formulario 2019 (lista de medicamentos cubiertos) · lista de medicamentos si lo reemplazamos con...

Y0096_MRK_TX_PDPFRM_Value19_C 728156.0119 Value

LEA LO SIGUIENTE: ESTE DOCUMENTO CONTIENE INFORMACIÓN ACERCA DE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN

N.º de identificación del archivo del formulario aprobado por HPMS: 00019191, Versión 8

Este formulario se actualizó el 01/16/2019. Para obtener información más reciente o si tiene otras preguntas, comuníquese con el Servicio al Cliente de Blue Cross MedicareRxSM al 1-888-285-2249 o, para los usuarios de TTY, al 711, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si llama del 1.º de abril al 30 de septiembre, durante los fines de semana y días feriados, se usarán tecnologías alternativas (por ejemplo, correo de voz). También puede visitar www.getbluetx.com/pdp/druglist.

Formulario 2019 (Lista de medicamentos cubiertos)Blue Cross MedicareRx Value (PDP)SM

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This information is available for free in other languages. Please call our Customer Service number at 1-888-285-2249. (TTY users should call 711). We are open between 8:00 a.m. – 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al 1-888-285-2249 (los usuarios de TTY deben llamar al 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 1.º de abril al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Nota para los miembros actuales: este Formulario ha cambiado con respecto al año pasado. Revise este documento para asegurarse de que aún contiene los medicamentos que toma.

Cuando esta Lista de medicamentos (Formulario) menciona “nosotros”, “nos” o “nuestro”, hace referencia a HCSC Insurance Services Company (HISC). Cuando dice “plan” o “nuestro plan”, hace referencia a Blue Cross MedicareRx.

Este documento incluye una lista de los medicamentos (Formulario) de nuestro plan, la cual está en vigencia desde enero de 2019. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en las páginas de la portada y la portada posterior.

Generalmente, debe concurrir a las farmacias de la red para usar el beneficio de medicamentos con receta. Los beneficios, el formulario, la red de farmacias o los copagos/el coseguro pueden cambiar el 1.º de enero de 2019, y periódicamente durante el año.

Blue Cross MedicareRx (PDP)

Formulario 2019 (Lista de medicamentos cubiertos)

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¿Qué es el Formulario de Blue Cross MedicareRx?Un Formulario es una lista de medicamentos cubiertos seleccionados por Blue Cross MedicareRx con la colaboración de un equipo de proveedores de atención médica, que representa los tratamientos con receta que se considera que son parte necesaria de un programa de tratamiento de calidad. Normalmente, Blue Cross MedicareRx cubrirá los medicamentos incluidos en el formulario, siempre que el medicamento sea médicamente necesario, el medicamento con receta se obtenga en una farmacia de la red de Blue Cross MedicareRx y se cumpla con otras normas del plan. Para obtener más información sobre cómo obtener sus medicamentos con receta, consulte la Evidencia de cobertura.

¿Puede cambiar el Formulario (la lista de medicamentos)?En general, si usted toma un medicamento de nuestro Formulario para 2019 que estaba cubierto al comienzo del año, nosotros no discontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2019, excepto cuando esté disponible un nuevo medicamento genérico de menor costo, cuando se dé a conocer nueva información acerca de la seguridad o eficacia del medicamento, o el medicamento sea retirado del mercado. (Consulte los puntos a continuación para obtener más información sobre cambios que afectan a los miembros que actualmente toman el medicamento). Otros tipos de cambios en el Formulario, por ejemplo, la eliminación de un medicamento, no afectarán a los miembros que estén actualmente tomando el medicamento. Por el resto del año de cobertura, continuará disponible al mismo costo compartido para aquellos miembros que estén tomándolo. A continuación se incluyen cambios en la Lista de medicamentos que también afectarán a los miembros que actualmente toman un medicamento: • Nuevos medicamentos genéricos. Podemos eliminar inmediatamente un medicamento de marca de nuestra

Lista de medicamentos si lo reemplazamos con un nuevo medicamento genérico que aparecerá en el mismo nivel de costo compartido o en un nivel de costo compartido más bajo y con las mismas restricciones o menos. Además, cuando agreguemos el nuevo medicamento genérico, podemos decidir mantener el medicamento de marca en nuestra Lista de medicamentos pero inmediatamente moverlo a un nivel de costo compartido diferente o agregar nuevas restricciones. Si actualmente está tomando ese medicamento de marca, quizás no le informemos con antelación antes de que realicemos el cambio, pero más adelante le proporcionaremos información sobre los cambios específicos que hemos realizado.

º Si realizamos un cambio, usted o la persona autorizada a dar recetas pueden solicitarnos que hagamos una excepción y sigamos cubriendo el medicamento de marca para usted. El aviso que le proporcionaremos también incluirá información sobre los pasos que puede tomar para solicitar una excepción, y usted también puede encontrar información en la sección a continuación titulada “¿Cómo puedo solicitar que se haga una excepción al Formulario de Blue Cross MedicareRx?”.

• Medicamentos retirados del mercado. Si la Administración de Drogas y Alimentos considera que un medicamento de nuestro Formulario es inseguro o el fabricante del medicamento lo retira del mercado, eliminaremos de inmediato dicho medicamento de nuestro Formulario y les notificaremos a los miembros que toman el medicamento en cuestión.

• Otros cambios. Podemos hacer otros cambios que afectan a los miembros que actualmente toman un medicamento. Por ejemplo, podemos agregar un medicamento genérico que no es nuevo en el mercado para reemplazar un medicamento de marca que actualmente se encuentre en el Formulario o agregar nuevas restricciones al medicamento de marca o moverlo a un nivel de costo compartido diferente. O bien, podemos hacer cambios en función de las nuevas pautas clínicas. Si retiramos medicamentos de nuestro Formulario, o agregamos autorizaciones previas, restricciones de límite de cantidad o de tratamiento escalonado en un medicamento o si pasamos un medicamento a un nivel superior de costo compartido, debemos notificarles a los miembros afectados por el cambio al menos 30 días antes de que entre en vigencia dicho cambio, o cuando el miembro solicite un resurtido del medicamento, momento en el cual el miembro recibirá un suministro del medicamento para 30 días.

El Formulario adjunto está vigente a partir del 16 de enero de 2019. Para recibir información actualizada sobre los medicamentos cubiertos por Blue Cross MedicareRx, comuníquese con nosotros. Nuestra información de contacto aparece en las páginas de la portada y la portada posterior.

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¿Cómo utilizo el Formulario? Hay dos formas para encontrar su medicamento dentro del Formulario:

Afección médicaEl Formulario comienza en la página 1. Los medicamentos de este Formulario están agrupados en categorías según el tipo de afección médica para cuyo tratamiento se los emplea. Por ejemplo, los medicamentos utilizados para tratar una afección cardíaca se enumeran dentro de la categoría “Agentes cardiovasculares”. Si sabe para qué se utiliza su medicamento, busque el nombre de la categoría en la lista que empieza en la página 1. Luego, busque su medicamento debajo del nombre de la categoría.

Listado alfabéticoSi no está seguro de qué categoría consultar, debe buscar su medicamento en el Índice que comienza en la página 112. El Índice proporciona una lista alfabética de todos los medicamentos incluidos en este documento. En el Índice, están tanto los medicamentos de marca como los genéricos. Busque en el Índice y encuentre su medicamento. Junto a su medicamento, verá el número de página donde puede encontrar información acerca de la cobertura. Vaya a la página que figura en el Índice y encuentre el nombre de su medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos?Blue Cross MedicareRx cubre tanto los medicamentos de marca como los genéricos. Un medicamento genérico está aprobado por la Administración de Drogas y Alimentos (Food and Drug Administration, FDA) dado que se considera que tiene el mismo ingrediente activo que el medicamento de marca. Normalmente, los medicamentos genéricos cuestan menos que los de marca.

¿Hay alguna restricción en mi cobertura?Algunos medicamentos cubiertos pueden tener requisitos o límites adicionales de cobertura. Estos requisitos y límites pueden incluir:• Autorización previa: Blue Cross MedicareRx exige que usted o su médico obtenga una autorización previa

para determinados medicamentos. Esto significa que necesitará contar con la aprobación de Blue Cross MedicareRx antes de obtener sus medicamentos con receta. Si no consigue la aprobación, es posible que Blue Cross MedicareRx no cubra el medicamento.

• Límites de cantidad: para ciertos medicamentos, Blue Cross MedicareRx limita la cantidad del medicamento que Blue Cross MedicareRx cubrirá. Por ejemplo, Blue Cross MedicareRx proporciona 30 tabletas por receta de alfuzosina de liberación prolongada. Esto puede ser complementario a un suministro estándar para un mes o tres meses.

• Tratamiento escalonado: en algunos casos, Blue Cross MedicareRx requiere que usted primero pruebe ciertos medicamentos para tratar su afección médica antes de que cubramos otro medicamento para esa enfermedad. Por ejemplo, si el medicamento A y el medicamento B tratan su afección médica, es posible que Blue Cross MedicareRx no cubra el medicamento B a menos que usted pruebe primero el medicamento A. Si el medicamento A no funciona para usted, entonces Blue Cross MedicareRx cubrirá el medicamento B.

Para averiguar si su medicamento tiene requisitos o límites adicionales, consulte el Formulario que empieza en la página 1. También puede obtener más información sobre las restricciones que se aplican a medicamentos cubiertos específicos en nuestro sitio web. Hemos publicado documentos en línea que explican nuestras restricciones de autorización previa y tratamiento escalonado. También puede pedirnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en las páginas de la portada y la portada posterior.Puede pedirle a Blue Cross MedicareRx que haga una excepción a estas restricciones o límites, o puede solicitarle una lista de otros medicamentos similares que puedan tratar su afección médica. Consulte la sección “¿Cómo puedo solicitar que se haga una excepción al Formulario de Blue Cross MedicareRx?” en la página iii para obtener información acerca de cómo solicitar una excepción.

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¿Qué pasa si mi medicamento no está en el Formulario?Si el medicamento que toma no está incluido en este Formulario (lista de medicamentos cubiertos), primero debe comunicarse con Servicio al Cliente y preguntar si su medicamento está cubierto.Si resulta que Blue Cross MedicareRx no cubre el medicamento que toma, tiene dos alternativas:• Puede pedir a Servicio al Cliente una lista de medicamentos similares que están cubiertos por Blue Cross

MedicareRx. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que esté cubierto por Blue Cross MedicareRx.

• Puede solicitarle que Blue Cross MedicareRx haga una excepción para que cubra su medicamento. Consulte a continuación para obtener información sobre cómo solicitar una excepción.

¿Cómo puedo solicitar que se haga una excepción al Formulario de Blue Cross MedicareRx?Puede solicitarle a Blue Cross MedicareRx que haga una excepción a nuestras normas de cobertura. Hay varios tipos de excepciones que puede solicitarnos. • Puede pedirnos que cubramos un medicamento, incluso si no está en nuestro Formulario. Si se aprueba,

este medicamento estará cubierto a un nivel de costo compartido predeterminado, y usted no podrá pedirnos que le brindemos el medicamento a un nivel de costo compartido menor.

• Puede pedirnos que cubramos un medicamento del Formulario a un nivel de costo compartido menor si este medicamento no está incluido en el nivel de medicamentos especializados. Si se aprueba, esto reduciría el monto que usted debe pagar por su medicamento.

• Puede pedirnos que no apliquemos restricciones o límites de cobertura para su medicamento. Por ejemplo, para ciertos medicamentos, Blue Cross MedicareRx limita la cantidad del medicamento que cubrirá. Si su medicamento tiene un límite de cantidad, puede pedirnos que hagamos una excepción al límite y cubramos una cantidad mayor.

Por lo general, Blue Cross MedicareRx solo aprobará su pedido de excepción si los medicamentos alternativos incluidos en el Formulario del plan, el medicamento de menor costo compartido o las restricciones de uso adicionales no fueran tan efectivos para tratar su afección o pudieran causarle efectos médicos adversos. Debe comunicarse con nosotros para solicitarnos una decisión inicial de cobertura para una excepción al Formulario, al nivel o a la restricción de uso. Cuando solicita una excepción al Formulario, al nivel o a la restricción de uso, debe presentar una declaración de su médico o de la persona autorizada a dar recetas que respalde su solicitud. Por lo general, debemos tomar una decisión dentro de las 72 horas a partir de la fecha de haber recibido la declaración que respalda su solicitud por parte de la persona autorizada a dar recetas. Puede solicitar una excepción acelerada (rápida) si usted o su médico consideran que esperar 72 horas para la toma de la decisión podría perjudicar gravemente su salud. Si se le concede el trámite rápido de la excepción, debemos comunicarle nuestra decisión a más tardar dentro de las 24 horas después de haber recibido la declaración de respaldo de su médico o de otra persona autorizada a dar recetas.

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¿Qué debo hacer antes de hablar con mi médico sobre el cambio de los medicamentos que tomo o la solicitud de una excepción?Como miembro nuevo o permanente de nuestro plan, es posible que esté tomando medicamentos que no están incluidos en el Formulario. También es posible que esté tomando un medicamento incluido en el Formulario pero su capacidad de conseguirlo sea limitada. Por ejemplo, puede necesitar nuestra autorización previa antes de poder obtener su medicamento con receta. Debe consultar con su médico para decidir si debe cambiar su medicamento por uno apropiado que nosotros cubramos o solicitar una excepción al formulario para que le cubramos el medicamento que toma. Mientras evalúa con su médico el procedimiento adecuado para seguir en su caso, podemos cubrir su medicamento, en ciertos casos, durante los primeros 90 días en que usted sea miembro de nuestro plan.Para cada uno de los medicamentos que no están incluidos en el Formulario o si su capacidad para conseguir los medicamentos es limitada, cubriremos un suministro temporal para 30 días. Si su receta está indicada para menos días, permitiremos que realice resurtidos por un máximo de hasta 30 días de suministro del medicamento. Después del primer suministro para 30 días, no seguiremos pagando estos medicamentos, incluso si ha sido miembro del plan durante menos de 90 días.Si es residente de un centro de atención a largo plazo y necesita un medicamento que no está en el Formulario o si su capacidad para conseguir los medicamentos es limitada, pero ya pasaron los primeros 90 días de membresía en nuestro plan, cubriremos un suministro de emergencia del medicamento para 31 días mientras solicita la excepción al Formulario. Es posible que haya casos en los que surjan transiciones imprevistas para miembros actuales y en los que los regímenes de medicamentos con receta puedan no estar en el Formulario del patrocinador del plan. Estos casos en general implican cambios en el nivel de atención en los que un miembro cambia de un entorno de tratamiento a otro. Para estas transiciones imprevistas, los miembros y las personas autorizadas a dar recetas deben usar nuestro proceso de excepciones y apelaciones. Las determinaciones y las redeterminaciones de cobertura se procesarán de la manera más expeditiva posible, según lo requiera su estado de salud. Para evitar una carencia temporal de la atención cuando un miembro recibe el alta hospitalaria para ir a su casa, los miembros pueden tener un suministro completo para paciente ambulatorio disponible para continuar con la terapia una vez que se les acabe el suministro limitado que recibieron en el momento del alta hospitalaria. Este suministro para paciente ambulatorio está disponible antes del alta hospitalaria de una hospitalización en virtud de la Parte A. Cuando un miembro es admitido en un centro de atención a largo plazo (Long Term Care, LTC), o recibe el alta de allí, y no tiene acceso al resto de la receta dispensada anteriormente, se procesa una anulación por única vez de las revisiones de “resurtido demasiado pronto” para cada medicamento que se vería afectado debido a la admisión o el alta del miembro. Las revisiones de los resurtidos anticipados no se usan para limitar el acceso apropiado y necesario al beneficio de la Parte D de un miembro, y, si este fuera el caso, se le permitirá el acceso a un resurtido tras el ingreso o el alta hospitalaria.

Para obtener más informaciónPara obtener información más detallada sobre la cobertura para medicamentos con receta de Blue Cross MedicareRx, consulte la Evidencia de cobertura y otra documentación del plan.Si tiene preguntas sobre Blue Cross MedicareRx, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en las páginas de la portada y la portada posterior.Si tiene preguntas generales sobre su cobertura para medicamentos con receta de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas, los 7 días de la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. O visite http://www.medicare.gov.

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Formulario de Blue Cross MedicareRxEl formulario a continuación proporciona información acerca de los medicamentos cubiertos por Blue Cross MedicareRx. Si tiene alguna dificultad para encontrar el medicamento que toma en la lista, consulte el Índice que comienza en la página 112.La primera columna de la tabla menciona el nombre del medicamento. Los medicamentos de marca están en letra mayúscula (por ejemplo, LANTUS) y los medicamentos genéricos están en letra minúscula y cursiva (por ejemplo, metformina).La información incluida en la columna de Requisitos/límites indica si Blue Cross MedicareRx tiene algún requisito especial para la cobertura del medicamento.Todos los medicamentos incluidos en este formulario están disponibles a través del beneficio de pedido por correo. Comuníquese con nosotros para obtener más detalles. Nuestra información de contacto aparece en las páginas de la portada y la portada posterior.

CLAVE

Nivel 1 = Medicamentos genéricos preferidosNivel 2 = Medicamentos genéricosNivel 3 = Medicamentos de marca preferidosNivel 4 = Medicamentos de marca no preferidosNivel 5 = Medicamentos especializados

BD = Medicamentos que pueden estar cubiertos por la Parte B o D de Medicare según el caso. Estos medicamentos requieren autorización previa para determinar la cobertura en función de la Parte B o la Parte D. Es posible que se requiera el aporte de información que describa el uso o el lugar en el que se recibe el medicamento para determinar la cobertura. AP = Autorización previaQL = Límites de cantidadST = Terapia de pasos* = Medicamento de distribución limitada. Esta receta puede estar disponible solo en algunas farmacias. Para obtener más información, consulte su Directorio de farmacias o llame a Servicio al Cliente al 1-888-285-2249, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si llama del 1.º de abril al 30 de septiembre, durante los fines de semana y días feriados, se usarán tecnologías alternativas (por ejemplo, correo de voz). Los usuarios de TTY deben llamar al 711.# = Medicamento de alto riesgo (High Risk Medication, HRM). Medicamentos que pueden ser inseguros para pacientes de más de 65 años de edad. Nuestra lista de medicamentos aprobados incluye la cobertura de algunos de estos medicamentos, pero es posible que haya alternativas en niveles de copago inferiores. Hable con su médico para saber si hay alternativas a estos medicamentos que sean apropiadas para que usted use.

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Montos de copago y coseguro:Nivel 1 - Medicamentos genéricos preferidos: $0/$5Nivel 2 - Medicamentos genéricos: $8/$14Nivel 3 - Medicamentos de marca preferidos: $42/$47Nivel 4 - Medicamentos de marca no preferidos: 40%/50%

Nivel 5 - Medicamentos especializados: 25%/25%

Esta información no es una descripción exhaustiva de beneficios. Para obtener más información, llame al 1-888-285-2249/TTY 711.

A continuación se muestra la clave para las abreviaturas utilizadas en la lista de medicamentos.

CLAVE

act activación mcg microgramo

ad adsorbido meq miliequivalente

aepb ampolla de polvo en aerosol mg miligramo

aer, aero aerosol ml mililitro

apl aplicador mu millones de unidades

ar, act resp, activ resp activado con la respiración nebu nebules

bau(bioequivalent allergy units) unidades de alergia bioequivalentes

comp de desintegr oral

comprimidos de desintegración oral

cáp, cáps cápsulas un, ung ungüento

cart cartucho of, oft oftálmico

comp mast comprimidos masticables osm osmótico

conc concentrado paq paquete

conj conjugar, conjugado sc sin conservantes

cris cristales ufp unidades formadoras de placa

imp impedimento po, pol polvo

desint desintegración prec, precar precargado

lr liberación retardada pdvs parche dos veces por semana

re recubrimiento entérico ps parche semanal

el, elu análisis de inmunoabsorción ligado a enzimas (enzyme-linked) recomb recombinante

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CLAVE (continuación)

li, pro, liberación prolong, prolongada, lib prolongada

liberación prolongada refrig refrigerar

ext extraer sl sublingual

gm gramo sol, solu solución

gu genitourinaria cmc centímetro cuadrado

h hora sup, supos supositorios

ig inmunoglobulina sus, susp suspensión

im intramuscular jer jeringa

inh, inhal inhalación com, comp comprimidos

iny inyección td transdérmico

ir índice de reactividad tl translingual

iv intravenoso und unidades

l litro va vaginal

fl, ufl unidades de floculación vac vacuna

liq, liqd líquido

2019

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

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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 4 QL (2700 mls/30 days)acetaminophen w/ codeine tab 300-15 mg 4 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-30 mg 4 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-60 mg 4 QL (180 tablets/30 days)butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg# 3 PA, QL (180 capsules/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 3butorphanol tartrate nasal soln 10 mg/ml 4 QL (87.5 mls/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 4 QL (180 tablets/30 days)codeine sulfate tab 30 mg 4 QL (180 tablets/30 days)codeine sulfate tab 60 mg 4 QL (180 tablets/30 days)diclofenac potassium tab 50 mg 2 QL (120 tablets/30 days)diclofenac sodium gel 1% 3 PAdiclofenac sodium soln 1.5% 3 PAdiclofenac 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)diflunisal tab 500 mg 3 QL (90 tablets/30 days)etodolac cap 200 mg 2 QL (150 capsules/30 days)

2019

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


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)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 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 25 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 37.5 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 50 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 62.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 75 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 87.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 100 mcg/hr 4 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 4 QL (3600 mls/30 days)hydrocodone-acetaminophen tab 10-325 mg 4 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-300 mg 4 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg 4 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-325 mg 4 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-325 mg 4 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 10-300 mg 4 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg 4 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg 4 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg 4 QL (150 tablets/30 days)hydromorphone hcl inj 2 mg/ml 4 BDhydromorphone hcl liqd 1 mg/ml 4 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 2 mg/ml 4 BDhydromorphone hcl preservative free inj 10 mg/ml 4 BDhydromorphone hcl tab 2 mg 4 QL (180 tablets/30 days)hydromorphone hcl tab 4 mg 4 QL (180 tablets/30 days)

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hydromorphone hcl tab 8 mg 4 QL (180 tablets/30 days)ibuprofen susp 100 mg/5ml 2ibuprofen tab 400 mg 2 QL (240 tablets/30 days)ibuprofen tab 600 mg 2 QL (150 tablets/30 days)ibuprofen tab 800 mg 2 QL (120 tablets/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 tab 2 mg 5 QL (120 tablets/30 days)meloxicam tab 7.5 mg 2 QL (60 tablets/30 days)meloxicam tab 15 mg 2 QL (30 tablets/30 days)methadone hcl tab 5 mg 3 QL (180 tablets/30 days)methadone hcl tab 10 mg 3 QL (360 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 4 BDmorphine sulfate inj pf 1 mg/ml 4 BDmorphine sulfate oral soln 10 mg/5ml 4 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml 4 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml) 4 QL (270 mls/30 days)morphine sulfate tab er 15 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 30 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg 4 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg 4 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg 4 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)naproxen sodium tab er 24hr 375 mg 3 QL (120 tablets/30 days)naproxen sodium tab er 24hr 500 mg 3 QL (90 tablets/30 days)naproxen sodium tab 275 mg 3 QL (150 tablets/30 days)naproxen sodium tab 550 mg 3 QL (90 tablets/30 days)naproxen susp 125 mg/5ml 3 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 2 QL (180 tablets/30 days)naproxen tab 375 mg 2 QL (120 tablets/30 days)naproxen tab 500 mg 2 QL (90 tablets/30 days)oxaprozin tab 600 mg 3 QL (90 tablets/30 days)

2019



oxycodone hcl tab 5 mg 4 QL (360 tablets/30 days)oxycodone hcl tab 10 mg 4 QL (180 tablets/30 days)oxycodone hcl tab 15 mg 4 QL (180 tablets/30 days)oxycodone hcl tab 20 mg 4 QL (180 tablets/30 days)oxycodone hcl tab 30 mg 4 QL (180 tablets/30 days)oxycodone w/ acetaminophen tab 2.5-325 mg 4 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 5-325 mg 4 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 7.5-325 mg 4 QL (240 tablets/30 days)oxycodone w/ acetaminophen tab 10-325 mg 4 QL (180 tablets/30 days)oxycodone-aspirin tab 4.8355-325 mg 4 QL (360 tablets/30 days)piroxicam cap 10 mg 3 QL (60 capsules/30 days)piroxicam cap 20 mg 3 QL (30 capsules/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 50 mg 3 QL (240 tablets/30 days)tramadol-acetaminophen tab 37.5-325 mg 2 QL (240 tablets/30 days)Medicamentos anestésicoslidocaine hcl gel 2% 2 PA, QL (150 mls/30 days)lidocaine hcl soln 4% 2 PA, QL (150 mls/30 days)lidocaine hcl viscous soln 2% 2lidocaine oint 5% 2 PA, QL (100 grams/30 days)lidocaine patch 5% 3 PA, QL (90 patches/30 days)lidocaine-prilocaine cream 2.5-2.5% 3 PA, QL (60 grams/30 days)Agentes contra las adicciones y para tratar el abuso deacamprosate calcium tab delayed release 333 mg 2buprenorphine hcl sl tab 2 mg 2 QL (90 tablets/30 days)buprenorphine hcl sl tab 8 mg 2 QL (90 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg 2 QL (120 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 8-2 mg 2 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 2

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disulfiram 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 3naloxone hcl inj 4 mg/10ml 3naltrexone 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 3 QL (120 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1 mg 3 QL (30 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 8-2 mg 3 QL (60 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 12-3 mg 3 QL (60 films/30 days)VIVITROL - naltrexone for im extended release susp 380 mg 5Medicamentos antibacterialesamikacin sulfate inj 500 mg/2ml (250 mg/ml) 3amikacin sulfate inj 1 gm/4ml (250 mg/ml) 3AMOXICILLIN - amoxicillin (trihydrate) chew tab 125 mg 3AMOXICILLIN - amoxicillin (trihydrate) chew tab 250 mg 3amoxicillin (trihydrate) cap 250 mg 2amoxicillin (trihydrate) cap 500 mg 2amoxicillin (trihydrate) for susp 125 mg/5ml 2amoxicillin (trihydrate) for susp 200 mg/5ml 2amoxicillin (trihydrate) for susp 250 mg/5ml 2amoxicillin (trihydrate) for susp 400 mg/5ml 2amoxicillin (trihydrate) tab 500 mg 2amoxicillin (trihydrate) tab 875 mg 2amoxicillin & k clavulanate for susp 200-28.5 mg/5ml 3amoxicillin & k clavulanate for susp 250-62.5 mg/5ml 3amoxicillin & k clavulanate for susp 400-57 mg/5ml 3amoxicillin & k clavulanate for susp 600-42.9 mg/5ml 3amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg 3amoxicillin & k clavulanate tab 250-125 mg 3amoxicillin & k clavulanate tab 500-125 mg 3amoxicillin & k clavulanate tab 875-125 mg 3AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & k

clavulanate chew tab 200-28.5 mg3

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

3

ampicillin & sulbactam sodium for inj 3 (2-1) gm 3ampicillin cap 500 mg 2AMPICILLIN SODIUM - ampicillin sodium for iv soln 1 gm 3ampicillin sodium for inj 250 mg 3ampicillin sodium for inj 500 mg 3ampicillin sodium for inj 1 gm 3ampicillin sodium for inj 2 gm 3ampicillin sodium for iv soln 2 gm 3ampicillin sodium for iv soln 10 gm 3AMPICILLIN-SULBACTAM - ampicillin & sulbactam sodium for iv

soln 3 (2-1) gm3

AUGMENTIN - amoxicillin & k clavulanate for susp125-31.25 mg/5ml

4

AZACTAM - aztreonam for inj 1 gm 4AZACTAM - aztreonam for inj 2 gm 4AZITHROMYCIN - azithromycin powd pack for susp 1 gm 3azithromycin for susp 100 mg/5ml 3azithromycin for susp 200 mg/5ml 3azithromycin iv for soln 500 mg 3azithromycin tab 250 mg 2azithromycin tab 500 mg 2azithromycin tab 600 mg 2aztreonam for inj 1 gm 3aztreonam for inj 2 gm 3BICILLIN 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 2cefadroxil for susp 250 mg/5ml 2cefadroxil for susp 500 mg/5ml 2cefadroxil tab 1 gm 2CEFAZOLIN SODIUM - cefazolin sodium for inj 20 gm 3

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cefazolin sodium for inj 500 mg 3cefazolin sodium for inj 1 gm 3cefazolin sodium for inj 10 gm 3cefdinir cap 300 mg 2cefdinir for susp 125 mg/5ml 3cefdinir for susp 250 mg/5ml 3cefepime hcl for inj 1 gm 3cefepime hcl for inj 2 gm 3cefixime for susp 100 mg/5ml 3cefixime for susp 200 mg/5ml 3CEFOTAXIME SODIUM - cefotaxime sodium for inj 500 mg 3cefotaxime sodium for inj 1 gm 3cefoxitin sodium for inj 10 gm 3cefoxitin sodium for iv soln 1 gm 3cefoxitin sodium for iv soln 2 gm 3cefpodoxime proxetil for susp 50 mg/5ml 3cefpodoxime proxetil for susp 100 mg/5ml 3cefpodoxime proxetil tab 100 mg 3cefpodoxime proxetil tab 200 mg 3cefprozil for susp 125 mg/5ml 3cefprozil for susp 250 mg/5ml 3cefprozil tab 250 mg 2cefprozil tab 500 mg 2ceftazidime for inj 1 gm 3ceftazidime for inj 2 gm 3ceftazidime for inj 6 gm 3ceftazidime for iv soln 2 gm 3CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxone

sodium in dextrose inj 20 mg/ml3

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

3

ceftriaxone sodium for inj 250 mg 3ceftriaxone sodium for inj 500 mg 3ceftriaxone sodium for inj 1 gm 3ceftriaxone sodium for inj 2 gm 3ceftriaxone sodium for inj 10 gm 3ceftriaxone sodium for iv soln 1 gm 3ceftriaxone sodium for iv soln 2 gm 3

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CEFTRIAXONE/DEXTROSE - ceftriaxone sodium for iv soln 1 gmand dextrose 3.74%

3

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

3

cefuroxime axetil tab 250 mg 2cefuroxime axetil tab 500 mg 2cefuroxime sodium for inj 750 mg 3cefuroxime sodium for inj 7.5 gm 3cefuroxime sodium for iv soln 1.5 gm 3cephalexin cap 250 mg 2cephalexin cap 500 mg 2cephalexin cap 750 mg 2cephalexin for susp 125 mg/5ml 3cephalexin for susp 250 mg/5ml 3CHLORAMPHENICOL SODIUM SUCCINATE - chloramphenicol

sodium succinate for iv inj 1 gm3

ciprofloxacin 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 3ciprofloxacin hcl tab er 24hr 500 mg 2ciprofloxacin hcl tab er 24hr 1000 mg 2ciprofloxacin hcl tab 250 mg 2ciprofloxacin hcl tab 500 mg 2ciprofloxacin hcl tab 750 mg 2ciprofloxacin 200 mg/100ml in d5w 3ciprofloxacin 400 mg/200ml in d5w 3clarithromycin for susp 125 mg/5ml 3clarithromycin for susp 250 mg/5ml 3clarithromycin tab er 24hr 500 mg 3clarithromycin tab 250 mg 2clarithromycin tab 500 mg 2CLEOCIN - clindamycin phosphate vaginal cream 2% 4clindamycin hcl cap 75 mg 2clindamycin hcl cap 150 mg 2clindamycin hcl cap 300 mg 2clindamycin palmitate hcl for soln 75 mg/5ml 3clindamycin phosphate gel 1% 2clindamycin phosphate in d5w iv soln 300 mg/50ml 3clindamycin phosphate in d5w iv soln 600 mg/50ml 3

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clindamycin phosphate in d5w iv soln 900 mg/50ml 3clindamycin phosphate inj 300 mg/2ml 3clindamycin phosphate inj 600 mg/4ml 3clindamycin phosphate inj 900 mg/6ml 3clindamycin phosphate inj 9 gm/60ml 3clindamycin phosphate iv soln 300 mg/2ml 3clindamycin phosphate iv soln 600 mg/4ml 3clindamycin phosphate iv soln 900 mg/6ml 3clindamycin phosphate lotion 1% 2clindamycin phosphate soln 1% 2clindamycin phosphate swab 1% 2clindamycin phosphate vaginal cream 2% 3colistimethate sod for inj 150 mg 5DALVANCE - dalbavancin hcl for iv soln 500 mg 5daptomycin for iv soln 500 mg 5demeclocycline hcl tab 150 mg 3demeclocycline hcl tab 300 mg 3dicloxacillin sodium cap 250 mg 3dicloxacillin sodium cap 500 mg 3DIFICID - fidaxomicin tab 200 mg 5doxycycline hyclate cap 50 mg 2doxycycline hyclate cap 100 mg 2doxycycline hyclate for inj 100 mg 3doxycycline hyclate tab 20 mg 2doxycycline hyclate tab 100 mg 2doxycycline monohydrate cap 50 mg 3doxycycline monohydrate cap 75 mg 3doxycycline monohydrate cap 100 mg 3doxycycline monohydrate cap 150 mg 3doxycycline monohydrate tab 50 mg 3doxycycline monohydrate tab 75 mg 3doxycycline monohydrate tab 100 mg 3doxycycline monohydrate tab 150 mg 3ertapenem sodium for inj 1 gm 4ERY-TAB - erythromycin tab delayed release 250 mg 4ERY-TAB - erythromycin tab delayed release 333 mg 4ERY-TAB - erythromycin tab delayed release 500 mg 4ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 4

2019



ERYTHROCIN LACTOBIONATE - erythromycin lactobionate forinj 500 mg

5

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 4erythromycin ethylsuccinate for susp 200 mg/5ml 3erythromycin pads 2% 2erythromycin soln 2% 2erythromycin tab 250 mg 3erythromycin tab 500 mg 3erythromycin w/ delayed release particles cap 250 mg 3gentamicin in saline inj 0.8 mg/ml 3gentamicin in saline inj 1 mg/ml 3gentamicin in saline inj 1.6 mg/ml 3gentamicin in saline inj 1.2 mg/ml 3gentamicin sulfate inj 10 mg/ml 3gentamicin sulfate inj 40 mg/ml 3imipenem-cilastatin intravenous for soln 250 mg 3imipenem-cilastatin intravenous for soln 500 mg 3IMPAVIDO - miltefosine cap 50 mg 5INVANZ - ertapenem sodium for inj 1 gm 4INVANZ - ertapenem sodium for iv inj 1 gm 4levofloxacin in d5w iv soln 250 mg/50ml 3levofloxacin in d5w iv soln 500 mg/100ml 3levofloxacin in d5w iv soln 750 mg/150ml 3levofloxacin iv soln 25 mg/ml 3levofloxacin oral soln 25 mg/ml 3levofloxacin tab 250 mg 2levofloxacin tab 500 mg 2levofloxacin tab 750 mg 2LINEZOLID - 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) 5linezolid tab 600 mg 3 PAmeropenem iv for soln 500 mg 3meropenem iv for soln 1 gm 3methenamine hippurate tab 1 gm 2METROGEL-VAGINAL - metronidazole vaginal gel 0.75% 4METRONIDAZOLE - metronidazole in nacl 0.74% iv soln

500 mg/100ml3

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metronidazole cap 375 mg 3metronidazole in nacl 0.79% iv soln 500 mg/100ml 3metronidazole iv soln 5 mg/ml 3metronidazole tab 250 mg 2metronidazole tab 500 mg 2metronidazole vaginal gel 0.75% 3minocycline hcl cap 50 mg 3minocycline hcl cap 75 mg 3minocycline hcl cap 100 mg 3minocycline hcl tab 50 mg 3minocycline hcl tab 75 mg 3minocycline hcl tab 100 mg 3MOXIFLOXACIN HCL - moxifloxacin hcl iv solution 400 mg/250ml 3moxifloxacin hcl tab 400 mg 2moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj 3NAFCILLIN SODIUM - nafcillin sodium for inj 10 gm 5NAFCILLIN SODIUM - nafcillin sodium for iv soln 1 gm 3NAFCILLIN SODIUM - nafcillin sodium for iv soln 2 gm 3nafcillin sodium for inj 1 gm 3nafcillin sodium for inj 2 gm 3nafcillin sodium for iv soln 10 gm 5neomycin sulfate tab 500 mg 2neomycin-polymyxin b gu irrigation soln 2nitrofurantoin macrocrystalline cap 50 mg# 3 PAnitrofurantoin macrocrystalline cap 100 mg# 3 PAnitrofurantoin monohydrate macrocrystalline cap 100 mg# 3 PAnitrofurantoin susp 25 mg/5ml# 4 PAofloxacin tab 400 mg 2paromomycin sulfate cap 250 mg 3penicillin g potassium for inj 5000000 unit 3penicillin g potassium for inj 20000000 unit 3PENICILLIN G POTASSIUM IN DEXTROSE - penicillin g

potassium inj 20000 unit/ml in dextrose3

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

3

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

3

PENICILLIN G SODIUM - penicillin g sodium for inj 5000000 unit 3penicillin v potassium for soln 125 mg/5ml 2

2019



penicillin v potassium for soln 250 mg/5ml 2penicillin v potassium tab 250 mg 2penicillin v potassium tab 500 mg 2piperacillin sod-tazobactam na for inj 3.375 gm (3-0.375 gm) 3piperacillin sod-tazobactam sod for inj 2.25 gm (2-0.25 gm) 3piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) 3SIVEXTRO - tedizolid phosphate for iv soln 200 mg 5SIVEXTRO - tedizolid phosphate tab 200 mg 5 PASTREPTOMYCIN SULFATE - streptomycin sulfate for inj 1 gm 3sulfacetamide sodium lotion 10% 2SULFADIAZINE - sulfadiazine tab 500 mg 3sulfamethoxazole-trimethoprim iv soln 400-80 mg/5ml 3sulfamethoxazole-trimethoprim susp 200-40 mg/5ml 3sulfamethoxazole-trimethoprim tab 400-80 mg 2sulfamethoxazole-trimethoprim tab 800-160 mg 2SUPRAX - 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) 5TAZICEF - ceftazidime for iv soln 1 gm 3TEFLARO - ceftaroline fosamil for iv soln 400 mg 5TEFLARO - ceftaroline fosamil for iv soln 600 mg 5tetracycline hcl cap 250 mg 3tetracycline hcl cap 500 mg 3tigecycline for iv soln 50 mg 5tinidazole tab 250 mg 3tinidazole tab 500 mg 3TOBRAMYCIN SULFATE - tobramycin sulfate inj 10 mg/ml 3TOBRAMYCIN SULFATE - tobramycin sulfate inj 2 gm/50ml

(40 mg/ml)3

tobramycin sulfate for inj 1.2 gm 3tobramycin sulfate inj 80 mg/2ml (40 mg/ml) 3tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml) 3trimethoprim tab 100 mg 2TYGACIL - tigecycline for iv soln 50 mg 5vancomycin hcl cap 125 mg 3vancomycin hcl cap 250 mg 3vancomycin hcl for iv soln 500 mg 3

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vancomycin hcl for iv soln 750 mg 3vancomycin hcl for iv soln 1 gm 3vancomycin hcl for iv soln 5 gm 3vancomycin hcl for iv soln 10 gm 3vancomycin hcl for iv soln 100 gm 3VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl-dextrose iv

soln 500 mg/100ml-5%4

VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl-dextrose ivsoln 750 mg/150ml-5%

4

VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl-dextrose ivsoln 1 gm/200ml-5%

4

VANCOMYCIN HYDROCHLORIDE - vancomycin hcl for iv soln250 mg

3

VANCOMYCIN HYDROCHLORIDE - vancomycin hcl for iv soln1.5 gm

3

ZOSYN - piperacillin sod-tazobactam sod in dex iv soln2-0.25gm/50ml

4

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

Medicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 5APTIOM - 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 2

2019



carbamazepine 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 2CELONTIN - methsuximide cap 300 mg 4clobazam suspension 2.5 mg/ml 4 PA, QL (480 mls/30 days)clobazam tab 10 mg 2 PA, QL (60 tablets/30 days)clobazam tab 20 mg 2 PA, QL (60 tablets/30 days)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)DIASTAT PEDIATRIC - diazepam rectal gel delivery system

2.5 mg4 QL (5 twin pack(s)/30 days)

DIAZEPAM - diazepam rectal gel delivery system 10 mg 4 QL (5 twin pack(s)/30 days)DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system

2.5 mg4 QL (5 twin pack(s)/30 days)

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system10 mg

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

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system20 mg

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

DILANTIN - phenytoin sodium extended cap 30 mg 3divalproex 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 2EPIDIOLEX - cannabidiol soln 100 mg/ml 5 PAethosuximide cap 250 mg 2ethosuximide soln 250 mg/5ml 2felbamate susp 600 mg/5ml 5felbamate tab 400 mg 3felbamate tab 600 mg 3fosphenytoin sodium inj 100 mg/2ml 3fosphenytoin sodium inj 500 mg/10ml 3FYCOMPA - perampanel susp 0.5 mg/ml 5FYCOMPA - perampanel tab 2 mg 4FYCOMPA - perampanel tab 4 mg 5FYCOMPA - perampanel tab 6 mg 5

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FYCOMPA - perampanel tab 8 mg 5FYCOMPA - perampanel tab 10 mg 5FYCOMPA - perampanel tab 12 mg 5gabapentin cap 100 mg 2 QL (1080 capsules/30 days)gabapentin cap 300 mg 2 QL (360 capsules/30 days)gabapentin cap 400 mg 2 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)lamotrigine tab chewable dispersible 5 mg 2lamotrigine tab chewable dispersible 25 mg 2lamotrigine tab 25 mg 2lamotrigine tab 100 mg 2lamotrigine tab 150 mg 2lamotrigine tab 200 mg 2levetiracetam in sodium chloride iv soln 500 mg/100ml 3levetiracetam in sodium chloride iv soln 1000 mg/100ml 3levetiracetam in sodium chloride iv soln 1500 mg/100ml 3levetiracetam inj 500 mg/5ml (100 mg/ml) 3levetiracetam 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)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)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) 3oxcarbazepine tab 150 mg 2

2019



oxcarbazepine tab 300 mg 2oxcarbazepine tab 600 mg 2PEGANONE - ethotoin tab 250 mg 4phenobarbital 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 15 mg# 4 PAphenobarbital tab 16.2 mg# 4 PAphenobarbital tab 30 mg# 4 PAphenobarbital tab 32.4 mg# 4 PAphenobarbital tab 60 mg# 4 PAphenobarbital tab 64.8 mg# 4 PAphenobarbital tab 97.2 mg# 4 PAphenobarbital tab 100 mg# 4 PAphenytoin 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 2primidone tab 50 mg 2primidone tab 250 mg 2SABRIL - 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 4tiagabine hcl tab 2 mg 3tiagabine hcl tab 4 mg 3tiagabine hcl tab 12 mg 3tiagabine hcl tab 16 mg 3topiramate sprinkle cap 15 mg 2topiramate sprinkle cap 25 mg 2topiramate tab 25 mg 2topiramate tab 50 mg 2topiramate tab 100 mg 2topiramate tab 200 mg 2valproate sodium inj 100 mg/ml 3

2019


17


valproate sodium oral soln 250 mg/5ml 2valproic acid cap 250 mg 2vigabatrin powd pack 500 mg* 5VIMPAT - 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 3zonisamide cap 25 mg 2zonisamide cap 50 mg 2zonisamide cap 100 mg 2Agentes contra la demenciadonepezil hydrochloride orally disintegrating tab 5 mg 2donepezil hydrochloride orally disintegrating tab 10 mg 2donepezil hydrochloride tab 5 mg 2donepezil hydrochloride tab 10 mg 2donepezil hydrochloride tab 23 mg 2ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 3 PAGALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml3

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 3 PAmemantine hcl tab 5 mg 2 PAmemantine hcl tab 10 mg 2 PAmemantine hcl tab 5 mg (28) & 10 mg (21) titration pak 2 PArivastigmine 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 3rivastigmine td patch 24hr 9.5 mg/24hr 3rivastigmine td patch 24hr 13.3 mg/24hr 3

2019



Medicamentos 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# 3 PAAMOXAPINE - amoxapine tab 50 mg# 3 PAAMOXAPINE - amoxapine tab 100 mg# 3 PAAMOXAPINE - amoxapine tab 150 mg# 3 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 3 QL (90 tablets/30 days)bupropion hcl tab er 24hr 300 mg 3 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 PAdesipramine hcl tab 10 mg# 4 PAdesipramine hcl tab 25 mg# 4 PAdesipramine hcl tab 50 mg# 4 PAdesipramine hcl tab 75 mg# 4 PAdesipramine hcl tab 100 mg# 4 PAdesipramine hcl tab 150 mg# 4 PAdesvenlafaxine succinate tab er 24hr 25 mg 3 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 50 mg 3 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 100 mg 3 QL (30 tablets/30 days)doxepin hcl cap 10 mg# 4 PA

2019


19


doxepin 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 3 QL (60 capsules/30 days)duloxetine hcl enteric coated pellets cap 30 mg 3 QL (90 capsules/30 days)duloxetine hcl enteric coated pellets cap 60 mg 3 QL (60 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 3 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 2 QL (90 capsules/30 days)fluoxetine hcl cap 20 mg 2 QL (120 capsules/30 days)fluoxetine hcl cap 40 mg 2 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# 3 PAimipramine hcl tab 25 mg# 3 PAimipramine hcl tab 50 mg# 3 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)

2019



MAPROTILINE HCL - maprotiline hcl tab 25 mg 3 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 3 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 3 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 5mirtazapine 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 1 QL (30 tablets/30 days)mirtazapine tab 15 mg 1 QL (45 tablets/30 days)mirtazapine tab 30 mg 1 QL (30 tablets/30 days)mirtazapine tab 45 mg 1 QL (30 tablets/30 days)NARDIL - phenelzine sulfate tab 15 mg 4NEFAZODONE HCL - nefazodone hcl tab 100 mg 3NEFAZODONE HCL - nefazodone hcl tab 150 mg 3nefazodone hcl tab 50 mg 2nefazodone hcl tab 250 mg 2NEFAZODONE HYDROCHLORIDE - nefazodone hcl tab 200 mg 3nortriptyline hcl cap 10 mg# 3 PAnortriptyline hcl cap 25 mg# 3 PAnortriptyline hcl cap 50 mg# 3 PAnortriptyline hcl cap 75 mg# 3 PAnortriptyline hcl soln 10 mg/5ml# 3 PAPARNATE - tranylcypromine sulfate tab 10 mg 4paroxetine hcl tab 10 mg# 3 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 3 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 3 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 3 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 2protriptyline hcl tab 5 mg# 3 PAprotriptyline hcl tab 10 mg# 3 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)

2019


21


REMERON - mirtazapine tab 15 mg 4 QL (45 tablets/30 days)REMERON - mirtazapine tab 30 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 concentrate for solution 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)tranylcypromine sulfate tab 10 mg 3trazodone hcl tab 50 mg 2trazodone hcl tab 100 mg 2trazodone hcl tab 150 mg 2trazodone hcl tab 300 mg 2trimipramine maleate cap 25 mg# 3 PAtrimipramine maleate cap 50 mg# 3 PAtrimipramine maleate cap 100 mg# 3 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 3 QL (60 tablets/30 days)venlafaxine hcl tab er 24hr 75 mg 3 QL (90 tablets/30 days)venlafaxine hcl tab er 24hr 150 mg 3 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)

ZOLOFT - sertraline hcl tab 25 mg 4 QL (45 tablets/30 days)ZOLOFT - sertraline hcl tab 50 mg 4 QL (45 tablets/30 days)

2019



ZOLOFT - sertraline hcl tab 100 mg 4 QL (60 tablets/30 days)Medicamentos antieméticosaprepitant capsule therapy pack 80 & 125 mg 3 BDaprepitant capsule 40 mg 3 BDaprepitant capsule 80 mg 3 BDaprepitant capsule 125 mg 3 BDCHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 4 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 4 PAchlorpromazine hcl tab 10 mg 3 PAchlorpromazine hcl tab 25 mg 3 PAchlorpromazine hcl tab 50 mg 3 PAchlorpromazine hcl tab 100 mg 3 PAchlorpromazine hcl tab 200 mg 3 PAdronabinol cap 2.5 mg 4 BDdronabinol cap 5 mg 4 BDdronabinol cap 10 mg 4 BDEMEND - fosaprepitant dimeglumine for iv infusion 150 mg 4granisetron hcl inj 1 mg/ml 3granisetron hcl inj 4 mg/4ml (1 mg/ml) 3granisetron hcl tab 1 mg 2 BDmeclizine hcl tab 12.5 mg# 3ondansetron hcl inj 4 mg/2ml (2 mg/ml) 3ondansetron hcl inj 40 mg/20ml (2 mg/ml) 3ondansetron hcl oral soln 4 mg/5ml 3 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 BDpalonosetron hcl iv soln 0.25 mg/5ml 5PALONOSETRON HYDROCHLORIDE - palonosetron hcl iv soln

pref syr 0.25 mg/5ml5

PALONOSETRON HYDROCHLORIDE - palonosetron hcl iv soln0.25 mg/2ml

5

perphenazine tab 2 mg 2 PAperphenazine tab 4 mg 2 PAperphenazine tab 8 mg 2 PAperphenazine tab 16 mg 2 PA

2019


23


prochlorperazine edisylate inj 5 mg/ml 4prochlorperazine maleate tab 5 mg 2prochlorperazine maleate tab 10 mg 2prochlorperazine suppos 25 mg 3promethazine hcl suppos 12.5 mg# 3 PApromethazine hcl suppos 25 mg# 3 PApromethazine hcl syrup 6.25 mg/5ml# 3 PApromethazine hcl tab 12.5 mg# 3 PApromethazine hcl tab 25 mg# 3 PApromethazine hcl tab 50 mg# 3 PAscopolamine td patch 72hr 1 mg/3days# 3 PAtrimethobenzamide hcl cap 300 mg 3Medicamentos antimicóticosAMBISOME - amphotericin b liposome iv for susp 50 mg 5 BDAMPHOTERICIN B - amphotericin b for inj 50 mg 3 BDCANCIDAS - 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% 2clotrimazole troche 10 mg 2CRESEMBA - isavuconazonium sulfate cap 186 mg 5 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 5 PAeconazole nitrate cream 1% 3fluconazole for susp 10 mg/ml 3fluconazole for susp 40 mg/ml 3fluconazole in dextrose inj 200 mg/100ml 3fluconazole in dextrose inj 400 mg/200ml 3fluconazole in nacl 0.9% inj 200 mg/100ml 3fluconazole in nacl 0.9% inj 400 mg/200ml 3fluconazole tab 50 mg 2fluconazole tab 100 mg 2fluconazole tab 150 mg 2fluconazole tab 200 mg 2

2019



flucytosine cap 250 mg 5flucytosine cap 500 mg 5griseofulvin microsize susp 125 mg/5ml 3griseofulvin microsize tab 500 mg 3griseofulvin ultramicrosize tab 125 mg 3griseofulvin ultramicrosize tab 250 mg 3itraconazole cap 100 mg 3ketoconazole cream 2% 2ketoconazole shampoo 2% 2ketoconazole tab 200 mg 2MYCAMINE - micafungin sodium for iv soln 50 mg 5MYCAMINE - micafungin sodium for iv soln 100 mg 5NOXAFIL - 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 2terbinafine hcl tab 250 mg 2terconazole vaginal cream 0.8% 3terconazole vaginal cream 0.4% 3terconazole vaginal suppos 80 mg 3voriconazole for inj 200 mg 3 PAvoriconazole for susp 40 mg/ml 5 PAvoriconazole tab 50 mg 5 PAvoriconazole tab 200 mg 5 PAAgentes contra la gotaallopurinol sodium for inj 500 mg 2allopurinol tab 100 mg 1allopurinol tab 300 mg 1colchicine 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 4

2019


25


ZYLOPRIM - 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)frovatriptan succinate tab 2.5 mg 3 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 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 3 QL (18 tablets/30 days)naratriptan hcl tab 2.5 mg 3 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 5 mg 2 QL (18 tablets/30 days)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 3 QL (12 units (2

packages)/30 days)sumatriptan nasal spray 20 mg/act 3 QL (12 units (2

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

prefilled syringe 6 mg/0.5ml4

sumatriptan succinate inj 6 mg/0.5ml 4sumatriptan succinate solution auto-injector 4 mg/0.5ml 4

2019



sumatriptan succinate solution auto-injector 6 mg/0.5ml 4sumatriptan succinate solution cartridge 4 mg/0.5ml 4sumatriptan succinate solution cartridge 6 mg/0.5ml 4sumatriptan 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)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 3MESTINON - pyridostigmine bromide syrup 60 mg/5ml 5pyridostigmine bromide tab er 180 mg 3pyridostigmine bromide tab 60 mg 2Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 4CYCLOSERINE - cycloserine cap 250 mg 5dapsone tab 25 mg 3dapsone tab 100 mg 3ethambutol hcl tab 100 mg 2ethambutol hcl tab 400 mg 2ISONIAZID - isoniazid inj 100 mg/ml 3isoniazid tab 100 mg 2isoniazid tab 300 mg 2PASER - aminosalicylic acid er granules packet 4 gm 4PRIFTIN - rifapentine tab 150 mg 4pyrazinamide tab 500 mg 3rifabutin cap 150 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 antineoplásicosabiraterone acetate tab 250 mg 5 PA, QL (120 tablets/30 days)ABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 5 PAAFINITOR - 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)

2019


27


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 5 PAALIMTA - pemetrexed disodium for iv soln 500 mg 5 PAALIQOPA - copanlisib hcl for iv soln 60 mg 5 PAALUNBRIG - brigatinib tab initiation therapy pack 90 mg & 180 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 30 mg 5 PA, QL (120 tablets/30 days)ALUNBRIG - brigatinib tab 90 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 180 mg 5 PA, QL (30 tablets/30 days)anastrozole tab 1 mg 2ARRANON - nelarabine iv soln 5 mg/ml 5arsenic trioxide inj 10 mg/10ml (1 mg/ml) 4ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 5 PAARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 5 PAAVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 5 PAAVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 5 PABAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/

ml)5 PA

BELEODAQ - belinostat for iv inj 500 mg* 5 PABENDEKA - bendamustine hcl iv soln 100 mg/4ml (25 mg/ml) 5BESPONSA - inotuzumab ozogamicin for iv soln 0.9 mg 5 PAbexarotene cap 75 mg 5 PAbicalutamide tab 50 mg 2BICNU - carmustine for inj 100 mg 4bleomycin sulfate for inj 15 unit 3 BDbleomycin sulfate for inj 30 unit 3 BDBLINCYTO - blinatumomab for iv infusion 35 mcg* 5 BD, PABOSULIF - bosutinib tab 100 mg 5 PA, QL (180 tablets/30 days)BOSULIF - bosutinib tab 400 mg 5 PA, QL (30 tablets/30 days)BOSULIF - bosutinib tab 500 mg 5 PA, QL (30 tablets/30 days)BRAFTOVI - encorafenib cap 50 mg 5 PA, QL (180 capsules/30 days)BRAFTOVI - encorafenib cap 75 mg 5 PA, QL (180 capsules/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)CALQUENCE - acalabrutinib cap 100 mg 5 PA, QL (60 capsules/30 days)

2019



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 3carboplatin iv soln 150 mg/15ml 3carboplatin iv soln 450 mg/45ml 3carboplatin iv soln 600 mg/60ml 3carmustine for inj 100 mg 4CISPLATIN - cisplatin inj 200 mg/200ml (1 mg/ml) 3cisplatin inj 50 mg/50ml (1 mg/ml) 3cisplatin inj 100 mg/100ml (1 mg/ml) 3cladribine iv soln 10 mg/10ml (1 mg/ml) 5 BDclofarabine 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*

5 PA, QL (112 capsules/28 days)

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


COPIKTRA - duvelisib cap 15 mg 5 PA, QL (56 capsules/28 days)COPIKTRA - duvelisib cap 25 mg 5 PA, QL (56 capsules/28 days)COSMEGEN - dactinomycin for inj 0.5 mg 5COTELLIC - cobimetinib fumarate tab 20 mg* 5 PA, QL (63 tablets/28 days)cyclophosphamide cap 25 mg 4 BDcyclophosphamide 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)* 5 PACYRAMZA - ramucirumab iv soln 500 mg/50ml (for infusion)* 5 PACYTARABINE - cytarabine inj 20 mg/ml 3 BDcytarabine inj pf 20 mg/ml 3 BDcytarabine inj pf 100 mg/ml 3 BDDACARBAZINE - dacarbazine for inj 100 mg 4dacarbazine for inj 200 mg 3dactinomycin for inj 0.5 mg 5DARZALEX - daratumumab iv soln 100 mg/5ml* 5 PADARZALEX - daratumumab iv soln 400 mg/20ml* 5 PAdaunorubicin hcl iv soln 20 mg/4ml 3

2019


29


DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln50 mg/10ml

3

decitabine for inj 50 mg 5dexrazoxane for inj 250 mg 5dexrazoxane for inj 500 mg 5DOCETAXEL - docetaxel for inj conc 160 mg/8ml (20 mg/ml) 5DOCETAXEL - docetaxel for inj conc 200 mg/10ml (20 mg/ml) 5docetaxel for inj conc 20 mg/ml 5docetaxel for inj conc 80 mg/4ml (20 mg/ml) 5docetaxel soln for iv infusion 20 mg/2ml 5docetaxel soln for iv infusion 80 mg/8ml 5docetaxel soln for iv infusion 160 mg/16ml 5doxorubicin hcl for inj 10 mg 4 BDdoxorubicin hcl for inj 50 mg 4 BDdoxorubicin hcl inj 2 mg/ml 3 BDdoxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml 5 BD, PAELITEK - rasburicase for iv soln 1.5 mg 5ELITEK - rasburicase for iv soln 7.5 mg 5EMCYT - estramustine phosphate sodium cap 140 mg 5EMPLICITI - elotuzumab for iv soln 300 mg 5 PAEMPLICITI - elotuzumab for iv soln 400 mg 5 PAepirubicin hcl iv soln 50 mg/25ml (2 mg/ml) 4epirubicin hcl iv soln 200 mg/100ml (2 mg/ml) 4ERBITUX - cetuximab iv soln 100 mg/50ml (2 mg/ml) 5 PAERBITUX - cetuximab iv soln 200 mg/100ml (2 mg/ml) 5 PAERIVEDGE - vismodegib cap 150 mg* 5 PA, QL (30 capsules/30 days)ERLEADA - apalutamide tab 60 mg 5 PA, QL (120 tablets/30 days)ERWINAZE - asparaginase erwinia chrysanthemi for inj 10000

unit5

ETHYOL - amifostine for inj 500 mg 5ETOPOPHOS - etoposide phosphate iv for inj 100 mg 4etoposide inj 100 mg/5ml (20 mg/ml) 3etoposide inj 500 mg/25ml (20 mg/ml) 3etoposide inj 1 gm/50ml (20 mg/ml) 3EVOMELA - melphalan hcl for inj 50 mg* 5exemestane tab 25 mg 3FARESTON - toremifene citrate tab 60 mg 5FARYDAK - panobinostat lactate cap 10 mg* 5 PA, QL (6 capsules/21 days)

2019



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 5fludarabine phosphate for inj 50 mg 3fludarabine phosphate inj 25 mg/ml 3fluorouracil iv soln 500 mg/10ml (50 mg/ml) 3 BDfluorouracil iv soln 1 gm/20ml (50 mg/ml) 3 BDfluorouracil iv soln 2.5 gm/50ml (50 mg/ml) 3 BDfluorouracil iv soln 5 gm/100ml (50 mg/ml) 3 BDflutamide cap 125 mg 2FOLOTYN - pralatrexate iv inj 20 mg/ml 5 PAFOLOTYN - pralatrexate iv inj 40 mg/2ml 5 PAGAZYVA - obinutuzumab soln for iv infusion 1000 mg/40ml

(25 mg/ml)5 PA

gemcitabine hcl for inj 200 mg 3gemcitabine hcl for inj 1 gm 3gemcitabine hcl for inj 2 gm 3gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) 3gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) 3gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) 3GILOTRIF - 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)GLEOSTINE - lomustine cap 10 mg 4GLEOSTINE - lomustine cap 40 mg 4GLEOSTINE - lomustine cap 100 mg 5HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 5 PAHERCEPTIN - trastuzumab for iv soln 150 mg* 5 PAHERCEPTIN - trastuzumab for iv soln 440 mg* 5 PAhydroxyurea cap 500 mg 3IBRANCE - 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) 5

2019


31


IDHIFA - 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 3ifosfamide iv inj 1 gm/20ml (50 mg/ml) 4ifosfamide iv inj 3 gm/60ml (50 mg/ml) 4imatinib 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 70 mg 5 PA, QL (30 capsules/30 days)IMBRUVICA - ibrutinib cap 140 mg 5 PA, QL (120 capsules/30 days)IMBRUVICA - ibrutinib tab 140 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 280 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 420 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 560 mg 5 PA, QL (30 tablets/30 days)IMFINZI - durvalumab soln for iv infusion 120 mg/2.4ml (50 mg/ml) 5 PAIMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 5 PAIMLYGIC - 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) 3irinotecan hcl inj 40 mg/2ml (20 mg/ml) 3irinotecan hcl inj 100 mg/5ml (20 mg/ml) 3ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 5 PAIXEMPRA KIT - ixabepilone for iv infusion 15 mg 5IXEMPRA 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) 5 PAKADCYLA - ado-trastuzumab emtansine for iv soln 100 mg 5 PAKADCYLA - ado-trastuzumab emtansine for iv soln 160 mg 5 PA

2019



KEYTRUDA - pembrolizumab iv soln 100 mg/4ml (25 mg/ml)* 5 PAKISQALI - 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 10 mg 5 PAKYPROLIS - carfilzomib for inj 30 mg 5 PAKYPROLIS - carfilzomib for inj 60 mg 5 PALARTRUVO - olaratumab soln for iv infusion 190 mg/19ml (10 mg/

ml)5 PA

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

5 PA

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


LENVIMA 12MG DAILY DOSE - lenvatinib cap therapy pack 4(3) 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 4 MG DAILY DOSE - lenvatinib cap therapy pack 4 mg* 5 PA, QL (30 capsules/30 days)LENVIMA 8 MG DAILY DOSE - lenvatinib cap therapy pack 4

(2) mg*5 PA, QL (60 capsules/30 days)

letrozole tab 2.5 mg 2LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 3LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 3leucovorin calcium for inj 50 mg 3leucovorin calcium for inj 100 mg 3leucovorin calcium for inj 200 mg 3leucovorin calcium for inj 350 mg 3leucovorin calcium for inj 500 mg 3leucovorin calcium tab 5 mg 3leucovorin calcium tab 25 mg 3LEUKERAN - chlorambucil tab 2 mg 5

2019


33


LIBTAYO - cemiplimab-rwlc iv soln 350 mg/7ml (50 mg/ml) 5 PALONSURF - 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)LUMOXITI - moxetumomab pasudotox-tdfk for iv soln 1 mg 5 PALYNPARZA - 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)MEKTOVI - binimetinib tab 15 mg 5 PA, QL (180 tablets/30 days)melphalan hcl for inj 50 mg 5mercaptopurine tab 50 mg 2mesna inj 100 mg/ml 3MESNEX - mesna tab 400 mg 5mitomycin for iv soln 5 mg 4mitomycin for iv soln 20 mg 4mitomycin for iv soln 40 mg 5mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) 3mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml) 3mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml) 3MYLOTARG - gemtuzumab ozogamicin for iv soln 4.5 mg 5 PANERLYNX - 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)nilutamide 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 5ONIVYDE - irinotecan hcl liposome iv inj 43 mg/10ml (4.3 mg/ml) 5 PAOPDIVO - nivolumab iv soln 40 mg/4ml* 5 PAOPDIVO - nivolumab iv soln 100 mg/10ml* 5 PAOPDIVO - nivolumab iv soln 240 mg/24ml* 5 PAoxaliplatin for iv inj 50 mg 5

2019



oxaliplatin for iv inj 100 mg 5oxaliplatin iv soln 50 mg/10ml 3oxaliplatin iv soln 100 mg/20ml 3paclitaxel iv conc 30 mg/5ml (6 mg/ml) 3paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) 3paclitaxel iv conc 300 mg/50ml (6 mg/ml) 3PANRETIN - alitretinoin gel 0.1% 5PERJETA - pertuzumab soln for iv infusion 420 mg/14ml (30 mg/

ml)*5 PA

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)* 5 PAPOTELIGEO - mogamulizumab-kpkc iv soln 20 mg/5ml (4 mg/ml) 5 PAPROLEUKIN - 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 5SPRYCEL - dasatinib tab 20 mg 5 PA, QL (90 tablets/30 days)SPRYCEL - dasatinib tab 50 mg 5 PA, QL (30 tablets/30 days)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)

2019


35


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 5 PATABLOID - 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)TALZENNA - talazoparib tosylate cap 0.25 mg 5 PA, QL (90 capsules/30 days)TALZENNA - talazoparib tosylate cap 1 mg 5 PA, QL (30 capsules/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 gel 1% 5TASIGNA - nilotinib hcl cap 50 mg 5 PA, QL (120 capsules/30 days)TASIGNA - 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)TECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 5 PATEMODAR - temozolomide for iv soln 100 mg 5temsirolimus soln for iv infusion 25 mg/ml 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 5TIBSOVO - ivosidenib tab 250 mg 5 PA, QL (60 tablets/30 days)topotecan hcl for inj 4 mg 4topotecan hcl inj 4 mg/4ml (for infusion) 4TREANDA - bendamustine hcl for iv soln 25 mg 5TREANDA - bendamustine hcl for iv soln 100 mg 5tretinoin cap 10 mg 5 PATRISENOX - arsenic trioxide iv soln 12 mg/6ml (2 mg/ml) 5

2019



TYKERB - lapatinib ditosylate tab 250 mg* 5 PA, QL (180 tablets/30 days)UNITUXIN - dinutuximab iv soln 17.5 mg/5ml (3.5 mg/ml)* 5 PAVALCHLOR - mechlorethamine hcl gel 0.016%* 5VECTIBIX - panitumumab iv soln 100 mg/5ml 5 PAVECTIBIX - panitumumab iv soln 400 mg/20ml 5 PAVELCADE - bortezomib for inj 3.5 mg 5 PAVENCLEXTA - 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)VERZENIO - abemaciclib tab 50 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 100 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 150 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 200 mg 5 PA, QL (60 tablets/30 days)VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 3 BDvincristine sulfate iv soln 1 mg/ml 3 BDvinorelbine tartrate inj 10 mg/ml 3vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 3VIZIMPRO - dacomitinib tab 15 mg 5 PA, QL (30 tablets/30 days)VIZIMPRO - dacomitinib tab 30 mg 5 PA, QL (30 tablets/30 days)VIZIMPRO - dacomitinib tab 45 mg 5 PA, QL (30 tablets/30 days)VOTRIENT - pazopanib hcl tab 200 mg* 5 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 5 PAXALKORI - 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)* 5 PAYERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 5 PAYONDELIS - trabectedin for inj 1 mg 5 PAYONSA - abiraterone acetate tab 125 mg* 5 PA, QL (120 tablets/30 days)ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 5 PAZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 5 PAZANOSAR - 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)

2019


37


ZYDELIG - idelalisib tab 150 mg* 5 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 5 PA, QL (90 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 antiparasitariosalbendazole tab 200 mg 5ALBENZA - albendazole tab 200 mg 5ALINIA - 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 2BENZNIDAZOLE - benznidazole tab 12.5 mg 4BENZNIDAZOLE - benznidazole tab 100 mg 4BILTRICIDE - praziquantel tab 600 mg 5CHLOROQUINE PHOSPHATE - chloroquine phosphate tab

250 mg3

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

300 mg4 BD

PENTAM 300 - pentamidine isethionate for soln 300 mg 4permethrin cream 5% 3praziquantel tab 600 mg 5PRIMAQUINE PHOSPHATE - primaquine phosphate tab 26.3 mg 3Agentes 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)benztropine mesylate tab 0.5 mg# 3 PAbenztropine mesylate tab 1 mg# 3 PAbenztropine mesylate tab 2 mg# 3 PA

2019



bromocriptine mesylate cap 5 mg 3bromocriptine mesylate tab 2.5 mg 3carbidopa & 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

entacapone tab 200 mg 3pramipexole dihydrochloride tab 0.125 mg 2pramipexole dihydrochloride tab 0.25 mg 2pramipexole dihydrochloride tab 0.5 mg 2pramipexole dihydrochloride tab 0.75 mg 2pramipexole dihydrochloride tab 1 mg 2pramipexole dihydrochloride tab 1.5 mg 2rasagiline mesylate tab 0.5 mg 3rasagiline mesylate tab 1 mg 3ropinirole 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 2

2019


39


selegiline hcl cap 5 mg 3selegiline hcl tab 5 mg 3tolcapone tab 100 mg 5Medicamentos antipsicóticosADASUVE - loxapine aerosol powder breath activated 10 mg 4 PAaripiprazole oral solution 1 mg/ml 3 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 3 PA, QL (45 tablets/30 days)aripiprazole tab 5 mg 3 PA, QL (45 tablets/30 days)aripiprazole tab 10 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 15 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 20 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 30 mg 3 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)





ARISTADA INITIO - aripiprazole lauroxil im er susp prefilled syr675 mg/2.4ml


clozapine orally disintegrating tab 12.5 mg 3 PA, QL (90 tablets/30 days)clozapine orally disintegrating tab 25 mg 3 PA, QL (270 tablets/30 days)clozapine orally disintegrating tab 100 mg 3 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)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)

2019



fluphenazine decanoate inj 25 mg/ml 3 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 3 PAFLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 3 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 3 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 mesylate for inj 20 mg 4 PA, QL (60 vials/30 days)haloperidol decanoate im soln 50 mg/ml 3 PAhaloperidol decanoate im soln 100 mg/ml 3 PAhaloperidol lactate inj 5 mg/ml 3 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 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)



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)

2019


41


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 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 5 mg 4 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 10 mg 4 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 25 mg 4 PANUPLAZID - pimavanserin tartrate cap 34 mg* 5 PA, QL (30 capsules/30 days)NUPLAZID - pimavanserin tartrate tab 10 mg* 5 PA, QL (30 tablets/30 days)NUPLAZID - pimavanserin tartrate tab 17 mg* 5 PA, QL (60 tablets/30 days)olanzapine for im inj 10 mg 3 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)paliperidone tab er 24hr 1.5 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg 4 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)PERSERIS - risperidone subcutaneous for er susp prefilled syr

90 mg5 PA, QL (1 syringe/30 days)

PERSERIS - risperidone subcutaneous for er susp prefilled syr120 mg


pimozide tab 1 mg 3pimozide tab 2 mg 3quetiapine fumarate tab er 24hr 50 mg 3 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 150 mg 3 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 200 mg 3 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 300 mg 3 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 400 mg 3 PA, QL (60 tablets/30 days)

2019



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 CONSTA - risperidone microspheres for inj 12.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 5 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 5 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 5 PA, QL (2 vials/28 days)risperidone orally disintegrating tab 0.25 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 0.5 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 1 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 2 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 3 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 4 mg 3 PA, QL (120 tablets/30 days)risperidone soln 1 mg/ml 2 PA, QL (480 mls/30 days)risperidone tab 0.25 mg 2 PA, QL (60 tablets/30 days)risperidone tab 0.5 mg 2 PA, QL (60 tablets/30 days)risperidone tab 1 mg 2 PA, QL (60 tablets/30 days)risperidone tab 2 mg 2 PA, QL (60 tablets/30 days)risperidone tab 3 mg 2 PA, QL (60 tablets/30 days)risperidone tab 4 mg 2 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)thioridazine hcl tab 10 mg 3 PAthioridazine hcl tab 25 mg 3 PAthioridazine hcl tab 50 mg 3 PAthioridazine hcl tab 100 mg 3 PAthiothixene cap 1 mg 2 PAthiothixene cap 2 mg 2 PA

2019


43


thiothixene 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 PAVRAYLAR - cariprazine hcl cap 1.5 mg 5 PA, QL (30 capsules/30 days)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 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)

Agentes antiespasmódicosbaclofen tab 10 mg 1baclofen tab 20 mg 1dantrolene 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 1tizanidine hcl tab 4 mg 1Medicamentos antiviralesabacavir sulfate soln 20 mg/ml 3 QL (960 mls/30 days)abacavir sulfate tab 300 mg 3 QL (60 tablets/30 days)abacavir sulfate-lamivudine tab 600-300 mg 3 QL (30 tablets/30 days)abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 5 QL (60 tablets/30 days)acyclovir cap 200 mg 2acyclovir oint 5% 4acyclovir sodium iv soln 50 mg/ml 3 BD

2019



acyclovir susp 200 mg/5ml 3acyclovir 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)atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)atazanavir sulfate cap 300 mg 5 QL (30 capsules/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 5BIKTARVY - bictegravir-emtricitabine-tenofovir af tab


cidofovir iv inj 75 mg/ml 5CIMDUO - lamivudine-tenofovir disoproxil fumarate tab

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

COMPLERA - emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg

5 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)DAKLINZA - daclatasvir dihydrochloride tab 30 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 60 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 90 mg 5 PADELSTRIGO - doravirine-lamivudine-tenofovir df tab


DENAVIR - penciclovir cream 1% 5DESCOVY - emtricitabine-tenofovir alafenamide fumarate tab


didanosine delayed release capsule 200 mg 3 QL (30 capsules/30 days)didanosine delayed release capsule 250 mg 3 QL (30 capsules/30 days)didanosine delayed release capsule 400 mg 3 QL (30 capsules/30 days)EDURANT - rilpivirine hcl tab 25 mg 5 QL (30 tablets/30 days)efavirenz cap 50 mg 3 QL (90 capsules/30 days)efavirenz cap 200 mg 5 QL (60 capsules/30 days)efavirenz tab 600 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)entecavir tab 0.5 mg 3

2019


45


entecavir tab 1 mg 3EPCLUSA - sofosbuvir-velpatasvir tab 400-100 mg 5 PAEPIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) 3EVOTAZ - 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 3 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 5 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)JULUCA - dolutegravir sodium-rilpivirine hcl tab 50-25 mg 5 QL (30 tablets/30 days)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 3 QL (960 mls/30 days)lamivudine tab 100 mg (hbv) 3lamivudine tab 150 mg 2 QL (60 tablets/30 days)lamivudine tab 300 mg 2 QL (30 tablets/30 days)

2019



lamivudine-zidovudine tab 150-300 mg 3 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 susp 50 mg/5ml 3 QL (1200 mls/30 days)nevirapine tab er 24hr 100 mg 3 QL (90 tablets/30 days)nevirapine tab er 24hr 400 mg 3 QL (30 tablets/30 days)nevirapine tab 200 mg 2 QL (60 tablets/30 days)NORVIR - ritonavir oral soln 80 mg/ml 4 QL (480 mls/30 days)NORVIR - ritonavir powder packet 100 mg 4 QL (360 packets/30 days)ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg 5 QL (30 tablets/30 days)oseltamivir phosphate cap 30 mg 3oseltamivir phosphate cap 45 mg 3oseltamivir phosphate cap 75 mg 3oseltamivir 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 PAPIFELTRO - doravirine tab 100 mg 5 QL (30 tablets/30 days)PREVYMIS - letermovir tab 240 mg 5PREVYMIS - letermovir tab 480 mg 5PREZCOBIX - 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 4RELENZA DISKHALER - zanamivir aero powder breath activated

5 mg/blister4

RESCRIPTOR - delavirdine mesylate tab 100 mg 4 QL (360 tablets/30 days)RESCRIPTOR - delavirdine mesylate tab 200 mg 4 QL (180 tablets/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)

2019


47


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 3ribavirin tab 200 mg 3ritonavir tab 100 mg 3 QL (360 tablets/30 days)SELZENTRY - 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


SUSTIVA - efavirenz cap 50 mg 4 QL (90 capsules/30 days)SUSTIVA - efavirenz cap 200 mg 5 QL (60 capsules/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 PASYMFI - efavirenz-lamivudine-tenofovir df tab 600-300-300 mg 5 QL (30 tablets/30 days)SYMFI LO - efavirenz-lamivudine-tenofovir df tab 400-300-300 mg 5 QL (30 tablets/30 days)SYMTUZA - darunavir-cobic-emtricitab-tenofov af tab


TAMIFLU - oseltamivir phosphate for susp 6 mg/ml 4TECHNIVIE - ombitasvir-paritaprevir-ritonavir tab 12.5-75-50 mg 5 PAtenofovir disoproxil fumarate tab 300 mg 5 QL (30 tablets/30 days)TIVICAY - dolutegravir sodium tab 10 mg 4 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 25 mg 5 QL (60 tablets/30 days)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)TROGARZO - ibalizumab-uiyk iv soln 200 mg/1.33ml (150 mg/ml) 5 QL (14 vials/28 days)TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab


2019



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 2valganciclovir hcl for soln 50 mg/ml 5valganciclovir hcl tab 450 mg 5VIDEX - 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)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)VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 5 PAXOFLUZA - baloxavir marboxil tab therapy pack 20 (2) mg (40 mg

dose)4

XOFLUZA - baloxavir marboxil tab therapy pack 40 (2) mg (80 mgdose)

4

ZEPATIER - elbasvir-grazoprevir tab 50-100 mg 5 PAZERIT - 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)zidovudine cap 100 mg 2 QL (180 capsules/30 days)zidovudine syrup 10 mg/ml 3 QL (1920 mls/30 days)zidovudine tab 300 mg 2 QL (60 tablets/30 days)

2019


49


Medicamentos ansiolíticosalprazolam tab 0.25 mg 4 QL (120 tablets/30 days)alprazolam tab 0.5 mg 4 QL (120 tablets/30 days)alprazolam tab 1 mg 4 QL (120 tablets/30 days)alprazolam tab 2 mg 4 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 2chlordiazepoxide hcl cap 5 mg 3 PA, QL (120 capsules/30 days)chlordiazepoxide hcl cap 10 mg 3 PA, QL (120 capsules/30 days)chlordiazepoxide hcl cap 25 mg 3 PA, QL (360 capsules/30 days)clonazepam 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 2 PA, QL (120 tablets/30 days)clonazepam tab 1 mg 2 PA, QL (120 tablets/30 days)clonazepam tab 2 mg 2 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 (360 tablets/30 days)clorazepate dipotassium tab 15 mg 2 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 3 PA, QL (1200 mls/30 days)diazepam conc 5 mg/ml 2 PA, QL (240 mls/30 days)diazepam tab 2 mg 2 PA, QL (120 tablets/30 days)diazepam tab 5 mg 2 PA, QL (120 tablets/30 days)diazepam tab 10 mg 2 PA, QL (120 tablets/30 days)hydroxyzine hcl syrup 10 mg/5ml# 3 PAhydroxyzine hcl tab 10 mg# 3 PAhydroxyzine hcl tab 25 mg# 3 PAhydroxyzine hcl tab 50 mg# 3 PAlorazepam tab 0.5 mg 2 PA, QL (120 tablets/30 days)lorazepam tab 1 mg 2 PA, QL (120 tablets/30 days)lorazepam tab 2 mg 2 PA, QL (150 tablets/30 days)Agentes bipolaresLITHIUM - lithium oral solution 8 meq/5ml 3

2019



lithium carbonate cap 150 mg 2lithium carbonate cap 300 mg 2lithium carbonate cap 600 mg 2lithium carbonate tab er 300 mg 2lithium carbonate tab er 450 mg 2lithium carbonate tab 300 mg 2Reguladores 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)ASSURE ID INSULIN SAFETY SYRINGE/U-100/0.5ML/29G X

1/2"3

ASSURE ID INSULIN SAFETY SYRINGE/U-100/1ML/29G X 1/2" 3ASSURE ID SAFETY PEN NEEDLES 31G X 5MM (3/16") 3BD SAFETYGLIDE INSULIN SYRINGE/0.3ML/31G X 15/64" 3BD SAFETYGLIDE INSULIN SYRINGE/0.5ML/31G X 15/64" 3BD SAFETYGLIDE INSULIN SYRINGE/1ML/31G X 15/64" 3BYDUREON - exenatide for inj extended release susp 2 mg 3 QL (4 vials/28 days), STBYDUREON BCISE - exenatide extended release susp auto-

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

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

3 QL (4 pens/28 days), ST

CYCLOSET - bromocriptine mesylate tab 0.8 mg 4 QL (180 tablets/30 days)EASY TOUCH FLIPLOCK SAFETY INSULIN SYRINGE 1ML/30G

X 1/2"3

EASY TOUCH INSULIN SYRINGE/SAFETY/U-100/0.5ML/29G X1/2"

3

EASY TOUCH INSULIN SYRINGE/SAFETY/U-100/1ML/30G X1/2"

3

EASY TOUCH SHEATHLOCK SAFETY INSULIN SYRINGE1ML/29G X 1/2"

3

EASY TOUCH SHEATHLOCK SAFETY SYRINGE 1ML/30G X1/2"

3

2019


51


GAUZE PADS 2" X 2" 3glimepiride tab 1 mg 1 QL (240 tablets/30 days)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 1 QL (240 tablets/30 days)glipizide tab er 24hr 5 mg 1 QL (120 tablets/30 days)glipizide tab er 24hr 10 mg 1 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 4 QL (4 kits/30 days)GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit 1 mg 4 QL (4 kits/30 days)GLUCOPHAGE - 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)GLYXAMBI - empagliflozin-linagliptin tab 10-5 mg 4 QL (30 tablets/30 days)GLYXAMBI - empagliflozin-linagliptin tab 25-5 mg 4 QL (30 tablets/30 days)HUMALOG - insulin lispro inj 100 unit/ml 2 QL (60 mls/30 days)HUMALOG - insulin lispro soln cartridge 100 unit/ml 2 QL (20 cartridges/30 days)HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector

100 unit/ml2 QL (20 pens/30 days)

HUMALOG KWIKPEN - insulin lispro soln pen-injector 100 unit/ml 2 QL (20 pens/30 days)HUMALOG KWIKPEN - insulin lispro soln pen-injector 200 unit/ml 2 QL (20 pens/30 days)HUMALOG MIX 50/50 - insulin lispro protamine & lispro inj 100

unit/ml (50-50)2 QL (6 vials/30 days)

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

2 QL (20 pens/30 days)

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

2 QL (6 vials/30 days)

2019



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 2 QL (60 mls/30 days)HUMULIN N KWIKPEN - insulin nph (human) (isophane) susp

pen-injector 100 unit/ml2 QL (20 pens/30 days)

HUMULIN R - insulin regular (human) inj 100 unit/ml 2 QL (60 mls/30 days)HUMULIN R U-500 (CONCENTRATE) - insulin regular (human) inj

500 unit/ml2 BD

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)

2 QL (60 mls/30 days)

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


INJECTION DEVICE FOR INSULIN 3INSULIN PEN NEEDLE 29G X 12.7MM 3INSULIN PEN NEEDLE 29G X 5MM (3/16") 3INSULIN PEN NEEDLE 29G X 8MM (5/16") 3INSULIN PEN NEEDLE 30G X 5MM (3/16") 3INSULIN PEN NEEDLE 30G X 8MM (1/3" OR 5/16") 3INSULIN PEN NEEDLE 31G X 4MM (1/6") 3INSULIN PEN NEEDLE 32G X 5MM (1/5" OR 3/16") 3INSULIN PEN NEEDLE 33G X 4MM (5/32") 3INSULIN PEN NEEDLE 33G X 5MM (1/5" OR 3/16") 3INSULIN PEN NEEDLE 33G X 6MM (1/4") 3INSULIN PEN NEEDLE 33G X 8MM (1/3" OR 5/16") 3INSULIN SYRINGE (DISP) U-100/0.3ML 3INSULIN SYRINGE (DISP) U-100/0.5ML 3INSULIN SYRINGE (DISP) U-100/1ML 3INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30 X 15/64" 3INSULIN SYRINGE/NEEDLE U-100 0.5 ML 30 X 15/64" 3INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X 15/64" 3INSULIN SYRINGE/NEEDLE U-100/0.3ML/28G X 1/2" 3INSULIN SYRINGE/NEEDLE U-100/0.3ML/29G 3INSULIN SYRINGE/NEEDLE U-100/0.3ML/29G X 1" 3INSULIN SYRINGE/NEEDLE U-100/0.3ML/30G 3INSULIN SYRINGE/NEEDLE U-100/0.3ML/31G X 1/4" (6MM) 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/27G X 1/2" 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/28G X 5/16" 3

2019


53


INSULIN SYRINGE/NEEDLE U-100/0.5ML/29G 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/29G X 5/16" 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/30G 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/30G X 3/16" (5MM) 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/30G X 3/8" 3INSULIN SYRINGE/NEEDLE U-100/0.5ML/31G X 1/4" (6MM) 3INSULIN SYRINGE/NEEDLE U-100/1ML/25G X 1" 3INSULIN SYRINGE/NEEDLE U-100/1ML/25G X 5/8" 3INSULIN SYRINGE/NEEDLE U-100/1ML/26G X 1/2" 3INSULIN SYRINGE/NEEDLE U-100/1ML/27G X 1/2" 3INSULIN SYRINGE/NEEDLE U-100/1ML/27G X 5/8" 3INSULIN SYRINGE/NEEDLE U-100/1ML/28G X 5/16" 3INSULIN SYRINGE/NEEDLE U-100/1ML/29G X 5/16" 3INSULIN SYRINGE/NEEDLE U-100/1ML/30G 3INSULIN SYRINGE/NEEDLE U-100/1ML/30G X 3/16" (5MM) 3INSULIN SYRINGE/NEEDLE U-100/1ML/31G X 1/4" (6MM) 3INSULIN SYRINGE/NEEDLE U-100/2ML/27.5G X 5/8" 3INSULIN SYRINGE/NEEDLE U-40/1ML/25G X 5/8" 3INSULIN SYRINGE/NEEDLE U-500/0.5ML/31G X 6MM (15/64") 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)

2019



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)

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

ml2 QL (20 pens/30 days)

LEVEMIR - insulin detemir inj 100 unit/ml 2 QL (6 vials/30 days)LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 100

unit/ml2 QL (20 pens/30 days)

metformin hcl tab er 24hr 500 mg 1 QL (120 tablets/30 days)metformin hcl tab er 24hr 750 mg 1 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)miglitol tab 25 mg 3 QL (360 tablets/30 days)miglitol tab 50 mg 3 QL (180 tablets/30 days)miglitol tab 100 mg 3 QL (90 tablets/30 days)MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.3ML/29G X 1/2"3

MONOJECT INSULIN SYRINGE/SAFETY/PERMNEEDLE/0.5ML/29G X 1/2"

3

MONOJECT INSULIN SYRINGE/SAFETY/PERMNEEDLE/1ML/29G X 1/2"

3

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)

2019


55


OZEMPIC - semaglutide soln pen-inj 0.25 or 0.5 mg/dose(2 mg/1.5ml)

3 QL (1 pen/28 days), ST

OZEMPIC - semaglutide soln pen-inj 1 mg/dose (2 mg/1.5ml) 3 QL (2 pens/28 days), STpioglitazone 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 3repaglinide 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)SAFETY INSULIN SYRINGES 1ML/30G X 1/2" 3STARLIX - nateglinide tab 60 mg 4 QL (180 tablets/30 days)STARLIX - nateglinide tab 120 mg 4 QL (90 tablets/30 days)SYMLINPEN 120 - pramlintide acetate pen-inj 2700 mcg/2.7ml

(1000 mcg/ml)5

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

5

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


TECHLITE INSULIN SYRINGE U-100/0.3ML/29G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/0.3ML/30G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/0.3ML/30G X 5/16" 3TECHLITE INSULIN SYRINGE U-100/0.3ML/31G X 15/64" 3

2019



TECHLITE INSULIN SYRINGE U-100/0.3ML/31G X 5/16" 3TECHLITE INSULIN SYRINGE U-100/0.5ML/29G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/0.5ML/30G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/0.5ML/30G X 5/16" 3TECHLITE INSULIN SYRINGE U-100/0.5ML/31G X 15/64" 3TECHLITE INSULIN SYRINGE U-100/0.5ML/31G X 5/16" 3TECHLITE INSULIN SYRINGE U-100/1ML/29G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/1ML/30G X 1/2" 3TECHLITE INSULIN SYRINGE U-100/1ML/30G X 5/16" 3TECHLITE INSULIN SYRINGE U-100/1ML/31G X 15/64" 3TECHLITE INSULIN SYRINGE U-100/1ML/31G X 5/16" 3TECHLITE PEN NEEDLES 29G X 10MM 3TECHLITE PEN NEEDLES 29G X 12MM 3TECHLITE PEN NEEDLES 31G X 5MM 3TECHLITE PEN NEEDLES/31G X 6MM 3TECHLITE PEN NEEDLES/31G X 8MM 3TECHLITE PEN NEEDLES/32G X 4MM 3TECHLITE PEN NEEDLES/32G X 6MM 3TECHLITE PEN NEEDLES/32G X 8MM 3TOUJEO MAX SOLOSTAR - insulin glargine soln pen-injector 300

unit/ml2 QL (60 mls/30 days)

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

2 QL (60 mls/30 days)

TRADJENTA - linagliptin tab 5 mg 4 QL (30 tablets/30 days)TRESIBA - insulin degludec inj 100 unit/ml 2 QL (6 vials/30 days)TRESIBA FLEXTOUCH - insulin degludec soln pen-injector 100

unit/ml2 QL (20 pens/30 days)

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


TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/29G X 1/2" 3TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/30G X 5/16" 3TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/31G X 5/16" 3TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/28G X 1/2" 3TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/29G X 1/2" 3TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/30G X 5/16" 3TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/31G X 5/16" 3TRUEPLUS INSULIN SYRINGE/U-100/1ML/28G X 1/2" 3TRUEPLUS INSULIN SYRINGE/U-100/1ML/29G X 1/2" 3TRUEPLUS INSULIN SYRINGE/U-100/1ML/30G X 5/16" 3

2019


57


TRUEPLUS INSULIN SYRINGE/U-100/1ML/31G X 5/16" 3TRUEPLUS PEN NEEDLES 29G X 12MM 3TRUEPLUS PEN NEEDLES 31G X 5MM 3TRUEPLUS PEN NEEDLES 31G X 6MM 3TRUEPLUS PEN NEEDLES 31G X 8MM 3TRUEPLUS PEN NEEDLES 32G X 4MM 3TRUEPLUS 5-BEVEL PEN NEEDLES 31GX5MM 3TRUEPLUS 5-BEVEL PEN NEEDLES 31GX6MM 3TRUEPLUS 5-BEVEL PEN NEEDLES 31GX8MM 3TRUEPLUS 5-BEVEL PEN NEEDLES 32GX4MM 3TRULICITY - dulaglutide soln pen-injector 0.75 mg/0.5ml 3 QL (4 pens/28 days), STTRULICITY - dulaglutide soln pen-injector 1.5 mg/0.5ml 3 QL (4 pens/28 days), STULTICARE INSULIN SAFETY SYRINGE/0.5ML/29G X 1/2" 3ULTICARE INSULIN SAFETY SYRINGE/1ML/29G X 1/2" 3VANISHPOINT INSULIN SYRINGE/0.5ML/30G X 1/2" 3VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) 3 QL (1 package/30 days), STHemoderivados/Modificadores de la sangre/ Expansores delanagrelide hcl cap 0.5 mg 3anagrelide hcl cap 1 mg 3ARANESP 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 5 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


5 PA


5 PA


5 PA


5 PA

2019




5 PA

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

5 PA

aspirin-dipyridamole cap er 12hr 25-200 mg 3azacitidine for inj 100 mg 5BEVYXXA - betrixaban maleate cap 40 mg 4 QL (43 capsules/42 days)BEVYXXA - betrixaban maleate cap 80 mg 4 QL (43 capsules/42 days)BRILINTA - ticagrelor tab 60 mg 3BRILINTA - ticagrelor tab 90 mg 3cilostazol tab 50 mg 1cilostazol tab 100 mg 1clopidogrel bisulfate tab 75 mg 2clopidogrel bisulfate tab 300 mg 3COUMADIN - 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 4dipyridamole tab 25 mg# 3dipyridamole tab 50 mg# 3dipyridamole tab 75 mg# 3ELIQUIS - apixaban tab 2.5 mg 3 QL (60 tablets/30 days)ELIQUIS - apixaban tab 5 mg 3 QL (74 tablets/30 days)ELIQUIS STARTER PACK - apixaban tab 5 mg 3 QL (74 tablets/30 days)enoxaparin sodium inj 30 mg/0.3ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 40 mg/0.4ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 60 mg/0.6ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 80 mg/0.8ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 100 mg/ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 120 mg/0.8ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 150 mg/ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 300 mg/3ml 4 QL (10 vials/90 days)EPOGEN - epoetin alfa inj 2000 unit/ml 4 PA

2019


59


EPOGEN - 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 5 PAfondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 4 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 5GRANIX - tbo-filgrastim subcutaneous inj 300 mcg/ml 5GRANIX - tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml)5

heparin sodium (porcine) inj 1000 unit/ml 3heparin sodium (porcine) inj 5000 unit/ml 3heparin sodium (porcine) inj 10000 unit/ml 3heparin sodium (porcine) inj 20000 unit/ml 3heparin sodium (porcine) pf inj 5000 unit/0.5ml 3heparin sodium (porcine) 40 unit/ml in d5w 3LEUKINE - sargramostim lyophilized for inj 250 mcg 5MOZOBIL - 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

NEUPOGEN - filgrastim inj 300 mcg/ml 5NEUPOGEN - filgrastim inj 480 mcg/1.6ml (300 mcg/ml) 5NEUPOGEN - filgrastim soln prefilled syringe 300 mcg/0.5ml 5NEUPOGEN - filgrastim soln prefilled syringe 480 mcg/0.8ml

(600 mcg/ml)5

PRADAXA - 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)PRADAXA - dabigatran etexilate mesylate cap 150 mg 4 QL (60 capsules/30 days)prasugrel hcl tab 5 mg 3prasugrel hcl tab 10 mg 3PROCRIT - 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 PA

2019



PROCRIT - epoetin alfa inj 40000 unit/ml 5 PAPROMACTA - eltrombopag olamine powder pack for susp

12.5 mg*5 PA

PROMACTA - 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 PARETACRIT - epoetin alfa-epbx inj 2000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 3000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 4000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 10000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 40000 unit/ml 4 PAtranexamic acid iv soln 1000 mg/10ml (100 mg/ml) 3tranexamic acid tab 650 mg 3warfarin sodium tab 1 mg 2warfarin sodium tab 2 mg 2warfarin sodium tab 2.5 mg 2warfarin sodium tab 3 mg 2warfarin sodium tab 4 mg 2warfarin sodium tab 5 mg 2warfarin sodium tab 6 mg 2warfarin sodium tab 7.5 mg 2warfarin sodium tab 10 mg 2XARELTO - rivaroxaban tab 2.5 mg 3 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 10 mg 3 QL (30 tablets/30 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

2019


61


acebutolol hcl cap 200 mg 2acebutolol hcl cap 400 mg 2acetazolamide cap er 12hr 500 mg 3acetazolamide tab 125 mg 3acetazolamide tab 250 mg 3ADALAT CC - nifedipine tab er 24hr 30 mg 4ADALAT CC - nifedipine tab er 24hr 60 mg 4ADALAT CC - nifedipine tab er 24hr 90 mg 4ALDACTONE - 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 100 mg 3amiodarone hcl tab 200 mg 2amiodarone hcl tab 400 mg 3amlodipine besylate tab 2.5 mg 1amlodipine besylate tab 5 mg 1amlodipine besylate tab 10 mg 1amlodipine besylate-atorvastatin calcium tab 2.5-10 mg 3amlodipine besylate-atorvastatin calcium tab 2.5-20 mg 3amlodipine besylate-atorvastatin calcium tab 2.5-40 mg 3amlodipine besylate-atorvastatin calcium tab 5-10 mg 3amlodipine besylate-atorvastatin calcium tab 5-20 mg 3amlodipine besylate-atorvastatin calcium tab 5-40 mg 3amlodipine besylate-atorvastatin calcium tab 5-80 mg 3amlodipine besylate-atorvastatin calcium tab 10-10 mg 3amlodipine besylate-atorvastatin calcium tab 10-20 mg 3amlodipine besylate-atorvastatin calcium tab 10-40 mg 3amlodipine besylate-atorvastatin calcium tab 10-80 mg 3amlodipine besylate-benazepril hcl cap 2.5-10 mg 2amlodipine besylate-benazepril hcl cap 5-10 mg 2amlodipine besylate-benazepril hcl cap 5-20 mg 2amlodipine besylate-benazepril hcl cap 5-40 mg 2

2019



amlodipine 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 3 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-25 mg 3 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg 3 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg 3 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-320-25 mg 3 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

16-12.5 mg4 QL (30 tablets/30 days)

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)AVAPRO - irbesartan tab 300 mg 4 QL (30 tablets/30 days)

2019


63


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 2bisoprolol & hydrochlorothiazide tab 5-6.25 mg 2bisoprolol & hydrochlorothiazide tab 10-6.25 mg 2bisoprolol fumarate tab 5 mg 2bisoprolol fumarate tab 10 mg 2bumetanide inj 0.25 mg/ml 3bumetanide tab 0.5 mg 2bumetanide tab 1 mg 2bumetanide tab 2 mg 2BYSTOLIC - nebivolol hcl tab 2.5 mg 4BYSTOLIC - nebivolol hcl tab 5 mg 4BYSTOLIC - nebivolol hcl tab 10 mg 4BYSTOLIC - nebivolol hcl tab 20 mg 4CALAN - verapamil hcl tab 80 mg 4CALAN - verapamil hcl tab 120 mg 4CALAN SR - verapamil hcl tab er 120 mg 4

2019



CALAN 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)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 2CARDIZEM - 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 300 mg 4CARDIZEM CD - diltiazem hcl coated beads cap er 24hr 360 mg 4carvedilol tab 3.125 mg 1carvedilol tab 6.25 mg 1carvedilol tab 12.5 mg 1carvedilol tab 25 mg 1CHLOROTHIAZIDE - chlorothiazide tab 250 mg 3chlorothiazide 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 td patch weekly 0.1 mg/24hr 2

2019


65


clonidine td patch weekly 0.2 mg/24hr 2clonidine td patch weekly 0.3 mg/24hr 2colestipol 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 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)DEMSER - metyrosine cap 250 mg 5DIGOXIN - digoxin oral soln 0.05 mg/ml# 3 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)# 3 PA, QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg 3diltiazem hcl cap er 12hr 90 mg 3diltiazem hcl cap er 12hr 120 mg 3diltiazem hcl cap er 24hr 120 mg 3diltiazem hcl cap er 24hr 180 mg 3diltiazem hcl cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 120 mg 3diltiazem hcl coated beads cap er 24hr 180 mg 3diltiazem hcl coated beads cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 300 mg 3diltiazem hcl coated beads cap er 24hr 360 mg 3diltiazem hcl coated beads tab er 24hr 180 mg 3diltiazem hcl coated beads tab er 24hr 240 mg 3diltiazem hcl coated beads tab er 24hr 300 mg 3diltiazem hcl coated beads tab er 24hr 360 mg 3diltiazem hcl coated beads tab er 24hr 420 mg 3diltiazem hcl extended release beads cap er 24hr 120 mg 3diltiazem hcl extended release beads cap er 24hr 180 mg 3diltiazem hcl extended release beads cap er 24hr 240 mg 3diltiazem hcl extended release beads cap er 24hr 300 mg 3

2019



diltiazem hcl extended release beads cap er 24hr 360 mg 3diltiazem hcl extended release beads cap er 24hr 420 mg 3diltiazem hcl tab 30 mg 3diltiazem hcl tab 60 mg 3diltiazem hcl tab 90 mg 3diltiazem hcl tab 120 mg 3DIOVAN - 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) 3dofetilide cap 250 mcg (0.25 mg) 3dofetilide cap 500 mcg (0.5 mg) 3doxazosin 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)enalapril maleate & hydrochlorothiazide tab 5-12.5 mg 1enalapril maleate & hydrochlorothiazide tab 10-25 mg 1enalapril maleate tab 2.5 mg 1enalapril maleate tab 5 mg 1enalapril maleate tab 10 mg 1enalapril maleate tab 20 mg 1ENTRESTO - sacubitril-valsartan tab 24-26 mg 3 QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 3 QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 3 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)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)

2019


67


EXFORGE HCT - amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg


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 67 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 2fluvastatin sodium cap 20 mg 3 QL (60 capsules/30 days)fluvastatin sodium cap 40 mg 3 QL (60 capsules/30 days)fluvastatin sodium tab er 24 hr 80 mg 3 QL (30 tablets/30 days)fosinopril 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 3furosemide oral soln 10 mg/ml 2furosemide tab 20 mg 1

2019



furosemide tab 40 mg 1furosemide tab 80 mg 1gemfibrozil tab 600 mg 2 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 2irbesartan tab 75 mg 1 QL (30 tablets/30 days)irbesartan tab 150 mg 1 QL (30 tablets/30 days)irbesartan tab 300 mg 1 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 150-12.5 mg 1 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 300-12.5 mg 1 QL (30 tablets/30 days)isosorbide 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 2isosorbide 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 PA

2019


69


JUXTAPID - 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 2LASIX - 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 1LOPRESSOR - metoprolol tartrate tab 50 mg 4LOPRESSOR - metoprolol tartrate tab 100 mg 4losartan 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 10 mg 4LOTENSIN - benazepril hcl tab 20 mg 4LOTENSIN - benazepril hcl tab 40 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)

2019



methazolamide tab 25 mg 3methazolamide tab 50 mg 3metolazone 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 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 2mexiletine 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 2minoxidil 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 2

2019


71


niacin 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)nicardipine hcl cap 20 mg 2nicardipine hcl cap 30 mg 2nifedipine tab er 24hr 30 mg 3nifedipine tab er 24hr 60 mg 3nifedipine tab er 24hr 90 mg 3nifedipine tab er 24hr osmotic release 30 mg 3nifedipine tab er 24hr osmotic release 60 mg 3nifedipine tab er 24hr osmotic release 90 mg 3nimodipine cap 30 mg 5NISOLDIPINE ER - nisoldipine tab er 24hr 25.5 mg 3nisoldipine tab er 24hr 8.5 mg 3nisoldipine tab er 24hr 17 mg 3nisoldipine tab er 24hr 34 mg 3NITRO-BID - nitroglycerin oint 2% 3nitroglycerin 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) 3NORTHERA - 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 1 QL (60 tablets/30 days)olmesartan medoxomil tab 20 mg 1 QL (30 tablets/30 days)olmesartan medoxomil tab 40 mg 1 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg 1 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg 1 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg 1 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg 3 QL (30 tablets/30 days)

2019



olmesartan-amlodipine-hydrochlorothiazide tab 40-5-12.5 mg 3 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25 mg 3 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-10-12.5 mg 3 QL (30 tablets/30 days)olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25 mg 3 QL (30 tablets/30 days)omega-3-acid ethyl esters cap 1 gm 2pentoxifylline tab er 400 mg 2perindopril 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 2PRAVACHOL - 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 1 QL (45 tablets/30 days)pravastatin sodium tab 20 mg 1 QL (45 tablets/30 days)pravastatin sodium tab 40 mg 1 QL (45 tablets/30 days)pravastatin sodium tab 80 mg 1 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 3propafenone hcl cap er 12hr 325 mg 3propafenone hcl cap er 12hr 425 mg 3propafenone hcl tab 150 mg 2propafenone hcl tab 225 mg 2propafenone hcl tab 300 mg 2propranolol 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

2019


73


propranolol hcl inj 1 mg/ml 3propranolol hcl tab 10 mg 1propranolol hcl tab 20 mg 1propranolol hcl tab 40 mg 1propranolol hcl tab 60 mg 1propranolol hcl tab 80 mg 1quinapril 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 3QUINIDINE SULFATE - quinidine sulfate tab 200 mg 3QUINIDINE SULFATE - quinidine sulfate tab 300 mg 3ramipril 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)simvastatin 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)simvastatin tab 80 mg 1 QL (30 tablets/30 days)sotalol hcl (afib/afl) tab 80 mg 2sotalol hcl (afib/afl) tab 120 mg 2

2019



sotalol 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 2spironolactone tab 50 mg 2spironolactone tab 100 mg 2TEKTURNA - 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-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)terazosin hcl cap 1 mg 1 QL (90 capsules/30 days)terazosin hcl cap 2 mg 1 QL (60 capsules/30 days)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

TIMOLOL MALEATE - timolol maleate tab 5 mg 3TIMOLOL MALEATE - timolol maleate tab 10 mg 3

2019


75


TIMOLOL MALEATE - timolol maleate tab 20 mg 3torsemide tab 5 mg 1torsemide tab 10 mg 1torsemide tab 20 mg 1torsemide tab 100 mg 1trandolapril tab 1 mg 1trandolapril tab 2 mg 1trandolapril tab 4 mg 1triamterene & hydrochlorothiazide cap 37.5-25 mg 2triamterene & hydrochlorothiazide tab 37.5-25 mg 2triamterene & hydrochlorothiazide tab 75-50 mg 2TRIBENZOR - 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


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 360 mg 2

2019



verapamil 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 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 1ZESTORETIC - 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 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 centralamphetamine-dextroamphetamine cap er 24hr 5 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 10 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 15 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 20 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 25 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 30 mg 4 QL (30 capsules/30 days)amphetamine-dextroamphetamine tab 5 mg 3 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 7.5 mg 3 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 10 mg 3 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 12.5 mg 3 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 15 mg 3 QL (60 tablets/30 days)

2019


77


amphetamine-dextroamphetamine tab 20 mg 3 QL (90 tablets/30 days)amphetamine-dextroamphetamine tab 30 mg 3 QL (60 tablets/30 days)AMPYRA - dalfampridine tab er 12hr 10 mg* 5 PAatomoxetine hcl cap 10 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 40 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg 3 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg 3 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg 3 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 3 QL (120 tablets/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 40 mg/ml 5 PA, QL (12 syringes/28 days)dalfampridine tab er 12hr 10 mg 5 PAdexmethylphenidate hcl tab 2.5 mg 4 QL (60 tablets/30 days)dexmethylphenidate hcl tab 5 mg 4 QL (60 tablets/30 days)dexmethylphenidate hcl tab 10 mg 4 QL (60 tablets/30 days)dextroamphetamine sulfate cap er 24hr 5 mg 4 QL (90 capsules/30 days)dextroamphetamine sulfate cap er 24hr 10 mg 4 QL (120 capsules/30 days)dextroamphetamine sulfate cap er 24hr 15 mg 4 QL (120 capsules/30 days)dextroamphetamine sulfate tab 5 mg 4 QL (90 tablets/30 days)dextroamphetamine sulfate tab 10 mg 4 QL (180 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 4 QL (90 tablets/30 days)methylphenidate hcl tab 5 mg 3 QL (90 tablets/30 days)methylphenidate hcl tab 10 mg 3 QL (90 tablets/30 days)methylphenidate hcl tab 20 mg 3 QL (90 tablets/30 days)NUEDEXTA - dextromethorphan hbr-quinidine sulfate cap

20-10 mg3 PA, QL (60 capsules/30 days)

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

5 PA, QL (2 syringes/28 days)

2019



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 3TECFIDERA - 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)TYSABRI - natalizumab for iv inj conc 300 mg/15ml* 5 PAAgentes dentales y oralescevimeline hcl cap 30 mg 3chlorhexidine gluconate soln 0.12% 1KEPIVANCE - palifermin for iv inj 6.25 mg 5pilocarpine hcl tab 5 mg 2pilocarpine hcl tab 7.5 mg 2triamcinolone acetonide dental paste 0.1% 2Agentes dermatológicosacitretin cap 10 mg 3acitretin cap 17.5 mg 3acitretin cap 25 mg 3alclometasone dipropionate cream 0.05% 2alclometasone dipropionate oint 0.05% 2azelaic acid gel 15% 3AZELEX - azelaic acid cream 20% 4benzoyl peroxide-erythromycin gel 5-3% 3betamethasone 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% 2

2019


79


betamethasone valerate oint 0.1% 2calcipotriene cream 0.005% 3calcipotriene oint 0.005% 3calcipotriene soln 0.005% (50 mcg/ml) 3CARAC - fluorouracil cream 0.5% 5clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% 3clindamycin phosphate-benzoyl peroxide gel 1-5% 3clobetasol propionate cream 0.05% 3clobetasol propionate emollient base cream 0.05% 3clobetasol propionate gel 0.05% 3clobetasol propionate oint 0.05% 3clobetasol propionate soln 0.05% 3clotrimazole w/ betamethasone cream 1-0.05% 2clotrimazole w/ betamethasone lotion 1-0.05% 2desonide cream 0.05% 3desonide lotion 0.05% 3desonide oint 0.05% 3desoximetasone cream 0.05% 3desoximetasone cream 0.25% 3desoximetasone gel 0.05% 3desoximetasone oint 0.25% 3diclofenac sodium gel 3% 5diflorasone diacetate oint 0.05% 4ELIDEL - pimecrolimus cream 1% 4 PAFINACEA - azelaic acid foam 15% 3FINACEA - azelaic acid gel 15% 3fluocinolone 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 - fluorouracil soln 2% 2FLUOROURACIL - fluorouracil soln 5% 2fluorouracil cream 5% 3fluticasone propionate cream 0.05% 2fluticasone propionate oint 0.005% 2gentamicin sulfate cream 0.1% 2

2019



gentamicin sulfate oint 0.1% 2halobetasol propionate cream 0.05% 3halobetasol propionate oint 0.05% 3hydrocortisone butyrate cream 0.1% 3hydrocortisone butyrate hydrophilic lipo base cream 0.1% 3hydrocortisone butyrate oint 0.1% 3hydrocortisone butyrate soln 0.1% 3hydrocortisone cream 1% 2hydrocortisone cream 2.5% 2hydrocortisone lotion 2.5% 2hydrocortisone oint 1% 2hydrocortisone oint 2.5% 2hydrocortisone valerate cream 0.2% 3hydrocortisone valerate oint 0.2% 3imiquimod cream 5% 2 PAisotretinoin cap 10 mg 3isotretinoin cap 20 mg 3isotretinoin cap 30 mg 3isotretinoin cap 40 mg 3lactic acid (ammonium lactate) cream 12% 2lactic acid (ammonium lactate) lotion 12% 2methoxsalen rapid cap 10 mg 5metronidazole 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 calcium cream 2% 3mupirocin 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)PICATO - ingenol mebutate gel 0.05% 3 QL (2 tubes/30 days)pimecrolimus cream 1% 4 PApodofilox soln 0.5% 2

2019


81


prednicarbate cream 0.1% 2prednicarbate oint 0.1% 2REGRANEX - becaplermin gel 0.01% 5 PA, QL (15 grams/30 days)SANTYL - collagenase oint 250 unit/gm 3selenium sulfide lotion 2.5% 2silver sulfadiazine cream 1% 3SOOLANTRA - ivermectin cream 1% 3tacrolimus oint 0.03% 2 PAtacrolimus oint 0.1% 2 PAtazarotene cream 0.1% 3TAZORAC - tazarotene cream 0.05% 4TAZORAC - tazarotene gel 0.05% 4TAZORAC - tazarotene gel 0.1% 4tretinoin cream 0.025% 3tretinoin cream 0.05% 3tretinoin cream 0.1% 3tretinoin gel 0.01% 3tretinoin gel 0.025% 3triamcinolone 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% 2Electrolitos/Minerales/Metales/Vitaminasamino acid electrolyte infusion 8.5% 4 BDamino acid infusion 6% 3 BDamino acid infusion 15% 3 BDAMINOSYN - amino acid infusion 8.5% 4 BDAMINOSYN - amino acid infusion 10% 4 BDAMINOSYN II - amino acid infusion 8.5% 4 BDAMINOSYN II - amino acid infusion 10% 4 BDAMINOSYN 7%/ELECTROLYTES - amino acid electrolyte infusion

7%4 BD

AMINOSYN-HBC - amino acid infusion 7% 4 BDAMINOSYN-PF - amino acid infusion 10% 4 BD

2019



AMINOSYN-PF 7% - amino acid infusion 7% 4 BDAMINOSYN-RF - amino acid infusion 5.2% 4 BDAURYXIA - ferric citrate tab 1 gm (210 mg ferric iron) 5 PAcalcium acetate cap 667 mg 2calcium acetate tab 667 mg 2CARBAGLU - carglumic acid tab 200 mg 5 PACHEMET - succimer cap 100 mg 4CLINIMIX E 2.75%/DEXTROSE 10% - amino acid electrolyte w/

cal infusion 2.75% in d10w4 BD

CLINIMIX E 2.75%/DEXTROSE 5% - amino acid electrolyte w/calinfusion 2.75% in d5w

4 BD

CLINIMIX E 4.25%/DEXTROSE 10% - amino acid electrolyte w/cal infusion 4.25% in d10w

4 BD

CLINIMIX E 4.25%/DEXTROSE 25% - amino acid electrolyte w/cal infusion 4.25% in d25w

4 BD

CLINIMIX E 4.25%/DEXTROSE 5% - amino acid electrolyte w/calinfusion 4.25% in d5w

4 BD

CLINIMIX E 5%/DEXTROSE 15% - amino acid electrolyte w/calinfusion 5% in d15w

4 BD


4 BD


4 BD

CLINIMIX 4.25%/DEXTROSE 10% - amino acid infusion 4.25% ind10w

4 BD


4 BD


4 BD

CLINIMIX 5%/DEXTROSE 15% - amino acid infusion 5% in d15w 4 BDCLINIMIX 5%/DEXTROSE 20% - amino acid infusion 5% in d20w 4 BDCLINIMIX 5%/DEXTROSE 25% - amino acid infusion 5% in d25w 4 BDdextrose inj 5% 3dextrose inj 10% 3dextrose 2.5% w/ sodium chloride 0.45% 3dextrose 5% in lactated ringers 3dextrose 5% w/ sodium chloride 0.2% 3dextrose 5% w/ sodium chloride 0.33% 3dextrose 5% w/ sodium chloride 0.45% 3dextrose 5% w/ sodium chloride 0.9% 3EXJADE - deferasirox tab for oral susp 125 mg* 5 PA

2019


83


EXJADE - deferasirox tab for oral susp 250 mg* 5 PAEXJADE - deferasirox tab for oral susp 500 mg* 5 PAfat emulsion iv soln 20% 4 BDfomepizole inj 1 gm/ml (for iv infusion) 5FOSRENOL - lanthanum carbonate oral powder pack 750 mg 5FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 5FREAMINE HBC 6.9% - amino acid infusion 6.9% 4 BDFREAMINE III - amino acid infusion 10% 4 BDHEPATAMINE - amino acid infusion 8% 4 BDJADENU - deferasirox tab 90 mg 5 PAJADENU - deferasirox tab 180 mg 5 PAJADENU - deferasirox tab 360 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 90 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 180 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 360 mg 5 PAK-TAB - potassium chloride tab er 20 meq (1500 mg) 3kcl 20 meq/l (0.15%) in nacl 0.45% inj 3kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj 3kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj 3kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj 3kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj 3kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj 3kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj 3lactated ringer's solution 4lanthanum carbonate chew tab 500 mg 5lanthanum carbonate chew tab 750 mg 5lanthanum carbonate chew tab 1000 mg 5levocarnitine oral soln 1 gm/10ml (10%) 3levocarnitine tab 330 mg 3magnesium sulfate inj 50% 3NEPHRAMINE - amino acid infusion 5.4% 4 BDNORMOSOL-M IN D5W - electrolyte-m in d5w soln 4PHOSLYRA - calcium acetate oral soln 667 mg/5ml 4potassium chloride cap er 8 meq 2potassium chloride cap er 10 meq 2POTASSIUM CHLORIDE ER - potassium chloride tab er 20 meq

(1500 mg)3

potassium chloride inj 2 meq/ml 3

2019



potassium chloride microencapsulated crys er tab 10 meq 2potassium chloride microencapsulated crys er tab 20 meq 2potassium chloride oral soln 10% (20 meq/15ml) 3potassium chloride tab er 8 meq (600 mg) 3potassium chloride tab er 10 meq 2potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 3POTASSIUM 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

3

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

3

potassium citrate tab er 5 meq (540 mg) 2potassium citrate tab er 10 meq (1080 mg) 2potassium citrate tab er 15 meq (1620 mg) 2PREMASOL - amino acid infusion 10% 4 BDPROCALAMINE - amino acid electrolyte infusion 3% 4 BDPROSOL - amino acid infusion 20% 4 BDSAMSCA - 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 3sodium chloride inj 0.45% 3sodium chloride irrigation soln 0.9% 2sodium chloride iv soln 0.9% 3sodium polystyrene sulfonate oral susp 15 gm/60ml 2sodium polystyrene sulfonate powder 2sodium polystyrene sulfonate rectal susp 30 gm/120ml 2TRAVASOL - amino acid infusion 10% 4 BDtrientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)TROPHAMINE - amino acid infusion 10% 4 BDVELPHORO - sucroferric oxyhydroxide chew tab 500 mg 5VELTASSA - patiromer sorbitex calcium for susp packet 8.4 gm 4VELTASSA - patiromer sorbitex calcium for susp packet 16.8 gm 4VELTASSA - patiromer sorbitex calcium for susp packet 25.2 gm 4water for irrigation, sterile irrigation soln 3Agentes gastrointestinalesalosetron hcl tab 0.5 mg 5

2019


85


alosetron hcl tab 1 mg 5AMITIZA - lubiprostone cap 8 mcg 3 PAAMITIZA - lubiprostone cap 24 mcg 3 PACARAFATE - sucralfate susp 1 gm/10ml 4CHENODAL - chenodiol tab 250 mg* 5 PAcimetidine 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 3dicyclomine hcl tab 20 mg# 3 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 mg3

esomeprazole sodium for intravenous soln 40 mg 3famotidine inj 20 mg/2ml 3famotidine inj 40 mg/4ml 3famotidine inj 200 mg/20ml 3famotidine tab 20 mg 2famotidine tab 40 mg 2GATTEX - 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 for soln

236 gm4

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 2methscopolamine bromide tab 2.5 mg 2methscopolamine bromide tab 5 mg 2

2019



metoclopramide hcl inj 5 mg/ml 3metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) 3metoclopramide hcl tab 5 mg 2metoclopramide hcl tab 10 mg 2misoprostol tab 100 mcg 2misoprostol tab 200 mcg 2MOVIPREP - peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln

100 gm4

MYALEPT - metreleptin for subcutaneous inj 11.3 mg* 5 PANEXIUM - 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


nizatidine 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 2 QL (30 capsules/30 days)omeprazole cap delayed release 20 mg 2 QL (60 capsules/30 days)omeprazole cap delayed release 40 mg 2 QL (60 capsules/30 days)pantoprazole sodium ec tab 20 mg 2 QL (30 tablets/30 days)pantoprazole sodium ec tab 40 mg 2 QL (60 tablets/30 days)pantoprazole sodium for iv soln 40 mg 3peg 3350-kcl-sod bicarb-nacl for soln 420 gm 3peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm 3peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm 2polyethylene glycol 3350 oral packet 2polyethylene glycol 3350 oral powder 2PYLERA - bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg5

ranitidine hcl cap 150 mg 2ranitidine hcl cap 300 mg 2ranitidine hcl syrup 15 mg/ml (75 mg/5ml) 2ranitidine hcl tab 150 mg 2

2019


87


ranitidine hcl tab 300 mg 2RELISTOR - 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 PAsucralfate tab 1 gm 2SUPREP BOWEL PREP KIT - sod sulfate-pot sulf-mg sulf oral sol

17.5-3.13-1.6 gm/177ml4

ursodiol cap 300 mg 3ursodiol tab 250 mg 3ursodiol tab 500 mg 3XIFAXAN - rifaximin tab 550 mg 5Trastorno genético o enzimático:ADAGEN - pegademase bovine inj 250 unit/ml* 5ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500

unit/5ml)*5

CEREZYME - imiglucerase for inj 400 unit* 5 PACREON - 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 PACYSTAGON - cysteamine bitartrate cap 150 mg* 4 PAELAPRASE - idursulfase soln for iv infusion 6 mg/3ml (2 mg/ml)* 5ELELYSO - taliglucerase alfa for inj 200 unit* 5 PAFABRAZYME - 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 PALUMIZYME - alglucosidase alfa for iv soln 50 mg 5miglustat cap 100 mg* 5 PA, QL (90 capsules/30 days)NAGLAZYME - galsulfase soln for iv infusion 1 mg/ml* 5

2019



OCALIVA - 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* 5PALYNZIQ - pegvaliase-pqpz subcutaneous soln pref syringe

2.5 mg/0.5ml5 PA

PALYNZIQ - pegvaliase-pqpz subcutaneous soln pref syringe10 mg/0.5ml

5 PA

PALYNZIQ - pegvaliase-pqpz subcutaneous soln pref syringe20 mg/ml

5 PA

PROLASTIN-C - alpha1-proteinase inhibitor (human) for iv soln1000 mg*

5 PA

PROLASTIN-C - alpha1-proteinase inhibitor (human) inj1000 mg/20ml*

5 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful 5 PAsodium phenylbutyrate tab 500 mg 5 PASTRENSIQ - 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 PAVPRIV - velaglucerase alfa for inj 400 unit 5 PAZENPEP - pancrelipase (lip-prot-amyl) dr cap 3000-10000-14000

unit3

ZENPEP - pancrelipase (lip-prot-amyl) dr cap 5000-17000-24000unit

3


3


3


3

ZENPEP - pancrelipase (lip-prot-amyl) dr cap25000-79000-105000 unit

3

ZENPEP - pancrelipase (lip-prot-amyl) dr cap40000-126000-168000 unit

3

Agentes genitourinariosalfuzosin hcl tab er 24hr 10 mg 2 QL (30 tablets/30 days)bethanechol chloride tab 5 mg 2

2019


89


bethanechol chloride tab 10 mg 2bethanechol chloride tab 25 mg 2bethanechol chloride tab 50 mg 2D-PENAMINE - penicillamine tab 125 mg 5DEPEN TITRATABS - penicillamine tab 250 mg 5dutasteride 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 2 QL (30 tablets/30 days)FLOMAX - tamsulosin hcl cap 0.4 mg 4 QL (60 capsules/30 days)methylergonovine maleate tab 0.2 mg 5MYRBETRIQ - mirabegron tab er 24 hr 25 mg 4 QL (30 tablets/30 days)MYRBETRIQ - mirabegron tab er 24 hr 50 mg 4 QL (30 tablets/30 days)oxybutynin 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 (90 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)silodosin cap 4 mg 3 QL (30 capsules/30 days)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)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/modificadoresCORTISONE ACETATE - cortisone acetate tab 25 mg 3DEXAMETHASONE - dexamethasone tab 1 mg 2DEXAMETHASONE - dexamethasone tab 2 mg 2dexamethasone elixir 0.5 mg/5ml 3dexamethasone sodium phosphate inj 4 mg/ml 3dexamethasone sodium phosphate inj 20 mg/5ml 3

2019



dexamethasone sodium phosphate inj 120 mg/30ml 3dexamethasone tab 0.5 mg 2dexamethasone tab 0.75 mg 2dexamethasone tab 1.5 mg 2dexamethasone tab 4 mg 2dexamethasone tab 6 mg 2fludrocortisone 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 2methylprednisolone sod succ for inj 40 mg 3methylprednisolone sod succ for inj 125 mg 3methylprednisolone sod succ for inj 1000 mg 3methylprednisolone tab therapy pack 4 mg (21) 3methylprednisolone tab 4 mg 3methylprednisolone tab 8 mg 3methylprednisolone tab 16 mg 3methylprednisolone tab 32 mg 3prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) 3prednisolone sod phosphate oral soln 15 mg/5ml 3prednisolone sod phosphate oral soln 10 mg/5ml 3prednisolone sod phosphate oral soln 20 mg/5ml 3prednisolone syrup 15 mg/5ml 3PREDNISONE - 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 3prednisone tab 1 mg 2prednisone tab 2.5 mg 2prednisone tab 5 mg 2prednisone tab 10 mg 2prednisone tab 20 mg 2Agentes hormonales, estimulantes/sustitutos/modificadoresCHORIONIC GONADOTROPIN - chorionic gonadotropin for im inj

10000 unit4 PA

2019


91


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

chorionic gonadotropin for im inj 10000 unit4 PA

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 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)danazol cap 50 mg 3 PAdanazol cap 100 mg 3 PAdanazol cap 200 mg 3 PADEPO-PROVERA - medroxyprogesterone acetate im susp

400 mg/ml4

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) 3desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg 3desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 3drospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451 mg 3drospirenone-ethinyl estrad-levomefolate tab 3-0.03-0.451 mg 3drospirenone-ethinyl estradiol tab 3-0.02 mg 3drospirenone-ethinyl estradiol tab 3-0.03 mg 3DUAVEE - conjugated estrogens-bazedoxifene tab 0.45-20 mg# 4 PAELLA - ulipristal acetate tab 30 mg 3estradiol & norethindrone acetate tab 0.5-0.1 mg# 4 PAestradiol & norethindrone acetate tab 1-0.5 mg# 4 PAestradiol tab 0.5 mg# 3 PA

2019



estradiol tab 1 mg# 3 PAestradiol tab 2 mg# 3 PAestradiol vaginal cream 0.1 mg/gm 3estradiol vaginal tab 10 mcg 2ESTROPIPATE - estropipate tab 0.75 mg# 3 PAethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg 3ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg 3HYDROXYPROGESTERONE 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) 3levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) 3levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg 3levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg 3levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg 3levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 3levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg 2medroxyprogesterone acetate im susp prefilled syr 150 mg/ml 3medroxyprogesterone acetate im susp 150 mg/ml 3medroxyprogesterone acetate tab 2.5 mg 2medroxyprogesterone acetate tab 5 mg 2medroxyprogesterone acetate tab 10 mg 2megestrol acetate susp 40 mg/ml# 3 PAmegestrol acetate tab 20 mg# 3 PAmegestrol acetate tab 40 mg# 3 PAmethyltestosterone cap 10 mg 5 PAnorethindrone & ethinyl estradiol tab 0.4 mg-35 mcg 3norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg 3norethindrone & ethinyl estradiol tab 1 mg-35 mcg 3norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg 3norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg 3norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg 3norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg 3norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg 3norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg 3norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg 3norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) 3norethindrone acetate tab 5 mg 2norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg# 4 PA

2019


93


norethindrone tab 0.35 mg 3norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg 3norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg 3norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg 3norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg 3norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg 3norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg 3oxandrolone tab 2.5 mg 3 PAoxandrolone tab 10 mg 5 PAPREMARIN - estrogens, conjugated vaginal cream 0.625 mg/gm 3PREMPHASE - 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

progesterone micronized cap 100 mg 3progesterone micronized cap 200 mg 3raloxifene hcl tab 60 mg 2testosterone cypionate im inj in oil 100 mg/ml 3 PAtestosterone cypionate im inj in oil 200 mg/ml 3 PAtestosterone enanthate im inj in oil 200 mg/ml 3 PAtestosterone td gel 25 mg/2.5gm (1%) 3 PA, QL (90 packets/30 days)testosterone td gel 50 mg/5gm (1%) 3 PA, QL (60 units/30 days)testosterone td gel 12.5 mg/act (1%) 3 PA, QL (4 pump

bottles/30 days)testosterone td gel 20.25 mg/1.25gm (1.62%) 3 PA, QL (30 packets/30 days)testosterone td gel 40.5 mg/2.5gm (1.62%) 3 PA, QL (60 packets/30 days)testosterone td gel 20.25 mg/act (1.62%) 3 PA, QL (2 pump

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

bottles/30 days)VAGIFEM - estradiol vaginal tab 10 mcg 4Agentes hormonales, estimulantes/sustitutos/modificadores)levothyroxine sodium tab 25 mcg 2levothyroxine sodium tab 50 mcg 2

2019



levothyroxine 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 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 5

2019


95


leuprolide acetate inj kit 5 mg/ml 5LUPRON 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

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) 3 PAoctreotide acetate inj 100 mcg/ml (0.1 mg/ml) 3 PAoctreotide acetate inj 200 mcg/ml (0.2 mg/ml) 3 PAoctreotide acetate inj 500 mcg/ml (0.5 mg/ml) 3 PAoctreotide acetate inj 1000 mcg/ml (1 mg/ml) 5 PASIGNIFOR - 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 10 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 20 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 30 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

2019



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 5 PATRELSTAR - triptorelin pamoate for im susp 11.25 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 5 PAAgentes hormonales, supresores (tiroides)methimazole tab 5 mg 2methimazole tab 10 mg 2propylthiouracil 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 PA

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 3ARCALYST - rilonacept for inj 220 mg* 5 PAATGAM - 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 3BENLYSTA - 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

3

CINRYZE - c1 esterase inhibitor (human) for iv inj 500 unit* 5 PA, QL (20 vials/30 days)

2019


97


COSENTYX - secukinumab subcutaneous soln prefilled syringe150 mg/ml*

5 PA

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

5 PA

cyclosporine cap 25 mg 3 BDcyclosporine cap 100 mg 3 BDcyclosporine iv soln 50 mg/ml 3 BDCYCLOSPORINE MODIFIED - cyclosporine modified cap 50 mg 3 BDcyclosporine modified cap 25 mg 3 BDcyclosporine modified cap 100 mg 3 BDcyclosporine modified oral soln 100 mg/ml 3 BDDAPTACEL - diph, acellular pert & tet tox inj 15 lf-23 mcg-5

lf/0.5ml3

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

3

DUPIXENT - dupilumab subcutaneous soln prefilled syringe300 mg/2ml

5 PA

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

2019



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, PAGAMMAPLEX - 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/0.1ml 5 PAHUMIRA - adalimumab prefilled syringe kit 10 mg/0.2ml 5 PAHUMIRA - adalimumab prefilled syringe kit 20 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 - adalimumab prefilled syringe kit 40 mg/0.4ml 5 PAHUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -

adalimumab prefilled syringe kit 40 mg/0.8ml5 PA

2019


99


HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -adalimumab prefilled syringe kit 80 mg/0.8ml

5 PA

HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -adalimumab prefilled syringe kit 80 mg/0.8ml & 40 mg/0.4ml

5 PA

HUMIRA PEN - adalimumab pen-injector kit 40 mg/0.8ml 5 PAHUMIRA PEN - adalimumab pen-injector kit 40 mg/0.4ml 5 PAHUMIRA PEN-CD/UC/HS STARTER - adalimumab pen-injector kit

40 mg/0.8ml5 PA

HUMIRA PEN-CD/UC/HS STARTER - adalimumab pen-injector kit80 mg/0.8ml

5 PA

HUMIRA PEN-PS/UV STARTER - adalimumab pen-injector kit40 mg/0.8ml

5 PA

HUMIRA PEN-PS/UV STARTER - adalimumab pen-injector kit80 mg/0.8ml & 40 mg/0.4ml

5 PA

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

lf/0.5ml4

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

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

4

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

3

methotrexate sodium for inj 1 gm 3methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) 3methotrexate sodium inj pf 250 mg/10ml (25 mg/ml) 3methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml) 3methotrexate sodium inj 50 mg/2ml (25 mg/ml) 3methotrexate 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 3 BD

2019



mycophenolate mofetil tab 500 mg 2 BDmycophenolate sodium tab dr 180 mg 3 BDmycophenolate sodium tab dr 360 mg 3 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

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 inj 5 mg/ml 4 BDPROQUAD - measles-mumps-rubella-varicella virus vaccines for

susp4

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

RENFLEXIS - infliximab-abda 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 oral soln 100 mg/ml 4 BDSHINGRIX - zoster vac recombinant adjuvanted for im inj

50 mcg/0.5ml3 QL (2 vaccines/lifetime)

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101


SIMULECT - basiliximab for iv soln 10 mg 5 BDSIMULECT - basiliximab for iv soln 20 mg 5 BDsirolimus tab 0.5 mg 3 BDsirolimus tab 1 mg 3 BDsirolimus tab 2 mg 5 BDSTAMARIL - yellow fever vaccine for inj suspension 4STELARA - 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 3 BDtacrolimus cap 1 mg 3 BDtacrolimus cap 5 mg 3 BDTENIVAC - tetanus-diphtheria toxoids (td) inj 5-2 lfu 4TETANUS/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 PAXOLAIR - omalizumab subcutaneous soln prefilled syringe

75 mg/0.5ml*5 PA

XOLAIR - omalizumab subcutaneous soln prefilled syringe150 mg/ml*

5 PA

YF-VAX - yellow fever vaccine subcutaneous inj 4

2019



ZORTRESS - everolimus tab 0.25 mg 5 BDZORTRESS - everolimus tab 0.5 mg 5 BDZORTRESS - everolimus tab 0.75 mg 5 BDZORTRESS - everolimus tab 1 mg 5 BDZOSTAVAX - zoster vaccine live for subcutaneous susp 19400

unit/0.65ml3 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 3balsalazide disodium cap 750 mg 2budesonide delayed release particles cap 3 mg 4CANASA - mesalamine suppos 1000 mg 5DELZICOL - mesalamine cap dr 400 mg 3DIPENTUM - olsalazine sodium cap 250 mg 5hydrocortisone enema 100 mg/60ml 3hydrocortisone rectal cream 1% 2hydrocortisone rectal cream 2.5% 2mesalamine enema 4 gm 2mesalamine rectal enema 4 gm & cleanser wipe kit 2mesalamine suppos 1000 mg 5mesalamine tab delayed release 800 mg 3mesalamine tab delayed release 1.2 gm 3PENTASA - mesalamine cap er 250 mg 4PENTASA - mesalamine cap er 500 mg 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)calcitonin (salmon) nasal soln 200 unit/act 2calcitriol cap 0.25 mcg 2calcitriol cap 0.5 mcg 2calcitriol inj 1 mcg/ml 4calcitriol oral soln 1 mcg/ml 3ETIDRONATE DISODIUM - etidronate disodium tab 200 mg 3ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 3

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103


FORTEO - teriparatide (recombinant) inj 600 mcg/2.4ml 5 PAibandronate sodium iv soln 3 mg/3ml 3ibandronate sodium tab 150 mg 2 QL (1 tablet/28 days)MIACALCIN - calcitonin (salmon) inj 200 unit/ml 5NATPARA - parathyroid hormone (recombinant) for inj cartridge

25 mcg*5 PA, QL (2 cartridges/28 days)

NATPARA - parathyroid hormone (recombinant) for inj cartridge50 mcg*

5 PA, QL (2 cartridges/28 days)





paricalcitol cap 1 mcg 3paricalcitol cap 2 mcg 3paricalcitol cap 4 mcg 3paricalcitol iv soln 2 mcg/ml 3paricalcitol iv soln 5 mcg/ml 3PROLIA - 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)SENSIPAR - cinacalcet hcl tab 30 mg 5 PASENSIPAR - cinacalcet hcl tab 60 mg 5 PASENSIPAR - cinacalcet hcl tab 90 mg 5 PATYMLOS - abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml5 PA

XGEVA - denosumab inj 120 mg/1.7ml 5 PAzoledronic acid inj conc for iv infusion 4 mg/5ml 4zoledronic acid iv soln 5 mg/100ml 4ZOMETA - zoledronic acid iv soln 4 mg/100ml 5Agentes oftálmicosALPHAGAN P - brimonidine tartrate ophth soln 0.1% 3azelastine hcl ophth soln 0.05% 2AZOPT - brinzolamide ophth susp 1% 4BACITRACIN - bacitracin ophth oint 500 unit/gm 3bacitracin-polymyxin b ophth oint 2bacitracin-polymyxin-neomycin-hc ophth oint 1% 2

2019



BESIVANCE - besifloxacin hcl ophth susp 0.6% 4betaxolol hcl ophth soln 0.5% 2BETOPTIC-S - betaxolol hcl ophth susp 0.25% 4bimatoprost ophth soln 0.03% 2brimonidine tartrate ophth soln 0.15% 2brimonidine tartrate ophth soln 0.2% 2bromfenac sodium ophth soln 0.09% (once-daily) 2carteolol hcl ophth soln 1% 2CILOXAN - ciprofloxacin hcl ophth soln 0.3% 4ciprofloxacin hcl ophth soln 0.3% 2COMBIGAN - brimonidine tartrate-timolol maleate ophth soln

0.2-0.5%3

cromolyn sodium ophth soln 4% 2CYSTARAN - cysteamine hcl ophth soln 0.44% 5DEXAMETHASONE SODIUM PHOSPHATE - dexamethasone

sodium phosphate ophth soln 0.1%3

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 2fluorometholone ophth susp 0.1% 3flurbiprofen sodium ophth soln 0.03% 2FML LIQUIFILM - fluorometholone ophth susp 0.1% 4gatifloxacin ophth soln 0.5% 3gentamicin 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% 2levobunolol hcl ophth soln 0.5% 2levofloxacin ophth soln 0.5% 3LUMIGAN - bimatoprost ophth soln 0.01% 3MAXITROL - neomycin-polymyxin-dexamethasone ophth oint

0.1%4

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105


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 2neomycin-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% 4PAZEO - olopatadine hcl ophth soln 0.7% 3PHOSPHOLINE IODIDE - echothiophate iodide ophth for soln

0.125%4

pilocarpine hcl ophth soln 1% 3pilocarpine hcl ophth soln 2% 3pilocarpine hcl ophth soln 4% 3polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% 2POLYTRIM - polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%4

PRED FORTE - prednisolone acetate ophth susp 1% 4prednisolone acetate ophth susp 1% 3PROLENSA - 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

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% 2timolol maleate ophth soln 0.5% 2timolol maleate ophth soln 0.5% (once-daily) 3TIMOPTIC - timolol maleate ophth soln 0.25% 4TIMOPTIC - timolol maleate ophth soln 0.5% 4TIMOPTIC-XE - timolol maleate ophth gel forming soln 0.25% 4TOBRADEX - tobramycin-dexamethasone ophth oint 0.3-0.1% 4

2019



tobramycin ophth soln 0.3% 2tobramycin-dexamethasone ophth susp 0.3-0.1% 2TRAVATAN Z - travoprost ophth soln 0.004% 3trifluridine ophth soln 1% 2VIROPTIC - trifluridine ophth soln 1% 4Agentes óticosacetic acid otic soln 2% 2CIPRODEX - ciprofloxacin-dexamethasone otic susp 0.3-0.1% 4fluocinolone acetonide (otic) oil 0.01% 3hydrocortisone w/ acetic acid otic soln 1-2% 3neomycin-polymyxin-hc otic soln 1% 2neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% 2ofloxacin otic soln 0.3% 3Agentes para el tracto respiratorio/pulmonaracetylcysteine inhal soln 10% 2 BDacetylcysteine inhal soln 20% 2 BDADCIRCA - tadalafil tab 20 mg (pah) 5 PA, QL (60 tablets/30 days)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 2albuterol sulfate tab er 12hr 4 mg 3

2019


107


albuterol sulfate tab er 12hr 8 mg 3albuterol sulfate tab 2 mg 3albuterol sulfate tab 4 mg 3ANORO ELLIPTA - umeclidinium-vilanterol aero powd ba

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

ARNUITY ELLIPTA - fluticasone furoate aerosol powder breathactiv 50 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












ATROVENT HFA - ipratropium bromide hfa inhal aerosol 17 mcg/act

4 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 3 BDbudesonide inhalation susp 0.5 mg/2ml 3 BDbudesonide inhalation susp 1 mg/2ml 3 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)

2019



cromolyn sodium soln nebu 20 mg/2ml 3 BDDALIRESP - roflumilast tab 250 mcg 4 PA, QL (30 tablets/30 days)DALIRESP - roflumilast tab 500 mcg 4 PA, QL (30 tablets/30 days)diphenhydramine hcl inj 50 mg/ml 3DULERA - 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 solution auto-injector 0.3 mg/0.3ml (1:1000) (genericfor EpiPen 2-Pak)

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

blister3 QL (1 inhaler/30 days)

FLOVENT DISKUS - fluticasone propionate aer pow ba 100 mcg/blister


FLOVENT DISKUS - fluticasone propionate aer pow ba 250 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)


fluticasone propionate nasal susp 50 mcg/act 2 QL (1 bottle/30 days)FLUTICASONE PROPIONATE/SALMETEROL - fluticasone-

salmeterol aer powder ba 55-14 mcg/act2 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


INCRUSE ELLIPTA - umeclidinium br aero powd breath act62.5 mcg/inh


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)

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109


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 3montelukast sodium tab 10 mg 2OFEV - 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)ORALAIR - grass mixed pollen ext sl tab 300 ir 4 PA, QL (30 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 100-125 mg* 5 PA, QL (60 packets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 150-188 mg* 5 PA, QL (60 packets/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)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 REDIHALER - beclomethasone diprop hfa breath act inh

aer 40 mcg/act3 QL (1 canister/30 days)

QVAR REDIHALER - beclomethasone diprop hfa breath act inhaer 80 mcg/act


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)SPIRIVA 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


2019



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


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


SYMDEKO - tezacaftor-ivacaftor 100-150 mg & ivacaftor 150 mgtab tbpk


tadalafil tab 20 mg (pah) 5 PA, QL (60 tablets/30 days)terbutaline sulfate tab 2.5 mg 3terbutaline sulfate tab 5 mg 3theophylline 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 for oral susp 32 mg* 5 PA, QL (120 tablets/30 days)TRACLEER - bosentan tab 62.5 mg* 5 PA, QL (60 tablets/30 days)TRACLEER - bosentan tab 125 mg* 5 PA, QL (60 tablets/30 days)TRELEGY ELLIPTA - fluticasone-umeclidinium-vilanterol aepb

100-62.5-25 mcg/inh3 QL (60 blisters/30 days)

UPTRAVI - selexipag tab therapy pack 200 mcg (140) & 800 mcg(60)*

5 PA, QL (1 pack (200tablets)/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 3zafirlukast tab 20 mg 3Relajantes de los músculos esqueléticoscyclobenzaprine hcl tab 5 mg# 4 PA

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111


cyclobenzaprine 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 3 PA, QL (30 tablets/30 days)armodafinil tab 150 mg 3 PA, QL (30 tablets/30 days)armodafinil tab 200 mg 3 PA, QL (30 tablets/30 days)armodafinil tab 250 mg 3 PA, QL (30 tablets/30 days)BELSOMRA - suvorexant tab 5 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 10 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 15 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 20 mg 3 QL (30 tablets/30 days)HETLIOZ - tasimelteon capsule 20 mg* 5 PA, QL (30 capsules/30 days)modafinil tab 100 mg 3 PA, QL (30 tablets/30 days)modafinil tab 200 mg 3 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 3 QL (30 capsules/30 days)temazepam cap 30 mg 3 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

2019

112

ÍNDICE

Aabacavir sulfate-lamivudine tab 600-300

mg................................................................................43abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg........................................................43abacavir sulfate soln 20 mg/ml.................................. 43abacavir sulfate tab 300 mg.......................................43abiraterone acetate tab 250 mg.................................26ABRAXANE...................................................................26ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1acamprosate calcium tab delayed release 333

mg..................................................................................4acarbose tab 100 mg.................................................. 50acarbose tab 25 mg.................................................... 50acarbose tab 50 mg.................................................... 50ACCUPRIL.................................................................... 60ACCUPRIL.................................................................... 60ACCUPRIL.................................................................... 60ACCUPRIL.................................................................... 60ACCURETIC................................................................. 60ACCURETIC................................................................. 60ACCURETIC................................................................. 60acebutolol hcl cap 200 mg..........................................61acebutolol hcl cap 400 mg..........................................61acetaminophen 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...........................61acetazolamide tab 125 mg......................................... 61acetazolamide tab 250 mg......................................... 61acetic acid otic soln 2%............................................ 106acetylcysteine inhal soln 10%..................................106acetylcysteine inhal soln 20%..................................106acitretin cap 10 mg......................................................78acitretin cap 17.5 mg...................................................78acitretin cap 25 mg......................................................78ACTHIB..........................................................................96ACTIMMUNE................................................................ 96ACTOS...........................................................................50ACTOS...........................................................................50

ACTOS...........................................................................50acyclovir cap 200 mg.................................................. 43acyclovir oint 5%..........................................................43acyclovir sodium iv soln 50 mg/ml.............................43acyclovir susp 200 mg/5ml......................................... 44acyclovir tab 400 mg................................................... 44acyclovir tab 800 mg................................................... 44ADACEL........................................................................ 96ADAGEN........................................................................87ADALAT CC..................................................................61ADALAT CC..................................................................61ADALAT CC..................................................................61ADASUVE..................................................................... 39ADCIRCA.................................................................... 106adefovir dipivoxil tab 10 mg........................................44ADEMPAS...................................................................106ADEMPAS...................................................................106ADEMPAS...................................................................106ADEMPAS...................................................................106ADEMPAS...................................................................106ADVAIR DISKUS....................................................... 106ADVAIR DISKUS....................................................... 106ADVAIR DISKUS....................................................... 106ADVAIR HFA.............................................................. 106ADVAIR HFA.............................................................. 106ADVAIR HFA.............................................................. 106AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR DISPERZ................................................... 26AFINITOR DISPERZ................................................... 27AFINITOR DISPERZ................................................... 27albendazole tab 200 mg............................................. 37ALBENZA...................................................................... 37albuterol sulfate soln nebu 0.083% (2.5

mg/3ml).....................................................................106albuterol sulfate soln nebu 0.5% (5 mg/

ml)............................................................................. 106albuterol sulfate soln nebu 0.63

mg/3ml......................................................................106albuterol sulfate soln nebu 1.25

mg/3ml......................................................................106albuterol sulfate syrup 2 mg/5ml..............................106albuterol sulfate tab 2 mg.........................................107albuterol sulfate tab 4 mg.........................................107albuterol sulfate tab er 12hr 4 mg........................... 106albuterol sulfate tab er 12hr 8 mg........................... 107alclometasone dipropionate cream

0.05%..........................................................................78alclometasone dipropionate oint

0.05%..........................................................................78

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ALCOHOL SWABS......................................................50ALDACTONE................................................................ 61ALDACTONE................................................................ 61ALDACTONE................................................................ 61ALDURAZYME............................................................. 87ALECENSA................................................................... 27alendronate sodium tab 10 mg................................ 102alendronate sodium tab 35 mg................................ 102alendronate sodium tab 5 mg.................................. 102alendronate sodium tab 70 mg................................ 102alfuzosin hcl tab er 24hr 10 mg................................. 88ALIMTA.......................................................................... 27ALIMTA.......................................................................... 27ALINIA............................................................................37ALINIA............................................................................37ALIQOPA....................................................................... 27allopurinol sodium for inj 500 mg...............................24allopurinol tab 100 mg.................................................24allopurinol tab 300 mg.................................................24alosetron hcl tab 0.5 mg............................................. 84alosetron hcl tab 1 mg................................................ 85ALPHAGAN P............................................................ 103alprazolam tab 0.25 mg.............................................. 49alprazolam tab 0.5 mg................................................ 49alprazolam tab 1 mg....................................................49alprazolam tab 2 mg....................................................49ALTACE......................................................................... 61ALTACE......................................................................... 61ALTACE......................................................................... 61ALTACE......................................................................... 61ALUNBRIG....................................................................27ALUNBRIG....................................................................27ALUNBRIG....................................................................27ALUNBRIG....................................................................27amantadine hcl cap 100 mg.......................................37amantadine hcl syrup 50 mg/5ml...............................37amantadine hcl tab 100 mg........................................37AMARYL........................................................................ 50AMARYL........................................................................ 50AMARYL........................................................................ 50AMBISOME...................................................................23AMERGE....................................................................... 25AMERGE....................................................................... 25amikacin sulfate inj 1 gm/4ml (250 mg/

ml)..................................................................................5amikacin sulfate inj 500 mg/2ml (250 mg/

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

mg................................................................................61amiloride hcl tab 5 mg.................................................61amino acid electrolyte infusion 8.5%.........................81amino acid infusion 15%.............................................81

amino acid infusion 6%...............................................81AMINOSYN................................................................... 81AMINOSYN................................................................... 81AMINOSYN 7%/ELECTROLYTES............................ 81AMINOSYN-HBC......................................................... 81AMINOSYN II............................................................... 81AMINOSYN II............................................................... 81AMINOSYN-PF.............................................................81AMINOSYN-PF 7%......................................................82AMINOSYN-RF.............................................................82amiodarone hcl tab 100 mg........................................61amiodarone hcl tab 200 mg........................................61amiodarone hcl tab 400 mg........................................61AMITIZA.........................................................................85AMITIZA.........................................................................85amitriptyline hcl tab 100 mg....................................... 18amitriptyline hcl tab 10 mg..........................................18amitriptyline hcl tab 150 mg....................................... 18amitriptyline hcl tab 25 mg..........................................18amitriptyline hcl tab 50 mg..........................................18amitriptyline hcl tab 75 mg..........................................18amlodipine besylate-atorvastatin calcium tab 10-10

mg................................................................................61amlodipine besylate-atorvastatin calcium tab 10-20



mg................................................................................61amlodipine besylate-atorvastatin calcium tab 2.5-10







mg................................................................................61amlodipine besylate-benazepril hcl cap 10-20


mg................................................................................62amlodipine besylate-benazepril hcl cap 2.5-10


mg................................................................................61

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114

amlodipine besylate-benazepril hcl cap 5-20mg................................................................................61

amlodipine besylate-benazepril hcl cap 5-40mg................................................................................61

amlodipine besylate-olmesartan medoxomil tab10-20 mg....................................................................62

amlodipine besylate-olmesartan medoxomil tab10-40 mg....................................................................62

amlodipine besylate-olmesartan medoxomil tab 5-20mg................................................................................62

amlodipine besylate-olmesartan medoxomil tab 5-40mg................................................................................62

amlodipine besylate tab 10 mg..................................61amlodipine besylate tab 2.5 mg.................................61amlodipine besylate tab 5 mg.................................... 61amlodipine besylate-valsartan tab 10-160

mg................................................................................62amlodipine besylate-valsartan tab 10-320



mg................................................................................62amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg.........................................................62amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg............................................................62amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg............................................................62amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg...........................................................62amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg.............................................................. 62AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXICILLIN................................................................. 5AMOXICILLIN................................................................. 5AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 5AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 6amoxicillin (trihydrate) cap 250 mg..............................5amoxicillin (trihydrate) cap 500 mg..............................5amoxicillin (trihydrate) for susp 125

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

mg/5ml.......................................................................... 5amoxicillin (trihydrate) for susp 250

mg/5ml.......................................................................... 5

amoxicillin (trihydrate) for susp 400mg/5ml.......................................................................... 5

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

mg/5ml.......................................................................... 5amoxicillin & k clavulanate for susp 250-62.5

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

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

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

mg..................................................................................5amoxicillin & k clavulanate tab 500-125

mg..................................................................................5amoxicillin & k clavulanate tab 875-125

mg..................................................................................5amoxicillin & k clavulanate tab er 12hr 1000-62.5

mg..................................................................................5amphetamine-dextroamphetamine cap er 24hr 10

mg................................................................................76amphetamine-dextroamphetamine cap er 24hr 15





mg................................................................................76amphetamine-dextroamphetamine tab 10

mg................................................................................76amphetamine-dextroamphetamine tab 12.5





mg................................................................................76amphetamine-dextroamphetamine tab 7.5

mg................................................................................76AMPHOTERICIN B......................................................23ampicillin & sulbactam sodium for inj 3 (2-1)

gm..................................................................................6ampicillin cap 500 mg....................................................6AMPICILLIN SODIUM................................................... 6ampicillin sodium for inj 1 gm.......................................6

2019

115

ampicillin sodium for inj 250 mg...................................6ampicillin sodium for inj 2 gm.......................................6ampicillin sodium for inj 500 mg...................................6ampicillin sodium for iv soln 10 gm..............................6ampicillin sodium for iv soln 2 gm................................6AMPICILLIN-SULBACTAM........................................... 6AMPYRA........................................................................77ANADROL-50............................................................... 91anagrelide hcl cap 0.5 mg.......................................... 57anagrelide hcl cap 1 mg............................................. 57anastrozole tab 1 mg...................................................27ANDRODERM.............................................................. 91ANDRODERM.............................................................. 91ANDROGEL.................................................................. 91ANDROGEL.................................................................. 91ANDROGEL PUMP..................................................... 91ANORO ELLIPTA.......................................................107APOKYN........................................................................37aprepitant capsule 125 mg.........................................22aprepitant capsule 40 mg........................................... 22aprepitant capsule 80 mg........................................... 22aprepitant capsule therapy pack 80 & 125

mg................................................................................22APRISO....................................................................... 102APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 13APTIVUS....................................................................... 44APTIVUS....................................................................... 44ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................57ARANESP ALBUMIN FREE.......................................58ARANESP ALBUMIN FREE.......................................58ARCALYST....................................................................96aripiprazole orally disintegrating tab 10

mg................................................................................39aripiprazole orally disintegrating tab 15

mg................................................................................39aripiprazole oral solution 1 mg/ml..............................39aripiprazole tab 10 mg................................................ 39

aripiprazole tab 15 mg................................................ 39aripiprazole tab 20 mg................................................ 39aripiprazole tab 2 mg...................................................39aripiprazole tab 30 mg................................................ 39aripiprazole tab 5 mg...................................................39ARISTADA.....................................................................39ARISTADA.....................................................................39ARISTADA.....................................................................39ARISTADA.....................................................................39ARISTADA INITIO........................................................39armodafinil tab 150 mg............................................. 111armodafinil tab 200 mg............................................. 111armodafinil tab 250 mg............................................. 111armodafinil tab 50 mg............................................... 111ARNUITY ELLIPTA....................................................107ARNUITY ELLIPTA....................................................107ARNUITY ELLIPTA....................................................107ARRANON.................................................................... 27arsenic trioxide inj 10 mg/10ml (1 mg/

ml)................................................................................27ARZERRA..................................................................... 27ARZERRA..................................................................... 27ASACOL HD...............................................................102ASMANEX HFA..........................................................107ASMANEX HFA..........................................................107ASMANEX TWISTHALER 120 METERED

DOSES.....................................................................107ASMANEX TWISTHALER 14 METERED





DOSES.....................................................................107aspirin-dipyridamole cap er 12hr 25-200

mg................................................................................58ASSURE ID INSULIN SAFETY SYRINGE/

U-100/0.5ML/29G X 1/2"......................................... 50ASSURE ID INSULIN SAFETY SYRINGE/

U-100/1ML/29G X 1/2".............................................50ASSURE ID SAFETY PEN NEEDLES 31G X 5MM

(3/16")......................................................................... 50ATACAND......................................................................62ATACAND......................................................................62ATACAND......................................................................62ATACAND......................................................................62ATACAND HCT............................................................ 62ATACAND HCT............................................................ 62ATACAND HCT............................................................ 62

2019

116

atazanavir sulfate cap 150 mg...................................44atazanavir sulfate cap 200 mg...................................44atazanavir sulfate cap 300 mg...................................44atenolol & chlorthalidone tab 100-25

mg................................................................................62atenolol & chlorthalidone tab 50-25 mg.................... 62atenolol tab 100 mg.....................................................62atenolol tab 25 mg.......................................................62atenolol tab 50 mg.......................................................62ATGAM.......................................................................... 96atomoxetine hcl cap 100 mg...................................... 77atomoxetine hcl cap 10 mg........................................ 77atomoxetine hcl cap 18 mg........................................ 77atomoxetine hcl cap 25 mg........................................ 77atomoxetine hcl cap 40 mg........................................ 77atomoxetine hcl cap 60 mg........................................ 77atomoxetine hcl cap 80 mg........................................ 77atorvastatin calcium tab 10 mg.................................. 62atorvastatin calcium tab 20 mg.................................. 62atorvastatin calcium tab 40 mg.................................. 62atorvastatin calcium tab 80 mg.................................. 62atovaquone-proguanil hcl tab 250-100

mg................................................................................37atovaquone-proguanil hcl tab 62.5-25

mg................................................................................37atovaquone susp 750 mg/5ml....................................37ATRIPLA........................................................................ 44ATROVENT HFA........................................................107AUGMENTIN...................................................................6AURYXIA.......................................................................82AVALIDE........................................................................ 62AVALIDE........................................................................ 62AVAPRO........................................................................ 62AVAPRO........................................................................ 62AVAPRO........................................................................ 62AVASTIN........................................................................27AVASTIN........................................................................27AVONEX........................................................................ 77AVONEX........................................................................ 77AVONEX PEN.............................................................. 77azacitidine for inj 100 mg............................................58AZACTAM........................................................................6AZACTAM........................................................................6AZASAN........................................................................ 96AZASAN........................................................................ 96AZATHIOPRINE........................................................... 96azathioprine tab 50 mg............................................... 96azelaic acid gel 15%................................................... 78azelastine hcl nasal spray 0.1% (137 mcg/

spray)........................................................................107azelastine hcl nasal spray 0.15% (205.5 mcg/

spray)........................................................................107

azelastine hcl ophth soln 0.05%..............................103AZELEX......................................................................... 78AZITHROMYCIN............................................................ 6azithromycin for susp 100 mg/5ml...............................6azithromycin for susp 200 mg/5ml...............................6azithromycin iv for soln 500 mg................................... 6azithromycin tab 250 mg...............................................6azithromycin tab 500 mg...............................................6azithromycin tab 600 mg...............................................6AZOPT.........................................................................103AZOR............................................................................. 63AZOR............................................................................. 63AZOR............................................................................. 63AZOR............................................................................. 63aztreonam for inj 1 gm.................................................. 6aztreonam for inj 2 gm.................................................. 6BBACITRACIN.............................................................. 103bacitracin-polymyxin b ophth oint............................ 103bacitracin-polymyxin-neomycin-hc ophth oint

1%............................................................................. 103baclofen tab 10 mg......................................................43baclofen tab 20 mg......................................................43balsalazide disodium cap 750 mg........................... 102BANZEL.........................................................................13BANZEL.........................................................................13BANZEL.........................................................................13BARACLUDE................................................................ 44BAVENCIO.................................................................... 27BCG VACCINE.............................................................96BD SAFETYGLIDE INSULIN SYRINGE/0.3ML/31G

X 15/64"......................................................................50BD SAFETYGLIDE INSULIN SYRINGE/0.5ML/31G

X 15/64"......................................................................50BD SAFETYGLIDE INSULIN SYRINGE/1ML/31G X

15/64"..........................................................................50BELEODAQ.................................................................. 27BELSOMRA................................................................ 111BELSOMRA................................................................ 111BELSOMRA................................................................ 111BELSOMRA................................................................ 111benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................63benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................63benazepril & hydrochlorothiazide tab 20-25

mg................................................................................63benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................63benazepril hcl tab 10 mg............................................ 63benazepril hcl tab 20 mg............................................ 63

2019

117

benazepril hcl tab 40 mg............................................ 63benazepril hcl tab 5 mg.............................................. 63BENDEKA..................................................................... 27BENICAR.......................................................................63BENICAR.......................................................................63BENICAR.......................................................................63BENICAR HCT............................................................. 63BENICAR HCT............................................................. 63BENICAR HCT............................................................. 63BENLYSTA.................................................................... 96BENLYSTA.................................................................... 96BENLYSTA.................................................................... 96BENLYSTA.................................................................... 96BENZNIDAZOLE..........................................................37BENZNIDAZOLE..........................................................37benzoyl peroxide-erythromycin gel

5-3%............................................................................78benztropine mesylate tab 0.5 mg.............................. 37benztropine mesylate tab 1 mg..................................37benztropine mesylate tab 2 mg..................................37BESIVANCE................................................................104BESPONSA.................................................................. 27betamethasone dipropionate augmented cream

0.05%..........................................................................78betamethasone dipropionate augmented gel

0.05%..........................................................................78betamethasone dipropionate augmented lotion

0.05%..........................................................................78betamethasone dipropionate augmented oint

0.05%..........................................................................78betamethasone dipropionate cream

0.05%..........................................................................78betamethasone dipropionate lotion

0.05%..........................................................................78betamethasone dipropionate oint

0.05%..........................................................................78betamethasone valerate cream 0.1%....................... 78betamethasone valerate lotion 0.1%.........................78betamethasone valerate oint 0.1%............................79BETASERON................................................................ 77betaxolol hcl ophth soln 0.5%..................................104betaxolol hcl tab 10 mg...............................................63betaxolol hcl tab 20 mg...............................................63bethanechol chloride tab 10 mg.................................89bethanechol chloride tab 25 mg.................................89bethanechol chloride tab 50 mg.................................89bethanechol chloride tab 5 mg...................................88BETOPTIC-S.............................................................. 104BEVYXXA......................................................................58BEVYXXA......................................................................58bexarotene cap 75 mg................................................ 27BEXSERO..................................................................... 96

bicalutamide tab 50 mg...............................................27BICILLIN L-A...................................................................6BICILLIN L-A...................................................................6BICILLIN L-A...................................................................6BICNU............................................................................27BIKTARVY..................................................................... 44BILTRICIDE...................................................................37bimatoprost ophth soln 0.03%................................. 104bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................63bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................63bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................63bisoprolol fumarate tab 10 mg................................... 63bisoprolol fumarate tab 5 mg..................................... 63bleomycin sulfate for inj 15 unit................................. 27bleomycin sulfate for inj 30 unit................................. 27BLINCYTO.....................................................................27BOOSTRIX....................................................................96BOSULIF....................................................................... 27BOSULIF....................................................................... 27BOSULIF....................................................................... 27BRAFTOVI.....................................................................27BRAFTOVI.....................................................................27BREO ELLIPTA..........................................................107BREO ELLIPTA..........................................................107BRILINTA.......................................................................58BRILINTA.......................................................................58brimonidine tartrate ophth soln 0.15%.................... 104brimonidine tartrate ophth soln 0.2%...................... 104BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13bromfenac sodium ophth soln 0.09% (once-

daily)......................................................................... 104bromocriptine mesylate cap 5 mg..............................38bromocriptine mesylate tab 2.5 mg........................... 38budesonide delayed release particles cap 3

mg............................................................................. 102budesonide inhalation susp 0.25

mg/2ml......................................................................107budesonide inhalation susp 0.5

mg/2ml......................................................................107budesonide inhalation susp 1 mg/2ml.....................107bumetanide inj 0.25 mg/ml......................................... 63bumetanide tab 0.5 mg............................................... 63bumetanide tab 1 mg.................................................. 63

2019

118

bumetanide tab 2 mg.................................................. 63buprenorphine hcl-naloxone hcl sl tab 2-0.5

mg..................................................................................4buprenorphine hcl-naloxone hcl sl tab 8-2

mg..................................................................................4buprenorphine hcl sl tab 2 mg......................................4buprenorphine hcl sl tab 8 mg......................................4bupropion hcl (smoking deterrent) tab er 12hr 150

mg..................................................................................4bupropion hcl tab 100 mg...........................................18bupropion hcl tab 75 mg.............................................18bupropion hcl tab er 12hr 100 mg............................. 18bupropion hcl tab er 12hr 150 mg............................. 18bupropion hcl tab er 12hr 200 mg............................. 18bupropion hcl tab er 24hr 150 mg............................. 18bupropion hcl tab er 24hr 300 mg............................. 18buspirone hcl tab 10 mg............................................. 49buspirone hcl tab 15 mg............................................. 49buspirone hcl tab 30 mg............................................. 49buspirone hcl tab 5 mg............................................... 49buspirone hcl tab 7.5 mg............................................ 49busulfan inj 6 mg/ml.................................................... 27butalbital-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-caff w/ cod cap

50-325-40-30 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................................................................................... 1BYDUREON..................................................................50BYDUREON BCISE.....................................................50BYDUREON PEN........................................................ 50BYSTOLIC.....................................................................63BYSTOLIC.....................................................................63BYSTOLIC.....................................................................63BYSTOLIC.....................................................................63Ccabergoline tab 0.5 mg............................................... 94CABOMETYX............................................................... 27CABOMETYX............................................................... 27CABOMETYX............................................................... 27caffeine citrate oral soln 60 mg/3ml........................ 107

CALAN........................................................................... 63CALAN........................................................................... 63CALAN SR.................................................................... 63CALAN SR.................................................................... 64calcipotriene cream 0.005%.......................................79calcipotriene oint 0.005%............................................79calcipotriene soln 0.005% (50 mcg/ml).....................79calcitonin (salmon) nasal soln 200 unit/

act..............................................................................102calcitriol cap 0.25 mcg.............................................. 102calcitriol cap 0.5 mcg................................................ 102calcitriol inj 1 mcg/ml.................................................102calcitriol oral soln 1 mcg/ml......................................102calcium acetate cap 667 mg...................................... 82calcium acetate tab 667 mg....................................... 82CALQUENCE................................................................27CANASA......................................................................102CANCIDAS....................................................................23candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg................................................................................64candesartan cilexetil-hydrochlorothiazide tab 32-12.5

mg................................................................................64candesartan cilexetil-hydrochlorothiazide tab 32-25

mg................................................................................64candesartan cilexetil tab 16 mg................................. 64candesartan cilexetil tab 32 mg................................. 64candesartan cilexetil tab 4 mg................................... 64candesartan cilexetil tab 8 mg................................... 64CAPASTAT SULFATE..................................................26CAPRELSA................................................................... 28CAPRELSA................................................................... 28captopril tab 100 mg....................................................64captopril tab 12.5 mg...................................................64captopril tab 25 mg......................................................64captopril tab 50 mg......................................................64CARAC.......................................................................... 79CARAFATE....................................................................85CARBAGLU.................................................................. 82carbamazepine cap er 12hr 100 mg......................... 13carbamazepine cap er 12hr 200 mg......................... 13carbamazepine cap er 12hr 300 mg......................... 13carbamazepine chew tab 100 mg..............................13carbamazepine susp 100 mg/5ml..............................14carbamazepine tab 200 mg........................................14carbamazepine tab er 12hr 100 mg.......................... 14carbamazepine tab er 12hr 200 mg.......................... 14carbamazepine tab er 12hr 400 mg.......................... 14CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................38CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................38

2019

119

CARBIDOPA/LEVODOPA/ENTACAPONE..........................................................38




carbidopa & levodopa orally disintegrating tab10-100 mg..................................................................38



carbidopa & levodopa tab 10-100 mg....................... 38carbidopa & levodopa tab 25-100 mg....................... 38carbidopa & levodopa tab 25-250 mg....................... 38carbidopa & levodopa tab er 25-100

mg................................................................................38carbidopa & levodopa tab er 50-200

mg................................................................................38carbidopa tab 25 mg................................................... 38carboplatin iv soln 150 mg/15ml................................ 28carboplatin iv soln 450 mg/45ml................................ 28carboplatin iv soln 50 mg/5ml.................................... 28carboplatin iv soln 600 mg/60ml................................ 28CARDIZEM....................................................................64CARDIZEM....................................................................64CARDIZEM....................................................................64CARDIZEM CD............................................................ 64CARDIZEM CD............................................................ 64CARDIZEM CD............................................................ 64CARDIZEM CD............................................................ 64CARDIZEM CD............................................................ 64carmustine for inj 100 mg...........................................28carteolol hcl ophth soln 1%...................................... 104carvedilol tab 12.5 mg.................................................64carvedilol tab 25 mg....................................................64carvedilol tab 3.125 mg...............................................64carvedilol tab 6.25 mg.................................................64caspofungin acetate for iv soln 50 mg...................... 23caspofungin acetate for iv soln 70 mg...................... 23cefaclor cap 250 mg......................................................6cefaclor cap 500 mg......................................................6cefadroxil cap 500 mg...................................................6cefadroxil for susp 250 mg/5ml....................................6cefadroxil for susp 500 mg/5ml....................................6cefadroxil tab 1 gm........................................................ 6CEFAZOLIN SODIUM................................................... 6cefazolin sodium for inj 10 gm..................................... 7cefazolin sodium for inj 1 gm....................................... 7cefazolin sodium for inj 500 mg................................... 7

cefdinir cap 300 mg....................................................... 7cefdinir for susp 125 mg/5ml........................................7cefdinir for susp 250 mg/5ml........................................7cefepime hcl for inj 1 gm.............................................. 7cefepime hcl for inj 2 gm.............................................. 7cefixime for susp 100 mg/5ml...................................... 7cefixime for susp 200 mg/5ml...................................... 7CEFOTAXIME SODIUM................................................7cefotaxime sodium for inj 1 gm.................................... 7cefoxitin sodium for inj 10 gm...................................... 7cefoxitin sodium for iv soln 1 gm................................. 7cefoxitin sodium for iv soln 2 gm................................. 7cefpodoxime proxetil for susp 100

mg/5ml.......................................................................... 7cefpodoxime proxetil for susp 50

mg/5ml.......................................................................... 7cefpodoxime proxetil tab 100 mg.................................7cefpodoxime proxetil tab 200 mg.................................7cefprozil for susp 125 mg/5ml...................................... 7cefprozil for susp 250 mg/5ml...................................... 7cefprozil tab 250 mg......................................................7cefprozil tab 500 mg......................................................7ceftazidime for inj 1 gm.................................................7ceftazidime for inj 2 gm.................................................7ceftazidime for inj 6 gm.................................................7ceftazidime for iv soln 2 gm..........................................7CEFTRIAXONE/DEXTROSE....................................... 8CEFTRIAXONE/DEXTROSE....................................... 8CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 7CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 7ceftriaxone sodium for inj 10 gm..................................7ceftriaxone sodium for inj 1 gm....................................7ceftriaxone sodium for inj 250 mg................................7ceftriaxone sodium for inj 2 gm....................................7ceftriaxone sodium for inj 500 mg................................7ceftriaxone sodium for iv soln 1 gm.............................7ceftriaxone sodium for iv soln 2 gm.............................7cefuroxime axetil tab 250 mg....................................... 8cefuroxime axetil tab 500 mg....................................... 8cefuroxime sodium for inj 7.5 gm.................................8cefuroxime sodium for inj 750 mg................................8cefuroxime sodium for iv soln 1.5 gm..........................8celecoxib cap 100 mg................................................... 1celecoxib cap 200 mg................................................... 1celecoxib cap 400 mg................................................... 1celecoxib cap 50 mg......................................................1CELEXA.........................................................................18CELEXA.........................................................................18CELEXA.........................................................................18CELONTIN.................................................................... 14

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cephalexin cap 250 mg.................................................8cephalexin cap 500 mg.................................................8cephalexin cap 750 mg.................................................8cephalexin for susp 125 mg/5ml..................................8cephalexin for susp 250 mg/5ml..................................8CEREZYME.................................................................. 87cevimeline hcl cap 30 mg...........................................78CHANTIX......................................................................... 4CHANTIX......................................................................... 4CHANTIX CONTINUING MONTH

PACK.............................................................................4CHANTIX STARTING MONTH PACK.........................4CHEMET........................................................................82CHENODAL.................................................................. 85CHLORAMPHENICOL SODIUM

SUCCINATE.................................................................8chlordiazepoxide hcl cap 10 mg................................ 49chlordiazepoxide hcl cap 25 mg................................ 49chlordiazepoxide hcl cap 5 mg.................................. 49chlorhexidine gluconate soln 0.12%..........................78CHLOROQUINE PHOSPHATE................................. 37chloroquine phosphate tab 500 mg...........................37CHLOROTHIAZIDE..................................................... 64chlorothiazide tab 500 mg.......................................... 64CHLORPROMAZINE HCL..........................................22CHLORPROMAZINE HCL..........................................22chlorpromazine hcl tab 100 mg..................................22chlorpromazine hcl tab 10 mg....................................22chlorpromazine hcl tab 200 mg..................................22chlorpromazine hcl tab 25 mg....................................22chlorpromazine hcl tab 50 mg....................................22chlorthalidone tab 25 mg............................................ 64chlorthalidone tab 50 mg............................................ 64cholestyramine light powder 4 gm/

dose............................................................................ 64cholestyramine light powder packets 4

gm................................................................................64cholestyramine powder 4 gm/dose............................64cholestyramine powder packets 4 gm.......................64choline fenofibrate cap dr 135 mg............................. 64choline fenofibrate cap dr 45 mg............................... 64CHORIONIC GONADOTROPIN................................90ciclopirox gel 0.77%.................................................... 23ciclopirox olamine cream 0.77%................................23ciclopirox olamine susp 0.77%...................................23ciclopirox shampoo 1%............................................... 23ciclopirox solution 8%..................................................23cidofovir iv inj 75 mg/ml.............................................. 44cilostazol tab 100 mg.................................................. 58cilostazol tab 50 mg.................................................... 58CILOXAN.....................................................................104CIMDUO........................................................................ 44

cimetidine hcl soln 300 mg/5ml..................................85cimetidine tab 200 mg.................................................85cimetidine tab 300 mg.................................................85cimetidine tab 400 mg.................................................85cimetidine tab 800 mg.................................................85CINRYZE.......................................................................96CIPRODEX................................................................. 106ciprofloxacin 200 mg/100ml in d5w............................. 8ciprofloxacin 400 mg/200ml in d5w............................. 8ciprofloxacin for oral susp 250 mg/5ml (5%) (5

gm/100ml).....................................................................8ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml).....................................................................8CIPROFLOXACIN HCL.................................................8ciprofloxacin hcl ophth soln 0.3%............................ 104ciprofloxacin hcl tab 250 mg.........................................8ciprofloxacin hcl tab 500 mg.........................................8ciprofloxacin hcl tab 750 mg.........................................8ciprofloxacin hcl tab er 24hr 1000 mg......................... 8ciprofloxacin hcl tab er 24hr 500 mg........................... 8CISPLATIN.................................................................... 28cisplatin inj 100 mg/100ml (1 mg/ml).........................28cisplatin inj 50 mg/50ml (1 mg/ml).............................28citalopram hydrobromide oral soln 10

mg/5ml........................................................................ 18citalopram hydrobromide tab 10 mg..........................18citalopram hydrobromide tab 20 mg..........................18citalopram hydrobromide tab 40 mg..........................18cladribine iv soln 10 mg/10ml (1 mg/

ml)................................................................................28clarithromycin for susp 125 mg/5ml.............................8clarithromycin for susp 250 mg/5ml.............................8clarithromycin tab 250 mg............................................ 8clarithromycin tab 500 mg............................................ 8clarithromycin tab er 24hr 500 mg...............................8CLEMASTINE FUMARATE......................................107CLEOCIN.........................................................................8clindamycin hcl cap 150 mg......................................... 8clindamycin hcl cap 300 mg......................................... 8clindamycin hcl cap 75 mg........................................... 8clindamycin palmitate hcl for soln 75

mg/5ml.......................................................................... 8clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................79clindamycin phosphate gel 1%.................................... 8clindamycin phosphate in d5w iv soln 300

mg/50ml........................................................................ 8clindamycin phosphate in d5w iv soln 600

mg/50ml........................................................................ 8clindamycin phosphate in d5w iv soln 900

mg/50ml........................................................................ 9clindamycin phosphate inj 300 mg/2ml....................... 9

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

mg/2ml.......................................................................... 9clindamycin phosphate iv soln 600

mg/4ml.......................................................................... 9clindamycin phosphate iv soln 900

mg/6ml.......................................................................... 9clindamycin phosphate lotion 1%................................ 9clindamycin phosphate soln 1%...................................9clindamycin phosphate swab 1%.................................9clindamycin phosphate vaginal cream

2%..................................................................................9clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5%......................................................................... 79CLINIMIX 4.25%/DEXTROSE 10%...........................82CLINIMIX 4.25%/DEXTROSE 25%...........................82CLINIMIX 4.25%/DEXTROSE 5%.............................82CLINIMIX 5%/DEXTROSE 15%................................ 82CLINIMIX 5%/DEXTROSE 20%................................ 82CLINIMIX 5%/DEXTROSE 25%................................ 82CLINIMIX E 2.75%/DEXTROSE 10%.......................82CLINIMIX E 2.75%/DEXTROSE 5%......................... 82CLINIMIX E 4.25%/DEXTROSE 10%.......................82CLINIMIX E 4.25%/DEXTROSE 25%.......................82CLINIMIX E 4.25%/DEXTROSE 5%......................... 82CLINIMIX E 5%/DEXTROSE 15%............................ 82CLINIMIX E 5%/DEXTROSE 20%............................ 82CLINIMIX E 5%/DEXTROSE 25%............................ 82clobazam suspension 2.5 mg/ml............................... 14clobazam tab 10 mg....................................................14clobazam tab 20 mg....................................................14clobetasol propionate cream 0.05%..........................79clobetasol propionate emollient base cream

0.05%..........................................................................79clobetasol propionate gel 0.05%................................79clobetasol propionate oint 0.05%.............................. 79clobetasol propionate soln 0.05%..............................79clofarabine iv soln 1 mg/ml.........................................28clomipramine hcl cap 25 mg...................................... 18clomipramine hcl cap 50 mg...................................... 18clomipramine hcl cap 75 mg...................................... 18clonazepam orally disintegrating tab 0.125

mg................................................................................49clonazepam orally disintegrating tab 0.25

mg................................................................................49clonazepam orally disintegrating tab 0.5

mg................................................................................49clonazepam orally disintegrating tab 1

mg................................................................................49

clonazepam orally disintegrating tab 2mg................................................................................49

clonazepam tab 0.5 mg.............................................. 49clonazepam tab 1 mg..................................................49clonazepam tab 2 mg..................................................49clonidine hcl tab 0.1 mg..............................................64clonidine hcl tab 0.2 mg..............................................64clonidine hcl tab 0.3 mg..............................................64clonidine hcl tab er 12hr 0.1 mg................................ 77clonidine td patch weekly 0.1 mg/24hr......................64clonidine td patch weekly 0.2 mg/24hr......................65clonidine td patch weekly 0.3 mg/24hr......................65clopidogrel bisulfate tab 300 mg................................58clopidogrel bisulfate tab 75 mg..................................58clorazepate dipotassium tab 15 mg...........................49clorazepate dipotassium tab 3.75 mg....................... 49clorazepate dipotassium tab 7.5 mg......................... 49clotrimazole cream 1%................................................23clotrimazole troche 10 mg.......................................... 23clotrimazole w/ betamethasone cream

1-0.05%...................................................................... 79clotrimazole w/ betamethasone lotion

1-0.05%...................................................................... 79clozapine orally disintegrating tab 100

mg................................................................................39clozapine orally disintegrating tab 12.5

mg................................................................................39clozapine orally disintegrating tab 25

mg................................................................................39clozapine tab 100 mg..................................................39clozapine tab 200 mg..................................................39clozapine tab 25 mg....................................................39clozapine tab 50 mg....................................................39COARTEM.....................................................................37codeine sulfate tab 15 mg............................................ 1codeine sulfate tab 30 mg............................................ 1codeine sulfate tab 60 mg............................................ 1colchicine w/ probenecid tab 0.5-500

mg................................................................................24COLCRYS..................................................................... 24colestipol hcl granule packets 5 gm.......................... 65colestipol hcl granules 5 gm.......................................65colestipol hcl tab 1 gm................................................ 65colistimethate sod for inj 150 mg................................. 9COLYTE-FLAVOR PACKS......................................... 85COMBIGAN................................................................ 104COMBIVENT RESPIMAT......................................... 107COMETRIQ...................................................................28COMETRIQ...................................................................28COMETRIQ...................................................................28COMPLERA.................................................................. 44COPAXONE.................................................................. 77

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COPIKTRA....................................................................28COPIKTRA....................................................................28COREG..........................................................................65COREG..........................................................................65COREG..........................................................................65COREG..........................................................................65CORLANOR..................................................................65CORLANOR..................................................................65CORTISONE ACETATE..............................................89COSENTYX.................................................................. 97COSENTYX SENSOREADY PEN............................ 97COSMEGEN................................................................. 28COTELLIC.....................................................................28COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COUMADIN...................................................................58COZAAR........................................................................65COZAAR........................................................................65COZAAR........................................................................65CREON..........................................................................87CREON..........................................................................87CREON..........................................................................87CREON..........................................................................87CREON..........................................................................87CRESEMBA.................................................................. 23CRESEMBA.................................................................. 23CRIXIVAN......................................................................44CRIXIVAN......................................................................44cromolyn sodium ophth soln 4%..............................104cromolyn sodium oral conc 100

mg/5ml........................................................................ 85cromolyn sodium soln nebu 20

mg/2ml......................................................................108cyclobenzaprine hcl tab 10 mg................................ 111cyclobenzaprine hcl tab 5 mg.................................. 110cyclobenzaprine hcl tab 7.5 mg...............................111cyclophosphamide cap 25 mg................................... 28cyclophosphamide cap 50 mg................................... 28cyclophosphamide for inj 1 gm.................................. 28cyclophosphamide for inj 2 gm.................................. 28cyclophosphamide for inj 500 mg..............................28CYCLOSERINE............................................................26CYCLOSET...................................................................50cyclosporine cap 100 mg............................................97cyclosporine cap 25 mg..............................................97cyclosporine iv soln 50 mg/ml....................................97

CYCLOSPORINE MODIFIED.................................... 97cyclosporine modified cap 100 mg............................ 97cyclosporine modified cap 25 mg.............................. 97cyclosporine modified oral soln 100 mg/

ml.................................................................................97CYRAMZA.....................................................................28CYRAMZA.....................................................................28CYSTADANE................................................................ 87CYSTAGON.................................................................. 87CYSTAGON.................................................................. 87CYSTARAN.................................................................104CYTARABINE............................................................... 28cytarabine inj pf 100 mg/ml........................................ 28cytarabine inj pf 20 mg/ml.......................................... 28DDACARBAZINE............................................................ 28dacarbazine for inj 200 mg.........................................28dactinomycin for inj 0.5 mg........................................ 28DAKLINZA.....................................................................44DAKLINZA.....................................................................44DAKLINZA.....................................................................44dalfampridine tab er 12hr 10 mg................................77DALIRESP.................................................................. 108DALIRESP.................................................................. 108DALVANCE......................................................................9danazol cap 100 mg....................................................91danazol cap 200 mg....................................................91danazol cap 50 mg......................................................91dantrolene sodium cap 100 mg................................. 43dantrolene sodium cap 25 mg....................................43dantrolene sodium cap 50 mg....................................43dapsone tab 100 mg................................................... 26dapsone tab 25 mg......................................................26DAPTACEL....................................................................97daptomycin for iv soln 500 mg..................................... 9DARAPRIM................................................................... 37DARZALEX................................................................... 28DARZALEX................................................................... 28daunorubicin hcl iv soln 20 mg/4ml........................... 28DAUNORUBICIN HYDROCHLORIDE......................29DDAVP...........................................................................91decitabine for inj 50 mg.............................................. 29DELSTRIGO................................................................. 44DELZICOL...................................................................102demeclocycline hcl tab 150 mg....................................9demeclocycline hcl tab 300 mg....................................9DEMSER....................................................................... 65DENAVIR.......................................................................44DEPEN TITRATABS.................................................... 89DEPO-PROVERA........................................................ 91DESCOVY.....................................................................44

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desipramine hcl tab 100 mg.......................................18desipramine hcl tab 10 mg......................................... 18desipramine hcl tab 150 mg.......................................18desipramine hcl tab 25 mg......................................... 18desipramine hcl tab 50 mg......................................... 18desipramine hcl tab 75 mg......................................... 18desmopressin acetate inj 4 mcg/ml...........................91desmopressin acetate nasal spray soln

0.01%..........................................................................91desmopressin acetate nasal spray soln 0.01%

(refrigerated).............................................................. 91desmopressin acetate tab 0.1 mg............................. 91desmopressin acetate tab 0.2 mg............................. 91desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5)..................................................................... 91desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg................................................................................91

desogestrel & ethinyl estradiol tab 0.15 mg-30mcg..............................................................................91

desonide cream 0.05%............................................... 79desonide lotion 0.05%.................................................79desonide oint 0.05%....................................................79desoximetasone cream 0.05%...................................79desoximetasone cream 0.25%...................................79desoximetasone gel 0.05%........................................ 79desoximetasone oint 0.25%....................................... 79desvenlafaxine succinate tab er 24hr 100

mg................................................................................18desvenlafaxine succinate tab er 24hr 25

mg................................................................................18desvenlafaxine succinate tab er 24hr 50

mg................................................................................18DEXAMETHASONE.................................................... 89DEXAMETHASONE.................................................... 89dexamethasone elixir 0.5 mg/5ml..............................89DEXAMETHASONE SODIUM

PHOSPHATE...........................................................104dexamethasone sodium phosphate inj 120

mg/30ml......................................................................90dexamethasone sodium phosphate inj 20

mg/5ml........................................................................ 89dexamethasone sodium phosphate inj 4 mg/

ml.................................................................................89dexamethasone tab 0.5 mg........................................90dexamethasone tab 0.75 mg......................................90dexamethasone tab 1.5 mg........................................90dexamethasone tab 4 mg...........................................90dexamethasone tab 6 mg...........................................90dexmethylphenidate hcl tab 10 mg............................77dexmethylphenidate hcl tab 2.5 mg...........................77dexmethylphenidate hcl tab 5 mg..............................77

dexrazoxane for inj 250 mg........................................29dexrazoxane for inj 500 mg........................................29dextroamphetamine sulfate cap er 24hr 10

mg................................................................................77dextroamphetamine sulfate cap er 24hr 15

mg................................................................................77dextroamphetamine sulfate cap er 24hr 5

mg................................................................................77dextroamphetamine sulfate tab 10 mg......................77dextroamphetamine sulfate tab 5 mg........................77dextrose 2.5% w/ sodium chloride

0.45%..........................................................................82dextrose 5% in lactated ringers................................. 82dextrose 5% w/ sodium chloride 0.2%...................... 82dextrose 5% w/ sodium chloride

0.33%..........................................................................82dextrose 5% w/ sodium chloride

0.45%..........................................................................82dextrose 5% w/ sodium chloride 0.9%...................... 82dextrose inj 10%.......................................................... 82dextrose inj 5%.............................................................82DIASTAT ACUDIAL......................................................14DIASTAT ACUDIAL......................................................14DIASTAT PEDIATRIC..................................................14DIAZEPAM.................................................................... 14DIAZEPAM.................................................................... 49diazepam conc 5 mg/ml..............................................49DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14diazepam tab 10 mg....................................................49diazepam tab 2 mg......................................................49diazepam tab 5 mg......................................................49diclofenac potassium tab 50 mg.................................. 1diclofenac sodium gel 1%.............................................1diclofenac sodium gel 3%...........................................79diclofenac sodium ophth soln 0.1%.........................104diclofenac sodium soln 1.5%........................................1diclofenac sodium tab delayed release 25

mg..................................................................................1diclofenac sodium tab delayed release 50

mg..................................................................................1diclofenac sodium tab delayed release 75

mg..................................................................................1diclofenac sodium tab er 24hr 100 mg........................1diclofenac w/ misoprostol tab delayed release 50-0.2

mg..................................................................................1diclofenac w/ misoprostol tab delayed release 75-0.2

mg..................................................................................1dicloxacillin sodium cap 250 mg.................................. 9dicloxacillin sodium cap 500 mg.................................. 9dicyclomine hcl tab 20 mg..........................................85

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didanosine delayed release capsule 200mg................................................................................44



DIFICID............................................................................ 9diflorasone diacetate oint 0.05%................................79diflunisal tab 500 mg..................................................... 1DIGOXIN........................................................................65digoxin tab 125 mcg (0.125 mg)................................65digoxin tab 250 mcg (0.25 mg).................................. 65DILANTIN...................................................................... 14diltiazem hcl cap er 12hr 120 mg.............................. 65diltiazem hcl cap er 12hr 60 mg.................................65diltiazem hcl cap er 12hr 90 mg.................................65diltiazem hcl cap er 24hr 120 mg.............................. 65diltiazem hcl cap er 24hr 180 mg.............................. 65diltiazem hcl cap er 24hr 240 mg.............................. 65diltiazem hcl coated beads cap er 24hr 120

mg................................................................................65diltiazem hcl coated beads cap er 24hr 180




mg................................................................................65diltiazem hcl coated beads tab er 24hr 180





mg................................................................................65diltiazem hcl extended release beads cap er 24hr

120 mg....................................................................... 65diltiazem hcl extended release beads cap er 24hr





420 mg....................................................................... 66diltiazem hcl tab 120 mg.............................................66

diltiazem hcl tab 30 mg...............................................66diltiazem hcl tab 60 mg...............................................66diltiazem hcl tab 90 mg...............................................66DIOVAN......................................................................... 66DIOVAN......................................................................... 66DIOVAN......................................................................... 66DIOVAN......................................................................... 66DIOVAN HCT................................................................66DIOVAN HCT................................................................66DIOVAN HCT................................................................66DIOVAN HCT................................................................66DIOVAN HCT................................................................66DIPENTUM................................................................. 102diphenhydramine hcl inj 50 mg/ml...........................108DIPHTHERIA/TETANUS TOXOIDS

ADSORBED...............................................................97dipyridamole tab 25 mg.............................................. 58dipyridamole tab 50 mg.............................................. 58dipyridamole tab 75 mg.............................................. 58disulfiram tab 250 mg....................................................4disulfiram tab 500 mg....................................................5divalproex sodium cap delayed release sprinkle 125

mg................................................................................14divalproex sodium tab delayed release 125



mg................................................................................14divalproex sodium tab er 24 hr 250 mg.....................14divalproex sodium tab er 24 hr 500 mg.....................14DOCETAXEL.................................................................29DOCETAXEL.................................................................29docetaxel for inj conc 20 mg/ml................................. 29docetaxel for inj conc 80 mg/4ml (20 mg/

ml)................................................................................29docetaxel soln for iv infusion 160

mg/16ml......................................................................29docetaxel soln for iv infusion 20

mg/2ml........................................................................ 29docetaxel soln for iv infusion 80

mg/8ml........................................................................ 29dofetilide cap 125 mcg (0.125 mg)............................66dofetilide cap 250 mcg (0.25 mg).............................. 66dofetilide cap 500 mcg (0.5 mg)................................ 66donepezil hydrochloride orally disintegrating tab 10

mg................................................................................17donepezil hydrochloride orally disintegrating tab 5

mg................................................................................17donepezil hydrochloride tab 10 mg........................... 17donepezil hydrochloride tab 23 mg........................... 17donepezil hydrochloride tab 5 mg..............................17

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dorzolamide hcl ophth soln 2%................................104dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml........................................................................ 104doxazosin mesylate tab 1 mg.................................... 66doxazosin mesylate tab 2 mg.................................... 66doxazosin mesylate tab 4 mg.................................... 66doxazosin mesylate tab 8 mg.................................... 66doxepin hcl cap 100 mg..............................................19doxepin hcl cap 10 mg................................................18doxepin hcl cap 150 mg..............................................19doxepin hcl cap 25 mg................................................19doxepin hcl cap 50 mg................................................19doxepin hcl cap 75 mg................................................19doxepin hcl conc 10 mg/ml.........................................19doxorubicin hcl for inj 10 mg...................................... 29doxorubicin hcl for inj 50 mg...................................... 29doxorubicin hcl inj 2 mg/ml.........................................29doxorubicin hcl liposomal inj (for iv infusion) 2 mg/

ml.................................................................................29doxycycline hyclate cap 100 mg..................................9doxycycline hyclate cap 50 mg.................................... 9doxycycline hyclate for inj 100 mg...............................9doxycycline hyclate tab 100 mg...................................9doxycycline hyclate tab 20 mg.....................................9doxycycline monohydrate cap 100 mg........................9doxycycline monohydrate cap 150 mg........................9doxycycline monohydrate cap 50 mg..........................9doxycycline monohydrate cap 75 mg..........................9doxycycline monohydrate tab 100 mg.........................9doxycycline monohydrate tab 150 mg.........................9doxycycline monohydrate tab 50 mg...........................9doxycycline monohydrate tab 75 mg...........................9D-PENAMINE............................................................... 89dronabinol cap 10 mg................................................. 22dronabinol cap 2.5 mg................................................ 22dronabinol cap 5 mg....................................................22drospirenone-ethinyl estradiol tab 3-0.02

mg................................................................................91drospirenone-ethinyl estradiol tab 3-0.03

mg................................................................................91drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg........................................................91drospirenone-ethinyl estrad-levomefolate tab

3-0.03-0.451 mg........................................................91DUAVEE........................................................................ 91DULERA......................................................................108DULERA......................................................................108duloxetine hcl enteric coated pellets cap 20

mg................................................................................19duloxetine hcl enteric coated pellets cap 30

mg................................................................................19

duloxetine hcl enteric coated pellets cap 60mg................................................................................19

DUPIXENT.................................................................... 97DUREZOL................................................................... 104dutasteride cap 0.5 mg............................................... 89dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................89EEASY TOUCH FLIPLOCK SAFETY INSULIN

SYRINGE 1ML/30G X 1/2"......................................50EASY TOUCH INSULIN SYRINGE/SAFETY/

U-100/0.5ML/29G X 1/2"......................................... 50EASY TOUCH INSULIN SYRINGE/SAFETY/

U-100/1ML/30G X 1/2".............................................50EASY TOUCH SHEATHLOCK SAFETY INSULIN

SYRINGE 1ML/29G X 1/2"......................................50EASY TOUCH SHEATHLOCK SAFETY SYRINGE

1ML/30G X 1/2"........................................................ 50econazole nitrate cream 1%.......................................23EDURANT..................................................................... 44efavirenz cap 200 mg..................................................44efavirenz cap 50 mg....................................................44efavirenz tab 600 mg...................................................44EGRIFTA....................................................................... 91ELAPRASE................................................................... 87ELELYSO.......................................................................87ELIDEL...........................................................................79ELIGARD.......................................................................94ELIGARD.......................................................................94ELIGARD.......................................................................94ELIGARD.......................................................................94ELIQUIS.........................................................................58ELIQUIS.........................................................................58ELIQUIS STARTER PACK......................................... 58ELITEK...........................................................................29ELITEK...........................................................................29ELLA...............................................................................91EMCYT.......................................................................... 29EMEND..........................................................................22EMPLICITI.....................................................................29EMPLICITI.....................................................................29EMSAM..........................................................................19EMSAM..........................................................................19EMSAM..........................................................................19EMTRIVA.......................................................................44EMTRIVA.......................................................................44enalapril maleate & hydrochlorothiazide tab 10-25

mg................................................................................66enalapril maleate & hydrochlorothiazide tab 5-12.5

mg................................................................................66enalapril maleate tab 10 mg.......................................66enalapril maleate tab 2.5 mg......................................66

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enalapril maleate tab 20 mg.......................................66enalapril maleate tab 5 mg.........................................66ENBREL........................................................................ 97ENBREL........................................................................ 97ENBREL........................................................................ 97ENBREL MINI...............................................................97ENBREL SURECLICK................................................ 97ENGERIX-B.................................................................. 97ENGERIX-B.................................................................. 97enoxaparin sodium inj 100 mg/ml..............................58enoxaparin sodium inj 120 mg/0.8ml........................ 58enoxaparin sodium inj 150 mg/ml..............................58enoxaparin sodium inj 300 mg/3ml............................58enoxaparin sodium inj 30 mg/0.3ml...........................58enoxaparin sodium inj 40 mg/0.4ml...........................58enoxaparin sodium inj 60 mg/0.6ml...........................58enoxaparin sodium inj 80 mg/0.8ml...........................58entacapone tab 200 mg..............................................38entecavir tab 0.5 mg....................................................44entecavir tab 1 mg.......................................................45ENTRESTO...................................................................66ENTRESTO...................................................................66ENTRESTO...................................................................66EPCLUSA......................................................................45EPIDIOLEX................................................................... 14epinastine hcl ophth soln 0.05%..............................104EPINEPHRINE........................................................... 108epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (generic for EpiPen 2-Pak).................... 108epirubicin hcl iv soln 200 mg/100ml (2 mg/

ml)................................................................................29epirubicin hcl iv soln 50 mg/25ml (2 mg/

ml)................................................................................29EPIVIR HBV..................................................................45eplerenone tab 25 mg.................................................66eplerenone tab 50 mg.................................................66EPOGEN....................................................................... 58EPOGEN....................................................................... 59EPOGEN....................................................................... 59EPOGEN....................................................................... 59EPOGEN....................................................................... 59ERBITUX....................................................................... 29ERBITUX....................................................................... 29ERGOLOID MESYLATES...........................................17ERIVEDGE....................................................................29ERLEADA......................................................................29ertapenem sodium for inj 1 gm.................................... 9ERWINAZE................................................................... 29ERYPED 400.................................................................. 9ERY-TAB..........................................................................9ERY-TAB..........................................................................9ERY-TAB..........................................................................9

ERYTHROCIN LACTOBIONATE...............................10ERYTHROCIN STEARATE........................................ 10erythromycin ethylsuccinate for susp 200

mg/5ml........................................................................ 10erythromycin ophth oint 5 mg/gm............................ 104erythromycin pads 2%.................................................10erythromycin soln 2%..................................................10erythromycin tab 250 mg............................................ 10erythromycin tab 500 mg............................................ 10erythromycin w/ delayed release particles cap 250

mg................................................................................10ESBRIET..................................................................... 108ESBRIET..................................................................... 108ESBRIET..................................................................... 108escitalopram oxalate soln 5 mg/5ml..........................19escitalopram oxalate tab 10 mg.................................19escitalopram oxalate tab 20 mg.................................19escitalopram oxalate tab 5 mg...................................19esomeprazole magnesium cap delayed release 20

mg................................................................................85esomeprazole magnesium cap delayed release 40

mg................................................................................85ESOMEPRAZOLE SODIUM...................................... 85esomeprazole sodium for intravenous soln 40

mg................................................................................85estradiol & norethindrone acetate tab 0.5-0.1

mg................................................................................91estradiol & norethindrone acetate tab 1-0.5

mg................................................................................91estradiol tab 0.5 mg.....................................................91estradiol tab 1 mg........................................................92estradiol tab 2 mg........................................................92estradiol vaginal cream 0.1 mg/gm........................... 92estradiol vaginal tab 10 mcg...................................... 92ESTROPIPATE............................................................. 92ethambutol hcl tab 100 mg.........................................26ethambutol hcl tab 400 mg.........................................26ethosuximide cap 250 mg...........................................14ethosuximide soln 250 mg/5ml.................................. 14ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg..............................................................................92ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg..............................................................................92ETHYOL........................................................................ 29ETIDRONATE DISODIUM........................................102ETIDRONATE DISODIUM........................................102etodolac cap 200 mg.....................................................1etodolac cap 300 mg.....................................................2etodolac tab 400 mg......................................................2etodolac tab 500 mg......................................................2etodolac tab er 24hr 400 mg........................................ 2etodolac tab er 24hr 500 mg........................................ 2

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etodolac tab er 24hr 600 mg........................................ 2ETOPOPHOS............................................................... 29etoposide inj 100 mg/5ml (20 mg/ml)........................29etoposide inj 1 gm/50ml (20 mg/ml).......................... 29etoposide inj 500 mg/25ml (20 mg/ml)......................29EVOMELA..................................................................... 29EVOTAZ.........................................................................45exemestane tab 25 mg............................................... 29EXFORGE.....................................................................66EXFORGE.....................................................................66EXFORGE.....................................................................66EXFORGE.....................................................................66EXFORGE HCT........................................................... 67EXFORGE HCT........................................................... 67EXFORGE HCT........................................................... 67EXFORGE HCT........................................................... 67EXFORGE HCT........................................................... 67EXJADE.........................................................................82EXJADE.........................................................................83EXJADE.........................................................................83ezetimibe-simvastatin tab 10-10 mg..........................67ezetimibe-simvastatin tab 10-20 mg..........................67ezetimibe-simvastatin tab 10-40 mg..........................67ezetimibe-simvastatin tab 10-80 mg..........................67ezetimibe tab 10 mg....................................................67FFABRAZYME................................................................ 87FABRAZYME................................................................ 87famciclovir tab 125 mg................................................45famciclovir tab 250 mg................................................45famciclovir tab 500 mg................................................45famotidine inj 200 mg/20ml........................................ 85famotidine inj 20 mg/2ml.............................................85famotidine inj 40 mg/4ml.............................................85famotidine tab 20 mg...................................................85famotidine tab 40 mg...................................................85FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT.........................................................................39FANAPT TITRATION PACK....................................... 39FARESTON...................................................................29FARYDAK......................................................................29FARYDAK......................................................................30FARYDAK......................................................................30FASLODEX................................................................... 30fat emulsion iv soln 20%.............................................83felbamate susp 600 mg/5ml....................................... 14

felbamate tab 400 mg................................................. 14felbamate tab 600 mg................................................. 14felodipine tab er 24hr 10 mg...................................... 67felodipine tab er 24hr 2.5 mg..................................... 67felodipine tab er 24hr 5 mg........................................ 67fenofibrate micronized cap 134 mg........................... 67fenofibrate micronized cap 200 mg........................... 67fenofibrate micronized cap 67 mg............................. 67fenofibrate tab 145 mg................................................67fenofibrate tab 160 mg................................................67fenofibrate tab 48 mg.................................................. 67fenofibrate tab 54 mg.................................................. 67fentanyl 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 37.5 mcg/hr..............................2fentanyl td patch 72hr 50 mcg/hr................................. 2fentanyl td patch 72hr 62.5 mcg/hr..............................2fentanyl td patch 72hr 75 mcg/hr................................. 2fentanyl td patch 72hr 87.5 mcg/hr..............................2FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA TITRATION PACK......................................19FINACEA....................................................................... 79FINACEA....................................................................... 79finasteride tab 5 mg.....................................................89FIRAZYR....................................................................... 97FIRMAGON...................................................................94FIRMAGON...................................................................94flecainide acetate tab 100 mg....................................67flecainide acetate tab 150 mg....................................67flecainide acetate tab 50 mg...................................... 67FLOMAX........................................................................89FLOVENT DISKUS....................................................108FLOVENT DISKUS....................................................108FLOVENT DISKUS....................................................108FLOVENT HFA...........................................................108FLOVENT HFA...........................................................108

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FLOVENT HFA...........................................................108fluconazole for susp 10 mg/ml................................... 23fluconazole for susp 40 mg/ml................................... 23fluconazole in dextrose inj 200

mg/100ml....................................................................23fluconazole in dextrose inj 400

mg/200ml....................................................................23fluconazole in nacl 0.9% inj 200

mg/100ml....................................................................23fluconazole in nacl 0.9% inj 400

mg/200ml....................................................................23fluconazole tab 100 mg...............................................23fluconazole tab 150 mg...............................................23fluconazole tab 200 mg...............................................23fluconazole tab 50 mg.................................................23flucytosine cap 250 mg............................................... 24flucytosine cap 500 mg............................................... 24fludarabine phosphate for inj 50 mg..........................30fludarabine phosphate inj 25 mg/ml.......................... 30fludrocortisone acetate tab 0.1 mg............................ 90fluocinolone acetonide (otic) oil

0.01%........................................................................106fluocinolone acetonide cream 0.01%........................ 79fluocinonide cream 0.05%.......................................... 79fluocinonide emulsified base cream

0.05%..........................................................................79fluocinonide gel 0.05%................................................79fluocinonide oint 0.05%...............................................79fluocinonide soln 0.05%..............................................79fluorometholone ophth susp 0.1%...........................104FLUOROURACIL......................................................... 79FLUOROURACIL......................................................... 79fluorouracil cream 5%................................................. 79fluorouracil iv soln 1 gm/20ml (50 mg/

ml)................................................................................30fluorouracil iv soln 2.5 gm/50ml (50 mg/

ml)................................................................................30fluorouracil iv soln 500 mg/10ml (50 mg/

ml)................................................................................30fluorouracil iv soln 5 gm/100ml (50 mg/

ml)................................................................................30FLUOXETINE DR........................................................ 19fluoxetine hcl cap 10 mg.............................................19fluoxetine hcl cap 20 mg.............................................19fluoxetine hcl cap 40 mg.............................................19fluoxetine hcl solution 20 mg/5ml.............................. 19fluoxetine hcl tab 10 mg..............................................19fluoxetine hcl tab 20 mg..............................................19fluphenazine decanoate inj 25 mg/ml........................40FLUPHENAZINE HCL.................................................40FLUPHENAZINE HCL.................................................40FLUPHENAZINE HCL.................................................40

fluphenazine hcl tab 10 mg........................................ 40fluphenazine hcl tab 1 mg.......................................... 40fluphenazine hcl tab 2.5 mg....................................... 40fluphenazine hcl tab 5 mg.......................................... 40flurbiprofen sodium ophth soln 0.03%.....................104flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................30FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 108FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 108FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 108fluticasone propionate cream 0.05%.........................79fluticasone propionate nasal susp 50 mcg/

act..............................................................................108fluticasone propionate oint 0.005%........................... 79fluvastatin sodium cap 20 mg.................................... 67fluvastatin sodium cap 40 mg.................................... 67fluvastatin sodium tab er 24 hr 80 mg.......................67fluvoxamine maleate tab 100 mg...............................19fluvoxamine maleate tab 25 mg.................................19fluvoxamine maleate tab 50 mg.................................19FML LIQUIFILM......................................................... 104FOLOTYN......................................................................30FOLOTYN......................................................................30fomepizole inj 1 gm/ml (for iv infusion)......................83fondaparinux sodium subcutaneous inj 10

mg/0.8ml.....................................................................59fondaparinux sodium subcutaneous inj 2.5

mg/0.5ml.....................................................................59fondaparinux sodium subcutaneous inj 5

mg/0.4ml.....................................................................59fondaparinux sodium subcutaneous inj 7.5

mg/0.6ml.....................................................................59FORTEO......................................................................103fosamprenavir calcium tab 700 mg........................... 45fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................67fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................67fosinopril sodium tab 10 mg....................................... 67fosinopril sodium tab 20 mg....................................... 67fosinopril sodium tab 40 mg....................................... 67fosphenytoin sodium inj 100 mg/2ml.........................14fosphenytoin sodium inj 500 mg/10ml.......................14FOSRENOL.................................................................. 83FOSRENOL.................................................................. 83FREAMINE HBC 6.9%................................................83FREAMINE III............................................................... 83frovatriptan succinate tab 2.5 mg.............................. 25

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furosemide inj 10 mg/ml..............................................67furosemide oral soln 10 mg/ml...................................67furosemide tab 20 mg................................................. 67furosemide tab 40 mg................................................. 68furosemide tab 80 mg................................................. 68FUZEON........................................................................45FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15Ggabapentin cap 100 mg.............................................. 15gabapentin cap 300 mg.............................................. 15gabapentin cap 400 mg.............................................. 15gabapentin oral soln 250 mg/5ml.............................. 15gabapentin tab 600 mg............................................... 15gabapentin tab 800 mg............................................... 15GALANTAMINE HYDROBROMIDE.......................... 17galantamine hydrobromide cap er 24hr 16

mg................................................................................17galantamine hydrobromide cap er 24hr 24

mg................................................................................17galantamine hydrobromide cap er 24hr 8

mg................................................................................17galantamine hydrobromide tab 12 mg...................... 17galantamine hydrobromide tab 4 mg.........................17galantamine hydrobromide tab 8 mg.........................17GAMMAGARD LIQUID............................................... 97GAMMAGARD LIQUID............................................... 97GAMMAGARD LIQUID............................................... 97GAMMAGARD LIQUID............................................... 97GAMMAGARD LIQUID............................................... 97GAMMAGARD LIQUID............................................... 97GAMMAGARD S/D......................................................98GAMMAGARD S/D......................................................98GAMMAPLEX............................................................... 98GAMMAPLEX............................................................... 98GAMMAPLEX............................................................... 98GAMMAPLEX............................................................... 98GAMMAPLEX............................................................... 98GAMMAPLEX............................................................... 98GAMUNEX-C................................................................ 98GAMUNEX-C................................................................ 98GAMUNEX-C................................................................ 98GAMUNEX-C................................................................ 98GAMUNEX-C................................................................ 98GAMUNEX-C................................................................ 98ganciclovir sodium for inj 500 mg.............................. 45

GARDASIL 9.................................................................98GARDASIL 9.................................................................98gatifloxacin ophth soln 0.5%.................................... 104GATTEX.........................................................................85GAUZE PADS 2" X 2".................................................51GAZYVA.........................................................................30gemcitabine hcl for inj 1 gm....................................... 30gemcitabine hcl for inj 200 mg...................................30gemcitabine hcl for inj 2 gm....................................... 30gemcitabine hcl inj 1 gm/26.3ml (38 mg/

ml)................................................................................30gemcitabine hcl inj 200 mg/5.26ml (38 mg/

ml)................................................................................30gemcitabine hcl inj 2 gm/52.6ml (38 mg/

ml)................................................................................30gemfibrozil tab 600 mg............................................... 68gentamicin in saline inj 0.8 mg/ml............................. 10gentamicin in saline inj 1.2 mg/ml............................. 10gentamicin in saline inj 1.6 mg/ml............................. 10gentamicin in saline inj 1 mg/ml.................................10gentamicin sulfate cream 0.1%..................................79gentamicin sulfate inj 10 mg/ml................................. 10gentamicin sulfate inj 40 mg/ml................................. 10gentamicin sulfate oint 0.1%...................................... 80gentamicin sulfate ophth oint 0.3%......................... 104gentamicin sulfate ophth soln 0.3%........................ 104GENVOYA.....................................................................45GEODON.......................................................................40GILOTRIF......................................................................30GILOTRIF......................................................................30GILOTRIF......................................................................30glatiramer acetate soln prefilled syringe 20 mg/

ml.................................................................................77glatiramer acetate soln prefilled syringe 40 mg/

ml.................................................................................77GLEOSTINE..................................................................30GLEOSTINE..................................................................30GLEOSTINE..................................................................30glimepiride tab 1 mg....................................................51glimepiride tab 2 mg....................................................51glimepiride tab 4 mg....................................................51glipizide-metformin hcl tab 2.5-250 mg.....................51glipizide-metformin hcl tab 2.5-500 mg.....................51glipizide-metformin hcl tab 5-500 mg........................ 51glipizide tab 10 mg...................................................... 51glipizide tab 5 mg.........................................................51glipizide tab er 24hr 10 mg.........................................51glipizide tab er 24hr 2.5 mg........................................51glipizide tab er 24hr 5 mg...........................................51GLUCAGEN HYPOKIT............................................... 51GLUCAGON EMERGENCY KIT............................... 51GLUCOPHAGE............................................................ 51

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GLUCOPHAGE............................................................ 51GLUCOPHAGE............................................................ 51GLUCOPHAGE XR..................................................... 51GLUCOPHAGE XR..................................................... 51GLUCOTROL................................................................51GLUCOTROL................................................................51GLUCOTROL XL......................................................... 51GLUCOTROL XL......................................................... 51GLUCOTROL XL......................................................... 51glycopyrrolate tab 1 mg.............................................. 85glycopyrrolate tab 2 mg.............................................. 85GLYXAMBI.................................................................... 51GLYXAMBI.................................................................... 51GOLYTELY....................................................................85granisetron hcl inj 1 mg/ml......................................... 22granisetron hcl inj 4 mg/4ml (1 mg/ml)......................22granisetron hcl tab 1 mg.............................................22GRANIX......................................................................... 59GRANIX......................................................................... 59GRANIX......................................................................... 59GRANIX......................................................................... 59griseofulvin microsize susp 125

mg/5ml........................................................................ 24griseofulvin microsize tab 500 mg............................. 24griseofulvin ultramicrosize tab 125 mg......................24griseofulvin ultramicrosize tab 250 mg......................24GUANIDINE HCL.........................................................26HH.P. ACTHAR............................................................... 90HAEGARDA.................................................................. 98HAEGARDA.................................................................. 98HALAVEN...................................................................... 30halobetasol propionate cream 0.05%........................80halobetasol propionate oint 0.05%............................ 80haloperidol decanoate im soln 100 mg/

ml.................................................................................40haloperidol decanoate im soln 50 mg/

ml.................................................................................40haloperidol lactate inj 5 mg/ml................................... 40haloperidol lactate oral conc 2 mg/ml........................40haloperidol tab 0.5 mg................................................ 40haloperidol tab 10 mg................................................. 40haloperidol tab 1 mg....................................................40haloperidol tab 20 mg................................................. 40haloperidol tab 2 mg....................................................40haloperidol tab 5 mg....................................................40HARVONI...................................................................... 45HAVRIX..........................................................................98HAVRIX..........................................................................98heparin sodium (porcine) 40 unit/ml in

d5w..............................................................................59

heparin sodium (porcine) inj 10000 unit/ml.................................................................................59




heparin sodium (porcine) pf inj 5000unit/0.5ml....................................................................59

HEPATAMINE............................................................... 83HERCEPTIN................................................................. 30HERCEPTIN................................................................. 30HETLIOZ..................................................................... 111HIBERIX........................................................................ 98HUMALOG.................................................................... 51HUMALOG.................................................................... 51HUMALOG JUNIOR KWIKPEN.................................51HUMALOG KWIKPEN.................................................51HUMALOG KWIKPEN.................................................51HUMALOG MIX 50/50.................................................51HUMALOG MIX 50/50 KWIKPEN............................. 51HUMALOG MIX 75/25.................................................51HUMALOG MIX 75/25 KWIKPEN............................. 52HUMIRA.........................................................................98HUMIRA.........................................................................98HUMIRA.........................................................................98HUMIRA.........................................................................98HUMIRA.........................................................................98HUMIRA.........................................................................98HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................98HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................99HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................99HUMIRA PEN............................................................... 99HUMIRA PEN............................................................... 99HUMIRA PEN-CD/UC/HS STARTER........................99HUMIRA PEN-CD/UC/HS STARTER........................99HUMIRA PEN-PS/UV STARTER...............................99HUMIRA PEN-PS/UV STARTER...............................99HUMULIN 70/30...........................................................52HUMULIN 70/30 KWIKPEN....................................... 52HUMULIN N..................................................................52HUMULIN N KWIKPEN.............................................. 52HUMULIN R..................................................................52HUMULIN R U-500 (CONCENTRATE).....................52HUMULIN R U-500 KWIKPEN...................................52hydralazine hcl tab 100 mg........................................ 68hydralazine hcl tab 10 mg.......................................... 68hydralazine hcl tab 25 mg.......................................... 68

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hydralazine hcl tab 50 mg.......................................... 68hydrochlorothiazide cap 12.5 mg...............................68hydrochlorothiazide tab 12.5 mg................................68hydrochlorothiazide tab 25 mg...................................68hydrochlorothiazide tab 50 mg...................................68hydrocodone-acetaminophen soln 7.5-325

mg/15ml........................................................................ 2hydrocodone-acetaminophen tab 10-300

mg..................................................................................2hydrocodone-acetaminophen tab 10-325



mg..................................................................................2hydrocodone-acetaminophen tab 7.5-300

mg..................................................................................2hydrocodone-acetaminophen tab 7.5-325

mg..................................................................................2hydrocodone-ibuprofen tab 10-200 mg.......................2hydrocodone-ibuprofen tab 5-200 mg......................... 2hydrocodone-ibuprofen tab 7.5-200 mg......................2hydrocortisone butyrate cream 0.1%........................ 80hydrocortisone butyrate hydrophilic lipo base cream

0.1%............................................................................80hydrocortisone butyrate oint 0.1%.............................80hydrocortisone butyrate soln 0.1%............................ 80hydrocortisone cream 1%...........................................80hydrocortisone cream 2.5%........................................80hydrocortisone enema 100 mg/60ml.......................102hydrocortisone lotion 2.5%......................................... 80hydrocortisone oint 1%............................................... 80hydrocortisone oint 2.5%............................................ 80hydrocortisone rectal cream 1%.............................. 102hydrocortisone rectal cream 2.5%...........................102hydrocortisone tab 10 mg...........................................90hydrocortisone tab 20 mg...........................................90hydrocortisone tab 5 mg............................................. 90hydrocortisone valerate cream 0.2%.........................80hydrocortisone valerate oint 0.2%............................. 80hydrocortisone w/ acetic acid otic soln

1-2%..........................................................................106hydromorphone hcl inj 2 mg/ml....................................2hydromorphone hcl liqd 1 mg/ml..................................2hydromorphone hcl preservative free inj 10 mg/

ml................................................................................... 2hydromorphone hcl preservative free inj 2 mg/

ml................................................................................... 2hydromorphone hcl tab 2 mg....................................... 2hydromorphone hcl tab 4 mg....................................... 2hydromorphone hcl tab 8 mg....................................... 3hydroxychloroquine sulfate tab 200 mg.................... 37

HYDROXYPROGESTERONECAPROATE................................................................92

hydroxyurea cap 500 mg............................................ 30hydroxyzine hcl syrup 10 mg/5ml.............................. 49hydroxyzine hcl tab 10 mg..........................................49hydroxyzine hcl tab 25 mg..........................................49hydroxyzine hcl tab 50 mg..........................................49HYZAAR........................................................................ 68HYZAAR........................................................................ 68HYZAAR........................................................................ 68Iibandronate sodium iv soln 3 mg/3ml..................... 103ibandronate sodium tab 150 mg..............................103IBRANCE.......................................................................30IBRANCE.......................................................................30IBRANCE.......................................................................30ibuprofen susp 100 mg/5ml.......................................... 3ibuprofen tab 400 mg.................................................... 3ibuprofen tab 600 mg.................................................... 3ibuprofen tab 800 mg.................................................... 3ICLUSIG........................................................................ 30ICLUSIG........................................................................ 30idarubicin hcl iv inj 10 mg/10ml (1 mg/

ml)................................................................................30idarubicin hcl iv inj 20 mg/20ml (1 mg/

ml)................................................................................30idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................30IDHIFA............................................................................31IDHIFA............................................................................31IFEX............................................................................... 31IFOSFAMIDE................................................................ 31ifosfamide for inj 1 gm.................................................31ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 31ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 31ILARIS............................................................................99ILEVRO........................................................................104imatinib mesylate tab 100 mg.................................... 31imatinib mesylate tab 400 mg.................................... 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMFINZI..........................................................................31IMFINZI..........................................................................31imipenem-cilastatin intravenous for soln 250

mg................................................................................10imipenem-cilastatin intravenous for soln 500

mg................................................................................10imipramine hcl tab 10 mg........................................... 19

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imipramine hcl tab 25 mg........................................... 19imipramine hcl tab 50 mg........................................... 19imiquimod cream 5%...................................................80IMITREX........................................................................ 25IMITREX........................................................................ 25IMITREX........................................................................ 25IMITREX........................................................................ 25IMITREX........................................................................ 25IMITREX........................................................................ 25IMITREX STATDOSE REFILL....................................25IMITREX STATDOSE REFILL....................................25IMITREX STATDOSE SYSTEM.................................25IMITREX STATDOSE SYSTEM.................................25IMLYGIC........................................................................ 31IMLYGIC........................................................................ 31IMOVAX RABIES (H.D.C.V.)...................................... 99IMPAVIDO..................................................................... 10INCRELEX.................................................................... 91INCRUSE ELLIPTA................................................... 108indapamide tab 1.25 mg............................................. 68indapamide tab 2.5 mg............................................... 68INFANRIX......................................................................99INJECTION DEVICE FOR INSULIN......................... 52INLYTA...........................................................................31INLYTA...........................................................................31INSULIN PEN NEEDLE 29G X

12.7MM.......................................................................52INSULIN PEN NEEDLE 29G X 5MM

(3/16")......................................................................... 52INSULIN PEN NEEDLE 29G X 8MM

(5/16")......................................................................... 52INSULIN PEN NEEDLE 30G X 5MM

(3/16")......................................................................... 52INSULIN PEN NEEDLE 30G X 8MM (1/3" OR

5/16")...........................................................................52INSULIN PEN NEEDLE 31G X 4MM

(1/6")........................................................................... 52INSULIN PEN NEEDLE 32G X 5MM (1/5" OR


(5/32")......................................................................... 52INSULIN PEN NEEDLE 33G X 5MM (1/5" OR


(1/4")........................................................................... 52INSULIN PEN NEEDLE 33G X 8MM (1/3" OR

5/16")...........................................................................52INSULIN SYRINGE/NEEDLE U-100/0.3ML/28G X

1/2".............................................................................. 52INSULIN SYRINGE/NEEDLE U-100/0.3ML/29

G..................................................................................52

INSULIN SYRINGE/NEEDLE U-100/0.3ML/29G X1"................................................................................. 52

INSULIN SYRINGE/NEEDLEU-100/0.3ML/30G......................................................52

INSULIN SYRINGE/NEEDLE U-100/0.3ML/31G X1/4" (6MM)..................................................................52

INSULIN SYRINGE/NEEDLE U-100/0.5ML/27G X1/2".............................................................................. 52

INSULIN SYRINGE/NEEDLE U-100/0.5ML/28G X5/16"............................................................................52


INSULIN SYRINGE/NEEDLE U-100/0.5ML/29G X5/16"............................................................................53


INSULIN SYRINGE/NEEDLE U-100/0.5ML/30G X3/16" (5MM)............................................................... 53

INSULIN SYRINGE/NEEDLE U-100/0.5ML/30G X3/8".............................................................................. 53

INSULIN SYRINGE/NEEDLE U-100/0.5ML/31G X1/4" (6MM)..................................................................53

INSULIN SYRINGE/NEEDLE U-100/1ML/25G X1"................................................................................. 53

INSULIN SYRINGE/NEEDLE U-100/1ML/25G X5/8".............................................................................. 53




INSULIN SYRINGE/NEEDLE U-100/1ML/28G X5/16"............................................................................53

INSULIN SYRINGE/NEEDLE U-100/1ML/29G X5/16"............................................................................53

INSULIN SYRINGE/NEEDLEU-100/1ML/30G.........................................................53

INSULIN SYRINGE/NEEDLE U-100/1ML/30G X3/16" (5MM)............................................................... 53

INSULIN SYRINGE/NEEDLE U-100/1ML/31G X1/4" (6MM)..................................................................53

INSULIN SYRINGE/NEEDLE U-100/2ML/27.5G X5/8".............................................................................. 53

INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30 X15/64"..........................................................................52

INSULIN SYRINGE/NEEDLE U-100 0.5 ML 30 X15/64"..........................................................................52

INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X15/64"..........................................................................52


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INSULIN SYRINGE/NEEDLE U-500/0.5ML/31G X6MM (15/64").............................................................53

INSULIN SYRINGE (DISP)U-100/0.3ML.............................................................. 52

INSULIN SYRINGE (DISP)U-100/0.5ML.............................................................. 52

INSULIN SYRINGE (DISP)U-100/1ML................................................................. 52

INTELENCE.................................................................. 45INTELENCE.................................................................. 45INTELENCE.................................................................. 45INTRON A.....................................................................45INTRON A.....................................................................45INTRON A.....................................................................45INTRON A.....................................................................45INTRON A.....................................................................45INTRON A W/DILUENT..............................................45INTRON A W/DILUENT..............................................45INTRON A W/DILUENT..............................................45INVANZ.......................................................................... 10INVANZ.......................................................................... 10INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA SUSTENNA.................................................. 40INVEGA TRINZA..........................................................40INVEGA TRINZA..........................................................40INVEGA TRINZA..........................................................40INVEGA TRINZA..........................................................40INVIRASE......................................................................45INVIRASE......................................................................45INVOKAMET.................................................................53INVOKAMET.................................................................53INVOKAMET.................................................................53INVOKAMET.................................................................53INVOKAMET XR..........................................................53INVOKAMET XR..........................................................53INVOKAMET XR..........................................................53INVOKAMET XR..........................................................53INVOKANA....................................................................53INVOKANA....................................................................53IPOL INACTIVATED IPV.............................................99ipratropium bromide inhal soln 0.02%.....................108ipratropium bromide nasal soln 0.03% (21 mcg/

spray)........................................................................108ipratropium bromide nasal soln 0.06% (42 mcg/

spray)........................................................................108irbesartan-hydrochlorothiazide tab 150-12.5

mg................................................................................68irbesartan-hydrochlorothiazide tab 300-12.5

mg................................................................................68

irbesartan tab 150 mg.................................................68irbesartan tab 300 mg.................................................68irbesartan tab 75 mg................................................... 68IRESSA..........................................................................31IRINOTECAN................................................................31irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................31irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 31ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS..................................................................45ISENTRESS HD...........................................................45ISONIAZID.................................................................... 26isoniazid tab 100 mg................................................... 26isoniazid tab 300 mg................................................... 26isosorbide dinitrate tab 10 mg....................................68isosorbide dinitrate tab 20 mg....................................68isosorbide dinitrate tab 30 mg....................................68isosorbide dinitrate tab 5 mg......................................68isosorbide mononitrate tab 10 mg............................. 68isosorbide mononitrate tab 20 mg............................. 68isosorbide mononitrate tab er 24hr 120

mg................................................................................68isosorbide mononitrate tab er 24hr 30

mg................................................................................68isosorbide mononitrate tab er 24hr 60

mg................................................................................68isotretinoin cap 10 mg.................................................80isotretinoin cap 20 mg.................................................80isotretinoin cap 30 mg.................................................80isotretinoin cap 40 mg.................................................80isradipine cap 2.5 mg..................................................68isradipine cap 5 mg..................................................... 68ISTALOL...................................................................... 104ISTODAX (OVERFILL)................................................31itraconazole cap 100 mg............................................ 24ivermectin tab 3 mg.....................................................37IXEMPRA KIT...............................................................31IXEMPRA KIT...............................................................31IXIARO...........................................................................99JJADENU........................................................................ 83JADENU........................................................................ 83JADENU........................................................................ 83JADENU SPRINKLE................................................... 83JADENU SPRINKLE................................................... 83JADENU SPRINKLE................................................... 83JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31

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JAKAFI...........................................................................31JAKAFI...........................................................................31JANUMET......................................................................53JANUMET......................................................................53JANUMET XR...............................................................53JANUMET XR...............................................................53JANUMET XR...............................................................53JANUVIA........................................................................53JANUVIA........................................................................54JANUVIA........................................................................54JARDIANCE..................................................................54JARDIANCE..................................................................54JENTADUETO.............................................................. 54JENTADUETO.............................................................. 54JENTADUETO.............................................................. 54JENTADUETO XR....................................................... 54JENTADUETO XR....................................................... 54JEVTANA.......................................................................31JULUCA.........................................................................45JUXTAPID..................................................................... 68JUXTAPID..................................................................... 68JUXTAPID..................................................................... 68JUXTAPID..................................................................... 68JUXTAPID..................................................................... 69JUXTAPID..................................................................... 69KKADCYLA......................................................................31KADCYLA......................................................................31KALETRA...................................................................... 45KALETRA...................................................................... 45KALYDECO.................................................................108KALYDECO.................................................................108KALYDECO.................................................................108kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

inj................................................................................. 83kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2%



inj................................................................................. 83kcl 20 meq/l (0.15%) in nacl 0.45% inj......................83kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45%


inj................................................................................. 83KEPIVANCE..................................................................78ketoconazole cream 2%..............................................24ketoconazole shampoo 2%........................................ 24ketoconazole tab 200 mg........................................... 24ketorolac tromethamine ophth soln

0.4%..........................................................................104

ketorolac tromethamine ophth soln0.5%..........................................................................104

KEYTRUDA...................................................................32KINERET....................................................................... 99KINRIX........................................................................... 99KISQALI.........................................................................32KISQALI FEMARA 200 DOSE...................................32KISQALI FEMARA 400 DOSE...................................32KISQALI FEMARA 600 DOSE...................................32KOMBIGLYZE XR........................................................54KOMBIGLYZE XR........................................................54KOMBIGLYZE XR........................................................54KORLYM........................................................................94K-TAB.............................................................................83KUVAN...........................................................................87KUVAN...........................................................................87KUVAN...........................................................................87KYNAMRO.................................................................... 69KYPROLIS.................................................................... 32KYPROLIS.................................................................... 32KYPROLIS.................................................................... 32Llabetalol hcl tab 100 mg..............................................69labetalol hcl tab 200 mg..............................................69labetalol hcl tab 300 mg..............................................69LACRISERT................................................................104lactated ringer's solution............................................. 83lactic acid (ammonium lactate) cream

12%............................................................................. 80lactic acid (ammonium lactate) lotion

12%............................................................................. 80lactulose (encephalopathy) solution 10

gm/15ml......................................................................85lactulose solution 10 gm/15ml....................................85lamivudine oral soln 10 mg/ml................................... 45lamivudine tab 100 mg (hbv)......................................45lamivudine tab 150 mg................................................45lamivudine tab 300 mg................................................45lamivudine-zidovudine tab 150-300 mg.................... 46lamotrigine tab 100 mg............................................... 15lamotrigine tab 150 mg............................................... 15lamotrigine tab 200 mg............................................... 15lamotrigine tab 25 mg................................................. 15lamotrigine tab chewable dispersible 25

mg................................................................................15lamotrigine tab chewable dispersible 5

mg................................................................................15lansoprazole cap delayed release 15

mg................................................................................85lansoprazole cap delayed release 30

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

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lanthanum carbonate chew tab 1000mg................................................................................83



LANTUS.........................................................................54LANTUS SOLOSTAR..................................................54LARTRUVO...................................................................32LARTRUVO...................................................................32LASIX............................................................................. 69LASIX............................................................................. 69LASIX............................................................................. 69latanoprost ophth soln 0.005%................................ 104LATUDA.........................................................................40LATUDA.........................................................................40LATUDA.........................................................................40LATUDA.........................................................................41LATUDA.........................................................................41LAZANDA........................................................................ 3LAZANDA........................................................................ 3LAZANDA........................................................................ 3leflunomide tab 10 mg.................................................99leflunomide tab 20 mg.................................................99LENVIMA 10 MG DAILY DOSE.................................32LENVIMA 12MG DAILY DOSE..................................32LENVIMA 14 MG DAILY DOSE.................................32LENVIMA 18 MG DAILY DOSE.................................32LENVIMA 20 MG DAILY DOSE.................................32LENVIMA 24 MG DAILY DOSE.................................32LENVIMA 4 MG DAILY DOSE...................................32LENVIMA 8 MG DAILY DOSE...................................32LETAIRIS.....................................................................109LETAIRIS.....................................................................109letrozole tab 2.5 mg.....................................................32LEUCOVORIN CALCIUM...........................................32LEUCOVORIN CALCIUM...........................................32leucovorin calcium for inj 100 mg.............................. 32leucovorin calcium for inj 200 mg.............................. 32leucovorin calcium for inj 350 mg.............................. 32leucovorin calcium for inj 500 mg.............................. 32leucovorin calcium for inj 50 mg................................ 32leucovorin calcium tab 25 mg.................................... 32leucovorin calcium tab 5 mg.......................................32LEUKERAN...................................................................32LEUKINE....................................................................... 59leuprolide acetate inj kit 5 mg/ml............................... 95LEVEMIR.......................................................................54LEVEMIR FLEXTOUCH..............................................54levetiracetam inj 500 mg/5ml (100 mg/

ml)................................................................................15

levetiracetam in sodium chloride iv soln 1000mg/100ml....................................................................15



levetiracetam oral soln 100 mg/ml.............................15levetiracetam tab 1000 mg......................................... 15levetiracetam tab 250 mg........................................... 15levetiracetam tab 500 mg........................................... 15levetiracetam tab 750 mg........................................... 15levobunolol hcl ophth soln 0.5%..............................104levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 83levocarnitine tab 330 mg............................................ 83levocetirizine dihydrochloride tab 5

mg............................................................................. 109levofloxacin in d5w iv soln 250

mg/50ml......................................................................10levofloxacin in d5w iv soln 500

mg/100ml....................................................................10levofloxacin in d5w iv soln 750

mg/150ml....................................................................10levofloxacin iv soln 25 mg/ml..................................... 10levofloxacin ophth soln 0.5%................................... 104levofloxacin oral soln 25 mg/ml..................................10levofloxacin tab 250 mg..............................................10levofloxacin tab 500 mg..............................................10levofloxacin tab 750 mg..............................................10levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg............................................................. 92levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg..............................................................................92levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg..............................................................................92levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg........................92levonorgestrel-ethinyl estradiol (continuous) tab

90-20 mcg..................................................................92levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7)...................................................................92levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7)...................................................................92levorphanol tartrate tab 2 mg....................................... 3levothyroxine sodium tab 100 mcg............................94levothyroxine sodium tab 112 mcg............................ 94levothyroxine sodium tab 125 mcg............................94levothyroxine sodium tab 137 mcg............................94levothyroxine sodium tab 150 mcg............................94levothyroxine sodium tab 175 mcg............................94levothyroxine sodium tab 200 mcg............................94levothyroxine sodium tab 25 mcg..............................93

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levothyroxine sodium tab 300 mcg............................94levothyroxine sodium tab 50 mcg..............................93levothyroxine sodium tab 75 mcg..............................94levothyroxine sodium tab 88 mcg..............................94LEXAPRO......................................................................19LEXAPRO......................................................................19LEXAPRO......................................................................19LEXIVA...........................................................................46LEXIVA...........................................................................46LIBTAYO........................................................................ 33LIDOCAINE HCL..........................................................69lidocaine hcl gel 2%.......................................................4lidocaine hcl soln 4%.....................................................4lidocaine hcl viscous soln 2%.......................................4lidocaine oint 5%............................................................4lidocaine patch 5%.........................................................4lidocaine-prilocaine cream 2.5-2.5%........................... 4lindane shampoo 1%...................................................37LINEZOLID....................................................................10linezolid for susp 100 mg/5ml.................................... 10linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................10linezolid tab 600 mg.................................................... 10LINZESS........................................................................85LINZESS........................................................................85LINZESS........................................................................85liothyronine sodium tab 25 mcg.................................94liothyronine sodium tab 50 mcg.................................94liothyronine sodium tab 5 mcg................................... 94LIPITOR.........................................................................69LIPITOR.........................................................................69LIPITOR.........................................................................69LIPITOR.........................................................................69lisinopril & hydrochlorothiazide tab 10-12.5

mg................................................................................69lisinopril & hydrochlorothiazide tab 20-12.5

mg................................................................................69lisinopril & hydrochlorothiazide tab 20-25

mg................................................................................69lisinopril tab 10 mg...................................................... 69lisinopril tab 2.5 mg..................................................... 69lisinopril tab 20 mg...................................................... 69lisinopril tab 30 mg...................................................... 69lisinopril tab 40 mg...................................................... 69lisinopril tab 5 mg.........................................................69LITHIUM........................................................................ 49lithium carbonate cap 150 mg....................................50lithium carbonate cap 300 mg....................................50lithium carbonate cap 600 mg....................................50lithium carbonate tab 300 mg.....................................50lithium carbonate tab er 300 mg................................50lithium carbonate tab er 450 mg................................50

LONSURF..................................................................... 33LONSURF..................................................................... 33loperamide hcl cap 2 mg............................................ 85lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................46LOPRESSOR................................................................69LOPRESSOR................................................................69lorazepam tab 0.5 mg................................................. 49lorazepam tab 1 mg.................................................... 49lorazepam tab 2 mg.................................................... 49losartan potassium & hydrochlorothiazide tab

100-12.5 mg.............................................................. 69losartan potassium & hydrochlorothiazide tab 100-25

mg................................................................................69losartan potassium & hydrochlorothiazide tab

50-12.5 mg.................................................................69losartan potassium tab 100 mg..................................69losartan potassium tab 25 mg....................................69losartan potassium tab 50 mg....................................69LOTENSIN.................................................................... 69LOTENSIN.................................................................... 69LOTENSIN.................................................................... 69lovastatin tab 10 mg....................................................69lovastatin tab 20 mg....................................................69lovastatin tab 40 mg....................................................69loxapine succinate cap 10 mg....................................41loxapine succinate cap 25 mg....................................41loxapine succinate cap 50 mg....................................41loxapine succinate cap 5 mg......................................41LUMIGAN....................................................................104LUMIZYME....................................................................87LUMOXITI......................................................................33LUPRON DEPOT (1-MONTH)...................................95LUPRON DEPOT (1-MONTH)...................................95LUPRON DEPOT (3-MONTH)...................................95LUPRON DEPOT (3-MONTH)...................................95LUPRON DEPOT (4-MONTH)...................................95LUPRON DEPOT (6-MONTH)...................................95LUPRON DEPOT-PED (1-MONTH)..........................95LUPRON DEPOT-PED (1-MONTH)..........................95LUPRON DEPOT-PED (1-MONTH)..........................95LUPRON DEPOT-PED (3-MONTH)..........................95LUPRON DEPOT-PED (3-MONTH)..........................95LYNPARZA....................................................................33LYNPARZA....................................................................33LYNPARZA....................................................................33LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15

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LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYSODREN...................................................................94Mmagnesium sulfate inj 50%........................................ 83malathion lotion 0.5%..................................................37MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MARPLAN..................................................................... 20MARQIBO......................................................................33MATULANE...................................................................33MAVYRET..................................................................... 46MAXALT.........................................................................25MAXALT-MLT................................................................25MAXALT-MLT................................................................25MAXITROL..................................................................104meclizine hcl tab 12.5 mg...........................................22medroxyprogesterone acetate im susp 150 mg/

ml.................................................................................92medroxyprogesterone acetate im susp prefilled syr

150 mg/ml.................................................................. 92medroxyprogesterone acetate tab 10

mg................................................................................92medroxyprogesterone acetate tab 2.5

mg................................................................................92medroxyprogesterone acetate tab 5

mg................................................................................92mefloquine hcl tab 250 mg......................................... 37megestrol acetate susp 40 mg/ml..............................92megestrol acetate tab 20 mg..................................... 92megestrol acetate tab 40 mg..................................... 92MEKINIST......................................................................33MEKINIST......................................................................33MEKTOVI.......................................................................33meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3melphalan hcl for inj 50 mg........................................ 33memantine hcl oral solution 2 mg/ml.........................17memantine hcl tab 10 mg...........................................17memantine hcl tab 5 mg............................................. 17memantine hcl tab 5 mg (28) & 10 mg (21) titration

pak...............................................................................17MENACTRA.................................................................. 99MENVEO....................................................................... 99mercaptopurine tab 50 mg......................................... 33meropenem iv for soln 1 gm...................................... 10meropenem iv for soln 500 mg.................................. 10mesalamine enema 4 gm.........................................102

mesalamine rectal enema 4 gm & cleanser wipekit...............................................................................102

mesalamine suppos 1000 mg..................................102mesalamine tab delayed release 1.2

gm............................................................................. 102mesalamine tab delayed release 800

mg............................................................................. 102mesna inj 100 mg/ml...................................................33MESNEX........................................................................33MESTINON................................................................... 26metformin hcl tab 1000 mg.........................................54metformin hcl tab 500 mg...........................................54metformin hcl tab 850 mg...........................................54metformin hcl tab er 24hr 500 mg............................. 54metformin hcl tab er 24hr 750 mg............................. 54methadone hcl tab 10 mg.............................................3methadone hcl tab 5 mg............................................... 3methazolamide tab 25 mg.......................................... 70methazolamide tab 50 mg.......................................... 70methenamine hippurate tab 1 gm..............................10methimazole tab 10 mg.............................................. 96methimazole tab 5 mg.................................................96methocarbamol tab 500 mg..................................... 111methocarbamol tab 750 mg..................................... 111METHOTREXATE SODIUM.......................................99methotrexate sodium for inj 1 gm.............................. 99methotrexate sodium inj 50 mg/2ml (25 mg/

ml)................................................................................99methotrexate sodium inj pf 1000 mg/40ml (25 mg/



ml)................................................................................99methotrexate sodium tab 2.5 mg............................... 99methoxsalen rapid cap 10 mg....................................80methscopolamine bromide tab 2.5 mg......................85methscopolamine bromide tab 5 mg......................... 85methylergonovine maleate tab 0.2 mg......................89methylphenidate hcl tab 10 mg..................................77methylphenidate hcl tab 20 mg..................................77methylphenidate hcl tab 5 mg....................................77methylphenidate hcl tab er 20 mg............................. 77methylprednisolone sod succ for inj 1000

mg................................................................................90methylprednisolone sod succ for inj 125

mg................................................................................90methylprednisolone sod succ for inj 40

mg................................................................................90methylprednisolone tab 16 mg...................................90methylprednisolone tab 32 mg...................................90methylprednisolone tab 4 mg.....................................90

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methylprednisolone tab 8 mg.....................................90methylprednisolone tab therapy pack 4 mg

(21)..............................................................................90methyltestosterone cap 10 mg...................................92metoclopramide hcl inj 5 mg/ml................................. 86metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................86metoclopramide hcl tab 10 mg...................................86metoclopramide hcl tab 5 mg.....................................86metolazone tab 10 mg................................................ 70metolazone tab 2.5 mg............................................... 70metolazone tab 5 mg...................................................70metoprolol & hydrochlorothiazide tab 100-25

mg................................................................................70metoprolol & hydrochlorothiazide tab 50-25

mg................................................................................70metoprolol succinate tab er 24hr 100




mg................................................................................70metoprolol tartrate tab 100 mg...................................70metoprolol tartrate tab 25 mg.....................................70metoprolol tartrate tab 50 mg.....................................70METROGEL-VAGINAL................................................10METRONIDAZOLE...................................................... 10metronidazole cap 375 mg.........................................11metronidazole cream 0.75%.......................................80metronidazole gel 0.75%............................................ 80metronidazole gel 1%..................................................80metronidazole in nacl 0.79% iv soln 500

mg/100ml....................................................................11metronidazole iv soln 5 mg/ml................................... 11metronidazole lotion 0.75%........................................ 80metronidazole tab 250 mg..........................................11metronidazole tab 500 mg..........................................11metronidazole vaginal gel 0.75%...............................11mexiletine hcl cap 150 mg..........................................70mexiletine hcl cap 200 mg..........................................70mexiletine hcl cap 250 mg..........................................70MIACALCIN................................................................ 103MICARDIS.....................................................................70MICARDIS.....................................................................70MICARDIS.....................................................................70MICARDIS HCT........................................................... 70MICARDIS HCT........................................................... 70MICARDIS HCT........................................................... 70MICROZIDE.................................................................. 70midodrine hcl tab 10 mg............................................. 70

midodrine hcl tab 2.5 mg............................................ 70midodrine hcl tab 5 mg............................................... 70MIGERGOT...................................................................25miglitol tab 100 mg...................................................... 54miglitol tab 25 mg........................................................ 54miglitol tab 50 mg........................................................ 54miglustat cap 100 mg..................................................87MIGRANAL....................................................................25minocycline hcl cap 100 mg.......................................11minocycline hcl cap 50 mg......................................... 11minocycline hcl cap 75 mg......................................... 11minocycline hcl tab 100 mg........................................11minocycline hcl tab 50 mg..........................................11minocycline hcl tab 75 mg..........................................11minoxidil tab 10 mg..................................................... 70minoxidil tab 2.5 mg.................................................... 70mirtazapine orally disintegrating tab 15

mg................................................................................20mirtazapine orally disintegrating tab 30

mg................................................................................20mirtazapine orally disintegrating tab 45

mg................................................................................20mirtazapine tab 15 mg................................................ 20mirtazapine tab 30 mg................................................ 20mirtazapine tab 45 mg................................................ 20mirtazapine tab 7.5 mg............................................... 20misoprostol tab 100 mcg............................................ 86misoprostol tab 200 mcg............................................ 86mitomycin for iv soln 20 mg....................................... 33mitomycin for iv soln 40 mg....................................... 33mitomycin for iv soln 5 mg..........................................33mitoxantrone hcl inj conc 20 mg/10ml (2 mg/

ml)................................................................................33mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/

ml)................................................................................33mitoxantrone hcl inj conc 30 mg/15ml (2 mg/

ml)................................................................................33M-M-R II........................................................................ 99modafinil tab 100 mg.................................................111modafinil tab 200 mg.................................................111moexipril hcl tab 15 mg...............................................70moexipril hcl tab 7.5 mg..............................................70moexipril-hydrochlorothiazide tab 15-12.5

mg................................................................................70moexipril-hydrochlorothiazide tab 15-25

mg................................................................................70moexipril-hydrochlorothiazide tab 7.5-12.5

mg................................................................................70MOLINDONE HYDROCHLORIDE............................ 41MOLINDONE HYDROCHLORIDE............................ 41MOLINDONE HYDROCHLORIDE............................ 41mometasone furoate cream 0.1%............................. 80

2019

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mometasone furoate nasal susp 50 mcg/act..............................................................................109

mometasone furoate oint 0.1%..................................80mometasone furoate solution 0.1%

(lotion).........................................................................80MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.3ML/29G X 1/2".................................... 54MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.5ML/29G X 1/2".................................... 54MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/1ML/29G X 1/2"........................................54montelukast sodium chew tab 4 mg........................109montelukast sodium chew tab 5 mg........................109montelukast sodium oral granules packet 4

mg............................................................................. 109montelukast sodium tab 10 mg................................109MORPHINE 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...................................3morphine sulfate tab er 15 mg..................................... 3morphine sulfate tab er 200 mg...................................3morphine sulfate tab er 30 mg..................................... 3morphine sulfate tab er 60 mg..................................... 3MOVIPREP................................................................... 86MOXEZA..................................................................... 105MOXIFLOXACIN HCL................................................. 11moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................11moxifloxacin hcl ophth soln 0.5%............................ 105moxifloxacin hcl tab 400 mg.......................................11MOZOBIL...................................................................... 59MULTAQ........................................................................ 70mupirocin calcium cream 2%..................................... 80mupirocin oint 2%........................................................ 80MYALEPT...................................................................... 86MYCAMINE...................................................................24MYCAMINE...................................................................24mycophenolate mofetil cap 250 mg...........................99mycophenolate mofetil for oral susp 200 mg/

ml.................................................................................99mycophenolate mofetil hcl for iv soln 500

mg................................................................................99mycophenolate mofetil tab 500 mg......................... 100mycophenolate sodium tab dr 180

mg............................................................................. 100

mycophenolate sodium tab dr 360mg............................................................................. 100

MYLOTARG.................................................................. 33MYRBETRIQ.................................................................89MYRBETRIQ.................................................................89Nnabumetone tab 500 mg...............................................3nabumetone tab 750 mg...............................................3nadolol tab 20 mg........................................................70nadolol tab 40 mg........................................................70nadolol tab 80 mg........................................................70NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................11nafcillin sodium for inj 1 gm........................................11nafcillin sodium for inj 2 gm........................................11nafcillin sodium for iv soln 10 gm.............................. 11NAGLAZYME................................................................87NALOXONE HCL........................................................... 5NALOXONE HCL........................................................... 5naloxone hcl inj 0.4 mg/ml............................................5naloxone hcl inj 4 mg/10ml...........................................5naltrexone hcl tab 50 mg.............................................. 5naproxen sodium tab 275 mg.......................................3naproxen sodium tab 550 mg.......................................3naproxen sodium tab er 24hr 375 mg......................... 3naproxen sodium tab er 24hr 500 mg......................... 3naproxen susp 125 mg/5ml.......................................... 3naproxen tab 250 mg.................................................... 3naproxen tab 375 mg.................................................... 3naproxen tab 500 mg.................................................... 3naproxen tab ec 375 mg...............................................3naproxen tab ec 500 mg...............................................3naratriptan hcl tab 1 mg..............................................25naratriptan hcl tab 2.5 mg...........................................25NARCAN..........................................................................5NARDIL..........................................................................20NATACYN....................................................................105nateglinide tab 120 mg............................................... 54nateglinide tab 60 mg..................................................54NATPARA....................................................................103NATPARA....................................................................103NATPARA....................................................................103NATPARA....................................................................103NEBUPENT...................................................................37NEFAZODONE HCL....................................................20NEFAZODONE HCL....................................................20nefazodone hcl tab 250 mg........................................20nefazodone hcl tab 50 mg..........................................20NEFAZODONE HYDROCHLORIDE.........................20

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neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin........................105

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml...........................105

neomycin-polymyxin b gu irrigationsoln..............................................................................11

neomycin-polymyxin-dexamethasone ophth oint0.1%..........................................................................105

neomycin-polymyxin-dexamethasone ophth susp0.1%..........................................................................105

neomycin-polymyxin-hc otic soln 1%...................... 106neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%................................................................ 106neomycin sulfate tab 500 mg.....................................11NEPHRAMINE..............................................................83NERLYNX......................................................................33NEULASTA....................................................................59NEULASTA ONPRO KIT............................................ 59NEUPOGEN..................................................................59NEUPOGEN..................................................................59NEUPOGEN..................................................................59NEUPOGEN..................................................................59nevirapine susp 50 mg/5ml........................................ 46nevirapine tab 200 mg................................................ 46nevirapine tab er 24hr 100 mg...................................46nevirapine tab er 24hr 400 mg...................................46NEXAVAR......................................................................33NEXIUM.........................................................................86NEXIUM.........................................................................86NEXIUM.........................................................................86NEXIUM.........................................................................86NEXIUM.........................................................................86niacin tab er 1000 mg................................................. 71niacin tab er 500 mg................................................... 71niacin tab er 750 mg................................................... 71nicardipine hcl cap 20 mg...........................................71nicardipine hcl cap 30 mg...........................................71NICOTROL INHALER................................................... 5NICOTROL NS............................................................... 5nifedipine tab er 24hr 30 mg...................................... 71nifedipine tab er 24hr 60 mg...................................... 71nifedipine tab er 24hr 90 mg...................................... 71nifedipine tab er 24hr osmotic release 30

mg................................................................................71nifedipine tab er 24hr osmotic release 60

mg................................................................................71nifedipine tab er 24hr osmotic release 90

mg................................................................................71nilutamide tab 150 mg.................................................33nimodipine cap 30 mg.................................................71NINLARO.......................................................................33NINLARO.......................................................................33

NINLARO.......................................................................33NIPENT..........................................................................33NISOLDIPINE ER........................................................ 71nisoldipine tab er 24hr 17 mg.................................... 71nisoldipine tab er 24hr 34 mg.................................... 71nisoldipine tab er 24hr 8.5 mg................................... 71NITRO-BID....................................................................71nitrofurantoin macrocrystalline cap 100

mg................................................................................11nitrofurantoin macrocrystalline cap 50

mg................................................................................11nitrofurantoin monohydrate macrocrystalline cap 100

mg................................................................................11nitrofurantoin susp 25 mg/5ml....................................11nitroglycerin sl tab 0.3 mg.......................................... 71nitroglycerin sl tab 0.4 mg.......................................... 71nitroglycerin sl tab 0.6 mg.......................................... 71nitroglycerin td patch 24hr 0.1 mg/hr.........................71nitroglycerin td patch 24hr 0.2 mg/hr.........................71nitroglycerin td patch 24hr 0.4 mg/hr.........................71nitroglycerin td patch 24hr 0.6 mg/hr.........................71nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................71nizatidine cap 150 mg.................................................86nizatidine cap 300 mg.................................................86norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg.................................................................92norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg.................................................................92norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg..............................................................................92norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg..............................................................................92norethindrone & ethinyl estradiol tab 1 mg-35

mcg..............................................................................92norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg.................................................................92norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg..............................................................................92norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg..............................................................................92norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg..............................................................................92norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24).....................................................................92norethindrone acetate-ethinyl estradiol tab 1 mg-5

mcg..............................................................................92norethindrone acetate tab 5 mg.................................92norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg.......................................................................92norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg.......................................................................93

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norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35mg-mcg.......................................................................93

norethindrone tab 0.35 mg......................................... 93norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg..............................................................................93norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.........................93norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg.........................93norgestrel & ethinyl estradiol tab 0.3 mg-30

mcg..............................................................................93NORMOSOL-M IN D5W............................................. 83NORTHERA.................................................................. 71NORTHERA.................................................................. 71NORTHERA.................................................................. 71nortriptyline hcl cap 10 mg......................................... 20nortriptyline hcl cap 25 mg......................................... 20nortriptyline hcl cap 50 mg......................................... 20nortriptyline hcl cap 75 mg......................................... 20nortriptyline hcl soln 10 mg/5ml................................. 20NORVASC..................................................................... 71NORVASC..................................................................... 71NORVASC..................................................................... 71NORVIR.........................................................................46NORVIR.........................................................................46NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NUEDEXTA...................................................................77NULOJIX..................................................................... 100NULYTELY/FLAVOR PACKS..................................... 86NUPLAZID.....................................................................41NUPLAZID.....................................................................41NUPLAZID.....................................................................41nystatin cream 100000 unit/gm..................................24nystatin oint 100000 unit/gm...................................... 24nystatin susp 100000 unit/ml......................................24nystatin tab 500000 unit..............................................24nystatin topical powder 100000 unit/

gm................................................................................24nystatin-triamcinolone cream 100000-0.1 unit/gm-

%..................................................................................80nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................80OOCALIVA....................................................................... 88OCALIVA....................................................................... 88octreotide acetate inj 1000 mcg/ml (1 mg/

ml)................................................................................95octreotide acetate inj 100 mcg/ml (0.1 mg/

ml)................................................................................95

octreotide acetate inj 200 mcg/ml (0.2 mg/ml)................................................................................95



OCUFLOX...................................................................105ODEFSEY..................................................................... 46ODOMZO...................................................................... 33OFEV........................................................................... 109OFEV........................................................................... 109ofloxacin ophth soln 0.3%........................................ 105ofloxacin otic soln 0.3%............................................ 106ofloxacin tab 400 mg...................................................11olanzapine for im inj 10 mg........................................ 41olanzapine orally disintegrating tab 10

mg................................................................................41olanzapine orally disintegrating tab 15



mg................................................................................41olanzapine tab 10 mg..................................................41olanzapine tab 15 mg..................................................41olanzapine tab 2.5 mg.................................................41olanzapine tab 20 mg..................................................41olanzapine tab 5 mg....................................................41olanzapine tab 7.5 mg.................................................41olmesartan-amlodipine-hydrochlorothiazide tab

20-5-12.5 mg............................................................. 71olmesartan-amlodipine-hydrochlorothiazide tab

40-10-12.5 mg...........................................................72olmesartan-amlodipine-hydrochlorothiazide tab

40-10-25 mg.............................................................. 72olmesartan-amlodipine-hydrochlorothiazide tab

40-5-12.5 mg............................................................. 72olmesartan-amlodipine-hydrochlorothiazide tab

40-5-25 mg................................................................ 72olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................71olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................71olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg....................................................................71olmesartan medoxomil tab 20 mg............................. 71olmesartan medoxomil tab 40 mg............................. 71olmesartan medoxomil tab 5 mg............................... 71olopatadine hcl nasal soln 0.6%..............................109olopatadine hcl ophth soln 0.1%..............................105olopatadine hcl ophth soln 0.2%..............................105omega-3-acid ethyl esters cap 1 gm.........................72

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omeprazole cap delayed release 10mg................................................................................86



OMNIPRED.................................................................105OMNITROPE................................................................ 91OMNITROPE................................................................ 91OMNITROPE................................................................ 91ONCASPAR.................................................................. 33ondansetron hcl inj 40 mg/20ml (2 mg/

ml)................................................................................22ondansetron hcl inj 4 mg/2ml (2 mg/

ml)................................................................................22ondansetron hcl oral soln 4 mg/5ml.......................... 22ondansetron hcl tab 24 mg.........................................22ondansetron hcl tab 4 mg...........................................22ondansetron hcl tab 8 mg...........................................22ondansetron orally disintegrating tab 4

mg................................................................................22ondansetron orally disintegrating tab 8

mg................................................................................22ONFI...............................................................................15ONFI...............................................................................15ONFI...............................................................................15ONGLYZA......................................................................54ONGLYZA......................................................................54ONIVYDE...................................................................... 33OPDIVO.........................................................................33OPDIVO.........................................................................33OPDIVO.........................................................................33OPSUMIT....................................................................109ORACEA........................................................................80ORALAIR.....................................................................109ORENCIA....................................................................100ORENCIA....................................................................100ORENCIA....................................................................100ORENCIA....................................................................100ORENCIA CLICKJECT............................................. 100ORFADIN.......................................................................88ORFADIN.......................................................................88ORFADIN.......................................................................88ORFADIN.......................................................................88ORFADIN.......................................................................88ORKAMBI....................................................................109ORKAMBI....................................................................109ORKAMBI....................................................................109ORKAMBI....................................................................109oseltamivir phosphate cap 30 mg..............................46oseltamivir phosphate cap 45 mg..............................46oseltamivir phosphate cap 75 mg..............................46

oseltamivir phosphate for susp 6 mg/ml.................................................................................46

OTEZLA.......................................................................100OTEZLA.......................................................................100oxaliplatin for iv inj 100 mg.........................................34oxaliplatin for iv inj 50 mg...........................................33oxaliplatin iv soln 100 mg/20ml..................................34oxaliplatin iv soln 50 mg/10ml....................................34oxandrolone tab 10 mg............................................... 93oxandrolone tab 2.5 mg..............................................93oxaprozin tab 600 mg....................................................3oxcarbazepine susp 300 mg/5ml (60 mg/

ml)................................................................................15oxcarbazepine tab 150 mg.........................................15oxcarbazepine tab 300 mg.........................................16oxcarbazepine tab 600 mg.........................................16oxybutynin chloride syrup 5 mg/5ml..........................89oxybutynin chloride tab 5 mg..................................... 89oxybutynin chloride tab er 24hr 10 mg......................89oxybutynin chloride tab er 24hr 15 mg......................89oxybutynin chloride tab er 24hr 5 mg........................89oxycodone-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..................................................................................4OZEMPIC...................................................................... 55OZEMPIC...................................................................... 55Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................34paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................34paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................34paliperidone tab er 24hr 1.5 mg.................................41paliperidone tab er 24hr 3 mg....................................41paliperidone tab er 24hr 6 mg....................................41paliperidone tab er 24hr 9 mg....................................41palonosetron hcl iv soln 0.25 mg/5ml........................22PALONOSETRON

HYDROCHLORIDE.................................................. 22

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PALONOSETRONHYDROCHLORIDE.................................................. 22

PALYNZIQ..................................................................... 88PALYNZIQ..................................................................... 88PALYNZIQ..................................................................... 88PANRETIN.....................................................................34pantoprazole sodium ec tab 20 mg........................... 86pantoprazole sodium ec tab 40 mg........................... 86pantoprazole sodium for iv soln 40 mg..................... 86paricalcitol cap 1 mcg............................................... 103paricalcitol cap 2 mcg............................................... 103paricalcitol cap 4 mcg............................................... 103paricalcitol iv soln 2 mcg/ml..................................... 103paricalcitol iv soln 5 mcg/ml..................................... 103PARNATE...................................................................... 20paromomycin sulfate cap 250 mg..............................11paroxetine hcl tab 10 mg............................................ 20paroxetine hcl tab 20 mg............................................ 20paroxetine hcl tab 30 mg............................................ 20paroxetine hcl tab 40 mg............................................ 20PASER........................................................................... 26PAXIL............................................................................. 20PAXIL............................................................................. 20PAXIL............................................................................. 20PAXIL............................................................................. 20PAXIL............................................................................. 20PAZEO.........................................................................105PEDIARIX....................................................................100PEDVAX HIB.............................................................. 100peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................86peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................86peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................86PEGANONE..................................................................16PEGASYS..................................................................... 46PEGASYS..................................................................... 46PEGASYS PROCLICK................................................46PEGASYS PROCLICK................................................46penicillin g potassium for inj 20000000

unit...............................................................................11penicillin g potassium for inj 5000000

unit...............................................................................11PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 11PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 11PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 11PENICILLIN G SODIUM............................................. 11

penicillin v potassium for soln 125mg/5ml........................................................................ 11

penicillin v potassium for soln 250mg/5ml........................................................................ 12

penicillin v potassium tab 250 mg............................. 12penicillin v potassium tab 500 mg............................. 12PENTACEL................................................................. 100PENTAM 300................................................................37PENTASA....................................................................102PENTASA....................................................................102pentoxifylline tab er 400 mg....................................... 72perindopril erbumine tab 2 mg................................... 72perindopril erbumine tab 4 mg................................... 72perindopril erbumine tab 8 mg................................... 72PERJETA.......................................................................34permethrin cream 5%..................................................37perphenazine tab 16 mg.............................................22perphenazine tab 2 mg............................................... 22perphenazine tab 4 mg............................................... 22perphenazine tab 8 mg............................................... 22PERSERIS.................................................................... 41PERSERIS.................................................................... 41phenelzine sulfate tab 15 mg.....................................20phenobarbital elixir 20 mg/5ml...................................16PHENOBARBITAL SODIUM...................................... 16PHENOBARBITAL SODIUM...................................... 16phenobarbital tab 100 mg...........................................16phenobarbital tab 15 mg.............................................16phenobarbital tab 16.2 mg..........................................16phenobarbital tab 30 mg.............................................16phenobarbital tab 32.4 mg..........................................16phenobarbital tab 60 mg.............................................16phenobarbital tab 64.8 mg..........................................16phenobarbital tab 97.2 mg..........................................16phenoxybenzamine hcl cap 10 mg............................72phenytoin chew tab 50 mg......................................... 16phenytoin sodium extended cap 100

mg................................................................................16phenytoin sodium extended cap 200

mg................................................................................16phenytoin sodium extended cap 300

mg................................................................................16phenytoin susp 125 mg/5ml....................................... 16PHOSLYRA...................................................................83PHOSPHOLINE IODIDE.......................................... 105PICATO..........................................................................80PICATO..........................................................................80PIFELTRO..................................................................... 46pilocarpine hcl ophth soln 1%..................................105pilocarpine hcl ophth soln 2%..................................105pilocarpine hcl ophth soln 4%..................................105pilocarpine hcl tab 5 mg..............................................78

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pilocarpine hcl tab 7.5 mg.......................................... 78pimecrolimus cream 1%..............................................80pimozide tab 1 mg....................................................... 41pimozide tab 2 mg....................................................... 41pindolol tab 10 mg....................................................... 72pindolol tab 5 mg......................................................... 72pioglitazone hcl-glimepiride tab 30-2

mg................................................................................55pioglitazone hcl-glimepiride tab 30-4

mg................................................................................55pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................55pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................55pioglitazone hcl tab 15 mg..........................................55pioglitazone hcl tab 30 mg..........................................55pioglitazone hcl tab 45 mg..........................................55piperacillin sod-tazobactam na for inj 3.375 gm

(3-0.375 gm)..............................................................12piperacillin sod-tazobactam sod for inj 2.25 gm

(2-0.25 gm)................................................................ 12piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5

gm).............................................................................. 12piroxicam cap 10 mg..................................................... 4piroxicam cap 20 mg..................................................... 4PLEGRIDY.................................................................... 77PLEGRIDY.................................................................... 78PLEGRIDY STARTER PACK..................................... 78PLEGRIDY STARTER PACK..................................... 78podofilox soln 0.5%..................................................... 80polyethylene glycol 3350 oral packet........................ 86polyethylene glycol 3350 oral powder.......................86polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%.................................................................... 105POLYTRIM.................................................................. 105POMALYST...................................................................34POMALYST...................................................................34POMALYST...................................................................34POMALYST...................................................................34PORTRAZZA................................................................ 34POTASSIUM CHLORIDE/DEXTROSE.....................84POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................84POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................84potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 84potassium chloride cap er 10 meq............................ 83potassium chloride cap er 8 meq...............................83POTASSIUM CHLORIDE ER.....................................83potassium chloride inj 2 meq/ml................................ 83

potassium chloride microencapsulated crys er tab 10meq............................................................................. 84

potassium chloride microencapsulated crys er tab 20meq............................................................................. 84

potassium chloride oral soln 10% (20meq/15ml).................................................................. 84

potassium chloride tab er 10 meq............................. 84potassium chloride tab er 8 meq (600

mg).............................................................................. 84potassium citrate tab er 10 meq (1080



mg).............................................................................. 84POTELIGEO................................................................. 34PRADAXA..................................................................... 59PRADAXA..................................................................... 59PRADAXA..................................................................... 59pramipexole dihydrochloride tab 0.125

mg................................................................................38pramipexole dihydrochloride tab 0.25




mg................................................................................38pramipexole dihydrochloride tab 1 mg...................... 38prasugrel hcl tab 10 mg..............................................59prasugrel hcl tab 5 mg................................................ 59PRAVACHOL................................................................ 72PRAVACHOL................................................................ 72PRAVACHOL................................................................ 72pravastatin sodium tab 10 mg....................................72pravastatin sodium tab 20 mg....................................72pravastatin sodium tab 40 mg....................................72pravastatin sodium tab 80 mg....................................72praziquantel tab 600 mg............................................. 37prazosin hcl cap 1 mg.................................................72prazosin hcl cap 2 mg.................................................72prazosin hcl cap 5 mg.................................................72PRECOSE.....................................................................55PRECOSE.....................................................................55PRECOSE.....................................................................55PRED FORTE............................................................ 105prednicarbate cream 0.1%......................................... 81prednicarbate oint 0.1%..............................................81prednisolone acetate ophth susp 1%......................105prednisolone sod phosphate oral soln 10

mg/5ml........................................................................ 90

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prednisolone sod phosphate oral soln 15mg/5ml........................................................................ 90

prednisolone sod phosphate oral soln 20mg/5ml........................................................................ 90

prednisolone sod phosph oral soln 6.7 mg/5ml (5mg/5ml base).............................................................90

prednisolone syrup 15 mg/5ml...................................90PREDNISONE.............................................................. 90PREDNISONE.............................................................. 90PREDNISONE.............................................................. 90PREDNISONE.............................................................. 90PREDNISONE.............................................................. 90PREDNISONE.............................................................. 90prednisone tab 10 mg................................................. 90prednisone tab 1 mg................................................... 90prednisone tab 2.5 mg................................................ 90prednisone tab 20 mg................................................. 90prednisone tab 5 mg................................................... 90PREGNYL W/DILUENT BENZYL ALCOHOL/

NACL.......................................................................... 91PREMARIN................................................................... 93PREMASOL.................................................................. 84PREMPHASE............................................................... 93PREMPRO.................................................................... 93PREMPRO.................................................................... 93PREMPRO.................................................................... 93PREMPRO.................................................................... 93PREVYMIS....................................................................46PREVYMIS....................................................................46PREZCOBIX................................................................. 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PREZISTA..................................................................... 46PRIFTIN.........................................................................26PRIMAQUINE PHOSPHATE......................................37primidone tab 250 mg................................................. 16primidone tab 50 mg................................................... 16PRINIVIL........................................................................72PRINIVIL........................................................................72PRINIVIL........................................................................72PROAIR HFA..............................................................109PROAIR RESPICLICK..............................................109probenecid tab 500 mg............................................... 24PROCALAMINE........................................................... 84PROCARDIA XL.......................................................... 72PROCARDIA XL.......................................................... 72PROCARDIA XL.......................................................... 72prochlorperazine edisylate inj 5 mg/ml......................23prochlorperazine maleate tab 10 mg.........................23prochlorperazine maleate tab 5 mg...........................23

prochlorperazine suppos 25 mg................................ 23PROCRIT...................................................................... 59PROCRIT...................................................................... 59PROCRIT...................................................................... 59PROCRIT...................................................................... 59PROCRIT...................................................................... 59PROCRIT...................................................................... 60progesterone micronized cap 100 mg.......................93progesterone micronized cap 200 mg.......................93PROGLYCEM............................................................... 55PROGRAF.................................................................. 100PROLASTIN-C..............................................................88PROLASTIN-C..............................................................88PROLENSA................................................................ 105PROLEUKIN................................................................. 34PROLIA........................................................................103PROMACTA.................................................................. 60PROMACTA.................................................................. 60PROMACTA.................................................................. 60PROMACTA.................................................................. 60PROMACTA.................................................................. 60promethazine hcl suppos 12.5 mg............................ 23promethazine hcl suppos 25 mg................................23promethazine hcl syrup 6.25 mg/5ml........................ 23promethazine hcl tab 12.5 mg....................................23promethazine hcl tab 25 mg.......................................23promethazine hcl tab 50 mg.......................................23propafenone hcl cap er 12hr 225 mg........................ 72propafenone hcl cap er 12hr 325 mg........................ 72propafenone hcl cap er 12hr 425 mg........................ 72propafenone hcl tab 150 mg...................................... 72propafenone hcl tab 225 mg...................................... 72propafenone hcl tab 300 mg...................................... 72propranolol hcl cap er 24hr 120 mg.......................... 72propranolol hcl cap er 24hr 160 mg.......................... 72propranolol hcl cap er 24hr 60 mg.............................72propranolol hcl cap er 24hr 80 mg.............................72propranolol hcl inj 1 mg/ml......................................... 73propranolol hcl tab 10 mg...........................................73propranolol hcl tab 20 mg...........................................73propranolol hcl tab 40 mg...........................................73propranolol hcl tab 60 mg...........................................73propranolol hcl tab 80 mg...........................................73propylthiouracil tab 50 mg.......................................... 96PROQUAD.................................................................. 100PROSCAR.....................................................................89PROSOL........................................................................84protriptyline hcl tab 10 mg.......................................... 20protriptyline hcl tab 5 mg............................................ 20PROZAC........................................................................20PROZAC........................................................................20PROZAC........................................................................20

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PULMOZYME.............................................................109PURIXAN.......................................................................34PYLERA.........................................................................86pyrazinamide tab 500 mg........................................... 26pyridostigmine bromide tab 60 mg............................ 26pyridostigmine bromide tab er 180 mg......................26QQUADRACEL............................................................. 100quetiapine fumarate tab 100 mg................................42quetiapine fumarate tab 200 mg................................42quetiapine fumarate tab 25 mg..................................42quetiapine fumarate tab 300 mg................................42quetiapine fumarate tab 400 mg................................42quetiapine fumarate tab 50 mg..................................42quetiapine fumarate tab er 24hr 150

mg................................................................................41quetiapine fumarate tab er 24hr 200



mg................................................................................41quetiapine fumarate tab er 24hr 50 mg.....................41quinapril hcl tab 10 mg............................................... 73quinapril hcl tab 20 mg............................................... 73quinapril hcl tab 40 mg............................................... 73quinapril hcl tab 5 mg..................................................73quinapril-hydrochlorothiazide tab 10-12.5

mg................................................................................73quinapril-hydrochlorothiazide tab 20-12.5

mg................................................................................73quinapril-hydrochlorothiazide tab 20-25

mg................................................................................73quinidine gluconate tab er 324 mg............................ 73QUINIDINE SULFATE................................................. 73QUINIDINE SULFATE................................................. 73QVAR REDIHALER................................................... 109QVAR REDIHALER................................................... 109RRABAVERT................................................................. 100raloxifene hcl tab 60 mg............................................. 93ramipril cap 1.25 mg....................................................73ramipril cap 10 mg.......................................................73ramipril cap 2.5 mg......................................................73ramipril cap 5 mg.........................................................73RANEXA........................................................................73RANEXA........................................................................73ranitidine hcl cap 150 mg........................................... 86ranitidine hcl cap 300 mg........................................... 86ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................86

ranitidine hcl tab 150 mg............................................ 86ranitidine hcl tab 300 mg............................................ 87RAPAFLO...................................................................... 89RAPAFLO...................................................................... 89RAPAMUNE................................................................100rasagiline mesylate tab 0.5 mg.................................. 38rasagiline mesylate tab 1 mg..................................... 38REBETOL......................................................................46RECOMBIVAX HB..................................................... 100RECOMBIVAX HB..................................................... 100RECOMBIVAX HB..................................................... 100REGRANEX.................................................................. 81RELENZA DISKHALER.............................................. 46RELISTOR.....................................................................87RELISTOR.....................................................................87RELISTOR.....................................................................87REMERON....................................................................21REMERON....................................................................21REMERON SOLTAB....................................................21REMERON SOLTAB....................................................21REMERON SOLTAB....................................................21REMODULIN.............................................................. 109REMODULIN.............................................................. 109REMODULIN.............................................................. 109REMODULIN.............................................................. 109RENFLEXIS................................................................ 100repaglinide tab 0.5 mg................................................ 55repaglinide tab 1 mg....................................................55repaglinide tab 2 mg....................................................55REPATHA...................................................................... 73REPATHA PUSHTRONEX SYSTEM........................73REPATHA SURECLICK.............................................. 73RESCRIPTOR.............................................................. 46RESCRIPTOR.............................................................. 46RESTASIS...................................................................105RESTASIS MULTIDOSE...........................................105RETACRIT.....................................................................60RETACRIT.....................................................................60RETACRIT.....................................................................60RETACRIT.....................................................................60RETACRIT.....................................................................60RETROVIR IV INFUSION...........................................46REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REVLIMID......................................................................34REXULTI........................................................................42REXULTI........................................................................42REXULTI........................................................................42REXULTI........................................................................42

2019

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REXULTI........................................................................42REXULTI........................................................................42REYATAZ.......................................................................46REYATAZ.......................................................................46REYATAZ.......................................................................46REYATAZ.......................................................................47RIBASPHERE...............................................................47RIBASPHERE...............................................................47RIBASPHERE RIBAPAK.............................................47RIBASPHERE RIBAPAK.............................................47ribavirin cap 200 mg....................................................47ribavirin for inhal soln 6 gm......................................109ribavirin tab 200 mg.....................................................47RIDAURA.................................................................... 100rifabutin cap 150 mg....................................................26rifampin cap 150 mg....................................................26rifampin cap 300 mg....................................................26rifampin for inj 600 mg................................................ 26riluzole tab 50 mg........................................................ 78risedronate sodium tab 150 mg...............................103risedronate sodium tab 30 mg................................. 103risedronate sodium tab 35 mg................................. 103risedronate sodium tab 5 mg................................... 103risedronate sodium tab delayed release 35

mg............................................................................. 103RISPERDAL CONSTA................................................ 42RISPERDAL CONSTA................................................ 42RISPERDAL CONSTA................................................ 42RISPERDAL CONSTA................................................ 42risperidone orally disintegrating tab 0.25

mg................................................................................42risperidone orally disintegrating tab 0.5

mg................................................................................42risperidone orally disintegrating tab 1




mg................................................................................42risperidone soln 1 mg/ml............................................ 42risperidone tab 0.25 mg..............................................42risperidone tab 0.5 mg................................................ 42risperidone tab 1 mg................................................... 42risperidone tab 2 mg................................................... 42risperidone tab 3 mg................................................... 42risperidone tab 4 mg................................................... 42ritonavir tab 100 mg.................................................... 47RITUXAN.......................................................................34RITUXAN.......................................................................34RITUXAN HYCELA......................................................34

RITUXAN HYCELA......................................................34rivastigmine tartrate cap 1.5 mg................................ 17rivastigmine tartrate cap 3 mg....................................17rivastigmine tartrate cap 4.5 mg................................ 17rivastigmine tartrate cap 6 mg....................................17rivastigmine td patch 24hr 13.3

mg/24hr...................................................................... 17rivastigmine td patch 24hr 4.6 mg/24hr.....................17rivastigmine td patch 24hr 9.5 mg/24hr.....................17rizatriptan benzoate oral disintegrating tab 10

mg................................................................................25rizatriptan benzoate oral disintegrating tab 5

mg................................................................................25rizatriptan benzoate tab 10 mg.................................. 25rizatriptan benzoate tab 5 mg.................................... 25ropinirole hydrochloride tab 0.25 mg.........................38ropinirole hydrochloride tab 0.5 mg...........................38ropinirole hydrochloride tab 1 mg.............................. 38ropinirole hydrochloride tab 2 mg.............................. 38ropinirole hydrochloride tab 3 mg.............................. 38ropinirole hydrochloride tab 4 mg.............................. 38ropinirole hydrochloride tab 5 mg.............................. 38rosuvastatin calcium tab 10 mg................................. 73rosuvastatin calcium tab 20 mg................................. 73rosuvastatin calcium tab 40 mg................................. 73rosuvastatin calcium tab 5 mg................................... 73ROTARIX.....................................................................100ROTATEQ....................................................................100RUBRACA.....................................................................34RUBRACA.....................................................................34RUBRACA.....................................................................34RYDAPT........................................................................ 34SSABRIL.......................................................................... 16SAFETY INSULIN SYRINGES 1ML/30G X

1/2".............................................................................. 55SAMSCA........................................................................84SAMSCA........................................................................84SANDIMMUNE...........................................................100SANTYL.........................................................................81SAPHRIS.......................................................................42SAPHRIS.......................................................................42SAPHRIS.......................................................................42scopolamine td patch 72hr 1 mg/3days.................... 23selegiline hcl cap 5 mg............................................... 39selegiline hcl tab 5 mg................................................ 39selenium sulfide lotion 2.5%.......................................81SELZENTRY.................................................................47SELZENTRY.................................................................47SELZENTRY.................................................................47SELZENTRY.................................................................47

2019

148

SELZENTRY.................................................................47SENSIPAR.................................................................. 103SENSIPAR.................................................................. 103SENSIPAR.................................................................. 103SEREVENT DISKUS.................................................109sertraline hcl oral concentrate for solution 20 mg/

ml.................................................................................21sertraline hcl tab 100 mg............................................ 21sertraline hcl tab 25 mg.............................................. 21sertraline hcl tab 50 mg.............................................. 21sevelamer carbonate packet 0.8 gm......................... 84sevelamer carbonate packet 2.4 gm......................... 84sevelamer carbonate tab 800 mg..............................84SHINGRIX...................................................................100SIGNIFOR..................................................................... 95SIGNIFOR..................................................................... 95SIGNIFOR..................................................................... 95SIGNIFOR LAR............................................................95SIGNIFOR LAR............................................................95SIGNIFOR LAR............................................................95SIGNIFOR LAR............................................................95SIGNIFOR LAR............................................................95sildenafil citrate tab 20 mg....................................... 109SILENOR.....................................................................111SILENOR.....................................................................111silodosin cap 4 mg.......................................................89silodosin cap 8 mg.......................................................89silver sulfadiazine cream 1%......................................81SIMBRINZA................................................................ 105SIMULECT.................................................................. 101SIMULECT.................................................................. 101simvastatin tab 10 mg.................................................73simvastatin tab 20 mg.................................................73simvastatin tab 40 mg.................................................73simvastatin tab 5 mg................................................... 73simvastatin tab 80 mg.................................................73sirolimus tab 0.5 mg..................................................101sirolimus tab 1 mg..................................................... 101sirolimus tab 2 mg..................................................... 101SIRTURO.......................................................................26SIVEXTRO.................................................................... 12SIVEXTRO.................................................................... 12sodium chloride inj 0.45%...........................................84sodium chloride irrigation soln 0.9%......................... 84sodium chloride iv soln 0.9%..................................... 84sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................88sodium phenylbutyrate tab 500 mg........................... 88sodium polystyrene sulfonate oral susp 15

gm/60ml......................................................................84sodium polystyrene sulfonate powder.......................84

sodium polystyrene sulfonate rectal susp 30gm/120ml....................................................................84

SOLTAMOX...................................................................34SOMATULINE DEPOT................................................95SOMATULINE DEPOT................................................95SOMATULINE DEPOT................................................95SOMAVERT.................................................................. 96SOMAVERT.................................................................. 96SOMAVERT.................................................................. 96SOMAVERT.................................................................. 96SOMAVERT.................................................................. 96SOOLANTRA................................................................81sotalol hcl (afib/afl) tab 120 mg..................................73sotalol hcl (afib/afl) tab 160 mg..................................74sotalol hcl (afib/afl) tab 80 mg....................................73sotalol hcl tab 120 mg.................................................74sotalol hcl tab 160 mg.................................................74sotalol hcl tab 240 mg.................................................74sotalol hcl tab 80 mg...................................................74SOVALDI....................................................................... 47SPIRIVA HANDIHALER............................................109SPIRIVA RESPIMAT................................................. 109SPIRIVA RESPIMAT................................................. 109spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................74spironolactone tab 100 mg.........................................74spironolactone tab 25 mg........................................... 74spironolactone tab 50 mg........................................... 74SPRITAM.......................................................................16SPRITAM.......................................................................16SPRITAM.......................................................................16SPRITAM.......................................................................16SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................34SPRYCEL......................................................................35STAMARIL...................................................................101STARLIX........................................................................ 55STARLIX........................................................................ 55stavudine cap 15 mg...................................................47stavudine cap 20 mg...................................................47stavudine cap 30 mg...................................................47stavudine cap 40 mg...................................................47STELARA....................................................................101STELARA....................................................................101STELARA....................................................................101STELARA....................................................................101STIMATE....................................................................... 91STIOLTO RESPIMAT................................................ 109STIVARGA.....................................................................35

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STRENSIQ....................................................................88STRENSIQ....................................................................88STRENSIQ....................................................................88STRENSIQ....................................................................88STREPTOMYCIN SULFATE...................................... 12STRIBILD...................................................................... 47SUBOXONE....................................................................5SUBOXONE....................................................................5SUBOXONE....................................................................5SUBOXONE....................................................................5sucralfate tab 1 gm......................................................87sulfacetamide sodium lotion 10%.............................. 12sulfacetamide sodium ophth soln

10%...........................................................................105sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%....................................................... 105SULFADIAZINE............................................................ 12sulfamethoxazole-trimethoprim iv soln 400-80

mg/5ml........................................................................ 12sulfamethoxazole-trimethoprim susp 200-40

mg/5ml........................................................................ 12sulfamethoxazole-trimethoprim tab 400-80

mg................................................................................12sulfamethoxazole-trimethoprim tab 800-160

mg................................................................................12sulfasalazine tab 500 mg..........................................102sulfasalazine tab delayed release 500

mg............................................................................. 102sulindac tab 150 mg...................................................... 4sulindac tab 200 mg...................................................... 4sumatriptan nasal spray 20 mg/act........................... 25sumatriptan nasal spray 5 mg/act..............................25SUMATRIPTAN SUCCINATE.....................................25sumatriptan succinate inj 6 mg/0.5ml........................25sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................25sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................26sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................26sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................26sumatriptan succinate tab 100 mg............................ 26sumatriptan succinate tab 25 mg...............................26sumatriptan succinate tab 50 mg...............................26SUPRAX........................................................................12SUPRAX........................................................................12SUPRAX........................................................................12SUPREP BOWEL PREP KIT.....................................87SUSTIVA........................................................................47SUSTIVA........................................................................47SUTENT........................................................................ 35

SUTENT........................................................................ 35SUTENT........................................................................ 35SUTENT........................................................................ 35SYLATRON................................................................... 47SYLATRON................................................................... 47SYLATRON................................................................... 47SYLVANT.....................................................................101SYLVANT.....................................................................101SYMBICORT...............................................................110SYMBICORT...............................................................110SYMDEKO.................................................................. 110SYMFI............................................................................ 47SYMFI LO..................................................................... 47SYMLINPEN 120......................................................... 55SYMLINPEN 60............................................................55SYMTUZA..................................................................... 47SYNAGIS.................................................................... 101SYNAGIS.................................................................... 101SYNAREL......................................................................96SYNERCID....................................................................12SYNJARDY................................................................... 55SYNJARDY................................................................... 55SYNJARDY................................................................... 55SYNJARDY................................................................... 55SYNJARDY XR............................................................ 55SYNJARDY XR............................................................ 55SYNJARDY XR............................................................ 55SYNJARDY XR............................................................ 55SYNRIBO...................................................................... 35SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94SYNTHROID.................................................................94TTABLOID........................................................................35tacrolimus cap 0.5 mg...............................................101tacrolimus cap 1 mg..................................................101tacrolimus cap 5 mg..................................................101tacrolimus oint 0.03%..................................................81tacrolimus oint 0.1%.................................................... 81tadalafil tab 20 mg (pah)...........................................110TAFINLAR..................................................................... 35TAFINLAR..................................................................... 35TAGRISSO.................................................................... 35

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TAGRISSO.................................................................... 35TALZENNA....................................................................35TALZENNA....................................................................35TAMIFLU........................................................................47tamoxifen citrate tab 10 mg........................................35tamoxifen citrate tab 20 mg........................................35tamsulosin hcl cap 0.4 mg..........................................89TARCEVA...................................................................... 35TARCEVA...................................................................... 35TARCEVA...................................................................... 35TARGRETIN..................................................................35TASIGNA....................................................................... 35TASIGNA....................................................................... 35TASIGNA....................................................................... 35tazarotene cream 0.1%...............................................81TAZICEF........................................................................ 12TAZORAC......................................................................81TAZORAC......................................................................81TAZORAC......................................................................81TECENTRIQ................................................................. 35TECFIDERA..................................................................78TECFIDERA..................................................................78TECFIDERA STARTER PACK...................................78TECHLITE INSULIN SYRINGE U-100/0.3ML/29G X

1/2".............................................................................. 55TECHLITE INSULIN SYRINGE U-100/0.3ML/30G X


5/16"............................................................................55TECHLITE INSULIN SYRINGE U-100/0.3ML/31G X

15/64"..........................................................................55TECHLITE INSULIN SYRINGE U-100/0.3ML/31G X





15/64"..........................................................................56TECHLITE INSULIN SYRINGE U-100/0.5ML/31G X

5/16"............................................................................56TECHLITE INSULIN SYRINGE U-100/1ML/29G X

1/2".............................................................................. 56TECHLITE INSULIN SYRINGE U-100/1ML/30G X

1/2".............................................................................. 56TECHLITE INSULIN SYRINGE U-100/1ML/30G X

5/16"............................................................................56TECHLITE INSULIN SYRINGE U-100/1ML/31G X

15/64"..........................................................................56

TECHLITE INSULIN SYRINGE U-100/1ML/31G X5/16"............................................................................56

TECHLITE PEN NEEDLES/31G X6MM............................................................................ 56





TECHLITE PEN NEEDLES 29G X10MM..........................................................................56

TECHLITE PEN NEEDLES 29G X12MM..........................................................................56

TECHLITE PEN NEEDLES 31G X5MM............................................................................ 56

TECHNIVIE................................................................... 47TEFLARO......................................................................12TEFLARO......................................................................12TEKTURNA...................................................................74TEKTURNA...................................................................74TEKTURNA HCT......................................................... 74TEKTURNA HCT......................................................... 74TEKTURNA HCT......................................................... 74TEKTURNA HCT......................................................... 74telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................74telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................74telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................74telmisartan tab 20 mg................................................. 74telmisartan tab 40 mg................................................. 74telmisartan tab 80 mg................................................. 74temazepam cap 15 mg............................................. 111temazepam cap 30 mg............................................. 111TEMODAR.................................................................... 35temsirolimus soln for iv infusion 25 mg/

ml.................................................................................35TENCON..........................................................................4TENIVAC..................................................................... 101tenofovir disoproxil fumarate tab 300

mg................................................................................47terazosin hcl cap 10 mg..............................................74terazosin hcl cap 1 mg................................................74terazosin hcl cap 2 mg................................................74terazosin hcl cap 5 mg................................................74terbinafine hcl tab 250 mg..........................................24terbutaline sulfate tab 2.5 mg.................................. 110terbutaline sulfate tab 5 mg......................................110

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terconazole vaginal cream 0.4%................................24terconazole vaginal cream 0.8%................................24terconazole vaginal suppos 80 mg............................24testosterone cypionate im inj in oil 100 mg/

ml.................................................................................93testosterone cypionate im inj in oil 200 mg/

ml.................................................................................93testosterone enanthate im inj in oil 200 mg/

ml.................................................................................93testosterone td gel 12.5 mg/act (1%)........................ 93testosterone td gel 20.25 mg/1.25gm

(1.62%)....................................................................... 93testosterone td gel 20.25 mg/act

(1.62%)....................................................................... 93testosterone td gel 25 mg/2.5gm (1%)......................93testosterone td gel 40.5 mg/2.5gm

(1.62%)....................................................................... 93testosterone td gel 50 mg/5gm (1%).........................93testosterone td soln 30 mg/act...................................93TETANUS/DIPHTHERIA TOXOIDS

ADSORBED.............................................................101tetrabenazine tab 12.5 mg..........................................78tetrabenazine tab 25 mg.............................................78tetracycline hcl cap 250 mg........................................12tetracycline hcl cap 500 mg........................................12THALOMID....................................................................35THALOMID....................................................................35THALOMID....................................................................35THALOMID....................................................................35theophylline tab er 12hr 100 mg..............................110theophylline tab er 12hr 200 mg..............................110theophylline tab er 12hr 300 mg..............................110theophylline tab er 12hr 450 mg..............................110theophylline tab er 24hr 400 mg..............................110theophylline tab er 24hr 600 mg..............................110thioridazine hcl tab 100 mg........................................ 42thioridazine hcl tab 10 mg.......................................... 42thioridazine hcl tab 25 mg.......................................... 42thioridazine hcl tab 50 mg.......................................... 42thiotepa for inj 15 mg.................................................. 35thiothixene cap 10 mg.................................................43thiothixene cap 1 mg...................................................42thiothixene cap 2 mg...................................................42thiothixene cap 5 mg...................................................43THYMOGLOBULIN....................................................101tiagabine hcl tab 12 mg.............................................. 16tiagabine hcl tab 16 mg.............................................. 16tiagabine hcl tab 2 mg.................................................16tiagabine hcl tab 4 mg.................................................16TIAZAC.......................................................................... 74TIAZAC.......................................................................... 74TIAZAC.......................................................................... 74

TIAZAC.......................................................................... 74TIAZAC.......................................................................... 74TIAZAC.......................................................................... 74TIBSOVO.......................................................................35tigecycline for iv soln 50 mg.......................................12TIMOLOL MALEATE................................................... 74TIMOLOL MALEATE................................................... 74TIMOLOL MALEATE................................................... 75timolol maleate ophth gel forming soln

0.25%........................................................................105timolol maleate ophth gel forming soln

0.5%..........................................................................105timolol maleate ophth soln 0.25%........................... 105timolol maleate ophth soln 0.5%..............................105timolol maleate ophth soln 0.5% (once-

daily)......................................................................... 105TIMOPTIC................................................................... 105TIMOPTIC................................................................... 105TIMOPTIC-XE.............................................................105tinidazole tab 250 mg..................................................12tinidazole tab 500 mg..................................................12TIVICAY......................................................................... 47TIVICAY......................................................................... 47TIVICAY......................................................................... 47tizanidine hcl cap 2 mg............................................... 43tizanidine hcl cap 4 mg............................................... 43tizanidine hcl cap 6 mg............................................... 43tizanidine hcl tab 2 mg................................................43tizanidine hcl tab 4 mg................................................43TOBRADEX................................................................ 105tobramycin-dexamethasone ophth susp

0.3-0.1%...................................................................106tobramycin nebu soln 300 mg/5ml.......................... 110tobramycin ophth soln 0.3%.....................................106TOBRAMYCIN SULFATE........................................... 12TOBRAMYCIN SULFATE........................................... 12tobramycin sulfate for inj 1.2 gm................................12tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................12tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................12tolcapone tab 100 mg................................................. 39TOLMETIN SODIUM..................................................... 4tolterodine tartrate cap er 24hr 2 mg.........................89tolterodine tartrate cap er 24hr 4 mg.........................89tolterodine tartrate tab 1 mg.......................................89tolterodine tartrate tab 2 mg.......................................89topiramate sprinkle cap 15 mg...................................16topiramate sprinkle cap 25 mg...................................16topiramate tab 100 mg................................................16topiramate tab 200 mg................................................16topiramate tab 25 mg.................................................. 16

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topiramate tab 50 mg.................................................. 16topotecan hcl for inj 4 mg........................................... 35topotecan hcl inj 4 mg/4ml (for

infusion)...................................................................... 35torsemide tab 100 mg................................................. 75torsemide tab 10 mg................................................... 75torsemide tab 20 mg................................................... 75torsemide tab 5 mg......................................................75TOUJEO MAX SOLOSTAR........................................56TOUJEO SOLOSTAR..................................................56TOVIAZ.......................................................................... 89TOVIAZ.......................................................................... 89TRACLEER.................................................................110TRACLEER.................................................................110TRACLEER.................................................................110TRADJENTA................................................................. 56tramadol-acetaminophen tab 37.5-325

mg..................................................................................4tramadol hcl tab 50 mg................................................. 4trandolapril tab 1 mg................................................... 75trandolapril tab 2 mg................................................... 75trandolapril tab 4 mg................................................... 75tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................60tranexamic acid tab 650 mg.......................................60tranylcypromine sulfate tab 10 mg............................ 21TRAVASOL....................................................................84TRAVATAN Z.............................................................. 106trazodone hcl tab 100 mg...........................................21trazodone hcl tab 150 mg...........................................21trazodone hcl tab 300 mg...........................................21trazodone hcl tab 50 mg.............................................21TREANDA..................................................................... 35TREANDA..................................................................... 35TRECATOR...................................................................26TRELEGY ELLIPTA...................................................110TRELSTAR....................................................................96TRELSTAR....................................................................96TRELSTAR MIXJECT..................................................96TRELSTAR MIXJECT..................................................96TRELSTAR MIXJECT..................................................96TRESIBA....................................................................... 56TRESIBA FLEXTOUCH.............................................. 56TRESIBA FLEXTOUCH.............................................. 56tretinoin cap 10 mg......................................................35tretinoin cream 0.025%............................................... 81tretinoin cream 0.05%................................................. 81tretinoin cream 0.1%................................................... 81tretinoin gel 0.01%.......................................................81tretinoin gel 0.025%.....................................................81triamcinolone acetonide cream

0.025%........................................................................81

triamcinolone acetonide cream 0.1%........................81triamcinolone acetonide cream 0.5%........................81triamcinolone acetonide dental paste

0.1%............................................................................78triamcinolone acetonide lotion 0.025%..................... 81triamcinolone acetonide lotion 0.1%..........................81triamcinolone acetonide oint 0.025%........................ 81triamcinolone acetonide oint 0.1%.............................81triamcinolone acetonide oint 0.5%.............................81triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................75triamterene & hydrochlorothiazide tab 37.5-25

mg................................................................................75triamterene & hydrochlorothiazide tab 75-50

mg................................................................................75TRIBENZOR................................................................. 75TRIBENZOR................................................................. 75TRIBENZOR................................................................. 75TRIBENZOR................................................................. 75TRIBENZOR................................................................. 75trientine hcl cap 250 mg............................................. 84trifluoperazine hcl tab 10 mg......................................43trifluoperazine hcl tab 1 mg........................................43trifluoperazine hcl tab 2 mg........................................43trifluoperazine hcl tab 5 mg........................................43trifluridine ophth soln 1%.......................................... 106trimethobenzamide hcl cap 300 mg.......................... 23trimethoprim tab 100 mg.............................................12trimipramine maleate cap 100 mg............................. 21trimipramine maleate cap 25 mg............................... 21trimipramine maleate cap 50 mg............................... 21TRINTELLIX..................................................................21TRINTELLIX..................................................................21TRINTELLIX..................................................................21TRISENOX....................................................................35TRIUMEQ......................................................................47TROGARZO..................................................................47TROPHAMINE..............................................................84trospium chloride cap er 24hr 60 mg.........................89trospium chloride tab 20 mg.......................................89TRUEPLUS 5-BEVEL PEN NEEDLES

31GX5MM.................................................................. 57TRUEPLUS 5-BEVEL PEN NEEDLES



32GX4MM.................................................................. 57TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/29G

X 1/2"..........................................................................56TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/30G

X 5/16"........................................................................56

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TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/31GX 5/16"........................................................................56

TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/28GX 1/2"..........................................................................56

TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/29GX 1/2"..........................................................................56



TRUEPLUS INSULIN SYRINGE/U-100/1ML/28G X1/2".............................................................................. 56

TRUEPLUS INSULIN SYRINGE/U-100/1ML/29G X1/2".............................................................................. 56

TRUEPLUS INSULIN SYRINGE/U-100/1ML/30G X5/16"............................................................................56

TRUEPLUS INSULIN SYRINGE/U-100/1ML/31G X5/16"............................................................................57

TRUEPLUS PEN NEEDLES 29G X12MM..........................................................................57

TRUEPLUS PEN NEEDLES 31G X5MM............................................................................ 57




TRULICITY....................................................................57TRULICITY....................................................................57TRUMENBA................................................................101TRUVADA......................................................................47TRUVADA......................................................................48TRUVADA......................................................................48TRUVADA......................................................................48TWINRIX..................................................................... 101TYBOST........................................................................ 48TYGACIL....................................................................... 12TYKERB........................................................................ 36TYMLOS......................................................................103TYPHIM VI..................................................................101TYSABRI....................................................................... 78UULORIC......................................................................... 24ULORIC......................................................................... 24ULTICARE INSULIN SAFETY SYRINGE/0.5ML/29G

X 1/2"..........................................................................57ULTICARE INSULIN SAFETY SYRINGE/1ML/29G X

1/2".............................................................................. 57UNITUXIN......................................................................36UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110

UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110UPTRAVI..................................................................... 110ursodiol cap 300 mg....................................................87ursodiol tab 250 mg.....................................................87ursodiol tab 500 mg.....................................................87VVAGIFEM.......................................................................93valacyclovir hcl tab 1 gm............................................ 48valacyclovir hcl tab 500 mg........................................48VALCHLOR................................................................... 36valganciclovir hcl for soln 50 mg/ml.......................... 48valganciclovir hcl tab 450 mg.....................................48valproate sodium inj 100 mg/ml.................................16valproate sodium oral soln 250 mg/5ml.................... 17valproic acid cap 250 mg............................................17valsartan-hydrochlorothiazide tab 160-12.5

mg................................................................................75valsartan-hydrochlorothiazide tab 160-25

mg................................................................................75valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................75valsartan-hydrochlorothiazide tab 320-25

mg................................................................................75valsartan-hydrochlorothiazide tab 80-12.5

mg................................................................................75valsartan tab 160 mg...................................................75valsartan tab 320 mg...................................................75valsartan tab 40 mg.....................................................75valsartan tab 80 mg.....................................................75vancomycin hcl cap 125 mg.......................................12vancomycin hcl cap 250 mg.......................................12vancomycin hcl for iv soln 100 gm............................ 13vancomycin hcl for iv soln 10 gm.............................. 13vancomycin hcl for iv soln 1 gm.................................13vancomycin hcl for iv soln 500 mg............................ 12vancomycin hcl for iv soln 5 gm.................................13vancomycin hcl for iv soln 750 mg............................ 13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HYDROCHLORIDE..........................13VANCOMYCIN HYDROCHLORIDE..........................13VANISHPOINT INSULIN SYRINGE/0.5ML/30G X

1/2".............................................................................. 57VAQTA......................................................................... 101VAQTA......................................................................... 101

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VARIVAX..................................................................... 101VASCEPA...................................................................... 75VASCEPA...................................................................... 75VASERETIC.................................................................. 75VASOTEC......................................................................75VASOTEC......................................................................75VASOTEC......................................................................75VASOTEC......................................................................75VECTIBIX...................................................................... 36VECTIBIX...................................................................... 36VELCADE......................................................................36VELPHORO.................................................................. 84VELTASSA.................................................................... 84VELTASSA.................................................................... 84VELTASSA.................................................................... 84VENCLEXTA.................................................................36VENCLEXTA.................................................................36VENCLEXTA.................................................................36VENCLEXTA STARTING PACK................................ 36venlafaxine hcl cap er 24hr 150 mg.......................... 21venlafaxine hcl cap er 24hr 37.5 mg......................... 21venlafaxine hcl cap er 24hr 75 mg............................ 21venlafaxine hcl tab 100 mg........................................ 21venlafaxine hcl tab 25 mg...........................................21venlafaxine hcl tab 37.5 mg....................................... 21venlafaxine hcl tab 50 mg...........................................21venlafaxine hcl tab 75 mg...........................................21venlafaxine hcl tab er 24hr 150 mg........................... 21venlafaxine hcl tab er 24hr 37.5 mg..........................21venlafaxine hcl tab er 24hr 75 mg............................. 21VENTAVIS................................................................... 110VENTAVIS................................................................... 110VENTOLIN HFA......................................................... 110verapamil hcl cap er 24hr 100 mg.............................76verapamil hcl cap er 24hr 120 mg.............................76verapamil hcl cap er 24hr 180 mg.............................76verapamil hcl cap er 24hr 200 mg.............................76verapamil hcl cap er 24hr 240 mg.............................76verapamil hcl cap er 24hr 300 mg.............................76verapamil hcl cap er 24hr 360 mg.............................75verapamil hcl tab 120 mg........................................... 76verapamil hcl tab 40 mg............................................. 76verapamil hcl tab 80 mg............................................. 76verapamil hcl tab er 120 mg.......................................76verapamil hcl tab er 180 mg.......................................76verapamil hcl tab er 240 mg.......................................76VERZENIO....................................................................36VERZENIO....................................................................36VERZENIO....................................................................36VERZENIO....................................................................36VICTOZA....................................................................... 57VIDEX............................................................................ 48

VIDEX............................................................................ 48VIDEX EC..................................................................... 48VIDEX EC..................................................................... 48VIDEX EC..................................................................... 48VIDEX EC..................................................................... 48VIEKIRA PAK................................................................48VIEKIRA XR..................................................................48vigabatrin powd pack 500 mg.................................... 17VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD STARTER PACK......................................... 21VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VINBLASTINE SULFATE............................................36vincristine sulfate iv soln 1 mg/ml..............................36vinorelbine tartrate inj 10 mg/ml.................................36vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................36VIRACEPT.................................................................... 48VIRACEPT.................................................................... 48VIRAMUNE................................................................... 48VIREAD..........................................................................48VIREAD..........................................................................48VIREAD..........................................................................48VIREAD..........................................................................48VIREAD..........................................................................48VIROPTIC................................................................... 106VIVITROL........................................................................ 5VIZIMPRO..................................................................... 36VIZIMPRO..................................................................... 36VIZIMPRO..................................................................... 36voriconazole for inj 200 mg........................................ 24voriconazole for susp 40 mg/ml.................................24voriconazole tab 200 mg............................................ 24voriconazole tab 50 mg...............................................24VOSEVI..........................................................................48VOTRIENT.................................................................... 36VPRIV............................................................................ 88VRAYLAR...................................................................... 43VRAYLAR...................................................................... 43VRAYLAR...................................................................... 43VRAYLAR...................................................................... 43VYXEOS........................................................................36Wwarfarin sodium tab 10 mg.........................................60warfarin sodium tab 1 mg...........................................60warfarin sodium tab 2.5 mg........................................60

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warfarin sodium tab 2 mg...........................................60warfarin sodium tab 3 mg...........................................60warfarin sodium tab 4 mg...........................................60warfarin sodium tab 5 mg...........................................60warfarin sodium tab 6 mg...........................................60warfarin sodium tab 7.5 mg........................................60water for irrigation, sterile irrigation

soln..............................................................................84XXALKORI....................................................................... 36XALKORI....................................................................... 36XARELTO...................................................................... 60XARELTO...................................................................... 60XARELTO...................................................................... 60XARELTO...................................................................... 60XARELTO STARTER PACK.......................................60XATMEP...................................................................... 101XGEVA.........................................................................103XIFAXAN........................................................................87XOFLUZA......................................................................48XOFLUZA......................................................................48XOLAIR........................................................................101XOLAIR........................................................................101XOLAIR........................................................................101XOPENEX HFA..........................................................110XTANDI.......................................................................... 36XYREM........................................................................111YYERVOY........................................................................36YERVOY........................................................................36YF-VAX........................................................................ 101YONDELIS.................................................................... 36YONSA.......................................................................... 36Zzafirlukast tab 10 mg.................................................110zafirlukast tab 20 mg.................................................110zaleplon cap 10 mg...................................................111zaleplon cap 5 mg..................................................... 111ZALTRAP.......................................................................36ZALTRAP.......................................................................36ZANOSAR..................................................................... 36ZEJULA..........................................................................36ZELBORAF................................................................... 36ZENPEP........................................................................ 88ZENPEP........................................................................ 88ZENPEP........................................................................ 88ZENPEP........................................................................ 88ZENPEP........................................................................ 88ZENPEP........................................................................ 88ZENPEP........................................................................ 88

ZEPATIER..................................................................... 48ZERIT.............................................................................48ZESTORETIC............................................................... 76ZESTORETIC............................................................... 76ZESTORETIC............................................................... 76ZESTRIL........................................................................76ZESTRIL........................................................................76ZESTRIL........................................................................76ZESTRIL........................................................................76ZESTRIL........................................................................76ZESTRIL........................................................................76ZIAGEN..........................................................................48zidovudine cap 100 mg...............................................48zidovudine syrup 10 mg/ml.........................................48zidovudine tab 300 mg................................................48ziprasidone hcl cap 20 mg..........................................43ziprasidone hcl cap 40 mg..........................................43ziprasidone hcl cap 60 mg..........................................43ziprasidone hcl cap 80 mg..........................................43ZOCOR..........................................................................76ZOCOR..........................................................................76ZOCOR..........................................................................76ZOCOR..........................................................................76ZOCOR..........................................................................76zoledronic acid inj conc for iv infusion 4

mg/5ml......................................................................103zoledronic acid iv soln 5 mg/100ml......................... 103ZOLINZA........................................................................36ZOLOFT.........................................................................21ZOLOFT.........................................................................21ZOLOFT.........................................................................22zolpidem tartrate tab 10 mg..................................... 111zolpidem tartrate tab 5 mg....................................... 111ZOMETA......................................................................103zonisamide cap 100 mg..............................................17zonisamide cap 25 mg................................................17zonisamide cap 50 mg................................................17ZONTIVITY....................................................................60ZORTRESS.................................................................102ZORTRESS.................................................................102ZORTRESS.................................................................102ZORTRESS.................................................................102ZOSTAVAX..................................................................102ZOSYN...........................................................................13ZOSYN...........................................................................13ZOSYN...........................................................................13ZYDELIG....................................................................... 36ZYDELIG....................................................................... 37ZYKADIA....................................................................... 37ZYLOPRIM....................................................................24ZYLOPRIM....................................................................25ZYPREXA RELPREVV............................................... 43

2019

156

ZYPREXA RELPREVV............................................... 43ZYPREXA RELPREVV............................................... 43ZYTIGA..........................................................................37ZYTIGA..........................................................................37

Blue Cross and Blue Shield of Texas cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Blue Cross and Blue Shield of Texas no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.

Blue Cross and Blue Shield of Texas:

• Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen demanera eficaz con nosotros, como los siguientes:

○ Intérpretes de lenguaje de señas capacitados.

○ Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otrosformatos).

• Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como lossiguientes:

○ Intérpretes capacitados.

○ Información escrita en otros idiomas.

Si necesita recibir estos servicios, comuníquese con el Coordinador de Derechos Civiles.

Si considera que Blue Cross and Blue Shield of Texas no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, [email protected]. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, el Coordinador de Derechos Civiles está a su disposición para brindársela.

También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación:

U.S. Department of Health and Human Services 200 Independence Avenue, SW

Room 509F, HHH Building Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

http://www.hhs.gov/ocr/office/file/index.html

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

mailto:[email protected]

ATT NTION If you peak Engli h, language a i tance ervice , free of charge, are avai able to youCall

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Llam <1-8 7- 4-8592> (TT < 11>)

Gọi < -877-774-8592 ( TY: <711>)

注意如果您使用繁體中文您可免費獲得語言援助服務。請致電 < -877 774-8592

해 주십 오

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walang baya Tumawag sa <1-877 4 8592> (T Y <711>)

Ap e e e < -877 74 8592> ( TS <71 >)

<1-877 774-8592> ( Yري تماس بگ

TY <7 1>)

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ВНИ А И Е и в говори е а р сс ом е т а ст п ы беспл ны луги пе ево аЗв ните < 877-774-85

رادربخ لوب ودر پآ رگا بز وک پآ و ،ںیہ ے م یک ن خ یک د ام یرک لاک ںیہ بیتسد ںیم تفم <1-877-7 >)

HÚ Ý u ạn nó T ếng V ệt, c ác d ch vụ hỗ trợ n ôn ng miễn phí dGọi s <1-877-7 4 8592> TTY <

ATT NZ ONE: In caso la lingua pa lata s a l’ital ano sono disponib l servizi di as is enza ling istica g atu ti

ATTENTION: If you speak English, language assistance services, free of charge, are available to you.Call 1-888-285-2249 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-888-285-2249 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số1-888-285-2249 (TTY: 711).

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 1-888-285-2249 (TTY: 711) 。

주의: 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다.

1-888-285-2249 (TTY: 711) 번으로전화해주십시오.

2249-285-888-1رقم ل تصا .نبالمجاك فر لتتواة يعدة اللغوات المسان خدمفإ، ةيبلعرة اغحدث اللتتت نا كإذ :ظحومل

.( 711:كمبواللصم اف تهام قر)

و کپ آو ت ، ہي ے تولبو ارد پ آ ر اگ :بردارخ ں میت مفت ادمخاں ں ريکل کا۔ ں ہی ب استيدی کد مدی کن زب

با .باشدمی همفراما ی شبران گايت رارصوه بنی بات زاليتسه، يدنی کگو متگفرسی فان باه زباگر :جهوت

ລິ

(TTY: 711). 1-888-285-2249يديرگبس مات.

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zurVerfügung. Rufnummer: 1-888-285-2249 (TTY: 711).

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-888-285-2249(TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-285-2249 (телетайп: 711).

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ້າພາສາ ລາວ, ການບໍ ການຊ່ວຍເຫຼື ອດ້ານພາສາ, ໂດຍບ່ໍ ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-888-285-2249 (TTY: 711).

1-888-285-2249

.(TTY: 711)

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-285-2249 (TTY: 711).

ATTENTION Si vous parlez français des services d’aide linguistique vous sont proposés gratuitement.Appelez le 1-888-285-2249 (ATS: 711).

ध्यान दें: यदद आप दहिं े े ललए मफ्त म भाषा सहायता सेवाएिंदी बोलत हैं तो आपक ु ें उपलब्ध हैं। 1-888-285-2249 (TTY: 711) पर कॉल करें।

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。1-888-285-2249 (TTY: 711).まで、お電話にてご連絡ください。

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-285-2249 (TTY: 711) We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-285-2249 (TTY: 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 1.º de abril al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Blue Cross MedicareRx es un plan de medicamentos con receta proporcionado por HCSC Insurance Services Company (HISC), un licenciatario independiente de Blue Cross and Blue Shield Association. Patrocinador aprobado de Medicare Parte D. La inscripción en el plan de HISC depende de la renovación del contrato.

Este formulario se actualizó el 01/16/2019. Para obtener información más reciente o si tiene otras preguntas, comuníquese con el Servicio al Cliente de Blue Cross MedicareRx al 1-888-285-2249 o, para los usuarios de TTY, al 711, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si llama del 1.º de abril al 30 de septiembre, durante los fines de semana y días feriados, se usarán tecnologías alternativas (por ejemplo, correo de voz). También puede visitar www.getbluetx.com/pdp/druglist.

formulario 2019 (lista de medicamentos cubiertos) · lista de medicamentos si lo reemplazamos con...

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