lista de medicamentos de 2018 (lista de medicamentos con ... · ii ¿qué es la lista de...

Lista de medicamentos de 2018 (Lista de medicamentos con cobertura)Blue Cross Medicare Advantage Dual Care (HMO SNP)SM

Y0096_MRK_NM_DSNPFRMLRY18f2SPA Accepted 09092017 475635.0918

POR FAVOR, LEA ESTE DOCUMENTO: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN

HPMS Approved Formulary File ID: 00018120, Versión 12

Esta lista de medicamentos se actualizó el 09/18/2018. Para obtener información más reciente o si tiene alguna pregunta, comuníquese con Servicio al Cliente de Blue Cross Medicare AdvantageSM, al 1-877-688-1813 o, para usuarios de TTY/TDD, al 7-1-1, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si llama del 15 de febrero al 30 de septiembre durante los fines de semana y días feriados, se usarán tecnologías alternativas (por ejemplo, correo de voz); o bien visite www.getbluenm.com/dsnp/druglist.

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This information is available for free in other languages. Please call our Customer Service number at 1-877-688-1813. (TTY/TDD users should call 711). We are open between 8:00 a.m. – 8:00 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al Cliente al 1-877-688-1813 (los usuarios de TTY/TDD deben llamar al 7-1-1). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y días feriados se usarán tecnologías alternativas (por ejemplo, correo de voz).

POR FAVOR, LEA ESTE DOCUMENTO: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN

Nota para los asegurados existentes: Esta lista de medicamentos cambió con respecto a la del año pasado. Repase este documento para asegurarse de que todavía incluye los medicamentos que usted recibe.

Cuando esta lista de medicamentos se refiere a “nosotros”, “nos” o “nuestro”, significa Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). Cuando se refiere a “el plan” o “nuestro plan”, significa Blue Cross Medicare Advantage.

Este documento incluye una lista de medicamentos para nuestro plan que está vigente desde septiembre de 2018. Para obtener una lista de medicamentos actualizada, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha en la que actualizamos la lista de medicamentos por última vez, aparece en la portada y en la contraportada.

Generalmente tiene que acudir a farmacias de la red para usar su beneficio de medicamentos con receta. Los beneficios, la lista de medicamentos, la red de farmacias y/o los copagos/coseguros pueden cambiar el 1.º de enero de 2018 y ocasionalmente durante el año.

Blue Cross Medicare Advantage

Lista de medicamentos de 2018 (Lista de medicamentos con cobertura)

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¿Qué es la Lista de medicamentos de Blue Cross Medicare Advantage?Es una Lista de medicamentos con cobertura seleccionados por Blue Cross Medicare Advantage en consulta con un equipo de profesionales de la salud que representa las terapias de medicamentos con receta que se consideran una parte necesaria de un programa de tratamiento de calidad. Blue Cross Medicare Advantage generalmente cubrirá los medicamentos incluidos en nuestra Lista de medicamentos siempre y cuando el medicamento sea necesario desde el punto de vista médico, se surta en una farmacia de la red de Blue Cross Medicare Advantage y se sigan otras reglas del plan. Para obtener más información acerca de cómo surtir sus medicamentos con receta, revise su Evidencia de Cobertura.

¿Puede cambiar la lista de medicamentos?Por lo general, si está recibiendo un medicamento que figura en nuestra lista de medicamentos de 2018 y que estaba cubierto a principio de año, no descontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2018, a menos que empiece a comercializarse un medicamento genérico nuevo y más económico o que se publique información nueva adversa sobre la seguridad o la eficacia del medicamento. Otros tipos de cambios de la lista de medicamentos, como la eliminación de un medicamento de la lista, no afectarán a los asegurados que estén recibiendo dicho medicamento actualmente. El medicamento seguirá disponible al mismo costo compartido para aquellos asegurados que estén recibiéndolo durante el resto del año de cobertura. Creemos que es importante que tenga acceso continuo, por el resto del año de cobertura, a los medicamentos de la lista de medicamentos que estaban disponibles cuando usted eligió su plan, excepto para los casos en los que usted puede ahorrar más dinero o nosotros podemos garantizar su seguridad. Si eliminamos medicamentos de nuestra lista, si agregamos autorizaciones previas, cantidades límite y/o restricciones a las terapias escalonadas para un medicamento o si cambiamos un medicamento a un nivel más alto de costos compartidos, tenemos que notificar a los asegurados afectados sobre el cambio al menos 60 días antes de que el cambio entre en vigor, o cuando el asegurado vuelva a surtir el medicamento, en cuyo momento el asegurado recibirá un suministro para 60 días del medicamento. Si la Administración de Medicamentos y Alimentos (FDA, en inglés) considera que un medicamento que figura en nuestra lista de medicamentos no es seguro o si el fabricante del medicamento lo retira del mercado, nosotros eliminaremos el medicamento de nuestra lista de medicamentos inmediatamente y les notificaremos a los asegurados que reciben el medicamento. La lista de medicamentos adjunta está vigente desde el 18 de septiembre de 2018. Para obtener información actualizada sobre los medicamentos cubiertos por Blue Cross Medicare Advantage, comuníquese con nosotros. Nuestra información de contacto aparece en la portada y en la contraportada.

¿Cómo uso la lista de medicamentos? Hay dos maneras de encontrar un medicamento en la lista:

Problema de saludLa Lista de medicamentos comienza en la página 1. Los medicamentos incluidos en esta lista están agrupados por categorías según el tipo de problema de salud que tratan. Por ejemplo, los medicamentos que se usan para tratar una enfermedad cardíaca figuran dentro de la categoría Agentes cardiovasculares. Si sabe para qué se usa su medicamento, busque el nombre de la categoría en la lista que comienza en la página 1. Luego, busque el medicamento debajo del nombre de la categoría.

Lista alfabéticaSi no está seguro sobre qué categoría consultar, debe buscar su medicamento en el Índice que comienza en la página 101. El Índice provee una lista alfabética de todos los medicamentos incluidos en este documento. Se incluyen tanto los medicamentos de marca como los genéricos. Busque en el Índice y encuentre su medicamento. Al lado del medicamento, verá el número de la página en la que puede encontrar información de cobertura. Encuentre la página indicada en el Índice y busque el nombre del medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos?Blue Cross Medicare Advantage cubre tanto los medicamentos de marca como los genéricos. Un medicamento genérico está aprobado por la FDA y tiene el mismo ingrediente activo que el medicamento de marca. En general, los medicamentos genéricos cuestan menos que los medicamentos de marca.

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¿Existe alguna restricción sobre mi cobertura?Algunos medicamentos cubiertos pueden tener requisitos adicionales o límites en la cobertura. Estos requisitos y límites pueden incluir lo siguiente:

• Autorización previa: Blue Cross Medicare Advantage requiere que usted o su médico obtengan una autorización previa para ciertos medicamentos. Esto significa que usted deberá obtener la aprobación de Blue Cross Medicare Advantage antes de comprar sus medicamentos recetados. Si no obtiene la aprobación, Blue Cross Medicare Advantage posiblemente no cubra el medicamento.

• Límites que rigen la cantidad: Para ciertos medicamentos, Blue Cross Medicare Advantage limita la cantidad de medicamento que Blue Cross Medicare Advantage va a cubrir. Por ejemplo, Blue Cross Medicare Advantage provee 30 tabletas por receta médica para alfuzosin ER. Esto puede ser además de un suministro estándar para un mes o tres meses.

• Terapia escalonada: En algunos casos, Blue Cross Medicare Advantage requiere que pruebe ciertos medicamentos para tratar su problema de salud antes de cubrir otro medicamento para ese problema. Por ejemplo, si tanto el medicamento A como el medicamento B tratan su problema de salud, Blue Cross Medicare Advantage podría no cubrir el medicamento B a menos que intente usar el medicamento A primero. Si el medicamento A no funciona para usted, entonces Blue Cross Medicare Advantage cubrirá el medicamento B.

Puede averiguar si su medicamento tiene algún requisito o límite adicionales al consultar la Lista de medicamentos que comienza en la página 1. También puede obtener más información acerca de las restricciones que se aplican a medicamentos específicos cubiertos visitando nuestro sitio web. Publicamos documentos en línea que explican nuestras restricciones de autorización previa y terapia escalonada. También puede solicitarnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha en la que actualizamos la lista de medicamentos por última vez, aparece en la portada y en la contraportada.

Usted puede solicitar a Blue Cross Medicare Advantage que haga una excepción a estas restricciones o límites, o pedir una lista de otros medicamentos similares que podrían tratar su problema de salud. Consulte la sección “¿Cómo solicito una excepción a la Lista de medicamentos de Blue Cross Medicare Advantage?” que se encuentra en la página iv para obtener información acerca de cómo solicitar una excepción.

¿Qué sucede si mi medicamento no está en la lista de medicamentos?Si su medicamento no está incluido en esta lista de medicamentos cubiertos, primero debe comunicarse con Servicio al Cliente y preguntar si su medicamento está cubierto.

Si descubre que Blue Cross Medicare Advantage no cubre su medicamento, usted tiene dos opciones:

• Puede solicitar a Servicio al Cliente una Lista de medicamentos similares que estén cubiertos por Blue Cross Medicare Advantage. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que esté cubierto por Blue Cross Medicare Advantage.

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

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¿Cómo solicito una excepción a la Lista de medicamentos de Blue Cross Medicare Advantage?Puede solicitar a Blue Cross Medicare Advantage que haga una excepción a nuestras reglas de cobertura. Existen varios tipos de excepciones que puede solicitarnos.

• Puede solicitarnos que cubramos un medicamento, incluso si no está en nuestra lista de medicamentos. Si lo aprobamos, este medicamento estará cubierto con un nivel predeterminado de costos compartidos y usted no podrá solicitarnos que brindemos el medicamento a un nivel inferior de costos compartidos.

• Puede solicitarnos que cubramos un medicamento de la lista con un nivel de costos compartidos inferior, si este medicamento no está en el nivel de medicamentos especializados. Si se aprueba, esto reducirá el monto que tiene que pagar por su medicamento.

• Puede solicitarnos que eximamos las restricciones o límites de cobertura de su medicamento. Por ejemplo, para ciertos medicamentos, Blue Cross Medicare Advantage limita la cantidad del medicamento que cubriremos. Si su medicamento tiene una cantidad límite, puede solicitarnos que eximamos el límite y cubramos un monto mayor.

Por lo general, Blue Cross Medicare Advantage solo aprobará su solicitud de excepción si los medicamentos alternativos que están incluidos en la Lista de medicamentos del plan, el medicamento con los costos compartidos más bajos o las restricciones adicionales de uso no fueran tan eficaces para tratar su problema y/o le provocaran efectos médicos adversos.

Debe comunicarse con nosotros para pedirnos una decisión de cobertura inicial de una excepción a las restricciones de la lista de medicamentos, en los niveles o en el uso. Cuando solicite una excepción a las restricciones de la lista de medicamentos, en los niveles o en el uso, debe presentar una declaración de la persona que le receta o del médico que respalde su solicitud. Por lo general, tenemos que tomar nuestra decisión dentro de las 72 horas posteriores a la recepción de la declaración de respaldo de la persona que le receta. Puede solicitar una excepción acelerada (rápida), si usted o su médico consideran que su salud podría perjudicarse seriamente si espera hasta 72 horas por una decisión. Si se acepta su solicitud de excepción acelerada, tenemos que proporcionarle una decisión dentro de las 24 horas después de haber recibido una declaración de respaldo de su médico u otra persona que receta.

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¿Qué hago antes de que pueda hablar con mi médico sobre un cambio en mis medicamentos o solicitar una excepción?Como asegurado nuevo o continuo de nuestro plan, es posible que esté recibiendo medicamentos que no se encuentran en nuestra lista de medicamentos. O bien, quizá usted esté recibiendo un medicamento que está en nuestra lista de medicamentos pero su capacidad para obtenerlo es limitada. Por ejemplo, podría necesitar una autorización previa de nuestra parte antes de que pueda comprar su medicamento con receta. Debe hablar con su médico para decidir si debe cambiar a un medicamento apropiado que cubramos o solicitar una excepción a la lista de medicamentos para que le cubramos el medicamento que recibe. Mientras habla con su médico para determinar la medida correcta a tomar, es posible que cubramos su medicamento en ciertos casos durante los primeros 90 días que usted esté asegurado en nuestro plan.Para cada uno de sus medicamentos que no esté en nuestra lista de medicamentos o si su capacidad para obtener medicamentos es limitada, cubriremos un suministro provisional de 30 días (a menos que tenga una receta médica por menos días) cuando acuda a una farmacia de la red. Luego del suministro de 30 días, no pagaremos estos medicamentos, incluso si ha sido un asegurado del plan durante menos de 90 días. Si es residente de un centro de atención médica a largo plazo, le permitiremos volver a surtir su receta médica hasta que le hayamos brindado un suministro de transición durante un máximo de 98 días, en consonancia con el incremento en el despacho (a menos que tenga una receta médica para menos días). Cubriremos más de un surtido de estos medicamentos durante los primeros 90 días que usted esté asegurado en nuestro plan. Si necesita un medicamento que no está incluido en nuestra Lista de medicamentos o si su capacidad para obtener su medicamento es limitada, pero ya han pasado más de los primeros 90 días desde que su plan entró en vigor, cubriremos un suministro de emergencia de 31 días de ese medicamento (a menos que usted tenga una receta médica por menos días) mientras tramita una excepción a la Lista de medicamentos. Puede experimentar cambios entre un tratamiento y otro. Durante este cambio de nivel de atención, quizá se le receten medicamentos que no estén cubiertos por nuestro plan. Si esto ocurre, usted y su médico tienen que usar los procesos de apelaciones y excepciones de su plan. Sin embargo, cuando se le admite, o se le da de alta, de un centro de atención médica a largo plazo (LTC, en inglés), quizá no tenga acceso a los medicamentos que recibió previamente. Puede volver a surtir su receta al ser admitido o dado de alta para evitar una interrupción en la atención.

Para obtener más informaciónPara obtener información más precisa acerca de la cobertura de medicamentos recetados de Blue Cross Medicare Advantage, repase su Evidencia de Cobertura y los otros materiales del plan.Si tiene preguntas acerca de Blue Cross Medicare Advantage, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha en la que actualizamos la lista de medicamentos por última vez, aparece en la portada y en la contraportada.Si tiene preguntas generales acerca de la cobertura de medicamentos con receta de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227) las 24 horas del día, los 7 días de la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. O, visite http://www.medicare.gov.

Lista de medicamentos de Blue Cross Medicare AdvantageLa siguiente lista de medicamentos brinda información de cobertura sobre los medicamentos cubiertos por Blue Cross Medicare Advantage. Si tiene problemas para encontrar su medicamento en la lista, consulte el Índice que comienza en la página 101.La primera columna del cuadro muestra el nombre del medicamento. Los medicamentos de marca están en mayúsculas (por ejemplo, LANTUS) y los medicamentos genéricos están en minúsculas cursivas (por ejemplo, metformina).La información en la columna de Requisitos/Límites indica si Blue Cross Medicare Advantage tiene algún requisito especial para la cobertura de su medicamento. Todos los medicamentos incluidos en esta lista de medicamentos están disponibles a través del beneficio de entrega a domicilio. Comuníquese con nosotros para obtener más información. Nuestra información de contacto aparece en la portada y en la contraportada.

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CLAVE

Nivel 1 = medicamentos genéricos y de marca

BD = los medicamentos que pueden estar cubiertos por la Parte B o la Parte D de Medicare, según las circunstancias. Estos medicamentos requieren autorización previa para determinar la cobertura de la Parte B o la Parte D. Es posible que deba proporcionarse información que describa el uso o el lugar donde el medicamento se recibe para determinar la cobertura.

PA = autorización previa

QL = cantidad límite

ST = terapia escalonada

* = medicamentos de distribución limitada. Es posible que este medicamento recetado esté disponible únicamente en determinadas farmacias. Para obtener más información, consulte el Directorio de farmacias o llame a Servicio al Cliente al 1-877-688-1813, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y días feriados se usarán tecnologías alternativas (por ejemplo, correo de voz). Los usuarios de TTY deben llamar al 711.

# = medicamentos de alto riesgo (HRM, en inglés). Medicamentos que podrían ser perjudiciales en pacientes de más de 65 años. Nuestra lista de medicamentos incluye cobertura para algunos de estos medicamentos, pero puede encontrar alternativas en los niveles de copago más bajos. Trate el tema con su médico para ver si existen alternativas a estos medicamentos que podrían ser adecuadas para usted.

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Montos de copago y coseguro:Nivel 1 - Medicamentos genéricos y de marca:Según sus ingresos y el estado institucional, usted paga lo siguiente:Por medicamentos genéricos (incluidos los medicamentos de marca tratados como genéricos):copago de $0; copago de $1.25; copago de $3.35; 15%Por todos los demás medicamentos:copago de $0; copago de $3.70; copago de $8.35; 15%Usted tiene que seguir pagando su prima de la Parte B de Medicare.Esta información no representa una descripción completa de los beneficios. Comuníquese con la aseguradora para obtener más información. Es posible que se apliquen limitaciones, copagos y restricciones. Los beneficios, las primas del seguro, los copagos y/o el coseguro pueden cambiar el 1.° de enero de cada año.La Lista de medicamentos, la red de farmacias y/o la red de profesionales de la salud pueden cambiar en cualquier momento. Usted recibirá un aviso cuando sea necesario.A continuación, se muestra la clave para las abreviaturas usadas dentro de la lista de medicamentos.

CLAVE

act activación la de acción prolongada

ad adsorbido mcg microgramos

aer, aero aerosol meq miliequivalente

ba, breath act, breath activ activado por inhalación mg miligramos

bau unidades bioequivalentes de alergia ml mililitro

cap cápsulas mu unidades de millón

chew tab tableta masticable nebu núbulas

conc concentrado NF no está en la lista de medicamentos

conj conjugado odt tableta de desintegración oral

cr de liberación controlada oin, oint ungüento

crys cristales op, ophth oftálmico

dr difusión retrasada pak paquete

deter elemento disuasivo pow, powd polvo

ec recubrimiento entérico pf sin conservantes

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CLAVE (Continuación)

el, eluanálisis de inmunoabsorción enzimática (enzyme-linked immunosorbent assay)

pfu unidades formadoras de placas

er, extend-release, extended, extended rel, xl, xr

difusión prolongada pref prellenado

ext extracto recomb recombinante

g, gm gramo sl sublingual

gu genitourinario sol, soln solución

hr hora suppos supositorios

ig inmunoglobulina sus, susp suspensión

ir índice de reactividad sr de liberación lenta

inh, inhal inhalación syr jeringa

inj inyección tab, tabs tableta

im intramuscular td transdermal

iv intravenoso tl translingual

l litro unt unidad

lf unidades de floculación va vaginal

liqd líquido vac vacuna

2018

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

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Nombre del medicamentoNivel delmedicamento Requisitos/Límites

Medicamentos analgésicosABSTRAL - fentanyl citrate sl tab 100 mcg 1 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 200 mcg 1 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 300 mcg 1 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 400 mcg 1 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 600 mcg 1 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 800 mcg 1 PA, QL (120 tablets/30 days)acetaminophen w/ codeine soln 120-12 mg/5ml 1 QL (2700 mls/30 days)acetaminophen w/ codeine tab 300-15 mg 1 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-30 mg 1 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-60 mg 1 QL (180 tablets/30 days)butalbital-acetaminophen tab 50-325 mg# 1 PA, QL (180 tablets/30 days)butalbital-acetaminophen-caffeine cap 50-300-40 mg# 1 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine cap 50-325-40 mg# 1 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine tab 50-325-40 mg# 1 PA, QL (180 tablets/30 days)butalbital-aspirin-caffeine cap 50-325-40 mg# 1 PA, QL (180 capsules/30 days)BUTORPHANOL TARTRATE - butorphanol tartrate inj 1 mg/ml 1butorphanol tartrate inj 2 mg/ml 1butorphanol tartrate nasal soln 10 mg/ml 1 QL (87.5 mls/30 days)celecoxib cap 50 mg 1 QL (60 capsules/30 days)celecoxib cap 100 mg 1 QL (60 capsules/30 days)celecoxib cap 200 mg 1 QL (60 capsules/30 days)celecoxib cap 400 mg 1 QL (30 capsules/30 days)codeine sulfate tab 15 mg 1 QL (180 tablets/30 days)codeine sulfate tab 30 mg 1 QL (180 tablets/30 days)codeine sulfate tab 60 mg 1 QL (180 tablets/30 days)diclofenac potassium tab 50 mg 1 QL (120 tablets/30 days)diclofenac sodium gel 1% 1 STdiclofenac sodium tab delayed release 25 mg 1 QL (240 tablets/30 days)diclofenac sodium tab delayed release 50 mg 1 QL (120 tablets/30 days)diclofenac sodium tab delayed release 75 mg 1 QL (60 tablets/30 days)diclofenac sodium tab er 24hr 100 mg 1 QL (60 tablets/30 days)diclofenac w/ misoprostol tab delayed release 50-0.2 mg 1 QL (120 tablets/30 days)diclofenac w/ misoprostol tab delayed release 75-0.2 mg 1 QL (90 tablets/30 days)etodolac cap 200 mg 1 QL (150 capsules/30 days)etodolac cap 300 mg 1 QL (90 capsules/30 days)etodolac tab er 24hr 400 mg 1 QL (60 tablets/30 days)etodolac tab er 24hr 500 mg 1 QL (60 tablets/30 days)

2018

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


etodolac tab er 24hr 600 mg 1 QL (30 tablets/30 days)etodolac tab 400 mg 1 QL (60 tablets/30 days)etodolac tab 500 mg 1 QL (60 tablets/30 days)fentanyl citrate lozenge on a handle 200 mcg 1 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 400 mcg 1 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 600 mcg 1 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 800 mcg 1 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1200 mcg 1 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1600 mcg 1 PA, QL (120 lozenges/30 days)fentanyl td patch 72hr 12 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 25 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 37.5 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 50 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 62.5 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 75 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 87.5 mcg/hr 1 PA, QL (15 patches/30 days)fentanyl td patch 72hr 100 mcg/hr 1 PA, QL (15 patches/30 days)flurbiprofen tab 50 mg 1 QL (180 tablets/30 days)flurbiprofen tab 100 mg 1 QL (90 tablets/30 days)hydrocodone-acetaminophen soln 7.5-325 mg/15ml 1 QL (3600 mls/30 days)hydrocodone-acetaminophen tab 10-325 mg 1 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-300 mg 1 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg 1 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-325 mg 1 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-325 mg 1 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 10-300 mg 1 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg 1 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg 1 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg 1 QL (150 tablets/30 days)hydromorphone hcl liqd 1 mg/ml 1 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 10 mg/ml 1 BDhydromorphone hcl tab 2 mg 1 QL (180 tablets/30 days)hydromorphone hcl tab 4 mg 1 QL (180 tablets/30 days)hydromorphone hcl tab 8 mg 1 QL (180 tablets/30 days)ibuprofen susp 100 mg/5ml 1 QL (4800 mls/30 days)ibuprofen tab 400 mg 1 QL (240 tablets/30 days)ibuprofen tab 600 mg 1 QL (150 tablets/30 days)ibuprofen tab 800 mg 1 QL (120 tablets/30 days)

2018


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ketoprofen cap 75 mg 1 QL (120 capsules/30 days)LAZANDA - fentanyl citrate nasal spray 100 mcg/act 1 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 300 mcg/act 1 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 400 mcg/act 1 PA, QL (30 bottles/30 days)LEVORPHANOL TARTRATE - levorphanol tartrate tab 2 mg 1 QL (120 tablets/30 days)meloxicam tab 7.5 mg 1 QL (60 tablets/30 days)meloxicam tab 15 mg 1 QL (30 tablets/30 days)methadone hcl tab 5 mg 1 QL (180 tablets/30 days)methadone hcl tab 10 mg 1 QL (360 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 15 mg 1 QL (240 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 30 mg 1 QL (180 tablets/30 days)morphine sulfate inj pf 0.5 mg/ml 1 BDmorphine sulfate inj pf 1 mg/ml 1 BDmorphine sulfate oral soln 10 mg/5ml 1 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml 1 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml) 1 QL (270 mls/30 days)morphine sulfate tab er 15 mg 1 PA, QL (90 tablets/30 days)morphine sulfate tab er 30 mg 1 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg 1 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg 1 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg 1 PA, QL (90 tablets/30 days)nabumetone tab 500 mg 1 QL (120 tablets/30 days)nabumetone tab 750 mg 1 QL (60 tablets/30 days)naproxen sodium tab 275 mg 1 QL (150 tablets/30 days)naproxen sodium tab 550 mg 1 QL (90 tablets/30 days)naproxen susp 125 mg/5ml 1 QL (1800 mls/30 days)naproxen tab ec 375 mg 1 QL (120 tablets/30 days)naproxen tab ec 500 mg 1 QL (90 tablets/30 days)naproxen tab 250 mg 1 QL (180 tablets/30 days)naproxen tab 375 mg 1 QL (120 tablets/30 days)naproxen tab 500 mg 1 QL (90 tablets/30 days)oxaprozin tab 600 mg 1 QL (90 tablets/30 days)oxycodone hcl tab 5 mg 1 QL (360 tablets/30 days)oxycodone hcl tab 10 mg 1 QL (180 tablets/30 days)oxycodone hcl tab 15 mg 1 QL (180 tablets/30 days)oxycodone hcl tab 20 mg 1 QL (180 tablets/30 days)oxycodone hcl tab 30 mg 1 QL (180 tablets/30 days)oxycodone w/ acetaminophen tab 2.5-325 mg 1 QL (360 tablets/30 days)

2018



oxycodone w/ acetaminophen tab 5-325 mg 1 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 7.5-325 mg 1 QL (240 tablets/30 days)oxycodone w/ acetaminophen tab 10-325 mg 1 QL (180 tablets/30 days)oxycodone-aspirin tab 4.8355-325 mg 1 QL (360 tablets/30 days)piroxicam cap 10 mg 1 QL (60 capsules/30 days)piroxicam cap 20 mg 1 QL (30 capsules/30 days)sulindac tab 150 mg 1 QL (60 tablets/30 days)sulindac tab 200 mg 1 QL (60 tablets/30 days)TENCON - butalbital-acetaminophen tab 50-325 mg# 1 PA, QL (180 tablets/30 days)TOLMETIN SODIUM - tolmetin sodium cap 400 mg 1 QL (120 capsules/30 days)tramadol hcl tab 50 mg 1 QL (240 tablets/30 days)tramadol-acetaminophen tab 37.5-325 mg 1 QL (240 tablets/30 days)ZOHYDRO ER - hydrocodone bitartrate cap er 12hr abuse-

deterrent 10 mg1 PA, QL (60 capsules/30 days)

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

1 PA, QL (60 capsules/30 days)









Medicamentos anestésicoslidocaine hcl gel 2% 1 PA, QL (150 mls/30 days)lidocaine hcl soln 4% 1 PAlidocaine hcl viscous soln 2% 1lidocaine oint 5% 1 PA, QL (100 grams/30 days)lidocaine patch 5% 1 PA, QL (90 patches/30 days)lidocaine-prilocaine cream 2.5-2.5% 1 PA, QL (60 grams/30 days)Agentes contra las adicciones y para tratar el abuso de sustanciasacamprosate calcium tab delayed release 333 mg 1buprenorphine hcl sl tab 2 mg 1 PA, QL (90 tablets/30 days)buprenorphine hcl sl tab 8 mg 1 PA, QL (90 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg 1 PA, QL (120 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 8-2 mg 1 PA, QL (90 tablets/30 days)bupropion hcl (smoking deterrent) tab er 12hr 150 mg 1CHANTIX - varenicline tartrate tab 0.5 mg 1CHANTIX - varenicline tartrate tab 1 mg 1

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CHANTIX CONTINUING MONTH PACK - varenicline tartrate tab1 mg

1

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

1

disulfiram tab 250 mg 1disulfiram tab 500 mg 1NALOXONE HCL - naloxone hcl soln cartridge 0.4 mg/ml 1NALOXONE HCL - naloxone hcl soln prefilled syringe 2 mg/2ml 1naloxone hcl inj 0.4 mg/ml 1naloxone hcl inj 4 mg/10ml 1naltrexone hcl tab 50 mg 1NARCAN - naloxone hcl nasal spray 4 mg/0.1ml 1NICOTROL INHALER - nicotine inhaler system 10 mg (4 mg

delivered)1

NICOTROL NS - nicotine nasal spray 10 mg/ml (0.5 mg/spray) 1SUBLOCADE - buprenorphine extended release soln pref syr

100 mg/0.5ml1

SUBLOCADE - buprenorphine extended release soln pref syr300 mg/1.5ml

1

SUBOXONE - buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 1 PA, QL (120 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1 mg 1 PA, QL (30 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 8-2 mg 1 PA, QL (60 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 12-3 mg 1 PA, QL (60 films/30 days)VIVITROL - naltrexone for im extended release susp 380 mg 1Medicamentos antibacterialesamikacin sulfate inj 500 mg/2ml (250 mg/ml) 1amikacin sulfate inj 1 gm/4ml (250 mg/ml) 1amoxicillin (trihydrate) cap 250 mg 1amoxicillin (trihydrate) cap 500 mg 1amoxicillin (trihydrate) for susp 125 mg/5ml 1amoxicillin (trihydrate) for susp 200 mg/5ml 1amoxicillin (trihydrate) for susp 250 mg/5ml 1amoxicillin (trihydrate) for susp 400 mg/5ml 1amoxicillin (trihydrate) tab 500 mg 1amoxicillin (trihydrate) tab 875 mg 1amoxicillin & k clavulanate for susp 200-28.5 mg/5ml 1amoxicillin & k clavulanate for susp 400-57 mg/5ml 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml 1amoxicillin & k clavulanate tab 250-125 mg 1

2018



amoxicillin & k clavulanate tab 500-125 mg 1amoxicillin & k clavulanate tab 875-125 mg 1AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & k

clavulanate chew tab 200-28.5 mg1

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

1

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

soln 3 (2-1) gm1

AVELOX - moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8%inj

1

AZACTAM - aztreonam for inj 1 gm 1AZACTAM - aztreonam for inj 2 gm 1AZACTAM IN ISO-OSMOTIC DEXTROSE - aztreonam in

dextrose inj 1 gm/50ml1

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

1

AZITHROMYCIN - azithromycin powd pack for susp 1 gm 1azithromycin for susp 100 mg/5ml 1azithromycin for susp 200 mg/5ml 1azithromycin iv for soln 500 mg 1azithromycin tab 250 mg 1azithromycin tab 500 mg 1azithromycin tab 600 mg 1aztreonam for inj 1 gm 1aztreonam for inj 2 gm 1BICILLIN L-A - penicillin g benzathine intramuscular susp 600000

unit/ml1

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

1

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

1

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cefaclor cap 250 mg 1cefaclor cap 500 mg 1cefadroxil cap 500 mg 1cefadroxil for susp 250 mg/5ml 1cefadroxil for susp 500 mg/5ml 1cefadroxil tab 1 gm 1CEFAZOLIN SODIUM - cefazolin sodium for inj 20 gm 1cefazolin sodium for inj 500 mg 1cefazolin sodium for inj 1 gm 1cefazolin sodium for inj 10 gm 1cefdinir cap 300 mg 1cefdinir for susp 125 mg/5ml 1cefdinir for susp 250 mg/5ml 1cefepime hcl for inj 1 gm 1cefepime hcl for inj 2 gm 1CEFOTAXIME SODIUM - cefotaxime sodium for inj 500 mg 1CEFOTAXIME SODIUM - cefotaxime sodium for inj 2 gm 1CEFOTAXIME SODIUM - cefotaxime sodium for inj 10 gm 1cefotaxime sodium for inj 1 gm 1cefoxitin sodium for inj 10 gm 1cefoxitin sodium for iv soln 1 gm 1cefoxitin sodium for iv soln 2 gm 1cefpodoxime proxetil for susp 50 mg/5ml 1cefpodoxime proxetil for susp 100 mg/5ml 1cefpodoxime proxetil tab 100 mg 1cefpodoxime proxetil tab 200 mg 1cefprozil for susp 125 mg/5ml 1cefprozil for susp 250 mg/5ml 1cefprozil tab 250 mg 1cefprozil tab 500 mg 1ceftazidime for inj 1 gm 1ceftazidime for inj 2 gm 1ceftazidime for inj 6 gm 1ceftazidime for iv soln 2 gm 1ceftazidime for iv soln 1 gm 1CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxone

sodium in dextrose inj 20 mg/ml1

2018



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

1

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

and dextrose 3.74%1

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

1

cefuroxime axetil tab 250 mg 1cefuroxime axetil tab 500 mg 1cefuroxime sodium for inj 750 mg 1cefuroxime sodium for inj 7.5 gm 1cefuroxime sodium for iv soln 1.5 gm 1cephalexin cap 250 mg 1cephalexin cap 500 mg 1cephalexin cap 750 mg 1cephalexin for susp 125 mg/5ml 1cephalexin for susp 250 mg/5ml 1CHLORAMPHENICOL SODIUM SUCCINATE - chloramphenicol

sodium succinate for iv inj 1 gm1

ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) 1ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) 1CIPROFLOXACIN HCL - ciprofloxacin hcl tab 100 mg 1ciprofloxacin hcl tab er 24hr 500 mg 1ciprofloxacin hcl tab er 24hr 1000 mg 1ciprofloxacin hcl tab 250 mg 1ciprofloxacin hcl tab 500 mg 1ciprofloxacin hcl tab 750 mg 1ciprofloxacin 200 mg/100ml in d5w 1ciprofloxacin 400 mg/200ml in d5w 1clarithromycin for susp 125 mg/5ml 1clarithromycin for susp 250 mg/5ml 1clarithromycin tab er 24hr 500 mg 1clarithromycin tab 250 mg 1

2018


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clarithromycin tab 500 mg 1clindamycin hcl cap 75 mg 1clindamycin hcl cap 150 mg 1clindamycin hcl cap 300 mg 1clindamycin phosphate gel 1% (generic for Cleocin-T gel 1%) 1clindamycin phosphate in d5w iv soln 300 mg/50ml 1clindamycin phosphate in d5w iv soln 600 mg/50ml 1clindamycin phosphate in d5w iv soln 900 mg/50ml 1clindamycin phosphate inj 300 mg/2ml 1clindamycin phosphate inj 600 mg/4ml 1clindamycin phosphate inj 900 mg/6ml 1clindamycin phosphate inj 9 gm/60ml 1clindamycin phosphate iv soln 300 mg/2ml 1clindamycin phosphate iv soln 600 mg/4ml 1clindamycin phosphate iv soln 900 mg/6ml 1clindamycin phosphate lotion 1% 1clindamycin phosphate soln 1% 1clindamycin phosphate swab 1% 1clindamycin phosphate vaginal cream 2% 1colistimethate sod for inj 150 mg 1DALVANCE - dalbavancin hcl for iv soln 500 mg 1daptomycin for iv soln 500 mg 1demeclocycline hcl tab 150 mg 1demeclocycline hcl tab 300 mg 1dicloxacillin sodium cap 250 mg 1dicloxacillin sodium cap 500 mg 1DIFICID - fidaxomicin tab 200 mg 1doxycycline hyclate cap 50 mg 1doxycycline hyclate cap 100 mg 1doxycycline hyclate for inj 100 mg 1doxycycline hyclate tab 20 mg 1doxycycline hyclate tab 100 mg 1doxycycline monohydrate cap 50 mg 1doxycycline monohydrate cap 75 mg 1doxycycline monohydrate cap 100 mg 1doxycycline monohydrate cap 150 mg 1doxycycline monohydrate tab 50 mg 1doxycycline monohydrate tab 75 mg 1

2018



doxycycline monohydrate tab 100 mg 1doxycycline monohydrate tab 150 mg 1ertapenem sodium for inj 1 gm 1ERY-TAB - erythromycin tab delayed release 250 mg 1ERY-TAB - erythromycin tab delayed release 333 mg 1ERY-TAB - erythromycin tab delayed release 500 mg 1ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 1ERYTHROCIN LACTOBIONATE - erythromycin lactobionate for

inj 500 mg1

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 1erythromycin ethylsuccinate for susp 200 mg/5ml 1erythromycin pads 2% 1erythromycin soln 2% 1erythromycin tab 250 mg 1erythromycin tab 500 mg 1gentamicin in saline inj 0.8 mg/ml 1gentamicin in saline inj 1 mg/ml 1gentamicin in saline inj 1.2 mg/ml 1gentamicin in saline inj 1.6 mg/ml 1gentamicin sulfate inj 10 mg/ml 1gentamicin sulfate inj 40 mg/ml 1imipenem-cilastatin intravenous for soln 250 mg 1imipenem-cilastatin intravenous for soln 500 mg 1IMPAVIDO - miltefosine cap 50 mg 1INVANZ - ertapenem sodium for inj 1 gm 1INVANZ - ertapenem sodium for iv inj 1 gm 1levofloxacin in d5w iv soln 250 mg/50ml 1levofloxacin in d5w iv soln 500 mg/100ml 1levofloxacin in d5w iv soln 750 mg/150ml 1levofloxacin iv soln 25 mg/ml 1levofloxacin oral soln 25 mg/ml 1levofloxacin tab 250 mg 1levofloxacin tab 500 mg 1levofloxacin tab 750 mg 1LINEZOLID - linezolid in sodium chloride iv soln

600 mg/300ml-0.9%1

linezolid for susp 100 mg/5ml 1 PAlinezolid iv soln 600 mg/300ml (2 mg/ml) 1

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linezolid tab 600 mg 1 PAmeropenem iv for soln 500 mg 1meropenem iv for soln 1 gm 1methenamine hippurate tab 1 gm 1METRONIDAZOLE - metronidazole in nacl 0.74% iv soln

500 mg/100ml1

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

potassium inj 20000 unit/ml in dextrose1

2018



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

1

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

1

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

(40 mg/ml)1

tobramycin sulfate for inj 1.2 gm 1tobramycin sulfate inj 10 mg/ml 1tobramycin sulfate inj 80 mg/2ml (40 mg/ml) 1tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml) 1trimethoprim tab 100 mg 1TYGACIL - tigecycline for iv soln 50 mg 1vancomycin hcl cap 125 mg 1

2018


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vancomycin hcl cap 250 mg 1vancomycin hcl for inj 100 gm 1vancomycin hcl for inj 500 mg 1vancomycin hcl for inj 750 mg 1vancomycin hcl for inj 1000 mg 1vancomycin hcl for inj 5000 mg 1vancomycin hcl for inj 10 gm 1VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose

5% inj 500 mg/100ml1

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

1

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

1

ZINACEF - cefuroxime in sterile water inj 1.5 gm/50ml 1ZOSYN - piperacillin sod-tazobactam sod in dex iv soln

2-0.25gm/50ml1

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

1

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

1

Medicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 1APTIOM - eslicarbazepine acetate tab 400 mg 1APTIOM - eslicarbazepine acetate tab 600 mg 1APTIOM - eslicarbazepine acetate tab 800 mg 1BANZEL - rufinamide susp 40 mg/ml 1BANZEL - rufinamide tab 200 mg 1BANZEL - rufinamide tab 400 mg 1BRIVIACT - brivaracetam iv soln 50 mg/5ml 1BRIVIACT - brivaracetam oral soln 10 mg/ml 1BRIVIACT - brivaracetam tab 10 mg 1BRIVIACT - brivaracetam tab 25 mg 1BRIVIACT - brivaracetam tab 50 mg 1BRIVIACT - brivaracetam tab 75 mg 1BRIVIACT - brivaracetam tab 100 mg 1carbamazepine cap er 12hr 100 mg 1carbamazepine cap er 12hr 200 mg 1carbamazepine cap er 12hr 300 mg 1carbamazepine chew tab 100 mg 1carbamazepine susp 100 mg/5ml 1

2018



carbamazepine tab er 12hr 100 mg 1carbamazepine tab er 12hr 200 mg 1carbamazepine tab er 12hr 400 mg 1carbamazepine tab 200 mg 1CELONTIN - methsuximide cap 300 mg 1DIASTAT ACUDIAL - diazepam rectal gel delivery system 10 mg 1 QL (5 twin pack(s)/30 days)DIASTAT ACUDIAL - diazepam rectal gel delivery system 20 mg 1 QL (5 twin pack(s)/30 days)DIASTAT PEDIATRIC - diazepam rectal gel delivery system

2.5 mg1 QL (5 twin pack(s)/30 days)

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

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

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system10 mg


DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system20 mg


DILANTIN - phenytoin sodium extended cap 30 mg 1divalproex sodium cap delayed release sprinkle 125 mg 1divalproex sodium tab delayed release 125 mg 1divalproex sodium tab delayed release 250 mg 1divalproex sodium tab delayed release 500 mg 1divalproex sodium tab er 24 hr 250 mg 1divalproex sodium tab er 24 hr 500 mg 1ethosuximide cap 250 mg 1ethosuximide soln 250 mg/5ml 1felbamate susp 600 mg/5ml 1felbamate tab 400 mg 1felbamate tab 600 mg 1fosphenytoin sodium inj 100 mg/2ml 1fosphenytoin sodium inj 500 mg/10ml 1FYCOMPA - perampanel susp 0.5 mg/ml 1FYCOMPA - perampanel tab 2 mg 1FYCOMPA - perampanel tab 4 mg 1FYCOMPA - perampanel tab 6 mg 1FYCOMPA - perampanel tab 8 mg 1FYCOMPA - perampanel tab 10 mg 1FYCOMPA - perampanel tab 12 mg 1gabapentin cap 100 mg 1 QL (1080 capsules/30 days)gabapentin cap 300 mg 1 QL (360 capsules/30 days)gabapentin cap 400 mg 1 QL (270 capsules/30 days)

2018


15


gabapentin oral soln 250 mg/5ml 1 QL (2160 mls/30 days)gabapentin tab 600 mg 1 QL (180 tablets/30 days)gabapentin tab 800 mg 1 QL (135 tablets/30 days)GABITRIL - tiagabine hcl tab 12 mg 1GABITRIL - tiagabine hcl tab 16 mg 1lamotrigine tab chewable dispersible 5 mg 1lamotrigine tab chewable dispersible 25 mg 1lamotrigine tab 25 mg 1lamotrigine tab 100 mg 1lamotrigine tab 150 mg 1lamotrigine tab 200 mg 1levetiracetam in sodium chloride iv soln 500 mg/100ml 1levetiracetam in sodium chloride iv soln 1000 mg/100ml 1levetiracetam in sodium chloride iv soln 1500 mg/100ml 1levetiracetam inj 500 mg/5ml (100 mg/ml) 1levetiracetam oral soln 100 mg/ml 1levetiracetam tab 250 mg 1levetiracetam tab 500 mg 1levetiracetam tab 750 mg 1levetiracetam tab 1000 mg 1LYRICA - pregabalin cap 25 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 50 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 75 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 100 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 150 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 200 mg 1 QL (90 capsules/30 days)LYRICA - pregabalin cap 225 mg 1 QL (60 capsules/30 days)LYRICA - pregabalin cap 300 mg 1 QL (60 capsules/30 days)LYRICA - pregabalin soln 20 mg/ml 1 QL (900 mls/30 days)ONFI - clobazam suspension 2.5 mg/ml 1 PA, QL (480 mls/30 days)ONFI - clobazam tab 10 mg 1 PA, QL (60 tablets/30 days)ONFI - clobazam tab 20 mg 1 PA, QL (60 tablets/30 days)oxcarbazepine susp 300 mg/5ml (60 mg/ml) 1oxcarbazepine tab 150 mg 1oxcarbazepine tab 300 mg 1oxcarbazepine tab 600 mg 1PEGANONE - ethotoin tab 250 mg 1PHENOBARBITAL - phenobarbital tab 15 mg# 1 PA

2018



PHENOBARBITAL - phenobarbital tab 30 mg# 1 PAPHENOBARBITAL - phenobarbital tab 60 mg# 1 PAPHENOBARBITAL - phenobarbital tab 100 mg# 1 PAphenobarbital elixir 20 mg/5ml# 1 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 65 mg/ml# 1 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 130 mg/

ml#1 PA

phenobarbital tab 16.2 mg# 1 PAphenobarbital tab 32.4 mg# 1 PAphenobarbital tab 64.8 mg# 1 PAphenobarbital tab 97.2 mg# 1 PAphenytoin chew tab 50 mg 1phenytoin sodium extended cap 100 mg 1phenytoin sodium extended cap 200 mg 1phenytoin sodium extended cap 300 mg 1phenytoin susp 125 mg/5ml 1primidone tab 50 mg 1primidone tab 250 mg 1SABRIL - vigabatrin powd pack 500 mg* 1SABRIL - vigabatrin tab 500 mg* 1SPRITAM - levetiracetam tab disintegrating soluble 250 mg 1SPRITAM - levetiracetam tab disintegrating soluble 500 mg 1SPRITAM - levetiracetam tab disintegrating soluble 750 mg 1SPRITAM - levetiracetam tab disintegrating soluble 1000 mg 1tiagabine hcl tab 2 mg 1tiagabine hcl tab 4 mg 1tiagabine hcl tab 12 mg 1tiagabine hcl tab 16 mg 1topiramate sprinkle cap 15 mg 1topiramate sprinkle cap 25 mg 1topiramate tab 25 mg 1topiramate tab 50 mg 1topiramate tab 100 mg 1topiramate tab 200 mg 1valproate sodium inj 100 mg/ml 1valproate sodium oral soln 250 mg/5ml 1valproic acid cap 250 mg 1vigabatrin powd pack 500 mg* 1

2018


17


VIMPAT - lacosamide iv inj 200 mg/20ml (10 mg/ml) 1VIMPAT - lacosamide oral solution 10 mg/ml 1VIMPAT - lacosamide tab 50 mg 1VIMPAT - lacosamide tab 100 mg 1VIMPAT - lacosamide tab 150 mg 1VIMPAT - lacosamide tab 200 mg 1zonisamide cap 25 mg 1zonisamide cap 50 mg 1zonisamide cap 100 mg 1Agentes contra la demenciadonepezil hydrochloride orally disintegrating tab 5 mg 1donepezil hydrochloride orally disintegrating tab 10 mg 1donepezil hydrochloride tab 5 mg 1donepezil hydrochloride tab 10 mg 1donepezil hydrochloride tab 23 mg 1ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 1 PAGALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml1

galantamine hydrobromide cap er 24hr 8 mg 1galantamine hydrobromide cap er 24hr 16 mg 1galantamine hydrobromide cap er 24hr 24 mg 1galantamine hydrobromide tab 4 mg 1galantamine hydrobromide tab 8 mg 1galantamine hydrobromide tab 12 mg 1memantine hcl oral solution 2 mg/ml 1 PAmemantine hcl tab 5 mg 1 PAmemantine hcl tab 10 mg 1 PAmemantine hcl tab 5 mg (28) & 10 mg (21) titration pak 1 PArivastigmine tartrate cap 1.5 mg 1rivastigmine tartrate cap 3 mg 1rivastigmine tartrate cap 4.5 mg 1rivastigmine tartrate cap 6 mg 1rivastigmine td patch 24hr 4.6 mg/24hr 1rivastigmine td patch 24hr 9.5 mg/24hr 1rivastigmine td patch 24hr 13.3 mg/24hr 1Medicamentos antidepresivosamitriptyline hcl tab 10 mg# 1 PAamitriptyline hcl tab 25 mg# 1 PA

2018



amitriptyline hcl tab 50 mg# 1 PAamitriptyline hcl tab 75 mg# 1 PAamitriptyline hcl tab 100 mg# 1 PAamitriptyline hcl tab 150 mg# 1 PAAMOXAPINE - amoxapine tab 25 mg# 1 PAAMOXAPINE - amoxapine tab 50 mg# 1 PAAMOXAPINE - amoxapine tab 100 mg# 1 PAAMOXAPINE - amoxapine tab 150 mg# 1 PAbupropion hcl tab er 12hr 100 mg 1 QL (90 tablets/30 days)bupropion hcl tab er 12hr 150 mg 1 QL (60 tablets/30 days)bupropion hcl tab er 12hr 200 mg 1 QL (60 tablets/30 days)bupropion hcl tab er 24hr 150 mg 1 QL (90 tablets/30 days)bupropion hcl tab er 24hr 300 mg 1 QL (30 tablets/30 days)bupropion hcl tab 75 mg 1 QL (60 tablets/30 days)bupropion hcl tab 100 mg 1 QL (120 tablets/30 days)citalopram hydrobromide oral soln 10 mg/5ml 1 QL (600 mls/30 days)citalopram hydrobromide tab 10 mg 1 QL (45 tablets/30 days)citalopram hydrobromide tab 20 mg 1 QL (45 tablets/30 days)citalopram hydrobromide tab 40 mg 1 QL (30 tablets/30 days)clomipramine hcl cap 25 mg# 1 PAclomipramine hcl cap 50 mg# 1 PAclomipramine hcl cap 75 mg# 1 PAdesipramine hcl tab 10 mg# 1 PAdesipramine hcl tab 25 mg# 1 PAdesipramine hcl tab 50 mg# 1 PAdesipramine hcl tab 75 mg# 1 PAdesipramine hcl tab 100 mg# 1 PAdesipramine hcl tab 150 mg# 1 PAdesvenlafaxine succinate tab er 24hr 25 mg 1 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 50 mg 1 QL (30 tablets/30 days)desvenlafaxine succinate tab er 24hr 100 mg 1 QL (30 tablets/30 days)doxepin hcl cap 10 mg# 1 PAdoxepin hcl cap 25 mg# 1 PAdoxepin hcl cap 50 mg# 1 PAdoxepin hcl cap 75 mg# 1 PAdoxepin hcl cap 100 mg# 1 PAdoxepin hcl cap 150 mg# 1 PAdoxepin hcl conc 10 mg/ml# 1 PA

2018


19


duloxetine hcl enteric coated pellets cap 20 mg 1 QL (60 capsules/30 days)duloxetine hcl enteric coated pellets cap 30 mg 1 QL (90 capsules/30 days)duloxetine hcl enteric coated pellets cap 60 mg 1 QL (60 capsules/30 days)EMSAM - selegiline td patch 24hr 6 mg/24hr 1EMSAM - selegiline td patch 24hr 9 mg/24hr 1EMSAM - selegiline td patch 24hr 12 mg/24hr 1escitalopram oxalate soln 5 mg/5ml 1 QL (600 mls/30 days)escitalopram oxalate tab 5 mg 1 QL (45 tablets/30 days)escitalopram oxalate tab 10 mg 1 QL (45 tablets/30 days)escitalopram oxalate tab 20 mg 1 QL (30 tablets/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 20 mg 1 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 40 mg 1 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 80 mg 1 QL (30 capsules/30 days)FETZIMA - levomilnacipran hcl cap er 24hr 120 mg 1 QL (30 capsules/30 days)FETZIMA TITRATION PACK - levomilnacipran hcl cap er 24hr 20

& 40 mg therapy pack1 QL (28 capsules/28 days)

FLUOXETINE DR - fluoxetine hcl cap delayed release 90 mg 1 QL (4 capsules/28 days)fluoxetine hcl cap 10 mg 1 QL (90 capsules/30 days)fluoxetine hcl cap 20 mg 1 QL (120 capsules/30 days)fluoxetine hcl cap 40 mg 1 QL (60 capsules/30 days)fluoxetine hcl solution 20 mg/5ml 1 QL (600 mls/30 days)fluoxetine hcl tab 10 mg 1 QL (90 tablets/30 days)fluoxetine hcl tab 20 mg 1 QL (120 tablets/30 days)fluvoxamine maleate tab 25 mg 1 QL (30 tablets/30 days)fluvoxamine maleate tab 50 mg 1 QL (30 tablets/30 days)fluvoxamine maleate tab 100 mg 1 QL (90 tablets/30 days)imipramine hcl tab 10 mg# 1 PAimipramine hcl tab 25 mg# 1 PAimipramine hcl tab 50 mg# 1 PAMAPROTILINE HCL - maprotiline hcl tab 25 mg 1 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 1 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 1 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 1mirtazapine orally disintegrating tab 15 mg 1 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 30 mg 1 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 45 mg 1 QL (30 tablets/30 days)mirtazapine tab 7.5 mg 1 QL (30 tablets/30 days)mirtazapine tab 15 mg 1 QL (45 tablets/30 days)

2018



mirtazapine tab 30 mg 1 QL (30 tablets/30 days)mirtazapine tab 45 mg 1 QL (30 tablets/30 days)NEFAZODONE HCL - nefazodone hcl tab 100 mg 1NEFAZODONE HCL - nefazodone hcl tab 150 mg 1NEFAZODONE HCL - nefazodone hcl tab 200 mg 1nefazodone hcl tab 50 mg 1nefazodone hcl tab 250 mg 1nortriptyline hcl cap 10 mg# 1 PAnortriptyline hcl cap 25 mg# 1 PAnortriptyline hcl cap 50 mg# 1 PAnortriptyline hcl cap 75 mg# 1 PAnortriptyline hcl soln 10 mg/5ml# 1 PAparoxetine hcl tab 10 mg# 1 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 1 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 1 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 1 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl oral susp 10 mg/5ml# 1 PA, QL (900 mls/30 days)phenelzine sulfate tab 15 mg 1protriptyline hcl tab 5 mg# 1 PAprotriptyline hcl tab 10 mg# 1 PAsertraline hcl oral concentrate for solution 20 mg/ml 1 QL (300 mls/30 days)sertraline hcl tab 25 mg 1 QL (45 tablets/30 days)sertraline hcl tab 50 mg 1 QL (45 tablets/30 days)sertraline hcl tab 100 mg 1 QL (60 tablets/30 days)tranylcypromine sulfate tab 10 mg 1trazodone hcl tab 50 mg 1trazodone hcl tab 100 mg 1trazodone hcl tab 150 mg 1trazodone hcl tab 300 mg 1trimipramine maleate cap 25 mg# 1 PAtrimipramine maleate cap 50 mg# 1 PAtrimipramine maleate cap 100 mg# 1 PATRINTELLIX - vortioxetine hbr tab 5 mg 1 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 10 mg 1 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 20 mg 1 QL (30 tablets/30 days)venlafaxine hcl cap er 24hr 37.5 mg 1 QL (60 capsules/30 days)venlafaxine hcl cap er 24hr 75 mg 1 QL (90 capsules/30 days)venlafaxine hcl cap er 24hr 150 mg 1 QL (30 capsules/30 days)

2018


21


venlafaxine hcl tab er 24hr 37.5 mg 1 QL (60 tablets/30 days)venlafaxine hcl tab er 24hr 75 mg 1 QL (90 tablets/30 days)venlafaxine hcl tab er 24hr 150 mg 1 QL (30 tablets/30 days)venlafaxine hcl tab 25 mg 1 QL (90 tablets/30 days)venlafaxine hcl tab 37.5 mg 1 QL (90 tablets/30 days)venlafaxine hcl tab 50 mg 1 QL (90 tablets/30 days)venlafaxine hcl tab 75 mg 1 QL (90 tablets/30 days)venlafaxine hcl tab 100 mg 1 QL (90 tablets/30 days)VIIBRYD - vilazodone hcl tab 10 mg 1 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 20 mg 1 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 40 mg 1 QL (30 tablets/30 days)VIIBRYD STARTER PACK - vilazodone hcl tab starter kit 10 (7) &

20 (23) mg1 QL (1 kit/30 days)

Medicamentos antieméticosALOXI - palonosetron hcl iv soln 0.25 mg/5ml 1aprepitant capsule therapy pack 80 & 125 mg 1 BDaprepitant capsule 40 mg 1 BDaprepitant capsule 80 mg 1 BDaprepitant capsule 125 mg 1 BDCHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 1 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 1 PAchlorpromazine hcl tab 10 mg 1 PAchlorpromazine hcl tab 25 mg 1 PAchlorpromazine hcl tab 50 mg 1 PAchlorpromazine hcl tab 100 mg 1 PAchlorpromazine hcl tab 200 mg 1 PAdronabinol cap 2.5 mg 1 BDdronabinol cap 5 mg 1 BDdronabinol cap 10 mg 1 BDEMEND - fosaprepitant dimeglumine for iv infusion 150 mg 1granisetron hcl inj 1 mg/ml 1granisetron hcl inj 4 mg/4ml (1 mg/ml) 1granisetron hcl tab 1 mg 1 BDmeclizine hcl tab 12.5 mg# 1ondansetron hcl inj 4 mg/2ml (2 mg/ml) 1ondansetron hcl inj 40 mg/20ml (2 mg/ml) 1ondansetron hcl oral soln 4 mg/5ml 1 BDondansetron hcl tab 4 mg 1 BD

2018



ondansetron hcl tab 8 mg 1 BDondansetron hcl tab 24 mg 1 BDondansetron orally disintegrating tab 4 mg 1 BDondansetron orally disintegrating tab 8 mg 1 BDpalonosetron hcl iv soln 0.25 mg/5ml 1PALONOSETRON HYDROCHLORIDE - palonosetron hcl iv soln

0.25 mg/2ml1

perphenazine tab 2 mg 1 PAperphenazine tab 4 mg 1 PAperphenazine tab 8 mg 1 PAperphenazine tab 16 mg 1 PAprochlorperazine edisylate inj 5 mg/ml 1prochlorperazine maleate tab 5 mg 1prochlorperazine maleate tab 10 mg 1prochlorperazine suppos 25 mg 1promethazine hcl suppos 12.5 mg# 1 PApromethazine hcl suppos 25 mg# 1 PApromethazine hcl syrup 6.25 mg/5ml# 1 PApromethazine hcl tab 12.5 mg# 1 PApromethazine hcl tab 25 mg# 1 PApromethazine hcl tab 50 mg# 1 PAMedicamentos antimicóticosAMBISOME - amphotericin b liposome iv for susp 50 mg 1 BDAMPHOTERICIN B - amphotericin b for inj 50 mg 1 BDCANCIDAS - caspofungin acetate for iv soln 50 mg 1CANCIDAS - caspofungin acetate for iv soln 70 mg 1caspofungin acetate for iv soln 50 mg 1caspofungin acetate for iv soln 70 mg 1ciclopirox gel 0.77% 1ciclopirox olamine cream 0.77% 1ciclopirox olamine susp 0.77% 1ciclopirox shampoo 1% 1ciclopirox solution 8% 1clotrimazole cream 1% 1clotrimazole troche 10 mg 1CRESEMBA - isavuconazonium sulfate cap 186 mg 1 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 1 PAeconazole nitrate cream 1% 1

2018


23


fluconazole for susp 10 mg/ml 1fluconazole for susp 40 mg/ml 1fluconazole in dextrose inj 200 mg/100ml 1fluconazole in dextrose inj 400 mg/200ml 1fluconazole in nacl 0.9% inj 200 mg/100ml 1fluconazole in nacl 0.9% inj 400 mg/200ml 1fluconazole tab 50 mg 1fluconazole tab 100 mg 1fluconazole tab 150 mg 1fluconazole tab 200 mg 1flucytosine cap 250 mg 1flucytosine cap 500 mg 1griseofulvin microsize susp 125 mg/5ml 1griseofulvin ultramicrosize tab 125 mg 1griseofulvin ultramicrosize tab 250 mg 1itraconazole cap 100 mg 1ketoconazole cream 2% 1ketoconazole shampoo 2% 1ketoconazole tab 200 mg 1MYCAMINE - micafungin sodium for iv soln 50 mg 1MYCAMINE - micafungin sodium for iv soln 100 mg 1NOXAFIL - posaconazole iv soln 300 mg/16.7ml (18 mg/ml) 1 PANOXAFIL - posaconazole susp 40 mg/ml 1 PANOXAFIL - posaconazole tab delayed release 100 mg 1 PAnystatin cream 100000 unit/gm 1nystatin oint 100000 unit/gm 1nystatin susp 100000 unit/ml 1nystatin tab 500000 unit 1nystatin topical powder 100000 unit/gm 1terbinafine hcl tab 250 mg 1terconazole vaginal cream 0.4% 1terconazole vaginal cream 0.8% 1terconazole vaginal suppos 80 mg 1voriconazole for inj 200 mg 1 PAvoriconazole for susp 40 mg/ml 1 PAvoriconazole tab 50 mg 1 PAvoriconazole tab 200 mg 1 PA

2018



Agentes contra la gotaallopurinol sodium for inj 500 mg 1allopurinol tab 100 mg 1allopurinol tab 300 mg 1colchicine w/ probenecid tab 0.5-500 mg 1COLCRYS - colchicine tab 0.6 mg 1probenecid tab 500 mg 1ULORIC - febuxostat tab 40 mg 1 STULORIC - febuxostat tab 80 mg 1 STAgentes contra las migrañasMIGERGOT - ergotamine w/ caffeine suppos 2-100 mg 1MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml 1 QL (8 mls/28 days)naratriptan hcl tab 1 mg 1 QL (18 tablets/30 days)naratriptan hcl tab 2.5 mg 1 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 5 mg 1 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 10 mg 1 QL (18 tablets/30 days)rizatriptan benzoate tab 5 mg 1 QL (18 tablets/30 days)rizatriptan benzoate tab 10 mg 1 QL (18 tablets/30 days)sumatriptan nasal spray 5 mg/act 1 QL (12 units (2

packages)/30 days)sumatriptan nasal spray 20 mg/act 1 QL (12 units (2

packages)/30 days)sumatriptan succinate inj 6 mg/0.5ml 1sumatriptan succinate solution auto-injector 4 mg/0.5ml 1sumatriptan succinate solution auto-injector 6 mg/0.5ml 1sumatriptan succinate solution cartridge 4 mg/0.5ml 1sumatriptan succinate solution cartridge 6 mg/0.5ml 1sumatriptan succinate tab 25 mg 1 QL (18 tablets/30 days)sumatriptan succinate tab 50 mg 1 QL (18 tablets/30 days)sumatriptan succinate tab 100 mg 1 QL (18 tablets/30 days)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 1MESTINON - pyridostigmine bromide syrup 60 mg/5ml 1pyridostigmine bromide tab er 180 mg 1pyridostigmine bromide tab 60 mg 1Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 1CYCLOSERINE - cycloserine cap 250 mg 1dapsone tab 25 mg 1

2018


25


dapsone tab 100 mg 1ethambutol hcl tab 100 mg 1ethambutol hcl tab 400 mg 1ISONIAZID - isoniazid inj 100 mg/ml 1isoniazid tab 100 mg 1isoniazid tab 300 mg 1PASER - aminosalicylic acid er granules packet 4 gm 1PRIFTIN - rifapentine tab 150 mg 1pyrazinamide tab 500 mg 1rifabutin cap 150 mg 1rifampin cap 150 mg 1rifampin cap 300 mg 1rifampin for inj 600 mg 1SIRTURO - bedaquiline fumarate tab 100 mg 1TRECATOR - ethionamide tab 250 mg 1Medicamentos antineoplásicosABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 1AFINITOR - everolimus tab 2.5 mg 1 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 5 mg 1 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 7.5 mg 1 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 10 mg 1 PA, QL (30 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 2 mg 1 PA, QL (60 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 3 mg 1 PA, QL (90 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 5 mg 1 PA, QL (60 tablets/30 days)ALECENSA - alectinib hcl cap 150 mg* 1 PA, QL (240 capsules/30 days)ALIMTA - pemetrexed disodium for iv soln 100 mg 1ALIMTA - pemetrexed disodium for iv soln 500 mg 1ALIQOPA - copanlisib hcl for iv soln 60 mg 1ALUNBRIG - brigatinib tab initiation therapy pack 90 mg & 180 mg 1 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 30 mg 1 PA, QL (180 tablets/30 days)ALUNBRIG - brigatinib tab 90 mg 1 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 180 mg 1 PA, QL (30 tablets/30 days)anastrozole tab 1 mg 1ARRANON - nelarabine iv soln 5 mg/ml 1ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 1ARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 1AVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 1AVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 1

2018



BAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/ml)

1

BELEODAQ - belinostat for iv inj 500 mg* 1BENDEKA - bendamustine hcl iv soln 100 mg/4ml (25 mg/ml) 1BESPONSA - inotuzumab ozogamicin for iv soln 0.9 mg 1bexarotene cap 75 mg 1 PAbicalutamide tab 50 mg 1BICNU - carmustine for inj 100 mg 1bleomycin sulfate for inj 15 unit 1 BDbleomycin sulfate for inj 30 unit 1 BDBLINCYTO - blinatumomab for iv infusion 35 mcg* 1 BDBOSULIF - bosutinib tab 100 mg 1 PA, QL (180 tablets/30 days)BOSULIF - bosutinib tab 400 mg 1 PA, QL (30 tablets/30 days)BOSULIF - bosutinib tab 500 mg 1 PA, QL (30 tablets/30 days)busulfan inj 6 mg/ml 1CABOMETYX - cabozantinib s-malate tab 20 mg* 1 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 40 mg* 1 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 60 mg* 1 PA, QL (30 tablets/30 days)CALQUENCE - acalabrutinib cap 100 mg 1 PA, QL (60 capsules/30 days)CAPRELSA - vandetanib tab 100 mg* 1 PA, QL (60 tablets/30 days)CAPRELSA - vandetanib tab 300 mg* 1 PA, QL (30 tablets/30 days)carboplatin iv soln 50 mg/5ml 1carboplatin iv soln 150 mg/15ml 1carboplatin iv soln 450 mg/45ml 1carboplatin iv soln 600 mg/60ml 1CISPLATIN - cisplatin inj 200 mg/200ml (1 mg/ml) 1cisplatin inj 50 mg/50ml (1 mg/ml) 1cisplatin inj 100 mg/100ml (1 mg/ml) 1cladribine iv soln 10 mg/10ml (1 mg/ml) 1 BDclofarabine iv soln 1 mg/ml 1COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20 mg (100

dose) kit*1 PA, QL (56 capsules/28 days)

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


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


COSMEGEN - dactinomycin for inj 0.5 mg 1COTELLIC - cobimetinib fumarate tab 20 mg* 1 PA, QL (63 tablets/28 days)cyclophosphamide cap 25 mg 1 BD

2018


27


cyclophosphamide cap 50 mg 1 BDcyclophosphamide for inj 500 mg 1cyclophosphamide for inj 1 gm 1cyclophosphamide for inj 2 gm 1CYRAMZA - ramucirumab iv soln 100 mg/10ml (for infusion)* 1CYRAMZA - ramucirumab iv soln 500 mg/50ml (for infusion)* 1CYTARABINE - cytarabine inj 20 mg/ml 1 BDcytarabine inj pf 20 mg/ml 1 BDcytarabine inj pf 100 mg/ml 1 BDDACARBAZINE - dacarbazine for inj 100 mg 1dacarbazine for inj 200 mg 1dactinomycin for inj 0.5 mg 1DARZALEX - daratumumab iv soln 100 mg/5ml* 1DARZALEX - daratumumab iv soln 400 mg/20ml* 1daunorubicin hcl inj 5 mg/ml 1DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln

20 mg/4ml1

DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln50 mg/10ml

1

decitabine for inj 50 mg 1dexrazoxane for inj 250 mg 1dexrazoxane for inj 500 mg 1DOCETAXEL - docetaxel for inj conc 20 mg/ml 1DOCETAXEL - docetaxel for inj conc 80 mg/4ml (20 mg/ml) 1DOCETAXEL - docetaxel for inj conc 160 mg/8ml (20 mg/ml) 1DOCETAXEL - docetaxel for inj conc 200 mg/10ml (20 mg/ml) 1DOCETAXEL - docetaxel soln for iv infusion 20 mg/2ml 1DOCETAXEL - docetaxel soln for iv infusion 80 mg/8ml 1DOCETAXEL - docetaxel soln for iv infusion 160 mg/16ml 1DOCETAXEL - docetaxel soln for iv infusion 200 mg/20ml 1docetaxel for inj conc 20 mg/ml 1docetaxel for inj conc 80 mg/4ml (20 mg/ml) 1docetaxel soln for iv infusion 20 mg/2ml 1docetaxel soln for iv infusion 80 mg/8ml 1docetaxel soln for iv infusion 160 mg/16ml 1doxorubicin hcl for inj 10 mg 1 BDdoxorubicin hcl for inj 50 mg 1 BDdoxorubicin hcl inj 2 mg/ml 1 BD

2018



doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml 1 BDELITEK - rasburicase for iv soln 1.5 mg 1ELITEK - rasburicase for iv soln 7.5 mg 1EMCYT - estramustine phosphate sodium cap 140 mg 1EMPLICITI - elotuzumab for iv soln 300 mg 1EMPLICITI - elotuzumab for iv soln 400 mg 1epirubicin hcl iv soln 50 mg/25ml (2 mg/ml) 1epirubicin hcl iv soln 200 mg/100ml (2 mg/ml) 1ERBITUX - cetuximab iv soln 100 mg/50ml (2 mg/ml) 1ERBITUX - cetuximab iv soln 200 mg/100ml (2 mg/ml) 1ERIVEDGE - vismodegib cap 150 mg* 1 PA, QL (30 capsules/30 days)ERLEADA - apalutamide tab 60 mg 1 PA, QL (120 tablets/30 days)ERWINAZE - asparaginase erwinia chrysanthemi for inj 10000

unit1

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

(25 mg/ml)1

gemcitabine hcl for inj 200 mg 1gemcitabine hcl for inj 1 gm 1

2018


29


gemcitabine hcl for inj 2 gm 1gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) 1gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) 1gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) 1GILOTRIF - afatinib dimaleate tab 20 mg 1 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 30 mg 1 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 40 mg 1 PA, QL (30 tablets/30 days)GLEOSTINE - lomustine cap 10 mg 1GLEOSTINE - lomustine cap 40 mg 1GLEOSTINE - lomustine cap 100 mg 1HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 1HERCEPTIN - trastuzumab for iv soln 150 mg* 1HERCEPTIN - trastuzumab for iv soln 440 mg* 1HEXALEN - altretamine cap 50 mg 1 PAhydroxyurea cap 500 mg 1IBRANCE - palbociclib cap 75 mg* 1 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 100 mg* 1 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 125 mg* 1 PA, QL (21 capsules/28 days)ICLUSIG - ponatinib hcl tab 15 mg 1 PA, QL (60 tablets/30 days)ICLUSIG - ponatinib hcl tab 45 mg 1 PA, QL (30 tablets/30 days)idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 1idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) 1idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) 1IDHIFA - enasidenib mesylate tab 50 mg 1 PA, QL (30 tablets/30 days)IDHIFA - enasidenib mesylate tab 100 mg 1 PA, QL (30 tablets/30 days)IFEX - ifosfamide for inj 3 gm 1IFOSFAMIDE - ifosfamide for inj 3 gm 1ifosfamide for inj 1 gm 1ifosfamide iv inj 1 gm/20ml (50 mg/ml) 1ifosfamide iv inj 3 gm/60ml (50 mg/ml) 1imatinib mesylate tab 100 mg 1 PA, QL (90 tablets/30 days)imatinib mesylate tab 400 mg 1 PA, QL (60 tablets/30 days)IMBRUVICA - ibrutinib cap 70 mg 1 PA, QL (30 capsules/30 days)IMBRUVICA - ibrutinib cap 140 mg 1 PA, QL (120 capsules/30 days)IMBRUVICA - ibrutinib tab 140 mg 1 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 280 mg 1 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 420 mg 1 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 560 mg 1 PA, QL (30 tablets/30 days)

2018



IMFINZI - durvalumab soln for iv infusion 120 mg/2.4ml (50 mg/ml) 1IMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 1IMLYGIC - talimogene laherparepvec intralesional inj 1000000

unit/ml*1

IMLYGIC - talimogene laherparepvec intralesional inj 100000000unit/ml*

1

INLYTA - axitinib tab 1 mg* 1 PA, QL (180 tablets/30 days)INLYTA - axitinib tab 5 mg* 1 PA, QL (120 tablets/30 days)IRESSA - gefitinib tab 250 mg* 1 PA, QL (30 tablets/30 days)IRINOTECAN - irinotecan hcl inj 500 mg/25ml (20 mg/ml) 1irinotecan hcl inj 40 mg/2ml (20 mg/ml) 1irinotecan hcl inj 100 mg/5ml (20 mg/ml) 1ISTODAX - romidepsin for iv inj 10 mg 1ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 1IXEMPRA KIT - ixabepilone for iv infusion 15 mg 1IXEMPRA KIT - ixabepilone for iv infusion 45 mg 1JAKAFI - ruxolitinib phosphate tab 5 mg* 1 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 10 mg* 1 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 15 mg* 1 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 20 mg* 1 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 25 mg* 1 PA, QL (60 tablets/30 days)JEVTANA - cabazitaxel inj 60 mg/1.5ml (for iv infusion) 1KADCYLA - ado-trastuzumab emtansine for iv soln 100 mg 1KADCYLA - ado-trastuzumab emtansine for iv soln 160 mg 1KEYTRUDA - pembrolizumab iv soln 100 mg/4ml (25 mg/ml)* 1KISQALI - ribociclib succinate tab 200 mg 1 PA, QL (63 tablets/28 days)KISQALI FEMARA 200 DOSE - ribociclib tab 200 mg & letrozole

tab 2.5 mg therapy pack1 PA, QL (91 tablets/28 days)

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

1 PA, QL (91 tablets/28 days)

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


KYPROLIS - carfilzomib for inj 10 mg 1KYPROLIS - carfilzomib for inj 30 mg 1KYPROLIS - carfilzomib for inj 60 mg 1LARTRUVO - olaratumab soln for iv infusion 190 mg/19ml (10 mg/

ml)1

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

1

2018


31


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


LENVIMA 12MG DAILY DOSE - lenvatinib cap therapy pack 4(3) mg*


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


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


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


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


LENVIMA 4 MG DAILY DOSE - lenvatinib cap therapy pack 4 mg* 1 PA, QL (30 capsules/30 days)LENVIMA 8 MG DAILY DOSE - lenvatinib cap therapy pack 4

(2) mg*1 PA, QL (60 capsules/30 days)

letrozole tab 2.5 mg 1LEUCOVORIN CALCIUM - leucovorin calcium for inj 500 mg 1LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 1LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 1leucovorin calcium for inj 50 mg 1leucovorin calcium for inj 100 mg 1leucovorin calcium for inj 200 mg 1leucovorin calcium for inj 350 mg 1leucovorin calcium tab 5 mg 1leucovorin calcium tab 25 mg 1LEUKERAN - chlorambucil tab 2 mg 1LONSURF - trifluridine-tipiracil tab 15-6.14 mg 1 PA, QL (100 tablets/28 days)LONSURF - trifluridine-tipiracil tab 20-8.19 mg 1 PA, QL (80 tablets/28 days)LYNPARZA - olaparib cap 50 mg* 1 PA, QL (480 capsules/30 days)LYNPARZA - olaparib tab 100 mg* 1 PA, QL (120 tablets/30 days)LYNPARZA - olaparib tab 150 mg* 1 PA, QL (120 tablets/30 days)MARQIBO - vincristine sulfate liposome iv susp 5 mg/31ml

(0.16 mg/ml)1

MATULANE - procarbazine hcl cap 50 mg* 1 PAMEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg* 1 PA, QL (90 tablets/30 days)MEKINIST - trametinib dimethyl sulfoxide tab 2 mg* 1 PA, QL (30 tablets/30 days)melphalan hcl for inj 50 mg 1mercaptopurine tab 50 mg 1mesna inj 100 mg/ml 1MESNEX - mesna tab 400 mg 1

2018



mitomycin for iv soln 5 mg 1mitomycin for iv soln 20 mg 1mitomycin for iv soln 40 mg 1mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) 1mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml) 1mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml) 1MUSTARGEN - mechlorethamine hcl for inj 10 mg 1MYLOTARG - gemtuzumab ozogamicin for iv soln 4.5 mg 1NERLYNX - neratinib maleate tab 40 mg 1 PA, QL (180 tablets/30 days)NEXAVAR - sorafenib tosylate tab 200 mg* 1 PA, QL (120 tablets/30 days)nilutamide tab 150 mg 1NINLARO - ixazomib citrate cap 2.3 mg 1 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 3 mg 1 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 4 mg 1 PA, QL (3 capsules/28 days)NIPENT - pentostatin for inj 10 mg 1ODOMZO - sonidegib phosphate cap 200 mg* 1 PA, QL (30 capsules/30 days)ONCASPAR - pegaspargase inj 750 unit/ml 1ONIVYDE - irinotecan hcl liposome iv inj 43 mg/10ml (4.3 mg/ml) 1OPDIVO - nivolumab iv soln 40 mg/4ml* 1OPDIVO - nivolumab iv soln 100 mg/10ml* 1OPDIVO - nivolumab iv soln 240 mg/24ml* 1oxaliplatin for iv inj 50 mg 1oxaliplatin for iv inj 100 mg 1oxaliplatin iv soln 50 mg/10ml 1oxaliplatin iv soln 100 mg/20ml 1paclitaxel iv conc 30 mg/5ml (6 mg/ml) 1paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) 1paclitaxel iv conc 300 mg/50ml (6 mg/ml) 1PANRETIN - alitretinoin gel 0.1% 1PERJETA - pertuzumab soln for iv infusion 420 mg/14ml (30 mg/

ml)*1

POMALYST - pomalidomide cap 1 mg* 1 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 2 mg* 1 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 3 mg* 1 PA, QL (21 capsules/28 days)POMALYST - pomalidomide cap 4 mg* 1 PA, QL (21 capsules/28 days)PORTRAZZA - necitumumab iv soln 800 mg/50ml (16 mg/ml)* 1PROLEUKIN - aldesleukin for iv soln 22000000 unit 1PURIXAN - mercaptopurine susp 2000 mg/100ml (20 mg/ml)* 1

2018


33


REVLIMID - lenalidomide caps 2.5 mg* 1 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 5 mg* 1 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 10 mg* 1 PA, QL (30 capsules/30 days)REVLIMID - lenalidomide cap 15 mg* 1 PA, QL (21 capsules/28 days)REVLIMID - lenalidomide cap 20 mg* 1 PA, QL (21 capsules/28 days)REVLIMID - lenalidomide cap 25 mg* 1 PA, QL (21 capsules/28 days)RITUXAN - rituximab iv soln 100 mg/10ml* 1 PARITUXAN - rituximab iv soln 500 mg/50ml* 1 PARITUXAN HYCELA - rituximab-hyaluronidase human inj

1400-23400 mg-unit/11.7ml1 PA

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

1 PA

RUBRACA - rucaparib camsylate tab 200 mg 1 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 250 mg 1 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 300 mg 1 PA, QL (120 tablets/30 days)RYDAPT - midostaurin cap 25 mg 1 PA, QL (240 capsules/30 days)SOLTAMOX - tamoxifen citrate oral soln 10 mg/5ml 1SPRYCEL - dasatinib tab 20 mg 1 PA, QL (90 tablets/30 days)SPRYCEL - dasatinib tab 50 mg 1 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 70 mg 1 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 80 mg 1 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 100 mg 1 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 140 mg 1 PA, QL (30 tablets/30 days)STIVARGA - regorafenib tab 40 mg* 1 PA, QL (84 tablets/28 days)SUTENT - sunitinib malate cap 12.5 mg 1 PA, QL (90 capsules/30 days)SUTENT - sunitinib malate cap 25 mg 1 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 37.5 mg 1 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 50 mg 1 PA, QL (30 capsules/30 days)SYNRIBO - omacetaxine mepesuccinate for inj 3.5 mg 1TABLOID - thioguanine tab 40 mg 1TAFINLAR - dabrafenib mesylate cap 50 mg* 1 PA, QL (120 capsules/30 days)TAFINLAR - dabrafenib mesylate cap 75 mg* 1 PA, QL (120 capsules/30 days)TAGRISSO - osimertinib mesylate tab 40 mg* 1 PA, QL (30 tablets/30 days)TAGRISSO - osimertinib mesylate tab 80 mg* 1 PA, QL (30 tablets/30 days)tamoxifen citrate tab 10 mg 1tamoxifen citrate tab 20 mg 1TARCEVA - erlotinib hcl tab 25 mg 1 PA, QL (60 tablets/30 days)TARCEVA - erlotinib hcl tab 100 mg 1 PA, QL (30 tablets/30 days)

2018



TARCEVA - erlotinib hcl tab 150 mg 1 PA, QL (30 tablets/30 days)TARGRETIN - bexarotene gel 1% 1TASIGNA - nilotinib hcl cap 50 mg 1 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 150 mg 1 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 200 mg 1 PA, QL (120 capsules/30 days)TECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 1TEMODAR - temozolomide for iv soln 100 mg 1temsirolimus soln for iv infusion 25 mg/ml 1THALOMID - thalidomide cap 50 mg 1 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 100 mg 1 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 150 mg 1 PA, QL (60 capsules/30 days)THALOMID - thalidomide cap 200 mg 1 PA, QL (60 capsules/30 days)thiotepa for inj 15 mg 1topotecan hcl for inj 4 mg 1topotecan hcl inj 4 mg/4ml (for infusion) 1TORISEL - temsirolimus soln for iv infusion 25 mg/ml 1TREANDA - bendamustine hcl for iv soln 25 mg 1TREANDA - bendamustine hcl for iv soln 100 mg 1tretinoin cap 10 mg 1 PATRISENOX - arsenic trioxide iv soln 12 mg/6ml (2 mg/ml) 1TYKERB - lapatinib ditosylate tab 250 mg* 1 PA, QL (180 tablets/30 days)UNITUXIN - dinutuximab iv soln 17.5 mg/5ml (3.5 mg/ml)* 1VALCHLOR - mechlorethamine hcl gel 0.016%* 1VECTIBIX - panitumumab iv soln 100 mg/5ml 1VECTIBIX - panitumumab iv soln 400 mg/20ml 1VELCADE - bortezomib for inj 3.5 mg 1VENCLEXTA - venetoclax tab 10 mg* 1 PA, QL (60 tablets/30 days)VENCLEXTA - venetoclax tab 50 mg* 1 PA, QL (30 tablets/30 days)VENCLEXTA - venetoclax tab 100 mg* 1 PA, QL (120 tablets/30 days)VENCLEXTA STARTING PACK - venetoclax tab therapy starter

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

tablets)/28 days)VERZENIO - abemaciclib tab 50 mg 1 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 100 mg 1 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 150 mg 1 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 200 mg 1 PA, QL (60 tablets/30 days)VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 1 BDvincristine sulfate iv soln 1 mg/ml 1 BDvinorelbine tartrate inj 10 mg/ml 1

2018


35


vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 1VOTRIENT - pazopanib hcl tab 200 mg* 1 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 1XALKORI - crizotinib cap 200 mg* 1 PA, QL (60 capsules/30 days)XALKORI - crizotinib cap 250 mg* 1 PA, QL (60 capsules/30 days)XTANDI - enzalutamide cap 40 mg* 1 PA, QL (120 capsules/30 days)YERVOY - ipilimumab soln for iv infusion 50 mg/10ml (5 mg/ml)* 1YERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 1YONDELIS - trabectedin for inj 1 mg 1YONSA - abiraterone acetate tab 125 mg* 1 PA, QL (120 tablets/30 days)ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 1ZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 1ZANOSAR - streptozocin for inj 1 gm 1ZEJULA - niraparib tosylate cap 100 mg 1 PA, QL (90 capsules/30 days)ZELBORAF - vemurafenib tab 240 mg* 1 PA, QL (240 tablets/30 days)ZOLINZA - vorinostat cap 100 mg 1 PA, QL (120 capsules/30 days)ZYDELIG - idelalisib tab 100 mg* 1 PA, QL (60 tablets/30 days)ZYDELIG - idelalisib tab 150 mg* 1 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 1 PA, QL (150 capsules/30 days)ZYTIGA - abiraterone acetate tab 250 mg* 1 PA, QL (120 tablets/30 days)ZYTIGA - abiraterone acetate tab 500 mg* 1 PA, QL (60 tablets/30 days)Medicamentos antiparasitariosALBENZA - albendazole tab 200 mg 1ALINIA - nitazoxanide for susp 100 mg/5ml 1ALINIA - nitazoxanide tab 500 mg 1atovaquone susp 750 mg/5ml 1atovaquone-proguanil hcl tab 62.5-25 mg 1atovaquone-proguanil hcl tab 250-100 mg 1BENZNIDAZOLE - benznidazole tab 12.5 mg 1BENZNIDAZOLE - benznidazole tab 100 mg 1BILTRICIDE - praziquantel tab 600 mg 1CHLOROQUINE PHOSPHATE - chloroquine phosphate tab

250 mg1

chloroquine phosphate tab 500 mg 1COARTEM - artemether-lumefantrine tab 20-120 mg 1DARAPRIM - pyrimethamine tab 25 mg 1hydroxychloroquine sulfate tab 200 mg 1ivermectin tab 3 mg 1

2018



LINDANE - lindane shampoo 1% 1malathion lotion 0.5% 1mefloquine hcl tab 250 mg 1NEBUPENT - pentamidine isethionate for nebulization soln

300 mg1 BD

PENTAM 300 - pentamidine isethionate for soln 300 mg 1 BDpermethrin cream 5% 1praziquantel tab 600 mg 1PRIMAQUINE PHOSPHATE - primaquine phosphate tab 26.3 mg 1Agentes contra la enfermedad de Parkinsonamantadine hcl cap 100 mg 1amantadine hcl syrup 50 mg/5ml 1amantadine hcl tab 100 mg 1APOKYN - apomorphine hcl soln cartridge 30 mg/3ml* 1 PA, QL (60 mls/30 days)benztropine mesylate tab 0.5 mg# 1 PAbenztropine mesylate tab 1 mg# 1 PAbenztropine mesylate tab 2 mg# 1 PAbromocriptine mesylate cap 5 mg 1bromocriptine mesylate tab 2.5 mg 1carbidopa & levodopa orally disintegrating tab 10-100 mg 1carbidopa & levodopa orally disintegrating tab 25-100 mg 1carbidopa & levodopa orally disintegrating tab 25-250 mg 1carbidopa & levodopa tab er 25-100 mg 1carbidopa & levodopa tab er 50-200 mg 1carbidopa & levodopa tab 10-100 mg 1carbidopa & levodopa tab 25-100 mg 1carbidopa & levodopa tab 25-250 mg 1carbidopa tab 25 mg 1CARBIDOPA/LEVODOPA/ENTACAPONE - carbidopa-levodopa-

entacapone tabs 12.5-50-200 mg1

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

1

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

1


1


1

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

1

2018


37


entacapone tab 200 mg 1NEUPRO - rotigotine td patch 24hr 1 mg/24hr 1NEUPRO - rotigotine td patch 24hr 2 mg/24hr 1NEUPRO - rotigotine td patch 24hr 3 mg/24hr 1NEUPRO - rotigotine td patch 24hr 4 mg/24hr 1NEUPRO - rotigotine td patch 24hr 6 mg/24hr 1NEUPRO - rotigotine td patch 24hr 8 mg/24hr 1pramipexole dihydrochloride tab 0.125 mg 1pramipexole dihydrochloride tab 0.25 mg 1pramipexole dihydrochloride tab 0.5 mg 1pramipexole dihydrochloride tab 0.75 mg 1pramipexole dihydrochloride tab 1 mg 1pramipexole dihydrochloride tab 1.5 mg 1rasagiline mesylate tab 0.5 mg 1rasagiline mesylate tab 1 mg 1ropinirole hydrochloride tab 0.25 mg 1ropinirole hydrochloride tab 0.5 mg 1ropinirole hydrochloride tab 1 mg 1ropinirole hydrochloride tab 2 mg 1ropinirole hydrochloride tab 3 mg 1ropinirole hydrochloride tab 4 mg 1ropinirole hydrochloride tab 5 mg 1selegiline hcl cap 5 mg 1selegiline hcl tab 5 mg 1tolcapone tab 100 mg 1Medicamentos antipsicóticosADASUVE - loxapine aerosol powder breath activated 10 mg 1 PAaripiprazole oral solution 1 mg/ml 1 PA, QL (750 mls/30 days)aripiprazole orally disintegrating tab 10 mg 1 PA, QL (60 tablets/30 days)aripiprazole orally disintegrating tab 15 mg 1 PA, QL (60 tablets/30 days)aripiprazole tab 2 mg 1 PA, QL (45 tablets/30 days)aripiprazole tab 5 mg 1 PA, QL (45 tablets/30 days)aripiprazole tab 10 mg 1 PA, QL (30 tablets/30 days)aripiprazole tab 15 mg 1 PA, QL (30 tablets/30 days)aripiprazole tab 20 mg 1 PA, QL (30 tablets/30 days)aripiprazole tab 30 mg 1 PA, QL (30 tablets/30 days)ARISTADA - aripiprazole lauroxil im er susp prefilled syr

441 mg/1.6ml1 PA, QL (1 syringe/28 days)

2018



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

1 PA, QL (1 syringe/28 days)





clozapine orally disintegrating tab 12.5 mg 1 PA, QL (90 tablets/30 days)clozapine orally disintegrating tab 25 mg 1 PA, QL (270 tablets/30 days)clozapine orally disintegrating tab 100 mg 1 PA, QL (270 tablets/30 days)clozapine tab 25 mg 1 PA, QL (90 tablets/30 days)clozapine tab 50 mg 1 PA, QL (90 tablets/30 days)clozapine tab 100 mg 1 PA, QL (270 tablets/30 days)clozapine tab 200 mg 1 PA, QL (120 tablets/30 days)FANAPT - iloperidone tab 1 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 2 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 4 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 6 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 8 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 10 mg 1 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 12 mg 1 PA, QL (60 tablets/30 days)FANAPT TITRATION PACK - iloperidone tab 1 mg & 2 mg & 4 mg

& 6 mg titration pak1 PA, QL (7 packs (56

tablets)/28 days)fluphenazine decanoate inj 25 mg/ml 1 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 1 PAFLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 1 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 1 PAfluphenazine hcl tab 1 mg 1 PAfluphenazine hcl tab 2.5 mg 1 PAfluphenazine hcl tab 5 mg 1 PAfluphenazine hcl tab 10 mg 1 PAGEODON - ziprasidone mesylate for inj 20 mg 1 PA, QL (60 vials/30 days)haloperidol decanoate im soln 50 mg/ml 1 PAhaloperidol decanoate im soln 100 mg/ml 1 PAhaloperidol lactate inj 5 mg/ml 1 PAhaloperidol lactate oral conc 2 mg/ml 1 PAhaloperidol tab 0.5 mg 1 PAhaloperidol tab 1 mg 1 PAhaloperidol tab 2 mg 1 PAhaloperidol tab 5 mg 1 PA

2018


39


haloperidol tab 10 mg 1 PAhaloperidol tab 20 mg 1 PAINVEGA SUSTENNA - paliperidone palmitate im extend-release

susp 117 mg/0.75ml1 PA, QL (1 kit/28 days)

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

1 PA, QL (1 kit/28 days)



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




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








LATUDA - lurasidone hcl tab 20 mg 1 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 40 mg 1 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 60 mg 1 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 80 mg 1 PA, QL (60 tablets/30 days)LATUDA - lurasidone hcl tab 120 mg 1 PA, QL (30 tablets/30 days)loxapine succinate cap 5 mg 1 PAloxapine succinate cap 10 mg 1 PAloxapine succinate cap 25 mg 1 PAloxapine succinate cap 50 mg 1 PANUPLAZID - pimavanserin tartrate cap 34 mg* 1 PA, QL (30 capsules/30 days)NUPLAZID - pimavanserin tartrate tab 10 mg* 1 PA, QL (30 tablets/30 days)NUPLAZID - pimavanserin tartrate tab 17 mg* 1 PA, QL (60 tablets/30 days)olanzapine for im inj 10 mg 1 PA, QL (90 vials/30 days)olanzapine orally disintegrating tab 5 mg 1 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 10 mg 1 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 15 mg 1 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 20 mg 1 PA, QL (30 tablets/30 days)olanzapine tab 2.5 mg 1 PA, QL (45 tablets/30 days)olanzapine tab 5 mg 1 PA, QL (45 tablets/30 days)olanzapine tab 7.5 mg 1 PA, QL (45 tablets/30 days)

2018



olanzapine tab 10 mg 1 PA, QL (45 tablets/30 days)olanzapine tab 15 mg 1 PA, QL (30 tablets/30 days)olanzapine tab 20 mg 1 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 1.5 mg 1 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg 1 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg 1 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 1 PA, QL (30 tablets/30 days)pimozide tab 1 mg 1pimozide tab 2 mg 1quetiapine fumarate tab er 24hr 50 mg 1 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 150 mg 1 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 200 mg 1 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 300 mg 1 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 400 mg 1 PA, QL (60 tablets/30 days)quetiapine fumarate tab 25 mg 1 PA, QL (120 tablets/30 days)quetiapine fumarate tab 50 mg 1 PA, QL (120 tablets/30 days)quetiapine fumarate tab 100 mg 1 PA, QL (120 tablets/30 days)quetiapine fumarate tab 200 mg 1 PA, QL (120 tablets/30 days)quetiapine fumarate tab 300 mg 1 PA, QL (60 tablets/30 days)quetiapine fumarate tab 400 mg 1 PA, QL (60 tablets/30 days)REXULTI - brexpiprazole tab 0.25 mg 1 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 0.5 mg 1 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 1 mg 1 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 2 mg 1 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 3 mg 1 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 4 mg 1 PA, QL (30 tablets/30 days)RISPERDAL CONSTA - risperidone microspheres for inj 12.5 mg 1 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 1 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 1 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 1 PA, QL (2 vials/28 days)risperidone orally disintegrating tab 0.25 mg 1 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 0.5 mg 1 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 1 mg 1 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 2 mg 1 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 3 mg 1 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 4 mg 1 PA, QL (120 tablets/30 days)risperidone soln 1 mg/ml 1 PA, QL (480 mls/30 days)risperidone tab 0.25 mg 1 PA, QL (60 tablets/30 days)

2018


41


risperidone tab 0.5 mg 1 PA, QL (60 tablets/30 days)risperidone tab 1 mg 1 PA, QL (60 tablets/30 days)risperidone tab 2 mg 1 PA, QL (60 tablets/30 days)risperidone tab 3 mg 1 PA, QL (60 tablets/30 days)risperidone tab 4 mg 1 PA, QL (120 tablets/30 days)SAPHRIS - asenapine maleate sl tab 2.5 mg 1 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 5 mg 1 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 10 mg 1 PA, QL (60 tablets/30 days)thioridazine hcl tab 10 mg 1 PAthioridazine hcl tab 25 mg 1 PAthioridazine hcl tab 50 mg 1 PAthioridazine hcl tab 100 mg 1 PAthiothixene cap 1 mg 1 PAthiothixene cap 2 mg 1 PAthiothixene cap 5 mg 1 PAthiothixene cap 10 mg 1 PAtrifluoperazine hcl tab 1 mg 1 PAtrifluoperazine hcl tab 2 mg 1 PAtrifluoperazine hcl tab 5 mg 1 PAtrifluoperazine hcl tab 10 mg 1 PAVERSACLOZ - clozapine susp 50 mg/ml 1 PA, QL (540 mls/30 days)VRAYLAR - cariprazine hcl cap 1.5 mg 1 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 3 mg 1 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 4.5 mg 1 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 6 mg 1 PA, QL (30 capsules/30 days)ziprasidone hcl cap 20 mg 1 PA, QL (90 capsules/30 days)ziprasidone hcl cap 40 mg 1 PA, QL (90 capsules/30 days)ziprasidone hcl cap 60 mg 1 PA, QL (60 capsules/30 days)ziprasidone hcl cap 80 mg 1 PA, QL (60 capsules/30 days)ZYPREXA RELPREVV - olanzapine pamoate for extended rel im

susp 210 mg1 PA, QL (2 vials/28 days)

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 300 mg

1 PA, QL (2 vials/28 days)

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 405 mg

1 PA, QL (1 vial/28 days)

Agentes antiespasmódicosbaclofen tab 10 mg 1baclofen tab 20 mg 1dantrolene sodium cap 25 mg 1

2018



dantrolene sodium cap 50 mg 1dantrolene sodium cap 100 mg 1tizanidine hcl cap 2 mg 1tizanidine hcl cap 4 mg 1tizanidine hcl cap 6 mg 1tizanidine hcl tab 2 mg 1tizanidine hcl tab 4 mg 1Medicamentos antiviralesabacavir sulfate soln 20 mg/ml 1 QL (960 mls/30 days)abacavir sulfate tab 300 mg 1 QL (60 tablets/30 days)abacavir sulfate-lamivudine tab 600-300 mg 1 QL (30 tablets/30 days)abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 1 QL (60 tablets/30 days)acyclovir cap 200 mg 1acyclovir oint 5% 1acyclovir sodium iv soln 50 mg/ml 1 BDacyclovir susp 200 mg/5ml 1acyclovir tab 400 mg 1acyclovir tab 800 mg 1adefovir dipivoxil tab 10 mg 1APTIVUS - tipranavir cap 250 mg 1 QL (120 capsules/30 days)APTIVUS - tipranavir oral soln 100 mg/ml 1 QL (380 mls/30 days)atazanavir sulfate cap 150 mg 1 QL (30 capsules/30 days)atazanavir sulfate cap 200 mg 1 QL (60 capsules/30 days)atazanavir sulfate cap 300 mg 1 QL (30 capsules/30 days)ATRIPLA - efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg1 QL (30 tablets/30 days)

BARACLUDE - entecavir oral soln 0.05 mg/ml 1BIKTARVY - bictegravir-emtricitabine-tenofovir af tab

50-200-25 mg1 QL (30 tablets/30 days)

cidofovir iv inj 75 mg/ml 1CIMDUO - lamivudine-tenofovir disoproxil fumarate tab

300-300 mg1 QL (30 tablets/30 days)

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

1 QL (30 tablets/30 days)

CRIXIVAN - indinavir sulfate cap 200 mg 1 QL (270 capsules/30 days)CRIXIVAN - indinavir sulfate cap 400 mg 1 QL (180 capsules/30 days)DAKLINZA - daclatasvir dihydrochloride tab 30 mg 1 PADAKLINZA - daclatasvir dihydrochloride tab 60 mg 1 PADAKLINZA - daclatasvir dihydrochloride tab 90 mg 1 PA

2018


43


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


didanosine delayed release capsule 200 mg 1 QL (30 capsules/30 days)didanosine delayed release capsule 250 mg 1 QL (30 capsules/30 days)didanosine delayed release capsule 400 mg 1 QL (30 capsules/30 days)EDURANT - rilpivirine hcl tab 25 mg 1 QL (30 tablets/30 days)efavirenz cap 50 mg 1 QL (90 capsules/30 days)efavirenz cap 200 mg 1 QL (60 capsules/30 days)efavirenz tab 600 mg 1 QL (30 tablets/30 days)EMTRIVA - emtricitabine caps 200 mg 1 QL (30 capsules/30 days)EMTRIVA - emtricitabine soln 10 mg/ml 1 QL (850 mls/30 days)entecavir tab 0.5 mg 1entecavir tab 1 mg 1EPCLUSA - sofosbuvir-velpatasvir tab 400-100 mg 1 PAEPIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) 1EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg 1 QL (30 tablets/30 days)famciclovir tab 125 mg 1famciclovir tab 250 mg 1famciclovir tab 500 mg 1fosamprenavir calcium tab 700 mg 1 QL (120 tablets/30 days)FUZEON - enfuvirtide for inj 90 mg 1 QL (60 vials/30 days)ganciclovir sodium for inj 500 mg 1 BDGENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mg1 QL (30 tablets/30 days)

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg 1 PAINTELENCE - etravirine tab 25 mg 1 QL (120 tablets/30 days)INTELENCE - etravirine tab 100 mg 1 QL (60 tablets/30 days)INTELENCE - etravirine tab 200 mg 1 QL (60 tablets/30 days)INTRON A - interferon alfa-2b inj 6000000 unit/ml 1INTRON A - interferon alfa-2b inj 10000000 unit/ml 1INTRON A - interferon alfa-2b for inj 10000000 unit 1INTRON A - interferon alfa-2b for inj 18000000 unit 1INTRON A - interferon alfa-2b for inj 50000000 unit 1INTRON A W/DILUENT - interferon alfa-2b for inj 10000000 unit 1INTRON A W/DILUENT - interferon alfa-2b for inj 18000000 unit 1INTRON A W/DILUENT - interferon alfa-2b for inj 50000000 unit 1INVIRASE - saquinavir mesylate cap 200 mg 1 QL (300 capsules/30 days)

2018



INVIRASE - saquinavir mesylate tab 500 mg 1 QL (120 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 25 mg 1 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 100 mg 1 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium packet for susp 100 mg 1 QL (60 packets/30 days)ISENTRESS - raltegravir potassium tab 400 mg 1 QL (60 tablets/30 days)ISENTRESS HD - raltegravir potassium tab 600 mg 1 QL (60 tablets/30 days)JULUCA - dolutegravir sodium-rilpivirine hcl tab 50-25 mg 1 QL (30 tablets/30 days)KALETRA - lopinavir-ritonavir tab 100-25 mg 1 QL (300 tablets/30 days)KALETRA - lopinavir-ritonavir tab 200-50 mg 1 QL (120 tablets/30 days)lamivudine oral soln 10 mg/ml 1 QL (960 mls/30 days)lamivudine tab 100 mg (hbv) 1lamivudine tab 150 mg 1 QL (60 tablets/30 days)lamivudine tab 300 mg 1 QL (30 tablets/30 days)lamivudine-zidovudine tab 150-300 mg 1 QL (60 tablets/30 days)LEXIVA - fosamprenavir calcium susp 50 mg/ml 1 QL (1800 mls/30 days)LEXIVA - fosamprenavir calcium tab 700 mg 1 QL (120 tablets/30 days)lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 1 QL (480 mls/30 days)MAVYRET - glecaprevir-pibrentasvir tab 100-40 mg 1 PAnevirapine susp 50 mg/5ml 1 QL (1200 mls/30 days)nevirapine tab er 24hr 100 mg 1 QL (90 tablets/30 days)nevirapine tab er 24hr 400 mg 1 QL (30 tablets/30 days)nevirapine tab 200 mg 1 QL (60 tablets/30 days)NORVIR - ritonavir cap 100 mg 1 QL (360 capsules/30 days)NORVIR - ritonavir oral soln 80 mg/ml 1 QL (480 mls/30 days)NORVIR - ritonavir powder packet 100 mg 1 QL (360 packets/30 days)NORVIR - ritonavir tab 100 mg 1 QL (360 tablets/30 days)ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg 1 QL (30 tablets/30 days)oseltamivir phosphate cap 30 mg 1oseltamivir phosphate cap 45 mg 1oseltamivir phosphate cap 75 mg 1oseltamivir phosphate for susp 6 mg/ml 1PEGASYS - peginterferon alfa-2a inj 180 mcg/ml 1 PAPEGASYS - peginterferon alfa-2a inj 180 mcg/0.5ml 1 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 135 mcg/0.5ml 1 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 180 mcg/0.5ml 1 PAPREZCOBIX - darunavir-cobicistat tab 800-150 mg 1 QL (30 tablets/30 days)PREZISTA - darunavir ethanolate susp 100 mg/ml 1 QL (400 mls/30 days)PREZISTA - darunavir ethanolate tab 75 mg 1 QL (300 tablets/30 days)

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45


PREZISTA - darunavir ethanolate tab 150 mg 1 QL (180 tablets/30 days)PREZISTA - darunavir ethanolate tab 600 mg 1 QL (60 tablets/30 days)PREZISTA - darunavir ethanolate tab 800 mg 1 QL (30 tablets/30 days)REBETOL - ribavirin soln 40 mg/ml 1RELENZA DISKHALER - zanamivir aero powder breath activated

5 mg/blister1

RESCRIPTOR - delavirdine mesylate tab 100 mg 1 QL (360 tablets/30 days)RESCRIPTOR - delavirdine mesylate tab 200 mg 1 QL (180 tablets/30 days)RETROVIR IV INFUSION - zidovudine iv soln 10 mg/ml 1REYATAZ - atazanavir sulfate cap 150 mg 1 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate cap 200 mg 1 QL (60 capsules/30 days)REYATAZ - atazanavir sulfate cap 300 mg 1 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate oral powder packet 50 mg 1 QL (240 packets/30 days)RIBASPHERE - ribavirin tab 400 mg 1RIBASPHERE - ribavirin tab 600 mg 1RIBASPHERE RIBAPAK - ribavirin tab 400 mg 1RIBASPHERE RIBAPAK - ribavirin tab 600 mg 1ribavirin cap 200 mg 1ribavirin tab 200 mg 1rimantadine hydrochloride tab 100 mg 1ritonavir tab 100 mg 1 QL (360 tablets/30 days)SELZENTRY - maraviroc oral soln 20 mg/ml 1 QL (1840 mls/30 days)SELZENTRY - maraviroc tab 25 mg 1 QL (240 tablets/30 days)SELZENTRY - maraviroc tab 75 mg 1 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 150 mg 1 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 300 mg 1 QL (120 tablets/30 days)SOVALDI - sofosbuvir tab 400 mg 1 PAstavudine cap 15 mg 1 QL (60 capsules/30 days)stavudine cap 20 mg 1 QL (60 capsules/30 days)stavudine cap 30 mg 1 QL (60 capsules/30 days)stavudine cap 40 mg 1 QL (60 capsules/30 days)STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab

150-150-200-300 mg1 QL (30 tablets/30 days)

SUSTIVA - efavirenz cap 50 mg 1 QL (90 capsules/30 days)SUSTIVA - efavirenz cap 200 mg 1 QL (60 capsules/30 days)SUSTIVA - efavirenz tab 600 mg 1 QL (30 tablets/30 days)SYLATRON - peginterferon alfa-2b for inj kit 200 mcg 1 PASYLATRON - peginterferon alfa-2b for inj kit 300 mcg 1 PA

2018



SYLATRON - peginterferon alfa-2b for inj kit 600 mcg 1 PASYMFI - efavirenz-lamivudine-tenofovir df tab 600-300-300 mg 1 QL (30 tablets/30 days)SYMFI LO - efavirenz-lamivudine-tenofovir df tab 400-300-300 mg 1 QL (30 tablets/30 days)TAMIFLU - oseltamivir phosphate for susp 6 mg/ml 1TECHNIVIE - ombitasvir-paritaprevir-ritonavir tab 12.5-75-50 mg 1 PAtenofovir disoproxil fumarate tab 300 mg 1 QL (30 tablets/30 days)TIVICAY - dolutegravir sodium tab 10 mg 1 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 25 mg 1 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 50 mg 1 QL (60 tablets/30 days)TRIUMEQ - abacavir-dolutegravir-lamivudine tab 600-50-300 mg 1 QL (30 tablets/30 days)TROGARZO - ibalizumab-uiyk iv soln 200 mg/1.33ml (150 mg/ml) 1 QL (14 vials/28 days)TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab


TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab133-200 mg






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

12.5-75-50 & 250 mg1 PA

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

1 PA

VIRACEPT - nelfinavir mesylate tab 250 mg 1 QL (270 tablets/30 days)VIRACEPT - nelfinavir mesylate tab 625 mg 1 QL (120 tablets/30 days)VIRAMUNE - nevirapine susp 50 mg/5ml 1 QL (1200 mls/30 days)VIREAD - tenofovir disoproxil fumarate oral powder 40 mg/gm 1 QL (240 grams/30 days)VIREAD - tenofovir disoproxil fumarate tab 150 mg 1 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 200 mg 1 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 250 mg 1 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 300 mg 1 QL (30 tablets/30 days)

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47


VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 1 PAZEPATIER - elbasvir-grazoprevir tab 50-100 mg 1 PAZERIT - stavudine for oral soln 1 mg/ml 1 QL (2400 mls/30 days)ZIAGEN - abacavir sulfate soln 20 mg/ml 1 QL (960 mls/30 days)zidovudine cap 100 mg 1 QL (180 capsules/30 days)zidovudine syrup 10 mg/ml 1 QL (1920 mls/30 days)zidovudine tab 300 mg 1 QL (60 tablets/30 days)Medicamentos ansiolíticosalprazolam tab 0.25 mg 1 QL (120 tablets/30 days)alprazolam tab 0.5 mg 1 QL (120 tablets/30 days)alprazolam tab 1 mg 1 QL (120 tablets/30 days)alprazolam tab 2 mg 1 QL (150 tablets/30 days)buspirone hcl tab 5 mg 1buspirone hcl tab 7.5 mg 1buspirone hcl tab 10 mg 1buspirone hcl tab 15 mg 1buspirone hcl tab 30 mg 1clonazepam orally disintegrating tab 0.125 mg 1 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.25 mg 1 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.5 mg 1 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 1 mg 1 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 2 mg 1 PA, QL (300 tablets/30 days)clonazepam tab 0.5 mg 1 PA, QL (120 tablets/30 days)clonazepam tab 1 mg 1 PA, QL (120 tablets/30 days)clonazepam tab 2 mg 1 PA, QL (300 tablets/30 days)clorazepate dipotassium tab 3.75 mg 1 PA, QL (120 tablets/30 days)clorazepate dipotassium tab 7.5 mg 1 PA, QL (90 tablets/30 days)clorazepate dipotassium tab 15 mg 1 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 1 PA, QL (1200 mls/30 days)diazepam conc 5 mg/ml 1 PA, QL (240 mls/30 days)diazepam tab 2 mg 1 PA, QL (120 tablets/30 days)diazepam tab 5 mg 1 PA, QL (120 tablets/30 days)diazepam tab 10 mg 1 PA, QL (120 tablets/30 days)hydroxyzine hcl syrup 10 mg/5ml# 1 PAhydroxyzine hcl tab 10 mg# 1 PAhydroxyzine hcl tab 25 mg# 1 PAhydroxyzine hcl tab 50 mg# 1 PAlorazepam tab 0.5 mg 1 PA, QL (120 tablets/30 days)

2018



lorazepam tab 1 mg 1 PA, QL (120 tablets/30 days)lorazepam tab 2 mg 1 PA, QL (150 tablets/30 days)Agentes bipolaresLITHIUM - lithium oral solution 8 meq/5ml 1lithium carbonate cap 150 mg 1lithium carbonate cap 300 mg 1lithium carbonate cap 600 mg 1lithium carbonate tab er 300 mg 1lithium carbonate tab er 450 mg 1lithium carbonate tab 300 mg 1Reguladores de la glucosa en sangreacarbose tab 25 mg 1 QL (360 tablets/30 days)acarbose tab 50 mg 1 QL (180 tablets/30 days)acarbose tab 100 mg 1 QL (90 tablets/30 days)ALCOHOL SWABS 1ASSURE ID INSULIN SAFETY SYRINGE/U-100/0.5ML/29G X

1/2"1

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

injector 2 mg/0.85ml1 QL (4 pens/28 days)

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

1 QL (4 pens/28 days)

CYCLOSET - bromocriptine mesylate tab 0.8 mg 1 QL (180 tablets/30 days)EASY TOUCH INSULIN SYRINGE/SAFETY/U-100/0.5ML/29G X

1/2"1

EASY TOUCH SHEATHLOCK SAFETY INSULIN SYRINGE1ML/29GX1/2"

1

GAUZE PADS 2" X 2" 1glimepiride tab 1 mg 1 QL (240 tablets/30 days)glimepiride tab 2 mg 1 QL (120 tablets/30 days)glimepiride tab 4 mg 1 QL (60 tablets/30 days)glipizide tab er 24hr 2.5 mg 1 QL (240 tablets/30 days)glipizide tab er 24hr 5 mg 1 QL (120 tablets/30 days)glipizide tab er 24hr 10 mg 1 QL (60 tablets/30 days)glipizide tab 5 mg 1 QL (240 tablets/30 days)glipizide tab 10 mg 1 QL (120 tablets/30 days)glipizide-metformin hcl tab 2.5-250 mg 1 QL (240 tablets/30 days)

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49


glipizide-metformin hcl tab 2.5-500 mg 1 QL (120 tablets/30 days)glipizide-metformin hcl tab 5-500 mg 1 QL (120 tablets/30 days)GLUCAGEN HYPOKIT - glucagon hcl (rdna) for inj 1 mg 1GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit 1 mg 1HUMALOG - insulin lispro inj 100 unit/ml 1 QL (60 mls/30 days)HUMALOG - insulin lispro soln cartridge 100 unit/ml 1 QL (20 cartridges/30 days)HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector

100 unit/ml1 QL (20 pens/30 days)

HUMALOG KWIKPEN - insulin lispro soln pen-injector 100 unit/ml 1 QL (20 pens/30 days)HUMALOG KWIKPEN - insulin lispro soln pen-injector 200 unit/ml 1 QL (20 pens/30 days)HUMALOG MIX 50/50 - insulin lispro protamine & lispro inj 100

unit/ml (50-50)1 QL (6 vials/30 days)

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


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

1 QL (6 vials/30 days)

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


HUMULIN N - insulin nph (human) (isophane) inj 100 unit/ml 1 QL (60 mls/30 days)HUMULIN N KWIKPEN - insulin nph (human) (isophane) susp

pen-injector 100 unit/ml1 QL (20 pens/30 days)

HUMULIN R - insulin regular (human) inj 100 unit/ml 1 QL (60 mls/30 days)HUMULIN R U-500 (CONCENTRATE) - insulin regular (human) inj

500 unit/ml1 BD

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


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

1 QL (60 mls/30 days)

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


INJECTION DEVICE FOR INSULIN 1INSULIN PEN NEEDLE 29 G X 10 MM 1INSULIN PEN NEEDLE 29 G X 12.7 MM 1INSULIN PEN NEEDLE 29 G X 5 MM (3/16") 1INSULIN PEN NEEDLE 29 G X 8 MM (5/16") 1INSULIN PEN NEEDLE 30 G X 5 MM (3/16") 1INSULIN PEN NEEDLE 30 G X 8 MM (1/3" OR 5/16") 1INSULIN PEN NEEDLE 31 G X 4 MM (1/6") 1INSULIN PEN NEEDLE 32 G X 5 MM (1/5" OR 3/16") 1INSULIN PEN NEEDLE 33 G X 4 MM (5/32") 1INSULIN PEN NEEDLE 33 G X 5 MM (1/5" OR 3/16") 1

2018



INSULIN PEN NEEDLE 33 G X 6 MM (1/4") 1INSULIN PEN NEEDLE 33 G X 8 MM (1/3" OR 5/16") 1INSULIN SYRINGE (DISP) U-100 0.3 ML 1INSULIN SYRINGE (DISP) U-100 1 ML 1INSULIN SYRINGE (DISP) U-100 1/2 ML 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 28 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 29 G 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 29 X 1" 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30 G 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 31 X 1/4" (6 MM) 1INSULIN SYRINGE/NEEDLE U-100 0.3 ML 31 X 15/64" 1INSULIN SYRINGE/NEEDLE U-100 0.5 ML 30 X 3/16" (5 MM) 1INSULIN SYRINGE/NEEDLE U-100 0.5 ML 31 X 1/4" (6 MM) 1INSULIN SYRINGE/NEEDLE U-100 1 ML 25 X 1" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 25 X 5/8" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 26 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 27 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 27 X 5/8" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 28 X 5/16" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 29 X 5/16" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 30 G 1INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X 3/16" (5 MM) 1INSULIN SYRINGE/NEEDLE U-100 1 ML 31 X 1/4" (6 MM) 1INSULIN SYRINGE/NEEDLE U-100 1 ML 31 X 15/64" 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 27 X 1/2" 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 28 X 5/16" 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 29 G 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 29 X 5/16" 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 30 G 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 30 X 3/8" 1INSULIN SYRINGE/NEEDLE U-100 1/2 ML 31 X 15/64" 1INSULIN SYRINGE/NEEDLE U-100 2 ML 27.5 X 5/8" 1INSULIN SYRINGE/NEEDLE U-40 1 ML 25 X 5/8" 1INSULIN SYRINGE/NEEDLE U-500 0.5 ML 31G X 6MM (15/64") 1INVOKAMET - canagliflozin-metformin hcl tab 50-500 mg 1 QL (120 tablets/30 days)INVOKAMET - canagliflozin-metformin hcl tab 50-1000 mg 1 QL (60 tablets/30 days)

2018


51


INVOKAMET - canagliflozin-metformin hcl tab 150-500 mg 1 QL (60 tablets/30 days)INVOKAMET - canagliflozin-metformin hcl tab 150-1000 mg 1 QL (60 tablets/30 days)INVOKAMET XR - canagliflozin-metformin hcl tab er 24hr


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






INVOKANA - canagliflozin tab 100 mg 1 QL (90 tablets/30 days)INVOKANA - canagliflozin tab 300 mg 1 QL (30 tablets/30 days)JANUMET - sitagliptin-metformin hcl tab 50-500 mg 1 QL (60 tablets/30 days)JANUMET - sitagliptin-metformin hcl tab 50-1000 mg 1 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 50-500 mg 1 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 50-1000 mg 1 QL (60 tablets/30 days)JANUMET XR - sitagliptin-metformin hcl tab er 24hr 100-1000 mg 1 QL (30 tablets/30 days)JANUVIA - sitagliptin phosphate tab 25 mg 1 QL (120 tablets/30 days)JANUVIA - sitagliptin phosphate tab 50 mg 1 QL (60 tablets/30 days)JANUVIA - sitagliptin phosphate tab 100 mg 1 QL (30 tablets/30 days)JARDIANCE - empagliflozin tab 10 mg 1 QL (60 tablets/30 days)JARDIANCE - empagliflozin tab 25 mg 1 QL (30 tablets/30 days)KOMBIGLYZE XR - saxagliptin-metformin hcl tab er 24hr

2.5-1000 mg1 QL (60 tablets/30 days)

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


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


LANTUS - insulin glargine inj 100 unit/ml 1 QL (6 vials/30 days)LANTUS SOLOSTAR - insulin glargine soln pen-injector 100 unit/

ml1 QL (20 pens/30 days)

LEVEMIR - insulin detemir inj 100 unit/ml 1 QL (6 vials/30 days)LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 100

unit/ml1 QL (20 pens/30 days)

metformin hcl tab er 24hr 500 mg 1 QL (120 tablets/30 days)metformin hcl tab er 24hr 750 mg 1 QL (60 tablets/30 days)metformin hcl tab 500 mg 1 QL (150 tablets/30 days)metformin hcl tab 850 mg 1 QL (90 tablets/30 days)metformin hcl tab 1000 mg 1 QL (75 tablets/30 days)MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.3ML/29GX1/2"1

2018



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

1

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

1

nateglinide tab 60 mg 1 QL (180 tablets/30 days)nateglinide tab 120 mg 1 QL (90 tablets/30 days)ONGLYZA - saxagliptin hcl tab 2.5 mg 1 QL (60 tablets/30 days)ONGLYZA - saxagliptin hcl tab 5 mg 1 QL (30 tablets/30 days)OZEMPIC - semaglutide soln pen-inj 0.25 or 0.5 mg/dose

(2 mg/1.5ml)1 QL (1 pen/28 days)

OZEMPIC - semaglutide soln pen-inj 1 mg/dose (2 mg/1.5ml) 1 QL (2 pens/28 days)pioglitazone hcl tab 15 mg 1 QL (90 tablets/30 days)pioglitazone hcl tab 30 mg 1 QL (30 tablets/30 days)pioglitazone hcl tab 45 mg 1 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-2 mg 1 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-4 mg 1 QL (30 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-500 mg 1 QL (90 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-850 mg 1 QL (90 tablets/30 days)PROGLYCEM - diazoxide susp 50 mg/ml 1repaglinide tab 0.5 mg 1 QL (960 tablets/30 days)repaglinide tab 1 mg 1 QL (480 tablets/30 days)repaglinide tab 2 mg 1 QL (240 tablets/30 days)SYMLINPEN 120 - pramlintide acetate pen-inj 2700 mcg/2.7ml

(1000 mcg/ml)1

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

1

SYNJARDY - empagliflozin-metformin hcl tab 5-500 mg 1 QL (120 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 5-1000 mg 1 QL (60 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 12.5-500 mg 1 QL (60 tablets/30 days)SYNJARDY - empagliflozin-metformin hcl tab 12.5-1000 mg 1 QL (60 tablets/30 days)SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr


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


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


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


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

2018


53


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

unit/ml1 QL (60 mls/30 days)

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

1 QL (60 mls/30 days)

TRESIBA FLEXTOUCH - insulin degludec soln pen-injector 100unit/ml


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


TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/29G X 1/2" 1TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/30G X 5/16" 1TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/31G X 5/16" 1TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/28G X 1/2" 1TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/29G X 1/2" 1TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/30G X 5/16" 1TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/31G X 5/16" 1TRUEPLUS INSULIN SYRINGE/U-100/1ML/28G X 1/2" 1TRUEPLUS INSULIN SYRINGE/U-100/1ML/29G X 1/2" 1TRUEPLUS INSULIN SYRINGE/U-100/1ML/30G X 5/16" 1TRUEPLUS INSULIN SYRINGE/U-100/1ML/31G X 5/16" 1TRUEPLUS PEN NEEDLES 29GX12MM 1TRUEPLUS PEN NEEDLES 31GX5MM 1TRUEPLUS PEN NEEDLES 31GX6MM 1TRUEPLUS PEN NEEDLES 31GX8MM 1

2018



TRUEPLUS PEN NEEDLES 32GX4MM 1ULTICARE INSULIN SAFETY SYRINGE/0.5ML/29G X 1/2" 1ULTICARE INSULIN SAFETY SYRINGE/1ML/29G X 1/2" 1VANISHPOINT INSULIN SYRINGE/0.5ML/30G X 1/2" 1VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) 1 QL (1 package/30 days)Hemoderivados/Modificadores de la sangre/ Expansores del volumen sanguíneoanagrelide hcl cap 0.5 mg 1anagrelide hcl cap 1 mg 1ARANESP ALBUMIN FREE - darbepoetin alfa soln inj 25 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 40 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 60 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 100 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 200 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 300 mcg/ml 1 PAARANESP ALBUMIN FREE - darbepoetin alfa soln prefilled

syringe 10 mcg/0.4ml1 PA

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

1 PA


1 PA


1 PA


1 PA


1 PA


1 PA


1 PA

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

1 PA

aspirin-dipyridamole cap er 12hr 25-200 mg 1azacitidine for inj 100 mg 1BEVYXXA - betrixaban maleate cap 40 mg 1 QL (43 capsules/42 days)BEVYXXA - betrixaban maleate cap 80 mg 1 QL (43 capsules/42 days)BRILINTA - ticagrelor tab 60 mg 1BRILINTA - ticagrelor tab 90 mg 1cilostazol tab 50 mg 1cilostazol tab 100 mg 1

2018


55


clopidogrel bisulfate tab 75 mg 1COUMADIN - warfarin sodium tab 1 mg 1COUMADIN - warfarin sodium tab 2 mg 1COUMADIN - warfarin sodium tab 2.5 mg 1COUMADIN - warfarin sodium tab 3 mg 1COUMADIN - warfarin sodium tab 4 mg 1COUMADIN - warfarin sodium tab 5 mg 1COUMADIN - warfarin sodium tab 6 mg 1COUMADIN - warfarin sodium tab 7.5 mg 1COUMADIN - warfarin sodium tab 10 mg 1dipyridamole tab 25 mg# 1dipyridamole tab 50 mg# 1dipyridamole tab 75 mg# 1EFFIENT - prasugrel hcl tab 5 mg 1EFFIENT - prasugrel hcl tab 10 mg 1ELIQUIS - apixaban tab 2.5 mg 1 QL (60 tablets/30 days)ELIQUIS - apixaban tab 5 mg 1 QL (120 tablets/30 days)ELIQUIS STARTER PACK - apixaban tab 5 mg 1 QL (120 tablets/30 days)enoxaparin sodium inj 30 mg/0.3ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 40 mg/0.4ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 60 mg/0.6ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 80 mg/0.8ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 100 mg/ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 120 mg/0.8ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 150 mg/ml 1 QL (30 syringes/90 days)enoxaparin sodium inj 300 mg/3ml 1 QL (10 vials/90 days)EPOGEN - epoetin alfa inj 2000 unit/ml 1 PAEPOGEN - epoetin alfa inj 3000 unit/ml 1 PAEPOGEN - epoetin alfa inj 4000 unit/ml 1 PAEPOGEN - epoetin alfa inj 10000 unit/ml 1 PAEPOGEN - epoetin alfa inj 20000 unit/ml 1 PAfondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 1 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 5 mg/0.4ml 1 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 1 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 10 mg/0.8ml 1 QL (30 syringes/90 days)GRANIX - tbo-filgrastim soln prefilled syringe 300 mcg/0.5ml 1GRANIX - tbo-filgrastim soln prefilled syringe 480 mcg/0.8ml 1heparin sodium (porcine) inj 1000 unit/ml 1

2018



heparin sodium (porcine) inj 5000 unit/ml 1heparin sodium (porcine) inj 10000 unit/ml 1heparin sodium (porcine) inj 20000 unit/ml 1heparin sodium (porcine) pf inj 5000 unit/0.5ml 1heparin sodium (porcine) 40 unit/ml in d5w 1LEUKINE - sargramostim lyophilized for inj 250 mcg 1MOZOBIL - plerixafor subcutaneous inj 24 mg/1.2ml (20 mg/ml) 1NEULASTA - pegfilgrastim soln prefilled syringe 6 mg/0.6ml 1NEULASTA ONPRO KIT - pegfilgrastim soln prefilled syringe kit

6 mg/0.6ml1

NEUPOGEN - filgrastim inj 300 mcg/ml 1NEUPOGEN - filgrastim inj 480 mcg/1.6ml (300 mcg/ml) 1NEUPOGEN - filgrastim soln prefilled syringe 300 mcg/0.5ml 1NEUPOGEN - filgrastim soln prefilled syringe 480 mcg/0.8ml

(600 mcg/ml)1

PRADAXA - dabigatran etexilate mesylate cap 75 mg 1 QL (60 capsules/30 days)PRADAXA - dabigatran etexilate mesylate cap 110 mg 1 QL (71 capsules/90 days)PRADAXA - dabigatran etexilate mesylate cap 150 mg 1 QL (60 capsules/30 days)prasugrel hcl tab 5 mg 1prasugrel hcl tab 10 mg 1PROCRIT - epoetin alfa inj 2000 unit/ml 1 PAPROCRIT - epoetin alfa inj 3000 unit/ml 1 PAPROCRIT - epoetin alfa inj 4000 unit/ml 1 PAPROCRIT - epoetin alfa inj 10000 unit/ml 1 PAPROCRIT - epoetin alfa inj 20000 unit/ml 1 PAPROCRIT - epoetin alfa inj 40000 unit/ml 1 PAPROMACTA - eltrombopag olamine tab 12.5 mg* 1 PAPROMACTA - eltrombopag olamine tab 25 mg* 1 PAPROMACTA - eltrombopag olamine tab 50 mg* 1 PAPROMACTA - eltrombopag olamine tab 75 mg* 1 PAtranexamic acid iv soln 1000 mg/10ml (100 mg/ml) 1tranexamic acid tab 650 mg 1warfarin sodium tab 1 mg 1warfarin sodium tab 2 mg 1warfarin sodium tab 2.5 mg 1warfarin sodium tab 3 mg 1warfarin sodium tab 4 mg 1warfarin sodium tab 5 mg 1

2018


57


warfarin sodium tab 6 mg 1warfarin sodium tab 7.5 mg 1warfarin sodium tab 10 mg 1XARELTO - rivaroxaban tab 10 mg 1 QL (30 tablets/30 days)XARELTO - rivaroxaban tab 15 mg 1 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 20 mg 1 QL (30 tablets/30 days)XARELTO STARTER PACK - rivaroxaban tab starter therapy pack

15 mg & 20 mg1 QL (51 tablets/30 days)

ZONTIVITY - vorapaxar sulfate tab 2.08 mg 1Agentes cardiovascularesacebutolol hcl cap 200 mg 1acebutolol hcl cap 400 mg 1acetazolamide cap er 12hr 500 mg 1acetazolamide tab 125 mg 1acetazolamide tab 250 mg 1amiloride & hydrochlorothiazide tab 5-50 mg 1amiloride hcl tab 5 mg 1amiodarone hcl tab 200 mg 1amiodarone hcl tab 400 mg 1amlodipine besylate tab 2.5 mg 1amlodipine besylate tab 5 mg 1amlodipine besylate tab 10 mg 1amlodipine besylate-atorvastatin calcium tab 2.5-10 mg 1amlodipine besylate-atorvastatin calcium tab 2.5-20 mg 1amlodipine besylate-atorvastatin calcium tab 2.5-40 mg 1amlodipine besylate-atorvastatin calcium tab 5-10 mg 1amlodipine besylate-atorvastatin calcium tab 5-20 mg 1amlodipine besylate-atorvastatin calcium tab 5-40 mg 1amlodipine besylate-atorvastatin calcium tab 5-80 mg 1amlodipine besylate-atorvastatin calcium tab 10-10 mg 1amlodipine besylate-atorvastatin calcium tab 10-20 mg 1amlodipine besylate-atorvastatin calcium tab 10-40 mg 1amlodipine besylate-atorvastatin calcium tab 10-80 mg 1amlodipine besylate-benazepril hcl cap 2.5-10 mg 1amlodipine besylate-benazepril hcl cap 5-10 mg 1amlodipine besylate-benazepril hcl cap 5-20 mg 1amlodipine besylate-benazepril hcl cap 5-40 mg 1amlodipine besylate-benazepril hcl cap 10-20 mg 1

2018



amlodipine besylate-benazepril hcl cap 10-40 mg 1amlodipine besylate-valsartan tab 5-160 mg 1 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-320 mg 1 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-160 mg 1 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-320 mg 1 QL (30 tablets/30 days)atenolol & chlorthalidone tab 50-25 mg 1atenolol & chlorthalidone tab 100-25 mg 1atenolol tab 25 mg 1atenolol tab 50 mg 1atenolol tab 100 mg 1atorvastatin calcium tab 10 mg 1 QL (45 tablets/30 days)atorvastatin calcium tab 20 mg 1 QL (45 tablets/30 days)atorvastatin calcium tab 40 mg 1 QL (45 tablets/30 days)atorvastatin calcium tab 80 mg 1 QL (30 tablets/30 days)benazepril & hydrochlorothiazide tab 5-6.25 mg 1benazepril & hydrochlorothiazide tab 10-12.5 mg 1benazepril & hydrochlorothiazide tab 20-12.5 mg 1benazepril & hydrochlorothiazide tab 20-25 mg 1benazepril hcl tab 5 mg 1benazepril hcl tab 10 mg 1benazepril hcl tab 20 mg 1benazepril hcl tab 40 mg 1betaxolol hcl tab 10 mg 1betaxolol hcl tab 20 mg 1bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg 1bisoprolol & hydrochlorothiazide tab 5-6.25 mg 1bisoprolol & hydrochlorothiazide tab 10-6.25 mg 1bisoprolol fumarate tab 5 mg 1bisoprolol fumarate tab 10 mg 1bumetanide inj 0.25 mg/ml 1bumetanide tab 0.5 mg 1bumetanide tab 1 mg 1bumetanide tab 2 mg 1candesartan cilexetil tab 4 mg 1 QL (60 tablets/30 days)candesartan cilexetil tab 8 mg 1 QL (60 tablets/30 days)candesartan cilexetil tab 16 mg 1 QL (60 tablets/30 days)candesartan cilexetil tab 32 mg 1 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg 1 QL (30 tablets/30 days)

2018


59


candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg 1 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-25 mg 1 QL (30 tablets/30 days)captopril tab 12.5 mg 1captopril tab 25 mg 1captopril tab 50 mg 1captopril tab 100 mg 1carvedilol tab 3.125 mg 1carvedilol tab 6.25 mg 1carvedilol tab 12.5 mg 1carvedilol tab 25 mg 1CHLOROTHIAZIDE - chlorothiazide tab 250 mg 1chlorothiazide tab 500 mg 1chlorthalidone tab 25 mg 1chlorthalidone tab 50 mg 1cholestyramine light powder packets 4 gm 1cholestyramine light powder 4 gm/dose 1cholestyramine powder packets 4 gm 1cholestyramine powder 4 gm/dose 1choline fenofibrate cap dr 45 mg 1 QL (60 capsules/30 days)choline fenofibrate cap dr 135 mg 1 QL (30 capsules/30 days)clonidine hcl tab 0.1 mg 1clonidine hcl tab 0.2 mg 1clonidine hcl tab 0.3 mg 1clonidine hcl td patch weekly 0.1 mg/24hr 1clonidine hcl td patch weekly 0.2 mg/24hr 1clonidine hcl td patch weekly 0.3 mg/24hr 1colesevelam hcl packet for susp 3.75 gm 1colesevelam hcl tab 625 mg 1colestipol hcl granule packets 5 gm 1colestipol hcl granules 5 gm 1colestipol hcl tab 1 gm 1CORLANOR - ivabradine hcl tab 5 mg 1 PA, QL (60 tablets/30 days)CORLANOR - ivabradine hcl tab 7.5 mg 1 PA, QL (60 tablets/30 days)DEMSER - metyrosine cap 250 mg 1DIGOXIN - digoxin oral soln 0.05 mg/ml# 1 QL (150 mls/30 days)digoxin tab 125 mcg (0.125 mg)# 1 QL (30 tablets/30 days)digoxin tab 250 mcg (0.25 mg)# 1 PA, QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg 1

2018



diltiazem hcl cap er 12hr 90 mg 1diltiazem hcl cap er 12hr 120 mg 1diltiazem hcl cap er 24hr 120 mg 1diltiazem hcl cap er 24hr 180 mg 1diltiazem hcl cap er 24hr 240 mg 1diltiazem hcl coated beads cap er 24hr 120 mg 1diltiazem hcl coated beads cap er 24hr 180 mg 1diltiazem hcl coated beads cap er 24hr 240 mg 1diltiazem hcl coated beads cap er 24hr 300 mg 1diltiazem hcl coated beads cap er 24hr 360 mg 1diltiazem hcl coated beads tab er 24hr 180 mg 1diltiazem hcl coated beads tab er 24hr 240 mg 1diltiazem hcl coated beads tab er 24hr 300 mg 1diltiazem hcl coated beads tab er 24hr 360 mg 1diltiazem hcl coated beads tab er 24hr 420 mg 1diltiazem hcl extended release beads cap er 24hr 120 mg 1diltiazem hcl extended release beads cap er 24hr 180 mg 1diltiazem hcl extended release beads cap er 24hr 240 mg 1diltiazem hcl extended release beads cap er 24hr 300 mg 1diltiazem hcl extended release beads cap er 24hr 360 mg 1diltiazem hcl extended release beads cap er 24hr 420 mg 1diltiazem hcl tab 30 mg 1diltiazem hcl tab 60 mg 1diltiazem hcl tab 90 mg 1diltiazem hcl tab 120 mg 1dofetilide cap 125 mcg (0.125 mg) 1dofetilide cap 250 mcg (0.25 mg) 1dofetilide cap 500 mcg (0.5 mg) 1doxazosin mesylate tab 1 mg 1 QL (60 tablets/30 days)doxazosin mesylate tab 2 mg 1 QL (60 tablets/30 days)doxazosin mesylate tab 4 mg 1 QL (60 tablets/30 days)doxazosin mesylate tab 8 mg 1 QL (60 tablets/30 days)enalapril maleate & hydrochlorothiazide tab 5-12.5 mg 1enalapril maleate & hydrochlorothiazide tab 10-25 mg 1enalapril maleate tab 2.5 mg 1enalapril maleate tab 5 mg 1enalapril maleate tab 10 mg 1enalapril maleate tab 20 mg 1

2018


61


ENTRESTO - sacubitril-valsartan tab 24-26 mg 1 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 1 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 1 PA, QL (60 tablets/30 days)eplerenone tab 25 mg 1eplerenone tab 50 mg 1ezetimibe tab 10 mg 1 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-10 mg 1 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-20 mg 1 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-40 mg 1 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-80 mg 1 QL (30 tablets/30 days)felodipine tab er 24hr 2.5 mg 1felodipine tab er 24hr 5 mg 1felodipine tab er 24hr 10 mg 1fenofibrate micronized cap 67 mg 1 QL (30 capsules/30 days)fenofibrate micronized cap 134 mg 1 QL (30 capsules/30 days)fenofibrate micronized cap 200 mg 1 QL (30 capsules/30 days)fenofibrate tab 48 mg 1 QL (60 tablets/30 days)fenofibrate tab 54 mg 1 QL (60 tablets/30 days)fenofibrate tab 145 mg 1 QL (30 tablets/30 days)fenofibrate tab 160 mg 1 QL (30 tablets/30 days)flecainide acetate tab 50 mg 1flecainide acetate tab 100 mg 1flecainide acetate tab 150 mg 1fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg 1fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg 1fosinopril sodium tab 10 mg 1fosinopril sodium tab 20 mg 1fosinopril sodium tab 40 mg 1furosemide inj 10 mg/ml 1furosemide oral soln 10 mg/ml 1furosemide tab 20 mg 1furosemide tab 40 mg 1furosemide tab 80 mg 1gemfibrozil tab 600 mg 1 QL (60 tablets/30 days)hydralazine hcl tab 10 mg 1hydralazine hcl tab 25 mg 1hydralazine hcl tab 50 mg 1hydralazine hcl tab 100 mg 1

2018



hydrochlorothiazide cap 12.5 mg 1hydrochlorothiazide tab 12.5 mg 1hydrochlorothiazide tab 25 mg 1hydrochlorothiazide tab 50 mg 1indapamide tab 1.25 mg 1indapamide tab 2.5 mg 1irbesartan tab 75 mg 1 QL (30 tablets/30 days)irbesartan tab 150 mg 1 QL (30 tablets/30 days)irbesartan tab 300 mg 1 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 150-12.5 mg 1 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 300-12.5 mg 1 QL (30 tablets/30 days)isosorbide dinitrate tab 5 mg 1isosorbide dinitrate tab 10 mg 1isosorbide dinitrate tab 20 mg 1isosorbide dinitrate tab 30 mg 1isosorbide mononitrate tab er 24hr 30 mg 1isosorbide mononitrate tab er 24hr 60 mg 1isosorbide mononitrate tab er 24hr 120 mg 1isosorbide mononitrate tab 10 mg 1isosorbide mononitrate tab 20 mg 1isradipine cap 2.5 mg 1isradipine cap 5 mg 1JUXTAPID - lomitapide mesylate cap 5 mg* 1 PAJUXTAPID - lomitapide mesylate cap 10 mg* 1 PAJUXTAPID - lomitapide mesylate cap 20 mg* 1 PAJUXTAPID - lomitapide mesylate cap 30 mg* 1 PAJUXTAPID - lomitapide mesylate cap 40 mg* 1 PAJUXTAPID - lomitapide mesylate cap 60 mg* 1 PAKYNAMRO - mipomersen sodium soln prefilled syringe 200 mg/

ml*1 PA

labetalol hcl tab 100 mg 1labetalol hcl tab 200 mg 1labetalol hcl tab 300 mg 1LIDOCAINE HCL - lidocaine hcl iv inj 10 mg/ml 1lisinopril & hydrochlorothiazide tab 10-12.5 mg 1lisinopril & hydrochlorothiazide tab 20-12.5 mg 1lisinopril & hydrochlorothiazide tab 20-25 mg 1lisinopril tab 2.5 mg 1

2018


63


lisinopril tab 5 mg 1lisinopril tab 10 mg 1lisinopril tab 20 mg 1lisinopril tab 30 mg 1lisinopril tab 40 mg 1losartan potassium & hydrochlorothiazide tab 50-12.5 mg 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-12.5 mg 1 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-25 mg 1 QL (30 tablets/30 days)losartan potassium tab 25 mg 1 QL (60 tablets/30 days)losartan potassium tab 50 mg 1 QL (60 tablets/30 days)losartan potassium tab 100 mg 1 QL (30 tablets/30 days)lovastatin tab 10 mg 1 QL (60 tablets/30 days)lovastatin tab 20 mg 1 QL (60 tablets/30 days)lovastatin tab 40 mg 1 QL (60 tablets/30 days)methazolamide tab 25 mg 1methazolamide tab 50 mg 1metolazone tab 2.5 mg 1metolazone tab 5 mg 1metolazone tab 10 mg 1metoprolol & hydrochlorothiazide tab 50-25 mg 1metoprolol & hydrochlorothiazide tab 100-25 mg 1metoprolol succinate tab er 24hr 25 mg 1metoprolol succinate tab er 24hr 50 mg 1metoprolol succinate tab er 24hr 100 mg 1metoprolol succinate tab er 24hr 200 mg 1metoprolol tartrate tab 25 mg 1metoprolol tartrate tab 50 mg 1metoprolol tartrate tab 100 mg 1mexiletine hcl cap 150 mg 1mexiletine hcl cap 200 mg 1mexiletine hcl cap 250 mg 1midodrine hcl tab 2.5 mg 1midodrine hcl tab 5 mg 1midodrine hcl tab 10 mg 1minoxidil tab 2.5 mg 1minoxidil tab 10 mg 1moexipril hcl tab 7.5 mg 1moexipril hcl tab 15 mg 1

2018



moexipril-hydrochlorothiazide tab 7.5-12.5 mg 1moexipril-hydrochlorothiazide tab 15-12.5 mg 1moexipril-hydrochlorothiazide tab 15-25 mg 1MULTAQ - dronedarone hcl tab 400 mg 1nadolol tab 20 mg 1nadolol tab 40 mg 1nadolol tab 80 mg 1niacin tab er 500 mg 1 QL (30 tablets/30 days)niacin tab er 750 mg 1 QL (60 tablets/30 days)niacin tab er 1000 mg 1 QL (60 tablets/30 days)nicardipine hcl cap 20 mg 1nicardipine hcl cap 30 mg 1nifedipine tab er 24hr 30 mg 1nifedipine tab er 24hr 60 mg 1nifedipine tab er 24hr 90 mg 1nifedipine tab er 24hr osmotic release 30 mg 1nifedipine tab er 24hr osmotic release 60 mg 1nifedipine tab er 24hr osmotic release 90 mg 1nimodipine cap 30 mg 1NISOLDIPINE ER - nisoldipine tab er 24hr 25.5 mg 1nisoldipine tab er 24hr 8.5 mg 1nisoldipine tab er 24hr 17 mg 1nisoldipine tab er 24hr 34 mg 1NITRO-BID - nitroglycerin oint 2% 1nitroglycerin sl tab 0.3 mg 1nitroglycerin sl tab 0.4 mg 1nitroglycerin sl tab 0.6 mg 1nitroglycerin td patch 24hr 0.1 mg/hr 1nitroglycerin td patch 24hr 0.2 mg/hr 1nitroglycerin td patch 24hr 0.4 mg/hr 1nitroglycerin td patch 24hr 0.6 mg/hr 1nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) 1NORTHERA - droxidopa cap 100 mg* 1 PANORTHERA - droxidopa cap 200 mg* 1 PANORTHERA - droxidopa cap 300 mg* 1 PAolmesartan medoxomil tab 5 mg 1 QL (60 tablets/30 days)olmesartan medoxomil tab 20 mg 1 QL (30 tablets/30 days)olmesartan medoxomil tab 40 mg 1 QL (30 tablets/30 days)

2018


65


olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg 1 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg 1 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg 1 QL (30 tablets/30 days)omega-3-acid ethyl esters cap 1 gm 1pentoxifylline tab er 400 mg 1perindopril erbumine tab 2 mg 1perindopril erbumine tab 4 mg 1perindopril erbumine tab 8 mg 1phenoxybenzamine hcl cap 10 mg 1pindolol tab 5 mg 1pindolol tab 10 mg 1PRALUENT - alirocumab subcutaneous soln pen-injector 75 mg/

ml*1 PA, QL (2 pens/28 days)

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

1 PA, QL (2 pens/28 days)

pravastatin sodium tab 10 mg 1 QL (45 tablets/30 days)pravastatin sodium tab 20 mg 1 QL (45 tablets/30 days)pravastatin sodium tab 40 mg 1 QL (45 tablets/30 days)pravastatin sodium tab 80 mg 1 QL (30 tablets/30 days)prazosin hcl cap 1 mg 1prazosin hcl cap 2 mg 1prazosin hcl cap 5 mg 1propafenone hcl cap er 12hr 225 mg 1propafenone hcl cap er 12hr 325 mg 1propafenone hcl cap er 12hr 425 mg 1propafenone hcl tab 150 mg 1propafenone hcl tab 225 mg 1propafenone hcl tab 300 mg 1propranolol hcl cap er 24hr 60 mg 1propranolol hcl cap er 24hr 80 mg 1propranolol hcl cap er 24hr 120 mg 1propranolol hcl cap er 24hr 160 mg 1propranolol hcl inj 1 mg/ml 1propranolol hcl tab 10 mg 1propranolol hcl tab 20 mg 1propranolol hcl tab 40 mg 1propranolol hcl tab 60 mg 1propranolol hcl tab 80 mg 1

2018



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

140 mg/ml1 PA, QL (2 syringes/28 days)

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

1 PA, QL (1 system/30 days)

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

1 PA, QL (2 pens/28 days)

rosuvastatin calcium tab 5 mg 1 QL (45 tablets/30 days)rosuvastatin calcium tab 10 mg 1 QL (45 tablets/30 days)rosuvastatin calcium tab 20 mg 1 QL (45 tablets/30 days)rosuvastatin calcium tab 40 mg 1 QL (30 tablets/30 days)simvastatin tab 5 mg 1 QL (45 tablets/30 days)simvastatin tab 10 mg 1 QL (45 tablets/30 days)simvastatin tab 20 mg 1 QL (60 tablets/30 days)simvastatin tab 40 mg 1 QL (45 tablets/30 days)simvastatin tab 80 mg 1 QL (30 tablets/30 days)sotalol hcl (afib/afl) tab 80 mg 1sotalol hcl (afib/afl) tab 120 mg 1sotalol hcl (afib/afl) tab 160 mg 1sotalol hcl tab 80 mg 1sotalol hcl tab 120 mg 1sotalol hcl tab 160 mg 1sotalol hcl tab 240 mg 1spironolactone & hydrochlorothiazide tab 25-25 mg 1

2018


67


spironolactone tab 25 mg 1spironolactone tab 50 mg 1spironolactone tab 100 mg 1TEKTURNA - aliskiren fumarate tab 150 mg 1 QL (30 tablets/30 days)TEKTURNA - aliskiren fumarate tab 300 mg 1 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-12.5 mg 1 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-25 mg 1 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-12.5 mg 1 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-25 mg 1 QL (30 tablets/30 days)telmisartan tab 20 mg 1 QL (30 tablets/30 days)telmisartan tab 40 mg 1 QL (30 tablets/30 days)telmisartan tab 80 mg 1 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 40-12.5 mg 1 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-12.5 mg 1 QL (60 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-25 mg 1 QL (30 tablets/30 days)terazosin hcl cap 1 mg 1 QL (90 capsules/30 days)terazosin hcl cap 2 mg 1 QL (60 capsules/30 days)terazosin hcl cap 5 mg 1 QL (60 capsules/30 days)terazosin hcl cap 10 mg 1 QL (60 capsules/30 days)TIMOLOL MALEATE - timolol maleate tab 5 mg 1TIMOLOL MALEATE - timolol maleate tab 10 mg 1TIMOLOL MALEATE - timolol maleate tab 20 mg 1torsemide tab 5 mg 1torsemide tab 10 mg 1torsemide tab 20 mg 1torsemide tab 100 mg 1trandolapril tab 1 mg 1trandolapril tab 2 mg 1trandolapril tab 4 mg 1triamterene & hydrochlorothiazide cap 37.5-25 mg 1triamterene & hydrochlorothiazide tab 37.5-25 mg 1triamterene & hydrochlorothiazide tab 75-50 mg 1valsartan tab 40 mg 1 QL (60 tablets/30 days)valsartan tab 80 mg 1 QL (60 tablets/30 days)valsartan tab 160 mg 1 QL (60 tablets/30 days)valsartan tab 320 mg 1 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 80-12.5 mg 1 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-12.5 mg 1 QL (30 tablets/30 days)

2018



valsartan-hydrochlorothiazide tab 160-25 mg 1 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-12.5 mg 1 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-25 mg 1 QL (30 tablets/30 days)VASCEPA - icosapent ethyl cap 0.5 gm 1VASCEPA - icosapent ethyl cap 1 gm 1verapamil hcl cap er 24hr 360 mg 1verapamil hcl cap er 24hr 100 mg 1verapamil hcl cap er 24hr 120 mg 1verapamil hcl cap er 24hr 180 mg 1verapamil hcl cap er 24hr 200 mg 1verapamil hcl cap er 24hr 240 mg 1verapamil hcl cap er 24hr 300 mg 1verapamil hcl tab er 120 mg 1verapamil hcl tab er 180 mg 1verapamil hcl tab er 240 mg 1verapamil hcl tab 40 mg 1verapamil hcl tab 80 mg 1verapamil hcl tab 120 mg 1WELCHOL - colesevelam hcl packet for susp 3.75 gm 1WELCHOL - colesevelam hcl tab 625 mg 1Agentes del sistema nervioso centralamphetamine-dextroamphetamine cap er 24hr 5 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 10 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 15 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 20 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 25 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 30 mg 1 QL (30 capsules/30 days)amphetamine-dextroamphetamine tab 5 mg 1 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 7.5 mg 1 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 10 mg 1 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 12.5 mg 1 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 15 mg 1 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 20 mg 1 QL (90 tablets/30 days)amphetamine-dextroamphetamine tab 30 mg 1 QL (60 tablets/30 days)AMPYRA - dalfampridine tab er 12hr 10 mg* 1 PAatomoxetine hcl cap 10 mg 1 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg 1 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg 1 QL (60 capsules/30 days)

2018


69


atomoxetine hcl cap 40 mg 1 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg 1 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg 1 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg 1 QL (30 capsules/30 days)AVONEX - interferon beta-1a for im inj kit 30mcg (33mcg(6.6 mu)/

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

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

30 mcg/0.5ml1 PA, QL (1 kit/28 days)

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

clonidine hcl tab er 12hr 0.1 mg 1 QL (120 tablets/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 40 mg/ml 1 PA, QL (12 syringes/28 days)dexmethylphenidate hcl tab 2.5 mg 1 QL (60 tablets/30 days)dexmethylphenidate hcl tab 5 mg 1 QL (60 tablets/30 days)dexmethylphenidate hcl tab 10 mg 1 QL (60 tablets/30 days)dextroamphetamine sulfate cap er 24hr 5 mg 1 QL (90 capsules/30 days)dextroamphetamine sulfate cap er 24hr 10 mg 1 QL (120 capsules/30 days)dextroamphetamine sulfate cap er 24hr 15 mg 1 QL (120 capsules/30 days)dextroamphetamine sulfate tab 5 mg 1 QL (90 tablets/30 days)dextroamphetamine sulfate tab 10 mg 1 QL (180 tablets/30 days)glatiramer acetate soln prefilled syringe 20 mg/ml 1 PA, QL (30 syringes/30 days)glatiramer acetate soln prefilled syringe 40 mg/ml 1 PA, QL (12 syringes/28 days)methylphenidate hcl tab er 20 mg 1 QL (90 tablets/30 days)methylphenidate hcl tab 5 mg 1 QL (90 tablets/30 days)methylphenidate hcl tab 10 mg 1 QL (90 tablets/30 days)methylphenidate hcl tab 20 mg 1 QL (90 tablets/30 days)NUEDEXTA - dextromethorphan hbr-quinidine sulfate cap

20-10 mg1

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

1 PA, QL (2 syringes/28 days)

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


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


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


riluzole tab 50 mg 1TECFIDERA - dimethyl fumarate capsule delayed release 120 mg 1 PA, QL (60 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 240 mg 1 PA, QL (60 capsules/30 days)

2018



TECFIDERA STARTER PACK - dimethyl fumarate capsule drstarter pack 120 mg & 240 mg


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

2018


71


clobetasol propionate soln 0.05% 1clotrimazole w/ betamethasone cream 1-0.05% 1clotrimazole w/ betamethasone lotion 1-0.05% 1desonide cream 0.05% 1desonide lotion 0.05% 1desonide oint 0.05% 1desoximetasone cream 0.05% 1desoximetasone cream 0.25% 1desoximetasone gel 0.05% 1desoximetasone oint 0.25% 1diclofenac sodium gel 3% 1diflorasone diacetate oint 0.05% 1ELIDEL - pimecrolimus cream 1% 1 PAFINACEA - azelaic acid foam 15% 1FINACEA - azelaic acid gel 15% 1fluocinolone acetonide cream 0.01% 1fluocinonide cream 0.05% 1fluocinonide emulsified base cream 0.05% 1fluocinonide gel 0.05% 1fluocinonide oint 0.05% 1fluocinonide soln 0.05% 1fluorouracil cream 5% 1fluorouracil soln 2% 1fluorouracil soln 5% 1fluticasone propionate cream 0.05% 1fluticasone propionate oint 0.005% 1gentamicin sulfate cream 0.1% 1gentamicin sulfate oint 0.1% 1halobetasol propionate cream 0.05% 1halobetasol propionate oint 0.05% 1hydrocortisone butyrate cream 0.1% 1hydrocortisone butyrate hydrophilic lipo base cream 0.1% 1hydrocortisone butyrate oint 0.1% 1hydrocortisone butyrate soln 0.1% 1hydrocortisone cream 1% 1hydrocortisone cream 2.5% 1hydrocortisone lotion 2.5% 1hydrocortisone oint 1% 1

2018



hydrocortisone oint 2.5% 1hydrocortisone valerate cream 0.2% 1hydrocortisone valerate oint 0.2% 1imiquimod cream 5% 1 PAisotretinoin cap 10 mg 1isotretinoin cap 20 mg 1isotretinoin cap 30 mg 1isotretinoin cap 40 mg 1lactic acid (ammonium lactate) cream 12% 1lactic acid (ammonium lactate) lotion 12% 1methoxsalen rapid cap 10 mg 1metronidazole cream 0.75% 1metronidazole gel 0.75% 1metronidazole gel 1% 1metronidazole lotion 0.75% 1mometasone furoate cream 0.1% 1mometasone furoate oint 0.1% 1mometasone furoate solution 0.1% (lotion) 1mupirocin oint 2% 1nystatin-triamcinolone cream 100000-0.1 unit/gm-% 1nystatin-triamcinolone oint 100000-0.1 unit/gm-% 1ORACEA - doxycycline cap delayed release 40 mg 1PICATO - ingenol mebutate gel 0.015% 1 QL (3 tubes/30 days)PICATO - ingenol mebutate gel 0.05% 1 QL (2 tubes/30 days)podofilox soln 0.5% 1prednicarbate cream 0.1% 1prednicarbate oint 0.1% 1REGRANEX - becaplermin gel 0.01% 1 PA, QL (15 grams/30 days)SANTYL - collagenase oint 250 unit/gm 1selenium sulfide lotion 2.5% 1silver sulfadiazine cream 1% 1SOOLANTRA - ivermectin cream 1% 1tacrolimus oint 0.03% 1 PAtacrolimus oint 0.1% 1 PAtazarotene cream 0.1% 1TAZORAC - tazarotene cream 0.05% 1TAZORAC - tazarotene gel 0.05% 1TAZORAC - tazarotene gel 0.1% 1

2018


73


tretinoin cream 0.025% 1tretinoin cream 0.05% 1tretinoin cream 0.1% 1tretinoin gel 0.01% 1tretinoin gel 0.025% 1triamcinolone acetonide cream 0.025% 1triamcinolone acetonide cream 0.1% 1triamcinolone acetonide cream 0.5% 1triamcinolone acetonide lotion 0.025% 1triamcinolone acetonide lotion 0.1% 1triamcinolone acetonide oint 0.025% 1triamcinolone acetonide oint 0.1% 1triamcinolone acetonide oint 0.5% 1Electrolitos/Minerales/Metales/Vitaminasamino acid infusion 6% 1 BDamino acid infusion 15% 1 BDcalcium acetate cap 667 mg 1calcium acetate tab 667 mg 1CARBAGLU - carglumic acid tab 200 mg 1CHEMET - succimer cap 100 mg 1dextrose inj 5% 1dextrose inj 10% 1dextrose 5% in lactated ringers 1dextrose 2.5% w/ sodium chloride 0.45% 1dextrose 5% w/ sodium chloride 0.2% 1dextrose 5% w/ sodium chloride 0.33% 1dextrose 5% w/ sodium chloride 0.45% 1dextrose 5% w/ sodium chloride 0.9% 1EXJADE - deferasirox tab for oral susp 125 mg* 1EXJADE - deferasirox tab for oral susp 250 mg* 1EXJADE - deferasirox tab for oral susp 500 mg* 1fat emulsion iv soln 20% 1 BDfomepizole inj 1 gm/ml (for iv infusion) 1FOSRENOL - lanthanum carbonate chew tab 500 mg 1FOSRENOL - lanthanum carbonate chew tab 750 mg 1FOSRENOL - lanthanum carbonate chew tab 1000 mg 1FOSRENOL - lanthanum carbonate oral powder pack 750 mg 1FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 1

2018



HEPATAMINE - amino acid infusion 8% 1 BDJADENU - deferasirox tab 90 mg 1JADENU - deferasirox tab 180 mg 1JADENU - deferasirox tab 360 mg 1JADENU SPRINKLE - deferasirox granules packet 90 mg 1JADENU SPRINKLE - deferasirox granules packet 180 mg 1JADENU SPRINKLE - deferasirox granules packet 360 mg 1kcl 20 meq/l (0.15%) in nacl 0.45% inj 1kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj 1kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj 1kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj 1lactated ringer's solution 1lanthanum carbonate chew tab 500 mg 1lanthanum carbonate chew tab 750 mg 1lanthanum carbonate chew tab 1000 mg 1levocarnitine oral soln 1 gm/10ml (10%) 1levocarnitine tab 330 mg 1magnesium sulfate inj 50% 1NORMOSOL-M IN D5W - electrolyte-m in d5w soln 1PHOSLYRA - calcium acetate oral soln 667 mg/5ml 1potassium chloride cap er 8 meq 1potassium chloride cap er 10 meq 1potassium chloride inj 2 meq/ml 1potassium chloride microencapsulated crys er tab 10 meq 1potassium chloride microencapsulated crys er tab 20 meq 1potassium chloride oral soln 10% (20 meq/15ml) 1potassium chloride tab er 8 meq (600 mg) 1potassium chloride tab er 10 meq 1potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 1POTASSIUM CHLORIDE/DEXTROSE - potassium chloride 40

meq/l (0.3%) in dextrose 5% inj1

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

1

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

1

potassium citrate tab er 5 meq (540 mg) 1

2018


75


potassium citrate tab er 10 meq (1080 mg) 1potassium citrate tab er 15 meq (1620 mg) 1RENVELA - sevelamer carbonate tab 800 mg 1SAMSCA - tolvaptan tab 15 mg 1 PASAMSCA - tolvaptan tab 30 mg 1 PAsevelamer carbonate packet 0.8 gm 1sevelamer carbonate packet 2.4 gm 1sevelamer carbonate tab 800 mg 1sodium chloride inj 0.45% 1sodium chloride irrigation soln 0.9% 1sodium chloride iv soln 0.9% 1sodium polystyrene sulfonate oral susp 15 gm/60ml 1sodium polystyrene sulfonate powder 1sodium polystyrene sulfonate rectal susp 30 gm/120ml 1SYPRINE - trientine hcl cap 250 mg 1 PA, QL (240 capsules/30 days)trientine hcl cap 250 mg 1 PA, QL (240 capsules/30 days)water for irrigation, sterile irrigation soln 1Agentes gastrointestinalesalosetron hcl tab 0.5 mg 1alosetron hcl tab 1 mg 1AMITIZA - lubiprostone cap 8 mcg 1 PAAMITIZA - lubiprostone cap 24 mcg 1 PACHENODAL - chenodiol tab 250 mg* 1cimetidine hcl soln 300 mg/5ml 1cimetidine tab 200 mg 1cimetidine tab 300 mg 1cimetidine tab 400 mg 1cimetidine tab 800 mg 1cromolyn sodium oral conc 100 mg/5ml 1dicyclomine hcl tab 20 mg# 1 PAesomeprazole magnesium cap delayed release 20 mg 1 QL (30 capsules/30 days)esomeprazole magnesium cap delayed release 40 mg 1 QL (30 capsules/30 days)ESOMEPRAZOLE SODIUM - esomeprazole sodium for

intravenous soln 20 mg1

esomeprazole sodium for intravenous soln 40 mg 1famotidine inj 20 mg/2ml 1famotidine inj 40 mg/4ml 1famotidine inj 200 mg/20ml 1

2018



famotidine tab 20 mg 1famotidine tab 40 mg 1GATTEX - teduglutide (rdna) for inj kit 5 mg* 1 PAglycopyrrolate tab 1 mg 1glycopyrrolate tab 2 mg 1lactulose (encephalopathy) solution 10 gm/15ml 1lactulose solution 10 gm/15ml 1lansoprazole cap delayed release 15 mg 1 QL (30 capsules/30 days)lansoprazole cap delayed release 30 mg 1 QL (30 capsules/30 days)LINZESS - linaclotide cap 72 mcg 1 PALINZESS - linaclotide cap 145 mcg 1 PALINZESS - linaclotide cap 290 mcg 1 PAloperamide hcl cap 2 mg 1methscopolamine bromide tab 2.5 mg 1methscopolamine bromide tab 5 mg 1metoclopramide hcl inj 5 mg/ml 1metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) 1metoclopramide hcl tab 5 mg 1metoclopramide hcl tab 10 mg 1misoprostol tab 100 mcg 1misoprostol tab 200 mcg 1MOVIPREP - peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln

100 gm1

MYALEPT - metreleptin for subcutaneous inj 11.3 mg* 1 PANEXIUM - esomeprazole magnesium for delayed release susp

packet 5 mg1 QL (30 packets/30 days)

NEXIUM - esomeprazole magnesium for delayed release susppacket 10 mg

1 QL (30 packets/30 days)





NEXIUM - esomeprazole magnesium for delayed release susppacket 2.5 mg


nizatidine cap 150 mg 1nizatidine cap 300 mg 1omeprazole cap delayed release 10 mg 1 QL (30 capsules/30 days)omeprazole cap delayed release 20 mg 1 QL (60 capsules/30 days)omeprazole cap delayed release 40 mg 1 QL (60 capsules/30 days)

2018


77


pantoprazole sodium ec tab 20 mg 1 QL (30 tablets/30 days)pantoprazole sodium ec tab 40 mg 1 QL (60 tablets/30 days)pantoprazole sodium for iv soln 40 mg 1peg 3350-kcl-sod bicarb-nacl for soln 420 gm 1peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm 1peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm 1polyethylene glycol 3350 oral packet 1polyethylene glycol 3350 oral powder 1PYLERA - bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg1

ranitidine hcl cap 150 mg 1ranitidine hcl cap 300 mg 1ranitidine hcl syrup 15 mg/ml (75 mg/5ml) 1ranitidine hcl tab 150 mg 1ranitidine hcl tab 300 mg 1RELISTOR - methylnaltrexone bromide inj 8 mg/0.4ml (20 mg/ml) 1 PARELISTOR - methylnaltrexone bromide inj 12 mg/0.6ml (20 mg/

ml)1 PA

RELISTOR - methylnaltrexone bromide tab 150 mg 1 PAsucralfate tab 1 gm 1SUPREP BOWEL PREP KIT - sod sulfate-pot sulf-mg sulf oral sol

17.5-3.13-1.6 gm/180ml1

ursodiol cap 300 mg 1ursodiol tab 250 mg 1ursodiol tab 500 mg 1XIFAXAN - rifaximin tab 550 mg 1Trastorno genético o enzimático: Sustitución, Modificadores, TratamientoADAGEN - pegademase bovine inj 250 unit/ml* 1ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500

unit/5ml)*1

BUPHENYL - sodium phenylbutyrate tab 500 mg 1CEREZYME - imiglucerase for inj 400 unit* 1CREON - pancrelipase (lip-prot-amyl) dr cap 3000-9500-15000

unit1

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

1

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

1

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

1

2018



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

1

CYSTADANE - betaine powder for oral solution 1CYSTAGON - cysteamine bitartrate cap 50 mg* 1CYSTAGON - cysteamine bitartrate cap 150 mg* 1ELAPRASE - idursulfase soln for iv infusion 6 mg/3ml (2 mg/ml)* 1ELELYSO - taliglucerase alfa for inj 200 unit* 1FABRAZYME - agalsidase beta for iv soln 5 mg* 1FABRAZYME - agalsidase beta for iv soln 35 mg* 1KUVAN - sapropterin dihydrochloride powder packet 100 mg* 1 PAKUVAN - sapropterin dihydrochloride powder packet 500 mg* 1 PAKUVAN - sapropterin dihydrochloride soluble tab 100 mg* 1 PALUMIZYME - alglucosidase alfa for iv soln 50 mg 1miglustat cap 100 mg* 1 PA, QL (90 capsules/30 days)NAGLAZYME - galsulfase soln for iv infusion 1 mg/ml* 1OCALIVA - obeticholic acid tab 5 mg* 1 PA, QL (30 tablets/30 days)OCALIVA - obeticholic acid tab 10 mg* 1 PA, QL (30 tablets/30 days)ORFADIN - nitisinone cap 2 mg* 1ORFADIN - nitisinone cap 5 mg* 1ORFADIN - nitisinone cap 10 mg* 1ORFADIN - nitisinone cap 20 mg* 1ORFADIN - nitisinone susp 4 mg/ml* 1PROLASTIN-C - alpha1-proteinase inhibitor (human) for iv soln

1000 mg*1 PA

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

1 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful 1sodium phenylbutyrate tab 500 mg 1STRENSIQ - asfotase alfa subcutaneous inj 18 mg/0.45ml* 1 PASTRENSIQ - asfotase alfa subcutaneous inj 28 mg/0.7ml* 1 PASTRENSIQ - asfotase alfa subcutaneous inj 40 mg/ml* 1 PASTRENSIQ - asfotase alfa subcutaneous inj 80 mg/0.8ml* 1 PAVIOKACE - pancrelipase (lip-prot-amyl) tab 10440-39150-39150

unit1

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

1

VPRIV - velaglucerase alfa for inj 400 unit 1ZAVESCA - miglustat cap 100 mg* 1 PA, QL (90 capsules/30 days)

2018


79


ZENPEP - pancrelipase (lip-prot-amyl) dr cap 3000-10000-14000unit

1


1


1


1


1

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

1

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

1

Agentes genitourinariosalfuzosin hcl tab er 24hr 10 mg 1 QL (30 tablets/30 days)bethanechol chloride tab 5 mg 1bethanechol chloride tab 10 mg 1bethanechol chloride tab 25 mg 1bethanechol chloride tab 50 mg 1DEPEN TITRATABS - penicillamine tab 250 mg 1dutasteride cap 0.5 mg 1 QL (30 capsules/30 days)dutasteride-tamsulosin hcl cap 0.5-0.4 mg 1 QL (30 capsules/30 days)finasteride tab 5 mg 1 QL (30 tablets/30 days)methylergonovine maleate tab 0.2 mg 1oxybutynin chloride syrup 5 mg/5ml 1 QL (600 mls/30 days)oxybutynin chloride tab er 24hr 5 mg 1 QL (30 tablets/30 days)oxybutynin chloride tab er 24hr 10 mg 1 QL (60 tablets/30 days)oxybutynin chloride tab er 24hr 15 mg 1 QL (60 tablets/30 days)oxybutynin chloride tab 5 mg 1 QL (120 tablets/30 days)RAPAFLO - silodosin cap 4 mg 1 QL (30 capsules/30 days)RAPAFLO - silodosin cap 8 mg 1 QL (30 capsules/30 days)tamsulosin hcl cap 0.4 mg 1 QL (60 capsules/30 days)tolterodine tartrate cap er 24hr 2 mg 1 QL (30 capsules/30 days)tolterodine tartrate cap er 24hr 4 mg 1 QL (30 capsules/30 days)tolterodine tartrate tab 1 mg 1 QL (60 tablets/30 days)tolterodine tartrate tab 2 mg 1 QL (60 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 4 mg 1 QL (30 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 8 mg 1 QL (30 tablets/30 days)trospium chloride cap er 24hr 60 mg 1 QL (30 capsules/30 days)

2018



trospium chloride tab 20 mg 1 QL (60 tablets/30 days)Agentes hormonales, estimulantes/sustitutos/modificadores (suprarrenal)CORTISONE ACETATE - cortisone acetate tab 25 mg 1DEXAMETHASONE - dexamethasone tab 1 mg 1DEXAMETHASONE - dexamethasone tab 2 mg 1dexamethasone elixir 0.5 mg/5ml 1dexamethasone sodium phosphate inj 4 mg/ml 1dexamethasone sodium phosphate inj 20 mg/5ml 1dexamethasone sodium phosphate inj 120 mg/30ml 1dexamethasone tab 0.5 mg 1dexamethasone tab 0.75 mg 1dexamethasone tab 1.5 mg 1dexamethasone tab 4 mg 1dexamethasone tab 6 mg 1fludrocortisone acetate tab 0.1 mg 1H.P. ACTHAR - corticotropin inj gel 80 unit/ml* 1 PAhydrocortisone tab 5 mg 1hydrocortisone tab 10 mg 1hydrocortisone tab 20 mg 1methylprednisolone sod succ for inj 40 mg 1methylprednisolone sod succ for inj 125 mg 1methylprednisolone sod succ for inj 1000 mg 1methylprednisolone tab therapy pack 4 mg (21) 1methylprednisolone tab 4 mg 1methylprednisolone tab 8 mg 1methylprednisolone tab 16 mg 1methylprednisolone tab 32 mg 1prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) 1prednisolone sod phosphate oral soln 15 mg/5ml 1prednisolone syrup 15 mg/5ml 1PREDNISONE - prednisone oral soln 5 mg/5ml 1PREDNISONE - prednisone tab therapy pack 5 mg (21) 1PREDNISONE - prednisone tab therapy pack 5 mg (48) 1PREDNISONE - prednisone tab therapy pack 10 mg (21) 1PREDNISONE - prednisone tab therapy pack 10 mg (48) 1PREDNISONE - prednisone tab 50 mg 1prednisone tab 1 mg 1prednisone tab 2.5 mg 1

2018


81


prednisone tab 5 mg 1prednisone tab 10 mg 1prednisone tab 20 mg 1Agentes hormonales, estimulantes/sustitutos/modificadores (pituitarios)chorionic gonadotropin for im inj 10000

unit(chorionic gonadotropin, pregnyl)1 PA

DDAVP - desmopressin acetate nasal soln 0.01% (refrigerated) 1desmopressin acetate inj 4 mcg/ml 1desmopressin acetate tab 0.1 mg 1desmopressin acetate tab 0.2 mg 1EGRIFTA - tesamorelin acetate for inj 1 mg* 1 PAEGRIFTA - tesamorelin acetate for inj 2 mg* 1 PAINCRELEX - mecasermin inj 40 mg/4ml (10 mg/ml)* 1OMNITROPE - somatropin for inj 5.8 mg 1 PAOMNITROPE - somatropin inj 5 mg/1.5ml 1 PAOMNITROPE - somatropin inj 10 mg/1.5ml 1 PASTIMATE - desmopressin acetate nasal soln 1.5 mg/ml 1Agentes hormonales, estimulantes/sustitutos/modificadores (hormonas/modificadores sexuales)ANADROL-50 - oxymetholone tab 50 mg 1 PAANDRODERM - testosterone td patch 24hr 2 mg/24hr 1 PA, QL (30 patches/30 days)ANDRODERM - testosterone td patch 24hr 4 mg/24hr 1 PA, QL (30 patches/30 days)ANDROGEL - testosterone td gel 20.25 mg/1.25gm (1.62%) 1 PA, QL (30 packets/30 days)ANDROGEL - testosterone td gel 40.5 mg/2.5gm (1.62%) 1 PA, QL (60 packets/30 days)ANDROGEL PUMP - testosterone td gel 20.25 mg/act (1.62%) 1 PA, QL (2 pump

bottles/30 days)danazol cap 50 mg 1 PAdanazol cap 100 mg 1 PAdanazol cap 200 mg 1 PADEPO-PROVERA - medroxyprogesterone acetate im susp

400 mg/ml1

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) 1desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg 1desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 1drospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451 mg 1drospirenone-ethinyl estrad-levomefolate tab 3-0.03-0.451 mg 1drospirenone-ethinyl estradiol tab 3-0.02 mg 1drospirenone-ethinyl estradiol tab 3-0.03 mg 1ELLA - ulipristal acetate tab 30 mg 1ESTRACE - estradiol vaginal cream 0.1 mg/gm 1

2018



estradiol & norethindrone acetate tab 0.5-0.1 mg# 1 PAestradiol & norethindrone acetate tab 1-0.5 mg# 1 PAestradiol tab 0.5 mg# 1 PAestradiol tab 1 mg# 1 PAestradiol tab 2 mg# 1 PAestradiol vaginal cream 0.1 mg/gm 1estradiol vaginal tab 10 mcg 1ESTROPIPATE - estropipate tab 0.75 mg# 1 PAethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg 1ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg 1HYDROXYPROGESTERONE CAPROATE - hydroxyprogesterone

caproate im in oil 1.25 gm/5ml1

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) 1levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) 1levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg 1levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg 1levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg 1levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 1levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg 1medroxyprogesterone acetate im susp prefilled syr 150 mg/ml 1medroxyprogesterone acetate im susp 150 mg/ml 1medroxyprogesterone acetate tab 2.5 mg 1medroxyprogesterone acetate tab 5 mg 1medroxyprogesterone acetate tab 10 mg 1megestrol acetate susp 40 mg/ml# 1 PAmegestrol acetate tab 20 mg# 1 PAmegestrol acetate tab 40 mg# 1 PAmethyltestosterone cap 10 mg 1 PAnorethindrone & ethinyl estradiol tab 0.4 mg-35 mcg 1norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg 1norethindrone & ethinyl estradiol tab 1 mg-35 mcg 1norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg 1norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg 1norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg 1norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg 1norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg 1norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg 1norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg 1

2018


83


norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) 1norethindrone acetate tab 5 mg 1norethindrone tab 0.35 mg 1norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg 1norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg 1norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg 1norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg 1norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg 1norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg 1oxandrolone tab 2.5 mg 1 PAoxandrolone tab 10 mg 1 PAPREMARIN - estrogens, conjugated vaginal cream 0.625 mg/gm 1PREMPHASE - conj est 0.625(14)/conj est-medroxypro ac tab

0.625-5mg(14)#1 PA

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

1 PA


1 PA


1 PA

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

1 PA

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

bottles/30 days)Agentes hormonales, estimulantes/sustitutos/modificadores (tiroides)levothyroxine sodium tab 25 mcg 1levothyroxine sodium tab 50 mcg 1levothyroxine sodium tab 75 mcg 1levothyroxine sodium tab 88 mcg 1levothyroxine sodium tab 100 mcg 1levothyroxine sodium tab 112 mcg 1levothyroxine sodium tab 125 mcg 1levothyroxine sodium tab 137 mcg 1levothyroxine sodium tab 150 mcg 1

2018



levothyroxine sodium tab 175 mcg 1levothyroxine sodium tab 200 mcg 1levothyroxine sodium tab 300 mcg 1liothyronine sodium tab 5 mcg 1liothyronine sodium tab 25 mcg 1liothyronine sodium tab 50 mcg 1SYNTHROID - levothyroxine sodium tab 25 mcg 1SYNTHROID - levothyroxine sodium tab 50 mcg 1SYNTHROID - levothyroxine sodium tab 75 mcg 1SYNTHROID - levothyroxine sodium tab 88 mcg 1SYNTHROID - levothyroxine sodium tab 100 mcg 1SYNTHROID - levothyroxine sodium tab 112 mcg 1SYNTHROID - levothyroxine sodium tab 125 mcg 1SYNTHROID - levothyroxine sodium tab 137 mcg 1SYNTHROID - levothyroxine sodium tab 150 mcg 1SYNTHROID - levothyroxine sodium tab 175 mcg 1SYNTHROID - levothyroxine sodium tab 200 mcg 1SYNTHROID - levothyroxine sodium tab 300 mcg 1Agentes hormonales, supresores (suprarrenal)KORLYM - mifepristone tab 300 mg* 1 PA, QL (120 tablets/30 days)LYSODREN - mitotane tab 500 mg 1Agentes hormonales, supresores (pituitarios)cabergoline tab 0.5 mg 1ELIGARD - leuprolide acetate (3 month) for subcutaneous inj kit

22.5mg1

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

1

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

1

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

3.75 mg1

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

1

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

1

2018


85


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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

octreotide acetate inj 50 mcg/ml (0.05 mg/ml) 1 PAoctreotide acetate inj 100 mcg/ml (0.1 mg/ml) 1 PAoctreotide acetate inj 200 mcg/ml (0.2 mg/ml) 1 PAoctreotide acetate inj 500 mcg/ml (0.5 mg/ml) 1 PAoctreotide acetate inj 1000 mcg/ml (1 mg/ml) 1 PASIGNIFOR - pasireotide diaspartate inj 0.3 mg/ml* 1 PASIGNIFOR - pasireotide diaspartate inj 0.6 mg/ml* 1 PASIGNIFOR - pasireotide diaspartate inj 0.9 mg/ml* 1 PASIGNIFOR LAR - pasireotide pamoate for im er susp 20 mg* 1 PASIGNIFOR LAR - pasireotide pamoate for im er susp 40 mg* 1 PASIGNIFOR LAR - pasireotide pamoate for im er susp 60 mg* 1 PASOMATULINE DEPOT - lanreotide acetate extended release inj

60 mg/0.2ml1 PA

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

1 PA

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

1 PA

SOMAVERT - pegvisomant for inj 10 mg* 1 PASOMAVERT - pegvisomant for inj 15 mg* 1 PASOMAVERT - pegvisomant for inj 20 mg* 1 PASOMAVERT - pegvisomant for inj 25 mg* 1 PASOMAVERT - pegvisomant for inj 30 mg* 1 PASYNAREL - nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) 1TRELSTAR - triptorelin pamoate for im susp 3.75 mg 1TRELSTAR - triptorelin pamoate for im susp 11.25 mg 1

2018



TRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 1TRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 1TRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 1Agentes hormonales, supresores (tiroides)methimazole tab 5 mg 1methimazole tab 10 mg 1propylthiouracil tab 50 mg 1Agentes inmunológicosACTHIB - haemophilus b polysaccharide conjugate vaccine for inj 1ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml (2000000

unit/0.5ml)*1

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 1ARCALYST - rilonacept for inj 220 mg* 1 PAATGAM - lymphocyte immune globulin anti-thymocyte g inj 50 mg/

ml(eq)1 BD

AZASAN - azathioprine tab 75 mg 1 BDAZASAN - azathioprine tab 100 mg 1 BDAZATHIOPRINE - azathioprine sodium for inj 100 mg 1 BDazathioprine tab 50 mg 1 BDBCG VACCINE - bcg vaccine inj 1BENLYSTA - belimumab for iv soln 120 mg 1 PABENLYSTA - belimumab for iv soln 400 mg 1 PABENLYSTA - belimumab subcutaneous solution auto-injector

200 mg/ml1 PA

BENLYSTA - belimumab subcutaneous solution prefilled syringe200 mg/ml

1 PA

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

1

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

1

CINRYZE - c1 esterase inhibitor (human) for iv inj 500 unit* 1 PA, QL (20 vials/30 days)COSENTYX - secukinumab subcutaneous soln prefilled syringe

150 mg/ml1 PA

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

1 PA

cyclosporine cap 25 mg 1 BDcyclosporine cap 100 mg 1 BDcyclosporine iv soln 50 mg/ml 1 BDcyclosporine modified cap 25 mg 1 BDcyclosporine modified cap 50 mg 1 BD

2018


87


cyclosporine modified cap 100 mg 1 BDcyclosporine modified oral soln 100 mg/ml 1 BDDAPTACEL - diph, acellular pert & tet tox inj 15 lf-23 mcg-5

lf/0.5ml1

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

1

DUPIXENT - dupilumab subcutaneous soln prefilled syringe300 mg/2ml

1 PA

ENBREL - etanercept for subcutaneous inj 25 mg 1 PAENBREL - etanercept subcutaneous soln prefilled syringe

25 mg/0.5ml1 PA

ENBREL - etanercept subcutaneous soln prefilled syringe 50 mg/ml

1 PA

ENBREL MINI - etanercept subcutaneous solution cartridge50 mg/ml

1 PA

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

1 PA

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

1 BD

ENGERIX-B - hepatitis b vaccine (recombinant) susp 20 mcg/ml 1 BDFIRAZYR - icatibant acetate inj 30 mg/3ml* 1 PA, QL (6 syringes/30 days)GAMMAGARD LIQUID - immune globulin (human) iv or

subcutaneous soln 1 gm/10ml1 BD, PA

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

1 BD, PA

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

1 BD, PA


1 BD, PA


1 BD, PA


1 BD, PA

GAMMAGARD S/D - immune globulin (human) iv for soln 5 gm 1 BD, PAGAMMAGARD S/D - immune globulin (human) iv for soln 10 gm 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 5 gm/100ml 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 10 gm/200ml 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 20 gm/400ml 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 5 gm/50ml 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 10 gm/100ml 1 BD, PAGAMMAPLEX - immune globulin (human) iv soln 20 gm/200ml 1 BD, PA

2018



GAMUNEX-C - immune globulin (human) iv or subcutaneous soln1 gm/10ml

1 BD, PA

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

1 BD, PA


1 BD, PA


1 BD, PA


1 BD, PA


1 BD, PA

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

1

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

1

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


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


HAVRIX - hepatitis a vaccine inj susp 720 el unit/0.5ml 1HAVRIX - hepatitis a vaccine inj susp 1440 el unit/ml 1HIBERIX - haemophilus b polysaccharide conjugate vac for inj

10 mcg1

HUMIRA - adalimumab prefilled syringe kit 10 mg/0.1ml 1 PAHUMIRA - adalimumab prefilled syringe kit 10 mg/0.2ml 1 PAHUMIRA - adalimumab prefilled syringe kit 20 mg/0.2ml 1 PAHUMIRA - adalimumab prefilled syringe kit 20 mg/0.4ml 1 PAHUMIRA - adalimumab prefilled syringe kit 40 mg/0.8ml 1 PAHUMIRA - adalimumab prefilled syringe kit 40 mg/0.4ml 1 PAHUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -

adalimumab prefilled syringe kit 40 mg/0.8ml1 PA

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

1 PA

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

1 PA

HUMIRA PEN - adalimumab pen-injector kit 40 mg/0.8ml 1 PAHUMIRA PEN - adalimumab pen-injector kit 40 mg/0.4ml 1 PAHUMIRA PEN-CD/UC/HS STARTER - adalimumab pen-injector kit

40 mg/0.8ml1 PA

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

1 PA

2018


89


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

1 PA

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

1 PA

ILARIS - canakinumab subcutaneous inj 150 mg/ml* 1 PAIMOVAX RABIES (H.D.C.V.) - rabies virus vaccine, hdc inj 1 BDINFANRIX - diph, acellular pert & tet tox inj 25 lf-58 mcg-10

lf/0.5ml1

IPOL INACTIVATED IPV - poliovirus vaccine, ipv injection 1IXIARO - japanese encephalitis vaccine inactivated adsorbed inj 1KINERET - anakinra subcutaneous soln prefilled syringe

100 mg/0.67ml1 PA

KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj 1leflunomide tab 10 mg 1leflunomide tab 20 mg 1M-M-R II - measles, mumps & rubella virus vaccines for inj 1MENACTRA - meningococcal (a, c, y, and w-135) conjugate

vaccine inj1

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

1

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

1

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

50 mg/0.4ml1 PA

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

1 PA

2018



ORENCIA - abatacept subcutaneous soln prefilled syringe125 mg/ml

1 PA

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

1 PA

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

1 PA

OTEZLA - apremilast tab 30 mg 1 PAPEDIARIX - diph-tetanus tox-acell pert-hepatitis b-polio ipv vac inj 1PEDVAX HIB - haemophilus b polysaccharide conj vac im susp

7.5 mcg/0.5 ml1

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

1

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

inj1

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

1

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

5 mcg/0.5ml1 BD

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

1 BD

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

1 BD

REMICADE - infliximab for iv inj 100 mg 1 PARENFLEXIS - infliximab-abda for iv inj 100 mg 1 PARIDAURA - auranofin cap 3 mg 1ROTARIX - rotavirus vaccine, live for oral susp 1ROTATEQ - rotavirus vaccine, live oral pentavalent soln 1SANDIMMUNE - cyclosporine oral soln 100 mg/ml 1 BDSHINGRIX - zoster vaccine recombinant adjuvanted for im inj

50 mcg1 QL (2 vaccines/lifetime)

SIMULECT - basiliximab for iv soln 10 mg 1 BDSIMULECT - basiliximab for iv soln 20 mg 1 BDsirolimus tab 0.5 mg 1 BDsirolimus tab 1 mg 1 BDsirolimus tab 2 mg 1 BDSTAMARIL - yellow fever vaccine for inj suspension 1STELARA - ustekinumab inj 45 mg/0.5ml 1 PA

2018


91


STELARA - ustekinumab iv soln 130 mg/26ml (5 mg/ml) (for ivinfusion)

1 PA

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

diphtheria toxoids (td) inj 2-2 lf/0.5ml1

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

1 BD

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

1

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

1

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

1

VAQTA - hepatitis a vaccine inj susp 25 unit/0.5ml 1VAQTA - hepatitis a vaccine inj susp 50 unit/ml 1VARIVAX - varicella virus vac live for subcutaneous inj 1350

pfu/0.5ml1

XATMEP - methotrexate oral soln 2.5 mg/ml 1 BDXOLAIR - omalizumab for inj 150 mg* 1 PAYF-VAX - yellow fever vaccine subcutaneous inj 1ZORTRESS - everolimus tab 0.25 mg 1 BDZORTRESS - everolimus tab 0.5 mg 1 BDZORTRESS - everolimus tab 0.75 mg 1 BDZOSTAVAX - zoster vaccine live for subcutaneous susp 19400

unit/0.65ml1 QL (1 vaccine/lifetime)

Agentes para tratar la enfermedad inflamatoria intestinalASACOL HD - mesalamine tab delayed release 800 mg 1balsalazide disodium cap 750 mg 1budesonide delayed release particles cap 3 mg 1CANASA - mesalamine suppos 1000 mg 1DELZICOL - mesalamine cap dr 400 mg 1

2018



DIPENTUM - olsalazine sodium cap 250 mg 1hydrocortisone enema 100 mg/60ml 1hydrocortisone rectal cream 1% 1hydrocortisone rectal cream 2.5% 1mesalamine enema 4 gm 1mesalamine rectal enema 4 gm & cleanser wipe kit 1mesalamine tab delayed release 800 mg 1sulfasalazine tab delayed release 500 mg 1sulfasalazine tab 500 mg 1Agentes para tratar la enfermedad ósea metabólicaalendronate sodium tab 5 mg 1 QL (30 tablets/30 days)alendronate sodium tab 10 mg 1 QL (120 tablets/30 days)alendronate sodium tab 35 mg 1 QL (4 tablets/28 days)alendronate sodium tab 70 mg 1 QL (4 tablets/28 days)calcitonin (salmon) nasal soln 200 unit/act 1calcitriol cap 0.25 mcg 1calcitriol cap 0.5 mcg 1calcitriol inj 1 mcg/ml 1calcitriol oral soln 1 mcg/ml 1ETIDRONATE DISODIUM - etidronate disodium tab 200 mg 1ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 1FORTEO - teriparatide (recombinant) inj 600 mcg/2.4ml 1 PAibandronate sodium iv soln 3 mg/3ml 1ibandronate sodium tab 150 mg 1 QL (1 tablet/28 days)MIACALCIN - calcitonin (salmon) inj 200 unit/ml 1NATPARA - parathyroid hormone (recombinant) for inj cartridge

25 mcg*1 PA, QL (2 cartridges/28 days)

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

1 PA, QL (2 cartridges/28 days)





paricalcitol cap 1 mcg 1paricalcitol cap 2 mcg 1paricalcitol cap 4 mcg 1paricalcitol iv soln 2 mcg/ml 1paricalcitol iv soln 5 mcg/ml 1PROLIA - denosumab inj 60 mg/ml 1 PA

2018


93


risedronate sodium tab delayed release 35 mg 1 QL (4 tablets/28 days)risedronate sodium tab 5 mg 1 QL (30 tablets/30 days)risedronate sodium tab 30 mg 1 QL (30 tablets/30 days)risedronate sodium tab 35 mg 1 QL (4 tablets/28 days)risedronate sodium tab 150 mg 1 QL (1 tablet/28 days)SENSIPAR - cinacalcet hcl tab 30 mg 1 PASENSIPAR - cinacalcet hcl tab 60 mg 1 PASENSIPAR - cinacalcet hcl tab 90 mg 1 PAXGEVA - denosumab inj 120 mg/1.7ml 1zoledronic acid inj conc for iv infusion 4 mg/5ml 1zoledronic acid iv soln 5 mg/100ml 1ZOMETA - zoledronic acid iv soln 4 mg/100ml 1Agentes oftálmicosALPHAGAN P - brimonidine tartrate ophth soln 0.1% 1azelastine hcl ophth soln 0.05% 1AZOPT - brinzolamide ophth susp 1% 1BACITRACIN - bacitracin ophth oint 500 unit/gm 1bacitracin-polymyxin b ophth oint 1bacitracin-polymyxin-neomycin-hc ophth oint 1% 1BESIVANCE - besifloxacin hcl ophth susp 0.6% 1betaxolol hcl ophth soln 0.5% 1BETOPTIC-S - betaxolol hcl ophth susp 0.25% 1brimonidine tartrate ophth soln 0.15% 1brimonidine tartrate ophth soln 0.2% 1bromfenac sodium ophth soln 0.09% (once-daily) 1carteolol hcl ophth soln 1% 1ciprofloxacin hcl ophth soln 0.3% 1COMBIGAN - brimonidine tartrate-timolol maleate ophth soln

0.2-0.5%1

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

sodium phosphate ophth soln 0.1%1

diclofenac sodium ophth soln 0.1% 1dorzolamide hcl ophth soln 2% 1dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml 1DUREZOL - difluprednate ophth emulsion 0.05% 1epinastine hcl ophth soln 0.05% 1

2018



erythromycin ophth oint 5 mg/gm 1fluorometholone ophth susp 0.1% 1flurbiprofen sodium ophth soln 0.03% 1gentamicin sulfate ophth oint 0.3% 1gentamicin sulfate ophth soln 0.3% 1ILEVRO - nepafenac ophth susp 0.3% 1ISTALOL - timolol maleate ophth soln 0.5% (once-daily) 1ketorolac tromethamine ophth soln 0.4% 1ketorolac tromethamine ophth soln 0.5% 1LACRISERT - artificial tear ophth insert 1latanoprost ophth soln 0.005% 1levobunolol hcl ophth soln 0.5% 1LOTEMAX - loteprednol etabonate ophth gel 0.5% 1LOTEMAX - loteprednol etabonate ophth oint 0.5% 1LOTEMAX - loteprednol etabonate ophth susp 0.5% 1LUMIGAN - bimatoprost ophth soln 0.01% 1MOXEZA - moxifloxacin hcl ophth soln 0.5% (2 times daily) 1moxifloxacin hcl ophth soln 0.5% 1NATACYN - natamycin ophth susp 5% 1neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin 1neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml 1neomycin-polymyxin-dexamethasone ophth oint 0.1% 1neomycin-polymyxin-dexamethasone ophth susp 0.1% 1ofloxacin ophth soln 0.3% 1olopatadine hcl ophth soln 0.1% 1olopatadine hcl ophth soln 0.2% 1PAZEO - olopatadine hcl ophth soln 0.7% 1PHOSPHOLINE IODIDE - echothiophate iodide ophth for soln

0.125%1

pilocarpine hcl ophth soln 1% 1pilocarpine hcl ophth soln 2% 1pilocarpine hcl ophth soln 4% 1polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% 1prednisolone acetate ophth susp 1% 1PROLENSA - bromfenac sodium ophth soln 0.07% 1RESTASIS - cyclosporine (ophth) emulsion 0.05% 1 PA, QL (60 vials/30 days)RESTASIS MULTIDOSE - cyclosporine (ophth) emulsion 0.05% 1 PA, QL (2 bottles/30 days)

2018


95


SIMBRINZA - brinzolamide-brimonidine tartrate ophth susp1-0.2%

1

sulfacetamide sodium ophth soln 10% 1sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% 1timolol maleate ophth gel forming soln 0.25% 1timolol maleate ophth gel forming soln 0.5% 1timolol maleate ophth soln 0.25% 1timolol maleate ophth soln 0.5% 1timolol maleate ophth soln 0.5% (once-daily) 1TOBRADEX - tobramycin-dexamethasone ophth oint 0.3-0.1% 1tobramycin ophth soln 0.3% 1tobramycin-dexamethasone ophth susp 0.3-0.1% 1TRAVATAN Z - travoprost ophth soln 0.004% 1trifluridine ophth soln 1% 1VIGAMOX - moxifloxacin hcl ophth soln 0.5% 1Agentes óticosacetic acid otic soln 2% 1ACETIC ACID/ALUMINUM ACETATE - acetic acid 2% in

aluminum acetate otic soln1

CIPRODEX - ciprofloxacin-dexamethasone otic susp 0.3-0.1% 1fluocinolone acetonide (otic) oil 0.01% 1hydrocortisone w/ acetic acid otic soln 1-2% 1neomycin-polymyxin-hc otic soln 1% 1neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% 1ofloxacin otic soln 0.3% 1Agentes para el tracto respiratorio/pulmonaracetylcysteine inhal soln 10% 1 BDacetylcysteine inhal soln 20% 1 BDADCIRCA - tadalafil tab 20 mg (pah) 1 PA, QL (60 tablets/30 days)ADEMPAS - riociguat tab 0.5 mg 1 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1 mg 1 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1.5 mg 1 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2 mg 1 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2.5 mg 1 PA, QL (90 tablets/30 days)ADVAIR DISKUS - fluticasone-salmeterol aer powder ba

100-50 mcg/dose1 QL (1 inhaler/30 days)

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

1 QL (1 inhaler/30 days)

2018



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


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

act1 QL (1 canister/30 days)

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

1 QL (1 canister/30 days)

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

62.5-25 mcg/inh1 QL (1 package/30 days)

ARNUITY ELLIPTA - fluticasone furoate aerosol powder breathactiv 50 mcg/act

1 QL (30 blisters/30 days)





ASMANEX HFA - mometasone furoate inhal aerosol suspension100 mcg/act


ASMANEX HFA - mometasone furoate inhal aerosol suspension200 mcg/act


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












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

1 QL (2 canisters/30 days)

2018


97


azelastine hcl nasal spray 0.1% (137 mcg/spray) 1 QL (2 bottles/30 days)azelastine hcl nasal spray 0.15% (205.5 mcg/spray) 1 QL (2 bottles/30 days)BREO ELLIPTA - fluticasone furoate-vilanterol aero powd ba

100-25 mcg/inh1 QL (1 package/30 days)

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

1 QL (1 package/30 days)

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

20-100 mcg/act1 QL (2 canisters/30 days)

cromolyn sodium soln nebu 20 mg/2ml 1 BDDALIRESP - roflumilast tab 250 mcg 1DALIRESP - roflumilast tab 500 mcg 1diphenhydramine hcl inj 50 mg/ml 1EPINEPHRINE - epinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000)1

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

1

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

1

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

1

ESBRIET - pirfenidone cap 267 mg* 1 PA, QL (270 capsules/30 days)ESBRIET - pirfenidone tab 267 mg* 1 PA, QL (270 tablets/30 days)ESBRIET - pirfenidone tab 801 mg* 1 PA, QL (90 tablets/30 days)FLOVENT DISKUS - fluticasone propionate aer pow ba 50 mcg/

blister1 QL (1 inhaler/30 days)

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


FLOVENT DISKUS - fluticasone propionate aer pow ba 250 mcg/blister

1 QL (4 inhalers/30 days)

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


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


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


fluticasone propionate nasal susp 50 mcg/act 1 QL (1 bottle/30 days)

2018



FLUTICASONE PROPIONATE/SALMETEROL - fluticasone-salmeterol aer powder ba 55-14 mcg/act






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


ipratropium bromide inhal soln 0.02% 1 BDipratropium bromide nasal soln 0.03% (21 mcg/spray) 1 QL (2 bottles/30 days)ipratropium bromide nasal soln 0.06% (42 mcg/spray) 1 QL (3 bottles/30 days)KALYDECO - ivacaftor packet 50 mg 1 PA, QL (60 packets/30 days)KALYDECO - ivacaftor packet 75 mg 1 PA, QL (60 packets/30 days)KALYDECO - ivacaftor tab 150 mg 1 PA, QL (60 tablets/30 days)LETAIRIS - ambrisentan tab 5 mg* 1 PA, QL (30 tablets/30 days)LETAIRIS - ambrisentan tab 10 mg* 1 PA, QL (30 tablets/30 days)levocetirizine dihydrochloride tab 5 mg 1mometasone furoate nasal susp 50 mcg/act 1 QL (2 bottles/30 days)montelukast sodium chew tab 4 mg 1montelukast sodium chew tab 5 mg 1montelukast sodium oral granules packet 4 mg 1montelukast sodium tab 10 mg 1OFEV - nintedanib esylate cap 100 mg* 1 PA, QL (60 capsules/30 days)OFEV - nintedanib esylate cap 150 mg* 1 PA, QL (60 capsules/30 days)olopatadine hcl nasal soln 0.6% 1 QL (1 bottle/30 days)OPSUMIT - macitentan tab 10 mg* 1 PA, QL (30 tablets/30 days)ORALAIR - grass mixed pollen ext tab sl 300 ir 1 PA, QL (30 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 100-125 mg* 1 PA, QL (60 packets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 150-188 mg* 1 PA, QL (60 packets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg* 1 PA, QL (120 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg* 1 PA, QL (120 tablets/30 days)PROAIR HFA - albuterol sulfate inhal aero 108 mcg/act 1 QL (36 grams/30 days)PROAIR RESPICLICK - albuterol sulfate aer pow ba 108 mcg/act 1 QL (2 canisters/30 days)PULMOZYME - dornase alfa inhal soln 1 mg/ml 1 BDQVAR REDIHALER - beclomethasone diprop hfa breath act inh

aer 40 mcg/act1 QL (1 canister/30 days)

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


REMODULIN - treprostinil sodium inj 1 mg/ml* 1 BD

2018


99


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

dose1 QL (1 inhaler/30 days)

sildenafil citrate tab 20 mg 1 PA, QL (90 tablets/30 days)SPIRIVA HANDIHALER - tiotropium bromide monohydrate inhal

cap 18 mcg1 QL (30 capsules/30 days)

SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 1.25 mcg/act


SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 2.5 mcg/act


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


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


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


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


tadalafil tab 20 mg (pah) 1 PA, QL (60 tablets/30 days)terbutaline sulfate tab 2.5 mg 1terbutaline sulfate tab 5 mg 1theophylline tab er 12hr 100 mg 1theophylline tab er 12hr 200 mg 1theophylline tab er 12hr 300 mg 1theophylline tab er 12hr 450 mg 1theophylline tab er 24hr 400 mg 1theophylline tab er 24hr 600 mg 1tobramycin nebu soln 300 mg/5ml 1 BDTRACLEER - bosentan tab for oral susp 32 mg* 1 PA, QL (120 tablets/30 days)TRACLEER - bosentan tab 62.5 mg* 1 PA, QL (60 tablets/30 days)TRACLEER - bosentan tab 125 mg* 1 PA, QL (60 tablets/30 days)TRELEGY ELLIPTA - fluticasone-umeclidinium-vilanterol aepb

100-62.5-25 mcg/inh1 QL (60 blisters/30 days)

triamcinolone acetonide nasal aerosol suspension 55 mcg/act 1 QL (1 bottle/30 days)UPTRAVI - selexipag tab therapy pack 200 mcg (140) & 800 mcg

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

tablets)/28 days)UPTRAVI - selexipag tab 200 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 400 mcg* 1 PA, QL (60 tablets/30 days)

2018



UPTRAVI - selexipag tab 600 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 800 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1000 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1200 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1400 mcg* 1 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1600 mcg* 1 PA, QL (60 tablets/30 days)VENTAVIS - iloprost inhalation solution 10 mcg/ml 1 BD, PA, QL (270 mls/30 days)VENTAVIS - iloprost inhalation solution 20 mcg/ml 1 BD, PA, QL (270 mls/30 days)VENTOLIN HFA - albuterol sulfate inhal aero 108 mcg/act 1 QL (36 grams/30 days)zafirlukast tab 10 mg 1zafirlukast tab 20 mg 1Relajantes de los músculos esqueléticoscyclobenzaprine hcl tab 5 mg# 1 PAcyclobenzaprine hcl tab 7.5 mg# 1 PAcyclobenzaprine hcl tab 10 mg# 1 PAmethocarbamol tab 500 mg# 1 PAmethocarbamol tab 750 mg# 1 PAAgentes para tratar los trastornos del sueñoarmodafinil tab 50 mg 1 PA, QL (30 tablets/30 days)armodafinil tab 150 mg 1 PA, QL (30 tablets/30 days)armodafinil tab 200 mg 1 PA, QL (30 tablets/30 days)armodafinil tab 250 mg 1 PA, QL (30 tablets/30 days)HETLIOZ - tasimelteon capsule 20 mg* 1 PA, QL (30 capsules/30 days)modafinil tab 100 mg 1 PA, QL (30 tablets/30 days)modafinil tab 200 mg 1 PA, QL (30 tablets/30 days)SILENOR - doxepin hcl tab 3 mg 1 QL (30 tablets/30 days)SILENOR - doxepin hcl tab 6 mg 1 QL (30 tablets/30 days)temazepam cap 15 mg 1 QL (30 capsules/30 days)temazepam cap 30 mg 1 QL (30 capsules/30 days)XYREM - sodium oxybate oral solution 500 mg/ml* 1 PA, QL (540 mls/30 days)zaleplon cap 5 mg# 1 PAzaleplon cap 10 mg# 1 PAzolpidem tartrate tab 5 mg# 1 PAzolpidem tartrate tab 10 mg# 1 PA

2018

101

ÍNDICE

Aabacavir sulfate-lamivudine tab 600-300

mg................................................................................42abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg........................................................42abacavir sulfate soln 20 mg/ml.................................. 42abacavir sulfate tab 300 mg.......................................42ABRAXANE...................................................................25ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1acamprosate calcium tab delayed release 333

mg..................................................................................4acarbose tab 100 mg.................................................. 48acarbose tab 25 mg.................................................... 48acarbose tab 50 mg.................................................... 48acebutolol hcl cap 200 mg..........................................57acebutolol hcl cap 400 mg..........................................57acetaminophen w/ codeine soln 120-12

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

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

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

mg..................................................................................1acetazolamide cap er 12hr 500 mg...........................57acetazolamide tab 125 mg......................................... 57acetazolamide tab 250 mg......................................... 57ACETIC ACID/ALUMINUM ACETATE...................... 95acetic acid otic soln 2%.............................................. 95acetylcysteine inhal soln 10%.................................... 95acetylcysteine inhal soln 20%.................................... 95acitretin cap 10 mg......................................................70acitretin cap 17.5 mg...................................................70acitretin cap 25 mg......................................................70ACTHIB..........................................................................86ACTIMMUNE................................................................ 86acyclovir cap 200 mg.................................................. 42acyclovir oint 5%..........................................................42acyclovir sodium iv soln 50 mg/ml.............................42acyclovir susp 200 mg/5ml......................................... 42acyclovir tab 400 mg................................................... 42acyclovir tab 800 mg................................................... 42ADACEL........................................................................ 86ADAGEN........................................................................77ADASUVE..................................................................... 37

ADCIRCA...................................................................... 95adefovir dipivoxil tab 10 mg........................................42ADEMPAS..................................................................... 95ADEMPAS..................................................................... 95ADEMPAS..................................................................... 95ADEMPAS..................................................................... 95ADEMPAS..................................................................... 95ADVAIR DISKUS..........................................................95ADVAIR DISKUS..........................................................95ADVAIR DISKUS..........................................................96ADVAIR HFA.................................................................96ADVAIR HFA.................................................................96ADVAIR HFA.................................................................96AFINITOR......................................................................25AFINITOR......................................................................25AFINITOR......................................................................25AFINITOR......................................................................25AFINITOR DISPERZ................................................... 25AFINITOR DISPERZ................................................... 25AFINITOR DISPERZ................................................... 25ALBENZA...................................................................... 35albuterol sulfate soln nebu 0.083% (2.5

mg/3ml).......................................................................96albuterol sulfate soln nebu 0.5% (5 mg/

ml)................................................................................96albuterol sulfate soln nebu 0.63

mg/3ml........................................................................ 96albuterol sulfate soln nebu 1.25

mg/3ml........................................................................ 96albuterol sulfate syrup 2 mg/5ml................................96albuterol sulfate tab 2 mg...........................................96albuterol sulfate tab 4 mg...........................................96albuterol sulfate tab er 12hr 4 mg..............................96albuterol sulfate tab er 12hr 8 mg..............................96alclometasone dipropionate cream

0.05%..........................................................................70alclometasone dipropionate oint

0.05%..........................................................................70ALCOHOL SWABS......................................................48ALDURAZYME............................................................. 77ALECENSA................................................................... 25alendronate sodium tab 10 mg.................................. 92alendronate sodium tab 35 mg.................................. 92alendronate sodium tab 5 mg.................................... 92alendronate sodium tab 70 mg.................................. 92alfuzosin hcl tab er 24hr 10 mg................................. 79ALIMTA.......................................................................... 25ALIMTA.......................................................................... 25ALINIA............................................................................35ALINIA............................................................................35ALIQOPA....................................................................... 25allopurinol sodium for inj 500 mg...............................24

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allopurinol tab 100 mg.................................................24allopurinol tab 300 mg.................................................24alosetron hcl tab 0.5 mg............................................. 75alosetron hcl tab 1 mg................................................ 75ALOXI.............................................................................21ALPHAGAN P...............................................................93alprazolam tab 0.25 mg.............................................. 47alprazolam tab 0.5 mg................................................ 47alprazolam tab 1 mg....................................................47alprazolam tab 2 mg....................................................47ALUNBRIG....................................................................25ALUNBRIG....................................................................25ALUNBRIG....................................................................25ALUNBRIG....................................................................25amantadine hcl cap 100 mg.......................................36amantadine hcl syrup 50 mg/5ml...............................36amantadine hcl tab 100 mg........................................36AMBISOME...................................................................22amikacin sulfate inj 1 gm/4ml (250 mg/

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

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

mg................................................................................57amiloride hcl tab 5 mg.................................................57amino acid infusion 15%.............................................73amino acid infusion 6%...............................................73amiodarone hcl tab 200 mg........................................57amiodarone hcl tab 400 mg........................................57AMITIZA.........................................................................75AMITIZA.........................................................................75amitriptyline hcl tab 100 mg....................................... 18amitriptyline hcl tab 10 mg..........................................17amitriptyline hcl tab 150 mg....................................... 18amitriptyline hcl tab 25 mg..........................................17amitriptyline hcl tab 50 mg..........................................18amitriptyline hcl tab 75 mg..........................................18amlodipine besylate-atorvastatin calcium tab 10-10

mg................................................................................57amlodipine besylate-atorvastatin calcium tab 10-20



mg................................................................................57amlodipine besylate-atorvastatin calcium tab 2.5-10



mg................................................................................57

amlodipine besylate-atorvastatin calcium tab 5-10mg................................................................................57




amlodipine besylate-benazepril hcl cap 10-20mg................................................................................57


amlodipine besylate-benazepril hcl cap 2.5-10mg................................................................................57




amlodipine besylate tab 10 mg..................................57amlodipine besylate tab 2.5 mg.................................57amlodipine besylate tab 5 mg.................................... 57amlodipine besylate-valsartan tab 10-160

mg................................................................................58amlodipine besylate-valsartan tab 10-320



mg................................................................................58AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXICILLIN/CLAVULANATE

POTASSIUM................................................................ 6AMOXICILLIN/CLAVULANATE

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

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



mg/5ml.......................................................................... 5amoxicillin (trihydrate) tab 500 mg...............................5amoxicillin (trihydrate) tab 875 mg...............................5

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103

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.......................................................................... 5

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

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

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



amphetamine-dextroamphetamine cap er 24hr 10mg................................................................................68






amphetamine-dextroamphetamine tab 10mg................................................................................68

amphetamine-dextroamphetamine tab 12.5mg................................................................................68





amphetamine-dextroamphetamine tab 7.5mg................................................................................68

AMPHOTERICIN B......................................................22ampicillin & sulbactam sodium for inj 3 (2-1)

gm..................................................................................6ampicillin cap 500 mg....................................................6AMPICILLIN SODIUM................................................... 6ampicillin sodium for inj 1 gm.......................................6ampicillin sodium for inj 250 mg...................................6ampicillin sodium for inj 2 gm.......................................6ampicillin sodium for inj 500 mg...................................6ampicillin sodium for iv soln 10 gm..............................6ampicillin sodium for iv soln 2 gm................................6AMPICILLIN-SULBACTAM........................................... 6AMPYRA........................................................................68ANADROL-50............................................................... 81

anagrelide hcl cap 0.5 mg.......................................... 54anagrelide hcl cap 1 mg............................................. 54anastrozole tab 1 mg...................................................25ANDRODERM.............................................................. 81ANDRODERM.............................................................. 81ANDROGEL.................................................................. 81ANDROGEL.................................................................. 81ANDROGEL PUMP..................................................... 81ANORO ELLIPTA.........................................................96APOKYN........................................................................36aprepitant capsule 125 mg.........................................21aprepitant capsule 40 mg........................................... 21aprepitant capsule 80 mg........................................... 21aprepitant capsule therapy pack 80 & 125

mg................................................................................21APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 13APTIVUS....................................................................... 42APTIVUS....................................................................... 42ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARCALYST....................................................................86aripiprazole orally disintegrating tab 10

mg................................................................................37aripiprazole orally disintegrating tab 15

mg................................................................................37aripiprazole oral solution 1 mg/ml..............................37aripiprazole tab 10 mg................................................ 37aripiprazole tab 15 mg................................................ 37aripiprazole tab 20 mg................................................ 37aripiprazole tab 2 mg...................................................37aripiprazole tab 30 mg................................................ 37aripiprazole tab 5 mg...................................................37ARISTADA.....................................................................37ARISTADA.....................................................................38ARISTADA.....................................................................38ARISTADA.....................................................................38

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armodafinil tab 150 mg............................................. 100armodafinil tab 200 mg............................................. 100armodafinil tab 250 mg............................................. 100armodafinil tab 50 mg............................................... 100ARNUITY ELLIPTA......................................................96ARNUITY ELLIPTA......................................................96ARNUITY ELLIPTA......................................................96ARRANON.................................................................... 25ARZERRA..................................................................... 25ARZERRA..................................................................... 25ASACOL HD.................................................................91ASMANEX HFA............................................................96ASMANEX HFA............................................................96ASMANEX TWISTHALER 120 METERED

DOSES....................................................................... 96ASMANEX TWISTHALER 14 METERED





DOSES....................................................................... 96aspirin-dipyridamole cap er 12hr 25-200

mg................................................................................54ASSURE ID INSULIN SAFETY SYRINGE/

U-100/0.5ML/29G X 1/2"......................................... 48ASSURE ID INSULIN SAFETY SYRINGE/

U-100/1ML/29G X 1/2".............................................48ASSURE ID SAFETY PEN NEEDLES 31G X 5 MM

(3/16")......................................................................... 48atazanavir sulfate cap 150 mg...................................42atazanavir sulfate cap 200 mg...................................42atazanavir sulfate cap 300 mg...................................42atenolol & chlorthalidone tab 100-25

mg................................................................................58atenolol & chlorthalidone tab 50-25 mg.................... 58atenolol tab 100 mg.....................................................58atenolol tab 25 mg.......................................................58atenolol tab 50 mg.......................................................58ATGAM.......................................................................... 86atomoxetine hcl cap 100 mg...................................... 69atomoxetine hcl cap 10 mg........................................ 68atomoxetine hcl cap 18 mg........................................ 68atomoxetine hcl cap 25 mg........................................ 68atomoxetine hcl cap 40 mg........................................ 69atomoxetine hcl cap 60 mg........................................ 69atomoxetine hcl cap 80 mg........................................ 69atorvastatin calcium tab 10 mg.................................. 58atorvastatin calcium tab 20 mg.................................. 58

atorvastatin calcium tab 40 mg.................................. 58atorvastatin calcium tab 80 mg.................................. 58atovaquone-proguanil hcl tab 250-100

mg................................................................................35atovaquone-proguanil hcl tab 62.5-25

mg................................................................................35atovaquone susp 750 mg/5ml....................................35ATRIPLA........................................................................ 42ATROVENT HFA..........................................................96AVASTIN........................................................................25AVASTIN........................................................................25AVELOX...........................................................................6AVONEX........................................................................ 69AVONEX........................................................................ 69AVONEX PEN.............................................................. 69azacitidine for inj 100 mg............................................54AZACTAM........................................................................6AZACTAM........................................................................6AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 6AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 6AZASAN........................................................................ 86AZASAN........................................................................ 86AZATHIOPRINE........................................................... 86azathioprine tab 50 mg............................................... 86azelastine hcl nasal spray 0.1% (137 mcg/

spray)..........................................................................97azelastine hcl nasal spray 0.15% (205.5 mcg/

spray)..........................................................................97azelastine hcl ophth soln 0.05%................................ 93AZELEX......................................................................... 70AZITHROMYCIN............................................................ 6azithromycin for susp 100 mg/5ml...............................6azithromycin for susp 200 mg/5ml...............................6azithromycin iv for soln 500 mg................................... 6azithromycin tab 250 mg...............................................6azithromycin tab 500 mg...............................................6azithromycin tab 600 mg...............................................6AZOPT........................................................................... 93aztreonam for inj 1 gm.................................................. 6aztreonam for inj 2 gm.................................................. 6BBACITRACIN................................................................ 93bacitracin-polymyxin b ophth oint.............................. 93bacitracin-polymyxin-neomycin-hc ophth oint

1%............................................................................... 93baclofen tab 10 mg......................................................41baclofen tab 20 mg......................................................41balsalazide disodium cap 750 mg............................. 91BANZEL.........................................................................13

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BANZEL.........................................................................13BANZEL.........................................................................13BARACLUDE................................................................ 42BAVENCIO.................................................................... 26BCG VACCINE.............................................................86BELEODAQ.................................................................. 26benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................58benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................58benazepril & hydrochlorothiazide tab 20-25

mg................................................................................58benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................58benazepril hcl tab 10 mg............................................ 58benazepril hcl tab 20 mg............................................ 58benazepril hcl tab 40 mg............................................ 58benazepril hcl tab 5 mg.............................................. 58BENDEKA..................................................................... 26BENLYSTA.................................................................... 86BENLYSTA.................................................................... 86BENLYSTA.................................................................... 86BENLYSTA.................................................................... 86BENZNIDAZOLE..........................................................35BENZNIDAZOLE..........................................................35benzoyl peroxide-erythromycin gel

5-3%............................................................................70benztropine mesylate tab 0.5 mg.............................. 36benztropine mesylate tab 1 mg..................................36benztropine mesylate tab 2 mg..................................36BESIVANCE..................................................................93BESPONSA.................................................................. 26betamethasone dipropionate augmented cream

0.05%..........................................................................70betamethasone dipropionate augmented gel

0.05%..........................................................................70betamethasone dipropionate augmented lotion

0.05%..........................................................................70betamethasone dipropionate augmented oint

0.05%..........................................................................70betamethasone dipropionate cream

0.05%..........................................................................70betamethasone dipropionate lotion

0.05%..........................................................................70betamethasone dipropionate oint

0.05%..........................................................................70betamethasone valerate cream 0.1%....................... 70betamethasone valerate lotion 0.1%.........................70betamethasone valerate oint 0.1%............................70BETASERON................................................................ 69betaxolol hcl ophth soln 0.5%.................................... 93betaxolol hcl tab 10 mg...............................................58

betaxolol hcl tab 20 mg...............................................58bethanechol chloride tab 10 mg.................................79bethanechol chloride tab 25 mg.................................79bethanechol chloride tab 50 mg.................................79bethanechol chloride tab 5 mg...................................79BETOPTIC-S.................................................................93BEVYXXA......................................................................54BEVYXXA......................................................................54bexarotene cap 75 mg................................................ 26BEXSERO..................................................................... 86bicalutamide tab 50 mg...............................................26BICILLIN L-A...................................................................6BICILLIN L-A...................................................................6BICILLIN L-A...................................................................6BICNU............................................................................26BIKTARVY..................................................................... 42BILTRICIDE...................................................................35bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................58bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................58bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................58bisoprolol fumarate tab 10 mg................................... 58bisoprolol fumarate tab 5 mg..................................... 58bleomycin sulfate for inj 15 unit................................. 26bleomycin sulfate for inj 30 unit................................. 26BLINCYTO.....................................................................26BOOSTRIX....................................................................86BOSULIF....................................................................... 26BOSULIF....................................................................... 26BOSULIF....................................................................... 26BREO ELLIPTA............................................................ 97BREO ELLIPTA............................................................ 97BRILINTA.......................................................................54BRILINTA.......................................................................54brimonidine tartrate ophth soln 0.15%...................... 93brimonidine tartrate ophth soln 0.2%........................ 93BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13BRIVIACT......................................................................13bromfenac sodium ophth soln 0.09% (once-

daily)............................................................................93bromocriptine mesylate cap 5 mg..............................36bromocriptine mesylate tab 2.5 mg........................... 36budesonide delayed release particles cap 3

mg................................................................................91

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106

budesonide inhalation susp 0.25mg/2ml........................................................................ 97

budesonide inhalation susp 0.5mg/2ml........................................................................ 97

budesonide inhalation susp 1 mg/2ml.......................97bumetanide inj 0.25 mg/ml......................................... 58bumetanide tab 0.5 mg............................................... 58bumetanide tab 1 mg.................................................. 58bumetanide tab 2 mg.................................................. 58BUPHENYL...................................................................77buprenorphine hcl-naloxone hcl sl tab 2-0.5

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

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

mg..................................................................................4bupropion hcl tab 100 mg...........................................18bupropion hcl tab 75 mg.............................................18bupropion hcl tab er 12hr 100 mg............................. 18bupropion hcl tab er 12hr 150 mg............................. 18bupropion hcl tab er 12hr 200 mg............................. 18bupropion hcl tab er 24hr 150 mg............................. 18bupropion hcl tab er 24hr 300 mg............................. 18buspirone hcl tab 10 mg............................................. 47buspirone hcl tab 15 mg............................................. 47buspirone hcl tab 30 mg............................................. 47buspirone hcl tab 5 mg............................................... 47buspirone hcl tab 7.5 mg............................................ 47busulfan inj 6 mg/ml.................................................... 26butalbital-acetaminophen-caffeine cap 50-300-40

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

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

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

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

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

ml................................................................................... 1BYDUREON..................................................................48BYDUREON BCISE.....................................................48BYDUREON PEN........................................................ 48Ccabergoline tab 0.5 mg............................................... 84CABOMETYX............................................................... 26

CABOMETYX............................................................... 26CABOMETYX............................................................... 26caffeine citrate oral soln 60 mg/3ml...........................97calcipotriene cream 0.005%.......................................70calcipotriene oint 0.005%............................................70calcipotriene soln 0.005% (50 mcg/ml).....................70calcitonin (salmon) nasal soln 200 unit/

act................................................................................92calcitriol cap 0.25 mcg................................................ 92calcitriol cap 0.5 mcg...................................................92calcitriol inj 1 mcg/ml...................................................92calcitriol oral soln 1 mcg/ml........................................92calcium acetate cap 667 mg...................................... 73calcium acetate tab 667 mg....................................... 73CALQUENCE................................................................26CANASA........................................................................91CANCIDAS....................................................................22CANCIDAS....................................................................22candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg................................................................................58candesartan cilexetil-hydrochlorothiazide tab 32-12.5

mg................................................................................59candesartan cilexetil-hydrochlorothiazide tab 32-25

mg................................................................................59candesartan cilexetil tab 16 mg................................. 58candesartan cilexetil tab 32 mg................................. 58candesartan cilexetil tab 4 mg................................... 58candesartan cilexetil tab 8 mg................................... 58CAPASTAT SULFATE..................................................24CAPRELSA................................................................... 26CAPRELSA................................................................... 26captopril tab 100 mg....................................................59captopril tab 12.5 mg...................................................59captopril tab 25 mg......................................................59captopril tab 50 mg......................................................59CARAC.......................................................................... 70CARBAGLU.................................................................. 73carbamazepine cap er 12hr 100 mg......................... 13carbamazepine cap er 12hr 200 mg......................... 13carbamazepine cap er 12hr 300 mg......................... 13carbamazepine chew tab 100 mg..............................13carbamazepine susp 100 mg/5ml..............................13carbamazepine tab 200 mg........................................14carbamazepine tab er 12hr 100 mg.......................... 14carbamazepine tab er 12hr 200 mg.......................... 14carbamazepine tab er 12hr 400 mg.......................... 14CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................36CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................36CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................36

2018

107

CARBIDOPA/LEVODOPA/ENTACAPONE..........................................................36



carbidopa & levodopa orally disintegrating tab10-100 mg..................................................................36



carbidopa & levodopa tab 10-100 mg....................... 36carbidopa & levodopa tab 25-100 mg....................... 36carbidopa & levodopa tab 25-250 mg....................... 36carbidopa & levodopa tab er 25-100

mg................................................................................36carbidopa & levodopa tab er 50-200

mg................................................................................36carbidopa tab 25 mg................................................... 36carboplatin iv soln 150 mg/15ml................................ 26carboplatin iv soln 450 mg/45ml................................ 26carboplatin iv soln 50 mg/5ml.................................... 26carboplatin iv soln 600 mg/60ml................................ 26carteolol hcl ophth soln 1%........................................ 93carvedilol tab 12.5 mg.................................................59carvedilol tab 25 mg....................................................59carvedilol tab 3.125 mg...............................................59carvedilol tab 6.25 mg.................................................59caspofungin acetate for iv soln 50 mg...................... 22caspofungin acetate for iv soln 70 mg...................... 22cefaclor cap 250 mg......................................................7cefaclor cap 500 mg......................................................7cefadroxil cap 500 mg...................................................7cefadroxil for susp 250 mg/5ml....................................7cefadroxil for susp 500 mg/5ml....................................7cefadroxil tab 1 gm........................................................ 7CEFAZOLIN SODIUM................................................... 7cefazolin sodium for inj 10 gm..................................... 7cefazolin sodium for inj 1 gm....................................... 7cefazolin sodium for inj 500 mg................................... 7cefdinir cap 300 mg....................................................... 7cefdinir for susp 125 mg/5ml........................................7cefdinir for susp 250 mg/5ml........................................7cefepime hcl for inj 1 gm.............................................. 7cefepime hcl for inj 2 gm.............................................. 7CEFOTAXIME SODIUM................................................7CEFOTAXIME SODIUM................................................7CEFOTAXIME SODIUM................................................7cefotaxime sodium for inj 1 gm.................................... 7cefoxitin sodium for inj 10 gm...................................... 7cefoxitin sodium for iv soln 1 gm................................. 7

cefoxitin sodium for iv soln 2 gm................................. 7cefpodoxime proxetil for susp 100

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

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

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

DEXTROSE................................................................. 8ceftriaxone sodium for inj 10 gm..................................8ceftriaxone sodium for inj 1 gm....................................8ceftriaxone sodium for inj 250 mg................................8ceftriaxone sodium for inj 2 gm....................................8ceftriaxone sodium for inj 500 mg................................8ceftriaxone sodium for iv soln 1 gm.............................8ceftriaxone sodium for iv soln 2 gm.............................8cefuroxime axetil tab 250 mg....................................... 8cefuroxime axetil tab 500 mg....................................... 8cefuroxime sodium for inj 7.5 gm.................................8cefuroxime sodium for inj 750 mg................................8cefuroxime sodium for iv soln 1.5 gm..........................8celecoxib cap 100 mg................................................... 1celecoxib cap 200 mg................................................... 1celecoxib cap 400 mg................................................... 1celecoxib cap 50 mg......................................................1CELONTIN.................................................................... 14cephalexin cap 250 mg.................................................8cephalexin cap 500 mg.................................................8cephalexin cap 750 mg.................................................8cephalexin for susp 125 mg/5ml..................................8cephalexin for susp 250 mg/5ml..................................8CEREZYME.................................................................. 77CHANTIX......................................................................... 4CHANTIX......................................................................... 4CHANTIX CONTINUING MONTH

PACK.............................................................................5CHANTIX STARTING MONTH PACK.........................5CHEMET........................................................................73CHENODAL.................................................................. 75

2018

108

CHLORAMPHENICOL SODIUMSUCCINATE.................................................................8

chlorhexidine gluconate soln 0.12%..........................70CHLOROQUINE PHOSPHATE................................. 35chloroquine phosphate tab 500 mg...........................35CHLOROTHIAZIDE..................................................... 59chlorothiazide tab 500 mg.......................................... 59CHLORPROMAZINE HCL..........................................21CHLORPROMAZINE HCL..........................................21chlorpromazine hcl tab 100 mg..................................21chlorpromazine hcl tab 10 mg....................................21chlorpromazine hcl tab 200 mg..................................21chlorpromazine hcl tab 25 mg....................................21chlorpromazine hcl tab 50 mg....................................21chlorthalidone tab 25 mg............................................ 59chlorthalidone tab 50 mg............................................ 59cholestyramine light powder 4 gm/

dose............................................................................ 59cholestyramine light powder packets 4

gm................................................................................59cholestyramine powder 4 gm/dose............................59cholestyramine powder packets 4 gm.......................59choline fenofibrate cap dr 135 mg............................. 59choline fenofibrate cap dr 45 mg............................... 59chorionic gonadotropin for im inj 10000 unit(chorionic

gonadotropin, pregnyl)............................................. 81ciclopirox gel 0.77%.................................................... 22ciclopirox olamine cream 0.77%................................22ciclopirox olamine susp 0.77%...................................22ciclopirox shampoo 1%............................................... 22ciclopirox solution 8%..................................................22cidofovir iv inj 75 mg/ml.............................................. 42cilostazol tab 100 mg.................................................. 54cilostazol tab 50 mg.................................................... 54CIMDUO........................................................................ 42cimetidine hcl soln 300 mg/5ml..................................75cimetidine tab 200 mg.................................................75cimetidine tab 300 mg.................................................75cimetidine tab 400 mg.................................................75cimetidine tab 800 mg.................................................75CINRYZE.......................................................................86CIPRODEX....................................................................95ciprofloxacin 200 mg/100ml in d5w............................. 8ciprofloxacin 400 mg/200ml in d5w............................. 8ciprofloxacin for oral susp 250 mg/5ml (5%) (5

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

gm/100ml).....................................................................8CIPROFLOXACIN HCL.................................................8ciprofloxacin hcl ophth soln 0.3%.............................. 93ciprofloxacin hcl tab 250 mg.........................................8ciprofloxacin hcl tab 500 mg.........................................8

ciprofloxacin hcl tab 750 mg.........................................8ciprofloxacin hcl tab er 24hr 1000 mg......................... 8ciprofloxacin hcl tab er 24hr 500 mg........................... 8CISPLATIN.................................................................... 26cisplatin inj 100 mg/100ml (1 mg/ml).........................26cisplatin inj 50 mg/50ml (1 mg/ml).............................26citalopram hydrobromide oral soln 10

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

ml)................................................................................26clarithromycin for susp 125 mg/5ml.............................8clarithromycin for susp 250 mg/5ml.............................8clarithromycin tab 250 mg............................................ 8clarithromycin tab 500 mg............................................ 9clarithromycin tab er 24hr 500 mg...............................8CLEMASTINE FUMARATE........................................ 97clindamycin hcl cap 150 mg......................................... 9clindamycin hcl cap 300 mg......................................... 9clindamycin hcl cap 75 mg........................................... 9clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................70clindamycin phosphate gel 1% (generic for Cleocin-T

gel 1%)......................................................................... 9clindamycin phosphate in d5w iv soln 300

mg/50ml........................................................................ 9clindamycin phosphate in d5w iv soln 600

mg/50ml........................................................................ 9clindamycin phosphate in d5w iv soln 900

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

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

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

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

2%..................................................................................9clobetasol propionate cream 0.05%..........................70clobetasol propionate emollient base cream

0.05%..........................................................................70clobetasol propionate gel 0.05%................................70clobetasol propionate oint 0.05%.............................. 70

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clobetasol propionate soln 0.05%..............................71clofarabine iv soln 1 mg/ml.........................................26clomipramine hcl cap 25 mg...................................... 18clomipramine hcl cap 50 mg...................................... 18clomipramine hcl cap 75 mg...................................... 18clonazepam orally disintegrating tab 0.125

mg................................................................................47clonazepam orally disintegrating tab 0.25

mg................................................................................47clonazepam orally disintegrating tab 0.5

mg................................................................................47clonazepam orally disintegrating tab 1

mg................................................................................47clonazepam orally disintegrating tab 2

mg................................................................................47clonazepam tab 0.5 mg.............................................. 47clonazepam tab 1 mg..................................................47clonazepam tab 2 mg..................................................47clonidine hcl tab 0.1 mg..............................................59clonidine hcl tab 0.2 mg..............................................59clonidine hcl tab 0.3 mg..............................................59clonidine hcl tab er 12hr 0.1 mg................................ 69clonidine hcl td patch weekly 0.1

mg/24hr...................................................................... 59clonidine hcl td patch weekly 0.2

mg/24hr...................................................................... 59clonidine hcl td patch weekly 0.3

mg/24hr...................................................................... 59clopidogrel bisulfate tab 75 mg..................................55clorazepate dipotassium tab 15 mg...........................47clorazepate dipotassium tab 3.75 mg....................... 47clorazepate dipotassium tab 7.5 mg......................... 47clotrimazole cream 1%................................................22clotrimazole troche 10 mg.......................................... 22clotrimazole w/ betamethasone cream

1-0.05%...................................................................... 71clotrimazole w/ betamethasone lotion

1-0.05%...................................................................... 71clozapine orally disintegrating tab 100

mg................................................................................38clozapine orally disintegrating tab 12.5

mg................................................................................38clozapine orally disintegrating tab 25

mg................................................................................38clozapine tab 100 mg..................................................38clozapine tab 200 mg..................................................38clozapine tab 25 mg....................................................38clozapine tab 50 mg....................................................38COARTEM.....................................................................35codeine sulfate tab 15 mg............................................ 1codeine sulfate tab 30 mg............................................ 1codeine sulfate tab 60 mg............................................ 1

colchicine w/ probenecid tab 0.5-500mg................................................................................24

COLCRYS..................................................................... 24colesevelam hcl packet for susp 3.75

gm................................................................................59colesevelam hcl tab 625 mg.......................................59colestipol hcl granule packets 5 gm.......................... 59colestipol hcl granules 5 gm.......................................59colestipol hcl tab 1 gm................................................ 59colistimethate sod for inj 150 mg................................. 9COMBIGAN...................................................................93COMBIVENT RESPIMAT........................................... 97COMETRIQ...................................................................26COMETRIQ...................................................................26COMETRIQ...................................................................26COMPLERA.................................................................. 42COPAXONE.................................................................. 69CORLANOR..................................................................59CORLANOR..................................................................59CORTISONE ACETATE..............................................80COSENTYX.................................................................. 86COSENTYX SENSOREADY PEN............................ 86COSMEGEN................................................................. 26COTELLIC.....................................................................26COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55CREON..........................................................................77CREON..........................................................................77CREON..........................................................................77CREON..........................................................................77CREON..........................................................................78CRESEMBA.................................................................. 22CRESEMBA.................................................................. 22CRIXIVAN......................................................................42CRIXIVAN......................................................................42cromolyn sodium ophth soln 4%................................93cromolyn sodium oral conc 100

mg/5ml........................................................................ 75cromolyn sodium soln nebu 20 mg/2ml.................... 97cyclobenzaprine hcl tab 10 mg................................ 100cyclobenzaprine hcl tab 5 mg.................................. 100cyclobenzaprine hcl tab 7.5 mg...............................100cyclophosphamide cap 25 mg................................... 26cyclophosphamide cap 50 mg................................... 27cyclophosphamide for inj 1 gm.................................. 27

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110

cyclophosphamide for inj 2 gm.................................. 27cyclophosphamide for inj 500 mg..............................27CYCLOSERINE............................................................24CYCLOSET...................................................................48cyclosporine cap 100 mg............................................86cyclosporine cap 25 mg..............................................86cyclosporine iv soln 50 mg/ml....................................86cyclosporine modified cap 100 mg............................ 87cyclosporine modified cap 25 mg.............................. 86cyclosporine modified cap 50 mg.............................. 86cyclosporine modified oral soln 100 mg/

ml.................................................................................87CYRAMZA.....................................................................27CYRAMZA.....................................................................27CYSTADANE................................................................ 78CYSTAGON.................................................................. 78CYSTAGON.................................................................. 78CYSTARAN...................................................................93CYTARABINE............................................................... 27cytarabine inj pf 100 mg/ml........................................ 27cytarabine inj pf 20 mg/ml.......................................... 27DDACARBAZINE............................................................ 27dacarbazine for inj 200 mg.........................................27dactinomycin for inj 0.5 mg........................................ 27DAKLINZA.....................................................................42DAKLINZA.....................................................................42DAKLINZA.....................................................................42DALIRESP.....................................................................97DALIRESP.....................................................................97DALVANCE......................................................................9danazol cap 100 mg....................................................81danazol cap 200 mg....................................................81danazol cap 50 mg......................................................81dantrolene sodium cap 100 mg................................. 42dantrolene sodium cap 25 mg....................................41dantrolene sodium cap 50 mg....................................42dapsone tab 100 mg................................................... 25dapsone tab 25 mg......................................................24DAPTACEL....................................................................87daptomycin for iv soln 500 mg..................................... 9DARAPRIM................................................................... 35DARZALEX................................................................... 27DARZALEX................................................................... 27daunorubicin hcl inj 5 mg/ml.......................................27DAUNORUBICIN HYDROCHLORIDE......................27DAUNORUBICIN HYDROCHLORIDE......................27DDAVP...........................................................................81decitabine for inj 50 mg.............................................. 27DELZICOL.....................................................................91demeclocycline hcl tab 150 mg....................................9

demeclocycline hcl tab 300 mg....................................9DEMSER....................................................................... 59DENAVIR.......................................................................43DEPEN TITRATABS.................................................... 79DEPO-PROVERA........................................................ 81DESCOVY.....................................................................43desipramine hcl tab 100 mg.......................................18desipramine hcl tab 10 mg......................................... 18desipramine hcl tab 150 mg.......................................18desipramine hcl tab 25 mg......................................... 18desipramine hcl tab 50 mg......................................... 18desipramine hcl tab 75 mg......................................... 18desmopressin acetate inj 4 mcg/ml...........................81desmopressin acetate tab 0.1 mg............................. 81desmopressin acetate tab 0.2 mg............................. 81desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5)..................................................................... 81desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg................................................................................81

desogestrel & ethinyl estradiol tab 0.15 mg-30mcg..............................................................................81

desonide cream 0.05%............................................... 71desonide lotion 0.05%.................................................71desonide oint 0.05%....................................................71desoximetasone cream 0.05%...................................71desoximetasone cream 0.25%...................................71desoximetasone gel 0.05%........................................ 71desoximetasone oint 0.25%....................................... 71desvenlafaxine succinate tab er 24hr 100

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

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

mg................................................................................18DEXAMETHASONE.................................................... 80DEXAMETHASONE.................................................... 80dexamethasone elixir 0.5 mg/5ml..............................80DEXAMETHASONE SODIUM

PHOSPHATE.............................................................93dexamethasone sodium phosphate inj 120

mg/30ml......................................................................80dexamethasone sodium phosphate inj 20

mg/5ml........................................................................ 80dexamethasone sodium phosphate inj 4 mg/

ml.................................................................................80dexamethasone tab 0.5 mg........................................80dexamethasone tab 0.75 mg......................................80dexamethasone tab 1.5 mg........................................80dexamethasone tab 4 mg...........................................80dexamethasone tab 6 mg...........................................80dexmethylphenidate hcl tab 10 mg............................69

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dexmethylphenidate hcl tab 2.5 mg...........................69dexmethylphenidate hcl tab 5 mg..............................69dexrazoxane for inj 250 mg........................................27dexrazoxane for inj 500 mg........................................27dextroamphetamine sulfate cap er 24hr 10

mg................................................................................69dextroamphetamine sulfate cap er 24hr 15

mg................................................................................69dextroamphetamine sulfate cap er 24hr 5

mg................................................................................69dextroamphetamine sulfate tab 10 mg......................69dextroamphetamine sulfate tab 5 mg........................69dextrose 2.5% w/ sodium chloride

0.45%..........................................................................73dextrose 5% in lactated ringers................................. 73dextrose 5% w/ sodium chloride 0.2%...................... 73dextrose 5% w/ sodium chloride

0.33%..........................................................................73dextrose 5% w/ sodium chloride

0.45%..........................................................................73dextrose 5% w/ sodium chloride 0.9%...................... 73dextrose inj 10%.......................................................... 73dextrose inj 5%.............................................................73DIASTAT ACUDIAL......................................................14DIASTAT ACUDIAL......................................................14DIASTAT PEDIATRIC..................................................14DIAZEPAM.................................................................... 47diazepam conc 5 mg/ml..............................................47DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14diazepam tab 10 mg....................................................47diazepam tab 2 mg......................................................47diazepam tab 5 mg......................................................47diclofenac potassium tab 50 mg.................................. 1diclofenac sodium gel 1%.............................................1diclofenac sodium gel 3%...........................................71diclofenac sodium ophth soln 0.1%...........................93diclofenac sodium tab delayed release 25

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

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

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

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

mg..................................................................................1dicloxacillin sodium cap 250 mg.................................. 9dicloxacillin sodium cap 500 mg.................................. 9dicyclomine hcl tab 20 mg..........................................75

didanosine delayed release capsule 200mg................................................................................43



DIFICID............................................................................ 9diflorasone diacetate oint 0.05%................................71DIGOXIN........................................................................59digoxin tab 125 mcg (0.125 mg)................................59digoxin tab 250 mcg (0.25 mg).................................. 59DILANTIN...................................................................... 14diltiazem hcl cap er 12hr 120 mg.............................. 60diltiazem hcl cap er 12hr 60 mg.................................59diltiazem hcl cap er 12hr 90 mg.................................60diltiazem hcl cap er 24hr 120 mg.............................. 60diltiazem hcl cap er 24hr 180 mg.............................. 60diltiazem hcl cap er 24hr 240 mg.............................. 60diltiazem hcl coated beads cap er 24hr 120

mg................................................................................60diltiazem hcl coated beads cap er 24hr 180




mg................................................................................60diltiazem hcl coated beads tab er 24hr 180





mg................................................................................60diltiazem hcl extended release beads cap er 24hr

120 mg....................................................................... 60diltiazem hcl extended release beads cap er 24hr





420 mg....................................................................... 60diltiazem hcl tab 120 mg.............................................60diltiazem hcl tab 30 mg...............................................60

2018

112

diltiazem hcl tab 60 mg...............................................60diltiazem hcl tab 90 mg...............................................60DIPENTUM....................................................................92diphenhydramine hcl inj 50 mg/ml.............................97DIPHTHERIA/TETANUS TOXOIDS

ADSORBED...............................................................87dipyridamole tab 25 mg.............................................. 55dipyridamole tab 50 mg.............................................. 55dipyridamole tab 75 mg.............................................. 55disulfiram tab 250 mg....................................................5disulfiram tab 500 mg....................................................5divalproex sodium cap delayed release sprinkle 125

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



mg................................................................................14divalproex sodium tab er 24 hr 250 mg.....................14divalproex sodium tab er 24 hr 500 mg.....................14DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27DOCETAXEL.................................................................27docetaxel for inj conc 20 mg/ml................................. 27docetaxel for inj conc 80 mg/4ml (20 mg/

ml)................................................................................27docetaxel soln for iv infusion 160

mg/16ml......................................................................27docetaxel soln for iv infusion 20

mg/2ml........................................................................ 27docetaxel soln for iv infusion 80

mg/8ml........................................................................ 27dofetilide cap 125 mcg (0.125 mg)............................60dofetilide cap 250 mcg (0.25 mg).............................. 60dofetilide cap 500 mcg (0.5 mg)................................ 60donepezil hydrochloride orally disintegrating tab 10

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

mg................................................................................17donepezil hydrochloride tab 10 mg........................... 17donepezil hydrochloride tab 23 mg........................... 17donepezil hydrochloride tab 5 mg..............................17dorzolamide hcl ophth soln 2%..................................93dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml.......................................................................... 93doxazosin mesylate tab 1 mg.................................... 60

doxazosin mesylate tab 2 mg.................................... 60doxazosin mesylate tab 4 mg.................................... 60doxazosin mesylate tab 8 mg.................................... 60doxepin hcl cap 100 mg..............................................18doxepin hcl cap 10 mg................................................18doxepin hcl cap 150 mg..............................................18doxepin hcl cap 25 mg................................................18doxepin hcl cap 50 mg................................................18doxepin hcl cap 75 mg................................................18doxepin hcl conc 10 mg/ml.........................................18doxorubicin hcl for inj 10 mg...................................... 27doxorubicin hcl for inj 50 mg...................................... 27doxorubicin hcl inj 2 mg/ml.........................................27doxorubicin hcl liposomal inj (for iv infusion) 2 mg/

ml.................................................................................28doxycycline hyclate cap 100 mg..................................9doxycycline hyclate cap 50 mg.................................... 9doxycycline hyclate for inj 100 mg...............................9doxycycline hyclate tab 100 mg...................................9doxycycline hyclate tab 20 mg.....................................9doxycycline monohydrate cap 100 mg........................9doxycycline monohydrate cap 150 mg........................9doxycycline monohydrate cap 50 mg..........................9doxycycline monohydrate cap 75 mg..........................9doxycycline monohydrate tab 100 mg...................... 10doxycycline monohydrate tab 150 mg...................... 10doxycycline monohydrate tab 50 mg...........................9doxycycline monohydrate tab 75 mg...........................9dronabinol cap 10 mg................................................. 21dronabinol cap 2.5 mg................................................ 21dronabinol cap 5 mg....................................................21drospirenone-ethinyl estradiol tab 3-0.02

mg................................................................................81drospirenone-ethinyl estradiol tab 3-0.03

mg................................................................................81drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg........................................................81drospirenone-ethinyl estrad-levomefolate tab

3-0.03-0.451 mg........................................................81duloxetine hcl enteric coated pellets cap 20

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

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

mg................................................................................19DUPIXENT.................................................................... 87DUREZOL..................................................................... 93dutasteride cap 0.5 mg............................................... 79dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................79

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113

EEASY TOUCH INSULIN SYRINGE/SAFETY/

U-100/0.5ML/29G X 1/2"......................................... 48EASY TOUCH SHEATHLOCK SAFETY INSULIN

SYRINGE 1ML/29GX1/2"........................................ 48econazole nitrate cream 1%.......................................22EDURANT..................................................................... 43efavirenz cap 200 mg..................................................43efavirenz cap 50 mg....................................................43efavirenz tab 600 mg...................................................43EFFIENT........................................................................55EFFIENT........................................................................55EGRIFTA....................................................................... 81EGRIFTA....................................................................... 81ELAPRASE................................................................... 78ELELYSO.......................................................................78ELIDEL...........................................................................71ELIGARD.......................................................................84ELIGARD.......................................................................84ELIGARD.......................................................................84ELIGARD.......................................................................84ELIQUIS.........................................................................55ELIQUIS.........................................................................55ELIQUIS STARTER PACK......................................... 55ELITEK...........................................................................28ELITEK...........................................................................28ELLA...............................................................................81EMCYT.......................................................................... 28EMEND..........................................................................21EMPLICITI.....................................................................28EMPLICITI.....................................................................28EMSAM..........................................................................19EMSAM..........................................................................19EMSAM..........................................................................19EMTRIVA.......................................................................43EMTRIVA.......................................................................43enalapril maleate & hydrochlorothiazide tab 10-25

mg................................................................................60enalapril maleate & hydrochlorothiazide tab 5-12.5

mg................................................................................60enalapril maleate tab 10 mg.......................................60enalapril maleate tab 2.5 mg......................................60enalapril maleate tab 20 mg.......................................60enalapril maleate tab 5 mg.........................................60ENBREL........................................................................ 87ENBREL........................................................................ 87ENBREL........................................................................ 87ENBREL MINI...............................................................87ENBREL SURECLICK................................................ 87ENGERIX-B.................................................................. 87ENGERIX-B.................................................................. 87enoxaparin sodium inj 100 mg/ml..............................55

enoxaparin sodium inj 120 mg/0.8ml........................ 55enoxaparin sodium inj 150 mg/ml..............................55enoxaparin sodium inj 300 mg/3ml............................55enoxaparin sodium inj 30 mg/0.3ml...........................55enoxaparin sodium inj 40 mg/0.4ml...........................55enoxaparin sodium inj 60 mg/0.6ml...........................55enoxaparin sodium inj 80 mg/0.8ml...........................55entacapone tab 200 mg..............................................37entecavir tab 0.5 mg....................................................43entecavir tab 1 mg.......................................................43ENTRESTO...................................................................61ENTRESTO...................................................................61ENTRESTO...................................................................61EPCLUSA......................................................................43epinastine hcl ophth soln 0.05%................................93EPINEPHRINE............................................................. 97EPINEPHRINE............................................................. 97EPIPEN 2-PAK............................................................. 97EPIPEN-JR 2-PAK....................................................... 97epirubicin hcl iv soln 200 mg/100ml (2 mg/

ml)................................................................................28epirubicin hcl iv soln 50 mg/25ml (2 mg/

ml)................................................................................28EPIVIR HBV..................................................................43eplerenone tab 25 mg.................................................61eplerenone tab 50 mg.................................................61EPOGEN....................................................................... 55EPOGEN....................................................................... 55EPOGEN....................................................................... 55EPOGEN....................................................................... 55EPOGEN....................................................................... 55ERBITUX....................................................................... 28ERBITUX....................................................................... 28ERGOLOID MESYLATES...........................................17ERIVEDGE....................................................................28ERLEADA......................................................................28ertapenem sodium for inj 1 gm.................................. 10ERWINAZE................................................................... 28ERYPED 400................................................................10ERY-TAB....................................................................... 10ERY-TAB....................................................................... 10ERY-TAB....................................................................... 10ERYTHROCIN LACTOBIONATE...............................10ERYTHROCIN STEARATE........................................ 10erythromycin ethylsuccinate for susp 200

mg/5ml........................................................................ 10erythromycin ophth oint 5 mg/gm.............................. 94erythromycin pads 2%.................................................10erythromycin soln 2%..................................................10erythromycin tab 250 mg............................................ 10erythromycin tab 500 mg............................................ 10ESBRIET....................................................................... 97

2018

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ESBRIET....................................................................... 97ESBRIET....................................................................... 97escitalopram oxalate soln 5 mg/5ml..........................19escitalopram oxalate tab 10 mg.................................19escitalopram oxalate tab 20 mg.................................19escitalopram oxalate tab 5 mg...................................19esomeprazole magnesium cap delayed release 20

mg................................................................................75esomeprazole magnesium cap delayed release 40

mg................................................................................75ESOMEPRAZOLE SODIUM...................................... 75esomeprazole sodium for intravenous soln 40

mg................................................................................75ESTRACE......................................................................81estradiol & norethindrone acetate tab 0.5-0.1

mg................................................................................82estradiol & norethindrone acetate tab 1-0.5

mg................................................................................82estradiol tab 0.5 mg.....................................................82estradiol tab 1 mg........................................................82estradiol tab 2 mg........................................................82estradiol vaginal cream 0.1 mg/gm........................... 82estradiol vaginal tab 10 mcg...................................... 82ESTROPIPATE............................................................. 82ethambutol hcl tab 100 mg.........................................25ethambutol hcl tab 400 mg.........................................25ethosuximide cap 250 mg...........................................14ethosuximide soln 250 mg/5ml.................................. 14ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg..............................................................................82ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg..............................................................................82ETIDRONATE DISODIUM..........................................92ETIDRONATE DISODIUM..........................................92etodolac cap 200 mg.....................................................1etodolac cap 300 mg.....................................................1etodolac tab 400 mg......................................................2etodolac tab 500 mg......................................................2etodolac tab er 24hr 400 mg........................................ 1etodolac tab er 24hr 500 mg........................................ 1etodolac tab er 24hr 600 mg........................................ 2ETOPOPHOS............................................................... 28etoposide inj 100 mg/5ml (20 mg/ml)........................28etoposide inj 1 gm/50ml (20 mg/ml).......................... 28etoposide inj 500 mg/25ml (20 mg/ml)......................28EVOMELA..................................................................... 28EVOTAZ.........................................................................43exemestane tab 25 mg............................................... 28EXJADE.........................................................................73EXJADE.........................................................................73EXJADE.........................................................................73ezetimibe-simvastatin tab 10-10 mg..........................61

ezetimibe-simvastatin tab 10-20 mg..........................61ezetimibe-simvastatin tab 10-40 mg..........................61ezetimibe-simvastatin tab 10-80 mg..........................61ezetimibe tab 10 mg....................................................61FFABRAZYME................................................................ 78FABRAZYME................................................................ 78famciclovir tab 125 mg................................................43famciclovir tab 250 mg................................................43famciclovir tab 500 mg................................................43famotidine inj 200 mg/20ml........................................ 75famotidine inj 20 mg/2ml.............................................75famotidine inj 40 mg/4ml.............................................75famotidine tab 20 mg...................................................76famotidine tab 40 mg...................................................76FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT TITRATION PACK....................................... 38FARESTON...................................................................28FARYDAK......................................................................28FARYDAK......................................................................28FARYDAK......................................................................28FASLODEX................................................................... 28fat emulsion iv soln 20%.............................................73felbamate susp 600 mg/5ml....................................... 14felbamate tab 400 mg................................................. 14felbamate tab 600 mg................................................. 14felodipine tab er 24hr 10 mg...................................... 61felodipine tab er 24hr 2.5 mg..................................... 61felodipine tab er 24hr 5 mg........................................ 61fenofibrate micronized cap 134 mg........................... 61fenofibrate micronized cap 200 mg........................... 61fenofibrate micronized cap 67 mg............................. 61fenofibrate tab 145 mg................................................61fenofibrate tab 160 mg................................................61fenofibrate tab 48 mg.................................................. 61fenofibrate tab 54 mg.................................................. 61fentanyl citrate lozenge on a handle 1200

mcg................................................................................2fentanyl citrate lozenge on a handle 1600



mcg................................................................................2

2018

115

fentanyl citrate lozenge on a handle 600mcg................................................................................2

fentanyl citrate lozenge on a handle 800mcg................................................................................2

fentanyl td patch 72hr 100 mcg/hr...............................2fentanyl td patch 72hr 12 mcg/hr................................. 2fentanyl td patch 72hr 25 mcg/hr................................. 2fentanyl td patch 72hr 37.5 mcg/hr..............................2fentanyl td patch 72hr 50 mcg/hr................................. 2fentanyl td patch 72hr 62.5 mcg/hr..............................2fentanyl td patch 72hr 75 mcg/hr................................. 2fentanyl td patch 72hr 87.5 mcg/hr..............................2FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA TITRATION PACK......................................19FINACEA....................................................................... 71FINACEA....................................................................... 71finasteride tab 5 mg.....................................................79FIRAZYR....................................................................... 87FIRMAGON...................................................................84FIRMAGON...................................................................84flecainide acetate tab 100 mg....................................61flecainide acetate tab 150 mg....................................61flecainide acetate tab 50 mg...................................... 61FLOVENT DISKUS......................................................97FLOVENT DISKUS......................................................97FLOVENT DISKUS......................................................97FLOVENT HFA.............................................................97FLOVENT HFA.............................................................97FLOVENT HFA.............................................................97fluconazole for susp 10 mg/ml................................... 23fluconazole for susp 40 mg/ml................................... 23fluconazole in dextrose inj 200

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

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

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

mg/200ml....................................................................23fluconazole tab 100 mg...............................................23fluconazole tab 150 mg...............................................23fluconazole tab 200 mg...............................................23fluconazole tab 50 mg.................................................23flucytosine cap 250 mg............................................... 23flucytosine cap 500 mg............................................... 23fludarabine phosphate for inj 50 mg..........................28fludarabine phosphate inj 25 mg/ml.......................... 28fludrocortisone acetate tab 0.1 mg............................ 80fluocinolone acetonide (otic) oil 0.01%..................... 95

fluocinolone acetonide cream 0.01%........................ 71fluocinonide cream 0.05%.......................................... 71fluocinonide emulsified base cream

0.05%..........................................................................71fluocinonide gel 0.05%................................................71fluocinonide oint 0.05%...............................................71fluocinonide soln 0.05%..............................................71fluorometholone ophth susp 0.1%.............................94fluorouracil cream 5%................................................. 71fluorouracil iv soln 1 gm/20ml (50 mg/

ml)................................................................................28fluorouracil iv soln 2.5 gm/50ml (50 mg/

ml)................................................................................28fluorouracil iv soln 500 mg/10ml (50 mg/

ml)................................................................................28fluorouracil iv soln 5 gm/100ml (50 mg/

ml)................................................................................28fluorouracil soln 2%..................................................... 71fluorouracil soln 5%..................................................... 71FLUOXETINE DR........................................................ 19fluoxetine hcl cap 10 mg.............................................19fluoxetine hcl cap 20 mg.............................................19fluoxetine hcl cap 40 mg.............................................19fluoxetine hcl solution 20 mg/5ml.............................. 19fluoxetine hcl tab 10 mg..............................................19fluoxetine hcl tab 20 mg..............................................19fluphenazine decanoate inj 25 mg/ml........................38FLUPHENAZINE HCL.................................................38FLUPHENAZINE HCL.................................................38FLUPHENAZINE HCL.................................................38fluphenazine hcl tab 10 mg........................................ 38fluphenazine hcl tab 1 mg.......................................... 38fluphenazine hcl tab 2.5 mg....................................... 38fluphenazine hcl tab 5 mg.......................................... 38flurbiprofen sodium ophth soln 0.03%.......................94flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................28FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 98FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 98FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 98fluticasone propionate cream 0.05%.........................71fluticasone propionate nasal susp 50 mcg/

act................................................................................97fluticasone propionate oint 0.005%........................... 71fluvoxamine maleate tab 100 mg...............................19fluvoxamine maleate tab 25 mg.................................19fluvoxamine maleate tab 50 mg.................................19FOLOTYN......................................................................28

2018

116

FOLOTYN......................................................................28fomepizole inj 1 gm/ml (for iv infusion)......................73fondaparinux sodium subcutaneous inj 10

mg/0.8ml.....................................................................55fondaparinux sodium subcutaneous inj 2.5

mg/0.5ml.....................................................................55fondaparinux sodium subcutaneous inj 5

mg/0.4ml.....................................................................55fondaparinux sodium subcutaneous inj 7.5

mg/0.6ml.....................................................................55FORTEO........................................................................92fosamprenavir calcium tab 700 mg........................... 43fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................61fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................61fosinopril sodium tab 10 mg....................................... 61fosinopril sodium tab 20 mg....................................... 61fosinopril sodium tab 40 mg....................................... 61fosphenytoin sodium inj 100 mg/2ml.........................14fosphenytoin sodium inj 500 mg/10ml.......................14FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73FOSRENOL.................................................................. 73furosemide inj 10 mg/ml..............................................61furosemide oral soln 10 mg/ml...................................61furosemide tab 20 mg................................................. 61furosemide tab 40 mg................................................. 61furosemide tab 80 mg................................................. 61FUZEON........................................................................43FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14FYCOMPA.....................................................................14Ggabapentin cap 100 mg.............................................. 14gabapentin cap 300 mg.............................................. 14gabapentin cap 400 mg.............................................. 14gabapentin oral soln 250 mg/5ml.............................. 15gabapentin tab 600 mg............................................... 15gabapentin tab 800 mg............................................... 15GABITRIL...................................................................... 15GABITRIL...................................................................... 15GALANTAMINE HYDROBROMIDE.......................... 17galantamine hydrobromide cap er 24hr 16

mg................................................................................17

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

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

galantamine hydrobromide tab 12 mg...................... 17galantamine hydrobromide tab 4 mg.........................17galantamine hydrobromide tab 8 mg.........................17GAMMAGARD LIQUID............................................... 87GAMMAGARD LIQUID............................................... 87GAMMAGARD LIQUID............................................... 87GAMMAGARD LIQUID............................................... 87GAMMAGARD LIQUID............................................... 87GAMMAGARD LIQUID............................................... 87GAMMAGARD S/D......................................................87GAMMAGARD S/D......................................................87GAMMAPLEX............................................................... 87GAMMAPLEX............................................................... 87GAMMAPLEX............................................................... 87GAMMAPLEX............................................................... 87GAMMAPLEX............................................................... 87GAMMAPLEX............................................................... 87GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88GAMUNEX-C................................................................ 88ganciclovir sodium for inj 500 mg.............................. 43GARDASIL 9.................................................................88GARDASIL 9.................................................................88GATTEX.........................................................................76GAUZE PADS 2" X 2".................................................48GAZYVA.........................................................................28gemcitabine hcl for inj 1 gm....................................... 28gemcitabine hcl for inj 200 mg...................................28gemcitabine hcl for inj 2 gm....................................... 29gemcitabine hcl inj 1 gm/26.3ml (38 mg/

ml)................................................................................29gemcitabine hcl inj 200 mg/5.26ml (38 mg/

ml)................................................................................29gemcitabine hcl inj 2 gm/52.6ml (38 mg/

ml)................................................................................29gemfibrozil tab 600 mg............................................... 61gentamicin in saline inj 0.8 mg/ml............................. 10gentamicin in saline inj 1.2 mg/ml............................. 10gentamicin in saline inj 1.6 mg/ml............................. 10gentamicin in saline inj 1 mg/ml.................................10gentamicin sulfate cream 0.1%..................................71gentamicin sulfate inj 10 mg/ml................................. 10gentamicin sulfate inj 40 mg/ml................................. 10gentamicin sulfate oint 0.1%...................................... 71gentamicin sulfate ophth oint 0.3%........................... 94

2018

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gentamicin sulfate ophth soln 0.3%...........................94GENVOYA.....................................................................43GEODON.......................................................................38GILOTRIF......................................................................29GILOTRIF......................................................................29GILOTRIF......................................................................29glatiramer acetate soln prefilled syringe 20 mg/

ml.................................................................................69glatiramer acetate soln prefilled syringe 40 mg/

ml.................................................................................69GLEOSTINE..................................................................29GLEOSTINE..................................................................29GLEOSTINE..................................................................29glimepiride tab 1 mg....................................................48glimepiride tab 2 mg....................................................48glimepiride tab 4 mg....................................................48glipizide-metformin hcl tab 2.5-250 mg.....................48glipizide-metformin hcl tab 2.5-500 mg.....................49glipizide-metformin hcl tab 5-500 mg........................ 49glipizide tab 10 mg...................................................... 48glipizide tab 5 mg.........................................................48glipizide tab er 24hr 10 mg.........................................48glipizide tab er 24hr 2.5 mg........................................48glipizide tab er 24hr 5 mg...........................................48GLUCAGEN HYPOKIT............................................... 49GLUCAGON EMERGENCY KIT............................... 49glycopyrrolate tab 1 mg.............................................. 76glycopyrrolate tab 2 mg.............................................. 76granisetron hcl inj 1 mg/ml......................................... 21granisetron hcl inj 4 mg/4ml (1 mg/ml)......................21granisetron hcl tab 1 mg.............................................21GRANIX......................................................................... 55GRANIX......................................................................... 55griseofulvin microsize susp 125

mg/5ml........................................................................ 23griseofulvin ultramicrosize tab 125 mg......................23griseofulvin ultramicrosize tab 250 mg......................23GUANIDINE HCL.........................................................24HH.P. ACTHAR............................................................... 80HAEGARDA.................................................................. 88HAEGARDA.................................................................. 88HALAVEN...................................................................... 29halobetasol propionate cream 0.05%........................71halobetasol propionate oint 0.05%............................ 71haloperidol decanoate im soln 100 mg/

ml.................................................................................38haloperidol decanoate im soln 50 mg/

ml.................................................................................38haloperidol lactate inj 5 mg/ml................................... 38haloperidol lactate oral conc 2 mg/ml........................38

haloperidol tab 0.5 mg................................................ 38haloperidol tab 10 mg................................................. 39haloperidol tab 1 mg....................................................38haloperidol tab 20 mg................................................. 39haloperidol tab 2 mg....................................................38haloperidol tab 5 mg....................................................38HARVONI...................................................................... 43HAVRIX..........................................................................88HAVRIX..........................................................................88heparin sodium (porcine) 40 unit/ml in

d5w..............................................................................56heparin sodium (porcine) inj 10000 unit/

ml.................................................................................56heparin sodium (porcine) inj 1000 unit/



ml.................................................................................56heparin sodium (porcine) pf inj 5000

unit/0.5ml....................................................................56HEPATAMINE............................................................... 74HERCEPTIN................................................................. 29HERCEPTIN................................................................. 29HETLIOZ..................................................................... 100HEXALEN......................................................................29HIBERIX........................................................................ 88HUMALOG.................................................................... 49HUMALOG.................................................................... 49HUMALOG JUNIOR KWIKPEN.................................49HUMALOG KWIKPEN.................................................49HUMALOG KWIKPEN.................................................49HUMALOG MIX 50/50.................................................49HUMALOG MIX 50/50 KWIKPEN............................. 49HUMALOG MIX 75/25.................................................49HUMALOG MIX 75/25 KWIKPEN............................. 49HUMIRA.........................................................................88HUMIRA.........................................................................88HUMIRA.........................................................................88HUMIRA.........................................................................88HUMIRA.........................................................................88HUMIRA.........................................................................88HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................88HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................88HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................88HUMIRA PEN............................................................... 88HUMIRA PEN............................................................... 88HUMIRA PEN-CD/UC/HS STARTER........................88HUMIRA PEN-CD/UC/HS STARTER........................88

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HUMIRA PEN-PS/UV STARTER...............................89HUMIRA PEN-PS/UV STARTER...............................89HUMULIN 70/30...........................................................49HUMULIN 70/30 KWIKPEN....................................... 49HUMULIN N..................................................................49HUMULIN N KWIKPEN.............................................. 49HUMULIN R..................................................................49HUMULIN R U-500 (CONCENTRATE).....................49HUMULIN R U-500 KWIKPEN...................................49hydralazine hcl tab 100 mg........................................ 61hydralazine hcl tab 10 mg.......................................... 61hydralazine hcl tab 25 mg.......................................... 61hydralazine hcl tab 50 mg.......................................... 61hydrochlorothiazide cap 12.5 mg...............................62hydrochlorothiazide tab 12.5 mg................................62hydrochlorothiazide tab 25 mg...................................62hydrochlorothiazide tab 50 mg...................................62hydrocodone-acetaminophen soln 7.5-325

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

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



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

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

mg..................................................................................2hydrocodone-ibuprofen tab 10-200 mg.......................2hydrocodone-ibuprofen tab 5-200 mg......................... 2hydrocodone-ibuprofen tab 7.5-200 mg......................2hydrocortisone butyrate cream 0.1%........................ 71hydrocortisone butyrate hydrophilic lipo base cream

0.1%............................................................................71hydrocortisone butyrate oint 0.1%.............................71hydrocortisone butyrate soln 0.1%............................ 71hydrocortisone cream 1%...........................................71hydrocortisone cream 2.5%........................................71hydrocortisone enema 100 mg/60ml.........................92hydrocortisone lotion 2.5%......................................... 71hydrocortisone oint 1%............................................... 71hydrocortisone oint 2.5%............................................ 72hydrocortisone rectal cream 1%................................ 92hydrocortisone rectal cream 2.5%.............................92hydrocortisone tab 10 mg...........................................80hydrocortisone tab 20 mg...........................................80hydrocortisone tab 5 mg............................................. 80hydrocortisone valerate cream 0.2%.........................72hydrocortisone valerate oint 0.2%............................. 72

hydrocortisone w/ acetic acid otic soln1-2%............................................................................95

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

ml................................................................................... 2hydromorphone hcl tab 2 mg....................................... 2hydromorphone hcl tab 4 mg....................................... 2hydromorphone hcl tab 8 mg....................................... 2hydroxychloroquine sulfate tab 200 mg.................... 35HYDROXYPROGESTERONE

CAPROATE................................................................82hydroxyurea cap 500 mg............................................ 29hydroxyzine hcl syrup 10 mg/5ml.............................. 47hydroxyzine hcl tab 10 mg..........................................47hydroxyzine hcl tab 25 mg..........................................47hydroxyzine hcl tab 50 mg..........................................47Iibandronate sodium iv soln 3 mg/3ml........................92ibandronate sodium tab 150 mg................................ 92IBRANCE.......................................................................29IBRANCE.......................................................................29IBRANCE.......................................................................29ibuprofen susp 100 mg/5ml.......................................... 2ibuprofen tab 400 mg.................................................... 2ibuprofen tab 600 mg.................................................... 2ibuprofen tab 800 mg.................................................... 2ICLUSIG........................................................................ 29ICLUSIG........................................................................ 29idarubicin hcl iv inj 10 mg/10ml (1 mg/

ml)................................................................................29idarubicin hcl iv inj 20 mg/20ml (1 mg/

ml)................................................................................29idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................29IDHIFA............................................................................29IDHIFA............................................................................29IFEX............................................................................... 29IFOSFAMIDE................................................................ 29ifosfamide for inj 1 gm.................................................29ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 29ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 29ILARIS............................................................................89ILEVRO..........................................................................94imatinib mesylate tab 100 mg.................................... 29imatinib mesylate tab 400 mg.................................... 29IMBRUVICA.................................................................. 29IMBRUVICA.................................................................. 29IMBRUVICA.................................................................. 29IMBRUVICA.................................................................. 29IMBRUVICA.................................................................. 29IMBRUVICA.................................................................. 29IMFINZI..........................................................................30

2018

119

IMFINZI..........................................................................30imipenem-cilastatin intravenous for soln 250

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

mg................................................................................10imipramine hcl tab 10 mg........................................... 19imipramine hcl tab 25 mg........................................... 19imipramine hcl tab 50 mg........................................... 19imiquimod cream 5%...................................................72IMLYGIC........................................................................ 30IMLYGIC........................................................................ 30IMOVAX RABIES (H.D.C.V.)...................................... 89IMPAVIDO..................................................................... 10INCRELEX.................................................................... 81INCRUSE ELLIPTA..................................................... 98indapamide tab 1.25 mg............................................. 62indapamide tab 2.5 mg............................................... 62INFANRIX......................................................................89INJECTION DEVICE FOR INSULIN......................... 49INLYTA...........................................................................30INLYTA...........................................................................30INSULIN PEN NEEDLE 29 G X 10

MM.............................................................................. 49INSULIN PEN NEEDLE 29 G X 12.7

MM.............................................................................. 49INSULIN PEN NEEDLE 29 G X 5 MM

(3/16")......................................................................... 49INSULIN PEN NEEDLE 29 G X 8 MM

(5/16")......................................................................... 49INSULIN PEN NEEDLE 30 G X 5 MM

(3/16")......................................................................... 49INSULIN PEN NEEDLE 30 G X 8 MM (1/3" OR

5/16")...........................................................................49INSULIN PEN NEEDLE 31 G X 4 MM

(1/6")........................................................................... 49INSULIN PEN NEEDLE 32 G X 5 MM (1/5" OR


(5/32")......................................................................... 49INSULIN PEN NEEDLE 33 G X 5 MM (1/5" OR


(1/4")........................................................................... 50INSULIN PEN NEEDLE 33 G X 8 MM (1/3" OR

5/16")...........................................................................50INSULIN SYRINGE/NEEDLE U-100 0.3 ML 28 X

1/2".............................................................................. 50INSULIN SYRINGE/NEEDLE U-100 0.3 ML 29

G..................................................................................50INSULIN SYRINGE/NEEDLE U-100 0.3 ML 29 X

1"................................................................................. 50

INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30G..................................................................................50

INSULIN SYRINGE/NEEDLE U-100 0.3 ML 30 X1/2".............................................................................. 50

INSULIN SYRINGE/NEEDLE U-100 0.3 ML 31 X1/4" (6 MM)................................................................ 50

INSULIN SYRINGE/NEEDLE U-100 0.3 ML 31 X15/64"..........................................................................50

INSULIN SYRINGE/NEEDLE U-100 0.5 ML 30 X3/16" (5 MM)..............................................................50

INSULIN SYRINGE/NEEDLE U-100 0.5 ML 31 X1/4" (6 MM)................................................................ 50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 27 X1/2".............................................................................. 50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 28 X5/16"............................................................................50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 29G..................................................................................50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 29 X5/16"............................................................................50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 30G..................................................................................50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 30 X3/8".............................................................................. 50

INSULIN SYRINGE/NEEDLE U-100 1/2 ML 31 X15/64"..........................................................................50

INSULIN SYRINGE/NEEDLE U-100 1 ML 25 X1"................................................................................. 50

INSULIN SYRINGE/NEEDLE U-100 1 ML 25 X5/8".............................................................................. 50




INSULIN SYRINGE/NEEDLE U-100 1 ML 28 X5/16"............................................................................50

INSULIN SYRINGE/NEEDLE U-100 1 ML 29 X5/16"............................................................................50

INSULIN SYRINGE/NEEDLE U-100 1 ML 30G..................................................................................50


INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X3/16" (5 MM)..............................................................50

INSULIN SYRINGE/NEEDLE U-100 1 ML 31 X1/4" (6 MM)................................................................ 50

INSULIN SYRINGE/NEEDLE U-100 1 ML 31 X15/64"..........................................................................50

INSULIN SYRINGE/NEEDLE U-100 2 ML 27.5 X5/8".............................................................................. 50

2018

120


INSULIN SYRINGE/NEEDLE U-500 0.5 ML 31G X6MM (15/64").............................................................50

INSULIN SYRINGE (DISP) U-100 0.3ML................................................................................50

INSULIN SYRINGE (DISP) U-100 1/2ML................................................................................50

INSULIN SYRINGE (DISP) U-100 1ML................................................................................50

INTELENCE.................................................................. 43INTELENCE.................................................................. 43INTELENCE.................................................................. 43INTRON A.....................................................................43INTRON A.....................................................................43INTRON A.....................................................................43INTRON A.....................................................................43INTRON A.....................................................................43INTRON A W/DILUENT..............................................43INTRON A W/DILUENT..............................................43INTRON A W/DILUENT..............................................43INVANZ.......................................................................... 10INVANZ.......................................................................... 10INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVIRASE......................................................................43INVIRASE......................................................................44INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET.................................................................51INVOKAMET.................................................................51INVOKAMET XR..........................................................51INVOKAMET XR..........................................................51INVOKAMET XR..........................................................51INVOKAMET XR..........................................................51INVOKANA....................................................................51INVOKANA....................................................................51IPOL INACTIVATED IPV.............................................89ipratropium bromide inhal soln 0.02%.......................98ipratropium bromide nasal soln 0.03% (21 mcg/

spray)..........................................................................98ipratropium bromide nasal soln 0.06% (42 mcg/

spray)..........................................................................98irbesartan-hydrochlorothiazide tab 150-12.5

mg................................................................................62

irbesartan-hydrochlorothiazide tab 300-12.5mg................................................................................62

irbesartan tab 150 mg.................................................62irbesartan tab 300 mg.................................................62irbesartan tab 75 mg................................................... 62IRESSA..........................................................................30IRINOTECAN................................................................30irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................30irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 30ISENTRESS..................................................................44ISENTRESS..................................................................44ISENTRESS..................................................................44ISENTRESS..................................................................44ISENTRESS HD...........................................................44ISONIAZID.................................................................... 25isoniazid tab 100 mg................................................... 25isoniazid tab 300 mg................................................... 25isosorbide dinitrate tab 10 mg....................................62isosorbide dinitrate tab 20 mg....................................62isosorbide dinitrate tab 30 mg....................................62isosorbide dinitrate tab 5 mg......................................62isosorbide mononitrate tab 10 mg............................. 62isosorbide mononitrate tab 20 mg............................. 62isosorbide mononitrate tab er 24hr 120

mg................................................................................62isosorbide mononitrate tab er 24hr 30

mg................................................................................62isosorbide mononitrate tab er 24hr 60

mg................................................................................62isotretinoin cap 10 mg.................................................72isotretinoin cap 20 mg.................................................72isotretinoin cap 30 mg.................................................72isotretinoin cap 40 mg.................................................72isradipine cap 2.5 mg..................................................62isradipine cap 5 mg..................................................... 62ISTALOL........................................................................ 94ISTODAX.......................................................................30ISTODAX (OVERFILL)................................................30itraconazole cap 100 mg............................................ 23ivermectin tab 3 mg.....................................................35IXEMPRA KIT...............................................................30IXEMPRA KIT...............................................................30IXIARO...........................................................................89JJADENU........................................................................ 74JADENU........................................................................ 74JADENU........................................................................ 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74

2018

121

JAKAFI...........................................................................30JAKAFI...........................................................................30JAKAFI...........................................................................30JAKAFI...........................................................................30JAKAFI...........................................................................30JANUMET......................................................................51JANUMET......................................................................51JANUMET XR...............................................................51JANUMET XR...............................................................51JANUMET XR...............................................................51JANUVIA........................................................................51JANUVIA........................................................................51JANUVIA........................................................................51JARDIANCE..................................................................51JARDIANCE..................................................................51JEVTANA.......................................................................30JULUCA.........................................................................44JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62JUXTAPID..................................................................... 62KKADCYLA......................................................................30KADCYLA......................................................................30KALETRA...................................................................... 44KALETRA...................................................................... 44KALYDECO...................................................................98KALYDECO...................................................................98KALYDECO...................................................................98kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

inj................................................................................. 74kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2%



inj................................................................................. 74kcl 20 meq/l (0.15%) in nacl 0.45% inj......................74kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45%


inj................................................................................. 74KEPIVANCE..................................................................70ketoconazole cream 2%..............................................23ketoconazole shampoo 2%........................................ 23ketoconazole tab 200 mg........................................... 23ketoprofen cap 75 mg................................................... 3ketorolac tromethamine ophth soln

0.4%............................................................................94

ketorolac tromethamine ophth soln0.5%............................................................................94

KEYTRUDA...................................................................30KINERET....................................................................... 89KINRIX........................................................................... 89KISQALI.........................................................................30KISQALI FEMARA 200 DOSE...................................30KISQALI FEMARA 400 DOSE...................................30KISQALI FEMARA 600 DOSE...................................30KOMBIGLYZE XR........................................................51KOMBIGLYZE XR........................................................51KOMBIGLYZE XR........................................................51KORLYM........................................................................84KUVAN...........................................................................78KUVAN...........................................................................78KUVAN...........................................................................78KYNAMRO.................................................................... 62KYPROLIS.................................................................... 30KYPROLIS.................................................................... 30KYPROLIS.................................................................... 30Llabetalol hcl tab 100 mg..............................................62labetalol hcl tab 200 mg..............................................62labetalol hcl tab 300 mg..............................................62LACRISERT.................................................................. 94lactated ringer's solution............................................. 74lactic acid (ammonium lactate) cream

12%............................................................................. 72lactic acid (ammonium lactate) lotion

12%............................................................................. 72lactulose (encephalopathy) solution 10

gm/15ml......................................................................76lactulose solution 10 gm/15ml....................................76lamivudine oral soln 10 mg/ml................................... 44lamivudine tab 100 mg (hbv)......................................44lamivudine tab 150 mg................................................44lamivudine tab 300 mg................................................44lamivudine-zidovudine tab 150-300 mg.................... 44lamotrigine tab 100 mg............................................... 15lamotrigine tab 150 mg............................................... 15lamotrigine tab 200 mg............................................... 15lamotrigine tab 25 mg................................................. 15lamotrigine tab chewable dispersible 25

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

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

mg................................................................................76lansoprazole cap delayed release 30

mg................................................................................76

2018

122

lanthanum carbonate chew tab 1000mg................................................................................74



LANTUS.........................................................................51LANTUS SOLOSTAR..................................................51LARTRUVO...................................................................30LARTRUVO...................................................................30latanoprost ophth soln 0.005%.................................. 94LATUDA.........................................................................39LATUDA.........................................................................39LATUDA.........................................................................39LATUDA.........................................................................39LATUDA.........................................................................39LAZANDA........................................................................ 3LAZANDA........................................................................ 3LAZANDA........................................................................ 3leflunomide tab 10 mg.................................................89leflunomide tab 20 mg.................................................89LENVIMA 10 MG DAILY DOSE.................................31LENVIMA 12MG DAILY DOSE..................................31LENVIMA 14 MG DAILY DOSE.................................31LENVIMA 18 MG DAILY DOSE.................................31LENVIMA 20 MG DAILY DOSE.................................31LENVIMA 24 MG DAILY DOSE.................................31LENVIMA 4 MG DAILY DOSE...................................31LENVIMA 8 MG DAILY DOSE...................................31LETAIRIS.......................................................................98LETAIRIS.......................................................................98letrozole tab 2.5 mg.....................................................31LEUCOVORIN CALCIUM...........................................31LEUCOVORIN CALCIUM...........................................31LEUCOVORIN CALCIUM...........................................31leucovorin calcium for inj 100 mg.............................. 31leucovorin calcium for inj 200 mg.............................. 31leucovorin calcium for inj 350 mg.............................. 31leucovorin calcium for inj 50 mg................................ 31leucovorin calcium tab 25 mg.................................... 31leucovorin calcium tab 5 mg.......................................31LEUKERAN...................................................................31LEUKINE....................................................................... 56leuprolide acetate inj kit 5 mg/ml............................... 84LEVEMIR.......................................................................51LEVEMIR FLEXTOUCH..............................................51levetiracetam inj 500 mg/5ml (100 mg/

ml)................................................................................15levetiracetam in sodium chloride iv soln 1000

mg/100ml....................................................................15levetiracetam in sodium chloride iv soln 1500

mg/100ml....................................................................15

levetiracetam in sodium chloride iv soln 500mg/100ml....................................................................15

levetiracetam oral soln 100 mg/ml.............................15levetiracetam tab 1000 mg......................................... 15levetiracetam tab 250 mg........................................... 15levetiracetam tab 500 mg........................................... 15levetiracetam tab 750 mg........................................... 15levobunolol hcl ophth soln 0.5%................................ 94levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 74levocarnitine tab 330 mg............................................ 74levocetirizine dihydrochloride tab 5 mg.....................98levofloxacin in d5w iv soln 250

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

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

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

0.15-0.03 mg............................................................. 82levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg..............................................................................82levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg..............................................................................82levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg........................82levonorgestrel-ethinyl estradiol (continuous) tab

90-20 mcg..................................................................82levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7)...................................................................82levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7)...................................................................82LEVORPHANOL TARTRATE....................................... 3levothyroxine sodium tab 100 mcg............................83levothyroxine sodium tab 112 mcg............................ 83levothyroxine sodium tab 125 mcg............................83levothyroxine sodium tab 137 mcg............................83levothyroxine sodium tab 150 mcg............................83levothyroxine sodium tab 175 mcg............................84levothyroxine sodium tab 200 mcg............................84levothyroxine sodium tab 25 mcg..............................83levothyroxine sodium tab 300 mcg............................84levothyroxine sodium tab 50 mcg..............................83levothyroxine sodium tab 75 mcg..............................83levothyroxine sodium tab 88 mcg..............................83LEXIVA...........................................................................44LEXIVA...........................................................................44

2018

123

LIDOCAINE HCL..........................................................62lidocaine hcl gel 2%.......................................................4lidocaine hcl soln 4%.....................................................4lidocaine hcl viscous soln 2%.......................................4lidocaine oint 5%............................................................4lidocaine patch 5%.........................................................4lidocaine-prilocaine cream 2.5-2.5%........................... 4LINDANE....................................................................... 36LINEZOLID....................................................................10linezolid for susp 100 mg/5ml.................................... 10linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................10linezolid tab 600 mg.................................................... 11LINZESS........................................................................76LINZESS........................................................................76LINZESS........................................................................76liothyronine sodium tab 25 mcg.................................84liothyronine sodium tab 50 mcg.................................84liothyronine sodium tab 5 mcg................................... 84lisinopril & hydrochlorothiazide tab 10-12.5

mg................................................................................62lisinopril & hydrochlorothiazide tab 20-12.5

mg................................................................................62lisinopril & hydrochlorothiazide tab 20-25

mg................................................................................62lisinopril tab 10 mg...................................................... 63lisinopril tab 2.5 mg..................................................... 62lisinopril tab 20 mg...................................................... 63lisinopril tab 30 mg...................................................... 63lisinopril tab 40 mg...................................................... 63lisinopril tab 5 mg.........................................................63LITHIUM........................................................................ 48lithium carbonate cap 150 mg....................................48lithium carbonate cap 300 mg....................................48lithium carbonate cap 600 mg....................................48lithium carbonate tab 300 mg.....................................48lithium carbonate tab er 300 mg................................48lithium carbonate tab er 450 mg................................48LONSURF..................................................................... 31LONSURF..................................................................... 31loperamide hcl cap 2 mg............................................ 76lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................44lorazepam tab 0.5 mg................................................. 47lorazepam tab 1 mg.................................................... 48lorazepam tab 2 mg.................................................... 48losartan potassium & hydrochlorothiazide tab

100-12.5 mg.............................................................. 63losartan potassium & hydrochlorothiazide tab 100-25

mg................................................................................63losartan potassium & hydrochlorothiazide tab

50-12.5 mg.................................................................63

losartan potassium tab 100 mg..................................63losartan potassium tab 25 mg....................................63losartan potassium tab 50 mg....................................63LOTEMAX..................................................................... 94LOTEMAX..................................................................... 94LOTEMAX..................................................................... 94lovastatin tab 10 mg....................................................63lovastatin tab 20 mg....................................................63lovastatin tab 40 mg....................................................63loxapine succinate cap 10 mg....................................39loxapine succinate cap 25 mg....................................39loxapine succinate cap 50 mg....................................39loxapine succinate cap 5 mg......................................39LUMIGAN...................................................................... 94LUMIZYME....................................................................78LUPRON DEPOT (1-MONTH)...................................84LUPRON DEPOT (1-MONTH)...................................84LUPRON DEPOT (3-MONTH)...................................84LUPRON DEPOT (3-MONTH)...................................85LUPRON DEPOT (4-MONTH)...................................85LUPRON DEPOT (6-MONTH)...................................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (1-MONTH)..........................85LUPRON DEPOT-PED (3-MONTH)..........................85LUPRON DEPOT-PED (3-MONTH)..........................85LYNPARZA....................................................................31LYNPARZA....................................................................31LYNPARZA....................................................................31LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYSODREN...................................................................84Mmagnesium sulfate inj 50%........................................ 74malathion lotion 0.5%..................................................36MAPROTILINE HCL.................................................... 19MAPROTILINE HCL.................................................... 19MAPROTILINE HCL.................................................... 19MARPLAN..................................................................... 19MARQIBO......................................................................31MATULANE...................................................................31MAVYRET..................................................................... 44meclizine hcl tab 12.5 mg...........................................21medroxyprogesterone acetate im susp 150 mg/

ml.................................................................................82

2018

124

medroxyprogesterone acetate im susp prefilled syr150 mg/ml.................................................................. 82

medroxyprogesterone acetate tab 10mg................................................................................82

medroxyprogesterone acetate tab 2.5mg................................................................................82

medroxyprogesterone acetate tab 5mg................................................................................82

mefloquine hcl tab 250 mg......................................... 36megestrol acetate susp 40 mg/ml..............................82megestrol acetate tab 20 mg..................................... 82megestrol acetate tab 40 mg..................................... 82MEKINIST......................................................................31MEKINIST......................................................................31meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3melphalan hcl for inj 50 mg........................................ 31memantine hcl oral solution 2 mg/ml.........................17memantine hcl tab 10 mg...........................................17memantine hcl tab 5 mg............................................. 17memantine hcl tab 5 mg (28) & 10 mg (21) titration

pak...............................................................................17MENACTRA.................................................................. 89MENVEO....................................................................... 89mercaptopurine tab 50 mg......................................... 31meropenem iv for soln 1 gm...................................... 11meropenem iv for soln 500 mg.................................. 11mesalamine enema 4 gm........................................... 92mesalamine rectal enema 4 gm & cleanser wipe

kit................................................................................. 92mesalamine tab delayed release 800

mg................................................................................92mesna inj 100 mg/ml...................................................31MESNEX........................................................................31MESTINON................................................................... 24metformin hcl tab 1000 mg.........................................51metformin hcl tab 500 mg...........................................51metformin hcl tab 850 mg...........................................51metformin hcl tab er 24hr 500 mg............................. 51metformin hcl tab er 24hr 750 mg............................. 51methadone hcl tab 10 mg.............................................3methadone hcl tab 5 mg............................................... 3methazolamide tab 25 mg.......................................... 63methazolamide tab 50 mg.......................................... 63methenamine hippurate tab 1 gm..............................11methimazole tab 10 mg.............................................. 86methimazole tab 5 mg.................................................86methocarbamol tab 500 mg..................................... 100methocarbamol tab 750 mg..................................... 100METHOTREXATE SODIUM.......................................89methotrexate sodium for inj 1 gm.............................. 89

methotrexate sodium inj 50 mg/2ml (25 mg/ml)................................................................................89

methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml)................................................................................89



methotrexate sodium tab 2.5 mg............................... 89methoxsalen rapid cap 10 mg....................................72methscopolamine bromide tab 2.5 mg......................76methscopolamine bromide tab 5 mg......................... 76methylergonovine maleate tab 0.2 mg......................79methylphenidate hcl tab 10 mg..................................69methylphenidate hcl tab 20 mg..................................69methylphenidate hcl tab 5 mg....................................69methylphenidate hcl tab er 20 mg............................. 69methylprednisolone sod succ for inj 1000

mg................................................................................80methylprednisolone sod succ for inj 125

mg................................................................................80methylprednisolone sod succ for inj 40

mg................................................................................80methylprednisolone tab 16 mg...................................80methylprednisolone tab 32 mg...................................80methylprednisolone tab 4 mg.....................................80methylprednisolone tab 8 mg.....................................80methylprednisolone tab therapy pack 4 mg

(21)..............................................................................80methyltestosterone cap 10 mg...................................82metoclopramide hcl inj 5 mg/ml................................. 76metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................76metoclopramide hcl tab 10 mg...................................76metoclopramide hcl tab 5 mg.....................................76metolazone tab 10 mg................................................ 63metolazone tab 2.5 mg............................................... 63metolazone tab 5 mg...................................................63metoprolol & hydrochlorothiazide tab 100-25

mg................................................................................63metoprolol & hydrochlorothiazide tab 50-25

mg................................................................................63metoprolol succinate tab er 24hr 100




mg................................................................................63metoprolol tartrate tab 100 mg...................................63metoprolol tartrate tab 25 mg.....................................63

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125

metoprolol tartrate tab 50 mg.....................................63METRONIDAZOLE...................................................... 11metronidazole cap 375 mg.........................................11metronidazole cream 0.75%.......................................72metronidazole gel 0.75%............................................ 72metronidazole gel 1%..................................................72metronidazole in nacl 0.79% iv soln 500

mg/100ml....................................................................11metronidazole iv soln 5 mg/ml................................... 11metronidazole lotion 0.75%........................................ 72metronidazole tab 250 mg..........................................11metronidazole tab 500 mg..........................................11metronidazole vaginal gel 0.75%...............................11mexiletine hcl cap 150 mg..........................................63mexiletine hcl cap 200 mg..........................................63mexiletine hcl cap 250 mg..........................................63MIACALCIN...................................................................92midodrine hcl tab 10 mg............................................. 63midodrine hcl tab 2.5 mg............................................ 63midodrine hcl tab 5 mg............................................... 63MIGERGOT...................................................................24miglustat cap 100 mg..................................................78MIGRANAL....................................................................24minocycline hcl cap 100 mg.......................................11minocycline hcl cap 50 mg......................................... 11minocycline hcl cap 75 mg......................................... 11minocycline hcl tab 100 mg........................................11minocycline hcl tab 50 mg..........................................11minocycline hcl tab 75 mg..........................................11minoxidil tab 10 mg..................................................... 63minoxidil tab 2.5 mg.................................................... 63mirtazapine orally disintegrating tab 15

mg................................................................................19mirtazapine orally disintegrating tab 30

mg................................................................................19mirtazapine orally disintegrating tab 45

mg................................................................................19mirtazapine tab 15 mg................................................ 19mirtazapine tab 30 mg................................................ 20mirtazapine tab 45 mg................................................ 20mirtazapine tab 7.5 mg............................................... 19misoprostol tab 100 mcg............................................ 76misoprostol tab 200 mcg............................................ 76mitomycin for iv soln 20 mg....................................... 32mitomycin for iv soln 40 mg....................................... 32mitomycin for iv soln 5 mg..........................................32mitoxantrone hcl inj conc 20 mg/10ml (2 mg/

ml)................................................................................32mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/

ml)................................................................................32mitoxantrone hcl inj conc 30 mg/15ml (2 mg/

ml)................................................................................32

M-M-R II........................................................................ 89modafinil tab 100 mg.................................................100modafinil tab 200 mg.................................................100moexipril hcl tab 15 mg...............................................63moexipril hcl tab 7.5 mg..............................................63moexipril-hydrochlorothiazide tab 15-12.5

mg................................................................................64moexipril-hydrochlorothiazide tab 15-25

mg................................................................................64moexipril-hydrochlorothiazide tab 7.5-12.5

mg................................................................................64mometasone furoate cream 0.1%............................. 72mometasone furoate nasal susp 50 mcg/

act................................................................................98mometasone furoate oint 0.1%..................................72mometasone furoate solution 0.1%

(lotion).........................................................................72MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.3ML/29GX1/2".......................................51MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/0.5ML/29G X 1/2".................................... 52MONOJECT INSULIN SYRINGE/SAFETY/PERM

NEEDLE/1ML/29G X 1/2"........................................52montelukast sodium chew tab 4 mg..........................98montelukast sodium chew tab 5 mg..........................98montelukast sodium oral granules packet 4

mg................................................................................98montelukast sodium tab 10 mg..................................98MORPHINE SULFATE.................................................. 3MORPHINE SULFATE.................................................. 3morphine sulfate inj pf 0.5 mg/ml.................................3morphine sulfate inj pf 1 mg/ml....................................3morphine sulfate oral soln 100 mg/5ml (20 mg/

ml)..................................................................................3morphine sulfate oral soln 10 mg/5ml......................... 3morphine sulfate oral soln 20 mg/5ml......................... 3morphine sulfate tab er 100 mg...................................3morphine sulfate tab er 15 mg..................................... 3morphine sulfate tab er 200 mg...................................3morphine sulfate tab er 30 mg..................................... 3morphine sulfate tab er 60 mg..................................... 3MOVIPREP................................................................... 76MOXEZA........................................................................94MOXIFLOXACIN HCL................................................. 11moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................11moxifloxacin hcl ophth soln 0.5%.............................. 94moxifloxacin hcl tab 400 mg.......................................11MOZOBIL...................................................................... 56MULTAQ........................................................................ 64mupirocin oint 2%........................................................ 72MUSTARGEN............................................................... 32

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MYALEPT...................................................................... 76MYCAMINE...................................................................23MYCAMINE...................................................................23mycophenolate mofetil cap 250 mg...........................89mycophenolate mofetil for oral susp 200 mg/

ml.................................................................................89mycophenolate mofetil hcl for iv soln 500

mg................................................................................89mycophenolate mofetil tab 500 mg........................... 89mycophenolate sodium tab dr 180 mg......................89mycophenolate sodium tab dr 360 mg......................89MYLOTARG.................................................................. 32Nnabumetone tab 500 mg...............................................3nabumetone tab 750 mg...............................................3nadolol tab 20 mg........................................................64nadolol tab 40 mg........................................................64nadolol tab 80 mg........................................................64NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................11nafcillin sodium for inj 1 gm........................................11nafcillin sodium for inj 2 gm........................................11nafcillin sodium for iv soln 10 gm.............................. 11NAGLAZYME................................................................78NALOXONE HCL........................................................... 5NALOXONE HCL........................................................... 5naloxone hcl inj 0.4 mg/ml............................................5naloxone hcl inj 4 mg/10ml...........................................5naltrexone hcl tab 50 mg.............................................. 5naproxen sodium tab 275 mg.......................................3naproxen sodium tab 550 mg.......................................3naproxen susp 125 mg/5ml.......................................... 3naproxen tab 250 mg.................................................... 3naproxen tab 375 mg.................................................... 3naproxen tab 500 mg.................................................... 3naproxen tab ec 375 mg...............................................3naproxen tab ec 500 mg...............................................3naratriptan hcl tab 1 mg..............................................24naratriptan hcl tab 2.5 mg...........................................24NARCAN..........................................................................5NATACYN......................................................................94nateglinide tab 120 mg............................................... 52nateglinide tab 60 mg..................................................52NATPARA...................................................................... 92NATPARA...................................................................... 92NATPARA...................................................................... 92NATPARA...................................................................... 92NEBUPENT...................................................................36NEFAZODONE HCL....................................................20NEFAZODONE HCL....................................................20NEFAZODONE HCL....................................................20

nefazodone hcl tab 250 mg........................................20nefazodone hcl tab 50 mg..........................................20neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin..........................94neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml............................. 94neomycin-polymyxin b gu irrigation

soln..............................................................................11neomycin-polymyxin-dexamethasone ophth oint

0.1%............................................................................94neomycin-polymyxin-dexamethasone ophth susp

0.1%............................................................................94neomycin-polymyxin-hc otic soln 1%........................ 95neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%.................................................................. 95neomycin sulfate tab 500 mg.....................................11NERLYNX......................................................................32NEULASTA....................................................................56NEULASTA ONPRO KIT............................................ 56NEUPOGEN..................................................................56NEUPOGEN..................................................................56NEUPOGEN..................................................................56NEUPOGEN..................................................................56NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37nevirapine susp 50 mg/5ml........................................ 44nevirapine tab 200 mg................................................ 44nevirapine tab er 24hr 100 mg...................................44nevirapine tab er 24hr 400 mg...................................44NEXAVAR......................................................................32NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76NEXIUM.........................................................................76niacin tab er 1000 mg................................................. 64niacin tab er 500 mg................................................... 64niacin tab er 750 mg................................................... 64nicardipine hcl cap 20 mg...........................................64nicardipine hcl cap 30 mg...........................................64NICOTROL INHALER................................................... 5NICOTROL NS............................................................... 5nifedipine tab er 24hr 30 mg...................................... 64nifedipine tab er 24hr 60 mg...................................... 64nifedipine tab er 24hr 90 mg...................................... 64nifedipine tab er 24hr osmotic release 30

mg................................................................................64

2018

127

nifedipine tab er 24hr osmotic release 60mg................................................................................64

nifedipine tab er 24hr osmotic release 90mg................................................................................64

nilutamide tab 150 mg.................................................32nimodipine cap 30 mg.................................................64NINLARO.......................................................................32NINLARO.......................................................................32NINLARO.......................................................................32NIPENT..........................................................................32NISOLDIPINE ER........................................................ 64nisoldipine tab er 24hr 17 mg.................................... 64nisoldipine tab er 24hr 34 mg.................................... 64nisoldipine tab er 24hr 8.5 mg................................... 64NITRO-BID....................................................................64nitrofurantoin macrocrystalline cap 100

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

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

mg................................................................................11nitrofurantoin susp 25 mg/5ml....................................11nitroglycerin sl tab 0.3 mg.......................................... 64nitroglycerin sl tab 0.4 mg.......................................... 64nitroglycerin sl tab 0.6 mg.......................................... 64nitroglycerin td patch 24hr 0.1 mg/hr.........................64nitroglycerin td patch 24hr 0.2 mg/hr.........................64nitroglycerin td patch 24hr 0.4 mg/hr.........................64nitroglycerin td patch 24hr 0.6 mg/hr.........................64nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................64nizatidine cap 150 mg.................................................76nizatidine cap 300 mg.................................................76norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg.................................................................82norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg.................................................................82norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg..............................................................................82norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg..............................................................................82norethindrone & ethinyl estradiol tab 1 mg-35

mcg..............................................................................82norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg.................................................................82norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg..............................................................................82norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg..............................................................................82norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg..............................................................................82

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20mcg (24).....................................................................83

norethindrone acetate tab 5 mg.................................83norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg.......................................................................82norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg.......................................................................83norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35

mg-mcg.......................................................................83norethindrone tab 0.35 mg......................................... 83norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg..............................................................................83norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.........................83norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg.........................83norgestrel & ethinyl estradiol tab 0.3 mg-30

mcg..............................................................................83NORMOSOL-M IN D5W............................................. 74NORTHERA.................................................................. 64NORTHERA.................................................................. 64NORTHERA.................................................................. 64nortriptyline hcl cap 10 mg......................................... 20nortriptyline hcl cap 25 mg......................................... 20nortriptyline hcl cap 50 mg......................................... 20nortriptyline hcl cap 75 mg......................................... 20nortriptyline hcl soln 10 mg/5ml................................. 20NORVIR.........................................................................44NORVIR.........................................................................44NORVIR.........................................................................44NORVIR.........................................................................44NOXAFIL....................................................................... 23NOXAFIL....................................................................... 23NOXAFIL....................................................................... 23NUEDEXTA...................................................................69NULOJIX........................................................................89NUPLAZID.....................................................................39NUPLAZID.....................................................................39NUPLAZID.....................................................................39nystatin cream 100000 unit/gm..................................23nystatin oint 100000 unit/gm...................................... 23nystatin susp 100000 unit/ml......................................23nystatin tab 500000 unit..............................................23nystatin topical powder 100000 unit/

gm................................................................................23nystatin-triamcinolone cream 100000-0.1 unit/gm-

%..................................................................................72nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................72OOCALIVA....................................................................... 78

2018

128

OCALIVA....................................................................... 78octreotide acetate inj 1000 mcg/ml (1 mg/

ml)................................................................................85octreotide acetate inj 100 mcg/ml (0.1 mg/




ml)................................................................................85ODEFSEY..................................................................... 44ODOMZO...................................................................... 32OFEV............................................................................. 98OFEV............................................................................. 98ofloxacin ophth soln 0.3%...........................................94ofloxacin otic soln 0.3%.............................................. 95ofloxacin tab 400 mg...................................................11olanzapine for im inj 10 mg........................................ 39olanzapine orally disintegrating tab 10

mg................................................................................39olanzapine orally disintegrating tab 15



mg................................................................................39olanzapine tab 10 mg..................................................40olanzapine tab 15 mg..................................................40olanzapine tab 2.5 mg.................................................39olanzapine tab 20 mg..................................................40olanzapine tab 5 mg....................................................39olanzapine tab 7.5 mg.................................................39olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................65olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................65olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg....................................................................65olmesartan medoxomil tab 20 mg............................. 64olmesartan medoxomil tab 40 mg............................. 64olmesartan medoxomil tab 5 mg............................... 64olopatadine hcl nasal soln 0.6%................................ 98olopatadine hcl ophth soln 0.1%................................94olopatadine hcl ophth soln 0.2%................................94omega-3-acid ethyl esters cap 1 gm.........................65omeprazole cap delayed release 10

mg................................................................................76omeprazole cap delayed release 20

mg................................................................................76omeprazole cap delayed release 40

mg................................................................................76

OMNITROPE................................................................ 81OMNITROPE................................................................ 81OMNITROPE................................................................ 81ONCASPAR.................................................................. 32ondansetron hcl inj 40 mg/20ml (2 mg/

ml)................................................................................21ondansetron hcl inj 4 mg/2ml (2 mg/

ml)................................................................................21ondansetron hcl oral soln 4 mg/5ml.......................... 21ondansetron hcl tab 24 mg.........................................22ondansetron hcl tab 4 mg...........................................21ondansetron hcl tab 8 mg...........................................22ondansetron orally disintegrating tab 4

mg................................................................................22ondansetron orally disintegrating tab 8

mg................................................................................22ONFI...............................................................................15ONFI...............................................................................15ONFI...............................................................................15ONGLYZA......................................................................52ONGLYZA......................................................................52ONIVYDE...................................................................... 32OPDIVO.........................................................................32OPDIVO.........................................................................32OPDIVO.........................................................................32OPSUMIT...................................................................... 98ORACEA........................................................................72ORALAIR.......................................................................98ORENCIA...................................................................... 89ORENCIA...................................................................... 89ORENCIA...................................................................... 89ORENCIA...................................................................... 90ORENCIA CLICKJECT............................................... 90ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORFADIN.......................................................................78ORKAMBI......................................................................98ORKAMBI......................................................................98ORKAMBI......................................................................98ORKAMBI......................................................................98oseltamivir phosphate cap 30 mg..............................44oseltamivir phosphate cap 45 mg..............................44oseltamivir phosphate cap 75 mg..............................44oseltamivir phosphate for susp 6 mg/

ml.................................................................................44OTEZLA.........................................................................90OTEZLA.........................................................................90oxaliplatin for iv inj 100 mg.........................................32oxaliplatin for iv inj 50 mg...........................................32oxaliplatin iv soln 100 mg/20ml..................................32

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129

oxaliplatin iv soln 50 mg/10ml....................................32oxandrolone tab 10 mg............................................... 83oxandrolone tab 2.5 mg..............................................83oxaprozin tab 600 mg....................................................3oxcarbazepine susp 300 mg/5ml (60 mg/

ml)................................................................................15oxcarbazepine tab 150 mg.........................................15oxcarbazepine tab 300 mg.........................................15oxcarbazepine tab 600 mg.........................................15oxybutynin chloride syrup 5 mg/5ml..........................79oxybutynin chloride tab 5 mg..................................... 79oxybutynin chloride tab er 24hr 10 mg......................79oxybutynin chloride tab er 24hr 15 mg......................79oxybutynin chloride tab er 24hr 5 mg........................79oxycodone-aspirin tab 4.8355-325 mg........................4oxycodone hcl tab 10 mg..............................................3oxycodone hcl tab 15 mg..............................................3oxycodone hcl tab 20 mg..............................................3oxycodone hcl tab 30 mg..............................................3oxycodone hcl tab 5 mg................................................3oxycodone w/ acetaminophen tab 10-325

mg..................................................................................4oxycodone w/ acetaminophen tab 2.5-325

mg..................................................................................3oxycodone w/ acetaminophen tab 5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 7.5-325

mg..................................................................................4OZEMPIC...................................................................... 52OZEMPIC...................................................................... 52Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................32paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................32paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................32paliperidone tab er 24hr 1.5 mg.................................40paliperidone tab er 24hr 3 mg....................................40paliperidone tab er 24hr 6 mg....................................40paliperidone tab er 24hr 9 mg....................................40palonosetron hcl iv soln 0.25 mg/5ml........................22PALONOSETRON

HYDROCHLORIDE.................................................. 22PANRETIN.....................................................................32pantoprazole sodium ec tab 20 mg........................... 77pantoprazole sodium ec tab 40 mg........................... 77pantoprazole sodium for iv soln 40 mg..................... 77paricalcitol cap 1 mcg................................................. 92paricalcitol cap 2 mcg................................................. 92paricalcitol cap 4 mcg................................................. 92paricalcitol iv soln 2 mcg/ml....................................... 92

paricalcitol iv soln 5 mcg/ml....................................... 92paromomycin sulfate cap 250 mg..............................11paroxetine hcl tab 10 mg............................................ 20paroxetine hcl tab 20 mg............................................ 20paroxetine hcl tab 30 mg............................................ 20paroxetine hcl tab 40 mg............................................ 20PASER........................................................................... 25PAXIL............................................................................. 20PAZEO........................................................................... 94PEDIARIX......................................................................90PEDVAX HIB................................................................ 90peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................77peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................77peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................77PEGANONE..................................................................15PEGASYS..................................................................... 44PEGASYS..................................................................... 44PEGASYS PROCLICK................................................44PEGASYS PROCLICK................................................44penicillin g potassium for inj 20000000

unit...............................................................................11penicillin g potassium for inj 5000000

unit...............................................................................11PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 11PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN G SODIUM............................................. 12penicillin v potassium for soln 125

mg/5ml........................................................................ 12penicillin v potassium for soln 250

mg/5ml........................................................................ 12penicillin v potassium tab 250 mg............................. 12penicillin v potassium tab 500 mg............................. 12PENTACEL....................................................................90PENTAM 300................................................................36pentoxifylline tab er 400 mg....................................... 65perindopril erbumine tab 2 mg................................... 65perindopril erbumine tab 4 mg................................... 65perindopril erbumine tab 8 mg................................... 65PERJETA.......................................................................32permethrin cream 5%..................................................36perphenazine tab 16 mg.............................................22perphenazine tab 2 mg............................................... 22perphenazine tab 4 mg............................................... 22perphenazine tab 8 mg............................................... 22phenelzine sulfate tab 15 mg.....................................20

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PHENOBARBITAL....................................................... 15PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16phenobarbital elixir 20 mg/5ml...................................16PHENOBARBITAL SODIUM...................................... 16PHENOBARBITAL SODIUM...................................... 16phenobarbital tab 16.2 mg..........................................16phenobarbital tab 32.4 mg..........................................16phenobarbital tab 64.8 mg..........................................16phenobarbital tab 97.2 mg..........................................16phenoxybenzamine hcl cap 10 mg............................65phenytoin chew tab 50 mg......................................... 16phenytoin sodium extended cap 100

mg................................................................................16phenytoin sodium extended cap 200

mg................................................................................16phenytoin sodium extended cap 300

mg................................................................................16phenytoin susp 125 mg/5ml....................................... 16PHOSLYRA...................................................................74PHOSPHOLINE IODIDE.............................................94PICATO..........................................................................72PICATO..........................................................................72pilocarpine hcl ophth soln 1%.................................... 94pilocarpine hcl ophth soln 2%.................................... 94pilocarpine hcl ophth soln 4%.................................... 94pilocarpine hcl tab 5 mg..............................................70pilocarpine hcl tab 7.5 mg.......................................... 70pimozide tab 1 mg....................................................... 40pimozide tab 2 mg....................................................... 40pindolol tab 10 mg....................................................... 65pindolol tab 5 mg......................................................... 65pioglitazone hcl-glimepiride tab 30-2

mg................................................................................52pioglitazone hcl-glimepiride tab 30-4

mg................................................................................52pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................52pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................52pioglitazone hcl tab 15 mg..........................................52pioglitazone hcl tab 30 mg..........................................52pioglitazone hcl tab 45 mg..........................................52piperacillin sod-tazobactam na for inj 3.375 gm

(3-0.375 gm)..............................................................12piperacillin sod-tazobactam sod for inj 2.25 gm

(2-0.25 gm)................................................................ 12piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5

gm).............................................................................. 12piroxicam cap 10 mg..................................................... 4piroxicam cap 20 mg..................................................... 4

PLEGRIDY.................................................................... 69PLEGRIDY.................................................................... 69PLEGRIDY STARTER PACK..................................... 69PLEGRIDY STARTER PACK..................................... 69podofilox soln 0.5%..................................................... 72polyethylene glycol 3350 oral packet........................ 77polyethylene glycol 3350 oral powder.......................77polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%...................................................................... 94POMALYST...................................................................32POMALYST...................................................................32POMALYST...................................................................32POMALYST...................................................................32PORTRAZZA................................................................ 32POTASSIUM CHLORIDE/DEXTROSE.....................74POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................74POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................74potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 74potassium chloride cap er 10 meq............................ 74potassium chloride cap er 8 meq...............................74potassium chloride inj 2 meq/ml................................ 74potassium chloride microencapsulated crys er tab 10

meq............................................................................. 74potassium chloride microencapsulated crys er tab 20

meq............................................................................. 74potassium chloride oral soln 10% (20

meq/15ml).................................................................. 74potassium chloride tab er 10 meq............................. 74potassium chloride tab er 8 meq (600

mg).............................................................................. 74potassium citrate tab er 10 meq (1080



mg).............................................................................. 74PRADAXA..................................................................... 56PRADAXA..................................................................... 56PRADAXA..................................................................... 56PRALUENT................................................................... 65PRALUENT................................................................... 65pramipexole dihydrochloride tab 0.125

mg................................................................................37pramipexole dihydrochloride tab 0.25



mg................................................................................37

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131

pramipexole dihydrochloride tab 1.5mg................................................................................37

pramipexole dihydrochloride tab 1 mg...................... 37prasugrel hcl tab 10 mg..............................................56prasugrel hcl tab 5 mg................................................ 56pravastatin sodium tab 10 mg....................................65pravastatin sodium tab 20 mg....................................65pravastatin sodium tab 40 mg....................................65pravastatin sodium tab 80 mg....................................65praziquantel tab 600 mg............................................. 36prazosin hcl cap 1 mg.................................................65prazosin hcl cap 2 mg.................................................65prazosin hcl cap 5 mg.................................................65prednicarbate cream 0.1%......................................... 72prednicarbate oint 0.1%..............................................72prednisolone acetate ophth susp 1%........................94prednisolone sod phosphate oral soln 15

mg/5ml........................................................................ 80prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base).............................................................80prednisolone syrup 15 mg/5ml...................................80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80PREDNISONE.............................................................. 80prednisone tab 10 mg................................................. 81prednisone tab 1 mg................................................... 80prednisone tab 2.5 mg................................................ 80prednisone tab 20 mg................................................. 81prednisone tab 5 mg................................................... 81PREMARIN................................................................... 83PREMPHASE............................................................... 83PREMPRO.................................................................... 83PREMPRO.................................................................... 83PREMPRO.................................................................... 83PREMPRO.................................................................... 83PREZCOBIX................................................................. 44PREZISTA..................................................................... 44PREZISTA..................................................................... 44PREZISTA..................................................................... 45PREZISTA..................................................................... 45PREZISTA..................................................................... 45PRIFTIN.........................................................................25PRIMAQUINE PHOSPHATE......................................36primidone tab 250 mg................................................. 16primidone tab 50 mg................................................... 16PROAIR HFA................................................................98PROAIR RESPICLICK................................................ 98probenecid tab 500 mg............................................... 24prochlorperazine edisylate inj 5 mg/ml......................22

prochlorperazine maleate tab 10 mg.........................22prochlorperazine maleate tab 5 mg...........................22prochlorperazine suppos 25 mg................................ 22PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROGLYCEM............................................................... 52PROGRAF.....................................................................90PROLASTIN-C..............................................................78PROLASTIN-C..............................................................78PROLENSA...................................................................94PROLEUKIN................................................................. 32PROLIA..........................................................................92PROMACTA.................................................................. 56PROMACTA.................................................................. 56PROMACTA.................................................................. 56PROMACTA.................................................................. 56promethazine hcl suppos 12.5 mg............................ 22promethazine hcl suppos 25 mg................................22promethazine hcl syrup 6.25 mg/5ml........................ 22promethazine hcl tab 12.5 mg....................................22promethazine hcl tab 25 mg.......................................22promethazine hcl tab 50 mg.......................................22propafenone hcl cap er 12hr 225 mg........................ 65propafenone hcl cap er 12hr 325 mg........................ 65propafenone hcl cap er 12hr 425 mg........................ 65propafenone hcl tab 150 mg...................................... 65propafenone hcl tab 225 mg...................................... 65propafenone hcl tab 300 mg...................................... 65propranolol hcl cap er 24hr 120 mg.......................... 65propranolol hcl cap er 24hr 160 mg.......................... 65propranolol hcl cap er 24hr 60 mg.............................65propranolol hcl cap er 24hr 80 mg.............................65propranolol hcl inj 1 mg/ml......................................... 65propranolol hcl tab 10 mg...........................................65propranolol hcl tab 20 mg...........................................65propranolol hcl tab 40 mg...........................................65propranolol hcl tab 60 mg...........................................65propranolol hcl tab 80 mg...........................................65propylthiouracil tab 50 mg.......................................... 86PROQUAD.................................................................... 90protriptyline hcl tab 10 mg.......................................... 20protriptyline hcl tab 5 mg............................................ 20PULMOZYME............................................................... 98PURIXAN.......................................................................32PYLERA.........................................................................77pyrazinamide tab 500 mg........................................... 25pyridostigmine bromide tab 60 mg............................ 24pyridostigmine bromide tab er 180 mg......................24

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132

QQUADRACEL................................................................90quetiapine fumarate tab 100 mg................................40quetiapine fumarate tab 200 mg................................40quetiapine fumarate tab 25 mg..................................40quetiapine fumarate tab 300 mg................................40quetiapine fumarate tab 400 mg................................40quetiapine fumarate tab 50 mg..................................40quetiapine fumarate tab er 24hr 150

mg................................................................................40quetiapine fumarate tab er 24hr 200



mg................................................................................40quetiapine fumarate tab er 24hr 50 mg.....................40quinapril hcl tab 10 mg............................................... 66quinapril hcl tab 20 mg............................................... 66quinapril hcl tab 40 mg............................................... 66quinapril hcl tab 5 mg..................................................66quinapril-hydrochlorothiazide tab 10-12.5

mg................................................................................66quinapril-hydrochlorothiazide tab 20-12.5

mg................................................................................66quinapril-hydrochlorothiazide tab 20-25

mg................................................................................66quinidine gluconate tab er 324 mg............................ 66QUINIDINE SULFATE................................................. 66QUINIDINE SULFATE................................................. 66QVAR REDIHALER..................................................... 98QVAR REDIHALER..................................................... 98RRABAVERT................................................................... 90raloxifene hcl tab 60 mg............................................. 83ramipril cap 1.25 mg....................................................66ramipril cap 10 mg.......................................................66ramipril cap 2.5 mg......................................................66ramipril cap 5 mg.........................................................66RANEXA........................................................................66RANEXA........................................................................66ranitidine hcl cap 150 mg........................................... 77ranitidine hcl cap 300 mg........................................... 77ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................77ranitidine hcl tab 150 mg............................................ 77ranitidine hcl tab 300 mg............................................ 77RAPAFLO...................................................................... 79RAPAFLO...................................................................... 79RAPAMUNE.................................................................. 90rasagiline mesylate tab 0.5 mg.................................. 37

rasagiline mesylate tab 1 mg..................................... 37REBETOL......................................................................45RECOMBIVAX HB....................................................... 90RECOMBIVAX HB....................................................... 90RECOMBIVAX HB....................................................... 90REGRANEX.................................................................. 72RELENZA DISKHALER.............................................. 45RELISTOR.....................................................................77RELISTOR.....................................................................77RELISTOR.....................................................................77REMICADE................................................................... 90REMODULIN................................................................ 98REMODULIN................................................................ 99REMODULIN................................................................ 99REMODULIN................................................................ 99RENFLEXIS.................................................................. 90RENVELA......................................................................75repaglinide tab 0.5 mg................................................ 52repaglinide tab 1 mg....................................................52repaglinide tab 2 mg....................................................52REPATHA...................................................................... 66REPATHA PUSHTRONEX SYSTEM........................66REPATHA SURECLICK.............................................. 66RESCRIPTOR.............................................................. 45RESCRIPTOR.............................................................. 45RESTASIS.....................................................................94RESTASIS MULTIDOSE.............................................94RETROVIR IV INFUSION...........................................45REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REXULTI........................................................................40REXULTI........................................................................40REXULTI........................................................................40REXULTI........................................................................40REXULTI........................................................................40REXULTI........................................................................40REYATAZ.......................................................................45REYATAZ.......................................................................45REYATAZ.......................................................................45REYATAZ.......................................................................45RIBASPHERE...............................................................45RIBASPHERE...............................................................45RIBASPHERE RIBAPAK.............................................45RIBASPHERE RIBAPAK.............................................45ribavirin cap 200 mg....................................................45ribavirin for inhal soln 6 gm........................................ 99ribavirin tab 200 mg.....................................................45RIDAURA...................................................................... 90

2018

133

rifabutin cap 150 mg....................................................25rifampin cap 150 mg....................................................25rifampin cap 300 mg....................................................25rifampin for inj 600 mg................................................ 25riluzole tab 50 mg........................................................ 69rimantadine hydrochloride tab 100 mg......................45risedronate sodium tab 150 mg................................. 93risedronate sodium tab 30 mg................................... 93risedronate sodium tab 35 mg................................... 93risedronate sodium tab 5 mg..................................... 93risedronate sodium tab delayed release 35

mg................................................................................93RISPERDAL CONSTA................................................ 40RISPERDAL CONSTA................................................ 40RISPERDAL CONSTA................................................ 40RISPERDAL CONSTA................................................ 40risperidone orally disintegrating tab 0.25

mg................................................................................40risperidone orally disintegrating tab 0.5

mg................................................................................40risperidone orally disintegrating tab 1




mg................................................................................40risperidone soln 1 mg/ml............................................ 40risperidone tab 0.25 mg..............................................40risperidone tab 0.5 mg................................................ 41risperidone tab 1 mg................................................... 41risperidone tab 2 mg................................................... 41risperidone tab 3 mg................................................... 41risperidone tab 4 mg................................................... 41ritonavir tab 100 mg.................................................... 45RITUXAN.......................................................................33RITUXAN.......................................................................33RITUXAN HYCELA......................................................33RITUXAN HYCELA......................................................33rivastigmine tartrate cap 1.5 mg................................ 17rivastigmine tartrate cap 3 mg....................................17rivastigmine tartrate cap 4.5 mg................................ 17rivastigmine tartrate cap 6 mg....................................17rivastigmine td patch 24hr 13.3

mg/24hr...................................................................... 17rivastigmine td patch 24hr 4.6 mg/24hr.....................17rivastigmine td patch 24hr 9.5 mg/24hr.....................17rizatriptan benzoate oral disintegrating tab 10

mg................................................................................24rizatriptan benzoate oral disintegrating tab 5

mg................................................................................24

rizatriptan benzoate tab 10 mg.................................. 24rizatriptan benzoate tab 5 mg.................................... 24ropinirole hydrochloride tab 0.25 mg.........................37ropinirole hydrochloride tab 0.5 mg...........................37ropinirole hydrochloride tab 1 mg.............................. 37ropinirole hydrochloride tab 2 mg.............................. 37ropinirole hydrochloride tab 3 mg.............................. 37ropinirole hydrochloride tab 4 mg.............................. 37ropinirole hydrochloride tab 5 mg.............................. 37rosuvastatin calcium tab 10 mg................................. 66rosuvastatin calcium tab 20 mg................................. 66rosuvastatin calcium tab 40 mg................................. 66rosuvastatin calcium tab 5 mg................................... 66ROTARIX.......................................................................90ROTATEQ......................................................................90RUBRACA.....................................................................33RUBRACA.....................................................................33RUBRACA.....................................................................33RYDAPT........................................................................ 33SSABRIL.......................................................................... 16SABRIL.......................................................................... 16SAMSCA........................................................................75SAMSCA........................................................................75SANDIMMUNE............................................................. 90SANTYL.........................................................................72SAPHRIS.......................................................................41SAPHRIS.......................................................................41SAPHRIS.......................................................................41selegiline hcl cap 5 mg............................................... 37selegiline hcl tab 5 mg................................................ 37selenium sulfide lotion 2.5%.......................................72SELZENTRY.................................................................45SELZENTRY.................................................................45SELZENTRY.................................................................45SELZENTRY.................................................................45SELZENTRY.................................................................45SENSIPAR.....................................................................93SENSIPAR.....................................................................93SENSIPAR.....................................................................93SEREVENT DISKUS...................................................99sertraline hcl oral concentrate for solution 20 mg/

ml.................................................................................20sertraline hcl tab 100 mg............................................ 20sertraline hcl tab 25 mg.............................................. 20sertraline hcl tab 50 mg.............................................. 20sevelamer carbonate packet 0.8 gm......................... 75sevelamer carbonate packet 2.4 gm......................... 75sevelamer carbonate tab 800 mg..............................75SHINGRIX..................................................................... 90SIGNIFOR..................................................................... 85

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SIGNIFOR..................................................................... 85SIGNIFOR..................................................................... 85SIGNIFOR LAR............................................................85SIGNIFOR LAR............................................................85SIGNIFOR LAR............................................................85sildenafil citrate tab 20 mg..........................................99SILENOR.....................................................................100SILENOR.....................................................................100silver sulfadiazine cream 1%......................................72SIMBRINZA...................................................................95SIMULECT.................................................................... 90SIMULECT.................................................................... 90simvastatin tab 10 mg.................................................66simvastatin tab 20 mg.................................................66simvastatin tab 40 mg.................................................66simvastatin tab 5 mg................................................... 66simvastatin tab 80 mg.................................................66sirolimus tab 0.5 mg.................................................... 90sirolimus tab 1 mg....................................................... 90sirolimus tab 2 mg....................................................... 90SIRTURO.......................................................................25SIVEXTRO.................................................................... 12SIVEXTRO.................................................................... 12sodium chloride inj 0.45%...........................................75sodium chloride irrigation soln 0.9%......................... 75sodium chloride iv soln 0.9%..................................... 75sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................78sodium phenylbutyrate tab 500 mg........................... 78sodium polystyrene sulfonate oral susp 15

gm/60ml......................................................................75sodium polystyrene sulfonate powder.......................75sodium polystyrene sulfonate rectal susp 30

gm/120ml....................................................................75SOLTAMOX...................................................................33SOMATULINE DEPOT................................................85SOMATULINE DEPOT................................................85SOMATULINE DEPOT................................................85SOMAVERT.................................................................. 85SOMAVERT.................................................................. 85SOMAVERT.................................................................. 85SOMAVERT.................................................................. 85SOMAVERT.................................................................. 85SOOLANTRA................................................................72sotalol hcl (afib/afl) tab 120 mg..................................66sotalol hcl (afib/afl) tab 160 mg..................................66sotalol hcl (afib/afl) tab 80 mg....................................66sotalol hcl tab 120 mg.................................................66sotalol hcl tab 160 mg.................................................66sotalol hcl tab 240 mg.................................................66sotalol hcl tab 80 mg...................................................66SOVALDI....................................................................... 45

SPIRIVA HANDIHALER.............................................. 99SPIRIVA RESPIMAT....................................................99SPIRIVA RESPIMAT....................................................99spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................66spironolactone tab 100 mg.........................................67spironolactone tab 25 mg........................................... 67spironolactone tab 50 mg........................................... 67SPRITAM.......................................................................16SPRITAM.......................................................................16SPRITAM.......................................................................16SPRITAM.......................................................................16SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33STAMARIL.....................................................................90stavudine cap 15 mg...................................................45stavudine cap 20 mg...................................................45stavudine cap 30 mg...................................................45stavudine cap 40 mg...................................................45STELARA...................................................................... 90STELARA...................................................................... 91STELARA...................................................................... 91STELARA...................................................................... 91STIMATE....................................................................... 81STIOLTO RESPIMAT.................................................. 99STIVARGA.....................................................................33STRENSIQ....................................................................78STRENSIQ....................................................................78STRENSIQ....................................................................78STRENSIQ....................................................................78STREPTOMYCIN SULFATE...................................... 12STRIBILD...................................................................... 45SUBLOCADE.................................................................. 5SUBLOCADE.................................................................. 5SUBOXONE....................................................................5SUBOXONE....................................................................5SUBOXONE....................................................................5SUBOXONE....................................................................5sucralfate tab 1 gm......................................................77sulfacetamide sodium lotion 10%.............................. 12sulfacetamide sodium ophth soln 10%..................... 95sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%..........................................................95SULFADIAZINE............................................................ 12sulfamethoxazole-trimethoprim iv soln 400-80

mg/5ml........................................................................ 12sulfamethoxazole-trimethoprim susp 200-40

mg/5ml........................................................................ 12

2018

135

sulfamethoxazole-trimethoprim tab 400-80mg................................................................................12

sulfamethoxazole-trimethoprim tab 800-160mg................................................................................12

sulfasalazine tab 500 mg............................................92sulfasalazine tab delayed release 500

mg................................................................................92sulindac tab 150 mg...................................................... 4sulindac tab 200 mg...................................................... 4sumatriptan nasal spray 20 mg/act........................... 24sumatriptan nasal spray 5 mg/act..............................24sumatriptan succinate inj 6 mg/0.5ml........................24sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................24sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................24sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................24sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................24sumatriptan succinate tab 100 mg............................ 24sumatriptan succinate tab 25 mg...............................24sumatriptan succinate tab 50 mg...............................24SUPRAX........................................................................12SUPRAX........................................................................12SUPRAX........................................................................12SUPREP BOWEL PREP KIT.....................................77SUSTIVA........................................................................45SUSTIVA........................................................................45SUSTIVA........................................................................45SUTENT........................................................................ 33SUTENT........................................................................ 33SUTENT........................................................................ 33SUTENT........................................................................ 33SYLATRON................................................................... 45SYLATRON................................................................... 45SYLATRON................................................................... 46SYLVANT.......................................................................91SYLVANT.......................................................................91SYMBICORT.................................................................99SYMBICORT.................................................................99SYMDEKO.................................................................... 99SYMFI............................................................................ 46SYMFI LO..................................................................... 46SYMLINPEN 120......................................................... 52SYMLINPEN 60............................................................52SYNAGIS.......................................................................91SYNAGIS.......................................................................91SYNAREL......................................................................85SYNERCID....................................................................12SYNJARDY................................................................... 52SYNJARDY................................................................... 52

SYNJARDY................................................................... 52SYNJARDY................................................................... 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNJARDY XR............................................................ 52SYNRIBO...................................................................... 33SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYNTHROID.................................................................84SYPRINE.......................................................................75TTABLOID........................................................................33tacrolimus cap 0.5 mg.................................................91tacrolimus cap 1 mg....................................................91tacrolimus cap 5 mg....................................................91tacrolimus oint 0.03%..................................................72tacrolimus oint 0.1%.................................................... 72tadalafil tab 20 mg (pah).............................................99TAFINLAR..................................................................... 33TAFINLAR..................................................................... 33TAGRISSO.................................................................... 33TAGRISSO.................................................................... 33TAMIFLU........................................................................46tamoxifen citrate tab 10 mg........................................33tamoxifen citrate tab 20 mg........................................33tamsulosin hcl cap 0.4 mg..........................................79TARCEVA...................................................................... 33TARCEVA...................................................................... 33TARCEVA...................................................................... 34TARGRETIN..................................................................34TASIGNA....................................................................... 34TASIGNA....................................................................... 34TASIGNA....................................................................... 34tazarotene cream 0.1%...............................................72TAZORAC......................................................................72TAZORAC......................................................................72TAZORAC......................................................................72TECENTRIQ................................................................. 34TECFIDERA..................................................................69TECFIDERA..................................................................69TECFIDERA STARTER PACK...................................70

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TECHLITE INSULIN SYRINGE U-100/0.3ML/29G X1/2".............................................................................. 52

TECHLITE INSULIN SYRINGE U-100/0.3ML/30G X5/16"............................................................................52






TECHLITE INSULIN SYRINGE U-100/1ML/29G X1/2".............................................................................. 53

TECHLITE INSULIN SYRINGE U-100/1ML/30G X5/16"............................................................................53

TECHLITE INSULIN SYRINGE U-100/1ML/31G X5/16"............................................................................53

TECHLITE PEN NEEDLES/31G X 6MM.............................................................................. 53

TECHLITE PEN NEEDLES/31G X8MM............................................................................ 53




TECHLITE PEN NEEDLES 29G x 10MM.............................................................................. 53

TECHLITE PEN NEEDLES 29G x 12MM.............................................................................. 53

TECHLITE PEN NEEDLES 31G X5MM............................................................................ 53

TECHNIVIE................................................................... 46TEFLARO......................................................................12TEFLARO......................................................................12TEKTURNA...................................................................67TEKTURNA...................................................................67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................67telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................67telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................67telmisartan tab 20 mg................................................. 67

telmisartan tab 40 mg................................................. 67telmisartan tab 80 mg................................................. 67temazepam cap 15 mg............................................. 100temazepam cap 30 mg............................................. 100TEMODAR.................................................................... 34temsirolimus soln for iv infusion 25 mg/

ml.................................................................................34TENCON..........................................................................4TENIVAC....................................................................... 91tenofovir disoproxil fumarate tab 300

mg................................................................................46terazosin hcl cap 10 mg..............................................67terazosin hcl cap 1 mg................................................67terazosin hcl cap 2 mg................................................67terazosin hcl cap 5 mg................................................67terbinafine hcl tab 250 mg..........................................23terbutaline sulfate tab 2.5 mg.....................................99terbutaline sulfate tab 5 mg........................................99terconazole vaginal cream 0.4%................................23terconazole vaginal cream 0.8%................................23terconazole vaginal suppos 80 mg............................23testosterone cypionate im inj in oil 100 mg/

ml.................................................................................83testosterone cypionate im inj in oil 200 mg/

ml.................................................................................83testosterone enanthate im inj in oil 200 mg/

ml.................................................................................83testosterone td gel 12.5 mg/act (1%)........................ 83testosterone td gel 25 mg/2.5gm (1%)......................83testosterone td gel 50 mg/5gm (1%).........................83TETANUS/DIPHTHERIA TOXOIDS

ADSORBED...............................................................91tetrabenazine tab 12.5 mg..........................................70tetrabenazine tab 25 mg.............................................70tetracycline hcl cap 250 mg........................................12tetracycline hcl cap 500 mg........................................12THALOMID....................................................................34THALOMID....................................................................34THALOMID....................................................................34THALOMID....................................................................34theophylline tab er 12hr 100 mg................................99theophylline tab er 12hr 200 mg................................99theophylline tab er 12hr 300 mg................................99theophylline tab er 12hr 450 mg................................99theophylline tab er 24hr 400 mg................................99theophylline tab er 24hr 600 mg................................99thioridazine hcl tab 100 mg........................................ 41thioridazine hcl tab 10 mg.......................................... 41thioridazine hcl tab 25 mg.......................................... 41thioridazine hcl tab 50 mg.......................................... 41thiotepa for inj 15 mg.................................................. 34thiothixene cap 10 mg.................................................41

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137

thiothixene cap 1 mg...................................................41thiothixene cap 2 mg...................................................41thiothixene cap 5 mg...................................................41THYMOGLOBULIN......................................................91tiagabine hcl tab 12 mg.............................................. 16tiagabine hcl tab 16 mg.............................................. 16tiagabine hcl tab 2 mg.................................................16tiagabine hcl tab 4 mg.................................................16tigecycline for iv soln 50 mg.......................................12TIMOLOL MALEATE................................................... 67TIMOLOL MALEATE................................................... 67TIMOLOL MALEATE................................................... 67timolol maleate ophth gel forming soln

0.25%..........................................................................95timolol maleate ophth gel forming soln

0.5%............................................................................95timolol maleate ophth soln 0.25%..............................95timolol maleate ophth soln 0.5%................................95timolol maleate ophth soln 0.5% (once-

daily)............................................................................95TIVICAY......................................................................... 46TIVICAY......................................................................... 46TIVICAY......................................................................... 46tizanidine hcl cap 2 mg............................................... 42tizanidine hcl cap 4 mg............................................... 42tizanidine hcl cap 6 mg............................................... 42tizanidine hcl tab 2 mg................................................42tizanidine hcl tab 4 mg................................................42TOBRADEX...................................................................95tobramycin-dexamethasone ophth susp

0.3-0.1%..................................................................... 95tobramycin nebu soln 300 mg/5ml............................ 99tobramycin ophth soln 0.3%.......................................95TOBRAMYCIN SULFATE........................................... 12tobramycin sulfate for inj 1.2 gm................................12tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................12tobramycin sulfate inj 10 mg/ml................................. 12tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................12tolcapone tab 100 mg................................................. 37TOLMETIN SODIUM..................................................... 4tolterodine tartrate cap er 24hr 2 mg.........................79tolterodine tartrate cap er 24hr 4 mg.........................79tolterodine tartrate tab 1 mg.......................................79tolterodine tartrate tab 2 mg.......................................79topiramate sprinkle cap 15 mg...................................16topiramate sprinkle cap 25 mg...................................16topiramate tab 100 mg................................................16topiramate tab 200 mg................................................16topiramate tab 25 mg.................................................. 16topiramate tab 50 mg.................................................. 16

topotecan hcl for inj 4 mg........................................... 34topotecan hcl inj 4 mg/4ml (for

infusion)...................................................................... 34TORISEL....................................................................... 34torsemide tab 100 mg................................................. 67torsemide tab 10 mg................................................... 67torsemide tab 20 mg................................................... 67torsemide tab 5 mg......................................................67TOUJEO MAX SOLOSTAR........................................53TOUJEO SOLOSTAR..................................................53TOVIAZ.......................................................................... 79TOVIAZ.......................................................................... 79TRACLEER................................................................... 99TRACLEER................................................................... 99TRACLEER................................................................... 99tramadol-acetaminophen tab 37.5-325

mg..................................................................................4tramadol hcl tab 50 mg................................................. 4trandolapril tab 1 mg................................................... 67trandolapril tab 2 mg................................................... 67trandolapril tab 4 mg................................................... 67tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................56tranexamic acid tab 650 mg.......................................56tranylcypromine sulfate tab 10 mg............................ 20TRAVATAN Z................................................................ 95trazodone hcl tab 100 mg...........................................20trazodone hcl tab 150 mg...........................................20trazodone hcl tab 300 mg...........................................20trazodone hcl tab 50 mg.............................................20TREANDA..................................................................... 34TREANDA..................................................................... 34TRECATOR...................................................................25TRELEGY ELLIPTA.....................................................99TRELSTAR....................................................................85TRELSTAR....................................................................85TRELSTAR MIXJECT..................................................86TRELSTAR MIXJECT..................................................86TRELSTAR MIXJECT..................................................86TRESIBA FLEXTOUCH.............................................. 53TRESIBA FLEXTOUCH.............................................. 53tretinoin cap 10 mg......................................................34tretinoin cream 0.025%............................................... 73tretinoin cream 0.05%................................................. 73tretinoin cream 0.1%................................................... 73tretinoin gel 0.01%.......................................................73tretinoin gel 0.025%.....................................................73triamcinolone acetonide cream

0.025%........................................................................73triamcinolone acetonide cream 0.1%........................73triamcinolone acetonide cream 0.5%........................73

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triamcinolone acetonide dental paste0.1%............................................................................70

triamcinolone acetonide lotion 0.025%..................... 73triamcinolone acetonide lotion 0.1%..........................73triamcinolone acetonide nasal aerosol suspension

55 mcg/act................................................................. 99triamcinolone acetonide oint 0.025%........................ 73triamcinolone acetonide oint 0.1%.............................73triamcinolone acetonide oint 0.5%.............................73triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................67triamterene & hydrochlorothiazide tab 37.5-25

mg................................................................................67triamterene & hydrochlorothiazide tab 75-50

mg................................................................................67trientine hcl cap 250 mg............................................. 75trifluoperazine hcl tab 10 mg......................................41trifluoperazine hcl tab 1 mg........................................41trifluoperazine hcl tab 2 mg........................................41trifluoperazine hcl tab 5 mg........................................41trifluridine ophth soln 1%............................................ 95trimethoprim tab 100 mg.............................................12trimipramine maleate cap 100 mg............................. 20trimipramine maleate cap 25 mg............................... 20trimipramine maleate cap 50 mg............................... 20TRINTELLIX..................................................................20TRINTELLIX..................................................................20TRINTELLIX..................................................................20TRISENOX....................................................................34TRIUMEQ......................................................................46TROGARZO..................................................................46trospium chloride cap er 24hr 60 mg.........................79trospium chloride tab 20 mg.......................................80TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/29G

X 1/2"..........................................................................53TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/30G

X 5/16"........................................................................53TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/31G





X 5/16"........................................................................53TRUEPLUS INSULIN SYRINGE/U-100/1ML/28G X

1/2".............................................................................. 53TRUEPLUS INSULIN SYRINGE/U-100/1ML/29G X

1/2".............................................................................. 53

TRUEPLUS INSULIN SYRINGE/U-100/1ML/30G X5/16"............................................................................53

TRUEPLUS INSULIN SYRINGE/U-100/1ML/31G X5/16"............................................................................53

TRUEPLUS PEN NEEDLES29GX12MM................................................................53

TRUEPLUS PEN NEEDLES31GX5MM.................................................................. 53




TRUMENBA.................................................................. 91TRUVADA......................................................................46TRUVADA......................................................................46TRUVADA......................................................................46TRUVADA......................................................................46TWINRIX........................................................................91TYBOST........................................................................ 46TYGACIL....................................................................... 12TYKERB........................................................................ 34TYPHIM VI.................................................................... 91TYSABRI....................................................................... 70UULORIC......................................................................... 24ULORIC......................................................................... 24ULTICARE INSULIN SAFETY SYRINGE/0.5ML/29G

X 1/2"..........................................................................54ULTICARE INSULIN SAFETY SYRINGE/1ML/29G X

1/2".............................................................................. 54UNITUXIN......................................................................34UPTRAVI....................................................................... 99UPTRAVI....................................................................... 99UPTRAVI....................................................................... 99UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100UPTRAVI..................................................................... 100ursodiol cap 300 mg....................................................77ursodiol tab 250 mg.....................................................77ursodiol tab 500 mg.....................................................77Vvalacyclovir hcl tab 1 gm............................................ 46valacyclovir hcl tab 500 mg........................................46VALCHLOR................................................................... 34valganciclovir hcl for soln 50 mg/ml.......................... 46valganciclovir hcl tab 450 mg.....................................46

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valproate sodium inj 100 mg/ml.................................16valproate sodium oral soln 250 mg/5ml.................... 16valproic acid cap 250 mg............................................16valsartan-hydrochlorothiazide tab 160-12.5

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

mg................................................................................68valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................68valsartan-hydrochlorothiazide tab 320-25

mg................................................................................68valsartan-hydrochlorothiazide tab 80-12.5

mg................................................................................67valsartan tab 160 mg...................................................67valsartan tab 320 mg...................................................67valsartan tab 40 mg.....................................................67valsartan tab 80 mg.....................................................67vancomycin hcl cap 125 mg.......................................12vancomycin hcl cap 250 mg.......................................13vancomycin hcl for inj 1000 mg................................. 13vancomycin hcl for inj 100 gm................................... 13vancomycin hcl for inj 10 gm......................................13vancomycin hcl for inj 5000 mg................................. 13vancomycin hcl for inj 500 mg................................... 13vancomycin hcl for inj 750 mg................................... 13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANISHPOINT INSULIN SYRINGE/0.5ML/30G X

1/2".............................................................................. 54VAQTA........................................................................... 91VAQTA........................................................................... 91VARIVAX........................................................................91VASCEPA...................................................................... 68VASCEPA...................................................................... 68VECTIBIX...................................................................... 34VECTIBIX...................................................................... 34VELCADE......................................................................34VENCLEXTA.................................................................34VENCLEXTA.................................................................34VENCLEXTA.................................................................34VENCLEXTA STARTING PACK................................ 34venlafaxine hcl cap er 24hr 150 mg.......................... 20venlafaxine hcl cap er 24hr 37.5 mg......................... 20venlafaxine hcl cap er 24hr 75 mg............................ 20venlafaxine hcl tab 100 mg........................................ 21venlafaxine hcl tab 25 mg...........................................21venlafaxine hcl tab 37.5 mg....................................... 21venlafaxine hcl tab 50 mg...........................................21venlafaxine hcl tab 75 mg...........................................21venlafaxine hcl tab er 24hr 150 mg........................... 21venlafaxine hcl tab er 24hr 37.5 mg..........................21

venlafaxine hcl tab er 24hr 75 mg............................. 21VENTAVIS................................................................... 100VENTAVIS................................................................... 100VENTOLIN HFA......................................................... 100verapamil hcl cap er 24hr 100 mg.............................68verapamil hcl cap er 24hr 120 mg.............................68verapamil hcl cap er 24hr 180 mg.............................68verapamil hcl cap er 24hr 200 mg.............................68verapamil hcl cap er 24hr 240 mg.............................68verapamil hcl cap er 24hr 300 mg.............................68verapamil hcl cap er 24hr 360 mg.............................68verapamil hcl tab 120 mg........................................... 68verapamil hcl tab 40 mg............................................. 68verapamil hcl tab 80 mg............................................. 68verapamil hcl tab er 120 mg.......................................68verapamil hcl tab er 180 mg.......................................68verapamil hcl tab er 240 mg.......................................68VERSACLOZ................................................................ 41VERZENIO....................................................................34VERZENIO....................................................................34VERZENIO....................................................................34VERZENIO....................................................................34VICTOZA....................................................................... 54VIDEX............................................................................ 46VIDEX............................................................................ 46VIDEX EC..................................................................... 46VIEKIRA PAK................................................................46VIEKIRA XR..................................................................46vigabatrin powd pack 500 mg.................................... 16VIGAMOX......................................................................95VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD STARTER PACK......................................... 21VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VINBLASTINE SULFATE............................................34vincristine sulfate iv soln 1 mg/ml..............................34vinorelbine tartrate inj 10 mg/ml.................................34vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................35VIOKACE.......................................................................78VIOKACE.......................................................................78VIRACEPT.................................................................... 46VIRACEPT.................................................................... 46VIRAMUNE................................................................... 46VIREAD..........................................................................46VIREAD..........................................................................46

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VIREAD..........................................................................46VIREAD..........................................................................46VIREAD..........................................................................46VIVITROL........................................................................ 5voriconazole for inj 200 mg........................................ 23voriconazole for susp 40 mg/ml.................................23voriconazole tab 200 mg............................................ 23voriconazole tab 50 mg...............................................23VOSEVI..........................................................................47VOTRIENT.................................................................... 35VPRIV............................................................................ 78VRAYLAR...................................................................... 41VRAYLAR...................................................................... 41VRAYLAR...................................................................... 41VRAYLAR...................................................................... 41VYXEOS........................................................................35Wwarfarin sodium tab 10 mg.........................................57warfarin sodium tab 1 mg...........................................56warfarin sodium tab 2.5 mg........................................56warfarin sodium tab 2 mg...........................................56warfarin sodium tab 3 mg...........................................56warfarin sodium tab 4 mg...........................................56warfarin sodium tab 5 mg...........................................56warfarin sodium tab 6 mg...........................................57warfarin sodium tab 7.5 mg........................................57water for irrigation, sterile irrigation

soln..............................................................................75WELCHOL.....................................................................68WELCHOL.....................................................................68XXALKORI....................................................................... 35XALKORI....................................................................... 35XARELTO...................................................................... 57XARELTO...................................................................... 57XARELTO...................................................................... 57XARELTO STARTER PACK.......................................57XATMEP........................................................................ 91XGEVA...........................................................................93XIFAXAN........................................................................77XOLAIR..........................................................................91XTANDI.......................................................................... 35XYREM........................................................................100YYERVOY........................................................................35YERVOY........................................................................35YF-VAX.......................................................................... 91YONDELIS.................................................................... 35YONSA.......................................................................... 35

Zzafirlukast tab 10 mg.................................................100zafirlukast tab 20 mg.................................................100zaleplon cap 10 mg...................................................100zaleplon cap 5 mg..................................................... 100ZALTRAP.......................................................................35ZALTRAP.......................................................................35ZANOSAR..................................................................... 35ZAVESCA...................................................................... 78ZEJULA..........................................................................35ZELBORAF................................................................... 35ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZENPEP........................................................................ 79ZEPATIER..................................................................... 47ZERIT.............................................................................47ZIAGEN..........................................................................47zidovudine cap 100 mg...............................................47zidovudine syrup 10 mg/ml.........................................47zidovudine tab 300 mg................................................47ZINACEF....................................................................... 13ziprasidone hcl cap 20 mg..........................................41ziprasidone hcl cap 40 mg..........................................41ziprasidone hcl cap 60 mg..........................................41ziprasidone hcl cap 80 mg..........................................41ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4zoledronic acid inj conc for iv infusion 4

mg/5ml........................................................................ 93zoledronic acid iv soln 5 mg/100ml........................... 93ZOLINZA........................................................................35zolpidem tartrate tab 10 mg..................................... 100zolpidem tartrate tab 5 mg....................................... 100ZOMETA........................................................................ 93zonisamide cap 100 mg..............................................17zonisamide cap 25 mg................................................17zonisamide cap 50 mg................................................17ZONTIVITY....................................................................57ZORTRESS...................................................................91ZORTRESS...................................................................91ZORTRESS...................................................................91ZOSTAVAX....................................................................91ZOSYN...........................................................................13

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ZOSYN...........................................................................13ZOSYN...........................................................................13ZYDELIG....................................................................... 35ZYDELIG....................................................................... 35ZYKADIA....................................................................... 35ZYPREXA RELPREVV............................................... 41ZYPREXA RELPREVV............................................... 41ZYPREXA RELPREVV............................................... 41ZYTIGA..........................................................................35ZYTIGA..........................................................................35

Blue Cross and Blue Shield of New Mexico cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Blue Cross and Blue Shield of New Mexico no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.

Blue Cross and Blue Shield of New Mexico:

• Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes:

○ Intérpretes de lenguaje de señas capacitados.

○ Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).

• Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes:

○ Intérpretes capacitados.

○ Información escrita en otros idiomas.

Si necesita recibir estos servicios, comuníquese con el Coordinador de Derechos Civiles.

Si considera que Blue Cross and Blue Shield of New Mexico no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, [email protected]. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, el Coordinador de Derechos Civiles está a su disposición para brindársela.

También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación:

U.S. Department of Health and Human Services 200 Independence Avenue, SW

Room 509F, HHH Building Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Y0096_MRK_NM_NDNOTICE17SPA Accepted 09042016 479040.0916

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

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

mailto:[email protected]

ATTENTION: If you speak English, language assistance services, free of charge, are available to you.Call 1-877-688-1813 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-877-688-1813 (TTY: 711).

Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dę́ę́’, t’áá jiik’eh,éí ná hólǫ́, kojį’ hódíílnih 1-877-688-1813 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số 1-877-688-1813 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zurVerfügung. Rufnummer: 1-877-688-1813 (TTY: 711).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-688-1813 (TTY: 711) 。

1813-688-877-1العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل رقم ملحوظ: إذا كنت تتحدث اللغة

711رقم هاتف الصم والبكم: ( )

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-877-688-1813 (TTY: 711) 번으로 전화해 주십시오.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nangwalang bayad. Tumawag sa 1-877-688-1813 (TTY: 711).

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-877-688-1813 (TTY: 711) まで、お電話にてご連絡ください。

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-877-688-1813 (ATS: 711).

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-877-688-1813 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-688-1813 (телетайп: 711).

ध्यान दें ं ेिैं े: ्दद आप हिदी बोलत तो आपक ललए मफुत में भयाषया सिया्तया सवेयाएं उपलब्ध िैं।1-877-688-1813 (TTY: 711) पर कॉल करें।

ا بد. اشبی مم راهفا مشرای بان گيراورت صه بی انزبالت يهستد، ينکی مو گتفگی ارسفان زبه بر اگه: وجت1-877-688-1813 (TTY: 711) د. يبگيرس تما

เรยีน: ถ้าคณุพดูภาษาไทยคณุสามารถใช้บรกิารช่วยเหลือทางภาษาได้ฟร ี โทร 1-877-688-1813 (TTY: 711).

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-688-1813 (TTY: 711). We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-688-1813 (TTY: 7-1-1). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y días feriados se usarán tecnologías alternativas (por ejemplo, correo de voz).

Blue Cross and Blue Shield of New Mexico, una división de Health Care Service Corporation, una compañía mutua de reserva legal (HCSC), licenciataria independiente de Blue Cross and Blue Shield Association, ofrece la cobertura Special Needs Plan HMO. HCSC es una organización Medicare Advantage con un contrato con Medicare y un contrato con el programa Medicaid en New Mexico. La inscripción en la cobertura de HCSC depende de la renovación del contrato.

Esta lista de medicamentos se actualizó el 09/18/2018. Para obtener información más reciente o si tiene alguna pregunta, comuníquese con Servicio al Cliente de Blue Cross Medicare Advantage, al 1-877-688-1813 o, para usuarios de TTY/TDD, al 7-1-1, de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si llama del 15 de febrero al 30 de septiembre durante los fines de semana y días feriados, se usarán tecnologías alternativas (por ejemplo, correo de voz); o bien visite www.getbluenm.com/dsnp/druglist.

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