1fosinopril sodium tab 20 mg^ 1fosinopril sodium tab 40 mg^ 1furosemide inj 10 mg/ml^ 2

2018



furosemide oral soln 10 mg/ml^ 2furosemide tab 20 mg^ 1furosemide tab 40 mg^ 1furosemide tab 80 mg^ 1gemfibrozil tab 600 mg^ 1 QL (60 tablets/30 days)hydralazine hcl tab 10 mg^ 2hydralazine hcl tab 25 mg^ 2hydralazine hcl tab 50 mg^ 2hydralazine hcl tab 100 mg^ 2hydrochlorothiazide cap 12.5 mg^ 1hydrochlorothiazide tab 12.5 mg^ 1hydrochlorothiazide tab 25 mg^ 1hydrochlorothiazide tab 50 mg^ 1HYZAAR - losartan potassium & hydrochlorothiazide tab


HYZAAR - losartan potassium & hydrochlorothiazide tab100-12.5 mg


HYZAAR - losartan potassium & hydrochlorothiazide tab100-25 mg


indapamide tab 1.25 mg^ 2indapamide tab 2.5 mg^ 2INDERAL LA - propranolol hcl cap er 24hr 60 mg 4INDERAL LA - propranolol hcl cap er 24hr 80 mg 4INDERAL LA - propranolol hcl cap er 24hr 120 mg 4INDERAL LA - propranolol hcl cap er 24hr 160 mg 4INSPRA - eplerenone tab 25 mg 4INSPRA - eplerenone tab 50 mg 4irbesartan tab 75 mg^ 2 QL (30 tablets/30 days)irbesartan tab 150 mg^ 2 QL (30 tablets/30 days)irbesartan tab 300 mg^ 2 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 150-12.5 mg^ 2 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 300-12.5 mg^ 2 QL (30 tablets/30 days)ISORDIL TITRADOSE - isosorbide dinitrate tab 5 mg 4isosorbide dinitrate tab 5 mg^ 2isosorbide dinitrate tab 10 mg^ 2isosorbide dinitrate tab 20 mg^ 2isosorbide dinitrate tab 30 mg^ 2isosorbide mononitrate tab er 24hr 30 mg^ 2isosorbide mononitrate tab er 24hr 60 mg^ 2

2018


75


isosorbide mononitrate tab er 24hr 120 mg^ 2isosorbide mononitrate tab 10 mg^ 2isosorbide mononitrate tab 20 mg^ 2isradipine cap 2.5 mg^ 2isradipine cap 5 mg^ 2JUXTAPID - lomitapide mesylate cap 5 mg* 5 PAJUXTAPID - lomitapide mesylate cap 10 mg* 5 PAJUXTAPID - lomitapide mesylate cap 20 mg* 5 PAJUXTAPID - lomitapide mesylate cap 30 mg* 5 PAJUXTAPID - lomitapide mesylate cap 40 mg* 5 PAJUXTAPID - lomitapide mesylate cap 60 mg* 5 PAKYNAMRO - mipomersen sodium soln prefilled syringe 200 mg/

ml*5 PA

labetalol hcl tab 100 mg^ 2labetalol hcl tab 200 mg^ 2labetalol hcl tab 300 mg^ 2LANOXIN - digoxin tab 62.5 mcg (0.0625 mg)# 4 QL (30 tablets/30 days)LANOXIN - digoxin tab 125 mcg (0.125 mg)# 4 QL (30 tablets/30 days)LANOXIN - digoxin tab 250 mcg (0.25 mg)# 4 PA, QL (30 tablets/30 days)LASIX - furosemide tab 20 mg 4LASIX - furosemide tab 40 mg 4LASIX - furosemide tab 80 mg 4LIDOCAINE HCL - lidocaine hcl iv inj 10 mg/ml 4LIPITOR - atorvastatin calcium tab 10 mg 4 QL (45 tablets/30 days)LIPITOR - atorvastatin calcium tab 20 mg 4 QL (45 tablets/30 days)LIPITOR - atorvastatin calcium tab 40 mg 4 QL (45 tablets/30 days)LIPITOR - atorvastatin calcium tab 80 mg 4 QL (30 tablets/30 days)lisinopril & hydrochlorothiazide tab 10-12.5 mg^ 1lisinopril & hydrochlorothiazide tab 20-12.5 mg^ 1lisinopril & hydrochlorothiazide tab 20-25 mg^ 1lisinopril tab 2.5 mg^ 1lisinopril tab 5 mg^ 1lisinopril tab 10 mg^ 1lisinopril tab 20 mg^ 1lisinopril tab 30 mg^ 1lisinopril tab 40 mg^ 1LOPID - gemfibrozil tab 600 mg 4 QL (60 tablets/30 days)LOPRESSOR - metoprolol tartrate tab 50 mg 4

2018



LOPRESSOR - metoprolol tartrate tab 100 mg 4LOPRESSOR HCT - metoprolol & hydrochlorothiazide tab

50-25 mg4

losartan potassium & hydrochlorothiazide tab 50-12.5 mg^ 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-12.5 mg^ 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-25 mg^ 1 QL (30 tablets/30 days)losartan potassium tab 25 mg^ 1 QL (60 tablets/30 days)losartan potassium tab 50 mg^ 1 QL (60 tablets/30 days)losartan potassium tab 100 mg^ 1 QL (30 tablets/30 days)LOTENSIN - benazepril hcl tab 20 mg 4LOTENSIN - benazepril hcl tab 40 mg 4LOTENSIN HCT - benazepril & hydrochlorothiazide tab

10-12.5 mg4

LOTENSIN HCT - benazepril & hydrochlorothiazide tab20-12.5 mg

4

LOTENSIN HCT - benazepril & hydrochlorothiazide tab 20-25 mg 4lovastatin tab 10 mg^ 1 QL (60 tablets/30 days)lovastatin tab 20 mg^ 1 QL (60 tablets/30 days)lovastatin tab 40 mg^ 1 QL (60 tablets/30 days)LOVAZA - omega-3-acid ethyl esters cap 1 gm 4MAXZIDE - triamterene & hydrochlorothiazide tab 75-50 mg 4MAXZIDE-25 - triamterene & hydrochlorothiazide tab 37.5-25 mg 4methazolamide tab 25 mg^ 2methazolamide tab 50 mg^ 2metolazone tab 2.5 mg^ 2metolazone tab 5 mg^ 2metolazone tab 10 mg^ 2metoprolol & hydrochlorothiazide tab 50-25 mg^ 2metoprolol & hydrochlorothiazide tab 100-25 mg^ 2metoprolol & hydrochlorothiazide tab 100-50 mg^ 2metoprolol succinate tab er 24hr 25 mg^ 2metoprolol succinate tab er 24hr 50 mg^ 2metoprolol succinate tab er 24hr 100 mg^ 2metoprolol succinate tab er 24hr 200 mg^ 2metoprolol tartrate tab 25 mg^ 1metoprolol tartrate tab 50 mg^ 1metoprolol tartrate tab 100 mg^ 1mexiletine hcl cap 150 mg^ 2mexiletine hcl cap 200 mg^ 2

2018


77


mexiletine hcl cap 250 mg^ 2MICARDIS - telmisartan tab 20 mg 4 QL (30 tablets/30 days)MICARDIS - telmisartan tab 40 mg 4 QL (30 tablets/30 days)MICARDIS - telmisartan tab 80 mg 4 QL (30 tablets/30 days)MICARDIS HCT - telmisartan-hydrochlorothiazide tab 40-12.5 mg 4 QL (30 tablets/30 days)MICARDIS HCT - telmisartan-hydrochlorothiazide tab 80-12.5 mg 4 QL (60 tablets/30 days)MICARDIS HCT - telmisartan-hydrochlorothiazide tab 80-25 mg 4 QL (30 tablets/30 days)MICROZIDE - hydrochlorothiazide cap 12.5 mg 4midodrine hcl tab 2.5 mg^ 2midodrine hcl tab 5 mg^ 2midodrine hcl tab 10 mg^ 2MINIPRESS - prazosin hcl cap 1 mg 4MINIPRESS - prazosin hcl cap 2 mg 4MINIPRESS - prazosin hcl cap 5 mg 4minoxidil tab 2.5 mg^ 2minoxidil tab 10 mg^ 2moexipril hcl tab 7.5 mg^ 2moexipril hcl tab 15 mg^ 2moexipril-hydrochlorothiazide tab 7.5-12.5 mg^ 2moexipril-hydrochlorothiazide tab 15-12.5 mg^ 2moexipril-hydrochlorothiazide tab 15-25 mg^ 2MULTAQ - dronedarone hcl tab 400 mg 3nadolol tab 20 mg^ 2nadolol tab 40 mg^ 2nadolol tab 80 mg^ 2niacin tab er 500 mg^ 2 QL (30 tablets/30 days)niacin tab er 750 mg^ 2 QL (60 tablets/30 days)niacin tab er 1000 mg^ 2 QL (60 tablets/30 days)NIASPAN - niacin tab er 500 mg 4 QL (30 tablets/30 days)NIASPAN - niacin tab er 750 mg 4 QL (60 tablets/30 days)NIASPAN - niacin tab er 1000 mg 4 QL (60 tablets/30 days)nicardipine hcl cap 20 mg^ 2nicardipine hcl cap 30 mg^ 2nifedipine tab er 24hr 30 mg^ 2nifedipine tab er 24hr 60 mg^ 2nifedipine tab er 24hr 90 mg^ 2nifedipine tab er 24hr osmotic release 30 mg^ 2nifedipine tab er 24hr osmotic release 60 mg^ 2

2018



nifedipine tab er 24hr osmotic release 90 mg^ 2NISOLDIPINE ER - nisoldipine tab er 24hr 25.5 mg 4nisoldipine tab er 24hr 8.5 mg^ 2nisoldipine tab er 24hr 17 mg^ 2nisoldipine tab er 24hr 34 mg^ 2NITRO-BID - nitroglycerin oint 2% 4nitroglycerin sl tab 0.3 mg^ 2nitroglycerin sl tab 0.4 mg^ 2nitroglycerin sl tab 0.6 mg^ 2nitroglycerin td patch 24hr 0.1 mg/hr^ 2nitroglycerin td patch 24hr 0.2 mg/hr^ 2nitroglycerin td patch 24hr 0.4 mg/hr^ 2nitroglycerin td patch 24hr 0.6 mg/hr^ 2nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)^ 2NITROLINGUAL PUMPSPRAY - nitroglycerin tl soln 0.4 mg/spray

(400 mcg/spray)4

NITROSTAT - nitroglycerin sl tab 0.3 mg 4NITROSTAT - nitroglycerin sl tab 0.4 mg 4NITROSTAT - nitroglycerin sl tab 0.6 mg 4NORTHERA - droxidopa cap 100 mg* 5 PANORTHERA - droxidopa cap 200 mg* 5 PANORTHERA - droxidopa cap 300 mg* 5 PANORVASC - amlodipine besylate tab 2.5 mg 4NORVASC - amlodipine besylate tab 5 mg 4NORVASC - amlodipine besylate tab 10 mg 4olmesartan medoxomil tab 5 mg^ 2 QL (60 tablets/30 days)olmesartan medoxomil tab 20 mg^ 2 QL (30 tablets/30 days)olmesartan medoxomil tab 40 mg^ 2 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg^ 2 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg^ 2 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg^ 2 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg^ 2 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-5-12.5 mg^ 2 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25 mg^ 2 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-10-12.5 mg^ 2 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25 mg^ 2 QL (30 tablets/30 days)omega-3-acid ethyl esters cap 1 gm^ 2pentoxifylline tab er 400 mg^ 2

2018


79


perindopril erbumine tab 2 mg^ 2perindopril erbumine tab 4 mg^ 2perindopril erbumine tab 8 mg^ 2phenoxybenzamine hcl cap 10 mg 5pindolol tab 5 mg^ 2pindolol tab 10 mg^ 2PRALUENT - alirocumab subcutaneous soln pen-injector 75 mg/

ml*5 PA, QL (2 pens/28 days)

PRALUENT - alirocumab subcutaneous soln pen-injector 150 mg/ml*

5 PA, QL (2 pens/28 days)

PRAVACHOL - pravastatin sodium tab 20 mg 4 QL (45 tablets/30 days)PRAVACHOL - pravastatin sodium tab 40 mg 4 QL (45 tablets/30 days)PRAVACHOL - pravastatin sodium tab 80 mg 4 QL (30 tablets/30 days)pravastatin sodium tab 10 mg^ 2 QL (45 tablets/30 days)pravastatin sodium tab 20 mg^ 2 QL (45 tablets/30 days)pravastatin sodium tab 40 mg^ 2 QL (45 tablets/30 days)pravastatin sodium tab 80 mg^ 2 QL (30 tablets/30 days)prazosin hcl cap 1 mg^ 2prazosin hcl cap 2 mg^ 2prazosin hcl cap 5 mg^ 2PRINIVIL - lisinopril tab 5 mg 4PRINIVIL - lisinopril tab 10 mg 4PRINIVIL - lisinopril tab 20 mg 4PROCARDIA XL - nifedipine tab er 24hr osmotic release 30 mg 4PROCARDIA XL - nifedipine tab er 24hr osmotic release 60 mg 4PROCARDIA XL - nifedipine tab er 24hr osmotic release 90 mg 4propafenone hcl cap er 12hr 225 mg^ 2propafenone hcl cap er 12hr 325 mg^ 2propafenone hcl cap er 12hr 425 mg^ 2propafenone hcl tab 150 mg^ 2propafenone hcl tab 225 mg^ 2propafenone hcl tab 300 mg^ 2PROPRANOLOL HCL - propranolol hcl oral soln 20 mg/5ml 4PROPRANOLOL HCL - propranolol hcl oral soln 40 mg/5ml 4propranolol hcl cap er 24hr 60 mg^ 2propranolol hcl cap er 24hr 80 mg^ 2propranolol hcl cap er 24hr 120 mg^ 2propranolol hcl cap er 24hr 160 mg^ 2

2018



propranolol hcl inj 1 mg/ml^ 2propranolol hcl tab 10 mg^ 2propranolol hcl tab 20 mg^ 2propranolol hcl tab 40 mg^ 2propranolol hcl tab 60 mg^ 2propranolol hcl tab 80 mg^ 2quinapril hcl tab 5 mg^ 1quinapril hcl tab 10 mg^ 1quinapril hcl tab 20 mg^ 1quinapril hcl tab 40 mg^ 1quinapril-hydrochlorothiazide tab 10-12.5 mg^ 2quinapril-hydrochlorothiazide tab 20-12.5 mg^ 2quinapril-hydrochlorothiazide tab 20-25 mg^ 2quinidine gluconate tab er 324 mg^ 2QUINIDINE SULFATE - quinidine sulfate tab 200 mg 4QUINIDINE SULFATE - quinidine sulfate tab 300 mg 4ramipril cap 1.25 mg^ 1ramipril cap 2.5 mg^ 1ramipril cap 5 mg^ 1ramipril cap 10 mg^ 1RANEXA - ranolazine tab er 12hr 500 mg 3 QL (60 tablets/30 days)RANEXA - ranolazine tab er 12hr 1000 mg 3 QL (60 tablets/30 days)REPATHA - evolocumab subcutaneous soln prefilled syringe

140 mg/ml5 PA, QL (2 syringes/28 days)

REPATHA PUSHTRONEX SYSTEM - evolocumab subcutaneoussoln cartridge/infusor 420 mg/3.5ml

5 PA, QL (1 system/30 days)

REPATHA SURECLICK - evolocumab subcutaneous soln auto-injector 140 mg/ml

5 PA, QL (2 pens/28 days)

rosuvastatin calcium tab 5 mg^ 2 QL (45 tablets/30 days)rosuvastatin calcium tab 10 mg^ 2 QL (45 tablets/30 days)rosuvastatin calcium tab 20 mg^ 2 QL (45 tablets/30 days)rosuvastatin calcium tab 40 mg^ 2 QL (30 tablets/30 days)RYTHMOL SR - propafenone hcl cap er 12hr 225 mg 4RYTHMOL SR - propafenone hcl cap er 12hr 325 mg 4RYTHMOL SR - propafenone hcl cap er 12hr 425 mg 4simvastatin tab 5 mg^ 1 QL (45 tablets/30 days)simvastatin tab 10 mg^ 1 QL (45 tablets/30 days)simvastatin tab 20 mg^ 1 QL (60 tablets/30 days)simvastatin tab 40 mg^ 1 QL (45 tablets/30 days)

2018


81


simvastatin tab 80 mg^ 1 QL (30 tablets/30 days)sotalol hcl (afib/afl) tab 80 mg^ 2sotalol hcl (afib/afl) tab 120 mg^ 2sotalol hcl (afib/afl) tab 160 mg^ 2sotalol hcl tab 80 mg^ 2sotalol hcl tab 120 mg^ 2sotalol hcl tab 160 mg^ 2sotalol hcl tab 240 mg^ 2spironolactone & hydrochlorothiazide tab 25-25 mg^ 2spironolactone tab 25 mg^ 1spironolactone tab 50 mg^ 1spironolactone tab 100 mg^ 1SULAR - nisoldipine tab er 24hr 8.5 mg 4SULAR - nisoldipine tab er 24hr 17 mg 4SULAR - nisoldipine tab er 24hr 34 mg 4TEKTURNA - aliskiren fumarate tab 150 mg 3 QL (30 tablets/30 days)TEKTURNA - aliskiren fumarate tab 300 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-12.5 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-25 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-12.5 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-25 mg 3 QL (30 tablets/30 days)telmisartan tab 20 mg^ 2 QL (30 tablets/30 days)telmisartan tab 40 mg^ 2 QL (30 tablets/30 days)telmisartan tab 80 mg^ 2 QL (30 tablets/30 days)telmisartan-amlodipine tab 40-5 mg^ 2 QL (30 tablets/30 days)telmisartan-amlodipine tab 40-10 mg^ 2 QL (30 tablets/30 days)telmisartan-amlodipine tab 80-5 mg^ 2 QL (30 tablets/30 days)telmisartan-amlodipine tab 80-10 mg^ 2 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 40-12.5 mg^ 2 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-12.5 mg^ 2 QL (60 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-25 mg^ 2 QL (30 tablets/30 days)TENORETIC 100 - atenolol & chlorthalidone tab 100-25 mg 4TENORETIC 50 - atenolol & chlorthalidone tab 50-25 mg 4TENORMIN - atenolol tab 25 mg 4TENORMIN - atenolol tab 50 mg 4TENORMIN - atenolol tab 100 mg 4terazosin hcl cap 1 mg^ 1 QL (90 capsules/30 days)terazosin hcl cap 2 mg^ 1 QL (60 capsules/30 days)

2018



terazosin hcl cap 5 mg^ 1 QL (60 capsules/30 days)terazosin hcl cap 10 mg^ 1 QL (60 capsules/30 days)TIAZAC - diltiazem hcl extended release beads cap er 24hr

120 mg4

TIAZAC - diltiazem hcl extended release beads cap er 24hr180 mg

4


4


4


4


4

TIKOSYN - dofetilide cap 125 mcg (0.125 mg) 4TIKOSYN - dofetilide cap 250 mcg (0.25 mg) 4TIKOSYN - dofetilide cap 500 mcg (0.5 mg) 4TIMOLOL MALEATE - timolol maleate tab 5 mg 4TIMOLOL MALEATE - timolol maleate tab 10 mg 4TIMOLOL MALEATE - timolol maleate tab 20 mg 4TOPROL XL - metoprolol succinate tab er 24hr 25 mg 4TOPROL XL - metoprolol succinate tab er 24hr 50 mg 4TOPROL XL - metoprolol succinate tab er 24hr 100 mg 4TOPROL XL - metoprolol succinate tab er 24hr 200 mg 4torsemide tab 5 mg^ 1torsemide tab 10 mg^ 1torsemide tab 20 mg^ 1torsemide tab 100 mg^ 1trandolapril tab 1 mg^ 2trandolapril tab 2 mg^ 2trandolapril tab 4 mg^ 2triamterene & hydrochlorothiazide cap 37.5-25 mg^ 1triamterene & hydrochlorothiazide tab 37.5-25 mg^ 1triamterene & hydrochlorothiazide tab 75-50 mg^ 1TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg4 QL (30 tablets/30 days)

TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-5-12.5 mg


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg


2018


83


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-10-12.5 mg


TRIBENZOR - olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg


valsartan tab 40 mg^ 2 QL (60 tablets/30 days)valsartan tab 80 mg^ 2 QL (60 tablets/30 days)valsartan tab 160 mg^ 2 QL (60 tablets/30 days)valsartan tab 320 mg^ 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 80-12.5 mg^ 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-12.5 mg^ 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-25 mg^ 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-12.5 mg^ 2 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-25 mg^ 2 QL (30 tablets/30 days)VASCEPA - icosapent ethyl cap 0.5 gm 3VASCEPA - icosapent ethyl cap 1 gm 3VASERETIC - enalapril maleate & hydrochlorothiazide tab

10-25 mg4

VASOTEC - enalapril maleate tab 2.5 mg 4VASOTEC - enalapril maleate tab 5 mg 4VASOTEC - enalapril maleate tab 10 mg 4VASOTEC - enalapril maleate tab 20 mg 4verapamil hcl cap er 24hr 100 mg^ 2verapamil hcl cap er 24hr 120 mg^ 2verapamil hcl cap er 24hr 180 mg^ 2verapamil hcl cap er 24hr 200 mg^ 2verapamil hcl cap er 24hr 240 mg^ 2verapamil hcl cap er 24hr 300 mg^ 2verapamil hcl cap er 24hr 360 mg^ 2verapamil hcl tab er 120 mg^ 2verapamil hcl tab er 180 mg^ 2verapamil hcl tab er 240 mg^ 2verapamil hcl tab 40 mg^ 1verapamil hcl tab 80 mg^ 1verapamil hcl tab 120 mg^ 1VERELAN - verapamil hcl cap er 24hr 120 mg 4VERELAN - verapamil hcl cap er 24hr 180 mg 4VERELAN - verapamil hcl cap er 24hr 240 mg 4VERELAN - verapamil hcl cap er 24hr 360 mg 4VERELAN PM - verapamil hcl cap er 24hr 100 mg 4

2018



VERELAN PM - verapamil hcl cap er 24hr 200 mg 4VERELAN PM - verapamil hcl cap er 24hr 300 mg 4VYTORIN - ezetimibe-simvastatin tab 10-10 mg 4 QL (30 tablets/30 days)VYTORIN - ezetimibe-simvastatin tab 10-20 mg 4 QL (30 tablets/30 days)VYTORIN - ezetimibe-simvastatin tab 10-40 mg 4 QL (30 tablets/30 days)VYTORIN - ezetimibe-simvastatin tab 10-80 mg 4 QL (30 tablets/30 days)WELCHOL - colesevelam hcl packet for susp 3.75 gm 4WELCHOL - colesevelam hcl tab 625 mg 4ZESTORETIC - lisinopril & hydrochlorothiazide tab 10-12.5 mg 4ZESTORETIC - lisinopril & hydrochlorothiazide tab 20-12.5 mg 4ZESTORETIC - lisinopril & hydrochlorothiazide tab 20-25 mg 4ZESTRIL - lisinopril tab 2.5 mg 4ZESTRIL - lisinopril tab 5 mg 4ZESTRIL - lisinopril tab 10 mg 4ZESTRIL - lisinopril tab 20 mg 4ZESTRIL - lisinopril tab 30 mg 4ZESTRIL - lisinopril tab 40 mg 4ZETIA - ezetimibe tab 10 mg 4 QL (30 tablets/30 days)ZIAC - bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg 4ZIAC - bisoprolol & hydrochlorothiazide tab 5-6.25 mg 4ZIAC - bisoprolol & hydrochlorothiazide tab 10-6.25 mg 4ZOCOR - simvastatin tab 5 mg 4 QL (45 tablets/30 days)ZOCOR - simvastatin tab 10 mg 4 QL (45 tablets/30 days)ZOCOR - simvastatin tab 20 mg 4 QL (60 tablets/30 days)ZOCOR - simvastatin tab 40 mg 4 QL (45 tablets/30 days)ZOCOR - simvastatin tab 80 mg 4 QL (30 tablets/30 days)Agentes del sistema nervioso centralADDERALL XR - amphetamine-dextroamphetamine cap er 24hr

5 mg4 QL (30 capsules/30 days)

ADDERALL XR - amphetamine-dextroamphetamine cap er 24hr10 mg

4 QL (30 capsules/30 days)









amphetamine-dextroamphetamine cap er 24hr 5 mg^ 2 QL (30 capsules/30 days)

2018


85


amphetamine-dextroamphetamine cap er 24hr 10 mg^ 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 15 mg^ 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 20 mg^ 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 25 mg^ 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 30 mg^ 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine tab 5 mg^ 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 7.5 mg^ 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 10 mg^ 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 12.5 mg^ 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 15 mg^ 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 20 mg^ 2 QL (90 tablets/30 days)amphetamine-dextroamphetamine tab 30 mg^ 2 QL (60 tablets/30 days)AMPYRA - dalfampridine tab er 12hr 10 mg* 5 PAatomoxetine hcl cap 10 mg^ 2 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg^ 2 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg^ 2 QL (60 capsules/30 days)atomoxetine hcl cap 40 mg^ 2 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg^ 2 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg^ 2 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg^ 2 QL (30 capsules/30 days)AVONEX - interferon beta-1a for im inj kit 30mcg (33mcg(6.6 mu)/

vial)5 PA, QL (1 kit/28 days)

AVONEX - interferon beta-1a im prefilled syringe kit 30 mcg/0.5ml 5 PA, QL (1 kit/28 days)AVONEX PEN - interferon beta-1a im auto-injector kit

30 mcg/0.5ml5 PA, QL (1 kit/28 days)

BETASERON - interferon beta-1b for inj kit 0.3 mg 5 PA, QL (15 vials/syringes/30 days)

clonidine hcl tab er 12hr 0.1 mg^ 2 QL (120 tablets/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 20 mg/ml 5 PA, QL (30 syringes/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 40 mg/ml 5 PA, QL (12 syringes/28 days)DEXEDRINE - dextroamphetamine sulfate cap er 24hr 5 mg 5 QL (90 capsules/30 days)DEXEDRINE - dextroamphetamine sulfate cap er 24hr 10 mg 5 QL (120 capsules/30 days)DEXEDRINE - dextroamphetamine sulfate cap er 24hr 15 mg 5 QL (120 capsules/30 days)dexmethylphenidate hcl tab 2.5 mg^ 2 QL (60 tablets/30 days)dexmethylphenidate hcl tab 5 mg^ 2 QL (60 tablets/30 days)dexmethylphenidate hcl tab 10 mg^ 2 QL (60 tablets/30 days)dextroamphetamine sulfate cap er 24hr 5 mg^ 2 QL (90 capsules/30 days)dextroamphetamine sulfate cap er 24hr 10 mg^ 2 QL (120 capsules/30 days)

2018



dextroamphetamine sulfate cap er 24hr 15 mg^ 2 QL (120 capsules/30 days)dextroamphetamine sulfate tab 5 mg^ 2 QL (90 tablets/30 days)dextroamphetamine sulfate tab 10 mg^ 2 QL (180 tablets/30 days)FOCALIN - dexmethylphenidate hcl tab 2.5 mg 4 QL (60 tablets/30 days)FOCALIN - dexmethylphenidate hcl tab 5 mg 4 QL (60 tablets/30 days)FOCALIN - dexmethylphenidate hcl tab 10 mg 4 QL (60 tablets/30 days)glatiramer acetate soln prefilled syringe 20 mg/ml 5 PA, QL (30 syringes/30 days)glatiramer acetate soln prefilled syringe 40 mg/ml 5 PA, QL (12 syringes/28 days)methylphenidate hcl tab er 20 mg^ 2 QL (90 tablets/30 days)methylphenidate hcl tab 5 mg^ 2 QL (90 tablets/30 days)methylphenidate hcl tab 10 mg^ 2 QL (90 tablets/30 days)methylphenidate hcl tab 20 mg^ 2 QL (90 tablets/30 days)NUEDEXTA - dextromethorphan hbr-quinidine sulfate cap

20-10 mg3

PLEGRIDY - peginterferon beta-1a soln pen-injector125 mcg/0.5ml

5 PA, QL (2 syringes/28 days)

PLEGRIDY - peginterferon beta-1a soln prefilled syringe125 mcg/0.5ml


PLEGRIDY STARTER PACK - peginterferon beta-1a soln pen-inj63 & 94 mcg/0.5ml pack


PLEGRIDY STARTER PACK - peginterferon beta-1a soln pref syr63 & 94 mcg/0.5ml pack


riluzole tab 50 mg^ 2RITALIN - methylphenidate hcl tab 5 mg 4 QL (90 tablets/30 days)RITALIN - methylphenidate hcl tab 10 mg 4 QL (90 tablets/30 days)RITALIN - methylphenidate hcl tab 20 mg 4 QL (90 tablets/30 days)STRATTERA - atomoxetine hcl cap 10 mg 4 QL (60 capsules/30 days)STRATTERA - atomoxetine hcl cap 18 mg 4 QL (60 capsules/30 days)STRATTERA - atomoxetine hcl cap 25 mg 4 QL (60 capsules/30 days)STRATTERA - atomoxetine hcl cap 40 mg 4 QL (60 capsules/30 days)STRATTERA - atomoxetine hcl cap 60 mg 4 QL (30 capsules/30 days)STRATTERA - atomoxetine hcl cap 80 mg 4 QL (30 capsules/30 days)STRATTERA - atomoxetine hcl cap 100 mg 4 QL (30 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 120 mg 5 PA, QL (60 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 240 mg 5 PA, QL (60 capsules/30 days)TECFIDERA STARTER PACK - dimethyl fumarate capsule dr

starter pack 120 mg & 240 mg5 PA, QL (60 capsules/30 days)

tetrabenazine tab 12.5 mg* 5 PA, QL (240 tablets/30 days)tetrabenazine tab 25 mg* 5 PA, QL (120 tablets/30 days)

2018


87


TYSABRI - natalizumab for iv inj conc 300 mg/15ml* 5 PAXENAZINE - tetrabenazine tab 12.5 mg* 5 PA, QL (240 tablets/30 days)XENAZINE - tetrabenazine tab 25 mg* 5 PA, QL (120 tablets/30 days)Agentes dentales y oralescevimeline hcl cap 30 mg^ 2chlorhexidine gluconate soln 0.12%^ 1KEPIVANCE - palifermin for iv inj 6.25 mg 5pilocarpine hcl tab 5 mg^ 2pilocarpine hcl tab 7.5 mg^ 2SALAGEN - pilocarpine hcl tab 5 mg 4SALAGEN - pilocarpine hcl tab 7.5 mg 4triamcinolone acetonide dental paste 0.1%^ 2Agentes dermatológicosacitretin cap 10 mg^ 2acitretin cap 17.5 mg^ 2acitretin cap 25 mg^ 2alclometasone dipropionate cream 0.05%^ 2alclometasone dipropionate oint 0.05%^ 2ALDARA - imiquimod cream 5% 5 PAAZELEX - azelaic acid cream 20% 4BENZAMYCIN - benzoyl peroxide-erythromycin gel 5-3% 4benzoyl peroxide-erythromycin gel 5-3%^ 2betamethasone dipropionate augmented cream 0.05%^ 2betamethasone dipropionate augmented gel 0.05%^ 2betamethasone dipropionate augmented lotion 0.05%^ 2betamethasone dipropionate augmented oint 0.05%^ 2betamethasone dipropionate cream 0.05%^ 2betamethasone dipropionate lotion 0.05%^ 2betamethasone dipropionate oint 0.05%^ 2betamethasone valerate cream 0.1%^ 2betamethasone valerate lotion 0.1%^ 2betamethasone valerate oint 0.1%^ 2calcipotriene cream 0.005%^ 2calcipotriene oint 0.005%^ 2calcipotriene soln 0.005% (50 mcg/ml)^ 2CARAC - fluorouracil cream 0.5% 5clindamycin phosphate-benzoyl peroxide gel 1-5%^ 2clobetasol propionate cream 0.05%^ 2

2018



clobetasol propionate emollient base cream 0.05%^ 2clobetasol propionate gel 0.05%^ 2clobetasol propionate oint 0.05%^ 2clobetasol propionate soln 0.05%^ 2clotrimazole w/ betamethasone cream 1-0.05%^ 2clotrimazole w/ betamethasone lotion 1-0.05%^ 2DERMATOP - prednicarbate cream 0.1% 4desonide cream 0.05%^ 2desonide lotion 0.05%^ 2desonide oint 0.05%^ 2desoximetasone cream 0.05%^ 2desoximetasone cream 0.25%^ 2desoximetasone gel 0.05%^ 2desoximetasone oint 0.25%^ 2diclofenac sodium gel 3% 5DIFLORASONE DIACETATE - diflorasone diacetate oint 0.05% 4DIPROLENE - betamethasone dipropionate augmented oint

0.05%4

DIPROLENE AF - betamethasone dipropionate augmented cream0.05%

4

DOVONEX - calcipotriene cream 0.005% 4ELIDEL - pimecrolimus cream 1% 4 PAELOCON - mometasone furoate cream 0.1% 4ELOCON - mometasone furoate oint 0.1% 4FINACEA - azelaic acid foam 15% 4FINACEA - azelaic acid gel 15% 4fluocinolone acetonide cream 0.01%^ 2fluocinonide cream 0.05%^ 2fluocinonide emulsified base cream 0.05%^ 2fluocinonide gel 0.05%^ 2fluocinonide oint 0.05%^ 2fluocinonide soln 0.05%^ 2fluorouracil cream 5%^ 2fluorouracil soln 2%^ 2fluorouracil soln 5%^ 2fluticasone propionate cream 0.05%^ 2fluticasone propionate oint 0.005%^ 2GENTAMICIN SULFATE - gentamicin sulfate oint 0.1% 4

2018


89


gentamicin sulfate cream 0.1%^ 2halobetasol propionate cream 0.05%^ 2halobetasol propionate oint 0.05%^ 2hydrocortisone butyrate cream 0.1%^ 2hydrocortisone butyrate oint 0.1%^ 2hydrocortisone butyrate soln 0.1%^ 2hydrocortisone cream 1%^ 1hydrocortisone cream 2.5%^ 1hydrocortisone lotion 2.5%^ 1hydrocortisone oint 1%^ 1hydrocortisone oint 2.5%^ 1hydrocortisone valerate cream 0.2%^ 2hydrocortisone valerate oint 0.2%^ 2imiquimod cream 5%^ 2 PAisotretinoin cap 10 mg^ 2isotretinoin cap 20 mg^ 2isotretinoin cap 30 mg^ 2isotretinoin cap 40 mg^ 2lactic acid (ammonium lactate) cream 12%^ 2lactic acid (ammonium lactate) lotion 12%^ 1LOCOID - hydrocortisone butyrate cream 0.1% 4LOTRISONE - clotrimazole w/ betamethasone cream 1-0.05% 4methoxsalen rapid cap 10 mg 5METROCREAM - metronidazole cream 0.75% 4METROGEL - metronidazole gel 1% 4METROLOTION - metronidazole lotion 0.75% 4metronidazole cream 0.75%^ 2metronidazole gel 0.75%^ 2metronidazole gel 1%^ 2metronidazole lotion 0.75%^ 2mometasone furoate cream 0.1%^ 2mometasone furoate oint 0.1%^ 2mometasone furoate solution 0.1% (lotion)^ 2mupirocin oint 2%^ 2nystatin-triamcinolone cream 100000-0.1 unit/gm-%^ 2nystatin-triamcinolone oint 100000-0.1 unit/gm-%^ 2ORACEA - doxycycline cap delayed release 40 mg 4PICATO - ingenol mebutate gel 0.015% 3 QL (3 tubes/30 days)

2018



PICATO - ingenol mebutate gel 0.05% 3 QL (2 tubes/30 days)podofilox soln 0.5%^ 2prednicarbate cream 0.1%^ 2prednicarbate oint 0.1%^ 2PRUDOXIN - doxepin hcl cream 5% 4REGRANEX - becaplermin gel 0.01% 5 PA, QL (15 grams/30 days)RETIN-A - tretinoin cream 0.025% 4RETIN-A - tretinoin cream 0.05% 4RETIN-A - tretinoin cream 0.1% 4RETIN-A - tretinoin gel 0.01% 4RETIN-A - tretinoin gel 0.025% 4SANTYL - collagenase oint 250 unit/gm 3selenium sulfide lotion 2.5%^ 1SILVADENE - silver sulfadiazine cream 1% 4silver sulfadiazine cream 1%^ 2SOOLANTRA - ivermectin cream 1% 3tacrolimus oint 0.03%^ 2 PAtacrolimus oint 0.1%^ 2 PAtazarotene cream 0.1%^ 2TAZORAC - tazarotene cream 0.05% 4TAZORAC - tazarotene gel 0.05% 4TAZORAC - tazarotene gel 0.1% 4TEMOVATE - clobetasol propionate soln 0.05% 4tretinoin cream 0.025%^ 2tretinoin cream 0.05%^ 2tretinoin cream 0.1%^ 2tretinoin gel 0.01%^ 2tretinoin gel 0.025%^ 2triamcinolone acetonide cream 0.025%^ 2triamcinolone acetonide cream 0.1%^ 2triamcinolone acetonide cream 0.5%^ 2triamcinolone acetonide lotion 0.025%^ 2triamcinolone acetonide lotion 0.1%^ 2triamcinolone acetonide oint 0.025%^ 2triamcinolone acetonide oint 0.1%^ 2triamcinolone acetonide oint 0.5%^ 2ULTRAVATE - halobetasol propionate cream 0.05% 4ULTRAVATE - halobetasol propionate oint 0.05% 4

2018


91


UVADEX - methoxsalen soln 20 mcg/ml 4WESTCORT - hydrocortisone valerate oint 0.2% 4ZONALON - doxepin hcl cream 5% 4Electrolitos/Minerales/Metales/Vitaminasamino acid infusion 6%^ 2 BDamino acid infusion 15%^ 2 BDAMINOSYN II - amino acid infusion 15% 4 BDcalcium acetate cap 667 mg^ 2calcium acetate tab 667 mg^ 2CARBAGLU - carglumic acid tab 200 mg 5CARNITOR - levocarnitine oral soln 1 gm/10ml (10%) 4CARNITOR - levocarnitine tab 330 mg 4CARNITOR SF - levocarnitine oral soln 1 gm/10ml (10%) 4CHEMET - succimer cap 100 mg 4dextrose inj 5%^ 1dextrose inj 10%^ 1dextrose 5% in lactated ringers^ 2dextrose 2.5% w/ sodium chloride 0.45%^ 2dextrose 5% w/ sodium chloride 0.2%^ 2dextrose 5% w/ sodium chloride 0.33%^ 2dextrose 5% w/ sodium chloride 0.45%^ 2dextrose 5% w/ sodium chloride 0.9%^ 2EXJADE - deferasirox tab for oral susp 125 mg* 5EXJADE - deferasirox tab for oral susp 250 mg* 5EXJADE - deferasirox tab for oral susp 500 mg* 5fat emulsion iv soln 20%^ 2 BDfomepizole inj 1 gm/ml (for iv infusion) 5FOSRENOL - lanthanum carbonate chew tab 500 mg 5FOSRENOL - lanthanum carbonate chew tab 750 mg 5FOSRENOL - lanthanum carbonate chew tab 1000 mg 5FOSRENOL - lanthanum carbonate oral powder pack 750 mg 5FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 5HEPATAMINE - amino acid infusion 8% 3 BDINTRALIPID - fat emulsion iv soln 30% 4 BDJADENU - deferasirox tab 90 mg 5JADENU - deferasirox tab 180 mg 5JADENU - deferasirox tab 360 mg 5JADENU SPRINKLE - deferasirox granules packet 90 mg 5

2018



JADENU SPRINKLE - deferasirox granules packet 180 mg 5JADENU SPRINKLE - deferasirox granules packet 360 mg 5K-TAB - potassium chloride tab er 10 meq 4K-TAB - potassium chloride tab er 20 meq (1500 mg) 4kcl 20 meq/l (0.15%) in nacl 0.45% inj^ 2kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj^ 1kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj^ 1kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj^ 1lactated ringer's solution^ 2lanthanum carbonate chew tab 500 mg 5lanthanum carbonate chew tab 750 mg 5lanthanum carbonate chew tab 1000 mg 5levocarnitine oral soln 1 gm/10ml (10%)^ 2levocarnitine tab 330 mg^ 2magnesium sulfate inj 50%^ 2MICRO-K - potassium chloride cap er 8 meq 4MICRO-K - potassium chloride cap er 10 meq 4NORMOSOL-M IN D5W - electrolyte-m in d5w soln 4PHOSLYRA - calcium acetate oral soln 667 mg/5ml 3potassium chloride cap er 8 meq^ 2potassium chloride cap er 10 meq^ 2POTASSIUM CHLORIDE ER - potassium chloride tab er 20 meq

(1500 mg)4

potassium chloride inj 2 meq/ml^ 2potassium chloride microencapsulated crys er tab 10 meq^ 2potassium chloride microencapsulated crys er tab 20 meq^ 2potassium chloride oral soln 10% (20 meq/15ml)^ 2potassium chloride tab er 8 meq (600 mg)^ 2potassium chloride tab er 10 meq^ 2potassium chloride 20 meq/l (0.15%) in dextrose 5% inj^ 2POTASSIUM CHLORIDE/DEXTROSE - potassium chloride 40

meq/l (0.3%) in dextrose 5% inj3

POTASSIUM CHLORIDE/DEXTROSE/LACTATED RINGERS -potassium chloride 20 meq/l (0.15%) in d5w lactated ringers

4

POTASSIUM CHLORIDE/DEXTROSE/LACTATED RINGERS -potassium chloride 40 meq/l (0.3%) in d5w lactated ringers

4

2018


93


potassium citrate tab er 5 meq (540 mg)^ 2potassium citrate tab er 10 meq (1080 mg)^ 2potassium citrate tab er 15 meq (1620 mg)^ 2RENVELA - sevelamer carbonate packet 0.8 gm 5RENVELA - sevelamer carbonate packet 2.4 gm 5RENVELA - sevelamer carbonate tab 800 mg 5SAMSCA - tolvaptan tab 15 mg 5 PASAMSCA - tolvaptan tab 30 mg 5 PAsevelamer carbonate packet 0.8 gm 5sevelamer carbonate packet 2.4 gm 5sevelamer carbonate tab 800 mg 5sodium chloride inj 0.45%^ 2sodium chloride irrigation soln 0.9%^ 2sodium chloride iv soln 0.9%^ 2sodium polystyrene sulfonate oral susp 15 gm/60ml^ 2sodium polystyrene sulfonate powder^ 2sodium polystyrene sulfonate rectal susp 30 gm/120ml^ 2SYPRINE - trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)TROPHAMINE - amino acid infusion 6% 4 BDwater for irrigation, sterile irrigation soln^ 2Agentes gastrointestinalesACTIGALL - ursodiol cap 300 mg 4alosetron hcl tab 0.5 mg^ 2alosetron hcl tab 1 mg 5AMITIZA - lubiprostone cap 8 mcg 3 PAAMITIZA - lubiprostone cap 24 mcg 3 PACARAFATE - sucralfate susp 1 gm/10ml 4CARAFATE - sucralfate tab 1 gm 4CHENODAL - chenodiol tab 250 mg* 5cimetidine hcl soln 300 mg/5ml^ 2cimetidine tab 200 mg^ 2cimetidine tab 300 mg^ 2cimetidine tab 400 mg^ 2cimetidine tab 800 mg^ 2COLYTE-FLAVOR PACKS - peg 3350-kcl-na bicarb-nacl-na

sulfate for soln 240 gm4

cromolyn sodium oral conc 100 mg/5ml^ 2CYTOTEC - misoprostol tab 100 mcg 4

2018



CYTOTEC - misoprostol tab 200 mcg 4dicyclomine hcl cap 10 mg# 3 PAdicyclomine hcl tab 20 mg# 4 PAesomeprazole magnesium cap delayed release 20 mg^ 2 QL (30 capsules/30 days)esomeprazole magnesium cap delayed release 40 mg^ 2 QL (30 capsules/30 days)ESOMEPRAZOLE SODIUM - esomeprazole sodium for

intravenous soln 20 mg4

esomeprazole sodium for intravenous soln 40 mg^ 2famotidine for susp 40 mg/5ml^ 2famotidine inj 20 mg/2ml^ 1famotidine inj 40 mg/4ml^ 1famotidine inj 200 mg/20ml^ 1famotidine tab 20 mg^ 1famotidine tab 40 mg^ 1GATTEX - teduglutide (rdna) for inj kit 5 mg* 5 PAglycopyrrolate tab 1 mg^ 2glycopyrrolate tab 2 mg^ 2GOLYTELY - peg 3350-kcl-na bicarb-nacl-na sulfate packet

227.1 gm4

GOLYTELY - peg 3350-kcl-na bicarb-nacl-na sulfate for soln236 gm

4

lactulose (encephalopathy) solution 10 gm/15ml^ 2lactulose solution 10 gm/15ml^ 2lansoprazole cap delayed release 15 mg^ 2 QL (30 capsules/30 days)lansoprazole cap delayed release 30 mg^ 2 QL (30 capsules/30 days)LINZESS - linaclotide cap 72 mcg 3 PALINZESS - linaclotide cap 145 mcg 3 PALINZESS - linaclotide cap 290 mcg 3 PAloperamide hcl cap 2 mg^ 2LOTRONEX - alosetron hcl tab 0.5 mg 5LOTRONEX - alosetron hcl tab 1 mg 5methscopolamine bromide tab 2.5 mg^ 2methscopolamine bromide tab 5 mg^ 2metoclopramide hcl inj 5 mg/ml^ 2metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)^ 2metoclopramide hcl tab 5 mg^ 1metoclopramide hcl tab 10 mg^ 1misoprostol tab 100 mcg^ 2misoprostol tab 200 mcg^ 2

2018


95


MOVIPREP - peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln100 gm

4

MYALEPT - metreleptin for subcutaneous inj 11.3 mg* 5 PANEXIUM - esomeprazole magnesium cap delayed release 20 mg 4 QL (30 capsules/30 days)NEXIUM - esomeprazole magnesium cap delayed release 40 mg 4 QL (30 capsules/30 days)NEXIUM - esomeprazole magnesium for delayed release susp

packet 5 mg4 QL (30 packets/30 days)

NEXIUM - esomeprazole magnesium for delayed release susppacket 10 mg

4 QL (30 packets/30 days)





NEXIUM - esomeprazole magnesium for delayed release susppacket 2.5 mg


NEXIUM I.V. - esomeprazole sodium for intravenous soln 40 mg 4nizatidine cap 150 mg^ 2nizatidine cap 300 mg^ 2NULYTELY/FLAVOR PACKS - peg 3350-kcl-sod bicarb-nacl for

soln 420 gm4

omeprazole cap delayed release 10 mg^ 1 QL (30 capsules/30 days)omeprazole cap delayed release 20 mg^ 1 QL (60 capsules/30 days)omeprazole cap delayed release 40 mg^ 1 QL (60 capsules/30 days)PAMINE - methscopolamine bromide tab 2.5 mg 4PAMINE FORTE - methscopolamine bromide tab 5 mg 4pantoprazole sodium ec tab 20 mg^ 1 QL (30 tablets/30 days)pantoprazole sodium ec tab 40 mg^ 1 QL (60 tablets/30 days)pantoprazole sodium for iv soln 40 mg^ 2peg 3350-kcl-sod bicarb-nacl for soln 420 gm^ 2peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm^ 2peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm^ 2polyethylene glycol 3350 oral packet^ 2polyethylene glycol 3350 oral powder^ 2PREVACID - lansoprazole cap delayed release 15 mg 4 QL (30 capsules/30 days)PREVACID - lansoprazole cap delayed release 30 mg 4 QL (30 capsules/30 days)PROTONIX - pantoprazole sodium ec tab 20 mg 4 QL (30 tablets/30 days)PROTONIX - pantoprazole sodium ec tab 40 mg 4 QL (60 tablets/30 days)PYLERA - bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg3

rabeprazole sodium ec tab 20 mg^ 2 QL (30 tablets/30 days)

2018



ranitidine hcl cap 150 mg^ 2ranitidine hcl cap 300 mg^ 2ranitidine hcl syrup 15 mg/ml (75 mg/5ml)^ 2ranitidine hcl tab 150 mg^ 2ranitidine hcl tab 300 mg^ 2REGLAN - metoclopramide hcl tab 5 mg 4REGLAN - metoclopramide hcl tab 10 mg 4RELISTOR - methylnaltrexone bromide inj 8 mg/0.4ml (20 mg/ml) 5 PARELISTOR - methylnaltrexone bromide inj 12 mg/0.6ml (20 mg/

ml)5 PA

RELISTOR - methylnaltrexone bromide tab 150 mg 5 PAROBINUL - glycopyrrolate tab 1 mg 4ROBINUL FORTE - glycopyrrolate tab 2 mg 4sucralfate tab 1 gm^ 2SUPREP BOWEL PREP KIT - sod sulfate-pot sulf-mg sulf oral sol

17.5-3.13-1.6 gm/180ml4

ursodiol cap 300 mg^ 2ursodiol tab 250 mg^ 2ursodiol tab 500 mg^ 2XIFAXAN - rifaximin tab 550 mg 5ZANTAC - ranitidine hcl tab 150 mg 4ZANTAC - ranitidine hcl tab 300 mg 4Trastorno genético o enzimático:ADAGEN - pegademase bovine inj 250 unit/ml* 5ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500

unit/5ml)*5

BUPHENYL - sodium phenylbutyrate tab 500 mg 5CEREZYME - imiglucerase for inj 400 unit* 5CREON - pancrelipase (lip-prot-amyl) dr cap 3000-9500-15000

unit3

CREON - pancrelipase (lip-prot-amyl) dr cap 6000-19000-30000unit

3

CREON - pancrelipase (lip-prot-amyl) dr cap 12000-38000-60000unit

3

CREON - pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit

3

CREON - pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit

3

CYSTADANE - betaine powder for oral solution 5CYSTAGON - cysteamine bitartrate cap 50 mg* 4

2018


97


CYSTAGON - cysteamine bitartrate cap 150 mg* 4ELAPRASE - idursulfase soln for iv infusion 6 mg/3ml (2 mg/ml)* 5ELELYSO - taliglucerase alfa for inj 200 unit* 5FABRAZYME - agalsidase beta for iv soln 5 mg* 5FABRAZYME - agalsidase beta for iv soln 35 mg* 5KUVAN - sapropterin dihydrochloride powder packet 100 mg* 5 PAKUVAN - sapropterin dihydrochloride powder packet 500 mg* 5 PAKUVAN - sapropterin dihydrochloride soluble tab 100 mg* 5 PANAGLAZYME - galsulfase soln for iv infusion 1 mg/ml* 5OCALIVA - obeticholic acid tab 5 mg* 5 PA, QL (30 tablets/30 days)OCALIVA - obeticholic acid tab 10 mg* 5 PA, QL (30 tablets/30 days)ORFADIN - nitisinone cap 2 mg* 5ORFADIN - nitisinone cap 5 mg* 5ORFADIN - nitisinone cap 10 mg* 5ORFADIN - nitisinone cap 20 mg* 5ORFADIN - nitisinone susp 4 mg/ml* 5PROLASTIN-C - alpha1-proteinase inhibitor (human) for iv soln

1000 mg*5 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful 5sodium phenylbutyrate tab 500 mg 5STRENSIQ - asfotase alfa subcutaneous inj 18 mg/0.45ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 28 mg/0.7ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 40 mg/ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 80 mg/0.8ml* 5 PAVIOKACE - pancrelipase (lip-prot-amyl) tab 10440-39150-39150

unit4

VIOKACE - pancrelipase (lip-prot-amyl) tab 20880-78300-78300unit

4

VPRIV - velaglucerase alfa for inj 400 unit 5ZAVESCA - miglustat cap 100 mg* 5 PA, QL (90 capsules/30 days)ZENPEP - pancrelipase (lip-prot-amyl) dr cap 3000-10000-16000

unit3

ZENPEP - pancrelipase (lip-prot-amyl) dr cap 5000-17000-27000unit

3


3


3


3

2018



ZENPEP - pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit

3


3


3

Agentes genitourinariosalfuzosin hcl tab er 24hr 10 mg^ 1 QL (30 tablets/30 days)AVODART - dutasteride cap 0.5 mg 4 QL (30 capsules/30 days)bethanechol chloride tab 5 mg^ 2bethanechol chloride tab 10 mg^ 2bethanechol chloride tab 25 mg^ 2bethanechol chloride tab 50 mg^ 2DEPEN TITRATABS - penicillamine tab 250 mg 5DETROL - tolterodine tartrate tab 1 mg 4 QL (60 tablets/30 days)DETROL - tolterodine tartrate tab 2 mg 4 QL (60 tablets/30 days)DETROL LA - tolterodine tartrate cap er 24hr 2 mg 4 QL (30 capsules/30 days)DETROL LA - tolterodine tartrate cap er 24hr 4 mg 4 QL (30 capsules/30 days)DITROPAN XL - oxybutynin chloride tab er 24hr 5 mg 4 QL (30 tablets/30 days)DITROPAN XL - oxybutynin chloride tab er 24hr 10 mg 4 QL (60 tablets/30 days)DITROPAN XL - oxybutynin chloride tab er 24hr 15 mg 4 QL (60 tablets/30 days)dutasteride cap 0.5 mg^ 2 QL (30 capsules/30 days)dutasteride-tamsulosin hcl cap 0.5-0.4 mg^ 2 QL (30 capsules/30 days)finasteride tab 5 mg^ 1 QL (30 tablets/30 days)FLOMAX - tamsulosin hcl cap 0.4 mg 4 QL (60 capsules/30 days)METHERGINE - methylergonovine maleate tab 0.2 mg 5methylergonovine maleate tab 0.2 mg 5oxybutynin chloride syrup 5 mg/5ml^ 2 QL (600 mls/30 days)oxybutynin chloride tab er 24hr 5 mg^ 2 QL (30 tablets/30 days)oxybutynin chloride tab er 24hr 10 mg^ 2 QL (60 tablets/30 days)oxybutynin chloride tab er 24hr 15 mg^ 2 QL (60 tablets/30 days)oxybutynin chloride tab 5 mg^ 2 QL (120 tablets/30 days)PROSCAR - finasteride tab 5 mg 4 QL (30 tablets/30 days)RAPAFLO - silodosin cap 4 mg 3 QL (30 capsules/30 days)RAPAFLO - silodosin cap 8 mg 3 QL (30 capsules/30 days)tamsulosin hcl cap 0.4 mg^ 2 QL (60 capsules/30 days)tolterodine tartrate cap er 24hr 2 mg^ 2 QL (30 capsules/30 days)tolterodine tartrate cap er 24hr 4 mg^ 2 QL (30 capsules/30 days)tolterodine tartrate tab 1 mg^ 2 QL (60 tablets/30 days)

2018


99


tolterodine tartrate tab 2 mg^ 2 QL (60 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 4 mg 3 QL (30 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 8 mg 3 QL (30 tablets/30 days)trospium chloride cap er 24hr 60 mg^ 2 QL (30 capsules/30 days)trospium chloride tab 20 mg^ 2 QL (60 tablets/30 days)Agentes hormonales, estimulantes/sustitutos/modificadoresCORTEF - hydrocortisone tab 5 mg 4CORTEF - hydrocortisone tab 10 mg 4CORTEF - hydrocortisone tab 20 mg 4CORTISONE ACETATE - cortisone acetate tab 25 mg 4DEXAMETHASONE - dexamethasone tab 1 mg 4DEXAMETHASONE - dexamethasone tab 2 mg 4dexamethasone elixir 0.5 mg/5ml^ 2dexamethasone sodium phosphate inj 4 mg/ml^ 2dexamethasone sodium phosphate inj 20 mg/5ml^ 2dexamethasone sodium phosphate inj 120 mg/30ml^ 2dexamethasone tab 0.5 mg^ 1dexamethasone tab 0.75 mg^ 1dexamethasone tab 1.5 mg^ 1dexamethasone tab 4 mg^ 1dexamethasone tab 6 mg^ 1fludrocortisone acetate tab 0.1 mg^ 2H.P. ACTHAR - corticotropin inj gel 80 unit/ml* 5 PAhydrocortisone tab 5 mg^ 2hydrocortisone tab 10 mg^ 2hydrocortisone tab 20 mg^ 2MEDROL - methylprednisolone tab 4 mg 4MEDROL - methylprednisolone tab 8 mg 4MEDROL - methylprednisolone tab 16 mg 4MEDROL - methylprednisolone tab 32 mg 4MEDROL DOSEPAK - methylprednisolone tab therapy pack 4 mg

(21)4

methylprednisolone sod succ for inj 40 mg^ 2methylprednisolone sod succ for inj 125 mg^ 2methylprednisolone sod succ for inj 1000 mg^ 2methylprednisolone tab therapy pack 4 mg (21)^ 2methylprednisolone tab 4 mg^ 2methylprednisolone tab 8 mg^ 2

2018



methylprednisolone tab 16 mg^ 2methylprednisolone tab 32 mg^ 2prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base)^ 2prednisolone sod phosphate oral soln 15 mg/5ml^ 2prednisolone syrup 15 mg/5ml^ 2PREDNISONE - prednisone oral soln 5 mg/5ml 3PREDNISONE - prednisone tab therapy pack 5 mg (21)^ 2PREDNISONE - prednisone tab therapy pack 5 mg (48)^ 2PREDNISONE - prednisone tab therapy pack 10 mg (21)^ 2PREDNISONE - prednisone tab therapy pack 10 mg (48)^ 2PREDNISONE - prednisone tab 50 mg 4prednisone tab 1 mg^ 1prednisone tab 2.5 mg^ 1prednisone tab 5 mg^ 2prednisone tab 10 mg^ 2prednisone tab 20 mg^ 1SOLU-MEDROL - methylprednisolone sod succ for inj 40 mg 4SOLU-MEDROL - methylprednisolone sod succ for inj 125 mg 4SOLU-MEDROL - methylprednisolone sod succ for inj 500 mg 4SOLU-MEDROL - methylprednisolone sod succ for inj 1000 mg 4Agentes hormonales, estimulantes/sustitutos/modificadoreschorionic gonadotropin for im inj 10000

unit(chorionic gonadotropin, pregnyl)^2 PA

DDAVP - desmopressin acetate nasal spray soln 0.01% 5DDAVP - desmopressin acetate tab 0.1 mg 4DDAVP - desmopressin acetate tab 0.2 mg 4desmopressin acetate inj 4 mcg/ml^ 2desmopressin acetate nasal soln 0.01% (refrigerated)^ 2desmopressin acetate nasal spray soln 0.01%^ 2desmopressin acetate nasal spray soln 0.01% (refrigerated)^ 2desmopressin acetate tab 0.1 mg^ 2desmopressin acetate tab 0.2 mg^ 2EGRIFTA - tesamorelin acetate for inj 1 mg* 5 PAEGRIFTA - tesamorelin acetate for inj 2 mg* 5 PAINCRELEX - mecasermin inj 40 mg/4ml (10 mg/ml)* 5OMNITROPE - somatropin for inj 5.8 mg 3 PAOMNITROPE - somatropin inj 5 mg/1.5ml 5 PAOMNITROPE - somatropin inj 10 mg/1.5ml 5 PA

2018


101


STIMATE - desmopressin acetate nasal soln 1.5 mg/ml 5Agentes hormonales, estimulantes/sustitutos/modificadoresANADROL-50 - oxymetholone tab 50 mg 5 PAANDRODERM - testosterone td patch 24hr 2 mg/24hr 3 PA, QL (30 patches/30 days)ANDRODERM - testosterone td patch 24hr 4 mg/24hr 3 PA, QL (30 patches/30 days)ANDROGEL - testosterone td gel 25 mg/2.5gm (1%) 4 PA, QL (90 packets/30 days)ANDROGEL - testosterone td gel 50 mg/5gm (1%) 4 PA, QL (60 packets/30 days)ANDROGEL - testosterone td gel 20.25 mg/1.25gm (1.62%) 3 PA, QL (30 packets/30 days)ANDROGEL - testosterone td gel 40.5 mg/2.5gm (1.62%) 3 PA, QL (60 packets/30 days)ANDROGEL PUMP - testosterone td gel 20.25 mg/act (1.62%) 3 PA, QL (2 pump

bottles/30 days)AXIRON - testosterone td soln 30 mg/act 4 PA, QL (2 pump

bottles/30 days)AYGESTIN - norethindrone acetate tab 5 mg 4BREVICON-28 - norethindrone & ethinyl estradiol tab

0.5 mg-35 mcg4

CYCLESSA - desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg

4

danazol cap 50 mg^ 2 PAdanazol cap 100 mg^ 2 PAdanazol cap 200 mg^ 2 PADEPO-PROVERA - medroxyprogesterone acetate im susp

400 mg/ml4

DEPO-PROVERA CONTRACEPTIVE - medroxyprogesteroneacetate im susp prefilled syr 150 mg/ml

4

DEPO-PROVERA CONTRACEPTIVE - medroxyprogesteroneacetate im susp 150 mg/ml

4

DEPO-TESTOSTERONE - testosterone cypionate im inj in oil100 mg/ml

4 PA

DEPO-TESTOSTERONE - testosterone cypionate im inj in oil200 mg/ml

4 PA

DESOGEN - desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 4desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5)^ 2desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg^ 2desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg^ 2DIVIGEL - estradiol td gel 0.25 mg/0.25gm (0.1%)# 4 PADIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.1%)# 4 PADIVIGEL - estradiol td gel 1 mg/gm (0.1%)# 4 PAdrospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451 mg^ 2drospirenone-ethinyl estradiol tab 3-0.02 mg^ 2

2018



drospirenone-ethinyl estradiol tab 3-0.03 mg^ 2ELLA - ulipristal acetate tab 30 mg 3ESTRACE - estradiol vaginal cream 0.1 mg/gm 4estradiol & norethindrone acetate tab 0.5-0.1 mg# 4 PAestradiol & norethindrone acetate tab 1-0.5 mg# 4 PAestradiol tab 0.5 mg# 4 PAestradiol tab 1 mg# 4 PAestradiol tab 2 mg# 4 PAestradiol td patch weekly 0.025 mg/24hr# 4 PAestradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)# 4 PAestradiol td patch weekly 0.05 mg/24hr# 4 PAestradiol td patch weekly 0.06 mg/24hr# 4 PAestradiol td patch weekly 0.075 mg/24hr# 4 PAestradiol td patch weekly 0.1 mg/24hr# 4 PAestradiol vaginal tab 10 mcg^ 2ESTROPIPATE - estropipate tab 0.75 mg# 4 PAESTROPIPATE - estropipate tab 1.5 mg# 4 PAESTROPIPATE - estropipate tab 3 mg# 4 PAESTROSTEP FE - norethindrone ac-ethinyl estrad-fe tab

1-20/1-30/1-35 mg-mcg4

ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg^ 2ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg^ 2EVISTA - raloxifene hcl tab 60 mg 4HYDROXYPROGESTERONE CAPROATE - hydroxyprogesterone

caproate im in oil 1.25 gm/5ml5

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7)^ 2levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7)^ 2levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg^ 2levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg^ 2levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg^ 2levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg^ 2LOESTRIN FE 1.5/30 - norethindrone ace & ethinyl estradiol-fe

tab 1.5 mg-30 mcg4

LOESTRIN FE 1/20 - norethindrone ace & ethinyl estradiol-fe tab1 mg-20 mcg

4

LOESTRIN 1.5/30-21 - norethindrone ace & ethinyl estradiol tab1.5 mg-30 mcg

4

LOESTRIN 1/20-21 - norethindrone ace & ethinyl estradiol tab1 mg-20 mcg

4

2018


103


LOSEASONIQUE - levonorg-eth est tab 0.1-0.02mg(84) & eth esttab 0.01mg(7)

4

medroxyprogesterone acetate im susp prefilled syr 150 mg/ml^ 2medroxyprogesterone acetate im susp 150 mg/ml^ 2medroxyprogesterone acetate tab 2.5 mg^ 1medroxyprogesterone acetate tab 5 mg^ 1medroxyprogesterone acetate tab 10 mg^ 1megestrol acetate susp 40 mg/ml# 4 PAmegestrol acetate tab 20 mg# 4 PAmegestrol acetate tab 40 mg# 4 PAMENEST - esterified estrogens tab 0.3 mg# 4 PAMENEST - esterified estrogens tab 0.625 mg# 4 PAMENEST - esterified estrogens tab 1.25 mg# 4 PAmethyltestosterone cap 10 mg^ 2 PAMIRCETTE - desogest-eth estrad & eth estrad tab

0.15-0.02/0.01 mg(21/5)4

norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg^ 2norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg^ 2norethindrone & ethinyl estradiol tab 1 mg-35 mcg^ 2norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg^ 2norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg^ 2norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg^ 2norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg^ 2norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg^ 2norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg^ 2norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg^ 2norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24)^ 2norethindrone acetate tab 5 mg^ 2norethindrone tab 0.35 mg^ 2norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg^ 2norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg^ 2norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg^ 2norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg^ 2norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg^ 2norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg^ 2NORINYL 1+35 - norethindrone & ethinyl estradiol tab

1 mg-35 mcg4

NUVARING - etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr

4

2018



ORTHO MICRONOR - norethindrone tab 0.35 mg 4ORTHO TRI-CYCLEN - norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg4

ORTHO-CYCLEN - norgestimate & ethinyl estradiol tab0.25 mg-35 mcg

4

ORTHO-NOVUM 1/35 - norethindrone & ethinyl estradiol tab1 mg-35 mcg

4

ORTHO-NOVUM 7/7/7 - norethindrone-eth estradiol tab0.5-35/0.75-35/1-35 mg-mcg

4

OVCON-35 - norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg 4oxandrolone tab 2.5 mg^ 2 PAoxandrolone tab 10 mg 5 PAPREMARIN - estrogens, conjugated vaginal cream 0.625 mg/gm 3PREMARIN - estrogens, conjugated tab 0.3 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.45 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.625 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.9 mg# 4 PAPREMARIN - estrogens, conjugated tab 1.25 mg# 4 PAPREMPHASE - conj est 0.625(14)/conj est-medroxypro ac tab

0.625-5mg(14)#4 PA

PREMPRO - conjugated estrogen-medroxyprogest acetate tab0.3-1.5 mg#

4 PA


4 PA


4 PA

PREMPRO - conjugated estrogen-medroxyprogest acetate tab0.625-5 mg#

4 PA

PROVERA - medroxyprogesterone acetate tab 2.5 mg 4PROVERA - medroxyprogesterone acetate tab 5 mg 4PROVERA - medroxyprogesterone acetate tab 10 mg 4raloxifene hcl tab 60 mg^ 2SEASONIQUE - levonorg-eth est tab 0.15-0.03mg(84) & eth est

tab 0.01mg(7)4

testosterone cypionate im inj in oil 100 mg/ml^ 2 PAtestosterone cypionate im inj in oil 200 mg/ml^ 2 PAtestosterone enanthate im inj in oil 200 mg/ml^ 2 PAtestosterone td gel 25 mg/2.5gm (1%)^ 2 PA, QL (90 packets/30 days)testosterone td gel 50 mg/5gm (1%)^ 2 PA, QL (60 packets/30 days)testosterone td gel 12.5 mg/act (1%)^ 2 PA, QL (4 pump

bottles/30 days)

2018


105


testosterone td soln 30 mg/act^ 2 PA, QL (2 pumpbottles/30 days)

TRI-NORINYL 28 - norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg

4

VAGIFEM - estradiol vaginal tab 10 mcg 4YASMIN 28 - drospirenone-ethinyl estradiol tab 3-0.03 mg 4YAZ - drospirenone-ethinyl estradiol tab 3-0.02 mg 4Agentes hormonales, estimulantes/sustitutos/modificadores)CYTOMEL - liothyronine sodium tab 5 mcg 4CYTOMEL - liothyronine sodium tab 25 mcg 4CYTOMEL - liothyronine sodium tab 50 mcg 4levothyroxine sodium tab 25 mcg^ 2levothyroxine sodium tab 50 mcg^ 2levothyroxine sodium tab 75 mcg^ 2levothyroxine sodium tab 88 mcg^ 2levothyroxine sodium tab 100 mcg^ 2levothyroxine sodium tab 112 mcg^ 2levothyroxine sodium tab 125 mcg^ 2levothyroxine sodium tab 137 mcg^ 2levothyroxine sodium tab 150 mcg^ 2levothyroxine sodium tab 175 mcg^ 2levothyroxine sodium tab 200 mcg^ 2levothyroxine sodium tab 300 mcg^ 2liothyronine sodium tab 5 mcg^ 2liothyronine sodium tab 25 mcg^ 2liothyronine sodium tab 50 mcg^ 2SYNTHROID - levothyroxine sodium tab 25 mcg 4SYNTHROID - levothyroxine sodium tab 50 mcg 4SYNTHROID - levothyroxine sodium tab 75 mcg 4SYNTHROID - levothyroxine sodium tab 88 mcg 4SYNTHROID - levothyroxine sodium tab 100 mcg 4SYNTHROID - levothyroxine sodium tab 112 mcg 4SYNTHROID - levothyroxine sodium tab 125 mcg 4SYNTHROID - levothyroxine sodium tab 137 mcg 4SYNTHROID - levothyroxine sodium tab 150 mcg 4SYNTHROID - levothyroxine sodium tab 175 mcg 4SYNTHROID - levothyroxine sodium tab 200 mcg 4SYNTHROID - levothyroxine sodium tab 300 mcg 4

2018



TIROSINT - levothyroxine sodium cap 13 mcg 4TIROSINT - levothyroxine sodium cap 25 mcg 4TIROSINT - levothyroxine sodium cap 50 mcg 4TIROSINT - levothyroxine sodium cap 75 mcg 4TIROSINT - levothyroxine sodium cap 88 mcg 4TIROSINT - levothyroxine sodium cap 100 mcg 4TIROSINT - levothyroxine sodium cap 112 mcg 4TIROSINT - levothyroxine sodium cap 125 mcg 4TIROSINT - levothyroxine sodium cap 137 mcg 4TIROSINT - levothyroxine sodium cap 150 mcg 4Agentes hormonales, supresores (suprarrenal)KORLYM - mifepristone tab 300 mg* 5 PA, QL (120 tablets/30 days)LYSODREN - mitotane tab 500 mg 5Agentes hormonales, supresores (pituitarios)cabergoline tab 0.5 mg^ 2ELIGARD - leuprolide acetate (3 month) for subcutaneous inj kit

22.5mg4

ELIGARD - leuprolide acetate (4 month) for subcutaneous inj kit30 mg

4

ELIGARD - leuprolide acetate (6 month) for subcutaneous inj kit45 mg

4

ELIGARD - leuprolide acetate for subcutaneous inj kit 7.5 mg 4FIRMAGON - degarelix acetate for inj 80 mg 4FIRMAGON - degarelix acetate for inj 120 mg 5leuprolide acetate inj kit 5 mg/ml^ 2LUPRON DEPOT (1-MONTH) - leuprolide acetate for inj kit

3.75 mg5

LUPRON DEPOT (1-MONTH) - leuprolide acetate for inj kit7.5 mg

5

LUPRON DEPOT (3-MONTH) - leuprolide acetate (3 month) for injkit 11.25 mg

5

LUPRON DEPOT (3-MONTH) - leuprolide acetate (3 month) for injkit 22.5 mg

5

LUPRON DEPOT (4-MONTH) - leuprolide acetate (4 month) for injkit 30 mg

5

LUPRON DEPOT (6-MONTH) - leuprolide acetate (6 month) for injkit 45 mg

5

LUPRON DEPOT-PED (1-MONTH) - leuprolide acetate for injpediatric kit 7.5 mg

5

LUPRON DEPOT-PED (1-MONTH) - leuprolide acetate for injpediatric kit 11.25 mg

5

2018


107


LUPRON DEPOT-PED (1-MONTH) - leuprolide acetate for injpediatric kit 15 mg

5

LUPRON DEPOT-PED (3-MONTH) - leuprolide acetate (3 month)for inj pediatric kit 11.25 mg

5

LUPRON DEPOT-PED (3-MONTH) - leuprolide acetate (3 month)for inj pediatric kit 30 mg

5

octreotide acetate inj 50 mcg/ml (0.05 mg/ml)^ 2 PAoctreotide acetate inj 100 mcg/ml (0.1 mg/ml)^ 2 PAoctreotide acetate inj 200 mcg/ml (0.2 mg/ml)^ 2 PAoctreotide acetate inj 500 mcg/ml (0.5 mg/ml)^ 2 PAoctreotide acetate inj 1000 mcg/ml (1 mg/ml) 5 PASANDOSTATIN LAR DEPOT - octreotide acetate for im inj kit

10 mg5 PA

SANDOSTATIN LAR DEPOT - octreotide acetate for im inj kit20 mg

5 PA

SANDOSTATIN LAR DEPOT - octreotide acetate for im inj kit30 mg

5 PA

SIGNIFOR - pasireotide diaspartate inj 0.3 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.6 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.9 mg/ml* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 20 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 40 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 60 mg* 5 PASOMATULINE DEPOT - lanreotide acetate extended release inj

60 mg/0.2ml5 PA

SOMATULINE DEPOT - lanreotide acetate extended release inj90 mg/0.3ml

5 PA

SOMATULINE DEPOT - lanreotide acetate extended release inj120 mg/0.5ml

5 PA

SOMAVERT - pegvisomant for inj 10 mg* 5 PASOMAVERT - pegvisomant for inj 15 mg* 5 PASOMAVERT - pegvisomant for inj 20 mg* 5 PASOMAVERT - pegvisomant for inj 25 mg* 5 PASOMAVERT - pegvisomant for inj 30 mg* 5 PASYNAREL - nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) 5TRELSTAR - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 5

2018



Agentes hormonales, supresores (tiroides)methimazole tab 5 mg^ 1methimazole tab 10 mg^ 1propylthiouracil tab 50 mg^ 2Agentes inmunológicosACTHIB - haemophilus b polysaccharide conjugate vaccine for inj 4ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml (2000000

unit/0.5ml)*5

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 4ARCALYST - rilonacept for inj 220 mg* 5 PAASTAGRAF XL - tacrolimus cap er 24hr 0.5 mg 4 BDASTAGRAF XL - tacrolimus cap er 24hr 1 mg 4 BDASTAGRAF XL - tacrolimus cap er 24hr 5 mg 4 BDATGAM - lymphocyte immune globulin anti-thymocyte g inj 50 mg/

ml(eq)5 BD

AZASAN - azathioprine tab 75 mg 4 BDAZASAN - azathioprine tab 100 mg 4 BDAZATHIOPRINE - azathioprine sodium for inj 100 mg 3 BDazathioprine tab 50 mg^ 2 BDBCG VACCINE - bcg vaccine inj 4BENLYSTA - belimumab for iv soln 120 mg 5 PABENLYSTA - belimumab for iv soln 400 mg 5 PABENLYSTA - belimumab subcutaneous solution auto-injector

200 mg/ml5 PA

BENLYSTA - belimumab subcutaneous solution prefilled syringe200 mg/ml

5 PA

BEXSERO - meningococcal vac b (recomb omv adjuv) inj prefilledsyringe

4

BOOSTRIX - tet tox-diph-acell pertuss ad inj 5-2.5-18.5 lf-lf-mcg/0.5ml

4

CELLCEPT - mycophenolate mofetil cap 250 mg 5 BDCELLCEPT - mycophenolate mofetil for oral susp 200 mg/ml 5 BDCELLCEPT - mycophenolate mofetil tab 500 mg 5 BDCELLCEPT INTRAVENOUS - mycophenolate mofetil hcl for iv

soln 500 mg4 BD

CINRYZE - c1 esterase inhibitor (human) for iv inj 500 unit* 5 PA, QL (20 vials/30 days)COSENTYX - secukinumab subcutaneous soln prefilled syringe

150 mg/ml5 PA

COSENTYX SENSOREADY PEN - secukinumab subcutaneoussoln auto-injector 150 mg/ml

5 PA

cyclosporine cap 25 mg^ 2 BD

2018


109


cyclosporine cap 100 mg^ 2 BDcyclosporine iv soln 50 mg/ml^ 2 BDcyclosporine modified cap 25 mg^ 2 BDcyclosporine modified cap 50 mg^ 2 BDcyclosporine modified cap 100 mg^ 2 BDcyclosporine modified oral soln 100 mg/ml^ 2 BDDAPTACEL - diph, acellular pert & tet tox inj 15 lf-23 mcg-5

lf/0.5ml4

DIPHTHERIA/TETANUS TOXOIDS ADSORBED - diphtheria-tetanus tox adsorbed (dt) im inj 25-5 unit/0.5ml

4

ENBREL - etanercept for subcutaneous inj 25 mg 5 PAENBREL - etanercept subcutaneous soln prefilled syringe

25 mg/0.5ml5 PA

ENBREL - etanercept subcutaneous soln prefilled syringe 50 mg/ml

5 PA

ENBREL MINI - etanercept subcutaneous solution cartridge50 mg/ml

5 PA

ENBREL SURECLICK - etanercept subcutaneous solution auto-injector 50 mg/ml

5 PA

ENGERIX-B - hepatitis b vaccine (recombinant) susp10 mcg/0.5ml

4 BD

ENGERIX-B - hepatitis b vaccine (recombinant) susp 20 mcg/ml 4 BDFIRAZYR - icatibant acetate inj 30 mg/3ml* 5 PA, QL (6 syringes/30 days)GAMMAGARD LIQUID - immune globulin (human) iv or

subcutaneous soln 1 gm/10ml5 BD, PA

GAMMAGARD LIQUID - immune globulin (human) iv orsubcutaneous soln 2.5 gm/25ml

5 BD, PA

GAMMAGARD LIQUID - immune globulin (human) iv orsubcutaneous soln 5 gm/50ml

5 BD, PA


5 BD, PA


5 BD, PA


5 BD, PA

GAMMAGARD S/D - immune globulin (human) iv for soln 5 gm 5 BD, PAGAMMAGARD S/D - immune globulin (human) iv for soln 10 gm 5 BD, PAGAMMAPLEX - immune globulin (human) iv soln 5 gm/100ml 5 BD, PAGAMMAPLEX - immune globulin (human) iv soln 10 gm/200ml 5 BD, PAGAMMAPLEX - immune globulin (human) iv soln 20 gm/400ml 5 BD, PAGAMMAPLEX - immune globulin (human) iv soln 5 gm/50ml 5 BD, PA

2018



GAMMAPLEX - immune globulin (human) iv soln 10 gm/100ml 5 BD, PAGAMMAPLEX - immune globulin (human) iv soln 20 gm/200ml 5 BD, PAGAMUNEX-C - immune globulin (human) iv or subcutaneous soln

1 gm/10ml5 BD, PA

GAMUNEX-C - immune globulin (human) iv or subcutaneous soln2.5 gm/25ml

5 BD, PA

GAMUNEX-C - immune globulin (human) iv or subcutaneous soln5 gm/50ml

5 BD, PA


5 BD, PA


5 BD, PA


5 BD, PA

GARDASIL 9 - human papillomavirus (hpv) 9-valent recomb vacim susp

4

GARDASIL 9 - human papillomavirus (hpv) 9-valent recomb vacsusp pref syr

4

HAEGARDA - c1 esterase inhibitor (human) for subcutaneous inj2000 unit


HAEGARDA - c1 esterase inhibitor (human) for subcutaneous inj3000 unit


HAVRIX - hepatitis a vaccine inj susp 720 el unit/0.5ml 4HAVRIX - hepatitis a vaccine inj susp 1440 el unit/ml 4HIBERIX - haemophilus b polysaccharide conjugate vac for inj

10 mcg4

HUMIRA - adalimumab prefilled syringe kit 10 mg/0.2ml 5 PAHUMIRA - adalimumab prefilled syringe kit 20 mg/0.4ml 5 PAHUMIRA - adalimumab prefilled syringe kit 40 mg/0.8ml 5 PAHUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -

adalimumab prefilled syringe kit 40 mg/0.8ml5 PA

HUMIRA PEN - adalimumab pen-injector kit 40 mg/0.8ml 5 PAHUMIRA PEN-CROHNS DISEASE STARTER - adalimumab pen-

injector kit 40 mg/0.8ml5 PA

HUMIRA PEN-PSORIASIS STARTER - adalimumab pen-injectorkit 40 mg/0.8ml

5 PA

ILARIS - canakinumab for inj 180 mg* 5 PAILARIS - canakinumab subcutaneous inj 150 mg/ml* 5 PAIMOVAX RABIES (H.D.C.V.) - rabies virus vaccine, hdc inj 3 BDIMURAN - azathioprine tab 50 mg 4 BDINFANRIX - diph, acellular pert & tet tox inj 25 lf-58 mcg-10

lf/0.5ml4

2018


111


IPOL INACTIVATED IPV - poliovirus vaccine, ipv injection 4IXIARO - japanese encephalitis vaccine inactivated adsorbed inj 4KINERET - anakinra subcutaneous soln prefilled syringe

100 mg/0.67ml5 PA

KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj 4leflunomide tab 10 mg^ 2leflunomide tab 20 mg^ 2M-M-R II - measles, mumps & rubella virus vaccines for inj 4MENACTRA - meningococcal (a, c, y, and w-135) conjugate

vaccine inj4

MENOMUNE-A/C/Y/W-135 - meningococcal vaccine a, c, y, andw-135 inj

4

MENVEO - meningococcal (a, c, y, and w-135) oligo conj vac forinj

4

METHOTREXATE SODIUM - methotrexate sodium inj250 mg/10ml (25 mg/ml)^

2

methotrexate sodium for inj 1 gm^ 2methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)^ 2methotrexate sodium inj pf 100 mg/4ml (25 mg/ml)^ 2methotrexate sodium inj pf 200 mg/8ml (25 mg/ml)^ 2methotrexate sodium inj pf 250 mg/10ml (25 mg/ml)^ 2methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml)^ 2methotrexate sodium inj 50 mg/2ml (25 mg/ml)^ 2methotrexate sodium tab 2.5 mg^ 2mycophenolate mofetil cap 250 mg^ 2 BDmycophenolate mofetil for oral susp 200 mg/ml 5 BDmycophenolate mofetil hcl for iv soln 500 mg^ 2 BDmycophenolate mofetil tab 500 mg^ 2 BDmycophenolate sodium tab dr 180 mg^ 2 BDmycophenolate sodium tab dr 360 mg^ 2 BDNEORAL - cyclosporine modified cap 25 mg 4 BDNEORAL - cyclosporine modified cap 100 mg 4 BDNEORAL - cyclosporine modified oral soln 100 mg/ml 4 BDNULOJIX - belatacept for iv infusion 250 mg 5 BDORENCIA - abatacept for iv soln 250 mg 5 PAORENCIA - abatacept subcutaneous soln prefilled syringe

50 mg/0.4ml5 PA

ORENCIA - abatacept subcutaneous soln prefilled syringe87.5 mg/0.7ml

5 PA

2018



ORENCIA - abatacept subcutaneous soln prefilled syringe125 mg/ml

5 PA

ORENCIA CLICKJECT - abatacept subcutaneous soln auto-injector 125 mg/ml

5 PA

OTEZLA - apremilast tab starter therapy pack 10 mg & 20 mg &30 mg

5 PA

OTEZLA - apremilast tab 30 mg 5 PAPEDIARIX - diph-tetanus tox-acell pert-hepatitis b-polio ipv vac inj 4PEDVAX HIB - haemophilus b polysaccharide conj vac im susp

7.5 mcg/0.5 ml4

PENTACEL - diph-ac per-tet tox ad-poliov-haemoph b poly vac forim susp

4

PROGRAF - tacrolimus cap 0.5 mg 4 BDPROGRAF - tacrolimus cap 1 mg 4 BDPROGRAF - tacrolimus cap 5 mg 4 BDPROGRAF - tacrolimus inj 5 mg/ml 4 BDPROQUAD - measles-mumps-rubella-varicella virus vaccines for

inj4

QUADRACEL - diph-tetanus tox ad-acell pert & polio virus, ipv vacinj

4

RABAVERT - rabies vaccine, pcec for inj 4 BDRAPAMUNE - sirolimus oral soln 1 mg/ml 5 BDRECOMBIVAX HB - hepatitis b vaccine (recombinant) susp

5 mcg/0.5ml4 BD

RECOMBIVAX HB - hepatitis b vaccine (recombinant) susp10 mcg/ml

4 BD

RECOMBIVAX HB - hepatitis b vaccine (recombinant) susp40 mcg/ml

4 BD

REMICADE - infliximab for iv inj 100 mg 5 PARIDAURA - auranofin cap 3 mg 5ROTARIX - rotavirus vaccine, live for oral susp 4ROTATEQ - rotavirus vaccine, live oral pentavalent soln 4SANDIMMUNE - cyclosporine cap 25 mg 4 BDSANDIMMUNE - cyclosporine cap 100 mg 4 BDSANDIMMUNE - cyclosporine iv soln 50 mg/ml 4 BDSANDIMMUNE - cyclosporine oral soln 100 mg/ml 4 BDSIMULECT - basiliximab for iv soln 10 mg 5 BDSIMULECT - basiliximab for iv soln 20 mg 5 BDsirolimus tab 0.5 mg^ 2 BDsirolimus tab 1 mg^ 2 BDsirolimus tab 2 mg 5 BD

2018


113


STELARA - ustekinumab inj 45 mg/0.5ml 5 PASTELARA - ustekinumab iv soln 130 mg/26ml (5 mg/ml) (for iv

infusion)5 PA

STELARA - ustekinumab soln prefilled syringe 45 mg/0.5ml 5 PASTELARA - ustekinumab soln prefilled syringe 90 mg/ml 5 PASYLVANT - siltuximab for iv infusion 100 mg 5SYLVANT - siltuximab for iv infusion 400 mg 5SYNAGIS - palivizumab im soln 50 mg/0.5ml* 5SYNAGIS - palivizumab im soln 100 mg/ml* 5tacrolimus cap 0.5 mg^ 2 BDtacrolimus cap 1 mg^ 2 BDtacrolimus cap 5 mg^ 2 BDTENIVAC - tetanus-diphtheria toxoids (td) inj 5-2 lfu 3TETANUS/DIPHTHERIA TOXOIDS ADSORBED - tetanus-

diphtheria toxoids (td) inj 2-2 lf/0.5ml3

THYMOGLOBULIN - anti-thymocyte globulin for iv soln 25 mg(lymphocyte ig)

5 BD

TRUMENBA - meningococcal group b vac (recomb) im suspprefilled syr

4

TWINRIX - hepatitis a (inact)-hep b (recomb) vac inj 720-20 elu-mcg/ml

4

TYPHIM VI - typhoid vi polysaccharide intramuscular vac inj25 mcg/0.5ml

4

VAQTA - hepatitis a vaccine inj susp 25 unit/0.5ml 4VAQTA - hepatitis a vaccine inj susp 50 unit/ml 4VARIVAX - varicella virus vac live for subcutaneous inj 1350

pfu/0.5ml4

XATMEP - methotrexate oral soln 2.5 mg/ml 5 BDXOLAIR - omalizumab for inj 150 mg* 5 PAYF-VAX - yellow fever vaccine subcutaneous inj 4ZORTRESS - everolimus tab 0.25 mg 5 BDZORTRESS - everolimus tab 0.5 mg 5 BDZORTRESS - everolimus tab 0.75 mg 5 BDZOSTAVAX - zoster vaccine live for subcutaneous susp 19400

unit/0.65ml4 QL (1 vaccine/lifetime)

Agentes para tratar la enfermedad inflamatoria intestinalAPRISO - mesalamine cap er 24hr 0.375 gm 4ASACOL HD - mesalamine tab delayed release 800 mg 3AZULFIDINE - sulfasalazine tab 500 mg 4

2018



AZULFIDINE EN-TABS - sulfasalazine tab delayed release500 mg

4

balsalazide disodium cap 750 mg^ 2budesonide delayed release particles cap 3 mg 5CANASA - mesalamine suppos 1000 mg 3COLAZAL - balsalazide disodium cap 750 mg 5DELZICOL - mesalamine cap dr 400 mg 3DIPENTUM - olsalazine sodium cap 250 mg 5hydrocortisone enema 100 mg/60ml^ 2hydrocortisone rectal cream 1%^ 2hydrocortisone rectal cream 2.5%^ 2LIALDA - mesalamine tab delayed release 1.2 gm 4mesalamine enema 4 gm^ 2mesalamine tab delayed release 1.2 gm^ 2PENTASA - mesalamine cap er 250 mg 4PENTASA - mesalamine cap er 500 mg 4SFROWASA - mesalamine sulfite-free enema 4 gm/60ml 4sulfasalazine tab delayed release 500 mg^ 2sulfasalazine tab 500 mg^ 2Agentes para tratar la enfermedad ósea metabólicaalendronate sodium tab 5 mg^ 1 QL (30 tablets/30 days)alendronate sodium tab 10 mg^ 1 QL (120 tablets/30 days)alendronate sodium tab 35 mg^ 1 QL (4 tablets/28 days)alendronate sodium tab 70 mg^ 1 QL (4 tablets/28 days)ATELVIA - risedronate sodium tab delayed release 35 mg 4 QL (4 tablets/28 days)BONIVA - ibandronate sodium iv soln 3 mg/3ml 4calcitonin (salmon) nasal soln 200 unit/act^ 2calcitriol cap 0.25 mcg^ 2calcitriol cap 0.5 mcg^ 2calcitriol inj 1 mcg/ml^ 2calcitriol oral soln 1 mcg/ml^ 2ETIDRONATE DISODIUM - etidronate disodium tab 200 mg 4ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 4FORTEO - teriparatide (recombinant) inj 600 mcg/2.4ml 5 PAFOSAMAX - alendronate sodium tab 70 mg 4 QL (4 tablets/28 days)ibandronate sodium iv soln 3 mg/3ml^ 2ibandronate sodium tab 150 mg^ 2 QL (1 tablet/28 days)MIACALCIN - calcitonin (salmon) inj 200 unit/ml 4

2018


115


NATPARA - parathyroid hormone (recombinant) for inj cartridge25 mcg*

5 PA, QL (2 cartridges/28 days)







paricalcitol cap 1 mcg^ 2paricalcitol cap 2 mcg^ 2paricalcitol cap 4 mcg^ 2paricalcitol iv soln 2 mcg/ml^ 2paricalcitol iv soln 5 mcg/ml^ 2PROLIA - denosumab inj 60 mg/ml 4 PArisedronate sodium tab delayed release 35 mg^ 2 QL (4 tablets/28 days)risedronate sodium tab 5 mg^ 2 QL (30 tablets/30 days)risedronate sodium tab 30 mg^ 2 QL (30 tablets/30 days)risedronate sodium tab 35 mg^ 2 QL (4 tablets/28 days)risedronate sodium tab 150 mg^ 2 QL (1 tablet/28 days)ROCALTROL - calcitriol cap 0.25 mcg 4ROCALTROL - calcitriol cap 0.5 mcg 4ROCALTROL - calcitriol oral soln 1 mcg/ml 4SENSIPAR - cinacalcet hcl tab 30 mg 5 PASENSIPAR - cinacalcet hcl tab 60 mg 5 PASENSIPAR - cinacalcet hcl tab 90 mg 5 PAXGEVA - denosumab inj 120 mg/1.7ml 5ZEMPLAR - paricalcitol cap 1 mcg 4ZEMPLAR - paricalcitol cap 2 mcg 4ZEMPLAR - paricalcitol iv soln 2 mcg/ml 4ZEMPLAR - paricalcitol iv soln 5 mcg/ml 4zoledronic acid inj conc for iv infusion 4 mg/5ml^ 2zoledronic acid iv soln 5 mg/100ml^ 2ZOMETA - zoledronic acid iv soln 4 mg/100ml 5Agentes oftálmicosACULAR - ketorolac tromethamine ophth soln 0.5% 4ACULAR LS - ketorolac tromethamine ophth soln 0.4% 4ALPHAGAN P - brimonidine tartrate ophth soln 0.1% 4ALPHAGAN P - brimonidine tartrate ophth soln 0.15% 4azelastine hcl ophth soln 0.05%^ 2

2018



AZOPT - brinzolamide ophth susp 1% 4BACITRACIN - bacitracin ophth oint 500 unit/gm 3bacitracin-polymyxin b ophth oint^ 2bacitracin-polymyxin-neomycin-hc ophth oint 1%^ 2BESIVANCE - besifloxacin hcl ophth susp 0.6% 4BETAGAN - levobunolol hcl ophth soln 0.5% 4betaxolol hcl ophth soln 0.5%^ 2BETOPTIC-S - betaxolol hcl ophth susp 0.25% 4brimonidine tartrate ophth soln 0.15%^ 2brimonidine tartrate ophth soln 0.2%^ 1bromfenac sodium ophth soln 0.09% (once-daily)^ 2carteolol hcl ophth soln 1%^ 1CILOXAN - ciprofloxacin hcl ophth soln 0.3% 4ciprofloxacin hcl ophth soln 0.3%^ 1COMBIGAN - brimonidine tartrate-timolol maleate ophth soln

0.2-0.5%3

COSOPT - dorzolamide hcl-timolol maleate ophth soln22.3-6.8 mg/ml

4

cromolyn sodium ophth soln 4%^ 1CYSTARAN - cysteamine hcl ophth soln 0.44% 5DEXAMETHASONE SODIUM PHOSPHATE - dexamethasone

sodium phosphate ophth soln 0.1%4

diclofenac sodium ophth soln 0.1%^ 2dorzolamide hcl ophth soln 2%^ 2dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml^ 2DUREZOL - difluprednate ophth emulsion 0.05% 3epinastine hcl ophth soln 0.05%^ 2erythromycin ophth oint 5 mg/gm^ 1fluorometholone ophth susp 0.1%^ 2flurbiprofen sodium ophth soln 0.03%^ 1FML LIQUIFILM - fluorometholone ophth susp 0.1% 4gentamicin sulfate ophth oint 0.3%^ 2gentamicin sulfate ophth soln 0.3%^ 2ILEVRO - nepafenac ophth susp 0.3% 3ISTALOL - timolol maleate ophth soln 0.5% (once-daily) 4ketorolac tromethamine ophth soln 0.4%^ 2ketorolac tromethamine ophth soln 0.5%^ 2LACRISERT - artificial tear ophth insert 4latanoprost ophth soln 0.005%^ 2

2018


117


levobunolol hcl ophth soln 0.5%^ 1LOTEMAX - loteprednol etabonate ophth gel 0.5% 3LOTEMAX - loteprednol etabonate ophth oint 0.5% 3LOTEMAX - loteprednol etabonate ophth susp 0.5% 3LUMIGAN - bimatoprost ophth soln 0.01% 3MAXITROL - neomycin-polymyxin-dexamethasone ophth oint

0.1%4

MOXEZA - moxifloxacin hcl ophth soln 0.5% (2 times daily) 4moxifloxacin hcl ophth soln 0.5%^ 2NATACYN - natamycin ophth susp 5% 4neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin^ 2neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/

ml^2

neomycin-polymyxin-dexamethasone ophth oint 0.1%^ 2neomycin-polymyxin-dexamethasone ophth susp 0.1%^ 2OCUFLOX - ofloxacin ophth soln 0.3% 4ofloxacin ophth soln 0.3%^ 2olopatadine hcl ophth soln 0.1%^ 2olopatadine hcl ophth soln 0.2%^ 2OMNIPRED - prednisolone acetate ophth susp 1% 4PATADAY - olopatadine hcl ophth soln 0.2% 3PATANOL - olopatadine hcl ophth soln 0.1% 4PAZEO - olopatadine hcl ophth soln 0.7% 3PHOSPHOLINE IODIDE - echothiophate iodide ophth for soln

0.125%4

pilocarpine hcl ophth soln 1%^ 2pilocarpine hcl ophth soln 2%^ 2pilocarpine hcl ophth soln 4%^ 2polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%^ 1POLYTRIM - polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%4

PRED FORTE - prednisolone acetate ophth susp 1% 4PRED MILD - prednisolone acetate ophth susp 0.12% 4prednisolone acetate ophth susp 1%^ 2PROLENSA - bromfenac sodium ophth soln 0.07% 4RESTASIS - cyclosporine (ophth) emulsion 0.05% 3 PA, QL (60 vials/30 days)RESTASIS MULTIDOSE - cyclosporine (ophth) emulsion 0.05% 3 PA, QL (2 bottles/30 days)SIMBRINZA - brinzolamide-brimonidine tartrate ophth susp

1-0.2%3

2018



sulfacetamide sodium ophth soln 10%^ 2sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)%^ 2timolol maleate ophth gel forming soln 0.25%^ 2timolol maleate ophth gel forming soln 0.5%^ 2timolol maleate ophth soln 0.25%^ 1timolol maleate ophth soln 0.5%^ 1TIMOPTIC - timolol maleate ophth soln 0.25% 4TIMOPTIC - timolol maleate ophth soln 0.5% 4TIMOPTIC OCUDOSE - timolol maleate preservative free ophth

soln 0.25%4

TIMOPTIC OCUDOSE - timolol maleate preservative free ophthsoln 0.5%

4

TIMOPTIC-XE - timolol maleate ophth gel forming soln 0.25% 4TIMOPTIC-XE - timolol maleate ophth gel forming soln 0.5% 4TOBRADEX - tobramycin-dexamethasone ophth oint 0.3-0.1% 4TOBRADEX - tobramycin-dexamethasone ophth susp 0.3-0.1% 4tobramycin ophth soln 0.3%^ 2tobramycin-dexamethasone ophth susp 0.3-0.1%^ 2TRAVATAN Z - travoprost ophth soln 0.004% 3trifluridine ophth soln 1%^ 2TRUSOPT - dorzolamide hcl ophth soln 2% 4VIGAMOX - moxifloxacin hcl ophth soln 0.5% 3VIROPTIC - trifluridine ophth soln 1% 4Agentes óticosacetic acid otic soln 2%^ 2ACETIC ACID/ALUMINUM ACETATE - acetic acid 2% in

aluminum acetate otic soln4

CIPRODEX - ciprofloxacin-dexamethasone otic susp 0.3-0.1% 4fluocinolone acetonide (otic) oil 0.01%^ 2hydrocortisone w/ acetic acid otic soln 1-2%^ 2neomycin-polymyxin-hc otic soln 1%^ 2neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%^ 2ofloxacin otic soln 0.3%^ 2Agentes para el tracto respiratorio/pulmonarACCOLATE - zafirlukast tab 10 mg 4ACCOLATE - zafirlukast tab 20 mg 4acetylcysteine inhal soln 10%^ 2 BDacetylcysteine inhal soln 20%^ 2 BDADCIRCA - tadalafil tab 20 mg 5 PA, QL (60 tablets/30 days)

2018


119


ADEMPAS - riociguat tab 0.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2.5 mg 5 PA, QL (90 tablets/30 days)ADVAIR DISKUS - fluticasone-salmeterol aer powder ba

100-50 mcg/dose3 QL (1 inhaler/30 days)

ADVAIR DISKUS - fluticasone-salmeterol aer powder ba250-50 mcg/dose

3 QL (1 inhaler/30 days)

ADVAIR DISKUS - fluticasone-salmeterol aer powder ba500-50 mcg/dose


ADVAIR HFA - fluticasone-salmeterol inhal aerosol 45-21 mcg/act 3 QL (1 canister/30 days)ADVAIR HFA - fluticasone-salmeterol inhal aerosol 115-21 mcg/

act3 QL (1 canister/30 days)

ADVAIR HFA - fluticasone-salmeterol inhal aerosol 230-21 mcg/act

3 QL (1 canister/30 days)

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)^ 2 BDalbuterol sulfate soln nebu 0.5% (5 mg/ml)^ 2 BDalbuterol sulfate soln nebu 0.63 mg/3ml^ 2 BDalbuterol sulfate soln nebu 1.25 mg/3ml^ 2 BDalbuterol sulfate syrup 2 mg/5ml^ 1albuterol sulfate tab er 12hr 4 mg^ 2albuterol sulfate tab er 12hr 8 mg^ 2albuterol sulfate tab 2 mg^ 2albuterol sulfate tab 4 mg^ 2ANORO ELLIPTA - umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inh3 QL (1 package/30 days)

ARNUITY ELLIPTA - fluticasone furoate aerosol powder breathactiv 100 mcg/act

3 QL (30 blisters/30 days)

ARNUITY ELLIPTA - fluticasone furoate aerosol powder breathactiv 200 mcg/act

3 QL (30 blisters/30 days)

ASMANEX HFA - mometasone furoate inhal aerosol suspension100 mcg/act


ASMANEX HFA - mometasone furoate inhal aerosol suspension200 mcg/act


ASMANEX TWISTHALER 120 METERED DOSES - mometasonefuroate inhal powd 220 mcg/inh






2018









ASTEPRO - azelastine hcl nasal spray 0.15% (205.5 mcg/spray) 4 QL (2 bottles/30 days)ATROVENT HFA - ipratropium bromide hfa inhal aerosol 17 mcg/

act4 QL (2 canisters/30 days)

azelastine hcl nasal spray 0.1% (137 mcg/spray)^ 2 QL (2 bottles/30 days)azelastine hcl nasal spray 0.15% (205.5 mcg/spray)^ 2 QL (2 bottles/30 days)BREO ELLIPTA - fluticasone furoate-vilanterol aero powd ba

100-25 mcg/inh3 QL (1 package/30 days)

BREO ELLIPTA - fluticasone furoate-vilanterol aero powd ba200-25 mcg/inh

3 QL (1 package/30 days)

budesonide inhalation susp 0.25 mg/2ml^ 2 BDbudesonide inhalation susp 0.5 mg/2ml^ 2 BDbudesonide inhalation susp 1 mg/2ml^ 2 BDcaffeine citrate oral soln 60 mg/3ml^ 2CLEMASTINE FUMARATE - clemastine fumarate tab 2.68 mg# 4 PACOMBIVENT RESPIMAT - ipratropium-albuterol inhal aerosol soln

20-100 mcg/act4 QL (2 canisters/30 days)

cromolyn sodium soln nebu 20 mg/2ml 3 BDDALIRESP - roflumilast tab 500 mcg 4desloratadine tab 5 mg^ 2diphenhydramine hcl inj 50 mg/ml^ 2DULERA - mometasone furoate-formoterol fumarate aerosol

100-5 mcg/act4 QL (1 canister/30 days)

DULERA - mometasone furoate-formoterol fumarate aerosol200-5 mcg/act


EPINEPHRINE - epinephrine solution auto-injector 0.15 mg/0.3ml(1:2000)

3

EPINEPHRINE - epinephrine solution auto-injector 0.3 mg/0.3ml(1:1000) (authorized generic for EpiPen 2-Pak)

3

EPIPEN 2-PAK - epinephrine solution auto-injector 0.3 mg/0.3ml(1:1000)

3

EPIPEN-JR 2-PAK - epinephrine solution auto-injector0.15 mg/0.3ml (1:2000)

3

ESBRIET - pirfenidone cap 267 mg* 5 PA, QL (270 capsules/30 days)ESBRIET - pirfenidone tab 267 mg* 5 PA, QL (270 tablets/30 days)ESBRIET - pirfenidone tab 801 mg* 5 PA, QL (90 tablets/30 days)

2018


121


FLOVENT DISKUS - fluticasone propionate aer pow ba 50 mcg/blister





3 QL (4 inhalers/30 days)

FLOVENT HFA - fluticasone propionate hfa inhal aero 44 mcg/act(50/valve)


FLOVENT HFA - fluticasone propionate hfa inhal aer 110 mcg/act(125/valve)


FLOVENT HFA - fluticasone propionate hfa inhal aer 220 mcg/act(250/valve)

3 QL (2 canisters/30 days)

fluticasone propionate nasal susp 50 mcg/act^ 1 QL (1 bottle/30 days)FLUTICASONE PROPIONATE/SALMETEROL - fluticasone-

salmeterol aer powder ba 55-14 mcg/act3 QL (1 inhaler/30 days)

FLUTICASONE PROPIONATE/SALMETEROL - fluticasone-salmeterol aer powder ba 113-14 mcg/act


FLUTICASONE PROPIONATE/SALMETEROL - fluticasone-salmeterol aer powder ba 232-14 mcg/act


GRASTEK - timothy grass pollen allergen ext tab sl 2800 bau 4 PA, QL (30 tablets/30 days)INCRUSE ELLIPTA - umeclidinium br aero powd breath act

62.5 mcg/inh3 QL (30 blisters/30 days)

ipratropium bromide inhal soln 0.02%^ 2 BDipratropium bromide nasal soln 0.03% (21 mcg/spray)^ 2 QL (2 bottles/30 days)ipratropium bromide nasal soln 0.06% (42 mcg/spray)^ 2 QL (3 bottles/30 days)KALYDECO - ivacaftor packet 50 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor packet 75 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor tab 150 mg 5 PA, QL (60 tablets/30 days)LETAIRIS - ambrisentan tab 5 mg* 5 PA, QL (30 tablets/30 days)LETAIRIS - ambrisentan tab 10 mg* 5 PA, QL (30 tablets/30 days)levocetirizine dihydrochloride tab 5 mg^ 1mometasone furoate nasal susp 50 mcg/act^ 2 QL (2 bottles/30 days)montelukast sodium chew tab 4 mg^ 2montelukast sodium chew tab 5 mg^ 2montelukast sodium oral granules packet 4 mg^ 2montelukast sodium tab 10 mg^ 1NASONEX - mometasone furoate nasal susp 50 mcg/act 4 QL (2 bottles/30 days)OFEV - nintedanib esylate cap 100 mg* 5 PA, QL (60 capsules/30 days)OFEV - nintedanib esylate cap 150 mg* 5 PA, QL (60 capsules/30 days)olopatadine hcl nasal soln 0.6%^ 2 QL (1 bottle/30 days)OPSUMIT - macitentan tab 10 mg* 5 PA, QL (30 tablets/30 days)

2018



ORALAIR - grass mixed pollen ext tab sl 300 ir 4 PA, QL (30 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg* 5 PA, QL (120 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg* 5 PA, QL (120 tablets/30 days)PATANASE - olopatadine hcl nasal soln 0.6% 4 QL (1 bottle/30 days)PROAIR HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)PROAIR RESPICLICK - albuterol sulfate aer pow ba 108 mcg/act 3 QL (2 canisters/30 days)PULMOZYME - dornase alfa inhal soln 1 mg/ml 5 BDQVAR - beclomethasone diprop inhal aero soln 40 mcg/act (50/

valve)3 QL (1 canister/30 days)

QVAR - beclomethasone diprop inhal aero soln 80 mcg/act (100/valve)

3 QL (2 canisters/30 days)

RAGWITEK - short ragweed pollen allergen extract tab sl 12 amba 1-u


REMODULIN - treprostinil sodium inj 1 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 2.5 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 5 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 10 mg/ml* 5 BDribavirin for inhal soln 6 gm 5SEREVENT DISKUS - salmeterol xinafoate aer pow ba 50 mcg/

dose3 QL (1 inhaler/30 days)

sildenafil citrate tab 20 mg^ 2 PA, QL (90 tablets/30 days)SINGULAIR - montelukast sodium chew tab 4 mg 4SINGULAIR - montelukast sodium chew tab 5 mg 4SINGULAIR - montelukast sodium oral granules packet 4 mg 4SINGULAIR - montelukast sodium tab 10 mg 4SPIRIVA HANDIHALER - tiotropium bromide monohydrate inhal

cap 18 mcg3 QL (30 capsules/30 days)

SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 1.25 mcg/act


SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 2.5 mcg/act


STIOLTO RESPIMAT - tiotropium br-olodaterol inhal aero soln2.5-2.5 mcg/act


SYMBICORT - budesonide-formoterol fumarate dihyd aerosol80-4.5 mcg/act


SYMBICORT - budesonide-formoterol fumarate dihyd aerosol160-4.5 mcg/act


terbutaline sulfate tab 2.5 mg^ 2terbutaline sulfate tab 5 mg^ 2THEO-24 - theophylline cap er 24hr 100 mg 4THEO-24 - theophylline cap er 24hr 200 mg 4

2018


123


THEO-24 - theophylline cap er 24hr 300 mg 4THEO-24 - theophylline cap er 24hr 400 mg 4theophylline tab er 12hr 100 mg^ 2theophylline tab er 12hr 200 mg^ 2theophylline tab er 12hr 300 mg^ 2theophylline tab er 12hr 450 mg^ 2theophylline tab er 24hr 400 mg^ 2theophylline tab er 24hr 600 mg^ 2tobramycin nebu soln 300 mg/5ml 5 BDTRACLEER - bosentan tab 62.5 mg* 5 PA, QL (60 tablets/30 days)TRACLEER - bosentan tab 125 mg* 5 PA, QL (60 tablets/30 days)triamcinolone acetonide nasal aerosol suspension 55 mcg/act^ 2 QL (1 bottle/30 days)UPTRAVI - selexipag tab therapy pack 200 mcg (140) & 800 mcg

(60)*5 PA, QL (1 pack (200

tablets)/28 days)UPTRAVI - selexipag tab 200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 400 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 600 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 800 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1000 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1400 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1600 mcg* 5 PA, QL (60 tablets/30 days)VENTAVIS - iloprost inhalation solution 10 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTAVIS - iloprost inhalation solution 20 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTOLIN HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)XOPENEX HFA - levalbuterol tartrate inhal aerosol 45 mcg/act 4 QL (2 canisters/30 days)zafirlukast tab 10 mg^ 2zafirlukast tab 20 mg^ 2Relajantes de los músculos esqueléticoscyclobenzaprine hcl tab 5 mg# 4 PAcyclobenzaprine hcl tab 7.5 mg# 4 PAcyclobenzaprine hcl tab 10 mg# 4 PAmethocarbamol tab 500 mg# 4 PAmethocarbamol tab 750 mg# 4 PAAgentes para tratar los trastornos del sueñoarmodafinil tab 50 mg^ 2 PA, QL (30 tablets/30 days)armodafinil tab 150 mg^ 2 PA, QL (30 tablets/30 days)armodafinil tab 200 mg^ 2 PA, QL (30 tablets/30 days)

2018



armodafinil tab 250 mg^ 2 PA, QL (30 tablets/30 days)HETLIOZ - tasimelteon capsule 20 mg* 5 PA, QL (30 capsules/30 days)modafinil tab 100 mg^ 2 PA, QL (30 tablets/30 days)modafinil tab 200 mg^ 2 PA, QL (30 tablets/30 days)NUVIGIL - armodafinil tab 50 mg 4 PA, QL (30 tablets/30 days)NUVIGIL - armodafinil tab 150 mg 4 PA, QL (30 tablets/30 days)NUVIGIL - armodafinil tab 200 mg 4 PA, QL (30 tablets/30 days)NUVIGIL - armodafinil tab 250 mg 4 PA, QL (30 tablets/30 days)SILENOR - doxepin hcl tab 3 mg 3 QL (30 tablets/30 days)SILENOR - doxepin hcl tab 6 mg 3 QL (30 tablets/30 days)temazepam cap 15 mg^ 1 QL (30 capsules/30 days)temazepam cap 30 mg^ 1 QL (30 capsules/30 days)XYREM - sodium oxybate oral solution 500 mg/ml* 5 PA, QL (540 mls/30 days)zaleplon cap 5 mg# 4 PAzaleplon cap 10 mg# 4 PAzolpidem tartrate tab 5 mg# 4 PAzolpidem tartrate tab 10 mg# 4 PA

2018

125

ÍNDICE

Aabacavir sulfate-lamivudine tab 600-300

mg................................................................................52abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg........................................................52abacavir sulfate soln 20 mg/ml.................................. 52abacavir sulfate tab 300 mg.......................................52ABILIFY..........................................................................45ABILIFY..........................................................................45ABILIFY..........................................................................45ABILIFY..........................................................................45ABILIFY..........................................................................46ABILIFY..........................................................................46ABRAXANE...................................................................33ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1acamprosate calcium tab delayed release 333

mg..................................................................................6acarbose tab 100 mg.................................................. 58acarbose tab 25 mg.................................................... 58acarbose tab 50 mg.................................................... 58ACCOLATE.................................................................118ACCOLATE.................................................................118ACCUPRIL.................................................................... 65ACCUPRIL.................................................................... 65ACCUPRIL.................................................................... 65ACCUPRIL.................................................................... 65ACCURETIC................................................................. 65ACCURETIC................................................................. 65ACCURETIC................................................................. 65acebutolol hcl cap 200 mg..........................................66acebutolol hcl cap 400 mg..........................................66acetaminophen w/ codeine soln 120-12

mg/5ml.......................................................................... 1acetaminophen w/ codeine tab 300-15

mg..................................................................................1acetaminophen w/ codeine tab 300-30

mg..................................................................................1acetaminophen w/ codeine tab 300-60

mg..................................................................................1acetazolamide cap er 12hr 500 mg...........................66acetazolamide tab 125 mg......................................... 66acetazolamide tab 250 mg......................................... 66ACETIC ACID/ALUMINUM

ACETATE................................................................. 118acetic acid otic soln 2%............................................ 118

acetylcysteine inhal soln 10%..................................118acetylcysteine inhal soln 20%..................................118acitretin cap 10 mg......................................................87acitretin cap 17.5 mg...................................................87acitretin cap 25 mg......................................................87ACTHIB........................................................................108ACTIGALL..................................................................... 93ACTIMMUNE.............................................................. 108ACTOS...........................................................................58ACTOS...........................................................................58ACTOS...........................................................................58ACULAR......................................................................115ACULAR LS................................................................115acyclovir cap 200 mg.................................................. 52acyclovir oint 5%..........................................................52ACYCLOVIR SODIUM................................................ 52acyclovir sodium iv soln 50 mg/ml.............................52acyclovir susp 200 mg/5ml......................................... 52acyclovir tab 400 mg................................................... 52acyclovir tab 800 mg................................................... 52ADACEL...................................................................... 108ADAGEN........................................................................96ADALAT CC..................................................................66ADALAT CC..................................................................66ADALAT CC..................................................................66ADASUVE..................................................................... 46ADCIRCA.................................................................... 118ADDERALL XR............................................................ 84ADDERALL XR............................................................ 84ADDERALL XR............................................................ 84ADDERALL XR............................................................ 84ADDERALL XR............................................................ 84ADDERALL XR............................................................ 84adefovir dipivoxil tab 10 mg........................................52ADEMPAS...................................................................119ADEMPAS...................................................................119ADEMPAS...................................................................119ADEMPAS...................................................................119ADEMPAS...................................................................119ADVAIR DISKUS....................................................... 119ADVAIR DISKUS....................................................... 119ADVAIR DISKUS....................................................... 119ADVAIR HFA.............................................................. 119ADVAIR HFA.............................................................. 119ADVAIR HFA.............................................................. 119AFINITOR......................................................................33AFINITOR......................................................................33AFINITOR......................................................................33AFINITOR......................................................................33AFINITOR DISPERZ................................................... 33AFINITOR DISPERZ................................................... 33AFINITOR DISPERZ................................................... 33

2018

126

AGGRENOX................................................................. 62AGRYLIN.......................................................................62ALBENZA...................................................................... 42albuterol sulfate soln nebu 0.083% (2.5

mg/3ml).....................................................................119albuterol sulfate soln nebu 0.5% (5 mg/

ml)............................................................................. 119albuterol sulfate soln nebu 0.63

mg/3ml......................................................................119albuterol sulfate soln nebu 1.25

mg/3ml......................................................................119albuterol sulfate syrup 2 mg/5ml..............................119albuterol sulfate tab 2 mg.........................................119albuterol sulfate tab 4 mg.........................................119albuterol sulfate tab er 12hr 4 mg........................... 119albuterol sulfate tab er 12hr 8 mg........................... 119alclometasone dipropionate cream

0.05%..........................................................................87alclometasone dipropionate oint

0.05%..........................................................................87ALCOHOL SWABS......................................................58ALDACTAZIDE............................................................. 66ALDACTONE................................................................ 66ALDACTONE................................................................ 66ALDACTONE................................................................ 66ALDARA........................................................................ 87ALDURAZYME............................................................. 96ALECENSA................................................................... 33alendronate sodium tab 10 mg................................ 114alendronate sodium tab 35 mg................................ 114alendronate sodium tab 5 mg.................................. 114alendronate sodium tab 70 mg................................ 114alfuzosin hcl tab er 24hr 10 mg................................. 98ALIMTA.......................................................................... 33ALIMTA.......................................................................... 33ALINIA............................................................................43ALINIA............................................................................43ALIQOPA....................................................................... 33allopurinol sodium for inj 500 mg...............................31allopurinol tab 100 mg.................................................31allopurinol tab 300 mg.................................................31ALOPRIM...................................................................... 31alosetron hcl tab 0.5 mg............................................. 93alosetron hcl tab 1 mg................................................ 93ALOXI.............................................................................27ALPHAGAN P............................................................ 115ALPHAGAN P............................................................ 115alprazolam tab 0.25 mg.............................................. 57alprazolam tab 0.5 mg................................................ 57alprazolam tab 1 mg....................................................57alprazolam tab 2 mg....................................................57ALTACE......................................................................... 66

ALTACE......................................................................... 66ALTACE......................................................................... 66ALTACE......................................................................... 66ALUNBRIG....................................................................33amantadine hcl cap 100 mg.......................................43amantadine hcl syrup 50 mg/5ml...............................43amantadine hcl tab 100 mg........................................43AMARYL........................................................................ 58AMARYL........................................................................ 58AMARYL........................................................................ 58AMBISOME...................................................................29AMERGE....................................................................... 31AMERGE....................................................................... 31amikacin sulfate inj 1 gm/4ml (250 mg/

ml)..................................................................................7amikacin sulfate inj 500 mg/2ml (250 mg/

ml)..................................................................................6amiloride & hydrochlorothiazide tab 5-50

mg................................................................................66amiloride hcl tab 5 mg.................................................66amino acid infusion 15%.............................................91amino acid infusion 6%...............................................91AMINOSYN II............................................................... 91amiodarone hcl tab 200 mg........................................66amiodarone hcl tab 400 mg........................................66AMITIZA.........................................................................93AMITIZA.........................................................................93amitriptyline hcl tab 100 mg....................................... 23amitriptyline hcl tab 10 mg..........................................23amitriptyline hcl tab 150 mg....................................... 23amitriptyline hcl tab 25 mg..........................................23amitriptyline hcl tab 50 mg..........................................23amitriptyline hcl tab 75 mg..........................................23amlodipine besylate-atorvastatin calcium tab 10-10

mg................................................................................66amlodipine besylate-atorvastatin calcium tab 10-20



mg................................................................................66amlodipine besylate-atorvastatin calcium tab 2.5-10





mg................................................................................66

2018

127

amlodipine besylate-atorvastatin calcium tab 5-40mg................................................................................66

amlodipine besylate-atorvastatin calcium tab 5-80mg................................................................................66

amlodipine besylate-benazepril hcl cap 10-20mg................................................................................67


amlodipine besylate-benazepril hcl cap 2.5-10mg................................................................................66




amlodipine besylate-olmesartan medoxomil tab10-20 mg....................................................................67

amlodipine besylate-olmesartan medoxomil tab10-40 mg....................................................................67

amlodipine besylate-olmesartan medoxomil tab 5-20mg................................................................................67

amlodipine besylate-olmesartan medoxomil tab 5-40mg................................................................................67

amlodipine besylate tab 10 mg..................................66amlodipine besylate tab 2.5 mg.................................66amlodipine besylate tab 5 mg.................................... 66amlodipine besylate-valsartan tab 10-160

mg................................................................................67amlodipine besylate-valsartan tab 10-320



mg................................................................................67amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg.........................................................67amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg............................................................67amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg............................................................67amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg...........................................................67amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg.............................................................. 67AMOXAPINE.................................................................23AMOXAPINE.................................................................23AMOXAPINE.................................................................23AMOXAPINE.................................................................23AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 7

AMOXICILLIN/CLAVULANATEPOTASSIUM................................................................ 7

amoxicillin (trihydrate) cap 250 mg..............................7amoxicillin (trihydrate) cap 500 mg..............................7amoxicillin (trihydrate) for susp 125

mg/5ml.......................................................................... 7amoxicillin (trihydrate) for susp 200



mg/5ml.......................................................................... 7amoxicillin (trihydrate) tab 500 mg...............................7amoxicillin (trihydrate) tab 875 mg...............................7amoxicillin & k clavulanate for susp 200-28.5

mg/5ml.......................................................................... 7amoxicillin & k clavulanate for susp 400-57

mg/5ml.......................................................................... 7amoxicillin & k clavulanate for susp 600-42.9

mg/5ml.......................................................................... 7amoxicillin & k clavulanate tab 250-125

mg..................................................................................7amoxicillin & k clavulanate tab 500-125

mg..................................................................................7amoxicillin & k clavulanate tab 875-125

mg..................................................................................7amphetamine-dextroamphetamine cap er 24hr 10

mg................................................................................85amphetamine-dextroamphetamine cap er 24hr 15





mg................................................................................84amphetamine-dextroamphetamine tab 10

mg................................................................................85amphetamine-dextroamphetamine tab 12.5





mg................................................................................85amphetamine-dextroamphetamine tab 7.5

mg................................................................................85

2018

128

AMPHOTERICIN B......................................................29AMPICILLIN.................................................................... 7AMPICILLIN.................................................................... 7ampicillin & sulbactam sodium for inj 3 (2-1)

gm..................................................................................7ampicillin cap 250 mg....................................................7ampicillin cap 500 mg....................................................7AMPICILLIN SODIUM................................................... 7ampicillin sodium for inj 1 gm.......................................7ampicillin sodium for inj 250 mg...................................7ampicillin sodium for inj 2 gm.......................................7ampicillin sodium for inj 500 mg...................................7ampicillin sodium for iv soln 10 gm..............................7ampicillin sodium for iv soln 2 gm................................7AMPYRA........................................................................85ANADROL-50............................................................. 101anagrelide hcl cap 0.5 mg.......................................... 62anagrelide hcl cap 1 mg............................................. 62ANAPROX DS................................................................ 1anastrozole tab 1 mg...................................................33ANDRODERM............................................................ 101ANDRODERM............................................................ 101ANDROGEL................................................................101ANDROGEL................................................................101ANDROGEL................................................................101ANDROGEL................................................................101ANDROGEL PUMP...................................................101ANORO ELLIPTA.......................................................119ANTABUSE..................................................................... 6ANTABUSE..................................................................... 6APOKYN........................................................................43aprepitant capsule 125 mg.........................................27aprepitant capsule 40 mg........................................... 27aprepitant capsule 80 mg........................................... 27aprepitant capsule therapy pack 80 & 125

mg................................................................................27APRISO....................................................................... 113APTIOM......................................................................... 16APTIOM......................................................................... 17APTIOM......................................................................... 17APTIOM......................................................................... 17APTIVUS....................................................................... 52APTIVUS....................................................................... 52ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62ARANESP ALBUMIN FREE.......................................62

ARANESP ALBUMIN FREE.......................................63ARANESP ALBUMIN FREE.......................................63ARANESP ALBUMIN FREE.......................................63ARANESP ALBUMIN FREE.......................................63ARANESP ALBUMIN FREE.......................................63ARANESP ALBUMIN FREE.......................................63ARCALYST................................................................. 108ARICEPT....................................................................... 22ARICEPT....................................................................... 22ARIMIDEX..................................................................... 33aripiprazole orally disintegrating tab 10

mg................................................................................46aripiprazole orally disintegrating tab 15

mg................................................................................46aripiprazole oral solution 1 mg/ml..............................46aripiprazole tab 10 mg................................................ 46aripiprazole tab 15 mg................................................ 46aripiprazole tab 20 mg................................................ 46aripiprazole tab 2 mg...................................................46aripiprazole tab 30 mg................................................ 46aripiprazole tab 5 mg...................................................46ARISTADA.....................................................................46ARISTADA.....................................................................46ARISTADA.....................................................................46ARISTADA.....................................................................46armodafinil tab 150 mg............................................. 123armodafinil tab 200 mg............................................. 123armodafinil tab 250 mg............................................. 124armodafinil tab 50 mg............................................... 123ARNUITY ELLIPTA....................................................119ARNUITY ELLIPTA....................................................119AROMASIN................................................................... 33ARRANON.................................................................... 33ARTHROTEC 50............................................................ 1ARTHROTEC 75............................................................ 1ARZERRA..................................................................... 33ARZERRA..................................................................... 33ASACOL HD...............................................................113ASMANEX HFA..........................................................119ASMANEX HFA..........................................................119ASMANEX TWISTHALER 120 METERED

DOSES.....................................................................119ASMANEX TWISTHALER 14 METERED





DOSES.....................................................................120

2018

129

aspirin-dipyridamole cap er 12hr 25-200mg................................................................................63

ASTAGRAF XL...........................................................108ASTAGRAF XL...........................................................108ASTAGRAF XL...........................................................108ASTEPRO................................................................... 120ATACAND......................................................................67ATACAND......................................................................67ATACAND......................................................................67ATACAND......................................................................67ATACAND HCT............................................................ 67ATACAND HCT............................................................ 67ATACAND HCT............................................................ 67ATELVIA...................................................................... 114atenolol & chlorthalidone tab 100-25

mg................................................................................67atenolol & chlorthalidone tab 50-25 mg.................... 67atenolol tab 100 mg.....................................................67atenolol tab 25 mg.......................................................67atenolol tab 50 mg.......................................................67ATGAM........................................................................ 108atomoxetine hcl cap 100 mg...................................... 85atomoxetine hcl cap 10 mg........................................ 85atomoxetine hcl cap 18 mg........................................ 85atomoxetine hcl cap 25 mg........................................ 85atomoxetine hcl cap 40 mg........................................ 85atomoxetine hcl cap 60 mg........................................ 85atomoxetine hcl cap 80 mg........................................ 85atorvastatin calcium tab 10 mg.................................. 67atorvastatin calcium tab 20 mg.................................. 67atorvastatin calcium tab 40 mg.................................. 67atorvastatin calcium tab 80 mg.................................. 67atovaquone-proguanil hcl tab 250-100

mg................................................................................43atovaquone-proguanil hcl tab 62.5-25

mg................................................................................43atovaquone susp 750 mg/5ml....................................43ATRIPLA........................................................................ 52ATROVENT HFA........................................................120AUGMENTIN...................................................................7AUGMENTIN...................................................................7AVALIDE........................................................................ 67AVALIDE........................................................................ 67AVAPRO........................................................................ 67AVAPRO........................................................................ 67AVAPRO........................................................................ 68AVASTIN........................................................................33AVASTIN........................................................................33AVELOX...........................................................................7AVELOX...........................................................................7AVODART..................................................................... 98AVONEX........................................................................ 85

AVONEX........................................................................ 85AVONEX PEN.............................................................. 85AXIRON.......................................................................101AYGESTIN.................................................................. 101azacitidine for inj 100 mg............................................63AZACTAM........................................................................7AZACTAM........................................................................7AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 8AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 8AZASAN...................................................................... 108AZASAN...................................................................... 108AZATHIOPRINE......................................................... 108azathioprine tab 50 mg............................................. 108azelastine hcl nasal spray 0.1% (137 mcg/

spray)........................................................................120azelastine hcl nasal spray 0.15% (205.5 mcg/

spray)........................................................................120azelastine hcl ophth soln 0.05%..............................115AZELEX......................................................................... 87AZILECT........................................................................43AZILECT........................................................................43AZITHROMYCIN............................................................ 8azithromycin for susp 100 mg/5ml...............................8azithromycin for susp 200 mg/5ml...............................8azithromycin iv for soln 500 mg................................... 8azithromycin tab 250 mg...............................................8azithromycin tab 500 mg...............................................8azithromycin tab 600 mg...............................................8AZOPT.........................................................................116AZOR............................................................................. 68AZOR............................................................................. 68AZOR............................................................................. 68AZOR............................................................................. 68aztreonam for inj 1 gm.................................................. 8aztreonam for inj 2 gm.................................................. 8AZULFIDINE...............................................................113AZULFIDINE EN-TABS.............................................114BBACITRACIN.............................................................. 116bacitracin-polymyxin b ophth oint............................ 116bacitracin-polymyxin-neomycin-hc ophth oint

1%............................................................................. 116baclofen tab 10 mg......................................................51baclofen tab 20 mg......................................................51BACTRIM.........................................................................8BACTRIM DS..................................................................8balsalazide disodium cap 750 mg........................... 114BANZEL.........................................................................17BANZEL.........................................................................17

2018

130

BANZEL.........................................................................17BARACLUDE................................................................ 52BARACLUDE................................................................ 52BARACLUDE................................................................ 52BAVENCIO.................................................................... 33BCG VACCINE...........................................................108BELEODAQ.................................................................. 33benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................68benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................68benazepril & hydrochlorothiazide tab 20-25

mg................................................................................68benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................68benazepril hcl tab 10 mg............................................ 68benazepril hcl tab 20 mg............................................ 68benazepril hcl tab 40 mg............................................ 68benazepril hcl tab 5 mg.............................................. 68BENDEKA..................................................................... 33BENICAR.......................................................................68BENICAR.......................................................................68BENICAR.......................................................................68BENICAR HCT............................................................. 68BENICAR HCT............................................................. 68BENICAR HCT............................................................. 68BENLYSTA..................................................................108BENLYSTA..................................................................108BENLYSTA..................................................................108BENLYSTA..................................................................108BENZAMYCIN.............................................................. 87benzoyl peroxide-erythromycin gel

5-3%............................................................................87benztropine mesylate tab 0.5 mg.............................. 43benztropine mesylate tab 1 mg..................................43benztropine mesylate tab 2 mg..................................43BESIVANCE................................................................116BESPONSA.................................................................. 33BETAGAN................................................................... 116betamethasone dipropionate augmented cream

0.05%..........................................................................87betamethasone dipropionate augmented gel

0.05%..........................................................................87betamethasone dipropionate augmented lotion

0.05%..........................................................................87betamethasone dipropionate augmented oint

0.05%..........................................................................87betamethasone dipropionate cream

0.05%..........................................................................87betamethasone dipropionate lotion

0.05%..........................................................................87

betamethasone dipropionate oint0.05%..........................................................................87

betamethasone valerate cream 0.1%....................... 87betamethasone valerate lotion 0.1%.........................87betamethasone valerate oint 0.1%............................87BETASERON................................................................ 85betaxolol hcl ophth soln 0.5%..................................116betaxolol hcl tab 10 mg...............................................68betaxolol hcl tab 20 mg...............................................68bethanechol chloride tab 10 mg.................................98bethanechol chloride tab 25 mg.................................98bethanechol chloride tab 50 mg.................................98bethanechol chloride tab 5 mg...................................98BETOPTIC-S.............................................................. 116bexarotene cap 75 mg................................................ 33BEXSERO...................................................................108bicalutamide tab 50 mg...............................................33BICILLIN L-A...................................................................8BICILLIN L-A...................................................................8BICILLIN L-A...................................................................8BICNU............................................................................34BILTRICIDE...................................................................43bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................68bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................68bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................68bisoprolol fumarate tab 10 mg................................... 68bisoprolol fumarate tab 5 mg..................................... 68bleomycin sulfate for inj 15 unit................................. 34bleomycin sulfate for inj 30 unit................................. 34BLINCYTO.....................................................................34BONIVA....................................................................... 114BOOSTRIX..................................................................108BOSULIF....................................................................... 34BOSULIF....................................................................... 34BREO ELLIPTA..........................................................120BREO ELLIPTA..........................................................120BREVICON-28............................................................101BRILINTA.......................................................................63BRILINTA.......................................................................63brimonidine tartrate ophth soln 0.15%.................... 116brimonidine tartrate ophth soln 0.2%...................... 116BRIVIACT......................................................................17BRIVIACT......................................................................17BRIVIACT......................................................................17BRIVIACT......................................................................17BRIVIACT......................................................................17BRIVIACT......................................................................17BRIVIACT......................................................................17

2018

131

bromfenac sodium ophth soln 0.09% (once-daily)......................................................................... 116

bromocriptine mesylate cap 5 mg..............................43bromocriptine mesylate tab 2.5 mg........................... 43budesonide delayed release particles cap 3

mg............................................................................. 114budesonide inhalation susp 0.25

mg/2ml......................................................................120budesonide inhalation susp 0.5

mg/2ml......................................................................120budesonide inhalation susp 1 mg/2ml.....................120bumetanide inj 0.25 mg/ml......................................... 68bumetanide tab 0.5 mg............................................... 68bumetanide tab 1 mg.................................................. 68bumetanide tab 2 mg.................................................. 68BUPHENYL...................................................................96buprenorphine hcl-naloxone hcl sl tab 2-0.5

mg..................................................................................6buprenorphine hcl-naloxone hcl sl tab 8-2

mg..................................................................................6buprenorphine hcl sl tab 2 mg......................................6buprenorphine hcl sl tab 8 mg......................................6bupropion hcl (smoking deterrent) tab er 12hr 150

mg..................................................................................6bupropion hcl tab 100 mg...........................................23bupropion hcl tab 75 mg.............................................23bupropion hcl tab er 12hr 100 mg............................. 23bupropion hcl tab er 12hr 150 mg............................. 23bupropion hcl tab er 12hr 200 mg............................. 23bupropion hcl tab er 24hr 150 mg............................. 23bupropion hcl tab er 24hr 300 mg............................. 23buspirone hcl tab 10 mg............................................. 57buspirone hcl tab 15 mg............................................. 57buspirone hcl tab 30 mg............................................. 57buspirone hcl tab 5 mg............................................... 57buspirone hcl tab 7.5 mg............................................ 57busulfan inj 6 mg/ml.................................................... 34butalbital-acetaminophen-caffeine cap 50-300-40

mg..................................................................................1butalbital-acetaminophen-caffeine cap 50-325-40

mg..................................................................................1butalbital-acetaminophen-caffeine tab 50-325-40

mg..................................................................................1butalbital-acetaminophen tab 50-325

mg..................................................................................1butalbital-aspirin-caffeine cap 50-325-40

mg..................................................................................1BUTORPHANOL TARTRATE.......................................1butorphanol tartrate inj 2 mg/ml................................... 1butorphanol tartrate nasal soln 10 mg/

ml................................................................................... 1BUTRANS........................................................................1

BUTRANS........................................................................1BUTRANS........................................................................1BUTRANS........................................................................1BUTRANS........................................................................1BYDUREON..................................................................58BYDUREON BCISE.....................................................58BYDUREON PEN........................................................ 58Ccabergoline tab 0.5 mg............................................. 106CABOMETYX............................................................... 34CABOMETYX............................................................... 34CABOMETYX............................................................... 34caffeine citrate oral soln 60 mg/3ml........................ 120CALAN........................................................................... 68CALAN........................................................................... 68CALAN SR.................................................................... 68CALAN SR.................................................................... 68calcipotriene cream 0.005%.......................................87calcipotriene oint 0.005%............................................87calcipotriene soln 0.005% (50 mcg/ml).....................87calcitonin (salmon) nasal soln 200 unit/

act..............................................................................114calcitriol cap 0.25 mcg.............................................. 114calcitriol cap 0.5 mcg................................................ 114calcitriol inj 1 mcg/ml.................................................114calcitriol oral soln 1 mcg/ml......................................114calcium acetate cap 667 mg...................................... 91calcium acetate tab 667 mg....................................... 91CANASA......................................................................114CANCIDAS....................................................................29CANCIDAS....................................................................29candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg................................................................................69candesartan cilexetil-hydrochlorothiazide tab 32-12.5

mg................................................................................69candesartan cilexetil-hydrochlorothiazide tab 32-25

mg................................................................................69candesartan cilexetil tab 16 mg................................. 69candesartan cilexetil tab 32 mg................................. 69candesartan cilexetil tab 4 mg................................... 68candesartan cilexetil tab 8 mg................................... 68CAPASTAT SULFATE..................................................32CAPRELSA................................................................... 34CAPRELSA................................................................... 34CAPTOPRIL/

HYDROCHLOROTHIAZIDE....................................69CAPTOPRIL/

HYDROCHLOROTHIAZIDE....................................69CAPTOPRIL/

HYDROCHLOROTHIAZIDE....................................69

2018

132

CAPTOPRIL/HYDROCHLOROTHIAZIDE....................................69

captopril tab 100 mg....................................................69captopril tab 12.5 mg...................................................69captopril tab 25 mg......................................................69captopril tab 50 mg......................................................69CARAC.......................................................................... 87CARAFATE....................................................................93CARAFATE....................................................................93CARBAGLU.................................................................. 91carbamazepine cap er 12hr 100 mg......................... 17carbamazepine cap er 12hr 200 mg......................... 17carbamazepine cap er 12hr 300 mg......................... 17carbamazepine chew tab 100 mg..............................17carbamazepine susp 100 mg/5ml..............................17carbamazepine tab 200 mg........................................17carbamazepine tab er 12hr 100 mg.......................... 17carbamazepine tab er 12hr 200 mg.......................... 17carbamazepine tab er 12hr 400 mg.......................... 17CARBATROL................................................................ 17CARBATROL................................................................ 17CARBATROL................................................................ 17CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................44CARBIDOPA/LEVODOPA/





ENTACAPONE..........................................................44carbidopa & levodopa orally disintegrating tab

10-100 mg..................................................................44carbidopa & levodopa orally disintegrating tab

25-100 mg..................................................................44carbidopa & levodopa orally disintegrating tab

25-250 mg..................................................................44carbidopa & levodopa tab 10-100 mg....................... 44carbidopa & levodopa tab 25-100 mg....................... 44carbidopa & levodopa tab 25-250 mg....................... 44carbidopa & levodopa tab er 25-100

mg................................................................................44carbidopa & levodopa tab er 50-200

mg................................................................................44carbidopa tab 25 mg................................................... 44carboplatin iv soln 150 mg/15ml................................ 34carboplatin iv soln 450 mg/45ml................................ 34carboplatin iv soln 50 mg/5ml.................................... 34carboplatin iv soln 600 mg/60ml................................ 34

CARDIZEM....................................................................69CARDIZEM....................................................................69CARDIZEM....................................................................69CARDIZEM CD............................................................ 69CARDIZEM CD............................................................ 69CARDIZEM CD............................................................ 69CARDIZEM CD............................................................ 69CARDIZEM LA............................................................. 69CARDIZEM LA............................................................. 69CARDIZEM LA............................................................. 69CARDIZEM LA............................................................. 69CARDIZEM LA............................................................. 69CARDIZEM LA............................................................. 69CARDURA.....................................................................69CARDURA.....................................................................69CARDURA.....................................................................69CARDURA.....................................................................69CARNITOR....................................................................91CARNITOR....................................................................91CARNITOR SF............................................................. 91carteolol hcl ophth soln 1%...................................... 116carvedilol phosphate cap er 24hr 10

mg................................................................................69carvedilol phosphate cap er 24hr 20



mg................................................................................69carvedilol tab 12.5 mg.................................................70carvedilol tab 25 mg....................................................70carvedilol tab 3.125 mg...............................................69carvedilol tab 6.25 mg.................................................70CASODEX.....................................................................34caspofungin acetate for iv soln 50 mg...................... 29caspofungin acetate for iv soln 70 mg...................... 29CATAPRES....................................................................70CATAPRES....................................................................70CATAPRES....................................................................70CATAPRES-TTS-1....................................................... 70CATAPRES-TTS-2....................................................... 70CATAPRES-TTS-3....................................................... 70cefaclor cap 250 mg......................................................8cefaclor cap 500 mg......................................................8cefadroxil cap 500 mg...................................................8cefadroxil for susp 250 mg/5ml....................................8cefadroxil for susp 500 mg/5ml....................................8cefadroxil tab 1 gm........................................................ 8CEFAZOLIN SODIUM................................................... 8cefazolin sodium for inj 10 gm..................................... 8cefazolin sodium for inj 1 gm....................................... 8cefazolin sodium for inj 500 mg................................... 8

2018

133

cefdinir cap 300 mg....................................................... 8cefdinir for susp 125 mg/5ml........................................8cefdinir for susp 250 mg/5ml........................................8cefepime hcl for inj 1 gm.............................................. 8cefepime hcl for inj 2 gm.............................................. 8CEFOTAXIME SODIUM................................................8CEFOTAXIME SODIUM................................................8CEFOTAXIME SODIUM................................................8CEFOTAXIME SODIUM................................................9cefoxitin sodium for inj 10 gm...................................... 9cefoxitin sodium for iv soln 1 gm................................. 9cefoxitin sodium for iv soln 2 gm................................. 9cefpodoxime proxetil for susp 100

mg/5ml.......................................................................... 9cefpodoxime proxetil for susp 50

mg/5ml.......................................................................... 9cefpodoxime proxetil tab 100 mg.................................9cefpodoxime proxetil tab 200 mg.................................9cefprozil for susp 125 mg/5ml...................................... 9cefprozil for susp 250 mg/5ml...................................... 9cefprozil tab 250 mg......................................................9cefprozil tab 500 mg......................................................9ceftazidime for inj 1 gm.................................................9ceftazidime for inj 2 gm.................................................9ceftazidime for inj 6 gm.................................................9ceftazidime for iv soln 1 gm..........................................9ceftazidime for iv soln 2 gm..........................................9CEFTIN............................................................................ 9CEFTRIAXONE/DEXTROSE....................................... 9CEFTRIAXONE/DEXTROSE....................................... 9CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 9CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 9ceftriaxone sodium for inj 10 gm..................................9ceftriaxone sodium for inj 1 gm....................................9ceftriaxone sodium for inj 250 mg................................9ceftriaxone sodium for inj 2 gm....................................9ceftriaxone sodium for inj 500 mg................................9ceftriaxone sodium for iv soln 1 gm.............................9ceftriaxone sodium for iv soln 2 gm.............................9cefuroxime axetil tab 250 mg....................................... 9cefuroxime axetil tab 500 mg....................................... 9cefuroxime sodium for inj 1.5 gm.................................9cefuroxime sodium for inj 7.5 gm.................................9cefuroxime sodium for inj 750 mg................................9cefuroxime sodium for iv soln 1.5 gm..........................9CELEBREX..................................................................... 1CELEBREX..................................................................... 1CELEBREX..................................................................... 1CELEBREX..................................................................... 1celecoxib cap 100 mg................................................... 1

celecoxib cap 200 mg................................................... 1celecoxib cap 400 mg................................................... 1celecoxib cap 50 mg......................................................1CELEXA.........................................................................23CELEXA.........................................................................23CELEXA.........................................................................23CELLCEPT..................................................................108CELLCEPT..................................................................108CELLCEPT..................................................................108CELLCEPT INTRAVENOUS....................................108CELONTIN.................................................................... 17cephalexin cap 250 mg...............................................10cephalexin cap 500 mg...............................................10cephalexin cap 750 mg...............................................10cephalexin for susp 125 mg/5ml................................10cephalexin for susp 250 mg/5ml................................10CEREZYME.................................................................. 96cevimeline hcl cap 30 mg...........................................87CHANTIX......................................................................... 6CHANTIX......................................................................... 6CHANTIX CONTINUING MONTH

PACK.............................................................................6CHANTIX STARTING MONTH PACK.........................6CHEMET........................................................................91CHENODAL.................................................................. 93CHLORAMPHENICOL SODIUM

SUCCINATE.............................................................. 10chlorhexidine gluconate soln 0.12%..........................87CHLOROQUINE PHOSPHATE................................. 43chloroquine phosphate tab 500 mg...........................43CHLOROTHIAZIDE..................................................... 70chlorothiazide tab 500 mg.......................................... 70CHLORPROMAZINE HCL..........................................27CHLORPROMAZINE HCL..........................................27chlorpromazine hcl tab 100 mg..................................28chlorpromazine hcl tab 10 mg....................................27chlorpromazine hcl tab 200 mg..................................28chlorpromazine hcl tab 25 mg....................................28chlorpromazine hcl tab 50 mg....................................28chlorthalidone tab 25 mg............................................ 70chlorthalidone tab 50 mg............................................ 70cholestyramine light powder 4 gm/

dose............................................................................ 70cholestyramine light powder packets 4

gm................................................................................70cholestyramine powder 4 gm/dose............................70cholestyramine powder packets 4 gm.......................70choline fenofibrate cap dr 135 mg............................. 70choline fenofibrate cap dr 45 mg............................... 70chorionic gonadotropin for im inj 10000 unit(chorionic

gonadotropin, pregnyl)...........................................100ciclopirox gel 0.77%.................................................... 29

2018

134

ciclopirox olamine cream 0.77%................................29ciclopirox olamine susp 0.77%...................................29ciclopirox shampoo 1%............................................... 29ciclopirox solution 8%..................................................29cidofovir iv inj 75 mg/ml.............................................. 52cilostazol tab 100 mg.................................................. 63cilostazol tab 50 mg.................................................... 63CILOXAN.....................................................................116cimetidine hcl soln 300 mg/5ml..................................93cimetidine tab 200 mg.................................................93cimetidine tab 300 mg.................................................93cimetidine tab 400 mg.................................................93cimetidine tab 800 mg.................................................93CINRYZE.....................................................................108CIPRO............................................................................10CIPRO............................................................................10CIPRO............................................................................10CIPRO............................................................................10CIPRODEX................................................................. 118CIPROFLOXACIN........................................................10CIPROFLOXACIN........................................................10ciprofloxacin 200 mg/100ml in d5w........................... 10ciprofloxacin 400 mg/200ml in d5w........................... 10ciprofloxacin for oral susp 250 mg/5ml (5%) (5

gm/100ml).................................................................. 10ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml).................................................................. 10CIPROFLOXACIN HCL...............................................10ciprofloxacin hcl ophth soln 0.3%............................ 116ciprofloxacin hcl tab 250 mg.......................................10ciprofloxacin hcl tab 500 mg.......................................10ciprofloxacin hcl tab 750 mg.......................................10ciprofloxacin hcl tab er 24hr 1000 mg....................... 10ciprofloxacin hcl tab er 24hr 500 mg......................... 10CIPRO I.V.-IN D5W..................................................... 10CISPLATIN.................................................................... 34cisplatin inj 100 mg/100ml (1 mg/ml).........................34cisplatin inj 50 mg/50ml (1 mg/ml).............................34citalopram hydrobromide oral soln 10

mg/5ml........................................................................ 23citalopram hydrobromide tab 10 mg..........................23citalopram hydrobromide tab 20 mg..........................23citalopram hydrobromide tab 40 mg..........................23cladribine iv soln 10 mg/10ml (1 mg/

ml)................................................................................34clarithromycin for susp 125 mg/5ml...........................10clarithromycin for susp 250 mg/5ml...........................10clarithromycin tab 250 mg.......................................... 10clarithromycin tab 500 mg.......................................... 10clarithromycin tab er 24hr 500 mg.............................10CLEMASTINE FUMARATE......................................120CLEOCIN.......................................................................10

CLEOCIN.......................................................................10CLEOCIN.......................................................................10CLEOCIN.......................................................................10CLEOCIN IN D5W....................................................... 10CLEOCIN IN D5W....................................................... 10CLEOCIN IN D5W....................................................... 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN PHOSPHATE............................................. 11CLEOCIN-T...................................................................11CLEOCIN-T...................................................................11CLEOCIN-T...................................................................11CLEOCIN-T...................................................................11clindamycin hcl cap 150 mg.......................................11clindamycin hcl cap 300 mg.......................................11clindamycin hcl cap 75 mg......................................... 11clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................87clindamycin phosphate gel 1%.................................. 11clindamycin phosphate in d5w iv soln 300

mg/50ml......................................................................11clindamycin phosphate in d5w iv soln 600

mg/50ml......................................................................11clindamycin phosphate in d5w iv soln 900

mg/50ml......................................................................11clindamycin phosphate inj 300 mg/2ml.....................11clindamycin phosphate inj 600 mg/4ml.....................11clindamycin phosphate inj 900 mg/6ml.....................11clindamycin phosphate inj 9 gm/60ml....................... 11clindamycin phosphate iv soln 300

mg/2ml........................................................................ 11clindamycin phosphate iv soln 600

mg/4ml........................................................................ 11clindamycin phosphate iv soln 900

mg/6ml........................................................................ 11clindamycin phosphate lotion 1%.............................. 11clindamycin phosphate soln 1%................................ 11clindamycin phosphate swab 1%.............................. 11clindamycin phosphate vaginal cream

2%............................................................................... 11clobetasol propionate cream 0.05%..........................87clobetasol propionate emollient base cream

0.05%..........................................................................88clobetasol propionate gel 0.05%................................88clobetasol propionate oint 0.05%.............................. 88

2018

135

clobetasol propionate soln 0.05%..............................88clofarabine iv soln 1 mg/ml.........................................34CLOLAR........................................................................ 34clomipramine hcl cap 25 mg...................................... 23clomipramine hcl cap 50 mg...................................... 23clomipramine hcl cap 75 mg...................................... 23clonazepam orally disintegrating tab 0.125

mg................................................................................57clonazepam orally disintegrating tab 0.25

mg................................................................................57clonazepam orally disintegrating tab 0.5

mg................................................................................57clonazepam orally disintegrating tab 1

mg................................................................................57clonazepam orally disintegrating tab 2

mg................................................................................57clonazepam tab 0.5 mg.............................................. 57clonazepam tab 1 mg..................................................57clonazepam tab 2 mg..................................................57clonidine hcl tab 0.1 mg..............................................70clonidine hcl tab 0.2 mg..............................................70clonidine hcl tab 0.3 mg..............................................70clonidine hcl tab er 12hr 0.1 mg................................ 85clonidine hcl td patch weekly 0.1

mg/24hr...................................................................... 70clonidine hcl td patch weekly 0.2

mg/24hr...................................................................... 70clonidine hcl td patch weekly 0.3

mg/24hr...................................................................... 70clopidogrel bisulfate tab 75 mg..................................63clorazepate dipotassium tab 15 mg...........................57clorazepate dipotassium tab 3.75 mg....................... 57clorazepate dipotassium tab 7.5 mg......................... 57clotrimazole cream 1%................................................29clotrimazole troche 10 mg.......................................... 29clotrimazole w/ betamethasone cream

1-0.05%...................................................................... 88clotrimazole w/ betamethasone lotion

1-0.05%...................................................................... 88clozapine orally disintegrating tab 100

mg................................................................................46clozapine orally disintegrating tab 25

mg................................................................................46clozapine tab 100 mg..................................................46clozapine tab 200 mg..................................................46clozapine tab 25 mg....................................................46clozapine tab 50 mg....................................................46CLOZARIL.....................................................................46CLOZARIL.....................................................................46COARTEM.....................................................................43codeine sulfate tab 15 mg............................................ 1codeine sulfate tab 30 mg............................................ 2

codeine sulfate tab 60 mg............................................ 2COLAZAL....................................................................114colchicine w/ probenecid tab 0.5-500

mg................................................................................31COLCRYS..................................................................... 31COLESTID.................................................................... 70COLESTID.................................................................... 70COLESTID.................................................................... 70COLESTID FLAVORED.............................................. 70COLESTID FLAVORED.............................................. 70colestipol hcl granule packets 5 gm.......................... 70colestipol hcl granules 5 gm.......................................70colestipol hcl tab 1 gm................................................ 70colistimethate sodium for inj 150 mg.........................12COLYTE-FLAVOR PACKS......................................... 93COMBIGAN................................................................ 116COMBIVENT RESPIMAT......................................... 120COMETRIQ...................................................................34COMETRIQ...................................................................34COMETRIQ...................................................................34COMPLERA.................................................................. 52COMTAN....................................................................... 44COPAXONE.................................................................. 85COPAXONE.................................................................. 85COREG..........................................................................70COREG..........................................................................70COREG..........................................................................70COREG..........................................................................70COREG CR...................................................................70COREG CR...................................................................71COREG CR...................................................................71COREG CR...................................................................71CORGARD....................................................................71CORGARD....................................................................71CORGARD....................................................................71CORLANOR..................................................................71CORLANOR..................................................................71CORTEF........................................................................ 99CORTEF........................................................................ 99CORTEF........................................................................ 99CORTISONE ACETATE..............................................99COSENTYX................................................................ 108COSENTYX SENSOREADY PEN.......................... 108COSMEGEN................................................................. 34COSOPT..................................................................... 116COTELLIC.....................................................................34COUMADIN...................................................................63COUMADIN...................................................................63COUMADIN...................................................................63COUMADIN...................................................................63COUMADIN...................................................................63COUMADIN...................................................................63

2018

136

COUMADIN...................................................................63COUMADIN...................................................................63COUMADIN...................................................................63COZAAR........................................................................71COZAAR........................................................................71COZAAR........................................................................71CREON..........................................................................96CREON..........................................................................96CREON..........................................................................96CREON..........................................................................96CREON..........................................................................96CRESEMBA.................................................................. 29CRESEMBA.................................................................. 29CRESTOR.....................................................................71CRESTOR.....................................................................71CRESTOR.....................................................................71CRESTOR.....................................................................71CRIXIVAN......................................................................52CRIXIVAN......................................................................52cromolyn sodium ophth soln 4%..............................116cromolyn sodium oral conc 100

mg/5ml........................................................................ 93cromolyn sodium soln nebu 20

mg/2ml......................................................................120CUBICIN........................................................................12CUBICIN RF................................................................. 12CYCLESSA.................................................................101cyclobenzaprine hcl tab 10 mg................................ 123cyclobenzaprine hcl tab 5 mg.................................. 123cyclobenzaprine hcl tab 7.5 mg...............................123CYCLOPHOSPHAMIDE............................................. 34CYCLOPHOSPHAMIDE............................................. 34cyclophosphamide for inj 1 gm.................................. 34cyclophosphamide for inj 2 gm.................................. 34cyclophosphamide for inj 500 mg..............................34CYCLOSERINE............................................................32CYCLOSET...................................................................58cyclosporine cap 100 mg..........................................109cyclosporine cap 25 mg............................................108cyclosporine iv soln 50 mg/ml..................................109cyclosporine modified cap 100 mg..........................109cyclosporine modified cap 25 mg............................ 109cyclosporine modified cap 50 mg............................ 109cyclosporine modified oral soln 100 mg/

ml...............................................................................109CYKLOKAPRON.......................................................... 63CYMBALTA....................................................................23CYMBALTA....................................................................23CYMBALTA....................................................................23CYRAMZA.....................................................................34CYRAMZA.....................................................................34CYSTADANE................................................................ 96

CYSTAGON.................................................................. 96CYSTAGON.................................................................. 97CYSTARAN.................................................................116CYTARABINE............................................................... 34cytarabine inj pf 100 mg/ml........................................ 35cytarabine inj pf 20 mg/ml.......................................... 35CYTOMEL...................................................................105CYTOMEL...................................................................105CYTOMEL...................................................................105CYTOTEC..................................................................... 93CYTOTEC..................................................................... 94CYTOVENE...................................................................52DDACARBAZINE............................................................ 35dacarbazine for inj 200 mg.........................................35DAKLINZA.....................................................................52DAKLINZA.....................................................................52DAKLINZA.....................................................................52DALIRESP.................................................................. 120DALVANCE................................................................... 12danazol cap 100 mg..................................................101danazol cap 200 mg..................................................101danazol cap 50 mg....................................................101DANTRIUM................................................................... 51DANTRIUM................................................................... 51dantrolene sodium cap 100 mg................................. 51dantrolene sodium cap 25 mg....................................51dantrolene sodium cap 50 mg....................................51dapsone tab 100 mg................................................... 32dapsone tab 25 mg......................................................32DAPTACEL................................................................. 109daptomycin for iv soln 500 mg...................................12DARAPRIM................................................................... 43DARZALEX................................................................... 35DARZALEX................................................................... 35daunorubicin hcl inj 5 mg/ml.......................................35DAYPRO.......................................................................... 2DDAVP.........................................................................100DDAVP.........................................................................100DDAVP.........................................................................100decitabine for inj 50 mg.............................................. 35DELZICOL...................................................................114DEMADEX.....................................................................71demeclocycline hcl tab 150 mg..................................12demeclocycline hcl tab 300 mg..................................12DEMSER....................................................................... 71DENAVIR.......................................................................52DEPACON.....................................................................17DEPAKENE...................................................................17DEPAKOTE...................................................................17DEPAKOTE...................................................................17DEPAKOTE...................................................................17

2018

137

DEPAKOTE ER............................................................ 17DEPAKOTE ER............................................................ 17DEPAKOTE SPRINKLES........................................... 17DEPEN TITRATABS.................................................... 98DEPO-PROVERA...................................................... 101DEPO-PROVERA

CONTRACEPTIVE................................................. 101DEPO-PROVERA

CONTRACEPTIVE................................................. 101DEPO-TESTOSTERONE......................................... 101DEPO-TESTOSTERONE......................................... 101DERMATOP.................................................................. 88DESCOVY.....................................................................52desipramine hcl tab 100 mg.......................................24desipramine hcl tab 10 mg......................................... 24desipramine hcl tab 150 mg.......................................24desipramine hcl tab 25 mg......................................... 24desipramine hcl tab 50 mg......................................... 24desipramine hcl tab 75 mg......................................... 24desloratadine tab 5 mg............................................. 120desmopressin acetate inj 4 mcg/ml.........................100desmopressin acetate nasal soln 0.01%

(refrigerated)............................................................100desmopressin acetate nasal spray soln

0.01%........................................................................100desmopressin acetate nasal spray soln 0.01%

(refrigerated)............................................................100desmopressin acetate tab 0.1 mg........................... 100desmopressin acetate tab 0.2 mg........................... 100DESOGEN.................................................................. 101desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5)...................................................................101desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg............................................................................. 101

desogestrel & ethinyl estradiol tab 0.15 mg-30mcg........................................................................... 101

desonide cream 0.05%............................................... 88desonide lotion 0.05%.................................................88desonide oint 0.05%....................................................88desoximetasone cream 0.05%...................................88desoximetasone cream 0.25%...................................88desoximetasone gel 0.05%........................................ 88desoximetasone oint 0.25%....................................... 88desvenlafaxine succinate tab er 24hr 100

mg................................................................................24desvenlafaxine succinate tab er 24hr 25

mg................................................................................24desvenlafaxine succinate tab er 24hr 50

mg................................................................................24DETROL........................................................................ 98DETROL........................................................................ 98

DETROL LA..................................................................98DETROL LA..................................................................98DEXAMETHASONE.................................................... 99DEXAMETHASONE.................................................... 99dexamethasone elixir 0.5 mg/5ml..............................99DEXAMETHASONE SODIUM

PHOSPHATE...........................................................116dexamethasone sodium phosphate inj 120

mg/30ml......................................................................99dexamethasone sodium phosphate inj 20

mg/5ml........................................................................ 99dexamethasone sodium phosphate inj 4 mg/

ml.................................................................................99dexamethasone tab 0.5 mg........................................99dexamethasone tab 0.75 mg......................................99dexamethasone tab 1.5 mg........................................99dexamethasone tab 4 mg...........................................99dexamethasone tab 6 mg...........................................99DEXEDRINE................................................................. 85DEXEDRINE................................................................. 85DEXEDRINE................................................................. 85dexmethylphenidate hcl tab 10 mg............................85dexmethylphenidate hcl tab 2.5 mg...........................85dexmethylphenidate hcl tab 5 mg..............................85dexrazoxane for inj 250 mg........................................35dexrazoxane for inj 500 mg........................................35dextroamphetamine sulfate cap er 24hr 10

mg................................................................................85dextroamphetamine sulfate cap er 24hr 15

mg................................................................................86dextroamphetamine sulfate cap er 24hr 5

mg................................................................................85dextroamphetamine sulfate tab 10 mg......................86dextroamphetamine sulfate tab 5 mg........................86dextrose 2.5% w/ sodium chloride

0.45%..........................................................................91dextrose 5% in lactated ringers................................. 91dextrose 5% w/ sodium chloride 0.2%...................... 91dextrose 5% w/ sodium chloride

0.33%..........................................................................91dextrose 5% w/ sodium chloride

0.45%..........................................................................91dextrose 5% w/ sodium chloride 0.9%...................... 91dextrose inj 10%.......................................................... 91dextrose inj 5%.............................................................91DIAMOX.........................................................................71DIASTAT ACUDIAL......................................................17DIASTAT ACUDIAL......................................................17DIASTAT PEDIATRIC..................................................18DIAZEPAM.................................................................... 57diazepam conc 5 mg/ml..............................................58DIAZEPAM RECTAL GEL.......................................... 18

2018

138

DIAZEPAM RECTAL GEL.......................................... 18DIAZEPAM RECTAL GEL.......................................... 18diazepam tab 10 mg....................................................58diazepam tab 2 mg......................................................58diazepam tab 5 mg......................................................58diclofenac potassium tab 50 mg.................................. 2diclofenac sodium gel 1%.............................................2diclofenac sodium gel 3%...........................................88diclofenac sodium ophth soln 0.1%.........................116diclofenac sodium tab delayed release 25

mg..................................................................................2diclofenac sodium tab delayed release 50

mg..................................................................................2diclofenac sodium tab delayed release 75

mg..................................................................................2diclofenac sodium tab er 24hr 100 mg........................2diclofenac w/ misoprostol tab delayed release 50-0.2

mg..................................................................................2diclofenac w/ misoprostol tab delayed release 75-0.2

mg..................................................................................2dicloxacillin sodium cap 250 mg................................ 12dicloxacillin sodium cap 500 mg................................ 12dicyclomine hcl cap 10 mg......................................... 94dicyclomine hcl tab 20 mg..........................................94didanosine delayed release capsule 125

mg................................................................................52didanosine delayed release capsule 200



mg................................................................................52DIFICID..........................................................................12DIFLORASONE DIACETATE.....................................88DIFLUCAN.................................................................... 29DIFLUCAN.................................................................... 29DIFLUCAN.................................................................... 29DIFLUCAN.................................................................... 29DIFLUCAN.................................................................... 29DIFLUCAN.................................................................... 29DIGOXIN........................................................................71digoxin tab 125 mcg (0.125 mg)................................71digoxin tab 250 mcg (0.25 mg).................................. 71DILANTIN...................................................................... 18DILANTIN...................................................................... 18DILANTIN-125.............................................................. 18DILANTIN INFATABS.................................................. 18diltiazem hcl cap er 12hr 120 mg.............................. 71diltiazem hcl cap er 12hr 60 mg.................................71diltiazem hcl cap er 12hr 90 mg.................................71diltiazem hcl cap er 24hr 120 mg.............................. 71diltiazem hcl cap er 24hr 180 mg.............................. 71

diltiazem hcl cap er 24hr 240 mg.............................. 71diltiazem hcl coated beads cap er 24hr 120

mg................................................................................71diltiazem hcl coated beads cap er 24hr 180




mg................................................................................71diltiazem hcl coated beads tab er 24hr 180





mg................................................................................71diltiazem hcl extended release beads cap er 24hr

120 mg....................................................................... 71diltiazem hcl extended release beads cap er 24hr





420 mg....................................................................... 72diltiazem hcl tab 120 mg.............................................72diltiazem hcl tab 30 mg...............................................72diltiazem hcl tab 60 mg...............................................72diltiazem hcl tab 90 mg...............................................72DIOVAN......................................................................... 72DIOVAN......................................................................... 72DIOVAN......................................................................... 72DIOVAN......................................................................... 72DIOVAN HCT................................................................72DIOVAN HCT................................................................72DIOVAN HCT................................................................72DIOVAN HCT................................................................72DIOVAN HCT................................................................72DIPENTUM................................................................. 114diphenhydramine hcl inj 50 mg/ml...........................120DIPHTHERIA/TETANUS TOXOIDS

ADSORBED.............................................................109DIPROLENE................................................................. 88DIPROLENE AF...........................................................88

2018

139

dipyridamole tab 25 mg.............................................. 63dipyridamole tab 50 mg.............................................. 63dipyridamole tab 75 mg.............................................. 63disulfiram tab 250 mg....................................................6disulfiram tab 500 mg....................................................6DITROPAN XL..............................................................98DITROPAN XL..............................................................98DITROPAN XL..............................................................98divalproex sodium cap delayed release sprinkle 125

mg................................................................................18divalproex sodium tab delayed release 125



mg................................................................................18divalproex sodium tab er 24 hr 250 mg.....................18divalproex sodium tab er 24 hr 500 mg.....................18DIVIGEL...................................................................... 101DIVIGEL...................................................................... 101DIVIGEL...................................................................... 101DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35DOCETAXEL.................................................................35docetaxel for inj conc 20 mg/ml................................. 35docetaxel for inj conc 80 mg/4ml (20 mg/

ml)................................................................................35dofetilide cap 125 mcg (0.125 mg)............................72dofetilide cap 250 mcg (0.25 mg).............................. 72dofetilide cap 500 mcg (0.5 mg)................................ 72DOLOPHINE................................................................... 2DOLOPHINE................................................................... 2donepezil hydrochloride orally disintegrating tab 10

mg................................................................................22donepezil hydrochloride orally disintegrating tab 5

mg................................................................................22donepezil hydrochloride tab 10 mg........................... 22donepezil hydrochloride tab 23 mg........................... 22donepezil hydrochloride tab 5 mg..............................22dorzolamide hcl ophth soln 2%................................116dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml........................................................................ 116DOVONEX.................................................................... 88doxazosin mesylate tab 1 mg.................................... 72doxazosin mesylate tab 2 mg.................................... 72doxazosin mesylate tab 4 mg.................................... 72doxazosin mesylate tab 8 mg.................................... 72

doxepin hcl cap 100 mg..............................................24doxepin hcl cap 10 mg................................................24doxepin hcl cap 150 mg..............................................24doxepin hcl cap 25 mg................................................24doxepin hcl cap 50 mg................................................24doxepin hcl cap 75 mg................................................24doxepin hcl conc 10 mg/ml.........................................24DOXORUBICIN HCL...................................................35DOXORUBICIN HCL...................................................35doxorubicin hcl inj 2 mg/ml.........................................35doxorubicin hcl liposomal inj (for iv infusion) 2 mg/

ml.................................................................................35doxycycline hyclate cap 100 mg................................12doxycycline hyclate cap 50 mg..................................12doxycycline hyclate for inj 100 mg.............................12doxycycline hyclate tab 100 mg.................................12doxycycline hyclate tab 20 mg...................................12doxycycline monohydrate cap 100 mg......................12doxycycline monohydrate cap 150 mg......................12doxycycline monohydrate cap 50 mg........................12doxycycline monohydrate cap 75 mg........................12doxycycline monohydrate tab 100 mg...................... 12doxycycline monohydrate tab 150 mg...................... 12doxycycline monohydrate tab 50 mg.........................12doxycycline monohydrate tab 75 mg.........................12dronabinol cap 10 mg................................................. 28dronabinol cap 2.5 mg................................................ 28dronabinol cap 5 mg....................................................28drospirenone-ethinyl estradiol tab 3-0.02

mg............................................................................. 101drospirenone-ethinyl estradiol tab 3-0.03

mg............................................................................. 102drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg..................................................... 101DULERA......................................................................120DULERA......................................................................120duloxetine hcl enteric coated pellets cap 20

mg................................................................................24duloxetine hcl enteric coated pellets cap 30

mg................................................................................24duloxetine hcl enteric coated pellets cap 60

mg................................................................................24DUREZOL................................................................... 116dutasteride cap 0.5 mg............................................... 98dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................98DYAZIDE....................................................................... 72EE.E.S. GRANULES......................................................12EC-NAPROSYN............................................................. 2EC-NAPROSYN............................................................. 2

2018

140

econazole nitrate cream 1%.......................................29EDURANT..................................................................... 52EFFEXOR XR...............................................................24EFFEXOR XR...............................................................24EFFEXOR XR...............................................................24EFFIENT........................................................................63EFFIENT........................................................................63EGRIFTA..................................................................... 100EGRIFTA..................................................................... 100ELAPRASE................................................................... 97ELDEPRYL....................................................................44ELELYSO.......................................................................97ELIDEL...........................................................................88ELIGARD.....................................................................106ELIGARD.....................................................................106ELIGARD.....................................................................106ELIGARD.....................................................................106ELIQUIS.........................................................................63ELIQUIS.........................................................................63ELITEK...........................................................................35ELITEK...........................................................................35ELLA............................................................................ 102ELOCON........................................................................88ELOCON........................................................................88EMCYT.......................................................................... 35EMEND..........................................................................28EMEND..........................................................................28EMEND..........................................................................28EMEND..........................................................................28EMEND TRIPACK........................................................28EMPLICITI.....................................................................35EMPLICITI.....................................................................35EMSAM..........................................................................24EMSAM..........................................................................24EMSAM..........................................................................24EMTRIVA.......................................................................52EMTRIVA.......................................................................52enalapril maleate & hydrochlorothiazide tab 10-25

mg................................................................................72enalapril maleate & hydrochlorothiazide tab 5-12.5

mg................................................................................72enalapril maleate tab 10 mg.......................................72enalapril maleate tab 2.5 mg......................................72enalapril maleate tab 20 mg.......................................72enalapril maleate tab 5 mg.........................................72ENBREL...................................................................... 109ENBREL...................................................................... 109ENBREL...................................................................... 109ENBREL MINI............................................................ 109ENBREL SURECLICK.............................................. 109ENGERIX-B................................................................ 109ENGERIX-B................................................................ 109

enoxaparin sodium inj 100 mg/ml..............................64enoxaparin sodium inj 120 mg/0.8ml........................ 64enoxaparin sodium inj 150 mg/ml..............................64enoxaparin sodium inj 300 mg/3ml............................64enoxaparin sodium inj 30 mg/0.3ml...........................63enoxaparin sodium inj 40 mg/0.4ml...........................63enoxaparin sodium inj 60 mg/0.6ml...........................63enoxaparin sodium inj 80 mg/0.8ml...........................64entacapone tab 200 mg..............................................44entecavir tab 0.5 mg....................................................53entecavir tab 1 mg.......................................................53ENTRESTO...................................................................72ENTRESTO...................................................................72ENTRESTO...................................................................72EPCLUSA......................................................................53epinastine hcl ophth soln 0.05%..............................116EPINEPHRINE........................................................... 120EPINEPHRINE........................................................... 120EPIPEN 2-PAK...........................................................120EPIPEN-JR 2-PAK.....................................................120epirubicin hcl iv soln 200 mg/100ml (2 mg/

ml)................................................................................35epirubicin hcl iv soln 50 mg/25ml (2 mg/

ml)................................................................................35EPIVIR........................................................................... 53EPIVIR........................................................................... 53EPIVIR........................................................................... 53EPIVIR HBV..................................................................53EPIVIR HBV..................................................................53eplerenone tab 25 mg.................................................72eplerenone tab 50 mg.................................................72EPOGEN....................................................................... 64EPOGEN....................................................................... 64EPOGEN....................................................................... 64EPOGEN....................................................................... 64EPOGEN....................................................................... 64EPZICOM...................................................................... 53ERBITUX....................................................................... 35ERBITUX....................................................................... 35ERGOLOID MESYLATES...........................................22ERIVEDGE....................................................................35ERWINAZE................................................................... 35ERYPED 200................................................................12ERYPED 400................................................................12ERY-TAB....................................................................... 12ERY-TAB....................................................................... 12ERY-TAB....................................................................... 12ERYTHROCIN LACTOBIONATE...............................12ERYTHROCIN STEARATE........................................ 12ERYTHROMYCIN BASE............................................ 12ERYTHROMYCIN BASE............................................ 12

2018

141

erythromycin ethylsuccinate for susp 200mg/5ml........................................................................ 12

erythromycin ophth oint 5 mg/gm............................ 116erythromycin pads 2%.................................................12erythromycin soln 2%..................................................12ESBRIET..................................................................... 120ESBRIET..................................................................... 120ESBRIET..................................................................... 120escitalopram oxalate soln 5 mg/5ml..........................24escitalopram oxalate tab 10 mg.................................24escitalopram oxalate tab 20 mg.................................24escitalopram oxalate tab 5 mg...................................24esomeprazole magnesium cap delayed release 20

mg................................................................................94esomeprazole magnesium cap delayed release 40

mg................................................................................94ESOMEPRAZOLE SODIUM...................................... 94esomeprazole sodium for intravenous soln 40

mg................................................................................94ESTRACE................................................................... 102estradiol & norethindrone acetate tab 0.5-0.1

mg............................................................................. 102estradiol & norethindrone acetate tab 1-0.5

mg............................................................................. 102estradiol tab 0.5 mg...................................................102estradiol tab 1 mg......................................................102estradiol tab 2 mg......................................................102estradiol td patch weekly 0.025

mg/24hr.................................................................... 102estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr).................................................................102estradiol td patch weekly 0.05

mg/24hr.................................................................... 102estradiol td patch weekly 0.06

mg/24hr.................................................................... 102estradiol td patch weekly 0.075

mg/24hr.................................................................... 102estradiol td patch weekly 0.1 mg/24hr.................... 102estradiol vaginal tab 10 mcg.................................... 102ESTROPIPATE...........................................................102ESTROPIPATE...........................................................102ESTROPIPATE...........................................................102ESTROSTEP FE........................................................102ethambutol hcl tab 100 mg.........................................32ethambutol hcl tab 400 mg.........................................32ethosuximide cap 250 mg...........................................18ethosuximide soln 250 mg/5ml.................................. 18ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg........................................................................... 102ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg........................................................................... 102ETHYOL........................................................................ 35

ETIDRONATE DISODIUM........................................114ETIDRONATE DISODIUM........................................114etodolac cap 200 mg.....................................................2etodolac cap 300 mg.....................................................2etodolac tab 400 mg......................................................2etodolac tab 500 mg......................................................2etodolac tab er 24hr 400 mg........................................ 2etodolac tab er 24hr 500 mg........................................ 2etodolac tab er 24hr 600 mg........................................ 2ETOPOPHOS............................................................... 35etoposide inj 100 mg/5ml (20 mg/ml)........................36etoposide inj 1 gm/50ml (20 mg/ml).......................... 36etoposide inj 500 mg/25ml (20 mg/ml)......................36EVISTA........................................................................ 102EVOMELA..................................................................... 36EVOTAZ.........................................................................53EXELON........................................................................ 22EXELON........................................................................ 22EXELON........................................................................ 22exemestane tab 25 mg............................................... 36EXFORGE.....................................................................72EXFORGE.....................................................................73EXFORGE.....................................................................73EXFORGE.....................................................................73EXFORGE HCT........................................................... 73EXFORGE HCT........................................................... 73EXFORGE HCT........................................................... 73EXFORGE HCT........................................................... 73EXFORGE HCT........................................................... 73EXJADE.........................................................................91EXJADE.........................................................................91EXJADE.........................................................................91ezetimibe-simvastatin tab 10-10 mg..........................73ezetimibe-simvastatin tab 10-20 mg..........................73ezetimibe-simvastatin tab 10-40 mg..........................73ezetimibe-simvastatin tab 10-80 mg..........................73ezetimibe tab 10 mg....................................................73FFABRAZYME................................................................ 97FABRAZYME................................................................ 97famciclovir tab 125 mg................................................53famciclovir tab 250 mg................................................53famciclovir tab 500 mg................................................53famotidine for susp 40 mg/5ml...................................94famotidine inj 200 mg/20ml........................................ 94famotidine inj 20 mg/2ml.............................................94famotidine inj 40 mg/4ml.............................................94famotidine tab 20 mg...................................................94famotidine tab 40 mg...................................................94FANAPT.........................................................................46FANAPT.........................................................................46

2018

142

FANAPT.........................................................................46FANAPT.........................................................................46FANAPT.........................................................................46FANAPT.........................................................................46FANAPT.........................................................................46FANAPT TITRATION PACK....................................... 46FARESTON...................................................................36FARYDAK......................................................................36FARYDAK......................................................................36FARYDAK......................................................................36FASLODEX................................................................... 36fat emulsion iv soln 20%.............................................91FAZACLO...................................................................... 46FAZACLO...................................................................... 46felbamate susp 600 mg/5ml....................................... 18felbamate tab 400 mg................................................. 18felbamate tab 600 mg................................................. 18FELDENE........................................................................ 2FELDENE........................................................................ 2felodipine tab er 24hr 10 mg...................................... 73felodipine tab er 24hr 2.5 mg..................................... 73felodipine tab er 24hr 5 mg........................................ 73FEMARA........................................................................36fenofibrate micronized cap 130 mg........................... 73fenofibrate micronized cap 134 mg........................... 73fenofibrate micronized cap 200 mg........................... 73fenofibrate micronized cap 43 mg............................. 73fenofibrate micronized cap 67 mg............................. 73fenofibrate tab 145 mg................................................73fenofibrate tab 160 mg................................................73fenofibrate tab 48 mg.................................................. 73fenofibrate tab 54 mg.................................................. 73fentanyl citrate lozenge on a handle 1200

mcg................................................................................2fentanyl citrate lozenge on a handle 1600





mcg................................................................................2fentanyl td patch 72hr 100 mcg/hr...............................2fentanyl td patch 72hr 12 mcg/hr................................. 2fentanyl td patch 72hr 25 mcg/hr................................. 2fentanyl td patch 72hr 50 mcg/hr................................. 2fentanyl td patch 72hr 75 mcg/hr................................. 2FETZIMA....................................................................... 24FETZIMA....................................................................... 24FETZIMA....................................................................... 24

FETZIMA....................................................................... 24FETZIMA TITRATION PACK......................................24FINACEA....................................................................... 88FINACEA....................................................................... 88finasteride tab 5 mg.....................................................98FIRAZYR..................................................................... 109FIRMAGON.................................................................106FIRMAGON.................................................................106FLAGYL......................................................................... 13FLAGYL......................................................................... 13FLAGYL......................................................................... 13flecainide acetate tab 100 mg....................................73flecainide acetate tab 150 mg....................................73flecainide acetate tab 50 mg...................................... 73FLOMAX........................................................................98FLOVENT DISKUS....................................................121FLOVENT DISKUS....................................................121FLOVENT DISKUS....................................................121FLOVENT HFA...........................................................121FLOVENT HFA...........................................................121FLOVENT HFA...........................................................121fluconazole for susp 10 mg/ml................................... 29fluconazole for susp 40 mg/ml................................... 29fluconazole in dextrose inj 200

mg/100ml....................................................................29fluconazole in dextrose inj 400

mg/200ml....................................................................29fluconazole in nacl 0.9% inj 200

mg/100ml....................................................................29fluconazole in nacl 0.9% inj 400

mg/200ml....................................................................29fluconazole tab 100 mg...............................................29fluconazole tab 150 mg...............................................29fluconazole tab 200 mg...............................................30fluconazole tab 50 mg.................................................29flucytosine cap 250 mg............................................... 30flucytosine cap 500 mg............................................... 30fludarabine phosphate for inj 50 mg..........................36fludarabine phosphate inj 25 mg/ml.......................... 36fludrocortisone acetate tab 0.1 mg............................ 99fluocinolone acetonide (otic) oil

0.01%........................................................................118fluocinolone acetonide cream 0.01%........................ 88fluocinonide cream 0.05%.......................................... 88fluocinonide emulsified base cream

0.05%..........................................................................88fluocinonide gel 0.05%................................................88fluocinonide oint 0.05%...............................................88fluocinonide soln 0.05%..............................................88fluorometholone ophth susp 0.1%...........................116fluorouracil cream 5%................................................. 88fluorouracil inj 1 gm/20ml (50 mg/ml)........................36

2018

143

fluorouracil inj 2.5 gm/50ml (50 mg/ml).....................36fluorouracil inj 500 mg/10ml (50 mg/

ml)................................................................................36fluorouracil inj 5 gm/100ml (50 mg/ml)......................36fluorouracil soln 2%..................................................... 88fluorouracil soln 5%..................................................... 88FLUOXETINE DR........................................................ 24fluoxetine hcl cap 10 mg.............................................24fluoxetine hcl cap 20 mg.............................................24fluoxetine hcl cap 40 mg.............................................25fluoxetine hcl solution 20 mg/5ml.............................. 25fluoxetine hcl tab 10 mg..............................................25fluoxetine hcl tab 20 mg..............................................25fluphenazine decanoate inj 25 mg/ml........................47FLUPHENAZINE HCL.................................................47FLUPHENAZINE HCL.................................................47FLUPHENAZINE HCL.................................................47fluphenazine hcl tab 10 mg........................................ 47fluphenazine hcl tab 1 mg.......................................... 47fluphenazine hcl tab 2.5 mg....................................... 47fluphenazine hcl tab 5 mg.......................................... 47flurbiprofen sodium ophth soln 0.03%.....................116flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................36FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 121FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 121FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 121fluticasone propionate cream 0.05%.........................88fluticasone propionate nasal susp 50 mcg/

act..............................................................................121fluticasone propionate oint 0.005%........................... 88fluvoxamine maleate tab 100 mg...............................25fluvoxamine maleate tab 25 mg.................................25fluvoxamine maleate tab 50 mg.................................25FML LIQUIFILM......................................................... 116FOCALIN....................................................................... 86FOCALIN....................................................................... 86FOCALIN....................................................................... 86FOLOTYN......................................................................36FOLOTYN......................................................................36fomepizole inj 1 gm/ml (for iv infusion)......................91fondaparinux sodium subcutaneous inj 10

mg/0.8ml.....................................................................64fondaparinux sodium subcutaneous inj 2.5

mg/0.5ml.....................................................................64fondaparinux sodium subcutaneous inj 5

mg/0.4ml.....................................................................64

fondaparinux sodium subcutaneous inj 7.5mg/0.6ml.....................................................................64

FORTAZ.........................................................................13FORTAZ.........................................................................13FORTAZ.........................................................................13FORTAZ.........................................................................13FORTAZ.........................................................................13FORTAZ.........................................................................13FORTAZ.........................................................................13FORTEO......................................................................114FOSAMAX...................................................................114fosamprenavir calcium tab 700 mg........................... 53fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................73fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................73fosinopril sodium tab 10 mg....................................... 73fosinopril sodium tab 20 mg....................................... 73fosinopril sodium tab 40 mg....................................... 73fosphenytoin sodium inj 100 mg/2ml.........................18fosphenytoin sodium inj 500 mg/10ml.......................18FOSRENOL.................................................................. 91FOSRENOL.................................................................. 91FOSRENOL.................................................................. 91FOSRENOL.................................................................. 91FOSRENOL.................................................................. 91furosemide inj 10 mg/ml..............................................73furosemide oral soln 10 mg/ml...................................74furosemide tab 20 mg................................................. 74furosemide tab 40 mg................................................. 74furosemide tab 80 mg................................................. 74FUZEON........................................................................53FYCOMPA.....................................................................18FYCOMPA.....................................................................18FYCOMPA.....................................................................18FYCOMPA.....................................................................18FYCOMPA.....................................................................18FYCOMPA.....................................................................18FYCOMPA.....................................................................18Ggabapentin cap 100 mg.............................................. 18gabapentin cap 300 mg.............................................. 18gabapentin cap 400 mg.............................................. 18gabapentin oral soln 250 mg/5ml.............................. 18gabapentin tab 600 mg............................................... 18gabapentin tab 800 mg............................................... 18GABITRIL...................................................................... 18GABITRIL...................................................................... 19GABITRIL...................................................................... 19GABITRIL...................................................................... 19GALANTAMINE HYDROBROMIDE.......................... 22

2018

144

galantamine hydrobromide cap er 24hr 16mg................................................................................22



galantamine hydrobromide tab 12 mg...................... 22galantamine hydrobromide tab 4 mg.........................22galantamine hydrobromide tab 8 mg.........................22GAMMAGARD LIQUID............................................. 109GAMMAGARD LIQUID............................................. 109GAMMAGARD LIQUID............................................. 109GAMMAGARD LIQUID............................................. 109GAMMAGARD LIQUID............................................. 109GAMMAGARD LIQUID............................................. 109GAMMAGARD S/D....................................................109GAMMAGARD S/D....................................................109GAMMAPLEX.............................................................109GAMMAPLEX.............................................................109GAMMAPLEX.............................................................109GAMMAPLEX.............................................................109GAMMAPLEX.............................................................110GAMMAPLEX.............................................................110GAMUNEX-C..............................................................110GAMUNEX-C..............................................................110GAMUNEX-C..............................................................110GAMUNEX-C..............................................................110GAMUNEX-C..............................................................110GAMUNEX-C..............................................................110ganciclovir sodium for inj 500 mg.............................. 53GARDASIL 9.............................................................. 110GARDASIL 9.............................................................. 110GATTEX.........................................................................94GAUZE PADS 2" X 2".................................................58GAZYVA.........................................................................36gemcitabine hcl for inj 1 gm....................................... 36gemcitabine hcl for inj 200 mg...................................36gemcitabine hcl for inj 2 gm....................................... 36gemcitabine hcl inj 1 gm/26.3ml (38 mg/

ml)................................................................................36gemcitabine hcl inj 200 mg/5.26ml (38 mg/

ml)................................................................................36gemcitabine hcl inj 2 gm/52.6ml (38 mg/

ml)................................................................................36gemfibrozil tab 600 mg............................................... 74gentamicin in saline inj 0.8 mg/ml............................. 13gentamicin in saline inj 1.2 mg/ml............................. 13gentamicin in saline inj 1.6 mg/ml............................. 13gentamicin in saline inj 1 mg/ml.................................13GENTAMICIN SULFATE............................................. 88gentamicin sulfate cream 0.1%..................................89gentamicin sulfate inj 10 mg/ml................................. 13

gentamicin sulfate inj 40 mg/ml................................. 13gentamicin sulfate iv soln 10 mg/ml.......................... 13gentamicin sulfate ophth oint 0.3%......................... 116gentamicin sulfate ophth soln 0.3%........................ 116GENVOYA.....................................................................53GEODON.......................................................................47GEODON.......................................................................47GEODON.......................................................................47GEODON.......................................................................47GEODON.......................................................................47GILOTRIF......................................................................36GILOTRIF......................................................................36GILOTRIF......................................................................36glatiramer acetate soln prefilled syringe 20 mg/

ml.................................................................................86glatiramer acetate soln prefilled syringe 40 mg/

ml.................................................................................86GLEEVEC......................................................................36GLEEVEC......................................................................36GLEOSTINE..................................................................36GLEOSTINE..................................................................36GLEOSTINE..................................................................36GLEOSTINE..................................................................36glimepiride tab 1 mg....................................................58glimepiride tab 2 mg....................................................59glimepiride tab 4 mg....................................................59glipizide-metformin hcl tab 2.5-250 mg.....................59glipizide-metformin hcl tab 2.5-500 mg.....................59glipizide-metformin hcl tab 5-500 mg........................ 59glipizide tab 10 mg...................................................... 59glipizide tab 5 mg.........................................................59glipizide tab er 24hr 10 mg.........................................59glipizide tab er 24hr 2.5 mg........................................59glipizide tab er 24hr 5 mg...........................................59GLUCAGEN HYPOKIT............................................... 59GLUCAGON EMERGENCY KIT............................... 59GLUCOPHAGE............................................................ 59GLUCOPHAGE............................................................ 59GLUCOPHAGE............................................................ 59GLUCOPHAGE XR..................................................... 59GLUCOPHAGE XR..................................................... 59GLUCOTROL................................................................59GLUCOTROL................................................................59GLUCOTROL XL......................................................... 59GLUCOTROL XL......................................................... 59GLUCOTROL XL......................................................... 59glycopyrrolate tab 1 mg.............................................. 94glycopyrrolate tab 2 mg.............................................. 94GOLYTELY....................................................................94GOLYTELY....................................................................94granisetron hcl inj 1 mg/ml......................................... 28granisetron hcl inj 4 mg/4ml (1 mg/ml)......................28

2018

145

granisetron hcl tab 1 mg.............................................28GRANIX......................................................................... 64GRANIX......................................................................... 64GRASTEK................................................................... 121griseofulvin microsize susp 125

mg/5ml........................................................................ 30griseofulvin ultramicrosize tab 125 mg......................30griseofulvin ultramicrosize tab 250 mg......................30GRIS-PEG.....................................................................30GRIS-PEG.....................................................................30GUANIDINE HCL.........................................................32HH.P. ACTHAR............................................................... 99HAEGARDA................................................................110HAEGARDA................................................................110HALAVEN...................................................................... 36HALDOL........................................................................ 47HALDOL DECANOATE 100.......................................47HALDOL DECANOATE 50......................................... 47halobetasol propionate cream 0.05%........................89halobetasol propionate oint 0.05%............................ 89haloperidol decanoate im soln 100 mg/

ml.................................................................................47haloperidol decanoate im soln 50 mg/

ml.................................................................................47haloperidol lactate inj 5 mg/ml................................... 47haloperidol lactate oral conc 2 mg/ml........................47haloperidol tab 0.5 mg................................................ 47haloperidol tab 10 mg................................................. 47haloperidol tab 1 mg....................................................47haloperidol tab 20 mg................................................. 47haloperidol tab 2 mg....................................................47haloperidol tab 5 mg....................................................47HARVONI...................................................................... 53HAVRIX........................................................................110HAVRIX........................................................................110heparin sodium (porcine) 40 unit/ml in

d5w..............................................................................64heparin sodium (porcine) inj 10000 unit/

ml.................................................................................64heparin sodium (porcine) inj 1000 unit/



ml.................................................................................64heparin sodium (porcine) pf inj 5000

unit/0.5ml....................................................................64HEPATAMINE............................................................... 91HERCEPTIN................................................................. 37HERCEPTIN................................................................. 37

HETLIOZ..................................................................... 124HEXALEN......................................................................37HIBERIX...................................................................... 110HIPREX..........................................................................13HUMALOG.................................................................... 59HUMALOG.................................................................... 59HUMALOG JUNIOR KWIKPEN.................................59HUMALOG KWIKPEN.................................................59HUMALOG KWIKPEN.................................................59HUMALOG MIX 50/50.................................................59HUMALOG MIX 50/50 KWIKPEN............................. 59HUMALOG MIX 75/25.................................................59HUMALOG MIX 75/25 KWIKPEN............................. 59HUMIRA...................................................................... 110HUMIRA...................................................................... 110HUMIRA...................................................................... 110HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.....................................................110HUMIRA PEN.............................................................110HUMIRA PEN-CROHNS DISEASE

STARTER.................................................................110HUMIRA PEN-PSORIASIS

STARTER.................................................................110HUMULIN 70/30...........................................................60HUMULIN 70/30 KWIKPEN....................................... 60HUMULIN N..................................................................59HUMULIN N KWIKPEN.............................................. 59HUMULIN R..................................................................60HUMULIN R U-500 (CONCENTRATE).....................60HUMULIN R U-500 KWIKPEN...................................60hydralazine hcl tab 100 mg........................................ 74hydralazine hcl tab 10 mg.......................................... 74hydralazine hcl tab 25 mg.......................................... 74hydralazine hcl tab 50 mg.......................................... 74HYDREA........................................................................37hydrochlorothiazide cap 12.5 mg...............................74hydrochlorothiazide tab 12.5 mg................................74hydrochlorothiazide tab 25 mg...................................74hydrochlorothiazide tab 50 mg...................................74hydrocodone-acetaminophen soln 7.5-325

mg/15ml........................................................................ 2hydrocodone-acetaminophen tab 10-300

mg..................................................................................3hydrocodone-acetaminophen tab 10-325



mg..................................................................................3hydrocodone-acetaminophen tab 7.5-300

mg..................................................................................3

2018

146

hydrocodone-acetaminophen tab 7.5-325mg..................................................................................3

hydrocodone-ibuprofen tab 10-200 mg.......................3hydrocodone-ibuprofen tab 5-200 mg......................... 3hydrocodone-ibuprofen tab 7.5-200 mg......................3hydrocortisone butyrate cream 0.1%........................ 89hydrocortisone butyrate oint 0.1%.............................89hydrocortisone butyrate soln 0.1%............................ 89hydrocortisone cream 1%...........................................89hydrocortisone cream 2.5%........................................89hydrocortisone enema 100 mg/60ml.......................114hydrocortisone lotion 2.5%......................................... 89hydrocortisone oint 1%............................................... 89hydrocortisone oint 2.5%............................................ 89hydrocortisone rectal cream 1%.............................. 114hydrocortisone rectal cream 2.5%...........................114hydrocortisone tab 10 mg...........................................99hydrocortisone tab 20 mg...........................................99hydrocortisone tab 5 mg............................................. 99hydrocortisone valerate cream 0.2%.........................89hydrocortisone valerate oint 0.2%............................. 89hydrocortisone w/ acetic acid otic soln

1-2%..........................................................................118hydromorphone hcl liqd 1 mg/ml..................................3hydromorphone hcl preservative free inj 10 mg/

ml................................................................................... 3hydromorphone hcl tab 2 mg....................................... 3hydromorphone hcl tab 4 mg....................................... 3hydromorphone hcl tab 8 mg....................................... 3hydroxychloroquine sulfate tab 200 mg.................... 43HYDROXYPROGESTERONE

CAPROATE............................................................. 102hydroxyurea cap 500 mg............................................ 37hydroxyzine hcl syrup 10 mg/5ml.............................. 58hydroxyzine hcl tab 10 mg..........................................58hydroxyzine hcl tab 25 mg..........................................58hydroxyzine hcl tab 50 mg..........................................58HYZAAR........................................................................ 74HYZAAR........................................................................ 74HYZAAR........................................................................ 74Iibandronate sodium iv soln 3 mg/3ml..................... 114ibandronate sodium tab 150 mg..............................114IBRANCE.......................................................................37IBRANCE.......................................................................37IBRANCE.......................................................................37ibuprofen susp 100 mg/5ml.......................................... 3ibuprofen tab 400 mg.................................................... 3ibuprofen tab 600 mg.................................................... 3ibuprofen tab 800 mg.................................................... 3ICLUSIG........................................................................ 37

ICLUSIG........................................................................ 37idarubicin hcl iv inj 10 mg/10ml (1 mg/

ml)................................................................................37idarubicin hcl iv inj 20 mg/20ml (1 mg/

ml)................................................................................37idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................37IDHIFA............................................................................37IDHIFA............................................................................37IFEX............................................................................... 37IFOSFAMIDE................................................................ 37ifosfamide for inj 1 gm.................................................37ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 37ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 37ILARIS..........................................................................110ILARIS..........................................................................110ILEVRO........................................................................116imatinib mesylate tab 100 mg.................................... 37imatinib mesylate tab 400 mg.................................... 37IMBRUVICA.................................................................. 37IMFINZI..........................................................................37IMFINZI..........................................................................37imipenem-cilastatin intravenous for soln 250

mg................................................................................13imipenem-cilastatin intravenous for soln 500

mg................................................................................13imipramine hcl tab 10 mg........................................... 25imipramine hcl tab 25 mg........................................... 25imipramine hcl tab 50 mg........................................... 25imiquimod cream 5%...................................................89IMITREX........................................................................ 31IMITREX........................................................................ 31IMITREX........................................................................ 31IMITREX........................................................................ 31IMITREX........................................................................ 31IMITREX........................................................................ 31IMITREX STATDOSE REFILL....................................31IMITREX STATDOSE REFILL....................................31IMITREX STATDOSE SYSTEM.................................31IMITREX STATDOSE SYSTEM.................................31IMLYGIC........................................................................ 37IMLYGIC........................................................................ 37IMOVAX RABIES (H.D.C.V.).................................... 110IMURAN...................................................................... 110INCRELEX.................................................................. 100INCRUSE ELLIPTA................................................... 121indapamide tab 1.25 mg............................................. 74indapamide tab 2.5 mg............................................... 74INDERAL LA.................................................................74INDERAL LA.................................................................74INDERAL LA.................................................................74INDERAL LA.................................................................74INFANRIX....................................................................110

2018

147

INLYTA...........................................................................37INLYTA...........................................................................37INSPRA..........................................................................74INSPRA..........................................................................74INSULIN INJECTION DEVICE...................................60INSULIN SYRINGE/NEEDLE.....................................60INTELENCE.................................................................. 53INTELENCE.................................................................. 53INTELENCE.................................................................. 53INTRALIPID.................................................................. 91INTRON A.....................................................................53INTRON A.....................................................................53INTRON A.....................................................................53INTRON A.....................................................................53INTRON A.....................................................................53INTRON A W/DILUENT..............................................53INTRON A W/DILUENT..............................................53INTRON A W/DILUENT..............................................53INVANZ.......................................................................... 13INVANZ.......................................................................... 13INVEGA......................................................................... 47INVEGA......................................................................... 47INVEGA......................................................................... 47INVEGA......................................................................... 47INVEGA SUSTENNA.................................................. 47INVEGA SUSTENNA.................................................. 47INVEGA SUSTENNA.................................................. 47INVEGA SUSTENNA.................................................. 48INVEGA SUSTENNA.................................................. 48INVEGA TRINZA..........................................................48INVEGA TRINZA..........................................................48INVEGA TRINZA..........................................................48INVEGA TRINZA..........................................................48INVIRASE......................................................................53INVIRASE......................................................................53INVOKAMET.................................................................60INVOKAMET.................................................................60INVOKAMET.................................................................60INVOKAMET.................................................................60INVOKAMET XR..........................................................60INVOKAMET XR..........................................................60INVOKAMET XR..........................................................60INVOKAMET XR..........................................................60INVOKANA....................................................................60INVOKANA....................................................................60IPOL INACTIVATED IPV.......................................... 111ipratropium bromide inhal soln 0.02%.....................121ipratropium bromide nasal soln 0.03% (21 mcg/

spray)........................................................................121ipratropium bromide nasal soln 0.06% (42 mcg/

spray)........................................................................121

irbesartan-hydrochlorothiazide tab 150-12.5mg................................................................................74

irbesartan-hydrochlorothiazide tab 300-12.5mg................................................................................74

irbesartan tab 150 mg.................................................74irbesartan tab 300 mg.................................................74irbesartan tab 75 mg................................................... 74IRESSA..........................................................................37IRINOTECAN................................................................37irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................37irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 37ISENTRESS..................................................................53ISENTRESS..................................................................53ISENTRESS..................................................................53ISENTRESS..................................................................53ISENTRESS HD...........................................................53ISONIAZID.................................................................... 32isoniazid tab 100 mg................................................... 32isoniazid tab 300 mg................................................... 32ISORDIL TITRADOSE................................................ 74isosorbide dinitrate tab 10 mg....................................74isosorbide dinitrate tab 20 mg....................................74isosorbide dinitrate tab 30 mg....................................74isosorbide dinitrate tab 5 mg......................................74isosorbide mononitrate tab 10 mg............................. 75isosorbide mononitrate tab 20 mg............................. 75isosorbide mononitrate tab er 24hr 120

mg................................................................................75isosorbide mononitrate tab er 24hr 30

mg................................................................................74isosorbide mononitrate tab er 24hr 60

mg................................................................................74isotretinoin cap 10 mg.................................................89isotretinoin cap 20 mg.................................................89isotretinoin cap 30 mg.................................................89isotretinoin cap 40 mg.................................................89isradipine cap 2.5 mg..................................................75isradipine cap 5 mg..................................................... 75ISTALOL...................................................................... 116ISTODAX.......................................................................37ISTODAX (OVERFILL)................................................37itraconazole cap 100 mg............................................ 30ivermectin tab 3 mg.....................................................43IXEMPRA KIT...............................................................37IXEMPRA KIT...............................................................38IXIARO.........................................................................111JJADENU........................................................................ 91JADENU........................................................................ 91JADENU........................................................................ 91

2018

148

JADENU SPRINKLE................................................... 91JADENU SPRINKLE................................................... 92JADENU SPRINKLE................................................... 92JAKAFI...........................................................................38JAKAFI...........................................................................38JAKAFI...........................................................................38JAKAFI...........................................................................38JAKAFI...........................................................................38JANUMET......................................................................60JANUMET......................................................................60JANUMET XR...............................................................60JANUMET XR...............................................................60JANUMET XR...............................................................60JANUVIA........................................................................60JANUVIA........................................................................60JANUVIA........................................................................60JARDIANCE..................................................................60JARDIANCE..................................................................60JENTADUETO.............................................................. 60JENTADUETO.............................................................. 60JENTADUETO.............................................................. 60JENTADUETO XR....................................................... 60JENTADUETO XR....................................................... 61JEVTANA.......................................................................38JUXTAPID..................................................................... 75JUXTAPID..................................................................... 75JUXTAPID..................................................................... 75JUXTAPID..................................................................... 75JUXTAPID..................................................................... 75JUXTAPID..................................................................... 75KKADCYLA......................................................................38KADCYLA......................................................................38KALETRA...................................................................... 53KALETRA...................................................................... 54KALETRA...................................................................... 54KALYDECO.................................................................121KALYDECO.................................................................121KALYDECO.................................................................121kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

inj................................................................................. 92kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2%



inj................................................................................. 92kcl 20 meq/l (0.15%) in nacl 0.45% inj......................92kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45%


inj................................................................................. 92

KEPIVANCE..................................................................87KEPPRA........................................................................ 19KEPPRA........................................................................ 19KEPPRA........................................................................ 19KEPPRA........................................................................ 19KEPPRA........................................................................ 19KEPPRA........................................................................ 19ketoconazole cream 2%..............................................30ketoconazole shampoo 2%........................................ 30ketoconazole tab 200 mg........................................... 30ketoprofen cap 50 mg................................................... 3ketoprofen cap 75 mg................................................... 3ketorolac tromethamine ophth soln

0.4%..........................................................................116ketorolac tromethamine ophth soln

0.5%..........................................................................116KEYTRUDA...................................................................38KEYTRUDA...................................................................38KINERET.....................................................................111KINRIX.........................................................................111KISQALI.........................................................................38KISQALI FEMARA 200 DOSE...................................38KISQALI FEMARA 400 DOSE...................................38KISQALI FEMARA 600 DOSE...................................38KLARON........................................................................13KOMBIGLYZE XR........................................................61KOMBIGLYZE XR........................................................61KOMBIGLYZE XR........................................................61KORLYM......................................................................106K-TAB.............................................................................92K-TAB.............................................................................92KUVAN...........................................................................97KUVAN...........................................................................97KUVAN...........................................................................97KYNAMRO.................................................................... 75KYPROLIS.................................................................... 38KYPROLIS.................................................................... 38Llabetalol hcl tab 100 mg..............................................75labetalol hcl tab 200 mg..............................................75labetalol hcl tab 300 mg..............................................75LACRISERT................................................................116lactated ringer's solution............................................. 92lactic acid (ammonium lactate) cream

12%............................................................................. 89lactic acid (ammonium lactate) lotion

12%............................................................................. 89lactulose (encephalopathy) solution 10

gm/15ml......................................................................94lactulose solution 10 gm/15ml....................................94LAMICTAL..................................................................... 19LAMICTAL..................................................................... 19

2018

149

LAMICTAL..................................................................... 19LAMICTAL..................................................................... 19LAMICTAL CHEWABLE

DISPERSIBLE........................................................... 19LAMICTAL CHEWABLE

DISPERSIBLE........................................................... 19LAMISIL......................................................................... 30lamivudine oral soln 10 mg/ml................................... 54lamivudine tab 100 mg (hbv)......................................54lamivudine tab 150 mg................................................54lamivudine tab 300 mg................................................54lamivudine-zidovudine tab 150-300 mg.................... 54lamotrigine tab 100 mg............................................... 19lamotrigine tab 150 mg............................................... 19lamotrigine tab 200 mg............................................... 19lamotrigine tab 25 mg................................................. 19lamotrigine tab chewable dispersible 25

mg................................................................................19lamotrigine tab chewable dispersible 5

mg................................................................................19LANOXIN.......................................................................75LANOXIN.......................................................................75LANOXIN.......................................................................75lansoprazole cap delayed release 15

mg................................................................................94lansoprazole cap delayed release 30

mg................................................................................94lanthanum carbonate chew tab 1000



mg................................................................................92LANTUS.........................................................................61LANTUS SOLOSTAR..................................................61LARTRUVO...................................................................38LARTRUVO...................................................................38LASIX............................................................................. 75LASIX............................................................................. 75LASIX............................................................................. 75latanoprost ophth soln 0.005%................................ 116LATUDA.........................................................................48LATUDA.........................................................................48LATUDA.........................................................................48LATUDA.........................................................................48LATUDA.........................................................................48LAZANDA........................................................................ 3LAZANDA........................................................................ 3LAZANDA........................................................................ 3leflunomide tab 10 mg.............................................. 111leflunomide tab 20 mg.............................................. 111LENVIMA 10 MG DAILY DOSE.................................38

LENVIMA 14 MG DAILY DOSE.................................38LENVIMA 18 MG DAILY DOSE.................................38LENVIMA 20 MG DAILY DOSE.................................38LENVIMA 24 MG DAILY DOSE.................................38LENVIMA 8 MG DAILY DOSE...................................38LETAIRIS.....................................................................121LETAIRIS.....................................................................121letrozole tab 2.5 mg.....................................................38LEUCOVORIN CALCIUM...........................................38LEUCOVORIN CALCIUM...........................................38LEUCOVORIN CALCIUM...........................................38leucovorin calcium for inj 100 mg.............................. 39leucovorin calcium for inj 200 mg.............................. 39leucovorin calcium for inj 350 mg.............................. 39leucovorin calcium for inj 50 mg................................ 38leucovorin calcium tab 25 mg.................................... 39leucovorin calcium tab 5 mg.......................................39LEUKERAN...................................................................39LEUKINE....................................................................... 64leuprolide acetate inj kit 5 mg/ml............................. 106LEVEMIR.......................................................................61LEVEMIR FLEXTOUCH..............................................61levetiracetam inj 500 mg/5ml (100 mg/

ml)................................................................................19levetiracetam in sodium chloride iv soln 1000

mg/100ml....................................................................19levetiracetam in sodium chloride iv soln 1500

mg/100ml....................................................................19levetiracetam in sodium chloride iv soln 500

mg/100ml....................................................................19levetiracetam oral soln 100 mg/ml.............................19levetiracetam tab 1000 mg......................................... 19levetiracetam tab 250 mg........................................... 19levetiracetam tab 500 mg........................................... 19levetiracetam tab 750 mg........................................... 19levobunolol hcl ophth soln 0.5%..............................117levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 92levocarnitine tab 330 mg............................................ 92levocetirizine dihydrochloride tab 5

mg............................................................................. 121LEVOFLOXACIN..........................................................13levofloxacin in d5w iv soln 250

mg/50ml......................................................................13levofloxacin in d5w iv soln 500

mg/100ml....................................................................13levofloxacin in d5w iv soln 750

mg/150ml....................................................................13levofloxacin iv soln 25 mg/ml..................................... 13levofloxacin tab 250 mg..............................................13levofloxacin tab 500 mg..............................................13levofloxacin tab 750 mg..............................................13

2018

150

levonorgestrel & ethinyl estradiol (91-day) tab0.15-0.03 mg........................................................... 102

levonorgestrel & ethinyl estradiol tab 0.15 mg-30mcg........................................................................... 102

levonorgestrel & ethinyl estradiol tab 0.1 mg-20mcg........................................................................... 102

levonorgestrel-eth estra tab0.05-30/0.075-40/0.125-30mg-mcg..................... 102

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab0.01mg(7).................................................................102

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab0.01mg(7).................................................................102

LEVORPHANOL TARTRATE....................................... 3levothyroxine sodium tab 100 mcg..........................105levothyroxine sodium tab 112 mcg..........................105levothyroxine sodium tab 125 mcg..........................105levothyroxine sodium tab 137 mcg..........................105levothyroxine sodium tab 150 mcg..........................105levothyroxine sodium tab 175 mcg..........................105levothyroxine sodium tab 200 mcg..........................105levothyroxine sodium tab 25 mcg............................105levothyroxine sodium tab 300 mcg..........................105levothyroxine sodium tab 50 mcg............................105levothyroxine sodium tab 75 mcg............................105levothyroxine sodium tab 88 mcg............................105LEXAPRO......................................................................25LEXAPRO......................................................................25LEXAPRO......................................................................25LEXIVA...........................................................................54LEXIVA...........................................................................54LIALDA........................................................................ 114LIDOCAINE HCL..........................................................75lidocaine hcl gel 2%.......................................................5lidocaine hcl local inj 1%...............................................5lidocaine hcl local preservative free inj

1%..................................................................................5lidocaine hcl soln 4%.....................................................5lidocaine hcl viscous soln 2%.......................................5lidocaine oint 5%............................................................5lidocaine patch 5%.........................................................5lidocaine-prilocaine cream 2.5-2.5%........................... 6LIDODERM......................................................................6LINDANE....................................................................... 43LINEZOLID....................................................................13linezolid for susp 100 mg/5ml.................................... 13linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................13linezolid tab 600 mg.................................................... 13LINZESS........................................................................94LINZESS........................................................................94LINZESS........................................................................94liothyronine sodium tab 25 mcg...............................105

liothyronine sodium tab 50 mcg...............................105liothyronine sodium tab 5 mcg.................................105LIPITOR.........................................................................75LIPITOR.........................................................................75LIPITOR.........................................................................75LIPITOR.........................................................................75lisinopril & hydrochlorothiazide tab 10-12.5

mg................................................................................75lisinopril & hydrochlorothiazide tab 20-12.5

mg................................................................................75lisinopril & hydrochlorothiazide tab 20-25

mg................................................................................75lisinopril tab 10 mg...................................................... 75lisinopril tab 2.5 mg..................................................... 75lisinopril tab 20 mg...................................................... 75lisinopril tab 30 mg...................................................... 75lisinopril tab 40 mg...................................................... 75lisinopril tab 5 mg.........................................................75LITHIUM........................................................................ 58lithium carbonate cap 150 mg....................................58lithium carbonate cap 300 mg....................................58lithium carbonate cap 600 mg....................................58lithium carbonate tab 300 mg.....................................58lithium carbonate tab er 300 mg................................58lithium carbonate tab er 450 mg................................58LITHOBID......................................................................58LOCOID......................................................................... 89LOESTRIN 1/20-21................................................... 102LOESTRIN 1.5/30-21................................................ 102LOESTRIN FE 1/20...................................................102LOESTRIN FE 1.5/30................................................102LONSURF..................................................................... 39LONSURF..................................................................... 39loperamide hcl cap 2 mg............................................ 94LOPID............................................................................ 75lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................54LOPRESSOR................................................................75LOPRESSOR................................................................76LOPRESSOR HCT...................................................... 76LOPROX SHAMPOO.................................................. 30lorazepam tab 0.5 mg................................................. 58lorazepam tab 1 mg.................................................... 58lorazepam tab 2 mg.................................................... 58losartan potassium & hydrochlorothiazide tab

100-12.5 mg.............................................................. 76losartan potassium & hydrochlorothiazide tab 100-25

mg................................................................................76losartan potassium & hydrochlorothiazide tab

50-12.5 mg.................................................................76losartan potassium tab 100 mg..................................76losartan potassium tab 25 mg....................................76

2018

151

losartan potassium tab 50 mg....................................76LOSEASONIQUE.......................................................103LOTEMAX................................................................... 117LOTEMAX................................................................... 117LOTEMAX................................................................... 117LOTENSIN.................................................................... 76LOTENSIN.................................................................... 76LOTENSIN HCT...........................................................76LOTENSIN HCT...........................................................76LOTENSIN HCT...........................................................76LOTRISONE................................................................. 89LOTRONEX.................................................................. 94LOTRONEX.................................................................. 94lovastatin tab 10 mg....................................................76lovastatin tab 20 mg....................................................76lovastatin tab 40 mg....................................................76LOVAZA.........................................................................76LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64LOVENOX..................................................................... 64loxapine succinate cap 10 mg....................................48loxapine succinate cap 25 mg....................................48loxapine succinate cap 50 mg....................................48loxapine succinate cap 5 mg......................................48LUMIGAN....................................................................117LUPRON DEPOT (1-MONTH).................................106LUPRON DEPOT (1-MONTH).................................106LUPRON DEPOT (3-MONTH).................................106LUPRON DEPOT (3-MONTH).................................106LUPRON DEPOT (4-MONTH).................................106LUPRON DEPOT (6-MONTH).................................106LUPRON DEPOT-PED (1-MONTH)....................... 106LUPRON DEPOT-PED (1-MONTH)....................... 106LUPRON DEPOT-PED (1-MONTH)....................... 107LUPRON DEPOT-PED (3-MONTH)....................... 107LUPRON DEPOT-PED (3-MONTH)....................... 107LYNPARZA....................................................................39LYNPARZA....................................................................39LYNPARZA....................................................................39LYRICA.......................................................................... 19LYRICA.......................................................................... 19LYRICA.......................................................................... 19LYRICA.......................................................................... 19LYRICA.......................................................................... 19LYRICA.......................................................................... 19LYRICA.......................................................................... 20LYRICA.......................................................................... 20

LYRICA.......................................................................... 20LYSODREN.................................................................106Mmagnesium sulfate inj 50%........................................ 92MALARONE.................................................................. 43MALARONE.................................................................. 43malathion lotion 0.5%..................................................43MAPROTILINE HCL.................................................... 25MAPROTILINE HCL.................................................... 25MAPROTILINE HCL.................................................... 25MARPLAN..................................................................... 25MARQIBO......................................................................39MATULANE...................................................................39MAVYRET..................................................................... 54MAXALT.........................................................................31MAXALT.........................................................................31MAXALT-MLT................................................................31MAXALT-MLT................................................................31MAXITROL..................................................................117MAXZIDE.......................................................................76MAXZIDE-25.................................................................76meclizine hcl tab 12.5 mg...........................................28meclizine hcl tab 25 mg..............................................28MEDROL....................................................................... 99MEDROL....................................................................... 99MEDROL....................................................................... 99MEDROL....................................................................... 99MEDROL DOSEPAK................................................... 99medroxyprogesterone acetate im susp 150 mg/

ml...............................................................................103medroxyprogesterone acetate im susp prefilled syr

150 mg/ml................................................................103medroxyprogesterone acetate tab 10

mg............................................................................. 103medroxyprogesterone acetate tab 2.5

mg............................................................................. 103medroxyprogesterone acetate tab 5

mg............................................................................. 103mefloquine hcl tab 250 mg......................................... 43megestrol acetate susp 40 mg/ml........................... 103megestrol acetate tab 20 mg................................... 103megestrol acetate tab 40 mg................................... 103MEKINIST......................................................................39MEKINIST......................................................................39meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3melphalan hcl for inj 50 mg........................................ 39memantine hcl oral solution 2 mg/ml.........................22memantine hcl tab 10 mg...........................................22memantine hcl tab 5 mg............................................. 22

2018

152

memantine hcl tab 5 mg (28) & 10 mg (21) titrationpak...............................................................................22

MENACTRA................................................................111MENEST......................................................................103MENEST......................................................................103MENEST......................................................................103MENOMUNE-A/C/Y/W-135...................................... 111MENVEO.....................................................................111mercaptopurine tab 50 mg......................................... 39meropenem iv for soln 1 gm...................................... 13meropenem iv for soln 500 mg.................................. 13MERREM.......................................................................14MERREM.......................................................................14mesalamine enema 4 gm.........................................114mesalamine tab delayed release 1.2

gm............................................................................. 114mesna inj 100 mg/ml...................................................39MESNEX........................................................................39MESTINON................................................................... 32MESTINON................................................................... 32MESTINON TIMESPAN.............................................. 32metformin hcl tab 1000 mg.........................................61metformin hcl tab 500 mg...........................................61metformin hcl tab 850 mg...........................................61metformin hcl tab er 24hr 500 mg............................. 61metformin hcl tab er 24hr 750 mg............................. 61methadone hcl tab 10 mg.............................................3methadone hcl tab 5 mg............................................... 3methazolamide tab 25 mg.......................................... 76methazolamide tab 50 mg.......................................... 76methenamine hippurate tab 1 gm..............................14METHERGINE..............................................................98methimazole tab 10 mg............................................ 108methimazole tab 5 mg.............................................. 108methocarbamol tab 500 mg..................................... 123methocarbamol tab 750 mg..................................... 123METHOTREXATE SODIUM.....................................111methotrexate sodium for inj 1 gm............................111methotrexate sodium inj 50 mg/2ml (25 mg/

ml)............................................................................. 111methotrexate sodium inj pf 1000 mg/40ml (25 mg/





ml)............................................................................. 111methotrexate sodium tab 2.5 mg.............................111methoxsalen rapid cap 10 mg....................................89

methscopolamine bromide tab 2.5 mg......................94methscopolamine bromide tab 5 mg......................... 94methylergonovine maleate tab 0.2 mg......................98methylphenidate hcl tab 10 mg..................................86methylphenidate hcl tab 20 mg..................................86methylphenidate hcl tab 5 mg....................................86methylphenidate hcl tab er 20 mg............................. 86methylprednisolone sod succ for inj 1000

mg................................................................................99methylprednisolone sod succ for inj 125

mg................................................................................99methylprednisolone sod succ for inj 40

mg................................................................................99methylprednisolone tab 16 mg.................................100methylprednisolone tab 32 mg.................................100methylprednisolone tab 4 mg.....................................99methylprednisolone tab 8 mg.....................................99methylprednisolone tab therapy pack 4 mg

(21)..............................................................................99methyltestosterone cap 10 mg.................................103metoclopramide hcl inj 5 mg/ml................................. 94metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................94metoclopramide hcl tab 10 mg...................................94metoclopramide hcl tab 5 mg.....................................94metolazone tab 10 mg................................................ 76metolazone tab 2.5 mg............................................... 76metolazone tab 5 mg...................................................76metoprolol & hydrochlorothiazide tab 100-25

mg................................................................................76metoprolol & hydrochlorothiazide tab 100-50

mg................................................................................76metoprolol & hydrochlorothiazide tab 50-25

mg................................................................................76metoprolol succinate tab er 24hr 100




mg................................................................................76metoprolol tartrate tab 100 mg...................................76metoprolol tartrate tab 25 mg.....................................76metoprolol tartrate tab 50 mg.....................................76METROCREAM............................................................89METROGEL.................................................................. 89METROGEL-VAGINAL................................................14METRO IV.....................................................................14METROLOTION........................................................... 89metronidazole cap 375 mg.........................................14metronidazole cream 0.75%.......................................89

2018

153

metronidazole gel 0.75%............................................ 89metronidazole gel 1%..................................................89metronidazole in nacl 0.79% iv soln 500

mg/100ml....................................................................14metronidazole lotion 0.75%........................................ 89metronidazole tab 250 mg..........................................14metronidazole tab 500 mg..........................................14metronidazole vaginal gel 0.75%...............................14mexiletine hcl cap 150 mg..........................................76mexiletine hcl cap 200 mg..........................................76mexiletine hcl cap 250 mg..........................................77MIACALCIN................................................................ 114MICARDIS.....................................................................77MICARDIS.....................................................................77MICARDIS.....................................................................77MICARDIS HCT........................................................... 77MICARDIS HCT........................................................... 77MICARDIS HCT........................................................... 77MICRO-K....................................................................... 92MICRO-K....................................................................... 92MICROZIDE.................................................................. 77midodrine hcl tab 10 mg............................................. 77midodrine hcl tab 2.5 mg............................................ 77midodrine hcl tab 5 mg............................................... 77MIGERGOT...................................................................31MIGRANAL....................................................................31MINIPRESS.................................................................. 77MINIPRESS.................................................................. 77MINIPRESS.................................................................. 77MINOCIN....................................................................... 14MINOCIN....................................................................... 14minocycline hcl cap 100 mg.......................................14minocycline hcl cap 50 mg......................................... 14minocycline hcl cap 75 mg......................................... 14minocycline hcl tab 100 mg........................................14minocycline hcl tab 50 mg..........................................14minocycline hcl tab 75 mg..........................................14minoxidil tab 10 mg..................................................... 77minoxidil tab 2.5 mg.................................................... 77MIRAPEX...................................................................... 44MIRAPEX...................................................................... 44MIRAPEX...................................................................... 44MIRAPEX...................................................................... 44MIRAPEX...................................................................... 44MIRAPEX...................................................................... 44MIRCETTE..................................................................103mirtazapine orally disintegrating tab 15

mg................................................................................25mirtazapine orally disintegrating tab 30

mg................................................................................25mirtazapine orally disintegrating tab 45

mg................................................................................25

mirtazapine tab 15 mg................................................ 25mirtazapine tab 30 mg................................................ 25mirtazapine tab 45 mg................................................ 25mirtazapine tab 7.5 mg............................................... 25misoprostol tab 100 mcg............................................ 94misoprostol tab 200 mcg............................................ 94MITOMYCIN..................................................................39mitomycin for iv soln 20 mg....................................... 39mitomycin for iv soln 40 mg....................................... 39mitoxantrone hcl inj conc 20 mg/10ml (2 mg/

ml)................................................................................39mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/

ml)................................................................................39mitoxantrone hcl inj conc 30 mg/15ml (2 mg/

ml)................................................................................39M-M-R II...................................................................... 111MOBIC............................................................................. 3MOBIC............................................................................. 3modafinil tab 100 mg.................................................124modafinil tab 200 mg.................................................124moexipril hcl tab 15 mg...............................................77moexipril hcl tab 7.5 mg..............................................77moexipril-hydrochlorothiazide tab 15-12.5

mg................................................................................77moexipril-hydrochlorothiazide tab 15-25

mg................................................................................77moexipril-hydrochlorothiazide tab 7.5-12.5

mg................................................................................77mometasone furoate cream 0.1%............................. 89mometasone furoate nasal susp 50 mcg/

act..............................................................................121mometasone furoate oint 0.1%..................................89mometasone furoate solution 0.1%

(lotion).........................................................................89montelukast sodium chew tab 4 mg........................121montelukast sodium chew tab 5 mg........................121montelukast sodium oral granules packet 4

mg............................................................................. 121montelukast sodium tab 10 mg................................121MORPHINE SULFATE.................................................. 3MORPHINE SULFATE.................................................. 3morphine sulfate inj pf 0.5 mg/ml.................................3morphine sulfate inj pf 1 mg/ml....................................3morphine sulfate oral soln 100 mg/5ml (20 mg/

ml)..................................................................................3morphine sulfate oral soln 10 mg/5ml......................... 3morphine sulfate oral soln 20 mg/5ml......................... 3morphine sulfate tab er 100 mg...................................4morphine sulfate tab er 15 mg..................................... 3morphine sulfate tab er 200 mg...................................4morphine sulfate tab er 30 mg..................................... 4morphine sulfate tab er 60 mg..................................... 4

2018

154

MOVIPREP................................................................... 95MOXEZA..................................................................... 117moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................14moxifloxacin hcl ophth soln 0.5%............................ 117moxifloxacin hcl tab 400 mg.......................................14MOZOBIL...................................................................... 64MULTAQ........................................................................ 77mupirocin oint 2%........................................................ 89MUSTARGEN............................................................... 39MYALEPT...................................................................... 95MYCAMINE...................................................................30MYCAMINE...................................................................30MYCOBUTIN................................................................ 32mycophenolate mofetil cap 250 mg........................ 111mycophenolate mofetil for oral susp 200 mg/

ml...............................................................................111mycophenolate mofetil hcl for iv soln 500

mg............................................................................. 111mycophenolate mofetil tab 500 mg......................... 111mycophenolate sodium tab dr 180

mg............................................................................. 111mycophenolate sodium tab dr 360

mg............................................................................. 111MYLOTARG.................................................................. 39MYSOLINE....................................................................20MYSOLINE....................................................................20Nnabumetone tab 500 mg...............................................4nabumetone tab 750 mg...............................................4nadolol tab 20 mg........................................................77nadolol tab 40 mg........................................................77nadolol tab 80 mg........................................................77NAFCILLIN SODIUM...................................................14NAFCILLIN SODIUM...................................................14nafcillin sodium for inj 10 gm......................................14nafcillin sodium for inj 1 gm........................................14nafcillin sodium for inj 2 gm........................................14NAGLAZYME................................................................97NALOXONE HCL........................................................... 6NALOXONE HCL........................................................... 6naloxone hcl inj 0.4 mg/ml............................................6naloxone hcl inj 4 mg/10ml...........................................6naltrexone hcl tab 50 mg.............................................. 6NAMENDA.................................................................... 22NAMENDA.................................................................... 22NAMENDA.................................................................... 22NAMENDA TITRATION PAK......................................22NAPROSYN.................................................................... 4naproxen sodium tab 275 mg.......................................4naproxen sodium tab 550 mg.......................................4

naproxen susp 125 mg/5ml.......................................... 4naproxen tab 250 mg.................................................... 4naproxen tab 375 mg.................................................... 4naproxen tab 500 mg.................................................... 4naproxen tab ec 375 mg...............................................4naproxen tab ec 500 mg...............................................4naratriptan hcl tab 1 mg..............................................31naratriptan hcl tab 2.5 mg...........................................31NARCAN..........................................................................6NARDIL..........................................................................25NASONEX...................................................................121NATACYN....................................................................117nateglinide tab 120 mg............................................... 61nateglinide tab 60 mg..................................................61NATPARA....................................................................115NATPARA....................................................................115NATPARA....................................................................115NATPARA....................................................................115NEBUPENT...................................................................43NEFAZODONE HCL....................................................25NEFAZODONE HCL....................................................25NEFAZODONE HCL....................................................25nefazodone hcl tab 250 mg........................................25nefazodone hcl tab 50 mg..........................................25neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin........................117neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml...........................117neomycin-polymyxin b gu irrigation

soln..............................................................................14neomycin-polymyxin-dexamethasone ophth oint

0.1%..........................................................................117neomycin-polymyxin-dexamethasone ophth susp

0.1%..........................................................................117neomycin-polymyxin-hc otic soln 1%...................... 118neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%................................................................ 118neomycin sulfate tab 500 mg.....................................14NEORAL......................................................................111NEORAL......................................................................111NEORAL......................................................................111NERLYNX......................................................................39NEULASTA....................................................................64NEULASTA ONPRO KIT............................................ 64NEUPRO....................................................................... 44NEUPRO....................................................................... 44NEUPRO....................................................................... 44NEUPRO....................................................................... 44NEUPRO....................................................................... 44NEUPRO....................................................................... 44NEURONTIN.................................................................20NEURONTIN.................................................................20

2018

155

NEURONTIN.................................................................20NEURONTIN.................................................................20NEURONTIN.................................................................20NEURONTIN.................................................................20NEVIRAPINE................................................................ 54nevirapine tab 200 mg................................................ 54nevirapine tab er 24hr 100 mg...................................54nevirapine tab er 24hr 400 mg...................................54NEXAVAR......................................................................39NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM.........................................................................95NEXIUM I.V...................................................................95niacin tab er 1000 mg................................................. 77niacin tab er 500 mg................................................... 77niacin tab er 750 mg................................................... 77NIASPAN....................................................................... 77NIASPAN....................................................................... 77NIASPAN....................................................................... 77nicardipine hcl cap 20 mg...........................................77nicardipine hcl cap 30 mg...........................................77NICOTROL INHALER................................................... 6NICOTROL NS............................................................... 6nifedipine tab er 24hr 30 mg...................................... 77nifedipine tab er 24hr 60 mg...................................... 77nifedipine tab er 24hr 90 mg...................................... 77nifedipine tab er 24hr osmotic release 30

mg................................................................................77nifedipine tab er 24hr osmotic release 60

mg................................................................................77nifedipine tab er 24hr osmotic release 90

mg................................................................................78NILANDRON.................................................................39nilutamide tab 150 mg.................................................39NINLARO.......................................................................39NINLARO.......................................................................39NINLARO.......................................................................39NIPENT..........................................................................39NISOLDIPINE ER........................................................ 78nisoldipine tab er 24hr 17 mg.................................... 78nisoldipine tab er 24hr 34 mg.................................... 78nisoldipine tab er 24hr 8.5 mg................................... 78NITRO-BID....................................................................78nitrofurantoin macrocrystalline cap 100

mg................................................................................14nitrofurantoin macrocrystalline cap 50

mg................................................................................14

nitrofurantoin monohydrate macrocrystalline cap 100mg................................................................................14

nitrofurantoin susp 25 mg/5ml....................................14nitroglycerin sl tab 0.3 mg.......................................... 78nitroglycerin sl tab 0.4 mg.......................................... 78nitroglycerin sl tab 0.6 mg.......................................... 78nitroglycerin td patch 24hr 0.1 mg/hr.........................78nitroglycerin td patch 24hr 0.2 mg/hr.........................78nitroglycerin td patch 24hr 0.4 mg/hr.........................78nitroglycerin td patch 24hr 0.6 mg/hr.........................78nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................78NITROLINGUAL PUMPSPRAY................................. 78NITROSTAT.................................................................. 78NITROSTAT.................................................................. 78NITROSTAT.................................................................. 78nizatidine cap 150 mg.................................................95nizatidine cap 300 mg.................................................95NIZORAL....................................................................... 30norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg...............................................................103norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg...............................................................103norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg........................................................................... 103norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg........................................................................... 103norethindrone & ethinyl estradiol tab 1 mg-35

mcg........................................................................... 103norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg...............................................................103norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg........................................................................... 103norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg........................................................................... 103norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg........................................................................... 103norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24)...................................................................103norethindrone acetate tab 5 mg...............................103norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg.....................................................................103norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg.....................................................................103norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35

mg-mcg.....................................................................103norethindrone tab 0.35 mg....................................... 103norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg........................................................................... 103norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.......................103

2018

156

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg.......................103

norgestrel & ethinyl estradiol tab 0.3 mg-30mcg........................................................................... 103

NORINYL 1+35.......................................................... 103NORMOSOL-M IN D5W............................................. 92NORPRAMIN................................................................ 25NORPRAMIN................................................................ 25NORTHERA.................................................................. 78NORTHERA.................................................................. 78NORTHERA.................................................................. 78NORTRIPTYLINE HCL............................................... 25nortriptyline hcl cap 10 mg......................................... 25nortriptyline hcl cap 25 mg......................................... 25nortriptyline hcl cap 50 mg......................................... 25nortriptyline hcl cap 75 mg......................................... 25NORVASC..................................................................... 78NORVASC..................................................................... 78NORVASC..................................................................... 78NORVIR.........................................................................54NORVIR.........................................................................54NORVIR.........................................................................54NOXAFIL....................................................................... 30NOXAFIL....................................................................... 30NOXAFIL....................................................................... 30NUCYNTA........................................................................4NUCYNTA........................................................................4NUCYNTA........................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUCYNTA ER.................................................................4NUEDEXTA...................................................................86NULOJIX..................................................................... 111NULYTELY/FLAVOR PACKS..................................... 95NUPLAZID.....................................................................48NUVARING................................................................. 103NUVIGIL...................................................................... 124NUVIGIL...................................................................... 124NUVIGIL...................................................................... 124NUVIGIL...................................................................... 124nystatin cream 100000 unit/gm..................................30nystatin oint 100000 unit/gm...................................... 30nystatin susp 100000 unit/ml......................................30nystatin tab 500000 unit..............................................30nystatin topical powder 100000 unit/

gm................................................................................30nystatin-triamcinolone cream 100000-0.1 unit/gm-

%..................................................................................89nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................89

OOCALIVA....................................................................... 97OCALIVA....................................................................... 97octreotide acetate inj 1000 mcg/ml (1 mg/

ml)............................................................................. 107octreotide acetate inj 100 mcg/ml (0.1 mg/




ml)............................................................................. 107OCUFLOX...................................................................117ODEFSEY..................................................................... 54ODOMZO...................................................................... 39OFEV........................................................................... 121OFEV........................................................................... 121ofloxacin ophth soln 0.3%........................................ 117ofloxacin otic soln 0.3%............................................ 118ofloxacin tab 400 mg...................................................14olanzapine for im inj 10 mg........................................ 48olanzapine orally disintegrating tab 10

mg................................................................................48olanzapine orally disintegrating tab 15



mg................................................................................48olanzapine tab 10 mg..................................................48olanzapine tab 15 mg..................................................48olanzapine tab 2.5 mg.................................................48olanzapine tab 20 mg..................................................48olanzapine tab 5 mg....................................................48olanzapine tab 7.5 mg.................................................48olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg............................................................. 78olmesartan-amlodipine-hydrochlorothiazide tab

40-10-12.5 mg...........................................................78olmesartan-amlodipine-hydrochlorothiazide tab

40-10-25 mg.............................................................. 78olmesartan-amlodipine-hydrochlorothiazide tab

40-5-12.5 mg............................................................. 78olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg................................................................ 78olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................78olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................78

2018

157

olmesartan medoxomil-hydrochlorothiazide tab40-25 mg....................................................................78

olmesartan medoxomil tab 20 mg............................. 78olmesartan medoxomil tab 40 mg............................. 78olmesartan medoxomil tab 5 mg............................... 78olopatadine hcl nasal soln 0.6%..............................121olopatadine hcl ophth soln 0.1%..............................117olopatadine hcl ophth soln 0.2%..............................117OLYSIO..........................................................................54omega-3-acid ethyl esters cap 1 gm.........................78omeprazole cap delayed release 10

mg................................................................................95omeprazole cap delayed release 20

mg................................................................................95omeprazole cap delayed release 40

mg................................................................................95OMNIPRED.................................................................117OMNITROPE.............................................................. 100OMNITROPE.............................................................. 100OMNITROPE.............................................................. 100ONCASPAR.................................................................. 39ondansetron hcl inj 40 mg/20ml (2 mg/

ml)................................................................................28ondansetron hcl inj 4 mg/2ml (2 mg/

ml)................................................................................28ondansetron hcl oral soln 4 mg/5ml.......................... 28ondansetron hcl tab 24 mg.........................................28ondansetron hcl tab 4 mg...........................................28ondansetron hcl tab 8 mg...........................................28ondansetron orally disintegrating tab 4

mg................................................................................28ondansetron orally disintegrating tab 8

mg................................................................................28ONFI...............................................................................20ONFI...............................................................................20ONFI...............................................................................20ONGLYZA......................................................................61ONGLYZA......................................................................61ONIVYDE...................................................................... 40OPDIVO.........................................................................40OPDIVO.........................................................................40OPSUMIT....................................................................121ORACEA........................................................................89ORALAIR.....................................................................122ORAP............................................................................. 48ORAP............................................................................. 48ORENCIA....................................................................111ORENCIA....................................................................111ORENCIA....................................................................111ORENCIA....................................................................112ORENCIA CLICKJECT............................................. 112ORFADIN.......................................................................97

ORFADIN.......................................................................97ORFADIN.......................................................................97ORFADIN.......................................................................97ORFADIN.......................................................................97ORKAMBI....................................................................122ORKAMBI....................................................................122ORTHO-CYCLEN...................................................... 104ORTHO MICRONOR................................................ 104ORTHO-NOVUM 1/35...............................................104ORTHO-NOVUM 7/7/7..............................................104ORTHO TRI-CYCLEN...............................................104oseltamivir phosphate cap 30 mg..............................54oseltamivir phosphate cap 45 mg..............................54oseltamivir phosphate cap 75 mg..............................54oseltamivir phosphate for susp 6 mg/

ml.................................................................................54OTEZLA.......................................................................112OTEZLA.......................................................................112OVCON-35..................................................................104OVIDE............................................................................43oxaliplatin for iv inj 100 mg.........................................40oxaliplatin for iv inj 50 mg...........................................40oxaliplatin iv soln 100 mg/20ml..................................40oxaliplatin iv soln 50 mg/10ml....................................40oxandrolone tab 10 mg.............................................104oxandrolone tab 2.5 mg............................................104oxaprozin tab 600 mg....................................................4oxcarbazepine susp 300 mg/5ml (60 mg/

ml)................................................................................20oxcarbazepine tab 150 mg.........................................20oxcarbazepine tab 300 mg.........................................20oxcarbazepine tab 600 mg.........................................20oxybutynin chloride syrup 5 mg/5ml..........................98oxybutynin chloride tab 5 mg..................................... 98oxybutynin chloride tab er 24hr 10 mg......................98oxybutynin chloride tab er 24hr 15 mg......................98oxybutynin chloride tab er 24hr 5 mg........................98oxycodone-aspirin tab 4.8355-325 mg........................4oxycodone hcl tab 10 mg..............................................4oxycodone hcl tab 15 mg..............................................4oxycodone hcl tab 20 mg..............................................4oxycodone hcl tab 30 mg..............................................4oxycodone hcl tab 5 mg................................................4oxycodone w/ acetaminophen tab 10-325

mg..................................................................................4oxycodone w/ acetaminophen tab 2.5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 7.5-325

mg..................................................................................4OXYCONTIN...................................................................4

2018

158

OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................5OXYCONTIN...................................................................5OXYCONTIN...................................................................5Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................40paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................40paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................40paliperidone tab er 24hr 1.5 mg.................................48paliperidone tab er 24hr 3 mg....................................48paliperidone tab er 24hr 6 mg....................................48paliperidone tab er 24hr 9 mg....................................48PAMINE......................................................................... 95PAMINE FORTE...........................................................95PANRETIN.....................................................................40pantoprazole sodium ec tab 20 mg........................... 95pantoprazole sodium ec tab 40 mg........................... 95pantoprazole sodium for iv soln 40 mg..................... 95paricalcitol cap 1 mcg............................................... 115paricalcitol cap 2 mcg............................................... 115paricalcitol cap 4 mcg............................................... 115paricalcitol iv soln 2 mcg/ml..................................... 115paricalcitol iv soln 5 mcg/ml..................................... 115PARNATE...................................................................... 25paromomycin sulfate cap 250 mg..............................14paroxetine hcl tab 10 mg............................................ 26paroxetine hcl tab 20 mg............................................ 26paroxetine hcl tab 30 mg............................................ 26paroxetine hcl tab 40 mg............................................ 26PASER........................................................................... 32PATADAY.....................................................................117PATANASE..................................................................122PATANOL.................................................................... 117PAXIL............................................................................. 26PAXIL............................................................................. 26PAXIL............................................................................. 26PAXIL............................................................................. 26PAXIL............................................................................. 26PAZEO.........................................................................117PEDIARIX....................................................................112PEDVAX HIB.............................................................. 112peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................95peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................95peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................95

PEGANONE..................................................................20PEGASYS..................................................................... 54PEGASYS..................................................................... 54PEGASYS PROCLICK................................................54PEGASYS PROCLICK................................................54penicillin g potassium for inj 20000000

unit...............................................................................14penicillin g potassium for inj 5000000

unit...............................................................................14PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 14PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 15PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 15PENICILLIN G SODIUM............................................. 15penicillin v potassium for soln 125

mg/5ml........................................................................ 15penicillin v potassium for soln 250

mg/5ml........................................................................ 15penicillin v potassium tab 250 mg............................. 15penicillin v potassium tab 500 mg............................. 15PENTACEL................................................................. 112PENTAM 300................................................................43PENTASA....................................................................114PENTASA....................................................................114pentoxifylline tab er 400 mg....................................... 78perindopril erbumine tab 2 mg................................... 79perindopril erbumine tab 4 mg................................... 79perindopril erbumine tab 8 mg................................... 79PERJETA.......................................................................40permethrin cream 5%..................................................43perphenazine tab 16 mg.............................................28perphenazine tab 2 mg............................................... 28perphenazine tab 4 mg............................................... 28perphenazine tab 8 mg............................................... 28PFIZERPEN-G..............................................................15phenelzine sulfate tab 15 mg.....................................26PHENOBARBITAL....................................................... 20PHENOBARBITAL....................................................... 20PHENOBARBITAL....................................................... 20PHENOBARBITAL....................................................... 20phenobarbital elixir 20 mg/5ml...................................20PHENOBARBITAL SODIUM...................................... 20PHENOBARBITAL SODIUM...................................... 20phenobarbital tab 16.2 mg..........................................20phenobarbital tab 32.4 mg..........................................20phenobarbital tab 64.8 mg..........................................20phenobarbital tab 97.2 mg..........................................20phenoxybenzamine hcl cap 10 mg............................79PHENYTEK...................................................................20PHENYTEK...................................................................20

2018

159

phenytoin chew tab 50 mg......................................... 20phenytoin sodium extended cap 100

mg................................................................................20phenytoin sodium extended cap 200

mg................................................................................20phenytoin sodium extended cap 300

mg................................................................................20phenytoin susp 125 mg/5ml....................................... 20PHOSLYRA...................................................................92PHOSPHOLINE IODIDE.......................................... 117PICATO..........................................................................89PICATO..........................................................................90pilocarpine hcl ophth soln 1%..................................117pilocarpine hcl ophth soln 2%..................................117pilocarpine hcl ophth soln 4%..................................117pilocarpine hcl tab 5 mg..............................................87pilocarpine hcl tab 7.5 mg.......................................... 87pimozide tab 1 mg....................................................... 49pimozide tab 2 mg....................................................... 49pindolol tab 10 mg....................................................... 79pindolol tab 5 mg......................................................... 79pioglitazone hcl-glimepiride tab 30-2

mg................................................................................61pioglitazone hcl-glimepiride tab 30-4

mg................................................................................61pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................61pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................61pioglitazone hcl tab 15 mg..........................................61pioglitazone hcl tab 30 mg..........................................61pioglitazone hcl tab 45 mg..........................................61piperacillin sod-tazobactam na for inj 3.375 gm

(3-0.375 gm)..............................................................15piperacillin sod-tazobactam sod for inj 2.25 gm

(2-0.25 gm)................................................................ 15piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5

gm).............................................................................. 15piroxicam cap 10 mg..................................................... 5piroxicam cap 20 mg..................................................... 5PLAQUENIL.................................................................. 43PLAVIX...........................................................................64PLEGRIDY.................................................................... 86PLEGRIDY.................................................................... 86PLEGRIDY STARTER PACK..................................... 86PLEGRIDY STARTER PACK..................................... 86podofilox soln 0.5%..................................................... 90polyethylene glycol 3350 oral packet........................ 95polyethylene glycol 3350 oral powder.......................95polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%.................................................................... 117POLYTRIM.................................................................. 117

POMALYST...................................................................40POMALYST...................................................................40POMALYST...................................................................40POMALYST...................................................................40PORTRAZZA................................................................ 40POTASSIUM CHLORIDE/DEXTROSE.....................92POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................92POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................92potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 92potassium chloride cap er 10 meq............................ 92potassium chloride cap er 8 meq...............................92POTASSIUM CHLORIDE ER.....................................92potassium chloride inj 2 meq/ml................................ 92potassium chloride microencapsulated crys er tab 10

meq............................................................................. 92potassium chloride microencapsulated crys er tab 20

meq............................................................................. 92potassium chloride oral soln 10% (20

meq/15ml).................................................................. 92potassium chloride tab er 10 meq............................. 92potassium chloride tab er 8 meq (600

mg).............................................................................. 92potassium citrate tab er 10 meq (1080



mg).............................................................................. 93PRADAXA..................................................................... 64PRADAXA..................................................................... 64PRADAXA..................................................................... 65PRALUENT................................................................... 79PRALUENT................................................................... 79pramipexole dihydrochloride tab 0.125

mg................................................................................44pramipexole dihydrochloride tab 0.25




mg................................................................................45pramipexole dihydrochloride tab 1 mg...................... 45prasugrel hcl tab 10 mg..............................................65prasugrel hcl tab 5 mg................................................ 65PRAVACHOL................................................................ 79PRAVACHOL................................................................ 79PRAVACHOL................................................................ 79

2018

160

pravastatin sodium tab 10 mg....................................79pravastatin sodium tab 20 mg....................................79pravastatin sodium tab 40 mg....................................79pravastatin sodium tab 80 mg....................................79prazosin hcl cap 1 mg.................................................79prazosin hcl cap 2 mg.................................................79prazosin hcl cap 5 mg.................................................79PRECOSE.....................................................................61PRECOSE.....................................................................61PRECOSE.....................................................................61PRED FORTE............................................................ 117PRED MILD................................................................ 117prednicarbate cream 0.1%......................................... 90prednicarbate oint 0.1%..............................................90prednisolone acetate ophth susp 1%......................117prednisolone sod phosphate oral soln 15

mg/5ml......................................................................100prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base).......................................................... 100prednisolone syrup 15 mg/5ml.................................100PREDNISONE............................................................100PREDNISONE............................................................100PREDNISONE............................................................100PREDNISONE............................................................100PREDNISONE............................................................100PREDNISONE............................................................100prednisone tab 10 mg............................................... 100prednisone tab 1 mg................................................. 100prednisone tab 2.5 mg..............................................100prednisone tab 20 mg............................................... 100prednisone tab 5 mg................................................. 100PREMARIN................................................................. 104PREMARIN................................................................. 104PREMARIN................................................................. 104PREMARIN................................................................. 104PREMARIN................................................................. 104PREMARIN................................................................. 104PREMPHASE............................................................. 104PREMPRO.................................................................. 104PREMPRO.................................................................. 104PREMPRO.................................................................. 104PREMPRO.................................................................. 104PREVACID.................................................................... 95PREVACID.................................................................... 95PREZCOBIX................................................................. 54PREZISTA..................................................................... 54PREZISTA..................................................................... 54PREZISTA..................................................................... 54PREZISTA..................................................................... 54PREZISTA..................................................................... 54PRIFTIN.........................................................................32PRIMAQUINE PHOSPHATE......................................43

primidone tab 250 mg................................................. 21primidone tab 50 mg................................................... 21PRINIVIL........................................................................79PRINIVIL........................................................................79PRINIVIL........................................................................79PRISTIQ........................................................................ 26PRISTIQ........................................................................ 26PRISTIQ........................................................................ 26PROAIR HFA..............................................................122PROAIR RESPICLICK..............................................122probenecid tab 500 mg............................................... 31PROCARDIA XL.......................................................... 79PROCARDIA XL.......................................................... 79PROCARDIA XL.......................................................... 79prochlorperazine edisylate inj 5 mg/ml......................28prochlorperazine maleate tab 10 mg.........................28prochlorperazine maleate tab 5 mg...........................28prochlorperazine suppos 25 mg................................ 28PROCRIT...................................................................... 65PROCRIT...................................................................... 65PROCRIT...................................................................... 65PROCRIT...................................................................... 65PROCRIT...................................................................... 65PROCRIT...................................................................... 65PROGLYCEM............................................................... 61PROGRAF.................................................................. 112PROGRAF.................................................................. 112PROGRAF.................................................................. 112PROGRAF.................................................................. 112PROLASTIN-C..............................................................97PROLENSA................................................................ 117PROLEUKIN................................................................. 40PROLIA........................................................................115PROMACTA.................................................................. 65PROMACTA.................................................................. 65PROMACTA.................................................................. 65PROMACTA.................................................................. 65promethazine hcl suppos 12.5 mg............................ 28promethazine hcl suppos 25 mg................................28promethazine hcl syrup 6.25 mg/5ml........................ 28promethazine hcl tab 12.5 mg....................................28promethazine hcl tab 25 mg.......................................28promethazine hcl tab 50 mg.......................................29propafenone hcl cap er 12hr 225 mg........................ 79propafenone hcl cap er 12hr 325 mg........................ 79propafenone hcl cap er 12hr 425 mg........................ 79propafenone hcl tab 150 mg...................................... 79propafenone hcl tab 225 mg...................................... 79propafenone hcl tab 300 mg...................................... 79PROPRANOLOL HCL.................................................79PROPRANOLOL HCL.................................................79propranolol hcl cap er 24hr 120 mg.......................... 79

2018

161

propranolol hcl cap er 24hr 160 mg.......................... 79propranolol hcl cap er 24hr 60 mg.............................79propranolol hcl cap er 24hr 80 mg.............................79propranolol hcl inj 1 mg/ml......................................... 80propranolol hcl tab 10 mg...........................................80propranolol hcl tab 20 mg...........................................80propranolol hcl tab 40 mg...........................................80propranolol hcl tab 60 mg...........................................80propranolol hcl tab 80 mg...........................................80propylthiouracil tab 50 mg........................................ 108PROQUAD.................................................................. 112PROSCAR.....................................................................98PROTONIX....................................................................95PROTONIX....................................................................95protriptyline hcl tab 10 mg.......................................... 26protriptyline hcl tab 5 mg............................................ 26PROVERA...................................................................104PROVERA...................................................................104PROVERA...................................................................104PROZAC........................................................................26PROZAC........................................................................26PROZAC........................................................................26PRUDOXIN................................................................... 90PULMOZYME.............................................................122PURIXAN.......................................................................40PYLERA.........................................................................95pyrazinamide tab 500 mg........................................... 33pyridostigmine bromide tab 60 mg............................ 32pyridostigmine bromide tab er 180 mg......................32QQUADRACEL............................................................. 112quetiapine fumarate tab 100 mg................................49quetiapine fumarate tab 200 mg................................49quetiapine fumarate tab 25 mg..................................49quetiapine fumarate tab 300 mg................................49quetiapine fumarate tab 400 mg................................49quetiapine fumarate tab 50 mg..................................49quetiapine fumarate tab er 24hr 150

mg................................................................................49quetiapine fumarate tab er 24hr 200



mg................................................................................49quetiapine fumarate tab er 24hr 50 mg.....................49quinapril hcl tab 10 mg............................................... 80quinapril hcl tab 20 mg............................................... 80quinapril hcl tab 40 mg............................................... 80quinapril hcl tab 5 mg..................................................80

quinapril-hydrochlorothiazide tab 10-12.5mg................................................................................80

quinapril-hydrochlorothiazide tab 20-12.5mg................................................................................80

quinapril-hydrochlorothiazide tab 20-25mg................................................................................80

quinidine gluconate tab er 324 mg............................ 80QUINIDINE SULFATE................................................. 80QUINIDINE SULFATE................................................. 80QVAR........................................................................... 122QVAR........................................................................... 122RRABAVERT................................................................. 112rabeprazole sodium ec tab 20 mg............................. 95RAGWITEK.................................................................122raloxifene hcl tab 60 mg........................................... 104ramipril cap 1.25 mg....................................................80ramipril cap 10 mg.......................................................80ramipril cap 2.5 mg......................................................80ramipril cap 5 mg.........................................................80RANEXA........................................................................80RANEXA........................................................................80ranitidine hcl cap 150 mg........................................... 96ranitidine hcl cap 300 mg........................................... 96ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................96ranitidine hcl tab 150 mg............................................ 96ranitidine hcl tab 300 mg............................................ 96RAPAFLO...................................................................... 98RAPAFLO...................................................................... 98RAPAMUNE................................................................112rasagiline mesylate tab 0.5 mg.................................. 45rasagiline mesylate tab 1 mg..................................... 45RAZADYNE...................................................................22RAZADYNE...................................................................22RAZADYNE...................................................................22RAZADYNE ER............................................................22RAZADYNE ER............................................................22RAZADYNE ER............................................................22REBETOL......................................................................54RECOMBIVAX HB..................................................... 112RECOMBIVAX HB..................................................... 112RECOMBIVAX HB..................................................... 112REGLAN........................................................................96REGLAN........................................................................96REGRANEX.................................................................. 90RELISTOR.....................................................................96RELISTOR.....................................................................96RELISTOR.....................................................................96REMERON....................................................................26REMERON....................................................................26

2018

162

REMERON....................................................................26REMERON SOLTAB....................................................26REMERON SOLTAB....................................................26REMERON SOLTAB....................................................26REMICADE................................................................. 112REMODULIN.............................................................. 122REMODULIN.............................................................. 122REMODULIN.............................................................. 122REMODULIN.............................................................. 122RENVELA......................................................................93RENVELA......................................................................93RENVELA......................................................................93repaglinide tab 0.5 mg................................................ 61repaglinide tab 1 mg....................................................61repaglinide tab 2 mg....................................................61REPATHA...................................................................... 80REPATHA PUSHTRONEX SYSTEM........................80REPATHA SURECLICK.............................................. 80REQUIP......................................................................... 45REQUIP......................................................................... 45REQUIP......................................................................... 45REQUIP......................................................................... 45REQUIP......................................................................... 45REQUIP......................................................................... 45REQUIP......................................................................... 45RESCRIPTOR.............................................................. 54RESCRIPTOR.............................................................. 54RESTASIS...................................................................117RESTASIS MULTIDOSE...........................................117RETIN-A........................................................................ 90RETIN-A........................................................................ 90RETIN-A........................................................................ 90RETIN-A........................................................................ 90RETIN-A........................................................................ 90RETROVIR....................................................................54RETROVIR....................................................................55RETROVIR IV INFUSION...........................................55REVLIMID......................................................................40REVLIMID......................................................................40REVLIMID......................................................................40REVLIMID......................................................................40REVLIMID......................................................................40REVLIMID......................................................................40REXULTI........................................................................49REXULTI........................................................................49REXULTI........................................................................49REXULTI........................................................................49REXULTI........................................................................49REXULTI........................................................................49REYATAZ.......................................................................55REYATAZ.......................................................................55REYATAZ.......................................................................55

REYATAZ.......................................................................55RIBASPHERE...............................................................55RIBASPHERE...............................................................55RIBASPHERE RIBAPAK.............................................55RIBASPHERE RIBAPAK.............................................55ribavirin cap 200 mg....................................................55ribavirin for inhal soln 6 gm......................................122ribavirin tab 200 mg.....................................................55RIDAURA.................................................................... 112rifabutin cap 150 mg....................................................33RIFADIN.........................................................................33RIFADIN.........................................................................33rifampin cap 150 mg....................................................33rifampin cap 300 mg....................................................33rifampin for inj 600 mg................................................ 33riluzole tab 50 mg........................................................ 86rimantadine hydrochloride tab 100 mg......................55risedronate sodium tab 150 mg...............................115risedronate sodium tab 30 mg................................. 115risedronate sodium tab 35 mg................................. 115risedronate sodium tab 5 mg................................... 115risedronate sodium tab delayed release 35

mg............................................................................. 115RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL..................................................................49RISPERDAL CONSTA................................................ 49RISPERDAL CONSTA................................................ 49RISPERDAL CONSTA................................................ 49RISPERDAL CONSTA................................................ 49RISPERDAL M-TAB.................................................... 49RISPERDAL M-TAB.................................................... 49RISPERDAL M-TAB.................................................... 49RISPERDAL M-TAB.................................................... 49RISPERDAL M-TAB.................................................... 49risperidone orally disintegrating tab 0.25

mg................................................................................49risperidone orally disintegrating tab 0.5

mg................................................................................49risperidone orally disintegrating tab 1




mg................................................................................50risperidone soln 1 mg/ml............................................ 50

2018

163

risperidone tab 0.25 mg..............................................50risperidone tab 0.5 mg................................................ 50risperidone tab 1 mg................................................... 50risperidone tab 2 mg................................................... 50risperidone tab 3 mg................................................... 50risperidone tab 4 mg................................................... 50RITALIN......................................................................... 86RITALIN......................................................................... 86RITALIN......................................................................... 86RITUXAN.......................................................................40RITUXAN.......................................................................40RITUXAN HYCELA......................................................40RITUXAN HYCELA......................................................40rivastigmine tartrate cap 1.5 mg................................ 23rivastigmine tartrate cap 3 mg....................................23rivastigmine tartrate cap 4.5 mg................................ 23rivastigmine tartrate cap 6 mg....................................23rivastigmine td patch 24hr 13.3

mg/24hr...................................................................... 23rivastigmine td patch 24hr 4.6 mg/24hr.....................23rivastigmine td patch 24hr 9.5 mg/24hr.....................23rizatriptan benzoate oral disintegrating tab 10

mg................................................................................32rizatriptan benzoate oral disintegrating tab 5

mg................................................................................31rizatriptan benzoate tab 10 mg.................................. 32rizatriptan benzoate tab 5 mg.................................... 32ROBINUL.......................................................................96ROBINUL FORTE........................................................96ROCALTROL.............................................................. 115ROCALTROL.............................................................. 115ROCALTROL.............................................................. 115ropinirole hydrochloride tab 0.25 mg.........................45ropinirole hydrochloride tab 0.5 mg...........................45ropinirole hydrochloride tab 1 mg.............................. 45ropinirole hydrochloride tab 2 mg.............................. 45ropinirole hydrochloride tab 3 mg.............................. 45ropinirole hydrochloride tab 4 mg.............................. 45ropinirole hydrochloride tab 5 mg.............................. 45ropinirole hydrochloride tab er 24hr 12

mg................................................................................45ropinirole hydrochloride tab er 24hr 2




mg................................................................................45rosuvastatin calcium tab 10 mg................................. 80rosuvastatin calcium tab 20 mg................................. 80rosuvastatin calcium tab 40 mg................................. 80

rosuvastatin calcium tab 5 mg................................... 80ROTARIX.....................................................................112ROTATEQ....................................................................112ROXICODONE............................................................... 5ROXICODONE............................................................... 5ROXICODONE............................................................... 5RUBRACA.....................................................................40RUBRACA.....................................................................40RUBRACA.....................................................................40RYDAPT........................................................................ 40RYTHMOL SR..............................................................80RYTHMOL SR..............................................................80RYTHMOL SR..............................................................80SSABRIL.......................................................................... 21SABRIL.......................................................................... 21SALAGEN......................................................................87SALAGEN......................................................................87SAMSCA........................................................................93SAMSCA........................................................................93SANDIMMUNE...........................................................112SANDIMMUNE...........................................................112SANDIMMUNE...........................................................112SANDIMMUNE...........................................................112SANDOSTATIN LAR DEPOT...................................107SANDOSTATIN LAR DEPOT...................................107SANDOSTATIN LAR DEPOT...................................107SANTYL.........................................................................90SAPHRIS.......................................................................50SAPHRIS.......................................................................50SAPHRIS.......................................................................50SEASONIQUE............................................................104selegiline hcl cap 5 mg............................................... 45selegiline hcl tab 5 mg................................................ 45selenium sulfide lotion 2.5%.......................................90SELZENTRY.................................................................55SELZENTRY.................................................................55SELZENTRY.................................................................55SELZENTRY.................................................................55SELZENTRY.................................................................55SENSIPAR.................................................................. 115SENSIPAR.................................................................. 115SENSIPAR.................................................................. 115SEREVENT DISKUS.................................................122SEROQUEL.................................................................. 50SEROQUEL.................................................................. 50SEROQUEL.................................................................. 50SEROQUEL.................................................................. 50SEROQUEL.................................................................. 50SEROQUEL.................................................................. 50SEROQUEL XR........................................................... 50SEROQUEL XR........................................................... 50

2018

164

SEROQUEL XR........................................................... 50SEROQUEL XR........................................................... 50SEROQUEL XR........................................................... 50sertraline hcl oral conc 20 mg/ml...............................26sertraline hcl tab 100 mg............................................ 26sertraline hcl tab 25 mg.............................................. 26sertraline hcl tab 50 mg.............................................. 26sevelamer carbonate packet 0.8 gm......................... 93sevelamer carbonate packet 2.4 gm......................... 93sevelamer carbonate tab 800 mg..............................93SFROWASA................................................................114SIGNIFOR...................................................................107SIGNIFOR...................................................................107SIGNIFOR...................................................................107SIGNIFOR LAR..........................................................107SIGNIFOR LAR..........................................................107SIGNIFOR LAR..........................................................107sildenafil citrate tab 20 mg....................................... 122SILENOR.....................................................................124SILENOR.....................................................................124SILVADENE...................................................................90silver sulfadiazine cream 1%......................................90SIMBRINZA................................................................ 117SIMULECT.................................................................. 112SIMULECT.................................................................. 112simvastatin tab 10 mg.................................................80simvastatin tab 20 mg.................................................80simvastatin tab 40 mg.................................................80simvastatin tab 5 mg................................................... 80simvastatin tab 80 mg.................................................81SINEMET.......................................................................45SINEMET.......................................................................45SINEMET.......................................................................45SINEMET CR............................................................... 45SINEMET CR............................................................... 45SINGULAIR.................................................................122SINGULAIR.................................................................122SINGULAIR.................................................................122SINGULAIR.................................................................122sirolimus tab 0.5 mg..................................................112sirolimus tab 1 mg..................................................... 112sirolimus tab 2 mg..................................................... 112SIRTURO.......................................................................33SIVEXTRO.................................................................... 15SIVEXTRO.................................................................... 15sodium chloride inj 0.45%...........................................93sodium chloride irrigation soln 0.9%......................... 93sodium chloride iv soln 0.9%..................................... 93sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................97sodium phenylbutyrate tab 500 mg........................... 97

sodium polystyrene sulfonate oral susp 15gm/60ml......................................................................93

sodium polystyrene sulfonate powder.......................93sodium polystyrene sulfonate rectal susp 30

gm/120ml....................................................................93SOLTAMOX...................................................................40SOLU-MEDROL.........................................................100SOLU-MEDROL.........................................................100SOLU-MEDROL.........................................................100SOLU-MEDROL.........................................................100SOMATULINE DEPOT..............................................107SOMATULINE DEPOT..............................................107SOMATULINE DEPOT..............................................107SOMAVERT................................................................ 107SOMAVERT................................................................ 107SOMAVERT................................................................ 107SOMAVERT................................................................ 107SOMAVERT................................................................ 107SOOLANTRA................................................................90sotalol hcl (afib/afl) tab 120 mg..................................81sotalol hcl (afib/afl) tab 160 mg..................................81sotalol hcl (afib/afl) tab 80 mg....................................81sotalol hcl tab 120 mg.................................................81sotalol hcl tab 160 mg.................................................81sotalol hcl tab 240 mg.................................................81sotalol hcl tab 80 mg...................................................81SOVALDI....................................................................... 55SPIRIVA HANDIHALER............................................122SPIRIVA RESPIMAT................................................. 122SPIRIVA RESPIMAT................................................. 122spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................81spironolactone tab 100 mg.........................................81spironolactone tab 25 mg........................................... 81spironolactone tab 50 mg........................................... 81SPORANOX..................................................................30SPORANOX PULSEPAK............................................30SPRITAM.......................................................................21SPRITAM.......................................................................21SPRITAM.......................................................................21SPRITAM.......................................................................21SPRYCEL......................................................................40SPRYCEL......................................................................40SPRYCEL......................................................................41SPRYCEL......................................................................41SPRYCEL......................................................................41SPRYCEL......................................................................41STARLIX........................................................................ 61STARLIX........................................................................ 61stavudine cap 15 mg...................................................55stavudine cap 20 mg...................................................55stavudine cap 30 mg...................................................55

2018

165

stavudine cap 40 mg...................................................55STELARA....................................................................113STELARA....................................................................113STELARA....................................................................113STELARA....................................................................113STIMATE..................................................................... 101STIOLTO RESPIMAT................................................ 122STIVARGA.....................................................................41STRATTERA.................................................................86STRATTERA.................................................................86STRATTERA.................................................................86STRATTERA.................................................................86STRATTERA.................................................................86STRATTERA.................................................................86STRATTERA.................................................................86STRENSIQ....................................................................97STRENSIQ....................................................................97STRENSIQ....................................................................97STRENSIQ....................................................................97STREPTOMYCIN SULFATE...................................... 15STRIBILD...................................................................... 55STROMECTOL.............................................................43SUBOXONE....................................................................6SUBOXONE....................................................................6SUBOXONE....................................................................6SUBOXONE....................................................................6sucralfate tab 1 gm......................................................96SULAR........................................................................... 81SULAR........................................................................... 81SULAR........................................................................... 81sulfacetamide sodium lotion 10%.............................. 15sulfacetamide sodium ophth soln

10%...........................................................................118sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%....................................................... 118SULFADIAZINE............................................................ 15sulfamethoxazole-trimethoprim iv soln 400-80

mg/5ml........................................................................ 15sulfamethoxazole-trimethoprim susp 200-40

mg/5ml........................................................................ 15sulfamethoxazole-trimethoprim tab 400-80

mg................................................................................15sulfamethoxazole-trimethoprim tab 800-160

mg................................................................................15sulfasalazine tab 500 mg..........................................114sulfasalazine tab delayed release 500

mg............................................................................. 114sulindac tab 150 mg...................................................... 5sulindac tab 200 mg...................................................... 5sumatriptan nasal spray 20 mg/act........................... 32sumatriptan nasal spray 5 mg/act..............................32SUMATRIPTAN SUCCINATE.....................................32

sumatriptan succinate inj 6 mg/0.5ml........................32sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................32sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................32sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................32sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................32sumatriptan succinate tab 100 mg............................ 32sumatriptan succinate tab 25 mg...............................32sumatriptan succinate tab 50 mg...............................32SUPRAX........................................................................15SUPRAX........................................................................15SUPRAX........................................................................15SUPREP BOWEL PREP KIT.....................................96SURMONTIL.................................................................26SURMONTIL.................................................................26SURMONTIL.................................................................26SUSTIVA........................................................................55SUSTIVA........................................................................55SUSTIVA........................................................................55SUTENT........................................................................ 41SUTENT........................................................................ 41SUTENT........................................................................ 41SUTENT........................................................................ 41SYLATRON................................................................... 55SYLATRON................................................................... 55SYLATRON................................................................... 55SYLVANT.....................................................................113SYLVANT.....................................................................113SYMBICORT...............................................................122SYMBICORT...............................................................122SYMLINPEN 120......................................................... 62SYMLINPEN 60............................................................62SYNAGIS.................................................................... 113SYNAGIS.................................................................... 113SYNAREL....................................................................107SYNERCID....................................................................15SYNJARDY................................................................... 62SYNJARDY................................................................... 62SYNJARDY................................................................... 62SYNJARDY................................................................... 62SYNJARDY XR............................................................ 62SYNJARDY XR............................................................ 62SYNJARDY XR............................................................ 62SYNJARDY XR............................................................ 62SYNRIBO...................................................................... 41SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105

2018

166

SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYNTHROID...............................................................105SYPRINE.......................................................................93TTABLOID........................................................................41tacrolimus cap 0.5 mg...............................................113tacrolimus cap 1 mg..................................................113tacrolimus cap 5 mg..................................................113tacrolimus oint 0.03%..................................................90tacrolimus oint 0.1%.................................................... 90TAFINLAR..................................................................... 41TAFINLAR..................................................................... 41TAGRISSO.................................................................... 41TAGRISSO.................................................................... 41TAMIFLU........................................................................55TAMIFLU........................................................................55TAMIFLU........................................................................55TAMIFLU........................................................................55tamoxifen citrate tab 10 mg........................................41tamoxifen citrate tab 20 mg........................................41tamsulosin hcl cap 0.4 mg..........................................98TARCEVA...................................................................... 41TARCEVA...................................................................... 41TARCEVA...................................................................... 41TARGRETIN..................................................................41TARGRETIN..................................................................41TASIGNA....................................................................... 41TASIGNA....................................................................... 41TASMAR........................................................................ 45TAXOTERE................................................................... 41TAXOTERE................................................................... 41tazarotene cream 0.1%...............................................90TAZORAC......................................................................90TAZORAC......................................................................90TAZORAC......................................................................90TECENTRIQ................................................................. 41TECFIDERA..................................................................86TECFIDERA..................................................................86TECFIDERA STARTER PACK...................................86TECHNIVIE................................................................... 55TEFLARO......................................................................15TEFLARO......................................................................15TEGRETOL...................................................................21TEGRETOL...................................................................21TEGRETOL-XR............................................................ 21TEGRETOL-XR............................................................ 21

TEGRETOL-XR............................................................ 21TEKTURNA...................................................................81TEKTURNA...................................................................81TEKTURNA HCT......................................................... 81TEKTURNA HCT......................................................... 81TEKTURNA HCT......................................................... 81TEKTURNA HCT......................................................... 81telmisartan-amlodipine tab 40-10 mg........................81telmisartan-amlodipine tab 40-5 mg..........................81telmisartan-amlodipine tab 80-10 mg........................81telmisartan-amlodipine tab 80-5 mg..........................81telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................81telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................81telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................81telmisartan tab 20 mg................................................. 81telmisartan tab 40 mg................................................. 81telmisartan tab 80 mg................................................. 81temazepam cap 15 mg............................................. 124temazepam cap 30 mg............................................. 124TEMODAR.................................................................... 41TEMOVATE................................................................... 90TENCON..........................................................................5TENIVAC..................................................................... 113TENORETIC 100......................................................... 81TENORETIC 50............................................................81TENORMIN................................................................... 81TENORMIN................................................................... 81TENORMIN................................................................... 81TERAZOL 7.................................................................. 30terazosin hcl cap 10 mg..............................................82terazosin hcl cap 1 mg................................................81terazosin hcl cap 2 mg................................................81terazosin hcl cap 5 mg................................................82terbinafine hcl tab 250 mg..........................................30terbutaline sulfate tab 2.5 mg.................................. 122terbutaline sulfate tab 5 mg......................................122terconazole vaginal cream 0.4%................................30terconazole vaginal cream 0.8%................................30terconazole vaginal suppos 80 mg............................30testosterone cypionate im inj in oil 100 mg/

ml...............................................................................104testosterone cypionate im inj in oil 200 mg/

ml...............................................................................104testosterone enanthate im inj in oil 200 mg/

ml...............................................................................104testosterone td gel 12.5 mg/act (1%)...................... 104testosterone td gel 25 mg/2.5gm

(1%).......................................................................... 104testosterone td gel 50 mg/5gm (1%).......................104

2018

167

testosterone td soln 30 mg/act.................................105TETANUS/DIPHTHERIA TOXOIDS

ADSORBED.............................................................113tetrabenazine tab 12.5 mg..........................................86tetrabenazine tab 25 mg.............................................86tetracycline hcl cap 250 mg........................................15tetracycline hcl cap 500 mg........................................15THALOMID....................................................................41THALOMID....................................................................41THALOMID....................................................................41THALOMID....................................................................41THEO-24..................................................................... 122THEO-24..................................................................... 122THEO-24..................................................................... 123THEO-24..................................................................... 123theophylline tab er 12hr 100 mg..............................123theophylline tab er 12hr 200 mg..............................123theophylline tab er 12hr 300 mg..............................123theophylline tab er 12hr 450 mg..............................123theophylline tab er 24hr 400 mg..............................123theophylline tab er 24hr 600 mg..............................123thioridazine hcl tab 100 mg........................................ 50thioridazine hcl tab 10 mg.......................................... 50thioridazine hcl tab 25 mg.......................................... 50thioridazine hcl tab 50 mg.......................................... 50thiotepa for inj 15 mg.................................................. 41thiothixene cap 10 mg.................................................50thiothixene cap 1 mg...................................................50thiothixene cap 2 mg...................................................50thiothixene cap 5 mg...................................................50THYMOGLOBULIN....................................................113tiagabine hcl tab 2 mg.................................................21tiagabine hcl tab 4 mg.................................................21TIAZAC.......................................................................... 82TIAZAC.......................................................................... 82TIAZAC.......................................................................... 82TIAZAC.......................................................................... 82TIAZAC.......................................................................... 82TIAZAC.......................................................................... 82TIKOSYN.......................................................................82TIKOSYN.......................................................................82TIKOSYN.......................................................................82TIMOLOL MALEATE................................................... 82TIMOLOL MALEATE................................................... 82TIMOLOL MALEATE................................................... 82timolol maleate ophth gel forming soln

0.25%........................................................................118timolol maleate ophth gel forming soln

0.5%..........................................................................118timolol maleate ophth soln 0.25%........................... 118timolol maleate ophth soln 0.5%..............................118TIMOPTIC................................................................... 118

TIMOPTIC................................................................... 118TIMOPTIC OCUDOSE..............................................118TIMOPTIC OCUDOSE..............................................118TIMOPTIC-XE.............................................................118TIMOPTIC-XE.............................................................118TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIROSINT....................................................................106TIVICAY......................................................................... 55TIVICAY......................................................................... 55TIVICAY......................................................................... 56tizanidine hcl cap 2 mg............................................... 51tizanidine hcl cap 4 mg............................................... 51tizanidine hcl cap 6 mg............................................... 51tizanidine hcl tab 2 mg................................................51tizanidine hcl tab 4 mg................................................51TOBRADEX................................................................ 118TOBRADEX................................................................ 118tobramycin-dexamethasone ophth susp

0.3-0.1%...................................................................118tobramycin nebu soln 300 mg/5ml.......................... 123tobramycin ophth soln 0.3%.....................................118TOBRAMYCIN SULFATE........................................... 15tobramycin sulfate for inj 1.2 gm................................15tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................15tobramycin sulfate inj 10 mg/ml................................. 15tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................15tolcapone tab 100 mg................................................. 45TOLMETIN SODIUM..................................................... 5tolterodine tartrate cap er 24hr 2 mg.........................98tolterodine tartrate cap er 24hr 4 mg.........................98tolterodine tartrate tab 1 mg.......................................98tolterodine tartrate tab 2 mg.......................................99topiramate sprinkle cap 15 mg...................................21topiramate sprinkle cap 25 mg...................................21topiramate tab 100 mg................................................21topiramate tab 200 mg................................................21topiramate tab 25 mg.................................................. 21topiramate tab 50 mg.................................................. 21TOPOTECAN HCL...................................................... 41topotecan hcl for inj 4 mg........................................... 41TOPROL XL..................................................................82TOPROL XL..................................................................82

2018

168

TOPROL XL..................................................................82TOPROL XL..................................................................82TORISEL....................................................................... 41torsemide tab 100 mg................................................. 82torsemide tab 10 mg................................................... 82torsemide tab 20 mg................................................... 82torsemide tab 5 mg......................................................82TOUJEO SOLOSTAR..................................................62TOVIAZ.......................................................................... 99TOVIAZ.......................................................................... 99TRACLEER.................................................................123TRACLEER.................................................................123TRADJENTA................................................................. 62tramadol-acetaminophen tab 37.5-325

mg..................................................................................5tramadol hcl tab 50 mg................................................. 5tramadol hcl tab er 24hr 100 mg..................................5tramadol hcl tab er 24hr 200 mg..................................5tramadol hcl tab er 24hr 300 mg..................................5trandolapril tab 1 mg................................................... 82trandolapril tab 2 mg................................................... 82trandolapril tab 4 mg................................................... 82tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................65tranexamic acid tab 650 mg.......................................65tranylcypromine sulfate tab 10 mg............................ 26TRAVATAN Z.............................................................. 118trazodone hcl tab 100 mg...........................................26trazodone hcl tab 150 mg...........................................26trazodone hcl tab 300 mg...........................................26trazodone hcl tab 50 mg.............................................26TREANDA..................................................................... 41TREANDA..................................................................... 41TRECATOR...................................................................33TRELSTAR..................................................................107TRELSTAR..................................................................107TRELSTAR MIXJECT............................................... 107TRELSTAR MIXJECT............................................... 107TRELSTAR MIXJECT............................................... 107TRESIBA FLEXTOUCH.............................................. 62TRESIBA FLEXTOUCH.............................................. 62tretinoin cap 10 mg......................................................42tretinoin cream 0.025%............................................... 90tretinoin cream 0.05%................................................. 90tretinoin cream 0.1%................................................... 90tretinoin gel 0.01%.......................................................90tretinoin gel 0.025%.....................................................90triamcinolone acetonide cream

0.025%........................................................................90triamcinolone acetonide cream 0.1%........................90triamcinolone acetonide cream 0.5%........................90

triamcinolone acetonide dental paste0.1%............................................................................87

triamcinolone acetonide lotion 0.025%..................... 90triamcinolone acetonide lotion 0.1%..........................90triamcinolone acetonide nasal aerosol suspension

55 mcg/act............................................................... 123triamcinolone acetonide oint 0.025%........................ 90triamcinolone acetonide oint 0.1%.............................90triamcinolone acetonide oint 0.5%.............................90triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................82triamterene & hydrochlorothiazide tab 37.5-25

mg................................................................................82triamterene & hydrochlorothiazide tab 75-50

mg................................................................................82TRIBENZOR................................................................. 82TRIBENZOR................................................................. 82TRIBENZOR................................................................. 82TRIBENZOR................................................................. 83TRIBENZOR................................................................. 83trifluoperazine hcl tab 10 mg......................................50trifluoperazine hcl tab 1 mg........................................50trifluoperazine hcl tab 2 mg........................................50trifluoperazine hcl tab 5 mg........................................50trifluridine ophth soln 1%.......................................... 118TRILEPTAL................................................................... 21TRILEPTAL................................................................... 21TRILEPTAL................................................................... 21TRILEPTAL................................................................... 21trimethoprim tab 100 mg.............................................15trimipramine maleate cap 100 mg............................. 27trimipramine maleate cap 25 mg............................... 26trimipramine maleate cap 50 mg............................... 26TRI-NORINYL 28.......................................................105TRINTELLIX..................................................................27TRINTELLIX..................................................................27TRINTELLIX..................................................................27TRISENOX....................................................................42TRIUMEQ......................................................................56TROPHAMINE..............................................................93trospium chloride cap er 24hr 60 mg.........................99trospium chloride tab 20 mg.......................................99TRUMENBA................................................................113TRUSOPT................................................................... 118TRUVADA......................................................................56TRUVADA......................................................................56TRUVADA......................................................................56TRUVADA......................................................................56TWINRIX..................................................................... 113TYBOST........................................................................ 56TYGACIL....................................................................... 15TYKERB........................................................................ 42

2018

169

TYPHIM VI..................................................................113TYSABRI....................................................................... 87UULORIC......................................................................... 31ULORIC......................................................................... 31ULTRACET......................................................................5ULTRAM.......................................................................... 5ULTRAVATE.................................................................. 90ULTRAVATE.................................................................. 90UNITUXIN......................................................................42UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123UPTRAVI..................................................................... 123ursodiol cap 300 mg....................................................96ursodiol tab 250 mg.....................................................96ursodiol tab 500 mg.....................................................96UVADEX........................................................................ 91VVAGIFEM.....................................................................105valacyclovir hcl tab 1 gm............................................ 56valacyclovir hcl tab 500 mg........................................56VALCHLOR................................................................... 42VALCYTE.......................................................................56VALCYTE.......................................................................56valganciclovir hcl for soln 50 mg/ml.......................... 56valganciclovir hcl tab 450 mg.....................................56valproate sodium inj 100 mg/ml.................................21valproate sodium oral soln 250 mg/5ml.................... 21valproic acid cap 250 mg............................................21valsartan-hydrochlorothiazide tab 160-12.5

mg................................................................................83valsartan-hydrochlorothiazide tab 160-25

mg................................................................................83valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................83valsartan-hydrochlorothiazide tab 320-25

mg................................................................................83valsartan-hydrochlorothiazide tab 80-12.5

mg................................................................................83valsartan tab 160 mg...................................................83valsartan tab 320 mg...................................................83valsartan tab 40 mg.....................................................83valsartan tab 80 mg.....................................................83VALTREX.......................................................................56VALTREX.......................................................................56

vancomycin hcl cap 125 mg.......................................15vancomycin hcl cap 250 mg.......................................16vancomycin hcl for inj 1000 mg................................. 16vancomycin hcl for inj 100 gm................................... 16vancomycin hcl for inj 10 gm......................................16vancomycin hcl for inj 5000 mg................................. 16vancomycin hcl for inj 500 mg................................... 16vancomycin hcl for inj 750 mg................................... 16VANCOMYCIN HCL IN DEXTROSE.........................16VANCOMYCIN HCL IN DEXTROSE.........................16VANCOMYCIN HCL IN DEXTROSE.........................16VAQTA......................................................................... 113VAQTA......................................................................... 113VARIVAX..................................................................... 113VASCEPA...................................................................... 83VASCEPA...................................................................... 83VASERETIC.................................................................. 83VASOTEC......................................................................83VASOTEC......................................................................83VASOTEC......................................................................83VASOTEC......................................................................83VECTIBIX...................................................................... 42VECTIBIX...................................................................... 42VELCADE......................................................................42VENCLEXTA.................................................................42VENCLEXTA.................................................................42VENCLEXTA.................................................................42VENCLEXTA STARTING PACK................................ 42venlafaxine hcl cap er 24hr 150 mg.......................... 27venlafaxine hcl cap er 24hr 37.5 mg......................... 27venlafaxine hcl cap er 24hr 75 mg............................ 27venlafaxine hcl tab 100 mg........................................ 27venlafaxine hcl tab 25 mg...........................................27venlafaxine hcl tab 37.5 mg....................................... 27venlafaxine hcl tab 50 mg...........................................27venlafaxine hcl tab 75 mg...........................................27venlafaxine hcl tab er 24hr 150 mg........................... 27venlafaxine hcl tab er 24hr 37.5 mg..........................27venlafaxine hcl tab er 24hr 75 mg............................. 27VENTAVIS................................................................... 123VENTAVIS................................................................... 123VENTOLIN HFA......................................................... 123verapamil hcl cap er 24hr 100 mg.............................83verapamil hcl cap er 24hr 120 mg.............................83verapamil hcl cap er 24hr 180 mg.............................83verapamil hcl cap er 24hr 200 mg.............................83verapamil hcl cap er 24hr 240 mg.............................83verapamil hcl cap er 24hr 300 mg.............................83verapamil hcl cap er 24hr 360 mg.............................83verapamil hcl tab 120 mg........................................... 83verapamil hcl tab 40 mg............................................. 83verapamil hcl tab 80 mg............................................. 83

2018

170

verapamil hcl tab er 120 mg.......................................83verapamil hcl tab er 180 mg.......................................83verapamil hcl tab er 240 mg.......................................83VERELAN......................................................................83VERELAN......................................................................83VERELAN......................................................................83VERELAN......................................................................83VERELAN PM.............................................................. 83VERELAN PM.............................................................. 84VERELAN PM.............................................................. 84VERSACLOZ................................................................ 50VFEND IV......................................................................30VIBRAMYCIN................................................................16VICTOZA....................................................................... 62VIDEX............................................................................ 56VIDEX............................................................................ 56VIDEX EC..................................................................... 56VIDEX EC..................................................................... 56VIDEX EC..................................................................... 56VIDEX EC..................................................................... 56VIEKIRA PAK................................................................56VIEKIRA XR..................................................................56vigabatrin powd pack 500 mg.................................... 21VIGAMOX....................................................................118VIIBRYD.........................................................................27VIIBRYD.........................................................................27VIIBRYD.........................................................................27VIIBRYD STARTER PACK......................................... 27VIMPAT.......................................................................... 21VIMPAT.......................................................................... 21VIMPAT.......................................................................... 21VIMPAT.......................................................................... 21VIMPAT.......................................................................... 21VIMPAT.......................................................................... 21VINBLASTINE SULFATE............................................42vincristine sulfate iv soln 1 mg/ml..............................42vinorelbine tartrate inj 10 mg/ml.................................42vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................42VIOKACE.......................................................................97VIOKACE.......................................................................97VIRACEPT.................................................................... 56VIRACEPT.................................................................... 56VIRAMUNE................................................................... 56VIRAMUNE XR............................................................ 56VIRAMUNE XR............................................................ 56VIREAD..........................................................................56VIREAD..........................................................................56VIREAD..........................................................................56VIREAD..........................................................................56VIREAD..........................................................................56VIROPTIC................................................................... 118

VIVITROL........................................................................ 6VOLTAREN......................................................................5voriconazole for inj 200 mg........................................ 30voriconazole for susp 40 mg/ml.................................30voriconazole tab 200 mg............................................ 30voriconazole tab 50 mg...............................................30VOSEVI..........................................................................57VOTRIENT.................................................................... 42VPRIV............................................................................ 97VRAYLAR...................................................................... 50VRAYLAR...................................................................... 51VRAYLAR...................................................................... 51VRAYLAR...................................................................... 51VYTORIN.......................................................................84VYTORIN.......................................................................84VYTORIN.......................................................................84VYTORIN.......................................................................84VYXEOS........................................................................42Wwarfarin sodium tab 10 mg.........................................65warfarin sodium tab 1 mg...........................................65warfarin sodium tab 2.5 mg........................................65warfarin sodium tab 2 mg...........................................65warfarin sodium tab 3 mg...........................................65warfarin sodium tab 4 mg...........................................65warfarin sodium tab 5 mg...........................................65warfarin sodium tab 6 mg...........................................65warfarin sodium tab 7.5 mg........................................65water for irrigation, sterile irrigation

soln..............................................................................93WELCHOL.....................................................................84WELCHOL.....................................................................84WELLBUTRIN SR........................................................27WELLBUTRIN SR........................................................27WELLBUTRIN SR........................................................27WELLBUTRIN XL........................................................ 27WELLBUTRIN XL........................................................ 27WESTCORT..................................................................91XXALKORI....................................................................... 42XALKORI....................................................................... 42XARELTO...................................................................... 65XARELTO...................................................................... 65XARELTO...................................................................... 65XARELTO STARTER PACK.......................................65XATMEP...................................................................... 113XENAZINE.................................................................... 87XENAZINE.................................................................... 87XGEVA.........................................................................115XIFAXAN........................................................................96XOLAIR........................................................................113

2018

171

XOPENEX HFA..........................................................123XTANDI.......................................................................... 42XYLOCAINE....................................................................6XYLOCAINE....................................................................6XYLOCAINE-MPF.......................................................... 6XYREM........................................................................124YYASMIN 28................................................................. 105YAZ...............................................................................105YERVOY........................................................................42YERVOY........................................................................42YF-VAX........................................................................ 113YONDELIS.................................................................... 42Zzafirlukast tab 10 mg.................................................123zafirlukast tab 20 mg.................................................123zaleplon cap 10 mg...................................................124zaleplon cap 5 mg..................................................... 124ZALTRAP.......................................................................42ZALTRAP.......................................................................42ZANAFLEX....................................................................51ZANOSAR..................................................................... 42ZANTAC.........................................................................96ZANTAC.........................................................................96ZARONTIN....................................................................21ZAVESCA...................................................................... 97ZEJULA..........................................................................42ZELBORAF................................................................... 42ZEMPLAR................................................................... 115ZEMPLAR................................................................... 115ZEMPLAR................................................................... 115ZEMPLAR................................................................... 115ZENPEP........................................................................ 97ZENPEP........................................................................ 97ZENPEP........................................................................ 97ZENPEP........................................................................ 97ZENPEP........................................................................ 97ZENPEP........................................................................ 98ZENPEP........................................................................ 98ZENPEP........................................................................ 98ZEPATIER..................................................................... 57ZERIT.............................................................................57ZERIT.............................................................................57ZERIT.............................................................................57ZERIT.............................................................................57ZERIT.............................................................................57ZESTORETIC............................................................... 84ZESTORETIC............................................................... 84ZESTORETIC............................................................... 84ZESTRIL........................................................................84ZESTRIL........................................................................84

ZESTRIL........................................................................84ZESTRIL........................................................................84ZESTRIL........................................................................84ZESTRIL........................................................................84ZETIA............................................................................. 84ZIAC............................................................................... 84ZIAC............................................................................... 84ZIAC............................................................................... 84ZIAGEN..........................................................................57ZIAGEN..........................................................................57zidovudine cap 100 mg...............................................57zidovudine syrup 10 mg/ml.........................................57zidovudine tab 300 mg................................................57ZINACEF....................................................................... 16ziprasidone hcl cap 20 mg..........................................51ziprasidone hcl cap 40 mg..........................................51ziprasidone hcl cap 60 mg..........................................51ziprasidone hcl cap 80 mg..........................................51ZITHROMAX.................................................................16ZITHROMAX.................................................................16ZITHROMAX.................................................................16ZITHROMAX.................................................................16ZITHROMAX.................................................................16ZITHROMAX.................................................................16ZITHROMAX TRI-PAK................................................ 16ZITHROMAX Z-PAK.................................................... 16ZOCOR..........................................................................84ZOCOR..........................................................................84ZOCOR..........................................................................84ZOCOR..........................................................................84ZOCOR..........................................................................84ZOFRAN........................................................................29ZOFRAN........................................................................29ZOFRAN........................................................................29ZOFRAN ODT.............................................................. 29ZOFRAN ODT.............................................................. 29ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5zoledronic acid inj conc for iv infusion 4

mg/5ml......................................................................115zoledronic acid iv soln 5 mg/100ml......................... 115ZOLINZA........................................................................42zolmitriptan orally disintegrating tab 2.5

mg................................................................................32zolmitriptan orally disintegrating tab 5

mg................................................................................32ZOLOFT.........................................................................27ZOLOFT.........................................................................27

2018

172

ZOLOFT.........................................................................27ZOLOFT.........................................................................27zolpidem tartrate tab 10 mg..................................... 124zolpidem tartrate tab 5 mg....................................... 124ZOMETA......................................................................115ZONALON..................................................................... 91ZONEGRAN..................................................................21ZONEGRAN..................................................................21zonisamide cap 100 mg..............................................22zonisamide cap 25 mg................................................22zonisamide cap 50 mg................................................22ZONTIVITY....................................................................65ZORTRESS.................................................................113ZORTRESS.................................................................113ZORTRESS.................................................................113ZOSTAVAX..................................................................113ZOSYN...........................................................................16ZOSYN...........................................................................16ZOSYN...........................................................................16ZOSYN...........................................................................16ZOSYN...........................................................................16ZOSYN...........................................................................16ZOVIRAX.......................................................................57ZOVIRAX.......................................................................57ZOVIRAX.......................................................................57ZOVIRAX.......................................................................57ZYBAN............................................................................. 6ZYDELIG....................................................................... 42ZYDELIG....................................................................... 42ZYKADIA....................................................................... 42ZYLOPRIM....................................................................31ZYLOPRIM....................................................................31ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA......................................................................51ZYPREXA RELPREVV............................................... 51ZYPREXA RELPREVV............................................... 51ZYPREXA RELPREVV............................................... 51ZYPREXA ZYDIS.........................................................51ZYPREXA ZYDIS.........................................................51ZYPREXA ZYDIS.........................................................51ZYPREXA ZYDIS.........................................................51ZYTIGA..........................................................................42ZYTIGA..........................................................................42ZYVOX...........................................................................16ZYVOX...........................................................................16ZYVOX...........................................................................16ZYVOX...........................................................................16

Este formulario fue actualizado el 01/01/2018. Si tiene preguntas o desea información más actualizada, comuníquese con Florida Blue a 1-800-926-6565 o, los usuarios de equipo teleescritor (TTY), llamen 1-877-955-8773. Nuestro horario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, desde el 1 de octubre hasta el 14 de febrero, excepto el día de Acción de Gracias y el día de Navidad. Desde el 15 de febrero hasta el 30 de septiembre, el horario es de 8:00 a.m. a 8:00 p.m. hora local, excepto los días feriados. O visite www.BlueMedicareFL.com.

87768 0217R

Section 1557 Notification: Discrimination is Against the Law

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO (collectively, “Florida Blue”), Florida

Combined Life and the Blue Cross and Blue Shield Federal Employee Program® (FEP) comply with applicable

Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or

sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability,

or sex.

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO, Florida Combined Life and FEP:

Provide free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provide free language services to people whose primary language is not English, such as:

o Qualified interpreters

o Information written in other languages

If you need these services, contact:

Florida Blue (health and vision coverage): 1-800-352-2583

Florida Combined Life (dental, life, and disability coverage): 1-888-223-4892

Federal Employee Program: 1-800-333-2227

If you believe that we have failed to provide these services or discriminated in another way on the basis of race,

color, national origin, age, disability, or sex, you can file a grievance with:

Florida Blue (including FEP members):

Section 1557 Coordinator

4800 Deerwood Campus Parkway, DCC 1-7

Jacksonville, FL 32246

1-800-477-3736 x29070

1-800-955-8770 (TTY)

Fax: 1-904-301-1580

[email protected]

Florida Combined Life:

Civil Rights Coordinator

17500 Chenal Parkway

Little Rock, AR 72223

1-800-260-0331

1-800-955-8770 (TTY)

[email protected]

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Section

1557 Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of

Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights

Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019

1-800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-

800-352-2583 (TTY: 1-877-955-8773). FEP: Llame al 1-800-333-2227

ATANSYON: Si w pale Kreyòl ayisyen, ou ka resevwa yon èd gratis nan lang pa w. Rele 1-800-352-2583 (pou

moun ki pa tande byen: 1-800-955-8770). FEP: Rele 1-800-333-2227

CHÚ Ý: Nếu bạn nói Tiếng Việt, có dịch vụ trợ giúp ngôn ngữ miễn phí dành cho bạn. Hãy gọi số 1-800-352-

2583 (TTY: 1-800-955-8770). FEP: Gọi số 1-800-333-2227

ATENÇÃO: Se você fala português, utilize os serviços linguísticos gratuitos disponíveis. Ligue para 1-800-

352-2583 (TTY: 1-800-955-8770). FEP: Ligue para 1-800-333-2227

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-800-352-2583（TTY: 1-800-955-

8770)。FEP：請致電1-800-333-2227

ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.

Appelez le 1-800-352-2583 (ATS : 1-800-955-8770). FEP : Appelez le 1-800-333-2227

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang

walang bayad. Tumawag sa 1-800-352-2583 (TTY: 1-800-955-8770). FEP: Tumawag sa 1-800-333-2227

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

Звоните 1-800-352-2583 (телетайп: 1-800-955-8770). FEP: Звоните 1-800-333-2227

)رقم هاتف الصم 008-253-3852-1اتصل برقم ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.

.7222-333-008-1. اتصل برقم 008-559-0778-1والبكم:

ATTENZIONE: Qualora fosse l'italiano la lingua parlata, sono disponibili dei servizi di assistenza linguistica

gratuiti. Chiamare il numero 1-800-352-2583 (TTY: 1-800-955-8770). FEP: chiamare il numero 1-800-333-

2227

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur

Verfügung. Rufnummer: +1-800-352-2583 (TTY: +1-800-955-8770). FEP: Rufnummer +1-800-333-2227

주의: 한국어 사용을 원하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-352-2583

(TTY: 1-800-955-8770) 로 전화하십시오. FEP: 1-800-333-2227 로 연락하십시오.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer

1-800-352-2583 (TTY: 1-800-955-8770). FEP: Zadzwoń pod numer 1-800-333-2227.

સચુના: જો તમ ેગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સવેા તમારા માટ ેઉપલબ્ધ છે.

ફોન કરો 1-800-352-2583 (TTY: 1-800-955-8770). FEP: ફોન કરો 1-800-333-2227

ประกาศ:ถา้คุณพดูภาษาไทย คุณสามารถใชบ้ริการช่วยเหลือทางภาษาไดฟ้รี โดยติดต่อหมายเลขโทรฟรี 1-800-352-2583 (TTY: 1-800-955-8770) หรือ FEP โทร 1-800-333-2227

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-352-2583（TTY: 1-

800-955-8770）まで、お電話にてご連絡ください。FEP: 1-800-333-2227

صحبت می کنید، تسهیالت زبانی رایگان در دسترس شما خواهد بود. فارسی : اگر به زبانتوجهتماس بگیريد. 2227-333-800-1با شماره :FEPتماس بگیريد. (TTY: 1-800-955-8770) 2583-352-800-1با شماره

Baa ákonínzin: Diné bizaad bee yáníłti’go, saad bee áká anáwo’, t’áá jíík’eh, ná hólǫ́. Kojį’ hodíílnih 1-800-

352-2583 (TTY: 1-800-955-8770). FEP ígíí éí kojį’ hodíílnih 1-800-333-2227.

tel:1-800-352-2583

tel:1-800-955-8770

tel:1-800-333-2227

florida’s blue cross and blue shield plan 2018 · bluemedicare complete rx (pdp) s5904-002...

Documents