Formulario completo de...

2019

Formulario completo de

BlueMedicareSM

Florida’s Blue Cross and Blue Shield Plan

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

Este formulario fue actualizado el 08/26/2019. Para obtener información más reciente o si tiene otras preguntas, llame a Servicio para miembros de BlueMedicare Preferred HMO al 1-844-783-5189 o 1-877 955-8773 para los usuarios de TTY . El horario es de 8:00 a.m. a 8:00 p.m., hora local, siete días de la semana. O visite www.floridablue/medicare.BeHealthy Florida, Inc., cuyo nombre comercial es Florida Blue Preferred HMO, una afiliada de Blue Cross and Blue Shield of Florida, Inc., ofrece cobertura HMO. Estas compañías son Licenciatarias Independientes de Blue Cross and Blue Shield Association.

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.

Y0011_34296S 0818 C: 08/2018

Florida’s Blue Cross and Blue Shield Plan

i

BlueMedicare Preferred (HMO)

BlueMedicare Preferred POS (HMO POS)

Formulario 2019 (Lista de Medicinas Cubiertas

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

Formulary ID 00019222, Version 16

Este formulario fue actualizado el 08/26/2019. Si tiene preguntas o desea información más actualizada, comuníquese con Servicios para miembros de BlueMedicare Preferred HMO y BlueMedicare Preferred POS 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, los 7 días de la semana. O visite www.floridablue.com/medicare.

Florida Blue Preferred HMO es un Plan HMO que tiene un contrato con Medicare. La inscripción en Florida Blue Preferred HMO depende de la renovación del contrato.

If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-800-926- 6565 (TTY: 1-800-955-8770).

Si habla español, tiene a su disposición servicios de traducción sin cargo. Llame al 1-877-926-2227 6565 (TTY: 1-877-955-8773).

Este formulario puede cambiar en cualquier momento. Recibirá un aviso cuando sea necesario.

http://www.floridablue.com/medicare.

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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 y BlueMedicare Preferred POS.

Este documento contiene una lista de las medicinas (formulario) para nuestro plan, la cual está actualizada al 26 de agosto de 2019. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, así como las fechas de actualización del formulario, aparece en la portada y contraportada.

Usted por lo general debe utilizar farmacias en la red para poder utilizar sus beneficios de medicinas recetadas. Los beneficios, el formulario, la red de farmacias y/o copagos/coseguro pueden cambiar el 1 de enero de 2020, y periódicamente durante el año.

¿Qué es el formulario de BlueMedicare Preferred 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 y 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 2019 que estaba cubierta al principio del año, no descontinuaremos o reduciremos la cobertura de la medicina durante el año de cobertura 2019, 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, o cuando sea retirada del mercado. (Vea las viñetas de abajo para obtener más información o ver cambios que podrían afectar a los miembros que se encuentran tomando 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.

Abajo están los cambios de la lista de la medicina que afectarán a los miembros que aún están tomando la medicina:

• Nuevas medicinas genéricas. Podemos eliminar de inmediato una medicina de marca denuestra Lista de medicinas si la reemplazamos con una nueva medicina genérica que aparecerá enel mismo nivel de costos compartidos o en un nivel más bajo y con las mismas o menosrestricciones. Además, al agregar la nueva medicina genérica, podemos decidir mantener lamedicina de marca en nuestra Lista de medicinas, pero moverla inmediatamente a un nivel de costocompartido diferente o agregar nuevas restricciones. Si actualmente está tomando esa medicina demarca, podríamos no informarle con anticipación antes de hacer ese cambio, pero luego lebrindaremos información sobre los cambios específicos que hemos realizado.

o Si hacemos dicho cambio, o bien usted y su proveedor pueden solicitar que el plan haga unaexcepción y que continúe brindándole cobertura para la medicina de marca. La notificaciónque le proporcionemos también incluirá información en los pasos que podría tomar alsolicitar la excepción, y también podrá encontrar información en la sección de abajo titulada"¿Cómo solicito una excepción al formulario de BlueMedicare Preferred y Preferred POS?”

• Medicinas eliminadas del mercado. Si la Administración de Alimentos y Medicinas (Food andDrug Administration) considera que una medicina en nuestro formulario no es segura o el fabricante

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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.

• Otros cambios. Podríamos hacer otros cambios que afectan a los miembros que se encuentrantomando actualmente la medicina. Por ejemplo, podemos agregar una medicina genérica nuevapara reemplazar una medicina de marca actualmente incluida en el formulario o agregar nuevasrestricciones a la medicina de marca o moverla a un nivel diferente de costo compartido.)Podríamos añadir una medicina genérica que no es nueva en el mercado, para remplazar unamedicina de marca que se encuentra en el formulario o añadir nuevas restricciones a la medicina demarca o moverla a un nivel de costo compartido diferente. O podríamos hacer cambios en base anuevos lineamientos clínicos.

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 30 días antes de que el cambio entre en vigencia, o en el momento en el que el miembro solicite un reabastecimiento de la medicina, para el cual el miembro recibirá un suministro de 30 días de la medicina.

Esta lista está actualizada al 26 de agosto de 2019. Para obtener información actualizada sobre las medicinas cubiertas por nuestro plan, comuníquese con nosotros. Nuestra información de contacto aparece en la portada y contraportada

BlueMedicare Preferred y BlueMedicare Preferred POS proporciona actualizaciones mensuales del formulario en (www.floridablue.com/medicare) y en papel como sea necesario. El siguiente párrafo explicará cómo será notificado en el caso de ciertos cambios.

BlueMedicare Preferred y BlueMedicare Preferred POS solo eliminará medicinas de la Parte D del formulario, moverá medicinas cubiertas por la Parte D a un nivel preferido 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 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 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 30 días de la medicina de la Parte Dbajo los mismos 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 listadas 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. Después busque bajo el nombre de la categoría de su medicina.

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Lista alfabética

Si no está seguro bajo qué categoría buscar, puede buscar la medicina en el índice que comienza en la página 103. 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 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.

• 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 la portada y contraportada.

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 y BlueMedicare Preferred POS?" en la página v 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 Servicios para miembros 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 Servicios para miembros un listado de las medicinas similares que estáncubiertas por su plan. Cuando reciba la lista, muéstresela a su médico y pídale que le recete unamedicina similar que esté cubierta por nuestro plan.

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• 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 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 solicitarnosque 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 se le exima 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, luego de recibir la declaración de su 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 miembro 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.

Para cada una de sus medicinas que no se encuentren en nuestro formulario o si su habilidad para recibir medicinas es limitada, cubriremos un suministro temporal de 30 días. Si su receta indica menos días, permitiremos que la medicina se rea varias veces para proporcionar hasta un máximo de 30 días de suministro de la medicina. Luego de su primer suministro de 30 días, no pagaremos por estas medicinas, incluso si usted ha sido miembro del plan por menos de 90 días.

Si reside en un establecimiento de cuidados a largo plazo y necesita una medicina que no está en nuestro formulario o si su capacidad para recibir la medicina es limitada, pero ya pasaron los primeros 90 días de la

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inscripción a nuestro plan, le cubriremos un suministro de emergencia de 31 días de esa medicina 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 medicinas 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 miembro es admitido o dado de alta de un establecimiento de cuidados a largo plazo (Long Term Care, LTC), este 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 medicina que sería afectada 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 reabastecimientos tempranos para limitar el acceso apropiado o necesario a los beneficios de la Parte D del miembro, y estos miembros 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 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 la portada y contraportada.

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.

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 103.

La primera columna de la tabla lista el nombre de la medicina. Los nombres de las medicinas de marca están en 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 mcg Microgramo

ad Absorbido meq Mili equivalente

aer, aero Aerosol mg Miligramo

app Aplicador ml Mililitro

ba, breath act, breath activ

Respiración activada mu Millones de unidades

bau Unidades bioequivalentes de alergia

nebu Nébula

cap, caps Cápsulas orally disintegr tab Tabletas que se desintegran por vía oral

cart Cartucho op, ophth Oftálmico

chew tab Tabletas masticables osm Osmótico

conc Concentración pf Libre de preservativos

conj Conjugar, conjugado pfu Unidades formadoras de placa

crys Cristales pow, powd Polvo

deter Disuasivo Pref, prefill Precargada

disint Desintegración pak Paquete

dr Liberación retrasada ptwk Parche semanal

ec Envoltura entérica pttw Parche dos veces a la semana

el, elu Ensayo por inmunoabsorción ligado a enzimas

recomb Recombinante

er, extended, extended rel, xl, xr

Liberación prolongada sl Sublingual

ext Extraer sol, soln Solución

gm Gramo sr Liberación sostenida

gu Genitourinario supp, suppos Supositorios

hr Hora sus, susp Suspensión

Ig Inmunoglobulina syr Jeringuilla

im Intramuscular tab, tabs Tableta

inh, inhal Inhalación td Transdermal

inj Inyección tl Translingual

IR Liberación inmediata unt Unidad

iv Intravenoso vac Vacunas

l Litro va Vaginal

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Etapa de cobertura inicial

La cantidad de copago/coseguro 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

Especia-lizadas

Nivel 6

Select Care

BlueMedicare Preferred (HMO) (Manatee, Sarasota)

De venta al por menor preferidas

$0 de copago

$1 de copago

$35 de copago

$100 de copago

33% del costo

$7 de copago

De venta al por menor 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


$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


$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)

(Manatee,

Pinellas y

Sarasota)


$0 de copago

$7 de copago

$35 de copago

$85 de copago

33% del costo

$7 de copago


$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 para las 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 de 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 demedicinas. Puede que estas medicinas estén disponibles sólo en algunas farmacias. Servicios paramiembros al 1-844-783-5189. (Los usuarios de TTY deben llamar al 1-877-955-8773). El horario es de8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. O visite www.floridablue.com/medicare.

# = Medicinas de alto riesgo (HRM). Medicinas que no son seguras para pacientes mayores 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.

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.

2019

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# 3 QL (180 tablets/30 days)butalbital-acetaminophen-caffeine cap 50-300-40 mg# 3 QL (180 capsules/30 days)butalbital-acetaminophen-caffeine cap 50-325-40 mg# 3 QL (180 capsules/30 days)butalbital-acetaminophen-caffeine tab 50-325-40 mg# 3 QL (180 tablets/30 days)butalbital-aspirin-caffeine cap 50-325-40 mg# 3 QL (180 capsules/30 days)BUTORPHANOL TARTRATE - butorphanol tartrate inj 1 mg/ml 3butorphanol tartrate inj 2 mg/ml 3butorphanol tartrate nasal soln 10 mg/ml 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 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 PAdiclofenac sodium tab delayed release 25 mg 2 QL (240 tablets/30 days)diclofenac sodium tab delayed release 50 mg 2 QL (120 tablets/30 days)diclofenac sodium tab delayed release 75 mg 2 QL (60 tablets/30 days)diclofenac sodium tab er 24hr 100 mg 2 QL (60 tablets/30 days)diclofenac w/ misoprostol tab delayed release 50-0.2 mg 2 QL (120 tablets/30 days)diclofenac w/ misoprostol tab delayed release 75-0.2 mg 2 QL (90 tablets/30 days)EC-NAPROXEN - naproxen tab ec 375 mg 2 QL (120 tablets/30 days)EC-NAPROXEN - naproxen tab ec 500 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)

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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 500 mg 2 QL (60 tablets/30 days)etodolac tab er 24hr 600 mg 2 QL (30 tablets/30 days)etodolac tab 400 mg 2 QL (60 tablets/30 days)etodolac tab 500 mg 2 QL (60 tablets/30 days)fentanyl citrate lozenge on a handle 200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 400 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 800 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1200 mcg 5 PA, QL (120 lozenges/30 days)fentanyl citrate lozenge on a handle 1600 mcg 5 PA, QL (120 lozenges/30 days)fentanyl td patch 72hr 12 mcg/hr 3 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 3 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 3 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 3 QL (360 tablets/30 days)hydrocodone-acetaminophen tab 7.5-300 mg 3 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 3 QL (180 tablets/30 days)hydrocodone-ibuprofen tab 5-200 mg 3 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 7.5-200 mg 3 QL (150 tablets/30 days)hydrocodone-ibuprofen tab 10-200 mg 4 QL (150 tablets/30 days)hydromorphone hcl inj 2 mg/ml 3 BDhydromorphone hcl liqd 1 mg/ml 3 QL (1440 mls/30 days)hydromorphone hcl preservative free inj 2 mg/ml 3 BDhydromorphone 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 2

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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)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 3 mg 5 QL (120 tablets/30 days)levorphanol tartrate tab 2 mg 5 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 3 QL (240 tablets/30 days)MORPHINE SULFATE - morphine sulfate tab 30 mg 3 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 3 QL (2700 mls/30 days)morphine sulfate oral soln 20 mg/5ml 3 QL (1350 mls/30 days)morphine sulfate oral soln 100 mg/5ml (20 mg/ml) 3 QL (270 mls/30 days)morphine sulfate tab er 15 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 30 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 60 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 100 mg 3 PA, QL (90 tablets/30 days)morphine sulfate tab er 200 mg 3 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 2 QL (150 tablets/30 days)naproxen sodium tab 550 mg 2 QL (90 tablets/30 days)naproxen susp 125 mg/5ml 3 QL (1800 mls/30 days)naproxen tab ec 375 mg 2 QL (120 tablets/30 days)naproxen tab ec 500 mg 2 QL (90 tablets/30 days)naproxen tab 250 mg^ 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)

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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)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 3 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 3 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 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 3 PA, QL (30 tablets/30 days)tramadol hcl tab er 24hr 200 mg 3 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 3 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 local inj 1%^ 1lidocaine hcl local preservative free inj 1%^ 1lidocaine hcl soln 4% 2 PA, QL (150 mls/30 days)lidocaine hcl urethral/mucosal gel 2% 2 PA, QL (150 mls/30 days)lidocaine hcl viscous soln 2% 2lidocaine oint 5% 3 PA, QL (100 grams/30 days)lidocaine patch 5% 3 PA, QL (90 patches/30 days)lidocaine-prilocaine cream 2.5-2.5% 3 PA, QL (60 grams/30 days)Agentes contra las adicciones y para tratar el abuso deacamprosate calcium tab delayed release 333 mg 2buprenorphine hcl sl tab 2 mg 2 QL (90 tablets/30 days)buprenorphine hcl sl tab 8 mg 2 QL (90 tablets/30 days)buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 2 QL (120 films/30 days)buprenorphine hcl-naloxone hcl sl film 4-1 mg 2 QL (30 films/30 days)buprenorphine hcl-naloxone hcl sl film 8-2 mg 2 QL (60 films/30 days)buprenorphine hcl-naloxone hcl sl film 12-3 mg 2 QL (60 films/30 days)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg 2 QL (120 tablets/30 days)buprenorphine hcl-naloxone hcl sl tab 8-2 mg 2 QL (90 tablets/30 days)bupropion hcl (smoking deterrent) tab er 12hr 150 mg 2CHANTIX - varenicline tartrate tab 0.5 mg 3CHANTIX - varenicline tartrate tab 1 mg 3CHANTIX CONTINUING MONTH PACK - varenicline tartrate tab

1 mg3

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

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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 4

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NICOTROL INHALER - nicotine inhaler system 10 mg (4 mgdelivered)

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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

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SUBOXONE - buprenorphine hcl-naloxone hcl sl film 2-0.5 mg 3 QL (120 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1 mg 3 QL (30 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 8-2 mg 3 QL (60 films/30 days)SUBOXONE - buprenorphine hcl-naloxone hcl sl film 12-3 mg 3 QL (60 films/30 days)VIVITROL - naltrexone for im extended release susp 380 mg 5Medicamentos antibacterialesamikacin sulfate inj 500 mg/2ml (250 mg/ml) 3amikacin sulfate inj 1 gm/4ml (250 mg/ml) 3amoxicillin (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 3amoxicillin & k clavulanate tab 500-125 mg 2amoxicillin & k clavulanate tab 875-125 mg 2AMOXICILLIN/CLAVULANATE POTASSIUM - amoxicillin & k

clavulanate chew tab 200-28.5 mg3

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

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

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ampicillin sodium for inj 2 gm 2ampicillin sodium for iv soln 2 gm 2ampicillin sodium for iv soln 10 gm 3AMPICILLIN-SULBACTAM - ampicillin & sulbactam sodium for iv

soln 3 (2-1) gm3

AZITHROMYCIN - azithromycin powd pack for susp 1 gm 3azithromycin for susp 100 mg/5ml 3azithromycin for susp 200 mg/5ml 2azithromycin iv for soln 500 mg 3azithromycin tab 250 mg 2azithromycin tab 500 mg 2azithromycin tab 600 mg 2aztreonam for inj 1 gm 3aztreonam for inj 2 gm 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

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cefaclor cap 250 mg 2cefaclor cap 500 mg 2cefadroxil cap 500 mg 2cefadroxil for susp 250 mg/5ml 2cefadroxil for susp 500 mg/5ml 2cefadroxil tab 1 gm 2CEFAZOLIN SODIUM - cefazolin sodium for inj 20 gm 3cefazolin sodium for inj 500 mg 3cefazolin sodium for inj 1 gm 3cefazolin sodium for inj 10 gm 3cefdinir cap 300 mg 2cefdinir for susp 125 mg/5ml 2cefdinir for susp 250 mg/5ml 2cefepime hcl for inj 1 gm 3cefepime hcl for inj 2 gm 3cefixime cap 400 mg 2CEFOTAXIME SODIUM - cefotaxime sodium for inj 500 mg 3cefotaxime sodium for inj 1 gm 3cefoxitin sodium for inj 10 gm 3

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

sodium in dextrose inj 20 mg/ml3

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

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

and dextrose 3.74%3

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

3

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

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CHLORAMPHENICOL SODIUM SUCCINATE - chloramphenicolsodium succinate for iv inj 1 gm

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ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) 2CIPROFLOXACIN HCL - ciprofloxacin hcl tab 100 mg 3ciprofloxacin 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 3clarithromycin tab er 24hr 500 mg 3clarithromycin tab 250 mg 2clarithromycin tab 500 mg 2clindamycin hcl cap 75 mg 2clindamycin hcl cap 150 mg 2clindamycin hcl cap 300 mg 2clindamycin phosphate gel 1% 2clindamycin phosphate in d5w iv soln 300 mg/50ml 3clindamycin phosphate in d5w iv soln 600 mg/50ml 3clindamycin phosphate in d5w iv soln 900 mg/50ml 2clindamycin phosphate inj 300 mg/2ml 3clindamycin phosphate inj 600 mg/4ml 3clindamycin phosphate inj 900 mg/6ml 3clindamycin phosphate inj 9 gm/60ml 3clindamycin phosphate iv soln 300 mg/2ml 3clindamycin phosphate iv soln 600 mg/4ml 3clindamycin phosphate iv soln 900 mg/6ml 3clindamycin phosphate lotion 1% 2clindamycin phosphate soln 1% 2clindamycin phosphate swab 1% 2clindamycin phosphate vaginal cream 2% 3colistimethate sod for inj 150 mg 5DALVANCE - dalbavancin hcl for iv soln 500 mg 5daptomycin for iv soln 500 mg 5demeclocycline hcl tab 150 mg 3demeclocycline hcl tab 300 mg 3dicloxacillin sodium cap 250 mg 2

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dicloxacillin 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 3doxycycline monohydrate cap 100 mg 2doxycycline monohydrate cap 150 mg 3doxycycline monohydrate tab 50 mg 2doxycycline monohydrate tab 75 mg 2doxycycline monohydrate tab 100 mg 2doxycycline monohydrate tab 150 mg 3ertapenem sodium for inj 1 gm 4ERYPED 400 - erythromycin ethylsuccinate for susp 400 mg/5ml 4ERYTHROCIN LACTOBIONATE - erythromycin lactobionate for

inj 500 mg5

ERYTHROCIN STEARATE - erythromycin stearate tab 250 mg 4erythromycin ethylsuccinate for susp 200 mg/5ml 3erythromycin ethylsuccinate for susp 400 mg/5ml 3erythromycin pads 2% 2erythromycin soln 2% 2erythromycin tab delayed release 250 mg 4erythromycin tab delayed release 333 mg 4erythromycin tab delayed release 500 mg 4erythromycin tab 250 mg 3erythromycin tab 500 mg 3gentamicin in saline inj 0.8 mg/ml 2gentamicin in saline inj 1 mg/ml 2gentamicin in saline inj 1.6 mg/ml 3gentamicin in saline inj 1.2 mg/ml 3gentamicin sulfate inj 10 mg/ml 2gentamicin sulfate inj 40 mg/ml 2imipenem-cilastatin intravenous for soln 250 mg 3imipenem-cilastatin intravenous for soln 500 mg 3IMPAVIDO - miltefosine cap 50 mg 5

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INVANZ - ertapenem sodium for inj 1 gm 4INVANZ - ertapenem sodium for iv inj 1 gm 4levofloxacin in d5w iv soln 250 mg/50ml 3levofloxacin in d5w iv soln 500 mg/100ml 3levofloxacin in d5w iv soln 750 mg/150ml 3levofloxacin iv soln 25 mg/ml 3levofloxacin oral soln 25 mg/ml 3levofloxacin tab 250 mg^ 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) 5linezolid tab 600 mg 3 PAmeropenem iv for soln 500 mg 3meropenem iv for soln 1 gm 2methenamine hippurate tab 1 gm 2METRONIDAZOLE - metronidazole in nacl 0.74% iv soln

500 mg/100ml3

METRONIDAZOLE - metronidazole iv soln 5 mg/ml 3metronidazole cap 375 mg 3metronidazole in nacl 0.79% iv soln 500 mg/100ml 3metronidazole tab 250 mg 2metronidazole tab 500 mg 2metronidazole vaginal gel 0.75% 3minocycline 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 3moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj 2NAFCILLIN SODIUM - nafcillin sodium for inj 10 gm 5NAFCILLIN SODIUM - nafcillin sodium for iv soln 1 gm 3NAFCILLIN SODIUM - nafcillin sodium for iv soln 2 gm 3

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nafcillin sodium for inj 1 gm 3nafcillin sodium for inj 2 gm 3nafcillin sodium for iv soln 10 gm 5neomycin sulfate tab 500 mg 2neomycin-polymyxin b gu irrigation soln 2nitrofurantoin macrocrystalline cap 50 mg# 3nitrofurantoin macrocrystalline cap 100 mg# 3nitrofurantoin monohydrate macrocrystalline cap 100 mg# 3nitrofurantoin susp 25 mg/5ml# 3ofloxacin tab 400 mg 2paromomycin sulfate cap 250 mg 3penicillin 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

3

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

3

PENICILLIN G SODIUM - penicillin g sodium for inj 5000000 unit 3penicillin v potassium for soln 125 mg/5ml 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 3sulfacetamide sodium lotion 10% 2SULFADIAZINE - sulfadiazine tab 500 mg 3sulfamethoxazole-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 3SUPRAX - cefixime chew tab 200 mg 3

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SYNERCID - quinupristin-dalfopristin for inj 500 mg (150-350 mg) 5TAZICEF - ceftazidime for iv soln 1 gm 3TAZICEF - ceftazidime for iv soln 2 gm 3TEFLARO - ceftaroline fosamil for iv soln 400 mg 5TEFLARO - ceftaroline fosamil for iv soln 600 mg 5tetracycline hcl cap 250 mg 3tetracycline hcl cap 500 mg 3tigecycline for iv soln 50 mg 5TOBRAMYCIN SULFATE - tobramycin sulfate inj 10 mg/ml 2TOBRAMYCIN SULFATE - tobramycin sulfate inj 2 gm/50ml

(40 mg/ml)3

tobramycin sulfate for inj 1.2 gm 3tobramycin sulfate inj 80 mg/2ml (40 mg/ml) 3tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml) 3trimethoprim tab 100 mg 2VANCOMYCIN HCL - vancomycin hcl for iv soln 100 gm 3vancomycin hcl cap 125 mg 3vancomycin hcl cap 250 mg 3vancomycin hcl for iv soln 500 mg 3vancomycin hcl for iv soln 750 mg 2vancomycin hcl for iv soln 1 gm 3vancomycin hcl for iv soln 5 gm 2vancomycin hcl for iv soln 10 gm 3VANCOMYCIN HCL IN DEXTROSE - vancomycin hcl-dextrose iv

soln 500 mg/100ml-5%4

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

4

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

4

VANCOMYCIN HYDROCHLORIDE - vancomycin hcl for iv soln250 mg

4

VANCOMYCIN HYDROCHLORIDE - vancomycin hcl for iv soln1.25 gm

4

VANCOMYCIN HYDROCHLORIDE - vancomycin hcl for iv soln1.5 gm

4

ZOSYN - piperacillin sod-tazobactam na for inj 3.375 gm(3-0.375 gm)

4

ZOSYN - piperacillin sod-tazobactam sod for inj 2.25 gm(2-0.25 gm)

4

ZOSYN - piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) 4

2019



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

4

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

4

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

4

Medicamentos anticonvulsantesAPTIOM - eslicarbazepine acetate tab 200 mg 5APTIOM - eslicarbazepine acetate tab 400 mg 5APTIOM - eslicarbazepine acetate tab 600 mg 5APTIOM - eslicarbazepine acetate tab 800 mg 5BANZEL - rufinamide susp 40 mg/ml 5BANZEL - rufinamide tab 200 mg 4BANZEL - rufinamide tab 400 mg 5BRIVIACT - brivaracetam iv soln 50 mg/5ml 4BRIVIACT - brivaracetam oral soln 10 mg/ml 5BRIVIACT - brivaracetam tab 10 mg 5BRIVIACT - brivaracetam tab 25 mg 5BRIVIACT - brivaracetam tab 50 mg 5BRIVIACT - brivaracetam tab 75 mg 5BRIVIACT - brivaracetam tab 100 mg 5carbamazepine cap er 12hr 100 mg 2carbamazepine cap er 12hr 200 mg 2carbamazepine cap er 12hr 300 mg 2carbamazepine chew tab 100 mg 2carbamazepine susp 100 mg/5ml 2carbamazepine tab er 12hr 100 mg 2carbamazepine tab er 12hr 200 mg 2carbamazepine tab er 12hr 400 mg 3carbamazepine tab 200 mg 2CELONTIN - methsuximide cap 300 mg 4clobazam suspension 2.5 mg/ml 4 PA, QL (480 mls/30 days)clobazam tab 10 mg 2 PA, QL (60 tablets/30 days)clobazam tab 20 mg 2 PA, QL (60 tablets/30 days)DIASTAT ACUDIAL - diazepam rectal gel delivery system 10 mg 4 QL (5 twin pack(s)/30 days)DIASTAT ACUDIAL - diazepam rectal gel delivery system 20 mg 4 QL (5 twin pack(s)/30 days)DIASTAT PEDIATRIC - diazepam rectal gel delivery system

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

DIAZEPAM - diazepam rectal gel delivery system 2.5 mg 4 QL (5 twin pack(s)/30 days)

2019


15


DIAZEPAM - diazepam rectal gel delivery system 10 mg 4 QL (5 twin pack(s)/30 days)DIAZEPAM - diazepam rectal gel delivery system 20 mg 4 QL (5 twin pack(s)/30 days)DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system

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

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system10 mg

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

DIAZEPAM RECTAL GEL - diazepam rectal gel delivery system20 mg

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

DILANTIN - phenytoin sodium extended cap 30 mg 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 2EPIDIOLEX - cannabidiol soln 100 mg/ml 5 PAethosuximide cap 250 mg 2ethosuximide soln 250 mg/5ml 2felbamate susp 600 mg/5ml 5felbamate tab 400 mg 3felbamate tab 600 mg 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 2

2019



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

ml#4

phenobarbital tab 15 mg# 4phenobarbital tab 16.2 mg# 4phenobarbital tab 30 mg# 4

2019


17


phenobarbital tab 32.4 mg# 4phenobarbital tab 60 mg# 4phenobarbital tab 64.8 mg# 4phenobarbital tab 97.2 mg# 4phenobarbital tab 100 mg# 4phenytoin 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 2pregabalin cap 25 mg 3 QL (90 capsules/30 days)pregabalin cap 50 mg 3 QL (90 capsules/30 days)pregabalin cap 75 mg 3 QL (90 capsules/30 days)pregabalin cap 100 mg 3 QL (90 capsules/30 days)pregabalin cap 150 mg 3 QL (90 capsules/30 days)pregabalin cap 200 mg 3 QL (90 capsules/30 days)pregabalin cap 225 mg 3 QL (60 capsules/30 days)pregabalin cap 300 mg 3 QL (60 capsules/30 days)primidone tab 50 mg 2primidone tab 250 mg 2SABRIL - vigabatrin tab 500 mg* 5SPRITAM - levetiracetam tab disintegrating soluble 250 mg 4SPRITAM - levetiracetam tab disintegrating soluble 500 mg 4SPRITAM - levetiracetam tab disintegrating soluble 750 mg 5SPRITAM - levetiracetam tab disintegrating soluble 1000 mg 4SYMPAZAN - clobazam oral film 5 mg 5 PA, QL (240 films/30 days)SYMPAZAN - clobazam oral film 10 mg 5 PA, QL (60 films/30 days)SYMPAZAN - clobazam oral film 20 mg 5 PA, QL (60 films/30 days)tiagabine 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^ 1

2019



valproate sodium inj 100 mg/ml 3valproate sodium oral soln 250 mg/5ml 2valproic acid cap 250 mg 2vigabatrin powd pack 500 mg* 5vigabatrin tab 500 mg* 5VIMPAT - lacosamide iv inj 200 mg/20ml (10 mg/ml) 3VIMPAT - lacosamide oral solution 10 mg/ml 3VIMPAT - lacosamide tab 50 mg 3VIMPAT - lacosamide tab 100 mg 3VIMPAT - lacosamide tab 150 mg 3VIMPAT - lacosamide tab 200 mg 3zonisamide cap 25 mg 2zonisamide cap 50 mg 2zonisamide cap 100 mg 2Agentes contra la demenciadonepezil hydrochloride orally disintegrating tab 5 mg 2donepezil hydrochloride orally disintegrating tab 10 mg 2donepezil hydrochloride tab 5 mg^ 1donepezil hydrochloride tab 10 mg^ 1donepezil hydrochloride tab 23 mg 3ERGOLOID MESYLATES - ergoloid mesylates tab 1 mg# 3GALANTAMINE HYDROBROMIDE - galantamine hydrobromide

oral soln 4 mg/ml3

galantamine hydrobromide cap er 24hr 8 mg 2galantamine hydrobromide cap er 24hr 16 mg 2galantamine hydrobromide cap er 24hr 24 mg 2galantamine hydrobromide tab 4 mg 2galantamine hydrobromide tab 8 mg 2galantamine hydrobromide tab 12 mg 2memantine hcl oral solution 2 mg/ml 4 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 3

2019


19


rivastigmine td patch 24hr 9.5 mg/24hr 3rivastigmine td patch 24hr 13.3 mg/24hr 3Medicamentos antidepresivosamitriptyline hcl tab 10 mg# 3 PAamitriptyline hcl tab 25 mg# 3 PAamitriptyline hcl tab 50 mg# 3 PAamitriptyline hcl tab 75 mg# 3 PAamitriptyline hcl tab 100 mg# 3 PAamitriptyline hcl tab 150 mg# 3 PAAMOXAPINE - amoxapine tab 25 mg# 3 PAAMOXAPINE - amoxapine tab 50 mg# 3 PAAMOXAPINE - amoxapine tab 100 mg# 3 PAAMOXAPINE - amoxapine tab 150 mg# 3 PAbupropion hcl tab er 12hr 100 mg 2 QL (90 tablets/30 days)bupropion hcl tab er 12hr 150 mg 2 QL (60 tablets/30 days)bupropion hcl tab er 12hr 200 mg 2 QL (60 tablets/30 days)bupropion hcl tab er 24hr 150 mg 3 QL (90 tablets/30 days)bupropion hcl tab er 24hr 300 mg 3 QL (30 tablets/30 days)bupropion hcl tab 75 mg 2 QL (60 tablets/30 days)bupropion hcl tab 100 mg 2 QL (120 tablets/30 days)citalopram hydrobromide oral soln 10 mg/5ml 2 QL (600 mls/30 days)citalopram hydrobromide tab 10 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 20 mg^ 1 QL (45 tablets/30 days)citalopram hydrobromide tab 40 mg^ 1 QL (30 tablets/30 days)clomipramine hcl cap 25 mg# 4 PAclomipramine hcl cap 50 mg# 4 PAclomipramine hcl cap 75 mg# 4 PAdesipramine hcl tab 10 mg# 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# 3 PAdoxepin hcl cap 25 mg# 3 PA

2019



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

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

FLUOXETINE DR - fluoxetine hcl cap delayed release 90 mg 2 QL (4 capsules/28 days)fluoxetine hcl cap 10 mg^ 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)fluoxetine hcl tab 20 mg 2 QL (120 tablets/30 days)fluvoxamine maleate tab 25 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 50 mg 2 QL (30 tablets/30 days)fluvoxamine maleate tab 100 mg 2 QL (90 tablets/30 days)imipramine hcl tab 10 mg# 3 PAimipramine hcl tab 25 mg# 3 PAimipramine hcl tab 50 mg# 3 PAMAPROTILINE HCL - maprotiline hcl tab 25 mg 3 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 50 mg 3 QL (90 tablets/30 days)MAPROTILINE HCL - maprotiline hcl tab 75 mg 3 QL (90 tablets/30 days)MARPLAN - isocarboxazid tab 10 mg 5

2019


21


mirtazapine 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 3NEFAZODONE HCL - nefazodone hcl tab 150 mg 3nefazodone hcl tab 50 mg 2nefazodone hcl tab 250 mg 2NEFAZODONE HYDROCHLORIDE - nefazodone hcl tab 200 mg 3nortriptyline hcl cap 10 mg# 3 PAnortriptyline hcl cap 25 mg# 3 PAnortriptyline hcl cap 50 mg# 3 PAnortriptyline hcl cap 75 mg# 3 PAnortriptyline hcl soln 10 mg/5ml# 3 PAparoxetine hcl tab 10 mg# 3 PA, QL (45 tablets/30 days)paroxetine hcl tab 20 mg# 3 PA, QL (30 tablets/30 days)paroxetine hcl tab 30 mg# 3 PA, QL (60 tablets/30 days)paroxetine hcl tab 40 mg# 3 PA, QL (45 tablets/30 days)PAXIL - paroxetine hcl oral susp 10 mg/5ml# 4 PA, QL (900 mls/30 days)phenelzine sulfate tab 15 mg 2protriptyline hcl tab 5 mg# 3 PAprotriptyline hcl tab 10 mg# 3 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)SPRAVATO 56MG DOSE - esketamine hcl nasal soln 28 mg/

device x 2 (56 mg dose pack)5 PA, QL (16 bottles/28 days)

SPRAVATO 84MG DOSE - esketamine hcl nasal soln 28 mg/device x 3 (84 mg dose pack)

5 PA, QL (24 bottles/28 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^ 1

2019



trimipramine maleate cap 25 mg# 3 PAtrimipramine maleate cap 50 mg# 3 PAtrimipramine maleate cap 100 mg# 3 PATRINTELLIX - vortioxetine hbr tab 5 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 10 mg 4 QL (30 tablets/30 days)TRINTELLIX - vortioxetine hbr tab 20 mg 4 QL (30 tablets/30 days)venlafaxine hcl cap er 24hr 37.5 mg 2 QL (60 capsules/30 days)venlafaxine hcl cap er 24hr 75 mg 2 QL (90 capsules/30 days)venlafaxine hcl cap er 24hr 150 mg 2 QL (30 capsules/30 days)venlafaxine hcl tab er 24hr 37.5 mg 3 QL (60 tablets/30 days)venlafaxine hcl tab er 24hr 75 mg 3 QL (90 tablets/30 days)venlafaxine hcl tab er 24hr 150 mg 3 QL (30 tablets/30 days)venlafaxine hcl tab 25 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 37.5 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 50 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 75 mg 2 QL (90 tablets/30 days)venlafaxine hcl tab 100 mg 2 QL (90 tablets/30 days)VIIBRYD - vilazodone hcl tab 10 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 20 mg 4 QL (30 tablets/30 days)VIIBRYD - vilazodone hcl tab 40 mg 4 QL (30 tablets/30 days)VIIBRYD STARTER PACK - vilazodone hcl tab starter kit 10 (7) &

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

Medicamentos antieméticosALOXI - palonosetron hcl iv soln 0.25 mg/5ml 5aprepitant capsule therapy pack 80 & 125 mg 3 BDaprepitant capsule 40 mg 3 BDaprepitant capsule 80 mg 3 BDaprepitant capsule 125 mg 2 BDCHLORPROMAZINE HCL - chlorpromazine hcl inj 25 mg/ml 4 PACHLORPROMAZINE HCL - chlorpromazine hcl inj 50 mg/2ml 3 PAchlorpromazine hcl tab 10 mg 3 PAchlorpromazine hcl tab 25 mg 4 PAchlorpromazine hcl tab 50 mg 4 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 BD

2019


23


EMEND - 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# 3meclizine hcl tab 25 mg# 3ondansetron hcl inj 4 mg/2ml (2 mg/ml) 2ondansetron hcl inj 40 mg/20ml (2 mg/ml) 2ondansetron hcl oral soln 4 mg/5ml 3 BDondansetron hcl tab 4 mg 2 BDondansetron hcl tab 8 mg 2 BDondansetron hcl tab 24 mg 2 BDondansetron orally disintegrating tab 4 mg 2 BDondansetron orally disintegrating tab 8 mg 2 BDpalonosetron hcl iv soln pref syr 0.25 mg/5ml 5palonosetron hcl iv soln 0.25 mg/5ml 5PALONOSETRON HYDROCHLORIDE - palonosetron hcl iv soln

0.25 mg/2ml5

perphenazine tab 2 mg 2 PAperphenazine tab 4 mg 2 PAperphenazine tab 8 mg 2 PAperphenazine tab 16 mg 2 PAprochlorperazine edisylate inj 10 mg/2ml 3prochlorperazine edisylate inj 50 mg/10ml 3prochlorperazine maleate tab 5 mg 2prochlorperazine maleate tab 10 mg 2prochlorperazine suppos 25 mg 3promethazine hcl suppos 12.5 mg# 3 PApromethazine hcl suppos 25 mg# 3 PApromethazine hcl syrup 6.25 mg/5ml# 3 PApromethazine hcl tab 12.5 mg# 3 PApromethazine hcl tab 25 mg# 3 PApromethazine hcl tab 50 mg# 3 PAMedicamentos antimicóticosAMBISOME - amphotericin b liposome iv for susp 50 mg 5 BDAMPHOTERICIN B - amphotericin b for iv soln 50 mg 3 BDcaspofungin acetate for iv soln 50 mg 5caspofungin acetate for iv soln 70 mg 5

2019



ciclopirox gel 0.77% 2ciclopirox olamine cream 0.77% 2ciclopirox olamine susp 0.77% 2ciclopirox shampoo 1% 2ciclopirox solution 8% 2clotrimazole cream 1% 2clotrimazole troche 10 mg 2CRESEMBA - isavuconazonium sulfate cap 186 mg 5 PACRESEMBA - isavuconazonium sulfate for iv soln 372 mg 5 PAeconazole nitrate cream 1% 3fluconazole for susp 10 mg/ml 2fluconazole for susp 40 mg/ml 2fluconazole in dextrose inj 200 mg/100ml 3fluconazole in dextrose inj 400 mg/200ml 3fluconazole in nacl 0.9% inj 200 mg/100ml 3fluconazole in nacl 0.9% inj 400 mg/200ml 3fluconazole tab 50 mg 2fluconazole tab 100 mg 2fluconazole tab 150 mg 2fluconazole tab 200 mg 2flucytosine cap 250 mg 5flucytosine cap 500 mg 5griseofulvin microsize susp 125 mg/5ml 3griseofulvin ultramicrosize tab 125 mg 3griseofulvin ultramicrosize tab 250 mg 3itraconazole cap 100 mg 3ketoconazole cream 2% 2ketoconazole shampoo 2% 2ketoconazole tab 200 mg 2MYCAMINE - micafungin sodium for iv soln 50 mg 5MYCAMINE - micafungin sodium for iv soln 100 mg 5NOXAFIL - posaconazole iv soln 300 mg/16.7ml (18 mg/ml) 4 PANOXAFIL - posaconazole susp 40 mg/ml 5 PANOXAFIL - posaconazole tab delayed release 100 mg 5 PAnystatin cream 100000 unit/gm 2nystatin oint 100000 unit/gm 2nystatin susp 100000 unit/ml 2nystatin tab 500000 unit 2

2019


25


nystatin topical powder 100000 unit/gm 2terbinafine hcl tab 250 mg^ 1terconazole vaginal cream 0.8% 3terconazole vaginal cream 0.4% 2terconazole vaginal suppos 80 mg 3voriconazole for inj 200 mg 3 PAvoriconazole for susp 40 mg/ml 5 PAvoriconazole tab 50 mg 5 PAvoriconazole tab 200 mg 5 PAAgentes contra la gotaallopurinol sodium for inj 500 mg 2allopurinol tab 100 mg^ 1allopurinol tab 300 mg^ 1colchicine w/ probenecid tab 0.5-500 mg 2COLCRYS - colchicine tab 0.6 mg 3febuxostat tab 40 mg 3 STfebuxostat tab 80 mg 3 STprobenecid tab 500 mg 2ULORIC - febuxostat tab 40 mg 3 STULORIC - febuxostat tab 80 mg 3 STAgentes contra las migrañasAIMOVIG - erenumab-aooe subcutaneous soln auto-injector

70 mg/ml3 PA, QL (2 pens/30 days)

AIMOVIG - erenumab-aooe subcutaneous soln auto-injector140 mg/ml

3 PA, QL (1 pen/30 days)

EMGALITY - galcanezumab-gnlm subcutaneous soln auto-injector120 mg/ml

3 PA, QL (2 pens/30 days)

EMGALITY - galcanezumab-gnlm subcutaneous soln prefilled syr120 mg/ml

3 PA, QL (2 syringes/30 days)

MIGERGOT - ergotamine w/ caffeine suppos 2-100 mg 5MIGRANAL - dihydroergotamine mesylate nasal spray 4 mg/ml 3 QL (8 mls/28 days)naratriptan hcl tab 1 mg 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)sumatriptan nasal spray 5 mg/act 3 QL (12 units (2

packages)/30 days)

2019



sumatriptan nasal spray 20 mg/act 4 QL (12 units (2packages)/30 days)

SUMATRIPTAN SUCCINATE - sumatriptan succinate solutionprefilled syringe 6 mg/0.5ml

3

sumatriptan succinate inj 6 mg/0.5ml 3sumatriptan succinate solution auto-injector 4 mg/0.5ml 3sumatriptan succinate solution auto-injector 6 mg/0.5ml 4sumatriptan succinate solution cartridge 4 mg/0.5ml 3sumatriptan succinate solution cartridge 6 mg/0.5ml 4sumatriptan succinate tab 25 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 50 mg 2 QL (18 tablets/30 days)sumatriptan succinate tab 100 mg 2 QL (18 tablets/30 days)Agentes antimiasténicosGUANIDINE HCL - guanidine hcl tab 125 mg 3MESTINON - pyridostigmine bromide syrup 60 mg/5ml 5pyridostigmine bromide syrup 60 mg/5ml 5pyridostigmine bromide tab er 180 mg 4pyridostigmine bromide tab 60 mg 2Medicamentos antimicobacterialesCAPASTAT SULFATE - capreomycin sulfate for inj 1 gm 4cycloserine 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 3PRIFTIN - rifapentine tab 150 mg 4pyrazinamide tab 500 mg 3rifabutin cap 150 mg 5rifampin cap 150 mg 2rifampin cap 300 mg 2rifampin for inj 600 mg 5SIRTURO - bedaquiline fumarate tab 100 mg 5TRECATOR - ethionamide tab 250 mg 4Medicamentos antineoplásicosabiraterone acetate tab 250 mg 5 PA, QL (120 tablets/30 days)

2019


27


ABRAXANE - paclitaxel protein-bound particles for iv susp 100 mg 5 PAAFINITOR - everolimus tab 2.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 7.5 mg 5 PA, QL (30 tablets/30 days)AFINITOR - everolimus tab 10 mg 5 PA, QL (30 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 2 mg 5 PA, QL (60 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 3 mg 5 PA, QL (90 tablets/30 days)AFINITOR DISPERZ - everolimus tab for oral susp 5 mg 5 PA, QL (60 tablets/30 days)ALECENSA - alectinib hcl cap 150 mg* 5 PA, QL (240 capsules/30 days)ALIMTA - pemetrexed disodium for iv soln 100 mg 5 PAALIMTA - pemetrexed disodium for iv soln 500 mg 5 PAALIQOPA - copanlisib hcl for iv soln 60 mg 5 PAALUNBRIG - brigatinib tab initiation therapy pack 90 mg & 180 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 30 mg 5 PA, QL (120 tablets/30 days)ALUNBRIG - brigatinib tab 90 mg 5 PA, QL (30 tablets/30 days)ALUNBRIG - brigatinib tab 180 mg 5 PA, QL (30 tablets/30 days)anastrozole tab 1 mg^ 1ARRANON - nelarabine iv soln 5 mg/ml 5arsenic trioxide inj 10 mg/10ml (1 mg/ml) 4ARZERRA - ofatumumab conc for iv infusion 100 mg/5ml* 5 PAARZERRA - ofatumumab conc for iv infusion 1000 mg/50ml* 5 PAAVASTIN - bevacizumab iv soln 100 mg/4ml (for infusion)* 5 PAAVASTIN - bevacizumab iv soln 400 mg/16ml (for infusion)* 5 PABALVERSA - erdafitinib tab 3 mg 5 PA, QL (90 tablets/30 days)BALVERSA - erdafitinib tab 4 mg 5 PA, QL (60 tablets/30 days)BALVERSA - erdafitinib tab 5 mg 5 PA, QL (30 tablets/30 days)BAVENCIO - avelumab soln for iv infusion 200 mg/10ml (20 mg/

ml)5 PA

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

2019



BOSULIF - bosutinib tab 400 mg 5 PA, QL (30 tablets/30 days)BOSULIF - bosutinib tab 500 mg 5 PA, QL (30 tablets/30 days)BRAFTOVI - encorafenib cap 75 mg 5 PA, QL (180 capsules/30 days)busulfan inj 6 mg/ml 5CABOMETYX - cabozantinib s-malate tab 20 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 40 mg* 5 PA, QL (30 tablets/30 days)CABOMETYX - cabozantinib s-malate tab 60 mg* 5 PA, QL (30 tablets/30 days)CALQUENCE - acalabrutinib cap 100 mg 5 PA, QL (60 capsules/30 days)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 2carmustine for inj 100 mg 4CISPLATIN - 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*


COPIKTRA - duvelisib cap 15 mg 5 PA, QL (56 capsules/28 days)COPIKTRA - duvelisib cap 25 mg 5 PA, QL (56 capsules/28 days)COTELLIC - cobimetinib fumarate tab 20 mg* 5 PA, QL (63 tablets/28 days)cyclophosphamide cap 25 mg 3 BDcyclophosphamide cap 50 mg 3 BDcyclophosphamide for inj 500 mg 5cyclophosphamide for inj 1 gm 5cyclophosphamide for inj 2 gm 5CYRAMZA - ramucirumab iv soln 100 mg/10ml (for infusion)* 5 PACYRAMZA - ramucirumab iv soln 500 mg/50ml (for infusion)* 5 PACYTARABINE - cytarabine inj 20 mg/ml 2 BDcytarabine inj pf 20 mg/ml 2 BDcytarabine inj pf 100 mg/ml 2 BD

2019


29


DACARBAZINE - dacarbazine for inj 100 mg 4dacarbazine for inj 200 mg 2dactinomycin for inj 0.5 mg 5DARZALEX - daratumumab iv soln 100 mg/5ml* 5 PADARZALEX - daratumumab iv soln 400 mg/20ml* 5 PAdaunorubicin hcl iv soln 20 mg/4ml 2DAUNORUBICIN HYDROCHLORIDE - daunorubicin hcl iv soln

50 mg/10ml2

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

2019



ERWINAZE - asparaginase erwinia chrysanthemi for inj 10000unit

5

ETHYOL - amifostine for inj 500 mg 5ETOPOPHOS - etoposide phosphate iv for inj 100 mg 4etoposide inj 100 mg/5ml (20 mg/ml) 3etoposide inj 500 mg/25ml (20 mg/ml) 3etoposide inj 1 gm/50ml (20 mg/ml) 3EVOMELA - melphalan hcl for inj 50 mg* 5exemestane tab 25 mg 3FARESTON - toremifene citrate tab 60 mg 5FARYDAK - panobinostat lactate cap 10 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 15 mg* 5 PA, QL (6 capsules/21 days)FARYDAK - panobinostat lactate cap 20 mg* 5 PA, QL (6 capsules/21 days)FASLODEX - fulvestrant inj 250 mg/5ml 5fludarabine phosphate for inj 50 mg 3fludarabine phosphate inj 25 mg/ml 2fluorouracil iv soln 500 mg/10ml (50 mg/ml) 3 BDfluorouracil iv soln 1 gm/20ml (50 mg/ml) 3 BDfluorouracil iv soln 2.5 gm/50ml (50 mg/ml) 3 BDfluorouracil iv soln 5 gm/100ml (50 mg/ml) 3 BDflutamide cap 125 mg 2FOLOTYN - pralatrexate iv inj 20 mg/ml 5 PAFOLOTYN - pralatrexate iv inj 40 mg/2ml 5 PAfulvestrant inj 250 mg/5ml 5GAZYVA - obinutuzumab soln for iv infusion 1000 mg/40ml

(25 mg/ml)5 PA

gemcitabine hcl for inj 200 mg 3gemcitabine hcl for inj 1 gm 3gemcitabine hcl for inj 2 gm 3gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) 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 5

2019


31


HALAVEN - eribulin mesylate inj 1 mg/2ml (0.5 mg/ml) 5 PAHERCEPTIN - trastuzumab for iv soln 150 mg* 5 PAHERCEPTIN HYLECTA - trastuzumab-hyaluronidase-oysk inj

600-10000 mg-unit/5ml*5 PA

hydroxyurea cap 500 mg 2IBRANCE - palbociclib cap 75 mg* 5 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 100 mg* 5 PA, QL (21 capsules/28 days)IBRANCE - palbociclib cap 125 mg* 5 PA, QL (21 capsules/28 days)ICLUSIG - ponatinib hcl tab 15 mg 5 PA, QL (60 tablets/30 days)ICLUSIG - ponatinib hcl tab 45 mg 5 PA, QL (30 tablets/30 days)idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 5idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) 5idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) 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) 5 PAIMFINZI - durvalumab soln for iv infusion 500 mg/10ml (50 mg/ml) 5 PAIMLYGIC - talimogene laherparepvec intralesional inj 1000000

unit/ml*4

IMLYGIC - talimogene laherparepvec intralesional inj 100000000unit/ml*

5

INLYTA - axitinib tab 1 mg* 5 PA, QL (180 tablets/30 days)INLYTA - axitinib tab 5 mg* 5 PA, QL (120 tablets/30 days)IRESSA - gefitinib tab 250 mg* 5 PA, QL (30 tablets/30 days)IRINOTECAN - irinotecan hcl inj 500 mg/25ml (20 mg/ml) 3irinotecan hcl inj 40 mg/2ml (20 mg/ml) 3

2019



irinotecan hcl inj 100 mg/5ml (20 mg/ml) 3ISTODAX (OVERFILL) - romidepsin for iv inj 10 mg 5 PAIXEMPRA KIT - ixabepilone for iv infusion 15 mg 5IXEMPRA KIT - ixabepilone for iv infusion 45 mg 5JAKAFI - ruxolitinib phosphate tab 5 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 10 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 15 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 20 mg* 5 PA, QL (60 tablets/30 days)JAKAFI - ruxolitinib phosphate tab 25 mg* 5 PA, QL (60 tablets/30 days)JEVTANA - cabazitaxel inj 60 mg/1.5ml (for iv infusion) 5 PAKADCYLA - ado-trastuzumab emtansine for iv soln 100 mg 5 PAKADCYLA - ado-trastuzumab emtansine for iv soln 160 mg 5 PAKEYTRUDA - pembrolizumab iv soln 100 mg/4ml (25 mg/ml)* 5 PAKISQALI - ribociclib succinate tab pack 200 mg daily dose 5 PA, QL (63 tablets/28 days)KISQALI - ribociclib succinate tab pack 400 mg daily dose

(200 mg tab)5 PA, QL (63 tablets/28 days)

KISQALI - ribociclib succinate tab pack 600 mg daily dose(200 mg tab)

5 PA, QL (63 tablets/28 days)

KISQALI FEMARA 200 DOSE - ribociclib 200 mg dose (200 mgtab) & letrozole 2.5 mg tbpk






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

ml)5 PA

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

5 PA

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


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


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


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


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


2019


33


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


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

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

letrozole tab 2.5 mg^ 1LEUCOVORIN CALCIUM - leucovorin calcium inj 100 mg/10ml

(10 mg/ml)4

LEUCOVORIN CALCIUM - leucovorin calcium tab 10 mg 3LEUCOVORIN CALCIUM - leucovorin calcium tab 15 mg 3leucovorin calcium for inj 50 mg 3leucovorin calcium for inj 100 mg 3leucovorin calcium for inj 200 mg 3leucovorin calcium for inj 350 mg 3leucovorin calcium for inj 500 mg 3leucovorin calcium inj 500 mg/50ml (10 mg/ml) 4leucovorin calcium tab 5 mg 2leucovorin calcium tab 25 mg 3LEUKERAN - chlorambucil tab 2 mg 5LIBTAYO - cemiplimab-rwlc iv soln 350 mg/7ml (50 mg/ml) 5 PALONSURF - trifluridine-tipiracil tab 15-6.14 mg 5 PA, QL (100 tablets/28 days)LONSURF - trifluridine-tipiracil tab 20-8.19 mg 5 PA, QL (80 tablets/28 days)LORBRENA - lorlatinib tab 25 mg 5 PA, QL (90 tablets/30 days)LORBRENA - lorlatinib tab 100 mg 5 PA, QL (30 tablets/30 days)LUMOXITI - moxetumomab pasudotox-tdfk for iv soln 1 mg 5 PALYNPARZA - olaparib tab 100 mg* 5 PA, QL (120 tablets/30 days)LYNPARZA - olaparib tab 150 mg* 5 PA, QL (120 tablets/30 days)MARQIBO - vincristine sulfate liposome iv susp 5 mg/31ml

(0.16 mg/ml)5

MATULANE - procarbazine hcl cap 50 mg* 5 PAMEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg* 5 PA, QL (90 tablets/30 days)MEKINIST - trametinib dimethyl sulfoxide tab 2 mg* 5 PA, QL (30 tablets/30 days)MEKTOVI - binimetinib tab 15 mg 5 PA, QL (180 tablets/30 days)melphalan hcl for inj 50 mg 5mercaptopurine tab 50 mg 2mesna inj 100 mg/ml 2MESNEX - mesna tab 400 mg 5mitomycin for iv soln 5 mg 4mitomycin for iv soln 20 mg 2

2019



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

ml)*5 PA

PIQRAY 200MG DAILY DOSE - alpelisib tab therapy pack 200 mgdaily dose


PIQRAY 250MG DAILY DOSE - alpelisib tab pack 250 mg dailydose (200 mg & 50 mg tabs)


PIQRAY 300MG DAILY DOSE - alpelisib tab pack 300 mg dailydose (2x150 mg tab)


POLIVY - polatuzumab vedotin-piiq for iv solution 140 mg 5 PAPOMALYST - 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)

2019


35


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

1400-23400 mg-unit/11.7ml5 PA

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

5 PA

RUBRACA - rucaparib camsylate tab 200 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 250 mg 5 PA, QL (120 tablets/30 days)RUBRACA - rucaparib camsylate tab 300 mg 5 PA, QL (120 tablets/30 days)RYDAPT - midostaurin cap 25 mg 5 PA, QL (240 capsules/30 days)SOLTAMOX - tamoxifen citrate oral soln 10 mg/5ml 5SPRYCEL - dasatinib tab 20 mg 5 PA, QL (90 tablets/30 days)SPRYCEL - dasatinib tab 50 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 70 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 80 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 100 mg 5 PA, QL (30 tablets/30 days)SPRYCEL - dasatinib tab 140 mg 5 PA, QL (30 tablets/30 days)STIVARGA - regorafenib tab 40 mg* 5 PA, QL (84 tablets/28 days)SUTENT - sunitinib malate cap 12.5 mg 5 PA, QL (90 capsules/30 days)SUTENT - sunitinib malate cap 25 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 37.5 mg 5 PA, QL (30 capsules/30 days)SUTENT - sunitinib malate cap 50 mg 5 PA, QL (30 capsules/30 days)SYNRIBO - omacetaxine mepesuccinate for inj 3.5 mg 5 PATABLOID - thioguanine tab 40 mg 4TAFINLAR - dabrafenib mesylate cap 50 mg* 5 PA, QL (120 capsules/30 days)TAFINLAR - dabrafenib mesylate cap 75 mg* 5 PA, QL (120 capsules/30 days)TAGRISSO - osimertinib mesylate tab 40 mg* 5 PA, QL (30 tablets/30 days)TAGRISSO - osimertinib mesylate tab 80 mg* 5 PA, QL (30 tablets/30 days)

2019



TALZENNA - talazoparib tosylate cap 0.25 mg 5 PA, QL (90 capsules/30 days)TALZENNA - talazoparib tosylate cap 1 mg 5 PA, QL (30 capsules/30 days)tamoxifen citrate tab 10 mg 2tamoxifen citrate tab 20 mg 2TARCEVA - erlotinib hcl tab 25 mg 5 PA, QL (60 tablets/30 days)TARCEVA - erlotinib hcl tab 100 mg 5 PA, QL (30 tablets/30 days)TARCEVA - erlotinib hcl tab 150 mg 5 PA, QL (30 tablets/30 days)TARGRETIN - bexarotene gel 1% 5TASIGNA - nilotinib hcl cap 50 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 150 mg 5 PA, QL (120 capsules/30 days)TASIGNA - nilotinib hcl cap 200 mg 5 PA, QL (120 capsules/30 days)TECENTRIQ - atezolizumab iv soln 840 mg/14ml* 5 PATECENTRIQ - atezolizumab iv soln 1200 mg/20ml* 5 PATEMODAR - temozolomide for iv soln 100 mg 5temsirolimus soln for iv infusion 25 mg/ml 5THALOMID - thalidomide cap 50 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 100 mg 5 PA, QL (30 capsules/30 days)THALOMID - thalidomide cap 150 mg 5 PA, QL (60 capsules/30 days)THALOMID - thalidomide cap 200 mg 5 PA, QL (60 capsules/30 days)thiotepa for inj 15 mg 5TIBSOVO - ivosidenib tab 250 mg 5 PA, QL (60 tablets/30 days)topotecan hcl for inj 4 mg 4topotecan hcl inj 4 mg/4ml (for infusion) 4toremifene citrate tab 60 mg 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 PAVALCHLOR - mechlorethamine hcl gel 0.016%* 5VECTIBIX - panitumumab iv soln 100 mg/5ml 5 PAVECTIBIX - panitumumab iv soln 400 mg/20ml 5 PAVELCADE - bortezomib for inj 3.5 mg 5 PAVENCLEXTA - venetoclax tab 10 mg* 3 PA, QL (60 tablets/30 days)VENCLEXTA - venetoclax tab 50 mg* 4 PA, QL (30 tablets/30 days)VENCLEXTA - venetoclax tab 100 mg* 5 PA, QL (180 tablets/30 days)

2019


37


VENCLEXTA STARTING PACK - venetoclax tab therapy starterpack 10 & 50 & 100 mg*

5 PA, QL (1 pack (42tablets)/28 days)

VERZENIO - abemaciclib tab 50 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 100 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 150 mg 5 PA, QL (60 tablets/30 days)VERZENIO - abemaciclib tab 200 mg 5 PA, QL (60 tablets/30 days)VINBLASTINE SULFATE - vinblastine sulfate inj 1 mg/ml 3 BDvincristine sulfate iv soln 1 mg/ml 2 BDvinorelbine tartrate inj 10 mg/ml 3vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 3VITRAKVI - larotrectinib sulfate cap 25 mg 5 PA, QL (180 capsules/30 days)VITRAKVI - larotrectinib sulfate cap 100 mg 5 PA, QL (60 capsules/30 days)VITRAKVI - larotrectinib sulfate oral soln 20 mg/ml 5 PA, QL (300 mls/30 days)VIZIMPRO - dacomitinib tab 15 mg 5 PA, QL (30 tablets/30 days)VIZIMPRO - dacomitinib tab 30 mg 5 PA, QL (30 tablets/30 days)VIZIMPRO - dacomitinib tab 45 mg 5 PA, QL (30 tablets/30 days)VOTRIENT - pazopanib hcl tab 200 mg* 5 PA, QL (120 tablets/30 days)VYXEOS - daunorubicin-cytarabine liposome for iv inj 44-100 mg 5 PAXALKORI - crizotinib cap 200 mg* 5 PA, QL (60 capsules/30 days)XALKORI - crizotinib cap 250 mg* 5 PA, QL (60 capsules/30 days)XOSPATA - gilteritinib fumarate tablet 40 mg 5 PA, QL (90 tablets/30 days)XTANDI - enzalutamide cap 40 mg* 5 PA, QL (120 capsules/30 days)YERVOY - ipilimumab soln for iv infusion 50 mg/10ml (5 mg/ml)* 5 PAYERVOY - ipilimumab soln for iv infusion 200 mg/40ml (5 mg/ml)* 5 PAYONDELIS - trabectedin for inj 1 mg 5 PAYONSA - abiraterone acetate tab 125 mg* 5 PA, QL (120 tablets/30 days)ZALTRAP - ziv-aflibercept iv soln 100 mg/4ml (for infusion) 5 PAZALTRAP - ziv-aflibercept iv soln 200 mg/8ml (for infusion) 5 PAZANOSAR - streptozocin for inj 1 gm 4ZEJULA - niraparib tosylate cap 100 mg 5 PA, QL (90 capsules/30 days)ZELBORAF - vemurafenib tab 240 mg* 5 PA, QL (240 tablets/30 days)ZOLINZA - vorinostat cap 100 mg 5 PA, QL (120 capsules/30 days)ZYDELIG - idelalisib tab 100 mg* 5 PA, QL (60 tablets/30 days)ZYDELIG - idelalisib tab 150 mg* 5 PA, QL (60 tablets/30 days)ZYKADIA - ceritinib cap 150 mg* 5 PA, QL (90 capsules/30 days)ZYKADIA - ceritinib tab 150 mg* 5 PA, QL (90 tablets/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)

2019



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

250 mg3

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

300 mg4 BD

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

2019


39


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

entacapone tabs 12.5-50-200 mg4

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

3

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

4


4


4

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

4

entacapone tab 200 mg 3INBRIJA - levodopa inhal powder cap 42 mg 5 PA, QL (300 capsules/30 days)pramipexole 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 2ropinirole hydrochloride tab 5 mg 2selegiline hcl cap 5 mg 2selegiline hcl tab 5 mg 2

2019



tolcapone 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 3 PA, QL (45 tablets/30 days)aripiprazole tab 5 mg 3 PA, QL (45 tablets/30 days)aripiprazole tab 10 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 15 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 20 mg 3 PA, QL (30 tablets/30 days)aripiprazole tab 30 mg 3 PA, QL (30 tablets/30 days)ARISTADA - aripiprazole lauroxil im er susp prefilled syr

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

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

5 PA, QL (1 syringe/28 days)





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


clozapine orally disintegrating tab 12.5 mg 3 PA, QL (90 tablets/30 days)clozapine orally disintegrating tab 25 mg 3 PA, QL (270 tablets/30 days)clozapine orally disintegrating tab 100 mg 3 PA, QL (270 tablets/30 days)clozapine tab 25 mg 2 PA, QL (90 tablets/30 days)clozapine tab 50 mg 2 PA, QL (90 tablets/30 days)clozapine tab 100 mg 2 PA, QL (270 tablets/30 days)clozapine tab 200 mg 3 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)fluphenazine decanoate inj 25 mg/ml 2 PAFLUPHENAZINE HCL - fluphenazine hcl elixir 2.5 mg/5ml 3 PA

2019


41


FLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml 3 PAFLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml 3 PAfluphenazine hcl tab 1 mg 2 PAfluphenazine hcl tab 2.5 mg 2 PAfluphenazine hcl tab 5 mg 2 PAfluphenazine hcl tab 10 mg 3 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 3 PAhaloperidol lactate oral conc 2 mg/ml 2 PAhaloperidol tab 0.5 mg 2 PAhaloperidol tab 1 mg 2 PAhaloperidol tab 2 mg 2 PAhaloperidol tab 5 mg 2 PAhaloperidol tab 10 mg 2 PAhaloperidol tab 20 mg 2 PAINVEGA SUSTENNA - paliperidone palmitate er susp pref syr

39 mg/0.25ml4 PA, QL (1 kit/28 days)

INVEGA SUSTENNA - paliperidone palmitate er susp pref syr78 mg/0.5ml

5 PA, QL (1 kit/28 days)



INVEGA SUSTENNA - paliperidone palmitate er susp pref syr156 mg/ml




INVEGA TRINZA - paliperidone palmitate er susp pref syr273 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)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)

2019



loxapine succinate cap 5 mg 2 PAloxapine succinate cap 10 mg 2 PAloxapine succinate cap 25 mg 2 PAloxapine succinate cap 50 mg 2 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 5 mg 4 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 10 mg 4 PAMOLINDONE HYDROCHLORIDE - molindone hcl tab 25 mg 4 PANUPLAZID - pimavanserin tartrate cap 34 mg* 5 PA, QL (30 capsules/30 days)NUPLAZID - pimavanserin tartrate tab 10 mg* 5 PA, QL (30 tablets/30 days)olanzapine for im inj 10 mg 3 PA, QL (90 vials/30 days)olanzapine orally disintegrating tab 5 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 10 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 15 mg 2 PA, QL (30 tablets/30 days)olanzapine orally disintegrating tab 20 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 2.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 7.5 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 10 mg 2 PA, QL (45 tablets/30 days)olanzapine tab 15 mg 2 PA, QL (30 tablets/30 days)olanzapine tab 20 mg 2 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 1.5 mg 3 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 3 mg 4 PA, QL (30 tablets/30 days)paliperidone tab er 24hr 6 mg 4 PA, QL (60 tablets/30 days)paliperidone tab er 24hr 9 mg 5 PA, QL (30 tablets/30 days)PERSERIS - risperidone subcutaneous for er susp prefilled syr

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

PERSERIS - risperidone subcutaneous for er susp prefilled syr120 mg


pimozide tab 1 mg 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)

2019


43


quetiapine fumarate tab 200 mg 2 PA, QL (120 tablets/30 days)quetiapine fumarate tab 300 mg 2 PA, QL (60 tablets/30 days)quetiapine fumarate tab 400 mg 2 PA, QL (60 tablets/30 days)REXULTI - brexpiprazole tab 0.25 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 0.5 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 1 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 2 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 3 mg 5 PA, QL (30 tablets/30 days)REXULTI - brexpiprazole tab 4 mg 5 PA, QL (30 tablets/30 days)RISPERDAL CONSTA - risperidone microspheres for inj 12.5 mg 4 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 25 mg 5 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 37.5 mg 5 PA, QL (2 vials/28 days)RISPERDAL CONSTA - risperidone microspheres for inj 50 mg 5 PA, QL (2 vials/28 days)risperidone orally disintegrating tab 0.25 mg 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 3 PAthioridazine hcl tab 25 mg 3 PAthioridazine hcl tab 50 mg 3 PAthioridazine hcl tab 100 mg 3 PAthiothixene cap 1 mg 2 PAthiothixene cap 2 mg 2 PAthiothixene cap 5 mg 2 PAthiothixene cap 10 mg 2 PAtrifluoperazine hcl tab 1 mg 2 PA

2019



trifluoperazine 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)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 3tizanidine 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 3 QL (60 tablets/30 days)abacavir sulfate-lamivudine tab 600-300 mg 4 QL (30 tablets/30 days)abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg 5 QL (60 tablets/30 days)acyclovir cap 200 mg 2acyclovir oint 5% 3acyclovir sodium iv soln 50 mg/ml 3 BDacyclovir susp 200 mg/5ml 3acyclovir tab 400 mg 2

2019


45


acyclovir tab 800 mg 2adefovir dipivoxil tab 10 mg 5APTIVUS - tipranavir cap 250 mg 5 QL (120 capsules/30 days)APTIVUS - tipranavir oral soln 100 mg/ml 5 QL (380 mls/30 days)atazanavir sulfate cap 150 mg 5 QL (30 capsules/30 days)atazanavir sulfate cap 200 mg 5 QL (60 capsules/30 days)atazanavir sulfate cap 300 mg 5 QL (30 capsules/30 days)ATRIPLA - efavirenz-emtricitabine-tenofovir df tab

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

BARACLUDE - entecavir oral soln 0.05 mg/ml 5BIKTARVY - bictegravir-emtricitabine-tenofovir af tab


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

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

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

5 QL (30 tablets/30 days)

CRIXIVAN - indinavir sulfate cap 200 mg 3 QL (270 capsules/30 days)CRIXIVAN - indinavir sulfate cap 400 mg 3 QL (180 capsules/30 days)DAKLINZA - daclatasvir dihydrochloride tab 30 mg 5 PADAKLINZA - daclatasvir dihydrochloride tab 60 mg 5 PADELSTRIGO - doravirine-lamivudine-tenofovir df tab


DENAVIR - 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)DOVATO - dolutegravir sodium-lamivudine tab 50-300 mg 5 QL (30 tablets/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 PA

2019



EPIVIR HBV - lamivudine oral soln 5 mg/ml (hbv) 3EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg 5 QL (30 tablets/30 days)famciclovir tab 125 mg 2famciclovir tab 250 mg 2famciclovir tab 500 mg 2fosamprenavir calcium tab 700 mg 5 QL (120 tablets/30 days)FUZEON - enfuvirtide for inj 90 mg 5 QL (60 vials/30 days)ganciclovir sodium for inj 500 mg 3 BDGENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab

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

HARVONI - ledipasvir-sofosbuvir tab 90-400 mg 5 PAINTELENCE - etravirine tab 25 mg 4 QL (120 tablets/30 days)INTELENCE - etravirine tab 100 mg 5 QL (60 tablets/30 days)INTELENCE - etravirine tab 200 mg 5 QL (60 tablets/30 days)INTRON A - interferon alfa-2b inj 6000000 unit/ml 5INTRON A - interferon alfa-2b inj 10000000 unit/ml 5INTRON A - interferon alfa-2b for inj 10000000 unit 5INTRON A - interferon alfa-2b for inj 18000000 unit 5INTRON A - interferon alfa-2b for inj 50000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 10000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 18000000 unit 5INTRON A W/DILUENT - interferon alfa-2b for inj 50000000 unit 5INVIRASE - saquinavir mesylate 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) 3lamivudine 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 3 QL (60 tablets/30 days)LEXIVA - fosamprenavir calcium susp 50 mg/ml 4 QL (1800 mls/30 days)lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) 5 QL (480 mls/30 days)

2019


47


MAVYRET - glecaprevir-pibrentasvir tab 100-40 mg 5 PAnevirapine susp 50 mg/5ml 4 QL (1200 mls/30 days)nevirapine 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)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 3oseltamivir phosphate cap 45 mg 3oseltamivir phosphate cap 75 mg 3oseltamivir phosphate for susp 6 mg/ml 3PEGASYS - peginterferon alfa-2a inj 180 mcg/ml 5 PAPEGASYS - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPEGASYS PROCLICK - peginterferon alfa-2a inj 180 mcg/0.5ml 5 PAPIFELTRO - doravirine tab 100 mg 5 QL (30 tablets/30 days)PREVYMIS - letermovir tab 240 mg 5PREVYMIS - letermovir tab 480 mg 5PREZCOBIX - darunavir-cobicistat tab 800-150 mg 5 QL (30 tablets/30 days)PREZISTA - darunavir ethanolate susp 100 mg/ml 5 QL (400 mls/30 days)PREZISTA - darunavir ethanolate tab 75 mg 4 QL (300 tablets/30 days)PREZISTA - darunavir ethanolate tab 150 mg 4 QL (180 tablets/30 days)PREZISTA - darunavir ethanolate tab 600 mg 5 QL (60 tablets/30 days)PREZISTA - darunavir ethanolate tab 800 mg 5 QL (30 tablets/30 days)REBETOL - ribavirin soln 40 mg/ml 4RELENZA DISKHALER - zanamivir aero powder breath activated

5 mg/blister4

RESCRIPTOR - delavirdine mesylate tab 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 5

2019



ribavirin cap 200 mg 2ribavirin tab 200 mg 2ritonavir tab 100 mg 3 QL (360 tablets/30 days)SELZENTRY - maraviroc oral soln 20 mg/ml 5 QL (1840 mls/30 days)SELZENTRY - maraviroc tab 25 mg 4 QL (240 tablets/30 days)SELZENTRY - maraviroc tab 75 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 150 mg 5 QL (60 tablets/30 days)SELZENTRY - maraviroc tab 300 mg 5 QL (120 tablets/30 days)SOVALDI - sofosbuvir tab 400 mg 5 PAstavudine cap 15 mg 2 QL (60 capsules/30 days)stavudine cap 20 mg 2 QL (60 capsules/30 days)stavudine cap 30 mg 2 QL (60 capsules/30 days)stavudine cap 40 mg 2 QL (60 capsules/30 days)STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab


SYLATRON - peginterferon alfa-2b for inj kit 200 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 300 mcg 5 PASYLATRON - peginterferon alfa-2b for inj kit 600 mcg 5 PASYMFI - efavirenz-lamivudine-tenofovir df tab 600-300-300 mg 5 QL (30 tablets/30 days)SYMFI LO - efavirenz-lamivudine-tenofovir df tab 400-300-300 mg 5 QL (30 tablets/30 days)SYMTUZA - darunavir-cobic-emtricitab-tenofov af tab


tenofovir 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 2

2019


49


valganciclovir hcl for soln 50 mg/ml 5valganciclovir hcl tab 450 mg 5VIDEX - didanosine for soln 2 gm 4 QL (1200 mls/30 days)VIDEX - didanosine for soln 4 gm 4 QL (1200 mls/30 days)VIDEX EC - didanosine delayed release capsule 125 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 200 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 250 mg 4 QL (30 capsules/30 days)VIDEX EC - didanosine delayed release capsule 400 mg 4 QL (30 capsules/30 days)VIEKIRA PAK - ombitas-paritapre-riton & dasab tab pak

12.5-75-50 & 250 mg5 PA

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)VOSEVI - sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg 5 PAXOFLUZA - baloxavir marboxil tab therapy pack 20 (2) mg (40 mg

dose)4

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

4

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

2019



clonazepam orally disintegrating tab 1 mg 2 PA, QL (90 tablets/30 days)clonazepam orally disintegrating tab 2 mg 2 PA, QL (300 tablets/30 days)clonazepam tab 0.5 mg^ 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 (360 tablets/30 days)clorazepate dipotassium tab 15 mg 2 PA, QL (180 tablets/30 days)DIAZEPAM - diazepam oral soln 1 mg/ml 3 PA, QL (1200 mls/30 days)diazepam conc 5 mg/ml 2 PA, QL (240 mls/30 days)diazepam tab 2 mg^ 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# 3 PAhydroxyzine hcl tab 10 mg# 3 PAhydroxyzine hcl tab 25 mg# 3 PAhydroxyzine hcl tab 50 mg# 3 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 3lithium 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 3BASAGLAR KWIKPEN - insulin glargine soln pen-injector 100

unit/ml4 QL (20 pens/30 days)

BYDUREON BCISE - exenatide extended release susp auto-injector 2 mg/0.85ml

3 QL (4 pens/28 days), ST

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

3 QL (4 pens/28 days), ST

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51


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)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 3GLYXAMBI - empagliflozin-linagliptin tab 10-5 mg 4 QL (30 tablets/30 days)GLYXAMBI - empagliflozin-linagliptin tab 25-5 mg 4 QL (30 tablets/30 days)HUMALOG - insulin lispro inj 100 unit/ml 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)

3 QL (20 pens/30 days)

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


2019



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)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


2019


53


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)LEVEMIR FLEXTOUCH - insulin detemir soln pen-injector 100


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), ST

OZEMPIC - semaglutide soln pen-inj 1 mg/dose (2 mg/1.5ml) 3 QL (2 pens/28 days), STpioglitazone 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)5

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

5

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

2019



SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr5-1000 mg




SYNJARDY XR - empagliflozin-metformin hcl tab er 24hr12.5-1000 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 - insulin degludec inj 100 unit/ml 3 QL (6 vials/30 days)TRESIBA FLEXTOUCH - insulin degludec soln pen-injector 100


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

syringe 10 mcg/0.4ml4 PA

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

4 PA


4 PA


5 PA


5 PA


5 PA

2019


55



5 PA


5 PA

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

5 PA

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

2019



EPOGEN - epoetin alfa inj 3000 unit/ml 4 PAEPOGEN - epoetin alfa inj 4000 unit/ml 4 PAEPOGEN - epoetin alfa inj 10000 unit/ml 4 PAEPOGEN - epoetin alfa inj 20000 unit/ml 5 PAfondaparinux sodium subcutaneous inj 2.5 mg/0.5ml 3 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 5 mg/0.4ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml 5 QL (30 syringes/90 days)fondaparinux sodium subcutaneous inj 10 mg/0.8ml 5 QL (30 syringes/90 days)GRANIX - tbo-filgrastim soln prefilled syringe 300 mcg/0.5ml 5GRANIX - tbo-filgrastim soln prefilled syringe 480 mcg/0.8ml 5GRANIX - tbo-filgrastim subcutaneous inj 300 mcg/ml 5GRANIX - tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml)5

heparin sodium (porcine) inj 1000 unit/ml 2heparin sodium (porcine) inj 5000 unit/ml 2heparin sodium (porcine) inj 10000 unit/ml 2heparin sodium (porcine) inj 20000 unit/ml 3heparin sodium (porcine) pf inj 5000 unit/0.5ml 2heparin sodium (porcine)-dextrose iv sol 20000 unit/500ml-5% 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

NEUPOGEN - filgrastim inj 300 mcg/ml 5NEUPOGEN - filgrastim inj 480 mcg/1.6ml (300 mcg/ml) 5PRADAXA - 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 powder pack for susp

12.5 mg*5 PA

2019


57


PROMACTA - eltrombopag olamine tab 12.5 mg* 5 PAPROMACTA - eltrombopag olamine tab 25 mg* 5 PAPROMACTA - eltrombopag olamine tab 50 mg* 5 PAPROMACTA - eltrombopag olamine tab 75 mg* 5 PARETACRIT - epoetin alfa-epbx inj 2000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 3000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 4000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 10000 unit/ml 4 PARETACRIT - epoetin alfa-epbx inj 40000 unit/ml 4 PAtranexamic acid iv soln 1000 mg/10ml (100 mg/ml) 3tranexamic acid tab 650 mg 3warfarin sodium tab 1 mg^ 1warfarin sodium tab 2 mg^ 1warfarin sodium tab 2.5 mg^ 1warfarin sodium tab 3 mg^ 1warfarin sodium tab 4 mg^ 1warfarin sodium tab 5 mg^ 1warfarin sodium tab 6 mg^ 1warfarin sodium tab 7.5 mg^ 1warfarin sodium tab 10 mg^ 1XARELTO - rivaroxaban tab 2.5 mg 3 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 10 mg 3 QL (30 tablets/30 days)XARELTO - rivaroxaban tab 15 mg 3 QL (60 tablets/30 days)XARELTO - rivaroxaban tab 20 mg 3 QL (30 tablets/30 days)XARELTO STARTER PACK - rivaroxaban tab starter therapy pack

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

ZONTIVITY - vorapaxar sulfate tab 2.08 mg 4Agentes cardiovascularesacebutolol hcl cap 200 mg 2acebutolol hcl cap 400 mg 2acetazolamide cap er 12hr 500 mg 2acetazolamide tab 125 mg 2acetazolamide tab 250 mg 2aliskiren fumarate tab 150 mg 3 QL (30 tablets/30 days)aliskiren fumarate tab 300 mg 3 QL (30 tablets/30 days)amiloride & hydrochlorothiazide tab 5-50 mg 2amiloride hcl tab 5 mg 2amiodarone hcl tab 200 mg 2

2019



amiodarone 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^ 6amlodipine 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)

2019


59


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 2bumetanide tab 1 mg 2bumetanide tab 2 mg 2BYSTOLIC - nebivolol hcl tab 2.5 mg 4BYSTOLIC - nebivolol hcl tab 5 mg 4BYSTOLIC - nebivolol hcl tab 10 mg 4BYSTOLIC - nebivolol hcl tab 20 mg 4candesartan 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^ 1

2019



carvedilol tab 25 mg^ 1CHLOROTHIAZIDE - chlorothiazide tab 250 mg 3chlorothiazide tab 500 mg 2chlorthalidone tab 25 mg 2chlorthalidone tab 50 mg 2cholestyramine light powder packets 4 gm 2cholestyramine light powder 4 gm/dose 2cholestyramine powder packets 4 gm 2cholestyramine powder 4 gm/dose 2choline fenofibrate cap dr 45 mg 2 QL (60 capsules/30 days)choline fenofibrate cap dr 135 mg 2 QL (30 capsules/30 days)clonidine hcl tab 0.1 mg 2clonidine hcl tab 0.2 mg 2clonidine hcl tab 0.3 mg 2clonidine td patch weekly 0.1 mg/24hr 2clonidine td patch weekly 0.2 mg/24hr 2clonidine td patch weekly 0.3 mg/24hr 2colestipol hcl granule packets 5 gm 2colestipol hcl granules 5 gm 2colestipol hcl tab 1 gm 2CORLANOR - 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# 3 QL (150 mls/30 days)digoxin tab 125 mcg (0.125 mg)# 2 QL (30 tablets/30 days)digoxin tab 250 mcg (0.25 mg)# 3 QL (30 tablets/30 days)diltiazem hcl cap er 12hr 60 mg 3diltiazem hcl cap er 12hr 90 mg 3diltiazem hcl cap er 12hr 120 mg 3diltiazem hcl cap er 24hr 120 mg 3diltiazem hcl cap er 24hr 180 mg 3diltiazem hcl cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 120 mg 3diltiazem hcl coated beads cap er 24hr 180 mg 3diltiazem hcl coated beads cap er 24hr 240 mg 3diltiazem hcl coated beads cap er 24hr 300 mg 3diltiazem hcl coated beads cap er 24hr 360 mg 3diltiazem hcl coated beads tab er 24hr 180 mg 2

2019


61


diltiazem 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) 3doxazosin mesylate tab 1 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 2 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 4 mg 2 QL (60 tablets/30 days)doxazosin mesylate tab 8 mg 2 QL (60 tablets/30 days)enalapril maleate & hydrochlorothiazide tab 5-12.5 mg^ 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 QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 49-51 mg 3 QL (60 tablets/30 days)ENTRESTO - sacubitril-valsartan tab 97-103 mg 3 QL (60 tablets/30 days)eplerenone tab 25 mg 2eplerenone tab 50 mg 2ezetimibe tab 10 mg 2 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 2

2019



felodipine 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^ 1furosemide 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 (60 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)

2019


63


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 2labetalol hcl tab 200 mg 2labetalol hcl tab 300 mg 2LIDOCAINE HCL - lidocaine hcl (cardiac) iv pf soln pref syr

50 mg/5ml(1%)4

LIDOCAINE HCL - lidocaine hcl (cardiac) iv soln pref syr50 mg/5ml (1%)

4

lisinopril & 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)

2019



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 3metolazone tab 2.5 mg 2metolazone tab 5 mg 2metolazone tab 10 mg 2metoprolol & hydrochlorothiazide tab 50-25 mg 2metoprolol & hydrochlorothiazide tab 100-25 mg 2metoprolol succinate tab er 24hr 25 mg 2metoprolol succinate tab er 24hr 50 mg 2metoprolol succinate tab er 24hr 100 mg 2metoprolol succinate tab er 24hr 200 mg 2metoprolol tartrate tab 25 mg^ 1metoprolol tartrate tab 50 mg^ 1metoprolol tartrate tab 100 mg^ 1mexiletine hcl cap 150 mg 2mexiletine hcl cap 200 mg 2mexiletine hcl cap 250 mg 2midodrine 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^ 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 2

2019


65


nifedipine 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 3nisoldipine 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 2nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) 3NORTHERA - droxidopa cap 100 mg* 5 PANORTHERA - droxidopa cap 200 mg* 5 PANORTHERA - droxidopa cap 300 mg* 5 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 2pravastatin sodium tab 10 mg^ 6 QL (45 tablets/30 days)

2019



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 2propranolol 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 3QUINIDINE SULFATE - quinidine sulfate tab 200 mg 3QUINIDINE SULFATE - quinidine sulfate tab 300 mg 3ramipril 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)

2019


67


ranolazine tab er 12hr 500 mg 3 QL (60 tablets/30 days)ranolazine tab er 12hr 1000 mg 3 QL (60 tablets/30 days)REPATHA - evolocumab subcutaneous soln prefilled syringe

140 mg/ml3 PA, QL (2 syringes/28 days)

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

3 PA, QL (1 system/30 days)

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

3 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 2sotalol 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)

2019



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 10 mg 3TIMOLOL MALEATE - timolol maleate tab 20 mg 3timolol maleate tab 5 mg 2torsemide 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^ 1triamterene & 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 360 mg 2verapamil hcl cap er 24hr 100 mg 2verapamil hcl cap er 24hr 120 mg 2verapamil hcl cap er 24hr 180 mg 2verapamil hcl cap er 24hr 200 mg 2verapamil hcl cap er 24hr 240 mg 2verapamil hcl cap er 24hr 300 mg 2verapamil hcl tab er 120 mg 2verapamil hcl tab er 180 mg 2

2019


69


verapamil hcl tab er 240 mg 2verapamil hcl tab 40 mg 2verapamil hcl tab 80 mg 2verapamil hcl tab 120 mg 2Agentes 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)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 3 QL (60 capsules/30 days)atomoxetine hcl cap 18 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 25 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 40 mg 3 QL (60 capsules/30 days)atomoxetine hcl cap 60 mg 3 QL (30 capsules/30 days)atomoxetine hcl cap 80 mg 3 QL (30 capsules/30 days)atomoxetine hcl cap 100 mg 3 QL (30 capsules/30 days)AUBAGIO - teriflunomide tab 7 mg 5 PA, QL (30 tablets/30 days)AUBAGIO - teriflunomide tab 14 mg 5 PA, QL (30 tablets/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)dalfampridine tab er 12hr 10 mg 5 PA

2019



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 3 QL (120 capsules/30 days)dextroamphetamine sulfate cap er 24hr 15 mg 3 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)GILENYA - fingolimod hcl cap 0.5 mg 5 PA, QL (30 capsules/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)MAYZENT - siponimod fumarate tab 0.25 mg 5 PA, QL (120 tablets/30 days)MAYZENT - siponimod fumarate tab 2 mg 5 PA, QL (30 tablets/30 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 PA, QL (60 capsules/30 days)

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


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


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


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


riluzole tab 50 mg 3TECFIDERA - dimethyl fumarate capsule delayed release 120 mg 5 PA, QL (60 capsules/30 days)TECFIDERA - dimethyl fumarate capsule delayed release 240 mg 5 PA, QL (60 capsules/30 days)TECFIDERA STARTER PACK - dimethyl fumarate capsule dr

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

tetrabenazine tab 12.5 mg 5 PA, QL (240 tablets/30 days)tetrabenazine tab 25 mg 5 PA, QL (120 tablets/30 days)TYSABRI - natalizumab for iv inj conc 300 mg/15ml* 5 PAAgentes dentales y oraleschlorhexidine gluconate soln 0.12%^ 1KEPIVANCE - palifermin for iv inj 6.25 mg 5pilocarpine hcl tab 5 mg 2pilocarpine hcl tab 7.5 mg 2

2019


71


triamcinolone acetonide dental paste 0.1% 2Agentes dermatológicosacitretin cap 10 mg 3acitretin cap 17.5 mg 3acitretin cap 25 mg 3alclometasone dipropionate cream 0.05% 2alclometasone dipropionate oint 0.05% 2azelaic acid gel 15% 3AZELEX - azelaic acid cream 20% 4benzoyl peroxide-erythromycin gel 5-3% 3betamethasone dipropionate augmented cream 0.05% 2betamethasone dipropionate augmented gel 0.05% 2betamethasone dipropionate augmented lotion 0.05% 2betamethasone dipropionate augmented oint 0.05% 2betamethasone dipropionate cream 0.05% 2betamethasone dipropionate lotion 0.05% 2betamethasone dipropionate oint 0.05% 2betamethasone valerate cream 0.1% 2betamethasone valerate lotion 0.1% 2betamethasone valerate oint 0.1% 2calcipotriene cream 0.005% 3calcipotriene oint 0.005% 3calcipotriene soln 0.005% (50 mcg/ml) 3CARAC - fluorouracil cream 0.5% 5clindamycin phosphate-benzoyl peroxide gel 1-5% 3clobetasol propionate cream 0.05% 2clobetasol propionate emollient base cream 0.05% 3clobetasol 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% 3desonide cream 0.05% 3desonide lotion 0.05% 3desonide oint 0.05% 3desoximetasone cream 0.05% 3desoximetasone cream 0.25% 2desoximetasone gel 0.05% 3

2019



desoximetasone oint 0.25% 3diclofenac sodium gel 3% 5diflorasone diacetate oint 0.05% 3ELIDEL - pimecrolimus cream 1% 4 PAFINACEA - azelaic acid foam 15% 3FINACEA - azelaic acid gel 15% 3fluocinolone acetonide cream 0.01% 2fluocinonide cream 0.05% 2fluocinonide emulsified base cream 0.05% 2fluocinonide gel 0.05% 2fluocinonide oint 0.05% 2fluocinonide soln 0.05% 2FLUOROURACIL - fluorouracil soln 2% 2FLUOROURACIL - fluorouracil soln 5% 2fluorouracil cream 5% 3fluticasone propionate cream 0.05% 2fluticasone propionate oint 0.005% 2gentamicin sulfate cream 0.1% 2gentamicin sulfate oint 0.1% 2halobetasol propionate cream 0.05% 3halobetasol propionate oint 0.05% 3hydrocortisone butyrate cream 0.1% 2hydrocortisone butyrate hydrophilic lipo base cream 0.1% 2hydrocortisone butyrate oint 0.1% 3hydrocortisone butyrate soln 0.1% 3hydrocortisone cream 1%^ 1hydrocortisone cream 2.5% 2hydrocortisone lotion 2.5% 2hydrocortisone oint 1% 2hydrocortisone oint 2.5% 2hydrocortisone valerate cream 0.2% 3hydrocortisone valerate oint 0.2% 3imiquimod cream 5% 2 PAisotretinoin cap 10 mg 3isotretinoin cap 20 mg 3isotretinoin cap 30 mg 3isotretinoin cap 40 mg 3lactic acid (ammonium lactate) cream 12% 2

2019


73


lactic acid (ammonium lactate) lotion 12% 2methoxsalen rapid cap 10 mg 5metronidazole cream 0.75% 2metronidazole gel 0.75% 2metronidazole gel 1% 3metronidazole lotion 0.75% 3mometasone 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-% 3nystatin-triamcinolone oint 100000-0.1 unit/gm-% 3ORACEA - doxycycline (rosacea) cap delayed release 40 mg 4PICATO - ingenol mebutate gel 0.015% 3 QL (3 tubes/30 days)PICATO - ingenol mebutate gel 0.05% 3 QL (2 tubes/30 days)pimecrolimus cream 1% 4 PApodofilox soln 0.5% 2PREDNICARBATE - prednicarbate oint 0.1% 2prednicarbate cream 0.1% 2REGRANEX - becaplermin gel 0.01% 5 PA, QL (15 grams/30 days)SANTYL - collagenase oint 250 unit/gm 3selenium sulfide lotion 2.5% 2silver sulfadiazine cream 1% 2SOOLANTRA - ivermectin cream 1% 3tacrolimus oint 0.03% 3 PAtacrolimus oint 0.1% 3 PAtazarotene cream 0.1% 3TAZORAC - tazarotene cream 0.05% 4TAZORAC - tazarotene gel 0.05% 4TAZORAC - tazarotene gel 0.1% 4tretinoin cream 0.025% 2tretinoin cream 0.05% 3tretinoin cream 0.1% 3tretinoin gel 0.01% 2tretinoin gel 0.025% 2triamcinolone acetonide cream 0.025% 2triamcinolone acetonide cream 0.1% 2triamcinolone acetonide cream 0.5% 2

2019



triamcinolone 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 BDAURYXIA - ferric citrate tab 1 gm (210 mg ferric iron) 5 PAcalcium acetate cap 667 mg 2calcium acetate tab 667 mg 2CARBAGLU - carglumic acid tab 200 mg 5 PACHEMET - succimer cap 100 mg 4deferasirox tab for oral susp 125 mg 5 PAdeferasirox tab for oral susp 250 mg 5 PAdeferasirox tab for oral susp 500 mg 5 PAdextrose inj 5% 2dextrose inj 10% 2dextrose 2.5% w/ sodium chloride 0.45%^ 1dextrose 5% in lactated ringers 3dextrose 5% w/ sodium chloride 0.2% 3dextrose 5% w/ sodium chloride 0.33%^ 1dextrose 5% w/ sodium chloride 0.45%^ 1dextrose 5% w/ sodium chloride 0.9%^ 1EXJADE - deferasirox tab for oral susp 125 mg* 5 PAEXJADE - deferasirox tab for oral susp 250 mg* 5 PAEXJADE - deferasirox tab for oral susp 500 mg* 5 PAfat emulsion plant based iv emulsion 20% 4 BDfomepizole inj 1 gm/ml (for iv infusion) 5FOSRENOL - lanthanum carbonate oral powder pack 750 mg 5FOSRENOL - lanthanum carbonate oral powder pack 1000 mg 5HEPATAMINE - amino acid infusion 8% 3 BDJADENU - deferasirox tab 90 mg 5 PAJADENU - deferasirox tab 180 mg 5 PAJADENU - deferasirox tab 360 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 90 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 180 mg 5 PAJADENU SPRINKLE - deferasirox granules packet 360 mg 5 PA

2019


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kcl 20 meq/l (0.15%) in nacl 0.45% inj 3kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj 3kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj 2kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj 2kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj 3kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj 2kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj 3lactated 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 ER - potassium chloride tab er 20 meq

(1500 mg)4

potassium 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) 3potassium chloride tab er 8 meq (600 mg) 3potassium chloride tab er 10 meq 2potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 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

3

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) 2SAMSCA - tolvaptan tab 15 mg 5 PASAMSCA - tolvaptan tab 30 mg 5 PAsevelamer carbonate packet 0.8 gm 5

2019



sevelamer carbonate packet 2.4 gm 5sevelamer carbonate tab 800 mg 3sodium chloride irrigation soln 0.9% 2sodium chloride iv soln 0.45% 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 2trientine hcl cap 250 mg 5 PA, QL (240 capsules/30 days)VELPHORO - sucroferric oxyhydroxide chew tab 500 mg 5VELTASSA - patiromer sorbitex calcium for susp packet 8.4 gm 4VELTASSA - patiromer sorbitex calcium for susp packet 16.8 gm 4VELTASSA - patiromer sorbitex calcium for susp packet 25.2 gm 4water for irrigation, sterile irrigation soln 2Agentes gastrointestinalesalosetron hcl tab 0.5 mg 5alosetron hcl tab 1 mg 5AMITIZA - lubiprostone cap 8 mcg 3 PAAMITIZA - lubiprostone cap 24 mcg 3 PACHENODAL - chenodiol tab 250 mg* 5 PACIMETIDINE HCL - cimetidine 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 3dicyclomine hcl cap 10 mg# 3 PAdicyclomine hcl tab 20 mg# 3 PAesomeprazole magnesium cap delayed release 20 mg 2 QL (30 capsules/30 days)esomeprazole magnesium cap delayed release 40 mg 2 QL (30 capsules/30 days)ESOMEPRAZOLE SODIUM - esomeprazole sodium for

intravenous soln 20 mg3

esomeprazole sodium for intravenous soln 40 mg 3famotidine for susp 40 mg/5ml 3famotidine inj 20 mg/2ml 2famotidine inj 40 mg/4ml 2famotidine inj 200 mg/20ml 2famotidine tab 20 mg 2

2019


77


famotidine tab 40 mg 2GATTEX - 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^ 1methscopolamine 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)





NEXIUM - esomeprazole magnesium for delayed release susppack 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)

2019



pantoprazole sodium ec tab 40 mg^ 1 QL (60 tablets/30 days)pantoprazole sodium for iv soln 40 mg 3peg 3350-kcl-sod bicarb-nacl for soln 420 gm 3peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm 3peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm 2PYLERA - bismuth subcit-metronidazole-tetracycline cap

140-125-125 mg5

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^ 1ranitidine hcl tab 300 mg^ 1RELISTOR - methylnaltrexone bromide inj 8 mg/0.4ml (20 mg/ml) 5 PARELISTOR - methylnaltrexone bromide inj 12 mg/0.6ml (20 mg/

ml)5 PA

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

17.5-3.13-1.6 gm/177ml4

ursodiol cap 300 mg 4ursodiol tab 250 mg 2ursodiol tab 500 mg 2XIFAXAN - rifaximin tab 550 mg 5Trastorno genético o enzimático:ALDURAZYME - laronidase soln for iv infusion 2.9 mg/5ml (500

unit/5ml)*5

CEREZYME - imiglucerase for inj 400 unit* 5 PACREON - pancrelipase (lip-prot-amyl) dr cap 3000-9500-15000

unit3

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

3

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

3

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

3

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

3

CRYSVITA - burosumab-twza inj 10 mg/ml 5 PACRYSVITA - burosumab-twza inj 20 mg/ml 5 PA

2019


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CRYSVITA - burosumab-twza inj 30 mg/ml 5 PACYSTADANE - betaine powder for oral solution 5CYSTAGON - cysteamine bitartrate cap 50 mg* 4 PACYSTAGON - cysteamine bitartrate cap 150 mg* 4 PAELAPRASE - idursulfase soln for iv infusion 6 mg/3ml (2 mg/ml)* 5ELELYSO - taliglucerase alfa for inj 200 unit* 5 PAFABRAZYME - agalsidase beta for iv soln 5 mg* 5FABRAZYME - agalsidase beta for iv soln 35 mg* 5KUVAN - sapropterin dihydrochloride powder packet 100 mg* 5 PAKUVAN - sapropterin dihydrochloride powder packet 500 mg* 5 PAKUVAN - sapropterin dihydrochloride soluble tab 100 mg* 5 PALUMIZYME - alglucosidase alfa for iv soln 50 mg 5miglustat cap 100 mg* 5 PA, QL (90 capsules/30 days)NAGLAZYME - galsulfase soln for iv infusion 1 mg/ml* 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* 5PALYNZIQ - pegvaliase-pqpz subcutaneous soln pref syringe

2.5 mg/0.5ml5 PA

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

5 PA

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

5 PA

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

5 PA

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

5 PA

REVCOVI - elapegademase-lvlr im soln 2.4 mg/1.5ml (1.6 mg/ml) 5sodium phenylbutyrate oral powder 3 gm/teaspoonful 5 PAsodium phenylbutyrate tab 500 mg 5 PASTRENSIQ - asfotase alfa subcutaneous inj 18 mg/0.45ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 28 mg/0.7ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 40 mg/ml* 5 PASTRENSIQ - asfotase alfa subcutaneous inj 80 mg/0.8ml* 5 PAVPRIV - velaglucerase alfa for inj 400 unit 5 PA

2019



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

3


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 2D-PENAMINE - penicillamine tab 125 mg 5DEPEN TITRATABS - penicillamine tab 250 mg 5dutasteride cap 0.5 mg 2 QL (30 capsules/30 days)dutasteride-tamsulosin hcl cap 0.5-0.4 mg 2 QL (30 capsules/30 days)finasteride tab 5 mg^ 1 QL (30 tablets/30 days)methylergonovine maleate tab 0.2 mg 5MYRBETRIQ - mirabegron tab er 24 hr 25 mg 4 QL (30 tablets/30 days)MYRBETRIQ - mirabegron tab er 24 hr 50 mg 4 QL (30 tablets/30 days)oxybutynin chloride syrup 5 mg/5ml 2 QL (600 mls/30 days)oxybutynin chloride tab er 24hr 5 mg 2 QL (30 tablets/30 days)oxybutynin chloride tab er 24hr 10 mg 2 QL (90 tablets/30 days)oxybutynin chloride tab er 24hr 15 mg 2 QL (60 tablets/30 days)oxybutynin chloride tab 5 mg 2 QL (120 tablets/30 days)RAPAFLO - silodosin cap 4 mg 3 QL (30 capsules/30 days)RAPAFLO - silodosin cap 8 mg 3 QL (30 capsules/30 days)silodosin cap 4 mg 3 QL (30 capsules/30 days)silodosin cap 8 mg 3 QL (30 capsules/30 days)solifenacin succinate tab 5 mg 4 QL (30 tablets/30 days)solifenacin succinate tab 10 mg 4 QL (30 tablets/30 days)tamsulosin hcl cap 0.4 mg 2 QL (60 capsules/30 days)

2019


81


tolterodine tartrate cap er 24hr 2 mg 2 QL (30 capsules/30 days)tolterodine tartrate cap er 24hr 4 mg 2 QL (30 capsules/30 days)tolterodine tartrate tab 1 mg 2 QL (60 tablets/30 days)tolterodine tartrate tab 2 mg 2 QL (60 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 4 mg 3 QL (30 tablets/30 days)TOVIAZ - fesoterodine fumarate tab er 24hr 8 mg 3 QL (30 tablets/30 days)trospium chloride cap er 24hr 60 mg 2 QL (30 capsules/30 days)trospium chloride tab 20 mg 2 QL (60 tablets/30 days)Agentes hormonales, estimulantes/sustitutos/modificadoresCORTISONE ACETATE - cortisone acetate tab 25 mg 3DEXAMETHASONE - dexamethasone tab 1 mg 3DEXAMETHASONE - dexamethasone tab 2 mg 3dexamethasone 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 butyrate hydrophilic lipo base cream 0.1% 2hydrocortisone 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 3methylprednisolone tab therapy pack 4 mg (21) 2methylprednisolone tab 4 mg 2methylprednisolone tab 8 mg 2methylprednisolone tab 16 mg 2methylprednisolone tab 32 mg 3prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) 3prednisolone sod phosphate oral soln 15 mg/5ml 2prednisolone syrup 15 mg/5ml 2

2019



PREDNISONE - prednisone oral soln 5 mg/5ml 3PREDNISONE - prednisone tab therapy pack 5 mg (21) 2PREDNISONE - prednisone tab therapy pack 5 mg (48) 2PREDNISONE - prednisone tab therapy pack 10 mg (21) 2PREDNISONE - prednisone tab therapy pack 10 mg (48) 2PREDNISONE - prednisone tab 50 mg 3prednisone tab 1 mg^ 1prednisone tab 2.5 mg^ 1prednisone tab 5 mg 2prednisone tab 10 mg 2prednisone tab 20 mg^ 1Agentes hormonales, estimulantes/sustitutos/modificadoresCHORIONIC GONADOTROPIN - chorionic gonadotropin for im inj

10000 unit3 PA

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

chorionic gonadotropin for im inj 10000 unit3 PA

STIMATE - desmopressin acetate nasal soln 1.5 mg/ml 5Agentes hormonales, estimulantes/sustitutos/modificadoresANADROL-50 - oxymetholone tab 50 mg 5 PAANDRODERM - testosterone td patch 24hr 2 mg/24hr 3 PA, QL (30 patches/30 days)ANDRODERM - testosterone td patch 24hr 4 mg/24hr 3 PA, QL (30 patches/30 days)ANDROGEL - testosterone td gel 20.25 mg/1.25gm (1.62%) 3 PA, QL (30 packets/30 days)ANDROGEL - testosterone td gel 40.5 mg/2.5gm (1.62%) 3 PA, QL (60 packets/30 days)ANDROGEL PUMP - testosterone td gel 20.25 mg/act (1.62%) 3 PA, QL (2 pump

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

2019


83


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%)# 4DIVIGEL - estradiol td gel 0.5 mg/0.5gm (0.1%)# 4DIVIGEL - estradiol td gel 0.75 mg/0.75gm (0.1%)# 4DIVIGEL - estradiol td gel 1 mg/gm (0.1%)# 4drospirenone-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 2DUAVEE - conjugated estrogens-bazedoxifene tab 0.45-20 mg# 4ELLA - ulipristal acetate tab 30 mg 3estradiol & norethindrone acetate tab 0.5-0.1 mg# 3estradiol & norethindrone acetate tab 1-0.5 mg# 3estradiol tab 0.5 mg# 3estradiol tab 1 mg# 3estradiol tab 2 mg# 3estradiol td patch weekly 0.025 mg/24hr# 3estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)# 3estradiol td patch weekly 0.05 mg/24hr# 3estradiol td patch weekly 0.06 mg/24hr# 3estradiol td patch weekly 0.075 mg/24hr# 3estradiol td patch weekly 0.1 mg/24hr# 3estradiol vaginal cream 0.1 mg/gm 4estradiol vaginal tab 10 mcg 2ethynodiol 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 2levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg 2

2019



levonorgestrel-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# 3 PAmegestrol acetate tab 20 mg# 3 PAmegestrol acetate tab 40 mg# 3 PAMENEST - esterified estrogens tab 0.3 mg# 4MENEST - esterified estrogens tab 0.625 mg# 4MENEST - esterified estrogens tab 1.25 mg# 4METHYLTESTOSTERONE - methyltestosterone cap 10 mg 5 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# 4PREMARIN - estrogens, conjugated tab 0.45 mg# 4PREMARIN - estrogens, conjugated tab 0.625 mg# 4

2019


85


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

0.625-5mg(14)#4

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

4


4


4

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

4

progesterone micronized cap 100 mg 2progesterone micronized cap 200 mg 2raloxifene 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%) 3 PA, QL (90 packets/30 days)testosterone td gel 50 mg/5gm (1%) 3 PA, QL (60 units/30 days)testosterone td gel 12.5 mg/act (1%) 3 PA, QL (4 pump

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

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

bottles/30 days)Agentes hormonales, estimulantes/sustitutos/modificadores)levothyroxine sodium tab 25 mcg (levo-t, levoxyl, unithroid,

unithroid direct)2

levothyroxine sodium tab 50 mcg (levo-t, levoxyl, unithroid,unithroid direct)

2


2


2


2


2

2019




2

levothyroxine sodium tab 137 mcg (levo-t, levoxyl, unithroid) 2levothyroxine sodium tab 150 mcg (levo-t, levoxyl, unithroid,

unithroid direct)2


2


2

levothyroxine sodium tab 300 mcg (levo-t, unithroid, unithroiddirect)

2

liothyronine sodium tab 5 mcg 2liothyronine sodium tab 25 mcg 2liothyronine sodium tab 50 mcg 2SYNTHROID - levothyroxine sodium tab 25 mcg 4SYNTHROID - levothyroxine sodium tab 50 mcg 4SYNTHROID - levothyroxine sodium tab 75 mcg 4SYNTHROID - levothyroxine sodium tab 88 mcg 4SYNTHROID - levothyroxine sodium tab 100 mcg 4SYNTHROID - levothyroxine sodium tab 112 mcg 4SYNTHROID - levothyroxine sodium tab 125 mcg 4SYNTHROID - levothyroxine sodium tab 137 mcg 4SYNTHROID - levothyroxine sodium tab 150 mcg 4SYNTHROID - levothyroxine sodium tab 175 mcg 4SYNTHROID - levothyroxine sodium tab 200 mcg 4SYNTHROID - levothyroxine sodium tab 300 mcg 4Agentes hormonales, supresores (suprarrenal)KORLYM - mifepristone tab 300 mg* 5 PA, QL (120 tablets/30 days)LYSODREN - mitotane tab 500 mg 5Agentes hormonales, supresores (pituitarios)cabergoline tab 0.5 mg 2ELIGARD - leuprolide acetate (3 month) for subcutaneous inj kit

22.5mg4

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

4

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

4

ELIGARD - leuprolide acetate for subcutaneous inj kit 7.5 mg 4FIRMAGON - degarelix acetate for inj 80 mg 4FIRMAGON - degarelix acetate for inj 120 mg 5

2019


87


leuprolide acetate inj kit 5 mg/ml 5LUPRON DEPOT (1-MONTH) - leuprolide acetate for inj kit

3.75 mg5

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

5

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

5

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

5

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

5

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

5

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

5

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

5

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

5

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

5

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

5

octreotide acetate inj 50 mcg/ml (0.05 mg/ml) 3 PAoctreotide acetate inj 100 mcg/ml (0.1 mg/ml) 3 PAoctreotide acetate inj 200 mcg/ml (0.2 mg/ml) 3 PAoctreotide acetate inj 500 mcg/ml (0.5 mg/ml) 3 PAoctreotide acetate inj 1000 mcg/ml (1 mg/ml) 5 PASIGNIFOR - pasireotide diaspartate inj 0.3 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.6 mg/ml* 5 PASIGNIFOR - pasireotide diaspartate inj 0.9 mg/ml* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 10 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 20 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 30 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 40 mg* 5 PASIGNIFOR LAR - pasireotide pamoate for im er susp 60 mg* 5 PASOMATULINE DEPOT - lanreotide acetate extended release inj

60 mg/0.2ml5 PA

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

5 PA

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

5 PA

2019



SOMAVERT - pegvisomant for inj 10 mg* 5 PASOMAVERT - pegvisomant for inj 15 mg* 5 PASOMAVERT - pegvisomant for inj 20 mg* 5 PASOMAVERT - pegvisomant for inj 25 mg* 5 PASOMAVERT - pegvisomant for inj 30 mg* 5 PASYNAREL - nafarelin acetate nasal soln 2 mg/ml (200 mcg/act) 5TRELSTAR - triptorelin pamoate for im susp 3.75 mg 5 PATRELSTAR - triptorelin pamoate for im susp 11.25 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 3.75 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 11.25 mg 5 PATRELSTAR MIXJECT - triptorelin pamoate for im susp 22.5 mg 5 PAAgentes hormonales, supresores (tiroides)methimazole tab 5 mg^ 1methimazole tab 10 mg^ 1propylthiouracil tab 50 mg 2Agentes inmunológicosACTHIB - haemophilus b polysaccharide conjugate vaccine for inj 3ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml (2000000

unit/0.5ml)*5 PA

ADACEL - tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml 3ARCALYST - rilonacept for inj 220 mg* 5 PAATGAM - lymphocyte immune globulin anti-thymocyte g inj 50 mg/

ml(eq)5 BD

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

200 mg/ml5 PA

BENLYSTA - belimumab subcutaneous solution prefilled syringe200 mg/ml

5 PA

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

3

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

3

CABLIVI - caplacizumab-yhdp for inj kit 11 mg 5CINRYZE - c1 esterase inhibitor (human) for iv inj 500 unit* 5 PA, QL (20 vials/30 days)

2019


89


COSENTYX - secukinumab subcutaneous soln prefilled syringe150 mg/ml*

5 PA

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

5 PA

cyclosporine cap 25 mg 3 BDcyclosporine cap 100 mg 4 BDcyclosporine iv soln 50 mg/ml 2 BDCYCLOSPORINE MODIFIED - cyclosporine modified cap 50 mg 3 BDcyclosporine modified cap 25 mg 2 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/0.5ml3

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

3

DUPIXENT - dupilumab subcutaneous soln prefilled syringe200 mg/1.14ml

5 PA

DUPIXENT - dupilumab subcutaneous soln prefilled syringe300 mg/2ml

5 PA

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

25 mg/0.5ml5 PA

ENBREL - etanercept subcutaneous soln prefilled syringe 50 mg/ml

5 PA

ENBREL MINI - etanercept subcutaneous solution cartridge50 mg/ml

5 PA

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

5 PA

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

3 BD

ENGERIX-B - hepatitis b vaccine (recombinant) susp 20 mcg/ml 3 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

2019




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


5 BD, PA


5 BD, PA

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

3

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

3

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 3HAVRIX - hepatitis a vaccine inj susp 1440 el unit/ml 3HIBERIX - haemophilus b polysaccharide conjugate vac for inj

10 mcg3

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 PA

2019


91


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

5 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

icatibant acetate inj 30 mg/3ml* 5 PA, QL (6 syringes/30 days)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/0.5ml3

IPOL INACTIVATED IPV - poliovirus vaccine, ipv injection 3IXIARO - japanese encephalitis vaccine inactivated adsorbed inj 3KINERET - anakinra subcutaneous soln prefilled syringe

100 mg/0.67ml5 PA

KINRIX - diph-tetanus tox ad-acell pert & polio virus, ipv vac inj 3leflunomide tab 10 mg 2leflunomide tab 20 mg 2M-M-R II - measles, mumps & rubella virus vaccines for inj 3MENACTRA - meningococcal (a, c, y, and w-135) conjugate

vaccine inj3

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

3

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 2

2019



mycophenolate 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 4 BDmycophenolate sodium tab dr 360 mg 4 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 3PEDVAX HIB - haemophilus b polysaccharide conj vac im susp

7.5 mcg/0.5 ml3

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

3

PROGRAF - tacrolimus inj 5 mg/ml 4 BDPROGRAF - tacrolimus packet for susp 0.2 mg 4 BDPROGRAF - tacrolimus packet for susp 1 mg 4 BDPROQUAD - measles-mumps-rubella-varicella virus vaccines for

susp3

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

3

RABAVERT - rabies vaccine, pcec for inj 3 BDRAPAMUNE - sirolimus oral soln 1 mg/ml 5 BDRECOMBIVAX HB - hepatitis b vaccine (recombinant) susp

5 mcg/0.5ml3 BD

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

3 BD

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

3 BD

RENFLEXIS - infliximab-abda for iv inj 100 mg 5 PARIDAURA - auranofin cap 3 mg 5

2019


93


ROTARIX - rotavirus vaccine, live for oral susp 3ROTATEQ - rotavirus vaccine, live oral pentavalent soln 3SANDIMMUNE - cyclosporine oral soln 100 mg/ml 4 BDSHINGRIX - zoster vac recombinant adjuvanted for im inj

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

SIMULECT - basiliximab for iv soln 10 mg 5 BDSIMULECT - basiliximab for iv soln 20 mg 5 BDsirolimus oral soln 1 mg/ml 5 BDsirolimus tab 0.5 mg 3 BDsirolimus tab 1 mg 4 BDsirolimus tab 2 mg 5 BDSTAMARIL - yellow fever vaccine for inj suspension 3STELARA - ustekinumab inj 45 mg/0.5ml 5 PASTELARA - ustekinumab iv soln 130 mg/26ml (5 mg/ml) (for iv

infusion)5 PA

STELARA - ustekinumab soln prefilled syringe 45 mg/0.5ml 5 PASTELARA - ustekinumab soln prefilled syringe 90 mg/ml 5 PASYLVANT - siltuximab for iv infusion 100 mg 5SYLVANT - siltuximab for iv infusion 400 mg 5SYNAGIS - palivizumab im soln 50 mg/0.5ml* 5SYNAGIS - palivizumab im soln 100 mg/ml* 5tacrolimus cap 0.5 mg 2 BDtacrolimus cap 1 mg 2 BDtacrolimus cap 5 mg 3 BDTDVAX - tetanus-diphtheria toxoids (td) inj 2-2 lf/0.5ml 3TENIVAC - tetanus-diphtheria toxoids (td) inj 5-2 lfu 3THYMOGLOBULIN - anti-thymocyte globulin for iv soln 25 mg

(lymphocyte ig)5 BD

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

3

TWINRIX - hep a-hep b vaccine susp pref syr 720-20 elu-mcg/ml 3TYPHIM VI - typhoid vi polysaccharide intramuscular vac inj

25 mcg/0.5ml3

VAQTA - hepatitis a vaccine inj susp 25 unit/0.5ml 3VAQTA - hepatitis a vaccine inj susp 50 unit/ml 3VARIVAX - varicella virus vac live for subcutaneous inj 1350

pfu/0.5ml3

XATMEP - methotrexate oral soln 2.5 mg/ml 5 BDXOLAIR - omalizumab for inj 150 mg* 5 PA

2019



XOLAIR - omalizumab subcutaneous soln prefilled syringe75 mg/0.5ml*

5 PA

XOLAIR - omalizumab subcutaneous soln prefilled syringe150 mg/ml*

5 PA

YF-VAX - yellow fever vaccine subcutaneous inj 3ZORTRESS - everolimus tab 0.25 mg 5 BDZORTRESS - everolimus tab 0.5 mg 5 BDZORTRESS - everolimus tab 0.75 mg 5 BDZORTRESS - everolimus tab 1 mg 5 BDZOSTAVAX - zoster vaccine live for subcutaneous susp 19400

unit/0.65ml3 QL (1 vaccine/lifetime)

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

2019


95


calcitriol cap 0.5 mcg 2calcitriol inj 1 mcg/ml 2calcitriol oral soln 1 mcg/ml 3cinacalcet hcl tab 30 mg 5 PAcinacalcet hcl tab 60 mg 5 PAcinacalcet hcl tab 90 mg 5 PAETIDRONATE DISODIUM - etidronate disodium tab 200 mg 3ETIDRONATE DISODIUM - etidronate disodium tab 400 mg 3FORTEO - 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 5NATPARA - parathyroid hormone (recombinant) for inj cartridge

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

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

5 PA, QL (2 cartridges/28 days)





paricalcitol cap 1 mcg 2paricalcitol cap 2 mcg 3paricalcitol cap 4 mcg 3paricalcitol iv soln 2 mcg/ml 2paricalcitol iv soln 5 mcg/ml 3PROLIA - denosumab inj soln prefilled syringe 60 mg/ml 4 PArisedronate sodium tab delayed release 35 mg 2 QL (4 tablets/28 days)risedronate sodium tab 5 mg 2 QL (30 tablets/30 days)risedronate sodium tab 30 mg 2 QL (30 tablets/30 days)risedronate sodium tab 35 mg 2 QL (4 tablets/28 days)risedronate sodium tab 150 mg 2 QL (1 tablet/28 days)SENSIPAR - cinacalcet hcl tab 30 mg 5 PASENSIPAR - cinacalcet hcl tab 60 mg 5 PASENSIPAR - cinacalcet hcl tab 90 mg 5 PATYMLOS - abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml5 PA

XGEVA - denosumab inj 120 mg/1.7ml 5 PAzoledronic acid inj conc for iv infusion 4 mg/5ml 3zoledronic acid iv soln 5 mg/100ml 3

2019



Agentes oftálmicosALPHAGAN P - brimonidine tartrate ophth soln 0.1% 3azelastine hcl ophth soln 0.05% 2AZOPT - brinzolamide ophth susp 1% 4BACITRACIN - bacitracin ophth oint 500 unit/gm 3bacitracin-polymyxin b ophth oint 2bacitracin-polymyxin-neomycin-hc ophth oint 1% 2BESIVANCE - besifloxacin hcl ophth susp 0.6% 4betaxolol hcl ophth soln 0.5% 2BETOPTIC-S - betaxolol hcl ophth susp 0.25% 4bimatoprost ophth soln 0.03% 2brimonidine tartrate ophth soln 0.15% 2brimonidine tartrate ophth soln 0.2% 2bromfenac sodium ophth soln 0.09% (once-daily) 2carteolol hcl ophth soln 1%^ 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%3

diclofenac sodium ophth soln 0.1% 2dorzolamide hcl ophth soln 2% 2dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml 2DUREZOL - difluprednate ophth emulsion 0.05% 3epinastine hcl ophth soln 0.05% 2erythromycin ophth oint 5 mg/gm 2fluorometholone ophth susp 0.1% 2flurbiprofen sodium ophth soln 0.03% 2gentamicin sulfate ophth oint 0.3% 2gentamicin sulfate ophth soln 0.3% 2ILEVRO - nepafenac ophth susp 0.3% 3ISTALOL - timolol maleate ophth soln 0.5% (once-daily) 4ketorolac tromethamine ophth soln 0.4% 2ketorolac tromethamine ophth soln 0.5% 2LACRISERT - artificial tear ophth insert 4latanoprost ophth soln 0.005% 2

2019


97


levobunolol hcl ophth soln 0.5%^ 1LUMIGAN - 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% 2timolol 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% 2

2019



Agentes óticosacetic acid otic soln 2% 3CIPRODEX - ciprofloxacin-dexamethasone otic susp 0.3-0.1% 4fluocinolone acetonide (otic) oil 0.01% 3hydrocortisone w/ acetic acid otic soln 1-2% 3neomycin-polymyxin-hc otic soln 1% 2neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% 2ofloxacin otic soln 0.3% 3Agentes para el tracto respiratorio/pulmonaracetylcysteine inhal soln 10% 3 BDacetylcysteine inhal soln 20% 2 BDADCIRCA - tadalafil tab 20 mg (pah) 5 PA, QL (60 tablets/30 days)ADEMPAS - riociguat tab 0.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 1.5 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2 mg 5 PA, QL (90 tablets/30 days)ADEMPAS - riociguat tab 2.5 mg 5 PA, QL (90 tablets/30 days)ADVAIR DISKUS - fluticasone-salmeterol aer powder ba

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

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

3 QL (1 inhaler/30 days)

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


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

act3 QL (1 canister/30 days)

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

3 QL (1 canister/30 days)

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) 2 BDalbuterol sulfate soln nebu 0.5% (5 mg/ml) 2 BDalbuterol sulfate soln nebu 0.63 mg/3ml 2 BDalbuterol sulfate soln nebu 1.25 mg/3ml 2 BDalbuterol sulfate syrup 2 mg/5ml 2albuterol sulfate tab er 12hr 4 mg 2albuterol sulfate tab er 12hr 8 mg 2albuterol sulfate tab 2 mg 3albuterol sulfate tab 4 mg 3ambrisentan tab 5 mg* 5 PA, QL (30 tablets/30 days)ambrisentan tab 10 mg* 5 PA, QL (30 tablets/30 days)

2019


99


ANORO ELLIPTA - umeclidinium-vilanterol aero powd ba62.5-25 mcg/inh

3 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)bosentan tab 62.5 mg* 5 PA, QL (60 tablets/30 days)bosentan tab 125 mg* 5 PA, QL (60 tablets/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 4 BDbudesonide inhalation susp 0.5 mg/2ml 4 BDbudesonide inhalation susp 1 mg/2ml 3 BDcaffeine citrate oral soln 60 mg/3ml 2CLEMASTINE FUMARATE - clemastine fumarate tab 2.68 mg# 3 PACOMBIVENT RESPIMAT - ipratropium-albuterol inhal aerosol soln

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

cromolyn sodium soln nebu 20 mg/2ml 3 BD

2019



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

3

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

blister3 QL (1 inhaler/30 days)

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


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

3 QL (4 inhalers/30 days)

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


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


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


fluticasone propionate nasal susp 50 mcg/act^ 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


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 25 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor packet 50 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor packet 75 mg 5 PA, QL (60 packets/30 days)KALYDECO - ivacaftor tab 150 mg 5 PA, QL (60 tablets/30 days)

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101


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 sl tab 300 ir 4 PA, QL (30 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 100-125 mg* 5 PA, QL (60 packets/30 days)ORKAMBI - lumacaftor-ivacaftor granules packet 150-188 mg* 5 PA, QL (60 packets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg* 5 PA, QL (120 tablets/30 days)ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg* 5 PA, QL (120 tablets/30 days)PROAIR HFA - albuterol sulfate inhal aero 108 mcg/act 3 QL (36 grams/30 days)PROAIR RESPICLICK - albuterol sulfate aer pow ba 108 mcg/act 3 QL (2 canisters/30 days)PULMOZYME - dornase alfa inhal soln 1 mg/ml 5 BDQVAR REDIHALER - beclomethasone diprop hfa breath act inh

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

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


REMODULIN - treprostinil inj soln 20 mg/20ml (1 mg/ml)* 5 BDREMODULIN - treprostinil inj soln 50 mg/20ml (2.5 mg/ml)* 5 BDREMODULIN - treprostinil inj soln 100 mg/20ml (5 mg/ml)* 5 BDREMODULIN - treprostinil inj soln 200 mg/20ml (10 mg/ml)* 5 BDribavirin for inhal soln 6 gm 5SEREVENT DISKUS - salmeterol xinafoate aer pow ba 50 mcg/

dose3 QL (1 inhaler/30 days)

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

cap 18 mcg3 QL (30 capsules/30 days)

SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 1.25 mcg/act


SPIRIVA RESPIMAT - tiotropium bromide monohydrate inhalaerosol 2.5 mcg/act


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


2019



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


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


SYMDEKO - tezacaftor-ivacaftor 50-75 mg & ivacaftor 75 mg tabtbpk


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


tadalafil tab 20 mg (pah) 5 PA, QL (60 tablets/30 days)terbutaline sulfate tab 2.5 mg 3terbutaline sulfate tab 5 mg 3theophylline tab er 12hr 100 mg 2theophylline tab er 12hr 200 mg 2theophylline tab er 12hr 300 mg 2theophylline tab er 12hr 450 mg 2theophylline tab er 24hr 400 mg 2theophylline tab er 24hr 600 mg 2tobramycin nebu soln 300 mg/5ml 5 BDTRACLEER - bosentan tab for oral susp 32 mg* 5 PA, QL (120 tablets/30 days)TRACLEER - bosentan tab 62.5 mg* 5 PA, QL (60 tablets/30 days)TRACLEER - bosentan tab 125 mg* 5 PA, QL (60 tablets/30 days)TRELEGY ELLIPTA - fluticasone-umeclidinium-vilanterol aepb

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

treprostinil inj soln 20 mg/20ml (1 mg/ml)* 5 BDtreprostinil inj soln 50 mg/20ml (2.5 mg/ml)* 5 BDtreprostinil inj soln 100 mg/20ml (5 mg/ml)* 5 BDtreprostinil inj soln 200 mg/20ml (10 mg/ml)* 5 BDUPTRAVI - 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)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)

2019


103


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# 3 PAcyclobenzaprine hcl tab 7.5 mg# 3 PAcyclobenzaprine hcl tab 10 mg# 3 PAmethocarbamol tab 500 mg# 3methocarbamol tab 750 mg# 3Agentes para tratar los trastornos del sueñoarmodafinil tab 50 mg 3 PA, QL (30 tablets/30 days)armodafinil tab 150 mg 3 PA, QL (30 tablets/30 days)armodafinil tab 200 mg 3 PA, QL (30 tablets/30 days)armodafinil tab 250 mg 3 PA, QL (30 tablets/30 days)BELSOMRA - suvorexant tab 5 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 10 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 15 mg 3 QL (30 tablets/30 days)BELSOMRA - suvorexant tab 20 mg 3 QL (30 tablets/30 days)HETLIOZ - tasimelteon capsule 20 mg* 5 PA, QL (30 capsules/30 days)modafinil tab 100 mg 3 PA, QL (30 tablets/30 days)modafinil tab 200 mg 3 PA, QL (30 tablets/30 days)SILENOR - doxepin hcl tab 3 mg 3 QL (30 tablets/30 days)SILENOR - doxepin hcl tab 6 mg 3 QL (30 tablets/30 days)temazepam cap 15 mg 3 QL (30 capsules/30 days)temazepam cap 30 mg 3 QL (30 capsules/30 days)XYREM - sodium oxybate oral solution 500 mg/ml* 5 PA, QL (540 mls/30 days)zaleplon cap 5 mg# 3 PAzaleplon cap 10 mg# 3 PAzolpidem tartrate tab 5 mg# 3 PAzolpidem tartrate tab 10 mg# 3 PA

2019

104

ÍNDICE

Aabacavir sulfate-lamivudine tab 600-300

mg................................................................................44abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg........................................................44abacavir sulfate soln 20 mg/ml.................................. 44abacavir sulfate tab 300 mg.......................................44abiraterone acetate tab 250 mg.................................26ABRAXANE...................................................................27ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1ABSTRAL........................................................................ 1acamprosate calcium tab delayed release 333

mg..................................................................................5acarbose tab 100 mg.................................................. 50acarbose tab 25 mg.................................................... 50acarbose tab 50 mg.................................................... 50acebutolol hcl cap 200 mg..........................................57acebutolol hcl cap 400 mg..........................................57acetaminophen w/ codeine soln 120-12

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

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

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

mg..................................................................................1acetazolamide cap er 12hr 500 mg...........................57acetazolamide tab 125 mg......................................... 57acetazolamide tab 250 mg......................................... 57acetic acid otic soln 2%.............................................. 98acetylcysteine inhal soln 10%.................................... 98acetylcysteine inhal soln 20%.................................... 98acitretin cap 10 mg......................................................71acitretin cap 17.5 mg...................................................71acitretin cap 25 mg......................................................71ACTHIB..........................................................................88ACTIMMUNE................................................................ 88acyclovir cap 200 mg.................................................. 44acyclovir oint 5%..........................................................44acyclovir sodium iv soln 50 mg/ml.............................44acyclovir susp 200 mg/5ml......................................... 44acyclovir tab 400 mg................................................... 44acyclovir tab 800 mg................................................... 45ADACEL........................................................................ 88ADASUVE..................................................................... 40ADCIRCA...................................................................... 98

adefovir dipivoxil tab 10 mg........................................45ADEMPAS..................................................................... 98ADEMPAS..................................................................... 98ADEMPAS..................................................................... 98ADEMPAS..................................................................... 98ADEMPAS..................................................................... 98ADVAIR DISKUS..........................................................98ADVAIR DISKUS..........................................................98ADVAIR DISKUS..........................................................98ADVAIR HFA.................................................................98ADVAIR HFA.................................................................98ADVAIR HFA.................................................................98AFINITOR......................................................................27AFINITOR......................................................................27AFINITOR......................................................................27AFINITOR......................................................................27AFINITOR DISPERZ................................................... 27AFINITOR DISPERZ................................................... 27AFINITOR DISPERZ................................................... 27AIMOVIG....................................................................... 25AIMOVIG....................................................................... 25albendazole tab 200 mg............................................. 38ALBENZA...................................................................... 38albuterol sulfate soln nebu 0.083% (2.5

mg/3ml).......................................................................98albuterol sulfate soln nebu 0.5% (5 mg/

ml)................................................................................98albuterol sulfate soln nebu 0.63

mg/3ml........................................................................ 98albuterol sulfate soln nebu 1.25

mg/3ml........................................................................ 98albuterol sulfate syrup 2 mg/5ml................................98albuterol sulfate tab 2 mg...........................................98albuterol sulfate tab 4 mg...........................................98albuterol sulfate tab er 12hr 4 mg..............................98albuterol sulfate tab er 12hr 8 mg..............................98alclometasone dipropionate cream

0.05%..........................................................................71alclometasone dipropionate oint

0.05%..........................................................................71ALCOHOL SWABS......................................................50ALDURAZYME............................................................. 78ALECENSA................................................................... 27alendronate sodium tab 10 mg.................................. 94alendronate sodium tab 35 mg.................................. 94alendronate sodium tab 5 mg.................................... 94alendronate sodium tab 70 mg.................................. 94alfuzosin hcl tab er 24hr 10 mg................................. 80ALIMTA.......................................................................... 27ALIMTA.......................................................................... 27ALINIA............................................................................38ALINIA............................................................................38

2019

105

ALIQOPA....................................................................... 27aliskiren fumarate tab 150 mg....................................57aliskiren fumarate tab 300 mg....................................57allopurinol sodium for inj 500 mg...............................25allopurinol tab 100 mg.................................................25allopurinol tab 300 mg.................................................25alosetron hcl tab 0.5 mg............................................. 76alosetron hcl tab 1 mg................................................ 76ALOXI.............................................................................22ALPHAGAN P...............................................................96alprazolam tab 0.25 mg.............................................. 49alprazolam tab 0.5 mg................................................ 49alprazolam tab 1 mg....................................................49alprazolam tab 2 mg....................................................49ALUNBRIG....................................................................27ALUNBRIG....................................................................27ALUNBRIG....................................................................27ALUNBRIG....................................................................27amantadine hcl cap 100 mg.......................................38amantadine hcl syrup 50 mg/5ml...............................38amantadine hcl tab 100 mg........................................38AMBISOME...................................................................23ambrisentan tab 10 mg............................................... 98ambrisentan tab 5 mg................................................. 98amikacin sulfate inj 1 gm/4ml (250 mg/

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

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

mg................................................................................57amiloride hcl tab 5 mg.................................................57amino acid infusion 15%.............................................74amino acid infusion 6%...............................................74amiodarone hcl tab 200 mg........................................57amiodarone hcl tab 400 mg........................................58AMITIZA.........................................................................76AMITIZA.........................................................................76amitriptyline hcl tab 100 mg....................................... 19amitriptyline hcl tab 10 mg..........................................19amitriptyline hcl tab 150 mg....................................... 19amitriptyline hcl tab 25 mg..........................................19amitriptyline hcl tab 50 mg..........................................19amitriptyline hcl tab 75 mg..........................................19amlodipine besylate-atorvastatin calcium tab 10-10

mg................................................................................58amlodipine besylate-atorvastatin calcium tab 10-20



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

amlodipine besylate-atorvastatin calcium tab 2.5-10mg................................................................................58



amlodipine besylate-atorvastatin calcium tab 5-10mg................................................................................58




amlodipine besylate-benazepril hcl cap 10-20mg................................................................................58


amlodipine besylate-benazepril hcl cap 2.5-10mg................................................................................58




amlodipine besylate tab 10 mg..................................58amlodipine besylate tab 2.5 mg.................................58amlodipine besylate tab 5 mg.................................... 58amlodipine besylate-valsartan tab 10-160

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



mg................................................................................58amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg.........................................................58amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg............................................................58amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg............................................................58amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg...........................................................58amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg.............................................................. 58AMOXAPINE.................................................................19AMOXAPINE.................................................................19AMOXAPINE.................................................................19AMOXAPINE.................................................................19

2019

106

AMOXICILLIN/CLAVULANATEPOTASSIUM................................................................ 6

AMOXICILLIN/CLAVULANATEPOTASSIUM................................................................ 6

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

mg/5ml.......................................................................... 6amoxicillin (trihydrate) for susp 200



mg/5ml.......................................................................... 6amoxicillin (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................................................................................69amphetamine-dextroamphetamine cap er 24hr 15





mg................................................................................69amphetamine-dextroamphetamine tab 10

mg................................................................................69amphetamine-dextroamphetamine tab 12.5





mg................................................................................69

amphetamine-dextroamphetamine tab 7.5mg................................................................................69

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

gm..................................................................................6ampicillin cap 500 mg....................................................6AMPICILLIN SODIUM................................................... 6ampicillin sodium for inj 1 gm.......................................6ampicillin sodium for inj 250 mg...................................6ampicillin sodium for inj 2 gm.......................................7ampicillin sodium for inj 500 mg...................................6ampicillin sodium for iv soln 10 gm..............................7ampicillin sodium for iv soln 2 gm................................7AMPICILLIN-SULBACTAM........................................... 7AMPYRA........................................................................69ANADROL-50............................................................... 82anagrelide hcl cap 0.5 mg.......................................... 54anagrelide hcl cap 1 mg............................................. 54anastrozole tab 1 mg...................................................27ANDRODERM.............................................................. 82ANDRODERM.............................................................. 82ANDROGEL.................................................................. 82ANDROGEL.................................................................. 82ANDROGEL PUMP..................................................... 82ANORO ELLIPTA.........................................................99APOKYN........................................................................38aprepitant capsule 125 mg.........................................22aprepitant capsule 40 mg........................................... 22aprepitant capsule 80 mg........................................... 22aprepitant capsule therapy pack 80 & 125

mg................................................................................22APRISO......................................................................... 94APTIOM......................................................................... 14APTIOM......................................................................... 14APTIOM......................................................................... 14APTIOM......................................................................... 14APTIVUS....................................................................... 45APTIVUS....................................................................... 45ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................54ARANESP ALBUMIN FREE.......................................55ARANESP ALBUMIN FREE.......................................55

2019

107

ARANESP ALBUMIN FREE.......................................55ARCALYST....................................................................88aripiprazole orally disintegrating tab 10

mg................................................................................40aripiprazole orally disintegrating tab 15

mg................................................................................40aripiprazole oral solution 1 mg/ml..............................40aripiprazole tab 10 mg................................................ 40aripiprazole tab 15 mg................................................ 40aripiprazole tab 20 mg................................................ 40aripiprazole tab 2 mg...................................................40aripiprazole tab 30 mg................................................ 40aripiprazole tab 5 mg...................................................40ARISTADA.....................................................................40ARISTADA.....................................................................40ARISTADA.....................................................................40ARISTADA.....................................................................40ARISTADA INITIO........................................................40armodafinil tab 150 mg............................................. 103armodafinil tab 200 mg............................................. 103armodafinil tab 250 mg............................................. 103armodafinil tab 50 mg............................................... 103ARNUITY ELLIPTA......................................................99ARNUITY ELLIPTA......................................................99ARNUITY ELLIPTA......................................................99ARRANON.................................................................... 27arsenic trioxide inj 10 mg/10ml (1 mg/

ml)................................................................................27ARZERRA..................................................................... 27ARZERRA..................................................................... 27ASACOL HD.................................................................94ASMANEX HFA............................................................99ASMANEX HFA............................................................99ASMANEX TWISTHALER 120 METERED

DOSES....................................................................... 99ASMANEX TWISTHALER 14 METERED





DOSES....................................................................... 99aspirin-dipyridamole cap er 12hr 25-200

mg................................................................................55atazanavir sulfate cap 150 mg...................................45atazanavir sulfate cap 200 mg...................................45atazanavir sulfate cap 300 mg...................................45atenolol & chlorthalidone tab 100-25

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

atenolol & chlorthalidone tab 50-25 mg.................... 58atenolol tab 100 mg.....................................................58atenolol tab 25 mg.......................................................58atenolol tab 50 mg.......................................................58ATGAM.......................................................................... 88atomoxetine hcl cap 100 mg...................................... 69atomoxetine hcl cap 10 mg........................................ 69atomoxetine hcl cap 18 mg........................................ 69atomoxetine hcl cap 25 mg........................................ 69atomoxetine hcl cap 40 mg........................................ 69atomoxetine hcl cap 60 mg........................................ 69atomoxetine hcl cap 80 mg........................................ 69atorvastatin calcium tab 10 mg.................................. 58atorvastatin calcium tab 20 mg.................................. 58atorvastatin calcium tab 40 mg.................................. 58atorvastatin calcium tab 80 mg.................................. 59atovaquone-proguanil hcl tab 250-100

mg................................................................................38atovaquone-proguanil hcl tab 62.5-25

mg................................................................................38atovaquone susp 750 mg/5ml....................................38ATRIPLA........................................................................ 45ATROVENT HFA..........................................................99AUBAGIO...................................................................... 69AUBAGIO...................................................................... 69AURYXIA.......................................................................74AVASTIN........................................................................27AVASTIN........................................................................27AVONEX........................................................................ 69AVONEX........................................................................ 69AVONEX PEN.............................................................. 69azacitidine for inj 100 mg............................................55AZASAN........................................................................ 88AZASAN........................................................................ 88AZATHIOPRINE........................................................... 88azathioprine tab 50 mg............................................... 88azelaic acid gel 15%................................................... 71azelastine hcl nasal spray 0.1% (137 mcg/

spray)..........................................................................99azelastine hcl nasal spray 0.15% (205.5 mcg/

spray)..........................................................................99azelastine hcl ophth soln 0.05%................................ 96AZELEX......................................................................... 71AZITHROMYCIN............................................................ 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........................................................................... 96aztreonam for inj 1 gm.................................................. 7

2019

108

aztreonam for inj 2 gm.................................................. 7BBACITRACIN................................................................ 96bacitracin-polymyxin b ophth oint.............................. 96bacitracin-polymyxin-neomycin-hc ophth oint

1%............................................................................... 96baclofen tab 10 mg......................................................44baclofen tab 20 mg......................................................44balsalazide disodium cap 750 mg............................. 94BALVERSA....................................................................27BALVERSA....................................................................27BALVERSA....................................................................27BANZEL.........................................................................14BANZEL.........................................................................14BANZEL.........................................................................14BARACLUDE................................................................ 45BASAGLAR KWIKPEN............................................... 50BAVENCIO.................................................................... 27BCG VACCINE.............................................................88BELEODAQ.................................................................. 27BELSOMRA................................................................ 103BELSOMRA................................................................ 103BELSOMRA................................................................ 103BELSOMRA................................................................ 103benazepril & hydrochlorothiazide tab 10-12.5

mg................................................................................59benazepril & hydrochlorothiazide tab 20-12.5

mg................................................................................59benazepril & hydrochlorothiazide tab 20-25

mg................................................................................59benazepril & hydrochlorothiazide tab 5-6.25

mg................................................................................59benazepril hcl tab 10 mg............................................ 59benazepril hcl tab 20 mg............................................ 59benazepril hcl tab 40 mg............................................ 59benazepril hcl tab 5 mg.............................................. 59BENDEKA..................................................................... 27BENLYSTA.................................................................... 88BENLYSTA.................................................................... 88BENLYSTA.................................................................... 88BENLYSTA.................................................................... 88BENZNIDAZOLE..........................................................38BENZNIDAZOLE..........................................................38benzoyl peroxide-erythromycin gel

5-3%............................................................................71benztropine mesylate tab 0.5 mg.............................. 38benztropine mesylate tab 1 mg..................................38benztropine mesylate tab 2 mg..................................38BESIVANCE..................................................................96BESPONSA.................................................................. 27

betamethasone dipropionate augmented cream0.05%..........................................................................71

betamethasone dipropionate augmented gel0.05%..........................................................................71

betamethasone dipropionate augmented lotion0.05%..........................................................................71

betamethasone dipropionate augmented oint0.05%..........................................................................71

betamethasone dipropionate cream0.05%..........................................................................71

betamethasone dipropionate lotion0.05%..........................................................................71

betamethasone dipropionate oint0.05%..........................................................................71

betamethasone valerate cream 0.1%....................... 71betamethasone valerate lotion 0.1%.........................71betamethasone valerate oint 0.1%............................71BETASERON................................................................ 69betaxolol hcl ophth soln 0.5%.................................... 96betaxolol hcl tab 10 mg...............................................59betaxolol hcl tab 20 mg...............................................59bethanechol chloride tab 10 mg.................................80bethanechol chloride tab 25 mg.................................80bethanechol chloride tab 50 mg.................................80bethanechol chloride tab 5 mg...................................80BETOPTIC-S.................................................................96BEVYXXA......................................................................55BEVYXXA......................................................................55bexarotene cap 75 mg................................................ 27BEXSERO..................................................................... 88bicalutamide tab 50 mg...............................................27BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICILLIN L-A...................................................................7BICNU............................................................................27BIKTARVY..................................................................... 45BILTRICIDE...................................................................38bimatoprost ophth soln 0.03%................................... 96bisoprolol & hydrochlorothiazide tab 10-6.25

mg................................................................................59bisoprolol & hydrochlorothiazide tab 2.5-6.25

mg................................................................................59bisoprolol & hydrochlorothiazide tab 5-6.25

mg................................................................................59bisoprolol fumarate tab 10 mg................................... 59bisoprolol fumarate tab 5 mg..................................... 59bleomycin sulfate for inj 15 unit................................. 27bleomycin sulfate for inj 30 unit................................. 27BLINCYTO.....................................................................27BOOSTRIX....................................................................88bosentan tab 125 mg.................................................. 99bosentan tab 62.5 mg................................................. 99

2019

109

BOSULIF....................................................................... 27BOSULIF....................................................................... 28BOSULIF....................................................................... 28BRAFTOVI.....................................................................28BREO ELLIPTA............................................................ 99BREO ELLIPTA............................................................ 99BRILINTA.......................................................................55BRILINTA.......................................................................55brimonidine tartrate ophth soln 0.15%...................... 96brimonidine tartrate ophth soln 0.2%........................ 96BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14BRIVIACT......................................................................14bromfenac sodium ophth soln 0.09% (once-

daily)............................................................................96bromocriptine mesylate cap 5 mg..............................38bromocriptine mesylate tab 2.5 mg........................... 38budesonide delayed release particles cap 3

mg................................................................................94budesonide inhalation susp 0.25

mg/2ml........................................................................ 99budesonide inhalation susp 0.5

mg/2ml........................................................................ 99budesonide inhalation susp 1 mg/2ml.......................99bumetanide inj 0.25 mg/ml......................................... 59bumetanide tab 0.5 mg............................................... 59bumetanide tab 1 mg.................................................. 59bumetanide tab 2 mg.................................................. 59buprenorphine hcl-naloxone hcl sl film 12-3

mg..................................................................................5buprenorphine hcl-naloxone hcl sl film 2-0.5

mg..................................................................................5buprenorphine hcl-naloxone hcl sl film 4-1

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

mg..................................................................................5buprenorphine 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...........................................19bupropion hcl tab 75 mg.............................................19bupropion hcl tab er 12hr 100 mg............................. 19bupropion hcl tab er 12hr 150 mg............................. 19

bupropion hcl tab er 12hr 200 mg............................. 19bupropion hcl tab er 24hr 150 mg............................. 19bupropion hcl tab er 24hr 300 mg............................. 19buspirone hcl tab 10 mg............................................. 49buspirone hcl tab 15 mg............................................. 49buspirone hcl tab 30 mg............................................. 49buspirone hcl tab 5 mg............................................... 49buspirone hcl tab 7.5 mg............................................ 49busulfan inj 6 mg/ml.................................................... 28butalbital-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 BCISE.....................................................50BYDUREON PEN........................................................ 50BYSTOLIC.....................................................................59BYSTOLIC.....................................................................59BYSTOLIC.....................................................................59BYSTOLIC.....................................................................59Ccabergoline tab 0.5 mg............................................... 86CABLIVI......................................................................... 88CABOMETYX............................................................... 28CABOMETYX............................................................... 28CABOMETYX............................................................... 28caffeine citrate oral soln 60 mg/3ml...........................99calcipotriene cream 0.005%.......................................71calcipotriene oint 0.005%............................................71calcipotriene soln 0.005% (50 mcg/ml).....................71calcitonin (salmon) nasal soln 200 unit/

act................................................................................94calcitriol cap 0.25 mcg................................................ 94calcitriol cap 0.5 mcg...................................................95calcitriol inj 1 mcg/ml...................................................95calcitriol oral soln 1 mcg/ml........................................95calcium acetate cap 667 mg...................................... 74calcium acetate tab 667 mg....................................... 74CALQUENCE................................................................28CANASA........................................................................94candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg................................................................................59

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candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg................................................................................59

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

candesartan cilexetil tab 16 mg................................. 59candesartan cilexetil tab 32 mg................................. 59candesartan cilexetil tab 4 mg................................... 59candesartan cilexetil tab 8 mg................................... 59CAPASTAT SULFATE..................................................26CAPRELSA................................................................... 28CAPRELSA................................................................... 28captopril tab 100 mg....................................................59captopril tab 12.5 mg...................................................59captopril tab 25 mg......................................................59captopril tab 50 mg......................................................59CARAC.......................................................................... 71CARBAGLU.................................................................. 74carbamazepine 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.......................... 14CARBIDOPA/LEVODOPA/

ENTACAPONE..........................................................39CARBIDOPA/LEVODOPA/





ENTACAPONE..........................................................39carbidopa & levodopa orally disintegrating tab

10-100 mg..................................................................38carbidopa & levodopa orally disintegrating tab

25-100 mg..................................................................39carbidopa & levodopa orally disintegrating tab

25-250 mg..................................................................39carbidopa & levodopa tab 10-100 mg....................... 39carbidopa & levodopa tab 25-100 mg....................... 39carbidopa & levodopa tab 25-250 mg....................... 39carbidopa & levodopa tab er 25-100

mg................................................................................39carbidopa & levodopa tab er 50-200

mg................................................................................39carbidopa tab 25 mg................................................... 39

carboplatin iv soln 150 mg/15ml................................ 28carboplatin iv soln 450 mg/45ml................................ 28carboplatin iv soln 50 mg/5ml.................................... 28carboplatin iv soln 600 mg/60ml................................ 28carmustine for inj 100 mg...........................................28carteolol hcl ophth soln 1%........................................ 96carvedilol tab 12.5 mg.................................................59carvedilol tab 25 mg....................................................60carvedilol tab 3.125 mg...............................................59carvedilol tab 6.25 mg.................................................59caspofungin 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.............................................. 7cefixime cap 400 mg..................................................... 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.................................................8CEFTRIAXONE/DEXTROSE....................................... 8CEFTRIAXONE/DEXTROSE....................................... 8CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 8CEFTRIAXONE IN ISO-OSMOTIC

DEXTROSE................................................................. 8

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ceftriaxone sodium for inj 10 gm..................................8ceftriaxone sodium for inj 1 gm....................................8ceftriaxone sodium for inj 250 mg................................8ceftriaxone sodium for inj 2 gm....................................8ceftriaxone sodium for inj 500 mg................................8ceftriaxone sodium for iv soln 1 gm.............................8ceftriaxone sodium for iv soln 2 gm.............................8cefuroxime axetil tab 250 mg....................................... 8cefuroxime axetil tab 500 mg....................................... 8cefuroxime sodium for inj 7.5 gm.................................8cefuroxime sodium for inj 750 mg................................8cefuroxime sodium for iv soln 1.5 gm..........................8celecoxib cap 100 mg................................................... 1celecoxib cap 200 mg................................................... 1celecoxib cap 400 mg................................................... 1celecoxib cap 50 mg......................................................1CELONTIN.................................................................... 14cephalexin cap 250 mg.................................................8cephalexin cap 500 mg.................................................8cephalexin cap 750 mg.................................................8cephalexin for susp 125 mg/5ml..................................8cephalexin for susp 250 mg/5ml..................................8CEREZYME.................................................................. 78CHANTIX......................................................................... 5CHANTIX......................................................................... 5CHANTIX CONTINUING MONTH

PACK.............................................................................5CHANTIX STARTING MONTH PACK.........................5CHEMET........................................................................74CHENODAL.................................................................. 76CHLORAMPHENICOL SODIUM

SUCCINATE.................................................................9chlorhexidine gluconate soln 0.12%..........................70CHLOROQUINE PHOSPHATE................................. 38chloroquine phosphate tab 500 mg...........................38CHLOROTHIAZIDE..................................................... 60chlorothiazide tab 500 mg.......................................... 60CHLORPROMAZINE 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............................................ 60chlorthalidone tab 50 mg............................................ 60cholestyramine light powder 4 gm/

dose............................................................................ 60cholestyramine light powder packets 4

gm................................................................................60cholestyramine powder 4 gm/dose............................60cholestyramine powder packets 4 gm.......................60

choline fenofibrate cap dr 135 mg............................. 60choline fenofibrate cap dr 45 mg............................... 60CHORIONIC GONADOTROPIN................................82ciclopirox gel 0.77%.................................................... 24ciclopirox olamine cream 0.77%................................24ciclopirox olamine susp 0.77%...................................24ciclopirox shampoo 1%............................................... 24ciclopirox solution 8%..................................................24cidofovir iv inj 75 mg/ml.............................................. 45cilostazol tab 100 mg.................................................. 55cilostazol tab 50 mg.................................................... 55CIMDUO........................................................................ 45CIMETIDINE HCL........................................................ 76cimetidine tab 200 mg.................................................76cimetidine tab 300 mg.................................................76cimetidine tab 400 mg.................................................76cimetidine tab 800 mg.................................................76cinacalcet hcl tab 30 mg.............................................95cinacalcet hcl tab 60 mg.............................................95cinacalcet hcl tab 90 mg.............................................95CINRYZE.......................................................................88CIPRODEX....................................................................98ciprofloxacin 200 mg/100ml in d5w............................. 9ciprofloxacin 400 mg/200ml in d5w............................. 9ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml).....................................................................9CIPROFLOXACIN HCL.................................................9ciprofloxacin hcl ophth soln 0.3%.............................. 96ciprofloxacin hcl tab 250 mg.........................................9ciprofloxacin hcl tab 500 mg.........................................9ciprofloxacin hcl tab 750 mg.........................................9CISPLATIN.................................................................... 28cisplatin inj 100 mg/100ml (1 mg/ml).........................28cisplatin inj 50 mg/50ml (1 mg/ml).............................28citalopram hydrobromide oral soln 10

mg/5ml........................................................................ 19citalopram hydrobromide tab 10 mg..........................19citalopram hydrobromide tab 20 mg..........................19citalopram hydrobromide tab 40 mg..........................19cladribine iv soln 10 mg/10ml (1 mg/

ml)................................................................................28clarithromycin 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........................................ 99clindamycin hcl cap 150 mg......................................... 9clindamycin hcl cap 300 mg......................................... 9clindamycin hcl cap 75 mg........................................... 9clindamycin phosphate-benzoyl peroxide gel

1-5%............................................................................71

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

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

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

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

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

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

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

2%..................................................................................9clobazam suspension 2.5 mg/ml............................... 14clobazam tab 10 mg....................................................14clobazam tab 20 mg....................................................14clobetasol propionate cream 0.05%..........................71clobetasol propionate emollient base cream

0.05%..........................................................................71clobetasol propionate gel 0.05%................................71clobetasol propionate oint 0.05%.............................. 71clobetasol propionate soln 0.05%..............................71clofarabine iv soln 1 mg/ml.........................................28clomipramine hcl cap 25 mg...................................... 19clomipramine hcl cap 50 mg...................................... 19clomipramine hcl cap 75 mg...................................... 19clonazepam orally disintegrating tab 0.125

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

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

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

mg................................................................................50clonazepam orally disintegrating tab 2

mg................................................................................50clonazepam tab 0.5 mg.............................................. 50clonazepam tab 1 mg..................................................50clonazepam tab 2 mg..................................................50clonidine hcl tab 0.1 mg..............................................60clonidine hcl tab 0.2 mg..............................................60clonidine hcl tab 0.3 mg..............................................60clonidine hcl tab er 12hr 0.1 mg................................ 69

clonidine td patch weekly 0.1 mg/24hr......................60clonidine td patch weekly 0.2 mg/24hr......................60clonidine td patch weekly 0.3 mg/24hr......................60clopidogrel bisulfate tab 75 mg..................................55clorazepate dipotassium tab 15 mg...........................50clorazepate dipotassium tab 3.75 mg....................... 50clorazepate dipotassium tab 7.5 mg......................... 50clotrimazole cream 1%................................................24clotrimazole troche 10 mg.......................................... 24clotrimazole w/ betamethasone cream

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

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

mg................................................................................40clozapine orally disintegrating tab 12.5

mg................................................................................40clozapine orally disintegrating tab 25

mg................................................................................40clozapine tab 100 mg..................................................40clozapine tab 200 mg..................................................40clozapine tab 25 mg....................................................40clozapine tab 50 mg....................................................40COARTEM.....................................................................38codeine sulfate tab 30 mg............................................ 1codeine sulfate tab 60 mg............................................ 1colchicine w/ probenecid tab 0.5-500

mg................................................................................25COLCRYS..................................................................... 25colestipol hcl granule packets 5 gm.......................... 60colestipol hcl granules 5 gm.......................................60colestipol hcl tab 1 gm................................................ 60colistimethate sod for inj 150 mg................................. 9COMBIGAN...................................................................96COMBIVENT RESPIMAT........................................... 99COMETRIQ...................................................................28COMETRIQ...................................................................28COMETRIQ...................................................................28COMPLERA.................................................................. 45COPAXONE.................................................................. 69COPAXONE.................................................................. 69COPIKTRA....................................................................28COPIKTRA....................................................................28CORLANOR..................................................................60CORLANOR..................................................................60CORTISONE ACETATE..............................................81COSENTYX.................................................................. 89COSENTYX SENSOREADY PEN............................ 89COTELLIC.....................................................................28COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55

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COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55COUMADIN...................................................................55CREON..........................................................................78CREON..........................................................................78CREON..........................................................................78CREON..........................................................................78CREON..........................................................................78CRESEMBA.................................................................. 24CRESEMBA.................................................................. 24CRIXIVAN......................................................................45CRIXIVAN......................................................................45cromolyn sodium ophth soln 4%................................96cromolyn sodium oral conc 100

mg/5ml........................................................................ 76cromolyn sodium soln nebu 20 mg/2ml.................... 99CRYSVITA.....................................................................78CRYSVITA.....................................................................78CRYSVITA.....................................................................79cyclobenzaprine hcl tab 10 mg................................ 103cyclobenzaprine hcl tab 5 mg.................................. 103cyclobenzaprine hcl tab 7.5 mg...............................103cyclophosphamide cap 25 mg................................... 28cyclophosphamide cap 50 mg................................... 28cyclophosphamide for inj 1 gm.................................. 28cyclophosphamide for inj 2 gm.................................. 28cyclophosphamide for inj 500 mg..............................28cycloserine cap 250 mg..............................................26CYCLOSET...................................................................51cyclosporine cap 100 mg............................................89cyclosporine cap 25 mg..............................................89cyclosporine iv soln 50 mg/ml....................................89CYCLOSPORINE MODIFIED.................................... 89cyclosporine modified cap 100 mg............................ 89cyclosporine modified cap 25 mg.............................. 89cyclosporine modified oral soln 100 mg/

ml.................................................................................89CYRAMZA.....................................................................28CYRAMZA.....................................................................28CYSTADANE................................................................ 79CYSTAGON.................................................................. 79CYSTAGON.................................................................. 79CYSTARAN...................................................................96CYTARABINE............................................................... 28cytarabine inj pf 100 mg/ml........................................ 28cytarabine inj pf 20 mg/ml.......................................... 28DDACARBAZINE............................................................ 29

dacarbazine for inj 200 mg.........................................29dactinomycin for inj 0.5 mg........................................ 29DAKLINZA.....................................................................45DAKLINZA.....................................................................45dalfampridine tab er 12hr 10 mg................................69DALIRESP.................................................................. 100DALIRESP.................................................................. 100DALVANCE......................................................................9danazol cap 100 mg....................................................82danazol cap 200 mg....................................................82danazol cap 50 mg......................................................82dantrolene sodium cap 100 mg................................. 44dantrolene sodium cap 25 mg....................................44dantrolene sodium cap 50 mg....................................44dapsone tab 100 mg................................................... 26dapsone tab 25 mg......................................................26DAPTACEL....................................................................89daptomycin for iv soln 500 mg..................................... 9DARAPRIM................................................................... 38DARZALEX................................................................... 29DARZALEX................................................................... 29daunorubicin hcl iv soln 20 mg/4ml........................... 29DAUNORUBICIN HYDROCHLORIDE......................29DAURISMO...................................................................29DAURISMO...................................................................29decitabine for inj 50 mg.............................................. 29deferasirox tab for oral susp 125 mg.........................74deferasirox tab for oral susp 250 mg.........................74deferasirox tab for oral susp 500 mg.........................74DELSTRIGO................................................................. 45DELZICOL.....................................................................94demeclocycline hcl tab 150 mg....................................9demeclocycline hcl tab 300 mg....................................9DEMSER....................................................................... 60DENAVIR.......................................................................45DEPEN TITRATABS.................................................... 80DEPO-PROVERA........................................................ 83DESCOVY.....................................................................45desipramine 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...........................82desmopressin acetate nasal spray soln

0.01%..........................................................................82desmopressin acetate nasal spray soln 0.01%

(refrigerated).............................................................. 82desmopressin acetate tab 0.1 mg............................. 82desmopressin acetate tab 0.2 mg............................. 82

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desogest-eth estrad & eth estrad tab 0.15-0.02/0.01mg(21/5)..................................................................... 83

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg................................................................................83

desogestrel & ethinyl estradiol tab 0.15 mg-30mcg..............................................................................83

desonide cream 0.05%............................................... 71desonide lotion 0.05%.................................................71desonide oint 0.05%....................................................71desoximetasone cream 0.05%...................................71desoximetasone cream 0.25%...................................71desoximetasone gel 0.05%........................................ 71desoximetasone oint 0.25%....................................... 72desvenlafaxine succinate tab er 24hr 100

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

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

mg................................................................................19DEXAMETHASONE.................................................... 81DEXAMETHASONE.................................................... 81dexamethasone elixir 0.5 mg/5ml..............................81DEXAMETHASONE SODIUM

PHOSPHATE.............................................................96dexamethasone sodium phosphate inj 120

mg/30ml......................................................................81dexamethasone sodium phosphate inj 20

mg/5ml........................................................................ 81dexamethasone sodium phosphate inj 4 mg/

ml.................................................................................81dexamethasone tab 0.5 mg........................................81dexamethasone tab 0.75 mg......................................81dexamethasone tab 1.5 mg........................................81dexamethasone tab 4 mg...........................................81dexamethasone tab 6 mg...........................................81dexmethylphenidate hcl tab 10 mg............................70dexmethylphenidate hcl tab 2.5 mg...........................70dexmethylphenidate hcl tab 5 mg..............................70dexrazoxane hcl for inj 250 mg..................................29dexrazoxane hcl for inj 500 mg..................................29dextroamphetamine sulfate cap er 24hr 10

mg................................................................................70dextroamphetamine sulfate cap er 24hr 15

mg................................................................................70dextroamphetamine sulfate cap er 24hr 5

mg................................................................................70dextroamphetamine sulfate tab 10 mg......................70dextroamphetamine sulfate tab 5 mg........................70dextrose 2.5% w/ sodium chloride

0.45%..........................................................................74dextrose 5% in lactated ringers................................. 74

dextrose 5% w/ sodium chloride 0.2%...................... 74dextrose 5% w/ sodium chloride

0.33%..........................................................................74dextrose 5% w/ sodium chloride

0.45%..........................................................................74dextrose 5% w/ sodium chloride 0.9%...................... 74dextrose inj 10%.......................................................... 74dextrose inj 5%.............................................................74DIASTAT ACUDIAL......................................................14DIASTAT ACUDIAL......................................................14DIASTAT PEDIATRIC..................................................14DIAZEPAM.................................................................... 14DIAZEPAM.................................................................... 15DIAZEPAM.................................................................... 15DIAZEPAM.................................................................... 50diazepam conc 5 mg/ml..............................................50DIAZEPAM RECTAL GEL.......................................... 15DIAZEPAM RECTAL GEL.......................................... 15DIAZEPAM RECTAL GEL.......................................... 15diazepam tab 10 mg....................................................50diazepam tab 2 mg......................................................50diazepam tab 5 mg......................................................50diclofenac potassium tab 50 mg.................................. 1diclofenac sodium gel 1%.............................................1diclofenac sodium gel 3%...........................................72diclofenac sodium ophth soln 0.1%...........................96diclofenac sodium tab delayed release 25

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

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

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

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

mg..................................................................................1dicloxacillin sodium cap 250 mg.................................. 9dicloxacillin sodium cap 500 mg................................ 10dicyclomine hcl cap 10 mg......................................... 76dicyclomine hcl tab 20 mg..........................................76didanosine delayed release capsule 200

mg................................................................................45didanosine delayed release capsule 250

mg................................................................................45didanosine delayed release capsule 400

mg................................................................................45DIFICID..........................................................................10diflorasone diacetate oint 0.05%................................72DIGOXIN........................................................................60digoxin tab 125 mcg (0.125 mg)................................60digoxin tab 250 mcg (0.25 mg).................................. 60

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DILANTIN...................................................................... 15diltiazem hcl cap er 12hr 120 mg.............................. 60diltiazem hcl cap er 12hr 60 mg.................................60diltiazem hcl cap er 12hr 90 mg.................................60diltiazem hcl cap er 24hr 120 mg.............................. 60diltiazem hcl cap er 24hr 180 mg.............................. 60diltiazem hcl cap er 24hr 240 mg.............................. 60diltiazem hcl coated beads cap er 24hr 120

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




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





mg................................................................................61diltiazem hcl extended release beads cap er 24hr

120 mg....................................................................... 61diltiazem hcl extended release beads cap er 24hr





420 mg....................................................................... 61diltiazem hcl tab 120 mg.............................................61diltiazem hcl tab 30 mg...............................................61diltiazem hcl tab 60 mg...............................................61diltiazem hcl tab 90 mg...............................................61DIPENTUM....................................................................94diphenhydramine hcl inj 50 mg/ml...........................100DIPHTHERIA/TETANUS TOXOIDS

ADSORBED...............................................................89dipyridamole tab 25 mg.............................................. 55dipyridamole tab 50 mg.............................................. 55dipyridamole tab 75 mg.............................................. 55disulfiram tab 250 mg....................................................5disulfiram tab 500 mg....................................................5

divalproex sodium cap delayed release sprinkle 125mg................................................................................15

divalproex sodium tab delayed release 125mg................................................................................15



divalproex sodium tab er 24 hr 250 mg.....................15divalproex sodium tab er 24 hr 500 mg.....................15DIVIGEL.........................................................................83DIVIGEL.........................................................................83DIVIGEL.........................................................................83DIVIGEL.........................................................................83DOCETAXEL.................................................................29docetaxel for inj conc 160 mg/8ml (20 mg/

ml)................................................................................29docetaxel for inj conc 20 mg/ml................................. 29docetaxel for inj conc 80 mg/4ml (20 mg/

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

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

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

mg/8ml........................................................................ 29dofetilide cap 125 mcg (0.125 mg)............................61dofetilide cap 250 mcg (0.25 mg).............................. 61dofetilide cap 500 mcg (0.5 mg)................................ 61donepezil hydrochloride orally disintegrating tab 10

mg................................................................................18donepezil hydrochloride orally disintegrating tab 5

mg................................................................................18donepezil hydrochloride tab 10 mg........................... 18donepezil hydrochloride tab 23 mg........................... 18donepezil hydrochloride tab 5 mg..............................18dorzolamide hcl ophth soln 2%..................................96dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml.......................................................................... 96DOVATO........................................................................ 45doxazosin mesylate tab 1 mg.................................... 61doxazosin mesylate tab 2 mg.................................... 61doxazosin mesylate tab 4 mg.................................... 61doxazosin mesylate tab 8 mg.................................... 61doxepin hcl cap 100 mg..............................................20doxepin hcl cap 10 mg................................................19doxepin hcl cap 150 mg..............................................20doxepin hcl cap 25 mg................................................19doxepin hcl cap 50 mg................................................20doxepin hcl cap 75 mg................................................20doxepin hcl conc 10 mg/ml.........................................20doxorubicin hcl for inj 10 mg...................................... 29

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116

doxorubicin hcl for inj 50 mg...................................... 29doxorubicin hcl inj 2 mg/ml.........................................29doxorubicin hcl liposomal inj (for iv infusion) 2 mg/

ml.................................................................................29doxycycline hyclate cap 100 mg................................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.........................10D-PENAMINE............................................................... 80dronabinol cap 10 mg................................................. 22dronabinol cap 2.5 mg................................................ 22dronabinol cap 5 mg....................................................22drospirenone-ethinyl estradiol tab 3-0.02

mg................................................................................83drospirenone-ethinyl estradiol tab 3-0.03

mg................................................................................83drospirenone-ethinyl estrad-levomefolate tab

3-0.02-0.451 mg........................................................83drospirenone-ethinyl estrad-levomefolate tab

3-0.03-0.451 mg........................................................83DUAVEE........................................................................ 83DULERA......................................................................100DULERA......................................................................100duloxetine hcl enteric coated pellets cap 20

mg................................................................................20duloxetine hcl enteric coated pellets cap 30

mg................................................................................20duloxetine hcl enteric coated pellets cap 60

mg................................................................................20DUPIXENT.................................................................... 89DUPIXENT.................................................................... 89DUREZOL..................................................................... 96dutasteride cap 0.5 mg............................................... 80dutasteride-tamsulosin hcl cap 0.5-0.4

mg................................................................................80EEC-NAPROXEN............................................................. 1EC-NAPROXEN............................................................. 1econazole nitrate cream 1%.......................................24EDURANT..................................................................... 45efavirenz cap 200 mg..................................................45efavirenz cap 50 mg....................................................45

efavirenz tab 600 mg...................................................45EGRIFTA....................................................................... 82ELAPRASE................................................................... 79ELELYSO.......................................................................79ELIDEL...........................................................................72ELIGARD.......................................................................86ELIGARD.......................................................................86ELIGARD.......................................................................86ELIGARD.......................................................................86ELIQUIS.........................................................................55ELIQUIS.........................................................................55ELIQUIS STARTER PACK......................................... 55ELITEK...........................................................................29ELITEK...........................................................................29ELLA...............................................................................83EMCYT.......................................................................... 29EMEND..........................................................................23EMGALITY.................................................................... 25EMGALITY.................................................................... 25EMPLICITI.....................................................................29EMPLICITI.....................................................................29EMSAM..........................................................................20EMSAM..........................................................................20EMSAM..........................................................................20EMTRIVA.......................................................................45EMTRIVA.......................................................................45enalapril maleate & hydrochlorothiazide tab 10-25

mg................................................................................61enalapril maleate & hydrochlorothiazide tab 5-12.5

mg................................................................................61enalapril maleate tab 10 mg.......................................61enalapril maleate tab 2.5 mg......................................61enalapril maleate tab 20 mg.......................................61enalapril maleate tab 5 mg.........................................61ENBREL........................................................................ 89ENBREL........................................................................ 89ENBREL........................................................................ 89ENBREL MINI...............................................................89ENBREL SURECLICK................................................ 89ENGERIX-B.................................................................. 89ENGERIX-B.................................................................. 89enoxaparin sodium inj 100 mg/ml..............................55enoxaparin sodium inj 120 mg/0.8ml........................ 55enoxaparin sodium inj 150 mg/ml..............................55enoxaparin sodium inj 300 mg/3ml............................55enoxaparin sodium inj 30 mg/0.3ml...........................55enoxaparin sodium inj 40 mg/0.4ml...........................55enoxaparin sodium inj 60 mg/0.6ml...........................55enoxaparin sodium inj 80 mg/0.8ml...........................55entacapone tab 200 mg..............................................39entecavir tab 0.5 mg....................................................45entecavir tab 1 mg.......................................................45

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ENTRESTO...................................................................61ENTRESTO...................................................................61ENTRESTO...................................................................61EPCLUSA......................................................................45EPIDIOLEX................................................................... 15epinastine hcl ophth soln 0.05%................................96EPINEPHRINE........................................................... 100epinephrine solution auto-injector 0.3 mg/0.3ml

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

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

ml)................................................................................29EPIVIR HBV..................................................................46eplerenone tab 25 mg.................................................61eplerenone tab 50 mg.................................................61EPOGEN....................................................................... 55EPOGEN....................................................................... 56EPOGEN....................................................................... 56EPOGEN....................................................................... 56EPOGEN....................................................................... 56ERBITUX....................................................................... 29ERBITUX....................................................................... 29ERGOLOID MESYLATES...........................................18ERIVEDGE....................................................................29ERLEADA......................................................................29erlotinib hcl tab 100 mg.............................................. 29erlotinib hcl tab 150 mg.............................................. 29erlotinib hcl tab 25 mg.................................................29ertapenem sodium for inj 1 gm.................................. 10ERWINAZE................................................................... 30ERYPED 400................................................................10ERYTHROCIN LACTOBIONATE...............................10ERYTHROCIN STEARATE........................................ 10erythromycin ethylsuccinate for susp 200

mg/5ml........................................................................ 10erythromycin ethylsuccinate for susp 400

mg/5ml........................................................................ 10erythromycin ophth oint 5 mg/gm.............................. 96erythromycin pads 2%.................................................10erythromycin soln 2%..................................................10erythromycin tab 250 mg............................................ 10erythromycin tab 500 mg............................................ 10erythromycin tab delayed release 250

mg................................................................................10erythromycin tab delayed release 333

mg................................................................................10erythromycin tab delayed release 500

mg................................................................................10ESBRIET..................................................................... 100ESBRIET..................................................................... 100ESBRIET..................................................................... 100

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

mg................................................................................76esomeprazole magnesium cap delayed release 40

mg................................................................................76ESOMEPRAZOLE SODIUM...................................... 76esomeprazole sodium for intravenous soln 40

mg................................................................................76estradiol & norethindrone acetate tab 0.5-0.1

mg................................................................................83estradiol & norethindrone acetate tab 1-0.5

mg................................................................................83estradiol tab 0.5 mg.....................................................83estradiol tab 1 mg........................................................83estradiol tab 2 mg........................................................83estradiol td patch weekly 0.025

mg/24hr...................................................................... 83estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr)................................................................... 83estradiol td patch weekly 0.05 mg/24hr.................... 83estradiol td patch weekly 0.06 mg/24hr.................... 83estradiol td patch weekly 0.075

mg/24hr...................................................................... 83estradiol td patch weekly 0.1 mg/24hr...................... 83estradiol vaginal cream 0.1 mg/gm........................... 83estradiol vaginal tab 10 mcg...................................... 83ethambutol hcl tab 100 mg.........................................26ethambutol hcl tab 400 mg.........................................26ethosuximide cap 250 mg...........................................15ethosuximide soln 250 mg/5ml.................................. 15ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg..............................................................................83ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg..............................................................................83ETHYOL........................................................................ 30ETIDRONATE DISODIUM..........................................95ETIDRONATE DISODIUM..........................................95etodolac 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........................................ 2etodolac tab er 24hr 600 mg........................................ 2ETOPOPHOS............................................................... 30etoposide inj 100 mg/5ml (20 mg/ml)........................30etoposide inj 1 gm/50ml (20 mg/ml).......................... 30etoposide inj 500 mg/25ml (20 mg/ml)......................30EVOMELA..................................................................... 30

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EVOTAZ.........................................................................46exemestane tab 25 mg............................................... 30EXJADE.........................................................................74EXJADE.........................................................................74EXJADE.........................................................................74ezetimibe-simvastatin tab 10-10 mg..........................61ezetimibe-simvastatin tab 10-20 mg..........................61ezetimibe-simvastatin tab 10-40 mg..........................61ezetimibe-simvastatin tab 10-80 mg..........................61ezetimibe tab 10 mg....................................................61FFABRAZYME................................................................ 79FABRAZYME................................................................ 79famciclovir tab 125 mg................................................46famciclovir tab 250 mg................................................46famciclovir tab 500 mg................................................46famotidine for susp 40 mg/5ml...................................76famotidine inj 200 mg/20ml........................................ 76famotidine inj 20 mg/2ml.............................................76famotidine inj 40 mg/4ml.............................................76famotidine tab 20 mg...................................................76famotidine tab 40 mg...................................................77FANAPT.........................................................................40FANAPT.........................................................................40FANAPT.........................................................................40FANAPT.........................................................................40FANAPT.........................................................................40FANAPT.........................................................................40FANAPT.........................................................................40FANAPT TITRATION PACK....................................... 40FARESTON...................................................................30FARYDAK......................................................................30FARYDAK......................................................................30FARYDAK......................................................................30FASLODEX................................................................... 30fat emulsion plant based iv emulsion

20%............................................................................. 74febuxostat tab 40 mg...................................................25febuxostat tab 80 mg...................................................25felbamate susp 600 mg/5ml....................................... 15felbamate tab 400 mg................................................. 15felbamate tab 600 mg................................................. 15felodipine tab er 24hr 10 mg...................................... 62felodipine tab er 24hr 2.5 mg..................................... 61felodipine tab er 24hr 5 mg........................................ 62fenofibrate micronized cap 134 mg........................... 62fenofibrate micronized cap 200 mg........................... 62fenofibrate micronized cap 67 mg............................. 62fenofibrate tab 145 mg................................................62fenofibrate tab 160 mg................................................62fenofibrate tab 48 mg.................................................. 62

fenofibrate tab 54 mg.................................................. 62fentanyl 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....................................................................... 20FETZIMA....................................................................... 20FETZIMA....................................................................... 20FETZIMA....................................................................... 20FETZIMA TITRATION PACK......................................20FINACEA....................................................................... 72FINACEA....................................................................... 72finasteride tab 5 mg.....................................................80FIRAZYR....................................................................... 89FIRMAGON...................................................................86FIRMAGON...................................................................86flecainide acetate tab 100 mg....................................62flecainide acetate tab 150 mg....................................62flecainide acetate tab 50 mg...................................... 62FLOVENT DISKUS....................................................100FLOVENT DISKUS....................................................100FLOVENT DISKUS....................................................100FLOVENT HFA...........................................................100FLOVENT HFA...........................................................100FLOVENT HFA...........................................................100fluconazole for susp 10 mg/ml................................... 24fluconazole for susp 40 mg/ml................................... 24fluconazole in dextrose inj 200

mg/100ml....................................................................24fluconazole in dextrose inj 400

mg/200ml....................................................................24fluconazole in nacl 0.9% inj 200

mg/100ml....................................................................24fluconazole in nacl 0.9% inj 400

mg/200ml....................................................................24fluconazole tab 100 mg...............................................24

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fluconazole tab 150 mg...............................................24fluconazole tab 200 mg...............................................24fluconazole tab 50 mg.................................................24flucytosine cap 250 mg............................................... 24flucytosine cap 500 mg............................................... 24fludarabine phosphate for inj 50 mg..........................30fludarabine phosphate inj 25 mg/ml.......................... 30fludrocortisone acetate tab 0.1 mg............................ 81fluocinolone acetonide (otic) oil 0.01%..................... 98fluocinolone acetonide cream 0.01%........................ 72fluocinonide cream 0.05%.......................................... 72fluocinonide emulsified base cream

0.05%..........................................................................72fluocinonide gel 0.05%................................................72fluocinonide oint 0.05%...............................................72fluocinonide soln 0.05%..............................................72fluorometholone ophth susp 0.1%.............................96FLUOROURACIL......................................................... 72FLUOROURACIL......................................................... 72fluorouracil cream 5%................................................. 72fluorouracil iv soln 1 gm/20ml (50 mg/

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

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

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

ml)................................................................................30FLUOXETINE DR........................................................ 20fluoxetine hcl cap 10 mg.............................................20fluoxetine hcl cap 20 mg.............................................20fluoxetine hcl cap 40 mg.............................................20fluoxetine hcl solution 20 mg/5ml.............................. 20fluoxetine hcl tab 10 mg..............................................20fluoxetine hcl tab 20 mg..............................................20fluphenazine decanoate inj 25 mg/ml........................40FLUPHENAZINE HCL.................................................40FLUPHENAZINE HCL.................................................41FLUPHENAZINE HCL.................................................41fluphenazine hcl tab 10 mg........................................ 41fluphenazine hcl tab 1 mg.......................................... 41fluphenazine hcl tab 2.5 mg....................................... 41fluphenazine hcl tab 5 mg.......................................... 41flurbiprofen sodium ophth soln 0.03%.......................96flurbiprofen tab 100 mg.................................................2flurbiprofen tab 50 mg................................................... 2flutamide cap 125 mg..................................................30FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 100FLUTICASONE PROPIONATE/

SALMETEROL........................................................ 100

FLUTICASONE PROPIONATE/SALMETEROL........................................................ 100

fluticasone propionate cream 0.05%.........................72fluticasone propionate nasal susp 50 mcg/

act..............................................................................100fluticasone propionate oint 0.005%........................... 72fluvoxamine maleate tab 100 mg...............................20fluvoxamine maleate tab 25 mg.................................20fluvoxamine maleate tab 50 mg.................................20FOLOTYN......................................................................30FOLOTYN......................................................................30fomepizole inj 1 gm/ml (for iv infusion)......................74fondaparinux sodium subcutaneous inj 10

mg/0.8ml.....................................................................56fondaparinux sodium subcutaneous inj 2.5

mg/0.5ml.....................................................................56fondaparinux sodium subcutaneous inj 5

mg/0.4ml.....................................................................56fondaparinux sodium subcutaneous inj 7.5

mg/0.6ml.....................................................................56FORTEO........................................................................95fosamprenavir calcium tab 700 mg........................... 46fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................62fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................62fosinopril sodium tab 10 mg....................................... 62fosinopril sodium tab 20 mg....................................... 62fosinopril sodium tab 40 mg....................................... 62fosphenytoin sodium inj 100 mg/2ml.........................15fosphenytoin sodium inj 500 mg/10ml.......................15FOSRENOL.................................................................. 74FOSRENOL.................................................................. 74fulvestrant inj 250 mg/5ml...........................................30furosemide inj 10 mg/ml..............................................62furosemide oral soln 10 mg/ml...................................62furosemide tab 20 mg................................................. 62furosemide tab 40 mg................................................. 62furosemide tab 80 mg................................................. 62FUZEON........................................................................46FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15FYCOMPA.....................................................................15Ggabapentin cap 100 mg.............................................. 15gabapentin cap 300 mg.............................................. 15gabapentin cap 400 mg.............................................. 15

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gabapentin oral soln 250 mg/5ml.............................. 15gabapentin tab 600 mg............................................... 15gabapentin tab 800 mg............................................... 15GABITRIL...................................................................... 15GABITRIL...................................................................... 15GALANTAMINE HYDROBROMIDE.......................... 18galantamine hydrobromide cap er 24hr 16

mg................................................................................18galantamine hydrobromide cap er 24hr 24

mg................................................................................18galantamine hydrobromide cap er 24hr 8

mg................................................................................18galantamine hydrobromide tab 12 mg...................... 18galantamine hydrobromide tab 4 mg.........................18galantamine hydrobromide tab 8 mg.........................18GAMMAGARD LIQUID............................................... 89GAMMAGARD LIQUID............................................... 89GAMMAGARD LIQUID............................................... 89GAMMAGARD LIQUID............................................... 89GAMMAGARD LIQUID............................................... 89GAMMAGARD LIQUID............................................... 90GAMMAGARD S/D......................................................90GAMMAGARD S/D......................................................90GAMMAPLEX............................................................... 90GAMMAPLEX............................................................... 90GAMMAPLEX............................................................... 90GAMMAPLEX............................................................... 90GAMMAPLEX............................................................... 90GAMMAPLEX............................................................... 90GAMUNEX-C................................................................ 90GAMUNEX-C................................................................ 90GAMUNEX-C................................................................ 90GAMUNEX-C................................................................ 90GAMUNEX-C................................................................ 90GAMUNEX-C................................................................ 90ganciclovir sodium for inj 500 mg.............................. 46GARDASIL 9.................................................................90GARDASIL 9.................................................................90GATTEX.........................................................................77GAUZE PADS 2" X 2".................................................51GAZYVA.........................................................................30gemcitabine hcl for inj 1 gm....................................... 30gemcitabine hcl for inj 200 mg...................................30gemcitabine hcl for inj 2 gm....................................... 30gemcitabine hcl inj 1 gm/26.3ml (38 mg/

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

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

ml)................................................................................30gemfibrozil tab 600 mg............................................... 62gentamicin in saline inj 0.8 mg/ml............................. 10

gentamicin 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%..................................72gentamicin sulfate inj 10 mg/ml................................. 10gentamicin sulfate inj 40 mg/ml................................. 10gentamicin sulfate oint 0.1%...................................... 72gentamicin sulfate ophth oint 0.3%........................... 96gentamicin sulfate ophth soln 0.3%...........................96GENVOYA.....................................................................46GEODON.......................................................................41GILENYA....................................................................... 70GILOTRIF......................................................................30GILOTRIF......................................................................30GILOTRIF......................................................................30glatiramer acetate soln prefilled syringe 20 mg/

ml.................................................................................70glatiramer acetate soln prefilled syringe 40 mg/

ml.................................................................................70GLEOSTINE..................................................................30GLEOSTINE..................................................................30GLEOSTINE..................................................................30glimepiride tab 1 mg....................................................51glimepiride tab 2 mg....................................................51glimepiride tab 4 mg....................................................51glipizide-metformin hcl tab 2.5-250 mg.....................51glipizide-metformin hcl tab 2.5-500 mg.....................51glipizide-metformin hcl tab 5-500 mg........................ 51glipizide tab 10 mg...................................................... 51glipizide tab 5 mg.........................................................51glipizide tab er 24hr 10 mg.........................................51glipizide tab er 24hr 2.5 mg........................................51glipizide tab er 24hr 5 mg...........................................51GLUCAGEN HYPOKIT............................................... 51GLUCAGON EMERGENCY KIT............................... 51glycopyrrolate tab 1 mg.............................................. 77glycopyrrolate tab 2 mg.............................................. 77GLYXAMBI.................................................................... 51GLYXAMBI.................................................................... 51granisetron hcl inj 1 mg/ml......................................... 23granisetron hcl inj 4 mg/4ml (1 mg/ml)......................23granisetron hcl tab 1 mg.............................................23GRANIX......................................................................... 56GRANIX......................................................................... 56GRANIX......................................................................... 56GRANIX......................................................................... 56griseofulvin microsize susp 125

mg/5ml........................................................................ 24griseofulvin ultramicrosize tab 125 mg......................24griseofulvin ultramicrosize tab 250 mg......................24GUANIDINE HCL.........................................................26

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HH.P. ACTHAR............................................................... 81HAEGARDA.................................................................. 90HAEGARDA.................................................................. 90HALAVEN...................................................................... 31halobetasol propionate cream 0.05%........................72halobetasol propionate oint 0.05%............................ 72haloperidol decanoate im soln 100 mg/

ml.................................................................................41haloperidol decanoate im soln 50 mg/

ml.................................................................................41haloperidol lactate inj 5 mg/ml................................... 41haloperidol lactate oral conc 2 mg/ml........................41haloperidol tab 0.5 mg................................................ 41haloperidol tab 10 mg................................................. 41haloperidol tab 1 mg....................................................41haloperidol tab 20 mg................................................. 41haloperidol tab 2 mg....................................................41haloperidol tab 5 mg....................................................41HARVONI...................................................................... 46HAVRIX..........................................................................90HAVRIX..........................................................................90heparin sodium (porcine)-dextrose iv sol 20000

unit/500ml-5%............................................................56heparin sodium (porcine) inj 10000 unit/

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



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

unit/0.5ml....................................................................56HEPATAMINE............................................................... 74HERCEPTIN................................................................. 31HERCEPTIN HYLECTA.............................................. 31HETLIOZ..................................................................... 103HIBERIX........................................................................ 90HUMALOG.................................................................... 51HUMALOG.................................................................... 51HUMALOG JUNIOR KWIKPEN.................................51HUMALOG KWIKPEN.................................................51HUMALOG KWIKPEN.................................................51HUMALOG MIX 50/50.................................................51HUMALOG MIX 50/50 KWIKPEN............................. 51HUMALOG MIX 75/25.................................................51HUMALOG MIX 75/25 KWIKPEN............................. 51HUMIRA.........................................................................90HUMIRA.........................................................................90HUMIRA.........................................................................90

HUMIRA.........................................................................90HUMIRA.........................................................................90HUMIRA.........................................................................90HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................91HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................91HUMIRA PEDIATRIC CROHNS DISEASE

STARTER PACK.......................................................91HUMIRA PEN............................................................... 91HUMIRA PEN............................................................... 91HUMIRA PEN-CD/UC/HS STARTER........................91HUMIRA PEN-CD/UC/HS STARTER........................91HUMIRA PEN-PS/UV STARTER...............................91HUMIRA PEN-PS/UV STARTER...............................91HUMULIN 70/30...........................................................52HUMULIN 70/30 KWIKPEN....................................... 52HUMULIN N..................................................................51HUMULIN N KWIKPEN.............................................. 51HUMULIN R..................................................................51HUMULIN R U-500 (CONCENTRATE).....................51HUMULIN R U-500 KWIKPEN...................................51hydralazine hcl tab 100 mg........................................ 62hydralazine hcl tab 10 mg.......................................... 62hydralazine hcl tab 25 mg.......................................... 62hydralazine hcl tab 50 mg.......................................... 62hydrochlorothiazide cap 12.5 mg...............................62hydrochlorothiazide tab 12.5 mg................................62hydrochlorothiazide tab 25 mg...................................62hydrochlorothiazide tab 50 mg...................................62hydrocodone-acetaminophen soln 7.5-325

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

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



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

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

mg..................................................................................2hydrocodone-ibuprofen tab 10-200 mg.......................2hydrocodone-ibuprofen tab 5-200 mg......................... 2hydrocodone-ibuprofen tab 7.5-200 mg......................2hydrocortisone butyrate cream 0.1%........................ 72hydrocortisone butyrate hydrophilic lipo base cream

0.1%............................................................................72hydrocortisone butyrate hydrophilic lipo base cream

0.1%............................................................................81

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hydrocortisone butyrate oint 0.1%.............................72hydrocortisone butyrate soln 0.1%............................ 72hydrocortisone cream 1%...........................................72hydrocortisone cream 2.5%........................................72hydrocortisone enema 100 mg/60ml.........................94hydrocortisone lotion 2.5%......................................... 72hydrocortisone oint 1%............................................... 72hydrocortisone oint 2.5%............................................ 72hydrocortisone rectal cream 1%................................ 94hydrocortisone rectal cream 2.5%.............................94hydrocortisone tab 10 mg...........................................81hydrocortisone tab 20 mg...........................................81hydrocortisone tab 5 mg............................................. 81hydrocortisone valerate cream 0.2%.........................72hydrocortisone valerate oint 0.2%............................. 72hydrocortisone w/ acetic acid otic soln

1-2%............................................................................98hydromorphone hcl inj 2 mg/ml....................................2hydromorphone hcl liqd 1 mg/ml..................................2hydromorphone hcl preservative free inj 10 mg/

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

ml................................................................................... 2hydromorphone hcl tab 2 mg....................................... 2hydromorphone hcl tab 4 mg....................................... 2hydromorphone hcl tab 8 mg....................................... 2hydroxychloroquine sulfate tab 200 mg.................... 38HYDROXYPROGESTERONE

CAPROATE................................................................83hydroxyurea cap 500 mg............................................ 31hydroxyzine hcl syrup 10 mg/5ml.............................. 50hydroxyzine hcl tab 10 mg..........................................50hydroxyzine hcl tab 25 mg..........................................50hydroxyzine hcl tab 50 mg..........................................50Iibandronate sodium iv soln 3 mg/3ml........................95ibandronate sodium tab 150 mg................................ 95IBRANCE.......................................................................31IBRANCE.......................................................................31IBRANCE.......................................................................31ibuprofen susp 100 mg/5ml.......................................... 2ibuprofen tab 400 mg.................................................... 3ibuprofen tab 600 mg.................................................... 3ibuprofen tab 800 mg.................................................... 3icatibant acetate inj 30 mg/3ml.................................. 91ICLUSIG........................................................................ 31ICLUSIG........................................................................ 31idarubicin hcl iv inj 10 mg/10ml (1 mg/

ml)................................................................................31idarubicin hcl iv inj 20 mg/20ml (1 mg/

ml)................................................................................31

idarubicin hcl iv inj 5 mg/5ml (1 mg/ml).....................31IDHIFA............................................................................31IDHIFA............................................................................31IFEX............................................................................... 31IFOSFAMIDE................................................................ 31ifosfamide for inj 1 gm.................................................31ifosfamide iv inj 1 gm/20ml (50 mg/ml)..................... 31ifosfamide iv inj 3 gm/60ml (50 mg/ml)..................... 31ILARIS............................................................................91ILEVRO..........................................................................96imatinib mesylate tab 100 mg.................................... 31imatinib mesylate tab 400 mg.................................... 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMBRUVICA.................................................................. 31IMFINZI..........................................................................31IMFINZI..........................................................................31imipenem-cilastatin intravenous for soln 250

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

mg................................................................................10imipramine hcl tab 10 mg........................................... 20imipramine hcl tab 25 mg........................................... 20imipramine hcl tab 50 mg........................................... 20imiquimod cream 5%...................................................72IMLYGIC........................................................................ 31IMLYGIC........................................................................ 31IMOVAX RABIES (H.D.C.V.)...................................... 91IMPAVIDO..................................................................... 10INBRIJA......................................................................... 39INCRELEX.................................................................... 82INCRUSE ELLIPTA................................................... 100indapamide tab 1.25 mg............................................. 62indapamide tab 2.5 mg............................................... 62INFANRIX......................................................................91INLYTA...........................................................................31INLYTA...........................................................................31INSULIN INJECTION DEVICE...................................52INSULIN SYRINGE/NEEDLE.....................................52INTELENCE.................................................................. 46INTELENCE.................................................................. 46INTELENCE.................................................................. 46INTRON A.....................................................................46INTRON A.....................................................................46INTRON A.....................................................................46INTRON A.....................................................................46INTRON A.....................................................................46INTRON A W/DILUENT..............................................46INTRON A W/DILUENT..............................................46

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INTRON A W/DILUENT..............................................46INVANZ.......................................................................... 11INVANZ.......................................................................... 11INVEGA SUSTENNA.................................................. 41INVEGA SUSTENNA.................................................. 41INVEGA SUSTENNA.................................................. 41INVEGA SUSTENNA.................................................. 41INVEGA SUSTENNA.................................................. 41INVEGA TRINZA..........................................................41INVEGA TRINZA..........................................................41INVEGA TRINZA..........................................................41INVEGA TRINZA..........................................................41INVIRASE......................................................................46INVOKAMET.................................................................52INVOKAMET.................................................................52INVOKAMET.................................................................52INVOKAMET.................................................................52INVOKAMET XR..........................................................52INVOKAMET XR..........................................................52INVOKAMET XR..........................................................52INVOKAMET XR..........................................................52INVOKANA....................................................................52INVOKANA....................................................................52IPOL INACTIVATED IPV.............................................91ipratropium bromide inhal soln 0.02%.....................100ipratropium bromide nasal soln 0.03% (21 mcg/

spray)........................................................................100ipratropium bromide nasal soln 0.06% (42 mcg/

spray)........................................................................100irbesartan-hydrochlorothiazide tab 150-12.5

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

mg................................................................................62irbesartan tab 150 mg.................................................62irbesartan tab 300 mg.................................................62irbesartan tab 75 mg................................................... 62IRESSA..........................................................................31IRINOTECAN................................................................31irinotecan hcl inj 100 mg/5ml (20 mg/

ml)................................................................................32irinotecan hcl inj 40 mg/2ml (20 mg/ml).................... 31ISENTRESS..................................................................46ISENTRESS..................................................................46ISENTRESS..................................................................46ISENTRESS..................................................................46ISENTRESS HD...........................................................46ISONIAZID.................................................................... 26isoniazid tab 100 mg................................................... 26isoniazid tab 300 mg................................................... 26isosorbide dinitrate tab 10 mg....................................63isosorbide dinitrate tab 20 mg....................................63isosorbide dinitrate tab 30 mg....................................63

isosorbide dinitrate tab 5 mg......................................63isosorbide mononitrate tab 10 mg............................. 63isosorbide mononitrate tab 20 mg............................. 63isosorbide mononitrate tab er 24hr 120

mg................................................................................63isosorbide mononitrate tab er 24hr 30

mg................................................................................63isosorbide mononitrate tab er 24hr 60

mg................................................................................63isotretinoin cap 10 mg.................................................72isotretinoin cap 20 mg.................................................72isotretinoin cap 30 mg.................................................72isotretinoin cap 40 mg.................................................72isradipine cap 2.5 mg..................................................63isradipine cap 5 mg..................................................... 63ISTALOL........................................................................ 96ISTODAX (OVERFILL)................................................32itraconazole cap 100 mg............................................ 24ivermectin tab 3 mg.....................................................38IXEMPRA KIT...............................................................32IXEMPRA KIT...............................................................32IXIARO...........................................................................91JJADENU........................................................................ 74JADENU........................................................................ 74JADENU........................................................................ 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74JADENU SPRINKLE................................................... 74JAKAFI...........................................................................32JAKAFI...........................................................................32JAKAFI...........................................................................32JAKAFI...........................................................................32JAKAFI...........................................................................32JANUMET......................................................................52JANUMET......................................................................52JANUMET XR...............................................................52JANUMET XR...............................................................52JANUMET XR...............................................................52JANUVIA........................................................................52JANUVIA........................................................................52JANUVIA........................................................................52JARDIANCE..................................................................52JARDIANCE..................................................................52JENTADUETO.............................................................. 52JENTADUETO.............................................................. 52JENTADUETO.............................................................. 52JENTADUETO XR....................................................... 52JENTADUETO XR....................................................... 52JEVTANA.......................................................................32JULUCA.........................................................................46JUXTAPID..................................................................... 63

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JUXTAPID..................................................................... 63JUXTAPID..................................................................... 63JUXTAPID..................................................................... 63JUXTAPID..................................................................... 63JUXTAPID..................................................................... 63KKADCYLA......................................................................32KADCYLA......................................................................32KALETRA...................................................................... 46KALETRA...................................................................... 46KALYDECO.................................................................100KALYDECO.................................................................100KALYDECO.................................................................100KALYDECO.................................................................100kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45%

inj................................................................................. 75kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2%



inj................................................................................. 75kcl 20 meq/l (0.15%) in nacl 0.45% inj......................75kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45%


inj................................................................................. 75KEPIVANCE..................................................................70ketoconazole cream 2%..............................................24ketoconazole shampoo 2%........................................ 24ketoconazole tab 200 mg........................................... 24ketorolac tromethamine ophth soln

0.4%............................................................................96ketorolac tromethamine ophth soln

0.5%............................................................................96KEYTRUDA...................................................................32KINERET....................................................................... 91KINRIX........................................................................... 91KISQALI.........................................................................32KISQALI.........................................................................32KISQALI.........................................................................32KISQALI FEMARA 200 DOSE...................................32KISQALI FEMARA 400 DOSE...................................32KISQALI FEMARA 600 DOSE...................................32KOMBIGLYZE XR........................................................52KOMBIGLYZE XR........................................................52KOMBIGLYZE XR........................................................53KORLYM........................................................................86KUVAN...........................................................................79KUVAN...........................................................................79KUVAN...........................................................................79KYNAMRO.................................................................... 63

KYPROLIS.................................................................... 32KYPROLIS.................................................................... 32KYPROLIS.................................................................... 32Llabetalol hcl tab 100 mg..............................................63labetalol hcl tab 200 mg..............................................63labetalol hcl tab 300 mg..............................................63LACRISERT.................................................................. 96lactated ringer's solution............................................. 75lactic acid (ammonium lactate) cream

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

12%............................................................................. 73lactulose (encephalopathy) solution 10

gm/15ml......................................................................77lactulose solution 10 gm/15ml....................................77lamivudine oral soln 10 mg/ml................................... 46lamivudine tab 100 mg (hbv)......................................46lamivudine tab 150 mg................................................46lamivudine tab 300 mg................................................46lamivudine-zidovudine tab 150-300 mg.................... 46lamotrigine tab 100 mg............................................... 16lamotrigine tab 150 mg............................................... 16lamotrigine tab 200 mg............................................... 16lamotrigine tab 25 mg................................................. 16lamotrigine tab chewable dispersible 25

mg................................................................................16lamotrigine tab chewable dispersible 5

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

mg................................................................................77lansoprazole cap delayed release 30

mg................................................................................77lanthanum carbonate chew tab 1000



mg................................................................................75LANTUS.........................................................................53LANTUS SOLOSTAR..................................................53LARTRUVO...................................................................32LARTRUVO...................................................................32latanoprost ophth soln 0.005%.................................. 96LATUDA.........................................................................41LATUDA.........................................................................41LATUDA.........................................................................41LATUDA.........................................................................41LATUDA.........................................................................41LAZANDA........................................................................ 3LAZANDA........................................................................ 3

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LAZANDA........................................................................ 3leflunomide tab 10 mg.................................................91leflunomide tab 20 mg.................................................91LENVIMA 10 MG DAILY DOSE.................................32LENVIMA 12MG DAILY DOSE..................................32LENVIMA 14 MG DAILY DOSE.................................32LENVIMA 18 MG DAILY DOSE.................................32LENVIMA 20 MG DAILY DOSE.................................32LENVIMA 24 MG DAILY DOSE.................................33LENVIMA 4 MG DAILY DOSE...................................33LENVIMA 8 MG DAILY DOSE...................................33LETAIRIS.....................................................................101LETAIRIS.....................................................................101letrozole tab 2.5 mg.....................................................33LEUCOVORIN CALCIUM...........................................33LEUCOVORIN CALCIUM...........................................33LEUCOVORIN CALCIUM...........................................33leucovorin calcium for inj 100 mg.............................. 33leucovorin calcium for inj 200 mg.............................. 33leucovorin calcium for inj 350 mg.............................. 33leucovorin calcium for inj 500 mg.............................. 33leucovorin calcium for inj 50 mg................................ 33leucovorin calcium inj 500 mg/50ml (10 mg/

ml)................................................................................33leucovorin calcium tab 25 mg.................................... 33leucovorin calcium tab 5 mg.......................................33LEUKERAN...................................................................33LEUKINE....................................................................... 56leuprolide acetate inj kit 5 mg/ml............................... 87LEVEMIR.......................................................................53LEVEMIR FLEXTOUCH..............................................53levetiracetam inj 500 mg/5ml (100 mg/

ml)................................................................................16levetiracetam in sodium chloride iv soln 1000

mg/100ml....................................................................16levetiracetam in sodium chloride iv soln 1500

mg/100ml....................................................................16levetiracetam in sodium chloride iv soln 500

mg/100ml....................................................................16levetiracetam oral soln 100 mg/ml.............................16levetiracetam tab 1000 mg......................................... 16levetiracetam tab 250 mg........................................... 16levetiracetam tab 500 mg........................................... 16levetiracetam tab 750 mg........................................... 16levobunolol hcl ophth soln 0.5%................................ 97levocarnitine oral soln 1 gm/10ml

(10%).......................................................................... 75levocarnitine tab 330 mg............................................ 75levocetirizine dihydrochloride tab 5

mg............................................................................. 101levofloxacin in d5w iv soln 250

mg/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 oral 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............................................................. 83levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg..............................................................................83levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg..............................................................................83levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg........................83levonorgestrel-ethinyl estradiol (continuous) tab

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

0.01mg(7)...................................................................83levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7)...................................................................83LEVORPHANOL TARTRATE....................................... 3levorphanol tartrate tab 2 mg....................................... 3levothyroxine sodium tab 100 mcg (levo-t, levoxyl,

unithroid, unithroid direct)........................................85levothyroxine sodium tab 112 mcg (levo-t, levoxyl,



unithroid).....................................................................86levothyroxine sodium tab 150 mcg (levo-t, levoxyl,




unithroid, unithroid direct)........................................85levothyroxine sodium tab 300 mcg (levo-t, unithroid,

unithroid direct)......................................................... 86levothyroxine sodium tab 50 mcg (levo-t, levoxyl,



unithroid, unithroid direct)........................................85LEXIVA...........................................................................46LIBTAYO........................................................................ 33LIDOCAINE HCL..........................................................63

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LIDOCAINE HCL..........................................................63lidocaine hcl local inj 1%...............................................5lidocaine hcl local preservative free inj

1%..................................................................................5lidocaine hcl soln 4%.....................................................5lidocaine hcl urethral/mucosal gel 2%.........................5lidocaine hcl viscous soln 2%.......................................5lidocaine oint 5%............................................................5lidocaine patch 5%.........................................................5lidocaine-prilocaine cream 2.5-2.5%........................... 5lindane shampoo 1%...................................................38LINEZOLID....................................................................11linezolid for susp 100 mg/5ml.................................... 11linezolid iv soln 600 mg/300ml (2 mg/

ml)................................................................................11linezolid tab 600 mg.................................................... 11LINZESS........................................................................77LINZESS........................................................................77LINZESS........................................................................77liothyronine sodium tab 25 mcg.................................86liothyronine sodium tab 50 mcg.................................86liothyronine sodium tab 5 mcg................................... 86lisinopril & hydrochlorothiazide tab 10-12.5

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

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

mg................................................................................63lisinopril tab 10 mg...................................................... 63lisinopril tab 2.5 mg..................................................... 63lisinopril tab 20 mg...................................................... 63lisinopril tab 30 mg...................................................... 63lisinopril tab 40 mg...................................................... 63lisinopril tab 5 mg.........................................................63LITHIUM........................................................................ 50lithium carbonate cap 150 mg....................................50lithium carbonate cap 300 mg....................................50lithium carbonate cap 600 mg....................................50lithium carbonate tab 300 mg.....................................50lithium carbonate tab er 300 mg................................50lithium carbonate tab er 450 mg................................50LONSURF..................................................................... 33LONSURF..................................................................... 33loperamide hcl cap 2 mg............................................ 77lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/

ml)................................................................................46lorazepam tab 0.5 mg................................................. 50lorazepam tab 1 mg.................................................... 50lorazepam tab 2 mg.................................................... 50LORBRENA.................................................................. 33LORBRENA.................................................................. 33

losartan potassium & hydrochlorothiazide tab100-12.5 mg.............................................................. 63

losartan potassium & hydrochlorothiazide tab 100-25mg................................................................................63

losartan potassium & hydrochlorothiazide tab50-12.5 mg.................................................................63

losartan potassium tab 100 mg..................................64losartan potassium tab 25 mg....................................63losartan potassium tab 50 mg....................................64lovastatin tab 10 mg....................................................64lovastatin tab 20 mg....................................................64lovastatin tab 40 mg....................................................64loxapine succinate cap 10 mg....................................42loxapine succinate cap 25 mg....................................42loxapine succinate cap 50 mg....................................42loxapine succinate cap 5 mg......................................42LUMIGAN...................................................................... 97LUMIZYME....................................................................79LUMOXITI......................................................................33LUPRON DEPOT (1-MONTH)...................................87LUPRON DEPOT (1-MONTH)...................................87LUPRON DEPOT (3-MONTH)...................................87LUPRON DEPOT (3-MONTH)...................................87LUPRON DEPOT (4-MONTH)...................................87LUPRON DEPOT (6-MONTH)...................................87LUPRON DEPOT-PED (1-MONTH)..........................87LUPRON DEPOT-PED (1-MONTH)..........................87LUPRON DEPOT-PED (1-MONTH)..........................87LUPRON DEPOT-PED (3-MONTH)..........................87LUPRON DEPOT-PED (3-MONTH)..........................87LYNPARZA....................................................................33LYNPARZA....................................................................33LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYRICA.......................................................................... 16LYSODREN...................................................................86Mmagnesium sulfate inj 50%........................................ 75malathion lotion 0.5%..................................................38MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MAPROTILINE HCL.................................................... 20MARPLAN..................................................................... 20MARQIBO......................................................................33MATULANE...................................................................33MAVYRET..................................................................... 47

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MAYZENT......................................................................70MAYZENT......................................................................70meclizine hcl tab 12.5 mg...........................................23meclizine hcl tab 25 mg..............................................23medroxyprogesterone acetate im susp 150 mg/

ml.................................................................................84medroxyprogesterone acetate im susp prefilled syr

150 mg/ml.................................................................. 84medroxyprogesterone acetate tab 10

mg................................................................................84medroxyprogesterone acetate tab 2.5

mg................................................................................84medroxyprogesterone acetate tab 5

mg................................................................................84mefloquine hcl tab 250 mg......................................... 38megestrol acetate susp 40 mg/ml..............................84megestrol acetate tab 20 mg..................................... 84megestrol acetate tab 40 mg..................................... 84MEKINIST......................................................................33MEKINIST......................................................................33MEKTOVI.......................................................................33meloxicam tab 15 mg....................................................3meloxicam tab 7.5 mg...................................................3melphalan hcl for inj 50 mg........................................ 33memantine 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.................................................................. 91MENEST........................................................................84MENEST........................................................................84MENEST........................................................................84MENVEO....................................................................... 91mercaptopurine tab 50 mg......................................... 33meropenem iv for soln 1 gm...................................... 11meropenem iv for soln 500 mg.................................. 11mesalamine cap dr 400 mg........................................94mesalamine enema 4 gm........................................... 94mesalamine rectal enema 4 gm & cleanser wipe

kit................................................................................. 94mesalamine suppos 1000 mg.................................... 94mesalamine tab delayed release 1.2

gm................................................................................94mesalamine tab delayed release 800

mg................................................................................94mesna inj 100 mg/ml...................................................33MESNEX........................................................................33MESTINON................................................................... 26metformin hcl tab 1000 mg.........................................53metformin hcl tab 500 mg...........................................53metformin hcl tab 850 mg...........................................53

metformin hcl tab er 24hr 500 mg............................. 53metformin hcl tab er 24hr 750 mg............................. 53methadone hcl tab 10 mg.............................................3methadone hcl tab 5 mg............................................... 3methazolamide tab 25 mg.......................................... 64methazolamide tab 50 mg.......................................... 64methenamine hippurate tab 1 gm..............................11methimazole tab 10 mg.............................................. 88methimazole tab 5 mg.................................................88methocarbamol tab 500 mg..................................... 103methocarbamol tab 750 mg..................................... 103METHOTREXATE SODIUM.......................................91methotrexate sodium for inj 1 gm.............................. 91methotrexate sodium inj 50 mg/2ml (25 mg/

ml)................................................................................91methotrexate sodium inj pf 1000 mg/40ml (25 mg/



ml)................................................................................91methotrexate sodium tab 2.5 mg............................... 91methoxsalen rapid cap 10 mg....................................73methscopolamine bromide tab 2.5 mg......................77methscopolamine bromide tab 5 mg......................... 77methylergonovine maleate tab 0.2 mg......................80methylphenidate hcl tab 10 mg..................................70methylphenidate hcl tab 20 mg..................................70methylphenidate hcl tab 5 mg....................................70methylphenidate hcl tab er 20 mg............................. 70methylprednisolone sod succ for inj 1000

mg................................................................................81methylprednisolone sod succ for inj 125

mg................................................................................81methylprednisolone sod succ for inj 40

mg................................................................................81methylprednisolone tab 16 mg...................................81methylprednisolone tab 32 mg...................................81methylprednisolone tab 4 mg.....................................81methylprednisolone tab 8 mg.....................................81methylprednisolone tab therapy pack 4 mg

(21)..............................................................................81METHYLTESTOSTERONE........................................ 84metoclopramide hcl inj 5 mg/ml................................. 77metoclopramide hcl soln 5 mg/5ml (10

mg/10ml).....................................................................77metoclopramide hcl tab 10 mg...................................77metoclopramide hcl tab 5 mg.....................................77metolazone tab 10 mg................................................ 64metolazone tab 2.5 mg............................................... 64metolazone tab 5 mg...................................................64

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metoprolol & hydrochlorothiazide tab 100-25mg................................................................................64

metoprolol & hydrochlorothiazide tab 50-25mg................................................................................64

metoprolol succinate tab er 24hr 100mg................................................................................64




metoprolol tartrate tab 100 mg...................................64metoprolol tartrate tab 25 mg.....................................64metoprolol tartrate tab 50 mg.....................................64METRONIDAZOLE...................................................... 11METRONIDAZOLE...................................................... 11metronidazole cap 375 mg.........................................11metronidazole cream 0.75%.......................................73metronidazole gel 0.75%............................................ 73metronidazole gel 1%..................................................73metronidazole in nacl 0.79% iv soln 500

mg/100ml....................................................................11metronidazole lotion 0.75%........................................ 73metronidazole tab 250 mg..........................................11metronidazole tab 500 mg..........................................11metronidazole vaginal gel 0.75%...............................11mexiletine hcl cap 150 mg..........................................64mexiletine hcl cap 200 mg..........................................64mexiletine hcl cap 250 mg..........................................64MIACALCIN...................................................................95midodrine hcl tab 10 mg............................................. 64midodrine hcl tab 2.5 mg............................................ 64midodrine hcl tab 5 mg............................................... 64MIGERGOT...................................................................25miglustat cap 100 mg..................................................79MIGRANAL....................................................................25minocycline hcl cap 100 mg.......................................11minocycline hcl cap 50 mg......................................... 11minocycline hcl cap 75 mg......................................... 11minocycline hcl tab 100 mg........................................11minocycline hcl tab 50 mg..........................................11minocycline hcl tab 75 mg..........................................11minoxidil tab 10 mg..................................................... 64minoxidil tab 2.5 mg.................................................... 64mirtazapine orally disintegrating tab 15

mg................................................................................21mirtazapine orally disintegrating tab 30

mg................................................................................21mirtazapine orally disintegrating tab 45

mg................................................................................21mirtazapine tab 15 mg................................................ 21

mirtazapine tab 30 mg................................................ 21mirtazapine tab 45 mg................................................ 21mirtazapine tab 7.5 mg............................................... 21misoprostol tab 100 mcg............................................ 77misoprostol tab 200 mcg............................................ 77mitomycin for iv soln 20 mg....................................... 33mitomycin for iv soln 40 mg....................................... 34mitomycin for iv soln 5 mg..........................................33mitoxantrone hcl inj conc 20 mg/10ml (2 mg/

ml)................................................................................34mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/

ml)................................................................................34mitoxantrone hcl inj conc 30 mg/15ml (2 mg/

ml)................................................................................34M-M-R II........................................................................ 91modafinil tab 100 mg.................................................103modafinil tab 200 mg.................................................103moexipril hcl tab 15 mg...............................................64moexipril hcl tab 7.5 mg..............................................64MOLINDONE HYDROCHLORIDE............................ 42MOLINDONE HYDROCHLORIDE............................ 42MOLINDONE HYDROCHLORIDE............................ 42mometasone furoate cream 0.1%............................. 73mometasone furoate nasal susp 50 mcg/

act..............................................................................101mometasone furoate oint 0.1%..................................73mometasone furoate solution 0.1%

(lotion).........................................................................73montelukast sodium chew tab 4 mg........................101montelukast sodium chew tab 5 mg........................101montelukast sodium oral granules packet 4

mg............................................................................. 101montelukast sodium tab 10 mg................................101MORPHINE 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................................................................... 77MOXEZA........................................................................97MOXIFLOXACIN HCL................................................. 11moxifloxacin hcl 400 mg/250ml in sodium chloride

0.8% inj.......................................................................11moxifloxacin hcl ophth soln 0.5%.............................. 97

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moxifloxacin hcl tab 400 mg.......................................11MOZOBIL...................................................................... 56MULTAQ........................................................................ 64mupirocin oint 2%........................................................ 73MYALEPT...................................................................... 77MYCAMINE...................................................................24MYCAMINE...................................................................24mycophenolate mofetil cap 250 mg...........................92mycophenolate mofetil for oral susp 200 mg/

ml.................................................................................92mycophenolate mofetil hcl for iv soln 500

mg................................................................................92mycophenolate mofetil tab 500 mg........................... 92mycophenolate sodium tab dr 180 mg......................92mycophenolate sodium tab dr 360 mg......................92MYLOTARG.................................................................. 34MYRBETRIQ.................................................................80MYRBETRIQ.................................................................80Nnabumetone tab 500 mg...............................................3nabumetone tab 750 mg...............................................3nadolol tab 20 mg........................................................64nadolol tab 40 mg........................................................64nadolol tab 80 mg........................................................64NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................11NAFCILLIN SODIUM...................................................11nafcillin sodium for inj 1 gm........................................12nafcillin sodium for inj 2 gm........................................12nafcillin sodium for iv soln 10 gm.............................. 12NAGLAZYME................................................................79NALOXONE 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..............................................25naratriptan hcl tab 2.5 mg...........................................25NARCAN..........................................................................5NATACYN......................................................................97nateglinide tab 120 mg............................................... 53nateglinide tab 60 mg..................................................53NATPARA...................................................................... 95

NATPARA...................................................................... 95NATPARA...................................................................... 95NATPARA...................................................................... 95NEBUPENT...................................................................38NEFAZODONE HCL....................................................21NEFAZODONE HCL....................................................21nefazodone hcl tab 250 mg........................................21nefazodone hcl tab 50 mg..........................................21NEFAZODONE HYDROCHLORIDE.........................21neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin..........................97neomycin-polymy-gramicid op sol

1.75-10000-0.025mg-unt-mg/ml............................. 97neomycin-polymyxin b gu irrigation

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

0.1%............................................................................97neomycin-polymyxin-dexamethasone ophth susp

0.1%............................................................................97neomycin-polymyxin-hc otic soln 1%........................ 98neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%.................................................................. 98neomycin sulfate tab 500 mg.....................................12NERLYNX......................................................................34NEULASTA....................................................................56NEULASTA ONPRO KIT............................................ 56NEUPOGEN..................................................................56NEUPOGEN..................................................................56nevirapine susp 50 mg/5ml........................................ 47nevirapine tab 200 mg................................................ 47nevirapine tab er 24hr 100 mg...................................47nevirapine tab er 24hr 400 mg...................................47NEXAVAR......................................................................34NEXIUM.........................................................................77NEXIUM.........................................................................77NEXIUM.........................................................................77NEXIUM.........................................................................77NEXIUM.........................................................................77niacin tab er 1000 mg................................................. 64niacin tab er 500 mg................................................... 64niacin tab er 750 mg................................................... 64nicardipine hcl cap 20 mg...........................................64nicardipine hcl cap 30 mg...........................................64NICOTROL INHALER................................................... 6NICOTROL NS............................................................... 6nifedipine tab er 24hr 30 mg...................................... 65nifedipine tab er 24hr 60 mg...................................... 65nifedipine tab er 24hr 90 mg...................................... 65nifedipine tab er 24hr osmotic release 30

mg................................................................................65nifedipine tab er 24hr osmotic release 60

mg................................................................................65

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nifedipine tab er 24hr osmotic release 90mg................................................................................65

nilutamide tab 150 mg.................................................34nimodipine cap 30 mg.................................................65NINLARO.......................................................................34NINLARO.......................................................................34NINLARO.......................................................................34NIPENT..........................................................................34NISOLDIPINE ER........................................................ 65nisoldipine tab er 24hr 17 mg.................................... 65nisoldipine tab er 24hr 34 mg.................................... 65nisoldipine tab er 24hr 8.5 mg................................... 65NITRO-BID....................................................................65nitrofurantoin macrocrystalline cap 100

mg................................................................................12nitrofurantoin macrocrystalline cap 50

mg................................................................................12nitrofurantoin monohydrate macrocrystalline cap 100

mg................................................................................12nitrofurantoin susp 25 mg/5ml....................................12nitroglycerin sl tab 0.3 mg.......................................... 65nitroglycerin sl tab 0.4 mg.......................................... 65nitroglycerin sl tab 0.6 mg.......................................... 65nitroglycerin td patch 24hr 0.1 mg/hr.........................65nitroglycerin td patch 24hr 0.2 mg/hr.........................65nitroglycerin td patch 24hr 0.4 mg/hr.........................65nitroglycerin td patch 24hr 0.6 mg/hr.........................65nitroglycerin tl soln 0.4 mg/spray (400 mcg/

spray)..........................................................................65nizatidine cap 150 mg.................................................77nizatidine cap 300 mg.................................................77norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg.................................................................84norethindrone & ethinyl estradiol-fe chew tab 0.8

mg-25 mcg.................................................................84norethindrone & ethinyl estradiol tab 0.4 mg-35

mcg..............................................................................84norethindrone & ethinyl estradiol tab 0.5 mg-35

mcg..............................................................................84norethindrone & ethinyl estradiol tab 1 mg-35

mcg..............................................................................84norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg.................................................................84norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg..............................................................................84norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg..............................................................................84norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg..............................................................................84norethindrone ace-ethinyl estradiol-fe tab 1 mg-20

mcg (24).....................................................................84norethindrone acetate tab 5 mg.................................84

norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35mg-mcg.......................................................................84

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35mg-mcg.......................................................................84

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35mg-mcg.......................................................................84

norethindrone tab 0.35 mg......................................... 84norgestimate & ethinyl estradiol tab 0.25 mg-35

mcg..............................................................................84norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg.........................84norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg.........................84norgestrel & ethinyl estradiol tab 0.3 mg-30

mcg..............................................................................84NORMOSOL-M IN D5W............................................. 75NORTHERA.................................................................. 65NORTHERA.................................................................. 65NORTHERA.................................................................. 65nortriptyline hcl cap 10 mg......................................... 21nortriptyline hcl cap 25 mg......................................... 21nortriptyline hcl cap 50 mg......................................... 21nortriptyline hcl cap 75 mg......................................... 21nortriptyline hcl soln 10 mg/5ml................................. 21NORVIR.........................................................................47NORVIR.........................................................................47NORVIR.........................................................................47NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NOXAFIL....................................................................... 24NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................3NUCYNTA ER.................................................................4NUEDEXTA...................................................................70NULOJIX........................................................................92NUPLAZID.....................................................................42NUPLAZID.....................................................................42nystatin cream 100000 unit/gm..................................24nystatin oint 100000 unit/gm...................................... 24nystatin susp 100000 unit/ml......................................24nystatin tab 500000 unit..............................................24nystatin topical powder 100000 unit/

gm................................................................................25nystatin-triamcinolone cream 100000-0.1 unit/gm-

%..................................................................................73nystatin-triamcinolone oint 100000-0.1 unit/gm-

%..................................................................................73OOCALIVA....................................................................... 79

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OCALIVA....................................................................... 79octreotide acetate inj 1000 mcg/ml (1 mg/

ml)................................................................................87octreotide acetate inj 100 mcg/ml (0.1 mg/




ml)................................................................................87ODEFSEY..................................................................... 47ODOMZO...................................................................... 34OFEV........................................................................... 101OFEV........................................................................... 101ofloxacin ophth soln 0.3%...........................................97ofloxacin otic soln 0.3%.............................................. 98ofloxacin tab 400 mg...................................................12olanzapine for im inj 10 mg........................................ 42olanzapine orally disintegrating tab 10

mg................................................................................42olanzapine orally disintegrating tab 15



mg................................................................................42olanzapine tab 10 mg..................................................42olanzapine tab 15 mg..................................................42olanzapine tab 2.5 mg.................................................42olanzapine tab 20 mg..................................................42olanzapine tab 5 mg....................................................42olanzapine tab 7.5 mg.................................................42olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg.................................................................65olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg.................................................................65olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg....................................................................65olmesartan medoxomil tab 20 mg............................. 65olmesartan medoxomil tab 40 mg............................. 65olmesartan medoxomil tab 5 mg............................... 65olopatadine hcl nasal soln 0.6%..............................101olopatadine hcl ophth soln 0.1%................................97olopatadine hcl ophth soln 0.2%................................97omega-3-acid ethyl esters cap 1 gm.........................65omeprazole cap delayed release 10

mg................................................................................77omeprazole cap delayed release 20

mg................................................................................77omeprazole cap delayed release 40

mg................................................................................77

OMNITROPE................................................................ 82OMNITROPE................................................................ 82OMNITROPE................................................................ 82ONCASPAR.................................................................. 34ondansetron hcl inj 40 mg/20ml (2 mg/

ml)................................................................................23ondansetron hcl inj 4 mg/2ml (2 mg/

ml)................................................................................23ondansetron hcl oral soln 4 mg/5ml.......................... 23ondansetron hcl tab 24 mg.........................................23ondansetron hcl tab 4 mg...........................................23ondansetron hcl tab 8 mg...........................................23ondansetron orally disintegrating tab 4

mg................................................................................23ondansetron orally disintegrating tab 8

mg................................................................................23ONFI...............................................................................16ONFI...............................................................................16ONFI...............................................................................16ONGLYZA......................................................................53ONGLYZA......................................................................53ONIVYDE...................................................................... 34OPDIVO.........................................................................34OPDIVO.........................................................................34OPDIVO.........................................................................34OPSUMIT....................................................................101ORACEA........................................................................73ORALAIR.....................................................................101ORENCIA...................................................................... 92ORENCIA...................................................................... 92ORENCIA...................................................................... 92ORENCIA...................................................................... 92ORENCIA CLICKJECT............................................... 92ORFADIN.......................................................................79ORFADIN.......................................................................79ORFADIN.......................................................................79ORFADIN.......................................................................79ORFADIN.......................................................................79ORKAMBI....................................................................101ORKAMBI....................................................................101ORKAMBI....................................................................101ORKAMBI....................................................................101oseltamivir phosphate cap 30 mg..............................47oseltamivir phosphate cap 45 mg..............................47oseltamivir phosphate cap 75 mg..............................47oseltamivir phosphate for susp 6 mg/

ml.................................................................................47OTEZLA.........................................................................92OTEZLA.........................................................................92oxaliplatin for iv inj 100 mg.........................................34oxaliplatin for iv inj 50 mg...........................................34oxaliplatin iv soln 100 mg/20ml..................................34

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oxaliplatin iv soln 50 mg/10ml....................................34oxandrolone tab 10 mg............................................... 84oxandrolone tab 2.5 mg..............................................84oxaprozin tab 600 mg....................................................4oxcarbazepine 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..........................80oxybutynin chloride tab 5 mg..................................... 80oxybutynin chloride tab er 24hr 10 mg......................80oxybutynin chloride tab er 24hr 15 mg......................80oxybutynin chloride tab er 24hr 5 mg........................80oxycodone-aspirin tab 4.8355-325 mg........................4oxycodone hcl tab 10 mg..............................................4oxycodone hcl tab 15 mg..............................................4oxycodone hcl tab 20 mg..............................................4oxycodone hcl tab 30 mg..............................................4oxycodone hcl tab 5 mg................................................4oxycodone w/ acetaminophen tab 10-325

mg..................................................................................4oxycodone w/ acetaminophen tab 2.5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 5-325

mg..................................................................................4oxycodone w/ acetaminophen tab 7.5-325

mg..................................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OXYCONTIN...................................................................4OZEMPIC...................................................................... 53OZEMPIC...................................................................... 53Ppaclitaxel iv conc 100 mg/16.7ml (6 mg/

ml)................................................................................34paclitaxel iv conc 300 mg/50ml (6 mg/

ml)................................................................................34paclitaxel iv conc 30 mg/5ml (6 mg/ml).....................34paliperidone tab er 24hr 1.5 mg.................................42paliperidone tab er 24hr 3 mg....................................42paliperidone tab er 24hr 6 mg....................................42paliperidone tab er 24hr 9 mg....................................42palonosetron hcl iv soln 0.25 mg/5ml........................23palonosetron hcl iv soln pref syr 0.25

mg/5ml........................................................................ 23

PALONOSETRONHYDROCHLORIDE.................................................. 23

PALYNZIQ..................................................................... 79PALYNZIQ..................................................................... 79PALYNZIQ..................................................................... 79PANRETIN.....................................................................34pantoprazole sodium ec tab 20 mg........................... 77pantoprazole sodium ec tab 40 mg........................... 78pantoprazole sodium for iv soln 40 mg..................... 78paricalcitol cap 1 mcg................................................. 95paricalcitol cap 2 mcg................................................. 95paricalcitol cap 4 mcg................................................. 95paricalcitol iv soln 2 mcg/ml....................................... 95paricalcitol iv soln 5 mcg/ml....................................... 95paromomycin sulfate cap 250 mg..............................12paroxetine hcl tab 10 mg............................................ 21paroxetine hcl tab 20 mg............................................ 21paroxetine hcl tab 30 mg............................................ 21paroxetine hcl tab 40 mg............................................ 21PASER........................................................................... 26PAXIL............................................................................. 21PAZEO........................................................................... 97PEDIARIX......................................................................92PEDVAX HIB................................................................ 92peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm................................................................................78peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240

gm................................................................................78peg 3350-kcl-sod bicarb-nacl for soln 420

gm................................................................................78PEGANONE..................................................................16PEGASYS..................................................................... 47PEGASYS..................................................................... 47PEGASYS PROCLICK................................................47penicillin 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....................................................................92

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PENTAM 300................................................................38pentamidine isethionate for soln 300

mg................................................................................38PENTASA...................................................................... 94PENTASA...................................................................... 94pentoxifylline tab er 400 mg....................................... 65perindopril erbumine tab 2 mg................................... 65perindopril erbumine tab 4 mg................................... 65perindopril erbumine tab 8 mg................................... 65PERJETA.......................................................................34permethrin cream 5%..................................................38perphenazine tab 16 mg.............................................23perphenazine tab 2 mg............................................... 23perphenazine tab 4 mg............................................... 23perphenazine tab 8 mg............................................... 23PERSERIS.................................................................... 42PERSERIS.................................................................... 42phenelzine sulfate tab 15 mg.....................................21phenobarbital elixir 20 mg/5ml...................................16PHENOBARBITAL SODIUM...................................... 16PHENOBARBITAL SODIUM...................................... 16phenobarbital tab 100 mg...........................................17phenobarbital tab 15 mg.............................................16phenobarbital tab 16.2 mg..........................................16phenobarbital tab 30 mg.............................................16phenobarbital tab 32.4 mg..........................................17phenobarbital tab 60 mg.............................................17phenobarbital tab 64.8 mg..........................................17phenobarbital tab 97.2 mg..........................................17phenoxybenzamine hcl cap 10 mg............................65phenytoin chew tab 50 mg......................................... 17phenytoin sodium extended cap 100

mg................................................................................17phenytoin sodium extended cap 200

mg................................................................................17phenytoin sodium extended cap 300

mg................................................................................17phenytoin susp 125 mg/5ml....................................... 17PHOSLYRA...................................................................75PHOSPHOLINE IODIDE.............................................97PICATO..........................................................................73PICATO..........................................................................73PIFELTRO..................................................................... 47pilocarpine hcl ophth soln 1%.................................... 97pilocarpine hcl ophth soln 2%.................................... 97pilocarpine hcl ophth soln 4%.................................... 97pilocarpine hcl tab 5 mg..............................................70pilocarpine hcl tab 7.5 mg.......................................... 70pimecrolimus cream 1%..............................................73pimozide tab 1 mg....................................................... 42pimozide tab 2 mg....................................................... 42pindolol tab 10 mg....................................................... 65

pindolol tab 5 mg......................................................... 65pioglitazone hcl-glimepiride tab 30-2

mg................................................................................53pioglitazone hcl-glimepiride tab 30-4

mg................................................................................53pioglitazone hcl-metformin hcl tab 15-500

mg................................................................................53pioglitazone hcl-metformin hcl tab 15-850

mg................................................................................53pioglitazone hcl tab 15 mg..........................................53pioglitazone hcl tab 30 mg..........................................53pioglitazone hcl tab 45 mg..........................................53piperacillin 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).............................................................................. 12PIQRAY 200MG DAILY DOSE...................................34PIQRAY 250MG DAILY DOSE...................................34PIQRAY 300MG DAILY DOSE...................................34piroxicam cap 10 mg..................................................... 4piroxicam cap 20 mg..................................................... 4PLEGRIDY.................................................................... 70PLEGRIDY.................................................................... 70PLEGRIDY STARTER PACK..................................... 70PLEGRIDY STARTER PACK..................................... 70podofilox soln 0.5%..................................................... 73POLIVY..........................................................................34polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1%...................................................................... 97POMALYST...................................................................34POMALYST...................................................................34POMALYST...................................................................34POMALYST...................................................................34PORTRAZZA................................................................ 35POTASSIUM CHLORIDE/DEXTROSE.....................75POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................75POTASSIUM CHLORIDE/DEXTROSE/LACTATED

RINGERS...................................................................75potassium chloride 20 meq/l (0.15%) in dextrose 5%

inj................................................................................. 75potassium chloride cap er 10 meq............................ 75potassium chloride cap er 8 meq...............................75POTASSIUM CHLORIDE ER.....................................75potassium chloride inj 2 meq/ml................................ 75potassium chloride microencapsulated crys er tab 10

meq............................................................................. 75potassium chloride microencapsulated crys er tab 20

meq............................................................................. 75

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potassium chloride oral soln 10% (20meq/15ml).................................................................. 75

potassium chloride tab er 10 meq............................. 75potassium chloride tab er 8 meq (600

mg).............................................................................. 75potassium citrate tab er 10 meq (1080



mg).............................................................................. 75POTELIGEO................................................................. 35PRADAXA..................................................................... 56PRADAXA..................................................................... 56PRADAXA..................................................................... 56pramipexole dihydrochloride tab 0.125

mg................................................................................39pramipexole dihydrochloride tab 0.25




mg................................................................................39pramipexole dihydrochloride tab 1 mg...................... 39prasugrel hcl tab 10 mg..............................................56prasugrel hcl tab 5 mg................................................ 56pravastatin sodium tab 10 mg....................................65pravastatin sodium tab 20 mg....................................66pravastatin sodium tab 40 mg....................................66pravastatin sodium tab 80 mg....................................66praziquantel tab 600 mg............................................. 38prazosin hcl cap 1 mg.................................................66prazosin hcl cap 2 mg.................................................66prazosin hcl cap 5 mg.................................................66PREDNICARBATE.......................................................73prednicarbate cream 0.1%......................................... 73prednisolone acetate ophth susp 1%........................97prednisolone sod phosphate oral soln 15

mg/5ml........................................................................ 81prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base).............................................................81prednisolone syrup 15 mg/5ml...................................81PREDNISONE.............................................................. 82PREDNISONE.............................................................. 82PREDNISONE.............................................................. 82PREDNISONE.............................................................. 82PREDNISONE.............................................................. 82PREDNISONE.............................................................. 82prednisone tab 10 mg................................................. 82prednisone tab 1 mg................................................... 82

prednisone tab 2.5 mg................................................ 82prednisone tab 20 mg................................................. 82prednisone tab 5 mg................................................... 82pregabalin cap 100 mg............................................... 17pregabalin cap 150 mg............................................... 17pregabalin cap 200 mg............................................... 17pregabalin cap 225 mg............................................... 17pregabalin cap 25 mg................................................. 17pregabalin cap 300 mg............................................... 17pregabalin cap 50 mg................................................. 17pregabalin cap 75 mg................................................. 17PREGNYL W/DILUENT BENZYL ALCOHOL/

NACL.......................................................................... 82PREMARIN................................................................... 84PREMARIN................................................................... 84PREMARIN................................................................... 84PREMARIN................................................................... 84PREMARIN................................................................... 85PREMARIN................................................................... 85PREMPHASE............................................................... 85PREMPRO.................................................................... 85PREMPRO.................................................................... 85PREMPRO.................................................................... 85PREMPRO.................................................................... 85PREVYMIS....................................................................47PREVYMIS....................................................................47PREZCOBIX................................................................. 47PREZISTA..................................................................... 47PREZISTA..................................................................... 47PREZISTA..................................................................... 47PREZISTA..................................................................... 47PREZISTA..................................................................... 47PRIFTIN.........................................................................26primaquine phosphate tab 26.3 mg...........................38primidone tab 250 mg................................................. 17primidone tab 50 mg................................................... 17PROAIR HFA..............................................................101PROAIR RESPICLICK..............................................101probenecid tab 500 mg............................................... 25prochlorperazine edisylate inj 10

mg/2ml........................................................................ 23prochlorperazine edisylate inj 50

mg/10ml......................................................................23prochlorperazine maleate tab 10 mg.........................23prochlorperazine maleate tab 5 mg...........................23prochlorperazine suppos 25 mg................................ 23PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56PROCRIT...................................................................... 56

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progesterone micronized cap 100 mg.......................85progesterone micronized cap 200 mg.......................85PROGLYCEM............................................................... 53PROGRAF.....................................................................92PROGRAF.....................................................................92PROGRAF.....................................................................92PROLASTIN-C..............................................................79PROLASTIN-C..............................................................79PROLENSA...................................................................97PROLEUKIN................................................................. 35PROLIA..........................................................................95PROMACTA.................................................................. 56PROMACTA.................................................................. 57PROMACTA.................................................................. 57PROMACTA.................................................................. 57PROMACTA.................................................................. 57promethazine hcl suppos 12.5 mg............................ 23promethazine hcl suppos 25 mg................................23promethazine hcl syrup 6.25 mg/5ml........................ 23promethazine hcl tab 12.5 mg....................................23promethazine hcl tab 25 mg.......................................23promethazine hcl tab 50 mg.......................................23propafenone hcl cap er 12hr 225 mg........................ 66propafenone hcl cap er 12hr 325 mg........................ 66propafenone hcl cap er 12hr 425 mg........................ 66propafenone hcl tab 150 mg...................................... 66propafenone hcl tab 225 mg...................................... 66propafenone hcl tab 300 mg...................................... 66propranolol hcl cap er 24hr 120 mg.......................... 66propranolol hcl cap er 24hr 160 mg.......................... 66propranolol hcl cap er 24hr 60 mg.............................66propranolol hcl cap er 24hr 80 mg.............................66propranolol hcl inj 1 mg/ml......................................... 66propranolol hcl tab 10 mg...........................................66propranolol hcl tab 20 mg...........................................66propranolol hcl tab 40 mg...........................................66propranolol hcl tab 60 mg...........................................66propranolol hcl tab 80 mg...........................................66propylthiouracil tab 50 mg.......................................... 88PROQUAD.................................................................... 92protriptyline hcl tab 10 mg.......................................... 21protriptyline hcl tab 5 mg............................................ 21PULMOZYME.............................................................101PURIXAN.......................................................................35PYLERA.........................................................................78pyrazinamide tab 500 mg........................................... 26pyridostigmine bromide syrup 60

mg/5ml........................................................................ 26pyridostigmine bromide tab 60 mg............................ 26pyridostigmine bromide tab er 180 mg......................26

QQUADRACEL................................................................92quetiapine fumarate tab 100 mg................................42quetiapine fumarate tab 200 mg................................43quetiapine fumarate tab 25 mg..................................42quetiapine fumarate tab 300 mg................................43quetiapine fumarate tab 400 mg................................43quetiapine fumarate tab 50 mg..................................42quetiapine fumarate tab er 24hr 150

mg................................................................................42quetiapine fumarate tab er 24hr 200



mg................................................................................42quetiapine fumarate tab er 24hr 50 mg.....................42quinapril hcl tab 10 mg............................................... 66quinapril hcl tab 20 mg............................................... 66quinapril hcl tab 40 mg............................................... 66quinapril hcl tab 5 mg..................................................66quinapril-hydrochlorothiazide tab 10-12.5

mg................................................................................66quinapril-hydrochlorothiazide tab 20-12.5

mg................................................................................66quinapril-hydrochlorothiazide tab 20-25

mg................................................................................66quinidine gluconate tab er 324 mg............................ 66QUINIDINE SULFATE................................................. 66QUINIDINE SULFATE................................................. 66QVAR REDIHALER................................................... 101QVAR REDIHALER................................................... 101RRABAVERT................................................................... 92rabeprazole sodium ec tab 20 mg............................. 78raloxifene hcl tab 60 mg............................................. 85ramipril cap 1.25 mg....................................................66ramipril cap 10 mg.......................................................66ramipril cap 2.5 mg......................................................66ramipril cap 5 mg.........................................................66RANEXA........................................................................66RANEXA........................................................................66ranitidine hcl cap 150 mg........................................... 78ranitidine hcl cap 300 mg........................................... 78ranitidine hcl syrup 15 mg/ml (75

mg/5ml).......................................................................78ranitidine hcl tab 150 mg............................................ 78ranitidine hcl tab 300 mg............................................ 78ranolazine tab er 12hr 1000 mg.................................67ranolazine tab er 12hr 500 mg...................................67RAPAFLO...................................................................... 80

2019

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RAPAFLO...................................................................... 80RAPAMUNE.................................................................. 92rasagiline mesylate tab 0.5 mg.................................. 39rasagiline mesylate tab 1 mg..................................... 39REBETOL......................................................................47RECOMBIVAX HB....................................................... 92RECOMBIVAX HB....................................................... 92RECOMBIVAX HB....................................................... 92REGRANEX.................................................................. 73RELENZA DISKHALER.............................................. 47RELISTOR.....................................................................78RELISTOR.....................................................................78RELISTOR.....................................................................78REMODULIN.............................................................. 101REMODULIN.............................................................. 101REMODULIN.............................................................. 101REMODULIN.............................................................. 101RENFLEXIS.................................................................. 92repaglinide tab 0.5 mg................................................ 53repaglinide tab 1 mg....................................................53repaglinide tab 2 mg....................................................53REPATHA...................................................................... 67REPATHA PUSHTRONEX SYSTEM........................67REPATHA SURECLICK.............................................. 67RESCRIPTOR.............................................................. 47RESTASIS.....................................................................97RESTASIS MULTIDOSE.............................................97RETACRIT.....................................................................57RETACRIT.....................................................................57RETACRIT.....................................................................57RETACRIT.....................................................................57RETACRIT.....................................................................57RETROVIR IV INFUSION...........................................47REVCOVI...................................................................... 79REVLIMID......................................................................35REVLIMID......................................................................35REVLIMID......................................................................35REVLIMID......................................................................35REVLIMID......................................................................35REVLIMID......................................................................35REXULTI........................................................................43REXULTI........................................................................43REXULTI........................................................................43REXULTI........................................................................43REXULTI........................................................................43REXULTI........................................................................43REYATAZ.......................................................................47REYATAZ.......................................................................47REYATAZ.......................................................................47REYATAZ.......................................................................47RIBASPHERE...............................................................47RIBASPHERE...............................................................47

RIBASPHERE RIBAPAK.............................................47RIBASPHERE RIBAPAK.............................................47ribavirin cap 200 mg....................................................48ribavirin for inhal soln 6 gm......................................101ribavirin tab 200 mg.....................................................48RIDAURA...................................................................... 92rifabutin cap 150 mg....................................................26rifampin cap 150 mg....................................................26rifampin cap 300 mg....................................................26rifampin for inj 600 mg................................................ 26riluzole tab 50 mg........................................................ 70risedronate sodium tab 150 mg................................. 95risedronate sodium tab 30 mg................................... 95risedronate sodium tab 35 mg................................... 95risedronate sodium tab 5 mg..................................... 95risedronate sodium tab delayed release 35

mg................................................................................95RISPERDAL CONSTA................................................ 43RISPERDAL CONSTA................................................ 43RISPERDAL CONSTA................................................ 43RISPERDAL CONSTA................................................ 43risperidone orally disintegrating tab 0.25

mg................................................................................43risperidone orally disintegrating tab 0.5

mg................................................................................43risperidone orally disintegrating tab 1




mg................................................................................43risperidone soln 1 mg/ml............................................ 43risperidone tab 0.25 mg..............................................43risperidone tab 0.5 mg................................................ 43risperidone tab 1 mg................................................... 43risperidone tab 2 mg................................................... 43risperidone tab 3 mg................................................... 43risperidone tab 4 mg................................................... 43ritonavir tab 100 mg.................................................... 48RITUXAN.......................................................................35RITUXAN.......................................................................35RITUXAN HYCELA......................................................35RITUXAN HYCELA......................................................35rivastigmine 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...................................................................... 19rivastigmine td patch 24hr 4.6 mg/24hr.....................18

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rivastigmine td patch 24hr 9.5 mg/24hr.....................19rizatriptan benzoate oral disintegrating tab 10

mg................................................................................25rizatriptan benzoate oral disintegrating tab 5

mg................................................................................25rizatriptan benzoate tab 10 mg.................................. 25rizatriptan benzoate tab 5 mg.................................... 25ropinirole hydrochloride tab 0.25 mg.........................39ropinirole hydrochloride tab 0.5 mg...........................39ropinirole hydrochloride tab 1 mg.............................. 39ropinirole hydrochloride tab 2 mg.............................. 39ropinirole hydrochloride tab 3 mg.............................. 39ropinirole hydrochloride tab 4 mg.............................. 39ropinirole hydrochloride tab 5 mg.............................. 39rosuvastatin calcium tab 10 mg................................. 67rosuvastatin calcium tab 20 mg................................. 67rosuvastatin calcium tab 40 mg................................. 67rosuvastatin calcium tab 5 mg................................... 67ROTARIX.......................................................................93ROTATEQ......................................................................93RUBRACA.....................................................................35RUBRACA.....................................................................35RUBRACA.....................................................................35RYDAPT........................................................................ 35SSABRIL.......................................................................... 17SAMSCA........................................................................75SAMSCA........................................................................75SANDIMMUNE............................................................. 93SANTYL.........................................................................73SAPHRIS.......................................................................43SAPHRIS.......................................................................43SAPHRIS.......................................................................43selegiline hcl cap 5 mg............................................... 39selegiline hcl tab 5 mg................................................ 39selenium sulfide lotion 2.5%.......................................73SELZENTRY.................................................................48SELZENTRY.................................................................48SELZENTRY.................................................................48SELZENTRY.................................................................48SELZENTRY.................................................................48SENSIPAR.....................................................................95SENSIPAR.....................................................................95SENSIPAR.....................................................................95SEREVENT DISKUS.................................................101sertraline hcl oral concentrate for solution 20 mg/

ml.................................................................................21sertraline hcl tab 100 mg............................................ 21sertraline hcl tab 25 mg.............................................. 21sertraline hcl tab 50 mg.............................................. 21sevelamer carbonate packet 0.8 gm......................... 75

sevelamer carbonate packet 2.4 gm......................... 76sevelamer carbonate tab 800 mg..............................76SHINGRIX..................................................................... 93SIGNIFOR..................................................................... 87SIGNIFOR..................................................................... 87SIGNIFOR..................................................................... 87SIGNIFOR LAR............................................................87SIGNIFOR LAR............................................................87SIGNIFOR LAR............................................................87SIGNIFOR LAR............................................................87SIGNIFOR LAR............................................................87sildenafil citrate tab 20 mg....................................... 101SILENOR.....................................................................103SILENOR.....................................................................103silodosin cap 4 mg.......................................................80silodosin cap 8 mg.......................................................80silver sulfadiazine cream 1%......................................73SIMBRINZA...................................................................97SIMULECT.................................................................... 93SIMULECT.................................................................... 93simvastatin tab 10 mg.................................................67simvastatin tab 20 mg.................................................67simvastatin tab 40 mg.................................................67simvastatin tab 5 mg................................................... 67simvastatin tab 80 mg.................................................67sirolimus oral soln 1 mg/ml.........................................93sirolimus tab 0.5 mg.................................................... 93sirolimus tab 1 mg....................................................... 93sirolimus tab 2 mg....................................................... 93SIRTURO.......................................................................26SIVEXTRO.................................................................... 12SIVEXTRO.................................................................... 12sodium chloride irrigation soln 0.9%......................... 76sodium chloride iv soln 0.45%................................... 76sodium chloride iv soln 0.9%..................................... 76sodium phenylbutyrate oral powder 3 gm/

teaspoonful.................................................................79sodium phenylbutyrate tab 500 mg........................... 79sodium polystyrene sulfonate oral susp 15

gm/60ml......................................................................76sodium polystyrene sulfonate powder.......................76sodium polystyrene sulfonate rectal susp 30

gm/120ml....................................................................76solifenacin succinate tab 10 mg.................................80solifenacin succinate tab 5 mg...................................80SOLTAMOX...................................................................35SOMATULINE DEPOT................................................87SOMATULINE DEPOT................................................87SOMATULINE DEPOT................................................87SOMAVERT.................................................................. 88SOMAVERT.................................................................. 88SOMAVERT.................................................................. 88

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SOMAVERT.................................................................. 88SOMAVERT.................................................................. 88SOOLANTRA................................................................73sotalol hcl (afib/afl) tab 120 mg..................................67sotalol hcl (afib/afl) tab 160 mg..................................67sotalol hcl (afib/afl) tab 80 mg....................................67sotalol hcl tab 120 mg.................................................67sotalol hcl tab 160 mg.................................................67sotalol hcl tab 240 mg.................................................67sotalol hcl tab 80 mg...................................................67SOVALDI....................................................................... 48SPIRIVA HANDIHALER............................................101SPIRIVA RESPIMAT................................................. 101SPIRIVA RESPIMAT................................................. 101spironolactone & hydrochlorothiazide tab 25-25

mg................................................................................67spironolactone tab 100 mg.........................................67spironolactone tab 25 mg........................................... 67spironolactone tab 50 mg........................................... 67SPRAVATO 56MG DOSE........................................... 21SPRAVATO 84MG DOSE........................................... 21SPRITAM.......................................................................17SPRITAM.......................................................................17SPRITAM.......................................................................17SPRITAM.......................................................................17SPRYCEL......................................................................35SPRYCEL......................................................................35SPRYCEL......................................................................35SPRYCEL......................................................................35SPRYCEL......................................................................35SPRYCEL......................................................................35STAMARIL.....................................................................93stavudine cap 15 mg...................................................48stavudine cap 20 mg...................................................48stavudine cap 30 mg...................................................48stavudine cap 40 mg...................................................48STELARA...................................................................... 93STELARA...................................................................... 93STELARA...................................................................... 93STELARA...................................................................... 93STIMATE....................................................................... 82STIOLTO RESPIMAT................................................ 101STIVARGA.....................................................................35STRENSIQ....................................................................79STRENSIQ....................................................................79STRENSIQ....................................................................79STRENSIQ....................................................................79STREPTOMYCIN SULFATE...................................... 12STRIBILD...................................................................... 48SUBLOCADE.................................................................. 6SUBLOCADE.................................................................. 6SUBOXONE....................................................................6

SUBOXONE....................................................................6SUBOXONE....................................................................6SUBOXONE....................................................................6sucralfate tab 1 gm......................................................78sulfacetamide sodium lotion 10%.............................. 12sulfacetamide sodium ophth soln 10%..................... 97sulfacetamide sodium-prednisolone ophth soln

10-0.23(0.25)%..........................................................97SULFADIAZINE............................................................ 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............................................94sulfasalazine tab delayed release 500

mg................................................................................94sulindac tab 150 mg...................................................... 4sulindac tab 200 mg...................................................... 4sumatriptan nasal spray 20 mg/act........................... 26sumatriptan nasal spray 5 mg/act..............................25SUMATRIPTAN SUCCINATE.....................................26sumatriptan succinate inj 6 mg/0.5ml........................26sumatriptan succinate solution auto-injector 4

mg/0.5ml.....................................................................26sumatriptan succinate solution auto-injector 6

mg/0.5ml.....................................................................26sumatriptan succinate solution cartridge 4

mg/0.5ml.....................................................................26sumatriptan succinate solution cartridge 6

mg/0.5ml.....................................................................26sumatriptan succinate tab 100 mg............................ 26sumatriptan succinate tab 25 mg...............................26sumatriptan succinate tab 50 mg...............................26SUPRAX........................................................................12SUPRAX........................................................................12SUPRAX........................................................................12SUPREP BOWEL PREP KIT.....................................78SUTENT........................................................................ 35SUTENT........................................................................ 35SUTENT........................................................................ 35SUTENT........................................................................ 35SYLATRON................................................................... 48SYLATRON................................................................... 48SYLATRON................................................................... 48SYLVANT.......................................................................93SYLVANT.......................................................................93SYMBICORT...............................................................102SYMBICORT...............................................................102

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SYMDEKO.................................................................. 102SYMDEKO.................................................................. 102SYMFI............................................................................ 48SYMFI LO..................................................................... 48SYMLINPEN 120......................................................... 53SYMLINPEN 60............................................................53SYMPAZAN...................................................................17SYMPAZAN...................................................................17SYMPAZAN...................................................................17SYMTUZA..................................................................... 48SYNAGIS.......................................................................93SYNAGIS.......................................................................93SYNAREL......................................................................88SYNERCID....................................................................13SYNJARDY................................................................... 53SYNJARDY................................................................... 53SYNJARDY................................................................... 53SYNJARDY................................................................... 53SYNJARDY XR............................................................ 54SYNJARDY XR............................................................ 54SYNJARDY XR............................................................ 54SYNJARDY XR............................................................ 54SYNRIBO...................................................................... 35SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86SYNTHROID.................................................................86TTABLOID........................................................................35tacrolimus cap 0.5 mg.................................................93tacrolimus cap 1 mg....................................................93tacrolimus cap 5 mg....................................................93tacrolimus oint 0.03%..................................................73tacrolimus oint 0.1%.................................................... 73tadalafil tab 20 mg (pah)...........................................102TAFINLAR..................................................................... 35TAFINLAR..................................................................... 35TAGRISSO.................................................................... 35TAGRISSO.................................................................... 35TALZENNA....................................................................36TALZENNA....................................................................36tamoxifen citrate tab 10 mg........................................36tamoxifen citrate tab 20 mg........................................36tamsulosin hcl cap 0.4 mg..........................................80

TARCEVA...................................................................... 36TARCEVA...................................................................... 36TARCEVA...................................................................... 36TARGRETIN..................................................................36TASIGNA....................................................................... 36TASIGNA....................................................................... 36TASIGNA....................................................................... 36tazarotene cream 0.1%...............................................73TAZICEF........................................................................ 13TAZICEF........................................................................ 13TAZORAC......................................................................73TAZORAC......................................................................73TAZORAC......................................................................73TDVAX........................................................................... 93TECENTRIQ................................................................. 36TECENTRIQ................................................................. 36TECFIDERA..................................................................70TECFIDERA..................................................................70TECFIDERA STARTER PACK...................................70TEFLARO......................................................................13TEFLARO......................................................................13TEKTURNA...................................................................67TEKTURNA...................................................................67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67TEKTURNA HCT......................................................... 67telmisartan-hydrochlorothiazide tab 40-12.5

mg................................................................................67telmisartan-hydrochlorothiazide tab 80-12.5

mg................................................................................67telmisartan-hydrochlorothiazide tab 80-25

mg................................................................................68telmisartan tab 20 mg................................................. 67telmisartan tab 40 mg................................................. 67telmisartan tab 80 mg................................................. 67temazepam cap 15 mg............................................. 103temazepam cap 30 mg............................................. 103TEMODAR.................................................................... 36temsirolimus soln for iv infusion 25 mg/

ml.................................................................................36TENCON..........................................................................4TENIVAC....................................................................... 93tenofovir disoproxil fumarate tab 300

mg................................................................................48terazosin hcl cap 10 mg..............................................68terazosin hcl cap 1 mg................................................68terazosin hcl cap 2 mg................................................68terazosin hcl cap 5 mg................................................68terbinafine hcl tab 250 mg..........................................25terbutaline sulfate tab 2.5 mg.................................. 102terbutaline sulfate tab 5 mg......................................102

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terconazole vaginal cream 0.4%................................25terconazole vaginal cream 0.8%................................25terconazole vaginal suppos 80 mg............................25testosterone cypionate im inj in oil 100 mg/

ml.................................................................................85testosterone cypionate im inj in oil 200 mg/

ml.................................................................................85testosterone enanthate im inj in oil 200 mg/

ml.................................................................................85testosterone td gel 12.5 mg/act (1%)........................ 85testosterone td gel 20.25 mg/1.25gm

(1.62%)....................................................................... 85testosterone td gel 20.25 mg/act

(1.62%)....................................................................... 85testosterone td gel 25 mg/2.5gm (1%)......................85testosterone td gel 40.5 mg/2.5gm

(1.62%)....................................................................... 85testosterone td gel 50 mg/5gm (1%).........................85testosterone td soln 30 mg/act...................................85tetrabenazine tab 12.5 mg..........................................70tetrabenazine tab 25 mg.............................................70tetracycline hcl cap 250 mg........................................13tetracycline hcl cap 500 mg........................................13THALOMID....................................................................36THALOMID....................................................................36THALOMID....................................................................36THALOMID....................................................................36theophylline tab er 12hr 100 mg..............................102theophylline tab er 12hr 200 mg..............................102theophylline tab er 12hr 300 mg..............................102theophylline tab er 12hr 450 mg..............................102theophylline tab er 24hr 400 mg..............................102theophylline tab er 24hr 600 mg..............................102thioridazine hcl tab 100 mg........................................ 43thioridazine hcl tab 10 mg.......................................... 43thioridazine hcl tab 25 mg.......................................... 43thioridazine hcl tab 50 mg.......................................... 43thiotepa for inj 15 mg.................................................. 36thiothixene cap 10 mg.................................................43thiothixene cap 1 mg...................................................43thiothixene cap 2 mg...................................................43thiothixene cap 5 mg...................................................43THYMOGLOBULIN......................................................93tiagabine hcl tab 12 mg.............................................. 17tiagabine hcl tab 16 mg.............................................. 17tiagabine hcl tab 2 mg.................................................17tiagabine hcl tab 4 mg.................................................17TIBSOVO.......................................................................36tigecycline for iv soln 50 mg.......................................13TIMOLOL MALEATE................................................... 68TIMOLOL MALEATE................................................... 68

timolol maleate ophth gel forming soln0.25%..........................................................................97

timolol maleate ophth gel forming soln0.5%............................................................................97

timolol maleate ophth soln 0.25%..............................97timolol maleate ophth soln 0.5%................................97timolol maleate ophth soln 0.5% (once-

daily)............................................................................97timolol maleate tab 5 mg............................................ 68TIVICAY......................................................................... 48TIVICAY......................................................................... 48TIVICAY......................................................................... 48tizanidine hcl cap 2 mg............................................... 44tizanidine hcl cap 4 mg............................................... 44tizanidine hcl cap 6 mg............................................... 44tizanidine hcl tab 2 mg................................................44tizanidine hcl tab 4 mg................................................44TOBRADEX...................................................................97tobramycin-dexamethasone ophth susp

0.3-0.1%..................................................................... 97tobramycin nebu soln 300 mg/5ml.......................... 102tobramycin ophth soln 0.3%.......................................97TOBRAMYCIN SULFATE........................................... 13TOBRAMYCIN SULFATE........................................... 13tobramycin sulfate for inj 1.2 gm................................13tobramycin sulfate inj 1.2 gm/30ml (40 mg/

ml)................................................................................13tobramycin sulfate inj 80 mg/2ml (40 mg/

ml)................................................................................13tolcapone tab 100 mg................................................. 40TOLMETIN SODIUM..................................................... 4tolterodine tartrate cap er 24hr 2 mg.........................81tolterodine tartrate cap er 24hr 4 mg.........................81tolterodine tartrate tab 1 mg.......................................81tolterodine tartrate tab 2 mg.......................................81topiramate 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........................................... 36topotecan hcl inj 4 mg/4ml (for

infusion)...................................................................... 36toremifene citrate tab 60 mg...................................... 36TORISEL....................................................................... 36torsemide tab 100 mg................................................. 68torsemide tab 10 mg................................................... 68torsemide tab 20 mg................................................... 68torsemide tab 5 mg......................................................68TOUJEO MAX SOLOSTAR........................................54TOUJEO SOLOSTAR..................................................54

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TOVIAZ.......................................................................... 81TOVIAZ.......................................................................... 81TRACLEER.................................................................102TRACLEER.................................................................102TRACLEER.................................................................102TRADJENTA................................................................. 54tramadol-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................................................... 68trandolapril tab 2 mg................................................... 68trandolapril tab 4 mg................................................... 68tranexamic acid iv soln 1000 mg/10ml (100 mg/

ml)................................................................................57tranexamic acid tab 650 mg.......................................57tranylcypromine sulfate tab 10 mg............................ 21TRAVATAN Z................................................................ 97trazodone hcl tab 100 mg...........................................21trazodone hcl tab 150 mg...........................................21trazodone hcl tab 300 mg...........................................21trazodone hcl tab 50 mg.............................................21TREANDA..................................................................... 36TREANDA..................................................................... 36TRECATOR...................................................................26TRELEGY ELLIPTA...................................................102TRELSTAR....................................................................88TRELSTAR....................................................................88TRELSTAR MIXJECT..................................................88TRELSTAR MIXJECT..................................................88TRELSTAR MIXJECT..................................................88treprostinil inj soln 100 mg/20ml (5 mg/

ml)............................................................................. 102treprostinil inj soln 200 mg/20ml (10 mg/

ml)............................................................................. 102treprostinil inj soln 20 mg/20ml (1 mg/

ml)............................................................................. 102treprostinil inj soln 50 mg/20ml (2.5 mg/

ml)............................................................................. 102TRESIBA....................................................................... 54TRESIBA FLEXTOUCH.............................................. 54TRESIBA FLEXTOUCH.............................................. 54tretinoin cap 10 mg......................................................36tretinoin cream 0.025%............................................... 73tretinoin cream 0.05%................................................. 73tretinoin cream 0.1%................................................... 73tretinoin gel 0.01%.......................................................73tretinoin gel 0.025%.....................................................73triamcinolone acetonide cream

0.025%........................................................................73

triamcinolone acetonide cream 0.1%........................73triamcinolone acetonide cream 0.5%........................73triamcinolone acetonide dental paste

0.1%............................................................................71triamcinolone acetonide lotion 0.025%..................... 74triamcinolone acetonide lotion 0.1%..........................74triamcinolone acetonide oint 0.025%........................ 74triamcinolone acetonide oint 0.1%.............................74triamcinolone acetonide oint 0.5%.............................74triamterene & hydrochlorothiazide cap 37.5-25

mg................................................................................68triamterene & hydrochlorothiazide tab 37.5-25

mg................................................................................68triamterene & hydrochlorothiazide tab 75-50

mg................................................................................68trientine hcl cap 250 mg............................................. 76trifluoperazine hcl tab 10 mg......................................44trifluoperazine hcl tab 1 mg........................................43trifluoperazine hcl tab 2 mg........................................44trifluoperazine hcl tab 5 mg........................................44trifluridine ophth soln 1%............................................ 97trimethoprim tab 100 mg.............................................13trimipramine maleate cap 100 mg............................. 22trimipramine maleate cap 25 mg............................... 22trimipramine maleate cap 50 mg............................... 22TRINTELLIX..................................................................22TRINTELLIX..................................................................22TRINTELLIX..................................................................22TRISENOX....................................................................36TRIUMEQ......................................................................48TROGARZO..................................................................48trospium chloride cap er 24hr 60 mg.........................81trospium chloride tab 20 mg.......................................81TRULICITY....................................................................54TRULICITY....................................................................54TRUMENBA.................................................................. 93TRUVADA......................................................................48TRUVADA......................................................................48TRUVADA......................................................................48TRUVADA......................................................................48TWINRIX........................................................................93TYBOST........................................................................ 48TYKERB........................................................................ 36TYMLOS........................................................................95TYPHIM VI.................................................................... 93TYSABRI....................................................................... 70UULORIC......................................................................... 25ULORIC......................................................................... 25UNITUXIN......................................................................36UPTRAVI..................................................................... 102

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UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102UPTRAVI..................................................................... 102ursodiol cap 300 mg....................................................78ursodiol tab 250 mg.....................................................78ursodiol tab 500 mg.....................................................78Vvalacyclovir hcl tab 1 gm............................................ 48valacyclovir hcl tab 500 mg........................................48VALCHLOR................................................................... 36valganciclovir hcl for soln 50 mg/ml.......................... 49valganciclovir hcl tab 450 mg.....................................49valproate sodium inj 100 mg/ml.................................18valproate sodium oral soln 250 mg/5ml.................... 18valproic acid cap 250 mg............................................18valsartan-hydrochlorothiazide tab 160-12.5

mg................................................................................68valsartan-hydrochlorothiazide tab 160-25

mg................................................................................68valsartan-hydrochlorothiazide tab 320-12.5

mg................................................................................68valsartan-hydrochlorothiazide tab 320-25

mg................................................................................68valsartan-hydrochlorothiazide tab 80-12.5

mg................................................................................68valsartan tab 160 mg...................................................68valsartan tab 320 mg...................................................68valsartan tab 40 mg.....................................................68valsartan tab 80 mg.....................................................68VANCOMYCIN HCL.................................................... 13vancomycin hcl cap 125 mg.......................................13vancomycin hcl cap 250 mg.......................................13vancomycin hcl for iv soln 10 gm.............................. 13vancomycin hcl for iv soln 1 gm.................................13vancomycin hcl for iv soln 500 mg............................ 13vancomycin hcl for iv soln 5 gm.................................13vancomycin hcl for iv soln 750 mg............................ 13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HCL IN DEXTROSE.........................13VANCOMYCIN HYDROCHLORIDE..........................13VANCOMYCIN HYDROCHLORIDE..........................13VANCOMYCIN HYDROCHLORIDE..........................13VAQTA........................................................................... 93VAQTA........................................................................... 93VARIVAX........................................................................93

VASCEPA...................................................................... 68VASCEPA...................................................................... 68VECTIBIX...................................................................... 36VECTIBIX...................................................................... 36VELCADE......................................................................36VELPHORO.................................................................. 76VELTASSA.................................................................... 76VELTASSA.................................................................... 76VELTASSA.................................................................... 76VENCLEXTA.................................................................36VENCLEXTA.................................................................36VENCLEXTA.................................................................36VENCLEXTA STARTING PACK................................ 37venlafaxine hcl cap er 24hr 150 mg.......................... 22venlafaxine hcl cap er 24hr 37.5 mg......................... 22venlafaxine hcl cap er 24hr 75 mg............................ 22venlafaxine hcl tab 100 mg........................................ 22venlafaxine hcl tab 25 mg...........................................22venlafaxine hcl tab 37.5 mg....................................... 22venlafaxine hcl tab 50 mg...........................................22venlafaxine hcl tab 75 mg...........................................22venlafaxine hcl tab er 24hr 150 mg........................... 22venlafaxine hcl tab er 24hr 37.5 mg..........................22venlafaxine hcl tab er 24hr 75 mg............................. 22VENTAVIS................................................................... 102VENTAVIS................................................................... 102VENTOLIN HFA......................................................... 103verapamil hcl cap er 24hr 100 mg.............................68verapamil hcl cap er 24hr 120 mg.............................68verapamil hcl cap er 24hr 180 mg.............................68verapamil hcl cap er 24hr 200 mg.............................68verapamil hcl cap er 24hr 240 mg.............................68verapamil hcl cap er 24hr 300 mg.............................68verapamil hcl cap er 24hr 360 mg.............................68verapamil hcl tab 120 mg........................................... 69verapamil hcl tab 40 mg............................................. 69verapamil hcl tab 80 mg............................................. 69verapamil hcl tab er 120 mg.......................................68verapamil hcl tab er 180 mg.......................................68verapamil hcl tab er 240 mg.......................................69VERSACLOZ................................................................ 44VERZENIO....................................................................37VERZENIO....................................................................37VERZENIO....................................................................37VERZENIO....................................................................37VICTOZA....................................................................... 54VIDEX............................................................................ 49VIDEX............................................................................ 49VIDEX EC..................................................................... 49VIDEX EC..................................................................... 49VIDEX EC..................................................................... 49VIDEX EC..................................................................... 49

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VIEKIRA PAK................................................................49vigabatrin powd pack 500 mg.................................... 18vigabatrin tab 500 mg................................................. 18VIIBRYD.........................................................................22VIIBRYD.........................................................................22VIIBRYD.........................................................................22VIIBRYD STARTER PACK......................................... 22VIMPAT.......................................................................... 18VIMPAT.......................................................................... 18VIMPAT.......................................................................... 18VIMPAT.......................................................................... 18VIMPAT.......................................................................... 18VIMPAT.......................................................................... 18VINBLASTINE SULFATE............................................37vincristine sulfate iv soln 1 mg/ml..............................37vinorelbine tartrate inj 10 mg/ml.................................37vinorelbine tartrate inj 50 mg/5ml (10 mg/

ml)................................................................................37VIRACEPT.................................................................... 49VIRACEPT.................................................................... 49VIRAMUNE................................................................... 49VIREAD..........................................................................49VIREAD..........................................................................49VIREAD..........................................................................49VIREAD..........................................................................49VITRAKVI...................................................................... 37VITRAKVI...................................................................... 37VITRAKVI...................................................................... 37VIVITROL........................................................................ 6VIZIMPRO..................................................................... 37VIZIMPRO..................................................................... 37VIZIMPRO..................................................................... 37voriconazole for inj 200 mg........................................ 25voriconazole for susp 40 mg/ml.................................25voriconazole tab 200 mg............................................ 25voriconazole tab 50 mg...............................................25VOSEVI..........................................................................49VOTRIENT.................................................................... 37VPRIV............................................................................ 79VRAYLAR...................................................................... 44VRAYLAR...................................................................... 44VRAYLAR...................................................................... 44VRAYLAR...................................................................... 44VYXEOS........................................................................37Wwarfarin sodium tab 10 mg.........................................57warfarin sodium tab 1 mg...........................................57warfarin sodium tab 2.5 mg........................................57warfarin sodium tab 2 mg...........................................57warfarin sodium tab 3 mg...........................................57warfarin sodium tab 4 mg...........................................57warfarin sodium tab 5 mg...........................................57

warfarin sodium tab 6 mg...........................................57warfarin sodium tab 7.5 mg........................................57water for irrigation, sterile irrigation

soln..............................................................................76XXALKORI....................................................................... 37XALKORI....................................................................... 37XARELTO...................................................................... 57XARELTO...................................................................... 57XARELTO...................................................................... 57XARELTO...................................................................... 57XARELTO STARTER PACK.......................................57XATMEP........................................................................ 93XGEVA...........................................................................95XIFAXAN........................................................................78XOFLUZA......................................................................49XOFLUZA......................................................................49XOLAIR..........................................................................93XOLAIR..........................................................................94XOLAIR..........................................................................94XOPENEX HFA..........................................................103XOSPATA...................................................................... 37XTANDI.......................................................................... 37XYREM........................................................................103YYERVOY........................................................................37YERVOY........................................................................37YF-VAX.......................................................................... 94YONDELIS.................................................................... 37YONSA.......................................................................... 37Zzafirlukast tab 10 mg.................................................103zafirlukast tab 20 mg.................................................103zaleplon cap 10 mg...................................................103zaleplon cap 5 mg..................................................... 103ZALTRAP.......................................................................37ZALTRAP.......................................................................37ZANOSAR..................................................................... 37ZEJULA..........................................................................37ZELBORAF................................................................... 37ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZENPEP........................................................................ 80ZEPATIER..................................................................... 49zidovudine cap 100 mg...............................................49zidovudine syrup 10 mg/ml.........................................49

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zidovudine tab 300 mg................................................49ziprasidone hcl cap 20 mg..........................................44ziprasidone hcl cap 40 mg..........................................44ziprasidone hcl cap 60 mg..........................................44ziprasidone hcl cap 80 mg..........................................44ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................4ZOHYDRO ER................................................................5ZOHYDRO ER................................................................5zoledronic acid inj conc for iv infusion 4

mg/5ml........................................................................ 95zoledronic acid iv soln 5 mg/100ml........................... 95ZOLINZA........................................................................37zolpidem tartrate tab 10 mg..................................... 103zolpidem tartrate tab 5 mg....................................... 103zonisamide cap 100 mg..............................................18zonisamide cap 25 mg................................................18zonisamide cap 50 mg................................................18ZONTIVITY....................................................................57ZORTRESS...................................................................94ZORTRESS...................................................................94ZORTRESS...................................................................94ZORTRESS...................................................................94ZOSTAVAX....................................................................94ZOSYN...........................................................................13ZOSYN...........................................................................13ZOSYN...........................................................................13ZOSYN...........................................................................14ZOSYN...........................................................................14ZOSYN...........................................................................14ZYDELIG....................................................................... 37ZYDELIG....................................................................... 37ZYKADIA....................................................................... 37ZYKADIA....................................................................... 37ZYPREXA RELPREVV............................................... 44ZYPREXA RELPREVV............................................... 44ZYPREXA RELPREVV............................................... 44ZYTIGA..........................................................................37ZYTIGA..........................................................................37

Este formulario fue actualizado el 08/26/2019. Para obtener información más reciente o si tiene otras preguntas, llame a Servicio para miembros de BlueMedicare Preferred HMO al 1-844-783-5189 o 1-877

O visite www.floridablue/medicare.955-8773 para los usuarios de TTY . El horario es de 8:00 a.m. a 8:00 p.m., hora local, siete días de la semana.

87768S 0217R

Esta es una traducción de su original en inglés. La versión en inglés prevalecerá.

Notificación de la sección 1557: La discriminación es en contra de la ley.

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO (colectivamente "Florida Blue"), Florida

Combined Life y el Blue Cross and Blue Shield Federal Employee Program® (FEP) cumplen con las leyes

federales de derechos civiles aplicables y no discriminan por motivos de raza, color, nacionalidad, edad,

discapacidad o sexo. No excluimos a las personas ni las tratamos de forma diferente debido a su raza, color,

nacionalidad, edad, discapacidad o sexo.

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO, Florida Combined Life y FEP:

• Proporcionan ayuda y servicios gratuitos a las personas con discapacidades para que se comuniquen de

manera eficaz con nosotros, como los siguientes:

o Intérpretes de lenguaje de señas capacitados

o Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros

formatos)

• Proporcionan servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los

siguientes:

o Intérpretes capacitados

o Información escrita en otros idiomas

Si necesita recibir estos servicios, llame a:

• Florida Blue (cobertura para la salud y la visión): 1-800-352-2583

• Florida Combined Life (cobertura dental, de vida y discapacidad): 1-888-223-4892

• Federal Employee Program (FEP): 1-800-333-2227

Si considera que no le proporcionamos estos servicios o lo discriminamos de otra manera por motivos de origen

étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a:

Florida Blue (incluyendo miembros FEP):

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]

Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para

presentar una queja, el Coordinador de la sección 1557 está disponible para ayudarle. También puede presentar

un reclamo de derechos civiles ante la Oficina de Derechos Civiles del Departamento de Salud y Servicios

Humanos de EE. UU. de manera electrónica a través del Portal de Reclamaciones de la Oficina de Derechos

Civiles, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, por correo postal o por teléfono:

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)

Puede obtener los formularios de reclamo en 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 008-253-3852-1ل برقم ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتص

.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

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