Formulario Completo BlueMedicare - Florida Blue · Blue Medicare Preferred HMO y Blue Medicare...

BlueMedicare Preferred (HMO) H2758-002, 004, 006BlueMedicare Preferred POS (HMO POS) H2758-008BlueMedicare Preferred HMO (HMO SNP)H2758-005 007

Este formulario fue actualizado el 09/01/2018. Si tiene alguna pregunta o desea información más actualizada, comuníquese con Florida Blue Preferred HMO al 1-844-783-5189. (Los usuarios de TTY deben llamar al 1-877-955-8773). El horario es de 8:00 a.m. a 8:00 p.m., hora local, siete días de la semana.

BeHealthy Florida, Inc., cuyo nombre commercial es Florida Blue Preferred HMO, una afiliada de Blue Cross and Blue Shield of Florida, Inc., ofrece cobertura HMO. Ambas compañías son licenciatarias independientes de Blue Cross and Blue Shield Association.

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2018FormularioCompletoBlueMedicareSM

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BlueMedicare Preferred (HMO) BlueMedicare Preferred HMO (HMO SNP) BlueMedicare Preferred POS (HMO POS)

Formulario 2018 (Lista de Medicinas Cubiertas)

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

Formulary ID 00018128, Version 13

Este formulario fue actualizado el 09/01/2018. Para obtener información más reciente o si tiene otras preguntas, comuníquese con Servicio al cliente de farmacia de BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS al 1-800-926-6565 o, para los usuarios de TTY, 1-877-955-8773. Nuestro horario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, desde el 1 de octubre hasta el 14 de febrero, excepto el día de Acción de Gracias y el día de Navidad. Desde el 15 de febrero hasta el 30 de septiembre, el horario es de 8:00 a.m. a 8:00 p.m. hora local, excepto los días feriados. O visite www.BlueMedicareFL.com.

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

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Nota para los asegurados actuales: Este formulario ha cambiado desde el año pasado. Revise este documento para asegurarse que aún contiene las medicinas que toma. Cuando esta lista de medicinas (formulario) dice “nosotros”, "nos" o “nuestro”, se refiere a Florida Blue Preferred HMO. Cuando se hace referencia a "plan" o "nuestro plan", se refiere a BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS. Este documento contiene una lista de las medicinas (formulario) para nuestro plan, la cual está actualizada al 1 de septiembre de 2018. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, así como las fechas de actualización del formulario, aparece en las portadas delantera y trasera.

Usted por lo general debe utilizar farmacias en la red para poder utilizar sus beneficios de medicinas recetadas. Los beneficios, la lista de medicinas cubiertas, la red de farmacias y/o copagos/coaseguro pueden cambiar el 1 de enero de 2019 y periódicamente durante el año.

¿Qué es el formulario de BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS? El formulario es una lista de las medicinas cubiertas seleccionadas por nuestro plan en conjunto con un equipo de proveedores de salud, los cuales representan las medicinas recetadas que se consideran como una parte necesaria de cualquier programa de tratamiento de calidad. Nuestro plan generalmente cubrirá las medicinas mencionadas en nuestro formulario siempre y cuando la medicina sea médicamente necesaria, sea surtida en una farmacia de la red BlueMedicare Preferred, BlueMedicare Preferred HMO and BlueMedicare Preferred POS y se sigan las otras reglas del plan. Para más información sobre cómo surtir sus recetas, consulte su Constancia de Cobertura.

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

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menor o añadirá requisitos de manejo de utilización 60 días después del inicio del año del contrato asociado con el periodo de elección anual, y solamente si estos cambios son aprobados por CMS. Si BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS debe hacer tales cambios al formulario, los miembros actuales que están tomando la medicina están exentos del cambio del formulario por el resto del año del contrato. Antes de eliminar una medicina cubierta por la Parte D de este formulario, o hacer algún cambio en el nivel de costo compartido o nivel de preferencia de una medicina cubierta por la Parte D, BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS:

• Proveerá una notificación escrita a los miembros afectados con al menos 60 días antes de la fechaen que el cambio sea efectivo; o

• En el momento en que los miembros afectados soliciten un reabastecimiento de la medicina de laParte D, le proporcionaremos al miembro con un suministro de 60 días de la medicina de la Parte Dbajo los mismo términos que estaban permitidos anteriormente y una notificación escrita sobre elcambio al formulario.

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

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

Lista alfabética Si no está seguro bajo qué categoría buscar, puede buscar la medicina en el índice que comienza en la página 100. El índice proporciona una lista alfabética de todas las medicinas que se incluyen en este documento. Tanto el nombre de marca como el genérico aparecen en el índice. Busque en el índice hasta encontrar su medicina. Al lado del nombre de la medicina, encontrará el número de la página donde puede encontrar la información de la cobertura. Vaya a la página indicada en el índice y encuentre el nombre de la medicina en la primera columna de la lista.

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

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

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

• Límites de cantidad: Por ejemplo, para ciertas medicinas, nuestro plan limita la cantidad de lamedicina que nuestro plan puede cubrir. Por ejemplo, nuestro plan proporciona 31 tabletas porreceta médica para Januvia. Esto puede ser adicional a un suministro normal para uno o tresmeses.

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• Terapia Escalonada: En algunos casos, nuestro plan le pedirá que primero pruebe ciertasmedicinas para tratar su condición médica, antes de que cubramos otra medicina para esacondición. Por ejemplo, si la Medicina A y la Medicina B tratan su condición médica, nuestro planpuede que no cubra la medicina B hasta que usted pruebe la medicina A primero. Si la Medicina Ano le funciona, entonces el plan puede cubrir la Medicina B.

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

¿Qué sucede si mi medicina no está en el Formulario? Si su medicina no está incluida en el Formulario (lista de medicinas cubiertas), debe primero comunicarse con Servicio al cliente y preguntar si su medicina está cubierta.

Si se entera de que nuestro plan no cubre su medicina, usted tendrá dos opciones:

• Puede solicitarle a Servicio al Cliente un listado de las medicinas similares que están cubiertas porsu plan. Cuando reciba la lista, muéstresela a su médico y pídale que le recete una medicina similar que esté cubierta por nuestro plan.

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

¿Cómo solicito una excepción al formulario de BlueMedicare Preferred, BlueMedicare Preferred HMO y BlueMedicare Preferred POS? Puede solicitarle a nuestro plan que haga una excepción a las normas de cobertura. Existen muchos tipos de excepciones que usted puede solicitar.

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

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

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

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

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médico que apoye su solicitud, debemos tomar nuestra decisión dentro de 72 horas. Usted puede solicitar una excepción acelerada (rápida) si usted o su médico entienden que su salud puede estar en serio peligro si espera las 72 horas para tomar una decisión. Si se le aprueba la excepción acelerada, debemos tomar una decisión no más tardar de 24 horas después de recibir las declaraciones de apoyo de su médico.

¿Qué debo hacer antes de hablar con mi médico acerca de cambiar mi medicina o solicitar una excepción? Como un nuevo o actual asegurado de nuestro plan, usted puede que esté tomando medicinas que no están en nuestro formulario. O, puede ser que esté tomando una medicina que está en nuestro formulario pero sólo puede recibir una cantidad limitada. Por ejemplo, puede que necesite una autorización previa de nuestra parte para surtir su medicina recetada. Debe hablar con su médico para decidir si debe cambiar a una medicina apropiada que esté cubierta o solicitar una excepción al formulario para que podamos cubrir la medicina que necesita. Mientras habla con su médico para determinar el curso de acción correcto para usted, puede ser que cubramos su medicina en ciertos casos durante los primeros 90 días en los que usted es miembro de nuestro plan. Por cada una de sus medicinas que no esté en nuestro formulario o si la cantidad que puede recibir es limitada, le cubriremos un suministro temporal de 30 días (a menos que su receta indique menos días) cuando vaya a una farmacia de la red. Luego de su primer suministro de 30 días, no pagaremos por esta medicina, aún si usted ha sido un miembro del plan por menos de 90 días.

Si usted es un residente de un establecimiento de cuidados a largo plazo, le permitiremos abastecer su medicina recetada hasta que le proporcionemos con un suministro de 98 días de transición, de acuerdo con el incremento del abastecimiento (a menos que su receta indique menos días). Cubriremos por más de un abastecimiento de esta medicina por los primeros 90 días en los que usted sea miembro de nuestro plan. Si necesita una medicina que no está en nuestro formulario o si la cantidad que puede recibir es limitada, pero ya pasaron los primeros 90 días de la afiliación a nuestro plan, le cubriremos un suministro de emergencia de 30 días de esa medicina (a menos que su receta médica indique menos días) mientras usted consigue una excepción al formulario.

Existen circunstancias en que transiciones no planificadas para miembros actuales podrían surgir y en que los regímenes de medicamentos recetas puedan no estar en el formulario. Estas circunstancias generalmente involucran cambios en el nivel de atención en que un miembro está cambiando de un lugar de tratamiento a otro. Para estas transiciones inesperadas, usted debe utilizar nuestro proceso de excepción y apelación. Las determinaciones y re determinaciones de cobertura serán procesadas tan rápido como lo requiera su condición. Cuando un asegurado es admitido o dado de alta de un establecimiento de cuidados a largo plazo (Long Term Care, LTC), no tendrá acceso al remanente de la medicina recetada abastecida anteriormente. Nos aseguraremos de que tenga un reabastecimiento al momento de la admisión o de alta. Se provee una anulación de las ediciones de “reabastecimiento demasiado pronto” para cada medicamento que sería afectado debido a que un miembro sea admitido o dado de alta de un centro de cuidado a largo plazo. No se utilizan los cambios a los abastecimientos tempranos para limitar el acceso apropiado o necesario a los beneficios de la Parte D del asegurado, y estos asegurados pueden obtener un abastecimiento al momento de la admisión o de alta.

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

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El Formulario de nuestro plan El formulario que comienza en la página 1 proporciona información de cobertura de las medicinas cubiertas por nuestro plan. Si tiene problemas encontrando su medicina en el formulario, vaya al índice que comienza en la página 100.

La primera columna de la tabla lista el nombre de la medicina. Los nombres de las medicinas de marca están letras mayúsculas (por ejemplo, LANTUS) y las medicinas genéricas están en letras minúsculas en cursiva (por ejemplo, metformin). La información en la columna Requisitos/Límites indica si su plan tiene algún requisito especial para cubrir su medicina. La información en la segunda columna de la tabla indica a qué nivel de cobertura se encuentra la medicina. La tercera columna de la tabla indica si se solicitan requisitos especiales para la cobertura de una medicina como por ejemplo, Autorización previa", "Límite de cantidad" y "Terapia escalonada". Si un Límite de cantidad aplica para una medicina, la cantidad de la restricción se muestra en el listado que comienza en la página 1.

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CLAVE DE ABREVIACIONES DE LAS DOSIS

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

l í ml Mililitro

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

conj Conjugar odt Tabletas de disolución oral

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

deter Disuasivo pf Libre de preservativos

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

el Ensayo por inmunoabsorción ligado a enzimas

pref Precargada

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

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

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Etapa de cobertura inicial La cantidad de copago/coaseguro que usted paga por un suministro de un mes (30 días) de la medicina en cada Nivel de medicina se muestra a continuación.

Tipo de farmacia

Nivel 1 Genéricas preferidas

Nivel 2 Genéricas

Nivel 3 De marca preferidas

Nivel 4 De marca

no preferidas

Nivel 5 Especiali

-zadas

Nivel 6 Select Care

BlueMedicare Preferred (HMO) (Manatee, Sarasota)

De venta al público preferidas

$0 de copago

$1 de copago

$35 de copago

$100 de copago

33% del

costo

$7 de copago

De venta al público estándar

$7 de copago

$8 de copago

$42 de copago

$100 de copago

Orden por correo

$0 de copago

$1 de copago

$35 de copago

$100 de copago

BlueMedicare Preferred (HMO) (Clay, Duval)


$0 de copago

$7 de copago

$35 de copago

$85 de copago

33% del costo

$7 de copago

De venta al público estándar

$7 de copago

$14 de copago

$42 de copago

$92 de copago

Orden por correo

$0 de copago

$7 de copago

$35 de copago

$85 de copago

BlueMedicare Preferred (HMO) (Pinellas)


$0 de copago

$1 de copago

$35 de copago

$100 de copago

33% del costo $7 de

copago De venta al público estándar

$7 de copago

$8 de copago

$42 de copago

$100 de copago

Orden por correo

$0 de copago

$1 de copago

$35 de copago

$100 de copago

BlueMedicare Preferred POS (HMO POS) (Pinellas)


$0 de copago

$7 de copago

$35 de copago

$85 de copago

33% del

costo $7 de


$7 de copago

$14 de copago

$42 de copago

$92 de copago

Orden por correo

$0 de copago

$7 de copago

$35 de copago

$85 de copago

BlueMedicare Preferred HMO (HMO SNP) (Manatee, Sarasota, Clay, Duval)


$0 de copago

$7 de copago

$35 de copago

$85 de copago

33% del

costo $7 de


$7 de copago

$14 de copago

$42 de copago

$92 de copago

Orden por correo

$0 de copago

$7 de copago

$35 de copago

$85 de copago

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Clave de abreviaturas

1 = Medicinas genéricas preferidas

2= Medicinas genéricas

3= Medicinas de marca preferidas

4= Medicinas de marca no preferidas

5= Medicinas especializadas

6 = Select Care

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

PA= Autorización previa (Prior Authorization)

QL= Límites de cantidad (Quantity Limits)

ST= Terapia escalonada (Step Therapy)

*= Las medicinas con distribución limitada están indicadas con un asterisco (*) en la lista de medicinas. Puede que estas medicinas estén disponibles sólo en algunas farmacias. Para más información, consulte nuestro Directorio de farmacia o llame al Departamento de Servicio al cliente al 1-855-457-0409. Los usuarios de equipo teleescritor (TTY) deben llamar al 1-877-955-8773. Nuestrohorario es de 8:00 a.m. a 8:00 p.m. hora local, los siete días de la semana, desde el 1 de octubrehasta el 14 de febrero, excepto el día de Acción de Gracias y el día de Navidad. Desde el 15 defebrero hasta el 30 de septiembre, el horario es de lunes a viernes de 8:00 a.m. a 8:00 p.m., horalocal, excepto los días feriados. O visite www.BlueMedicareFL.com.

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

^ =Se proporciona cobertura adicional de estas medicinas recetadas durante la brecha en la cobertura.

2018

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

1

Nombre del medicamentoNivel delmedicamento Requisitos/Límites

Medicamentos analgésicosABSTRAL - fentanyl citrate sl tab 100 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 200 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 300 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 400 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 600 mcg 5 PA, QL (120 tablets/30 days)ABSTRAL - fentanyl citrate sl tab 800 mcg 5 PA, QL (120 tablets/30 days)acetaminophen w/ codeine soln 120-12 mg/5ml 3 QL (2700 mls/30 days)acetaminophen w/ codeine tab 300-15 mg 3 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-30 mg 3 QL (360 tablets/30 days)acetaminophen w/ codeine tab 300-60 mg 3 QL (180 tablets/30 days)butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)butalbital-acetaminophen-caffeine cap 50-300-40 mg# 4 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine cap 50-325-40 mg# 4 PA, QL (180 capsules/30 days)butalbital-acetaminophen-caffeine tab 50-325-40 mg# 4 PA, QL (180 tablets/30 days)butalbital-aspirin-caffeine cap 50-325-40 mg# 4 PA, QL (180 capsules/30 days)BUTORPHANOL TARTRATE - butorphanol tartrate inj 1 mg/ml 3butorphanol tartrate inj 2 mg/ml 4butorphanol tartrate nasal soln 10 mg/ml 3 QL (87.5 mls/30 days)celecoxib cap 50 mg 2 QL (60 capsules/30 days)celecoxib cap 100 mg 2 QL (60 capsules/30 days)celecoxib cap 200 mg 2 QL (60 capsules/30 days)celecoxib cap 400 mg 2 QL (30 capsules/30 days)codeine sulfate tab 15 mg 3 QL (180 tablets/30 days)codeine sulfate tab 30 mg 3 QL (180 tablets/30 days)codeine sulfate tab 60 mg 3 QL (180 tablets/30 days)diclofenac potassium tab 50 mg 2 QL (120 tablets/30 days)diclofenac sodium gel 1% 2 STdiclofenac sodium tab delayed release 25 mg 2 QL (240 tablets/30 days)diclofenac sodium tab delayed release 50 mg 2 QL (120 tablets/30 days)diclofenac sodium tab delayed release 75 mg 2 QL (60 tablets/30 days)diclofenac sodium tab er 24hr 100 mg 2 QL (60 tablets/30 days)diclofenac w/ misoprostol tab delayed release 50-0.2 mg 2 QL (120 tablets/30 days)diclofenac w/ misoprostol tab delayed release 75-0.2 mg 2 QL (90 tablets/30 days)etodolac cap 200 mg 2 QL (150 capsules/30 days)etodolac cap 300 mg 2 QL (90 capsules/30 days)etodolac tab er 24hr 400 mg 2 QL (60 tablets/30 days)etodolac tab er 24hr 500 mg 2 QL (60 tablets/30 days)

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 2 QL (30 tablets/30 days)etodolac tab 400 mg 2 QL (60 tablets/30 days)etodolac tab 500 mg 2 QL (60 tablets/30 days)fentanyl citrate lozenge on a handle 200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 400 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 800 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl td patch 72hr 12 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 25 mcg/hr 3 PA, QL (15 patches/30 days)fentanyl td patch 72hr 37.5 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 50 mcg/hr 3 PA, QL (15 patches/30 days)fentanyl td patch 72hr 62.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 75 mcg/hr 4 PA, QL (15 patches/30 days)fentanyl td patch 72hr 87.5 mcg/hr 5 PA, QL (15 patches/30 days)fentanyl td patch 72hr 100 mcg/hr 4 PA, QL (15 patches/30 days)flurbiprofen tab 50 mg 2 QL (180 tablets/30 days)flurbiprofen tab 100 mg 2 QL (90 tablets/30 days)hydrocodone-acetaminophen soln 7.5-325 mg/15ml 3 QL (3600 mls/30 days)hydrocodone-acetaminophen tab 10-325 mg 3 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-300 mg 2 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg 2 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 5-325 mg 3 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-325 mg 3 QL (180 tablets/30 days)hydrocodone-acetaminophen tab 10-300 mg 2 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg 2 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg 2 QL (150 tablets/30 days)hydromorphone hcl liqd 1 mg/ml 3 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 10 mg/ml 3 BDhydromorphone hcl tab 2 mg 3 QL (180 tablets/30 days)hydromorphone hcl tab 4 mg 3 QL (180 tablets/30 days)hydromorphone hcl tab 8 mg 3 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)

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ketoprofen cap 75 mg 2 QL (120 capsules/30 days)LAZANDA - fentanyl citrate nasal spray 100 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 300 mcg/act 5 PA, QL (30 bottles/30 days)LAZANDA - fentanyl citrate nasal spray 400 mcg/act 5 PA, QL (30 bottles/30 days)LEVORPHANOL TARTRATE - levorphanol tartrate tab 2 mg 4 QL (120 tablets/30 days)meloxicam tab 7.5 mg^ 1 QL (60 tablets/30 days)meloxicam tab 15 mg^ 1 QL (30 tablets/30 days)methadone hcl tab 5 mg 3 QL (180 tablets/30 days)methadone hcl tab 10 mg 3 QL (360 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 15 mg 4 QL (240 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 30 mg 4 QL (180 tablets/30 days)morphine sulfate inj pf 0.5 mg/ml 3 BDmorphine sulfate inj pf 1 mg/ml 3 BDmorphine sulfate oral soln 10 mg/5ml 2 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml 2 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml) 2 QL (270 mls/30 days)morphine sulfate tab er 15 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 30 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg 2 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg 2 PA, QL (90 tablets/30 days)nabumetone tab 500 mg 2 QL (120 tablets/30 days)nabumetone tab 750 mg 2 QL (60 tablets/30 days)naproxen sodium tab 275 mg^ 1 QL (150 tablets/30 days)naproxen sodium tab 550 mg^ 1 QL (90 tablets/30 days)naproxen susp 125 mg/5ml 2 QL (1800 mls/30 days)naproxen tab ec 375 mg 2 QL (120 tablets/30 days)naproxen tab ec 500 mg 2 QL (90 tablets/30 days)naproxen tab 250 mg^ 1 QL (180 tablets/30 days)naproxen tab 375 mg^ 1 QL (120 tablets/30 days)naproxen tab 500 mg^ 1 QL (90 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 50 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 100 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 150 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 200 mg 3 PA, QL (60 tablets/30 days)NUCYNTA ER - tapentadol hcl tab er 12hr 250 mg 3 PA, QL (60 tablets/30 days)oxaprozin tab 600 mg 2 QL (90 tablets/30 days)oxycodone hcl tab 5 mg 3 QL (360 tablets/30 days)

2018



oxycodone hcl tab 10 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 15 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 20 mg 3 QL (180 tablets/30 days)oxycodone hcl tab 30 mg 3 QL (180 tablets/30 days)oxycodone w/ acetaminophen tab 2.5-325 mg 2 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 5-325 mg 3 QL (360 tablets/30 days)oxycodone w/ acetaminophen tab 7.5-325 mg 3 QL (240 tablets/30 days)oxycodone w/ acetaminophen tab 10-325 mg 3 QL (180 tablets/30 days)oxycodone-aspirin tab 4.8355-325 mg 2 QL (360 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 10 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 15 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 20 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 30 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 40 mg 3 PA, QL (60 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 60 mg 3 PA, QL (120 tablets/30 days)OXYCONTIN - oxycodone hcl tab er 12hr deter 80 mg 3 PA, QL (120 tablets/30 days)piroxicam cap 10 mg 2 QL (60 capsules/30 days)piroxicam cap 20 mg 2 QL (30 capsules/30 days)sulindac tab 150 mg 2 QL (60 tablets/30 days)sulindac tab 200 mg 2 QL (60 tablets/30 days)TENCON - butalbital-acetaminophen tab 50-325 mg# 4 PA, QL (180 tablets/30 days)TOLMETIN SODIUM - tolmetin sodium cap 400 mg 3 QL (120 capsules/30 days)tramadol hcl tab er 24hr 100 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 200 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 300 mg 2 PA, QL (30 tablets/30 days)tramadol hcl tab 50 mg 3 QL (240 tablets/30 days)tramadol-acetaminophen tab 37.5-325 mg 2 QL (240 tablets/30 days)ZOHYDRO ER - hydrocodone bitartrate cap er 12hr abuse-

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

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

4 PA, QL (60 capsules/30 days)









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Medicamentos anestésicoslidocaine hcl gel 2%^ 1 PA, QL (150 mls/30 days)lidocaine hcl local inj 1%^ 1lidocaine hcl local preservative free inj 1%^ 1lidocaine hcl soln 4% 2 PAlidocaine hcl viscous soln 2%^ 1lidocaine oint 5% 2 PA, QL (100 grams/30 days)lidocaine patch 5% 3 PA, QL (90 patches/30 days)lidocaine-prilocaine cream 2.5-2.5% 3 PA, QL (60 grams/30 days)Agentes contra las adicciones y para tratar el abuso deacamprosate calcium tab delayed release 333 mg 2buprenorphine hcl sl tab 2 mg 2 PA, QL (90 tablets/30 days)buprenorphine hcl sl tab 8 mg 2 PA, QL (90 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg 3 PA, QL (120 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 8-2 mg 4 PA, QL (90 tablets/30 days)bupropion hcl (smoking deterrent) tab er 12hr 150 mg 2CHANTIX - varenicline tartrate tab 0.5 mg 3CHANTIX - varenicline tartrate tab 1 mg 3CHANTIX CONTINUING MONTH PACK - varenicline tartrate tab

1 mg3

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

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

delivered)4

NICOTROL NS - nicotine nasal spray 10 mg/ml (0.5 mg/spray) 4SUBLOCADE - buprenorphine extended release soln pref syr

100 mg/0.5ml5

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

5

SUBOXONE - buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 4 PA, QL (120 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1 mg 4 PA, QL (30 films/30 days)

2018



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

clavulanate chew tab 200-28.5 mg4

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

4

ampicillin & sulbactam sodium for inj 3 (2-1) gm 2ampicillin cap 500 mg^ 1AMPICILLIN SODIUM - ampicillin sodium for iv soln 1 gm 4ampicillin sodium for inj 250 mg 2ampicillin sodium for inj 500 mg 2ampicillin sodium for inj 1 gm 2ampicillin sodium for inj 2 gm 2ampicillin sodium for iv soln 2 gm 2ampicillin sodium for iv soln 10 gm 2AMPICILLIN-SULBACTAM - ampicillin & sulbactam sodium for iv

soln 3 (2-1) gm2

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

3

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

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

4

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

4

AZITHROMYCIN - azithromycin powd pack for susp 1 gm 4azithromycin for susp 100 mg/5ml 2azithromycin for susp 200 mg/5ml 2azithromycin iv for soln 500 mg 2azithromycin tab 250 mg^ 1azithromycin tab 500 mg^ 1azithromycin tab 600 mg^ 1aztreonam for inj 1 gm 3aztreonam for inj 2 gm 2BICILLIN L-A - penicillin g benzathine intramuscular susp 600000

unit/ml4

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

4

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

4

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

2018



cefoxitin sodium for iv soln 1 gm 3cefoxitin sodium for iv soln 2 gm 3cefpodoxime proxetil for susp 50 mg/5ml 2cefpodoxime proxetil for susp 100 mg/5ml 2cefpodoxime proxetil tab 100 mg 2cefpodoxime proxetil tab 200 mg 2cefprozil for susp 125 mg/5ml 2cefprozil for susp 250 mg/5ml 2cefprozil tab 250 mg 2cefprozil tab 500 mg 2ceftazidime for inj 1 gm 2ceftazidime for inj 2 gm 2ceftazidime for inj 6 gm 2ceftazidime for iv soln 1 gm 2ceftazidime for iv soln 2 gm 2CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE - ceftriaxone

sodium in dextrose inj 20 mg/ml4

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

4

ceftriaxone sodium for inj 250 mg 2ceftriaxone sodium for inj 500 mg 2ceftriaxone sodium for inj 1 gm 2ceftriaxone sodium for inj 2 gm 2ceftriaxone sodium for inj 10 gm 3ceftriaxone sodium for iv soln 1 gm 2ceftriaxone sodium for iv soln 2 gm 2CEFTRIAXONE/DEXTROSE - ceftriaxone sodium for iv soln 1 gm

and dextrose 3.74%4

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

4

cefuroxime axetil tab 250 mg 2cefuroxime axetil tab 500 mg 2cefuroxime sodium for inj 750 mg 2cefuroxime sodium for inj 7.5 gm 2cefuroxime sodium for iv soln 1.5 gm 3cephalexin cap 250 mg^ 1cephalexin cap 500 mg^ 1cephalexin cap 750 mg^ 1cephalexin for susp 125 mg/5ml 2

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cephalexin for susp 250 mg/5ml 2CHLORAMPHENICOL SODIUM SUCCINATE - chloramphenicol

sodium succinate for iv inj 1 gm4

ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) 2ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) 2CIPROFLOXACIN HCL - ciprofloxacin hcl tab 100 mg 4ciprofloxacin hcl tab er 24hr 500 mg 2ciprofloxacin hcl tab er 24hr 1000 mg 2ciprofloxacin hcl tab 250 mg^ 1ciprofloxacin hcl tab 500 mg^ 1ciprofloxacin hcl tab 750 mg^ 1ciprofloxacin 200 mg/100ml in d5w 2ciprofloxacin 400 mg/200ml in d5w 2clarithromycin for susp 125 mg/5ml 2clarithromycin for susp 250 mg/5ml 2clarithromycin tab er 24hr 500 mg 2clarithromycin tab 250 mg 2clarithromycin tab 500 mg 2clindamycin hcl cap 75 mg^ 1clindamycin hcl cap 150 mg^ 1clindamycin hcl cap 300 mg^ 1clindamycin phosphate gel 1% (generic for Cleocin-T gel 1%) 2clindamycin phosphate in d5w iv soln 300 mg/50ml 2clindamycin phosphate in d5w iv soln 600 mg/50ml 2clindamycin phosphate in d5w iv soln 900 mg/50ml 2clindamycin phosphate inj 300 mg/2ml^ 1clindamycin phosphate inj 600 mg/4ml^ 1clindamycin phosphate inj 900 mg/6ml^ 1clindamycin phosphate inj 9 gm/60ml^ 1clindamycin phosphate iv soln 300 mg/2ml^ 1clindamycin phosphate iv soln 600 mg/4ml^ 1clindamycin phosphate iv soln 900 mg/6ml^ 1clindamycin phosphate lotion 1% 2clindamycin phosphate soln 1% 2clindamycin phosphate swab 1% 2clindamycin phosphate vaginal cream 2% 2colistimethate sod for inj 150 mg 5DALVANCE - dalbavancin hcl for iv soln 500 mg 5

2018



daptomycin for iv soln 500 mg 5demeclocycline hcl tab 150 mg 2demeclocycline hcl tab 300 mg 2dicloxacillin sodium cap 250 mg 2dicloxacillin sodium cap 500 mg 2DIFICID - fidaxomicin tab 200 mg 5doxycycline hyclate cap 50 mg 2doxycycline hyclate cap 100 mg 2doxycycline hyclate for inj 100 mg 3doxycycline hyclate tab 20 mg 2doxycycline hyclate tab 100 mg 2doxycycline monohydrate cap 50 mg 2doxycycline monohydrate cap 75 mg 2doxycycline monohydrate cap 100 mg 2doxycycline monohydrate cap 150 mg 2doxycycline monohydrate tab 50 mg 2doxycycline monohydrate tab 75 mg 2doxycycline monohydrate tab 100 mg 2doxycycline monohydrate tab 150 mg 2ertapenem sodium for inj 1 gm 4ERY-TAB - erythromycin tab delayed release 250 mg 4ERY-TAB - erythromycin tab delayed release 333 mg 4ERY-TAB - erythromycin tab delayed release 500 mg 4ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 4ERYTHROCIN LACTOBIONATE - erythromycin lactobionate for

inj 500 mg4

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 4erythromycin ethylsuccinate for susp 200 mg/5ml 2erythromycin pads 2% 2erythromycin soln 2% 2erythromycin tab 250 mg 4erythromycin tab 500 mg 4gentamicin in saline inj 0.8 mg/ml 2gentamicin in saline inj 1 mg/ml 2gentamicin in saline inj 1.2 mg/ml 2gentamicin in saline inj 1.6 mg/ml 2gentamicin sulfate inj 10 mg/ml 2gentamicin sulfate inj 40 mg/ml 2

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imipenem-cilastatin intravenous for soln 250 mg 3imipenem-cilastatin intravenous for soln 500 mg 3IMPAVIDO - miltefosine cap 50 mg 5INVANZ - ertapenem sodium for inj 1 gm 4INVANZ - ertapenem sodium for iv inj 1 gm 4LEVOFLOXACIN - levofloxacin oral soln 25 mg/ml 3levofloxacin in d5w iv soln 250 mg/50ml 2levofloxacin in d5w iv soln 500 mg/100ml 2levofloxacin in d5w iv soln 750 mg/150ml 2levofloxacin iv soln 25 mg/ml 3levofloxacin tab 250 mg^ 1levofloxacin tab 500 mg^ 1levofloxacin tab 750 mg^ 1LINEZOLID - linezolid in sodium chloride iv soln

600 mg/300ml-0.9%5

linezolid for susp 100 mg/5ml 5 PAlinezolid iv soln 600 mg/300ml (2 mg/ml) 4linezolid tab 600 mg 3 PAmeropenem iv for soln 500 mg 2meropenem iv for soln 1 gm 2methenamine hippurate tab 1 gm 2METRO IV - metronidazole in nacl 0.74% iv soln 500 mg/100ml 4metronidazole cap 375 mg 2metronidazole in nacl 0.79% iv soln 500 mg/100ml 2metronidazole iv soln 5 mg/ml 2metronidazole tab 250 mg 2metronidazole tab 500 mg 2metronidazole vaginal gel 0.75% 2minocycline hcl cap 50 mg 2minocycline hcl cap 75 mg 2minocycline hcl cap 100 mg 2minocycline hcl tab 50 mg 2minocycline hcl tab 75 mg 2minocycline hcl tab 100 mg 2MOXIFLOXACIN HCL - moxifloxacin hcl iv solution 400 mg/250ml 2moxifloxacin hcl tab 400 mg 2moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj 2NAFCILLIN SODIUM - nafcillin sodium for iv soln 1 gm 4

2018



NAFCILLIN SODIUM - nafcillin sodium for iv soln 2 gm 4nafcillin sodium for inj 1 gm 3nafcillin sodium for inj 2 gm 2nafcillin sodium for iv soln 10 gm 5neomycin sulfate tab 500 mg 2neomycin-polymyxin b gu irrigation soln 2nitrofurantoin macrocrystalline cap 50 mg# 4 PAnitrofurantoin macrocrystalline cap 100 mg# 4 PAnitrofurantoin monohydrate macrocrystalline cap 100 mg# 4 PAnitrofurantoin susp 25 mg/5ml# 4 PAofloxacin tab 400 mg 2paromomycin sulfate cap 250 mg 4penicillin g potassium for inj 5000000 unit 2penicillin g potassium for inj 20000000 unit 2PENICILLIN G POTASSIUM IN DEXTROSE - penicillin g

potassium inj 20000 unit/ml in dextrose4

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

4

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

4

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

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SUPRAX - cefixime chew tab 200 mg 4SYNERCID - quinupristin-dalfopristin for inj 500 mg (150-350 mg) 5TEFLARO - ceftaroline fosamil for iv soln 400 mg 5TEFLARO - ceftaroline fosamil for iv soln 600 mg 5tetracycline hcl cap 250 mg 3tetracycline hcl cap 500 mg 3tigecycline for iv soln 50 mg 5TOBRAMYCIN SULFATE - tobramycin sulfate inj 2 gm/50ml

(40 mg/ml)4

tobramycin sulfate for inj 1.2 gm 2tobramycin sulfate inj 10 mg/ml 2tobramycin sulfate inj 80 mg/2ml (40 mg/ml) 2tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml) 2trimethoprim tab 100 mg 2TYGACIL - tigecycline for iv soln 50 mg 5vancomycin hcl cap 125 mg 4vancomycin hcl cap 250 mg 4vancomycin hcl for inj 100 gm 2vancomycin hcl for inj 500 mg 2vancomycin hcl for inj 750 mg 2vancomycin hcl for inj 1000 mg 2vancomycin hcl for inj 5000 mg 2vancomycin hcl for inj 10 gm 2VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl in dextrose

5% inj 500 mg/100ml4

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

4

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

4

ZINACEF - cefuroxime in sterile water inj 1.5 gm/50ml 4ZOSYN - piperacillin sod-tazobactam sod in dex iv soln

2-0.25gm/50ml4

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

4

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

4

Medicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 5APTIOM - eslicarbazepine acetate tab 400 mg 5APTIOM - eslicarbazepine acetate tab 600 mg 5

2018



APTIOM - eslicarbazepine acetate tab 800 mg 5BANZEL - rufinamide susp 40 mg/ml 5BANZEL - rufinamide tab 200 mg 4BANZEL - rufinamide tab 400 mg 5BRIVIACT - brivaracetam iv soln 50 mg/5ml 4BRIVIACT - brivaracetam oral soln 10 mg/ml 5BRIVIACT - brivaracetam tab 10 mg 5BRIVIACT - brivaracetam tab 25 mg 5BRIVIACT - brivaracetam tab 50 mg 5BRIVIACT - brivaracetam tab 75 mg 5BRIVIACT - brivaracetam tab 100 mg 5carbamazepine cap er 12hr 100 mg 2carbamazepine cap er 12hr 200 mg 2carbamazepine cap er 12hr 300 mg 2carbamazepine chew tab 100 mg 2carbamazepine susp 100 mg/5ml 2carbamazepine tab er 12hr 100 mg 2carbamazepine tab er 12hr 200 mg 2carbamazepine tab er 12hr 400 mg 2carbamazepine tab 200 mg 2CELONTIN - methsuximide cap 300 mg 4DIASTAT ACUDIAL - diazepam rectal gel delivery system 10 mg 4 QL (5 twin pack(s)/30 days)DIASTAT ACUDIAL - diazepam rectal gel delivery system 20 mg 4 QL (5 twin pack(s)/30 days)DIASTAT PEDIATRIC - diazepam rectal gel delivery system

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

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

4 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 4divalproex sodium cap delayed release sprinkle 125 mg 2divalproex sodium tab delayed release 125 mg 2divalproex sodium tab delayed release 250 mg 2divalproex sodium tab delayed release 500 mg 2divalproex sodium tab er 24 hr 250 mg 2divalproex sodium tab er 24 hr 500 mg 2ethosuximide cap 250 mg 2

2018


15


ethosuximide soln 250 mg/5ml 2felbamate susp 600 mg/5ml 5felbamate tab 400 mg 4felbamate tab 600 mg 4fosphenytoin sodium inj 100 mg/2ml 3fosphenytoin sodium inj 500 mg/10ml 3FYCOMPA - perampanel susp 0.5 mg/ml 5FYCOMPA - perampanel tab 2 mg 4FYCOMPA - perampanel tab 4 mg 5FYCOMPA - perampanel tab 6 mg 5FYCOMPA - perampanel tab 8 mg 5FYCOMPA - perampanel tab 10 mg 5FYCOMPA - perampanel tab 12 mg 5gabapentin cap 100 mg^ 1 QL (1080 capsules/30 days)gabapentin cap 300 mg^ 1 QL (360 capsules/30 days)gabapentin cap 400 mg^ 1 QL (270 capsules/30 days)gabapentin oral soln 250 mg/5ml 2 QL (2160 mls/30 days)gabapentin tab 600 mg 2 QL (180 tablets/30 days)gabapentin tab 800 mg 2 QL (135 tablets/30 days)GABITRIL - tiagabine hcl tab 12 mg 4GABITRIL - tiagabine hcl tab 16 mg 4lamotrigine tab chewable dispersible 5 mg 2lamotrigine tab chewable dispersible 25 mg 2lamotrigine tab 25 mg^ 1lamotrigine tab 100 mg^ 1lamotrigine tab 150 mg^ 1lamotrigine tab 200 mg^ 1levetiracetam in sodium chloride iv soln 500 mg/100ml 3levetiracetam in sodium chloride iv soln 1000 mg/100ml 3levetiracetam in sodium chloride iv soln 1500 mg/100ml 3levetiracetam inj 500 mg/5ml (100 mg/ml) 3levetiracetam oral soln 100 mg/ml 2levetiracetam tab 250 mg 2levetiracetam tab 500 mg 2levetiracetam tab 750 mg 2levetiracetam tab 1000 mg 2LYRICA - pregabalin cap 25 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 50 mg 3 QL (90 capsules/30 days)

2018



LYRICA - pregabalin cap 75 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 100 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 150 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 200 mg 3 QL (90 capsules/30 days)LYRICA - pregabalin cap 225 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin cap 300 mg 3 QL (60 capsules/30 days)LYRICA - pregabalin soln 20 mg/ml 3 QL (900 mls/30 days)ONFI - clobazam suspension 2.5 mg/ml 5 PA, QL (480 mls/30 days)ONFI - clobazam tab 10 mg 5 PA, QL (60 tablets/30 days)ONFI - clobazam tab 20 mg 5 PA, QL (60 tablets/30 days)oxcarbazepine susp 300 mg/5ml (60 mg/ml) 4oxcarbazepine tab 150 mg 2oxcarbazepine tab 300 mg 2oxcarbazepine tab 600 mg 2PEGANONE - ethotoin tab 250 mg 4PHENOBARBITAL - phenobarbital tab 15 mg# 4 PAPHENOBARBITAL - phenobarbital tab 30 mg# 4 PAPHENOBARBITAL - phenobarbital tab 60 mg# 4 PAPHENOBARBITAL - phenobarbital tab 100 mg# 4 PAphenobarbital elixir 20 mg/5ml# 4 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 65 mg/ml# 4 PAPHENOBARBITAL SODIUM - phenobarbital sodium inj 130 mg/

ml#4 PA

phenobarbital tab 16.2 mg# 4 PAphenobarbital tab 32.4 mg# 4 PAphenobarbital tab 64.8 mg# 4 PAphenobarbital tab 97.2 mg# 4 PAphenytoin chew tab 50 mg 2phenytoin sodium extended cap 100 mg 2phenytoin sodium extended cap 200 mg 2phenytoin sodium extended cap 300 mg 2phenytoin susp 125 mg/5ml 2primidone tab 50 mg 2primidone tab 250 mg 2SABRIL - vigabatrin powd pack 500 mg* 4SABRIL - vigabatrin tab 500 mg* 5SPRITAM - levetiracetam tab disintegrating soluble 250 mg 4SPRITAM - levetiracetam tab disintegrating soluble 500 mg 4

2018


17


SPRITAM - levetiracetam tab disintegrating soluble 750 mg 5SPRITAM - levetiracetam tab disintegrating soluble 1000 mg 4tiagabine hcl tab 2 mg 3tiagabine hcl tab 4 mg 4tiagabine hcl tab 12 mg 4tiagabine hcl tab 16 mg 4topiramate sprinkle cap 15 mg 2topiramate sprinkle cap 25 mg 2topiramate tab 25 mg^ 1topiramate tab 50 mg^ 1topiramate tab 100 mg^ 1topiramate tab 200 mg^ 1valproate sodium inj 100 mg/ml 2valproate sodium oral soln 250 mg/5ml 2valproic acid cap 250 mg 2vigabatrin powd pack 500 mg* 4VIMPAT - lacosamide iv inj 200 mg/20ml (10 mg/ml) 3VIMPAT - lacosamide oral solution 10 mg/ml 3VIMPAT - lacosamide tab 50 mg 3VIMPAT - lacosamide tab 100 mg 3VIMPAT - lacosamide tab 150 mg 3VIMPAT - lacosamide tab 200 mg 3zonisamide cap 25 mg 2zonisamide cap 50 mg 2zonisamide cap 100 mg 2Agentes contra la demenciadonepezil hydrochloride orally disintegrating tab 5 mg 2donepezil hydrochloride orally disintegrating tab 10 mg 2donepezil hydrochloride tab 5 mg^ 1donepezil hydrochloride tab 10 mg^ 1donepezil hydrochloride tab 23 mg 3ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 3 PAGALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml4

galantamine hydrobromide cap er 24hr 8 mg 2galantamine hydrobromide cap er 24hr 16 mg 2galantamine hydrobromide cap er 24hr 24 mg 2galantamine hydrobromide tab 4 mg 2

2018



galantamine hydrobromide tab 8 mg 2galantamine hydrobromide tab 12 mg 2memantine hcl oral solution 2 mg/ml 2 PAmemantine hcl tab 5 mg 2 PAmemantine hcl tab 10 mg 2 PAmemantine hcl tab 5 mg (28) & 10 mg (21) titration pak 2 PArivastigmine tartrate cap 1.5 mg 2rivastigmine tartrate cap 3 mg 2rivastigmine tartrate cap 4.5 mg 2rivastigmine tartrate cap 6 mg 2rivastigmine td patch 24hr 4.6 mg/24hr 2rivastigmine td patch 24hr 9.5 mg/24hr 2rivastigmine td patch 24hr 13.3 mg/24hr 2Medicamentos antidepresivosamitriptyline hcl tab 10 mg# 4 PAamitriptyline hcl tab 25 mg# 4 PAamitriptyline hcl tab 50 mg# 4 PAamitriptyline hcl tab 75 mg# 4 PAamitriptyline hcl tab 100 mg# 4 PAamitriptyline hcl tab 150 mg# 4 PAAMOXAPINE - amoxapine tab 25 mg# 4 PAAMOXAPINE - amoxapine tab 50 mg# 4 PAAMOXAPINE - amoxapine tab 100 mg# 4 PAAMOXAPINE - amoxapine tab 150 mg# 4 PAbupropion hcl tab er 12hr 100 mg 3 QL (90 tablets/30 days)bupropion hcl tab er 12hr 150 mg 3 QL (60 tablets/30 days)bupropion hcl tab er 12hr 200 mg 3 QL (60 tablets/30 days)bupropion hcl tab er 24hr 150 mg 3 QL (90 tablets/30 days)bupropion hcl tab er 24hr 300 mg 3 QL (30 tablets/30 days)bupropion hcl tab 75 mg 2 QL (60 tablets/30 days)bupropion hcl tab 100 mg 2 QL (120 tablets/30 days)citalopram hydrobromide oral soln 10 mg/5ml 2 QL (600 mls/30 days)citalopram hydrobromide tab 10 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 20 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 40 mg^ 1 QL (30 tablets/30 days)clomipramine hcl cap 25 mg# 4 PAclomipramine hcl cap 50 mg# 4 PAclomipramine hcl cap 75 mg# 4 PA

2018


19


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

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

FLUOXETINE DR - fluoxetine hcl cap delayed release 90 mg 2 QL (4 capsules/28 days)fluoxetine hcl cap 10 mg^ 1 QL (90 capsules/30 days)fluoxetine hcl cap 20 mg^ 1 QL (120 capsules/30 days)fluoxetine hcl cap 40 mg^ 1 QL (60 capsules/30 days)fluoxetine hcl solution 20 mg/5ml 2 QL (600 mls/30 days)fluoxetine hcl tab 10 mg 2 QL (90 tablets/30 days)

2018



fluoxetine hcl tab 20 mg 2 QL (120 tablets/30 days)fluvoxamine maleate tab 25 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 50 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 100 mg 2 QL (90 tablets/30 days)imipramine hcl tab 10 mg# 4 PAimipramine hcl tab 25 mg# 4 PAimipramine hcl tab 50 mg# 4 PAMAPROTILINE HCL - maprotiline hcl tab 25 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 4 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 4 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 4mirtazapine orally disintegrating tab 15 mg 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 30 mg 2 QL (30 tablets/30 days)mirtazapine orally disintegrating tab 45 mg 2 QL (30 tablets/30 days)mirtazapine tab 7.5 mg 2 QL (30 tablets/30 days)mirtazapine tab 15 mg 2 QL (45 tablets/30 days)mirtazapine tab 30 mg 2 QL (30 tablets/30 days)mirtazapine tab 45 mg 2 QL (30 tablets/30 days)NEFAZODONE HCL - nefazodone hcl tab 100 mg 4NEFAZODONE HCL - nefazodone hcl tab 150 mg 4NEFAZODONE HCL - nefazodone hcl tab 200 mg 4nefazodone hcl tab 50 mg 2nefazodone hcl tab 250 mg 2nortriptyline hcl cap 10 mg# 4 PAnortriptyline hcl cap 25 mg# 4 PAnortriptyline hcl cap 50 mg# 4 PAnortriptyline hcl cap 75 mg# 4 PAnortriptyline hcl soln 10 mg/5ml# 4 PAparoxetine hcl tab 10 mg# 4 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 4 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 4 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 4 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl oral susp 10 mg/5ml# 4 PA, QL (900 mls/30 days)phenelzine sulfate tab 15 mg 2PRISTIQ - desvenlafaxine succinate tab er 24hr 25 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 50 mg 4 QL (30 tablets/30 days)PRISTIQ - desvenlafaxine succinate tab er 24hr 100 mg 4 QL (30 tablets/30 days)protriptyline hcl tab 5 mg# 4 PA

2018


21


protriptyline hcl tab 10 mg# 4 PAsertraline hcl oral concentrate for solution 20 mg/ml 2 QL (300 mls/30 days)sertraline hcl tab 25 mg^ 1 QL (45 tablets/30 days)sertraline hcl tab 50 mg^ 1 QL (45 tablets/30 days)sertraline hcl tab 100 mg^ 1 QL (60 tablets/30 days)tranylcypromine sulfate tab 10 mg 3trazodone hcl tab 50 mg^ 1trazodone hcl tab 100 mg^ 1trazodone hcl tab 150 mg^ 1trazodone hcl tab 300 mg^ 1trimipramine maleate cap 25 mg# 4 PAtrimipramine maleate cap 50 mg# 4 PAtrimipramine maleate cap 100 mg# 4 PATRINTELLIX - vortioxetine hbr tab 5 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 10 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 20 mg 4 QL (30 tablets/30 days)venlafaxine hcl cap er 24hr 37.5 mg 2 QL (60 capsules/30 days)venlafaxine hcl cap er 24hr 75 mg 2 QL (90 capsules/30 days)venlafaxine hcl cap er 24hr 150 mg 2 QL (30 capsules/30 days)venlafaxine hcl tab er 24hr 37.5 mg 3 QL (60 tablets/30 days)venlafaxine hcl tab er 24hr 75 mg 3 QL (90 tablets/30 days)venlafaxine hcl tab er 24hr 150 mg 3 QL (30 tablets/30 days)venlafaxine hcl tab 25 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 37.5 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 50 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 75 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 100 mg 2 QL (90 tablets/30 days)VIIBRYD - vilazodone hcl tab 10 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 20 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 40 mg 4 QL (30 tablets/30 days)VIIBRYD STARTER PACK - vilazodone hcl tab starter kit 10 (7) &

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

Medicamentos antieméticosALOXI - palonosetron hcl iv soln 0.25 mg/5ml 4aprepitant capsule therapy pack 80 & 125 mg 2 BDaprepitant capsule 40 mg 2 BDaprepitant capsule 80 mg 2 BDaprepitant capsule 125 mg 2 BD

2018



CHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 4 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 4 PAchlorpromazine hcl tab 10 mg 2 PAchlorpromazine hcl tab 25 mg 3 PAchlorpromazine hcl tab 50 mg 3 PAchlorpromazine hcl tab 100 mg 4 PAchlorpromazine hcl tab 200 mg 4 PAdronabinol cap 2.5 mg 3 BDdronabinol cap 5 mg 4 BDdronabinol cap 10 mg 4 BDEMEND - fosaprepitant dimeglumine for iv infusion 150 mg 4granisetron hcl inj 1 mg/ml 2granisetron hcl inj 4 mg/4ml (1 mg/ml) 2granisetron hcl tab 1 mg 2 BDmeclizine hcl tab 12.5 mg# 4meclizine hcl tab 25 mg# 4ondansetron hcl inj 4 mg/2ml (2 mg/ml) 2ondansetron hcl inj 40 mg/20ml (2 mg/ml) 2ondansetron hcl oral soln 4 mg/5ml 2 BDondansetron hcl tab 4 mg 2 BDondansetron hcl tab 8 mg 2 BDondansetron hcl tab 24 mg 2 BDondansetron orally disintegrating tab 4 mg 2 BDondansetron orally disintegrating tab 8 mg 2 BDpalonosetron hcl iv soln 0.25 mg/5ml 4PALONOSETRON HYDROCHLORIDE - palonosetron hcl iv soln

0.25 mg/2ml4

perphenazine tab 2 mg 2 PAperphenazine tab 4 mg 2 PAperphenazine tab 8 mg 2 PAperphenazine tab 16 mg 2 PAprochlorperazine edisylate inj 5 mg/ml 4prochlorperazine maleate tab 5 mg^ 1prochlorperazine maleate tab 10 mg^ 1prochlorperazine suppos 25 mg 2promethazine hcl suppos 12.5 mg# 4 PApromethazine hcl suppos 25 mg# 4 PApromethazine hcl syrup 6.25 mg/5ml# 4 PA

2018


23


promethazine hcl tab 12.5 mg# 4 PApromethazine hcl tab 25 mg# 4 PApromethazine hcl tab 50 mg# 4 PAMedicamentos antimicóticosAMBISOME - amphotericin b liposome iv for susp 50 mg 5 BDAMPHOTERICIN B - amphotericin b for inj 50 mg 4 BDCANCIDAS - caspofungin acetate for iv soln 50 mg 5CANCIDAS - caspofungin acetate for iv soln 70 mg 5caspofungin acetate for iv soln 50 mg 5caspofungin acetate for iv soln 70 mg 5ciclopirox gel 0.77% 2ciclopirox olamine cream 0.77% 2ciclopirox olamine susp 0.77% 2ciclopirox shampoo 1% 2ciclopirox solution 8% 2clotrimazole cream 1%^ 1clotrimazole troche 10 mg 2CRESEMBA - isavuconazonium sulfate cap 186 mg 5 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 5 PAeconazole nitrate cream 1% 2fluconazole for susp 10 mg/ml 2fluconazole for susp 40 mg/ml 2fluconazole in dextrose inj 200 mg/100ml 2fluconazole in dextrose inj 400 mg/200ml 2fluconazole in nacl 0.9% inj 200 mg/100ml 2fluconazole in nacl 0.9% inj 400 mg/200ml 2fluconazole tab 50 mg 2fluconazole tab 100 mg 2fluconazole tab 150 mg 2fluconazole tab 200 mg 2flucytosine cap 250 mg 5flucytosine cap 500 mg 5griseofulvin microsize susp 125 mg/5ml 2griseofulvin ultramicrosize tab 125 mg 2griseofulvin ultramicrosize tab 250 mg 2itraconazole cap 100 mg 4ketoconazole cream 2% 2ketoconazole shampoo 2% 2

2018



ketoconazole tab 200 mg 2MYCAMINE - micafungin sodium for iv soln 50 mg 5MYCAMINE - micafungin sodium for iv soln 100 mg 5NOXAFIL - posaconazole iv soln 300 mg/16.7ml (18 mg/ml) 4 PANOXAFIL - posaconazole susp 40 mg/ml 5 PANOXAFIL - posaconazole tab delayed release 100 mg 5 PAnystatin cream 100000 unit/gm 2nystatin oint 100000 unit/gm 2nystatin susp 100000 unit/ml 2nystatin tab 500000 unit 2nystatin topical powder 100000 unit/gm 2terbinafine hcl tab 250 mg^ 1terconazole vaginal cream 0.4% 2terconazole vaginal cream 0.8% 2terconazole vaginal suppos 80 mg 2voriconazole for inj 200 mg 3 PAvoriconazole for susp 40 mg/ml 5 PAvoriconazole tab 50 mg 5 PAvoriconazole tab 200 mg 5 PAAgentes contra la gotaallopurinol sodium for inj 500 mg 2allopurinol tab 100 mg^ 1allopurinol tab 300 mg^ 1colchicine w/ probenecid tab 0.5-500 mg 2COLCRYS - colchicine tab 0.6 mg 3probenecid tab 500 mg 2ULORIC - febuxostat tab 40 mg 3 STULORIC - febuxostat tab 80 mg 3 STAgentes contra las migrañasMIGERGOT - ergotamine w/ caffeine suppos 2-100 mg 5MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml 3 QL (8 mls/28 days)naratriptan hcl tab 1 mg 2 QL (18 tablets/30 days)naratriptan hcl tab 2.5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate oral disintegrating tab 10 mg 2 QL (18 tablets/30 days)rizatriptan benzoate tab 5 mg 2 QL (18 tablets/30 days)rizatriptan benzoate tab 10 mg 2 QL (18 tablets/30 days)

2018


25


sumatriptan nasal spray 5 mg/act 2 QL (12 units (2packages)/30 days)

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

sumatriptan succinate inj 6 mg/0.5ml 4sumatriptan succinate solution auto-injector 4 mg/0.5ml 2sumatriptan succinate solution auto-injector 6 mg/0.5ml 4sumatriptan succinate solution cartridge 4 mg/0.5ml 4sumatriptan succinate solution cartridge 6 mg/0.5ml 4sumatriptan succinate tab 25 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 50 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 100 mg 2 QL (18 tablets/30 days)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 4MESTINON - pyridostigmine bromide syrup 60 mg/5ml 5pyridostigmine bromide tab er 180 mg 2pyridostigmine bromide tab 60 mg 2Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 4CYCLOSERINE - cycloserine cap 250 mg 5dapsone tab 25 mg 2dapsone tab 100 mg 2ethambutol hcl tab 100 mg 2ethambutol hcl tab 400 mg 2ISONIAZID - isoniazid inj 100 mg/ml 3isoniazid tab 100 mg^ 1isoniazid tab 300 mg^ 1PASER - aminosalicylic acid er granules packet 4 gm 4PRIFTIN - rifapentine tab 150 mg 4pyrazinamide tab 500 mg 2rifabutin cap 150 mg 4rifampin cap 150 mg 2rifampin cap 300 mg 2rifampin for inj 600 mg 5SIRTURO - bedaquiline fumarate tab 100 mg 5TRECATOR - ethionamide tab 250 mg 4Medicamentos antineoplásicosABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 5AFINITOR - everolimus tab 2.5 mg 5 PA, QL (30 tablets/30 days)

2018



AFINITOR - everolimus tab 5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 7.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 10 mg 5 PA, QL (30 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 2 mg 5 PA, QL (60 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 3 mg 5 PA, QL (90 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 5 mg 5 PA, QL (60 tablets/30 days)ALECENSA - alectinib hcl cap 150 mg* 5 PA, QL (240 capsules/30 days)ALIMTA - pemetrexed disodium for iv soln 100 mg 5ALIMTA - pemetrexed disodium for iv soln 500 mg 5ALIQOPA - copanlisib hcl for iv soln 60 mg 5ALUNBRIG - brigatinib tab initiation therapy pack 90 mg & 180 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 30 mg 5 PA, QL (180 tablets/30 days)ALUNBRIG - brigatinib tab 90 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 180 mg 5 PA, QL (30 tablets/30 days)anastrozole tab 1 mg^ 1ARRANON - nelarabine iv soln 5 mg/ml 5ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 5ARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 5AVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 5AVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 5BAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/

ml)5

BELEODAQ - belinostat for iv inj 500 mg* 5BENDEKA - bendamustine hcl iv soln 100 mg/4ml (25 mg/ml) 5BESPONSA - inotuzumab ozogamicin for iv soln 0.9 mg 5bexarotene cap 75 mg 5 PAbicalutamide tab 50 mg 2BICNU - carmustine for inj 100 mg 4bleomycin sulfate for inj 15 unit 2 BDbleomycin sulfate for inj 30 unit 3 BDBLINCYTO - blinatumomab for iv infusion 35 mcg* 5 BDBOSULIF - bosutinib tab 100 mg 5 PA, QL (180 tablets/30 days)BOSULIF - bosutinib tab 400 mg 5 PA, QL (30 tablets/30 days)BOSULIF - bosutinib tab 500 mg 5 PA, QL (30 tablets/30 days)busulfan inj 6 mg/ml 5CABOMETYX - cabozantinib s-malate tab 20 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 40 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 60 mg* 5 PA, QL (30 tablets/30 days)

2018


27


CALQUENCE - acalabrutinib cap 100 mg 5 PA, QL (60 capsules/30 days)CAPRELSA - vandetanib tab 100 mg* 5 PA, QL (60 tablets/30 days)CAPRELSA - vandetanib tab 300 mg* 5 PA, QL (30 tablets/30 days)carboplatin iv soln 50 mg/5ml 2carboplatin iv soln 150 mg/15ml 2carboplatin iv soln 450 mg/45ml 2carboplatin iv soln 600 mg/60ml 2CISPLATIN - cisplatin inj 200 mg/200ml (1 mg/ml) 2cisplatin inj 50 mg/50ml (1 mg/ml) 2cisplatin inj 100 mg/100ml (1 mg/ml) 2cladribine iv soln 10 mg/10ml (1 mg/ml) 5 BDclofarabine iv soln 1 mg/ml 5COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20 mg (100

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

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


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


COSMEGEN - dactinomycin for inj 0.5 mg 5COTELLIC - cobimetinib fumarate tab 20 mg* 5 PA, QL (63 tablets/28 days)cyclophosphamide cap 25 mg 4 BDcyclophosphamide cap 50 mg 4 BDcyclophosphamide for inj 500 mg 5cyclophosphamide for inj 1 gm 5cyclophosphamide for inj 2 gm 5CYRAMZA - ramucirumab iv soln 100 mg/10ml (for infusion)* 5CYRAMZA - ramucirumab iv soln 500 mg/50ml (for infusion)* 5CYTARABINE - cytarabine inj 20 mg/ml 2 BDcytarabine inj pf 20 mg/ml 2 BDcytarabine inj pf 100 mg/ml 2 BDDACARBAZINE - dacarbazine for inj 100 mg 4dacarbazine for inj 200 mg 2dactinomycin for inj 0.5 mg 5DARZALEX - daratumumab iv soln 100 mg/5ml* 5DARZALEX - daratumumab iv soln 400 mg/20ml* 5daunorubicin hcl inj 5 mg/ml 2DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln

20 mg/4ml2

2018



DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln50 mg/10ml

2

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

unit5

ETHYOL - amifostine for inj 500 mg 5ETOPOPHOS - etoposide phosphate iv for inj 100 mg 4etoposide inj 100 mg/5ml (20 mg/ml) 2

2018


29


etoposide inj 500 mg/25ml (20 mg/ml) 2etoposide inj 1 gm/50ml (20 mg/ml) 2EVOMELA - melphalan hcl for inj 50 mg* 5exemestane tab 25 mg 4FARESTON - toremifene citrate tab 60 mg 5FARYDAK - panobinostat lactate cap 10 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 15 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 20 mg* 5 PA, QL (6 capsules/21 days)FASLODEX - fulvestrant inj 250 mg/5ml 5fludarabine phosphate for inj 50 mg 2fludarabine phosphate inj 25 mg/ml 2fluorouracil 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 2FOLOTYN - pralatrexate iv inj 20 mg/ml 5FOLOTYN - pralatrexate iv inj 40 mg/2ml 5GAZYVA - obinutuzumab soln for iv infusion 1000 mg/40ml

(25 mg/ml)5

gemcitabine hcl for inj 200 mg 3gemcitabine hcl for inj 1 gm 3gemcitabine hcl for inj 2 gm 3gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) 2gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) 2gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) 2GILOTRIF - afatinib dimaleate tab 20 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 30 mg 5 PA, QL (30 tablets/30 days)GILOTRIF - afatinib dimaleate tab 40 mg 5 PA, QL (30 tablets/30 days)GLEOSTINE - lomustine cap 10 mg 4GLEOSTINE - lomustine cap 40 mg 4GLEOSTINE - lomustine cap 100 mg 4HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 5HERCEPTIN - trastuzumab for iv soln 150 mg* 5HERCEPTIN - trastuzumab for iv soln 440 mg* 5HEXALEN - altretamine cap 50 mg 5 PAhydroxyurea cap 500 mg 2IBRANCE - palbociclib cap 75 mg* 5 PA, QL (21 capsules/28 days)

2018



IBRANCE - palbociclib cap 100 mg* 5 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 125 mg* 5 PA, QL (21 capsules/28 days)ICLUSIG - ponatinib hcl tab 15 mg 5 PA, QL (60 tablets/30 days)ICLUSIG - ponatinib hcl tab 45 mg 5 PA, QL (30 tablets/30 days)idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 5idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) 5idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) 5IDHIFA - enasidenib mesylate tab 50 mg 5 PA, QL (30 tablets/30 days)IDHIFA - enasidenib mesylate tab 100 mg 5 PA, QL (30 tablets/30 days)IFEX - ifosfamide for inj 3 gm 4IFOSFAMIDE - ifosfamide for inj 3 gm 4ifosfamide for inj 1 gm 2ifosfamide iv inj 1 gm/20ml (50 mg/ml) 2ifosfamide iv inj 3 gm/60ml (50 mg/ml) 2imatinib mesylate tab 100 mg 5 PA, QL (90 tablets/30 days)imatinib mesylate tab 400 mg 5 PA, QL (60 tablets/30 days)IMBRUVICA - ibrutinib cap 70 mg 5 PA, QL (30 capsules/30 days)IMBRUVICA - ibrutinib cap 140 mg 5 PA, QL (120 capsules/30 days)IMBRUVICA - ibrutinib tab 140 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 280 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 420 mg 5 PA, QL (30 tablets/30 days)IMBRUVICA - ibrutinib tab 560 mg 5 PA, QL (30 tablets/30 days)IMFINZI - durvalumab soln for iv infusion 120 mg/2.4ml (50 mg/ml) 5IMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 5IMLYGIC - talimogene laherparepvec intralesional inj 1000000

unit/ml*4

IMLYGIC - talimogene laherparepvec intralesional inj 100000000unit/ml*

5

INLYTA - axitinib tab 1 mg* 5 PA, QL (180 tablets/30 days)INLYTA - axitinib tab 5 mg* 5 PA, QL (120 tablets/30 days)IRESSA - gefitinib tab 250 mg* 5 PA, QL (30 tablets/30 days)IRINOTECAN - irinotecan hcl inj 500 mg/25ml (20 mg/ml) 3irinotecan hcl inj 40 mg/2ml (20 mg/ml) 3irinotecan hcl inj 100 mg/5ml (20 mg/ml) 3ISTODAX - romidepsin for iv inj 10 mg 5ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 5IXEMPRA KIT - ixabepilone for iv infusion 15 mg 5IXEMPRA KIT - ixabepilone for iv infusion 45 mg 5

2018


31


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

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

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

5 PA, QL (91 tablets/28 days)

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


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

ml)5

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

5

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


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


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


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


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


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


letrozole tab 2.5 mg^ 1LEUCOVORIN CALCIUM - leucovorin calcium for inj 500 mg 4LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 3LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 4leucovorin calcium for inj 50 mg 4leucovorin calcium for inj 100 mg 4leucovorin calcium for inj 200 mg 4

2018



leucovorin calcium for inj 350 mg 3leucovorin calcium tab 5 mg 2leucovorin calcium tab 25 mg 4LEUKERAN - chlorambucil tab 2 mg 3LONSURF - trifluridine-tipiracil tab 15-6.14 mg 5 PA, QL (100 tablets/28 days)LONSURF - trifluridine-tipiracil tab 20-8.19 mg 5 PA, QL (80 tablets/28 days)LYNPARZA - olaparib cap 50 mg* 5 PA, QL (480 capsules/30 days)LYNPARZA - olaparib tab 100 mg* 5 PA, QL (120 tablets/30 days)LYNPARZA - olaparib tab 150 mg* 5 PA, QL (120 tablets/30 days)MARQIBO - vincristine sulfate liposome iv susp 5 mg/31ml

(0.16 mg/ml)5

MATULANE - procarbazine hcl cap 50 mg* 5 PAMEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg* 5 PA, QL (90 tablets/30 days)MEKINIST - trametinib dimethyl sulfoxide tab 2 mg* 5 PA, QL (30 tablets/30 days)melphalan hcl for inj 50 mg 5mercaptopurine tab 50 mg 2mesna inj 100 mg/ml 2MESNEX - mesna tab 400 mg 4mitomycin for iv soln 5 mg 4mitomycin for iv soln 20 mg 2mitomycin for iv soln 40 mg 5mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) 2mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml) 2mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml) 2MUSTARGEN - mechlorethamine hcl for inj 10 mg 4MYLOTARG - gemtuzumab ozogamicin for iv soln 4.5 mg 5NERLYNX - neratinib maleate tab 40 mg 5 PA, QL (180 tablets/30 days)NEXAVAR - sorafenib tosylate tab 200 mg* 5 PA, QL (120 tablets/30 days)nilutamide tab 150 mg 5NINLARO - ixazomib citrate cap 2.3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 3 mg 5 PA, QL (3 capsules/28 days)NINLARO - ixazomib citrate cap 4 mg 5 PA, QL (3 capsules/28 days)NIPENT - pentostatin for inj 10 mg 5ODOMZO - sonidegib phosphate cap 200 mg* 5 PA, QL (30 capsules/30 days)ONCASPAR - pegaspargase inj 750 unit/ml 5ONIVYDE - irinotecan hcl liposome iv inj 43 mg/10ml (4.3 mg/ml) 5OPDIVO - nivolumab iv soln 40 mg/4ml* 5OPDIVO - nivolumab iv soln 100 mg/10ml* 5

2018


33


OPDIVO - nivolumab iv soln 240 mg/24ml* 5oxaliplatin for iv inj 50 mg 5oxaliplatin for iv inj 100 mg 5oxaliplatin iv soln 50 mg/10ml 4oxaliplatin iv soln 100 mg/20ml 4paclitaxel iv conc 30 mg/5ml (6 mg/ml) 3paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) 3paclitaxel iv conc 300 mg/50ml (6 mg/ml) 3PANRETIN - alitretinoin gel 0.1% 5PERJETA - pertuzumab soln for iv infusion 420 mg/14ml (30 mg/

ml)*5

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

1400-23400 mg-unit/11.7ml5 PA

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

5 PA

RUBRACA - rucaparib camsylate tab 200 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 250 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 300 mg 5 PA, QL (120 tablets/30 days)RYDAPT - midostaurin cap 25 mg 5 PA, QL (240 capsules/30 days)SOLTAMOX - tamoxifen citrate oral soln 10 mg/5ml 4SPRYCEL - dasatinib tab 20 mg 5 PA, QL (90 tablets/30 days)SPRYCEL - dasatinib tab 50 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 70 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 80 mg 5 PA, QL (30 tablets/30 days)

2018



SPRYCEL - dasatinib tab 100 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 140 mg 5 PA, QL (30 tablets/30 days)STIVARGA - regorafenib tab 40 mg* 5 PA, QL (84 tablets/28 days)SUTENT - sunitinib malate cap 12.5 mg 5 PA, QL (90 capsules/30 days)SUTENT - sunitinib malate cap 25 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 37.5 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 50 mg 5 PA, QL (30 capsules/30 days)SYNRIBO - omacetaxine mepesuccinate for inj 3.5 mg 5TABLOID - thioguanine tab 40 mg 4TAFINLAR - dabrafenib mesylate cap 50 mg* 5 PA, QL (120 capsules/30 days)TAFINLAR - dabrafenib mesylate cap 75 mg* 5 PA, QL (120 capsules/30 days)TAGRISSO - osimertinib mesylate tab 40 mg* 5 PA, QL (30 tablets/30 days)TAGRISSO - osimertinib mesylate tab 80 mg* 5 PA, QL (30 tablets/30 days)tamoxifen citrate tab 10 mg 2tamoxifen citrate tab 20 mg 2TARCEVA - erlotinib hcl tab 25 mg 5 PA, QL (60 tablets/30 days)TARCEVA - erlotinib hcl tab 100 mg 5 PA, QL (30 tablets/30 days)TARCEVA - erlotinib hcl tab 150 mg 5 PA, QL (30 tablets/30 days)TARGRETIN - bexarotene gel 1% 5TASIGNA - nilotinib hcl cap 50 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 150 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 200 mg 5 PA, QL (120 capsules/30 days)TECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 5TEMODAR - temozolomide for iv soln 100 mg 5THALOMID - thalidomide cap 50 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 100 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 150 mg 5 PA, QL (60 capsules/30 days)THALOMID - thalidomide cap 200 mg 5 PA, QL (60 capsules/30 days)thiotepa for inj 15 mg 5topotecan hcl for inj 4 mg 5topotecan hcl inj 4 mg/4ml (for infusion) 5TORISEL - temsirolimus soln for iv infusion 25 mg/ml 5TREANDA - bendamustine hcl for iv soln 25 mg 5TREANDA - bendamustine hcl for iv soln 100 mg 5tretinoin cap 10 mg 5 PATRISENOX - arsenic trioxide iv soln 12 mg/6ml (2 mg/ml) 5TYKERB - lapatinib ditosylate tab 250 mg* 5 PA, QL (180 tablets/30 days)UNITUXIN - dinutuximab iv soln 17.5 mg/5ml (3.5 mg/ml)* 5

2018


35


VALCHLOR - mechlorethamine hcl gel 0.016%* 5VECTIBIX - panitumumab iv soln 100 mg/5ml 5VECTIBIX - panitumumab iv soln 400 mg/20ml 5VELCADE - bortezomib for inj 3.5 mg 5VENCLEXTA - venetoclax tab 10 mg* 3 PA, QL (60 tablets/30 days)VENCLEXTA - venetoclax tab 50 mg* 4 PA, QL (30 tablets/30 days)VENCLEXTA - venetoclax tab 100 mg* 5 PA, QL (120 tablets/30 days)VENCLEXTA STARTING PACK - venetoclax tab therapy starter

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

tablets)/28 days)VERZENIO - abemaciclib tab 50 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 100 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 150 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 200 mg 5 PA, QL (60 tablets/30 days)VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 4 BDvincristine sulfate iv soln 1 mg/ml 2 BDvinorelbine tartrate inj 10 mg/ml 3vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 3VOTRIENT - pazopanib hcl tab 200 mg* 5 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 5XALKORI - crizotinib cap 200 mg* 5 PA, QL (60 capsules/30 days)XALKORI - crizotinib cap 250 mg* 5 PA, QL (60 capsules/30 days)XTANDI - enzalutamide cap 40 mg* 5 PA, QL (120 capsules/30 days)YERVOY - ipilimumab soln for iv infusion 50 mg/10ml (5 mg/ml)* 5YERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 5YONDELIS - trabectedin for inj 1 mg 5YONSA - abiraterone acetate tab 125 mg* 5 PA, QL (120 tablets/30 days)ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 5ZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 5ZANOSAR - streptozocin for inj 1 gm 4ZEJULA - niraparib tosylate cap 100 mg 5 PA, QL (90 capsules/30 days)ZELBORAF - vemurafenib tab 240 mg* 5 PA, QL (240 tablets/30 days)ZOLINZA - vorinostat cap 100 mg 5 PA, QL (120 capsules/30 days)ZYDELIG - idelalisib tab 100 mg* 5 PA, QL (60 tablets/30 days)ZYDELIG - idelalisib tab 150 mg* 5 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 5 PA, QL (150 capsules/30 days)ZYTIGA - abiraterone acetate tab 250 mg* 5 PA, QL (120 tablets/30 days)ZYTIGA - abiraterone acetate tab 500 mg* 5 PA, QL (60 tablets/30 days)

2018



Medicamentos antiparasitariosALBENZA - albendazole tab 200 mg 5ALINIA - nitazoxanide for susp 100 mg/5ml 5ALINIA - nitazoxanide tab 500 mg 5atovaquone susp 750 mg/5ml 5atovaquone-proguanil hcl tab 62.5-25 mg 2atovaquone-proguanil hcl tab 250-100 mg 2BENZNIDAZOLE - benznidazole tab 12.5 mg 4BENZNIDAZOLE - benznidazole tab 100 mg 4BILTRICIDE - praziquantel tab 600 mg 4CHLOROQUINE PHOSPHATE - chloroquine phosphate tab

250 mg3

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

300 mg4 BD

PENTAM 300 - pentamidine isethionate for soln 300 mg 4 BDpermethrin cream 5% 2praziquantel tab 600 mg 4PRIMAQUINE PHOSPHATE - primaquine phosphate tab 26.3 mg 4Agentes contra la enfermedad de Parkinsonamantadine hcl cap 100 mg 2amantadine hcl syrup 50 mg/5ml 2amantadine hcl tab 100 mg 2APOKYN - apomorphine hcl soln cartridge 30 mg/3ml* 5 PA, QL (60 mls/30 days)benztropine mesylate tab 0.5 mg# 3 PAbenztropine mesylate tab 1 mg# 3 PAbenztropine mesylate tab 2 mg# 3 PAbromocriptine mesylate cap 5 mg 2bromocriptine mesylate tab 2.5 mg 3carbidopa & levodopa orally disintegrating tab 10-100 mg 2carbidopa & levodopa orally disintegrating tab 25-100 mg 2carbidopa & levodopa orally disintegrating tab 25-250 mg 2

2018


37


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

entacapone tabs 12.5-50-200 mg3

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

3

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

3


3


3

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

3

entacapone tab 200 mg 3NEUPRO - rotigotine td patch 24hr 1 mg/24hr 3NEUPRO - rotigotine td patch 24hr 2 mg/24hr 3NEUPRO - rotigotine td patch 24hr 3 mg/24hr 3NEUPRO - rotigotine td patch 24hr 4 mg/24hr 3NEUPRO - rotigotine td patch 24hr 6 mg/24hr 3NEUPRO - rotigotine td patch 24hr 8 mg/24hr 3pramipexole dihydrochloride tab 0.125 mg^ 1pramipexole dihydrochloride tab 0.25 mg^ 1pramipexole dihydrochloride tab 0.5 mg^ 1pramipexole dihydrochloride tab 0.75 mg^ 1pramipexole dihydrochloride tab 1 mg^ 1pramipexole dihydrochloride tab 1.5 mg^ 1rasagiline mesylate tab 0.5 mg 4rasagiline mesylate tab 1 mg 4ropinirole hydrochloride tab 0.25 mg 2ropinirole hydrochloride tab 0.5 mg 2ropinirole hydrochloride tab 1 mg 2ropinirole hydrochloride tab 2 mg 2ropinirole hydrochloride tab 3 mg 2ropinirole hydrochloride tab 4 mg 2

2018



ropinirole hydrochloride tab 5 mg 2selegiline hcl cap 5 mg 2selegiline hcl tab 5 mg 2tolcapone tab 100 mg 5Medicamentos antipsicóticosADASUVE - loxapine aerosol powder breath activated 10 mg 4 PAaripiprazole oral solution 1 mg/ml 2 PA, QL (750 mls/30 days)aripiprazole orally disintegrating tab 10 mg 5 PA, QL (60 tablets/30 days)aripiprazole orally disintegrating tab 15 mg 5 PA, QL (60 tablets/30 days)aripiprazole tab 2 mg 4 PA, QL (45 tablets/30 days)aripiprazole tab 5 mg 4 PA, QL (45 tablets/30 days)aripiprazole tab 10 mg 4 PA, QL (30 tablets/30 days)aripiprazole tab 15 mg 4 PA, QL (30 tablets/30 days)aripiprazole tab 20 mg 4 PA, QL (30 tablets/30 days)aripiprazole tab 30 mg 4 PA, QL (30 tablets/30 days)ARISTADA - aripiprazole lauroxil im er susp prefilled syr

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

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

5 PA, QL (1 syringe/28 days)





clozapine orally disintegrating tab 12.5 mg 2 PA, QL (90 tablets/30 days)clozapine orally disintegrating tab 25 mg 2 PA, QL (270 tablets/30 days)clozapine orally disintegrating tab 100 mg 2 PA, QL (270 tablets/30 days)clozapine tab 25 mg 2 PA, QL (90 tablets/30 days)clozapine tab 50 mg 2 PA, QL (90 tablets/30 days)clozapine tab 100 mg 2 PA, QL (270 tablets/30 days)clozapine tab 200 mg 2 PA, QL (120 tablets/30 days)FANAPT - iloperidone tab 1 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 2 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 4 mg 4 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 6 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 8 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 10 mg 5 PA, QL (60 tablets/30 days)FANAPT - iloperidone tab 12 mg 5 PA, QL (60 tablets/30 days)FANAPT TITRATION PACK - iloperidone tab 1 mg & 2 mg & 4 mg

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

tablets)/28 days)

2018


39


fluphenazine decanoate inj 25 mg/ml 2 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 4 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 4 PAfluphenazine hcl tab 1 mg 2 PAfluphenazine hcl tab 2.5 mg 2 PAfluphenazine hcl tab 5 mg 2 PAfluphenazine hcl tab 10 mg 2 PAGEODON - ziprasidone mesylate for inj 20 mg 4 PA, QL (60 vials/30 days)haloperidol decanoate im soln 50 mg/ml 2 PAhaloperidol decanoate im soln 100 mg/ml 2 PAhaloperidol lactate inj 5 mg/ml 2 PAhaloperidol lactate oral conc 2 mg/ml 2 PAhaloperidol tab 0.5 mg 2 PAhaloperidol tab 1 mg 2 PAhaloperidol tab 2 mg 2 PAhaloperidol tab 5 mg 2 PAhaloperidol tab 10 mg 2 PAhaloperidol tab 20 mg 2 PAINVEGA SUSTENNA - paliperidone palmitate im extend-release

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

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

4 PA, QL (1 kit/28 days)



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




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








LATUDA - lurasidone hcl tab 20 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 40 mg 5 PA, QL (30 tablets/30 days)LATUDA - lurasidone hcl tab 60 mg 5 PA, QL (30 tablets/30 days)

2018



LATUDA - lurasidone hcl tab 80 mg 5 PA, QL (60 tablets/30 days)LATUDA - lurasidone hcl tab 120 mg 5 PA, QL (30 tablets/30 days)loxapine succinate cap 5 mg 2 PAloxapine succinate cap 10 mg 2 PAloxapine succinate cap 25 mg 2 PAloxapine succinate cap 50 mg 2 PANUPLAZID - pimavanserin tartrate cap 34 mg* 5 PA, QL (30 capsules/30 days)NUPLAZID - pimavanserin tartrate tab 10 mg* 5 PA, QL (30 tablets/30 days)NUPLAZID - pimavanserin tartrate tab 17 mg* 5 PA, QL (60 tablets/30 days)olanzapine for im inj 10 mg 2 PA, QL (90 vials/30 days)olanzapine orally disintegrating tab 5 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 10 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 15 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 20 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 2.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 7.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 10 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 15 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 20 mg 2 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 1.5 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg 4 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)pimozide tab 1 mg 2pimozide tab 2 mg 2quetiapine fumarate tab er 24hr 50 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 150 mg 4 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 200 mg 4 PA, QL (30 tablets/30 days)quetiapine fumarate tab er 24hr 300 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab er 24hr 400 mg 4 PA, QL (60 tablets/30 days)quetiapine fumarate tab 25 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 50 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 100 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 200 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 300 mg 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab 400 mg 2 PA, QL (60 tablets/30 days)REXULTI - brexpiprazole tab 0.25 mg 5 PA, QL (30 tablets/30 days)

2018


41


REXULTI - brexpiprazole tab 0.5 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 1 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 2 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 3 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 4 mg 5 PA, QL (30 tablets/30 days)RISPERDAL CONSTA - risperidone microspheres for inj 12.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 5 PA, QL (2 vials/28 days)risperidone orally disintegrating tab 0.25 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 0.5 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 1 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 2 mg 2 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 3 mg 3 PA, QL (60 tablets/30 days)risperidone orally disintegrating tab 4 mg 3 PA, QL (120 tablets/30 days)risperidone soln 1 mg/ml 2 PA, QL (480 mls/30 days)risperidone tab 0.25 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 0.5 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 1 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 2 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 3 mg^ 1 PA, QL (60 tablets/30 days)risperidone tab 4 mg^ 1 PA, QL (120 tablets/30 days)SAPHRIS - asenapine maleate sl tab 2.5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 5 mg 4 PA, QL (60 tablets/30 days)SAPHRIS - asenapine maleate sl tab 10 mg 4 PA, QL (60 tablets/30 days)thioridazine hcl tab 10 mg 4 PAthioridazine hcl tab 25 mg 4 PAthioridazine hcl tab 50 mg 4 PAthioridazine hcl tab 100 mg 4 PAthiothixene cap 1 mg 2 PAthiothixene cap 2 mg 2 PAthiothixene cap 5 mg 2 PAthiothixene cap 10 mg 2 PAtrifluoperazine hcl tab 1 mg 2 PAtrifluoperazine hcl tab 2 mg 2 PAtrifluoperazine hcl tab 5 mg 2 PAtrifluoperazine hcl tab 10 mg 2 PAVERSACLOZ - clozapine susp 50 mg/ml 5 PA, QL (540 mls/30 days)

2018



VRAYLAR - cariprazine hcl cap 1.5 mg 5 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 3 mg 5 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 4.5 mg 5 PA, QL (30 capsules/30 days)VRAYLAR - cariprazine hcl cap 6 mg 5 PA, QL (30 capsules/30 days)ziprasidone hcl cap 20 mg 2 PA, QL (90 capsules/30 days)ziprasidone hcl cap 40 mg 2 PA, QL (90 capsules/30 days)ziprasidone hcl cap 60 mg 2 PA, QL (60 capsules/30 days)ziprasidone hcl cap 80 mg 2 PA, QL (60 capsules/30 days)ZYPREXA RELPREVV - olanzapine pamoate for extended rel im

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

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 300 mg

5 PA, QL (2 vials/28 days)

ZYPREXA RELPREVV - olanzapine pamoate for extended rel imsusp 405 mg

5 PA, QL (1 vial/28 days)

Agentes antiespasmódicosbaclofen tab 10 mg 2baclofen tab 20 mg 2dantrolene sodium cap 25 mg 2dantrolene sodium cap 50 mg 2dantrolene sodium cap 100 mg 2tizanidine hcl cap 2 mg 2tizanidine hcl cap 4 mg 2tizanidine hcl cap 6 mg 2tizanidine hcl tab 2 mg 2tizanidine hcl tab 4 mg 2Medicamentos antiviralesabacavir sulfate soln 20 mg/ml 4 QL (960 mls/30 days)abacavir sulfate tab 300 mg 4 QL (60 tablets/30 days)abacavir sulfate-lamivudine tab 600-300 mg 5 QL (30 tablets/30 days)abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 5 QL (60 tablets/30 days)acyclovir cap 200 mg^ 1acyclovir oint 5% 2acyclovir sodium iv soln 50 mg/ml 2 BDacyclovir susp 200 mg/5ml 3acyclovir tab 400 mg 2acyclovir tab 800 mg 2adefovir dipivoxil tab 10 mg 5APTIVUS - tipranavir cap 250 mg 5 QL (120 capsules/30 days)APTIVUS - tipranavir oral soln 100 mg/ml 5 QL (380 mls/30 days)

2018


43


atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)atazanavir sulfate cap 300 mg 5 QL (30 capsules/30 days)ATRIPLA - efavirenz-emtricitabine-tenofovir df tab

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

BARACLUDE - entecavir oral soln 0.05 mg/ml 4BIKTARVY - bictegravir-emtricitabine-tenofovir af tab

50-200-25 mg5 QL (30 tablets/30 days)

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

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

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

5 QL (30 tablets/30 days)

CRIXIVAN - indinavir sulfate cap 200 mg 3 QL (270 capsules/30 days)CRIXIVAN - indinavir sulfate cap 400 mg 3 QL (180 capsules/30 days)DAKLINZA - daclatasvir dihydrochloride tab 30 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 60 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 90 mg 5 PADENAVIR - penciclovir cream 1% 5DESCOVY - emtricitabine-tenofovir alafenamide fumarate tab


didanosine delayed release capsule 200 mg 2 QL (30 capsules/30 days)didanosine delayed release capsule 250 mg 2 QL (30 capsules/30 days)didanosine delayed release capsule 400 mg 3 QL (30 capsules/30 days)EDURANT - rilpivirine hcl tab 25 mg 5 QL (30 tablets/30 days)efavirenz cap 50 mg 2 QL (90 capsules/30 days)efavirenz cap 200 mg 5 QL (60 capsules/30 days)efavirenz tab 600 mg 5 QL (30 tablets/30 days)EMTRIVA - emtricitabine caps 200 mg 4 QL (30 capsules/30 days)EMTRIVA - emtricitabine soln 10 mg/ml 4 QL (850 mls/30 days)entecavir tab 0.5 mg 4entecavir tab 1 mg 4EPCLUSA - sofosbuvir-velpatasvir tab 400-100 mg 5 PAEPIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) 3EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg 5 QL (30 tablets/30 days)famciclovir tab 125 mg 2famciclovir tab 250 mg 2famciclovir tab 500 mg 2fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)

2018



FUZEON - enfuvirtide for inj 90 mg 5 QL (60 vials/30 days)ganciclovir sodium for inj 500 mg 2 BDGENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab

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

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg 5 PAINTELENCE - etravirine tab 25 mg 4 QL (120 tablets/30 days)INTELENCE - etravirine tab 100 mg 4 QL (60 tablets/30 days)INTELENCE - etravirine tab 200 mg 5 QL (60 tablets/30 days)INTRON A - interferon alfa-2b inj 6000000 unit/ml 5INTRON A - interferon alfa-2b inj 10000000 unit/ml 5INTRON A - interferon alfa-2b for inj 10000000 unit 5INTRON A - interferon alfa-2b for inj 18000000 unit 5INTRON A - interferon alfa-2b for inj 50000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 10000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 18000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 50000000 unit 5INVIRASE - saquinavir mesylate cap 200 mg 5 QL (300 capsules/30 days)INVIRASE - saquinavir mesylate tab 500 mg 5 QL (120 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 25 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium chew tab 100 mg 3 QL (180 tablets/30 days)ISENTRESS - raltegravir potassium packet for susp 100 mg 4 QL (60 packets/30 days)ISENTRESS - raltegravir potassium tab 400 mg 5 QL (60 tablets/30 days)ISENTRESS HD - raltegravir potassium tab 600 mg 5 QL (60 tablets/30 days)JULUCA - dolutegravir sodium-rilpivirine hcl tab 50-25 mg 5 QL (30 tablets/30 days)KALETRA - lopinavir-ritonavir tab 100-25 mg 5 QL (300 tablets/30 days)KALETRA - lopinavir-ritonavir tab 200-50 mg 5 QL (120 tablets/30 days)lamivudine oral soln 10 mg/ml 2 QL (960 mls/30 days)lamivudine tab 100 mg (hbv) 4lamivudine tab 150 mg 2 QL (60 tablets/30 days)lamivudine tab 300 mg 2 QL (30 tablets/30 days)lamivudine-zidovudine tab 150-300 mg 4 QL (60 tablets/30 days)LEXIVA - fosamprenavir calcium susp 50 mg/ml 4 QL (1800 mls/30 days)LEXIVA - fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 5 QL (480 mls/30 days)MAVYRET - glecaprevir-pibrentasvir tab 100-40 mg 5 PAnevirapine tab er 24hr 100 mg 3 QL (90 tablets/30 days)nevirapine tab er 24hr 400 mg 4 QL (30 tablets/30 days)nevirapine tab 200 mg 2 QL (60 tablets/30 days)

2018


45


NORVIR - ritonavir cap 100 mg 4 QL (360 capsules/30 days)NORVIR - ritonavir oral soln 80 mg/ml 4 QL (480 mls/30 days)NORVIR - ritonavir powder packet 100 mg 4 QL (360 packets/30 days)NORVIR - ritonavir tab 100 mg 4 QL (360 tablets/30 days)ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg 5 QL (30 tablets/30 days)oseltamivir phosphate cap 30 mg 2oseltamivir phosphate cap 45 mg 2oseltamivir phosphate cap 75 mg 2oseltamivir phosphate for susp 6 mg/ml 2PEGASYS - peginterferon alfa-2a inj 180 mcg/ml 5 PAPEGASYS - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 135 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPREZCOBIX - darunavir-cobicistat tab 800-150 mg 5 QL (30 tablets/30 days)PREZISTA - darunavir ethanolate susp 100 mg/ml 5 QL (400 mls/30 days)PREZISTA - darunavir ethanolate tab 75 mg 4 QL (300 tablets/30 days)PREZISTA - darunavir ethanolate tab 150 mg 4 QL (180 tablets/30 days)PREZISTA - darunavir ethanolate tab 600 mg 5 QL (60 tablets/30 days)PREZISTA - darunavir ethanolate tab 800 mg 5 QL (30 tablets/30 days)REBETOL - ribavirin soln 40 mg/ml 4RELENZA DISKHALER - zanamivir aero powder breath activated

5 mg/blister4

RESCRIPTOR - delavirdine mesylate tab 100 mg 4 QL (360 tablets/30 days)RESCRIPTOR - delavirdine mesylate tab 200 mg 4 QL (180 tablets/30 days)RETROVIR IV INFUSION - zidovudine iv soln 10 mg/ml 4REYATAZ - atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)REYATAZ - atazanavir sulfate cap 300 mg 5 QL (30 capsules/30 days)REYATAZ - atazanavir sulfate oral powder packet 50 mg 5 QL (240 packets/30 days)RIBASPHERE - ribavirin tab 400 mg 5RIBASPHERE - ribavirin tab 600 mg 5RIBASPHERE RIBAPAK - ribavirin tab 400 mg 5RIBASPHERE RIBAPAK - ribavirin tab 600 mg 5ribavirin cap 200 mg 2ribavirin tab 200 mg 2rimantadine hydrochloride tab 100 mg 2ritonavir tab 100 mg 3 QL (360 tablets/30 days)SELZENTRY - maraviroc oral soln 20 mg/ml 5 QL (1840 mls/30 days)

2018



SELZENTRY - maraviroc tab 25 mg 4 QL (240 tablets/30 days)SELZENTRY - maraviroc tab 75 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 150 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 300 mg 5 QL (120 tablets/30 days)SOVALDI - sofosbuvir tab 400 mg 5 PAstavudine cap 15 mg 2 QL (60 capsules/30 days)stavudine cap 20 mg 2 QL (60 capsules/30 days)stavudine cap 30 mg 2 QL (60 capsules/30 days)stavudine cap 40 mg 2 QL (60 capsules/30 days)STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab

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

SUSTIVA - efavirenz cap 50 mg 4 QL (90 capsules/30 days)SUSTIVA - efavirenz cap 200 mg 5 QL (60 capsules/30 days)SUSTIVA - efavirenz tab 600 mg 5 QL (30 tablets/30 days)SYLATRON - peginterferon alfa-2b for inj kit 200 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 300 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 600 mcg 5 PASYMFI - efavirenz-lamivudine-tenofovir df tab 600-300-300 mg 5 QL (30 tablets/30 days)SYMFI LO - efavirenz-lamivudine-tenofovir df tab 400-300-300 mg 5 QL (30 tablets/30 days)TAMIFLU - oseltamivir phosphate for susp 6 mg/ml 4TECHNIVIE - ombitasvir-paritaprevir-ritonavir tab 12.5-75-50 mg 5 PAtenofovir disoproxil fumarate tab 300 mg 5 QL (30 tablets/30 days)TIVICAY - dolutegravir sodium tab 10 mg 4 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 25 mg 5 QL (60 tablets/30 days)TIVICAY - dolutegravir sodium tab 50 mg 5 QL (60 tablets/30 days)TRIUMEQ - abacavir-dolutegravir-lamivudine tab 600-50-300 mg 5 QL (30 tablets/30 days)TROGARZO - ibalizumab-uiyk iv soln 200 mg/1.33ml (150 mg/ml) 5 QL (14 vials/28 days)TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab


TRUVADA - emtricitabine-tenofovir disoproxil fumarate tab133-200 mg






TYBOST - cobicistat tab 150 mg 3 QL (30 tablets/30 days)valacyclovir hcl tab 500 mg 2valacyclovir hcl tab 1 gm 2valganciclovir hcl for soln 50 mg/ml 5

2018


47


valganciclovir hcl tab 450 mg 5VIDEX - didanosine for soln 2 gm 4 QL (1200 mls/30 days)VIDEX - didanosine for soln 4 gm 4 QL (1200 mls/30 days)VIDEX EC - didanosine delayed release capsule 125 mg 4 QL (30 capsules/30 days)VIEKIRA PAK - ombitas-paritapre-riton & dasab tab pak

12.5-75-50 & 250 mg5 PA

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

5 PA

VIRACEPT - nelfinavir mesylate tab 250 mg 5 QL (270 tablets/30 days)VIRACEPT - nelfinavir mesylate tab 625 mg 5 QL (120 tablets/30 days)VIRAMUNE - nevirapine susp 50 mg/5ml 4 QL (1200 mls/30 days)VIREAD - tenofovir disoproxil fumarate oral powder 40 mg/gm 5 QL (240 grams/30 days)VIREAD - tenofovir disoproxil fumarate tab 150 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 200 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 250 mg 5 QL (30 tablets/30 days)VIREAD - tenofovir disoproxil fumarate tab 300 mg 5 QL (30 tablets/30 days)VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 5 PAZEPATIER - elbasvir-grazoprevir tab 50-100 mg 5 PAZERIT - stavudine for oral soln 1 mg/ml 4 QL (2400 mls/30 days)ZIAGEN - abacavir sulfate soln 20 mg/ml 4 QL (960 mls/30 days)zidovudine cap 100 mg 2 QL (180 capsules/30 days)zidovudine syrup 10 mg/ml 2 QL (1920 mls/30 days)zidovudine tab 300 mg 2 QL (60 tablets/30 days)Medicamentos ansiolíticosalprazolam tab 0.25 mg 3 QL (120 tablets/30 days)alprazolam tab 0.5 mg 3 QL (120 tablets/30 days)alprazolam tab 1 mg 3 QL (120 tablets/30 days)alprazolam tab 2 mg 3 QL (150 tablets/30 days)buspirone hcl tab 5 mg 2buspirone hcl tab 7.5 mg 2buspirone hcl tab 10 mg 2buspirone hcl tab 15 mg 2buspirone hcl tab 30 mg 2clonazepam orally disintegrating tab 0.125 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.25 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 0.5 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 1 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 2 mg 2 PA, QL (300 tablets/30 days)

2018



clonazepam tab 0.5 mg^ 1 PA, QL (120 tablets/30 days)clonazepam tab 1 mg^ 1 PA, QL (120 tablets/30 days)clonazepam tab 2 mg^ 1 PA, QL (300 tablets/30 days)clorazepate dipotassium tab 3.75 mg 2 PA, QL (120 tablets/30 days)clorazepate dipotassium tab 7.5 mg 2 PA, QL (90 tablets/30 days)clorazepate dipotassium tab 15 mg 2 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 4 PA, QL (1200 mls/30 days)diazepam conc 5 mg/ml 2 PA, QL (240 mls/30 days)diazepam tab 2 mg^ 1 PA, QL (120 tablets/30 days)diazepam tab 5 mg^ 1 PA, QL (120 tablets/30 days)diazepam tab 10 mg^ 1 PA, QL (120 tablets/30 days)hydroxyzine hcl syrup 10 mg/5ml# 4 PAhydroxyzine hcl tab 10 mg# 4 PAhydroxyzine hcl tab 25 mg# 4 PAhydroxyzine hcl tab 50 mg# 4 PAlorazepam tab 0.5 mg^ 1 PA, QL (120 tablets/30 days)lorazepam tab 1 mg^ 1 PA, QL (120 tablets/30 days)lorazepam tab 2 mg^ 1 PA, QL (150 tablets/30 days)Agentes bipolaresLITHIUM - lithium oral solution 8 meq/5ml 4lithium carbonate cap 150 mg 3lithium carbonate cap 300 mg^ 1lithium carbonate cap 600 mg 3lithium carbonate tab er 300 mg 2lithium carbonate tab er 450 mg 2lithium carbonate tab 300 mg 2Reguladores de la glucosa en sangreacarbose tab 25 mg 2 QL (360 tablets/30 days)acarbose tab 50 mg 2 QL (180 tablets/30 days)acarbose tab 100 mg 2 QL (90 tablets/30 days)ALCOHOL SWABS 3BYDUREON - exenatide for inj extended release susp 2 mg 3 QL (4 vials/28 days)BYDUREON BCISE - exenatide extended release susp auto-

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

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

3 QL (4 pens/28 days)

CYCLOSET - bromocriptine mesylate tab 0.8 mg 4 QL (180 tablets/30 days)GAUZE PADS 2" X 2" 3glimepiride tab 1 mg^ 6 QL (240 tablets/30 days)

2018


49


glimepiride tab 2 mg^ 6 QL (120 tablets/30 days)glimepiride tab 4 mg^ 6 QL (60 tablets/30 days)glipizide tab er 24hr 2.5 mg^ 6 QL (240 tablets/30 days)glipizide tab er 24hr 5 mg^ 6 QL (120 tablets/30 days)glipizide tab er 24hr 10 mg^ 6 QL (60 tablets/30 days)glipizide tab 5 mg^ 6 QL (240 tablets/30 days)glipizide tab 10 mg^ 6 QL (120 tablets/30 days)glipizide-metformin hcl tab 2.5-250 mg^ 6 QL (240 tablets/30 days)glipizide-metformin hcl tab 2.5-500 mg^ 6 QL (120 tablets/30 days)glipizide-metformin hcl tab 5-500 mg^ 6 QL (120 tablets/30 days)GLUCAGEN HYPOKIT - glucagon hcl (rdna) for inj 1 mg 3GLUCAGON EMERGENCY KIT - glucagon (rdna) for inj kit 1 mg 3HUMALOG - insulin lispro inj 100 unit/ml 3 QL (60 mls/30 days)HUMALOG - insulin lispro soln cartridge 100 unit/ml 3 QL (20 cartridges/30 days)HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector

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

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

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

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


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

3 QL (6 vials/30 days)

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


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

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

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

500 unit/ml3 BD

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


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

3 QL (60 mls/30 days)

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


INSULIN INJECTION DEVICE 3INSULIN SYRINGE/NEEDLE 3INVOKAMET - canagliflozin-metformin hcl tab 50-500 mg 3 QL (120 tablets/30 days)

2018



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


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






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

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

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


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


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


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


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

ml3 QL (20 pens/30 days)

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

2018


51


LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 100unit/ml


metformin hcl tab er 24hr 500 mg^ 6 QL (120 tablets/30 days)metformin hcl tab er 24hr 750 mg^ 6 QL (60 tablets/30 days)metformin hcl tab 500 mg^ 6 QL (150 tablets/30 days)metformin hcl tab 850 mg^ 6 QL (90 tablets/30 days)metformin hcl tab 1000 mg^ 6 QL (75 tablets/30 days)nateglinide tab 60 mg^ 6 QL (180 tablets/30 days)nateglinide tab 120 mg^ 6 QL (90 tablets/30 days)ONGLYZA - saxagliptin hcl tab 2.5 mg 3 QL (60 tablets/30 days)ONGLYZA - saxagliptin hcl tab 5 mg 3 QL (30 tablets/30 days)OZEMPIC - semaglutide soln pen-inj 0.25 or 0.5 mg/dose

(2 mg/1.5ml)3 QL (1 pen/28 days)

OZEMPIC - semaglutide soln pen-inj 1 mg/dose (2 mg/1.5ml) 3 QL (2 pens/28 days)pioglitazone hcl tab 15 mg^ 6 QL (90 tablets/30 days)pioglitazone hcl tab 30 mg^ 6 QL (30 tablets/30 days)pioglitazone hcl tab 45 mg^ 6 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-2 mg^ 6 QL (30 tablets/30 days)pioglitazone hcl-glimepiride tab 30-4 mg^ 6 QL (30 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-500 mg^ 6 QL (90 tablets/30 days)pioglitazone hcl-metformin hcl tab 15-850 mg^ 6 QL (90 tablets/30 days)PROGLYCEM - diazoxide susp 50 mg/ml 4repaglinide tab 0.5 mg^ 6 QL (960 tablets/30 days)repaglinide tab 1 mg^ 6 QL (480 tablets/30 days)repaglinide tab 2 mg^ 6 QL (240 tablets/30 days)SYMLINPEN 120 - pramlintide acetate pen-inj 2700 mcg/2.7ml

(1000 mcg/ml)3

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

3

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


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


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


2018



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


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


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


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

unit/ml3 QL (20 pens/30 days)

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


TRULICITY - dulaglutide soln pen-injector 0.75 mg/0.5ml 4 QL (4 pens/28 days)TRULICITY - dulaglutide soln pen-injector 1.5 mg/0.5ml 4 QL (4 pens/28 days)VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml) 3 QL (1 package/30 days)Hemoderivados/Modificadores de la sangre/ Expansores delanagrelide hcl cap 0.5 mg 2anagrelide hcl cap 1 mg 2ARANESP ALBUMIN FREE - darbepoetin alfa soln inj 25 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 40 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 60 mcg/ml 4 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 100 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 200 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln inj 300 mcg/ml 5 PAARANESP ALBUMIN FREE - darbepoetin alfa soln prefilled

syringe 10 mcg/0.4ml4 PA

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

4 PA


4 PA


4 PA


5 PA


5 PA


5 PA


5 PA

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

5 PA

aspirin-dipyridamole cap er 12hr 25-200 mg 2

2018


53


azacitidine for inj 100 mg 5BEVYXXA - betrixaban maleate cap 40 mg 4 QL (43 capsules/42 days)BEVYXXA - betrixaban maleate cap 80 mg 4 QL (43 capsules/42 days)BRILINTA - ticagrelor tab 60 mg 3BRILINTA - ticagrelor tab 90 mg 3cilostazol tab 50 mg 2cilostazol tab 100 mg 2clopidogrel bisulfate tab 75 mg^ 1COUMADIN - warfarin sodium tab 1 mg 4COUMADIN - warfarin sodium tab 2 mg 4COUMADIN - warfarin sodium tab 2.5 mg 4COUMADIN - warfarin sodium tab 3 mg 4COUMADIN - warfarin sodium tab 4 mg 4COUMADIN - warfarin sodium tab 5 mg 4COUMADIN - warfarin sodium tab 6 mg 4COUMADIN - warfarin sodium tab 7.5 mg 4COUMADIN - warfarin sodium tab 10 mg 4dipyridamole tab 25 mg# 4dipyridamole tab 50 mg# 4dipyridamole tab 75 mg# 4EFFIENT - prasugrel hcl tab 5 mg 3EFFIENT - prasugrel hcl tab 10 mg 3ELIQUIS - apixaban tab 2.5 mg 3 QL (60 tablets/30 days)ELIQUIS - apixaban tab 5 mg 3 QL (120 tablets/30 days)ELIQUIS STARTER PACK - apixaban tab 5 mg 3 QL (120 tablets/30 days)enoxaparin sodium inj 30 mg/0.3ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 40 mg/0.4ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 60 mg/0.6ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 80 mg/0.8ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 100 mg/ml 2 QL (30 syringes/90 days)enoxaparin sodium inj 120 mg/0.8ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 150 mg/ml 4 QL (30 syringes/90 days)enoxaparin sodium inj 300 mg/3ml 4 QL (10 vials/90 days)EPOGEN - epoetin alfa inj 2000 unit/ml 4 PAEPOGEN - epoetin alfa inj 3000 unit/ml 4 PAEPOGEN - epoetin alfa inj 4000 unit/ml 4 PAEPOGEN - epoetin alfa inj 10000 unit/ml 4 PAEPOGEN - epoetin alfa inj 20000 unit/ml 4 PA

2018



fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 4 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 5 mg/0.4ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 10 mg/0.8ml 5 QL (30 syringes/90 days)GRANIX - tbo-filgrastim soln prefilled syringe 300 mcg/0.5ml 5GRANIX - tbo-filgrastim soln prefilled syringe 480 mcg/0.8ml 5heparin sodium (porcine) inj 1000 unit/ml 2heparin sodium (porcine) inj 5000 unit/ml 2heparin sodium (porcine) inj 10000 unit/ml 2heparin sodium (porcine) inj 20000 unit/ml 2heparin sodium (porcine) pf inj 5000 unit/0.5ml 2heparin sodium (porcine) 40 unit/ml in d5w 2LEUKINE - sargramostim lyophilized for inj 250 mcg 5MOZOBIL - plerixafor subcutaneous inj 24 mg/1.2ml (20 mg/ml) 5NEULASTA - pegfilgrastim soln prefilled syringe 6 mg/0.6ml 5NEULASTA ONPRO KIT - pegfilgrastim soln prefilled syringe kit

6 mg/0.6ml5

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

2018


55


warfarin sodium tab 4 mg^ 1warfarin sodium tab 5 mg^ 1warfarin sodium tab 6 mg^ 1warfarin sodium tab 7.5 mg^ 1warfarin sodium tab 10 mg^ 1XARELTO - rivaroxaban tab 10 mg 3 QL (30 tablets/30 days)XARELTO - rivaroxaban tab 15 mg 3 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 20 mg 3 QL (30 tablets/30 days)XARELTO STARTER PACK - rivaroxaban tab starter therapy pack

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

ZONTIVITY - vorapaxar sulfate tab 2.08 mg 4Agentes cardiovascularesacebutolol hcl cap 200 mg 2acebutolol hcl cap 400 mg 2acetazolamide cap er 12hr 500 mg 2acetazolamide tab 125 mg 2acetazolamide tab 250 mg 2amiloride & hydrochlorothiazide tab 5-50 mg 2amiloride hcl tab 5 mg 2amiodarone hcl tab 200 mg 2amiodarone hcl tab 400 mg 2amlodipine besylate tab 2.5 mg^ 1amlodipine besylate tab 5 mg^ 1amlodipine besylate tab 10 mg^ 1amlodipine besylate-atorvastatin calcium tab 2.5-10 mg^ 6amlodipine besylate-atorvastatin calcium tab 2.5-20 mg^ 6amlodipine besylate-atorvastatin calcium tab 2.5-40 mg^ 6amlodipine besylate-atorvastatin calcium tab 5-10 mg^ 6amlodipine besylate-atorvastatin calcium tab 5-20 mg^ 6amlodipine besylate-atorvastatin calcium tab 5-40 mg^ 6amlodipine besylate-atorvastatin calcium tab 5-80 mg^ 6amlodipine besylate-atorvastatin calcium tab 10-10 mg^ 6amlodipine besylate-atorvastatin calcium tab 10-20 mg^ 6amlodipine besylate-atorvastatin calcium tab 10-40 mg^ 6amlodipine besylate-atorvastatin calcium tab 10-80 mg^ 6amlodipine besylate-benazepril hcl cap 2.5-10 mg^ 6amlodipine besylate-benazepril hcl cap 5-10 mg^ 6amlodipine besylate-benazepril hcl cap 5-20 mg^ 6

2018



amlodipine besylate-benazepril hcl cap 5-40 mg^ 6amlodipine besylate-benazepril hcl cap 10-20 mg^ 6amlodipine besylate-benazepril hcl cap 10-40 mg^ 6amlodipine besylate-valsartan tab 5-160 mg^ 6 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 5-320 mg^ 6 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-160 mg^ 6 QL (30 tablets/30 days)amlodipine besylate-valsartan tab 10-320 mg^ 6 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg^ 6 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 5-160-25 mg^ 6 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg^ 6 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg^ 6 QL (30 tablets/30 days)amlodipine-valsartan-hydrochlorothiazide tab 10-320-25 mg^ 6 QL (30 tablets/30 days)atenolol & chlorthalidone tab 50-25 mg 2atenolol & chlorthalidone tab 100-25 mg 2atenolol tab 25 mg^ 1atenolol tab 50 mg^ 1atenolol tab 100 mg^ 1atorvastatin calcium tab 10 mg^ 6 QL (45 tablets/30 days)atorvastatin calcium tab 20 mg^ 6 QL (45 tablets/30 days)atorvastatin calcium tab 40 mg^ 6 QL (45 tablets/30 days)atorvastatin calcium tab 80 mg^ 6 QL (30 tablets/30 days)benazepril & hydrochlorothiazide tab 5-6.25 mg^ 6benazepril & hydrochlorothiazide tab 10-12.5 mg^ 6benazepril & hydrochlorothiazide tab 20-12.5 mg^ 6benazepril & hydrochlorothiazide tab 20-25 mg^ 6benazepril hcl tab 5 mg^ 6benazepril hcl tab 10 mg^ 6benazepril hcl tab 20 mg^ 6benazepril hcl tab 40 mg^ 6betaxolol hcl tab 10 mg 2betaxolol hcl tab 20 mg 2bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg^ 1bisoprolol & hydrochlorothiazide tab 5-6.25 mg^ 1bisoprolol & hydrochlorothiazide tab 10-6.25 mg^ 1bisoprolol fumarate tab 5 mg 2bisoprolol fumarate tab 10 mg 2bumetanide inj 0.25 mg/ml 2bumetanide tab 0.5 mg 2

2018


57


bumetanide tab 1 mg 2bumetanide tab 2 mg 2candesartan cilexetil tab 4 mg^ 6 QL (60 tablets/30 days)candesartan cilexetil tab 8 mg^ 6 QL (60 tablets/30 days)candesartan cilexetil tab 16 mg^ 6 QL (60 tablets/30 days)candesartan cilexetil tab 32 mg^ 6 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg^ 6 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg^ 6 QL (30 tablets/30 days)candesartan cilexetil-hydrochlorothiazide tab 32-25 mg^ 6 QL (30 tablets/30 days)captopril tab 12.5 mg^ 6captopril tab 25 mg^ 6captopril tab 50 mg^ 6captopril tab 100 mg^ 6carvedilol tab 3.125 mg^ 1carvedilol tab 6.25 mg^ 1carvedilol tab 12.5 mg^ 1carvedilol tab 25 mg^ 1CHLOROTHIAZIDE - chlorothiazide tab 250 mg 4chlorothiazide tab 500 mg 2chlorthalidone tab 25 mg 2chlorthalidone tab 50 mg 2cholestyramine light powder packets 4 gm 2cholestyramine light powder 4 gm/dose 2cholestyramine powder packets 4 gm 2cholestyramine powder 4 gm/dose 2choline fenofibrate cap dr 45 mg 2 QL (60 capsules/30 days)choline fenofibrate cap dr 135 mg 2 QL (30 capsules/30 days)clonidine hcl tab 0.1 mg^ 1clonidine hcl tab 0.2 mg^ 1clonidine hcl tab 0.3 mg^ 1clonidine hcl td patch weekly 0.1 mg/24hr 2clonidine hcl td patch weekly 0.2 mg/24hr 2clonidine hcl td patch weekly 0.3 mg/24hr 2colesevelam hcl packet for susp 3.75 gm 4colesevelam hcl tab 625 mg 4colestipol hcl granule packets 5 gm 2colestipol hcl granules 5 gm 2colestipol hcl tab 1 gm 2

2018



CORLANOR - ivabradine hcl tab 5 mg 3 PA, QL (60 tablets/30 days)CORLANOR - ivabradine hcl tab 7.5 mg 3 PA, QL (60 tablets/30 days)DEMSER - metyrosine cap 250 mg 5DIGOXIN - digoxin oral soln 0.05 mg/ml# 4 QL (150 mls/30 days)digoxin tab 125 mcg (0.125 mg)# 2 QL (30 tablets/30 days)digoxin tab 250 mcg (0.25 mg)# 4 PA, QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg 3diltiazem hcl cap er 12hr 90 mg 3diltiazem hcl cap er 12hr 120 mg 3diltiazem hcl cap er 24hr 120 mg 3diltiazem hcl cap er 24hr 180 mg 3diltiazem hcl cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 120 mg 3diltiazem hcl coated beads cap er 24hr 180 mg 3diltiazem hcl coated beads cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 300 mg 3diltiazem hcl coated beads cap er 24hr 360 mg 2diltiazem hcl coated beads tab er 24hr 180 mg 2diltiazem hcl coated beads tab er 24hr 240 mg 2diltiazem hcl coated beads tab er 24hr 300 mg 2diltiazem hcl coated beads tab er 24hr 360 mg 2diltiazem hcl coated beads tab er 24hr 420 mg 2diltiazem hcl extended release beads cap er 24hr 120 mg 3diltiazem hcl extended release beads cap er 24hr 180 mg 3diltiazem hcl extended release beads cap er 24hr 240 mg 3diltiazem hcl extended release beads cap er 24hr 300 mg 3diltiazem hcl extended release beads cap er 24hr 360 mg 3diltiazem hcl extended release beads cap er 24hr 420 mg 3diltiazem hcl tab 30 mg 2diltiazem hcl tab 60 mg 2diltiazem hcl tab 90 mg 2diltiazem hcl tab 120 mg 2dofetilide cap 125 mcg (0.125 mg) 4dofetilide cap 250 mcg (0.25 mg) 4dofetilide cap 500 mcg (0.5 mg) 4doxazosin mesylate tab 1 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 2 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 4 mg 2 QL (60 tablets/30 days)

2018


59


doxazosin mesylate tab 8 mg 2 QL (60 tablets/30 days)enalapril maleate & hydrochlorothiazide tab 5-12.5 mg^ 6enalapril maleate & hydrochlorothiazide tab 10-25 mg^ 6enalapril maleate tab 2.5 mg^ 6enalapril maleate tab 5 mg^ 6enalapril maleate tab 10 mg^ 6enalapril maleate tab 20 mg^ 6ENTRESTO - sacubitril-valsartan tab 24-26 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 3 PA, QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 3 PA, QL (60 tablets/30 days)eplerenone tab 25 mg 2eplerenone tab 50 mg 2ezetimibe tab 10 mg 3 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-10 mg^ 6 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-20 mg^ 6 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-40 mg^ 6 QL (30 tablets/30 days)ezetimibe-simvastatin tab 10-80 mg^ 6 QL (30 tablets/30 days)felodipine tab er 24hr 2.5 mg 2felodipine tab er 24hr 5 mg 2felodipine tab er 24hr 10 mg 2fenofibrate micronized cap 67 mg 2 QL (30 capsules/30 days)fenofibrate micronized cap 134 mg 2 QL (30 capsules/30 days)fenofibrate micronized cap 200 mg 2 QL (30 capsules/30 days)fenofibrate tab 48 mg 2 QL (60 tablets/30 days)fenofibrate tab 54 mg 2 QL (60 tablets/30 days)fenofibrate tab 145 mg 2 QL (30 tablets/30 days)fenofibrate tab 160 mg 2 QL (30 tablets/30 days)flecainide acetate tab 50 mg 2flecainide acetate tab 100 mg 2flecainide acetate tab 150 mg 2fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg^ 6fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg^ 6fosinopril sodium tab 10 mg^ 6fosinopril sodium tab 20 mg^ 6fosinopril sodium tab 40 mg^ 6furosemide inj 10 mg/ml 2furosemide oral soln 10 mg/ml 2furosemide tab 20 mg^ 1

2018



furosemide tab 40 mg^ 1furosemide tab 80 mg^ 1gemfibrozil tab 600 mg^ 1 QL (60 tablets/30 days)hydralazine hcl tab 10 mg 2hydralazine hcl tab 25 mg 2hydralazine hcl tab 50 mg 2hydralazine hcl tab 100 mg 2hydrochlorothiazide cap 12.5 mg^ 1hydrochlorothiazide tab 12.5 mg^ 1hydrochlorothiazide tab 25 mg^ 1hydrochlorothiazide tab 50 mg^ 1indapamide tab 1.25 mg 2indapamide tab 2.5 mg 2irbesartan tab 75 mg^ 6 QL (30 tablets/30 days)irbesartan tab 150 mg^ 6 QL (30 tablets/30 days)irbesartan tab 300 mg^ 6 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 150-12.5 mg^ 6 QL (30 tablets/30 days)irbesartan-hydrochlorothiazide tab 300-12.5 mg^ 6 QL (30 tablets/30 days)isosorbide dinitrate tab 5 mg 2isosorbide dinitrate tab 10 mg 2isosorbide dinitrate tab 20 mg 2isosorbide dinitrate tab 30 mg 2isosorbide mononitrate tab er 24hr 30 mg 2isosorbide mononitrate tab er 24hr 60 mg 2isosorbide mononitrate tab er 24hr 120 mg 2isosorbide mononitrate tab 10 mg 2isosorbide mononitrate tab 20 mg 2isradipine cap 2.5 mg 2isradipine cap 5 mg 2JUXTAPID - lomitapide mesylate cap 5 mg* 5 PAJUXTAPID - lomitapide mesylate cap 10 mg* 5 PAJUXTAPID - lomitapide mesylate cap 20 mg* 5 PAJUXTAPID - lomitapide mesylate cap 30 mg* 5 PAJUXTAPID - lomitapide mesylate cap 40 mg* 5 PAJUXTAPID - lomitapide mesylate cap 60 mg* 5 PAKYNAMRO - mipomersen sodium soln prefilled syringe 200 mg/

ml*5 PA

labetalol hcl tab 100 mg 2

2018


61


labetalol hcl tab 200 mg 2labetalol hcl tab 300 mg 2LIDOCAINE HCL - lidocaine hcl iv inj 10 mg/ml 4lisinopril & hydrochlorothiazide tab 10-12.5 mg^ 6lisinopril & hydrochlorothiazide tab 20-12.5 mg^ 6lisinopril & hydrochlorothiazide tab 20-25 mg^ 6lisinopril tab 2.5 mg^ 6lisinopril tab 5 mg^ 6lisinopril tab 10 mg^ 6lisinopril tab 20 mg^ 6lisinopril tab 30 mg^ 6lisinopril tab 40 mg^ 6losartan potassium & hydrochlorothiazide tab 50-12.5 mg^ 6 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-12.5 mg^ 6 QL (30 tablets/30 days)losartan potassium & hydrochlorothiazide tab 100-25 mg^ 6 QL (30 tablets/30 days)losartan potassium tab 25 mg^ 6 QL (60 tablets/30 days)losartan potassium tab 50 mg^ 6 QL (60 tablets/30 days)losartan potassium tab 100 mg^ 6 QL (30 tablets/30 days)lovastatin tab 10 mg^ 6 QL (60 tablets/30 days)lovastatin tab 20 mg^ 6 QL (60 tablets/30 days)lovastatin tab 40 mg^ 6 QL (60 tablets/30 days)methazolamide tab 25 mg 3methazolamide tab 50 mg 4metolazone tab 2.5 mg 2metolazone tab 5 mg 2metolazone tab 10 mg 2metoprolol & hydrochlorothiazide tab 50-25 mg 2metoprolol & hydrochlorothiazide tab 100-25 mg 2metoprolol succinate tab er 24hr 25 mg 2metoprolol succinate tab er 24hr 50 mg 2metoprolol succinate tab er 24hr 100 mg 2metoprolol succinate tab er 24hr 200 mg 2metoprolol tartrate tab 25 mg^ 1metoprolol tartrate tab 50 mg^ 1metoprolol tartrate tab 100 mg^ 1mexiletine hcl cap 150 mg 2mexiletine hcl cap 200 mg 2mexiletine hcl cap 250 mg 2

2018



midodrine hcl tab 2.5 mg 2midodrine hcl tab 5 mg 2midodrine hcl tab 10 mg 2minoxidil tab 2.5 mg 2minoxidil tab 10 mg 2moexipril hcl tab 7.5 mg^ 6moexipril hcl tab 15 mg^ 6moexipril-hydrochlorothiazide tab 7.5-12.5 mg^ 6moexipril-hydrochlorothiazide tab 15-12.5 mg^ 6moexipril-hydrochlorothiazide tab 15-25 mg^ 6MULTAQ - dronedarone hcl tab 400 mg 3nadolol tab 20 mg 2nadolol tab 40 mg 2nadolol tab 80 mg 2niacin tab er 500 mg 2 QL (30 tablets/30 days)niacin tab er 750 mg 2 QL (60 tablets/30 days)niacin tab er 1000 mg 2 QL (60 tablets/30 days)nicardipine hcl cap 20 mg 2nicardipine hcl cap 30 mg 2nifedipine tab er 24hr 30 mg 3nifedipine tab er 24hr 60 mg 3nifedipine tab er 24hr 90 mg 2nifedipine tab er 24hr osmotic release 30 mg 3nifedipine tab er 24hr osmotic release 60 mg 3nifedipine tab er 24hr osmotic release 90 mg 3nimodipine cap 30 mg 5NISOLDIPINE ER - nisoldipine tab er 24hr 25.5 mg 4nisoldipine tab er 24hr 8.5 mg 2nisoldipine tab er 24hr 17 mg 2nisoldipine tab er 24hr 34 mg 2NITRO-BID - nitroglycerin oint 2% 4nitroglycerin sl tab 0.3 mg 2nitroglycerin sl tab 0.4 mg 2nitroglycerin sl tab 0.6 mg 2nitroglycerin td patch 24hr 0.1 mg/hr 2nitroglycerin td patch 24hr 0.2 mg/hr 2nitroglycerin td patch 24hr 0.4 mg/hr 2nitroglycerin td patch 24hr 0.6 mg/hr 2

2018


63


nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) 2NORTHERA - droxidopa cap 100 mg* 5 PANORTHERA - droxidopa cap 200 mg* 5 PANORTHERA - droxidopa cap 300 mg* 5 PAolmesartan medoxomil tab 5 mg^ 6 QL (60 tablets/30 days)olmesartan medoxomil tab 20 mg^ 6 QL (30 tablets/30 days)olmesartan medoxomil tab 40 mg^ 6 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg^ 6 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-12.5 mg^ 6 QL (30 tablets/30 days)olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg^ 6 QL (30 tablets/30 days)omega-3-acid ethyl esters cap 1 gm 2pentoxifylline tab er 400 mg 2perindopril erbumine tab 2 mg^ 6perindopril erbumine tab 4 mg^ 6perindopril erbumine tab 8 mg^ 6phenoxybenzamine hcl cap 10 mg 5pindolol tab 5 mg 2pindolol tab 10 mg 2PRALUENT - alirocumab subcutaneous soln pen-injector 75 mg/

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

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

5 PA, QL (2 pens/28 days)

pravastatin sodium tab 10 mg^ 6 QL (45 tablets/30 days)pravastatin sodium tab 20 mg^ 6 QL (45 tablets/30 days)pravastatin sodium tab 40 mg^ 6 QL (45 tablets/30 days)pravastatin sodium tab 80 mg^ 6 QL (30 tablets/30 days)prazosin hcl cap 1 mg 2prazosin hcl cap 2 mg 2prazosin hcl cap 5 mg 2propafenone hcl cap er 12hr 225 mg 3propafenone hcl cap er 12hr 325 mg 4propafenone hcl cap er 12hr 425 mg 4propafenone hcl tab 150 mg 2propafenone hcl tab 225 mg 2propafenone hcl tab 300 mg 2propranolol hcl cap er 24hr 60 mg 2propranolol hcl cap er 24hr 80 mg 2propranolol hcl cap er 24hr 120 mg 2

2018



propranolol hcl cap er 24hr 160 mg 2propranolol hcl inj 1 mg/ml 2propranolol hcl tab 10 mg 2propranolol hcl tab 20 mg 2propranolol hcl tab 40 mg 2propranolol hcl tab 60 mg 2propranolol hcl tab 80 mg 2quinapril hcl tab 5 mg^ 6quinapril hcl tab 10 mg^ 6quinapril hcl tab 20 mg^ 6quinapril hcl tab 40 mg^ 6quinapril-hydrochlorothiazide tab 10-12.5 mg^ 6quinapril-hydrochlorothiazide tab 20-12.5 mg^ 6quinapril-hydrochlorothiazide tab 20-25 mg^ 6quinidine gluconate tab er 324 mg 2QUINIDINE SULFATE - quinidine sulfate tab 200 mg 4QUINIDINE SULFATE - quinidine sulfate tab 300 mg 4ramipril cap 1.25 mg^ 6ramipril cap 2.5 mg^ 6ramipril cap 5 mg^ 6ramipril cap 10 mg^ 6RANEXA - ranolazine tab er 12hr 500 mg 3 QL (60 tablets/30 days)RANEXA - ranolazine tab er 12hr 1000 mg 3 QL (60 tablets/30 days)REPATHA - evolocumab subcutaneous soln prefilled syringe

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

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

5 PA, QL (1 system/30 days)

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

5 PA, QL (2 pens/28 days)

rosuvastatin calcium tab 5 mg^ 6 QL (45 tablets/30 days)rosuvastatin calcium tab 10 mg^ 6 QL (45 tablets/30 days)rosuvastatin calcium tab 20 mg^ 6 QL (45 tablets/30 days)rosuvastatin calcium tab 40 mg^ 6 QL (30 tablets/30 days)simvastatin tab 5 mg^ 6 QL (45 tablets/30 days)simvastatin tab 10 mg^ 6 QL (45 tablets/30 days)simvastatin tab 20 mg^ 6 QL (60 tablets/30 days)simvastatin tab 40 mg^ 6 QL (45 tablets/30 days)simvastatin tab 80 mg^ 6 QL (30 tablets/30 days)sotalol hcl (afib/afl) tab 80 mg 2

2018


65


sotalol hcl (afib/afl) tab 120 mg 2sotalol hcl (afib/afl) tab 160 mg 2sotalol hcl tab 80 mg 2sotalol hcl tab 120 mg 2sotalol hcl tab 160 mg 2sotalol hcl tab 240 mg 2spironolactone & hydrochlorothiazide tab 25-25 mg 2spironolactone tab 25 mg^ 1spironolactone tab 50 mg^ 1spironolactone tab 100 mg^ 1TEKTURNA - aliskiren fumarate tab 150 mg 3 QL (30 tablets/30 days)TEKTURNA - aliskiren fumarate tab 300 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-12.5 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 150-25 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-12.5 mg 3 QL (30 tablets/30 days)TEKTURNA HCT - aliskiren-hydrochlorothiazide tab 300-25 mg 3 QL (30 tablets/30 days)telmisartan tab 20 mg^ 6 QL (30 tablets/30 days)telmisartan tab 40 mg^ 6 QL (30 tablets/30 days)telmisartan tab 80 mg^ 6 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 40-12.5 mg^ 6 QL (30 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-12.5 mg^ 6 QL (60 tablets/30 days)telmisartan-hydrochlorothiazide tab 80-25 mg^ 6 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 4TIMOLOL MALEATE - timolol maleate tab 10 mg 4TIMOLOL MALEATE - timolol maleate tab 20 mg 4torsemide tab 5 mg^ 1torsemide tab 10 mg^ 1torsemide tab 20 mg^ 1torsemide tab 100 mg^ 1trandolapril tab 1 mg^ 6trandolapril tab 2 mg^ 6trandolapril tab 4 mg^ 6triamterene & hydrochlorothiazide cap 37.5-25 mg^ 1triamterene & hydrochlorothiazide tab 37.5-25 mg^ 1

2018



triamterene & hydrochlorothiazide tab 75-50 mg^ 1valsartan tab 40 mg^ 6 QL (60 tablets/30 days)valsartan tab 80 mg^ 6 QL (60 tablets/30 days)valsartan tab 160 mg^ 6 QL (60 tablets/30 days)valsartan tab 320 mg^ 6 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 80-12.5 mg^ 6 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-12.5 mg^ 6 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 160-25 mg^ 6 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-12.5 mg^ 6 QL (30 tablets/30 days)valsartan-hydrochlorothiazide tab 320-25 mg^ 6 QL (30 tablets/30 days)VASCEPA - icosapent ethyl cap 0.5 gm 3VASCEPA - icosapent ethyl cap 1 gm 3verapamil hcl cap er 24hr 100 mg 2verapamil hcl cap er 24hr 120 mg 2verapamil hcl cap er 24hr 180 mg 2verapamil hcl cap er 24hr 200 mg 2verapamil hcl cap er 24hr 240 mg 2verapamil hcl cap er 24hr 300 mg 2verapamil hcl cap er 24hr 360 mg 2verapamil hcl tab er 120 mg 2verapamil hcl tab er 180 mg 2verapamil hcl tab er 240 mg 2verapamil hcl tab 40 mg^ 1verapamil hcl tab 80 mg^ 1verapamil hcl tab 120 mg^ 1WELCHOL - colesevelam hcl packet for susp 3.75 gm 4WELCHOL - colesevelam hcl tab 625 mg 4Agentes del sistema nervioso centralamphetamine-dextroamphetamine cap er 24hr 5 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 10 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 15 mg 2 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 20 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 25 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine cap er 24hr 30 mg 3 QL (30 capsules/30 days)amphetamine-dextroamphetamine tab 5 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 7.5 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 10 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 12.5 mg 2 QL (60 tablets/30 days)

2018


67


amphetamine-dextroamphetamine tab 15 mg 2 QL (60 tablets/30 days)amphetamine-dextroamphetamine tab 20 mg 2 QL (90 tablets/30 days)amphetamine-dextroamphetamine tab 30 mg 2 QL (60 tablets/30 days)AMPYRA - dalfampridine tab er 12hr 10 mg* 5 PAatomoxetine hcl cap 10 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 40 mg 4 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg 4 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg 4 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg 4 QL (30 capsules/30 days)AVONEX - interferon beta-1a for im inj kit 30mcg (33mcg(6.6 mu)/

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

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

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

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

clonidine hcl tab er 12hr 0.1 mg 3 QL (120 tablets/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 20 mg/ml 5 PA, QL (30 syringes/30 days)COPAXONE - glatiramer acetate soln prefilled syringe 40 mg/ml 5 PA, QL (12 syringes/28 days)dexmethylphenidate hcl tab 2.5 mg 2 QL (60 tablets/30 days)dexmethylphenidate hcl tab 5 mg 2 QL (60 tablets/30 days)dexmethylphenidate hcl tab 10 mg 2 QL (60 tablets/30 days)dextroamphetamine sulfate cap er 24hr 5 mg 2 QL (90 capsules/30 days)dextroamphetamine sulfate cap er 24hr 10 mg 2 QL (120 capsules/30 days)dextroamphetamine sulfate cap er 24hr 15 mg 2 QL (120 capsules/30 days)dextroamphetamine sulfate tab 5 mg 2 QL (90 tablets/30 days)dextroamphetamine sulfate tab 10 mg 2 QL (180 tablets/30 days)glatiramer acetate soln prefilled syringe 20 mg/ml 5 PA, QL (30 syringes/30 days)glatiramer acetate soln prefilled syringe 40 mg/ml 5 PA, QL (12 syringes/28 days)methylphenidate hcl tab er 20 mg 3 QL (90 tablets/30 days)methylphenidate hcl tab 5 mg 2 QL (90 tablets/30 days)methylphenidate hcl tab 10 mg 2 QL (90 tablets/30 days)methylphenidate hcl tab 20 mg 2 QL (90 tablets/30 days)NUEDEXTA - dextromethorphan hbr-quinidine sulfate cap

20-10 mg3

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

5 PA, QL (2 syringes/28 days)

2018



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 4TECFIDERA - dimethyl fumarate capsule delayed release 120 mg 5 PA, QL (60 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 240 mg 5 PA, QL (60 capsules/30 days)TECFIDERA STARTER PACK - dimethyl fumarate capsule dr

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

tetrabenazine tab 12.5 mg* 5 PA, QL (240 tablets/30 days)tetrabenazine tab 25 mg* 5 PA, QL (120 tablets/30 days)TYSABRI - natalizumab for iv inj conc 300 mg/15ml* 5 PAAgentes dentales y oraleschlorhexidine gluconate soln 0.12%^ 1KEPIVANCE - palifermin for iv inj 6.25 mg 5pilocarpine hcl tab 5 mg 2pilocarpine hcl tab 7.5 mg 2triamcinolone acetonide dental paste 0.1% 2Agentes dermatológicosacitretin cap 10 mg 4acitretin cap 17.5 mg 4acitretin cap 25 mg 4alclometasone dipropionate cream 0.05% 2alclometasone dipropionate oint 0.05% 2AZELEX - azelaic acid cream 20% 4benzoyl peroxide-erythromycin gel 5-3% 2betamethasone dipropionate augmented cream 0.05% 2betamethasone dipropionate augmented gel 0.05% 2betamethasone dipropionate augmented lotion 0.05% 2betamethasone dipropionate augmented oint 0.05% 2betamethasone dipropionate cream 0.05% 2betamethasone dipropionate lotion 0.05% 2betamethasone dipropionate oint 0.05% 2betamethasone valerate cream 0.1% 2betamethasone valerate lotion 0.1% 2betamethasone valerate oint 0.1% 2calcipotriene cream 0.005% 4

2018


69


calcipotriene oint 0.005% 4calcipotriene soln 0.005% (50 mcg/ml) 3CARAC - fluorouracil cream 0.5% 5clindamycin phosphate-benzoyl peroxide gel 1-5% 2clobetasol propionate cream 0.05% 2clobetasol propionate emollient base cream 0.05% 2clobetasol propionate gel 0.05% 3clobetasol propionate oint 0.05% 3clobetasol propionate soln 0.05% 2clotrimazole w/ betamethasone cream 1-0.05% 2clotrimazole w/ betamethasone lotion 1-0.05% 2desonide cream 0.05% 2desonide lotion 0.05% 2desonide oint 0.05% 2desoximetasone cream 0.05% 4desoximetasone cream 0.25% 2desoximetasone gel 0.05% 2desoximetasone oint 0.25% 2diclofenac sodium gel 3% 5DIFLORASONE DIACETATE - diflorasone diacetate oint 0.05% 4ELIDEL - pimecrolimus cream 1% 4 PAFINACEA - azelaic acid foam 15% 4FINACEA - azelaic acid gel 15% 4fluocinolone acetonide cream 0.01% 2fluocinonide cream 0.05% 2fluocinonide emulsified base cream 0.05% 2fluocinonide gel 0.05% 2fluocinonide oint 0.05% 2fluocinonide soln 0.05% 2fluorouracil cream 5% 3fluorouracil soln 2% 2fluorouracil soln 5% 2fluticasone propionate cream 0.05% 2fluticasone propionate oint 0.005% 2gentamicin sulfate cream 0.1% 2gentamicin sulfate oint 0.1% 2halobetasol propionate cream 0.05% 2halobetasol propionate oint 0.05% 2

2018



hydrocortisone butyrate cream 0.1% 2hydrocortisone butyrate hydrophilic lipo base cream 0.1% 2hydrocortisone butyrate oint 0.1% 2hydrocortisone butyrate soln 0.1% 2hydrocortisone cream 1%^ 1hydrocortisone cream 2.5%^ 1hydrocortisone lotion 2.5%^ 1hydrocortisone oint 1%^ 1hydrocortisone oint 2.5%^ 1hydrocortisone valerate cream 0.2% 2hydrocortisone valerate oint 0.2% 2imiquimod cream 5% 2 PAisotretinoin cap 10 mg 3isotretinoin cap 20 mg 4isotretinoin cap 30 mg 4isotretinoin cap 40 mg 4lactic acid (ammonium lactate) cream 12% 2lactic acid (ammonium lactate) lotion 12%^ 1methoxsalen rapid cap 10 mg 5metronidazole cream 0.75% 2metronidazole gel 0.75% 2metronidazole gel 1% 2metronidazole lotion 0.75% 2mometasone furoate cream 0.1% 2mometasone furoate oint 0.1% 2mometasone furoate solution 0.1% (lotion) 2mupirocin oint 2% 2nystatin-triamcinolone cream 100000-0.1 unit/gm-% 2nystatin-triamcinolone oint 100000-0.1 unit/gm-% 2ORACEA - doxycycline cap delayed release 40 mg 4PICATO - ingenol mebutate gel 0.015% 3 QL (3 tubes/30 days)PICATO - ingenol mebutate gel 0.05% 3 QL (2 tubes/30 days)podofilox soln 0.5% 2prednicarbate cream 0.1% 2prednicarbate oint 0.1% 2REGRANEX - becaplermin gel 0.01% 5 PA, QL (15 grams/30 days)SANTYL - collagenase oint 250 unit/gm 3selenium sulfide lotion 2.5%^ 1

2018


71


silver sulfadiazine cream 1% 2SOOLANTRA - ivermectin cream 1% 3tacrolimus oint 0.03% 2 PAtacrolimus oint 0.1% 2 PAtazarotene cream 0.1% 4TAZORAC - tazarotene cream 0.05% 4TAZORAC - tazarotene gel 0.05% 4TAZORAC - tazarotene gel 0.1% 4tretinoin cream 0.025% 2tretinoin cream 0.05% 2tretinoin cream 0.1% 2tretinoin gel 0.01% 2tretinoin gel 0.025% 2triamcinolone acetonide cream 0.025% 2triamcinolone acetonide cream 0.1% 2triamcinolone acetonide cream 0.5% 2triamcinolone acetonide lotion 0.025% 2triamcinolone acetonide lotion 0.1% 2triamcinolone acetonide oint 0.025% 2triamcinolone acetonide oint 0.1% 2triamcinolone acetonide oint 0.5% 2Electrolitos/Minerales/Metales/Vitaminasamino acid infusion 6% 2 BDamino acid infusion 15% 2 BDcalcium acetate cap 667 mg 2calcium acetate tab 667 mg 2CARBAGLU - carglumic acid tab 200 mg 5CHEMET - succimer cap 100 mg 4dextrose inj 5%^ 1dextrose inj 10%^ 1dextrose 5% in lactated ringers 2dextrose 2.5% w/ sodium chloride 0.45% 2dextrose 5% w/ sodium chloride 0.2% 2dextrose 5% w/ sodium chloride 0.33% 2dextrose 5% w/ sodium chloride 0.45% 2dextrose 5% w/ sodium chloride 0.9% 2EXJADE - deferasirox tab for oral susp 125 mg* 5EXJADE - deferasirox tab for oral susp 250 mg* 5

2018



EXJADE - deferasirox tab for oral susp 500 mg* 5fat emulsion iv soln 20% 3 BDfomepizole inj 1 gm/ml (for iv infusion) 5FOSRENOL - lanthanum carbonate chew tab 500 mg 5FOSRENOL - lanthanum carbonate chew tab 750 mg 5FOSRENOL - lanthanum carbonate chew tab 1000 mg 5FOSRENOL - lanthanum carbonate oral powder pack 750 mg 5FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 5HEPATAMINE - amino acid infusion 8% 3 BDJADENU - deferasirox tab 90 mg 5JADENU - deferasirox tab 180 mg 5JADENU - deferasirox tab 360 mg 5JADENU SPRINKLE - deferasirox granules packet 90 mg 5JADENU SPRINKLE - deferasirox granules packet 180 mg 5JADENU SPRINKLE - deferasirox granules packet 360 mg 5kcl 20 meq/l (0.15%) in nacl 0.45% inj 2kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj^ 1kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj^ 1kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj^ 1kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj^ 1lactated ringer's solution 2lanthanum carbonate chew tab 500 mg 5lanthanum carbonate chew tab 750 mg 5lanthanum carbonate chew tab 1000 mg 5levocarnitine oral soln 1 gm/10ml (10%) 2levocarnitine tab 330 mg 2magnesium sulfate inj 50% 2NORMOSOL-M IN D5W - electrolyte-m in d5w soln 4PHOSLYRA - calcium acetate oral soln 667 mg/5ml 3potassium chloride cap er 8 meq 2potassium chloride cap er 10 meq 2potassium chloride inj 2 meq/ml 2potassium chloride microencapsulated crys er tab 10 meq 2potassium chloride microencapsulated crys er tab 20 meq 2potassium chloride oral soln 10% (20 meq/15ml) 2potassium chloride tab er 8 meq (600 mg) 3

2018


73


potassium chloride tab er 10 meq 2potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 2POTASSIUM CHLORIDE/DEXTROSE - potassium chloride 40

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

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

4

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

4

potassium citrate tab er 5 meq (540 mg) 2potassium citrate tab er 10 meq (1080 mg) 2potassium citrate tab er 15 meq (1620 mg) 2RENVELA - sevelamer carbonate tab 800 mg 5SAMSCA - tolvaptan tab 15 mg 5 PASAMSCA - tolvaptan tab 30 mg 5 PAsevelamer carbonate packet 0.8 gm 5sevelamer carbonate packet 2.4 gm 5sevelamer carbonate tab 800 mg 5sodium chloride inj 0.45% 2sodium chloride irrigation soln 0.9% 2sodium chloride iv soln 0.9% 2sodium polystyrene sulfonate oral susp 15 gm/60ml 2sodium polystyrene sulfonate powder 2sodium polystyrene sulfonate rectal susp 30 gm/120ml 2SYPRINE - trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)water for irrigation, sterile irrigation soln 2Agentes gastrointestinalesalosetron hcl tab 0.5 mg 4alosetron hcl tab 1 mg 5AMITIZA - lubiprostone cap 8 mcg 3 PAAMITIZA - lubiprostone cap 24 mcg 3 PACHENODAL - chenodiol tab 250 mg* 5cimetidine hcl soln 300 mg/5ml 2cimetidine tab 200 mg 2cimetidine tab 300 mg 2cimetidine tab 400 mg 2cimetidine tab 800 mg 2cromolyn sodium oral conc 100 mg/5ml 2dicyclomine hcl cap 10 mg# 3 PA

2018



dicyclomine hcl tab 20 mg# 4 PAesomeprazole magnesium cap delayed release 20 mg 2 QL (30 capsules/30 days)esomeprazole magnesium cap delayed release 40 mg 2 QL (30 capsules/30 days)ESOMEPRAZOLE SODIUM - esomeprazole sodium for

intravenous soln 20 mg4

esomeprazole sodium for intravenous soln 40 mg 3famotidine for susp 40 mg/5ml 2famotidine inj 20 mg/2ml^ 1famotidine inj 40 mg/4ml^ 1famotidine inj 200 mg/20ml^ 1famotidine tab 20 mg^ 1famotidine tab 40 mg^ 1GATTEX - teduglutide (rdna) for inj kit 5 mg* 5 PAglycopyrrolate tab 1 mg 2glycopyrrolate tab 2 mg 2lactulose (encephalopathy) solution 10 gm/15ml 2lactulose solution 10 gm/15ml 2lansoprazole cap delayed release 15 mg 2 QL (30 capsules/30 days)lansoprazole cap delayed release 30 mg 2 QL (30 capsules/30 days)LINZESS - linaclotide cap 72 mcg 3 PALINZESS - linaclotide cap 145 mcg 3 PALINZESS - linaclotide cap 290 mcg 3 PAloperamide hcl cap 2 mg 2methscopolamine bromide tab 2.5 mg 2methscopolamine bromide tab 5 mg 2metoclopramide hcl inj 5 mg/ml 2metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) 2metoclopramide hcl tab 5 mg^ 1metoclopramide hcl tab 10 mg^ 1misoprostol tab 100 mcg 2misoprostol tab 200 mcg 2MOVIPREP - peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln

100 gm4

MYALEPT - metreleptin for subcutaneous inj 11.3 mg* 5 PANEXIUM - esomeprazole magnesium for delayed release susp

packet 5 mg4 QL (30 packets/30 days)

NEXIUM - esomeprazole magnesium for delayed release susppacket 10 mg

4 QL (30 packets/30 days)

2018


75






NEXIUM - esomeprazole magnesium for delayed release susppacket 2.5 mg


nizatidine cap 150 mg 2nizatidine cap 300 mg 2omeprazole 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)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 2peg 3350-kcl-sod bicarb-nacl for soln 420 gm 2peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm 2peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm 2polyethylene glycol 3350 oral packet 2polyethylene glycol 3350 oral powder 2PYLERA - bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg3

rabeprazole sodium ec tab 20 mg 2 QL (30 tablets/30 days)ranitidine hcl cap 150 mg 2ranitidine hcl cap 300 mg 2ranitidine hcl syrup 15 mg/ml (75 mg/5ml) 2ranitidine hcl tab 150 mg 2ranitidine hcl tab 300 mg 2RELISTOR - methylnaltrexone bromide inj 8 mg/0.4ml (20 mg/ml) 5 PARELISTOR - methylnaltrexone bromide inj 12 mg/0.6ml (20 mg/

ml)5 PA

RELISTOR - methylnaltrexone bromide tab 150 mg 5 PAsucralfate tab 1 gm 2SUPREP BOWEL PREP KIT - sod sulfate-pot sulf-mg sulf oral sol

17.5-3.13-1.6 gm/180ml4

ursodiol cap 300 mg 4ursodiol tab 250 mg 2ursodiol tab 500 mg 2XIFAXAN - rifaximin tab 550 mg 5Trastorno genético o enzimático:ADAGEN - pegademase bovine inj 250 unit/ml* 5

2018



ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500unit/5ml)*

5

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

unit3

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

3

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

3

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

3

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

3

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

1000 mg*5 PA

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

5 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful 5sodium phenylbutyrate tab 500 mg 5

2018


77


STRENSIQ - asfotase alfa subcutaneous inj 18 mg/0.45ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 28 mg/0.7ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 40 mg/ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 80 mg/0.8ml* 5 PAVIOKACE - pancrelipase (lip-prot-amyl) tab 10440-39150-39150

unit4

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

4

VPRIV - velaglucerase alfa for inj 400 unit 5ZAVESCA - miglustat cap 100 mg* 5 PA, QL (90 capsules/30 days)ZENPEP - pancrelipase (lip-prot-amyl) dr cap 3000-10000-14000

unit3

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

3


3


3


3

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

3

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

3

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

2018



RAPAFLO - silodosin cap 4 mg 3 QL (30 capsules/30 days)RAPAFLO - silodosin cap 8 mg 3 QL (30 capsules/30 days)tamsulosin hcl cap 0.4 mg 2 QL (60 capsules/30 days)tolterodine tartrate cap er 24hr 2 mg 2 QL (30 capsules/30 days)tolterodine tartrate cap er 24hr 4 mg 2 QL (30 capsules/30 days)tolterodine tartrate tab 1 mg 2 QL (60 tablets/30 days)tolterodine tartrate tab 2 mg 2 QL (60 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 4 mg 3 QL (30 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 8 mg 3 QL (30 tablets/30 days)trospium chloride cap er 24hr 60 mg 2 QL (30 capsules/30 days)trospium chloride tab 20 mg 2 QL (60 tablets/30 days)Agentes hormonales, estimulantes/sustitutos/modificadoresCORTISONE ACETATE - cortisone acetate tab 25 mg 4DEXAMETHASONE - dexamethasone tab 1 mg 4DEXAMETHASONE - dexamethasone tab 2 mg 4dexamethasone elixir 0.5 mg/5ml 2dexamethasone sodium phosphate inj 4 mg/ml 2dexamethasone sodium phosphate inj 20 mg/5ml 2dexamethasone sodium phosphate inj 120 mg/30ml 2dexamethasone tab 0.5 mg^ 1dexamethasone tab 0.75 mg^ 1dexamethasone tab 1.5 mg^ 1dexamethasone tab 4 mg^ 1dexamethasone tab 6 mg^ 1fludrocortisone acetate tab 0.1 mg 2H.P. ACTHAR - corticotropin inj gel 80 unit/ml* 5 PAhydrocortisone tab 5 mg 2hydrocortisone tab 10 mg 2hydrocortisone tab 20 mg 2methylprednisolone sod succ for inj 40 mg 2methylprednisolone sod succ for inj 125 mg 2methylprednisolone sod succ for inj 1000 mg 2methylprednisolone tab therapy pack 4 mg (21) 2methylprednisolone tab 4 mg 2methylprednisolone tab 8 mg 2methylprednisolone tab 16 mg 2methylprednisolone tab 32 mg 2prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) 2

2018


79


prednisolone sod phosphate oral soln 15 mg/5ml 2prednisolone syrup 15 mg/5ml 2PREDNISONE - prednisone oral soln 5 mg/5ml 3PREDNISONE - prednisone tab therapy pack 5 mg (21) 2PREDNISONE - prednisone tab therapy pack 5 mg (48) 2PREDNISONE - prednisone tab therapy pack 10 mg (21) 2PREDNISONE - prednisone tab therapy pack 10 mg (48) 2PREDNISONE - prednisone tab 50 mg 4prednisone tab 1 mg^ 1prednisone tab 2.5 mg^ 1prednisone tab 5 mg 2prednisone tab 10 mg 2prednisone tab 20 mg^ 1Agentes hormonales, estimulantes/sustitutos/modificadoreschorionic gonadotropin for im inj 10000

unit(chorionic gonadotropin, pregnyl)3 PA

desmopressin acetate inj 4 mcg/ml 3desmopressin acetate nasal spray soln 0.01% 2desmopressin acetate nasal spray soln 0.01% (refrigerated) 3desmopressin acetate tab 0.1 mg 2desmopressin acetate tab 0.2 mg 2EGRIFTA - tesamorelin acetate for inj 1 mg* 5 PAEGRIFTA - tesamorelin acetate for inj 2 mg* 5 PAINCRELEX - mecasermin inj 40 mg/4ml (10 mg/ml)* 5OMNITROPE - somatropin for inj 5.8 mg 3 PAOMNITROPE - somatropin inj 5 mg/1.5ml 5 PAOMNITROPE - somatropin inj 10 mg/1.5ml 5 PASTIMATE - desmopressin acetate nasal soln 1.5 mg/ml 5Agentes hormonales, estimulantes/sustitutos/modificadoresANADROL-50 - oxymetholone tab 50 mg 5 PAANDRODERM - testosterone td patch 24hr 2 mg/24hr 3 PA, QL (30 patches/30 days)ANDRODERM - testosterone td patch 24hr 4 mg/24hr 3 PA, QL (30 patches/30 days)ANDROGEL - testosterone td gel 20.25 mg/1.25gm (1.62%) 3 PA, QL (30 packets/30 days)ANDROGEL - testosterone td gel 40.5 mg/2.5gm (1.62%) 3 PA, QL (60 packets/30 days)ANDROGEL PUMP - testosterone td gel 20.25 mg/act (1.62%) 3 PA, QL (2 pump

bottles/30 days)danazol cap 50 mg 2 PAdanazol cap 100 mg 3 PAdanazol cap 200 mg 4 PA

2018



DEPO-PROVERA - medroxyprogesterone acetate im susp400 mg/ml

4

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) 2desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg 2desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2DIVIGEL - estradiol td gel 0.25 mg/0.25gm (0.1%)# 4 PADIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.1%)# 4 PADIVIGEL - estradiol td gel 1 mg/gm (0.1%)# 4 PAdrospirenone-ethinyl estrad-levomefolate tab 3-0.02-0.451 mg 2drospirenone-ethinyl estrad-levomefolate tab 3-0.03-0.451 mg 3drospirenone-ethinyl estradiol tab 3-0.02 mg 2drospirenone-ethinyl estradiol tab 3-0.03 mg 2ELLA - ulipristal acetate tab 30 mg 3ESTRACE - estradiol vaginal cream 0.1 mg/gm 4estradiol & norethindrone acetate tab 0.5-0.1 mg# 4 PAestradiol & norethindrone acetate tab 1-0.5 mg# 4 PAestradiol tab 0.5 mg# 4 PAestradiol tab 1 mg# 4 PAestradiol tab 2 mg# 4 PAestradiol td patch weekly 0.025 mg/24hr# 4 PAestradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)# 4 PAestradiol td patch weekly 0.05 mg/24hr# 4 PAestradiol td patch weekly 0.06 mg/24hr# 4 PAestradiol td patch weekly 0.075 mg/24hr# 4 PAestradiol td patch weekly 0.1 mg/24hr# 4 PAestradiol vaginal cream 0.1 mg/gm 4estradiol vaginal tab 10 mcg 2ESTROPIPATE - estropipate tab 0.75 mg# 4 PAESTROPIPATE - estropipate tab 1.5 mg# 4 PAethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg 2ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg 2HYDROXYPROGESTERONE CAPROATE - hydroxyprogesterone

caproate im in oil 1.25 gm/5ml5

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) 2levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) 2levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg 2levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg 2levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg 2

2018


81


levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 2levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg 2medroxyprogesterone acetate im susp prefilled syr 150 mg/ml 2medroxyprogesterone acetate im susp 150 mg/ml 2medroxyprogesterone acetate tab 2.5 mg^ 1medroxyprogesterone acetate tab 5 mg^ 1medroxyprogesterone acetate tab 10 mg^ 1megestrol acetate susp 40 mg/ml# 4 PAmegestrol acetate tab 20 mg# 4 PAmegestrol acetate tab 40 mg# 4 PAMENEST - esterified estrogens tab 0.3 mg# 4 PAMENEST - esterified estrogens tab 0.625 mg# 4 PAMENEST - esterified estrogens tab 1.25 mg# 4 PAmethyltestosterone cap 10 mg 4 PAnorethindrone & ethinyl estradiol tab 0.4 mg-35 mcg 2norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg 2norethindrone & ethinyl estradiol tab 1 mg-35 mcg 2norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg 2norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg 2norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg 2norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg 2norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg 2norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg 2norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg 2norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) 2norethindrone acetate tab 5 mg 2norethindrone tab 0.35 mg 2norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg 2norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg 2norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg 2norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg 2norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg 2norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg 2oxandrolone tab 2.5 mg 3 PAoxandrolone tab 10 mg 5 PAPREMARIN - estrogens, conjugated vaginal cream 0.625 mg/gm 3PREMARIN - estrogens, conjugated tab 0.3 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.45 mg# 4 PA

2018



PREMARIN - estrogens, conjugated tab 0.625 mg# 4 PAPREMARIN - estrogens, conjugated tab 0.9 mg# 4 PAPREMARIN - estrogens, conjugated tab 1.25 mg# 4 PAPREMPHASE - conj est 0.625(14)/conj est-medroxypro ac tab

0.625-5mg(14)#4 PA

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

4 PA


4 PA


4 PA

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

4 PA

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

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

bottles/30 days)Agentes hormonales, estimulantes/sustitutos/modificadores)levothyroxine sodium tab 25 mcg 2levothyroxine sodium tab 50 mcg 2levothyroxine sodium tab 75 mcg 2levothyroxine sodium tab 88 mcg 2levothyroxine sodium tab 100 mcg 2levothyroxine sodium tab 112 mcg 2levothyroxine sodium tab 125 mcg 2levothyroxine sodium tab 137 mcg 2levothyroxine sodium tab 150 mcg 2levothyroxine sodium tab 175 mcg 2levothyroxine sodium tab 200 mcg 2levothyroxine sodium tab 300 mcg 2liothyronine sodium tab 5 mcg 2liothyronine sodium tab 25 mcg 2liothyronine sodium tab 50 mcg 2SYNTHROID - levothyroxine sodium tab 25 mcg 4

2018


83


SYNTHROID - levothyroxine sodium tab 50 mcg 4SYNTHROID - levothyroxine sodium tab 75 mcg 4SYNTHROID - levothyroxine sodium tab 88 mcg 4SYNTHROID - levothyroxine sodium tab 100 mcg 4SYNTHROID - levothyroxine sodium tab 112 mcg 4SYNTHROID - levothyroxine sodium tab 125 mcg 4SYNTHROID - levothyroxine sodium tab 137 mcg 4SYNTHROID - levothyroxine sodium tab 150 mcg 4SYNTHROID - levothyroxine sodium tab 175 mcg 4SYNTHROID - levothyroxine sodium tab 200 mcg 4SYNTHROID - levothyroxine sodium tab 300 mcg 4Agentes hormonales, supresores (suprarrenal)KORLYM - mifepristone tab 300 mg* 5 PA, QL (120 tablets/30 days)LYSODREN - mitotane tab 500 mg 5Agentes hormonales, supresores (pituitarios)cabergoline tab 0.5 mg 2ELIGARD - leuprolide acetate (3 month) for subcutaneous inj kit

22.5mg4

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

4

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

4

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

3.75 mg5

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

5

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

5

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

5

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

5

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

5

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

5

2018



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

5

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

5

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

5

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

5

octreotide acetate inj 50 mcg/ml (0.05 mg/ml) 4 PAoctreotide acetate inj 100 mcg/ml (0.1 mg/ml) 4 PAoctreotide acetate inj 200 mcg/ml (0.2 mg/ml) 4 PAoctreotide acetate inj 500 mcg/ml (0.5 mg/ml) 4 PAoctreotide acetate inj 1000 mcg/ml (1 mg/ml) 5 PASIGNIFOR - pasireotide diaspartate inj 0.3 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.6 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.9 mg/ml* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 20 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 40 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 60 mg* 5 PASOMATULINE DEPOT - lanreotide acetate extended release inj

60 mg/0.2ml5 PA

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

5 PA

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

5 PA

SOMAVERT - pegvisomant for inj 10 mg* 5 PASOMAVERT - pegvisomant for inj 15 mg* 5 PASOMAVERT - pegvisomant for inj 20 mg* 5 PASOMAVERT - pegvisomant for inj 25 mg* 5 PASOMAVERT - pegvisomant for inj 30 mg* 5 PASYNAREL - nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) 5TRELSTAR - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 5TRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 5Agentes hormonales, supresores (tiroides)methimazole tab 5 mg^ 1methimazole tab 10 mg^ 1propylthiouracil tab 50 mg 2

2018


85


Agentes inmunológicosACTHIB - haemophilus b polysaccharide conjugate vaccine for inj 4ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml (2000000

unit/0.5ml)*5

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 4ARCALYST - rilonacept for inj 220 mg* 5 PAATGAM - lymphocyte immune globulin anti-thymocyte g inj 50 mg/

ml(eq)5 BD

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

200 mg/ml5 PA

BENLYSTA - belimumab subcutaneous solution prefilled syringe200 mg/ml

5 PA

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

4

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

4

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

150 mg/ml5 PA

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

5 PA

cyclosporine cap 25 mg 3 BDcyclosporine cap 100 mg 4 BDcyclosporine iv soln 50 mg/ml 2 BDcyclosporine modified cap 25 mg 2 BDcyclosporine modified cap 50 mg 3 BDcyclosporine modified cap 100 mg 2 BDcyclosporine modified oral soln 100 mg/ml 3 BDDAPTACEL - diph, acellular pert & tet tox inj 15 lf-23 mcg-5

lf/0.5ml4

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

4

DUPIXENT - dupilumab subcutaneous soln prefilled syringe300 mg/2ml

5 PA

2018



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

25 mg/0.5ml5 PA

ENBREL - etanercept subcutaneous soln prefilled syringe 50 mg/ml

5 PA

ENBREL MINI - etanercept subcutaneous solution cartridge50 mg/ml

5 PA

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

5 PA

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

4 BD

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

subcutaneous soln 1 gm/10ml5 BD, PA

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

5 BD, PA

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

5 BD, PA


5 BD, PA


5 BD, PA


5 BD, PA

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

1 gm/10ml5 BD, PA

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

5 BD, PA

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

5 BD, PA


5 BD, PA

2018


87



5 BD, PA


5 BD, PA

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

4

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

4

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


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


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

10 mcg4

HUMIRA - adalimumab prefilled syringe kit 10 mg/0.1ml 5 PAHUMIRA - adalimumab prefilled syringe kit 10 mg/0.2ml 5 PAHUMIRA - adalimumab prefilled syringe kit 20 mg/0.2ml 5 PAHUMIRA - adalimumab prefilled syringe kit 20 mg/0.4ml 5 PAHUMIRA - adalimumab prefilled syringe kit 40 mg/0.8ml 5 PAHUMIRA - adalimumab prefilled syringe kit 40 mg/0.4ml 5 PAHUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK -

adalimumab prefilled syringe kit 40 mg/0.8ml5 PA

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

5 PA

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

5 PA

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

40 mg/0.8ml5 PA

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

5 PA

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

5 PA

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

5 PA

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

lf/0.5ml4

2018



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

100 mg/0.67ml5 PA

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

vaccine inj4

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

4

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

2

methotrexate sodium for inj 1 gm 2methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) 2methotrexate sodium inj pf 250 mg/10ml (25 mg/ml) 2methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml) 2methotrexate sodium inj 50 mg/2ml (25 mg/ml) 2methotrexate sodium tab 2.5 mg 3mycophenolate mofetil cap 250 mg 2 BDmycophenolate mofetil for oral susp 200 mg/ml 5 BDmycophenolate mofetil hcl for iv soln 500 mg 2 BDmycophenolate mofetil tab 500 mg 2 BDmycophenolate sodium tab dr 180 mg 2 BDmycophenolate sodium tab dr 360 mg 2 BDNULOJIX - belatacept for iv infusion 250 mg 5 BDORENCIA - abatacept for iv soln 250 mg 5 PAORENCIA - abatacept subcutaneous soln prefilled syringe

50 mg/0.4ml5 PA

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

5 PA

ORENCIA - abatacept subcutaneous soln prefilled syringe125 mg/ml

5 PA

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

5 PA

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

5 PA

OTEZLA - apremilast tab 30 mg 5 PAPEDIARIX - diph-tetanus tox-acell pert-hepatitis b-polio ipv vac inj 4

2018


89


PEDVAX HIB - haemophilus b polysaccharide conj vac im susp7.5 mcg/0.5 ml

4

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

4

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

inj4

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

4

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

5 mcg/0.5ml4 BD

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

4 BD

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

4 BD

REMICADE - infliximab for iv inj 100 mg 5 PARENFLEXIS - infliximab-abda for iv inj 100 mg 5 PARIDAURA - auranofin cap 3 mg 5ROTARIX - rotavirus vaccine, live for oral susp 4ROTATEQ - rotavirus vaccine, live oral pentavalent soln 4SANDIMMUNE - cyclosporine oral soln 100 mg/ml 4 BDSHINGRIX - zoster vaccine recombinant adjuvanted for im inj

50 mcg4 QL (2 vaccines/lifetime)

SIMULECT - basiliximab for iv soln 10 mg 5 BDSIMULECT - basiliximab for iv soln 20 mg 5 BDsirolimus tab 0.5 mg 4 BDsirolimus tab 1 mg 4 BDsirolimus tab 2 mg 5 BDSTAMARIL - yellow fever vaccine for inj suspension 4STELARA - ustekinumab inj 45 mg/0.5ml 5 PASTELARA - ustekinumab iv soln 130 mg/26ml (5 mg/ml) (for iv

infusion)5 PA

STELARA - ustekinumab soln prefilled syringe 45 mg/0.5ml 5 PASTELARA - ustekinumab soln prefilled syringe 90 mg/ml 5 PASYLVANT - siltuximab for iv infusion 100 mg 5SYLVANT - siltuximab for iv infusion 400 mg 5SYNAGIS - palivizumab im soln 50 mg/0.5ml* 5SYNAGIS - palivizumab im soln 100 mg/ml* 5

2018



tacrolimus cap 0.5 mg 2 BDtacrolimus cap 1 mg 2 BDtacrolimus cap 5 mg 4 BDTENIVAC - tetanus-diphtheria toxoids (td) inj 5-2 lfu 3TETANUS/DIPHTHERIA TOXOIDS ADSORBED - tetanus-

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

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

5 BD

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

4

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

4

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

4

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

pfu/0.5ml4

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

unit/0.65ml4 QL (1 vaccine/lifetime)

Agentes para tratar la enfermedad inflamatoria intestinalAPRISO - mesalamine cap er 24hr 0.375 gm 4ASACOL HD - mesalamine tab delayed release 800 mg 3balsalazide disodium cap 750 mg 2budesonide delayed release particles cap 3 mg 5CANASA - mesalamine suppos 1000 mg 3DELZICOL - mesalamine cap dr 400 mg 3DIPENTUM - olsalazine sodium cap 250 mg 5hydrocortisone enema 100 mg/60ml 2hydrocortisone rectal cream 1% 2hydrocortisone rectal cream 2.5% 2LIALDA - mesalamine tab delayed release 1.2 gm 4mesalamine enema 4 gm 2mesalamine rectal enema 4 gm & cleanser wipe kit 2

2018


91


mesalamine tab delayed release 1.2 gm 4PENTASA - mesalamine cap er 250 mg 4PENTASA - mesalamine cap er 500 mg 4sulfasalazine tab delayed release 500 mg 2sulfasalazine tab 500 mg 2Agentes para tratar la enfermedad ósea metabólicaalendronate sodium tab 5 mg^ 1 QL (30 tablets/30 days)alendronate sodium tab 10 mg^ 1 QL (120 tablets/30 days)alendronate sodium tab 35 mg^ 1 QL (4 tablets/28 days)alendronate sodium tab 70 mg^ 1 QL (4 tablets/28 days)calcitonin (salmon) nasal soln 200 unit/act 2calcitriol cap 0.25 mcg 2calcitriol cap 0.5 mcg 2calcitriol inj 1 mcg/ml 2calcitriol oral soln 1 mcg/ml 3ETIDRONATE DISODIUM - etidronate disodium tab 200 mg 4ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 4FORTEO - teriparatide (recombinant) inj 600 mcg/2.4ml 5 PAibandronate sodium iv soln 3 mg/3ml 2ibandronate sodium tab 150 mg 2 QL (1 tablet/28 days)MIACALCIN - calcitonin (salmon) inj 200 unit/ml 4NATPARA - parathyroid hormone (recombinant) for inj cartridge

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

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

5 PA, QL (2 cartridges/28 days)





paricalcitol cap 1 mcg 2paricalcitol cap 2 mcg 4paricalcitol cap 4 mcg 4paricalcitol iv soln 2 mcg/ml 2paricalcitol iv soln 5 mcg/ml 2PROLIA - denosumab inj 60 mg/ml 4 PArisedronate sodium tab delayed release 35 mg 2 QL (4 tablets/28 days)risedronate sodium tab 5 mg 2 QL (30 tablets/30 days)risedronate sodium tab 30 mg 2 QL (30 tablets/30 days)risedronate sodium tab 35 mg 2 QL (4 tablets/28 days)

2018



risedronate sodium tab 150 mg 2 QL (1 tablet/28 days)SENSIPAR - cinacalcet hcl tab 30 mg 5 PASENSIPAR - cinacalcet hcl tab 60 mg 5 PASENSIPAR - cinacalcet hcl tab 90 mg 5 PAXGEVA - denosumab inj 120 mg/1.7ml 5zoledronic acid inj conc for iv infusion 4 mg/5ml 3zoledronic acid iv soln 5 mg/100ml 3ZOMETA - zoledronic acid iv soln 4 mg/100ml 5Agentes oftálmicosALPHAGAN P - brimonidine tartrate ophth soln 0.1% 4azelastine hcl ophth soln 0.05% 2AZOPT - brinzolamide ophth susp 1% 4BACITRACIN - bacitracin ophth oint 500 unit/gm 3bacitracin-polymyxin b ophth oint 2bacitracin-polymyxin-neomycin-hc ophth oint 1% 2BESIVANCE - besifloxacin hcl ophth susp 0.6% 4betaxolol hcl ophth soln 0.5% 2BETOPTIC-S - betaxolol hcl ophth susp 0.25% 4brimonidine tartrate ophth soln 0.15% 2brimonidine tartrate ophth soln 0.2%^ 1bromfenac sodium ophth soln 0.09% (once-daily) 2carteolol hcl ophth soln 1%^ 1ciprofloxacin hcl ophth soln 0.3%^ 1COMBIGAN - brimonidine tartrate-timolol maleate ophth soln

0.2-0.5%3

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

sodium phosphate ophth soln 0.1%4

diclofenac sodium ophth soln 0.1% 2dorzolamide hcl ophth soln 2% 2dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml 2DUREZOL - difluprednate ophth emulsion 0.05% 3epinastine hcl ophth soln 0.05% 2erythromycin ophth oint 5 mg/gm^ 1fluorometholone ophth susp 0.1% 2flurbiprofen sodium ophth soln 0.03%^ 1gentamicin sulfate ophth oint 0.3% 2

2018


93


gentamicin sulfate ophth soln 0.3% 2ILEVRO - nepafenac ophth susp 0.3% 3ISTALOL - timolol maleate ophth soln 0.5% (once-daily) 4ketorolac tromethamine ophth soln 0.4% 2ketorolac tromethamine ophth soln 0.5% 2LACRISERT - artificial tear ophth insert 4latanoprost ophth soln 0.005% 2levobunolol hcl ophth soln 0.5%^ 1LOTEMAX - loteprednol etabonate ophth gel 0.5% 3LOTEMAX - loteprednol etabonate ophth oint 0.5% 3LOTEMAX - loteprednol etabonate ophth susp 0.5% 3LUMIGAN - bimatoprost ophth soln 0.01% 3MOXEZA - moxifloxacin hcl ophth soln 0.5% (2 times daily) 4moxifloxacin hcl ophth soln 0.5% 2NATACYN - natamycin ophth susp 5% 4neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin 2neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml 2neomycin-polymyxin-dexamethasone ophth oint 0.1% 2neomycin-polymyxin-dexamethasone ophth susp 0.1% 2ofloxacin ophth soln 0.3% 2olopatadine hcl ophth soln 0.1% 2olopatadine hcl ophth soln 0.2% 3PAZEO - olopatadine hcl ophth soln 0.7% 3PHOSPHOLINE IODIDE - echothiophate iodide ophth for soln

0.125%4

pilocarpine hcl ophth soln 1% 2pilocarpine hcl ophth soln 2% 2pilocarpine hcl ophth soln 4% 2polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%^ 1prednisolone acetate ophth susp 1% 2PROLENSA - bromfenac sodium ophth soln 0.07% 4RESTASIS - cyclosporine (ophth) emulsion 0.05% 3 PA, QL (60 vials/30 days)RESTASIS MULTIDOSE - cyclosporine (ophth) emulsion 0.05% 3 PA, QL (2 bottles/30 days)SIMBRINZA - brinzolamide-brimonidine tartrate ophth susp

1-0.2%3

sulfacetamide sodium ophth soln 10% 2sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% 2timolol maleate ophth gel forming soln 0.25% 2

2018



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

aluminum acetate otic soln4

CIPRODEX - ciprofloxacin-dexamethasone otic susp 0.3-0.1% 4fluocinolone acetonide (otic) oil 0.01% 2hydrocortisone w/ acetic acid otic soln 1-2% 2neomycin-polymyxin-hc otic soln 1% 2neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% 2ofloxacin otic soln 0.3% 2Agentes para el tracto respiratorio/pulmonaracetylcysteine inhal soln 10% 2 BDacetylcysteine inhal soln 20% 2 BDADCIRCA - tadalafil tab 20 mg 5 PA, QL (60 tablets/30 days)ADEMPAS - riociguat tab 0.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2.5 mg 5 PA, QL (90 tablets/30 days)ADVAIR DISKUS - fluticasone-salmeterol aer powder ba

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

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

3 QL (1 inhaler/30 days)

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


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

act3 QL (1 canister/30 days)

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

3 QL (1 canister/30 days)

2018


95


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

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

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

3 QL (30 blisters/30 days)





ASMANEX HFA - mometasone furoate inhal aerosol suspension100 mcg/act


ASMANEX HFA - mometasone furoate inhal aerosol suspension200 mcg/act


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












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

4 QL (2 canisters/30 days)

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

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

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

3 QL (1 package/30 days)

budesonide inhalation susp 0.25 mg/2ml 3 BD

2018



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

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

cromolyn sodium soln nebu 20 mg/2ml 3 BDDALIRESP - roflumilast tab 250 mcg 4DALIRESP - roflumilast tab 500 mcg 4diphenhydramine hcl inj 50 mg/ml 2DULERA - mometasone furoate-formoterol fumarate aerosol

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

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


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

3

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

3

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

3

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

3

ESBRIET - pirfenidone cap 267 mg* 5 PA, QL (270 capsules/30 days)ESBRIET - pirfenidone tab 267 mg* 5 PA, QL (270 tablets/30 days)ESBRIET - pirfenidone tab 801 mg* 5 PA, QL (90 tablets/30 days)FLOVENT DISKUS - fluticasone propionate aer pow ba 50 mcg/

blister3 QL (1 inhaler/30 days)

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


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

3 QL (4 inhalers/30 days)

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


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


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


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

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

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


2018


97


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


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


ipratropium bromide inhal soln 0.02% 2 BDipratropium bromide nasal soln 0.03% (21 mcg/spray) 2 QL (2 bottles/30 days)ipratropium bromide nasal soln 0.06% (42 mcg/spray) 2 QL (3 bottles/30 days)KALYDECO - ivacaftor packet 50 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor packet 75 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor tab 150 mg 5 PA, QL (60 tablets/30 days)LETAIRIS - ambrisentan tab 5 mg* 5 PA, QL (30 tablets/30 days)LETAIRIS - ambrisentan tab 10 mg* 5 PA, QL (30 tablets/30 days)levocetirizine dihydrochloride tab 5 mg^ 1mometasone furoate nasal susp 50 mcg/act 2 QL (2 bottles/30 days)montelukast sodium chew tab 4 mg 2montelukast sodium chew tab 5 mg 2montelukast sodium oral granules packet 4 mg 2montelukast sodium tab 10 mg^ 1OFEV - nintedanib esylate cap 100 mg* 5 PA, QL (60 capsules/30 days)OFEV - nintedanib esylate cap 150 mg* 5 PA, QL (60 capsules/30 days)olopatadine hcl nasal soln 0.6% 2 QL (1 bottle/30 days)OPSUMIT - macitentan tab 10 mg* 5 PA, QL (30 tablets/30 days)ORALAIR - grass mixed pollen ext tab sl 300 ir 4 PA, QL (30 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg* 5 PA, QL (120 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg* 5 PA, QL (120 tablets/30 days)PROAIR HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)PROAIR RESPICLICK - albuterol sulfate aer pow ba 108 mcg/act 3 QL (2 canisters/30 days)PULMOZYME - dornase alfa inhal soln 1 mg/ml 5 BDQVAR - beclomethasone diprop inhal aero soln 80 mcg/act (100/

valve)3 QL (2 canisters/30 days)

QVAR REDIHALER - beclomethasone diprop hfa breath act inhaer 40 mcg/act


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


REMODULIN - treprostinil sodium inj 1 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 2.5 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 5 mg/ml* 5 BDREMODULIN - treprostinil sodium inj 10 mg/ml* 5 BDribavirin for inhal soln 6 gm 5

2018



SEREVENT DISKUS - salmeterol xinafoate aer pow ba 50 mcg/dose


sildenafil citrate tab 20 mg 2 PA, QL (90 tablets/30 days)SPIRIVA HANDIHALER - tiotropium bromide monohydrate inhal

cap 18 mcg3 QL (30 capsules/30 days)

SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 1.25 mcg/act


SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 2.5 mcg/act


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


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


terbutaline sulfate tab 2.5 mg 2terbutaline sulfate tab 5 mg 2theophylline tab er 12hr 100 mg 2theophylline tab er 12hr 200 mg 2theophylline tab er 12hr 300 mg 2theophylline tab er 12hr 450 mg 2theophylline tab er 24hr 400 mg 2theophylline tab er 24hr 600 mg 2tobramycin nebu soln 300 mg/5ml 5 BDTRACLEER - bosentan tab for oral susp 32 mg* 5 PA, QL (120 tablets/30 days)TRACLEER - bosentan tab 62.5 mg* 5 PA, QL (60 tablets/30 days)TRACLEER - bosentan tab 125 mg* 5 PA, QL (60 tablets/30 days)TRELEGY ELLIPTA - fluticasone-umeclidinium-vilanterol aepb

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

triamcinolone acetonide nasal aerosol suspension 55 mcg/act 2 QL (1 bottle/30 days)UPTRAVI - selexipag tab therapy pack 200 mcg (140) & 800 mcg

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

tablets)/28 days)UPTRAVI - selexipag tab 200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 400 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 600 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 800 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1000 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1200 mcg* 5 PA, QL (60 tablets/30 days)UPTRAVI - selexipag tab 1400 mcg* 5 PA, QL (60 tablets/30 days)

2018


99


UPTRAVI - selexipag tab 1600 mcg* 5 PA, QL (60 tablets/30 days)VENTAVIS - iloprost inhalation solution 10 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTAVIS - iloprost inhalation solution 20 mcg/ml 5 BD, PA, QL (270 mls/30 days)VENTOLIN HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)XOPENEX HFA - levalbuterol tartrate inhal aerosol 45 mcg/act 4 QL (2 canisters/30 days)zafirlukast tab 10 mg 2zafirlukast tab 20 mg 2Relajantes de los músculos esqueléticoscyclobenzaprine hcl tab 5 mg# 4 PAcyclobenzaprine hcl tab 7.5 mg# 4 PAcyclobenzaprine hcl tab 10 mg# 4 PAmethocarbamol tab 500 mg# 4 PAmethocarbamol tab 750 mg# 4 PAAgentes para tratar los trastornos del sueñoarmodafinil tab 50 mg 4 PA, QL (30 tablets/30 days)armodafinil tab 150 mg 4 PA, QL (30 tablets/30 days)armodafinil tab 200 mg 2 PA, QL (30 tablets/30 days)armodafinil tab 250 mg 4 PA, QL (30 tablets/30 days)HETLIOZ - tasimelteon capsule 20 mg* 5 PA, QL (30 capsules/30 days)modafinil tab 100 mg 4 PA, QL (30 tablets/30 days)modafinil tab 200 mg 4 PA, QL (30 tablets/30 days)SILENOR - doxepin hcl tab 3 mg 3 QL (30 tablets/30 days)SILENOR - doxepin hcl tab 6 mg 3 QL (30 tablets/30 days)temazepam cap 15 mg 3 QL (30 capsules/30 days)temazepam cap 30 mg 3 QL (30 capsules/30 days)XYREM - sodium oxybate oral solution 500 mg/ml* 5 PA, QL (540 mls/30 days)zaleplon cap 5 mg# 4 PAzaleplon cap 10 mg# 4 PAzolpidem tartrate tab 5 mg# 4 PAzolpidem tartrate tab 10 mg# 4 PA

2018

100

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..................................................................................5acarbose tab 100 mg.................................................. 48acarbose tab 25 mg.................................................... 48acarbose tab 50 mg.................................................... 48acebutolol hcl cap 200 mg..........................................55acebutolol hcl cap 400 mg..........................................55acetaminophen 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...........................55acetazolamide tab 125 mg......................................... 55acetazolamide tab 250 mg......................................... 55ACETIC ACID/ALUMINUM ACETATE...................... 94acetic acid otic soln 2%.............................................. 94acetylcysteine inhal soln 10%.................................... 94acetylcysteine inhal soln 20%.................................... 94acitretin cap 10 mg......................................................68acitretin cap 17.5 mg...................................................68acitretin cap 25 mg......................................................68ACTHIB..........................................................................85ACTIMMUNE................................................................ 85acyclovir 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........................................................................ 85ADAGEN........................................................................75ADASUVE..................................................................... 38

ADCIRCA...................................................................... 94adefovir dipivoxil tab 10 mg........................................42ADEMPAS..................................................................... 94ADEMPAS..................................................................... 94ADEMPAS..................................................................... 94ADEMPAS..................................................................... 94ADEMPAS..................................................................... 94ADVAIR DISKUS..........................................................94ADVAIR DISKUS..........................................................94ADVAIR DISKUS..........................................................94ADVAIR HFA.................................................................94ADVAIR HFA.................................................................94ADVAIR HFA.................................................................94AFINITOR......................................................................25AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR......................................................................26AFINITOR DISPERZ................................................... 26AFINITOR DISPERZ................................................... 26AFINITOR DISPERZ................................................... 26ALBENZA...................................................................... 36albuterol sulfate soln nebu 0.083% (2.5

mg/3ml).......................................................................95albuterol sulfate soln nebu 0.5% (5 mg/

ml)................................................................................95albuterol sulfate soln nebu 0.63

mg/3ml........................................................................ 95albuterol sulfate soln nebu 1.25

mg/3ml........................................................................ 95albuterol sulfate syrup 2 mg/5ml................................95albuterol sulfate tab 2 mg...........................................95albuterol sulfate tab 4 mg...........................................95albuterol sulfate tab er 12hr 4 mg..............................95albuterol sulfate tab er 12hr 8 mg..............................95alclometasone dipropionate cream

0.05%..........................................................................68alclometasone dipropionate oint

0.05%..........................................................................68ALCOHOL SWABS......................................................48ALDURAZYME............................................................. 76ALECENSA................................................................... 26alendronate sodium tab 10 mg.................................. 91alendronate sodium tab 35 mg.................................. 91alendronate sodium tab 5 mg.................................... 91alendronate sodium tab 70 mg.................................. 91alfuzosin hcl tab er 24hr 10 mg................................. 77ALIMTA.......................................................................... 26ALIMTA.......................................................................... 26ALINIA............................................................................36ALINIA............................................................................36ALIQOPA....................................................................... 26allopurinol sodium for inj 500 mg...............................24

2018

101

allopurinol tab 100 mg.................................................24allopurinol tab 300 mg.................................................24alosetron hcl tab 0.5 mg............................................. 73alosetron hcl tab 1 mg................................................ 73ALOXI.............................................................................21ALPHAGAN P...............................................................92alprazolam tab 0.25 mg.............................................. 47alprazolam tab 0.5 mg................................................ 47alprazolam tab 1 mg....................................................47alprazolam tab 2 mg....................................................47ALUNBRIG....................................................................26ALUNBRIG....................................................................26ALUNBRIG....................................................................26ALUNBRIG....................................................................26amantadine hcl cap 100 mg.......................................36amantadine hcl syrup 50 mg/5ml...............................36amantadine hcl tab 100 mg........................................36AMBISOME...................................................................23amikacin sulfate inj 1 gm/4ml (250 mg/

ml)..................................................................................6amikacin sulfate inj 500 mg/2ml (250 mg/

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

mg................................................................................55amiloride hcl tab 5 mg.................................................55amino acid infusion 15%.............................................71amino acid infusion 6%...............................................71amiodarone hcl tab 200 mg........................................55amiodarone hcl tab 400 mg........................................55AMITIZA.........................................................................73AMITIZA.........................................................................73amitriptyline hcl tab 100 mg....................................... 18amitriptyline hcl tab 10 mg..........................................18amitriptyline hcl tab 150 mg....................................... 18amitriptyline hcl tab 25 mg..........................................18amitriptyline hcl tab 50 mg..........................................18amitriptyline hcl tab 75 mg..........................................18amlodipine besylate-atorvastatin calcium tab 10-10

mg................................................................................55amlodipine besylate-atorvastatin calcium tab 10-20



mg................................................................................55amlodipine besylate-atorvastatin calcium tab 2.5-10



mg................................................................................55

amlodipine besylate-atorvastatin calcium tab 5-10mg................................................................................55




amlodipine besylate-benazepril hcl cap 10-20mg................................................................................56


amlodipine besylate-benazepril hcl cap 2.5-10mg................................................................................55




amlodipine besylate tab 10 mg..................................55amlodipine besylate tab 2.5 mg.................................55amlodipine besylate tab 5 mg.................................... 55amlodipine besylate-valsartan tab 10-160

mg................................................................................56amlodipine besylate-valsartan tab 10-320



mg................................................................................56amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg.........................................................56amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg............................................................56amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg............................................................56amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg...........................................................56amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg.............................................................. 56AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXAPINE.................................................................18AMOXICILLIN/CLAVULANATE

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

POTASSIUM................................................................ 6amoxicillin (trihydrate) cap 250 mg..............................6amoxicillin (trihydrate) cap 500 mg..............................6

2018

102

amoxicillin (trihydrate) for susp 125mg/5ml.......................................................................... 6




amoxicillin (trihydrate) tab 500 mg...............................6amoxicillin (trihydrate) tab 875 mg...............................6amoxicillin & k clavulanate for susp 200-28.5

mg/5ml.......................................................................... 6amoxicillin & k clavulanate for susp 400-57

mg/5ml.......................................................................... 6amoxicillin & k clavulanate for susp 600-42.9

mg/5ml.......................................................................... 6amoxicillin & k clavulanate tab 250-125

mg..................................................................................6amoxicillin & k clavulanate tab 500-125

mg..................................................................................6amoxicillin & k clavulanate tab 875-125

mg..................................................................................6amphetamine-dextroamphetamine cap er 24hr 10

mg................................................................................66amphetamine-dextroamphetamine cap er 24hr 15





mg................................................................................66amphetamine-dextroamphetamine tab 10

mg................................................................................66amphetamine-dextroamphetamine tab 12.5





mg................................................................................66amphetamine-dextroamphetamine tab 7.5

mg................................................................................66AMPHOTERICIN B......................................................23ampicillin & sulbactam sodium for inj 3 (2-1)

gm..................................................................................6ampicillin cap 500 mg....................................................6

AMPICILLIN 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........................................................................67ANADROL-50............................................................... 79anagrelide hcl cap 0.5 mg.......................................... 52anagrelide hcl cap 1 mg............................................. 52anastrozole tab 1 mg...................................................26ANDRODERM.............................................................. 79ANDRODERM.............................................................. 79ANDROGEL.................................................................. 79ANDROGEL.................................................................. 79ANDROGEL PUMP..................................................... 79ANORO ELLIPTA.........................................................95APOKYN........................................................................36aprepitant capsule 125 mg.........................................21aprepitant capsule 40 mg........................................... 21aprepitant capsule 80 mg........................................... 21aprepitant capsule therapy pack 80 & 125

mg................................................................................21APRISO......................................................................... 90APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 13APTIOM......................................................................... 14APTIVUS....................................................................... 42APTIVUS....................................................................... 42ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARANESP ALBUMIN FREE.......................................52ARCALYST....................................................................85aripiprazole orally disintegrating tab 10

mg................................................................................38aripiprazole orally disintegrating tab 15

mg................................................................................38

2018

103

aripiprazole oral solution 1 mg/ml..............................38aripiprazole tab 10 mg................................................ 38aripiprazole tab 15 mg................................................ 38aripiprazole tab 20 mg................................................ 38aripiprazole tab 2 mg...................................................38aripiprazole tab 30 mg................................................ 38aripiprazole tab 5 mg...................................................38ARISTADA.....................................................................38ARISTADA.....................................................................38ARISTADA.....................................................................38ARISTADA.....................................................................38armodafinil tab 150 mg............................................... 99armodafinil tab 200 mg............................................... 99armodafinil tab 250 mg............................................... 99armodafinil tab 50 mg................................................. 99ARNUITY ELLIPTA......................................................95ARNUITY ELLIPTA......................................................95ARNUITY ELLIPTA......................................................95ARRANON.................................................................... 26ARZERRA..................................................................... 26ARZERRA..................................................................... 26ASACOL HD.................................................................90ASMANEX HFA............................................................95ASMANEX HFA............................................................95ASMANEX TWISTHALER 120 METERED

DOSES....................................................................... 95ASMANEX TWISTHALER 14 METERED





DOSES....................................................................... 95aspirin-dipyridamole cap er 12hr 25-200

mg................................................................................52atazanavir sulfate cap 150 mg...................................43atazanavir sulfate cap 200 mg...................................43atazanavir sulfate cap 300 mg...................................43atenolol & chlorthalidone tab 100-25

mg................................................................................56atenolol & chlorthalidone tab 50-25 mg.................... 56atenolol tab 100 mg.....................................................56atenolol tab 25 mg.......................................................56atenolol tab 50 mg.......................................................56ATGAM.......................................................................... 85atomoxetine hcl cap 100 mg...................................... 67atomoxetine hcl cap 10 mg........................................ 67atomoxetine hcl cap 18 mg........................................ 67atomoxetine hcl cap 25 mg........................................ 67

atomoxetine hcl cap 40 mg........................................ 67atomoxetine hcl cap 60 mg........................................ 67atomoxetine hcl cap 80 mg........................................ 67atorvastatin calcium tab 10 mg.................................. 56atorvastatin calcium tab 20 mg.................................. 56atorvastatin calcium tab 40 mg.................................. 56atorvastatin calcium tab 80 mg.................................. 56atovaquone-proguanil hcl tab 250-100

mg................................................................................36atovaquone-proguanil hcl tab 62.5-25

mg................................................................................36atovaquone susp 750 mg/5ml....................................36ATRIPLA........................................................................ 43ATROVENT HFA..........................................................95AVASTIN........................................................................26AVASTIN........................................................................26AVELOX...........................................................................6AVONEX........................................................................ 67AVONEX........................................................................ 67AVONEX PEN.............................................................. 67azacitidine for inj 100 mg............................................53AZACTAM........................................................................6AZACTAM........................................................................6AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 7AZACTAM IN ISO-OSMOTIC

DEXTROSE................................................................. 7AZASAN........................................................................ 85AZASAN........................................................................ 85AZATHIOPRINE........................................................... 85azathioprine tab 50 mg............................................... 85azelastine hcl nasal spray 0.1% (137 mcg/

spray)..........................................................................95azelastine hcl nasal spray 0.15% (205.5 mcg/

spray)..........................................................................95azelastine hcl ophth soln 0.05%................................ 92AZELEX......................................................................... 68AZITHROMYCIN............................................................ 7azithromycin for susp 100 mg/5ml...............................7azithromycin for susp 200 mg/5ml...............................7azithromycin iv for soln 500 mg................................... 7azithromycin tab 250 mg...............................................7azithromycin tab 500 mg...............................................7azithromycin tab 600 mg...............................................7AZOPT........................................................................... 92aztreonam for inj 1 gm.................................................. 7aztreonam for inj 2 gm.................................................. 7BBACITRACIN................................................................ 92bacitracin-polymyxin b ophth oint.............................. 92

2018

104

bacitracin-polymyxin-neomycin-hc ophth oint1%............................................................................... 92

baclofen tab 10 mg......................................................42baclofen tab 20 mg......................................................42balsalazide disodium cap 750 mg............................. 90BANZEL.........................................................................14BANZEL.........................................................................14BANZEL.........................................................................14BARACLUDE................................................................ 43BAVENCIO.................................................................... 26BCG VACCINE.............................................................85BELEODAQ.................................................................. 26benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................56benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................56benazepril & hydrochlorothiazide tab 20-25

mg................................................................................56benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................56benazepril hcl tab 10 mg............................................ 56benazepril hcl tab 20 mg............................................ 56benazepril hcl tab 40 mg............................................ 56benazepril hcl tab 5 mg.............................................. 56BENDEKA..................................................................... 26BENLYSTA.................................................................... 85BENLYSTA.................................................................... 85BENLYSTA.................................................................... 85BENLYSTA.................................................................... 85BENZNIDAZOLE..........................................................36BENZNIDAZOLE..........................................................36benzoyl peroxide-erythromycin gel

5-3%............................................................................68benztropine mesylate tab 0.5 mg.............................. 36benztropine mesylate tab 1 mg..................................36benztropine mesylate tab 2 mg..................................36BESIVANCE..................................................................92BESPONSA.................................................................. 26betamethasone dipropionate augmented cream

0.05%..........................................................................68betamethasone dipropionate augmented gel

0.05%..........................................................................68betamethasone dipropionate augmented lotion

0.05%..........................................................................68betamethasone dipropionate augmented oint

0.05%..........................................................................68betamethasone dipropionate cream

0.05%..........................................................................68betamethasone dipropionate lotion

0.05%..........................................................................68betamethasone dipropionate oint

0.05%..........................................................................68

betamethasone valerate cream 0.1%....................... 68betamethasone valerate lotion 0.1%.........................68betamethasone valerate oint 0.1%............................68BETASERON................................................................ 67betaxolol hcl ophth soln 0.5%.................................... 92betaxolol hcl tab 10 mg...............................................56betaxolol hcl tab 20 mg...............................................56bethanechol chloride tab 10 mg.................................77bethanechol chloride tab 25 mg.................................77bethanechol chloride tab 50 mg.................................77bethanechol chloride tab 5 mg...................................77BETOPTIC-S.................................................................92BEVYXXA......................................................................53BEVYXXA......................................................................53bexarotene cap 75 mg................................................ 26BEXSERO..................................................................... 85bicalutamide tab 50 mg...............................................26BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICNU............................................................................26BIKTARVY..................................................................... 43BILTRICIDE...................................................................36bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................56bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................56bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................56bisoprolol fumarate tab 10 mg................................... 56bisoprolol fumarate tab 5 mg..................................... 56bleomycin sulfate for inj 15 unit................................. 26bleomycin sulfate for inj 30 unit................................. 26BLINCYTO.....................................................................26BOOSTRIX....................................................................85BOSULIF....................................................................... 26BOSULIF....................................................................... 26BOSULIF....................................................................... 26BREO ELLIPTA............................................................ 95BREO ELLIPTA............................................................ 95BRILINTA.......................................................................53BRILINTA.......................................................................53brimonidine tartrate ophth soln 0.15%...................... 92brimonidine tartrate ophth soln 0.2%........................ 92BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14

2018

105

bromfenac sodium ophth soln 0.09% (once-daily)............................................................................92

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

mg................................................................................90budesonide inhalation susp 0.25

mg/2ml........................................................................ 95budesonide inhalation susp 0.5

mg/2ml........................................................................ 96budesonide inhalation susp 1 mg/2ml.......................96bumetanide inj 0.25 mg/ml......................................... 56bumetanide tab 0.5 mg............................................... 56bumetanide tab 1 mg.................................................. 57bumetanide tab 2 mg.................................................. 57BUPHENYL...................................................................76buprenorphine hcl-naloxone hcl sl tab 2-0.5

mg..................................................................................5buprenorphine hcl-naloxone hcl sl tab 8-2

mg..................................................................................5buprenorphine hcl sl tab 2 mg......................................5buprenorphine hcl sl tab 8 mg......................................5bupropion hcl (smoking deterrent) tab er 12hr 150

mg..................................................................................5bupropion 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..................................................................48

BYDUREON BCISE.....................................................48BYDUREON PEN........................................................ 48Ccabergoline tab 0.5 mg............................................... 83CABOMETYX............................................................... 26CABOMETYX............................................................... 26CABOMETYX............................................................... 26caffeine citrate oral soln 60 mg/3ml...........................96calcipotriene cream 0.005%.......................................68calcipotriene oint 0.005%............................................69calcipotriene soln 0.005% (50 mcg/ml).....................69calcitonin (salmon) nasal soln 200 unit/

act................................................................................91calcitriol cap 0.25 mcg................................................ 91calcitriol cap 0.5 mcg...................................................91calcitriol inj 1 mcg/ml...................................................91calcitriol oral soln 1 mcg/ml........................................91calcium acetate cap 667 mg...................................... 71calcium acetate tab 667 mg....................................... 71CALQUENCE................................................................27CANASA........................................................................90CANCIDAS....................................................................23CANCIDAS....................................................................23candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg................................................................................57candesartan cilexetil-hydrochlorothiazide tab 32-12.5

mg................................................................................57candesartan cilexetil-hydrochlorothiazide tab 32-25

mg................................................................................57candesartan cilexetil tab 16 mg................................. 57candesartan cilexetil tab 32 mg................................. 57candesartan cilexetil tab 4 mg................................... 57candesartan cilexetil tab 8 mg................................... 57CAPASTAT SULFATE..................................................25CAPRELSA................................................................... 27CAPRELSA................................................................... 27captopril tab 100 mg....................................................57captopril tab 12.5 mg...................................................57captopril tab 25 mg......................................................57captopril tab 50 mg......................................................57CARAC.......................................................................... 69CARBAGLU.................................................................. 71carbamazepine cap er 12hr 100 mg......................... 14carbamazepine cap er 12hr 200 mg......................... 14carbamazepine cap er 12hr 300 mg......................... 14carbamazepine chew tab 100 mg..............................14carbamazepine susp 100 mg/5ml..............................14carbamazepine tab 200 mg........................................14carbamazepine tab er 12hr 100 mg.......................... 14carbamazepine tab er 12hr 200 mg.......................... 14carbamazepine tab er 12hr 400 mg.......................... 14

2018

106

CARBIDOPA/LEVODOPA/ENTACAPONE..........................................................37






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



carbidopa & levodopa tab 10-100 mg....................... 37carbidopa & levodopa tab 25-100 mg....................... 37carbidopa & levodopa tab 25-250 mg....................... 37carbidopa & levodopa tab er 25-100

mg................................................................................37carbidopa & levodopa tab er 50-200

mg................................................................................37carbidopa tab 25 mg................................................... 37carboplatin iv soln 150 mg/15ml................................ 27carboplatin iv soln 450 mg/45ml................................ 27carboplatin iv soln 50 mg/5ml.................................... 27carboplatin iv soln 600 mg/60ml................................ 27carteolol hcl ophth soln 1%........................................ 92carvedilol tab 12.5 mg.................................................57carvedilol tab 25 mg....................................................57carvedilol tab 3.125 mg...............................................57carvedilol tab 6.25 mg.................................................57caspofungin acetate for iv soln 50 mg...................... 23caspofungin acetate for iv soln 70 mg...................... 23cefaclor 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.............................................. 7

CEFOTAXIME SODIUM................................................7CEFOTAXIME SODIUM................................................7CEFOTAXIME SODIUM................................................7cefotaxime sodium for inj 1 gm.................................... 7cefoxitin sodium for inj 10 gm...................................... 7cefoxitin sodium for iv soln 1 gm................................. 8cefoxitin sodium for iv soln 2 gm................................. 8cefpodoxime proxetil for susp 100

mg/5ml.......................................................................... 8cefpodoxime proxetil for susp 50

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

DEXTROSE................................................................. 8CEFTRIAXONE 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..................................9CEREZYME.................................................................. 76CHANTIX......................................................................... 5

2018

107

CHANTIX......................................................................... 5CHANTIX CONTINUING MONTH

PACK.............................................................................5CHANTIX STARTING MONTH PACK.........................5CHEMET........................................................................71CHENODAL.................................................................. 73CHLORAMPHENICOL SODIUM

SUCCINATE.................................................................9chlorhexidine gluconate soln 0.12%..........................68CHLOROQUINE PHOSPHATE................................. 36chloroquine phosphate tab 500 mg...........................36CHLOROTHIAZIDE..................................................... 57chlorothiazide tab 500 mg.......................................... 57CHLORPROMAZINE HCL..........................................22CHLORPROMAZINE HCL..........................................22chlorpromazine hcl tab 100 mg..................................22chlorpromazine hcl tab 10 mg....................................22chlorpromazine hcl tab 200 mg..................................22chlorpromazine hcl tab 25 mg....................................22chlorpromazine hcl tab 50 mg....................................22chlorthalidone tab 25 mg............................................ 57chlorthalidone tab 50 mg............................................ 57cholestyramine light powder 4 gm/

dose............................................................................ 57cholestyramine light powder packets 4

gm................................................................................57cholestyramine powder 4 gm/dose............................57cholestyramine powder packets 4 gm.......................57choline fenofibrate cap dr 135 mg............................. 57choline fenofibrate cap dr 45 mg............................... 57chorionic gonadotropin for im inj 10000 unit(chorionic

gonadotropin, pregnyl)............................................. 79ciclopirox gel 0.77%.................................................... 23ciclopirox olamine cream 0.77%................................23ciclopirox olamine susp 0.77%...................................23ciclopirox shampoo 1%............................................... 23ciclopirox solution 8%..................................................23cidofovir iv inj 75 mg/ml.............................................. 43cilostazol tab 100 mg.................................................. 53cilostazol tab 50 mg.................................................... 53CIMDUO........................................................................ 43cimetidine hcl soln 300 mg/5ml..................................73cimetidine tab 200 mg.................................................73cimetidine tab 300 mg.................................................73cimetidine tab 400 mg.................................................73cimetidine tab 800 mg.................................................73CINRYZE.......................................................................85CIPRODEX....................................................................94ciprofloxacin 200 mg/100ml in d5w............................. 9ciprofloxacin 400 mg/200ml in d5w............................. 9ciprofloxacin for oral susp 250 mg/5ml (5%) (5

gm/100ml).....................................................................9

ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml).....................................................................9

CIPROFLOXACIN HCL.................................................9ciprofloxacin hcl ophth soln 0.3%.............................. 92ciprofloxacin hcl tab 250 mg.........................................9ciprofloxacin hcl tab 500 mg.........................................9ciprofloxacin hcl tab 750 mg.........................................9ciprofloxacin hcl tab er 24hr 1000 mg......................... 9ciprofloxacin hcl tab er 24hr 500 mg........................... 9CISPLATIN.................................................................... 27cisplatin inj 100 mg/100ml (1 mg/ml).........................27cisplatin inj 50 mg/50ml (1 mg/ml).............................27citalopram 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)................................................................................27clarithromycin for susp 125 mg/5ml.............................9clarithromycin for susp 250 mg/5ml.............................9clarithromycin tab 250 mg............................................ 9clarithromycin tab 500 mg............................................ 9clarithromycin tab er 24hr 500 mg...............................9CLEMASTINE FUMARATE........................................ 96clindamycin hcl cap 150 mg......................................... 9clindamycin hcl cap 300 mg......................................... 9clindamycin hcl cap 75 mg........................................... 9clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................69clindamycin 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%.................................9

2018

108

clindamycin phosphate vaginal cream2%..................................................................................9

clobetasol propionate cream 0.05%..........................69clobetasol propionate emollient base cream

0.05%..........................................................................69clobetasol propionate gel 0.05%................................69clobetasol propionate oint 0.05%.............................. 69clobetasol propionate soln 0.05%..............................69clofarabine iv soln 1 mg/ml.........................................27clomipramine 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.............................................. 48clonazepam tab 1 mg..................................................48clonazepam tab 2 mg..................................................48clonidine hcl tab 0.1 mg..............................................57clonidine hcl tab 0.2 mg..............................................57clonidine hcl tab 0.3 mg..............................................57clonidine hcl tab er 12hr 0.1 mg................................ 67clonidine hcl td patch weekly 0.1

mg/24hr...................................................................... 57clonidine hcl td patch weekly 0.2

mg/24hr...................................................................... 57clonidine hcl td patch weekly 0.3

mg/24hr...................................................................... 57clopidogrel bisulfate tab 75 mg..................................53clorazepate dipotassium tab 15 mg...........................48clorazepate dipotassium tab 3.75 mg....................... 48clorazepate dipotassium tab 7.5 mg......................... 48clotrimazole cream 1%................................................23clotrimazole troche 10 mg.......................................... 23clotrimazole w/ betamethasone cream

1-0.05%...................................................................... 69clotrimazole w/ betamethasone lotion

1-0.05%...................................................................... 69clozapine orally disintegrating tab 100

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

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

mg................................................................................38clozapine tab 100 mg..................................................38

clozapine tab 200 mg..................................................38clozapine tab 25 mg....................................................38clozapine tab 50 mg....................................................38COARTEM.....................................................................36codeine sulfate tab 15 mg............................................ 1codeine sulfate tab 30 mg............................................ 1codeine sulfate tab 60 mg............................................ 1colchicine w/ probenecid tab 0.5-500

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

gm................................................................................57colesevelam hcl tab 625 mg.......................................57colestipol hcl granule packets 5 gm.......................... 57colestipol hcl granules 5 gm.......................................57colestipol hcl tab 1 gm................................................ 57colistimethate sod for inj 150 mg................................. 9COMBIGAN...................................................................92COMBIVENT RESPIMAT........................................... 96COMETRIQ...................................................................27COMETRIQ...................................................................27COMETRIQ...................................................................27COMPLERA.................................................................. 43COPAXONE.................................................................. 67COPAXONE.................................................................. 67CORLANOR..................................................................58CORLANOR..................................................................58CORTISONE ACETATE..............................................78COSENTYX.................................................................. 85COSENTYX SENSOREADY PEN............................ 85COSMEGEN................................................................. 27COTELLIC.....................................................................27COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53COUMADIN...................................................................53CREON..........................................................................76CREON..........................................................................76CREON..........................................................................76CREON..........................................................................76CREON..........................................................................76CRESEMBA.................................................................. 23CRESEMBA.................................................................. 23CRIXIVAN......................................................................43CRIXIVAN......................................................................43cromolyn sodium ophth soln 4%................................92

2018

109

cromolyn sodium oral conc 100mg/5ml........................................................................ 73

cromolyn sodium soln nebu 20 mg/2ml.................... 96cyclobenzaprine hcl tab 10 mg.................................. 99cyclobenzaprine hcl tab 5 mg.................................... 99cyclobenzaprine hcl tab 7.5 mg................................. 99cyclophosphamide cap 25 mg................................... 27cyclophosphamide cap 50 mg................................... 27cyclophosphamide for inj 1 gm.................................. 27cyclophosphamide for inj 2 gm.................................. 27cyclophosphamide for inj 500 mg..............................27CYCLOSERINE............................................................25CYCLOSET...................................................................48cyclosporine cap 100 mg............................................85cyclosporine cap 25 mg..............................................85cyclosporine iv soln 50 mg/ml....................................85cyclosporine modified cap 100 mg............................ 85cyclosporine modified cap 25 mg.............................. 85cyclosporine modified cap 50 mg.............................. 85cyclosporine modified oral soln 100 mg/

ml.................................................................................85CYRAMZA.....................................................................27CYRAMZA.....................................................................27CYSTADANE................................................................ 76CYSTAGON.................................................................. 76CYSTAGON.................................................................. 76CYSTARAN...................................................................92CYTARABINE............................................................... 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.....................................................................43DAKLINZA.....................................................................43DAKLINZA.....................................................................43DALIRESP.....................................................................96DALIRESP.....................................................................96DALVANCE......................................................................9danazol cap 100 mg....................................................79danazol cap 200 mg....................................................79danazol cap 50 mg......................................................79dantrolene sodium cap 100 mg................................. 42dantrolene sodium cap 25 mg....................................42dantrolene sodium cap 50 mg....................................42dapsone tab 100 mg................................................... 25dapsone tab 25 mg......................................................25DAPTACEL....................................................................85daptomycin for iv soln 500 mg...................................10DARAPRIM................................................................... 36

DARZALEX................................................................... 27DARZALEX................................................................... 27daunorubicin hcl inj 5 mg/ml.......................................27DAUNORUBICIN HYDROCHLORIDE......................27DAUNORUBICIN HYDROCHLORIDE......................28decitabine for inj 50 mg.............................................. 28DELZICOL.....................................................................90demeclocycline hcl tab 150 mg..................................10demeclocycline hcl tab 300 mg..................................10DEMSER....................................................................... 58DENAVIR.......................................................................43DEPEN TITRATABS.................................................... 77DEPO-PROVERA........................................................ 80DESCOVY.....................................................................43desipramine hcl tab 100 mg.......................................19desipramine hcl tab 10 mg......................................... 19desipramine hcl tab 150 mg.......................................19desipramine hcl tab 25 mg......................................... 19desipramine hcl tab 50 mg......................................... 19desipramine hcl tab 75 mg......................................... 19desmopressin acetate inj 4 mcg/ml...........................79desmopressin acetate nasal spray soln

0.01%..........................................................................79desmopressin acetate nasal spray soln 0.01%

(refrigerated).............................................................. 79desmopressin acetate tab 0.1 mg............................. 79desmopressin acetate tab 0.2 mg............................. 79desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5)..................................................................... 80desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg................................................................................80

desogestrel & ethinyl estradiol tab 0.15 mg-30mcg..............................................................................80

desonide cream 0.05%............................................... 69desonide lotion 0.05%.................................................69desonide oint 0.05%....................................................69desoximetasone cream 0.05%...................................69desoximetasone cream 0.25%...................................69desoximetasone gel 0.05%........................................ 69desoximetasone oint 0.25%....................................... 69desvenlafaxine succinate tab er 24hr 100

mg................................................................................19desvenlafaxine succinate tab er 24hr 25

mg................................................................................19desvenlafaxine succinate tab er 24hr 50

mg................................................................................19DEXAMETHASONE.................................................... 78DEXAMETHASONE.................................................... 78dexamethasone elixir 0.5 mg/5ml..............................78DEXAMETHASONE SODIUM

PHOSPHATE.............................................................92

2018

110

dexamethasone sodium phosphate inj 120mg/30ml......................................................................78

dexamethasone sodium phosphate inj 20mg/5ml........................................................................ 78

dexamethasone sodium phosphate inj 4 mg/ml.................................................................................78

dexamethasone tab 0.5 mg........................................78dexamethasone tab 0.75 mg......................................78dexamethasone tab 1.5 mg........................................78dexamethasone tab 4 mg...........................................78dexamethasone tab 6 mg...........................................78dexmethylphenidate hcl tab 10 mg............................67dexmethylphenidate hcl tab 2.5 mg...........................67dexmethylphenidate hcl tab 5 mg..............................67dexrazoxane for inj 250 mg........................................28dexrazoxane for inj 500 mg........................................28dextroamphetamine sulfate cap er 24hr 10

mg................................................................................67dextroamphetamine sulfate cap er 24hr 15

mg................................................................................67dextroamphetamine sulfate cap er 24hr 5

mg................................................................................67dextroamphetamine sulfate tab 10 mg......................67dextroamphetamine sulfate tab 5 mg........................67dextrose 2.5% w/ sodium chloride

0.45%..........................................................................71dextrose 5% in lactated ringers................................. 71dextrose 5% w/ sodium chloride 0.2%...................... 71dextrose 5% w/ sodium chloride

0.33%..........................................................................71dextrose 5% w/ sodium chloride

0.45%..........................................................................71dextrose 5% w/ sodium chloride 0.9%...................... 71dextrose inj 10%.......................................................... 71dextrose inj 5%.............................................................71DIASTAT ACUDIAL......................................................14DIASTAT ACUDIAL......................................................14DIASTAT PEDIATRIC..................................................14DIAZEPAM.................................................................... 48diazepam conc 5 mg/ml..............................................48DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14DIAZEPAM RECTAL GEL.......................................... 14diazepam tab 10 mg....................................................48diazepam tab 2 mg......................................................48diazepam tab 5 mg......................................................48diclofenac potassium tab 50 mg.................................. 1diclofenac sodium gel 1%.............................................1diclofenac sodium gel 3%...........................................69diclofenac sodium ophth soln 0.1%...........................92diclofenac sodium tab delayed release 25

mg..................................................................................1

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

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

diclofenac 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................................ 10dicloxacillin sodium cap 500 mg................................ 10dicyclomine hcl cap 10 mg......................................... 73dicyclomine hcl tab 20 mg..........................................74didanosine delayed release capsule 200

mg................................................................................43didanosine delayed release capsule 250

mg................................................................................43didanosine delayed release capsule 400

mg................................................................................43DIFICID..........................................................................10DIFLORASONE DIACETATE.....................................69DIGOXIN........................................................................58digoxin tab 125 mcg (0.125 mg)................................58digoxin tab 250 mcg (0.25 mg).................................. 58DILANTIN...................................................................... 14diltiazem hcl cap er 12hr 120 mg.............................. 58diltiazem hcl cap er 12hr 60 mg.................................58diltiazem hcl cap er 12hr 90 mg.................................58diltiazem hcl cap er 24hr 120 mg.............................. 58diltiazem hcl cap er 24hr 180 mg.............................. 58diltiazem hcl cap er 24hr 240 mg.............................. 58diltiazem hcl coated beads cap er 24hr 120

mg................................................................................58diltiazem hcl coated beads cap er 24hr 180




mg................................................................................58diltiazem hcl coated beads tab er 24hr 180





mg................................................................................58

2018

111

diltiazem hcl extended release beads cap er 24hr120 mg....................................................................... 58






diltiazem hcl tab 120 mg.............................................58diltiazem hcl tab 30 mg...............................................58diltiazem hcl tab 60 mg...............................................58diltiazem hcl tab 90 mg...............................................58DIPENTUM....................................................................90diphenhydramine hcl inj 50 mg/ml.............................96DIPHTHERIA/TETANUS TOXOIDS

ADSORBED...............................................................85dipyridamole tab 25 mg.............................................. 53dipyridamole tab 50 mg.............................................. 53dipyridamole tab 75 mg.............................................. 53disulfiram 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.....................14DIVIGEL.........................................................................80DIVIGEL.........................................................................80DIVIGEL.........................................................................80DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28DOCETAXEL.................................................................28docetaxel for inj conc 20 mg/ml................................. 28docetaxel for inj conc 80 mg/4ml (20 mg/

ml)................................................................................28docetaxel soln for iv infusion 160

mg/16ml......................................................................28

docetaxel soln for iv infusion 20mg/2ml........................................................................ 28

docetaxel soln for iv infusion 80mg/8ml........................................................................ 28

dofetilide cap 125 mcg (0.125 mg)............................58dofetilide cap 250 mcg (0.25 mg).............................. 58dofetilide cap 500 mcg (0.5 mg)................................ 58donepezil 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%..................................92dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml.......................................................................... 92doxazosin mesylate tab 1 mg.................................... 58doxazosin mesylate tab 2 mg.................................... 58doxazosin mesylate tab 4 mg.................................... 58doxazosin mesylate tab 8 mg.................................... 59doxepin hcl cap 100 mg..............................................19doxepin hcl cap 10 mg................................................19doxepin hcl cap 150 mg..............................................19doxepin hcl cap 25 mg................................................19doxepin hcl cap 50 mg................................................19doxepin hcl cap 75 mg................................................19doxepin hcl conc 10 mg/ml.........................................19DOXORUBICIN HCL...................................................28DOXORUBICIN HCL...................................................28doxorubicin hcl inj 2 mg/ml.........................................28doxorubicin hcl liposomal inj (for iv infusion) 2 mg/

ml.................................................................................28doxycycline hyclate cap 100 mg................................10doxycycline hyclate cap 50 mg..................................10doxycycline hyclate for inj 100 mg.............................10doxycycline hyclate tab 100 mg.................................10doxycycline hyclate tab 20 mg...................................10doxycycline monohydrate cap 100 mg......................10doxycycline monohydrate cap 150 mg......................10doxycycline monohydrate cap 50 mg........................10doxycycline monohydrate cap 75 mg........................10doxycycline monohydrate tab 100 mg...................... 10doxycycline monohydrate tab 150 mg...................... 10doxycycline monohydrate tab 50 mg.........................10doxycycline monohydrate tab 75 mg.........................10dronabinol cap 10 mg................................................. 22dronabinol cap 2.5 mg................................................ 22dronabinol cap 5 mg....................................................22drospirenone-ethinyl estradiol tab 3-0.02

mg................................................................................80

2018

112

drospirenone-ethinyl estradiol tab 3-0.03mg................................................................................80

drospirenone-ethinyl estrad-levomefolate tab3-0.02-0.451 mg........................................................80

drospirenone-ethinyl estrad-levomefolate tab3-0.03-0.451 mg........................................................80

DULERA........................................................................ 96DULERA........................................................................ 96duloxetine hcl enteric coated pellets cap 20

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

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

mg................................................................................19DUPIXENT.................................................................... 85DUREZOL..................................................................... 92dutasteride cap 0.5 mg............................................... 77dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................77Eeconazole nitrate cream 1%.......................................23EDURANT..................................................................... 43efavirenz cap 200 mg..................................................43efavirenz cap 50 mg....................................................43efavirenz tab 600 mg...................................................43EFFIENT........................................................................53EFFIENT........................................................................53EGRIFTA....................................................................... 79EGRIFTA....................................................................... 79ELAPRASE................................................................... 76ELELYSO.......................................................................76ELIDEL...........................................................................69ELIGARD.......................................................................83ELIGARD.......................................................................83ELIGARD.......................................................................83ELIGARD.......................................................................83ELIQUIS.........................................................................53ELIQUIS.........................................................................53ELIQUIS STARTER PACK......................................... 53ELITEK...........................................................................28ELITEK...........................................................................28ELLA...............................................................................80EMCYT.......................................................................... 28EMEND..........................................................................22EMPLICITI.....................................................................28EMPLICITI.....................................................................28EMSAM..........................................................................19EMSAM..........................................................................19EMSAM..........................................................................19EMTRIVA.......................................................................43EMTRIVA.......................................................................43

enalapril maleate & hydrochlorothiazide tab 10-25mg................................................................................59

enalapril maleate & hydrochlorothiazide tab 5-12.5mg................................................................................59

enalapril maleate tab 10 mg.......................................59enalapril maleate tab 2.5 mg......................................59enalapril maleate tab 20 mg.......................................59enalapril maleate tab 5 mg.........................................59ENBREL........................................................................ 86ENBREL........................................................................ 86ENBREL........................................................................ 86ENBREL MINI...............................................................86ENBREL SURECLICK................................................ 86ENGERIX-B.................................................................. 86ENGERIX-B.................................................................. 86enoxaparin sodium inj 100 mg/ml..............................53enoxaparin sodium inj 120 mg/0.8ml........................ 53enoxaparin sodium inj 150 mg/ml..............................53enoxaparin sodium inj 300 mg/3ml............................53enoxaparin sodium inj 30 mg/0.3ml...........................53enoxaparin sodium inj 40 mg/0.4ml...........................53enoxaparin sodium inj 60 mg/0.6ml...........................53enoxaparin sodium inj 80 mg/0.8ml...........................53entacapone tab 200 mg..............................................37entecavir tab 0.5 mg....................................................43entecavir tab 1 mg.......................................................43ENTRESTO...................................................................59ENTRESTO...................................................................59ENTRESTO...................................................................59EPCLUSA......................................................................43epinastine hcl ophth soln 0.05%................................92EPINEPHRINE............................................................. 96EPINEPHRINE............................................................. 96EPIPEN 2-PAK............................................................. 96EPIPEN-JR 2-PAK....................................................... 96epirubicin 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.................................................59eplerenone tab 50 mg.................................................59EPOGEN....................................................................... 53EPOGEN....................................................................... 53EPOGEN....................................................................... 53EPOGEN....................................................................... 53EPOGEN....................................................................... 53ERBITUX....................................................................... 28ERBITUX....................................................................... 28ERGOLOID MESYLATES...........................................17ERIVEDGE....................................................................28ERLEADA......................................................................28

2018

113

ertapenem 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.............................. 92erythromycin pads 2%.................................................10erythromycin soln 2%..................................................10erythromycin tab 250 mg............................................ 10erythromycin tab 500 mg............................................ 10ESBRIET....................................................................... 96ESBRIET....................................................................... 96ESBRIET....................................................................... 96escitalopram 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................................................................................74esomeprazole magnesium cap delayed release 40

mg................................................................................74ESOMEPRAZOLE SODIUM...................................... 74esomeprazole sodium for intravenous soln 40

mg................................................................................74ESTRACE......................................................................80estradiol & norethindrone acetate tab 0.5-0.1

mg................................................................................80estradiol & norethindrone acetate tab 1-0.5

mg................................................................................80estradiol tab 0.5 mg.....................................................80estradiol tab 1 mg........................................................80estradiol tab 2 mg........................................................80estradiol td patch weekly 0.025

mg/24hr...................................................................... 80estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr)................................................................... 80estradiol td patch weekly 0.05 mg/24hr.................... 80estradiol td patch weekly 0.06 mg/24hr.................... 80estradiol td patch weekly 0.075

mg/24hr...................................................................... 80estradiol td patch weekly 0.1 mg/24hr...................... 80estradiol vaginal cream 0.1 mg/gm........................... 80estradiol vaginal tab 10 mcg...................................... 80ESTROPIPATE............................................................. 80ESTROPIPATE............................................................. 80ethambutol hcl tab 100 mg.........................................25ethambutol hcl tab 400 mg.........................................25

ethosuximide cap 250 mg...........................................14ethosuximide soln 250 mg/5ml.................................. 15ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg..............................................................................80ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg..............................................................................80ETHYOL........................................................................ 28ETIDRONATE DISODIUM..........................................91ETIDRONATE DISODIUM..........................................91etodolac 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).......................... 29etoposide inj 500 mg/25ml (20 mg/ml)......................29EVOMELA..................................................................... 29EVOTAZ.........................................................................43exemestane tab 25 mg............................................... 29EXJADE.........................................................................71EXJADE.........................................................................71EXJADE.........................................................................72ezetimibe-simvastatin tab 10-10 mg..........................59ezetimibe-simvastatin tab 10-20 mg..........................59ezetimibe-simvastatin tab 10-40 mg..........................59ezetimibe-simvastatin tab 10-80 mg..........................59ezetimibe tab 10 mg....................................................59FFABRAZYME................................................................ 76FABRAZYME................................................................ 76famciclovir tab 125 mg................................................43famciclovir tab 250 mg................................................43famciclovir tab 500 mg................................................43famotidine for susp 40 mg/5ml...................................74famotidine inj 200 mg/20ml........................................ 74famotidine inj 20 mg/2ml.............................................74famotidine inj 40 mg/4ml.............................................74famotidine tab 20 mg...................................................74famotidine tab 40 mg...................................................74FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT.........................................................................38FANAPT TITRATION PACK....................................... 38

2018

114

FARESTON...................................................................29FARYDAK......................................................................29FARYDAK......................................................................29FARYDAK......................................................................29FASLODEX................................................................... 29fat emulsion iv soln 20%.............................................72felbamate susp 600 mg/5ml....................................... 15felbamate tab 400 mg................................................. 15felbamate tab 600 mg................................................. 15felodipine tab er 24hr 10 mg...................................... 59felodipine tab er 24hr 2.5 mg..................................... 59felodipine tab er 24hr 5 mg........................................ 59fenofibrate micronized cap 134 mg........................... 59fenofibrate micronized cap 200 mg........................... 59fenofibrate micronized cap 67 mg............................. 59fenofibrate tab 145 mg................................................59fenofibrate tab 160 mg................................................59fenofibrate tab 48 mg.................................................. 59fenofibrate tab 54 mg.................................................. 59fentanyl citrate lozenge on a handle 1200

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





mcg................................................................................2fentanyl td patch 72hr 100 mcg/hr...............................2fentanyl td patch 72hr 12 mcg/hr................................. 2fentanyl td patch 72hr 25 mcg/hr................................. 2fentanyl td patch 72hr 37.5 mcg/hr..............................2fentanyl td patch 72hr 50 mcg/hr................................. 2fentanyl td patch 72hr 62.5 mcg/hr..............................2fentanyl td patch 72hr 75 mcg/hr................................. 2fentanyl td patch 72hr 87.5 mcg/hr..............................2FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA....................................................................... 19FETZIMA TITRATION PACK......................................19FINACEA....................................................................... 69FINACEA....................................................................... 69finasteride tab 5 mg.....................................................77FIRAZYR....................................................................... 86FIRMAGON...................................................................83FIRMAGON...................................................................83flecainide acetate tab 100 mg....................................59flecainide acetate tab 150 mg....................................59

flecainide acetate tab 50 mg...................................... 59FLOVENT DISKUS......................................................96FLOVENT DISKUS......................................................96FLOVENT DISKUS......................................................96FLOVENT HFA.............................................................96FLOVENT HFA.............................................................96FLOVENT HFA.............................................................96fluconazole 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..........................29fludarabine phosphate inj 25 mg/ml.......................... 29fludrocortisone acetate tab 0.1 mg............................ 78fluocinolone acetonide (otic) oil 0.01%..................... 94fluocinolone acetonide cream 0.01%........................ 69fluocinonide cream 0.05%.......................................... 69fluocinonide emulsified base cream

0.05%..........................................................................69fluocinonide gel 0.05%................................................69fluocinonide oint 0.05%...............................................69fluocinonide soln 0.05%..............................................69fluorometholone ophth susp 0.1%.............................92fluorouracil cream 5%................................................. 69fluorouracil iv soln 1 gm/20ml (50 mg/

ml)................................................................................29fluorouracil iv soln 2.5 gm/50ml (50 mg/

ml)................................................................................29fluorouracil iv soln 500 mg/10ml (50 mg/

ml)................................................................................29fluorouracil iv soln 5 gm/100ml (50 mg/

ml)................................................................................29fluorouracil soln 2%..................................................... 69fluorouracil soln 5%..................................................... 69FLUOXETINE 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..............................................19

2018

115

fluoxetine hcl tab 20 mg..............................................20fluphenazine decanoate inj 25 mg/ml........................39FLUPHENAZINE HCL.................................................39FLUPHENAZINE HCL.................................................39FLUPHENAZINE HCL.................................................39fluphenazine hcl tab 10 mg........................................ 39fluphenazine hcl tab 1 mg.......................................... 39fluphenazine hcl tab 2.5 mg....................................... 39fluphenazine hcl tab 5 mg.......................................... 39flurbiprofen sodium ophth soln 0.03%.......................92flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................29FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 96FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 96FLUTICASONE PROPIONATE/

SALMETEROL.......................................................... 97fluticasone propionate cream 0.05%.........................69fluticasone propionate nasal susp 50 mcg/

act................................................................................96fluticasone propionate oint 0.005%........................... 69fluvoxamine maleate tab 100 mg...............................20fluvoxamine maleate tab 25 mg.................................20fluvoxamine maleate tab 50 mg.................................20FOLOTYN......................................................................29FOLOTYN......................................................................29fomepizole inj 1 gm/ml (for iv infusion)......................72fondaparinux sodium subcutaneous inj 10

mg/0.8ml.....................................................................54fondaparinux sodium subcutaneous inj 2.5

mg/0.5ml.....................................................................54fondaparinux sodium subcutaneous inj 5

mg/0.4ml.....................................................................54fondaparinux sodium subcutaneous inj 7.5

mg/0.6ml.....................................................................54FORTEO........................................................................91fosamprenavir calcium tab 700 mg........................... 43fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................59fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................59fosinopril sodium tab 10 mg....................................... 59fosinopril sodium tab 20 mg....................................... 59fosinopril sodium tab 40 mg....................................... 59fosphenytoin sodium inj 100 mg/2ml.........................15fosphenytoin sodium inj 500 mg/10ml.......................15FOSRENOL.................................................................. 72FOSRENOL.................................................................. 72FOSRENOL.................................................................. 72FOSRENOL.................................................................. 72

FOSRENOL.................................................................. 72furosemide inj 10 mg/ml..............................................59furosemide oral soln 10 mg/ml...................................59furosemide tab 20 mg................................................. 59furosemide tab 40 mg................................................. 60furosemide tab 80 mg................................................. 60FUZEON........................................................................44FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15Ggabapentin cap 100 mg.............................................. 15gabapentin cap 300 mg.............................................. 15gabapentin cap 400 mg.............................................. 15gabapentin oral soln 250 mg/5ml.............................. 15gabapentin tab 600 mg............................................... 15gabapentin tab 800 mg............................................... 15GABITRIL...................................................................... 15GABITRIL...................................................................... 15GALANTAMINE HYDROBROMIDE.......................... 17galantamine hydrobromide cap er 24hr 16

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

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

mg................................................................................17galantamine hydrobromide tab 12 mg...................... 18galantamine hydrobromide tab 4 mg.........................17galantamine hydrobromide tab 8 mg.........................18GAMMAGARD LIQUID............................................... 86GAMMAGARD LIQUID............................................... 86GAMMAGARD LIQUID............................................... 86GAMMAGARD LIQUID............................................... 86GAMMAGARD LIQUID............................................... 86GAMMAGARD LIQUID............................................... 86GAMMAGARD S/D......................................................86GAMMAGARD S/D......................................................86GAMMAPLEX............................................................... 86GAMMAPLEX............................................................... 86GAMMAPLEX............................................................... 86GAMMAPLEX............................................................... 86GAMMAPLEX............................................................... 86GAMMAPLEX............................................................... 86GAMUNEX-C................................................................ 86GAMUNEX-C................................................................ 86GAMUNEX-C................................................................ 86GAMUNEX-C................................................................ 86

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GAMUNEX-C................................................................ 87GAMUNEX-C................................................................ 87ganciclovir sodium for inj 500 mg.............................. 44GARDASIL 9.................................................................87GARDASIL 9.................................................................87GATTEX.........................................................................74GAUZE PADS 2" X 2".................................................48GAZYVA.........................................................................29gemcitabine hcl for inj 1 gm....................................... 29gemcitabine hcl for inj 200 mg...................................29gemcitabine 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............................................... 60gentamicin 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%..................................69gentamicin sulfate inj 10 mg/ml................................. 10gentamicin sulfate inj 40 mg/ml................................. 10gentamicin sulfate oint 0.1%...................................... 69gentamicin sulfate ophth oint 0.3%........................... 92gentamicin sulfate ophth soln 0.3%...........................93GENVOYA.....................................................................44GEODON.......................................................................39GILOTRIF......................................................................29GILOTRIF......................................................................29GILOTRIF......................................................................29glatiramer acetate soln prefilled syringe 20 mg/

ml.................................................................................67glatiramer acetate soln prefilled syringe 40 mg/

ml.................................................................................67GLEOSTINE..................................................................29GLEOSTINE..................................................................29GLEOSTINE..................................................................29glimepiride tab 1 mg....................................................48glimepiride tab 2 mg....................................................49glimepiride tab 4 mg....................................................49glipizide-metformin hcl tab 2.5-250 mg.....................49glipizide-metformin hcl tab 2.5-500 mg.....................49glipizide-metformin hcl tab 5-500 mg........................ 49glipizide tab 10 mg...................................................... 49glipizide tab 5 mg.........................................................49glipizide tab er 24hr 10 mg.........................................49glipizide tab er 24hr 2.5 mg........................................49glipizide tab er 24hr 5 mg...........................................49GLUCAGEN HYPOKIT............................................... 49

GLUCAGON EMERGENCY KIT............................... 49glycopyrrolate tab 1 mg.............................................. 74glycopyrrolate tab 2 mg.............................................. 74granisetron hcl inj 1 mg/ml......................................... 22granisetron hcl inj 4 mg/4ml (1 mg/ml)......................22granisetron hcl tab 1 mg.............................................22GRANIX......................................................................... 54GRANIX......................................................................... 54griseofulvin microsize susp 125

mg/5ml........................................................................ 23griseofulvin ultramicrosize tab 125 mg......................23griseofulvin ultramicrosize tab 250 mg......................23GUANIDINE HCL.........................................................25HH.P. ACTHAR............................................................... 78HAEGARDA.................................................................. 87HAEGARDA.................................................................. 87HALAVEN...................................................................... 29halobetasol propionate cream 0.05%........................69halobetasol propionate oint 0.05%............................ 69haloperidol decanoate im soln 100 mg/

ml.................................................................................39haloperidol decanoate im soln 50 mg/

ml.................................................................................39haloperidol lactate inj 5 mg/ml................................... 39haloperidol lactate oral conc 2 mg/ml........................39haloperidol tab 0.5 mg................................................ 39haloperidol tab 10 mg................................................. 39haloperidol tab 1 mg....................................................39haloperidol tab 20 mg................................................. 39haloperidol tab 2 mg....................................................39haloperidol tab 5 mg....................................................39HARVONI...................................................................... 44HAVRIX..........................................................................87HAVRIX..........................................................................87heparin sodium (porcine) 40 unit/ml in

d5w..............................................................................54heparin sodium (porcine) inj 10000 unit/

ml.................................................................................54heparin sodium (porcine) inj 1000 unit/



ml.................................................................................54heparin sodium (porcine) pf inj 5000

unit/0.5ml....................................................................54HEPATAMINE............................................................... 72HERCEPTIN................................................................. 29HERCEPTIN................................................................. 29HETLIOZ........................................................................99

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HEXALEN......................................................................29HIBERIX........................................................................ 87HUMALOG.................................................................... 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.........................................................................87HUMIRA.........................................................................87HUMIRA.........................................................................87HUMIRA.........................................................................87HUMIRA.........................................................................87HUMIRA.........................................................................87HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................87HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................87HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................87HUMIRA PEN............................................................... 87HUMIRA PEN............................................................... 87HUMIRA PEN-CD/UC/HS STARTER........................87HUMIRA PEN-CD/UC/HS STARTER........................87HUMIRA PEN-PS/UV STARTER...............................87HUMIRA PEN-PS/UV STARTER...............................87HUMULIN 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........................................ 60hydralazine hcl tab 10 mg.......................................... 60hydralazine hcl tab 25 mg.......................................... 60hydralazine hcl tab 50 mg.......................................... 60hydrochlorothiazide cap 12.5 mg...............................60hydrochlorothiazide tab 12.5 mg................................60hydrochlorothiazide tab 25 mg...................................60hydrochlorothiazide tab 50 mg...................................60hydrocodone-acetaminophen soln 7.5-325

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

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

mg..................................................................................2hydrocodone-acetaminophen tab 5-300

mg..................................................................................2

hydrocodone-acetaminophen tab 5-325mg..................................................................................2

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

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

hydrocodone-ibuprofen tab 10-200 mg.......................2hydrocodone-ibuprofen tab 5-200 mg......................... 2hydrocodone-ibuprofen tab 7.5-200 mg......................2hydrocortisone butyrate cream 0.1%........................ 70hydrocortisone butyrate hydrophilic lipo base cream

0.1%............................................................................70hydrocortisone butyrate oint 0.1%.............................70hydrocortisone butyrate soln 0.1%............................ 70hydrocortisone cream 1%...........................................70hydrocortisone cream 2.5%........................................70hydrocortisone enema 100 mg/60ml.........................90hydrocortisone lotion 2.5%......................................... 70hydrocortisone oint 1%............................................... 70hydrocortisone oint 2.5%............................................ 70hydrocortisone rectal cream 1%................................ 90hydrocortisone rectal cream 2.5%.............................90hydrocortisone tab 10 mg...........................................78hydrocortisone tab 20 mg...........................................78hydrocortisone tab 5 mg............................................. 78hydrocortisone valerate cream 0.2%.........................70hydrocortisone valerate oint 0.2%............................. 70hydrocortisone w/ acetic acid otic soln

1-2%............................................................................94hydromorphone 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.................... 36HYDROXYPROGESTERONE

CAPROATE................................................................80hydroxyurea cap 500 mg............................................ 29hydroxyzine hcl syrup 10 mg/5ml.............................. 48hydroxyzine hcl tab 10 mg..........................................48hydroxyzine hcl tab 25 mg..........................................48hydroxyzine hcl tab 50 mg..........................................48Iibandronate sodium iv soln 3 mg/3ml........................91ibandronate sodium tab 150 mg................................ 91IBRANCE.......................................................................29IBRANCE.......................................................................30IBRANCE.......................................................................30ibuprofen susp 100 mg/5ml.......................................... 2ibuprofen tab 400 mg.................................................... 2

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ibuprofen tab 600 mg.................................................... 2ibuprofen tab 800 mg.................................................... 2ICLUSIG........................................................................ 30ICLUSIG........................................................................ 30idarubicin hcl iv inj 10 mg/10ml (1 mg/

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

ml)................................................................................30idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................30IDHIFA............................................................................30IDHIFA............................................................................30IFEX............................................................................... 30IFOSFAMIDE................................................................ 30ifosfamide for inj 1 gm.................................................30ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 30ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 30ILARIS............................................................................87ILEVRO..........................................................................93imatinib mesylate tab 100 mg.................................... 30imatinib mesylate tab 400 mg.................................... 30IMBRUVICA.................................................................. 30IMBRUVICA.................................................................. 30IMBRUVICA.................................................................. 30IMBRUVICA.................................................................. 30IMBRUVICA.................................................................. 30IMBRUVICA.................................................................. 30IMFINZI..........................................................................30IMFINZI..........................................................................30imipenem-cilastatin intravenous for soln 250

mg................................................................................11imipenem-cilastatin intravenous for soln 500

mg................................................................................11imipramine hcl tab 10 mg........................................... 20imipramine hcl tab 25 mg........................................... 20imipramine hcl tab 50 mg........................................... 20imiquimod cream 5%...................................................70IMLYGIC........................................................................ 30IMLYGIC........................................................................ 30IMOVAX RABIES (H.D.C.V.)...................................... 87IMPAVIDO..................................................................... 11INCRELEX.................................................................... 79INCRUSE ELLIPTA..................................................... 97indapamide tab 1.25 mg............................................. 60indapamide tab 2.5 mg............................................... 60INFANRIX......................................................................87INLYTA...........................................................................30INLYTA...........................................................................30INSULIN INJECTION DEVICE...................................49INSULIN SYRINGE/NEEDLE.....................................49INTELENCE.................................................................. 44INTELENCE.................................................................. 44INTELENCE.................................................................. 44

INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A.....................................................................44INTRON A W/DILUENT..............................................44INTRON A W/DILUENT..............................................44INTRON A W/DILUENT..............................................44INVANZ.......................................................................... 11INVANZ.......................................................................... 11INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA SUSTENNA.................................................. 39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVEGA TRINZA..........................................................39INVIRASE......................................................................44INVIRASE......................................................................44INVOKAMET.................................................................49INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET.................................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKAMET XR..........................................................50INVOKANA....................................................................50INVOKANA....................................................................50IPOL INACTIVATED IPV.............................................88ipratropium bromide inhal soln 0.02%.......................97ipratropium bromide nasal soln 0.03% (21 mcg/

spray)..........................................................................97ipratropium bromide nasal soln 0.06% (42 mcg/

spray)..........................................................................97irbesartan-hydrochlorothiazide tab 150-12.5

mg................................................................................60irbesartan-hydrochlorothiazide tab 300-12.5

mg................................................................................60irbesartan tab 150 mg.................................................60irbesartan tab 300 mg.................................................60irbesartan tab 75 mg................................................... 60IRESSA..........................................................................30IRINOTECAN................................................................30irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................30irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 30ISENTRESS..................................................................44ISENTRESS..................................................................44ISENTRESS..................................................................44

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ISENTRESS..................................................................44ISENTRESS HD...........................................................44ISONIAZID.................................................................... 25isoniazid tab 100 mg................................................... 25isoniazid tab 300 mg................................................... 25isosorbide dinitrate tab 10 mg....................................60isosorbide dinitrate tab 20 mg....................................60isosorbide dinitrate tab 30 mg....................................60isosorbide dinitrate tab 5 mg......................................60isosorbide mononitrate tab 10 mg............................. 60isosorbide mononitrate tab 20 mg............................. 60isosorbide mononitrate tab er 24hr 120

mg................................................................................60isosorbide mononitrate tab er 24hr 30

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

mg................................................................................60isotretinoin cap 10 mg.................................................70isotretinoin cap 20 mg.................................................70isotretinoin cap 30 mg.................................................70isotretinoin cap 40 mg.................................................70isradipine cap 2.5 mg..................................................60isradipine cap 5 mg..................................................... 60ISTALOL........................................................................ 93ISTODAX.......................................................................30ISTODAX (OVERFILL)................................................30itraconazole cap 100 mg............................................ 23ivermectin tab 3 mg.....................................................36IXEMPRA KIT...............................................................30IXEMPRA KIT...............................................................30IXIARO...........................................................................88JJADENU........................................................................ 72JADENU........................................................................ 72JADENU........................................................................ 72JADENU SPRINKLE................................................... 72JADENU SPRINKLE................................................... 72JADENU SPRINKLE................................................... 72JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JAKAFI...........................................................................31JANUMET......................................................................50JANUMET......................................................................50JANUMET XR...............................................................50JANUMET XR...............................................................50JANUMET XR...............................................................50JANUVIA........................................................................50JANUVIA........................................................................50JANUVIA........................................................................50

JARDIANCE..................................................................50JARDIANCE..................................................................50JENTADUETO.............................................................. 50JENTADUETO.............................................................. 50JENTADUETO.............................................................. 50JENTADUETO XR....................................................... 50JENTADUETO XR....................................................... 50JEVTANA.......................................................................31JULUCA.........................................................................44JUXTAPID..................................................................... 60JUXTAPID..................................................................... 60JUXTAPID..................................................................... 60JUXTAPID..................................................................... 60JUXTAPID..................................................................... 60JUXTAPID..................................................................... 60KKADCYLA......................................................................31KADCYLA......................................................................31KALETRA...................................................................... 44KALETRA...................................................................... 44KALYDECO...................................................................97KALYDECO...................................................................97KALYDECO...................................................................97kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

inj................................................................................. 72kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2%



inj................................................................................. 72kcl 20 meq/l (0.15%) in nacl 0.45% inj......................72kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45%


inj................................................................................. 72KEPIVANCE..................................................................68ketoconazole cream 2%..............................................23ketoconazole shampoo 2%........................................ 23ketoconazole tab 200 mg........................................... 24ketoprofen cap 75 mg................................................... 3ketorolac tromethamine ophth soln

0.4%............................................................................93ketorolac tromethamine ophth soln

0.5%............................................................................93KEYTRUDA...................................................................31KINERET....................................................................... 88KINRIX........................................................................... 88KISQALI.........................................................................31KISQALI FEMARA 200 DOSE...................................31KISQALI FEMARA 400 DOSE...................................31KISQALI FEMARA 600 DOSE...................................31

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KOMBIGLYZE XR........................................................50KOMBIGLYZE XR........................................................50KOMBIGLYZE XR........................................................50KORLYM........................................................................83KUVAN...........................................................................76KUVAN...........................................................................76KUVAN...........................................................................76KYNAMRO.................................................................... 60KYPROLIS.................................................................... 31KYPROLIS.................................................................... 31Llabetalol hcl tab 100 mg..............................................60labetalol hcl tab 200 mg..............................................61labetalol hcl tab 300 mg..............................................61LACRISERT.................................................................. 93lactated ringer's solution............................................. 72lactic acid (ammonium lactate) cream

12%............................................................................. 70lactic acid (ammonium lactate) lotion

12%............................................................................. 70lactulose (encephalopathy) solution 10

gm/15ml......................................................................74lactulose solution 10 gm/15ml....................................74lamivudine 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................................................................................74lansoprazole cap delayed release 30

mg................................................................................74lanthanum carbonate chew tab 1000



mg................................................................................72LANTUS.........................................................................50LANTUS SOLOSTAR..................................................50LARTRUVO...................................................................31LARTRUVO...................................................................31latanoprost ophth soln 0.005%.................................. 93

LATUDA.........................................................................39LATUDA.........................................................................39LATUDA.........................................................................39LATUDA.........................................................................40LATUDA.........................................................................40LAZANDA........................................................................ 3LAZANDA........................................................................ 3LAZANDA........................................................................ 3leflunomide tab 10 mg.................................................88leflunomide tab 20 mg.................................................88LENVIMA 10 MG DAILY DOSE.................................31LENVIMA 14 MG DAILY DOSE.................................31LENVIMA 18 MG DAILY DOSE.................................31LENVIMA 20 MG DAILY DOSE.................................31LENVIMA 24 MG DAILY DOSE.................................31LENVIMA 8 MG DAILY DOSE...................................31LETAIRIS.......................................................................97LETAIRIS.......................................................................97letrozole 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.............................. 32leucovorin calcium for inj 50 mg................................ 31leucovorin calcium tab 25 mg.................................... 32leucovorin calcium tab 5 mg.......................................32LEUKERAN...................................................................32LEUKINE....................................................................... 54leuprolide acetate inj kit 5 mg/ml............................... 83LEVEMIR.......................................................................50LEVEMIR 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....................................................................15levetiracetam in sodium chloride iv soln 500

mg/100ml....................................................................15levetiracetam 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%................................ 93levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 72levocarnitine tab 330 mg............................................ 72levocetirizine dihydrochloride tab 5 mg.....................97LEVOFLOXACIN..........................................................11

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121

levofloxacin in d5w iv soln 250mg/50ml......................................................................11

levofloxacin in d5w iv soln 500mg/100ml....................................................................11

levofloxacin in d5w iv soln 750mg/150ml....................................................................11

levofloxacin iv soln 25 mg/ml..................................... 11levofloxacin tab 250 mg..............................................11levofloxacin tab 500 mg..............................................11levofloxacin tab 750 mg..............................................11levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg............................................................. 80levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg..............................................................................80levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg..............................................................................80levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg........................81levonorgestrel-ethinyl estradiol (continuous) tab

90-20 mcg..................................................................81levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7)...................................................................80levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7)...................................................................80LEVORPHANOL TARTRATE....................................... 3levothyroxine sodium tab 100 mcg............................82levothyroxine sodium tab 112 mcg............................ 82levothyroxine sodium tab 125 mcg............................82levothyroxine sodium tab 137 mcg............................82levothyroxine sodium tab 150 mcg............................82levothyroxine sodium tab 175 mcg............................82levothyroxine sodium tab 200 mcg............................82levothyroxine sodium tab 25 mcg..............................82levothyroxine sodium tab 300 mcg............................82levothyroxine sodium tab 50 mcg..............................82levothyroxine sodium tab 75 mcg..............................82levothyroxine sodium tab 88 mcg..............................82LEXIVA...........................................................................44LEXIVA...........................................................................44LIALDA...........................................................................90LIDOCAINE HCL..........................................................61lidocaine hcl gel 2%.......................................................5lidocaine hcl local inj 1%...............................................5lidocaine hcl local preservative free inj

1%..................................................................................5lidocaine hcl soln 4%.....................................................5lidocaine hcl viscous soln 2%.......................................5lidocaine oint 5%............................................................5lidocaine patch 5%.........................................................5lidocaine-prilocaine cream 2.5-2.5%........................... 5LINDANE....................................................................... 36LINEZOLID....................................................................11

linezolid for susp 100 mg/5ml.................................... 11linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................11linezolid tab 600 mg.................................................... 11LINZESS........................................................................74LINZESS........................................................................74LINZESS........................................................................74liothyronine sodium tab 25 mcg.................................82liothyronine sodium tab 50 mcg.................................82liothyronine sodium tab 5 mcg................................... 82lisinopril & hydrochlorothiazide tab 10-12.5

mg................................................................................61lisinopril & hydrochlorothiazide tab 20-12.5

mg................................................................................61lisinopril & hydrochlorothiazide tab 20-25

mg................................................................................61lisinopril tab 10 mg...................................................... 61lisinopril tab 2.5 mg..................................................... 61lisinopril tab 20 mg...................................................... 61lisinopril tab 30 mg...................................................... 61lisinopril tab 40 mg...................................................... 61lisinopril tab 5 mg.........................................................61LITHIUM........................................................................ 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..................................................................... 32LONSURF..................................................................... 32loperamide hcl cap 2 mg............................................ 74lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................44lorazepam tab 0.5 mg................................................. 48lorazepam tab 1 mg.................................................... 48lorazepam tab 2 mg.................................................... 48losartan potassium & hydrochlorothiazide tab

100-12.5 mg.............................................................. 61losartan potassium & hydrochlorothiazide tab 100-25

mg................................................................................61losartan potassium & hydrochlorothiazide tab

50-12.5 mg.................................................................61losartan potassium tab 100 mg..................................61losartan potassium tab 25 mg....................................61losartan potassium tab 50 mg....................................61LOTEMAX..................................................................... 93LOTEMAX..................................................................... 93LOTEMAX..................................................................... 93lovastatin tab 10 mg....................................................61lovastatin tab 20 mg....................................................61lovastatin tab 40 mg....................................................61

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loxapine succinate cap 10 mg....................................40loxapine succinate cap 25 mg....................................40loxapine succinate cap 50 mg....................................40loxapine succinate cap 5 mg......................................40LUMIGAN...................................................................... 93LUMIZYME....................................................................76LUPRON DEPOT (1-MONTH)...................................83LUPRON DEPOT (1-MONTH)...................................83LUPRON DEPOT (3-MONTH)...................................83LUPRON DEPOT (3-MONTH)...................................83LUPRON DEPOT (4-MONTH)...................................83LUPRON DEPOT (6-MONTH)...................................83LUPRON DEPOT-PED (1-MONTH)..........................83LUPRON DEPOT-PED (1-MONTH)..........................84LUPRON DEPOT-PED (1-MONTH)..........................84LUPRON DEPOT-PED (3-MONTH)..........................84LUPRON DEPOT-PED (3-MONTH)..........................84LYNPARZA....................................................................32LYNPARZA....................................................................32LYNPARZA....................................................................32LYRICA.......................................................................... 15LYRICA.......................................................................... 15LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYSODREN...................................................................83Mmagnesium sulfate inj 50%........................................ 72malathion lotion 0.5%..................................................36MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MARPLAN..................................................................... 20MARQIBO......................................................................32MATULANE...................................................................32MAVYRET..................................................................... 44meclizine hcl tab 12.5 mg...........................................22meclizine hcl tab 25 mg..............................................22medroxyprogesterone acetate im susp 150 mg/

ml.................................................................................81medroxyprogesterone acetate im susp prefilled syr

150 mg/ml.................................................................. 81medroxyprogesterone acetate tab 10

mg................................................................................81medroxyprogesterone acetate tab 2.5

mg................................................................................81medroxyprogesterone acetate tab 5

mg................................................................................81

mefloquine hcl tab 250 mg......................................... 36megestrol acetate susp 40 mg/ml..............................81megestrol acetate tab 20 mg..................................... 81megestrol acetate tab 40 mg..................................... 81MEKINIST......................................................................32MEKINIST......................................................................32meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3melphalan hcl for inj 50 mg........................................ 32memantine hcl oral solution 2 mg/ml.........................18memantine hcl tab 10 mg...........................................18memantine hcl tab 5 mg............................................. 18memantine hcl tab 5 mg (28) & 10 mg (21) titration

pak...............................................................................18MENACTRA.................................................................. 88MENEST........................................................................81MENEST........................................................................81MENEST........................................................................81MENVEO....................................................................... 88mercaptopurine tab 50 mg......................................... 32meropenem iv for soln 1 gm...................................... 11meropenem iv for soln 500 mg.................................. 11mesalamine enema 4 gm........................................... 90mesalamine rectal enema 4 gm & cleanser wipe

kit................................................................................. 90mesalamine tab delayed release 1.2

gm................................................................................91mesna inj 100 mg/ml...................................................32MESNEX........................................................................32MESTINON................................................................... 25metformin 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.......................................... 61methazolamide tab 50 mg.......................................... 61methenamine hippurate tab 1 gm..............................11methimazole tab 10 mg.............................................. 84methimazole tab 5 mg.................................................84methocarbamol tab 500 mg........................................99methocarbamol tab 750 mg........................................99METHOTREXATE SODIUM.......................................88methotrexate sodium for inj 1 gm.............................. 88methotrexate sodium inj 50 mg/2ml (25 mg/

ml)................................................................................88methotrexate sodium inj pf 1000 mg/40ml (25 mg/

ml)................................................................................88methotrexate sodium inj pf 250 mg/10ml (25 mg/

ml)................................................................................88

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methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)................................................................................88

methotrexate sodium tab 2.5 mg............................... 88methoxsalen rapid cap 10 mg....................................70methscopolamine bromide tab 2.5 mg......................74methscopolamine bromide tab 5 mg......................... 74methylergonovine maleate tab 0.2 mg......................77methylphenidate hcl tab 10 mg..................................67methylphenidate hcl tab 20 mg..................................67methylphenidate hcl tab 5 mg....................................67methylphenidate hcl tab er 20 mg............................. 67methylprednisolone sod succ for inj 1000

mg................................................................................78methylprednisolone sod succ for inj 125

mg................................................................................78methylprednisolone sod succ for inj 40

mg................................................................................78methylprednisolone tab 16 mg...................................78methylprednisolone tab 32 mg...................................78methylprednisolone tab 4 mg.....................................78methylprednisolone tab 8 mg.....................................78methylprednisolone tab therapy pack 4 mg

(21)..............................................................................78methyltestosterone cap 10 mg...................................81metoclopramide hcl inj 5 mg/ml................................. 74metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................74metoclopramide hcl tab 10 mg...................................74metoclopramide hcl tab 5 mg.....................................74metolazone tab 10 mg................................................ 61metolazone tab 2.5 mg............................................... 61metolazone tab 5 mg...................................................61metoprolol & hydrochlorothiazide tab 100-25

mg................................................................................61metoprolol & hydrochlorothiazide tab 50-25

mg................................................................................61metoprolol succinate tab er 24hr 100




mg................................................................................61metoprolol tartrate tab 100 mg...................................61metoprolol tartrate tab 25 mg.....................................61metoprolol tartrate tab 50 mg.....................................61METRO IV.....................................................................11metronidazole cap 375 mg.........................................11metronidazole cream 0.75%.......................................70metronidazole gel 0.75%............................................ 70metronidazole gel 1%..................................................70

metronidazole in nacl 0.79% iv soln 500mg/100ml....................................................................11

metronidazole iv soln 5 mg/ml................................... 11metronidazole lotion 0.75%........................................ 70metronidazole tab 250 mg..........................................11metronidazole tab 500 mg..........................................11metronidazole vaginal gel 0.75%...............................11mexiletine hcl cap 150 mg..........................................61mexiletine hcl cap 200 mg..........................................61mexiletine hcl cap 250 mg..........................................61MIACALCIN...................................................................91midodrine hcl tab 10 mg............................................. 62midodrine hcl tab 2.5 mg............................................ 62midodrine hcl tab 5 mg............................................... 62MIGERGOT...................................................................24miglustat cap 100 mg..................................................76MIGRANAL....................................................................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..................................................... 62minoxidil tab 2.5 mg.................................................... 62mirtazapine orally disintegrating tab 15

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

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

mg................................................................................20mirtazapine tab 15 mg................................................ 20mirtazapine tab 30 mg................................................ 20mirtazapine tab 45 mg................................................ 20mirtazapine tab 7.5 mg............................................... 20misoprostol tab 100 mcg............................................ 74misoprostol tab 200 mcg............................................ 74mitomycin 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)................................................................................32M-M-R II........................................................................ 88modafinil tab 100 mg...................................................99modafinil tab 200 mg...................................................99moexipril hcl tab 15 mg...............................................62moexipril hcl tab 7.5 mg..............................................62

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moexipril-hydrochlorothiazide tab 15-12.5mg................................................................................62

moexipril-hydrochlorothiazide tab 15-25mg................................................................................62

moexipril-hydrochlorothiazide tab 7.5-12.5mg................................................................................62

mometasone furoate cream 0.1%............................. 70mometasone furoate nasal susp 50 mcg/

act................................................................................97mometasone furoate oint 0.1%..................................70mometasone furoate solution 0.1%

(lotion).........................................................................70montelukast sodium chew tab 4 mg..........................97montelukast sodium chew tab 5 mg..........................97montelukast sodium oral granules packet 4

mg................................................................................97montelukast sodium tab 10 mg..................................97MORPHINE 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................................................................... 74MOXEZA........................................................................93MOXIFLOXACIN HCL................................................. 11moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................11moxifloxacin hcl ophth soln 0.5%.............................. 93moxifloxacin hcl tab 400 mg.......................................11MOZOBIL...................................................................... 54MULTAQ........................................................................ 62mupirocin oint 2%........................................................ 70MUSTARGEN............................................................... 32MYALEPT...................................................................... 74MYCAMINE...................................................................24MYCAMINE...................................................................24mycophenolate mofetil cap 250 mg...........................88mycophenolate mofetil for oral susp 200 mg/

ml.................................................................................88mycophenolate mofetil hcl for iv soln 500

mg................................................................................88mycophenolate mofetil tab 500 mg........................... 88mycophenolate sodium tab dr 180 mg......................88mycophenolate sodium tab dr 360 mg......................88

MYLOTARG.................................................................. 32Nnabumetone tab 500 mg...............................................3nabumetone tab 750 mg...............................................3nadolol tab 20 mg........................................................62nadolol tab 40 mg........................................................62nadolol tab 80 mg........................................................62NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................12nafcillin sodium for inj 1 gm........................................12nafcillin sodium for inj 2 gm........................................12nafcillin sodium for iv soln 10 gm.............................. 12NAGLAZYME................................................................76NALOXONE 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......................................................................93nateglinide tab 120 mg............................................... 51nateglinide tab 60 mg..................................................51NATPARA...................................................................... 91NATPARA...................................................................... 91NATPARA...................................................................... 91NATPARA...................................................................... 91NEBUPENT...................................................................36NEFAZODONE HCL....................................................20NEFAZODONE HCL....................................................20NEFAZODONE HCL....................................................20nefazodone hcl tab 250 mg........................................20nefazodone hcl tab 50 mg..........................................20neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin..........................93neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml............................. 93neomycin-polymyxin b gu irrigation

soln..............................................................................12neomycin-polymyxin-dexamethasone ophth oint

0.1%............................................................................93

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neomycin-polymyxin-dexamethasone ophth susp0.1%............................................................................93

neomycin-polymyxin-hc otic soln 1%........................ 94neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%.................................................................. 94neomycin sulfate tab 500 mg.....................................12NERLYNX......................................................................32NEULASTA....................................................................54NEULASTA ONPRO KIT............................................ 54NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37NEUPRO....................................................................... 37nevirapine tab 200 mg................................................ 44nevirapine tab er 24hr 100 mg...................................44nevirapine tab er 24hr 400 mg...................................44NEXAVAR......................................................................32NEXIUM.........................................................................74NEXIUM.........................................................................74NEXIUM.........................................................................75NEXIUM.........................................................................75NEXIUM.........................................................................75niacin tab er 1000 mg................................................. 62niacin tab er 500 mg................................................... 62niacin tab er 750 mg................................................... 62nicardipine hcl cap 20 mg...........................................62nicardipine hcl cap 30 mg...........................................62NICOTROL INHALER................................................... 5NICOTROL NS............................................................... 5nifedipine tab er 24hr 30 mg...................................... 62nifedipine tab er 24hr 60 mg...................................... 62nifedipine tab er 24hr 90 mg...................................... 62nifedipine tab er 24hr osmotic release 30

mg................................................................................62nifedipine tab er 24hr osmotic release 60

mg................................................................................62nifedipine tab er 24hr osmotic release 90

mg................................................................................62nilutamide tab 150 mg.................................................32nimodipine cap 30 mg.................................................62NINLARO.......................................................................32NINLARO.......................................................................32NINLARO.......................................................................32NIPENT..........................................................................32NISOLDIPINE ER........................................................ 62nisoldipine tab er 24hr 17 mg.................................... 62nisoldipine tab er 24hr 34 mg.................................... 62nisoldipine tab er 24hr 8.5 mg................................... 62NITRO-BID....................................................................62

nitrofurantoin macrocrystalline cap 100mg................................................................................12

nitrofurantoin macrocrystalline cap 50mg................................................................................12

nitrofurantoin monohydrate macrocrystalline cap 100mg................................................................................12

nitrofurantoin susp 25 mg/5ml....................................12nitroglycerin sl tab 0.3 mg.......................................... 62nitroglycerin sl tab 0.4 mg.......................................... 62nitroglycerin sl tab 0.6 mg.......................................... 62nitroglycerin td patch 24hr 0.1 mg/hr.........................62nitroglycerin td patch 24hr 0.2 mg/hr.........................62nitroglycerin td patch 24hr 0.4 mg/hr.........................62nitroglycerin td patch 24hr 0.6 mg/hr.........................62nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................63nizatidine cap 150 mg.................................................75nizatidine cap 300 mg.................................................75norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg.................................................................81norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg.................................................................81norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg..............................................................................81norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg..............................................................................81norethindrone & ethinyl estradiol tab 1 mg-35

mcg..............................................................................81norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg.................................................................81norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg..............................................................................81norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg..............................................................................81norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg..............................................................................81norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24).....................................................................81norethindrone acetate tab 5 mg.................................81norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg.......................................................................81norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg.......................................................................81norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35

mg-mcg.......................................................................81norethindrone tab 0.35 mg......................................... 81norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg..............................................................................81norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.........................81norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg.........................81

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126

norgestrel & ethinyl estradiol tab 0.3 mg-30mcg..............................................................................81

NORMOSOL-M IN D5W............................................. 72NORTHERA.................................................................. 63NORTHERA.................................................................. 63NORTHERA.................................................................. 63nortriptyline 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.........................................................................45NORVIR.........................................................................45NORVIR.........................................................................45NORVIR.........................................................................45NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUEDEXTA...................................................................67NULOJIX........................................................................88NUPLAZID.....................................................................40NUPLAZID.....................................................................40NUPLAZID.....................................................................40nystatin cream 100000 unit/gm..................................24nystatin oint 100000 unit/gm...................................... 24nystatin susp 100000 unit/ml......................................24nystatin tab 500000 unit..............................................24nystatin topical powder 100000 unit/

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

%..................................................................................70nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................70OOCALIVA....................................................................... 76OCALIVA....................................................................... 76octreotide acetate inj 1000 mcg/ml (1 mg/

ml)................................................................................84octreotide acetate inj 100 mcg/ml (0.1 mg/




ml)................................................................................84

ODEFSEY..................................................................... 45ODOMZO...................................................................... 32OFEV............................................................................. 97OFEV............................................................................. 97ofloxacin ophth soln 0.3%...........................................93ofloxacin otic soln 0.3%.............................................. 94ofloxacin tab 400 mg...................................................12olanzapine for im inj 10 mg........................................ 40olanzapine orally disintegrating tab 10

mg................................................................................40olanzapine orally disintegrating tab 15



mg................................................................................40olanzapine tab 10 mg..................................................40olanzapine tab 15 mg..................................................40olanzapine tab 2.5 mg.................................................40olanzapine tab 20 mg..................................................40olanzapine tab 5 mg....................................................40olanzapine tab 7.5 mg.................................................40olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................63olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................63olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg....................................................................63olmesartan medoxomil tab 20 mg............................. 63olmesartan medoxomil tab 40 mg............................. 63olmesartan medoxomil tab 5 mg............................... 63olopatadine hcl nasal soln 0.6%................................ 97olopatadine hcl ophth soln 0.1%................................93olopatadine hcl ophth soln 0.2%................................93omega-3-acid ethyl esters cap 1 gm.........................63omeprazole cap delayed release 10

mg................................................................................75omeprazole cap delayed release 20

mg................................................................................75omeprazole cap delayed release 40

mg................................................................................75OMNITROPE................................................................ 79OMNITROPE................................................................ 79OMNITROPE................................................................ 79ONCASPAR.................................................................. 32ondansetron hcl inj 40 mg/20ml (2 mg/

ml)................................................................................22ondansetron hcl inj 4 mg/2ml (2 mg/

ml)................................................................................22ondansetron hcl oral soln 4 mg/5ml.......................... 22ondansetron hcl tab 24 mg.........................................22ondansetron hcl tab 4 mg...........................................22

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ondansetron hcl tab 8 mg...........................................22ondansetron orally disintegrating tab 4

mg................................................................................22ondansetron orally disintegrating tab 8

mg................................................................................22ONFI...............................................................................16ONFI...............................................................................16ONFI...............................................................................16ONGLYZA......................................................................51ONGLYZA......................................................................51ONIVYDE...................................................................... 32OPDIVO.........................................................................32OPDIVO.........................................................................32OPDIVO.........................................................................33OPSUMIT...................................................................... 97ORACEA........................................................................70ORALAIR.......................................................................97ORENCIA...................................................................... 88ORENCIA...................................................................... 88ORENCIA...................................................................... 88ORENCIA...................................................................... 88ORENCIA CLICKJECT............................................... 88ORFADIN.......................................................................76ORFADIN.......................................................................76ORFADIN.......................................................................76ORFADIN.......................................................................76ORFADIN.......................................................................76ORKAMBI......................................................................97ORKAMBI......................................................................97oseltamivir phosphate cap 30 mg..............................45oseltamivir phosphate cap 45 mg..............................45oseltamivir phosphate cap 75 mg..............................45oseltamivir phosphate for susp 6 mg/

ml.................................................................................45OTEZLA.........................................................................88OTEZLA.........................................................................88oxaliplatin for iv inj 100 mg.........................................33oxaliplatin for iv inj 50 mg...........................................33oxaliplatin iv soln 100 mg/20ml..................................33oxaliplatin iv soln 50 mg/10ml....................................33oxandrolone tab 10 mg............................................... 81oxandrolone tab 2.5 mg..............................................81oxaprozin tab 600 mg....................................................3oxcarbazepine susp 300 mg/5ml (60 mg/

ml)................................................................................16oxcarbazepine tab 150 mg.........................................16oxcarbazepine tab 300 mg.........................................16oxcarbazepine tab 600 mg.........................................16oxybutynin chloride syrup 5 mg/5ml..........................77oxybutynin chloride tab 5 mg..................................... 77oxybutynin chloride tab er 24hr 10 mg......................77oxybutynin chloride tab er 24hr 15 mg......................77

oxybutynin chloride tab er 24hr 5 mg........................77oxycodone-aspirin tab 4.8355-325 mg........................4oxycodone hcl tab 10 mg..............................................4oxycodone hcl tab 15 mg..............................................4oxycodone hcl tab 20 mg..............................................4oxycodone hcl tab 30 mg..............................................4oxycodone hcl tab 5 mg................................................3oxycodone w/ acetaminophen tab 10-325

mg..................................................................................4oxycodone w/ acetaminophen tab 2.5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 7.5-325

mg..................................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OZEMPIC...................................................................... 51OZEMPIC...................................................................... 51Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................33paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................33paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................33paliperidone 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.....................................................................33pantoprazole sodium ec tab 20 mg........................... 75pantoprazole sodium ec tab 40 mg........................... 75pantoprazole sodium for iv soln 40 mg..................... 75paricalcitol cap 1 mcg................................................. 91paricalcitol cap 2 mcg................................................. 91paricalcitol cap 4 mcg................................................. 91paricalcitol iv soln 2 mcg/ml....................................... 91paricalcitol iv soln 5 mcg/ml....................................... 91paromomycin sulfate cap 250 mg..............................12paroxetine hcl tab 10 mg............................................ 20paroxetine hcl tab 20 mg............................................ 20paroxetine hcl tab 30 mg............................................ 20paroxetine hcl tab 40 mg............................................ 20

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PASER........................................................................... 25PAXIL............................................................................. 20PAZEO........................................................................... 93PEDIARIX......................................................................88PEDVAX HIB................................................................ 89peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................75peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................75peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................75PEGANONE..................................................................16PEGASYS..................................................................... 45PEGASYS..................................................................... 45PEGASYS PROCLICK................................................45PEGASYS PROCLICK................................................45penicillin g potassium for inj 20000000

unit...............................................................................12penicillin g potassium for inj 5000000

unit...............................................................................12PENICILLIN G POTASSIUM IN

DEXTROSE............................................................... 12PENICILLIN 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....................................................................89PENTAM 300................................................................36PENTASA...................................................................... 91PENTASA...................................................................... 91pentoxifylline tab er 400 mg....................................... 63perindopril erbumine tab 2 mg................................... 63perindopril erbumine tab 4 mg................................... 63perindopril erbumine tab 8 mg................................... 63PERJETA.......................................................................33permethrin cream 5%..................................................36perphenazine tab 16 mg.............................................22perphenazine tab 2 mg............................................... 22perphenazine tab 4 mg............................................... 22perphenazine tab 8 mg............................................... 22phenelzine sulfate tab 15 mg.....................................20PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16PHENOBARBITAL....................................................... 16

phenobarbital 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............................63phenytoin 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...................................................................72PHOSPHOLINE IODIDE.............................................93PICATO..........................................................................70PICATO..........................................................................70pilocarpine hcl ophth soln 1%.................................... 93pilocarpine hcl ophth soln 2%.................................... 93pilocarpine hcl ophth soln 4%.................................... 93pilocarpine hcl tab 5 mg..............................................68pilocarpine hcl tab 7.5 mg.......................................... 68pimozide tab 1 mg....................................................... 40pimozide tab 2 mg....................................................... 40pindolol tab 10 mg....................................................... 63pindolol tab 5 mg......................................................... 63pioglitazone hcl-glimepiride tab 30-2

mg................................................................................51pioglitazone hcl-glimepiride tab 30-4

mg................................................................................51pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................51pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................51pioglitazone hcl tab 15 mg..........................................51pioglitazone hcl tab 30 mg..........................................51pioglitazone hcl tab 45 mg..........................................51piperacillin sod-tazobactam na for inj 3.375 gm

(3-0.375 gm)..............................................................12piperacillin sod-tazobactam sod for inj 2.25 gm

(2-0.25 gm)................................................................ 12piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5

gm).............................................................................. 12piroxicam cap 10 mg..................................................... 4piroxicam cap 20 mg..................................................... 4PLEGRIDY.................................................................... 67PLEGRIDY.................................................................... 68PLEGRIDY STARTER PACK..................................... 68PLEGRIDY STARTER PACK..................................... 68

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podofilox soln 0.5%..................................................... 70polyethylene glycol 3350 oral packet........................ 75polyethylene glycol 3350 oral powder.......................75polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%...................................................................... 93POMALYST...................................................................33POMALYST...................................................................33POMALYST...................................................................33POMALYST...................................................................33PORTRAZZA................................................................ 33POTASSIUM CHLORIDE/DEXTROSE.....................73POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................73POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................73potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 73potassium chloride cap er 10 meq............................ 72potassium chloride cap er 8 meq...............................72potassium chloride inj 2 meq/ml................................ 72potassium chloride microencapsulated crys er tab 10

meq............................................................................. 72potassium chloride microencapsulated crys er tab 20

meq............................................................................. 72potassium chloride oral soln 10% (20

meq/15ml).................................................................. 72potassium chloride tab er 10 meq............................. 73potassium chloride tab er 8 meq (600

mg).............................................................................. 72potassium citrate tab er 10 meq (1080



mg).............................................................................. 73PRADAXA..................................................................... 54PRADAXA..................................................................... 54PRADAXA..................................................................... 54PRALUENT................................................................... 63PRALUENT................................................................... 63pramipexole dihydrochloride tab 0.125

mg................................................................................37pramipexole dihydrochloride tab 0.25




mg................................................................................37pramipexole dihydrochloride tab 1 mg...................... 37prasugrel hcl tab 10 mg..............................................54

prasugrel hcl tab 5 mg................................................ 54pravastatin sodium tab 10 mg....................................63pravastatin sodium tab 20 mg....................................63pravastatin sodium tab 40 mg....................................63pravastatin sodium tab 80 mg....................................63praziquantel tab 600 mg............................................. 36prazosin hcl cap 1 mg.................................................63prazosin hcl cap 2 mg.................................................63prazosin hcl cap 5 mg.................................................63prednicarbate cream 0.1%......................................... 70prednicarbate oint 0.1%..............................................70prednisolone acetate ophth susp 1%........................93prednisolone sod phosphate oral soln 15

mg/5ml........................................................................ 79prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base).............................................................78prednisolone syrup 15 mg/5ml...................................79PREDNISONE.............................................................. 79PREDNISONE.............................................................. 79PREDNISONE.............................................................. 79PREDNISONE.............................................................. 79PREDNISONE.............................................................. 79PREDNISONE.............................................................. 79prednisone tab 10 mg................................................. 79prednisone tab 1 mg................................................... 79prednisone tab 2.5 mg................................................ 79prednisone tab 20 mg................................................. 79prednisone tab 5 mg................................................... 79PREMARIN................................................................... 81PREMARIN................................................................... 81PREMARIN................................................................... 81PREMARIN................................................................... 82PREMARIN................................................................... 82PREMARIN................................................................... 82PREMPHASE............................................................... 82PREMPRO.................................................................... 82PREMPRO.................................................................... 82PREMPRO.................................................................... 82PREMPRO.................................................................... 82PREZCOBIX................................................................. 45PREZISTA..................................................................... 45PREZISTA..................................................................... 45PREZISTA..................................................................... 45PREZISTA..................................................................... 45PREZISTA..................................................................... 45PRIFTIN.........................................................................25PRIMAQUINE PHOSPHATE......................................36primidone tab 250 mg................................................. 16primidone tab 50 mg................................................... 16PRISTIQ........................................................................ 20PRISTIQ........................................................................ 20PRISTIQ........................................................................ 20

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PROAIR HFA................................................................97PROAIR RESPICLICK................................................ 97probenecid tab 500 mg............................................... 24prochlorperazine edisylate inj 5 mg/ml......................22prochlorperazine maleate tab 10 mg.........................22prochlorperazine maleate tab 5 mg...........................22prochlorperazine suppos 25 mg................................ 22PROCRIT...................................................................... 54PROCRIT...................................................................... 54PROCRIT...................................................................... 54PROCRIT...................................................................... 54PROCRIT...................................................................... 54PROCRIT...................................................................... 54PROGLYCEM............................................................... 51PROGRAF.....................................................................89PROLASTIN-C..............................................................76PROLASTIN-C..............................................................76PROLENSA...................................................................93PROLEUKIN................................................................. 33PROLIA..........................................................................91PROMACTA.................................................................. 54PROMACTA.................................................................. 54PROMACTA.................................................................. 54PROMACTA.................................................................. 54promethazine hcl suppos 12.5 mg............................ 22promethazine hcl suppos 25 mg................................22promethazine hcl syrup 6.25 mg/5ml........................ 22promethazine hcl tab 12.5 mg....................................23promethazine hcl tab 25 mg.......................................23promethazine hcl tab 50 mg.......................................23propafenone hcl cap er 12hr 225 mg........................ 63propafenone hcl cap er 12hr 325 mg........................ 63propafenone hcl cap er 12hr 425 mg........................ 63propafenone hcl tab 150 mg...................................... 63propafenone hcl tab 225 mg...................................... 63propafenone hcl tab 300 mg...................................... 63propranolol hcl cap er 24hr 120 mg.......................... 63propranolol hcl cap er 24hr 160 mg.......................... 64propranolol hcl cap er 24hr 60 mg.............................63propranolol hcl cap er 24hr 80 mg.............................63propranolol hcl inj 1 mg/ml......................................... 64propranolol hcl tab 10 mg...........................................64propranolol hcl tab 20 mg...........................................64propranolol hcl tab 40 mg...........................................64propranolol hcl tab 60 mg...........................................64propranolol hcl tab 80 mg...........................................64propylthiouracil tab 50 mg.......................................... 84PROQUAD.................................................................... 89protriptyline hcl tab 10 mg.......................................... 21protriptyline hcl tab 5 mg............................................ 20PULMOZYME............................................................... 97PURIXAN.......................................................................33

PYLERA.........................................................................75pyrazinamide tab 500 mg........................................... 25pyridostigmine bromide tab 60 mg............................ 25pyridostigmine bromide tab er 180 mg......................25QQUADRACEL................................................................89quetiapine 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............................................... 64quinapril hcl tab 20 mg............................................... 64quinapril hcl tab 40 mg............................................... 64quinapril hcl tab 5 mg..................................................64quinapril-hydrochlorothiazide tab 10-12.5

mg................................................................................64quinapril-hydrochlorothiazide tab 20-12.5

mg................................................................................64quinapril-hydrochlorothiazide tab 20-25

mg................................................................................64quinidine gluconate tab er 324 mg............................ 64QUINIDINE SULFATE................................................. 64QUINIDINE SULFATE................................................. 64QVAR............................................................................. 97QVAR REDIHALER..................................................... 97QVAR REDIHALER..................................................... 97RRABAVERT................................................................... 89rabeprazole sodium ec tab 20 mg............................. 75raloxifene hcl tab 60 mg............................................. 82ramipril cap 1.25 mg....................................................64ramipril cap 10 mg.......................................................64ramipril cap 2.5 mg......................................................64ramipril cap 5 mg.........................................................64RANEXA........................................................................64RANEXA........................................................................64ranitidine hcl cap 150 mg........................................... 75ranitidine hcl cap 300 mg........................................... 75ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................75

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ranitidine hcl tab 150 mg............................................ 75ranitidine hcl tab 300 mg............................................ 75RAPAFLO...................................................................... 78RAPAFLO...................................................................... 78RAPAMUNE.................................................................. 89rasagiline mesylate tab 0.5 mg.................................. 37rasagiline mesylate tab 1 mg..................................... 37REBETOL......................................................................45RECOMBIVAX HB....................................................... 89RECOMBIVAX HB....................................................... 89RECOMBIVAX HB....................................................... 89REGRANEX.................................................................. 70RELENZA DISKHALER.............................................. 45RELISTOR.....................................................................75RELISTOR.....................................................................75RELISTOR.....................................................................75REMICADE................................................................... 89REMODULIN................................................................ 97REMODULIN................................................................ 97REMODULIN................................................................ 97REMODULIN................................................................ 97RENFLEXIS.................................................................. 89RENVELA......................................................................73repaglinide tab 0.5 mg................................................ 51repaglinide tab 1 mg....................................................51repaglinide tab 2 mg....................................................51REPATHA...................................................................... 64REPATHA PUSHTRONEX SYSTEM........................64REPATHA SURECLICK.............................................. 64RESCRIPTOR.............................................................. 45RESCRIPTOR.............................................................. 45RESTASIS.....................................................................93RESTASIS MULTIDOSE.............................................93RETROVIR IV INFUSION...........................................45REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REVLIMID......................................................................33REXULTI........................................................................40REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REXULTI........................................................................41REYATAZ.......................................................................45REYATAZ.......................................................................45REYATAZ.......................................................................45REYATAZ.......................................................................45RIBASPHERE...............................................................45RIBASPHERE...............................................................45

RIBASPHERE RIBAPAK.............................................45RIBASPHERE RIBAPAK.............................................45ribavirin cap 200 mg....................................................45ribavirin for inhal soln 6 gm........................................ 97ribavirin tab 200 mg.....................................................45RIDAURA...................................................................... 89rifabutin cap 150 mg....................................................25rifampin cap 150 mg....................................................25rifampin cap 300 mg....................................................25rifampin for inj 600 mg................................................ 25riluzole tab 50 mg........................................................ 68rimantadine hydrochloride tab 100 mg......................45risedronate sodium tab 150 mg................................. 92risedronate sodium tab 30 mg................................... 91risedronate sodium tab 35 mg................................... 91risedronate sodium tab 5 mg..................................... 91risedronate sodium tab delayed release 35

mg................................................................................91RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41RISPERDAL CONSTA................................................ 41risperidone orally disintegrating tab 0.25

mg................................................................................41risperidone orally disintegrating tab 0.5

mg................................................................................41risperidone orally disintegrating tab 1




mg................................................................................41risperidone soln 1 mg/ml............................................ 41risperidone tab 0.25 mg..............................................41risperidone 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................................ 18rivastigmine tartrate cap 3 mg....................................18rivastigmine tartrate cap 4.5 mg................................ 18rivastigmine tartrate cap 6 mg....................................18rivastigmine td patch 24hr 13.3

mg/24hr...................................................................... 18

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rivastigmine td patch 24hr 4.6 mg/24hr.....................18rivastigmine td patch 24hr 9.5 mg/24hr.....................18rizatriptan benzoate oral disintegrating tab 10

mg................................................................................24rizatriptan benzoate oral disintegrating tab 5

mg................................................................................24rizatriptan 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.............................. 38rosuvastatin calcium tab 10 mg................................. 64rosuvastatin calcium tab 20 mg................................. 64rosuvastatin calcium tab 40 mg................................. 64rosuvastatin calcium tab 5 mg................................... 64ROTARIX.......................................................................89ROTATEQ......................................................................89RUBRACA.....................................................................33RUBRACA.....................................................................33RUBRACA.....................................................................33RYDAPT........................................................................ 33SSABRIL.......................................................................... 16SABRIL.......................................................................... 16SAMSCA........................................................................73SAMSCA........................................................................73SANDIMMUNE............................................................. 89SANTYL.........................................................................70SAPHRIS.......................................................................41SAPHRIS.......................................................................41SAPHRIS.......................................................................41selegiline hcl cap 5 mg............................................... 38selegiline hcl tab 5 mg................................................ 38selenium sulfide lotion 2.5%.......................................70SELZENTRY.................................................................45SELZENTRY.................................................................46SELZENTRY.................................................................46SELZENTRY.................................................................46SELZENTRY.................................................................46SENSIPAR.....................................................................92SENSIPAR.....................................................................92SENSIPAR.....................................................................92SEREVENT DISKUS...................................................98sertraline hcl oral concentrate for solution 20 mg/

ml.................................................................................21sertraline hcl tab 100 mg............................................ 21sertraline hcl tab 25 mg.............................................. 21

sertraline hcl tab 50 mg.............................................. 21sevelamer carbonate packet 0.8 gm......................... 73sevelamer carbonate packet 2.4 gm......................... 73sevelamer carbonate tab 800 mg..............................73SHINGRIX..................................................................... 89SIGNIFOR..................................................................... 84SIGNIFOR..................................................................... 84SIGNIFOR..................................................................... 84SIGNIFOR LAR............................................................84SIGNIFOR LAR............................................................84SIGNIFOR LAR............................................................84sildenafil citrate tab 20 mg..........................................98SILENOR.......................................................................99SILENOR.......................................................................99silver sulfadiazine cream 1%......................................71SIMBRINZA...................................................................93SIMULECT.................................................................... 89SIMULECT.................................................................... 89simvastatin tab 10 mg.................................................64simvastatin tab 20 mg.................................................64simvastatin tab 40 mg.................................................64simvastatin tab 5 mg................................................... 64simvastatin tab 80 mg.................................................64sirolimus tab 0.5 mg.................................................... 89sirolimus tab 1 mg....................................................... 89sirolimus tab 2 mg....................................................... 89SIRTURO.......................................................................25SIVEXTRO.................................................................... 12SIVEXTRO.................................................................... 12sodium chloride inj 0.45%...........................................73sodium chloride irrigation soln 0.9%......................... 73sodium chloride iv soln 0.9%..................................... 73sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................76sodium phenylbutyrate tab 500 mg........................... 76sodium polystyrene sulfonate oral susp 15

gm/60ml......................................................................73sodium polystyrene sulfonate powder.......................73sodium polystyrene sulfonate rectal susp 30

gm/120ml....................................................................73SOLTAMOX...................................................................33SOMATULINE DEPOT................................................84SOMATULINE DEPOT................................................84SOMATULINE DEPOT................................................84SOMAVERT.................................................................. 84SOMAVERT.................................................................. 84SOMAVERT.................................................................. 84SOMAVERT.................................................................. 84SOMAVERT.................................................................. 84SOOLANTRA................................................................71sotalol hcl (afib/afl) tab 120 mg..................................65sotalol hcl (afib/afl) tab 160 mg..................................65

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sotalol hcl (afib/afl) tab 80 mg....................................64sotalol hcl tab 120 mg.................................................65sotalol hcl tab 160 mg.................................................65sotalol hcl tab 240 mg.................................................65sotalol hcl tab 80 mg...................................................65SOVALDI....................................................................... 46SPIRIVA HANDIHALER.............................................. 98SPIRIVA RESPIMAT....................................................98SPIRIVA RESPIMAT....................................................98spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................65spironolactone tab 100 mg.........................................65spironolactone tab 25 mg........................................... 65spironolactone tab 50 mg........................................... 65SPRITAM.......................................................................16SPRITAM.......................................................................16SPRITAM.......................................................................17SPRITAM.......................................................................17SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................33SPRYCEL......................................................................34SPRYCEL......................................................................34STAMARIL.....................................................................89stavudine cap 15 mg...................................................46stavudine cap 20 mg...................................................46stavudine cap 30 mg...................................................46stavudine cap 40 mg...................................................46STELARA...................................................................... 89STELARA...................................................................... 89STELARA...................................................................... 89STELARA...................................................................... 89STIMATE....................................................................... 79STIOLTO RESPIMAT.................................................. 98STIVARGA.....................................................................34STRENSIQ....................................................................77STRENSIQ....................................................................77STRENSIQ....................................................................77STRENSIQ....................................................................77STREPTOMYCIN SULFATE...................................... 12STRIBILD...................................................................... 46SUBLOCADE.................................................................. 5SUBLOCADE.................................................................. 5SUBOXONE....................................................................5SUBOXONE....................................................................5SUBOXONE....................................................................6SUBOXONE....................................................................6sucralfate tab 1 gm......................................................75sulfacetamide sodium lotion 10%.............................. 12sulfacetamide sodium ophth soln 10%..................... 93

sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%..........................................................93

SULFADIAZINE............................................................ 12sulfamethoxazole-trimethoprim iv soln 400-80

mg/5ml........................................................................ 12sulfamethoxazole-trimethoprim susp 200-40

mg/5ml........................................................................ 12sulfamethoxazole-trimethoprim tab 400-80

mg................................................................................12sulfamethoxazole-trimethoprim tab 800-160

mg................................................................................12sulfasalazine tab 500 mg............................................91sulfasalazine tab delayed release 500

mg................................................................................91sulindac tab 150 mg...................................................... 4sulindac tab 200 mg...................................................... 4sumatriptan nasal spray 20 mg/act........................... 25sumatriptan nasal spray 5 mg/act..............................25sumatriptan succinate inj 6 mg/0.5ml........................25sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................25sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................25sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................25sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................25sumatriptan succinate tab 100 mg............................ 25sumatriptan succinate tab 25 mg...............................25sumatriptan succinate tab 50 mg...............................25SUPRAX........................................................................12SUPRAX........................................................................12SUPRAX........................................................................13SUPREP BOWEL PREP KIT.....................................75SUSTIVA........................................................................46SUSTIVA........................................................................46SUSTIVA........................................................................46SUTENT........................................................................ 34SUTENT........................................................................ 34SUTENT........................................................................ 34SUTENT........................................................................ 34SYLATRON................................................................... 46SYLATRON................................................................... 46SYLATRON................................................................... 46SYLVANT.......................................................................89SYLVANT.......................................................................89SYMBICORT.................................................................98SYMBICORT.................................................................98SYMDEKO.................................................................... 98SYMFI............................................................................ 46SYMFI LO..................................................................... 46SYMLINPEN 120......................................................... 51

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SYMLINPEN 60............................................................51SYNAGIS.......................................................................89SYNAGIS.......................................................................89SYNAREL......................................................................84SYNERCID....................................................................13SYNJARDY................................................................... 51SYNJARDY................................................................... 51SYNJARDY................................................................... 51SYNJARDY................................................................... 51SYNJARDY XR............................................................ 51SYNJARDY XR............................................................ 51SYNJARDY XR............................................................ 51SYNJARDY XR............................................................ 52SYNRIBO...................................................................... 34SYNTHROID.................................................................82SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYNTHROID.................................................................83SYPRINE.......................................................................73TTABLOID........................................................................34tacrolimus cap 0.5 mg.................................................90tacrolimus cap 1 mg....................................................90tacrolimus cap 5 mg....................................................90tacrolimus oint 0.03%..................................................71tacrolimus oint 0.1%.................................................... 71TAFINLAR..................................................................... 34TAFINLAR..................................................................... 34TAGRISSO.................................................................... 34TAGRISSO.................................................................... 34TAMIFLU........................................................................46tamoxifen citrate tab 10 mg........................................34tamoxifen citrate tab 20 mg........................................34tamsulosin hcl cap 0.4 mg..........................................78TARCEVA...................................................................... 34TARCEVA...................................................................... 34TARCEVA...................................................................... 34TARGRETIN..................................................................34TASIGNA....................................................................... 34TASIGNA....................................................................... 34TASIGNA....................................................................... 34tazarotene cream 0.1%...............................................71TAZORAC......................................................................71TAZORAC......................................................................71

TAZORAC......................................................................71TECENTRIQ................................................................. 34TECFIDERA..................................................................68TECFIDERA..................................................................68TECFIDERA STARTER PACK...................................68TECHNIVIE................................................................... 46TEFLARO......................................................................13TEFLARO......................................................................13TEKTURNA...................................................................65TEKTURNA...................................................................65TEKTURNA HCT......................................................... 65TEKTURNA HCT......................................................... 65TEKTURNA HCT......................................................... 65TEKTURNA HCT......................................................... 65telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................65telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................65telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................65telmisartan tab 20 mg................................................. 65telmisartan tab 40 mg................................................. 65telmisartan tab 80 mg................................................. 65temazepam cap 15 mg............................................... 99temazepam cap 30 mg............................................... 99TEMODAR.................................................................... 34TENCON..........................................................................4TENIVAC....................................................................... 90tenofovir disoproxil fumarate tab 300

mg................................................................................46terazosin hcl cap 10 mg..............................................65terazosin hcl cap 1 mg................................................65terazosin hcl cap 2 mg................................................65terazosin hcl cap 5 mg................................................65terbinafine hcl tab 250 mg..........................................24terbutaline sulfate tab 2.5 mg.....................................98terbutaline sulfate tab 5 mg........................................98terconazole vaginal cream 0.4%................................24terconazole vaginal cream 0.8%................................24terconazole vaginal suppos 80 mg............................24testosterone cypionate im inj in oil 100 mg/

ml.................................................................................82testosterone cypionate im inj in oil 200 mg/

ml.................................................................................82testosterone enanthate im inj in oil 200 mg/

ml.................................................................................82testosterone td gel 12.5 mg/act (1%)........................ 82testosterone td gel 25 mg/2.5gm (1%)......................82testosterone td gel 50 mg/5gm (1%).........................82testosterone td soln 30 mg/act...................................82TETANUS/DIPHTHERIA TOXOIDS

ADSORBED...............................................................90

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135

tetrabenazine tab 12.5 mg..........................................68tetrabenazine tab 25 mg.............................................68tetracycline hcl cap 250 mg........................................13tetracycline hcl cap 500 mg........................................13THALOMID....................................................................34THALOMID....................................................................34THALOMID....................................................................34THALOMID....................................................................34theophylline tab er 12hr 100 mg................................98theophylline tab er 12hr 200 mg................................98theophylline tab er 12hr 300 mg................................98theophylline tab er 12hr 450 mg................................98theophylline tab er 24hr 400 mg................................98theophylline tab er 24hr 600 mg................................98thioridazine 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.................................................41thiothixene cap 1 mg...................................................41thiothixene cap 2 mg...................................................41thiothixene cap 5 mg...................................................41THYMOGLOBULIN......................................................90tiagabine hcl tab 12 mg.............................................. 17tiagabine hcl tab 16 mg.............................................. 17tiagabine hcl tab 2 mg.................................................17tiagabine hcl tab 4 mg.................................................17tigecycline for iv soln 50 mg.......................................13TIMOLOL MALEATE................................................... 65TIMOLOL MALEATE................................................... 65TIMOLOL MALEATE................................................... 65timolol maleate ophth gel forming soln

0.25%..........................................................................93timolol maleate ophth gel forming soln

0.5%............................................................................94timolol maleate ophth soln 0.25%..............................94timolol maleate ophth soln 0.5%................................94timolol maleate ophth soln 0.5% (once-

daily)............................................................................94TIVICAY......................................................................... 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...................................................................94tobramycin-dexamethasone ophth susp

0.3-0.1%..................................................................... 94tobramycin nebu soln 300 mg/5ml............................ 98

tobramycin ophth soln 0.3%.......................................94TOBRAMYCIN SULFATE........................................... 13tobramycin sulfate for inj 1.2 gm................................13tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................13tobramycin sulfate inj 10 mg/ml................................. 13tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................13tolcapone tab 100 mg................................................. 38TOLMETIN SODIUM..................................................... 4tolterodine tartrate cap er 24hr 2 mg.........................78tolterodine tartrate cap er 24hr 4 mg.........................78tolterodine tartrate tab 1 mg.......................................78tolterodine tartrate tab 2 mg.......................................78topiramate sprinkle cap 15 mg...................................17topiramate sprinkle cap 25 mg...................................17topiramate tab 100 mg................................................17topiramate tab 200 mg................................................17topiramate tab 25 mg.................................................. 17topiramate tab 50 mg.................................................. 17topotecan hcl for inj 4 mg........................................... 34topotecan hcl inj 4 mg/4ml (for

infusion)...................................................................... 34TORISEL....................................................................... 34torsemide tab 100 mg................................................. 65torsemide tab 10 mg................................................... 65torsemide tab 20 mg................................................... 65torsemide tab 5 mg......................................................65TOUJEO MAX SOLOSTAR........................................52TOUJEO SOLOSTAR..................................................52TOVIAZ.......................................................................... 78TOVIAZ.......................................................................... 78TRACLEER................................................................... 98TRACLEER................................................................... 98TRACLEER................................................................... 98TRADJENTA................................................................. 52tramadol-acetaminophen tab 37.5-325

mg..................................................................................4tramadol hcl tab 50 mg................................................. 4tramadol hcl tab er 24hr 100 mg..................................4tramadol hcl tab er 24hr 200 mg..................................4tramadol hcl tab er 24hr 300 mg..................................4trandolapril tab 1 mg................................................... 65trandolapril tab 2 mg................................................... 65trandolapril tab 4 mg................................................... 65tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................54tranexamic acid tab 650 mg.......................................54tranylcypromine sulfate tab 10 mg............................ 21TRAVATAN Z................................................................ 94trazodone hcl tab 100 mg...........................................21trazodone hcl tab 150 mg...........................................21

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trazodone hcl tab 300 mg...........................................21trazodone hcl tab 50 mg.............................................21TREANDA..................................................................... 34TREANDA..................................................................... 34TRECATOR...................................................................25TRELEGY ELLIPTA.....................................................98TRELSTAR....................................................................84TRELSTAR....................................................................84TRELSTAR MIXJECT..................................................84TRELSTAR MIXJECT..................................................84TRELSTAR MIXJECT..................................................84TRESIBA FLEXTOUCH.............................................. 52TRESIBA FLEXTOUCH.............................................. 52tretinoin cap 10 mg......................................................34tretinoin cream 0.025%............................................... 71tretinoin cream 0.05%................................................. 71tretinoin cream 0.1%................................................... 71tretinoin gel 0.01%.......................................................71tretinoin gel 0.025%.....................................................71triamcinolone acetonide cream

0.025%........................................................................71triamcinolone acetonide cream 0.1%........................71triamcinolone acetonide cream 0.5%........................71triamcinolone acetonide dental paste

0.1%............................................................................68triamcinolone acetonide lotion 0.025%..................... 71triamcinolone acetonide lotion 0.1%..........................71triamcinolone acetonide nasal aerosol suspension

55 mcg/act................................................................. 98triamcinolone acetonide oint 0.025%........................ 71triamcinolone acetonide oint 0.1%.............................71triamcinolone acetonide oint 0.5%.............................71triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................65triamterene & hydrochlorothiazide tab 37.5-25

mg................................................................................65triamterene & hydrochlorothiazide tab 75-50

mg................................................................................66trientine hcl cap 250 mg............................................. 73trifluoperazine hcl tab 10 mg......................................41trifluoperazine hcl tab 1 mg........................................41trifluoperazine hcl tab 2 mg........................................41trifluoperazine hcl tab 5 mg........................................41trifluridine ophth soln 1%............................................ 94trimethoprim tab 100 mg.............................................13trimipramine maleate cap 100 mg............................. 21trimipramine maleate cap 25 mg............................... 21trimipramine maleate cap 50 mg............................... 21TRINTELLIX..................................................................21TRINTELLIX..................................................................21TRINTELLIX..................................................................21TRISENOX....................................................................34

TRIUMEQ......................................................................46TROGARZO..................................................................46trospium chloride cap er 24hr 60 mg.........................78trospium chloride tab 20 mg.......................................78TRULICITY....................................................................52TRULICITY....................................................................52TRUMENBA.................................................................. 90TRUVADA......................................................................46TRUVADA......................................................................46TRUVADA......................................................................46TRUVADA......................................................................46TWINRIX........................................................................90TYBOST........................................................................ 46TYGACIL....................................................................... 13TYKERB........................................................................ 34TYPHIM VI.................................................................... 90TYSABRI....................................................................... 68UULORIC......................................................................... 24ULORIC......................................................................... 24UNITUXIN......................................................................34UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 98UPTRAVI....................................................................... 99ursodiol cap 300 mg....................................................75ursodiol tab 250 mg.....................................................75ursodiol tab 500 mg.....................................................75Vvalacyclovir hcl tab 1 gm............................................ 46valacyclovir hcl tab 500 mg........................................46VALCHLOR................................................................... 35valganciclovir hcl for soln 50 mg/ml.......................... 46valganciclovir hcl tab 450 mg.....................................47valproate sodium inj 100 mg/ml.................................17valproate sodium oral soln 250 mg/5ml.................... 17valproic acid cap 250 mg............................................17valsartan-hydrochlorothiazide tab 160-12.5

mg................................................................................66valsartan-hydrochlorothiazide tab 160-25

mg................................................................................66valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................66valsartan-hydrochlorothiazide tab 320-25

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

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137

valsartan-hydrochlorothiazide tab 80-12.5mg................................................................................66

valsartan tab 160 mg...................................................66valsartan tab 320 mg...................................................66valsartan tab 40 mg.....................................................66valsartan tab 80 mg.....................................................66vancomycin hcl cap 125 mg.......................................13vancomycin 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.........................13VAQTA........................................................................... 90VAQTA........................................................................... 90VARIVAX........................................................................90VASCEPA...................................................................... 66VASCEPA...................................................................... 66VECTIBIX...................................................................... 35VECTIBIX...................................................................... 35VELCADE......................................................................35VENCLEXTA.................................................................35VENCLEXTA.................................................................35VENCLEXTA.................................................................35VENCLEXTA STARTING PACK................................ 35venlafaxine hcl cap er 24hr 150 mg.......................... 21venlafaxine hcl cap er 24hr 37.5 mg......................... 21venlafaxine hcl cap er 24hr 75 mg............................ 21venlafaxine hcl tab 100 mg........................................ 21venlafaxine hcl tab 25 mg...........................................21venlafaxine hcl tab 37.5 mg....................................... 21venlafaxine hcl tab 50 mg...........................................21venlafaxine hcl tab 75 mg...........................................21venlafaxine hcl tab er 24hr 150 mg........................... 21venlafaxine hcl tab er 24hr 37.5 mg..........................21venlafaxine hcl tab er 24hr 75 mg............................. 21VENTAVIS..................................................................... 99VENTAVIS..................................................................... 99VENTOLIN HFA........................................................... 99verapamil hcl cap er 24hr 100 mg.............................66verapamil hcl cap er 24hr 120 mg.............................66verapamil hcl cap er 24hr 180 mg.............................66verapamil hcl cap er 24hr 200 mg.............................66verapamil hcl cap er 24hr 240 mg.............................66verapamil hcl cap er 24hr 300 mg.............................66verapamil hcl cap er 24hr 360 mg.............................66verapamil hcl tab 120 mg........................................... 66verapamil hcl tab 40 mg............................................. 66

verapamil hcl tab 80 mg............................................. 66verapamil hcl tab er 120 mg.......................................66verapamil hcl tab er 180 mg.......................................66verapamil hcl tab er 240 mg.......................................66VERSACLOZ................................................................ 41VERZENIO....................................................................35VERZENIO....................................................................35VERZENIO....................................................................35VERZENIO....................................................................35VICTOZA....................................................................... 52VIDEX............................................................................ 47VIDEX............................................................................ 47VIDEX EC..................................................................... 47VIEKIRA PAK................................................................47VIEKIRA XR..................................................................47vigabatrin powd pack 500 mg.................................... 17VIGAMOX......................................................................94VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD.........................................................................21VIIBRYD STARTER PACK......................................... 21VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VIMPAT.......................................................................... 17VINBLASTINE SULFATE............................................35vincristine sulfate iv soln 1 mg/ml..............................35vinorelbine tartrate inj 10 mg/ml.................................35vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................35VIOKACE.......................................................................77VIOKACE.......................................................................77VIRACEPT.................................................................... 47VIRACEPT.................................................................... 47VIRAMUNE................................................................... 47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................47VIREAD..........................................................................47VIVITROL........................................................................ 6voriconazole for inj 200 mg........................................ 24voriconazole for susp 40 mg/ml.................................24voriconazole tab 200 mg............................................ 24voriconazole tab 50 mg...............................................24VOSEVI..........................................................................47VOTRIENT.................................................................... 35VPRIV............................................................................ 77VRAYLAR...................................................................... 42VRAYLAR...................................................................... 42

2018

138

VRAYLAR...................................................................... 42VRAYLAR...................................................................... 42VYXEOS........................................................................35Wwarfarin sodium tab 10 mg.........................................55warfarin sodium tab 1 mg...........................................54warfarin sodium tab 2.5 mg........................................54warfarin sodium tab 2 mg...........................................54warfarin sodium tab 3 mg...........................................54warfarin sodium tab 4 mg...........................................55warfarin sodium tab 5 mg...........................................55warfarin sodium tab 6 mg...........................................55warfarin sodium tab 7.5 mg........................................55water for irrigation, sterile irrigation

soln..............................................................................73WELCHOL.....................................................................66WELCHOL.....................................................................66XXALKORI....................................................................... 35XALKORI....................................................................... 35XARELTO...................................................................... 55XARELTO...................................................................... 55XARELTO...................................................................... 55XARELTO STARTER PACK.......................................55XATMEP........................................................................ 90XGEVA...........................................................................92XIFAXAN........................................................................75XOLAIR..........................................................................90XOPENEX HFA............................................................99XTANDI.......................................................................... 35XYREM.......................................................................... 99YYERVOY........................................................................35YERVOY........................................................................35YF-VAX.......................................................................... 90YONDELIS.................................................................... 35YONSA.......................................................................... 35Zzafirlukast tab 10 mg...................................................99zafirlukast tab 20 mg...................................................99zaleplon cap 10 mg..................................................... 99zaleplon cap 5 mg....................................................... 99ZALTRAP.......................................................................35ZALTRAP.......................................................................35ZANOSAR..................................................................... 35ZAVESCA...................................................................... 77ZEJULA..........................................................................35ZELBORAF................................................................... 35ZENPEP........................................................................ 77

ZENPEP........................................................................ 77ZENPEP........................................................................ 77ZENPEP........................................................................ 77ZENPEP........................................................................ 77ZENPEP........................................................................ 77ZENPEP........................................................................ 77ZEPATIER..................................................................... 47ZERIT.............................................................................47ZIAGEN..........................................................................47zidovudine cap 100 mg...............................................47zidovudine syrup 10 mg/ml.........................................47zidovudine tab 300 mg................................................47ZINACEF....................................................................... 13ziprasidone hcl cap 20 mg..........................................42ziprasidone hcl cap 40 mg..........................................42ziprasidone hcl cap 60 mg..........................................42ziprasidone hcl cap 80 mg..........................................42ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4zoledronic acid inj conc for iv infusion 4

mg/5ml........................................................................ 92zoledronic acid iv soln 5 mg/100ml........................... 92ZOLINZA........................................................................35zolpidem tartrate tab 10 mg....................................... 99zolpidem tartrate tab 5 mg..........................................99ZOMETA........................................................................ 92zonisamide cap 100 mg..............................................17zonisamide cap 25 mg................................................17zonisamide cap 50 mg................................................17ZONTIVITY....................................................................55ZORTRESS...................................................................90ZORTRESS...................................................................90ZORTRESS...................................................................90ZOSTAVAX....................................................................90ZOSYN...........................................................................13ZOSYN...........................................................................13ZOSYN...........................................................................13ZYDELIG....................................................................... 35ZYDELIG....................................................................... 35ZYKADIA....................................................................... 35ZYPREXA RELPREVV............................................... 42ZYPREXA RELPREVV............................................... 42ZYPREXA RELPREVV............................................... 42ZYTIGA..........................................................................35ZYTIGA..........................................................................35

Este formulario fue actualizado el 09/01/2018. Si tiene alguna pregunta o desea información más actualizada, comuníquese con Florida Blue Preferred HMO al 1-844-783-5189. (Los usuarios de TTY deben llamar al 1-877-955-8773). El horario es de 8:00 a.m. a 8:00 p.m., hora local, siete días de la semana.

87768 0217R

Section 1557 Notification: Discrimination is Against the Law

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO (collectively, “Florida Blue”), Florida

Combined Life and the Blue Cross and Blue Shield Federal Employee Program® (FEP) comply with applicable

Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or

sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability,

or sex.

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO, Florida Combined Life and FEP:

Provide free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provide free language services to people whose primary language is not English, such as:

o Qualified interpreters

o Information written in other languages

If you need these services, contact:

Florida Blue (health and vision coverage): 1-800-352-2583

Florida Combined Life (dental, life, and disability coverage): 1-888-223-4892

Federal Employee Program: 1-800-333-2227

If you believe that we have failed to provide these services or discriminated in another way on the basis of race,

color, national origin, age, disability, or sex, you can file a grievance with:

Florida Blue (including FEP members):

Section 1557 Coordinator

4800 Deerwood Campus Parkway, DCC 1-7

Jacksonville, FL 32246

1-800-477-3736 x29070

1-800-955-8770 (TTY)

Fax: 1-904-301-1580

[email protected]

Florida Combined Life:

Civil Rights Coordinator

17500 Chenal Parkway

Little Rock, AR 72223

1-800-260-0331

1-800-955-8770 (TTY)

[email protected]

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Section

1557 Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of

Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights

Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019

1-800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-

800-352-2583 (TTY: 1-877-955-8773). FEP: Llame al 1-800-333-2227

ATANSYON: Si w pale Kreyòl ayisyen, ou ka resevwa yon èd gratis nan lang pa w. Rele 1-800-352-2583 (pou

moun ki pa tande byen: 1-800-955-8770). FEP: Rele 1-800-333-2227

CHÚ Ý: Nếu bạn nói Tiếng Việt, có dịch vụ trợ giúp ngôn ngữ miễn phí dành cho bạn. Hãy gọi số 1-800-352-

2583 (TTY: 1-800-955-8770). FEP: Gọi số 1-800-333-2227

ATENÇÃO: Se você fala português, utilize os serviços linguísticos gratuitos disponíveis. Ligue para 1-800-

352-2583 (TTY: 1-800-955-8770). FEP: Ligue para 1-800-333-2227

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-800-352-2583（TTY: 1-800-955-

8770)。FEP：請致電1-800-333-2227

ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.

Appelez le 1-800-352-2583 (ATS : 1-800-955-8770). FEP : Appelez le 1-800-333-2227

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang

walang bayad. Tumawag sa 1-800-352-2583 (TTY: 1-800-955-8770). FEP: Tumawag sa 1-800-333-2227

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

Звоните 1-800-352-2583 (телетайп: 1-800-955-8770). FEP: Звоните 1-800-333-2227

)رقم هاتف الصم 008-253-3852-1اتصل برقم ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.

.7222-333-008-1. اتصل برقم 008-559-0778-1والبكم:

ATTENZIONE: Qualora fosse l'italiano la lingua parlata, sono disponibili dei servizi di assistenza linguistica

gratuiti. Chiamare il numero 1-800-352-2583 (TTY: 1-800-955-8770). FEP: chiamare il numero 1-800-333-

2227

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur

Verfügung. Rufnummer: +1-800-352-2583 (TTY: +1-800-955-8770). FEP: Rufnummer +1-800-333-2227

주의: 한국어 사용을 원하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-352-2583

(TTY: 1-800-955-8770) 로 전화하십시오. FEP: 1-800-333-2227 로 연락하십시오.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer

1-800-352-2583 (TTY: 1-800-955-8770). FEP: Zadzwoń pod numer 1-800-333-2227.

સચુના: જો તમ ેગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સવેા તમારા માટ ેઉપલબ્ધ છે.

ફોન કરો 1-800-352-2583 (TTY: 1-800-955-8770). FEP: ફોન કરો 1-800-333-2227

ประกาศ:ถา้คุณพดูภาษาไทย คุณสามารถใชบ้ริการช่วยเหลือทางภาษาไดฟ้รี โดยติดต่อหมายเลขโทรฟรี 1-800-352-2583 (TTY: 1-800-955-8770) หรือ FEP โทร 1-800-333-2227

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-352-2583（TTY: 1-

800-955-8770）まで、お電話にてご連絡ください。FEP: 1-800-333-2227

صحبت می کنید، تسهیالت زبانی رایگان در دسترس شما خواهد بود. فارسی : اگر به زبانتوجهتماس بگیريد. 2227-333-800-1با شماره :FEPتماس بگیريد. (TTY: 1-800-955-8770) 2583-352-800-1با شماره

Baa ákonínzin: Diné bizaad bee yáníłti’go, saad bee áká anáwo’, t’áá jíík’eh, ná hólǫ́. Kojį’ hodíílnih 1-800-

352-2583 (TTY: 1-800-955-8770). FEP ígíí éí kojį’ hodíílnih 1-800-333-2227.

tel:1-800-352-2583

tel:1-800-955-8770

tel:1-800-333-2227

Formulario Completo BlueMedicare - Florida Blue · Blue Medicare Preferred HMO y Blue Medicare...

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