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Lista de medicamentos aprobados del Mercado de California de Kaiser Permanente, 2017 • Página 1 de 51

Lista de medicamentos

aprobados del Mercado

de California de 2017 (Lista de medicamentos cubiertos)

FAVOR DE LEER: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS

QUE CUBRIMOS CUANDO PARTICIPA EN UN PLAN DE SALUD CALIFICADO OFRECIDO POR

KAISER PERMANENTE QUE INCLUYE EL MERCADO DE SEGUROS DE SALUD (EN CALIFORNIA,

EL MERCADO SE CONOCE COMO COVERED CALIFORNIA).

Esta lista de medicamentos aprobados fue actualizada el 09/28/2017 y entra en vigencia el 1º de Octubre 2017. Para información más reciente u otras preguntas, llame a nuestra Central de Llamadas de Servicio a los Miembros, las 24 horas del día, los siete días de la semana (excepto los días festivos). 1-800-788-0616 en español, 1-800-464-4000 en inglés, 1-800-757-7585 en dialectos chinos, 711 Línea TTY para personas con problemas auditivos o del habla.

¿Qué es la Lista de medicamentos aprobados del Mercado de California de Kaiser Permanente?

La Lista de medicamentos aprobados del Mercado de California (California Marketplace Formulary) es una lista de

los medicamentos cubiertos elegidos por un grupo de médicos y farmacéuticos de Kaiser Permanente que se

conocen como el Comité de Farmacia y Terapéutica (Pharmacy and Therapeutics Committee). El Comité se reúne

periódicamente para evaluar y seleccionar medicamentos que son seguros y eficaces para nuestros miembros.

Esta Lista de medicamentos aprobados cumple con los requisitos delineados en las regulaciones federales de

Planes de Salud Calificados (Qualified Health Plans) que se ofrecen en un mercado de seguros de salud (en

California, el mercado se conoce como Covered California).

¿Qué medicamentos están cubiertos?

En general, Kaiser Permanente cubrirá medicamentos de marca y genéricos incluidos en la Lista de medicamentos

aprobados del Mercado de California siempre que el medicamento sea necesario desde el punto de vista médico,

se surte el medicamento recetado en una farmacia de Kaiser Permanente o una farmacia afiliada, y se siguen otras

reglas de cobertura.

Si a usted le recetan un medicamento incluido que la Lista de medicamentos aprobados del Mercado de California,

el medicamento se cubrirá de conformidad con los términos de su beneficio de medicamentos.


Cómo obtener una excepción a la lista de medicamentos aprobados

Los medicamentos que no figuran en la lista de medicamentos aprobados se llaman medicamentos no incluidos

en la lista de medicamentos aprobados (non-formulary drugs). Si un médico de Kaiser Permanente determina

que un medicamentos que no está incluido en la lista de medicamentos aprobados es apropiado y necesario

desde el punto de vista médico, ese medicamento estará cubierto según los términos de sus beneficios (si tiene

un beneficio de medicamentos recetados). Si no tiene un beneficio de medicamentos recetados, tendrá que

pagar el precio minorista total del medicamento.

La manera más efectiva de obtener una excepción a la lista de medicamentos aprobados es enviar un correo

electrónico seguro a su médico. Usted y su médico son quienes mejor pueden determinar los medicamentos que

usted necesita.

También puede comunicarse con Servicio a los Miembros, llenando un formulario en línea. O llame a Servicio a

los Miembros, las 24 horas del día, los 7 días de la semana.

¿Hay alguna restricción a los medicamentos cubiertos por la Lista de medicamentos aprobados?

Algunos medicamentos cubiertos pueden tener requisitos o límites de cobertura adicionales, como por ejemplo

límites a la cantidad. Para determinados medicamentos, Kaiser Permanente puede limitar la cantidad del

medicamento que se dispensa a un suministro de una determinada cantidad de días. Además, cuando haya

escasez nacional de un medicamento, podríamos limitar la cantidad dispensada del medicamento.

¿Qué es un medicamento de marca?

Los medicamentos de marca en general son fabricados y vendidos por la compañía farmacéutica que hizo la

investigación y el desarrollo original del medicamento. Cuando vence la patente del medicamento de marca, otras

compañías farmacéuticas pueden fabricar y vender una versión genérica del medicamento aprobada por la FDA

con el/los mismo(s) ingrediente(s) activo(s) a un precio menor.

¿Qué es un medicamento genérico?

Un medicamento genérico está aprobado por la FDA al tener el mismo ingrediente activo que el medicamento de

marca. En general los medicamentos genéricos tienen menor costo que los medicamentos de marca.

¿Qué medicamentos pueden ser enviados desde la farmacia de pedido por correo?

La mayoría de los medicamentos pueden ser enviados desde nuestra farmacia de pedido por correo. Es posible

que algunos medicamentos (por ejemplo, medicamentos que tienen un costo extremadamente alto o que requieren

cuidados especiales) no se puedan enviar por correo. Los medicamentos no se pueden enviar fuera de los Estados

Unidos.

Usted puede pedir el resurtido de medicamentos recetados a través de nuestro servicio de pedido por correo en línea en kp.org/refill (en inglés) o por teléfono o con la aplicación móvil. No hay un cargo adicional por pedir los resurtidos por correo. Se aplicará el costo compartido apropiado (según su beneficio de medicamentos recetados).

Su beneficio de medicamentos recetados puede tener un menor costo compartido si usa la farmacia de pedido por correo.

Consulte su Evidencia de Cobertura (Evidence of Coverage) o su Certificado de Seguro (Certificate of Insurance)

para información detallada sobre sus beneficios de medicamentos recetados.

http://kp.org/refill


Lista de medicamentos aprobados del Mercado de California de Kaiser Permanente

Kaiser Permanente puede agregar o eliminar medicamentos de la Lista de medicamentos aprobados del Mercado de California en cualquier momento del año. Estos cambios a la Lista de medicamentos aprobados están basados en información nueva o medicamentos nuevos disponibles.

La Lista de medicamentos aprobados del Mercado de California más reciente empieza en la página 4; proporciona información sobre la cobertura de algunos de los medicamentos cubiertos por Kaiser Permanente. Además puede buscar los medicamentos en forma alfabética usando el índice que empieza en la página 31.

La primera columna de la tabla indica el nombre del medicamento. Los nombres de marca aparecen en mayúscula (ej. ALBENZA) y los medicamentos genéricos aparecen en minúscula y letra cursiva (ej. amoxicillin).

El posible que no se incluyan en la Lista de medicamentos aprobados todas las formas y concentraciones de las dosis de un determinado medicamento. Algunos medicamentos están disponibles en múltiples dosis. En dichos casos, es posible que algunas dosis estén en la Lista de medicamentos aprobados y otras no. Nota: Algunos de estos medicamentos pueden estar disponibles solo en un entorno clínico.

La segunda columna “Nivel del medicamento” indicará el número de nivel en que se encuentra el medicamento. Los medicamentos en la Lista de medicamentos aprobados del Mercado de California están categorizados en tres niveles.

Nivel 1 – Nivel genérico

Nivel 2 – Nivel de marca

Nivel 4 – Nivel especializado

Nota: El nivel de clasificación de un medicamento genérico o de marca puede cambiar en cualquier momento del año. Además, determinados medicamentos de marca pueden estar cubiertos con el costo compartido que se aplica al Nivel 1 y determinados medicamentos genéricos pueden estar cubiertos con el costo compartido que se aplica al Nivel 2. El Nivel 4 es para medicamentos especializados que se cubren con un costo compartido mayor.

La tercera columna de la tabla indicará cualquier requisito o límite para ese medicamento:

QL = Límites de cantidad (Quantity Limits): Para determinados medicamentos podremos limitar la cantidad del medicamento que pueda recibir. Además, cuando haya escasez nacional de un medicamento, podremos limitar la cantidad dispensada del medicamento.


Nombre del medicamento

Nivel del

medicamento

Requisitos/ Límites

ANTI-INFECTIVE AGENTS

ANTHELMINTICS

ALBENZA 2

BILTRICIDE 2

ivermectin 1

PREZCOBIX 2

ANTI-HIV AGENTS

abacavir sulfate 1, 2

abacavir sulfate-lamivudine

1

abacavir sulfate-lamivudine-zidovudine

1

APTIVUS 2

ATRIPLA 2

COMPLERA 2

CRIXIVAN 2

didanosine 1, 2

EDURANT 2

EMTRIVA 2

FUZEON 2 QL

INTELENCE 2

INVIRASE 2

ISENTRESS 2

KALETRA 2

lamivudine 1

lamivudine-zidovudine 1

LEXIVA 2

nevirapine 1, 2

NORVIR 2

PREZISTA 2

RESCRIPTOR 2

REYATAZ 2

SELZENTRY 2

stavudine 1

STRIBILD 2

SUSTIVA 2

TIVICAY 2

TRIUMEQ 2

TRUVADA 2

VIRACEPT 2

VIREAD 2

zidovudine 1, 2

ANTIBACTERIALS

amikacin sulfate 1

amoxicillin 1, 2


Nivel del

medicamento


amoxicillin & pot clavulanate

1, 2

ampicillin 1, 2

ampicillin & sulbactam sodium

1

ampicillin sodium 1, 2

AVELOX 2

AZACTAM IN DEXTROSE

2

azithromycin 1, 2

aztreonam 1

bacitracin 1

BACTOCILL IN DEXTROSE

2

BICILLIN L-A 2

CAYSTON 4 LD

cefaclor 1

cefadroxil 1

CEFAZOLIN IN D5W 1

cefazolin sodium 1

CEFAZOLIN SODIUM-DEXTROSE

2

cefdinir 1

cefepime hcl 1

CEFEPIME-DEXTROSE 2

CEFOTAXIME SODIUM 1

cefotetan disodium 1

CEFOTETAN DISODIUM-DEXTROSE

2

cefoxitin sodium 1

CEFOXITIN SODIUM-DEXTROSE

2

cefpodoxime proxetil 1

ceftazidime 1, 2

ceftriaxone sodium 1

CEFTRIAXONE SODIUM IN DEXTROSE

1

CEFTRIAXONE SODIUM-DEXTROSE

2

cefuroxime axetil 1, 2

cefuroxime sodium 1, 2

CEFUROXIME-DEXTROSE

2

cephalexin 1, 2



Nivel del

medicamento


CHLORAMPHENICOL SOD SUCCINATE

2

ciprofloxacin 1, 2

ciprofloxacin hcl 1

ciprofloxacin in d5w 1

clarithromycin 1

CLEOCIN IN D5W 2

clindamycin hcl 1

clindamycin palmitate hydrochloride

1, 2

clindamycin phosphate 1

CUBICIN 4

demeclocycline hcl 1

dicloxacillin sodium 1

doxycycline (monohydrate)

1

doxycycline hyclate 1

ERYTHROCIN LACTOBIONATE

2

FLUCONAZOLE IN SODIUM CHLORIDE

1

FORTAZ IN D5W 2

gentamicin in saline 1, 2

gentamicin sulfate 1

INVANZ 4

levofloxacin 1

levofloxacin in d5w 1

linezolid 1, 4

meropenem 1

minocycline hcl 1, 2

moxifloxacin hcl 1

nafcillin sodium 1

NAFCILLIN SODIUM IN DEXTROSE

2

neomycin sulfate 1

oxacillin sodium 1

PENICILLIN G POT IN DEXTROSE

2

penicillin g potassium 1

PENICILLIN G PROCAINE

2

PENICILLIN G SODIUM 2

penicillin v potassium 1

piperacillin sodium-tazobactam sodium

1


Nivel del

medicamento


PRIMAXIN IV 2

PRIMSOL 2

STREPTOMYCIN SULFATE

2

SULFADIAZINE 2

sulfamethoxazole-trimethoprim

1, 2

sulfasalazine 1

SUPRAX 2

SYNERCID 4

TETRACYCLINE HCL 2

tobramycin 1, 4

tobramycin sulfate 1

vancomycin hcl 1

VANCOMYCIN HCL IN DEXTROSE

2

XIFAXAN 2 QL

ZINACEF IN STERILE WATER

2

ZOSYN 2

ANTIFUNGALS

ABELCET 2

AMBISOME 4

AMPHOTERICIN B 2

CANCIDAS 4

fluconazole 1

fluconazole in dextrose 1

fluconazole in nacl 1

flucytosine 1

griseofulvin microsize 1, 2

griseofulvin ultramicrosize 1

itraconazole 1, 2

ketoconazole 1

nystatin 1

nystatin (mouth-throat) 1

terbinafine hcl 1

voriconazole 1, 2

ANTIHEPATITIS C AGENTS

HARVONI 4 QL

PEG-INTRON REDIPEN 4 QL

PEGASYS 4 QL

ribavirin (hepatitis c) 1

SOVALDI 4 QL

ANTIMYCOBACTERIALS

CAPASTAT SULFATE 2



Nivel del

medicamento


CYCLOSERINE 2

dapsone 1

ethambutol hcl 1

isoniazid 1, 2

PRIFTIN 2

pyrazinamide 1

rifabutin 1

RIFAMATE 2

rifampin 1

TRECATOR 2

ANTIPROTOZOALS

ALINIA 2

atovaquone 1

atovaquone-proguanil hcl 1

chloroquine phosphate 1

COARTEM 2

DARAPRIM 2

hydroxychloroquine sulfate

1

mefloquine hcl 1

metronidazole 1

metronidazole in nacl 1, 2

NEBUPENT 2

paromomycin sulfate 1

PRIMAQUINE PHOSPHATE

2

YODOXIN 2

ANTIVIRALS

acyclovir 1

acyclovir sodium 1

adefovir dipivoxil 1

cidofovir 1

DAKLINZA 4

DESCOVY 2

entecavir 1, 4

EPCLUSA 4 QL

EVOTAZ 2

famciclovir 1

FOSCAVIR 2

ganciclovir sodium 1

GENVOYA 2

lamivudine (hbv) 1, 2

ODEFSEY 2

oseltamivir phosphate 1, 2

RELENZA DISKHALER 2


Nivel del

medicamento


rimantadine hydrochloride 1

SELZENTRY 2

SYNAGIS 4

TIVICAY 2

TRUVADA 2

valacyclovir hcl 1

valganciclovir hcl 1, 4 QL

VIRAZOLE 4

voriconazole 1

URINARY ANTI-INFECTIVES

methenamine hippurate 1

nitrofurantoin 1

nitrofurantoin macrocrystal

1, 2

nitrofurantoin monohyd macro

1

trimethoprim 1

ANTIHISTAMINE DRUGS

FIRST GENERATION ANTIHISTAMINES

chlorpheniramine & phenylephrine

1

cyproheptadine hcl 1

diphenhydramine hcl 1

promethazine hcl 1

ANTINEOPLASTIC AGENTS


ABRAXANE 4

ADCETRIS 2

AFINITOR 4 QL

ALECENSA 4 QL

ALIMTA 4

ALKERAN 2

ALUNBRIG 4 QL

anastrozole 1

ARRANON 4

AVASTIN 4

azacitidine 1

BENDEKA 2, 4

bicalutamide 1

BICNU 2

bleomycin sulfate 1

BLINCYTO 4

CABOMETYX 4 QL, LD

CAMPTOSAR 1, 2

capecitabine 1 QL



Nivel del

medicamento


CAPRELSA 4 QL, LD

cisplatin 1

cladribine 1

COSMEGEN 4

COTELLIC 4 QL

cyclophosphamide 1, 2

CYRAMZA 4

cytarabine 1, 2

dacarbazine 1, 2

DACOGEN 4

daunorubicin hcl 1

DAUNOXOME 2

DEPOCYT 2

DOCETAXEL 1, 2, 4

doxorubicin hcl 1

doxorubicin hcl liposomal 1, 2

EMCYT 4 QL

ERBITUX 4

ERIVEDGE 4 QL

ERWINAZE 2

etoposide 1, 2

exemestane 1

FASLODEX 4 QL

fludarabine phosphate 1

fluorouracil 1

flutamide 1

GAZYVA 4

gemcitabine hcl 1, 4

GLEOSTINE 2

HALAVEN 4

HERCEPTIN 4 QL

HEXALEN 4

hydroxyurea 1

IBRANCE 4 QL

idarubicin hcl 1, 2

ifosfamide 1

IFOSFAMIDE-MESNA 2

imatinib mesylate 1 QL

IMBRUVICA 4 QL

INTRON A 4 QL

IRESSA 2 QL

ISTODAX 4

IXEMPRA KIT 4

JAKAFI 4 QL

JEVTANA 4


Nivel del

medicamento


KADCYLA 4

KEYTRUDA 4

KYPROLIS 4 QL

LENVIMA 10 MG DAILY DOSE

4 QL

letrozole 1

LEUKERAN 2

leuprolide acetate 1, 2

LONSURF 4 QL

LUPRON DEPOT (3-MONTH)

2


2


2

LUPRON DEPOT-PED (1-MONTH)

2

LUPRON DEPOT-PED (3-MONTH)

2

LYNPARZA 4 QL, LD

LYSODREN 2 QL

MARQIBO 4

MATULANE 4 QL

megestrol acetate 1

MEKINIST 4 QL

melphalan hcl 1

mercaptopurine 1, 4 QL

methotrexate sodium 1

mitomycin 1

mitoxantrone hcl 1

MUSTARGEN 2

MYLERAN 4

NEXAVAR 4 QL

NINLARO 4 QL

ODOMZO 4 QL

ONCASPAR 4

OPDIVO 4

oxaliplatin 1

paclitaxel 1

pentostatin 1

PERJETA 4

POMALYST 4 QL

PROLEUKIN 4

REVLIMID 2 QL

RITUXAN 2



Nivel del

medicamento


RYDAPT 4 QL

SPRYCEL 4 QL

STIVARGA 4 QL

SUTENT 4 QL

SYLVANT 4

TABLOID 2

TAFINLAR 4 QL

TAGRISSO 4 QL

tamoxifen citrate 1

TARCEVA 4 QL

TARGRETIN 2

TASIGNA 4 QL

TECENTRIQ 4 QL

temozolomide 1

TENIPOSIDE 2

thiotepa 1

topotecan hcl 1, 4 QL

TORISEL 4

tretinoin (chemotherapy) 1 QL

TRISENOX 4

TYKERB 4 QL

UNITUXIN 4

VELCADE 4

VENCLEXTA 4 QL

VINBLASTINE SULFATE 2

vincristine sulfate 1

vinorelbine tartrate 1

VOTRIENT 4 QL

XALKORI 4 QL

XGEVA 4 QL

XTANDI 4 QL

YERVOY 4

YONDELIS 4

ZANOSAR 4

ZEJULA 4 QL

ZELBORAF 4 QL

ZYDELIG 4 QL

ZYKADIA 4 QL

ZYTIGA 4 QL

AUTONOMIC DRUGS

ANTICHOLINERGIC AGENTS

atropine sulfate 1

ATROVENT HFA 2

BELLADONNA ALKALOIDS-OPIUM

2


Nivel del

medicamento


chlordiazepoxide hcl-clidinium bromide

1

dicyclomine hcl 1, 2

DONNATAL 2

glycopyrrolate 1, 2

hyoscyamine sulfate 1, 2

ipratropium bromide 1

ipratropium bromide (nasal)

1

PROPANTHELINE BROMIDE

2

SCOPOLAMINE HBR 2

SPIRIVA RESPIMAT 2

STIOLTO RESPIMAT 2

AUTONOMIC DRUGS, MISCELLANEOUS

CHANTIX 2

nicotine 1

nicotine polacrilex 1, 2

PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS

bethanechol chloride 1

donepezil hydrochloride 1

ENLON 2

galantamine hydrobromide

1

GUANIDINE HCL 2

neostigmine methylsulfate 1, 2

PHYSOSTIGMINE SALICYLATE

2

pilocarpine hcl (oral) 1

pyridostigmine bromide 1, 2

SKELETAL MUSCLE RELAXANTS

atracurium besylate 1

baclofen 1, 2

cisatracurium besylate 1

cyclobenzaprine hcl 1

dantrolene sodium 1, 2

methocarbamol 1

PANCURONIUM BROMIDE

1

QUELICIN 2

rocuronium bromide 1

tizanidine hcl 1

vecuronium bromide 1



Nivel del

medicamento


SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS

dihydroergotamine mesylate

1, 2

ERGOMAR 2

guanfacine hcl 1

phenoxybenzamine hcl 1

PHENTOLAMINE MESYLATE

2

SYMPATHOMIMETIC (ADRENERGIC) AGENTS

ADVAIR DISKUS 2

albuterol sulfate 1, 2

dobutamine hcl 1

dobutamine in d5w 1

dopamine hcl 1, 2

dopamine in d5w 1

ephedrine sulfate (pressors)

1

EPINEPHRINE 2

epinephrine hcl 1

ipratropium-albuterol 1

isoproterenol hcl 1, 2

METAPROTERENOL SULFATE

2

midodrine hcl 1

norepinephrine bitartrate 1

phenylephrine hcl (pressors)

1

SEREVENT DISKUS 2

STRIVERDI RESPIMAT 2

terbutaline sulfate 1

BLOOD DERIVATIVES

BLOOD DERIVATIVES

albumin, human 1

PLASMANATE 2

BLOOD FORMATION, COAGULATION, AND THROMBOSIS

ANTIANEMIA DRUGS

INFED 2

polysaccharide iron complex

1

PROFERRIN ES 2

PROFERRIN-FORTE 2

VENOFER 2

ANTIHEMORRHAGIC AGENTS


Nivel del

medicamento


ADVATE 2 QL

AFSTYLA 2 QL

ALPHANATE/VWF COMPLEX/HUMAN

2 QL

ALPHANINE SD 2 QL

aminocaproic acid 1, 2

BENEFIX 2

ELOCTATE 2 QL

GELFILM 2

GELFOAM SPONGE 2

HELIXATE FS 2 QL

HEMOFIL M 2 QL

IDELVION 2 QL

KCENTRA 2

NOVOSEVEN RT 2

PHENOL 2 QL

PRAXBIND 4

PROFILNINE 2 QL

PROTAMINE SULFATE 1

RECOTHROM 2

THROMBIN-JMI 2

tranexamic acid 1

XYNTHA 2 QL

ANTITHROMBOTIC AGENTS

ACD-A NOCLOT-50 2

ACTIVASE 2

anagrelide hcl 1

ANGIOMAX 2

ARGATROBAN 1, 2

aspirin-dipyridamole 1

BRILINTA 2

clopidogrel bisulfate 1

EFFIENT 2

heparin (porcine) in sodium chloride

1, 2

heparin sod (porcine) in d5w

1

heparin sodium (porcine) 1

heparin sodium (porcine) lock flush

1

INTEGRILIN 4

LOVENOX 2 QL

PRADAXA 2

REOPRO 2

THROMBATE III 2



Nivel del

medicamento


TNKASE 2

warfarin sodium 1

HEMATOPOIETIC AGENTS

LEUKINE 4 QL

NEUMEGA 4

NEUPOGEN 4 QL

PROCRIT 2 QL

PROMACTA 4 QL

ZARXIO 2 QL

HEMORRHEOLOGIC AGENTS

pentoxifylline 1

CARDIOVASCULAR DRUGS

ALPHA-ADRENERGIC BLOCKING AGENTS

doxazosin mesylate 1

prazosin hcl 1

tamsulosin hcl 1

terazosin hcl 1

ANTILIPEMIC AGENTS

atorvastatin calcium 1

cholestyramine 1

cholestyramine light 1

colestipol hcl 1

fenofibrate 1

gemfibrozil 1

lovastatin 1

metoprolol succinate 1

pravastatin sodium 1

rosuvastatin calcium 1

simvastatin 1

BETA-ADRENERGIC BLOCKING AGENTS

atenolol 1

atenolol & chlorthalidone 1

bisoprolol & hydrochlorothiazide

1

bisoprolol fumarate 1

BREVIBLOC IN NACL 2

carvedilol 1

esmolol hcl 1

labetalol hcl 1

metoprolol succinate 1

metoprolol tartrate 1

METOPROLOL-HYDROCHLOROTHIAZIDE

1

nadolol 1


Nivel del

medicamento


propranolol hcl 1

sotalol hcl 1

sotalol hcl (afib/afl) 1

CALCIUM-CHANNEL BLOCKING AGENTS

amlodipine besylate 1

CARDENE IV 2

CLEVIPREX 2

diltiazem hcl 1

diltiazem hcl coated beads

1

nicardipine hcl 1

nifedipine 1

nimodipine 1

verapamil hcl 1

CARDIAC DRUGS

adenosine 1

amiodarone hcl 1

digoxin 1, 2

disopyramide phosphate 1, 2

flecainide acetate 1

ibutilide fumarate 1

lidocaine hcl (cardiac) 1, 2

lidocaine in d5w 1

mexiletine hcl 1

milrinone lactate 1

milrinone lactate in dextrose

1

PROCAINAMIDE HCL 2

propafenone hcl 1

quinidine gluconate 1, 2

QUINIDINE SULFATE 1, 2

TIKOSYN 2

HYPOTENSIVE AGENTS

clonidine hcl 1

hydralazine hcl 1

methyldopa 1

METHYLDOPATE HCL 2

minoxidil 1

NITROPRESS 2

PROGLYCEM 4

RESERPINE 2

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS

benazepril hcl 1

captopril 1



Nivel del

medicamento


enalaprilat 1

ENTRESTO 2

lisinopril 1

lisinopril & hydrochlorothiazide

1

losartan potassium 1

losartan potassium & hydrochlorothiazide

1

ramipril 1

spironolactone 1

spironolactone & hydrochlorothiazide

1

valsartan 1

valsartan-hydrochlorothiazide

1

SCLEROSING AGENTS

ETHAMOLIN 2

SOTRADECOL 2

VARITHENA 2

VASODILATING AGENTS

alprostadil 1

CAVERJECT 2 QL

dipyridamole 1

isosorbide dinitrate 1, 2

isosorbide mononitrate 1

LETAIRIS 4 LD

LEVITRA 2 QL

nitroglycerin 1, 2

nitroglycerin in d5w 1, 2

PAPAVERINE HCL 2

REMODULIN 4 LD

sildenafil citrate (pulmonary hypertension)

1 QL

TRACLEER 4 QL, LD

TYVASO 2 QL, LD

VENTAVIS 4 QL, LD

CENTRAL NERVOUS SYSTEM AGENTS

ANALGESICS AND ANTIPYRETICS

acetaminophen w/ codeine

1

alfentanil 1

buprenorphine hcl 1

buprenorphine hcl-naloxone hcl dihydrate

1 QL

butorphanol tartrate 1


Nivel del

medicamento


choline & mag salicylate 1

CODEINE SULFATE 1, 2

etodolac 1

fentanyl 1 QL

fentanyl citrate 1, 2

hydrocodone-acetaminophen

1, 2

hydromorphone hcl 1, 2 QL

ibuprofen 1

indomethacin 1, 2

INDOMETHACIN SODIUM

1

INFUMORPH 200 2

ketorolac tromethamine 1

MECLOFENAMATE SODIUM

2

mefenamic acid 1

meloxicam 1

meperidine hcl 1

methadone hcl 1, 2

morphine sulfate 1, 2

nabumetone 1

nalbuphine hcl 1

naproxen 1

naproxen sodium 1

NEOPROFEN 2

OFIRMEV 2

OPANA 2

oxycodone hcl 1

oxycodone w/ acetaminophen

1

pentazocine w/ naloxone 1

salsalate 1

sufentanil citrate 1

sulindac 1

tramadol hcl 1

tramadol-acetaminophen 1

ULTIVA 2

ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS

amphetamine-dextroamphetamine

1, 2

caffeine citrate 1

dexmethylphenidate hcl 1



Nivel del

medicamento


dextroamphetamine sulfate

1

methylphenidate hcl 1, 2

VYVANSE 2

ANTICONVULSANTS

BANZEL 4

carbamazepine 1, 2

CELONTIN 2

clonazepam 1

divalproex sodium 1

EQUETRO 2

ethosuximide 1

felbamate 1

fosphenytoin sodium 1

gabapentin 1

lamotrigine 1, 2

levetiracetam 1

LEVETIRACETAM IN NACL

2

magnesium sulfate 1, 2

oxcarbazepine 1

phenytoin 1

phenytoin sodium 1

phenytoin sodium extended

1, 2

primidone 1

SABRIL 4 QL, LD

topiramate 1

valproate sodium 1

valproic acid 1

ANTIMANIC AGENTS

LITHIUM 2

lithium carbonate 1

ANTIMIGRAINE AGENTS

ERGOLOID MESYLATES 1

ergotamine w/ caffeine 1, 2

isometheptene-dichloralphenazone-acetaminophen

1

naratriptan hcl 1

rizatriptan benzoate 1

sumatriptan 1

sumatriptan succinate 1

ANTIPARKINSONIAN AGENTS

amantadine hcl 1


Nivel del

medicamento


APOKYN 4 QL

AZILECT 2

benztropine mesylate 1

bromocriptine mesylate 1

cabergoline 1

carbidopa 1, 2

carbidopa-levodopa 1, 4

CARBIDOPA-LEVODOPA-ENTACAPONE

2

entacapone 1

pramipexole dihydrochloride

1

ropinirole hydrochloride 1

selegiline hcl 1

trihexyphenidyl hcl 1

ANXIOLYTICS, SEDATIVES, AND HYPNOTICS

alprazolam 1

buspirone hcl 1

BUTISOL SODIUM 2

chlordiazepoxide hcl 1

clorazepate dipotassium 1

DIASTAT ACUDIAL 2

diazepam 1, 2

droperidol 1

hydroxyzine hcl 1, 2

hydroxyzine pamoate 1, 2

lorazepam 1

midazolam hcl 1

NEMBUTAL 2

oxazepam 1

phenobarbital 1, 2

PHENOBARBITAL SODIUM

2

PRECEDEX 2

temazepam 1

zolpidem tartrate 1

CENTRAL NERVOUS SYSTEM AGENTS, MISCELLANEOUS

acamprosate calcium 1

flumazenil 1

memantine hcl 1, 2

riluzole 1

selegiline hcl 1

GENERAL ANESTHETICS



Nivel del

medicamento


BREVITAL SODIUM 2

etomidate 1

FORANE 2

ketamine hcl 1

propofol 1

MULTIPLE SCLEROSIS AGENTS

AVONEX 4 QL

EXTAVIA 2 QL

glatiramer acetate 1 QL

OPIATE ANTAGONISTS

naloxone hcl 1, 2

naltrexone hcl 1, 2

PSYCHOTHERAPEUTIC AGENTS

amitriptyline hcl 1

AMOXAPINE 2

aripiprazole 1

bupropion hcl 1

chlorpromazine hcl 1, 2

citalopram hydrobromide 1

clomipramine hcl 1

clozapine 1

desipramine hcl 1

doxepin hcl 1, 2

duloxetine hcl 1

escitalopram oxalate 1

fluoxetine hcl 1

fluphenazine decanoate 1

fluphenazine hcl 1, 2

fluvoxamine maleate 1

haloperidol 1

haloperidol decanoate 1

haloperidol lactate 1

imipramine hcl 1

loxapine succinate 1

MAPROTILINE HCL 2

mirtazapine 1

nefazodone hcl 1, 2

nortriptyline hcl 1, 2

olanzapine 1

ORAP 2

paroxetine hcl 1

perphenazine 1

PERPHENAZINE-AMITRIPTYLINE

2

phenelzine sulfate 1


Nivel del

medicamento


prochlorperazine 1

prochlorperazine edisylate

1

prochlorperazine maleate 1

protriptyline hcl 1

quetiapine fumarate 1

risperidone 1

sertraline hcl 1

SURMONTIL 2

thioridazine hcl 1

thiothixene 1

tranylcypromine sulfate 1

trazodone hcl 1

trifluoperazine hcl 1

venlafaxine hcl 1

ziprasidone hcl 1

CONTRACEPTIVES (FOAMS, DEVICES)

CONTRACEPTIVES (FOAMS, DEVICES)

levonorgestrel & eth estradiol

1

WIDE-SEAL DIAPHRAGM 60

2

DEVICES

DEVICES

AEROCHAMBER Z-STAT PLUS

2

AEROTRACH PLUS 2

BAYER BREEZE 2 CONTROL

2

BD INSULIN SYR ULTRAFINE II

2

BD INSULIN SYRINGE U-500

2

BD LANCET DEVICE 2

BD LANCET ULTRAFINE 33G

2

BD LUER-LOK SYRINGE 2

BD PEN NEEDLE MINI U/F

2

BD SAFETYGLIDE SYRINGE/NEEDLE

2

DISPOSABLE POWER 2

ONETOUCH ULTRA MINI

2



Nivel del

medicamento


PEDIATRIC SMALL MASK

2

PENLET II BLOOD SAMPLER

2

TRUZONE PEAK FLOW METER

2

DIAGNOSTIC AGENTS

DIAGNOSTIC AGENTS

ACETEST 2

adenosine (diagnostic) 1

ALBUSTIX 2

CANDIN 2

CHEMSTRIP 9 2

CHIRHOSTIM 2

CLINITEST 2

CONRAY 2

CORTROSYN 2

CREON 2

CYSTOGRAFIN 2

D-XYLOSE 2

DIASTIX 2

E-Z-CAT DRY 2

EOVIST 2

fluorescein sodium injection

1

fluorescein sodium topical 1

fluorescein w/ benoxinate 1

GADAVIST 2

GASTROGRAFIN 2

INDIGO CARMINE 2

KETO-DIASTIX 2

LEXISCAN 2

LUMASON 2

MAGNEVIST 2

METOPIRONE 2

MULTIHANCE 2

OMNIPAQUE 2

ONETOUCH ULTRA BLUE

2

THYROGEN 2

TUBERSOL 2

ELECTROLYTIC, CALORIC, AND WATER BALANCE

ALKALINIZING AGENTS


Nivel del

medicamento


pot & sod citrates w/citric ac

1

potassium citrate (alkalinizer)

1

potassium citrate-citric acid

1

sodium acetate 1

sodium bicarbonate 1, 2

sodium citrate & citric acid

1

THAM 2

AMMONIA DETOXICANTS

lactulose 1

lactulose (encephalopathy)

1

LITHOSTAT 2

sodium phenylbutyrate 1, 4 QL

CALORIC AGENTS

amino acid electrolyte infusion

1, 2

amino acid infusion 1, 2

CLINIMIX E/DEXTROSE (2.75/10)

2


2


2

CLINIMIX E/DEXTROSE (5/15)

2

CLINIMIX E/DEXTROSE (5/20)

2

CLINIMIX/DEXTROSE (2.75/5)

2


2


2


2

CLINIMIX/DEXTROSE (5/15)

2

dextrose 1, 2

fat emulsion 1, 2

PHENEX-1 2

DIURETICS



Nivel del

medicamento


amiloride & hydrochlorothiazide

1

bumetanide 1

chlorthalidone 1

DYRENIUM 2

EDECRIN 2

furosemide 1, 2

hydrochlorothiazide 1

indapamide 1

mannitol 1

metolazone 1

SODIUM EDECRIN 2

torsemide 1

triamterene & hydrochlorothiazide

1

ION-REMOVING AGENTS

RENVELA 2

sodium polystyrene sulfonate

1

IRRIGATING SOLUTIONS

acetic acid 1

DIANEAL LOW CALCIUM/4.25% DEX

2

lactated ringer's (irrigation)

1

ringer's irrigation 1

sodium chloride (gu irrigant)

1

water for irrigation, sterile 1

REPLACEMENT PREPARATIONS

calcium acetate (phosphate binder)

1, 2

calcium chloride (dihydrate)

1

calcium gluconate 1

CHROMIC CHLORIDE 2

COPPER CHLORIDE 2

COPPER SULFATE 2

DEXTROSE 5%/ELECTROLYTE #48

2

dextrose in lactated ringers

1

dextrose in ringers 1

dextrose w/ sodium chloride

1, 2


Nivel del

medicamento


hetastarch in sodium chloride

1

HEXTEND 2

HYPERLYTE-CR 2

K-PHOS 2

KCL-LACTATED RINGERS-D5W

2

lactated ringer's 1

LMD IN D5W 2

LMD IN NACL 2

M.T.E.-5 CONCENTRATE

2

MAGNESIUM SULFATE IN D5W

2

MANGANESE CHLORIDE

2

PLASMA-LYTE A 2

potassium acetate 1

potassium bicarbonate 1

potassium chloride 1, 2

potassium chloride in dextrose

1

potassium chloride in dextrose & sodium chloride

1, 2

potassium chloride in nacl 1

potassium chloride microencapsulated crystals cr

1

potassium phosphate dibasic

1

potassium phosphates 1

ringer's 1

saline, bacteriostatic 1

SELENIUM 2

sodium chloride 1

sodium chloride flush 1

sodium phosphates (sodium phosphate dibasic & monobasic)

1

trace minerals (cr-cu-mn-zn)

1, 2

ZINC SULFATE 2

ZINC TRACE METAL 2

URICOSURIC AGENTS



Nivel del

medicamento


colchicine w/ probenecid 1

probenecid 1

ENZYMES

ENZYMES

ALDURAZYME 4

CEREZYME 4

ELAPRASE 4

ELITEK 4

FABRAZYME 4

HYLENEX 2

LUMIZYME 4

NAGLAZYME 4

PROLASTIN-C 2 LD

PULMOZYME 4

STRENSIQ 4 QL

VIMIZIM 4

VORAXAZE 4

VPRIV 4

EYE, EAR, NOSE, AND THROAT (EENT) PREPARATIONS

ANTI-INFECTIVES

BACITRACIN 2

bacitracin-polymyxin b (ophth)

1

chlorhexidine gluconate (mouth-throat)

1

ciprofloxacin hcl (ophth) 1

erythromycin (ophth) 1

gatifloxacin (ophth) 1, 2

gentamicin sulfate (ophth) 1

MITOSOL 2

neomycin-bacitracin zn-polymyxin

1

neomycin-polymyxin-gramicidin

1

ofloxacin (ophth) 1

ofloxacin (otic) 1

polymyxin b-trimethoprim 1

sulfacetamide sodium (ophth)

1

tobramycin (ophth) 1, 2

trifluridine 1

ANTI-INFLAMMATORY AGENTS

CIPRODEX 2

COLY-MYCIN S 2


Nivel del

medicamento


DEXAMETHASONE SODIUM PHOSPHATE

1

diclofenac sodium (ophth) 1

flunisolide (nasal) 1

fluorometholone (ophth) 1, 2

FLURBIPROFEN SODIUM

1

fluticasone propionate (nasal)

1

ketorolac tromethamine (ophth)

1

neomycin-polymy-dexameth

1

neomycin-polymyxin-hc (otic)

1

OZURDEX 4

prednisolone acetate (ophth)

1, 2

PREDNISOLONE SODIUM PHOSPHATE

2

RESTASIS 2

RETISERT 2

sulfacetamide sod-prednisolone

1, 2

TOBRADEX 2

VEXOL 2

ANTIALLERGIC AGENTS

ALOCRIL 2

azelastine hcl 1

cromolyn sodium (ophth) 1

olopatadine hcl 1

ANTIGLAUCOMA AGENTS

acetazolamide 1

acetazolamide sodium 1

betaxolol hcl (ophth) 1

brimonidine tartrate 1

dorzolamide hcl 1

dorzolamide hcl-timolol maleate

1

latanoprost 1

levobunolol hcl 1

LUMIGAN 2

methazolamide 1

MIOCHOL-E 2

MIOSTAT 2



Nivel del

medicamento


PHOSPHOLINE IODIDE 2

pilocarpine hcl 1

timolol maleate (ophth) 1

EENT DRUGS, MISCELLANEOUS

acetic acid (otic) 1

ACETIC ACID-ALUMINUM ACETATE

1

apraclonidine hcl 1, 2

EYLEA 2

HEALON5 2

JETREA 2

LACRISERT 2

LUCENTIS 2 LD

MACUGEN 2

ophthalmic irrigation solution - intraocular

1

VISUDYNE 2

LOCAL ANESTHETICS

AKTEN 2

COCAINE HCL 2

lidocaine hcl (mouth-throat)

1

proparacaine hcl 1, 2

tetracaine hcl (ophth) 1

MYDRIATICS

atropine sulfate (ophthalmic)

1, 2

CYCLOMYDRIL 2

cyclopentolate hcl 1, 2

homatropine hbr 1

tropicamide 1

VASOCONSTRICTORS

NAPHAZOLINE HCL 2

phenylephrine hcl (ophth) 1

GASTROINTESTINAL DRUGS


balsalazide disodium 1

mesalamine 1, 2

ANTIDIARRHEA AGENTS

diphenoxylate w/ atropine 1, 2

PAREGORIC 2

ANTIEMETICS

AKYNZEO 2 QL

dronabinol 1

EMEND TAB 2 QL


Nivel del

medicamento


EMEND INJ 2

meclizine hcl 1

ondansetron 1

ondansetron hcl 1

TRANSDERM-SCOP (1.5 MG)

2

ANTIULCER AGENTS AND ACID SUPPRESSANTS

cimetidine hcl 1

famotidine 1

FAMOTIDINE PREMIXED

2

misoprostol 1

omeprazole 1

pantoprazole sodium 1, 2

ranitidine hcl 1

sucralfate 1, 2

CATHARTICS AND LAXATIVES

AMITIZA 2

CASCARA SAGRADA 2

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate

1

SORBITOL 2

CHOLELITHOLYTIC AGENTS

ursodiol 1, 2

DIGESTANTS

CREON 2

PROKINETIC AGENTS

metoclopramide hcl 1

GOLD COMPOUNDS

GOLD COMPOUNDS

RIDAURA 2

HEAVY METAL ANTAGONISTS


BAL IN OIL 2

CHEMET 4

deferoxamine mesylate 1

DEPEN TITRATABS 4

EXJADE 4 QL

sodium thiosulfate 1, 2

HORMONES AND SYNTHETIC SUBSTITUTES

ADRENALS

A-HYDROCORT 1, 2

ARISTOSPAN INTRA-ARTICULAR

2



Nivel del

medicamento


ASMANEX 120 METERED DOSES

2

betamethasone sod phosphate & acetate

1

budesonide 1

budesonide (inhalation) 1, 2

CORTISONE ACETATE 2

dexamethasone 1, 2

dexamethasone sodium phosphate

1

FLOVENT HFA 2

fludrocortisone acetate 1

hydrocortisone 1

KENALOG 2

methylprednisolone 1, 2

methylprednisolone acetate

1

methylprednisolone sod succ

1, 2

prednisolone 1, 2

prednisolone sodium phosphate

1

prednisone 1, 2

QVAR 2

ANDROGENS

ANDRODERM 1, 2

ANDROID 2

ANDROXY 2

danazol 1

oxandrolone 1

testosterone cypionate 1, 2

testosterone enanthate 1

ANTIDIABETIC AGENTS

acarbose 1

BYDUREON 2

glimepiride 1

glipizide 1

glipizide-metformin hcl 1

glyburide 1

HUMALOG 2

HUMALOG MIX 50/50 2

HUMULIN 70/30 2

HUMULIN N 2

HUMULIN R 2

JARDIANCE 2


Nivel del

medicamento


LANTUS 2

metformin hcl 1

pioglitazone hcl 1

TOLBUTAMIDE 2

TRADJENTA 2

ANTIHYPOGLYCEMIC AGENTS

GLUCAGEN DIAGNOSTIC

2

GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY

2

CONTRACEPTIVES

desogestrel & ethinyl estradiol

1

drospirenone-ethinyl estradiol

1

ELLA 2

ethynodiol diacet & eth estrad

1

levonorgestrel & eth estradiol

1

levonorgestrel (emergency oc)

1

levonorgestrel-eth estradiol (triphasic)

1

MIRENA (52 MG) 2

NECON 1/50 (28) 2

NECON 10/11 (28) 2

NEXPLANON 2

norethin acet & estrad-fe 1

norethindrone & eth estradiol

1

norethindrone (contraceptive)

1

norethindrone acet & eth estra

1

norethindrone-eth estradiol (triphasic)

1

norgestimate-ethinyl estradiol

1

norgestimate-ethinyl estradiol (triphasic)

1

norgestrel & ethinyl estradiol

1, 2

NUVARING 2



Nivel del

medicamento


XULANE 2

ESTROGENS AND ESTROGEN AGONISTS-ANTAGONISTS

clomiphene citrate 1

DEPO-ESTRADIOL 2

esterified estrogens & methyltestosterone

1

ESTRACE 2

estradiol 1, 2

estradiol valerate 1, 2

PREMARIN 2

raloxifene hcl 1

GONADOTROPINS

BRAVELLE 2

GONAL-F 2

MENOPUR 2

NOVAREL 1

OVIDREL 2

SYNAREL 4

PARATHYROID

calcitonin (salmon) 1, 2

FORTEO 4 QL

PITUITARY

desmopressin acetate 1, 4

desmopressin acetate refrigerated

1

desmopressin acetate spray

1

desmopressin acetate spray refrigerated

1

HP ACTHAR 2 LD

vasopressin 1

PROGESTINS

DEPO-PROVERA 2

ENDOMETRIN 2

MAKENA 2 QL

medroxyprogesterone acetate

1

medroxyprogesterone acetate (contraceptive)

1

norethindrone acetate 1

progesterone 1

progesterone micronized 1

SOMATROPIN AGONISTS-ANTAGONISTS


Nivel del

medicamento


NORDITROPIN FLEXPRO

2, 4 QL

SEROSTIM 4 QL

THYROID AND ANTITHYROID AGENTS

levothyroxine sodium 1, 2

liothyronine sodium 1

methimazole 1

propylthiouracil 1

SSKI 2

IMMUNOLOGICAL AGENTS

ANTIRHEUMATIC AGENTS

ENBREL 4 QL

HUMIRA 4 QL

KINERET 4 QL, LD

leflunomide 1

ORENCIA 4 QL

OTEZLA 4 QL

RASUVO 2

REMICADE 4

IMMUNE SUPPRESSANTS

ATGAM 2

azathioprine 1

cyclosporine modified (for microemulsion)

1, 2

mycophenolate mofetil 1

SANDIMMUNE 2

sirolimus 1, 2

tacrolimus 1, 2

LOCAL ANESTHETICS

LOCAL ANESTHETICS

bupivacaine hcl 1

bupivacaine in dextrose 1

bupivacaine w/ epinephrine

1, 2

chloroprocaine hcl 1, 2

lidocaine hcl (cardiac) 1

lidocaine hcl (local anesth.)

1

lidocaine w/ epinephrine 1, 2

mepivacaine hcl 1

NAROPIN 2

TETRACAINE HCL 2

MISCELLANEOUS THERAPEUTIC AGENTS


acetylcysteine 1



Nivel del

medicamento


acetylcysteine (antidote) 1

ACTIMMUNE 2 QL

alendronate sodium 1, 2

allopurinol 1

amifostine 1

BOTOX 2

BOTOX COSMETIC 2

BRIDION 2

CERDELGA 4 QL

CINRYZE 4 QL

COLCHICINE 2

CYSTADANE 4 QL, LD

CYSTAGON 2 QL, LD

dexrazoxane 1

disulfiram 1, 2

ELMIRON 2

ETIDRONATE DISODIUM

2

finasteride 1

FIRAZYR 4 QL

FLUOR-A-DAY 2

FUSILEV 2

GRASTEK 2

INFLECTRA 4

KALYDECO 4 QL

leflunomide 1

leucovorin calcium 1

levocarnitine (metabolic modifiers)

1

mesna 1, 2 QL

methylene blue (antidote) 1

MYOBLOC 2

octreotide acetate 1, 4 QL

ORENCIA 4 QL

pamidronate disodium 1, 2

RIMSO-50 2

SENSIPAR 4

sodium fluoride 1, 2

sodium fluoride (dental) 1, 2

SOLIRIS 2

THALOMID 4 QL

THIOLA 2 LD

TRI-CHLOR 2

TYSABRI 2 LD

water for injection, sterile 1


Nivel del

medicamento


XELJANZ 4 QL

zoledronic acid 1

OXYTOCICS

OXYTOCICS

CERVIDIL 2

HEMABATE 2

methylergonovine maleate

1

MIFEPREX 2

oxytocin 1

PHARMACEUTICAL AIDS

PHARMACEUTICAL AIDS

ALOE VERA 2

ALPROSTADIL 2

ATROPINE SULFATE MONOHYDRATE

2

BACLOFEN 2

BACTERIOSTATIC WATER(BENZ ALC)

2

BIOTIN-D 2

BORIC ACID 2

CANTHARIDIN 2

CARBAMAZEPINE 2

CHLOROFORM 2

CHLORPROMAZINE HCL

2

CHOLESTEROL ACETATE

2

CLINDAMYCIN HCL 2

CLOBETASOL PROPIONATE

2

CLONIDINE HCL 2

CLOTRIMAZOLE 2

COAL TAR 2

COLLODION FLEXIBLE 2

CYSTEAMINE HCL 2

DEXAMETHASONE 2

DILTIAZEM HCL 2

ESTRADIOL 2

GABAPENTIN 2

GLYCERIN 2

GLYCOPYRROLATE 2

HALOPERIDOL 2

HYDROCORTISONE 2

HYDROPHILIC 2



Nivel del

medicamento


HYDROXOCOBALAMIN 2

HYDROXYPROGESTERONE CAPROATE

2

INDOMETHACIN 2

ISOSORBIDE 2

KETAMINE HCL 2

KETOPROFEN 2

L-ARGININE 2

L-CITRULLINE 2

L-ISOLEUCINE 2

L-PROLINE 2

L-VALINE 2

LACTIC ACID 2

LACTOSE 2

LACTOSE MONOHYDRATE

2

LIDOCAINE HCL 2

METHADONE HCL 2

METOCLOPRAMIDE HCL MONOHYDRATE

2

METRONIDAZOLE 2

MORPHINE SULFATE 2

NEOMYCIN SULFATE 2

PAPAVERINE HCL 2

PHENOBARBITAL 2

PHENTOLAMINE MESYLATE

2

PLURONIC F127 2

PODOPHYLLUM RESIN 2

POLYETHYLENE GLYCOL 400

2

POLYETHYLENE GLYCOL 8000

2

PROGESTERONE MICRONIZED

2

PROGESTERONE WETTABLE

2

PROPYLENE GLYCOL 2

QUINACRINE HCL 2

SALICYLIC ACID 2

SODIUM BENZOATE 2

SORBITOL 2

SQUARIC ACID DIBUTYLESTER

2

SULFUR PRECIPITATED 2


Nivel del

medicamento


TESTOSTERONE PROPIONATE

2

THYMOL 2

TRANEXAMIC ACID 2

TRIAMCINOLONE ACETONIDE

2

UREA 2

VERAPAMIL HCL 2

water for injection, sterile 1

ZINC SULFATE 2

RESPIRATORY TRACT AGENTS


AEROSPAN 2

COMBIVENT RESPIMAT 2

CROMOLYN SODIUM 1

cromolyn sodium (mastocytosis)

1

DULERA 2

montelukast sodium 1

ANTITUSSIVES

benzonatate 1

guaifenesin-codeine 1

hydrocodone w/ homatropine

1

phenylephrine-chlorphen-dm

1

PHENYLHISTINE DH 2

promethazine w/codeine 1

promethazine-dm 1

pseudoephedrine w/ codeine-gg

1

MUCOLYTIC AGENTS

sodium chloride (inhalant) 1

PULMONARY SURFACTANTS

CUROSURF 2

SURVANTA 2

RESPIRATORY AGENTS, MISCELLANEOUS

DALIRESP 2

ORKAMBI 4 QL

XOLAIR 4 QL, LD

VASODILATING

OPSUMIT 4 QL, LD

SERUMS, TOXOIDS, AND VACCINES

SERUMS



Nivel del

medicamento


ANTIVENIN LATRODECTUS MACTANS

2

CARIMUNE NF 2

CROFAB 2

CYTOGAM 2

DIGIFAB 2

GAMASTAN S/D 2

GAMMAGARD 2

HIZENTRA 4 QL

HYPERRAB S/D 2

HYPERTET S/D 2

HYQVIA 4 QL

MICRHOGAM ULTRA-FILTERED PLUS

2

NABI-HB 2

VARIZIG 2

TOXOIDS

ADACEL 2

DIPHTHERIA-TETANUS TOXOIDS DT

2

INFANRIX 2

TETANUS-DIPHTHERIA TOXOIDS TD

2

VACCINES

ACTHIB 2

AFLURIA 2

AFLURIA PRESERVATIVE FREE

2

BEXSERO 2

ENGERIX-B 2

FLUAD 2

FLUARIX QUADRIVALENT

2

FLUBLOK 2

FLUCELVAX 2

FLUMIST QUADRIVALENT

2

FLUVIRIN 2

FLUVIRIN PRESERVATIVE FREE

2

FLUZONE HIGH-DOSE 2

GARDASIL 2

GARDASIL 9 2

HAVRIX 2


Nivel del

medicamento


IMOVAX RABIES 2

IPOL 2

IXIARO 2

KINRIX 2

M-M-R II 2

MENVEO 2

PEDIARIX 2

PNEUMOVAX 23 2

PREVNAR 13 2

PROQUAD 2

RABAVERT 2

ROTARIX 2

ROTATEQ 2

THERACYS 2

TWINRIX 2

TYPHIM VI 2

VARIVAX 2

VAXCHORA 2

VIVOTIF 2

YF-VAX 2

ZOSTAVAX 2

SKIN AND MUCOUS MEMBRANE AGENTS

ANTI-INFECTIVES

benzoyl peroxide-erythromycin

1, 2

clindamycin phosphate (topical)

1

clindamycin phosphate vaginal

1

clindamycin phosphate-benzoyl peroxide

1

clindamycin phosphate-benzoyl peroxide (refrigerate)

1

clotrimazole 1

dakin's solution 1, 2

erythromycin (acne aid) 1, 2

gentamicin sulfate (topical)

1, 2

iodoquinol-hc 1

ketoconazole (topical) 1

malathion 1

metronidazole (topical) 1

metronidazole vaginal 1

mupirocin 1



Nivel del

medicamento


neomycin/polymyxin b gu 1

nystatin (topical) 1

permethrin 1, 2

selenium sulfide 1

silver sulfadiazine 1

SULFAMYLON 2


alclometasone dipropionate

1

betamethasone dipropionate (topical)

1

betamethasone dipropionate augmented

1

betamethasone valerate 1

clobetasol propionate 1, 2

CORDRAN 2

CORTISPORIN 2

DESOWEN 2

desoximetasone 1

fluocinolone acetonide 1

fluocinonide 1

fluticasone propionate 1

halobetasol propionate 1

hydrocortisone (intrarectal)

1

hydrocortisone (rectal) 1

hydrocortisone (topical) 1

hydrocortisone acetate (rectal)

1

mometasone furoate 1

nystatin-triamcinolone 1

pramoxine-hc 1, 2

PROCTOFOAM HC 2

triamcinolone acetonide (mouth)

1

triamcinolone acetonide (topical)

1

ANTIPRURITICS AND LOCAL ANESTHETICS

hydrocortisone acetate w/ pramoxine

1, 2

lidocaine 1

lidocaine hcl 1

lidocaine-prilocaine 1

PHENOL 2


Nivel del

medicamento


ASTRINGENTS

DRYSOL 2

XERAC AC 2

CELL STIMULANTS AND PROLIFERANTS

KEPIVANCE 4

RETIN-A MICRO 2

tretinoin 1, 2

DEPIGMENTING AND PIGMENTING AGENTS

8-MOP 2

methoxsalen rapid 1, 2

OXSORALEN 2

KERATOLYTIC AGENTS

KERALYT 2

sulfacetamide sodium w/ sulfur

1, 2

KERATOPLASTIC AGENTS

ELTA TAR 2

SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS

acitretin 1

adapalene 1, 2

AQUAPHOR 2

BENZOIN 2

benzoin compound 1

calcipotriene 1

COSENTYX 300 DOSE 4 QL

DESITIN 2

diclofenac sodium (topical)

1

DRITHO-CREME HP 2

ELIDEL 2

EPIDUO 1, 2

fluorouracil (topical) 1, 2

imiquimod 1

isotretinoin 1 QL

LEVULAN KERASTICK 2

PODOCON 2

podofilox 1, 2

SANTYL 2

sodium chloride 1

STELARA 4

tacrolimus (topical) 1

TARGRETIN 4 QL

TAZORAC 2

VECTICAL 2



Nivel del

medicamento


SMOOTH MUSCLE RELAXANTS

GENITOURINARY SMOOTH MUSCLE RELAXANTS

oxybutynin chloride 1

OXYTROL 2

trospium chloride 1

RESPIRATORY SMOOTH MUSCLE RELAXANTS

aminophylline 1

theophylline 1

THEOPHYLLINE IN D5W 2

VITAMINS

MULTIVITAMIN PREPARATIONS

b-complex w/ c & folic acid

1

INFUVITE 2

INFUVITE PEDIATRIC 2

ped multivitamins w/fl & iron

1

pediatric multiple vitamin w/ c

1

pediatric multivitamins w/fl

1

pediatric vitamins acd w/ fluoride

1

POLY-VI-SOL/IRON 2

VITAMIN A

AQUASOL A 2

VITAMIN B COMPLEX

cyanocobalamin 1

FOLIC ACID 2

niacin 1, 2

POTABA 2

pyridoxine hcl 1

thiamine hcl 1

VITAMIN C

ascorbic acid 1

VITAMIN D

calcitriol 1

ergocalciferol 1

VITAMIN K ACTIVITY

phytonadione 1, 2


Los medicamentos que figuran a continuación no están incluidos en la Lista de medicamentos aprobados del Plan. Si su médico de Kaiser Permanente determina por medio de un proceso de excepción que uno de estos medicamentos es necesario desde el punto de vista médico, el medicamento será cubierto como un medicamento de Nivel 4, con el costo compartido correspondiente.


ANTI-INFECTIVE AGENTS

ANTIBACTERIALS

BETHKIS NEB 300/4ML

DALVANCE SOL 500MG

DIFICID TAB 200MG

KITABIS PAK NEB 300/5ML

LINEZOLID SOLN 2MG/ML

ORBACTIV SOL 400MG

SIVEXTRO INJ 200MG

SIVEXTRO TAB 200MG

TYGACIL INJ 50MG

VANCOCIN HCL CAP 125MG

VANCOCIN HCL CAP 250MG

ZYVOX SOL 2MG/ML

ANTIFUNGALS

ANCOBON CAP 250MG

ANCOBON CAP 500MG

CRESEMBA SOLR 372 MG

CRESEMBA CAPS 186 MG

MYCAMINE INJ 100MG

MYCAMINE INJ 50MG

NOXAFIL SUS 40MG/ML

NOXAFIL SOLN 300 MG/16.7ML

NOXAFIL TAB 100MG

VFEND SUS 40MG/ML

VFEND TAB 200MG

VFEND TAB 50MG

ANTIMYCOBACTERIALS

MYCOBUTIN CAP 150MG

SIRTURO TAB 100MG

ANTIPROTOZOALS

IMPAVIDO CAPS 50 MG

MEPRON SUS

ANTIVIRALS


BARACLUDE TAB 0.5MG

BARACLUDE TAB 1MG

DAKLINZA TABS 90 MG

EPCLUSA TABS 400-100 MG

HEPSERA TAB 10MG

MAVYRET TAB 100-40MG

RAPIVAB SOLN 200 MG/20ML

TYZEKA 600 MG TABLET

VALCYTE TAB 450MG

VEMLIDY TABS 25 MG

VISTIDE INJ 75MG/ML

VOSEVI TAB

ANTIHEPATITIS C AGENTS

OLYSIO CAP 150MG

TECHNIVIE TABS 12.5-75-50 MG

VIEKIRA PAK TAB

VIEKIRA XR TB24 200-8.33-50- 33.33 MG

ZEPATIER TABS



AFINITOR DISPERZ TAB 2MG



ALIMTA SOLR 100 MG

ARZERRA CON 100/5ML

BAVENCIO SOLN 200 MG/10ML

BELEODAQ INJ 500MG

BESPONSA

BOSULIF TAB 100MG

BOSULIF TAB 500MG

BUSULFEX INJ 6MG/ML

COSMEGEN INJ 0.5MG

DARZALEX SOLN 100 MG/5ML

DARZALEX SOLN 400 MG/20ML

DOCETAXEL (NON-ALCOHOL) SOLN

ELOXATIN INJ 100MG

ELOXATIN INJ 200MG

ELOXATIN INJ 50MG

EMPLICITI SOLR 300 MG

EMPLICITI SOLR 400 MG

EVOMELA SOLR 50 MG



FARESTON 60 MG TABLET

FARYDAK CAP 10MG

FARYDAK CAP 15MG

FARYDAK CAP 20MG

GILOTRIF TAB 20MG

GILOTRIF TAB 30MG

GILOTRIF TAB 40MG

HYCAMTIN 4 MG VIAL

HYCAMTIN CAP 0.25MG

HYCAMTIN CAP 1MG

ICLUSIG TAB 15MG

ICLUSIG TAB 45MG

IDHIFA TAB

IMFINZI SOLN

IMLYGIC SUSP 1000000 UNIT/ML

IMLYGIC SUSP 100000000 UNIT/ML

INLYTA TAB 1MG

INLYTA TAB 5MG

INTRON-A KIT 10MU/ML

INTRON-A INJ 10MU PEN



KISQALI TABS

KISQALI PAK FEMARA

KYPROLIS 30 MG VIAL

LARTRUVO SOLN 500 MG/50ML

LARTRUVO INJ 190/19ML

LENVIMA PACK 4 (2) MG (8 MG DAILY DOSE)

LENVIMA PACK 10 & 4 (2) MG (18 MG DAILY DOSE)

MYLOTARG SOLR

NERLYNX TAB 40MG

NIPENT INJ 10MG

ONIVYDE INJ 43 MG/10ML

PORTRAZZA SOLN 800 MG/50ML

PURINETHOL

RITUXAN HYCELA SOLN

RUBRACA TABS

SUPPRELIN LA KIT 50 MG

SYLATRON KIT 200MCG

SYLATRON KIT 300MCG


SYLATRON KIT 600MCG

SYNRIBO INJ 3.5MG

TAXOTERE INJ 80MG/4ML

TEMODAR CAP 100MG

TEMODAR CAP 140MG

TEMODAR CAP 180MG

TEMODAR CAP 20MG

TEMODAR CAP 250MG

TEMODAR CAP 5MG

TEMODAR INJ 100MG

TEPADINA SOLR

TREANDA INJ 180MG

TREANDA INJ 25MG

TREANDA INJ 45MG

TRELSTAR DEPOT MIXJECT INJ 3.75MG

TRELSTAR LA MIXJECT INJ 11.25MG

TRELSTAR MIXJECT INJ 22.5MG

VALSTAR SOL 40MG/ML

VANTAS KIT 50MG

VECTIBIX INJ 100MG

VECTIBIX INJ 400MG

VYXEOS SUSR

XATMEP SOL 2.5MG/ML

ZALTRAP INJ 100/4ML

ZALTRAP INJ 200/8ML

ZOLINZA CAP 100MG

AUTONOMIC DRUGS

SYMPATHOMIMETIC (ADRENERGIC) AGENTS

AUVI-Q SOAJ 0.15 MG/0.15ML

AUVI-Q SOAJ 0.3 MG/0.3ML

NORTHERA CAP 100MG

NORTHERA CAP 200MG

NORTHERA CAP 300MG

BLOOD FORMATION, COAGULATION, AND THROMBOSIS

ANTIHEMORRHAGIC AGENTS

CYKLOKAPRON 100 MG/ML AMPUL

HEMATOPOIETIC AGENTS

GRANIX INJ 300/0.5

GRANIX INJ 480/0.8



LEUKINE 500 MCG/ML VIAL

MOZOBIL 20 MG/ML VIAL

NEULASTA INJ 6MG/0.6M

CARDIAC DRUGS

ANTILIPEMIC AGENTS

JUXTAPID CAP 10MG

JUXTAPID CAP 20MG

JUXTAPID CAP 30MG

JUXTAPID CAP 40MG

JUXTAPID CAP 5MG

JUXTAPID CAP 60MG

KYNAMRO INJ 200MG/ML

PRALUENT SOSY 150 MG/ML

PRALUENT SOSY 75 MG/ML

REPATHA SOSY 140 MG/ML

REPATHA SURECLICK SOAJ 140 MG/ML

REPATHA PUSH INJ 420/3.5

HYPOTENSIVE AGENTS

VASODILATING AGENTS

ADCIRCA TAB 20MG

REVATIO INJ

REVATIO TAB 20MG

CENTRAL NERVOUS SYSTEM AGENTS

ANALGESICS AND ANTIPYRETICS

ARYMO ER TBEA 60 MG

PROBUPHINE IMPLANT KIT IMPL 74.2 MG

ILARIS INJ 180MG

ILARIS SOLN 150 MG/ML

ANTICONVULSANTS

APTIOM TAB 200MG

APTIOM TAB 400MG

APTIOM TAB 600MG

APTIOM TAB 800MG

BRIVIACT SOLN 10 MG/ML

BRIVIACT TABS

BRIVIACT 50 MG/5 ML VIAL

FELBATOL SUS 600/5ML

FELBATOL TAB 400MG

FELBATOL TAB 600MG


SABRIL TAB 500MG

SPRITAM TB3D

ANTIPARKINSONIAN AGENTS

RYTARY

TASMAR 100 MG TABLET

ANXIOLYTICS/SEDATIVES/HYPNOTICS

HETLIOZ CAP 20MG

CENTRAL NERVOUS SYSTEM AGENTS, MISCELLANEOUS

AUSTEDO TABS

INGREZZA CAPS 40 MG

RADICAVA INJ 30MG

RILUTEK TAB 50MG

XENAZINE TAB 12.5MG

XENAZINE TAB 25MG

XYREM SOL 500MG/ML

MULTIPLE SCLEROSIS

AUBAGIO TAB 14MG

AUBAGIO TAB 7MG

COPAXONE INJ 40MG/ML

GILENYA CAP 0.5MG

PLEGRIDY INJ

PLEGRIDY INJ PEN

PLEGRIDY STARTER PACK INJ STARTER

REBIF INJ 22/0.5

REBIF INJ 44/0.5

REBIF REBIDOSE INJ 22/0.5

REBIF REBIDOSE INJ 44/0.5

REBIF REBIDOSE TITRATION PACK SOL TITRATN

REBIF TITRATION PACK SOL PACK

TECFIDERA CAP 120MG

TECFIDERA CAP 240MG

TECFIDERA STARTER PACK MIS STARTER

OPIATE AGENTS

EVZIO SOAJ 2 MG/0.4ML

VIVITROL 380MG INJ

PSYCHOTHERAPEUTIC AGENTS

ARISTADA PRSY

INVEGA TB24 1.5 MG



INVEGA TB24 3 MG

INVEGA TB24 6 MG

INVEGA TB24 9 MG

INVEGA SUSTENNA INJ 117/0.75



INVEGA SUSTENNA INJ 78/0.5ML

NUPLAZID TABS 17 MG

REXULTI TABS

VRAYLAR CAPS

VRAYLAR CPPK 1.5 & 3 MG

ELECTROLYTIC, CALORIC, AND WATER BALANCE

AMMONIA DETOXICANTS

BUPHENYL POW

RAVICTI LIQ 1.1GM/ML

DIURETICS

SAMSCA 15 MG TABLET

SAMSCA 30 MG TABLET

ION-REMOVING AGENTS

FOSRENOL CHW 1000MG

FOSRENOL CHW 500MG

FOSRENOL CHW 750MG

FOSRENOL PACK 750 MG

FOSRENOL PACK 1000 MG

EYE, EAR, NOSE, AND THROAT (EENT) PREPARATIONS


ILUVIEN 0.19MG IMPLANT

ENZYMES

ENZYMES

CEREZYME INJ 200UNIT

ELELYSO INJ 200UNIT

KANUMA SOLN 20 MG/10ML

VIMIZIM INJ 5MG/5ML

GASTROINTESTINAL DRUGS

ANTIEMETIC

SYNDROS SOL 5MG/ML

ANTIDIARRHEA AGENTS

XERMELO 250 MG TABLET



DIPENTUM CAP 250MG

LOTRONEX TAB 0.5MG

LOTRONEX TAB 1MG

GI DRUGS, MISCELLANEOUS

ENTYVIO INJ 300MG

GATTEX KIT 5MG

OCALIVA

RELISTOR 12 MG/0.6 ML KIT

RELISTOR SOLN 8 MG/0.4ML

RELISTOR TABS 150 MG

VIBERZI TABS 75 MG

VIBERZI TABS 100 MG



CUPRIMINE CAPS 250 MG

FERRIPROX TAB 500MG

FERRIPROX SOLN 100 MG/ML

JADENU SPRINKLE PACK

HORMONES AND SYNTHETIC SUBSTITUTES

ADRENALS

EMFLAZA TABS

ENTOCORT EC CAP 3MG/24HR

UCERIS TAB 9MG

DIABETIC AGENTS

KORLYM TAB 300MG

XULTOPHY SOPN 100-3.6 UNIT-MG/ML

GONADOTROPINS

TRIPTODUR SRER 22.5 MG

PARATHYROID

NATPARA CART 100 MCG

NATPARA CART 25 MCG

NATPARA CART 50 MCG

NATPARA CART 75 MCG

TYMLOS SOPN 3120 MCG/1.56ML

PROGESTINS

MAKENA INJ 250MG/ML

SOMATOTROPIN AGONISTS AND ANTAGONISTS

BETASERON KIT 0.3 MG

EGRIFTA INJ 1MG

EGRIFTA SOL 2MG



GENOTROPIN INJ 12MG

GENOTROPIN INJ 5MG

GENOTROPIN MINIQUICK INJ 0.2MG








GENOTROPIN MINIQUICK INJ 1MG

GENOTROPIN MINIQUICK INJ 2MG

HUMATROPE COMBO PACK INJ 5MG

HUMATROPE INJ 12MG

HUMATROPE INJ 24MG

HUMATROPE INJ 6MG

INCRELEX INJ 40MG/4ML

NORDITROPIN FLEXPRO INJ 10/1.5ML

NORDITROPIN FLEXPRO INJ 5/1.5ML

NORDITROPIN NORDIFLEX PEN INJ 30/3ML

NUTROPIN AQ INJ 10MG/2ML

NUTROPIN AQ NUSPIN 5 INJ NUSPIN 5

NUTROPIN AQ NUSPIN 10 SOLN 10 MG/2ML

NUTROPIN AQ NUSPIN 20 SOLN 20 MG/2ML

NUTROPIN AQ PEN INJ 10MG/2ML

NUTROPIN AQ PEN INJ 20MG/2ML

NUTROPIN INJ 10MG

SAIZEN CLICK.EASY INJ 8.8MG

SAIZEN SOLR 5 MG

SIGNIFOR INJ 0.3MG/ML



SIGNIFOR LAR INJ 20MG



SOMAVERT INJ 10MG

SOMAVERT INJ 15MG

SOMAVERT INJ 20MG

SOMAVERT INJ 25MG


SOMAVERT INJ 30

ZOMACTON SOLR 5 MG

ZOMACTON SOLR 10 MG

ZORBTIVE INJ 8.8MG

IMMUNOLOGICAL AGENTS

ANTIRHEUMATIC AGENTS

ACTEMRA INJ

ACTEMRA INJ 162/0.9

ACTEMRA SOLN 80 MG/4ML

ACTEMRA SOLN 400 MG/20ML

ARAVA TAB

CIMZIA KIT

CIMZIA KIT 200MG/ML

ORENCIA SOSY 50 MG/0.4ML

ORENCIA SOSY 87.5 MG/0.7ML

SIMPONI ARIA SOL 50MG/4ML

SIMPONI INJ 100MG/ML

SIMPONI INJ 50MG

XELJANZ TAB 5MG

XELJANZ XR TB24 11 MG



AMPYRA TAB 10MG

ARCALYST INJ 220MG

ASTAGRAF XL CP24 0.5 MG

ASTAGRAF XL CAP 1MG

ASTAGRAF XL CAP 5MG

BERINERT INJ 500UNIT

HAEGARDA INJ

KEVEYIS TABS 50 MG

KEVZARA INJ

KUVAN POWDER

KUVAN TAB 100MG

LEMTRADA SOLN 12 MG/1.2ML

MYALEPT INJ 11.3MG

NITYR TAB

NULOJIX INJ 250MG

OCREVUS SOLN 300 MG/10ML

ORFADIN CAP 10MG

ORFADIN CAP 2MG

ORFADIN CAP 5MG



ORFADIN CAPS 20 MG

ORFADIN SUS 4MG/ML

PROCYSBI CAP 25MG

PROCYSBI CAP 75MG

RENFLEXIS INJ 100MG

RUCONEST INJ 2100UNIT

SAXENDA

SIMULECT INJ 10MG

SIMULECT INJ 20MG

SOMATULINE DEPOT INJ 120/.5ML

SOMATULINE DEPOT INJ 60/0.2ML

SOMATULINE DEPOT INJ 90/0.3ML

SPINRAZA SOLN 12 MG/5ML

THYMOGLOBULIN INJ 25MG

VISTOGARD PACK 10 GM

XEOMIN SOLR 200 UNIT

XURIDEN PACK 2 GM

ZAVESCA CAP 100MG

ZINBRYTA INJ 150MG/ML

ZORTRESS TAB 0.25MG

ZORTRESS TAB 0.5MG

ZORTRESS TAB 0.75MG

SYSTEMIC LUPUS ERYTHEMATOSUS

BENLYSTA INJ 120MG

BENLYSTA INJ 200MG

BENLYSTA INJ 400MG

RESPIRATORY TRACT AGENTS


CINQAIR SOLN 100 MG/10ML

GASTROCROM 100 MG/5 ML CONC

NUCALA SOLR 100 MG

ZYFLO CR TAB 600MG

ZYFLO TAB 600MG

RESPIRATORY AGENTS, MISCELLANEOUS

ARALAST NP SOLR 500 MG

ESBRIET CAP 267MG

ESBRIET TABS 801 MG

EXONDYS 51 SOLN

GLASSIA INJ

OFEV CAP 100MG


OFEV CAP 150MG

ZEMAIRA SOLR 1000 MG

VASODILATING AGENTS

ADEMPAS TAB 0.5MG

ADEMPAS TAB 1.5MG

ADEMPAS TAB 1MG

ADEMPAS TAB 2.5MG

ADEMPAS TAB 2MG

OPSUMIT TAB 10MG

ORENITRAM TAB 0.125MG

ORENITRAM TAB 0.25MG

ORENITRAM TAB 1MG

ORENITRAM TAB 2.5MG

ORENITRAM TAB 5MG

UPTRAVI TABS

SERUMS, TOXOIDS, AND VACCINES

SERUMS

CUVITRU SOLN

ZINPLAVA SOLN 1000 MG/40ML

SKIN AND MUCOUS MEMBRANE AGENTS

ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS MEMBRANE)

TACLONEX OIN

TACLONEX SUSP 0.005-0.064 %

TREMFYA INJ 100MG/ML

ULTRAVATE LOTN 0.05 %

SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS

DUPIXENT SOSY 300 MG/2ML

PANRETIN GEL 0.1%

REGRANEX GEL 0.01%

RYNODERM CREA 37.5 %

SILIQ INJ 210/1.5

SORIATANE CAP 10MG

SORIATANE CAP 17.5MG

SORIATANE CAP 25MG

TALTZ SOSY 80 MG/ML

TALTZ SOAJ 80 MG/ML

VALCHLOR GEL 0.016%

VITAMINS

VITAMIN D

RAYALDEE CPCR 30 MCG


8

8-MOP ............................................................. 20

A

abacavir sulfate ................................................. 4 abacavir sulfate-lamivudine ............................... 4 abacavir sulfate-lamivudine-zidovudine ............. 4 ABELCET .......................................................... 5 ABRAXANE ....................................................... 6 acamprosate calcium ....................................... 11 acarbose .......................................................... 16 ACD-A NOCLOT-50 .......................................... 8 acetaminophen w/ codeine .............................. 10 acetazolamide ................................................. 15 acetazolamide sodium ..................................... 15 ACETEST ........................................................ 12 acetic acid ................................................. 13, 15 acetic acid (otic) ............................................... 15 ACETIC ACID-ALUMINUM ACETATE ............ 15 acetylcysteine .................................................. 17 acetylcysteine (antidote) .................................. 17 acitretin ............................................................ 21 ACTEMRA INJ ................................................. 26 ACTEMRA INJ 162/0.9 .................................... 26 ACTEMRA SOLN 400 MG/20ML ..................... 26 ACTEMRA SOLN 80 MG/4ML ......................... 26 ACTHIB ........................................................... 19 ACTIMMUNE ................................................... 17 ACTIVASE ......................................................... 9 acyclovir ............................................................ 6 acyclovir sodium ................................................ 6 ADACEL .......................................................... 19 adapalene ........................................................ 21 ADCETRIS ........................................................ 6 ADCIRCA TAB 20MG ...................................... 24 adefovir dipivoxil ................................................ 6 ADEMPAS TAB 0.5MG ................................... 26 ADEMPAS TAB 1.5MG ................................... 26 ADEMPAS TAB 1MG ...................................... 27 ADEMPAS TAB 2.5MG ................................... 27 ADEMPAS TAB 2MG ...................................... 27 adenosine .................................................... 9, 12 adenosine (diagnostic) ..................................... 12 ADVAIR DISKUS ............................................... 8 ADVATE ............................................................ 8 AEROCHAMBER Z-STAT PLUS ..................... 12 AEROSPAN..................................................... 19 AEROTRACH PLUS ........................................ 12 AFINITOR .................................................... 6, 22

AFINITOR DISPERZ TAB 2MG ....................... 22 AFINITOR DISPERZ TAB 3MG ....................... 22 AFINITOR DISPERZ TAB 5MG ....................... 22 AFLURIA .......................................................... 19 AFLURIA PRESERVATIVE FREE ................... 19 AFSTYLA ........................................................... 8 A-HYDROCORT .............................................. 16 AKTEN ............................................................. 15 AKYNZEO ........................................................ 15 ALBENZA ...................................................... 3, 4 albumin, human ................................................. 8 ALBUSTIX........................................................ 12 albuterol sulfate .................................................. 8 alclometasone dipropionate ............................. 20 ALDURAZYME ................................................ 14 ALECENSA ........................................................ 6 alendronate sodium ......................................... 17 alfentanil .......................................................... 10 ALIMTA ........................................................ 6, 22 ALIMTA SOLR 100 MG .................................... 22 ALINIA ............................................................... 5 ALKERAN .......................................................... 6 allopurinol ........................................................ 17 ALOCRIL ......................................................... 15 ALOE VERA ..................................................... 18 ALPHANATE/VWF COMPLEX/HUMAN ............ 8 ALPHANINE SD ................................................. 8 alprazolam ....................................................... 11 alprostadil ........................................................ 10 ALPROSTADIL ................................................ 18 ALUNBRIG......................................................... 6 amantadine hcl ................................................. 11 AMBISOME........................................................ 5 amifostine ........................................................ 17 amikacin sulfate ................................................. 4 amiloride & hydrochlorothiazide ....................... 13 amino acid electrolyte infusion ......................... 13 amino acid infusion .......................................... 13 aminocaproic acid .............................................. 8 aminophylline ................................................... 21 amiodarone hcl .................................................. 9 AMITIZA ........................................................... 15 amitriptyline hcl ................................................ 11 amlodipine besylate ........................................... 9 AMOXAPINE .................................................... 11 amoxicillin ...................................................... 3, 4 amoxicillin & pot clavulanate .............................. 4 amphetamine-dextroamphetamine ................... 10 AMPHOTERICIN B ............................................ 5 ampicillin ............................................................ 4 ampicillin & sulbactam sodium ........................... 4


ampicillin sodium ............................................... 4 AMPYRA TAB 10MG ....................................... 26 anagrelide hcl .................................................... 9 anastrozole ........................................................ 6 ANCOBON CAP 250MG ................................. 22 ANCOBON CAP 500MG ................................. 22 ANDRODERM ................................................. 16 ANDROID ........................................................ 16 ANDROXY ....................................................... 16 ANGIOMAX ....................................................... 9 ANTIVENIN LATRODECTUS MACTANS ........ 19 APOKYN ......................................................... 11 apraclonidine hcl .............................................. 15 APTIOM TAB 200MG ...................................... 24 APTIOM TAB 400MG ...................................... 24 APTIOM TAB 600MG ...................................... 24 APTIOM TAB 800MG ...................................... 24 APTIVUS ........................................................... 4 AQUAPHOR .................................................... 21 AQUASOL A .................................................... 21 ARALAST NP SOLR 500 MG .......................... 26 ARAVA TAB .................................................... 26 ARCALYST INJ 220MG ................................... 26 ARGATROBAN ................................................. 9 aripiprazole ...................................................... 11 ARISTADA PRSY ............................................ 24 ARISTADA PRSY 1064 MG/3.9ML ................. 24 ARISTOSPAN INTRA-ARTICULAR ................ 16 ARRANON......................................................... 6 ARYMO ER TBEA 60 MG ............................... 24 ARZERRA CON 100/5ML ................................ 22 ascorbic acid .................................................... 21 ASMANEX 120 METERED DOSES ................ 16 aspirin-dipyridamole .......................................... 9 ASTAGRAF XL CAP 1MG ............................... 26 ASTAGRAF XL CAP 5MG ............................... 26 ASTAGRAF XL CP24 0.5 MG ......................... 26 atenolol .............................................................. 9 atenolol & chlorthalidone ................................... 9 ATGAM ............................................................ 17 atorvastatin calcium ........................................... 9 atovaquone ........................................................ 5 atovaquone-proguanil hcl .................................. 5 atracurium besylate ........................................... 8 ATRIPLA ........................................................... 4 atropine sulfate ............................................ 7, 15 atropine sulfate (ophthalmic) ........................... 15 ATROPINE SULFATE MONOHYDRATE ........ 18 ATROVENT HFA ............................................... 7 AUBAGIO TAB 14MG ...................................... 24 AUBAGIO TAB 7MG........................................ 24 AUSTEDO TABS ............................................. 24

AUVI-Q SOAJ 0.15 MG/0.15ML ....................... 23 AUVI-Q SOAJ 0.3 MG/0.3ML ........................... 23 AVASTIN ........................................................... 6 AVELOX ............................................................ 4 AVONEX .......................................................... 11 azacitidine .......................................................... 6 AZACTAM IN DEXTROSE ................................. 4 azathioprine ..................................................... 17 azelastine hcl ................................................... 15 AZILECT .......................................................... 11 azithromycin ....................................................... 4 aztreonam .......................................................... 4

B

bacitracin ..................................................... 4, 14 BACITRACIN ................................................... 14 bacitracin-polymyxin b (ophth) ......................... 14 baclofen ............................................................. 8 BACLOFEN...................................................... 18 BACTERIOSTATIC WATER(BENZ ALC) ........ 18 BACTOCILL IN DEXTROSE .............................. 4 BAL IN OIL ....................................................... 15 balsalazide disodium ........................................ 15 BANZEL ........................................................... 10 BARACLUDE TAB 0.5MG ............................... 22 BARACLUDE TAB 1MG .................................. 22 BAVENCIO SOLN 200 MG/10ML .................... 22 BAYER BREEZE 2 CONTROL ........................ 12 b-complex w/ c & folic acid ............................... 21 BD INSULIN SYR ULTRAFINE II ..................... 12 BD INSULIN SYRINGE U-500 ......................... 12 BD LANCET DEVICE ....................................... 12 BD LANCET ULTRAFINE 33G ........................ 12 BD LUER-LOK SYRINGE ................................ 12 BD PEN NEEDLE MINI U/F ............................. 12 BD SAFETYGLIDE SYRINGE/NEEDLE .......... 12 BELEODAQ INJ 500MG .................................. 22 BELLADONNA ALKALOIDS-OPIUM ................. 7 benazepril hcl ................................................... 10 BENDEKA .......................................................... 6 BENEFIX ........................................................... 8 BENLYSTA INJ 120MG ................................... 26 BENLYSTA INJ 200MG ................................... 26 BENLYSTA INJ 400MG ................................... 26 BENZOIN ......................................................... 21 benzoin compound ........................................... 21 benzonatate ..................................................... 19 benzoyl peroxide-erythromycin ........................ 20 benztropine mesylate ....................................... 11 BERINERT INJ 500UNIT ................................. 26 BESPONSA ..................................................... 22 betamethasone dipropionate (topical) .............. 20


betamethasone dipropionate augmented......... 20 betamethasone sod phosphate & acetate........ 16 betamethasone valerate .................................. 20 BETASERON KIT 0.3 MG ............................... 25 betaxolol hcl (ophth) ........................................ 15 bethanechol chloride ......................................... 8 BETHKIS NEB 300/4ML .................................. 22 BEXSERO ....................................................... 19 bicalutamide ...................................................... 6 BICILLIN L-A ..................................................... 4 BICNU ............................................................... 6 BILTRICIDE ....................................................... 4 BIOTIN-D ......................................................... 18 bisoprolol & hydrochlorothiazide ........................ 9 bisoprolol fumarate ............................................ 9 bleomycin sulfate ............................................... 6 BLINCYTO......................................................... 6 BORIC ACID .................................................... 18 BOSULIF TAB 100MG ..................................... 22 BOSULIF TAB 500MG ..................................... 22 BOTOX ............................................................ 17 BOTOX COSMETIC ........................................ 17 BRAVELLE ...................................................... 17 BREVIBLOC IN NACL ....................................... 9 BREVITAL SODIUM ........................................ 11 BRIDION ......................................................... 17 BRILINTA .......................................................... 9 brimonidine tartrate .......................................... 15 BRIVIACT 50 MG/5 ML VIAL ........................... 24 BRIVIACT SOLN 10 MG/ML ............................ 24 BRIVIACT TABS .............................................. 24 bromocriptine mesylate .................................... 11 budesonide ...................................................... 16 budesonide (inhalation) ................................... 16 bumetanide ...................................................... 13 BUPHENYL POW ............................................ 24 bupivacaine hcl ................................................ 17 bupivacaine in dextrose ................................... 17 bupivacaine w/ epinephrine ............................. 17 buprenorphine hcl ............................................ 10 buprenorphine hcl-naloxone hcl dihydrate ....... 10 bupropion hcl ................................................... 11 buspirone hcl ................................................... 11 BUSULFEX INJ 6MG/ML ................................. 22 BUTISOL SODIUM .......................................... 11 butorphanol tartrate ......................................... 10 BYDUREON .................................................... 16

C

cabergoline ...................................................... 11 CABOMETYX .................................................... 6 caffeine citrate ................................................. 10

calcipotriene ..................................................... 21 calcitonin (salmon) ........................................... 17 calcitriol ............................................................ 21 calcium acetate (phosphate binder) ................. 13 calcium chloride (dihydrate) ............................. 13 calcium gluconate ............................................ 13 CAMPTOSAR .................................................... 6 CANCIDAS ........................................................ 5 CANDIN ........................................................... 12 CANTHARIDIN ................................................ 18 CAPASTAT SULFATE ....................................... 5 capecitabine ....................................................... 6 CAPRELSA ........................................................ 6 captopril ........................................................... 10 carbamazepine ................................................ 10 CARBAMAZEPINE .......................................... 18 carbidopa ......................................................... 11 carbidopa-levodopa ......................................... 11 CARBIDOPA-LEVODOPA-ENTACAPONE ..... 11 CARDENE IV ..................................................... 9 CARIMUNE NF ................................................ 19 carvedilol ............................................................ 9 CASCARA SAGRADA ..................................... 15 CAVERJECT .................................................... 10 CAYSTON.......................................................... 4 cefaclor .............................................................. 4 cefadroxil ........................................................... 4 CEFAZOLIN IN D5W ......................................... 4 cefazolin sodium ................................................ 4 CEFAZOLIN SODIUM-DEXTROSE ................... 4 cefdinir ............................................................... 4 cefepime hcl ....................................................... 4 CEFEPIME-DEXTROSE .................................... 4 CEFOTAXIME SODIUM .................................... 4 cefotetan disodium ............................................. 4 CEFOTETAN DISODIUM-DEXTROSE .............. 4 cefoxitin sodium ................................................. 4 CEFOXITIN SODIUM-DEXTROSE .................... 4 cefpodoxime proxetil .......................................... 4 ceftazidime ......................................................... 4 ceftriaxone sodium ............................................. 4 CEFTRIAXONE SODIUM IN DEXTROSE ......... 4 CEFTRIAXONE SODIUM-DEXTROSE.............. 4 cefuroxime axetil ................................................ 4 cefuroxime sodium ............................................. 4 CEFUROXIME-DEXTROSE .............................. 4 CELONTIN ....................................................... 10 cephalexin .......................................................... 4 CERDELGA ..................................................... 17 CEREZYME ............................................... 14, 25 CEREZYME INJ 200UNIT ............................... 25 CERVIDIL ........................................................ 18


CHANTIX ........................................................... 8 CHEMET ......................................................... 16 CHEMSTRIP 9 ................................................ 12 CHIRHOSTIM .................................................. 12 CHLORAMPHENICOL SOD SUCCINATE ........ 4 chlordiazepoxide hcl .................................... 7, 11 chlordiazepoxide hcl-clidinium bromide ............. 7 chlorhexidine gluconate (mouth-throat) ........... 14 CHLOROFORM ............................................... 18 chloroprocaine hcl ........................................... 17 chloroquine phosphate ...................................... 5 chlorpheniramine & phenylephrine .................... 6 chlorpromazine hcl .......................................... 11 CHLORPROMAZINE HCL ............................... 18 chlorthalidone .................................................. 13 CHOLESTEROL ACETATE ............................ 18 cholestyramine .................................................. 9 cholestyramine light ........................................... 9 choline & mag salicylate .................................. 10 CHROMIC CHLORIDE .................................... 13 cidofovir ............................................................. 6 cimetidine hcl ................................................... 15 CIMZIA KIT ...................................................... 26 CIMZIA KIT 200MG/ML ................................... 26 CINQAIR SOLN 100 MG/10ML ....................... 26 CINRYZE ......................................................... 17 CIPRODEX ...................................................... 14 ciprofloxacin................................................. 4, 14 ciprofloxacin hcl ........................................... 4, 14 ciprofloxacin hcl (ophth) ................................... 14 ciprofloxacin in d5w ........................................... 4 cisatracurium besylate ....................................... 8 cisplatin ............................................................. 6 citalopram hydrobromide ................................. 11 cladribine ........................................................... 6 clarithromycin .................................................... 4 CLEOCIN IN D5W ............................................. 4 CLEVIPREX ...................................................... 9 clindamycin hcl .................................................. 4 CLINDAMYCIN HCL ........................................ 18 clindamycin palmitate hydrochloride .................. 4 clindamycin phosphate ................................ 4, 20 clindamycin phosphate (topical)....................... 20 clindamycin phosphate vaginal ........................ 20 clindamycin phosphate-benzoyl peroxide ........ 20 clindamycin phosphate-benzoyl peroxide

(refrigerate) .................................................. 20 CLINIMIX E/DEXTROSE (2.75/10) .................. 13 CLINIMIX E/DEXTROSE (2.75/5) .................... 13 CLINIMIX E/DEXTROSE (4.25/25) .................. 13 CLINIMIX E/DEXTROSE (5/15) ....................... 13 CLINIMIX E/DEXTROSE (5/20) ....................... 13

CLINIMIX/DEXTROSE (2.75/5) ........................ 13 CLINIMIX/DEXTROSE (4.25/10) ...................... 13 CLINIMIX/DEXTROSE (4.25/20) ...................... 13 CLINIMIX/DEXTROSE (4.25/25) ...................... 13 CLINIMIX/DEXTROSE (5/15)........................... 13 CLINITEST....................................................... 12 clobetasol propionate ....................................... 20 CLOBETASOL PROPIONATE ......................... 18 clomiphene citrate ............................................ 16 clomipramine hcl .............................................. 11 clonazepam...................................................... 10 clonidine hcl ....................................................... 9 CLONIDINE HCL ............................................. 18 clopidogrel bisulfate ........................................... 9 clorazepate dipotassium .................................. 11 clotrimazole ...................................................... 20 CLOTRIMAZOLE ............................................. 18 clozapine .......................................................... 11 COAL TAR ....................................................... 18 COARTEM ......................................................... 5 COCAINE HCL ................................................ 15 CODEINE SULFATE........................................ 10 COLCHICINE ................................................... 17 colchicine w/ probenecid .................................. 14 colestipol hcl ...................................................... 9 COLLODION FLEXIBLE .................................. 18 COLY-MYCIN S ............................................... 14 COMBIVENT RESPIMAT ................................ 19 COMPLERA ....................................................... 4 CONRAY ......................................................... 12 COPAXONE INJ 40MG/ML .............................. 24 COPPER CHLORIDE ...................................... 13 COPPER SULFATE ......................................... 13 CORDRAN ....................................................... 20 CORTISONE ACETATE .................................. 16 CORTISPORIN ................................................ 20 CORTROSYN .................................................. 12 COSENTYX 300 DOSE ................................... 21 COSMEGEN ................................................ 6, 22 COSMEGEN INJ 0.5MG .................................. 22 COTELLIC ......................................................... 6 CREON ...................................................... 12, 15 CRESEMBA CAPS 186 MG ............................ 22 CRESEMBA SOLR 372 MG ............................ 22 CRIXIVAN .......................................................... 4 CROFAB .......................................................... 19 CROMOLYN SODIUM ..................................... 19 cromolyn sodium (mastocytosis) ...................... 19 cromolyn sodium (ophth) .................................. 15 CUBICIN ............................................................ 4 CUPRIMINE CAPS 250 MG ............................ 25 CUROSURF ..................................................... 19


CUVITRU SOLN .............................................. 27 cyanocobalamin ............................................... 21 cyclobenzaprine hcl ........................................... 8 CYCLOMYDRIL ............................................... 15 cyclopentolate hcl ............................................ 15 cyclophosphamide ............................................. 6 CYCLOSERINE ................................................. 5 cyclosporine modified (for microemulsion) ....... 17 CYKLOKAPRON 100 MG/ML AMPUL ............ 23 cyproheptadine hcl ............................................ 6 CYRAMZA ......................................................... 6 CYSTADANE ................................................... 17 CYSTAGON .................................................... 17 CYSTEAMINE HCL ......................................... 18 CYSTOGRAFIN ............................................... 12 cytarabine .......................................................... 6 CYTOGAM ...................................................... 19

D

dacarbazine ....................................................... 6 DACOGEN ........................................................ 6 DAKLINZA ................................................... 6, 22 DAKLINZA TABS 90 MG ................................. 22 DALIRESP ....................................................... 19 DALVANCE SOL 500MG ................................ 22 danazol ............................................................ 16 dantrolene sodium ............................................. 8 dapsone ............................................................. 5 DARAPRIM........................................................ 5 DARZALEX SOLN 100 MG/5ML ..................... 22 DARZALEX SOLN 400 MG/20ML ................... 22 daunorubicin hcl ................................................ 6 DAUNOXOME ................................................... 6 deferoxamine mesylate .................................... 16 demeclocycline hcl ............................................ 4 DEPEN TITRATABS........................................ 16 DEPOCYT ......................................................... 6 DEPO-ESTRADIOL ......................................... 17 DEPO-PROVERA ............................................ 17 DESCOVY ......................................................... 6 desipramine hcl ............................................... 11 DESITIN .......................................................... 21 desmopressin acetate...................................... 17 desmopressin acetate refrigerated .................. 17 desmopressin acetate spray ............................ 17 desmopressin acetate spray refrigerated ......... 17 desogestrel & ethinyl estradiol ......................... 16 DESOWEN ...................................................... 20 desoximetasone .............................................. 20 dexamethasone ............................................... 16 DEXAMETHASONE .................................. 14, 18 dexamethasone sodium phosphate ................. 16

DEXAMETHASONE SODIUM PHOSPHATE .. 14 dexmethylphenidate hcl ................................... 10 dexrazoxane .................................................... 17 dextroamphetamine sulfate .............................. 10 dextrose ........................................................... 13 DEXTROSE 5%/ELECTROLYTE #48 ............. 13 dextrose in lactated ringers .............................. 13 dextrose in ringers ........................................... 13 dextrose w/ sodium chloride ............................. 13 DIANEAL LOW CALCIUM/4.25% DEX ............ 13 DIASTAT ACUDIAL ......................................... 11 DIASTIX ........................................................... 12 diazepam ......................................................... 11 diclofenac sodium (ophth) ................................ 14 diclofenac sodium (topical) ............................... 21 dicloxacillin sodium ............................................ 4 dicyclomine hcl ................................................... 7 didanosine ......................................................... 4 DIFICID TAB 200MG ....................................... 22 DIGIFAB .......................................................... 19 digoxin ............................................................... 9 dihydroergotamine mesylate .............................. 8 diltiazem hcl ....................................................... 9 DILTIAZEM HCL .............................................. 18 diltiazem hcl coated beads ................................. 9 DIPENTUM CAP 250MG ................................. 25 diphenhydramine hcl .......................................... 6 diphenoxylate w/ atropine ................................ 15 DIPHTHERIA-TETANUS TOXOIDS DT ........... 19 dipyridamole ..................................................... 10 disopyramide phosphate .................................... 9 DISPOSABLE POWER .................................... 12 disulfiram ......................................................... 17 divalproex sodium ............................................ 11 dobutamine hcl ................................................... 8 dobutamine in d5w ............................................. 8 DOCETAXEL ............................................... 6, 22 DOCETAXEL (NON-ALCOHOL) SOLN ........... 22 donepezil hydrochloride ..................................... 8 DONNATAL ....................................................... 7 dopamine hcl ...................................................... 8 dopamine in d5w ................................................ 8 dorzolamide hcl ................................................ 15 dorzolamide hcl-timolol maleate ....................... 15 doxazosin mesylate ........................................... 9 doxepin hcl ....................................................... 12 doxorubicin hcl ................................................... 6 doxorubicin hcl liposomal ................................... 6 doxycycline (monohydrate) ................................ 4 doxycycline hyclate ............................................ 5 DRITHO-CREME HP ....................................... 21 dronabinol ........................................................ 15


droperidol ........................................................ 11 drospirenone-ethinyl estradiol .......................... 16 DRYSOL .......................................................... 20 DULERA .......................................................... 19 duloxetine hcl ................................................... 12 DUPIXENT SOSY 300 MG/2ML ...................... 27 D-XYLOSE ...................................................... 12 DYRENIUM ..................................................... 13

E

EDECRIN ........................................................ 13 EDURANT ......................................................... 4 EFFIENT ........................................................... 9 EGRIFTA INJ 1MG .......................................... 25 EGRIFTA SOL 2MG ........................................ 25 ELAPRASE...................................................... 14 ELELYSO INJ 200UNIT ................................... 25 ELIDEL ............................................................ 21 ELITEK ............................................................ 14 ELLA ................................................................ 16 ELMIRON ........................................................ 17 ELOCTATE........................................................ 8 ELOXATIN INJ 100MG .................................... 22 ELOXATIN INJ 200MG .................................... 22 ELOXATIN INJ 50MG ...................................... 22 ELTA TAR ....................................................... 20 EMCYT .............................................................. 6 EMEND INJ ..................................................... 15 EMEND TAB .................................................... 15 EMFLAZA TABS .............................................. 25 EMPLICITI SOLR 300 MG ............................... 22 EMPLICITI SOLR 400 MG ............................... 22 EMTRIVA .......................................................... 4 enalaprilat ........................................................ 10 ENBREL .......................................................... 17 ENDOMETRIN ................................................ 17 ENGERIX-B ..................................................... 19 ENLON .............................................................. 8 entacapone ...................................................... 11 entecavir ............................................................ 6 ENTOCORT EC CAP 3MG/24HR ................... 25 ENTRESTO ..................................................... 10 ENTYVIO INJ 300MG ...................................... 25 EOVIST ........................................................... 12 EPCLUSA .................................................... 6, 22 EPCLUSA TABS 400-100 MG ......................... 22 ephedrine sulfate (pressors) .............................. 8 EPIDUO ........................................................... 21 EPINEPHRINE .................................................. 8 epinephrine hcl .................................................. 8 EQUETRO ....................................................... 11 ERBITUX ........................................................... 6

ergocalciferol .................................................... 21 ERGOLOID MESYLATES ................................ 11 ERGOMAR ........................................................ 8 ergotamine w/ caffeine ..................................... 11 ERIVEDGE ........................................................ 6 ERWINAZE ........................................................ 6 ERYTHROCIN LACTOBIONATE ....................... 5 erythromycin (acne aid) .................................... 20 erythromycin (ophth) ........................................ 14 ESBRIET CAP 267MG ..................................... 26 ESBRIET TABS 801 MG .................................. 26 escitalopram oxalate ........................................ 12 esmolol hcl ......................................................... 9 esterified estrogens & methyltestosterone ....... 17 ESTRACE ........................................................ 17 estradiol ........................................................... 17 ESTRADIOL ..................................................... 18 estradiol valerate .............................................. 17 ethambutol hcl .................................................... 5 ETHAMOLIN .................................................... 10 ethosuximide .................................................... 11 ethynodiol diacet & eth estrad .......................... 16 ETIDRONATE DISODIUM ............................... 17 etodolac ........................................................... 10 etomidate ......................................................... 11 etoposide ........................................................... 6 EVOMELA SOLR 50 MG ................................. 22 EVOTAZ ............................................................ 6 EVZIO SOAJ 2 MG/0.4ML ............................... 24 exemestane ....................................................... 6 EXJADE ........................................................... 16 EXONDYS 51 SOLN ........................................ 26 EXTAVIA .......................................................... 11 EYLEA ............................................................. 15 E-Z-CAT DRY .................................................. 12

F

FABRAZYME ................................................... 14 famciclovir .......................................................... 6 famotidine ........................................................ 15 FAMOTIDINE PREMIXED ............................... 15 FARESTON 60 MG TABLET ........................... 22 FARYDAK CAP 10MG ..................................... 22 FARYDAK CAP 15MG ..................................... 22 FARYDAK CAP 20MG ..................................... 22 FASLODEX ........................................................ 6 fat emulsion...................................................... 13 felbamate ......................................................... 11 FELBATOL SUS 600/5ML ............................... 24 FELBATOL TAB 400MG .................................. 24 FELBATOL TAB 600MG .................................. 24 fenofibrate .......................................................... 9


fentanyl ............................................................ 10 fentanyl citrate ................................................. 10 FERRIPROX SOLN 100 MG/ML ..................... 25 FERRIPROX TAB 500MG ............................... 25 finasteride ........................................................ 17 FIRAZYR ......................................................... 18 flecainide acetate ............................................... 9 FLOVENT HFA ................................................ 16 FLUAD ............................................................. 19 FLUARIX QUADRIVALENT ............................. 19 FLUBLOK ........................................................ 19 FLUCELVAX .................................................... 19 fluconazole ........................................................ 5 fluconazole in dextrose ...................................... 5 fluconazole in nacl ............................................. 5 FLUCONAZOLE IN SODIUM CHLORIDE ......... 5 flucytosine ......................................................... 5 fludarabine phosphate ....................................... 6 fludrocortisone acetate .................................... 16 flumazenil ........................................................ 11 FLUMIST QUADRIVALENT ............................ 19 flunisolide (nasal) ............................................. 14 fluocinolone acetonide ..................................... 20 fluocinonide ..................................................... 20 FLUOR-A-DAY ................................................ 18 fluorescein sodium injection ............................. 12 fluorescein sodium topical ............................... 12 fluorescein w/ benoxinate ................................ 12 fluorometholone (ophth) ................................... 14 fluorouracil ................................................... 6, 21 fluorouracil (topical) ......................................... 21 fluoxetine hcl .................................................... 12 fluphenazine decanoate ................................... 12 fluphenazine hcl ............................................... 12 FLURBIPROFEN SODIUM .............................. 14 flutamide ............................................................ 6 fluticasone propionate................................ 14, 20 fluticasone propionate (nasal) .......................... 14 FLUVIRIN ........................................................ 19 FLUVIRIN PRESERVATIVE FREE ................. 19 fluvoxamine maleate ........................................ 12 FLUZONE HIGH-DOSE ................................... 19 FOLIC ACID .................................................... 21 FORANE ......................................................... 11 FORTAZ IN D5W ............................................... 5 FORTEO ......................................................... 17 FOSCAVIR ........................................................ 6 fosphenytoin sodium ........................................ 11 FOSRENOL CHW 1000MG ............................. 24 FOSRENOL CHW 500MG ............................... 24 FOSRENOL CHW 750MG ............................... 24 FOSRENOL PACK 1000 MG........................... 24

FOSRENOL PACK 750 MG ............................. 24 furosemide ....................................................... 13 FUSILEV .......................................................... 18 FUZEON ............................................................ 4

G

gabapentin ....................................................... 11 GABAPENTIN .................................................. 18 GADAVIST ....................................................... 12 galantamine hydrobromide ................................. 8 GAMASTAN S/D .............................................. 19 GAMMAGARD ................................................. 19 ganciclovir sodium ............................................. 6 GARDASIL ....................................................... 19 GARDASIL 9 .................................................... 19 GASTROCROM 100 MG/5 ML CONC ............. 26 GASTROGRAFIN ............................................ 12 gatifloxacin (ophth) ........................................... 14 GATTEX KIT 5MG ........................................... 25 GAZYVA ............................................................ 6 GELFILM ........................................................... 8 GELFOAM SPONGE ......................................... 8 gemcitabine hcl .................................................. 6 gemfibrozil.......................................................... 9 GENOTROPIN INJ 12MG ................................ 25 GENOTROPIN INJ 5MG .................................. 25 GENOTROPIN MINIQUICK INJ 0.2MG ........... 25 GENOTROPIN MINIQUICK INJ 0.4MG ........... 25 GENOTROPIN MINIQUICK INJ 0.6MG ........... 25 GENOTROPIN MINIQUICK INJ 0.8MG ........... 25 GENOTROPIN MINIQUICK INJ 1.2MG ........... 25 GENOTROPIN MINIQUICK INJ 1.4MG ........... 25 GENOTROPIN MINIQUICK INJ 1.6MG ........... 25 GENOTROPIN MINIQUICK INJ 1.8MG ........... 25 GENOTROPIN MINIQUICK INJ 1MG .............. 25 GENOTROPIN MINIQUICK INJ 2MG .............. 25 gentamicin in saline ........................................... 5 gentamicin sulfate .................................. 5, 14, 20 gentamicin sulfate (ophth) ................................ 14 gentamicin sulfate (topical) .............................. 20 GENVOYA ......................................................... 6 GILENYA CAP 0.5MG ..................................... 24 GILOTRIF TAB 20MG ...................................... 22 GILOTRIF TAB 30MG ...................................... 22 GILOTRIF TAB 40MG ...................................... 22 GLASSIA INJ ................................................... 26 glatiramer acetate ............................................ 11 GLEOSTINE ...................................................... 6 glimepiride........................................................ 16 glipizide ............................................................ 16 glipizide-metformin hcl ..................................... 16 GLUCAGEN DIAGNOSTIC .............................. 16


GLUCAGEN HYPOKIT .................................... 16 GLUCAGON EMERGENCY ............................ 16 glyburide .......................................................... 16 GLYCERIN ...................................................... 18 glycopyrrolate .................................................... 7 GLYCOPYRROLATE ...................................... 18 GONAL-F ........................................................ 17 GRANIX INJ 300/0.5........................................ 23 GRANIX INJ 480/0.8........................................ 23 GRASTEK ....................................................... 18 griseofulvin microsize ........................................ 5 griseofulvin ultramicrosize ................................. 5 guaifenesin-codeine ........................................ 19 guanfacine hcl ................................................... 8 GUANIDINE HCL .............................................. 8

H

HAEGARDA INJ .............................................. 26 HALAVEN .......................................................... 6 halobetasol propionate .................................... 20 haloperidol ....................................................... 12 HALOPERIDOL ............................................... 18 haloperidol decanoate ..................................... 12 haloperidol lactate ........................................... 12 HARVONI .......................................................... 5 HAVRIX ........................................................... 19 HEALON5 ........................................................ 15 HELIXATE FS .................................................... 8 HEMABATE ..................................................... 18 HEMOFIL M ....................................................... 8 heparin (porcine) in sodium chloride .................. 9 heparin sod (porcine) in d5w ............................. 9 heparin sodium (porcine) ................................... 9 heparin sodium (porcine) lock flush ................... 9 HEPSERA TAB 10MG ..................................... 22 HERCEPTIN ...................................................... 6 hetastarch in sodium chloride .......................... 13 HETLIOZ CAP 20MG ...................................... 24 HEXALEN .......................................................... 6 HEXTEND ....................................................... 13 HIZENTRA....................................................... 19 homatropine hbr .............................................. 15 HP ACTHAR .................................................... 17 HUMALOG ...................................................... 16 HUMALOG MIX 50/50 ..................................... 16 HUMATROPE COMBO PACK INJ 5MG .......... 25 HUMATROPE INJ 12MG ................................. 25 HUMATROPE INJ 24MG ................................. 25 HUMATROPE INJ 6MG ................................... 25 HUMIRA .......................................................... 17 HUMULIN 70/30 .............................................. 16 HUMULIN N ..................................................... 16

HUMULIN R ..................................................... 16 HYCAMTIN 4 MG VIAL .................................... 23 HYCAMTIN CAP 0.25MG ................................ 23 HYCAMTIN CAP 1MG ..................................... 23 hydralazine hcl ................................................... 9 hydrochlorothiazide .......................................... 13 hydrocodone w/ homatropine ........................... 19 hydrocodone-acetaminophen ........................... 10 hydrocortisone ........................................... 16, 20 HYDROCORTISONE ....................................... 18 hydrocortisone (intrarectal) .............................. 20 hydrocortisone (rectal) ..................................... 20 hydrocortisone (topical) .................................... 20 hydrocortisone acetate (rectal) ......................... 20 hydrocortisone acetate w/ pramoxine ............... 20 hydromorphone hcl .......................................... 10 HYDROPHILIC ................................................ 18 HYDROXOCOBALAMIN .................................. 18 hydroxychloroquine sulfate ................................ 5 HYDROXYPROGESTERONE CAPROATE ..... 18 hydroxyurea ....................................................... 6 hydroxyzine hcl ................................................ 11 hydroxyzine pamoate ....................................... 11 HYLENEX ........................................................ 14 hyoscyamine sulfate........................................... 7 HYPERLYTE-CR ............................................. 13 HYPERRAB S/D .............................................. 19 HYPERTET S/D ............................................... 19 HYQVIA ........................................................... 19

I

IBRANCE ........................................................... 6 ibuprofen .......................................................... 10 ibutilide fumarate ................................................ 9 ICLUSIG TAB 15MG ........................................ 23 ICLUSIG TAB 45MG ........................................ 23 idarubicin hcl ...................................................... 6 IDELVION .......................................................... 8 IDHIFA TAB ..................................................... 23 ifosfamide .......................................................... 6 IFOSFAMIDE-MESNA ....................................... 6 ILARIS INJ 180MG .......................................... 24 ILARIS SOLN 150 MG/ML ............................... 24 ILUVIEN 0.19MG IMPLANT ............................. 25 imatinib mesylate ............................................... 6 IMBRUVICA ....................................................... 6 IMFINZI SOLN ................................................. 23 imipramine hcl .................................................. 12 imiquimod ........................................................ 21 IMLYGIC SUSP 1000000 UNIT/ML ................. 23 IMLYGIC SUSP 100000000 UNIT/ML ............. 23 IMOVAX RABIES ............................................. 19


IMPAVIDO CAPS 50 MG ................................. 22 INCRELEX INJ 40MG/4ML .............................. 25 indapamide ...................................................... 13 INDIGO CARMINE .......................................... 12 indomethacin ................................................... 10 INDOMETHACIN ....................................... 10, 18 INDOMETHACIN SODIUM .............................. 10 INFANRIX ........................................................ 19 INFED ................................................................ 8 INFLECTRA..................................................... 18 INFUMORPH 200 ............................................ 10 INFUVITE ........................................................ 21 INFUVITE PEDIATRIC .................................... 21 INGREZZA CAPS 40 MG ................................ 24 INLYTA TAB 1MG ........................................... 23 INLYTA TAB 5MG ........................................... 23 INTEGRILIN ...................................................... 9 INTELENCE ...................................................... 4 INTRON A ......................................................... 6 INTRON-A KIT 10MU/ML ............................ 23 INTRON-A INJ 10MU PEN .............................. 23 INTRON-A INJ 3MU PEN ................................ 23 INTRON-A INJ 5MU PEN ................................ 23 INVANZ ............................................................. 5 INVEGA SUSTENNA INJ 117/0.75 ................. 24 INVEGA SUSTENNA INJ 234/1.5 ................... 24 INVEGA SUSTENNA INJ 39/0.25 ................... 24 INVEGA SUSTENNA INJ 78/0.5ML ................ 24 INVEGA TB24 1.5 MG ..................................... 24 INVEGA TB24 3 MG ........................................ 24 INVEGA TB24 6 MG ........................................ 24 INVEGA TB24 9 MG ........................................ 24 INVIRASE .......................................................... 4 iodoquinol-hc ................................................... 20 IPOL ................................................................ 19 ipratropium bromide ........................................... 7 ipratropium bromide (nasal) ............................... 7 ipratropium-albuterol .......................................... 8 IRESSA ............................................................. 6 ISENTRESS ...................................................... 4 isometheptene-dichloralphenazone-

acetaminophen ............................................ 11 isoniazid ............................................................ 5 isoproterenol hcl ................................................ 8 ISOSORBIDE .................................................. 18 isosorbide dinitrate .......................................... 10 isosorbide mononitrate .................................... 10 isotretinoin ....................................................... 21 ISTODAX ........................................................... 7 itraconazole ....................................................... 5 ivermectin .......................................................... 4 IXEMPRA KIT .................................................... 7

IXIARO ............................................................. 19

J

JADENU SPRINKLE PACK ............................. 25 JAKAFI ............................................................... 7 JARDIANCE ..................................................... 16 JETREA ........................................................... 15 JEVTANA ........................................................... 7 JUXTAPID CAP 10MG ..................................... 23 JUXTAPID CAP 20MG ..................................... 23 JUXTAPID CAP 30MG ..................................... 23 JUXTAPID CAP 40MG ..................................... 23 JUXTAPID CAP 5MG ....................................... 23 JUXTAPID CAP 60MG ..................................... 23

K

KADCYLA .......................................................... 7 KALETRA .......................................................... 4 KALYDECO ..................................................... 18 KANUMA SOLN 20 MG/10ML ......................... 25 KCENTRA .......................................................... 8 KCL-LACTATED RINGERS-D5W .................... 13 KENALOG........................................................ 16 KEPIVANCE .................................................... 20 KERALYT ........................................................ 20 ketamine hcl ..................................................... 11 KETAMINE HCL .............................................. 18 ketoconazole ................................................ 5, 20 ketoconazole (topical) ...................................... 20 KETO-DIASTIX ................................................ 12 KETOPROFEN ................................................ 18 ketorolac tromethamine .............................. 10, 14 ketorolac tromethamine (ophth) ....................... 14 KEVEYIS TABS 50 MG .................................... 26 KEVZARA INJ .................................................. 26 KEYTRUDA ....................................................... 7 KINERET ......................................................... 17 KINRIX ............................................................. 20 KISQALI PAK FEMARA ................................... 23 KISQALI TABS ................................................. 23 KITABIS PAK NEB 300/5ML ............................ 22 KORLYM TAB 300MG ..................................... 25 K-PHOS ........................................................... 13 KUVAN POWDER ........................................... 26 KUVAN TAB 100MG ........................................ 26 KYNAMRO INJ 200MG/ML .............................. 23 KYPROLIS ................................................... 7, 23 KYPROLIS 30 MG VIAL ................................... 23

L

labetalol hcl ........................................................ 9


LACRISERT .................................................... 15 lactated ringer's ......................................... 13, 14 lactated ringer's (irrigation) .............................. 13 LACTIC ACID .................................................. 18 LACTOSE ........................................................ 18 LACTOSE MONOHYDRATE ........................... 18 lactulose .......................................................... 13 lactulose (encephalopathy) .............................. 13 lamivudine ..................................................... 4, 6 lamivudine (hbv) ................................................ 6 lamivudine-zidovudine ....................................... 4 lamotrigine ....................................................... 11 LANTUS .......................................................... 16 L-ARGININE .................................................... 18 LARTRUVO INJ 190/19ML .......................... 23 LARTRUVO SOLN 500 MG/50ML ................... 23 latanoprost ....................................................... 15 L-CITRULLINE ................................................ 18 leflunomide ................................................ 17, 18 LEMTRADA SOLN 12 MG/1.2ML .................... 26 LENVIMA ..................................................... 7, 23 LENVIMA 10 MG DAILY DOSE ......................... 7 LENVIMA PACK 10 & 4 (2) MG (18 MG DAILY

DOSE) ......................................................... 23 LENVIMA PACK 4 (2) MG (8 MG DAILY DOSE)

..................................................................... 23 LETAIRIS ........................................................ 10 letrozole ............................................................. 7 leucovorin calcium ........................................... 18 LEUKERAN ....................................................... 7 LEUKINE ..................................................... 9, 23 LEUKINE 500 MCG/ML VIAL .......................... 23 leuprolide acetate .............................................. 7 levetiracetam ................................................... 11 LEVETIRACETAM IN NACL ............................ 11 LEVITRA ......................................................... 10 levobunolol hcl ................................................. 15 levocarnitine (metabolic modifiers) .................. 18 levofloxacin ........................................................ 5 levofloxacin in d5w ............................................ 5 levonorgestrel & eth estradiol .................... 12, 16 levonorgestrel (emergency oc) ........................ 16 levonorgestrel-eth estradiol (triphasic) ............. 16 levothyroxine sodium ....................................... 17 LEVULAN KERASTICK ................................... 21 LEXISCAN ....................................................... 12 LEXIVA .............................................................. 4 lidocaine .......................................... 9, 15, 17, 20 lidocaine hcl ..................................... 9, 15, 17, 20 LIDOCAINE HCL ............................................. 18 lidocaine hcl (cardiac) .................................. 9, 17 lidocaine hcl (local anesth.) ............................. 17

lidocaine hcl (mouth-throat) .............................. 15 lidocaine in d5w ................................................. 9 lidocaine w/ epinephrine ................................... 17 lidocaine-prilocaine .......................................... 20 linezolid .............................................................. 5 LINEZOLID SOLN 2MG/ML ............................. 22 liothyronine sodium .......................................... 17 lisinopril ............................................................ 10 lisinopril & hydrochlorothiazide ......................... 10 L-ISOLEUCINE ................................................ 18 LITHIUM .......................................................... 11 lithium carbonate .............................................. 11 LITHOSTAT ..................................................... 13 LMD IN D5W .................................................... 14 LMD IN NACL .................................................. 14 LONSURF .......................................................... 7 lorazepam ........................................................ 11 losartan potassium ........................................... 10 losartan potassium & hydrochlorothiazide ........ 10 LOTRONEX TAB 0.5MG .................................. 25 LOTRONEX TAB 1MG ..................................... 25 lovastatin ............................................................ 9 LOVENOX.......................................................... 9 loxapine succinate ........................................... 12 L-PROLINE ...................................................... 18 LUCENTIS ....................................................... 15 LUMASON ....................................................... 12 LUMIGAN ........................................................ 15 LUMIZYME ...................................................... 14 LUPRON DEPOT (3-MONTH) ........................... 7 LUPRON DEPOT (4-MONTH) ........................... 7 LUPRON DEPOT (6-MONTH) ........................... 7 LUPRON DEPOT-PED (1-MONTH) ................... 7 LUPRON DEPOT-PED (3-MONTH) ................... 7 L-VALINE ......................................................... 18 LYNPARZA ........................................................ 7 LYSODREN ....................................................... 7

M

M.T.E.-5 CONCENTRATE ............................... 14 MACUGEN....................................................... 15 magnesium sulfate ........................................... 11 MAGNESIUM SULFATE IN D5W .................... 14 MAGNEVIST .................................................... 12 MAKENA .................................................... 17, 25 MAKENA INJ 250MG/ML ................................. 25 malathion ......................................................... 20 MANGANESE CHLORIDE ............................... 14 mannitol ........................................................... 13 MAPROTILINE HCL......................................... 12 MARQIBO .......................................................... 7 MATULANE ....................................................... 7


MAVYRET TAB 100-40MG ............................. 22 meclizine hcl .................................................... 15 MECLOFENAMATE SODIUM ......................... 10 medroxyprogesterone acetate ......................... 17 medroxyprogesterone acetate (contraceptive) . 17 mefenamic acid ............................................... 10 mefloquine hcl ................................................... 5 megestrol acetate .............................................. 7 MEKINIST ......................................................... 7 meloxicam ....................................................... 10 melphalan hcl .................................................... 7 memantine hcl ................................................. 11 MENOPUR ...................................................... 17 MENVEO ......................................................... 20 meperidine hcl ................................................. 10 mepivacaine hcl ............................................... 17 MEPRON SUS ................................................ 22 mercaptopurine .................................................. 7 meropenem ....................................................... 5 mesalamine ..................................................... 15 mesna .............................................................. 18 METAPROTERENOL SULFATE ....................... 8 metformin hcl ................................................... 16 methadone hcl ................................................. 10 METHADONE HCL ......................................... 18 methazolamide ................................................ 15 methenamine hippurate ..................................... 6 methimazole .................................................... 17 methocarbamol .................................................. 8 methotrexate sodium ......................................... 7 methoxsalen rapid ........................................... 20 methyldopa ........................................................ 9 METHYLDOPATE HCL ..................................... 9 methylene blue (antidote) ................................ 18 methylergonovine maleate ............................... 18 methylphenidate hcl ......................................... 10 methylprednisolone ......................................... 16 methylprednisolone acetate ............................. 16 methylprednisolone sod succ .......................... 16 metoclopramide hcl ......................................... 15 METOCLOPRAMIDE HCL MONOHYDRATE . 18 metolazone ...................................................... 13 METOPIRONE ................................................ 12 metoprolol succinate .......................................... 9 metoprolol tartrate ............................................. 9 METOPROLOL-HYDROCHLOROTHIAZIDE .... 9 metronidazole .............................................. 5, 20 METRONIDAZOLE .......................................... 18 metronidazole (topical) .................................... 20 metronidazole in nacl ......................................... 5 metronidazole vaginal ...................................... 20 mexiletine hcl ..................................................... 9

MICRHOGAM ULTRA-FILTERED PLUS ......... 19 midazolam hcl .................................................. 11 midodrine hcl ...................................................... 8 MIFEPREX....................................................... 18 milrinone lactate ................................................. 9 milrinone lactate in dextrose .............................. 9 minocycline hcl ................................................... 5 minoxidil ............................................................. 9 MIOCHOL-E ..................................................... 15 MIOSTAT ......................................................... 15 MIRENA (52 MG) ............................................. 16 mirtazapine ...................................................... 12 misoprostol....................................................... 15 mitomycin ........................................................... 7 MITOSOL ......................................................... 14 mitoxantrone hcl ................................................. 7 M-M-R II ........................................................... 20 mometasone furoate ........................................ 20 montelukast sodium ......................................... 19 morphine sulfate .............................................. 10 MORPHINE SULFATE ..................................... 18 moxifloxacin hcl .................................................. 5 MOZOBIL 20 MG/ML VIAL .............................. 23 MULTIHANCE .................................................. 12 mupirocin ......................................................... 20 MUSTARGEN .................................................... 7 MYALEPT INJ 11.3MG .................................... 26 MYCAMINE INJ 100MG ................................... 22 MYCAMINE INJ 50MG ..................................... 22 MYCOBUTIN CAP 150MG .............................. 22 mycophenolate mofetil ..................................... 17 MYLERAN.......................................................... 7 MYLOTARG SOLR .......................................... 23 MYOBLOC ....................................................... 18

N

NABI-HB .......................................................... 19 nabumetone ..................................................... 10 nadolol ............................................................... 9 nafcillin sodium .................................................. 5 NAFCILLIN SODIUM IN DEXTROSE ................ 5 NAGLAZYME ................................................... 14 nalbuphine hcl .................................................. 10 naloxone hcl ..................................................... 11 naltrexone hcl ................................................... 11 NAPHAZOLINE HCL........................................ 15 naproxen .......................................................... 10 naproxen sodium ............................................. 10 naratriptan hcl .................................................. 11 NAROPIN ........................................................ 17 NATPARA CART 100 MCG ............................. 25 NATPARA CART 25 MCG ............................... 25


NATPARA CART 50 MCG ............................... 25 NATPARA CART 75 MCG ............................... 25 NEBUPENT ....................................................... 5 NECON 1/50 (28) ............................................ 16 NECON 10/11 (28) .......................................... 16 nefazodone hcl ................................................ 12 NEMBUTAL ..................................................... 11 neomycin sulfate ................................................ 5 NEOMYCIN SULFATE .................................... 18 neomycin/polymyxin b gu ................................ 20 neomycin-bacitracin zn-polymyxin ................... 14 neomycin-polymy-dexameth ............................ 14 neomycin-polymyxin-gramicidin ....................... 14 neomycin-polymyxin-hc (otic) .......................... 14 NEOPROFEN .................................................. 10 neostigmine methylsulfate ................................. 8 NERLYNX TAB 40MG ..................................... 23 NEULASTA INJ 6MG/0.6M .............................. 23 NEUMEGA ........................................................ 9 NEUPOGEN ...................................................... 9 nevirapine .......................................................... 4 NEXAVAR ......................................................... 7 NEXPLANON .................................................. 16 niacin ............................................................... 21 nicardipine hcl .................................................... 9 nicotine .............................................................. 8 nicotine polacrilex .............................................. 8 nifedipine ........................................................... 9 nimodipine ......................................................... 9 NINLARO .......................................................... 7 NIPENT INJ 10MG .......................................... 23 nitrofurantoin ...................................................... 6 nitrofurantoin macrocrystal ................................ 6 nitrofurantoin monohyd macro ........................... 6 nitroglycerin ..................................................... 10 nitroglycerin in d5w .......................................... 10 NITROPRESS ................................................... 9 NITYR TAB ...................................................... 26 NORDITROPIN FLEXPRO ........................ 17, 25 NORDITROPIN FLEXPRO INJ 10/1.5ML ........ 25 NORDITROPIN FLEXPRO INJ 5/1.5ML .......... 25 NORDITROPIN NORDIFLEX PEN INJ 30/3ML

..................................................................... 25 norepinephrine bitartrate .................................... 8 norethin acet & estrad-fe ................................. 16 norethindrone & eth estradiol ........................... 16 norethindrone (contraceptive) .......................... 16 norethindrone acet & eth estra......................... 16 norethindrone acetate ...................................... 17 norethindrone-eth estradiol (triphasic) ............. 16 norgestimate-ethinyl estradiol .......................... 16 norgestimate-ethinyl estradiol (triphasic) ......... 16

norgestrel & ethinyl estradiol ............................ 16 NORTHERA CAP 100MG ................................ 23 NORTHERA CAP 200MG ................................ 23 NORTHERA CAP 300MG ................................ 23 nortriptyline hcl ................................................. 12 NORVIR ............................................................. 4 NOVAREL ........................................................ 17 NOVOSEVEN RT .............................................. 8 NOXAFIL SOLN 300 MG/16.7ML .................... 22 NOXAFIL SUS 40MG/ML ................................. 22 NOXAFIL TAB 100MG ..................................... 22 NUCALA SOLR 100 MG .................................. 26 NULOJIX INJ 250MG ....................................... 26 NUPLAZID TABS 17 MG ................................. 24 NUTROPIN AQ INJ 10MG/2ML ....................... 25 NUTROPIN AQ NUSPIN 10 SOLN 10 MG/2ML

..................................................................... 25 NUTROPIN AQ NUSPIN 20 SOLN 20 MG/2ML

..................................................................... 25 NUTROPIN AQ NUSPIN 5 INJ NUSPIN 5 ....... 25 NUTROPIN AQ PEN INJ 10MG/2ML ............... 25 NUTROPIN AQ PEN INJ 20MG/2ML ............... 25 NUTROPIN INJ 10MG ..................................... 25 NUVARING ...................................................... 16 nystatin ........................................................ 5, 20 nystatin (mouth-throat) ....................................... 5 nystatin (topical) ............................................... 20 nystatin-triamcinolone ...................................... 20

O

OCALIVA ......................................................... 25 OCREVUS SOLN 300 MG/10ML ..................... 26 octreotide acetate ............................................ 18 ODEFSEY .......................................................... 6 ODOMZO ........................................................... 7 OFEV CAP 100MG .......................................... 26 OFEV CAP 150MG .......................................... 26 OFIRMEV ........................................................ 10 ofloxacin (ophth) .............................................. 14 ofloxacin (otic) .................................................. 14 olanzapine ....................................................... 12 olopatadine hcl ................................................. 15 OLYSIO CAP 150MG ....................................... 22 omeprazole ...................................................... 15 OMNIPAQUE ................................................... 12 ONCASPAR ....................................................... 7 ondansetron ..................................................... 15 ondansetron hcl ............................................... 15 ONETOUCH ULTRA BLUE ............................. 13 ONETOUCH ULTRA MINI ............................... 12 ONIVYDE INJ 43 MG/10ML ............................. 23 OPANA ............................................................ 10


OPDIVO ............................................................ 7 ophthalmic irrigation solution - intraocular ........ 15 OPSUMIT .................................................. 19, 27 OPSUMIT TAB 10MG ...................................... 27 ORAP .............................................................. 12 ORBACTIV SOL 400MG ................................. 22 ORENCIA ............................................ 17, 18, 26 ORENCIA SOSY 50 MG/0.4ML ....................... 26 ORENCIA SOSY 87.5 MG/0.7ML .................... 26 ORENITRAM TAB 0.125MG ........................... 27 ORENITRAM TAB 0.25MG ............................. 27 ORENITRAM TAB 1MG .................................. 27 ORENITRAM TAB 2.5MG ............................... 27 ORENITRAM TAB 5MG .................................. 27 ORFADIN SUS 4MG/ML ............................ 26 ORFADIN CAP 10MG ..................................... 26 ORFADIN CAP 2MG ....................................... 26 ORFADIN CAP 5MG ....................................... 26 ORFADIN CAPS 20 MG .................................. 26 ORKAMBI ........................................................ 19 oseltamivir phosphate ........................................ 6 OTEZLA .......................................................... 17 OVIDREL ......................................................... 17 oxacillin sodium ................................................. 5 oxaliplatin .......................................................... 7 oxandrolone ..................................................... 16 oxazepam ........................................................ 11 oxcarbazepine ................................................. 11 OXSORALEN .................................................. 20 oxybutynin chloride .......................................... 21 oxycodone hcl .................................................. 10 oxycodone w/ acetaminophen ......................... 10 oxytocin ........................................................... 18 OXYTROL ....................................................... 21 OZURDEX ....................................................... 14

P

paclitaxel ........................................................... 7 pamidronate disodium ..................................... 18 PANCURONIUM BROMIDE .............................. 8 PANRETIN GEL 0.1% ..................................... 27 pantoprazole sodium ....................................... 15 PAPAVERINE HCL ................................... 10, 18 PAREGORIC ................................................... 15 paromomycin sulfate.......................................... 5 paroxetine hcl .................................................. 12 ped multivitamins w/fl & iron ............................ 21 PEDIARIX ........................................................ 20 pediatric multiple vitamin w/ c .......................... 21 pediatric multivitamins w/fl ............................... 21 PEDIATRIC SMALL MASK .............................. 12 pediatric vitamins acd w/ fluoride ..................... 21

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ..................................................................... 15

PEGASYS .......................................................... 5 PEG-INTRON REDIPEN .................................... 5 PENICILLIN G POT IN DEXTROSE .................. 5 penicillin g potassium ......................................... 5 PENICILLIN G PROCAINE ................................ 5 PENICILLIN G SODIUM .................................... 5 penicillin v potassium ......................................... 5 PENLET II BLOOD SAMPLER ......................... 12 pentazocine w/ naloxone .................................. 10 pentostatin ......................................................... 7 pentoxifylline ...................................................... 9 PERJETA ........................................................... 7 permethrin ........................................................ 20 perphenazine ................................................... 12 PERPHENAZINE-AMITRIPTYLINE ................. 12 phenelzine sulfate ............................................ 12 PHENEX-1 ....................................................... 13 phenobarbital ................................................... 11 PHENOBARBITAL ..................................... 11, 18 PHENOBARBITAL SODIUM ............................ 11 PHENOL ...................................................... 8, 20 phenoxybenzamine hcl ...................................... 8 PHENTOLAMINE MESYLATE ..................... 8, 18 phenylephrine hcl (ophth) ................................. 15 phenylephrine hcl (pressors) .............................. 8 phenylephrine-chlorphen-dm ........................... 19 PHENYLHISTINE DH ...................................... 19 phenytoin ......................................................... 11 phenytoin sodium ............................................. 11 phenytoin sodium extended ............................. 11 PHOSPHOLINE IODIDE .................................. 15 PHYSOSTIGMINE SALICYLATE ....................... 8 phytonadione ................................................... 21 pilocarpine hcl .............................................. 8, 15 pilocarpine hcl (oral) ........................................... 8 pioglitazone hcl ................................................ 16 piperacillin sodium-tazobactam sodium.............. 5 PLASMA-LYTE A ............................................. 14 PLASMANATE ................................................... 8 PLEGRIDY INJ ................................................ 24 PLEGRIDY INJ PEN ........................................ 24 PLEGRIDY STARTER PACK INJ STARTER ... 24 PLURONIC F127 ............................................. 18 PNEUMOVAX 23 ............................................. 20 PODOCON ...................................................... 21 podofilox .......................................................... 21 PODOPHYLLUM RESIN .................................. 18 POLYETHYLENE GLYCOL 400 ...................... 18 POLYETHYLENE GLYCOL 8000 .................... 18 polymyxin b-trimethoprim ................................. 14


polysaccharide iron complex ............................. 8 POLY-VI-SOL/IRON ........................................ 21 POMALYST ....................................................... 7 PORTRAZZA SOLN 800 MG/50ML ................. 23 pot & sod citrates w/citric ac ............................ 13 POTABA .......................................................... 21 potassium acetate ........................................... 14 potassium bicarbonate ..................................... 14 potassium chloride ........................................... 14 potassium chloride in dextrose ........................ 14 potassium chloride in dextrose & sodium chloride

..................................................................... 14 potassium chloride in nacl ............................... 14 potassium chloride microencapsulated crystals cr

..................................................................... 14 potassium citrate (alkalinizer) .......................... 13 potassium citrate-citric acid ............................. 13 potassium phosphate dibasic .......................... 14 potassium phosphates ..................................... 14 PRADAXA ......................................................... 9 PRALUENT SOSY 150 MG/ML ....................... 23 PRALUENT SOSY 75 MG/ML ......................... 23 pramipexole dihydrochloride ............................ 11 pramoxine-hc ................................................... 20 pravastatin sodium ............................................ 9 PRAXBIND ........................................................ 8 prazosin hcl ....................................................... 9 PRECEDEX ..................................................... 11 prednisolone .............................................. 14, 16 prednisolone acetate (ophth) ........................... 14 prednisolone sodium phosphate ...................... 16 PREDNISOLONE SODIUM PHOSPHATE ...... 14 prednisone ....................................................... 16 PREMARIN...................................................... 17 PREVNAR 13 .................................................. 20 PREZCOBIX ...................................................... 4 PREZISTA ......................................................... 4 PRIFTIN ............................................................ 5 PRIMAQUINE PHOSPHATE ............................. 5 PRIMAXIN IV ..................................................... 5 primidone ......................................................... 11 PRIMSOL .......................................................... 5 probenecid ....................................................... 14 PROBUPHINE IMPLANT KIT IMPL 74.2 MG .. 24 PROCAINAMIDE HCL ....................................... 9 prochlorperazine .............................................. 12 prochlorperazine edisylate ............................... 12 prochlorperazine maleate ................................ 12 PROCRIT .......................................................... 9 PROCTOFOAM HC ......................................... 20 PROCYSBI CAP 25MG ................................... 26 PROCYSBI CAP 75MG ................................... 26

PROFERRIN ES ................................................ 8 PROFERRIN-FORTE ......................................... 8 PROFILNINE ..................................................... 8 progesterone .................................................... 17 progesterone micronized .................................. 17 PROGESTERONE MICRONIZED ................... 19 PROGESTERONE WETTABLE ....................... 19 PROGLYCEM .................................................. 10 PROLASTIN-C ................................................. 14 PROLEUKIN ...................................................... 7 PROMACTA ....................................................... 9 promethazine hcl ................................................ 6 promethazine w/codeine .................................. 19 promethazine-dm ............................................. 19 propafenone hcl ................................................. 9 PROPANTHELINE BROMIDE ........................... 7 proparacaine hcl .............................................. 15 propofol ............................................................ 11 propranolol hcl ................................................... 9 PROPYLENE GLYCOL .................................... 19 propylthiouracil ................................................. 17 PROQUAD ....................................................... 20 PROTAMINE SULFATE ..................................... 8 protriptyline hcl ................................................. 12 pseudoephedrine w/ codeine-gg ...................... 19 PULMOZYME .................................................. 14 PURINETHOL .................................................. 23 pyrazinamide ...................................................... 5 pyridostigmine bromide ...................................... 8 pyridoxine hcl ................................................... 21

Q

QUELICIN .......................................................... 8 quetiapine fumarate ......................................... 12 QUINACRINE HCL .......................................... 19 quinidine gluconate ............................................ 9 QUINIDINE SULFATE ....................................... 9 QVAR ............................................................... 16

R

RABAVERT...................................................... 20 RADICAVA INJ 30MG ..................................... 24 raloxifene hcl .................................................... 17 ramipril ............................................................. 10 ranitidine hcl ..................................................... 15 RAPIVAB SOLN 200 MG/20ML ....................... 22 RASUVO .......................................................... 17 RAVICTI LIQ 1.1GM/ML .................................. 24 RAYALDEE CPCR 30 MCG ............................ 27 REBIF INJ 22/0.5 ............................................. 24 REBIF INJ 44/0.5 ............................................. 24


REBIF REBIDOSE INJ 22/0.5 ......................... 24 REBIF REBIDOSE INJ 44/0.5 ......................... 24 REBIF REBIDOSE TITRATION PACK SOL

TITRATN ...................................................... 24 REBIF TITRATION PACK SOL PACK ............. 24 RECOTHROM ................................................... 8 REGRANEX GEL 0.01% ................................. 27 RELENZA DISKHALER ..................................... 6 RELISTOR 12 MG/0.6 ML KIT......................... 25 RELISTOR SOLN 8 MG/0.4ML ....................... 25 RELISTOR TABS 150 MG ............................... 25 REMICADE...................................................... 17 REMODULIN ................................................... 10 RENFLEXIS INJ 100MG .................................. 26 RENVELA ........................................................ 13 REOPRO ........................................................... 9 REPATHA PUSH INJ 420/3.5.......................... 24 REPATHA SOSY 140 MG/ML ......................... 23 REPATHA SURECLICK SOAJ 140 MG/ML .... 23 RESCRIPTOR ................................................... 4 RESERPINE .................................................... 10 RESTASIS ....................................................... 14 RETIN-A MICRO ............................................. 20 RETISERT ....................................................... 15 REVATIO INJ .................................................. 24 REVATIO TAB 20MG ...................................... 24 REVLIMID ......................................................... 7 REXULTI TABS ............................................... 24 REYATAZ .......................................................... 4 ribavirin (hepatitis c) .......................................... 5 RIDAURA ........................................................ 15 rifabutin .............................................................. 5 RIFAMATE ........................................................ 5 rifampin .............................................................. 5 RILUTEK TAB 50MG ....................................... 24 riluzole ............................................................. 11 rimantadine hydrochloride ................................. 6 RIMSO-50 ....................................................... 18 risperidone ....................................................... 12 RITUXAN ..................................................... 7, 23 RITUXAN HYCELA SOLN ............................... 23 rizatriptan benzoate ......................................... 11 rocuronium bromide ........................................... 8 ropinirole hydrochloride ................................... 11 rosuvastatin calcium .......................................... 9 ROTARIX ........................................................ 20 ROTATEQ ....................................................... 20 RUBRACA TABS ............................................. 23 RUCONEST INJ 2100UNIT ............................. 26 RYDAPT ............................................................ 7 RYNODERM CREA 37.5 % ............................. 27 RYTARY .......................................................... 24

S

SABRIL ...................................................... 11, 24 SABRIL TAB 500MG........................................ 24 SAIZEN CLICK.EASY INJ 8.8MG .................... 25 SAIZEN SOLR 5 MG........................................ 25 SALICYLIC ACID ............................................. 19 saline, bacteriostatic......................................... 14 salsalate ........................................................... 10 SAMSCA 15 MG TABLET ................................ 24 SAMSCA 30 MG TABLET ................................ 24 SANDIMMUNE ................................................ 17 SANTYL ........................................................... 21 SAXENDA ........................................................ 26 SCOPOLAMINE HBR ........................................ 8 selegiline hcl .................................................... 11 SELENIUM....................................................... 14 selenium sulfide ............................................... 20 SELZENTRY .................................................. 4, 6 SENSIPAR ....................................................... 18 SEREVENT DISKUS ......................................... 8 SEROSTIM ...................................................... 17 sertraline hcl ..................................................... 12 SIGNIFOR INJ 0.3MG/ML ................................ 25 SIGNIFOR INJ 0.6MG/ML ................................ 25 SIGNIFOR INJ 0.9MG/ML ................................ 25 SIGNIFOR LAR INJ 20MG ............................... 25 SIGNIFOR LAR INJ 40MG ............................... 25 SIGNIFOR LAR INJ 60MG ............................... 26 sildenafil citrate (pulmonary hypertension) ....... 10 SILIQ INJ 210/1.5 ...................................... 27 silver sulfadiazine ............................................. 20 SIMPONI ARIA SOL 50MG/4ML ...................... 26 SIMPONI INJ 100MG/ML ................................. 26 SIMPONI INJ 50MG ......................................... 26 SIMULECT INJ 10MG ...................................... 26 SIMULECT INJ 20MG ...................................... 26 simvastatin ......................................................... 9 sirolimus ........................................................... 17 SIRTURO TAB 100MG .................................... 22 SIVEXTRO INJ 200MG .................................... 22 SIVEXTRO TAB 200MG .................................. 22 sodium acetate ................................................. 13 SODIUM BENZOATE ...................................... 19 sodium bicarbonate .......................................... 13 sodium chloride .............................. 13, 14, 19, 21 sodium chloride (gu irrigant) ............................. 13 sodium chloride (inhalant) ................................ 19 sodium chloride flush ....................................... 14 sodium citrate & citric acid ............................... 13 SODIUM EDECRIN.......................................... 13 sodium fluoride ................................................. 18


sodium fluoride (dental) ................................... 18 sodium phenylbutyrate ..................................... 13 sodium phosphates (sodium phosphate dibasic &

monobasic) .................................................. 14 sodium polystyrene sulfonate .......................... 13 sodium thiosulfate ............................................ 16 SOLIRIS .......................................................... 18 SOMATULINE DEPOT INJ 120/.5ML .............. 26 SOMATULINE DEPOT INJ 60/0.2ML .............. 26 SOMATULINE DEPOT INJ 90/0.3ML .............. 26 SOMAVERT INJ 10MG ................................... 26 SOMAVERT INJ 15MG ................................... 26 SOMAVERT INJ 20MG ................................... 26 SOMAVERT INJ 25MG ................................... 26 SOMAVERT INJ 30 ......................................... 26 SORBITOL ................................................ 15, 19 SORIATANE CAP 10MG ................................. 27 SORIATANE CAP 17.5MG .............................. 27 SORIATANE CAP 25MG ................................. 27 sotalol hcl .......................................................... 9 sotalol hcl (afib/afl) ............................................. 9 SOTRADECOL ................................................ 10 SOVALDI ........................................................... 5 SPINRAZA SOLN 12 MG/5ML ........................ 26 SPIRIVA RESPIMAT ......................................... 8 spironolactone ................................................. 10 spironolactone & hydrochlorothiazide .............. 10 SPRITAM TB3D .............................................. 24 SPRYCEL .......................................................... 7 SQUARIC ACID DIBUTYLESTER ................... 19 SSKI ................................................................ 17 stavudine ........................................................... 4 STELARA ........................................................ 21 STIOLTO RESPIMAT ........................................ 8 STIVARGA ........................................................ 7 STRENSIQ ...................................................... 14 STREPTOMYCIN SULFATE ............................. 5 STRIBILD .......................................................... 4 STRIVERDI RESPIMAT .................................... 8 sucralfate ......................................................... 15 sufentanil citrate .............................................. 10 sulfacetamide sodium (ophth) .......................... 14 sulfacetamide sodium w/ sulfur ........................ 20 sulfacetamide sod-prednisolone ...................... 15 SULFADIAZINE ................................................. 5 sulfamethoxazole-trimethoprim .......................... 5 SULFAMYLON ................................................ 20 sulfasalazine ...................................................... 5 SULFUR PRECIPITATED ............................... 19 sulindac ........................................................... 10 sumatriptan ...................................................... 11 sumatriptan succinate ...................................... 11

SUPPRELIN LA KIT 50 MG ............................. 23 SUPRAX ............................................................ 5 SURMONTIL .................................................... 12 SURVANTA ..................................................... 19 SUSTIVA ........................................................... 4 SUTENT ............................................................ 7 SYLATRON KIT 296MCG ................................ 23 SYLATRON KIT 444MCG ................................ 23 SYLATRON KIT 888MCG ................................ 23 SYLVANT .......................................................... 7 SYNAGIS ........................................................... 6 SYNAREL ........................................................ 17 SYNDROS SOL 5MG/ML............................ 25 SYNERCID ........................................................ 5 SYNRIBO INJ 3.5MG ....................................... 23

T

TABLOID ........................................................... 7 TACLONEX OIN .............................................. 27 TACLONEX SUSP 0.005-0.064 % ................... 27 tacrolimus .................................................. 17, 21 tacrolimus (topical) ........................................... 21 TAFINLAR.......................................................... 7 TAGRISSO ........................................................ 7 TALTZ SOAJ 80 MG/ML .................................. 27 TALTZ SOSY 80 MG/ML ................................. 27 tamoxifen citrate ................................................. 7 tamsulosin hcl .................................................... 9 TARCEVA .......................................................... 7 TARGRETIN ................................................ 7, 21 TASIGNA ........................................................... 7 TASMAR 100 MG TABLET .............................. 24 TAXOTERE...................................................... 23 TAXOTERE INJ 80MG/4ML ............................. 23 TAZORAC ........................................................ 21 TECENTRIQ ...................................................... 7 TECFIDERA CAP 120MG ................................ 24 TECFIDERA CAP 240MG ................................ 24 TECFIDERA STARTER PACK MIS STARTER 24 TECHNIVIE TABS 12.5-75-50 MG ................... 22 temazepam ...................................................... 11 TEMODAR CAP 100MG .................................. 23 TEMODAR CAP 140MG .................................. 23 TEMODAR CAP 180MG .................................. 23 TEMODAR CAP 20MG .................................... 23 TEMODAR CAP 250MG .................................. 23 TEMODAR CAP 5MG ...................................... 23 TEMODAR INJ 100MG .................................... 23 temozolomide ..................................................... 7 TENIPOSIDE ..................................................... 7 TEPADINA SOLR ............................................ 23 terazosin hcl ....................................................... 9


terbinafine hcl .................................................... 5 terbutaline sulfate .............................................. 8 testosterone cypionate ..................................... 16 testosterone enanthate .................................... 16 TESTOSTERONE PROPIONATE ................... 19 TETANUS-DIPHTHERIA TOXOIDS TD .......... 19 TETRACAINE HCL .......................................... 17 tetracaine hcl (ophth) ....................................... 15 TETRACYCLINE HCL ....................................... 5 THALOMID ...................................................... 18 THAM .............................................................. 13 theophylline ..................................................... 21 THEOPHYLLINE IN D5W ................................ 21 THERACYS ..................................................... 20 thiamine hcl ..................................................... 21 THIOLA ........................................................... 18 thioridazine hcl ................................................. 12 thiotepa .............................................................. 7 thiothixene ....................................................... 12 THROMBATE III ................................................ 9 THROMBIN-JMI ................................................ 8 THYMOGLOBULIN INJ 25MG......................... 26 THYMOL ......................................................... 19 THYROGEN .................................................... 13 TIKOSYN ........................................................... 9 timolol maleate (ophth) .................................... 15 TIVICAY ........................................................ 4, 6 tizanidine hcl ...................................................... 8 TNKASE ............................................................ 9 TOBRADEX ..................................................... 15 tobramycin ................................................... 5, 14 tobramycin (ophth) ........................................... 14 tobramycin sulfate ............................................. 5 TOLBUTAMIDE ............................................... 16 topiramate ....................................................... 11 topotecan hcl ..................................................... 7 TORISEL ........................................................... 7 torsemide ......................................................... 13 trace minerals (cr-cu-mn-zn) ............................ 14 TRACLEER ..................................................... 10 TRADJENTA ................................................... 16 tramadol hcl ..................................................... 10 tramadol-acetaminophen ................................. 10 tranexamic acid ................................................. 8 TRANEXAMIC ACID........................................ 19 TRANSDERM-SCOP (1.5 MG) ........................ 15 tranylcypromine sulfate .................................... 12 trazodone hcl ................................................... 12 TREANDA ....................................................... 23 TREANDA INJ 180MG .................................... 23 TREANDA INJ 25MG ...................................... 23 TREANDA INJ 45MG ...................................... 23

TRECATOR ....................................................... 5 TRELSTAR DEPOT MIXJECT INJ 3.75MG ..... 23 TRELSTAR LA MIXJECT INJ 11.25MG ........... 23 TRELSTAR MIXJECT INJ 22.5MG .................. 23 TREMFYA INJ 100MG/ML ............................... 27 tretinoin ........................................................ 7, 20 tretinoin (chemotherapy) .................................... 7 TRIAMCINOLONE ACETONIDE ..................... 19 triamcinolone acetonide (mouth) ...................... 20 triamcinolone acetonide (topical) ...................... 20 triamterene & hydrochlorothiazide .................... 13 TRI-CHLOR ..................................................... 18 trifluoperazine hcl ............................................. 12 trifluridine ......................................................... 14 trihexyphenidyl hcl ........................................... 11 trimethoprim ....................................................... 6 TRIPTODUR SRER 22.5 MG........................... 25 TRISENOX......................................................... 7 TRIUMEQ .......................................................... 4 tropicamide ...................................................... 15 trospium chloride .............................................. 21 TRUVADA ...................................................... 4, 6 TRUZONE PEAK FLOW METER .................... 12 TUBERSOL...................................................... 13 TWINRIX .......................................................... 20 TYGACIL INJ 50MG......................................... 22 TYKERB ............................................................ 7 TYMLOS SOPN 3120 MCG/1.56ML ................ 25 TYPHIM VI ....................................................... 20 TYSABRI ......................................................... 18 TYVASO .......................................................... 10 TYZEKA 600 MG TABLET ............................... 22

U

UCERIS TAB 9MG ........................................... 25 ULTIVA ............................................................ 10 ULTRAVATE LOTN 0.05 % ............................. 27 UNITUXIN .......................................................... 7 UPTRAVI TABS ............................................... 27 UREA ............................................................... 19 ursodiol ............................................................ 15

V

valacyclovir hcl ................................................... 6 VALCHLOR GEL 0.016% ................................ 27 VALCYTE TAB 450MG .................................... 22 valganciclovir hcl ................................................ 6 valproate sodium .............................................. 11 valproic acid ..................................................... 11 valsartan .......................................................... 10 valsartan-hydrochlorothiazide .......................... 10


VALSTAR SOL 40MG/ML ............................... 23 VANCOCIN HCL CAP 125MG......................... 22 VANCOCIN HCL CAP 250MG......................... 22 vancomycin hcl .................................................. 5 VANCOMYCIN HCL IN DEXTROSE ................. 5 VANTAS KIT 50MG ......................................... 23 VARITHENA .................................................... 10 VARIVAX ......................................................... 20 VARIZIG .......................................................... 19 vasopressin ..................................................... 17 VAXCHORA .................................................... 20 VECAMYL TAB 2.5MG .................................... 24 VECTIBIX INJ 100MG ..................................... 23 VECTIBIX INJ 400MG ..................................... 23 VECTICAL ....................................................... 21 vecuronium bromide .......................................... 8 VELCADE .......................................................... 7 VEMLIDY TABS 25 MG ................................... 22 VENCLEXTA ..................................................... 7 venlafaxine hcl ................................................. 12 VENOFER ......................................................... 8 VENTAVIS ....................................................... 10 verapamil hcl ..................................................... 9 VERAPAMIL HCL ............................................ 19 VEXOL ............................................................ 15 VFEND SUS 40MG/ML ................................... 22 VFEND TAB 200MG ........................................ 22 VFEND TAB 50MG .......................................... 22 VIBERZI TABS 100 MG ................................... 25 VIBERZI TABS 75 MG ..................................... 25 VIEKIRA PAK TAB .......................................... 22 VIEKIRA XR TB24 200-8.33-50- 33.33 MG ..... 22 VIMIZIM ..................................................... 14, 25 VIMIZIM INJ 5MG/5ML .................................... 25 VINBLASTINE SULFATE .................................. 7 vincristine sulfate ............................................... 7 vinorelbine tartrate ............................................. 7 VIRACEPT......................................................... 4 VIRAZOLE ......................................................... 6 VIREAD ............................................................. 4 VISTIDE INJ 75MG/ML .................................... 22 VISTOGARD PACK 10 GM ............................. 26 VISUDYNE ...................................................... 15 VIVITROL 380MG INJ ..................................... 24 VIVOTIF .......................................................... 20 VORAXAZE ..................................................... 14 voriconazole .................................................. 5, 6 VOSEVI TAB .................................................. 22 VOTRIENT ........................................................ 7 VPRIV .............................................................. 14 VRAYLAR CAPS ............................................. 24 VRAYLAR CPPK 1.5 & 3 MG .......................... 24

VYVANSE ........................................................ 10 VYXEOS SUSR ............................................... 23

W

warfarin sodium .................................................. 9 water for injection, sterile ........................... 18, 19 water for irrigation, sterile ................................. 13 WIDE-SEAL DIAPHRAGM 60 .......................... 12

X

XALKORI ........................................................... 7 XATMEP SOL 2.5MG/ML ................................ 23 XELJANZ ................................................... 18, 26 XELJANZ TAB 5MG......................................... 26 XELJANZ XR TB24 11 MG .............................. 26 XENAZINE TAB 12.5MG ................................. 24 XENAZINE TAB 25MG .................................... 24 XEOMIN SOLR 200 UNIT ................................ 26 XERAC AC....................................................... 20 XERMELO 250 MG TABLET ........................... 25 XGEVA .............................................................. 7 XIFAXAN ........................................................... 5 XOLAIR ............................................................ 19 XTANDI .............................................................. 7 XULANE .......................................................... 16 XULTOPHY SOPN 100-3.6 UNIT-MG/ML ....... 25 XURIDEN PACK 2 GM .................................... 26 XYNTHA ............................................................ 8 XYREM SOL 500MG/ML ................................. 24

Y

YERVOY ............................................................ 7 YF-VAX ............................................................ 20 YODOXIN .......................................................... 5 YONDELIS ......................................................... 7

Z

ZALTRAP INJ 100/4ML .................................... 23 ZALTRAP INJ 200/8ML .................................... 23 ZANOSAR.......................................................... 7 ZARXIO ............................................................. 9 ZAVESCA CAP 100MG ................................... 26 ZEJULA ............................................................. 7 ZELBORAF ........................................................ 7 ZEMAIRA SOLR 1000 MG ............................... 26 ZEPATIER TABS ............................................. 22 zidovudine .......................................................... 4 ZINACEF IN STERILE WATER ......................... 5 ZINBRYTA INJ 150MG/ML .......................... 26 ZINC SULFATE ......................................... 14, 19


ZINC TRACE METAL ...................................... 14 ZINPLAVA SOLN 1000 MG/40ML ................... 27 ziprasidone hcl ................................................. 12 zoledronic acid ................................................. 18 ZOLINZA CAP 100MG .................................... 23 zolpidem tartrate .............................................. 11 ZOMACTON SOLR 10 MG .............................. 26 ZOMACTON SOLR 5 MG ................................ 26 ZORBTIVE INJ 8.8MG ..................................... 26 ZORTRESS TAB 0.25MG ............................... 26 ZORTRESS TAB 0.5MG ................................. 26 ZORTRESS TAB 0.75MG ............................... 26 ZOSTAVAX ..................................................... 20 ZOSYN .............................................................. 5 ZYDELIG ........................................................... 7 ZYFLO CR TAB 600MG .................................. 26 ZYFLO TAB 600MG ........................................ 26 ZYKADIA ........................................................... 7 ZYTIGA ............................................................. 7 ZYVOX SOL 2MG/ML ...................................... 22

Kaiser Permanente 2016 California Marketplace Formulary • of 51

Kaiser Permanente no discrimina a ninguna persona por su edad, raza, etnia, color, país de origen, antecedentes culturales, ascendencia, religión, sexo, identidad de género, expresión de género, orientación sexual, estado civil, discapacidad física o mental, fuente de pago, información genética, ciudadanía, lengua materna o estado migratorio. La Central de Llamadas de Servicio a los Miembros (Member Service Contact Center) brinda servicios de asistencia con el idioma las 24 horas del día, los siete días de la semana (excepto los días festivos). Se ofrecen servicios de interpretación sin costo alguno para usted durante el horario de atención, incluido el lenguaje de señas. También podemos ofrecerle a usted, a sus familiares y amigos cualquier ayuda especial que necesiten para acceder a nuestros centros de atención y servicios. Además, puede solicitar los materiales del plan de salud traducidos a su idioma, y también los puede solicitar con letra grande o en otros formatos que se adapten a sus necesidades. Para obtener más información, llame al 1-800-788-0616 (los usuarios de la línea TTY deben llamar al 711).

Una queja es una expresión de inconformidad que manifiesta usted o su representante autorizado a través del proceso de quejas. Una queja incluye una queja formal o una apelación. Por ejemplo, si usted cree que ha sufrido discriminación de nuestra parte, puede presentar una queja. Consulte su Evidencia de Cobertura (Evidence of Coverage) o Certificado de Seguro (Certificate of Insurance), o comuníquese con un representante de Servicio a los Miembros (Member Services) para conocer las opciones de resolución de disputas que le corresponden. Esto tiene especial importancia si es miembro de Medicare, MediCal, MRMIP (Major Risk Medical Insurance Program, Programa de Seguro Médico para Riesgos Mayores), MediCal Access, FEHBP (Federal Employees Health Benefits Program, Programa de Beneficios Médicos para los Empleados Federales) o CalPERS ya que dispone de otras opciones para resolver disputas. Puede presentar una queja de las siguientes maneras:

• completando un formulario de queja o de reclamación/solicitud de beneficios en una oficina de Servicio a los Miembros ubicada en un centro del plan (consulte las direcciones en Su Guía)

• enviando por correo su queja por escrito a una oficina de Servicio a los Miembros en un centro del plan (consulte las direcciones en Su Guía)

• llamando a la línea telefónica gratuita de la Central de Llamadas de Servicio a los Miembros al 1-800-788-0616 (los usuarios de la línea TTY deben llamar al 711)

• completando el formulario de queja en nuestro sitio web en kp.org

Llame a nuestra Central de Llamadas de Servicio a los Miembros si necesita ayuda para presentar una queja. Se le informará al coordinador de derechos civiles (Civil Rights Coordinator) de Kaiser Permanente de todas las quejas relacionadas con la discriminación por motivos de raza, color, país de origen, género, edad o discapacidad. También puede comunicarse directamente con el coordinador de derechos civiles de Kaiser Permanente en One Kaiser Plaza, 12th Floor, Suite 1223, Oakland, CA 94612. También puede presentar una queja formal de derechos civiles de forma electrónica ante la Oficina de Derechos Civiles (Office for Civil Rights) en el Departamento de Salud y Servicios Humanos de los Estados Unidos (U. S. Department of Health and Human Services) mediante el portal de quejas formales de la Oficina de Derechos Civiles (Office for Civil Rights), en ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo postal o por teléfono a: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 1-800-537-7697(línea TDD). Los formularios de queja formal están disponibles en www.hhs.gov/ocr/office/file/index.html.

http://ocrportal.hhs.gov/ocr/portal/lobby.jsf

http://www.hhs.gov/ocr/office/file/index.html

Kaiser Permanente 2016 California Marketplace Formulary • of 51

Servicio a los Miembros de California Las 24 horas del día, los siete días de la semana (excepto los días festivos) 1-800-788-0616 en español 1-800-464-4000 en inglés 1-800-757-7585 en dialectos chinos 711 Línea TTY para personas con problemas auditivos o del habla

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