La siguiente es una lista de los fármacos más comúnmente recetados. Representa unaversión resumida de la lista de fármacos (lista de medicamentos disponibles) que es eleje de su plan de beneficios para fármacos de venta con receta. Esta lista no escompleta y no garantiza la cobertura. Además de usar esta lista, le recomendamos quele pida a su médico que le recete fármacos genéricos siempre que sea apropiado.

FORMULARIO ENFOQUE CLINICO

TENGA EN CUENTA LO SIGUIENTE: Es posible que los medicamentos de marcacambien al estado de “Fuera de Formulario” si durante el año una versión genérica sepone a disposición. No todos los fármacos que aparecen en la lista están cubiertospor todos los programas de beneficios de fármacos recetados; lea su material sobrebeneficios para ver qué medicamentos específicos están cubiertos y cuáles son loscopagos según su programa de beneficios de medicamentos recetados. Si tienepreguntas específicas sobre su cobertura, llame al número de teléfono que apareceen su tarjeta de identificación de miembros.

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS

ADDERALL XRAE

ADDERALLAE

ADHANSIA XRQL, ST, AE

ADIPEX-PQL, PA

ADZENYS ERQL, AE

ADZENYS XR-ODTQL, ST, AE

AMPHETAMINE ERQL, AE

amphetamine sulfateQL, ST, AE

amphetamine-dextroamphet erAE

amphetamine-dextroamphetamineAE

APTENSIO XRQL, AE

armodafinilQL, PA

atomoxetine hclQL, AE

AZSTARYSQL, ST

benzphetamine hclQL, PA

CAFCITCAFFEINE ANHYDROUSCAFFEINE CITRATEDcaffeine citrateCAFFEINEclonidine hcl erQL

CONTRAVEQL, PA

COTEMPLA XR-ODTQL, ST, AE

DESOXYNPA, AE

DEXEDRINEQL, AE

dexmethylphenidate hclerQL, AE

dexmethylphenidate hclQL, AE

dextroamphetamine sulfateerAE

dextroamphetaminesulfateQL, ST, AE

diethylpropion hcl erPA

DIETHYLPROPION HCLQL, PA

EVEKEO ODTQL, ST, AE

EVEKEOQL, ST, AE

FOCALIN XRQL, ST, AE

FOCALINQL, AE

guanfacine hcl erQL

INTUNIVQL

KAPVAYQL

LOMAIRAQL, PA

metadate erQL, AE

methamphetamine hclPA, ST,

AE

METHYLINQL, AE

methylphenidate hcl er(cd)QL, AE

methylphenidate hcl er(la)QL, AE

methylphenidate hcl er(xr)QL, AE

methylphenidate hcl erQL, AE

methylphenidate hclQL, ST, AE

modafinilQL, PA

NUVIGILQL

phendimetrazine tartrateQL,

PA

phentermine hclQL, PA

procentraQL, ST, AE

PROVIGILQL

QELBREEQL

QSYMIAQL, PA

REGIMEXQL, PA

RITALIN LAQL, AE

RITALINQL, AE

STRATTERAQL, AE

WEGOVYQL, PA

XENICALQL, PA

ZENZEDIQL, ST, AE

ALLERGENICEXTRACTS/BIOLOGICALSMISC

ALK SQ CAT HAIR [INJ]HONEY BEE TREATMENT[INJ]HONEY BEE VENOM [INJ]MIXED VESPID VENOMPROTEIN [INJ]ORALAIR CHILDRENSSTARTER PACKQL

WASP VENOM PROTEIN[INJ]WHITE FACED HORNETVENOM PROT [INJ]YELLOW HORNET VENOMPROTEIN [INJ]YELLOW JACKET VENOMPROTEIN [INJ]

ALTERNATIVE MEDICINES

ALPHA-LIPOIC ACID [INJ]COENZYME Q-10 [INJ]RESERVAPAK PLUSRESERVAPAK

AMEBICIDES

IODOQUINOL

AMINOGLYCOSIDES

amikacin sulfate [INJ]AMIKACIN SULFATEGENTAMICIN IN SALINE

gentamicin sulfate [INJ]neomycin sulfateSTREPTOMYCIN SULFATETOBRAMYCIN SULFATE [INJ]TOBRAMYCIN SULFATE

ANALGESICS - ANTI-INFLAMMATORY

ANAPROX DSARAVAARTHROTECQL

CELEBREXQL

celecoxibQL, ST

DAYPROdiclofenac potassiumdiclofenac sodium erdiclofenac sodiumdiclofenac-misoprostolQL

DYLOJECTEC-NAPROSYNec-naproxenetodolac eretodolacFELDENEFENOPROFEN CALCIUMFLURBIPROFENibuprofen lysineIBUPROFENibuINDOCINindomethacin erST

indomethacin sodiumINDOMETHACINketoprofenketorolac tromethamineQL

[INJ]ketorolac tromethamineQL

KETOROLAC-ROPIV-KETAMINE [INJ]leflunomideLODINEMECLOFENAMATE SODIUMMEFENAMIC ACIDmeloxicamMOBICnabumetoneNALFONNAPROSYNnaproxen sodiumNAPROXENoxaprozinST

PHENYLBUTAZONEPIROXICAMPONSTEL

profenoRELAFEN DSQL, ST

relafenSULINDAC

ANALGESICS -NONNARCOTIC

acetaminophenACETYL SALICYLIC ACIDASPIRINbacQL

butalbital-acetaminophenQL

butalbital-apap-caffeineQL

butalbital-apapQL

butalbital-aspirin-caffeineQL

capacetQL

choline-mag trisalicylateDIFLUNISALESGICQL

FIORICETQL

FIORINALQL

marten-tabQL

OFIRMEVphrenilin forteQL

salsalateSODIUM SALICYLATETENCONQL

VANATOL LQQL

VANATOL SQL

zebutalQL

ANALGESICS - OPIOID

acetaminophen-codeine #2acetaminophen-codeine #3acetaminophen-codeine #4acetaminophen-codeineACTIQQL, PA

ALFENTANIL HCLAPADAZQL

APAP-CAFF-DIHYDROCODEINEQL

ARYMO ERQL

ascomp-codeineQL

BELBUCAQL, PA

BENZHYDROCODONE-ACETAMINOPHENQL

BUPRENEX [INJ]buprenorphine hcl-naloxone hclQL

buprenorphine hclQL [INJ]buprenorphine hclQL

BUPRENORPHINEQL

butalbital-apap-caff-codQL

butalbital-asa-caff-codeineQL

butorphanol tartrateQL, PA

[INJ]butorphanol tartrateQL, PA

BUTRANSQL

CODEINE PHOSPHATECODEINE SULFATECONZIPQL

DEMEROLDILAUDID [INJ]DILAUDIDDOLOPHINEDSUVIAduramorph [INJ]DVORAHQL

EMBEDAendocetQL

EXALGOQL

FENTANYL CIT-ROPIVACAINE-NACLfentanyl citrate (pf) [INJ]FENTANYL CITRATE-NACLFENTANYL CITRATEFENTANYL CITRATEQL, PA

fentanylQL

FIORICET/CODEINEQL

FIORINAL/CODEINE #3QL

hydrocodone bitartrate erQL

hydrocodone-acetaminophenHYDROCODONE-ACETAMINOPHENhydrocodone-ibuprofenhydromorphone hcl erQL

HYDROMORPHONE HCL PF[INJ]HYDROMORPHONE HCL-NACLHYDROMORPHONE HCL[INJ]HYDROMORPHONE HCLHYSINGLA ERQL

IBUDONEIONSYSKADIANQL

lorcet hdlorcet pluslorcetLORTABmeperidine hcl [INJ]MEPERIDINE HCLMEPERIDINE-PROMETHAZINEmethadone hcl intensolMETHADONE HCL [INJ]

METHADONE HCLMETHADOSE SUGAR-FREEMETHADOSEmitigo [INJ]morphine sulfate(concentrate)morphine sulfate (pf) [INJ]morphine sulfate (pf)MORPHINE SULFATE ERBEADSQL

morphine sulfate erQL

MORPHINE SULFATE-NACL[INJ]MORPHINE SULFATE-NACLMORPHINE SULFATEMS CONTINQL

nalbuphine hcl [INJ]NORCOOLINVYKPA

OPANAQL [INJ]OPANAQL

OXAYDOOXYCODONE HCLOXYCODONE-ACETAMINOPHENQL

oxycodone-aspirinOXYMORPHONE HCL ERQL

oxymorphone hclQL

panlorQL

pentazocine-naloxone hclPERCOCETQL

remifentanil hclROXICODONESUBSYSQL, PA

sufentanil citrateSYNALGOS-DCtramadol hcl er (biphasic)QL

TRAMADOL HCL ERQL

tramadol hclTRAMADOL HCLQL

tramadol-acetaminophenTYLENOL WITH CODEINE #3TYLENOL WITH CODEINE #4ULTRACETULTRAMverdrocetvicodin esvicodin hpvicodinXODOLXTAMPZA ERQL

xylonZAMICET

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

ANDROGENS-ANABOLIC

ANDROGELPA

ANDROIDPA

AVEEDPA

DANAZOLDEPO-TESTOSTERONEEC-RX TESTOSTERONEPA

FIRST-TESTOSTERONE MCPA

FIRST-TESTOSTERONEPA

METHYLTESTOSTERONENANDROLONE DECANOATE[INJ]NANDROLONE-TESTOSTERONE CYP&EN[INJ]OXANDRINoxandroloneTESTIMPA

TESTONE CIKPA

TESTOPELPA

TESTOSTERONECOMPOUNDING KITPA

TESTOSTERONE CYPIONATE& PROPPA [INJ]TESTOSTERONE CYPIONATE[INJ]testosterone cypionateTESTOSTERONEENANTHATEPA [INJ]testosterone enanthatePA

TESTOSTERONEPROPIONATEPA [INJ]TESTOSTERONEPA

TESTREDPA

VOGELXO PUMPPA

XYOSTEDPA

ANORECTAL ANDRELATED PRODUCTS

ana-lexANALPRAM HC SINGLESANALPRAM HCANALPRAM-HCanucort-hcANUSOL-HCcolocortCORTENEMAhemmorex-hchydrocort-pramoxine(perianal)hydrocortisone (perianal)hydrocortisone ace-pramoxinehydrocortisone acetatehydrocortisonelidocaine-hydrocort(perianal)lidocaine-hydrocortisoneacelidocortPROCORTprocto-med hcprocto-pakPROCTOCORT

proctosol hcproctozone-hc

ANTACIDS

MAGNESIUM OXIDEMAGNESIUM TRISILICATE

ANTHELMINTICS

albendazoleALBENZABENZNIDAZOLEAE

BILTRICIDEEGATENivermectinQL

MEBENDAZOLEPIPERAZINE CITRATEpraziquantelSTROMECTOLQL

THIABENDAZOLE

ANTI-INFECTIVE AGENTS -MISC.

AEMCOLOQL, PA

atovaquoneAZACTAM [INJ]aztreonam [INJ]azuphen mbbaciimbacitracinBACTRIM DSBACTRIMCLEOCIN PHOSPHATE [INJ]CLEOCIN PHOSPHATECLEOCINclindamycin hclclindamycin palmitate hclclindamycin phosphate ind5wclindamycin phosphate [INJ]clindamycin phosphateCUBICIN RFCUBICINdapsoneAE

daptomycinDORIPENEMertapenem sodium [INJ]FIRST-METRONIDAZOLEFIRST-VANCOMYCINFLAGYLfosfomycin tromethaminefuradantinHIPREXhyolev mbimipenem-cilastatinindiomin mbINVANZ [INJ]LINCOCIN [INJ]lincomycin hcl [INJ]linezolidQL

MACROBIDMACRODANTINme/naphos/mb/hyo1MEPRONmeropenemMERREM

methenamine hippuratemethenamine mandelateMETRONIDAZOLEBENZO+SYRSPENDmetronidazole in naclmetronidazoleMONUROLNALIDIXIC ACIDnitazoxanideQL, PA

NITROFURANTOINMACROCRYSTALnitrofurantoin monohydmacronitrofurantoinpentamidine isethionate[INJ]pentamidine isethionatePENTAM [INJ]phosphasalpolymyxin b sulfate [INJ]POLYMYXIN B SULFATEPRIMAXIN IVPRIMSOLRECARBRIOsulfamethoxazole-trimethoprimsulfatrim pediatricSYNERCIDTINDAMAXtinidazoleTRIMETHOPRIMTRIMPEXur n-curamit mburelleuretron d/suribelurin dsuro-458uro-mpurophen mburylustellUTAuticaputira-cutrona-cVABOMEREQL, PA

VANCOCIN HCLVANCOCINVANCOMYCIN HCL INDEXTROSEVANCOMYCIN HCL IN NACLVANCOMYCIN HCLVANCOSOL PACKvilamit mbvilevev mbXENLETAQL, PA, AE

ZYVOXQL

ANTIANGINAL AGENTS

DILATRATE-SRISORDIL TITRADOSEisosorbide dinitrate

isosorbide mononitrate erisosorbide mononitrateminitranNITRO-DURnitro-timenitroglycerin ernitroglycerin in d5wnitroglycerinNITROLINGUALNITROSTATranolazine erQL

ANTIANXIETY AGENTS

alprazolam eralprazolam xralprazolamATIVAN [INJ]ATIVANbuspirone hclchlordiazepoxide hclclorazepate dipotassiumdiazepam intensoldiazepam [INJ]diazepamdroperidol [INJ]DROPERIDOLhydroxyzine hclHYDROXYZINE PAMOATElorazepam intensollorazepam [INJ]lorazepamLOREEV XRPA

meprobamateoxazepamTRANXENE-TVALIUMVISTARILXANAX XRXANAX

ANTIARRHYTHMICS

adenosineamiodarone hclCORVERTdisopyramide phosphateflecainide acetateibutilide fumaratelidocaine hcl (cardiac) pflidocaine hcl (cardiac)lidocaine in d5wMULTAQQL

NORPACE CRNORPACEpaceroneprocainamide hcl [INJ]PROCAINAMIDE HCLpropafenone hcl erpropafenone hclquinidine gluconate erRYTHMOL SRXYLOCAINE (CARDIAC)

ANTIASTHMATIC ANDBRONCHODILATORAGENTS

AIRDUO DIGIHALERQL, PA

ALBUTEROL SULFATE ERalbuterol sulfate hfaQL

ALBUTEROL SULFATEAMINOPHYLLINEANHYDROUSAMINOPHYLLINEARMONAIR DIGIHALERQL, PA

ARMONAIR RESPICLICK113QL

ARMONAIR RESPICLICK232QL

ARMONAIR RESPICLICK 55QL

budesonideQL

CROMOLYN SODIUMdifil-g forteELIXOPHYLLINEPHEDRINE HCLEPHEDRINE SULFATEFLUNISOLIDEIPRATROPIUM BROMIDEipratropium-albuterolisoproterenol hcl [INJ]ISOPROTERENOL-SODIUMCHLORIDEISUPREL [INJ]levalbuterol hclQL

LEVALBUTEROL TARTRATEQL

LONHALA MAGNAIR REFILLKITQL

LONHALA MAGNAIRSTARTER KITQL

METAPROTERENOLSULFATEmontelukast sodiumPULMICORTQL

SINGULAIRSTRIVERDI RESPIMATQL

terbutaline sulfate [INJ]TERBUTALINE SULFATEtheophylline erTHEOPHYLLINE-ETHYLENEDIAMINEtheophyllineUTIBRON NEOHALERQL

VOSPIRE ERXOPENEX CONCENTRATEQL

XOPENEXQL

zafirlukast

ANTICOAGULANTS

ANGIOMAXARGATROBANARIXTRAbivalirudin trifluoroacetateBIVALIRUDIN-SODIUMCHLORIDEenoxaparin sodium [INJ]enoxaparin sodiumfondaparinux sodiumHEPARIN (PORCINE) INNACLheparin lock flush

heparin sod (porcine) ind5wHEPARIN SOD (PORCINE)-D10heparin sodium (porcine) pf[INJ]HEPARIN SODIUM(PORCINE) [INJ]HEPARIN SODIUM(PORCINE)heparin sodium flushheparin sodium lock flushIPRIVASKjantovenLOVENOX [INJ]LOVENOXSASH KITSODIUM CITRATE LOCKFLUSHWARFARIN SODIUM

ANTICONVULSANTS

BANZELQL

BRIVIACTQL

carbamazepine erCARBAMAZEPINEclobazamDEPACONDEPAKENEDEPAKOTE SPRINKLESDILANTIN INFATABSDILANTINdivalproex sodium erepitolfelbamatefosphenytoin sodium [INJ]gabapentinGABITRILKLONOPINLAMICTAL ODTQL

LAMICTAL STARTERQL

LAMICTAL XRLAMICTALlamotrigine erlamotrigine starter kit-blueQL

lamotrigine starter kit-greenQL

lamotrigine starter kit-orangeQL

levetiracetam erlevetiracetam in naclLYRICAQL

MYSOLINENEURONTINONFIoxcarbazepinePHENYTEKphenytoin infatabsphenytoin sodium extendedphenytoin sodium [INJ]PHENYTOIN SODIUMQUDEXY XRQL

roweepra xr

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

roweeprarufinamideQL

SPRITAMQL

subvenite starter kit-blueQL

subvenite starter kit-greenQL

subvenite starter kit-orangeQL

subveniteSYMPAZANTEGRETOL-XRtiagabine hclTOPAMAX SPRINKLEtopiramate erQL

TOPIRAMATE ERQL

topiramateVALTOCO 10 MG DOSEQL, PA

VALTOCO 15 MG DOSEQL, PA

VALTOCO 20 MG DOSEQL, PA

VALTOCO 5 MG DOSEQL, PA

XCOPRI (250 MG DAILYDOSE)QL

XCOPRI (350 MG DAILYDOSE)QL

XCOPRIQL

ZONEGRAN

ANTIDEPRESSANTS

amitriptyline hclANAFRANILbupropion hcl er (sr)bupropion hcl er (xl)bupropion hclCELEXAQL

citalopram hydrobromideQL

clomipramine hclCYMBALTAQL

DESIPRAMINE HCLDESVENLAFAXINE ERQL, ST

desvenlafaxine succinateerQL

doxepin hclduloxetine hclQL

EFFEXOR XRELAVILEMSAMQL, PA

escitalopram oxalatefluoxetine hclfluvoxamine maleate erQL, ST

fluvoxamine maleateIMIPRAMINE HCLimipramine pamoateKHEDEZLAQL, ST

LEXAPROMARPLANmirtazapineNARDILNEFAZODONE HCLNORPRAMINNORTRIPTYLINE HCLPAMELORPARNATEparoxetine hcl erST

paroxetine hclPAXIL CR

PAXILPEXEVAQL, ST

phenelzine sulfatePRAMLYTEPRISTIQQL

protriptyline hclPROZACREMERON SOLTABREMERONsertraline hclTOFRANILtranylcypromine sulfateTRAZODONE HCLTRIMIPRAMINE MALEATEvenlafaxine hcl erST

venlafaxine hclWELLBUTRIN SRZOLOFT

ANTIDIABETICS

acarboseACTOPLUS METACTOSADLYXIN STARTER PACKQL, PA

ADLYXINQL, PA

AMARYLAVANDIAQL

CYCLOSETQL

diazoxideDUETACTglimepirideglipizide erglipizide xlglipizide-metformin hclGLIPIZIDEGLUCAGON EMERGENCYQL

[INJ]GLUCOPHAGE XRQL

GLUCOPHAGEGLUCOTROL XLGLUCOTROLGLUCOVANCEglyburide micronizedglyburide-metforminGLYBURIDEGLYNASEGLYSETQL

metformin hcl erQL

metformin hclQL

miglitolQL

MYXREDLINnateglinidepioglitazone hcl-glimepiridepioglitazone hcl-metforminhclpioglitazone hclPRANDINQL

PRECOSEPROGLYCEMREPAGLINIDE-METFORMINHCLQL

repaglinideQL

RIOMET ERQL

RIOMETQL

STARLIXTANZEUMPA

ZEGALOGUEQL

ANTIDIARRHEAL/PROBIOTIC AGENTS

BISMUTH SUBGALLATEdiphenoxylate-atropineKAOLINLOMOTILLOPERAMIDE HCLMOTOFENopiumPECTIN

ANTIDOTES AND SPECIFICANTAGONISTS

ACETADOTEANTIZOLCETYLEVCHARCOAL ACTIVATEDCYANOKITDUODOTEEDETATE CALCIUMDISODIUMflumazenilfomepizoleKLOXXADOMETHYLENE BLUE [INJ]naloxone hcl [INJ]naltrexone hclQL

NALTREXONEPENTETATE CALCIUMTRISODIUMPENTETATE ZINCTRISODIUMPRALIDOXIME CHLORIDEPRAXBINDQL

ANTIEMETICS

ALOXIPA

ANZEMETPA

aprepitantQL, PA

BARHEMSYSPA

CESAMETQL, PA

dronabinolQL, PA

EMEND TRI-PACKQL, PA

EMENDQL, PA

FOSAPREPITANTDIMEGLUMINEPA

GRANISETRON HCLMARINOLQL, PA

MECLIZINE HCLONDANSETRON HCL-NACLONDANSETRON HCLQL [INJ]ondansetron hclQL

ondansetronPALONOSETRON HCLPA

scopolamineQL

SUSTOLQL, PA

SYNDROSPA

TIGANTRANSDERM SCOP (1.5MG)QL

TRANSDERM-SCOP (1.5MG)QL

trimethobenzamide hclZOFRAN ODTZOFRANQL

ZUPLENZ

ANTIFUNGALS

AMBISOMEAMPHOTERICIN BANCOBONBIO-STATINBREXAFEMMEQL, PA

CANCIDAScaspofungin acetateDIFLUCANfluconazole in dextrosefluconazole in sodiumchloridefluconazoleflucytosineGRIS-PEGgriseofulvin microsizegriseofulvin ultramicrosizeitraconazoleketoconazoleLAMISILmicafungin sodiumMICONAZOLEMYCAMINENOXAFILPA

nystatinONMELPA

posaconazolePA

SPORANOX PULSEPAKSPORANOXterbinafine hclTOLSURAPA

VFEND IVVFENDvoriconazole

ANTIHISTAMINES

BROMPHENIRAMINEMALEATEBROMPHENIRAMINETANNATEcarbinoxamine maleatecetirizine hclCHLORPHENIRAMINEMALEATECLARINEXQL

CLEMASTINE FUMARATEcyproheptadine hcldesloratadineQL

DEXCHLORPHENIRAMINEMALEATEdi-phenQL, PA

DICOPANOL RAPIDPAQdiphenhydramine hcl [INJ]DIPHENHYDRAMINE HCLdiphenDOXYLAMINE SUCCINATE

levocetirizinedihydrochloridephenadozPHENERGAN [INJ]phenerganpromethazine hcl [INJ]promethazine hclprometheganPYRILAMINE MALEATERYCLORATRIPELENNAMINE HCL

ANTIHYPERLIPIDEMICS

ANTARAQL, ST

atorvastatin calciumcholestyramine lightcholestyraminecolesevelam hclQL

COLESTID FLAVOREDCOLESTIDcolestipol hclCRESTORQL

ezetimibe-simvastatinQL, ST

ezetimibeQL, ST

fenofibrate micronizedQL, ST

fenofibrateQL, ST

fenofibric acidQL

FENOGLIDEQL

FLOLIPIDST

fluvastatin sodium erQL, ST

fluvastatin sodiumQL, ST

GEMFIBROZILicosapent ethylQL

LESCOL XLQL

LIPITORLOFIBRALOPIDlovastatinLOVAZAQL

MEVACORNEXLIZETQL, PA

niacin er(antihyperlipidemic)QL

NIASPANQL

omega-3-acid ethyl estersQL

PRAVACHOLpravastatin sodiumprevaliteQUESTRAN LIGHTQUESTRANrosuvastatin calciumQL

simvastatinTRICORQL

TRIGLIDEQL

trikloQL

TRILIPIXQL

VYTORINQL

ZETIAQL

ZOCORZYPITAMAGQL, ST

ANTIHYPERTENSIVES

ACCUPRILACCURETIC

ACEONaliskiren fumarateQL, ST

ALTACEamlodipine besy-benazeprilhclamlodipine besylate-valsartanQL

amlodipine-olmesartanQL

amlodipine-valsartan-hctzQL,

ST

ATACAND HCTATACANDQL

atenolol-chlorthalidoneAVALIDEAVAPROAZORQL

benazepril hclbenazepril-hydrochlorothiazideBENICAR HCTQL

BENICARQL

bisoprolol-hydrochlorothiazideBYVALSONQL, ST

candesartan cilexetil-hctzQL

candesartan cilexetilQL

CAPTOPRIL-HYDROCHLOROTHIAZIDEcaptoprilCARDURACATAPRES-TTS-1CATAPRES-TTS-2CATAPRES-TTS-3CATAPRESCLONIDINE HCLclonidineCLORPRESCORZIDEST

COZAARDIBENZYLINEDIOVAN HCTDIOVANdoxazosin mesylateenalapril maleateenalapril-hydrochlorothiazideenalaprilatepanedQL, PA

eplerenoneEPROSARTAN MESYLATEQL

EXFORGE HCTQL

EXFORGEQL

fosinopril sodium-hctzfosinopril sodiumguanfacine hclhydralazine hcl [INJ]hydralazine hclHYZAARINSPRAirbesartan-hydrochlorothiazideirbesartanlisinopril-hydrochlorothiazide

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

lisinoprilLOPRESSOR HCTlosartan potassium-hctzlosartan potassiumLOTENSIN HCTLOTENSINLOTRELMETHYLDOPATE HCLmethyldopaMETOPROLOL-HYDROCHLOROTHIAZIDEMICARDIS HCTQL

MICARDISQL

MINIPRESSminoxidilmoexipril hclmoexipril-hydrochlorothiazidenadolol-bendroflumethiazideST

NITROPRESSnitroprusside sodiumolmesartan medoxomil-hctzQL

olmesartan medoxomilQL

olmesartan-amlodipine-hctzQL

perindopril erbuminephenoxybenzamine hclphentolamine mesylate[INJ]PRAZOSIN HCLPRINIVILQBRELISQL, PA

quinapril hclquinapril-hydrochlorothiazideramiprilRESERPINEsodium nitroprussideTARKAtelmisartan-amlodipineQL, ST

telmisartan-hctzQL, ST

telmisartanQL

TENORETIC 100TENORETIC 50terazosin hclTRANDOLAPRIL-VERAPAMILHCL ERST

trandolaprilTRIBENZORQL

TWYNSTAQL

valsartan-hydrochlorothiazidevalsartanVASERETICVASOTECZESTORETICZESTRILZIAC

ANTIMALARIALS

ARAKODAatovaquone-proguanil hcl

CHLOROQUINE PHOSPHATEhydroxychloroquine sulfateMALARONEmefloquine hclPLAQUENILPRIMAQUINE PHOSPHATEQL

pyrimethaminePA

QUALAQUINQL

QUINACRINE HCLQUININE SULFATEDIHYDRATEQUININE SULFATEQL

ANTIMYASTHENIC/CHOLINERGIC AGENTS

pyridostigmine bromide er

ANTIMYCOBACTERIALAGENTS

AMINOSALICYLIC ACID-4cycloserineETHAMBUTOL HCLISONIAZIDMYAMBUTOLMYCOBUTINPRETOMANIDQL, PA

pyrazinamiderifabutinRIFADINRIFAMPIN+SYRSPEND SFrifampin

ANTINEOPLASTICS ANDADJUNCTIVE THERAPIES

anastrozoleARIMIDEXAROMASINbicalutamideCASODEXdexrazoxane hclexemestaneFEMARAflutamideHYDREAhydroxyurealetrozoleleucovorin calcium [INJ]leucovorin calciumLEVAMISOLE HCLMEGESTROL ACETATEmercaptopurineMETASTRONmethotrexate sodium (pf)[INJ]methotrexate sodium [INJ]methotrexate sodiumMETHOTREXATENILANDRONnilutamideRYLAZEPA

tamoxifen citratetoremifene citratetretinoinAE

XATMEPPA

ZINECARD

ANTIPARKINSON ANDRELATED THERAPYAGENTS

AZILECTQL

benztropine mesylate [INJ]benztropine mesylateBROMOCRIPTINE MESYLATEcarbidopa-levodopa ercarbidopa-levodopaCOGENTIN [INJ]COMTANELDEPRYLentacaponeGOCOVRIQL, PA

KYNMOBI TITRATION KITQL,

PA

KYNMOBIQL, PA

LEVODOPALODOSYNMIRAPEX ERQL

MIRAPEXNOURIANZQL, PA, AE

ONGENTYSQL

OSMOLEX ERQL, PA

PARLODELpramipexoledihydrochloride erQL, ST

pramipexoledihydrochlorideREQUIP XLQL

REQUIPropinirole hcl erQL, ST

ropinirole hclSELEGILINE HCLSINEMET CRSINEMETTASMARtolcaponetrihexyphenidyl hclXADAGOQL, PA, ST

ZELAPAR

ANTIPSYCHOTICS/ANTIMANIC AGENTS

ABILIFYADASUVEPA

aripiprazoleQL, ST

asenapine maleateQL, ST

CAPLYTAQL

chlorpromazine hclCLOZAPINECLOZARILcomproEQUETROFANAPT TITRATION PACKFANAPTQL, ST

FAZACLOfluphenazine decanoate[INJ]fluphenazine hclGEODONQL, PA

HALDOL DECANOATEHALDOL [INJ]haloperidol decanoate

haloperidol lactate [INJ]haloperidol lactatehaloperidolINVEGA HAFYERAQL, PA

INVEGA SUSTENNAQL, PA

INVEGA TRINZAQL, PA

INVEGAQL, ST

lithium carbonate erLITHIUM CARBONATEloxapine succinateolanzapineQL

paliperidone erQL, ST

perphenazinePERSERISQL, PA

prochlorperazine edisylate[INJ]PROCHLORPERAZINEMALEATEprochlorperazinequetiapine fumarate erQL, ST

quetiapine fumarateQL

REXULTIQL, ST

RISPERDAL M-TABRISPERDALQL

risperidone m-tabrisperidoneQL

SECUADOQL, PA

SEROQUEL XRQL, ST

SEROQUELQL

thioridazine hclthiothixenetrifluoperazine hclVERSACLOZVRAYLARQL, ST

ziprasidone hclQL

ziprasidone mesylateQL, PA

ZYPREXA RELPREVVQL, PA

ZYPREXA ZYDISZYPREXAQL

ANTISEPTICS &DISINFECTANTS

CETYLCIDE-GCHLORHEXIDINEGLUCONATEformadonformaldehydePHENOLSILVER PROTEIN MILDTHIMEROSAL

ANTIVIRALS

acyclovir sodiumacyclovircidofovirCYTOVENEemtricitabineQL, †

famciclovirFLUMADINEfoscarnet sodiumFOSCAVIRganciclovir sodiumoseltamivir phosphateQL

TAMIFLUQL

valacyclovir hcl

VALCYTEvalganciclovir hclVALTREXVOCABRIAQL, †

XOFLUZA (40 MG DOSE)QL

XOFLUZA (80 MG DOSE)QL

ZOVIRAX

BETA BLOCKERS

ACEBUTOLOL HCLATENOLOLBETAPACE AFBETAPACEbetaxolol hclbisoprolol fumarateBREVIBLOC IN NACLBREVIBLOC PREMIXED DSBREVIBLOC PREMIXEDBREVIBLOCcarvedilol phosphate erQL, ST

carvedilolCOREG CRQL

COREGCORGARDesmolol hcl-sodium chlorideesmolol hclINDERAL LAKAPSPARGO SPRINKLELABETALOL HCL-DEXTROSELABETALOL HCL-SODIUMCHLORIDElabetalol hclLOPRESSORmetoprolol succinate erMETOPROLOL TARTRATEQL,

ST

NADOLOLST

nebivolol hclQL, ST

pindololpropranolol hcl erPROPRANOLOL HCLsorinesotalol hcl (af)sotalol hclTENORMINTIMOLOL MALEATETOPROL XLZEBETA

CALCIUM CHANNELBLOCKERS

ADALAT CCafeditab crAMLODIPINEBES+SYRSPEND SFamlodipine besylateCALAN SRCALANCARDENE IVCARDIZEM CDCARDIZEM LAST

CARDIZEMcartia xtdilt-xrdiltiazem cd

diltiazem hcl er beadsdiltiazem hcl er coatedbeadsST

diltiazem hcl erdiltiazem hclfelodipine erisradipineKATERZIAQL, ST

matzim laNICARDIPINE HCL IN NACLnicardipine hclnifedipine er osmoticreleasenifedipine erNIFEDIPINEnimodipineST

NISOLDIPINE ERST

NORVASCPROCARDIA XLPROCARDIASULARtaztia xttiadylt erTIAZACverapamil hcl erVERAPAMIL HCLVERELAN

CARDIOTONICS

digitekdigoxin [INJ]digoxindigoxdobutamine hcldobutamine in d5wdopamine hcldopamine in d5wLANOXIN [INJ]LANOXINmilrinone lactate indextrosemilrinone lactate

CARDIOVASCULARAGENTS - MISC.

ABLYSINOLamlodipine-atorvastatinST

CADUETcardioplegicCAVERJECT IMPULSEQL

CIALISQL

EDEXQL

IFE-PG20isoxsuprine hclLEVITRAQL

NYLIDRIN HCLPAPAV-PHENTOLAMINE-ALPROSTADILPAPAVERINE HCL [INJ]PAPAVERINE HCLPAPAVERINE-PHENTOLAMINEsildenafil citrateQL

tadalafilQL, ST

vardenafil hclQL

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

VERQUVOQL, PA

VIAGRAQL

CEPHALOSPORINS

cefaclorcefadroxilCEFAZOLIN IN SODIUMCHLORIDECEFAZOLIN SODIUM-DEXTROSECEFAZOLIN SODIUM-NACLcefazolin sodium [INJ]CEFAZOLIN SODIUMcefdinircefepime hcl [INJ]cefiximeCEFOTAN [INJ]cefotaxime sodium [INJ]CEFOTAXIME SODIUM [INJ]cefotetan disodium [INJ]cefoxitin sodium [INJ]cefoxitin sodiumcefpodoxime proxetilcefprozilceftazidime [INJ]CEFTINCEFTRI-IMceftriaxone sodium [INJ]ceftriaxone sodiumCEFTRISOL PLUS [INJ]cefuroxime axetilcefuroxime sodium [INJ]cefuroxime sodiumcephalexinDAXBIAFORTAZ [INJ]KEFLEXMAXIPIME [INJ]MAXIPIMESUPRAXtazicef [INJ]TAZICEFZINACEF IN STERILE WATERZINACEF [INJ]ZINACEF

CHEMICALS

2-DEOXY-D-GLUCOSE2-METHOXYESTRADIOL4-AMINOBUTYRIC ACID4-AMINOPYRIDINE4-METHYLPYRAZOLE5-FLUOROURACIL5-HTP5-HYDROXY-L-TRYPTOPHAN5-METHYLTETRAHYDROFOLATE CALC7-KETO DHEA9-AMINOACRIDINE HCLAC DERMAPEPTIDEACARBOSEACEPROMAZINE MALEATEACESULFAME POTASSIUM

ACETAMINOPHENACETARSONEACETAZOLAMIDEACETIC ACID GLACIALACETIC ACIDACETONEACETYL DIPEPTIDE-1 CETYLESTERACETYL HEXAPEPTIDE-8ACETYL-D-GLUCOSAMINEACETYL-L-CARNITINE HCLACETYLCHOLINE CHLORIDEACIDOPHILUSLACTOBACILLUSACTIPHYTE OF ALGAE GLACTIPHYTE OF CUCUMBERACTIPHYTE OF IVYACTIPHYTE OFLEMONGRASSACYCLOVIRADEMETIONINE DISULFTOSYLATEADENOSINEADRENOCHROMESEMICARBAZONEADRENOCORTICOTROPHICHORMONEAGARALASKAN RED ALGAEALBENDAZOLEALCOHOL, USPALDOSTERONEALGINIC ACIDALKYL BENZOATE C12-15ALLANTOINALLOPURINOLALMOND OIL (SWEET)ALOE VERA FREEZE DRIEDALOE VERA LEAFALOE VERAALPHA-GPC 50%ALPHA-KETOGLUTARIC ACIDALPHA-LIPOIC ACIDALPHA-TOCOPHEROLALPRAZOLAMALPROSTADILALTRENOGESTALUMINUM ACETATE BASICALUMINUMCHLOROHYDRATEALUMINUM HYDROXIDEDRIED GELALUMINUM POTASSIUMSULFATEALUMINUM SULFATEAMANTADINE HCLAMERICAN GINSENGAMINOCAPROIC ACIDAMINOLEVULINIC ACID HCLAMINOPROPYLRACEMENTHYL PHOSAMITRIPTYLINE HCLAMLODIPINE BESYLATEAMMONIUM BROMIDE

AMMONIUM CHLORIDEAMMONIUM HYDROXIDEAMMONIUM LACTATEAMMONIUM LAURYLSULFATEAMMONIUM MOLYBDATETETRAHYDAMMONIUM PHOSPHATEDIBASICAMMONIUM SULFATEANASTROZOLEANDROSTENEDIONEANISINDIONEANTIMONY POTASSIUMTARTRATEANTIMONY TRICHLORIDEANTIMONY TRISULFIDEANTIPYRINEAPOMORPHINE HCLARBUTIN ALPHAARGININE HCLARLACEL 165ARSENIC TRIOXIDEASCORBIC ACID CASSAVEASCORBIC ACID FINEASCORBIC ACIDASCORBYL PALMITATEASPARAGINEMONOHYDRATEATORVASTATIN CALCIUMATOVAQUONEATTAPULGITEAVICEL PH 101 MICROCELLULOSEAVICEL PH 105 MICROCELLULOSEAVIPTADIL ACETATEAVOCADO OILAZELAIC ACIDAE

AZELASTINE HCLQL

AZITHROMYCIN DIHYDRATEAZITHROMYCINBACITRACIN MICRONIZEDBASE G ALMOND OIL(SWEET)BASIC FUCHSIN HCLBAY OILBECLOMETHASONEDIPROPIONATEBELLADONNA EXTRACTBELLADONNA LEAFEXTRACTBELLADONNABENACTYZINE HCLBENAZEPRIL HCLBENFOTIAMINEBENZETHONIUM CHLORIDEBENZOCAINEBENZOIN GUMBENZOQUINONE (PARA)BENZYL BENZOATEBETA CAROTENEBETA CYCLODEXTRINBETA GLUCAN

BETAHISTINEDIHYDROCHLORIDEBETAHISTINE HCLBETAINE ANHYDROUSBETAINE HCLBETAMETHASONE ACETATEBETAMETHASONEBETANAPHTHOLBETHANECHOL CHLORIDEBHABHTBIMATOPROSTST

BIORE HYDRATINGMOISTURIZERBIOTINBISABOLOL, ALPHA-LBISMUTH CITRATEBISMUTH SUBCARBONATEBISMUTH SUBNITRATEBISMUTH SUBSALICYLATEBITTER ORANGEBLUE AGAVE ORGANICBORIC ACIDBORON AMORPHOUS FINEBORON CITRATEBOSWELLIA SERRATAEXTRACTBRIJ 35BRIJ 700BRIJ 93BRILLIANT GREENBRIMONIDINE TARTRATEBROMFENAC SODIUMBUDESONIDEQL

BUFLOMEDIL HCLBUPRENORPHINE HCLQL

BUPROPION HCLBUSPIRONE HCLBUTALBITALBUTORPHANOLTARTRATEQL, PA

BUTYL ALCOHOLBUTYLATEDHYDROXYANISOLEBUTYLATEDHYDROXYTOLUENEBUTYLENE GLYCOLC INDICUM & C SINESISLEAF EXTCALCIPOTRIENEMONOHYDRATECALCIPOTRIENECALCIPOTRIOLCALCITRIOL IN ALMOND OILCALCIUM ACETATECALCIUM ALGINATECALCIUM AMINO ACIDCHELATECALCIUM CHLORIDEANHYDROUSCALCIUM CITRATETETRAHYDRATECALCIUM CITRATECALCIUM FOLINATE

CALCIUM FRUCTOBORATECALCIUM GLUBIONATECALCIUMGLYCEROPHOSPHATECALCIUM HYDROXIDECALCIUM HYDROXYAPATITECALCIUM LEVULINATEDIHYDRATECALCIUM PROPIONATECALCIUM PYRUVATECALCIUM SACCHARINCALCIUM STEARATECALCIUM SULFATEHEMIHYDRATECALCIUM SULFATECALCIUM THIOGLYCOLATECANADIAN BALSAMCANNABIDIOLCAPRYLIC ACIDCAPRYLIC CAPRICTRIGLYCERIDECAPSAICIN PALMITATECAPSICUM OLEORESINCAPTOPRILCARBACHOLCARBAMIDE PEROXIDECARBAZOCHROMECARBIDOPA ANHYDROUSCARBIDOPACARBIMAZOLECARBOMER 934P RESINCARBOMER 934PCARBOMER 940CARBOMER 941CARBOPOL 940 NFCARBOPOL 940CARBOXYMETHYLCELLULOSE SODIUMCARMINECARNAUBA WAXCARNITINE (L)CARNOSINE LCASTOR OILCEDAR LEAF OILCEFTAZIDIME WITH SODCARBONATECEFTAZIDIMECEFTRIAXONE SODIUMCELECOXIBQL, ST

CELLULASECELLULOSE CARMELLOSESODIUMCELLULOSECERAPHYL SLKCERESIN WAXCESIUM CHLORIDECETEARYL ALCOHOL-CETEARETH 20CETOSTEARYL ALCOHOLCETYL ESTERS WAXCETYL MYRISTOLEATECETYLPYRIDINIUMCHLORIDECHICKEN PROTEIN

CHLORAMBUCILCHLORAMPHENICOLPALMITATECHLORAMPHENICOLCHLORHEXIDINE DIACETATECHLOROFORMCHLOROPHYLLIN SODIUMCOPPERCHLOROXINECHLOROXYLENOLCHLORPROMAZINE HCLCHOLECALCIFEROLCHOLESTEROLCHOLINE CHLORIDECHOLINE MAGTRISALICYLATECHONDROITIN SULFATESODIUMCHORIONICGONADOTROPINCHROMIC CHLORIDECHROMIUM CHLORIDECHROMIUM K SULFATEDODECAHYDCHROMIUM PICOLINATECHROMIUMPOLYNICOTINATECHRYSINCIDOFOVIRCINNAMON BARKCIPROFLOXACIN HCLCISAPRIDECISPLATINCITRIC ACID ANHYDROUSCITRIC ACIDMONOHYDRATECITRIC ACIDCITRONELLA OILCITRULLINECITRUS BIOFLAVONOIDSCLARITHROMYCINCLEMIZOLE HCLCLIDINIUM BROMIDECLINDAMYCIN HCLMONOHYDRATECLINDAMYCIN HCLCLINDAMYCIN PHOSPHATECLOFAZIMINECLOMIPRAMINE HCLCLONAZEPAMCLOPIDOGREL BISULFATECLORSULONCLOVE OILCOAL TAR EXTRACTCOAL TARCOBALT GLUCONATECOBAMAMIDECOCAMIDE DEACOCONUT OILCOENZYME Q10COLHIBINCOLISTIMETHATE SODIUMCOLLAGEN HYDROLYSATECOPASIL

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

COPPER GLUCONATECOPPER GLYCINATECOPPER PEPTIDECORAL CALCIUMCORN OILCORN STARCHCORTICOTROPINCOSMOCIL CQCOTTONSEED OILCOUMARINCRANBERRYCREATINE MONOHYDRATECREATINECREATININECRESOLCROSCARMELLOSE SODIUMCROTAMITONCROTON OILCRYOSERVCUCUMBER MELONCUPRIC CHLORIDEDIHYDRATECUPUACU BUTTERCURCUMIN EXTRACTCURCUMINCYANOCOBALAMINCYCLANDELATECYCLOBENZAPRINE HCLCYCLOBENZAPRINECYCLODEXTRIN-BETACYCLOMETHICONECYCLOPENTASILOX-PEG/PPG DIMETHCYCLOPENTOLATE HCLCYCLOPHOSPHAMIDECYCLOSERINECYCLOSPORINE ACYCLOSPORINECYPROHEPTADINE HCLCYSTEAMINE HCLD-MANNOSED-RIBOSEDALFAMPRIDINEDANTROLENE SODIUMDAPIPRAZOLE HCLDAPSONEAE

DEHYDROCHOLIC ACIDDEHYDROEPIANDROSTERONE MICRODEHYDROEPIANDROSTERONEDEMECARIUM BROMIDEDENATONIUM BENZOATEDEOXYCHOLIC ACIDSODIUMDEOXYCHOLIC ACIDDERMACINRX ETHOXYDIGLYCOLDESICCATED BEEF LIVERDESMOPRESSIN ACETATEDESOXIMETASONEST

DESOXYCORTICOSTERONEACETATEDEVILS CLAW

DEXAMETHASONE ACETATEDEXAMETHASONE BASEDEXAMETHASONEISONICOTINATEDEXAMETHASONEDEXPANTHENOLDEXTRAN 40000DEXTRAN 75000DEXTROMETHORPHANDHEA MICRONIZEDDHEADIAMINOPYRIDINEDIAZEPAMDIAZOXIDEDIBUCAINE HCLDIBUCAINEDIBUTYL SQUARATEDICHLORALPHENAZONEDICHLOROACETIC ACIDDICLAZURILDICLOFENAC SODIUMDICUMAROLDICYCLOMINE HCLDIETHANOLAMINEDIETHYL PHTHALATEDIETHYL TOLUAMIDEDIETHYLCARBAMAZINECITRATEDIETHYLENE GLYCOLMONOETHYL ETDIETHYLSTILBESTROLDIGOXIN MICRONIZEDDIGOXINDIHYDROCODEINEBITARTRATEDIHYDROXYACETONE (1,3)DIMERDIINDOLYLMETHANEDIIODO-L-THYRONINE 3,5DILTIAZEM HCLDIMENHYDRINATEDIMERCAPTOPROPANE-SULFONATE NADIMERCAPTOSUCCINICACIDDIMETHYL FUMARATEDIMETHYL SILOXANEHYDROXYALKYLDIMETHYL SULFONEDIMETHYL SULFOXIDEDIMETHYLACETAMIDEDIMETHYLAMINOETHANOLDIMETHYLGLYCINE HCLDINITROCHLOROBENZENEDIOSGENINDIOSMINDIOXYBENZONEDIPHENIDOL HCLDIPHENYLCYCLOPROPENONEDIPYRIDAMOLEDISOPHENOLDISULFIRAMQL

DIVALPROEX SODIUM

DL-3-HYDROXYBUTYRICACID SODDL-ALPHA LIPOIC ACIDDL-PANTHENOL ALCOHOLDL-PANTHENOLDMAE BITARTRATEDOCOSANOLDOCUSATE SODIUM-SODBENZOATEDOPAMINE HCLDOW CORNING 1501 FLUIDDOW CORNING 200DOXAZOSIN MESYLATEDOXEPIN HCLDOXYCYCLINEMONOHYDRATEDRAKKAR NOIRDULOXETINE HCLQL

DUTASTERIDEQL

DYCLONINE HCLDYPHYLLINEECONAZOLE NITRATEEDETATE ACIDEDETATE DISODIUMDIHYDRATEEDETATE DISODIUMEDETATE SODIUMEDETIC ACIDEDROPHONIUM CHLORIDEEGCGEMU OILENALAPRIL MALEATEENOVARX-AMITRIPTYLINEENROFLOXACINEPINEPHRINE BASEEPINEPHRINE BITARTRATEEPINEPHRINEQL, PA

ERGOLOID MESYLATESERYTHROMYCIN ESTOLATEESTRADIOL BENZOATEESTRADIOL CYPIONATEESTRADIOL HEMIHYDRATE(BULK)ESTRADIOL MICRONIZEDESTRADIOL VALERATEESTRIOL MICRONIZEDESTRIOLESTRONEETHERETHOSUXIMIDEETHOXY DIGLYCOLETHYL ALCOHOLETHYL OLEATEETHYL VANILLINETHYLCELLULOSEETHYLENEDIAMINEETHYLPARABENETOMIDATEETOPOSIDEEUCALYPTOLEUCALYPTUS OILEUGENOLFAMOTIDINEFENBENDAZOLE

FENOFIBRATEQL, ST

FERRIC AMMONIUMCITRATEFERRIC CHLORIDEHEXAHYDRATEFERRIC PYROPHOSPHATEFERRIC SUBSULFATEFERRIC SULFATEFERROUS BISGLYCINATECHELATEFERROUS FUMARATEFERROUS GLUCONATEDIHYDRATEFERROUS GLUCONATEFERULIC ACIDFEVERFEWFEXOFENADINE HCLFINASTERIDEFLIBANSERINFLOXURIDINEFLUCONAZOLEFLUCYTOSINEFLUMAZENILFLUNIXIN MEGLUMINEFLUORESCEIN SODIUMFLUORESCEINFLUOROURACILFLUOXETINE HCLFLUPHENAZINEDECANOATEFLUTICASONEPROPIONATEST

FORMOTEROL FUMARATEDIHYDRATEFORMOTEROL FUMARATEFORSKOLINFREEDOM ESTERDERMFRESH LINEN FRAGRANCEFULLERS EARTHFUMARIC ACIDFURAZOLIDONEGALACTOSEGAMMA-AMINOBUTYRICACIDGARDENIA FRAGRANCEGATIFLOXACINGENISTEINGERANIUM OILGERMALL PLUSGERMANIUM SESQUIOXIDEGINGER OILGINGER ROOTGINSENG ROOTGLUCONOLACTONEGLUCOSAMINE HCLGLUCOSAMINE SULFATENACLGLUCOSAMINE SULFATEPOTASSIUMGLUCOSAMINE SULFATEGLUTARALDEHYDE INWATERGLYCERINEGLYCERIN

GLYCEROL FORMALGLYCEROL MONOOLEATEGLYCERYL MONOSTEARATEGLYCINE SOYA PROTEINGLYCOFUROLGLYCOPYRROLATEGLYCOSAMINOGLYCANSGLYCYRRHIZIC ACIDGOLD SODIUMTHIOMALATEGRAMICIDIN DGRAPE SEEDGREEN SOAPGREEN TEA OIL FRAGRANCEGREEN TEAGRISEOFULVINMICRONIZEDGRISEOFULVIN MICROSIZEGUAIACOLGUANABENZ ACETATEGUANETHIDINE SULFATEGUANIDINEACETIC ACIDGUAR GUMGUARANA SEED EXTRACTGYMNEMA SYLVESTRISLEAFHALOPERIDOL DECANOATEHALOPERIDOLHAWTHORN BERRYHEMATOXYLINHEPARIN SODIUMHEPESHEPTAMINOLHISTAMINE PHOSPHATEHOMATROPINEMETHYLBROMIDEHONEY ALMONDFRAGRANCEHUMAN CHORIONICGONADOTROPINHUPERZINE SERRATE AHYALURONATE SODIUMHYALURONIC ACID SODIUMHYALURONIC ACIDHYALURONIDASEHYDRALAZINE HCLHYDRAZINE SULFATEHYDROCHLORIC ACIDHYDROCODONEBITARTRATEHYDROCORTISONEHEMISUCCINATEHYDROFLUORIC ACIDHYDROXOCOBALAMIN HCLHYDROXOCOBALAMINHYDROXYAMPHETAMINEHBRHYDROXYCHLOROQUINESULFATEHYDROXYETHYL CELLULOSEHYDROXYETHYLMETHACRYLATEHYDROXYPROGESTERONECAPROATE

HYDROXYPROPYLCELLULOSEHYDROXYPROPYLMETHYLCELLULOSEHYDROXYPROPYL-BETA-CYCLODEXTHYDROXYQUINOLINESULFATEHYDROXYTRYPTOPHAN L-5HYDROXYTRYPTOPHANHYDROXYUREAHYDROXYZINE HCLHYPROMELLOSE METHOCELK100MHYPROMELLOSEIDEBENONEIDOXURIDINEIMIDUREAIMIQUIMODINDOCYANINE GREENINDOLE-3-CARBINOLINOSITOL HEXANICOTINATEINOSITOLIODINE RESUBLIMEDIODINE STRONG (LUGOL'S)IODINEIODOFORMIOPANOIC ACIDISOMETHEPTENE MUCATEISOPROPYL ALCOHOLISOPROPYL MYRISTATEISOPROPYL PALMITATEISOPROTERENOL HCLISOSORBIDEISOTRETINOINPA, AE

ISOXSUPRINE HCLITRACONAZOLEIVERMECTINQL

JASMINE FRAGRANCEJOJOBA OILJUNIPER TARKANAMYCIN SULFATEKETOPROFENKETOTIFEN FUMARATEKETOTIFEN HYDROGENFUMARATEKINETINKIWI FRAGRANCEKOJIC ACIDKUDZUL-ARGININE HCLL-ASPARAGINEL-ASPARTIC ACIDL-CARNITINEL-CARNOSINEL-CITRULLINEL-CYSTEINE HCLL-CYSTEINEL-GLUTAMIC ACIDMONOSOD SALTL-LYSINE HCLL-MENTHOLL-METHYLFOLATE CALCIUM

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

L-ORNITHINEHYDROCHLORIDEL-SELENOMETHIONINEBLENDL-SELENOMETHIONINEL-SERINELABETALOL HCLLACTASE 5000LACTIC ACIDLAMOTRIGINEQL

LANSOPRAZOLELAURETH-9 POLIDOCANOLLAURIC ACIDLAVENDER OILLEAD ACETATE TRIHYDRATELEAD TETROXIDELECITHIN SOYALEFLUNOMIDELETROZOLELEUCOVORIN CALCIUMLEVALBUTEROL HCLQL

LEVETIRACETAMLEVOCARNITINELEVOCETIRIZINEDIHYDROCHLORIDELEVOFLOXACINHEMIHYDRATELEVOFLOXACINLEVOMEFOLATE CALCIUMLEVOMEFOLATEGLUCOSAMINELEVORPHANOL TARTRATELICORICEDEGLYCYRRHIZINATEDLICORICE ROOTLIDOCAINE HCLMONOHYDRATELIDOCAINEQL

LIME OILLIMONENELINCOMYCIN HCLLINOLEIC ACIDLINSEED OILLIOTHYRONINE SODIUMLIOTHYRONINELIPACTIVE INCA INCHI WOLIPOIC ACIDLISINOPRILLITHIUM CITRATETETRAHYDRATELOCUST BEAN GUMLORATADINELORAZEPAMLOSARTAN POTASSIUMLUTEINLYSINE HCLMACA ROOTMACADAMIA NUT OILMAFENIDE ACETATEMAGNASWEET 110MAGNASWEET 135MAGNESIUM ALUMINUMSILICATE

MAGNESIUM AMINO ACIDCHELATEMAGNESIUM ASCORBATEMAGNESIUM BISGLYCINATEDIHYDMAGNESIUM CITRATEMAGNESIUM GLUCONATEMAGNESIUM GLYCINATEMAGNESIUM HYDROXIDEMAGNESIUM MALATEMAGNESIUM PHOSPHATEMAGNESIUM SALICYLATEMALEIC ACIDMALIC ACIDMALTODEXTRINMANDELIC ACIDMANGANESE CHLORIDETETRAHYDMANGANESE GLUCONATEMANGANESE SULFATEMANNITOLMECAMYLAMINE HCLMECHLORETHAMINE HCLMECLOFENOXATE HCLMEDIUM CHAINTRIGLYCERIDESMEDROXYPROGESTERONEACE MICROMEDROXYPROGESTERONEACETATEQL

MEDROXYPROGESTERONEMICRONIZEDMEGLUMINEMELATONINMELOXICAMMEMANTINE HCLQL

MENADIONE SODIUMBISULFITEMENADIONEMENTHOLMEQUINOLMERCAPTOPURINEMONOHYDRATEMERCAPTOPURINEMETACRESOL ACETATEMETFORMIN HCLQL

METHACHOLINE CHLORIDEMETHACRYLIC ACIDCOPOLYMER AMETHANESULFONIC ACIDMETHANOLMETHENAMINEMANDELATEMETHENAMINEMETHOCARBAMOLMETHOCEL E4M PREMIUMCRMETHOCEL E4M PREMIUMMETHOCEL E4MMETHOCEL K100 PREMIUMMETHOCEL K100MPREMIUMMETHOXYAMINEHYDROCHLORIDE

METHOXYETHANOLMETHSCOPOLAMINEBROMIDEMETHSCOPOLAMINENITRATEMETHYL FOLATEMETHYL METHACRYLATECROSSPOLYMETHYL SULFONEMETHYLCOBALAMINPREMIUMMETHYLCOBALAMINMETHYLENE BLUEMETHYLMETHACRYLCROSSPOLYMERMETHYLPHENIDATE HCLQL, ST,

AE

METHYLSULFONYLMETHANEMETHYSERGIDE MALEATEMETRONIDAZOLEBENZOATEMETRONIDAZOLEMEXILETINE HCLMICROCRYSTAL CELLULOSENF 101MICROCRYSTAL CELLULOSENF 105MILK THISTLEMINOXIDILMIRTAZAPINEMISOPROSTOL DISPERSION(HPMC)MISOPROSTOL-HPMCMISOPROSTOLMITOMYCINMITOTANEMOLYBDENUMMOMETASONE FUROATEQL

MONOBENZONEMONOETHANOLAMINEMONTELUKAST SODIUMMORANTEL TARTRATEMOXISYLYTE HCLMUPIROCINN-ACETYL-L-CARNOSINENABUMETONENADH DISODIUMNADHNALBUPHINE HCLNALOXONE HCL DIHYDRATENALOXONE HCLNALTREXONE HCLANHYDROUSNALTREXONE HCLQL

NANDROLONE DECANOATENAPHAZOLINE HCLNATAPRESNATURAL MIXEDTOCOPHEROLSNEOSTIGMINEMETHYLSULFATENEPAFENACNETTLE LEAF

NIAOULINICLOSAMIDENICOTINAMIDE ADENINEDINUCLEONICOTINAMIDE RIBOSIDECHLORIDENICOTINE POLACRILEXNICOTINE TARTRATENIFEDIPINE MICRONIZEDNIMODIPINEST

NITRIC ACIDNITROFURANTOINANHYDROUSNITROFURANTOINMONOHYDRATENONOXYNOL-9NOREPINEPHRINEBITARTRATENORETHINDRONENOURISILNYSTATINOCTINOXATEOCTYL STEARATEOLIVE OILOLMESARTANMEDOXOMILQL

OMEPRAZOLEONDANSETRON HCLQL

ORIGANUM OILORLISTATORNITHINE HCLOSELTAMIVIR PHOSPHATEQL

OXALIC ACID DIHYDRATEOXANDROLONEOXYBENZONEOXYBUTYNIN CHLORIDEOXYMETAZOLINE HCLOXYMETHOLONEOXYTETRACYCLINEDIHYDRATEOXYTOCINPALMAROSAPALMIDROLPALMITOYL PENTAPEPTIDE-3PALMITOYL TRIPEPTIDE-3PANCREATINPANTHENOLPANTOPRAZOLE SODIUMQL,

ST

PAPAINPARACHLOROPHENOLPARAFORMALDEHYDEPAROMOMYCIN SULFATEPCCA DMAE COMPLEXPCCA T3 SODIUMPCCA T4 SODIUMPEANUT OILPEG 400 MONOSTEARATEPEG-40 CASTOR OILPENICILLAMINEPENNYROYAL OILPENTOSAN POLYSULFATESODIUM

PENTOXIFYLLINEPENTYLENE GLYCOLPENTYLENETETRAZOLEPEPPERMINT OILPERFLUORODECALINPERGOLIDE MESYLATEPERMETHRINPERPHENAZINEPERUVIAN BALSAMPEUCEDANUMOSTRUTHIUM EXTRACTPHENELZINE SULFATEPHENINDIONEPHENIRAMINE MALEATEPHENOLSULFONIC ACIDPHENOXYBENZAMINE HCLPHENOXYETHANOLPHENTERMINE HCLQL, PA

PHENTOLAMINE MESYLATEPHENYL SALICYLATEPHENYLETHYL ALCOHOLPHENYLETHYLAMINE HCLPHENYLMERCURIC ACETATEPHENYLMERCURIC NITRATEPHENYLTOLOXAMINECITRATEPHENYTOINPHOSPHATIDYLCHOLINEPHOSPHATIDYLSERINEPHOSPHORIC ACIDPHYTIC ACID IN WATERPHYTONADIONEPILOCARPINE HCLPILOCARPINE NITRATEPIMOBENDANPINE BARK EXTRACTPINE NEEDLE OILPINE OILPINE TARPINEAPPLE EXTRACTPINENE (L-ALPHA)PIPERINEPIRACETAMPMX-1184 SILICONEPODOFILOXPOLYETHYLENE GLYCOL 600(BULK)POLYHEXAMETHYLENEBIGUANIDEPOLYOX WSR-301POLYSORBATE 20POLYSORBATE 40POLYSORBATE 60POLYSORBATE 80POLYVINYL ALCOHOLPOLYVINYLPYRROLIDONE K-30POLYVINYLPYRROLIDONE K-90POMEGRANATE SEEDPONAZURILPOTASH SULFURATEDLUMPPOTASSIUM ACETATE

POTASSIUM ASPARTATEPOTASSIUM AZELAOYLDIGLYCINATEPOTASSIUM BENZOATEPOTASSIUM BITARTRATEPOTASSIUM BROMIDEPOTASSIUM CARBONATEPOTASSIUM GLUCONATEANHYDROUSPOTASSIUM HYDROXIDEPOTASSIUM IODIDEPOTASSIUMMETABISULFITEPOTASSIUM NITRATEPOTASSIUM PERCHLORATEPOTASSIUMPERMANGANATEPOTASSIUM PHOSPHATEDIBASICPOTASSIUM PHOSPHATEMONOBASICPOTASSIUM SODIUMTARTRATEPOTASSIUM SULFATEPOVIDONE K-30POVIDONEPOWDER SCENTFRAGRANCEPRASTERONE MICRONIZEDPRAZIQUANTELPREGABALINQL, ST

PREGNENOLONEMICRONIZEDPREGNENOLONEPRILOCAINE HCLPRILOCAINEPRIMIDONEPROCARBAZINE HCLPROCHLORPERAZINEEDISYLATEPROFLAVINE HEMISULFATEPROGESTERONE MILLEDPROGESTERONE ULTRAMICRONIZEDPROGESTERONE WETTABLEPROGESTERONEPROMAZINE HCLPROPANEDIOLPROPARACAINE HCLPROPYL GALLATEPROPYLENE GLYCOLMONOSTEARATEPROPYLENE GLYCOLPROPYLTHIOURACILPROSTAGLANDIN E1PROSTAGLANDIN E2PROTAMINE SULFATEPROTEASEPSYLLIUM HUSKPULLULANPUMICE (FLOUR)PYRANTEL PAMOATEPYRAZINAMIDEPYRIDOSTIGMINE BROMIDE

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

PYRIDOXAL-5 PHOSPHATEPYRIDOXAL-5-PHOSPHATEPYRIMETHAMINEPA

PYROGALLOLPYRUVIC ACIDQUATERNIUM-15QUERCETIN DIHYDRATEQUINIDINE SULFATEDIHYDRATEQUININE HCL DIHYDRATERACEPINEPHRINE HCLRANITIDINE HCLRAPESEED OILRASAGILINE MESYLATEQL, ST

RAUWOLFIA SERPENTINARED YEAST RICERENOVAGERESORCINOLRESVERATROLRETINALRETINOL MOLECULAR FILMRIBAVIRINRIBOFLAVIN 5-PHOSPHATESODIUMRIBOFLAVIN-5-PHOSPHATESODIUMRIBOFLAVINRIBOSE (D)RIFAMPINRIFAXIMINROCURONIUM BROMIDERONIDAZOLEROPIVACAINE HCLROSE BENGAL BROSE OILROSEMARY OILROSINRUBIDIUM CHLORIDERUTINSACCHARIN CALCIUMSAFFLOWER OILSAGE LEAFSALICYLIC ACIDSALSALATESASSAFRAS OILSAW PALMETTO BERRYSAW PALMETTOSCARLET REDSECRETIN-MANNITOLSELENIUM SULFIDESELENIUM YEASTSENNASEPICALM VGSERMORELIN ACETATESEROTONIN HCLSERTRALINE HCLSESAME OILSHARK CARTILAGESHOWER FRESHFRAGRANCESIBERIAN GINSENGSILDENAFIL CITRATEQL

SILICA

SILICON DIOXIDE (SYLOID244FP)SILICON DIOXIDESILICONE BLEND CUSTOMSILICONE ELASTOMERBLENDSILICONE FLUID 556SILVER SULFADIAZINESIMVASTATINSINCALIDE IN MANNITOLSIROLIMUSPA, †

SODIUM 4-AMINOSALICYLATESODIUM ACETATETRIHYDRATESODIUM ALGINATESODIUM ASCORBYL PHOSDIHYDRATESODIUM ASPARTATEMONOHYDRATESODIUM ASPARTATESODIUM BICARBONATE-NACLSODIUM BICARBONATESODIUM BISULFITESODIUM BITARTRATEMONOHYDRATESODIUM BORATEDECAHYDRATESODIUM BROMIDESODIUM BUTYRATESODIUM CACODYLATESODIUM CAPRATESODIUM CAPRYLATESODIUM CARBONATEANHYDROUSSODIUM CARBONATEMONOHYDRATESODIUM CHLORITESODIUM CITRATEDIHYDRATESODIUM COCOYLGLUTAMATESODIUM DEHYDROACETATESODIUM DEOXYCHOLATESODIUM DIACETATESODIUMDICHLOROACETATESODIUM FLUORIDESODIUMFLUOROPHOSPHATESODIUM GLUCONATESODIUM HYALURONATESODIUM HYDROXIDESODIUM IODIDESODIUM LACTATESODIUM LAURETH SULFATESODIUM METABISULFITESODIUM MOLYBDATESODIUMMONOFLUOROPHOSPHATESODIUM NITRATESODIUM NITRITESODIUM OLEATE

SODIUM PERBORATESODIUM PHENYLBUTYRATESODIUM PHOSPHATEDIBASIC HEPTASODIUM PHOSPHATEDIBASICSODIUM PHOSPHATEMONOBASICSODIUM PHOSPHATETRIBASICSODIUM PIDOLATESODIUM PROPIONATESODIUM PYROPHOSPHATESODIUM SELENITESODIUM STEARATESODIUM STEARYLFUMARATESODIUM SUCCINATESODIUM SULFATESODIUM SULFITESODIUM TARTRATEDIHYDRATESODIUM TETRADECYLSULFATESODIUM THIOSALICYLATESODIUM VALPROATESORBITAN MONOLAURATESORBITAN MONOOLEATESORBITANMONOPALMITATESORBITAN MONOSTEARATESORBITOLSOYABEAN CASEIN DIGESTMEDIUMSOYBEAN LECITHINSOYBEAN OILSPAN 80SPEARMINT OILSPIRULINASQUALANESQUARIC ACIDST JOHNS WORTSTANNOUS CHLORIDEDIHYDRATESTANNOUS FLUORIDESTANOZOLOLSTARCH RICESTEVIA EXTRACTSTEVIOL GLYCOSIDESSTEVIOSIDESTRONTIUM CHLORIDESTRONTIUM NITRATESUCCIMER DMSASUCCINIC ACIDSUCCINYLCHOLINECHLORIDESUCROSE OCTAACETATESUCROSESUFENTANIL CITRATESULFACETAMIDESULFADIMETHOXINESULFAMERAZINESULFANILAMIDE

SULFOSALICYLIC ACIDDIHYDRATESULFUR PRECIPITATEDSULFUR SUBLIMEDSULFURIC ACIDSULFURSULPIRIDESUMATRIPTANSUCCINATEQL

SUMATRIPTANQL

SUPEROXIDE DISMUTASESYN-AKETACROLIMUSTADALAFILQL, ST

TALCTAMOXIFEN CITRATEMICRONIZEDTAMOXIFEN CITRATETARTARIC ACIDTEA COCOYL GLUTAMINETEA TREE OILTERBINAFINE HCLTESTOSTERONE CYPIONATETESTOSTERONEENANTHATEPA

TESTOSTERONEMICRONIZEDTESTOSTERONEPROPIONATEPA

TETRACAINE HCLTETRACAINETETRAHYDROBIOPTERINDIHCLTETRAHYDROCURCUMINTETRAHYDROZOLINE HCLTHEANINETHEOBROMINETHEOPHYLLINEANHYDROUSTHIOGUANINETHIORIDAZINE HCLTHIOTEPATHYMOL IODIDE PURIFIEDTHYMOL IODIDETHYMOLTHYMUSTHYROID (PORCINE)THYROID 3X (PORCINE)TICARCILLIN-POTCLAVULANATETINIDAZOLETINOGARD TLTIOPRONINTITANIUM DIOXIDETIZANIDINE HCLQL, ST

TOBRAMYCINTOCOPHERYL ACID SUCC D-ALPHATOCOTRIENOLSTOLAZOLINE HCLTOLTRAZURILTOLU BALSAMTOLUIDINE BLUE OTRAMADOL HCL

TRANEXAMIC ACIDQL

TRANILASTTRIACETINTRIAMCINOLONEHEXACETONIDETRIAMCINOLONETRICHLORMETHIAZIDETRICHLOROACETIC ACIDTRICLOSANTRIETHANOLAMINE LAURYLSULFATETRIETHYL CITRATETRILOSTANETRIMEPRAZINE TARTRATETRIMETHOBENZAMIDE HCLTRIOXSALENTRIPROLIDINE HCLTRITON X-100TROMETHAMINETROPOLONETRYPSINTURMERIC ROOTTURMERICTYLOSIN TARTRATETYLOXAPOLUBIDECARENONEUBIQUINOLUNDECYLENIC ACIDURIDINEURSODIOLVALACYCLOVIR HCLVALERIAN ROOTVALPROATE SODIUMVALPROIC ACIDVANADIUMVANADYL SULFATEHYDRATEVANILLINVICTORIAS SECRET VANILLALACEVIDARABINEVINPOCETINEVITAMIN A ACETATEVITAMIN A PALMITATEVITAMIN AVITAMIN D3VITAMIN E ACETATEVITAMIN E SUCCINATEVITAMIN EVITAMIN K2VORICONAZOLEWHEY PROTEIN ISOLATEWHITE KIDNEY BEANEXTRACTWHITE WILLOW BARKWITCH HAZELXYLAZINE HCLXYLITOLXYLOMETAZOLINE HCLYEAST EXTRACTYLANG-YLANG OILFRAGRANCEYOHIMBINE HCLZEAXANTHIN

ZINC CHLORIDEZINC CITRATEZINC GLUCONATEZINC MONOMETHIONINEZINC OXIDEZINC PICOLINATEZINC PYRITHIONEZINC UNDECYLENATEZIRCONIUM OXIDEZOLMITRIPTANQL

ZONISAMIDE

CONTRACEPTIVES

afirmellealtaveraalyacen 1/35alyacen 7/7/7amethia loQL

amethiaQL

amethystANNOVERAQL

apriaranelleashlynaQL

aubra eqaubraaurovela 1.5/30aurovela 1/20aurovela 24 feaurovela fe 1.5/30aurovela fe 1/20avianeayunaazuretteBALCOLTRAbalzivabekyreeBEYAZblisovi 24 feblisovi fe 1.5/30blisovi fe 1/20briellyncamilacamrese loQL

camreseQL

caziantcharlotte 24 fechateal eqchatealcryselle-28cyclafem 1/35cyclafem 7/7/7CYCLESSAcyred eqcyreddasetta 1/35dasetta 7/7/7dayseeQL

deblitanedelylaDEPO-PROVERAQL

DESOGENdesogestrel-ethinylestradiol

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

dolishaledrospiren-eth estrad-levomefoldrospirenone-ethinylestradiolelinesteluryngQL

emoquetteenpresse-28enskyceerrinestaryllaethynodiol diac-ethestradioletonogestrel-ethinylestradiolQL

FALESSAfalminafayosimQL

femynorgemmilygianvigildagiahailey 1.5/30hailey 24 fehailey fe 1.5/30hailey fe 1/20heathericleviaQL

incassiaintrovaleQL

isibloomjaimiessQL

jasmieljencyclajolessaQL

jolivettejuleberjunel 1.5/30junel 1/20junel fe 1.5/30junel fe 1/20junel fe 24kaitlib fekalligakarivakelnor 1/35kelnor 1/50kimidesskurvelolarin 1.5/30larin 1/20larin 24 felarin fe 1.5/30larin fe 1/20larissialayolis feleenalessinalevonestlevonorg-eth estradtriphasiclevonorgest-eth est & ethestQL

levonorgest-eth estrad 91-dayQL

levonorgestrel-ethinylestradlevora 0.15/30 (28)lillowlo-zumandimineLOESTRIN 1.5/30 (21)LOESTRIN 1/20 (21)LOESTRIN FE 1.5/30LOESTRIN FE 1/20lojaimiessQL

lomedia 24 felorynalow-ogestrelluteralyleqlyzamarlissamedroxyprogesteroneacetateQL

melodetta 24 femerzeemibelas 24 femicrogestin 1.5/30microgestin 1/20microgestin 24 femicrogestin fe 1.5/30microgestin fe 1/20milimono-linyahmononessamyzilranecon 0.5/35 (28)necon 7/7/7NEXTSTELLISnikkinora-benorethin ace-eth estrad-fenorethin-eth estradiol-fenorethindrone acet-ethinylestnorethindronenorgestim-eth estradtriphasicnorgestimate-eth estradiolnorlydanorlyrocnortrel 0.5/35 (28)nortrel 1/35 (21)nortrel 1/35 (28)nortrel 7/7/7NUVARINGQL

nylia 7/7/7nymyoocellaorsythiaORTHO MICRONORORTHO TRI-CYCLEN (28)ORTHO TRI-CYCLEN LOORTHO-CYCLEN (28)ORTHO-NOVUM 1/35 (28)ORTHO-NOVUM 7/7/7 (28)philith

pimtreapirmella 1/35pirmella 7/7/7portia-28previfemquasenseQL

rajanireclipsenrivelsaQL

setlakinQL

sharobelsimliyasimpesseQL

SLYNDsprintec 28sronyxsyedatarina 24 fetarina fe 1/20 eqtarina fe 1/20taysofytilia fetri femynortri-estaryllatri-legest fetri-linyahtri-lo-estaryllatri-lo-marziatri-lo-militri-lo-sprintectri-miliTRI-NORINYL (28)tri-nymyotri-previfemtri-sprintectri-vylibra lotri-vylibratrinessa (28)trinessa lotrivora (28)tulanaTWIRLAQL

tyblumetydemyvelivetvesturavienvaviorelevolneavyfemlavylibrawerawymzya fexulaneQL

YASMIN 28YAZzafemyQL

zarahzenchent fezenchentzovia 1/35 (28)zovia 1/35e (28)zovia 1/50e (28)zumandimine

CORTICOSTEROIDS

BETAMETHASONE COMBO[INJ]BETAMETHASONE SODPHOS & ACET [INJ]BETAMETHASONE SODIUMPHOSPHATE [INJ]BETAMETHASONE SODIUMPHOSPHATEbudesonide erCELESTONE SOLUSPAN [INJ]CORTEFCORTISONE ACETATEdecadrondeltasoneDEPO-MEDROL [INJ]DEX COMBO [INJ]DEXAMETHASONE (LA) [INJ]DEXAMETHASONE ACE &SOD PHOS [INJ]DEXAMETHASONE SODPHOS IN D5WDEXAMETHASONE SODPHOS-BUPIV [INJ]DEXAMETHASONE SODPHOSPHATE PF [INJ]DEXAMETHASONE SODIUMPHOSPHATE [INJ]DEXAMETHASONE SODIUMPHOSPHATEdexamethasoneDEXONTO 0.4%DEXOPIN [INJ]ENTOCORT ECFLUDROCORTISONEACETATEKENALOG-80 [INJ]KENALOG [INJ]LIDOCIDEX I [INJ]MEDROLMETHYLPREDNISOLONEACE-LIDO [INJ]METHYLPREDNISOLONEACETATE [INJ]METHYLPREDNISOLONEACETATEmethylprednisolone sodiumsucc [INJ]METHYLPREDNISOLONEMILLIPREDORAPRED ODTPEDIAPREDPREDNISOLONE ACETATEPREDNISOLONEANHYDROUSPREDNISOLONE SODIUMPHOSPHATEPREDNISOLONEPREDNISONEROPIDEX [INJ]SOLU-CORTEF [INJ]SOLU-MEDROL [INJ]

TRIAMCINOLONEACETONIDEST [INJ]TRIAMCINOLONE DIACETMICRONIZETRIAMCINOLONEDIACETATE [INJ]TRIAMCINOLONEDIACETATEUCERISVERIPRED 20ZILRETTAQL

COUGH/COLD/ALLERGY

ACETYLCYSTEINEbenzonatatebiotuss pediatricBROMHEXINE HCLCARBAPHEN 12 PEDCARBAPHEN 12CLARINEX-D 12 HOURQL

CODAR ARDEXTROMETHORPHAN HBRMONOHYDDEXTROMETHORPHAN HBRGILPHEX TRgiltuss pediatricGILTUSS TRGUAIFENESINHYCOFENIXhydrocod polst-cpm polst erhydrocodone-homatropineHYPERSALN-ACETYL-L-CYSTEINENEBUSALnortuss-deNORTUSS-EXPHENYLEPHRINE-GUAIFENESINpromethazine vc plainpromethazine vc/codeinepromethazine vcpromethazine-codeinepromethazine-phenyleph-codeinepromethazine-phenylephrinePSEUDOEPH-CHLORPHEN-HYDROCODpulmosalREZIRASEMPREX-Dsodium chlorideSSKITERPIN HYDRATEMONOHYDRATETERPIN HYDRATETESSALON PERLEStussigonTUSSIONEX PENNKINETICERTUXARIN ERQL

TUZISTRA XRZUTRIPRO

DERMATOLOGICALS

7t lidoaccutanePA, AE

acitretinACLOVATEACTICOAT 7ACTICOAT FLEX 3ACTICOAT FLEX 7ACTICOAT MOISTURECONTROLACTICOAT SITEACTICOAT SURGICALACTICOATACZONEAE

adapalene-benzoylperoxideAE

ADAPALENEAE

ADVANCED ALLERGYCOLLECTIONAKLIEFQL

AKTIPAKAE

ALA SCALPST

ala-cortalclometasone dipropionateALDARAalevicyn dermal sprayALLEVYN AG GENTLEalphaquin hpALTRENOQL, AE

ALUMINUM CHLORIDEHEXAHYDRATEAMELUZQL, PA

ammonium lactateamnesteemPA, AE

ANACAINEANASTIAANTHRALINARAZLOQL

arzol silver nit applicatorsASTEROATOPAVOavar cleanserAE

AVAR LS CLEANSERAE

AVAR LSAE

avar-e emollientAE

avar-e greenAE

AVAR-E LSAE

AVARAE

avitaAE

AVO CREAMazelaic acidAE

AZELEXAE

BACITRACIN ZINCBACITRACINBACTROBANBENZAC AC WASHAE

BENZACLIN WITH PUMPAE

BENZACLINAE

BENZAMYCINAE

BENZEFOAMULTRAAE

BENZEFOAMAE

benzepro creamy washAE

benzepro foaming clothsAE

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

benzepro short contactAE

benzeproAE

BENZIQ LSAE

BENZIQAE

BENZOIC ACIDBENZOYL PEROXIDE FORTE-HCAE

BENZOYL PEROXIDEHYDROUSAE

benzoyl peroxide-erythromycinAE

BENZOYL PEROXIDEAE

beserST

betamethasonedipropionate augBETAMETHASONEDIPROPIONATEST

BETAMETHASONEVALERATEST

BIAFINEbimatoprostST

BIONECTblanchebp foaming washbp foamAE

bp washAE

bpo foaming clothsAE

BPOAE

CALAMINEcalcipotriene-betamethdipropPA

calcipotrienecalcitreneCAMPHORCANTHARIDINCAPEXST

CAPSAICINCENTANY ATCENTANYcerovelCHLOROACETIC ACIDCICLODAN SOLUTIONciclodanCICLOPIROX OLAMINEciclopirox treatmentciclopiroxclaravisPA, AE

clearplex xCLENIA PLUSQL

CLEOCIN-Tclindacin etzclindacin-pCLINDAGELclindamycin phos-benzoylperoxAE

CLIOQUINOLCLOBETASOL 17PROPIONATEclobetasol prop emollientbaseST

clobetasol propionateemulsionST

clobetasol propionate eST

CLOBETASOL PROPIONATEST

CLOBEX SPRAYCLOBEXCLOCORTOLONE PIVALATEPUMPST

CLOCORTOLONE PIVALATEST

clodanST

CLODERM PUMPST

CLODERMST

clotrimazole-betamethasoneCLOTRIMAZOLECOCAINE HCLCOLLAGENASECORDRANcormax scalp applicationCORTANE-Bcorti-savCORTISPORINCUTIVATEdeluoDERMA-SMOOTHE/FS BODYDERMA-SMOOTHE/FSSCALPDERMATOPDERMAWERX SURGICALPLUS PAKdermazeneDERMAZONEDESONATEST

DESONIDEST

DESOWENdesoximetasoneST

desrxDIFFERINAE

diflorasone diacetateST

DIPROLENE AFDIPROLENEDOVONEXDOXYCYCLINEQL, PA

DUACAE

DURAFIBER AGDURAFIBEReconazole nitrateEFUDEXELIMITEELOCONENOVARX-BACLOFENENOVARX-NAPROXENENOVARX-TRAMADOLenzoclearAE

EPIFOAMEPIQUIN MICROEQUIPTO-NAPROXENERTACZOERYGELeryEURAXEVOCLINEXELDERMEXTINAFABIORAE

finasterideFIRST-HYDROCORTISONE

fluocinolone acetonidebodyST

fluocinolone acetonidescalpST

FLUOCINOLONEACETONIDEST

fluocinonide emulsifiedbaseST

FLUOCINONIDEST

fluorouracilflurandrenolideST

FORAXAGENTAMICIN SULFATEGENTIAN VIOLETGLYCOLIC ACIDglydoGORDOFILMGORDONS UREAgrafco silver nit applicatorhalcinonideST

HALOBETASOLPROPIONATEST

HALOGHALOTINHYDRO 40HYDROCORTISONEACETATEhydrocortisone butyr lipobaseST

hydrocortisone butyrateST

hydrocortisone inabsorbaseST

HYDROCORTISONEMICRONIZEDhydrocortisone valerateST

hydrocortisone-iodoquinolHYDROCORTISONEHYDROQUINONEHYGELICHTHAMMOLimiquimodIMPOYZST

isotretinoinPA, AE

KAXMKENALOGKERALYT SCALPKERALYTketodanKETOPHENE RAPIDPAQKETOROLACTROMETHAMINEQL

KLARONAE

KLISYRIQL, PA

klofensaid iiKYBELLALAC-HYDRINlactic acidLATISSELATRIX XMLDO PLUSlevicyn dermal sprayLEVULAN KERASTICKQL, PA

LEXETTEST

lido-k

lido-sorblidocaine hclurethral/mucosallidocaine pakQL

LIDOCAINE-HYDROCORTISONE ACElidocaine-prilocainelidocaineQL

LIDODERMQL

lidopinLIDORXLIDOSOL-HCLIDOVEXLIDOVINlidozionLIDOZOLLINDANELOCOID LIPOCREAMLOCOIDlokaraST

LOPROXLOTRISONELURADROXLUXIQLYDEXAmafenide acetatemalathionmethoxsalen rapidMETHOXSALENMETROCREAMMETROGELMETROLOTIONMICONAZOLE NITRATEMICORT-HCST

mupirocin calciummupirocinmyorisanPA, AE

naftifine hclNAFTINNEO-SYNALARNEOMYCIN SULFATEneuacAE

NITROFURAZONENIZORALnolixST

NOXIFINE WOUNDDRESSINGNUCORTNUMBONEXnyamycnyatanystatin-triamcinolonenystopOLUX-EORACEAQL, PA

OVACE PLUS WASHOVACE PLUSOVACE WASHOVIDEOXISTATPA

OXSORALEN ULTRAPANRETINPENLACpermethrin

pimecrolimusPLEXION CLEANSERAE

PLEXION CLEANSINGCLOTHAE

PLEXIONAE

PODOCONpodofiloxPODOPHYLLUM RESINpr benzoyl peroxide washAE

PRAMOSONE EPRAMOSONEPRAMOXINE HCLpramoxPREDNICARBATEST

premium lidocaineQL

PROPECIAPROTOPICPRUTECTPYROGALLIC ACIDQBREXZAQL, PA, AE

RADIAURArea lo 39rea lo 40remergent hqremevenRENUU NLRETIN-AAE

RETINOIC ACIDREXAPHENACREZESOLAE

rosadanrosanil cleanserAE

RYNODERMsalacynSALEXsalicylic acid ersalicylic acid wart removersalicylic acid-cleansersalicylic acidsalimezsalisol forteSALISOLsalitech forteSALITECHSALRIXSALVAX DUO PLUSSALVAXSCULPTRA [INJ]seb-prev washselenium sulfideSELRXSERNIVOQL, ST

SILAZONE PHARMAPAKSILAZONE-IISILVADENESILVER NITRATEsilver sulfadiazineSILVERSEAL HYDROGELDRESSINGskin bleaching-sunscreenskin bleachingSKLICEsodium sulfacetamide washsodium sulfacetamide

SONAFINESORIATANESORILUXQL

ssdsss 10-5AE

SULCONAZOLE NITRATEsulfacetamide sod-sulfurwashAE

sulfacetamide sodium(acne)AE

SULFACETAMIDE SODIUM-SULFURAE

SULFACETAMIDE SODIUMsulfacleanse 8/4AE

SULFAMYLONSUMADAN WASHAE

SUMADAN XLTPA, AE

SUMADANAE

SUMAXIN TSAE

SUMAXIN WASHAE

SUMAXINAE

SYNALARtacrolimusTANNIC ACIDTAZAROTENEAE

tbcTEMOVATE ETEMOVATETETRACYCLINE HCLTETRAVEXTEXACORTST

THERAPEVOtl hydroquinoneTOLAKTOLNAFTATETOPICORT SPRAYTOPICORTtovetST

TRANSCYTETRANZARELTRETIN-Xtretinoin microspherepumpAE

tretinoin microsphereAE

TRETINOINAE

TRIAMCINOLONEACETONIDEST

tridermST

TRIDESILONULESFIAULTRASAL-ERULTRAVATE X (CREAM)ULTRAVATE X (OINTMENT)ULTRAVATEST

umecta mousseURALISSURAMAXIN GTURAMAXINURE-KUREA IN ZN UNDECYL-LACTIC ACIDurea nailurea-c40UREA

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

uredeburemez-40URESOLUREVAZVANOSvashe cleansingVENIPUNCTURE CPIQL, PA

VERDESOST

VIRASALWESTCORTWINLEVIQL, PA

WOUNDGELHA MATRIXXALIXXEPIQL, PA

XOLEGEL COREPAKxureaZACAREAE

zenatanePA, AE

zenciaAE

ZENEVIXQL, PA

zionodil 100zionodil

DIAGNOSTIC PRODUCTS

adenosine (diagnostic)ARIDOLASPERGILLUS FUMIGATUScandida albicans skn tstantgnCANDINCLARISCANCONRAY 30CONSTANT TRICHOPHYTONCORTROSYN [INJ]cosyntropin [INJ]CUSHING SYNDROMEDIAGNOSTICCYSVIEWDIAGNOSTIC [INJ]DMSADOTAREME-Z-DISKE-Z-DOSEGASTROGRAFINGLEOLANGLOFIL-125GLUCAGON HCL(DIAGNOSTIC) [INJ]HYSKONINDIGO CARMINE [INJ]INULINisosulfan bluemd-gastroviewMETOPIRONEOMNIPAQUEOPTIMARKPROSTASCINTPROVOCHOLINESERMORELIN ACETATEDIAGNOSTIC [INJ]SINOGRAFIN [INJ]T.R.U.E. TESTTRICHOPHYTON

DIETARYPRODUCTS/DIETARYMANAGEMENTPRODUCTS

ASPARTAME(NUTRASWEET)ASPARTAMEASTAMED MYOAVAILNEXCEREFOLIN NACDEPLIN 15DEPLIN 7.5ELFOLATE PLUSFOLBIC RFFOLTANX RFFOLTXGLYGESTL-METHYLFOLATE CA ME-CBL NACL-METHYLFOLATEFORMULA 15L-METHYLFOLATEFORMULA 7.5L-METHYLFOLATE FORTEL-METHYLFOLATE-ALGAE-B12-B6L-METHYLFOLATE-ALGAEL-METHYLFOLATE-B6-B12LIMBREL250LIMBREL500LIMBRELLUKAID GLAMETAFOLBIC PLUS RFMETANXMETHYLFOL-ALGAE-B12-ACETYLCYSTniva-folPODIAPNPURALOR CISACCHARINVAYACOGVAYARINVAYAROLvirt-vite forteXAQUIL XR

DIGESTIVE AIDS

L-GLUTAMIC ACID HCLPEPSIN

DIURETICS

acetazolamide eracetazolamide sodium [INJ]acetazolamideALDACTAZIDEALDACTONEAMILORIDE HCLamiloride-hydrochlorothiazidebumetanide [INJ]bumetanideBUMEXCAROSPIRQL, PA

chlorothiazide sodium

chlorothiazidechlorthalidoneDEMADEXDIAMOX SEQUELSDYAZIDEDYRENIUMEDECRINethacrynate sodiumethacrynic acidfurosemide [INJ]FUROSEMIDEHYDROCHLOROTHIAZIDEindapamideLASIXmannitolMAXZIDE-25MAXZIDEMETHAZOLAMIDEMETHYCLOTHIAZIDEmetolazoneMICROZIDENEPTAZANEosmitrolSODIUM DIURILSODIUM EDECRINspironolactone-hctzSPIRONOLACTONEtorsemidetriamterene-hctzTRIAMTERENE

ENDOCRINE ANDMETABOLIC AGENTS -MISC.

ACTONELQL

ALENDRONATE SODIUMATELVIAQL

BONIVAQL

cabergolinecalcitonin (salmon) [INJ]calcitonin (salmon)CALCITRIOLCARNITOR SFCARNITORCLOMIPHENE CITRATECYSTADANEddavp pf [INJ]DDAVP [INJ]DDAVPdesmopressin ace sprayrefrigdesmopressin acetate pf[INJ]desmopressin acetate spraydesmopressin acetate [INJ]desmopressin acetatedoxercalciferolETIDRONATE DISODIUMEVISTAQL

FOSAMAXHECTOROLibandronate sodiumQL

KERENDIAQL, PA

levocarnitine sf

LEVOCARNITINE [INJ]levocarnitineMIACALCIN [INJ]MIFEPREXmifepristoneNEXVIAZYMEPA, †

NOCTIVAQL, PA, AE

OSPHENAQL

paricalcitolraloxifene hclQL

risedronate sodiumQL, ST

ROCALTROLsod benz-sod phenylacetVASOPRESSIN-SODIUMCHLORIDEZEMPLAR

ESTROGENS

ACTIVELLAALORAQL

amabelzANGELIQQL

BI-EST 50:50BI-EST PROGEST-TESTOSTERONEQL

BIJUVAQL

CLIMARAQL

covaryx hscovaryxDELESTROGENdottiQL

EC-RX ESTRADIOLeemt hseemtest estrogens-methyltest dsest estrogens-methyltest hsest estrogens-methyltestESTRACEestradiol valerateestradiol-norethindroneacetESTRADIOLQL

ESTRIOL-PROGESTERONEMICROQL

ESTROGELQL

ETHINYL ESTRADIOLFEMHRTQL

fyavolvQL

jevantique loQL

jinteliQL

lopreezalyllanaQL

MENOSTARQL

mimvey lomimveynorethindrone-ethestradiolQL

PREFESTQL

VIVELLE-DOTQL

FLUOROQUINOLONES

AVELOXBAXDELAQL, PA

ciprofloxacin hcl

ciprofloxacin in d5wciprofloxacin-ciproflox hclerCIPROFLOXACINCIPROLEVAQUINlevofloxacin in d5wlevofloxacinmoxifloxacin hcl in naclmoxifloxacin hclST

ofloxacin

GASTROINTESTINALAGENTS - MISC.

ACTIGALLalosetron hclQL, PA

alvimopanAMINOSALICYLIC ACID-5APRISOQL

ASACOL HDQL

AURYXIAAZULFIDINE EN-TABSAZULFIDINEbalsalazide disodiumBYLVAYQL, PA, †

calcium acetate (phosbinder)calcium acetateCOLAZALDELZICOLQL

DIPENTUMST

ENTEREGenuloseFOSRENOLGASTROCROMgenerlacGIAZOlactulose encephalopathylanthanum carbonatemesalamine ermesalamine-cleanserMESALAMINEQL, ST

METOCLOPRAMIDE HCLMONOHYDRATEmetoclopramide hcl [INJ]METOCLOPRAMIDE HCLMOTEGRITYQL, PA

PHOSLYRAREGLANRENAGELRENVELAROWASAsevelamer carbonateSEVELAMER HCLSFROWASASIMETHICONESULFASALAZINETRULANCEQL, PA

URSO 250URSO FORTEURSODIOL+SYRSPEND SFursodiolZELNORMQL, PA

GENERAL ANESTHETICS

etomidateFORANEfresenius propovenisofluraneKETALAR [INJ]KETAMINE HCL-SODIUMCHLORIDEKETAMINE HCL [INJ]KETAMINE HCLpropofol-lipuroPROPOFOLsevofluraneSUPRANEterrell

GENITOURINARY AGENTS- MISCELLANEOUS

alfuzosin hcl eraminoacetic acidargyle sterile salineAVODARTQL

CARDURA XLQL, ST

curity sterile salinecytra k crystalsDEFLUX [INJ]dutasteride-tamsulosinhclQL, ST

dutasterideQL

FLOMAXglycine urologicGLYCINEJALYNQL

K-PHOS NO 2LITHOSTATneomycin-polymyxin b guNEOSPORIN GU IRRIGANTORACITPHENAZOPYRIDINE HCLphenazopot & sod cit-cit acpotassium citrate erPOTASSIUM CITRATEMONOHYDRATEpotassium citrate-citric acidPOTASSIUM CITRATEPROSCARPYRIDIUMRAPAFLOQL

RIMSO-50silodosinST

sod citrate-citric acidSODIUM CITRATEANHYDROUSSODIUM CITRATEtamsulosin hcltaron-crystalstricitratesUROCIT-K 10UROCIT-K 15UROCIT-K 5UROXATRALvirtrate-2virtrate-3virtrate-k

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

GOUT AGENTS

allopurinol sodiumallopurinolcolchicine-probenecidCOLCHICINEQL

febuxostatprobenecidULORICQL

ZYLOPRIM

HEMATOLOGICALAGENTS - MISC.

AGGRENOXQL

AGRYLINalbuked 25albuked 5albumin humanalbumin-zlbalbuminar-25albuminar-5alburxalbuteinanagrelide hclaspirin-dipyridamole erQL

buminatecilostazolclopidogrel bisulfatedipyridamoleEFFIENTQL

eptifibatideflexbuminhetastarch-naclhuman albumin grifolskedbuminPANHEMATINpentoxifylline erplasbumin-25plasbumin-5PLAVIXprasugrel hclQL

RETAVASE HALF-KITRETAVASE

HEMATOPOIETIC AGENTS

abaneu-slACCRUFERQL, PA

ACTIVE FEairaviteav-vite fbAXIFOLCENFOLCENTRATEXcorvita 150CORVITE 150CORVITE FEcyanocobalamin [INJ]CYFOLEXDIVISTAfa-vitamin b-6-vitamin b-12fabbFERAHEMEFERIVA 21/7FERIVAFAFERIVA

feroconferotrinsicFERRO-PLEX HEMATINICferrocite plusFERROTRINFERROUS SULFATEferumoxytolfolbeeFOLGARD RXfolic acid [INJ]FOLIC ACIDfolplex 2.2FOLTRATEfoltrinhematinic plus vit/mineralshematinic/folic acidhematogen fortehematogenHEMOCYTE PLUShemocyte-fhemocyte-plusiferex 150 forteINFED [INJ]k-tan plusLIPO-BMAXFEMETHYLCOBALAMIN [INJ]myferon 150 fortena ferric gluc cplx in sucroseNEPHRON FANEURIN-SLNIFEREXNOXIFOL-DNUFERAnufolpoly-iron 150 fortepolysaccharide iron fortePRE-FOLICPUREFE PLUSpurevit dualfe plusROXIFOL-Dse-tan plusSIKLOSTANDEM PLUStl gard rxtl icontl-hem 150triconTRIFERICtrigels-f fortevirt-gardvirt-viteVIT B12-METHIONINE-INOS-CHOLwestab miniwestab one

HEMOSTATICS

AMICARaminocaproic acidASTRINGYNEVICELEVITHROMLYSTEDAQL

RAPLIXARECOTHROM SPRAY KITRECOTHROMTHROMBI-PADTHROMBIN-JMI EPISTAXISTHROMBIN-JMITHROMBOGENTRANEXAMIC ACID-NACLtranexamic acidQL

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS

AMBIEN CRQL

AMBIENQL

BUTISOL SODIUMCHLORAL HYDRATEdexmedetomidine hcl innacldexmedetomidine hclEDLUARQL, ST

estazolameszopicloneQL

HALCIONLUMINAL [INJ]LUNESTAQL

midazolam hcl (pf) [INJ]MIDAZOLAM HCL-SODIUMCHLORIDEmidazolam hcl [INJ]MIDAZOLAM HCLMIDAZOLAM+SYRSPEND SFMIDAZOLAM-KETAMINE-ONDANSETRONMIDAZOLAMMKO MELT DOSE PACKpentobarbital sodium [INJ]PENTOBARBITAL SODIUMPHENOBARBITAL SODIUM[INJ]PHENOBARBITAL SODIUMPHENOBARBITALPRECEDEXramelteonQL

RESTORILROZEREMQL

SONATAtemazepamtriazolamzaleplonzolpidem tartrate erQL

zolpidem tartrateQL

LAXATIVES

BISACODYLCOLYTE WITH FLAVORPACKSconstuloseDOCUSATE SODIUMgavilyte-cgavilyte-ggavilyte-hgavilyte-n with flavor packGOLYTELYlactuloseMAGNESIUM SULFATE

MINERAL OIL HEAVYMINERAL OIL LIGHTMINERAL OILMURI-LUBENULYTELY LEMON-LIMENULYTELY WITH FLAVORPACKSOSMOPREPpeg 3350-kcl-na bicarb-naclpeg 3350/electrolytespeg-3350/electrolytes/ascorbatQ

L

peg-3350/electrolytespeg-kcl-nacl-nasulf-na asc-cQL

peg-preppegylaxPLENVUpolyethylene glycol 3350trilyte

LOCAL ANESTHETICS-PARENTERAL

articadent dental [INJ]BUPIVACAINEFISIOPHARMA [INJ]bupivacaine hcl (pf) [INJ]BUPIVACAINE HCL-NACL[INJ]BUPIVACAINE HCL-NACLBUPIVACAINE HCL [INJ]BUPIVACAINE HCLbupivacaine in dextrosebupivacaine spinalbupivacaine-epinephrine(pf) [INJ]bupivacaine-epinephrine[INJ]chloroprocaine hcl (pf) [INJ]LIDOCAINE HCL (PF) [INJ]LIDOCAINE HCL [INJ]LIDOCAINE HCLlidocaine-epinephrine [INJ]MEPIVACAINE HCLMLD [INJ]NESACAINE-MPF [INJ]NESACAINE [INJ]polocaine-mpf [INJ]polocaine [INJ]PROCAINE HCLROPIV-CLONIDINE-KETOROLACROPIVACAINE HCL-NACL[INJ]ROPIVACAINE HCL-NACLropivacaine hcl [INJ]sensorcaine-mpf spinalsensorcaine-mpf/epinephrine [INJ]sensorcaine-mpf [INJ]sensorcaine/epinephrine[INJ]sensorcaine [INJ]

xylocaine dental [INJ]XYLOCAINE-MPF [INJ]ZINGO

MACROLIDES

azithromycinclarithromycin erclarithromycinDIFICIDPA

E.E.S. GRANULESery-tabERYPED 200ERYPED 400erythromycin baseERYTHROMYCINETHYLSUCCINATEERYTHROMYCINPCEZITHROMAX TRI-PAKZITHROMAX Z-PAKZITHROMAXZMAX

MEDICAL DEVICES ANDSUPPLIES

INSPIREASE RESERVOIRBAGS

MIGRAINE PRODUCTS

almotriptan malateQL

AMERGEQL

AXERTCAFERGOTD.H.E. 45QL [INJ]dihydroergotaminemesylateQL [INJ]DIHYDROERGOTAMINEMESYLATEQL

eletriptan hydrobromideQL

ERGOMARERGOTAMINE TARTRATEergotamine-caffeinefrovatriptan succinateQL

FROVAQL

IMITREX STATDOSE REFILLQL

IMITREX STATDOSESYSTEMQL

IMITREXQL

isometheptene-dichloral-apapMAXALT-MLTQL

MAXALTQL

MIGRANALQL

naratriptan hclQL

nodolorONZETRA XSAILQL

PRODRINRELPAXQL

rizatriptan benzoateQL

sumatriptan succinaterefillQL

sumatriptan succinateQL

sumatriptanQL

zolmitriptanQL

ZOMIG ZMTQL

ZOMIGQL

MINERALS &ELECTROLYTES

bd posiflushCALCIFOLCALCIUM CARBONATELIGHTCALCIUM CARBONATECALCIUM CHLORIDEDIHYDRATEcalcium chlorideCALCIUM GLUCONATEANHYDROUSCALCIUM GLUCONATEMONOHYDRATECALCIUM GLUCONATE-NACLCALCIUM GLUCONATECALCIUM LACTATEPENTAHYDRATECALCIUM PHOSPHATEDIBASICCALCIUM PHOSPHATETRIBASICchloromag [INJ]CUPRIC SULFATEdextrose in lactated ringersdextrose-nacldextrose-sodium chlorideEFFER-Keffervescent pot chlorideFLORIVAfluor-a-dayFLUORABONfluoritabFLURA-DROPSk-effervescentk-primeK-TABk-vescentKCL (IN NACL 0.9%)kcl in dextrose-naclKCL IN LACTATED RINGERSKCL-LIDOCAINE IN NACLklor-con 10klor-con m10klor-con m20klor-con sprinkleklor-con/efklor-conlactated ringersludentMAGNESIUM CARBONATEHEAVYMAGNESIUM CARBONATEMAGNESIUM CHLORIDE[INJ]MAGNESIUM CHLORIDEMAGNESIUM SULFATE IND5WMAGNESIUM SULFATE [INJ]monoject flush syringe

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

monoject sodium chlorideflushmultitrace-4 concentratemultitrace-5 concentratenafrinse dropsnafrinsenormal saline flushnutrilytephospha 250 neutralphospho-trin 250 neutralphosphorousPOTASSIUM ACETATE-NACLPOTASSIUM BICARBONATEpotassium chloride crys erpotassium chloride erPOTASSIUM CHLORIDE IND5Wpotassium chloride indextrosePOTASSIUM CHLORIDE INNACLpotassium chloride proampPOTASSIUM CHLORIDEpotassium phosphates(66meq k)POTASSIUM PHOSPHATES-DEXTROSEpotassium phosphatesringerssaline flush zrsaline flushSODIUM ACETATESODIUM BICARBONATE[INJ]sodium chloride (pf) [INJ]sodium chloride flushsodium chloride [INJ]SODIUM CHLORIDESODIUM PHOSPHATE-NACLSODIUM PHOSPHATES-DEXTROSESODIUM PHOSPHATESswabflush saline flushTHAMvirt-phos 250 neutralZINC SULFATEHEPTAHYDRATEZINC SULFATEMONOHYDRATEZINC SULFATE

MISCELLANEOUSTHERAPEUTIC CLASSES

ADENOSINE-5-MONOPHOSPHATEADENOSINE-5-TRIPHOSPHATEalprostadil [INJ]AMPHADASE [INJ]argyle sterile waterASTAGRAF XLAZATHIOPRINEBROMELAINCELLCEPT INTRAVENOUS

CHYMOTRYPSIN (ALPHA)cyclosporine modifiedDEPEN TITRATABSENDEAVORRXENVARSUS XReverolimusgengrafHYLENEX [INJ]IMURANkionexMAHANA IBSmycophenolate mofetil hclmycophenolate mofetilmycophenolate sodiumMYFORTICPHOXILLUM B22K4/0PHOXILLUM BK4/2.5physiolytephysiosol irrigationPOLIDOCANOLPROSTIN VR [INJ]RESET FOR ANDROID APPRESET FOR IOS APPRESET FOR IOS ORANDROID APPRESET-O FOR ANDROID APPRESET-O FOR IOS APPRESET-O FOR IOS ORANDROID APPSARAPIN [INJ]sodium polystyrenesulfonateSOMRYSTspssterile water for irrigationTRISODIUM CITRATE/CRRTVARITHENAVITRASE [INJ]water for irrigation, sterileZORTRESS

MOUTH/THROAT/DENTAL AGENTS

ARESTINcavarestcevimeline hclchlorhexidine gluconateclinpro 5000DEBACTEROLdenta 5000 plusdentageleasygelEVOXACFIRST-MOUTHWASH BLMfluoridex daily renewalfluoridex enhancedwhiteningfluoridex sensitivity relieffluoridexGELCLAIRGELXlidocaine viscous hclNAFRINSE DAILYACIDULATED

NAFRINSE DAILY/NEUTRALNAFRINSE WEEKLYneutragard advancedneutral sodium fluorideoraloneORAPEUTICORAVIGparoexPERIDEXperiogardpilocarpine hclPREVIDENT 5000 BOOSTERPLUSPREVIDENT 5000 DRYMOUTHPREVIDENT 5000 ENAMELPROTECTPREVIDENT 5000 ORTHODEFENSEPREVIDENT 5000 PLUSPREVIDENT 5000 SENSITIVEPREVIDENTSALAGENsf 5000 plussfsodium fluoride 5000enamelsodium fluoride 5000 plussodium fluoride 5000 ppmsodium fluoride 5000sensitivesodium fluorideZINC ACETATE

MULTIVITAMINS

ACTIVE OBactiviteadc/f (0.5mg/ml)ATABEX ECb complex vitamins [INJ]B-COMPLEX [INJ]b-plex plusb-plexbiocelBP MULTINATAL PLUSCITRANATAL B-CALMCITRANATAL BLOOMCORVITAcorvite freeCORVITEdavitedexifolDIALYVITE 3000DIALYVITE 5000DIALYVITE SUPREME DdialyviteDUET DHA 400DUET DHA BALANCEDENBRACE HRESCAVITE DESCAVITE LQFOLBEE PLUS CZfolbee plusFOLET DHA

FOLET ONEfolika-tFOLIKA-VGENICIN VITA-Qgenicin vita-shylaviteKOSHER PRENATAL PLUSIRONLEVOMEFOLATE DHAloridlysiplex plusMARNATAL-Fmulti-vit/fluoride/ironmulti-vit/fluoridemulti-vitamin/fluoride/ironmulti-vitamin/fluoridemultipromultivitamin/fluoride/ironMULTIVITAMIN/FLUORIDEmultivitamins/fluoridemvc-fluoridemynephrocapsmynephronNATACHEWNATALVITNEEVO DHANEONATAL + DHAQL

NEPHROCAPSnephronexNESTABS ABCNESTABS ONENEXA PLUSNICOMIDENICOTINAMIDEnutrifac zxO-CAL PRENATALOB COMPLETE ONEOB COMPLETE PETITEOB COMPLETE PREMIEROB COMPLETE/DHAOBSTETRIX ONEONEVITEPNV PRENATAL PLUSMULTIVIT+DHAPOLY-VI-FLOR FSPOLY-VI-FLOR/IRONPOLY-VI-FLORPREFERA OBPREFERAOB +DHAPREMESISRXPRENAISSANCE NEXT-BPRENATAL + DHAPRENATAPRENATE AMPRENATE DHAPRENATE ELITEPRENATE ENHANCEPRENATE ESSENTIALPRENATE MINIPRENATE PIXIEPRENATE RESTOREPRENATEPRIMACAREPROVIDA DHA

PROVIDA OBPUREFE OB PLUSQUFLORA FE PEDIATRICQUFLORA FEQUFLORA GUMMIESQUFLORA PEDIATRICR-NATAL OBrenalRENATABS WITH IRONRENATABSreno capsSELECT-OBSTROVITE FORTESUPERVITETEXAVITE LQTL FOLATETRI-VI-FLOROTRI-VI-FLORTRI-VIT/FLUORIDE/IRONtri-vit/fluoridetri-vitamin/fluoridetri-vite/fluorideTRICARE PRENATAL DHAONETRICARE PRENATALtriphrocapsTRISTART DHATRISTART FREEQL

TRISTART ONEtronviteUDAMIN SPurosexv-c forteVENTRIXYLvic-forteVINATE DHA RFvirt-capsvirt-vite plusvita s fortevita-minVITA-PRENvitacelVITAFOL FE+VITAFOL GUMMIESVITAFOL STRIPSVITAFOL ULTRAVITAFOL-NANOVITAFOLVITAL-D RXvitamax pediatricvitamin b complex 100 [INJ]VITAMIN B COMPLEX-HYDROXOCOBAL [INJ]vitamin b-complex 100 [INJ]vitamins acd-fluoridevitasureVITAXYMEvol-care rxVP-PNV-DHAvp-vite rxWESTGEL DHAxvite

MUSCULOSKELETALTHERAPY AGENTS

ACTIVE-CYCLOBENZAPRINEBACLOFENcarisoprodol-aspirin-codeinecarisoprodol-aspirinCARISOPRODOLST

CYCLOPHENE RAPIDPAQDANTRIUMENOVARX-CYCLOBENZAPRINE HCLFIRST-BACLOFENmetaxallST

metaxaloneST

methocarbamol [INJ]orphenadrine citrate erorphenadrine citrate [INJ]ORPHENADRINE CITRATErevontoROBAXIN-750ROBAXIN [INJ]ROBAXINSKELAXINST

SOMATABRADOL RAPIDPAQvanadomZANAFLEXQL

NASAL AGENTS -SYSTEMIC AND TOPICAL

ADRENALINASTEPROQL

azelastine hclQL

azelastine-fluticasoneQL

BACTROBAN NASALBECONASE AQQL

DYMISTAQL

fluticasone propionateST

mometasone furoateQL

NASONEXQL

olopatadine hclQL

OMNARISQL

PATANASEQL

PHENYLEPHRINE HCLPHENYLPROPANOLAMINEHCLPROPEL MINIPROPELPSEUDOEPHEDRINE HCLtriamcinolone acetonideST

ZETONNAQL

NEUROMUSCULARAGENTS

atracurium besylatecisatracurium besylate (pf)cisatracurium besylateEXSERVANQL, PA

QUELICIN [INJ]RILUTEKriluzoleSUCCINYLCHOLINECHLORIDE [INJ]

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

TIGLUTIKQL

vecuronium bromide

NUTRIENTS

ALANINEalcohol [INJ]aminoamrmsaminoreliefrmsaminosyn ii/electrolytesaminosyn/electrolytesARGININE HCL [INJ]BCAA [INJ]BCAACALM [INJ]CARDIOVID PLUSCHOLINE BITARTRATEclinisol sfCLINOLIPIDCYTOTINEdehydrated alcohol [INJ]DEXTROSE ANHYDROUSDEXTROSEDL-ALANINEDL-LEUCINEDL-METHIONINEDL-PHENYLALANINEELCYSFRUCTOSEGABA [INJ]glucoseGLUTAMINEGLUTATHIONE-L REDUCEDGLUTATHIONE-LGLUTATHIONE [INJ]GLUTATHIONEGLYCINE [INJ]INTRALIPIDL-ALANINEL-ARGININEL-CYSTINEL-GLUTAMIC ACIDL-GLUTAMINEL-HISTIDINEMONOHYDROCHLORIDEL-ISOLEUCINEL-LEUCINEL-METHIONINEL-PHENYLALANINEL-PROLINEL-THREONINEL-TRYPTOPHANL-TYROSINEL-VALINELECITHINLEUCINELIPO-CLIPOMETHIONINENUTRILIPIDplenaminepremasolTAURINE [INJ]TAURINETHREONINE

TRI-AMINO [INJ]TRYPTOPHANVALINE

OPHTHALMIC AGENTS

ACULAR LSACULARak-fluorak-poly-bacAKTENALCAINEALOCRILALOMIDEALPHAGAN PALREXaltacainealtafluor benoxaltafluoraltafrinapraclonidine hclATROPINE SULFATE-NACLATROPINE SULFATEbacitra-neomycin-polymyxin-hcbacitracin-polymyxin bbalanced saltbepotastine besilateBEPREVEBESIVANCEST

BETADINE OPHTHALMICPREPBETAGANBETIMOLBETOPTIC-Sbio gloBLEPH-10BLEPHAMIDE S.O.P.BLEPHAMIDEbrimonidine tartrateBRIMONIDINE-DORZOLAMIDEbrinzolamidebromfenac sodium (once-daily)bromfenac sodiumBROMSITEQL

carteolol hclCEFUROXIME SODIUM-NACLCELLUGELCHONDROITIN SULFATECILOXANCOSOPT PFCOSOPTCYCLOGYLCYCLOMYDRILcyclopentolate hclDEXAMETH-MOXIFLOX-KETOROLACDEXAMETHASONE-MOXIFLOXACINDISCOVISCdorzolamide hcl-timolol malpf

dorzolamide hcl-timolol malDORZOLAMIDE HCLDOUBLE PMDUOVISCELESTATEMADINEepinastine hclEYSUVISPA

FLAREXflucainefluor-i-strips a.t.fluorescein-benoxinateFLUORESCITEfluorometholoneFLURA-SAFEflurbiprofen sodiumfluroxFML FORTEFML LIQUIFILMful-gloGATIFLOXACIN-DEXAMETHASONEgatifloxacinglostripsgreen glo lissamine greenhomatropairehomatropine hbrILEVROIOPIDINEISOPTO CARPINEISTALOLLATANOPROSTlevobunolol hclLIDOCAINE-PHENYLEPHRINElissamine greenLOTEMAXloteprednol etabonateMAXIDEXMAXITROLMETIPRANOLOLMIOCHOL-EMITOSOLMOXEZAmoxifloxacin hcl (2x day)ST

MOXIFLOXACIN HCL-BSSMOXIFLOXACIN HCLST

MYDRIACYLneo-polycin hcneo-polycinneomycin-bacitracin zn-polymyxneomycin-polymyxin-dexamethneomycin-polymyxin-gramicidinNEOSPORINocucoat viscoadherentOCUFLOXOMIDRIAOMNIPREDPAREMYDPATADAYPATANOLpolycin

polymyxin b-trimethoprimPOLYTRIMPOVIDONE-IODINEPRED-G S.O.P.PRED-GPREDNISOL ACE-MOXIFLOX-BROMFENPREDNISOLON-GATIFLOX-BROMFENACPREDNISOLON-MOXIFLOX-BROMFENACPREDNISOLON-MOXIFLOX-KETOROLACPREDNISOLONE ACETATE P-FPREDNISOLONE-BROMFENACPREDNISOLONE-GATIFLOXACINPREDNISOLONE-MOXIFLOXACINPROLENSAproparacaine hclproparacaine-fluoresceinRESCULAROCKLATANsulfacetamide-prednisolonetetcainetetracaine hcltetravisc fortetetravisctimolol maleate ocudosetimolol maleate pfTIMOPTIC OCUDOSETIMOPTIC-XETIMOPTICTOBRADEXtobramycin-dexamethasonetobramycinTOBREXtravoprost (bak free)TRIAMCINOLONE-MOXIFLOXACINTRIESENCEtrifluridineTRIPLE PMBTRIPLE PMKTROPICAMIDE-PHENYLEPHRINETROPICAMIDETRUSOPTUPNEEQQL, PA

VIGAMOXVIROPTICVISCOATVYZULTAQL, ST

XALATANZIRGANZYMAXID

OTIC AGENTS

acetasol hcacetic acidCIPRO HC

CIPRODEXciprofloxacin-dexamethasoneCORTANE-B AQUEOUScortic-ndDERMOTICexotic-hcflacFLOXIN OTIChydrocortisone-acetic acidneomycin-polymyxin-hcOTICIN HC NROTIPRIOQL

PRAMOTIC

OXYTOCICS

HEMABATEmetherginemethylergonovine maleate[INJ]methylergonovine maleateoxytocin [INJ]PROSTIN E2

PASSIVE IMMUNIZINGAND TREATMENTAGENTS

ANAVIPANTIVENIN LATRODECTUSMACTANS [INJ]HYPERRAB S/D [INJ]HYPERRAB [INJ]IMOGAM RABIES-HT [INJ]KEDRAB [INJ]

PENICILLINS

AMOXICILLIN TRIHYDRATEamoxicillin-pot clavulanateerAMOXICILLIN-POTCLAVULANATEamoxicillinampicillin sodium [INJ]ampicillin sodiumampicillin-sulbactamsodium [INJ]AMPICILLIN-SULBACTAMSODIUMAUGMENTIN ES-600AUGMENTIN XRAUGMENTINBICILLIN L-Adicloxacillin sodiumMOXATAGnafcillin sodium [INJ]nafcillin sodiumoxacillin sodium [INJ]oxacillin sodiumpenicillin g potassium [INJ]PENICILLIN G PROCAINEpenicillin v potassiumPFIZERPEN [INJ]piperacillin sod-tazobactamsoUNASYN [INJ]

UNASYNZOSYN

PHARMACEUTICALADJUVANTS

ACACIAALFALFA FLAVORALKYL ACRYLATECROSSPOLYMERALMOND OIL BITTERFLAVORAMARANTHANHYDROUS GEL BASEANISE EXTRACTANISE FLAVORAPPLE FLAVORAPRICOT FLAVORASTRAGALUS ROOTAUXIPRO PLASTICIZEDBACOCALMINEBACON FLAVORBANANA CONCENTRATEBANANA CREAM FLAVORBANANA CREME FLAVORBANANA FLAVORBASE A POLYETHYLENEGLYCOLBASE C POLYETHYLENEGLYCOL 300BASE D POLYETHYLENEGLYCOLBASE FOR SALTSBASE FOR WOUNDSBASE GELATIN GUMMYTROCHEBASE XBEEF FLAVORBEEF TYPE FLAVORNATURALBEEF TYPE FLAVOR OSBEEF-ADEBEES WAXBEESWAX (YELLOW)BEESWAXBENTONITEBENZYL ALCOHOLBHRT BASEBITTER DRUGBITTER STOP FLAVORBITTERNESS MASK FLAVORBITTERNESS REDUCINGAGENTBITTERNESS SUPPRESSORFLAVORBLACKBERRY FLAVORBLUEBERRY FLAVORBRILLIANT BLUE GBUBBLE GUMCONCENTRATEBUBBLE GUM FLAVORBUTTER FLAVORBUTTER RUM FLAVORBUTTERSCOTCH FLAVORCAPSUBLEND-H

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

CAPSUBLEND-PCAPSUBLEND-SCARAMEL FLAVORCARRAGEENANCETYL ALCOHOLCHEESE-ADE FLAVORCHEESECAKE FLAVORCHEMSIL K-12CHEMSIL K-51CHERRY FLAVORCHERRY-ADE FLAVORCHEW-HESIVECHICKEN BROTH FLAVORCHICKEN FLAVOR OILSOLUBLECHICKEN FLAVOR WATERMISCIBLECHICKEN FLAVORCHLOROBUTANOLANHYDROUSCHLOROBUTANOLCHOCOLATE FLAVORCHOCOLATE HAZELNUTFLAVORCINNAMON FLAVORCLOVAGELCOCOA BUTTERCOCONUT FLAVORCOFFEE FLAVORCOLA FLAVORCOLLASIL OSACOLLODIONCOTTON CANDY FLAVORCRAN-RASPBERRY FLAVORCREME DEMENTHE FLAVORCUSTOM LIPOTHENE 110CUSTOM LIPOTHENE 133CUSTOM POLYGLYCOLTROCHE BASEDERMASHIELD HYDROGELDILUENT FOR TREPROSTINILEFFERVESCENT BASEEMULGADE CMEMULSIFYING WAXEMULSION CONCENTRATEENGLISH TOFFEE FLAVORETHYL ACETATEEUCALYPTUS FLAVOREUGENOL FLAVOREVANS BLUEEXQUISITE HRTF-MELTFAGRON CAPFILL PROFAGRON DISPERSAPROFD&C YELLOW #5FD&C YELLOW #6ALUMINUM LAKEFDC BLUE 1FDC BLUE 2FDC GREEN #3FDC RED #3FDC RED 40FDC YELLOW 6FISH FLAVOR

FIXED OIL SUSPENSIONFIZZMIX BASEFLAVOR CONC-CHLORHEXIDINEFOOD COLOR BLACKFOOD COLOR BLUEFOOD COLOR BROWNFOOD COLOR GREENFOOD COLOR LIME GREENFOOD COLOR ORANGEFOOD COLOR PINKFOOD COLOR REDFOOD COLOR VIOLETFOOD COLOR WHITEFOOD COLOR YELLOW #5ALUM LAKEFOOD COLOR YELLOWFP CEPAFP DERMFP NATURALFP SILOFREEDOM ADAPTADERMFREEDOM CEPAPROFREEDOM LOLLIPOP BASEFREEDOM ODT BASEFREEDOM PEG TROCHEBASEFREEDOM POLOXITOLFREEDOM POLYMATRIXFREEDOM SET-GELFREEDOM SILOMACANHYDROUSFREEDOM SILOMAC ULTRAFREEDOM SIMPLECAPFREEDOM TRIBLEND BASEGELATINGRAPE FLAVORGRAPEFRUIT FLAVORGUAVA FLAVORGUM ARABICGUM BASE (GELATIN)H20 GEL BASEHAM FLAVORHONEY FLAVORHORMONE CREAM BASEHRT BASE (MEN)HRT BASEHRT BOTANICALHRT CREAM BASE WOMENHRT CREAM BASEHRT CREAMHRT ESSENTIALHRT HEAVYHRT NATURAL BASEHRT NATURAL CREAM BASEHRT NATURALHRT SUPREME CREAM BASEHSA STERILE DILUENT [INJ]ISOMALT LOLLIPOP BASEKAHLUA FLAVORKARAYA GUMKRIS-ESTER 236LACTOSE ANHYDROUSLACTOSE MONOHYDRATE

LACTOSELANOLIN ALCOHOLlanolinLECITHIN-ISOPROPYLPALMITATELEMON EXTRACTLEMON FLAVORLEMONADE FLAVORLICORICE FLAVORLIDOCAINE-PRILOCAINE(BULK)LIME FLAVORLIPMAXLIPOGEL CR BASELIPOPEN ANHYDROUSLIQUIGEL COMPLEXLISSAMINE GREEN BLIVER FLAVORLOXORAL BASELUBRAJEL NPMAGNESIUM STEARATEMANGO FLAVORSWEETENEDMANGO FLAVORMAPLE FLAVORMARSHMALLOW FLAVORMEDI-RDT BASEMEDI-RDTMEDIBASE CMETER BUFFERMETHYLCELLULOSEMETHYLPARABEN SODIUMMETHYLPARABENMINT CHOCOLATE CHIPFLAVORMOLASSES FLAVORMUCOLOXMYRJ 53NOVAFILMOINTMENT BASE(EMULSIFYING)OLEABASE PLASTICIZEDOLEIC ACIDORANGE CREAM FLAVORORANGE FLAVORORANGE OIL FLAVORPARAFFINPASSION FRUIT FLAVORSWEETENEDPASSION FRUIT FLAVORPCCA CUSTOM TROCHEBASE (LS)PCCA EMULSIFIX-205 BASEPCCA FIXED OIL BASEPCCA GELATIN BASEPCCA LECITHIN ISOPROPYLPALMPCCA LIPODERM HMWPCCA LOXASPERSE BASEPCCA OCCLUSADERMPCCA PLASTICIZED BASEPCCA PLURONIC F127 BASEPCCA POLOXAMER 407PCCA POLYGLYCOL TROCHE

PCCA PRACAMAC BASEPCCA RAPID DISSOLVETABLETPCCA SORBITOL LOLLIPOPBASEPCCA SPIRA-WASH BASEPCCA SWEETNESSENHANCERPCCA XYLIFOS BASEPEACH FLAVORPEANUT BUTTER FLAVORPEG 300PEPPERMINT FLAVORPH BUFFERPINA COLADA FLAVORPINEAPPLE FLAVORPLASTIBASEPLASTICIZED BASEPLURONIC F127PLURONIC L64PLURONICPOLOXAMER 188POLOXAMER 407POLYETHYLENE GLYCOL1000POLYETHYLENE GLYCOL1450POLYETHYLENE GLYCOL1500POLYETHYLENE GLYCOL 300POLYETHYLENE GLYCOL3350POLYETHYLENE GLYCOL 400POLYETHYLENE GLYCOL4500POLYETHYLENE GLYCOL 600POLYETHYLENE GLYCOL8000POLYETHYLENE GLYCOLPOLYMAC PROGELPOLYOXYL 40 STEARATEPOLYPEGPOTASSIUM SORBATEPRALINES AND CREAMFLAVORPROPYLPARABEN SODIUMPROPYLPARABENPUMPKIN FLAVORQUINIZARIN GREEN SSRASPBERRY CONCENTRATERASPBERRY FLAVORRDT-PLUSREGENT ALCOHOLRENEWCREAM HRTROOT BEER FLAVORsaline bacteriostatic [INJ]SEPINEO P 600SHEA BUTTER ORGANICSHEA BUTTERSHRIMP FLAVORSIMPLGEL 30SODIUM BENZOATEsodium chloridebacteriostatic [INJ]

SODIUM LAURYL SULFATESODIUM THIOSULFATESOLU-KSORBIC ACIDSORBITOL CANDY BASESPEARMINT FLAVORSPG SUPPOSI-BASESTEARIC ACIDSTEARYL ALCOHOLsterile diluent/epoprostenolsterile water for injection[INJ]sterile water for injectionSTEVIA GLYCERITE EXTRACTSTRAWBERRY FLAVORSULPHAN BLUESUPER SYNERSWEETFLAVORSUPPOSI-PURESUPPOSITORY BLENDSWEET CORN FLAVORSWEETENING ENHANCERSYNAPSINTANGERINE FLAVORSWEETENEDTANGERINE FLAVORTEABERRY FLAVORTOMMY GELTRAGACANTHTROCHE BASETROLAMINETROPICAL PUNCH FLAVORTRYPAN BLUETUNA FLAVORTUTTI FRUTTI FLAVORTUTTI-FRUTTI FLAVORUCARE POLYMER JR-400VANILLA BUTTERNUTFLAVORVANILLA FLAVORVANILLIN FLAVORVERSABASEVERSAPRO ANHYDROUSBASEVERSAPROWATERMELON FLAVORWAX, WHITEWHITE BEES WAXWILD CHERRY FLAVORWILEY BASIC ELEMENTSBHRT BASEWITEPSOLWOUND WASH BASEXANTHAN GUMZOSIL

PROGESTINS

AYGESTINEC-RX PROGESTERONEMEGACE ESNORETHINDRONE ACETATEPROGESTERONECOMPOUNDING KIT

PROGESTERONEMICRONIZEDprogesteronePROMETRIUMPROVERA

PSYCHOTHERAPEUTICAND NEUROLOGICALAGENTS - MISC.

acamprosate calciumQL

ADDYIQL, PA

ANTABUSEQL

ARICEPTQL

BRISDELLEQL

bupropion hcl er (smokingdet)QL

donepezil hclQL

EXELONQL

fluoxetine hcl (pmdd)FLUOXETINE HCL (PMDD)galantamine hydrobromideerQL

GALANTAMINEHYDROBROMIDEQL

LUCEMYRAQL, PA

LYRICA CRQL, ST

memantine hcl erQL, ST

NAMENDA TITRATIONPAKQL

NAMENDA XRQL

NAMENDANICOTROL NSNICOTROLolanzapine-fluoxetine hclQL

ORAPparoxetine mesylateQL

pimozidepregabalin erST

RAZADYNE ERQL

RAZADYNEQL

rivastigmine tartrateQL

rivastigmineQL, ST

SARAFEMSYMBYAXQL

ZYBANQL

RESPIRATORY AGENTS -MISC.

BRONCHITOL TOLERANCETESTQL, PA, †

BRONCHITOLQL, PA, †

SURVANTA

SULFONAMIDES

SULFADIAZINE SODIUMSULFADIAZINESULFAMETHOXAZOLEMICROSULFAMETHOXAZOLESULFAPYRIDINESULFATHIAZOLESULFISOXIZOLE

TETRACYCLINES

ADOXA PAK 1/100ADOXA PAK 1/150

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ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

ADOXA PAK 2/100ADOXAavidoxydemeclocycline hcldoxy 100DOXYCYCLINE HYCLATEPA

doxycycline monohydrateMINOCINMINOCYCLINE HCLmondoxyne nlMONODOXmorgidoxNUZYRAQL, PA

okeboOXYTETRACYCLINE HCLSEYSARAQL, PA, AE

soloxidePA

tetracycline hclTIGECYCLINETYGACILVIBRAMYCINXERAVAPA

THYROID AGENTS

CYTOMELeuthyroxlevo-tLEVOTHYROXINE SODIUMlevoxylliothyronine sodiumMETHIMAZOLENATURE-THROIDnp thyroidpropylthiouracilTAPAZOLETHYQUIDITYTHYROIDTHYROLAR-1/2THYROLAR-1/4THYROLAR-1THYROLAR-2THYROLAR-3unithroidWP THYROID

ULCERDRUGS/ANTISPASMODICS/ANTICHOLINERGICS

ACIPHEX SPRINKLEQL, ST

ACIPHEXamoxicill-clarithro-lansoprazQL

ANASPAZATROPENATROPINE SULFATEMONOHYDRATEatropine sulfate [INJ]ATROPINE SULFATE [INJ]BENTYLCARAFATEchlordiazepoxide-clidiniumcimetidine hclCIMETIDINECYTOTECdicyclomine hcl

DONNATALed-spazesomeprazole magnesiumQL,

ST

esomeprazole sodiumESOMEPRAZOLESTRONTIUMfamotidineFIRST-LANSOPRAZOLEFIRST-OMEPRAZOLEGLYCOPYRROLATE PF [INJ]glycopyrrolate [INJ]glycopyrrolateGLYRX-PF [INJ]hyoscyamine sulfate erhyoscyamine sulfate slhyoscyamine sulfate [INJ]HYOSCYAMINE SULFATEhyosyneISOPROPAMIDE IODIDElansoprazoleLEVBIDLEVSIN/SLLEVSIN [INJ]LEVSINLIBRAXmethscopolamine bromidemisoprostolnizatidinenulevOMEPRAZOLE+SYRSPENDSF ALKAomeprazoleoscimin srosciminpantoprazole sodiumQL, ST

pb-hyoscy-atropine-scopolaminePEPCIDphenobarbital-belladonnaalkphenohytroPREVACID SOLUTABPREVACIDPREVPACPROPANTHELINE BROMIDEPROTONIXQL

PYLERAQL

rabeprazole sodiumRANITIDINE HCL [INJ]ranitidine hclROBINUL-FORTEROBINUL [INJ]ROBINULSCOPOLAMINE HBRSUCRALFATESYMAX DUOTABsymax-slsymax-srZANTAC [INJ]ZANTAC

URINARYANTISPASMODICS

darifenacin hydrobromideerQL, ST

DETROL LAQL

DETROLDITROPAN XLENABLEXQL

flavoxate hclGEMTESAQL, ST

oxybutynin chloride eroxybutynin chlorideOXYTROLQL

solifenacin succinateQL, ST

tolterodine tartrate erQL, ST

tolterodine tartratetrospium chloride erQL, ST

trospium chlorideURECHOLINEVESICARE LSQL

VESICAREQL

VACCINES

BIOTHRAXVAXCHORA

VAGINAL AND RELATEDPRODUCTS

AVC VAGINALCLINDESSEFEMRINGQL

FIRST-PROGESTERONE VGSGYNAZOLE-1IMVEXXY MAINTENANCEPACKQL

IMVEXXY STARTER PACKQL

METROGEL-VAGINALNUVESSAPHEXXIQL

TERAZOL 7terconazoleVAGIFEMvandazoleyuvafem

VASOPRESSORS

ADRENACLICKQL [INJ]EPHEDRINE SULFATE(PRESSORS) [INJ]ephedrine sulfate [INJ]epinephrine (anaphylaxis)[INJ]EPINEPHRINE HCL-DEXTROSEEPINEPHRINE HCL-NACLepinephrine pf [INJ]EPINEPHRINEQL, PA [INJ]LEVOPHEDmidodrine hclnorepinephrine bitartrateNOREPINEPHRINE-DEXTROSENOREPINEPHRINE-SODIUMCHLORIDEPHENYLEPHRINE HCL(PRESSORS)

PHENYLEPHRINE HCL-DEXTROSEPHENYLEPHRINE HCL-NACLVAZCULEP

VITAMINS

AMINOBENZOATEPOTASSIUMAMINOBENZOIC ACIDascorbic acid [INJ]CALCIUM ASCORBATECALCIUM PANTOTHENATECALCIUM-D-PANTOTHENATEDRISDOLERGOCALCIFEROLERGOCALmega-c/a plus [INJ]MEPHYTONNIACINAMIDENIACINortho-cs 250 [INJ]PARA-AMINOBENZOIC ACIDphytonadione [INJ]POTABAPOTASSIUMAMINOBENZOATEPYRIDOXINE HCL [INJ]PYRIDOXINE HCLsodium ascorbate [INJ]SODIUM ASCORBATEthiamine hcl [INJ]THIAMINE HCLTHIAMINE MONONITRATEvitamin d (ergocalciferol)vitamin k1 [INJ]

ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.

FORMULARIO ENFOQUE CLINICO

LEYE

ND

A

[INJ]: fármaco inyectable

ER: liberación prolongada

DR: liberación retardada

AE: especificación de edad

LD: distribución limitada

PA: autorización previa

QL: límite de cantidad

ST: terapia escalonada

† Indica medicamentos deespecialidad

Para el miembro: Es posible que el diseño específico de su plan de beneficios de medicamentos no cubradeterminados productos o categorías, independientemente de que aparezcan en este documento. Puedeque los productos reciente-mente aprobados por la Administración de Medicamentos y Alimentos (FDA,Food and Drug Administration) de los EE. UU. no estén cubiertos tras su lanzamiento al mercado.

WellDyne podrá comunicarse con su proveedor tras recibir una receta para solicitar la consideración de unproducto que figura en la lista de fármacos o de un equivalente genérico. Esto puede dar como resultadoque su proveedor recete, cuando sea clínicamente apropiado, un producto de marca diferente o unequivalente genérico en lugar del producto original. Los medicamentos genéricos contienen los mismosingredientes activos que los correspondientes medicamentos de marca, aunque pueden ser de color oforma diferente. Han sido aprobados por la FDA, de acuerdo con estrictas normas.

En la mayoría de los casos, cuando un producto genérico se hace disponible, el fármaco de marcacorrespondiente se designará como no preferido o la opción se excluirá tras el lanzamiento al mercado delproducto genérico.

Para el médico: Los genéricos deben considerarse primero a la hora de recetar. Recete productos preferidosy permita sustituciones por genéricos cuando sea clínicamente adecuado. Los fármacos de marca seenumeran con letras MAYÚSCULAS, mientras que los genéricos se enumeran en letras minúsculas.

Esta lista de fármacos es un resumen de la cobertura de medicamentos, no incluye todas las opcionesposibles y no garantiza la cobertura. Es posible que el diseño específico del plan de beneficios demedicamentos del miembro no cubra determinados productos o categorías, independientemente de queaparezcan en este documento. Puede que los productos recientemente aprobados por la FDA no esténcubiertos tras su lanzamiento al mercado.

ACTUALIZADA EL 9/1/2021. ESTA LISTA ESTÁ SUJETA A CAMBIO.©2021 Todos los derechos reservados.